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https://clinton.presidentiallibraries.us/files/original/06d77a9e68bc13ae109b229640b638c7.pdf
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PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
3679
OA/ID Number:
FolderlD:
Folder Title:
[Small Business Letters] [binder] [5]
Stack:
Row:
Section:
Shelf:
Position:
s
52
3
7
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TVPE
SUBJECT/TITLE
DATE
RESTRICTION
001. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
002. letter
Personal (Partial); Address (Partial) (2 pages)
03/11/1993
P6/b(6)
003. letter
Personal (Partial); Address (Partial) (1 page)
02/26/1993
P6/b(6)
004. form
Personal (Partial); Address (Partial) (1 page)
02/26/1993
P6/b(6)
005. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
006. letter
Personal (Partial); Address (Partial) (1 page)
03/01/1993
P6/b(6)
007. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
008. letter
Personal (Partial); Address (Partial) (2 pages)
02/18/1993
P6/b(6)
009. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
010. letter
Personal (Partial) (1 page)
03/25/1993
P6/b(6)
011. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
012. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/09/1993
P6/b(6)
013. note
Address (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
im815
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
RESTRICTION
SUBJECT/TITLE
DATE
014. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
015. note
Personal (Partial); Address (Partial) (I page)
n.d.
P6/b(6)
016. note
Address (Partial) (I page)
n.d.
P6/b(6)
017. note
Address (Partial) (1 page)
n.d.
P6/b(6)
018. note
Personal (Partial); Address (Partial) (I page)
n.d.
P6/b(6)
019. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
020. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
021. note
Address (Partial) (1 page)
n.d.
P6/b(6)
022. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
023. note
Address (Partial) (1 page)
n.d.
P6/b(6)
024. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
025. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
026. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
im815
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA)
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIAj
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECT/TITLE
RESTRICTION
027. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
028. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
029. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
030. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
031. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
032. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
033. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
034. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
035. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
036. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
037. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
038. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
039. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
im8l5
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
040. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
041. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
042. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
043. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
044. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
045. note
Personal (Partial); Address (Partial) (I page)
n.d.
P6/b(6)
046. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
047. note
Personal (Partial); Address (Partial) (I page)
n.d.
P6/b(6)
048. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
049. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
050. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
051. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
052. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
im815
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
053. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
054. note
Address (Partial) (I page)
n.d.
P6/b(6)
055. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
056. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
057. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
058. note
Address (Partial) (1 page)
n.d.
P6/b(6)
059. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
im8l5
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
National Security Classified Information |(a)(l) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRAj
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(S) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
VNJ
�CONSENT GIVEN 08/26/93 CD: NH-1
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
William R. Watson
Watson Family, I n c .
P.O. Box 539, Route 16
West Ossipee, NH 03890
(603) 539-4313
BRIEF SYNOPSIS OF LETTER
Small business o f 11 employees had 4 claims on Workman's Comp. i n 1991, so
t h a t i t now costs over $9,000.00/yr.
They cannot a f f o r d t h a t plus health
insurance. He believes Workman's Comp. i s abused and suggests i t be dropped,
w i t h a s i n g l e medical plan i n i t ' s place, so businesses l i k e h i s can a f f o r d
the coverage.
IDENTIFICATION OF PRIMARY LETTER CONTENT
OTHER PROGRAM-Workman's Comp.; include i n s i n g l e h e a l t h plan.
�WATSON FAMILY INC.
P.O. Box 539, Route 16
West Ossipee, NH 03890
Telephone (603) 539-4313
Fax (603) 539-6885
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/
2
^
^
liP^J^tz^
~^Us ^Jr
^
^C*t?/?9/
^
^
^
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm8l5
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOI A]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of thc PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN
PERSONAL STORIES DATABASE
8/23/93 CD: AR-2
IDENTIFICATION OF WRITER
1
pir:':'.-- -''.''
' P6/(b)(6)
...r ••, . .
I'"
00
1
'• r •
v
i
BRIEF SYNOPSIS OF LETTER
grocery s t o r e , i n s
63 year o l d husband and 61 year o l d w i f e operate s m a l l _
cost i s more than $800 per month w i t h $500 d e d u c t i b l e , 300% increase i n l a s t
t h r e e years
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUB.IEC 17111 I E
DATE
Personal (Partial); Address (Partial) (2 pages)
03/11/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
.jm8l5
RESTRICTION CODES
Presidential Rceords Act - |44 ll.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security ClassiFied Information 1(a)(1) of thc PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice hetween the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
PC Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA)
b(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�\
P6/(b)(6)
£00 a]
March 11, 1993
Mrs. Hillary Rodham Clinton
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Mrs. Clinton:
I have heard and read that you are concerned and intend to do
something about the cost of health care in our United St! es. I wish
you God's speed and good luck.
I am 63 and my wife is 61 and we have operated two siflall grocery
stores (one at a time) in Pulaski County for 30 years, I have just
received a new increase in our health care insurance; it is now
$804.37 a month; $9,652.44 a year; or perhaps I should say $200 a
week or $26.79 a day. f will have to make $255 a week >efore taxes
each week just to pay my health care insurance.
I also have to earn enough to pay the $500 deductible eftch and the
20 percent of the first $5,000 on each of us, which idds up to
mother $3,000. If we should have sickness of any ii mount, ©ur
yearly checkup expense is not allowed to count i gainst our
deductible!
In March of 1990 our monthly premium was $278.01; in April of
1990 it was increased to $301.65; in April of 1991 it w s increased
to $449.17; in April of 1992 it was increased to $618.75; in April of
1993 in was raised to $804.37.
This represents nearly 300 percnet increase in 37 months. Each
increase was approved by the Arkansas State Insurance Commission.
I called each year and was told once it was a 37 percer increase;
another year it was about 20 percent, now it is about 30 percent this
April - all increases added together add up to less than 00 percent,
yet the total amount from $278.01 to $804.39 equals pearly 300
percent. Simple math is sure hard to understand when they add a
little each year and turns out to be three times as muct it was to
begin with when their three increases add up to lesi than 100
percent.
It is my feeling that not only me, but nearly everyone is paying too
much for health care insurance. Think of what these igher rates
will do to companies who try to furnish employees with iealth care
coverage?
�When you ask a doctor, a hospital, or lab; why are thfej charges so
high?
They all say the same thing, "we only charj ; what the
insurance will pay." One reason why all of the high charj;;s started is
for the past 20 years the Insurance Companies have "ovei sold us in
our coverage; thus encouraging higher charges for medic ul services."
The same has happened in Auto Insurance. They would much rather
make the mark up (commission and customary profits) <fi a $800 a
month premium than on a near $278 one.
About eight or ten years ago our local hospitals ins ailed a new
service to lower customer cost. It was "outpatient" and it did cut cost
for a couple of years, but 'now a four or five hod: outpatient
operation costs more than the same operation with a fi 't day stay
did 10 years ago.
How can so many hospitals get by with operating as a "non-profit"
business and enjoy the tax benefits as a "non-profit"; just use a
church name; and invest their surplus in tax sheltered investments.
It's disgusting and a very sorry thing which has appened in
America when a couple in their early 60s have to spen $12,000 a
year for health care counting the $9,652.44 premiums $500 each
deductible and 20 percent of the first $5,000 each.
I am including a copy of the premium increase nlitice and a
suggested increased deductible schedule, which only SM aps dollars
for dollars.
1 hope you can understand what I am trying to get acjjoss. Thank
you for your itme and consideration.
Yours truly,
,P6/(b)(6)
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
DATE
SUBJECT/TITI.E
02/26/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE.
[Small Business Letters] [binder] [5]
2006-0885-F
im815
RESTRICTION CODES
PrcsidentiHl Records Act -144 U.S.C. 2204(a)]
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of thc PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�TIME INSURANCE COMPANY
5 0 1 W e s t Michigan
P 0 Box 6 2 4
Milwaukee. W l 5 3 2 0 1 - 0 6 2 4
Telephone: (414) 2 7 1 - 3 0 1 1
FEBRUARY 2 6 ,
TIME
1993
oo3
L l
Policy/Certi f icate:
Dear Mr
Agent
#:
P6/(b)(6)
P6/(b)(6)' i
P6/(b)(6)
E f f e c t i v e 0 k / 0 \ / ) S S l , your current premium of $
MONTHLY
This new premium is guaranteed for
address and the coverage currently in f o r c e
6 1 8 . 7 5 will increa
to:
$
80A.37
12 months, which is tifesed upon the above
Your
W e normally adjust pur premium rates once each year to keep pace with nedical costs
state has n o w approved our national rate table. Unfortunately, your rate ir Crease is larger than
usual because your state had not approved a previous rate increase or appr ved an increase that
was smaller than the national increase
In order t o reduce your overall premium, you have the option t o increase yc^ ir current Deductible
Amount o f $
500.
This will also increase the maximum amount you •pight spend o u t - o f p o c k e t These t w o items are the costs you initially pay that your insurance do as not cover. Please
complete and return the enclosed f o r m if you wish to increase your deductible
I realize the premium increase adds t o your financial burden. I w o u l d also We to assure you that
TIME Insurance Company is making every e f f o r t to help control these rising :osts
W e urge you
t o read the enclosed brochure about health insurance The brochure explains vhy health care costs
and premiums are rising, what we are doing and what you can do
I would like t o take this opportunity t o tnank you f o r being a valued custonNer of TIME Insurance
Company Please feel f r e e to contact our Individual Policyholder Service Desf at (414) 2 9 9 - 8 3 1 1.
or your TIME Representative, with any questions you may have
Sincerely,
Spencer N. Smith, Vice President
Health Administration
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. form
DATE
SUBJECT/TITLE
02/26/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm81S
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 5S2(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or conndential commercial or
Financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
h(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�T I M E INSURANCE COMPANY
* 5 0 1 West Michigan
P 0 Box 6 2 4
Milwaukee. W l 5 3 2 0 1 - 0 6 2 4
Telephone
(414) 2 7 1 - 3 0 1 1
TIME
CURRENT ADDRESS:
Agent #:
P6/(b)(6)
DEDUCTIBLE AMOUNT OPTIONS
Below are Deductible Amount options available t o you. The premiums c joted are based o n the
above address and current coverage in f o r c e as of: FEBRUARY 2 6 , 199
If y o u have already satisfied your current deductible, the difference betw en your new deductible
and your current deductible will be satisfied f r o m any future covered expe i ses submitted according
to the terms o f your contract.
By increasing your Deductible Amount, this will increase the maximum
nount you might spend
o u t - o f - p o c k e t If you would like t o increase your Deductible Amount, plietse check your selection
and return this f o r m in the enclosed self-addressed envelope
Policy #:
Insured s Name:
P6/(b)(6)/
Deductible:
Premium:
• P6/(t5)(6)
1,000
715-3* M N H Y
OTL
1
Deductible:
Premium:
$
$
1,500 /5- ' J ^ ' t '
661.50 M N H Y
OTL
The e f f e c t i v e date you select must be 0 ^ / 0 1 / 1 9 9 3 or later.
Please make this change e f f e c t i v e
(month only)
Owner's signature:
Home Phone # With Area Code:
Date:
/19.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
im815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA|
National Security Classified Information 1(a)(1) ofthe PRA)
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA)
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
64 year o l d man owned a company t h a t went under. Has h i g h blood pressure,
c o n d i t i o n and
Has t r o u b l e f i n d i n g insurance, because o f p r e - e x i s t i n
d e s c r i m i n a t i o n due t o h i s age.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LOSS OF COVERAGE
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICARE
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. letter
DATE
SUBJECT/TITLE
03/01/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Mrh 1 19
ac , 93
FIRST L D H L A Y C I T N
AY I L R L N O
OFICE O 7t£ P E I E T O T € U I E S A E O MRICA
F
RSDN F V NTD TTS F
WSIGO, D C 2 5 0
AHNTN . . 0 1
D a First Lady,
er
(pnceming Health Care
Because I believe that Y u h v a heartfelt interest in the plight of n n Arericans
o ae
ay
probably the type of
I a taking this opportunity to m k You a a e of itiy problems.which I believe are ntji
m
ae
wr
the
problan's shared by m n Arericans. In your evaluation of the Health care problems of) Nation,I believe
ay
roblerc.and it is with
that yxi n e an insist to all the concerns of the public at large relative to this
ed
that in m n that I h v chosen to contact You. I will briefly sunrarize ny p o l n , J } followip with w a
id
ae
rbeierd
ht
I believe is a m k sense solution.
ae
First let ITE ssy that I will be 64 >ears old in A g s of this year.and I have no pi in the foreseeable
uut
future of filing for benefits u d r the Social Security Act. Vt/ p o l m is that as alifornia Real Estate
ne
rbe
Developer I was forced to file Bankruptcy for a California Corporation in which I w<the sole Stockholder
a
dotfistream protection
and also an Enployse ( President & C a r a of the Board ). I was also forced to seel
himn
by filing Banknptcy personally because of personal Gaurantees of Corporate debt. TCorporation enployed
h:
was
over 30 people which w r a ccnbination of office and field personnel. The Bankruptcy directly attributable
ee
okd
to the National E o o y and its effect on California Real Estate. I lost everything had w r e for all ny
cnn
life. The sentence one receives for seeking protection from business failure debts v credit report notations
nov
is extremely difficult to o e c m in g o times , let alone t f e o o i tines w ' facing.
vrce
od
he c n m c
e <
The Corporation provided at it's o n expense full health care for every enployee and heir family's, teedless
w
to say w all lost our jobs a d in addition w w r no longer covered by the Health ji^sirance at the C n a y
e
n
e ee
opn
expense. W t m concentration with paying off personal debts in the mistaken belief this w u d be a plus
ih y
hat
ol
for m with future creditors,! could not afford the conversion privileges provided bj policy and I had to
s
the
take a chance of waiting until such time as I could afford coverage. As a result of
p o condition of the
or
Real Estate Industry and the descrimination due to the age factor, I was forced to at«te ny o n enployment.
w
This I h v b e able to do to the extent that I a self supporting,but the problems
ae en
m
(jreated a health p o l m
rbe
for m in that I developed hi^i blood pressure. D to this problem,! a inable to in Health Insirance that
e
o
m
will not exenpt m from illness of the vascular systan and urinary tract due to a
e
existing condition" &
the rates are prohibitive because of age. By the tine the pre existing condition i ions are renoved I
w u d be 65 and qualify for Medicaire whether or not I a drawing benefits. In the m^ntime I e uninsured &
ol
m
m
a nedical p o l m w u d no dotbt drive ne to ruin.
rbe ol
fty suggestion to Y u w u d be as follows;
o ol
Inplement a plan w e e y medicaire w u d be available to all individuals reaching thfage of 62 ipon payment
hrb
ol
of a ncnthly p e i un to be determined by Artuary's. This w u d be a plan that autcmal terminated *ter\
rm
ol
cally
the person covered reached the age of 65. Properly structured this plan w u d create additional e^enses
ol
io
to the Taxpayer and w u d be self siqxrting.
ol
There is no free ride here, just a gairanteed coverage for those w o are being descrtfrinated
h
against by the
Insurance Industry due to age and failing health." It imst be ranenbered, if nedicalfjifoblems result in dHving
people in this category to financial ruin, their ability to recover are yossly affec e by their age and/or
d
_hea.l.th,i^lflnK._Give_iis^_^w^to carry our o n wei*t.
w
. P6/(bj(6)'
�CONSENT GIVEN 08/26/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Employees
C & E. Auto P a r t s I n c .
3720 Southwest 4 7 t h Avenue
Davie, FL 33314
1-800 831-3443
BRIEF SYNOPSIS OF LETTER
The case t o be made f o r some changes, t o make h e a l t h c a r e more a f f o r t a b l e f o r
s m a l l b u s i n e s s . The h i g h c o s t o f h e a l t h c a r e must change. Concerned about
c o s t o f workmems compensation, c a n ' t a f f o r d h e a l t h i n s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
�C & E AUTO PARTS INC.
3720 S.W. 47th Ave., Davie, FL 33314 • Phone: 581-9070 - Fla Wats 1-800-831-3443
Dear First Lady,
We decided to write t o you reguarding the Health Insurance Plan your
composing. Our small company located in Davie, Florida employees seven (7),
age ranging from mid-twenties to late f i f t i e s . Our boss pays Workmens
Compensation over $9,000 a year f o r our benefit that if we get h u r t on the
job we would be able to get Medical attention and collect a percentage of our
pay if we were unable to r e t u r n to work r i g h t away. This small Company has
been in business over 15 years (Salvage Yard-Junk Dealer) never f i l i n g any
Claims with Workmens Comp. We all have been t r y i n g to get Heeilth Insurance
f o r ourselfs and dependants but it's impossible to f i n d Companies that are
within our price range. We've even agreed t o pay half of the cost out of
pocket but are still not able to afford it. During our coffee break discussions
we thought "What If that $9,000 plus our boss pays into Workers Comp was
put into Health Insurance." We could be covered at home or at work and if we
were unable to work why not be able t o collect from Social Security until
we're able to r e t u r n to work. I f a cap was put on the number of weeks
collecting and the dollar amount that's available, we t h i n k more people would
r e t u r n to work sooner than if they stayed out on disability t h r o u g h Workers
Comp. We could have a great Insurance Package f o r that amount of money.
You've probally got all your ideas sealed and ready f o r delivery but we're
unsure if this ever crossed your mind. Thanking you f o r taking time t o read
this and also f o r your interest in t h i s problem we are all facing.
All the Employees at
C * E Auto Parts, Inc.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
.im815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) of thc PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIAj
h(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 0(8/19/93 CD: NC-6
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
P6/(b)(6) '
:
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 44 year o l d w r i t e r and her 46 year o l d husband, w i t h 2 children,
have a small business, husband has severe Diabetes but cc: itinue to work a
l i t t l e , constant increase i n health ins. premiums w i t h very igh deductibles,
family i s making $20,000 - $25,000 per year, and s t r u g g l i n i , they could not
obtain a l t e r n a t i v e coverage due t o husband's pre-existingi condition, now
going up again
paying $400/month w i t h deductibles of $900 and $1,000,
and may have t o drop ins., no coverage f o r medications or D v i s i t s , female
^
physical cost $282, struggling t o survive
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
DOCTORS FEES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
LOST COVERAGE/GAINFUL EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
02/18/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jmSIS
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of thc FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors [a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�,P6/(b)(6)
A
February 18, 1993
Mrs. Hilllary Clinton
c/o The White House
Washington, D. C.
Dear Mrs. Clinton:
1 live in a small rural town right in the heart of North Carolii|i about 5 miles
from the North Carolina Zoological Park, about half-way between rharlotte, North
Carolina & Raleigh, North Carolina. I am 44 years old, have 2 i own children,
2 grandchildren & a sick husband. I am normally a vout R e p u b l i ^ but I helped
put your husband in the White House because our country i s in t^buble & we have
to have help, especially in the area of health care & hospital/A alth insurance.
dical problems
My husband i s 46 yrs. old & approximately 5 years ago developed
which ended up being Diabetes I I plus high blood pressure. He i Lso has feet
problems which w i l l not allow him to work for a big company hav:. ig to stand a l l
day. We have a small machine shop which i s located In our backyird of our home.
We have 2 employees besides ourselves, our 23 year-old son & a < ) yr. old man.
I t takes my husband maybe 14-16 hours a day to be able to get 8 LO hours of work
in but he i s not considered disabled. Our biggest worry & concern & biggest expense i s the cost of our monthly hospital insurance premimum & o i r medical b i l l s .
As of June of this year, my husband w i l l probably be totally un.isured & cannot
get any more insurance because of the Diabetes that we can affo : i . For the last
5 years, our hospital/health insurance has increased every 6 mo iths by $50 a month
premimum. Two years ago, I had to drop myself from the policy >ecause our joint
premimum went to over $400 a month. When I dropped myself, my iusband's premimum
decreased to around $100 a month. Then suddenly the $50 a mont i premimum increases
every 6 months brought his back up to almost $300 a month alone
He was out-ofwork at that time having surgery on both feet, I had a broken aikle & a broken
leg & our teenage daughter had just had knee surgery (1990). I had no choice but
to drop my hospital insurance completely at that time as we cou d not pay for i t .
Until 4 months ago, I had no Insurance coverage on myself at all—now I have a
private policy which i s not that great a coverage ($900 deductilie for around
$100 a month) but I had to decrease my husband's coverage to be able to keep his
to a $1,000 deductible, with 70/30 coverage. Now i t pays n o t h i g on his monthly
medication which runs around $48 a month or his doctor's v i s i t s every 3 months for
the diabetes not counting other medical expenses. With a $1,00 deductible, & a
$900 deductible, we w i l l not use the Insurance at a l l unless we have a major H i ness. By the time we add his premimum, my premimum & his medicine & doctor's v i s i t s ,
we are again paying $400 a month not counting having any illnesfles. His premimum
w i l l increase again in June & we cannot pay any more so I w i l l ave no choice but
to drop i t . No other company w i l l even take an application on im.
I had considered the possibility of going back to work to get hHalth insurance on
him but am finding that i s not likely because of the diabetes, I would also have
to pay someone more than I w i l l be able to make at public work to do the c l e r i c a l
work I now do for our business plus I am the roadrunner, clean- P person, etc.
I don't know where to go or where to turn to.
�Ms. Clinton
I ige 2
Our small modest home i s paid for so we do not qualify f o r any ty]»Bhelp such as
Medicaid i f we have a major I l l n e s s . Our combined Income for botqi Of U8 OUt of
our small business i s between $20-S2'j, 000 it year,
The reason 1 am w r i t i n g t h i s l e t t e r i s I know your husband has pu you i n charge
of the health program. Please, I beg of you, don't forget the peoble l i k e my husband & myself, who are not e l i g i b l e for welfare programs but who ire struggling t o
j u s t exist r i g h t now, I know i f I go to the doctor f o r a cold, my b i l l w i l l be
basically $100 by the time I go to him & stop by the drug store f >r medicine.
Jess I am deathly
Therefore, I don't go to the doctor anv more even for checkups un
s i c k — I f i n a l l y went i n January for a yearly female physical whic ended up costing
me $282 to t e l l me I was f i n e . My insurance did not touch any ofthat b i l l . I
don't f e e l I can even a f f o r d to <j}0 to the dentist f o r a checkup bicause he charges
me based on people having dentar insurance & does not take
J4emi9n that
I do not have i t . Our health system i s not f a i r . • i ^ t h j j j g ^ J ^
8 » congrown, my home was paid f o r , that l i f e could be e a s i e r ^ b u t ' i t * ! ;
stant struggle to meet daily obligations. I do not consider mys
p o o r — I have
very much to be extremely thankful f o r . I have a warm roof over Jijy head, I have
food f o r my family, I have warm clothes to wear but I am i n constp|nt danger of
not being able to get health care when & i f I need i t . What i f I \ave t o drop
my husband's health insurance & he has a heart attack or a major l l n e s s , then we
stand to lose everything we have worked a l l of our l i v e s f o r — o u r home. Please
t r y to get medical care available to everyone, please don't l e t uif a l l thru the
cracks i n the system.
I have discussed this problem with our Insurance Commissioner & hk sent me i n f o r mation on the mandatory insurance (standard) coverage that companies i n UC now must
issue on.people with health problems. I t ' s a jokef The coverage i s so nominal that
you're l e f t wide open with any health problems & the premimuros ar|i j u s t as high
as any other policy, maybe higher. I t hurts when I see friends w: o can walk into
a doctor's o f f i c e & get any medical care they need for $5 or $10 v i s i t j u s t because they happen to work for a p a r t i c u l a r company & my family ha to do without.
W cannot even afford to take our grandchildren to the doctor hardly when they are
e
s i c k — a routine o f f i c e v i s i t has gone to $40 plus they charge for] every bandaid,
every cotton b a l l , every thing they touch extra. Last week my 2 ear old grandson,
was taken with bronchitis & his doctor v i s i t was $68 plus a t r i p {o the drug store,
Something has to give somewhere, someway. Thar, was a day's aalar; for his mother,
plus she lost a day's work to be out & take him. Please, I bego: you, help us
somewhere, someway.
I listened to the President's speech last n i g h t — I know i n my heaftt that Congress;
w i l l not l e t him carry thru with his proposal but he i s 100X corn ct —we a l l have
to s a c r i f i c e . I've cut comers as much as I possibly can i n my c m home—there's
no more c u t t i n g , Our extent of even eating out i s to eat seafood which costs us
around $15-18 once a month. To even replace an appliance l i k e a tove or r e f r i g e r a t o r
is a major spending.
Thanks f o r taking the time to read t h i s — j u s t please remember thc^e of us caught i n
the middle who have health problems we can't do away w i t h or can change.
Ypurs t r u l y .
�Clinton Presidential Records
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jmSIS
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PA Release would constitute a clearly unwarranted invasion of
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P R M . Personal record misfile defined in accordance with 44 U.S.C.
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RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/26/93 CD: FL-14
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Recently s t a r t e d own business and cannot o b t a i n insurance i ue t o son's pree x i s t i n g h e a r t problems. Pays son's l a r g e monthly medica expenses o u t o f
pocket because self-owned business cannot a f f o r d t o cover i surance f o r p r e e x i s t i n g c o n d i t i o n . GOOD QUOTES.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
HOSPITAL CHARGES
DOCTORS FEES
�9
March 25, 1993
H i l a r y R. C l i n t o n
The White House
1600 Pennsylvania Avenue
Washington, D.C.
20500
Dear P r e s i d e n t and Mrs. C l i n t o n :
I know you must g e t hundreds o f l e t t e r s from people who a r e
v i c t i m s o f t h e c u r r e n t h e a l t h care system.
T h i s i s y e t ano t h e r one. I f i r s t want t o say how happy and h o p e f u l we are
t h a t you are t r y i n g so hard t o r e v i s e t h e c u r r e n t h e a l t h
care system.
No one has cared enough about t h e problems o f
o r d i n a r y Americans w i t h i n t h i s system u n t i l your a d m i n i s t r a t i o n .
I thank you f o r c a r i n g enough about us t o t r y and change t h i n g s .
Now f o r my s t o r y .
Four years ago my husband and I were b l e s s e d w i t h a b e a u t i f u l
baby boy. His name i s E r i k . He was a h e a l t h y baby boy except
f o r one t h i n g . He was born w i t h a c o n g e n i t a l h e a r t d e f e c t .
I t i s a m i l d h e a r t problem and does n o t s t o p him from l e a d i n g
a p e r f e c t l y normal l i f e .
I t i s a j o y t o watch him r u n and
p l a y and be a happy, normal, w e l l - a d j u s t e d l i t t l e boy.
A couple o f years ago my husband s e t o u t t o b e t t e r our l i v e s
by s t a r t i n g h i s own e l e c t r i c a l c o n t r a c t i n g b u s i n e s s . He has
been i n business f o r almost t h r e e years now and works v e r y
h a r d ; and t h e business i s s u c c e s s f u l . The problem i s t h a t
when he l e f t h i s r e g u l a r j o b t o s t a r t h i s own b u s i n e s s , we
had t o shop f o r new h e a l t h i n s u r a n c e . We c o u l d n o t f i n d
anyone who would cover our son, E r i k , because o f h i s h e a r t
problem.
Even though he i s p e r f e c t l y h e a l t h y , has never
needed m e d i c a t i o n or t r e a t m e n t f o r h i s h e a r t c o n d i t i o n ,
^ s t i l l no one would o f f e r t h i s c h i l d any h e a l t h i n s u r a n c e
We c o n t i n u e d t o shop around and f i n a l l y found a company who
would cover our son b u t o n l y i f we signed a l i f e - t i m e r i d e r
on h i s h e a r t . Since no o t h e r company would o f f e r a n y t h i n g
b e t t e r because o f E r i k ' s p r e - e x i s t i n g c o n d i t i o n , we .purchased
t h i s i n s u r a n c e . We have been v e r y l u c k y because our son's
c o n d i t i o n has n o t worsened, however t h e y e a r l y check-ups are
v e r y expensive. We have t o pay f o r them o u t o f our own money.
I f h i s c o n d i t i o n ever does worsen, and he needs t r e a t m e n t , we
again have t o pay f o r t h e expensive t r e a t m e n t w i t h no h e l p
from our i n s u r a n c e company. I t i s so f r u s t r a t i n g because we
are hard w o r k i n g people; we own our own b u s i n e s s , own our own
home and pay our i n s u r a n c e premiums every month. However, i f
our son needed a h e a r t o p e r a t i o n some day, we would l o s e e v e r y t h i n g we've worked so hard f o r t o t r y t o come up w i t h t h e money
t o pay f o r h i s s u r g e r y .
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DOCUMENT NO.
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Personal (Partial) (1 page)
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
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2006-0885-F
jm815
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PI National Security Classified Information [(a)(1) ofthe PRA]
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P3 Release would violate a Federal statute 1(a)(3) of thc PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice hetween the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
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b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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RR. Document will he reviewed upon request.
�». 1 -
Page Two
^ P e o p l e l i k e us need your help, and there are so
y of us out
\ here. The hard working American deserves to know
s family
has adequate health care in the event they need i some day.
Insurance companies should have to cover pre-exis i;|ing conditions;
after a l l we a l l pay enough j u s t to have coverage and i t ' s
time every American had the s e c u r i t y of knowing they are f u l l y
covered and never have to worry again about s e l l i ng t h e i r
homes, or obtaining loans to pay for an expensive pre-existing
condition. We can do better than t h i s , for we Airutr icans deserve
oetter.
11
Thank you for your e f f o r t s and we are a l l behind ou i n finding
a better way to deal with the health care c r i s i s , Thank you
for caring about us and God Bless you and your faiji i l y and God
Bless America.
; •
P6/(b)(6)
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oio
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
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PI National Security Classified Information 1(a)(1) of the PRA|
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P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors [a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe I OIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance wilh 44 U.S.C.
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�CONSENT GIVEN 0 /23/93 CD: NY-31
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
• , •
_.Z , •-»t
,J.
r
P6/(b)(6)
a
BRIEF SYNOPSIS OF LETTER
Owner of small business can barely afford coverage f o r herself and her
husband, would l i k e t o cover one employee but j u s t too exper sive, the cost i s
a burden compared t o other expenses, wished she could g€ : an inexpensive
group rate.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
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DOCUMENT NO.
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DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/09/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
im815
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Presidential Records Act -144 U.S.C. 2204(a)]
Freedom of Information Act -15 U.S.C. 552(b)]
PI
P2
P3
P4
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b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(S) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIAj
National Security Classified Information |(a)(l) of the PRA]
Relating to thc appointment to Federal office 1(a)(2) ofthe PRAj
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
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�^
...
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Ms. H i l l a r y Rodham Clinton,
F i r s t Lady of the United States
The White House
1600 Pennsylvania Ave. NW
Washington, DC 20500
March 9,
1993
Dear Ms. Clinton:
On behalf of my family and my small s t a f f I am k^riting
to describe our health insurance s i t u a t i o n . Ours in not an
extraordinary s i t u a t i o n although f i n a n c i a l l y
difficult.
However, I understand you are a o l i c i t i n g l e t t e r s from working
f o l k s l i k e us so as to develop a strategy toward improving
the health care provision throughout the country.
May I f i r s t say "hurrah" and good luck to you flor
attacking t h i s complex and t e r r i b l e problem in our nation
today! And, good for you that you are standing firip| i n not
including the AMA i n your discussions.
Now to our s i t u a t i o n : I worked as a s o c i a l ser-jrlice
o f f i c i a l i n a l o c a l DSS here in Elmira, NY for 15 yoars. I
" r e t i r e d " to get married and have a baby i n 1986 and, as my
husband was not covered by any health insurance plan where he
worked, I continued on the County GHI plan and extended i t to
my family. The premiums s t a r t e d at $180 per month :.n 1986
and i t has r i s e n to $361 per month now! When I began the plan
a l l p r e s c r i p t i o n s and doctor's v i s i t s were included * As of
t h i s year, however, i n order to avoid an increase in
premiums, we must pay for some p r e s c r i p t i o n s and a Ji5 co-pay
for each doctor's v i s i t .
I f e e l that at t h i s premiun rate I
should not have to pay anything at a l l and I resent i t ! My
former co-workers are s t i l l getting t h i s plan for a very
small premium co-pay.
Last June, against a l l odds, my husband and I began a
r e t a i l computer store in downtown Elmira. We have one
employee (an e x c e l l e n t , hard-working salesman) and nould l i k e
to o f f e r him health insurance but at the rate i t ' s noing, we
don't even know how long we can stay on my plan! 0\ir l a t e
model car died l a s t week and i t ' s a r e a l temptation to cancel
the health insurance and buy a r e l i a b l e car. One truck
between the two of us and c a r t i n g a 5-year-old betwoen school
and a c t i v i t i e s i s becoming a r e a l t e s t of the nerved.
In short, we f e e l that a group rate should be a v a i l a b l e
�among small business owners to allow smaller premiun^ for our
f a m i l i e s and to cover our employees. The County
used to be great but when you have to pay your own ifi?emiums
as we do i t i s downright p r o h i b i t i v e .
I hope you are able to come up with some viablt
solutions to the cost of health insurance and the ccbe
i t s e l f . We w i l l be praying for your success i n thit I matter.
* When I was planning to have a baby I asked my hea]th
insurance company for a l l the necessary informatiq and
they indicated that I was covered for a l l prenata care and
the e n t i r e d e l i v e r y . I had a C-section and, althd igh I
l i v e in New York State, I had the c h i l d about 20 m Lie away
in Pennsylvania. Shortly a f t e r my c h i l d was born
received a b i l l for about $800 from the Pediatricllkn.
told the c l i n i c I was covered by GHI and they wer«
p a r t i c i p a t i n g but i t seems that GHI (New York base i) viewed
the P e d i a t r i c i a n as an a s s i s t a n t surgeon. However
Pennsylvania law required that a P e d i a t r i c i a n be i r e s e n t at
any b i r t h by C-section. Therefore, I had to pay 3180 per
month for my health insurance (which I was assurec would
cover a l l and any doctor's and h o s p i t a l b i l l s ) p l i i $25 per
month on t h i s additional b i l l u n t i l i t was paid i r f f u l l .
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Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Kreedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Pederal office 1(a)(2) of the PRA]
P3 Release would violate a Kedcral statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe KOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe KOIA)
b(3) Release would violate a federal statute 1(h)(3) ofthe KOIA]
b(4) Release would disclose trade secrets or confidential nr financial
information |(b)(4) ofthe KOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the KOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe KOIA|
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe KOIA]
h(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the KOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Wendy D o m b r o s k i
o
BRIEF SYNOPSIS OF LETTER
26 y e a r o l d woman has h e r own s m a l l b u s i n e s s , h a i r s a l o n , o n l y employee,
h e a l t h c o v e r a g e f o r s i n g l e young woman w/ no d e p e n d e n t s i s $211.16/month.
T h i s i s t o o much f o r s e l f - e m p l o y e d p e r s o n .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
/ i L ^ JL^lUi . . M i l U y®l C U
CC
�Withdrawal/Redaction Marker
Clinton Library
DOCl'MENT NO.
AND TYPE
014. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Erecdom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) nf thc I OIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of thc FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
1)(S) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion nf
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
h
i
,
i
V .H :
'' ;
11
+
."P6/(b)(6)
'."' . - ^i
BRIEF SYNOPSIS OF LETTER
Son i s a u t i s t i c , she works f o r small business t h a t w i l ! not cover son,
c u r r e n t l y son i s covered by COBRA from former husband; ht i s e l i g i b l e f o r
Medicaid, b u t i s d i f f i c u l t t o t r e a t .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
COBRA'S
COVERAGE TOO SHORT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
015. note
SUBJECT/TITLE
DATE
Persona] (Partial); Address (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jmSIS
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA|
Relating tn the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Husband has r e n a l disease w i t h b i l l s f o $150,000 f o r t h e pas; 15 months. Has
no insurance as he owns a s m a l l business, covered under w Ee's p l a n . Wife
now l a i d o f f ; b e l i e v e s company was u n w i l l i n g t o c o n t i n u e pa i n g f o r spouse's
treatment.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
OTHER
Small business owners have no insurance.
MEDICAL COSTS - EXCESSIVE
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
016. note
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 5S2(b)|
PI National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute [(a)(3) of thc PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of thc PRA|
P.S Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BjoiUDjexexsn
P6/(b)(6)
:
c
BRIEF SYNOPSIS OF LETTER
W r i t e r discusses t h e h e a l t h care costs i n c u r r e d by h i sb i j o t h e r - i n - l a w and
s i s t e r - i n - l a w who own a small business, they a r e a middld -class couble i n
t h e i r 60's who pay $12,012 a n n u a l l y f o r h e a l t h insuranc)^ w i t h a $1,500
deductible.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
017. note
DATE
SUBJECT/TITLE
Address (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOI A]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office [(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or conFidential commercial or
financial information 1(a)(4) ofthe PRAj
P5 Release would disclose conFidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Barbar_a_S_t_aa!_ex_
T
r •" P6/(t5)(6f • ;
.;
BRIEF SYNOPSIS OF LETTER
W r i t e r owns s m a l l business, a r e s t a u r a n t , w i t h 23 s t a f f , wiMrkers comp costs
$12,000 p e r year, she has o n l y had two claims i n 27 years, wants t o g e t r i d
o f worker's comp and p r o v i d e employee h e a l t h insurance instlead
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
WORKERS COMP
HIGH COST
LOW BENEFITS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
018. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose conFidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misllle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Husband and w i f e own t h e i r own s m a l l business and can't ai ford t o purchase
h e a l t h insurance f o r t h e i r employees and have t r o u b l e paying t h e i r own
premiums.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
CAN'T PAY FOR EMPLOYEES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
019. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm8l5
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute [(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or conFidential commercial or
Financial information [(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or conFidential or Financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
• .,: P6/(b)(6).t.
;
on
BRIEF SYNOPSIS OF LETTER
W r i t e r ' s s i s t e r w i t h h e a r t disease worked f o r a small bus ness, a winery,
which went o u t o f business i n t h e recession, t h e r e was no ZOBRA because i t
was a small business, and t h e s i s t e r cannot g e t new insurancj^ due t o her preexisting condition.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
COBRA'S
NOT FOR SMALL BUSINESS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
020. note
SUB.IEC T/TI I'LE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 I'.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA)
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the I OIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
. b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
0
BRIEF SYNOPSIS OF LETTER
Family w i t h s m a l l business maybe denied coverage f o r dauglvj: ar who needs l i p
1
and p a l a t e r e p a i r surgery. Insurance r e p r e s e n t a t i v e from H " 0 i n d i c a t e d t h e
business i s t o o small and t h e surgery i s expensive.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LIMITED BENEFITS
OTHER— coverage f o r surgery may be denied because business i s t o o
small and surgery i s t o o expensive
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TVPE
021. note
DATE
SUBJECT/TITLE
Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Reeords Aet -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of thc FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
..7±ll_Wes.t
. . P6''(p)(6)
0 2\\
BRIEF SYNOPSIS OF LETTER
Daughter w r i t e s how mother's employer, a small business, w:.ll have t o close
i t s place o f business, i f f o r c e d t o pay h e a l t h care c o s t s <t|f employees.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
022. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Reeords Aet - |44 ll.S.C. 2204(»)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute |(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information [(b)(1) of thc FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe F01A|
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
, £,-J P6/(b)(6) ,
•
BRIEF SYNOPSIS OF LETTER
Small business owner i s unable t o o b t a i n insurance f o r h e r s e l f
employees due t o past i l l n e s s
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
and her
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
023. note
DATE
SUBJECT/TITLE
n.d.
Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm8l5
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. SS2(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of thc FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information [(a)(1) of thc PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Ben Bronwein
,
. tt:"..
., P6/(bK6)'
• • !.• •
( .•;
.
'
-,, ,
_ ,-4
BRIEF SYNOPSIS OF LETTER
Small business owner o f mom & pop sandwich shop s t a t e s he 11 be f o r c e d t o
c l o s e h i s business i f t h e govt, compels him t o p r o v i d e heal h care coverage
f o r h i s 7 p a r t - t i m e workers
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
024. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER T I T L E :
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Reeords Aet -144 Ll.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) o f t h e FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) o f t h e F O I A j
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the F O I A j
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e F O I A j
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the F O I A j
h(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) o f t h e F O I A j
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
W r i t e r and her husband are small business owners o f a puppfft t h e a t e r , Mass.
BC/BS has r a i s e d t h e premium f o r t h e i r non-group p o l i c y by 2.6% i n t h e l a s t
year, t h r e a t e n i n g her business, a l s o o b j e c t s t o end o f Fedtax deduction.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
OTHER CONTENT
FED TAX DEDUCTION FOR SELF-EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
025. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)]
PI National Security ClassiFied Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , w r i t e r ' s son has a c h i l d t h a t was born w i t h o u t oxygen and s u f f e r e d
b r a i n damage, when t h e f a t h e r i n t e r v i e w e d f o r a new j o b w h c h he was l i k e l y
t o g e t , he was t u r n e d down when he mentioned h i s son's i l l n e n s (probably f i r m
was a small business and was a f r a i d insurance premiums would r i s e )
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
026. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(h)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(h)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information |(a)(l) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
- P6/(b)(6)
BRIEF SYNOPSIS OF LETTER
Writer employed by small business, insurance company, AETNA,
changed plans, overcharged employees for deductibles, denied
claims, neglected to pay legitimate b i l l s , doubled co payments
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
BAD BUSINESS PRACTICES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
027. note
SUBJECT/TITLE
DATE
n.d.
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm8l5
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security' Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute [(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) nf the PRA]
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential nr financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(h)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
"''
•r' •
—
^
^—
i.
• . •:
P6/(b)(6)
'-„.!.. v . :
0
L-
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , husband works i n a family-owned s m a l l business, t h e r e i s no i n s .
coverage, her husband i s on a p r i v a t e p l a n w i t h a pre-ex s t i n g c o n d i t i o n ,
w i f e and two c h i l d r e n went on another p l a n when t h e premitjms f o r t h e f i r s t
plan went over $600/month, a year ago a l l f o u r were on plans w i t h $500
d e d u c t i b l e s c o s t i n g $400/month, t h i s year t h e premium went up $45/month and
they w i l l have t o go t o a $1,000 d e d u c t i b l e t o keep t h e CO: t a t $400, which
i s almost as bad as no insurance a t a l l
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
LOCKED INTO PLAN
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
028. note
SUBJECT/TITLE
DATE
n.d.
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jmSIS
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security ClassiFied Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office [(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA)
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions |(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
't
•."
i'
'
1
,..
'
o U
P6/(b)(6) '-*- •
•-•;:vt"
•
'
„
'"> -
I f
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , permanently d i a b l e d r e g i s t e r e d nurse i s i n e l i g ale f o r Medicare
because o f f a m i l y income, husband employed by small business no h e a l t h i n s . ,
s t a t e p l a n a v a i l a b l e costs $400/month w i t h $1,500 dedi : t i b l e f o r each
occurrance, t o o much f o r l i m i t e d incomes, now f a c i n g expi i n s i v e t e s t s f o r
cancer
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
HOSPITAL CHARGES
DOCTORS FEES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
LOST COVERAGE/GAINFUL EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
029. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
im815
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information [(h)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA]
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , w r i t e r i s t h e mother o f a 5 year o l d and anothe adoptive c h i l d ,
both w i t h d i s a b i l i t i e s , husband operated a small business gas s t a t i o n ) f o r
a l a r g e o i l company which p r o v i d e d h e a l t h i n s . , they compan r e q u i r e d him t o
become an independent o p e r a t o r w i t h no h e a l t h i n s . , f a m i l y i s now on COBRA,
concerned about what w i l l happen when t h i s runs o u t , C u r r e n t l y paying
$300/month which i s s t i l l t o o h i g h , a n y t h i n g e l s e w i l l be i g h e r , HMO would
i n s u r e f o r $l,000/month
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
LOST COVERAGE/GAINFUL EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
030. note
SUBJECT/TITLE
DATE
Persona] (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidcnlial Records Act - [44 U.S.C. 2204(a)|
Ercedom of Information Act - [S U.S.C. S52(b)|
PI National Security' Classified Information 1(a)(1) of the PRA|
P2 Relating to thc appointment to Federal office [(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) nf the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning thc regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 44 year o l d w r i t e r and her 46 year o l d husband, w i t h 2 c h i l d r e n ,
have a small business, husband has severe Diabetes b u t cc: i t i n u e t o work a
l i t t l e , constant increase i n h e a l t h i n s . premiums w i t h v e r y i g h d e d u c t i b l e s ,
they could n o t
f a m i l y i s making $20,000 - $25,000 per year, and s t r u g g l i n
o b t a i n a l t e r n a t i v e coverage due t o husband's p r e - e x i s t i n k c o n d i t i o n , now
paying $400/month w i t h d e d u c t i b l e s o f $900 and $1,000, r a > going up again
t
and may have t o drop i n s . , no coverage f o r medications o r D
^ v i s i t s , female
p h y s i c a l c o s t $282, s t r u g g l i n g t o s u r v i v e
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
DOCTORS FEES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
LOST COVERAGE/GAINFUL EMPLOYED
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Roger D. S t . Amend
Derigo Realty
237 Main S t r e e t
W a t e r v i l l e , ME 04901
TEL 207-873-7141
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , man and w i f e a r e b o t h s m a l l business owners, c o s t o f i n s . v e r y
h i g h , j u s t r a i s e d r a t e s by 3 1 %
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
031. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
31
>
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 26 year o l d d i a b e t i c i s having t r o u b l e g e t t i n g i :,s. she l e f t her
j o b and was c a r r i e d on COBRA f o r 18 months, and t h e end o t h i s p e r i o d she
could n o t g e t i n s . through her j o b , because she wnnt t o Jrork f o r a small
eddlng date so t h a t
business t h a t c u i l d n o t a f f o r d i n s . , she moved up her wi
her new husband's i n s . would cover her, b u t 5 days a f t e r phe e n r o l l e d t h e
i n s . company dropper her because o f her p r e - e x i s t i n g condi i o n .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
032. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Reeords Aet - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
h(3) Release would violate a Federal statute [(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIAj
National Security Classified Information [(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
1 6 Release would constitute a clearly unwarranted invasion of
*
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION
OF WRITER
1*1
BRIEF SYNOPSIS OF LETTER
Daughter d i e d 11 years ago from b r a i n tumor, mother f e l s t h a t
t e s t s t h a t coould have saved daughter's l i f e were d e l yed because
she was a s i n g l e mother and Drs. d i d n ' t t h i n k she cou d pay f o r
t e s t s , now mother owns a small business, a p r i v a t e p i n f o r her
family
f a m i l y c o s t s $4,000/year w i t h a l a r g e d e d u c t i b l e , t h e
income i s $25,000/year
IDENTIFICATION
OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
QUALITY OF CARE
CARE NOT PROVIDED BECAUSE BELIEVED UNABLE TO PAY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
033. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security ClassiFied Information 1(a)(1) of thc PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe I OIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
' i i ^ ,
, ,-
» ; ^..1- Vif;
if
P6/(b)(6)
BRIEF SYNOPSIS OF LETTER
Woman i n her SO's was d i v o r c e d by husband, she g o t a ob as a
l e g a l r e c e p t i o n i s t , a small business w i t h no h e a l t h i surance,
husband had s t r i p p e d bank account and o t h e r assets, f es r e q u i r e d
f o r l e g a l assistance and educcation, could n o t a f f o r d insurance,
she had a massive h e a r t a t t a c k w i t h a blood c l o t i n hr l e g , l o s t
t h e l e g . Medicaid (Medical) demands $800/month as hershare o f
c o s t s , p l u s she owes on o t h e r costs n o t covered by Me i c a i d ,
i
income from husband's m i l i t a r y r e t i r e m e n t and her d i s b i l i t y i s
$1,368/month, now she must pay an a d d i t i o n a l $800 i n dvance t o
get an a t i f i c i a l l e g
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH CO-PAYMENTS
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
HOSPITAL CHARGES
DOCTORS FEES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
HIGH COST SHARING
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
034. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - [S U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to thc appointment to Federal office [(a)(2) of thc PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Small business owner has t o pay very h i g h r a t e s f o r i surance t o
cover h i s f a m i l y and h i s p a r t n e r ' s f a m i l y , b u t cannot change
insurance companies due t o h i s w i f e ' s p r e - e x i s t i n g M.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
LOCKED INTO INSURANCE COMPANY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
035. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security ClassiFied Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of thc PRAj
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , husband and w i f e own small business, i n t h e pas had h e a l t h i n s .
f o r employees and f a m i l i e s w i t h d e n t a l care, c o s t increases have made i t
necessary t o drop coverage o f f a m i l i e s , now r e q u i r i n g em loyees t o cover
premium increases and may drop d e n t a l p l a n , l o c k i n g i n t o i n s . company by
w i f e ' s p r e - e x i s i t n g back c o n d i t i o n , a l s o she and her mother has s i m i l a r back
s u r g e r i e s , her mother's o p e r a t i o n covered by Medicare c o ^ t$100,000, her
o p e r a t i o n through i n s . company cost $50,000
1
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICARE
PAYS HIGH PRICES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
036. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Rceords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
PJ
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
0
36
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 31 year o l d woman, s u f f e r e d severe depressio: a f t e r b i r t h o f
daughter was diagnosed w i t h obsessive compulsive d i s o r d e r , o l l o w i n g several
years o f t r e a t m e n t , symptoms were c o n t r o l l e d w i t h medic i t i o n , p r e s e n t l y
probably small
employed as a c a s h i e r f o r $5.25/hour (maybe p a r t - t i m e
business), has a v e r y l a r g e bust which i s p a i n f u l and waiilts t o g e t breast
r e d u c t i o n b u t has no i n s . . Medicaid w i l l n o t help her becaise she makes t o o
much money, a l s o some q u e s t i o n about s t a t u s o f her 5 year ol J daughter now i n
a f o s t e r home
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
LIMITED BENEFITS
ERRONEOUSLY CLASSIFIED COSMETIC SURGERY
BREAST REDUCTION SURGERY FOR PAIN
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
LOST COVERAGE/GAINFUL EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
037. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
Presidential Records Act - |44 U.S.C. 2204(a)|
RESTRICTION CODES
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PKA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
b(1) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA]
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
3-a
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 40 year o l d s i n g l e mother w i t h 7 year o l d daughjt e r , f a t h e r never
married and unable t o c o n t r i b u t e t o support o f f a m i l y , mot er self-employed
i 1992, no i n s . ,
w i t h small business, wallpaper, b u t business went under
works odd j o b s and makes about $14,000/year so n o t e l i g i b i f o r unemployment
or Medicaid, cannot a f f o r d $200 o r $500 f o r l a b t e s t s , moher and daughter
both need d e n t a l care, a l s o when she was pregnant w i t h her cjnughter she t r i e d
t o work t o support h e r s e l f i n wallpaper business, s t r a i n caused premature
d e l i v e r y i n t h e s i x t h month, went on Medicaid, t o t a l c o s t Wc ; $150,000, which
could have been saved i f some support had been g i v e n t o p rgnant mother
IDENTIFICATION OF PRIMARY LETTER CONTENT
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
DOCTORS FEES
UNNECESSARY PROCEDURES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
LOST COVERAGE/GAINFUL EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
038. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Reeords Act - [44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office |(a)(2) of the PRA|
P3 Release would violate a Federal statute [(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) nf thc PRA]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation nf
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 43 year o l d married woman, self-employed w i t h small business,
premium has gone up from $126/month t o $324/month w h i l e drop [ling p r e s c r i p t i o n
coverage, husband covered s e p a r a t e l y by HMO ( K a i s e r Foundat an) t h a t w i l l not
i n c l u d e spouses, having d i f f i c u l t y g e t t i n g o t h e r i n s u i mce because o f
q u e s t i o n a b l e " p r e - e x i s t i n g " c o n d i t i o n s , she one saw a doc : or f o r childhood
a r t h r i t i s , and a s t r a i n e d lower back and she was t r e a t e d f t t r " i n f e r t i l i t y " .
however she i s c u r r e n t l y extremely t r i m and h e a l t h y
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LIMITED BENEFITS
HMO WILL NOT COVER SPOUSES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
039. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
im815
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or conndential commercial or
Financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information [(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , husband and w i f e were both l a i d o f f from good j o b s , COBRA cost
$400/month when they had no income, b u t they kept i t up, aughter r e q u i r e d
surgery t o r e p a i r her ear drums, i t c o s t $12,000 f o r 24 ours, a f t e r t h i s
they dropped t h e COBRA, they are both working again, t h e i f e a t a low pay
j o b and t h e husband i s self-employed w i t h h i s own small b siness, t h e best
p o l i c y they can g e t now i s $400/month w i t h $3,000/year d e d u c t i b l e , but t h i s
w i l l exclude h e r husband's h e a r t , he had an a t t a c k 5 yelirs ago, and her
daughter's ears, they o n l y way they can g e t care now i s t p s e l l e v e r y t h i n g
and go on w e l f a r e
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
COBRA'S
INCREASED CO-PAYMENT
MEDICAID
SPENDING D W POOR
ON
LOST COVERAGE/GAINFUL EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
040. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box NLimber:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
Presidential Records Act - [44 ll.S.C. 2204(a)|
RESTRICTION CODES
Freedom of Information Act -15 U.S.C. S52(b)|
PI National Security ClassiFied Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe F()IA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
> P6/(b)(6)
.••>>'••.' :
,
D
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 34 year o l d woman has c o n t r o l l a b l e Epilepsy, sometimes has been
covered under plans when she worked f o r l a r g e employers, qnt when was s e l f employed o r worked f o r a small business she c o u l d n o t g e t isurance due t o a
p r e - e x i s t i n g c o n d i t i o n , when t h i s happended she stopped t a k i g medication and
stopped going t o Drs.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
041. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jmSIS
Presidential Records Act - [44 U.S.C. 2204(a)
RESTRICTION CODES
Freedom of Information Act -15 U.S.C. 5.S2(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute [(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of thc FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) nf the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
' ^
^V.
P6/(b)(6)' •
i
• .v^ .,••„:"-;• -•••^
'•k'
,
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , college-educated
veteran, works i n b l u e - cc Liar j o b f o r ,
presumably, small business. M a i l e r s Dta Services, o n l y p r o r i d e s h e a l t h i n s .
f o r w h i t e - c o l l a r employees, p a i d $300 f o r a r o o t canal e : a l o c a l d e n t a l
o f f i c e , a l s o complains about long w a i t t o o b t a i n improper n s d i c a t i o n a t a VA
facility
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH PREMIUMS
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
VETERAN'S PROGRAMS
IMPROPER MEDICATION
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
042. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jmSIS
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. S52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of thc FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information |(a)(]) ofthe PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PICA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 33 y e a r o l d mother describes s t u g g l e w i t h h gh premiums f o r
h e r s e l f , her c h i l d and her self-employed husband who has i small business
( b a r b e r ) , they pay $4,000/year f o r i n s . and an a d d i t i o n a l $l| 500 -$2,000/year
i s medical expenses, cannot change p o l i c i e s because husbanf i s a barber and
i n s . companys regard him as a h i g h HIV r i s k
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
COVERAGE DENIED BASED ON OCCUPATION
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
043. note
SUBJECT/TITLE
DATE
n.d.
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security ClassiFied Information [(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
i3\
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , d i v o r c e d mother o f two c h i l d r e n age 3 and 5, wer t on w e l f a r e when
husband l e f t her, found a j o b , but employer does n o t providei insurance (maybe
small b u s i n e s s ) , she has Epilepsy and one c h i l d has S t r a b i $mus, cannot gent
p r i v a t e i n s . due t o p r e - e x i s t i n g c o n d i t i o n s , no o t h e r c h i d has severe ear
problem, may l o s e hearing, but Drs. w i l l n j o t accept Medicaljd, also l i k l e y t o
lose Medicaid because income t o o h i g h , d i v o r c e d husband r e q u i r e d t o provide
h e a l t h i n s . b u t and a s s i s t w i t h medical b i l l s b u t he does n e i t h e r .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
LOST COVERAGE/GAINFUL EMPLOYED
SPECIALISTS WILL NOT ACCEPT MEDICAID
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
044. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) of thc PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
Financial information [(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices nf
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , w r i t e r i s low income, d r i v e s bus f o r pre-school c h i l d r e n , small
business, probably p a r t - t i m e , no i n s . , pay l a s t year was $1 ,613.89, she has
high blood pressure and c h o l e s t e r o l , must c o n t r o l blood pres:|sure t o keep j o b ,
a p p a r e n t l y medication c o s t s $165/month, had been o b t a i n i n g medication a t $3
per p r e s c r i p t i o n through community h e a l t h c e n t e r , now cent€ has gone t o 50%
payment due t o shortage o f Federal funds, w r i t e r cannot affrord $1,000 annual
cost f o r medications
IDENTIFICATION OF PRIMARY LETTER CONTENT
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
OTHER PROGRAM
COMMUNITY HEALTH CENTER STOPPED SUBSIDIZING MEDICATIONS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
045. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security ClassiFied Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) of the FOI A|
b(4) Release would disclose trade secrets or confidential nr financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , w r i t e r i s mother o f two g i r l s , 10 and 15 years o l d , husband i s
owner o f a small business, shoe r e p a i r , p r i v a t e insurance Josts $5,000/year
and i s t h r e a t e n i n g t o go up, she i s not sure they can afforjc increase but i s
a f r a i d t o drop i n s . , her husband's cousin d i e d l a s t year bee luse he could not
a f f o r d t o go t o a Dr. a f t e r dropping h i s h e a l t h i n s . becausd i t cost too much
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
046. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm8l5
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security ClassiFied Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial informalion [(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion nf
personal privacy 1(a)(6) of thc PRA\
b(l) National security classified information 1(b)(1) of thc FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIAj
b(4) Release would disclose trade secrets or confidential nr financial
information |(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 40 year o l d s i n g l e mother o f two, has medical c o r i d i t i o n , drugs t o
c o n t r o l c o n d i t i o n c o s t $150/month, she i s working b u t hafci no h e a l t h i n s .
(maybe small business), sometimes cannot a f f o r d medicine and s k i p s doses,
w o r r i e d about h e a l t h care f o r h e r s e l f and c h i l d r e n , cheape t p l a n she could
f i n d i s $275/month w i t h $500 d e d u c t i b l e f o r o f f i c e v i s i t s p ^ person and $500
d e d u c t i b l e f o r p r e s c r i p t i o n s per person, she can't a f f o r d Hthis
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
DOCTORS FEES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
047. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information |(h)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
o
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , husband and w i f e both 55 years o l d r u n a small business,
c o n s u l t i n g , i n s . company switched t o a HMO and d o u b l i t l premiums from
$2,430.90/year t o $4,991.28/year o r $415.94/month, w o r r i e d t h a t they may be
forced t o g i v e up h e a l t h i n s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
048. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
.jm8l5
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |S U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
1 2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
*
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) nf thc PRA]
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOI A]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , w r i t e r l o s t j o b and i n s . , has had t o purchase private plan (may
now be self-employed o r working f o r s m a l l business w i t i l e s s than four
enmployees), he has p r e - e x i s t i n g h i g h blood pressure, t h e ojr|ily plan he could
f i n d c o s t s $300/month f o r h o s p i t a l coverage o n l y w i t h a $ ,500 deductible,
cannot a f f o r d Dr. v i s i t and b e l i e v e s t h a t he w i l l r e i n f o r c e pre-existing
d i s q u a l i f i c a t i o n i f he takes blood pressure medication
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
049. note
DATE
SUBJECT/TITLE
n.d.
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of thc PRA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P.S Release would disclose confidential advice between thc President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
5
—•—;
' „
~
•
r-TT
r
—
^ [ y l - ' P6/(b)(6)
r
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , husband i s owner o f a small business, auto t r i m shop, w i f e works
as a nurse's aide a t l o c a l h o s p i t a l , f a m i l y i s coveret through w i f e ' s
employer, b u t she pays $148 every two weeks out o f paycheck, f a m i l y income i s
$30,000/year, youngest daughter diagnosed w i t h Severe SeJ sure Disorder on
f i r s t b i r t h d a y , i s m u l t i p l e handcapped, i n s . pays 80% i f b i l l s , f a m i l y
medical c o s t s are very h i g h , now approaching l i m i t on coverage f o r daughter's
i l l n e s s , cannot g e t o t h e r coverage due t o p r e - e x i s t i n g con: i t i o n
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH PREMIUMS
HIGH CO-PAYMENTS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LIMITED BENEFITS
COST CAPS - CEILINGS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
050. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) of thc PRA]
Relating tu thc appointment to Federal office 1(a)(2) of the PKA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Wife dies o f metastisized breat cancer a f t e r three tnontilhs i n hospitals,
believes t h a t hospitals overcharged by $10,000 t o $12,OC )i n unnecessaty
.1
charges, also worried because h i s two daughters have a siWal business, i f
would bankrupt
they had t o provide coverage f o r t h e i r three employees,
them, they are operating on very narrow margins
1
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
HOSPITAL CHARGES
DOCTORS FEES
UNNECESSARY PROCEDURES
PROCEDURES NOT PERFORMED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
051. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)]
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , w r i t e r works p a r t - t i m e and receives no i n s . thrcugh her employer,
her husband has none through h i s e i t h e r (probably small busilKess ), they t r i e d
t o buy h e a l t h i n s because she has o n l y one kidney and a i r t h d e f e c t , she
delayed going t o t h e d o c t o r t h i s year because o f t h e cost ind g o t pnuemonia
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
DOCTORS FEES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
052. note
SUBJECT/TITLE
DATE
n.d.
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) of thc PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
C. Closed in accordance wilh restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
48 year o l d woman w i t h severe back problems, worked f o r i : i years i n a shoe
f a c t o r y then 12 years i n a small business, a grocery s t o r e as manager o f t h e
d e l i counter, f o u r years ago t h e grocery s t o r e changed ov l e r s and t h e new
owner c o u l d n o t a f f o r d h e a l t h i n s . f o r her, she c o u l d nc t a f f o r d p r i v a t e
i n s . , i n 1990 she c o u l d no longer work, she had back surgery
a rehab program, b u t i t d i d not help, youngest married daughter's f a m i l y had
t o move i n w i t h her and pay her b i l l s , now they cannot a f f o r d t o buy a home,
she t r i e d t o get on d i s a b i l i t y but could not get a Dr. t o s t ^ her because she
d i d n ' t have any i n s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
HOSPITAL CHARGES
DOCTORS FEES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
SOCIAL SECURITY/DISABILITY
DIFFICULTY IN GETTING ACCESS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
053. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm8l5
RESTRICTION CODES
PresidcntiHl Records Act - (44 U.S.C. 2204(a)
Freedom of Information Act - [5 U.S.C. 5.52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
-.PEHTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 12 year o l d son i s p h y s i c a l l y d i s a b l e d , uses a wheelchair and a
" L i b e r a t o r " communication device, w i f e i s a d e n t i s t , hust ind was t h e v i c e
p r e s i d e n t o f a small company w i t h a g r e a t h e a l t h p l a n , then l i s company moved
t o F l o r i d a , f a m i l y stayed i n L i n c o l n because o f son,f a t h e r now owns small
business, l o s t i n s . when he l e f t t h e company, cannot gEit new coverage,
b e l i e v e t h a t t h e i r o n l y choices a r e t o q u i t work and sper 1 down and go on
w e l f a r e o r g i v e up custody o f son t o become ward o f s t a t e
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
SPENDING D W POOR
ON
LOST COVERAGE/GAINFUL EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
054. note
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm8l5
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of the PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information [(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
V i r g i n i a Kowalskl
BRIEF SYNOPSIS OF LETTER
Small business owner o f b a r / r e s t a u r a n t 86 years o l d , i.s opposed
t o s i n t a x on l i q u o r and r e q u i r e d employer coverage f i r
employees, e v e r y t h i n g c o s t s t o o much, t h e d o c t o r s a r e c h e a t i n g ,
people a r e misusing h e a l t h care
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
MEDICAL COSTS - EXCESSIVE
DOCTORS FEES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
055. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm8l5
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(h)|
PI
P2
Vi
P4
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Small business owner, 17 year o l d daughter was denied coverage on
f a m i l y p l a n , a p p a r e n t l y due t o a minor l e g c o n d i t i o n , b e l i e v e
insurance company d i s c r i m i n a t e s against small businesk:
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
DISCRIMINATION AGAINST SMALL BUSINESS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
056. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jmSIS
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. SS2(b)|
PI
P2
P3
IM
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or conFidential commercial or
Financial information [(a)(4) of thc PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Small business owner, o r i g i n a l l y was paying $239.93/quarter f o r
insuruance, now c o s t s $1,166.69/quarter w i t h $1,500 cUsductible,
f i r m i s locked i n t o insurance company because w i f e hajcf nonmalignant lumpectomy s e v e r a l years ago
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
LOCKED INTO INSURANCE COMPANY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
057. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)l
Freedom of Information Act - |S U.S.C. 552(b)]
PI
P2
P3
P4
h(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
obi
< • . , • •• •
>'
:'
,
' P6/(b)(6)
'i-'-'ri,:-
•:
3
BRIEF SYNOPSIS OF LETTER
42 year o l d woman l o s t j o b i n bank, went t o work f o r small
business, they p r o v i d e no insurance, found t h a t even minimum
p r i v a t e insurance costs $400/month, a l s o 81 year o l d a t h e r - i n law i n j u r e d neck i n farm a c c i d e n t . Medicare w i l l onlyl cover 82
days o f longterm care, n u r s i n g home w i l l c o s t $2500/nnj<j>nth p l u s
medications
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
LIMITED BENEFITS
LONG TERM CARE
PRESCRIPTIVE DRUGS
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
HOSPITAL/NURSING HOME CHARGES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICARE
LONG TERM CARE
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
058. note
SUBJECT/TITLE
DATE
Address (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Records Act -144 ll.S.C. 2204(a)|
Freedom of Information Act - |5 I'.S.C. 5S2(b)|
PI
P2
P3
IM
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRAj
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
E.._J.ason McCoy
•• '
'P6/(b)(6) •
:
"' •
'
•
o
BRIEF SYNOPSIS OF LETTER
R e t i r e d chairman o f small business, company has stoppeid being
p r o f i t a b l e due t o h i g h costs o f employee h e a l t h progrim
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Enid Morrone
Construciton Associates, I n c .
585 N. B a r r y Avenue
Mamaroneck, NY 10543
TEL 914-381-1800
BRIEF SYNOPSIS OF LETTER
W r i t e r manages h e a l t h coverage f o r s m a l l business, c o n s t r u c t i o n
company, r a t e s a r e v e r y h i g h , company can now a f f o r d t o pay o n l y
50% o f employeee premiums, t r i e d t o change p l a n s , b u t one
employee i s handicapped which l o c k s i n e n t i r e group
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH PREMIUMS
HIGH CO-PAYMENTS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
LACK OF PORTABILITY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
059. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [5]
2006-0885-F
jm815
RESTRICTION CODES
Presidential Reeords Aet - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information [(b)(1) ofthe FOIA)
1)(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
56 year o l d man s t a r t e d own small business, must pure lase p r i v a t e
insurance, c o s t s $500/month w i t h a $2,500 d e d u c t i b l e br
$l,200/month f o r an HMO, premiums on t h e cheaper plari are due t o
go up, complains t h a t government l i m i t e d t a x deduction f o r h e a l t h
insurance
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Small Business Letters] [binder] [5]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 8
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-008-001-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/5bcaf152b0090dd77a5925a8595b7dd5.pdf
90281627ee2aa13bdea5873d71f368e5
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
3679
OA/ID Number:
FolderlD:
Folder Title:
[Small Business Letters] [binder] [4]
Stack:
Row:
Section:
Shelf:
Position:
s
52
3
7
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
002. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
05/28/1993
P6/b(6)
003. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
004. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/25/1993
P6/b(6)
005. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
006. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/03/1993
P6/b(6)
007. statement
re: Insurance invoice (1 page)
03/01/1993
P6/b(6)
008. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
009. letter
Personal (Partial) (1 page)
02/01/1993
P6/b(6)
010. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
011. letter
Personal (Partial) (1 page)
02/13/1993
P6/b(6)
012. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
013. letter
Personal (Partial); Address (Partial) (2 pages)
04/16/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Leners] [binder] [4]
2006-0885-F
im814
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8)ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
National Security Classified Information |(a)(l) ofthe PRA|
Relating to thc appointment to Federal office [(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
014. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
015. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
03/02/1993
P6/b(6)
016. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
017. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/09/1992
P6/b(6)
018. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
019. letter
DOB (Partial); Personal (Partial); Address (Partial); Phone No.
(Partial) (3 pages)
03/14/1993
P6/b(6)
020. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
021. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
022. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
04/22/1993
P6/b(6)
023. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
024. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
01/26/1993
P6/b(6)
025. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-()885-F
im814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - \S U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors [a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
026. letter
Address (Partial) (I page)
02/02/1993
P6/b(6)
027. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
028. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/15/1993
P6/b(6)
029. letter
Personal (Partial); Address (Partial) (2 pages)
02/01/1993
P6/b(6)
030. form
Personal (Partial) (I page)
04/01/1987
P6/b(6)
031. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
032. letter
Personal (Partial); Address (Partial) (1 page)
05/27/1993
P6/b(6)
033. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
034. statement
re: Insurance bill (5 pages)
03/01/1990
P6/b(6)
035. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
036. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/19/1993
P6/b(6)
037. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
038. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
20()6-0885-F
im814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of thc FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIAj
National Security Classified Information [(a)(1) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECT/TITLE
RESTRICTION
039. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
04/07/1993
P6/b(6)
040. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
041. letter
Personal (Partial); Address (Partial) (I page)
02/01/1993
P6/b(6)
042. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
043. letter
Personal (Partial); Address (Partial) (1 page)
01/2/6/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Uox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
im814
RESTRICTION CODES
PresidcntiHl Records Act - |44 U.S.C. 2204(a)|
Kreedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
h(l) National security classified information 1(h)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
S
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. note
DATE
SUBJECT/TITUE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Erecdom of Information Act - |S U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/26/fl3 CD: CA-46 & 47
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
;
;
P6/(b)(6) '
1
'il. '"'..
1
^ '
V"'^''
BRIEF SYNOPSIS OF LETTER
Small business owner whose husband had malignant melanoma nd has been l a i d
off.
Insurance Co. w i l l n o t take him because o f p r e -e x i s t i n g c o n d i t i o n .
Godchild w i t h a h e a r t t r a n s p l a n t w i l l n o t be picked up by a Aother company i s
her f a t h e r ever loses insurance.
Suggests German h e a l t h i l a n and caps on
doctors fees.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SU BJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
05/28/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm8l4
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
h(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice hetween the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�.
., •
1
• P6/(b)(6) ^A-:-.
; .
« •
May 28, 1993
J I 91 9
G
93
The President's Task Force on
National Health Care Reform
The White House
1600 Pennsylvania Avenue
Washington D.C. 20500
Attention:
Mrs. Hillary Clinton
Dear Mrs. Clinton:
I am taking this opportunity to write to your Tas : Force to
express my concerns regarding national health care re orm.
I am
generally a person who does not get p o l i t i c a l l y invol red because
I generally do not see any type of change. However, this issue
i s very close to me because of having family member with preexisting conditions and the need for health c a i 3 for a l l
»
individuals.
I am not only a consumer but a small businest owner in
I have a husband who was diagnosed wit Malignant
California.
Melanoma as of last year and who w i l l be laid off i r California
within the next few months. He can be covered by COBIik however,
trying to find insurance for the two of us h<i3 been em
interesting situation. A number of companies would x >t take him
because of the pre-existing condition.
However, I was lucky
enough to locate insurance through a national p rofessional
organization that I belong to. However, i n contactij^g a number
of insurance companies, most companies did not want to take my
husband because of the pre-existing condition.
Also, we have a godchild who had a heart transpla t at three
months of age approximately four years ago.
Her father has
insurance which has paid for most of her care up to this point,
However, he works in aerospace, and as you are awari employment
in the aerospace industry has been greatly reduced
Most
insurance companies w i l l not take the child on beca jise of this
supposedly experimental surgery. By the way, she i s joing really
well. One would never know that this l i t t l e g i r l who i s now four
years old had a heart transplant.
She i s truly a miracle,
However, i f my cousin loses his job, no other insurance company
w i l l pick her up at the present time.
�Mrs. Hillary Clinton
May 28, 1993
Page Two
There i s some new legislation that was passed i n California
effective July 1, 1993.
The legislation relates to small
employers who apply as a group, and i f one of the em loyees has
a pre-existing condition they w i l l not be able to be turned down
for insurance because of this.
But, let's face i t insurance
companies w i l l find a way to get out of i t .
types of
I have been reading about and watching a number
health care reforms i n various countries that are a (lailable at
the present time. An area that I am interested i n and that I
would possibly like to suggest i s investigating the ealth care
reform available i n Germany. There, the doctors ac ually have
however,
input as to exactly what can happen to the patien
there are some caps.
Here, in California, I am a vocational rehabilitatio: counselor
and we already have caps.
I do not see any reason why there
cannot be caps at the present time for physicians, witjjiin reason,
since many professions are going i n that direction.
Another idea i s to take the individual with a pre-*
existing as an
assigned risk.
I f the individual wants insurance, ind can pay
for i t , then l e t i t be at his/her disposal.
Presently, i f an individual or a family member has a fljre-existing
and they have insurance, they are essentially tied tc their job.
However, with the new California legislation hopes fully some
situations w i l l change. At the present time, the ujnly way we
were able to secure insurance for my husband was :ecause the
large professional organization I belong to appl. ed as one
employer and we were able to obtain guaranteed rates as well as
be treated as a group i n general and pre-existing was lot a major
problem.
At this time, I am requesting that you thoroughly Investigate
health reform and that some type of change be institu4|ed
Please
do not l e t this issue die or get bogged down with juslf discussion
and no action. W need to provide health care at
e
reasonable
cost that i s appropriate and effective for a l l indivic; lals in the
United States.
I would like to thank you for reading this letter and ask that
you share i t with the Task Force members as i t i iof urgent
importance and a major issue i n our country.
Respectfully submitted,
r-r—
^ — —
: . ./ v
:~
;
' P6/(b)(6)
„
.-
-
,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm8l4
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)
Freedom of Information Aet - |5 U.S.C. SS2(b)|
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose conndential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe 1 ()IA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
(.'. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSEHT GIVEN 08/27/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
i
• "•
^
P6/(b)(6)
^;
o o3>
"i-i &•'••<•• •
:, Ay-.,},;.*'-
BRIEF SYNOPSIS OF LETTER
Premiums
Small law firm.
Can only cover themselves and not employees
increasing every 6 months.
Turned down by Prudential d i i t o p r e e x i s t i n g
heart condition. E n t h u s i a s t i c a l l y endorses health reform.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TVPE
004. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/25/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-()885-F
jm814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(h)|
PI National Security Classified Information 1(a)(1) of the PRA|
12 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
*
Pi Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
nnancial information 1(a)(4) ofthe PRA|
P5 Release would disclose conndential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information [(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of Ihe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 25, 1993
Mrs. H i l l a r y C l i n t o n
1600 Pennsylvania Ave., N
W
Washington, D. C. 20500-0001
RE:
Health Care
Dear Mrs. C l i n t o n :
There are
We are a small law p r a c t i c e serving the working class
two people i n the o f f i c e and one lawyer.
I hope you ijon't f o r g e t
about t h i s segment of the p o p u l a t i o n . P r e s e n t l y , we ^re c a r r y i n g
h e a l t h coverage f o r the a t t o r n e y , who i s my husband. and myself.
We have not been able t o put our legal a s s i s t a n t ont the health'
p o l i c y because our own personal coverage i s so h i g h , liy husband i s '
f i f t y e i g h t years o l d and I am f i f t y .
We pay about J 350.00/month
f o r h e a l t h coverage which c a r r i e s a $1,000.00 deducti Die f o r each
of us.
T h i s , i n my o p i n i o n , i s an outrageous sum because the
p o l i c i e s have h a r d l y been used over the years and th»!y keep going
up every s i x months. Soon they w i l l be u n a f f o r d a b l e aecause they
have already doubled i n three years.
We have recen* l y t r i e d t o
convert our insurance p o l i c y w i t h P r u d e n t i a l over t o i n HMO wi t h i n
the company so t h a t we could add on the legal a s s i s t m t f o r about
the same money. Although an HMO type p o l i c y has some : rawbacks, we
were w i l l i n g because t h i s was the only way we cipuld provide
coverage f o r the l e g a l a s s i s t a n t .
We were turned down by P r u d e n t i a l because my hus nd had been
t e s t e d by a c a r d i o l o g i s t l a s t year who i n d i c a t e d t h a t ;;' e might have
a heart blockage. Further t e s t s were recommended by he doctor t o
search out the f i n d i n g , but my husband d i d not f o i l O i through, as
these t e s t s , i n themselves, were i n v a s i v e and c a r r i e a p o t e n t i a l
danger.
I t h i n k i t i s important t o say here that he has been
symptomless a l l h i s l i f e .
b
This i s my p o i n t ... I h a r d l y see how we would have t o pay any more
i n taxes than we are already paying t o P r u d e n t i a l i a u n i v e r s a l
h e a l t h c a r e system were set i n place!
I say l e t ' s ge : on w i t h i t .
Too many Americans have been l e f t out i n the c o l d i n our present
healthcare s i t u a t i o n .
The insurance companies and the d o c t o r s ,
e s p e c i a l l y , have become too greedy. I'm happy f o r tjhem t o lead a
f i n a n c i a l l y rewarding l i f e , but most of the doctor
I know own
several Mercedes and very expensive homes...a l i f e s t e which only
the r i c h could a f f o r d i n the past. I t ' s g o t t e n out af hand!!!
S i n c e r e l y yours,
P6/(b)(6)
;
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)]
Freedom of Information Act - |S U.S.C. .552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/25/(13 CD: CA-46 & 47
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
4
• P6/(b)(6)
0^5
BRIEF SYNOPSIS OF LETTER
They've
Pharmacist's insurance premium went up to $2,017.02 from $1,400.
only had one i l l n e s s i n 10 years, and f i l e d only one claim i>r $3,700.00. His
business owed no taxes because p r o f i t s were eaten up by rlj$e i n premium for
employers. May not be able to afford i t much longer.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/03/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
im814
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Erecdom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(i) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAj
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions [(b)(8) ofthe FOIAj
h(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of thc PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PR A]
PS Release would disclose confidential advice between the President
and his advisors, nr between such advisors |a)(S) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�AMERICAN PHARMACEUTICAL ASSN
2215 Constitution Avenue N.W.
Washington DC 20037
John A Gans, Pharm D
Executive Vice President
Dear John,
This month I will celebrate my 60 birthday and
my 37th year as a Registered Pharma 1st. I have
already received my "greetings" from he Amercan Pharmaceutical Association and th Pharmacist Insurance Trust.
The monthly premium on the APhACa e major
medical plan for mv wife and I, has
increased
to $2017.02 as of March 1 1993. Six m<j iths ago, It
was $1400.00 and four months before hat is was
$900 00 The only claim we have pres^fi ted was for
$3700.00 over one year ago. We are st 1 waiting for
reimbursement for that claim.
P6/(b)(6)
1 ,
i
1
The sad fact Is that each of us work c er 48 hours
per week and have taken only a day ilnd one-half
off due to Illness In 10 years, Other thdln insurance
premiums our medical expenses are rr nor
f"
1
»
Last year our pharmacy did not owe 4|ny federal
Income tax. Our losses were Just aboUit equal to
the Increases In employee health insurltnce costs.
I am not sure, that I can afford to con Inue to pay
the present APhACare premium? I wa «offered the
$100.00 a day hospitalization plan whl h does not
meet our needs. I do not wish to becc ne part
of the 34,000,000 uninsured Amencan:
What Is the APhA doing for us lately? Who is
monitoring Insurance companies such s Insurance
Company of North America, a Cigna cotmpany who
�raise premiums, raise deductables and raise :opays
without notice. I have not been able to obt in
current rate card. How much and when wil|l the
next increase come?
/
-'• •y." ~'
? i
•" i'j'
P6/(b)(6) " >'
S
'^-•'•• ' '
1
: .r'"
•/•••t
•: T!fr:' ••'':•••
Copy Presidents Commission on Health Care Reform
Enclosures: Copy of premium notice & paym nt
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. statement
SUBJECT/TITLE
DATE
03/01/1993
re: Insurance invoice (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
.im814
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TVPE
008. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Bo\ Number:
367'J
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jtn814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe F()IA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security' Classified Information 1(a)(1) of thc PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRAj
1 6 Release would constitute a clearly unwarranted invasion of
*
personal privacy [(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN (7/20/93 CD: AZ-1
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
00%
P6/(b)(6)
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , w r i t e r works p a r t - t i m e and r e c e i v e s no i n s . t h r o gh h e r employer,
her husband has none through h i s e i t h e r (probably s m a l l b u s i n e s s ) , they t r i e d
Lrth d e f e c t , she
t o buy h e a l t h i n s because she has o n l y one kidney and a
delayed going t o t h e d o c t o r t h i s year because o f t h e c o s t 9f\d g o t pnuemonia
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
DOCTORS FEES
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
009. letter
SUBJECT/TITLE
DATE
02/01/1993
Personal (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jin814
RESTRICTION CODES
Prcsidenlial Records Act - |44 ll.S.C. 2204(a)|
PI
P2
P3
P4
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
Freedom of Informalion Act - |5 U.S.C. 552(b)l
b(l) National security classified information 1(b)(1) o f t h e FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential nr financial
information 1(b)(4) o f t h e FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA)
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) o f t h e FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) o f t h e FOIA|
�6a;
S f^ts^Lj
^>j^t
cmc c c +
c • c ceo
<
/UVULAE
'WZr^lf
*
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out/
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. note
SUBJECT/TITLK
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm8l4
RESTRICTION CODES
Presidential Reeords Aet - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of thc FOIA]
h(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN qfc/23/93 CD: MA-10
PERSONAL STORIES DATABASE
riFICATIQN OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r w r i t e r i s mother of two g i r l s , 10 and 15 year$ old, husband i s
owner of a small business, shoe r e p a i r , p r i v a t e insurance :osts $5,000/year
and i s threatening to go up, she i s not sure they can affojfta increase but i s
a f r a i d to drop i n s . , her husband's cousin died l a s t year be:ause he could not
afford to go to a Dr. a f t e r dropping h i s health i n s . becaust i t cost too much
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
�F/rj"/
hecxr
Mrs
Ci'{'n-ton.
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uuritleYj
nctywe. ts
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very
Acre
ho^c-.
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luell
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schedule.
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pu^- -food ok? -Me +otb/e.. ®u+ evt*-) -f
Mrs CUtyoio is no dqn^er . IPtth or-c^t..
i,
f J
J
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-Me. i>J«y • ^
o-f
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�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
O i l . letter
DATE
SUBJECTTTI I LE
02/13/1993
Personal (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(h)(1) o f t h e FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e F O I A |
b(3) Release would violate a Federal statute 1(b)(3) of the F01A|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e I O l A]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
h(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the F O I A |
National Security' Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office [(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�eJ 4crs-l-op if
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
012. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jmSH
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Erecdom of Information Act - [5 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(h)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of thc PRA|
Relating to the appointment tn Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P.S Release would disclose confidential advice hetween the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�CONSENT GIVEN 01726/93 CD: CA-49
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
:
•:*r''..iA ~'
,
, ••'-r^ V': -.'.- -- i
(
v
i
",P6/(b)(6) .
5
1
BRIEF SYNOPSIS OF LETTER
Husband i s s e l f employed a r c h i t e c t i n small f i r m . Cannot <ifford insurance,
B/C p l a n f o r small business t o o expensive. Medical b i l l s i i ] c r e a s i n g d e s p i t e
recession. Wants s i n g l e payer p l a n .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMKNT NO.
AND TYPE
013. letter
SUBJECIYIHIE
DATE
Personal (Partial); Address (Partial) (2 pages)
04/16/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information |(a)(l) of thc PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
b(l) National security classified informalion 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
h(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential nr financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�ol3
P6/(b)(6)
... «
B
ApriX~l"b
Lear Mrs. C l i n t o n ,
I want to thank you f o r t a c k l i n g one o f the biggest ; roblems
i n America, the h e a l t h care c r i s i s .
I decided t o w r i t e and t e l l you o f the problems my h sband and
I have w i t h medical coverage and c o s t s .
I understand y u want t o
hear from the p u b l i c about t h i s i s s u e .
e
Ny husband i s a self-employed a r c h i t e c t i n a small (firm. W
cannot get medical coverage under any b i g insurance p l a s because of our f i r m ' s small size so we are f o r c e d t o take out i n d i v i d u a ! p r i v a t e insurance. For a short time we were covered by
an a r c h i t e c t ' s insurance p o l i c y , but the premiums got t o be more
than we could a f f o r d so we withdrew from t h a t p o l i c y t o l o o k f o r
another cne w i t h lower premiums. That has been the problem f o r
us over the past decade. Each year or so our premiums have gone
up and we have gone from one insurance company t o another, seeking the one whose premiums we could a f f o r d . At t h i s p e n t we
have coverage under Blue Cross of C a l i f o r n i a w i t h a $.2,t)00 ded u c t i b l e . That i s another problem f o r u s . To save on tremiums
our d e d u c t i b l e has t o be l a r g e r and we are f o r c e d t o pqy a t f u l l
cost e v e r y t h i n g under $2,000 o u r s e l v e s .
I have seen my d o c t o r ' s b i l l go from $71 two years kgo t o
^105 t h i s year f o r the same r o u t i n e p h y s i c a l examinatic - . And
J
- h i s i s t y p i c a l , not the e x c e p t i o n . For doctors there £ =ems t o
be no r e c e s s i o n .
W have seen our medical b i l l s r i s e £ t e a d i l y
e
over the past years f o r the same services performed, ar i i n s p i t e
of the recession t h a t the country and C a l i f o r n i a has b« en exp e r i e n c i n g . San Diego has been h i t v e r y hard economically.
My husband has had a hard time f i n d i n g new work.Many a r c h i t e c t u r a l f i r m s i n our area have gone out o f business.
But s t i l l
insurance companies and doctors have r a i s e d t h e i r p r i c e s . Our
s a l a r y has gone down.
�I believe that what t h i s country needs to do i s o t r y a
medical system l i k e Canada has, a single-payer system.
om what
I hear most of Canadian citizens are quite pleased with It. I
l i k e the idea of everyone paying to be covered under one iealth
plan. There, people go to the doctors and hospitals of l e i r
choice and t i l l the government according to a standard f $e schedule.
|
I t cuts paper work and seems much more e f f i c i e n t .
T read that your committee i s leaning towards a anaged
competitive system. I t sounds l i k e a step i n the r i g h t qjirection
but f a l l s short of the best solution because the insuran (tie companies
would s t i l l be involved and the price for coverage would s t i l l be
a big problem for the small professional firm l i k e ours, Doctor's
salaries would s t i l l be too high i n our opinion as would l o s p i t a l
costs.
v' believe that the present medical system must hange
.e
and we think that to do much good i t should change more ;han the
managed ccmpetitive plan would allow. We believe that by adopting
the single-payer sys ter;; more money would be saved and t h d e f i c i t
>• o ' i
.
cut by much more.
This i s a good time for a more r a d i c a l approach o the medi c a l problem. Everyone, except those who are making hug p r o f i t s
from i t , know that our medical system needs to change,
t i s not
meeting the needs of our c i t i z e n s . We believe that the Majority
of Americans would support the single-payer system.
Sincerely,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
014. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Rox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
1 5 Release would disclose confidential advice between the President
*
and his advisors, or between such advisors |a)(5) of the PRA]
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the I OIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential nr financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN On/23/93 CD: CA-27
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
3
'. . . ^ . J ' - - "
L
•" - • *
,J
" '
. "; ' " 'A' -
.. . .Vi-'
• • • /A
•,.- ;..s/:'
J1
.P6/(b)(6) . . . .
BRIEF SYNOPSIS OF LETTER
O f f i c e manager o f p u b l i s h i n g company w i t h a small group poI i c y announces
t e r m i n a t i o n o f t h i s coverage because o f 5 r a t e increases Ln l e s s than one
year.
The c a r r i e r . Home L i f e I n s , Co., s t a t e d i t was t h e i r p o l i c y t o
a u t o m a t i c a l l y r a i s e r a t e s on small groups every q u a r t e r , w t h o u t regard.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
015. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
03/02/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm8l4
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
h(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of Ihe FOIA|
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA]
P5 Release would disclose confidential advice between Ihe President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�02 March 1993
PIAN NO,
Home Life Insurance Company
Met Operations
P.O. Box 15244
Newark, NJ 07192-5244
P6/(b)(6)
NOTICE OF Cf VCELLATION
To whom it may concern:
is terminating the co erage provided by
P6/(b)(6) .
This is formal notification that
Home Life Insurance Company effective March 1, 1993.
reived in less than
The reason for termination of coverage is the five rale increases that we
12 months. Our records show rate increases on:
Decembei 24, 1992
January 7 1993
March 26, 1992
June 26, 1992
September 25, 1992
Also, when I called and spoke to Paul J. Leiniger, Vice President, Group Infebrance Operations,
I was appalled to be told that it was the policy of Home Life Insimance Company to
automatically raise the rates on small groups every quarter, without regard. This is
unacceptable. If Home Life Insurance Company does not want to deal witt small groups, stop
covering them, don't gouge them with higher premiums every quarter unt^l you put them in a
position of having to look for coverage elsewhere. Putting them in the posHible position of not
being able to get approved for other coverage, and worse, not being ble to cover their
employees at all.
1
Our coverage is paid through the end of February, we will not be paying I arch 1993 invoice.
Sincerely,
•'JM -'
*! •' >•:•'•»":,'.•?
' •.
P6/(b)(6);,, ,. ,
:,:
,v';y '
cc:
Hillary Rodham Clinton
Office of the First Lady, The White House
P6/(b)(6)
�Withdrawal/Redaction Marker
Clinton Library
D O C U M K N T NO.
A N D TYPE
016. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
O A / B o x Number:
3679
FOLDER T I T L E :
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b ( l ) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e KOI A]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA|
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
National Security Classified Information 1(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute [(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSEN"! GIVEN 08/26/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Olio
BRIEF SYNOPSIS OF LETTER
42 year o l d widow w i t h 3 c h i l d r e n . Small business emp oyee, accident,
h o s p i t a l i z a t i o n , t h e r a t e increases f o r company. Company changes c a r r i e r ,
she was r e j e c t e d by 2. Company covered her by COBRA, a f r a i c company won't do
t h i s f o r long.
IDENTIFICATION OF PRIMARY LETTER C
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
017. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/09/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA]
1 2 Relating to thc appointment to Federal office 1(a)(2) of thc PRA]
*
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice hetween the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PKA]
b(l) National security classified information [(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�on
February 9, 1992
Hillary Clinton
Chairperson, Healthcare Reform
The White House
1600 Pennsylvania Avenue
Washington, D.C.
Re:
Health insurance cancellation
Dear Mrs. Clinton:
My name is ~ P6/(b)(6) .... ' and I am a widowed 42 year old mother of thret children. I am a
graduate of the PennsylvaniFState University in 1972. My husband and I moved Abilene, Texas in
I
1977. In January, 19781 passed the examination and became a Certified Public AcaHrotanthave been
PG/(b)(6) •
employed by
CPA's since that time. We are a small combfctny, employing 10
people, including the owner.
They range in age
In April, 1990, my husband died, leaving me with my three daughters to raise alone
seijiOus accident. I fell
todayfromnine years old to 17 years old. In September, 19911 suffered a very
during a Chamber of Commerce Leadership training program, andfracturedthe #lumbar vertebra in
my spine.
Following a 10 day hospitalization in Dallas, I returned home, entered physical tij^rapy, and am now
enjoying a relatively normal life. I was fortunate beyond imagination, in that I su:ered no permanent
disability as a result of the accident. I am able to walk and did not ever lose any > d function. Nn
oy
further treatment has been planed by my physicians.
In February, 1992, August, 1992, and February, 1993 the Company's health insu: mce was renewed,
with substantial rate increases, which were a dirert result ofthe claims filed to fo my accident. The
pay
insurance company had to be threatened by my attorney to pay the claims initi ly. Following the
iti^
payment of the claims, the_rate JivcreasM_hay^b«»me a financial burden Qn theCompany, and my
employer decided to change health insurance, Atjhis time, two different ^arri: s have denied me
nt ia
coverage. I have enclosed a copy ofthe most recent "rejection letter for yourreffei-ence. So far, my
employer has agreed to continue to cover my insurance costs, but the" rest of the sta will be insured by
the company who denied coverage to me. I am assuming that my employer w have me make a
;
COBRA election to continue the cancelled group insurance, and my guess is thattWs coverage will be
-
�approximately $1,200 to $1,500 per month, I am sure that the Company will only ] iy this for a short
period of time.
My biggest fear is that I have become uninsurable, and that all of my savings wl be exhausted if I
hnpen to me, and it
should become ill. There is no one else to raise my children if something should *
is impossible for me to be issued any additional life insurance.
We have the best medical care available in the world in the United States. I belie •:that my recovery
is a prime example of how the best physicians can be located and excellent healt care facilities are
I
available, but I was only able to obtain the best because I had insurance in 1991. S i >rtly will become
a member of the group of Americans who have no health insurance, through nofoi1of my own.
1
help me with this
Please offer me some hope to the future that you and the President's administrationIIw
problem. I realize that I am probably one person among many in this circumstande I try to remind
em remains from
myself that T am fominate in that, while I shall soon have no insurance, no major prqbl
my accident that must be corrected while I have no insurance.
I want to thank you in advance for taking the time to read my letter, and hope tha you can empathize
with me because you are a mother, and can understand my fears of raising my children alone with no
insurance to protect us.
r
yeay.trul.v_YO.urs...
P6/(b)(6)
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
018. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(5)1
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) o f t h e FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
nnancial institutions |(b)(8) o f t h e FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
National Security Classified Information 1(a)(1) of thc PRA]
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or conndential commercial or
financial information [(a)(4) of thc PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile deFincd in accordance wilh 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN, DAUGHTER GAVE CONSENT )8/23/93 CD: CA-2
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
ol8
BRIEF SYNOPSIS OF LETTER
30 Year-old Daughter diagnosed w i t h Hodskin's Disease. She works f o r a small
company w i t h no h e a l t h insurance.
She makes t o o much •jnoney f o r p u b l i c
assistance.
She i s unable t o g e t insurance, because o f t h e p r e - e x i s t i n g
condition.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
GOVERNMENT - RELATED HEALTH CARE
PROGRAMS
MEDICAID
LOST COVERAGE/
GAINFUL EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND TYPE
SUBJECTTTI I LE
DATE
DOB (Partial); Personal (Partial); Address (Partial); Phone No.
(Partial) (3 pages)
019. letter
03/14/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
O A / B o x Number:
FOLDER
3679
TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
,im8l4
RESTRICTION CODES
Presidcnlial Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. S52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) o f t h e FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e F O I A j
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe F O I A j
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) o f t h e F O I A j
National Security Classified Information 1(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or conndential commercial or
nnancial information [(a)(4) o f t h e PRA|
P5 Release would disclose conndential advice between the President
and his advisors, or between such advisors |a)(.S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�I
1 * . -
t/<>
_
.
/ If fl
It
fl A
^
^
W
I
-W
6o
9J
P6/(b)(6;
3
JM*A
��AM&AO
^A ^suyiJkb
�JA
-
(JJQ / V ^ / /MUii/iA^.
QJY[
���.,.,P6/(b)(6)
:;
I
T
.'; .•
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
020. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
1 2 Relating to the appointment to Federal office 1(a)(2) ofthe PRAj
*
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�o20
Remote? on Fox 40 News, Sacramento, CA
Producer: Wendy Hopkins
(916) 454-4548
Working on the story of I " P / b ( )
6()6
\ 30 year old w man with
^
Hodgkins Disease who i s not eligible for MediCal and i s unable
to get insurance because of pre-existing condition. tforks for
small Public Relations firm and was just notified tha^ she has
been denied MediCal assistance, primarily because of hemotherapy
her condition has improved.
Original letter to Mrs. Clinton was from mother, __
but ( P / b ( ) | has indicated that she also has written.
6()6
L
P6/(b)(6)
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
021. note
SUBJECT/TITLE
DATE
Persona] (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/13ox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information |(b)(l) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOI A|
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information |(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/27/93
P6/(b)(6)
GIVES CONSENT
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
—
-.
P6/(b)(6)
^
—
—
-.i .
.
1
— ^
1S
' .'• ;
V.f'f ,„ • V*;. • - * ' ,-
•S-'n ^'4L',.-.'
i' , '
' ( ' • • ' ' • ..."
BRIEF SYNOPSIS OF LETTER
Employer has written wrenching l e t t e r about employee's pijoblems r e s u l t i n g
from insurance compnay's r e f u s a l t o pay costs f o r 7 month premature baby.
Had t o d e c l a r e bankruptcy.
Employer's p l a n s t a t e d he would be exempted
b e f o r e company signed. Previous c h i l d born w i t h o u t covera e caused e a r l i e r
bankruptcy,
Employer w r i t e s t h a t man i s "smart, energel Lc, t a l e n t e d and
destroyed."
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LOSS OF COVERAGE
OTHER CONTENT
Supposedly
bankruptcy
another.
had coverage b u t insurance r e f u s a l t o pay r e s u l t e d i n
mature b i r t h o f
t w i c e a f t e r b i r t h o f one c h i l d and p r
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
022. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
04/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Prcsidenlial Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
PJ
P4
b(l) National security classified information |(b)(l)of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA)
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation nf
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to thc appointment to Federal office 1(a)(2) of thc PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�L
Mrs. Hillary Clinton
1600 Pennsylvania Ave.
Washington, DC
03 5
k
April 22, 1993
Dear Mrs. Clinton:
I write this letter to you because of your position and understanding of ttji» health
care crisis in our country. I imagine you get thousands of letters on this subject nd cannot
read them all. I hope this one gets through to you to read. I voted for Bill Clinto for one
rea$on alone: HEALTH CARE REFORM PROMISES, This letter Is the story of an >fnployee of
•mtneuwho-ls now hopelessly' in debt, due to the' health care costs he incurred froji ithe births*"-
«tf&24Dfchl8'4»chj|di{en».
P6/(b)(6)'« ' |ls 27 years old. He is married and now has 4 children., Tt second, i
^bild was where this story .begins. He came to work for my company 4 years
>>.Mi8<:Wif9
was seven.months pregnant with his second child.- He was covered by. insurancefrom his
then,employer. I offered him a job, but our insurance didn't immediatley start... h i said.he .
' was covered for 60 days after he left the other.employers employ.. His baby yvai boqn
,withen the 60 days, but the insurance paid nothing and as a result he was.foroM to filer
bankruptcy-to cover the more than $25,000 in medical coits. ThflubSQ^SyRtfiV^i i^SXPect^d
iyjged his'cred'rt. He was constantly hounded by creditors and faced humiliation from nearly
everyone. He was unable to buy anything except with cash and his attitude pi un ated as
one might expect. As if all of this isn't enough of a story, this is only the beginnffig.
I allowed my employees to choose our insurance plan. I stated that considering the
costs of premiums, I wanted them to have the choice in the plan by way of a voir. 75% of
the employess (I counted as one vote just as each employee did) had to vote yes :o approve
of the plan for us to accept it. Hoping to prevent another fiasco like the previoui child had
caused, Randy questioned the insurance company rep. about the plan. They-ass. red him hewould be excepted. Because of this, he voted for our plan. After the insurance i/as paid
and in place, he took his wife to the doctor and found out she was pregnant aga i > She
.
actually conceived prior to the policy, however, because of a lack of funds they I id not
gone to the doctor and did not know she was pregnarjt. -Her baby was'bom^rr: nths*
^premature causing.tremendous problems to the baby. The babywarin Intensive sare-for
.about a'month and the bills incurred exceeded $150,000, to which the insurance stated *
point blank, that they were not going to cover due to the pre-existing condition c I her. _
pregnancy, Of couse on a less than $2000 monthly income with 3 children, and i wife"who
could not work, he was in debtors hell, with no hope left. He cannot file bankruj cy again
for 5 years. He cannot begin to pay these bills. I this week received a wage am i :hment on *.
-••his-salary which will take out 25% of his income for the next 20,000y©ai£. Wit interest
compounding, he will owe the entire gross national debt before he dies.
This man is smart, energetic, talented, and destroyed. He does not knov\ what to
do. Welfare would pay him better than I can (minus the 25%garnishment). I api )al to you
to do something. We need to help this man. Under the current situation, why sh )uld he
love America? What incentive does he have to try? Why shouldn't he go on welfare? I'm
�mad about this. What chance do I have to motivate this man to achieve under tMase
circumstances? The answers to these questions are simple once we have a national health
care law. I know you know that. I know you believe in it and are working for it I support
you fully. But what hope can I give to Randy? Dp I fire him and rehire him at m jjimum
'"'wage'to cheat the system? •DoTpay him "out bf my own pocket the difference? krt'walk away and not care? I have to help this man. I have to. I would like to see an eflBmption on
have
waiting 7 years to file a second bankruptcy, if the reason for filing is medical billfi
jn he tried
witnessed the attitude of others towards Randy be influenced to the negative
to buy a car and they did a credit check. I tried to help him start up a new ered* record by
cosigning for a car for him. He was treated like an aids patient when they looked at his
credit file. They did^not care that it was for medical bills,to aave his newborns,lie . He was
simply a flake to the credit people. He has been harrassed by countless calls to dollect. The
people of the hospital and the doctors saved the life of his baby, and he is indebjtjed to them
for their skills, but should he have to pay for this till death due him part from th ; earth? He
is so damaged by all of this, that when he and his wife discovered another bab on the
way, he considered abortion or adoption because of the financial burden. He iiWformed me
of his fourth child, only days before its birth. He was actually ashamed to have Another
child. He chose to have the baby because he and his wife could not bear to par: with it. I
am proud of him for this choice. I am pro-choice, and this was his choice. I to i him to be
proud of it. To hell with all the debt on earth, that baby is worth more, I told hin Do not
be ashamed, be proud. 100 years ago, 4 sons would have rendered him a hero, hot
shamed. I told him to fight for his rights. I told him to seek his congressman, ( i^ preacher,
•
and his lawyer. I feel for this man. This man who is white, native born, and get* far less
help from our government than the immegrants we share this country with or tt foreigners
we give money to. He has been damaged by the rules of this country. Does h< sue the
federal government for damages? What does he have to lose?
1
1
4
Automatic health care for every citizen is the answer, I pledge my vote l|o the
someone who can right the wrongs that exist in health care. It is a monumenta task you
have. I dearly hope you succeed. I write you this even though I offer health ca ) to my
of-*
employees and am fortunate enough to afford the premiums. It is for the
P.6/(b)(6)
nhis country I write you. I care about this country and I care about the employees of my
business. It is my hope that I can help sP6/(b)(8)
to repair his financially de itroyed life.
He is not without fault. He could have chosen abbrtibn or used better birth cor I rol. The
hospital and doctors did their jobs wonderfully well, and deserve to be paid, bu how can
anyone without insurance afford $3.00 aspirin, and $10 bandaids that hospitals charge,
Doctors perform miracles everyday, and they deserve to be well paid, but who left to
afford their fees and the hospitals fees. His family is now healthy and beautif
but.thiff
*man carries burdons of debt, shame and humiliation that nojnan Jn^hiaxouiUCV khould have
to.bare. , ask foryour help for this man*. Is their anything we can do that I hav|f missed? I
1
look forward to your reply.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
023. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm8l4
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 5S2(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P.S Release would disclose confidential advice between the President
and his advisors, or hetween such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(h)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN BUT DO NOT USE NAME CD: PA-20
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
1
i ;
. .'Kv";,.^ '''.-. ;='
~>"
':
r
>.! "'v.^;^^^;^•^^:;^>;i;•-" '
"; :
:
D ^3
BRIEF SYNOPSIS OF LETTER
Widow with two children, owned small business, paid $7 0/mo f o r health
insurance. Daughter (28) was diagnosed with M.S. when she ViiLS 19, now cannot
get new insurance even though she has been fine f o r many yftars.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
024. letter
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
01/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jin814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
1 2 Relating tn the appointment to Federal office 1(a)(2) of the PRA|
*
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe F"OIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning thc regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM, Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�••'.AS'.
1
.-"v ;.... • • ,:,*;•• 5*-
• 1_
P6/(b)(6)
t
•',.>,;••*•••_ ' :.;. H...i. .:;.;..i:'
January 26, 1993
Mrs. William Clinton
White House
Washington, D.C.
Re:
Health Care Reform
Dear Mrs. Clinton:
Hooray! At last maybe someone who cares can make charjtes i n our
Health Care program for the nation. I feel that to have to t ike up
contributions and set up agencies to make sure people can ha\|* affordable
health care i s a crime i n a nation such as ours.
On a personal note, I am a widow and have been very sv. oces f u l i n
s
my own business. However, when my two children were l i v i n g
home with
me, my h o s p i t a l i z a t i o n alone per month cost $750 approximate]) ' My son i s
now i n the U.S. Army so I dropped him from my insurance; howqyer my daughter
is on some national l i s t as she was diagnosed with M.S. when the was 19 and
cannot get insurance should she be dropped from her place of employment. The
coverage provided there i s not as good as the one I am s t i l l carrying. The
cost to me per month now i s $450 approximately, t h i s i s mine ind hers. She
i s unable to purchase insurance again even though she has beej t fine since she
was 19—she i s now 28. I would l i k e very much to r e t i r e i n
few years, but
I cannot due to the cost for health insurance.
I have heard over and over again that the costs are rUnup by too
many t e s t s , etc., but I am thinking that the doctors charges ire important
i n the costs, too. I j u s t was charged an exhorbitant cost f : some foot work
I had done. After receiving what he could on insurance, I hfre also been
b i l l e d $180. This i s outrageous.
Anything you can do to help those of us i n the middle et a l i t t l e
r e l i e f , I w i l l be forever g r a t e f u l . After t a l k i n g with Canac .ans, Austrailians,
Germans and English, I find they are appalled at my story of •rhat we have to do
to make sure a hospital stay and an i l l n e s s costs us. We coi .d go i n t o r bankruptcy.
Thank you f o r your help.
Sincerelv.
�Withdrawal/Redaction Marker
Clinton Library
D O C U M K N T NO.
AND T Y P E
025. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
im814
RESTRICTION CODES
Presidential Rceords Act - [44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(h)|
PI
P2
P3
P4
b ( l ) National security classified information 1(b)(1) of thc FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e F O I A |
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of thc FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) o f t h e FOIA]
National Security Classified Information 1(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA]
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy |(a)(fi) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/23/93 CD:NM-3
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Barbara Stanley
. P6/(b)(6) • ::;'±AK
BRIEF SYNOPSIS OF LETTER
W r i t e r owns s m a l l business, a r e s t a u r a n t , w i t h 23 s t a f f , w: r k e r s comp costs
$12,000 per year, she has o n l y had two claims i n 27 years, wants t o g e t r i d
of worker's comp and p r o v i d e employee h e a l t h insurance ins;ead
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
WORKERS COMP
HIGH COST
LOW BENEFITS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
026. letter
SUBJECT/TITLE
DATE
02/02/1993
Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number;
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Prcsidenlial Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of thc FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(h)(2) ofthe I O I A ]
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(h)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information [(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�/
. • . • P6/(b)(6|
Cost]
Tebruary 2~,^I<i~9S'
Ms. H i l l a r y Rodham-Clinton
Chair, H e a l t h Care Reform Task Force
White House
Washington, D.C.
20500
Dear Mrs. C l i n t o n ,
I am pleased t h a t you have agreed t o accept t h e r e s p o n s i b i l i t y
f o r t h e development o f a h e a l t h care r e f o r m proposa
Enclosed i s a column t h a t I wrote f o r our small weekly paper.
I understand t h a t Workman's Compensation prograjijis are s t a t e
mandated; but t h e c r e a t i o n o f a n a t i o n w i d e h e a l t h Jare insurance
p l a n c o u l d g i v e t h e Federal government leverage t o t r a d e o f f these
programs.
I own and operate a 24 hour f u l l s e r v i c e r i staurant t h a t
grosses lees than $500,000.00 per year and employi twenty t h r e e
people. Our annual Workman's Comp insurance premium s $12,000.00.
I n our 27 years o f o p e r a t i o n we have had two c l a i m s , One c l a i m was
f o r $34.00 and t h e o t h e r was $412.00. Most o f my inployees have
b<?en w i t h us f o r over 15 years.
otldnan 'Cl'TJbfcatx i^teu^fcee--. We a r e c u r r e n t l y paying a g r e a t deal of
money f o r a program t h a t my employees do n o t b e n e f i from.
I do n o t want t o harm my employees; b u t gt /ernment must
r e a l i z e t h a t my business cannot a f f o r d t o absorb t h e :osts o f these
a d d i t i o n a l mandated programs. Since many mandated programs are
based on a percentage o f gross p a y r o l l , business has l e s s and l e s s
i n c e n t i v e t c p r o v i d e employee r s i t . e s .
I t i s past time t h a t government a t a l l l e v e l r e - t h i n k t h e
tendency t o simply add a d d i t i o n a l burdens on busine i s . We should
be concerned w i t h t h e most cost e f f e c t i v e means o f p r o v i d i n g r e a l
b e n e f i t s t o a l l employees.
Good l u c k w i t h your d i f f i c u l t
task.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
027. note
SU BJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
PresidcntiHl Rceords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors [a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe I ()IA|
h(2) Release would disclose internal personnel rules and practices nf
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe F01A|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN q8/19/93 CD: ME-1
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
-• r '
0 21
iVv"-
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , man and w i f e a r e both small business owners, 4 ^ s t o f i n s . very
h i g h , j u s t r a i s e d r a t e s by 3 1 %
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
028. letter
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
02/15/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating tn the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
IM Release would disclose trade secrets or confidential commercial or
nnancial information 1(a)(4) of thc PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices nf
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or nnancial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�1
•
*. •.
P6/(b)(6) .-''
/
\. o
2 -15
f'"
Mrr..
HJ ] .1 a r y C l i n t o n
w h i t e H o u F. e
Ka F. h i ngt on, DC
Dear
Mrs
Clinton:
I w j F h y r u g r e a t r . t r e n g t h and p e r s e v e r a n c e
Medi c a l - L e g a l i l n s y r a n ce_Com]2 l e x .
1-;
'..)•".
:rf T .nie b o t h s m a l l
About nie ••! i ^ 1 i ri;.. ur,, no e fl f.
h o •.- oi 11 y r ;•> r o l d d a u g h t e r .
We h a ••• T- wori-. ed hai-d
II 1 r •
.-, - f, - F. s i h 1 e.
to
in
d e a l i n g with the
b u s i n e s s o w n e r s who a r e doncerned
c o n t i nu* t o r»ge.
«3 s r
th 46 and
jmprcve
our
health
habit?,
so
are i l l
as
Today 1 r e r e i v e d a not.-ice r r o m S t a t e,--Pnr m I n s u r a n c e dtr h e a l t h
Ti<-ri~r .
They have n o t i f i e d UF. OT 'a 31% i n c r e a s e i n cost with no
u e r i e r j l . changer;, h o w e v e r i T we want'^p—a^d-ert-e'cfur hos >ital bed
l ' - n . r j f wr c. a n pa y mo r e .
I f t )ie i n- uranre company has the power to i n c r e a s e ra.eF. at t h i s
:;
r a l e , wii.-. t. w i l l the:, do i f I get s i c k ?
They can drqp me at any
( i in"? '.dir.- *-oij]d take UF. then? at what cost?
.
r t a t e Farrr, d'-eF. a good j o b a d m i n i s t e r i n g t h e i r
what i F wi- on a?
i n s u r a ice
business,
It FeamF. to me that the insurance companies c r ea ned the system
taking th<? best from the e a r l y l a r g e Blue Cross a r r i e r s
lea '/ing them with junk, f o r c i n g them to r a i s e th !i r r a t e s and
then j u s t followed behind i n c r e a s i n g t h e i r p r o f i :s along the
w a y.
rhy can' t we be part
share.
of one l a r g e group were we a l l ppy a f a i r
I b e l i e v e that with you i n charge,
but you won't l e t them hide.
P6/(b)(6)
>:...„
0
rc:
,'"
'.'
'
^-, f,-.
>3
' *
'
1
'
J
!
1
, l
" '
, :
William S. Cohen
Cer-rge J M i t c h e l l
Ton- Andrewf.
'.'•I ymp i , ,1. Snowe
H
like
children, th4\/
will
all
cry
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
029. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
02/01/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Iiox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm8l4
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of thc PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute [(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�State arm Insurance Company
100 St te Farm Place
Ballst n Spa, NY. 12020-8000
February 1, 1993
RE:
Dear Plan Administrator:
Group t i a l t h Plan
P6/(bj(6)
The anniversary of your Group Health Insurance Plan w i l l be onA i r i l 1. 1993.
W would appreciate your review of the plan's enrollment at this iime to verify
e
that a l l eligible employees who desire coverage are enrolled, Ycjvr most
recent billing statement reflects the current enrollment as showr by our records.
Please refer to the Administration Manual for the normal e l i g i b i ] ty guidelines
and restrictions. W have included an Employer Confidential Infc •mat ion
e
Anniversary Update form to assist you in this review. Please coir>lete the form
and return i t to us.
HOSPITAL/MEDICAL EXPENSE PLAN:
The premium for your Group Hospital/Medical Expense Plan w i l l be id justed as
of your next Plan Anniversary Date. Premium adjustments are necr ssary from
time to time in order that insurance costs may be kept d i s t r i b u t e as f a i r l y
as possible among a l l our planholders. This adjustment applies 1.) a l l
similar plans in your area. Most employees w i l l notice a premiur|i increase,
However, some employee's premium w i l l remain the same and some eihbioyees may
receive a premium decrease.
Following i s a table of the premiums that w i l l be in effect for ^ u r Hospital/Medical
Expense Plan as of April 1, 1993.
ATTAINED AGE
16-29
Male
Female
Child
30-34
74.10
93.90
104.00
77.60
114.00
35-39
40-44
45-49
50-54
86.20 94.90
121.40 126.80
Jt58.30
20
144.90
160.50
55-5 J
202.2
190.4
Under the Guaranteed Increase Option of your Hospital/Medical Ex
increase your Daily Room Benefit from $260 to $280 without evide
As with any increase in coverage this must be done on an anniver
date. Notification to increase the Daily Room Benefit must be r
office in writing, by the anniversary date.
192-54JO
IHOOiii)
60-64
65 +
209.70
198.10
35.80
35.80
ense Plan, you may
ce of insurability,
ary of the plan
ceived in this
�February 1, 1993
P6/(b)(6)
{ I f you choose to exercise this option, your premiums for a Hospital/Medical
Expense Daily Room Benefit of $280 would be as follows:
ATTAINED AGE
16-29
Male
Female
Child
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65 +
76.20
97.20
107.40
80.00
118.20
89.00
126.10
98.20
131.70
33.20
63.70
149.80
166.20
209.00
196.30
16.80
04.60
35.80
35.80
HOSPITAL INCOME PLAN:
Due to the favorable experience on Group Hospital Income plans, rl* rate change is
necessary. Certain individuals may experience an increase or adecrease in their
premium charge i f their attained age as of the anniversary date vould place them in
the next higher five-year rating age classification.
You may also wish to contact your State Farm agent to review your existing coverages
in relation to the prevailing hospital charges in your area. At Jour request,
State Farm w i l l consider changing the flexible benefit provision of your plan,
A requested increase in the plan benefits can be approved only or an anniversary
of the plan date. State Farm reserves the right to underwrite aid approve, amend
or disapprove any requested coverage increase. W appreciate yoi • continued
e
participation in the program.
Sincerely yours.
Health Insurance
CC:
JOHN FORTIER
Enclosure:
132-5520
IH0C2S£I
(J
1002 19
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
030. form
SUBJECT/TITLE
DATE
Personal (Partial) (1 page)
04/01/1987
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
im8l4
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Ercedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
nnancial information 1(a)(4) ofthe PRA|
PS Release would disclose conndential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA]
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(S) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�030
EMPLOYER APPLICATION
PART B
EMPLOYER:
| '••••i6()6
. .••'>R/b()
'
EMPLOYER PLAN NUMBER: |
PLAN DATE:
mm)
APRIL 01. 1987
POLICYHOLDER:
STATE FARM INSURANCE TRUST POLICY NUMBER
INSURANCE AND REAL ESTATE INDUSTRY
6
LIL ^K6)_J FOR THE
COVERAGE SUMMARY
MAXIMUM
COVERAGE INFORMATION
kPRIL -Ol, 1992
$260 PER DAY
36 5 DAYS PER CONFINEMENT
$100 PER CALENDAR YEAR
$260 PER DAY
14 DAYS PER CONFINEMENT
80% OF COVERED EXPENSES
$8000
80% OF COVERED EXPOSES
$500
$130 PER DAY
60 DAYS PER CALENDAR YEAR
$100 PER OCCURRENCi:
40 V I S I T S
$1,000,000 PER PERSbN
$2 500 PER CALENDAR if EAR
$5000 PER CALENDAR PEAR
$4 000 SCHEDULE
GROUP HOSPITAL/MEDICAL EXPENSE PLAN
HOSPITAL DAILY BENEFIT
MAXIMUM BENEFIT PERIOD
DEDUCTIBLE - PER PERSON
INTENSIVE CARE DAILY BENEFIT
MAXIMUM BENEFIT PERIOD
MISCELLANEOUS MEDICAL EXPENSE
MAXIMUM BENEFIT AMOUNT
PHYSICIANS IN-HOSPITAL EXPENSE
MAXIMUM BENEFIT AMOUNT
EXTENDED CARE DAILY BENEFIT
MAXIMUM BENEFIT PERIOD
AMBULANCE BENEFIT
HOME HEALTH CARE
CATASTROPHIC MEDICAL EXPENSE BENEFIT
DEDUCTIBLE - PER PERSON
- PER FAMILY
SURGICAL EXPENSE
99801
99812
99802
99818
EFFECTIVE DATE
ALCOHOL AND DRUG TREATMENT BENEFIT
DEDUCTIBLE RIDER -$250
(SUPERSEDES HOSPITAL DAILY BENEFIT DEDUCTIBLE)
LIBERALIZATION OF COVERAGE RIDER
AMENDMENT RIDER
APRIL 01. 1987
APRIL 01, 1992
APRIL 01, 1987
APRIL 01. 1987
DEPENDENT COVERAGE APPLIES TO THIS PLA1!
SCHEDULE OF MONTHLY PREMIUMS - EFFECTIVE APRIL U l , 1992
ATTAINED AGE
16-29
MALE
FEMALE
CHILDREN
55.80
72.60
99.10
30-34
58.80
89.40
35-39
66.10
95.10
40-44
45-49
50-54
55 59 60-64
73.50 -"57.90 111.10 1 54 10 160.40
99.50 £21.50 123.20 1
144 50 150.90
AGENT JOHN -ORTIER
65 +
35.80
35.80
1002 19
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
031. note
SUB.IEC T/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jni8l4
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of thc FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of thc PRA|
Relating to thc appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN q8/25/93 CD: KS-3
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
0
BRIEF SYNOPSIS OF LETTER
Couple w i t h v e r y small business i s concerned t h a t a l o t o f businesses w i l l go
bankrupt i f they are r e q u i r e d t o o f f e r h e a l t h insurarifce coverage f o r
employees. Couple d i d p r o v i d e coverage f o r employees and i Employer, and a i d
f o r t h e i r dependents. However w i f e has MS , cvould n o t cha: ige insurance and
i t was u n f a i r t o ask employees t o pay h i s premiums.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
OTHER CONTENT
Small business owners concerned about p r o v i d i n g coverage f o r .
employees.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
032. letter
SUBJECT/TITLE
DATE
05/27/1993
Personal (Partial); Address (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm8l4
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) of the PRA|
PJ Release would violate a Federal statute [(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning thc regulation of
financial institutions [(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance w ith 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�.P6/(b)(6)
May
27,
o35
1993
Mrs H i 1 a r y C l i n t o n
The W h i t e House
Washington,
D.C.
D e a r Mrs.
Clinton:
I a p p l a u d y o u e f f o r t s i n g e t t i n g some t y p e o f h e a l t h c a r e f|or a i
O r i g i n a l l y I am f r o m E n g l a n d , so I know how t h e i r N a t i o n a l
w o r k s , t r y i n g t o t h i n k o f a b e t t e r p l a n , my f a m i l y and I c:.
with
the f o l l o w i n g s o l u t i o n .
E v e r y o n e n e e d s t o pay s o m e t h i n g n
matter i f
t h e y a r e u n e m p l o y e d , on s o c i a l s e c u r i t y , w e l f a r e o r a s s i s
nee o f any
k i n d , a c e r t a i n a m o u n t c o u l d be s e t d e p e n d i n g on t h e c i r c un s t a n c e s ,
I t seems m o s t u n f a i r t h a t t h e p e o p l e who do h o l d on t o a jijib h a v e t o
a job ,
pay f o r t h e o n e s who d o n ' t and h a v e any i n t e n t i o n s o f hav
T
h^ y
i f t h e a s s i s t a n c e t h e p e o p l e a r e on i s c u t t o t h e same as
b and g e t
w e r e w o r k i n g maybe t h e i n c e n t i v e w o u l d be t h e r e t o g e t a
o f f t h e u n e m p l o y m e n t and p u b l i c a s s i s t a n c e r o l l s .
I f t h e >|mount was
d e d u c t e d f r o m t h e i r c h e c k s b e f o r e t h e c h e c k was s e n t , t h e y wou1d n t
h a v e an o p t i o n n o t t o pay i t .
My h u s b a n d & I s t a r t e d a ve y s m a l l
<
b u s i n e s s 15 y e a r s a g o , we pay a l l o u r t a x e s e t c . , due t o c j i e n t s
p a y i n g l a t e o r s o m e t i m e s n o t p a y i n g a t a l l , we a r e s o m e t i m s i a t e b u t
we do pay them and any i n t e r e s t and p e n a l t i e s , i f b u s i n e s s h a v e t o
c o v e r t h e i r e m p l o y e e s w i t h h e a l t h c o v e r a g e an a w f u l l o t o f bus i n e s s '
w i l l b e - b a n k r u p t b e f o r e - t o o l o n g , we d i d o f f e r c o v e r a g e fo|t t h e
e m p l o y e e s , ' t h e y p a i d t h e i r d e p e n d a n t c o v e r a g e b u t due t o m
having
MS
I c o u l d n ' t c h a n g e i n s u r a n c e c o m p a n i e s i t was u n f a i r t o ask o t h e r
p e o p l e t o pay h i g h p r e m i u m s when 1 knew t h e y c o u l d g e t c h e a p e r
lyse 1 f &
i n s u r a n c e j u s t as g o o d e l s e w h e r e , we now h a v e my h u s b a n d
month
for
one o t h e r guy w i t h t h e same c o v e r a g e , we pay $ 5 0 . 0 0 p e r
e m p l o y e e s c o v e r a g e , t h e o t h e r e m p l o y e e s a r e c o v e r e d w i t h ttfie i r
spouse's p o 1 i c y .
T h a n k y o u f o r y o u r t i m e , I w i s h y o u much l u c k i n t h e f u t u r (!
1
Si ncere1y,
" . .JA'JV
.
.4 >
.; ,
•P6/(b)(6) :
.
-vv-.. • T . .
.V.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
033. note
SUB.IEC"171 ITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
im814
RESTRICTION CODES
Prcsidenlial Records Act - |44 U.S.C. 22()4(a)l
Freedom of Information Act - |S U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOI A]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA|
National Security Classified Information 1(a)(1) of thc PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
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financial information 1(a)(4) ofthe PRAj
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
Pfi Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�C0NSE1 T GIVEN 08/25/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
P6/(b)(8)v.: i.--;;^"-
110 33."
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 12 year o l d son i s p h y s i c a l l y d i s a b l e d , uses a wheelchair and a
" L i b e r a t o r " communication device, w i f e i s a d e n t i s t , hust ind was t h e v i c e
p r e s i d e n t o f a small company w i t h a g r e a t h e a l t h p l a n , then i i s company moved
t o F l o r i d a , f a m i l y stayed i n L i n c o l n because o f son, f ath< r now owns small
business, l o s t i n s . when he l e f t t h e company, cannot g t t new coverage,
b e l i e v e t h a t t h e i r o n l y choices are t o q u i t work and sperjji down and go on
w e l f a r e o r g i v e up custody o f son t o become ward o f s t a t e
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
SPENDING D W POOR
ON
LOST COVERAGE/GAINFUL EMPLOYED
�CONSENT GIVEN 08/25/93 CD: NJ 10 & 11
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Rodolfo S t r a u s s
President
S t r a u s s P l a s t i c Co, I n c .
P.O. Box 5218
111 G o t t h a r t S t r e e t
Newark, NJ 07105
TEL: 201-589-1876
BRIEF SYNOPSIS OF LETTER
w r i t e r i s p r e s i d e n t o f s m a l l business, concerned about h i g h i n c r e a s e s i n
h e a l t h premiums f o r h i s f i r m o f 8-9 employees, c o s t o f i n s . has gone up
approx. 83% s i n c e 1990, w o r r i e d about l o s i n g c o m p e t i t i o n w i t h f o r e i g n
companies t h a t do n o t p r o v i d e h e a l t h i n s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�QjtKlUM •
PLASTIC CO., INC.
P. 0. BOX
5218
111 GOTTHART STREET, NEWARK, N.J. 07105 (201)589-1876
March 29,
1993
The Honorable H i l l a r y Rodham C l i n t o n
Care o f f N a t i o n a l H e a l t h Reform
1600 Pennsylvania Avenue
Washington, DC
20500
Dear Mrs. C l i n t o n :
Since you have undertaken the v e r y d i f f i c u l t t a s k of searching
f o r s o l u t i o n s t o the h e a l t h care problems c u r r e n t l y a f f e c t i n g
our g r e a t c o u n t r y , I am w r i t i n g you w i t h an example of what has
been happening w i t h t h e c o s t of h e a l t h insurance i n the small
Company which I operate.
I n March of 1990 we p a i d $3,265.12 on a monthly b a s i s t o i n s u r e
9 employees and 1 minor. The average cost per employee was
$362.79, not t a k i n g t h e minor i n t o c o n s i d e r a t i o n . Our c u r r e n t
monthly premium i s $5,333.74 f o r 8 employees, an average of $666.71
per employee. This r e p r e s e n t s an increase of 63% i n t o t a l monthly
premiums, 83% i f you c o n s i d e r c o s t on a per employee b a s i s .
The
percentage i n c r e a s e would have been h i g h e r but f o r the f a c t t h a t
we chose an i n f e r i o r p l a n t o reduce c o s t s . I am e n c l o s i n g documentation t o s u b s t a n t i a t e these f i g u r e s . Those who f e e l t h a t t h i s
i s a c c e p t a b l e should c o n s i d e r t h a t small manufactures l i k e o u r s e l v e s
are competing i n a g l o b a l economy a g a i n s t places l i k e China and
Mexico which do not p r o v i d e these types of b e n e f i t s t o t h e i r employees,
I n c r e a s i n g premiums are r a p i d l y r e d u c i n g our a b i l i t y t o compete and
i f they remain unchecked, I f e a r f o r our f u t u r e and t h a t of o t h e r
small e n t e r p r i s e s .
I s t r o n g l y r e c o g n i z e t h e need f o r change and applaud your c o n t i n u i n g
e f f o r t s t o b r i n g i t about.
You have my support and my wishes f o r
success.
Very t
Rodolfo Strauss
President
RS/sp
QUALITY INJECTION CUSTOM MOLDERS AND MOLD DESIGN AND REPAIR
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
034. statement
SUBJECITTHLE
DATE
re: Insurance bill (5 pages)
03/01/1990
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of thc FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of thc PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
035. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm814
RESTRICTION CODES
Presidential Reeords Aet - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of thc PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
nnancial information 1(a)(4) of the PRA]
P5 Release would disclose conndential advice between Ihe President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion nf
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or conndential or Financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning the regulation of
nnancial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�CONSENT GIVEN 08 26/93 CD: CA-27
PERSONAL STORIES DATABASE
IDEHTIFICATjQlH Qf WRITER
"•
1
t
i,; "A'
, L
/• , . • • -':'] •
-
BRIEF gYNQPSIg QF LETTER
Self-employed paralegal and a r t i s t . Has been turned down ftpr insurance twice
because of pre-existing condition. Wants catastrophic coverage only i n
National Health Care.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
036. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/19/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jmSH
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Ercedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P.S Release would disclose confidential advice between thc President
and his advisors, or hetween such advisors [a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological nr geophysical information
concerning wells 1(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�P6/(b)(6)
March 19, 1993
The Honorable Hillary Rodham Clinton
White House
1600 Pennsylvania Avenue
Washington, D.C.
Re: Health Care Task Force & Health Care Reform
Dear Ms. Clinton:
I am self employed as a free lance paralegal and artist. I believt it is
important to consider the situation ofthe self-employed or sole proprj tor when you
make your recommendations regarding health care reform.
I have been trying to write this letter for almost 2 months. I fe:l overwhelmed
every time 1 start to write because this is such an important issue in i y own and
all
other people's lives. It is hard to stress the major points without pullL 11 of the
meat of the bone of the story. Also, each time I write I am overwheln^ ;d by feelings
of anger, powerlessness, and frustration.
I used to work part time for a large corporation in California, ank of
America, and had health care under a group program through Blue S ield of
California. I also worked part time as a freelance paralegal. The Blue Shield
insurance was affordable.
I had surgery in 1978. After the surgery, the hospital bill was s :nt to me
inadvertently. I was billed by Cedars Sinai Hospital for items I never Received. I
highlighted all of these items and sent Blue Shield the bill, and asked them not to
pay for these items. In my own way I tried to keep health care costs ( awn.
When I stopped working for Bank of America in 1985 and star id working
solely as a paralegal, I was offered an individual plan through Blue S lield. After a
few quarters, I could not afford it and let it lapse. From 1985 until 1 )1 I had no
<
health care insurance. I spent between $700 to $1500 a year on total ealth care
costs, (including psychotherapy, eyeglasses, etc.)
In 1991, the Paralegal Association to which I belonged annountbd that
members could obtain "group" health insurance through the associatio; I applied. To
my surprise, I was turned down because of having received psychothej ipy. having had
surgery, and having had two benign breast tumors. The agent told me that I would
never be able to receive health insurance from a California company Mess I worked
for a large corporation.
Then I applied for health insurance with a $5,000 to 10,000 de uctible with the
1
i i u ' " ' . . ' . .g.i
�«
v.
Honorable Piillary Rodham Clinton
Page Two
March 19, 1993
National Association for Self Employed. I told the agent that I had been turned
down for insurance and gave him the rejection letter from Blue Shield. When he
prepared the application he checked the box stating I had not been turned down. He
would not allow me to complete the application or to review what he had done,
which concerned me at the time. The company accepted me. When I received a copy
of the policy, I showed it to one of the attorneys with whom I work and he advised
me to write the insurer and explain I had been rejected. He said not to say that the
agent had lied on the application. They cancelled the policy because of pre-existing
conditions: benign fiber adenomas (breast tumors); migraine headaches, and back
muscle spasms, even if I excluded these from any medical insurance.
I then re-applied with Blue Shield of California for an individual policy with
the highest deductible available ($2500 I believe) and was turned down. A friend told
me about a new program with the State of California, the Major Risk Medical
Insurance Program. I applied and was accepted. This special program was created to
cover 10,000 people in California who could not otherwise obtain insurance. My
understanding was that the plan created a pool of high risk people and Blue Cross,
Blue Shield, and Pacific Mutual would share this "high risk" group. Further, the plan
was supposed to be subsidized by Proposition 65 taxes so that the cost would be
affordable and relatively comparable to group plans.
The insurers presented the above plans as being "group rates" when in fact
they were individual rates. Should you design a health care plan, do not chose a
phoney "group" rate plan. Make allowances for people like me who want only
catastrophic coverage with a high deductible. Omit red lining. I think the "Rochester,
New York" type plan where the entire city pays real group rates is a good plan. It
spreads the risk into a large group and the cost for each participant is affordable.
I have been covered under the California Major Risk Medical Insurance
Program since its inception in 1991. When 1 initially enrolled, my monthly premium
was $223.00 per month. In March, 1992, when I turned 40, the premium increased to
$312.50 per month. On January 26, 1993, I received a bill which shows a monthly rate
of $373.00. In 12 months, the premiums have risen from $225.00 to $373.00 per
month, an increase of 40%. Last year my adjusted gross income was about $22,000.
This year, due to the recession in California, my income has dropped. At present,
one-quarter of my gross income goes to health insurance, not health expenses.
This new rate is approximately $5,000.00 per year for insurance alone, which exceeds
my medical costs.
If I drop the insurance and require medical treatment, hospitals will refuse to
treat me, even if I can afford to pay for my medical care.
Most people I know pay far less than I do for comparable medical insurance
coverage, even after serious illness, and on individual plans. Most people are able to
�*
Honorable Hillary Rodham Clinton
Page Three
March 19, 1993
choose a higher deductible to reduce their premiums. The Major Risk Medical Plan
does not allow participants to choose high deductibles. The deductible is set by the
plan.
I do not believe that these rates are "affordable". I do not believe that the
Major Risk Medical Insurance Program created a "highrisk"pool to be apportioned
through the major health insurance providers so that the risk would be apportioned
evenly and costs lowered and managed.
I believe that the insurance companies have not adhered to their contract with
the State of California in the Major Risk Medical Insurance Program. They have
used this program to create a high risk pool and then charge "red-lined" rates. I
believe that the insurance companies proposed selling my group the most expensive
kind of insurance (low e time total [$250,000] and low deductible [$250-$500]) to
take advantage of those of who could not otherwise obtain insurance, make money
off us and the State of California. I do not believe that the insurance companies are
acting in good faith and that their actions of the are unconscionable.
lif
I would like to know the following:
1. Why a group of 3,00tto 10,000 people (the "plan participants") has higher
premiums than those charged smaller groups;
2. What is the national average insurance premium for those in groups and
for individuals;
3. What the average group and individual rates are in California;
4. What are the average rates for my group?
5. How much higher are the rates my "group" is charged?
6. What is the average claims rate and how much higher the claims rate is for
this "highrisk"group of 10,000 than for other groups of a similar size;
7. What are the average rate increases for regular insureds?
8. Is "red-lining" in medical insurance lawful?
9. Would RICO charges be sustained against some of the insurance
companies?
Another aspect you may wish to consider in developing health care options is
to create affordable catastrophic insurance. I was denied coverage by several
insurance companies, even with a $2,000 - $10,000 annual deductible. I desired to
�Honorable Hillary Rodham Clinton
Page Four
March 19, 1993
have only catastrophic medical coverage, for a broken leg, heart attaflc, or other
major medical problem.
us who are
The premise of the Major Risk pool was to spread out those
basically healthy and able to work but high risk, and to create a large "group" to
make insurance affordable. If this group of 10,000 people came from la major
employer, like Bonk of America, Kodak, or American Airlines, our premiums would
be significantly lower.
For thefirstyear and one half, when the insurance premiums fere $225.00 per
month, I did not file many claims. I believed that this would keep m rates down and
;
help the program. After thefirstrate increase, I did begin to filecliims because I
could not afford to do otherwise (pay the premiums and pay for all i:y health care
costs).
This, of course, causes the insurance companies to raise their ijates again,
claiming they cannot afford to provide insurance because of the numerous claims. It
is a Catch 22. I do recall the automobile insurers making the same claims prior to
California's Proposition 103, yet these same insurance companies stil found $35
million to advertise against the proposition.
I am writing everyone who is in a position to help although I im not very
optimistic. The insurance commissioner of this State, seems to be more concerned
with his political future than with making any real changes.
I implore you to do something. I think that you are intelligent so that you will
not set up a plan that sounds great to those of us who are hard to iriSure but turns
out to be the major expense of our lives for crummy coverage. I used to be able to
save money for emergencies but can no longer afford to do so. I sho Id save money
for retirement but I cannot afford to do so. I am not alone. It seems that the
Rochester plan is the best, but it may not help people in rural areas You have my
best thoughts and prayers as you try to reach a reasonable resolution for this national
disaster.
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
037. note
SUBJECT/TITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRIC TION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/l3ox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
20()6-0885-F
jm814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(h)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of thc PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/2:1/93 CD: TX 1 6 4
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
'•
' P6/(b)(6)
BRIEF SYNOPSIS OF LETTER
Husband l e f t l a r g e employer t o s t a r t own f i r m , so they W l i t l t on COBRA w i t h
Aetna. Then 4 year o l d son developed C y s t i c F i b r o s i s , and now no i n s u r e r
w i l l cover him. They are f i n a n c i a l l y w e l l o f f b u t betwee h i s medications
which c o s t $18,000/year and t h e p o s s i b i l i t y o f premiums a t $12,000/year,
equals t o a t o t a l o f $30,000/year, they can n o t a f f o r d t h i l i amount.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
SPECIFIC DISEASES
LIMITED BENEFITS
HIGH CO-PAYMENTS
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
COBRA' S
COVERAGE TOO SHORT
�March 15, 1993
Hillary Rodham Clinton
Chairperson
Task Force on National Health Care Reforin
The White House
Washington, DC 20510
Dear Mrs. Clinton,
I am the parent of a*four year old son who was diagnosed just
last year with Cystic Fibrosis. My family i s currently paying
premiums into a COBRA Health Care plan with my husbands previous
employer. This decision to use a COBRA plan was made before my son
was diagnosed with CF. We had no idea that something l i k e this
i l l n e s s would ever affect our l i v e s . Our COBRA policy w i l l end i n
July of this year and we are looking at some pretty grim options.
As you know, Aetna (our current insurance c a r r i e r under COBRA)
could very well deny my son coverage saying that this was a preexisting i l l n e s s . Or another p o s s i b i l i t y i s that they could raise
our premiums so high ($1,000 per month), for example that we could
not afford them. Hot only that, they could very well attach
waivers to the policy that w i l l not cover any medications that
might be related to the disease. The reason I am t e l l i n g you this
i s because I have called every insurance company i n the country,
only to be slapped in the face with the same story. Until their i s
a cure for CF, we w i l l not cover your c h i l d .
I t i s devastating
enough to learn that your child has a chronic i l l n e s s and then to
have to deal with the nightmare of insurance.
My husband has always worked for large corporations until last
year when he was given the opportunity to be part owner i n a small
business. Unfortunately a l l of these decisions were made before
our son was diagnosed.
We are very hard working americans and have prided ourselves
to be able to l i v e the american dream. We have never had financial
problems and so being faced with this situation i s a b i t alarming.
We have no interest to ask the government for help or be covered on
a medicaid program. We are very financially well off but s t i l l
could not afford an excessive premium or tne high cost of the
medication. For instance my son's medication cost $3,000 every 2
months.
I plead with you to keep these important issues i n mind while
putting together our health care package. We want assurance that
l e g i s l a t i o n w i l l be passed to ensure that private insurance
companies cannot deny coverage to individuals with a chronic
i l l n e s s or pre-existing i l l n e s s .
We wish you gods love and guidence as you make these very
important decisions that w i l l affect so many of our l i v e s .
�CONSENT GIVEN 08/26/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Nancy T h u r s t o n
R a n d a l l H, Hazner & Company, I n c .
1321 C o n n e c t i c u t Avenue, N,W.
Washington, DC
20036
(202) 857-4300
BRIEF SYNOPSIS OF LETTER
Small D.C. r e a l e s t a t e f i r m has 20 f u l l t i m e employees t h e y have always
i n s u r e d . From '86 t o '89, premium went from $112 t o $505/mo. f o r i n d i v i d u a l s .
W i t h a new c a r r i e r t h e y went from $176 i n '90 t o $257 i n '92, and w i l l be
renewed ( i f renewed) a t 75-100% i n c r e a s e . COBRA c o s t s and major i l l n e s s i n
one o r two have had a b i g impact.
She i s hard pressed t o f i n d a f f o r t a b l e
coverage f o r t h e , e s p e c i a l l y s i n c e one employee has been diagnosed w i t h
cancer.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS-Firm cannot a f f o r d i t .
OTHER-Had t o f i n d c a r r i e r t h e y can a f f o r d .
OTHER CONTENT
Need h e l p f a s t .
�PA-1 '
H.
HAOIVER &
COMPANY
INCORPORATED
J ^ S
(
/Jf / €o7vneoticu/ S&>*nue, jV.W.
H/aJu^yn, &
February 2,
20036
1993
Mrs. H i l l a r y Rodham Clinton
Task Force on National Care Reform
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C.
Dear Mrs. Clinton:
As Director of Administration for a small Washington r e a l
estate firm that has been i n business for 89 years, I continually
am faced with the d i f f i c u l t i e s of obtaining reasonably priced
medical insurance for some AO f u l l time employees. Details of
our medical benefits history include the following:
A. From 1986-1989, Hagner was insured with a major national
c a r r i e r . During that period our employee premiums increased 350%
or from $112 a month to $504 a month per employee (for individual
coverage) as the r e s u l t of having to carry a COBRA participant
and upon h i s death, h i s widow under the COBRA plan. Both i n d i v i duals required major medical expenditures which dramatically
affected our insurance premiums.
B. I n 1990 we moved our coverage to another major national
c a r r i e r and have remained with them. We began with a healthy
pool of insureds u n t i l an employee experienced a premature b i r t h
which forced her to leave her position to devote f u l l time monitoring and attending to her baby. Under COBRA regulations, we
have continued coverage for her baby, and medical expenditures
to date have exceeded $500,000. Our employee monthly premiums,
(for individual coverage) which were $176 i n 1990, escalated 46%
to $257 i n 1992, and we have been advised that i f we are renewed
on our anniversary date t h i s May, we can expect an increase of
75-100%. Unfortunately, a d i v i s i o n head was diagnosed with bone
cancer i n December which further compounds our renewal problem.
My concern i s that I may not be able to secure affordable
medical insurance. We have always provided coverage for our
employees regardless of cost. However, due to the economic times
which have d r a s t i c a l l y affected our business of r e a l estate, and
then the almost impossible pricing imposed by the insurance
c a r r i e r s , I do not know what to do. I might add that the issue
of family coverage has not been mentioned. Our employees who
require such coverage must bear the f u l l r e s p o n s i b i l i t y of the
�R A N D A L L H.
I I A O X K K &
C O M P A N Y
Mrs. H i l l a r y Rodham Clinton
February 2, 1993
Page Two
monthly premium which currently stands at $504 a month.
Under
our previous plan family coverage increased 364% over a 4-year
period. Our current plan has increased 49%. I t should also be
noted that our current plan i s considered to be basic and does
not provide for pharmacy discount cards, dental or eye care
programs. Further, i n an effort to control costs the employee
has the option of co-insurance or "Preferred Provider".
The fact that you have taken on t h i s problem of health care
gives me great hope. You have asked for suggestions - I would
recommend the formation of a "catastrophic pool" which would be
funded i n part by employers and insurance companies with federal
assistance to allow coverage continuation for employees with
major health problems. The "pool" would automatically take the
employee requiring such attention out of the company's benefit
program thereby eliminating the substantial increase i n premiums
which r e s u l t with major medical claims. I am not suggesting that
a company's major medical coverage not be applied to claims which
a r i s e in the normal course of events, but rather to those which
may be categorized as catastrophic requiring long-term care.
I f t h i s area of health care reform i s not addressed, more
and more small companies may be forced to eliminate medical
benefits which can only r e s u l t i n increased burdens on l o c a l ,
state and federal programs.
I urge you and the members of your task force to act s w i f t l y
and with consideration for employers who do feel a moral obligation to provide major health care benefits for t h e i r employees
without being penalized for catastrophic i l l n e s s e s .
Thank you for your time and attention.
Sincerely,
Nancy F. Thurston
Director of Administration
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C. Closed in accordance with restrictions contained in donor's deed
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�CONSEHT GIVEN 08/27/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
BC/BS has pulled employers and employees with no health prot .ems out of pool,
leaving only those with catastrophic health problems i n pool, therefore
exorbitant r a t e s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUM
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COLLECTION:
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Health Care Task Force
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�Pe/(b)(6)
1 r
1
••
' '!
'
...
y •. •• ••:
Heaitn Lare Task Force
U.S. C a p i t o l
Washington D.C. 20515
Re:
Health Insurance Cost
Dear Ms. C l i n t o n :
company t h a t manufacturer's
;tems f o r commercial b u i l d i n g s .
formed, --.I.
Since my company
ranee on my employe4(s and t h e i r
:ost of t h e insurance on t h e
insurance f o r h i sdependents.
i Blue Cross and Blu€: S h i e l d , we
nto an extremely l a :-ge p o o l of
Lt of being i n t h i s .arge p o o l ,
erious h e a l t h p r o b l ^ h i t would
our insurance. Nottihing could
My w i f e and I are owners of a
Computerized Temperature C o n t r o l S^
I employ approximately 20 people,
have maintained h e a l t h and l i f e i n s
dependents.
I pay 100 6 of the
employee and the employee pays the
When we purchased our insurance f r
were t o l d t h a t we would be placed
employers and employees. As a r e s i
should one of our employees have a i
not d r a s t i c a l l y a f f e c t the cost of
have been f u r t h e r from the t r u t h .
developed cancer, He has had
n therapy and i s p r e s e n t l y
f h i s i l l n e s s , we atfk unable t o
surance o r g a n i z a t i o
Over t h e
Blue S h i e l d has e f f e c t i v e l y
nipt t o c o n t r o l rate]:; when our
= h e a l t h insurance btemiums, we
e coverage and iitlcrease t h e
i l d . Effectively,-oi|i|r employees
nsurance coverage.
Five years ago one of our employee
surgery once, undergone
radiati
undergoing chemotherapy. Because c
o b t a i n bids from any other h e a l t h i :
past t h r e e years, Blue Cross ani
t r i p l e d our r a t e s .
Now i n an a t t f
company and employees can a f f o r d th
have had t o reduce the e f f e c t !
d e d u c t i b l e s and co-insurance four f
now only have c a t a s t r o p h i c h e a l t h
Blue S h i e l d systema : i c a l l y has
nave not experience^ any h e a l t h
l e f t us i n a pool f employers
jerienced catastrop l i e
health
of t h e p o o l t o t h e s o i n t where
rdable by t h e compank and by t h e
The reason i s t h a t Blue Cross and
p u l l e d employers and employees who
problems out of our p o o l . This ha;
and employees who have a l l ex
problems. This has r a i s e d the cosi
h e a l t h insurance i s almost not a f f c
employees f o r t h e i r dependents.
Shield has p u l l e d the employers
:ed medical problems out of t h e
The reason why Blue Cross and Blue
and employees who have not experier
:
�pool and placed them i n other pools i s so t h a t they can be more
c o m p e t i t i v e w i t h other h e a l t h insurance companies i s ^ l i n g newer
p o l i c i e s . Although t h i s keeps Blue Cross and Blue Shie d h e a l t h y ,
i t places a tremendous burden on any employer or group o employees
who have a s i n g l e employee w i t h a h e a l t h problem.
s
C o n t r i b u t i n g t o t h i s problem i s the greed of the hos 3 i t a l ! and
p h y s i c i a n s who t r e a t c a t a s t r o p h i c i l l n e s s e s .
I t is d f f i c u l t to
b e l i e v e the charges f o r the i n d i v i d u a l s e r v i c e s and t h ^ amount of
of these
the i n d i v i d u a l s e r v i c e s rendered t o t h i s man.
Man
s e r v i c e s are not only d u p l i c a t e d , but are admitted unnfcjce ssary by
have the
both the p h y s i c i a n and the t r e a t e d i n d i v i d u a l .
Bot
a t t i t u d e t h a t the person who i s s i c k has already passefl the l i m i t
on h i s d e d u c t i b l e and co-insurance, t h e r e f o r e the a d d i t i o n a l
t r e a t m e n t s , t e s t s and the cost of these are not a bur ien t o the
employee.
The problem w i t h the greed c f the h e a l t l insurance
companies, physicians and h o s p i t a l s , and i n many cases the
i n d i v i d u a l r e c e i v i n g treatment, can only be solved 3y f e d e r a l
intervention .
My w i f e i s German and we v i s i t Germany q u i t e o f t e n , I have had
numerous discussions w i t h her r e l a t i v e s , who are both i n p r i v a t e
and p u b l i c s e c t o r . Based on the i n f o r m a t i o n t h a t I ha e obtained
about the German h e a l t h care system, i t appears t h a t t h i s i s an
a p p r o p r i a t e system f o r the US to adopt.
I t provides reasonable
I t has
h e a l t h care costs f o r reasonable h e a l t h care treatmerj ;.
checks and balances t h a t c o n t r o l the greed of a l l title p a r t i e s .
infant
Based upon the comparison between Germany's and ttur
m o r t a l i t y r a t e , i n f a n t b i r t h weight, and l i f e expec ;ancy, the
German system i s f a r s u p e r i o r t o the market base system /e now have
i n the United States.
I f something i s not done t o c o n t r o l problems l i k e my conlpany and my
employees have experienced, we w i l l not be able t o proft ide h e a l t h
insurance f o r our employees and our employees w i l l not be able t o
a f f o r d h e a l t h insurance f o r t h e i r dependents. This s i n j i l y adds t o
the l a r g e and growing pool of c i t i z e n s who are witlnlout h e a l t h
insurance.
From a mora], and governmental standpoi t t h i s i s
i n a c c e p t a b i e . The f e d e r a l government muse step i n and t . i ke a c t i o n .
Market based h e a l t h care has f a l l e n apart because of the i n c r e a s i n g
greed of a l l p a r t i e s i n v o l v e d .
Thank you very muc.i f o r your
c o n s i d e r a t i o n and good l u c k i n s o l v i n g t h i s very import i t problem.
P6/(b)'(6)\ "
cc:
A l l employees
File
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�CONSE'T GIVEN 08/26/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
O
BRIEF SYNOPSIS OF LETTER
I n 4.5 years, premiums s i x times t h e o r i g i n a l c o s t i n f i v e iji icreases. Cannot
5e
drop insurance because o f h e a r t c o n d i t i o n . No o t h e r insurar 5e w i l l take him.
Wants premiums f o r self-employed t o be 100% d e d u c t i b l e .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
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�Gillette Wyoming
Febmary 1, 1993
Mrs. Hillary Clinton
The White House
Washington, D. C .
Dear Mrs. Clinton:
I am writing this letter to point out some health care.
which have affected me.
;
I bought a health tt. accident insurance policy from Aetna
i n July, 1988, i t cost $125.20 per month. In two years (July,
premiums had increased to $218.82 per month. At this time, i t
I had blockage in m heart which required by-pass surgery, which Ae
y
for. By September 1991, m premiums had gone up to $381.58 per monl|h
y
In October 1991, Aetna Insurance Co. sold my policy to Mutual bf Omaha
Insurance Co. In March 1992, Mutual of Omaha raised m premiums 25 to
y
$1^76.97 per month. In September 1992, they raised m premiums agai:, to
y
$b91.95 per month. A few days ago, I received notification that on March 1,
1993, m premiums would be $737.93 per month, a $ % increase orer t e prevy
0
ious premium. I believe health care costs have gone up, but not nearly as
fast as premiums
In
years, m premiums are almost 6 times the original cost. In 16
y
months with Mutual of Omaha, m premiums have gone from $301.58 to B737.93
y
per month. Since Mutual of Omaha has had ny policy (for 16 months) to the
present date, premiums have amounted to $7,339.8U and benefits paid by them
are $783.85 for various tests and medication, and this is before th^ir 505t
increase goes into effect. I don't feel this increase i s j u s t i f i e d
Mutual of Omaha is not m choice of companies to be insured witjh because
y
the company I worked for had health & accident insurance with them ack i n the
early 60's. At that time, we had a small group policy with them wh n 2 employees wives got terminal illnesses for which they were f i l i n g claiHs
Iramedlately, Mutual of Omaha started raising premiums drastically (like iine) thus
forcing the company to look elsewhere for insurance. I don't have this option,
because of m heart surgery, no other insurance co. w i l l insure me, thus leavy
ing m at the mercy of the company I am with, or dropping the insurance which
e
I feel is what this company is trying to get m to do.
e
Another thing I would like to point out are som flaws in Interial Revenue
Service Codes. Health insurance premiums paid by corporations for heir employees are totally deductible by the corporation, and does not have to be claimed as income by the employee. I have no quarrel with t h i s , but a pirson who
i s self-employed can only deduct 25$ of his premiums. A person who i s not
self-employed, but is paying his own premiums cannot deduct anythini unless
he has enough to itemize.
I hope consideration can be given problems such as these i n yoj^r health
reform.
. ' ^6/(b)(6) , ,
r
v
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
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Divider Title:
^
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
042. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Rox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jin814
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [S U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforecment
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of thc PRA|
Relating to thc appointment to Federal office [(a)(2) ofthe PRAj
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or hetween such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/26/ J3 CD: MI-11 & 12
PERSONAL STORIES DATABASE
riFICATIQN OF WRITER
oH2
BRIEF SYNOPSIS OF LETTER
Husband owns small c o n s t r u c t i o n company w i t h on f u l l - t i m e i wnployee. Income
i n $20,000 range - f a m i l y o f 6. Had t o take insurance w i t h p2,500 deductible
and 50% co-pay a t $300 per month. Needs laparoscopy b u t can't afford i t
because t h e 45 minute procedure costs $5,000.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
MEDICAL COSTS - EXCESSIVE
DOCTORS FEES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
043. letter
SU BJEC'I'/TITI-E
DATE
01/2/6/1993
Personal (Partial); Address (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [4]
2006-0885-F
jm8l4
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
PJ Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice hetween the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(a)((>) ofthe PRAj
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance w ith restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�3
January 26,1993
Mrs. Hillary Rodham Clinton
Task Force on National Health Care Reform
The White House
Washington, DC 20510
Dear Mrs. Clinton,
While reading my newspaper this morning I was encouraged toreadthat you vere encouraging
Americans to write with their suggestions and concerns regarding health ca' Obviously, the
t.
two major issues you will be addressing are the availability of health care to Americans and
ill
the reduction of health care costs. I hope the following account of my indivi situation will
ual
give you further insight to the problems that need to delt with.
\
^
My husband owns a small construction firm and he employs one full time pe i son. Our income
the past two years has been in the $ 20,000 range. (Due to an ailing Michi; in economy, but
that letter goes to another task force!) In selecting health care for our fa i oily of six and for
his one employee, we did do our homework, and we interviewed companies t liat specialized in
insurance for small businesses. To our dismay, we soon discovered that if) < > want any kind
u
ofc
ofcomprehensive coverage, your premium is going to be in the $700\mo. ra: ge, and even that
5 as so many disclaimers and strings attached you would be amazed. Becaus; $700\mo. is what
we can afford to pay for our house payment, and not health insurance, we o | ted for $300\mo.
premium which includes a $2500 deductible and 50% co-pay on the n<: ct $5000. To us,
$300\mo. is a lot of money, and in this case it is a lot of money for basicalty nothing.
Which takes us to the next problem...
Earlier this month, having some minor health problems, I learned the reali the costs of
es of
our health care system.My doctor hadrecommendeda laprascopy, a relaUvely
simple outpatient procedure, taking approximately forty-five minutes. The costs inv Ived would have
totaled slightly under $5000, with $3800 of that coming from the operating room! lets get
! Now
real and try to figure out just how 45 minutes in that little room cou4 possibly be so
1
expensive.This is something that you need to address. To end my tale of Ifelment,we simply
could not afford to go through with the procedure, and I decided to live wit!) the pain, hoping
that, as promised, the Clinton administration would make affordable, adelfluate health care
available to all Americans.
Sincerely,
P6/(b)(6)'
�Clinton Presidential Records
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This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
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2006-0885-F
Text
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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[Small Business Letters] [binder] [4]
Creator
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-007-008-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/5ad4b1437894585bcd8ea0a94b63300a.pdf
96259eb40276a23431250be22a598af0
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/11) Number:
3679
FolderlD:
Folder Title:
[Small Business Letters] [binder] [3]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
7
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
002. letter
Personal (Partial); Address (Partial) (I page)
04/15/1993
P6/b(6)
003. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
004. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/09/1993
P6/b(6)
005. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
006. letter
Personal (Partial); Address (Partial) (I page)
04/13/1993
P6/b(6)
007. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
008. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
07/04/1993
P6/b(6)
009. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
010. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/28/1993
P6/b(6)
011. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
012. letter
Personal (Partial); Address (Partial) (I page)
05/13/1993
P6/b(6)
013. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
im8l3
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
h(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(f>) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security ClassiFied Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of thc PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJEOTTITI.E
DATE
RESTRICTION
014. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/03/1993
P6/b(6)
015. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
016. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
04/10/1993
P6/b(6)
017. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
018. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/30/1993
P6/b(6)
019. form
Personal (Partial); Address (Partial) (1 page)
04/01/1993
P6/b(6)
020. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
021. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/08/1993
P6/b(6)
022. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
023. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
03/25/1993
P6/b(6)
024. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
08/26/1993
P6/b(6)
025. letter
Personal (Partial); Address (Partial) (I page)
08/26/1993
P6/b(6)
026. letter
Personal (Partial); Address (Partial) (1 page)
08/26/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
im8l3
RESTRICTION CODES
Presidential Rceords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation nf
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information |(a)(l) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
027. letter
Personal (Partial); Address (Partial) (1 page)
08/26/1993
P6/b(6)
028. profile
Personal (Partial) (2 pages)
08/26/1993
P6/b(6)
029. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
030. letter
Personal (Partial); Address (Partial) (1 page)
04/16/1993
P6/b(6)
031. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
032. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
02/26/1993
P6/b(6)
033. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
034. letter
Personal (Partial); Address (Partial) (1 page)
02/03/1993
P6/b(6)
035. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/10/1993
P6/b(6)
036. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
02/10/1993
P6/b(6)
037. note
Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
038. letter
Personal (Partial); Address (Partial) (I page)
03/13/1993
P6/b(6)
039. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
im813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of thc PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) of thc PRA|
P3 Release would violate a Federal statute 1(a)(3) of thc PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) of thc FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
040. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/15/1993
P6/b(6)
041. note
Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
042. letter
Address (Partial) (1 page)
02/15/1993
P6/b(6)
043. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
044. letter
Personal (Partial); Address (Partial) (2 pages)
01/24/1993
P6/b(6)
045. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
046. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (3 pages)
06/01/1993
P6/b(6)
047. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
048. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/18/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
im8l3
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
L
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-()885-F
jm8l3
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. S52(b)l
PI
P2
P3
P4
b(l) National security classified information 1(h)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIA|
b(4) Release would disclose trade secrets or confidential nr financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion nf
personal privacy [(b)(6) of the FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) of thc PRAj
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/4p/93 CD: NY-3 & 5
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
P6/(b)(6) '
BRIEF SYNOPSIS OF LETTER
A Woman and h e r husband own t h e i r own business and a r d f o r c e d t o " s e l f
i n s u r e , take a huge d e d u c t i b l e , and pay f o r monthly medic^p- expenses out o f
pocket."
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBJECT/TITLE
DATE
04/15/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of thc PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the F01A|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe F01A|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�April 15, 1993
Hillary Rodham Clinton
Health Care Reform Task Force
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear First Lady:
We have a small business in which my husband and myself are the only employees.
We also have an eight month old son.
In our experience obtaining health insurance, firms will only underwrite your company if
you have three or more employees. Thus, we are forced to self insure take a huge
deductible, and pay for monthly medical expenses out of pocket.
For example, coverage with a $750 per person deductible went fronr $457 per month
to $775 per month on April 1st. What small family can afford this in Edition to paying
out of pocket for monthly well baby care and vaccinations?
We are certainly willing to pay a fair amount for insurance, but we wero forced to cancel
our premium because we just can't afford up to $950 per month for rr }dical expenses,
Unfortunately, we then become the burden of everyone else should sq(ne major health
My only other option is to seek full time employment with a firm wlji ch offers health
benefits and put my son in day care. With this option, corporate fe becomes my
priority and my son becomes second. So much for "family values'.
Thank you for taking the time to review my concerns.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
im813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - [5 ll.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning thc regulation of
financial institutions [(b)(8) of thc FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 0i;/23/93 CD: MI-12
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
•
. .,P6/(b)(6)
BRIEF SYNOPSIS OF LETTER
husband and w i f e own small p r i n t i n g company w i t h t h r e e employees sent copy o f
l e t t e r t o h e a l t h i n s . co complaining about 24% increase i n premiums
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. letter
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/09/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/l3ox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
,im813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) ofthe PRAj
Relating to thc appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�1
:
,>".k^ -
0^4
March 9,1993
T/ie Chairman of the Board c/o
Central Reserve Life
17800 Royalton Road
Strongsville, Ohio 44136-5197
Reference: Policy #
P6/(b)(6)
Dear Sir:
We have just received your company's letter RA-3A (24%) dated Febiuary 23, 1993.
This letter asks us to absorb a cost increase of 2 % after a previousiiifcrease of 9 last
4
i
%
year.
As a very small business (3 people), we have never heard of such a:' increase m one
year. Nor have any of our suppliers or customers. If any of us did such a thing we
would shortly be out of business.
We cannot believe that anything we did deserved such a rate ncrease. Your
experience with us has been excellent with very few claims.
We believe that this inaease is primarily due to price gouging be^}>re legislation is
enacted to stop just such practices.
We are so upset with this unconscionable increase that we are nov actively seeking
legislative assistance from all who will listen. Note we have Jopied our local
Chamber of Commerce, the State of Michigan Health Insurance agency and The
President of the United States with your notification.
We fully expect to hear from you rednding such an increase to a reisonable level
cc:
Madison Heights, MI Chamber of Commerce
Michigan Health Insurance Agency
The President of the United States of America
�Central Reserve Life
INSURANCE COMPANY
February 23, 1993
Dear CRL Insured Policyholder:
While many insurers pass on huge cost increases indiscriminately to their customers, we constantly
monitor rates, inflationary trends, and medical cost controls to ensure that you consistently receive
the best value for your health insurance premiums.
Current cost evaluation has determined that, in order to maintain the level of protection your plan
provides, with no reduction in benefits, it is necessary for us to increase your monthly premium rate
by 24%, effective April 1, 1993. This new premium will be in effect for the next 12 MONTHS.
If you currently have a full maternity benefit, you can save on your renewal premiums by replacing
your maternity benefit with a graded schedule of maternity benefits. Federal laws and certain state
laws may require an employer to provide the same coverage for pregnancy as is provided for an
illness. If you are uncertain of the requirements, please consult your own legal advisor.
Also, you can change to a higher calendar-year deductible, if available, resulting in a reduction in
your renewal premium.
An authorized written request is necessary to process all policy benefit changes you request to
initiate.
We believe that your group medical plan continues to be an excpllent value, and we pledge our
continued efforts to keep the cost of your plan as low as possible, while maintaining superior benefits
and services.
Should you have any questions regarding this notice or your medical insurance coverage with CRL,
please contact your Home Office Customer Service Representative at 1-800-362-0673 (in Ohio) or 1800-321-3997 (all other states).
Sincerely,
Your Customer Service RepresentativesJoyce, Char, Pam, Terri
RA-3A (24%)
CRLPmZA
• 17800 ROYALTON ROAD • STRONGSVILLE. OHIO 44136-5197 • 2 1 6 - 5 7 2 - 2 4 0 0
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLFXTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Rox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
im8l3
RESTRICTION CODES
Prcsidenlial Records Act - |44 U.S.C. 22U4(a)|
Erecdom of Information Act - [5 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08 26/93 CD: MI-11
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Couple I n 70's - husband f i r e d because o l d e r employees care c o s t s t o o much no pension o r p r i v a t e h e a l t h care - o n l y medicare.
IDENTIFICATION OF PRIMARY LETTER CONTENT
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICARE
OTHER COVERAGE
SOCIAL
SECURITY/DISABILITY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. letter
DATE
SUBJECT/TITLE
04/13/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRAj
P3 Release would violate a Federal statute [(a)(3) of thc PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIAj
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�^ L A ^
jiy/^^-^
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f
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zA^^^A-^A*^-<A/ ^
/<^£A A^ t<+^/7tA^A^Au^ A
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^
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�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
M
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
iiTi8l3
RESTRICTION CODES
Presidential Records Aet -144 U.S.C. 2204(a)
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(K) Release would disclose information concerning the regulation uf
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA)
National Security Classified Information |(a)(l) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/26/^^ CD: CA-2 AND 22
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
.,
. . .
.
• ' P6/(b)(6) . .
00l
1
• " V. \
BRIEF SYNOPSIS OF LETTER
Couple-run Small business has 3 p a r t - t i m e employees who cnoose not t o j o i n
the Mackie's p l a n because o f t h e c o s t . (he i s 62 and d i a b e t i c ') He f e e l s
m o r a l l y o b l i g a t e d t o cover them but cannot: they n e t $20,C )0.00/yr w i t h no
s a l a r i e s f o r themselves. They b e l i e v e some k i n d o f p a y r o l or income t a x i s
the way t o f i n a n c e i t .
He grew up i n England and bel:.eves t h a t e x o t i c
Canadian system " w i t h a l l t h e i r w a r t s " are t h e best c h o i c ^
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY-Employees choose no t o
OTHER-employer unable t o pay f o r employees now (tk ever under what
he b e l i e v e s t o be t h e new p r o p o s a l .
OTHER CONTENT
Support income t a x f i n a n c i n g , and Canadie i / E n g l i s h type
system.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
07/04/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) of thc PRA|
P3 Release would violate a Federal statute 1(a)(3) of thc PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) nf the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�,. v '
.P6/(b)(6) :
:
00
Mrs. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, NW
Washington, D.C. 20500
L $\
0,
M A-l L_
July 4,1993
Dear Mrs. Clinton,
Thank you for your efforts to improve the national health system. I grew up in Engla id, under Mr. Sevan's
health program. This, or the Canadian system (with all their warts), seem the only cofjiiprehensive alternatives.
My wife and I run a mom-and-pop business, employing three part-time employees. Hie highest paid gets $7.50
an hour and the others get $5.00. Their work week varies between 20 and 40 hours ench.
We have a company health insurance program (through a trade group) with only my: (If and my wife enrolled,
Our employees elect not to participate because ofthe cost. We feel a moral obligatioj] to pay the premiums for
our employees. However, our net profit is around $20 thousand a year (we take no sajllaries) and out of that we
have to pay our living expenses. Obviously, there is no room for generosity.
Frankly, we're frightened by the prospect of footing the health insurance bill for our i r nployees under the
program you are considering. If this provision were enacted into law, our labor costs fould increase about 50%
and the consequences would be extreme. People with businesses like ours simply cat lot afford this expense.
We can barely afford our own health premiums. I am a diabetic. Thus, we pay a higtir premium, although (at
62) I'm remarkably healthy and have never spent a day in hospital since I was diagnciied 30 years ago.
"
My wife and I pay $7,680 annually for our medical insurance. This Is more than a toird of our total income.
The question is, /<ovt can you lift the existing burden from our backs? Wc cannot car ' a heavier load.
Whatever direction your deliberations take, we believe it must be paid for by some kiid of payroll or income
tax. At least his would relate to ability to pay. We cannot be counted among the mil Ions with no health
insurance but we suffer almost as much in trying to protect ourselves. Like millions i f other working paupers,
we welcome your effort to find a better solution. We wish you well.
P6/(b)(6)
1
••J v ,;'
••S ";'
'
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DOCUMENT NO.
AND TYPE
009. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/l3o.\ Number:
3679
FOLDER TITLE:
[Small Business Leners] [binder] [3]
2006-0885-F
jm8l3
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of thc FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of thc FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to thc appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PR A]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�PARTIAL CONSENT OBTAINED, DO NOT USE NAME IN CONNECTION WITH FERTILITY
08/19/93 CD: CA 24 & 29
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
*.
.;
P6/(b)(6)
1
V •"'.^ii
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 43 year o l d married woman, self-employed w i t l ^ small business,
premium has gone up from $126/month t o $324/month w h i l e drop >ing p r e s c r i p t i o n
coverage, husband covered s e p a r a t e l y by HMO ( K a i s e r Foundat; on ) t h a t w i l l not
i n c l u d e spouses, having d i f f i c u l t y
g e t t i n g o t h e r Insurance because o f
q u e s t i o n a b l e " p r e - e x i s t i n g " c o n d i t i o n s , she one saw a doc or f o r childhood
a r t h r i t i s , and a s t r a i n e d lower back and she was t r e a t e d f f t r " i n f e r t i l i t y " .
however she i s c u r r e n t l y extremely t r i m and h e a l t h y
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LIMITED BENEFITS
HMO WILL NOT COVER SPOUSES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. letter
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/28/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
20()6-0885-F
,im8l3
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to thc appointment to Federal office [(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information \(a)(4) ofthe PRA|
P.S Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA1
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�X ; ;, •iKp'6/(t))'(6):rv .-f?
v
1
January 28, 1993
Mrs. H i l a r y Rodham C l i n t o n
The White House
1600 Pennsylvania Avenue N.W.
Washington, D.C. 20500
RE:
Health Care Reform
Dear Mrs. Rodham C l i n t o n :
I am a A3 year o l d , married, p r o f e s s i o n a l woman. I am s e l f employed owning a p r o p e r t y
management business. I am a one person business; I have no employse
5S. I w i l l soon be
w i t h o u t h e a l t h insurance because the company I'm w i t h , Consume^ U n i t e d Insurance
Company, i n 2 1/2 years has r a i s e d my monthly premium from $126
$324 and I cannot
a f f o r d $324. And as they've raided-Jdie premiums t h e y "have iieletec bene f t f i s Jtacliadi n g
coverage f o r p r e s c r i p t i o n drugs.
My husband i s covered by an HMO (Kaiser Foundation) which w i l l -icjl: cover spouses. I
have not been able t o f i n d other coverage f o r myself because insurance companies are
not i n t e r e s t e d i n c o v e r i n g a s i n g l e i n d i v i d u a l . And even though Cal i f o r n i a passed a
b i l l , e f f e c t i v e J u l y 1, 1993, r e q u i r i n g insurance companies t o covi!(r employers w i t h as
few as three employees, I w i l l n o t be helped because I am my only employee.
I n a d d i t i o n , I , l i k e many o t h e r s , have what insurance companies ci 11 a "pre e x i s t i n g
c o n d i t i o n " ( I once saw a doctor f o r c h i l d h o o d a r t h r i t i s , a s t r a i n e d lower back and have
been t r e a t e d f o r i n f e r t i l i t y ) and am considered an u n i n s u r a b l e r i s
I should mention
t h a t I am t r i m , h e a l t h y and extremely a c t i v e ; s i x mornings a week I swim w i t h a Masters
( c o m p e t i t i v e ) swim team. I am probably more h e a l t h y and f i t
99% o f the U.S.
p o p u l a t i o n . But a p p a r e n t l y h e a l t h insurance i s intended o n l y f o r :he young and those
who have never v i s i t e d a d o c t o r . Also, few i n s u r e r s cover doctors v i s i t s f o r p r e n a t a l
m a t e r n i t y and d e l i v e r y .
Though I am honest, I ' l l admit I have considered w i t h h o l d i n g my EEdi c a l h i s t o r y when
f i l l i n g out h e a l t h insurance a p p l i c a t i o n s .
Whether I do or doA ' t wouldn't matter
because i n s u r e r s o b t a i n an i n d i v i d u a l ' s medical h i s t o r y from i medical g a t h e r i n g
s e r v i c e t o which i n s u r e r s r e p o r t a l l claims submitted.
I d e s p e r a t e l y need a f f o r d a b l e h e a l t h insurance. I am n o t poor...] can and am w i l l i n g
to pay a reasonable amount f o r i t . But none i s a v a i l a b l e t o me.
Please, when w r i t i n g a h e a l t h care p r o p o s a l , consider me and my nieds.
�Withdrawal/Redaction Marker
Clinton Library
DOCl'MENT NO.
AND TYPE
Oil. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm8l3
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)
Freedom of Information Act -15 ll.S.C. 552(b)|
PI National Sccurily Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA)
P3 Release would violate a Federal statute 1(a)(3) of thc PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information [(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of thc FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 I'.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSMT GIVEN 08/27/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Retiree-guarenteed medical coverage f o r l i f e ,
Compan; now decreasing
b e n e f i t s , took l i f e insurance and d e n t a l care,
Now lave t o pay f o r
medication (co-pay).
IDENTIFICATION OF PRIMARY LETTER CONTENT
OTHER CONTENT
Retirees benefits.
�c^v zw^yy ^jc -c,
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j£^J> sM*^
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^ s4^/3As<J).
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^LlJ'^
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TVPE
012. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
05/13/1993
RESTRIC liON
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRAj
P3 Release would violate a Federal statute [(a)(3) of thc PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
aud his advisors, or between such advisors [a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) nf the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�^^•-c^
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�WOLF-CREEK
COLLIERIES
COMPANY
P. O. B O X 1 7 9
TCLCPHoHc
395-5361
LOVELY,
KENTUCKY
41231
December 30, 1982
Dear Mr. & Mrs.
I want t o t e l l you about a brand new b e n e f i t you have by being a Wolf
Creek C o l l i e r i e s Company employee. The idea behind i t i s t o make sure
you can continue to afford q u a l i t y medical care a f t e r you r e t i r e or
become disabled .
^~ •
=
~
^
=
That's important to a l l of us, because serious medical expenses can get
in the way of having the kind of retirement we want. The new benefit i s
called vour Re t i ree Medical Benefits Plan, and i t goes into effect
January 1, 1983 for qualified employees.
i
|
i
|
Let me take t h i s opportunity to share some of the d e t a i l s of the new
benefit w i t h you. They include:
*
You have a package of up to $100,000 worth of protection
under this plan. After an annual deductible of $600 per
e l i g i b l e family member following your retirement you and
your family are granted 100% medical coverage.
*
These benefits are designed
*
You are covered for most medical expenses, including vision
care.
to pay when medicare does not.
Further information which w i l l explain this new benefit and i t s l i m i t a tions w i l l be available soon. New benefits l i k e this one are one way
the company has to show you how important you are to Wolf Creek
C o l l i e r i e s Company. I know that you and your family j o i n with me i n the
excitement of the announcement of each addition to your excellent
benefit package.
George Oberlick
President
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
013. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
im813
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of thc PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA]
b(l) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe I OIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 0 /25/93 CD: CA-36
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
,
..P6/(b)(6).
BRIEF SYNOPSIS OF LETTER
She
Small b u s i n e r s s s t o r e owner had medical emergency b u t nc insurance.
asked t o go t o t h e county h o s p i t a l , b u t was taken t o p r rate one. B i l l s
t o t a l e d $20,000, which she cannot p o s s i b l y pay. (Hos i t a l s t h a t were
:
a p p l y i n g f o r Medi-Cal, w i t h no b a s i s f o r t h i n k i n g o f he : q u a l i f y i n g f o r
a s s i s t a n c e : she wasn't) Fears c r e d i t o r s w i l l take her busness; bankruptcy
d, n o t valued by
would upset her wholesale r e l a t i o n s h i p s . She f e e l discs
s o c i e t y . She t h e "average c i t i z e n " needs h e l p w i t h these r :.sing h e a l t h care
costs.
IDENTIFICATION OF PRIMARY LETTER CONTENT
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMEN T NO.
AND TYPE
014. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/03/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRAj
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 3,
1993
Ms. H i l a r y C l i n t o n
The White House
Washington, DC 20201
Dear Ms.
Clinton;
I am w r i t i n ? t h i s i n d e s p e r a t i o n as I have never w r i t t e n P u b l i c
O f f i c i a l s b e f o r e , and d o n ' t even know i f my l e t t e r w i l be
acknowledged.
During
I am a s m a l l b u s i n e s s owner i n Manhattan Beach, C a l i f o f t n i a .
the H o l i d a y s I went w i t h my Fiancee t o v i s i t my daught r ,
s o n - i n - l a w and g r a n d c h i l d r e n and spend C h r i s t m a s w i t h tjhem i n
A t a s c a d e r o , Ca.
The day a f t e r C h r i s t m a s I g o t v e r y s i c k and t h e parame ies had t o
be c a l l e d .
I i n f o r m e d them I had no i n s u r a n c e and ask d t o be
t a k e n t o t h e c o u n t y f a c i l i t y i n San L u i s Obispo.
They t o o k me t o
i n t e n s i v e c a r e a t t h e n e a r e s t h o s p i t a l , Twin C i t i e s Ho p i t a l , 5
m i l e s away ( t h e c o u n t y was about 12-13 m i l e s ) .
I spen f o u r days
t h e r e and was t r a n s f e r r e d t o Frenchs H o s p i t a l i n San L i s Obispo
f o r a $5,000.00 t e s t .
A g a i n I k e p t t e l l i n g them, as d i d my
d a u g h t e r and f i a n c e e , t h a t I had no i n s u r a n c e ( F r e n c h s H o s p i t a l i s
o n l y 5 b l o c k s from t h e c o u n t y f a c i l i t y ) .
The p e o p l e i f i n a n c i a l
Little
a i d t o l d my f i a n c e e t h e y p u t me down as "Medi-Cal pend ng".
d i d I know t h a t because I am n o t under 2 1 , o v e r 65, pr ?gnant. have
no dependent c h i l d r e n and am n o t d i s a b l e d , I do n o t qu£ l i f y f o r any
a s s i s t a n c e i n h e l p i n g pay t h e enormous b i l l s i n c u r r e d .
The c h a r g e s were o u t r a g e o u s , t h e " T a x i c a b " r i d e t o t r a n s f e r me t o
Frenchs H o s p i t a l a l o n e was o v e r $600....over $700 t o ta ce me t o
Twin C i t i e s H o s p i t a l i n Templeton, 5 m i l e s f r o m my d a u g h t e r s
house. My q u e s t i o n i s what happens t o us who do n o t
the
q u a l i f i c a t i o n s as s e t down by LA County? We pay o u r t a x e s o n l y t o
h e l p o t h e r s , b u t when we need h e l p t h e r e i s none a v a l Iv.ole ! T h i s
i s so u n f a i r .
I draw a v e r y modest l i v i n g f r o m my s t o r e and w i t h
the economy t h e way i t i s , b e l i e v e me i t i s modest. I v o u l d make
a l o t b e t t e r l i v i n g as a w a i t r e s s , b u t t h i s i s ray c a r e e cho i c e .
Now w i t h o v e r $20,000.00 o f D o c t o r and H o s p i t a l b i l l s t h a t I cannot
p o s s i b l y pay, I am a f r a i d t h e c r e d i t o r s can t h r e a t e n m w i t h t a k i n g
my b u s i n e s s away. I suppose I can f i l e b a n k r u p t c y b u t i t would n o t
set w e l l w i t h my w h o l e s a l e r s i f I d i d t h a t .
Why shoulc I be
burdened w i t h t h e s e o u t r a g e o u s b i l l s j u s t because I am ' i n t h e
m i d d l e " n o t under 2 1 , o v e r 65, p r e g n a n t , w i t h dependent c h i I d r e n
and n o t d i s a b l e d .
T h i s i s n o t an expense I chose, and
am d e e p l y
concerned as t o how I can p o s s i b l y pay t h e s e b i l l s .
I i o n ' t expect
�f o r anyone t o p i c k up a l l t h e b i l l s , j u s t a s s i s t a n c e , :erhaps share
of c o s t i n p a y i n g them. I f e e l so d i s c a r d e d , as i f we who f i t i n
the m i d d l e a r e n o t i m p o r t a n t c i t i z e n s .
I have never a p l i e d f o r
a s s i s t a n c e and have worked a l l my l i f e .
When I c a l l e d t h e Medi-Cal o f f i c e t h e y were so rude anc have o n l y
c a l l e d me on t h e phone t o t e l l me I d o n ' t q u a l i f y even though I
sent i n a completed a p p l i c a t i o n .
I have never r e c e: i v e d a n y t h i n g i n
i
writing.
The h o s p i t a l s have t o l d me t h a t I have a r i g i t t o appeal
Medi-Cal's f i n d i n g , b u t a p p e a l what? A t e l e p h o n e conve s a t i o n ? Why
i s o u r c o u n t y n o t w i l l i n g t o a s s i s t p e o p l e o f my incomt and age?
San L u i s Obispo c o u n t y a t l e a s t has a program c a l l e d CfllSP t h a t
h e l p s p e o p l e w i t h my needs, b u t even though t h i s o c c u r ed i n San
L u i s Obispo c o u n t y , I d o n ' t q u a l i f y because I am a r e s dent o f LA
County.
When can we "The Average C i t i z e n s " e x p e c t some h e l p w i h t h e r i s i n g
h e a l t h care costs.
Can you d i r e c t me? There must be iome h e l p f o r
us who a r e i n t h e m i d d l e . I would c e r t a i n l y a p p r e c i a t e any
a s s i s t a n c e you may be a b l e t o g i v e .
I am so d i s t r a u g h o v e r t h i s ,
the w o r r y a l o n e i s r u i n i n g my h e a l t h .
Hope I hear froifi you .
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DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
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P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
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b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 0 8 / 2 6 / 3 3 CD: PA-14 6 18
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
P6/(b)(6)
OlS
BRIEF SYNOPSIS OF LETTER
Small business owner covers employees b u t s t r e s s e s h i g h cosl^ o f premiums (20%
of owners gross p a y ) . Mentions h i g h cost o f d e d u c t i b l e s f o f f i c e v i s i t s .
Small business owner concerned because has 2 s m a l l c I d r e n and need
a f f o r d a b l e coverage. Cannot see doctor no f o r c h i l d r e n beq use o f h i g h cost
of o f f i c e v i s i t .
Si
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
UNABLE TO PAY
HIGH CO-PAYMENTS
MEDICAL COSTS - EXCESSIVE
DOCTORS FEES
�Withdrawal/Redaction Marker
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DOCUMENT NO.
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016. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
04/10/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
20()6-0885-F
im8l3
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PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
h(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the F01A|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA|
National Security Classified Information |(a)(l) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
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P6 Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�r
'
- "-',v
P6/(b)(6)
'
.
'
,
Oi(o
April 10, 1993
Mrs. H i l l a r y Rodham Clinton
Commission on Health Care Reforin
Tlie White House
Pennsylvania Avenue
Washington, D
C
Dear Mrs. Clinton,
First l e t me offer m condolences on the death of your father,
y
am a direct result of the love and nurturing of my parents and
was seriously i l l last year, I was deeply pained. I can only
d i f f i c u l t time t h i s i s for you, but know that your father must
proud of what his love and nurturing put f o r t h in you, a kind,
woman who is facing head on a problem that i s plaguing t h i s na
health care monopoly.
I feel that I
when m mother
y
magine what a
have been very
intelligent
ion - the
T feel m family i s representative of the average middle class American family
\
P6/(b)(6)
—
-
pre-school age children of whom I take care of ftTlT t~ime. Tli¥ costroT—fieartTli
care benefits at m husband's company are now shared by the eiployees because
y
the cost was raised so high. The employees wanted an H O plat] so as to keep
M
the expenses down and m husband agreed. At that point we on / had two
y
children and f e l t that we needed more extensive coverage whicl would allow us
to select, our own physicians especially in the event that any j f the children
showed a l i f e threatening disease. As you know, when your ch Idren are so
young, you don't know what to expect and you certainly don't i k n t to face the
unknown with an unknown doctor or doctor l i m i t a t i o n s as well, So, we opted
for self-pay Pennsylvania Blue Cross & Blue Shield (non group coverage) f o r
which we pay $7,704 a year or $642 a month and the price has sen r i s i n g at a
rate of about 25% a year. Hard to_belieye_i.5ii. _t--itr?—&w~±l-^— i-w^nt rmo f i f > h
of - P6/(b)(6) gross. For that amount you would think we'd have hospital wing
named afTer us but guess again. Our d e d u c t i b l e _ . f o r _ o f f i
i i t s i s $500 a
person (not per family) and after that," BCBS only reimburses $>%. I was i n
the hospital for 5 weeks last year f o r placenta previa, a l a t pregnancy
comjilication. With a l l m coverage I s t i l l had to pay $50 a tilay times the
y
f i r s t 6 days or $300. And t r y i n g to reach BCBS f o r forms or o discuss
anything proves less possible than the likelihood of reaching you by phone,
Most of the time you have to leave your name and number and t ey w i l l c a l l you
back. Don't count on i t .
,
-
CG
v
The real reason that I a w r i t i n g you i s t h i s . Here I am, ani n t e l l i g e n t
m
educated woman, who has found myself putting o f f taking my chlJld ren to the
doctor when they are i l l because I know that the o f f i c e v i s i t is going to cost
m a minimum of $35,00 whether they are r e a l l y sick or not. Ithe throat
e
culture w i l l be $10.00. The urinalysis w i l l be $15.00. And qhe a n t i b i o t i c
may be up to $40.00 or more. Even i n the group plan that we re t r y i n g to get
into through the Pittsburgh Builders Exchange a child's anti b: ot ic i s not one
of the "covered" prescriptions. Well, what could be more impt rtant to cover?
�I've never written l i k e t h i s to anyone before, I guess I am )w because I am
a registered Democrat and t r u l y believe that you want to do s( nething about
t h i s . Do I have to give up my own doctors of which 1 have be i with f o r years
to have "some" of these things covered? Last week my Obstetr nan recommended
that I see a neurologist for back pain. The o f f i c e v i s i t was 5140 (not
covered). Some people i n the waiting room were covered. I
to wait three
months to save up for t h i s . And I'm paying $7704 a year. Foi' what??? Today,
to avoid an ophthalmologist's b i l l on my daughter f o r a probaMe eye
infection, my pediatrician prescribed a simple a n t i b i o t i c oin'.nent over the
phone to a local competitive pharmacy. My husband j u s t got br :k from the
store with a 1 1/2 inch by 1/3 inch tube of Neosporin Ophthali ic Ointment of
which I am enclosing the receipt. I am a c e r t i f i e d ophthalmic technician and
we used to give the same size tube away i n the o f f i c e as a samle size. This
sample size tube cost $22.19!!! This simple, common ointment f h i c h a p p l i e d
lliree times a day for my daughter's simple eye infection may i s t me only a
few days. How can they charge that much in an economy where i r husband i s
being priced out of his business every day by larger companies who pay workers
Can t h i s be
less and use i n f e r i o r building products to turn a better prof
f a i r ? Where's the price war i n the prescription business?
I guess we are hoping that the middle class isn't forgotten i i
and well anticipated health care reform. I hate to be cynica
profession is in a l l i e d health, but when i t comes to discussii
my husband and I have only one word to describe a l l participai
Please don't forget us, the middle class, Ms. Rodham Clinton,
on you as our only hope. And we're behind you and want to do
there anything we can do to help?
the upcoming
when my own
5 h e a l t h care,
:s: t h i e v e s .
We're counting
)ur p a r t .
Is
Sincerely,
THF I F T
DF JG
Oi/10/73
7009 0+6
TOTAL Dtit
CASH
rrr.*:
1
21. V
CHANGE
THANK
YOU
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
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�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Carolyn Melnhardt
President
Wordware, I n c .
26616 CSA Highway 24
Dassel, MN 55325
TEL: 612-275-2621
BRIEF SYNOPSIS OF LETTER
W r i t e r owns s m a l l business w i t h 4 employees l o c a t e d 75 m i l e s o u t s i d e o f
M i n n e a p o l i s , a l l o f her employees a r e covered by t h e i r spouse's p l a n s , one o f
her employees i s l i m i t e d by h e r husband's p l a n t o d o c t o r s based i n
M i n n e a p o l i s , employee l o s e s a day o f work whenever she v i s i t s t h e d r .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
OTHER
SUBURBAN RESIDENTS FORCED TO USE DRS I N CENTRAL CITY UNDER HEALTH
PLANS USED BY DOWNTOWN BUSINESSES
�. INC.
26616 CSA HIGHWAY 24
•
DASSEL, MINNESOTA 55325
•
CAROLYN MEINHARDT
(612)275-2621
PRESIDENT
March 4, 1993
Mrs. Hiliary Clinton
White House
Pennsylvania Ave
Washington, DC 20500
Dear Mrs. Clinion;
Thank-you for your efforts in putting together a comprehensive health care system for
our nation. I have a problem that I would like you to include in your considerations.
1 am the owner of a very small business (4 employees) located 75 miles from downtown Minneapolis. All of the employees of my company receive health insurance
coverage from their spouse's work plans. One of my primary staff people is a woman
with three children. Her husband works in Minneapolis, and is covered by a plan that
requires that they use a doctor from a health care facility in Minneapolis. Whenever
one of her children is sick, requiring a doctor's attention, she must take off a whole day
of work, take the child out of school for a whole day (even if the child is not ill), and
drive a minimum of 150 miles round-trip, even if the appointment is only for something as minor as receiving a vaccination, treating a rash, etc. A simple 10 minute
doctor visit costs my company an employee day, my employee a day's pay, the child a
day's education, and the country several gallons of a non-renewable resource (gasoline), just because she is not allowed to go to the local physician whose offices are less
than a mile from the school. The final irony is that the local doctor's charges for routine care are far less than what the insurance company is paying the big-city doctor.
There must be flexibility and room for common-sense legislated into the new health
care provisions. At a minimum, health care recipients must be allowed to receive noncritical services where it makes the most sense to go.
Thank-you for your considerations. We eagerly await your recommendations.
Sincenely,
Caroly^Meinhardt
President, WORDWARE, Inc.
BRINGING P E O P L E AND T E C H N O L O G Y T O G E T H E R
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DOCUMENT NO.
AND TYPL
017. note
SllBJF.CT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Reeords Aet -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information [(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
IM Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) of thc PRA]
P5 Release would disclose conndential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of Ihe PRA]
b(1) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or conndential or Financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FDIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
Financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 ll.S.C.
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RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/25/ )3 CD: NY-14 & 15
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
ol-7
BRIEF SYNOPSIS OF LETTER
Young married couple-each has own successful business, ThcLr f a m i l y premium
j u s t went from $273.00 t o $455.00/month under New York's community r a t i n g
p l a n . While they agree they probely l i v e b e t t e r than most " t h i s i s beyond
the l i m i t o f what can be expected f o r small business peoplfe who have t o pay
t h e i r own h e a l t h insurance." When her baby a r r i v e s i t w i l l - go up again.
/
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
018. letter
SUBJECTATI LE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/30/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2()06-0885-F
im8l3
RESTRICTION CODES
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PI National Security Classified Information [(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute [(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
(.'. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�}
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�MimiflL^OmaHo
Companies
Dear Customer,
The New York State Legislature recently passed a l a W N Y Assembly
B i l l 12350-A, 1992.
This law regulates the premium rate for your health insurance
coverage. I t requires insurance companies to charge the same rate
for everyone in the same geographic acjg.a- wi-th the same coverage,
regardless of age, sex, ic^&pxtton'^GrKia'ltHT" " This method of
controlling rates i s known'"as Comaunity Rating and i t applies to
insurance coverage issuedvin the State of New York-, -regardless of
where an insured currently I J ves. - -tte trav^ enclosed a brochure to
help answer your questions about the law and how i t a f f e c t s
insurance premiums.
This law w i l l affect the ar.cur.t you pay f c r your health insurance.
Your new premium and the date i t becomes e f f e c t i v e are shown on the
enclosed selection form. Send no money now. We w i l l b i l l you for
the new amount.
An e f f e c t i v e way to help reduce your premium i s to increase your
deductible amount. The premi ur. for the higher deductible i s also
shown on the enclosed selection fox-^j. I f you choose the higher
deductible, please sign and return the form within 10 days.
I f you have any questions ibout your coverage, please
local Mutual of Omaha office. Or, you can write us
Office, ATTN: CSO-General Services Area, or c a l l
Customer Service represer.t?t ? VPS at 1-800-775-4414
a.m. and 4:30 p.m., Central Tnrc.
contact your
at our Home
one of our
between 8:00
We appreciate your confidence : n our Company.
.
Sincerely,
Glenn Kippes
Second Vice President and Director
General Services Area
Customer Service Operation
Mimiat^OmoHO bisuRonce Comwiw •
NYCR Ml
-.ILTI
a OF OMAHA PLAZA •
OMAHA. NE sei 75
• 402-342-/600
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
019. form
DATE
SUBJECT/TITLE
04/01/1993
Personal (Partial); Address (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm8l3
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 I'.S.C. S52(b)|
PI
P2
P3
IM
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FTMA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Informalion 1(a)(1) of the PRA)
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of thc PRA|
C. Closed in accordance wilh restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Deductible Amount thiJt meets your needs.
Here's what to do .
Selection Form
' P6/(b)(6)
POLICY N :
O
RNWL D T :
EEA A E
APRIL 01, 1 9
93
C R E T DEDUCTIBLES ARE:
URN
A C D N - $1,000
CIET
SICKNESS - $1,000
'
i.'wfsh to kwp your coverage exactly as it is nov^ there
'^•fs no need to do anything. Eveijyone in your state with thisN
same policy is being changed o the latest rate schedule. I
Effective on your next rene4|il date, your new renewal/
premium will be $445.72 NINTHLY
S
(B)
:;
P6/(b)(6) . '"v
If you wish to increase your d^Juctible amount, please sign
both riders below. Attach ot^ rider to your policy and
return the other rider in the postage paid envelope provided.
3070B
2640Y
Mf40t2 E2 12-46
DEDUCTIBLE AMOUNT ADJUSTMENT RIDER
This rider is made a pari of the policy/certificate io which it is atuehed. Ail provisions of the policy/^uificate that are not in
conflict with the provisions of this rider apply to this rider.
Rider Date
Adjusted Premium
APRIL 01
1993
$297.94 M N H Y
OTL
New Policy/Certincate Number
•'P6/(6)(6)
The payment of the Adjusted Premium puts thisriderin force as ofthe Rider Date. For this the eductible Amount
shown in thc policy/certificate Schedule is changed to ACntTN; - i?,0n0
STfKNFSS • s?ono
t
Signature of Insured/Merflber
MUTUAL OF OMAHA INSURA ^CE COMPANY
P6/(b)(6) . - -
0
Form 2536M-EZ
Chief •xecutive Officer
DEDUCTIBLE AMOUNT ADJUSTMENT RIDER
Thisrideris made a part of the policy/certificate to which it is attached. All provisions of the policy/ftrtificate that are not in
conflict with the provisions of this rider apply to this rider.
Rider Date
Adjusted Premium
APRIL 01
1993
$297.94 M N H Y
OTL
New Policy/Certificate Number
P6/(b)(6)
The payment of thc Adjusted Premium puti thisriderin fo'a. is of thc Rider Date. For this the Ifleductible Amount
shown in the policy/certificate Schedule is changed to ._ ACT IFF.NT - $2 .000
SICKNESS
$2.000
Signature of Insured/Men i >er
MUTUAL OF OMAHA INSURAI ICE COMPANY
Form 2S36M-EZ
Chief Executive Officer
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
020. note
SUBJECT/TITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/I3ox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
20()6-0885-F
jm8I3
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating lo the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or conFidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information [(b)(1) of Ihe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
h(3) Release would violate a Federal statute 1(b)(3) ofthe F01A|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 07/0V93 CD: AZ-2 & 4
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , husband and w i f e own small business, i n the pasf had h e a l t h i n s .
>s have made i t
f o r employees and f a m i l i e s w i t h d e n t a l care, c o s t i n c
necessary t o drop coverage o f f a m i l i e s , now r e q u i r i n g en bloyees t o cover
premium increases and may drop d e n t a l p l a n , l o c k i n g i n t o ] i n s . company by
w i f e ' s p r e - e x i s i t n g back c o n d i t i o n , also she and her mother has s i m i l a r back
s u r g e r i e s , her mother's o p e r a t i o n covered by Medicare CC!>t $100,000, her
o p e r a t i o n through i n s . company c o s t $50,000
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICARE
PAYS HIGH PRICES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
021. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/08/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
,im813
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
h(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of thc FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(h)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�^—
•
'.''•ii
X:f-XyX'l • • -•
, P6/(b)(6)
o
L3
Febr ary
8.
1993
Mrs. H i l l a r y C l i n t o n
The White House
16^0 Penris>'lvania Ave .
( & r K rx-r+or. D.C.
;.-?
20^00
De2r Mr?r.
Clinton'
I have been e x t r e m e l y concerned w i t h t h e h e a l t h
t h ^ t our cci' tf>' fz^p^- and
very pleased
that
p l ? n r t o ?ddrers t h i ? problem.
in
a r e problems
he p r e s i d e n t
T ur,^,, w,, ^v-p
-,
p-c-^opi- w o r k i n g a l o n g w i t h your committee on
t.h . r t^'Tk. Ulh^t concern? me
i r t h e mix o f t h e p e ^ p l e who are
wori-ing w i t h
you.
Are t h e y s m a l l b u s i n e s s
peopl who have t o
year?
A^e
fa^e
i n c r e a s e i n h e a l t h i n s u r a n c e premiums ever
they people
with pre-evsisting
c o n d i t i o n s t h a t a r e unj n s u r a b l e ?
or t h e i r
H W - the;.- had m e d i c a l
PC,
problems t h a t
have c o s t t em
Have
f a m i l i e s hundreds o f thousands o f d o l l a r s i n medical p i l l s ?
pr.y - f t-hem been t u r n e d down f o r h e a l t h
i n s u r a n c e because t h e y
r-^n't a f f n r W
t h e c o s t o f t h e i n s u r a n c e ? Most impor ent , are you
i ^ - t -^,- g f , p e o p l e who
f a c e t h e s e problems e v e r y day o f t h e i r
;
0
n
r
T r-r.
> t i ng t o ycL' as
'
an average American who
many o f t h e s e problems asked ab^ve, i n h^pes
c o n s i d * ' t h e s e problems we f a c e when you make your
as t o what s h o u l d be done w i t h h e a l t h i n s u r a n c e i n
1
ha had t o f a c e
t at
you w i l l
f nal a n a l y s i s
tH
country.
My husband and
T own
and
operate a .Ismail
b u s i t t e ss ^ h e r e i n
Phoenix.
Ulhen we
s t a r t e d our
busine^g^Tw? p a i d f o ^ -health c a r e
f o r our employees and
their families.
We
a l s o ca'-lried d e n t a l ,
term
short
term
unemployment
insurance
as w e l l
a:; l o n g
uncrnpl ?yment i n s u r a n c e . Over t h e y e a r s t h e premium c o s t has gone
up so
much t h a t
we no l o n g e r cover t h e employees f i p i i l y p l u s we
dropped t h e s h o r t term unemployment i n s u r a n c e . T h i s year we w i l l
make our
employees pay f o r any i n c r e a s e i n premiums and may d r o p
the d e n t a l i n s u r a n c e a l t o g e t h e r .
T h i s w i l l be
a bu rden on our
employees as our i n d u s t r y i s not a v e r y h i g h p a y i n g i e l d , b u t we
a r e at a p o i n t t h a t our
b u s i n e s s can
n o t a f f o r d tWe e s c a l a t i n g
costs
Our company can not shop around f o r lower c o s t hea t h i n s u r a n c e
because T am u n i n s u r a b l e . I have had numerous back j r g e r i e s and
n^ i n s u r a n c e company w i l l accept our group because o' me.
I f our
p r e s e n t i n s u r a n c e company d e c i d e s
t o drop
u s , we »n 11 have no
insurance.
must pay whatever t h e i n c r e a s e i n prerfi i urns w.i 1 1 b^
which have been around 20-30 per c e n t p e r y e a r .
Ue are t ^ u l y a t
the mercy o f t h e i n s u r a n c e companies.
:
�My mother and I had s i m i l a r back s u r g e r i e s except th i t she l i v e s
i n Southern C a l i f o r n i a .
Our s u r g e r i e s were ver> s i m i l a r i n
nature end our h o s p i t a l stays were the same. She las medicare
P H sruplemental insurance through AARP.
Her s u r g e o cost twice
as much as mine d i d . My t o t a l costs came close t > $ 50 ,000 . ,
w h i l e her's cost close t o * 100,000.
There i s d e f i n i t e l y
something wrong w i t h our system when doctors and H o s p i t a l s can
charge such a discrepancy i n fees f o r the same servicj^
?
your
When you and your committee present t o t h e pres dent
conclusions as t o what i s best f o r the c o u n t r y , I wi;h you would
consider the f o l l o w i n g 1.
Tf th-'-re i s t o be a N a t i o n a l Health Care Insure ice program,
not make business pay 100 percent of i t . This w i l hurt small
-•'."ci ness such ?s ours.
I s t r o n g l y f e e l each wc king person
should help pay f o r t h i s as w e l l as each business,
we are a l l
tc- shr^e i n the b e n e f i t s of a N a t i o n a l Health Insurar e Plan then
a l l of us, businesses
large and s m a l l , i n d i v i d u a l s as w e l l as
government should help pay f o r i t .
2
F s t a b l i s h a c e i l i n g on how much insurance companies can r a i s e
premiums. This i n i t s e l f leads t o a l o t of uninsurec people. At
the same time I do f e e l t h a t there should be a l i m i
as t o ho IN'
much a j u r y can award t o people i n medical castfe brought t o
mijrt
This wou Id help the physicians w i t h l i a b i l i t > i nsurance.
Thorp, ne^ds t o be some laws e s t a b l i s h e d t o
•otect those
people w i t h p r e - e x s i s t i n g c o n d i t i o n s . Insurance comp smes should
h^ve t o accept anyone who a p p l i e s and can pay t h e cost of t h e
insurance.
Py not having t o accept people w i t h i -e-exsist ing
c o n d i t i o n s the insurance companies prevent people Like us from
^hooping around f o r cheaper insurance.
4.
There needs t o be some type of s e t fees t h a t ^ s p i t a l s and
doctors can charge p a t i e n t s .
I realize price
s e t t i n g goes
against our f r e e e n t e r p r i s e system and t h a t t h e AMA and H o s p i t a l
Associations w i l l disagree, but t h e costs o f m e d i a l care has
gone w?y out of s i g h t .
The going r a t e f o r son s o p e r a t i o n s
depends on where one l i v e s i n t h i s c o u n t r y . This i s :he only way
t h a t I can see t o keeping medical costs down.
This i s a very d i f f i c u l t problem t h a t you have be< n handed. I
wish you luck i n t r y i n g t o f i n d t h e s o l u t i o n t o t h e
problems t h a t
w i l l be f a i r and equal t o a l l o f us.
:
" - • .'':'
•
• • P6/(b)(6)'
• •
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
022. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jiTi8l3
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of thc PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information [(b)(1) of thc FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets nr confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN
PERSONAL STORIES DATABASE
8/26/93 CD: OH-2
IDENTIFICATION OF WRITER
•
• P6/(b)(6) •
'
'
••>
- ,
BRIEF SYNOPSIS OF LETTER
Small business owner employees 24 f u l l time, and pays 100% o f a l l premiums,
Over past 9 months, premiums have increased 48% (incremen a l steps o f 15%,
14%, and 15% d i s g u i s e t h e t r u e amount. ) This i s e x h o r b i ant. Can q u i c k l y
I t is
c l o s e t h e doors o f a small business o r burden t h e en >loyees.
and Golden Rule
u n t h i n k a b l e t h a t t h e h e a l t h care i n d u s t r y i n general.
Insurance Co . i n p a r t i c u l a r , should be allowed t o c o n t i n u e :o r a i s e premiums
a t such an unconscionable r a t e . "
Feels VAT ( v a l u e add' d t a x ) gives no
incentive t o cut costs.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
OTHER CONTENT-VAT ( v a l u e added t a x ) i s n o t t h e way t o f i n inced i t .
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
023. letter
SUB.IECI7I ITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
03/25/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm8l3
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(h)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of thc PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information [(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute 1(b)(3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
coneerning wells 1(b)(9) of thc FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�• — • ^ r — ^ r - — , , .W,,
m
P6/(b)(6)
.P6/(b)(6)
March 25,1993
Mrs. HiUaij' Rodham Clinion
The White House
1600 Pennsylvania Avenue
Wariicgtoii. D.C. 20500
Dear Mrs. Clinton:
I am writing to you to express m concerns over thc health care systemreformsthat you1 ooking into. I am a
y
are
disd
small business owner of an electronics company that manufactures controls for the power irationindustry. My
firm employs twenty-four fulltune personnel and an ever changing number of temporary lyees.
empl
airier.
Over the past nine months we have experienced three rate increasesfromour health insurance Golden Rule
Insurance Company. These have been 15%, 14%, and 15%,respectively.The true increaseactually 48% if you
j : exorbitant increase
consider that each of the prior increases had a cumulative effect. It is m opinion that thisi is
y
over a relatively short period of time. We are oontinually being told that small groupsnoi being singled out as
are
targets forrateincreases. Our experience over the past nine months does not validate that claiii.
At the present lime m company pays 100% of the cost of each employee's premium, /is you can see, the
y
bus
constantly escalating cost of health care coverage can quickly close the doors of a small tess or put a greater
burden on the employee. It is unthinkable thai the health care industry in general, andGwlen Rule Insurance
Company in particular, should be allowed to contiuue to raise premiums at such an
unconscio i ablerate.
I fee! that the value added tax (VAT) proposal gives absolutely no incentive to insurance > npanies, doctors, or
o
hospitals to bold the line on their rapidly rising costs. The only thing a VAT would do is to more of the burden
p: t
on iudhiduals or corporations who are already paying the price for a system that is of coi rol. Lester Thurrow
out
has therightprescription for a tax overhaul to a VAT.
char
I strongly urge you to look to the health care industry, rather than the public, to make j es It is about tune
that insurance companies, doctors, and hospitals take responsibility for a problem that they created. We as
liave
individuals and corporations are already dealing with diminishing spending power. We don': the addition of
need
more taxes to confront us.
Sincereiy,
cc: Golden Rule Insurance Company
DWM/lar
P6/(b)(6);
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TVPE
024. letter
SUBJECT/TITLE
DATE
Persona] (Partial); Address (Partial); Phone No. (Partial) (1 page)
08/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jin813
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIAj
b(4) Release would disclose trade secrets or conndential or Financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
Hnancial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or conndential commercial or
nnancial information 1(a)(4) ofthe PRA]
PS Release would disclose conndential advice between the President
and his advisors, or between such advisors [a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misFilc defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�i
l
J
> '•
'
1
.
r
;
*''': .''•<,':'J;---'-<'?" ' '*' .
• , A- :': ' . • ' •
. ^ .j.
P6/(b)(6)
... ..^
«,
•:
.• .
''•''.j'.itff-"- •
• ' i ' ' , .'
Dear Ms: Allen:
0 ^
Enclosed you w i l l find the letters of increases exacted from the Gold in
Rule
Insurance provider for ICMl's healthcare policy. ICMI from inception in 1973
has provided and paid f u l l y for heaIthinsurance coverage for a l l employees
W have continued this policy todate, though with radical increases v i saw l a s t
e
year, we are obliged to review. As I stated our cost fiscal 1991 wer« $ 24,688.47.
Our fiscal year ending June 30-1993, were $ 35,620.00 .
I would not mind i f these statistics were used, but only, with my prijor approval
whether i n print or other public media. I do share the administratior s desires
to effect cost controls and managed care competition via grouping sire .1 firms
such as ourselves.
I also readily admit, due to this, and the Budget " d e f i c i t " b i l l , we ire using
Personnel Agency workers to f u l I f i l l any additional enployees needed ;o meet
production demands, incidentally, the demands after the budget b i l l ijiissed, has
effected our firm negatively. I am convinced even the MAZE of added |<j)nfusing
c
federal mandated tax changes w i l l axicmatically effect us negatively,and cause
an already depressing confusion over compliance requirements to beccc !
more aggravating,
To be sure, H& R Block saw a great rise i n their stock because cf i t iince they are
usually the beneficiaries of government changes and personal and corj|<prate tax law.
I further feel, with Governor Pete Wilson of California, we need to BlLOT t r i a l
programs, and have adequate phase i n for any changes, not RETPQACTIVE as the
recent B D E legislation which w i l l put our personal lives " N H L ' u n t i l we
UGT
O OD
later learn what the damages w i l l be to us as individuals. NOT G O ifpLlCY!!!!
OD
I appreciate your interest i n finding a solution to the Health care j ^ l i c y ,
and w i l l appreciate a copy of any i n i t i a t i v e put forth i n writing
With kindest regards.
P6/(b)(6) .
yj.i*-".
P6/(b)(6) •
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
025. letter
SUBJECT/TITLE
DATE
08/26/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Aet -15 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRAj
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(h)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�HUG
26
P.62
P6/(b)(6^
15108
'93
G Wn u*
Q eHl
e
P6/(b)(6)
;
RE:
.
, ,
;
Rats increase
'
"P6/(b)(6)
It has been two years since we last had to adjust premiums for yoi group
health insurance coverage. The pool of business In which you and nany
other small businesses are insured has obviously had very favorat((e claims
experience.
As you no doubt are aware, however, the cost of medical care continues to
increase. New technologies, cost shifting from Medicare and Medicaid,
increased utilization, and inflation all contribute.
Despite all this, your rates will increase by only 15%, effective with rour
premium billing due in July.
We are confident that your renewal rates are competitive with otheij plans in
the market Should you choose, however, to cancel your coverage vith
Golden Rule, you will be obligated to pay premiums through the da:»that
notice of your cancellation is received by Golden Rule's Home Off^e
We hope you will continue your insurance with us.
Sincerely,
Karen F. Lange
Assistant Manager
Insurance Services Division
Golden Rule Insurance Company
Home Office
Golden Rule Building
Lwrenceville, Illinois 62439
Telephone (618) 943-8000
M«r.fl92
�Withdrawal/Redaction Marker
Clinton Library
DOCUMKNT NO.
AND TYPE
026. letter
DATE
SUBJECT/TITLE
08/26/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
,im8l3
RESTRICTION CODES
Presidential Records Aet - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security' Classified Information |(a)(l) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
Financial information [(a)(4) of the PRA]
P5 Release would disclose conFidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�BUG 26 ' ? :
15 185
P.03
P6/(bj(6)
6)
RE:
| P6/(b)(6)
Effective Date:
November 15, 19
Dear Enployer:
Last July your small group health insurance ratiis
increased 15 percent. I t was the f i r s t increase i n
premium rates for the pool of business in which you are
insured in over two years.
Golden Rule continuously monitors health care costs. Part
of this ongoing evaluation involves changes in costs by
geography, age, gender, family status, and indict r i a l
classification.
We are making adjustments to the rates of oursppall group
business to reflect these changing costs. Yourl rates w i l l
increase approximately 14 percent, effective tqt
date shown above.
Vie appreciate your business and continue to maldt every
effort possible to s t a b i l i z e your health insurance
premiums.
Sincerely,
Patrick W Nazelin, Manager
.
insurance Services Division
cc: JAMES A GULICK
Golden Rule Insurance Company
Home Office
712 Eleventh Street
Uwraavme, HHnou 62439-2395
Telephonv (618) 943-8000
QRP055-1
�Withdrawal/Redaction Marker
Clinton Library
DOCUMKNT NO.
AND TYPE
027. letter
DATE
SUBJECT/TITLE
08/26/1993
Personal (Partial); Address (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
im813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
h(l) National security classified information 1(h)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets nr confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of thc PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors la)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�AUG
26
'93
J5i09
J
P6/(b)(6) •
021
•
RE:
P . 04
GokJenRde
_P6/(b)(6)
"Effective Date:
March 15, 19
Since your last rate increase in July 1992, the pool of
business in which you are insured has experiencid
ongoing and significant health care cost inflation.
Despite using a number of cost containment techiques,
we have only been able to slow this inflation aijd not
eliminate i t .
Therefore, your rates w i l l increase 15 percent,
effective the date shown above. You are not being
singled out for this increase; a l l groups in yoj^r pool
are receiving this same rate increase.
Many employers have found a way to offset this iate i n crease. I t ' s called a Premium-Only-Plan.
Inclded i s
a pocket brochure which explains this optional ;irogram.
If you are interested in this plan, you w i l l fifyd a card
that you can complete and return.
W appreciate your business. W strive to pay kfour claims
e
e
promptly and accurately. Tour insurance plan i i backed by
Golden Rule Insurance Company, rated A+ superioi by A.M.
Best 6 Company. W look forward to continuing your insure
ance program.
Enclosure:
s
s
cc: JAMES A GULICR
i
s
I
i
Golden Rule Insurance Company
•
Home Office
s
*
712 Eleventh Street
Uvrcncaville, nUaois 62439-2395
1
Teleptaoee (618) 943-8000
QRP06e-l
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
028. profile
SUBJECT/TITLE
DATE
Personal (Partial) (2 pages)
08/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - \S U.S.C. .S52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(h)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information |(a)( I) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(.S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�RUG 26
'93
15:09
P . 03
P6/(b)(6)
MESSAGE
FROM THE PRESIDE
or Golden Rule Insurance Company, the year 1992 represented a
period of steady growthtaassets,
"
prtnihuns, and earnings.
These events highKgbted another prosperous year.
• Admitted assets increased 31.5 percent, reaching a total
of $896.1 million on December 31,1992.
• Premium increased 282 percentto$739.9 million.
• Net income from operations rosefrom$30.1 million in
1991to$32.1 million in 1992.
Few companies in our industry can match Golden Rule's
solid, balanced performance over the past decade, h the last
three years, our Company's admitted assets and premium
have almost doubled. During the s m period, capital and
a e
surplus increased by 92 percent
This strong performance reflects a c m a y able to maino pn
tain a rock-solidfinandalposition in thefaceof increasing
regulatory restraints and despite the effects of a slow-paced
national e o o y At the s m time, our robust growth
cnm.
a e
demonstrates that more and m r brokers and consumers
oe
have found Golden Rule provides effective and affordable
productstomeet their health and life Insurance ueeds.
Industry rating agencies have also recognized Golden
Rule'sfinandalstrength. Standard & Poor's has awarded ihe
C m a y an "AA-" (Excellent) claims paying rating, and
o pn
during 1992 A.M. Best upgraded our Company's rating to
"A+" (Superior).
niroughout 1992, we continued diversifying our Company's product lines. Sales of asset-based products, including
Asset-Care* and annuities, reached $138 million.
W also devoted considerable time toredefiningGolden
e
Rule's strategies for the future. W anticipate significant
e
changes in our mdu$try and have positioned Golden Rule to
take advantage of them.
No matter what direction national p B y issues may take
oc
in the m nh ahead, we intend to maintain our leadership
ots
role in the insurance industry. W remain committed to
e
meeting our customers' needs whh the best longterm value
products we can offer. In reaching this commitment, we will
critically focus on developing innovative new products,
maintaining excellent broker relations, and providing
superior customer service.
As in the past, we sincerely appreciate the trust and confidence placed in us by brokers and consumers.
F
JohnM.Whelan
President and Chief Executive Officer
ABOUT THE COMPANY
OUR MjisiON
olden Rule chooses to > ethical because it is
e
right, not because it is rood business practice.
We value hard work a u promptness, and we are
d
committed to doing thingsri!ht Our products will
provide the customer with tl$ best long-term value in
the marketplace.
G
BACKGFtoUND
G
olden Rule was incorp: rated
more than 50 years
ago. Measured by prefjiiumincome, Golden Rule
is among the top 100(fimpanies in the country.
Since 1983, the quality of )|-oducts offered by Golden
Rule spurred premium growth an average of 2% per
at
3
year. Despite one of the indu ijtry's
most dynamic
growth rates, the Company'sj
financial base grew just as
rapidly. Capital and Surplus L
increased an average of 2%
5
per year since 1983. As a restflt, Company was in
the
the strongestfinandalpositi > in its 52-year history at
i
the end of 1992.
1
ITS CUS )MERS
(he majority of the Con pan/ s products are
targeted to the individk al consumer. During
1992, more than 850.C! consumers were
0
insured by Golden Rule for Ipe,health, and financial
,
planning needs.
Golden Rule has alwaystj Lenipride in its prompt
service to its customers. InfHct one of the most
important ways an insurance
company is judged ie by
the way it performs when ycf need to collect benefits,
Thafs why Golden Rule" ! tressed efficient benefit
has
payments since its founding111940. And our dedicated
staff of claims personneldisl i ibuted more than $381
mCEon in benefitstoourpol<yholdersml992.
Ti
How OUR PRODUC I S ARE MARKETED
G
olden Rule's products ire distributed by over
62,000 bdependentai tnts and agencies, brokers
andfinandalplannen
In addition, Golden Rule':products are sold by some
of this nation's largest insurihce
companies, whose
combined assets total more lan $145 billion.
�RUG 26 '93
15110
P. 06
P6/(b)(6)
3£
*•'**
okien Rule's assets have grown cansi^
GROWTH I —tentiytothe last 1 years. Exciting new
0
IN
V J products to meet the ever-changing life,
health, long-terra care, and financial needs of
individual consumers have permitted this
steady growth.
M
5
S
t
1
b
ADMITTED ASSETS
(in jniffioos)
$896.1
19
92
T
he safety of an insurana company
OUR
Is largely based on the s: ength
and safety of its investm! it port- INVESTMENT
folio. The strength of Golden 1 le's
1
portfolio is highlighted by the igh per- PORTFOLIO
AS OF
centage of U.S. government se; unties
and investment grade corporat: bonds. DECEMBER
This strategy has been recogn; ed by
31,
insurance c m a y rating sen i :esasa
o pn
sound investment approach. G: Iden
1992
Rule's practice has beentoinv s it in safe,
conservative, "value added" oj; ortunities designed to
provide policyholders a good r i turn without a sizable
exposuretohigh-risk investnu: its. While the Company
invests in m n asset categoric i, the portfolio
ay
consists predominantly of higfj-prade corporate and
government bonds.
ASSET CATEGORIES
$302.9
$241.0 1987
'$182.1 1986
$133.4 1 8
95
$86.7 1 8
94
1983
**'
olden Rule has experienced an average
GROWTH I _ growth in p e m income overfeepast
rm m
IN
PREMIUM
INCOME
V J j10 years of 23% per year.
C percent)
m
Real Estate
and Mortgages
0.7%
Other Assets
(Accrued Income,
Policy Loans,
Stocks, etc.)
7.2%
PREMIUM INCOME
$739.9
19
92
Cash and Other
Short-Term
Investments
3%
.
9
on-Investment
Grade Bonds
-I /
Q millions)
n
\
'$307.9
'$252.4 1 8
97
$200.4 1 8
96
^
$158.6 1985
$111.9 1 8
94
1983
1
Investment Grade
Corporate and
Other Bonds
3.%
19
U.S. Government Bonds,
Political Subdivisions,
Agencies and Authorities
50%
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
029. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
O A / I i o x Number:
3679
FOLDER T I T L E :
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act • |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
h(4) Release would disclose trade secrets or conndential or financial
information 1(b)(4) o f t h e FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) o f t h e F O I A |
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) o f t h e F O I A j
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) o f t h e FOIA|
National Security Classified Information 1(a)(1) o f t h e PRA|
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
P R M . Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSEHT GIVEN 08/27/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
1
P6/(b)(6) 'X^-^
" *. • .
.'
.
BRIEF SYNOPSIS OF LETTER
Mom and Pop business. Covered as a group o f 3 u n t i l f o r c e d to l e t #3 go. At
age 55, r a t e s went from $500/ f a m i l y t o $2,000. With BC BS f o r 30 years.
Cannot f i n d a f f o r d a b l e coverage.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
UNABLE TO PAY
HIGH CO-PAYMENTS
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
030. letter
SUBJECT/TITLE
DATE
04/16/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Iiox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm8l3
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
h(2) Release would disclose internal personnel rules and practices nf
an agency 1(h)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(K) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(<>) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
National Security Classified Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information |(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CT"
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
031. note
SUBJECT/TITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
,im813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 22()4(a)
Freedom of Information Act - |S U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information |(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA|
National Security Classified Information [(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN )8/26/93 CD: LA-4
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Observed high cost for mother's care, now understands why ;ost for employee
health coverage is so high, why he is forced to pay such I Lgh premiums
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
032. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
02/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIAj
National Security Classified Information 1(a)(1) ofthe PRA)
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�\
P6/(6)(6) •
!
;
: . ; .y-;. ;\ . V
. V
:
3^
February 26,
• P6/(b)(6)
1993
Mrs. Hilary Clinton
The White House
Health Task Force
1600 Pennsylvania Ave., N
W
Washington, DC 20500
Dear Mrs. Clinton,
First, may I tell you how pleased I am that this Health 'ask Force has
been formed. I believe i t is one of the most needed areas in our economy.
The attached statement is a prime example of why the Medicare program is
in the financial predicament that i t i s .
I took my 86 year old Mother to the doctor with a bladder infection. This
is her statement from the Lab for one urinalysis. She called when she got
this outrageous bill and they told her to send her Medicare lipber and that
she shouldn't have even been billed. But we as tax payers pa either way. I f
you and your task force can eliminate even a small portion of this "theft",
the whole nation will benefit.
As a small business owner, I am fully aware of my cost in furnishing my
employee with hospitalization and after seeing billing such as this, I can see
why I am paying the high premium that I am being forced to pafc
A "stopping point" must be found.
Sincerely,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMKNT NO.
AND TYPE
033. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
RESTRICTION CODES
Prcsidenlial Records Act - [44 II.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the F01A|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/26/93 TO USE STORY BUT fOT NAME CD: RI-2
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Small business owner has f a m i l l y coverage f o r h i s f a m i l y o 3; $900/mo. His
w i f e was h o s p i t a l i z e d e a r l i e r t h i s year, c o s t i n g n e a r l y $100,000.00. He
feared t h e c a r r i e r would c u t them o f f , and they d i d , on p i j ^ t e x t t h a t he had
but was a Conn,
moved h i s business out o f Conn, ( i t never had been i n Conn
t
" I t ' s just
Corp). Now they have no hope o f g e t t i n g insurance a t any o s t .
not r i g h t . "
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
COVERAGE DENIED-Because o f new c o n d i t i o n .
LOSS OF COVERAGE-For whole f a m i l y .
FROM CONTINUED CARE
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
034. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
02/03/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
20()6-0885-F
im813
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRAj
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe I O I A]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�February 3, 1993
P6/(b)(6) .
' • •"
.•
'
RE: Group Policy Number
P6/(b)(6),:
Our f i l e s indicate that your b i l l i n g address i s no onger i n
Connecticut. F i r s t Connecticut Life Insurance Comp ny i s not
authorized to provide insurance in states where we ire not licensed
by the Insurance Department of that state to operat
This letter serves as notification that we must ter:inate your
policy effective March 31, 1993. In order to maint in your
coverage with us, you must provide documentation th t your primary
residence and/or business operation i s in Connectic t. I f you can
provide such documentation, please do so by Februar 20, 1993.
You should contact your insurance agent as soon as possible to
arrange for other health coverage.
Sincerely,
GROUP MEMBER SERV CES
Barton, Roseann
The Capital Planning Group
140 Greenwich Avenue
Greenwich, CT 06830-
CAPITAL BENEFIT PLANS. INC. • ONE TORRINCTON OFFICE PLAZA • P.O. BOX 779 • TCtfJUNGTON. CT 06790
203/496-0000 • FAX 203/496-7676
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
ANDTVI'E
035. letter
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
02/10/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of thc PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
1 3 Release would violate a Federal statute [(a)(3) of the PRA|
*
P4 Release would disclose trade secrets or conndential commercial or
nnancial information 1(a)(4) ofthe PRA|
PS Release would disclose conndential advice between the President
and his advisors, or between such advisors |a)(S) of the PKA]
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information [(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(K) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�P6/(b)(6)
-...
.•v
(5
HILARY RODHAM CLINTON, CHAIR
PRESIDENT'S COMMISSION ON HEALTH CARE REFORM
THE WHITE HOUSE
WASHINGTON, D.C. 20004
FE I . 10, 1993
DEAR MRS. CLINTON,
PERIOD OF
LAST SUMMER MY WIFE WAS HOSPITALIZED FOR
SEVERAL WEEKS. I OWN AND RUN MY OWN CONPANY ND HAVE BEEN
FORTUNATE ENOUGH TO BE ABLE TO AFFORD OUR O > MEDICAL PLAN.
W
THAT PLAN CURRENTLY RUNS NEARLY $'3flc5. M N H J p FOR A FAMILY
OTI/
OF THREE. CLAIRE'S ILLNESS COST NEARLY $100 )00. AND 1 HAVE
HAD THE DISTINCT FEELING THAT ONE WAY OR ANO IER THE
INSURANCE COMPANY WOULD CUT US OFF.
E EE
JUST BEFORE MY WIFE CAME D W WITH HER I ] LNESS, W W R
ON
ABOUT TO TAKE A SPRING HOLIDAY IN IRELAND. Tl 3SE PLANS WERE
OF COURSE CANCELED. THE DOCTORS HAD GIVEN HE! ALMOST NO
CHANCE TO LIVE, BUT THEY WERE WRONG. WE REI N$[rATATED THAT
RECEIVED
HOLIDAY TRIP JUST TWO WEEKS AGO. UPON RETURN
POST BOX. I COPY
NOTIFICATION OF CANCELATION OF INSURANCE IN
ATTACHED) IN THE CIRCUMSTANCES WE HAVE LITTL CHANCE OF
OBTAINING HEALTH CARE AT ANY COST. IT JUST I NOT RIGHT. WE
WISH YOU WELL IN YOUR ENDEVOR, AND HOPE THAT THE FRUITS OF
YOUR LABOR WILL HELP ALL AMERICANS.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMKNT NO.
AND TYPE
036. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/10/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm8l3
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA|
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(K) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of thc FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�..... •}• \
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P6/(b)(6)
..
:
CAPITAL BENIFIT PLANS, INC.
ONE TORRINGTON OFFICE PLAZA
P.O. 799
FEB. 10 1993
TORRINGTON, CONN. 06790
ATT; "GROUP MEMBER SERVICES"
BY CERTIFIED MAIL
DEAR M / S "GROUP MEMBER SERVICES",
RM
WE HAVE RECEIVED YOUR CORRESPONDENCE OF FEB 3, 1993, A
COPY ATTACHED. CAPITAL BENEFIT PLANS, INC. TOOKOVER OUR
COMPANY'S MEDICAL PLAN MORE THAN A YEAR AGO Fit D BUSINESS
M
SERVICES OF BRIDGEPORT. WE HAVE NOT MOVED SINttt THAT DATE.
THIS COMPANY HAS BEEN AT THIS ADDRESS SINCE 1 87. WE ARE A
CONNECTICUT CORPORATION. HAD WE BEEN NOTIFIED BY CAPITAL
BENEFIT PLANS THAT WE WERE NOT ACCEPTABLE WHEN YOU TOOK OVER
OUR COVERAGE, WE WOULD HAVE ACCEPTED THAT AS W UNFORTUNATE
CIRCUMSTANCE. WE WERE NOT SO ADVISED.
AT THAT TIME IT WOULD HAVE BEEN RELATIVELY EASY TO SWITCH
TO ANOTHER GROUP PLAN. YOU CHOSE TO ACCEPT US AND OUR
PAYMENTS. AS FATE WOULD HAVE I T , WE HAVE HAD
USE YOUR
SERVICE IN THE PAST YEAR, A FACT THAT YOU ARE itfELL AWARE OF.
IT WOULD APPEAR TO US THAT YOU ARE PRPOSONG TO CUT US
OFF BECAUSE WE HAVE MADE RECENT CLAIMS. WE FIND YOUR
ULTIMATUM UNACCEPTABLE, AND ALTHOUGH WE WILL AfTTEMPT TO PLACE
THE COVERAGE ELSEWHERE, WE ARE BOTH WELL AWAft E THIS WILL NOT
BE AN EASY TASK, PARTICULARLY GIVEN THE SHORT UT OFF DATE
PROPOSED.
I FIND YOUR UNREGISTERED, UNSIGNED CORRESPONDENCE A VERY
UNPROFESSIONAL WAY TO APPROACH THE VERY SERIOUS BUSINESS OF
TERMINATING HEALTH CARE. HAVE SOMEONE GET IN OUCH WITH ME.
CC; SEN. CHRISTOPHER J. DODD, WASHINGTON, DC
HILARY RODHAM CLINTON, THE WHITE HOUSE, WASHINGTON, DC
HOWARD OWENS, ATTY. TRUMBULL, CT
ROSEANN BARTON, CAPITAL PLANNING GROUP, GREENWICH,CT
.P6/(b)(6)
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
hi
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
O
�CONSENT GIVEN 08/23/93 CD: CA-29 & 36
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Doris O l i k e r
432 Sherman Canal
Venice, CA 90291
TEL: 310-305-7263
BRIEF SYNOPSIS OF LETTER
w r i t e r used t o r u n a s m a l l p r i v a t e s c h o o l , i n s c o s t s f o r s c h o o l s t a f f were
h i g h , so i n c r e a s e d d e d u c t i o n from $250 t o $1,000, s c h o o l agreed t o pay
employees t h e d i f f e r e n c e between t h e two d e d u c t i b l e s , b u t no one ever
exceeded t h e $250, school saved a l o t o f money on premiums
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
�VEN CE
FINANCIAL
CORPORATION
I A C O B O L I K E R , PRESIDENT • 4 3 2 S H E R M A N C A N A L - V E N I C E , C A L I F O R N I A
9 0 2 9 1 • 310 / 3 0 5 - 7 2 6 3
Februarys, 1993
Hillary Rodham Clinton, Esq.
White House
Washington, DC
Re: Health Insurance
Dear Mrs. Clinton:
I have an idea for the control of health insurance costs that worked for me
when I ran a small private school.
The usual deductible for the school was $250. It was costly and as the
staff was young, they hardly used the insurance. The school reduced its
premiums by raising the deductible to $1,000, and guaranteeing the difference
between $250 and $1,000. If an employee incurred more than $250 in charges,
the school paid the difference up to a maximum of $750.
Even if some had used the guarantee it would have saved us money. As it
happened no one ever did.
Sincerely,
Doris Oliker
042610
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DOCUMENT NO.
AND TYPE
037. note
SlIBJECmiTLE
DATE
Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jmSO
RESTRICTION CODES
Presidential Reeords Aet - [44 U.S.C. 2204(a)
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
IM
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or conndential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
National Security Classified Information |(a)(l) of thc PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRAj
Release would violate a Federal statute 1(a)(3) of thc PRA|
Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) ofthe PR A]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�CONSENT GIVEN
PERSONAL STORIES DATABASE
8/26/93 CD: MN-2
IDENTIFICATION OF WRITER
^ary Olson
BRIEF SYNOPSIS OF LETTER
Employer did not pay premiums, cancelled insurance
employees. Employees now has to pay medical b i l l s .
wi.thout
notifying
IDENTIFICATION OF PRIMARY LETTER CONTENT
OTHER CONTENT
Employer did not pay premiums, cancelled insurance without t e l l i n g
employees
�KV^^:,..;..-....
'J9S llxULzD ..^. ..J^lcuuJL
Jlllisiu^
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lULL/TTtj AUL&.
'JIM
AUJUKJ
/laL. AU-^
1XJ
at
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
038. letter
SUBJEOYITILE
DATE
03/13/1993
Personal (Partial); Address (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5.S2(b)|
PI
P2
Pi
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or conndential or nnancial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of thc FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or conndential commercial or
nnancial information 1(a)(4) of the PRA]
PS Release would disclose conndential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�\J5L
J
^
jolrn*
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
^
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
039. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Rox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. SS2(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
b(l) National security classified information [(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions [(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/:!4/93 CD: IL-5 & 9
PERSONAL STORIES DATABASE
riFICATIQN OF WRITER
"'• P6/(b)(6)
BRIEF SYNOPSIS OF LETTER
24 year o l d devorced mother o f 2 has I l l n e s s a f f e c t i n g colon.
Her new
employer's i n s u r e r turned her down because o f t h e p r e - e x i s^ing c o n d i t i o n , so
she m a i n t a i n s h e r coverage under t h e o l d employer. Her c h i l d r e n have no
insurance, and a r e on p u b l i c a i d which w i l l be f o r her to<i on 8/93.
IDENTIFICATION OF PRIMARY LETTER C
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
�Withdrawal/Redaction Marker
Clinton Library
DOCUMRNT NO.
AND TYPE
040. letter
SLIBJF.CT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
02/15/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA)
1 3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
*
P4 Release would disclose trade secrets or confidential commercial or
Tmancial information 1(a)(4) of thc PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(S) of the PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions [(b)(8) of the FOI A]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�^ v-: •; Kir'
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Rudnani
Cl ] n t o n
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d i ••••ur (.fed fTioft-ier D + t w o d a u o h t e r s . 4 and 3 v e e r s o l d
f7i='?. n •r.c-'-iCe-rn i s t h e i r - f u t u r e a n d w h a t we? a r e g o i n g
J fr;.- t t h e . - i t o d e s l
with.
r i ciiiis
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t iis.-e a c h r o n i c i J 1 ne&s c a l l e d C r o h n ' s d i s e a s e w h i f l h
r f n - c t ~ t h i - sma.i i a n d 1 a r q e i n t e s t i n e . A - f t e r b e i n g
c i cHUiiC-sft-ci i i . h a r c h o-f 1 9 9 2 , 1 h a v e b e e n l a i d o+-f t r t l m o n e
: ..r.. rt::(..' i-ic< v e s t a r t e a a n e w o n e . I h a v e c o n t i n u e d my
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• '-vtn o t J i + e t f i r e x t e r n n g a n d 1 am i n r e
t c tri*- medi C r - t i o n s w h i c h 1 m u s t t a k e e v e r y d
i r i -: o i i j y k n o w n c u r e i s - t o r e n i o v e t h e whr.-l e
mi n-:r i = s v i 1 .1 h e « l t h y , t h e r e i s n o r e a s o n
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+
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too
o-:• - i - n . h u L J ani h o p i n g t h a t w i t h t h i s n e w p r e s i d e n t ! a l
a .^T-r: n:; s t r a t i o n , p e o p l e w h o h o n e s t l y t r y t o w o r k : w i l ]
be
: •••> ' •• 4 i n d a - i f o r d a b l e a l t e r n a t i v e s t o m a k e t h e i r c|<^n
u r n : n g t o P u b l i c a s s i s t a n c e s h o u l d n ' t h a v e t o ae s o
:
ri'-^Ff
li'vi p t o c h a n g e t h e o v e r w h e l m i n g c o n t r o l
insurance
•romp a m e-s h a v e o v e r p e o p l e a n d t h e i r l i v e s s o we c a n h a v e
r
L a; i l i i uj c r i a i i c e a t l i v i n g a h e a l t h y l i f e
without
Ui s c r i mi n a t j o r i .
•_••••!• j
. -ror war a t o
P6/(b)(6) •
progress.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
041. note
SUBJECT/TITLE
DATE
n.d.
Address (Partial); Phone No. (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Rox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Prcsidenlial Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of thc PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or conndential commercial or
nnancial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or conndential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN )8/23/93 CD: SC-2
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Barbara P i n k e r t o n
BRIEF SYNOPSIS OF LETTER
Cannot f i n d a f f o r t a b l e group insurance coverage.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
042. letter
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
02/15/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
,im813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of thc PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
PJ Release would violate a Federal statute |(a)(J) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning Ihe regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�w 1 UJ:
m 1
February 15, 1993
Ms. Hillary Rodham Clinton
The White House
Washington, D. C.
Dear Ms. Clinton:
Thank you for donating your time and energy in I lan effort
to develop a national health plan. My husband and : own a
:
small manufacturing business in Beaufort, S. C. whici we
bought in October, 1990. Since that time the numbet of people
we employ has tripled to over more than twenty.
We have encountered two problems in i n i t i a t i n g a health
care program. F i r s t , none of our competitors have one. As
you may know the f i r s t three years are the most d i f f i c u l t in
developing a business. I n i t i a l l y we would not have seen able
to compete i f we had taken on the cost of providing iealth
care because our competitors did not and do not provide such.
A universal requirement for a l l employers regardless of the
size of the business would solve this problem.
When our business began to stabilize, we looker into
providing some type of health care and encountered < second
.
problem; namely, finding an insurance company to coy(er our
employees. Group insurers do not necessarily cover everyone
which we feel i s inadequate coverage since leaving sfprne
employees off a plan does not build team s p i r i t . A so, a
small businessperson does not have the resources or bime to
evaluate the health plans available. Signing up fo^ a program
can lock a business and i t s employees into a plan o
inadequate coverage which a l l may later regret.
Individual health programs presents problems t6]p. These
programs do not want the employer to pay any portion of the
employees premium and usually do not cover preexist^
conditions.
My husband and I very much want to cover a l l o\i)c
employees with a policy which w i l l best benefit then and not
handicap our a b i l i t y to compete. I hope that sharii b the
roadblocks we have encountered might shed some insic fit into
the problems small businesses are facing in their at :empts to
provide health care. You have our support, I f we din be of
any help, please l e t us know.
Sincerely,
Barbara Pinkerton
�Clinton Presidential Records
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marker by the William J. Clinton Presidential Library Staff.
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digitization capabilities, we are sometimes unable to adequately
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DOCUMRNT NO.
AND TYPE
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DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
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Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of thc PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
1 6 Release would constitute a clearly unwarranted invasion of
*
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation nf
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/23/93 :D: MA-7 & 8
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
P6/(b)(6)
:
OH3
BRIEF SYNOPSIS OF LETTER
Small business owner has t o pay v e r y h i g h r a t e s f o r insurance t o
cover h i s f a m i l y and h i s p a r t n e r ' s f a m i l y , b u t cannot change
insurance companies due t o h i s w i f e ' s p r e - e x i s t i n g M.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
LOCKED INTO INSURANCE COMPANY
�li
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
044. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
01/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Ercedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment tn Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOI A|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�urM
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:.P6/(b)(6)
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND TYPE
045. note
DATE
SUBJECI/IITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER T I T L E :
[Small Business Letters] [binder] [3]
2006-0885-F
jni813
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) o f t h e FOIA)
b(3) Release would violate a Federal statute 1(b)(3) o f t h e I O I A]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the F01A|
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) o f t h e FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
National Security Classified Information 1(a)(1) of thc PRA|
Relating to the appointment to Federal office [(a)(2) of the PRA|
Release would violate a Federal statute |(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(S) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/27/93 VER1 WILLING TO HELP
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
which i s going
32 year old couple have j u s t started a construction busines
well using non-union workers. Son has Marfan's Syndrome j e v e r l y - COBRA,
which does cover the Marfan's, cost $369.00/mo., but sut sequent p o l i c i e s
won't: recent surgery cost $88,662.00 plus, and there w i l l bis more. Everyone
should have coverage without q u a l i f i c a t i o n . Workman's Coiib . a l r e a d y takes
32.12% of a l l they earn.
How w i l l t h e i r son have a future i f he has t o
q u a l i f y for medicaid/medicare? People should be required to be covered.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LOSS OF COVERAGE
FROM PARENT'S POLICY
OTHER-Should i n c l u d e d e n t a l & v i s i o n .
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
SPENDING D W POOR
ON
MEDICARE
LONG TERM CARE
OTHER CONTENT
Request a v i s i t from H i l l a r y to see t h e i r problems f i r t hand,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
046. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (3 pages)
06/01/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(li)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(h)(3) ofthe I ()IA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of thc FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�5
6/1/93
—
.
1 ,! ,
:
•••' • •:" "' '" •' "'
< '•'* ' ' /
':( '
.
./..•• ;.• • , P6/(b)(6)
1(c
V,
Hillary Rodham Clinton, Chair
Interagency Task Force on Health Care
White House
Wa.DC 20500
. v ; r ,,.
RE: Health Care Reform
care.
I don't have specific solutions, but 1 want to tell you m concerns about healtl
y
Let's start with a little about myself and family. My husband and I are your av srage
healthy 32 year olds. We have a 14 month old son named^bKeji your averag* healthy 14
month old. We have a three year old son named P6/(b)(6)| not your average hea Ihy three
year old. 'pe/tbxsjhas Marfan Syndrome. Abraham tincoln is thought to have ind Marfan.
It is a connective tissue disorder, affecting the heart, skeleton and vision, ^[bx^is
severely affected. He has the following health problems; dialated aorta,nitrdl'
mitrr"
valves
prolapse, scoliosis, numerous other, skeletal problems that keep himironidoii
doiii what, other
kid? his age can do, near sightedness.(-23.5 and worsening all the time), and islocated
lenses. These problems are the most severe, he does have other conditions th^t we need
to be aware of.
1
~ 6( )6 jhave had our own construction business since May. of 1992. We s; e making
P /b( )
money, making a living.fce/Mefrhasbeen in the Carpenters Union since 1979. to
nor
venturing into our own business, we researched the health insurance industry; sure
obe
that our son|p6/(b)(6)|has adequate coverage for his health condition. A surpriw us that as
|to
I told different companies of |p6/(b)(6)|Marfan Syndrome, we were told they ild cover
w^
c
him, but would not cover anything related to Marfan Syndrome. So, what w to do,
<
had
was stay in the union (we are now in Cobra, paying $369 per month), not let know
lem
that we have started our own business, and start up the business to see ifwi i jld succeed,
it
The businesses succeeding. It now seems that we have no choice but to sign
union n n
contract, hire union employees, pay their fringe benefits, increased hourly i y. etc,
sals
arriving at a minimum hourly rate of $24.00 Record keeping and reporting
^ould also
increase dramatically. We currently pay our carpenters between $12,50 and 5.00 per
3
hour and they are quite satisfied. What i'm trying to say is we can go union, i
increase the
hourly rate we charge customers by about 60% (which would not be good business) :
foi
and pay approximately $600.00 per month for our family health care (inwhich are i.v,:.
we
assuming that[p6;(b)(6))viH always be covered). Or we can go non union, pay a i
HMO for
coverage and pay out of pocket for |
P6/(b)(6)fcarerelating to Marfan.
1
!
�Page 2
Health Reform
P6/(b)(6)
pe/ibjte^just had scoliosis surgery on March 1, 1993. He wentfroman 85 degn i to
curve
approximately a 25 degree curve. He is recuperating just beautifully. The of his
coflls
surgery? $88,662 and climbing. Our insurance has paid for 100% to 90% on costs.
most
CCS (California Children's Services) is going to pick up the remainder of appijdxiniately.
$13,000. Thank goodness we qualified for CCS with our 1992 tax return (th< year we
started up our business), otherwise, with a currently excellent healthy insurant program
(compared to what most people have) we would have to pay the approx. $13, 00 out of
pocket.
We have two very grave concerns: 1, The allowed prejudice in the health coypage
industry, and 2 The incredible costs of both health insurance and health care.
Everyone in the country should be allowed medical coverage; health, dentalvision,
ar 1
Individuals with a syndrome or other health condition that is beyond theirtol
con
shouldn't have to pay $1,000 or $600 or $200 per month if another individual
icovered
for a minimal amount through an employer, government program, etc. Nojhould be
on
sufferingfroma lack of insurance due to the prejudice of insurance carriersi lack of
or
proper, medical care due to insufficient or no coverage
no i
Concerns for| p6/(b)(6)jfuture: What will happen when he is an adult and we calonger
forcover him? Wiirfie"have to go on Medicare? Will he have tofinanciallyquali:
Medicare, rnqaning he vyiU. npt.be able to pursue the career of his choice?
Health Insurance is a very complex issue Increasing taxes isn't gonna do it. \ \ orker's
Compensation (it costs us 32.12% of every $100 earned to pay for Worker's (! )mp. and
we don't even have a claim), Medical and Welfare seriously need to be brough: under
control. If these three items can be revised, take out the neglect andfraud,th^re would be
plenty of money available to help with Health Care Reform.
I know car insurance isn't a real good example, but in California it is against jie law not
to have car insurance, therefore if you have a car, you'd better have insurance. People
should be required to have health insurance, whether it be employer paid or pt i lately paid.
I am becoming more and more aware of people that do not have health covert | je, only
because they do not want to pay for it or they can't afford it. ^People with sev< ne health
problems, such as m son, should not be turned awayfrominsurance, they she ild have to
y
be insured by a state or federal ran program. All others should be covered by n employer
or by their own accord.
�Page 3
Health Care Reform
• 'P6/(b)(6)
We are only on this earth a short time. Each of us should be allowed the mediHal care and
coverage that we deserve, that I believe we worn with the right to have.
Mrs. Clinton, please take this letter with the great seriousness that I am putting into it. I
have never written to a First Lady or President before The subject of healthcsre is very
important to me. I look forward to you or a member of your team to contact Ae with any
questions you may have. I would also be interested in meeting with you in my
environment, so you can seefirsthand what a hard working, tax paying, regisiired voting
American family, with a little guy with Marfan Syndrome gets though the basift pf life.
Thank you for your time,
Sincerejy,
cc:
Elizabeth Short, M.D.
Veterans Administration
810 Vermont Avenue, NW
Washington, DC 20420
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
047. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jin813
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRAj
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
Vd Release would constitute a clearly unwarranted invasion nf
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information 1(b)(1) ofthe F O I \ |
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of thc FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/l$|/93 CD: FL-5 & 9
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
' P6/(b)(6) •
•
BRIEF SYNOPSIS OF LETTER
Small business owner i s unable to obtain insurance f o r h e r s e l f and her
employees due to past i l l n e s s
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
048. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
02/18/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [3]
2006-0885-F
jm813
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthcFOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA)
h(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of thc FOI A]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information |(a)(l) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRAj
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�.P6/(b)(6)
February 18, 1993
64
Mrs. H i l l a r y C l i n t o n
The White House
Washington, DC
20500
RE:
Health Coverage
Dear Mrs.
Clinton,
I am a woman owned business i n the s t a t e of F l o r i d a , Vly company i s
very s m a l l , w i t h only two other employees.
At the present time, I am unable t o o f f e r coverage t o my employees.
I am unable t o have coverage f o r myself due t o past i Inesses. I have
had several companies d e c l i n e coverage t o me. A f t e r jeing d e c l i n e d
coverage more than once, my name i s l i s t e d as a bad r sk t o other
companies.
I would l i k e t o o f f e r words o f encouragement t o you awd your s t a f f i n
t r y i n g t o solve t h i s most d e v a s t a t i n g problem t h a t so many o f us are
faced w i t h . I f e e l very c o n f i d e n t t h a t you w i l l f i n d a s o l u t i o n i n
the very near f u t u r e . This seemed l i k e an impossible task u n t i l you
came along.
I would l i k e t o wish you and President C l i n t o n good ljj|ck i n b r i n g i n g
our United States of America back t o where i t should e.
I also want t o t e l l you t h a t I t h i n k Chelsea i s a mos b e a u t i f u l
young lady and I wish t h a t I had her h a i r . I pay har$ earned money
t o achieve h a i r t h a t looks l i k e hers. She i s very 1 uc ty
The news
media has been very c u r e l toward Chelsea and I t h i n k t h a t they have
been very u n f a i r . They l i k e t o be c r u e l t o the ones hat they are
jealous o f . Please t e l l her f o r me t h a t I am one o f i l l i o n s t h a t t h i n k
t h a t she i s a b s o l u t e l y b e a u t i f u l .
Good l u c k i n our f u t u r e .
Sincerely,
P6l(b)(6)
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Small Business Letters] [binder] [3]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Reproduction-Reference
Date Created
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3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-007-007-2015
12092992
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https://clinton.presidentiallibraries.us/files/original/94c5d7ac9cbf9d07e6a9b04a961aa4f3.pdf
f66cac536e84a07aee065975a4de9020
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3679
FolderlD:
Folder Title:
[Small Business Letters] [binder] [2]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
7
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
002. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
n.d.
P6/b(6)
003. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
004. letter
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
005. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
006. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/04/1993
P6/b(6)
007. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
008. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
01/25/1993
P6/b(6)
009. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
010. letter
Personal (Partial); Address (Partial) (1 page)
02/08/1993
P6/b(6)
011. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
012. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
04/01/1993
P6/b(6)
013. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im8l2
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Kreedom of Information Act - |S U.S.C. 552(b)|
PI
P2
P3
P4
h(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning thc regulation nf
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA|
National Security Classified Information 1(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information |(a)(4) ofthe PRA]
P.S Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
014. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/31/1992
P6/b(6)
015. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
016. letter
Personal (Partial); Address (Partial) (1 page)
04/14/1993
P6/b(6)
017. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
018. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
019. letter
Personal (Partial); Address (Partial) (2 pages)
02/12/1993
P6/b(6)
020. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
021. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/03/1993
P6/b(6)
022. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
023. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
05/25/1993
P6/b(6)
024. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
025. letter
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
026. statement
re: Insurance premiums and rates (4 pages)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im8l2
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act -15 ll.S.C. S52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of thc FOI A)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
National Security Classified Information |(a)(l) of the PRA]
Relating to the appointment to Federal office [(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(.S) ofthe PRA|
P6 Release would constitute a clctirly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
027. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
028. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/30/1993
P6/b(6)
029. letter
Personal (Partial) (I page)
02/19/1993
P6/b(6)
030. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
031. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/24/1993
P6/b(6)
032. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
033. letter
Personal (Partial); Address (Partial) (2 pages)
03/21/1993
P6/b(6)
034. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
035. letter
Personal (Partial); Address (Partial) (I page)
02/21/1993
P6/b(6)
036. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
037. letter
Personal (Partial) (1 page)
02/26/1993
P6/b(6)
038. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
039. statement
re: Explanation of benefits (1 page)
02/27/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im812
RESTRICTION CODES
Presidential Records Act - [44 ll.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
040. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
041. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
05/27/1993
P6/b(6)
042. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
043. letter
Personal (Partial); Address (Partial) (1 page)
03/15/1993
P6/b(6)
044. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
045. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/16/1993
P6/b(6)
046. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
047. letter
Personal (Partial); Address (Partial) (I page)
02/11/1993
P6/b(6)
048. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
049. letter
Personal (Partial) (1 page)
03/27/1993
P6/b(6)
050. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
051. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
052. letter
Personal (Partial); Address (Partial) (I page)
01/22/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion nf
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment tn Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) of thc PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of thc PRA]
Relating tn thc appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute » clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/26/93 CD: FL-7
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
1
1 , ( i"«
M
•
• if}."- . "
• " ' P6/(b)(6) •
:
oO
BRIEF SYNOPSIS OF LETTER
g
51 year o l d grandmother had h e a l t h i n s . f o r h e r s e l f and t ^ o r a n d c h i l d r e n ,
l e s s than 25
l o s t j o b b u t could n o t g e t COBRA because small busines
employees, was n o t covered by COBRA program
IDENTIFICATION OF PRIMARY LETTER CONTENT
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
COBRA's
DOES NOT APPLY TO SMALL BUSINESS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
PrcsidentiHl Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
IM Release would disclose trade secrets or confidential commercial or
nnancial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or belwccn such advisors |a)(S) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of thc FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or conndential or financial
information 1(b)(4) ofthe FOIA|
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�H i l l a r y Rodham C l i n t o n
c/o The Whitehouse
Washington, DC
Dear Hi 1 l a r y :
I am
a 51 year o l d grandmother who has cu ;ody of two
I d i d not a|?k f o r these
g r a n d c h i l d r e n ages f i v e and nine,
c h i l d r e n but circumstances demanded I take them and I am t r y i n g
to do the best I can f o r them.
My reason f o r w r i t i n g t o you i s i n hopes you can dc something t o
help the l i t t l e
people such as myself.
I was hired by a company
t o do
i n September
1992 as
an A d m i n i s t r a t i v e Assi :ant
documentation, (they make c e n t r i f u g e s ) at a s a l a r y of $18,000 a
year.
I was o f f e r e d a good h e a l t h care package whi i I paid inXo-n
to include my two g r a n d c h i l d r e n . Upon being dismi sed on A p r i l
14, 1993 I learn because the company employs l e s than twenty
employees I am not e l i g i b l e f o r the Cobra plan and ipon checking
w i t h Aetna our i n s u r e r I am t o l d my insurance w i l l ost me $2000
type of
a quarter.
What unemployed person could a f f o r d :his
insurance?
My complaint i s coupled by the f a c t tha't not only am i
I unemployed now but I am the product of a mother vt had r u b e l l a " ^
measles d u r i n g pregnancy and due t o t h a t ( I f e e l t'm extremely
f o r t u n a t e ) I wear hearing aids and have a pacemaker, rwhich i f any
job.
p r o s p e c t i v e employer i s aware of I would never get
H i l l a r y I have two associate degrees from c o l l e g e . >ne being an
A d m i n i s t r a t i v e A s s i s t a n t w i t h Machine T r a n s c r i p t i i and as a
Medical Secretary and l o t s of years of experience i s e c r e t a r i a l
work .
During my l a s t employment I was c o n s t a n t l y t o l d 1 DW v a l u a b l e I
was and what a good employee I was and how I se such a good
example f o r the other employees. I can not prove •vflny I was l a i d
off,
although I f e e l i t was due t o the f a c t the} found I had
hearing aids as I had my h a i r c u t , but the insuranc ; i s the main
thing.
I do r e c e i v e s t a t e a i d of $241 a month and s t a t e [insurance f o r
the c h i l d r e n but I am not covered as I am a g r a n d f a t h e r and not
e l i g i b l e although I am the care g i v e r . I w i l l be l i g i b l e f o r a
l i t t l e e x t r a money of approximately $70.00.
My gifbndson Shawn
who i s f i v e has A t t e n t i o n D e f i c i t
Hyperactive Disorder and
requires R i t a l i n
(brand) which i s not covered
unc sr the s t a t e
insurance program. I now have t o pay f o r t h i s out of my pocket.
We found t h a t the brand name helped him more than the generic,
The next biggest problem i s f i n d i n g a doctor who acr epts medicaid
�e
and not very many doctors d o e s p e c i a l l y who w i l l t = ,k Shawn as
hi.r
usually i t i s a p e d i a t r i c i a n .
I'm not asking f o r c i t y but the
a b i l i t y t o keep the doctors we have been using f o r t h e past year
and a decent insurance.
7
Hillary,
people l i k e me need HELP immediately.
I f a company
o f f e r s insurance no matter how many employees thdy should be
e n t i t l e d t o Cobra. The insurance lady who contacted me admitted
the company makes the p o l i c y amount so high t h a t disicourages you
from t a k i n g
i t up, then i f you chose another p an the pree x i s t i n g clauses are i n e f f e c t and i n essence you pay f o r
insurance f o r a year you cannot use.
Please do something t o help us.
Thank you f o r your time i n reading t h i s l e t t e r and
am so happy
t h a t Mr. C l i n t o n became President so you could help us
Si n c e r e l y ,
„
,..,,„..,....
«i # : \
• „
•„,'
P6/(b)'(6) '
.1
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
F*
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im812
RESTRICTION CODES
Prcsidenlial Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |S U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to thc appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN qfc/23/93 CD: PA-13
However, i f t h i s i s used, where t h e 15 year o l d son mayb r e f e r r e d t o , he
must g i v e consent.
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
GOOD QUOTE: "Mom, my treatment i s n ' t a l u x u r y . . . i t ' s my l i :e! I can't w a i t
u n t i l you can a f f o r d i t because by then i t j u s t might be t oo l a t e f o r me."
Mother w r i t e s o f 15 y e a r - o l d son's 4-year s t r u g g l e w i t h meivtal i l l n e s s . She
and her f a m i l y spent $120,000. Family business was forcec i n t o bankruptcy,
Lack o f funds f o r c e d her t o remove son from r e s i d e n t i a l treatment center
where he had made progress.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
LIMITED BENEFITS
MENTAL HEALTH
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(S) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(h)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRAj
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Dear Ms. C l i n t o n ,
Congratulations on your appointment as d i r e c t o r of t h e task
force f o r h e a l t h care. I am delighted w i t h the president's choice
and f e e l t h a t you w i l l be a great asset t o t h e n a t i o n i n your new
p o s i t i o n . I would l i k e t o share my concerns w i t h you and h o p e f u l l y
they w i l l a i d i n your understanding of an unbearable burden which
many American f a m i l i e s are facing.
The day t h a t my son was diagnosed was t h e day t h a t every
mother dreads. He was 11 years o l d and h o s p i t a l i z e d f o r 30 days i n
a p s y c h i a t r i c f a c i l i t y . Before discharge the doctors t o l d me t h a t
he would need extensive p s y c h i a t r i c treatment. I could choose
between i n t e n s i v e psychotherapy 4 times a week($ 500.00 weekly)
while he l i v e d a t home, or a r e s i d e n t i a l treatment center
($100,000.00 annually).
My health insurance which
is a
comprehensive Blue Cross Blue Shield plan covers $1,000.00 i n t h e
care of mental i l l n e s s !
Here I was devastated by the news t h a t my
son had a chronic, serious i l l n e s s only t o be t o l d t h a t w i t h huge
sums of money there was hope f o r him. Without funds, however,
there was none!
No parent should have t o hear those words ever
again.
America needs a health care system t h a t provides a
comprehensive set of b e n e f i t s t o a l l i t s c i t i z e n s . Americans w i t h
long-term i l l n e s s e s , e i t h e r physical or mental, face b a r r i e r s i n
o b t a i n i n g h e a l t h insurance because of the continued p r a c t i c e of
denying coverage t o persons w i t h p r e - e x i s t i n g c o n d i t i o n s .
As a
r e s u l t f a m i l i e s are forced t o cover the astronomical costs of
p s y c h i a t r i c and long term care services out of pocket which can
lead t o complete impoverishment.
Let me explain what t h i s means i n terms of one American
f a m i l y . I am t h e s i n g l e parent of three c h i l d r e n . Although t h e
c h i l d r e n ' s ' f a t h e r has never paid any c h i l d support, my extended
f a m i l y and I have contributed t o h i s care. Since h i s diagnosis 4
years ago we have spent over $120,000 f o r h i s care. Everyone
i n c l u d i n g my two younger c h i l d r e n have s a c r i f i c e d i n order t o get
my son b e t t e r .
Although i t has been a s t r u g g l e , emotionally,
p h y s i c a l l y , and f i n a n c i a l l y draining,he has made tremendous s t r i d e s
and i s g r e a t l y improved. I was always so g r a t e f u l f o r t h e money
t h a t enabled him t o begin t o heal because from my connection w i t h
other f a m i l i e s I knew of t h e horrors facing them.
Unfortunately j u s t l a s t month our f a m i l y became another
s t a t i s t i c as our business was forced i n t o bankruptcy. Whereas t h e
other members of my family were faced w i t h t h e economic
devastation and emotional trauma, foremost i n my mind, i n a d d i t i o n
to a l l of the other concerns, was /'What w i l l become of my son?" I
used t o say t h a t the day I made the decision t o place my son a t t h e
r i p e o l d age o f 13 i n r e s i d e n t i a l treatment was t h e hardest t h i n g
I ever had t o do. However nothing could compare t o having t o take
him away from there f o r f i n a n c i a l reasons only. I had o f f e r e d him
a r e a l chance f o r recovery and due t o lack of funds was forced t o
remove him from t h e very place which had helped him so immensely.
J kept t h i n k i n g as we drove the long r i d e home/'If he were
a f f l i c t e d w i t h any other physical i l l n e s s , would t h i s be
happening?If he had emphysema, diabetes, or cancer would my
f i n a n c i a l s i t u a t i o n a f f e c t h i s treatment? Would d i a l y s i s be stopped
�or chemotherapy discontinued?"
Believe me, having a child with a serious disease i s a pain
that never leaves you from the moment you open your eyes u n t i l you
f i n a l l y get to bed at night. I often think that while most people
fear nightmares while asleep, my nightmares(and those of other
parents of kids with severe emotional disturbance)begin upon
awakening each day.
And yet in the majority of cases the
difference between sickness and health i s money, and that i s the
r e a l tragedy. I t ' s not l i k e AIDS where unfortunately there i s no
cure. Help i s here to those who can afford i t ! Surely no parent
should have to l i v e with the thought that i f he had the money his
child could have gotten better. That i s cruel and unfair. As my
son so bravely and eloquently
put i t to me when I withdrew h i s
treatment,"Mom, my treatment isn't a luxury to me.
I t ' s my l i f e !
I can't wait u n t i l you can afford i t because by then i t j u s t might
be too late for me.
D i f f i c u l t words to hear for any parent but
true nonetheless.
Since my son i s on several medications he must be treated by
a p s y c h i a t r i s t for psychotherapy and psychopharmacology. Since my
entire family was wiped out f i n a n c i a l l y I turned to the department
of public welfare for medical assistance. Although I am currently
unemployed and without savings my son has a few thousand dollars
which he has accumulated by putting a l l his birthday money away
each year.Because of these monies he was denied Medicaid and
therefore I have been unable to offer him treatment on a private
basis and time i s not on h i s side.He has been stripped of h i s
p s y c h i a t r i s t , s p e c i a l school,and entire treatment plan.
I have taken the time to write you t h i s very lengthy personal
account of our family's experience with the hope that i t w i l l aid
in your understanding of the urgency of health care reform for a l l
Americans.
Health insurance should be equitable and
not
discriminate against people with severe mental i l l n e s s .
The
following services need to be provided:
1. Stop-loss protection for catastrophic expenses.
2. Coverage of f a c i l i t y based care.
3. Coverage of outpatient medical management including
preventative, diagnostic, therapeutic, and r e h a b i l i t a t i v e
services.
4. Coverage of v i s i t s for psychotherapy.
5. Coverage of essential prescription drugs.
6. Home and community-based services.
As you are well aware people with mental i l l n e s s are often
discriminated against. Due to the stigma of mental i l l n e s s that
prevails even to t h i s day my son did not f e e l comfortable even
having me write to you about him.
( I assured him that you would
protect h i s confidentiality and we agreed not to use h i s name.)Let
the health insurers lead the nation in putting an end to
discrimination against individuals with a disease not unlike cancer
or diabetes. I urge you to include mental health benefits in any
national health care reform. Children and adolescents with serious
emotional, behavioral, or mental disorders can be healed and saved.
Please do your utmost to see that they are provided with the health
insurance coverage they so desperately need and are e n t i t l e d to.
I f you feel that I can be of any further assistance to
�you in educating the task force or that my personal testimony would
*
00^
:
. P6/(b)(6)'
; "
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im812
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) of the F01A|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOI A|
b(9) Release would disclose geological or geophysical informalion
concerning wells [(b)(9) of the F01A|
National Security Classified Information 1(a)(1) ofthe PRAj
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA)
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/26/ 3 CD: CA-24 & 26
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
^';<)^-
>6/(b)(6)
.-
• '
BRIEF SYNOPSIS OF LETTER
—
•
M
B u i l d e r s Emporium, mid-sized company, switched covered do H O to reduce
c o s t s , one employee, AIDS v i c t i m was concerned about care u|j|ider HMO, company
r e v i s e d plans t o c o n t i n u e same coverage f o r employees w i t h long-term
disabilities.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
OTHER CONTENT
SMALL COMPANIES FORCED TO SWITCH TO HMOS TO CONTROL 20STS MAY AFFECT
CARE OF EMPLOYEES WITH SPECIAL NEEDS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/04/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA)
National Security Classified Information |(a)(l) of thc PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute ((a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�mm)
oo4>
,;,
fi.t.- v.r,.'
February 4,1993
Hillary Rodman Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C.
Dear Mrs. Clinton:
4 With companies cutting expenditures by reducing healthcare contributions, th individual is
/ being lost in the shuffle. But not always. There are a few companies who ancontinuing to take
, a personal interest in their well being and absorb the increased costs of doing so.
One such company is Builders Emporium - Ole's - Cashway, headquartered ii Irvine, California.
A friend of mine,
was employed by Builders until August of 991 when he was
P6/(b)(6).
diagnosed with AIDSTThe company assisted with advice and guidance in applying for long
term disability. Even after a year, when theirresponsibilityhad diminished, ere was contact
t
and concern.
This January,[p^(B)'(6)jwas notified that the only healthcare offered was to bea: HMO. This
meant new doctors, labs, pharmacies, hospitals, etc. This gave him a life threatening feeling - a
major upheaval when stress is thc last thing needed. |p6/(b)(6)|called to express is concern and ask
for advice. For thefirsttime, none was forthcoming.
Within a short four-hour period. Builders Emporium's internal wheels must
hiveireally been
spinning. They called P6/(b)(6)|and notified him that all long term disability enjfcloyees would
experience no change in coverage.
P6/(b)(6)|knew this was not done only for him and we have no idea how many ] ople are involved,
The point is that Builders Emporium put the well being of employees before lie almighty
bottom line.
There is hope that other companies like Builders Emporium will support thei employees, and in
return that, wc, the buying public, will show our loyalty and support
Sincerely,
P6/(b)(6)
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Clinton Library
DOCUMENT NO.
AND TYPE
007. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2()06-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) of thc PRA|
P2 Relating to the appointment to Federal office [(a)(2) of thc PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information [(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT G|fVEN Wa-1/7
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
:'•
P6/(b)(6) ^•••^
BRIEF SYNOPSIS OF LETTER
Husband i s self-employed carpenter, makes $18,000/ye :, w o r r i e d
t h a t i f he had t o pay workers compensation and h e a l t l insurance.
i t would cost him $7,500/year
1
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
WORKERS COMPENSATION
TOO EXPENSIVE FOR SELF-EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
01/25/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Erecdom of Information Act -15 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of thc PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose conndential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of thc FOIA|
b(2) Release would disclose internal personnel rules and practices nf
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�- P6/(b)(6).
Office of the Insurance Commissioner
Insurance Building
P.O. Box 40255
Olvmpia. WA 98504-0255
Januai; 25, 1993
Dear Ms. Senn.
I am writing to you because I am very concerned about [he "cost
saving" steps that insurance companies are taking against qheir
insured. As of January 1, 1993 Snohomish County Insurar e
Company will no longer cover on the job injuries as a part if their
basic insurance coverage (no riders are available). Their I > jrspective
is that injuries are covered by Labor and Industries (L & I)
insurance, and that eliminating coverage of on the job injuries is
a'cost sa\ing" step. Snohomish County is following Blue Cross Blue
Shield's lead as of last year Blue Cross Blue Shield also pu} ;ued this
line of reasoning and "cost saving" steps.
For most indhiduals L & I does cover on the job injury laims.
However, for the self employed L & I insurance coverage i not
always an financial option. L & I charges $3.00 per hour ftbr everv
hour worked for a carpenter. My husband a self-employe
carpenter, had a net income of $18,000 in 1992. In order or him
maintain L & I insurance, and health insurance the total cost would
have been S7,560.00 a year, 42% of his net income. Even lough he
has never filed a L & I claim before.
Sole proprietorships and small businesses do not have large
impact on the insurance industry when standing alone, But
collectively and with your help they can at least be heard, Millions
of Americans are affected by blocked access to health insi; ranee. I
am not speaking of individuals at the poverty level, or the homeless,
we are a middle class couple trying to get by and get ahea . One
�small accident could wipe out years of hard work due to lack of
adequate affordable insurance coverage. This is a concern or us and
many other small business men and women. Any assistan: e or
information that you could provide us on this situation would be
appreciated.
cc: Hiliary Clinton - one more item to consider in your loo at health
care issues
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Leners] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential nr financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSE'T GIVEN
NC-9/13
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , husband works i n a family-owned small business, t h e r e i s no i n s .
coverage, her husband i s on a p r i v a t e p l a n w i t h a pre-ex s t i n g c o n d i t i o n ,
w i f e and two c h i l d r e n went on another p l a n when t h e premi ms f o r t h e f i r s t
p l a n went over $600/month, a year ago a l l f o u r were on plans w i t h $500
d e d u c t i b l e s c o s t i n g $400/month, t h i s year t h e premium went up $45/month and
they w i l l have t o go t o a $1,000 d e d u c t i b l e t o keep t h e c o s t a t $400, which
i s almost as bad as no insurance a t a l l
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
LOCKED INTO PLAN
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DOCUMENT NO.
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010. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
02/08/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
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PI
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purposes 1(b)(7) ofthe FOIA]
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Release would violate a Federal statute [(a)(3) ofthe PRA]
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financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�.)-,..
.
p 6 /
b
6
. ( '( ^
February 87T993I'
First Lady Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington, D. C. 20500
My dear Mrs. Clinton:
I was happy over your husband's election because he was goirtt to establish
a nationwide health plan. Since you have been assigned to head mis reform,
I am writing to express my concerns.
I read where this plan w i l l give coverage to the poor and ttf. ones who
cannot afford to get health insurance. Please do not forget aboil, those of us
who are being inpoverished trying to pay for insurance i n case ofa catastrophic
illness.
Please l e t me t e l l you about our situation. My husband works in a snail
family business. There i s no group coverage, therefore we have tliken out
individual policies to cover the two of us and our two children, c .ges 11 and 8.
Because of a pre-existing condition, my husband has one insurance ccnpany; but
my children and I were forced to find sate other carrier two years ago when
the coverage for the four of us went to well over $600 a month, is i t stands
now, we pay almost $400 a month for l i t t l e or no coverage. Last ear my
husband and my children and I a l l went to a $500 deductible each ^o keep the
amount we pay monthly below $400. My children and I have f i l e d ro claims,
up and we
Thank heaven we have continued to remain healthy. Now the year
are being h i t with another increase which w i l l put us paying em additional
$45 a month to maintain the $500 deductible coverage. I f I want \o keep my
monthly payments below $400, my children and I w i l l need to go tc a $1000
deductible. We cannot continue to pay this monthly pcendum that ' h i l l only be
good i f there i s a catastrophic illness.
Please when planning the health care reform, do not forget sjl^out those of
us who are struggling to pay our way with no r e l i e f .
Respectfully yoijis.
'P6/(b)(6)
mtf
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DOCUMENT NO.
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n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
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[Small Business Letters] [binder] [2]
2006-0885-F
jm812
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PI
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information 1(b)(4) ofthe FOIA]
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purposes 1(b)(7) ofthe FOIA|
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financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
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financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
Pf> Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN
PERSONAL STORIES DATABASE
8/23/93 CD: WI-5
IDENTIFICATION OF WRITER
• •V^
• -y
P6/(b)(6)
e
oil
• ^ • .• • " •'
'.
BRIEF SYNOPSIS OF LETTER
Owner o f s m a l l b u i l d i n g / design f i r m has s u s t a i n e d 12-18% l e a l t h care cost
premium increases b u t has n o t been able t o pass i n c r e a e onto consumer
marketplace. Also, proposed reguirement t o cover 3/4 o f dtnployees premium
c o s t s would p u t them o u t o f business.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
012. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
04/01/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
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Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) of thc FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�April 1, 1993
Mrs. Hilary Rodham Clinton
The White House
Washington, D.C. 20500
Dear Mrs. Clinton:
I am a small business owner in Milwaukee, Wisconsin. I am concernedabodl the health
care crisis in this country as it has affected my personal health care and thea irtto our
business.
myself as well as
First, we operate a small design-buildfirmthat employs my husband and
3 other employees. The problem we have faced over the years is that we tunjc
been
refused coverage by all of the insurance companies here in Wisconsin. The
cidy
companies that would consider us were H.M.O.8. So we have been on an D
PI •plan
through Primecare. The complaint that we have is that the cost for this
covet ige is too
high for our company and yet it is our only option.
Second, every year we are faced with a price increase on our premium and cannot pass
\
iw:
this increase along to our customers or we would not be competitive in this industryHow " \ \
each yeart
can a small business survive with the 12 to 18 percent increases we receive
/
This has got to stop or it wQlfinanciallydevastate the small businesses such ai
ours.
Also, we cannot afford to pay more than 1/2 of the premium, as we currently lo, for it
to pay
will be too costly. Your task force has had suggestions that employers be reqtyred
up to 3/4 of the cost of the premium for each employee, this is asking small
businesses to
incur too great of a cost for health insurance coverage and wiD do more to
driie more
companies out of business.
The quality of care I have receivedfromPrimecare has generally been good,pwever, they
have on several occasions denied claims forreasonswe did not feel was legjtiiWate so
and
when we disputed their denials, it fell on deaf ears. To be fair to the consumqi, believe
I
that insurance companies should be required to submit the claim disputes to outside
ai
board who would make the decision, not the insurance company. The Insurance
Commissioner has done little in this area to help.
djf
•P6/(b)(6)
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DOCUMENT NO.
AND TYPE
013. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)]
Freedom of Information Act - |S U.S.C. .S52(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information |(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
h(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOI A]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN UT-1
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
,;Yi. ,•:'"< •' ..• '
^
;
1
5
;
" '.•,I'•^,",'^•i-''>•'' ^ '
. P6/(b)(6), , ,
.
_
BRIEF SYNOPSIS OF LETTER
42 year o l d woman l o s t j o b i n bank, went t o work f o r s m a l l
business, they p r o v i d e no insurance, found t h a t even linimum
p r i v a t e insurance c o s t s $400/month, a l s o 81 year o l d t a t h e r - i n law i n j u r e d neck i n farm a c c i d e n t . Medicare w i l l only) cover 82
days o f longterm care, n u r s i n g home w i l l c o s t $2500/m^nth p l u s
medications
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
LIMITED BENEFITS
LONG TERM CARE
PRESCRIPTIVE DRUGS
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
HOSPITAL/NURSING HOME CHARGES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICARE
LONG TERM CARE
�January
31 , 1993
Mrs. H i l l a r y C l i n t o n
The White House
Pennsylvania Avenue
Washington, D.C.
Dear Mr s . Ci in con :
I have never even w r i t t e n a l e t t e r i o the e d i t o r of our l o c a l
newspaper, so i t seems odd t h a t I would s t a r t w i t h the F i r s t
Lady o f the U n i t e d S t a t e s , b u t I f e e l you w i l l be i n t e r e s t e d
i n what I have t o say.
A number of year.* ago, i he;-! rd Johnn\ Ca rson say t h a t the d e f i n i t i o n
of a r e c e s s i o n i s when your neighbor loses h i s j o b . The d e f i n i t i o n
of d e p r e s s i o n i s when YOU lose your j o b ! I am a -t2-year o l d woman
who has had t o work since T moved from my p a r e n t s ' home i n 1970.
.
For t h e past 20 y e a r s , I have been i n b a n k i n g , t h e l a s t 14| years
at a l o c a l bank w o r k i n g as a loan o f f i c e r .
I t was n o t t h e career
I would have chosen 20 years ago i f had known I would be w o r k i n g
t h i s l o n g , but 1 d i d nor 'nave- the c o l l e g e degree 1 needed t o apply
f o r a number of p o s i t i o n s .
On October 30, 1992, our Regional Manage
came t o our branch s p e c i f i c a l l y t o meet w i t h me. I was t e r r i f i e d ;
I was a f r a i d I was l o s i n g my j o b and a l l t h e s e c u r i t y t h a t goes
w i t h i t . I had n o t been p a r t i c u l a r l y happy t h e r e and had looked
elsewhere, b u t I. found t h a t I would be s t a r t i n g over f i n a n c i a l l y
i f I changed employers.
7
He s t a r t e d our meeting w i t h " I n my 2 years o f b a n k i n g , t h i s i s
the h a r d e s t t h i n g I have ever done." That's a l l he needed t o say.
I knew I had l o s t my j o b . We had j u s t had a change i n managers.
The new one i s young and a m b i t i o u s and spent much more time a t t h e
o f f i c e than the former manager. The Regional Manager s a i d they
j u s t d i d not need a loan o f f i c e r i n a d d i t i o n t o our manager.
They
were r i g h t .
T was not busy a i l the t i m e , and I u n d e r s t o o d . The
problem l i e s i n h a n d l i n g such a d r a s t i c change i n income and
benefits.
During our c o n v e r s a t i o n , he s a i d , " I don't know your
personal s i t u a t i o n .
Do you NEED t o work?"
I came unglued and
s a i d , "My husband i s a farmer. He b r i n g s home $1,000 per month
and the r e s t i s up t o me." There was s i l e n c e i n t h a t room. I
d i d n ' t bother t e l l i n g him that we are i n our l a s t year o f c h i l d
support payments which are now $200 ner month. J u s t as you t h i n k
women have come a long way, someone says, "Do you REALLY need t o
work?
�In a l l honesty, the bank was very f a i r t o me. I r e c e i v e d 4
months severance pay, and they sent me t o an outplacement f i r m
t h a t helped me g r e a t l y i n f i n d i n g a new j o b .
^
In December I found a dream-come - true- j o b as manager o f a
l o c a l shop t h a t has c r a f t s , custom b l i n d s and c u r t a i n s , wedding
d e c o r a t i o n , e t c . The owner i s w o n d e r f u l , but because t h i s i s
a small shop, there are no insurance b e n e f i t s . We have checked
w i t h a number o f p l a c e s . Because my husband i s s e l f employed
and a farmer, i n d i v i d u a l insurance costs a f o r t u n e . He has had
some h e a l t h problems i n the past few years which caused a couple
of insurance companies t o deny h i s g e t t i n g insurance at a l l .
We t a l k e d t o one insurance agent who r e p r e s e n t s the N a t i o n a l
A s s o c i a t i o n o f the S e l f Employed. His best o f f e r would c o s t
us $500 per month and would only cover h o s p i t a l charges a f t e r /
paying a $600 d e d u c t i b l e f o r EACH OCCURANCE. Another o p t i o n i s ;
f o r me and the g i r l s t o go w i t h one company and Joe a t another.
I t w i l l s t i l l cost us a minimum o f $^00 per month w i t h no a s s i s tance from an employer.
People are f o r c e d t o stay w i t h a j o b they hate - as i d i d f o r 20 years and longer j u s t because they can't a f f o r d t h e
insurance premiums i f they are s e l f - e m p l o y e d .
My daughter now has some back problems, and I am a f r a i d t o s w i t c h
insurance companies i n case she- needs surgery.
Two days a f t e r I began my new j o b , my f a t h e r - i n - l a w had an
a c c i d e n t on the farm.
Twenty bales o f hay came down from t h e
s t a c k and broke h i s neck i n t h r e e p l a c e s . The farm insurance
w i l l n o t cover him f o r a c c i d e n t s because he i s 81 years o l d .
He was i n i n t e n s i v e care f o r over two weeks because he was on
oxygen w i t h a b r e a t h i n g cube, a f e e d i n g tube, and had a " h a l o "
neck brace d r i l l e d i n t o h i s head. He i s now i n a n u r s i n g home s t i l l on oxygen w i t h a t r a c h - t u b e , f e e d i n g tube, and t h i s awful
headgear. The d o c t o r advises us t o keep him i n t h e n u r s i n g home
u n t i l t h e h a l o i s removed. The time v a r i e s from t h r e e t o s i x
months or l o n g e r . C o n s i d e r i n g t h e f a c t t h a t he i s 81 and a
d i a b e t i c on i n s u l i n , we don't expect the recovery t o be v e r y
q u i c k . Medicare informed my husband t h a t they w i l l o n l y cover
the f i r s t 82 days o f h i s time i n the home. The base cost therei s $2500 or so plus a l l the drugs and a d d i t i o n a l care.
To take him home before he i s healed w i l l be i m p o s s i b l e .
Before
h i s a c c i d e n t he had d i f f i c u l t y w a l k i n g because o f a h i p replacement
s e v e r a l years ago. With the h a l o , he i s very unsteady. This 6'3"
man cannot be supported at home by h i s 5'2" - 100-pound w i f e .
My husband i s t h e i r on'!;.' civile! and i s now t r y i n g t o run t h e
f a m i l y farm by h i m s e l f w i t h a p a r t - t i m e worker. There a r e n ' t
enough hours i n the day f o r him t o take care o f h i s f a t h e r and
run t h e farm.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
014. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
01/31/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jin812
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. SS2(b)|
PI National Security Classified Information 1(a)(1) of thc PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of thc PRAj
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information [(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
nnancial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�3
During the e l e c t i o n campaign, we kept hearing your hjipsband talk
of r i s i n g h e a l t h costs and • he unemployment problems Suddenly,
;
w i t h i n a 60-day p e r i o d , we were part of those s t a t i s t i c s
My l e t t e r to you i s to l e t you know that there are rr^ny of us
who need help with health and insurance costs. I wajtch my husband
work 7 days a week
365 days a year, and half of his wage w i l l
be going to insurance premiums.
1 have a dear f r i e n d at the h.-mk that is dying of c aliticer. She
has had chemo treatments, l o s t her h a i r , her a p p e t i qe, and her
w i l l to l i v e .
But even though she i s 63-years o l d , ;he i s not
e l i g i b l e f o r r e t i r e m e n t yet and cannot a f f o r d t o q u i her job
because she w i l l lose her insurance. This past week she was
h o s p i t a l i z e d w i t h pneumonia. She i.s home now on oxyljen at night
but hopes to r e t u r n to worh i n r, we el-: or so.
Something i s wrong here
very wrong. 1 have confidence i n
you personally that you w i l l help the Americans with their
health care. That confidence in you i s what gave me the confidence
to write t h i s l e t t e r .
Thank you f o r your time,
a l l you are doing f o r ou:
wish vou and your husbanlip well in
ni-i* r v .
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
015. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Erecdom of Information Act - [5 I'.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment tn Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRAj
P5 Release would disclose conndential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRAI
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�CONSENT GIVEN 08/2 /93 CD: VA-1 & 7
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
A gentleman who owns h i s own business w r i t e s i n support o f i e a l t h reform. He
f e e l t h a t t h e system we have now i s s t u c t u r e d f o r t h e very r i c h o r t h e very
poor. He c o n t i n u e s t h a t t h e pharmaceutical companies a r e Overcharging and,
consequently, sucking t h e l i f e b l o o d o u t o f America and i t s people. He
s t r o n g l y supports change.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
HOSPITAL CHARGES
DOCTORS FEES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
016. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
04/14/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAJ
National Security Classified Information |(a)(l) of thc PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�A p r i l 14,
1993
L>s.
Clinton
c/o H-e-.lth Csre T'i.^k Force
V/hi-e House
D.C.
I
Tn -:
t i n j tc c..mnlirr.ent yon on your endeavors t
9 "y.'ten to the p o i n t t h ? t i t v : i l l s e r v i c e
of Ar. ,;^
v= i t m o u l d . Anyone ••./ith a g^.in o f i n t e i
re::: i s u n f a i r •••nd s t r u c t u r e d f c r the
v..-"
-o r . rr." " i e r have t h « rnon^y to pr:y f o r top ca
.-r: rr. . r-':'. t i -vein f r*:r the j c v e r n e n t .
.." ••Ir". -n-'i I .^-r.
-11 businers ?n& f o r the Iris
r ?T. j - r . "rhle to ; ; y f i . r ho2: t h ihwUr^r.ce. Sc evdry
c io-.c-r- ^•..•r> tc y - u . ' he•••.•'• pr.d ' v r n i e r i n g i f ever, a r
:' 0 i x'": 1 TV--- i ' l v/ip-'. out 30 yeqrs of hard work. J
r.-r. f
to f i l l n ^ . r e i : r i ^ - i c r . and 40 cqp.?ule.t cost $.
thri s b p' -o vec to c o n t i n u e . The pharmaceutical comp
h o - ; ; 1 " -re plov/ly ruc-cin^ the l i f e b l o o c out o f A
m
i
Q
>
-
b r i n ^ our
the c i t i z e n s
igence can see
ery r i c h o r the
e and the poor
3 years hsve
ay i s l i k e having
l a t i v e i y short
at r e c e n t l y , I
42.00. How can
m e s and t h e
r i c a and i t c '
—. •
I ••"'; bier clo.-ely ••:-tc.'tinj the v v r i c u s t)r:v:r ms n C-Span and
:•.•
Vv-.v- be ' •v - z-c: - t th-3 a t t d t v d e o f the h e - l t l f c-re nd....-.try. They
hoiy
f •••fIw.- -hove r e g u l a t i o n and. beyond any re."t i c t i o n z . I t ' s
•
as f a r ac they are concerned. There
•. tl - • ; - t o r ! : v-s i t . " s i t u a t i o n
' "' .OS-.
; .' fc-r the h e a l t h i n i u c t r y i n v e s t o r s d scussed than the
.n
f
.-rick ?.r.d d y i n ^ c: tir.enc o f t h i s countbfy. The h e a l t h
. '- •.--•- a-:
.^ •-.:•; :-;
a- t'-'O'/yh th-ay are ans a r a b l e o n l y t the;r. .elves and
" • 0 - r.olerate a r y i n t e r f e r e n c e from t h " oeo ,le 0 • t h . go; e^r:-!!:-nt.
_ •
un ' • ur:'---tely, i n the :ar?t our govern:.icnt has enc uraged the
•
of
in .. u . - -r hcv-Jth care t o put p r o f i t s before h e a l t h Kov;, however,
I fe":! ^ 1:: a? about t o change. 3y a p p o i n t i n g you t o lead t h e comr.icsion, I f e e l President C l i n t o n t r u l y srjovvs h i s cohtcern f o r t h i s
i n g problem. I f e e l t h a t you, President Cl .nton, A l and
lony-st:
T l p ; e r ( re h-.ve shov/n g r e a t courage and d e t e n n i n a t i >n i n s t a n d i n g
ur t o z: h i y h l y organized and f i n a n c e d h e a l t h Indus r y . Do n o t be
disc cur- ac. by t h e a t t a c k s on you and t h e P r e s i d e n t , iviost o f t h e p u b l i c
support s t r u e h e a l t h r e f o r i n and your e f f o r t s t o c o r r act a l o n g overdue
sad s i t ua t i o n i n t h i s c o u n t r y .
1 1
lt
'"' \ J. ^ • ' • • ^
" ; ': .
P6/(b)(6)
,
'•> . -'{; . ••,
— • • ',
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
017. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information [(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIAJ
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/ 5/93
PERSONAL STORIES DATABASE
CD: TN
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Small business owner, o r i g i n a l l y was paying $239. 93/qLarter f o r
insuruance, now c o s t s $1,166.69/quarter w i t h $1,500 d l i d u c t i b l e ,
f i r m i s locked i n t o insurance company because w i f e h a i nonmalignant lumpectomy s e v e r a l years ago
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
LOCKED INTO INSURANCE COMPANY
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
018. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)l
Freedom of Information Act - (S U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRAI
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P.S Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforecment
purposes 1(b)(7) ofthe FOIA)
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN P8/24/93 CD: AR-3
TO USE LETTER BUT WOULD APPRECI1 LTE NO NAME USED
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
•r
f,
P6/(b)(6)
Co'
BRIEF SYNOPSIS OF LETTER
Small business owners l o s t insurance, when insurance comp ny was sold, new
company no good.
Replacement deductable
policy very limited, only
h o s p i t a l i z a t i o n , worried about loopholes i n other p o l i c i 4 ^3 cancel a t any
Lci€:
time, does not have chronic i l l n e s s , very expensive medicat Lon not covered.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
LIMITED BENEFITS
OTHER—Only h o s p i t a l i z a t i o n , no medication
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
019. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
02/12/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the F'OIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRAj
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or conndential commercial or
Financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile deFincd in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�y
R0
P6/(b)(6)
February
12,
1991
Ms. H i l l a r y C l i n t o n
Health Care Task Force
The White House
Washington, D.C.
Dear Ms.
Clinton:
The media observe o f t e n t h a t t h e r e are about f o r t y
m i l l i o n Americans w i t h o u t h e a l t h insurance
It is
less w e l l known t h a t there are m i l l i o n s more who do
have h e a l t h coverage which i s flawed and nadequate.
This i s e s p e c i a l l y the case f o r those of i s who are
self-employed.
Ny w i f e and I are i n our l a t e f o r t i e s . W e own and
l:
operate a very small r e t a i l business whicli up t o now
has provided a decent, lower middle c l a s s l i v i n g
standard f o r our f a m i l y of f o u r . When we began i n
business f i f t e e n years ago, people i n our category
could purchase good, comprehensive h e a l t h coverage.
This i s no longer the case.
About t h r e e years ago we were f o r c e d t o f nd a new
p o l i c y because the company which had covered us was
sold and the emendations i n coverage o f f e r e d by the
successor company were w h o l l y unacceptabllEi
We
shopped d i l i g e n t l y , t a l k i n g w i t h numerous salesmen.
At l e n g t h we were compelled t o purchase a p o l i c y which
provides payment only f o r h o s p i t a l i z a t i o n
It will
not pay f o r medications or proceedures ot: er than f o r
inpatient, hospitalized patients.
There were other
insurance plans a v a i l a b l e which provided or o u t p a t i e n t
care and medications, but every one of thsis e — i n the
f-wfiie p r i n t — g a v e the insurance company ({.he o p t i o n
t o cancel us a t t h e i r d i s c r e t i o n . This f awed, hosp i t a l - o n l y p o l i c y , was the very best we cciu I d f i n d a t
any p r i c e because i t could not be cancel
(We had
commercial neighbors who indeed were cane l i e d when
the w i f e s u f f e r e d a d e b i l i t a t i n g i l l n e s s .
�page 2
For the p o l i c y which I have described we >ay $5,000.
per year. I t has a high d e d u c t i b l e and p i t i f u l l y
parsimonious s u r g i c a l allowance, which tcj'jether assure
t h a t t h e insured w i l l pay a l a r g e chunk c : any
hospitalization.
Since we took t h i s p o l i c y I have been diejnosed w i t h
a chronic i l l n e s s and have been h o s p i t a l ! :ed t w i c e .
We have paid d e a r l y each t i m e . As t h i s i .Iness progresses,
i t w i l l r e q u i r e thousands of d o l l a r s per rear i n o u t p a t i e n t medications. Already our house j f a l l i n g
apart because there i s no money f o r upkee 5. We are
unable t o send our daughter t o c o l l e g e , ^nd yes,
e v e n t u a l l y I w i l l d i e f o r want o f medicat ions which
are beyond our a b i l i t y t o purchase.
This country needs a Canadian s t y l e healt care system,
but t h a t i t probably impossible p o l i t i c a ] Ly. The next
best a l t e r n a t i v e would be a comprehensivt system o f
hoin. C u r r e n t l y ,
HMO's i n which everyone has t h e r i g h t t o
HMO's w i l l have n o t h i n g t o do w i t h t h e s4 M employed,
Our c u r r e n t h e a l t h care system i s a t onc€ c a p r i c i o u s
and i n d i f f e r e n t .
My w i f e and I have voted f o r you and B i l many times
and we know t h a t your hearts are i n t h e Lght place,
i
(How good i t i s — a f t e r a l l these y e a r s — t 3 be able
to w r i t e the White House, knowing t h a t or 2 i s addressing
f r i e n d s . ) May God g r a n t you success as vbu work t o
b r i n g j u s t i c e t o our h e a l t h care d e l i v e r y system.
I am r e s p e c t f u l l y yours,
P6''(b)(6) .
.".^ :-:y . •" . r-^,^ < . ; . ^ '^.„• .
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
020. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [S U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA)
b(l) National security classified information [(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute |(h)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe F01A|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(H) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/24/93 CD: CO-3
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Sandra, M i t c h and t h e i r 6 c h i l d r e n represent minimum wage en;>loyees - working
($8,000 t o
f o r themselves
o r small companies w i t h no insurance
$22,000/year) 16 year o l d son working f o r a neighbor c u t his f i n g e r s o f f . No
insurance; neighbor's homeowner's p o l i c y denied a l l o f f i rt $31,000 except
phic
$1,000.
$20,000 more (neurosurgery) needed. Need c a t a s : r ojphic coverage,
Close t o 50, b o t h employed, b u t worse o f f f i n a n c i a l l y the(h any o f past 30
years, w i t h many l a y o f f s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
OTHER CONTENT - LOW INCOME PEOPLE
HAVE NO COVERAGE
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
021. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
DATE
02/03/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
('residential Reeords Aet - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) of thc FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(S) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�3-
CC
C C
P6/(b)(6)
c
c c c c
O ( v. C 3 «
C • ( ( c.«
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c m -c c •
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.
.
V
�CONSENT GIVEN 08/24/93 CD: TX-22
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
L o i s Gremminger
Elge I n c .
P.O. 944
Richmond, TX 77406-0944
(713) 232-0463
BRIEF SYNOPSIS OF LETTER
W r i t e r and husband have s m a l l p h a r m a c e u t i c a l m a n u f a c t o r i n g
business,
s p e c i a l i z i n g i n g e n e r i c drugs.
But as an "S c o r p . "
they are personally
t a x e d on t h e i r own (owners) i n s u r a n c e , C c o r p s , don't pay t a x e s on i n s u r a n c e
provided.
I f s m a l l p h a r m a c e u t i c a l mfgs. have t o p r o v i d e i n s u r a n c e , t h e y
don't be a b l e t o keep p r i c e s down. H e a l t h p l a n = i n c r e a s i n g m e d i c a l c o s t s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
�Elge,
Inc.
P.O. Box 944
Richmond, Texas 77406-0944
(713) 232-0463
May 19,
1993
Mrs. Hillary Clinton
Chairperson of the National Task Force on Healthcare Reform
The White House
1600 Pennsylvania Ave./ N
W
Washington, D.C. 20500
RE: Healthcare Reform
Dear Mrs. Clinton:
The reform of our nation's healthcare i s a great undertaking and
I applaud you for your interest and concern; however, I am concerned
as a small business owner and a pharmaceutical manufacturer as t o how
the reform w i l l affect our only means of supporting our family. I
would l i k e to take this time to share my views of the current affect
of health care as well as my views on the industry.
My husband and I have been small business pharmaceutical
manufacturers for 13 years. Our company specializes i n generic drugs
because we feel that i s the best area to help control pricing and
a v a i l a b i l i t y to individuals. However, we are penalized for supplying
health insurance to ourselves, because we are a "S" Corporation we are
personally taxed on the insurance provided t o us as owners. Yet our
employees do not pay taxes on the insurance which we pay for them.
This does not seem f a i r to us. Yet i f we provide insurance f o r
ourselves and not our employees there i s a cry of "discrimination"
against the employees. However, I say that as owners of a "S"
Corporation we are discriminated against. Regular "C" Corporations do
not pay taxes on the insurance which they are provided. Can something
please be done to relieve the load which S Corporations bare i n trying
to provide insurance to themselves as well as their employees?
Secondly, i t i s imperative that generic companies are not hurt by
the Health Reform because of the tremendous amount of energy and money
i t currently takes just t o compete with the branded and/or large
corporations i n order t o control drug pricing. Many generic
manufacturers make a very low p r o f i t , at least I know our company
does, i n order to provide lower pricing for therapeutically equivalent
drugs. I f small pharmaceutical manufacturers are forced by mandate t o
provide insurance, then the low drug prices which they currently are
trying to maintain become higher and higher. I t ' s l i k e a vicious cycle
— more mandates, higher cost, higher prices.
�Page 2
I really feel that i f we are t o manage health care cost, we
should look into the amount of money which i s currently being spent i n
the Department of Health and Human Services wastefully, and the
increased cost associated with business performing to more government
regulations. Health Reform i s only another government regulation which
in the short term may sound great, but i n the long term w i l l only
cause increased drug pricing and higher medical rates.
Please reconsider the health reform policy.
Thank you for your commitment and your interest i n controlling
healthcare costs.
Sincerely,
Lois Gremminger
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
022. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)]
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion nf
personal privacy 1(a)(6) of thc PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/23/;3 CD: CA-44
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
W r i t e r employs an aide t o care f o r w i f e w i t h A l t z h e i m e r ' s concerned about
paying h e a l t h b e n e f i t s f o r aide, a l r e a d y pays s t a t e unemployment d i s a b i l i t y ,
and aide, hopes
employment t r a i n i n g t a x , SS and Medicare t a x f o r b o t h himse
t h a t i f he has t o pay h e a l t h i n s f o r aide t h a t govt, w i l l cttver c o s t o f home
h e a l t h care f o r w i f e .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
LIMITED BENEFITS
HOME HEALTH CARE
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
023. letter
SUBJECT/TITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
05/25/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information [(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) of thc PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�P6/(b)(6)
May 25, 1993
Health Care Task Force
O f f i c e of the White Hoi ~
The White House
Washington,D.C.
RE:
^pe/tbxe).
Employer Tax P o r t i o n of Recommendations
Dear Persons:
1
I am a small employer and have r e c e i v e d the impress!0 1 t h a t a t a x
i s t o be imposed upon the small employer t o cover paf of the
expense associated w i t h the enhanced h e a l t h program 3 be
proposed by your group.
My p a y r o l l c o n s i s t s of one person, h i r e d t o be i n my lome d u r i n g
the daytime hours of noon t o s i x p.m. f o r f i v e days ; sr week,
Her d u t i e s are t o care f o r my w i f e who has alzheimer^ and i s
ambulatory but needs care f o r d a i l y types of tasks, iHath, t o i l e t ,
dressing, p r e p a r i n g meals, e t c . My employees s a l a r y s $250.00
per week or $13,000 per year.
I am now paying s t a t e unemployment insurance (3.4%), d i s a b i l i t y
insurance (1.3%), and employment t r a i n i n g t a x (0.10% b o t h sides
f o r me and my employee.
A d d i t i o n a l l y , f e d e r a l s o c i a l s e c u r i t y t a x (12.4%) and medicare
tax (2.9%) i s payable.
Aside from t h i s t h e r e i s due b o t h the f e d e r a l and st£|te personal
income taxes on my own separate incomes which are qu te modest.
Now my p o i n t i s t h a t t h i s issue should be c a r e f u l l y iieviewed t o
e s t a b l i s h the a p p r o p r i a t e basis f o r your proposed small business
" h e a l t h s e r v i c e s " t a x as i t might apply t o my s i t u a t |on. My
employee i s senior and i s m a r r i e d t o a man w i t h b o t h medicare and
a p u b l i c agency sponsored medicare supplement prograijr f o r which
she i s e l i g i b l e . She does not need a new h e a l t h program nor does
she want one as she has l i t e r a l l y 100% coverage f o r 11 forms of
ailments.
Please do respond t o my comments as I do a p p r e c i a t e :he work
which your group i s doing and wish t o make i t f u l l y iicceptable.
I am b r i n g i n g t h i s s i t u a t i o n t o your a t t e n t i o n so t h f l t your
�planning mechanisms v t i l l give f u l l consideration t o tfpe end
product of your program, that i s t o provide f o r heal coverage
to those now lacking such personal care a t t e n t i o n .
Should I be subject t o some form of health services 4^x, then I
would hope that your group would give great weight to an
insurance type program whereby my wife would be e l i g Die f o r home
health care services payments t o cover the s i t u a t i o n urtiich I have
described. I am prepared t o pay f o r t h i s but would 4pcpect t o be
grandfathered i n f o r acceptance at the program inceptj:fi.on.
Sincerely,
P6/(b)(6),
cc: Senator Feinstein
Congressman McCANDLESS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
024. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jin812
RESTRICTION CODES
Presidential Reeords Aet - (44 U.S.C. 2204(a)|
Freedom of Information Aet - |5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of thc PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN )8/23/93 CD: TX-5
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
:[„vi...
•
'•.'<,•
.
1
•
'•'M'- P /b( ) ' '"-.'ffi*'-' ' "'
6( )6
:..
-y.-.-V^.'- .,
BRIEF SYNOPSIS OF LETTER
This woman says t h a t her small business took insurance f torn LGS insurance
company i n Sept. 1991 and t h e r e have been t h r e e increases s i n c e t h a t time,
The t h i r d being more than 70%. They ask t h e task f o r d e t o "plesas be
i n s t u m e n t a l i n h e l p i n g small business i n t h e regard."
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
025. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jiTi812
RESTRICTION CODES
Presidential Rceords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information |(a)(l) ofthe PRA]
P2 Relating to the appointment lo Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOI A]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforecment
purposes |(b)(7) ofthe FOIA]
b(K) Release would disclose information concerning the regulation nf
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�, .-.i.-H.:
MRS. HILLARY CLINTON
INSURANCE ADVIC-ARY COMMITTEE
k'HI TE HOUSE
WASHINGTON. D.C. 20510
DEAR MRS. CLU-JTON:
HAPPENING TO
I
E'JCLOSINC A VERY GOOD EXAMPLE OF WHAT I S
r!..' tWZ.y.-lZSZ OWNERS IH REGARD TO INSURANCE.
.-A.v
.j!,r COnr-ANY TOO!' INSURANCE FROM LGS INSURANCE (COMPANY I N
E
R . r-^j AIJD THE ENCLOSED REFLECTS THE THI R b INCREASE
i
T H- T DATE.
/
o
THE LATEST BEING MORE THAN 70 o INCREASE . MORE
L*"•! COMPAHY CAN WITHSTAND. OR EACH EMPLOY!!E REPRESENTED
'':_.
: J " ' t-<.- T r i
r
C C
T
1
YQ ,! .
T 1. 117
NSTRU.MErJTAL
I N HELPING
SMALL
BUSINE: SES
I N THIS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
026. statement
SUBJECT/TITLE
DATE
re: Insurance premiums and rates (4 pages)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
,jm812
RESTRICTION CODES
Presidential Records Act - \44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information coneerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of thc PRA|
(.'. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
027. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
PrcsidentiHl Records Act -144 U.S.C. 2204(a)]
Freedom of Information Act - |S U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of thc PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/24/93 CD: CA-51
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
. . i
' ,:v j.
P6/(b)(6). ,
:
"'••V
'-.V.
-,
,
:'' •
•
'
,». -.
BRIEF SYNOPSIS OF LETTER
owner o f small business was f o r c e d t o l a y o f f 10 o u t o f 14 employees d u r i n g
slow-down because could n o t a f f o r d t h e cost o f h e a l t h Ins.ranee f o r a l l o f
the employees
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
028. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/30/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
1 2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
*
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose conndential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA|
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�t'W
1
KF' '
•^
'
.V"
'
- : • *: .-: •".
. P6/(b)(6)
;
1
-
1
March 30,
,
.:-,..J'
1993
Dear H i l a r y :
Enclosed i s a summary of my f a m i l y ' s experience w i t h our c u r r e n t
U.S. h e a l t h
h e a l t h care system.
I t i s another example of why thi
care system i s screaming f o r reform. I am d e l i g h t e d you are
a t t a c k i n g the problems our n a t i o n faces i n t h i s area
Although I d i d not vote f o r Clinton/Gore, I support our e f f o r t s
ittessman
t o reform our h e a l t h care system.
I am a small b u s i
p r o v i d i n g energy and mechanical design c o n s u l t i n g s e r v i c e s t o
a r c h i t e c t s i n Southern C a l i f o r n i a . During t h i s rece s i o n my
s t a f f has been cut from f o u r t e e n employees t o f o u r , One of the
main reasons I had t o l e t go of t e n wonderful employ)!!es was t h a t
I c o u l d no longer a f f o r d the h e a l t h insurance premi
IU:LS f o r t h a t
many employees. My business went from g r o s s i n g 750, 00 0 a n n u a l l y
t o 250,000 annually and the hardest d e c i s i o n ( l e t t i n g go
employees) was made easy when I r e a l i z e d how much I itould save
i n monthly h e a l t h insurance premiums alone.
One l a s t word. I have spent countless unproductive ours t r y i n g
t o r e s o l v e t h i s d i s p u t e w i t h Blue Cross over $300 no y e t p a i d t o
M i l l s H o s p i t a l . These were hours which could have blien used
a t t e m p t i n g t o generate new business, a much more p r o d u c t i v e use
of time f o r myself, f o r my f a m i l y , and f o r my remain ng employees.
I f you would l i k e t o c a l l me f o r f u r t h e r i n p u t or id|^as, I can be
reached daytime a t
'P6/(b)(6).
Thank you f o r your d i l i g e n t work on behalf of a l l Airjfricans on
t h i s c r i t i c a l matter.
•^^/(bxe)
P6/(b)(6)
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
029. letter
SUBJECT/TITLE
DATE
Personal (Partial) (1 page)
02/19/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(h)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRAj
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�February 19, 1993
Aaron S. Jackson, A t t o r n e y a t Law
12 04 Burlingame Ave.
Burlingame CA 94 010
RE: Packet Number:
-P6/(b)(6)
Dear Aaron:
The e n t i r e amount you are attempting t o have me pay or
medical expenses i n c u r r e d from your c l i e n t i s not my
responsibility.
Enclosed i s a summary showing a l l of my f a m i l y ' s med
f o r 1991. I t shows t h e h e a l t h coverage plan from B l
s e l e c t e d . This plan l i m i t e d our personal r e s p o n s i b i l
medical b i l l s t o $2,125 ($250 d e d u c t i b l e + $1,875).
the e f f o r t s I made throughout the course of 1991 and
each p r o v i d e r p a i d by both myself and by Blue Cross.
1991
cal b i l l s
e Cross we
t y f o r our
I t shows
1992 t o get
There i s a l s o a Blue Cross claim form p r o v i d e d f o r y ur c l i e n t t o
submit t o Blue Cross. Please note i n t h e A l l i e d C l i i c a l Lab
s e c t i o n of t h i s c o m p i l a t i o n of our medical r e c o r d s t a t A l l i e d
C l i n i c a l Lab was mailed a Blue Cross c l a i m form on O t o b e r 16,
199 2 along w i t h our Blue Cross Prudent Buyer Plan Me ber Card,
Since I have not heard from them I am assuming t h a t here f i n a l
amount due was p a i d by Blue Cross. My recommendatio , t o your
c l i e n t i s t h a t they do l i k e w i s e and resubmit t h e i r c aim t o Blue
Cross on t h e c l a i m form provided.
I f t h e r e i s f u r t h e r d i s p u t e of t h i s c l a i m by your c l ent, I would
l i k e t o have a t r i a l by j u r y t o o b t a i n a judgment,
(eedless t o
say, t h i s has been a tremendous nuisance t o me.
I h ive been
d i l i g e n t i n p u r s u i n g payment f o r a l l of our p r o v i d e r ; and I p a i d
my h e a l t h insurance premiums i n a t i m e l y f a s h i o n ,
i s my
d e s i r e t o see t h i s d i s p u t e ended as q u i c k l y as possipbl e.
�One l a s t word. I now r e a l i z e t h a t my experience i n t h i s o r d e a l
I t cost
i s what has Americans screaming f o r h e a l t h care reform
Much o f t h a t
$18,400 f o r us t o b r i n g a new c h i l d i n t o t h e w o r l d
cost goes t o paying f o r those persons who do n o t ha e h e a l t h
insurance b u t s t i l l b e n e f i t from our h e a l t h care sy tern. Much of
e
t h a t cost u n d e r w r i t e s t h e insurance companies and t : i r numerous
employees p l u s whatever a d m i n i s t r a t i v e costs are as o c i a t e d w i t h
processing claims. And then much o f t h e cost suppo t s t h e l e g a l
p r o f e s s i o n which o f t e n steps i n t o attempt t o clean up f i n a n c i a l
i s t h e case
entanglements between p r o v i d e r s and p a t i e n t s such
w i t h your t a k i n g on t h i s unaccounted f o r b i l l by yolir c l i e n t .
I t seems t o me t h a t by e l i m i n a t i n g these t h r e e majoff addendums t o
the present cost o f running our h e a l t h care system our $18,400
b i l l f o r b r i n g i n g a much loved and wanted c h i l d into* t h i s w o r l d
could be reduced s i g n i f i c a n t l y . So t h a t my o p i n i on i s heard, I
am sending a copy o f t h i s l e t t e r t o H i l a r y C l i n t o n along w i t h t h e
c o m p i l a t i o n o f our medical records f o r 1991.
P6/(b)(6) •
' V, ,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
030. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRAj
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FTMA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/23/ 3 CD: CA-12
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
1
V*;;-?"
• ^J' •
.
...
6 3^
-;
; , , a .rv.
:
•tp.'.
BRIEF SYNOPSIS OF LETTER
owner o f small business denied coverage because she was verweight, notes
t h a t i n l a r g e r f i r m s w i t h l a r g e group p o l i c i e s , they do n o t Jeny coverage f o r
t h i s type o f c o n d i t i o n .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
031. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
PrcsidentiHl Records Act - |44 U.S.C. 2204(H)]
Freedom of Information Act -15 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) of thc FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
Nationnl Security ClassiFied Informalion 1(a)(1) ofthe PRA]
Relating to thc appointment to Federal office |(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�r
—-• • •
<.
_
%
—-•-
,.• .„
_
February 24, 1993
H i l l a r y Rodham Clinton
1600 Pennsylvania Avenue N.W.
Washington D.C. 20500
Fyp.ruti.ve O f f i c e s
Dear Mrs. Clinton,
4
Welcome to the White House, and your new duties i health care
reform.
I am writing today because of my recent exclusio from Kaiser
Permanente's Medical Plan because of my weight. I wasl born f a t and
have been f a traye n t i r e l i f e . I don't have high blooj: pressure or
any other r e l a t e d conditions. I find t h i s not only d scriminatory
against f a t people, but also genetic screening, and to the extreme,
Darwinism.
More importantly, I was discriminated against because I own my
own business, which i s too small to be e l i g i b l e for . group plan,
People applying as a group don't f i l l out any questio naires about
t h e i r medical h i s t o r i e s .
This i s a continuing problem a t my house, sindfc my husband
works at Sear's i n s t a l l i n g t i r e s .
His employment : part-time,
.
expressly so that he i s not e n t i t l e d to any benefits uch as group
health care.
When I contacted Kaiser, I was looking for a l l ! i n c l u s i v e ,
q u a l i t y health care, for $3,000 per year for both o us. I w i l l
continue to search.
I t seems, i r o n i c a l l y , that only Medical doesn't iscriminate.
Sincerely,
�CONSENT GIVEN 08/25/93 CD:
PERSONAL STORIES DATABASE
NJ-11
IDENTIFICATION OF WRITER
Ann Hoag
R o l f i s O f f i c e Machine Repair
4 L i n c o l n Place Box 182
Madison, NJ 07490
(201) 822-1243
BRIEF SYNOPSIS OF LETTER
Employee hasn't bbeen a b l e t o buy c o m p e t i t i v e i n s u r a n c e . Small business w i t h
one f u l l - t i m e employee i s b e i n g charged $12,000/year f o r i n s u r a n c e premiums.
Advocates f o r i n s u r a n c e p o o l so s m a l l business can buy i n s u r a n c e .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�IQepaiz, ^Haintenance and SaCei
4 LINCOLN PLACE • P.O. BOX 182 • MADISON. NEW JERSEY 07940
larch
(201) 822-1243 • FAX (201) 966-9690
18, 1993
Ms. H i l l a r y Rodham C l i n t o n
The White House
Pennsylvania Avenue
Washington, D. C.
Dear Mrs. C 1 : n r :> :
. .n
I wrote to President C l i n t o n three times already, and
now s i n c e you are i n charge of the.health insurance
i s s u e , I am w r i t i n g to you.
This year we w i l l s s pay i np. 51 Z ,000 f o r h e a l t h i n s u r a n c e .
«
We have one f u l l 11 Te employee anr' one of my daughters
works here p a r t time. We pay f o r our employee's insurance
i n f u l l and we have to have an e x t r a p o l i c y f o r my daughter
s i n c e she's 19. Our h e a l t h i n s u r a n c e i s u n a f f o r d a b l e .
We have a s m a l l business here and have been s t r u g g l i n g
since 1990 to stay i n b u s i n e s s . Between taxes and t h i s
h e a l t h insurance h i l l , w? r n n ' t s.-ve very much. Sometimes \. look i o u t : busine-s check book and c r i n g e .
We have changed health insurance c a r r i e r s , but most of
them don't want small businesses and the ones that do
are outrageously high. There should be insurance pools
where small businesses or i n d i v i d u a l s can buy insurance
at lower r a t e s , iust as b i .? b u s i n t s s e s do. Small business
<.
owners get a oum rap. W can only deduct 25% of t h i s
e
big health insurance b i l l o f f our income tax for our
family. In order to pay for health insurance, we have
to r a i s e our deductible much higher than people who
work i n large companies. For a l l we pay', i f we get
s i c k there are big out-of-pocket expenses.
I hope you w i l l come up with some reforms that w i l l
help working people. As I wrote to President C l i n t o n ,
people who own businesses are not r i c h people. J u s t
look up and down Main S t r e e t and see how many s t o r e s
are c l o s e d . Small businesses need help, e s p e c i a l l y
with h e a l t h insurance.
Sincerely yours,
Ann Hoag
(^J
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
032. note
SUB.IEC 1711 H E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to thc appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN i 8/26/93 CD: OK-6
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Farmer/ Small Business Owner / S i n g l e Mother s t r e s s p r o b l e s i n paying high
Has heart
insurance premiums w i t h business / farming r e l a t e d expei ses.
Requests
problem and f e a r s w i l l n o t be able t o pay insurance pre liums
f i n a n c i a l a s s i s t a n c e i n paying premiums, speaks f o r o t h e r farmer's p l i g h t .
Lives below p o v e r t y l e v e l b u t cannot g e t assistance becaus 6 she owns a 200
acre farm.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
MEDICAL COSTS - EXCESSIVE
OTHER PROGRAM - Farming and A g r i c u l t u r a l
Subsidies
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
033. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
03/21/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-08S5-F
jm812
RESTRICTION CODES
Presidential Records Aet - |44 ll.S.C. 2204(a)
Freedom of Information Act -15 ll.S.C. 552(b)]
PI
P2
P3
P4
h(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of thc FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information |(a)(l) of the PRA]
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion nf
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�5
,
•i.?^(b)(6)''>jL:
_
Mar. 2~1T1"9"9"3~
Dear Mrs. C l i n t o n ,
I f i r s t want t o thank you and President C l i n t o n fctlr extending
the i n v i t a t i o n t o us, the average American c i t i z e n , to respond
w i t h our own ideas and suggestions concerning the i e a l t h care
c r i s i s i n t h i s country.
r
I am a s i n g l e mother of a t e n year o l d son and I ifr a farmer,
I have no other source of income except farming. We grow wheat,
c o t t o n and c a t t l e i n my area. Since t h e o i l i n d u s t y c o l l a p s e d
here, I have seen my town of 3, 500 s l o w l y d i e , a 1 t h r e e of
our banks close and t o o many of my neighbors go i n t o ^ankruptsy. /
One
/
I know of no one here who i s n ' t s t r u g g l i n g t o hang on
of the issues I hear discussed and w o r r i e d about t h ^ most among
the farmers here i s h e a l t h care and the cost of medic 1 insurance
I am so very happy you are heading t h e committee t > look i n t o
what can be done t o t u r n around t h i s h o r r i d h e a l t h are p r o b l e j
i n t h i s country. I want t o add my v o i c e t o c a l l i i j t t e n t i o n
a s e r i o u s problem we farmers and small business owners have [
concerning h e a l t h care.
net
income i s f a r below the poverty l e v e l .
Hcilwever, even
I would apply f o r f i n a n c i a l a s s i s t a n c e , I woul(in'' t q u a l i f y
because, you see, I own 200 acres of farm l a n d . Th s past year
has been a f i n a n c i a l nightmare f o r us. We have tad t o move
i n w i t h my 86 year o l d mother because I cannot pay
utilities
nor buy g r o c e r i e s . I can't pay my insurance premi Urns, e i t h e r ,
and t h a t burden has a l s o f a l l e n on my mother. I 1 ive a h e a r t
problem, and my worst f e a r i s t h a t i f we cannot pay oh i r " ! nsurance
premiums and one of us has t o have e x t e n s i v e medic i l care, we
could end up l o s i n g our farm t o pay our b i l l s .
I n ejid f i n a n c i a l
assistance w i t h my premiums, there's no way arou d t h a t .
I
am not alone, because most farmers i n my area are in the same
boat. We can't a f f o r d t o be w i t h o u t insurance and ^et we can' t
a f f o r d i t , e i t h e r . The day t o day worry o f what can we do w i t h out next i n order t o pay insurance makes one f e e l de|±perate.
-
I have a suggestion on how t o determine who quali-Jflfs f o r help
and who doesn't.
When farmers go t o t h e i r CP.A.
tax t i m e ,
a l l those whose net incomes are below t h e poverty levj<!1, r e g a r d less of how much land they own, would q u a l i f y f o r f i n a n c i a l
assistance i n paying insurance premiums. A l l t h ef i g u r e s are
t h e r e on paper, so i t would be easy t o determine l i g i b i l i t y .
I even have a suggestion as t o how t o pay f o r t h i s program,
I b e l i e v e any farmer who p a r t i c i p a t e s i n t h e farm s u t s i d y program
should not q u a l i f y f o r subsidy payments i f h i s n€
income i s
over $100,000. P e r i o d . That would e l i m i n a t e m i l l i o r : o f d o l l a r s
spent on farmers who don't NEED help and on Agribus ness, which
shouldn't q u a l i f y i n t h e f i r s t place.
�I a l s o want t o g i v e you my views on other issues.
I am pro-choice.
I b e l i e v e i n a woman's r i g h t
i f she wants and I b e l i e v e the d e c i s i o n should
and her doctor alone.
to
be
I am f o r a person's r i g h t t o choose t o d i e w i t h
do not b e l i e v e i n keeping someone a l i v e a t any c o s t ,
of Oregon's approach t o c u t t i n g h e a l t h care c o s t s .
i abortion
itween her
gnity.
I
I approve
I b e l i e v e h o s p i t a l s must be made accountable f o r the tr charges,
For example, charging a p a t i e n t $5 f o r an a s p e r i n i s a surd I
rices drug
I b e l i e v e there must be some k i n d of c o n t r o l of
companies and pharmacies should be allowed t o charge c stomers.
ies which
Making a p r o f i t i s the American Way.
However, compapi
have monopolies on the manufacturing of c e r t a i n kinqs of drugs
should not have the l i c e n s e t o abuse people who must have these
medicines, by overcharging 300% or more. This j u s t i s n t r i g h t .
My l a s t statement i s about crime. I b e l i e v e i n capi a l punishment, against e a r l y p a r o l e f o r v i o l e n t o f f e n d e r s , be ieve every
s t a t e should have a ' s t a l k i n g ' law, and am f o r so ie type of
gun c o n t r o l , e s p e c i a l l y having a w a i t i n g p e r i o d and c l >ser exami n a t i o n of anyone buying a gun. I b e l i e v e i n a p r i son term f o r
anyone owning or c a r r y i n g a semi-automatic weapon of a liy k i n d .
I s t r o n g l y b e l i e v e i n education and t r a i n i n g programs, e s p e c i a l l y
f o r those on w e l f a r e . I b e l i e v e i n Head S t a r t , f e d e r a l l y funded
eace Corps
Day Care f o r the poor w i t h j o b s , and I wish the
would expand t o take i n Black k i d s i n the L.A. ghettofc; and teach
them how t o help o t h e r s , give them some s e l f p r i d e .
Before I close I j u s t want t o say t h a t we farmers feed] the w o r l d ,
sel no one
And y e t , we are such a t i n y m i n o r i t y of people I
speaks f o r us or l i s t e n s t o us.
We have no s t r o n b lobby on
our b e h a l f . Most of us have no time t o even s i t and w i t e anyone
We don't
i n our government because we don't work an 8 t o 5 day
have our weekends away from work...my animals have t o be fed
seven days a week whether I f e e l up t o i t or n o t . What I am
t r y i n g t o say i s , we work very hard f o r very l i t t l ^ and w h i l e
we don't want or need more handouts, we do need so ne help i n
the way of h e a l t h insurance premiums. Please conside our problems.
Thank you f o r reading t h i s and thank you and Pres i q i n t C l i n t o n
f o r f a c i n g American's problems head on i n s t e a d of t e l l i n g us
how w e l l we as a n a t i o n are doing when we as Amer can people
see a l l around us and i n our own l i v e s t h a t t h i s j u s t i s n ' t
t r u e . Thank you f o r reading t h i s .
X • w^-j • ' P6/(b)(6)
-
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2006-0885-F
jm812
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C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 ll.S.C.
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RR. Document will be reviewed upon request.
�CONSE fT GIVEN 08/27/93
PERSONAL STORIES DATABASE
ZPmmCftTXQN QF WRITER
3
BRIEF SYNOPSIS OF LETTER
Wife p a i d f o r insurance through employer, but a f t e r husbanc got cancer, she
found she was not covered - an o v e r s i g h t by her employer, 10 promptly f i l e d
f o r bankruptcy. Senator Thurmond s a i d , Dept. o f Insurance( 5C) would handle
D s p i t a l i s suing,
i t . Dept. o f Insurance says t h a t they can't do any more,
t h r e a t e n s l o s s o f t h e i r house. Can't a f f o r d t o m a i n t a i n c<}.irage on husband
w i t h , S.C. H e a l t h Pool Insurance, Which p r e s e n t l y c o s t $5C|(t).00/mo.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
LOSS OF COVERAGE
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
OTHER PROGRAM-South C a r o l i n a Health Insurance Pool,
OTHER CONTENT
Employer evading r e s p o n s i b i l i t y f o r coverage.
�/
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SUBJECT/TITLE
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02/21/1993
Personal (Partial); Address (Partial) (1 page)
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COLLECTION:
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b(l) National security classified information [(b)(1) of the FOIA)
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b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
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b(7) Release would disclose information compiled for law enforcement
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b(8) Release would disclose information concerning the regulation of
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COLLECTION:
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Health Care Task Force
Steven Edelstein
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C
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PRM. Personal record misfile defined in accordance with 44 ll.S.C.
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�CONSENT GIVEN [8/26/93 CD: SC-4
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Carmen J. J e t e r
Paragon P l a s t i c s , I n c .
P.O. Box 100
Union, SC 29379
TEL:
:; p6/(b)(6)
[>3<
FAX (803)
429-0259
BRIEF SYNOPSIS OF LETTER
She has a manufacturing business w i t h 75 insured employees, Only 16 are able
t o a f f o r d f a m i l y coverage @ $183.58/mo. Company can't a f i o r d t o p i c k t h i s
up; premiums c o s t per year were $125,000.00. t h e e x t r a ccwild be d i f f e r e n c e
between p r o f i t and l o s s .
Feels d o c t o r b i l l s , h o s p i t a l charges, and
pharmaceuticals are t o blame.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY - For f a m i l y coverage, company enployees
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
HOSPITAL CHARGES
DOCTORS FEES
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DOCIIMF.NTNO.
AND TYPE
037. letter
SUBJECT/TITLE
DATE
Personal (Partial) (1 page)
02/26/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number;
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
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PI National Security' Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
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P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(S) ofthe PRA|
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
b(l) National security classified information 1(b)(1) of the FOI A|
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the F'OIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(K) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�^PARAGON
Plastics, Incorporated
Post Office Box 100
IAMES E. MATH IS
President
Union, South Carolina 29379
Fax (803) 429-0259
February 26, 1993
Iliijiii v Rodham CJir.tor.
Coordinator for Health Reforin
The While House
Washington, DC 20500
Dear Ms. Clinton,
I am very pleased that you have been selected as Coordinator for Health lleform. You are
facing a most difficult task, and I wish you every success.
I am sure you are aware that the problem of health care cost is rooted in < xcessive medical
charges by doctors, pharmacies, and hospitals. My amtpanVls * mam i 'acturinglMflity
AKith 75 insured employe^. Of thai 75, only 16 are able io afford Tamil coverage which Ut
Us $lK3.5H/moith. Our entry level wage is $5.50/hour; our skilled wafce is $10.00/hour.
fcven al (he higher rate, $183.58 is not affordable to the majority of our employees. AB
- company, we cannot pay this cost; the total amount we paid in insurai s premiums last
e
year was $125,000. For a company our size, that figure could be the diff^enceln profit or*
loss for the year.*
5*
Lam_atlachinti_examples of what I feel creates these large insurance premiums. The
P6/(b)(6)
situation. I hope this will be enlightening for you and will aid you in a mall way.
Again, I wish you the best of luck....
Sincerely,
Carmen J. Jet^MrS.)
Vice President
Administration
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DATE
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RESTRICTION
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COLLECTION:
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Health Care Task Force
Steven Edelstein
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FOLDER TITLE:
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2006-0885-F
im812
RESTRICTION CODES
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P4 Release would disclose trade secrets or confidential commercial or
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P5 Release would disclose confidential advice between thc President
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P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PKA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
h(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
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RR. Document will be reviewed upon request.
�CONSENT GIVEN
PERSONAL STORIES DATABASE
8 / 2 6 / 9 3 CD: NY-2
IDENTIFICATION OF WRITER
P6/(b)(6)
If .! '
• i''-'" •
. • J? • . •
•
;
;
v-'.a' h
,, 1
|
. ^ • •'• '
=
r
1
*
BRIEF SYNOPSIS OF LETTER
Owner o f a 6 employee business paying $25,000 f o r h e a l t h ins irance objects to
cost o f having c y s t s on s k i n removed, even though i n d i v i d alco-pay i s only
$10.00/visit.
IDENTIFICATION OF PRIMARY LETTER CONTENT
MEDICAL COSTS - EXCESSIVE
DOCTORS FEES
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039. statement
SUBJECT/TITLE
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re: Explanation of benefits (1 page)
02/27/1993
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P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information |(b)(l) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical informalion
concerning wells |(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
040. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 5S2(b)|
PI National Security Classified Information |(a)(]) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
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b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
h(3) Release would violate a Federal statute 1(b)(3) ofthe F01A|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSEHT GIVEN 08/27/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Small businessman who had to discontinue h i s health covera e for employees,
Now has no employees and can't get insurance because of genetic disease and
arthritis.
Gets care at VA h o s p i t a l .
Wants coverage for p r e e x i s t i n g
conditions.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
LACK OF PORTABILITY
LOSS OF COVERAGE
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
041. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
05/27/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Aet - |5 U.S.C. 552(b)]
PI National Security ClassiFied Information 1(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of thc PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PR A]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOI A]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�P6/(b)(6)V....^ '
'
0
May 27, 1993
L^
Mrs. H i l l a r y Rodham C l i n t o n
The White House
Washington, D. C. 20500
Dear Mrs. C l i n t o n :
I am a small business man, based i n New Jerse;
very much concerned w i t h the d i r e c t i o n o f our nati|f>nal
health policy.
I am a f i s c a l conservative who d i d n o t vote ar the
P r e s i d e n t , b u t respect many o f h i s p o l i c y t h r u s t s ind
understand t h a t h i s success i s ours.
A f t e r s e r v i c e i n V i e t Nam, then over t e n yeai Is as
a Special Agent i n the Federal Bureau o f I n v e s t i g c . t i o n ,
and f i v e years on Wall S t r e e t , I founded my own ccj>ppany
i n 1985.
Subsequently, I c o n t r a c t e d f o r group h e a l t h ilnsurance
f o r myself and two employees.
When i n 1988 and 1989 my f i r m experienced f i a n c i a l
d i f f i c u l t i e s and monthly h e a l t h insurance premium had
r i s e n t o approximately $1,500.00 per month, I had t o d i s c o n t i n u e
t h a t coverage.
I am now a one man business and have been unable
t o o b t a i n new coverage, because o f g e n e t i c a l l y i n e r i t e d
diseases of hypertension and a r t h r i t i s , w i t h o u t extensive
e x c l u s i o n a r y clauses.
F o r t u n a t e l y , I have been able t o r e c e i v e fins medical
a t t e n t i o n through the Veterans A d m i n i s t r a t i o n Hospiital
i n East Orange, New Jersey.
My concern, and I b e l i e v e t h a t o f many small business
men, as the n a t i o n a l debate on h e a l t h care p o l i c y u n f o l d s ,
i s t h a t we may i n c u r a d d i t i o n a l costs w i t h o u t f u l coverage
f o r p r e - e x i s t i n g o r narrowly d e f i n e d c o n d i t i o n s .
�- 2 -
W i l l we be paying f o r something we don't r e c e i ^ e?
A s i m i l a r s i t u a t i o n i n New Jersey i s t h a t I must paj f o r
unemployment compensation and d i s a b i l i t y premiums b t ,
as a sole owner of a business, do not q u a l i f y f o r t ose
benefits.
I do not t h i n k t h a t we should i n c u r these cost
f u l l , e q u i t a b l e treatment.
without
I hope t h a t you w i l l consider my views i n the < ssessment
t h a t you are doing.
A s o l i d n a t i o n a l h e a l t h p o l i c y i s long overdue
we a l l wish you w e l l .
Respectfully,
•jyxi-:-: .
•
P6/(b)(6). (bK7Kc)'
WDJ/rc
cc: Honorable W i l l i a m Bradley
Honorable Frank Lautenberg
and
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DOCUMENT NO.
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SUBJECTS r n . E
DATE
Persona! (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act -15 U.S.C. 552(b)]
PI
P2
P3
IM
b(l) National security classified information [(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe F01A|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(h)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(h)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to thc appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between thc President
aud his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 1)8/25/93 CD: AL-5
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
1
'% -j'fk •'"
.
,
, ••••• •
P6/(b)(6)
^ 1
a :•.
BRIEF SYNOPSIS OF LETTER
Small business owner and s i n g l e mother o f two, l o s t her i f surance coverage
when she opened her new business. A f t e r opening her busjiess, she had t o
have surgery which i s going t o cost her $10,000, which she cannot a f f o r d .
IDENTIFICATION OF PRIMARY LETTER CONTENT
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
OTHER CONTENT
Small business owner i n c u r r e d surgery b i l l s a f t e r opening business.
has no h e a l t h insurance.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
043. letter
SUBJECT/TITLE
DATE
03/15/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [S U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of thc PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b( I) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of thc FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIAj
('. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 15 1993
Dear Mrs C l i n t o n ,
I am w r i t i n g t h i s i n regards t o H o s p i t a l I n irance
and H o s p i t a l b i l l s . I had Insurance u n t i l I open a sn i
11
Business s i x months ago and h a r d l y use i t .
Sense then I am going t o have Surgery. I dort have
the Insurance anymore. So I am going t o have t o payf >r I t
myself. I t i s going t o cost me t e n thousand d o l l a r s t lat I
d o n i t have. That does not count the Doctors b i l l s . I ran't
f i n d any help anywhere and I don't know how I am goirjfc to
pay I t , But I w i t h get by I always have.
I have not ask f o r anything i n my l i f e so I f i l l
k i n d o f d i r t y and I f i l l cheap when I ask. I w i l l not make t h a t
mistake again. lam not a bum,I pay taxes, I know t h a any b i l l
t h a t you get past i s not going t o help me w i t h t h i s , Jut i t
w i l l help me i n the f u t u r e .
I hope you get some laws passed t o lower I n arance
r a t e s and H o s p i t a l B i l l s so people l i k e me, as A sine Le w h i t e
Mother o f two can a f f o r d t o pay f o r I t . I l i v e on a n a i l : income. I l i v e on e i g h t thousand nine hundred d o l l a r a y e a r
and a check t h a t my daughter gets from - her decesed I j k t h e r . I
qpse t h e
hope you can hurry and lower these t h i n g s so I t can
burden on some o f us who l i v e week t o week.
Please I would love t o have some answers on t3w I can
help get these past. I know t h a t you won't be readinc t h i s b u t
I am sure someone w i l l . I t sure has made me f i l l bett sr knowing
I have g o t t e n I t o f f my chest
Please excuse t h e t y i n g I am not a T y i s t and [ am n o t
a w r i t e r e t h e r . I do h a i r f o r a l i v i n g .
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
k-
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DOCUMENT NO.
AND TYPE
044. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im8l2
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(h)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of thc FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIAj
National Security Classified Information |(a)(l) of the PRA]
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�CONSENT GIVEN 08/ 3/93 CD: NV-1 & 2
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
owner o f a small business provides coverage f o r twoempl: )yees, but cannot
o b t a i n coverage f o r h i m s e l f due t o a p r e - e x i s t i n g cifjjndition, chronic
h e p a t i t i s , b e l i e v e s t h a t i n l a r g e f i r m s they cover every ne and pay lower
premiums, t h e r e f o r e small f i r m s are s u b s i d i z i n g l a r g e r fiiHns
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
045. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/16/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Uox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute [(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) nf the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(h)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�February 16, 1993
Hillary R. Clinton, Esq.
The White House
1600 Pennsylvania Ave.
Washington, DC
Dear Ms. Clinton:
I am a small business man without health insurance. The reascn for my lack of
health insurance is that when 1 left my job with a big corporation (Lockli;ed) I could not
afford to keep up my COBRA payments. During the time I was without insurance, my
liver enzymes became elevated due to chronic hepatitis C. I had acute hepatitis in 1971
but since then I graduated from college and graduate school and in t l : SO's I ran two
marathons. Unfortunately, the insurance company I was insured by (ujifder my father's
policy) in 1971 when I was infected with the virus is not liable for this cl onic illness and
no other insurance company will accept me due to the risk. I provide ealth insurance
for my two employees but cannot get it myself
It is my understanding that you have accepted the task of attempWing to make the
health insurance system in the U.S. fair. I believe that the health insurs)tn? system is an
example of the problems of capitalism; after the highly touted fall of iDmmunism it is
even more important for us to evaluate ourselves and our system to be ; ure we are fair.
Due to my medical history health-insurance companies will not a<$ept me because
I may be an above-average risk based upon demographic models thej have. I do not
es based upon
believe that it makes sense for insurance companies to set their
demographics and to then be selective based upon case-specific facts, ' this allows them
to first build a fair profit into their rates and then to try to get mon profit through
beating the odds. Unfortunately, when they "beat the odds' I get beat b cause there will
be no firm to serve my 'market sector.'
�In the interest of fairness, two items arise in my mind with respekjtto this matter.
The first is the availability of health insurance ("access") to those currently denied it.
Right now, if I become ill I will be forced to give my belongings to nv family, declare
ise
bankruptcy, and go to Medicaid or some Federal program. This is beca no insurance
company will allow me to pay them for insurance.
Secondly, insurance companies provide automatic entry, without evaluation of
business. One
medical records, to employees of largefirms.This is not so with my sm'c.l
company (State Farm) came and took blood and urine samples (and rej :cted me). State
Farm also has access and input to a computer database of rejections, so 'm out for good,
In addition, rates for those people are lower than the rates I can get fo(i my employees,
This bias towards largefirms,with their minimal effect on economic rejuvenation, is
The resulting
actually a subsidy by small business of big-business' health insurance cosjtjs
better benefit packages for big business can tend to drive workers tothsm.
I believe that, in auto insurance, there is a category called Assigned Risk" or a
similar term to refer to high-risk drivers who are assigned to specific fi'ns by the state,
d
(If there is not now, there was 20 years ago). Such an approach coi^ be used with
health insurance. If health-insurance companies all used the same rsi es (based upon
demographics) the way to enhance profit would be to lower costs (ina :ase efficiency),
Under such a system, (demographically based rates with Assigned Ri: cs) I would not
protest the fact that D.C. - area residents have a higher frequency of ce: icerjust as I do
not protest taking the whole nations nuclear waste here in Nevada, I it this "sacrifice
thing" (as a recent president might put it) must be shared. Then I :lieve it will all
balance out; if someone believes they are being treated unfairly because they are paying
for insurance and not being ill, we should allow them to get sick sc they won't feel
cheated.
I congratulate you and your spouse for your victorious campaigi.and I wish you
luck with your task; if you need further information please feel free to co me. Thank
tact
you for your attention to this.
Sincerelv.
„
£
• • ^ • ; ' r l : v - " ^ • '•'••'V
•
cc:
..•• ^.. . .. P6/(b).(6)r,-,,J
(
(
1
Correspondence File
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
046. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
Presidential Reeords Aet -144 U.S.C. 22(l4(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/24 93 CD: IN-9
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
, P6/(b)(6) '
'•.•:-';fV <> .- ' r . . ^ i " ! ' " ',
;
j
:
o4^
u r]
BRIEF SYNOPSIS OF LETTER
Twin c h i l d r e n born w i t h c o r r e c t a b l e b i r t h d e f e c t , emp oyer's
h e a l t h insurance dropped t h e t w i n s from coverage and tyhen dropped
the e n t i r e f a i m i l y from coverage, f a m i l y was u n i n s u r a : l e w i f e
had t o q u i t work t o lower f a m i l y income enough t o q u a ! i f y f o r
Medicaid
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
LOST COVERAGE/GAINFUL EMPLOYED
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
047. letter
SUBJECT/TITLE
DATE
02/11/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute [(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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1
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
048. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
Presidential Rceords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) of thc PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 0 8 / 2 i i / 9 3 CD: I L - 5 & 7
PERSONAL STORIES DATABASE
I D E N T I F I C A T I O N OF WRITER
'•; ;^(bj(6)'.-'j*y;;j:-^; ;„v,
:
£648
r
BRIEF SYNOPSIS OF LETTER
Small business w i t h 2 f u l l time employees has had monthly premiums go from
$350.00 t o $1,237.00, s i n c e 1988 w i t h no increase i n coverage o r no
s i g n i f i c a n t c l a i m s . I f they have t o reduce b e n e f i t s t o sa e money, t h e y ' l l
end w i t h coverage o f n o t h i n g . What i s a small business own^r t o do? Please
make q u a l i t y h e a l t h insurance a v a i l a b l e i n a way t h a t small business can stay
i n business.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
OTHER-Outrageous increases
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
049. letter
SUBJECT/TITLE
DATE
Personal (Partial) (1 page)
03/27/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im812
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |S U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) of thc PRA]
P3 Release would violate a Federal statute [(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information |(h)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(fi) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) nf the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed iu accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�May 27, 1993
First Lady Hillary Rodham-Clinton
THE WHITE HOUSE
1600 Pennsylvania Avenue
Washington D.C. 20500
RE:
Healthcare/Iasurance Reform
Dear Ms. Clinton:
I am a frustrated small business owner and have reached a poinjt where it is
becoming increasingly difficult to afford health insurance. My firm has only two
full-time employees which substantially limits our selection of insurai :e carriers.
In 1988 we selected an insurance company by the name of IDS and b:gan paying a
monthly premium of approximately $350. Since then, our policy ha^ been bought
out and/or the company has changed ownership twice. As a result our monthly
premiums have skyrocketed over 250% to a monthly premium of 'S1237. These
increases have been merely to maintain our current level of benefits and
deductible. We have not had any long-term illnesses or made laige claims to
warrant such an increase. In fact, the few claims that have been maj^e are what I
would consider "usual and customary", a normal maternity delivery, in out-patient
oral surgery and a couple of broken bones.
I am sure you will agree that this is outrageous. It does not make seiiie that just to
maintain a certain level of benefits, a person would have to pay mt e. W««we are
forced to reduce benefits to save dollars, eventually we will end tip (with * policy
that has been whittled away to nothing.
My question to you and your committee on healthcare reform is • w ia is a small
t
business owner like myself suppose to do? I know you are in the 1 nal stages of
completing your healthcare package. I am asking for you to conside how to make
quality health insurance affordable for small businesses to remain in msiness.
Sincerely,
>
ll
™i " '
v;
'«
• P6/(b)(6) _
V'.'"'
u
P6/{b)(6)...
:
;i
v
'i : '»-. *** '
1
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
050. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm812
RESTRICTION CODES
Presidential Rceords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose informalion concerning the regulation of
financial institutions 1(b)(8) of thc FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSEN' GIVEN 08/23/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
. .. P6/(b)(6)
.
;
5
.
BRIEF SYNOPSIS OF LETTER
Young couple's i n s u r e r went bankrupt and wrote them $8,O ) i n bad checks.
C
They had t o pay t h i s amount. They were r e j e c t e d i n w r i t i n by 43 insurance
companies. Husband i s t o t a l l y d i s a b l e d w i t h rheumatoid A r t h r i t i s . She i s
own t h e i r own
also.
They spend $l,100/month on p r e s c r i p t i o n s .
The
business,so can't g e t Medicaid.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
LOST COVERAGE/GAINFUL EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
051. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
jm8l2
RESTRICTION CODES
PresidcntiHl Records Act - |44 U.S.C. 2204(a)|
Erecdom of Information Act - |5 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) of thc FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of (he FOIA)
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA)
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRAj
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors [a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSEN'' GIVEN 08/27/93
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
|
;
r:
* " ! • * . • •P6/(b)(6);' " ' . "'
•••?•
BRIEF SYNOPSIS OF LETTER
Husband pays premiums f o r family coverage t o self-insurance company. She was
l a t e r informed ( a f t e r submission of a claim that she was not severed, because
Company also
she made more money than he did. ) Wants "family" d e f i n e l
changed underwriters so pre-authorized surgery f o r c h i l d w4p not covered as
underwriter had changed since l e t t e r of authorization.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
COVERAGE DENIED
LIMITED BENEFITS
CLAIM DENIED
�J i\ N U A F Y 2 ; . j. D 9 3
<
,
FIRST LADY HILLARY CLINTON
1600 PENNSYLVANIA AVfNUE
WASHINGTON , 1' , U . : .
i:
DLAR FIRST L A 0 Y , HILLARY CLINTON;
,
.
I AM WRITING THIS LETTER TO YOU TODAY, BEFORE I LOSE . Y NERVE. I JUST
M
HEARD A NEWS REPORT THAT STATED THAT YOU ARE GOING TO BE HEADING A TASK
FORCE TO IMPROVE OUR MEDICAL INSURANCE FOR ALL AMERICAN PEOPLE .
I WOULD LIKE TO S H ARC WITH VOU Qui-; PARTICULAR PLIGHT WITH OUR MEDICAL
IN S U R A N C E IN THE PAST FEW YEARS.
MY HUSBAND WORKS FOR A "SELF-INSURED" COMPANY.
THIS REALLY MEANS THAT THE
CAN CHANGE THE RULES AS NEEDED TO SERVE THEIR INTERESTS. WHEN MY HUSBAND
TOOK.-.THIS JOB .3'. YEARS AGO, HE WAS TOLD I T WAS FULL. L F A L I I L Y COVERAGE. : WE L. .
I WENT . O .THE DOCTOR AND WHEN THE INSURANCE CLAIM: WAS. .DENIED,, .1 CALLED AND
T
T , O R : SURPRISE , I WAS NOT COVERED BECAUSE I EARNED flO R E . T A N MY : H U S 8 A N D
O.U.
.H
DID IN. THE.PRIOR YEAR. I WOULD LIKE THE TERM "FAMILY" BE DEFINED BY THE
INSURANCE COMPANY AND THE GOVERNMENT.
MY HUSBAND HAS A "FAMILY INSURANCE
DEDUCTION'!, TAK.EN.; F O M E ACH • CHECK . : . T I<• AM/iN.QJ^QV&ftfeP COlAtfe&S i^N ^ i
R.
YE
A.QDITIQ^Atf TMO .XHQUSANO; DOLLAR CiEXPeNSe.ivP.QR ^ E BECAUSE I AM SELF-EMPLOYED
M.
AND HAVE ZERO BENEFITS AND CAN ONLY USE 25% AS A TAX DEDUCTION.
IN 1992 MY HUSCAND ' i. EMPLOYER DEC IDLO TO CHANCE INSURANCE UNDERWRITERS IN
MID STREAM. THE OLD INSURANCE COMPANY APPROVED. MY D U H E . . . SURGERY BY A
AGTR'.S
LETTER. NOW THEY WILL NOT PAY BECAUSE THEY SAY THE NEW INSURANCE COMPANY
IS IN CHARGE. THE NEW INSURANCE COMPANY WILL NOT PAY BECAUSE THEY DID NOT
AUTHORIZE THE SURGERY. TO ADD INSULT TO INJURY, MY FAMILY HAS TO CHANGE
ALL DOCTORS AND MEET A NEW DEDUCTIBLE FOR 19 9 2 WHICH M FAMILY HAD MET
Y
EARLIER IN THE YEAR. THEY ALSO HAVE TO MEET A NEW DEDUCTIBLE FOR 1393.
W HEN IS THIS GOING 1 O I N 0 ? M Y r A r. I I V 1 S S T li C WI T H MANY MEDICAL BILLS
'
K
I F WE PURSUE THIS'WITH AN ATTORNEY, W WILL HAVE MANY ATTORNEY BILLS.
E
FURTHERMORE, M HUSBANDS SUPERIORS HAVE STATED THAT, I F WE GIVE THE
Y
EMPLOYER A HARD TIME ABOUT THIS, THEY WILL MAKE ME PAY FOR THE CHILDREN AS
.
WELL.-AND; OR .LOSE HIS JOB.
ACCORDING TO NEWSPAPER ARTICLE C . i H C S ! A T E $ ' SUPREME COURTS ARE RULING I
,
'
FAVOR OF THESE CO M P A N I E S . I HE Y A i; F A I. i.. 0 U . ti 0 Y H L S E COMPANIES TO D
1
"
COVERAGE FOR ANY ILLNESS THEY 0 E E I'l i l ' i . 1 THEY CHOSE TO NOT PAY FOR
CANCER, THEY JUST HAVE TO NOTIFY THE PEOPLE AND I T IS DONE.
THIS I S MY,FIRST LETTER TO THE WHITE HOUSE. I CAN ONLY HOPE THAT SOMEONE
WILL CARE WHAT A PERSON IN SLINGER, WISCONSIN IS THINKING.
BECAUSE YOU AND
I ARE OF THE SAME AGE A N 0 A R E M 0 T HER ' 0 Y Y A U G H T E RS , ( I MA V C
.
•
J
FOUR , 13 „ 16 , 2 1 . 2 3 ) T F EEL THAT ;'(:'.•• \:i,:Y Ah I N T C1! 'I AS TO WHAT 1 AM FEELI
,
WHAT ARE OUR CHILDREN ANO OUR CH1CUREN'S CHILDREN ( I HAVE TWO), GOING TO
BE DEALING WITH WHEN THEY ARE OUR AGE? ARE COMPANIES GOING TO DICTATE WHAT
HEALTH CARE POLICIES SHOULD BE? OUR FAMILY WILL SURVIVE ANO WE WILL MANAGE
TO PAY OUR BILLS AND GET OUR CHILDREN THROUGH COLLEGE I F , I DON'T GET SICK.
WHAT HAPPENS THEN?
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
052. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
01/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binder] [2]
2006-0885-F
im812
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [S U.S.C. S52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
h(3) Release would violate a Federal statute |(b)(3)of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(h)(8) of thc FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) of thc PRA]
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(a)((i) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�I AM ASKING YOU AS FIRST LADY OF THIS GREAT COUNTRY, TR PLEASE NOT BE
SWAYED BY THE SPECIAL INTEREST GROUPS 0f AMERICA AND T MAKE DECISIONS
I LIES,
BASED ON A " H A I 1 , Q E 3 T I-Q K > J 0 K I- I N L r A M LIES, POOR F A YOUNG ADUL!
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THE NEWS THAT THE INSURANCE COMPANYS WANT TO COOPERATE WITH THE
ADMINISTRATION• FRIGHTENS ME. THEY WERE SO QUICK TO COMDEMN ANY CHANGES.
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ARE THEIR ULTERIOR MOTIVES? BETTER HEALTH CARE FOR A LI OR "MONEY" ?
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THE PAST 10 YEARS , M HUSBAND HAS BEEN A VICTIM OF CO PANY TAKEOVERS,
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CLOSINGS, MERGERS, AND LOSS OF PENSIONS AND BENEFITS Nt MEROUS TIMES. HE I
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COULD GO ON FOREVER. I WISH I COULD DO MORE THAN WRIT THIS LETTER. I AM
ONLY ONE PERSON. I CAN ONLY HOPE THAT THIS LETTER WIL BE READ BY YOU OR
SOMEONE THAT CAN MAKE A DIFFERENCE.
I PRAY FOR YOU ANO THE PRESIDENT FOR THE STRENGTH ANO
TO DO WHAT I S RIGHT FOR THE PEOPLE OF AMERICA.
OURAGE I T WILL TAKE
I WISH YOU CONGRATULATIONS ON BECOMING THE FIRST L AO Y F THE UNITED STATES
OF AMERICA.. I KNOW IT TOOK ALOT OF SELF-SACRIFICE AND DETERMINATION TO
ACHIEVE THIS GOAL. I LOOK WITH OPTIMISM TO THE FUTUR
FOR AFTER ALL A
"BABY BOOMER" I S IN THE WHITE HOUSE ! 1 I
GOD
BLESS YOU .
SINCERELY
YOURS,
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Small Business Letters] [binder] [2]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-007-006-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/8ec81e64f5b2a408a02e287a38ae5360.pdf
2198937e7531b0de6f037a8d530ebcea
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3679
FolderlD:
Folder Title:
[Small Business Letters] [binder] [1]
Stack:
Row:
Section:
Shelf:
S
52
3
7
Position:
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. list
Personal (4 pages)
n.d.
P6/b(6)
002. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
003. letter
Personal (Partial) (2 pages)
n.d.
P6/b(6)
004. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
005. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/18/1993
P6/b(6)
006. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
007. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/24/1993
P6/b(6)
008. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
009. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/15/1993
P6/b(6)
010. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
011. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
012. letter
Personal (Partial) (2 pages)
02/22/1993
P6/b(6)
013. lettter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
02/22/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 22U4(a)|
Freedom of Information Act - [S U.S.C. SS2(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA|
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office [(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCl'MENT NO.
AND TYPE
DATE
SUBJECT/TITLE
RESTRICTION
014. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
12/16/1992
P6/b(6)
015. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
016. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/18/1993
P6/b(6)
017. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
018. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
03/24/1993
P6/b(6)
019. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
020. letter
Personal (Partial) (1 page)
03/03/1993
P6/b(6)
021. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
022. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/30/1993
P6/b(6)
023. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
024. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
05/16/1993
P6/b(6)
025. statement
re: Pay statement (1 page)
04/28/1993
P6/b(6)
026. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [I]
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Records Aet -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C 5S2(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
1 3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
*
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PR A]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
h(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
027. letter
Personal (Partial); Address (Partial) (2 pages)
02/18/1993
P6/b(6)
028. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
029. letter
Personal (Partial); Address (Partial) (2 pages)
02/14/1993
P6/b(6)
030. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
031. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
03/15/1993
P6/b(6)
032. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
033. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
01/28/1993
P6/b(6)
034. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
035. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/11/1993
P6/b(6)
036. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
037. letter
Personal (Partial); Address (Partial) (I page)
01/26/1993
P6/b(6)
038. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
039. letter
Personal (Partial); Address (Partial) (2 pages)
02/07/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
National Security Classified Information 1(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
040. note
Personal (Partial); Address (Partial) (I page)
n.d.
P6/b(6)
041. letter
Personal (Partial); Address (Partial) (1 page)
06/21/1993
P6/b(6)
042. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
043. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
06/15/1993
P6/b(6)
044. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
045. letter
Personal (Partial); Address (Partial) (1 page)
04/23/1993
P6/b(6)
046. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
047. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/14/1993
P6/b(6)
048. letter
Personal (Partial); Address (Partial) (I page)
02/12/1993
P6/b(6)
049. statement
re: Insurance adjustments (1 page)
03/31/1993
P6/b(6)
050. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
051. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/02/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
im8l I
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�THE WHITE H O U S E
WASHINGTON
SMALL BUSINESS LETTERS
Attached are 101 l e t t e r s received by Mrs. Clinton and the
Health Care Task Force related to small business. Most of the
l e t t e r s are either small business owners or employees, but
primarily owners. A l l have been contacted and have given consent
to share t h e i r stories i n whatever way deemed necessary.
Before releasing the exact l e t t e r , however, names of
s p e c i f i c physicians and hospitals should be deleted to protect
the writer from l i a b i l i t y .
These small business l e t t e r s have been arranged
alphabetically with a state index on page two. Congressional
D i s t r i c t s are l i s t e d i n the top left-hand corner of each database
sheet. Those indicating more than one CD are located i n an area
that borders more than one CD.
CONTACT:
Barbara Allen
Director, Health Care
(202) 456-2813
Correspondence
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. list
SUBJECT/TITLE
DATE
Personal (4 pages)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute [(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
(.'. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
A
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
im8l 1
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(h)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information [(a)(1) of thc PRA)
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENI GIVEN
CD: GA-9
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
48 year o l d woman w i t h severe back problems, worked f o r 1 | years i n a shoe
f a c t o r y then 12 years i n a small business, a grocery s t o r e as manager o f t h e
d e l i counter, f o u r years ago t h e grocery s t o r e changed o t h e r s and t h e new
owner c o u l d n o t a f f o r d h e a l t h i n s . f o r her, she c o u l d n o t a f f o r d p r i v a t e
i n s . , i n 1990 she c o u l d no longer work, she had back surgery and went through
a rehab program, b u t i t d i d not h e l p , youngest married daughter's f a m i l y had
t o move i n w i t h her and pay her b i l l s , now they cannot a f f c -d t o buy a home.
she t r i e d t o get on d i s a b i l i t y but could not get a Dr. t o s€ i her because she
d i d n ' t have any i n s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
HOSPITAL CHARGES
DOCTORS FEES
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
SOCIAL SECURITY/DISABILITY
DIFFICULTY IN GETTING ACCESS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
SUBJECI/mLE
DATE
Personal (Partial) (2 pages)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jmSI 1
RESTRICTION CODES
PrcsidentiHl Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA)
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�£00 £1
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. note
SUBJECT/TITLE
DATE
Persona] (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of thc PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONS!:NT GIVEN
NJ-5/8
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
v P6/(b)(6)
1^1
BRIEF SYNOPSIS OF LETTER
CG l e t t e r , 33 y e a r o l d mother describes s t u g g l e w i t h h:. j h premiums f o r
h e r s e l f , her c h i l d and her self-employed husband who has j s m a l l business
( b a r b e r ) , they pay $4,000/year f o r i n s . and an a d d i t i o n a l $1 500 -$2,000/year
i s medical expenses, cannot change p o l i c i e s because husban^i i s a barber and
i n s . companys regard him as a h i g h HIV r i s k
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
COVERAGE DENIED BASED ON OCCUPATION
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/18/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [I]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - [S U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of thc FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office [(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�; ^ P6/(b)(6), , ,.
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. note
SUBJECT/TITLE
DATE
F'ersonal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information [(a)(1) ofthe PRA)
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN {'26/93 CD: MI-13
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
" j - ^ r • ' ;,^P6/(b)(6)'. ,,• , ',J•
0 0(0
r, •' • ' • v
•
]
!
^^J'^kX' ''•^7^' :". •'• ' LL'"
BRIEF SYNOPSIS OF LETTER
S e l f employed and uninsured. Unable t o g e t insurance and h,!d b r e a s t cancer,
Coverage
tat
Got Medicaid b u t had d i f f i c u l t y f i n d i n g a d o c t o r t o treajt her.
Now needs
c a n c e l l e d i n 1991. But cancer now gone, b u t s t i l l on t r e a t i ients
t o pay $6,000 f o r g a l l bladder surgery.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID
LOST COVERAGE/GAINFUL EMPLOYED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
20()6-0885-F
jm8l 1
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of thc PRA|
P2 Relating to thc appointment to Federal office [(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRAj
I'd Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance w ith restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�. r.
:
,.
S
-
P6/(b)(6)
3
06 7
Mrs. Hilary Clinton
Commission on Health
White House
Washington, DC 20500
Hay 24, 1993
Mrs. Clinton;
My name is | ,.;„, P6/(b)(6) .| and I s n amount the many residents of
u
Michigan who are HP ff-employed and_unin3ured. The only thing
t h a t sets me apart from a l o t of these people is the fact I
am unable to obtain insurance.
In February of 1990 I was diagnosised with breast cancer.
Our business was s t i l l very_young and almost every cent that
came i n went right back out. This nade me eligible f o r
Medicaid. Not only did I have the worry of the cancer but
also experienced problems finding a doctor that would treat
me with the chemo therapy because of the Medicaid. Medicaid
required me to f i l l out reports every month disclosing a l l
the money that came into the household and business and
a l l that went out. Then each month they would determine
weather I was eligible or not for that month. In December of
1991 my coverage was cancelled because I was no longer
considered disabled according to Federal and State
definitions I am s t i l l under Doctors care and must have
blood test done every three months and a bone scan done
every year. This i s about three thousand a year without
prescriptions.
Now I am faced with a new problem I have had one serious
gallbladder attack and they are t e l l i n g me I am going to have
to have i t removed. The hospital is going to want five t o
six thousand dollars for this procedure. I have never been a
sick person aside from 3 children and my appendix I have
never really been sick. In fact I seldom ever got a cold.
I do not feel that I am the only person with this kind of
problem.
In fact with every thing I have read and heard
this is one of the major problems i n this country and
especially in Michigan. I really want to know what actions
are being developed and w i l l they be in place during t h i s
administration, to assist people in our situation.
�I consider us as average income, middle class people. My
business is s t i l l so small that I have not hired any
employees as yet. My husband (who is not insurable either)
and I rum the business and do a l l the work. W just don't
e
seem to f a l l into any special category, that would entitle us
to any assistance with the medical b i l l s . This i s a typical
catch 22 situation.
I am sure you are now wondering what is the point of this
letter. Well maybe there isn't one, i am just so frustrated
with trying to fight the system only to keep getting caught
up in medical b i l l s .
There must be an answer to the problem of medical services.
W never abused the insurance when we were younger and had
e
small children, Now that we are self employed we cannot
afford to take off time to be sick or in the hospital.
This letter is starting to sound like rambling. Thank you
fcr the time vou or your staff took in reading i t .
•
> iy
"
:
^ v" ''.V'-rj' ' " V-'
•"iV
'fi'' . .'•
- i ' ,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. note
SUBJECT/TITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [I]
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Rceords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of thc PRAj
Relating to thc appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P(> Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIV N
OH-12/15
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
;:
!
!', •" ''
!::
';
P6/(b)(6) ,
0 0%
BRIEF SYNOPSIS OF LETTER
56 year o l d man s t a r t e d own small business, must pure ase p r i v a t e
insurance, costs $500/month w i t h a $2,500 d e d u c t i b l e Br
$l,200/month f o r an HMO, premiums on t h e cheaper p l a n are due t o
go up, complains t h a t government l i m i t e d t a x deductior f o r h e a l t h
insurance
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/15/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Kreedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of thc PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of thc FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�„'»'
0^^
.
P6/(b)(6)'
! J,
/
February 15,1993
Mrs. H i l l a r y C l i n t o n
The White House
1600 Pennsylvania Ave.
Washington, DC
Dear Mrs. C l i n t o n ;
I am w r i t i n g t o you regarding t h e hardships faced i n t r y i n g
to operate a small business when faced w i t h r i s i n g h i l t h
jvide
care costs and the governments lack of a c t i v i t y t o pi
answers or meaningful t a x i n c e n t i v e s t o a s s i s t t h e sr i l 1
business.
Four years ago, the company I had worked f o r was cauc i t i n a
s e r i e s of f i n a n c i a l r e v e r s a l s and a f o r e i g n a c q u i s i t 5n
r e s u l t i n g i n the loss of my p o s i t i o n a t age 56. TosiJ r v i v e ,
1 s t a r t e d my own s m a l l , (one man) business. My f i r s t shock
was the outrageous cost of h e a l t h insurance t o cover ny w i f e
and I . Costs ranged from $500 per month f o r a no f r ]iL s
program w i t h $2,500 per person deductables, t o $1,20(1 per
month f o r good coverage w i t h a l o c a l HMO. The only t h Lng
w i t h i n reach was the cheaper program and a t the end o f one
year
year the premium was increased 58%. And t h a t was i n ;i
when we had no sickness and submitted no claims.
The only break we got was a 25% business t a x d e d u c t i i h based
on the cost of the annual premium. Much t o my s u r p r i s e and
my accountants, when f i l i n g out our 1992 taxes we discovered
the government q u i e t l y s l i p p e d through a change sometime
during t h e year t o reduce t h e deduction t o 25% f o r only t h e
f i r s t 6 months of the year and n o t h i n g f o r the balande of
the year. So much f o r the breaks f o r small business!
Our p o l i c y i s now up f o r annul review and based on thle
increase we have seen i n the p a s t , i t appears we are about
to j o i n the other 37 m i l l i o n American who can no longer
a f f o r d h e a l t h insurance.
,P6/(b)(6)
�••-r
P6/(b)(6)'
' ''V-
During the campaign, President C l i n t o n mentioned man]h times
the need f o r h e a l t h care reform and increased incent: ves f o r
the small business operator. One of h i s proposals was t o
increase t h e h e a l t h insurance premium deduction f o r spiall
businesses t o 100% of the annual c o s t . Since univers;,
h e a l t h insurance appears t o be l i g h t years away, I urbe you
to use your i n f l u e n c e t o push f o r the 100% t a x deduction.
With the media now warning of t h e Presidents plans tcj)
increase taxes on the middle c l a s s i n order t h a t we a l l pay
our f a i r share", i t appears t o me t h a t a 60 year o l d nan
s t r u g g l i n g t o s u r v i v e , might be b e t t e r o f f on w e l f a r i At
l e a s t we wouldn't have t o worry about our h e a l t h c a r f
needs...we•11 j u s t l e t the s t a t e take care of us f o rf r e e .
Please respond and t e l l me of your e f f o r t s on behalf of the
small business owner.
'4
v
•f' • :.'Sr' • .
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AWA:" : v i *
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P6/(b)(6)
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P6/(b)(6)
�Clinton Presidential Records
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This is not a presidential record. This is used as an administrative
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DOCUMENT NO.
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010. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
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FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
jm8l I
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOI A]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning the regulation of
financial institurions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of thc PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of thc PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
1 6 Release would constitute a clearly unwarranted invasion of
*
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�N
CONSENT GIV! I
PERSONAL STORIES DATABASE
IL-18/20
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Small business owner, 17 year o l d daughter was denied coverage on
f a m i l y p l a n , a p p a r e n t l y due t o a minor l e g c o n d i t i o n , b e l i e v e
insurance company d i s c r i m i n a t e s a g a i n s t small businesjii
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
DISCRIMINATION AGAINST SMALL BUSINESS
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
011. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI National Security Classified Information [(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute [(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) ofthe PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information [(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of thc FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe F01A|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN i:8/23/93 CD: MD-6
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
" P6/(b)(6)
BRIEF SYNOPSIS OF LETTER
er
Family w i t h s m a l l business maybe denied coverage f o r daughjt who needs l i p
and p a l a t e r e p a i r surgery. Insurance r e p r e s e n t a t i v e from MO i n d i c a t e d t h e
business i s t o o small and t h e surgery i s expensive.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LIMITED BENEFITS
OTHER— coverage f o r surgery may be denied because business i s t o o
small and surgery i s t o o expensive
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
012. letter
SUBJECT/TITLE
DATE
Personal (Partial) (2 pages)
02/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-()885-F
jm811
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of Ihe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of thc PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(h)(1) ofthe FOIA]
h(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
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P6/(b)(6)
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
013. lettter
SUBJECIYPITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [I]
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Records Act - |-U U.S.C. 22U4(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
PJ
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA)
b(3) Release would violate a Federal statute 1(b)(3) of thc FOI A]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of thc FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�<,
i
^'V.v^^^r''.^'^.?''
American Community Mutual Ins. Co.
39201 Seven Mile Road
Livonia, MI 48152-9981
February
1993
Attn: Rita Morris
Health Underwriting
P6/(b)(6) .,
Policy
Re:
Dear Ms. Morris,
I'm writing as a follow up to my request for more information about youi declination of health
insurance coverage for our daughter Getter of 12/31/92; your response of 1/27/! p)
Specifically, what was in our daughter's medical records that caused your (tympany to decline
health coverage for her? She has not seen a doctor for a former leg pain conditi(||i (medical diagnosis:
post-viral neuritis) since last April, and she has not taken medication for this coi iition since last
summer. All of her tests have been negative, including MRIs; and no claims havjc ever been made to
our previous health insurance carrier.
We are very concerned about your company's reluctance to insure our d ightier due to a former
condition for which she is not even under a doctor's care. Would you please rect nsider her for
coverage...at the very least, for the present time, for non-neuritis related condit >ns? We would be
willing to have her take a physical, or other tests, if required for Insurance cove pge. We are especially
...she Is a senior in
frustrated over this declination because Jill Is not even being treated for an illne^
high school, working a part-time job as a library page, who hasn't missed a day ftj illness since school
started this past August!
My husband and I have run our own small business for the past ten yean and we are struggling
to afford health insurance for our family as it is. But, of course, there's no deduc: on in our monthly
premium even though you're not covering our daughter...this Is your family plan|? We are certainly
witnessing first hand what Is wrong with our country's health insurance industry and I hope our new
administration can do something to prevent this kind of discrimination very soc ifi
Please help us resolve this matter quickly. We have an uninsured child.
p6/(b)(6);
cc:
Hillary Rodham Clinton
Illinois Department of Insurance
National Health Insurance Task Force Consumer Complaints
The White House
320 West Washington, Sprlngfi(il|d, IL 62701
1600 Pennsylvania Ave., NW
Washington, D.C. 20500
Jerry Palmer, Regional Representative
American Community Mutual Ir . Co.
3201 W. White Oaks Dr., SprinMeld, IL 62704
P6/(b)(6) V ; . . .
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DOCUMENT NO.
AND TYPE
014. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
12/16/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of thc PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�December 16,
1992
a
President E l e c t B i l l Clinton
1800 Center St.
L i t t l e Rock, AR 72206
Dear Mr.
Clinton,
.•"P6/(b)(6)
J l am married and have four chi Idren.
We
My name i s
are an average american middle c l a s s family. We ha v*| owned a well
established small business i n the building and cons truction f i e l d
for over 15 years. We have survived the recession t|ius far as well
as other ups and downs and yet maintained our s t a b i l ty i n the small
business world.
J
As you know; and have stated before, the small busin* ss person i s
being taken advantage of in several ways. This l e t t ^ l r i s in concern
to that f a c t .
We have j u s t recently adopted our fourth c h i l d . We have two adopted
and two b i o l o g i c a l c h i l d r e n . Our l a t e s t addition i s | b e a u t i f u l f i v e
a
month old l i t t l e g i r l named I
P6/(b)(6), •
•
w i l l need two
c o r r e c t i v e surgeries for the repair or c l e f t T T i p and c l e f t palate,
After these surgeries are complete she w i l l need no urther treatment
for t h i s condition. She i s otherwise a very healthy happy and
normal l i t t l e g i r l . Our dilemma l i e s within our hea th care company.
We have been with a "Health Maintainence Organizatioji" (HMO) for the
past two years. This, we thought, was an e x c e l l e n t health insurance
for our family because of i t s 100% coverage. After i uch searching
and i n v e s t i g a t i n g we went with t h i s HMO plan becau§e_.iJb_vL9uld cover
a l l of the d i a b e t i c needs of our oldest daughter. •P6/(b)(6)
age 13.
The HMO accepted her and the e n t i r e family with no qflesTions asked.
I might mention that we pay almost $500.00 per month for t h i s wonderful
coverage.
Our dilemma began when we attempted to add our newly adopted daughter,
f i v e month old • ..P6/(b)(6) to the policy. I was t o l d tha she would be
added to the policy t he following month a f t e r her ar i v a l i n December
1992, making that date January 1, 1993.
I mentioned the fact that
she would need l i p and palate repair surgery.
Our i:: surai
nee representat i v e stated " I see ncgroblem with that". At the enc of our conversation he asked mfe the s i z e of~T5UT -tmsiness-and how many employees we
had.
Being a small business, we have 2 employees, ,i|t t h i s time,he
retorted, "well i n that case, I dori't think her surgery w i l l be covered.- Your group i s too small. I t i s too expenTtVe 'oI~ar 5urgery~
for us to cover for you".
I was told that i f I worked for a large
-
�company or the government, t h e r e would be no problem w i t h coverage,
i t seems t o me t h a t t h i s i s pure d i s c r i m i n a t i o n agai itst the f a c t
t h a t we are a small business.
I can't understand ho^ insurance
companies can p i c k and choose who and what they w i 11 cover. When
ll
we took the p o l i c y , we were under the assumption t h a t we would r e ceive the same treatment as another company no matt er what s i z e the
business. This seems extremely u n f a i r . They are pun i s h i n g us f o r
being a small business, when i n t u r n , I f e e l small businesses are
the backbone of our country.
Mr. C l i n t o n , we are prepared t o take on t h i s expense ourselves, out
of our own pockets, over and above the cost of our 4{>nthly premium;
but we f e e l such an u n f a i r n e s s about the whole s i t u a h i o n , simply
because we are business people t o o . We have always ibperated our
business i n a very f a i r manner, w i t h customer s a t i s f a c t i o n as a goal
and key o b j e c t i v e . This has most c e r t a i n l y worked flor us f o r 15
years.
Please understand t h a t we do not f e e l t h a t we are as t i n g f o r anything
unreasonable. Our y e a r l y insurance premiums can cei : a i n l y j u s t i f y
the surgery c o s t s .
Please, Mr. C l i n t o n , something must be done. We, as w e l l as s e v e r a l
others i n our s i t u a t i o n are drowning. Please Help!
Very much appre :iated and s i n c e r e l y ,
^
copies:
Sen. A l Gore
Sen. Barbara M i k u l s k i
Md. Gov. W i l l i a m Donald Schaefer
:
P6/(b)(6)
1
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DOCUMENT NO.
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n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
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FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jm8l 1
RESTRICTION CODES
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Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
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b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
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Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
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financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/23/9;; CD: NY-19 OR 22
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
• , • -h
, ^R6/(b)(6).^
BRIEF SYNOPSIS OF LETTER
This employer r e t a i n s a group h e a l t h insurance p r o v i d e r , T h e i r insurance
p r o v i d e r j u s t r a i s e d t h e i r r a t e s 150%, i n response t o a Neu York State law
p r o h i b i t i n g insurance companies from d e s c r i m i n a t i n g on t h e t j ^ s i s o f age, sex,
(1) Drop a l l
or p r e - e x i s i t i n g c o n d i t i o n . Employer faces t h r e e c h o i c e i
coverage;
( 2 ) Accept l e s s coverage a t higher c o s t , expos .ng employers t o
p o t e n t i a l f i n a n c i a l d i s a s t e r i n medical emergency; ( 3 ) Go out o f business.
Good quote: "Mrs C l i n t o n , we need help and f a s t . "
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
016. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/18/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
jmSI 1
RESTRICTION CODES
Presidential Rceords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�;
P6/(b)(6)
t
Mrs. Hillary Roc ,s¥*'
Thc While Hous '.
1600 Pennsylvanta^v^'hTTe^"
Washinmon. DC 20500
•
.
• ^^
. '-"VV •'
[>/&]
1
March 18,1993
Dear Mrs. Clinton,
Job sectiritv v. health insurance?
We thought both were essential to the well-being of our employees. Now it eems we
have to make a choice between them.
We heard during the campaign that small businesses are the backbone of society and
om
our economy. Our small business is struggling to survive in these difficulttifres, while
still affording a decent living and security to our employees. Established in978, we
provided health insurance to our employees long before this became a national
issue.
i;
Today we received a notice from our group health insurance provider. The uardian Life
Insurance Company of America, informing us of an increase in the already^ky-high
premiuin of businesses employing less than 50 people (which is our case) b 150
percent!! The "justification" is the recent New York State law prohibiting ii ;urance
companies from discriminating on the basis of age, sex, or pre-existing condition. The
insurers' response is to raise everyone's premium to a level that is far abov< the previous
maximum rate for the oldest age category.
Our choices under these circumstances are:
!
Drop all coverage.
2.
Accept considerably less coverage at a still considerably higher cost, ^posing
our people to financial disaster in the case of a major emergency;
Discontinue business.
3.
This is a pood example, in our opinion, of a well-intentioned law gone awn with the
insurance companies virtually unregulated, n will result in more people dro ping out of
the system and being left with no coverage, risking disastrous consequence:
Mrs. Clinton, wc need help and fast!!
'
P6/(b)(6) "
•
'
i
':" '!': " j . ' • - "
t'.
'
f",
P6/(b)(6)
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
017. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1
2006-0885-F
jm81 1
RESTRICTION CODES
Prcsidenlial Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P.S Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/23/$t3 CD: TX-20 & 28
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
.
;
>
^^.^fV^* ; 6 ( ) 6 ' - . ' H V
P/b() .
.-«
:
.
• '
.jC
'-
f;* :
:.'
BRIEF SYNOPSIS OF LETTER
husband and w i f e own small business, p r o v i d e i n s coverage through small group
p o l i c y , she had kidney t r a n s p l a n t s e v e r a l years ago, wanted t o change s t a t u s
from "spouse" t o "employee" t o p r o t e c t h e r s e l f i n case husband predeceases
her, b u t i n s co would n o t make t h e change due t o pre-ex^. s t i n g c o n d i t i o n ,
premiums f o r small group have increased d r a m a t i c a l l y since her i l l n e s s
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
018. letter
SUBJECmiTLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
03/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Reeords Act -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOI A]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of thc PRAj
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�ex..
... i'S":
P6/(b)(6)
March 24, 1993
Mrs. Hillary Clinton
The White House
1600 Pennsyivania Avenue
Washinton, D.C. 20500
Re:
Health Insurance Reform
Dear Mrs. Clinton:
I am writing this letter to you as a request and a plea of hope that you can ^ I p me change two
crucial aspects regarding m health insurance. M husband and I own
y
y
P /(b)(6)I in San
urrerrtty insured as
Antonio, Texas and are insured through a small group health insurance policy. I am
a spouse and have been for the past fifteen years but I have worked as an employee for the last three
years. It is critical that m status be changed from 'spouse* to 'employee' because is an impossibility
y
for me to obtain insurance coverage should m husband pre-decease me. As ai i] i
y
established policy
holder, I believe that I have the right to this change of status but the insurance ^pmpany refuses to
change my policy.
mach e until I received a
In 1987,1 suffered kidney failure and was dependent upon a dialysis
normal life with the
perfectly matched kidney transplant four years ago. I am now able to lead a relativel
aid of anti-rejection medication. Although I feel extremely blessed and thankful for ie transplant which
has saved m life, I am very distressed and concerned about the exorbitant cost < the medication for
y
which I must take to maintain m health.
y
that
Also, because of m failed kidney, m insurance premiums have risen so drastically I am not
y
y
$28,000.00 per
able to continue paying for them. Our group health insurance now costs approxim^ely
a^
year which is an increase of approximately $1000.00 per month. This figure is quiteonishing especially
muaily.
when you consider that many people in the United States do not earn $28,000.00
I am appealing to you for your help as it is inconceivable that I can keep with the rocketing
be
cost of m premiums and should I not be able to retain coverage, m life will, once ai,ain, in jeopardy.
y
y
Thank you for your kind consideration and attention to this matter. Pleas do not hesitate to
contact me at the above address and telephone numbers if you would like further
irWormation regarding
my plight.
BKB.di
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DOCUMENT NO.
AND TYPE
019. note
SUBJECTS I I I,E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of thc PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
1 3 Release would violate a Federal statute [(a)(3) ofthe PRA|
*
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
h(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/26/9:1 CD: GA-4 AND 11
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
P6/(b)(6) '
BRIEF SYNOPSIS OF LETTER
Small business employees $33,000.00 j o i n t income.
L i m i ed p o l i c y , poor
coverage.
Dropped p o l i c y and may n o t be able t o g e t anot ier premium p l u s
deductables, p l u s o u t o f pocket equals t o o much.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
INSURANCE COVERAGE EXCLUSIONS TO CARE
LIMITED BENEFITS
QUALITY OF CARE
LACK OF SERVICES
�March 3, 1993
Hillary Rodham-Clinton
White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
N.W.
Dear H i l l a r y :
Thank you for taking the time to read my l e t t e r .
brief.
I w i l l try to be
Our joint income i s $3 3,000. a year. Both my husband and I work at
small companies. His offers insurance and we did purchase i t for
a time u n t i l we discovered i t did not cover accidents.
The
discovery was made when we had taken our son to the hospital for an
injury to the head. The deductible on the insurance was $500.00
per person per year. The premiums were $152.00 a month. We would
have spent $1500. for the deductible plus $1,824. for the premiums.
The total cost for the yearly coverage would be $3,324.00. not
including what our co-pay would have been for routine office v i s i t s
and cost of any medications. Needless to say, we had to pay for the
hospital v i s i t out of our own pocket while continuing to pay the
premiums for the insurance that did not pay for the accident.
This policy seemed to be worthless and in time we did drop i t .
Now however, we find that having dropped the policy may well keep
us from qualifying to purchase insurance through something other
than our jobs. My job offers no insurance and even i f i t did
chances are the premiums would be too high for me to afford to
carry the insurance. I t seems the l e s s employees the more the
company has to pay to provide insurance for that employee and h i s
or her dependents.
Neither my husband and I have serious medical problems. We are
considered healthy.
We don't smoke and drink i s done i n
moderation. We do feel persecuted for being well and having lower
middle c l a s s income. I f we were i l l and could not work we could
possibly qualify for medicaid. But we are well and are working but
are expected to pay through the nose. Please do not think that I
do not want to be responsible and not pay for coverage. The cost
of the insurance i s so high as are the rates for the doctors,
nurses, hospital, medicine, etc. God forbid i f we ever got s i c k .
Thank you for your time. I am confident that you w i l l improve upon
our current health care system. I do have one other thing to add.
While my c h i l d was younger i t seemed as though he was inoculated
a l l the time. Recently, I have wondered i f the school would be
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
020. letter
SUBJECT/TITLE
DATE
03/03/1993
Personal (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of thc PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRAj
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) nf the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Page
There have
contacting me i f he needed any additional inoculations
been measles and tuberculosis in the news a lot 1 tely and no
mention at the schools of any additional shots being g ven. Again,
expect the
I remember as a child being given TB tests. I don
am just not
schools to be responsible for giving the shots but
sure of when and how often the shots are to be given anymore. I
honestly feel dumb about such things and I was always the one that
was so informed at one time. What i s happening?
Sincerely,
• "P6/(b)(6y
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
021. note
SIIB.IECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
jmSI I
RESTRICTION CODES
PresidcntiHl Records Act - |44 U.S.C. 2204(n)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
Nalionnl Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 1)8/23/93 CD: FL-8
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Husband has r e n a l disease w i t h b i l l s f o $150,000 f o r t h e pas 15 months. Has
no insurance as he owns a small business, covered under v i .Ife's p l a n . Wife
now l a i d o f f ; b e l i e v e s company was u n w i l l i n g t o c o n t i n u e p a i i n g f o r spouse's
treatment.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
OTHER
Small business owners have no insurance.
MEDICAL COSTS - EXCESSIVE
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
022. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/30/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Rox Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating to thc appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of thc FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions |(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�P6/(b)(6)
foraiary 30,1993
Ms. Hillary Rodl\ain Clinton
Die WTiitr House
16CG Petu\£y lvania Avenue, NW
Washington, DC
Dear Ms. Clinton:
I hope that j our review of the health care and insurance system will result in a structure that will
ease the burden both on patients and on employere Let me tell you my story:
About 15 months ago, my husband developed End Stage Renal Disease (kidney ailure). Since
that time he has been on kidney dialysis and has been hospitalized twice. His tc 1 1 medical bills
1
for die past 15 months are in the neighborhood of $100,000. Because he owns a i nail business,
he was covered under my group health insurance. The company does about $Sp million in sales
and employs about 300 people It is self-insured.
Two weeks ago 1 was laid off, along with a colleague whose wife had been ver' ill last year
with a neurological problem. Her medical bills were in excess of $20,000. The -lasonwewere
g:'v<>:i wa'. "organizational changes." We believe, however, that we were let gc because the
company was unwilling or unable to continue paying medical bills for our spoil s. We intend,
of course, to continue our group health coverage for 18 months under COBRA, bit at the end of
that time we may be in trouble, especially if we obtain new group insurance thai restricts
cov erage of pre-existing conditions.
I can understand the problem employers face when confronted with medical exp snses of this
ion. However, it would be impossible for individuals or families to pay these costs over any
Icii^Ui ot time.
My husband t closing Itis business, since his health prevents him from running it He will be
eligible for Medicare in July, so we will probably manage all right (although, w i h two children
u colicge it won't be easy) 1 am currently receiving unemployment compensaf on and looking
>
lor another job.
1 Imve gone into some detail to let you know how urgent the health-care crisis hi to one
>ks
your
fairly norma; American family 1 certainly don't know what the answer is; 1 hopt
commission can (md a solution.
^_S.inr.er.eIy_v.ours..
•P6/(b)(6):-
A
1
!•
i
I '•
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
023. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
jmSI 1
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(S) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of thc FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN ( U / 2 5 / 9 3 CD:
PERSONAL STORIES DATABASE
NJ-1
I D E N T I F I C A T I O N OF WRITER
v>,-•:•••"
:
P6/(b)(6)
• ,•-,,4
BRIEF SYNOPSIS OF LETTER
Divorced mother of 2 cannot afford health premiums offered by her employer.
They are covered by former husband, but h i s job i s i n jeopijrdy (Chevron):
she could be without any coverage.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
024. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
05/16/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
,jm81 1
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRAj
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
h(l) National security classified information |(b)(l)of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�i'
5-
,/yYi.y P/hyz^Psx.
j ff&cAvn^
-^Do (Us&Q /v»y r n ^ A ^ L
P6/(b).(6)
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
025. statement
SUBJECT/TITLE
DATE
04/28/1993
re: Pay statement (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
iin8l I
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 5.52(b)|
PI National Security' Classified Information |(a)(l) of thc PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of thc PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�"
ATTENTION
1
1
0 P E N
ATTENTION
! !
E N R O L L M E N T
ATTENTION
! !
"
ATTENTION
! !
I t i s OF'EN ENROLLMENT t i m e i o r U.S. H e a l t h c a r e HMO FA/NJ/DE.
There a r e
2 d i - f - f e r e n t t y p e s o-f c o v e r a g e t o c h o o s e -from.
C o v e r a g e i s b e i n g o-f-fered
t o a l l " e l i g i b l e " e m p l o y e e s o-f R o c k i n g H o r s e .
I-f you have been w i t h
R o c k i n g H o r s e -for MORE t h a n 90 Days, a r e - f u l l t i m e and d i d n o t e l e c t t o h a v e c o v e r a g e a t y o u r t i m e o-f h i r e ,
this i s
the o p p o r t u n i t y
-for y o u t o e n r o l l
with
U.S. H e a l t h c a r e
HMO PA/NJ/DE.
P l e a s e see a t t a c h e d i n - f o .
Open e n r o l l m e n t i s o n l y t h r o u g h May 3 1 1993.
Those who w o u l d l i k e t o
enroll
w i l l become e - f - f e c t i v e
JUNE 1 , 1993.
You MUST c o m p l e t e t h e
a t t a c h e d s e l e c t i on -form and r e t u r n i t t o y o u r d i r e c t o r
NO
LATER
THAN
MAY 19. 1993 i n o r d e r -for us t o p r o c e s s i n t i m e .
I-f y o u e l e c t ,
we w i l l
t h e n be s e n d i n g you an a p p l i c a t i o n
based on t h e p l a n y o u s e l e c t e d . You
w i l l have t o c o m p l e t e t h e a p p l i c a t i o n i m m e d i a t e l y upon r e c e i v i n g i t .
J
�t t t t OE E R L M N t » » t
PN N O L E T
CVRG S L C I N FR - U H A T C R / H
OEAE E E T O OM
S ELHAEHO
R T S AE E F C I E J N 1, 1993 T R MY 31, 1 9
AE R F E T V U E
HU A
94
t t P E I R HO t t
RME M
PA T P :
LN Y E
I t V L E P U HO t t
AU LS M
ElLYE
fPOE
CVRG^IEU
OEAEHEKp
TP
YE
D E c l N PA TP
EUTO
LN YE
HO N - no dental S N L
M J
IGE
HO N - no dental F M L
M J
AIY
$67.50
J248.85
Ei
H
CVR^J-EEL,
OEAEIHEKY
TP
Y E D D C 1 U"
EUT N
HO N - no dental S N L
M J
I G E $59.61
HO N - no dental F M L 1219.71
M J
AIY
HO N - / dental,SINGLE
M J w
^flHO N - V dentaH^AHILY 1261.60
J /
H O < _ w dental S N L
HJJ- /
IGE »33
6.1
HO N - M dental F M L 1231.86j:
M J /
AIY
-
HO P - n dental S N L
M A o
IGE
HO P - n dental F M L
M A o
AIY
$51.09
$184.29
HO P - no dental S N L
M A
IGE
HO P - no dental F M L
M A
AIY
$43.80
$157.95
HO P - H/ dental S N L
M A
IGE
HO P - nl dental F M L
M A
AIY
$54.74
$196.09
HO P - « dental S N L
M A /
IGE
HO P - M/ dental F M L
M A
AIY
$47.45
$169.75
HO D - n dental S N L
M E
o
IGE
$57.45
HO D - n dental F M L
M E o
A I Y $219.75
HO D - M dental S N L
M E /
IGE
HO D - w dental F M L
M E /
AIY
HO N - «/ dental S N L
M J
IGE
^MO^J-^tiV" dental F M L
AIY
HO D - no dental S N L
M E
I G E $50.79
HO D - n dental F M L $194.29
M E o
AIY
$61.20 HO D - M dental S N L
M E /
IGE
$232.10 HO DE-«/ dental F M L
M
AIY
$54.54
$206.64
$71.80
$T63.00
$63.91
$233.86,
HO N - » dental S N L
M J /
IGE
HO N - •/ dental F M L
M J »
AIY
titttitttuttnttittttttitttiititttutittititttttttttutttttiitittttiutiuttt
mtmtmmmtttmmsumtummmmmmmmmmmmtstmt
I A A A E O T E O T O S A A L B E T H AD E E T A F L O S
M KR F H P I N V I A L O E N L C S O L N :
(olease check onlv one)
I Hould lii.e to enroll with the ^reiier Hriu' coverage
I would like to enroll with the 'Value Plus" coverage
I do Jlfll wish to enroll at this tiie a d ai aware that
n
I cannot enroll again until the 'next' open enrollient
which will not b until June 1, 1 9 .
e
94
(eiployee naie. please print)
(school t)
(eiployees signature)
(date signed)
(original date of hire)
I I P E S C M L T AD R T R THIS FR T YU D R C O B HY 19, 1 9 t t
L A E OPEE N EUN
OM O OR I E T R Y A
93
ttttttttutiittitttttututttttttttttuttititttttttttutufttttttttttttutitu
tttuttuuttutittttttttuttutttttiuttittttttttttttttutttuutuitttttitu
�q p L aiE
m R Hs
v
IQEFITS -
AU
mnm m vs. V L E
o
PU W
LS O
PEIR W
RME O
VALUE PLUS W
O
mmi mi PHYSICIAN VISITS
Office Houri
10 • 1 c p y
01 2 o a
10 * 10 cpy
02 1 oa
Mtir Houri/Hoii Vilit
1 0 * tS c p y
01
oa
10 •15 cpy
02 1 oa
SPECIALTY C R
AE
Offici Vnitt
I-Riys/Lab Tistt
Outpititnt Surqtry
ConiulUtiont
HMI Htalth Strvicii
10
01
10
02
10
01
10
01
100!
1 0 + IIS c p y
02
oa
1 0 * tlS c p y
02
oa
10 • 10 cpy
02 10 oa
1 0 + IIS c p y
02
oa
10
02
HOSPITALIZATION I S RE Y
U6R
Rooi t Boird (Sfii-private)
burg try • Ancsthesi*
Htdical I Surgical Specialist Care
X-Rays/Lib Ttstt
10
01
10
02
10
02
10
02
$4 cpy
20 oa
1 C after c p y
02
oa
1 0 after c p y
02
oa
1 0 after c p y
02
oa
E E G N Y RO
M R E C OK
tlS copay
$35 c p y
oa
HTRIY
AENT
O Vititi
1002
1 0 * 115 c p y for Itt viiit
02
oa
1002
1002
10 +$4 cpy
02 20 oa
10
02
1002
10 + 102 cpy
02 1/5 oa
10 • 14 cpy
02 20 oa
1 0 • I2S c p y
02
oa
S K A C AUE t I
U T N E BS
Inpatient
Outpatitflt
1002
1002
10 * $4 cpy
02 20 oa
1 0 * 1 5 c p y u to 1 4 MI
02 1 oa p
20
P E E T V CR
H V N I E AE
Ey« E »
s2
i n Eiu
Pediatric ttntal Ezu
KauogrM
toe; * JI cuw
1002 • 12 copay
1002 * 12 copay
1002
IOOA • lla c p y
oa
1 0 + IIS c p y
02
oa
N t covered
o
1 0 « US c p y
02
oa
H A T Y OTOK P O R H
E L H ULO R B A S
Ntalthy Eating Progru
Healthy Irtathing Prograi
Fitness Reioburseaent
Prim for wight lots
Prizes for sacking cessation
U to 1200 annually
p
Prizes for Might loss
Prizes for sacking cessation
U to $ 0 annually
p
20
P E C I T O L N RIBREET
R S R P I N E S EMUSMN
$35 every 24 tonths
N t covtrtd
o
PECITOS
RSRPIN
$2.50 each
1 . 0 tach
75
teipital
L'il Appleseed Prograi
RNA HAT t t
ETL ELH
Inpititnt
Outpatient
All non-eaergency specialty a d hospital services require a prior uritttn
n
referral froo the priaary care physician.
t t Coverage a d copays vary b state
n
y
I
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
026. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
jmSI I
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information |(a)(l) ofthe PRA]
P2 Relating to the appointment to Federal office [(a)(2) of thc PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
h(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of Ihe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN BY WIFE 08/25/93 CD: rX-3, 26, AND 30
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
v
P6/(b)(6)
BRIEF SYNOPSIS OF LETTER
Insurance premiums f o r 3 employees have r i s e n 1,100% since 1981.
$765.00 per person/month. This i s bankrupting t h e f i r m .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
Now pays
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
027. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
02/18/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jmSI I
RESTRICTION CODES
Presidential Reeords Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning Ihe regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
National Security Classified Information [(a)(1) ofthe PRA]
Relating tn the appointment tn Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA)
Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) of thc PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Mrs. Hillary Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
February 18, 1993
Re: H A T I S R N E
ELH NUAC
* *•
Deaf Mrs/'flInton:
Our American health care / health insurance system is broken, nd is desperately
in need of an overhaul. I would like to point out s m BIG probl *ms.
oe
It has become commonplace for m n health insurance companies ; cancel the
ay
o
policies of those who get sick, or to raise the premium rates to ie point that the
insured might almost as well just pay his own medical expenses ou ight. (I a one
m
in the later group.) This sleezy way of doing business complete defeats the very
concept of insurance, which should be to spread the risk. Instead these insurance
companies are in the business of avoiding risk. I think this sfbul d be regarded
as a form of fraud. These companies are selling insurance that r ^ l ly is not insurance,
They collect the premiums but find a way to avoid standing behind he promise,
explicit or implied, to protect the insured in time of need. It a cruel shell
g m ; "now you see it, now you don't."
ae
Our government has "truth in lending" laws, "truth in adverti ng" laws, and a
UH
host of other consumer protection statutes. Why isn't there a " * T IN INSURANCE"
law? Why does our government allow these deceitful, crooked and financially devistating practices to go on? Why can't the insurance companies be "equired to provide
what they say they do ... real protection against risk. Why shoiMl dn't the law
ibit segregating
require that premium rates be averaged a o g all people, and profip
mn
policies between sick and well persons? Apparantly the law now llows an insurance
agent to promise (or imply) wonderful coverage in his sales presefltati on, but the
renege on
policy sold has s m fine print loopholes that allow the company
oe
ultimately assuming the risk. Why is this not illegal? And thi is not a penneyante shell g m ; we are talking about fraud that frequently amouflts to tens and
ae
even hundreds of thousands of dollars on just a single policy.
Another shady practice of m n insurance companies is the "co version clause" found
ay
in most group policies. This clause in tbe contract appears to gurantee that an
individual insured through the group can have personal insurance overage, regardless
of health conditions, should he leave the group by changing jobs, etc. Provision
of a policy for the person may be guranteed, but the terms and cok erage of said
individual policy are nothing like those of the group. Often thi monthly premiums
are double, and coverage is so limited as to make the policy almot worthless. Do you
think this is disclosed when the insurance agent makes his sales (presentation?
Not likely. The agent just lets the succer buying the policy assume that the
coverage and terms would be equal. S m agents absolutely refusr to let a prospective
oe
customer read the fine print of the proposed insurance policy cor ract until the
customer signs to purchase the policy and makes the Innitial paynj^nt
Why are such
business practices legal?
n
I a the owner of a small business with three (3) employees. Our group health
m
Insurance premiums are now eleven (11) times as high as when we lurchased the i n n i t i a l
policy In 1981, and we are insuring fewer persons now at higher (jtductibles. That's
an 1100% increase! That's not just adjustment for Inflation; no even health care
costs have inflated anything like that! What happened is that cie person in our
�.P6/(b),(6)..
Page 2
Feb. 18, 1993
HAT ISRNE
ELH NUAC
group developed a chronic health condition and submitted a lot o claims. Right
W are now
e
after that, our insurance premiums escalated right through the rc if
paying $765 per m n h per person. This burden is bankrupting oi little firm,
ot
To drop the policy would leave the sick employee without insurant prgteetion for
years. H is considered uninsurable through the private sector nder present
e
insurance practices, and to m knowledge there is N G V R M N !
y
O O E N E T ^FETY NET, except
for medicare, for which this person will not qualify for 12 m r /ears.
oe
I can't stomach to hear any m r partizan rhetoric about h w wonderful the
oe
o
present American health care system is. The system is a mess! It is full of
inequality, fraud, greed, waste and inefficiency! W o is going to fix it? Who else
h
but the government has the power and resources to tackle such a rge problem?
The American people need, want, and expect to see something done I believe that
the H A T C R CRISIS is the N M E O E ISSUE facing our nation
ELH AE
UBR N
W need
e
(1)
(2)
(3)
(4)
to find a way to:
Equalize medical insurance premiums,
Stop the greed and fraud by insurance companies,
Control health care costs, and
Assure that all Americans have access to coverage.
I would appreciate hearing from you about your ideas on h w ;) achieve
o
these goals, and h w quickly you believe we can reach them.
o
Awaiting your sol tion,
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COLLECTION:
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FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jmSll
RESTRICTION CODES
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Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of thc PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN
PERSONAL STORIES DATABASE
8/25/93 CD: ME-1
IDENTIFICATION OF WRITER
,':p6/(b)(6)-3,
:
,fj'" '
j
>
:
BRIEF SYNOPSIS OF LETTER
Small business owner can't afford to insure 50 employees, insurance only for
f u l l time employees, but very expensive. Must stay with B /BS due to
employees' p r e - e x i s t i n g conditions.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
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SUBJECT/TITLE
DATE
02/14/1993
Personal (Partial); Address (Partial) (2 pages)
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
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FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
jm8l 1
RESTRICTION CODES
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Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(h)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(M) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
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�I'"
February
14,
1993
H i l l a r y Rodham C l i n t o n
The White House
1600 P e n n s y l v a n i a Avenue
W a s h i n g t o n , D.C.
20020
Dear Ms.
Rodham C l i n t o n :
Let me b e g i n t h i s l e t t e r by t e l l i n g you t h a t I am a g
a d m i r e r o f y o u r s and have been s i n c e you and y o u r hus
began c a m p a i g n i n g .
I am v e r y p l e a s e d t h a t P r e s i d e n t
had p u t you i n a p o s i t i o n o f such i m p o r t a n c e as d i r e c
t h e t a s k f o r c e on h e a l t h c a r e .
eat
and
1 inton
or of
L e t me a l s o t e l l you t h a t b o t h my husband and I each
wn
s m a l l b u s i n e s s and between us employ a p p r o x i m a t e l y f i t y
people.
My husband a l s o has a c h r o n i c d i s e a s e , so I m
s p e a k i n g from b o t h s i d e s o f the i s s u e , as a p r o v i d e r f
m e d i c a l i n s u r a n c e and a l s o as a b e n e f i c i a r y o f h e a l t h c a r e
I f e e l t h a t t h e c u r r e n t system o f h e a l t h c a r e i n Amer
o n l y be c o r r e c t e d by sweeping changes; f i d d l i n g w i t h
a d j u s t m e n t s won't do a t h i n g .
I f e e l t h a t t h e answer
clear: The United States desperately needs a single
h e a l t h system s i m i l a r t o t h a t used i n Canada w h i c h wi
a s s u r e coverage f o r everyone.
ca can
mall
is
ayor
1
As a s m a l l b u s i n e s s owner, I know t h a t I c a n ' t a f f o r d t o
i n s u r e a l l o f my employees. C u r r e n t l y I p r o v i d e i n s u ance
t o o n l y my f u l l - t i m e w o r k e r s , w h i c h i s an enormous expense
f o r me.
I f a government mandate f o r c e d me t o p r o v i d e
o v e r a g e t o my p a r t - t i m e employees as w e l l , my b u s i n e s
w o u l d n ' t be a b l e t o s u r v i v e .
The same s i t u a t i o n i s t r u e
i n my husband's b u s i n e s s .
I n h i s case, i t would make more
sense f o r him t o h i s reduce h i s s t a f f and work t h e f u 1-time
employees more h o u r s t o a v o i d h a v i n g t o i n s u r e a l l t h r t y
f u l l - and p a r t - t i m e employees. Don't m i s u n d e r s t a n d , 'e
would l o v e t o be a b l e t o i n s u r e a l l o f our employees, b u t i t
s i m p l y i s n ' t p o s s i b l e i f we are t o s t a y i n b u s i n e s s .
�-2 C l e a r l y , s m a l l b u s i n e s s e s c a n ' t be asked t o f o o t t h e i l l .
As i t i s i n o u r s i t u a t i o n , t h e coverage I p r o v i d e t o fly
employees i s Blue C r o s s / B l u e S h i e l d , w h i c h i s g r e a t
c o v e r a g e , b u t v e r y e x p e n s i v e . I am n o t i n a p o s i t i o n
shop around f o r a l e s s e x p e n s i v e p o l i c y because o f p r ^
e x i s t i n g c o n d i t i o n s a f f e c t i n g s e v e r a l members o f my s
So we're s t u c k w i t h t h e p o l i c y we now have.
My emplo
t e l l me t h a t t h e y can never l e a v e my company because
never a g a i n be a b l e t o g e t m e d i c a l i n s u r a n c e t h a t wou
cover t h e i r c o n d i t i o n s .
T h i s i s n o t t h e way American
c a r e s h o u l d be.
I f t h e U.S. went t o a system w i t h t h e government p r o v id i ng
i n s u r a n c e f o r t h o s e p e o p l e no o t h e r i n s u r a n c e company would
t o u c h , i t i s doomed t o f a i l .
The government system w u i d be
a dumping ground f o r t h e s i c k e s t Americans.
The o n l y answer i s a s i n g l e payer system.
Tinkering
t h e c u r r e n t system w i l l o n l y d e l a y t h e i n e v i t a b l e .
i tn
H i l l a r y , I'm c o n f i d e n t t h a t you won't be swayed by t h
s p e c i a l i n t e r e s t groups.
I know t h a t y o u ' l l f i x i t a d
i t r i g h t the f i r s t time.
7 . •
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•-',•• . • ';:"v •?*
cc:
S e n a t o r George M i t c h e l l
S e n a t o r W i l l i a m Cohen
Congressman Tom Andrews
fi^
• •.
�Clinton Presidential Records
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This marker identifies the place of a tabbed divider. Given our
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DATE
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n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
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FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
jmSI 1
RESTRICTION CODES
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Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
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b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
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RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/26/93 CD: GA-5
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
o3
0
^
BRIEF SYNOPSIS OF LETTER
59 year o l d man and w i f e ( 6 1 ) . Contract engineer w i t h no permanent j o b .
Pays own h e a l t h insurance a t $700.00 per month. Supports n a t i o n a l h e a l t h
care.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
?
�Withdrawal/Redaction Marker
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031. letter
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SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/15/1993
RESTRICTION
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COLLECTION:
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2006-0885-F
jm811
RESTRICTION CODES
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PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA |
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
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RR. Document will be reviewed upon request.
�From:
0
March llith 1993
To:
H i l a r y Rodham C l i n t o n
THE WHITE HOUSE
Washington D.C.
Dear H i l a r y ,
r e ; THE NATIONAL HEALTH SCHEME - ' E 1
!S
been h i r e d on
!
My husband i s 59 and I am 61 years o l d . He has
i c o n t r a c t as an engineer f o r the l a s t two years. He coes not have
' a permanent j o b and h i s h e a l t h insurance i s c o s t i n g Almost $700 a
month f o r the two o f us. We have debts we cannot put because o f
t h i s and a t the r a t e the insurance c a r r i e r s increase t e i r premiums
each year we w i l l be paying about $1,000 a month i i t h r e e years
t i m e . This w i l l be beyond our reach and we w i l l be j u s t another
s t a t i s t i c t o add t o the o t h e r m i l l i o n s who are uninsi]red today.
We have always p a i d our way but h e l p i n g t o prop up o t h e r people
i s c o s t i n g us d e a r l y . We a r e g l a d t o help b u t f e e ] the c o s t o f
h e a l t h insurance should be shared by a l l people, not. j u s t a few.
( that there
I f t h e l a s t twelve years has t a u g h t us a n y t h i n g i t
are those who are g e t t i n g very r i c h a t t h e expense bf those who
always pay f o r t h e country's b i l l s . We are s l o w l y tecoming very
poor, over-burdened and mad as h e l l .
We do not want t o go backward i n humanitarian c a r but s p e c i a l
i
i n t e r e s t groups a l s o have t o recognize t h e i r r e s p o n s i n i l i t y i n t h e
order o f t h i n g s and not c o n s i s t e n t l y look f o r such h i q h p r o f i t s i n
h e a l t h care. We are almost a T h i r d World N a t i o n i n he h e a l t h o f
our c i t i z e n s . I t i s a d i s g r a c e .
England was made t o recognize t h a t by t h er e t u r n i n g war
veterans.
England had People Power i n 1947 eve^i though t h e
n a t i o n a l debt was h i g h ; they d i d i t . l .
Other count i e s f o l l o w e d
s u i t - even those who were defeated i n World War 11 -because they
are governments who b e l i e v e i t s n a t u r a l resource i s p^bple. So you
increase a gas t a x by 15 cents, c i g a r e t t e s and l i q u o : by 20 cents
t o pay f o r i t . I f you want t o w i n a war you havef t o make t h e
people b e l i e v e i t can be done; BE BOLD AND JUST DO *3L_L
Yours very sincere|l|y
.
P6/(b)(6)
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b(2) Release would disclose internal personnel rules and practices of
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b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of thc PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN Ofl/25/93 CD: VA-H
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
-T;—r——r
„ .
—:—-**-r—
; * J*
-V'..!i'.
^ '"t- ' :
•
-P6/(b)(6) '
y4'v
BRIEF SYNOPSIS OF LETTER
Carolyn Gatz L e t t e r , President o f small business(80-140) pec slehas moved h i s
company from indemnity coverage t o PPO/HMO. Costs a r e c o n t i r u i n g t o e s c a l a t e ,
He i s s t i l l p r o v i d i n g coverage b u t can see a s h r i n k i n g bottcjfi l i n e and f u t u r e
breaking p o i n t o f u n d e r i n s u r i n g o r n o t p r o v i d i n g coverage
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
OTHER CONTENT
Small Business p e r s p e c t i v e
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SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
01/28/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
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OA/Box Number:
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FOLDER TITLE:
[Small Business Letters] [binders] [I]
2006-0885-F
jni8l I
RESTRICTION CODES
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Freedom of Information Act - |5 I'.S.C. 552(b)]
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of thc PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(5) of the PRA]
I'd Release would constitute a clearly unwarranted invasion nf
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA)
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�(
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January 28,
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Mrs. Hillary Rodham Clinton
The White House
Washington, DC 20001
Dear Mrs. Clinton:
Congratulations on your appointment to r.ead the
President's task force on national health calire reforin.
number of
This i s a subject that has intrigued me for
years as I wear many hats around the health i a r e industry.
I a a small businessman who owns an arqihitectural
m
precast concrete firm in Woodbridge, VA, whitth is' 25 - miles
south of Washington. Our payroll i s usually between 80 and
140 dedicated men and women who are trying to make a living
in these very trying.times. One of our maj .costs, and
lor
1th
certainly our employees', i s the cost of hea care for
them and their families.
Over the course of the years, we have gtone from an
indemnity type arrangement with many insurance companies,
to our current PPO and H O optional coverage for our
M
employees. As the cost of our employees' health care hits
their individual pockets, they are becoming ^cutely aware
of the high cost of health care in our natiajn
I am very
afraid of where these high costs w i l l lead sua] businesses
11
like mine in the future. As these costs esca:
late and our
bottom lines shrink, there w i l l come a break ;.ng point where
k .i
good wholesome all-American companies l i k e curs w i l l be
forced to either under-insure our employees 4 r provide no
>
insurance at a l l . I believe very strongly in the approach
of protecting our employees from catastrophi financial
burdens of i l l n e s s or injury, but there are times when i t
i s very tough. . 7
I obviously share the.same concerns of ny employees as
I am paying for the medical .'care'of .my."wife »nd three children. Although my disposal income i s celt"tainly higher
than most, the everyday cost of proper mediq&l care i s
affecting even the most wealthy among us.
�Hillary Rodham Clinton
January 28, 1993
Page Three
can see our hospital having to share some of the burdens of
health care reform and I am afraid, notnecessar i l y for the
short term, but for the long term as to thereplacement of
the very high tech necessities of l i f e in runjtjiing a modern
hospital. Obviously in the not for profit sector of
hospitals, we c a l l our residual earnings surp us. We use
that surplus to fund the quickly depreciating assets that
are necessary in our business and those long term assets,
like buildings, for the future.
I believe you have your hands f u l l , and
would like
to offer my assistance in any way that I can. I believe
that I have a very unique perspective of seei
mg both sides
of the medical world, as a provider and as a ^ayer and I
have devoted thousands of hours of my free tine to the
success of health care in our area. I do not know what the
task force w i l l be doing regarding John Q. C i : i zen like
myself, but i f I can be a part of the study c: •
the decision
making process, I would be proud and happy to serve you,
the president, and the nation.
Thanks for listening and please l e t me kjijiow i f I may
be of some help.
Very truly ydtrs,
P6/{bH6). .
:
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n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
O A / B o x Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
jm8l I
RESTRICTION CODES
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Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRAj
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PR A]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN <|>|8/23/93 CD: AR-2
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
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BRIEF SYNOPSIS OF LETTER
Ins. company refused t o pay medical expenses f o r i n d i v i d t i l covered under
small group p o l i c y of a small buisness, employee subseq e n t l y died from
cancer
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LIMITED BENEFITS
CLAIM DENIED
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
035. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/11/1993
RESTRIC TION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(h)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information [(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or conndential commercial or
nnancial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�P6/(b)(6)
March 11, 1993
Mr. Mike A. Moore
Group Claims Supervisor .
John Alden Insurance Company
P. O. Box 528060
Miami, FL 33152-8060
RE:
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Dear Mr. Moore:
I most certainly have concerns about the decisi on of
your company to rescind |
P / b ( ) ,. - I insurance,YIQUT agents
6()6 .
accepted Scott as part of our group without requir ng a •
pre-qualification physical examination. There i s (Absolutely
nothing which indicates that Scott nor his physicians had
any reason to suspect that he might not be perfect y
healthy, and in fact, his oncologist has stated th
thftt Scott's
particular kind of cancer i s extremely fast acting and in
his opinion, Scott did not contract the cancer unt 1 after
his effective date of insurance. Your own conpan has
contacted the family with o f f i c i a l notices that h
claims
would be paid.
Your company has shown conplete contempt for
contractual obligations that you assume as an ins
attempting to "welch on your bet", because Scott
and died. I protest t h i s highhanded effort on void:
company's part to sidestep your legal responsiblli':ies
I am further appalled at your company's inabil ty both
to issue policies that are accurate (our recent isjiuances
had a 71% error rate), and to process claims in a :imely
manner. Two other claims in addition to Scott's Mliich were
f i l e d in the f a l l have not yet been paid, as far en I know.
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�This letter i s to advise you that we do not be Leve tt>at
returning the payments i s an acceptable alternative to
honoring your contract and we protest.
cc:
Lee Douglas, Arkansas Insurance Commissioner
Mrs. Hilary Rodham Clinton, President's Health Reform
Commission
Mrs. Linda Collier, Attorney
Employee f i l e
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DATE
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n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [L
2006-0885-F
jm8l I
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRAj
P4 Release would disclose trade secrets or confidential commercial or
Financial information 1(a)(4) of thc PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 1)8/24/93 CD: NM-3
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
writer i s owner of small business has group health ins thtough Chamber of
Commerce, but cannot affort coverage for part-time emplc: ees and worries
about son and other others who are self-employed
r
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
�Withdrawal/Redaction Marker
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DOCUMEINTNO.
AND TYPE
037. letter
DATE
SlIBJFXmULE
Personal (Partial); Address (Partial) (1 page)
01/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�P6/(b)(6)
Janua:y 26, 1993
Dear Mrs. Clinton,
F i r s t , congratulations to you and the President I This wa
the f i r s t elec-
t i o n i n 30 year where I actually voted FOR someone.
I wanted to offer a few thoughts on the subject of health care.
I don't
see how a country that c a l l s i t s e l f advanced can leave over 35 n i l l i o n people
with no health coverage.
By no means are a l l of us below the soverty level -
although we certainly would be i f we were struck w i t h a catast lophic i l l n e s s .
I own a small business and currently I do have a group insuraaip. policy through
the Chamber of Commerce, but my parttime employee has none, Ne [Jther does my
son, a free lance photographer.
Nor do the thousands of a r t i s :B, w r i t e r s , and
seasonal employees who struggle to make a l i v i n g I n Santa Fe.
small farmers and those temporarily in-between jobs?
And what about
There seins to exist a
bureacratic mentality that assumes that a l l Americans collect .i| W-2 form at
the end of the year.
My son was born i n Canada while his father was temporaril; working there
and we had complete coverage for my pregnancy, his b i r t h , and Jis pediatric
care.
We had competent medical care of our own choice.
Ward "poms i n the
hospital were free, semi-private rooms charged a small fee, or >ne could choose
a private room, as 1 d i d , for a larger amount. As far as haviub long waiting
l i s t s for elective surgery, i t seems to me the whole point of .ny surgery being
elective i s that i t isn't an emergency and can wait.
When I sustained a slipped
disc and a pinched s c i a t i c nerve t h i s past summer, several doc :
to perform back surgery.
I insisted on t r y i n g a l t e r n a t i v e treii tments f i r s t and,
a f t e r a few months, i t became clear that the surgery r e a l l y vain't necessary.
F i n a l l y , please t e l l the President to hang i n there on thn subject of gays
in the m i l i t a r y .
He's going to have a tough b a t t l e - i t alway: i s when you're
t r y i n g to change old biases and prejudices. But i f he can win he w i l l long
be remembered for his courage.
• P6/(b)(6)
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038. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) of thc PRA|
1 2 Relating to the appointment to Federal office 1(a)(2) of thc PRA|
*
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
nnancial information 1(a)(4) of thc PRA]
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b( I) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or conndential or nnancial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
nnancial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/23/93 CD: WI- 4, 5 6 9
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
2
BRIEF SYNOPSIS OF LETTER
Family small business whose owners cannot
themselves o r employees.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
affprd
heali:i
insurance f o r
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
039. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
02/07/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [S U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
h(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-P6/(b)(6)
February 7
1993
Mrs. H i l l a r y Rodham-Clinton
The White House
1600 Pennsylvania Avenue N
W
Washington, DC 20500-0002
C I
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Dear Mrs. Rodham-Clinton:
I would l i k e to share with you some of my observatiHns and concerns about
health care i n the United States.
P6/(b)(6)
For the past 5 years I have worked i n the
rt and
During t h i s time I have seen tfifi cost o
P6/(b)(6)
outpatient services almost double. Some medications nov cost $10 or more for a
single p i l l . The hospital b i l l s a l l payors at the same;ates. These costs are
i n f l a t e d , but the hospital does not collect a l l that i s i i l l e d . A large portion
of the costs for Medicare and Medicaid patients are writjien o f f . In Milwaukee
we also have health care plans for the indigent which ai(! financed by taxpayers
and additional w r i t e - o f f s . Payments from private insurt " help t o make up f o r
s
much of the w r i t t e n o f f charges. This keeps the hospits . out of the red but
increases health insurance premiums for everyone. This sxplains some of the
i
high medical costs but i n no way i s i t my intention to ; s t i f y them.
-
's
There has also been a p r o l i f e r a t i o n of HMO's and Plft> during the past 5
years. These have not reduced costs - they have shiftet costs to other payors,
Medicare, Medicaid, H O s and PPO's with t h e i r num< :ous plans have created
M'
giant headaches f o r people l i k e me who have t o keep trac c of which plan gets
what discount. But even worse, they create endless con ision f o r our c l i e n t s ,
Many of the elderly and uneducated get frustrated t r y i n j ; to understand terms l i k e
coinsurance, spend down, preauthorization, and r e f e r r a l
What we need i s a simpler, more uniform methold of >aying f o r health care
for everyone i n terms that a l l can understand.
On a more personal level I am concerned about the ([Jjality of health care my
My husband has some
husband and I w i l l receive i n the future and at what cos:
health problems that necessitate my leaving my job t o b home with him. I w i l l
r e t i r e then end of t h i s month at the age of 63 - 2 year^ e a r l i e r than planned,
Because 1 am not old enough f o r Medicare I w i l l have t o pay $400 monthly f o r
Doubtless t h i s w i l l
health care premiums (2/3 of my Social Security benefit
increase i n 1994.
I am a diabetid and my 71 year old husband had h i g blood pressure and
heart problems. These are conditions that most Medicar^ supplements either
exclude from coverage or add additional premiums. FortJnately I w i l l be able
to continue with my current insurance without worring a 3out pre-existing
conditions.
Paying f o r health care i s another of my concerns, My daughter has her own
business. At one time she had 5 employees. But as the
quit she did not
replace them because of the high cost of p a y r o l l taxes nd insurance premiums.
�Now her only employee i s her brother who i s covered unde his wife's health
care plan. My daughter herself i s covered under her bus and's plan.
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My brother i s not as fortunate. He also has his ow business but the
economy of the past couple years has hurt him. Several onths ago he had to
drop his health insurance because he could no longer a f f rd the premiums. He
i s 56 and his wife i s 53 - both a long way away from Med c are.
I t would be unfair to make these and other small, f mily businesses pay
into a pool to insure others when they can't afford to i sure themselves.
I would l i k e to see everyone get the health care th y need from the doctor
or hospital of t h e i r choice at a cost that w i l l not bankrupt themselves, taxpayers, or owners of small family businesses. For mysel
I hope I w i l l always
be able to choose my own doctors and hospital. The HMO e f e r r a l system i s
onerous. From my l i m i t e d experience with HMO's and what HMO patients t e l l me
t h e i r methods are t o t a l l y unsatisfactory.
There w i l l no doubt
You have taken on a big problem with no easy solut i n
Please t r y to f i n d
be many who w i l l be outraged at your f i n a l recommendations
solutions that w i l l not cause further hardships f o r the housands of others l i k e
myself and my family. You w i l l be i n my prayers as you xestle w i t h t h i s most
d i f f i c u l t matter.
Sincerely,
�Clinton Presidential Records
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n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
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FOLDER TITLE:
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2006-0885jm81
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Freedom of Information Act -15 U.S.C. SS2(b)|
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P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of thc PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
h(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
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personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
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financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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�CONS EN1 GIVEN
1
CA-47/48
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
P6/(b)(6)
" V-''' ' >
a / ' J l ' ; . ' - -
BRIEF SYNOPSIS OF LETTER
Physician's w i f e — a t 43 they topped $100,OOO.OO/year—angry t o be considered
as "having made i t b i g i n t h e 80's and most able t o pay" : Recount t h e years
when they both were f u l l time students and f u l l time emplo^ ees i n graduaate
school, i n e l i g i b l e f o r g r a n t s , f o l l o w e d f o r many years by usband's h o l d i n g
two j o b s t o accrue c a p i t a l t o open p r i v a t e p r a c t i c e + $70, 00.00-debt,
c o n t i n u i n g a second j o b f o r years i t took f o r h i s p r a c t i c e t o support them.
I n Orange Co., CA $100,000.00 i s l i k e $66,000.00 i n Kansas C i t y , they have
already l a i d o f f one empolyee and w i l l have t o l a y o f f o t h e i s i f h e a l t h care
reform i s passed. Cannot a f f o r d t o pay f o r employee cover ge. Believes i n
equal o p p o r t u n i t y , n o t equal r e s u l t s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
�J u n e 2 1 , i=>«3
Senator- ^ e i n s t e i n
Senate C f f i c e Building
W a s h i n o t o n D.C.
Dear
Senator
Feinstein,
As o n e o f t h o s e d u b b e d " m o s t a b l e t o p a y " i n t h e new ta;; scname
I am r e a l l y i n c e n s e d t o c o n t i n u a l l y h e a r u s r e f e r r e d t o a s t n o s e
who made i t b i g i n t h e 3 0 ' s .
While t h e r e may be a grou.D t o whom
t h a t a p p l i e s , i t i s c e r t a i n l y n o t t r u e o f a l l who w i l l f i n a l l y
r e a c h t h e * 1 0 0 , 0 0 0 income l e v e l i n 1993.
In t h e 80's
paying our
f u l l time.
assistance
bank l o a n s
to come.
my husDand and I w e r e b o t h i n g r a d u a t e s c h o o l ,
own way by w o r k i n g f u l l t i m e w h i l e a t t e n d i n g s c h o o l
T h i s w o r k , o f c o u r s e , made u s i n e l i g i b l e f o r g - a n t s o r
and c u r o n l y t u i t i o n a s s i s t a n c e was h i g h i n t e r e s t
w h i c h we w i l l c o n t i n u e t o be p a y i n g o n f o r
ny y s a r s
L'pon g r a d u a t i o n i n 1933 w i t h t w o B.S's, a M.S. and a D o c t o r a t 5.
my h u s b a n d w o r k e d t w o j o b s t o s a v e t h e c a p i t a l n e c e s s a r y t o
o p e n a p r - i v a t e p r a c '"ice.
He t h e n w e n t an a d d i t i o n a l '$70,000 ir,
d e b t ' f o r e q u i p m e n t and r e m a i n i n g s t a r t up e x p e n s e s .
He t h e n
c o n t i n u e d t o work a second job to s u p p o r t us f o r tne year's i t
t o o k t o b ^ i n g t h e p r a c t i c e t o a p o i n t o f p r o f i t a b i l i t y which
e n a b l e d i t t o s u p p o r t i t s e l f and u s .
When he f i n a l l y g a v e up
t h e s e c o n d j o b we h a d a c o m f o r t a b l e , b u t by no means r i c h , l i f e
style.
I t was n o t u n t i l 1991 t h a t we f i n a l l y t o p p e d * 1 0 0 , 0 0 0 i n
a d j u . s t e d g r o s s i n c o m e , a t t h e age o f 4 3 .
3 o y o u r e a l l y t h i n k a f t e r a i l t h i s w o r k a n d s a c r i f i c e i t i s 'fair"'
t o t a k e i t away f r o m u s t o s u b s i d i z e t h o s e who h a v e n o t w o r k e d
as h a r d ?
I s t h e r e any j u s t i f i c a t i o n t o s a y we g e t some s o e c i a i
a d v a n t a g e s i n t h e SO's"'
•Df a $75,415 t a x a b l e income in 1992, t h e F e d e r a l government took
$26,458.
C a l i f o r n i a S t a t e Income Tax was an a d d i t i o n a l $ 5 , 3 4 2 .
• f c o u r s e p r o p e r t y t a x , s a l e s t a x , g a s t a x , e t c a r e a l l on toe
of t h a t .
I am n o t u n d e r t a x e d .
I am a l r e a d y c o n t r i b u t i n o my
"fair share".
The p r o p o s e d H e a l t h C a r e R e f o r m p a c k a g e i f e n a c t e d , w i l l be t w o
more h i t s .
E v e r y h e a l t h c a r e p r o v i d e r i s a l s o an e m p l o y e r . I f
y o u c u t t h e f e e s we c a n r e c e i v e f o r o u r s e r v i c e s , we w i l l p a y a
l a r g e r share f o r t h i s "reform" than Americans in o t h e r f i e l d s .
A t t h e same t i m e y o u w i l l a s k u s t o p a y some s o r t o f a d d i t i o n a l
p a y r o l l tax f o r our employees.
One h a s a l r e a d y b e e n l a i d o f f .
I f t h i s i s e n a c t e d o t h e r s w i l l go.
We w i l l h a v e no c h o i c e .
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
041. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
06/21/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
jmSI 1
RESTRICTION CODES
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Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�W h i l e I a d m i t t h a t we h a v e a n i c e i n c o m e we a r e b y n o i r H a n s
rich.
A s y o u a r e w e l l a w a r e $ 1 0 0 , 0 0 0 d o e s n o t b u y t h e ; ama
l i f e s t y l e i n Change C o u n t y , C a l i f o r n i a a s i t w o u l d in man, o t h e r
p a r t s of the c o u n t r y .
Another i n e q u i t y of the ta:; system.
U'nile i t may ( t h o u g h i t i s h a r d t o b e l i e v e ) , p l a c e me i n 1 i e u p p e r
6"/. o f A m e r i c a n s b y d o l l a r s o f i n c o m e , a c o m p a r a b l e
lifestyle
c o u l d be p u r c h a s e d i n K a n s a s C i t y f o r * 5 0 - 6 0 , 0 0 0 .
My l i f e s t y l e
i s c e r t a i n l y NOT u p p e r 6'/..
While c o n s i d e r i n g t h e t r i p l e t a x a f f e c t y o u a r e
threaten ig to
i m p o s e o n t h e h e a l t h p r n - f p s s i o n s , p l e a s e k e e p i n mind t h t t h e s e
nice incomes a r e n o t a c h i e v e d f o r us u n t i l well i n t o o u r middle
years.
P e o p l e c h o o s i n g o t h e r l o w e r p a y i n g f i e l d s h a v e bj^en
e a r n i n g i n c o m e s f o r a s many a s 2 0 y e a r s b e f o r e a d o c t o
can
g e t e s t a b l i s h e d i n p r i v a t e p r a c t i c e a n d e a r n o v e r $100,0C i 0 .
All
t h a t t i m e h e / s h e h a s b e e n s p e n d i n g money and t i m e and i f o r t
to
get to this point.
T h e r e s h o u l d be some c o m p e n s a t i o n f ( 3 - t h a t
during the earning years.
America needs q u a l i t y doctors if
they
are to have q u a l i t y health care.
Who w i l l b e c o m e a d o c t Dr w i t h
b u r d e n s s u c h a s t h o s e now b e i n g c o n s i d e r e d ?
I certainl
would
not advice it for our children.
:
The American Dream i s n e t t h a t a l l r e s o u r c e s a r e a i i o c a
evenly.
I t is t h a t a l l have the o p p o r t u n i t y t o succeed
t h e i r own e f f o r t s .
I believe in equal opportunity.
That
not equate with equal r e s u l t s .
Establishing p e n a l t i e s ir
s t r u c t u r e f o r s u c c e s s , removes i n c e n t i v e t o work.
It t
away t h e A m e r i c a n Dream t h a t a n y o n e can s u c c e e d .
As
y o u n g e r g e n e r a t i o n w a t c h e s t h o s e o f u s who h a v e s u c c e
t h e o l d f a s h i o n e d way ' h a r d work) h a v e t h e p r o c e e a s o f
s u c c e s s c o n f i s c a t e d by o u r g o v e r n m e n t and r e d i s t r i b u t e d
t h o s e who h a v e n o t c o n t r i b u t e d , t h e y w i t n e s s t h e d e m i s e
t h e i r own h o p e s a n d d r e a m s .
I would a p p r e c i a t e
comments.
your
consiceration
3 Incerely,
P6/(b)(6)
• ,' *
;
c c . C h r i s t o p h e r Cox
Bill Clinton
Hillary Clinton^
Barbar Boxer
of
these
points
a^
ea
ihruugh
does
t n e ta;:e5
e
ed,
j r
to
of
in
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Clinton Presidential Records
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Steven Edelstein
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jm8l 1
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P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOI A]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN On/25/93 CD: FL-10
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
P6/(b)(6)•'r;^"'.'i*.
BRIEF SYNOPSIS OF LETTER
L e t t e r t o P r u d e n t i a l i n s . co, o b j e c t i n g t o p a t t e r n o f ralte increases f o r
small business employee h e a l t h plan
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
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DOCUMENT NO.
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043. letter
SUBJECTTTITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
06/15/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
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FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jm811
RESTRICTION CODES
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Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of thc PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of thc FOIA|
h(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�i.:, •
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S B E T Employee Medical Insurance
UJC:
Advance Notice of Premium Charge
Plan .-,l?6/(b)(6)
W appreciate your "Advance Notice" of the 12.2* incn ase
e
in our employee medical insurance premiums effective June
30, 1993. I continue to be appalled by your blatant < isregard for C S C N A N E T of our medical insurance Josts.
OT OTIMN
Listed below are just the latest Increases.
June 30, 1991
December 1992
June 30, 1992
t
:.fi'-
' -V:
;i
Ms. Mlndy Sawning
The Prudential Insurance Co.
South Central H m Office
oe
Jacksonville, F 32231
L
* .
+12.2X
+13.«
+10.41
Every six months you seem to be able t o j u s t i f y these frequent
and compounding Increases f a r above anything rational in
today's economy.
My vote w i l l be t o close you f o l k s down In support of any
reasonable national program. Federal bureaucracy can ' t
be much worse!
I hope you a r e ' s t i l l ' report-fng record p r o f i t s as i n 1<91
and 1992.
Your d i s s a t i s f i e d customer.
cctj/rfrs. Hillary Rodham Clinton, President Council c Health
W
Care
Mr. Mike B l l i r a k l s , Member of the U. S. Congress|
Mr. Tom Gallagher, Insurance Commissioner
Mr. Mike Porter, Prudential Insurance
Mr. Dale D. Dewalt, President, Kodlak Metal ServHce,
Incorporated
' „ "A minorities stock owned and controlled corporation"
#5,. pg 23
K
v. .-• • . '
]
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DOCUMENT NO.
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044. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
jm8l 1
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
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PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA]
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOI A]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOlAl
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning Ihe regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 0 /25/93 CD: OH-18
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
1
•I
r^yji*^
••
P6/(b)(6) • '
BRIEF SYNOPSIS OF LETTER
26 year o l d woman has her own small 1
h e a l t h coverage f o r s i n g l e young woman w/ no dependents
This i s t o o much f o r self-employed person.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
o n l y employee,
s $211.16/month.
�•
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(
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
045. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
04/23/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [I]
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - \44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P.S Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(.S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�AoiP
LOWL
-Ujut
7
ftOUl -bLeAjL. dt.
ijh. eUtidjL
5
•J
"l T
:
'*" P6/(b)(6K;-' ". ,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
046. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders]
2006-0885-F
jm8l 1
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
Financial information 1(a)(4) ofthe PRA|
P5 Release would disclose conndential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of thc FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe I OIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN :8/23/93 CD: AL-5
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
A
BRIEF SYNOPSIS OF LETTER
(Good quote Carolyn Gatz L e t t e r )
President o f small business w r i t e s about 90% increase i n h e a l t h insurance
costs f o r him and h i s f i v e employees d u r i n g previous s i x mt n t h s . Good quote
" There i s no way we can a f f o r d t h i s and s t i l l s t a y open."
" what do I do as a company owner and boss?" He w o r r i e s a l s o about how t o
cover h i s two employees who have h e a l t h c o n d i t i o n s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
Insrance Coverage
Exclusions t o Care
PRE-EXISTING CONDITION
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
047. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/14/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
im811
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices nf
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�--./,< P6/(b)(6)
•..•:
' ' ' ' ' r
HILLARY RCDHAM CLINTON
1600 r'ENNB ' L V i I A AVE
'.CN
THE WHITE HOUSE
WASHINGTON. D.C.
HEALTH INSURANCE
Ci.. INTON,
•INS n u A COF Y DF OUR F'RESENT HEALTH I No RANCE COSTS
'• 0 T r - i E LETTEF WE JUST RECEIVED FROM OL CARRIER
;•
.
O
NL \ I R ' T E INCREASE. THIS IS WHAT SMALL
•
E
r '.:••]•: :ii--!TO. . LT!. H - V 5 PEOPL.E WCKKING Iff:ERE AFiD W .
! 'M.Y . . E
S ] NLE
LVLYvL W.•' OUR CDI'.P'Ar.iY K A 3 NG 75V 0 " TH: . O .
'">•
'Y .
Tr'E EN^LOVEEE CAY INS 25/. OF THE SINGLE F TE AND lOOv
907..
. :•• r v . " ' LC'VERAOE. THE RATE OF INCREASE Iffi
•'£ . E N ;
•.•
"L^:...h. DUR PRESENT COST. OUR PAST MEDICAL HISTORY
LLLT • MONTHS HAS NOT BEEN TOO BAD. RRIO* TO THAT
•
'E.IU 6
-''OS
WERE NOT GOOD I AM A 4^ YEtoR OLD
A HEAR" ATTACK AND OPEN HEA T 3UR5EE .
BILLS RAN A LJTTLE OVER t-iOC O O . 00 AND
'O
•. ' E L . LFROME HAD ii-U- ";(•DONE THAT RAN ABCj'JiT $8000.00.
'Y ;
£-- •
>
: l-L^ET OI" • - L PEOPLE HAD LITTi_E; REQUIREMENTS Fd^ MEDICAL
E
o!
i
- OLR T L ' OF INCREASE 6 MONTHS AGO WAS 10*/., 4 N THIS
*D
TI ME THEY WANT ROA. SO W WILL GO FROM $897.00 Td A MINIMUM
E
0- - • ' - - . . : 0 . THERE IS NO WAY WE CAN AFFORD THIS4»ND STILL
." . . " 0 . ' :
L ' V DFr.N, i-f: WI L L LOOK. AROUND FOR OTHER INSURANT! COVERAGE
!K
•. T Nr
£"
p-l-VLL HAVE TO 00 THOUGH "HE P'RE-EXIS" N3
0
" . ON ^ELUIREUENTS WHICH MEANS THAT FHR 6 MON H TO A
'
.
'S
' ^ '. ' - . -/JY THINS W WERE TREATED -OR IN THE F A WILL NOT
"R N ^ E
';
T
os
F:RLD. J L(JL:LD HA^'E MORE HEART PROB.EMS AND NOT BE
LOVE:-ED. . S JEROME COULD HAVE I-ORE PROBLr.rlS WITH IER SURGERY
M
f-'-D THAT WILL NOT BE COVERED. NONE OF HER CHILDREN AND HER
r - . S A D MEDICAL. PROBLEMS WILL BE COVERED I F THERE WAS ANY
.'TNS
T : . A M N IN THE LAST YEAR. NOR MS. ULANDS TWO CH :LDREN AND
R.::ET
riUifc-AMD,N:jR THE OTHER TWO LADIES WORKING FOR ME NOW. THIS IS
N Y I" ; T . S ALL ABOUT. HOW CAN A COMPANY JUST UP Vt)UR RATES BY
-•
'
!
'
' A A f WITH IT? WHAT DO 1 DO A£ A COMPANY OWNER AND
W'
ROSS • TO NE THERE IS ONLY ONE ANSWER. THERE MUST bE A
NEN
SOVtrF• M . T MEDICAL PROGRAM OF INSURANCE OR GUARANl "EED MEDICAL
DED FOR PEOPLE WHO MAKE LESS THEN $50000.00
YEAR. IT
SHOUL. D E !FUNDED BY A TAX OF 7.7.85 ON WAGES OF PElt)PLE WHO
.
L
F r,.
£50001.00 OR MORE A YEAR AND ALSO A 7.85 TA>j ON THE
[.•'.
NILS TH:-'
THESE SALARIES. THIS IS THE AMOUNT OF TAX
: . A IS HOT BE I NO COLLECTED FOR SOCIAL SECURITY HtoHT NOW .
HT
f ::
:
S L.il-T J0 KNOJJ U H T N O ; THINK CAN BE DONE. I NOW YOU CAN
JA
'L
: O T •£!.' MY COMPANV OR THESE PEOPLE NOW. YOU DO NtlT HAVE THE
T :'.F
- • 'i I.I ;
•
NOR 'HE FLAr- NJR THE. HELP OF CONGRESS TO DO '"HIS. MAYBE
InP A . A THAT MANDATES SOCIAL MEDICAL CARE, I GOVERNMENT
.W
DhD MED I C ! . : A R E . TAKE OVER THE P R I V A T E I N i l • • . H N L E
M.
•
• it-', i i
v
V
!
:
:
;
�CJr'PA'-UEE ArO NOT LET THEN COVER ANYONE WHO MAKES) 50000.00 A
' ' A 0- LESS, I LD NOT KNOW THE ANSWER BUT HERE IS ONE MORE
•ER
EXAMPLE OF WHAT IS HAPPEN ING OUT HERE IN THE BUS IM1E5S WORLD.
ONE OR THE REASONS I HAVE BEEN IN BUSINESS 20 YEA :S IS TO BE
ABLE TO PROVIDE SOME OF THESE THINGS TO OUR EMPLOf
S. NOW
THAT DREAM IS GONE. IS THIS WHAT IT IS ALL ABOUT
THANK YOU VERjy MUCH.
:
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
048. letter
SUBJECT/TITLE
DATE
02/12/1993
Personal (Partial); Address (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1
2006-0885-F
jm811
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(]) of thc PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(a)((>) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe l"OIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Located At 5130
Clinton Way, FiMno, CA 93727
O.Box 55010, FrMno, CA 93747-5010
Jaiephoner (209) 151-4861 • Fmcarmler. (209) 252-2581
AMERICAN CHOICE I I
GROUP
P6/(b)(6)
DEAR P A R T I C I P A T I N G ENPLOYERt
AS YOU ARE UNDOUBTEDLY AWARE, INCREASES IN MEDICUt CARE
U T I L I Z A T I O N AND INFLATION CONTINUE TO IMPACT ME )ICAL CARE COSTS.
NATIONAL AMERICAN L I F E INSURANCE COMPANY OF PENNSVLVAN1 A, THE
C A R R I E R FOR THE AMERICAN CHOICE I I , HAS J U S T
COMPLETED THE ACTUARIAL REVIEW JF THESE 1 N F L A T I W A R Y E F F E C T S ON
THE AMERICAN CHOICE I I MEDICAL IND DENTAL P L A N .
AS A R E S U L T , I T HAS BEEN DETERMINED THAT A 90 tl INCREASE I S
NECESSARY AT THE PRESENT T I M E *
T H I S INCREASE w t l L BE E F F E C T I V E
WITH YOUR A P R I L
PREMIUM BI . L I N G ANO WILL AflPLY TO
MEDICAL, DENTAL AND OPTIONAL MATERNITY R A T E S .
I F YOU HAVE ANY QUESTIONS, PLEASE CONTACT YOUR AGENT O
R
-rrOUR—GFf-l-G€-iH-RECTLY
THANK -VOU FOR YOUR SUPPOR
OF THE
AMERICAN CHOICE I I .
SINCERELY,
WESTERN STATES ADMINISTRATORS
.LOYO WILLIAMS
MNAGER
JNOERWRI TING OEPAhTMENT
A G E N T S L A T T O N , RONALD F i
BROKER SOUTHEASTERN INS CONCEPTS, INC EL400PI
175*12889
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
049. statement
SUBJECT/TITLE
DATE
re: Insurance adjustments (I page)
03/31/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [ I ]
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to thc appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or conndential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
050. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1]
2006-0885-F
jmSll
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to thc appointment to Federal office [(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of thc PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/24/9$ CD: NC-9 AND 12
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
r
BRIEF SYNOPSIS OF LETTER
COBRA conversion f o r d i a b e t i c woman, $1,177.44 p e r quarte t , $4,709.79 per
year, a f t e r taxes.
Income i s $13,217.88, i n 1991. Insu ranee went up t o
is
$9,419.52 p e r year, and she had t o drop i t .
Small busines: c o u l d n o t f i n d
insurance t o cover.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
COBRA's
COVERAGE TOO SHORT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
051. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
02/02/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Small Business Letters] [binders] [1
2006-0885-F
jm811
RESTRICTION CODES
PresidcntiHl Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of thc FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) nf the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�February
2,
1993
F i r s t Lady
Hillary Clinton
White House
Washington, D. C.
Dear Mrs.
Reference:
Clinton,
Health Insurance
on
A
P6/(b)(6)
T h i s l e t t e r i s i n r e f e r e n c e t o m|(y i n s u r a n c e w t h
N a t i o n w i d e I n s u r a n c e Co., p o l i c y ]
P6/(b)(6).,' •
A f t e r l e a v i n g a j o b w i t h Thermal-Guard of C h a r l o t t e ,
i n 1988, I went on the Coba Plan f o r 18 months
A f t e r t h i s p e r i o d , I being a d i a b e t i c , I c o u l d not
f i n d anorher i n s u r a n c e company t o cover me, t h e r e f o r e ,
even w i t h the coverage so h i g h i n c o s t , $1,177 44
q u a r t e r l y , I had t o s t a y w i t h t h e c o n v e r s i o n p: an
N a t i o n w i d e a f f o r d me. I make $13,217.88, a f t e r t a x e s ,
a year, which means my h e a l t h i n s u r a n c e t o o k
$4,709.76 of t h i s .
Then I r e c e i v e an i n c r e s e 4>f
50% from N a t i o n w i d e , s t a r t i n g October 1, 1991
T h i s would t a k e a t o t a l of $9,419.52 of
y e a r l y , l e a v i n g o n l y $3,798.36.
my s a l
ry
There i s no way the American people can a f f o r d these
prices!
Where i s t h i s g o i n g t o stop?
We need h e l p
i n c o n t r o l i n g t h i s problem.
How can we l e t a ompany
i n c r e a s e premiums 50% on w o r k i n g people who t h ' j y
know can not o b t a i n coverage elsewhere because of
an e x i s t i n g h e a l t h problem?
I am 58 years old and work for a small company that
has t r i e d to f i n d an insurance firm to cover m^
I have t r i e d about 9 companies and have been t ir ned
down as soon as they f i n d I am a d i a b e t i c . Wh£|re
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Dublin Core
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Title
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Health Care Task Force Records
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White House Health Care Task Force
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 3
Is Part Of
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Box 7
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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3/16/2015
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42-t-12092992-20060885F-Seg3-007-005-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/37ddecaa97924252cf082d97204a168c.pdf
fdc2bc3667b54d5c49fa8f014d9d8e72
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
3678
OA/ID Number:
FolderlD:
Folder Title:
"Rump Group" Proposal
Stack:
Row:
Section:
Shelf:
Position:
s
52
3
7
2
�6/27/94
6 p.m.
MAINSTREAM COALITION PROPOSED AGREEMENT
PART ONE - COVERAGE
I.
INSURANCE COVERAGE
This section guarantees access to Qualified Health Plans for all U.S. citizens and
lawful residents not covered under other public programs such as Medicare,
Medicaid, CHAMPUS and DVA. This section details the establishment of Health
Care Coverage Areas (HCCAs), institutes insurance market reforms, establishes
standardized benefits packages, creates Qualified Health Plans (QHP), establishes
eligibility for low-income assistance vouchers and expands tax deductibility of
health insurance premiums.
A.
Assurance of Universal Coverage
1.
A National Health Commission (as described in Section XIV.) must
report to Congress biennially on the status of health insurance
coverage in the nation. The report must include, but is not limited to,
the structure and performance measures of every market area,
including the following:
a.
b.
Demographics of the uninsured, and findings on why those
individuals are uninsured;
Structure of delivery system;
c.
Number, organizational form of health plans;
d.
Level of enrollment in health plans;
e.
State implementation of responsibilities, including
establishment of coverage areas;
f.
Status of insurance reforms;
g.
Development of purchasing groups and other buyer reforms;
h.
Success of market and other mechanisms of controlling health
expenditures and premium costs in the market area and
nationally;
�i.
j.
Adequacy of subsidies for low income individuals;
k.
Status of Medicare beneficiaries, transition into Medicare
managed care and QHPs;
1.
Coverage progress among those who are employed, including
status and level of voluntary employer contributions and
participation rates in pools and among large employers;
m.
Percentage of individuals who are enrolled in Qualified Health
Plans, separated into categories of Medicare, Medicaid, employed
individuals and individuals eligible for low-income subsidies;
n.
Informal recommendations, specific to each market area, on
how the area might increase coverage among the residents and
further moderate growth in premiums; and,
o.
B.
Status of transition of Medicaid toward managed care and
integration into AHPs;
Evaluation of adequacy of benefit packages.
Coverage Trigger
1.
Establishes a national goal that 95% of all Americans will have health
care coverage by 2002.
2.
If this goal is not met, the Commission must submit formal and
specific recommendations to Congress by January 1, 2002 as draft
legislation. The recommendations shall include methods to reach 95%
coverage in market areas that have failed to meet that target. They
must address all relevant parties, including states, employers,
employees, unemployed and low income individuals, public program
beneficiaries, etc.
3.
In addition to any other recommendations it submits, the Commission
must make separate recommendations on the following:
a.
A schedule of assessments or contributions to encourage
employers who are not doing so to purchase coverage for their
employees;
b.
A method of encouraging full coverage which does not require
any assessments on or contributions from employers;
�c.
d.
Possible adjustments to subsidies; and,
e.
4.
Possible adjustments to the benefits package;
Possible adjustments to tax treatment of benefits.
Congressional Consideration of the National Health Care Commission
Report. This proposed process is being reviewed by the Senate and
House Parliamentarians.
A.
Rules for the Senate
1.
The Majority Leader must introduce the Report as a bill
on the first day of session following the submission of the
Report and legislative language. If the Majority Leader
has not introduced the bill within five days of session, any
Senator may do so.
2.
The bill will be referred to the appropriate Senate
Committee.
3.
If the Committee fails to report the legislation by July 1,
2002 (or if the Senate is not in session on this date, by the
first day of session after this date), it shall be automatically
discharged from further consideration of the bill; and the
bill shall be placed on the appropriate Senate calendar.
4.
Within 5 session days after the bill is placed on the
calendar, the Majority Leader, at a time to be determined
by the Majority Leader in consultation with the Minority
Leader, shall proceed to the consideration of the bill.
If on the sixth day of session, the Senate has not proceeded
to consideration of the bill, then the presiding officer must
automatically put the bill before the Senate for
consideration.
5.
30 Hours of consideration
a.
Two hours for first degree relevant amendments
b.
One hour for each relevant second degree
amendment.
c.
30 minutes on each debatable motion, appeal, or
point of order submitted by the presiding officer to
�the Senate and no motion to recommit shall be in
order.
6.
B.
There shall be five hours of consideration of motions and
amendment appropriate to resolve the differences
between the Houses, at any particular stage of the
proceedings.
Rules for the House of Representatives
1.
The Majority Leader must introduce the Report as a bill
on the first day of session following the submission of the
Report and legislative language. If the Majority Leader
has not introduced the bill within five days of session, any
Member may do so.
2.
The bill will be referred to the appropriate House
Committee or Committees.
3.
If the committee or committees fails to report the
legislation by July 1, 2002 (or if the House is not in session
on this date, by the first day of session after this date), they
shall be automatically discharged from further
consideration of the bill.
4.
On the sixth legislative day (the day on which the House
is in session) after the date on which the bill has been
placed on the appropriate calendar, it shall be privileged
for any Member to move that the House resolve itself into
the Committee of the Whole House on the State of the
Union, for the consideration of the bill, and the first
reading of the bill shall be dispensed with.
5.
After general debate, which shall be confined to the bill
and which shall not exceed four hours, to be equally
divided and controlled by the Chairman and Ranking
Minority Member of the Committee or Committees to
which the bill had been referred, the bill shall be
considered as read for amendment under the five-minute
rule. The total time for considering all amendments shall
be limited to 26 hours of which the total time for debating
each amendment under the five minute rule shall not
exceed one hour.
6.
At the conclusion of the consideration of the bill for
amendment, the Committee shall rise and report the bill
�to the House with such amendments as may have been
adopted, and the previous question shall be considered as
ordered on the bill and the amendments thereto to final
passage without intervening motion except one motion to
recommit.
Health Care Coverage Area
The major vehicle for reorganizing the health care marketplace would be the
establishment of geographic areas called Health Care Coverage Areas
(HCCAs). Employees of employers with fewer than 100 employees and
individuals residing or working in the HCCA would be pooled together and
would be eligible for insurance at an age-adjusted community rate. HCCAs
are established by each state and a minimum number of 250,000 lives must be
included in the HCCA rating pool. States may enter into cooperative
agreements to establish interstate HCCAs. States may decrease the number of
covered lives included in a rating pool.
Within each HCCA, consumers will have several different options available
to purchase health insurance. Employers and individuals may purchase
coverage directly from an insurer or agent, they may enroll at designated
state enrollment sites or they may chose to join a purchasing cooperative.
Accountable Health Plans may charge different administrative (or
enrollment) fees depending upon how the plan is purchased. If a Point of
Service (POS) Option plan is not available in the HCCA in which an
individual lives or works, the individual may purchase such a plan in an
adjacent HCCA.
D.
Insurance Market Reforms
The Secretary of HHS shall, within six months of enactment, and in
consultation with private expert entities such as the National Association of
Insurance Commissioners (NAIC), develop federal standards with which
Qualified Health Plans must comply in order to be deductible by an employer
or an individual. While these federal standards will be established by the
Secretary of Health and Human Services, the enforcement will be by the state
or the Department of Labor depending on the nature of the Qualified Health
Plan. All Qualified Health Plans must:
1.
Guarantee issue to all qualified applicants.
2.
Guarantee availability throughout the entire area in which it is offered.
3.
Guarantee renewal to all qualified enrollees, except in instances of non-
�payment of premiums or fraud or misrepresentation.
4.
Not deny, limit, or condition coverage based on health status, claims
experience, or medical history during the. annual open enrollment
period. The bill includes a first-time enrollment amnesty extended for
a certain period after the date of enactment. Individuals are
encouraged to maintain continuous coverage. Continuous coverage
means that the period between the date of enrollment in a health plan
and the last date of coverage may be no longer than three months. If
an individual has not maintained continuous coverage or is enrolling
in a plan for the first time after the initial open enrollment period,
coverage may be subject to a pre-existing condition limitation of no
more than six months. Pregnancy and pre-natal care are exempted
from this limitation.
5.
Comply with all rating requirements, including age and family size
adjustments, within the coverage area. ( Special rules will be
established to apply to Employer Sponsored Heatlh Plans and
Qualified Association Plans).
6.
Comply with enrollment process.
7.
Comply with financial solvency requirements, premium and collection
criteria. (Special solvency rules are established for certain types of plans
for large employers).
Benefit Packages
1.
Within six months of enactment, the Commission (described in
Section XIV.) shall develop and submit to the Congress clarification of
the initial standard and basic benefits packages. These packages must
adhere to the following:
a.
The actuarial value of the Standard Benefit Package can not
exceed the actuarial value of the Blue Cross/Blue Shield
Standard Option under the Federal Employees Health Benefits
program.
b.
The Basic Benefit Package must contain higher cost sharing
and/or fewer categories of benefits.
c.
Both benefit packages must include a full range of medically
appropriate treatments and preventive services.
�2.
Categories:
The following categories of benefits are to be included in the benefits
package:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
1.
3.
Inpatient and outpatient care.
Emergency, including appropriate transport services.
Clinical preventive services, including services for high risk
populations, immunizations, tests or clinician visits.
Mental Illness and Substance Abuse.
Family planning and services for pregnant women.
Prescription drugs and biologicals.
Hospice Care.
Home health care.
Outpatient laboratory, radiology and diagnostic,
Outpatient rehabilitation services.
Vision care, hearing aids and dental care for individuals under
22 years of age.
Patient care costs associated with investigational treatments that
are part of approved clinical trial.
Priorities:
Within the constraints of the actuarial limits set in this act. Congress
directs the Commission to adhere to the following priorities:
a.
b.
Consideration for needs of children and vulnerable populations,
including rural and underserved persons.
c.
4.
Parity for mental health and substance abuse services, which
shall consist of a broad array of mental health and rehabilitation
services managed to ensure access to medically necessary, and
psychologically necessary treatment and to encourage the use of
outpatient treatments to the greatest extent feasible.
Improving the health of Americans through prevention.
Medically Necessary or Appropriate
A Qualified Health Plan shall provide for coverage of the categories of
benefits described in this section for treatment and diagnostic
procedures that are medically necessary or appropriate.
An item or service is "medically necessary or appropriate" if, consistent
with prevailing medical standards, it is;
�a.
For treatment of a medical condition.
b.
Safe and effective (i.e., there is sufficient evidence to
demonstrate that the item can reasojriably be expected to produce
the intended health outcome or provide the intended
information).
c.
Medically appropriate for a specific patient (i.e., it can reasonably
be expected to provide a clinically meaningful benefit if
furnished in a setting commensurate with the patient's needs).
Criteria for determination of medically necessary or appropriate are set
forth. QHPs shall make all coverage decisions under these criteria.
The Commission can, in limited circumstances, issue interim coverage
recommendations.
5.
Cost-Sharing
The Commission shall also develop multiple cost sharing schedules
which vary by delivery system organization. In making these
determinations, the Commission will consult with expert groups for
appropriate schedules for covered services. This clarification is subject
to approval by Congress under expedited procedures.
6.
Limitations
The Commission is prohibited from specifying provider types or
specific procedures in the benefit packages.
7.
Additional Commission duties related to defining the basic and
standard benefits packages:
a.
Develop interim coverage decisions in limited circumstances.
b.
Design the basic and standard benefits packages to prevent
adverse risk selection when combined with the risk adjustments
called for in the bill.
c.
May not specify provider types when clarifying covered benefits.
d.
May not specify particular procedures or treatments or classes
thereof.
8
�8.
Consideration of Commission Recommendations
The Commission will have the authority to propose modifications to
the benefits package (within the actuarial value ceiling described above)
that would not go into effect unless approved by Congress under baseclosing procedures. The Commission is responsible for any updates to
the benefits packages after the first year and these updates are also
subject to Congressional approval under expedited procedures.
O.
Qualified Health Plans
A.
Accountable Health Plans (AHPs)
1.
Definition: a health plan that may be operated as a variety of delivery
systems such as indemnity plans, preferred provider organizations,
health maintenance organizations, or other delivery systems. An AHP
is a health plan that is certified by the state as meeting insurance
market reform standards, health plan standards, quality, reporting
standards, and other standards.
2.
Standards
The National Health Care Commission (described in Section XIV.) will
establish standards for AHPs. In addition, AHPs:
a.
Must meet insurance reforms described in (I., C ) .
b.
May not engage in marketing or other practices intended to
discourage and/or limit the issuance to eligible individuals on
the basis of health condition, industry, geographic area or other
risk factors.
c.
Must make a health plan available throughout the entire HCCA
area in which it is offered.
d.
Must demonstrate its ability to make available and accessible to
each potential enrolle in the area the full range of benefits
required under the standard and basic benefit packages, when
medically necessary and promptly.
e.
Must provide for the application of coverage standards (for
benefits) which are consistent with the coverage standards issued
by the Commission and disclosed to plan enrollees.
�f.
g.
Must make available to nonparticipating providers the criteria
used in selecting those providers that are permitted to participate
in the plan.
h.
Must comply with federal information requirements.
i.
Must offer the standard and basic benefit packages, but may also
offer benefits in addition to these packages, if such additional
benefits are offered and priced separately from the standard and
basic benefit packages.
j.
B.
Must not accept enrollment of an individual who is currently
enrolled in another AHP.
Must comply with a system of binding arbitration for coverage
disputes.
Employer-Sponsored (risk-bearing) Plans
1.
Definition: a group health plan that may be operated as a network plan
or an indemnity plan for which the employer retains all or a portion of
the insurance risk, commonly referred to as self-insured.
2.
Standards:
a.
Employer sponsored plans must meet all the standards for AHPs
and insurance market reforms, except they are not required to
take all applicants, and the population served and area covered
is defined by such an employer's employee population.
b.
Financial solvency, reserve, and guarantee fund standards will
be established by the Secretary of the Department of Labor (DoL)
consistent with the applicable rules under Part 4 of Title I of
ERISA.
c.
The Secretary of DoL may take corrective actions to terminate or
disqualify an employer-sponsored plan that does not meet the
above standards.
d.
The Secretary of DoL is appointed as trustee for insolvent
employer-sponsored health plans.
10
�Qualified Association Plans (QAPs)
1.
Definition: Association health plans that have been in existence for
three years prior to the date of enactment.
2.
Standards:
a.
Must meet all standards for AHPs with the following exceptions:
i.
ii.
3.
Special solvency requirements will be established by DoL
for QAPs.
Must only take any member in their designated
association.
Requirements for Sponsoring Entity (Association)
a.
b.
Must have appropriate by-laws that specifically state the purpose,
as a trade association, industry association, professional
association, chamber of commerce, religious organization, or
public entity association.
c.
Must have been established and maintained for substantial
purposes other than to provide the health care required under
this section.
d.
Must be, and have been, in operation (together with its
immediate predecessor, if any) for a continuous period of not
less than 3 years.
e.
4.
Must be organized and maintained in good faith.
Must receive the active support of its membership.
Treatment of Multiple Employer Welfare Arrangements (MEWAs)
a.
In general, upon enactment, a MEWA will meet the standards to
become either a QAP or a certified purchasing group.
b.
Any MEWA that has been in effect for not less than 18 months
upon enactment and with respect to which there is application
with the domicile state for certification as a QAP, shall be treated
for purposes of this subtitle as a Qualified Health Plan (if such
plan otherwise meets the requirements of this Act);
11
�, c.
However, MEW As will not be able to continue to operate if the
domicile state can demonstrate that -i.
ii.
the plan that is the subject of the application, on its face,
fails to meet the requirements for a complete application;
or
iii.
5.
the sponsor has made fraudulent or material
misrepresentation(s) in the application;
a financial impairment exists with respect to the applicant
that is sufficient to demonstrate the applicant's inability to
continue its operations.
Treatment of Rural Electric Cooperatives (RECs) and Rural Telephone
Cooperative Associations (RTCs)
RECs and RTCs can continue to exist if they meet the same standards as
QAPs; or if they are certified by the state as a purchasing group.
D.
Multi-Employer (Taft-Hartley) Plans
Taft-Hartley plans must meet the same requirements as large employers. (See
Section III.B. below)
E.
Public Programs
Existing public programs like Medicare, Medicaid, Department of Defense
health programs. Department of Veterans Affairs health programs and Indian
Health Service programs are considered to be Qualified Health Plans for the
purposes of this section.
F.
Pre-emption of Certain State Laws regulating Insurance Plans
The following state laws relating to health plans are preempted for any QHP:
1.
State laws that restrict plans from:
a.
limiting the number and type of providers who participate in a
plan;
b.
requiring enrollees to obtain health services from participating
providers;
12
�c.
d.
3.
G.
establishing different payment rates for participating providers;
e.
2.
requiring enrollees to obtain referral for treatment by a specialist
or health institution;
creating incentives to encourage the use of participating
providers;
State corporate practice of medicine laws;
State mandated benefit laws.
Advance Directives
1.
. Right to Self-Determination
a.
Each Qualified Health Plan must notify enrollees of their rights
to self-determination in health care decision-making and of the
plan's policy regarding advance directives. Plans must
maintain procedures to require that the existence and content of
an advance directive is recorded in the patient's chart (written or
electronic) and provide for a mechanism to notify all appropriate
health care providers of the information.
b.
Plans must provide for educational activities for patients and
providers and must have a functioning process to provide for
communication between the patient and the appropriate health
care provider regarding all aspects of the patient's care, including
obtaining informed consent, patient prognosis and treatment
decisions, and the formulation of advance directives.
Discussions of prognosis and treatment alternatives should
occur at the time of diagnosis, prior to treatment and whenever
there is a significant change of status which affects diagnosis,
prognosis and treatment.
c.
In order to receive Medicare or Medicaid reimbursement for
particular procedure codes to be determined by the Secretary of
HHS, claims forms (written or electronic) must include the
physician's certification indicating that the patient discussed
with the physician the diagnosis, prognosis and treatment
options and that the patient's questions were answered.
13
�2.
Decisions by Surrogates
In the event that a state does not have a law on surrogate decisionmaker for health care decisions, a federal health care surrogate standard
shall apply. This standard is:
a.
A surrogate may make a health-care decision for a patient who is
an adult or emancipated minor if the patient has been
determined by the primary physician to lack capacity and no
agent or guardian has been appointed or the agent or guardian is
not reasonably available.
b.
An adult or emancipated minor may designate any individual to
act as surrogate by personally informing the supervising healthcare provider or specifying it in a health care power of attorney.
In the absence of a designation, or if the designee is not
reasonably available, any member of the following classes of the
patient's family who is reasonably available, in descending order
of priority, may act as surrogate:
i.
the spouse, unless legally separated;
ii.
an adult child;
iii.
a parent; or
iv.
an adult brother or sister.
c.
d.
III.
If none of these individuals are reasonably available, an adult
who has exhibited special care and concern for the patient, who
is familiar with the patient's personal values, and who is
reasonably available may act as surrogate.
A surrogate shall communicate his or her assumption of
authority as promptly as practicable to the specified members of
the patient's family who can be readily contacted.
Large and Small Employer Responsibilities and Purchasing Groups
A.
Small Employer Purchasers
1.
Definition: employers with 100 or fewer full-time employees.
2.
Responsibilities:
14
�a.
b.
Must provide all employees (including part-time and seasonal)
with information regarding all AHPs offered in the HCCA in
which the employer is located.
c.
If an employee resides in another HCCA, the employer must
provide information regarding how to obtain information
regarding AHPs available in that HCCA.
d.
Small employers must make available to their employees a
choice of at least three Qualified Health Plans either by joining a
purchasing group or through independent brokers or insurance
agents.
e.
Small employers who contribute toward coverage must pay to
any Qualified Health Plan selected by the employee an amount
equal to the contribution they would make on the employee's
behalf to the health plan selected by the employer.
f.
B.
May not be the sponsor of a risk-bearing plan, but if a member of
an eligible Association may join a QAP.
Payroll Deduction. If an employee requests, employer must
arrange for payroll deduction to pay the premium amount due,
less any employer contribution, to the plan or purchasing group
of the employee's choice. However, if the employee selects a
plan other than those offered by the employer, the
administrative cost of making such a payroll deduction may be
charged to the employee.
Large Employer Purchasers
1.
Definition:
employers with more than 100 full-time employees.
2.
Responsibilities:
a.
All large employers must offer their employees a choice of at
least three QHPs, one of which must be a point-of-service option
and one of which must offer a basic benefits package. A large
employer may comply with this subsection by offering QHPs
provided by a single entity. Large employers may also meet this
obligation, in part, by making available to their employees the
choice of a Qualified Association Plan (see below).
b.
Large employers are ineligible to join the small employer and
individual purchasing groups or to purchase insurance at the
15
�community rate either through a broker, independent agent,
purchasing cooperative, or public enrollment office.
c.
d.
All large employer purchasers are regulated by the DoL and
remain subject to ERISA.
e.
If an employer contributes to its employee's health coverage, it
must provide coverage as of the first day of the month in which
an employee becomes eligible. Once terminated, coverage
continues through the end of the month of termination.
f.
COBRA. An individual whose employment has been
terminated by a large employer must elect within 30 days of the
termination to either remain in the plan provided by the
employer for a period not to exceed 12 months, or until the
individual is reemployed, whichever is less.
g.
C
Employees of large employers are also ineligible to purchase
insurance at the community rate either through a broker,
independent agent, purchasing cooperative, or public
enrollment office.
Selection of Plan by Majority of employees. Each employer shall
make selection of health plans on an annual basis. Employers,
who are not contributing to coverage, shall comply with a
selection made by more than 50% of employees.
Individual and Small Employer Purchasing Groups
1.
These purchasing groups shall be chartered under state law.
2.
Membership in these purchasing groups will be voluntary and limited
to employers and employees of businesses with 100 or fewer
employees, and to all other non-Medicaid U.S. citizens or legal
residents not employed by a large employer who live in the HCCA
area.
3.
Nothing in the Act shall be construed to require any individual or
small employer to purchase exclusively through a purchasing group.
4.
Nothing in the Act requires the establishment of a purchasing group
nor prohibits the establishment of a purchasing group in an area.
5.
Nothing in the Act shall be construed from preventing a purchasing
group from being the purchasing group for more than one HCCA.
16
�6.
7.
D.
. Nothing shall be construed to prevent a state from establishing or
designating more than one purchasing group in a HCCA.
Purchasing groups are permitted to contract selectively with Qualified
Health Plans. Purchasing groups are permitted to negotiate a price
lower than the community rate, if so, that price becomes the plan's
new commimity rate. Nothing in this act shall be construed to prevent
a purchasing group from negotiating prices on administrative fees or
items outside the basic and standard benefits packages which may be
unique to the purchasing group.
Allowing Access to Federal Employee Health Benefit Program
Any plan under the Federal Employee Health Benefit plan offered to federal
employees in a HCCA must be available for purchase by individual and small
group purchasers in that area. Non-federal employee purchasers shall pay a
premium amount based on the local community rate for that plan, and shall
not be a part of the FEHB insurance pool. Plans offered nationally through
FEHB shall not be required to be open to non-federal employee enrollment.
IV.
Nondiscrimination provisions that apply to all employers:
A.
General Rules
Employers that contribute to the purchase of any employee's health care
coverage may not discriminate against any employee based on the employee's
income. Employers that contribute to the purchase of any full-time
employee's health care coverage must make an equal dollar contribution to
all full-time employees choosing to purchase health care coverage offered by
such employer. In addition, employers that contribute to the purchase of any
part-time employee's health care coverage must make a proratated equal
dollar contribution to all part-time employees choosing to purchase health
care coverage offered by such employer.
1.
A large employer that otherwise contributes shall not be required to
offer an equal dollar contribution to an employee or "cash out" an
employee that does not choose to purchase health care coverage offered
by such employer.
2.
For purposes of part-time employees, a dollar contribution will
constitute an equal dollar contribution if the employer makes a dollar
contribution proportionate to the number of hours worked by the parttime employee.
17
�B.
Special Rule for Small Employers
1.
To the extent a small employer contributes to an employee's heialth
care coverage, the employer cannot discriminate against an employee
that chooses to purchase health care coverage from other than such
small employer.
2.
In no event shall a small employer be required to "cash out" an
employee who does not choose to purchase health care coverage
through the employer. For example, if a small employer makes a
contribution on behalf of a full-time employee that chooses a plan the
employer offers, it must also make a contribution to a full-time
employee that chooses a Qualified Health Plan not offered by the
employer.
3.
Small employers may charge a reasonable fee to cover their
administrative costs associated with withholding and remitting
employee health insurance premiums of employees not opting for the
health care coverage offered by the small employer.
Penalties
To the extent an employer does not comply with these nondiscrimination
rules, a penalty will be assessed for the period of time the employer is in
noncompliance. Such penalty will be equal to $100 for each day, or part
thereof, of such period. (See Section 4980B of the Internal Revenue Code for
analogous rules).
D.
Definitions
1.
A full-time employee is defined as an individual who is employed for
an average of 30 or more hours per week.
2.
A part-time employee is defined as an individual who is employed for
an average of at least 10 hours per week, but less than 30 hours per
week.
3.
An individual does not qualify as a full-time or part-time employee
until the individual has been employed for six months (i.e., seasonal
employees are not treated as part-time employees).
18
�E.
Exemption for Collectively Bargained Plans
Single-employer and multi-employer bona fide collectively bargained plans
are exempt from these nondiscrimination rules.
V.
Assistance to Individuals and Families for the General Purchase of Insurance
A.
Eligibility:
Individuals and/or families not otherwise eligible for Medicare or Medicaid,
whose income is less than 240% of the federal poverty level will be eligible for
a voucher for the purchase of a Qualified Health Plan.
B.
Amount of Voucher
1.
2.
C
For individuals and families with incomes less than 100% of poverty
the voucher will be equal to 100% of the average premium of the
lowest 2/3 of Qualified Health Plans offered in the HCCA in which
they reside or work.
For individuals and families with income above 100% of the federal
poverty level, the Voucher amount will be decreased on a sliding scale
basis to 240% of the federal poverty level.
Phase-in Schedule for Vouchers
Vouchers will be phased-in at the beginning of each year under the
following schedule:
Calendar Year
Percentage of Poverty
1997
1998
1999
2000
2001
D.
90%
120%
150%
180%
240%
Administration of Vouchers
1.
The Secretary of HHS will establish a mechanism for
determining eligibility for vouchers, for distributing application
19
�forms, and to the extent practicable, for allowing enrollment in a
Qualified Health Plan at the time of application for subsidy.
2.
The Secretary may provide for administration of Vouchers through an
appropriate State agency.
VI.
Assistance to Individuals and Families — Expanded Tax Deductibility
(Described in Section XIII.,B.)
VII.
Expanding Access for Underserved Populations
A.
Community-Based Primary Care Grant Program
1.
Three grant programs would be established to promote community
health plans and practice networks.
a.
The HHS Secretary will establish a program to administer grants
to the states for the purpose of creating or enhancing
community-based primary care entities that provide services to
low-income or medically underserved populations. This
provision is designed to complement the existing federal
Community and Migrant Health Center programs by making
flexible funding available to local public health departments,
rural hospitals, and other public and private community care
entities.
b.
The Secretary of HHS may make grants to and enter into
contracts with consortia of public and private health care
providers for the development of qualified community health
plans and practice networks. The Secretary will give preference
to plans and networks with three or more categories of providers
such as EACH/RPCHs, MAFs and other rural hospitals, migrant
health centers, community health centers, homeless health
services providers, public housing providers, family planning
clinics, Indian health programs, maternal and child health
providers, federally qualified health centers and rural health
clinics, state and local health department programs and health
professionals and institutions providing services in one or more
Health Professional Shortage Areas (HPSAs) or to medically
underserved populations.
c.
Loans and loan guarantees for capital costs would be authorized
for the development of qualified community health plans or
practice networks.
20
�B.
Enhanced Assistance for Federally Qualified Health Centers
1.
Expanded resources will be provided for the Federally Qualified Health
Centers;
2.
This provision is intended to complement the state-based community
primary care grant program described above. Both provisions are
aimed at addressing the shrinking availability of primary health care
services in the country's rural and inner-city communities.
C
Tax Incentives for Practice in Rural, Frontier, and Urban Underserved Areas
(As described in Section XIII., D.)
D.
Development of Networks of Care in Rural and Frontier Areas
1.
2.
E.
The HHS Secretary is authorized to waive certain Medicare and
Medicaid requirements for demonstration projects to operate rural
health networks. Public and private entities may apply for such
waivers. The Secretary may award grants to assist organizations in
rural networks planning.
The Secretary will conduct a study on the benefits of developing a
supplemental benefit package and making available premiums that
will improve access to health services in rural areas.
Grant Program for Low Interest loans for Capital Improvement in Rural and
Underserved Areas
Loans and loan guarantees for capital costs would be authorized for the
development of qualified community health plans or practice networks.
F.
Office of the Assistant Secretary for Rural Health
Under this provision, the position of Director of the Office of Rural Health
would be elevated to the position of the Assistant Secretary for Rural Health.
The mission of the office would be expanded to include advising on how
health care reform could impact rural areas.
21
�G.
Rural and Frontier Emergency Care
A rural emergency medical services program is established to improve
emergency medical services (EMS) operating in rural and frontier
communities. This program will:
1.
2.
Provide federal grants to states for telecommunications demonstration
projects linking rural and urban health care facilities;
3.
Establish an Office of Emergency Medical Services to provide technical
assistance to state EMS programs;
4.
H.
Offer a matching grant program for improving state EMS services.
These grants will encourage better training for health professionals and
provide necessary technical assistance to public and private entities
which provide emergency medical services;
Federal grant support will also be provided to the states for the
development of air transport systems to enhance access to emergency
medical services.
Medicare Dependent Hospitals
1.
Modify Payments to Medicare Dependent Hospitals in the following
manner:
a.
b.
clarify of updates; and,
d.
I.
conform target amounts to extension of additional payments;
c.
2.
base payments on a 36 month period beginning with the first day
of the cost reporting period that begins on or after April 1, 1990;
would extend Medicare-dependent hospital classification
through 1998.
Would establish a demonstration project regarding payment to larger
Medicare dependent hospitals.
EACH/RPCH Program Improvements and Extension to all States
1.
Expands the EACH/RPCh program to all states.
2.
Rural community hospitals meeting eligibility criteria may qualify as
22
�Rural Emergency Access Community Hospitals (REACHs).
3.
Current special reimbursement to small rural Medicare-dependent
hospitals enacted in Omnibus Budget Reconciliation Act of 1989 is
extended.
4.
Modify provisions that relate to hospital inpatient services in a Rural
Primary Care Hospital so that:
a.
b.
the RPCH cannot perform surgery or any service requiring
general anesthesia (unless the risk of transferring the patient
outweigh the benefits);
c.
the Secretary can terminate the RPCH designation if the average
length of stay for the previous year exceeded 72 hours. In
determining the average length of stay, cases which exceed 72
hours due to inclement weather or other emergency conditions
are not included in the calculations;
d.
5.
a RPCH cannot have more than 6 beds;
the GAO must submit a report determining if the revised RPCH
criteria have resulted in RPCHs providing patient care beyond
their abilities or have limited RPCHs' abilities to provide needed
services.
Designates EACH hospitals so that:
a.
urban hospitals can be designated as EACHs and do not need to
meet the 35 mile criteria, but do have to meet all the remaining
criteria. Urban EACHs would still be subject to the Medicare
Protective Payment System; and,
b.
hospitals located in adjoining states and otherwise eligible as
EACHs and RPCHs can participate in a state's rural health
network and these hospitals or facilities are permitted to receive
grants.
6.
Permit RPCHs to maintain swing beds in a Skilled Nursing Facility
except that the number of swing beds may not exceed the total number
of swing beds established at the time the facility applied for its RPCH
designation. Beds in a distinct-part SNF do not count towards the total
number of swing beds.
7.
Extend the deadline for the development of prospective payment
system for inpatient RPCH services to January 1, 1996.
23
�8.
_ Clarify that physician staffing criteria only apply to doctors of medicine
and osteopathy.
9.
10.
The Department of Justice and Federal Trade Commission would be
instructed to issue formal guidelines for EACH/RPCHs.
11.
The Secretary would be permitted to designate an unlimited number of
RPCHs in non-EACH states. The RPCHs must establish relationships
with a full-service rural hospital that meet the same criteria as EACHs
with the exception of the criteria that the EACH have 75 beds.
12.
HHS would be required to conduct a pilot program that would allow
RPCHs to admit patients on a limited DRG basis instead of using the
72-hour average length of stay criteria.
13.
Codify the MAF requirements into Medicare, allowing Medicare to
reimburse on a cost basis those facilities which meet the MAF
requirements.
14.
J.
Adopt technical amendments relating to Part A deductible, coinsurance
and spell of illness.
Develop a grant program for states that operate MAFs. The grant
program would be modeled after the EACH/RPCH program.
Extends the Rural Health Transition Grant Program
Extends the program through FY 1998 with authorized appropriations of $30
million annually, FY 1993 - 1998. Reports from grantees would be required
every 12 months. As of October 1, 1994, RPCHs are eligible for rural health
transition grants.
K.
Increases reimbursement to PAs and NPs under Medicare
1.
Certified Nurse Practitioners and Physicians Assistants would be
reimbursed at 85% of the RBRVS rate for services performed in all
outpatient settings.
2.
Under Medicare, certified Nurse Practitioners would be reimbursed at
65% of the RBRVS rate for assisting at surgery in urban areas.
3.
States would be required to directly reimburse all certified Nurse
Practitioners in a rural area under Medicaid. This expands the current
24
�requirement that all states directly reimburse pediatric and family
.. Nurse Practitioners, which gives states the option of directly
reimbursing other types of NPs.
Telemedicine and Related Telecommunications Technology
1.
2.
M.
Coordinates various federal grant programs which fund telemedicine
and related telecommunications demonstrations and grant programs.
This provision establishes a federal interagency task force, coordinated
and chaired by the Department of Health and Human Services, would
be established to oversee telemedicine and other telecommunications
demonstration projects already underway.
A grant program would be established to fund telemedicine and related
telecommunications technology in rural areas. The program would be
administered through the Assistant Secretary for Rural Health.
Applicants for the grant would be rural health care providers such as
rural referral centers, rural health clinics, community health centers,
migrant health centers, area health and education centers, local health
departments and public hospitals.
National Health Service Corps
1.
2.
N.
Fully funds the National Health Service Corps program and require
that at least 20% of those in the Scholarship and Loan Repayment
Program be nurses and physicians assistants
Reauthorize the Community Scholarship Program. In addition, the
criteria for selecting students should be modified and a 15%
administration fee for those agencies administering the scholarships
should be established.
Indian Health Reform Amendments
1.
Indian Health Service remains as a provider of health care for the
Indian population.
2.
Reaffirms current federal policy of guaranteeing that Indian Tribes
should be eligible to apply for all appropriated funds and grants created
under health reform legislation, at levels not less than any other
qualified entities. This provision is simply a reaffirmation of current
Federal policy.
25
�3.
4.
O.
Requires the Assistant Secretary for Indian Health to establish a new
formula for the distribution to tribes of all new funds that become
available for health care initiatives and programs under health reform.
This formula would consider differences in local resources, status of
health, socioeconomic status of Tribal people, and
facilities/equipment/staff that are available.
Retains Indian eligibility under current law for additional benefits.
Under this provision, whatever comprehensive benefits one accrues
through health reform legislation, Indians would not lose any current
benefits. Such benefits include all supplemental benefits, such as
environmental health, mental health benefits, and alcohol abuse
treatment.
Transitional Requirements for Plans Serving Special Needs Populations
1.
Nondiscrimination Service Area Standards
Health plans must not discriminate in the drawing of services area
boundaries on the basis of race, ethnicity, socioeconomic status, age, or
anticipated need for health services.
2.
Special Access Standards
Plans must meet special access standards that take into account the
special needs and circumstances of urban and rural underserved areas.
The Secretary would be required to establish access standards for
enrollees living in medically underserved areas that take into account
the following indicators:
a.
b.
c.
Accessibility of primary care services based on measures such as
the ratio of primary care providers to expected enrollees;
Accessibility of other services, based on measures such as travel
time;
Accessibility of health plans services for individuals with
limited ability to speak the English language, and for population
with similar needs.
3.
Reporting Requirements
Health plans must report on key indicators of access, quality and
service in a manner that provides separate information and
monitoring for those in medically underserved areas.
4.
Designation of Underserved Communities and Populations
The Secretary would annually designate underserved areas and
populations as either of the following areas:
a.
Areas with a shortage of personal health services as designated
26
�b.
c.
d.
5.
under section 332(a)(3) or 1302(7) of the Public Health Service
Act;
Health Professional Shortage Areas as described in section
332(a)(1)(a) of the PHS Act;
High impact areas as described in section 329(a)(3) of the PHS
Act; or
an area which includes a population group which the Secretary
determines as a health manpower shortage area under Section
332(a)(1)(B) of the PHS Act.
Certification of Essential Community Providers
Any public or non-profit private entity furnishing services in a
designated medically underserved community or population may
apply to the Secretary for certification as an essential community
provider. In order to be certified, the entity:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Must be a public or non profit private entity;
Must be capable of providing for a full range of primary health
care services that are available and accessible promptly, as
appropriate and in a manner which assures continuity;
Have organization arrangements for quality assurance programs
and maintaining patient record confidentiality;
Demonstrate financial responsibility;
Accept all patients notwithstanding their ability to pay;
Make every effort to collect appropriate reimbursement from
Medicare, Medicaid and third party payers;
Establish a sliding-scale fee schedule based on ability to pay for
services;
Reviews annually its catchment area;
Where appropriate, provides access to patients with limited
english-speaking ability;
Meets the requirements of section 1861(z) of the Social Security
Act, compiles appropriate statistical and other information.
6.
Obligation to Offer Contracts for Primary Care Services
All health plans, including self-insured plans, would be required to
offer a contract with a reasonable number as determined by the
Secretary of certified essential community providers. Mandatory
contracting would be in effect for the first five years after enactment.
7.
Scope of Contracts
The contract between health plans shall:
a.
Provide for primary health services that are included in the
uniform benefit package, furnished on an outpatient basis and
provided directly by the essential community provider.
27
�b.
Terms and conditions applied to the agreements shall be
comparable to terms and conditions that apply to other
providers furnishing comparable services to the health plan.
c.
Payment will be based on Section 1876 of the Social Security Act.
8.
Health Plan Obligation for Non-primary Care
Health plans must meet general access standards for non-primary care
services to insure accessibility and availability of all covered and noncovered primary care services for all enrolled members. (Needs more
definition.)
9.
Access in Underserved Areas
The Office of Technology Assessment (OTA) will conduct a study on
improving access in underserved areas.
P.
Urban " Safety-Net" Hospitals
Establishes a revolving loan fund and grant program to fund capital
improvements for publicly owned and operated "safety-net" hospitals.
Q.
Other Urban Hospitals
Demonstration for inaccessible other urban Hospitals to qualify as Sole
Community Hospitals.
VIII. New Home and Community Based Long Term Care Program
A.
General
Establishes a new capped program in the Social Security Act to provide
home-and community-based services for older Americans and
individuals with disabilities. The program is administered by the
States with federal matching payments for services provided. Total
funding is capped, and there is no individual entitlement to services
under this program.
B.
Eligibility
The Secretary will issue regulation establishing uniform eligibility
criteria and assessment protocols. In order to receive benefits under
the program, an individual must be determined eligible, must undergo
28
�a standardized assessment and have a individualized plan of care
developed. To be eligible, an individual must be in one of the
following categories. The first three categories apply to individuals of
all ages; the final category applies only to children under age six.
1.
Requires hands-on or stand-by personal assistance supervision
or cues in three or more of five activities of daily living: eating
dressing bathing, toileting, and transferring in and out of bed.
2.
Presents evidence of severe cognitive or mental impairment.
3.
Has severe or profound mental retardation.
4.
Is under age six and would otherwise require hospital or
institutional care for a severe disability or chronic medical
condition.
Covered Services
1.
2.
D.
At a minimum, a state's array of services must include personal
assistance (both agency administered and consumer directed) for every
eligible category of participant. Services may include, but are not
limited to: case management, homemaker and chore assistance, home
modifications, respite services, assistive technology, adult day services,
habilitation and rehabilitation, supported employment, and home
health services.
Services may be delivered in a home, a range of community residential
arrangements, or outside the home. Services may not be provided in
licensed nursing homes or intermediate care facilities for the mentally
retarded.
Cost Sharing
Eligible individuals with incomes over 150% of the federal poverty level pay
co-insurance to cover a portion of the cost of all services they receive
according to a sliding scale. Persons with incomes between 150% and 200% of
the federal poverty level pay 10% of the cost of care; between 200% and 250%
of poverty 20% co-insurance, and persons with income over 250% of poverty
pay a 25% co-insurance.
29
�E.
State Administration
Each state must have an approved plan, which specifies: administering
agency or agencies; services to be covered, and how the needs of all types of
eligible individuals will be met; provide a plan for making eligibility
determinations: provide information on how the state will develop care
plans, coordinate services, reimburse providers and plans, administer
vouchers or cash payments, license or certify providers. In addition, the state
must develop a system of determining allocation of resources and how the
new program with be integrated with existing long-term care programs, and
must assure that low-income persons in the program is at least equal to the
proportion of low-income persons in the state's population.
F.
Quality Assurance
States are responsible for developing comprehensive quality assurance
programs that monitor health and safety of participants as well as assure that
services are of the highest quality. States must develop, for federal approval,
quality assurance systems that include consumer satisfaction surveys. In
addition, consumer advisory groups are expected to play a strong role in
assuring and enhancing quality.
G.
Federal Matching Payments to States
A federal matching payment will be made to states based on the current
Medicaid match rate plus 28 percentage points. Federal matching percentages
can be no less than 78 percent and no more than 95 percent. No federal
matching payments will be made once the cap is reached.
H.
Funding, Allotments to States
For federal Fiscal years 1996-2002 - No federal funds allocated.
PART TWO - COST CONTAINMENT & CONSUMER PROTECTION
A.
High Cost Plan Assessment
(described in Section XIII., A.)
30
�B.
Medical Liability Reform
1.
Alternative Dispute Resolution
a.
b.
2.
No health care malpractice action may be brought in court until
final resolution of the claim under an alternative dispute
resolution (ADR) method adopted by the state from models
developed by the Secretary of HHS, or developed by the state and
approved by the Secretary of HHS.
If the party initiating court action following the ADR receives a
worse result with respect to liability or a level of damages 33
1/3% below that awarded in the ADR, that party must pay the
costs and attorneys fees of the other party incurred subsequent to
the ADR.
Damages
Non-economic damages awarded to a plaintiff in a health care
malpractice claim or action may not exceed $250,000, indexed for
inflation.
3.
Several Liability
The liability of each defendant in a health care malpractice action for
non-economic and punitive damages will be based on each defendant's
proportion of responsibility for the claimant's harm.
4.
Punitive Damages
Seventy-five percent of punitive damage awards will be paid to the
state in which the action is brought and such funds will be used for
provider licensing, disciplinary activities and quality assurance
programs.
5.
Statute of Repose
A twenty year statute of repose will be applied to health care
malpractice actions.
6.
Fee Reform
Lawyers may not charge contingency fees greater than 33 1 /3% of the
first $150,000 of the award in a health care malpractice action and 25%
of amounts in excess of $150,000. Calculation of permissible
contingency fees is based on after tax amounts.
31
�7.
_ Limited Preemption
State laws that have higher limits on attorneys fees and noneconomic damages are preempted. State laws that provide for longer
statutes of repose are preempted. Does not preempt those laws with
lower limits on attorneys fees and non-economic damages are
preempted. Does not preempt state laws with shorter statutes of
repose.
Administrative Simplification and Paperwork Reduction
Implements a national health information network to reduce the burden of
administrative complexity, paper work, and cost on the health care system; to
provide the information on cost and quality necessary for competition in
health care; and to provide information tools that allow improved fraud
detection, outcomes research, and quality of care.
1.
National Health Information Network
Requires the Secretary of HHS to implement a national health
information network by adopting standards for:
a.
representing the content and format of health information in
both paper and electronic forms,
b.
transmitting information electronically,
c.
conducting transactions using this information,
d.
certifying public or private entities to perform the intermediary
functions which implement the network,
e.
monitoring performance to assure compliance,
f.
establishing procedures for adding codes to previously adopted
standards,
g.
making changes to previously adopted standards, and
h.
developing, testing, and adopting new standards.
32
�2.
Health Information Advisory Commission
In carrying out duties under this part, the Secretary would consult with
an Advisory Commission consisting of 15. members from the private
sector with expertise and practical experience in developing and
applying health information and networking standards. The members
would be appointed by the President and serve staggered 5 year terms,
and would include providers and consumers.
3.
Requirements for Qualified Health Plans and Health Care Providers
All Qualified Health Plans, including Federal and State plans, and all
health care providers would be required to comply with federal
standards for formatting information and electronic transactions.
The Secretary may require transactions to be consistent with the goal of
reducing administrative costs. In addition, certain standard data must
be made available electronically on the health information network to
authorized inquiries. Other requirements for electronic information,
such as quality related information, may be specified in other parts of
the law and would be put through the same standards setting
procedure before becoming required.
4.
Accessing Health Information
a.
b.
5.
The Secretary would establish technical standards for requesting
standard health information from participants in the health
information network which assure that a request for health
information is authorized under federal privacy provisions.
The Secretary would establish standards for the appropriate
release of health information to researchers and government
agencies, including public health agencies. The Secretary would
establish standards for the electronic identification of a request as
one which comes from a person authorized to receive health
information under federal privacy provisions.
Effective Date
A timetable of effective dates would be included which would specify
when each requirement would take effect relative to the date of
enactment. In general, the Secretary would adopt existing standards
within 9 months of enactment and more time is given for standards
which must be developed. At least 12 months grace period is allowed
after any standard is adopted before use of that standard becomes
required.
33
�D.
Quality Assurance
The goal of health reform is to ensure that Americans have access to health
care plans that compete on the basis of price and quality. Assessing quality
requires reliable and comparable information on the outcomes and
effectiveness of services provided by plans. Under this subtitle. Qualified
Health Plans are required to annually report data on the quality of their
services to the Secretary of HHS in a format prescribed under the National
Health Information Network. The Secretary may determine the manner in
which these data are provided to certifying authorities in states. This title also
provides direction to the Secretary to improve and expand the capability of
HHS to support and encourage research and evaluation of medical outcomes.
Standards and Measurements of Quality
The Secretary, in consultation with relevant private entities, will develop
quality standards with which all Qualified Health Plans must comply. These
standards are designed to improve the data available upon which to assess
quality and the processes by which quality care is continuously improved.
The Secretary will study the capabilities of entities within its jurisdiction to
accomplish these goals including:
1.
setting priorities for strengthening the medical research base;
2.
supporting research and evaluation on medical effectiveness through
technology assessment, consensus development, outcomes research
and the use of practice guidelines;
3.
conducting effectiveness trials in collaboration with medical specialty
societies, medical educators and qualified health plans;
4.
maintaining a clearinghouse and other registries on clinical trials and
outcomes research data;
5.
assuring the systematic evaluation of existing and new treatments, and
diagnostic technologies in an effort to upgrade the knowledge base for
clinical decision making and policy choice;
6.
designing an interactive, computerized dissemination system of
information on outcomes research, practice guidelines, and other
information for providers.
34
�E.
Anti-fraud and Abuse Control Program
This subtitle establishes a stronger, better coordinated federal effort to combat
fraud and abuse in our health care system. It expands criminal and civil
penalties for health care fraud to provide a stronger deterrent to the billing of
fraudulent claims and to eliminate waste in our health care system resulting
from such practices. It also seeks to deter fraudulent utilization of health care
services. It would:
1.
Require the HHS Secretary and Attorney General to jointly establish
and coordinate a national health care fraud program to combat fraud
and abuse in government and Qualified Health Plans;
2.
Finance the anti-fraud efforts by setting up an Anti-Fraud and Abuse
Trust Fund. Monies from penalties, fines, and damages assessed for
health care fraud are dedicated to the Trust Fund to pay for the antifraud efforts;
3.
Increase and extend Medicare and Medicaid civil money and criminal
penalties for fraud to all health care programs;
4.
Bar providers convicted of health care fraud felonies from participating
in the Medicare program;
5.
Require HHS to publish the names of providers and suppliers who
have had final adverse actions taken against them for health care
fraud; and,
6.
Establish a new health care fraud statute patterned after existing mail
and wire fraud statutes under Title XXIII of the Criminal Code and
allows for criminal forfeiture of proceeds.
X. REFORM OF EXISTING PUBLIC PROGRAMS
A.
Medicaid (Some would like to integrate Medicaid faster if it did not adversely
affect the cost of health care reform.)
1.
Integration of Medicaid beneficiaries into Qualified Health Plans
a.
The Secretary shall make recommendations on the integration
of AFDC and non-cash recipients into the community-rated pool
and into Qualified Health Plans. The Secretary's
recommendations shall address:
35
�i.
ii.
the administration of subsidies,
iii.
2.
the impact on private health insurance premiums,
the adequacy of services for Medicaid recipients and the
need for and structure of wrap around services.
New State Option for Medicaid Coverage in Qualified Health Plans
States may give their AFDC and non-cash eligible beneficiaries
(excluding medically needy) the option to receive medical assistance
through enrollment in a Qualified Health Plan offered in a local HCCA
instead of through the Medicaid plan.
a.
b.
3.
The state may not restrict an individual's choice of plan and is
not required to pay more than the applicable dollar limit for the
HCCA area.
The number of individuals electing to enroll in a Qualified
Health Plan is limited to a fifteen percent of the eligible
population in each of the first three years, and ten percent in
each year thereafter.
Limitation on Certain Federal Medicaid Payments
Federal financial participation for acute medical services, including
expenditures for payments to Qualified Health Plans, is subject to an
annual federal payment cap.
a.
The cap is determined by multiplying a per capita limit (defined
below) by the average number of Medicaid categorical
individuals entitled to receive medical assistance in the state
plan.
b.
The per-capita limit for fiscal year 1996 is equal to 118% of the
base per capita funding amount (determined by dividing the
total expenditures made for medical assistance furnished in 1994
by the average total number of Medicaid categorical individuals
for that year).
c.
After 1996, the per-capita limit is equal to the per-capita funding
amount determined for the previous fiscal year increased by 6
percent for fiscal years 1997 through 2000, and 5 percent for fiscal
year 2001 and beyond.
36
�d.
e.
4.
Expenditures for which no federal financial participation was
provided and disproportionate share payments are excluded
from this calculation.
States are required to continue to make eligible for medical
assistance any class category of individuals that were eligible for
assistance in fiscal year 1994.
State Flexibility to Contract for Coordinated Care Services
a.
States have the option, to establish a program under Medicaid
program to allow states to enter into contracts with at-risk
primary care case management (PCCM) providers.
b.
An at-risk PCCM provider must be a physician, group of
physicians, a federally qualified health center, a rural health
clinic or other entity having other arrangements with physicians
operating under contract with a state to provide services under a
primary care case management program.
c.
Qualified risk contracting entities must:
i.
meet federal organizational requirements;
ii.
guarantee enrolled access; and,
iii.
have a written contract with the state agency that includes:
(a) .
an experienced-based payment methodology;
(b) .
premiums that do not discriminate among eligible
individuals based on health status;
(c) .
requirements for health care services; and,
(d) .
detailed specification of the responsibilities of the
contracting entity and the state for providing for, or
arranging for, health care services.
d.
Meet federal standards for internal quality assurance.
e.
Enter into written provider participation agreements with
essential community providers;
1.
States are required to contract directly with essential
community providers, or at the election of the ECP, each
37
�risk contracting entity may enter into agreement to make
payments to the essential community provider for
services.
2.
Essential community providers include:
a.
Federally Qualified Health Centers,
b.
Public Housing Providers,
c.
Family Planning Clinics,
d.
AIDS providers under the Ryan White Act,
e.
Maternal and Child Health Providers, and
f.
B.
Rural Health Clinics.
Medicare
1.
Medicare remains a separate program and continues to be federally
administered. Beneficiaries enrolled in Part B continue to pay a
monthly premium. The statutorily defined Medicare benefits continue
to be the Medicare benefit package in both fee-for-service and managed
care.
2.
Beneficiary opt-in to private qualified health plans.
a.
b.
For individuals choosing an AHP, Medicare will pay the federal
contribution calculated for Medicare risk contracts. Individuals
are responsible for paying the difference between the premium
charged and the federal contribution.
c.
3.
Medicare beneficiaries may opt into a qualified health plan in
their HCCA.
During the annual enrollment period, Medicare-eligibles may
choose a new plan through their employer/purchasing
cooperative or they may return to the traditional Medicare
program.
Medicare Select
a.
The Medicare Select program would become a permanent option
in all States.
38
�b.
c.
4.
Medicare Select policies will be offered during Medicare's
coordinated open enrollment period.
Plans may not discriminate based on health status.
Medicare Risk Contract Program
a.
Medicare health plans must meet Qualified Health Plan
standards and cover all Medicare benefits under a risk contract
for a uniform monthly premium for a year.
b.
Employers may sponsor Medicare health plans for former or
current employees.
c.
Cost contracts, SHMOs, etc. would continue as under current
law. The 50/50 requirement is terminated at the point at which
the Secretary determines that health plans have alternative
quality assurance mechanisms in place that effectively provide
sufficient quality safeguards. In the interim, the Secretary may
grant waivers of the 50/50 requirement.
e.
Medicare health plans will offer a standard benefit package
comprised of the current Medicare benefits defined in statute or
an alternative package, defined by the Secretary, covering
identical services but with cost-sharing consistent with typical
managed care practice and not to exceed the actuarial value of
PES.
f.
Standardize supplemental benefits that risk contractors may
offer in addition to Medicare benefits. In addition to the
standardized policies, health plans may offer other supplemental
policies. However, Medicare health plans must at least offer two
supplements to be defined by the Secretary: one which would
cover catastrophic costs (out-of-pocket limit) and other items
traditionally covered in employer-sponsored plans, and one
covering outpatient prescription drugs.
g.
The current standardized Medigap plans would be changed so
that Medigap may only pay up to one-half of the 20% part B
coinsurance. Beneficiaries currently holding Medigap plans
covering the entire 20% coinsurance would be exempt from this
change as long as they renew their current insurance.
h.
The Secretary shall define Medicare market areas which shall be
consistent with the health care coverage areas defined by the
39
�non-Medicare population. For the Medicare program, the MSAs
may cross state lines if the Secretary determines it is necessary to
increase choices to Medicare beneficiaries. The federal
contribution for a Medicare health plan will be the same
throughout the Medicare market area.
i.
The Secretary will administer a coordinated annual open
enrollment period during which Medicare beneficiaries will
choose from all plans (including Medigap insurers) offering
products to Medicare beneficiaries. The Secretary may authorize
any variations of participation in the enrollment process.
j.
The Secretary of HHS will provide to all Medicare beneficiaries
in a market area uniform materials for enrolling in health plans.
k.
The federal contribution is calculated as the weighted average of
fee-for-service per capita cost in the market area and the
premiums submitted by Medicare health plans to the Secretary
to provide Medicare benefits. The Secretary is authorized to
adjust for heart disease, cancer, or stroke.
1.
Beneficiaries pay the difference between the federal contribution
and the total premium charged by the health plan they select. If
the health plan's premium is less than the federal contribution,
the beneficiary is entitled to a rebate that the plan may provide
in cash or apply to supplementary coverage. The rebate would
be treated as non-taxable income.
i.
ii.
5.
Beneficiaries eligible for Medicare prior to 1999 are
grandfathered under these provisions and may always
enroll in Medicare FFS (regardless of local costs) for the
regular part B premium only.
If the federal contribution is less than the FFS per capita
cost in the market area and the beneficiary selects
Medicare FFS, the beneficiary pays an additional premium
to the Federal Government equal to the difference
between the federal contribution and FFSPCC.
Administrative Simplification
The Secretary has authority to consolidate the functions of fiscal
intermediaries and carriers. Provides for coordination of Medicare and
supplemental insurance claims processing. Permits standardized,
paperless process.
40
�6.
Study and Demonstration for Medicare Cost Containment
a.
Requires ProPAC to study and make recommendations to
Congress regarding ways to slow the rate of Medicare growth at
the local market level. The study should include ways to set
local expenditure targets and monitor success in controlling
costs. Updates for payment rates under Parts A and B should be
set to achieve local targeted expenditure levels, while rewarding
efficient providers and/or markets.
b.
A demonstration is authorized to evaluate Part A expenditures
for hospital service and/or Part B expenditures in fee for service
using provider-group or State-level volume performance
standards.
GRADUATE MEDICAL EDUCATION
[Under Discussion]
41
�I.
FINANCING
A.
Financing Totals (Estimated Over 5 years; $ in Billions)
Savings
Medicare Savings
Medicaid Savings
Postal Service Retirement
$70.1
$55.8
$13.0
SUBTOTAL SPENDING REDUCTIONS
$138.9
Revenues
High Cost Plan Premium Assessment
Tobacco Tax ($1.00 increase)
HI State/Local
Income Relating Medicare Part B Premiums
$30.0*
$62.3
$ 7.6
$ 8.0
SUBTOTAL REVENUES
$107.9
TOTAL FINANCING
* Preliminary estimate based on available information
$246.8
B.
Descriptions of Medicare Savings
1.
Adjust Inpatient Capital Payments. This proposal combines three
inpatient payment adjustments to reflect more accurate base year data
and cost projections. The first would reduce inpatient capital payments
to hospitals excluded from Medicare's prospective payment system by
15%. The second would reduce PPS Federal capital payments by 7.31%
and hospital-specific amount by 10.41% to reflect new data on the FY 89
capital cost per discharge and the increase in Medicare inpatient costs.
The third piece would reduce payments for hospital inpatient capital
with a 22.1% reduction to the updates of the capital rates.
2.
Revise Disproportionate Share Hospital Adjustment. This Act limits
the current disproportionate share hospital adjustment with a new
voucher program to cover health care provided to those with out
health insurance.
3.
Extend OBRA 93 Provision to Catch-up after the SNF Freeze Expires
Included in OBRA 93. OBRA 93 established a two-year freeze on
update to the cost limits for skilled nursing facilities. A catch-up is
allowed after the freeze expires on October 1, 1995. This Act eliminates
the catch-up.
4.
Change the Medicare Volume Performance Standard to Real Growth
GDP. This Act substitutes the five-year average growth in real GDP
42
�per-capita for this volume and intensity factor and the performance
standard factor for physician's services.
5.
Establish Cumulative Growth Targets for Physician Services. Under
" this Act, the Medical Volume Performance Standard for each category
of physician services would be built on a designated base-year and
updated annually for changes in beneficiary enrollment and inflation,
but not for actual outlay growth above and below the target.
6.
Reduce the Medicare Fee Schedule Conversion Factor by 3% i n 1995,
Except Primary Care Services. The conversion factor is a dollar amount
that converts the fee schedule's relative value units into a payment
amount for each physician service. This Act reduces the factor by 3% to
account for excessively high targets.
7.
Extend OBRA-93 Provisions on Part B Premium Collections. OBRA 93
established the Part B premium collections at 25% of program costs.
This Act extends the collection of these premiums.
8.
Extend OBRA 93 Catch-up After the Home Health Freeze Expires.
OBRA 93 eliminated the inflation adjustment to the home health
limits for two years. This Act eliminates the inflation catch-up
currently allowed after the freeze expires on July 1,1996.
9.
Extend OBRA 93 Medicare Secondary Payor Date Match with SSA and
IRS. OBRA 93 included an extension of the data match between HCFA,
IRS and SSA to identify the primary payers for Medicare enrollees with
health coverage in addition to Medicare.
10.
Increase Part B Deductible for Enrollees. Increase the amount that
enrollees must pay for services each year before the government shares
responsibility for physician services. The deductible would be
increased to $150 and indexed to the rate of growth.
11.
Reduce Hospital Market basket Index Update. This proposal reduces
the Hospital Market Basket Index Update by 2%. Currently Medicare
changes the inpatient per-discharge standardized amount by a certain
amount every year to reflect input costs changes in Congressional
direction. OBRA 1993 reduced the Index in Fiscal Years 1994 through
1997. This proposal would reduce the updates by 2% for Fiscal Years
1997 through 2000.
Medicaid Savings
1.
Revise Disproportionate Share Hospital Adjustment. This proposal
eliminates the current disproportionate share hospital adjustment
with the new voucher program to cover health care provided to those
with out health insurance. Medicaid DSH payments are to be
43
�eliminated in FY 1996 - 15%, FY 1997 - 25%, FY 1998 - 60% and 1999 100% (unless 95% coverage is not reached in which case it will not be
completely phased-out)
2.
D.
" Capitate the Federal Payments Made for Medicaid Acute Care Medical
Services under Medicaid Program. The per-capita federal financial
participation growth rate for acute medical services under the Medicaid
program would be capped at 6% for fiscal years 1997 through 2000 and
at 5% for fiscal year 2001 and beyond.
Revenues
1.
Postal Service Retirement. Require the U.S.P.S. to fund the U.S.P.S.
Retirement System in the U.S.P.S. budget rather than the Federal
Budget. This would free funds from the Federal budget.
2.
Tobacco Tax. The proposal increases the tax on tobacco by $50 per
thousand cigarettes ($1 per pack of 20 cigarettes). Described in Section
xm., G.)
3.
4.
XII.
H I State and Local. State and local jurisdictions can opt to pay the H I
payroll tax for State and local workers hired before April 1, 1986. The
proposal would extend the payroll tax to all remaining exempt State
and local workers.
Income Related Part B Premiums. This proposal would charge highincome enrollees a premium up to 75% of program costs based on an
enrolle's modified adjusted gross income.
Fiscal Responsibility
Fail-Safe Mechanism
The bill establishes a Fail-Safe mechanism to ensure health care reform does
not increase the deficit. Details are described below:
1.
A Current Health Spending Baseline (CHSB) is established. The CHSB
includes:
a.
Medicare Expenditures
b.
Medicaid Expenditures
c.
Health Related Tax Expenditures
i.
The employee exclusion of employer-provided health
insurance premiums.
44
�ii.
iii.
2.
Employer deduction for health insurance premiums.
7.5% floor for deduction of medical expenses.
A Health Reform Spending Estimate (HRSE) is established. The HRSE
includes:
a.
b.
Deduction for purchase of Qualified Health Plans by all
individuals.
c.
Cigarette excise tax.
d.
Vouchers for purchase of a Qualified Health Plan.
e.
3.
Everything included in the CHSB.
High-Cost Plan Assessment
In any year that the Director of OMB notifies Congress that HRSE will
exceed the CHSB, the following automatic actions will occur to prevent
deficit spending:
a.
b.
The assessment on high cost insurance plans is increased.
c.
The expanded tax deduction phase-in is slowed down.
d.
Out-of-pocket limits in the standard and basic benefit packages
are increased.
e.
4.
The voucher phase-in is delayed.
Starting in the year 2004, an employer may no longer deduct and
an employer may no longer exclude supplemental benefits
provided to employees and contributed to by employers.
Congress may act on alternative recommendations made by the
National Health Commission to avoid the actions listed above.
XIII. Tax Provisions
A.
High Cost Plan Assessment
1.
Beginning in 1996, an annual assessment will be imposed on High Cost
Plans. High Cost Plans are those health care packages whose premiums
exceed a target amount. The target amount will be set by the IRS at the
beginning of each year based on the premium bids submitted to the
HCCA for Basic plans (Primary Basics) and Standard plans (Primary
Standards). The target amount will be set at a level such that forty
45
�percent of the plans in each area are above that amount.
a.
To determine whether a plan is a High Cost Plan, an insurer
divides its plans into two categories:
i.
Primary Basics including the value of any supplemental
benefits, and
ii.
Primary Standards including the value of any
supplemental benefits.
b.
c.
The IRS will also determine the lowest 25% of geographicallyadjusted Primary Basic and Primary Standard premiums
nationally. Plans (including supplemental benefits) that fall
within the lowest 25% of the geographically-adjusted premiums
are exempt from the High Cost Plan Assessment.
d.
The geographically adjusted premium will be calculated by the
IRS by adjusting each accountable health plan's premium for
regional variations. Such adjustments shall include, but not be
limited to, variations in the cost of living and demographics.
e.
2.
A n insurer then determines which, if any, of such plans are
above the applicable target amount.
Treasury will be given the authority to develop regulations
implementing this provision.
The assessment on a High Cost Plan is equal to 25% of the difference
between the premium charged for the Primary Basic plus
supplementals, if any, and the Primary Standard plus supplementals, if
any, and a reference premium.
a.
b.
3.
For purposes of determining the assessment on the Primary
Basic plus supplementals, if any, the applicable reference
premium is the average of all Primary Basic premiums in the
HCCA.
For purposes of determining the assessment on the Primary
Standard plus supplementals, if any, the applicable reference
premium is the average of all Primary Standard premiums in
the area.
The High Cost Plan Assessment also applies to self-insured plans. The
tax will apply to the difference between the self-insured High Cost
Plan's premium (including any supplementals) and the applicable
reference premium for the HCCA. In calculating this tax, the high cost
self-insured plan's premium will be the premium used for meeting the
COBRA requirement. The Department of Treasury will be given
46
�authority to develop regulations implementing this provision.
6.
Assistance to Individuals and Families — Expanded Tax Deductibility
1.
Self-employed individuals purchasing health insurance may take an
above-the-line deduction for 100% of the cost of such insurance (i.e.,
not subject to the 7.5% floor), subject to a phase-in period. However,
the deduction is limited to the cost of either a basic or standard benefits
package. To the extent self-employed individuals purchase benefits
supplementing such packages, the cost of such supplemental benefits
will be deductible as medical expenses under current law (i.e., subject to
the 7.5% floor).
2.
Individuals (other than self-employed) that purchase health insurance
will be allowed an above-the-line deduction (i.e., not subject to the
7.5% floor) for 100% of the cost of either a basic or standard benefit
package. To the extent an individual purchases benefits
supplementing the packages, the cost of such supplemental benefits
will be deductible as medical expenses under current law (i.e., subject to
the 7.5% floor).
Employer-Provided Health Insurance
1.
2.
Employers may take a deduction for amounts contributed towards a
standard benefits package, as well as all benefits supplementing such
package, if any.
3.
Employers may take a deduction for amounts contributed towards a
basic benefits package. However, no deduction is permitted for any
contributions made towards benefits supplementing the basic benefits
package.
4.
D.
Employees may continue to exclude from gross income all employerprovided health insurance.
Fail-Safe option includes possible employer and employee cap on
supplementals after 2004.
Tax Incentives for Practice in Rural, Frontier, and Urban Underserved Areas
1.
Physicians practicing full-time and either newly certified or newly
relocated to a rural, frontier, or urban Health Professional Shortage
Areas (HPSA) are allowed a tax credit equal to $1,000 a month up to a
total of $36,000. Tax credits will be prorated in direct relation to the
time worked in the HPSA, up to a total of $36,000;
47
�2.
Nurse practitioners and physician assistants practicing full-time and
either newly certified or newly relocated to a rural, frontier, or urban
HPSA would be eligible for a similar credit equal to $500 per month up
to the a total of $18,000;
3.
In order to retain the full value of the credit, the physician, nurse
practitioner or physician's assistant must practice continuously in the
area for five years.
4.
Loan repayments made on behalf on an individual as part of the
National Health Service Corps Loan Repayment Program are excluded
from taxable income of the individual;
5.
The cost of annually purchased medical equipment, owned directly or
indirectly, and used by a physician in a rural or frontier Health
Professional Shortage Area (HPSA) can be immediately expensed, up to
$32,500;
6.
Interest, up to $5,000 annually, paid on professional medical education
loans of a physician, registered nurse, nurse practitioner, or physician's
assistant will be allowed as an itemized deduction if the individual
agrees to practice in a rural, frontier or urban Health Professional
Shortage Area (HPSA).
Long Term Care Tax Provisions
1.
2.
Employer provided qualified long-term care coverage which meets
certain consumer protection standards promulgated by the National
Association of Insurance Commissioners, is excluded from an
employee's taxable income. Premiums paid by an individual for
qualified long-term care coverage are deductible as a medical expense
(i.e. subject to the 7.5% floor);
3.
F.
Expenditures for qualified long-term care services are deductible as
medical expenses (i.e. subject to the 7.5% floor). Such services include
diagnostic, preventive, therapeutic, rehabilitative, maintenance and
personal care. Provision of such services must be contingent upon
certification of impairment in three or more activities of daily living by
a licensed health care practitioner;
NAIC is directed to promulgate standards for the use of uniform
language and definitions in qualified long-term care coverage
insurance policies, with permissible variations to take into account
differences in state licensing requirements for long-term care
providers.
Accelerated Death Benefits
48
�Clarifies the income tax treatment of accelerated death benefits paid to
terminally ill persons. Payments made under a qualified terminal illness
rider can be received tax-free as if they were paid after the insured's death.
G.
Tobacco Tax
The proposal increases the tax on tobacco by approximately $16.67 per pound
of tobacco for cigarettes. At proportional increase is applied to all other
tobacco products. In addition it extends the tax to tobacco to be used in "rollyour-own" cigarettes. The new tax rates would be:
1.
Cigarettes:
small cigarettes
$62 per thousand (i.e., $1.24 per pack of
20 cigarettes)
large cigarettes
2.
$130.20 per thousand
Cigars:
small cigars
$5.82 per thousand
large cigars
65.875 percent of manufacturers price
(not more than $155 per thousand)
3.
Cigarette papers and tubes:
cigarette papers
cigarette tubes
4.
3.88 cents per 50 papers
7.75 cents per 50 tubes
Snuff, chewing tobacco, pipe tobacco, "roll-your-own" tobacco:
snuff
chewing tobacco
6.
62 cents per pound
pipe tobacco
5.
$1.86 per pound
$3.49 per pound
"roll-your-own" tobacco
$3.49 per pound
The proposal would repeal the present-law exemptions for tobacco
products provided to employees of the manufacturer and for use by the
United States.
The proposal also includes several administrative and compliance
provisions designed to improve the collection of the excise tax.
49
�XIV.
National Health Commission
An independent National Health Commission is established to oversee the
health market much like the Securities and Exchange Commission oversees
the financial markets.
A.
Operation
1.
2.
The Commission members will have gained national
recognition for their expertise in health markets.
3.
The Commission shall appoint an Executive Director and such
additional officers and employees it deems necessary to carry out
its responsibilities under this act.
4.
B.
The Commission shall be composed of 7 members appointed by
the President with the advice and consent of the Senate. The
Commission members will serve 6 year overlapping terms. No
more than four members of the Commission may be from the
same political party. The members shall be compensated at level
IV of the Executive Schedule. One member of the Commission
shall be designated as the Chairman by the President.
The Commission will be advised by expert private sector boards
which focus on health benefits and health plan standards.
Responsibilities
1.
Clarify the standard and basic benefits packages.
2.
Develop and clarify the quality standards set in this act for
Qualified Health Plans and provide for this information to be
distributed to consumers in a standardized format. This
information will include reporting prices, evaluating health
outcomes and measuring consumer satisfaction.
3.
Report to Congress on a biannual basis (described in Section
I.,A.).
d.
Develop risk adjustment factors for Accountable Health Plans.
e.
Monitor the Fail-Safe Mechanism to prevent deficit
(described in Section X1.,B,4.).
f.
Recommend methods to achieve universal coverage if trigger
mechanism is engaged in the year 2002 (described in Section
I.,B.).
50
spending
�6/27/54
3 a.m.
MAINSTREAM CtALITIGN PR»P«SE» AGREEMENT
I
COVERAGE F#R ALL AMERICANS
This section guarantees access to Qualified Health Plans for all U.S. citizens and
lawful residents not covered under other public programs such as Medicare,
Medicaid, CHAMPUS and DVA. This seciion details the establishment of Health
Care Coverage Areas (HCCAs), institutes insurance market reforms, establishes
standardized benefits packages, creates -.^countable Health Plans, establishes
eligibility for low-income assistance vouchers and expands tax deductibility of
health insurance premiums.
A.
Assurance of Universal Coverage
1.
A National Health Commission (as described in Section XIV.) must
report to Congress biennually on the status of health insurance
coverage in the nation. The report must include, but is not limited to,
the structure and performance measures of every market area,
including the following:
a.
Demographics of the uninsured, and findings on why those
individuals are uninsured;
b."
Structure of delivery system;
c.
Number, organizational form of health'plans;
d.
Level of enrollment in health plans;
e.
State implementation of responsibilities, including
establishment of coverage areas;
'f.
Status of insurance reforms;
g-
Development of purchasing groups and other buyer reforms;
h.
Success of market and other mechanisms of controlling health
expenditures and premium costs in the market area and
nationally;
i.
Status of transition of Medicaid toward managed care and
integration into AHPs;
�j.
k.
Status of Medicare: beneficifri^, transition into Medicare
managed care and QHPs;
I.
Coverage progress among those who are employed, including
status and level of voluntary employer contributions and
participation rates in pools and among large employers;
m.
Percentage of individuals who are enrolled in Qualified Health
Plans, separated into categories of Medicare, Medicaid, employed
individuals and individuals eligible for low-income subsidies;
n.
Informal recommendations, specific to each market area, on
how the area might increase coverage among the residents and
further moderate growth in premiums; and,
o.
B.
Adequacy of subsidies for low income individuals;
Evaluation of adequacy of benefit packages.
Coverage Trigger
1.
Establishes a nationalgoal that 95% of all Americans will be enrolled in
^(Qualified^H^
by 2002.
-
this goal is not met, the Commission must submit formal and
specific recommendations to Congressmen how market areas that have
failed to reach 95% coverage can achieve that status. Those formal
recommendations must address all relevant parties, including states,
employers, employees, unemployed and low income individuals,
public program beneficiaries, etc.
3.
In addition to any other recommendations it submits, the Commission
must make separate recommendations on the following:
^
.. "
f)'^ ^
•i t' •
2
a-
A schedule of assessments or contributions to encourage
employers who are not doing so to purchase coverage for their
employees;
b.
A method of encouraging full coverage which does not require
any assessments on or contributions from employers;
c.
Possible adjustments to the benefits package;
d.
Possible adjustments to subsidies; and,
e.
Possible adjustments to tax treatment of benefits.
�4.
Congressional Consideration of the National Health Care Commission
Report. This proposed process is being reviewed by the Senate and
House Parliamentarians.
A.
Rules for the Senate
1.
The Majority Leader must introduce the Report as a bill
on the first day of session following the submission of the
Report and'legislative language.
2.
The bill will be referred to the appropriate Senate
Committee.
3.
If the Committee fails tb report the legislation within 180
calendar days of January 1, 2002, it shall be automatically
discharged from further consideration of the bill and the
bill shall be placed on the appropriate Senate calendar.
4.
Within 5 session days after the bill is placed on the
calendar, the Majority Leader, at a time to be determined
by the Majority Leader in consultation with the Minority
Leader, shall proceed to the consideration of the bill.
If on the sixth day of session, the Senate has not proceeded
to consideration of the bill, then the presiding officer must
automatically put the bill before the Senate for
consideration.
5.
30 Hours of consideration
a.
b.
B.
One hour for each relevant second degree
amendment.
c.
6.
Two hours for first degree germane amendments
30 minutes on each debatable motion, appeal, or
point of order submitted by the presiding officer to
the Senate and no motion to recommit shall be in.
order.
10 Hours time limit on the conference report.
Rules for the House of Representatives
�1.
2.
The bill will be referred to the appropriate House
Committee or Committees.
3.
If the Committee or Committees' fails to report the
legislation within 180 calendar days of January 1, 2002,
they shall be automatically discharged from further
consideration of the bill.
4.
On the sixth day on which the House is in session after
the date on which the bill has been reported or on which
the Committee or Committees have been discharged from
its further consideration, whichever date comes first, it
shall be in order for any member to move that the House
resolve itself into the Committee of the Whole House on
the State of the Union for the consideration of the bill,
and the first reading of the bill shall be dispensed with.
5.
After general debate, which shall be confined to the bill
and which shall not exceed four hours, to be equally
divided and controlled by the Chairman and Ranking
Minority Member of the Committee or Committees to
which the bill had been referred, the bill shall be
considered for amendment under the five-minute rule
and each section shall be considered as having been read.
The total time for'considering all amendments shall be
limited to 26 hours of which the total time for debating
each amendment under the five minute rule shall not
exceed one hour.
6.
C
The Majority Leader must introduce the Report as a bill
on the first day of session following the submission of the
Report and legislative language.
At the conclusion of the consideration of the bill for
amendment, the Committee shall rise and report the bill
to the House with such amendments as may have been
adopted, and the previous question shall be considered as
ordered on the bill and the amendments thereto to final
passage without intervening motion except one motion to
recommit.
Health Care Coverage Area
The major vehicle for reorganizing the health care marketplace would be the
establishment of geographic areas called Health Care Coverage Areas (HCCAs).
Employees of employers with fewer than 100 employees and individuals residing or
�working in the HCCA would be pooled together and would be eligible for insurance
at an age-adjusted community rate. HCCAs are established by each state and a
minimum number of 250,000 lives must be included in the HCCA rating pool.
States may enter into cooperative agreements to establish interstate HCCAs.
•
D.
Within each HCCA, consumers will have several different options available to
purchase health insurance. Employers and individuals may purchase coverage
directly from an insurer or agent, they may enroll at designated state enrollment
sites or they may chose lo join a purchasing cooperative. Accountable Health Plans
may charge different administrative (or enrollment) fees depending upon how the
plan is purchased.
Insurance Market Reform
The Secretary of HHS shall, within six months of enactment, and in consultation
with private expert entities such as the National Association of Insurance
Commissioners (NAIC), develop federal standards with which Qualified Health
Plans must comply in order to be deductible by an employer or an individual.
While these federal standards will be established by the Secretary of Health and
Human Services, the enforcement will be by the state or the Department of Labor
depending on the nature of the Qualified Health Plan. All Qualified Health Plans
must:
1.
Guarantee issue to all qualified applicants.
2.
Guarantee availability throughout the'entire area in which it is offered.
3.
Guarantee renewal to all qualified enrollees, except in instances of nonpayment of premiums or fraud or misrepresentation.
4.
Not deny, limit, or condition coverage based on health status, claims
experience, or medical history during the annual open enrollment period.
The bill includes a first-time enrollment amnesty extended for a certain
period after the date of enactment. Individuals are encouraged to maintain
continuous coverage. Continuous coverage means that the period between
the date of enrollment in a health plan and the last date of coverage may be
no longer than three months. If an individual has not maintained
continuous coverage or is enrolling in a plan for the first time aiter the initial
open enrollment period, coverage may be subject to a pre-existing condition
limitation of no more than six months. Pregnancy and pre-natal care are
exempted from this limitation.
5.
Comply with all rating requirements, including age and family size
adjustments, within the coverage area. ( Spedal rules will be established to
apply to Employer Sponsored Heatlh Plans and Qualified Association Plan?).
�6.
Comply with enrollment process.
7.
Comply with financial solvency requirements, premium and collection
criteria. (Special solvency rules are established for certain types of plans for
large employers).
Benefits Package
1.
Within six months of enactment, the Commission (described inSection XTV.)
sha:ll develop and submit to the Congress clarification of the initial standard
and basic benefits packages. These packages must adhere to the following:
a.
The actuarial value of the Standard Benefit Package can not exceed the
- actuarial value of the Blue Cross/Blue Shield Standard Option under
the Federal Employees Health Benefits program.
b.
The Basic Benefit Package-must contain higher cost sharing and/or
fewer categories of benefits.
c.
Both benefit packages must include a full range of medically
appropriate treatments and preventive services.
Categories:
The following categories of benefits are to be included in the benefits package:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
1.
3.
a.
Inpatient and outpatient care.
Emergency, including appropriate transport services.
Clinical preventive services, including services for high risk
populations, immunizations, tests or clinician visits.
Mental Illness and Substance Abuse.
Family planning and services for pregnant women.
Prescription drugs and biologicals.
Hospice Care.
Home health care.
Outpatient laboratory, radiology and diagnostic,
Outpatient rehabilitation services.
Vision care, hearing aids and dental care for individuals under 22 years
of age.
Patient care costs associated with investigational treatments that.are
part of approved clinical trial.
Priorities:
Within the constraints of the actuarial limits set in this act. Congress directs
�the Commission to adhere to the following priorities:
1.
2.
Consideration for needs of children and vulnerable populations,
including rural and underserved persons.
3.
4.
Parity for mental health and substance abuse services, which
shall consist of a broad array of mental health and rehabilitation
services managed to ensure access to medically necessary, and
psychologically necessary treatment and to encourage the use of
outpatient treatments to the greatest extent feasible.
Improving the-Kcalth of Americans through prevention.
Medically Necessary or Appropriate
A Qualified Health Plan shall provide for coverage of the categories of
benefits desaibed in this section for treatment and diagnostic procedures that
are medically necessary or appropriate.
An item or service is "medically necessary or appropriate" if consistent with
prevailing medicine standards:
a.
b.
It is safe and effective (i.e., there is sufficient evidence to demonstrate
that the item can reasonably be expected to produce the intended health
outcome or provide the intended information).
c.
5.
It is for treatment of a medical condition.
It is medically appropriate for a specific patient (i.e., it can reasonably be
expected to provide a clinically meaningful benefit if furnished in a
setting commensurate with the patient's needs).
Cost-Sharing
The Commission shall also develop multiple cost sharing schedules which
vary by delivery system organization. In making these determinations, lhe
Conunission will consult with expert groups for appropriate schedules for
covered services. This clarification is subject to approval by Congress under
expedited procedures.
r-—.
,o'
? 6.
Cost Containment
If in any year the Commission is notified by the Director of the Office of
Management and Budget that the Health Care Reform Spending Estimate
(HCRSE) will exceed the Current Health Spending Baseline (CHSB) has been
or will be exceeded in any year, they must submit a report to Congress
�recommending methods to avoid the fail-safe mechanism automatic actions
(described in Section Xn.,B.,3.). This recommendation must be submitted to
Congress within 60 days after receiving such notification.
7.
Additional Commission duties related to defining the basic and standard
benefits packages:
a.
b.
Design the basic and standard benefits packages to prevent adverse risk
selection when combined with the risk adjustments called for in the
bill.
c
8.
Develop interim coverage decisions in limited circumstances.
May not specify provider types when clarifying covered benefits.
Consideration of Commission Recommendations
The Commission will have the authority to propose modifications to the
benefits package that would not go into effect unless approved by Congress
under base-dosing procedures. The Commission is responsible for any
, ^
updates to the benefits packages after the first year and these updates are also
subject to Congressional approval under expedited procedures. ^CUA
-^jLt^L
IL
Qualified Health Plans
A.
Accountable Health Plans ("AHPs")
1.
AHPs may include a variety of delivery systems such as indemnity
plans, preferred provider organizations, health maintenance
organizations, or other delivery systems. An AHP is a health plan that
is certified by the state as meeting insurance market reform standards,
health plan standards, quality, reporting standards, and other
standards.
2.
Standards
The National Health Care Commission (described in Section XIV.) will
establish standards for AHPs. In addition, AHPs:
a.
Must meet insurance reforms described in (I., C).
b.
May not engage in marketing or other practices intended to
discourage and/or limit the issuance to eligible individuals on
the basis of health condition, industry, geographic area or other
risk factors.
�c.
Must make a health plan available throughout the entire HCCA
area in which it is offered.
d.
Must demonstrate its ability to make available and accessible to
each potential enrollee in the area the full range of benefits
required under the standard and basic benefit packages, when
medically necessary, promptly and in a manner that assures
continuity.
e.
Must provide for the application of coverage standards (for
benefits) which are consistent with the coverage standards issued
by the Commission and disclosed to plan enrollees.
• f.
Must not accept enrollment of an individual who is currently
enrolled in another AHP.
g.
Must make available to nonparticipating providers the criteria
used in selecting those providers that are permitted to participate
in the plan.
h.
Must comply with federal information requirements.
i.
Must offer the standard and basic benefit packages, but may also
offer benefits in addition to these packages, if such additional
benefits are offered and priced separately from the standard and
basic benefit packages.
Must have in place a system of binding arbitration, as defined'by
the state, for coverage disputes.
B.
Employer-Sponsored (risk-bearing) Plans
1.
Definition: a group health plan that may be operated as a network plan
or an indemnity plan for which the employer retains all or a portion of
the insurance risk, commonly referred to as self-insured. .
2.
Standards:
a.
Employer sponsored plans must meet all the standards for AHPs
and insurance market reforms, except they are not required to
take all applicants, and the population served and area covered
is defined by such an employer's employee population.
b.
Financial solvency, reserve, and guarantee fund standards will
be established by the Secretary of the Department of Labor (DoL)
�consistent with the applicable rules under Part 4 of Title I of
ERISA.
c.
The Secretary of DoL may take corrective actions to terminate or
disqualify an employer-sponsored plan that does not meet the
above standards.
d.
The Secretary of DoL is appointed as trustee for insolvent
employer-sponsored health plans.
Qualified Association Flans ("QAPs")
1.
Definition: Association health plans that have been in existence for
three years prior to the date of enactment.
2.
Standards:
a.
Must meet all standards for AHPs with the following exceptions:
1.
2.
3.
Special solvency requirements will be established by DoL
for QAPs.
Must only take any member in their designated
association.
Requirements for Sponsoring Entity (Association)
a.
b.
Must have appropriate by-laws that specifically state the purpose,
as a trade association, industry association, professional
association, chamber of commerce, religious organization, or
public entity association.
c.
Must have been established and maintained for substantial
purposes other than to provide the health care required under
this section.
d.
Must be, and have been, in operation (together with its
immediate predecessor, if any) for a continuous period of not
less than 3 years.
e.
4.
Must be organized and maintained in good faith.
Must receive the active support of its membership.
Treatment of Multiple Employer Welfare Arrangements ("MEWAs")
10
�a.
In general, upon enactment, a MEWA will meet the standards to
become either a QAP or a certified purchasing group.
b.
Any MEWA that, as of June 1, 1994, has been in effect for not less
than 18 months and with respect to which there is pending
application with the domicile state for certification as a QAP,
shall be treated for purposes of this subtitle as a Qualified Health
Plan (if such plan otherwise meets the requirements of this Act);
c.
However, MEWAs will not be able to continue to operate if the
domicile state can demonstrate that —
1.
2.
the plan that is the subject of the application, on its face,
fails to meet the requirements for a complete application;
or
3.
5.
the sponsor has made fraudulent or material
misrepresentation(s) in the application;
a financial impairment exists with respect to the applicant
that is sufficient to demonstrate the applicant's inability to
continue its operations.
Treatment of Rural Electric Cooperatives ("RECs") and Rural
Telephone Cooperative Associations ("RTCs")
RECs and RTCs can continue to exist if they meet the same standards as
QAPs; or if they are certified by the state as a purchasing group.
D.
Multi-Employer (Taft-Hartley) Plans
Taft-Hartley plans must meet the same requirements as large employers.
E
Public Programs
Existing public programs like Medicare, Medicaid, Department of Defense
health programs. Department of Veterans Affairs health programs and Indian
Health Service programs are considered to be Qualified Health Plans for the
purposes of this section.
F.
Pre-emption of Certain State Laws regulating Insurance Plans
The following state laws relating to health plans are preempted for any QHP:
l.
State laws that restrict plans from:
11
�a.
b.
requiring enrollees to obtain referraJ for treatment by a specialist
or health institution;
d-
establishing different payment rates for participating providers;
e.
creating incentives to encourage the use of participating
providers;
State corporate practice of medicine laws;
3.
G.
requiring enrollees to obtain health services from participating
providers;
c.
2.
limiting the number and type of providers who participate in a
plan;
State mandated benefit laws.
A^vftnca Directives-^
Qy
X
-Right to Self-Determination
a.
Each Qualified Health Plan must notify enrollees of their rights
to self-determination in health care dedsion-making and of the
plan's policy regarding advance directives. Plans must
mdintain procedures to require that the existence and content of
an advance directive is recorded in the patient's chart (written or
electronic) and provide for a mechanism to notify all appropriate
health care providers of the information.
b.
Plans must provide for educational activities for patients and
providers and must have a functioning process to provide for
communication between the patient and the appropriate health
care provider regarding all aspects of the patient's care, including
obtaining informed consent, patient prognosis and treatment
decisions, and the formulation of advance directives.
Discussions of prognosis and treatment alternatives should
occur at the time of diagnosis, prior to treatment and whenever
there is a significant change of status which affects diagnosis,
prognosis and treatment.
c.
In order to receive Medicare or Medicaid reimbursement for
particular procedure codes to be determined by the Secretary of
HHS, claims forms (written or electronic) must include the
physician's certification indicating that the patient discussed
12
�with the physician the diagnosis, prognosis and treatment
options and that the patient's questions were answered.
d.
Decisions by Surrogates
In the event that a state does not have a law on surrogate
decision-maker for health care decisions, a federal health care
surrogate standard shall apply. This standard is:
1.
A surrogate may make a health-care decision for a patient
who is an adult or emancipated minor if the patient has
been determined by the primary physician to lack capacity
and no agent or guardian has been appointed or the agent
or guardian is not reasonably available.
2.
An adult or emancipated minor may designate any
individual to act as surrogate by personally informing the
supervising health-care provider or specifying it in a
health care power of attorney. In the absence of a
designation, or if the designee is not reasonably available,
any member of the following classes of the patients
family who is reasonably available, in descending order of
priority, may act as surrogate:
a.
the spouse,- unless legally separated;
b.
an adult child;
. c.
d.
a parent; or
an adult brother or sister.
3.
4.
III.
If none of these individuals are reasonably available, an adult
who has exhibited special care and concern for the patient, who
is familiar with the patient's personal values, and who is
reasonably available may act as surrogate.
A surrogate shall communicate his or her assumption of
authority as promptly as practicable to the specified members of
the patient's family who can be readily contacted.
Large and Small Employer Responsibilities; and Purchasing Groups
A.
Small Employer Purchasers
13
�1.
Definition: employers with 100 or fewer full-time employees.
2.
Responsibilities:
a.
b.
Must provide all employees (including part-time and seasonal)
with information regarding all AHPs offered in the HCCA in
which the employer is located.
c.
If an employee resides in another HCCA, the employer must
provide information regarding how to obtain information
regarding AHPs available in that HCCA.
d.
Small employers must make available to their employees a
choice of at least three Qualified Health Plans either by joining a
purchasing group or by purchasing through independent brokers
or insurance agents, one of which must include a point of
service option if available.
e.
Small employers who contribute toward coverage must pay for
any Qualified Health Plan selected by thc employee an amount
equal to the contribution they would make on the employee's
behalf to the health plan selected by the employer.
f.
B.
May not be the sponsor of a risk-bearing plan, but if a member of
an Association may join an existing QAP.
Payroll Deduction. If an employee requests, employer must
arrange for payroll deduction to pay the premium amount due,
less any employer contribution^ to the plan or purchasing group
of the employee's choice. However, if the employee selects a
plan other than those offered by the employer, the
administrative cost of making such a payroll deduction may be
charged to the employee.
Large Employer Purchasers
1.
Definition:
2.
Responsibilities:
a.
employers with more than 100 full-time employees.
All large employers must offer their employees a choice of at
least three AHPs, one of which must be a point-of-service
option, if available, and one of which must offer a basic benefits
package. A large employer may comply with this subsection by
offering AHPs provided by a single entity. Large employers may
also meet this obligation, i n part, by making available to their
14
�employees the choice of a Qualified Association Plan (see below).
b.
Large employers are ineligible to join the small employer and
individual purchasing groups or to purchase insurance at the
community rate either through a broker, independent agent,
purchasing cooperative, or public enrollment office.
c.
Employees of large employers are also ineligible to purchase
insurance at the community rate either through a broker,
independent agent, purchasing cooperative, or public
enrollment, office.
d.
All large employer purchasers are regulated by the DoL and
remain subject to ERISA.
e.
If an employer contributes to its employee's health coverage, it
must provide coverage as of the first day of the month in which
an employee becomes eligible. Once terminated, coverage
continues through the end of the month of termination.
f.
COBRA. An individual whose employment has been
terminated by a large employer must elect within 30 days of the
termination to either remain in the plan provided by the
employer for a period not to exceed 12 months, or until the
individual is reemployed, whichever is less.
g.
Selection of Plan by Majority of employees. Each employer shall
make selection of health plans on an annual basis. Employers,
who are not contributing'to coverage, shall comply with a
selection made by more than 50% of employees.
Individual and Small Employer Purchasing Croups
1.
Purchasing groups shall be chartered under state law.
2.
Membership in these purchasing groups will be voluntary and limited
to employers and employees of businesses with 100 or fewer
employees, and to all other non-Medicaid U.S. citizens or legal
residents'not employed by a large employer who live in the HCCA
area.
3.
Nothing shall be construed to require any individual or small
employer to purchase exclusively through a purchasing group.
4.
Nothing in the Act requires the establishment of a purchasing group
nor prohibits the establishment of a purchasing group in an area.
15
�5.
6.
Xothing shall be conEtrued to prevent a slate from establishing or
designadng more than one purchasing group in a HCCA.
7.
IJ,
Nothing in this Act shaW be construed from preventing A purchasing
group from being the purchasing group for more than one HCCA-
Purchasing groups are permitted to cnnlract selectively with Qualified
Health Finns. Purchasing groups nre permitted to negotiate a price
lower than the community rate, if so, that price becomes the plan's
new community ratt." Nothing in this act shall be construed to prevent
/) purchasing group from negotiating prices on administrative fees or
items outside the basic and 6tarda rd benefits packages which may be
unique to the purchasing group.
Allowing Access to Federal tmployee Health Benefit Prnjrram
Any plan uAder tlie Tedcral timployee Health Benefit plan offered to federal
employees in a HCCA must be available for purchase by individual and small
group purchasers In that area. Non-federal employee purchasers shall pay a
premium amount based on the local community rate for that plan, and shall
not be a part of lhe Fh'HB insurance pool. Plans offered nationally through
FEHB shall not be required'to be open to non-federal employee enrollment.
IV.
NandLscrimLnation provisions that apply to all employers:
Employers that contribute to the purchase of any employee's healrh cave covciafie
may no^ disr-rlminate ng^itict any t>mployec based on th£_CQvp.lovee's income The
concern is that employers may choose to only contribute to the purchase of health
care coverage for those employees that are ineligible for government subsidies, in
effect dumping the subsidy-eligible employees.
Moreover, the general rule is that employers that contribute to Ihe purchase of any
full-time employee's health care coverage must make an equal dollar contribution
to all full-time employees choosing to purchase health care coverage offered by such
employer. In addidon, employers that contribute to the purchase of any part-time
employee's health care coverage must make an equal dollar contribution to all parttiiiip employees choosing to purchase heahh care coverage offered by such
employer. In no event shall a large employer that otherwise contributes be required
to offer an equal dollar contribution to an employee or "cash out" an employt*" that
does not choose to purchase health CHIP coverage offered by such employer.
Special rules are provided for small employers below. Tor purposes of part-time
employer's, a dollar contribution will constitute an equal dollar contribution if thc
employer makes a dollar contribution proportionate to the number of hours worked
16
�by the part-time employee.
Tlie special rule for small employers is as followv;: To the extent a small employer
rontributes to an employee's health rare coverage, the employer cannot discriminate
against an employee that chooses lo purchase ht-ihh core coverage fiom other than
such small employer. However, in no event shall a small employer be required to
"cash out" an employee who dties not choose to purchase health care coverage. For
example, if a small employer makes a contribution on behalf of a full-time
employee that chooses a plan the employer offers, it must also m^ke a contribution
to a full-time employee that chooses a Qualified Health Plan not offered by the
employer. Small employers may "charge a reasonable fee to cover their
administrative costs associated with withholding and remilling employee health
insurant*; premiums of employees not opting for thc health care coverage offered by
the small employer.
To the extent an employer docs not comply v.-ith these nnndiscrimination rules, a
penalty will be assessed for the period of time the employer is in noncompliance.
Such penalty will be equal to $100 for each day, or part thereof, of such period. (See
StKlion 4980B of the Internal Revenue Code for analogous rules). A full-time employee is defined as an individual who i$ employed for an average of
30 or more hours per week. A part-lime employe? is defined as an individual who
is employed for an average of at least 10 hours per week, but less than 30 hours per
week. An individual does not qualify as a full-lime or part-time employee until thv
individual has been employeO for six months ( i . , seasonal emplovees are not
treated as part-time employees).
.
'
Single-employer and multi-employer bona fide collectively bargained plnno are
exempt from these nondiscrimination rules.
V.
Assistance to Individuals and Families for die General Purchase of Insurance
A.
Eligibility:
Indsviduak and/or families not mherwiso eligible for Medicare or Medicaid,
whose income is less than 240% of thc federal poverty level will be eligible for
a Voucher for the. purchase of a Qualified Health Plan.
B.
Amount of Voucher
1.
For individuals and families with incomes less than 100% of_govcrty
the voucher will Iw? equal to 100% of the average prerfuiTnTafthe
lowest 2/3 of Qualified Health Flans offered in the HCCA in which
they r^sidp or work.
1.'
�2.
For individuals and families with income above 100% of the federal
poverty level, the Voucher amount will be decreasyd on a sliding scale
basis to 240% of the federal poverty level.
Phase-In Schedule for Vouchers
Vouchers will be phased-ln at the beginning of each year under thc
following schedule: ~
Calendar Year
Percentage of Poverty
1997
D.
90%
1998
19992U
UG
2001
1 20%
150%
180%
240%
n
^Wff' '
\ ,
Administration of Vouchers
1.
The Secretary of HHS will establish a mechanism for
determining eligibility for vouchers, for distributing application
forms, and to the extent practicable, for allowing enrollment in a
Qualified Health "Plan at the time of application for subsidy.
2.
Ihe Secretary may provide tor adininistrction of Vouchers through an
appropriate State agency.
VI.
Assistance to Individuals and Families - Expanded Tax Deductibility
(Described in Section XIII.,B^
VII.
Expanding Access for Underserved Populations
A.
Community-Based Primary Care Grant Program
1.
Three grant programs would be established to promote cornmunity
health plans and practice networks.
d.
Tha HHS Secretary will establish a program to administer grants
to the states for the purpose of creeling or enham ing
community-based primary care entities that provide services to
low-income or medically underserved populations. This
provision is designed to complement the existing federal
Community and Migrant Health Center progranis by making
flexible funding available to local public henlth departments,
rural hospitals, and other public and prlvHt»» community care
entities.
18
�b.
c.
B.
Tlie Secretary of HHS may make grants to and enter into
contracts with consortia of public ond private health care
providers for the developmcni of qualified community health
plans and practice networks. The Secretary will give preference
to plans and networks with three or more categories of providers
such as EACH/RPCHs, MAFs and other rural hospitals, migrant
health centers, community health centers, homeless health
services providers, public housing providers, family planning
clinics, Indian health programs, maternal and child health
providers, federally quMific-d health cenlers and rural health
clinics, stAle and local health department program* and health
professionals and institutions providing services in one or more
Healrh Professional Shortage Areas (HPSAs) or io medically
undprserved populations.
Loans and loan guarantees for capital costs would be authorized
for the development of qualified community health plans or
practice networks.
F.nhanced Assistance for Federally Qualified Health Centers
1.
Expanded resources will be provided for the Federally Qualified Health
Comers,
2.
This provision is intended to complement the state-based community
primary care grant program d^rribed above. Both provisions are
aimed at addressing the shrinking availability of primary hcdlth care
services in th« country's rural and inner-city communities.
C
Tax Incentives for Practice in Rural, Frontier, and Urban Underserved Areas
(As described in Section XIII., D.)
D.
Development of Networks of Ca re in Rural and Frontier Arens
1.
lhe HHS Secretary Is authorized to waive certain Medicare and
Mediraid requirements for demonstralion projects to operate rural
health networks. Public and private entities may *pply for such
waivers. The Secretary may award grants to assist organizations in
rural networks planning.
2.
The Secretary will conduct a study nn the benefits of developing a
supplemental benefit package and maJdng available premiums that
will improvt; Access to haalth services in rural Hieas.
19
�£.
Grant Program for Low Interest loans for Tapilal Improvement in Rural and
Undrrscrved Areas
T.oan3 and loan guarantees for capital costs would be authorized for tlie
development of qualified community health plans or practice networks.
F.
Office of the Assistant Secielary for Rural Health
Under this provision, lhe position of Director of the Office of Rural Health
would be elevated to the position of the Assistant Secretary for Rural Health
'fhe mission of the office would be expanded to include advising on how
health care reform could impact rural areas.
C
Rural and Frontier Emergency Care
A rural emergeiu-y medical services program is established to improve
emergency medical services (EMS) operating in rural and frontier
communities. This program wilh
1.
2.
Provide federal gidnto to states fhr telecommunications demonstration
projects linking rural and urban health care facilities;
3.
Establish an Office of Emergency Medical Services to pn^ide technical
assistance to stale CMS progriims;
4.
H.
Offer a matching grant program for improving stale EMS services.
These grants will encourage better training for health professionals and
provide necessary technical assistance to public ^nd private entities
which provide emergency medhal aervicae;
Federal grant support will also be provided to the state* for the
development of air transport systems to enhance access lo emergency
medical services.
Medicare Dependent Hospitals
1.
Modify Payments to Medicare. Depemlent Hocpitak in thc following
manner:
a
base paymenis on a 36 month period beginning with die first day
of the cost reporting period that begins on nr after April 1, 1990:
h.
confunn target amounts to extension of additional pavments;
20
�C
d.
2.
clarify of updates; and.
would extend Medicare-dependent hospital classification
through 1998.
Would establish a demonstration project regarding payment to larger
Medicare dependent hospitals.
EACH/RPCH Program Improvements and Extension to all States
1.
Expands thc EACH/RPCh program to all states.
2.
Rural community hospitals meeting eligibility criteria may qualify as
• Rural Emergency Access Community Hospitals (REACHs).
3.
Current special reimbursement to small rural Medicare-dependent
hospitals enacted in Omnibus budget Reconciliation Act of 19S9 is
extended.
4.
Modify provisions that relate to hospital inpatient services in a Rural
Primary Care Hospital so that:
a.
a RPCH.cannot have more than 6 beds;
b.
c
the Secretary can terminate the RPCH designation if the average
length of stay for the previous year exceeded 72 hours. In
determining the average length of stay, cases which exceed 72
hours due to inclement weather or other emergency conditions
are not included in the calculations,
d.
5.
the RPCH cannot perform surgery or any service requiring
general anesthesia (unless the risk of transferring the patient
outweigh the benefits);
Ihe GAO must submit a report determining if the revised RPCH
criteria have resulted in RPCHs providing patient care beyond
their abilities or have limited RPCHs' abilities to provide needed
services.
Designates EACH hospitals so that:
a.
urban hospitals can be designated as EACHs and do not need to
meet the 35 mile criteria, but do have to meet all the remaining
criteria. Urban EACHs would still be subject to the Medicare
Protective Payment System; and.
21
�b.
hospitals located in adjoining states and otherwise eligible as
EACHs and RPCHs can participate in a state's rural health
network and these hospitals or facilities are permitted to receive
grants.
6.
7.
Extend the deadline for the development of prospective payment
system for inpatient RPCH services lo January 1, 1996.
8.
Clarify that physician staffing criteria only apply to doctors of medicine
and osteopathy.
9.
Adopt technical amendments relating to Part A deductible, coinsurance
and spell of illness-
10.
The Department of Justice and Federal Trade Commission would be
instructed to issue formal guidelines for EACH/RPCHs-
11.
The Secretary would be permitted to designate an unlimited number of
RPCHs in non-EACH states. Tlie RPCHs must establish relationships
with a full-service rural hospital thai meet the same aiteria as HACHs
with the exception of the criteria that the EACH have 75 beds.
12.
HHS would be required to conduct a pilot program that would allow
RPCHs to admit patients on a limited DRG basis instead of using the
72-hour average length of stay criteria.
13.
Codify the MAF requirements into Medicare, allowing Medicare to
reimburse on a cost basis those facilities which meet the MAF
requirements.
14.
J.
Permit RPCHs to maintain swing beds in a Skilled Nursing Facility
except that the number of swing beds may not exceed the total number
of swing beds established at the time the facility applied for its RPCH
designation. Beds in a distinct-part SJVF do not count towards the total
number of swing beds,
Develop a grant program for states that operate MAF?. The gram
program would be modeled after the EACH/Rl'CH program.
Extends the Rural Health Transition Grant Program
Extends the program through FY 1998 with authorized appropriations of S30
million annually, FV. 1993 - 1998. Reports from grantees would be required
every 12 months. As of October 1, 1994, KPCHs are eligible for rural health
transition grants.
22
�K.
Increases reimbursement to PAs and NPs under Medicare
1.
2.
Under Medicare, certified Nurse Practitioners would be reimbursed at
65% of the RBRVS rate for assisting at surgery in urban areas.
3.
L
Certified Nurse Practitioners and Physicians Assistants would be
reimbursed at Sb% of the RBKVS ratp for services performed in all
outpatient settings.
States would be required to directly reimburse all certified Nurse
Practitioners In a rural area under Medicaid. This expands the current
requirement that all states directly reimburse pediatric <md family
Nurse Practitionrrs, which gives states the option of directly
. reimbursing other types of NP.v
Telemedicine and Related Telecommunications Technology
1.
2.
M.
Coordinates various federal grant programs which fund telemedicine
and related telecommunications demonstrations and grant programs.
This provision establishes a federal interagency task force, coordinated
and chaired by the Department of Health,and Human Services, would
be established to oversee telemedicine and other telecommunications
demonstration projects already underway.
A grant program would be established to fund telemedicine and related
telecommunications technology in rural areas. The program would be
administered through thc A££isfant Secretary for Rural Health.
Applicants for the grant would be rural health care provkleis such
rural referral centers, rural health clinics, community health centers,
migrant health centers, area health and ediu ation centers, local health
departments and public hospitals.
National TTealth Service Corps
1.
2.
N.
Fully funds the National Health Service Corps program and require
that at least 20% of thoeo in Ihe Scholarship and Loan Repayment
Program be nurses and physicians assistants
Reauthorize the Commimity Scholarilup Program Tn addition, the
criteria fur selecting students should be modified and a 15%
administration fee for those agencies administering the scholarships
should be established.
Indian Health Reform Auiendmcnls
L
Indian Health Service remains as a provider of health care for the
23
�Indian population.
2.
3.
Requires the Assistant Secretary for Indian Health to establish * new
formula for the distribution to tribes of all new funds that become
available fur health care initiatives and programs under health reform.
This formula would consider differences in local resources, status of
health, socioeconomic status of Tribal people, and
facilides/equipment/staff that are available.
4.
Q
Reaffirms current federal policy of guaranteeing that Indian Tribes
should be eiiglbln to apply for all appropriated funds and grants created
under health reform legislation, at levels not less than'any other
qualified enritiejs. This provision is simply a reaffirmation of current
Federal policy.
Retains Indian eligibility under current law for additional benefits.
Under this provision, whatever comprehensive benefits one accrues
through health reform legislation, Indians would not lose any current
benefits. Such benefits include all supplemental benefits, auch as
environmental health, mental health benefits, and alcohol abuse
treatment.
Study on Access in Underserved Areas
The Office of Technology Assessment (OTA) will conduct * study on
improving access in underserved areas.
VTII. New Home and Community Based Long Term Care Program
A.
General
Establishes a new capped program in the Social Security Act to provide
home-and community-based services for older Americans and
individuals with disabilities. The program is f<dmini£tered by thc
States with federal matching payments for services provided. Total
funding is capped, and there is no individual entitlement to services
under this program.
B.
tligibllity
The Secretary will issue rpgulation establishing uniform eligibility
criteria and assessment protocols. In order to receive benefits under
the program, an individual must be determined eligible, must undergo
a Gtandardued assessment and havt a individudl7.ed plan of care
developed. To be eligible, an individual must be in one of the
following categories. The first Uiree categories apply to individuals of
24
�all ages; the final category applies only lo children under age six.
I
Requires hands-on or stand-by personal assistance supervision
or cutrs in three or more of five activities of daily living: eating
dressing bathing, toileting, and iransferring in and out of bed.
2.
Presents evidence nf severe cognitive or mental impairment.
3.
Has severe or profound mental retardation.
4.
Is under age six and would otherwise require hospital or
institutional care for a severe disability or chronic medical
condition.
Coveted Services
1-
2.
D.
At a minimum, a state's array of services muit include personal
assistance (both agency administered and consumer directed) for
every eligible category of parridpant. Services may include, but
are not limited to-, case management, homemaker and chore
assistance, home modifications, respite services, assistive
technology, adult day services, habilitation and rehabilitation,
supported employment, and home health services.
Services may be delivered in a homo, a range of community
residential arrangements, or outside th* home. Services may
not be provided in licenced nursing homes or intermediate care
facilities for lhe mentally retarded.
Cost Sharing
Eligible individuals with incomes over 150% of the federal poverty
lev^l pay co-insurance to cover a portion of the cost of all services they
receive according to a sliding scale. Persons with incomes between
ir>0% and 2007 of the federal jwertv level pay 10% of the C S of care;
Ot
between 200% and 250% of poverty 20% ro-insurance, and persons with
income ovor ?sn% of poverty pay a 25% r.o-insurance.
n
E.
State Administration
Each stare must have an approved plan, which specifics: administering
agency nr agencies; services to be covered, and how the needs of all
types of eligible individuals will.be met; provide a plan for making
eligibility doterminationc: provide information on how the state will
develop care plans, coordinate services, reimbuise providers and plans.
25
�administer vouchers or cash payments, license or certify providers. In
addition, the state must develop a system of determining allocation of
resources and how the new program with be integrated with existing
long-term care programs, and must assure that low'-income persons in
the program is at least equal lo the proportion of low-income persons
In the state's population.
F.
Quality Assurance
Slates are responsible for developing comprehensive quality assurance
programs that monitor health and safety of participants as well as
assure that services are of the highesl quality- States must develop, for
federal approval, quality assurance systems thai include consumer
satisfaction survcyG. In addition, consumer advisory groups arc
expected to play a strong role In assuring ami enhancing quality.
Cl
.Federal Matching Paymenis to States
A federal matching payment will bo made to states based on the current
Medicaid match rate plus 28 percentage jxunts. Federal matching
percentages can be no less than 78 percent and no more than 95 percent.
No federal matching payments will be made once the cap is reached.
H.
Prmding, Allotments to States
For federal Fiscal years 1996-2002 - No federal funds allocated.
IX
COST CONTAINMENT &. CONSUMER PROTECTION
A.
High Cost Plan Assessment
(described in Section XHI., A.)
B.
Medical Liability Reform
1.
Alternative Dispute Resolution
a.
No health care malpractice acdon may be brought In court until final
resolution of the claim under an alternative dispute resolution (ADR)
method adopted by the stare from models, developed by thc Secretary of
HHS, or developed by the state and approved by the Secretary of IIIIS.
b.
If the party initiating court action following the ADR receives a worse
result with respect to liability or a level of damages 33 1/3% below that
awardpd in thc ADR, that party must pay th*? costs and attorneys fees of
the other party incurred subsequent to the A DR.
26
�2.
Damages
Nnn-economic damages awarded to a plaintiff in a health care malpractice
claim or action may nor exceed $250,000, indexed lor inflation.
3.
Several Liability
Thc Habllity of each defendant in a health care malpractice action for noneconomic and punitive damages will be based on each defendant's proportion
of responsibility for the claima_nt's harm.
4.
Punttiv'e Damages
Seventy five percent of punitive damage awards will be paid to the state in
which the action is brought and such funds will be used for provider
licensing, disciplinary activities and quality aecurance programs.
5.
Statute of Repose
A twenty year statute of repose will be applied to health care malpractice
actions.
6.
bee Reform
Lawyers may not charge contingency foes greater than 3.1 1/3% of tlie first
$150,000 of the award in a health care malpractice action and 25% of amounts
In excess of S1V),000. CalculMion of permissible contingency fees is based on
after tax amounts.
7.
Limited Preemption
State laws that have higher limits on attorneys fees and non-economic
damages are preempted. State laws that provide for longer statutes of repose
are preempted. Does not preempt those laws with lower limits on attorneys
fees and non-economic damages ar* preempted Docs nor preempt state laws
with shorter statutee of repose.
C
Administrative Simplification and Paperwork Reduction
Implements a national health information network to reduce the burden of
administrative complexity, paper work, and cost on the health care system; to
provide the information on cost and quality necessary for compedriun in
health care; and tu provide information tools that allow improved fraud
detection, omnmies research, and quality of care.
1.
T
National Health Information K ( iwork
27
�Requires the Secretary of HHS to implemeru a national health
information network by adopting standards for:
a.
b.
transmitting information electronically,
c.
conducting transactions using this information,
d.
certifying public or private entities to perform the intermediary
functions vvhich implement the network,
e.
monitortng performance to assure compliance,
f.
establishing procedures for adding codes to previously adopted
standards,
g.
making changes to previously adopted standards, and
h.
2.
representing the content and format of health infuunation in
both paper and electronic forms,
developing, testing, and adopting new standards.
Health Information Advisory CommiEcion
In carrying out duties imdcr this pari, the Secretary would consult with an
Advisory Commission consisting of 15 members from the private eoctnr with
expertise and pracdcil experience in developing and applying health
information and networking standards. The members vamld be appointed by
the Prtssident and serve staggered S year terms, and would include providers
and consumers.
3.
Requirements for Qualified Health Plans and Health Care Providers
All Qualified Health Plane, Including Federal and State plans, and all health
care providers would be required to comply with federal standards for
foi matting information and electronic transactions.
Tlie Secretary may require transactions to be consistent with the goal of
reducing administrative costs. In addition, certain standard data must be
made available electronically on the health information network to
authorized inquiries. Other requirements for electronic Information, such as
quality related information, may be specified in other partr, of the law ind
wotild be put through the same standards selling procedure before becoming
required.
28
�4.
Accessing Health Information
a.
Tlie Secretary would establish technical standards fur requesting
standard health informabon from partidpenta in the health
information network which assure that a request for health
information is authorized under federal privacy provisions.
b-
The Secretary would e^iabli?h standards for the appropriate
release of health information to researchers and government
agencies, including public health agencies. The Secretary would
establish standards for the electronic identification of a request as
one w-luch comes from a person authorized to receive health
information under federa privacy provisions.
1.
Preempts state "Quill Pen" T^vvj, including provisions
that require health records lo be maintained In written,
rather than electronic, form.
2.
Establishes a Health Security Card for which the Secretary
would determine a standard format and which includes a
form of the social sccurily number to uniquely identify
each individual. Using this standard, health plans will,
issue cards to individual enrollees.
3.
Expects parlicipants to comply with stancWda and
submieslorn of required transactions widiin a reasonable
tunc unless specifically excluded or waiwd. lhe Secretary
would impose a penalty of not more than 51,000 for each
violation of health Information network standards and
requirements. Additional penalties are imposed for
violation of federal privacy provisions
4.
Prevents the loss of health information due to bankruptcy
of a health information network participant, provision
would be made, for the rescue and reassignment of
information he'd by persons who cease to function in a
manner that would threaten the continuous availability
of their information.
5.
Allows the Secretary may make grants for demonstrations
projects to promote the development and use of
electronically integrated, community-based clinical
informalion systems and computerised p«(ient record
systems.
29
�6.
5.
Repeals Medicare and Medicaid coverage data bank.
Section 13581 of Part V of OBRA 93, which requires the
establishment the Medicare and Medicaid Coverage Data
Bank by adding Section 1144 to Part A of tide XI (42 U.S.C.
1301 et seq.), would be repealed. Its function would be
replaced through the requirement on all health plans to
ensure the electronic availability on the health
information network of standardized enrollment and
eligibility information on every covered individual. In
addition/ certified health information network access
services Would be capable of performing automated
electronic coordination of benefits and responding to
queries from health care providers and health plans, in
standardized transactions as defined by the Secretary,
regarding the enrollment and coverage for any individual
under any health plan.
Effective Date
A timetable of effective dates would be included which would specify when
each requirement would take effect relative to the date of enactment. In
general, the Secretary would adopt existing standards within 9 months of
enactment and more time is given for standards which must be developed.
A t least 12 months grace period is allowed after any standard is adopted before
- use of that standard becomes required.
D.
QUALITY ASSURANCE
The goal of health reform is to ensure that Americans have access to health
care plans that compete on the basis of price and quality. Assessing quality
requires reliable and comparable information on the outcomes and
effectiveness of services provided by plans. Under this subtitle. Qualified
Health Plans are required to annually report data on the quality of their
services to the Secretary of HHS in a format prescribed under the National
Health Information Network. The Secretary may determine the manner in
which these data are provided to certifying authorities in states. This title also
provides direction to the Secretary to improve and expand the capability of
HHS to support and encourage research and evaluation of medical outcomes.
Standards and Measurements of Quality
The Secretary, in consultation with relevant private en Li des, will develop
quality standards with which all Qualified Health Plans must comply. These
standards are designed to improve the data available upon which to assess
quality and the processes by which quality care is continuously improved.
30
�The Secrelary will study the capabilities of endties within its jurisdiction to
accomplish these goals. The authority uf IIHS will b«? expanded to include:
1.
setting pnorides for strengthening the medical research base;
2.
supporting research and evaluation on medical effectiveness through
technology assessment, consensus development, outcomes research
and the use of practice guidelines;
3.
conducting effectiveness trinls in collaboraiion with medical specialty
societies, medical educators and qualified health plans;
4.
maimainhig a clearinghouse and other registries on clinical trials and
. outcomes research data;
5.
6.
E.
assuring the systematic evaluation of existing and npw treatments, and
diaguoslic technologies in an effort to upgrade the Vnnwledge base for
clinical decision rnkking and policy choice;
designing an interac tive, computerized dissemination system of
information on outcomes research, practice guidelines, and other
information for providers.
ANTI-FRAUD AND ABUSE CONTROL PROGRAM
This subtitle establishes a stronger, letter coordinated federal effort to combai
fraud and abuse in our health care system. It expands crifninal and d v i l
penalties for health care fraud to provide a stronger deterrent ro the billing of
fraudulent claims.and to eliminate waste in our health care system resulting
from such practices. It also seeks to deter fraudulent utilizarion of health care
sendees. It would:
1.
Require the HHS Secretary and Attorney General to jointly establish
and coordinate a national health care fraud program to combat fraud
and abuse in government and Qualified Health Flans,
2.
Finance the anti-fraud efforts by setting up an Anri-Fraud and Abuse
Trust Fund. Monies from penalties, fines, and damages assessed for
health care fraud are dedicated to ihe Truct Fund io pay for the antifraud efforts;
3.
Increase and extend Medicare and Medicaid civil money and criminal
penalties for fraud to nil health care programs;
4.
Bar providers convicted of health care fraud felonies from participating
in the Medicare program;
31
.
�5.
Require HHS to publish the names of providers and suppliers who
have had final adverse actions taken against them for health care
fraud; and,
6.
Establish a new health care fraud statute patterned after existing mail
and wire fraud statutes under Title XXM of the Criminal Code and
allows for criminal forfeiture of proceeds.
X REFORM OF EXISTING PUBLIC PRO'CRAMS
A.
Medicaid
1.
Integration of Medicaid beneficiaries into Qualified Health Plans
a.
The Secretary shall make recommendations on the integration
of AFDC and non-cash recipients into the community-rated pool
and into. Qualified Health Plans. The Secretary's
recommendations shall address:
1.
2.
the administration of subsidies,
3.
2.
the impact on private health insurance premiums,
the adequacy of services for Medicaid recipients and the
need for and structure of wrap around services.
New State Option for Medicaid Coverage in QualiHed Health Plans
States may give their AFDC and non-cash eligible beneficiaries
(excluding medically needy) the option to receive medical assistance
through enrollment in a Qualified Health Plan offered in a local HCCA
instead of through the Medicaid plan.
a.
b.
3.
The state may not restrict an individual's choice of plan and is
not required to pay more than the applicable dollar limit for the
HCCA area.
The number of individuals electing to enroll in a Qualified
Health Plan is limited to a fifteen percent of the eligible
population in each of the first three years, and ten percent in
each year thereafter.
Limitation on Certain Federal Medicaid Payments
32
�Federal financial participation for acute medical services, including
expenditures for payments to Qualified Health Plans, is subject to an
annual federal payment cap.
a.
b.
The per-capita limit for fiscal year 1996 is equal to 118% of the
base per capita funding amount (determined by dividing the
total expenditures made for medical assistance furnished in 1994
by the average total number of Medicaid categorical individuals
for that year).
c.
After 1996, the per-capita limit is equal to the per-capita funding
amount determined for the previous fiscal year increased by 6
percent for fiscal years 1997 through 2000, and 5 percent for fiscal
year 2001 and beyond.
d.
Expenditures for which no federal financial participation was
provided and disproportionate share payments are excluded
from this calculation.
e.
4.
The cap is determined by multiplying a per capita limit (defined
below) by the average number of Medicaid categorical
individuals entitled to receive medical assistance in the state
plan.
States are required to continue to make eligible for medical
assistance any class category of individuals that were eligible for
assistance in fiscal year 1994.
State Flexibility to Contract for Coordinated Care Services
a.
States have the option, to establish a program under Medicaid
program to allow states to enter into contracts with at-risk
primary care case management (PCCM) providers.
b.
An at-risk PCCM provider must be a physician, group of
physicians, a federally qualified health center, a rural health
clinic or other entity having other arrangements with physicians
operating under contract with a state to provide services under a
"
primary care case management program.
c
Qualified risk contracting entities must:
1.
2.
meet federal organizational requirements;
guarantee enrolled access; and.
33
�3.
have a written contract with the state agency that includes:
a.
an experienced-based payment methodology;
b.
premiums that do not discriminate among eligible
individuals based on health status;
c
requirements for health care services; and,
d.
• detailed specification of the responsibilities of the
contracting entity and the state for providing for, or
arranging for, health care services.
d.
Meet federal standards for internal quality assurance.
e.
Enter into, written provider participation agreements with
essential community providers;
1.
2.
States are required to contract directly with essential
community providers, or at the election of the ECP, each
risk contracting entity may enter into agreement to make
payments to the essential community provider for
services.
Essential community providers include:
a.
. Federally Qualified Health Centers,
b.
Public Housing Providers,
c
Family Planning Clinics,
d.
AIDS providers under the Ryan White Act,
e.
Maternal and Child Health Providers, and
f.
B.
Rural Health Clinics.
Medicare
1.
Medicare remains a separate program and continues to be federally
administered. Beneficiaries enrolled in Part B continue to pay a
monthly premium. The statutorily defined Medicare benefits continue
to be the Medicare benefit package in both fee-for-service and managed
34
�care.
2.
Beneficiary opt-in to private qualified health'plans.
a.
b.
For individuals choosing an AHP, Medicare will pay the federal
contribution calculated for Medicare risk contracts. Individuals
are responsible for paying the difference between the premium
charged and the federal contribution.
c.
3.
Medicare beneficiaries may opt into a qualified health plan in
their HCCA.
During the annual enrollment period, Medicare-eligibles may
choose a new plan through their employer/purchasing
cooperative or they may return to the traditional Medicare
program.
Medicare Select
a.
b.
Medicare Select policies will be offered during Medicare's
coordinated open enrollment period.
c.
4.
The Medicare Select program would become a permanent option
in all States.
Plans may not discriminate based on health status.
Medicare Risk Contract Program
a.
Medicare health plans must meet Qualified Health Plan
standards and cover all Medicare benefits under a risk contract
for a uniform monthly premium for a year.
b.
Employers.may sponsor Medicare health plans for former or
current employees.
c.
Cost contracts, SHMOs, etc. would continue as under current
law. Waivers of thc 50/50 requirement may be granted if the
Secretary determines that health plans have alternative quality
assurance mechanisms in place that effectively provide
sufficient quality safeguards.
e.
Medicare health plans will offer a standard benefit package
comprised of the current Medicare benefits defined in statute or
35
�an alternative package, defined by the Secretary, covering
identical services but with cost-sharing consistent with typical
. managed care practice and not to exceed the actuarial value of
FFS.
f.
Standardize supplemental benefits that risk contractors may
offer in addition to Medicare benefits. In addition to the
standardized policies, health plans may offer other supplemental
policies. However, Medicare health plans must at least offer two
supplements to be defined by the Secretary: one which would
cover catastrophic costs (out-of-pocket limit) and other items
traditionally covered in employer-sponsored plans, and one
covering outpatient prescription drugs.
g.
The current standardized Medigap plans would be changed so
that Medigap may only pay up to one-half of the 20% part B
coinsurance. Beneficiaries currently holding Medigap plans
covering the entire 20% coinsurance would be exempt from this
change as long as they renew their current insurance.
h.
The Secretary will administer a coordinated annual open
enrollment period during which Medicare beneficiaries will
choose from all plans (including Medigap insurers) offering
products to Medicare beneficiaries. The Secretary may authorize
any variations of participation in the enrollment process.
i.
The Secretary of HHS will provide to all Medicare beneficiaries
in a market area uniform materials for enrolling in health plans.
j.
The federal contribution is calculated as the weighted average of
fee-for-service per capita cost in the market area and the
premiums submitted by Medicare health plans to the Secretary
to provide Medicare benefits. The Secretary is authorized to
adjust for heart disease, cancer, or stroke.
k.
Beneficiaries pay the difference between the federal contribution •
and the total premium charged by the health plan they select. If
the health plan's premium is less than the federal contribution,
the beneficiary is entitled to a rebate that the plan may provide
in cash or apply to supplementary coverage. The rebate would
be treated as non-taxable income.
i.
Benefidanes eligible for Medicare prior to 1999 are
grandfathered under these provisions and may
always enroll in Medicare FFS (regardless of local
costs) for the regular part B premium only.
36
�ii.
5.
However, if the federal contriburion is less than the
FFS per capita cost in the market area and the
beneficiary selects Medicare FFS, the beneficiary
pays an additional premium to the Federal
Government equal to the difference between the
federal contribution and FFSPCC.
Administrative Simplification
The Secretary has authority to consolidate the functions of fiscal
intermediaries and carriers. Provides for coordination of Medicare and
supplemental insurance claims processing. Permits standardized,
paperless process.
6.
- Study and Demonstration for Medicare Cost Containment
a.
b.
C
Requires ProPAC to study and make recommendations to
Congress regarding ways to slow the rate of Medicare growth at
the local market level. The study should include ways to set
local expenditure targets and monitor success in controlling
costs. Updates for payment rates under Parts A and B should be
set to achieve local targeted expenditure levels, while rewarding
efficient providers and/or markets.
A demonstration is authorized to evaluate Part A expenditures
for hospital service and/or Part B expenditures in fee for service
.using provider-group or State-level volume performance
standards.
GRADUATE MEDICAL EDUCATION
[Under Discussion]
XL
FINANCING
A.
Financing Totals (Estimated Over 5 years; $ in Billions)
Savings
Medicare Savings
Medicaid Savings
Postal Service Retirement
$77.7
$55.8
$13.0
SUBTOTAL SPENDING REDUCTIONS
37
SI46 5
�Revenues
High Cost Plan Premium Assessment
Tobacco Tax (SI .00 increase)
H I State/Local
$30.0*
$62.3
S 7.6
SUBTOTAL REVENUES
S99.9
TOTAL FINANCING
$246.4
B.
Descriptions of Medicare Savings
1.
2.
Adjust Inpatient Capital Payments. This proposal combines three
inpatient payment adjustments to reflect more accurate base year data
and cost projections. The first would reduce inpatient capital payments
to hospitals excluded from Medicare's prospective payment system by
' 15%. The second would reduce PPS Federal capital payments by 7.31%
and hospital-specific amount by 10.41% to reflect new data on the FY 89
capital cost per discharge and the increase in Medicare inpatient costs.
The third piece would reduce payments for hospital inpatient capital
with a 22.1% reduction to the updates of the capital rates.
Revise Disproportionate Share Hospital Adjustment. ThisAct
eliminates the current disproportionate share hospital adjustment
with a new voucher program to cover health care provided to those
with out health insurance.
Extend OBRA 93 Provision to Catch-up after the SNF Freeze Expires
Included in OBRA 93. OBRA 93 established a two-year freeze on
update to the cost limits for skilled nursing facilities. A catch-up is
allowed after the freeze expires on October 1, 1995. This Act eliminates
.the catdvup.
Change the Medicare Volume Performance Standard to Real Growth
GDP. This Act substitutes the five-year average growth in real GDP
per-capita for this volume and intensity factor and the performance
standard factor for physician's services.
Establish Cumulative Growth Targets for Physician Services. Under
this Act, the Medical Volume Performance Standard for each category
of physician services would be built on a designated base-year and
updated annually for changes in beneficiary enrollment and inflation, •
but not for actual outlay growth above and below the target.
6.
Reduce the Medicare Fee Schedule Conversion Factor by 3% in 1995,
Except Primary Care Services. The conversion factor is a dollar amount
that converts the fee schedule's relative value units into a payment
amount for each physician service. This Act reduces the factor by 3% to
account for excessively high targets.
38
�7.
Extend OBRA-93 Provisions on Part B Premium Collections. OBRA 93
established the Part B premium collections at 25% of program costs.
This Act extends the collection of these premiums.
8.
Extend OBRA 93 Catch-up After the Home Health Freeze Expires.
OBRA '93 eliminated the inflation adjustment to the home health
limits for two years. This Act eliminates the inflation catch-up
currently allowed after the freeze expires on July 1, 1996.
9.
Require a 10% Copayment on All Home Health Visits for Visits other
than Those Occurring 30 Days After a Hospital Discharge. This
provision charges a corpayment on all home health visits except those
received within 30 days of an inpatient hospital discharge. The copayment would .be equal to 10% of the average cost per visit.'
10.
' Extend OBRA 93 Medicare Secondary Payor Data Match with SSA and
IRS. OBRA 93 included an extension of the data match between HCFA,
ERS and SSA to identify the primary payers for Medicare enrollees with
health coverage in addition to Medicare.
11.
Increase Part B Deductible for Enrollees. Increase the amount that
enrollees must pay for services each year before the government shares
responsibility for physician services. The deductible would be
increased to $150 and indexed to the rate of growth.
Medicaid Savings
1.
2.
D.
Revise Disproportionate Share Hospital Adjustment. This proposal
eliminates the current disproportionate share hospital adjustment
with the new voucher program to cover health care provided to those
with out health insurance. Medicaid DSH payments are to be
eliminated in FY 1996 - 15%, FY 1997 - 25%, FY 1998 - 60% and 1999 100%
Capitate the Federal Payments Made for Medicaid Acute Care Medical
Services under Medicaid Program. The per-capita federal financial
participation growth rate for acute medical services under the Medicaid
program would be capped at 6% for fiscal years 1997 through 2000 and
at 5% for fiscal year 2001 and beyond.
Revenues
1.
Postal Service Retirement. Require the U.S.P.S. to fund the U.S.P.S.
Retirement System in the U.S.P.S. budget rather than the Federal
Budget. This would free funds from the Federal budget.
2.
Tobacco TAX. The proposal increases the tax on tobacco by
per
thousand pounds ($1 per pack of 20 cigamies). Described in Section
39
.
.
�xm., G.)
3.
4.
XII.
H I State and Local. State and local jurisdictions can opt to pay the H I
payroll tax for State and local workers hired before April 1, 1986. The
proposal would extend the payroll tax to all remaining exempt State
and local workers.
Income Related Part B Premiums. This proposal would charge highincome enrollees a premium up to 75% of program costs based on an
enrolle's modified adjusted gross income.
Fiscal Responsibility
A.
The b i l l establishes a Fail-Safe mechanism to ensure health care reform does
not increase the deficit
B.
Fail-Safe Mechanism
1.
A Current Health Spending Baseline (CHSB) is established. The CHSB
includes:
a.
Medicare Expenditures
b.
Medicaid Expenditures
c.
Health Related Tax Expenditures
1.
2.
Employer deduction for health insurance premiums.
3.
2.
The employee exclusion of employer-provided health
insurance premiums.
7.5% floor for deduction of medical expenses.
A Health Care Reform Spending Estimate (HCRSE) is established. The
HCRSE includes:
a.
Everything included in the CHSB.
b.
Deduction for purchase of Qualified Health Plans by all
individuals.
c.
Cigarette excise tax.
d.
Vouchers for purchase of a Qualified Health Plan.
e.
High-Cost Plan Assessment
40
�3.
In any year that the Director of OMB notifies Congress that HCRSE will
exceed the CHSB, the following automatic actions will occur to prevent
deficit spending:
a.
b.
The assessment on high cost insurance plans is increased,
c
The expanded tax deduction phase-in is slowed down.
d.
Out-of-pocket limits in the standard and basic benefit packages
are increased.
e.
4.
The voucher phase-in is delayed.
Starting in the year 2004, an employer may no longer deduct and
an employer may no longer exclude supplemental benefits
provided to employees and contributed to by employers.
Congress may act .on alternative recommendations made by the
National Health Commission to avoid the actions listed above.
XIIL Tax Provisions
A.
High Cost Plan Assessment
1.
Beginning in 1996, an annual assessment w i l l be imposed on High Cost
Plans. High Cost Plans are those health care packages whose premiums
(not including supplemental benefits, if any) exceed a certain dollar
amount.
a.
To determine whether a plan is a High Cost Plan, an insurer
divides its plans into two categories:
1.
those based on the basic package (Stripped Basics), and
2.
those based on the standard package (Stripped Standards).
b.
It then determines which, if any, of either the Stripped Basics or
Stripped Standards are priced such that they are in the top 40
percent of all such plans in the health care coverage area
(HCCA).
c.
Plans that fall within the lowest 25% of the geographically adjusted plan premiums nationally are exempt. For purposes of
determining whether a plan is exempt, the Stripped Basic and
Stripped Standard plans are considered separately.
The geographically adjusted premium is calculated by adjustingeach accountable health plan's premium for regional variations.
Such adjustments shall include, but not be limited to, variations
41
�in the cost of living and demographics2.
The assessment on a High Cost Plan is equal to 25% of the difference
between the premium charged for the Stripped Basic plus
supplementals, if any, and the Stripped Standard plus supplementals, if
any, and a reference premium.
a.
b.
3.
B.
For purposes of determining the assessment on the Stripped
Basic plus supplementals, if any, the reference premium is the
average of all Stripped Basics in the HCCA.
For purposes of determining the assessment on the Stripped
Standard plus supplementals, if any, the reference premium is
the average of all Stripped Standards in the area.
The High Cost Plan Assessment also applies to self-insured plans. The
•tax will apply to the difference between the self-insured High Cost
Plan's premium (including any supplementals) and the applicable
reference premium for the HCCA. In calculating this tax, the high cost
self-insured plan's premium will be the premium used for meeting the
COBRA requirement. The Department of Treasury will be given
authority to develop regulations implementing this provision.
Assistance to Individuals and Families - Expanded Tax Deductibility
1.
2.
C
Self-employed individuals purchasing health insurance may take an
above-the-line deduction for 100% of the cost of such insurance (i.e.,
not subject to the 7.5% floor), subject to a phase-in period. However,
the deduction is limited to the cost of either a basic or standard benefits
package. To the extent self-employed individuals purchase benefits
supplementing such packages, the cost of such supplemental benefits
will be deductible as medical expenses under current law (i.e., subject to
the 7.5% floor).
Individuals (other than self-employed) that purchase health insurance
will be allowed an above-the-line deduction (i.e., not subject to the
7.5% floor) for the cost of either a basic or standard benefit package. To
the extent an individual purchases benefits supplementing the
packages, the cost of such supplemental benefits will be deductible as
medical expenses under current law (i.e., subject to the 7.5% floor).
Employer-Provided Health Insurance
1.
Employees may continue to exclude from gross income all employer- •
provided health insurance.
2.
Employers may take a deduction for amounts contributed towards a
standard benefits package, as well as all benefits supplementing such
42 •
�package, if any.
3-
4.
D.
Employers may take a deduction for amounts contributed towards a
basic benefits package. However, no deduction is permitted for any
contributions made towards benefits supplementing the basic benefits
package.
Fail-Safe option includes possible employer and employee cap on
supplementals after 2004.
Tax Incentives for Practice in Rural, Frontier, and Urban Underserved Areas
1.
Physicians practicing full-time and either newly certified or newly
relocated to a rural, frontier, or urban Health Professional Shortage
Areas (HPSA) are allowed a tax credit equal to 51,000 a month. Tax
. credits will be prorated in direct relation to the time worked in the
HPSA, up to a total of 536,000;
2.
3.
Loan repayments made on behalf on an individual as part of the
National Health Service Corps Loan Repayment Program are excluded
from taxable income of the individual;
4.
The cost of annually purchased medical equipment, owned directly or
indirectly, and used by a physician in a rural or frontier Health
Professional Shortage Area (ITPSA) can be immediately expensed, up to532,500;
5.
E.
Nurse practitioners and physician assistants would be eligible for a
similar credit equal to S500 per month. Tax credits will be prorated in
direct relation to the time worked in a shortage area, up to a total of
SI 8,000;
Interest, up to 55,000 annually, paid on professional medical education
loans of a physician, registered nurse, nurse practitioner, or physician's
assistant will be allowed as an itemized deduction if the individual
agrees to practice in a rural, frontier or urban Health Professional
Shortage Area (HPSA).
Long Term Care Tax Provisions
1.
Expenditures for qualified long-term care services are deductible as
medical expenses. Such services include diagnostic, preventive,
therapeutic, rehabilitative, maintenance and personal care. Provision
of such services must be contingent upon certification of impairment
in three or more activities of daily living by a licensed health care
practitioner;
2.
Employer provided long-term care coverage which meets certain
43
�consumer protection standards promulgated by the National
Association of Insurance Commissioners, is excluded from an
employee's taxable income. Premiums paid by an individual for
qualified long-term care coverage are deductible as a medical expense;
3.
F.
NAIC is directed to promulgate standards for the use of uniform
language and definitions in long-term care coverage insurance poiides,
with permissible variations to take into account differences in state,
licensing requirements for long-term care providers.
Accelerated Death. Benefits
Clarifies the income tax treatment of accelerated death benefits paid to
terminally ill persons. Payments made under a qualified terminal illness
rider can be received tax-free as if they were paid after the insured's death.
G ; Tobacco Tax
The proposal increases the tax on tobacco by approximately SI 6.67 per pound
of tobacco products, and would extend the tax to tobacco to be used in "rollyour-own" dgarettes. The new tax rates would be:
1.
Cigarettes: ;
small cigarettes
large dgarettes
2.
S62 per thousand (i.e., SI.24 per pack of
20 cigarettes)
5130.20 per thousand
Cigars:
small cigars
S5.S2 per thousand
large dgars
65.875 percent of manufacturers price
(not more than 5155 per thousand)
3.
Cigarette papers and tubes:
dgarette papers
cigarette tubes
4.
3.88 cents per 50 papers
7.75 cents per 50 tubes
Snuff, chewing tobacco, pipe tobacco, "roll-your-own" tobacco:
snuff
51.86 per pound
chewing tobacco
62 cents per pound
pipe tobacco
53.49 per pound
44
�"roll-your-own" tobacco
53.49 per pound
5.
6.
XIV.
The proposal would repeal the present-law exemptions for tobacco
products provided to employees of the manufacturer and for use by the
United States.
The proposal also includes several administrative and compliance
provisions designed to improve the collection of the exdse tax.
National Health Commission
An independent National Health Commission is established to oversee the
health market much like the Securities and Exchange Commission oversees
the financial markets.
A.
Operation
1.
Z
The Commission members w i l l have gained national
recognition for their expertise in health markets.
3.
The Commission shall appoint an Executive Director and such
additional officers and employees it deems necessary to carry out
its responsibilities under this act.
4.
B.
The Commission shall be composed of 7 members appointed by
the President with the advice and consent of the Senate. The
Commission members will serve 6 year overlapping terms. No
more.'than four members of the Commission may be from the
same political party. The members shall be compensated at level
IV of the Executive Schedule. One member of the Commission
shall be designated as the Chairman by the President.
The Commission will be advised by expert private sector boards
which focus on health benefits and health plan standards.
Responsibilities
1.
Clarify the standard and basic benefits packages.
2.
Develop and clarify the quality standards set in this act for
Qualified Health Plans and provide for this information to be
distributed to consumers in a standardized format. This
information will include reporting prices, evaluating health
outcomes and measuring consumer satisfaction.
3.
Report to Congress on a biannual basis (described in Section
L.A.).
45
�d.
Develop risk adjustment factors for Accountable Health Plans.
e.
Monitor the Fail-Safe Mechanism to prevent deficit spending
(described in Section XI^BA)-
f.
Recommend methods to achieve universal coverage if trigger
mechanism is engaged in the year 2002 (described in Section
1.3.).
46
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©002
8/22/94
4 p.m.
MAINSTREAM COALITION PROPOSED AGREEMENT
PART ONE - COVERAGE
I.
INSURANCE COVERAGE
This section guarantees access to Certified Health Plans for all U.S. citizens and
lawful residents. It details the establishment of Community-Rated, Areas (CRAs),
institutes insurance market reforms, standardizes benefits packages, sets standards
for Certified Health Plans (CHPs), establishes subsidies for low-income individuals
and expands tax deductibility of health insurance premiums to individuals and the
self-employed.
A.
Assurance of Universal Coverage
1.
A Health Commission must report to Congress biennially on the status
of health insurance coverage in the nation. The report must include,
but is not limited to, the structure and performance measures of every
market area, including the following:
a.
Demographics of the uninsured, and findings on why those
individuals are uninsured;
b.
Structure of delivery system;
c
Number and organizational form of health plans;
d.
Level of enrollment in health plans;
e.
State implementation of responsibilities, including
establishment of coverage areas;
f.
Status of insurance reforms;
g.
Development of purchasing groups and other buyer reforms;
h.
Success of market and other mechanisms of controlling health
expenditures and premium costs in the market area and
nationally;
i.
Adequacy of subsidies for low income individuals;
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j.
k.
Coverage progress among those who are employed, including
status and level of voluntary employer contributions and
participation rates in pools and among large employers;
1.
Percentage of individuals who are enrolled in CHPs, separated
into categories of Medicare, Medicaid, employed individuals and
individuals eligible for low-income subsidies;
m.
Informal recommendations, specific to each market area, on
how the area might increase coverage among the residents and
further moderate growth in premiums; and,
n.
B.
Status of Medicare beneficiaries, and their transition into
Medicare Risk Contracts and CHPs;
Evaluation of adequacy of benefit packages.
Coverage Recommendations
1.
Establishes a national goal that 95% of all Americans will have health
care coverage by 2002.
2.
If this goal is not met, the Commission must submit formal and
specific recommendations to Congress by January 1, 2002. The
recommendations shall include methods to reach universal coverage
in market areas that have failed to meet that target. They must address
all relevant parties, including states, employers, employees,
unemployed and low income individuals, public program
beneficiaries, etc.
3.
In addition to any other recommendations it submits, the Commission
must make separate recommendations on the following:
a.
A method of encouraging full coverage which does not require
any assessments on or contributions from employers;
b.
A schedule of assessments or contributions to encourage
employers who are not doing so to purchase coverage for their
employees;
c.
Possible adjustments to the benefits packages;
d.
Possible adjustments to subsidies; and,
e.
Possible adjustments to tax treatment of benefits.
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4.
C
Congressional Consideration of the Health Care Commission Report.
The Commission recommendations are fully amendable, but are
subject to an expedited process for consideration.
Community-Rated Area
The major vehicle for reorganizing the health care marketplace would be the
establishment of geographic areas called Community-Rated Areas (CRAs).
Employees of employers with 100 or fewer employees and individuals
residing, or working in the CRA would be pooled together and would be
eligible for insurance at an age-adjusted community rate. CRAs are
established by each state and a minimum number of 100,000 lives must be
included in the CRA rating pool. States may enter into cooperative
agreements to establish interstate CRAs.
Within each CRA, consumers will have several different options available to
purchase health insurance. Employers and individuals may purchase
coverage directly from an insurer or agent, they may enroll at designated
state enrollment sites or they may choose to join a purchasing cooperative.
Accountable Health Plans may charge different administrative (or
enrollment) fees depending upon how the plan is purchased. If a Point of
Service (POS) Option or fee-for-service plan is not available in the CRA in
which an individual lives or works, the individual may purchase such a plan
in an adjacent CRA.
D.
Insurance Market Reforms
The Secretary of HHS shall, within six months of enactment, and in
consultation with private expert entities such as the National Association of
Insurance Commissioners (NAIC), develop federal standards which Certified
Health Plans must meet in order to be deductible by an employer or an
individual. While these federal standards will be established by the Secretary
of HHS, certification of the plan will be by the state or the Department of
Labor depending on the nature of the Health Plan. In general, all Certified
Health Plans must:
1.
Guarantee issue to all qualified applicants.
2.
Guarantee availability throughout the entire CRA in which it is
offered. States may waive this requirement for closed-panel networks
if they meet anti-redlining standards.
3.
Guarantee renewal to all qualified enrollees, except in instances of nonpayment of premiums or fraud or misrepresentation.
4.
Not deny, limit, or condition coverage based on health status, claims
1^)004
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1^005
experience, or medical history during the annual open enrollment
period. The bill includes a first-time enrollment amnesty extended for
a certain period after the date of enactment. Individuals are
encouraged to maintain continuous coverage. Continuous coverage
means that the period between the date of enrollment in a health plan
and the last date of coverage may be no longer than three months. If
an individual has not maintained continuous coverage or is enrolling
in a plan for the first time after the initial open enrollment period,
coverage may be subject to a pre-existing condition limitation of no
more than six months. Pregnancy and pre-natal care are exempted
from this limitation.
5.
6.
Comply with enrollment process.
7.
E.
Comply with all rating requirements, including age and family size
adjustments, within the coverage area.
Comply with financial solvency requirements, premium and collection
criteria.
Benefit Packages
1.
Within six months of enactment, the Commission shall develop and
submit to the Congress clarification of the initial standard and basic
benefits packages. These packages must adhere to the following:
a.
b.
The Basic Benefit Package must contain higher cost sharing
and/or fewer categories of benefits. It will have a lower
actuarial value than the standard benefit package.
c.
Both benefit packages must include medically necessary or
appropriate services within the covered benefit categories.
d.
2.
The actuarial value of the Standard Benefit Package must be no
greater than the actuarial value of the Blue Cross/Blue Shield
Standard Option under the Federal Employees Health Benefits
program.
Design the basic and standard benefits packages to prevent
adverse risk selection when combined with the risk adjustments
called for in the bill.
Categories:
The following categories of benefits are to be included in the benefits
package:
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a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
1.
3.
I^OOt
Inpatient and outpatient care, including hospital and health
professional services.
Emergency, including appropriate transport services.
Preventive services, including services for high risk
populations, immunizations, tests and clinician visits.
Mental Illness and Substance Abuse.
Family planning and pregnancy related services.
Prescription drugs and biologicals.
Hospice Care services.
Home health care services.
Outpatient laboratory, radiology and diagnostic services and
medical equipment, including orthotics and prosthetics.
Extended care and outpatient rehabilitation services,
Vision care, hearing aids and dental care for individuals under
22 years of age.
Patient care costs pursuant to qualified investigational
treatments.
Priorities:
Within the constraints of the actuarial limits set in this act. Congress
directs the Commission to adhere to the following priorities:
a.
b.
Consideration for needs of children and vulnerable populations,
including rural and underserved persons.
c.
4.
Parity for mental health and substance abuse services, which
shall consist of a broad array of mental health and rehabilitation
services managed to ensure access to medically necessary or
appropriate services, and psychologically necessary or
appropriate treatment and to encourage the use of outpatient
treatments to the greatest extent feasible.
Improving the health of Americans through prevention.
Medically Necessary or Appropriate
A Certified Health Plan shall provide for coverage of the categories of
benefits described in this section for treatment and diagnostic
procedures that are medically necessary or appropriate.
A n item or service is "medically necessary or appropriate" if, consistent
with prevailing medical standards, it is;
a.
For treatment of a"medical condition.
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1^007
b.
c.
5.
Safe and effective (i.e., there is sufficient evidence to
demonstrate that the service can reasonably be expected to
produce the intended health outcome and if the expected benefit
outweighs any potential harm.
Medically appropriate for the enrollee (i.e., it can reasonably be
expected to provide a clinically meaningful benefit for the
enrollee).
Cost-Sharing
The Commission shall also develop multiple cost sharing schedules
which vary by delivery system organization. In making these
determinations, the Commission will consult with expert groups for
appropriate schedules for covered services. This clarification is subject
to approval by Congress under expedited procedures.
6.
Limitations
The Commission is prohibited from specifying provider types, or
specific procedures or treatment in the benefit packages.
7.
Consideration of Commission Recommendations
The Commission will have the authority to propose modifications to
the benefits package (within the actuarial value ceiling described above)
that would not go into effect unless approved by Congress. Tlie
Commission is responsible for any updates to the benefits packages
after the first year and these updates are also subject to Congressional
approval under expedited procedures.
H.
CERTIFIED HEALTH PLANS
A.
Accountable Health Plans (AHPs)
1.
Definition: a health plan that may be operated as a variety of delivery
systems such as indemnity plans, preferred provider organizations,
health maintenance organizations, or other delivery systems. An AHP
is a health plan that is certified by the state as meeting insurance
market reform standards, health plan standards, quality, reporting
standards, and other standards. It may be offered in the communityrated or experience-rated markets.
2.
Standards
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a.
b.
May not engage in marketing or other practices intended to
discourage and/or limit the issuance to eligible individuals on
the basis of health condition, industry, geographic area or other
risk factors.
c.
Must demonstrate its ability to make available and accessible to
each potential enrollee in the area the full range of benefits
required under the standard and basic benefit packages.
d.
Must not accept enrollment of an individual who is currently
enrolled in another AHP.
e.
Must make available to nonparticipating providers the criteria
used in selecting those providers that are permitted to participate
in the plan.
f.
Must comply with federal information requirements.
g.
Must offer the standard and basic benefit packages, but may also
offer benefits in addition to these packages, if such additional
benefits are offered and priced separately from the standard and
basic benefit packages.
h.
Must comply with a system of claims dispute resolution for
coverage disputes.
i.
B.
Must meet insurance reforms described in (I., D.).
Must comply with Essential Community provider provisions.
Self-Insured (Risk Bearing) Plans (SIPs)
1.
Definition: a group health plan for which the employer or association
retains a significant portion of the insurance risk. They are regulated
by DoL and are subject to ERISA. They are an option in the experiencerated market. Some association plans serving the community-rated
market are grandfathered as discussed in (II., C).
2.
Standards:
a.
Self-insured plans must meet all the standards for AHPs,
including the insurance market reforms, except they must accept
only their own employees or members (and their dependents, if
applicable) and the population they must serve and area they
must cover is defined by such plan's workforce or membership.
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b.
Financial solvency standards will be established by the Secretary
of the Department of Labor (DoL) consistent with the applicable
rules under Part 4 of Title I of ERISA.
c.
The Secretary of DoL may take corrective actions to terminate or
disqualify a self-insured plan that does not meet the above
standards.
Certified Association Plans (CAPs)
1.
Definition: Associations that have been in existence for three years
prior to the date of enactment may continue to sponsor experiencerated health plans for their members who fall within the communityrated market.
2.
Standards:
a.
Must meet all standards for AHPs with the following exceptions:
i.
ii.
3.
Special solvency requirements will be established by DoL
for CAPs.
Are required only to take any member in their designated
association.
Requirements for Sponsoring Entity (Association)
a.
b.
Must have appropriate by-laws that specifically state the purpose,
as a trade association, industry association, professional
association, chamber of commerce, religious organization, or
public entity association.
c.
Must have been established and maintained for substantial
purposes other than to provide the health care required under
this section.
d.
Must be, and have been, in operation (together with its
immediate predecessor, if any) for a continuous period of not
less than 3 years.
e.
4.
Must be organized and maintained in good faith.
Must receive the active support of its membership.
Treatment of Multiple Employer Welfare Arrangements (MEWAs)
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a.
In general, upon enactment, a MEWA will meet the standards to
become either a CAP or an association purchasing cooperative,
(defined in Section III., D.)
b.
Any self-insured MEWA that has been in effect for not less than
18 months prior to enactment and with respect to which there is
an application pending with the domicile state for certification as
a CAP, shall be treated as a CHP (if such plan otherwise meets
the requirements of this Act);
c.
However, MEWAs will not be able to continue to operate if the
domicile state can demonstrate that i.
n.
the plan that is the subject of the application, on its face,
fails to meet the requirements for a complete application;
or
iii.
D.
the sponsor has made fraudulent or material
misrepresentation(s) in the application;
a financial impairment exists with respect to the applicant
that is sufficient to demonstrate the applicant's inability to
continue its operations.
Multi-Employer (Taft-Hartley) Plans, Rural Electric Cooperatives
(RECs), Rural Telephone Cooperative (RTCs), and Church Plans
Taft-Hartley plans, RECs, RTCs, and Church Plans must meet the same
requirements as large employers. (See Section III.B. below)
E.
Public Programs
Existing public programs like Medicare, Medicaid, Department of Defense
health programs. Department of Veterans Affairs health programs and Indian
Health Service programs are considered to be CHPs for the purposes of this
section.
F.
Pre-emption of Certain State Laws regulating Insurance Plans
The following state laws relating to health plans are preempted for any CHP:
1.
State laws that restrict plans from:
a.
limiting the number_and type of providers who participate in a
plan;
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b.
c.
establishing different payment rates for participating providers;
e.
G.
requiring enrollees to obtain referral for treatment by a specialist
or health institution;
d.
2.
requiring enrollees to obtain health services from participating
providers;
creating incentives to encourage the use of participating
providers;
State mandated benefit laws.
Patients Right To Self-Determination
1.
2.
Requires Certified Health Plans to notify enrollees of their rights to
self-determination in health care decision-making and of the Plan's
policy regarding advance directives, and to comply with the other
requirements of Patient Self-Determination Act.
3.
III.
Extends current requirements under the Patient Self-Determination
Act. In notifying patients of their right to execute an advance
directive, institutions must also notify individuals of what happens in
the absence of an advance directive. Such institutions must also have
a process in place to provide for effective communication between the
patient and provider regarding treatment decisions and advance
directives.
Clarifies that validly executed advance directives are portable and will
be honored in other states.
LARGE AND SMALL EMPLOYER RESPONSIBILITIES AND PURCHASING
COOPERATIVES
A.
Small Employers
1.
Definition: employers with 100 or fewer full-time employees.
2.
Responsibilities:
a.
May not sponsor a self-insured plan, but if a member of an
eligible Association may join a CAP.
b.
Must provide all employees (including part-time and seasonal)
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with the state-provided standard information regarding all
AHPs offered in the CRA in which the employer is located.
c.
d.
Small employers must make available to their employees a
choice of at least three CHPs one of which must be either a pointof-service or a fee for service plan, if available, either by joining a
purchasing group or through independent brokers or insurance
agents.
e.
B.
If an employee resides in another CRA, the employer must
provide information regarding how to obtain information
regarding AHPs available in that CRA.
Payroll Deduction. If an employee requests, employers must
arrange for payroll deduction to pay the premium amount due,
less any employer contribution, to the health plan or purchasing
cooperative selected by the employee.
Large Employers
1.
Definition: employers with more than 100 full-time employees.
2.
Responsibilities:
a.
b.
Large employers and their employees are ineligible to join the
small employer and individual purchasing cooperatives or to
purchase insurance at the community rate either through a
broker, independent agent, purchasing cooperative, or public
enrollment office.
c.
All large employer purchasers are regulated by the DoL and
remain subject to ERISA.
d.
C
All large employers must offer their employees a choice of at
least three CHPs, one of which must be either a point-of-service
option or a fee-for-service plan, if available. A large employer
may comply with this subsection by offering three CHPs
provided by a single carrier.
If an employer contributes to its employee's health coverage, it
must provide coverage as of the first day of the month in which
an employee becomes eligible. Once terminated, coverage
continues through the end of the month of termination.
Individual and Small Employer Purchasing Cooperatives
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1.
2.
States must establish CRAs and certify purchasing cooperatives.
3.
Cooperatives are voluntary and may be either public or private.
4.
They may serve multiple community-rated areas in multiple states.
5.
Cooperatives do not assume risk, and do not have any regulatory
authority.
6.
They must accept all individuals and small businesses in the CRA they
serve.
7.
They must enroll and administer health plans for individuals and
employees of small business who wish to join.
8.
Membership in these purchasing cooperatives will be voluntary and
limited to employers and employees of businesses with 100 or fewer
employees, and to all other non-Medicaid U.S. citizens or legal
residents not employed by a large employer who live in the CRA.
9.
Nothing in the Act shall be construed to require any individual or
small employer to purchase exclusively through a purchasing
cooperative.
10.
Nothing in the Act requires the establishment of a purchasing
cooperative nor prohibits the establishment of a purchasing
cooperative in an area.
11.
D.
Individuals and small employers have the same purchasing power and
economies of scale as large companies with the option to buy health
insurance through purchasing cooperatives at the age-adjusted
community rate.
Nothing shall be construed to prevent more than one purchasing
cooperative in a CRA.
Association Purchasing Cooperatives (APCs)
1.
Definition: Associations that have been in existence for three years
prior to the date of enactment may offer health plans to their members
at the adjusted community rate.
2.
Standards: Must meet all standards for purchasing cooperatives, except
that they may offer plans only to members in their designated
association. They are permitted to offer one experience rated plan, but
all other plans must be offered at the age-adjusted CRA community
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0014
rates.
3.
Requirements for Sponsoring Entity (Association)
a.
b.
Must have appropriate by-laws that specifically state the purpose,
as a trade association, industry association, professional
association, chamber of commerce, religious organization, or
public entity association.
c.
Must have been established and maintained for substantial
purposes other than to provide the health care required under
this section.
d.
Must be, and have been, in operation (together with its
immediate predecessor, if any) for a continuous period of not
less than 3 years.
e.
E.
Must be organized and maintained in good faith.
Must receive the active support of its membership.
Allowing Access to Federal Employee Health Benefit Program
Any plan under the Federal Employee Health Benefit plan offered to federal
employees in a CRA must be available for purchase by individual and small
group purchasers in that area. Non-federal employee purchasers shall pay a
premium amount based on the local community rate for that plan, and shall
not be a part of the FEHB insurance pool. Plans offered nationally through
FEHB shall not be required to be open to non-federal employee enrollment.
IV.
NONDISCRIMINATION PROVISIONS THAT APPLY TO ALL EMPLOYERS:
A.
General Rules
Employers that contribute to the purchase of any employee's health care
coverage may not discriminate against any employee based on the employee's
income. Employers may not vary that dollar amount of their contribution to
an employee's health care coverage based on the plan selected by the
employee, among those offered by the employer.
1.
For purposes of part-time employees, a dollar contribution will
constitute an equal dollar contribution if the employer makes a dollar
contribution proportionate.to the number of hours worked by the parttime employee.
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Definitions
1.
A full-time employee is defined as an individual who is employed for
an average of 25 or more hours per week.
2.
A part-time employee is defined as an individual who is employed for
an average of at least 10 hours per week, but less than 25 hours per
week.
3.
An individual does not qualify as a full-time or part-time employee
until the individual has been employed for six months (i.e., seasonal
employees are not treated as part-time employees).
Exemption for Collectively Bargained Plans
Single-employer and multi-employer bona fide collectively bargained plans
are exempt from these nondiscrimination rules.
V.
ROLE OF FEDERAL AND STATE GOVERNMENTS
States establish programs to implement the Act's requirements based on
federal guidelines. The federal government does not require states to set up
specific processes or bureaucracies. The Federal government continues to
oversee ERISA plans. States can implement a single-payer system that allows
certain large employers to opt out.
A.
Responsibilities of State Governments
1.
States must establish a state program to carry out state responsibilities
specified in the Act. State responsibilities include:
a.
Certifying insured health plans (as they do now);
b.
Establishing Community-rated Areas;
c
Establishing procedures for setting up and operating purchasing
cooperatives;
d.
Preparing standardized information concerning CHPs;
e.
Administering a risk adjustment program for community-rated
health plans; and
f.
Specifying an annual general open enrollment period and an
14
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initial enrollment period for community-rated plans.
2.
3.
B.
States must establish State programs by January 1, 1996.
States must submit to the Secretary of HHS, at intervals determined by
the Secretary, a report on compliance of the state with the above
requirements.
Responsibilities of Federal Government.
1.
The Secretary of HHS must, among other things, periodically review
state programs and notify states of failure to comply with federal
requirements;
2.
The Secretary of Labor's duties include:
a.
b.
G
Establishing standards for self-insured health plans (in
consultation with the Secretary of HHS), including applying
certain fiduciary and fund management requirements in ERISA;
Certifying (and decertifying) self-insured health plans.
Single Payer systems.
States can implement a single-payer system that allows certain large
employers to opt out.
VI.
ASSISTANCE TO INDIVIDUALS AND FAMILIES FOR THE GENERAL
PURCHASE OF INSURANCE
A.
Eligibility For Vouchers:
1.
2.
B.
Individuals and/or families not othenvise eligible for Medicare or
Medicaid, whose income is less than 200% of the federal poverty level
will be eligible for a voucher for the purchase of a CHP.
Subsidies will also be available for pregnant women and children up to
18 years with incomes up to 240% of the Federal poverty level.
Amount of Voucher
1.
For individuals and families with incomes less than 100% of poverty
the voucher will be equal to the average premium of the standard
benefit packages offered by'AHPs in the CRA in which they reside or
15
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work.
2.
For individuals and families with income above 100% of the federal
poverty level, the Voucher amount will be decreased on a sliding scale
basis to 200% of the federal poverty level.
3.
Pregnant women and children up to 18 years with incomes less than
185% of the federal poverty level, will receive a f u l l voucher, and from
185% to 240% the voucher amount will be decreased on a sliding scale.
Phase-in Schedule for Vouchers
1.
Vouchers for individuals and families will be phased-in at the
beginning of each year under the following schedule: (subject to
additional information from CBO)
Calendar Year
Percentage of Poverty
1997
1998
. 1999
2000
2001
2002
2003
2004
2.
90%
105%
120%
135%
150%
165%
180%
200%
Vouchers for pregnant women and children up to 18 years w i l l be
phased in at the beginning of each year under the following schedule:
Calendar Year
Percentage of Poverty
1997
1998
1999
D.
185%
215%
240%
Administration of Vouchers
1.
The Secretary of HHS will establish a mechanism for
determining eligibility for vouchers, for distributing application
forms, and to the extent practicable, for allowing enrollment in a
CHP at the time of application for subsidy.
2.
The Secretary may provide for administration of Vouchers through an
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10018
appropriate State agency.
E.
VII.
Expanded Tax Deductibility
(Described in Section XII.,B.)
EXPANDING ACCESS FOR RURAL AND UNDERSERVED POPULATIONS
A.
Community-Based Primary Care Grant Program
Competitive grants are authorized to develop community health networks,
certified community health plans, and provide capital assistance. The grants
will help address geographic, financial and other barriers to health care
services in underserved urban and rural areas. The agreement also
authorizes rural health plan demonstrations to improve access to plans in
rural areas, and a telemedicine program to assist rural providers with
specialty consultation, continuing education, referrals, and provider
collaboration.
B.
Tax Incentives for Practice in Rural, Frontier, and Urban Underserved Areas
(As described in Section XII., D.)
C.
Medicare Dependent Hospitals
1.
Modify Payments to Medicare Dependent Hospitals in the following
manner:
a.
b.
conform target amounts to extension of additional payments;
c.
clarify of updates; and,
d.
D.
base payments on a 36 month period beginning with the first day
of the cost reporting period that begins on or after April 1,1990;
extend Medicare-dependent hospital classification through 1999.
Limited Service Hospital Program
Expands the EACH/RPCH and MAF programs to all states and makes
technical improvements to both programs.
E.
Extends the Rural Health Transition Grant Program
Extends the program through FY 1998 with authorized appropriations of $30
million annually, FY 1993 - 1998. Reports from grantees would be required
every 12 months. As of October 1, 1994, RPCHs are eligible for rural health
17
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transition grants.
F.
Increases of reimbursement to PAs and NPs and Direct Payment for Nurses as
Assistants at Surgery under Medicare
1.
2.
Under Medicare, certified Nurse Practitioners would be reimbursed at
65% of the RBRVS rate for assisting at surgery in urban areas.
3.
States would be required to directly reimburse all certified Nurse
Practitioners in a rural area under Medicaid. This expands the current
requirement that all states directly reimburse pediatric and family
Nurse Practitioners, which gives states the option of directly
reimbursing other types of NPs.
4.
G.
Certified Nurse Practitioners and Physicians Assistants would be
reimbursed at 85% of the RBRVS rate for services performed in all
outpatient settings.
Under Medicare, registered nurses under the supervision of a
physician as an assistant at surgery and legally authorized by the state
would be reimbursed.
Telemedicine and Related Telecommunications Technology
1.
Coordinates various federal grant programs which fund telemedicine
and related telecommunications demonstrations and grant programs.
This provision establishes a federal interagency task force, coordinated
and chaired by the Department of Health and Human Services, would
be established to oversee telemedicine and other telecommunications
demonstration projects already underway.
2.
A demonstr ation grant program would be established to fund
telemedicine and related telecommunications technology in rural
areas. The program would be administered through the Secretary of
Health and Human Services. Applicants for the grant would be rural
health care providers such as rural referral centers, rural health clinics,
community health centers, migrant health centers, area health and
education centers, local health departments and public hospitals.
VIII. NEW HOME AND COMMUNITY-BASED LONG TERM CARE PROGRAM
A.
General
States would have the option of establishing a new program for home
and community based long term care for individuals with disabilities
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under the Medicaid program. The Secretary would be required to
designate an agency responsible for program administration within six
months of enactment. States could implement programs on or after
January 1, 1998.
B.
Eligibility
The State plan must specify a system for conducting an initial screening
to determine if a individual has a qualifying level of disability. A State
" may not limit eligibility for services based on: age, geography, nature,
or category of disability, residential setting (other than an institutional
setting), or on other grounds specified by the Secretary except that a
State would be permitted to limit eligibility for services based on the
level of disability. The State plan would have to assure that an
individual receiving Medicaid home and community based services
would continue to receive an appropriate level of services either under
Medicaid. An eligible individual must have an income at or below
150% of the federal poverty level, however, persons with
developmental disabilities are not subject to the means test, but will
pay cost sharing and premiums based on income.
Covered Services
1.
2.
3.
Care Management.
The State program must make available care management services
which include a (1) comprehensive assessment of the' individual's
need for home and community based services, (2) an individualized
plan of care based on the assessment, (3) arrangements for the
provision of services specified in the plan of care, and (4) monitoring
the delivery of services.
Personal Care.
The program shall include personal care in the array of services
covered by the State. Available personal care services shall include
both agency-administered and consumer-directed. States shall act as
the employer of personal providing consumer-directed personal care
services and assume responsibility for providing bill, provider
payment,tax withholding, unemployment insurance and workers'
compensation coverage. Beneficiaries shall retain the right to select,
hire, terminate, and direct the services of a consumer-directed
provider.
Additional Services.
States may provide a range of services in addition to care management
and personal care including; home-maker and chore assistance, home
modifications, respite services, assistant devices, adult day services,
habilitation and rehabilitation, supported employment, home health
services, transportation, and other care or assistive services specified by
19
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the State and approved by the Secretary.
D.
Federal Matching Payments to States
Federal matching rate shall be the Federal Medical Assistance Matching
Percentage plus 15 percentage points, except that the Federal percentage under
this part shall not exceed 90 percent.
E.
Funding, Allotments to States
For federal Fiscal years 1996-2002 ten billion dollars.
PART TWO - COST CONTAINMENT & CONSUMER PROTECTION
IX.
COST CONTAINMENT
A.
Limit On The Amount Of Health Insurance To Be Deductible
(described in Section XII^A.)
B.
Medical Liability Reform
1.
Alternative Dispute Resolution
a.
b.
2.
No health care malpractice action may be brought in court until
final resolution of the claim under an alternative dispute
resolution (ADR) method adopted by the state from models
developed by the Secretary of HHS, or developed by the state and
approved by the Secretary of HHS.
If the party initiating court action following the ADR receives a
worse result with respect to liability or a level of damages 33
1/3% below that awarded in the ADR if initiated by plaintiff (or
33 1/3% above if initiated by the defendant) that party must pay
the costs and attorneys fees of the other party incurred
subsequent to the ADR.
Damages
Non-economic damages awarded to a plaintiff in a health care
malpractice claim or action may not exceed $250,000, indexed for
inflation. Within one year, an advisory committee will recommend to
Congress a sliding scale of limits for non-economic damages, based on
severity of harm.
20
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Several Liability
The liability of each defendant in a health care malpractice action for
non-economic and punitive damages will be based on each defendant's
proportion of responsibility for the claimant's harm.
4.
Punitive Damages
Seventy-five percent of punitive damage awards will be paid to the
state in which the action is brought and such funds will be used for
provider licensing, disciplinary activities and quality assurance
programs.
5.
Fee Reform
Lawyers may not charge contingency fees greater than 33 1/3% of the
first $150,000 of the award in a health care malpractice action and 25%
of amounts in excess of $150,000. Calculation of permissible
contingency fees is based on after tax amounts.
6.
Limited Preemption
State laws that have higher limits on attorneys fees and non-economic
damages are preempted. This section does not preempt state laws to
the extent such laws impose greater restrictions on attorneys fees,
damages or liability, or provide additional defenses to malpractice
actions.
C
Remedies For Benefit Claims Disputes
In general, all claims disputes are adjudicated by a neutral third-party, not affiliated
with the health plan. A clear distinction is made between the coverage dispute
resolution process and utilization review negligence.
1.
Claims disputes, whether with respect to a pre-authorization decision or a
post-treatment payment dispute, would be handled exclusively under an
expedited administrative process, unless the plan establishes an alternative
mandatory binding arbitration process that is certified by the Department of
Labor..
2.
The administrative process is Federally run with both urgent and non-urgent
post-plan review by Federal grievance review officers with moderation of all
~- claims. All pre-authorization decisions will be granted de-novo review by the
hearing officers. Health Plans' post-treatment payment disputes will be given
deferential treatment by the decision maker. Decisions can be appealed to the
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a
10023
U.S. Court of Appeals.
3.
A plan may establish a mandatory binding arbitration system in which all
plan participants would be required to participate. This arbitration process
would be required to be certified by the Department of Labor and would have
to meet specific consumer protection and neutrality requirements. The
provisions of Title 9, U.S. Code, on arbitration shall also govern. This
includes the ability to set aside an arbitration award that is in manifest
disregard of the law. The arbitrators' decisions would have to be reported to
the Department of Labor so that a consistent body of decisions could develop.
4.
Remedies available through the administrative process or arbitration are:
payment of the claim or ordering the treatment, pre-judgement interest and
costs (including reasonable attorney's fees to a prevailing claimant). A plan
could recover attorney's fees from the claimant or claimant's counsel (as
determined by the hearing officer) in the event of a frivolous claim.
5.
If the Department of Labor determines that a plan has a pattern and practice of
bad-faith claims denial, the Department can assess a civil monetary penalty of
up to $1 million.
6.
Persons conducting pre-authorization or utilization review are required to
use reasonable care in making medical judgements with respect to
determining whether a treatment, item, or service requested by a participant
was medically necessary or appropriate. A Federal cause of action has been
established to handle these claims.
a.
In order to recover, plaintiff would have to demonstrate that the
person's medical judgement to deny coverage, or authorization,fails to
satisfy a federally defined standard of care and that the standard
medical judgement actually and proximately resulted in the denial or
delay of medical care, which resulted in medical harm.
Plaintiff would also be required to exhaust plan and administrative
remedies and to mitigate damages. A decision by a hearing officer or
arbitrator (upheld on appeal) that the plan was correct in denying
coverage would be a complete defense to this cause of action.
b.
D.
Utilization reviewers that fail to use reasonable care may be liable for
compensatory damages with a cap on non-economic damages.
Administrative Simplification, Paperwork Reduction, and Privacy
This section would implement a national health information network to
reduce the burden of administrative complexity, paperwork, and cost on the
health care system; to provide information on cost and quality; and to
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provide information tools that allow improved fraud detection, outcomes
research, and quality of care.
1.
Requirements for the Secretary of HHS
A.
B.
The Secretary would be required to establish expedited procedures to
adopt health information standards that are already in common use or
that are recommended or developed by standards setting organizations
accredited by the American National Standards Institute (ANSI).
C.
2.
The Secretary would be required to implement a national health
information network by adopting standards for:
1.
representing the content and format of health information in
both paper and electronic form,
2-.
transmitting health information over the network,
3.
conducting transactions using this information,
4.
certifying public or private entities to perform the intermediary
functions which implement the network, and
5.
monitoring performance to assure compliance.
The Secretary would be required to establish procedures for:
1.
adding codes to previously adopted standards;
2.
making changes to previously adopted standards; and
3.
developing, testing, and adopting new standards.
Establishment of a Health Information Advisory Committee
The Secretary would be required to consult with a Health Information
Advisory Committee consisting of 15 members from the private sector
including providers, consumers, and experts with practical experience
in developing and applying health information and networking
standards. The members w ould be appointed by the President and
serve staggered, 5 year terms.
T
3.
Requirements for Health Plans and Health Care Providers
A.
All health plans, including Federal and State health programs, and all
health care providers would be required to participate in the health
information network either directly or through a contract with a
certified health information service.
B.
The Secretary may require other transactions to be conducted
electronically, consistent with the goal of reducing administrative costs.
C.
In addition, plans and providers would be required to make certain
standard data available electronically on the health information
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network to authorized inquiries.
4.
Standards for Accessing Health Information
The Secretary would be required to establish technical standards for
requesting standard health information from participants in the health
information network which assure that a request for health information is
authorized under the Privacy and Confidentiality Subtitle or that it requests
health information that is not protected under the Privacy and
Confidentiality Subtitle because individuals cannot be identified using the
information requested.
The Secretary would be required to establish standards for the appropriate
release of health information to researchers and government agencies,
including public health agencies. The Secretary would establish standards for
the electronic identification of a request as one which comes from a person
authorized to receive the requested health information under the Subtitle on
Privacy and Confidentiality.
5.
Replacement of Medicare and Medicaid Coverage Data Bank
The function of the Medicare and Medicaid Coverage Data Bank would be
replaced through the requirement on all health plans to ensure the electronic
availability on the health information network of standardized enrollment
and eligibility information on every covered individual.
In order to be certified, health information network services would be
required to be capable of performing automated electronic coordination of
benefits and responding to queries from health care providers and health
plans, in standardized transactions as defined by the Secretary, regarding the
enrollment and coverage for any individual under any health plan.
E.
Privacy And Confidentiality
1.
Rule Of Nondisclosure For Protected Health Information
All health information that could reasonably be related to a specific
individual would be protected from disclosure. Comprehensive
protections of this protected health information would apply regardless
of form or medium, whether kept in paper files or ih electronic
databases, whether retained in doctors' offices or insurance company
files, or available from an information system or over a computer
network.
2.
Penalties
24
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0026
Unauthorized disclosures of protected health information would be
subject to criminal sanctions, civil actions, and administrative
penalties. Penalties would range from fines of up to $50,000 and prison
terms of up to one year for wrongful disclosure or obtaining of
protected health information, to fines of up to $100,000 and prison
terms of up to five years for violations committed under false
pretenses, to fines of up to $250,000 and prison terms of up to ten years
for offenses committed with intent to sell protected health information
for commercial advantage or personal gain.
F.
Quality Management and Improvement
The Secretary shall establish a National Quality Council to oversee a
program of quality management and improvement designed to
enhance the quality, appropriateness and effectiveness of health care
services and access to such services.
Tlie National Quality Council, appointed by the President and
confirmed by the Senate, has the following duties:
1.
2.
3.
4.
G.
develop national goals and performance measures;
develop survey methodology and sampling methods;
oversee the design and production of Consumer Report Cards;
oversee the quality improvement foundation (QIF)
demonstration project.
Anti-fraud and Abuse Control Program
This subtitle establishes a stronger, better coordinated federal effort to
combat fraud and abuse in our health care system. It expands criminal
and civil penalties for health care fraud to provide a stronger deterrent
to the billing of fraudulent claims and to eliminate waste in our health
care system resulting from such practices. It also seeks to deter
fraudulent utilization of health care services. It would:
1.
Require the HHS Secretary and Attorney General to jointly
establish and coordinate a national health care fraud program to
combat fraud and abuse in government and Qualified Health
Plans;
2.
Finance the anti-fraud efforts by setting up an Anti-Fraud and
Abuse Trust Fund. Monies from penalties, fines, and damages
assessed for health care fraud are dedicated to the Trust Fund to
pay for the anti-fraud efforts;
3.
Increase and extend Medicare and Medicaid civil money and
~- .
25
�08/22/94
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0027
criminal penalties for fraud to all health care programs;
4.
Bar providers convicted of health care fraud felonies from
participating in the Medicare program;
5.
Require HHS to publish the names of providers and suppliers
who have had final adverse actions taken against them for
health care fraud; and,
6:
Establish a new health care fraud statute patterned after existing
mail and wire fraud statutes under Title XXIII of the Criminal
Code and allows for criminal forfeiture of proceeds.
X. REFORM OF EXISTING PUBLIC PROGRAMS
A.
Medicaid
1.
State Flexibility to Contract for Coordinated Care Services
a.
States have the option to establish a program under Medicaid
program to allow states to enter into contracts with at-risk
primary care case management (PCCM) providers.
b.
An at-risk PCCM provider must be a physician, group of
physicians, a federally qualified health center, a rural health
clinic or other entity having' other arrangements with physicians
operating under contract with a state to provide services under a
primary care case management program.
c.
Qualified risk contracting entities must:
i.
meet federal organizational requirements;
ii.
guarantee enrolled access; and,
iii.
have a written contract with the state agency that includes:
(a)
an experienced-based payment methodology;
(b)
premiums that do not discriminate among eligible
individuals based on health status;
(c)
requirements for health care services; and,
(d)
detailed specification of the responsibilities of the
26
�08/22/94
18:48
©
0028
contracting entity and the state for providing for, or
arranging for, health care services.
d.
Meet federal standards for internal quality assurance.
e.
Enter into written provider participation agreements with
essential community providers;
1.
B.
States are required to contract directly with essential
community providers, or at the election of the ECP, each
risk contracting entity may enter into agreement to make
payments to the essential community provider for
services.
Medicare
1.
Medicare remains a separate program and continues to be federally
administered. Beneficiaries enrolled in Part B continue to pay a
monthly premium. The statutorily defined Medicare benefits continue
to be the Medicare benefit package in both fee-for-service and managed
care.
2.
Beneficiary opt-in to private Certified Health Plans.
a.
b.
For individuals choosing an CHP, Medicare will pay the federal
contribution calculated for Medicare risk contracts. Individuals
are responsible for paying the difference between the premium
charged and the federal contribution.
c.
3.
Medicare beneficiaries may opt into a certified health plan in
their CRA.
During the annual enrollment period. Medicare-eligible persons
may choose a new plan through their employer/purchasing
cooperative or they may return to the traditional Medicare
program.
Medicare Select
a.
The Medicare Select program would become a permanent option
in all States.
b.
Medicare Select policies will be offered during Medicare's
coordinated open enrollment period.
c.
Plans may not discriminate based on health status.
27
�03/22/94
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©029
4.
Medicare Risk Contract Program
This program is improved to encourage more plan participation
including revision of federal payment to help plans to reflect market
cost. Additionally, it makes comparing available choices easier for
beneficiaries.
5.
Administrative Simplification
The Secretary has authority to consolidate the functions of fiscal
intermediaries and carriers. Provides for coordination of Medicare and
supplemental insurance claims processing. Permits standardized,
paperless process.
6.
Study and Demonstration for Medicare Cost Containment
a.
b.
XI.
Requires ProPAC and PPRC to study and make
recommendations to Congress regarding ways to slow the rate of
Medicare growth at the local market level. The study should
include ways to set local expenditure targets and monitor success
in controlling costs. Updates for payment rates under Parts A
and B should be set to achieve local targeted expenditure levels,
while rewarding efficient providers and/or markets.
A demonstration is authorized to evaluate Part A expenditures
for hospital service and/or Part B expenditures in fee for service
using provider-group or State-level volume performance
standards.
FISCAL RESPONSIBILITY
Fail-Safe Mechanism
The bill establishes a Fail-Safe mechanism to ensure health care reform
reduces the deficit. Details are described below:
1.
A Current Health Spending Baseline (CHSB) is established. The CHSB
includes:
a.
b.
c
Medicare Expenditures
Medicaid Expenditures
Health Related Tax Expenditures
i.
The employee exclusion of employer-provided health
insurance premiums.
ii.
Employer deduction for health insurance premiums.
iii.
7.5% floor for deduction of medical expenses.
28
�• 08/22/94
18:49
'Q
10030
2.
A Health Reform Spending Estimate (HRSE) is established. The HRSE
includes:
a.
b.
c.
d.
e.
f.
3.
Everything included in the CHSB.
Deduction for purchase of Certified Health Plans by all selfemployed and individuals.
Cigarette excise tax.
Vouchers for purchase of a Certified Health Plan.
Limit on Deductibility of health insurance for employees
Deficit reduction of approximately 100 billion over 10 years
(pending discussion with CBO)
In any year that the Director of OMB notifies Congress that HRSE will exceed
the CHSB, the following automatic actions will occur to prevent a deficit
increase:
a.
b.
c.
The voucher phase-in is delayed.
The limit on deductibility is increased.
The expanded tax deduction phase-in is slowed down.
4.
Congress may act on alternative recommendations made by the National
Health Commission to avoid the actions listed above.
5.
If Medicare increases are the cause of excess spending, the President must
make specific recommendations to reduce Medicare each year.
6.
The President is required to identify the percentage of federal taxes that are
being spent on total federal health care programs. For each year in which
total federal health spending rises. Congress must report on the additional
amount of federal taxes that are attributable to federal health care spending.
XII. TAX PROVISIONS
A.
Limit on Employer Deductibility
1.
Beginning in 1997 the deductibility of employer contributions for the
standard or basic health insurance premium cost will be limited to
110% of the average cost of such plans in the community-rated market.
For experience rated plans, employers may choose between the limit
determined annually for the community-rated market or the plan's
actual costs for 1997. The 1997 cost amount is frozen for the purpose of
this calculation in subsequent years. This will create additional
incentives for employers and employees to bring down the cost of their
health plans through more efficient health care delivery. Beginning in
the year 2000, supplemental insurance policies that cover copayments
and deductibles under the standard or basic plans are non-deductible to
the employer and taxable to the employee. Other supplementals
remain fully deductible to the employer and excludable to the
29
�08/22/94
18:49
'Q
0031
employee.
B.
Assistance to Individuals and Families - Expanded Tax Deductibility
1.
2.
C
Self-employed individuals are provided a full deduction for the cost of
health insurance (i.e., not subject to the 7.5% floor), subject to a phasein period. The deduction is available only for the cost of either a basic
or standard benefits package and is limited to 110% of the average cost
of such plans in the community-rated market. To the extent selfemployed individuals purchase benefits supplementing such packages,
the cost of such supplemental benefits will be deductible as medical
expenses under current law (i.e., subject to the 7.5% floor).
Individuals (other than self-employed) whose employer does not
provide insurance are provided a full deduction for the cost of either
the basic or standard benefit packages. To the extent an individual
purchases benefits supplementing the packages, the cost of such
supplemental benefits will be deductible as medical expenses under
current law (i.e., subject to the 7.5% floor).
Employer-Provided Health Insurance
1.
2.
D.
Through 1999 employees may continue to exclude from gross income
all employer-provided health insurance. Beginning January 1, 2000
employer-provided supplemental policies covering co-payments and
deductibles must be included in taxable income.
Employer provided health care coverage offered through a flexible
spending account is includible in employee taxable income beginning
in 1996.
Tax Incentives for Practice in Rural, Frontier, and Urban Underserved Areas
1.
Physicians practicing full-time and either newly certified or newly
relocated to a rural, frontier, or urban Health Professional Shortage
Areas (HPSA) are allowed a tax credit equal to $1,000 a month, limited
to a total credit of $36,000. Tax credits will be prorated in direct relation
to the time worked in the HPSA.
2.
Nurse practitioners and physician assistants practicing full-time and
either newly certified or newly relocated to a rural, frontier, or urban
HPSA would be eligible for a tax credit equal to $500 per month, limited
to a total credit of $18,000. Tax credits will be prorated in direct relation
to the time worked in the HPSA.
^ 3.
In order to retain the full value of the credit, the physician, nurse
practitioner or physician's assistant must practice continuously in the
area for five years.
30
�08/22/84
18:50
4.
E.
'Q
The cost, limited to $32,500 annually, of medical equipment used by a
physician in a rural or frontier HPSA can be immediately expensed.
Long Term Care Tax Provisions
1.
Expenditures for qualified long-term care services are deductible as
medical expenses (i.e. subject to the 7.5% floor). Such services include
diagnostic, curing, mitigating, treatment, preventive, therapeutic,
rehabilitative, maintenance and personal care. To be deductible, such
services must be provided to a person who suffers impairment in two
or more activities of daily living or severe cognitive impairment as
certified by a licensed health care practitioner.
2.
Employer-provided qualified long-term care coverage which meets
certain consumer protection standards promulgated by the National
Association of Insurance Commissioners, is excluded from an
employee's taxable income. Premiums paid by an individual for
qualified long-term care coverage are deductible as a medical expense
(i.e. subject to the 7.5% floor);
3.
NAIC is directed to promulgate standards for the use of uniform
language and definitions in qualified long-term care coverage
insurance policies, with permissible variations to take into account
differences in state licensing requirements for long-term care
providers.
F.
Tobacco Tax
(Pending Discussion)
G.
Extending Medicare Hospital Insurance coverage to state and local Employees.
Under current law, certain state and local employees hired prior to 1986 may
elect to opt out of Medicare hospital insurance coverage. This election is
repealed for years after September 30,1995.
31
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
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2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
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Paper
Dublin Core
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“Rump Group” Proposal
Creator
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
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2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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Reproduction-Reference
Date Created
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3/16/2015
Source
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42-t-12092992-20060885F-Seg3-007-004-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/623a500169a7241504cdde82393527c2.pdf
1ea942640906e6f3fc12b7a574bbd447
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
2385
OA/ID Number:
FolderlD:
Folder Title:
[Physician Letters] [loose] [14]
Stack:
Row:
Section:
Shelf:
Position:
s
56
3
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Hillary Clinton
White House
Washington, D . C.
Dear M r s . Clinton:
t was an^early supporter of President Clinton d u r i n g the campaign because of his
clear intention to deal w i t h the economy and healthcare.
D u r i n g y o u r hearings, i t became clear to me that there is going to be a great deal
of opposition to any changes i n the healthcare system b y special interest groups.
I watched, w i t h a great deal of apprehension, attempts to incapacitate any
process.
So f a r , I have been v e r y impressed b y the way you have handled the situation.
The United States is unique among the i n d u s t r i a l countries i n this world that have
not attempted to control the escalation of healthcare costs and the system of
availability of services.
I work i n t h i n n e r c i t y . ) Most of our patients have either no insurance or have
such poor instrpdJiLe t l m i t is almost non-existent.
I t is one of the major;embarrassments i n our c o u n t r y that medical insurance is not
available to a s i ^ S T c a m ''pa i ¥ %§*£he population.
L lf
,
The o p p o r t u n i t y to make a f f e c t i v e changes is here now. I doubt that i t can be
resurrected i n the f u t u r e i f we f a i l . Your e f f o r t s to r e s t r u c t u r e the system are
appreciated even among many of the healthcare p r o v i d e r s .
I f there is a n y t h i n g that I can to assist y o u , please don't hesitate to let me know.
Very t r u l y y o i l r s ,
,
-GedrgerB. Jacobs, M . D .
~ Director o f Spine Services
Professoi/of Neurosurgery
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G.G. Kotia,
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G.S. Hamlin.
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F.M. Bohan.
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Pediatrics
W.C. MacFarland.
M.D.. RC.
E.M. Shalz. M.D.
L. Cusumano.
M.D.
Orthopedic Surgery
and Sports Medicine
R.J. Multy.
RR Schwach.
E.E. Griffin.
M.D., RC.
M.D.. RC.
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Podiatry
J. R Miller.
D.RM.
Oleon medical Group
535 main Street. Oleon. fleuu York 14760
7I6-372-OI4I
February 24, 1993
Dermatology
A.L. Beck. M.D.. RC.
G.T Spigel. M.D., PC.
W.M. Jaremko. M.D.
Gynecology
rS. Wojcik, M.D.. P.C.
B.J. Porcello. R.N.. C.N.P.
Obstetrics and Gynecology
H.R. Ylizarde. Jr.. M.D.
Ms. H i l l a r y Rodham Clinton
The White House
1600 Penn. Ave. N.W.
Washington, D.C. 20500
Cardiology
H.D. Storch.
R.J. Neuleld.
M.D..
PC
M.D.. PC.
Dear Ms. H i l l a r y Rodham C l i n t o n :
Gaslroenterology
J.A. Balacki. M.D. RC.
K.D. Chan Pong, M.D.
Pulmonology
G.W. Wills, M.D.. RC.
Family Practice
RE. Dionne. M.D., P.C.
D.S. Shulman.
M.D.
J.H. Lalor. M.D.
A.L. Knowles. III. M.D., PC.
A. Soland. C.F.N.P.
Physical Therapy
JR. Bova. PJ.
J.C. Slear, P.T.
L.E. Weise. P.T.
J.R. Eaton. AXC.
Internal Medicine
P Godfrey. M.D., RC.
H.L Lochte, M.D. RC.
J.F. Henncssy.
M.D.
J.A. Balacki. M.D.. RC.
L.W. Stevens. M.D.. P.C.
G.N. Wine. M.D.. PC.
Allergy and Immunology
F.H. Lewis. M.D.. P.C.
Radiology
LA.
Dallaire,
M.D.
Urology
J.P. Bohan. M.D.. RC.
P.J. Stuart. M.D.
Otolaryngology
R. Querubin.
M.D., RC.
L.M. Mackenzie.
M.D.
Facial. Plastic. Reconstructive
and Cosmetic Surgery
fi. Querubin.
M.D.. RC.
Rheumatology
L.W. Stevens. M.D.. P.C.
Audiology
M. Simon.
R. Andrzejewskt,
M.A.
M.A.
S p e e c h Pathology
E.
Wagner
Neurology
M.H. Feldman.
M.D.
Franklinville O l l i c e
AX MiUura. M.D, P.C.
Family
Practice
S a l a m a n c a Office
J.L. Veale.
M.D.
Pediatrics
Administration
T.M.
D.A.
Callaghan
Bennett
I am a physician working i n a r u r a l community i n New
York State, and I applaud your e f f o r t s on health care
reform. You are receiving many learned opinions from
experts i n the f i e l d of medicine, law, insurance, e t c .
The "Town Hall Meeting" concept of the Clinton Administrat i o n i s excellent since i t gives the average c i t i z e n a
chance f o r input. I would l i k e t o o f f e r a thought-out,
but by no means p e r f e c t , opinion of a physician engaged
i n day t o day p a t i e n t care.
F i r s t , a b i t about myself. I have been i n p r i v a t e
p r a c t i c e as a s a l a r i e d physician f o r a m u l t i - s p e c i a l t y
group since July 1991.
P r i o r t o t h a t , I was i n the United
States A i r Force f o r 8 years. I have also had the opport u n i t y t o work and study i n England, Germany, and I t a l y
i n the medical f i e l d . Thus, I have seen s o c i a l i z e d medicine
i n day t o day use, and had the opportunity t o compare
t h i s t o fee f o r service medicine as practiced i n America.
I think t h a t the most i d e a l system i s what was available
when I was i n the m i l i t a r y — a n HMO type of arrangement
w i t h p r a c t i c a l l y unlimited funds and access t o the l a t e s t
i n technology; i f something wasn't available w i t h i n the
system I had very l i t t l e trouble sending the p a t i e n t i n t o
the c i v i l i a n community. Also, the system of Quality Assurance
t h a t was i n place ensured t h a t the best type of medicine
was being practiced. Nevertheless, t r a d e - o f f s had t o
be made; such as a r e l a t i v e l i m i t a t i o n i n access t o care.
There were simply more patients than physicians, and there
was sometimes a s i g n i f i c a n t w a i t i n g period before being
seen by a healthcare provider. C e r t a i n l y , urgent cases
were seen, but routine v i s i t s often had t o wait. Such
a system would not be affordable on a national scale.
Limitations i n access t o care or " r a t i o n i n g " i f you w i l l
i s also a problem i n Europe. A f r i e n d of ours i n England
was t o l d t h a t her every 3 year Pap smear (done yearly
here) could wait another couple of years since i t would
�Ms. H i l l a r y Rodham Clinton
- 2 -
February 24,
1993
be hard f o r her t o get an appointment. New York State recently mandated
t h a t insurance c a r r i e r s pay f o r a yearly Pap smear since i t was f e l t
to be so important. I n the United States, when a h i p i s broken i t i s
usually repaired t h a t day or the next; i n England patients can wait days
to weeks f o r surgery since i t i s not l i f e - t h r e a t e n i n g . Those w i t h money
can, of course, be seen r i g h t away.
Thus, I do not f e e l t h a t a system based on the European or Canadian
model i s the best answer. Despite what many say, I f e e l t h a t we have
the best healthcare system i n the world. When my daughter was born at
our r u r a l h o s p i t a l l a s t summer, I knew t h a t i f she had a serious problem
she would have been a i r l i f t e d t o a r e f e r r a l center f o r immediate s p e c i a l i s t
care i f n e c e s s a r y — t h i s i s not true everywhere else. How do we keep
our excellent system but s t i l l maintain a reasonable cost?
A managed care/HMO type of arrangement can be made t o work but
must be attacked from several f r o n t s .
1) Make the p a t i e n t also responsible f o r c o n t r o l of costs. I n
the A i r Force, physicians were swamped because the patients came i n f o r
every l i t t l e cold. Worse y e t , they used the Emergency Room as a primary
care c l i n i c f o r every l i t t l e sore t h r o a t , etc. since i t was convenient
and they d i d not have t o wait f o r an appointment. This could be c o n t r o l l e d
through the use of a co-payment system and/or a d e d u c t i b l e — b o t h of which
could be based on the previous year's income tax statement. The more
t h a t a p a t i e n t earns, the higher the co-payment and/or deductible u n t i l
the insurance kicks i n . Thus, those best able t o a f f o r d i t w i l l also
be the ones t o shoulder the greater burden of health care costs. The
co-payment and/or deductible must never be zero, but should be proport i o n a t e l y " p a i n f u l " depending upon income. I t should not be so high
t h a t i t would prevent the p a t i e n t from seeking medical a t t e n t i o n but
high enough t h a t they w i l l t h i n k twice before going t o the physician
f o r something t r i v i a l .
2) Legal costs must be c o n t r o l l e d as w e l l . Yes, there are some
doctors who should be singled out f o r poor care. However, medicine i s
an a r t , not a black and white science, and we are human and make mistakes.
I f sincere e f f o r t was expended on the p a r t of the physician and things
don't go as expected, i s he/she wrong? Because of the l e g a l climate,
a large amount of money i s spent on "defensive medicine": cesarian sections
t h a t maybe weren't needed, unnecessary t e s t s , and v i s i t s t o a consultant,
etc.
One quick example without too much d e t a i l : I have an e l d e r l y
p a t i e n t and I biopsied a l e s i o n on his forehead t h a t I thought was benign
but needed t o r u l e out a malignancy. The f i r s t biopsy showed t h a t i t
was probably benign, but t o make sure we sent him t o a national l e v e l
cancer h o s p i t a l . They agreed w i t h the f i r s t biopsy, but performed a
second biopsy w i t h special s t a i n s , which confirmed the p r i o r r e s u l t . However,
because of a very small chance of malignancy, they suggested a battery
of expensive, invasive and p o t e n t i a l l y dangerous t e s t s . This was "cover
your behind" medicine. I chose t o play p a t i e n t advocate instead. He
and I sat down and I explained everything t o him, and we agreed t o a
few simple t e s t s and c a r e f u l observation. Was I wrong? Probably not.
However, even i f i t proves t o be malignant, I t h i n k t h a t I d i d the r i g h t
t h i n g f o r him, by treat:'.ny him as a human being w i t h a medical problem
�Ms. H i l l a r y Rodham C l i n t o n
- 3 -
February 24, 1993
and considering h i s needs, f e a r s , and l i f e ' s s i t u a t i o n , rather than seeing
him as a disease and a p o t e n t i a l l e g a l problem.
My suggestions t o r e l i e v e these d i f f i c u l t i e s are as f o l l o w s :
A.
Place a cap on awards.
B.
Consider e l i m i n a t i o n of t o r t f o r a l l but the.poorest of p a t i e n t s .
C.
Create a medical-legal referee systein. which decides the merits
of a case and tosses out the ones t h a t have no business being
i n court. This i s a real problem; o f t e n , the physician d i d
nothing wrong, but the insurance company s e t t l e s out of court,
since i t i s cheaper t o s e t t l e than t o pay l e g a l costs. The
physician i s also t o l d t h a t i f he decides t o f i g h t the decision
and loses, the insurance company w i l l not pay the award! Thus,
he/she i s stuck w i t h a judgement f o r t h e o r e t i c a l l y no wrong
doing. I believe a system such as t h i s i s already i n place
i n England.
D.
I n England, there i s also a system where the person who brought
the charges i s responsible f o r the l e g a l fees of the other
party i f he loses. Why should the innocent party bear t h i s
burden?
3) The t a l k of a uniform insurance form i s laudable. Our Medical
Group must maintain a rather large business o f f i c e w i t h experts on the
various insurances. Every insurance company has a unique set of rules
t h a t we must f o l l o w t o the l e t t e r or they w i l l deny payment.
4) The "micro-management" of Medicare i s also a d i f f i c u l t y . The
rules t h a t they have are very s p e c i f i c , but r e a l l y q u i t e complex, w i t h
many exceptions. I t i s easy t o make a mistake, and reading the b u l l e t i n s
from our c a r r i e r s i t almost sounds as i f we are g u i l t y u n t i l proven innocent-as i f we intended t o defraud—again, I r e a l i z e t h a t people do, but not
most. I may be naive but I have not y e t f i g u r e d out how a physician can
become wealthy operating a Medicare/Medicaid m i l l unless he/she i s not
even seeing the p a t i e n t .
5) Physician's fees could use some type of c o n t r o l , but as you
know, t h i s i s not one of the major causes f o r increases i n health care
spending. I have heard a v a r i e t y of ways of c o n t r o l l i n g costs such as
an across-the-board percentage fee reduction, a "cap" on charges, or even
charging an extra percentage tax on physician's incomes t o fund the new
system. A l l of thesf; might seem f i n e a t f i r s t glance but could p o t e n t i a l l y
be f i n a n c i a l l y devestating t o many physicians. Not a l l c l i n i c s charge
an o v e r - i n f l a t e d r a t e , many charge what i s appropriate f o r the community
i n which they reside. Many of these c l i n i c s are already operating a p r e t t y
narrow margin of p r o f i t t o loss. Percentage reductions i n fees or a d d i t i o n a l
charges on income tax could be ruinous. However, a f a i r "cap" would not
a f f e c t the c l i n i c s already charging a reasonable fee, but c o n t r o l the
c l i n i c s t h a t are charging an e x o r b i t a n t r a t e .
I emphasize that " f a i r " needs t o be the operative word.
For instance.
�Ms. H i l l a r y Rodham Clinton
- 4 -
February 24, 1993
our c l i n i c accepts Medicaid as a community service since there i s no county
c l i n i c . I am paid $7.20 per v i s i t but i t costs me $20.00 t o see the p a t i e n t .
We lose but our community wins. Obviously, i f a l l insurance reimbursed
at t h i s rate we'd be out of business.
We are on the verge of a new f r o n t i e r i n medicine w i t h the chance
to do good f o r many, but should proceed cautiously. I n my opinion i t
might not even be necessary t o change the whole system a l l a t once, but
perhaps s t a r t on the people who work and earn enough t o not be on Welfare/
Medicaid but cannot a f f o r d insurance. These f o l k s are r e a l l y between
a rock and a hard p l a c e — t r y i n g t o become productive c i t i z e n s but having
a tough time of i t — t h e y are surely deserving of our e a r l i e s t e f f o r t s .
I have complete confidence t h a t you w i l l , w i t h the assistance of
many learned professionals, devise a way t o correct America's health care
system f o r the good of both the p a t i e n t and the physician. I applaud
your tremendous e f f o r t i n t h i s important task set f o r t h before you, and
know t h a t whatever decision made w i l l be b e n e f i c i a l t o our great country.
Yours most sincerely.
William M. Jaremko, M.D.
WMJ:cmd
�NYTBROO
Health Sciences Center
Department of Preventive Medicine
School of Medicine
January 25,
1993
H i l l a r y Rodham Clinton, Esq.
West Wing
The White House
Washington, DC 20005
Dear Mrs. Clinton,
I was delighted to learn that you w i l l be the f i r s t wife of a
President ( i s " F i r s t Lady" perhaps becoming a term that i s passe?)
to have an o f f i c e in the West Wing of the White House, and further
to know that one of your f i r s t tasks w i l l be to coordinate the
development of a comprehensive health plan for our country.
We have previously communicated, with me in the role of
p o l i t i c a l analyst (see your enclosed l e t t e r to me about my book. The
New Americanism: How the Democratic Party Can Win the Presidency).
By profession, I am a health policy analyst (see enclosed c.v.). In
that role, I am pleased to send you an unpublished monograph of mine
on health care delivery system reform. You may find i t to be of
interest and use. Please accept i t with my compliments.
You may well be aware that one of the major elements in
creating long-term, productive reform of the health care delivery
system i s to require very basic changes in the way medicine i s
practiced, both in terms of cost-containment per se and in terms of
a re-orientation from c r i s i s management/sick care towards health
promotion and disease prevention. This change would, of course,
both save money and help people live happier, more productive
lives.
To do that of course requires that fundamental changes be made
in the way physicians practice medicine. And that w i l l in turn
require basic changes in undergraduate and graduate medical education and, so that we won't have to wait forever to see positive outcomes in the practice of medicine, in continuing medical education
as well. The gradual approach which seems to be a feature of President Clinton's approach to the issue of health care reform i s well-
State University of New York at Stony Brook
Stony Brook.. New York 11794-8036
516-444-2190 Fax: 516-444-7525
�^Sp'iHJ/
-2
suited to making positive change in medical education, which for
many reasons would take quite some time to effect.
;
I speak to these issues in the enclosed written materials. I
apologize for their bulk (which among other things, decreases the
chances that anyone w i l l read them, I know), but the subject i s a
complicated one. Also, please don't be put off by the fact that I
happen to favor a single-payor system. I know that at present that
is p o l i t i c a l l y infeasible, and I think that many of the reforms that
I believe to be essential can be instituted within a multiple payor
system.
If I can help you in any way, (other than in a full-time
capacity), please let me know.
With my best wishes,
Since
M.D., M.P.H.
�Chnton
FOR PRESIDENT COMMITTEE
June 29, 1992
Steven Jonas. M.D., M.P.H.
State University of New York
Strony Brook Health Sciences Center
Department of Preventive Medicine
Stony Brook, NY 11794-8036
Dear Steven:
Thank you for your thoughtful l e t t e r and your book, The New
Americanism, with i t s many good ideas about how the Democratic
Party can seize the i n i t i a t i v e i n t h i s and coming campaigns.
Your emphasis on framing our rhetoric i n terms of our having an
agenda which promotes the basic American values of l i b e r t y and
freedom i s both interesting and promising. I have forwarded a
copy of your book to our communications department.
As the campaign progresses, I continue to be encouraged by the
overwhelmingly positive responses and many bright suggestions
we've received from around the country. We welcome your
p a r t i c i p a t i o n i n t h i s great endeavor and encourage you to help
further i n any way you can.
Sincerely yours,
\
Hillary
cc:
lodham Clinton
Communications
National Campaign Headquarters • P.O. Box 615 • Little Rock, Arkansas 72203 • Telephone (501) 372-1992 • FAX (501) 372-2292
@
Printed on Recycled Paper
Paid for by the Clinton for President Committee
Contributions to the Clinton tor President Committee are not tax deductible.
12<^J^:, £
�U.S.iV.iA&L
5 4 .! 0 =
��Health Sciences Center
Department of Preventive Medicine
School of Medicine
January 25, 1993
H i l l a r y Rodham C l i n t o n , Esq.
West Wing
The White House
Washington, DC 20005
Dear Mrs. C l i n t o n ,
I was d e l i g h t e d t o l e a r n t h a t you w i l l be t h e f i r s t w i f e o f , a
P r e s i d e n t ( i s " F i r s t Lady" perhaps becoming a term t h a t i s passe?)
to have an o f f i c e i n t h e West Wing of t h e White House, and f u r t h e r
to know t h a t one of your f i r s t t a s k s w i l l be t o c o o r d i n a t e t h e
development of a comprehensive h e a l t h p l a n f o r our c o u n t r y .
We have p r e v i o u s l y communicated, w i t h me i n t h e r o l e o f
p o l i t i c a l a n a l y s t (see your enclosed l e t t e r t o me about my book, The
New Americanism: How t h e Democratic P a r t y Can Win t h e P r e s i d e n c y ) .
By p r o f e s s i o n , I am a h e a l t h p o l i c y a n a l y s t (see enclosed c . v . ) . I n
t h a t r o l e , I am pleased t o send you an u n p u b l i s h e d monograph of mine
on h e a l t h care d e l i v e r y system r e f o r m . You may f i n d i t t o be of
i n t e r e s t and use. Please accept i t w i t h my compliments.
You may w e l l be aware t h a t one of t h e major elements i n
c r e a t i n g l o n g - t e r m , p r o d u c t i v e r e f o r m of t h e h e a l t h care d e l i v e r y
system i s t o r e q u i r e v e r y b a s i c changes i n t h e way medicine i s
p r a c t i c e d , b o t h i n terms of c o s t - c o n t a i n m e n t per se and i n terms of
a r e - o r i e n t a t i o n from c r i s i s management/sick care towards h e a l t h
p r o m o t i o n and disease p r e v e n t i o n . T h i s change would, of course,
b o t h save money and h e l p people l i v e h a p p i e r , more p r o d u c t i v e
1ives.
To do t h a t of course r e q u i r e s t h a t fundamental changes be made
i n t h e way p h y s i c i a n s p r a c t i c e medicine. And t h a t w i l l i n t u r n
r e q u i r e b a s i c changes i n undergraduate and graduate medical educat i o n and, so t h a t we won't have t o w a i t f o r e v e r t o see p o s i t i v e o u t comes i n t h e p r a c t i c e of m e d i c i n e , i n c o n t i n u i n g medical e d u c a t i o n
as w e l l . The g r a d u a l approach which seems t o be a f e a t u r e of P r e s i dent C l i n t o n ' s approach t o t h e issue of h e a l t h care r e f o r m i s w e l l -
State University of New York at Stony Brook
Stony Brook, New York 11794-8036
516-444-2190 Fax: 516-444-7525
�-2suited t o making p o s i t i v e change i n medical education, which f o r
many reasons would take q u i t e some time t o e f f e c t .
I speak t o these issues i n the enclosed w r i t t e n materials. I
apologize f o r t h e i r bulk (which among other things, decreases the
chances that anyone w i l l read them, I know), but the subject i s a
complicated one. Also, please don't be put o f f by the f a c t that I
happen t o favor a single-payor system. I know that at present that
is p o l i t i c a l l y i n f e a s i b l e , and I think that many of the reforms that
I believe t o be essential can be i n s t i t u t e d w i t h i n a m u l t i p l e payor
system.
I f I can help you i n any way, (other than i n a f u l l - t i m e
c a p a c i t y ) , please l e t me know.
With my best wishes,
Since
nas, M.D., M.P.H.
�Chnton
FOR PRESIDENT COMMITTEE
June 29, 1992
Steven Jonas. M.D., M.P.H.
State University of New York
Strony Brook Health Sciences Center
Department of Preventive Medicine
Stony Brook, NY 11794-8036
Dear Steven:
Thank you for your thoughtful l e t t e r and your book, The New
Americanism, with i t s many good ideas about how the Democratic
Party can seize the i n i t i a t i v e i n t h i s and coming campaigns.
Your emphasis on framing our rhetoric i n terms of our having an
agenda which promotes the basic American values of liberty and
freedom i s both interesting and promising. I have forwarded a
copy of your book to our communications department.
As the campaign progresses, I continue to be encouraged by the
overwhelmingly positive responses and many bright suggestions
we've received from around the country. We welcome your
participation i n t h i s great endeavor and encourage you to help
further i n any way you can.
Sincerely yours,
\
Hillary
cc:
iodham Clinton
Communications
National Campaign Headquarters • P.O. Box 615 • Little Rock, Arkansas 72203 • Telephone (501) 372-1992 • FAX (501) 372-2292
@
Printed on Recycled Paper
Paid lor by lhe Clinton for President Committee
Contributions to the Clinton tor President Committee are not tax deductible
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�CURRICULUM VITAE
FOR
STEVEN JONAS, M.D., M.P.H.
Professor
Department of Preventive
Medicine
School of Medicine
State U n i v e r s i t y of New York
Stony Brook, NY 11794-8036
(516) 444-2190, 2147
September 1992
�-2I.
EDUCATION AND PROFESSIONAL TRAINING
1954-58
1958-62
1962- 63
1963- 64
1964- 65
1965- 67
1965- 68
1986-87
II.
Columbia C o l l e g e , New York, NY, B.A., 1958
Harvard Medical School, Boston, MA, M.D., 1962
Lenox H i l l H o s p i t a l , New York, NY, I n t e r n s h i p
U n i v e r s i t y College o f London, London, England,
Department o f Anatomy, U n i t e d S t a t e s P u b l i c H e a l t h
S e r v i c e F e l l o w s h i p i n Neurophysiology.
London School o f Economics, London, England,
Department o f S o c i a l A d m i n i s t r a t i o n , Research
Fellow
Yale School o f Medicine, New Haven, CT, Department
of Epidemiology and P u b l i c H e a l t h . I n r e s i d e n c e
1965- 66 o n l y .
M.P.H., 1967.
New York C i t y Department o f H e a l t h , Residency i n
Preventive Medicine-Public Health
Touro College School o f Law, H u n t i n g t o n , NY.
(Completed f i r s t year.)
MAJOR PROFESSIONAL EXPERIENCE
1966- 69
1969-71
1969-71
19691970- 71
1971-
Department o f H e a l t h , New York C i t y
1966- 67 P u b l i c H e a l t h P h y s i c i a n Resident
1967- 68 D i s t r i c t H e a l t h O f f i c e r (July-Nov. 1968,
Medical D i r e c t o r , Drew Neighborhood H e a l t h Center,
St. Mary H o s p i t a l , B r o o k l y n , NY)
D i r e c t o r , Department o f S o c i a l Medicine,
M o r r i s a n i a C i t y H o s p i t a l , Bronx, NY.
A s s i s t a n t P r o f e s s o r , Department o f Community H e a l t h ,
A l b e r t E i n s t e i n C o l l e g e o f Medicine, Bronx, NY.
L e c t u r e r , Department o f Community Medicine, Mount
S i n a i School o f Medicine, New York, NY.
Adjunct A t t e n d i n g P h y s i c i a n , Department o f S o c i a l
Medicine, M o n t e f i o r e H o s p i t a l and Medical Center.
H e a l t h Sciences Center, S t a t e U n i v e r s i t y o f New
York a t Stony Brook, Stony Brook, NY.
1971-74 A s s i s t a n t P r o f e s s o r , Department o f
Community Medicine
1971-74 C o o r d i n a t o r o f Ambulatory S e r v i c e s ,
University Hospital
1973- 86 A s s i s t a n t A t t e n d i n g , Department o f
Medicine, Nassau County Medical Center, East
Meadow, NY.
1974- 83 A s s o c i a t e P r o f e s s o r , Department o f
Community and P r e v e n t i v e Medicine
1979- C o n s u l t a n t , Department o f Medicine,
W i n t h r o p - U n i v e r s i t y H o s p i t a l , ( f o r m e r l y Nassau
H o s p i t a l ) , Mineola, NY.
1980- A t t e n d i n g , Department o f Community and
P r e v e n t i v e Medicine, ( f r o m 1989, Department o f
Preventive Medicine), University Hospital at
Stony Brook.
�-31983-
1977-79
Columbia U n i v e r s i t y School of A r c h i t e c t u r e Program
i n H e a l t h Services P l a n n i n g and Design, V i s i t i n g ,
then Adjunct A s s o c i a t e P r o f e s s o r .
1980-
III.
P r o f e s s o r , Department of Community and P r e v e n t i v e
Medicine, ( f r o m 1989, Department of P r e v e n t i v e
Medicine).
Texas College o f O s t e o p a t h i c Medicine,
TX, Department o f Medical Education,
Associate Professor.
F o r t Worth,
Adjunct
OTHER SIGNIFICANT PROFESSIONAL EXPERIENCE
1974-77
1976- 79
1977- 78
1977-87
1977- 86
19781978- 81
1979
1979- 82
1983-84
1983-86
19831984- 89
1987- 92
1988- 89
1991-92
1990-
Eurosystem H o s p i t a l l e r , B r u s s e l s , Belgium.
Associate Consultant.
Springer P u b l i s h i n g Co., New York, NY, H e a l t h Care
and S o c i e t y book s e r i e s . Chief E d i t o r .
New York S t a t e Assembly S p e c i a l A d v i s o r y Council on
Medical L i c e n s u r e and P r o f e s s i o n a l Conduct,
member.
New York S t a t e Board f o r Medicine, member.
P r e v e n t i v e Medicine and P u b l i c H e a l t h , A p p l e t o n C e n t u r y - C r o f t s , E d i t o r i a l A d v i s o r y Board, member.
S p r i n g e r P u b l i s h i n g Co., New York, NY, Medical
Educat i o n book s e r i e s , Chief E d i t o r .
Nassau P h y s i c i a n s Review O r g a n i z a t i o n , member Board
of D i r e c t o r s . Chairman, Education
Committee (1979-81).
H e a l t h Manpower Task Force o f t h e New York S t a t e
Commission on H e a l t h Education and I l l n e s s
P r e v e n t i o n , member.
Nassau Plan f o r H e a l t h Care, member Board o f
D i r e c t o r s , (Chairman, 1981-82).
FLEX I Test M a t e r i a l Development Subcommittee,
member.
School o f A l l i e d H e a l t h P r o f e s s i o n s , H e a l t h Sciences
Center a t Stony Brook H e a l t h Promotion/Disease
P r e v e n t i o n N a t i o n a l Resource Center, N a t i o n a l
A d v i s o r y Board, member.
P r e v e n t i v e Medicine, A s s o c i a t e E d i t o r f o r General
P r e v e n t i v e Medicine and P u b l i c H e a l t h .
U n i t e d States P r e v e n t i v e Services Task
Force, Department o f H e a l t h and Human S e r v i c e s ,
Washington, DC, Senior A d v i s o r .
American J o u r n a l o f P r e v e n t i v e Medicine, A s s o c i a t e
E d i t o r f o r Medical and P u b l i c H e a l t h Education.
The WalkWays Center, Washington, DC, M e d i c a l / H e a l t h
Advisor.
American J o u r n a l o f P r e v e n t i v e Medicine, Book Review
Edi t o r
N a t i o n a l Drug S t r a t e g y Network A d v i s o r y Board, Member
�-41990-
George Mason U n i v e r s i t y Center f o r H e a l t h P o l i c y
A d v i s o r y Committee, Member
American P u b l i c H e a l t h A s s o c i a t i o n , Working Group on
A l c o h o l and Drug P o l i c y o f t h e Program Development
Board, T e c h n i c a l E x p e r t .
E d i t o r i a l A d v i s o r y Committee t o t h e Task Force on
H e a l t h Promotion and Disease P r e v e n t i o n o f t h e
A s s o c i a t i o n o f Academic H e a l t h Centers, Member
N a t i o n a l Wellness C o a l i t i o n , Member, P o l i c y A d v i s o r y
Commi t tee
Group f o r t h e S c i e n t i f i c Reappraisal o f t h e
HIV/AIDS Hypothesis, Member, E x e c u t i v e Committee
American J o u r n a l o f P r e v e n t i v e Medicine, Member,
E d i t o r i a l Board
J o u r n a l o f t h e I n t e r A m e r i c a n Medical and H e a l t h
A s s o c i a t i o n , Member, E d i t o r i a l Board
19901991
1991199119921992IV.
HONORS AND OTHER PROFESSIONAL QUALIFICATIONS
1958
1969
1971
1971
1972
1982
1982
1986-87
1988-
V.
B.A., cum laude. Phi Beta Kappa
F e l l o w , American P u b l i c H e a l t h A s s o c i a t i o n
Diplomate, American Board o f P r e v e n t i v e MedicinePublic Health
F e l l o w , American C o l l e g e o f P r e v e n t i v e Medicine
F e l l o w , New York Academy o f Medicine
R e c i p i e n t , American J o u r n a l of Nursing Book of t h e
Year Award f o r H e a l t h Care D e l i v e r y i n t h e U n i t e d
States•
R e c i p i e n t , Founders' Medal f o r C o n t r i b u t i o n s t o
Medical E d u c a t i o n , Texas C o l l e g e of Osteopathic
Medicine.
Dean's F e l l o w , Touro C o l l e g e School of Law,
H u n t i n g t o n , NY.
Who's Who i n America, 4 5 t h , 4 6 t h , 47th E d i t i o n s ,
Biographee.
PUBLICATIONS
A.
Books, I n d i v i d u a l
1.
Q u a l i t y C o n t r o l o f Ambulatory Care: A Task f o r
H e a l t h Departments. S p r i n g e r P u b l i s h i n g Co., New
York, NY, 1977.
2.
Medical Mystery:
United States.
3.
T r i a t h l o n i n q f o r Ordinary Mortals.
WW
. . Norton, 1986.
4.
An I n t r o d u c t i o n t o t h e U.S. H e a l t h Care System, 3rd
ed.. New York: S p r i n g e r P u b l i s h i n g Co., 1992.
The T r a i n i n g o f Doctors i n t h e
WW
. . Norton Co., New York, NY, 1978
New York:
�-55.
The New Americanism: How the Democratic P a r t y Can
the P r e s i d e n c y , Monroe, NY: L i b r a r y Research
Associates/Thomas J e f f e r s o n Press, 1992.
6.
T a k i n g C o n t r o l of Your Weight, Yonkers, NY:
Win
Consumer
Reports Books, 1993, ( i n p r e s s ) .
B.
Books, w i t h Other Authors
1.
e d H a n f Banta, D. , McCarthy, C ,
Barhydt, ,N., i t o r , t , R., Koran, L., E n r i g h t , M.,
Rimer, B., H e a l t h Care D e l i v e r y i n the U n i t e d
S t a t e s . S p r i n g e r P u b l i s h i n g Co., New York, NY,
1977 .
Smith, H.A., ed. , Roseman, C , Sanger, J.M.,
A x e l r o d , R., Mason, S.A., and L i g h t l e ,
M.A.,
A l t e r n a t i v e Uses of H e a l t h Care Resources: The
Role of Conversion. Houston, TX: Southwest Center
f o r Urban Research, 1979.
, e d i t o r , Banta, D. , McCarthy, C , B a r h y d t ,
N., H a n f t , R., Koran, L., E n r i g h t , M., Pearson, D.,
Wetle, T., H e a l t h Care D e l i v e r y i n the U n i t e d
S t a t e s , 2nd ed., New York: S p r i n g e r P u b l i s h i n g Co.,
1981.
, e d i t o r , Banta, D., B a r h y d t , N., Koran, L.,
L e v i t t , J., McCarthy, C , Pearson, D., Rosenberg,
S., S c h a r f s t e i n , S., Thorpe, K., Wetle, T., H e a l t h
Care D e l i v e r y i n the U n i t e d S t a t e s , 3rd ed.. New
York: S p r i n g e r P u b l i s h i n g Co., 1986.
, and Radetsky, P. PaceWaIking: The
Balanced Way t o A e r o b i c H e a l t h . New York: Crown
P u b l i s h e r s , 1988.
, and Aronson, V. The " I Don't Eat, ( b u t
I can't l o s e ) " Weight Loss Program. New York:
Rawson/McMi1lan, 1989.
7.
C.
Woolf, S.,
, and Lawrence, R. , Eds.,
Manual of H e a l t h Promotion and Disease P r e v e n t i o n i n
C l i n i c a l P r a c t i c e , B a l t i m o r e , MD: W i l l i a m s and
W i l k i n s , 1994 ( i n p r e p a r a t i o n ) .
Monographs, Book Chapters, and E d i t e d J o u r n a l Issues
1.
"The D e l i v e r y of H e a l t h Care." W i t h V.W. S i d e l i n
T i c e ' s P r a c t i c e of M e d i c i n e , V o l . 1, Chapter 21.
Hagerstown, MD:
Harper and Row, 1973.
New
E d i t i o n , w i t h D. Drosness and V.W. S i d e l , 1977.
�-62.
"Organized Ambulatory Services and the Enforcement
of H e a l t h Care Q u a l i t y Standards i n New York S t a t e . '
I n Lieberman, M., ed. The Impact of N a t i o n a l H e a l t h
Insurance on New York. New York: P r o d i s t , 1977,
p. 191.
3.
"Closing Address—Future D i r e c t i o n s i n Health
F a c i l i t y Reuse." I n H e a l t h F a c i l i t y Reuse,
R e t r o f i t , and R e c o n f i g u r a t i o n , H y a t t s v i l l e , MD:
N a t i o n a l Center f o r H e a l t h Services Research, 1980.
4.
" P r o v i s i o n of P u b l i c H e a l t h S e r v i c e s . " Chap. 48
i n L a s t , J.M., ed. P u b l i c H e a l t h and P r e v e n t i v e
Medicine, 11th Ed., New York:
Appleton-CenturyC r o f t s , 1980; Chap. 54 i n the 12th Ed.,
1986.
5.
The Need f o r P r e v e n t i v e and Community Medicine
F a c u l t y i n Schools of Medicine.
Monograph
p u b l i s h e d by the O f f i c e of Graduate Medical
E d u c a t i o n , P u b l i c H e a l t h S e r v i c e , U.S. Department
of H e a l t h and Human S e r v i c e s , H y a t t s v i l l e , MD,
January, 1981.
6.
"Planning f o r N a t i o n a l H e a l t h Insurance by
O b j e c t i v e : The C o n t r a c t Mechanism." Chap. 8 i n
S t r a e t z , R.A.,
e_t a_l. , Ed. C r i t i c a l Issues i n
H e a l t h P o l i c y , L e x i n g t o n , MA:
D.C. Heath and
Co.,
1981.
7.
"Forum: The Place of P r e v e n t i o n i n Medical
Education:
Past, Present, and F u t u r e . "
Edited,
w i t h Charles B. A r n o l d as C o - e d i t o r , f o r
P r e v e n t i v e Medicine, 10, 661-740, 1981.
8.
"Education i n the H e a l t h Sciences Network." I n
Mustard, J.F., et a l , Eds., New Trends i n H e a l t h
Sciences Education, Research, and S e r v i c e s :
The
McMaster Experience.
New York: Praeger, 1982.
9.
" N a t i o n a l P o l i c y f o r Medical Student Education i n
Prevention."
I n Barker, W.H.,
Ed. Teaching
P r e v e n t i v e Medicine i n Primary Care. New York:
S p r i n g e r P u b l i s h i n g Co.,
1983.
10.
" R e g u l a t i n g the Q u a l i t y of P a t i e n t Care."
H a f f n e r , A.N.,
, and P o l l o c k , B.J.
Chap. 1 i n Pena, J.J., H a f f n e r , A.N., Rosen, B.,
and L i g h t , D., Eds., Q u a l i t y Assurance, Risk
Management, and Program E v a l u a t i o n : Tools f o r
C l i n i c i a n s and A d m i n i s t r a t o r s . R o c k v i l l e , MD:
Aspen Systems Corp., 1984.
�-711.
12.
"The U.S. Drug Problem and the U.S. Drug C u l t u r e : A
P u b l i c H e a l t h S o l u t i o n . " Chapter E i g h t i n I n c i a r d i ,
J., Ed. The Drug L e g a l i z a t i o n Debate, V o l . Seven of
"Studies i n Crime, Law, and J u s t i c e . " Newbury Park,
CA: Sage P u b l i c a t i o n s , 1991.
13.
D.
" P o p u l a t i o n Data f o r H e a l t h and H e a l t h Care,"
Chapter 3, and "Health Manpower," Chapter 4, i n
Kovner, A., Ed. H e a l t h Care D e l i v e r y i n the U n i t e d
S t a t e s , 4 t h E d i t i o n , New York, S p r i n g e r
P u b l i s h i n g Co., 1990.
" P u b l i c H e a l t h Approach t o the P r e v e n t i o n of Substance
Abuse." A c h a p t e r i n Lowinson, J., et a l , Eds.,
Substance Abuse: A Comprehensive Textbook, 2nd Ed.,
B a l t i m o r e , MD: W i l l i a m s and W i l k i n s , 1992.
O r i g i n a l Papers, I n d i v i d u a l
1.
"Development of Tolerance t o LSD-25 i n Monkeys."
Psychopharmacologia, 6, 303, June 1964.
2.
"Why Do They Emigrate?"
1965, p. 18.
3.
" ' S o c i a l i z e d Medicine' i n America."
Medical
World
(London), J u l y 5, 1965, p. 18.
4.
"The F u t u r e of the B r i t i s h N a t i o n a l H e a l t h
S e r v i c e . " P h y s i c i a n s ' Forum, 2, 2, F a l l 1965.
5.
"Medicare Gets Under Way."
Medical
(London), September 1966, p. 35.
6.
"Heart Disease, Cancer and Stroke -- Regional
Medical Programs. L e g i s l a t i v e Development and
A d m i n i s t r a t i v e I n t e r p r e t a t i o n . " J o u r n a l of the
N a t i o n a l Medical A s s o c i a t i o n , 59, 7, March 1967.
7.
"From J o u r n a l of I n d u s t r i a l Hygiene t o A r c h i v e s
of Environmental H e a l t h . A Survey of Changing
Scope." A r c h i v e s of Environmental H e a l t h , 14, 634.
A p r i l , 1967
( A l s o appeared i n t r a n s l a t i o n as, "Nota
h i s t o r i c a l Del " J o u r n a l of I n d u s t r i a l Hygiene' a los
"Archives of Environmental H e a l t h . ' Examen de un
cambio," Medicine De Empresa, ( S p a i n ) , 4., 448, 1968).
8.
The Lancet, June 5,
World
"Why A u d i t Q u a l i t y of Medical Care?" J o u r n a l of
the N a t i o n a l Medical A s s o c i a t i o n , 60, 228, May 1968.
�-89.
" F i n a n c i n g Systems f o r H e a l t h S e r v i c e s : The r o l e
of the H e a l t h Services A d m i n i s t r a t o r and the Schools
of P u b l i c H e a l t h , " comment on a paper by E v e l i n e M.
Burns. American J o u r n a l o f P u b l i c H e a l t h ,
Supplement, January 1969, p.23.
10.
" N a r c o t i c s : A Conference f o r P r o f e s s i o n a l s , NonP r o f e s s i o n a l s , and the Community i n H e a l t h . " New
York S t a t e J o u r n a l of Medicine, 70, 799, 1970.
11.
"Planning f o r H o s p i t a l Emergency S e r v i c e s . "
PostGraduate Medicine,
No. 1, p. 223, January 1971.
R e p r i n t e d i n C l a r k , V.V., ed. O u t p a t i e n t Services
J o u r n a l A r t i c l e s , 2nd ed., Medical
Examination
P u b l i s h i n g Co., New York, 1973.
12.
"Appointment-breaking
i n a General Medical C l i n i c . "
Medical Care, 9, 82, January-February, 1971.
13.
"A T h e o r e t i c a l Approach t o the Question o f 'Community
C o n t r o l ' o f H e a l t h Services F a c i l i t i e s . "
American
J o u r n a l o f P u b l i c H e a l t h , 6 1 , 916, 1971.
14.
"Community and M i n o r i t y Group R e l a t i o n s . " Yale
J o u r n a l o f B i o l o g y and Medicine, Weinerman Memorial
I s s u e , V o l . 44, No. 1, p. 172, August 1971.
15.
"Heroin U t i l i z a t i o n :
A Communicable Disease?" New
York S t a t e J o u r n a l o f Medicine, 72, 1292, 1972.
16.
" I n f l u e n c e o f the Weather on Appointment-Breaking i n a
General Medical C l i n i c . Medical Care, 9, 72, 1973.
17.
"A V i s i t t o a R e h a b i l i t a t i o n H o s p i t a l i n Japan."
H o s p i t a l s , J.A.H.A., June 1, 1973, p. 101.
18.
"Some Thoughts on Primary Care." I n t e r n a t iona1
J o u r n a l o f H e a l t h S e r v i c e s , 3, 177, 1973.
19.
"Broaden the Cure f o r Racism." H o s p i t a l s , J.A.H.A.,
Vol. 48, p. 72, February 16, 1974.
20.
"Issues i n N a t i o n a l H e a l t h Insurance i n the U n i t e d
S t a t e s o f America." The Lancet, J u l y 20, 1974,
p. 143.
21.
"The D i s t r i c t H e a l t h Center i n Japan: H i s t o r y ,
Services and Future Development." American J o u r n a l
of P u b l i c H e a l t h , 65, 58, 1975.
22.
"Health S e r v i c e s i n Japan." H o s p i t a l s , J.A.H.A., V o l .
49, September 1, 1975, p. 56.
�-923.
"Copayment and N a t i o n a l H e a l t h Insurance i n the U n i t e d
S t a t e s : A C r i t i q u e o f Work by Newhouse, Phelps and
Schwartz." I n t e r n a t i o n a l J o u r n a l o f H e a l t h S e r v i c e s ,
7, 489, 1977.
24.
"The Japanese Experience w i t h N a t i o n a l H e a l t h
Insurance." Massachusetts P h y s i c i a n , V o l . 37, I n two
p a r t s : May, June 1978.
25.
" L i m i t a t i o n s of Community C o n t r o l o f H e a l t h F a c i l i t i e s
and S e r v i c e s . " American J o u r n a l o f P u b l i c H e a l t h ,
68., 541, 1978.
26.
" P r e s i d e n t ' s Address: 35th Annual Meeting,
A s s o c i a t i o n o f Teachers o f P r e v e n t i v e Medicine.
H e a l t h - O r i e n t e d P h y s i c i a n Education:
There's HOPE
f o r the F u t u r e . " J o u r n a l o f Community H e a l t h , 4 ,
.
259, 1979.
27.
" F e e - f o r - S e r v i c e P r i v a t e P r a c t i c e Medicine:
Problems
and C o n t r a d i c t i o n s . " Consumer H e a l t h P e r s p e c t i v e s ,
V o l . V I , No. 4, August 1979, p. 1.
28.
" H o s p i t a l s Adopt New Role."
October 1, 1979, p. 84.
29.
"Rx f o r H e a l t h Care D e l i v e r y . "
No. 2, March 1980, p. 14.
30.
" F e e - f o r - S e r v i c e P r i v a t e P r a c t i c e Medicine:
Part 2."
Consumer H e a l t h P e r s p e c t i v e s , V o l . V I I , No. 2, A p r i l
1980, p. 1.
31.
"Planning f o r N a t i o n a l H e a l t h Insurance by
O b j e c t i v e . " P o l i c y Studies J o u r n a l , V o l . 9, No. 2,
S p e c i a l # 1 , 1980-81.
32.
" P r e v e n t i o n : H e l p i n g P a t i e n t s ' Up F r o n t . "
March 1981, p. 9.
33.
"Some Thoughts on the Future o f H e a l t h Services i n t h e
U n i t e d S t a t e s . " Employee B e n e f i t s J o u r n a l , V o l . 6,
No. 2, June 1981 , p. 10.
34.
"Assuring the Q u a l i t y o f the T r a i n i n g of F o r e i g n
Medical Students and Graduates E n t e r i n g New York
S t a t e . " New England J o u r n a l of Medicine, 305, 45,
1981 .
35.
" H e a l t h - O r i e n t e d P h y s i c i a n Education."
Medicine, 10, 700, 1981.
H o s p i t a l s , J.A.H.A.,
Environment, V o l . 22,
Co 1loquy,
Prevent i v e
�-10-
36.
" H e a l t h - O r i e n t e d P h y s i c i a n Education and
Medicine."
The DO, A p r i l , 1982, p. 109.
i n The Texas DO, June, 1982.)
Osteopathic
(Reprinted
37.
"A P e r s p e c t i v e on Educating P h y s i c i a n s f o r
P r e v e n t i o n . " P u b l i c H e a l t h Reports, 97, 199,
1982.
38.
"Osteopathic Medicine and the Texas College of
O s t e o p a t h i c Medicine."
The DO, May, 1983, p. 81.
39.
"The D e s t r u c t i o n of C i v i l i z a t i o n i n Nuclear
War."
J o u r n a l of the American Medical A s s o c i a t i o n , 251,
197, 1984.
40.
"The Personal H e a l t h Care System." New
J o u r n a l of Medicine, 84.. 187, 1984.
41.
"The H i s t o r i c a l and T h e o r e t i c a l Basis f o r the New York
S t a t e Board of Regents' P o l i c y Concerning U.S.
Foreign Medical Students."
New York S t a t e J o u r n a l of
Medicine, 84, 345, 1984.
42.
"The Case f o r Change i n Medical Education i n the
U n i t e d S t a t e s . " The Lancet, August 25, 1984, p.
York S t a t e
452.
43.
"A Modest Proposal f o r C o n t r o l l i n g the I n f l u x of
U n i t e d S t a t e s C i t i z e n F o r e i g n Medical Graduates i n
the U n i t e d S t a t e s . " F e d e r a t i o n B u l l e t i n , 72, 106,
1985 .
44.
"On Homelessness and the American Way" ( E d i t o r i a l ) .
American J o u r n a l of P u b l i c H e a l t h , 76, 1084,
1986.
45.
"Implementing the Recommendations of the GPEP Report
P e r t a i n i n g t o P r e v e n t i v e Medicine."
American J o u r n a l
of P r e v e n t i v e Medicine, 3, 233, 1987.
46.
"The C l i n i c a l P r e v e n t i v e Medicine S p e c i a l i s t : A
Proposed Model." P e r s p e c t i v e s on P r e v e n t i o n , V o l . 2,
No. 1, F a l l , 1987, p. 17.
47.
"Health Promotion i n Medical
J o u r n a l of H e a l t h Promotion,
48.
"AIDS: An A l t e r n a t i v e Scenario."
Congress iona1
Record, V o l . 134, No. 127, Sept. 15, 1988.
Reprinted
i n AIDS Forum, 2, 32, September, 1989.
49.
" I s the Drug Problem Soluble?"
S c i e n t i s t , 32, 295, 1989.
50.
"How t o I n c o r p o r a t e H e a l t h Promotion i n t o N a t i o n a l
H e a l t h Insurance."
American J o u r n a l of H e a l t h
Promot i o n , 3, 73, S p r i n g , 1989.
Education."
American
3, 37, 1988.
American B e h a v i o r a l
�-1151.
52.
" P u b l i c H e a l t h Approach t o Designing
The Drug P o l i c y L e t t e r , V o l . I I , No.
1990, p. 10.
53.
E.
" F i g h t New Enemies i n the War on Drugs."
February 20, 1990, V i e w p o i n t s p. 45.
" S o l v i n g the Drug Problem: A P u b l i c H e a l t h Approach
t o the Reduction of the Use and Abuse of Both Legal
and I l l e g a l R e c r e a t i o n a l Drugs." H o f s t r a Law Review,
Vol. 18, No. 3, S p r i n g , 1990, p. 751.
O r i g i n a l , w i t h other
Newsday,
Drug P o l i c y . "
2, M a r c h / A p r i l ,
Authors
1.
Rosenblut, A.,
, W a s s e r t h e i l , S., Meyer,
S.,
"OPD W a i t i n g Time Reduced by Use of I n d i v i d u a l
Time Appointment System." H o s p i t a l Topics, March
1972.
2.
, O'Dwyer, E., Zendel, J., S i d e l , V.,
"Ambulatory Heroin D e t o x i f i c a t i o n i n a M u n i c i p a l
H o s p i t a l . " New York S t a t e J o u r n a l of Medicine, 72,
2099, 1972.
3.
, and Banta, D.
"The 1974 R e o r g a n i z a t i o n of
the B r i t i s h N a t i o n a l H e a l t h S e r v i c e : An A n a l y s i s . "
J o u r n a l of Community H e a l t h , I , 91, 1975.
, F l e s h , R., Brooke, R.,
Wasserthei1-Smoller,
S.
" M o n i t o r i n g U t i l i z a t i o n of a M u n i c i p a l H o s p i t a l
Emergency Department." H o s p i t a l Topics, V o l . 54,
Jan./Feb. 1976, p. 43.
, Cox, T. and Lament, CT.
"A Family Medicine
Residency Program i n a Semi-Rural S e t t i n g :
Development of A Plan." New York S t a t e J o u r n a l of
Medicine, 77, 108, 1977.
V u o r i , H. and
, " F i n n i s h Reform of Medical
Education:
I m p l i c a t i o n s f o r the U n i t e d S t a t e s . "
H e a l t h P o l i c y and Education, I , 367, 1980.
Barker, W.H. w i t h
, "The Teaching of P r e v e n t i v e
Medicine i n American medical Schools, 1940-1980."
P r e v e n t i v e Medicine, 10, 674, 1981.
, and W i l l i a m Parker.
"Architectural
Expression of a S o c i a l H i e r a r c h y . " Environment, V o l .
24, No. 4, May 1982, p. 42.
, and Nan S i l v e r .
"The
American H e a l t h , V o l . IV, No.
Last C u r e - A l l . "
2, p. 62, March
1985.
�-1210.
11.
, and Burton P o l l a c k . "The Legal System of t h e
U n i t e d S t a t e s . " J o u r n a l o f Law and E t h i c s i n
D e n t i s t r y , 2, , 1989.
12.
F.
, and Burton P o l l a c k . "The Bases o f the Law."
J o u r n a l o f Law and E t h i c s i n D e n t i s t r y , 2, 96, 1989.
, and Burton P o l l a c k . "How the Courts
F u n c t i o n . " J o u r n a l o f Law and E t h i c s i n D e n t i s t r y ,
3,
, 1990.
Forwards
1.
2.
Successful F a c u l t y i n Academic Medicine, Carole J.
Bland, e t a_L, S p r i n g e r S e r i e s on Medical E d u c a t i o n .
New York: S p r i n g e r P u b l i s h i n g , 1990.
3.
H e a l t h Without Drugs, A r a b e l l a M e l v i l l e and C o l i n
Johnson. New York: Fireside/Simon and Schuster, 1990.
4.
G.
A P r a c t i c a l Guide t o C l i n i c a l Teaching i n Medicine,
Kaaren C. Douglas, e l a i , eds.. S p r i n g e r S e r i e s on
Medical E d u c a t i o n . New York: S p r i n g e r P u b l i s h i n g ,
1988 .
H e a l t h Care D e l i v e r y i n the U n i t e d S t a t e s , 4 t h
E d i t i o n , Anthony J. Kovner, ed. New York: S p r i n g e r
P u b l i s h i n g Co., 1990.
Book Reviews
1.
""The American H e a l t h Empires's' New C l o t h e s . "
Nations's H e a l t h . American P u b l i c H e a l t h
A s s o c i a t i o n . March 1971.
The
2.
"The G i f t R e l a t i o n s h i p , " by Richard Titmuss.
American J o u r n a l o f P u b l i c H e a l t h , 62, 1153, 1972.
3.
" I n t e r n a t i o n a l Medical Care," by John F r y and W.A.J.
Farndale. Medical World, J o u r n a l o f the Medical
P r a c t i t i o n e r s ' s Union ( E n g l a n d ) , J u l y 1973.
4.
"The P o l i t i c s o f H e a l t h Care: Nine Case S t u d i e s o f
I n n o v a t i v e P l a n n i n g i n New York C i t y , "
Herbert
Harvey Hyman, ed. H o s p i t a l s , J.A.H.A., October 1,
1974 .
5.
" P u b l i c E x p e c t a t i o n s and H e a l t h Care," by David
Mechanic. Medical Care, X I I , 968, 1974.
6.
" B i l l i o n s f o r Band-aids," by Tom Bodenheimer, et_
al.
I n t e r n a t i o n a l Journal of Health Services. 1 ,
723, 1974.
�-137.
" B l u e p r i n t f o r H e a l t h , " by David Stark-Murray.
H o s p i t a l s , J.A.H.A. May 16, 1975, p. 102.
8.
"The American H e a l t h Care System: I t s Genesis and
T r a j e c t o r y , " by John Gordon Freymann. Medical World,
(England). November 1975, p.12.
9.
"Beyond t h e Medical Mystique: How t o Choose and Use
Your Doctor," by Marvin Belsky, M.D. and Leonard
Gross. Medical World, ( E n g l a n d ) , January-February,
1976, p. 18.
10.
"The Healer's A r t : A New Approach t o the DoctorP a t i e n t R e l a t i o n s h i p , " by E r i c C a s s e l l , M.D. Medical
World, ( E n g l a n d ) , August-September 1976, p. 14.
11.
"Health P u r i f i e r s and t h e i r Enemies," by J u l i u s A.
Roth. The Q u a r t e r l y Review o f B i o l o g y , Summer, 1978.
12.
" H e a l t h Insurance B a r g a i n i n g : F o r e i g n Lessons f o r
Americans," by W i l l i a m A. Glaser. New England
J o u r n a l o f M e d i c i n e , 300, 869, 1979.
13.
" S t a t e Mental H o s p i t a l s : Problems and P o t e n t i a l s , "
John A. T a l b o t t , e d i t o r . New England J o u r n a l o f
M e d i c i n e , 304, 549, 1981.
14.
"Medical Education F i n a n c i n g : P o l i c y Analyses and
Options f o r t h e 1980's." Jack Hadley (ed.) I n q u i r y
X V I I I , 369, W i n t e r , 1981.
15.
"Gentle Vengeance: An Account o f the F i r s t Year a t
Harvard Medical School" by Charles LeBaron. Medical
Care, XX, 654, 1982.
16.
H e a l t h Care i n the U.S.: E q u i t a b l e f o r Whom?" by Lu
Ann Aday, Ronald Andersen, and Gretchen V. Fleming.
The Q u a r t e r l y Review o f B i o l o g y , 57, 231, 1982.
17.
" H e a l t h P l a n n i n g i n the U n i t e d S t a t e s : S e l e c t e d
P o l i c y I s s u e s . " 2 V o l s , by the Committee on H e a l t h
P l a n n i n g Goals and Standards, I n s t i t u t e o f Medicine.
J o u r n a l o f Community H e a l t h , 8, 50, 1982.
18.
" E x p l o r a t i o n s i n Q u a l i t y Assessment and M o n i t o r i n g " 2
V o l s , by Avedis Donabedian. J o u r n a l o f Community
H e a l t h , 8, 279, 1983.
19.
" Q u a l i t y Assurance i n H o s p i t a l s " by Nancy O. Graham,
(ed.) J o u r n a l o f Community H e a l t h , 8, 280, 1983.
20.
"The Youngest Science" by Lewis Thomas.
290, 1983.
I n q u i r y , 20,
�-1421.
"The S o c i a l T r a n s f o r m a t i o n o f American Medicine" by
Paul S t a r r . The Q u a r t e r l y Review o f B i o l o g y , 59.,
105, 1984.
22.
" I s P r e v e n t i o n B e t t e r Than Cure?" by Louise R u s s e l l .
American J o u r n a l o f H e a l t h Promotion, W i n t e r 1987, p.
84.
" S e l l i n g Smoke: C i g a r e t t e A d v e r t i s i n g and P u b l i c
H e a l t h " by Kenneth Warner. American J o u r n a l o f
P r e v e n t i v e M e d i c i n e , 4 , 56, 1988.
.
23.
24.
25.
"FitnessWorks" by Jane Katz, "Beyond T r a i n i n g " by
M e l v i n W i l l i a m s , and "The Calcium Plus Workbook" by
Evelyn W h i t l o c k . American J o u r n a l of P r e v e n t i v e
M e d i c i n e , 5, 245, 1989.
26.
" P u b l i c H e a l t h and Human Ecology" by John L a s t .
England J o u r n a l o f Medicine, 320, 260, 1989.
27.
VI.
" B u i l d i n g a H e a l t h y America" ed. by T e r r y Lierman,
and "Disease P r e v e n t i o n / H e a l t h Promotion: The Facts"
by the O f f i c e o f Disease P r e v e n t i o n and H e a l t h
Promotion, USPHS. American J o u r n a l o f P r e v e n t i v e
Medicine, 5, 59, 1989.
"Personal Best" by George Sheehan. American Medical
A t h l e t i c s A s s o c i a t i o n N e w s l e t t e r , Vo1. 5, No. 1,
Feb., 1990, p. 12.
New
PROFESSIONAL JOURNAL ACTIVITIES
A.
"Medical L e t t e r from America" Medical World. J o u r n a l of t h e
Medical P r a c t i t i o n e r s ' Union, England.
Monthly column.
Commenced December 1972, concluded 1976.
I n addition to
the book reviews noted above, the more i m p o r t a n t papers i n
t h i s series included:
1.
" N a t i o n a l H e a l t h Insurance i n t h e U n i t e d S t a t e s , I ,
I I , I I I , IV." January 1973, March, May, J u l y , 1974.
2.
"The Causes o f t h e Rise i n H o s p i t a l Costs."
1974 .
3.
"The C o r p o r a t i z a t i o n o f American Medical P r a c t i c e . "
A p r i l 1974.
4.
" P r o f e s s i o n a l Standards Review O r g a n i z a t i o n s . " D e c ,
1974 .
5.
"Newhouse, Phelps and Schwartz on t h e E f f e c t o f NHI on
H e a l t h Care D e l i v e r y i n t h e U.S.: A C r i t i g u e . "
February 1975.
January,
�-156.
B.
"Some Problems i n Medical
1975.
Reviewer o f Manuscripts
Education."
f o r the f o l l o w i n g
September,
journals:
1.
American J o u r n a l of P u b l i c H e a l t h , 1971-89
2.
Medical
3.
New England J o u r n a l o f Medicine, 1977-
4.
J o u r n a l o f Community H e a l t h , 1979-84.
5.
P r e v e n t i v e Medicine,
6.
P u b l i c H e a l t h Reports, 1983-
Care, 1976-85
1982-83
C.
D.
American Medical A t h l e t i c s A s s o c i a t i o n N e w s l e t t e r ,
C o n t r i b u t i n g E d i t o r , 1986- ( f r o m 1990 i n c o r p o r a t e d i n t o
the Annals of Sports Medicine.)
E.
B e t t e r H e a l t h and L i v i n g , H e a l t h and F i t n e s s
A d v i s o r , 1986-88
F.
The East Coast T r i a t h l e t e , C o n t r i b u t i n g W r i t e r , 1987-89
G.
The WalkWays Center N e w s l e t t e r , Regular Columnist, 1988
H.
T r i a t h l o n Today!, Monthly Columnist, 1989-
I.
T r i a t h l o n Times, C o n t r i b u t i n g E d i t o r , 1990-91
J.
VII.
American Medical Joggers A s s o c i a t i o n N e w s l e t t e r , r e g u l a r
c o n t r i b u t o r , 1984-86
T r i - i n g Times, C o n t r i b u t i n g w r i t e r , 1991-
PAPERS DELIVERED AT CONFERENCES
1.
" F i n a n c i n g Systems f o r H e a l t h S e r v i c e s : The Role o f t h e
H e a l t h Services A d m i n i s t r a t o r and t h e Schools o f P u b l i c
H e a l t h . " Comment on a paper by E v e l i n e M. Burns. Fa Ik
Symposium. Yale School o f Medicine, New Haven, CT, May 10,
1968 .
2.
" D e c e n t r a l i z a t i o n . The Ambulatory Care Program of t h e New
York C i t y Department o f H e a l t h . " Presented a t a Community
H e a l t h Conference sponsored by t h e C i t i z e n s Committee of 100
f o r Harlem H o s p i t a l , New York, NY, May 10, 1969.
3.
"Some Thoughts on 'Community C o n t r o l ' of H e a l t h Services
F a c i l i t i e s . " Weinerman Memorial Session.
American P u b l i c
H e a l t h A s s o c i a t i o n Annual Meeting, Houston, TX, October 26,
1970.
�-164.
"Some Thoughts on Primary Care." The Keynote Address o f "A
Forum on Primary H e a l t h S e r v i c e s " sponsored by the I n s t i t u t e
f o r Man and Science.
R e n s s e l a e r v i 1 l e , NY, September 24,
1971.
5.
"Community E x p e c t a t i o n s o f M u n i c i p a l H o s p i t a l H e a l t h
S e r v i c e s . " I n s t i t u t e on Community R e l a t i o n s presented by
the N a t i o n a l A s s o c i a t i o n o f H e a l t h Services E x e c u t i v e s , New
York Chapter, New York Academy o f Medicine.
October 8,
1971 .
6.
" P r e p a r i n g P h y s i c i a n s f o r Community Medicine."
The Address
to the F i r s t Annual Meeting, Nassau-Suffolk Home Care
C o u n c i l , Hauppauge, NY, A p r i l 5, 1972.
7.
"The R e o r g a n i z a t i o n o f the B r i t i s h N a t i o n a l H e a l t h S e r v i c e :
An A n a l y s i s . " American P u b l i c H e a l t h A s s o c i a t i o n Annual
Meeting, San F r a n c i s c o , CA, November 1973.
8.
"PSRO: Issues i n Q u a l i t y Review and R e g u l a t i o n . " American
P u b l i c H e a l t h A s s o c i a t i o n Annual Meeting, New Orleans, LA,
October 1974.
9.
" P o l i t i c a l Dimensions o f H e a l t h Care f o r Non-White
Americans: An Agenda f o r a Post-Nixon Era." P a n e l i s t .
American P u b l i c H e a l t h A s s o c i a t i o n Annual Meeting, New
Orleans, LA, October 1974.
10.
" P u b l i c Law 93-641: P l a n n i n g a t the Crossroads." P u b l i c
H e a l t h A s s o c i a t i o n o f New York C i t y Meeting, September 30,
1975.
11.
"Health Care: 1984 Plus One." Commemorative Address.
Tenth A n n i v e r s a r y C e l e b r a t i o n . E p i l e p s y Foundation o f
Nassau County. Hempstead, NY, November 9, 1975.
12.
"The Economy and H e a l t h Care P o l i c y : The C o r p o r a t i z a t i o n
of American Medical P r a c t i c e . " American P u b l i c H e a l t h
A s s o c i a t i o n Annual Meeting. Chicago, I L , November 1975.
13.
"The P o l i t i c s o f Medical Education Reform."
Medical Student A s s o c i a t i o n Annual Meeting.
March 1977.
14.
"The Case f o r P u b l i c F i n a n c i n g o f N a t i o n a l H e a l t h
Insurance."
Board of Church and S o c i e t y of the U n i t e d
Methodist Church. New York, NY, October 5, 1977.
15.
"Future D i r e c t i o n s f o r F a c i l i t y Reuse." Columbia
U n i v e r s i t y School o f A r c h i t e c t u r e Conference on H e a l t h
F a c i l i t y Reuse. New York, NY, A p r i l 26, 1978.
American
Chicago, I L ,
�-1716.
" H o s p i t a l s and P r e v e n t i v e H e a l t h S e r v i c e s . " H o s p i t a l
A d m i n i s t r a t o r s ' D i s c u s s i o n Group. S l o a n - K e t t e r i n g Memorial
H o s p i t a l . New York, NY, May 4, 1978.
17.
" H e a l t h - O r i e n t e d P h y s i c i a n Education: There's HOPE f o r the
F u t u r e . " P r e s i d e n t i a l Address at the Annual Meeting,
A s s o c i a t i o n of Teachers of P r e v e n t i v e Medicine.
Los
Angeles, CA, October 15, 1978.
18.
" H e a l t h - O r i e n t e d P h y s i c i a n Education: A Key t o
P r e v e n t i o n . " American P u b l i c H e a l t h A s s o c i a t i o n Annual
Meeting.
New York, NY, November 1979.
19.
" H e a l t h - O r i e n t e d P h y s i c i a n Education and O s t e o p a t h i c
Medicine." Texas C o l l e g e of O s t e o p a t h i c Medicine, F o r t
Worth, TX, March 25, 1980.
20.
"Future Prospects f o r P r e v e n t i o n i n Primary Care: N a t i o n a l
P o l i c i e s f o r Manpower T r a i n i n g . " S p r i n g Conference of the
A s s o c i a t i o n of Teachers of P r e v e n t i v e Medicine.
New
Orleans, LA, March 28, 1980.
21.
"Personal Aspects of P r e v e n t i o n . " Annual Conference of the
Michigan P u b l i c H e a l t h A s s o c i a t i o n . Kalamazoo, MI, May 28,
1980 .
22.
" H e a l t h , A Prognosis f o r the 1980's -- Lessons from
H i s t o r y . " Conference of the I n s t i t u t e f o r H e a l t h S t u d i e s ,
Iona C o l l e g e , New R o c h e l l e , NY, October 18, 1980; Medical
Grand Rounds, Greenwich, CT, November 14, 1980; Annual
Meeting, Hudson V a l l e y H e a l t h Systems Agency, S t e r l i n g
F o r e s t , NY, December 14, 1980; Q u a r t e r l y Meeting of the
Medical S o c i e t y of the County of Orange (NY), Pine I s l a n d ,
NY, October 6, 1981.
23.
" H e a l t h - O r i e n t e d P h y s i c i a n Education." Herman Biggs
S o c i e t y , New York, NY, November 13, 1980.
Also presented
a t : the U n i v e r s i t y of Ottawa School of Medicine, PQ, Canada,
January 28, 1981; at the Medical C o l l e g e of Georgia,
Augusta, GA, October 5, 1982; the Texas Medical Branch at
Galveston, May 17, 1983; the New York Academy of Medicine,
Medical Education Committee, December 8, 1983.
24.
"The Teaching of P r e v e n t i v e and Community Medicine i n
Medical Schools."
Department of Epidemiology, School of
Medicine, U n i v e r s i t y of Ottawa, PQ, January 28, 1981.
25.
"A P e r s p e c t i v e on Educating P h y s i c i a n s f o r P r e v e n t i o n . "
N a t i o n a l Symposium on P r e v e n t i o n and Medical P r a c t i c e :
The
Role of Undergraduate Medical E d u c a t i o n , N a t i o n a l I n s t i t u t e s
of H e a l t h , Bethesda, MD, October 5, 1981.
�-1826.
" H e a l t h - O r i e n t a t i o n i n Medical E d u c a t i o n : I m p l i c a t i o n s f o r
H e a l t h Education Media." Annual Conference of the H e a l t h
Education Media A s s o c i a t i o n , D a l l a s , TX, May 1, 1982.
27.
"Address."
F i f t h Annual F a l l Convocation, Texas C o l l e g e of
O s t e o p a t h i c M e d i c i n e / N o r t h Texas S t a t e U n i v e r s i t y , F o r t
Worth, TX, October 1, 1982.
28.
"Teaching H e a l t h Promotion: The R a t i o n a l e . " Annual Meeting
of the A s s o c i a t i o n of American Medical C o l l e g e s , Washington,
DC, November 9, 1982.
29.
"The Personal H e a l t h Care System: N a t i o n a l H e a l t h Care by
C o n t r a c t . " Annual Meeting of the American P u b l i c H e a l t h
A s s o c i a t i o n , M o n t r e a l , PQ, Canada, November 16, 1982.
30.
" P r e v e n t i v e Medicine i n Undergraduate Medical E d u c a t i o n . "
Keynote Address t o the Annual Meeting of the American
O s t e o p a t h i c Academy of P u b l i c H e a l t h and P r e v e n t i v e
Medicine. New Orleans, LA, October 24, 1983.
31.
"The H i s t o r i c a l and T h e o r e t i c a l Basis f o r the Current P o l i c y
of the New York S t a t e Board of Regents Concerning
U.S.
C i t i z e n F o r e i g n Medical Students." Conference:
"New York
S t a t e and the O f f s h o r e Medical Schools."
Downstate Medical
Center, B r o o k l y n , NY, March 13, 1984.
32. "Medical Education i n the 21st Century."
Worth (TX) Rotary, August 3,
1984.
Presented t o F t .
33.
" T r a i n i n g f o r the H e a l t h y R e c r e a t i o n a l Endurance A t h l e t e . "
F i r s t N a t i o n a l Medical Meeting on the T r i a t h l e t e .
Virginia
Beach, VA, September 22, 1984; American Medical Jogger's
A s s o c i a t i o n Marine Corps Marathon Symposium, A r l i n g t o n , VA,
November 2, 1984.
34.
" I m p l i c a t i o n s of P r o s p e c t i v e C u r r i c u l u m P l a n n i n g . " Annual
Meeting of the A s s o c i a t i o n of American Medical C o l l e g e s ,
Research i n Medical Education Conference.
Chicago, I L ,
October 31, 1984.
35.
"Implementing the GPEP Recommendations on P r e v e n t i v e
Medicine."
P r e v e n t i o n "85. A t l a n t a , GA, A p r i l 6, 1985.
36.
" T r a i n i n g i n Minutes, not M i l e s . " Second N a t i o n a l Medical
Meeting on the T r i a t h l e t e . V i r g i n i a Beach, VA, September
21, 1985.
37.
" R e v i s i n g Medical School E d u c a t i o n : From Sickness
O r i e n t a t i o n t o H e a l t h O r i e n t a t i o n . " Conference: P r e v e n t i v e
H e a l t h Care: I s i t Worth i t ? The I n s t i t u t e f o r H e a l t h
P o l i c y and Law, Stevens P o i n t , WI, A p r i l 14, 1986.
�-1938.
"Problems i n t h e I m p l e m e n t a t i o n o f a H e a l t h - O r i e n t e d Problem
Based Medical E d u c a t i o n Program."
Presented t o t h e f a c u l t y
and a d m i n i s t r a t i o n o f t h e School o f M e d i c i n e , U n i v e r s i t y of
Tennessee Center f o r t h e H e a l t h Sciences, Memphis, TN, June
5, 1986.
39.
"The Role o f t h e P h y s i c i a n i n H e a l t h Promotion/Disease
P r e v e n t i o n . " N a t i o n a l Wellness A s s o c i a t i o n Conference,
Stevens P o i n t , WI, J u l y 2 1 , 1986.
40.
"Cost-Containment and t h e Q u a l i t y o f Medical Care." New
York S t a t e P u b l i c H e a l t h A s s o c i a t i o n Annual Meeting,
Uniondale, NY, June 4, 1987.
41.
" E x e r c i s e Promotion i n C l i n i c a l P r a c t i c e : A Workshop."
P r e v e n t i o n '88, A t l a n t a , GA, A p r i l 16, 1988; Grand Rounds,
Department o f Community and Family M e d i c i n e , U n i v e r s i t y o f
C a l i f o r n i a a t San Diego, May 25, 1988; P r e v e n t i o n '89,
A t l a n t a , GA, A p r i l 13, 1989; C o n t i n u i n g E d u c a t i o n Program
f o r D i e t i c i a n s and N u t r i t i o n i s t s , S t . Charles H o s p i t a l , Port
J e f f e r s o n , NY, March 22, 1990.
42.
"Dealing W i t h Drugs: The Role o f t h e Drug C u l t u r e . " The
Mayor's Drug P o l i c y Workshop, B a l t i m o r e , MD, August 4, 1988;
I n t e r n a t i o n a l Conference on Drug P o l i c y Reform, Bethesda,
MD, October 21, 1988; ACLU Drug P o l i c y Forum, H o f s t r a
U n i v e r s i t y , Hempstead, NY, January 25, 1989.
43.
" N a t i o n a l H e a l t h I n s u r a n c e : Lessons from Canada." N a t i o n a l
H e a l t h Forum o f t h e N a t i o n a l C o u n c i l f o r Senior C i t i z e n s ,
Queens C o l l e g e , NY, June 2, 1989; at S t . John's U n i v e r s i t y ,
Queens, NY, October 27, 1989.
44.
"Some Problems i n Medical E d u c a t i o n f o r H e a l t h
Promotion/Disease P r e v e n t i o n . " Address t o t h e U.S.
P r e v e n t i v e S e r v i c e s C o o r d i n a t i n g Committee, Washington, DC,
October 6, 1989. S i m i l a r p r e s e n t a t i o n s made a t t h e
Ambulatory Care P r e v e n t i v e Medicine Conference, N o r t h p o r t
(NY) V e t e r a n s ' A d m i n i s t r a t i o n Conference, January 24, 1990;
P r e v e n t i o n '90, A t l a n t a , GA, A p r i l 2 1 , 1990.
45.
"A P u b l i c H e a l t h Approach t o S o l v i n g t h e Drug Problem."
P r e s e n t a t i o n t o t h e Due Process Committee of t h e Board o f
D i r e c t o r s o f t h e American C i v i l L i b e r t i e s Union, New York,
NY, December 16, 1989. S i m i l a r p r e s e n t a t i o n s made a t t h e :
N a t i o n a l Drug P o l i c y Network, Washington, DC, January 23,
1990; ACLU/CUNY T r a i n i n g Session on L e g a l i z a t i o n , February
17, 1990; Mayor D i n k i n s ' Study Group on Drug A d d i c t i o n ,
March 13, 1990; New York I n s t i t u t e of Technology, C e n t r a l
�-20I s l i p Campus, A p r i l 4, 1990; New York County Lawyers'
A s s o c i a t i o n , A p r i l 26, 1990; American P u b l i c H e a l t h
A s s o c i a t i o n Annual Meeting, New York, NY, October 4, 1990;
F o u r t h I n t e r n a t i o n a l Conference on Drug P o l i c y Reform,
Washington, DC, November 3, 1990; American P u b l i c H e a l t h
A s s o c i a t i o n Annual Meeting, A t l a n t a , GA, November 12, 1991.
46.
" S t r e n g t h s and L i m i t a t i o n s of t h e New F e d e r a l i s m : Regional
D i v e r s i t y and F i n a n c i n g . " Conference: H e a l t h P o l i c y i n t h e
21st Century, sponsored by the Center f o r H e a l t h P o l i c y ,
School o f N u r s i n g , George Mason U n i v e r s i t y , h e l d a t Rosslyn,
VA, May 22, 1990.
47.
"On P r o h i b i t i o n . " F i f t h I n t e r n a t i o n a l Conference on Drug
P o l i c y Reform, Washington, DC, November 15, 1991.
VIII.
CONSULTATIONS
1968
Candeub, F l e i s i g and A s s o c i a t e s , Newark, NJ. Aided
i n p r e p a r a t i o n o f the h e a l t h p o r t i o n o f Model C i t i e s
Act p l a n n i n g g r a n t a p p l i c a t i o n s f o r Holyoke, MA and
Greensboro, NC.
1968-69
Trans Century C o r p o r a t i o n , Washington, DC. Aided i n
development o f a h e a l t h services-community
o r g a n i z a t i o n p r o j e c t b e i n g c a r r i e d out f o r the U n i t e d
S t a t e s P u b l i c H e a l t h S e r v i c e : Fresno, CA; Toledo,
OH; Fairmount, WV.
1968-69
E.D. Rosenfeld A s s o c i a t e s , New York, NY. Study o f
the O u t - p a t i e n t Department and Emergency Room
A d m i n i s t r a t i o n , (1968). F a c i l i t i e s Review, Long
Range P l a n , P r o j e c t C o o r d i n a t o r , (1969) Mount S i n a i
H o s p i t a l , Chicago, I L .
1970
Drew Postgraduate Medical School, Los Angeles, CA.
Review o f p l a n n i n g f o r a comprehensive h e a l t h c e n t e r
i n the King General H o s p i t a l D i s t r i c t .
1971-72
WHK Communications A s s o c i a t e s , I n c . , New York, NY.
Aided i n p r e p a r a t i o n o f a Master Plan f o r M e t h o d i s t
H o s p i t a l , B r o o k l y n , NY.
1973
Center f o r New York C i t y A f f a i r s , New School f o r
S o c i a l Research, New York, NY. Prepared a p r o p o s a l
f o r a Graduate Program i n Urban H e a l t h Care P o l i c y
A n a l y s i s and P l a n n i n g .
1974-75
E u r o s i x t e m H o s p i t a l i e r , B r u s s e l s , Belgium. Study f o r
a h e a l t h care system f o r the c i t y o f Kinshasa,
Zaire. Associate Consultant.
�-211978-79
1982
Rogatz-Meyers-Rosenfeld.
P r e p a r a t i o n of an
a p p l i c a t i o n f o r a c c r e d i t a t i o n of an I n t e r n a l Medicine
Residency Program at J o i n t Diseases N o r t h General
H o s p i t a l , New York, NY.
1982-83
New Jersey School of O s t e o p a t h i c M e d i c i n e / U n i v e r s i t y
of Medicine and D e n t i s t r y of New J e r s e y , Camden,
NJ. Development of a h e a l t h - o r i e n t e d medical
e d u c a t i o n program.
1984-85
Rogatz-Meyers-Rosenfeld.
E v a l u a t i o n and program
development f o r t h e graduate medical e d u c a t i o n
program, M i s e r i c o r d i a H o s p i t a l , Bronx, NY.
1984-85
Rogatz-Meyers-Rosenfeld.
E v a l u a t i o n and program
development f o r the graduate medical e d u c a t i o n
program, St. John's E p i s c o p a l H o s p i t a l , South Shore
D i v i s i o n , Far Rockaway, NY.
1986
IX.
New Orleans (LA) Area/Bayou-River H e a l t h Systems
Agency, I n c . Study of a l t e r n a t i v e uses f o r t h e F.
Edward Hebert H o s p i t a l . C o n s u l t a n t f o r h e a l t h
services planning.
M e r i d e n - W a l l i n g f o r d (CN) H o s p i t a l . F a c u l t y A d v i s e r
t o a Departmental P r e v e n t i v e Medicine R e s i d e n t , Nancy
Sheehan, M.D., who wrote a p l a n f o r development of a
Wellness Center and Program by the h o s p i t a l .
TEACHING ACTIVITIES
A.
Courses
1.
I n t r o d u c t i o n t o the U.S. H e a l t h Care D e l i v e r y System.
This m a t e r i a l was taught i n a course or p a r t of a
course, i n s e v e r a l v a r i a n t s , i n a v a r i e t y of s e t t i n g s
i n the H e a l t h Sciences Center, 1971-89.
2.
Ambulatory H e a l t h Care S e r v i c e s . An e l e c t i v e o f f e r e d t o
graduate s t u d e n t s i n h e a l t h s e r v i c e s a d m i n i s t r a t i o n ,
1971-76.
3.
I n t e r n a t i o n a l Comparisons of H e a l t h Care D e l i v e r y
Systems.
An e l e c t i v e o f f e r e d t o graduate s t u d e n t s i n
h e a l t h s e r v i c e s a d m i n i s t r a t i o n , (1972-75), and medicine
( 1977 ) .
4.
H e a l t h Promotion/Disease P r e v e n t i o n . A course f o r
Residents i n P r e v e n t i v e M e d i c i n e , 1984-
�-22B.
Clinical
1.
X.
I n t r o d u c t i o n t o C l i n i c a l Medicine. Preceptor.
This i s
the course i n i n t e r v i e w i n g , h i s t o r y - t a k i n g and p h y s i c a l
d i a g n o s i s f o r f i r s t - y e a r medical s t u d e n t s .
1975-77.
RESEARCH GRANTS AND AWARDS
1974
1975
"Health Departments and Ambulatory Care Q u a l i t y
C o n t r o l . " Study D i r e c t o r . Task Force on t h e
Impact o f N a t i o n a l Insurance on New York o f t h e New
York M e t r o p o l i t a n Regional Medical Program.
1976
E d i t o r i a l Support Grant f o r the P r o d u c t i o n of
H e a l t h Care D e l i v e r y i n t h e U n i t e d S t a t e s , p u b l i s h e d
by Springer P u b l i s h i n g Co., New York, NY, 1977. Macy
Foundat i o n .
1977- 78
Conference on t h e Reuse o f H e a l t h F a c i l i t i e s ,
Columbia U n i v e r s i t y School o f A r c h i t e c t u r e , New
York, NY. C o - P r i n c i p a l I n v e s t i g a t o r . N a t i o n a l
Center f o r H e a l t h Services Research, U.S. Department
of H e a l t h , Education and Welfare.
1978- 79
XI.
" F e a s i b i l i t y Study f o r t h e Development o f Organized
H e a l t h Services on S h e l t e r I s l a n d . " C o - P r i n c i p a l
I n v e s t i g a t o r . Town Government o f S h e l t e r I s l a n d ,
NY.
"A Cost E f f e c t i v e n e s s Manual f o r H e a l t h Systems
Agency P l a n n i n g . "
American H e a l t h Foundation, New
York, NY. C o - P r i n c i p a l I n v e s t i g a t o r . N a t i o n a l
Center f o r H e a l t h Services Research.
NON-TEACHING ACADEMIC RESPONSIBILITIES
1971-73
Member, E x e c u t i v e
Senate
Committee, U n i v e r s i t y F a c u l t y
1971-72
P a r l i a m e n t a r i a n , U n i v e r s i t y F a c u l t y Senate
1971-79
Member, School o f Medicine R e s p i r a t o r y Systems
Commi t tee
1971- 73
Chairman, U n i v e r s i t y H o s p i t a l Ambulatory Care
Committee
1972- 74
Member, School o f Medicine Governance
Commi t tee
1972-74
Chairman, H e a l t h Sciences Center Committee on
Interdisciplinary
Education
Planning
�-231972-75
Member, Program i n H e a l t h Services A d m i n i s t r a t i o n
C u r r i c u l u m Committee
1972-75
Departmental
1975- 76
Chairman, Departmental
1976- 79
Member, School of Medicine
1978
Chairman, Departmental
1978-83
C o o r d i n a t o r , Departmental
Program
Continuing
1978- 79
C o o r d i n a t o r , Departmental
Committee
N u t r i t i o n Course P l a n n i n g
1979- 83
Member, School o f Medicine
C o o r d i n a t o r , Primary Care C l e r k s h i p
C u r r i c u l u m Committee
C u r r i c u l u m Committee
By-Laws Committee
Education
Committee on Academic
Standing
1980
Member, U n i v e r s i t y H o s p i t a l P r o f e s s i o n a l Standards
1980- 85
Chairman, U n i v e r s i t y H o s p i t a l Committee on Q u a l i t y
Assurance and U t i l i z a t i o n Review
Member, U n i v e r s i t y H o s p i t a l Committee on Medical
Records
1981- 85
1983-84
1985- 87
Member, A d v i s o r y Committee on A t h l e t i c s
1986- 87
Member, U n i v e r s i t y H o s p i t a l Committee on Q u a l i t y
Assurance and U t i l i z a t i o n Review
1986-92
Member, U n i v e r s i t y H o s p i t a l N u t r i t i o n Committee
1988XII.
Member, U n i v e r s i t y F a c u l t y Senate Committee on
A d m i n i s t r a t i v e Review
Member, Department o f P r e v e n t i v e Medicine
on Q u a l i t y Assurance
Committee
ORGANIZATION MEMBERSHIPS AND ACTIVITIES
A. P r o f e s s i o n a l
American A s s o c i a t i o n o f P u b l i c H e a l t h P h y s i c i a n s
American College o f P r e v e n t i v e Medicine.
Chairman, Subcommittee on P o l i c y F o r m u l a t i o n , 1979-82
American H o s p i t a l A s s o c i a t i o n .
American P u b l i c H e a l t h A s s o c i a t i o n .
Chairman, Caucus f o r Peace and Human R i g h t s , 1968-69
Member, Medical Care S e c t i o n Committee on S o c i a l P o l i c y
and R e s o l u t i o n s , 1969-70
Medical Care S e c t i o n R e p r e s e n t a t i v e t o Governing C o u n c i l ,
1975-76
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
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5
X
^ U:
i
�-24Parliamentarian, Governing Counci1, 1975-77
Association of American Medical Colleges.
Association of Teachers of Preventive Medicine.
Departmental Liaison Representative, 1975President, 1977-78
Chairman, Committee on Academic Programs, 1.979
New York Academy of Medicine.
Member, Medical Education Committee, 1983New York State Public Health A s s o c i a t i o n .
Physicians Forum.
Member, Board of Directors, 1966-71
B.
XIII.
Union
United University Professions, AFT/AFL-CIO.
President, Stony Brook Health Sciences Center Chapter,
1972-74.
Co-Grievance Chairperson, 1974-75.
Academic Grievance Chairperson, 1984-.
PERSONAL .DATA
O f f i c e Address:
Department of Preventive Medicine
School of Mediciffe
State U n i v e r s i t y of New York
Stony Brook, NY 11794-8036
(516) 444-2190, 2147
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Physician Letters] [loose] [14]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-007-003-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/c7cae70c7a197092e02f707e9409ab6d.pdf
e96626d7c5220f97badf717f13948c38
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Physician Letters] [loose] [13]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-007-002-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/06c663dce61fa9acb9ba079b7d6c9a46.pdf
9f7a8d2cb72f22436c0668db366d3168
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
2385
OA/ID Number:
FolderlD:
Folder Title:
[Physician Letters] [loose] [12]
Stack:
Row:
Section:
Shelf:
Position:
S
56
3
4
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUB.IFXT/TITLE
DATE
RESTRICTION
001. letter
Personal (Partial) (1 page)
02/28/1993
P6/b(6)
002. letter
Address (Partial); Phone No. (Partial) (1 page)
03/21/1993
P6/b(6)
003. letter
Phone No. (Partial) (1 page)
02/18/1993
P6/b(6)
004. letter
Addresses (Partial) (1 page)
03/03/1993
P6/b(6)
005. resume
Phone No. (Partial) (2 pages)
n.d.
P6/b(6)
006. resume
Personal (Partial) (1 page)
n.d.
P6/b(6)
007. letter
Phone No. (Partial) (I page)
02/18/1993
P6/b(6)
008. resume
Address (Partial) (I page)
n.d.
P6/b(6)
009. letter
Address (Partial); Phone No. (Partial) (I page)
03/31/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
im782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(bK6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning lhe regulation of
financial institutions 1(b)(8) ofthe I OIA|
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P.S Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�HI
NORTHERN
NEVADA
MEDICAL
GROUP
INTERNAL MEDICINE
Catherine Goring, M.D.
Brad T. Craves, M.D.
Kirsten Lorenzen, M.D.
Lorrie M. Oksenholt, D.O.
Christopher Scully, M.D.
OB/GYN/INFERTILITY
Victor Knutzen, M.D.
Clarence Blea, M.D.
Ricardo Garcia, M.D.
Lester Ho, M.D.
Craig W. Klose, M.D.
Terrence McGaw, M.D.
*Robert G. Proctor, M.D.
PEDIATRICS
Berkley R. Powell, M.D.
REPRODUCTIVE
ENDOCRINOLOGY/
INFERTILITY
•Carlos E. SotoAlbors, M.D.
RHEUMATOLOGY
Christopher Scully, M.D.
PSYCHOLOGY/
FAMILY COUNSELING
*Jack Mayville, Ph.D., M.F.T.
MAMMOGRAPHY/RADIOLOGY
•Richard H. Ardill, M.D.
*Eugene A. DeBardelaben, M.D.
•Robert W. Kenton, M.D.
*J. W. Kraft, M.D.
*K. L. Learey, M.D.
FAMILY NURSE PRACTITIONER
lacqueline F. Webb, R.N., M.S.N.
OB/GYN NURSE PRACTITIONER
Laurie Smith, B.N., R.N.C., A.P.N.
Karen Wood, R.N.C., A.P.N.
PEDIATRIC
NURSE PRACTITIONER
Linda Cliff, R.N., M.S.N., C.P.N.P.
January 29, 1993
Mrs. H i l l a r y Rodham C l i n t o n
Chairwoman o f t h e P r e s i d e n t ' s Task Force
on N a t i o n a l H e a l t h Reform
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Madam Chairwoman:
May I c o n g r a t u l a t e you on your appointment as
Chairwoman o f t h e P r e s i d e n t ' s Task Force on N a t i o n a l
H e a l t h Reform.
This t o p i c ,
l o n g overdue f o r
government and s o c i e t a l s c r u t i n y , may w e l l be t h e
s i n g l e most i m p o r t a n t domestic monetary i s s u e ,
o u t s i d e o f t h e economy, t o face t h e n a t i o n t h i s
decade.
As a member o f t h e medical community and.
w i t h a background i n t i m a t e l y shaped, by d i f f e r i n g
m e d i c a l systems, I would l i k e , t o o f f e r my s e r v i c e s
and those o f t h e m e d i c a l group I r e p r e s e n t i n t h i s
l e t t e r , t o you and your t a s k f o r c e .
Our m e d i c a l group i n N o r t h e r n Nevada has e s t a b l i s h e d
a model o f m e d i c a l care t o t h e poor as w e l l as t o
t h e w e l l i n s u r e d , p r o v i d i n g a range o f s e r v i c e s ,
w i t h t h e t w i n goals o f h i g h e s t g u a l i t y medical care
a t reasonable p r i c e s .
This model, c e n t e r e d m o s t l y
on m a t e r n a l c a r e , has improved pregnancy outcomes i n
N o r t h e r n Nevada t o such an e x t e n t t h a t we have
a t t r a c t e d and r e c e i v e d support from Governor Bob
M i l l e r and t h e H e a l t h Department o f t h e S t a t e o f
Nevada.
Dr. V i c t o r Knutzen, t h e founder o f t h e group, had a
South A f r i c a n and B r i t i s h background i n medicine,
h i s p a r t n e r s from t h e U.S., Canada, and A u s t r a l i a .
I t i s these i n t e r n a t i o n a l f a c t o r s t h a t have formed
t h e unusual c h a r a c t e r o f t h i s medical p r a c t i c e .
I
b e l i e v e we deserve c l o s e r s c r u t i n y f o r we share t h e
sentiment t h e P r e s i d e n t has expressed, namely t h a t
f r e e e n t e r p r i s e , government and t h e market p l a c e
can, and p r o b a b l y s h o u l d , shape what w i l l be a
u n i q u e l y American answer t o t h e q u e s t i o n of how t o
f u l f i l l our o b l i g a t i o n s t o t h e community - something
v i r t u a l l y a l l o t h e r c o u n t r i e s have addressed and
implemented i n one form o r another.
NUTRITION SERVICES
•Bonnie J. Vogler, M.A., R.D.
75 Pringle Way
'Independent Contractor
Suite 801
Reno, Nevada 89502
( 702) 688-5800
Affiliated with Reno Women's Center
FAX: (702) 688-5626
�January 29, 1993
Page two
I hope t h a t t h i s l e t t e r e n t i c e s your committee t o seek f u r t h e r
i n f o r m a t i o n about our c o n t r i b u t i o n t o t h e awesome m e d i c a l dilemma
t h a t i s c a u s i n g such g r i e f and d i s l o c a t i o n among so many people i n
t h i s c o u n t r y . We would be honored t o a s s i s t your e f f o r t s i n any
s m a l l way.
Respectfully,
ROBIN J . WILLCOURT, M.D.
Medical D i r e c t o r
Washoe P e r i n a t a l S e r v i c e s
VICTOR K. KNUTZEN, M.D.
Medical D i r e c t o r
N o r t h e r n Nevada M e d i c a l Group
N o r t h e r n Nevada F e r t i l i t y Center
RJW/VKK:aq
cc:
The Honorable Bob M i l l e r
Governor o f Nevada
Jerry Gripentrog
D i r e c t o r , Department o f Human
Resources
�•^m p
TARRYTOWN
INTERNAL
MEDICINE
ASSOCIATES
'
X h
March 25,
Mrs. H i l l a r y Rodham C l i n t o n
H e a l t h Care Reform Committee
The White House
Washington, D.C. 20500
€
1
Board Certified
In Internal Medicine
RICHARD B. FRIEDMAN,
1993
Dear Mrs. C l i n t o n :
M.D.
K N E H D T O A , M.D.
ENT .HMS
CHARLES F C R I R M.D.
.ARE,
SUSANNA S. WILKENS,
M.D.
BELINDA L. CASTOR,
M.D.
From a p r i m a r y care p h y s i c i a n ' s p e r s p e c t i v e , I cannot
e n v i s i o n a n y t h i n g s h o r t o f r a d i c a l r e f o r m as y i e l d i n g
m e a n i n g f u l change i n our c u r r e n t h e a l t h care system.
I
know you a r e s t r u g g l i n g t o balance t h e needs and d e s i r e s
of many i n t e r e s t s i n a d e s i g n i n g a r e f o r m package. I
b e l i e v e t h e enclosed e d i t o r i a l a r t i c u l a t e s t h e b a s i c
changes we need t o make t o d e l i v e r t h e most h e a l t h c a r e
t o t h e most people.
From o b s e r v i n g b o t h you and your husband from here i n New
Hampshire, I am c o n f i d e n t t h a t you possess b o t h t h e
courage and i n t e l l e c t t o achieve m e a n i n g f u l h e a l t h c a r e
reform.
Good l u c k .
Sincerely
Charles F. C a r r i e r ,
CFC/mrn
FOUR ELLIOT
SUITE
WAY
203
MANCHESTER, N H 03103
603-622-6700
M.D.
�r
40 .
THE BOSTON GLOBE •
health care
agrees they are large and rapidly becoming larger.
B Reahty 5: When there is a system with multiple
deciders and multiple payers without any one institution
or person being responsible for trading off total costs
EALTH CARE REFORM IS DIFFICULT:
and benefits, the results are going to be chaotic and exWe all know what the problems are, but we
don't want to face up to any of the obvious an- pensive. In health care we have just such a system and
the results are exactly what any organizational theorist
swers.
would predict - chaotic and expensive.
Basically we would like yet another patch
B Reality 6: There are almost 40 million Americans
"on the system so it will keep going without us having to
without health care coverage and those numbers are go'face reality. Hillary Rodham Clinton's task is difficult
ihg to get larger very rapidly. By moving abroad or by
"'sirite there may now be so many patches on the system
replacing full-timers with either part-time or temporary
^ that yet another patch cannot be designed. Reality at
workers, businesses can avoid health care spending.
Ib'rig last may have to be faced. .
Businesses are now doing so in larger numbers.
• Reality 1: Health care spending has nothing to do
Conversely if businesses have to pay for'health care
""with health. The United States spends by far the most on
costs, no business wants to hire older workers where
£ health care (14 percent of the gross domestic product
they might become liable for their health care costs dur-'versus 9 percent of the GDP in the next highest-spending retirement. Regardless of skill levels if you are uning country). Yet the United States is well down the
-'world's tables on any measure of health (19th in male life employed after 55 years of age, health care costs are
your principle handicap when it comes to being reem-^expectancy, hear the bottom among industrial countries
ployed.
.^Iri'infant mortality).
B Reality 7: Businesses cannot afford to pay for
:' •'
The United States could
health care in a global economy if their competitors in
spend a lot less and be healthier. If Americans want health, the rest of the world do not pay for health care costs.
Elsewhere health care is often paid for by taxes or other
they concentrate on prevendirect personal charges such as the Provident Fund in
tion, immunizations, poverty,
Singapore.
guns, illegal drugs and car acAbroad, health care is often not a business responsicidents. Doctor's and hospitals
bility. If American businesses have to put health care
-'kggBBBnHBBBH
have very little to do with'
costs in the prices of their products and this makes them
health. .
non-competitive vis-a-vis those that do not pay for health
B Reality 2: Some very large fraction of total health
care costs, Americans will simply go out of business with
care spending (40 to 60 percent depending upon which
study you believe) goes to individuals in their last year of the loss of both health care benefits and wages.
America cannot for much longer run a health care
"Tif£ The doctor says "terminal cancer," several hundred
thousand dollars are spent and the doctor was right The system where businesses are forced to pay the costs of
health care. Businesses can play a role in organizing the
patient dies. Other countries simply don't spend large
system, but the costs will have to come from wage deducsums .of money without a reasonable probability of suctions and not corporate contributions.
cess.
No one knows what Mrs. Clinton's task force will recHere Americans should remember the words of the
ommend, but workability of whatever she proposes is goAmerican Indian grandfather in the movie, "Little Big
Man": "Today is a good day to die." For every human be- ing to be easy to judge. Simply ask how many of these
seven fundamental realities she solves.
ing, there is a good day to die. Spending billions isn't goDoes the proposal understand the difference between
ing to change this reahty for even a single human being.
• Reality 3: The current malpractice system has got health and spending on health care? Are limits placed on
to go. The problem is not so much the direct malpractice how much can be spent in hopeless causes? Does she get
the lawyers out of the health care system? Does the sysinsurance premiums (although they are large) but the
tem have a single decision maker for each individual.
defensive medicine they force everyone to practice. Billions are spent on tests and treatments that would not be Have layers of paperwork been eliminated? Are those
not now covered, covered? Does America have a healthspent if doctors and hospitals knew that they would not
: spending system that leaves its industries globally combe sued.
petitive?
D Reahty 4: Multiple insurance systems have now
If she deals with all seven realities, give her an A + .
created a paperwork nightmare. Each doctor or hospital
has to have someone skilled in filling out all of the different forms that are required by all of the different payers. Lester C. Thurow is dean of the Alfred P. Sloan School of
,
Estimates of the costs of paperwork differ but everyone Management at MIT. .
LESTER G.THUROW
1
iAnqther patch
on the system
^qii't work
hi-13
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
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Clinton Library
D O C U M E N T NO.
A N D TYPE
001. letter
SU B.JECT/TITLE
DATE
Personal (Partial) (I page)
02/28/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
jm782
RESTRICTION CODES
Presidential Records Act - (•W U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) o f t h e F O I A j
b(2) Release would disclose internal personnel rules and practices of
an agency 1(h)(2) o f t h e FOIA]
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h(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) o f t h e FOIA|
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personal privacy 1(b)(6) o f t h e FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
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h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of thc FOIA)
National Security ClHssificd Information [(a)(1) of the PRA)
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Release would violate a Federal statute 1(a)(3) o f t h e PRA|
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financial information 1(a)(4) of the PR A]
PS Release would disclose confidential advice between the President
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P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Kenneb h
Snell.
M.D.
•rv:
February
M r v=. H i 1 1 ^ r y Rodman
The W h i t e H o u s e
W-., i n g t on , D . C .
a--h
D^ar
Mr a.
28,
1^93
Clinton
CIinton,
I a m dc> 1 i q h t e d bhat your h u s b a n d
you
-si'''? i; o h e a d
the- reorganisation
of
I a m w r 1 1 i f i g t Li - o f f e r my s e r v i c e s , on.
a id,
.i n a n y w a y t h a t " T
T a (ii
year
i-,«ct i c S t *
y ears
i n that
i s P r e s i d e n t , and t h a t
our h e a l t h c a r e s y s t e m ,
a volunteer b a s i s , to
r eor g a n 1 2 5 t i o n
oil d i L o a r d c e r t i f i e d
C 1965II R a d i o l on i s t ,
d i a g n o s t i c R a d i o l o g y i n MaS3.au.b.LLSj5.t-tja-
- r j ' . l - i - •-rf
that time a senior
ri')T?in"C"&T o"f a g r o u p o f t e n r a d i o l o g i s t s , who d e c i d e d , I am
q iJ 11 e ^ LI )• : on t h e b a s i s b h a t t h e y c o u l d h i r e a y o u n g d o c t o r
f
3 h c.ut of r e s i d e n c y t o t a k e my p l a c e f o r a b o u t o n e - t h i r d
• j r my s a l \i y, t h a t I s h o u l d r e t i r e on d i s a b i l i t y . As a
'
of t i m e and w o u l d l i k e t o d e v o t e some of
I" U LI 1 L , [ h-jvi- l o t s
"
i t t o t h e t a s k w h i c h you h a v e , n o b l y , i f not w i s e l y ,
under taken.
:
Du.r i n g my p r a c t i c e y e a r s I s e r v e d o n s e v e r a l
committees
to
the present
d i s c u s s i o n .
One was
a
w h i c hi a • r e a p r o p ' . j s
r a d i o l o g i s t s
attempting
to develop
a l i s t
of
c omm11 t e e o f
procedures
a p p r o p r i a t e
for
a p a t i e n t
with
a
i" -vid i ' - ' j r a p h i c
•j i . t i n
" c l i 11:; f c o m p 1 a i n t " o r
p r e l i m i n a r y
diagnosis
upon
a i j iti i - z c i ci i i t o a h o s p i t a 1
A second committee,
working
with
B 1 u e C i- ' I ' S S / D l L.ie SI i i i a l c i , w a s c h a r g e d
with
e v a l u a t i n g
•n i ' j a t i o r ) i ci w h i c h
t h e E-.Lues h a d r e j e c t e d
a
r a d i o l o g i s t ' s
l'i a r g e s , a n d
the physician
wished
to appeal
t h e i r
.decision.
Tl-i i s
t a Jl
led
t * m> t r a v e l i n g
in t o BC/BS h e a d q u a r t e r s
for
.Stiver a l m o n t h s t o mon i t e r
cases where a payment
r e j e c t i o n
had
I J e e i "i m ad e b y a n u i - s e ,
and t h e y w i s h e d
another
opinion
before
send i n q the
r e j e c t i o n
n o t i c e
to the
p h y s i c i a n .
D u r i n g my y e a r s
i
i n t e r e=.t
in the
var iou
•c.iiu g o v e r n m e n t " g r o u p ' i
i inprove,
hc-w ( t i e d i c i n e
^track
by t h e n o t i o n
t
very
l i t t l e
under
t and
n pr a c t i c e ,
and s i n c e ,
I have had
an
s d e c i s i o n s
made by t h i r d - p a r t y
payers'
in a t t e m p t s
to a l t e r ,
and h o p e f u l l y
is p r a c t i c e d .
I have r e p e a t e d l y
been
hat
the d e c i s i o n s
seem t o be -based
on
ing of
medicine
or
p a t i e n t s
and
�c e r t a i n l y w i t h v e r y l i t t l e r e g a r d f o r t h e e f f e c t t h a t would
b e cau s e d i f t he new r u1e or r eq u i r e men t wer e ap p1 l e d
u n i f o r m l y t o s i m i l a r s i t u a t i o n s rather than j u s t t p t h e
p a r t i c u l a r p r o b l e m t h a t e n g e n d e r e d t h e change i n t h e f i r s t
p 1 ace„
For example; M a s s a c h u s e t t s i s p r e s e n t l y c o n s i d e r i n g a
s e t o f r e g u 1 a t i o n s f o r m a m m o g r a p h y. T h e r e i s n o q u e s t i o n i n
my mind t h a t mammography i s a good p r o c e d u r e , f r o m b o t h an
a c c u r a cy a n d an i mp or t an ce v i e w .
T h e r e i s n o q ue s t i on t h a t
t h o s e p e r f o r m i n g t h e procedures, b o t h r a d i o g r a p h e r and
r ad i o1og i s t , shou1d be e s p e c i a l l y t r a i n ed or t h at t he
e q u i p m e n t used s h o u l d be e s p e c i a l l y d e s i g n e d and w e l l m a i n t a i n e d . E<ut t h e r e t h e n f o l l o w s a r e g u l a t i o n w h i c h s a y s
"the
e x a m i n e r must be s u r e t h a t t h e p a t i e n t f u l l y u n d e r s t a n d s
111 e r e s u11 s o f t h e s t ud y, b e for e t h e p a t i e n t l e a v es t h e
f a c i 1 i t y.. " A t f i r s t a n d c u r s o r y g l an c e t h a t s o u n d s v e r y g o o d .
The p a t i e n t has j u s t u n d e r g o n e an e x p e n s i v e , and p o s s i b l y
uncomfor t a b 1 e t e s t , and i s n a t u r a l l y v e r y c u r i o u s and anx i o u s
a b o u t 11 "i e f : n d i n g . N o w c o m e s t h e v e r y b i g " H 0 W E V E R. " T h i e
L
p r a c t i c e o f w h i c h I was a p a r t , m a i n t a i n s an o f f i c e so1e1y
f or mammogr aphy,
1"he t echn ic i a n who does t h e i m a g i n g i s v e r y
good a t I")er j o b and i s per f ec 11 y c a p a b l e o f chec k i ng t he
f i 1ms and d e t e r m i n i n g i f t h e y a r e is a t i s f a c t r y f o r
interpretation..
P a t i e n t s a r e s c h e d u l e d one per h a l f hour
t h r o u g h o u t t h e day, and most days t h e s c h e d u l e i s f u l l .
S i n c e a 11 pa t :i. e n t s a r e r e f e r r e d f r o m o t h e r p h y s i c i a n s , i t i s
a s s u m e d t h a t a p h y s i c a 1 e x a m i n a t i o n was p e r f o r m e d . Tlie
t e c h n i c i a n d e t e r m i n e s t h a t t h i s i n f o r m a t i o n as w e l l as o t h e r
per t i n en t i n f o r mat i on such as q est at i ona1 and menst r ua1
h i s t o r y and any r e l e v a n t f a m i l y h i s t o r y i s on t h e
r eq u i s i t i on .
A t t hi e c 1 ose o f t he d ay t h e s t u d i e s ar e
a s s e m b l e d and d e l i v e r e d by c o u r i e r t o t h e n e a r b y h o s p i t a l
where t h e r a d i o l o g i s t s have s p e n t t h e day. The f i l m s on each
p a t i e n t a r e v i e w e d by a r a d i o l o g i s t , and t a k i n g i n t o
c o n s i d e r a t i o n any per t i n e n t f a c t s f r om t h e r e q u i s i t i o n ,
a
r e p o r t d : >: t a t e d .
L :
:
F' o 11 o w i n g t r a n s c r i p t i o n o f t h e r e p o r t , t h e
f i l m s and t h e r e p o r t a r e s u b m i t t e d t o a second r a d i o l o g i s t
w h o v i e w s t h e f i l m s , c o me s t o h i s own conc1u s i on, and t h e n
r e a d s t h e t r a n s c r i b e d r e p o r t . I f he a g r e e s w i t h t h e r e p o r t ,
i t i s sent out t o t h e r e f e r r i n g physician,.
I n almost a l l
c a s e s where a m a l i g n a n c y i s d i a g n o s e d , t h e w r i t t e n r e p o r t i s
p r e c e e d e d b y a t e 1 e p h o n e t r a n s m :i. s s i o n o f t h e f i n d i n g . I f
.
t h e r e i s d i s a g r e e m e n t as t o t h e f i n d i n g s , a d i s c u s s i o n ensues
between t h e t w o d o c t o r s , p e r h a p s i n v o l v i n g a t h i r d
r e d i o l o g i s t as an a r b i t e r , u n t i l agreement i s r e a c h e d . I f
t fi :i. s r e q u i r e s a r e t y p :i. n q o f a r e p o r t , t h i s i 5 d o n e a n d s e n t
out .
I am n o t f a m i l i a r w i t h a\ny ot her hosp i t a 1 or o f f i c e
where a 11 m a m m o g r a p h i c s t u d i e s a r e " d o u b l e r e a d " , b u t i t
worked f o r u s , and we were w i l l i n g t o spend t h e t i m e .
0b v i ous 1 y t h i s pr ac t :i. c e wou 1 d be s e v e r e l y hand i c apped :i. f t h e
new M A s s a c h u s e t t s r u l e were t o go i n t o e f f e c t . F i r s t l y , i t
w o u 1 d r e q u i r e a r a d i 1 o g i s t t o be p r e s e n t i n t h e o f f :i. c e a t
a l l t i m e s . S e c o n d l y , I see no p r a c t i c a l way in. w h i c h d o u b l e
r & a d i n q c o LI 1 d o c c u r ,.
:
�A n o t h e r major p r o b l e m w i t h making s u r e t h a t t h e p a t i e n t
" f u l l y u n d e r s t a n d s " t h e r e s u l t s o f her mammogram i s t h a t t h e
f i 1 ens ar e n o t easy t o i n t er pr e t „ I have s p e n t many hour s
?
a t t e m p t i n g t o e x p l a i n mammography f i n d i n g s t o s u r g e o n s , who
a r e 1 ] h o p e f u l l y above a v e r a g e i n i n t e l l i g e n c e and 211
f a m i l i a r with reviewing other x-ray f i l m s with r a d i o l o g i s t s
so t h a t t h e y have some n o t i o n as t o i m a g i n g p r o c e d u r e s and
t e r m i n o I o g y.
T h e t h oug h t o f t r y i n g t o e x p1 a i n suc h f i n d i n g s
t o p a t i e n t s, h a l f o f wh o m a r e b y d e f i n i t i o n b e1ow a v e r a g e i n
i n t e l l i g en ce, a n d wh o h a v e n o b a c kg r ou n d i n i mag i ng
t e c h n i que s, as w e l l a s b e i n g ner v ous and ap p r ehen s i v e o ver
t h e s u b j e c t under d i s c u s s i o n , b o g g l e s t h e i m a g i n a t i o n .
I w o u 1 d e s t i m a t e t h a t a n y s u c h a 11 e m p t w o u 1 d t a k e a t 1 e a s t
t h r e e t i m e s a s 1 o n g a s i t d o e s t o i n t e r p r e t t h e f i l m s. T h i s
w o u l d t h e n s e r v e t o c u t a r a d i o l o g i s t s p r o d u c t i o n by 3/4,
when I am g i v e n t o b e l i e v e we a r e t r y i n g t o r e d u c e m e d i c a l
c o s t s - I t a l s o o c c u r s t o me t h a t one c a n n o t , i n good
c o n s c i e n c e , i s o1 a t e m ammog r a p h y f r o m o t h er r a d i oq r a p h i c
s t u d i e s , so t h a t t h e same r u l e s t h a t a p p l y t o mammography
s h o u l d a p p l y t o b a r i u m enemas, g a l l b l a d d e r s t u d i e s ,
finger
x - r a y s, etc,, And why j u s t x r a y s t u d i e s ? S h o u I d n o t t h e
same r u l e s a p p l y t o t h e l a b o r a t o r y , and t o
e 1 ec t r o c ar d i og r ap h i c fa c i 1 i t i e s? As k you r c ar d i o 1 og i s t h ow
he f e e l s a b o u t a r u l e t h a t s a y s each p a t i e n t must " f u l l y
understand" t h e r e s u l t s before leaving t h e f a c i l i t y .
T h i r d1y, wh en any d o c t o r g i v e s any pat i en t a d i a g n os i s ,
t h e n e x t words f r o m t h e p a t i e n t a r e "what a r e y o u g o i n g t o do
about i t ? " I t i s p r e s e n t p r a c t i c e t h a t a " g e n e r a l i s t "
p h y s i c i a n o f some n a t u r e s e e s t h e p a t i e n t , o b t a i n s h i s t o r i c a l
i n f o r m a t i o n , does a p h y s i c a l exam, and t h e n , i f a p p r o p r i a t e ,
r e f e r s t he pa t i en t f or o t h er s t u d i e s , I a bor a t o r y, x r a y , e t c .
• nce he/she has t he r esu11 s o f t he v a r i o u s t e s t s , an op i n i o n
i s formed as t o t h e most l i k e l y d i a g n o s i s and t h e a p p r o p r i a t e
t r e a t m e n t i s p 1 a n n e d . "1" h i s i n f o r m a t i o n i is t h e n c o n v e y e d t o
t h e p a t i e n t a t a t i m e and i n a s e t t i n g where r a t i o n a l p l a n s
can be made. I t i s most d i s c o n c e r t i n g t a p a t i e n t t o have a
r a d i o l o g i s t t e l l her "you have a s m a l l c a n c e r i n your l e f t
b r e a s t " , and n o t be i n a p o s i t i o n t o answer t h e "what a r e y o u
g o i n q t o do a b o u t i t " q u e s t :i. o n .
Enough a l r e a d y on t h a t s u b j e c t .
I am p r e s e n t l y
living
i n New H amp s h i r e, b u t h a v e p 1 a n s t o tn o v e t o t h e P h o e n i x a r e a
i n m i d •- A p r i 1 - M a y . I have t i m e . T h a v e p a t i e n c e a n d n o
•
p a t i e n t s . I w o u l d l i k e v e r y much t o c o n t r i b u t e . May I ?
Sincerely
yours,
K e n n e t h B . Snel 1 , M„ D„
.
�CODER:.
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
GENERAL SORT:
General mail
.Personal stories
Other Health Providers
POSTCARD 1:
_Letter Campaign
POSTCARD 2:
Offers to help/Employment
FORM LETTER:
Letterhead
_Policy
REROUTE:
Casework
.Scheduling
Physicians
President
Other
POLICY AND PERSONAL STORIES:
.ORGANIZATION (I)
^insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
working families
unemployed/low income
benefits
providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
FINANCING (VII)
.MENTAL HEALTH (IX)
.LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
_AIDS
women's health
immunizations/children
.rural
urban
OTHER
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBJECT/TITLE
DATE
Address (Partial); Phone No. (Partial) (1 page)
03/21/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
jm782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |S U.S.C. 552(b)|
PI
P2
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�GORDON C. G. THOMAS, M D
..
^3
March 21, 1993
Ms H i l l a r y Rodham C l i n t o n
Health-Care Task Force
1600 Pennsylvania Avenue, N W ,
..
Washington, D C 20500
Dear Ms C l i n t o n :
Although I am almost r e t i r e d , I are extremely concerned' about
the -health-care systeiB i n the U. S. Please note my 6/92 a r t i c l e i n
one o f the most c o n s e r v a t i v e papers i n the c o u n t r y . The W.S.J. , a n d
o t h e r p o l l s , show t h a t we a l l want changes f o r the b e t t e r . When
h a l f o f the Vermont doctors f a v o r a Canadian type systera, and they
are q u i t e f a m i l i a r w i t h i t , we should give i t our most serious
cons i d e r a t i o n .
At t h i s p o i n t I are begging and pleading t h a t you do not Jump
at any type o f managed o r H O p l a n . The U. S. deserves b e t t e r .
M
Although pushed so v i g o r o u s l y by the insurance coapanies and other
p r o f i t - m a k i n g groups, such as HMO's and b i g business, I do not bel i e v e you could f i n d any p h y s i c i a n , who would honestly e l e c t t o have
his own care through such a system. Why? We r e a l l y know the answer?.
The f i n a n c i a l i n c e n t i v e s are t o do less f o r p a t i e n t s , regardless ofthe i n d i c a t i o n s . Managed or l i m i t e d care i s g r e a t , unless one-gets
s i c k . Again I plead. Canadian and German systems are-proven, even
though not p l e a s i n g every one. We have a woman emergency room doct o r here-, who married a German and worked t h e r e t h r e e years. She
said: p a t i e n t s and p r o v i d e r s were very pleased w i t h t h a t system. I
beg.you t o t a l k w i t h her. England i s the p r i s e example o f the H O o r M
c a p i t a t i o n p l a n , which s t i l l gives second-rate care. One should noti'
e l e c t t o have a plan t h a t has most s t r o n g l y been proven a d i s a s t e r .
Again, we deserve b e t t e r . A small value-added t a x would end
the unconscionable t i e between h e a l t h and employment. A good, none a p i t a t i o n systera could and should be utilized» The b u r e a u c r a t i c
s i m p l i c i t y , along w i t h good cost c o n t r o l s , would give e x c e l l e n t careand s t i l l cost 150 b i l l i o n a year less than we are spending now.
!• would be happy, t o t a l k w i t h , meet w i t h anyone or help w i t h anything'-,
t h a t would help solve one o f our isost urgent problems.
Gordon G. G. Thomas, M D .
..
:
�THE UNION LEADER, Manchester, N.H. — Monday, June 1,1992
' Y O U R T U R N , ' New Hampshire
Health Care System in Absolute Chaos
guaranteed, the costs will-escalate.
Look what happened to college fees.
The Feds and other sources implied
years in medicine I have
- seen many changes. Polio is — that grants. and/or_loans would be.avail-_
able and all were urged to apply. In
gone... antibiotics came on
other words, colleges and universities
the scene, as well as the trancould increase fees without any conquilizers and antidepressants. There
cern about an individual's ability to
have been many developments in
pay. So, what happened? Skyrocketing
pharmacology, endoscopic procedures,
costs.
CT and other scans, one day surgery,
What about the recent race to build
plastic lenses to replace cataracts, anhundreds and hundreds of condos
gioplasty, open heart surgery, organ
without many commitments to buy, i.e.
transplants, etc.
keep building; buyers will show up to
In spite of all the wonderful developtake care of them. But, they did not.
ments, our health care system is in abCould there have been touches of
solute chaos. Costs keep skyrocketing,
greed causing some compromises in
whether hospital
business judgments?
bills, doctors' fees, r-, - -•v- '•'•^im^ :^rM
The explosion in medical technology
medical equipis tempting every facility to have as
ment, medicamuch of the expensive equipment as
tions, etc. Costs
possible. There are more and more test
now exceed the
procedures, treatment modalities, etc.
ability of many ininvolving increased staff and paperdividuals to pay,
work. The costs of which keep rising at
unless they are in
will, with the expectation that some inthe wealthy catesurance will somehow cover it.
gory. Insurance is
Health care is now an entitlement, as
supposed to more
it should be. This is the greatest counor less cover the
try on earth and our citizens should resituation. We all know that often this is
ceive needed care. The questions are:
absent or inadequate, or worse, unafHow do we do it, what type of plan is
fordable, as it is with 37 million people.
best, who will control it, how can costs
Each year in the United States we
be restrained, and, of course, how will
spend about $700 billion or 12 percent
it be paid for?
of GNP for health care, compared to 8
Paper-work or administration is estipercent in Canada. Yet, Medicare unmated at about 20 percent, which
fortunately does not cover the most
would be $140,000,000,000. Just imagcostly of all medical expenses of the eline, $140 billion a year, which is really
derly, i.e. chronic, severe invalidism. If
wasted money. To correct this, as much
someone goes into a nursing home and
as possible, we need a single paper sysis unfortunate enough to live a few
tem, as in Canada. The regular private
years, all family resources can be used
practice of medicine and the private
up, the spouse becoming destitute and
hospital systems should continue.
going on welfare. What a system the
The big change would be that all
government has derived for our latter
health care bills would be sent to a cenyears.
tral, or regional, government agency.
When something is essentially
By GORDON C.G. THOMAS
D
URING MY MORE than 45
m
Fee schedules would be developed, as
is done with Medicare. These should
be realistic, but not excessive. Every
year_qiJwo a blue ribbon commission
would have hearings and review all
fees. The system would cover all medical bills, hospital charges, nursing
home costs, group home care for various types of patients, home health
care, dental care and m'edications. A
national fee schedule is absolutely necessary, if the fantastic rises in costs are
ever to be contained. Peer review and
quality assurance programs would be
operating at all times, to insure good
care, as well as trying to prevent any
abuse ofthe system. We should avoid
any arrangements that would offer any
financial incentives for providing less
care for patients.
Whenever anything resembling the
Canadian system is mentioned, we
hear objections such as: we can't afford
it, the whole thing is beyond our ability
to carry it out, etc. If we are spending
12 percent of GNP now, and if we put
in a Canadian-type, one paper system,
the costs could drop possibly to 10 percent of GNP. In rough figuring, the
savings would be at least $100 billion.
—Dr. Thomas is a resident of Laconia
and at age 72, is in semi-retirement.
Opinions expressed in this weekly
column aren't necessarily those ef
The Union Leader. AH readers are
welcome to submit essays of up to 759
words for the editor's
consideration.
Please include a word or two about
yourself, along with name, address,
phone number and, if possible, a photograph. Mail to: Your Turn, c/o The
Union Leader, P.O. Box 9555, Manchester, NH, 03108. All submissions
become property of Thi Union Leader
and can't be returned.
�AMERICAN MEDICAL NEWS/MARCH 22/29, 1993
Survey: Half of Vermont doctors back Canada plan
BERLIN, Vt. (AP) — Roughly half
of Vermont's physicians favor scrapping the current medical insurance system for one similar to Canada's, suggests an informal survey.
Vermont Physicians for National
Health Care said 49.9% of the 402
state-licensed doctors responding to its
mail survey said they backed a singlepayer plan. Just 10.7% supported managed competition, the modified multiple-payer system the Clinton
Administration appears to be pursuing.
But the president of the Vermont
State Medical Society says he doubts
the survey represented the sentiments
of a majority of physicians statewide.
"Their agenda is different from what
the State Medical Society's is," said
Edward Leib, MD. "Theirs is a membership that is more biased toward primary care and, I think, single-payer."
; Vermont (Physicians for National
Health Care is the state affiliate of the
"national organization lobbying for a
. single-payer system.
Lee Emerson, MD, a Brattleboro
physician who is conducting the survey, said he was not surprised by the
results "because I think physicians are
more Jn J favor of it than we usually
acknowledge." . - V' •• • \ *
Vermont lawmakers will have to
choose between single payer or a modified, more highly regulated system of
multiple insurers during their 1994 session, when the Health Care Authority
they created last year presents options
for each system. " '
Dr. Emerson said his group would
try to use its survey results to influence
r
:
the outcome of that legislative decision. " I think they [lawmakers] feel if
they did favor a single-payer program,
they'd have to get medical doctors in
line. I think that isn't necessarily true."
Vermont Physicians for National
Health Care released its survey during
a meeting at Central Vermont Hospital
promoting a single-payer system.
About 75 medical professionals turned
up for the meeting to hear a Canadian
physician explain her country's health
system and for Rep. Bernard Sanders
(Ind, Vt.) to make a similar pitch.
The group sent survey post cards
with return postage paid to 1,404 licensed doctors in Vermont. Four hundred twenty-one returned the cards,
but not all answered every question.
Dr. Emerson said he had not yet
determined whether the sample was
representative of the state's physician
population. Of the respondents listing
a specialty, 18.8% were family physicians and 25.1% internists.
Dr. Leib said that might be enough
to skew the survey results, because
those are the doctors most affected by
the insurance bureaucracy.
" " I think there are number of physicians out there who would favor some
form of single-payer," he said. But " I
think that group does not represent the
general membership of physicians in
the state."
The medical society opposes a singlepayer system but supports "a limited
multipayer system where we would not
have government controlling" insurance payments, Dr. Leib said.
�AMERICAN MEDICAL NEWS/JUNE 22. 1992
House Democrats say in survey
Single-payer, not play-or-pay,
best for health reform
Congress should 'move forward with reforms on
which there is agreement, rather than wait for any
Utopian solution that frankly may never develop.'
House Republican
By Harris Meyer
AMN STAFF
In a surprising split with party leaders, more House Democrats favored a
single-payer health reform solution
than a play-or-pay approach, a recently
released survey says.
In the poll of 98 congressmen by the
Democratic Study Group, 43% picked
a Canadian-style single-payer national
insurance system as their first choice
among five solutions; 11% chose it as
their second favorite. The play-or-pay
system pushed by Senate Democratic
leaders won first-place votes from only
27%.
Even more noteworthy, 36% said
they were likely to vote against a playor-pay bill, compared with only 15%
likely to vote against a single-payer bill.
The survey, though released last
month, was taken last fall. Scott Lilly,
executive director of the Democratic
Study Group, acknowledged that
House members' sentiment in the fastmoving reform debate is "evolving"
and might have changed since the poll
was taken:
The poll is, however, one of the few
available indicators of how Democrats
might jump. The study group said the
survey sample was representative of
the 270 House Democrats.
" I think single-payer is not as much
of a pipe dream as some people say,"
said Lilly, whose group is a research
organization for House Democrats. "1
was surprised to see that even most of
the Southerners were opting for singlepayer over play-or-pay."
The survey reflects Democratic disarray on health reform;. Democrats
hoped to capitalize on the politically
potent health reform issue to boost
their presidential chances, but find
themselves badly split between the two
approaches.
Leader Robert
Michel
Acknowledging the differences, | interest groups."
House Democratic leaders are pushing
Despite the show of support for sinfor passage of a stop-gap bill offering
gle-payer, there was, not surprisingly,
global spending limits and reform of
the current small-group private insurance market. But they don't have the
little agreement on how to finance it.
votes yet for passage, and certainly lack
A payroll tax paid equally by ema veto-proof majority.
| ployers and employees had the'most
The Republicans, meanwhile, have ,
gained momentum with a small-group :
insurance reform bill minus the controsupport — favored by 45% of the conversial spending caps.
gressmen as either their first or second
Congress should "move forward
choice. An income tax hike came in a
with reforms on which there is agreement, rather than wait for any Utopian
solution that frankly may never develdistant second, with only 22% listing it
op," House Republican Leader Robert
as one of their top two picks. The least
Michel (R, 111.) said at a news conferpopular choice was a system requiring
ence. Some prominent Democrats, like
Sen. Lloyd Bentsen (D, Texas), agree.
Under the leading single-player bill,
individuals to pay for coverage based
HR 1300, sponsored by Rep. Marty
on their level of insurance risk.
Russo (D, 111.), a tax-funded governSixty percent said it was "extremely
ment insurance system would cover evimportant" that a health reform bill be
eryone. Under the Senate Democratic
brought to the floor this year. The repleadership's Health America bill, all
resentatives favored a sweeping reform
employers would have to either proproposal over a modest one by a simivide coverage for their employees or
lar margin. Two-thirds preferred inclupay into a public plan that would offer
sion of long-term care, and three-quarcoverage. Both bills feature overall cost
ters wanted to fold Medicare into the
controls, though the Russo plan would
new system.
be stricter.
On medical malpractice, 43% said
Opposition to play-or-pay probably
they favored encouraging states to
is due to the burden it would place on
adopt liability system changes, while
small businesses that don't offer health
24% said the federal government
coverage, the survey report explained.
shouldn't play a role in this area.
Small firms have lobbied heavily
against the proposal. There hasn't been
as much lobbying against a Canadianstyle system because it's not yet seen as
a serious option, some say.
Russo, in a prepared statement, said
the survey shows that momentum is
building in Congress for "true" reform
legislation, and that congressmen "are
listening more to what their constituents are demanding and less to special-
�THE WALL STREET JOURNAL FRIDAY, MARCH 12, 1993
Seeking a Cure: Most Americans
Want Changes in Health System
•:HIt certainly lailea the 46-year-old retail
worker. When her employer was bought
; out by another company, her insurance
I premiums tripled pvernlghL Unable to
j afford the coverage, she had to drop it.
, Percentagestini.,*« ~ . ^ . . — . . . , • v.^^
Shortly thereafter, her teenage daughter
iUnacteptable
developed serious health problems, run- ning up huge bills that Ms. Owens can't
pay. She still has no medical coverage.
Eleanor Leopold, 48, also thinks the
U.S. health system stinks, even though her
health insurance covers 90% of her doctor,
dentist and prescription-drug bills. She'
worries that her coverage could vanish if
her husband, an (employee-relations manager, loses his job, or that it could be
onaquairti
drastically cut back if his employer falls oh
hard times. She wants the system
LlmlUioBivna
changed, and she is willing to pay higher
l-V:.^, - * r
taxes to change i t '
More Bovemnie-.
A Sweeping Consensus '
.' intha liealt
That kind of agreement between people
•v; y. • V? a i ^
at opposite ends of the coverage spectrum
reflects a sweeping national consensus. A
new nationwide Wall Street Journal/NBC
^ Liinils ooiite .
News poll shows that 7 % of the public
8
believes that the current health-care sysftem doesn't meet the needs of most
•LlmCtsonibe
Americans, and 74% say a complete overhaul is neededto.cover everyone and
control costs.
. Higher tnssraii
Moreover, the survey finds a surprising
willingnesstoaccept some sacrifices. Of
those surveyed, 6 % say they would be
6
willing .to pay higher taxes so that
T E W L SRE J U N L B NW POLL
H AL T ET O R A / C E S
N
everyone could get health insurance; 5 %
2
could accept limits on the righttochoose
their own doctors; and 4 % could even
6
How; Poll Was Conducted
accept higher Insurance deductibles and
The Wall Street Joumal/NBC News
co-payments.
poll was based on nationwide telephone
Americans believe" the system "needs
interviews of 1,503 adults (1,186 of them
major change, not just tinkering or work
registered voters) conducted Saturday
around the edges," conclude Robert Tee-.
through Tuesday by the polling organi; ter, a Republican,' and Peter Hart, a
zations of Peter Hart and Robert TeeI Democrat, who conducted the poll for the
ter.
: Journal and NBC.
The sample was drawn from 3 5
1
The survey results are good news for
randomly selected geographic points in
i President Clinton. They suggest that If he
the continental U.S. Each region was
. fulfills his promise to deliver a bold plan to;
represented in proportion to its populaguarantee universal access' to health care
tion. Households were selected by a
and curb therelentlessrise In medical
method that gave all telephone numPoll Shows Stunning Backing costs, Americans arereadytoaccept the
bers, listed and unlisted, an equal chance
possibly unpleasant tradeoffs.
of being included.
For an Overhaul, Giving Concerted Drive Needed :
One adult, 1 years or older, was
8
selected from each household by a proce; The President a Big Boost' areIndeed, Mr. Clinton's political advisers,
arguing that his health-care package is
dure to provide the correct number of
more likely to win public support if it is
male and female respondents.
seen as radical shift in
sense
Chances are 19 of 20 that if all adults
Support for Equal Treatment j that theapublic will havepolicy. Theyin a
confidence
with telephones in the U.S. had been
plan's chances of truly solving problems
surveyed, the findings would differ from
only if it appears to be a sharp departure
these poll results by no more than
By HILARY STOUT ~ :
from the current system. A package seen
2.6 percentage points in either direcStaff Reporter of THE W A H . STREET JOURNM.
tion. A limited number of questions
- MT. LAUREL, NJ-"We may have one as simply more of the kind of tinkering that
were asked of half the sample; for
of the best health systems in the world,", i has been tried before would be hard to sell,
these, the margin of error was 3.6
says Sandra Owens, "but it has failed us the advisers contend. But Mr. Clinton will
points. The margin for any subgroup
miserably.".
- :' still have to educate people about the
would depend on that group's size.
r
r
iS
H
Seeking a Cure
MostAmericansPledge
Sacrifice to Help Fix ;
The Health System •
:
�;
Cynthia Wynn, a 32year-old single
"The government has to take care for
mother of a four-year-old daughter, says
erhaul :
she can barely afford the $ 0 a month she those who don't have coverage, but if we're
20
talking about across-the-board intervenmust contribute to enroll in the health
tion, the government kjiows nothing about
maintenance organization her company
W>m\jmlcb$tsaadcowr:
ismp
.
the medical profession," Ms. Owens says.
offers. But she learned an even more
. mtyone withpin a tmpjeto amhaul oi painful lesson a few years ago when she
"The government's part should be making
it available to everyone who wants it,
was without any coverage-and her daughneeds it and cannot afford it."
ter was diagnosed as having diabetes.
Federal Role Disparaged
Ms. Wynn thinks the government
should pay for everybody's health care.
Richard Sooy, a 38-year-old mechanic
"That's a fairer way of doing it, so
who rates his current medical coverage as
everyone gets health care equally," she
A-plus, fears that the government would
says. She is opposed to paying higher taxes just mess things up. " I don't think the
for coverage-"people like myself, a single
government can handle it," he says. He
parent who only makes $15,000 a year,
vehemently opposes medical price controls
should not be taxed" - but less financially
and says the system should instead be
pressed members of the group say they
based on incentives for the medical profesT E W L SRE JOUHNAL/NBC NEWS POLL
H AL T ET
understand the need for higher taxes and
sion to treat uncovered Americans.
are willing, within reason, to pay them.
necessary trade-offs and forcefully explain
"Instead of penalizing people for
the intended benefits. However much
achieving in this free-enterprise system,
"I would pay more," Ms. Leopold says.
Americans clamor for change, they are
why don't we reward the medical profes"I personally would, but then my income
obviously confused about what they want
sion with tax breaks and tax cuts and tax
would stand it." Frank Giardinelli, a 35in health care, and their confusion could ,
incentives to give their time?" he asks.
year-old carpenter, says, "I say you either
prove perilous for the president.
have specific kinds of taxes or you raise
But such views are clearly in the minor"For Clinton, the devil will be in the
taxes, because to ignore the plight of
ity, the poll shows. An overwhelming 8 7
7c
'details," Mr. Teeter says. "As soon as you
someone else in society is, at least how I
of Americans favor government limitaget to the specific details of implementawas raised, immoral."
tions on doctor and hospital costs. And 6 %
3
tion, you will create a lot of opposition." An
say all employers, even small-business
A Sense of Vulnerability
object lesson is Congress's 1988 expansion
owners, should be required to provide
But another reason even people with
of Medicare to insure senior citizens, for a
health insurance to their employees - a
decent coverage are willing to entertain
moderate extra premium, against the cost
measure that President Clinton's advisers
sweeping changes is a lurking sense of
of catastrophic illness; something that
say he is likely to include in his plan.
their own vulnerability. "I'm working, and
looked wildly popular in theory turned out
Although the poll backs up the notion
I have pretty good coverage," Mr. Giardinto be wildly unpopular in practice, and
that many Americans understand tho
elli says. "But if I was out of work, I'd be in
angry seniors forced the law's repeal.
trade-offs that health-care reform might
a lot of trouble. My coverage comes
To further explore Americans' desire
entail, it also finds them willing to make
through a union; so, if I'm out of work a
for and reservations about health-care
those trade-offs. Of those surveyed, 5 %
6
certain time, I lose my benefits."
reform, the Journal asked Mr. Hart to
say the possible advantages - universal
To help pay for revamping the system,
bring together this week a group to discuss
coverage, no loss of benefits for changing
the nationwide Journal/NBC poll found
the issues - a group that included Ms.
jobs or becoming seriously ill, lower costs
overwhelming support for "sin taxes" on
Owens, Ms. Leopold and 1 of their neigh0
to the government and economy - outcigarettes, alcohol or other products conbors here in the New Jersey suburbs of
weigh the possible disadvantages - higher
sidered health hazards. Of those surveyed,
Philadelphia. Most of them were middletaxes, more government involvement, loss
7 % said they could accept a whopping $2
0
class working people, the vast and dispachoice for patients. And 3 % think the
3
increase in the tax on a pack of cigarettes;
rate group whose strong support the presidisadvantages would outweigh the advan8 % said they could accept a 50-cent in7
dent will need to push through his propostages.
crease in the tax on a six-pack of beer; and
als. Four of the 12 people had no health
The feeling that the benefits would be
8 % said they could accept a $1 increase in worth the problems was evident in the New
5
insurance; six had lacked any coverage at
the tax on a quart of liquor or wine.
some point in their lives. The group was too
Jersey group. "There was a sense that this
small to be a scientific sample, but the
Overall, 6 7 said it won't be possible to is not a something-for-nothing game," Mr.
7o
participants' concerns both echo and amHart observes. "These people are willing
provide health coverage for all Americans
plify thefindingsof the nationwide poll.
to make changes and adaptations either in
without raising taxes. In terms of benefits,
terms of what they are paying or what they
"What we could feel in New Jersey was
people want it all: The survey indicates
have to contribute or the way in which they
the sense of angst and uncertainty that
that strong majorities favor coverage not
receive health care."
people have when it comes to health care in
only for hospital and doctor fees but also
America," says Mr. Hart, who conducted
for nursing-home care, prescription drugs,
The one thing most of them - and most
the discussion. "Their difficulty is in
and dental and vision care, even if such
Americans - aren't wiUing to do is to do
reaching a single defined solution of how to
extended coverage would increase their
nothing. Asked his reaction if President
deal with the problem."
own costs under the program.
Clinton were to delay dealing with the
Both the poll and the discussion group
health-care problem until late in his term,
But people are ambivalent over the
suggest that, despite Americans' intense
Howard Myers, a 47-year-old administragovernment's role in the health system.
dissatisfaction with the overall health systor and therapist, responds with one word:
Although 71% are willing to accept more
tern, most of them are happy with their
"Impeachment."
government involvement, that doesn't inown medical care. According to the poll,
dicate that they favor a complete govern7 % are satisfied with the quality of health
4
ment takeover. Instead, 7 % say the sys0
care their families receive, and an identitem should be an amalgamation of public
cal percentage is satisfied with its availaand private insurers, with government
bility. Their biggest concern is cost: 5 %
6
regulation to control costs and insure
are very or somewhat dissatisfied with
how much they have to pay for coverage. j a minimum level of care for everyone.
!
1
�CODER:.
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President
Other
POLICY AND PBRSONAT, STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
working families
.unemployed/low income
.benefits
.providers
INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
.FINANCING (VII)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
.rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
a
1
��James .Atkinson IIIr-.-MsD
J. J a r r e t t ' C l i n t o n , M.D.
Administrator
Agency f o r Health Care P o l i c y and Research
A p r i l 30, 1993
U.S. Public Health ServiceDear.. Doctor J. Jarret " C l i n t o n ,
We are face^l w i t h the challenge of reforming American h e a l t h
care. How can we balance the inunediate need t o save money and
yet expand access to m i l l i o n s of uninsured? How can we improve
the u n f a i r service we now provide t o many Americans? Expanding
managed care i s under c o n s i d e r a t i o n .
1
Many p a t i e n t s fear change. Managed competition might change
t h e i r insurance, t h e r f h o s p i t a l , or t h e i r doctors. However, they
fear changing t h e i r doctors the most. Blue Cross and Blue Shield
of.New Jersey"recent 1y changed a l l three f o r some of my p a t i e n t s .
They are confused, a f r a i d , and angry. I f a company changes
insurance, or a person changes jobs or i s l a i d o f f , the doctors
might change. A pregnant woman might have a d i f f e r e n t doctor f o r
every t r i m e s t e r of pregnancy!
)
0 m
o
My p a t i e n t s gfrnn' ^T/"^ ^hHQf
because I work f o r a local
hospital/HMO ./^ut, ^ ^ ^ j ^ l pr '- - i ^ T " ^ •"' •
[inr-t-iwo
med R" 1 ne^
i k r a r r i c i p a t e i n Medicare and Medicaid. We a l l know
that indemnity plans l i k e Medicare are l o s i n g money. I
p a r t i c i p a t e i n four open panel HMO's. We know the HMO concept
seems to provide more care f o r less money, e s p e c i a l l y f o r
Medicaid p a t i e n t s . I t i s the gatekeeper concept that saves the
money yet expands access and maintains c o n t i n u i t y of care. I
p e r s o n a l l y don't b e l i e v e managed competition w i l l save money.
Any money saved w i l l go t o the "managers" or be wasted i n the
federal a d m i n i s t r a t i o n of hundreds of competing plans. I b e l i e v e
the Congressional Budget O f f i c e came t o the same conclusion.
3
1
-
4
,
Managed competition w i l l f i a t ^ r o v i d e more f a i r service.
.
They wTTI compete f o r the heai tny"; young, and employed. The
-^t
senior c i t i z e n w i l l s t i l l have to decide between food and
^=
medicine. Our nursing homes w i l l s t i l l provide impersonal •career*-'
for the r i c h "and poor wi th bankruptcy f o r the middle class. The",
unemployed, poor self-employed, or disabled w i l l s t i l l have t o
f i g h t a bureaucracy and wait to receive care. Providers w i l l
s t i l l waste b i l l i o n s of hours and d o l l a r s on unnecessary paper • -_
work. Germany and Canada may be q u i t e d i f f e r e n t , but t h e i r
"'
h e a l t h systems g e n e r a l l y work without managed competition. Why
reinvent the wheel? I f you would l i k e an a l t e r n a t i v e plan to
serve our f e l l o w Americans, please read on.
T
:
�My plan i s enclosed. While many of these concepts have
already been proposed, many are bold new ideas. For instance;
pay-or-play, l i m i t e d tax deduction, "smart cards", expanding the
RBRVS/DRG's to a l l payers, s i n taxes, and national drug
purchasing are already on the table. Conversely, my plans f o r
streamlining a d m i n i s t r a t i o n , senior nursing home care, pro-rated
premiums and co-pays, and national q u a l i t y assurance are q u i t e
new.
I have chosen the most important part of other proposals;
no f a u l t awards ( t o r t reform), c a p i t a t e d gatekeeper (managed
care), annual provider negotiations ( a n t i - t r u s t exemption and
f i x e d budgets), and universal coverage w i t h central c o n t r o l
(Canadian s t y l e national health insurance).
I represent myself and my p a t i e n t s . No one group w i l l l i k e
a l l my proposals but a l l p a r t i e s (except health insurers,
American T r i a l Lawyers, and pharmaceutical companies) might
accept the package. The a l t e r n a t i v e s of maintaining the status
quo or only expanding managed care are both e t h i c a l l y and
f i n a n c i a l l y unacceptable.
Please consider my proposal and I hope you can support
it.
Sincerely yours
James Atkinson I I I , M.D.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
rW ****
SO*?
• /...
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•'• '
-:' '-7. '
'
�James .Atkinson.-XII,
-
M.D.
-
Mrs. H i l l a r y Rodham C l i n t o n
Chairperson, Health Care Task Force
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Chairperson- Hi 1 l a r y C l i n t o n ,
As a p r a c t i c i n g p h y s i c i a n I share your concern f o r American
h e a l t h care and recognize the need f o r change. Medicine has been
in my f a m i l y f o r generations and I have witnessed great changes.
I beli'eve I have a good perspective to suggest what changes we
should now make. Health care i n the United States has'three main
problems; excessive cost, inadequate access, and i n e q u i t y . My
" i d e a l but a f f o r d a b l e " American h e a l t h care system i s summarized
below. Numbers i n parenthesis r e f e r to d e t a i l e d explanations
attached to t h i s l e t t e r .
Excessive cost i s the primary problem. Unless we can cut
costs and get more bang f o r the buck we can't expand access or
r e s t o r e e q u i t y . Health care costs can be d i v i d e d i n t o out-ofpocket expenses, h o s p i t a l type o r g a n i z a t i o n s , p r o v i d e r s i . e .
d o c t o r s , medications, equipment, t e s t s , senior care, and,
admini s t r a t i o n .
One payer c a l l e d Health Care America (HCAHl) would disburse
a l l f e d e r a l funds.
I n i t i a l l y , f e d e r a l and s t a t e insured persons
would be e n r o l l e d . ( F S I P ) ( 2 ) Other c u r r e n t t h i r d p a r t y payers
(TPP)(3) would coexist f o r employed persons under a "play or pay"
(4)law w i t h a l i m i t e d tax deduction ( 5 ) . Any company or person
could buy i n t o HCA w i t h a p r o - r a t e d income based premium ( 6 ) .
Each HCA member would be assigned a co-pay l e v e l based on
income ( 7 ) . Higher co-pays might be a p p r o p r i a t e . f o r e l e c t i v e or
expensive procedures ( 8 ) . .
A HCA medication, equipment, and t e s t i n g board (MET) (9)
would purchase these goods and services. Regional senior care
boards (SCB)(10), s i m i l a r to school boards, w i t h HCA, s t a t e , an
l o c a l funding, would manage the care f o r the aged and disabled.;*^
A n a t i o n a l nursing home board (NHB)(11) would set g u i d e l i n e s an<i^
negotiate rates.
A l l h e a l t h insurance companies (HCA and TPP) would pay
h o s p i t a l s or h e a l t h care organizations (HCO)(12) on a modified r"^
and n e g o t i a t e d (13) diagnosis r e l a t e d group (DRG)(14) scale. A l l "
American h e a l t h providers (AHP)(15), except HMO c a p i t a t e d primary
care physicians (16), would be paid by a m o d i f i e d and negotiated
(17) r e l a t i v e value scale (RVS)(18).
�A l l medical care would be reviewed by a n a t i o n a l q u a l i t y
assurance board (QAB)(19).
This board could see records, audit
HCA payments, and sanction p r o v i d e r s . A n a t i o n a l malpractice
review panel (MRP)(20) would review a l l v a r i a t i o n s from standards
of care and/or adverse r e s u l t s .
A l l Americans would carry a HCA i d e n t i f i c a t i o n card (21),
choose a primary physician (22), and cooperate w i t h record
keeping (23). That doctor would act as a gate keeper generating
r e f e r r a l s (24) and as a record keeper from a l l consultants. A l l
records would be t r a n s f e r r e d e l e c t r o n i c a l l y v i a modem (25). Names
and diagnoses could be shared by p r o v i d e r s , but only numbers and
codes would be sent to HCA or TPP (26)
Single payer purchasing power, l o c a l senior support,
c o n t r o l l e d and budgeted provider reimbursement, malpractice
reform, coordinated primary care, and a d m i n i s t r a t i o n streamlining
should save b i l l i o n s of d o l l a r s .
Freedom t o negotiate DRG and RVS payments, s i m p l i f i e d record
keeping and b i l l i n g , true peer review, f e e - f o r - s e r v i c e medicine,
and malpractice reform are t r a d e - o f f s t o American providers.
Nationwide coverage w i t h choice of doctor, employer or HCA
income based premiums and co-pays, and increased drug, d e n t i s t r y ,
and nursing home coverage w i l l r e s t o r e f a i r health coverage to
most Americans.
The HCA payment system might be expanded from FSIP etc. to
a l l Americans w i t h even greater savings, uniform access, and
t o t a l equity.
I would be happy to t r a v e l to Washington at my own expense
to discuss my proposals. Thank you f o r your concern w i t h American
health care and f o r reading my l e t t e r .
Sincerely yours.
James Atkinson I I I ,
cc: members of congress, et a l .
M.D,
�Health Care America (in detail)
Numbered paragraphs in this attachment explain in more detail each matching
item in my preceding letter.
(1) HCA (Health Care America) would be quasi-government agency managed by an
appointed board, independent of, but funded frou Congress with annual budgets.
Nine board members would be appointed by the president for four, eight, or
twelve year terms. Only the HCA agency could decide how to manage health care
and propose changes, not congress. Medicare, Medicaid, Chanpus, Veterans
Hospitals, Medigap insurance, and federal and state arployee health plans
would be replaced. The states would be free of the Medicaid millstone.
Further funding should be pro-rated such as a medical income tax or derived
frcm sin taxes. Those who are rich value l i f e more and those who abuse their
bodies deserve to contribute more. Veterans hospitals would become nursing
homes for Veterans under the same guidelines as senior care (10) below.
(2) FSIP (Federal and State Insured Persons) would include a l l those people
and their dependents who are employed by or retired from any federal, state,
and local government. This would include congress, a l l public school
enployees, as well as current members in the aforementioned HCA incorporated
plans. A l l those over 65, greater than 50% disabled, with 20 years military
service, handicapped, and recently injured (see MRP # 20) or unenployed would
automatically be enrolled. Including congress would ensure adequate funding.
No supplemental health insurance, l i a b i l i t y medical payments, or special
benefits would be allowed. Veterans would no longer fear losing their health
care with a base closing.
(3) TPP (Third Party Payers) would co-exist for a while. They would have
their own board, annual meeting, propose utilization criteria to the QAB, and
negotiate payments to providers (exempt from anti-trust law). However, cost
shifting might continue as providers would i n i t i a l l y seek out these patients.
Even H O s look for large groups to spread the risk. Health insurance would
M'
partially be tied to employment limiting job movement. Brployers would
continue to try to avoid coverage by contracting enployees and hiring
temporary workers. TPP would want to charge and employers would want to hire
based upon health risk. Currently, patients might have to change doctors
every year or travel far to participating specialists as their employer or
it's health insurance company shops around for the best deal. Some women
even have to change in mid-pregnancy. Expanding managed care w i l l only
increase this trend.
National guidelines for H O s should be established to avoid underM'
utilization or excessive provider financial risk (responsibility for hospital
b i l l s i f HMO not notified, large withholds, and huge penalties for referring
inadvertently to non-participating providers). Providers or groups of
providers should be allowed to negotiate their fees.(exerrpt from anti-trust)
�However, keeping TPP would keep millions of workers enployed. HCA
coverage should automatically be primary for the aged, disabled, injured,
handicapped, and unenployed, and their spouses and dependents. This should
encourage their enployment. Newborns without insurance would autanatically be
covered by HCA. The ridiculous burden of C B A payments on the unenployed
OR
would end. Allowing income based buy-in to HCA (see #6 below) would act as a
safety net.
HCA guidelines for provider payment (DRG/RVS), fair quality assurance,
malpractice reform, HCA identification "smart" cards, emphasis on primary
care, free preventive care, mental health coverage, and electronic b i l l i n g and
record keeping could be required of TPP also. This would save additional
money, provide better service, and avoid most of the provider "hassle factor".
(4) Play-or-pay should require employers to either pay for their enployees
health care or buy into HCA for each arployee not already covered by HCA. Any
contracted, temporary, or migrant worker should be covered. The enployer
portion of premiums should start on the f i r s t day of enployment whereas the
enployee portion should start after 90 days. I t should mandate pooled risk
sharing and no denial of coverage or higher premium for illness or health
risk.
(5) Health care tax deductions for employers or an individual should be
limited to 100% of the highest HCA premium. This would force the TPP to keep
coverage and rates competitive with HCA. Considering TPP would only cover
well working people and HCA would cover the sick and poor, HCA premiums should
be higher.
(6) HCA/FSIP premiums would be arbitrarily set for wealthy applicants. HCA
then establishes a sliding scale for those making less than five times the
federal poverty level plus cost of living raises. Those receiving less than
two times the federal poverty level (with cost of living increases) the
unenployed, injured, and recently disabled w i l l automatically be enrolled and
premiums waived for a set time. The re-enployed would be required to purchase
TPP or HCA coverage as an employed person after 1 year. Brployers would then
have to pay at least 50% of the HCA premium. Wealthy (five times the poverty
level) retirees or disabled would pay a maximum of 50% of the premium, with
HCA picking up the other half. The income base would be the lessor of the
current or previous year. No one would have to sell their house or wait
months to be eligible.
(7) HCA/FSIP co-pays would be pro-rated based on income over the federal
poverty level (with cost of living increases). A person with income five
times the poverty level might pay five times the co-pay of a poor person. The
income base would be the lessor of the current or previous year with urgently
reduced co-pays for the recently retired, unenployed, injured, or disabled.
These co-pays could apply to a l l services such as hospitalization, physician
care, prescriptions, and/or nursing home care. HCA should prohibit balance
b i l l i n g and avoid deductibles or co-insurance.
�8) Higher basic co-pays might be assigned to avoid certain services, up to a
maximum, i.e. 25$ for certain specialists, or 50$ for Emergency Services,
second opinions, braces or dentures. A "0" co-pay for a l l would be
appropriate for any maternal-child-health care, vaccinations, and screening
tests or physicals. HCA might also decide not to cover certain useless care
such as removing a wart from a bedridden patient. However, once a service or
substance is approved by the QAB as standard care or treatment, HCA must
provide coverage in spite of i t ' s cost, political concerns, or how new i t is.
(9) The MET (Medication, Equipment, and Testing) Board would negotiate
nationally for the best price for any product or service for HCA/FSIP members.
Each division of MET; pharmacy, equipment, or testing would propose broad
utilization guidelines for the QAB. Over utilization might generate a notice
to the beneficiary, the ordering provider, and the primary physician. The QAB
might then be requested to audit repeat offenders.
Sane QIC products and probably useful products should be covered. The
MET should not require generic substitution, therapeutic equivalent
substitution, or certain quantities. However, co-pays should be minimal for
generic, standard amounts of medications i.e. #100 furosemide and higher for
unusual amounts such as 10# furosemide, or brand name only, or less useful
products. Poor senior citizens would no longer have to decide between buying
food or medicine.
No product should be denied coverage i f considered standard treatment
regardless of cost, or newness. Products should be bought for chronic
conditions (i.e. wheelchair), not rented, with an incentive to return to a
senior center i f no longer needed. Only a provider signature and code number
should be necessary to order a test or piece of equipment. Documentation of
diagnosis, or severity of illness should not be required. Current rules
require a provider personally complete a two page form for a bandage or bag!
No person should have to drive more than a certain distance for standard
inexpensive test i.e. mairmogram. Routine testing should be done in the
primary physician's office such as a blood count, urineanalysis, or ECG.
Laboratory testing would be reimbursed the same, regardless of drawing station
except approved hone visits. Testing of disabled, uncooperative, or highly
contagious patients might be reimbursed higher. Names would be coded for
b i l l i n g to maintain confidentiality. Patients at risk for HIV infection
should not fear test disclosure.
Certain jut-patient testing (such as x-rays, vascular, biopsies, etc)
should have one encompassing test charge, not a technical and interpretive (or
pathology) portion. However, invasive same day procedures such as surgery,
lithotripsy, and colonoscopy should allow a separate DRG (HCO) payment. Copays might be higher for those of marginal benefit: i.e. oxygen for mild C P ,
OD
or i f extremely expensive such as MRI's.
(10) Regional SCB (Senior Care Boards) would manage a l l senior and nursing
home care similar to local school boards. Every high school district in the
country would elect a SCB. HCA, the individual state, and the local SCB would
each pay 1/3 of the cost. Each SCB would have authority to tax and issue
construction bonds similar to school boards. Hopefully, new nursing home
construction would add new jobs.
�Admission criteria would include severity of disability and years of
residency. Disability determination would be done by two geriatricians using
losses of Activities of Daily Living. Years of residency would apply to the
senior citizen and/or chosen next-of-kin. Each disabled senior citizen would
be entitled to support for preferably hone care, day care, or boarding care,
or nursing home care as the last resort.
Each S B district would define it's disabled population and provide
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adequate care for each including residential care i f necessary. Although
purchasing existing beds within the district would be allowed, a l l the other
levels of care must be provided and national guidelines would s t i l l be in
effect. Bnpty beds waiting for hospital discharges would be appropriate.
Geographic bed roulette would end. Hopefully, residential homes, senior day
care, meals-on-wheels, nutrition centers, M T stations, and senior centers
E
could share some central facilities and transportation.
Residential and senior day care should be similar to heme care; no
l i a b i l i t y for injury and no restrictions to activity except to prevent
wandering in the streets. Driving, visiting family, shopping, and apartment
style living should be encouraged when appropriate. For those limited to the
f a c i l i t y ; washing clothes and making beds should be encouraged. Volunteers
would be strongly encouraged also. A l l of us could now relate to our own
local f a c i l i t y . Rehabilitation centers would be a separate wing or entity
with similar guidelines. Co-pays would again be graduated and based upon
incone. Conpare this to our current over-regulated, inpersonal nursing hone
care for the poor and rich with bankruptcy for the middle class.
(11) A national nursing hone board (NHB) would consist of 1/3 geriatric
providers, 1/3 nursing hone administrators, and 1/3 senior lay members. I t
would meet, propose "standards of care" and utilization criteria to the Q B
A
and propose rates to HCA. (therefore exempt from current anti-trust
regulations) Tri-annual meetings would take place with H A to negotiate rates
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with disputes subject to binding arbitration.
(12) H O (Health Care Organizations) would include a l l those institutions that
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provide in-patient care (except senior care above) such as hospitals and some
out-patient care such as stand alone surgical and endoscopy centers. H O
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members could meet to propose guidelines for "standards-of-care" and
utilization review to the QAB, suggest capital outlays, and propose fees for
each D G payment (from HCA or TPP) to H O (therefore exenpt from current antiR
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trust regulations). These negotiations could prevent H O S frcm arbitrarily
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deserting and bankrupting hospitals.
(13) Tri-annual meetings would take place between HCA and H O to negotiate D G
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payments and capital outlays with disputes subject to binding arbitration. No
lock-outs would be permitted under federal law.
�(14) D G (Diagnosis Related Group) payments are currently used by Medicare to
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pay hospitals based upon the principal discharge diagnosis and some modifiers.
They have been very effective in streamlining hospital care, with less
testing, and a shorter length of stay. However, they would have to be
extremely nodified to adjust for younger (lower), more co-morbid conditions
(higher), and other inadequacies of the current D G system. Pediatrics and
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other specialties would be added. Bonuses might be added for lower
utilization and readmission rate, a good QA rating, and excellent patient
approval. Some out-patient care such as same day surgery, lithotripsy, and
colonoscopy would have a D G payment with an incentive for out-of-hospital
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care.
Discharge diagnoses and names of patients would be coded (to maintain
confidentiality) with dates of service and provider numbers sent
electronically to HCA. Only QAB representatives and not payers (HCA/TPP)
would have access to the medical records. HCA would pay each institution or
out-patient center monthly based on at least 90% of expected billings and
distribute credits or debits annually. No penalties would occur for
unintentional misscoding. Payment could not be denied i f a service was
rendered. Currently, Medicare requires f u l l signatures, exact information and
otherwise practices micro management.
(15) A l l AHP (American Health Providers) such as physicians, dentists,
chiropractors, opticians, nurse practitioners, therapists, etc. would meet
annually to propose guidelines for "standards-of-care" and proper utilization
of each specialty to the QAB, suggest educational outlays, propose under
served areas or specialties for additional HCA support, and propose the
conversion factor for RSV payments (from HCA and TPP) to AHP (therefore exempt
from anti-trust law).
(16) Capitated primary care physicians are paid per assigned patients and
therefore not on a RVS payment system. However, many of these same physicians
see patients not on their assigned H O l i s t and therefore should be paid on a
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RVS payment scale for this care.
(17) Tri-annual meetings (alternating with H O and NHB above) would take place
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between HCA and AHP to negotiate the RVS conversion factor, up to 3% of the
individual RVS fees, special support, and educational outlays with disputes
subject to binding arbitration. (See exenpt frcm anti-trust law above) No
strikes would be permitted under federal law.
(18) The RVS (Relative Value Scale) method of paying physicians was chosen by
Medicare (with physician participation) as a relatively fair method of valuing
each physician service. Previously, procedures were historically over-priced
and specialists were paid more than a general physician for the same service.
These RVS payments would have to be extremely modified to adjust for younger
patients (pediatrics) and non-physician services (dentists, chiropractors,
physician assistants, nurse practitioners, therapists). A l l services
considered standard care would have to have some reimbursement including
dental cleaning, E G interpretation, telephone calls to patients and families,
K
heme case management, and corpleting extensive forms.
�Bonuses should be added for primary care of the heme bound,
handicapped, and for service in an under served area. There should also be
financial incentives for low utilization, good QA. rating, and excellent
patient approval. HCA would electronically pay each provider at least 90% of
expected monthly billings. HCA would adjust credits and debits annually.
Monthly statements to HCA would l i s t coded patients, procedure or service
codes, and dates of service. No other information would be necessary except
i f audited by the QAB.
(19) A l l medical, nursing home, and hospital care would be reviewed by a
national QAB (Quality Assurance Board) made up of 1/4 physicians, 1/4 other
AHP, 1/4 H O and NHB representatives, and 1 4 legal/lay representatives. This
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board would have offices in every major hospital and/or county. HCA would pay
50% of their budget with HCO, AHP, NHB, TPP, and MET each paying 10%. Each
provider (HCO, AHP, NHB, TPP) would propose standards of care and utilization
criteria to the QAB.
Beneficiaries (patients) would have their own board and propose
utilization criteria and a l i s t of patient's rights to the QAB. The QAB would
review, negotiate, approve, and publish these utilization criteria, standards
of care, and patient's b i l l of rights.
H A T P would have secret thresholds (similar to IRS) that might
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generate an audit by the QAB.(i.e. an internist doubles his number of ECG's, a
dentist removes too many teeth, a patient has 2 gallbladder surgeries) The
beneficiary board, any state board of medical examiners, HCA, M B (below),
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HCO, AHP, NHB, TPP could request an audit of a provider or beneficiary. No
individual could generate an audit except through his representative board.
This would prevent disgruntled enployees, angry patients, and jealous
providers from initiating fruitless audits. Possible assault would require
iirmediate review. However, a provider would be considered innocent until
proven guilty.
The QAB could copy any medical records, without notice, for review.
Those copied records would be held strictly confidential and only released
frcm the QAB with signed consent or by court order. Only a board certified
specialist (active or retired) in the same field (dentist to dentist, midwife
to midwife, neurosurgeon to neurosurgeon) could perform a QAB officer review.
A QAB officer would determine i f there was any violation of standards of care.
A QAB officer could enter any part of medical practice (Operating room, office
examining room) without notice to observe a practitioner.
The QAB board in turn could sanction any provider for over-utilization,
substance abuse, variance from standards of care, illegal activity,
intentional fraud, unethical behavior, etc. Sanctions should include education
and review of subsequent care. The punishment should f i t the crime; i.e.
over-utilization; underpayment, too many wound infections; a small fine,
substance abuse; detoxification and mandatory monitoring as a condition for
continued practice. A l l Q B review, decisions, and sanctions would be
A
absolutely confidential and except when initiated by the M P (below) or a
R
state board of medical examiners, non-discoverable. Beneficiaries could be
fined for abuse but never denied coverage. Any provider or beneficiary could
appeal his sanction through the courts. Currently; a mentally i l l woman could
accuse her physician of assault and ruin his practice before any t r i a l occurs.
8
�(20) The M P (malpractice review panel) would consist of 1/3 medical, 1/3
R
legal, and 1/3 lay representatives. Any conplaint of an adverse result or
negligence could generate a claim. Beneficiaries could directly f i l e a claim
without legal advice. Attorneys, the victims survivors, or the QAB could also
f i l e a claim on behalf of a victim. The QAB would be notified and would proceed as usual to copy records and provide "same specialty" review. The QAB
would determine i f there was any variation from standards of care and propose
any sanction to the provider. The M P would review the case, hear testimony
R
and only make one determination; i f an adverse result occurred (no-fault
concept). I f there was an adverse result the M P would suggest an appropriate
R
coirpensation based solely on the severity of the loss.
No award either from the M P or a court of law should allow compensation
R
for medical care, punitive damages, or non-econcmic losses in excess of a set
amount. Medical care frcm an injury would automatically be covered under HCA
and punishment of any negligent provider would be determined by the QAB. M P
R
conpensation would not include legal fees as legal advice would not be
necessary to receive compensation.
At this point the p l a i n t i f f or his survivors could review the QAB
records, and/or refuse the award and sue for greater compensation. Any
conpensation would then be put in an interest bearing escrow account. I f the
court ordered additional payment (guilty) the plaintiffs attorneys would not
be able to take any portion of the original conpensation or more than 50% of
the extra award. I f the t r i a l court found the award appropriate or excessive,
(not guilty), or i f the suit was later dropped or dismissed, the plaintiff's
attorneys would have to pay for the provider's legal fees.
Workman's conpensation, automobile and injury l i a b i l i t y payments for
medical care would be eliminated for a l l Americans as H A would become primary
C
for any injury or disability. This would prevent practitioners frcm becoming
ambulance chasers as well.
(21) A HCA (Health Care America) identification card should be carried by a l l
Americans. Even those enrolled with TPP such as H O s would carry the HCA
M'
card. This "smart" card should carry the patient's name, code number, date of
birth, social security number, address, phone numbers at hone and work,
names, phone numbers, and addresses of the next-of-kin, primary doctor (and
his fax and modem numbers), an advance directive decision, and a organ donor
decision. The primary physician is in a good position to advise the patient
on the latter. A l l primary physician offices (given) and institutions
(purchased) would have equipment to encode and read this information. Other
providers would have to purchase their own readers but could not add
information. I f any medical information is included i t might be a problem,
drug, and allergy l i s t generated by the primary physician, (excluding
confidential information below #23) HCA/FSIP enrollment or TPP identification
numbers could be added to this.
�(22) Primary physicians are familiar with various medical problems and proper
use of hospitals and specialists, and capable of providing a history,
physical, and routine consultation.(i.e. child-pediatrician, adult-general
internist, or both-family physician) Each senior in residential care would
choose a primary physician. Primary care is much more cost effective than,
direct specialty care. Many specialists appropriately act as a patient's main
physician (such as an oncologist with a leukemia patient, or a nephrologist
with a dialysis patient). However, even in these situations, record keeping
and further referral or hospitalization should be discussed with the primary
physician. This would avoid the current expensive practice of multispecialty
groups inter-referring for minor new synptoms.
(23) The patient should assist with establishing and maintaining his medical
records. Fill-in-the-blank forms should be available in primary physician's
offices and institutions for both the H A "smart card" and for a conplete
C
medical history. The patient or his family could pick than up and conplete
than before their f i r s t v i s i t or on admission. The patient should remind a l l
other providers to forward subsequent records to the primary physician
electronically.
(24) The primary physician acts as a gatekeeper when he determines when and
where to refer his patients. (Except emergency and urgent hospital care when
he should be notified the next working day) This is a very effective but
practical method of controlling costs. Indemnity plans such as Medicare and
Blue Cross tried deductibles and 20% co-pays to discourage utilization.
Medicaid pays so poorly no provider wants the patient. Both of these methods
of cost control failed in spite of reams of regulations and prosecuting
"abuse". Sane H O s require phone calls, or limit the availability of certain
M'
specialists with tremendous stress on provider and consumer alike. Only the
primary physician gatekeeper concept has allowed f u l l access but controlled
costs.
(25) The primary physician would also function as the patient's medical record
keeper. A l l hospital suirmaries, specialists' reports, and emergency care
records would electronically be forwarded to the primary physician listed on
the HCA "smart" card. Then i f a patient changes doctors or moves he can
obtain his records from one location. The records would be divided into a
s t r i c t l y personal portion including alcohol use, sexual diseases and
preference, HIV status, psychiatric care and a general portion.
(26) Names and diagnoses could be shared among providers as long as electronic
connections to each provider were accurate and confidential. However, only a
Q B agent could see the actual record without a signed release. Names and
A
diagnoses would be coded for any other purpose such as b i l l i n g , research,
overutilization review.
10
��NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
J
fi
A S> (7£.
J>
<: •.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
SUBJECT/TITLE
DATE
02/18/1993
Phone No. (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
jm782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(H)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of thc PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�/
.993
February
Mrs. H i l a r y R. C l i n t o n
j ^ h i t c House
Washington D.C
Dear H i l a r y ,
. . . '
"
".
'^
. : ;
,
.'.V-'r'y ' .
N
' '.
;
May I t e l l y r , how proud ^
^ '
0
< : J
; J^a,.*.:
S L ' s r i S « S : : ^ l ^ M - c ^ Ic^ooi
in 1939, have p r a c t i c e d . P e d i a t r i c and
and have heard . Ms M e j ^ ^ a p e a k
SAM
c a n ' t thank you a n d - ^ " - e n o u g h f o r a l l yo
have done f o r c h i l d r e n . .
Keep g o i n g ! ' :
.
v '
Affectionately,
E l l a -^"cummins, M.D.
(Dr. Bobby)
P.S. I f ever I can h e l p , please l e t . me know.
EJC:gl
.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
D
'.'•** ...
�March 1, 1993
Ms. H i l l a r y Rodham Clinton
Task Force on Health Care Reform
The Whi-te House
1600 Pennsylvania Avenue
Washington,
D.C.
Dear Ms. Cl -vnton:
,,
r
/
As a progressive physician (Georgetown M '68) I applaud the efforts of
* your task force directed towards the reform of our health care system.
I believe that most health care professionals will be willing to make
some sacrifices in order to solve this problem.
Although I have many thoughts on health care reform I want t o share only
one.
Americans seem to be addicted t o health care.
Any attempt t o
reduce health care spending, that does not address the demand side of
the equation is doomed to f a i l u r e .
A great deal of unnecessary services
. t.
are performed, p a r t i c u l a r l y for the elderly, and the motivation i s not
always greed on the part of the provider. I would l i k e t o see some
modification of the Oregon system.
Outcome analysis i s needed to
determine which services delivered under which conditions actually work
to the benefit of the patient.
• ;•
' *
Anything else should not be covered, and
:J.'
�really should not be performed.
This i s not rationing, i t i s as Dr.
Arnold Relman has said, simply good medicine.'
I wish you and your team good luck i n the next few months as you develop
your plan, and I look forward to learning the details.
Sincerely yours,
Lewis J.' Kampel , M.D.
�cXuiz
(Si/e
dissociates
Opllllialnjologi/
r«if) ''Wescotl tfjiive, Suite
SFLnungton, Jl. S
304
08S22-4605
'Helephone goS - 788-6472
G E O R G E H . K U R Z , M. D.
P A U L P H I L L I P S , M. D.
SFax QO8 - 788-6467
V I N C E N T F. S A R D I . M. D.
L A R R Y W E I S F E L D . M. D.
May 3, 1993
H i l l a r y Rodhair. C l i n t o n , Chairperson o f t h e
S p e c i a l Committee f o r H e a l t h Care Reform
The Whitehouse
1600 Pennsylvania Avenue
Washington, DC 20201
Re: H e a l t h Care Reform: P r e v e n t i o n and Education.
Dear Mrs. C l i n t o n :
The r o l e o f p r e v e n t i o n and e d u c a t i o n i n h e a l t h care cannot be overemphasized.
I f e e l t h a t a h e a l t h insurance p l a n s t r e s s i n g
p r e v e n t i o n c o u l d be a major f a c t o r i n c o s t containment i n t h e l o n g
r u n . A system t h a t rewards p r e v e n t i v e measures and p e n a l i z e s those
who f a i l t o heed t o recommended p r e v e n t i v e measures, a l t h o u g h
expensive t o s e t up and a d m i n i s t e r i n i t i a l l y , c o u l d have p r o f o u n d
l o n g t e r m b e n e f i t s i n a h e a l t h i e r p o p u l a t i o n and r e d u c t i o n i n l o n g
t e r m c o s t l y care o f v i c t i m s o f s t r o k e , h e a r t d i s e a s e , l u n g cancer,
etc. Accordingly I o f f e r t h e f o l l o w i n g suggestions:
A p i l o t p l a n s h o u l d be developed which s t r e s s e s p r e v e n t i o n by
r e q u i r i n g p a r t i c i p a n t s t o undergo a p e r i o d i c s t a n d a r d i z e d w e l l n e s s
assessment and covers t h e c o s t t h e r e o f ( i n c o n t r a s t t o many c u r r e n t
p l a n s which do n o t cover r o u t i n e p h y s i c a l e x a m i n a t i o n s ) .
Such
assessments s h o u l d be r e q u i r e d , say every f i v e (5) years f o r a d u l t s
age 18-49 and every two (2) years t h e r e a f t e r . They would c o n s i s t
of three p a r t s .
A.
An e x t e n s i v e medical h i s t o r y i n which t h e p a r t i c i p a n t
i n t e r a c t s w i t h a computer.
I n a d d i t i o n t o g a t h e r i n g d a t a which
would be used t o come up w i t h recommendations, t h e computerized
h i s t o r y would serve an i m p o r t a n t e d u c a t i o n a l f u n c t i o n .
I t would
r e q u i r e t h e p a r t i c i p a n t t o look a t h i s own f a m i l y m e d i c a l h i s t o r y
from which he might draw c o n c l u s i o n s about h i s own r i s k o f v a r i o u s
t y p e s o f diseases
such as h e a r t disease, cancer,
diabetes,
glaucoma. He would be asked about h i s e x e r c i s e program, smoking
and e a t i n g h a b i t s , frequency w i t h which he wears seat b e l t s , e t c .
�-2H i l l a r y Rodham C l i n t o n , Chairperson
Re: Health Care Reform: Prevention and Education
May 3, 1993
B.
A t e c h n i c i a n would take c e r t a i n standardized measurements
such as h e i g h t , weight, blood pressure, pulse, v i s u a l a c u i t y . The
t e c h n i c i a n would perform c e r t a i n t e s t s such as electrocardiogram,
u r i n a l y s i s , blood t e s t s .
The r e s u l t s of these measurements and
t e s t s would be entered i n t o the computer.
C.
Recommendations f o r reduced r i s k of l a t e r i l l n e s s might
derive from t h e data gathered. These would be reviewed w i t h the
p a r t i c i p a n t by a health care professional such as a primary care
physician
or p u b l i c health nurse.
Some, but not a l l
recommendations could be monitored f o r compliance. Examples are:
1.
The obese could be t o l d t h a t they must get r i d of
75% of t h e i r excess pounds beyond t h e i r i d e a l weight
by t h e time of t h e i r next assessment.
2.
Heavy smokers: q u i t smoking. P a r t i c i p a t i o n i n a program
t o help t h e i n d i v i d u a l accomplish t h a t goal should be a
covered item.
3.
Immunizations should be brought up t o date.
covered by the p l a n ) .
4.
Exercise program, e s p e c i a l l y f o r those w i t h a sedentary
l i f e s t y l e and family h i s t o r y of heart disease.
5.
Wear seat b e l t s while d r i v i n g .
One observation by a
p o l i c e o f f i c e r of absent seat b e l t s a t t h e time of a
minor t r a f f i c v i o l a t i o n would be s u f f i c i e n t t o document
non-compliance.
6.
Alcohol and drug abusers r e f e r r e d f o r r e h a b i l i t a t i o n
(again a covered s e r v i c e ) .
7.
Persons w i t h blood pressure l e v e l s or blood l i p i d l e v e l s
t h a t put them a t high r i s k f o r heart a t t a c k or stroke
would be advised t o reduce those l e v e l s t o lower the r i s k
by d i e t a r y change, exercise programs, and/or medication.
8.
Diabetics would be advised t o have an annual examination
by an ophthalmologist t o access any need f o r treatment of
d i a b e t i c retinopathy a t an early stage h o p e f u l l y t o
prevent serious v i s u a l impairment t h a t might r e s u l t from
the diabetes.
(Their cost
�-3H i l l a r y Rodham C l i n t o n , Chairperson
Re: H e a l t h Care Reform: P r e v e n t i o n and Education
May 3, 1993
9.
As g u i d e l i n e s are developed f o r v a r i o u s s c r e e n i n g s w i d e l y
recommended as b e n e f i c i a l i n t h e e a r l y d e t e c t i o n o f cancer, such as
p e r i o d i c mammography, such s c r e e n i n g s would be recommended and
would be covered by i n s u r a n c e .
F a i l u r e t o f o l l o w t h e recommendations would r e s u l t i n p e n a l t i e s
e i t h e r i n t h e form o f s t i f f i n c r e a s e s i n h e a l t h i n s u r a n c e premiums
or an i n c r e a s e i n t h e co-insurance payments r e q u i r e d o f t h e
p a r t i c i p a n t f o r medical care.
The r e l a t i v e s e v e r i t y o f t h e
p e n a l t i e s c o u l d be based on e p i d e m i o l o g i c s t u d i e s o f t h e r e l a t i v e
r i s k s o f c o n t i n u e d o b e s i t y , c o n t i n u e d heavy smoking, e t c . Repeated
f a i l u r e t o c o r r e c t t h e c o r r e c t a b l e could r e s u l t i n repeated
i n c r e a s e s i n h e a l t h i n s u r a n c e premiums a t each p e r i o d i c w e l l n e s s
assessment. On t h e o t h e r hand s u c c e s s f u l l y m a i n t a i n e d r e d u c t i o n o f
r i s k f a c t o r s c o u l d be rewarded by a r e d u c t i o n o f premium o r
r e d u c t i o n i n c o - i n s u r a n c e payment r e q u i r e d by t h e p a r t i c i p a n t f o r
his h e a l t h care.
I would l o v e t o see a s e r i e s o f w e l l n e s s assessment c e n t e r s
e s t a b l i s h e d i n much t h e same way as we have motor v e h i c l e
i n s p e c t i o n s t a t i o n s s c a t t e r e d across our s t a t e w i t h t h e aim o f
maintaining
safety
on t h e highway, o n l y a t a much more
sophisticated level.
Such a p l a n would say t o those w i t h poor h e a l t h h a b i t s t h a t , u n l e s s
t h e y a r e w i l l i n g t o change, i n l a t e r years t h e y a r e s t a t i s t i c a l l y
l i k e l y t o c o s t t h e system f a r more t h a n t h e i r share.
Therefore,
t h e y w i l l need t o pay s i g n i f i c a n t l y h i g h e r premiums f o r t h e i r
i n s u r a n c e o r s i g n i f i c a n t l y h i g h e r co-payments f o r t h e i r b e n e f i t s .
I doubt t h a t any humanly d e v i s e d system can ever be t o t a l l y
T h i s I f e e l would be a reasonable s t a r t .
"fair."
The o p i n i o n s expressed
i n t h i s l e t t e r a r e my own and n o t
n e c e s s a r i l y t h o s e o f t h e U n i v e r s i t y o f Medicine and D e n t i s t r y o f
New J e r s e y .
Sincerely yours.
2*
George H. Kurz, M.D.
C l i n i c a l P r o f e s s o r o f Ophthalmology
U n i v e r s i t y o f Medicine and D e n t i s t r y o f New Jersey:
Robert Wood Johnson Medical School
GHK:wtc
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
004. letter
SUBJECT/TITLE
DATE
03/03/1993
Addresses (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/l3ox Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
,im782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - 1? U.S.C. 552(b)l
PI National Security Classified Information |(a)(l) of thc PRA]
P2 Relating to the appointment to Federal office [(a)(2) of Ihe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) of thc FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe I ()IA|
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CC: Senator B i l l Bradley
,P6/(b)(6)
Senator Frank Lautenberg
Gateway 1, Room 1510
Newark, NJ 07102
Richard
Ziminer
• P6/(b)(6)
^
Norman H. Edelman, M.D.
Dean, Robert Wood Johnson Medical School
675 Hoes Lane
Piscataway, NJ 0885.1-5635
Robert D. Reinecke, M.D.
W i l l s Eye H o s p i t a l
900 Walnut S t r e e t
P h i l a d e l p h i a , PA 19107
�Beth
r
Cardiac '
Transplant ^
PyOgraffl
~—
-^-^^—^
TECHNOLOGY WITH COMPASSION
Newark Beth Israel Medical Center • 201 Lyons Avenue at Osborne Terrace • Newark, New Jersey 07112
March 1, 1993
Ms. Hillary Rodham Clinton
West Wing - White House
1600 Pennsylvania Avenue
Washington, D C.
Dear Ms. Clinton:
Approximately one month ago I sent a copy of my curriculum vitae and a letter expressing
an interest in working with you and the other distinguished members of your health care task
force. A copy of that letter is herewith attached. I am disheartened that neither you nor a
member of your staff has so much as acknowledged the receipt of my letter nor my offer of
assistance.
As you can see from the attached letter, it was my concern that the health care task force
would be comprised of well-known, highly-respected individuals, but would not include the day to
day providers of care. The article in this Sunday's business section of the New York Times
strongly suggests that I was correct. While I recognize that the members ofthe Jackson Hole
Group are not your only advisors, that group is heavily weighted against the physicians. Many
physicians feel that the American Medical Association does not represent their interests. It is for
this reason that membership in that association is so low. Likewise, Dr. Todd, the executive vice
president of the association, as a non-practicing physician cannot understand the problems we all
face. Although 1 am certain that he believes otherwise, he is wrong. Academics, writers,
consultants, and representatives from the pharmaceutical industry are important participants, but
no more important than the physicians and nurses who treat America's sick.
I am not politically "connected." T do not know how to get through to you, other than by
writing a letter such as this. To be honest, it is not clear to me that anyone is interested in the
opinions ofthe most important players in this crisis - the physicians. Again, I ask that you
seriously consider my request to work with the iadministration in planning health care for the
future. As a physician and attorney who practices in inner city Newark, I am well versed with the
problems facing us.
There are individuals "but there" who are sincerely interested in helping. I am one such ah
individual. Please do not ignore my offer of assistance. My insights into the problems and
solutions may prove quite valuable. I look forward to hearing from you in the near future
Should you wish a second copy of my curriculum vitae (resume), please feelfreeto call and we
will forward or fax it to you.
Thank you for your reconsideration in this matter.
Sincerely yours,
. Mark Jay pucker, M.D:, J.D , F A C C , F.C.L.M
Director, Cardiac Transplantation Program
Assistant Professor of Medicine
University of Medicine and Dentistry of N.J. - New Jersey Medical School
Medical Director
Surgical Director
Heart Failure Program
o
•
o
Mark Jay Zucker. M.D.. F.A.C.C.. Assistam Professor of Medicine
Uiszlo Fuzexi. M.D.. Clinical Assistant Professor of Surgery
Hillel S. Kibncr. M.D.. F.A.C.C.. Professor of Medicine
•
«
e
(201)926-7205
(201)926-7325
(201)926-7X90
Transplant Coordinator
o
Sandra L. Bausback-Ahallo. R.N.
»
(201) 926-721 I
AITilkile of University of Medicine ;mc! Dentistry of New Jersey • Member ol' United Jewish Federation of Metro West
�Transplant ^
P r o g r a m
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WITH COMPASSION
Newark Beth Israel Medical Center < 201 Lyons Avenue at Osborne Terrace < Newark, New Jersey 07112
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»
January 27, 1993
Mrs. Hillary Clinton
West Wing - White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Mrs. Clinton:
Let me take this opportunity to congratulate you on your recent appointment. Ac you
undoubtedly know, reforming the healthcare system in America cannot be described as a
minor task. Undoubtedly, members of many nationally recognized organizations have
stepped forward to offer their services to you. While many of these individuals may be
highly respected and well recognized, they are frequently isolated from the day-to-day
interactions with the "system". To ensure that all groups are fairly and accurately
represented, it is necessary to include on your healthcare task force individuals, such as
myself, who practice high-tech inner-city medicine and deal with the realities of our
healthcare system each and every day. As you can see from the enclosed curriculum vitae,
I am a well trained physician as well as an attorney. I have participated actively in revising
the healthcare plan in New Jersey. I am a member of thc Board of Directors of the New
Jersey Affiliate of the American Heart Association as well as the New Jersey Organ and
Tissue Sharing Network. I would be honored to have an opportunity to work with you and
the other distinguished members of the task forces and subcommittees that will ultimately
restructure the American healthcare system.
Please be assured that the physicians are as unhappy with the present system as are the
politicians and public constituencies. Reformation is a challenging but necessary task. I ask
that you seriously consider my request to assist you in one way or another. I know that
yjM! wi!! find my active participi:lion to be worthwhile zivJ. piafi&He.
Thank you in advance for your consideration in this matter.
Sincerely yours,
Mark J. Zucker, M.D., F.A.C.C.
Director, Cardiac Transplantation Program
Assistant Professor of Medicine
UMDNJ - New Jersey Medical School
Medical Director
Surgical Director
Heart Failure Program
Transplant Coordinator
•
•
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o
Mark Jay Zucker, M.D., F.A.C.C, Assistant Professor of Medicine
Laszlo Ftnesi. M.D.. Clinical Assistant Professor of Surgery
Hillel S. Rihncr. M.D.. F.A.C.C. Professor of Medicine
Samlra L. Bausback-Ahallo. R.N.
Affiliate of University of Medicine and Dentistry of New Jersey
•
e
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o
(201) 926-7205
(201) 926-7325
(201) 926-7890
(201)926-7211
Meinhcr of United Jewish Federation of Metro West
�CODER:
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
OENRRAL SORT:
POSTCARD 1:
.Personal stories
.General mail
.Letter Campaign
Other Health Providers
P O S T C A R D 2:
.Offers to help/Employment
FORM LETTER:
Letterhead
REROUTE:
Casework
.Policy
'hysicians
Scheduling
President
Other
POLICY AND PERSONAL STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
. C O V E R A G E (II)
working families
unemployed/low income
benefits
providers
. I N F R A S T R U C T U R E / W O R K F O R C E (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
. G O V E R N M E N T PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
.medical equipment
fraud & abuse
.FINANCING (VII)
. M E N T A L H E A L T H (EX)
L O N G - T E R M C A R E (X)
.PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Oara k E l i z a L e t k A l l e n , M D
j^cJ^r
^
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d^as.
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�P E D I A T R I C C A R D I O L O G Y A S S O C I A T E S cfr N E W M E X I C O
ST. J O S E P H S Q U A R E
7 1 5 G R A N D A V E N U E . NE
— •
S U I T E 2 0 7 . A L B U Q U E R Q U E . NM 8 7 1 0 2 . ( 5 0 5 )
848-3700
February 4, 1993
1
WILLIAM BERMAN, JR.. M.D.
R A Y M O N D R. FRIPP, M . D .
STUART A . R O W E , M . D .
STEVEN M . Y A B E K , M.D.
Hillary Rodham Clinton
Coordinator, Federal Office for
Health Care Delivery and Insurance
White House
1600 Pennsylvania NW
Washington, DC 20006
RE: Proposed input regarding federal health care programs
Dear Director Clinton:
I am writing to ask you or the member of your organization who reviews letters such as this
to consider accepting my input and recommendations regarding the developmenLof-an
health care delivery and/or insurance program.
^=^±z===^ •
My name is Bill Berman. I am a doctor, currently living in Albuquerque, New Mexico, and
I have enclosed my CV for review by anyone who cares to document the details of my
background.
Briefly, I grew up in the midwest, kl^tTLouiSj^ssf^bri^was bom at Ft. Riley, Kansas
when my father was in the semce^ttended'mrvard CoTl&gk, Washington University
School of Medicine, and did my pediatricttaining^Lthe-Umversityof California in San
Francisco. Following a two year period of service in the TTnitpH Statpg Pnblir alth
SeryiceJLfcontinued training in the field of pediatric cardiology and cardiovascular
physiology at the Cardiovascular Research Institute of the University of California. I have
held academic positions ai the Pennsylvania State University in Hershey and the University
of New Mexico in Albuquerque. I have done sabbatical work at Yale, received four NIH
funded research grants, am the director of the division of Pediatric Cardiology at the
University of New Mexico, am the former secretary-treasurer of the Society of Pediatric
Research, and since 1986 have been engaged in the private practice of pediatric cardiology
in Albuquerque and throughout the state of New Mexico.
Hp
I practice in a poor state whe/e 50%pf my patients are on federal and/or state financial
assistance. I was, from my perrod~of entry into medical school in 1965 through 1985,
involved in academic medicine with heavy responsibilities in teaching, training and
research. Since 1986 I have been preoccupied with the delivery of medical care in an under
populated rural state. I think I have, if not a unique, a broader medical perspective than
most because of my involvement in a variety of medical settings throughout my period of
training and practice.
DIPLOMATES OF THE AMERICAN BOARD OF PEDIATRICS AND SUB-BOARD OF PEDIATRIC CARDIOLOGY
�Page 2
February 4, 1993
Hillary Rodham Clinton
I have opinions (? prejudices ?) regarding the issues of health care delivery in rural and
urban settings; the advantages and disadvantages of "managed care"; the potentially
destructive as well as constructive aspects of medical "competition", and a number of other
issues which I am sure are under consideration by you and your task force during the
development of a national approach to health care delivery and financing. As one might
guess from what I just said, I believe the delivery and distribution of health care must be
integrated into any reimbursement system and it is this primary objective I would love to
have the opportunity to discuss with you or a member of your staff.
If a grass roots approach such as this one is in any way, shape, or form attractive to you or
your task force, I would be happy to provide more explicit information about specific
medical care issues. If not, I am glad I function in a system where I have the opportunity to
write a letter such as this.
All my best wishes and good luck in your gargantuan task.
Sincer
Willfaj n Berman Jr., M. D.
Adjunct Professor
Pediatrics (Cardiology)
Pediatric Cardiology Associates of New Mexico
WB:LT
enclosure
ADDENDUM: As references regarding my background and qualifications, I would
respectfully offer the following: 1. Jeff Bingaman, United States Senator, State of New
Mexico. Jeff and I were college house mates together. We have more than occasionally
been in touch in New Mexico and in Washington over the past several years and I think he
would be a qualified professional reference for me. 2. Bowman Cutter, economic advisor
to the President, currently officed in the White House. Bowman and I were roommates at
Harvard and have stayed in touch over the years. Recently, Bowman and I discussed in
modest detail the issue of health care reform and its economic consequences. Bowman
would also be an accurate professional reference for me. 3. Steve Fiance, Democratic
committee person in the State of New Mexico and manager of the gubernatorial campaign
for Bruce King during his last election. Steve and I grew up together in St. Louis and have
remained close friends over the years. He is an avid participant in all democratic political
issues in the Santa Fe, New Mexico area. Steve knows me as well as anyone in my life. He
would not only provide a reference for me, but together we can also most likely come up
with an extemporaneous rendition of almost any song by the Platters, Jerry Butler, Everly
Brothers, Gordon Lightfoot etc.
�CLINIC LOCATIONS:
ADMINISTRATIVE O F F I C E
1812 Candelaria N.W.
Albuquerque, N.M. 87107
(505) 768-5465
2001 N. Centro Familiar S.W.
Albuquerque, N.M. 87105
(505) 768-5400
1316 Broadway S.E.
Albuquerque, N.M. 87102
(505) 768-5450
ALBUQUERQUE
1259 Highway 85
Los Lunas, N.M 87031
CENTRO FAMILIAR DE SALUD
Bernie Sanchez, Board President
FAMILY HEALTH CENTER
Luis Rey Gonzales, M B A
Executive Director
2001 N. C e n t r o Familiar S W / Albuquerque, New Mexico 87105
(505) 768-5400 (Administration)
(505) 865-4618
Edward Lamon, M.D.F.A.A.P.
Medical Director
2001 N. Centro Familiar S.W.
Albuquerque, N.M. 87105
(505) 768-5440
2127 Los Padillas Rd., S.W.
Albuquerque, N.M. 87105
(505) 768-5480
7704 2nd St., N.W.
Albuquerque, N.M. 87114
(505) 768-5475
February 10, 1993
Mrs. Hillary Rodham Clinton
Medical Health Care Reform Committee
White House
Washington, D.C.
Dear Mrs. Clinton:
First of all, I wish to congratulate you and Mr. Clinton for your recent victory.
I am very pleased that such swift attention has been given to medical health care reform
and I support your efforts.
My area of interest is in bridging traditional and alternative medicine. My goal
is to participate in establishing a series of Medical Health Care Centers in which both
of these disciplines could come together. I believe that by focusing on the causation,
prevention and treatment of disease, much could be done to reduce the costs of health
care.
I am available as a consultant in evaluation, implementation and research of
Alternative Medical Practices.
Sincerelv.
Milton G. Godine
�V
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
c
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. resume
SUBJECT/TITI.E
DATE
Phone No. (Partial) (2 pages)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
jin782
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)
Freedom of Informalion Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOI A)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) nf the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to thc appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CURRICULUM VITAE
Milton G. Godinez, M.D
•,.P6/(b)(6)
My goal is to participate in bridging traditional and alternative medicine. I am interested
in Native American Healing practices and energy medicine. I would like to participate in
creating a series of Medical Health Centers to incorporate a new model for medical care.
Included in, this new model are education and research.
Vital Statistics:
Experience:
3/1/92 - Present: Albuquerque Family Health Center, 2001 N. Centro Familiar S.W.,
Albuquerque, New Mexico 87105. (505) 768-5440.
1/1/92 - 12/31/92: Health Source, La Mesa Medical Center, 7000 Cutler N.E., E-6,
Albuquerque, New Mexico 87110. (505) 884-3039. The center specializes in'Energy
Medicine, Transformational Medicine, bridging traditional and alternative medicine.
9/1/91 - 2/31/92: ACL Hospital, Acoma Pueblo, New Mexico. (505) 552-6634.
7/1/80 - 8/31/91: OB/GYN Assoc. Ltd., 8200 Constitution PI. N.E., Albuquerque, New
Mexico 87110. (505) 292-0444.
Education:
Undergraduate - University of New Mexico, Pre-Med, B.A, - 1972.
Graduate - University of New Mexico, School of Medicine, M.D. - 1976.
Post-Graduate - Kaiser Foundation Hospital, Los Angeles, California, OB/GYN
Internship -1977.
Kaiser Foundation Hospital, Los Angeles, California, OB/GYN Residency - 1980.
�Milton G. Godinez, M.D.
P6/(b)(6) . .
References:
Donna L. Denning, M.D.
Center for Health Awareness, 120 Aliso Dr. S.E., Albuquerque, New Mexico 87108.
(505) 266-8876.
Ralph Luciani, D.O., Phd.
The Albuquerque Clinic, 2301 San Pedro Dr. N.E., Albuquerque, New Mexico 87110.
(505) 888-5995.
Angelique Cook-Wilcox, L.A.C.
Health Source, 7000 Cutler N.E., E-6, Albuquerque, New Mexico 87110. (505) 884-3039.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
5
3
..-.-.v
..- . .-. •• • / » •
. •>:x-'--.'; -. -y.'V.
�/ \
March 15th, 1993
Hillary Rodham Clinton,
Health Care Reform Task Force
The White House , .
Washington, D.C.
Dear Ms. Rodham Clinton,
It is refreshing for me to see a change of direction in Washington and
I hope many of our pressing social and economic problems will be
addressed. I am completely supportive of the steps you have taken so far. I
have some areas that your task force should explore. I hope my input is not
too late. Your task is formitable, and you will need all the help you can
get!
^
I am a- gomrnuDUy oriented emergency physician who believes that a
synthesis of emergency medicine and public health disciplines will yield a
great deal of useful information for managing our health care - delivery
problems. I have rich "front line" experience every working day with our
health care crisis. I have come to see the emergency department as a
window on our communities whose neglected role is to provide
information about the status of our people and of the health care system
as a whole.
The Emergency Department is the "safety net" where the ill effects of
our out-of-control social and medical problems are managed. Examples are
substance abuse and its many casualties of all types, personal and
domestic violence, lack of access to primary care physicians, medical and
administrative inefficiencies which together form a microcosm of our-^
condition. We have become the Primary Care Clinic for our society.
Thus, I am responding to your request for input and ideas, some ofg|^
which are the product of two years of unpublished research. I hope that mj^p
observations may be of use. They fall into two categories, as follows:
A) Observations made by myself over time in various Emergency
Departments and recommendations which may help stop the
financial hemorrage.
r
r
�Page Two
B) A recommendation that the Federal Government, as part of its
technology initiative, develop the technological tools needed
to control the flow of medical and health related information
and therby provide the tools needed to control and optimize our
health care system . It represent the kind of bold
interdisciplinary initiative that I believe is needed to "get a
handle" on our health care crisis. The proposal converts some
of the resources available from our two National Laboratories
and our close knit, but diversified, medical and academic
community into a Federal Medical Informatics Laboratory
based at the University of New Mexico. An analysis of the
benefits of the DynaMedics Provider Interface is also included.
My C V . and my partner's C V . are enclosed as an addendum at the end
of this document. I am prepared to volunteer my services to you in any
capacity you need. I believe I have the network, the "front line" experience,
the insight, and motivation to help you develop these areas. My special
organizational talent is in working between and within institutions,
building bridges, identifying common interests and "key" people. I would
be honored to help.
Respectfully Yours,
Haywood HalF
cc. Senator Jeff Bingaman D-NM
Representative Bill Richardson D-NM
�List of Twelve
Recommendations from an
Emergency Physicians Point of View
1) Promote a Single Party Payer System
Of course, the insurance industry will fight tooth and
nail. Managed competition may not work in rural, underserved areas
and may not result in administrative streamlining. Working a few
hours each day in a federal hospital or clinic (as in Costa Rica)
seems like a good system.
2) Federal Medical Informatics Laboratory as a part of the
Technology Initiative
The technology must be developed to control the flow of
medical and health related information, which will be the key to
controlling and transforming the health care system. An all out
effort will have to be made to develop Medical Informatics (the use
of computer and information sciences to streamline and re-engineer
the flow of medically related information) as useful tools for
providers (especially primary care), and for health care systems
monitoring. Administrative and clinical practice are tremendously
inefficient and can be streamlined with the right tools, (see next
section)
3) Reform Medical Education and Training
A) Encourage the Community-Based, Problem-Oriented
Primary Care Curriculum pioneered by the University of
New Mexico School of Medicine.
B) Integrate Public Health, Primary Care and Medical and
Post-Graduate Medical Curricula. Schools of Public
Health and Medical Schools are generally found
completely separated physically and intellectually
(probably the core of the problem). I have tried to develop
and integrate an MPH program into our Medical School
(with some success).
�C) People going into Medical School should expect to come
out of the medical training as primary care physicians.
After 5 years of primary care practice and if there is a
need, they should be allowed to subspecialize. (This will
make better primary care physicians, and make
specialists who better understand the context in which
we must provide health care).
D) Reactivate and re-energize the National Public Health
Service Corps. Use it to attract and retain primary care
and public health oriented physicians. Make primary care
medical education affordable so that physicians do not
try to recover the cost of their education on the
population by subspecializing and charging high fees.
4) Make Primary Care the Center of our Health Care System.
Probably 75+% of physicians should be doing Primary Care (the
situation is reversed). Although technologically facinating, the
preeminance of speciallists is destroying our health care system and
undermining our health. Develop effective use primary care midlevel providers (Nurse Practicioners/ Midwives and Physician
Assistants).
5) Incorporate Emergency Departments as a Feedback-Control
Mechanism for the Health Care Reform Process
Our health care system is out of control and from a "systems"
point of view an effective feedback and control mechanism must be
established. Since all of our health care dysfuntions spill over into the
Emergency Department, we need to develop the emergency departments of
our country to fill this function. Using an Emergency Medicine version of
Community Oriented Primary Care (melding clinical Emergency Medicine
with Public Health approaches) powerful tools can be developed to keep an
eye on the Medical and Social "Bottom Line". Such a Feedback-Control
mechanism would generate powerful epidemiologic, health services
administration, and clinical research data, for health promotion as well as
medical human resource assessment. It would provide the tools for
medical, administrative and public health initiative impact analysis.
�6) Focus on Emergency Departments during the transition
phase from a speciallist oriented health care system to a primary
care oriented health care system.
The uninsured, underinsured, and the many people who can't
find a primary care doctor presently use the Emergency Departments
as their Primary Care Clinics. By having combined Emergency and
Urgent Care Centers with a shared "triage" area, we will
immediately "off load" our overextended Emergency Departments,
and provide more appropriate, cost effective care for the "at risk"
population. As our primary care capabilities expand, we will need to
place these patients into a primary care network and use waivable
co-payment to discourage frivolous use of the Emergency
Department.
7) Improved Medical Control in Nursing Homes
A large resource drain is directly the result of poor
medical control in nursing homes. Because most nursing homes do
not have active Medical Directors, or even "mid-levels" (nursepracticioners or physicians assistants), trivial medical problems
are sent to the local Emergency Departments by people with minimal
assesment skills. This means a two way ambulance trip and and an
Emergency Department visit ($500 is not an ureasonable estimate
for even the most trivial problem).
8) Reform Pre-hospital Care
Innapropriate Ambulance patients "short circuits" our normal triage
system making it harder to treat seriously ill or "salvagable" patients.
Perhaps as much as 50% of ambulance transfers are innappropriate.
ParaMedics should be allowed to not transfer people by ambulance who do
not even remotely have an emergency problem. Strictly enforced
"Certificate of Need" declarations should be signed by all physicians
receiving ambulance patients (define need as to whether the patient had
reasonable cause). Patients without this certification by physicians
should be billed directly, regardless of third party payer status. Repeat
offenders should go to an orientation class provided by Emergency Medical
Technicians. Emergency Medical Systems released from the buden of non-
�4
emergency transfers should be involved in highly visable, community
centered safety and health promotion activities.
9) "Sin Tax" on alcohol and tobacco to cover the actual cost to
society.
You seem to be on this track already. Congratulations for your
courage!! I agree that those people who drink alcohol and smoke tobacco
should not have their massive health care and other direct and indirect
cost subsidized by the rest of us. A tax to cover the amount of cost to
society is only fair. The Center for Disease Control has released
information that 95% or more of the cost of substance abuse is due to
tobacco and alcohol alone.
An example of the problem is the major drain on our system by the
"hopeless" alcoholics who are often found "down and out" and repeatedly
brought by ambulance to our Emergency Departments (often 50 to 100
times a year) where we become a very high priced "drunk tank". They often
spend 8-12 hours per visit (total cost including ambulance: $750 to
$1,000 per visit!!).
10) Reform Narcotics Policy
Other substance abuse issues need to be addressed. There are many
people who routinely request drug treatment and I am unable to find
facilities for them. Drug abuse is a major vector for the spread of AIDS,
and is probably the major factor in property (and increasingly) violent
crime. Drug related arrests are a major resource drain on our legal
system, so much so, that our criminal justice system may collapse. A
radical solution is required (although politically may be difficult). A
combination decriminalization of the casual use of narcotics, treatment
on demand, drug use prevention initiatives, government regulated supply,
registration and taxation of "recreational" drug users, heavy civil
penalties and enforced treatment for "problem users", harsh criminal
penalties for drug dealers may be the kind of approach needed. Clearly,
those things that re-enforce the psychology of despair (unemployment,
lack of opportunities disenfranchisement) need to be addressed. Such a
program would have as its strongest opponents the drug cartels since they
would have the most to loose.
�11) Reform the Disaster Management System
The command and control of medical and public health responses to
disaster is a disaster in itself. It should be coordinated and administered
by the Public Health Service. The National Disaster Medical System (NDMS)
command and control must be streamlined and demilitarized as much as
possible. The political use of disaster response teams is reprehensible.
A) Presently, disaster response requires activation through FEMA,
the VA, DOD, PHS, and the State Department to name a few
which makes it very political, unweildly and ineffecient.
B) In many situations (international and inner cities, for
example) a humanitarian response with a military facade
may be insensitive and counterproductive in the long run.
Community-based PHS reserve medical personel should
make up a large number of the response teams.
12) Increase Active AIDS Prevention and Intervention
Initiatives
If an AIDS "czar" is to be considered, I can think of no one more
qualified than Jonathan Mann, M.D.. As you may know, he spearheaded the
United Nations AIDS effort (and may have been too successful!). He is
presently at Harvard, I believe. The most effective vector control will be
health education, access and use of condoms and clean needles.
New Mexico, I believe, has much to offer to develop some of the areas
listed above. If you wish, I can help you put together fact finding
committees in the areas of Emergency Medicine and Health Care Reform
and to consider the development of a Federal Informatics Laboratory in
New Mexico. There are excellent resources across academic, private, and
governmental sectors that need horizontal integration (which a federal
initiative could provide) to develop these interdisciplinary areas. I have
good contacts here in these areas, as well as ideas about how to develop
them. I believe that our community has the right balance of critical mass
and informality to make such development projects feasable. I am, and
will be, always, at your disposal.
Haywood Hall MD
n
�Advanced Medical Computer Applications
Laboratory Mission Statement
(Proposed)
The Advanced Medical Computer Applications Laboratory, will be
based at the University of New Mexico School of Medicine, Center for
Community Medicine and Public Health. It's purpose is to stimulate and
support non-proprietary research and development of management
information systems, developing data exchange standards, systems
integration, provider interface and medical system re-engineering as it
relates to health care services. The outcome will be to develop government
run medical computer systems and technologies which will provide the
needed tools for health care management in the United States.
It will be a consortium of the following New Mexico Institutions: The
University of New Mexico, The Computer Research Laboratory at New Mexico
State University, Los Alamos and Sandia Lational Laboratories (technology
transfer and technical support), Lovelace Medical Center (HMO), Lovelace
Scientific Resources, the State of New Mexico Health Department, the Public
Health Service/Indian Health Service, and the Veterans/Kirtland Air Force
Base Hospital with support from the Center for Disease Control, and the
National Institute of Health.
OPJECTIYEiS
1) To make health care systems more productive, to increase the
quality of care by providing portable, easy to use, point of contact computing
to health care practicioners and to develop productive pen-based computer
systems and to set new standards in applied medical computing.
2) To bring these provider-based computers into a government
administered local area network that will streamline and re-engineer the
flow of medical systems information, thereby reducing administrative
overhead
3) To develop and promote the concepts of computer assisted
management of the patient encounter and use its National Medical Computer
Systems as a tool for monitoring, development, and transformation of U.S.
health care systems.
4) To create an environment of cooperation, innovation, and
technological advancement, with the same type of urgency and focus as the
Manhattan Project, that will meet the challenges of an evolving health care
system and to provide the tools to convert a chaotic health care system into a
rational, well managed, high quality health care system for all.
�2
5) To provide a means to convert New Mexico's largely military based
economy to productive civilian use.
STRATEGY
1) University of New Mexico School of Medicine provides the open
academic environment available at a major university and medical
coordination with a special focus on Primary Care and Emergency Services
settings. The project will build on the many existing innovative activities of
the University and New Mexico.
2) Los Alamos and Sandia National Laboratories in collaboration with
the Computer Research Center will provide the technological and engineering
support for the project, therby providing a means to redirect the military
industial complex to social and economic needs.
3) Lovelace Medical Center provide its Health
Maintenance
Organization management expertise, and its outpatient clinics as
development sites for the project, Lovelace Scientific Resources will provide
its technology development and assesment skills to the project.
5) The Center for Disease Control Field Office and NIH input will ensure
that medical and health services data generated by the systems developed
will provide useful epidemiologic, clinical research, and health services
administration information.
6) Other agencies input will be developed as needed.
I feel I can help you organize this project, if the administration throws
its weight behind it. I will accept a transient organizing role, with your
assistance and supervision, if this is needed to make the project successful. I
am also willing to sign over any rights on the work I have done on this
project so far, which might result in financial enrichment.
Our Health Care System, Computer Technology, and Economy are in a
state of flux, which provide opportunities for innovative horizontal solutions
to our critical social health problems. But timing is essential.
�Benefits of the DynaMedics System
1) Decreases the time physicians spend documenting by
allowing the practicioner to "document as you go". Physicians may
spend as much as 30% of their time documenting, thus, this system
should allow the physician to see more patients or to spend more
time with the patient.
2) Provides "problem oriented templates" for historical and
physical findings therby prompting the physician not to omit
important medical and medico-legal information. This feature
assures that standards of care are met and should decrease the
number of lawsuits.
3) Provides easy to use , intuitively obvious, graphic user
interface, which will for the first time put truly portable computers
in the health care workers hands. Computers are everywhere around
medical practice except at the point of contact between the physician
and the patient. Modern medical computer systems spend a
tremendous amount of manpower and resources
retroactively
reconstructing
this encounter.
4) Automatically assists the physician in selecting the
appropriate billing codes (ICD-9 and CPT) and makes sure that all
documentation supporting billing is done. Coding is now done by
coders who are not medically trained, and have to select the
(supposed) appropriate billing codes based on often incomplete and
illegible hand written charts. This feature should reduce
transcription and translation errors, administrative overheads, and
third party audits.
5) Provides a list of diagnostic possibilities (differential
diagnosis) based on information selected in the history and physical
templates. This feature should increase the chance that the correct
diagnosis is made.
6) Provides problem oriented flow diagrams to assist the
physician in working
up the patient. It suggests pertinent laboratory
and diagnostic studies based on medico-legal standards and third
payer re-imbursement patterns. This feature should assure that
standards of care are being met in the most cost effective manner.
�7) Imports encapsulated medical record from patients previous
encounters, including problem lists, medications, etc. Also able to
export same to hard copy, to hospital computer, or to Fax to
insurance companies or other physicians. In an integrated system,
this feature circumvents many of the problems with traditional
medical records access and makes available the important bare facts
from previous encounters, therby increasing the quality of care. The
hard copy feature allows the system to be used in a modular fashion
and provides additional back-up.
8) Allows orders and prescriptions to be done directly from the
pen-based computer and automatically informs in-house pharmacy
and materials management of items used. It also generated a bill for
those items. Further streamlines the flow of medical information and
provides superior inventory control. Prescriptions are derived from a
software based formulary which gives the physician prescribing
information, cost indexes, suggested substitutions, etc.
9) Automates customized discharge instructions, giving
problem and diagnosis based instructions, information on prescribed
drugs and treatments, and follow up information. Able to generate
discharge instructions in Spanish. Decreases time physicians and
nurses spent on developing written discharge instructions and
provides a vastly superior and more detailed output.
10) Functions as the physicians "personal organizer" , keeping
track of appointments, patient status, etc.
11) It would provide administrative information to physicians
and administrators for practice analysis such as peak flow ,
frequency of problems/diagnoses, acuity scales, monitoring of patient
flow times, etc. Essential for Quality Assurance and Control
12) Able to assist the physician an Continuing Medical
Education. The system will keep track of what kinds of cases have
been seen by the physician thus is able to periodically provide a list
of problems not recently encountered which the physician is
nonetheless still required to maintain proficiency in. Using the
�template database, the system can present simulated problems for
the physician to work on. With the emerging multimedia capabilities,
the system will be able to hook up to a teaching workstation and
manage a realistic simulated patient. Will provide a mechanism to
keep practicioners current who are isolated from medical centers.
13) Especially well suited for Managed Care Systems
incorperating Total Quality Management techniques such as HMO's,
PPO's, etc. All templates, flow diagrams, and major software
algorhythms will be customizable. This feature allows medical
administrators to closely monitor physician activity and to "program"
changes in physician/patient
interactions through quality
assurance/improvement
committees making algorhythmic changes in
the software. It also allows for changes in medical practice to be
incorporated.
14) Able to assist in epidemiologic analysis in large integrated
systems. The system could provide biostatistical analysis to problems
seen by physicians, and thus give early clues to epidemiological
events ( ie. early outbreaks of epidemics). Summary information
could be sent to the state health department and the Center for
Disease Control for further analysis
15) Will bring the overwhelming amount of information that
primary care practicioners have to manage under control. One of the
causes of overspecialization is the need many in medicine have to
have a good grasp information relevent for practice. The system
proposed will provide major solutions in this area.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
6Y
.•. .. J . . . ..
•
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n.d.
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jm782
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IM
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financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CURRICULUM VITA
Haywood: Hall
Personal
M.D.,
Information:
Professional
Associations
(past
&
present)
American College of Emergency Physicians
American College of Physicians
Member, Greater Albuquerque Medical Association
Member, New Mexico Medical Society
Licenses
and
Certifications:
* New Mexico Medical License
#247-87
* State Pharmacy License
#9751
Drug Enforcement Agency Number:
• pe/tbxef*
Certifications:
•
Education
* MD
and
o0(o
Medical Control Emergency Physician, Bernalillo
current
Advanced Cardiac Life Support, current
Advanced Trauma Life Support, not current
Pediatric Advanced Life Support, not current
Professional
County,
NM
Training
Degree, Baylor College of Medicine, Houston Texas 1982-1986
Honors In Community Medicine, Cardiology, Pulmonary,
Anesthesiology, and Emergency Medicine
* Completed Internal Medicine and Emergency Medicine Residency
Programs
with 9 months
of advanced
critical
care training
Including
3 months as Medical Intensive
Case Unit Fellow,
University
of New Mexico.
1986 to 1991
'
Board
BA
Eligible In
Internal
Degree, Cum Laude,
New York, Graduated
Medicine
and
Emergency
Biology, Brooklyn College,
1981. Entered with G.E.D.
V
/
^
^r-
Medicine
City
University
.
of
.--
�Page Two
Current
Employment
and
Appointments:
* Adjunct Assistant Professor, Departments of Emergency Medicine and
Community Medicine, University of New Mexico School of
Medicine
* Medical Director, Emergency Department, Clovis High Plains
Hospital, Clovis, New Mexico
* Medical Director, Region III Emergency Medical Services, Emergency
Medical and Primary Care Bureau, State of New Mexico
* Team Physician, New Mexico Disaster Medical Assistance Team,
National Disaster Medical System (NDMS)
* Emergency Staff Physician, University of New Mexico Hospital
* Emergency Staff Physician, Lovelace Medical Center, Albuquerque,
New Mexico.
* Emergency Physician, Memorial Medical Center, Los Cruces, New
Mexico
Past
Clinical Experience:
*Over 5000 hours in Emergency Departments around the State of New
Mexico Including Farmington, Gallup, Espanola, Grants, Roswell,
Belen, Holloman Alrforce Base, Klrtland/VA Emergency Center,
Presbyterian Hospital
(Albuquerque)
Paraprofesslonal
Activities
* Organized and incorporated the DynaMedics Medical Computer
Corporation to develop integrated penbased Computerized
Patient Records systems computers. 1991
* Initiated the Masters In Public Health program at the University of
New Mexico.
Wrote the original development proposal which
emphasized an Interdisciplinary approach. Organized and served
as a member of the MPH executive committee. Co-chaired the
Internatlona/RuralBorder/Cultural
Health MPH
subcommittee.
Coordinator between the MPH Program and University Graduate
School. Continues as community organizer for the development of
UNM Public Health Programs.
* Technical advisor to the Dissemination Unit of the World Health
Organization Collaborative Center for Community Based
Medical Education. Helped develop their present computer
capability in Desk Top Publishing.
* Developed and directed the Medical Spanish program for residents,
medical students, faculty, and staff of the University of New
Mexico Medical Center funded under the Robert Wood Johnson
Foundation Social Medicine Grant.
�Page Three
* Founded the New Mexico House Staff Association 1989. Edited the
New Mexico House Staff Association Newsletter. Successfully led
Interns, resident, and fellows in wage and working condition
disputes in 1991.
* Founded the Intercultural Health Organization, 1988.
Resulted In
the development of the Housestaff Association, changes in the
Internal Medicine residency program to a more outpatient
/primary care orientation, the Medical Spanish Program, the
Masters In Public Health (MPH) initiative, and a student health
service for 18,000 Technical-Vocational Institute (TVI)
students.
Research and Publications:
* "Community Oriented Learning for Emergency Medicine Residents "
Academic Emergency Medicine, 1990, Vol 2, No.
* "Problem-Based Learning for Emergency Medicine Residents"
Academic Emergency Medicine, 1990, Vol 2, No.
* "Controlled Vocabulary, Narrative Comments, and Novel Syntax in
the design of a computer-based Patient Record System" K
Rosenberg MD, H Hall MD, D Coultas MD, in progress
* Pharyngeal-Tracheal Lumen Airway Study. UNM Dept. of Emergency
Medicine
* "Effect of written orientation materials on patient satisfaction in the
Emergency Department" In progress
* "Community Oriented Primary Care: Public Health and the
Emergency Physician." in progress.
* Research assistant, Estrogen Receptor Study, Baylor College of
Medicine, 1982
* Research assistance Rlbavlron Drug Study Baylor College of
Medicine, 1982
Extra-Currlcular
Activities
and
non-medical
work
experience
* Traveled extensively throughout southern Mexico and In Jamaica,
West Indies and observed health care delivery in a variety of
settings.
1982-1986
* Organized and participated in mural project for Ben Taub Hospital's
pediatric clinic waiting rooms, treatment rooms, and on the
pediatric ward, Houston, Texas 1983-1984
* Officer of Rlverrun, the Brooklyn College's literary arts magazine
1979 to 1991
* Organized a cultural festival at Brooklyn College 1979
* Traveled with my wife, my father and mother and sister to China,
India, Turkey, Germany, and England during the summer of
1 978.
�Page Four
* Employed by the English Department and the Department of
Educational Services as a tutor In English, Biology and
Anthropology at Brooklyn College.
Trainer and administrator
of peer tutors.
* Worked as a meter reader, piano tuner, and taxlcab driver in New
York City prior to obtaining a General Equivalency Diploma
(GED) 1972 to 1976
Special
*
*
*
*
*
Interests
Interdisciplinary studies, social ecology and social change/evolution,
process Inovatlon and information re-engineering,
Health care provider centered, point of contact computer applications
to solve broad based problems in clinical medicine, medical
economics, health care delivery, public health and medical
education.
Development of Emergency Medical and Primary Care Services in
rural and underserved areas.
Medical Anthropology. Interested in the provision of health care
services In multicultural
environments.
Music.
Played percussion, keyboard and guitar since 1967, as well
as some composing and arranging.
References
Larry Gordon, MA, (505)
277-3312
Visiting Professor of Public Administration,
University of New Mexico,
Former Secretary of Health and Environment,
State of New Mexico
Scott Obenshaln, MD
(505)
277-2321
Assistant Dean, Professor of Pediatrics, UNM School of
William
Wiese, MD
(505)
277-3253
Chairman, Department of Community Medicine,
UNM School of Medicine
President, U.S. Public Health Association
Paul Roth, MD
(505)
272-5062
Chief of Staff, University of New Mexico Hospital
Chairman, Department of Emergency Medicine
Commander, New Mexico Disaster Assistance Team,
National Medical Disaster System
Tom Becker, MD, PhD
(505)
277-5541
Faculty, Internal Medicine
Epidemiologist & Medical Anthropologist
Former Epidemiologic Intelligence Officer,
Center for Disease Control, Atlanta, GA.
Medicine
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Kevin Marcus Rosenb
Persona
Information
Undergraduate
Education
University of California at San Diego
B.A. in Biochemistry / Cell Biology conferred June 1983
MCAT scores: Biology 99.9% Science Problems98%
Physics 98%
Chemiitry
97%
University of Catifornia at Irvine, School of Medicine
Medical Degree conferred June 1988
Postgraduate
Education
Honors
Grants
Awarded
Professional
Activities
Work
Experience
University of New Mexico, Albuquerque
Internal Medicine internship: 24 June 1988 to 22 June 1989
Internal Medicine residency: 1 July 1990 to present
Graduated cum laude, U.C. San Diego (CPA 3.75)
National Dean's List / Third College Academic Honor List / Provost's Honor List
Canyon High School's Oatstanding Science Achievement award
David Jay CFambee Memorial Fellowship grant, 1982
U.C. San Diego Chancellor's Associates grant, 1982
Member American Medical Informatics Association (1991-present)
Member American Medical Association (1989-present)
Member New Mexico Medical Association (1989-present)
Member Greater Albuquerque Medical Association (1989-present)
Member California Medical Association (1983-88)
Member of California Medical Association's Committee on Computers in Medicine (1984-85. 1985-86)
Member UC Irvine Admissions Committee (1983-85)
Co-director and founding member of UC San Diego Peer Health Advocates (1981-1983)
1991-prcs
1989-pres
1988
1984-86
1983
1979
1979
1978-79
1977-79
Designing and implementing a computerized medicalrecordsystem for DynaMedics, Inc
Locum Tenens Emergency Room and Urgent Care Physician, over 4000 hours
Extending and documenting expert system shell at the National Library of Medicine.
Statistical analysis using statistic and graphic languages and custom programs.
-v
Wrote computer program to print contents of a color graphic screen for Anadex Printer, Inc."%
Wrote computer program to control multi-theaterticket-sellingand accounting system for
Pacific Theaters, Inc.
•^F
Pharmacy clerk.
.31;;.
Computer hardware and software technician for Microcomputer Business Consultants, Inc*,,
Wrote majority of Canyon High School's computer programs that analyze and record results of
the experiments for their chemistry and physics courses.
�Research
Experience
1991
University of New Mexico, May 1992 to June 1993
Designing and implementing a computerized record of the patients seen at the
Multidisiplinary clinic. The system will store the patients' medical problems and
medications, using the Unified Medical Language System's standarized codes.
1988
National Institutes of Health, 7 March to 15 May 1988
Participation in Computers in Clinical Medicine lecture series and research in medical
artificial intelligence. Designed and implemented an expert system that reasons with a
hybrid of criteria tables and production rules. The program can display its reasoning
governing how it reached its conclusions. It can also display videodisc images of
requested physical findings as well as dial MEDLINE and display the latest references in
the literature concerning those findirigs. The program is comprised of 24,000 lines of
computer code. The system, named CTX, will replace the current expert system at the
AI/RHEUM clinical test centers.
1987
Wrote program for S.P.E.C.T. scanner to calculate liver, spleen, and bone marrow scintillation
ratios. Program used on all liver/spleen scans done at UC Irvine Medical Center.
1985- 87 Data collection, manipulation, and statistical analysis using SPSSX for large and small-scale
clinical studies:
• Clinical and laboratory associations with spontaneous bacterial peritonitis.
• Characterizing liver tissue with:
• Liver/spleen/bone marrow ratios of Tc99 sulfur-colloid distribution
• Frequency-demodulated ultrasound imaging
• AM Ultrasound attenuation using zero-crossing technique
• AM Ultrasound attenuation using narrow-band technique
1986
Solved equations and wrote simulator for model of hepatic blood flow after portosystemic
shunt. Verified with laboratory model and clinical data.
1984-87 Studied computed tomography and requisite sub-disciplines. Wrote and evaluated a complete
CT. simulator. Data collection of a phantom object is simulated and beam hardening, photon
statistics, scatter, and random noise can be specified. Images are reconstructed using several
algorithms and then statistically and visually compared to the phantom image. Incorporated
and evaluated the novel application of B-spline approximation to the convolution computation
in CT reconstruction.
1986- 87 Wrote a comprehensive library of image processing programs for digital filtering, contrast
enhancement, edge detection, areas of organs, image statistics, etc.
1982
Special
Skills
Extracuiricular
Activities
San Diego Veterans Administration Nuclear Medicine Laboratory. Studied numerical analysis
and wrote a computer program to find the best-fitting polynomial for a set of data points by
least-squares minimization.
Extensive computer programming experience; writing hundreds of programs in more than a dozen
computer languages, almost all are computer, natural, or applied science related.
Skills in multimedia programming, electrical engineering, physics, and cognitive sciences.
Playing guitar, bass, keyboards, vocals with informal groups. Song writing, composing, and recording
using a computer to control multiple synthesizers and drum machines.
Readings in mathematics, physics, cognitive science, philosophy, natural sciences, anthropology, history.
Ham radio operator (technician class, call letters are WD6ERB)
Bicycling; skiing; dancing; camping;films;theater; travel.
�Bibliography
Published
1.
Rosenberg KM, Duerinckx AJ, Hoefs JC, Kanel G, Ferrari L, Aufrichtig DA, Cole-Beuglet C. Estimation of
acoustic attenuation in liver: Difficulties with a narrow-band estimator and the importance of fat. (Abstract).
(Presented to 11th Symposium on Ultrasonic Imaging and Tissue Characterization, Washington DC, June 3
1986)
2.
Rypins EB, Rosenberg KM, Sarfeh IJ, Houck J, Conroy RM, Milne N. Computer analysis of portal hemodynamics
after small diameter portacaval H-grafts: Vie tlieoretical basis for partial shunting. Journal of Surgical Research
42:354-61, 1987. (Opening presentation of Annual Meeting of the Association for Academic Surgery,
Washington D.C, November 5-8,1986)
3.
Duerinckx AJ, Aufrichtig DA, Rosenberg KM, Hoefs JC, Ferrari LA, Cole-Beuglet C. Tlie importance of fat in
the estimation of acoustic attenuation in liver with a narrow-band estimator. (Presented at the 31st AIUM Annual
Convention, Las Vegas, Nevada, Sept 16-19,1986)
4.
Martinez JE, Ming R, Rosenberg KM, Becker T, Strickland R. Inflammatory bowel disease in Native Americans
and Hispanics: How common is it? Gastroenterology, May 1989.
Poster
1.
Martinez JE, Ming R, Rosenberg KM. Inflammatory bowel disease in Native Americans and Hispanics: How
common is it? American College of Physicians, Albuquerque, New Mexico. Dec 5-7,1989.
In Press
5.
Duerinckx AJ, Rosenberg KM, Hoefs JC, Aufrichtig DA, Cole-Beuglet C, Kanel G, Lottenberg S, Ferrari L.
In-vivo acoustic attenuation in liver: Correlation with histology and blood tests. Ultrasound in Medicine and
Biology.
6.
Duerinckx AJ, Hoefs JC, Cole-Beuglet C, Ferrari LA, Rosenberg KM. Estimation of acoustic attenuation in
diffuse liver disease: Difficulties with tlie zero-crossing technique. Journal of Clinical Ultrasound.
7.
Hoefs JC, Kutch J, Utrick R, Kanel G, Donner B, Runyon B, Bridges R, Ocariz J, Meth E, Rosenberg KM,
Braunstein P. Precise quantitation of the abnormal sulfur-colloid distribution by liver- spleen scan with SPECT
analysis in patients with liver disease: Functional and histologic correlation. Hepatology.
Submitted for Publication
8.
Hoefs JC, Kanel G, Cole-Beuglet C, Aufrichtig DA, Lottenberg S, Donner B, Rosenberg KM, Ferrari L,
Friedenberg RM. Frequency demodulated ultrasound: Detection of hepatic fat and differentiation from hepatic
fibrosis. Hepatology.
9.
Ocariz J, Hoefs JC, Kanel G, Bridges R, Udkoff R, Rosenberg KM, Braunstein-P. Liver-Spleen Scan with SPECT
analysis: A Precise Method of Staging and Following the Progression of Viral Hepatitis.
10. Orcariz J, Hoefs JC, Kanel G, Bridges R, Udkoff R, Rosenberg KM, Braunstein P. Liver-spleen scan with SPECT
analysis in tlie progression and prognosis of primary biliary cirrhosis, primary sclerosing cholangitis and secondary
sclerosing cholangitis.
11. Wang F, Udkoff R, Braunstein P, Bridges R, Orcariz J, Kanel G, Rosenberg KM, Hoefs JC. Quantification of
sulfur colloid distribution in liver-spleen scanning by SPECT analysis.
Unpublished Manuscripts
12.
Rosenberg KM. An expert system using criteria table reasoning with tlie Al/RHEUM knowledge base: Tlieory,
implementation, guide for users, and guide for programmers. National Institutes of Health - National Library of
Medicine, 1988.
13.
Rosenberg KM, Sankar PV. Computed tomography reconstruction using B-spline approximation of convolution
filtering on a personal computer.
In Preparation
14.
Hoefs JC, Rosenberg KM, [plus investigators from clinical centers). Spontaneous bacterial peritonitis and
analysis of tlie Ascities International Diagnosis Society's questionnaire results.
�CODER
HEALTH CAKE TASK FORCE SORTING SHEET
s ate
INPUT DATE:
GRMRRAT. SOPT-
POSTCARD 2:
General mail
Personal stories
Other Health Providers
POSTCARD 1:
Letter Campaign
.Offers to help/Employment
>
.Physicians
FORM LETTER:
Letterhead
.Policy
REROUTE:
Casework
.Scheduling
President
Other
POLTCY AND PF.RSOISTAT, STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (H)
working families
unemployed/low income
benefits
.providers
.INFRASTRUCTURE/WORKFORCE (IH)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
.manpower issues (training)
.unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
FINANCING (VTI)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
AIDS
women's health
Jmmunizations/children
.rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
13 oX
•
,
'-7.
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
007. letter
DATE
SUBJECT/TITLE
Phone No. (Partial) (I page)
02/18/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
im782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
b ( l ) National security classified information 1(b)(1) of the I OI A|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) o f t h e FOIA|
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning thc regulation of
financial institutions 1(b)(8) of the F O I A |
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the F O I A |
National Security Classified Inrorniation 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA|
PS Release would disclose confidential advice between thc President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Alert / y ^ r i M ^ ^ w
^H-^il^
-.Shisf,^
;^^n>^<
4
February 18, 1993
Ms. Hillary Rodham Clinton jVe/btffo[
Dear Ms. Clinton
P6/(b)(6)-.
I am writing in support of serious health care reform. I bope^your task
force can design the changes so sorely needed. Furthermore, I support strongly
President Clinton's Budget proposal that he specified in his State of the Union
Address to die Joint Session of Congress on the evening of February 17, 1993. I
agree with the president that we will all need to sacrifice to avoid the economic
disintegration of the nation.
I understand that this budget plan represents only a first good step. Another
good step would be a modest increase in the minimum wage, which should
increase our tax base without significantly decreasing jobs, according to recent
economic research.
kpow
However, no plan will work without sweeping health care
this fromfirst-handexperience, for I am a physician. 1 practict )ediatric£/in
Albuquerque, New Mexico. In the last five years, I also worked extensively with
the children of pgor, uninsured families in California. I have seen a four year-ol
child near death with diphtheria, later requiring a pacemaker and tracheostomy
tube for life, from a disease easily preventable by early immunization. I have
seen children and teens with permanent brain damage from measles encephalit}
regret to say also that I have seen scores of premature infants bom permanent
disabled, drug-addicted, and underweight to mothers who had no access to
prenatal care.
/
I agree with President Clinton that all infants and children£ai!£L^ttfts-fbr
that matter) should have free and unfettered access to complet^nmunization^It
is not only cost-effective in the long run, but it makes basic pubUcTieaTlli cUmmon
sense. The same holds true for prenatal care. It is far more costly in economic
and human terms to ignore the care of pregnant women, only to pay for the
astronomical cost of neonatal intensive care and lifelong: custodial costs for the
substantial fraction of babies bom with bad outcomes because of a lack of
'
preventive care and education.
�This suggests a broader point. Any health care reform must center
itself on the paradigmatic change that preventive and primary care is
the emphasis and centerpiece of any health care system. That primary
care can be delivered by physicians, nurse practitioners, and supervised
physician's assistants at a reasonable cost. In contrast the outrageous
reimbursements for procedure-oriented, surgical, and subspecialized care can be
reduced by two- or three-fold at a substantial savings to our society, still leaving
the average orthopedic surgeon with a "paltry" approximately $150,000 per year
annual income. Two caveats must be understood for this to be true. First, the
burden of immense malpractice insurance premiums and potential medical
liability would have to be eased by significant tort reform. Second, the structure
of medical reimbursement would need to be altered, so that a physician and
associated staff for adequate care of the patient, as opposed to per procedure,
according to its length, complexity, and "what-the-traffic-will-bear" going rate.
If this system is not altered, then there will always be incentive to do more
procedures at more cost for borderline indications justified under the mystery of
medical expertise.
All patients should have a primary provider. That provider can act as the
agent for primary care, health promotion, and the gatekeeper for subspecialty
and surgical referrals. Choice of primary providers is essential in any publicly
or privately coherent health care system. Free access and self-referral to
subspecialty or surgical care leads to inappropriate consultation, potential
duplication of services, and overuse of limited resources. To avoid unnecessary
bottlenecks, basic mental health, family planning, and women's health services
should either be considered primary care or open to free(non-referrred) access.
The cost of medical equipment and hospital supplies also need drastic cuts.
There is no true "free market" for these items. The costs are universally inflated
and the demand is captive. Medical supplies have hit the level of defense
procurement for price astronomically beyond the cost of production and a
reasonable margin of profit. The patient or the third party payor has little choice
but to pay the price once the necessity of the involved procedure, medication, or
equipment is ascertained. Because a proprietary drug or vascular catheter is the
best choice to improve health or save a life is not sufficient reason to extort the
maximum possible price from the payor. However, this extortion is the norm in
medical supply pricing and hospital billing. Cost controls and honesty in pricing
are needed, yet will still supply the pharmaceutical, medical and surgical
equipment, and health technologies a sizable profit(albeit not the record-breaking
profits of present years.) One caveat is that a significant tax credit or support
must be maintained for research and development in these industries to stimulate
the continued pursuit of improved health care. Perhaps a disincentive of some
�sort could be provided to reduce the massive budgets for marketing,
advertisement,and promotion of these products, so that these funds could be
channeled back to R&D and quality control. The horde of "detail men" that flood
doctor's offices and hospitals could be eliminated without much harm to the
public. The ethically questionable meals, trips, conferences, and outings
sponsored or wholly paid for by these corporations for health care personnel and
administrators could be curtailed or eliminated.
Many other vital issues need to be tackled in detail. Long-term care must
have a comprehensive plan. No longer can Medicaid be the ad hoc payor for
custodial and prolonged nursing care by impoverishing individuals and their
families. Creative community and in-home options for this care can be supported
with greater quality and decreased cost. Also, the huge bulk of health care bills
generated by top-heavy, paper-heavy administrative system must be pared down
and simplified.
Finally, we need an explicit national health policy. At the present time, we
have implicit health rationing on the ability to pay or find reimbursement. In
other words, we pay billions of dollars each year for the intensive care of the
extreme elderly or the extremely premature infant(<28 weeks or <600 grams)
regardless of whether there is any reasonable prognosis for recovery, returned
function, survival, or quality of life. We do so simply because we provide no
alternate decision; by practice, all possible intensive care is provided to all
patients without discretion in all but the most extremely futile circumstances. By
abdicating any societal priorities to heath care, we pay for these exorbitant, futile
or ill-advised treatment and leave no money or means to pay for the greater
benefit of preventive, primary, or prenatal care. Our present unnamed ad hoc
medical rationing system shows no long-range thinking. We pay for extreme
things of little utility now, thereby depriving manyfold more people of the care
needed to prevent these extreme andftitileevents in the future, thus multiplying
costs by a huge amount and deriving little qualitative benefit. We must set our
health care priorities, then live by our societal decisions. The Oregon experiment
with "rationing" was laudable, but doomed to uninterpretable results because of
its position couched in an otherwise unchanged and contrary national health care
system. Ideally, we should set up a National Health Policy Board with an
independent status like the Federal Reserve Bank, so that tough decisions about
health priorities both for public and private payors and about health resource
utilization can be made without the immediate vascilladons caused by electoral
politics. This board should be made of people with experience and expertise in
health care and health policy, but no immediate vested interest in the decisions
made.
All in all, all Americans must be provided basic health care, but profound
�reform of the health care system and business must occur simultaneously. This is
the next step after the passage of President Clinton's well-designed budget
package.
Sincerely,
Paul H. Kalz, M.D.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�EVE A.
N, M D
..
^
February 21, 1992
Mrs. H i l i a r y R. C l i n t o n
The White House
Washington, D.C.
Dear Mrs. C l i n t o n ;
I am w r i t i n g you t o o f f e r any assistance I may be able t o
provide. I am a physician who f o r the past four years worked
i n the corporate medical department o f a major n a t i o n a l
insurerer,- I was responsible f o r p o l i c y making i n areas of
claims payment. At the present time I am medical d i r e c t o r 'df
a union t r u s t fund. We are a HMO and PPO, although some of
our members are also covered under an indemnity plan. I have
also provided advice t o the t h i r d p a r t y a d m i n i s t r a t o r paying
claims.
I am aware t h a t you have f i n e consultants t o advise you, however,
I might be able t o add the dimension of someone who a c t u a l l y
i s i n v o l v e d i n the p r o v i s i o n o f services and who i s f a m i l i a r
w i t h how claims are paid as w e l l as what providers a c t u a l l y
bill.
Enclosed i s a copy of my resume.
I t i s , however, incomplete
since my present p o s i t i o n i s not l i s t e d . This i s , Medical
D i r e c t o r , 1115 Employees B e n e f i t Funds, 761 Merrick Avenue,
Westbury N.Y. 11590.
4
�f
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
'JO
V
C • J~^f"JfJ / • - S ft/ f
- .•
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. resume
DATE
SUBJECT/TITLE
n.d.
Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER T I T L E :
[Physician Letters] [loose] 12]
2006-0885-F
jm782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |S U.S.C. 552(b)|
PI
P2
P3
IM
b ( l ) National security classified information 1(b)(1) o f t h e FOIA]
h(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) o f t h e FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of thc FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(K) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) o f t h e FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) o f t h e FOIA|
National Security' Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of thc PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of thc PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�EVE A. KLIPSTEIN, M.D.
p6/(b)(6)
00%
Telephone
; : -;:,
SUMMARY
Physician with excellent management skills and a vast knowledge of medicine and how it applies to
the area of health insurance. Responsible for building a claims unit that served as a resource to a
leading national insurer. Participated in the development of a Long Term Care product and
subsequent underwriting, marketing, and benefits determinations.
PROFESSIONAL EXPERIENCE
METROPOLITAN LIFE INSURANCE COMPANY
Corporate Medical Department
1987 - 1992
Medical Director and Officer-in-Charge of Claims (1990 -1992)
Associate Medical Director (1988)
Assistant Medical Director (1987)
Responsibilities include the Management of a unit which consists of fifteen professionals and support
staff. Service Group Health Claims,,Group National Accounts, Personal Health Insurance, Long
Term Care Insurance, the Corporate Legal Department and Actuarial.
Specific accomplishments include:
• Developed cost-containment systems used by Managed Care Medical Directors and nurses
resulting in 23% reduction in payment of claims.
..
• Developed internal definition of medical necessity and experimental/investigational procedures
and services. Supervised and organized Company-wide guidelines and criteria for handling
relevant claims. For example, surgical site lists, experimental/investigational lists, etc.
• Responsible for development of a system to enable medical personnel and claims approvers
to handle claims in a cost effective manner which is uniform and consistent.
• Wrote guidelines in conjunction with group claims operation for medical directors, nurses and
senior claims approvers to properly adjudicate claims.
• Designed protocol and criteria for transplants and other significant medical issues resulting
in cohesive, time sensitive responses.
• Worked as Medical Director of a team to develop a long term care product. Continued to
provide underwriting and benefits support.
•
Interacted with the provider community (medical associations, physicians, etc.) in cost
containment issues.
Interacted with the benefits administrators and medical directors of customer companies such
as Johnson & Johnson, American Airlines, and General Motors in an effon to develop claims
policies specific to their needs.
�EVE A. KLIPSTEIN, M.D.
PAGE 2
ALBERT EINSTEIN SCHOOL OF MEDICINE
and MONTEFIORE MEDICAL CENTER
1986 - 1987
Anesthesia Residency
CIGNA
1982 - 1985
Associate Medical Director
Worked in health insurance, disability insurance, and re-insurance underwriting. Represented HIAA
and worked with HCFA reviewing studies for which they had contracted on physician payment
reform and prospective payment systems. Duties were primarily in re-insurance underwriting.
PRIVATE PRACTICE in PEDIATRICS, Manchester, CT
1971 - 1980
EDUCATION
AB
MD
Intern
Resident Pediatrics
Smith College
New York University School of Medicine
Montefiore
Mt. Sinai Hospital, New York City
1961
1965
1965 - 1966
1966 - 1967
PROFESSIONAL ACTIVITIES
Board Certified in Insurance Medicine.
Hartford County Medical Association, Hartford, CT.
1975 - 1986
Board of Directors; Chairwoman of several committees. Chaired committee for underwriting
applicants for our malpractice insurance carrier; served on the committee that screens suits.
�i
ALBUQUERQUE ANESTHESIA CONSULTANTS
H.-n-mmiC. Rcngcr. Ph.D.. M.D.. P.A.
VVilli.nn |. Brvn, Pli.D.. M.D.. I'.A.
March 3, 1993
Mrs. H i l l a r y Rodham C l i n t o n
The W h i t e House
P r e s i d e n t ' s Task F o r c e on H e a l t h Care Reform
1600 P e n n s y l v a n i a Avenue, N.W.
W a s h i n g t o n , D.C.
20500
Dear Mrs. C l i n t o n :
I am a member o f PHYSICIANS WHO CARE. I am d e e p l y c o n c e r n e d a b o u t
access t o q u a l i t y
h e a l t h care
f o r a l l Americans.
Equally
i m p o r t a n t , I f e e l s t r o n g l y t h a t p a t i e n t s s h o u l d be a b l e t o choose
t h e i r p h y s i c i a n f r e e l y , n o t f r o m a c l o s e d p a n e l p r o v i d e r l i s t o f an
HMO.
I r e s p e c t f u l l y r e q u e s t t h a t y o u a l l o w D r . R o n a l d Bronow,
P r e s i d e n t o f PHYSICIANS WHO CARE, t o p r e s e n t t o y o u a p l a n f o r
r e f o r m i n g h e a l t h c a r e . He w i l l e x p r e s s t o y o u o u r s t r o n g f e e l i n g s
t h a t m e d i c a l d e c i s i o n s s h o u l d n o t be based s o l e l y on c o s t o r
c o r p o r a t e p r o f i t , as i s t h e case i n most managed c a r e h e a l t h p l a n s .
Please g i v e these views your utmost c o n s i d e r a t i o n .
Sincerelv
vours,
/A
"
Hartmut
Rengjpffc, P h . D . ,
M.D,
HR:mb
SIII'L',<:I-Y C r m . i ol AlbuquririiH' • 1720 VVyomim; N . E . • AllHiqucrquc. New Mexico !i71 VI • (fiOfi) 2!J2-!>2<'n
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
B6X 93
S,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. letter
SUBJECT/TITI.E
DATE
Address (Partial); Phone No. (Partial) (I page)
03/31/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [12]
2006-0885-F
jm782
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) o f t h e FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) o f t h e F O I A |
b(3) Release would violate a Federal statute 1(b)(3) o f t h e F O I A j
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) o f t h e F O I A j
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the F O I A j
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe F O I A j
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of thc F O I A j
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) of thc PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance wilh restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�EDGAR,SIMON
ABOMlA
M.D
n
.P6/(b)(6)
Maivh 31. 1993
HJ1IJI\- Rodham Ctimon.
Chiinr.ui. F*rti.idcri\ T a s l f-'otce on N'diiiuul hcilih Rct'orm
Tlte V-liiic House, 'ft ashmfion. D C.
Dear Mrs Cl:r.:onI applaud ytwr conurutmcm ro rcsti-JClining thc htalih i-»r^ indmir*. It ii gTanlymg lo know lhai a PrciiJc.i!
Hnally realiied ihai
ihis counry Con no kirgci cnniinui; on the pulii whioi ha( led u', in -Jeady mcreaic in tht hoditi fare i-onip<incnl of ihi G I U M Sluiimal
PrnduLT
Ac-^irdiniiK. I would greaily tppii-Liait- u if yoi: would rcvicM [he enclosed lencr diisrl L O W 10 Dr. Gcor»- Whcail). Mcdir»J
Di:cciur of Uic Surioik Coumy Dcparjuint of Social Services in Hauppaupc. Nev, Voik Please *11o*- me lo sumrrunze its cimtrnii.
Tlic Cji-isifuphii: New Y o r i Siztr He*lih Insurance Plan, with in apptoprijie check sysiem. d c K no; rrquire any nan-up nr phme-in
penod. vinujllvrliuiiaaic. all p=pcrwurt and allows ibt r m i m u n i iavinp; by all taxpayer. In addition, a p.TUiive balance ol ihe
caiaiunphic (mid is mjinuiiied jea-'ly by grajua] incrciisc tn pre-esublishe*; prenuumi. Litetine eovejage ii provided tor bom lhe
uninMjretJ ai * e l l di ihe undennsutcJ, ^iili fiaud ^ndjor ahuse heiog elimiaaifd or ci leaii reduced to a drtrjmcniefl mt.vmum by Ihe
cheeL fcysiein. wilh the toi^iJ b-mk. and audoal by paiierui *jid provider*
The sy^iem I am micijhiinp is dciigncd to eveniuallj reiiuce and hupcfully elinunaie the Medicate and Medicaid budgei The general
public will leani [o become aware uf lhe coil and lean huw lo cunrro! excessive- e^penditurei. Pfrveuti»c medicine will be stressed ai
a *-s> oi ultmuiely bringing all expenses down to r.n acceptable level Or.ipeiition by priiaie p ™ tiring ph\ siciam, liojpruii cLniL-s.
HIP. etc.. thruush the managed conipemion coocepf. njll alio iciuh in subtumial iivingi and [In: impcailiun of cuM coni/ol tncctwnisnn It is anticipaicd thai et^pleyers wili volunurily [mj ihe prrmiuors associaicd with ihe Cj^sirophic Fund, [haeby resulting in
portabiliry of policies. For all new employees it is no lonser wcessary thev AIS id ready equally Ltsutrd, ihciffoic helping cieaie new
jobs. (ImMgin*- len million workinj; tiixpnycnp pacing S3OO0.O0 by 6-1-93 and i h i real by 4-I5-9J nnd 5-31-94, plus payrocni
f r « n all new c c i p l u t r u • n d uneanplojtrd worktrs. tod payments rrom Medicarx and Medicaid Tor lhe poor and boniekas.)
! have tried to ftcieni a generj] overview rif z program I am convinced will save money, co^er neryane, SOINC our 1 legal immigrant
1
pmbleni. main!tin p-Jtienl freedom uf choice, and control mulpociice insurant^: premiums Included for your irvicw. jr.formuiion and
reierem-e. is a deiiilcd cornpiHu>n of Prnidem Clinton's proposal ind lite Caiastrophif Ne*- Yoifc Insunuicr I'bn I havi- postuiaied.
I 'incerely
tnanl yc.i tn: yimu time and contirieraiion,
su^t.'. »T)UI<1 Lite ii miller •.•aie.'ni advisemem.
JHQ | am confideni that you wjl) sw [lie advanuj.-es with my propisal.
I anxiously snail youi positue response to thii
and as
\c\izi.
Sincerely.
./
:V.-/.
Edgar Simon A h o o U M.D.
encs.
Donna Shale I.i. Secretary of H:alih and Hunian S m i c e i
IViet i m a n i . M.D . Ph.D.. Direcior of Health. Columhu-.. Otno
Senwor Orrin G. Hjtch
S e n a i n - F d w a i J M kLnncdy
Scnno; Daniel P Moynitun
Rhodd H Kjrpatfcm. C u n s u n m Union ofilte U S.
D:.Ji«!yn E l J m
Mi. Maiio Mcntthmi. New York Siatc Meditjl Scf ieiy
Dawd Ajinutuiaio. M.D., AnicriL-an AL-adcmv of Pediamcs
Donald
r.roinisch. M.D.. ClLiirmjn. D q x . of Pediaaic*. Naisau County Medical Cenicr
Amiricins ai age t;? ha-c a -13 pciceni clwntr uf necdins lonp-lcrm care. ECCIHTJIDP to Djvid E. Huphes, senior vice presidem for
lonj-ienn care el L I S U M . a major insurer based in Pori;ind. M.:
The earlier you buy ihe policy ihe bener, bt-cause you lock in a lev el prcmiuin foi life. For example. Mi. llufihes. uho is ^5. pay^leu
than HOO a year Fur hii 73-year-old moiner. (lit premium iiS17O0. "Youcnni aflurd It; wail," said Mr. SlrauiS "It » a wonderful
buy « 55. II"? nill a relaiivelj ood buv at &0. Ai a»e ti5 arid Lp. iis stans to get crpeniive."
E
THli NEW Y O R K T I M E S . S U N D A Y . M A R C H 14, 1 » 3
' It rs tine to end (he diifrscerijl double standard in health u r c "
...If you ajc uoi allowed m pay equitable health care ihrnnjh ihr incnnic lat... (ahoul S3000.00. . foi a life-nme of family or individual mpavcr... Y O U W I L L A L W A Y S H A V E ' D O U h L F S T A N D A R D IN H E A L T H C.AR^" - i h e i r is m puperwurk.
�,.1*^
•1
-
EDGAR SIMON ABONIA. M D.
/ f'*
"t"
March 31, 1993
Mrs. Hillary Rodham Clinton,
Chairman, President's Task Force on National Health Reform
The White House, Washington, D.C.
Dear Mrs. Clinton:
I applaud your commitment to restructuring the health care industry. It is gratifying to know that a President has finally realized that
this country can no longer continue on the path which has led us to steady increase in the health care component of the Gross National
Product.
Accordingly, I would greatly appreciate it if you would review the enclosed letter dated 1/29/93 to Dr. George Wheatly, Medical
Director of the Suffolk County Department of Social Services in Hauppauge, New York. Please allow me to summarize its contents.
The Catastrophic New York State Health Insurance Plan, with an appropriate check system, does not require any start-up or phase-in
period, virtually eliminates all paperwork and allows for maximum savings by all taxpayers. In addition, a positive balance of the
catastrophic fund is maintained yearly by gradual increase in pre-established premiums. Lifetime coverage is provided for both the
uninsured as well as the underinsured, with fraud and/or abuse being eliminated or at least reduced to a documented minimum by the
check system, with the local bank, and audited by patients and providers.
The system I am articulating is designed to eventually reduce and hopefully eliminate the Medicare and Medicaid budget. The general
public will learn to become aware of the cost and learn how to control excessive expenditures. Preventive medicine will be stressed as
a way of ultimately bringing all expenses down to an acceptable level. Competition by private practicing physicians, hospitals, clinics,
HIP, etc., through the managed competition concept, will also result in substantial savings and the imposition of cost control mechanisms. It is anticipated that employers will voluntarily pay the premiums associated with the Catastrophic Fund, thereby resulting in
portability of policies. For all new employees it is no longer necessary they are already equally insured, therefore helping create new
jobs. (Imagine ten million working taxpayers paying $3000.00 by 6-1-93 and the rest by 4-15-94 and 5-31-94, plus payment
from all new employees and unemployed workers, and payments from Medicare and Medicaid for the poor and homeless.)
I have tried to present a general overview of a program I am convinced will save money, cover everyone, solve our illegal immigrant
problem, maintain patient freedom of choice, and control malpractice insurance premiums. Included for your review, information and
reference, is a detailed comparison of President Clinton's proposal and the Catastrophic New York Insurance Plan I have postulated.
I sincerely thank you for your time and consideration, and I am confident that you will see the advantages with my proposal, and as
such, would take it under careful advisement. I anxiously await your positive response to this letter.
Sincerely,
rt*:
ia,
igar Simon Abonia, MX).
encs.
Donna Shalala, Secretary of Health and Human Services
Peter Somani, M.D., Ph.D., Director of Health, Columbus, Ohio
Senator Orrin G. Hatch
Senator Edward M. Kennedy
Senator Daniel P. Meynihan
Rhoda H. Karpatkin, Consumers Union of the U.S.
Dr. Jocelyn Elders
Mr. Mario Menghini, New York State Medical Society
David Annunziato, M.D., American Academy of Pediatrics
Donald S. Gromisch, M.D., Chairman, Dept. of Pediatrics, Nassau County Medical Center
Americans at age 65 have a 43 percent chance of needing long-term care, according to David E. Hughes, senior vice president for
long-term care at UNUM, a major insurer based in Portland, M.^.
The earlier you buy the policy the better, because you lock in a level premium for life. For example, Mr. Hughes, who is 45, pays less
than $400 a year. For his 73-year-old mother, the premium is $1700. "You can't afford to wait," said Mr. Strauss. "It's a wonderful
buy at 55. It's still a relatively good buy at 60. At age 65 and up, its starts to get expensive."
THE NEW YORK TIMES, SUNDAY, MARCH 14, 1993
"It is time to end the disgraceful double standard in health care."
...If you are not allowed to pay equitable health care through the income tax... (about $3000.00,... for a life-time of family or individual taxpayer... YOU WILL ALWAYS HAVE "DOUBLE STANDARD IN HF.ALTH CARE" -.there is no paperwork.
�
Dublin Core
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Title
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Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
Identifier
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2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Physician Letters] [loose] [12]
Creator
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
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3/16/2015
Source
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42-t-12092992-20060885F-Seg3-007-001-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/c97fecabb763f6ca2539438eeff901d5.pdf
1d11d67dc0279e22d9906b65dd62f860
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
2385
OA/ID Number:
FolderlD:
Folder Title:
[Physician Letters] [loose] [11]
Stack:
Row:
Section:
Shelf:
Position:
s
56
3
4
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECI/ITTLE
DATE
RESTRICTION
001. report
Address (Partial); Phone No. (Partial) (1 page)
03/1993
P6/b(6)
002. letter
Phone No. (Partial) (1 page)
03/05/1993
P6/b(6)
003. resume
DOB (Partial); POB (Partial) (1 page)
09/23/1976
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [ I I ]
2006-0885-F
iin78l
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)
Freedom of Information Act - (S U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRAj
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute |(bK3) ofthe I Ol A|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Addictive Disease
1220 Dewey Aveniu?
Wa ii w; it o sa /{^consm^ 53213
Medical Consultants, s.c.
4l4/259-5()0(r
David G. lienzcr, D.O.
Charles .1. IZngel, M.D.
Michael S. Goldslone, M.D.
Roland Yl. Henmglon, M.D.
March 10,
1993
Mrs. T i p p e r Gore
Committee Member
White House
1600 Pennsylvania
Washington, D.C.
Avenue,
20500
N.W.
Dear Mrs. Gore:
I am p l e a s e d t o see t h a t t h i s n a t i o n has begun t o c o l l e c t i v e l y search f o r an
e f f e c t i v e way t o p r o v i d e h e a l t h care f o r a l l Americans. I am dismayed, however, t o
l e a r n t h a t o r g a n i z a t i o n s r e p r e s e n t i n g t h e i n t e r e s t s o f p h y s i c i a n s have, t o d a t e ,
been b a r r e d from a s s i s t i n g i n t h e d r a f t i n g phase o f c r e a t i n g these e x c i t i n g new
p r o p o s a l s . My concern i s e s p e c i a l l y heightened i n t h e realm o f p r o v i d i n g b e n e f i t s
f o r those Americans a f f l i c t e d w i t h a d d i c t i o n s t o a l c o h o l , o t h e r drugs and gambling.
Current h e a l t h insurance p o l i c i e s provide n e g l i g i b l e b e n e f i t s i n t r e a t i n g a d d i c t i v e
d i s o r d e r s . As a c h r o n i c disease, t h e r e i s l i t t l e debate t h a t a d d i c t i v e d i s o r d e r s
need l o n g t e r m c a r e . This care i s g e n e r a l l y i n t e n s i v e i n i t i a l l y b u t d i m i n i s h e s over
t i m e , when l e f t u n t r e a t e d a d d i c t i o n has a s i g n i f i c a n t c o s t t o s o c i e t y . This c o s t
can be assessed by many parameters. A d d i c t i o n has been a s s o c i a t e d w i t h
s i g n i f i c a n t l y i n c r e a s e d crime r a t e s ( i n c l u d i n g crimes o f v i o l e n c e ) , c h i l d abuse,
spouse abuse, motor v e h i c l e deaths, l o s s o f c o r p o r a t e d o l l a r s (by mechanisms r a n g i n g
from absenteeism t o embezzlement, t o gross negligence by w h i t e c o l l a r a d d i c t s ) and
i m p a i r e d p h y s i c a l h e a l t h . The above examples h i g h l i g h t o n l y a few o f t h e means by
which a d d i c t i o n c o s t s s o c i e t y i n d o l l a r s , p r o p e r t y , l i v e s and e m o t i o n a l w e l l - b e i n g .
Our p r i s o n system a l r e a d y i s o v e r f l o w i n g and t h e war on drugs promises an even
g r e a t e r need f o r p r i s o n beds.
w i t h i n t e n s i v e i n i t i a l t r e a t m e n t and a p p r o p r i a t e l o n g i t u d i n a l f o l l o w up, an
overwhelming percentage o f a d d i c t e d i n d i v i d u a l s w i l l f i n d r e m i s s i o n from t h e i r
d i s e a s e . An i m p r e s s i n g number o f those i n r e c o v e r y r e t u r n t o s o c i e t y as p r o d u c t i v e
members. The c o n t r a s t i n g argument i s that, these i n d i v i d u a l s no i o n y e r c o s t s o c i e t y
i n terms o f t h e methods l i s t e d above.
A d d i c t i o n does w i e l d a t e r r i b l e c o s t upon s o c i e t y . I propose t h a t t h e c o s t o f
treatment n o t only i s the least devastating but i s the only cost t o society t h a t i s
l i k e l y t o y i e l d an e v e n t u a l b e n e f i t . I i m p l o r e you t o c o n s i d e r these arguments when
f a c i n g t h e c h a l l e n g e o f d e s i g n i n g a n a t i o n a l h e a l t h r e f o r m p l a n . I f I c o u l d be o f
any a s s i s t a n c e , I would be more t h a n happy t o g e t i n v o l v e d .
B a r r y S p i e g e l , D.O.
A d d i c t i o n Medicine S e r v i c e
BS/jk
�MEDICAL
COLLEGE
OF WISCONSIN
Department of Anesthesiology
Pain Management Center
March 31, 1993
First Lady Hillary Rodham Clinton
1600 Pennsylvania Avenue N.W.
Washington, D.C. 20500
My Dear Mrs. Clinton,
I hope you will find time to read the article ihht 1 hav^ cnclosecj^s it embodies some of the thoughts
that have occupied my desire to provide care fot^hej^istjWily some odd years. The issues for
America really is explained quite completely in the first paragraph. We need universal coverage, we
have to curb costs, and we must reduce administrative hassle.
Many years ago I disassociated myself from the American Medical Association, as that too represents a
lobby such as the like the world has never seen. In essence, they like insurance companies, like drug
companies, like government, all have turf to protect.
I wish you well, and with the advent of the Oregon Plan, 1 think we arc making a step to bring into the
fold additional Americans who go without health care.
My warmest greetings to you and to the President, and my prayers are for your prudent thinking in this
most important issue of our lifetimes.
With warmest personal regards.
Sincerely,
Sheldon L. Burchman, M.D.
SLB/as
M CONDOLENCES CONCERNING YOUR FATHER.
Y
Milwaukee County Medical Complex
8700 West Wisconsin Avenue
Milwaukee, Wisconsin 53226
(414) 257-6259
�PAIN M N G M N CENTER
AAEET
B X 183
O
MEDICAL
COLLEGE
FIRST LADY HILLARY R D A CLINTON
OHM
1600 PENNSYLVANIA AVENUE N W
..
WASHINGTON, D.C. 20500
OF WISCONSIN
iMMl^uU.limiin^iM
Department of Anesthesiology
Milwaukee County Medical Complex
8700 West Wisconsin Avenue
Milwaukee, Wisconsin 53226
�CODER:.
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
19§3
OF.NF.RAL SORT:
POSTCARD 1:
General mail
.Personal stories
Other Health Providers
.Letter Campaign
POSTCARD 2:
Offers to help/Employment
FORM LETTER:
Letterhead
.Policy
REROUTE:
Casework
.Scheduling
.Physicians
President
Other
POTJCY AND PERSON AT, STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (H)
working families
unemployed/low income
.benefits
.providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
.FINANCING (VII)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
rural
urban
OTHER
�Suzanne
o£el$ef
dorricfan,
4 2 2 5 WINGREN. SUITE 1 0 5
IRVING. T E X A S
TELEPHONE
March 29, 1993
^
^
(2 1 4 )
75062
717-KIDS
^ ' ^ T ^ of
fept
Dear Mrs. Clinton,
I was very happy that the President appointed you to head up the health care task force. As
you will no doubt learn from Dr. Elders & Dr. Betty Lowe, children all over thfi_coimtrv are .,
suffering from a basic loss of routine health care services. As a mother and the wife of the
President, you are in an unique position to help make the lives of these children better. Because
children do not vote, their issues are frequently the last addressed by legislatures. As a mother
of 3 and a Pediatrician, I seefirsthand the effects of poor healthcare on children. Dallas was
one of the areas of the country where the measles epidemic of the 90*8 hit hard. The woefully
inadequate immunization level of our children resulted in more than 10 deaths and 3.5 million
dollars being spent to take care of the victims of that epidemic, where it would have taken only
$39,000.00 to immunize those same children who were hospitalized. Immunizations are the
hallmark for how other health care needs of our children are being met. Our terrible record on
the number of children immunized is matched by our poor infant mortality rate.s and poor
access to well-child care. The President has begun to address the immunization crisis. But,
additional funding is not the only need. The liability issue must be addressed as well, so that
we can get bulk rates on vaccines, these rates should also be extended to the private physicians
so that their patients who are now being forced to go to health care clinics for shots can return
to their physicians offices. If the federal government could assume liability which is actually
very low, we would probably have a very good chance for reducing the costs of vaccines. Also,
if all health insurance companies could be made toj)ay for well-child care, we could save
billions in terms of later morbidity and mortality. This would be very cost-effective. The data
proving that prenatal care, immunizations, and well-child care all save money in the long run,
is already available.
Please help us to make the ideal of a "medical home" for every child, a reahty!
If at any time I can be of any assistance, please do not hesitate to call on me.
Suzanne LeBel€orrigan M.D. ^
Member of the American Academy
of Pediatrics Task Force on Access
to Care (SCAPA)
President-elect
Pediatric Society of Greater Dallas.
�1 5 6 5 W. B I G B E A V E R R O A D - B L D G . F
TROY, MICHIGAN 4 8 0 8 4
PHONE: (313) 6 4 3 - 7 7 7 5
April 11, 1993
Mrs. Hillary Rodham-Clinton
Office of the First Lady
The White House
Washington, D.C.
Dear Mrs. Clinton:
You have accepted an immeasurable challenge to reform the health care system in
the United States, and, undoubtedly, you will make a great and lasting impact on
the betterment of life-quality in America. Please accept my best wishes.
To make a small contribution to your endeavors, I have taken it upon myself to
bring the following to your attention since directly, and by extension, it affords a
great potential for saving of lives and financial resources. Additionally, it can be
an effective agent of primary care preventive medicine embracing the female
sector of our population.
As a direct outcome of the inadequacies of the cervical cytological cell sampling
devices currently being used in the United States, not only many lives are lost, but
also a great financial burden is placed on the nation's health care system. The
sampling errors caused by these inadequate devices result in a high number of pap
smear repeats and false negatives. The inaccuracy and the unreliability of the
results obtained translate into unwarranted loss of lives due to nondetection of
cervical cancer—which is totally preventable. Statistics show that approximately
63 million pap smears are taken annually in the United States—an optimistic
stipulation would place the number of repeats at approximately 6.84 percent of
this figure. Considering 6.84 percent as the basis, this translates into 4,309,200
number of repeats annually nationwide—totaling at $267,170,400—a financial
resource that can best be used for preventive medicine.
If vaccines are intended as preventive medicine to reduce diseases among
children—^resulting in reduction of financial burdens in the long run—a similar
argument can be made for universal pap smears for women. If cervical cancer can
be detected at an early stage and if a pap smear is the definitive way of accomplishing this, why not use pap smear as an agent of universal, primary care
preventive medicine for women. Routine pap smears reduce the possibility of
developing cervical cancer. A cervical cell sampler that efficiently and accurately
harvests and transfers cervical cells can be an effective component of such agent—
especially if it is inexpensively and readily available—to save lives and financial
resources.
(more)
�Mrs. Hillary Rodham-Clinton
Office of the First Lady, The White House
April 11, 1993 — Page 2
I am a practicing OB-GYN. For almost 27 years, I have used all the available
cytological cell sampling devices in my practice and have found them to be
inadequate and inefficient, yielding inaccurate results. To overcome these
inadequacies, I invented a cell sampler which, because of its functional and
structural capabilities and the material used in its manufacture, provides an
excellent cervical cell sampling system.
The device reduces the necessity of repeats and the high rate of false negatives.
My studies show that by using this device, the health care system will save at least
$170 million annually just by reducing the number of unnecessary repeats due to
sampling errors. This does not include the high cost of medical care for the false
negatives which eventually lead to invasive cervical cancer. This is a valid
example of how the perfection and simplification of any medical procedure, test,
or instrument can deliver the most effective medical care possible, while reducing
costs as well. I have taken the liberty of enclosing additional information for your
reference.
I would consider it an honor and a privilege to be invited to discus the aforementioned issues at length, or to answer any questions that you or the President's
Task Force on National Health Care Reform may have.
I wish you and the President success in your efforts to maintain the leadership of
our great nation in all areas. I am confident that we will achieve still greater
heights.
Most respectfully yours,
Reza S. Mohajer, M.D., F.A.C.O.G
End:
1.
Rationale in Defense of What Constitutes an Optimal Cervical Cell
Sampler and Why Use of Other Instruments Should Be Explored
2. Cell-Sweep®—Optimal Design for Meeting Cervical Cell Sampling
Requirements ...
3. Cell-Sweep® Statistics
4. 510(K)
�Rationale in Defense of What Constitutes
an Optimal Cervical Cell Sampler and
Why Use of Other Instruments Should Be Explored
Michael J. Campion, M.D., "The Adequate Cervical Smear: A Modem
Dilemma," The Journal of Family Practice, Volume 34, Number 3, 1992,
pp. 273-5.
G. Peter Vooijs et. al., "The Influence of Sample Takers on the Cellular
Composition of Cervical Smears," The International Academy of Cytology,
May-June 1986, pp. 251-7.
J. Douglas Gay et. al., "False-Negative Results in Cervical Cytologic
Studies," Acta Cytologica, Volume 29,1985, pp. 1043-6.
Arthur Elias et. al., "The Significance of Endocervical Cells in the
Diagnosis of Cervical Epithelial Changes," The International Academy of
Cytology, August 1982, pp. 225-9.
L. W. Coppleson, M.D, & Barry Brown, Ph. D., "The Estimation of the
Screening Error From the Observed Detection Rates in Repeated Cervical
Cytology," American Journal of Obstetrics & Gynecology, Volume 119
(7), 1974.
From 1974 through 1992, the common dilemma, as evidenced by the
testimony of the above medical research papers (and others too numerous
to mention) has been the continual sampling errors experienced in the
results of pap smears. After almost twenty years, sampling error still
remains with us and directly contributes to die occurrences of more than
two-thirds of false negatives. What causes sampling error is lack of
adequate and effective cell sampling devices and techniques. (It must be
noted that a pap smear comprises the total results of the two integral steps
of harvesting and transferring that take place during the cell sampling
process.) It is obvious that a vacuum exists that needs to be addressed and
remedied. It is our obligation to examine the factors that contribute to the
persistence of sampling errors and find a way to immediately eliminate
these factors in order to improve the results that will, in turn, translate into
�higher detection of cervical cancer in precursor status. During my search
of the medical literature, I have not found any claim that indicates that
sampling error does not contribute to the occurrences oi false negatives.
Therefore, I believe that the present cervical cell sampling devices and
techniques are sub-standard and need to be changed.
First, I will briefly state the factors that I believe contribute to the
persistence of the cervical cell sampling dilemma, and then, where
appropriate, I will reference relevant testimonies from published medical
articles in support of my claim.
A. An optimal cervical cell sampling device must eliminate the drying
artifact phenomenon and permit the spreading and the spraying of two
different cell specimens on a single slide in 5 seconds. Steinerl states
that this is not feasible with the currently available cell sampling
devices and techniques and questions whether there should be an
assistant to help with the adequate and quick spraying. She also states
that it is difficult to teach prospective sample-takers how to use
sampling devices because "The physician would say, 'you do what I am
doing.' when there was no way to actually see him scraping the
cervix." This attests to the impracticality and inadequacy of the
present cell sampling systems. Having two people perform a simple
procedure so that the procedure would provide adequate results is
definitely not a cost-effective measure. None of the current systems
enable adequate and accurate sampling, or provide ease of use.
B. Sample-taking is a science that has to be precisely performed. The
effectiveness of the device in doing what it is supposed to do is
sufficient to render adequate results. The skill level of the sampletaker should not affect the quality of the pap smear because it is solely
the performance capability of the device that dictates the adequacy and
the accuracy of the pap smear. Effective sample-taking should not be
an art or a random happening. Lee2 states that, "Longer training did
not equate with greater skill in obtaining endocervical cells. Obtaining
adequate smears appears to be as much an art as a science." The
implication here is that desired results cannot be expected from the
currently available cell sampling devices, but are rather randomly
experienced.
�C. The intrinsic nature of wood and cotton make them ineffective cell
sampling mediums because they trap cells during the harvest and
transfer steps—cells that could be cancerous. Plastic, on the other
hand, does not have a trapping effect. Both Rubio3 and Lee2 attest to
the inferior nature of wood and cotton ball applicators as agents of cell
transfers.
D. The brush is not an effective medium for cervical cell sampling. It
repeatedly samples the same area of the endocervical canal during the
harvesting step, resulting in presence of red cells and deep
endocervical cells in the specimen. Koonings^ in an effort to "...
determine whether use of the Cytobrush/spatula or the cotton
swab/spatula is better in obtaining satisfactory pap smears ..." found
that using these standard devices, i.e., Cytobrush® and Mylex® spatula
resulted in a combined 37% unsatisfactory and less than optimal pap
smears, and in 25% false negative results. Koonings states that, "Lessthan-optimal smears accounted for 28% of the Cytobrush group and
38% of the cotton-swab group....There seems to be no difference in
each method's ability to obtain satisfactory smears." Since cotton
applicators are undoubtedly inferior instruments, this proves that the
brush cannot be an effective instrument either. Furthermore, Kinney5
states "...that certain characteristic endocervical cytologic changes are
frequently observed in specimens obtained by the Cytobrush." This
alteration can cause confusion in interpretation. Additionally, it
becomes obvious that in order to harvest endocervical cells, one should
not jeopardize the quality of the sample by subjecting it to deviceinduced alteration.
E. The Transformation Zone of the Squamous Columnar Junction
(T-Zone/SCJ) is a continuous surface and must be sampled in its
entirety and continuously. Two devices used at two different times
cannot perform this complete sweep of the T-Zone. Beal6 testifies to
this belief by stating that, "An accurate reading depends on the
practitioner obtaining a sample that is representative of the entire 360degree sweep of the transformation zone of the cervix. Unless this is
done, abnormal cells from a lesion located as part of the
squamocolumnar junction may not be picked up." Fluhmann? seconds
this belief and states that the proximal end of the transformation zone
can be as high as 12.3 mm into the cervical canal and since the T-Zone
�starts from inside of the cervix and extends to the outside, two devices
cannot sample the zone in its entirety in one sweep.
Cost-effectiveness
BedrossianS indicates that out of 12,789 pap smears (1989-1990), 875 had
to be repeated because of less than optimal results—which came to 6.84
percent of the total—costing $54,250. There are documented statistics on
the number of repeats (arising out of unsatisfactory and less than optimal
results) that range anywhere from 4% in small series, to 11% in larger
series, and even up to 37%4 in other series. It is, therefore, safe to assume
that the annual national average is somewhat larger—which translates into
higher costs. Statistics also indicate that in the US, there are approximately
63 million pap smears taken each year. Considering the above 6.84 percent
figure as the basis, this translates into 4,309,200 number of repeats
annually nationwide—^totaling at $267,170,400. (It should be noted,
though, that the 6.8 percent is an optimistic number.)
Why Cell-Sweep®?
According to the evidence gathered from search of scientific medical
literature, it seems that the shape and the other physical properties of CellSweep® make it perfect for total and continuous T-Zone sampling in a
360-degree clockwise motion. If we only take this one merit into
consideration and ignore the rest, this translates into drastic reduction in
occurrences of false negatives and unnecessary repeats due to unsatisfactory
and less than optimal results. Unpublished personal communications from
several medical centers attests to the validity of this claim. Statistics
gathered by several gynecologists show that by using Cell-Sweep®, they
have experienced considerable reduction in the number of repeats (due to
unsatisfactory and less than optimal results). Out of 40,000 pap smears
taken by Cell-Sweep®, the rate of unsatisfactory and less than optimal
results ranged from 1 to 4 percent—yielding an approximate average of
2%. This translates into financial savings of millions of dollars—without
even considering the financial gain from the reduction in false negatives.
1.
Steiner C. Cervical Cancer Screening from the Public Health Perspective. Acta Cytologica JulyAugust 1989;33(4):471-474.
�2.
3.
4.
5.
6.
7.
8.
Lee D, Patrissi, GA, Kaminski PF. Accuracy of Papanicolaou Smears: Art or Science. The Journal
of Reproductive Medicine October 1988;33(10):795-798.
RubioCA. The False Negative Smear: II. The Trapping Effect of Collecting Instruments.
Obstetrics & Gynecology May 1977;49(5):576-580.
Koonings PP. Dickinson K, d'Ablaing III G, Schlaerth, JB. The Randomized Clinical Trial
Comparing the Cytobrush and Cotton Swab for Papanicolaou Smears. Obstetrics and Gynecology
August 1992;80(2):241-245.
Kinney JR, Piraino. PS, Strumpf KB, Schmidt S. Analysis of Altered Endocervical Cells Observed
in Cytobrush Smears. (From the Department of Cytotechnology, State University of New York
Health Science Center, the Department of Cytotechnology, Pathology Associates of Syracuse, and the
Department of Pathology, Crouse Irving Memorial Hospital, Syracuse, New York, U.S.A.); date and
publication source unknown.
Seal MW. Cervical Cytology. Clinical Issues In Prenatal and Women's Health, Nursing
1990;l(4):470-478.
RuhmannCF. The Squamocolumnar Transitional Zone of the Cervix Uteri. Journal of Obstetrics
and Gynecology August 1959;14(2):133-148.
Bottles K, Reiter RC, Steiner AL, Zaleski S, Bedrossian CWM, Johnson SR. Problems Encountered
With the Bethesda System: The University of Iowa Experience. Obstetrics & Gynecology
September 1991;78(3, Part 1):410-414.
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DATE
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RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
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2385
FOLDER TITLE:
[Physician Letters] [loose] [ I I ]
2006-0885-F
jm781
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RR. Document will be reviewed upon request.
�Cell-Sweep®
Optimal Design for Meeting
Cervical Cell Sampling Requirements:
The Correlation Between
Sampling Device Effectiveness and
the Adequacy and Accuracy of Pap Smears
(Design Conformity to Functional Requirements)
March 1993
Reza S. Mohajer, M.D., F.A.C.O.G.
•;
•
v
• 'pWKe)
�The Correlation Between
Sampling Device Effectiveness and
the Adequacy and Accuracy of Pap Smears
The performance capability of any cell sampling device dictates
the adequacy and the accuracy of pap smears. Therefore, proper
sampling is essential in obtaining adequate pap smears. Proper
sampling can only be achieved through the use of an effective
instrument. If an instrument is not capable of fulfilling the
expected requirements, the skill level of the user will have very
little bearing on the results.
A cell sampling device must produce the following results:
(1)
(2)
(3)
(4)
(5)
It must sample the T-Zone/SCJ continuously and completely.
It must be capable of a monolayer cell spread.
It must eliminate the drying artifact occurrences.
It must eliminate presence of deep endocervical cells.
It must eliminate or reduce red blood cells to, at least, a negligible
amount, if not totally.
(6) It must be consistently system reproducible.
Cell-Sweep® performs many vital functions that have not been possible so
far through the use of currently available cell sampling devices. CellSweep®^ precise design completely conforms to and enables the functions
that are required of any effective cell sampling device. These functions are
briefly described below:
T-Zone and SCJ Sampling
The Transformation Zone of the Squamous Columnar Junction
(T-Zone/SCJ) is a continuous surface and must be sampled in its
entirety and continuously. Moreover, the presence of endocervical
cells on a slide only means that the device has entered the cervix high
enough to reach the columnar epithelium, not that the T-Zone/SCJ was
sampled completely. Therefore, the presence of endocervical
Cell-Sweep®—Design Conformity to Functional Requirements
�components alone is not an indicator of slide adequacy and accuracy.
If the sampling device does not completely embrace and cover the
T-Zone/SCJ during the sampling process, a small window of lesion can
be missed in the course of cell harvesting. This can lead to false
negatives. Cell-Sweep® completely embraces and covers the
T-Zone/SCJ during cell sampling and enables automatic and continuous
T-Zone/SCJ sampling, as well as efficient and effective cell harvest and
transfer.
During the 360-degree clockwise motion of the device, the ectocervix
is sampled by the distal tip of the lower bristles to the distal point of
the spatula. This provides an effective sampling diameter of 2.2
centimeters. The 17-millimeter height of the bristle section allows
adequate endocervical sampling. The spatula and the bristles
sample the ectocervix at the os twice during this single 360degree rotation. Cell-Sweep® eliminates sampling error, which is
the major cause of false negatives, and enables accurate and adequate
cell harvest and transfer during all sample-takings, regardless of the
knowledge and the skill of the pap-sampler.
Monolayer Spreading
The late Dr. John Frost, in his 1969 paper entitled Diagnostic Accuracy
of Cervical Smears, indicated that, "Specimen spreading should
strive for a single-cell thickness, uniformly dispersed over
the largest area to be eventually covered by the coverslip
and examined (i.e., terminal 2/3 of the microscopic slide)."
The textured area of Cell-Sweep®^ spatula section grips the harvested
material, while the smooth section produces a monolayer cell spread
during cell transfer. These differences in physical textures are
repeated in every bristle of Cell-Sweep® so that the endocervical
components also spread in a monolayer fashion. The combination of
the above functions eliminates non-smearing pap smear.
Elimination of the Drying Artifact
In order to analyze cells in their natural state—thus, avoiding any
distortions or drying artifact—the cells must be harvested,
Cell-Sweep®—Design Conformity to Functional Requirements
�transferred, and fixed onto the slide as quickly as possible. CellSweep® aids in eliminating the unnecessary and undesirable waste of
time during cell transfer. Cell-Sweep® allows the endocervical and the
ectocervical cells to be transferred onto a single slide within seconds of
each other—thus, enabling quick fixation.
Ease of Cell Separation
The upper bristles inside the cervical canal collect endocervical cells;
the spatula collects ectocervical cells. This unique type of cell
collection takes place simultaneously at opposite sides and on separate
surfaces of the device. This enables optimal separation of the two
different cells—columnar and squamous.
The separation of the cells also leads to proper gross and microscopic
identification of the cell location. The endocervical cells are identified
by their striped uniformity; the ectocervical cells by their solid spread.
System Reproducibility
The overall design and the locking capability of the device to the edge
of the slide and the unique harvest and transfer capability of the device
make it possible to repeatedly achieve uniform results. Since there is
only one way to harvest and transfer the two different cells, the cell
sampling process is not left to chance. There are no random results
and no reasons for confusion—after the final preparation, all slides
will look similar. The one slide technique is most desirable in cervical
cancer screening.
Good Cellularity
The quality of cell samples obtained by Cell-Sweep® is most desirable
because the bristle section of the device does not repeatedly sample the
same area of the endocervical canal during the cell harvesting process
(contrary to the brush). As a result, red cells and deep endocervical
cells are not present in any pap smears obtained by Cell-Sweep®
(elimination of brush atypia).
Cell-Sweep®—Design Conformity to Functional Requirements
�Device Versatility
Cell-Sweep® is capable of accomplishing the following diverse critical
functions:
(1) It is a pan-cervical sampler.
(2) Its paddle section can be used to sample the vaginal pool, the
vaginal wall, and the ectocervix during pregnancy. In the unlikely
event that the spatula does not touch the ectocervix, while the
bristles are being inserted into the canal, the physician,
recognizing this rare situation, can use the paddle section to
sample the ectocervix.
(3) It is capable of STD sampling.
Technical and Medical Aspects of Cell-Sweep®
Technically, the combination of Cell-Sweep®'s design, physical
properties, and functional characteristics creates a unique cell sampling
device that permits simplicity of use.
Medically, Cell-Sweep® completely and effectively performs all of the
functions that are required of any cell sampling device.
In conclusion, the use of Cell-Sweep® has
resulted in superior quality pap smears; increased
accuracy during slide interpretation; drastic
reduction of repeats; and saving of time, effort,
and money for patients, physicians, and
cytotechnologists.
Cell-Sweep®—Design Conformity to Functional Requirements
�Reza S. Mohajer, M.D.
1565 W. Big Beaver Road, Building F
Troy, Michigan 48084
Telephone: 313-643-7775; Fax: 313-643-0999
Cell-Sweep® Statistics
Total Number of Cytological Cell Samplings: 775
Period: January through December 1992
Period
Total No.
of Pap
Smears
Jan
54
Feb
58
Mar
70
Apr
71
May
56
Jun
71
Jul
81
Au£
70
Sep
70
Oct
61
Nov
62
Dec
51
TOTALS
775
Normal
Results
40
74.07%
42
72.41%
49
70.00%
58
81.69%
37
66.07%
56
78.87%
52
64.20%
59
84.29%
64
91.43%
52
85.25%
52
83.87%
47
92.16%
608
78.50%
Squamos Atypia
Less Than Unsatisfac- Reactive/Repar- of Undetermined
tory
Optimal
ative Changes*
Significance
6
6
0
0
11.11%
11.11%
0%
0%
2
0
0
13
22.41%
0%
0%
3.45%
7
12
0
0
17.14%
10.00%
0%
0%
4
8
0
0
11.27%
0%
5.63%
0%
1
0
13
5
23.21%
8.93%
1.79%
0%
1
11
3
0
1.41%
0%
15.49%
4.23%
17
6
3
0
7.41%
0%
20.99%
3.70%
7
2
0
1
0%
1.43%
10.00%
2.86%
2
1
0
0
0%
2.86%
1.43%
0%
4
0
0
0
0%
0%
6.56%
0%
4
2
0
0
6.45%
0%
0%
3.23%
2
4
0
1
3.92%
7.84%
0%
1.96%
11
1
90
46
1.42%**
5.94%
0.13%**
11.61%
SIL
Low
Grade
1
1.85%
1
1.72%
1
1.42%
1
1.41%
0
0%
0
0%
3
3.70%
1
1.43%
1
1.43%
0
0%
0
0%
2
3.92%
11
1.42%
SIL
High
Grade
1
1.85%
0
0%
1
1.43%
0
0%
0
0%
0
0%
0
0%
0
0%
2
2.86%
1
1.64%
3
4.84%
0
0%
8
1.03%
*Reactive/Reparative changes include the following:
— Inflammatory changes
— Follicular Cervicitis
— Radiation effects
— Chemotherapy effects
— Cytobrush effects
— DES changes
"Combined results from "Less Than Optimal" and "Unsatisfactory" equaled 1.55%
Results obtained from: Pennsylvania Cytology Services: Suite 200, Jonnet Building, 4099 William Penn Highway, Monroeville,
PA 15146-2512, Telephone: 1-800-344-1026
�DEPARTMENT OF HEALTH & HUMAN SERVICES
Food and Drug Administraiion
1390 Piccard Drive
Rockville, MD 20850
MY 2 I 1 9
A
91
Reza S. Mohajer, M.D.
%Krass and Young
A t t n : Mr. Ronald W Citkowski
.
3001 West Big Beaver Road
Suite 624
Troy, Michigan 48084-3109
Public Health Service
Re:
K911327/A
Cell-Sweep
Dated: May 3, 1991
Received: May 8, 1991
Regulatory Class: I I
21 CFR 884.4530
Dear Mr. Citkowski:
We have reviewed your Section 5l0(k) notification of intent to market the device referenced above and we
have determined the device is substantially equivalent to devices marketed in interstate commerce prior
to May 28, 1976, the enactment date of the Medical Device Amendments. You may. therefore, market the
device, subject to the general controls provisions of the Federal Food, Drug, and Cosmetic Act (Act).
The general controls provisions of the Act include requirements for annual registration, lisdng of
devices, good manufacturing practice, and labeling, and prohibitions against misbranding and
adulteration.
If your device is classified (see above) into either class I I (Performance Standards) or class I I I
(Premarkct Approval) it may be subject to additional controls. Existing major regulations affecting
your device can be found in the Code of Federal Regulations, Tide 21, Parts 800 to 895. In addidon,
the Food and Drug AdministratiSh (FDA) may publish further announcements concerning your device in the
Federal Register. Please note: this response to your premarkct notification submission does not affect
any obligation you might have under the Radiation Control for Health and Safety Act of 1968, or other
Federal Laws or Regulations.
This letter immediately will allow you to begin markedng your device as described. An FDA finding of
substantial equivalence of your , device to. a prc-Amendracnts device results in a classification for your
device and permits your device to proceed to the market, but it does not mean that FDA approves your,
device. Therefore, you may not promote or in anyway represent your device or its labeling as being
approved by FDA. I f you desire, specific advice on the labeling for your device please contact the
Division of Compliance Operations, Regulatory Guidance Branch (HFZ-323) at (301) 427-8040. Other
general information on your responsibilities under the Act, may be obtained from the Division of Small
Manufacturers Assistance at their toll free number (800) 638-2041 or at (301) 443-6597.
Sincerely yours.
m 2 4 J9
9J
KRASS & YOUNG
Lillian Yin. Ph.D.
Director. Division of OB-GT
and Dental Devices
Office of Device Evaluation
Center for Devices and Radiological Health
�COpER:
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Other
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insurance premiums
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boards and oversight
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benefits
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women's health
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OTHER
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'a
••r •
,•
�C h r i s t o p h e r C. S t a e h e l i MD
H i l l a r y Rodham Clinton
Chairperson
Task Force on National Healthcare Reform
The White House
Washington, D.C.
March 16,
1993
Mrs. Clinton:
I am a physician and f i r s t year law student at the
University of Michigan Law School. I have eight years
experience i n Family Medicine. My i n t e r e s t i s i n Health
Law and Health Care Policy. I am seeking a summer legal
i n t e r n position and hope to focus i n the area of Health
Care Policy.
I have been deeply interested in Health Care Policy since
my f i r s t year of medical school, working in community free
c l i n i c s in Seattle throughout medical school. My deep
interest and committment has kept me abreast of the
developments in Health Law and Health Care Policy
throughout my service as a Navy phycician. My desire to
improve the Healthcare system, and access to i t , led me to
law school. I believe a legal intern position with the
Task Force on Health care reform would be a unique
opportunity and benefit to me. I also believe I have
something unique to offer as a practicing physician with a
committed interest in Healthcare reform. I have enclosed a
resume and curriculum vitae for your information.
I can be reached at my home address and phone number noted
above. I f you desire any further information please l e t me
know. Thank you for your time and consideration.
Sincerely,
Christopher C. Staeheli
• -i
*
,
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Christopher C. Staeheli MD
Address:
EDUCATION
The U n i v e r s i t y of Michigan Law School, Ann Arbor, Michigan
J.D. candidate. May 1995
U n i v e r s i t y o f Washington School o f Medicine, S e a t t l e , WA
M.D. June 1984
Gonzaga U n i v e r s i t y , Spokane, WA
B.S. Biology, B.A. P o l i t i c a l Science, Minor Chemistry
May 1980
Honors: Magna Cum Laude
• .
Honor Society: Alpha Sigma Nu
Awards: Academic Scholarship 1975-80
EEC Studies Scholarship 1978
Chemistry Scholarship 1979
Thesis: The I n h i b i t i o n o f L e c i t h i n Cholesterol
Acyltransferase by Cholesterol Hydroperoxide
EXPERIENCE
Central Minnesota Group Health, St. Cloud, MN
Family Physician, January 1991 t o J u l y 1992
St. Cloud H o s p i t a l , St. Cloud, MN
S t a f f Physician January 1991 t o J u l y 1992
•Member Department o f Family Practice
•Liason member Department o f P e d i a t r i c s
Stearns County J a i l , St. Cloud, MN
S t a f f Physician February 1992 t o J u l y 1992
St. Cloud Family Planning Center, St. Cloud, MN
S t a f f Physician Volunteer March 1991 t o J u l y 1992
Operation Raleigh Zimbabwe 1990 Expedition
Senior S t a f f Physician and Project Leader
September t o December 1990
•Coordinated c o n s t r u c t i o n o f a youth camp
•Organized and lead wilderness t r e k s
•Provided medical expertise and care
•Drafted e x p e d i t i o n medical r e p o r t
U.S. Naval F l i g h t Surgeon P a t r o l Squadron Eleven
Naval A i r S t a t i o n Assignments: Brunswick, ME;
K e f l a v i k , Iceland; Sigonella, S i c i l y
May 1988 t o September 1990
• A v i a t i o n Medicine Department Head NAS Brunswick, ME
�U.S. Naval Aerospace Medical I n s t i t u t e , Pensacola, FL
F l i g h t Surgeon Program October 1987 t o A p r i l 1988
U.S. Naval Branch Medical C l i n i c Gaeta, I t a l y
C l i n i c D i r e c t o r and sole Physician
July 1985 t o October 1987
•Drafted prenatal care protocol f o r the four i s o l a t e d
U.S. Naval Medical C l i n i c s i n the Mediteranean
•Developed and implemented q u a l i t y assurance programs
f o r Radiology, Pharmacy, Laboratory, and Primary Care
•Provided a l l outpatient care services f o r two-thousand
Americans seven days a week
Portsmouth Naval Hospital, Portsmouth, VA
General Surgery Internship June 1984 t o July 1985
AWARDS
Navy Achievement Medal Twice Awarded
Meritorious Unit C i t a t i o n Three Awards
ACTIVITIES
U.S. Naval Reserve Naval A i r F a c i l i t y , D e t r o i t , MI
Commanding O f f i c e r Fourth Marine A i r Wing Medical Unit
F i r s t Care Ambulatory Care Centers, Ann Arbor, MI
Contract part-time physician
Health Law Society
INTERESTS
Health Law, Running, Soccer, Downhill & Cross-country
skiing
�NQTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�CURRICULUM VITAE
Christopher C. Staeheli, M.D.
PERSONAL INFORMATION
Home Address:
Present Position.
Student at the University of Michigan Law School
Date of Birth:
Place of Birth.
N
Marital Status:
EDUCATIONAL BACKGROUND
Undergraduate:
Seattle University
f
• •.. Gonzaga University
Location:
Attended:
Major:
Seattle, Washington
September 1973 to June 1975
English
Spokane, Washington
August 1975 to May 1980
May 1980
Biology, Political Science
Chemistry
B.S. Biology, B.A. Political Science
Magna Cum Laude
Academic Scholarship 1975-80
EEC Studies Scholarship 1978
Chemistry Scholarship 1979
Honor Society. Alpha Sigma Nu
Location.
Attended:
Graduated:
Major.
Minor:
Degrees:
Honors.
Awards:
•f.
Graduate.
University of Washington
School of Medicine
Location: Seattle, Washington
Attended: September 1980 to June 1984
Graduate. June 1984
Degree: M.D.
�Internship:
Portsmouth Naval Hospital
Location:
Attended:
Type:
Portsmouth, Virginia
June 1984 to July 1985
General Surgery
Military Education:
1981 to 1984
Armed Forces Health Professions Scholarship Program
July 1983
Dermatology Clerkship
Bethesda Naval Hospital
Cardiology Clerkship
Bethesda Naval Hospital
Internal Medicine Clerkship
Bethesda Naval Hospital
August 1983
April 1984
Medical Department Basic
Management Development Course
Flight Surgeon Program
December 1986
Naval School of the Health Services
Naval Aerospace Medical Institute
Pensacola, Florida
October 1987 to
April 1988
PROFESSIONAL BACKGROUND
Portsmouth Naval Hospital
Location: Portsmouth, Virginia
Position:
General Surgery Intern
Dates:
June 1984 to July 1985
U.S. Naval Branch Medical
Clinic Gaeta
Location:
Position:
Dates:
Pensacola Naval Hospital
Location:
Position:
Dates:
U.S. Naval Branch Medical
Clinic Brunswick
Location:
Position.
Dates:
Gaeta, Italy
Clinic Director
General Medical Officer
July 1985 to October 1987
Pensacola, Florida
General Medical Officer
Acute Care Clinic Watchstander
October 1987 to April 1988
Naval Air Station, Brunswick, Maine
Flight Surgeon Patrol Squadron Eleven
Clinic General Medical Officer
Urgent Care Clinic Watchstander
May 1988 to November 1988
�U.S. Naval Hospital Keflavik
Location: Naval Air Station, Keflavik, Iceland
Position. Flight Surgeon Patrol Squadron Eleven,
Base Flight Surgeon, General Medical Officer,
Emergency Room Watchstander
Dates:
November 1988 to May 1989
U.S Naval Branch Medical
Clinic Brunswick
Location:
Position:
Dates:
U.S. Naval Branch Hospital
Sigonella
Naval Air Station, Brunswick, Maine
Flight Surgeon Patrol Squadron Eleven,
Brunswick Naval Air Station Senior Flight Surgeon,
Clinic General Medical Officer,
Urgent Care Clinic Watchstander
May 1988 to June 1990
Location: Naval Air Station, Sigonella, Sicily
Position: Flight Surgeon Patrol Squadron Eleven,
Sigonella Naval Air Station Senior Flight Surgeon,
Naval Hospital Staff Medical Officer and
Watchstander
Dates.
June 1990 to September 1990
Operation Raleigh
Location:
Zimbabwe '90 "Intusto" Expedition
Position:
Dates:
Central Headquarters London, England
Field Headquarters Harare, Zimbabwe
Physician and Project Leader
September 1990 to December 1990
Central Minnesota Group
Health Plan
Location:
Position:
Dates:
1245 15th Street North, St. Cloud, MN 56303
General Practice Family Physician
January 1991 to July 1992
St. Cloud Hospital
Location:
Position:
Dates.
1406 6th Avenue North, St. Cloud, MN 56303
Family Physician, Member Medical Staff,
Member of Department of Family Practice
January 1991 to July 1992
St. Cloud Family Planning
Location:
Position:
Dates:
26 1/2 N. 7th Ave., St. Cloud, MN 56301
Volunteer Staff Physician
April 1991 to June 1992
Navy Air Reserve Center
Minneapolis
Location:
6201 32nd Ave. South
Minneapolis, MN 55450-2898
Flight Surgeon, Lieutenant Commander
Reserve Office
February 1992 to July 1992
Position:
Dates:
�County of Steams Community
Health Services Department
Location:
3400 1st Street North, Box 153,
St. Cloud, MN 56302
Position: Steams County Jail Physician
Dates:
Febmary 1992 to July 1992
St Cloud Surgical Center
Location:
Position.
Dates:
Location:
Position:
Naval Air Facility Detroit
Dates:
First Care Medical Centers PC
1401 W. St. Germain Street, St. Cloud, MN 56301
Surgical Assistant Privileges,
Member of Medical Staff
July 1992
Selfridge AFB Mount demons, MI 48045
Commanding Officer 4th Marine Air Wing Medical
Unit
November 1992 to Present
Location: 2755 Carpenter Ann Arbor, MI 48108
Position: Contract Part-time Physician
Dates:
October 1992 to Present
Certifications:
ATLS Certification
BCLS Certification
ACLS Certificaiton
April 1990
November 1992
November 1992
Medical Licenses:
State of Washington #26193
State of Minnesota #34348
State of Michigan #4301060684
Professional Associations:
American Medical Association
AWARDS
Navy Achievement Medal Twice Awarded
Meritorious Unit Citation Three Awards
RESEARCH
Undergraduate Thesis:
"The Inhibition of Lecithin Cholesterol Acyltransferase
by Cholseterol Hydroperoxide"
September 1979 to July 1980
�HEALTH CARE TASK FORCE SORTING SHEET
CODER: - j < J ^ -
04
INPUT DATE:
OKNF.RAI, SORT:
P O S T C A R D 1:
.General mail
Personal stories
Other Health Providers
.Letter Campaign
P O S T C A R D 2:
Offers to help/Employment
FORM L E T T E R ;
Letterhead
.Policy
REROUTE:
Casework
.Scheduling
Physicians
President
Other
POLTCY AND PERSONAL STORIES:
.ORGANIZATION (I)
^insurance premiums
insurance reform
^insurance pools
boards and oversight
. C O V E R A G E (II)
working families
unemployed/low income
benefits
providers
I N F R A S T R U C T U R E / W O R K F O R C E (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
. G O V E R N M E N T PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
.FINANCING (VII)
. M E N T A L H E A L T H (IX)
. L O N G - T E R M C A R E (X)
PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
rural
urban
OTHER
�PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�'
5 o
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tf^e).
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Ted J .
Ms. Hillary•Rodham C l i n t o n ^
The White House
1600 Pennsylvania Ave.
Washington', D.C. 20000
April
0^
12, 199
:linton,
I am a family practitioner and have been in practice sinf*
^^ ^
1980. My f i r s t t h r e e y e a r s o f prnr-M r r , wr^i spent i n t h e P u b l i c *
'r '-5
H e a l t h ser^/ice i n
small town i n Qrural
wa A I have p r a c t i c e d
I
nesoTa i n p r i v a t e
t h e l a s t s=n years i n s m a l l towns i n
p r a c t i c e . I am board c e r t i f i e d by the'American Board o f f a m i l y
P r a c t i c e and am dot a meKlbyr Uf CtiS A.M. A. bi^-«tfiy o t h e r form o f
o r g a n i z e d medicirte^ t n e r e r o r e cnese viewt! dt) n o t r e f l e c t t h e
views o f anyone but m y s e l f .
You and' P r e s i d e n t C l i n t o n a r e c o r r e c t i n y o u r a s s e r t i o n s
t h a t t h e h e a l t h - c a r e d e l i v e r y system needs t o be o v e r h a u l e d . Not
o n l y does t h e p r e s e n t system need t o be changed b u t a l s o t h e
e x p e c t a t i o n s o f t h e American p e o p l e need t o be changed as w e l l .
Some or o u r b a s i c views on l i f e , d e a t h , and d i s a b i l i t y need t o be
s e r i o u s l y examined and changed i f we a r e t o have an a f f o r d a b l e
system. With t h e k i n d o f l e a d e r s h i p you and y o u r husband can
p r o v i d e I am c o n v i n c e d t h i s i s p o s s i b l e .
Mo m e a n i n g f u l r e d u c t i o n s i n h e a l t h - c a r e c o s t s o r improvement
i n h e a l t h - c a r e d e l i v e r y can happen u n t i l people change t h e i r
expject^rjjia-s. Much o f t h e c o s t o f t h e system i s based on Wlidt—
people expect i t t o do. Both p a t i e n t s and p h y s i c i a n s have f a l s e
e x p e c t a t i o n s t h a t must be examined and changed. I r e a l i z e t h a t
many people f e e l t h e r e i s a l o t o f ' f a t ' i n t h e system t h a t can
be trimmed t o reduce t h e c o s t o f h e a l t h - c a r e and t o a c e r t a i n
' l i m i t e d ' e x t e n t t h i s i s t r u e . However t h e o p e r a t i o n a l word i s
' l i m i t e d ' , and t r i m m i n g t h e f a t w i l l n o t go n e a r l y f a r enough t o
sSv-r '-he economy, o r t h e American p u b l i c . We have heard a l o t
about g e t t i n g b e t t e r h e a l t h - c a r e f o r l e s s money and t h i s s i m p l y
i s not p o s s i b l e u n l e s s we change o u r e x p e c t a t i o n s . I cannot come
home and t e l l my f a m i l y we're g o i n g t o have more t h i n g s and pay
l e s s f o r them, and s i m i l a r l y t h i s w i l l n o t happen i n t h e
h e a l t h - c a r e system. We can have a b e t t e r h e a l t h - c a r e system and
have i t cost l e s s , b u t we cannot have more o f what we have been
g e t t i n g f o r l e s s money. I t has been i m p l i e d t h a t t h i s c o u l d
happen j u s t by r u t t i n g out t h e f a t i n t h e p r e s e n t system but
t h e r e i s s i m p l y not t h a t much f a t i n t h e p r e s e n t system. We must
be w i l i i n c t o accept something d i f f e r e n t i f i t i s t o c o s t l e s s
money. People must make fundamental changes i n what they c o n s i d e r
b e t t e r hea I t h - c a r e . T h i s w i l l r e q u i r e l e a d e r s h i p as w e l l as
1eg i s l a t i o n . For i n s t a n c e , The P r e s i d e n t cannot go i n t o t h e Mayo
C l i n i c hoc-pitai f o r a checkup w i t h 3-4 d o c t o r s a t t e n d i n g . The
people o f t h i s c o u n t r y cannot be l e a d t o b e l i e v e t h a t t h i s i s a
Cf,
�cost effective way to deliver medical care, and unfortunately
this is the message they have gotten in the past. The unspoken
implication of this message is that there is a two tier system,
one for the privileged few and one for the rest of us. If our
leaders send this message it is hard to convince the public that
the system they are stuck with is the best, if it is the best why
t
doesn't the president use it or better yet why can' t everyone go
to the Mayo Clinic and have three sg&J2-±&iAgts^j^c^-t-tTelr physi?ra-L? ^f\(J
The problem o f c a r i n g f o r t h ^ e l o e r l y T f s one t h a t w i l l not
go away, and w i l l not respond t o s*fft^i€r-Cost c u t t i n g measures
such as r e d u c i n g t h e amount you a r e going t o pay f o r each u n i t o f
s e r v i c e . The problem demands a more c o n s i d e r e d and l e s s
s i m p l i s t i c s o l u t i o n . Services t o keep t h e e l d e r l y out of long
term care and t o improve t h e i r h e a l t h p r a c t i c e s such as e x e r c i s e ,
d i e t , e t c . , should be increased s i n c e these w i l l save money long
term. S i m i l a r l y access t o p r e v e n t i v e s e r v i c e s such as i n f l u e n z a
immunizations, mammograms, p r o s t a t e s c r e e n i n g , e t c . should be
e a s i e r and cheaper f o r t h e e l d e r l y . On t h e o t h e r hand each person
i n t h i s c o u n t r y r e g a r d l e s s o f age should c o n s i d e r what they want
done i n t h e event o f a t o t a l l y c a t a s t r o p h i c event such as a coma,
massive s t r o k e e t c . I f a l i v i n g w i l l were mandatory and a v a i l a b l e
f o r e l d e r l y i n d i v i d u a l s i t would e l i m i n a t e much f a m i l i a l g u i l t
and f u t i l e i n t e n s i v e care measures.
When you t a l k t o t h e e l d e r l y members o f your f a m i l y o r t o
f r i e n d s you never encounter one who wants t o end l i f e i n a
n u r s i n g home, more o f t e n than not they say they would r a t h e r d i e
than go t o one. Why i s i t then t h a t we suddenly f o r g e t t h i s when
they a c t u a l l y end up i n t h e n u r s i n g home and rush poor Grandma t o
the h o s p i t a l a t t h e drop o f a hat t o p u t h e r t h r o u g h more misery
and make sure she l i v e s even l o n g e r i n a p l a c e she never wanted
t o go? T h i s makes a b s o l u t e l y no sense and does not f i t my
d e f i n i t i o n o f b e t t e r medical care. O f t e n Grandma t e l l s t h e d o c t o r
" j u s t l e t me d i e ! " While t h e concerned f a m i l y members t e l l him
"do whatever you can Doc!" I t would make much more sense t o do
whatever we can f o r 'permanent' n u r s i n g home r e s i d e n t s , w h i l e
they a r e s t i l l i n t h e n u r s i n g home, and have a n a t i o n a l p o l i c y
t h a t they w i l l not be h o s p i t a l i z e d under most circumstances. This
p o l i c y c o u l d be m o d i f i e d under s p e c i a l circumstances o r f o r
temporary r e s i d e n t s j u s t s t a y i n g i n a n u r s i n g home t o r e c o v e r
a f t e r a h o s p i t a l i z a t i o n . Grandma would not s u f f e r s i n c e she i s
not happy being i n t h e home anyway, and t h e f a m i l y would f e e l
t h a t they were doing t h e r i g h t t h i n g i n s t e a d of f e e l i n g g u i l t y i f
they do not push f o r i n t e n s i v e care s e r v i c e s . I f e e l t h e care t h e
r e s i d e n t s r e c e i v e would a c t u a l l y be b e t t e r than what they a r e
g e t t i n g now and t h e savings would be a s t r o n o m i c a l . I am not
a d v o c a t i n g abandoning these people, I'm suggesting a low t e c h .
approach t o t h e i r problems t h a t would s t r e s s use of m e d i c a t i o n i n
the n u r s i n g home and o u t - p a t i e n t s e r v i c e s r a t h e r than h i g h t e c h .
i n - p a t i e n t medical t r e a t m e n t . S u r g i c a l problems such as h i p
f r a c t u r e s e t c . would r e q u i r e c a r e f u l c o n s i d e r a t i o n and r e s e a r c h
t o determine t h e most e f f e c t i v e and l e a s t t r a u m a t i c t r e a t m e n t .
AIDS should be a t o p p r i o r i t y i n view o f t h e p r o b a b l e cost
of t h e care o f people s u f f e r i n g from AIDS i n t h e f u t u r e , and
c u r r e n t cost i n terms o f s u f f e r i n g , premature death, and
�d i s a b i l i t y . Even i f t h e cure o r p r e v e n t i o n o f t h i s s p e c i f i c v i r u s
i s f o r t h c o m i n g t h e government and s o c i e t y as a whole needs t o
come t o terms w i t h s e x u a l i t y and drug abuse. I f necessary t o
l i m i t t h e spread o f AIDS, i f n o t , t o l i m i t t h e spread o f o t h e r
diseases now present o r y e t t o be d e t e c t e d . Condoms should be
r e a d i l y a v a i l a b l e i n h i g h s c h o o l s , bars and i n b o t h men's and
women's restrooms. Sex e d u c a t i o n w i t h s p e c i f i c emphasis on safe
sex and what t h a t means should be mandatory i n a l l j u n i o r h i g h
and h i g h s c h o o l s . GOD does not p u n i s h people and we should not
use 'GOD's w i l l
as an excuse f o r p u n i s h i n g our c h i l d r e n when
they don't f o l l o w our a d v i c e r e g a r d i n g a b s t i n e n c e . There i s no
excuse f o r l e t t i n g s p e c i a l i n t e r e s t groups, under t h e g u i s e o f
m o r a l i t y , d i c t a t e t h e terms o f our response t o t h e needs o f t h e
g r e a t e s t number o f people. I agree w i t h P r e s i d e n t C l i n t o n t h a t
a l l l o b b y i s t s should be r e g i s t e r e d , and l o b b y i n g a c t i v i t i e s
should no l o n g e r be t a x d e d u c t i b l e we s h o u l d no l o n g e r s u b s i d i z e
the e f f o r t s o f s p e c i a l i n t e r e s t groups w h i l e undermining t h e
p u b l i c i n t e r e s t . Let one i s s u e s p e c i a l i n t e r e s t groups pay f o r
t h e i r pwR—advert i s i n g .
^ t e r i l e hypodermic n d 1 ' ^pa_nd_Ry r i ng-?p—gh^nlH hp R ^ q i l q h l q
f o r a d d i c t s i n ~ d i u g aLuies "arid^government o u t l e t s f r e e o f charge
i f necessary. Drugs should be d e c r i m i n a l i z e d o r users w i l l not
come f o r w a r d f o r c l e a n needles. T h i s does not mean drugs should
be a v a i l a b l e t o minors, t h e r e should be even s t i f f e r p e n a l t i e s
than now f o r p r o v i d i n g drugs t o minors! I f e e l t h a t under a
r e g u l a t e d d e c r i m i n a l i z e d system we would be b e t t e r a b l e t o keep
drugs o u t o f t h e hands o f minors. A l l drugs should be a v a i l a b l e
and r e g u l a t e d t h r o u g h t h e government! The war on drugs has not
worked i n i t s present i n c a r n a t i o n , and t h i s f a c t should be
a d m i t t e d . No drugs, i n c l u d i n g a l c o h o l and tobacco, should be
a d v e r t i s e d , a l l drugs s h o u l d be s o l d o n l y t h r o u g h government
o u t l e t s , where t r e a t m e n t f o r a l c o h o l , tobacco, and drug a d d i c t i o n
i s r e a d i l y a v a i l a b l e as w e l l . We w i l l never e l i m i n a t e t h e use o f
any o f these drugs, b u t a l l c o u l d be s i g n i f i c a n t l y reduced w i t h
p r o p e r e f f o r t s , w i t h a concomitant drop i n t h e cost o f c a r i n g f o r
a l c o h o l , tobacco, and drug r e l a t e d medical problems. I agree w i t h
t h e P r e s i d e n t ' s p l a n t o i n c r e a s e t h e taxes on a l c o h o l and tobacco
and would suggest t h a t my p l a n would d i v e r t a l a r g e p a r t o f t h e
cash now f l o w i n g o u t o f t h e economy f o r i l l i c i t drug use back
i n t o t h e economy and t h e t a x system. Treatment and e d u c a t i o n
c o u l d be a p r i o r i t y , t h e p r o f i t motive would be m i n i m i z e d , and
the f i n a n c i a l need t o p e r p e t u a t e t h e system would e v e n t u a l l y
disappear. With t h e d e c r i m i n a l i z a t i o n o f drug use t h e a c t u a l use
of drugs would d e c l i n e (our s t a t e d o b j e c t i v e i n t h e p a s t ) , w h i l e
c u r r e n t users would be more a c c e s s i b l e f o r t r e a t m e n t , t h e r e would
be no c o n f u s i n g double s t a n d a r d r e g a r d i n g ' l e g a l drugs', a l c o h o l
and tobacco, and ' i l l e g a l drugs'! P r i s o n c o s t s , l e g a l f e e s , law
enforcement, e t c . would cost l e s s a t a l l l e v e l s o f government.
There i s a b s o l u t e l y no excuse f o r a l l o w i n g t h e a d v e r t i s i n g o f
a l c o h o l and tobacco t o anyone ever under any c i r c u m s t a n c e s . More
money -shonl^dMie poured i n t o drug t r e a t m e n t programs and programs
t o h e l p smokers q u i t as w e l l . More money should be spe-nt on d r u g —
"etluidLiem—anU fedUCdliun—in g e n e r a l t o cure some o f t h e i l l s t h a t
l e a d t o drug and a l c o h o l use i n o u r s o c i e t y , such as l a c k of
1
Q Q
:
�hope, u n a v a i l a b l e j o b s , absence of s u i t a b l e l e i s u r e a c t i v i t i e s
and i n t e r e s t s . Programs aimed at e d u c a t i n g t h e h a r d t o reach
y o u t h (whether f o r c u l t u r a l , economic, o r i n t e l l e c t u a l reasons)
w i l l pay f o r themselves many times over i n money saved over t h e
long h a u l , money saved on p r i s o n c o s t s , e n t i t l e m e n t programs,
missed t a x o p p o r t u n i t i e s , wasted l i v e s and human p o t e n t i a l .
F e d e r a l g u i d e l i n e s should be developed f o r people i n c h r o n i c
v e g e t a t i v e s t a t e s , coma, e t c . I f a person has no reasonable
p o t e n t i a l f o r recovery o f at l e a s t a minimal l e v e l of awareness
they s h o u l d r e c e i v e comfort measures o n l y . Tube f e e d i n g s merely
p r o l o n g t h e s u f f e r i n g o f t h e i n d i v i d u a l and t h e i r f a m i l i e s .
Dehydration i s not a q u a l i t a t i v e l y worse way t o d i e than spending
years i n a v e g e t a t i v e s t a t e w i t h e v e n t u a l death from some e q u a l l y
unpleasant cause. F a m i l i e s are not capable of making r a t i o n a l
d e c i s i o n s i n these cases and should not be expected t o make a
d e c i s i o n on what i s best f o r t h e i r l o v e d one. I am not s u g g e s t i n g
w i t h h o l d i n g food o r f l u i d s from people a b l e t o take them by mouth
even i f they r e q u i r e a s s i s t a n c e by a care t a k e r . I do not f a v o r
euthanasia and never w i l l , I do f a v o r however a person's r i g h t t o
die i f they have no p o t e n t i a l of ever l i v i n g on t h e i r own. We
should not be expected t o a s s i s t i n speeding t h e i r death, on t h e
o t h e r hand we should be expected t o r e a l i z e where t o draw the
l i n e when a c t i v e l y d e l a y i n g an i n e v i t a b l e demise. Doctors and
p a t i e n t s have t o come t o g r i p s w i t h t h e f a c t t h a t a l l o w i n g
someone t o d i e when t h e i r l i f e i s over i s not a i d i n g o r causing
t h e i r death. T h i s does not mean t h a t no one should have tube
f e e d i n g s o r t h a t people should not have d i a l y s i s , i t means t h a t a
person i n a v e g e t a t i v e s t a t e t h a t i s i r r e v e r s i b l e o r a person
d y i n g of o l d age s h o u l d not have tube f e e d i n g s , I.V. f l u i d s e t c .
They s h o u l d not be r e s u s c i t a t e d , p l a c e d on v e n t i l a t o r s , o r even
have t h a t o p t i o n .
I f n a t i o n a l h e a l t h insurance i s going t o be a reaLLhy—ife
w i l l be necessary t o set up a system o
f
—
^
fees t o a v o i d
overuse and abuse of t h e system. There p r o b a b l y snould De no
'
co-pay f o r h e a l t h maintenance s e r v i c e s such as w e l l c h i l d
immunizations, and a schedule of graduated co-pays f o r o t h e r
s e r v i c e s , w i t h the l a r g e s t fee f o r use of t h e emergency room f o r
r o u t i n e h e a l t h v i s i t s . Consider basing co-pay l e v e l s on a
person's h e a l t h h a b i t s , i . e . , $10 f o r a smoker, $5 f o r a d r i n k e r ,
$5 more f o r a drug user e t c . Encourage good h e a l t h h a b i t s by
making i t cheaper t o see the d o c t o r . A system w i t h no out of
pocket expenses w i l l e s c a l a t e c o s t s due t o overuse and r e s u l t i n
e x c e s s i v e E.R. v i s i t s at hours more convenient f o r t h e p a t i e n t
but a l s o more expensive f o r t h e system. The r e a l i t y of t h e m a t t e r
i s t h a t t h e r e i s no reasonable way f o r a nurse o r d o c t o r t o l i m i t
a p a t i e n t ' s access t o t h e system w i t h o u t f i r s t seeing the p a t i e n t
so t o a c e r t a i n e x t e n t minimum out of pocket expenses would cause
a p a t i e n t t o e x e r c i s e some s e l f c o n t r o l over access. Reduce
co-pays f o r people who improve h e a l t h h a b i t s and get r o u t i n e
p h y s i c a l s e t c . Perhaps p a r t o f t h e co-pay should be based on how
f a r a person can go on a t r e a d m i l l i n t w e l v e minutes. A e r o b i c
e x e r c i s e and d i e t a r y t r a i n i n g c o u l d be a v a i l a b l e at f r e e o r
reduced cost t o a s s i s t people i n e v e n t u a l l y l o w e r i n g t h e i r
co-pay. Make any s e r v i c e s t h a t should reduce t o t a l c o s t s , such as
�immunizations, chemical dependence t r e a t m e n t , PAPs, mammograms,
PSAs, e t c . f r e e of co-pays. People need t o assume more
r e s p o n s i b i l i t y f o r t h e i r own bad h e a l t h choices and have t h e
o p p o r t u n i t y t o make good choices w i t h o u t excessive expense.
Workers compensation, m a l p r a c t i c e , and p e r s o n a l i n j u r y
c l a i m s a l l take a v e r y l a r g e t o l l on p a t i e n t s , d o c t o r s , and the
system, whether i t be p r i v a t e or p u b l i c . A l l t h r e e areas cause
s i m i l a r problems and would respond t o s i m i l a r s o l u t i o n s . There
are two b a s i c problems t h a t a l l t h r e e systems have i n common.
There i s a v e r y long t i m e frame i n v o l v e d b e f o r e t h e compensation
issues are s e t t l e d , which delays or p r e v e n t s a p a t i e n t ' s a b i l i t y
t o r e c o v e r , o r a t t h e v e r y l e a s t causes a d i s i n c e n t i v e t o
r e c o v e r . The l o n g e r a person takes t o begin a recovery t h e l e s s
l i k e l y he o r she i s ever t o recover. There i s a tendency i n an
a d v e r s a r i a l system f o r people t o expect e x c e s s i v e l y l a r g e
s e t t l e m e n t s o f t e n u n r e a l i s t i c a l l y which leads t o f r a u d , excessive
expense, and o f t e n a l l o w s people w i t h l e g i t i m a t e expenses t o f a l l
t h r o u g h the s a f e t y n e t . I propose a system t h a t i s
n o n - a d v e r s a r i a l i n n a t u r e based not on f a u l t but on adverse
outcome f o r whatever reason. There i s n o t h i n g t o be gained by
a s s i g n i n g blame and much t o be gained by r e a c h i n g a prompt
s e t t l e m e n t t h a t w i l l h e l p a p a t i e n t or worker deal w i t h h i s
f u t u r e medical expenses and l o s s of income. A board should be
e s t a b l i s h e d i n every s t a t e t o r e v i e w workers comp., m a l p r a c t i c e ,
and p e r s o n a l i n j u r y c l a i m s and e s t a b l i s h reasonable and e q u i t a b l e
judgements r e g a r d i n g expenses and l o s s of income f o r people w i t h
adverse outcomes, whether anyone was a t f a u l t , whether i n j u r e d i n
an auto, at work, o r at home. I f t h e board sees a reason t o
b e l i e v e t h a t a p r a c t i t i o n e r i s incompetent they c o u l d r e p o r t t o
the a p p r o p r i a t e l i c e n s i n g board and t h e problem c o u l d be d e a l t
w i t h on t h a t l e v e l . I b e l i e v e t h e savings would be not o n l y i n
terms of t o t a l money spent, but a l s o i n terms of time l o s t ,
avoidance o f permanent d i s a b i l i t y r e s u l t i n g from c u r r e n t
d i s i n c e n t i v e t o get b e t t e r , decreased cost and a n x i e t y r e l a t e d t o
m a l p r a c t i c e insurance and l i t i g a t i o n , decreased cost of s e t t l i n g
workers comp. and p e r s o n a l i n j u r y c l a i m s .
F i n a l l y t h e problem of cost of m e d i c a t i o n must be addressed.
Drug companies should be r e q u i r e d t o base the cost of drugs on
the cost of p r o d u c t i o n not on how s i m i l a r p r o d u c t s are p r i c e d . To
o f f s e t t h e h i g h c o s t s o f R&D p a t e n t s should be permanent o r
renewable, g e n e r i c drugs should be banned, a d v e r t i s i n g t o
p a t i e n t s and p h y s i c i a n s should be banned, and cost of R&D should
be s u b s i d i z e d by t h e government. A n a t i o n a l f o r m u l a r y should be
developed w i t h g u i d e l i n e s and e d u c a t i o n a l m a t e r i a l r e g a r d i n g cost
and e f f i c a c y of a v a i l a b l e drugs. As w i t h a l l economizing measures
the t r a n s i t i o n t o t h i s t y p e of system w i l l take s e v e r a l years i f
we are t o a v o i d f i n a n c i a l d e v a s t a t i o n f o r the companies i n v o l v e d .
We have n o t h i n g t o g a i n i f the c o u n t r y goes bankrupt w h i l e we
save money. The c u r r e n t s i t u a t i o n i s a k i n t o the problems
Eisenhower saw w i t h the M i l i t a r y I n d u s t r i a l Complex, t h e system
must be d i s m a n t l e d v e r y c a r e f u l l y i f we are t o save t h e economy
because t o a l a r g e e x t e n t the h e a l t h - c a r e system i s the economy.
I hope you can i n c o r p o r a t e a l l these ideas i n t o your new
v i s i o n f o r t h i s c o u n t r y . I do not advocate these ideas because
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
,a
6
.'.VJ • .-—,
.•»•{•
•, T.!••.*••.
�they w i l l save money, I believe they .a-re truly the 'right' thing
to do. We have been on the 'wrong' track for quite some time,
i.e., in error, and that i s why our current system costs so much.
If a new system i s 'right' i t w i l l not cost too much! You and
President Clinton have demonstrated that you are w i l l i n g to do
what i s 'right' even i f i t i s unpopular, and that i s why I
believe there i s hope for f i n a l l y changing the system for the
better! Thanks for taking the time to consider my ideas. I f I can
be of help or answer any quest long...write-me a£ ..the address above,
or c a l l me at, 612-274-3234 wof}
Sincerely,
Ted J. Akers
.
»
�INTERMED CONSULTANTS
O f f i c e of Hennepin Faculty Associates
A p r i l 4,
1993
Specialists in
Nephrology
Infectious Diseases
& Critical Care Medicine
Diplomaics, American Board nf
hucnial MediciM and Nephroln^y
James R. Bieitcnhuchcr. M.D.
Patricia A. Hail. M.D.
Thomas K. Slack. M.D.
Sleplianic Slackhousc. M.D.
Diplomale. American Board of
Internal Medicine. Nephrology
and Critical Care Medicine
James 11. Somcrville. M.D.
Diplomaics. American Board of
Internal Medicim'. and
I nfect ions D is eases
Daniel A. Zydowicz. M.D.
Slephen R. Obaid. M.D.
Steven M. Dines. M.D.
Fairvicw Southdale Physicians Building
6363 Fiance Avenue Soulh • Suae 400
Edina. Minnesola 55435
Fairvicw - Riverside Medical Office Buildinu
606-24th Avenue South • Suite 200
Minneapolis. Minnesola 55454
Meadowbrook Medical OITice Building
6490 Excelsior Boulevard • Suae W-106
Si. Louis Park. Minnesola 55426
Ridticview Medical Buildiii"
JO^^ast Nicollcl Boulevard • Suite 3S3
Burnsville, Minnesola 55337
Nancy J. Blumbcrg. R.N.
Clinic Manajicr
612/920-207(»
Fax 612/920-7444
Mrs. H i l l a r y Clinton
Chairwoman
Commission on Health Care
The White House
1600 Pennsylvania Avenue N
W
Washington, D.C.
20500
Dear Ms. Clinton:
At the urging of several friends and
non-medical
colleagues, I am w r i t i n g to express several concerns
about health care reform. My opinions and views are not
popular amongst physicians, but I believe some of us
need t o be heard. I am a 46 year old nephrologist with
a very busy medical practice. I practice w i t h i n a large
group of both academic and p r a c t i c i n g physicians from
virtually
a l l disciplines,
both primary care and
specialty.
I have an income well i n excess of s i x
f i g u r e s , although I work 80 hours per week to maintain
this.
I practice high technology medicine_.
I ^am both a
nephrologist andan i n t e n s i v i s t , and many of my patients
are i n InteTTsTve Care Units'] T am increasingly appalled
at the health care resources that are being u t i l i z e d to
keep patients with dismal prognoses a l i v e and believe
that one of the p r i o r i t i e s of the health commission must
be to address the drain of medical resources going i n t o
the care of terminally i l l patients. But, t h i s i s not
my only concern.
I am f e a r f u l that current fee
structures w i l l continue to drive physicians out of
primary care medicine and i n t o costly s u b - s p e c i a l i t i e s .
I am concerned that technology i s l i t e r a l l y running away
with our a b i l i t y to pay f o r i t . W practice i n a system
e
driven by consumer demand, fueled by new technology and
constantly threatened by our legal system.
�PAGE 2
I would l i k e to address these issues one at a time, and w i l l t r y to
make my remarks as succint as possible. F i r s t of a l l , f u t i l i t y
issues i n medical care are an increasing concern of physicians,
nurses and others in the health care system. We cannot continue to
spend the majority of Medicare d o l l a r s t r e a t i n g terminal i l l n e s s e s .
Physicians have, i n large measure, l o s t the a b i l i t y to determine
appropriate care. Patients and families are allowed to demand (and
the court i n e v i t a b l y rules against the medical profession) low y i e l d
and sometimes t o t a l l y inappropriate care. In my own f i e l d , we have
thousands of patients on chronic d i a l y s i s , being transported from
nursing homes to d i a l y s i s units, many of them barely aware of t h e i r
surroundings.
These people have no q u a l i t y of l i f e , but i n most
cases, some family member has decided that comfort measures and a
d i g n i f i e d death are not acceptable and we are frequently forced to
continue expensive therapy such as t h i s simply at the whim of
family. This i s demoralizing to physicians, nurses and the health
care community i n general. Certainly the cynics on your commission
can point out that there are physicians who choose to provide these
therapies because i t increases t h e i r income. I would c e r t a i n l y not
argue that t h i s never happens, but I can assure you that i n my
community t h i s i s rare.
The c o r r e c t i o n of t h i s problem requires a great deal of education
for both the general public and the medical caregivers a l i k e . We do
not have i n f i n i t e resources! Somebody needs to convey to the public
the message that there must be l i m i t s on the health care provided ta
the popuiation, but _clgailll_these l i m i t s nee3 to apply to everyone,
"fts a physician "on the f r o n t l i n e " I am always aware o l ~ the f a c t
that patients an3 l a m i i i e s have an excellent understanding of the
need to decrease health care expenditures u n t i l they or a loved one
i s a c t u a l l y sick. I t i s okay to l i m i t someone else's health care,
but not mine.
The erosion of primary care practice i n the country i s another major
concern.
Although I am a sub-specialist and realize that my views
would be highly unpopular with many of my colleagues, there i s
absolutely no question that increasing sub-specialization leads to
higher costs i n medical care.
I think the decline i n number of
p r a c t i c i n g primary care physicians i s going to continue unless and
u n t i l primary care i s made more a t t r a c t i v e from a f i n a n c i a l and
l i f e s t y l e perspective. Let me give you some quick examples. In my
community, the largest group of orthopedic surgeons and the largest
group of r a d i o l o g i s t s have average incomes that are many multiples
of p r a c t i c i n g primary caregivers. What i s more appalling i s the
f a c t that these physicians achieve these income levels working only
9 months per year. Both of these large groups mandate three months
of vacation time to each physician in the group.
Ophthalmologists
in our community, p a r t i c u l a r l y those who do large numbers of
cataract operations, have incredible incomes, and also ample
vacation and free time.
None of these s p e c i a l i t i e s that I have
singled out have rigorous night c a l l .
Although some of these
�PAGE 3
specialities
require more t r a i n i n g
years
than primary
care
physicians, the difference has narrowed over the years. Today's
young physician i s increasingly interested i n q u a l i t y of l i f e s t y l e .
I t i s clear that many would choose a primary care s p e c i a l i t y , even
at lower t o t a l salary i f some of the benefits, vacation time, etc.
were comparable.
Unfortunately, most young physicians are faced
with a f a i r l y easy choice. They can choose a rigorous 80 hour work
week, frequent night c a l l , d i s r u p t i o n to t h e i r family and lower pay,
or they can choose to go i n t o a sub-speciality that provides a much
more desirable income and l i f e s t y l e .
The answer to t h i s problem would seem r e l a t i v e l y simple. I f our
national p r i o r i t y is to increase patient a c c e s s i b i l i t y to physicians
( p a r t i c u l a r l y primary care physicians), to provide health care f o r
a l l , and to lower the o v e r a l l cost of the system, we need to begin
implementing the economic controls to allow t h i s to happen. We have
an excellent model that I , as a nephrologist, have practiced w i t h i n
for years. As you are undoubtedly aware, Medicare began decreasing
reimbursement f o r end-stage renal disease services almost 10 years
ago.
While my colleagues have c e r t a i n l y not been happy about t h i s
s i t u a t i o n , I would be hard pressed to t e l l you that I am not
adequately paid.
I would suggest that there are a number of
s p e c i a l t i e s i n medicine, where i n c r e d i b l e incomes are achieved by
physicians who enjoy a l i f e s t y l e magnitude better than the primary
care physician. Reimbursement f o r procedures in these areas should
begin to a c t u a l l y decrease j u s t as happened f o r us i n nephrology.
The technology issue is c l e a r l y more d i f f i c u l t , but also extremely
important i n the o v e r a l l medical cost structure.
Advances i n
technology are rapidly reported i n the medical l i t e r a t u r e and picked
up by the lay press. The explosion of endoscopic and laparoscopic
surgery i s an excellent example. While there are c e r t a i n l y benefits
to patients from t h i s advance, there have also been complications
and a d d i t i o n a l risks as physicians were rapidly trained i n these new
procedures.
In a d d i t i o n , the current p r i c i n g structure in medicine
generally d i c t a t e s that prices for these procedures are set at a
l e v e l to simply compete with whatever i s the a l t e r n a t e procedure.
I f a laparoscopic cholecystectomy saves 3 or 4 hospital days for the
average patient, the fees and hospital charges are set at a l e v e l
that allows a minimal cost saving to the insurer, but often
guarantees greatly increased p r o f i t to the h o s p i t a l and physician.
There are m u l t i p l e examples l i k e t h i s i n medicine. I could give you
some from our own practice. The bottom l i n e here i s that technology
i s advancing at a rate which makes evaluation of new procedures
d i f f i c u l t . Consumer demand often drives the cycle and, as I already
mentioned, the lawyers are always behind us to see that we leave no
stones unturned.
F i n a l l y , l e t me address the l i t i g a t i o n issue. This has been studied
by past commissions, and the cost of threatened l i t i g a t i o n to the
health care system cannot be under estimated. Primary physicians,
�PAGE 4
emergency room physicians, and s p e c i a l i s t s are a l l constantly aware
of the threat of l i t i g a t i o n should a diagnosis be missed, a test not
ordered, e t c . W l i v e i n a society where a bad outcome i s always
e
equated with blame.
While i t seems obvious that patients and
f a m i l i e s should be compensated for true malpractice or incompetence,
there need to be l i m i t s .
I sometimes believe that America has
become not the land of opportunity, but the land of l i t i g a t i o n . The
American dream i s to either win the l o t t e r y or to suffer an i n j u r y
s u f f i c i e n t l y disabling (even i f only alleged "pain and s u f f e r i n g " )
to make a quick retirement buck.
Many of m thoughts were c r y s t a l i z e d i n the course of a recent t r i p
y
to Costa Rica. I was part of a small contingent of physicians from
t h i s community, sponsored by the University of Minnesota, that put
on a medical conference f o r Central American physicians. I came
away feeling that I had learned much more than I had taught. Costa
Rica i s a country with very limited resources. Their p r i o r i t i e s are
education and health care. The health care system i s run by the
government and covers everyone. Physicians do not carry malpractice
insurance.
There i s v i r t u a l l y no such problem. Patients i n the
system are extremely well cared f o r . I was humbled by m v i s i t s to
y
several intensive care units where despite old and sometimes a
d i l a p i d a t e d equipment, the patients were c l e a r l y g e t t i n g a l e v e l of
care that was comparable t o that provided i n most United States
hospitals.
The physicians are well trained, although c l e a r l y
underpaid.
In looking at what Costa Rica does with i t s resources,
compared with what we do with ours, one can only come away with a
sense of shame at the incredible waste i n our system. (As an aside,
I wonder how many people i n t h i s country are aware of what the
United States "AIDS-phobia" did to the world cost of latex rubber
gloves.
Many t h i r d world countries are l i t e r a l l y unable to buy
these gloves f o r needed surgical procedures, while we use them by
the m i l l i o n s to protect health care workers from a v i r t u a l l y
n e g l i g i b l e medical r i s k . . . . t h e real r i s k i s l i t i g a t i o n ! )
In c l o s i n g , i t seems to me that anything other than a complete
overhaul of the whole system i s doomed to f a i l u r e . The government's
role i s to set standards and p r i o r i t i e s . For meaningful health care
reform t o occur, I believe that a l l of the following elements w i l l
need to be put into place w i t h i n a r e l a t i v e l y short period of time.
F i r s t , health care must be mandated for every American c i t i z e n . The
basic benefits to be provided must be spelled out i n d e t a i l by the
federal government.
Health care plans, HMOs, etc. must not be
allowed to compete based on varying levels of of benefit of service.
I t i s a l l too easy f o r an uninformed public to pick the cheapest
health plan only to find l a t e r that i t doesn't cover needed
services.
Price
controls
(or perhaps
more appropriately
reimbursement caps) must go into e f f e c t f o r a l l sectors of the
medical system. These controls must be mandatory and followed by
every
insurer.
They must include physicians, hospitals and
suppliers (and that includes drug companies). Once again, i f the
�PAGE 5
controls are mandatory and nation-wide, there w i l l be no opportunity
for " s l i c k operators" to compete based on d i f f e r e n t levels of
service or withholding c e r t a i n key benefits, drugs, etc.
I believe we need a return to the health commissions or health
advisory
boards of past years.
New technologies should be
adequately tested and price structures determined before they are
made available to the practicing physician and the general public.
Certainly t h i s may have a temporary adverse e f f e c t on technologic
advance, but to those who would argue that t h i s w i l l i r r e p a i r a b l y
harm our health care system, I would suggest a t r i p to Costa Rica.
We need to put physicians and health care management back i n charge
of health care. Medical decisions should be made by physicians, not
by f a m i l i e s and not by lawyers. We do not have i n f i n i t e resources,
and continuing to spend b i l l i o n s of d o l l a r s per year providing
aggressive
therapy
f o r terminally
i l l patients i s obscene,
p a r t i c u l a r l y when we can't even immunize a l l of our youngsters.
F i n a l l y , none of the above w i l l work without sweeping changes to the
legal system and t o r t reform.
Unfortunately, I fear that t h i s ,
perhaps more than any other f a c t o r , may make a national health care
system the only a l t e r n a t i v e .
I f lawyers can continue to l i t i g a t e
every adverse outcome i n medicine and also contest any attempts to
l i m i t or discontinue care which i s deemed medically inappropriate,
the e n t i r e system i s doomed to f a i l u r e .
In c l o s i n g , I would l i k e to indicate that I voted f o r President
Clinton and f e e l very positive about his o v e r a l l p r i o r i t i e s . I want
very much for h i s administration succeed.
He w i l l only do so,
however, by taking some very bold steps which l i k e l y w i l l have
adverse consequences f o r many sectors i n the health care system. I
am sometimes p a i n f u l l y aware that angering doctors i s no longer a
p o l i t i c a l l i a b i l i t y and that as a group we have increasingly l i m i t e d
p o l i t i c a l c l o u t . Much of t h i s i s deserved, some of i t not. I wish
the commission; the best of luck and have enormous sympathy f o r the
i n c r e d i b l e task ahead of you.
Sincerely' yours,
.James R. Breitenbucher,
IjjiterMed Consultants
M.D.
JRB/ldp
cc:
Senator Paul Wellstone
Senator David Durenberger
Representative James Ramstad
�March 26, 1993
the
OWATONNA
CLINIC, P.A.
Hillary Rodham-Clinton
The White House
Pennsylvania Avenue
Washington, D.C. 20510
Dear Ms. Rodham-Clinton:
FAMILY P R A C T I C E
R. W. deWerd, M.D.
K. L. Buresh, M.D.
J. D. Miller. M.D.
P. J. Greenwood, M.D.
C. E. Oien, M.D.
K. L. Blomquist, M.D.
R. H. Plate, M.D.
K. R. Dornfeld, M.D.
J. M. Beckman, M.D.
B. E. Bunkers, M.D.
K. S. Bunkers, M.D.
P. A. Kaupa, M.D.
B. L. Whited, M.D.
FAMILY P R A C T I C E
(Vine St. Office)
J. C. Henry, M.D.
J. E. McEnaney, M.D.
DERMATOLOGY
K. J. Chemey, M.D.
INTERNAL MEDICINE
P. F. Wichmann, M.D.
R. D. Wertwijn, M.D.
C. J. Winter, M.D.
W. D. Shepard, M.D.
SURGERY
E. F. Durst, M.D.
C. D. Welch. M.D.
O B S T E T R I C S and
GYNECOLOGY
J. H. Staff M.D.
T. M. Gingrich, M.D.
OPHTHALMOLOGY
G. D. Heslep, M.D.
ADMINISTRATION
Terry R. Tone
Karen O'Hearn
Greetings! I wholeheartedly endorse your efforts to hold
down pharmaceutical costs.
Every day we have drug
representatives that are trying to s e l l us their
medications.
I t r y t o aggressively avoid these drug representatives
because I l i k e to get my information through the Medical
Letter, which seems t o be more objective. I t concerns me
that drug companies keep turning out medications when
there are already many adequate medications available.
New medications require new testing and research, even
more fueling the cost of medical care. Some medications
now available run $3.00 to $4.00 per p i l l !
What prompted my l e t t e r was, today I was walking through
the hallway and a drug representative told me about yet
another antidepressant that i s available.
This i s the
t h i r d antidepressant t h i s year, a l l of them supposedly
better than the next, but having about the same effects as
far as I can see. I have three new antibiotics within the
last six months, none of which I have prescribed widely,
and two of which I never have used and w i l l probably not
use. I have been i n practice just four years.
My concern i s , why do we need more medications, more
research and development, more money spent on marketing,
and more money going t o fund the pharmaceutical companies
when there seems to be adequate medications available? I
can emphathize with the drug companies i n their attempt to
keep people healthy, but enough i s enough. I do support
the quest f o r new and better drugs, but not unnecessary
duplication.
I certainly don't intend to c r i t i c i z e a l l drug companies,
and they certainly provide a needed service.
I truly
appreciate the drug representatives leaving samples o f f at
our c l i n i c , as we a l l give away our share to people who
cannot otherwise afford medications. Thank you for your
concern and interest i n t h i s matter.
MAIN OFFICE
134 Southview
Owatonna, MN 55060
Phone. (507) 451-1120
Fax. 507 451-8932
VINE ST. OFFICE
127 West Vine
Owatonna, MN 55060
Phone: (507) 451-0156
rmest regards
Kirk R. Dornfel^h.D.
KRD/alb
��ASSOCIATES IN PSYCHIATRY AND PSYCHOLOGY
ROCHESTER OFFICE
(507) 288-8544
FAX 288-8545
TOLL FREE 1-800-422-0249
OWATONNA OFFICE
Professional Bldg.
605 Hillcrest Ave.
(507)455-0992
WINONA OFFICE
1-800-422-0249
D. GRAVETT, M.D.
Ironwood Square Bldg., Suite 405
300 3rd Avenue S.E.
Rochester, MN 55904
BY APPOINTMENT
February 12, 1993
Ms. H i l l a r y Clinton
White House
Washington, D.C. 20005
I. NESSELER, M.D.
S. JENKINS, M.D.
A. HOBAN, M.D.
C. CLEVELAND, M.D.
B. PATTON, Ph.D.
J. ANDERSON, ACSW
L. BLISSENBACH, ACSW
J. HUDRLIK, ACSW
P. DAVIS, M.S., L.P.
C. SMITH, M.S.. L.P.
J. HENKE, M.S., L P.
J. RIGGOTT, M.S., L.P.
W. KLEIS, M.S.
J. CHARBONNEAU, M.S.
Dear Ms. Clinton:
I rejoice that you were named to head the president's commission
on health-care reform. I hope that you can set a new standard for the
professional involvement of the president's spouse.
I am a psychiatrist i n private practice. I am writing to alert
you to some problem areas that I know very well, and to invite you to
v i s i t Rochester, Minnesota.
Psychiatry i s a relatively straight-forward medical specialty.
Outpatient psychiatry involves l i t t l e sophisticated equipment. A l l of
my cost increases over the past several years have been due to
paper-work. U n t i l CPT codes became mandatory, most psychiatrists
b i l l e d based on units of time. A one-hour therapy appointment at my
office i s currently $135.00. Approximately one-fourth of my
professional time each week i s spent i n unbillable a c t i v i t i e s :
paper-work, phone calls, office business, supervision of non-MD
professional staff, and medical education. About one-tenth of my
b i l l a b l e hours are "written o f f " i n the form of charity care and
uncollectible patient debts. Out of every $100 that I collect, $40
goes to office overhead and non-professional staff salaries and
benefits. Of the remaining $60, half goes for taxes. Of the
remaining $30, about $15 goes to pay my professional organization
dues, malpractice insurance, and medical education expenses. Very few
people realize that out of the $135 fee, only about $10 i s disposable
income.
D. ESCH, M.S.
Managed care has seriously complicated my a b i l i t y to charge a
f a i r price for my services, and r e s t r i c t s competition i n the market
place. When a managed mental health organization contracted with my
c i t i e s major employer, we providers were forbidden under anti-trust
statutes from discussing the contract with each other to decide
whether i t constituted f a i r and reasonable practice conditions. The
managed care company pressured providers into signing by threatening
to "close the network." Therapists and doctors whose practices were
not doing well were the f i r s t to sign-up with the new plan, i n the
hopes of increasing their referrals. Providers with strong patient
bases who were reluctant to sign a contract that committed us to
�Page 2.
limited reimbursement and an onerous level of increased paper-work hesitated, with
the result that some of the most highly s k i l l e d and experienced people i n the
community were "shut out" when the network closed. Clearly, the managed care
agency, headquartered out of state, had no sense of what was best for their
constituency. When I discussed the contract with my patients whose benefits were
being restricted, they expressed surprise. The contract was presented to them as a
cost-saving measure. They were not informed about the change i n their level of
coverage, or the increased burden upon therapists and doctors with whom they had
worked with for years.
I noted above that my usual hourly rate i s $135. lhe managed care
organization caps reimbursement at $108. Medical Assistance i n Minnesota
reimburses at $72; Medicare at $80.
On a daily basis, I must keep track of changes i n Medicare, Medical
Assistance, and about twenty insurance companies' regulations concerning proper use
of diagnostic and b i l l i n g codes, which plan w i l l reimburse for which types of
therapies, which plans reimburse for social workers, psychologists (M.S. and Ph.D.
l e v e l ) , and which reimburse only for psychiatrists, and which require documentation
before i n i t i a t i n g therapy, on-going reports during treatment, periodic updates, or
only information upon request. Most physicians, including myself, would l i k e to
practice with a minimum of bureaucracy. W hate having to c u r t a i l treatment plans
e
because of money problems, and we are annoyed at having to waste resources on
defensive medicine. Few physicians went into this career for the money (people who
want to get rich don't waste their youth i n medical school). When our patients
deteriorate because of money or insurance limitations on treatment, most of us
simply shoulder the burden i n the form of unpaid care, and t r y to shore-up our
patients to the best of our a b i l i t y . W waste our training by spending hours on
e
the phone as social workers, trying to locate inexpensive resources and alternate
forms of care.
Ms. Clinton, I would l i k e to extend a personal i n v i t a t i o n to you and your
staff to v i s i t Rochester, Minnesota. You w i l l find representatives of a l l types of
medical delivery here, i n a well-organized community. The Mayo Clinic represents an
international standard of excellence i n delivering tertiary-care medicine. Mayo
also has a unique and cost-effective health care benefit for i t s nearly 15,000
employees and their dependents, which includes unlimited access to Mayo Clinic
resources and almost no out-of-pocket expense. Just two miles away i s the Olmsted
Medical Group, a multispecialty c l i n i c with 30+ physicians who staff the local
community hospital. They represent the finest t r a d i t i o n of state- of-the-art family
practice medicine. And then, please v i s i t my office, the Associates i n Psychiatry
and Psychology. W are one of the few remaining private practice professional
e
associations. W w i l l be happy to serve you and your staff tea, and explain
e
anything we can about the joys and headaches of private outpatient psychiatry and
psychology. Finally, about three miles from my office are the Zumbro Valley Mental
�Page 3.
Health Center and the Federal Medical Center, two fine public i n s t i t u t i o n s .
I believe the health care system has failed providers as well as patients. I
know that you are busy, but I extend this i n v i t a t i o n i n a l l seriousness and a
genuine desire to assist you i n your commission to reform the nation's health care
system.
Sincerely,
Susan C. Jenkins, M.D.
Psychiatrist
SCJ/nlj
��Surgery Clinic of Hattiesburg, P.A.
J.P. CULPEPPER, III, M.D., F.A.C.S.
DIPLOMATE, AMEKICAPI BOARD O r SUKGERY
J.E. VARNER, JR., M.D., F.A.C.S.
Post O f f i c e B o x 1 6 1 4 9
105 Asbury Circle
Hattiesburg, Mississippi 39404-6149
DIPLOMATE, AMERICAN BOARD OE SURGERY
LEWIS E. HATTEPi, M.D., F.A.C.S.
Phone 601-268-5100
DIPLOMATE, A M E R I C A h BOARD OE SURGERY
General,
Thoracic,
GEORGE E. McGEE, M.D., F.A.C.S.
DIPLOMATE, AMERICAH BOARD OE SURGERY
Gl
Vascular
and
Endoscopy
Surgery,
Fax Mo. 6 0 1 - 2 6 8 - 5 1 1 8
T o l l Free 8 0 0 - 6 2 8 - 7 6 2 0
(in Mississippi)
V. JONN BAG NATO, M.D., F.A.C.S.
DIPLOMATE. AMERICAH BOARD OF SURGERY
BRENT R. WHEELER, M.D.
DIPLOMATE, AMERICAH BOARD OF SURGERY
KIRK J. BANQUER, M.D., F.A.C.S.
March 12,
1993
DIPLOMATE. AMERICAH BOARD OF SURGERY
Ms. H i l l a r y Rodham C l i n t o n
D i r e c t o r , H e a l t h Care Reform Task Force
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear Ms. C l i n t o n :
I f e e l compelled t o w r i t e t o express some concerns I have
r e g a r d i n g some p e r c e p t i o n s and m i s p e r c e p t i o n s t h a t many o f my
c o l l e a g u e s have expressed over t h e l a s t s e v e r a l weeks.
As a
p r a c t i c i n g p h y s i c i a n i n a community based p r a c t i c e , I have t a k e n
t h e t i m e t o s t a y i n f o r m e d on H e a l t h Care Reform Issues and was
extremely
interested
i n the positions that
the various
p r e s i d e n t i a l candidates took d u r i n g t h e Campaign. As a r e s u l t o f
my a n a l y s i s I became a s t r o n g s u p p o r t e r o f B i l l C l i n t o n d u r i n g
t h e Campaign and worked v e r y hard t o convince my c o l l e a g u e s t h a t
t h e ideas and p r i n c i p l e s t h a t he was e x p r e s s i n g i n t h e Campaign
were t h o s e w h i c h I t h o u g h t most p h y s i c i a n s c o u l d s t r o n g l y
support.
I would be honest and say t h a t t h e r e were n o t many
o t h e r Democratic s u p p o r t e r s among my l o c a l c o l l e a g u e s d e s p i t e my
p o i n t i n g o u t t h e complete f a i l u r e o f t h e p r e v i o u s a d m i n i s t r a t i o n
t o do a n y t h i n g meaningful toward h e a l t h care r e f o r m .
I s t r o n g l y c o n g r a t u l a t e t h e e f f o r t t h a t y o u a r e now
u n d e r t a k i n g d e a l i n g w i t h t h i s v e r y complex and d i f f i c u l t i s s u e .
I r e c o g n i z e t h e p o l i t i c a l reasons f o r n o t i n v o l v i n g t h e American
M e d i c a l A s s o c i a t i o n i n t h e "uppermost c e n t e r group"
as you
develop t h e h e a l t h system r e f o r m p l a n b u t I am a f r a i d t h a t t h i s
has been p e r c e i v e d by many o f my c o l l e a g u e s as b e i n g a s l a p i n
t h e face t o a l l p h y s i c i a n s .
I c e r t a i n l y know and understand
t h a t t h e r e a r e p h y s i c i a n s i n v o l v e d i n v a r i o u s l e v e l s o f y o u r Task
Force b u t I t h i n k some reassurance t o p h y s i c i a n s t h a t p h y s i c i a n s
are a c t i v e l y i n v o l v e d i n t h e H e a l t h System Reform Task Force
would be h e l p f u l .
I have had comments d i r e c t e d t o me such as,
"How can we have a system o f h e a l t h care developed w i t h o u t t h e
i n p u t o f p h y s i c i a n s who a r e expected t o d i r e c t t h a t system", and
" I h a r d l y t h i n k t h a t Legal System Reform would be undertaken
w i t h o u t t h e prominent r o l e f o r t h e American Bar A s s o c i a t i o n " .
�I t h i n k you a r e w e l l aware
that the vast m a j o r i t y of of
p h y s i c i a n s i n t h i s c o u n t r y a r e s u p p o r t i v e o f H e a l t h System Reform
and i n f a c t t h e A m e r i c a n M e d i c a l A s s o c i a t i o n , t h e l a r g e s t
o r g a n i z a t i o n o f p h y s i c i a n s i n t h e w o r l d , has i n f a c t been
p r o m o t i n g h e a l t h care r e f o r m w i t h a s p e c i f i c p l a n o f a c t i o n f o r
several years.
I c e r t a i n l y would n o t want t o see p h y s i c i a n s
p a i n t e d as t h e "bad guys" and I t h i n k t h e r e i s a good o p p o r t u n i t y
t o reach o u t t o p h y s i c i a n s a t t h i s t i m e and p r o v i d e
some
assurance t h a t p h y s i c i a n s i n p u t i s i n f a c t o c c u r r i n g .
I f r a n k l y have n o t seen such pessimism among my c o l l e a g u e s
r e g a r d i n g t h e i r p e r c e p t i o n s o f t h e f u t u r e o f medical p r a c t i c e
s i n c e I s t a r t e d p r a c t i c e over 10 years ago. With t h e c o n t i n u e d
d i s c u s s i o n s about t h e problems a s s o c i a t e d w i t h our c u r r e n t
h e a l t h care d e l i v e r y system, many p h y s i c i a n s a r e f e e l i n g l i k e
"red headed s t e p c h i l d r e n " and a r e a l s o v e r y concerned t h a t many
of t h e v e r y f i n e p o i n t s about our H e a l t h Care System and b e i n g
o v e r l o o k e d and may i n f a c t f a l l by t h e way-side i n h e a l t h system
reform.
I b r i n g t h i s t o your a t t e n t i o n , Ms. C l i n t o n , n o t as any
c r i t i c i s m f o r what you have o r have n o t done b u t r a t h e r h o p e f u l l y
t o p r o v i d e you some i n s i g h t w i t h t h e c u r r e n t t h i n k i n g o f many
physicians.
I leave i t t o your wisdom t o decide i f you f e e l
a c t i o n needs t o be made w i t h r e g a r d t o these i s s u e s . I am f i r m l y
convinced t h a t our h e a l t h care d e l i v e r y system i n t h i s c o u n t r y
can be s t r e n g t h e n e d , p r e s e r v i n g a l l o f t h e good q u a l i t i e s t h a t
have made American medicine , i n i t s best sense, t h e envy o f t h e
w o r l d and y e t can d e a l w i t h t h e problems t h a t a r e v e r y r e a l and
r e q u i r e changes w i t h i n o u r s y s t e m so t h a t o u r h e a l t h c a r e
d e l i v e r y system can be w i t h o u t q u e s t i o n t h e best system i n t h e
world.
I f i r m l y b e l i e v e also t h a t there i s a very b r i g h t f u t u r e
f o r p h y s i c i a n s i n t h a t medicine can and w i l l c o n t i n u e t o be an
honorable p r o f e s s i o n a t t r a c t i n g our best and b r i g h t e s t young
people.
�Good luck and sincere best wishes as you continue t o deal
w i t h t h i s very d i f f i c u l t task.
Sincerely,
George E. McGee, M.D.
GEM/mlj
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
^
o 'J
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�Hillary Clinton
Chairperson, Task Force on
National Health Care Reform
The White House,
Washington, D.C. 20501 •'
Dear Mrs. Clinton
As a prologue to my letter containing reform suggestions for the task force on National Health
Care Reform, I felt compelled to in form you that I stand among your most admiring of fans.
You are an inspiration to professional woman like myself who have bumped aeainsLthe "glass
ceiling", and you are an.important roTeTfiudel for Amencan female youth.
You have a tremendous potential to further revolutionize the role of the first lady, to greater
heights than even Eleanor Roosevelt, whom I have idealized since childhood. In addition, your
achievements, strength of character, and capacity to propel humanitarian progress distinguish
you in your own right among important women in American history.
Sincerely, with warmest regards and best wishes,
Jessee L. Crane M.D.
Family Practice Physician
St. Louis, Missouri
P.S. A texas Governor, W.Lee O'Daniel once said of Eleanor Roosevelt's influence on F.D.R.
"Any good things he may have done during his political career are due to her. Any mistakes
he may have made are-due to his not taking up the matter with his wife." It seems President
Clinton already has the advantage over F.D.R., as he has the good sense to "...run it past
Hillary".
�Task Force on National Health Care Reform
The White House,
Washington, D.C.
As a female Family Practice physician in St. Louis, Missouri, I appreciate and accept the
invitation to provide suggestions on health care reform.
I come from a po^^jrafMissouri familyNl received my medical degree at the University of
Missouri Medical SctiSof^uteitiary carepemer in rural central Missouri. My insight and beliefs
have been formed through my experiences in: an affluent suburban hospital Family Practice
Residency program which incorporated (included) OB-GYN and Pediatric rotations in inner-city
hospitals, an assistant professorship on faculty for an inner-city hospital based Family Practice
Residency program which involved an office-based practice and prenatal care at a Job Corp
center, and more recently in Urgent Care and Emergency Medicine in a more rural setting.
I would like to describe the current maldistribution of health care resources, with its areas of
wasteful over utilization, that extravagantly and uniquely burden the American health care
budget in a way that does not exist in any other industrialized nation. I will then follow with
recommendations to more equitably distribute health care resources without increasing its total
cost. Additionally, I offer an important investment strategy that will promote reductions in total
health care costs for generations to come.
First, let me provide an analogy of the maldistribution of health care in America.
If Health Care in America were food, the following statements could be accurately
asserted in regard to it's distribution among Americans:
There are adequate resources to nutritionally sustain all Americans, the majority of
whom receive an ample supply, and many of whom allow themselves frequent over
indulgences. Yet, there are the gluttonous multitudes that are excessively spoon fed by
well meaning loved ones past the point of being able to appreciate or even recognize their
indulgence, while the growing masses are left malnourished and even starving for the
want of a few scraps to spill from the table.
�Problem #1 Wasteful over utilization of health care resources bv patients, aided bv
litigation fearing physicians.
Too little emphasis is placed on the wasteful overindulgences of the fortunate group of medically
insured Americans accustomed to
the luxury of unlimited access to health care at the expense of their insurance carriers. This
luxury certainly does not exist in Canada or Great Britain.
Example a.) Abuse of access to care
Not uncommonly, a skeptical media-educated patient will see two or three physicians for the
same viral illness out of a compulsive need for a second or even third opinion.
Example b.) Over utilization of expensive sub-specialist
A common occurrence is the patient who refers him- or herself to a urologist for a simple
urinary tract infection or to an Ear- Nose and Throat specialist for an ear wax buildup. The
resulting fees to insurance carriers are many times more than would have been charged by a
primary care physician.
Example c.) Over utilization of expensive medical technology by specialists and subspecialists
A man with chest pain refers himself to his uncle's Cardiologist and has multiple expensive
cardiac tests performed, only to find out that his problem is not heart related. He is the refers
to a Gastroenterologist who also performs multiple expensive tests in order to diagnose "gastritis
with esophageal reflux" commonly known as "heartburn". Had this individual first consulted his
primary care physician this diagnosis might well have been made without any expensive tests
at all.
Example d.) Over utilization of expensive technology by litigation fearing physicians
A physician bends to the pressure of a thirty year old , over stressed office worker requesting
a CT scan of her head for what the physicians believes to be tension headaches. The patient ins
worried that she may have a brain tumor like the woman she read about in a grocery store
tabloid. If the physician declined to order the CT scan, the patient could then a.) seek and find
another physician who would order the test, and b.) successfully sue the first physician at any
time in the future if she did develop a brain tumor.
Example e.) Outright abuse by public aid recipients of emergency services because they are
more accessible than a primary care physician.
Any inner city OB-GYN nurse can testify to the frequency with which a pregnant medicaid
patient will pretend to be in labor or exaggerate pregnancy related symptoms to obtain a free
ride via ambulance for treatment of a minor and perhaps unrelated problem.
�Recommendation #1
la.) Incorporate into the reforms a " Gatekeeper" model of health care access in which the
primary care physician, chosen by the patient, provides basic health care needs, orders or
approves utilization of ancillary medical services and authorizes referrals to health care
specialists. Failure to obtain such approval or authorization except in true emergencies or other
extenuating circumstances would result in denial of payment. Many HMOs already use such a
model effectively with out undue inconvenience to the patient or the physician.
lb.) Ease the risk of litigation on physicians who resist ordering expensive tests or procedures
when the likelihood of benefit to the patient is remote. For example when there is less than
0.05% chance of finding an abnormality in a given clinical setting.
Problem #2 Extravagant over utilization of health care resources on patients who least
benefit in terms of quality of life or prolongation of meaningful life.
I recognize the inherent medical- ethical problems when discussing medically futile and terminal
health care issues, but remember, I am the one in the fox-hole, and from where I sit, physicians
and families are in need of strong government guidance. This is a time when all American
factions are united in a plea for health care reform. There is a growing understanding and
acceptance of the fact that America will go bankrupt if we continue to..."do everything, for
everyone, all of the time". (It is obvious that terminal intensive care is one of the most
expensive drains on health care resources.)
Example:
A patient of mine , 79 year old Mrs. W., spent two months in the I.C.U., receiving thousands
of dollars of health care each day. As it became increasingly obvious that her condition was
almost certainly terminal, her husband began to plead with me to "pull the plug" and "end her
suffering". Sympathizing with the husband I consulted the pulmonologist, the ICU attending
physician, several trusted colleagues and the hospital legal advisor. All agreed that to comply
with the husbands request would lay us wide open for malpractice litigation via a different family
member or even the state of Missouri. For four painful weeks, we all helplessly watched tens
of thousands of Medicare dollars and the patient's remaining financial resources drained.
Finally, she died mercifully when her heart failed.
�Recommendation #2
Incorporate into the reform a means for objectively weighing the cost of a health resource
against it's true value to the individual recipient. In addition provide protections against
malpractice litigation when the physicians, family members, and medical-ethics committee agree
on the futility of introducing or continuing expensive medical care.
One manner of achieving the former recommendation is through a well-respected federal
medical-ethics committee, whose members might include the Surgeon General, physicians,
nurses, social workers, insurance agency executives, medical ethicists, social psychologists,
lawyers, politicians, etc.
Perhaps guidelines could be set up to outline medical care extravagances that could not be
justified in the current economic climate and therefore not eligible for insurance coverage. An
example might be to establish exclusionary criteria for ICU admissions, with a system to make
exceptions in unusual cases. Again, I am aware of the red flags before your eyes and the
inevitable oppositions. Yet, I implore you to at least plant the seed of a National Medical
Ethics Committee, the contributions and boldness of which might grow with the public's
awareness of the need to redistribute our precious health care resources away from futile and
inhumane last efforts-
Problem #3 The shortage of Primary Care Physicians
Primary care physicians are the key to a cost-controlled health care delivery system, as any
HMO model can substantiate. More and more Primary Care Physicians are retiring each year,
while fewer, and fewer medical students are choosing primary care medicine. The reason is
obvious, medical students for decades have been attracted to the specialty and sub-specialty
medical fields by higher salaries, urban or suburban life styles, academic affiliations, and
inflated social prestige.
Example:
During my years as assistant clinical professor at St,Louis University Medical School, many of
the medical students I taught revealed a strong interest in primary care medicine, but ultimately
dismissed this consideration as incompatible with repayment of their crushing medical education
debts.
�Recommendation #3
Invest in the recruitment, training, and continuing practice of primary health care providers as
key players in the most cost efficient health care system. These providers could be Family
Practice physicians, Internists, Pediatricians, Physician Assistants, Nurse Practitioners, and even
OB-GYN physicians with better training in preventative medicine. This investment should come
in the form of economic and social incentives.
Economic incentives should include assistance in educational debt repayment and improving
reimbursement for primary care services relative to reimbursement for specialty or sub-specialty
services. Another incentive and major morale booster would be to take steps to reduce primary
care providers risk of falling victim to unjust and financially crippling malpractice claims.
Social incentives might include government assistance in rebuilding the damaged trust and
respect society once held towards physicians. It will serve America's health care future best
to foster a positive relationship between health care professionals and patients, resulting in
increased incentive to pursue primary health care as a career, less litigation, lower malpractice
costs, and better patient compliance within a managed health care delivery system.
CONCLUSION
The health care system I optimistically envision is one where no one is denied timely access to
care, where a gatekeeper primary care physician provides quality, cost effective care in the
bonds of a mutually respectful patient physician relationship, yet guards against abuse and over
utilization of health care resources. I further envision a system in which the burden of deciding
to withhold or withdraw certain health care resources when justified, can be shouldered not just
by the physician and family but by a carefully selected National Medical Ethics Committee.
Finally, I envision that this could be, and must be accomplished, with far less cost due to
malpractice litigation.
lessee L. Crane M.D.
Board Certified: Family Practice
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
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�PULMONARY CONSULTANTS, INCORPORATE
11133 DUNN ROAD
ST. LOUIS, MO. 63136
(314) .355-2.300
Fax (JM) 653-4My
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February 1, 1993
Mrs. H i l l a r y C l i n t o n
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20510
Dear Mrs. C l i n t o n :
I want t o commend you on your r e c e n t appointment as t h e
d i r e c t o r i n charge o f r e v x s i o n o f t h e h e a l t h care p o l i c y
i n t h e U n i t e d S t a t e s . I know t h i s w i l l be a t a s k you w i l l
a t t a c k w i t h g r e a t v i g o r and enthusiasm. I would l i k e t o
h e l p you i n t h i s t a s k i n any way p o s s i b l e .
As a p h y s i c i a n who p r a c t i c e s pulmonary medicine and
c r i t i c a l care medicine, I am f a c e d w i t h many d i f f i c u l t
i s s u e s t h r o u g h o u t t h e day and t h r o u g h o u t t h e y e a r . I
would welcome your attendance a t any t i m e i n my p r a c t i c e
so t h a t I c o u l d t a k e you on rounds and demonstrate t o you
the d i f f i c u l t i e s encountered by p r a c t i c i n g p h y s i c i a n s . I
would pay f o r your way here and pay f o r your way back t o
Washington, D.C. so t h a t you c o u l d observe p r a c t i c e as i t
happens a t no expense t o t h e t a x p a y e r s , o t h e r t h a n me. I
t h i n k t h a t you need t o be i n f o r m e d w i t h r e g a r d t o h e a l t h
c a r e , and I don't know t h a t as a lawyer you have any o f
t h i s i n f o r m a t i o n . I would l i k e t o h e l p you o b t a i n t h i s
important perspective.
S i n c e r e l y and r e s p e c t f u l l y ,
Mark S. Wald, M.D., FCCP
MSW/ar
�Mrs. H i l l a r y Rodham C l i n t o n
C o o r d i n a t o r f o r H e a l t h Care Reform
The White House
1600 Pennsylvania Avenue
Washington, D.C.20500
Dear Mrs.
Clinton:
As I f l y home from t h e I n a u g u r a l f e s t i v i t i e s , which I l o v e d , I read
t h a t you are t o be i n charge o f h e a l t h care r e f o r m . I am d e l i g h t e d
and r e a s s u r e d t h a t such an i n t e l l i g e n t , conunitted and e n e r g e t i c
person as you w i l l be w o r k i n g on t h i s t h o r n y problem.
I am a p e d i a t r i c i a n i n t h e C i t y o f St. L o u i s . I have a f a s c i n a t i n g
p r a c t i c e which i s h a l f u n i v e r s i t y p r o f e s s o r t y p e s and h a l f w o r k i n g
urban poor, t h e c h i l d r e n o f p o s t a l employees, bus
drivers,
t e a c h e r s a i d e s , e t c . I n t h e p a s t I have been a g e n e r a l p r a c t i t i o n e r
i n t h e I n d i a n H e a l t h S e r v i c e i n South Dakota a t t h e t i m e o f Wounded
Knee. I have been a p a r t - t i m e ER d o c t o r , a t e a c h e r o f b o t h
p e d i a t r i c and f a m i l y p r a c t i c e house s t a f f i n two urban t e a c h i n g
programs which have s i n c e f o l d e d , i n p r i v a t e p r a c t i c e i n t h e suburbs
f o r 7 years and c u r r e n t l y i n t h e same group p r a c t i c e b u t i n an
urban l o c a t i o n f o r 5 y e a r s . I ' d l i k e t o share a few o f my t h o u g h t s
w i t h you about these l a s t 20 years o f p r a c t i c e i n these v a r i e d
locations.
1
1. H e a l t h c a r e i s a r e l i g i o n i n t h e suburbs. People w i l l b r i n g
t h e i r k i d s i n b e f o r e a t r i p t o London t o be sure t h e y a r e w e l l . T h e y
would c a l l me on t h e phone when t h e r e was a s a l e on a t t h e
department s t o r e t o ask me what k i n d o f a m a t t r e s s t o buy. P a r t l y
t h i s i s because t h e r e are no extended f a m i l i e s o r n e i g h b o r s a t home
w i t h whom an i s o l a t e d mother can d i s c u s s such t h i n g s b u t i t i s a l s o
t h a t people b e l i e v e i n p r o f e s s i o n a l a d v i c e t o t o o g r e a t an e x t e n t .
O v e r u t i l i z a t i o n was rampant i n t h e HMO p a t i e n t s w i t h no copay and
was v e r y d e m o r a l i z i n g t o me. Each day 1 would ask m y s e l f i f I had
done a n y t h i n g i m p o r t a n t and t h e answer was u s u a l l y no.
2. I n t h e c i t y where food and s h e l t e r are immediate concerns,
h e a l t h p r o v i d e r s are u n d e r u t i l i z e d by p a r e n t s . Parents a r e g r a t e f u l
and s u r p r i s e d t h a t anyone would be i n t e r e s t e d i n h e l p i n g them w i t h
p a r e n t i n g , n u t r i t i o n , and school f a i l u r e problems. By d e f a u l t ,
p e d i a t r i c i a n s have begun t o spend a s i g n i f i c a n t amount o f t i m e on
school problems - because no one e l s e i s . You have p r o b a b l y read
Savage I n e q u a l i t i e s by Jonathan Kozol. I t i s n o t an e x a g g e r a t i o n .
3. An immoral and d i s p r o p o r t i o n a t e number o f h e a l t h c a r e d o l l a r s
are spent i n t h e l a s t . f e w months o f l i f e f o r v e r y e l d e r l y people
and o t h e r s w i t h f a t a l diagnoses. R e c e n t l y a t a p a r t y w i t h lawyers
and j u d g e s , I asked whether we s h o u l d spend $80,000 f o r a premie
�i n an ICU or $80,000 f o r an 80 year o l d f o r a heart t r a n s p l a n t .
Everyone of them chose the 80 year o l d ! The reason given was t h a t
more people would miss the 80 year o l d and t h a t few people would
be attached t o a new born baby. To me t h i s i s i n c r e d i b l e . C h i l d r e n
are our f u t u r e . But as you know b e t t e r than most people, c h i l d r e n
are a disenfranchised constituency. Retired people have more time
and resources t o p a r t i c i p a t e i n the p o l i t i c a l process than the
parents of young c h i l d r e n do. I n c r e d i b l y these r e t i r e d people seem
t o be t o t a l l y self-absorbed and not w i l l i n g t o give the next
generation a f i g h t i n g chance.
4. Big money i s wasted everyday i n h o s p i t a l s .
What's good f o r
h o s p i t a l s i s not necessarily what i s good f o r physicians and
p a t i e n t s . Hospitals w i t h t h e i r b i g budgets and l o b b y i s t s would have
you believe t h a t they represent the " i n d u s t r y " .
5. A l l the HMOs and PPOs have not decreased h e a l t h care costs. They
have merely r e d i s t r i b i t e d the health care d o l l a r t o undereducated
managers who are not f a m i l i a r w i t h medical terminology or d e c i s i o n making. The HMO requires t h a t I , not an agent of mine, c a l l t h i s
person w i t h a high school education and j u s t i f y an admission or a
continued stay. Frequently the c l e r k asks me t o s p e l l the diagnos i s , asks me what i t means and then says her r u l e s deny the added
stay . The h o s p i t a l i s crawling w i t h u t i l i z a t i o n review nurses who
pore over charts a l l day and put s t i c k e r s on them deciding how many
days w i l l be paid f o r . Then i t i s my j o b t o c a l l and beg f o r more
days. The system seems t o be t o shortchange a l l p a t i e n t s on days
hoping t h a t the physician w i l l be too busy or discouraged t o c a l l
and f i g h t f o r more days. A l l of t h i s takes
hours and hours
everyday, nonetpf which i s compensated. I don't mind missing supper
w i t h my f a m i l y occasionally f o r a s i c k p a t i e n t but I r o u t i n e l y miss
dinner 4 or 5 days a week because of paperwork nonsense.
6. Consider when you set up a system of managed competition t h a t
i f the p a t i e n t changes every year t o a d i f f e r e n t plan,and I don't
take the new p l a n , t h e o r e t i c a l l y , t h e p a t i e n t could have a new doctor
every year. This i s demoralizing t o me a f t e r I have invested a
f a i r amount of time a t the beginning t o know a p a t i e n t ' s h i s t o r y
and begin t o work on whatever problem they might have and i t i s
discouraging t o the p a t i e n t . They, however, must change e i t h e r
because the o l d plan i s no longer o f f e r e d or because i t now costs
too much. A l l of t h i s makes medicine more of a business and less
of a profession , something I don't want t o see and I don't t h i n k
the consumer wants t o see t h i s e i t h e r .
7. I f I win the l o t t e r y I w i l l take Medicaid. U n t i l then i t i s not
possible t o provide anything l i k e q u a l i t y care and cover my
overhead. Both because the fees paid are low but also because
reimbursement i s slow and claims are returned again and again f o r
irregularities.
�8.
Keep in mind that medicine could become l i k e teaching - a
poorly paid "women's " profession. - Or a two-tiered system as in
Russia where the women do the poorly paid primary care and the men
do the highly paid prestige jobs such as cardiac surgery. Partly
t h i s i s a result of biology. Women are unable or unwilling to put
in 12 years of t h e i r reproductive years to become a cardiac
surgeon. But partly i t i s a continuation of a pattern of sex
discrimination at a l l the medical schools.
9. Doctors are human. They have families and emotions and needs.
This giving a l l day can suck one dry. In a time when physicians
are held in l e s s and l e s s esteem, they become l i k e factory workersclocking in and clocking out- because the intangible rewards are
fewer. Again t h i s i s analagous to teaching. As teachers have less
and less autonomy and decision making they have given up, l e t the
administrators run the schools, and j u s t put in t h e i r time. I have
worked with the same physician group for 13 years. At the beginning
we were a salaried HMO. Now we are a fee-for-service private group
practice which accepts many HMOs and PPOs.There i s no doubt in my
mind that the majority of the physicians provide more service and
work more hours when their compensation i s d i r e c t l y related to
their effort. Patient s a t i s f a c t i o n i s higher when physician income
depends on s a t i s f i e d patients and not a captive audience.
10. S t i l l no one has told the American people that they can't have
i t a l l - second and third heart transplants and basic care for poor
people. I'd choose the l a t t e r but most of the voters want to be
able to have extraordinary measures applied to them as well as
everyone else. Physicians cannot be the gatekeepers for these
u t i l i z a t i o n decisions. We must always be patient advocates.lt would
be far better to have the elected representatives of the people
make some hard ethical choices about where scarce d o l l l a r s w i l l do
the most good. Now insurance companies make the decisions and deny
service to people but they keep the money the services would have
cost to pay a l l their layers of people who harass physicians and
patients, hoping that the paper work requirements w i l l exhaust
either the doctor or the patient and they won't have to pay
again.An i n t e l l i g e n t allocation of resources w i l l s h i f t dollars to
primary care and away from high tech and high t i c k e t items. This
w i l l solve the.;maldistribution of physicians - moving them out of
subspecialties and into primary care i f that i s where the money i s .
I could go
paperwork.
on
but
I haven't got
the time. Gotta go
do more
I wish you well and so do a l l of my friends. You and the President
are fine and courageous people- so i n t e l l i g e n t that powerful people
are threatened and w i l l need to c r i t i c i z e you to make themselves
look l e s s stupid. Don't l e t i t get to you.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
,
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���DAVID A. JASPER, M.D., F.A.C.P.
5-01-93
INTERNAL MEDICINE
7710 Mercy Road, Suite 406
Omaha, Nebraska 68124 •
Telephone 397-1821
Hilary Clinton
H e a l t h Care Task Force
White House
Washington, D.C. 20500
Dear Mrs. C l i n t o n :
As a busy p r a c t i c i n g p h y s i c i a n , I b e l i e v e I am i n a good spot t o
h e l p w i t h some suggestions t h a t a r e v e r y p r a c t i c a l and v e r y easy
f o r s t a f f people t o d e l i n e a t e as c o s t i n e f f e c t i v e .
One o f t h e most f l a g r a n t o v e r - c o s t s t h a t I've have seen i n r e c e n t
months, (and t h e r e a r e many, which I can share w i t h you l a t e r , i f
i n t e r e s t e d ) , i s t h e f a c t t h a t when a Medicare p a t i e n t r e q u i r e s IV
a n t i b i o t i c s f o l l o w i n g a h o s p i t a l s i t u a t i o n , f o r i n s t a n c e , l i k e an
i n f e c t e d h i p j o i n t o r knee j o i n t a f t e r s u r g e r y t h e y r e q u i r e 6
weeks o f IV a n t i b i o t i c t h e r a p y and Medicare w i l l n o t care f o r t h e
I V s and a n t i b i o t i c s t o be done a t home b u t w i l l o n l y pay f o r i t
i n a n u r s i n g home s i t u a t i o n .
1
At c e r t a i n times t h i s i s a p p r o p r i a t e , b u t a l o t o f t i m e s , w i t h a
d e d i c a t e d p h y s i c i a n , a d e d i c a t e d f a m i l y and d e d i c a t e d home h e a l t h
care s t a f f e r s , t h i s can be accomplished a t home.
I r e c e n t l y had a v e r y n i c e gentleman who t h i s happened t o , and:
1.
I thought he c o u l d go home, 2. He wanted t o go home, 3. He
was ready, m e d i c a l l y , t o go home,
4.
H i s f a m i l y wanted him
home, 5. They c o u l d n ' t a f f o r d t h e a n t i b i o t i c s i f no one p a i d f o r
it,
6. W i t h a g r e a t deal o f t i m e and e f f o r t we f i n a l l y worked
out a s o l u t i o n w i t h a secondary p r e s c r i p t i o n c a r d t h a t he had t o
p r o v i d e t h e IV m e d i c a t i o n a t home.
He was t h e r e f o r e d i s m i s s e d
home, and I f i g u r e d up t h e d a i l y
l o d g i n g charges ( l o d g i n g alone, t h a t i s ) ,
f o r him t o g e t h i s
a n t i b i o t i c t h e r a p y was $6,400, i f he went t o a n u r s i n g home.
I t i s i n t e r e s t i n g t o note when p a t i e n t s a r e m o t i v a t e d and t h e y
have an a t t e n t i v e f a m i l y and a p h y s i c i a n t o m o n i t o r those t h i n g s
c l o s e l y , t h e y can be t a k e n care o f a t home f r e q u e n t l y , as was
done i n t h i s case and t h e home h e a l t h care agency o n l y made 3
v i s i t s because t h e f a m i l y was so a l e r t and on t o p o f t h i n g s , t h e y
knew how t o hang t h e IV, how t o c l e a n t h e IV s i t e o f t u b i n g f o r
t h e a n t i b i o t i c s to^be connected t o , and we saved a l o t o f c o s t ,
even on t h e home h e a l t h c a r e . A f t e r 3 v i s i t s h i s o n l y c o s t was
t h e a n t i b i o t i c which was u l t i m a t e l y cheaper as an o u t p a t i e n t than
i t would have been as an i n p a t i e n t .
T h i s p r o b a b l y added another
$800 as he had a 6-week course o f a n t i b i o t i c s t h e r a p y , e q u a l i n g a
t o t a l c o s t savings o f $7,200.
�pg. 2 of 2
T h i s i s from one i n s t a n c e i n one l i t t l e
h o s p i t a l and one
p h y s i c i a n i n Omaha, Nebraska, and when I asked t h e nurses on t h e
orthopedic f l o o r
i f t h i s happens f r e q u e n t l y , t h e y s a i d t h e y have
at
l e a s t two p a t i e n t s a week t h a t have t o go t o t h e n u r s i n g home
on
I V ' s and t h e y e s t i m a t e d about 60-75% o f those p a t i e n t s
a c t u a l l y c o u l d go home i f t h e y c o u l d g e t t h e i r m e d i c a t i o n s p a i d
for.
I b e l i e v e t h i s i s a c l a s s i c example o f a v e r y
cost-ineffective
r u l e t h a t c e r t a i n l y s h o u l d be looked a t and c o u l d be e a s i l y
t r a c k e d by d i a g n o s t i c codes from a p a t i e n t i n a h o s p i t a l w i t h an
i n f e c t e d j o i n t t h a t i s discharged
somewhere on IV a n t i b i o t i c s .
I f t h e y went t o a n u r s i n g home, I suspect t h e c o s t would be
s t a g g e r i n g t h r o u g h o u t t h e c o u n t r y i n one year alone.
Thank you f o r l i s t e n i n g , and i f I can be o f
any o t h e r way, please l e t us know.
Respectfully,
David A./Jasper, M.D.
DJ:dvf
any h e l p t o you i n
�DAVID A. JASPER, M.D., F.A.C.P.
INTERNAL MEDICINE
7710 Mercy Road, Suite 406
Omaha, Nebraska 68124
Telephone 397-1821
�FGItDfTlflD DlflGnOSTIC CLIIIIC
SUNRISE
3196
MEDICAL
MARYLAND
CENTER
PARKWAY
LflS VEGAS. flEVADfl 89109
TELEPHONE
702 •
732-2042
February 25, 1993
Mrs. H i l a r y Rodham-Clinton
White House
1600 Pennsylvania Avenue
Washington, DC
Dear Mrs. Rodham-Clinton:
I am a 1941 graduate of the U n i v e r s i t y of Arkansas School of
Medicine.
E a r l y on I became i n t e r e s t e d i n the q u a l i t y and c o s t
of h e a l t h care. I applaud the P r e s i d e n t ' s e f f o r t s
to provide
a f f o r d a b l e , h i g h standard medical care f o r a l l Americans.
The
skyrocketing cost
of medical
care must
be c u r t a i l e d as
e x p e d i e n t l y as p o s s i b l e .
I n e v a l u a t i n g t h i s problem. B u r e a u c r a t i c s t a t i s t i c s i n themselves w i l l not provide a p r a c t i c a l
solution.
The p r a c t i c i n g
p h y s i c i a n , as w e l l as the academician, should be c o n s u l t e d i n
these e f f o r t s .
Band-aids w i l l n o t cure t h i s problem.
The e n t i r e
system, p u b l i c and p r i v a t e , r e q u i r e s d r a s t i c r e v i s i o n .
Some of my t h o u g h t s on t h e g e n e r a l s u b j e c t of H e a l t h Care
are enclosed f o r your p e r u s a l .
I t i s r e a l i s t i c a l l y conceivable
to design a p i l o t study which would r e f l e c t the P r e s i d e n t ' s goals
very q u i c k l y .
I t may n o t even r e q u i r e Congressional a p p r o v a l . I
am convinced t h a t the p i l o t p l a n w i l l demonstrate s u b s t a n t i a l
"real dollar"
savings w i t h o u t compromising
the d e l i v e r y of
e x c e l l e n t and expanded medical care s e r v i c e s .
I am a v a i l a b l e
f o r consultation
regarding t h i s o v e r a l l
problem, a t your convenience.
Good l u c k t o you and the P r e s i d e n t
i n your e f f o r t s ,
3 iud ec e1y,
Louis L- Friedman,
enclosures
MD
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. resume
SUBJECT/TITLE
DATE
09/23/1976
DOB (Partial); POB (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [I
2006-0885-F
jni781
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1 2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
*
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financial informHtion 100(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
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P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
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b(3) Release would violate a Federal statute 1(b)(3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
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b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�LOUIS LAHRENCi: L'RIKDMAN, M . U .
SepLe.niher 2 3 ,
1976
HISTORICAL SKETCH:
Bora:
P6/(b)(6)
oofi
Graduated, C i t y College, New York., 1934, degree bachelor of
Science, i n Soci.al Science, l a t e r took s p e c i a l postgraduate work a t Columbia U n i v e r s i t y
Graduated, U n i v e r s i t y o f Arkansas, 1941, degree Bachelor of
Science i n Medicine and Doctor oi: Medicine
I n t e r n e d , Touro I n C :i. rma ry , New Orleans, Louisiana
Residency, I n t e r n a l Medicine and Tuberculos i.s. C h a r i t y H o s p i t a l
New Or Leans, Loui siana
I.I.
C I U . T AND PAST MEMBERSHIP IN THE FOLLOWING SCIENTIFIC ORGANIZATIONS:
UU'N
American Medical A s s o c i a t i o n
J e f f e r s o n County (Alabama) Medical Society
Alabama State Medical Society
Arkansas Medical Society
C a l i f o r n i a Medical A s s o c i a t i o n
Louisiana Medical A s s o c i a t i o n
American Trudeau Society
American College o f ('best Physicians (Fellow)
Southern Chapter, American College of Chest Physicians
Fellow o f American Medical A s s o c i a t i o n
Alabama Chapter Sigma XI
Alabama Academy o f Science
Southern Medical A s s o c i a t i o n
American A s s o c i a t i o n f o r the Advancement of Science
United States P u b l i c Health A s s o c i a t i o n
Common Cold Foundation, Medical Advisory Committee
World Medical A s s o c i a t i o n
I n d u s t r i a l Medical A s s o c i a t i o n
Honorary Member Mexican Society f o r Study of T u b e r c u l o s i s
Honorary Member o f the Tuberculosis Society of Cordoba, Argentina
Honorary Member of the Peruvian T u b e r c u l o s i s Society
N a t i o n a l R e h a b i l l t a t ion A s s o c i a t i o n
Society o f Medical Jurisprudence
Former Member of the Board o f D i r e c t o r s of the Medical Advisory
Council of the N a t i o n a l Tuberculosis A s s o c i a t i o n
Past Chairman of the Committee f o r Occupational Diseases of
the. Chest, American College of Chest: Physicians
Past Chairman of J o i n t Committee f o r Occupational Diseases o f
the Chest of the I n d u s t r i a l Medical A s s o c i a t i o n , American
College o f Chest Physicians and American Trudeau Society
Nevada Medical A s s o c i a t i o n
Clark County Medical A s s o c i a t i o n
Western I n d u s t r i a l Medical A s s o c i a t i o n
In termoun t a i n Thorac ic Society
American College o f Physicians
�Louis Lawrence Friedman, M.D.
III
I I
September 23, 1977
MISCELLANEOUS
Past Consultant f o r Diseases of the Chest, Veterans Administration
Founder, Council on Research, American College of Chest Physicians
IV
UNIVERSITY/COLLEGE ACTIVITIES
Member of University Development Committee, University of
Arkansas
Board of Trustees, University of Arkansas Alumni Association
Board of Trustees, U n i v e r s i t y of Arkansas Endowment and Trust
Fund
President, University of Arkansas, Endowment and Trust Fund
Formerly I n s t r u c t o r i n Medicine, Louisiana State U n i v e r s i t y
School of Medicine—Assistant Professor of Medicine and
Assistant t o the Dean, Medical College of Alabama
Director of House S t a f f , University Hospital
V
CERTIFICATION
American Board of I n t e r n a l Medicine*
VI
HOSPITAL STAFF MEMBERSHIP
Sunrise Hospital, Las Vegas, Nevada
Desert Springs Hospital, Las Vegas, Nevada
Southern Nevada Memorial Hospital, Las Vegas, Nevada
Valley Hospital, Las Vegas, Nevada
Women's Hospital, Las Vegas, Nevada
R e c e r t i f i e d October, 1977
�l l i i L I O G R A P H Y
LOUIS L . FRIEDMAN, M.D.
TEXTBOOKS
1.
Chapter on "Diseases o f t h e R e s p i r a t o r y T r a c t " : THERAPEUTICS IN
INTERNAL MEDICINE: F r a n k l i n A. Kyser, M.D.: ; Thomas Nelson and
Sons, P u b l i s h e r s , New York, 1951, F i r s t E d i t i o n .
Revised c h a p t e r on "Diseases o f t h e R e s p i r a t o r y T r a c t " :
Franklin
A. Kyser, M.D/:
Paul B. Hoeber, I n c . , P u b l i s h e r s , New York, 1953,
Second E d i t i o n .
2.
Chapter on "Diseases o f the P l e u r a " : NON-TUBERCULOUS DISEASES OF
THE CHEST: E d i t o r , Andrew L. B a n y a i , M.D.:
Charles C. Thomas,
P u b l i s h e r s , I l l i n o i s , 1954.
3.
Chapter on "Diseases o f t h e R e s p i r a t o r y T r a c t " : TERAPEUTICIA CLINICA:
E d i t o r , Dr. A r t u r o R. Ros: C u l t u r a l , S.A., P u b l i s h e r s , La Habana,
Cuba, 1954.
4.
Chapter on "Diseases o f t h e P l e u r a " : BRONCHOPULMONARY DISEASES:
E m i l A. N a c l e r i o , M.D.:
Paul B. Hoeber, I n c . P u b l i s h e r s , New
York, 1957, F i r s t E d i t i o n .
ORIGINAL PAPERS
1.
D a n i e l N. S i l v e r m a n , M.D. and L o u i s L. Friedman, M.D.:
G a s t r i c F i b r o s i s i n v o l v i n g the Duodenum: G a s t r o e n t e r o l o g y , 2:
186: (March) 1944
2.
John J . S i g n o r e l l l , M.D. and L o u i s L. Friedman, M.D.:
P e n i c i l l i n and Heparin i n t h e Treatment of Pneumococcal
M e n i n g i t i s : Southern M e d i c a l J o u r n a l : 38: 776-778:
(December) 1945
3.
L o u i s L. Friedman, M.D. and John J . S i g n o r e l l l , M.D.:
B l a s t o m y c o s i s : A B r i e f Review o f t h e L i t e r a t u r e and a
r e p o r t o f a Case I n v o l v i n g t h e Meninges:
Annals o f I n t e r n a l
M e d i c i n e : 24: 385: (March) 1946
4.
L o u i s L. Friedman, M.D. and James R. Garber, M.D.:
The R e c o g n i t i o n , E v a l u a t i o n and Management o f Heart Disease
i n Pregnancy: J o u r n a l o f the M e d i c a l A s s o c i a t i o n o f t h e
S t a t e o f Alabama: 15: 309: (May) 1946
�II
L o u i s L. Friedman,
5.
L o u i s L. Friedman, M.D.:
The Value of I n f l u e n z a V i r u s Vaccine,
Types A and B: Some L i m i t e d O b s e r v a t i o n s : Southern M e d i c a l
J o u r n a l : 39: 809:
( O c t o b e r ) 1946
6.
L o u i s L. Friedman, M.D. and James R. Garber, M.D.:
The
Problem o f Pregnancy and T u b e r c u l o s i s : I t s Present S t a t u s :
American Review of T u b e r c u l o s i s : 54: 275: (September) 1946
7.
L o u i s L. Friedman, M.D.:
A T u b e r c u l o s i s Teaching Program f o r the
M e d i c a l P r o f e s s i o n : J o u r n a l of t h e A s s o c i a t i o n of American
M e d i c a l Schools: 21: 339:
(November) 1946
8.
L o u i s L. Friedman, M.D.:
The D i a g n o s i s of Pulmonary Disease:
Progress S e c t i o n of t h e American J o u r n a l of t h e M e d i c a l Sciences:
213: 97:
( J a n u a r y ) 1947
9.
L o u i s L. Friedman, M.D. and p.W. Gary Moore, M.D.:
M u l t i p l e Caseous and C y s t i c T u b e r c u l o s i s of the Bones:
J o u r n a l of the Mediccil A s s o c i a t i o n of the S t a t e o f
Alabama: 16: 332:
( A p r i l ) 1947
10.
L o u i s L. Friedman, M.D., L.O. Davenport, M.D. and J.G. Bohorfoush,
M.D.:
E x t r a p l e u r a l Pneumothorax:
R e v i s t a Panamericana:
1:
99:
(October, November and December) 1947
11.
L o u i s L. Friedman, M.D.:
A e r o s o l Therapy of Bronchopulmonary
Diseases: Diseases o f the Chest: 16: 848:
(December) 1949
12.
L o u i s L. Friedman, M.D.:
of the Chest: 15: 306:
13.
L o u i s L. Friedman, M.D.:
A e r o s o l B e n a d r y l i n t h e Treatment o f
B r o n c h i a l Asthma.: Southern M e d i c a l J o u r n a l : 42: 291:
(June) 1949
14.
L o u i s L. Friedman, M.D.:
Treatment o f M i g r a i n e w i t h Cafergone:
The J o u r n a l o f t h e M e d i c a l A s s o c i a t i o n o f the S t a t e o f Alabama:
19: 137:
(November) 1949
15.
L o u i s L. Friedman, M.D.:
Spontaneous Pneumothorax:
The
J o u r n a l of t h e M e d i c a l A s s o c i a t i o n o f the S t a t e o f Alabama:
4:
( J u l y ) 1950
E x t r a p l e u r a l Pneumothorax:
(March) 1949
Diseases
16.
D i s c u s s i o n of a n t h r a c o s i l i c o s i s a t June, 1949, m e e t i n g o f
the American C o l l e g e o f Chest P h y s i c i a n s i n A t l a n t i c C i t y :
Diseases of the Chest: 17: 249:
(March) 1950
17.
L o u i s L. Friedman, M.D.:
Tumors o f the P l e u r a :
the Chest: 17: 756:
(June) 1950
Diseases o f
20:
M.D.
�Ill
Louis L. Friedman,
18.
L o u i s L. Friedman, M.D.:
The Management o f Emphysema:
The J o u r n a l o f the M e d i c a l A s s o c i a t i o n o f the S t a t e of
Alabama: 22: 255:
( A p r i l ) 1953
19.
L o u i s L. Friedman, M.D.,
Hugh H. Haden, J r . , M.D.,
Ernest N.
L e r n e r , M.D.,
George C. Risman, M.D.:
"Gomment on Emotional
Aspects o f R e s p i r a t o r y D i s o r d e r s i n Coal Miners": J o u r n a l
of the American M e d i c a l A s s o c i a t i o n : 156:
1350:
(December)
1954
20.
L o u i s L. Friedman, M.D.:
The D i a g n o s i s of Bronchopulmonary
Disease:
The American J o u r n a l o f Surgery:
89:
141-149:
(January) 1955
21.
M.D.
L o u i s L. Friedman, M.D.:
S i g n i f i c a n t Case of Pneumoconiosis
i n a S o f t - C o a l Worker: A.M.A. A r c h i v e s of I n t e r n a l Medicine:
95: 328-332: ( F e b r u a r y ) 1955
SCIENTIFIC EXHIBITS
1.
E x h i b i t " E x t r a p l e u r a l Pneumothorax" a t Miami, F l o r i d a , meeting
of Southern M e d i c a l A s s o c i a t i o n : October, 1948.
2.
E x h i b i t on A n t h r a c o s i l i c o s i s a t the American M e d i c a l Ass o c i a t i o n Annual Meeting i n A t l a n t i c C i t y : June, 1951.
3.
E x h i b i t on A n t h r a c o s i l i c o s i s a t the Southern M e d i c a l Ass o c i a t i o n i n D a l l a s , Texas: November, 1951.
Second Prize. Award.
4.
E x h i b i t on "Pneumoconiosis o f S o f t - C o a l Workers" a t the
American M e d i c a l A s s o c i a t i o n Annual Meeting i n New York:
June, 1953.
LECTURES
L e c t u r e s on v a r i o u s aspects of chest diseases have been d e l i v e r e d a t
meetings of the American M e d i c a l A s s o c i a t i o n , Mexican S o c i e t y f o r the
study of T u b e r c u l o s i s and S i l i c o s i s . . . a l s o a t m e d i c a l meetings i n
Peru, C h i l e , A r g e n t i n a , B r a z i l , U r u g u a y — - l i k e w i s e , a t v a r i o u s S t a t e
m e d i c a l meetings i n the U n i t e d S t a t e s , l o c a l meetings of o r g a n i z e d
m e d i c a l groups and a t many p o s t g r a d u a t e courses on chest d i s e a s e s .
�July, 1977
COMMENTS ON THE QUALITY AND COST OF MEDICAL CARE
BY
LOUIS L. FRIEDMAN, M.D.
Medicare and other government-supported r e h a b i l i t a t i o n
and health programs are p h i l o s o p h i c a l l y and morally c o r r e c t . These
programs are intended t o provide r e a d i l y available h i g h - q u a l i t y
health services. S p i r a l i n g costs, however, are not only jeopardizing
e x i s t i n g programs, but are also delaying implementation of much
needed expansion of n a t i o n a l health services. Cost of d e l i v e r y must
be c o n t r o l l e d without compromising standards or diminishing the zeal
of health providers. I n accomplishing t h i s objective the emphasis
should be on ready a v a i l a b i l i t y to a l l c i t i z e n s of h i g h - q u a l i t y
health services. Piecemeal remedial measures w i l l not address the
problem. The e n t i r e system must be subjected t o c r i t i c a l unbiased
review before appropriate l e g i s l a t i v e changes may be suggested.
Physicians should accept a cooperative r e s p o n s i b i l i t y i n t h i s e f f o r t .
Certain g l a r i n g abuses and shortcomings, nevertheless, demand u r gent a t t e n t i o n and c o r r e c t i o n .
A sincere e f f o r t to l i m i t h o s p i t a l admissions i s imperative.
Preventative and expanded o u t - p a t i e n t health services should be
encouraged. Hospital admissions f o r any non-acute i l l n e s s or medical
emergency should require p r i o r a u t h o r i z a t i o n . U t i l i z a t i o n and audit
reviews are c o s t l y time-consuming f a i l u r e s which do not e f f e c t i v e l y
l i m i t h o s p i t a l admissions or the length of h o s p i t a l stay.
In-hosp i t a l services should be scrupulously avoided unless absolutely
necessary. A graded p a t i e n t f i n a n c i a l r e s p o n s i b i l i t y schedule would
be very h e l p f u l i n accomplishing t h i s goal. Patient pressure on
the physician f o r h o s p i t a l admission as w e l l as out-patient services
would be e f f e c t i v e l y r e l i e v e d or a t least diminished.
Medications and other therapeutic modalities should be
made a v a i l a b l e to a l l government b e n e f i c i a r i e s as an out-patient
service based on the f i n a n c i a l r e s p o n s i b i l i t y formula. This innovation
w i l l also assist i n preventing unnecessary and avoidable h o s p i t a l i z a t i o n . P r e s c r i p t i o n drugs should be l i m i t e d t o generic terminology
and only those drugs approved by the Food and Drug Administration.
On the surface there appears to be o v e r - u t i l i z a t i o n of
emergency room and c r i t i c a l care u n i t services. New guidelines
are needed. These u n i t s are staffed, densely w i t h the most capable
and e f f i c i e n t personnel a v a i l a b l e . The basic needs of other less
glamorous h o s p i t a l areas are frequently ignored. As a r e s u l t of
�Ill
accepting "Have government health insurance. W i l l t r a v e l . "
as a way of l i f e . Government b e n e f i c i a r i e s should have a l l p e r t i n e n t
medical information stored i n regional computers. The information
should be r e a d i l y a v a i l a b l e to p a r t i c i p a t i n g physicians and h o s p i t a l s .
This w i l l avoid d u p l i c a t i o n of expensive services.
The government should organize a professional malpractice
corporation to cover a l l physicians who render services to government b e n e f i c i a r i e s . This program can be funded by adding a prorated premium c o n t r i b u t i o n to a l l physicians' fees. This would have
the net e f f e c t of decelerating and diminishing the tendency to p r a c t i c e
c o s t l y defensive medicine. Each t e s t , especially the very expensive
diagnostic parametric studies, should be j u s t i f i e d .
Expenditures
above c e r t a i n l e v e l s should require p r i o r a u t h o r i z a t i o n . I t i s
possible f o r the government to watch the d o l l a r while not i n t e r f e r i n g
w i t h good medical p r a c t i c e and standards. The easiest way to reduce
the cost of medical care i s to prevent unnecessary expenditures.
Physicians' Medicare fees should be standardized f o r the
e n t i r e country. The present p r a c t i c e of fee d i f f e r e n t i a l s based
upon r e g i o n a l reasonable usual and customary guidelines contributes
to an over-abundance of physicians i n those areas w i t h high fee
schedules and a consequent paucity of physicians i n other areas
of the country w i t h lower fee schedules.
Hospital-based/geographic
physicians should b i l l patients d i r e c t l y f o r t h e i r services.
�July, 1976
o
A MEDICARE PROPOSAL
PURPOSE
The purpose of the memorandum i s to d i r e c t your a t t e n t i o n to a
serious deficiency i n the o u t - p a t i e n t care of Medicare b e n e f i c i a r i e s
and to propose an u r g e n t l y needed remedial measure.
THE PROBLEM
Non-indigent senior c i t i z e n s are frequently unable to a f f o r d the
p r i c e of prescribed medications.
The dimensions of t h i s problem
have recently increased due to the skyrocketing cost of l i v i n g .
Increasing numbers o f Medicare b e n e f i c i a r i e s are accordingly faced
w i t h the f r u s t r a t i n g decision of deciding between food and other
necessities of l i f e , and o u t - p a t i e n t medications.
Those who suf-
f e r from chronic diseases are more often than not concerned w i t h
t h i s problem.
I n a b i l i t y to purchase prescribed medications i s
not only a serious h e a l t h hazard/menace, but may w e l l be a precursor to avoidable and expensive h o s p i t a l i z a t i o n s .
PROPOSAL
The Medicare law should be amended to provide graded f i n a n c i a l
assistance to p a t i e n t s whose treatment/medication
exceed t h e i r f i n a n c i a l a b i l i t y .
requirements
Regional government medication
dispensing warehouses may also merit consideration.
F i r s t of two pages
�II.
COMMENT
A w e l l conceived and administered Out-Patient treatment program should
not be an added f i n a n c i a l burden to the taxpayer.
On the contrary,
by preventing repeated, expensive h o s p i t a l i z a t i o n s , i t may a c t u a l l y . I n
p r a c t i c e , conserve the taxpayer's d o l l a r .
Louis L. Friedman,
M.D.
�95TH CONGRESS
16T SESSION
H. R. 3146
A BILL
To amend title X V I I I of the Social Security
Act to include outpatient drugs, prescribed
by a physician, among the medical expenses
with respect to which payment may be made
under the voluntary program of supplementary medical insurance benefits for the
aged.
By Mr. DELANET
FEBECAET 7,1977
Referred jointly to the Committees on Ways and Mean*
aud Interstate and Foreign Commerce
�-?£SK?"-H R.
3146
I N THE HOUSE OF liEPBESENTATIVES
FEnnuATtr 7,1077
Mr. DELANET introclncod tlio. following bill; wliic.h was referred jointly to the
Committees on Waj'S and Means and Interstate and Foreign Comincice
i •
f
A BILL
To amend title X V I I I of the Social Security Act to iiiclutle
outpatient drugs, prescribed by a physician, among the
medical expenses with respect to which payment may be
made under the volunlary program of supplementary medical
insurance benefits for the aged.
1
Be il enacted by (he Seitale and House of llepresenla-
2
lives of the United States of America in Congress assembled,
3 That section
1861 (s)
of the Social Security Act is
4 amended—
5
6
7
8
(1) by striking out "and" at the end of paragraph
(8);
(2) by striking out the period at the end of paragraph (9) and inserting in lieu thereof
and";
�2
1
2
3
4
5
(3) by inserting after paragraph (9) the following new paragraph:
"(10) outpatient drugs and biologicals which are
obtainable on the prescription of a physician."; and
(4) by redesignating paragraphs
(10), (11),
6
(12), and (13) as paragraphs (11), (12), (13), and
7
(14), respectively.
8
SEC. 2. (a) Section 1835 (a) of the Social Security Act
9 is amended by adding at the end thereof the following new
10 sentence: "With respect to outpatient drugs and biologicals
U
described in section 1861 (c) (10), the certification require-
12 ments of paragraph (2) (B) shall be satisfied by the phy13 sician's prescription."
14
(b) Section 1861 (m) (5) of such Act is amended hy
15 striking out "(other than drugs and biologicals)" and in16 serting in lieu thereof " (including outpatient drugs and
17 biologicals to the extent provided in regulations) ".
18
(c) Section 1861 (s) (2) of such Act is amended by
19 striking out " (including drugs and biologicals which cannot,
20 as determined in accordance with regulations, be self21 administered) " in subparagraphs (A) and (B) and insert22 ing in lieu thereof "(including outpatient drugs and bio23 logicals)".
24
(d) Section 1861 (t) of such Act is amended—
�3
1
2
(1) by striking out
except for purposes of sub-
section (m) (5) of this section,"; and
3
(2) by striking out "or as are approved" and
4
inserting in lieu thereof "or, in the case of drugs and
5
biologicals furnished by a hospital, as are approved".
6
(e) Section 1864 (a) of such Act is amended by strik-
.7 ing out "paragraphs (10) and (11)" and inserting in lieu
8 thereof "paragraphs (11) and (12)".
9
SEC. 3. This Act shall take effect with respect to ex-
10 penses incurred on or after the first day of the third month
11 following its date of enactment.
�CDR.
OE:
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OTHER
�:ITJS
arthritis scrum, w l i i c h is
related to the non-specific
Jiancing power of the serum,
he globulin f r u c t k m and Umt
ineraia is characteristic of
arthritis.
T h e relationship
ered serum proteins and nonlomena :umIogoiis to collodionIr.iination is well established,
d serum globulin (or more
a reversal of the n l b u m i n io) has been found responsible
•idal gold, T n k a t a - A n i , ceph!ro! and f o n u o l g e l " reactions.
8
PROGRESS
OF
MEDICAL SCIENCE
MEDICINE
VNi>j-.n r u t CMAIIGE or
.HHIN 11. MUSSER. M.U.
7
F11UKF.MSCIII (II- MM'ICMNF.. T I" I.A Nr.
.M:W
8
The occurrence of relatively
tmiiis ftir tlie Group A bemoicoccus in the sera of normal
is a t t r i b u t e d to the f u n c t i o n
uil human nasophuryiijc as a
rvoir for this organism. In
: of rheumatoid a r t h r i t i s , the
icse antibodies appears l o be
i a non-specific manner, by a
jperly of the serum.
This
apparently related to the
r i h r i t i s serimi to agclutinale
of fine collodion particles,
i.
T h e weight of evidence
it the increased a b i l i t y of the
;nts w i t h typical rheiimatoi<]
•t'nritis to agglutinate selected
hemolytic streptococcus of
hie to a non-specific cnbani.T: action of normally present
THE
DISEASE
riioi'F.PHOR
or
IH.IMCIM;
niK.MINrMAM, A I .A IIA M A
( F m n i U i c M c i l i r : i l (.'ollcco of A l n l m u m )
IH'!'.!'-'. the past decade or so umisually
tlK-C'iii.'ir'nj.' progress has been made in
the Hiii.'ical and medical inanapemcnl of
Kcutr and chronie pulmonary disease,
l l i r o u g h an intelligent and prompf utilizatitui of new and pcifecteil therapeutic
Ircliniijiics and measures we arc now able
to olur it favorable prognosis fur survival
F.IKI hope for cure in many pulmonary
disc.ves which wire previously considered
iri'vilably fatal or doomed a patient to
chronic invalidism and eventual death.
I'nwarranted delay, unfortunalely, or
f.ctua] failure t > establish the correct
<
(ini.n'.'si:'- lia\e only too n f l r n d'-Iirivnl
nmny j-.aiieul:- of the benefits of siiecessiul
ttif-rapeui ie inter\ent ion in pulmonary
uimlitions which are amenable to existing
r.nd availaMc remedial me.'LSures. On
CKtirvsion, the most astute clinicians are
unable to solve some of the more difficult
(iingiiostic pmhlcir.s even after careful
tn'.l prolonged con petcnt study.
'J'his
jiltiiititin is to be exjieeted and excused,
but theie. i? no aiiology for ignorance or
failure to utilize all existing and available
(linic.il and laboratory diagnostic aids in
fondiictini: an investigation of a pulmor-My di-'.ase jiroeess. I t is the purpose of
tuis inanir-cript to catalogue .and discuss
Pel.. ISt,
id Mel.. 31, KM. UKlCi.
IK.:.. 21, JS7,
DIAGNOSIS OP' PULMONARY
AKMHTAST
i
MEL..
r N I V r n S I T T o r I.OUIHIANA
i.oeisiANA
J5v Lot is L. I'nir.nM.^N, M . D .
!-.^itnl. r i i i l : i ' \ < : l i > ! u : i , u n ' l t T f i Clival
M - ' . i i i . i i ! C.ill'.T-:.
O u r t l i . n i l : n urn
-•.•iirnTat i o n urirl t o M r s . C h : u l t > t i n
L r .i\L'r?ity nf I V l i n p y l v - ' i r i i a . i i u f l ' T
'I'hf.' M:-'.'. cif Uit: I i i ' j i l i i i r . i f>i tlni
r.'i'j.
OE. H. F..: A«. J.
DIII.LANK,
um.
'•V.I.
I ! . : .1 C l i i . . I n v e s t . . 2 2 ,
VMX
a.-.! C l i n . M v d . , 2 1 , I'.'.r.. I'.l'.'.t..
Ir.i). Sei., 2 1 2 , 713. I f lO.
.(;.
»c.L. 213. NO. 1 -JA.vcAHr. 11M7
. 1537.
'.if':•.¥•"
briefly (hose clinical and laboratory procedures which, if applied intelligently, will
help establish aceurately a m i w i t h o u t
undue delay the correct diagnosis in conditions involving the lungs. N o real eff o r t will be made t o evaluate the relative
importance of the various procedures mentioned below, as i t is f e l t t h a t the real
value of each depends upon its timely
utilization and correct interpretation in
the light of all other available facts in
each individual case.
I . History ami P h j a i c a l Examination.
A. ROUTINK JIlSTOUY.
(1) chief «UUp l n i n l ; ('.'.) history of present illness; (3)
system review; (•}) past history; (5) f a m i l y
history; (fi) marital h i s t o r y ; (7) social
history.
Logical investigation of each
case should begin w i t h a brief clear stnteinent of the patient's chief complaint f o l lowed by a detailed and nccuiatc history
obtained i n a friendly a n d leisurely m a n ner in the scfjuenee outlined above. T h e
final recorded story of the illness should
be an integrated simple word picture of
the information supplied spontaneously
by the patient to which has been added
the examiner's objective obfc.rvnlions.
F.aeh syinptom r c o n i i t s careful cvnhintion, but the (liderentiaJ characteristics of
�tliose wliicli nrc cspcciiilly irforabk' to tlie
]uiif.'S deserve painstakiiij; study mif] ccrrelated interpretation.
I'art.ieiilar emphasis should he placed (in such symptoms
and observations its cough, sputum, hemoptysis, dyspnea, oilhopnca, wheezing,
cyanosis, pain in the chest, hoarseness,
fever, chills, loss of weight., nature of ousel
and progress of the illness, Ke.iisonal, d i urnal, climatic and geographic variations,
relation to previous illness, and method
of obtaining relief. Any or all of these
symptoms and observations when present
rcphre careful quantitative and (pialitalive evaluation (if their characteristics so
that to each may be assigned its r i g h t f u l
signilicance in the over-all clinical picture.
I
I
Mi
1 »
For csample. the symploni cough, unless
analyzed carefully and its special characteristics assessed properly, will have no
significant value in helping to establish a
correct diagnosis. On the other hand, if
the differential characteristics of each
symptom and observation are evaluated
with diligence, the eoriect diagnosis is
suspected or established in many instances
while the integrated history of the present
illness is being recorded. The history of
the (.'resent illness should not be recorded
in final form until the physician has conducted a detailed system review.
This
procedure aflords an opportunity for the
examiner to as.k questions which may u n earlh additional pertinent facts for i n corporation in the history of the present
illness, or to recinpluisizc the true sign ficaucc of previously obtained information. The patient's negative or n f i i i m a tive reply to a simple routine tpiestion in
the system review, which on the surface
seems entirely unrelated to the respiratory
oigaus, may f i c p i e n t l y supply the missing
link in a diflieult diagnostic problem.
All too freouently (he existence of acute
or chronic pulmonary disease masqin'iades
behind a curtain of such bizarre symplonintology that even the. most cr.pei i c o ' c d
examiner is often misled and eomplctcly
ii-norant of the true nature of the dif.r-a.'e
after the history of the present illness and
svsteui review have been carefully ob-
:/-'v^.^:.i; :-H^u
:
tained. I n these instances the true m i t u r
of the disease process may be clarified
suspected while obtaining the past history
of the piiticnt. J'ubnomiry tuberculosis
l>ronchiectn.sis, and other chronie pulmoa.
ary diseases such its fungus infections I I I ;
be suggested by a past history of recurrent
pleurisy, f n y p i e n t colds and influenza, re.
current and frequent pneumonia w i l l j
atypical courses, periodic loss of weight
and energy w i t h o u t obvious reasons, and
recurrent bouts of fever and night sweat*
of undetermined origin. A recent histoty
of an operative procedure such as a ton.
sillect.omy or tooth extraction, or any
localized or generalized infection of the
mouth, tonsils, nasal and oral p h a r y m
may focus attention on the possibility of
a lung abscess, while, a history of innebic
dysentery in the past may actually suggest
the etiologie agent responsible for the
pulmonary lesion. I ' u h u o n a i y embolisni,
infarction and metastatic abscesses may
be suspected if the examiner obtains «
hislnry of jihlcholhrombosis, thrombophlebitis, recent f r a c l u i ' ' , or severe localized or generalized systemic infection.
The hislovy of a childhood illness complicated in its convalescent stage by pneumonia or a prolonged cough should invite
the consideration of broucliiectiisis as (he
diagnosis.
J'ulmonary abscess, bronchiectasis, and chronie pneumonitis should
be considered when one elicits n history
of esophageal stricture, carcinoma or
cardiospasm.
T h e history of the prolonged use of oily nose drops and oily
cathartics requires the inchision of lipoid
pueumonia in the differential diagnosis.
Keeent intense radiation therapy of ft
lesion in the region of the thorax should
lead one to suspect radiation pneumoiijl j i:.?K.ri.(( 'J'his complication is especially
frequent following Roentgen ray therapy
for carcinoma of the luea-st. These are
but a few examples of the obvious valut
of a caicfully obtuioed past history.
e
0 r
1V
s
The strictly personal elements in »
patient's history frequent ly acquire added
significance when interpieted in the light
of (he family and marital history. This
�M F.I)It'INK
In these instimces the true nature
iscase process may be clarified or
] wliile obbdning the past history
aiient. Pulmonary tuberculosis
ctasis, and other chronic puhnu,,.
ses such (us fungus infections may
Ued by a jtast history of recurrent
f m p i c n t eolds and influenza, re.
and frequent pneumonia ivith
courses, jxriodic loss of veigln
gy without obvious reasons, a n j
bouts of fever and night sweats
•nnined origin. A recent history
jrative procedure such as n ton,• or tooth extraction, or any
or gcneralizcaf infection of the
onsils, musal IUK! oral j i l i a r y m
s attention on the possibility of
•scess, while a history of amebic
in the past may actually suggest
)gic agent responsible f o r the
y lesion. Pulmonary embolisui,
and met.-Lst.atic abscesses may
:ted if the examiner obtains a
>f phlebothrombosis, tliromborecent fracture, or severe localgeneralized systemic infection,
ry of n childhood illness complits convalescent stage by pneua prolonged cough should invite
eration of bronchiectasis ns the
Pulmonary abscess, bronchiid chronic pneumonitis should
:red when one elicits n history
igeal stricture, carcinoma or
in.
The history of the pro? of oily nose drops and oily .
requires the inclusion of li|K)id
i in the differential diagnosis,
tense radiation therapy of a
he region of the thorax should
•.o suspect radiation pnenmon' This complication is especially .
illowing Roentgen ray therapy
una of the breast. These are . i
examples of the obvious value
lly obtained past history,
ictly personal elements in *
istory frequently acquire added
• when interpreted in the light
ily and marital history. This
j , fcjiccially true of contagious diseases
mirli as pneumonia and tuberculosis or
uhrii n hereditary tendency is uncovered
to FUpp
Possible diagnosis of asthma
r rancer. I n obtaining the family history
l examiner should not accept uncquivor/illv the ]'iitient's proffered diagnosis (if
familial illnesses. ' I e should attempt to
ff.iifirui nil diagm.ises sujiplied by the patient, especially those which may influence
] i f ultimate decision in the case. This
objective may be attained by ascertaining
jnd evaluating the signs and symptoms
personally or by obtaining the information
ducctlv froui the physician who established the diagnosis in question, f n l e s s
FXtreiue caution is exercised in (his respect,
iniuiy serious errors will be commit ted in
thr name of good medicine. Investigation
of every diagnosis in this fashion will
prove many to be misleading and still
(itlurs to be completely erroneous. On
the other hand, patients will conceal wellrMiihlished and unquestionable diagnoses
in order to avoid what they consider a
.vidal onus. This vexing problem is esjiefiallv true of pulmonary tuberculosis.
(,rt
P
t
i r
t
Finally, the examiner should obtain the
patient's social history. Such pulmonary
diseases as silicosis, asbestosis, byssinosis,
unthracosis, bagassosis and arc-vv-elder's
(iisrc-sc may be suspected from the patients occupation. Geographic considcratiorir- may necessitate the inclusion of coccidioidomyeosis, echinoeoccal disease and
other conditions in the dilTerent ial diagnosis. Psittacosis should lie included in
the- differential diagnosis of patients exposed to members of the parrot f a m i l y ,
pigeons and fowl known to harbor the
rt^ponsihle virus.
I n general, 'all per«onnl habits which may be of significance
in the final analysis of the case should
l>c ruled carefully.
An orderly correlated history obtnincd
in this fashion will suggest the diagnosis
in many instances before the physical e.xnuiination or any other procedures are
rouiplrted. In a substantial number of
cases, however, the examiner will be distrcssed at the apparent lack of assistance
' y
' -t
7/1 •
gained f r o m even the most assiduously
recorded history. N o matter bow o f t e n
this unfortunate, situation occurs, the
physician must never consciously lower
the recognized standards of n satisfactory
history. As it so o f t e n happens, the first
manifestation of carelessness will be rewarded by n missed diagnosis. Those of
us who have experienced tins p i t f a l l in the
past will never again be satisfied w i t h an
abbreviated rccoid of a patient's illnfss.
The apparent, bonanzas of short cuts to
diagnoses have a notorious habit of backfiring at the 'wrong (ime lo the complete
embairassmcnt of their would-be beneficiaries and to (he detriment of the u n f o r t u nate guinea pig patient. This latter observation applies w i t h equal significance
to all elements of the patient's examinat i o n ; history, physical and laboratory.
The physician, not the clerical helper or
nurse, should obtain the history.
I ! . Piivsic'.M. Fx.vMiNW'rioN. A routine
physical examination of the patient suspected of suffering f r o m pulmonary disease must be performed in each case. N o
matter how ineontrovcrtibly the evidence
in the patient's history points to a pulmonary disease, omission (if the slightest
detail in the routine physical examination
is fraught w i l h danger.
I n general, the
physical findings will confirm or disprove
the impressions gained from the patient's
clinical history. Quite often a routine
examination will reveal significant physical findings in an organ, or organs, other
than the one l o which the history has
directed the examiner's attention. I m a g ine
the physician's surprise when a
disease process is located in the left lower
lobe of the lung of a patient complaining
of anorexia, nausea, v o m i t i n g , and epigastric pain. I n this, and similar circumstances, the examiner w i l l find it necessary
to supplement the original history w i t h
new and added information obtained by
re-interrogation of the patient for the purpose of emphasizing symptoms referable
to the organ involved. I t is agreed (hat
a m a j o r i t y of diseases i n v o l v i n g the lungs
are usually localized processes, but a sig-
�100
rnoGHr:ss OF MEDJC.VL SHENCK
nificant ininoiily me merely refleelions
in (hut orgfin c.'f n more remote or systemic disorder. This very fact ngaio emI'hnsiws the necessity of n comi'letc
pliysiciJ examination even in those instances that on the surface do not seem
to warrant such a detailed procedure.
The discovery of phlebothromhosis or
thrombophlebitis in an extremity will not
only help establish a more accurate etiologie background for pubuonary embolism
and infarction but will also facilitate the
institution of prophylactic mcasmes to
avoid further possibly fatal accidents.
Dependent edema, venous engorpement,
and a tender hepatic enlargement will
incriminate the heart as the icsponsiblc
organ rather than the lungs in a patient
complaining of cough, blood-tinged sputum and dyspnea. The physical examinal ion in such instances serves to evaluate
and correlate the clinical history. A distant lymph node, a draining sinus, a skin
lesion, or an enlarged prostate discovered
by careful physical examination may reveal the true nature of the pulmonary
disease process w hen examined histopat.holotic.ally or bactcriologieally at the proper
(ime.
Such a simple observation as clubbing of the fingers and toes may lead to
a suspicion, and subsequent confirmation,
of pulmonary disease. I t is fairly obvious
f r o m these foregoing remarks that n caref u l complete physical examination, not
only of the lungs but of the entire body,
is very important in confirming or disproving the existence of pulmonary disease and, on occasion, will reveal a previously unsuspected pulmonary lesion.
I I . CLinkal snJ Laboratory Aids in the
Diagnosis of Ftilrnonary Disease. When
the history and physical examination nrc
complete and correlated, the diagnosis is
often apparent. There are, however, a
significant number (if pulmonary diseases
which can be diagnosed only w i t h the
iLSsistanee of routine and highly specialized clinical and laboratory diagnostic
procedures. Pnmiliarity with all of these
procedures, nevertheless, is not only an
essential part of the armamentarium of
•rr-TT
!
• '. '•• \'''iv ;•>•,.{•>.•:r.'^r-
those physicians who arc interested e ^
cially in diseases of the chest, but shou]^
be equally familiar to all engaged in ([^
practice of medicine and its various sj,^
cialties. A working knowledge of tlies#
procedures will enable the physician to
diagnose pulmonary diseases w i t h greats
frcqucney, rapidity and accuracy. I n n.i.
d i t i o n , a realization of his own limitatiom
will prompt, him to offer the patient t l *
benefit of more specialized consultatidy
study if indicated. I n general, nil of t } ^
following diagnostic measures should
considered ns secondary aids and u t i l i ^ j
only after a complete history II.-LS betn
obtained and a thorough physical exatninalion has been performed.
7
A. Hr.MVii.iUK-.K; Sit:i>ii-s.
I t is |
rather infrequent occurrence for rou(.in
hematologic studies to be of any signif,.
cant value in establishing the diagnosis
of pulmonary disease.
A normal red
blood count, or one manifesting soint
degree of aneinia is of no particular i i .
portanoc. lioth conditions may be found
in innumerable pulmonary diseases. 1'oly.
cylbemia. on the other hand, may lie i
very siguidcaut laboratory fiiiding. h i
existence may not only help to confirm
the diagnosis, but, on occasion, may call
attention to underlying pulmonary disease which was not suspected before
examination of the blood, h'.rythrocytosis, when associated w i t h
pulmonary
disease, usually signifies chronic oxygen
lack and may accompany such clinical
entities as Ayerza's disease, cmj.ihyse.ini,
far-adv aitccd cystic disease, or any other
condition interfering w i t h adequate oxygenation of the red cells." I t is a rather
(.'(.instant, finding in pulmonary hemangioma (nrleiiovcnons f i s t u l a ) . " - - " E r y t h remia or jiolycythemia vera is commonly
accompanied by pulmonary signs and
s y n i j i l o n i s . " The total white blood count
and dilferenlial are. useful in determining
the existence and type of infection. l o r
example, one may usually expect a normal total white blood count w i l h primary
atypical pneumonia of undetermined ctiologv; on the other hand, a definite leukot
a
1
1
vt<>Si
of I " '
Vs n '
roiint
luiii"''
5|KTifi
It i * '
of «"
to the
r
1
or cc
lunpU-eri r
does i
blood •
ifingno
tity or
proces!
the ten
tial UC
assist a
n si ml,
coiitril
ntion o
it is i
study (
rmy 1'
nu
rvnlu,'
disease
(unit i c
riot on
diagno'
uiust I
falling
shihinj
pro|.-no
ns thev
ii. i-:
though
instano
this ex:
ucvertl
hiborat
in coic
In a m i
the t i n
second:
usual si
c. s
In I X K
�jCIE.VCK
liysicinns who are intprrst.ed csp..
i dispapes of (lie cliest, Imt S]IO |J
dly f a m i l i a r to all engagrd in
; of medicine nnd its various gj,.,
A w o r k i n g knowledge of t l
irrs w i l l enable the jihysician ^
e juilmonary diseases w i t h prettier
cy. r a p i d i t y and accuracy. I n RJ.
a realiznlion of his own limitntiom
>mpt h i m to (.>ff(T the jiaticnt t l i
of more specialized consullation
indicated. I n general, all of t h .
g diagnostic measures should
red tts secondary aids and utilized
ter a complete history has been
^ and a thorough physical cxnr .
ha.s been performed.
U
l e s e
(
D
EMATOI.OCIK;
Si'i'iur.s.
It
is
t
infretjuent occurrence for routine
ogic studies to be of any sigriifi.
due in establishing the diagnosis
nonary disease.
A normal red
•ount, or one manifesting some
)f anemia is of no particular imD o t h conditions may be found
ncrable pulmonary diseases. I'olva, on the other hand, may be i
rnifieant laboratory finding. I t j
e may not only help to confirm
miosis, but, on occasion, may call
n to underlying pulmonary dislieh was not suspected before
t.ion of the blood. Erythrocytoen associated w i t h iiulmonaty
usually signifies chronic oxygen
J may accompany such clinics]
ns Ayerza's disease, emphysema,
need eysiie disease, or any other
ti interfering w i t h adequate or.yof the red cells." I t is a rather
finding in pulmonary hemanpteriovenous
fistuln)."b.rytli• jx.'lycy(hernia vera i.s coInmotll}•'
.nied l i y pulmonary signs and
ns.
T h e total white blood count
;rential are useful in determining )
.enee and type of infection. I'or
. one may usually expect a nor1 white blood count w i t h primary
pueumonia of undetermined etii the other hand, a definite Icuko
11
101
M EDI CINE
l ^ . i s with a left shift is rather typical
j lobar or bron(. ho]ineimionia.'-' "'- *- \ A rule, however, the total white blood
M.niit and differential contribute only
lirnitf'! assistance in helping to establish
«|,r<-ific diagnoses in pulmonary disease,
j l js (rue. nevertheless, that the finding
„f nn eosinophilia may be (he first clue
(„ (he correct diagnosis in such diseases
m boefiler's syndrome. Hodgkin's disease,
,
echinoeoccal disease involving the
lungs.'-'" Sonic degree of eosinopliilia has
l^en reported in silicosis, but the author
,1,^^ not believe that the total white
1,|(KHI count or differential is of particular
diagnostic significance in this disease enj i n ' or in tuberculosis. ' When leukemic
poK-csses involve the puhnonary tissue,
,|ie total white blood count and differential may be, and usually are, of conctete
assistance. Aside from Hodgkin's disease,
„ studv of the white blood cells docs not
contribute much to the diagnosis or evalu(itinn of the other lymphomas."• ' Although
jt js true that the routine hematologic
studv of a patient is not too commonly of
miv real significanee in the ultimate
rvnluation and diagnosis of pulmonary
diseases in general, it should never be
onutlcd because, in many instances, it is
not only of real help but is praelieally
dingnostic of certain conditions. Also, i l
mnsl be remembered that a rising or
fullinL' total white blood count and a
shifting Sclnlnng count have the same
prognostic value in juilmonary infections
as they do in other infectious diseases.
r>
f
,
1
;,
4:
4li
c
(
r
:;
r
IS. I-'.XAMINATKIN 01' lllF. I ' l . t M . . A l though the author does not recall any
instances of pulmonary disease in which
this examination was diagnostic, it should,
lie\erl heless, continue to be a routine
laboratory procedure because of its value
in considering the differential diagnosis.
In acute and chronic jiulmonary diseases
the urine could eonceivnhly show some
secondary changes to which none but (he
usual significance can be attached.
C
Sl'OOl. KXAMINATIUN FOIl I'.MtASI'l I . S .
In l/'cffler's syndr
e, the discovery of
Slnmquhnileii
slin onr/i.', .Isnni.'
hnnfjn-
cnulc.n, A'rni/or macnr.anuf, or other ova
in the stool i.s of great assistance. When
V.iiilnvurha hiMolyiica cysts or trophozoites
are found in the feces, the etiology of a
lung abscess may be susj>ccted and subsequently proved.
'Iliese are b u t a few
examjilcs in which examination of the stool
for parasites may yield i m j x i r t a n t diagnostic i n f o r m a t i o n .
D . S u t o L o n i c T E S T Fort S r r n n . i s . O n l y
on rare occasions is this test of any diagnostic significance in juilmonary disease.
It should, nevertheless, continue to be a
routine procedure in the examinalion of
all jiatients.
B. S r t i t ' M K N A M I N A T I O V . This is one
of the most reliable and i m j v r t a n t pr\>cedurcs and should be utilized routinely
in every case of susjiected or undiagnosed
juilmonary disease.
Suitable sjiecimens
for examination may be obtained f r o m
ordinary ex|>eclorated material.
When
the amount o f s i m t u m raised is insuflicicnt
or unsalisfactory. iiiateria.l for examination may be obtained by pulmonary lavage
or bronchoscopic aspiration of the trachea
and accessible bronchi." "
Frequent
microscojiic examination of apjiroj'riately
stained smears should be jieiformed in a
search for the resjionsiblc jiathrigen. One
should not be content w i t h 1, 2, or even
.'< negative results if strong clinical e v i dence exists which incriminates the lungs
and ]>oiiits to a certain disease process.
Rejicated careful examinations are mandnt o i y when tuberculosis is susjx-cted. A
concent rated L' l hour sjiutum sjiecimen is
the jinicedure of choice.
The t y j i e of
stiiin employed is a matter of individual
jpicfcrcnce. I f the usual staining technique does not yield the desired or satisfactory resnlt, then the sputum should
be cultured on ajijirojiriate media. Fresh
unstained material should be examined
w hen nt tempting to i d e n t i f y lhe trophozoites of E. hislchitica. A n unstained
specimen mixed w i t h either a 10% solution of |'Ot!Lssium hydroxide or sodium
hydroxide is also the procedure of choice
when a fungus is being sought.." ' ^Y)lC!l
echinoeoccal disease of the lungs is sus1
15
4
�rituGllKSS f i r MEDICAL SCIENCE
3 02
pectrd, 111-' .ruipicsi? I'li'y ' ' f cstaMislini
l.y i.lcntili'.alicli of l l u ' licil-.l-'ts ur i n n u |,',•;,„.• nf tin- ryst in a |)n.| .-rl\ s l i i i n c l
.•.penmen.' In all eases of lobar or t.runcliopneumonia the spmum sliouli! he tyjied
i , , order to identify (he specific iniero(-.iganism lespousihle for the infection.
If examination of the s j m u m i shmild
end with a search for the reP|»msihle
pathogenic microorganism, it wonld he
, p l , . t e hecaiise the gross a „ d other
stained am! unstained microscopic characiei-istics of the juilmonary exctcla innst
he. studied in order to secure the maximum
diagnostic heuefits f r o m this examination.
The identification of fat globules will in
itself confutu or suggest, the diagnosis .,f
lipoid pneumonia. W" fllct's syndrome or
...-.<hina may be susjx.ctetl when the j m l , „ a , i , m ' cellular elements are eosinoplnls while rhe additional jHcsenoc of
claMic fibrils and Charcot-\ .eyden crystals
d ; r the l:.n< r possil.itity mo.e .n.bable.
'J'be recoguiticn of larva- of A . lumhwnnr.*
sbonld suggest immediately an a^cans
pneumonitis. H b.onch<,:enie caremtuna
is st.sj.ccted. jnoperly j.rejiaie.l si.ecimens
should be examined for cancer cells.l
it"
i n (
) n l
(
(
1
n n
problem. Characteristic suljihtir g r a i n , ^
mean nctinoinycosis u n t i l juoved o t h .
wise, while the j-resence of Curschmai,,,',
spirals and l.aenuec's j.earls are suggestiv
<,f asthma. 1'rom the iibove remarks <„,,
should be able to aj.jueciatc the value \ «
a carefully J.eiformed s p u l n m extunina.
lion and assign l o it a high jiriority ratinj
on t h , list of routine diagnostic j.roeedurw.
F. C, \sT)iH' C O N T E N T S . 'J'he examination of fasting gastric contents in the aged,
the debilitated, and young children mny
help prove the diagnosis of pulmoniiry
tuberculosis. ' "
H is frequently U,
l v metho,! of establisliing the ihagnosi,
bevond (|iieslion. T h i s very reliable and
vduable ,-ro..-edure should be c m j . h n ^
wh-iiever the b a c t d i o l o g i c results of spu1u,n examination by stain ami culture art
c n s i s t e n t l v negative while all available
clinical evidence, nevertheless, is to t l ,
cr
e
b
1
3 7
e
if
( ) n
1
e
contrarv.
.
(; Jl,,,01. Cri.Tt'ur.s.
burly in t l ,
,.,„„-,,. of lobar or bronchopneumonia, and
befo,e a cbemothc-ajH-utic or a n . i b , ^
acent bar- been emj-loyed. the blood eul.
„ „ , . , „ a v be j-ositive.
Isolation of t h
re-q.ruisible organism in the blood stream
is not use,.] to establish a diagnosis bat
'J'be gross characteristics of the spi.tnm
n U h e r t o c o n n r m i t . . As a rule, blood eul- ^
s t be studied carefully as this part of
the examinalion Ire<iuently suggests the turcs are of very l i m i t e d value m the ,
diagnosis. For exam|.le, a frothy rust- ,Iia,..|i()sip of j-ubnonary disease
Jl ^RIN TisTS.
In many obscure jail- ,
eolorcd sjnitimi. with or without bloodthe diagnosis
may l«
strcahing, inv-ues a diagnosis of juilmon- ,„„„'„;;. conditions
,„,,,,.sn.d
bv an allergic res]-onse of the
ary edema, while a iMayered S|»utmi. ts
b.M to a measured
minute skin test dose
sn'^.cmive of hronehicctasis. I'ulmonai-y
f antigen obtained
bom a s,>ccilic microtubcu-culosis. bronchiectasis and neoplasm
organism.
This test is especially
valual e
are among the dian.oses to be cousidere,
i„ such diseases as tuberculosis,
coccidiin the presence of varying degrees ol
, , oosis,
blastomycosis
hemoptvsis. A very foul-smcllmg sputum
sis and other fungus diseases. •'• '
should make one suspect lung abscess or
|„ some instances,
a negative result
howbronchiectasis. Pniue juice colored espec.. er
is of far more clinical
sigmfieanee
toration may signify lobar pneumonia,
than
a j-osilivc
reaction'
I'hysieuu,
while amebic access of the lung may be
should
not emj.h.y
(bis diagnostic
pro.h..--1rri7ed bv an anchovy same colored
.,.
. less
they are thoroughly
hnmhar
tvpe of sj-utnu'i. When the gross characwith (be correct technique
«.f
J-cformuig
,;,.isiic.s of the sputum are similar to fluid
the p.st and how to read and interpret
i»
obtained by thoracentesis, a hioncbo- results
When ecbi.ioc<K'cal disease of the
pleural f.stnla must be considered.
1 he I,,,,,,
is susjiected,
Casoni's
intradermal
accidental discovery of a bronchohth may
U-sf'is juac/ically
sjKcifk.*
Ml
f**™*
W the answer to a diflieult diagnostic
n i ;
vai
f
1
t
1
I
l n t l
(1
li(1( mV
V
IP
,1,
t
t
m
V...'' 'f • [ ".
•
( l l i r (
im
II
�*rit;.\rE
'
C i
'"• . ™ " K t m s t i c M . l p i , ^
,
»7»<«».vmsi until
p r o v j ^
lie ^Iinnlil lie tested for allereie re^Donse
.pi.ious antigen, both k t
s
10 .«!
-o,,,,!,
1,,
-
B
b
o
v
e
r
n
^
u
I
:.. .
,,fl,„r , r • i
<. .
M.'"/
'« .»«'»'««r.v procedures.
On occasmn. (he results of physical examniation of the lungs are more i n f o r m a t i v e
th'.n
the roentgenogram..
More fre•incntly. however, the Roentgen ray will
reveal a pulmonary lesion even after the
•nost compctctcnt physical diagnostician
Ims rendered a negative opinion.
This
nnrortuiiale shortcoming f the phvsical
<hagnos.s in the recognition of p u l m o n a r v
disease can be corrected onlv througii
""•.eased utilization of routine Roentgen
ray examinations of the lungs at regular
("•'•iodic intervals. E q u i p m e n t and supplies for mass radiographic campaigns are
now becoming increasingly available and
the cost is so nominal that even economic
considerations are of no real consequence.
One should remember, nevertheless, that
a Hoenlgen ray film of the lungs is onlv
' n f r c q u c n t l y diagnostic of pulmonary disease.
It does, however, permit 'earlv
detection of si),.,,, .,,„] un.^sp^.,,.,]
,
•,• .
purjxise? a'"' therapeutic possibilities
I srpnn.NiVIION HAIF..
J'or t,,.,,^
^
^ ^
this determination has been a
j , , r t i o n l l y routine procedure in the studv
j miinc chronic pulmonary diseases. Its
p.^ularily certainly dries not originate
(n.ni it--- diagnostic value, but may be
jirril.utcd to its (juestionable prognostic
,i !uTican.e and ease of aecoinplishmont.
j,
a non-specific laboratory test which
,|„,iild he interpreted and accepted o n k
in the light of the over-all clinical and
|,(oratory picture.
r t
v
. f - ^ n n e d .p,,,,,,,,
e
^ f
x
• ^ n to it a hi.h p r i ^ U v
'S'ofroul.np,,;
;
^
r
i l f : i l 0 s l i
^'-nic COXTL.VTS.
Th
e
^ t r i e con,™,,
•
,
T T
( )
r
»
u e s , i
«--
This
r^;!;
=
.P-mi-e
shoohi ,
; ^ ,
/''e I'.-'ctcnoJogic results of Z,, ^
'^stain and ^uL"
'
ie
e i
Ir
J
, e
»'d«K-e. nevertheless, i ,
on CfLxujtr.s.
^^rorb
I ( ) 1 K
.,
F-irlv
.,
m p i l c
"—herapenic
o
l m o M i
u
> Hie
»' Ha
_
r
-nploved. the blood c
^ P'^'t'vc.
Isolation of t u
• ' " ^ ' " s m in th,. blood s „ . , '
Establish a d i a g , ^
,
f - ' < - . A s a rule. b U
' ^
t
J
y
m
,J
V: ,
?Pnhnonaiy'"' ' "
T
disca.se
'^STS.
J„ ,„..,„,.
e
( ) I j s t
tl-c
.
J. I'm.i irin.v A M I Co.M|.u;.\n;.vj-n. .
liu\- T l •:> These jiroccdures are of real
value in the diagnosis of virus and fungus
di«..'i-es. ^Mieii significant positive results
arc obtained, they may be consideicd diagnostic. In some instances, as for example
i,, blastomycosis and coccidioidomycosis.
risiiiL' or falling of (iter is cf pn.f.-nostic
I ns diagnostic v alue."--'^"
'""s and careful follow-up examinations
K HI.U.M (iiis'oi.ficic
l-XAMINA I ION.
Jherem lies its greatest c o n t r i b u t i o n to
No rxamination of the lungs is comj.lele
the study of puhnonary disease.
without a Kcentgen ray film of the chest..
'J'he following Rocngen ray studies of
An eiect posterior-nnterior view should
the lungs are valuable diagnostic proI r a routine procedure for all patients
cedures: (1) erect post erior-anterior; (2)
su.=jK.ctei.l of having pulmonary disease.
'•"eral; O ) oblique; . \ ) lordotic; (-.) stereThe .-mlhor shares the opinion (hat a good
oscopic; (C) jilanographie studies; (7)
lateral view of the chest i.s as important
hymographie studies; (S) bucky film; (<))
n routine procedure as a posterior-antep o t f i l m ; (HI) i n a x i m u m insjiiration and
rior f i l m .
Not infrequently lesions are
e-M'iration. Any of these studies, and
recognized on the lateral view which are
especially the more d i f f i c u l t t.-dmical
' ' • " I even suspected after the most careful
p'-ocedures. should be iindert.'d:en and
interpretation of
}
posterior-anterior
interpreted only by physicians qualified
film.
If economic considerations permit
"> cnga.ee in the praeiice of n.entgenologv
' " " c . equipment and personnel
or diseases of the chest. "J-he adequate
r.re available, the lateral view should be
study of pulmonarv disease? is so depena routine procedure in the diagnosis of
<!cnl on the lioentren rav e.vammation
pulmonary disease. Jioenlcen rav exam
'h.'it K is almo.-i oblir-atorv f..r
XA
{
i i
s
n i )
•
'espouse of , |
^ u r r J ndnute skin test dose
,
l e
11
fron, ^"•-i.'H tnicro•'" »<*« > specially v d ,
s
s
,
s
;
1 ; i M c
.
t
•; '"'-ndosis. ,,,.idi.
(
^ouneosis. his,op! , , .
' " " P ' S diseases..! ;.s
„
" - ' ' ' ' ' "'.ganve r c s u l , hoiv; "'ore clinical significance
i'hvsicians
7 ' 'li^nostie p, .
""•^
t l - n . , , , - ! . ! , - faunliar
' ' ' ' " ' " i n e of performing
' ^
interpret its
' ' ''""'cor cal disease of ,),„
•ct«:d, Casoni s intraderuud
•''ll.v s p e c i f i c '
asthmn;
1
;
<
(
s
Iln
,
,
s
r
,
v
( )
1
•.•..••
c
h
1
r
i
•
- f the n,ost valuable J all di.vmo , .
d;.,,./
"f
most
of
("•'"•edurcs, bul under no ciremns,anecs
Mould it be considered a substitute for
'I'e roinme history and phvsical examiuaThe leal anrl f u l l value of „ ,.|„.. ,
li"entgeii ray , , „ , he realized only if its
final interpretation is made contingent on
the history, the physical examination, and
. 7:.^-, -;:-•:/: • • . • . - . . • • ; : • . . : • • ^;-;f';V.
^
' ' " ^ . f ' ' 0 — n s to
ntgeno|,, ists a, f.,,.
thorax is
• n t emed.
ba. 1, of i!„.
maiions men!ion...,| above
place in the study of pubii'-uary <:• = •.•:•:-•.•?.
••'"d. if p i o p d y employed at the correct
time, will yield gratifying icsults in (he
hands of competent individuals. On occasion, a study of any part of the gastroimpel.a,I
'
10
f:
;
•
�I'llOtiKKSS o r .MEDICAL SCIENCE
inU-stimil tract with a radiojiatjiic substance sucli as liariuin may In.- iodicalvd
ccause of dilferenlial diagnostic cnnsidcratious. Tliis is esjiecially tine in diaI'liragiimtic hernias and diseases of the
esophagus. Hoenlgen ray evaminations of
other parts of (he body may also he i n d i cated under certain ciremnstances, hut
the occasions are so inconstant and (he
variety of examinations so multitudinous
that it is merely mentioned in passing for
completeness. For example, if the p u l monary lesion appears to he metastatic,
one is required to investigate all possible
primary sties.
L. F u ' o i t o s f o i - v . This study of the
ungs is very valuable in detcrmimng
mobility and other dynamic features of (he
chest during various phases of respiration.
One may study and estimate the functional
vital capacity of each lung in this manner
iy noticing the changes in its density during various respiratory phases together
w i t h the movement of the ribs, mediastinal structures, and excursion of (he
diaphragm. Aneurysms may be diagnosed
from their expansile nature and so differentiated f r o m solid tumors. Fluoroscopy
is of untold value in such eondilions as
pneumothorax and pleural elfusions. I t
is no adequate substitute for hoenlgen
ray photographs of the lungs. Too many
lesions escape detection by even the most
competent flnoroscopisls if sole reliance i.s
placed on this method of examination.
However, when it is necessary to consider
the gastro-intestinal tract in the differential diagnosis of puhnonary disease, fluoroscopic examination i.s probably a more
important study and reliable evaluation
than the roentgenogram.
M.
EXAMINATION
OF
I'I.EVHAI,
Fi.tun
A.so GASES. Whenever the presence of a
pleural effusion is a-scei (ained, a specimen must be obtained for diagnostic purposes as soon ;us possible. Unless specifically indicated, air should not be introduced into thc pleural cavity during, or
following, diagnostic aspiration. A part
of the fluid obtained should be consigned
fur bacteriologic examination.
I f the
specific diagnosis is suspected, spec-i^
stains, cultures nnd other bacterioh -;
studies may be carried out. For exampj.
if one suspects a tuberculous effusion, t ) , ^ '
a guinea pig inoculation is in order. 1%-^
which has developed synpneumonieullj
or metnpnenmonically, should be t y j , j
for specific piieumocooci. I f one s u s p e ^
a malignancy, part of the specimen shou^
be examined histopathologienlly for n ^
plastic elements. T h e type of leukocyte
if present, can be determined from j
stained smear while searching for p a t h ^
genie bacteria.
I n this way lhe inflanj.
matory nature of an effusion can be de.
tected.
Sufhcient fluid should be oh.
fuincd to determine the specific gravity •
or protein content.
These e.\aminalioi
arc valuable in differentiating an c.\udat
f r o m a liansudate.
Jfefore withdrawing
the aspirating needle. 10 cc. of 1 % methyl,
cue blue, or some other suitable dye, mav
be instilled if a bronchopleural fistula i j
suspected. I n the. presence of this coinplicalion the s p u t u m will have a bhiisli
discoloration w i t h i n J2 to 21 hours, ur
sooner, following injection. This is a very
v aluable diagnostic aid which offers ineontrovcrtible evidence when positive. Where
facilities for gas analysis are available,
(he existence of a bronchopleural fisiuh
may be suggested by a determination of
(he carbon dioxide and oxygen eonient
of gas obtained f r o m the pleural c a v i t y . c
This (ime-consunimg procedure is usually
unnecessary and merely of academic
interest.
lf
c
H
u
e
:;
Macroscopic examination of (he fluid
oblained by thoracentesis is not a very
reliable procedure; but odor, viscosity and
color may suggest certain diagnostic JHJSsibilitics and methods of examination.
For example, a pale straw-colored IluiiJ
obtained f r o m the right hemitborax may
suggest congestive failure w i t h hydrothorax. M i l k y , t h i n fluid invites thc diagnosis of chylotborax which can be confirmed by staining w i t h Sudan 111 and
chemical analysis of its f a t content." A
blood-tinged, or frankly, bloody, fluid
suggests p u l m o n a r y i n f a r c t i o n , trauma,
�8
SC1EKCK
105
MEDICINE
ic (liagnosis is susjicclcd, sjiccjjj j
, cultures find oilier l.i;ieteriolog|
s may he carried out. For exampl,,
suspects a tuberculous cITusion, t l , |
ica pig inoculation is in order. ] % \ ^
JI.'LS develojicd syniinetimonicallv
;ta|)iieuiiionically, slioubl be t y j ^ j
ecific pneumococci. I f one suspect
gnancy, fiart of tlie specimen shoulj ij
imined histopathologically for nc-of
C t
• elements. The type of leukocy^
sent, can be determined from |
1 smear while searching for pathobacteria.
I n this way the inflain.
• nature of an effusion can be do.
Suflicicnt fluid should be oU
t o determine the specific gravity
tein eonient. These cxnininatinnj
nal.ile in difTerentiating an exudate
transudate. liefore withdrawing
i r a l i n g needle, 10 cc. of 1 % methv],
e, or some other suitable dye, may
illed if fi broi)cho|)leural fistula u
od.
In the presence of this coin/ i the s p u t u m will have a bhiisli
•ntion w i t h i n 12 to 24 hours, or
following injection. This is a very
? diagnostic aid which offers ineonfile evidence when positive. Wheit
; for gas analysis are available,
tence of a bronchopleural fistula
suggested by a determination of
x m dioxide and oxygen content
itained f r o m the pleural c a v i t y . "
le-consuiuing procedure is usually
:iry
and merely of academic
rtnigesl've heart failure, tuberculosis, p u l ,nnrv or jileural neoplasni,
and other
^•abilities.
Foul-smelling
fluid
may
'
• an anaerobic infection or n colon
-|1?
h»rill - These gross features should fill
^ fvaluated in the light of the available
finical am' f'ther laboratory evidence nnd
late f u r t h e r studv undertaken to
1
en" ''""'
prov e the diagnosis, h rom this biief dis^ission the diagnostic imjiortance of fluid
in the jileural cavity should be obvious,
,nil 'I'e J'hysician must be juejiared to
pMain every jiossible assistance frcini the
j^uiplctc investigation of this easily availJ,|r jiathologic material.
\'. JiiioNfTiost oi'V.
'I'his diagnostic aid
\* not emjiloyed w i t h suflicicnt frequency
;„ the diagnosis of jiulmonary disease.
Y d , it aflords the clinician an o j i j i o r t u n j,v to visualize the lesion diicctly, if it is
lociitcd in an accessible area, nnd to obtain
[ustcrial for bacteriologic and hislojiathoJogir examinaticin w i t h which to establish
thf diagnosis.
' I he ajijicarance of some
Jcsions is almost diagnostic. In any tine.vpbiined jiulmonary disease, or susjiected
trschco-bronchial disease, this examination should be [icrformed without proerastinntion as it is a relatively harmless j u o rednre in the hands of comjietent broncho•iciijiists. Thc jihysician should not hesitate to submit his jiatient to this examination for (he CNjiccted benefits are far more
numerous than the jiossible dangers,
hmm hoscojiic examination should be eonjidcrcd in all cases of obscure and atyjiical
jiulmonary lesions in all jiatients jiast the
»gf rif •)(). In this way more cases of j>ultiionary cancer will be discovered in an
njierahle and jjossibly remedial stage."-' '
(
21
K
•scopic examination of the fluid
by thoracentesis is not a very
procedure; but odor, viscosity nnd
y suggest certain diagnostic JKISand methods of examination., j
npie, a pale strnw-colorcd fluid ' j
f r o m the right hemithorax may . --i
congestive failure w i t h hydroM i l b y , t h i n fluid invites the dingcbylothorax which can be cony staining w i t h Sudan I I I and
analysis of its fat content." A
ged, or f r a n k l y bloody, fluid
puhnonary i n f a r c t i o n , traurnn, _ f
- i,
:
0 1 , 1
0. J^soriiAOoscoi'V. On occasion this
may be a very •valuable procedure in differentiating between esojihageal and pub
mcmary disease. N o t infrequently, esophtgeal disease is discovered l o aecount for
v.-condary jiulmonary comjilientions as in
Jtridure and carcinoma of the csojihagus
or cnrdiosjiasm.
1'. Ibo.iNCiio'MtM HT. The introduelion
of u radiojiaque substance (lijiiodol) into
the tracheo-broiiehial tree is a simjile, safe
and valuable jiroeedure. I t is of unparalleled value in cases susjiected of having
hronehicctasis and rnny also be emjiloyed
to demonstrate bronehial occlusions, cystic disease nnd j i u l m o n a r y cavitation.
'J'he method of choice in carrying out this
examination is one of individual preference. Follow ing the instillation of lijiiodol
into (he tracheo-bronchial tree, immediate
(luoroscojiic and pholograjihic examination should be j i e r f o r m c d .
Q.
jMiscr.Li.\Nr.ous
USES
OF
HADIO-
I'AOKF. M . \ T i . l t l A l . .
When a sinus tract
appears to eommunieate with the lung
or the jileural c a v i t y , lijjiodol. or some
other suitable material, may be used to
outline the tract and to ascertain the
communication. In jiositive instances the
Iquodol can be demonstrated in the lungs
fliKiroscojiically and roeut genologieally.
'I'his jiroeedure may be esjiecially useful
in Ihoraco-ahdominul actinomyeosis w i t h
sinus tracts.
H. Uioi'sv o r I . I . S I O N r o n H i s r o r A i u o i.ootr A N O H.nt.-i I'.iui.iuioic Si t iiv. \Vhen
a diagnosis cannot be established
by
sputum examinations or other simjile
laboratory (eehniques, biojisy of available
jiathologic material may be jierformcd.
The tissue should then be examined by
the jiroper histojiathologie and bacteriologic methods.
Material for biojisy may be obtained
f r o m the local jiulmoiiic lesion or from cither
sites if the jiulmonary disease jiroecss is
[•art of a general systemic condition. Suitable sjieeimens may be obtained hronchoscojiically if suflicicnt material is biojisied
from the jirojjer j i o r t i o n of the lesion.~ ™ ™
Hronchial adenomas have a tendency to
bleed following biojisy, but this is only
a minor comjilication and should not be
considered a contraindication to the jiroeedure. The bronchoscojiist must be well
oriented before securing the biojisy specimen and is required to determine carefull.v before thc ojicrative procedure is
iindertaken the possible existence of n
thoracic aneurysm.
Accidental biojisy of
the aorta or other great vessels may be a
rather embarrassing complication. When
J
�IOC)
I'JtOGHESS OF .MEDICAL SCIENCE
iiiiilf-riril for Kinpsy ha? liccn fmuid
iuacccsMlile tii-(iiii-!i(isc(>i>ir:illy. the audmr
lins iiiiln'?i(uting!y ju rfdnncd iiiininK'iiil)lf
iJiiiicli liiopsii.'s of pnlinonary lesions si(\inted al icspcrlalile distances from vita!
structures.
I f a Vim-Sih erman liinpsy
needle is used, suflicicnt material of diapnnsiic (junlity can lie ol.itaincil u i t l i n u t
any more serious seipieL-e than transient
Mood-spil I inj;.
.Aspirat inn hiopsy is not
lis
if
V. THE Jh.FCi iioc'AiiiiKKmAM.
Thi,
procedure
has very
limited
value („
diagnosing
|iulniiiiiat v lesions.
As in t|
ra'e
of cor pMliiionalc.
it f i ripieoi 1 y
fliil'i
.'•n I I' f f l ' l | IV
|l'.
Illllll'lillt
lil.lllill'Fl
in
llii
In luuii | . le.uidl^ iiisiilliclcnl lol
adnjuate liistojiaiholoric eNamination, althoujdi i.|uite fie(|ueiitly snital.le for liaeteriologie stu<ly.
\ \ hen pulmonary tissue is not avaihdile for histopathologic,
or haotcriologic, examination or has hcen
found non-diaenost ic. material may lie
ohtained from other aeecssiMc sites. In
such instances one may ascertain the
diagnosis from an involved lymph node,
a skin lesion, a draining sinus, or f r o m
any other site involved hy the same disease proee.'s. If it appears that the p u l monaiy dr.ea' e lep/evenla a mepr lalie
lesion, then, in any event, hiopsy of the
original focus is preferahle.
Suspected
leukemic infiltrtitions of the lung may he
dinninscd hy asjiiration or hiojisy of the
sternal hone marrow.
Ilistopalhologic
and hacteriologic extimination of involved
tissue ohtained hy hiopsy is an excellent
•and usually safe, method of esttihlishing
an etiologie diagnosis quickly .and indisputably.
p
1
1
S. D M U N O S T I C J'NKi'.MuTiioiiAX.
This
is a very excellent method of distinguishing between inirapulmonary and cxlraIHihuonary lesions.
T. 1.' IA 0 N OS'I IC T N r.t.'MOITKI'l (>:•: ?. CM .
"
'I'his jiroeedure lias very little place in
the diagnosis of jiulmonary disease unless
diagnostic jmemnothorax fails to reveal
the exact location of a lesion in thc region
of the dinjiliragm.
L". TllORACOSCOI'IC F.XAMl.NA i ION. A f ter a diagnostic jiiieumothorax of sufficient
quantity has been induced, it is a relatively minor surgical jiroeedure to examine the ((intents of the jileural cavity
with the thoracoscojie.
This someli
permits direct visualization of the lesi^
for jiurjnises of surgical evaluation n ^
diagnosis. Biojisy sjiecimens may hp ^
taiued in this manner for liistoj>a(holoj.i
and bacteriologic examination.
M|I
r
t
n'tl
r"
m i
ia
ii i f
V
,.'.1*
|p
, iodine
lilnl
I " • I 11 i o 111111
'olui-li,,,
lions and cllecls of j i u l m o m i i y disease, hut
if the investigation has been conducted
ennectly and in logical order, the informs,
lion obtained f r o m the oleetrocardiogrbio
will be of c o n f i r m a t o r y rather l l i a u ding,
nostic imjiortance. When the di(Tcretitia|
diagnosis rests between juilmonary
.
holism and coronary occlusion, however,
it may be of real diagnostic value. IAJ*
voltage in the jircsence of massive jiletmd
effusion is only of academic interest.
c m
1
W.
VENOUS
J'IIESSIJIIE ANO
, -. - i
r.-n
,,,n
»ii(l
i
r 'in-.
"
'/'.
(••.ie
Cinci.u.
HON TIME.
In the jiresenee of eardinr
lailme lhe venous jiiessuie is commonhelev ated. This is not usually the case 'ID
juilmonary disease. On occasion, primary
or metastatic tumors in the thorax wil)
obstruct the venous return f r o m one jiart
of the body or another, but this is rarely
symmetrical as one would exjiect in cardiac decomjieustition. 'I'his latter observalion together w i l h other available evidence, such as collateral circulation, will
usually decide the issue.
D e l e n n i n n t i o n of the circulation lime
in jiulmonary disease is of (juestionable
value although it is significantly prolonged
in many cases of anthracosilicosis/ A
jirolonged circulation time is a far more
ronstant characteristic of cardiac decoinjiensation than jiubnonarv disease. 'Hit
venous pressure and circulation time ate
of definite value in bcljiing to dilferentiale
hclvveeii cardiac and |iulmonary disease
processes.
X.
r"'
* ''
T i i E K A i ' E r T i c T E S T Dosr. OF DF.LP
linENTOF.N H A T T H E H . W Y .
I f a jiulmoaary lesion remains undiagnosed tdler all
available diagnostic procedures have been
I"
yt-
r,V.
u
run
n.v)
1 .'
f:
:
;
r.:"!
ir.iti.v
r- ' i
e
'J '
�k
•
L SCIENCE
U SCIENCE
1
1
. „.
, the thoraeoseo e. T h i ^ o m e t i n u ,
; ' direct visnalization of the l , , ,
'
f .oreical evaluation and
r
S
^ ^ I w
'•>•
h
r
U
l
1
'
,
l t
( k
,.,,,,1 of having a pulmonar.N
,,,.,1
linvi»P H pulnicmnry
patient ^ r T ^ e ' ^ u t, and ahnost
suspected
,
V.^tu.e and to place g e (
, „ ll,.nt-
B
C
THE
^
t
vcrv
htnitcd
l
l
,
i
11m
value ,„
,
t 1
fluouslubc-toryrn
J«
stances where i t « u n
-••» ru.» < *
..t
r
r u c l i
"r
the thorax frou
tecbnic.an
or n
^
, ,
<1
n
il
m l <™o„»rv . . - c l . . . . ™ . I " ™ ' ' " '
!
, ! U 1
'
n
T
0
M
,
s
.y
.h^'^
^ i M in
, ?
'
1 i diagnostic P-cedurc
" ' ' " , n certain selected cases.
' t "T
, a competent thoracic
m l
1 1 , 1
•••
,
1 U
r
, , , C , h t : m e
""" ' "
ing cilective an,...
T
^
Wv decide the issue^
\
^
,
y
0
,
r
i
!
i
^
; v W
may he cnV" T ' I ,
; il r pmc the supplcT ' l m f o t l r indicated and
r
U
K
{
]
,
s
U
cardiac and p u h n o n a n
5
" " '
T
,r
T
k
-
"---;:;:rrpn,dures^u
T
:
v
effort ^
j
^io,,any;n J ^
-
.
t
0
i
i
aWM.
... "
1 1 , 6
l a i c a l and » • ' • . « ' £ "
—r;'; s:;: s;mc
.is n
"
.
l J , l
a
i
e
correct diagnor
r s
.
Mailable facili^ .
,
l I l i l l U l I
tic
lor l ^ ' ^ J o *
v.he,. indicated. AUc
'•^--•
Ph>'=ic^ « ' ; : » » f ^ '
vionslv outlined, the
U
s
examiner has
, l the
d l i c l l
maimer
election of ^ . W y
,
o.e next
i s
an almosi
5
!
' "'" , '
^ . U i s h U1 . l i ^
K
"nu'at
liilitic?
J »l«.v
i-'r;";:. r ' • ->
l U
^.vestig^.on o
C
«"
^ l"' ""'"^'
i sVieiitiRc manner
U,«- i t l n c ^ n . tins sc
and
B
l1
,
V
-" '-'' of p r o m p t and correct
^
' " ^ Z ^
'and P ^ y ^ a n
i ' '
- .
r!t f r o m this approach to
, 1
t
the history and pli,-"•«>'
•
1
these l-ossihuost i m p o s s i b l e - •'•
' ••"t'l'.a-
1 1 1 K U
?
r
.'igiimeiil-
T E S T D O S E OF D E "
:TGES R \ V
V
after
...icn remains v.ndn.f:m^«i *
a,W diapi.o f,c procedures have
n
would be almost ^
^
tablished, w i t h o u t rea l
k i
l
,
sis of many o b s i u n )
..ucstiotialAe \
^
,i,aracter.stic of '
„
1
l l C
l l C
highly
^tabh:
unplc.
---'--rci;;,"-^'
f C
cut
t ) u r
B
» ^ - " ^
construed ^ ' ^
d.e im,'ortance of U (
,
i \,
: a n l
for the gun^
1
of
of / r
bi]'arotom> - »
1
t m l f
T '
dis c^e V o
uhnunary dtscase
l
i ^ "
J'-jLtiauSei^^^'-^
^
"
U -
e
1
practice of
r
m ) t
d m i
, n a t K ,
b
::;:x;ti--^e,,ia,idm ^
,
dke^se On occasion, pninarT
S i o r s in Hie t h o r a , * i j
^
e venous return f r o m «.i.r part
ic
« r =uu»thcr. but tins ,s rareh
1 -us one would expect ... ear.
metrical as one
,
^ v * .
„ipensatmn
»- - ; ^
^
, , ,
this
l
.
to
.
coinuumly :
l
E
n 5
^^ately.
valuable \ ^ . .
r
U i C
Hall
>
•^
f
1
v(
l t i c l l t
docU,r ex-ept
the final " l ^
" "
, n . b l y line boss. J
k
i
r,.«iire
biehh- trained lecbn.e.al
td U v r i - o l v e d a p p a i i .
therefore not recommemled
^ u t i . - M - " ^ ' -
i
M
l K ,
a
t l i c
^ " ' r ^ e
mav not even sec i
.^-f' "
.»J
'
^ T ' n t
o I
,
1
l
o r
1
oihri
l
reached
f tunnte
^
V —
" X , ' a m b L U o n , and t h ,
' T ' S ' h ve Mibtmtted to all sorts of
'
"'" L i v e and ofttimes super(on.plic^tcd.espcnsn
^
^
•if
s
l l i 0 S t
1 -
i
( l i r
: d u
KUXTKOC.MU.IOCIIAM
»
U
- » ^
5 r - c S
„f diagnosi..
I I - Ip , ! , . wbe e o I t
^ ver; suikin,
n
may he
S t t h ^ - e r
for h i
abacteriolopic exatnuudton
V
(
,
; ,
:
c
, ( , 5 C S
f
^
e
P^ormed
^
-
|
�HP
iC.VL SCIENCE
107
MEDICINE
ill) t l i e llior.'icoseope. This sometij,,,
Tinits direct visuidization of the ] ^
T purjioses of surgicnl evahifilion
j
npnosis. Hiopsy specimens may he oL
ined in this manner for liistojiatholop
d hacteriologic examination.
V. T H E ELEcmocAiiDKKJit.AM. ' j j , ^
occdure has very limited value j , ,
ignosing pulmonary lesions. As in
<e of cor iiulmonale, it freipiently ,
: u cardiac and pericardial c o m | i l i .
c
tilired, then a tesl dose of deep Roent* n rav therajiy is indicated.
Resjionse
^ ilii ; fcrm oh therapy is v e r y striking
' " ivinjihoblastoiniLs and its successful
s
a i ) (
jiatient susjiected of having a j i u l m o n a r y
disease nnd to place greater and almost
complete reliance on laboratory methods
of diagnosis. T h i s practice has reached
the point where only the more f o r t u n a t e
jiatients receive the benefit of even a
cursory jihysical examination, and this
after they have submitted to all sorts of
comjilicated, cxjiensive and ofttimes sujierIhious laboratory procedures. I n those i n stances where it i.s the added jiractice of
the jihysician to rely cm a clerical aid, a
technician, or a nurse to obtain the abbreviated f o r m - f i t t i n g history, thc jiatient
may not even see the doctor except to
hear the final cxjiensive verdict of the assembly line boss.
U n f o r t u n a t e l y , this
dejilorable trend not only destroys the
very valuable personal jiatient-jihysician
relationshij) on which the jiractice of
modern medicine is b u i l t , but is s u j i j i l y ing effective a m m u n i t i o n for the guns of
those who are blasting at our present
medical structure and demanding socialized medicine.
1
c
i f l i M i i " " is hoth therajieutie and dingn"^'
y
r
.
.\\(,io(:AItlil(i(:itAriIv. A n mtravenimracardiac injection of ti r;ii.li<i|H1*
istance will frctjucntly differenti^ | i " '
vascular tumors of the thorax f r o m
„[hrr jiulmonary lesions."
The diag^ ^ . [ i . of jiulmonary arteriovenous fistula
de established beyond (|iiestion by
,(Tf('t utilization of this jiroeedure. This
(linguo.-tie procedure is not without danger
j , , , ) requires highly trained technical
distance aud rather involved ajipara"
It is, therefore, not recommended
^ s routine procedure.
(
n r
F
r t
B t f
C8
41
and efTects of juilmonary disctise, but,
the investigation has been conducted
rectly and in logical order, the inforinv
n obtained f r o m the electroeardiogrni
1 be of confirmatory rather than diaj,.
tic importance. When the differential
gnosis rests between jiulmonary cmi. iii and coronary occlusion, however
nay be of real diagnostic value. I / n ,
tape i n (he jircsence of massive jileurn]
:sion is only of academic interest.
rtn
n
n
=
t u S
:
1
V. V E N O U S
ritEssi.'nE
'/.. F.xri.OKAT'-inv TIIOKACOK.I.MY.
A N D CHU.TLA.
N TIME.
I n the jircsence of cardiac
jre the venous pressure is commonly
ated. This is not usually the case in
nonary disease. On occasion, jirinmry
netastatic tumors in the (horax will
ract the venous return f r o m one jiatt
he body or another, but this is rartU
metrical as one would exjiect in enrdecomjiensation. This latter observj. '
i(>gether w i t h other available evie. such as collateral circulation, will
lly decide the issue.
e:?niiination of the circulation timt
•uimonary disease is of qucstionahlt
f although it is significantly prolonged
rany cases of anthracosilicosis. A
mged circulation time is a far more
.ant characteristic of cardiac decoraition than jiulmonary disease. 'Hie
u? pressure and circulation time rut
finite value in bcljiing to diffcrentint*
een cardiac- and jiulmonary discast
•s.-es.
6
T i i E i t A r E t T i c T E S T D O S E OF D c t r
.'TCEN R A Y T n E n . w y . I f a jnihnone=ion remains undiagnosed after all
ihle dingnostic jiroccdures have hern .
"'
•.•.•i.j^iiiMMfn.r'.T,-
n
'J'he foregoing considerations of the
manner in which diagnostic clinical and
laboratory jiroccdures are emjiloyed should
not be construed its an effort to minimize
the importance of these very valuable and
occasionally indisjiensable aids. On the
contrary, i t is felt that the correct diagnosis of many obscure jiulmonary eondilions
would be almost imjiossible, or never established, without readily available facilities for jierforming these examinations
when indicated. A f t e r the examiner has
obtained the history and conducted the
jihysical examination, in the manner jirev iously outlined, the selection of jiossibly
beneficial diagnostic jiroccdures is the next
logical and imj.iortant step in the diagnosis
of juilmonary disease. Investigation of
the illness in this scientific manner and
orderly sequence will result in a much
higher incidence of j i r o m j i t and correct
diagnoses.
The jiatient and jihysician
will both benefit f r o m this njijiroach to
the jiroblem.
Fewer laboratory procedures will be performed and more diag-
Some jiuhuonary diseases may he enniimtcred which will retjuire the sujijilementary utilization of other indicated and
highly specialized jiroccdures in order to
fstablish the correct diagnosis.
For exinijile, bronclmsjiirometiic studies, gastrC'Seojiie examination, determination of
the alkaline jihosjihatasc blood level, or a
retrograde Jiyclogram may lie necessary
tn establish the diagnosis in some instances.
To enumerate and discuss all these jiossibilities would be an almost imjiossible asfigninent. As a rule, intelligent utilization, correct interjiretation ;uid careful
.•election of indicated clinical and laboratory jiroccdures enumerated above will
l * rewarded by a jirompt and accurate
dmgnosis of existing pulmonary disease.
In recent years there has been a jierccjitible and annoying tendency among
s.'ine jihysicians to discredit the value of
the history and physical examination of a
.-3
'
r
Jf all
other examinations fail to establish the
ih.iL'iiosis, the jihysician is justified in
rrctniiincnding this diagnostic jiroeedure
».< the last resort in certain selected cases.
|
the hands of a comjietent thoracic
lurgeon this procedure carries no greater
risk than an exjiloratory lajiarotom.v aud
miiv eventuate in a cure.
;• -fr
H' !•- ill »"
1 1 1
"' " ^ ' " ^ T ?
• • 1 .''jv-',' ' ' J i T V - ' V - T ' '
r
l
"
:
r
" • " — T ' " T T - ' - r . >,-
;
;s ; — -
7
. - iT-TTTTTT *:
�If
It
m 9i
4
Mm
I'KOGIIEBS OF MEIUCAE SCIENCE
noses will lie innde. To render a patieht
the best possible service, the jihysician
must be thoronyhly familiar with and
willing to practice thc jirojier and accejitable methods of orderly investigation.
Summary. 1. The imjiortance of j
jirompt and correct diagnosis of puhnon.
ary disease has been emjihasized.
2. An orderly and scientific manner o|
iincstigation has been outlined.
The auttior wirtties u , express liis Riurnrc
ecitilinn to Or. M m t'inm>r of Borkr.toy, Catif^iTni^
nod Dr. l;iiwiird AV. Iluyus ot Moorovin. (.."Mliloniiu, (or their viiluuMe ntsiBtuiicc nod coiistructivt
criticiini in tlic jiruimrnlioli of this nmimscript.
KEIEUENCES
1
Is:
m
m
m
m
(1.) Aslun&n, R., and H u l l , E . : EssciitmU of E l t c u u c u i i l i o p r n j i h y . New Y o r k . M a c m i l l a n , lft41.
(2.) Barrett, N . R.: J. Thorur: S u i t . , fl. Hiil. I'.l.'IS. ( H i llnyil, W. C : I 'MI..Inn., n i h l n of I I I I I I I I I I I O I , ^ ,
//<'»• Y I . I I I . Iiilflni:i.:iii.i! I ' u M . . Itil.'J. (1.) JJrown, U . : ins. of l.'hesl. 11, .'.ill., ItM.'i.
(6.) Cajiuiro, F. Q.: Monivvidoo. Eersonul coniiiiiiiiicuiioii. (6.) Charr, R., nnd Riddle, R.: A M . J
M E D . Sen, 104, 602, 1937. (7.) Christie, A., and Peterson, J. C : A m . J. Tiib. Health. 35, 1131, ISMj'
(8.) Conant, N . F., M a r t i n , I ) . S., Smith, D . T., Baker, R. D., uud Callaway, J. L . : Mnrnml of C l i u i c j
Mycology, I'hila., launders. I'.Ml. (9.) Cnrnen, E. C , M i i i c k , Q. S., Z i t g l o r , } . E., Lewis, T., a j
Ilorafall, F. L . : J. Clu.. lii\x;st.. 21, L'O'J, 1(115.
(10.) De Abrsu, M.: His. of Chest, 11, (;39. I'-Ha. (11.) De Abreu, M.: Am. ll.-.v. Tulierc,
63.
57 0, IDlfi.
(12.) Desjardius,
A. U.: Am. J. Itocut lien, nnd It ad. Thci., 28, 701, I'.Ki'J. (13.)
DeBjardinij
A. D.: l)is. of Cheat, 11. 505, 1915. (14.) Dorbecker,
N.: InsLioite of Cariliolofty.
Mexico City, Per.
soiial comiminication.
(16.) Downey, H.: Ilundlxiok
of Ilen.utolocy,
New York, Hoeber, vol. 4, 19JS.
(16.) Dudgeon, L. 3., and Pa'.rick, C. V.: Hiit. J. Svng., 15, •j:.t). WW.
(17.) Fold, D. D . : Am. Hev. T u l i e r c , CO, 181, 11144. (18.) Fernandes, R.: Itio de Janeiro, Personal
commmiir.ation.
(19.) Qoldman. A . : Dis. ot Chesl, 9, -Wtl. 1913.
(20.) Habeeb, W . J.: A m . Hev. T u b e r c . 52. 337. 1915. .21.) Holinger, P. H . : Dia. of Cliest. 11,
427, 1915. (22.) Holinger, P. H . , and Hara, IE J.: Ann. Olol.. l i h i n o l . nnd Laryngol., 62, 53K, 1943.
(23.) Jones, J. C , and Thompson, W. P.: J. Thorur.. Sing.. 13, 357, 1914.
(21.) Karpel, 8., Waggoner, I . M . , and M c C o w n , O. S.: Ann. I n t . Me.I.. 22. 4()S. I'.IIS. (25.) KrackB,
R. R.: Dirminghnm, Ala., Tersonul coinmunicution.
(2G.) Martin, D. S., and Smith, D . T . : A m . Hev. Tubei c. 39. ISS, 1939. (27.) M a t s u t a w a . D.:
C^mut. Dull.. Sea View Host... 4. L'SC, 1939. (28.1 Mclnto.ih, H . C : ltii<li..l.^y. 23, 55S, 1931. (29.;
Moiklejohn, 0., Eaton, M . D., and van Herick, W . : J. Clin. Inve.a., 24, 211. 1915.
(30.) Ochsner, A., and DeBakoy, M . : I lib. of Chest., 11. 97, 1915. (31.) Olaen, A. M . , and Wilson,
Q. T . : J. Thome. Surg . 13. 53, 1944. (32.) Ornstein, (3. Q., and Herman, M . : Dis. of Chest, 12, 1,
1U1G.
(33.) OTerholt, R. H . : Dis. of Cliust, 9. 197, 19i:i.
(34.) Palmer, C. E.: I'nb. Ileultli Ken., CO, 513, 1915. (35.) Pemlergass, E. P., and White, G.:
Am. J. Roentgen, and Had. Tlier., 59, 491, 1913. (36.) Peterson, O. L . , nnd Finland, M . : M e d . Clin.
N u i t h Auieriea, 27, 1291, 1913.
(37.) Poulaen, V., nnd Amlersen, A. O . :
A m . J. Mis. Child., 43,
307, 1931.
(33.) Robb, Q. P., and Steinberg, I . : .1. A m . Med. Afsn., 114, 474, 194(1. (39.) Robinson, 3. L . , and
D u a n , W. T . : A m . Rev. Tnt.orc., 47. 413, 1913.
(40.) Smith, C. E.: Med. Clin. North America, 27, 790, 1913.
(41.) Taylor, H . K..: Dis. of Chest. 11, (121. 1915. (42.i Turner, R. W . D . : Luncet, 248, 493. 1945.
(43.) Van Pernis, P. A., Benson, M . E., and Holinger, P. H . : J. Am. Me l . Assn.. 117. 43G. 1911.
(44.) Warren, S., and Spencer, J.: A m . J. Itoentgen. and Had. Thcr., 43. (',S2, ItHO. (46.) W o l p a » ,
S. E., Higley, C. S., nnd Hauaer, H . : A m . J. Hoenlgen. and Hud. The.-.. 52. 374, 11)14.
(4S.) T o u n j , L. Y., Storey, M . , aud Redmond, A. J.: A M . J. M E D . SCI.. 206, 750. 1013.
(47.) Zinsser, H . , and Bayne-Jonos, S.: 'I'eitbook of Bacterir.lucy, New Y o r k . Anplcuin-Ccntury,
1937.
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Physician Letters] [loose] [11]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-006-007-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/c60738afb46b69eea77289589931c346.pdf
211e3c090d52b88b5481669eb0c07c64
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
2385
OA/ID Number:
FolderlD:
Folder Title:
[Physician Letters] [loose] [10]
Stack:
Row:
Section:
Shelf:
Position:
S
56
3
4
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPK
SUBJECT/TITLE
DATE
RESTRICTION
001. letter
Address (Partial); Phone No. (Partial) (1 page)
01/23/1993
P6/b(6)
002. letter
Personal (I page)
04/01/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [10]
2006-0885-F
im780
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)]
PI
P2
PJ
IM
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAj
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute |(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confitleiitial advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. letter
SUBJECT/TITLE
DATE
01/23/1993
Address (Partial); Phone No. (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [10]
2006-0885-F
jm780
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
PJ Release would violate a Federal statute |(a)(J) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(J) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(J).
RR. Document will be reviewed upon request.
�HOUSE OF DELEGATES
WEST VIRGINIA
LEGISLATURE
STATE CAPITOL — PHONE (304)
CHARLESTON
JOHN C. H I N'TWORK. M.D.
oo
P6/(b)(6)
January
23,
34O-32O0
25305
Committees:
Judiciiry
P n l i t i n l Subdivisions
Roads & Transportation
1993
First Lady Hillary
The White House
Washington, D.C.
Clinton
Madame First Lady:
I am glad you will be charting America's health care future. Your obvious ability, your record on
social issues, your unique position, the mandate of the recent election and the growing cost crisis in our
health care system have created an historic opportunity for health care reform. I do not believe that you
will waste this window of opportunity on cosmetic changes.
As a doctor, a Democrat and a member of the West Virginia Legislature, I have written the
enclosed health care cost control bill, which I immodestly commend to your consideration as a model for
real cost containment in any health care reform.
I know this bill is imperfect. It is not supported by any organized medical group. Major issues
such as the control of obscene drug prices, th^ creation of a "single payor" insurance system, community
premium ratings, etc.. which are necessary and inevitable at the national level, are ignored in this statelevel reform proposal.
However, this bill h a s the virtue that it e x p o s e s the r o o t s of
innappropriate health care c o s t s .
P r e o c c u p a t i o n with " m a x i m i z i n g the f i n a n c i a l c o n s e q u e n c e s of patient c o n t a c t " - a euphemism for "running up the patient's bill" which I picked up at an office management s e m i n a r - i s
pervasive.
T h e i n c e n t i v e s driving our health c a r e s y s t e m are f u n d a m e n t a l l y
corrupt.
Until they c h a n g e , nothing will c h a n g e .
I have lived and worked within this system for 25 years. I know that surface changes related to
financing m e c h a n i s m s , global budgets, etc. are needed and may temporarily cap the national health care
bill, but the health care system will remain a "whited sepulchre." In my opinion, the outcome of such
changes, if e n a c t e d without raising the nation's health-consciousness and without mitigating the financial
corruption of doctor-patient and provider-insurer relationships, will be declines in health and chaos in
health care s e r v i c e s .
Incidentally, my twin brother, Jim Huntwork, and his wife Patty (nee Patience Tipton), are both
Yale Law Grads (class of 71).
Perhaps you were contemporaries.
Sincerely,
John C. Huntwork, M.D.
�HEALTH CARE COST CONTROL ACT OF 1993
BILL SUMMARY
The center of the
b u s i n e s s ; c o s t denies
health care storm is cost: cost
care; cost restricts s e r v i c e s .
hurts
What could create more West Virginia jobs than an advantage over
other states in the cost of health benefits?
But, the savings must be real. Skimpy benefit packages and inferior
health care services only shift costs and leave people sick; they do not
lower total health care costs. Only a healthier population and a more
efficient health care delivery system can lower costs without sacrificing
the quality of care.
This bill seeks to reduce health care costs by promoting healthy
lifestyles, by eliminating improper incentives for health care providers
and by eliminating waste and abuse, measures that will determine the
success of any system of health care financing.
Initiatives related to the financing of health care, such as the
creation of a "single payor" insurance system or the support of employee
health benefits through broad-based taxation, however meritorious, are
consciously avoided in this act.
Every interest group, including the general public, gives up
something, but gains something, in this bill.
The public is asked to give up poor health habits and imprudent or
redundant health care spending, but it is rewarded with better health,
lower costs, new health care options, new remedies for poor care, a
properly motivated provider and hospital system, and a healthier economy.
�Health care providers give up their high fees for procedures and the
profits from the tests and services which they order, and they are
subjected to the investigation of consumer complaints, reporting
requirements for restricted procedures, and set fees, but they are
rewarded with less bureaucracy, less preauthorization, lower malpractice
costs, less managed care and relief from "economic credentialing."
Hospitals are stripped of the preposterous incentives that have led
to overbuilding, overborrowing and overdiversification. Their boards of
directors are subjected to conflict-of-interest standards.
But, they are
rewarded with less competition for profitable outpatient services.
Health insurers' profits and overhead are reduced dramatically by
this proposal, but they are given a chance to stay in business if they can
at least approach the efficiency of a state-run, single payor system.
Lawyers, like doctors, lose income in this proposal, but patients
injured by medical malpractice will keep more of their awards, and bona
fide malpractice victims will have the benefit of an objective state
agency to support their claims, while good health care providers will
know that objective reviewers will report to the jury.
The new penalties for poor or wasteful health care providers are
substantial: new ways to redress substandard care; loss of prerogatives or
even licensure for non-compliance; heavy fines for those who neglect the
requirements created by this act.
Finally, this proposal has the advantage that it does not "reinvent
the wheel."
The primary administrative agency, HCCRA, already exists.
The time-tested role of our county boards of health is expanded and
enhanced; they are not scrapped for a vague and untried concept.
This bill is an honest effort to control unproductive health care
costs, to improve West Virginia's business climate and to free the vast
sums of money now being squandered on inappropriate health care
spending so that we can better provide for the genuine health needs of our
people.
�HEALTH CARE COST CONTROL ACT OF 1993
BILL OUTLINE
Section
Section
Section
Section
1:
2:
3:
4:
Title
Scope and Purpose
Legislative Findings
Definitions
Section
5:
Health
A.
B.
C.
Section
A.
Care
Cost
Review
Authority
Expands rights and prerogatives
Creates Medical Advisory Committee
Establishes insurer and provider tax to fund program
6.
Incentives
to
modify
unsafe
behavior
B.
Seat belt law
1. Misdemeanor offense: $25 fine
2. Contributory negligence
No smoking in public places
C.
Insurance rebates and board of health role in wellness
Section
A.
B.
C.
Section
A.
B.
C.
Section
7.
Standard
fee
and
payment
schedules
Provider fee schedules and insurer pay schedules created
Circumstances where scheduled fees are mandatory
Reporting of fees and payments to consumers
8.
Malpractice
reform
Consumer reporting, mandatory investigation of substandard care
Medical Liability Review Commission Created
Procedural changes
9.
Prioritization
of
spending
A. Mandatory standard health benefits plan
B. Enumeration and reporting of restricted procedures
�Section
A.
B.
C.
Section
10.
Providers'
conflicts
of
interest
prohibited
Elimination of contingent fees and economic credentialing
Physician self-referral prohibited
RBRVS payment schedule; reduced incentives for procedures
11.
Health
insurance
overhead;
guaranteed
A.
ratios
Insurance profits and overhead restricted to 10%
B.
loss
Guaranteed loss ratio increased to 90%
Section
12.
Hospital
reimbursement
rates
A. Universal DRGs
B. Payment rates set by HCCRA
C.
Section
Variation in payment rates greatly limited
13.
Hospital
boards
of
directors
restricted
A.
Control of hospital finances to be maintained by board
B.
Conflicts of interest of board members restricted
Section
A.
B.
C.
D.
Section
A.
14.
Control
of
duplicative
services
Consumer designation of primary care provider
Penalties for use of multiple providers
Choice of primarily medical or primarily chiropractic coverage
Non-payment for repetitive diagnostic tests
15. Profits from health care ventures controlled
Reporting of equipment ownership based on fees received
B. Charges for services to be determined by HCCRA
Section
16.
Advertising
of
health
care
services
A.
B.
Section
Definition of appropriate subjects for advertising
Disapproval criteria
17.
Civil penalties for violations
restricted
�ARTICLE 29E
THE HEALTH CARE COST CONTROL ACT OF 1993
16-29E-1.
TITLE
This article shall be known and may be cited as the Health Care Cost
Control Act of 1993.
16-29E-2.
S C O P E AND PURPOSE
(A)
It is the intent of this act to control expenditures on health care in
West Virginia to the extent possible without compromising the quality of
health care, the availablity of health care or the actual health of West
Virginia's residents and citizens.
(B)
The scope of this act shall be the identification and mitigation of
any and all expenditures on health care and/or related goods and services
which, without significantly improving the quality or availability of
health care services or the actual health of West Virginia's citizens,
increase the total cost of health care in West Virginia.
16-29E-3.
LEGISLATIVE
FINDINGS
The Legislature finds and declares as follows:
(A)
Access to high-quality, affordable, basic health care is a right of
every citizen and a primary concern of public policy.
(B)
West Virginia's health care, and consequently the health of West
Virginians, is in jeopardy due to the following factors:
(1)
The spiraling aggregate cost of health care services.
(2)
The high demand for health care services.
(3)
The unavailability of affordable health insurance
coverage for many West Virginians.
(4)
The inaccessibility of health care services.
�(5)
The state's high proportion of uncompensated and
undercompensated health care
( C ) Although the price of specific health care services in West Virginia
may be lower than national averages, high health care costs nevertheless
contribute to the following significant hardships for our people,
government and economy:
(1)
Health insurance is increasingly unavailable and/or
unaffordable to the people of West Virginia.
( 2 ) Uninsured or underinsured health care services often
result in financial catastrophe for West Virginia's families.
( 3 ) The deferral of needed health care services and/or
preventive health care contribute to an increased incidence of
marginal to poor health among West Virginia's citizens.
( 4 ) An increasing and unmanageable burden on the state
budget due to health care costs has resulted in higher taxes and
reduced government services for the people of West Virginia.
( 5 ) The increasing cost of employee health benefits erodes
the competitiveness of West Virginia's industries, jeopardizing
jobs.
( 6 ) The increasing cost of health care benefits erodes the
disposable income of West Virginia's employees, retarding economic
development.
( D ) The following factors, which add to the cost of health care without
significantly improving the quality thereof or access thereto, must be
reduced to the extent possible:
( 1 ) Overutilization of health care services due to the poor
health habits of West Virginia's citizens.
�( 2 ) Overutilization of health care services due to
inappropriate provider incentives.
( 3 ) Overutilization of health care services due to an absence
of appropriate consumer restraints.
( 4 ) Overutilization of health care services due to tortconscious medical decisions.
(5)
Inappropriate allocation of health care resources
due to an absence of spending priorities.
(6)
Irrational valuation of health care services, rewarding
resource-intensive procedures substantially more than less costly
cognitive and primary care services.
(7)
Excessive administrative costs, advertising and profits
in the health insurance and hospital industries.
(8)
Excessive costs due to unnecessary bureaucracy,
overregulation and redundancy throughout the entire health care
system, both public and private.
(9)
Excessive incomes of certain workers in health-related
fields, including many insurance company employees, many
hospital administrative personnel and many health care providers.
( 1 0 ) Overlapping and redundant services being provided by
practitioners in different, often competing, health care disciplines.
( E ) A reduction of the unproductive health care costs identified above
would be desirable regardless of the method by which health care may be
financed, a separate matter requiring the attention of the Legislature of
West Virginia and the Congress of the United States.
�(F)
Since the first and foremost cause of health care expenditures is
impaired health, to the extent that good health can be maintained or
restored by legislation relating to the physical, mental, environmental, or
social condition of the people of West Virginia, or affecting their healthrelated behavior, it is appropriate for the legislature to act thereon,
within the framework of the constitution.
(G) Under current circumstances, "market forces" which might
moderate the cost of health care rarely exist. Virtually all health care
expenditures result from the decisions of health care practitioners acting
with the consent of their patients. While most health care decisions are
wisely and appropriately made in other respects, they are generally made
without consideration of cost, because health care practitioners usually
have neither incentive nor sanction to make cost a priority and because
patients often lack the incentive and/or the knowledge to participate in
cost-conscious decision making. To reduce health care costs, a costcompetitive health care marketplace must be created at the primary care
level, and, whenever practicable, providers and patients must be
empowered and expected to make cost-conscious health care choices.
( H ) An inherent conflict of interest exists when a health care provider
refers a patient to an entity in which the health care provider has an
ownership or profit-sharing interest, or, conversely, when a provider is
financially rewarded for withholding services. For cost control to become
a consistent and appropriate consideration in medical decisions, the
incentive for providers to favor one course of action over another based on
greater financial reward must be eliminated.
(I)
Under certain circumstances, where it is inappropriate or
unrealistic for patients to consider cost in the choice of health care,
public policy should protect health care consumers by means of a binding
fee schedule. Examples of such circumstances are:
(1)
In true emergencies, where time rather than cost should
dictate health care choices.
�(2)
In the pricing of hospital-based ancillary services,
where patients have no meaningful control over the choice of
laboratory, x-ray and other services.
(3)
In the care of those patients who, because of age or
mental status, are incapable of making appropriate cost-based
health care choices.
(4)
In the care of those patients for whom, because of
poverty or other hardship, any significant cost would be an obstacle
to health care.
(J)
Existing policies regarding medical malpractice neither adequately
reduce the incidence of substandard health care services nor reliably
identify and sanction substandard health care practitioners. Moreover,
they have raised the aggregate cost of health care by creating a climate in
which health care services are often performed to ward off malpractice
claims rather than to provide optimum patient care and they have
restricted the availability of many important health care services by
making the practice of certain "high-risk" health care specialties
financially and/or emotionally untenable. The following are ways in
which the legislature can protect the public interest in affordable,
available health care without restricting the right of a party injured by
negligence or incompetence to be fully compensated for their loss:
(1)
Create mechanisms to penalize patterns of substandard
health care rather than catastrophic instances thereof.
( 2 ) Create an advisory panel to present independent
information and opinions to juries in malpractice cases.
( 3 ) Limit non-economic damages to $250,000.00, except for
gross negligence or intentional injury.
(4)
Require that economic damages be reimbursed as they
are incurred, not "before the fact" or in a lump sum.
�(5)
Restrict attorney's fees to a maximum of 25% of monies
awarded if a tort-related liability claim is adjudicated at trial, and
a maximum of $10,000.00 if a case is settled before trial.
( 6 ) Establish that no person be required to pay a greater
percentage of a liability award than the percentage of actual
liability for the injury attributed to that person by the jury.
(7)
Establish that "punitive damages" be paid into the West
Virginia fund for victims of crime, rather than to the plaintiff in a
specific case.
( 8 ) Assure that collateral sources of compensation be
considered in awarding economic damages.
( K ) However distasteful they may be, limitations on access to health
care exist in some form in every society, under every health care system.
Access may be limited inappropriately by individual patients' ability to
pay, by a scarcity of certain services, and/or by overt rationing, or
appropriately by the rational prioritization of health care services based
on costs and benefits. Unless public policy requires that health care be
made available to all according to a rational assessment of the costs and
benefits of specific services, the ability of individuals or communities to
pay for health care services will continue to determine their availability.
(L)
The traditional valuation of health care services creates incentives
to perform high cost, hospital-based procedures rather than cognitive and
primary care services. The need for an immense bureaucracy devoted to
preauthorization of services, utilization review and the like results in
large part from this fact. It is imperative that a payment scale be
adopted which eliminates the financial incentive to perform procedures.
Eliminating the major cause of unnecessary procedures would reduce the
need for a major part of the massive health care bureaucracy.
�( M ) The profits, salaries and overhead of health insurance companies,
hospital corporations and other profit-oriented health care ventures have
become a substantial factor in the aggregate cost of health care. In
addition to higher cost, other pervasive problems which result from the
application of traditional business concepts to health care include:
( 1 ) Marketing and advertising which create inappropriate
demand for, unrealistic expectations of, or misconceptions about
health care services.
( 2 ) The avoidance of responsibility for poorly remunerative
patients or services.
( 3 ) Competition for patients, facilities and services based
on profitability rather than community need.
( 4 ) A pervasive focus on the financial consequences of
health care rather than the welfare of patients.
( N ) Those profits which result from efficiency, economy or productivity
are appropriate in health care and related services, but those profits
which result from misinformation, from the artificial creation of demand,
from the avoidance of community responsibility, from monopolistic
practices or from strategies that select financially rewarding patients or
services are not.
(O) The redundant oversight of health care by overlapping peer review
organizations, private and public inspection agencies, utilization review
standards, multiple insurance companies and the like create waste,
duplication, inefficiency and instances of poor patient care throughout the
health care system. To the extent possible, these services should be
combined and simplified.
�8
( P ) It is in the public interest to maintain regulated competition in
health care, both between different types of health care, such as
chiropractic versus allopathic medical care, and between practitioners
offering similar health care services. However, the costly practice of
freely and/or simultaneously utilizing competing health care services or
health care disciplines must be curtailed.
(Q) Therefore, whereas the purpose of this enactment is to provide for a
comprehensive resolution of the matters set forth above, the Legislature
has determined that, insofar as they relate to or otherwise affect the
overall cost of health care for the people of West Virginia, changes in the
laws regulating health insurance and the health insurance industry, the
laws regulating hospitals and the hospital industry, the laws regulating
various classes of health care providers, the laws regulating third-party
payment for certain health care services, the laws regulating the extent
and nature of profits which may derive from investment in health-related
ventures, the laws regulating the public behavior of West Virginia's
citizens as it relates to identified health care risks, the laws regulating
the pattern of utilization of health care services as it relates both to the
decisions of health care providers and those of the public-at-large, and
the common law and statutory rights and procedures under which our
citizens may seek compensation for health-care-related injuries and
death must be enacted together as necessary, mutual and synergistic
components of the appropriate legislative response.
16-29E-4.
Definitions
As used in this article:
(1) " A n c i l l a r y hospital s e r v i c e s " means those hospital services such
as clinical laboratory services, diagnostic imaging services,
electrocardiography and other similar diagnostic services which are not
directly therapeutic in nature but which are necessary to allow and
support direct patient care.
(2) " B a l a n c e b i l l i n g " means to submit a bill of charges for medical
services which are greater than the amount allowed or established in the
standard provider fee schedule created pursuant to section 7 of this act.
�(3) " B a n k " means an institution for the custody, loan or exchange of
money and regulated under the banking laws of one of the several states of
the United States.
(4) " B o a r d " means the West Virginia Health Care Cost Review Authority.
(5) " B o a r d of d i r e c t o r s " , in reference to hospitals, means that group
of people, defined according to the separate bylaws of various hospitals,
who exercise supervisory and managerial powers over a hospital and its
employees.
(6) "CPT c o d e s " means current Common Procedure Terminology codes.
(7) "Calendar year" means a period of a year beginning with January 1,
and ending with December 31.
(8) " C h i r o p r a c t i c p h y s i c i a n " means a practitioner of chiropractic
licensed by, or eligible to be licensed by the West Virginia board of
chiropractic examiners.
(9) " C o - p a y m e n t " means a payment for health care services made by the
recipient of such services which is over-and-above that payment made by
a health insurer, up to the standard provider fee schedule established
pursuant to Section 7 of this act.
(10) " C o g n i t i v e s e r v i c e s " means activities related to health care
which require medical knowledge or skill but which do not involve the
performance of an identifiable diagnostic test or therapeutic procedure.
(11) " C o l l a t e r a l s o u r c e " means any individual, organization,
government, governmental subdivision or agency, or any other legal entity
that has compensated a claimant for injuries for which the claimant is
alleging damages due to medical professional liability.
(12) " C o m m i s s i o n " means the Medical Liability Review Commission
established pursuant to Section 8 of this act.
(13) " C o n t i n g e n t f e e s " means fees for services which are dependent or
conditioned on the outcome of an action.
(14) "Cost of L i v i n g " means the cost of purchasing those goods and
services which are included in an accepted federal or state index of
consumption.
(15) " D R G " means diagnosis-related group
(16) "DRG payment schedule" means a prospective payment schedule
for inpatient hospital services in which uniform reimbursement rates are
set for diagnosis-related groups, based on average costs, resource
consumption and length-of-stay patterns.
�10
(17) " D i a g n o s i s related g r o u p " means one of a comprehensive
classification of groups of patients based on diagnosis, resource
consumption and length-of-hospital-stay patterns.
(18) " D i a g n o s t i c p r o c e d u r e " means a health care service which is not
directly therapeutic in nature, but the purpose of which is to provide
information regarding the nature of a health problem or to monitor a
course of treatment.
(19) " E c o n o m i c d a m a g e s " means the full value of all money, property,
or income lost or expended as the result of an injury, plus interest on such
losses from the time such loss occurred, plus the present value of all
future lost income or expenses related to such injury.
(20) " F a m i l y p r a c t i c e " means that health care specialty defined and
certified by the American Academy of Family Practice.
(21) " H C C R A " means the West Virginia Health Care Cost Review
Authority.
(22) " H M O " means a health maintenance organization.
(23) "Health care d i s c i p l i n e " means a distinct category of health care
theory and practice, such as Nursing, Allopathic medicine, Osteopathic
Medicine and Chiropractic.
(24) " H e a l t h maintenance o r g a n i z a t i o n " means a prepaid health care
plan operating pursuant to Chapter 33, Article 25A of this code.
(25) " H o m e health s e r v i c e s " means in-home health care provided for
home-bound patients by employees of home health agencies.
(26) " I m a g i n g p r o c e d u r e " means a diagnostic procedure intended to
provide information in visual form regarding the presence or absence of
abnormal anatomic or physiologic conditions.
(27) " I m m u n i z a t i o n " means the administration of vaccines or other
measures to create a condition of immunity or resistance to infections or
infectious diseases,
(28) " I n c e n t i v e " means something which tends to incite or to influence
actions.
(29) " I n d i c a t i o n " means a specific circumstance that makes or tends to
make a particular medical decision or action necessary or advisable.
(30) " I n p a t i e n t h o s p i t a l s e r v i c e s " means health care services which
are provided to a person who has been admitted to and is under the
observation and care of a licensed hospital.
(31) " I n s u r a n c e c o m m i s s i o n e r " means the Insurance Commissioner of
West Virginia.
�11
(32) " I n s u r e r " means any entity transacting individual or group health
and accident insurance pursuant to Chapter 33 of this code.
(33) " I n t e n t i o n a l " means done voluntarily, purposefully and by design
(34) "Internal m e d i c i n e " means that medical specialty defined and
certified by the American Board of Internal Medicine.
(35) " I n v e s t m e n t i n t e r e s t " means ownership or partial ownership,
except ownership of registered securities and/or shares of publicly owned
corporations.
(36) " L a b o r a t o r y t e s t " means a diagnostic procedure generally
performed by a clinical laboratory.
(37) " L o s s r a t i o " means the ratio of incurred claims to earned
premiums.
(38) " M a l p r a c t i c e " means medical professional liability.
(39) " M a l p r a c t i c e carrier" means an insurer indemnifying against
losses for medical professional liability.
(40) " M e d i c a i d " means the federal medicaid program and any state
agencies or programs created pursuant thereto.
(41) " M e d i c a l advisory c o m m i t t e e " means that committee created
pursuant to Section (5) (B) of this act.
(42) " M e d i c a l p h y s i c i a n " means a medical doctor licensed by, or
eligible to be licensed by the West Virginia Board of Medicine.
(43) " M e d i c a l p r o f e s s i o n a l l i a b i l i t y " means any liability for
damages resulting from the death or injury of a person for any tort or
breach of contract based on health care services rendered, or which should
have been rendered, by a health care provider or health care facility to a
patient.
(44) " M e d i c a r e " means the Federal Medicare program.
(45) " N e g l i g e n t " means marked by neglect or carelessness.
(46) " N o n - e c o n o m i c l o s s " means losses including, but not limited to,
pain, suffering, mental anguish and grief.
(47) " N o n - p r o f i t h o s p i t a l " means a hospital organized and licensed as
a non-profit hospital or hospital corporation.
(48) " O b s t e t r i c s " means that medical discipline dealing with
pregnancy, labor and delivery and generally defined and certified by the
American Board of Obstetrics and Gynecology.
(49) " O p e r a t i o n " means a surgical procedure carried out on a living
body, generally involving the use of instruments, anesthesia and sterile
technique.
�12
(50) " O p e r a t i v e p r o c e d u r e " means an operation.
(51) " O s t e o p a t h i c p h y s i c i a n " means a practitioner of osteopathic
medicine licensed by, or eligible to be licensed by, the West Virginia
Board of Osteopathy.
(52) " P e d i a t r i c s " means a health care specialty dealing with the health
care of children, and generally defined and certified by the American
Board of Pediatrics.
(53) "Peer r e v i e w " means critical review of the medical records or the
services of health care providers by similar providers who were
uninvolved in those records or care.
(54) " P h y s i c a l t h e r a p y " means that health care practice dealing with
the evaluation and treatment of disease processes and trauma by the use
of physical agents, the education for which is generally defined and
certified by the American Physical Therapy Association.
(55) " P r a c t i t i o n e r " means a person providing health care services.
(56) " P r e a u t h o r i z a t i o n " means prior approval.
(57) "Present value of future d a m a g e s " means an estimation of
future losses resulting from an injury, assuming that their dollar value
will remain constant.
(58) "Primary care" means a health care service dealing with a wide
range of common health care problems, and serving as a source of referral
when specialty health care services are necessary.
(59) " P r i m a r y care p h y s i c i a n " means a physician providing primary
care services.
(60) "Primary care provider" means any health care provider engaged
in primary care services.
(61) " P r i v i l e g e " means permission granted to a health care practitioner
to render specific patient care services in a hospital, including access to
the hospital, its facilities and personnel.
(62) "Probable c a u s e " means facts or circumstances that would lead a
reasonable person to conclude that a charge or accusation is well-founded.
(63) " P r o c e d u r e " means a specific, defined health care service.
(64) " P r o f e s s i o n a l s e r v i c e " means a procedure or function performed
by a licensed health care provider in the course of practicing his or her
profession.
(65) " P r o g r e s s i v e c o p a y m e n t s " means a schedule of copayments
whose dollar amount becomes greater with increasing personal income.
�13
(66) " P r o v i d e r " means a licensed health care practitioner performing
medical procedures and services.
(67) " P u b l i c r o a d w a y " means any road or right-of-way accessible to
members of the general public.
(68) " P u n i t i v e damages" means exemplary or vindictive damages
awarded against a party in a civil action to penalize egregious behavior
and to provide deterrence against similar future conduct by any party.
Punitive damages do not include damages awarded for injury or loss.
(69) " R a d i a t i o n t h e r a p y " means that medical practice dealing with the
treatment of disease by means of radiation and radioactivity.
(70) " R e b a t e " means a return of part of a payment, specifically a return
of part of a health care premium in return for healthy behavior.
(71) " R e h a b i l i t a t i v e s e r v i c e s " means health care services involving
multiple health care providers and disciplines in a single setting for the
purpose of assisting patients to recover independence after catastrophic
injuries or diseases.
(72) " R e i n s u r a n c e " means insurance purchased by an insurer to
indemnify that insurer against unanticipated losses due to claims made.
(73) " R e s p o n s i b l e p r o v i d e r " means that health care provider who
made the decision to perform a restricted procedure.
(74) "Seat belt" means a system of straps or other restraints designed
to reduce injury in case of a motor vehicle accident, approved for that
purpose by the National Highway Traffic Safety Administration, and used
according to the manufacturer's instructions.
(75) "Severity of d i s e a s e " means a degree of illness creating an
atypical consumption of services or length-of-stay.
(76) "Single payor" means a government agency acting as a single
state-wide insurer.
(77) " S k i l l e d n u r s i n g s e r v i c e s " means a level of nursing care
requiring the services of professional licensed and registered nurses.
(78) " S p e c i a l t y s e r v i c e " means a health care service intended to
provide care for particular types of patients or diseases, or to perform
particular health care procedures.
(79) " S t a t i s t i c a l r e c o r d s " means collections of numerical or
quantitative data and the mathematical analysis thereof.
(80) "Standard f e e s " means fees established pursuant to Section 7 of
this act.
�14
(81) " S u b s t a n d a r d c a r e " means health care which does not exhibit that
degree of care, skill and learning required or expected of a reasonable,
prudent health care provider in the profession or class to which the health
care provider belongs, acting in the same or similar circumstances.
(82) " S u r g e r y " means that specialty of medicine concerned with
diseases and conditions requiring or amenable to operative procedures.
(83) " S u r g i c a l " means of or pertaining to surgery.
(84) "X-ray s t u d i e s " means diagnostic imaging procedures involving
the use of X rays.
16-2 9 E - 5 .
HEALTH C A R E COST REVIEW AUTHORITY
( A ) In addition to its rights and duties under Chapter 16, Article 29B of
this code, the West Virginia health care cost review authority, hereinafter
referred to as the board or as HCCRA, shall assume the rights and duties
created under this act. Unless specifically so stated, the additional
requirements of this act shall not in any way modify the existing
activities, procedures or obligations of the board.
( B ) The HCCRA medical advisory committee is hereby established.
The
HCCRA medical advisory committee shall consist of seven members, all of
whom shall be health care providers licensed to practice in the State of
West Virginia. One such member shall be selected by the Dean of the West
Virginia University School of Medicine, one shall be appointed by the Dean
of the Marshall University School of Medicine, one shall be appointed by
the Dean of the West Virginia School of Osteopathic Medicine, one shall be
appointed by the West Virginia State Medical Association, one shall be
appointed by the West Virginia Osteopathic Association, and two shall be
appointed by the board.
The board shall consult with and receive the opinion of the medical
advisory committee prior to taking action on any matter for which that
committee's advice is required under this act.
Actions or policies established by HCCRA in accordance with this
act shall be consider rules subject to the provisions of Chapter 29A,
article 3 of this code.
�15
( C ) The additional funding requirements created by this act shall be met
by an assessment on the health care providers, accident and sickness
insurers and health maintenance organizations regulated herein, on a pro
rata basis using the gross revenues of each provider and insurer. The
amount of this assessment shall be determined by the board, but in no
case shall any obligation exceed one tenth of one percent of the gross
revenues of any entity. Such fees shall be paid to the State Tax
Department on or before the first day of July in each year and shall be
deposited into that special fund designated as the "health care cost
review fund," with the monies so collected being expendable after
appropriation by the legislature for purposes consistent with this article.
The State Tax Department shall make such deposits as an aggregate
and shall not disclose or make public the separate payments or gross
revenues of the providers regulated under this article.
16-29E-6.
(A)
INCENTIVES TO MODIFY UNSAFE BEHAVIOR
Seat belt use mandatory.
( 1 ) No person may operate a motor vehicle on a public roadway
within the State of West Virginia unless each occupant of that vehicle is
wearing a seat belt or is otherwise protected by a passive restraint
device approved by the National Highway Traffic Safety Administration,
except as provided in subdivision (4) of this subsection.
( 2 ) A person operating a motor vehicle in violation of this
subsection shall be guilty of a misdemeanor and upon conviction thereof
shall pay a fine of $25.00. This subsection shall not be enforced unless a
vehicle is stopped because of a separate moving violation or is involved in
a motor vehicle accident in which a person is injured.
�16
(3)
In a motor vehicle accident in which a person not wearing a
seat belt is injured, except as provided in subdivision (4) of this
subsection, the failure to wear a seat belt shall be considered an act of
negligence and a cause of injury separate and distinct from the cause of
such accident. The purpose of this paragraph being to discourage the
negligent failure to wear a seat belt, and to place the financial and other
consequences for such negligence upon the responsible negligent party, it
is hereby stipulated that, unless they are one-and-the-same person, the
person responsible for the occurrance of an accident and the person
responsible for the failure of an injured party to wear a seat belt shall
not be considered joint tort feasors or be in any other way financially coresponsible for the separate financial obligations specified below.
Therefore, although an injury or injuries sustained by a motor vehicle
passenger not wearing a seat belt may be single and indivisible, financial
responsibility for such an injury or injuries is deemed to be multiple and
divisible, and shall be determined, divided and assigned as follows:
( a ) The total monetary damages resulting from such injury
or injuries shall be determined and the sum of $5,000.00 shall be
subtracted from the total so determined. This sum shall be the
responsibility of the injured person and no third party payor shall be
obligated to reimburse the injured person for the initial $5,000.00
in damages.
( b ) If any monetary damages remain after step (a) above, the
amount shall be determined by which the injury or injuries so
sustained would probably, though not necessarily, have been
mitigated or prevented if the injured person had been wearing a
seat belt. In making this determination, averages from similar
accidents, other applicable statistical data and pertinent expert
testimony shall be considered.
(c)
The balance of damages, if any, remaining after step (a)
above shall be reduced by the amount determined in step (b) above.
�17
( d ) The amount of liability remaining after step (c) above, if
any, is the amount which is due to the accident per se and shall be
the obligation of the person or persons whose negligence caused the
accident in which the injury or injuries were suffered.
( e ) The first $5,000.00 of damages, as specified in step (a)
above, plus the amount that seat belt usage would probably have
reduced damages, as determined in step (b) above, shall be the total
amount of liability for the injury or injuries due to the failure to
wear a seat belt, and shall be the obligation of the injured person,
or of the person financially responsible for the actions of the
injured person if the injured person is other than a competent adult.
(4)
Under the following circumstances, the failure to wear a seat
belt shall be neither a violation of this act nor an act of negligence
subject to the provisions of subdivision (3) of this subsection:
( a ) If a passenger has a bona fide medical condition which
reasonably prevents the wearing of a seat belt, the failure of that
passenger to wear a seat belt shall not be a violation of this act,
nor, if that passenger is injured in a motor vehicle accident, shall
the provisions of subdivision (3) of this subsection apply. After
consultation with the medical advisory committee, the board shall
prepare a list of medical conditions, if any, which would reasonably
prevent the wearing of a seat belt. In the case of an injury
sustained in a motor vehicle accident by a person not wearing a seat
belt, the burden of proof shall be on the person seeking to
establish that such a medical condition actually existed at the
time of the injury.
( b ) If, under applicable federal or state laws, a vehicle is
not required to be equipped with seat belts, the provisions of this
subsection shall not apply.
�18
(c)
If an accident is caused by the negligence of a person
illegally operating a vehicle under the influence of alcohol or any
other intoxicating or illegal substance, or if an accident occurs due
to intentional or wanton recklessness, or if an accident occurs due
to the negligence of an unlicensed driver or a driver whose license is
under suspension at the time of the accident, the provisions of
subdivision (3) of this subsection shall not apply.
( B ) Smoking restricted and tobacco advertising prohibited in public
places.
(1)
In any indoor place accessible to members of the general
public, and during outdoor events accessible to members of the general
public at which those in attendance are seated or otherwise positioned
closely together, smoking shall be prohibited except in designated
smoking areas.
Persons under the age of 18 years may not enter
designated smoking areas unless accompanied by a parent or guardian. Any
person violating any provision of this paragraph shall be guilty of a
misdemeanor, and, upon conviction thereof, shall pay a fine of twenty-five
dollars.
( 2 ) To meet the requirements of subdivision (1) of this subsection,
above, designated smoking areas must be clearly marked, must be separate
and discrete areas, must not, in the aggregate, constitute more than 50%
of the space within the area they serve, must be so positioned or designed
that smoke therefrom will not significantly enter areas not designated as
smoking areas, and must not contain attractions or features unavailable
outside of smoking areas.
Nothing contained herein shall be interpreted
to require the provision of a designated smoking area within any public
place or event, but, if a smoking area be designated, it must comply with
the requirements listed herein. Any person, firm or corporation
designating a smoking area which fails to comply with the requirements
of this paragraph is guilty of a misdemeanor, and, upon conviction thereof,
shall be fined twenty-five dollars for the first offense and an additional
twenty-five dollars for each subsequent offense.
�19
( 3 ) The advertising or promotion of cigarettes, cigarette paper,
cigars, pipes, snuff or chewing tobacco in any place accessible to
members of the general public under the age of 18 years is hereby
prohibited. Any person, firm or corporation violating any provision of this
paragraph is guilty of a misdemeanor, and, upon conviction thereof, shall
be fined one thousand dollars for the first offense and an additional one
thousand dollars for each subsequent offense.
(C)
Insurance and public health incentives for wellness
( 1 ) After consultation with the medical advisory committee, the
board shall prepare, publish and update as necessary a listing of those
laboratory tests, x-ray studies, other diagnostic procedures,
immunizations and other disease-prevention procedures, along with
recommended frequencies for such tests, studies and procedures, which it
deems necessary and cost-effective for routine health monitoring and/or
disease prevention, taking into account the diverse needs of the various
subdivisions of the population due to age, gender, occupation, geographical
location and the like.
The board shall further, on an annual basis, perform a market study
to determine and establish appropriate pricing for each study and
procedure so listed.
Each county board of health shall make such testing and/or
procedures available to any resident of the county or counties which it
serves at the prices determined by the Health Care Cost Review Authority.
County boards of health may separately or collectively designate or
contract with private or public health services, laboratories or the like to
perform such testing. The results of such testing shall be given directly
to the person tested, and shall not otherwise be released. County boards
of health shall not be obligated to provide medical advice regarding such
health maintenance testing or procedures except as provided in
subdivision (2) of this subsection.
All third-party payors shall, without deductables or copayments,
reimburse for the procedures so listed at the prices so determined, within
the frequencies so recommended.
�20
If disease-prevention testing and/or procedures be performed by
health care facilities or providers other than county boards of health or
their designees, there shall be no obligation on third party payors to
reimburse for such services more than the amounts determined by the
board or at frequencies greater than those designated by the board, nor is
any third-party payor obligated to pay for any disease-prevention service
which is not listed by HCCRA as necessary for that purpose.
( 2 ) County boards of health shall make available to the residents
of the county or counties which they serve certain types of generic
medical information, as determined and distributed by the Health care
Cost review Authority after consultation with the medical advisory
committee. Such information may be in written, audio or visual form, and
may be disseminated as determined by HCCRA or the county boards of
health, including advertisements, mailings, literature displays, classes,
public forums or individual counseling.
HCCRA and the several county boards of health may provide such
health-related information as they deem appropriate, but, after
consultation with the medical advisory committee, shall, at a minimum,
provide information regarding the following topics:
( a ) A list of primary care physicians and/or other primary
care providers who are accepting new patients within or near the
county served by that board of health, along with those providers'
education, board certification, hospital affiliations and fee
schedules, as reported under the requirements of section 7 of
this act.
( b ) General information regarding exercise for cardiovascular fitness, including specific fitness activities with
appropriate warnings and disclaimers.
( c ) General dietary information, including, at a minimum,
information on calorie restriction for the purpose of weight control,
dietary guidelines for control of salt intake and dietary guidelines
for the control of cholesterol.
�21
( d ) Information and education regarding prenatal maternal
and fetal health, childbirth and parenting.
( e ) Information regarding health-maintenance testing
and procedures as recommended under subdivision (1) of this
subsection, including the list of the procedures so recommended ,
the general reasons for each such test or procedure and, in general
terms, appropriate responses to the results thereof.
( 3 ) After consultation with the medical advisory committee, the
board shall establish a health insurance rebate program to reward
individuals who maintain healthy habits and lifestyles. Such rebates shall
be up to $200.00 per year for any individual, and shall be based on
objective criteria indicative of beneficiaries' health-related behavior
rather than their actual state of health. Such criteria shall include
control of existing health problems, participation in exercise programs,
currency of vaccinations, control of body weight, avoidance of substance
abuse, tobacco usage, and motor vehicle violations, and such additional
factors as the board shall establish.
1 6 - 2 9 E - 7.
FEE AND PAYMENT SCHEDULES
( A ) Establishment of a standard payment schedule for health care
providers and health insurers
( 1 ) The board shall establish and publish a standard provider
reimbursement schedule. This schedule shall establish standard fees for
all health care procedures which are performed more than 100 times
annually within the state of West Virginia and for which the board
determines that insurance reimbursement is appropriate. In establishing
this schedule, the board shall consider the following factors:
(a)
The payment schedule should be uniform statewide and
should provide similar reimbursement for similar services provided
by practitioners of similar experience, training and skill.
( b ) The payment schedule should provide additional
incentives for primary care, particularly in underserved areas.
�22
(c)
To the extent possible without reducing the availability
of specialty and surgical health care services within the state, the
payment schedule should attempt to reduce or eliminate existing
incentives to perform operative and other high cost procedures.
( d ) The payment schedule should not be so low as to reduce
or discourage the availability of health care under the
circumstances defined in subdivision (2) of this subsection, in which
balance billing shall be unlawful.
(2)
Under the following circumstances, the payment schedule
determined pursuant to subdivision (1) of this subsection shall be the
fixed fee which providers must accept as payment in full, and copayments or balance billing shall be unlawful except as noted:
(a)
For health care delivered in true emergencies, defined as
follows, the payment schedule shall be mandatory.
After consultation with the medical advisory committee, the
board shall develop and publish a list of those health problems and
circumstances which it deems to constitute true medical
emergencies. It shall be presumed that under such defined
emergency circumstances there should exist no cost-related
obstacle to health care, that health care consumers should consider
time rather than cost in the selection of health care services and
that health care providers and facilities should cooperate rather
than compete to assure the delivery of timely health care.
(b)
For health care services provided to individuals who are
not mentally competent because of age or any other reason to make
informed, cost-conscious health care choices, the standard payment
schedule shall be mandatory.
�23
(c)
For health care services provided to individuals whose
family income is less than twice the defined federal poverty level,
any payment beyond carefully-defined, progressive copayments may
constitute a barrier to health care. Under such circumstances, the
standard payment schedule developed pursuant to this subsection
shall be mandatory, provided that the board may allow or require
small copayments and/or deductibles, but balance-billing beyond the
standard fees and copayments so established shall be prohibited.
(d)
For professional fees for ancillary hospital services,
both inpatient and outpatient, including, specifically, fees for the
interpretation of imaging procedures, electrocardiograms,
laboratory services and other services for which a professional
service by other than the attending physician is required by hospital
policy, regulation or law, the standard payment schedule developed
pursuant to subdivision (1) of this subsection shall be mandatory.
(3)
health-care
specifically
pursuant to
consumers,
In order to encourage appropriate cost-based shopping by
consumers, under no circumstances other than those
stated in this act shall the standard fee schedule established
subdivision (1) of this subsection be binding upon health care
providers, or insurers.
( B ) Reporting and publishing of provider fees and third-party
reimbursement rates.
( 1 ) On or before the first day of January of each year, each insurer
shall publish and distribute to all policyholders of such insurer their
payment schedules for common medical services and procedures, and
shall additionally make such information available to any member of the
public upon request. Such payments shall be uniform throughout the State
of West Virginia for providers of similar training and skill.
Additionally,
insurers shall upon request advise policy holders of their payment for any
procedure. Such payments shall be at least equal to the standard fee
developed by the board, less any policy-specific cost-sharing adjustment.
�24
( 2 ) On or before the first day of January of each year, each health
care provider licensed in the State of West Virginia shall furnish to the
board, and make available to any member of the public upon request, the
C.P.T. codes and fees for the twenty-five procedures he or she most
frequently performed during the previous calendar year.
Additionally,
each provider shall furnish to the board his or her fees for such other
services as the board may request, and shall, upon the request of any
patient, advise that patient of the fee for any contemplated procedure or
service not so reported. Fees may be lowered for selected patients, but
providers may charge no patient more for any procedure than the fee
reported to the board for that procedure during the applicable calendar
year.
( 3 ) The board shall compile the information it receives pursuant
to this subsection and shall distribute it to all county boards of health, to
all hospitals within the state, and to any member of the general public
upon request. Additionally, the board shall develop useful price indicessuch as the total fees for a standard surgical procedure or the fees for a
week of hospital care to treat a non-surgical medical problemappropriate to various types and specialties of health care providers, so
that members of the public may have meaningful information regarding
out-of-pocket cost differences between specific health care providers.
16-29E-8.
(A)
Malpractice
reform
Non-judicial remedies for substandard health care
( 1 ) Upon the written complaint of any person, professional
organization, hospital administrator, hospital board of directors, peer
review organization, peer review committee, health insurance company or
health-related government agency to any health care licensing board
alleging that a health care practitioner licensed thereby has failed to
exercise that degree of care, skill and learning required or expected of a
reasonable, prudent health care provider in the profession or class to
which the health care provider belongs, that licensing board shall
investigate the complaint in sufficient detail to determine whether there
is probable cause to believe that such a failure occurred.
�25
To make a determination under this act that a provider has failed to
follow the accepted standard of care, it shall not be relevant whether
such failure resulted in injury to or the death of any patient.
In making such a determination, the licensing board may employ the
assistance, advice and council of such persons as it deems necessary for
the proper evaluation of the complaint. Additionally, the licensing board
may obtain medical records from such sources as it deems necessary for
the proper evaluation of a complaint.
Any physician-patient privilege does not apply in any investigation
under this subsection while a licensing board is acting within the scope of
its authority, provided that the disclosure of any information under this
subsection shall not be considered a waiver of any such privilege in any
other proceeding and provided further that any medical records which
pertain to a person who has not expressly waved his or her rights to the
confidentiality of such records may not be open to the public.
Upon the determination that there is probable cause to believe that
substandard care has occurred, the licensing board shall notify the
practitioner of such determination. The practitioner shall have 15 days to
provide written comments on the findings of the board, which comments
shall remain part of any record regarding the complaint. After review of
such comments, the board may uphold, revise or reverse its determination.
The complaints to and records of any licensing board pursuant to
this subsection shall not be open to the public nor shall any determination
based on the complaint or its investigation be the basis of any
disciplinary action except, for physicians and podiatrists, through
subsequent disciplinary procedures specified in Chapter 30, Article 3,
section 14 of this code, and, for other practitioners, under the established
disciplinary procedures of their respective licensing boards.
�26
(2)
Upon the basis of any such complaint, a licensing board may
further investigate the professional competence of any health care
practitioner licensed by that board, according to the procedures specified
within this subsection or according to the procedures of chapter 30,
article 3, section 14 of this code. If any licensing board finds probable
cause to believe that a violation of the standard of care specified in
subdivision (1) of this subsection has occurred in 3 separate complaints
regarding any licensee of that board during the most recent five year
period, or if three or more judgements arising from medical professional
liability have been rendered or made against any health care practitioner
during the most recent five year period, that licensing board shall initiate
an investigation according to the procedures specified within this
subsection.
(3)
Further investigation by any licensing board under this
subsection shall be to determine whether a health care provider generally
exercises that degree of care, skill and learning required or expected of a
reasonable, prudent health care provider in the profession or class to
which the health care provider belongs, acting in the same or similar
circumstances.
In an investigation under subdivision (3) of this subsection, the
licensing board shall obtain and review records relevant to a provider's
services within the most recent six month period. Such records shall
include any disciplinary actions by peer review organizations, hospitals,
professional societies and malpractice carriers. Additionally, the
licensing board shall review a sufficient number of randomly selected
hospital and/or outpatient medical records to ascertain the scope of
practice and practice habits of the subject provider.
In such investigation, the licensing board may employ such persons
as it deems necessary to compile and evaluate the information so
obtained. At a minimum, the records so obtained shall be reviewed by a
health care provider who is actively practicing in the same or an
essentially similar medical field as the subject health care provider.
�27
If, after a review of the above information, the licensing board
determines that the provider under investigation generally fails to meet
the accepted standard of care, resulting in unnecessary or unusual risks or
injuries to patients, it shall so advise the subject provider, including a
specific listing of the alleged deficiencies. The subject provider shall
have thirty days from the receipt of such notification to respond to the
findings of the board.
If the subject provider accepts the findings of the licensing board,
the board shall immediately impose appropriate sanctions upon the
provider within the scope of its authority under Chapter 30, Article 3 of
this code, in the case of physicians and podiatrists, or under the
applicable laws referable to other licensing boards.
If the subject provider disputes the conclusions of the board, the
board shall consider said provider's written response to the alleged
deficiency or deficiencies. If, after such consideration, the board
continues to find disputed deficiencies, it shall initiate formal
disciplinary proceedings, which, for physicians or podiatrists shall be
under chapter 30, article 3, section 14 of this code, charging the subject
provider with professional incompetence.
( B ) Optional
claims
(1)
pre-trial
review of health-related
professional
liability
Medical Liability Review Commission Created
(a)
There is hereby created a Medical Liability Review
Commission as an independent agency within the executive branch.
The commission shall consist of five members, of whom one shall be
a medical or osteopathic physician licensed to practice in the state
of West Virginia, and one shall be a registered nurse licensed to
practice in the state of West Virginia. Members shall be
compensated as provided in the state budget from that fund created
in subdivision (1) (d) of this subsection, and known as the medical
liability review fund.
�28
(b)
Members shall be appointed by the governor with the
advice and consent of the senate from the list of candidates
submitted by the nominating bodies specified in subdivision (1) (c)
of this subsection. The governor shall designate one member whose
initial term of office shall be one year, one member whose initial
term shall be two years, one member whose initial term shall be
three years, one member whose initial term shall be four years, and
one member whose initial term shall be five years. Upon the
completion of any member's term, he or she shall replaced by a
nominee of the same body as nominated the member whose term
expired. After the initial appointments, the term of office of all
members shall be five years. Members shall be eligible for
reappointment and shall be removable by the governor for neglect of
duty or malfeasance in office, but for no other cause. Annually, the
governor shall designate one of the members to serve as the
Chairperson of the Commission. The chairperson shall assume such
additional powers and duties as the Commission shall determine,
except that the chairperson shall exercise no more than one vote on
any matter before the Commission.
(c)
Nominations for appointment to the Commission shall be
as follows: for one position on the board, The West Virginia Medical
Association shall nominate two persons, of whom the governor may
appoint one, with the advice and consent of the Senate; for one
position, the West Virginia Nursing Association shall nominate two
persons, of whom the governor may appoint one, with the advice and
consent of the Senate; for the remaining three positions, the
governor shall appoint such persons as he may, subject to the advice
and consent of the Senate.
�29
( d ) There is hereby created in the state treasury a fund
known as the medical liability review fund. The funding
requirements of the Medical Liability Review Commission shall be
met by a tax of one tenth of one percent on all health care related
liabilty insurance providing coverage within the state of West
Virginia, plus such fees as the Commission may assess for its
services and such funds as may be appropriated for this purpose by
the State Legislature, all of which shall be placed into the medical
liability review fund, the monies in which may be expended by the
commission after appropriation by the legislature for purposes
consistent with this subsection.
(2)
In addition to any other rights or duties created herein, the
Medical Liability Review Commission may:
(a)
Adopt, amend and repeal necessary, appropriate and
lawful policy guidelines, rules and regulations in accordance with
Chapter 29A, article 3 of this code.
(b)
Meet, hold hearings, file complaints with health provider
licensing boards, and may subpoena records, papers and documents in
connection therewith.
The board may administer oaths or
affirmations in connection with any matter under its juridiction.
(c)
Rent, purchase, maintain, sell, equip and assign rights or
dispose of any property consistent with the objectives of the
Commission, subject to the approval of the Legislature.
(d)
Contract and be contracted with and execute all
instruments necessary or convenient in carrying out the
Commission's functions and duties.
( e ) Appoint such attorneys, claim reviewers, investigators
and other employees as are necessary for the proper performance of
its duties.
�30
(f)
Delegate any of its powers to one or more of its members
or to one of its employees, provided that no opinion regarding a
specific legal action before it may be issued without an affirmative
vote thereon by at least three members of the Commission.
( g ) Apply for, receive, accept and expend on purposes
consistent with this subsection, gifts, payments, and other funds
and advances from the United States, the state or any other
governmental body, agency or agencies or from any other private or
public corporation or person (with the exception of any person,
corporation, foundation or political action group involved in the
practice of medicine or law or primarily identified or associated
with legal or medical concerns) and enter into agreements with
respect thereto, including the undertaking of studies, plans
demonstrations or projects, provided that no such funds may inure in
any respect to the private benefit of any member of the Commission.
(h)
Exercise all other powers which are reasonably
necessary to effect the express objectives of this article.
(3)
Additional
legislative
directives:
(a)
Upon the request of any party involved in a healthrelated professional liability action, the Commission shall, within
15 days, notify all parties to the action, plaintiff and defendant, of
its involvement therein.
(b)
Within 30 days of such notification, each party so
notified shall acknowledge such notification and shall provide the
Commission with a summary of its position on the matter, along
with the medical records, expert testimony, and other evidence it
has developed in support of its position, and shall from time to time
update the information so provided if substantial changes therein
occur.
�31
(c)
At any time that the Commission determines that
additional facts or records concerning the matter in dispute are
needed, it may require, by subpoena, deposition or hearing, any party
to the action, or any third party, to provide such information.
(d)
At any time, the Commission may determine that it has
sufficient information to render an opinion about a matter before it,
whereupon it may issue an opinion subject to subdivision (4) of this
subsection.
( e ) The Commission shall be notified within 48 hours if a
trial date be set on any matter which is before the Commission. In
any matter before the Commission, at least 60 days shall be allowed
between such notification and the trial date. Upon such notification,
the Commission shall require from all parties to the case any
evidence not previously provided which may be considered at trial.
(f)
At least 14 days prior to a trial date for any matter
before it, the Commission shall render an opinion on the matter,
subject to the provisions of subdivision (3) of this subsection.
(g)
An opinion of the Medical Liability Advisory Commission
may be introduced as evidence at any trial deciding any matter
which has come before the Commission by any party to the action,
defendant or plaintiff. If it be introduced, It shall be introduced in
its entirety, along with any supporting material supplied by the
Commission. The failure of a majority of the Commission to agree
on any specific matter shall not be made known to the jury.
�32
( 4 ) Opinions of the Commission shall not be issued without the
affirmative vote of at least three members of the Commission. Such
opinions shall include a statement that the Commission was created by
the Legislature to assure that juries adjudicating malpractice cases have
access to objective medical information, and shall further include the
names, occupations and method of appointment of the members of the
Commission and the fact that the Commission's opinion is advisatory in
nature, the actual decision being entirely the jury's. The opinion shall
further include a statement as to the percentage of cases in which the
Commission's opinion has favored the plaintiff in an action, the
percentage which has favored the defendant, and the percentage in which
the Commission has been unable to render an opinion. Additionally, the
opinion may include any, or all, of the following:
(a)
action.
Answers to specific questions asked by any party to the
( b ) An opinion supporting the position of any of the parties
to the action.
(c)
Recommendations as to the nature and extent of
economic damages suffered by any party to a case.
(d)
Recommendations as to the merit of any claim for
punitive damages.
(e)
Information in written, printed, audio or visual form
bearing on any question which the board considers important to the
matter in dispute, including any explanatory remarks concerning
such information which the board may see fit to attach thereto.
( 5 ) Any member of, employee of, person under contract with or
person providing information to the Commission, if acting in good faith,
shall be immune from suit under any law of this state or political
subdivision thereof for any act or decision made in such capacity.
�33
(6)
Pursuant to the provisions of section four, article ten, chapter
four of this code, the Medical Liability Review Committee shall continue
to exist until the first day of July, 1998, to allow for a completion of an
audit by the Joint Committee on Government Operations.
(C)
Limit on liability for non-economic loss
In any medical professional liability action brought against a health
care provider, the maximum amount recoverable as damages for noneconomic loss shall not exceed two hundred fifty thousand dollars.
(D)
Periodic payment of future damages
If the present value of all future damages awarded in any healthcare related professional liability action exceeds two hundred fifty
thousand dollars ($250,000.00), the award shall be made in accordance
with a periodic payment schedule with the yearly amount based on the life
expectancy of the claimant. The court may require the defendant to
purchase an annuity making the awarded yearly amounts if the court finds
that the defendant may not pay the awarded yearly amounts. Payments for
future damages shall cease in the event of the death of the claimant.
The parties may agree, with the approval of the court, to a lump sum
payment.
(E)
In actions for injuries alleging medical professional
contingent attorney fees shall be limited as follows:
liability,
(1)
If an action is settled prior to the mandatory status
conference required in chapter 55, article 7B, section 6 of this code, the
plaintiff shall not be required to pay contingent attorney fees in excess of
ten thousand dollars ($10,000.00). In calculating such fees, reasonable
expenses shall first be deducted.
(2)
If an action is settled before or during trial, the plaintiff shall
not be required to pay contingent attorney fees in excess of 20% of any
settlement, after reasonable expenses have been deducted.
�34
(3)
If an action is adjudicated at trial, the plaintiff shall not be
required to pay contingent attorney's fees in excess of 25% of any award,
after reasonable expenses have been deducted.
(F)
Joint and several
liability
( 1 ) When factors other than medical professional liability, such as
the patient's pre-existing medical condition or the actions of individuals
other than the health care provider, including the patient, contribute to
the patient's injury, the health care provider's liability shall be limited to
the extent of his or her responsibility for the injury, as determined by the
jury.
( 2 ) When a judgement of joint and several liabilty is entered in a
medical professional liability action, the total dollar award to any
plaintiff shall be reduced by a dollar amount equal to the percentage of
negligence and liability attributed by the court or jury to any defendant
who entered into a good faith settlement with said plaintiff prior to the
jury's report of its findings to the court or the court's findings as to the
total dollar amount awarded as to damages, multiplied by the total dollar
award to any plaintiff. The remaining dollar amount of the award shall be
the obligation of the remaining jointly and severally liable defendants
(G)
Punitive damages
( 1 ) Punitive damages shall be awarded in medical professional
liability actions only for egregious behavior that is truly shocking, and
where the evidence leaves no serious or substantial doubt that the
defendant in the action acted with intent to cause serious injury to the
plaintiff or acted with a flagrant indifference to the rights of the
plaintiff and with an awareness that such conduct would result in serious
injury to the plaintiff.
�35
(2)
If punitive damages are assessed in any medical professional
liability action, only the first ten thousand dollars ($10,000.00) thereof
shall be awarded to the plaintiff in that action. Any punitive damages in
excess of ten thousand dollars ($10,000.00) shall be deposited into that
special fund of the state of West Virginia known as the "crime victims
compensation fund," to be expended as appropriated by the Legislature.
(H)
Collateral
sources
(1)
In any action finding medical professional liability, the
amount of economic damages shall be reduced by the total of all amounts
which have been paid or shall be paid for the benefit of the claimant or
which are otherwise available to him as a result of the injury, from all
collateral sources.
(2) Except for payments out of earned income to the United States
Government pursuant to the federal Social Security Act, any reduction
because of sums paid to the claimant by a collateral source shall be
offset by any amount which has been paid, contributed or forfeited to the
collateral source by the claimant in order to secure the claimant's rights
to the sums paid by the collateral source.
(I)
Filing
requirement: Certification
of
merit
Upon the filing of a medical professional liability action against a
health care provider, the attorney bringing the action on behalf of the
patient or his representative shall attach to the complaint an affidavit
stating that a qualified health care practitioner practicing in the same or
similar field of medicine as each defendant health care provider has
prepared a written report which reflect his or her belief that there is a
"reasonable and meritorious cause for filing such action" and a copy of
such report shall be attached thereto.
�36
16-29E-9.
(A)
Prioritization
of
health
care
spending
Mandatory standard health benefits plan
After consultation with the medical advisory committee and the
insurance commissioner of West Virginia, HCCRA shall establish and
periodically update a standard health benefits plan which shall apply to
every health insurance program and pre-paid health care plan operating
within the State of West Virginia and subject to the regulatory authority
thereof. The standard plan shall include alternatives of approximately
equal cost per covered individual, to allow the consumer choices specified
in Section 14 of this act. The plan shall include all of the following:
( 1 ) A listing of those services and circumstances for which there
shall be full payment without deductibles, copayments or other
contribution by insurees, which shall be those services and circumstances
specified previously in this act or elsewhere within the code of West
Virginia.
For any service so specified, the board may stipulate the price
thereof, which shall be binding on all health care providers and
institutions within the state of West Virginia unless otherwise noted in
this act.
( 2 ) A listing of other covered services and benefits, including
such limitations on total payments, number of visits, number of inpatient
days and the like as the board may stipulate.
( 3 ) A progressive scale of copayments and other contributions by
insurees for health care services not covered under subdivision (A) (1) of
this section, based on family income. Such payments shall be sufficiently
large to encourage serious consideration before seeking such health care
services, but shall not be so onerous as to create serious financial injury
to prudent beneficiaries. Such copayments shall be made to the insurance
carrier rather than to the health care provider. Such copayments shall be
so structured as to encourage less costly health care choices, such as
higher copayments for emergency room services, for name brand drugs or
otherwise more costly medications, and the like.
�37
( 4 ) A list of services which shall not be covered under any
circumstances, and/or under limited circumstances. In the case of
procedures approved under limited circumstances, those circumstances
shall be specifically enumerated by the board, shall be based on specific
objective criteria and shall be subject to the reporting requirements of
this section, below.
( 5 ) A list of services, in a specific order of priority, which the
board deems to be marginally cost-effective compared with alternative
health care expenditures. If the board determines that insurance coverage
of any or all such procedures compromises the delivery of more costeffective health care services, the board may, after consultation with the
medical advisory committee, discontinue coverage of such procedures,
according to the order of priority so established, subject to the
provisions of Chapter 29A, Article 3 of this code.
(6)
Nothing contained herein shall be construed to prevent any
insurer from offering coinsurance which provides for the coverage of
services limited or excluded under the standard health benefits plan
created herein.
(B)
Reporting of restricted procedures
(1)
HCCRA shall create a list of technologies and procedures
deemed to be so costly or so subject to overutilization as to require
specific monitoring and control, including those procedures listed
pursuant to subdivision (A) (4) of this section. After consultation with
the medical advisory committee, the board shall establish a list of
specific indications for the use of any technology or the performance of
any procedure so indicated, such indications to be based on specific,
objective criteria rather than vague concepts such as "medical necessity."
Any technology or procedure so identified shall be subject to the reporting
requirement of this section, below.
�38
(2)
HCCRA shall promulgate and distribute a form for the reporting
of restricted procedures and/or the use of restricted technologies, as
specified in sudivisions (A) (4) and (B) (1) of this section. Such form shall
be no larger than 8 1/2"x11". It shall be used by all providers and all
insurers to report all procedures restricted under this act, except as
provided herein.
(3)
Prior to the performance of any procedure restricted under
subdivision (A) (4) or (B) (1) of this section, the provider responsible for
the performance of such procedure shall complete the form created in
subdivision (B) (2) of this section, and shall upon such form provide an
initial statement specifying the applicable indication for such procedure
as established by HCCRA. The responsible provider shall assure that such
form is forwarded to HCCRA, by mail or otherwise. Additionally, a copy of
the completed form and attachments thereto shall accompany any request
for payment for the restricted service.
It shall not be required that the initial statement specifying the
applicable indication for the restricted procedure include documentation
of such indication, nor shall it be required that such statement include any
other medical history or medical records. Unless otherwise expressly
permitted or required by law, no party shall require preauthorization for
such restricted procedures or withhold payment for such procedures
pending the receipt or review of medical records or other documentation,
nor may preauthorization be required for any covered service not subject
to restriction under this section, by any insurer.
No person or insurer shall be required to pay for the performance of
any restricted procedure until that person or insurer has received a copy
of the completed restricted procedure reporting form.
(4)
If a health care provider believes that a restricted procedure
should be performed for reasons other than an indication recognized by
HCCRA, he or she may request preauthorization for that procedure from a
reviewing authority which HCCRA shall designate for that purpose.
�39
( 5 ) A restricted procedure shall not be performed for reasons
other than an indication recognized by HCCRA without such
preauthorization unless the patient has knowingly signed a consent form
acknowledging that the procedure is being performed for reasons
inconsistent with the health care policies of the state of West Virginia
and that no third party payor shall reimburse for such services.
(6)
HCCRA shall keep statistical and other records on all health
care providers reporting restricted procedures, and shall review a
sufficient number of cases involving restricted procedures to assure
general compliance with this act. In so doing, HCCRA shall:
(a)
cases.
Review in detail a small number of randomly selected
(b)
Review cases regarding which a specific complaint has
been received, provided that the cost for such investigation may be
imposed on the person or entity so complaining if the complaint is
not found by the board to be valid.
(c)
Review cases chosen because of any pattern, statistical
or otherwise, which the board feels may indicate improper
utilization of restricted procedures by any provider.
(7)
In reviewing any case under this act, the board shall obtain
from any source such medical records and reports as it requires to
ascertain whether the responsible provider's statement specifying the
approved indication for the restricted procedure was factual. Any physicianpatient privilege does not apply in any investigation under this section
while the board is acting within the scope of its authority, provided that
the disclosure of any information under this section shall not be
considered a waiver of any such privilege in any other proceeding and
provided further that any medical records which pertain to a person who
has not expressly waived his or her rights to the confidentiality of such
records may not be open to the public.
�40
If it be determined that the responsible provider's statement was
substantially accurate, the review shall be complete. In making such
determination, the benefit of any reasonable doubt shall go to the subject
health care provider.
If it be determined that the responsible provider's statement was
inaccurate, the board shall notify the subject provider of a finding of noncompliance and shall review such additional cases as are necessary to
determine whether a pattern exists indicating intentional or negligent
abuse of restricted procedures by the subject provider. If, in the opinion
of the board, such a pattern exists, or if, after the first notice of noncompliance, repeated instances thereof are detected, HCCRA shall have the
authority to file a complaint with the appropriate licensing board, to
suspend the subject provider's prerogative to order or perform restricted
procedures pending disciplinary procedures by said licensing board, or to
pursue civil remedies specified in Section 17 of this act.
(8)
In the absence of an approved indication to perform any
procedure restricted by HCCRA under this section, the failure to perform
such procedure shall not be considered negligence in any action alleging
medical professional liability, provided that, in such action, the question
of whether such an indication actually existed shall be an open question of
fact.
(C)
Control of bureaucracy
HCCRA shall undertake a study of the potential cost savings that
might result from consolidating the various bureaucratic functions that
regulate and control health care activities. The study shall include:
( 1 ) The potential cost savings which might result from the
development of a single-payer reimbursement system within the state of
West Virginia.
( 2 ) The extent to which the regulations of medicare, medicaid and
private regulatory agencies could be combined into a single set of rules,
and the savings potentially resulting therefrom.
�41
( 3 ) The extent to which the inspections required by various public
agencies and private groups could be performed by the same group of
inspectors and/or during the same period of time, and the savings
potentially resulting therefrom.
( 4 ) The extent to which peer review activities in West Virginia
could be consolidated under a single agency and redirected towards the
identification and mitigation of serious breeches of a standard of care
rather than technical deficiencies.
( 5 ) The identification of other potential cost savings and/or
improved quality control that might result from the mitigation of
redundancy, conflicting regulations and/or waste in the health care
bureaucracy.
(6)
Specific recommendations for legislation to effect such
potential savings or improvements, if any, such recommendations to be
made to the legislature on or before the first day of January, 1994.
16-29E-10.
(A)
Inappropriate
Contingent fees; financial
Financial
Incentives
credentialing
No entity may employ, contract with, otherwise remunerate, or grant
benefits or privileges to any health care practitioner for professional
services, nor shall any health care practitioner knowingly enter into any
such relationship, where such employment, contract, remuneration,
benefit or privilege, or the level thereof, is contingent in any way upon the
ordering or performance by the practitioner of particular types, numbers
or quotas of laboratory, diagnostic, surgical or other procedures or
services based on their dollar value, profitability or other economic
consideration, or where the level of compensation is contingent in any
way on the withholding of such procedures or services, except that the
remuneration or compensation of health care providers based on the
number of hours worked, the number of patients treated, or the fees for
professional services which are personally performed by the health care
practitioner shall not be affected by this section.
�42
(B)
Physician self-referral
prohibited
( 1 ) Except as provided in subdivision (B) (4) of this section, no
health care practitioner shall refer any patient for any service designated
in subdivision (B) (3) of this section to any entity in which the health care
practitioner has an investment interest or other interest such that the
referral of that patient would financially benefit the health care
practitioner other than by the payment of fees for professional services
personally performed by the practitioner.
(2)
Except as provided in subdivision (B) (4) of this section, no
health care provider shall profit from or enjoy any other personal
financial gain, directly or indirectly, from any service performed by or at
the instigation of or upon the order of that provider and designated in
subdivision (B) (3) of this section.
(3)
The services subject to the prohibitions of this subsection are:
(a)
Physical therapy services
(b)
Rehabilitative
(c)
Clinical
(d)
Diagnostic imaging services
(e)
Radiation therapy services
services
laboratory
services
( 4 ) The following services and circumstances shall be exempt
from the provisions of this section:
(a)
A health care practitioner may receive compensation for
procedures and services which are personally performed by the
health care practitioner.
�43
(b)
Radiologists may receive compensation for diagnostic
imaging services which are performed by or under the supervision of
that radiologist if they are performed pursuant to a consultation
requested by another physician.
(c)
A pathologist may receive compensation for diagnostic
clinical laboratory tests and pathological examination services, if
such tests and services are furnished by or under the supervision of
the pathologist pursuant to a consultation from another physician.
(d)
Recognizing the convenience and utility of having
available within practitioners' offices the services prohibited
herein, practitioners may provide such services or contract for such
services to be performed within their offices, provided that the
office be physically separate from any facility offering similar
services, that the practitioner's aggregate profit or other financial
benefit from all such services taken together shall be no more than
$5,000.00 per annum, and that, for services billed by the physician
but performed by an entity outside of the physician's practice, the
physician may not charge an amount above his or her cost for such
services, except for a $5.00 fee for phlebotomy services and a two
dollar fee for the handling of other specimens.
HCCRA shall promulgate such rules and require such separate
accounting of financial activities related to restricted services as
to assure compliance with these provisions, subject to Chapter 29A,
Article 3 of this code.
(e)
Physicians who are currently referring to entities in
which they have an investment interest or who are providing
services restricted by this section may continue to refer to such
entities and provide such services until January 1, 1996, but no
physician may enter into any new such referral pattern or begin to
provide any such service after January 1, 1993.
�44
( C ) HCCRA, working with the Insurance Commissioner, the various
health care provider organizations and the Deans of West Virginia's
Schools of Medicine and Osteopathy, shall reduce to the extent possible
the financial incentives for health care providers to enter certain
specialties rather than others, to locate in certain areas rather than
others and to make certain diagnostic and therapeutic choices rather than
others. Recognizing that fees for various medical services are subject to
nation-wide pricing patterns beyond the control of this state or any of its
agencies, and that the consequences of driving such services from West
Virginia would be catastophic, including the loss of the economic activity
created by such services and the exodus from West Virginia of residents
seeking such services, HCCRA should, to the extent possible without
significantly compromising the availability of specialty and surgical
health care services within West Virginia, use the reimbursement ratesetting authority and other powers granted in this act to:
(1)
Minimize the financial incentives for particular classes of
health care providers to perform certain procedures as opposed to
cognitive and other services. Such fee adjustments should be based on the
time required for given classes of providers to perform various services,
and should include a combination of reduced fees for procedures and
increased fees for cognitive and other non-surgical services.
( 2 ) Create incentives for primary care, including Family Practice,
Internal Medicine, Pediatrics and Obstetrics, especially in underserved
areas of West Virginia, by means of:
(a)
Enhanced fee schedules for certain services in certain
areas, the provisions of Section (7), subdivision (A) (1) (a) of this
act notwithstanding.
(b)
Recruitment of physicians into underserved areas,
including income guarantees, provision of office space, malpractice
insurance coverage and such other incentives as may be necessary.
(c)
Relief from the provisions of the physician self-referral
and resticted services profit limitations created above.
�45
(3)
Use any means necessary, subject to chapter 29A, article 3 of
this code, to:
(a)
Inform the public of its rights under this act.
(b)
Educate the public in the use of the reimbursement
schedules and fee schedules created herein to make cost-conscious
health care decisions.
(c)
Encourage the public to make use of the wellness
incentives created herein, including the cost-free procedures and
medical information available through the various county health
departments.
(d)
Make the public aware of less costly alternatives in
health care services, including hospital rates, practitioner's fees,
alternative types of treatment and alternative health care
disciplines.
16-29E-11.
(A)
Health
insurance
overhead; guaranteed
loss
ratios
Premium rate approval.
( 1 ) After the first day of January, 1994, the Insurance
Commissioner shall disapprove any application for premium rate charges
for any individual or group accident and sickness insurance policy issued
by any insurer pursuant to Chapter 33 of this code, or for any contract or
coverage issued by any health maintenance organization pursuant to
Chapter 33 of this code, if the overall premium rate structure for all
health and accident insurance or coverage issued within West Virginia by
the insurer or health maintenance organization making such application is
not in compliance with the following requirements:
�46
(a)
The expected ratio of claims incurred to premiums
earned by the insurer or health maintenance organization must be
ninety percent (90%) or greater. Any taxes on earned premiums and
any costs for reinsurance shall first be subtracted from the
premiums received before calculating this ratio, provided that, to
qualify for this exemption, any reinsurance premium rate must also
be based on a loss ratio of 90%. Also before calculating this ratio,
any insurer or health maintenance organization which directly
provides health care services to its policy holders, which employs
health care practitioners, and which owns and maintains facilities
and equipment to provide health care services, may include in the
total of claims incurred the wages and benefits of such health care
practitioners, and the costs of owning and maintaining such
facilities and equipment, to the extent that such employees,
facilities and equipment are used to provide direct health care
servicies to policy-holders.
( b ) The highest premium rate per covered beneficiary for any
individual or group accident and sickness insurance policy issued in
West Virginia by any insurer or health maintenance organization
must not exceed 120% of the lowest premium rate for a policy
providing a similar benefit package issued in West Virginia by that
insurer or health maintenance organization.
( B ) Except as provided in subsection (C) of this section, after the first
day of January, 1994, no insurer may transact any individual, group or
employer group accident and sickness insurance, or operate any health
maintenance organization or other prepaid health care plan pursuant to
chapter 33 of this code, without the expressed approval of the Insurance
Commissioner of the premium rates for such coverage.
( C ) Any insurer may apply to the Insurance Commissioner to operate on a
guaranteed loss ratio basis, pursuant to Chapter 33, Section 6C of this
code, provided that, after the first day of January, 1994, the guaranteed
loss ratio shall not be less than 90%.
�47
16-29E-12.
Hospital
reimbursement
rates
After the first day of January, 1994, reimbursement for all
inpatient hospital services provided in the State of West Virginia to the
beneficiaries of individual or group health and accident insurance policies
issued in West Virginia, or to the enrollees of any health maintenance
organization, or to the beneficiaries of any employee benefit plan covering
hospital services, shall be based on and determined by reference to a
system of diagnosis related groups (DRG's) as established by HCCRA,
subject to Chapter 29A, Article 3 of this code. Such DRG's and the
reimbursement rates therefor shall further be subject to the following:
( 1 ) The DRG categories, modifiers and definitions adopted by
HCCRA shall be patterned generally after those used to determine hospital
reimbursement under the Federal Medicare system, but may be modified
and enhanced as necessary by HCCRA.
( 2 ) On at least a yearly basis, HCCRA shall determine a payment
rate for hospital services, which generally shall be expressed as a single,
uniform numerical multiplier of the DRG payment schedule established by
medicare.
( 3 ) The payment rate for selected DRG's shall be modified upward
or downward by HCCRA if it appears that certain services produce atypical
levels of profit or loss compared to other services. In making such
modifications, HCCRA shall attempt to assure that all necessary hospital
services are equally profitable, to create the incentive for hospitals to
compete for patients based on the total number served rather than on the
basis of particularly profitable services or types of patients.
( 4 ) The payment schedule shall be generally uniform statewide. It
shall not be modified based on traditional hospital charges or fees, but
may be modified up to a total of 2 1/2% (two and one-half per cent)
upward or downward for any or all DRG's, as determined by HCCRA, based
on one or more of the following considerations:
(a)
Any difference in the cost of living between the areas in
which various hospitals are located.
�48
(b)
Any major departure from the expected severity of
disease within any major DRG at any particular hospital, if
adequately documented.
(c)
Payments made by hospitals to service debts owed to
banks or other commercial lending institutions, provided that, if any
hospital is owed money other than for unpaid hospital services, or if
any hospital has incurred any mortgage or other lien against its
assets, and the proceeds of such mortgage or lien have passed from
the control of the hospital board of directors or have been used for
purposes that do not relate directly to the provision of health care
services, such payments may not be considered in reimbursement
rates.
(d)
Costs of education.
( 5 ) An additional adjustment of the reimbursement rate for any
hospital shall be made for the profits and/or losses from laboratory, xray, or other diagnostic services, physical therapy services, rehabilitation
services, home health services, skilled nursing services, clinics and other
outpatient health care services provided by, owned by, or otherwise
financially associated with that hospital, up to the full total dollar
amount of such profits or losses.
( 6 ) An additional adjustment shall be made for any unusually high
or low amount of uncompensated or undercompensated inpatient care
provided by any hospital, the value of such services to be determined by
reference to the DRG category of such care and the standard DRG
reimbursement schedule.
( 7 ) An additional adjustment to the reimbursement rate for any
hospital shall be made based on the income or profits realized by that
hospital from any investments and assets not associated with patient
care, up to the full dollar value of such income or profits.
�49
16-29E-13.
Hospital
Boards
of
Directors
( 1 ) The board of directors of any non-profit hospital, and of any
hospital owned by a county, city or other political subdivision of the State
of West Virginia shall have and retain control over all decisions of the
hospital relating to or affecting the cost of hospital services or the type
of health care services offered by the hospital. Such control may not be
delegated by contract or otherwise to any other person or entity. The
scope of authority granted herein shall be interpreted broadly, and shall
include the employment and supervision of the chief executive officer of
the hospital and control over all funds received as payment for health care
and related services.
(2)
No person may serve on the board of directors of any nonprofit hospital or hospital owned by any county, city or other political
subdivision of the state of West Virginia who is employed by or receives
any other remuneration or financial benefit from the hospital or from any
subsidiary or affiliate thereof, or who owns or is employed by any entity
selling or seeking to sell goods and/or services to that hospital.
(3)
No person may serve on the board of directors of any nonprofit hospital or hospital owned by any county, city or other political
subdivision of the state of West Virginia who owns, is employed by, or has
other financial interest in any other hospital or any other entity providing
any health-related service which is in competition with such hospital, or
with any service offered by such hospital.
�50
16-29E-14.
(A)
Control
of
duplicative
health
care
services
Designation of primary care provider; incentives
( 1 ) Any person who is a beneficiary of any individual or group
accident and sickness policy issued pursuant to Chapter 33 of this code
shall, on or before the first day of January of each year, be offered by the
insurer the opportunity to designate a personal primary care provider for
the ensuing calendar year. Primary care providers for the enrollees of
health maintenance organizations shall be designated according to the
terms of the enrollee's contract with the health maintenance
organization.
( 2 ) Any health care services provided by a beneficiary's
designated primary care provider, or upon the order of or at the request of
that provider, or by another provider consulted by the designated provider,
or by another provider covering for such designated provider, shall be
reimbursed by the beneficiary's insurer to at least the level of the
standard payment schedule for health care services established by HCCRA
pursuant to Section 7 of this act, subject to any policy-specific
copayments and limitations of coverage.
( 3 ) Any health care service provided by or at the request of a
provider who is not listed in subdivision (A) (2) of this section, except as
provided in section 7 (B) (2) of this act, shall be reimbursed by the insurer
at no more than 90% of the standard payment schedule established by
HCCRA, subject to any policy-specific copayments and limitations of
coverage. The remaining 10% shall be the obligation of the beneficiary.
(B)
Selection of coverage
The mandatory standard benefit package established by HCCRA
pursuant to section 8 of this act shall include sufficient preselectable
choices to satisfy the policy of non-discrimination among health care
providers established in Chapter 33 of this code while strongly
discouraging the simultaneous utilization of competing health care
services and/or disciplines. Such choices shall conform to the following
guidelines:
�51
( 1 ) On or before the first day of January of each year,
beneficiaries shall be offered a choice of basic coverage packages, which
choices shall include:
(a)
Primarily Medical or Osteopathic physician coverage
with limited coverage of Chiropractic physicians and/or other
secondary providers, such limitations to include limited or no
payments or substantial copayments for services from such
secondary providers, or
(b)
Primarily Chiropractic physician coverage with limited
coverage for Medical and Osteopathic physicians and/or other
secondary providers, such limitations to include limited or no
payments or substantial copayments for services from such
secondary providers.
(c)
Such other choices as HCCRA shall determine.
( 2 ) Such alternative basic benefit packages shall be designed to be
of approximately equal cost per covered individual.
( 3 ) Such alternative basic benefit packages shall be structured so
as to strongly encourage the use of only one health care discipline and, to
the extent possible, of only one health care provider during any calendar
year.
(C)
Non-payment for duplicative services
No insurer shall be obligated to reimburse for any outpatient
laboratory test, x-ray or other diagnostic procedure, or any similar
procedure, which is performed twice or more within any 3-month period,
unless such test or procedure meets one or more of the following criteria:
( 1 ) Any tests or procedures ordered or performed by the
beneficiary's designated primary care provider.
�52
(2)
Both tests or procedures were ordered by the same provider,
and no similar test or procedure has also been done by another provider in
the interim.
( 3 ) The statement or bill requesting reimbursement for any such
procedure is accompanied by a written explanation of the necessity
therefor, in sufficient detail to demonstrate the need for such repetition.
16-29E-15.
Profits
from
health
care
ventures
( A ) This section shall not apply to any medical equipment or facility
which is wholly owned and operated by any hospital or hospitals operating
within the state of West Virginia, and more than 50% of the use of which
is to provide services to inpatients of such hospital or hospitals.
( B ) On or before the first day of January, 1995, HCCRA shall promulgate
rules and regulations pursuant to Chapter 29A, Section 3 of this code,
which shall require that:
( 1 ) Any person or entity which owns or operates medical
equipment or facilities used to perform diagnostic testing or procedures
for which that person or entity receives total payments of more than
$5,000.00 per year shall report such ownership to HCCRA.
( 2 ) On a form and in a manner to be determined by HCCRA, any such
person or entity shall report all required financial activity associated
with such equipment or its operation, including the cost to purchase, the
cost to finance, the cost to operate, the depreciation thereof and such
other information as HCCRA shall require.
( 3 ) On the basis of the information so supplied, HCCRA shall
determine the charges for any procedure using such equipment. In
establishing such charges, HCCRA shall consider:
(a)
The amount invested in such equipment.
( b ) The cost of servicing any debt resulting from the
purchase of such equipment.
�53
(c)
The risk, if any, involved in such investment.
(d)
The reasonable cost to operate such equipment.
(e)
A reasonable profit or return from the ownership of such
equipment, which generally shall not be greater than 5% per year,
based on the amount invested and considering any depreciation, or
appreciation, of the value of such equipment.
16-29E-16.
Advertising of
health
care and
related
services
( A ) Any paid advertising of health care or related services must be
submitted to and preapproved by HCCRA. Those entities specifically
subject to this provision shall include all licensed health care
practitioners, all hospitals and hospital corporations, all medical
corporations, all insurers and all health maintenance organizations and
other partnerships, corporations or associations providing health care
services.
(B)
In general, such advertising should be limited to:
(1)
Statements which are generally factual in nature.
( 2 ) Statements which inform the public as to the availability of
certain health care services, provided that such statements may not serve
to increase the demand for such services unless HCCRA believes that such
increased demand is in the public interest.
( 3 ) The relative cost of specific health care services from
specific providers or hospitals.
( 4 ) Other factors relating to the location, convenience or cost of
health care services.
(C)
In general, HCCRA shall disapprove any paid advertising which:
�54
(1)
Is political in nature, or which is designed to affect public
policy, unless such advertising is paid for by individuals in accordance
with laws referable to political activity and lobbying.
(2)
Contains information which is untrue, misleading or deceptive.
( 3 ) Contains any statement, image or other means of
communication which is intended to increase demand for specific health
care services, unless HCCRA, after consultation with the medical advisory
committee, determines that such increased demand is in the public
interest.
( 4 ) Contains any statement or implication which tends to
denigrate the character or competence of any health care provider, unless
such statement is a direct quotation from a licensing or reviewing body
which has sanctioned, publicly reprimanded or otherwise publicly
censured such provider.
16-29E-17.
Penalties
for
violations
( A ) Except as otherwise provided herein, any violation of this act shall
be subject to any or all of the following penalties:
( 1 ) Actions against the licensure of any practitioner or institution
may include: a public reprimand; restrictions or limitations of
authorization to provide health care services; revocation of certificate of
need; suspension of licensure for up to five years; revocation of licensure.
(2)
Remedial actions which may be required include: a program of
education as prescribed by the board; a requirement to practice or do
business under the direction of another person specified by the board;
public service, as specified by the board.
( 3 ) Civil fines of not less than $100 nor more than $1,000 may be
assessed against any entity and any individual for a first violation of this
act.
�55
( 4 ) Civil fines of not less than $1,000 nor more than $10,000 may
be levied against any entity and any individual for a second violation of
this act.
( 5 ) Civil fines of not less than $10,000 nor more than $100,000
may be assessed against any entity and any individual for repeated
violations of this act.
(6)
In addition to any such fines, any financial gain realized as a
result of any violation of this act shall be refunded by any individual or
any entity responsible for such violation.
( B ) Upon determination by the board that there is probable cause to
believe that any person, partnership, corporation, association, insurance
company, health maintenance organization or other entity subject to the
provisions of this act, or if any such entity fails or refuses to make a
report required by this act, the board shall provide written notice to the
alleged violater stating the nature of the alleged violation and the time
and place at which the alleged violator shall appear to show good cause
why such a penalty should not be imposed.
The hearing shall be conducted in accordance with the provisions of
Chapter 29A, Article 5 of this code.
After reviewing the record of such hearing, if the board determines
that a violation of this act has occurred, the board shall assess a penalty
as described above, provided that no action may be taken against the
licensure of any individual without a subsequent disciplinary hearing
conducted by the respective licensing board.
Anyone so penalized shall be notified in writing and the notification
shall include the reasons for such penalty. If the violator fails to meet
the penalty within thirty days, or such longer period as may be specified
by the board, the Attorney General may institute a civil action in the
circuit court of Kanawha County to enforce the penalty.
( C ) Any person against whom a civil penalty is assessed pursuant to the
provisions of this act, has the right to judicial review as provided in
Chapter 29A, Articles 5 and 6 of this code.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
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�March 18,
1993
I r a Magaziner
Task Force' f o r N a t i o n a l Health Care Reform
The White House
1400 Pennsylvania Avenue, N.W.
Washington,D.C. 20500
01 #
Dear Mr. Magaziner:
I applaud the e f f o r t s of President C l i n t o n t o expand access
to h e a l t h care and c o n t r o l c o s t s . He c e r t a i n l v _ n f i c o g n i z e s the
c r u c i a l r o l e of h e a l t h c a r e ^ e o s t ^ i n both rg€forTna]^--hf;a 1 t h v
^econgroy^and p r o t e c t i n g thei^healthj of a l l our'' c i t i z e n s .
l
The Admi-nistration' s plan w i l l no doubt r e q u i r e a d d i t i o n a l
p u b l i c expenditures t o implement i t , and I am ready t o ' '
c o n t r i b u t e . I do a n t i c i p a t e the plan t o i n c l u d e a major e f f o r t
to e l i m i n a t e waste and cut c o s t s .
I would l i k e t o suggest?*action which could be taken now t o
both e l i m i n a t e waste and cut costs i n one program, and am
sure t h a t by p o i n t i n g out many such a c t i o n s taken President
C l i n t o n w i l l increase the support f o r h i s plan both i n the
Congress and the American people.
Minnesota i s charging a l l doctors with Minnesota l i c e n s e s
(1992 Minnesota Laws, Chapter 513, A r t i c l e 7, Section 9,
Subdivision 6) a $400 annual fee to obtain federal Medicaid
matching funds and return the money to the doctors i n the form
of a twenty-five per cent (25%) increase i n t h e i r Minnesota
Medicaid fees. This amounts to a $11,593,600 f e d e r a l l y funded
kickback at no cost to the State and without any improvement
or expansion of s e r v i c e s . This could be stopped now by HHS
Secretary Donna Shelala declaring t h i s not e l i g i b l e for
federal matching and cancelling the waiver.
Keep up the good work.
S i n c e r e l y yoyafS,
•a-
Arthur•.L,—Arnold,
M.D.
�LINDA BERGLIN
Senator 60th District
G-10 Slate Capitol Building
St. Paul, Minnesota 55155
Phone: 296-4261
Senate
State of Minnesota
February 2 , 1993
Dr. A r t h u r L. A r n o l d
Twin P o r t s VA O u t p a t i e n t C l i n i c
3520 Tower Avenue
Superior, Wisconsin
54880
Dear Dr. A r n o l d :
Thank y o u f o r c o n t a c t i n g my o f f i c e t o express y o u r c o n c e r n
r e g a r d i n g t h e m e d i c a l l i c e n s e f e e surcharge. As you may o r may
not know, t h e revenue r a i s e d from t h e surcharge i s p a r t o f t h e
s t a t e ' s e f f o r t s t o b r i n g i n more f e d e r a l Medicaid f u n d i n g f o r t h e
M e d i c a l A s s i s t a n c e program.
I n 1991, a s u r c h a r g e was p l a c e d on n u r s i n g homes, h o s p i t a l s , and
h e a l t h p l a n s p a r t i c i p a t i n g i n t h e MA p r e p a i d p l a n t o be used as
the s t a t e match i n g e n e r a t i n g more f e d e r a l matching payments.
The a d d i t i o n a l f e d e r a l f u n d i n g i s b e i n g used t o o f f s e t c u t s t o
M e d i c a l A s s i s t a n c e p r o v i d e r s t h a t had been proposed by t h e
Governor and t o f u n d i n c r e a s e s i n p r o v i d e r reimbursement.
Because d o c t o r s a r e r e c e i v i n g a minimum 25% i n c r e a s e i n M e d i c a l
A s s i s t a n c e reimbursement r a t e s from t h e i n c r e a s e d f e d e r a l
f u n d i n g , t h e 1992 L e g i s l a t u r e decided t h e y s h o u l d a l s o share i n
the s u r c h a r g e . The s t a t e c o u l d have p l a c e d a s u r c h a r g e on t o t a l
revenues o f a l l p h y s i c i a n s o r a surcharge on l i c e n s e f e e s . The
L e g i s l a t u r e chose t h e l a t t e r surcharge because o f t h e ease o f
administration.
A l t h o u g h I u n d e r s t a n d y o u r concerns, i t i s i m p o r t a n t t o remember
t h a t any exemptions t o t h e surcharge would c r e a t e l e s s f e d e r a l
match money f o r t h e s t a t e . Decreased f e d e r a l M e d i c a i d revenues
c o u l d mean t h e r e would be inadequate funds t o pay t h e i n c r e a s e s
t o h e a l t h c a r e p r o v i d e r s s e r v i n g t h e Medical A s s i s t a n c e and o t h e r
s t a t e funded h e a l t h c a r e programs. The s t a t e would t h e n need t o
c o n s i d e r c u t t i n g back on p r o v i d e r pay t o p i c k up t h e s l a c k .
General f u n d i n g o f t h e program would be d i f f i c u l t a t a t i m e when
o t h e r c u t s a r e b e i n g l o o k e d a t t o balance t h e s t a t e budget.
COMMITTEES
• Chair, Health anil Human Services • Rules and Adniinistialion • Taxes • Judiciary •
Coniineri'c • Commission on the l-'conomic Slams ol Women • Council on Menial Health • Long Term
Care Commission • Planning and Piscal Policy Commission
a&g&i*
�However, I am c u r r e n t l y w o r k i n g w i t h
A s s o c i a t i o n and t h e Board o f M e d i c a l
d r a f t e d t o create a separate license
W i t h t h e new l e g i s l a t i o n and m e d i c a l
would n o t need t o pay t h e surcharge.
t h e Minnesota M e d i c a l
P r a c t i c e t o get l e g i s l a t i o n
f o r r e t i r e d physicians.
license, r e t i r e d physicians
Once a g a i n , t h a n k you f o r c o n t a c t i n g me.
I f I can be o f any
f u r t h e r a s s i s t a n c e , p l e a s e c a l l my o f f i c e a t (612)296-4261.
Sincerely,
Linda B e r g l i n
S t a t e Senator
P.S.
Next y e a r i t w i l l be p o s s i b l e f o r us t o change t h e p r e s e n t
system t o one t h a t w i l l be based upon p h y s i c i a n s income i n
Minnesota.
T h i s w i l l s u b s t a n t i a l l y reduce t h e impact on o u t o f
s t a t e p h y s i c i a n s . At t h e present t i m e , the data i s u n a v a i l a b l e
t o process t h a t i n f o r m a t i o n . However, we may have t h e d a t a by
1994.
LB/kj
�4 W I W r f IKetxM
UPDATE"
S^M, I^S
$400 SURCHARGE PAYMENT REQUIRED FOR RENEWAL
^ h e Summer 1992 Minnesota
Board of Medical Practice Update
newsletter notified physicians of the
1992 legislation which provided for
a 25 percent increase in fees paid to
physicians by Medical Assistance.
The increase is to be funded, in
part, by annually assessing a $400
surcharge for each licensed
physician residing in Minnesota or
contiguous states.
The law requires the Board to
issue the surcharge invoice and the
Department of Human Services to
collect, impose interest and
penalties, and to take court action
where necessary to collect the
surcharge.
has been levied, a liability is
incurred which cannot be erased.
The law does not contain any
provisions for waiver, exclusion, or
exemption and neither the Board nor
the Department of Human Services
has the authority to grant any
waivers, exclusions Or exemptions.
If you have received a surcharge
notice and do not pay, the Board will
be unable to renew your medical
If you are in Group 2 and you are
practicing in North Dakota, South
Dakota, Iowa or Wisconsin, you may
avoid the May 1993 surcharge
liability: 1) if you have already
allowed your license to lapse
through nonrenewal; 2) by resigning
your license; or 3) by obtaining
emeritus status if you are completely
retired from the practice of medicine
and do not see patients or do any
prescribing.
Once the surcharge has been
billed, the Board cannot renew a
license until any delinquent
surcharge amount (including
interest and penalties) has been
paid. The law requires the $400
surcharge to be assessed as follows:
Group 1. A physician whose
license is issued or renewed between
April 1 and September 30 shall be
billed on or before November 15 and
the physician must pay the
surcharge by December 15; and
Group 2. A physician whose
license is issued or renewed between
October 1 and March 31 shall be
billed on or before May 15 and the
physician must pay the surcharge by
June 15.
license. Late fees and interest will
beassessed for late payment of the
surcharge by the Department of
Human Services.
Any questions concerning
remittance should be directed to the
Medical Care Surcharge Unit,
Department of Human Services, 444
Lafayette Road, St. Paul, M N 551553850. Metro area call 296-6607.
Greater Minnesota call 1-800-6573762.
The Board sent the first surcharge
notice to Group 1 on November 1,
1992. Physicians with an October to
March birth month will be billed as
of May 1, 1993. O ce the surcharge
If you are in Group 1 and have
been issued a surcharge invoice, you
must clear up the surcharge with the
Department of Human Services.
Resigning your license or obtaining
emeritus status will not alleviate
n
your liability for the surcharge
already incurred.
You may prevent future
surcharge liability by: 1) allowing
your license to lapse through
nonrenewal; 2) resigning your
license; or 3) obtaining emeritus
status if you are completely retired
from the practice of medicine and do
not see patients or do any
prescribing.
If you resign your license or
request emeritus status, you are not
entitled to a refund of your annual
fee. Your resignation request will be
processed at the next bimonthly
Licensure Committee Meeting.
Several issues concerning the
surcharge are pending as of January
18,1993. It is anticipated that the
Legislature will review the
surcharge legislation in the 1993
session (January to May). A class
action lawsuit has been filed against
the state claiming the improper
application of the law
retrospectively to physicians
renewing between April and
September, 1992. Finally, there is
some question as to how the federal
rules governing surcharges will be
applied to the Minnesota surcharge.
PAGE FIVE
�Practice limited to hand surgery
and microvascular surgery
North East Wisconsin
Center for Surgery &
Rehabilitation of
the Hand, Ltd.
John C. Bax, M.D.
Larry C. Livengood, M.D.
Jean Krause, Office Manager
Office hours
by appointment
506 E. Longview Drive
Appleton, Wl 54911
Ph. #414-730-8833
Fax # 414-730-8263
March 30,
1993
Mrs. Hillary Rodham Clinton
Chair, National Task Force on Health Care Reform
The White House
1600 Pennsylvania Avenue, N W
..
Washington, D 20500
C
RE:
Health Care in the United States
Dear Mrs. Clinton:
I would like to take this opportunity to make myself available to you on health
care reform. As a private practice physician, practicing in the trenches and
not at a teaching institution, I will have a different perspective on health
care in the United States than others may have. I have also had the opportunity
to know and understand the Canadian system. I also performed part of m hand
y
surgery fellowship in Australia and was even the guest of a hand and microvascular surgeon in Bejing, China.
N
I f this interests you or you are in Wisconsin, do not hesitate to let me know,
because I would be very happy to participate on this very important subject.
I was saddened to hear about your father's recent illness and I wish him a speedy
recovery.
Yours sincere
John C Bax, M D
.
..
JCB:jsr
�^.4 ic^
A. Yale Gerol, M.D.
26 January, 1993
F.A.C.S.
Neurology & Neurological Surgery
Electro-encephalography
Mrs. W.J. ( H i l l a r y ) C l i n t o n
The White House
Washington, D.C
My Dear M r s . C l i n t o n :
As t h e proud f a t h e r o f a W e l l e s l e y alumna who
was p r e s i d e n t o f Munger i n 73/'74, I
c o n g r a t u l a t e you on assuming t h e l e a d e r s h i p r o l e
i n t h e h e a l t h care b a t t l e . You b r i n g t h e f i r s t
glimmer o f hope t o a t l e a s t b e g i n n i n g t o s o l v e a
c r i s i s I know f i r s t hand.
/
2985 Forest View Circle\
FranksviJIe, Wisconsin 53126/
7414) 835-4740
Fax (414) 835-1601
For y e a r s , as t h e Medical A f f a i r s D i r e c t o r o f a
h o s p i t a l , much o f my t i m e was wasted a t t e m p t i n g
t o b r i n g meaningful q u a l i t y c r i t e r i a and
c o n t r o l s t o t h e work p h y s i c i a n s performed. The
physicians refused t o e s t a b l i s h guidelines t o
measure performance.
I became t h e medical d i r e c t o r o f an IPA model
HMO and q u i c k l y found a b i z a r r e Pareto
p r i n c i p l e : 80% o f an IPA's f i n a n c i a l l o s s e s were
t h e r e s u l t o f t h e egregious b e h a v i o r o f 20% o f
t h e p h y s i c i a n s . Yet, t h e o t h e r p h y s i c i a n s when
apprised of t h i s refused t o d i s c i p l i n e the
outliers.
There i s a s t r a n g e d u a l i t y , I l e a r n e d , i n
medicine.
There a r e some c o n t r o l s " f i g l e a f e d "
by t h e JCAH0 d i r e c t e d a t p h y s i c i a n s who p r a c t i c e
i n h o s p i t a l , b u t t h e r e i s an u n d e r c l a s s o f
r e p t i l e - p h y s i c i a n s who never e n t e r t h e h o s p i t a l
and p r a c t i c e w i t h o u t l e t o r h i n d r a n c e . These
p h y s i c i a n s a r e b u t a few o f t h e 10% o f c u r r e n t l y
p r a c t i c i n g p h y s i c i a n s who a r e f e l o n s , f a k e s , and
f r a u d s ( a c c o r d i n g t o A r n o l d Relman) and g e n e r a t e
b i l l i o n s o f unnecessary c o s t s .
There i s a form o f medicine c h a r a c t e r i z e d by
outrageous r a p a c i t y , greed, and f r a u d y e t
supported by a l l p r a c t i t i o n e r s ; t h e l e a d e r s o f
medicine do n o t h i n g t o d i s c i p l i n e t h e
e n t r e p r e n e u r - p h y s i c i a n s who generate t h e b l a c k
h o l e o f "Workers Compensation". Not once has t h e
American College o f Surgeons o r t h e Academy o f
�'"A. Yale Gerol, M.D.
Orthopedic Surgeons demanded t h a t any p h y s i c i a n s
who n e e d l e s s l y a f f l i c t workers comp s u r g e r i e s
s h o u l d be d i s c i p l i n e d .
When I was t h e i r Medical D i r e c t o r , I went t o t h e
Board o f D i r e c t o r s o f t h e p a r e n t i n s u r a n c e
company and t o l d them t h a t , f o r s t a r t e r s , I
would d i s m i s s 20 o f our p h y s i c i a n panel as
incompetent.
Although t h e Board
e n t h u s i a s t i c a l l y agreed and supported me, t h e
a t t o r n e y s who defended t h e f i r s t l a w s u i t s a i d i t
had c o s t us d e a r l y t o r i d o u r s e l v e s o f t h e f i r s t
r e p t i l e and t h e r e wasn't enough t i m e t o
continue.
The 14% o f p r a c t i c i n g p h y s i c i a n s i m p a i r e d by
chemical abuse a r e r a r e l y s a n c t i o n e d u n t i l
c o m p l a i n t s a r e lodged w i t h a d m i n i s t r a t o r s s i n c e
t h e peers a r e s i l e n t . Furthermore s i n c e t h e r e
are no q u a l i t y c o n t r o l s , by J u s t i c e O'Connor's
r u l e o f thumb, 25% o f p h y s i c i a n s a r e rank
f a i l u r e s . P h y s i c i a n s be they m e d i c a l ,
osteopathic, or c h i r o p r a c t i c are responsible f o r
the elegant t h e f t t h a t i s " r e h a b i l i t a t i o n
medicine" and t h e a r r o g a n t c u p i d i t y t h a t i s
" p a i n c o n t r o l c e n t e r " and t h e b o u t i q u e t h a t i s
" s p o r t s medicine". Nobody so f a r demands "Stop
i n God's Name".
There a r e ways o f c o n t r o l l i n g t h e hemorrhage o f
m e d i c a l c o s t s and t h e r e a r e many i n t h e t r e n c h e s
l i k e myself who w i l l support you i n a l l you
a t t e m p t . The d e s p a i r I f e l t came w h i l e I
watched h e l p l e s s l y as I p a i d f o r every
unnecessary mammilloplasty and had l i t t l e l e f t
t o t r e a t t h e cocaine babies.
I p l a n t o r e t i r e i n 62 days f o r I f i n d t h a t I
can no l o n g e r c o n t a i n t h e rage I f e e l a t t h e
s i l e n c e o f my peers; b u t i f you need t h e h e l p o f
a g r i z z l e d o l d bear I w i l l work, g r a t i s , i n any
way t o begin t h e b e g i n n i n g . A f t e r a l l , I c a n ' t
l e t a W e l l e s l e y alumna f i g h t alone.
VerMl r e s p e d t f u l l y
yours,
�AMBULATORY^NliSTHl-SIA ASSOCIATES, S.C.
April 1, 1993
Hillary Rodham Clinton
Head of Task Force on National Health Care Reform
The White House
Washington, D.C. 20510
Dear Ms. Clinton:
I would like to introduce myself to you in order to give a voice to my view of the task that is set
before you. I feel that I have a unique perspective on many of the issues that your task force is
addressing.
My name is Pamela Avery Redon and I voted for your husband. I admire you because you are
a woman very much like myself. I am 41 years old and am a private practicing anesthesiologist.
I am married and have 2 children, ages 9 and 11. While my husband is a research scientist at
the Universtiy of Wisconsin, I have been the major financial support of our family. I have
practiced medicine in Madison, Wi since 1982. I know all about managed competition in the
marketplace as Madison is a hotbed of exactly that. I have survived the dissolution of a group
practice of 23 anesthesiologists, a solo practice, a multi-speciality clinic practice and now have
my own very small group practice that consists of approximately 50% Medicare in an
opthamology Day Surgery Center. I have also lived through the merger of 2 major hospitals. I
accept Medicare assignment and participate in an HMO.
I love my current practice! I thoroughly enjoy my Medicare patients and love doing anesthesia
for eye surgery. I go to Honduras and The Dominacan Republic 2 weeks out of every year to do
volunteer medical mission work in eye surgery. I am enclosing photos of our team of a
H
volunteer US health care professionals who have seen national health services at the worst
levels possible in Third World countries. Our patients there have few expectations but are
grateful for what little we can offer them. I have been paid in eggs, sugar cane and even had
one patient's family mop our floor in appreciation. My love affair with medicine is rapidly
becoming a love-hate relationship. I love my patients and being able to help them but hate the
increasing frustration of dealing with third party payers who only dilute the doctor-patient
relationship to a cold business arrangement. I am so burned out by the politics of medical
practice in the US that I have seriously considered a second career and am considering a very
early retirement from US based medicine. I wouldn't wish this life for my children.
Pamela G. Avery, M.D. Sheila Carlson Davenport, M.D. Mark A. Hoenecke, M.D. Laurie A. Noll, M.D.
P.O. Box 5245, Madison, Wl 53705-0245 6O8-257-fi8O0
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBJECT/TITLE
DATE
04/01/1993
Personal (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [10]
2006-0885-F
jm780
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 22()4(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA1
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
��Photograph © PJ Saine
Permission (exclusively to companies and individuals who supported
The Dominican Eye Project') for use in newsletters is granted on the
conditions that:
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P
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1 5
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Published next to the image &
2. a copy of the published photograph is sent to:
PJ Saine
Photography Department
Davis Duehr Eye Associates
1025 Regent Street
Madison, Wl 53715
(608)282-2180
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��Photograph © PJ Saine
Permission (exclusively to companies and individuals who supported
'The Dominican Eye Project') for use in newsletters is granted on the
conditions that:
1. a byline 'Photograph by PJ Saine' is published next to the image &
2. a copy of the published photograph is sent to:
PJ Saine
Photography Department
Davis Duehr Eye Associates
1025 Regent Street
Madison, Wl 53715
(608)282-2180
�CODER:.
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
GENERAL SORT:
POSTCARD 1:
General mail
Personal stories
Other Health Providers
POSTCARD 2:
FORM LETTER:
REROUTE:
.Letter Campaign
Offers to help/Employment
.Letterhead
Casework
Policy
Physicians
Scheduling
President
Other
POLICY AND PERSONAL STORIES:
ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
working families
unemployed/low income
benefits
_providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
^malpractice & tort reform
manpower issues (training)
unnecessary procedures
GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
_COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
.FINANCING (VII)
MENTAL HEALTH (EX)
.LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
AIDS
..women's health
Jmmunizations/children
_rural
urban
OTHER
�
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Title
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Health Care Task Force Records
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White House Health Care Task Force
Is Part Of
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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[Physician Letters] [loose] [10]
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 3
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Box 6
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
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Clinton Presidential Records: White House Staff and Office Files
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dd76df65e0604981bd6eb51618a0e7fb
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Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
2385
FolderlD:
Folder Title:
[Physician Letters] [loose] [9]
Stack:
Section:
Shelf:
Position:
s
I
Row:
56
3
4
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. envelope
Address (1 page)
03/30/1993
P6/b(6)
002. letter
Address (Partial) (1 page)
03/27/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [9]
2006-0885-F
im779
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA)
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information |(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe l'RA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed jpon request.
�March 27, 1993
Dear Mrs. C l i n t o n :
I am a n e u r o l o g y r e s i d e n t who w i l l c o m p l e t i n g my
t r a i n i n g i n June o f t h i s y e a r and t h e r e f o r e am q u i t e
i n t e r e s t e d i n t h e d i r e c t i o n h e a l t h care i s going t o take i n
the f u t u r e .
I would l i k e t o s h a r e w i t h you a few o f my
concerns r e g a r d i n g t h i s issue.
F i t r s t , I was p l e a s e d t o hear o f y o u r i n t e r e s t i n t h e
Oregon P l a n .
I b e l i e v e t h i s i s t h e d i r e c t i o n h e a l t h care
must t a k e b u t t h e r e i s a f u n d a m e n t a l q u e s t i o n I have n o t y e t
h e a r d d i s c u s s e d . Can we as a s o c i e t y a c c e p t one l e v e l o f
c a r e f o r one segment o f o u r p o p u l a t i o n and a h i g h e r l e v e l
f o r t h e e c o n o m i c a l l y advantaged?
I would l i k e t o i l l u s t r a t e
the c o m p l e x i t y o f t h i s p r o b l e m w i t h two b r i e f e x a m p l e s :
Two e l d e r l y p a t i e n t s w i t h e n d - s t a g e h e a r t d i s e a s e a r e
admitted f o r exacerbation of t h e i r heart f a i l u r e .
One
p a t i e n t has o n l y m e d i c a r e , t h e o t h e r has s u p p l e m e n t a l
i n s u r a n c e . The f a m i l i e s o f each r e q u e s t m a x i m a l s u p p o r t .
Are we as p h y s i c i a n s supposed t o t e l l one f a m i l y t h a t
t h e i r l o v e d one i s n o t e n t i t l e d t o i n t e n s i v e c a r e as t h e
o t h e r i s a d m i t t e d t o t h e ICU?
Two 26 week, 550 gram i n f a n t s a r e b o r n , one t o a p o o r
i n n e r - c i t y mother, t h e o t h e r i n t o a w e a l t h y f a m i l y .
I s t h e n e o n a t o l o g i s t t o go and c h e c k t h e c h a r t f o r
insurance status before c a l l i n g the t h e r a p i s t t o
intubate the infant?
W h i l e I do n o t l o o k f o r w a r d t o t h e r o l e o f g a t e - k e e p e r ,
I am w i l l i n g t o do so i f o u r s o c i e t y d e c i d e s t h i s i s t h e
p a t h we choose t o t a k e . F u r t h e r m o r e , i f you do n o t t h i n k 60
M i n u t e s and 2 0 / 2 0 a r e n o t g o i n g t o be w a i t i n g t o c a t c h t h e s e
dramas on t a p e y o u ' r e m i s t a k e n . I can see t h e s t o r y now
e n t i t l e d "Mrs. C l i n t o n K i l l e d My Baby." Can o u r s o c i e t y
t o l e r a t e t h e s e l i f e and d e a t h c o n f l i c t s ?
P e r s o n a l l y , I b e l i e v e t h a t t h e g r e a t e s t area t o l i m i t
h e a l t h care spending i s i n f a c t i n t h e c r i t i c a l l y i l l a t the
e x t r e m e s o f l i f e and i n e x p e n s i v e , low y i e l d t h e r a p i e s , i . e .
l i v e r t r a n s p l a n t a t i o n . I f we want u n i v e r s a l c o v e r a g e as a
s o c i e t y , t h e s e a r e t h e c h o i c e s we w i l l have t o make and i t
i s c r i t i c a l t h a t you and t h e P r e s i d e n t mak§ t h i s v e r y c l e a r
to t h e American people.
F o r me, i t i s somewhat a n a l o g o u s t o
the Food Stamp p r o g r a m ;
We,as a s o c i e t y , a g r e e t h a t a l l
f a m i l i e s a r e e n t i t l e d t o f o o d b u t we l i m i t t h e amount t h e y
r e c e i v e and we p l a c e r e a s o n a b l e r e s t r i c t i o n s on what can be
purchased.
:
Page - 1
�The success or f a i l u r e of r e f o r m w i l l hinge on t h i s
fundamental q u e s t i o n of l i m i t i n g access. As a p h y s i c i a n I
am w i l l i n g t o p l a y my p a r t .
I hope you are able t o convince
the American people and the Congress t h a t unless we make
these a g o n i z i n g d e c i s i o n s , our n a t i o n ' s economic s u r v i v a l i s
at r i s k .
Thank you f o r your c o n s i d e r a t i o n and best of l u c k .
Sincerely,
Jonathan Richman,
M.D.
Sr. Resident N e u r o l o g i s t
Box 394
Dept. of Neurology
Univ. of V i r g i n i a
C h a r l o t t e s v i l l e , VA 22908
Page - 2
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACT!
FROM THIS DOCUMENT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. envelope
SUB.IF.C 171 ITLE
DATE
03/30/1993
Address (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [9]
2006-0885-F
jm779
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
PI
P2
P3
P4
National Security Classified Information |(a)(l) of the PRA]
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA]
Release would violate a Federal statute 1(a)(3) o f t h e PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of t ic PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between sucti advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom of Information Act - [S U.S.C. 552(b)|
b(l) National security classified information 1(b)(1) o f t h e FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) o f t h e FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
�S
HEALTH CARE TASK FORCE SORTING SHEET
CODER}
INPUT DATE:^
GENERAL SORT:
General mail
Personal stories
Other Health Providers
POSTCARD 1:
Letter Campaign
POSTCARD 2:
Offers to help/Employment
FORM LETTER:
Letterhead
.Policy
REROUTE:
Casework
.Scheduling
\/ Physicians
President
Other
POLICY AND PERSONAL STORIES:
_ORGANIJ5ATION (I)
insurance premiums
insurance reform
insurance pools
boairds and oversight
.COVERAGE (H)
working families
one mploved/low income
benefits
.providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
FINANCING (VII)
.MENTAL HEALTH (IX)
LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
.women's health
.immunizations/children
.rural
urban
OTHER
�D A V I D G. S C H W A R T Z ; M.D.
LOUISA MEDICAL CENTER
P.O. BOX 5 3 2
LOUISA, VIRGINIA
23093
TELEPHONE (703) 9 6 7 - 2 0 5 0
20 March 93
H i l l a r y Rodham Clinton
The White House
1600 Pennsylvania Ave
Washington, D.C.
Dear Ms. C l i n t o n :
Thank you f o r taking on the Herculean task of reforming the health
care system. I practice family medicine i n a r u r a l town that has many
e l d e r l y p a t i e n t s . I t r y to do as much preventive work as possible t o
keep patients out of the h o s p i t a l .
I voted f o r B i l l because I thought he could bring about changes
to r e v i t a l i z e our country, and I am eager t o see a more e f f e c t i v e , coste f f i c i e n t health care system.
Please remember that every d o l l a r spent on good preventive primary
care outside the hospital saves several dollars i n long term health costs.
I f medicare payments to primary care physicians are cut, I see that very
l i k e l y h o s p i t a l costs would increase, as many medicare r e c i p i e n t s w i l l
no longer have primary care physicians, because many r u r a l practices
l i k e my own would close due t o f i n a n c i a l insolvency i f they continue
to trea-; medicare patients.
In a newly overhauled health care system, do you see a way to preserve
f i n a n c i a l incentives f o r primary and secondary prevention, while c u t t i n g
o v e r a l l costs?
Sincerely,
/j
David G. Schwartz, M.D.
dgs
�CLINICAL
PROFESSori O F
DIRECTOR^OF DEPARTMENT
JEFFERSON MEMORIAL
SURGERY
OF SURGERY
HOSPITAL
r'
LASZLO
N.
T A U B E R . M.D., F.A.C.S..
JEFFERSON MEMORIAL HOSPITAL
4600
KING STREET. SUITE
ALEXANDRIA.
(7031
\'II«;INIA
998
P.I.C.S.
2C
22302
4801
January 2:7, 1993
H i l l a r y R. Clinton, Esquire
Chairwoman
Task Force on National
Health Care Reform
White House
Washington, D.C.
20500
Dear Mrs. Clinton:
I would l i k e to offer my services to participate on the Task Force
on National Health Care Reform. Naturally I would not consider any
compensation however, I think with my background I can offer
valuable insight as to how to deal with the problem.
I have enclosed copies of an a r t i c l e published i n the American
Medical News on April 15, 1991 and an a r t i c l e published by the
Associcited Press which w i l l give you an outline of my
q u a l i f i c a t i o n s . I would greatly appreciate your response.
Sincerely yours,
Laszlo N. Tauber, M.D.
Enclosure
�THE
$0
50
MILLION
PHYSICIAN
Laszlo Tauber, MD, made a
fortune in real estate, but his
passion lies in helping others.
Story and photo by RYAN VER BERKMOES
aszlo Tauber, MD,
displays none of the
flamboyance that
;
might be expected
from
someone
4 W*
whose buildings dot
the Washington, D.C, metropolitan area. His slight frame, careful
voice and slow movements suggest
timidity.
But this mild-mannered demeanor masks a complex man.
He is a real-estate magnate. Penniless when he came to the United
States in 1948, he has amassed a
personal tbrtune in the area of
$500 million. The only practicing
physician on Forbes magazine's list
of the 400 richest people in the
country, he's the federal government's biggest landlord.
He is a successful surgeon. At
76, Dr. Tauber still practices surgery full-time in a hospital he built
himself.
He is a philanthropist. Dr.
Tauber's bills to patients are often
low or nonexistent. He gives as
much as $ 1 million a year in charitable contributions. And these are
just examples of his generosity.
"He is a completely remarkable
and giving man," says Margaret
Heckler, the former secretary of
Health and Human Services, who
1
met Dr. Tauber 10 years ago after
he went to great lengths to assist
her cousin, a physician who had
been semi-incapacitated after a
fall. "He has this tremendous desire to be helpful."
Perhaps the key ingredient in
Dr. Tauber's personality is this
drive to help others^ combined
with a deep loyalty to anyone who
has ever befriended him. Its roots
lie in his past — in the Nazi regime
in Budapest, which Dr. Tauber
survived while 600,000 other Hungarian Jews did not.
Ai his spi'avviiiig 42-acrc estate
in the rolling hills of Potomoc,
Md., the walls of the library are
lined with medical texts and books
about Jewish history during World
War II. He reads the first for pleasure, the latter because he must. " I
can never forget what happened,"
he says in a gentle, accented voice.
"1 can never stop learning about
what happened."
As a child in Hungary in the early 1930s, he was a gymnast, named
Hungary's "best sport student."
He represented the country in
many international competitions.
In 1938, he graduated from
medical school and began practicing at the Jewish hospital in Buda5a' DR. TAUBER, next page
AMERICAN MEDICAL NEWS/ APRIL
�Dr. Tauber
Tauber and his family moved to
Washington, D.C, where he set up a
general practice.
Continued from preceding page
pest. But in 1940, Hungary joined th.;
hroughout his life, Dr.
war on the side of Nazi Germany. Dr.
Tauber has been helped by
Tauber's only brother, Imre, was sen.
others, and he seems to
to a concentration camp where he died
feel that he can never fully
repay that debt. Says his daughter, InDr. Tauber managed to avoid the
grid Tauber, PhD: "My father has this
same fate because there was a shortage
forever allegiance to his past. He's
of physicians to treat the remaining
driven by the fear that, if you let the
Jews. But by the fall of 1944, condimemory go, it will be lost. That's retions for Jews in Budapest had beflected in his loyalty to those who have
come horrific. The Nazis had seized
helped him. He must remember the
the Jewish hospital, forcing the repeople who have made a difference in
maining staff to relocate in a buildinj;
his life."
that lacked running, water. At age 29,
Dr. Tauber was acting chief of surgery.
Among those he has remembered is
On the night of Oct. 16, Nazis wen i
his benefactor Dr. Sacher. Ten years
on a rampage in the Jewish neighborago, Dr. Tauber gave more than $1.5
hoods. Because almost all the men
million to Brandeis and Dr. Sacher to
and many ofthe women had already
establish the Tauber Institute for the
been shipped to concentration camps,
Study of European Jewry. Named in
they could victimize only mothers,
honor of his parents — his father,
small children and the elderly.
Gyula, who died in World War I , and
mother, Katica, who lived with Dr.
Eva Bentley was 10 years old at the
Tauber until her death in 1971 — the
lime. She was shot in the kidney by a
institute studies Jewish history since
band of thugs. Eventually her mother
the 17th century with a special focus
and grandmother got her to the makeon the Holocaust.
shift hospital.
Bentley, who
He was not
today lives in
• • ^ • M M^BHM
able to help the
Philadelphia, reSwiss governess
members the docwho had rescued
tor who operathim from the
ed on her. "As 1
Nazis, but that
came to from
was not for want
surgery, 1 turned
of trying. Some
Ingrid Tauber, PhD
my head and
^^^^^
four decades afsaw Dr. Tauber
ter the war, he
crying. He was holding the hand of a
found her in Switzerland. " I called
childhood friend who had just died."
and introduced myself," he says glumAs she recovered, Bentley got to
ly, "but when I told her I was the perknow her surgeon. Dr. Tauber "operat- son she had hid in her bedroom, she
ed night and day. He slept on the conbecame very upset. She exclaimed
crete floor. When someone tried to give that she never did such a thing and
him a blanket or pillow he would get
hung up the phone."
very upset and insist they be given to
Still, there are many others who can
his patients."
be helped, and they need not be people
Later that year, as the Russians adwho have helped Dr. Tauber himself.
vanced on the city, the round-ups of
After learning that a Christian HungarJews intensified. One day, as Dr.
ian general who had saved tens of
Tauber was visiting a patient at home,
thousands of Jewish children from the
the gestapo began searching the buildNazis was living as a beggar in Budaing. Fearing that he was about to be
pest, Dr. Tauber supported him for the
rounded up, Dr. Tauber sought refuge
remaining 10 years of his life.
with an old friend who employed a
To this day, about 50 families who
Swiss governess. When the gestapo
were victims of the Holocaust — or
entered her room, she Hashed her Swiss who were Christians who helped Jews
passport while implying that Dr.
— receive monthly checks to make
Tauber was her lover. The Germans
their lives easier. Some helped Dr.
left without Dr. Tauber.
Tauber at key points of his life, others
A few days later he was seized by
have never met him.
the gestapo and taken to an area when:
Such generosity would never have
he and others would be shipped to a
been possible, however, had Dr.
concentration camp. But the Soviet
Tauber not lived a rags-lo-riches story
Army was marching on Budapest and
following his arrival in the United
the situation was chaotic. Dr. Tauber
States.
found a simple means of escape.
In 1949, Dr. Tauber made his fate" I just walked away like I knew
ful decision to invest in real estate.
where 1 was going. I never looked
During the next 10 years, he built
back."
apartments in Washington and rapidly
After the war, Dr. Tauber won a
growing Montgomery County in subfellowship to study neurosurgery in
urban Maryland. Along the way he
Stockholm. In 1947, he decided to
made valuable business contacts and
immigrate to the United States, where
refined his strategies.
his first wife, Lilly, was waiting to
Central to his method was careful
give birth to his son, Alfred. However,
study of the zoning laws. He was a
he became caught in bureaucratic
master at finding loopholes that alhang-ups.
lowed him to acquire land cheaply and
Abram Sacher, PhD. was then head
then use it in ways that would yield
ofthe Hillel Foundation, which was
great payoffs. Dr. Tauber's strategy,
working to ease the immigration trouwhich left local governments scrambles lacing European Jewish scholars
bling in his wake to close the loopholes,
and scientists. "Our selecting Dr.
drew criticism.
Tauber was almost providential," says
Dr. Tauber is nonplussed. "Who's
Dr. Sacher, who later founded Branto blame? The person who wrote the
deis University in Waltham, Mass.,
zoning law or the one who follows
where he is the chancellor. "We had
it?"
so many applications. For many it was
In the early 1960s, Dr. Tauber hit
because the secretary chose their file
upon the formula that allowed him to
over many others."
expand his empire and his income exDr. Sacher cut through the red tape
ponentially.
and secured Dr. Tauber a teaching job
Thanks to growth in the federal buat the University of South Dakota
reaucracy, the government had a nearSchool of Medicine in Vermillion. But
insatiable appetite for office space.
the urbanite from Budapest wasn't at
Dr. Tauber discovered that federal law
home on the range. After a year, Dr.
required the government's leasing
My father remembers
'people who have made
a difference in his life.'
20
AMERICAN MEDICAL NEWS/APRIL
15.1991
been the key to his success," says Rearm — the General Services Adminisgardie, who said that Dr. Tauber's
tration — to lease buildings based on
strategy has earned him "great rerental cost, not location or amenities.
spect" from other D.C. developers.
With his low overhead and fanatiCarlson, now a restaurateur, decal attention to costs, Dr. Tauber could
fends his former boss's strategy. "The
put up plain buildings in cheap locagovernment didn't get ivory' towers,
tions at prices the GSA literally
but the taxpayer sure saved money."
couldn't refuse.
Between working full lime at surFor financing, Dr. Tauber found a
gery and becoming Uncle Sam's largest
law that required Canadian insurance
landlord. Dr. Tauber ran out of time
companies doing business in the
for things like his personal life. He
United States to invest in this country.
takes great pride in the success of his
This largely untapped source of capitwo grown children. Daughter Ingrid is
tal gave him the money he needed to
now a clinical psychologist in San
expand.
Francisco. Son Alfred, a physician, is
From his large but simply decoratchief of hematology at the Boston
ed office at Jefferson Hospital in AlexUniversity School of Medicine.
andria, Va., Dr. Tauber would make
decisions worth millions of dollars in
But his daughter remembers that,
between operations.
when she was growing up, he was at the
hospital 16 hours a day. " I lived in
Associates were amazed at his busiawe of him. I went to school with the
ness acumen. "I'd phone Dr. Tauber
daughters of other developers, and
with a price quote for 300,000 cubic
could never figure out why my father
feel of concrete and he'd take the call
didn't put his name on his buildings
just after he had operated on some inlike my friend's fathers did.
digent patient," recalls A n Carlson,
who helped supervise Dr. Tauber's
"He would say that he didn't want
real estate projects in the early 1970s.
to flaunt his wealth."
"We'd give him the numbers and he'd
In 1964, Dr. Tauber's first wife dipause a minute, say that they were too
vorced him and moved to Switzerland.
high and then
He remained
tell us what the
^^^^m^mmmmmmm
single until he
right price
should be.
n 1y 7 3 T h i ;
"His ability to
do numbers in his
3
head was amazing."
The high
In 1981, Dr.
point of Dr.
Tauber began experiencing chest pains and underwent
Tauber's building spree came in
open heart surgery al Georgetown Uni1970, when the huge 1.75-millionversity Medical Center. That, and the
square-foot Parkland Building was
collapse of the Washington real estate
completed in Rockville, Md., for the
market in the early 1980s, conspired
Food and Drug Administration.
to cause him to reduce his workload.
The low point came a short time
Today, he is contemplating retirelater at a place fittingly called Buzment. But he still puts in a full day al
zard's Point. There, Dr. Tauber erectJefTcrson Hospital, lhe 120-bed facilied a 400,000-square-foot building to
ty he founded in 1964. As he prowls
house the Securities & Exchange
Commission. But horrified bureaucrats the familiar corridors, the staffs respect is palpable.
rebelled at the thought of relocating
"He is revered," says Eugene Steto what was then a swampy site in a
venson, MD, chief of the Division of
desolate corner of southwest WashGeneral Surgery at Jefferson. "In the
ington on the Anacostia River.
seven years I have been here, I have
A scries of articles in the Washingnever known him to raise his voice to
ton Post suggested that Dr. Tauber and
anyone. The nurses love him. He althe GSA were engaged in some shady
ways makes himself available for condeals. Congressional invesiigations folsultations and he's very generous wilh
lowed, dragging his name through the
mud. Eventually, the investigations de- his lime."
termined that the deal had saved the
Dr. Tauber had planned lo begin l i government more than $ I million.
quidating his holdings, which include
numerous buildings in New York
Dr. Tauber didn't forget the experiCity, but the recession has put those
ence. Arthur Sampson, the GSA Adplans on hold.
ministrator who had negotiated the
Still, Dr. Tauber hasn't given up on
deal, lost his job even though the invesdevelopment. He's been actively bidtigation had turned up no evidence of
ding on the Navy Consolidation Projwrongdoing. Dr. Tauber hired him.
ect. An enormous government developThis prompted more bad headlines.
ment that will be worth several
" I figured people could think what
hundred million dollars, it is considthey want. This man stayed by me
ered the Washington-area real estate
through the whole ordeal so I helped
plum of the decade.
him out," Dr. Tauber says. Sampson
Although the GSA recently threw
died in 1988, but his son, Arthur
Sampson I I I , says that his father always out all the competing bids and asked
remembered Dr. Tauber's "loyally
potential developers lo start over
and friendship. "
again from scratch. Dr. Tauber reDr. Tauber also didn't forgei the
mains confident. " I f the bidding proWushington I'ost. Last year the paper
cess is fair, we will of course win."
called him for a story they were doing
In retirement, Dr. Tauber hopes lo
on lhe holiest developmcni location in
devote his time 10 medical research. " I
Washington — lhe now-desirable
will never be able lo leave medicine,"
Buzzard's Point. He refused to cooperhe says.
ale. Eventually, the paper ran a small
Medicine has always been, and reitem in which Dr. Tauber was referred
mains, his first love and greatest interto as "The Prophet of Buzzard's
est. Dr. Tauber professes. " I spend
Point."
5% of my time on real estate, and 95%
Dr. Tauber has also come under
of my lime on medicine. Bui I make
fire for the bland appearance of his
95% of my money from real estate and
buildings. "His projects are typical of
5% from medicine."
mediocre 20-year-old architecture,"
If this is so, why has he pursued
says Bill Regardie, publisher of Rereal estate to such an enormously profgardie's. a Washington business magaitable exieni? " I i allows me to live my
zinc.
life as I want. I can practice medicine
"Where other developers like to
the way I want, and I can give money
build Buicks, Dr. Tauber builds
to help who I want," he says without a
stripped-down Chevys. But that's
trace of smugness.
In 1949, Dr. Tauber
made his fateful
decision to invest in
real estate.
' ,
daughterXchad.
�K
THE JOURNAL WEDNESDAY, APRIL 17,1991 A7
0
Doctor makes Forbes richest list
Physician builds $500 million real estate fortune
By PAUL RECER
In 1^48, Dr. Laszlo N. Tauber w;is
a penniless Jewish refugee from Europe who felt lucky to be alive and
working as a surgeon in the United
States.
He's still practicing medicine, still
charging some of his original U.S.
patients $5 for an office visit.
, But he's far from penniless,
v .-Tauber, the only practicing physician on Forbes magazine's list of the
400 richest people in the United
States, has built a real estate fortune
estimated at $500 million.
"'Medicine is still my life," said
Tauber, sitting in the modest office
in'the Alexandria hospital he built. " I
spend 5 percent of my time on real
estate and 95 percent on medicine.
That's the most important to me."
Tauber owns more than 7 million
square feet of office space. He luis
buildings all over the Washington
area, four properties in New York
City, one in Nashville and one in
Houston.
He's the federal government's bij'gest landlord, leasing more than 4
million square feet to U.S. agencies.
The 76-year-old physician keeps
office hours and reguiarly performs
surgery, but makes no pretense of
making a living in medicine.
" I don't make enough in medicirie
to pay the overhead," he says with a
smile. "That'sthe way I like it."
Tauber is a man of small stature,
with glasses and steel-gray hair. His
office at Jefferson Memorial Hospit-d
is decorated with certificates, diplomas and signed photos from such
people as famed Houston heart surgeon Denton Cooley, a close friend.
A phone on his neat desk rin$:s
frequently.
He discusses medicine with a fellow doctor and moments later gives
orders that affect a multimillioh dollar office lease.
When asked about his personal
history, the answers to the questions
he chooses to answer are precise.
"My memory is very good,"
Tauber said. " I remember
everything."
Then he sighs.
"Sometimes I remember too
much. There are a lot of bad, bad
memories."
Most of those are from his life as a
Jew during the German occupation
of his native Hungary.
Tauber was born in Budapest in
1915, just months after his father
was killed in World War I. He was an
excellent student and a talented
gymnast, winning Hungary's "be:5t
sport student" award at 14.
He earned a medical degree from
the University of Budapest in 1938
and was a resident in general surgeiy
when the Nazis occupied the coun-
try. He began working at what had
been called the Jewish Hospital.
"It [the name] was changed to the
International Red Cross Hospital,"
Tauber recalls. "When the Germans
on the street saw the name, they left
it alone. I worked there until
liberation."
In the fall of 1944, when Nazis
started a special operation to liquidate Hungarian Jews, Tauber helped
organize a makeshift hospital in his
former high school and often performed surgery there day and night,
treating the war-wounded from the
Jewish ghetto.
\
Asked for details of that period,
the doctor shakes his headland
changes the subject.
•
In 1946, as the Soviets tightened
their control over Hungary, Taaber
secured a fellowship to a neurosurgical clinic at the University of
Stockholm.
His wife, a German Jew, was p egnant with their son.
Because the United States alio red
virtually unlimited immigration by
German Jews, Tauber said the couple decided she should go to America to have the child,
j
"We wanted him to be bom a relive American," Tauber said.
i
Alfred I. Tauber was bom in 1941.
Later that year, Tauber joined hi>
family in Washington.
Alfred Tauber is a professor of
medicine at Boston University. A
daughter, Ingrid D. Tauber, is a psychologist in San Francisco. Tauber
and his first wife divorced in 1964,
and he remarried in 1973.
After passing a series of difficult
tests to become certified as a surgeon in the United States, Tauber
found work in a Washington hospital
and later decided to open his own
practice. It was the first step to a real
estate empire.
" I was looking for an office," he
recalls. "That was when I got acquainted with the U.S. system of real
estate finance."
In Europe, Tauber said, the tradition was that real estate was sold for
cash, but he found that U.S. banks
were willing to make mortgages. He
scraped together $ 1,500 and made a
downpayment on hisfirstproperty, a
four-unit apartment house in
Washington.
Since then, Tauber has bought and
sold hundreds of properties. But his
best tenant is the federal govern; ment, with the Postal Service and
Food and Drug Administration
among the agencies renting space in
Tauber's buildings.
But real estate remains a part-time
activity.
Tauber still performs surgery regularly and still accepts new patipnts.
Associated Press
Dr. Laszlo N. Tauber of Alexandria is the only practicing physician
on Forbes magazine's list of the 400 richest Americans.
though he does it for the love of new patient,' ' Tauber said. "That's
enough."
inedicine not the money.
" I charge $20 an office visit for a Associated Press
�CODER:
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE
••Mi'
GENERAL SOKL:
POSTCARD I:
_Personal stories
_General mail
_Letter Campaign
Other Health Providers
POSTCARD 2:
.Offers to help/Employment
/ , Physicians
FORM LETTER:
Letterhead
_Policy
REROUTE:
Casework
.Scheduling
President
Other
POLICY AND PERSONAL STORIES:
_ORGANESATION (I)
insurance premiums
^insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
working families
unemployed/low income
benefits
providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
FINANCING (VII)
MENTAL HEALTH (EX)
LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
rural
urban
OTHER
�W H I T E RIVER FAMILY PRACTICE
76 Olcotl Professional Bldg.
White River Jet., VT 05001
802-295-6132
Thomas B. Parrott, M.D.
Morris Bol, M.D.
Mark M. Nunlist, M.D.
Nancy Arnold, RN, FNP
March 17,
1993
Mrs. H i l l a r y Clinton
c/o The White House
1600 Pennsyr /ania Avenue
Washington, D.C. 20006
,
Dear Mrs. Clinton,
When I discuss issues of health care reform with my patients, I encourage
them to "write to H i l l a r y " - and i f I urge them to do so, I should write
to you my sell".
I enclose a copy of my l e t t e r t o Ira Magaziner, an individual whom I watched
apply his b r i l l i a n c e and leadership to curriculum reform when we were at
Brown University together a generation ago.
I am as excited as you must be at the challenge of addressing and correcting
problems i n health care f o r Americans. Thank you f o r your efforts and
your leadership.
Sincerely,
Mark M. Nunlist,
MMN/vtm
End.
M.D.
�WHITE RIVER FAMILY PRACTICE
76 Olcott Professional Bldg.
White River Jet., VT 05001
802-295-6132
Thomas B. Parrott, M.D.
Morris Bol, M.D.
Mark M. Nunlist, M.D.
Nancy Arnold, RN, FNP
March 17, 1993
Ira Magaziner
White House Adviser on Health Care Reform
c/o The White House
Washingion, D.C. 20006
Dear Ira:
I watched you reform Brown University's curriculum a generation ago when I
was an undergraduate there (Class of 70), and I have periodically wondered
whatever became of you. In the intervening years, I served in the U.S. Navy
(submarines) and returned to Brown University as a medical student to
ultimately land here in northern New England as a family physician where I
have practiced since 1983. Over the last decade, I have had a first-hand look at
some of the problems of health care in this country. President Clinton's election,
the designation of Mrs. Clinton as task force leader and the announcement that
you were to be involved in the process of health care reform restored my hope
for real progress in health care reform. I am moved to become involved now
(albeit belatedly in your hundred-day process) because I believe I have
something constructive to add.
Todav I read of a proposed across-the-board short term freeze in health-care
costs. As outlined in the press, such a fee freeze appears to lock in the already
large disparity between the incomes of procedurally oriented specialists and
those of us in primary care. New medical school graduates will continue to be
influenced to enter highly reimbursed sub-specialties while studies continue to
find too few primary care providers in this country. And a fee freeze appears to
control my income while doing nothing to control my expenses.
My staff,
already working for a primary care physician as opposed to a sub-specialist, can
expect little if any salary increase over the term of the freeze although their
costs of living continue to grow as do those of all of us.
If you stop reading now, 1 simply might appear to be another physician who
thinks he is underpaid and over worked, and who complains about proposed
�reforms which might limit potential income. But I did not enter Family Medicine
in northern New England intending to become wealthy.
And while there is
indeed the need for fundamental reform in our system, I cannot abide those who
complain but offer no remedy.
~~
~
'
Thus, I offer my suggestions for improvements:
* If fees are to be "frozen", even for the relatively short term of two or
three years, they should be allowed to change annually at some rate to reflect
cost of living increases (or decreases).
* Limitations in fees should encourage changes in provider and consumer
behavior.
Relatively more costly care should be relatively more frozen,
especially when less expensive alternatives are available.
The loss to a
procedurally oriented subspecialist from a fee freeze would seem somehow more
easily borne than that to a primary care provider.
My current annual gross
income is approximately $70,000. I am losing colleagues in rural primary care
because they cannot afford to practice medicine for $45,000 per year. I cannot
attract newly trained physicians to join me here even if I offer them as a
starting salary what I myself earn.
And considering the range of income
expectations across various specialties, it is little wonder that new medical school
graduates opt for procedurally oriented sub-specialty medicine.
*
Care which is clearly futile should not be provided, or, if provided,
should be very costly to the provider and to the recipient. One might consider
the definition of "futile care" to be difficult, but as a Supreme Court justice noted
with respect to pornography, "(we) sure as hell know it when we see it." An
acceptable starting point is to consider futile care to include care which a patient
does not want. As you no doubt know, the great majority of medicare dollars
are expended in frequently intensive care provided to individuals at the end of
their lives. It is simply unconscionable to tolerate this waste. I have made it my
practice during the last ten years to encourage Advance Directives and Living
Wills; I find individuals rarely want heroic end-of-life care for themselves and
almost always refuse it if given the choice. Yet we persist in presuming that this
care is desired and provide it at enormous cost.
* Reform must include a defined basic benefit plan for everyone, based on
what we can afford as a society, and on what is most beneficial to us as patients.
An "Oregon style" plan most closely seems to approach this standard, though I'm
sure improvements could be made. It is unacceptable to me to watch a young
mother go without her anti-convulsant medication while we simultaneously pay
for end-stage heroic but unsuccessful intensive medical care for individuals
already in extreme poor health.
�* The billing and insurance aspects of health care reimbursement must be
greatly simplified, even to the extent of employing a universal form if not a
single payor.
I frequently sit with my elderly patients reviewing a stack of
financial statements to assist them in understanding what they owe and to
whom it should be paid. The paperwork is all but impossible to understand, is
wasteful, and cannot all be necessary.
* And - perhaps most importantly - health care entitlements must be
based on the financial need of the recipient. At present, we have the working
people of this country (mostly young) subsidizing the provision of health care to
their elders. If the elders cannot afford it, then by all means, we should provide
the subsidy.
I firmly believe that we are ail entitled to a basic standard of
health care. But if elder recipients can afford their care, costly though it may be,
then they should be expected to pay (at least more of their share) for it. Time
and again, I see young working adults unable to pay for medical care for
themselves or their children, while their more well-to-do parents' care is paid
for by Medicare. This is one of the greatest cost-shifts in health care, and does
not encourage behavioral change. If the elderly need not pay even a pro rata
share of the true cost of their care, why should they exercise any restraint or
judgment in choosing their care? And when I review this principle with my
medicare patients, they all express amazement and agree that they should
shoulder their own costs to the extent of their ability rather than bankrupt their
offspring.
There!
I've spoken my piece.
This is truly an exciting time for health care reform. Our system surely needs
work. And I am grateful that you have reappeared on my scene in time to help
effect these reforms.
Sincerely,
Mark M. Nunlist, M.D.
cc. Mrs. Hillary Rodham Clinton
�Albert G. Corrado, M.D., J . D . (Hon.), Inc., P.S.
. Corrado Medical Building
' 800 Swill Blvd.. Suite 200
Richland, WA 99352
(509)946-4631
February 1 1 , 1993
Mrs. H i l l a r y Rodham C l i n t o n
The White House
Washincjton, D. C.
Dear Mi:s. C l i n t o n :
C o n g r a t u l a t i o n s t o you and P r e s i d e n t C l i n t o n on your
v i c t o r y i n t h i s p a s t year's e l e c t i o n .
More i m p o r t a n t l y , c o n g r a t u l a t i o n s on your new
l e a d e r s h i p p o s i t i o n on t h e h e a l t h care i s s u e . I t i s
g r a t i f y i n g t o know t h a t t h e number one s o c i a l problem f a c i n g
our c o u n t r y has been p l a c e d i n t h e competent hands o f t h o s e
closest t o the President.
I am a 78 year o l d p r i v a t e p r a c t i t i o n e r s p e c i a l i z i n g i n
A l l e r g y and I n t e r n a l Medicine. I have served as P r e s i d e n t
of t h e American C o l l e g e o f A l l e r g y and Immunology and am
a l s o a r e t i r e d C o l o n e l i n t h e Army Reserve M e d i c a l Corp
where I was awarded t h e M e r i t o r i o u s S e r v i c e Medal. While
o b v i o u s l y i n t h e m i n o r i t y , I s t i l l make house c a l l s and am
q u i t e pleased t o _ r e c e i v e o n l y a Christmas c a r d from many
p a t i e n t s who have no means t o pay f o r my s e r v i c e s . I t i s my
hope t h a t 50 years o f experience w i l l open t h e doors f o r
c o n s t r u c t i v e concerns I have about our h e a l t h care system
and r e s p o n s i b i l i t y you have assumed.
The problems you w i l l f a c e w i l l be d e a l i n g w i t h t h e
bureaucracy - b o t h f e d e r a l and m e d i c a l - as w e l l as t h e
m u l t i t u d e o f i n s u r a n c e c a r r i e r s . The focus o f h e a l t h c a r e
i s s u e s w i l l most c e r t a i n l y c e n t e r on t h e d o l l a r amounts
a s s o c i a t e d w i t h v a r i o u s s c e n a r i o s and t h e p r o t e c t i o n i s m
which i s sure t o s u r f a c e from a l l p a r t i e s concerned.
T y p i c a l l y , we a t t a c k these problems by h i r i n g expensive
c o n s u l t a n t s who g e n e r a l l y c o n f i r m our b a s i c i n s t i n c t s and
U n i v e r s i t y p r o f e s s o r s who may spend t h e i r c a r e e r s s e a r c h i n g
f o r answers t o our s o c i a l i l l s .
While these methods may
have t h e i r p l a c e I f e a r t h a t we may embark on a p a t h which
does n o t i n c l u d e those who p r o v i d e p r i m a r y h e a l t h c a r e , t h e
everyday p h y s i c i a n and nurses. I t i s these people who see
p a t i e n t s every day and t r e a t t h e i r disease and l i s t e n t o
t h e i r problems. Understanding h e a l t h care means
,understa.nding t o t a l l y , , p a t i e n t ' s needs, and I dare say t h a t
Certified
By:
American Board Internal Mcclicinc
American Board Al/crryi./ (S-. Immnnolofiti
Fellow:
American
American
Felloic
American
Coilec/e P/ii/sicid/is
Collcfic Chest
i'lvisicians.
& Past I'resid(-nt
Colk'fie Alleniji & Immnnolofifi
�Mrs.
Clinton
-2-
February
11,
1993
c o n s u l t a n t s and U n i v e r s i t y professors are not q u a l i f i e d on
t h i s point.
While I b e l i e v e everyone w i l l want to p r o t e c t h i s
domain, I must a l s o say t h a t everyone involved i s
r e s p o n s i b l e f o r the mess we face today. Our l e g a l system
has held the everyday p r a c t i t i o n e r to a standard of
e x c e l l e n c e t h a t few Popes could achieve, and have not
recognized the inherent r i s k a s s o c i a t e d with the d e t e c t i o n
and treatment of d i s e a s e . As a form of protectionism and
sometimes r e t a l i a t i o n , thousands of u s e l e s s medical t e s t s
and procedures are conducted every year a t horrendous c o s t s .
I t i s r o t unusual to f i n d a p a t i e n t who has spent $1,000 i n
procedure c o s t s before a doctor has even heard the symptoms
of the problem. Insurance c a r r i e r s chip i n by s e t t l i n g
f r i v o l o u s law s u i t s and simply r a i s i n g malpractice premiums.
P a t i e n t s c o n t r i b u t e by expecting medicine to be an exact
science: with sure and quick cures and do not assume
r e s p o n s i b i l i t y for t h e i r own good h e a l t h . Medicare p l a c e s
such a burden of paperwork and c o s t on the p h y s i c i a n to the
point t h a t i t i s cheaper not to charge these p a t i e n t s , or
worse y e t , r e f u s e to see them.
Obviously, I cannot cover a l l segments of t h i s problem
i n a l e t t e r . I simply ask that you include those who
provide b a s i c care i n your d e l i b e r a t i o n s . Please do not
s e t t l e f o r a p o l i c y which may be f i s c a l l y sound, but ignores
the b a s i c needs of the p a t i e n t .
I have given 54 years to the p r a c t i c e of medicine and
would o f f e r my remaining years to c o r r e c t i n e f f i c i e n c i e s
a s s o c i a t e d with i t s p r a c t i c e i f you so wish. Thank you so
much f o r the time and e f f o r t t h a t w i l l be required of you i n
the coming y e a r s .
S i n c e r e l y yours.
A l b e r t G. Corrado,
cc:
Bouse Speaker Thomas Foley
Rep. NDrm Dicks
Rep. Jay Inslee
M.D.
�MORRIS CREEDON-MCVEAN, D.O.
GENERAL PRACTICE
17320 - 135TH AVENUE N.E. SUITE D
WOODINVILLE, WASHINGTON 98072
(206) 485-5558
M a r c h 9 , 1993
Ms. H i l l a r y Rodham C l i n t o n
Head o f The Task Force on Healthcare Reform
The White House
1600 Pensylvania Avenue
Washington, D.C. 20500
Dear Ms. Rodham C l i n t o n :
I t i s my f e r v e n t hope t h a t t h i s l e t t e r w i l l reach your eyes and t h a t
you w i l l f i n d t h e suggestions h e r e i n h e l p f u l .
A b i t o f background i s i n o r d e r . My husband and I have been i n
g e n e r a l p r a c t i c e f o r 12 years. We have a "mom-and-Lpop" type
p r a c t i c e : he does e v e r y t h i n g w i t h t h e p a t i e n t s and I r u n t h e " f r o n t "
of t h e o f f i c e . We h v ^ f 1 i " " & p o f p r a c t i c e t h a t people always t a l k
ae'cT§"~ye
about w a n t i n g : we run ^n^ t i m e ' j w h a t a novel c o n c e p t ! ) ; M o r r i s spends
a minimum o f \ hour on r ^ l u i T T p a t i e n t s no matter what t h e i r problem;
we do n o t book 2-3 p a t i e n t s a t t h e same time so t h a t they have t o
w a i t ; I know my p a t i e n t s by v o i c e on t h e phone b e f o r e they say t h e i r
name; i n o t h e r words, we care deeply f o r t h e people who come t o us.
Both M o r r i s and I spend a l a r g e amount o f time t a l k i n g t o those who
come t o us. I f you watched B i l l Moyers s p e c i a l on N a t i o n a l P u b l i c
T e l e v i s i o n , HEALING AND THE MIND, you w i l l have an idea o f how we
p r a c t i c e . We view t h e person as an i n d i v i d u a l w i t h a uniqueness t h a t
needs t o be l i s t e n e d t o and addressed.
1
The j o u r n e y t o h e a l t h i s a p a r t n e r s h i p . Or, i t should be. So many o f
the people who come t o us are very f r u s t r a t e d because they have been t o
too many d o c t o r s , a l l t o no a v a i l . These d o c t o r s have n o t l i s t e n e d
to them. The c u r r e n t medical system f o s t e r s t h i s , rewards t h i s type
of p r a c t i c e . The insurance companies w i l l o n l y pay f o r t h i s type
of " s e r v i c e . " Most p h y s i c i a n s see 6-8 p a t i e n t s per hour.
We see 1-2.
How can anyone t r u l y be able t o see what a person i s s t r u g g l i n g w i t h i n
5 minutes? Thus, i f t h e problem or problems are complex, t h e primary care
p h y s i c i a n sees t h e p a t i e n t once and then punts t o a s p e c i a l i s t s ? or i n
many cases s e v e r a l d i f f e r e n t s p e c i a l i s t s because insurance w i l l n o t pay
f o r t h e GP t o c o n t i n u e t o see a p a t i e n t and h e l p him/her work w i t h t h e i r
h e a l t h c h a l l e n g e s . But insurance companies w i l l pay thousands t o s p e c i a l i s t s
to see a p a t i e n t .
There are c l e a r l y two problems, a t l e a s t , as I have j u s t o u t l i n e d .
F i r s t , t h e insurance companies need t o be looked a t v e r y deeply. They,
f o r t h e most p a r t , have no concept o f t h e word:"PREVENTION." How many times
have insurance companies refused t o pay f o r a f l u shot o r f o r c h o l e s t e r o l
t e s t i n g or f o r y e a r l y p h y s i c a l s . Yet they w i l l pay f o r bypass surgery.
�MORRIS CREEDON-MCVEAN, D.O.
GENERAL PRACTICE
17320 - 135TH AVENUE N.E. SUITE D
WOODINVILLE, WASHINGTON 98072
(206) 485-5558
PAGE
2
pneumonia from f l u o r any number o f i l l n e s s e s t h a t a r i s e because a p a t i e n t
has n o t "caught" the warning signs i n time because he/she does not go
f o r p h y s i c a l s because insurance won't pay!
Let me g i v e you one o f the best examples I can t h i n k o f from our p r a c t i c e .
A p a t i e n t o f about 65 y r s o l d came t o us f i n a l l y t o s a t i s f y the repeated
u r g i n g s o f h e r daughter who has been w i t h us f o r years. I w i l l c a l l her
"Annie."
Annie had m u l t i p l e c o m p l a i n t s . She had been t o a n e u r o l o g i s t ,
a r h e u m a t o l o g i s t , a c a r d i o l o g i s t , and an i n t e r n i s t . A l l these d o c t o r s
d i d work-ups on Annie and she went t h r o u g h thousands o f d o l l a r s worth
of t e s t i n g s . A l l t o no a v a i l .
She came t o see M o r r i s . He spent one
hour t a l k i n g w i t h h e r , diagnosed d e p r e s s i o n , put her on ant-depressant
m e d i c a t i o n , and charges her $100.
She phoned the o f f i c e 2 days l a t e r
saying she had n o t f e l t t h i s good i n y e a r s . He f o l l o w e d up w i t h two more
1 hour " t a l k i n g " sessions and t h a t was i t . He l i s t e n e d when no one e l s e
had.
Does t h i s mean her i l l s were psychosomatic? Not a t a l l . We have
learned t h a t the body w i l l send o u t d i s t r e s s s i g n a l s . I f a person does
not l i s t e n , t h e body w i l l keep c r y i n g o u t u n t i l he/she takes care o f i t .
I c o u l d l i s t many l i k e Annie who f i n d us. A woman I w i l l c a l l " J o a n " i s
about 35 w i t h MS. F i n a l l y , she decided a f t e r a few years o f merely
d e a l i n g w i t h the p h y s i c a l aspects t o s t a r t coming t o M o r r i s f o r " t a l k i n g "
f o r one hour a week. At a f a m i l y r e u n i o n , her r e l a t i v e were astounded a t
how w e l l she seemed. They asked i f t h e r e was some new drug t h a t was
h e l p i n g her MS. She r e p l i e d : " N o , I go t a l k t o my d o c t o r once a week."
My p o i n t , w i t h these examples, i s t h a t i f we can o n l y convince primary
care p h y s i c i a n s t o t a k e time t o l i s t e n and t a l k t o t h e i r p a t i e n t s , n o t
o n l y w i l l thouseinds o f d o l l a r s be saved by not having t o go h i t h e r and yon
to v a r i o u s s p e c i a l i s t s t o t r y t o f i n d answers t h a t are u s u a l l y r i g h t i n s i d e
the p a t i e n t , b u t the q u a l i t y o f l i f e o f t h a t p a t i e n t w i l l be v a s t l y
improved.
We have a s o c i e t y o f f r a g m e n t a t i o n . I f a toe h u r t s , go t o a
P o d i a t r i s t ; i f a headache, go t o a N e u r o l o g i s t ; i f a chest pain,go t o
a C a r d i o l o g i s t ; i f an abdominal p a i n , go t o an I n t e r n i s t , e t c . I assure
you, we are not t r y i n g t o put s p e c i a l i s t s o u t o f business.
I f GPs would
p r a c t i c e as I here suggest, t h e r e would s t i l l be p l e n t y o f business f o r
s p e c i a l i s t s :but ; i t :w6uld~hot ^be: .disprop6rtionate . P i c t u r e going t o a
C a r d i o l o g i s t , seeing him/her f o r 10 minutes and being charged $132.!
Or, you see h i s nurse p r a c t i t i o n e r and a r e charges $72 f o r a t e n minute
v i s i t ! ( T h a t s more than we charge f o r a h h r . c a l l o f one-on-one time
w i t h the d o c t o r ! ) Or, you have t o have a s t r e s s t r e a d m i l l t e s t and are
charged $750. This i s pure u n d a d u l t e r a t e d greed! These charges are obscene!
;
1
The s u b j e c t o f money leads i n t o my next t o p i c . More and more d o c t o r s are
being t o l d how t o p r a c t i c e medicine, mainly by insurance companies by how
much they w i l l pay.
There are now " f o r m u l a r i e s " out by insurance companies
t h a t attempt t o d i c t a t e t o d o c t o r s what drug t o g i v e a' p a t i e n t . I f someone
has h i g h blood p r e s s u r e or h i g h c h o l e s t e r o l they seem t o assume t h a t one
durg f i t s a l l s .
THey w i l l not pay f o r , a t t i m e s , v e r y necessary t e s t s .
But i f something goes wrong, who g e t s sued? That's r i g h t , t h e p h y s i c i a n !
�MORRIS CREEDON-MCVEAN, D.O.
GENERAL PRACTICE
17320 - 135TH AVENUE N.E. SUITE D
WOODINVILLE, WASHINGTON 98072
(206) 485-5558
PAGE 3
This cannot be a l l o w e d . A p h y s i c i a n must be f r e e t o p r a c t i c e w i t h o u t
t h e f e a r o f being sued c o n s t a n t l y hanging over h i s / h e r head. I n a
n a t i o n where e n t e r t a i n e r s o f a l l d e s c r i p t i o n are paid m i l l i o n s per year
we w i l l n o t pay the people i n t o whose hands we put our h e a l t h a wage
w i t h o u t a l a r g e amount o f l o v e / h a t e e q u i v o c a t i o n a t t a c h e d .
I agree,
t h a t i n many cases p h y s i c i a n s are p a i d a horrendously d i s p r o p o r t i o n a t e
amount BUT i f s a l a r i e s are c u t too much you w i l l f i n d a v a s t shortage
of p h y s i c i a n s i n t h e years t o come. Your husband now has an idea
of what i t must be l i k e t o be a p h y s i c i a n . imagine t h a t each time
you walk i n t o a room you must have t h e c o r r e c t answer or face being
sued? At l e a s t , no one has y e t t r i e d t o sue a P r e s i d e n t ! The
amount o f s t r e s s a p h y s i c i a n l i v e s under i s monumental. To then
take h i s / h e r power away even more by empowering the insurance companies
to make even more d e c i s i o n s about t r e a t i n g people they do n o t even know
would be d i s a s t r o u s ! Again, t h i s i s a complex i s s u e . There must be
some c e i l i n g put on m a l p r a c t i c e . I am the f i r s t one t o encourage s u i t i
i f t h e r e i s t r u e n e g l i g e n c e , but most o f the time t h e r e t r u l y i s n o t .
As I have r e p e a t e d l y s t a t e d , t h i s i s a monumental t a s k . I t w i l l very
l i k e l y take years t o change. Education i s p r i m a r y . People need t o
be t a u g h t t h a t t h e i r h e a l t h i s t h e i r r e s p o n s i b i l i t y . They should
be in. a p a r t n e r s h i p w i t h t h e i r p h y s i c i a n . The p h y s i c i a n needs t o be
encouraged t o take t i m e t o 1 i s t e n , - t a I k , and educate. This should be
the j o b o f the p r i m a r y care p h y s i c i a n , GP, or Family P r a c t i t i o n e r .
But t h i s w i l l o n l y happen i f the insurance companies are encouraged t o
eticourage t h i s type o f t r e a t m e n t by paying f o r a physican t o t a l k
to his/her p a t i e n t .
I n t u r n , i f t h i s i s done, i t i s our f i r m b e l i e f
t h a t m i l l i o n s c o u l d be saved per year i n the h e a l t h care system.
I am not a s k i n g the insurance company t o pay e x o r b i t a n t amounts:
how about $100 f o r 1 hour w i t h one p a t i e n t ? T h i s , seems a b a r g a i n ,
when a c a r d i o l o g i s t spends 10 minutes and r e c e i v e s $132 or an o r t h o p a e d i c
surgeon spends 15 minutes examining a p p a t i e n t and r e c e i v e s $350. (These
are a c t u a l f a c t s . ) Or, yet a g a i n , a GP spends 10 minutes and i s paid
$40-$50.
As r a m b l i n g as t h i s l e t t e r has been, i t i s o n l y the t i p .
I truly
b e l i e v e t h a t my husband and I c o u l d h e l p you and your aides t o
s o r t through a l l t h i s . We do not ask f o r pay or r e c o g n i t i o n ;
o n l y t o h e l p i n what we see as a c r i t i c a l t i m e . We have extremely
o b j e c t i v e , l u c i d views.
Some, I f e e l , which could be o f v a s t h e l p .
We ask t h a t you c o n s i d e r t h i s c a r e f u l l y .
�MORRIS CREEDON-MCVEAN, D.O.
GENERAL PRACTICE
17320 - 135TH AVENUE N.E. SUITE D
WOODINVILLE, WASHINGTON 98072
(206) 485-5558
PAGE 4
We thank you f o r your courage i n t a k i n g on t h i s c h a l l e n g e .
much l i k e t o h e l p .
We would very
Sincerely,
Jan Creedon-McVean
P.S.
v
M o r r i s Creedon-McVean,D.0.
On a p e r s o n a l note,have you read WOMEN WHO RUN WITH WOLVES ?
I f e e l you p r o b a b l y have. I f n o t , y o u ' l l love i t , I am sure.
More o f us need t o "run w i t h wolves" and I am so g l a d you are
where you a r e ! Thanks!
�CODER:.
HEALTH C ARE TASK FORCE SORTING SHEET
INPUT DATE:
GENERAL !3QRT:
POSTCARD 2:
eral mail
Personal stories
ier Health Providers
POSTCARD 1:
Letter Campaign
.Offers to help/Employment
FORM LETTER:
Letterhead
_Policy
.cians
REROUTE:
Casework
.Scheduling
President
Other
POLICY AND PERSON AT. STORIES:
ORGANIZATION (I)
irsurance premiums
inisurance reform
insurance pools
boards and oversight
.COVERAGE (H)
working families
_u]iemployed/low income
.benefits
.providers
.INFRASTRUCTURE/WORKFORCE (HI)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
^medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
FINANCING (VII)
MENTAL HEALTH (IX)
.LONG-TERM CARE (X)
I / PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
[/prevention
_AIDS
women's health
immunizations/children
rural
urban
OTHER
�Thomas Heller, M.D.,M.P.H.
Inivmal Medicine
PIKE MARKET
MEDICAL CLINIC
1930 Post Alley
Seattle, WA 98101-1015
728-4143
�NOTICE
PEHSONAL INFORMATION HAS BEEN REDACTED
•RJOM THIS OOCUHENT
D
5P
******
/
�«N'-V- J I KI'
^
February 2, 1993
First Lady Hillary Rodham Clinton
The White; .House
1600 Pennsylvania Avenue
Washington, D.C.
Dear First Lady Clinton,
.
.r»
I am deeply grateful to you and to President Clinton for catalyzing serious
reform of our health care system..^ From my own perspective as a
physician who has spent most of the last seventeen years caring for the
uninsured and disenfranchised, I am keenly aware how services on the one
hand are denied those who must pay out-of-pocket for every nickel's
worth of health care they receive while those with insurance provided, as
an untaxed work benefit pay not a penny and receive often excessive and
unnecessary care. It is a Kafkaesque nightmare that has caused quiet but
profound suffering for hundreds of thousands of our people. This must be
remedied.
I am convinced that the task you confront of shaping a health care plan for
America that guarantees access to health services for every citizen while
maintaining quality and cutting costs is eminently doable. I.am enclosing
a letter I sent to President Clinton in November that I urge you to read.
As you develop your plan for a new American health care system, I urge
you to examine carefully the philosophical underpinnings of the program
you create. I personally do not believe that competition breeds a "leaner,
meaner," more efficient health care system, even when you call it
|Ynanaqed competition." Competition may be the mother of invention and
ingenuity" in some endeavors, but in the health care industry it ticegds__^
ju&etegs^jjyerhead^ in the fomLOf advertisement and marketingjbudgets
needed-tQ_ capture^market share, and in the dupiication'"~ofadministrative
£ •
.Jgf
\J'.
.
�cost. It slows the efficient streamlining of medical services as the
"losers" in a competitive system are kept in the dark about efficiencies
developed by the "winners." It fragments the community of health care
providers, interrupting referral patterns and forcing primary care
physicians to refer to a limited panel of specialists with whom they may
be unfamiliar. Furthermore, and most importantly, a multiple payer
system, even in the form of managed competition, fragments the
community at large. The establishment of different health plans for
different sectors of our society separates us and fosters the "you people"
mentality articulated so eloquently during the campaign by a champion in
the competitive marketplace.
Under a single payer system, on the other hand, the health care problems
of our community become our problems. Crack babies, victims of violence,
persons suffering from AIDS are no longer the problem of "you people."
They are our problems. The same doctors who care for them care for us.
The same hospitals that serve them serve us. The same health care costs
which face them face us. I see no greater tool to bring us together as a
people to solve our huge social problems than to connect us one to each
other under a single payer health care system.
I hope this argument gets
your attention and that you read the letter to the President I have
enclosed.
Looking forward to your comments and to the successful completion of
your task.
My best wishes.
Sincerely,
Thomas A. Heller, M.D., M.P.H.
�•
T A " V '•
',
^
.•;
NOTICE
K
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS OOCUMENT
A -A/
:
• •••..v'.
�Thomas A. Heller, M.D., M.RH.
November 21, 1992
President-Elect Bill Clinton
Governor's Mansion
Little Rock, Arkansas
Dear President-Elect Clinton:
What a great day November 3rd was for America!
At last we have come to
the end of a bleak twelve y e ^ period in our history and can look forward
to a change in the American character from one of greed, materialism, and
divisiveness to one of compassion, inclusion, and a sense of the common
good. I profoundly thank you for having the courage and vision to lead the
charge.
Mr. President-Elect, you are right; the country is ready for change. Just as
you foresaw the disenchantment of the American people with the ReaganBush agenda, so I urge you to recognize that the American people are
disenchanted with the American health care system as it now exists and
are ready to embrace a radically different system. I am a physician and
have worked all my professional life in community clinic settings, serving
mainly those who are unserved by the private sector. What is becoming
increasingly apparent to me is that American insurance companies do not
enjoy the allegiance of the American, people. They are viewed as the ogres
who have raised their premiums 30 to 70% year after year, who refuse to
insure entire professions because of their likely health risks, who do all
they can to exclude the sick and include only the healthy. This is the time
to seize the distrust that has developed toward the private health
insurance industry and move to a system more akin to the Canadian model
of a single payer.
The following are my arguments against a "pay-or-play" system such as
that you have suggested and in favor of a single payer system:
4V
�1. Health insurance was introduced as a work benefit at a time when it
made sense from an employer's point of view to do so. By spending
pennies on insurance an employer could assure dollars worth of
productivity from a healthy work force. It is ironic that with all the
advances in medicine that concept no longer applies. Our health care
system has become so inefficient-such a small fraction of the total
health care dollar contributes to the maintenance of the good health of the
worker--that it is no longer in the best interest of the employer to
provide this benefit. It also may not be in the best interest of the worker,
who may be benefitted more by his employer's ability to use his capital on
growth and expansion of his business rather than on inefficient health
insurance for his employees.
2. I do not understand the employer based "pay or play" concept. Why
would an employer "pay" rather than "play"? Wouldn't this happen only if
an insurance company offered a premium rate for the employees higher
than that which the employer would have to pay into the national health
care fund? And wouldn't the higher rate be offered only because in the
insurer's assessment, this group's risk for expensive health care services
was high? And isn't the insurer likely to be correct? And will this not
lead to another two tiered system where there are those employee groups
who are for the most part healthy, who are covered by private health
insurance, and those employee groups who carry a disproportionate risk
burden, whose health care costs are covered by the national fund, which by
virtue of adverse selection is underfunded? Where has my thinking gone
awry? Please explain how the system would work in a way that avoids
this pitfall.
3. Wouldn't a "pay-or-play" system result in hiring discrimination against
those with large families?
4. The whole notion that Americans are used to and entitled to "choice" in
health insurance is in my view a "straw man"- a non-issue. The
existence of multiple insurance plans actually l i m i t s choice. Commonly,
as a result of a change in employment or a change in the employer's
insurance options, an employee is forced to change insurance companies.
As a result many patients are forced to leave the care of a physician
whom they have grown to trust because that physician is not on the panel
of physicians contracting with the new insurance company. With a single,
universal health care plan all doctors would be part of the same plan.
�Hence, access to the primary care physician of one's choice would be more
readily assured. Likewise, primary care physicians could refer to the subspecialists of their choice rather than be limited to a small list of subspecialists that are the preferred providers contracting with the patient's
insurance company.
5. I presume in a "pay or play" system moneys used by employers to
purchase health insurance for their employees or contributed to a national
health care fund would not be taxed. These moneys, if not put to some
other tax protected use, would under a single payer system be taxable
revenue and help defray the cost of the national health insurance program.
6. Woolhandler and Himmelstein {New England Journal of Medicine, 1991,
324, 1253-58) have estimated health care administrative costs in the U.S.
were $400-$497 per capita in 1987 compared to $117 to $156 per capita
in Canada. If the U.S. had Canada's administrative efficiency, we would
have saved 69.0 to 83.2 billion dollars out of a total health care
expenditure of $501 billion in 1987. While adoption of a universal billing
form will hopefully help decrease administrative costs, the continued
existence of hundreds of private insurance companies (1500 in 1990)
cannot help but result in duplication of administrative functions and limit
the achievement of maximum administrative cost savings. If the
maintenance of hundreds of insurance companies had inherent social value,
it would be reasonable to sacrifice some administrative savings, but do
these companies have inherent social value? I don't think so.
7. Were a single payer system adopted, a large cohort of insurance
workers would need to be retrained in other professions. What a fertile
investment this would be, putting all these people to work in productive
sectors of our economy rather than wasting their skills in the
unproductive, inefficient bureaucratic morass that the health insurance
industry has become.
8. While the potential for administrative cost savings in a single payer
system would be enormous, the potential for saving money in the actual
practice of medicine would be even greater. We physicians are not trained
in the management of scarce resources. We are taught to "above all, do no
harm." Unfortunately, that dictum does not extend beyond the bedside to
include concern for the harm done to society for the overuse and misuse of
expensive technologies. We are taught to "do everything we can" for our
�patients, which is all too often translated into ordering every test and
applying every treatment, no matter how little evidence there may be for
its utility. An example of such wastefulness was just published in this
month's Archives of Internal Medicine and is included with this letter. In
a study of chronically ill patients who experienced cardiac arrest and
were subjected to cardio-pulmonary resuscitation (CPR) in an intensive
care unit setting, 6 of 114 patients left the hospital alive, 4 of the 6 were
dead within a year, and the two who survived a year were severely
debilitated. We are doing people no favor with these efforts and spending
millions of dollars in the process. Examples of similar costly and unwise
medical decisions by physicians abound--from choosing the highest cost,
most recently advertised antibiotic instead of the older, cheaper,
perfectly adequate and in fact medically preferable generic antibiotic, to
the selection of hopelessly ill patients for heroic interventions, from the
inappropriate use of "high-tech" diagnostic studies to the unnecessary
repeated ordering of "little ticket" technologies such as blood counts and
clotting studies, physicians in their medical decision making waste tens
to hundreds of billions of dollars yearly. We could save these billions
without harming a single patient by the institution of guidelines for the
use of medical technologies. Practice guidelines need to be developed by
panels of the best minds in medicine, leaders in academic medicine who
command the respect of the medical community. These panels could
reconvene every six to twelve months to review their guidelines, consider
criticisms from the general medical community, and make modifications
based on developments in medical science. Under a single payer system
adherence to these guidelines can be insisted upon before expensive
technology is utilized, or retrospective audits can be performed to
identify practitioners not adhering to the guidelines. This is a tool to
control costs (and in a sense to ration care to "appropriate use only") not
as readily employable in a multiple payer system. It is heavy handed, but
it is fair, and it is necessary. Doctors will be willing to accept such
guidelines as long as those writing them are highly respected colleagues
and not faceless bureaucrats. These guidelines will also result in
decreased malpractice claims and hence decreased malpractice insurance
premiums, as malpractice would be difficult to prove against a physician
in compliance with established practice guidelines.
9. Special attention must be paid to the care of terminal conditions. A
huge portion of the health care dollar is spent caring for people in their
last two months of life. While it can be argued that it is only in
�retrospect that one can know that a person was in his last two months of
life, there are nonetheless many opportunities to emphasize quality of life
over the needless and costly medicalizing of life when faced with a known
fatal illness. These are issues that can no longer be dealt with simply
within the doctor-patient relationship. Because decisions made within
that relationship are consuming major portions of our wealth, they now
warrant public concern and demand public policy. Again, I believe it
appropriate that government promoted guidelines be developed through
panels of experts with representation from organized medicine, organized
religion, medical ethics, and citizens' groups including the disabled and
the elderly. Whatever guidelines for the care of terminal conditions that
are developed could best be implemented through a single payer health
care system.
10. This final idea is perhaps too Orwellian for the American electorate,
but I submit it for your consideration anyway. It is time to play hardball
with the tobacco industry. The cost of cigarettes to our country in terms
of medical expenses and lost productivity and wages is staggering. We
cannot allow the tobacco industry, in the name of free enterprise, to
continue to addict our children.
I would suggest that in order to purchase
cigarettes, a person should be forced to register as a smoker. All
registered smokers would receive information on a regular basis on
methods for quitting smoking. These methods would be fully funded by the
national health plan. Registered smokers would have five years to quit
smoking. If they failed to quit smoking, they would lose their membership
in the national health plan and would have to purchase private smokers'
health insurance (perhaps underwritten by the tobacco industry!) until
they actually quit at which point they could be reinstated in the national
health plan. In conjunction with this proposal would be job retraining
programs for cigarette factory workers and subsidies for tobacco farmers
to convert from tobacco to other crops.
Mr. President-Elect, I desperately want you to succeed. In the arena of
health care, your success will be measured by how well costs are
controlled over the next four years and how completely you extend
coverage to those presently uninsured. As a practicing physician, I am
convinced that these goals cannot be met without direct government
policies to curb the enormous amount of waste that presently pervades
the American health care system and accounts for our spending more
�money on health care than any other country while leaving 37 million
uninsured.
I have no doubt that a single payer system is the most
efficient way to implement such policies. I am also convinced that the
American public is ready to accept a Canadian-like single payer model if
it is forthrightly promoted by our leaders. I hope you will take very
seriously this option available to you. While you will undoubtedly
encounter political resistance from organized medicine and obviously
from the insurance industry, please recall that these groups also resisted
the Medicare and Medicaid legislation of the 60's and virtually every
effort made by government to extend access to health services to our
entire population. If not swayed by fear mongers, there will grow in this
country a mass grassroots movement in favor of a single payer system. I
hope you will be leading that movement. You are right-we are ready for
change. You are right-we are one community. In this spirit, we should be
covered under a single health insurance plan that protects us all.
Please do not feel obliged to answer this letter. On the other hand, if I
can serve your administration in any fashion as you design reforms in the
American health care system, I would be prepared to give up my job to do
so. Therefore, I have submitted my curriculum vitae with this letter.
With my very best wishes.
Thomas A. Heller, M.D., M.P.H.
Enclosures:
Landry.FJ, et. al., Outcomes of Cardiopulmonary Resuscitation
in the Intensive Care Setting, Archives of Internal Medicine,
1992, 152, 2305-08.
Curriculum vitae
�•: ' • .
NOTICE
PERSONAL INFORMATION HAS BEEN REDACT]
FROM THIS OOCUMENT
..^
^
:. .
�The Honorable Jim McDermott
The United States House of Representatives
Washington, DC 20515
Dear Dr\
McDermott:
I'm an avid supporter of yours, and I'm glad that a
physic io-n i s taking such an a c t i v e r o l e in n a t i o n a l health,
care reform. T don't pretend to know much about the concept
nf "managed competition" or i t s a l t e r n a t i v e s , but a f t e r
reading of your doubts about managed care, I wanted to share
some of my own persona 1 ^experience .
I'm a p e d i a t r i c o n c o l o g i s t a t Group H e a l t h , an HMO,
as
you know. Our " c o m p e t i t o r s " i n c l u d e our c o l l e a g u e s a t two
l o c a l meccas cf m e d i c a l c a r e . C h i l d r e n ' s H o s p i t a l and the
Hutchinson Cancer Research Center.
I t r a i n e d a t both
c e n t e r s , r e t a i n w o n d e r f u l c o l l e g i a l r e l a t i o n s h i p s and s t a f f
p r i v i l e g e s , and u t i l i z e b o t h f a c i l i t i e s r e g u l a r l y , when
necessary, f o r p a t i e n t s .
A l a y person would p r o b a b l y never choose our s e r v i c e
over a mecca. We do not a d v e r t i s e our s e r v i c e , or seek any
exposure.
Yet our p a t i e n t s who have been i n a l l t h r e e
.-ystemj would s t r o n g l y agree t h a t we p r o v i d e e x c e l l e n t ,
s t a t e - o f - t h e - a r t , p e r s o n a l i z e d oncology care n o t a v a i l a b l e
i n academic c e n t e r s . We f e e l t h a t we surpass our c o l l e a g u e s
in p r o v i d i n g p s y c h o - s o c i a l s u p p o r t , i n c l u d i n g s c h o o l v i s i t s ,
p s y c h i a t r i c l i a i s o n s e r v i c e , home v i s i t s , home t h e r a p y and
Ii nine has p ice .
We've i n s t i t u t e d these programs for the b e n e f i t of
p a t i e n t s , and we f e e l we provide these s e r v i c e s a t lower
c o s t . Eut cost i s not the d r i v e r for us. I f r e q u e n t l y
request and administer expensive , or experimental, or
o f f - l a b e l therapies for the p a t i e n t s .
We r e c e n t l y cared f o r an e i g h t year o l d g i r l w i t h acute
n c n - l y m p h o c y t i c leukemia.
She s t a r t e d her care a t CHMC.
Her p r e v i o u s insurance would not cover her leukemia Care
once d i s c h a r g e d , and would not cover marrow t r a n s p l a n t a t i o n .
Through her s t e p - f a t h e r ' s coverage, we accepted her,
a l t h o u c h the f a m i l y was r e l u c t a n t t o come. She spent the
4s
V
�.s,
n e x t s i x t o e i g h t weeks i n o u r h o s p i t a l ( o n t h e same
n a t i o n a l r e s e a r c h p r o t o c o l ) as we p r e p a r e d h e r f o r marrow
t r a n s p l a n t a t t h e FHCRC, w h i c h we c o v e r e d .
We t o o k h e r
r i g h t b.ack a f t e r d i s c h a r g e t h e r e , and p r o v i d e d o v e r two
months o f home i . v . t h e r a p y and c l o s e f o l l o w u p . ;
T h i s c h i l d i s now h e a l t h y and happy ( s h e was a l w a y s
w o n d e r f u l l y happy anyway!) and h e r p a r e n t s a r e among o f o u r
most v o c a l s u p p o r t e r s .
I c a n name -numerous o t h e r f a m i l i i e s
who w o u l d n o t have chosen us o v e r o t h e r a l t e r n a t i v e s , who
have had e x p e r i e n c e i n ' o t h e r i n s t i t u t i o n s , b u t who have be'en
i m m e n s e l y s a t i s f i e d w i t h t h e c a r e we p r o v i d e .
I guess t h e p o i n t t h a t I'm t r y i n g t o make i s t h a t
" p h y s i c i a n c h o i c e l i m i t a t i o n s " a l w a y s seem b a d , b u t t h e
r e a l i t y i s t h a t c a r e may a c t u a l l y i m p r o v e i n a managed c a r e
situation:.
J u s t as some i n s t i t u t i o n s have r e p u t a t i o n s t h a t
exceed r e a l i t y , o t h e r s may have an u n d e s e r v e d poor
reputat ion.
I n d e p e n d e n t q u a l i t y measures may be i m p o r t a n t , b u t most
p e o p l e make c h o i c e s on a " g u t l e v e l " based on media and
exposure.
W i t h a s i n g l e p a y e r s y s t e m , t h e r e may be
i n c e n t i v e t o do more t o t h e p a t i e n t , j u s t t o " l o o k b e t t e r "
and a t t r a c t more p a t i e n t s . The r e s u l t w i l l be h i g h e r c o s t s .
S incerely.
R o n a l d R. L o u i e ,
cc
Rep. Mike K r e i d l e r , OD
F i r s t Lady H i l l a r y Rodham C l i n t o n
P h i l Nudelman, PhD, CEO, GHC
MD
�Sam
Sionim,
Harch
IB,
1393
H i l l a r y Rodham C l i n t o n
Task Force on H e a l t h Care Reform
The White House
1600 Pennyslvania Ave NU
Washington, DC E0500
Dear- f i r s . C l i n t o n / T a s k
Force,
I would l i k e t o express my support For t h e work you a r e
doing on h e a l t h care r e f o r m and a l s o f o r t h e
overall
A d m i n i s t r a t i o n performance t o d a t e .
I would l i k e t o o f f e r f o r your c o n s i d e r a t i o n a s p e c i f i c
p r o p o s a l f o r r e f o r m o f t h e h e a l t h care d e l i v e r y system.
I
t h i n k t h i s i s a way t o p u t t o g e t h e r a l o t o f your g o a l s and
p r e f e r r e d methods t o achieve
them i n t o a
comprehensive
package. As examples:
ID
You a r e l o o k i n g f o r l a r g e p o o l s o f i n s u r e d people.
This
p l a n e s s e n t i a l l y has one pool o f a l l Americans (each
person
chooses which insurance company they w a n t ) . There would be
u n i v e r s a l access t o b a s i c coverage.
E)
Insurance t h a t i s p o r t a b l e - t h i s proposal would end t h e
a s s o c i a t i o n between employment and h e a l t h insurance
...
everyone has i n s u r a n c e .
Employers pay p a y r o l l t a x b u t don't
purchase i n s u r a n c e .
3D
Reduce a d m i n i s t r a t i v e w a s t e / i n e f f i c i e n c y - t h e r e would be
a board/commission which s e t s u n i f o r m
procedures/terminology
f o r a l l t o f a l l o w Cbut i t would n o t be an insurance company).
4)
C i g a r e t t e t a x . I ' d go even f u r t h e r and i n c l u d e o t h e r
b e h a v i o r s t h a t a l s o i n c r e a s e h e a l t h c o s t s . . Rather than
call
i t a " s i n " t a x and funds r a i s e d from
i t Just used f o r t h e
u n i n s u r e d , t h i s p r o p o s a l would make i t a "use" t a x , goes t o
pay f o r h e a l t h insurance f o r a l l , and t h e amount i s based on
t h t j a c t u a l h e a l t h c o s t s due t o c i g a r e t t e s and o t h e r s .
This
a l s o promotes i n d i v i d u a l r e s p o n s i b i l i t y
i n t h a t those whose
b e h a v i o r s cause i n c r e a s e d spending pay more.
5)
Managed Care C o m p e t i t i o n
- since
t h e r e would
be
c o m p e t i t i o n t o s i g n up p a t i e n t s , those i n s u r e r s who do t h e
best Cmost c o s t - e f f i c i e n t ) w i l l win o u t - t h i s w i l l u s u a l l y be
managed care p l a n s .
6)
G l o b a l budget cap - w h i l e t h i s i s n ' t d i r e c t l y s p e c i f i e d ,
i t would be t h e r e .
The p l a n would pay i n s u r e r s a s e t
c a p i t a t e d amount f o r each p a t i e n t they i n s u r e so you c o u l d add
i t a l l up and c a l l t h e t o t a l a g l o b a l budget. The p u b l i c Cby
a v o t e ) would decide how much they want t o spend/have
covered
- see item tt 10 o f p r o p o s a l . There a r e many c o s t
containment
features i n the proposal.
7)
E l i m i n a t i o n o f t a x d e d u c t i b i l i t y f o r p o r t i o n s o f premiums
going f o r s e r v i c e s beyond b a s i c coverage - i n c l u d e d .
34616
1 1TH P L A C E S O U T H , S U I T E 5
F E D E R A L WAY, W A S H I N G T O N
98003
TELEPHONE ( 2 0 6 ) 9 2 7 - 6 5 0 0
�EnclasE.'d are what I c o n s i d e r t o he t h e g o a l s , t h e proposal
and then my r a t i o n a l e f o r t h e components o f t h e p r o p o s a l .
itself,
Recently I've read t h a t some s t a t e s C? Colorado, C a l i f o r n i a ,
North
C a r o l i n a ) hcive p r o p o s a l s
similar to this.
Key d i f f e r e n c e s from
them:
making i t n a t i o n a l vs. s t a t e ;
f u n d i n g sources Cincome t a x vs. employee
t a x ; p l u s t a x on h i g h r i s k b e h a v i o r s ) ; a d e f a u l t insurance Citem tt 5 i n
p r o p o s a l ) ; and t h e idea o f having t h e p u b l i c v o t e on what i s i n c l u d e d i n
b a s i c coverage. A d d i t i o n a l l y , I'm n o t sure i f they address t h e i s s u e o f
c o s t s a t t h e p a t i e n t - p r o v i d e r l e v e l Citem tt 7 ) .
I have a l s o enclosed a d i s c u s s i o n about c o s t s a t t h e p a t i e n t p r o v i d e r l e v e l , where J u s t about a l l c o s t s are generated.
This
includes
examples o f what I'm sure you're l o o k i n g f o r : areas where c o s t s can be
reduced w i t h o u t s a c r i f i c i n g q u a l i t y .
Thank you f o r c o n s i d e r i n g t h i s and e s p e c i a l l y f o r d e a l i n g w i t h these
problems.
Sincerely,
Sam Slonim,
MD
�PROPOSAL FOR HEALTH CARE REFORM
OUTLINE/CONTENTS
page
1
Goals
2-3
Proposal
4-9
R a t i o n a l e / D i s c u s s i o n (For items i n p r o p o s a l )
�GOALS
1
U n i v e r s a l coverage
(everyone covered For a b a s i c coverage package)
E
Q u a l i t y care
3
Cost containment ... but not by s a c r i F i c i n g access or q u a l i t y
4
F a i r n e s s i n regards t o paying For i t - i e , expenses shared
by a l l i n c l u d i n g by 1) a b i l i t y t o pay, 2) amount oF
care needed/used, and 3) h e a l t h h a b i t s / r i s k s
5
Choice - m a i n t a i n o p t i o n s For p a t i e n t s and
6
A d m i n i s t r a t i v e reForms:
reduce uiaste/dupl i c a t i o n ,
( i n c l u d i n g uniForm c l a i m Form and t e r m i n o l o g y )
7
Encourage h e a l t h b e h a v i o r s and use of system t h a t lead t o b e t t e r
providers
simpl i F i c a t ion
o v e r a l l h e a l t h (and thus lower expenses)
B
A d a p t a b i l i t y oF system over time
... able t o make changes as needed
9
Keep the good p a r t s oF c u r r e n t system i n place
Supplemental P r i n c i p l e s t o h e l p achieve g o a l s :
1
Costs oF s e r v i c e s must be known and taken i n t o c o n s i d e r a t i o n
Best way t o do so:
P a t i e n t s must pay something For every s e r v i c e
(a percentage oF charge)
E
EliminatEi p r e - e x i s t i n g c o n d i t i o n s and w a i t i n g p e r i o d s
3 . Everyone should have one and only one h e a l t h insurance
4
People should choose t h e i r h e a l t h insurance company/plan
�HEALTH CARE REFORM PROPOSAL
1.
A l l c i t i z e n s are covered f o r a "basic coverage" package.
What i s
included
i n b a s i c coverage
package determined as d e s c r i b e d i n
10
below.
2.
A g o v e r n i n g board/commission ("Board") oversees t h e system (see
11
f o r i t s F u n c t i o n s ) but i s not an i n s u r a n c e company. P r i v a t e insurance
companies a c t u a l l y p r o v i d e t h e i n s u r a n c e .
Board i s independent
From
government ( a d m i n i s t r a t i o n & l e g i s l a t u r e ) .
3.
People ( p a t i e n t s ) themselves choose which insurance p l a n they want.
Can changie once per year. There i s no charge ( t o t h e p a t i e n t ) For t h e
premium For "basic coverage"
(Funding For t h i s discussed i n
9
below).
Insurance companies ( p a r t i c i p a t i n g i n t h i s system) must oFFer
"basic coverage" as a minimum and can not deny coverage - i . e . , must
accept anybody who chooses t h e i r i n s u r a n c e p l a n . Can oFFer p l a n s w i t h
expanded c o v e r a g e / o p t i o n s but p a t i e n t s must pay For t h e a d d i t i o n a l
cost/premium themselves and t h i s i s not t a x - d e d u c t i b l e ... i F p a i d by
employer, t h i s amount c o n s i d e r e d as a d d i t i o n a l s a l a r y and t a x a b l e .
4.
I n r e g a r d s t o b a s i c coverage: no p r e - e x i s t i n g o r excluded c o n d i t i o n s
a l l o w e d ; no w a i t i n g p e r i o d s .
Also, would
cover a l l h e a l t h
care
( w i t h i n b a s i c coverage) needed, no m a t t e r what the cause.
(Example:
workers compensation, auto a c c i d e n t s , t h i r d p a r t y l i a b i l i t y cases ...
a l l covered under one h e a l t h i n s u r a n c e ) .
Thus, everyone would have one and o n l y one h e a l t h insurance company.
5.
There would be a " d e F a u l t " i n s u r a n c e — t h i s would cover people who
don't s i g n up w i t h any i n s u r a n c e company (people c o u l d a l s o s p e c i F i cally
choose t h e d e F a u l t p l a n ) .
DeFault p l a n would be the b a s i c
coverage p l a n .
Consider making t h e deFault p l a n one w i t h
"gatekeeper" Features.
6.
Funding
For premiums For b a s i c coverage c o l l e c t e d by Board (see
9
For sources.) Board t h e n pays each i n s u r a n c e company a monthly
premium For each person t h a t chooses t h e insurance company - amount
For each p a t i e n t based on p a t i e n t ' s age, sex, and geographic l o c a t i o n .
Amount (by a g e , s e x , l o c a t i o n ) i s the same For a l l insurance companies
i n c l u d i n g deFault plan.
7.
P a t i e n t s must pay something For every s e r v i c e they r e c e i v e ( a pjar.ce_ntage oF t h e a l l o w e d amount oF t h e charge;
"co-pay," "coinsurance").
As a p o s s i b l e example: 20% oF F i r s t $500, 10% oF amount
over S500.
Probably s e t a maximum amount per year per person/Family.
PatientEi a l s o pay For non-covered s e r v i c e s .
(Would
call
t h i s the "co-pay" a l t h o u g h under c u r r e n t t e r m i n o l o g y ,
co-insurance would be more c o r r e c t as t h i s i s a percentage not a s e t
amount EIS c u r r e n t co-pays u s u a l l y a r e . Do NOT use d e d u c t i b l e s as they
p r o v i d e i n c e n t i v e not t o seek care i F not met and once met,
then no
i n c e n t i v e t o watch c o s t . )
�B.
9.
3
I n s u r a n c e companies and p r o v i d e r s a r e F r e e t o make any a r r a n g e m e n t s
t h e y u a n t w i t h c e r t a i n e x c e p t i o n s Cmust have a co-pay,
must
Follotu
rules
established
by Board s u c h as u s i n g u n i F o r m b i l l i n g p r o c e d u r e s ,
c l a i m Forms, e t c . ) .
However,
iF a provider
bills
For
services
provided
t o p a t i e n t s on t h e d e F a u l t p l a n t h e n p r o v i d e r a g r e e s t o payment oF Fees on Fee s c h e d u l e s e t up by B o a r d .
F u n d i n g s o u r c e s For t h e premium c o s t oF b a s i c c o v e r a g e From 3 a r e a s :
p a y r o l l t a x on e m p l o y e r s
income t a x
t a x on b e h a v i o r s t h a t l e a d t o i n c r e a s e d h e a l t h c a r e e x p e n s e s
- s u c h as:
.. c i g a r e t t e s
.. a l c o h o l
.. h i g h F a t c o n t e n t Foods
.. n o t w e a r i n g s e a t b e l t s , u s i n g h e l m e t s
CFines l e v i e d when p u l l e d o v e r by p o l i c e and t h i s n o t e d )
- amounts w o u l d be based on e x p e c t e d c o s t s
For e x a m p l e ,
smoking:
e s t i m a t e c o s t s s p e n t on h e a l t h
care
For
conditions
caused/worsened
by s m o k i n g d i v i d e d by
number oF c i g a r e t t e s s o l d e q u a l s t h e t a x CFor
health
c a r e s y s t e m ) added t o a pack oF c i g a r e t t e s .
CNote: i F
p e o p l e q u i t s m o k i n g won't have t h e s e c o s t s
so
won't
need t h i s r e v e n u e .. i . e . , i t b a l a n c e s o u t . )
A n o t e an r e l a t i v e r a t e s / a m o u n t s between t h e 3:
# 3 w o u l d be d e t e r mined as above.
Thus,
c o s t s oF s y s t e m ( p r e m i u m s For b a s i c c o v e r a g e )
minus r e v e n u e From
tt3=
# l + # 2 .
S e t a r a t i o between 1 & 2
...
For example: p e r c e n t a g e r a t e oF #1 i s Four t i m e s tt 2.
1)
2)
3)
10.
What i s i n c l u d e d
i n b a s i c coverage?
P u b l i c d e c i d e s by a v o t e ..
vote every 2 years ( w i t h congressional e l e c t i o n s )
to allow
changes.
The
board/commission
prepares a l t e r n a t i v e s
For
p u b l i c t o v o t e on.
Would b a s i c a l l y be g i v e n a c h o i c e s u c h as:
t o add
coverage
For
XYZ
would
cost
an
a d d i t i o n a l .20% on p a y r o l l t a x and a d d i t i o n a l .05% t o
income t a x . Do you/we want t h i s ?
Thus,
those deciding are both the
u s e r s and p a y e r s oF t h e s y s t e m .
11.
Governing
Board:
How
chosen?
Some c o m b i n a t i o n oF:
p e o p l e app o i n t e d by a d m i n i s t r a t i o n &
legislature,
some v o t e d
by
public i n
g e n e r a l e l e c t i o n ( ? ? p e r h a p s a l l ) , p e r h a p s some as r e p r e s e n t a t i v e s oF
p r o v i d e r community.
T h i s b o a r d makes d e c i s i o n s For t h e s y s t e m ... n o t t h e a d m i n i s t r a t i o n
or C o n g r e s s .
No movement oF money/Funds between h e a l t h
care
system
and g e n e r a l g o v e r n m e n t b u d g e t .
F u n c t i o n s would include-.
o v e r s e e i n g system,
c o l l e c t i n g Funds (# 9 )
and d i s t r i b u t i n g t o i n s u r a n c e c o m p a n i e s ,
p r e p a r i n g o p t i o n s For p u b l i c
t o v o t e on (# 1 0 ) , d e t e r m i n i n g Fee s c h e d u l e For d e F a u l t i n s u r a n c e ( * ) ,
s e t t i n g up u n i v e r s a l c l a i m F o r m s / t e r m i n o l o g y / p r o c e d u r e s , e t c .
(* see r a t i o n a l e pages i n r e g a r d s t o t h e Fee s c h e d u l e For d e F a u l t i n s u r a n c e w h i c h i s v e r y i m p o r t a n t component i n s u c c e s s oF s y s t e m . )
12.
Medicaid.Pretty
much r e p l a c e d as e v e r y o n e w o u l d have i n s u r a n c e .
Would c o v e r : 1) t h e co-pay For t h o s e v e r y p o o r who
c a n ' t aFFord
the
co-pay
( o r perhaps
r e d u c e t h e amount oF co-pay p a t i e n t p a y s ) and 2 )
non-covered s e r v i c e s ( i n basic coverage) t h a t
the state
elects
to
cover
For
the poor.
F u n d i n g For
m e d i c a i d amounts comes From
o t h e r / c u r r e n t s t a t e s o u r c e s , n o t From F u n d i n g
For
basic
coverage
premiums (tt 9 ) .
Medicare:
i n c l u d e d i n t h e system.
�RATIONALE / DISCUSSION
C#s r e f e r t o i t e m s i n p r o p o s a l )
Self explanatory
One m a j o r q u e s t i o n on r e f o r m i s w h e t h e r we
want a s i n g l e - p a y e r
system.
I would
hope we
could
have a f i n a n c i a l l y v i a b l e s y s t e m
w i t h o u t i t b e i n g s i n g l e - p a y e r . Based on my e x p e r i e n c e s w i t h M e d i c a r e ,
M e d i c a i d , and many p r i v a t e i n s u r a n c e s c o m p a n i e s , I am f e a r f u l a s i n g l e
p a y e r c o u l d g e t t o o p o w e r f u l ...
a c t i n g l i k e a monopoly.
I t seems
many
i n s u r e r s ' number one p r i o r i t y becomes c o s t s f o r a c o m b i n a t i o n o f
r e a s o n s : 1) p r o f i t ,
2 ) l o w e r premiums t o o f f e r t o e m p l o y e r s ,
and
3)
save t a x d o l l a r s .
Often t h i s c o n f l i c t s w i t h the best i n t e r e s t s of
p a t i e n t s and f a i r / r e a s o n a b l e i n t e r a c t i o n s
with
p r o v i d e r s (which I
believe
i s needed
to maintain delivery
of high q u a l i t y care t o
patients).
I n a l l aspects of l i f e ,
p e o p l e need t o have some c h o i c e s
(albeit
n o t a l w a y s g r e a t o n e s ) and t h i s a l s o a p p l i e s t o h e a l t h c a r e p a t i e n t s and p r o v i d e r s . A s i n g l e - p a y e r s y s t e m r e d u c e s c h o i c e s .
The b o a r d can do a l o t t o " l e v e l t h e p l a y i n g f i e l d "
so a l l i n surance
c o m p a n i e s need
t o f o l l o w some b a s i c r u l e s and you have f a i r
competition.
The
board
would
also help
with
administrative
waste/reform
by e s t a b l i s h i n g
uniform b i l l i n g terminology,
billing
p r o c e d u r e s , e t c . f o r everyone t o use.
( N o t e : s i n c e t h e b o a r d w i l l be
paying
t h e i n s u r a n c e c o m p a n i e s - # S - i n s u r a n c e s w i l l need t o f o l l o w
board's reiquirements . )
By h c i v i n g a b o a r d t h a t o v e r s e e s t h e i n s u r a n c e c o m p a n i e s ,
doctors
and p a t i e n t s can go o v e r t h e heads o f i n s u r a n c e c o m p a n i e s when t h e y do
t h i n g s t h a t a r e c l e a r l y wrong ... c u r r e n t l y you have t o go t o c o u r t o r
usually
Just
" e a t i t " - p u t up w i t h t h e i r nonsense because i t s n o t
w o r t h t h e e f f o r t i t w o u l d t a k e t o f i g h t them.
( I f you want e x a m p l e s ,
l e t me know.)
Medical
b i l l i n g / h a n d l i n g , o f c l a i m s and management o f h e a l t h c a r e
d e l i v e r y i s v e r y c o m p l e x and i n s u r a n c e c o m p a n i e s have e v o l v e d and g o t t e n good a t t h i s .
We s h o u l d n o t t h r o w them a l l away; use t h e c u r r e n t
i n s u r a n c e c o m p a n i e s and t h e i r e x p e r t i s e b u t r e q u i r e t h e y
follow
cert a i n g u i d e l i n e s , procedures, e t c .
Finally,
t h e board
should
n o t become p o l i t i c a l o r an arm o f
government.
I t h i n k h e a l t h c a r e s h o u l d s t a n d by i t s e l f — r a i s e t h e
money nee.'ded t o r u n t h e s y s t e m and use t h a t money f o r h e a l t h c a r e .
Don't s t a r t m o v i n g f u n d s t o o r f r o m g e n e r a l g o v e r n m e n t b u d g e t .
Curr e n t l y t h e f e d e r a l g o v e r n m e n t i s " b o r r o w i n g " ?100s o f b i l l i o n s o f d o l lars
from
Social Security;
M e d i c a r e has been c o n t i n u a l l y c u t — i n
p a r t t o reduce t h e budget d e f i c i t .
We need t o a v o i d t h i s s i t u a t i o n
—
I s u g g e s t we c l e a r l y do so f r o m t h e s t a r t .
H a v i n g p e o p l e t h e m s e l v e s choose w h i c h i n s u r a n c e company t h e y want
( a n d i n s u r e r s r e c e i v i n g t h e premium f r o m t h e s y s t e m - # 6 ) makes i n surance
c o m p a n i e s r e s pans i y B_t g _p a t I_B n t s — wham t h i s w h a l e s y s t e m i s
s u p p o s e d t o be s e t up f o r .
Those o f f e r i n g p o o r q u a l i t y s e r v i c e
will
lose
o u t ...
r e a l c o m p e t i t i o n w i l l be added.
C u r r e n t l y , insurance
c o m p a n i e s a r e most r e s p o n s i v e t o e m p l o y e r s (who o f t e n m o s t l y J u s t want
costs lowered);
g o v e r n m e n t i s r e s p o n s i v e t o v o t e r s who d o n ' t want t o
pay t a x e s ( b u t want s e r v i c e s ) .
�Insurance
companies can o f f e r o p t i o n a l coverages beyond what i s
i n b a s i c coverage.
For example, i f b a s i c coverage was s e t up on a
"gate-keeper" model C a l l care from, o r r e f e r r a l s a u t h o r i z e d by, a
designated, primary care p h y s i c i a n ) which saves on c o s t s , c o u l d
offer
p a t i e n t s a p l a n where they d i d n ' t need t o go through a primary care
d o c t o r but t h i s might c o s t t h e p a t i e n t an a d d i t i o n a l ,
say, $E5 per
month premium f o r t h i s f e a t u r e .
Similarly
f o r t h i n g s such as a
p r i v a t e h o s p i t a l room v s . shared.
Also, f o r a d d i t i o n a l
coverage
beyond b a s i c coverage
... example: say a p a r t i c u l a r e x p e r i m e n t a l
t r e a t m e n t f o r one t y p e o f cancer wasn't covered by b a s i c coverage
c o u l d purchase expanded insurance p l a n t h a t covered t h a t . These a d d i tional
items would be p a i d by t h e p a t i e n t w i t h no t a x d e d u c t i o n f o r
them. Thus, people c o u l d look a t these t h i n g s and decide i f they a r e
worth t h e e x t r a expense ... o r i f they'd r a t h e r spend t h e money on
something e l s e .
T h i s again promotes c o m p e t i t i o n between
insurances
and a l s o g i v e s people CHOICES.
I n sum: everyone would g e t t h e necessary Cbasic coverage),
those t h a t want t h e " l u x u r y " items can have
them b u t they need t o pay f o r them.
Or i n terms o f an analogy:
everyone g e t s a t i c k e t on t h e a i r p l a n e .. i f you want a f i r s t
class
s e a t , you pay f o r t h e upgrade.
By having p a t i e n t s choose and insurance companies r e q u i r e d t o accept a l l who choose them, you w i l l have c r e a t e d an i n s u r e d pool o f a l l
Americans C~ ESQ m i l l i o n ) .
Note:
For o p t i o n a l coverages beyond b a s i c coverage insurance companies c o u l d p u t i n p r e - e x i s t i n g c l a u s e s .
However, t h i s would n o t be
allowed
i n t h e f i r s t E-3 years.
Would need t h i s l a t e r p r o v i s i o n t o
a l l o w those who c u r r e n t l y have coverage f o r t h i n g s t h a t b a s i c coverage
wouldn't cover t h e o p p o r t u n i t y t o purchase them.
No p r e - e x i s t i n g o r excluded c o n d i t i o n s Cin b a s i c coverage):
most
people have f i g u r e d o u t t h a t t h i s i s needed t o assure access f o r a l l
and t o " l e v e l t h e p l a y i n g f i e l d " among i n s u r e r s .
Another key i n h e a l t h care r e f o r m i s t h a t everyone should
have
one
and only one i n s u r a n c e ,
i t should be e a s i l y i d e n t i f i e d ,
and i t
should cover a l l h e a l t h c o s t s C w i t h i n b a s i c coverage) no matter
what
caused them. Why?
In d e a l i n g w i t h i n s u r e r s on a d a i l y b a s i s , i t seems t h a t t h e r e now
i s an u n w r i t t e n "golden r u l e " t h a t insurances operate under which i s
to
a v o i d o r delay paying f o r t h i n g s as o f t e n and as long as p o s s i b l e
by any means p o s s i b l e . CThis i s t o reduce c o s t s as much as p o s s i b l e i n s t e a d o f having t o i n c r e a s e premiums even h i g h e r than
currently.)
One o f t h e ways t h i s i s done i s by a v o i d i n g / d e l a y i n g payments i n e f f o r t s t o determine i f someone e l s e i s r e s p o n s i b l e f o r p a y i n g .
Often
the
forms
they
use
are
difficult
t o understand
and many
p e o p l e / p a t i e n t s don't understand them and throw them o u t r a t h e r than
sending them back t o t h e insurance company ... l e a d i n g t o non-payment
by t h e i n s u r e r . A h y p o t h e t i c a l example may be h e l p f u l :
�A 17 year o l d g i r l s l i p s on t h e steps a t home and
sprains
her a n k l e . Her d o c t o r b i l l s f o r the o f f i c e v i s i t w i t h a d i a g n o s i s code f o r s p r a i n .
When t h e insurance company gets the
b i l l and e n t e r s i t i n t o t h e i r computer, l e t t e r s are a u t o m a t i cally
generated and sent out t o the p a t i e n t / p a r e n t s i n q u i r i n g
about what happened and i f t h e r e i s o t h e r i n s u r a n c e .
Until
these are f i l l e d out and r e t u r n e d , t h e insurance company takes
no f u r t h e r a c t i o n on t h e b i l l .
Since t h e d i a g n o s i s was a
s p r a i n , one such l e t t e r might be t o i n q u i r e i f she had been i n
an auto a c c i d e n t Cso auto
insurance
would be r e s p o n s i b l e ) .
There might
be another t o determine i f t h i s might have happened a t work ( w o r k e r s ' compensation).
And p o s s i b l y a
third
to
determine
i f her o t h e r parent has insurance t h a t might be
primary.
Note t h a t none of these s i t u a t i o n s need t o a c t u a l l y
exist,
Just t h e p o s s i b i l i t y of them leads t o t h e forms being
sent.
L e t s say she i s seen i n f o l l o w - u p one week l a t e r
and
another b i l l i s sent i n .
B e l i e v e i t or n o t , the same l e t t e r s
o f t e n go out a l l over a g a i n .
CThis i s a l s o an example of t h e
a d m i n i s t r a t i v e waste i n our system.)
In a d d i t i o n t o c u t t i n g out a bunch of paper work and
delayed
or
denied payments, I t h i n k having a l l h e a l t h s e r v i c e s covered by one i n surance would save c o s t s i n o t h e r ways.
You'd have h i g h e r h e a l t h i n surance premiums but lower auto insurance premiums f o r example.
I
t h i n k you'd lower auto c o s t s more than r a i s e h e a l t h c o s t s because
h e a l t h i n s u r e r s do a b e t t e r Job of h a n d l i n g h e a l t h c l a i m s than auto i n surers
...
f o r example, they u s u a l l y have c o n t r a c t e d networks of
p r o v i d e r s ("managed c a r e " ) w h i l e auto i n s u r e r s u s u a l l y pay
the
full
charge.
Additionally,
whatever percentage of l i a b i l i t y law s u i t s Cof
any t y p e : medical,
business,
e t c . ) t h a t are i n i t i a l l y brought J u s t t o
get a person's medical expenses p a i d would not be needed as they would
know they have h e a l t h insurance
coverage
...
thus l o w e r i n g t h e
l i a b i l i t y l a w s u i t s , l i a b i l i t y insurance premiums, and consumer p r i c e s .
For v a r i o u s reasons many people may not s i g n up w i t h an i n s u r e r .
This assures t h a t they Cand t h u s a l l Americans) have h e a l t h
insurance
and makes i t easy t o know which insurance each person has.
I would env i s i o n t h e board/commission having an a c c e s s i b l e c o m p u t e r / e l e c t r o n i c
l i s t i n g of which insurance people have.
Note t h a t t h e d e f a u l t insurance i s not a " w e l f a r e / m e d i c a i d " p l a n i t o f f e r s t h e same b a s i c coverage as any
o t h e r insurance
...
Just
w i t h o u t any o p t i o n s chosen f o r a d d i t i o n a l coverages.
The
d e f a u l t insurance
would a c t u a l l y be
i n d i v i d u a l companies
Cexample: one i n each s t a t e ) t h a t c o n t r a c t w i t h t h e board
to provide
t h i s i n t h e i r geographic area — s i m i l a r t o how HCFA now uses l o c a l i n s u r e r s t o a d m i n i s t e r Medicare.
The
d e f a u l t insurance
would a l s o be i m p o r t a n t i n reimbursement
issues f o r t h e whole system - see tt B, 11.
This g i v e s every American access t o a b a s i c coverage
insurance
p o l i c y , guarantees payment of premium t o t h e insurance company and puts
i n s u r e r s on equal
grounds as they a l l p a i d the same per p a t i e n t
category.
Since people choose t h e i r i n s u r e r , t h i s w i l l promote competition
among i n s u r e r s t o p r o v i d e the best p r o d u c t / s e r v i c e t o
patients.
Again,
as i n tt 3,
i n s u r e r s can o f f e r
additional
s e r v i c e s / c o v e r a g e t h a t people have t h e o p t i o n t o purchase.
�7
See s e p a r a t e d i s c u s s i o n r e g a r d i n g c o s t s .
B
I n s u r e r s would s i g n up p r o v i d e r s Cas i s o c c u r r i n g i n PPDs, HMDs,
etc.
now] d u r i n g which f e e schedules w i l l u s u a l l y be set/agreed
upon
... the system/board does not i n t e r f e r e i n t h i s .
P r o v i d e r s do not s i g n
up w i t h t h e d e f a u l t i n s u r e r but t o b i l l t h e d e f a u l t insurance r e q u i r e s
acceptances o f d e f a u l t system f e e schedule and procedures.
Since i n surers w i l l
r e c e i v e t h e same c a p i t a t i o n / p r e m i u m as d e f a u l t i n s u r a n c e ,
the d e f a u l t system's f e e schedule w i l l i n d i r e c t l y a f f e c t f e e
schedules
used by i n s u r e r s . For example, i f an i n s u r e r chose t o reimburse a part i c u l a r s e r v i c e more t h a n d e f a u l t d i d they would probably need t o pay
l e s s f o r something e l s e Cor charge p a t i e n t s more f o r t h e premium).
S
Oeciding how t o fund t h e system should be based, among o t h e r
t h i n g s , on: f a i r n e s s , e f f i c i e n c y ,
and where p o s s i b l e , should promote
cost savings and b e t t e r h e a l t h .
1) P a y r o l l Tax:
Employers Cplus government) c u r r e n t l y pay t h e m a j o r i t y o f h e a l t h
insurance premiums.
Additionally,
employers Cand employees) pay
p a y r o l l t a x t o fund Medicare.
Having a l l employers pay t h e same percentage of employee's s a l a r i e s o f f e r s t h e f o l l o w i n g advantages over t h e
c u r r e n t system:
A)
F a i r n e s s - a l l employers are paying t h e same Cpercentage)
B)
Gets employers out of t h e h e a l t h care business.
They
J u s t pay t h e i r percentage - but don't need t o spend time
and
money each year d e t e r m i n i n g which insurance p o l i c y t o
purchase Cand making some employees happy, o t h e r s upset
over c h o i c e s made).
P a t i e n t s w i l l be choosing t h e i r own
insurer.
I suspect t h a t a l o t o f money i s spent
by
employers on J u s t d e a l i n g w i t h h e a l t h insurance - beyond
the a c t u a l amount spent on premium payments. T h i s would be
saved.
C)
Ends p r a c t i c e o f people working S3 1/2
hrs/week because
health benefits kick
i n a t 30, e t c .
Also,
Csmall)
employers wouldn't have t o t a k e a person's h e a l t h Cin terms
of c o s t s t o i n s u r e them) i n t o c o n s i d e r a t i o n i n h i r i n g
decisions.
D)
Everyone would
have access t o an equal insurance p l a n .
C u r r e n t l y , b i g g e r companies u s u a l l y get b e t t e r p l a n s ,
b e n e f i t s , and lower premiums than s m a l l e r companies. I f we
b e l i e v e i n equal access t o h e a l t h care, then why should
working f o r employer A g i v e you b e t t e r insurance than working f o r employer B Ceverything e l s e being e q u a l ) ?
Notes: 1) No maximum amount on t a x a b l e s a l a r y f o r p a y r o l l t a x Csuch as
S o c i a l SE5curity and Medicare have now);
2) t a x c o l l e c t e d goes d i r e c t l y
to t h e heeilth system - does not go t o f e d e r a l budget Csee #2 above,
last
paragraph);
3) would be c o l l e c t e d w i t h s o c i a l s e c u r i t y t a x e s , so system
i s s e t up t o handle t h i s a l r e a d y w i t h o u t much a d d i t i o n a l expense.
2)
Income: Tax:
T h i s i s the best way t o c o n t r i b u t e based
By u s i n g income t a x as opposed t o an employee
so t a x r a t e can be lower. Also, employee t a x
money on money are not being taxed w h i l e hard
w i t h p a y r o l l t a x , system a l r e a d y i n p l a c e so
m i n i s t r a t i v e expense t o c o l l e c t .
on one's a b i l i t y
to
pay.
t a x you have a broader base
i s not f a i r as those making
working employees a r e .
As
wouldn't r e q u i r e much ad-
�a
3D
Tax an b e h a v i o r s t h a t lead t o i n c r e a s e d h e a l t h care expenses:
The concept i s t h a t we determine Cas best as p o s s i b l e ) what the
c o s t s of h e a l t h care are due t o a p a r t i c u l a r behavior Cexample:
smoking)
and ask those people p r a c t i c i n g those b e h a v i o r s t o share t h a t c o s t . T h i s
way
people can see t h e r e a l / F u l l c o s t s o f t h i n g s Cex: t h e cost o f t h e
c i g a r e t t e p l u s t h e c o s t o f h e a l t h care needed due t o
i t ) and
government/others s t o p s u b s i d i z i n g those who
p r a c t i c e the behavior.
Rather t h a n a " s i n t a x , " you c o u l d c a l l t h i s a "use t a x . "
Note: we are t a l k i n g about b e h a v i o r s / s i t u a t i o n s t h a t people have
c o n t r o l over Cfor example: not on people w i t h i n c r e a s e d g e n e t i c r i s k s o f
a d i s e a s e ) ; ones t h a t a reasonable e s t i m a t e o f t h e i r c o s t can
be
obtained., and a reasonable way of assessing t h e t a x e x i s t s . For example,
I'm not sure how p r a c t i c a l / p o s s i b l e i t would be t o t a x those b e h a v i o r s
t h a t put people a t r i s k f o r AIDS.
... DK,
perhaps you t h i n k these methods of f i n a n c i n g t h e system are
fair,
but ... are they p o l i t i c a l l y v i a b l e ?
A f t e r a l l , these are new
taxes.
I don't know but c o n s i d e r : I t h i n k t h e h i g h r i s k h e a l t h behavior
tax can e a s i l y be argued as a f a i r n e s s & f i n a n c i a l r e s p o n s i b i l i t y i s s u e
and a s i m u l t a n e o u s a t t e m p t t o improve p u b l i c h e a l t h .
In regards t o
p a y r o l l and income t a x , i f t h i s p r o p o s a l i s accepted i n whole, you can
p o i n t out t h a t i n r e t u r n f o r these people would g e t :
1)
Employer
and i n d i v i d u a l premiums c u r r e n t l y p a i d are r e placed by these
E)
E l i m i n a t i o n of Medicare p a y r o l l and employee t a x
3)
E l i m i n a t i o n o f Medicare premium ( c u r r e n t l y p a i d by soc i a l s e c u r i t y r e c i p i e n t s ) and Medicare d e d u c t i b l e
4)
C u r r e n t income t a x c o u l d be lowered C s l i g h t l y ) t o a d j u s t
for
reduced f e d e r a l spending on Medicaid;
similarly in
states
5)
Should see r e d u c t i o n s i n auto i n s u r a n c e premiums Chealth
c o s t s of a c c i d e n t s p a i d by h e a l t h system)
S)
P a s s i b l e r e d u c t i o n i n C a l l areas) l i a b i l i t y c o u r t
cases
and expenses l e a d i n g t o reduced premiums and t h u s reduced
consumer p r i c e s
7)
Most o f a l l , a l l Americans would have access t o b a s i c
h e a l t h coverage
i n a system p a i d f o r i n an e q u i t a b l e
manner. I n a d d i t i o n t o t h e a c t u a l h e a l t h c a r e , t h i s i s
something I t h i n k Americans c o u l d f e e l proud about.
10
A b i g problem i n our c u r r e n t "system" i s t h a t everyone wants more
coverage f o r themselves but they want someone e l s e (employer, government)
t o pay f o r i t .
The more we can get people t o see what a c t u a l c o s t s a r e ,
the b e t t e r we w i l l do w i t h c o s t - c o n t a i n m e n t ... i n o t h e r words,
l e s s use
of m a r g i n a l s e r v i c e s t h a t are very expensive f o r l i t t l e b e n e f i t .
I f you have a board d e c i d i n g what i s i n b a s i c coverage, t h e c u r r e n t
problem w i l l c o n t i n u e - people w i l l complain t h a t t h e y ' r e n o t g e t t i n g
enough coverage and w i l l
expect t h e b o a r d / o t h e r s t o come up w i t h t h e
f i n a n c i n g ( b u t not a n y t h i n g t h a t c o s t s them more). T h i s way (by having a
v o t e ) t h e p u b l i c w i l l be making t h e d e c i s i o n s ( t h u s can't complain) and
will
be a b l e t o see what a s e r v i c e would c o s t and decide i f we (American
c i t i z e n s as a whole) want i t i n b a s i c coverage. God f o r b i d , but i f c o s t s
e s c a l a t e i n t h e f u t u r e t o t h e p o i n t t h a t s i g n i f i c a n t r a t i o n i n g i s needed,
I would t h i n k t h a t t h e p u b l i c d e c i d i n g would be much b e t t e r than a handf u l o f people making such d e c i s i o n s .
�The
whole
idea
i s t o make t h i s a s y s t e m f o r a l l o f u s ; t h e more
everyone p a r t i c i p a t e s ,
the better.
The more c o n t r o l / p a r t i c i p a t i o n
one
has i n s o m e t h i n g ,
t h e l e s s l i k e l y one i s t o c o m p l a i n and t h e more l i k e l y
one i s t o work t o make i t b e t t e r .
In reiview,
t o d e t e r m i n e how a p a r t i c u l a r h e a l t h c a r e s e r v i c e
be c o v e r e d / p a i d f o r : t h e p r o c e s s w o u l d go s o m e t h i n g l i k e t h i s :
1)
2)
3)
4)
would
Is i t a legal service?
C f o r i s s u e s s u c h as a b o r t i o n , e u t h a n a s i a )
i f no
> not available
i f yes
>
Cgo t o # 2 )
I s i t covered i n b a s i c coverage?
.. p u b l i c v o t e d e c i d e s t h i s
Cexamples: g e n e r a l m e d i c a l c a r e , p r e n a t a l c a r e ,
immunizations, p r e s c r i p t i o n s , mental h e a l t h )
i f yes
> p a r t o f everyone's insurance p l a n
( p a t i e n t J u s t pays t h e c o - p a y )
i f no
> (go t o #3)
A)
E v e r y o n e has t h e o p t i o n t o p u r c h a s e c o v e r a g e f o r t h e
s e r v i c e i n t h e i r i n s u r a n c e p o l i c y - i n s u r e r s c a n deny
i n d i v i d u a l s on t h i s a n d / o r p u t p r e - e x i s t i n g , e x c l u d e d c l a u s e s
( p a t i e n t pays a d d i t i o n a l premium f o r t h i s ;
if/when
s e r v i c e u t i l i z e d : co-pay as d e t e r m i n e d by i n s u r e r )
B)
F o r l o w income ( o n s t a t e m e d i c a i d ) :
I s i t c o v e r e d by s t a t e m e d i c a i d ?
.. s t a t e s d e c i d e
( e x a m p l e s : a b o r t i o n s , c u s t o d i a l n u r s i n g home c o s t s
... i f t h e s e a r e n o t i n b a s i c c o v e r a g e )
I f 2 and 3 a r e b o t h no — > p a t i e n t s c a n pay ( f u l l p r i c e ) f o r
s e r v i c e themselves
11
R a t i o n a l e f o r a g o v e r n i n g b o a r d and i t s f u n c t i o n s has been d i s c u s s e d
above ( m a i n l ytt2 ) .
I n r e g a r d s t o t h e f e e s c h e d u l e f o r d e f a u l t i n s u r a n c e : t h i s has t o be
a
l e g i t i m a t e / r e a s o n a b l e amount o r s y s t e m w i l l f a i l ( a t l e a s t i n t e r m s o f
providing quality care).
N o t q u i t e what c o m m e r c i a l i n s u r a n c e s p a y i n g now
but a l s o n o t t h e l o w r a t e s
of current
government
plans
(Medicare,
Medicaid,
worker's
compensation).
S h o u l d use RBRUS o r s i m i l a r ( i . e . ,
less
f o r doing
procedures
and more f o r c o g n i t i v e / t a l k i n g - l i s t e n i n g
services).
Y e a r l y i n c r e a s e s w o u l d be based on c o s t - o f - l i v i n g b u t w o u l d
a l s o need t o f a c t o r i n a d d i t i o n a l i n c r e a s e s due t o e x p e n s i v e
technology
advances ( u n l e s s p u b l i c v o t e s n o t t o cover them),
aging p o p u l a t i o n , d i s e a s e s ( e x a m p l e : i n c r e a s e d numbers o f AIDS p t s ) , e t c . Whatever y e a r l y i n c r e a s e i n premium needed f o r d e f a u l t p l a n a l s o goes t o o t h e r
insurances
(same a m o u n t ) .
12
Pretty
much s e l f e x p l a n a t o r y .
I'm s u r e y o u r e a l i z e t h a t t h o s e on
Medicaid
have a "second
tier"
insurance
in
that
i t is
often
h a r d / d i f f i c u l t t o f i n d p r o v i d e r s t o see p a t i e n t s on w e l f a r e . T h i s i s due
to
t h e poor
reimbursement
rates
( m o s t l y ) ... a f t e r
the state of
Washington decided t o s i g n i f i c a n t l y i n c r e a s e reimbursement
f o r prenatal
and
pediatric
care
a m a z i n g l y t h e c r i s i s i n a c c e s s f o r t h e s e g r o u p s has
improved.
I f t h i n g s c o n t i n u e as t h e y a r e ,
Medicare p a t i e n t s
may
well
f i n d t h e m s e l v e s i n t h e same s i t u a t i o n b e f o r e t o o l o n g ... i f n o t a l r e a d y
i n some l o c a t i o n s / s i t u a t i o n s .
L e t s p u t e v e r y o n e i n t h e same s y s t e m - i f
we b e l i e v e h e a l t h c a r e i s a r i g h t ( o r we're s a y i n g t h a t i n 1993 we want
a l l A m e r i c a n s t o have a c c e s s t o h e a l t h c a r e ) ,
s h o u l d n ' t we a t l e a s t t r y
t o make t h i s e q u a l a c c e s s ?
�HEALTH CARE COSTS:
A LOOK AT THE PAT IENT-PROUIDER LEUEL
In a d d i t i o n t o o t h e r methods o f cost-containment,
I urge you t o
address t h i s issue a t t h e p a t i e n t - p r o v i d e r l e v e l where most d e c i s i o n s are
made t o o b t a i n / p u r c h a s e h e a l t h care s e r v i c e s .
Despite a l l t h e p u b l i c d i s cussion
o f c a s t s . c o s t i s u s u a l l y n o t a c o n s i d e r a t i o n i n d e c i s i o n making.
Two key reasons: 1) those making t h e d e c i s i o n s Cthe d o c t o r
and p a t i e n t )
are u s u a l l y n o t t h e ones paying f o r t h e s e r v i c e s ( i n s u r a n c e companies and
government), and 2) t o a much g r e a t e r degree than i t should be, d o c t o r s and
p a t i e n t s a r e n o t aware o f a c t u a l c o s t s .
I b e l i e v e t h e r e a r e many areas where equal q u a l i t y
care can be
p r o v i d e d f o r lower c o s t s ... and would be i f t h e d e c i s i o n makers were aware
of t h e c o s t s and took them i n t o c o n s i d e r a t i o n . On t h e f o l l o w i n g pages I've
enclosed a number o f examples o f t h i s i n c l u d i n g i n t h e areas o f medications
( g e n e r i c s , s p e c i f i c examples), use o f t h e h e a l t h care system, and use o f
expensive, o f t e n un-necessaru d i a g n o s t i c t e s t s .
A few s u g g e s t i o n s on how t h i s c o u l d be accomplished:
1)
Whatever' r e f o r m we have, I t h i n k i t i s i m p o r t a n t t h a t i t i n c l u d e t h a t
p a t i e n t s must pay something f o r every s e r v i c e p r o v i d e d .
I t h i n k t h i s should
be a per.cerit.age o f t h e charge. CObviously, t h e r e would be l i m i t s and t h e
amount p a i d reduced o r e l i m i n a t e d f o r t h e poor.) By r e q u i r i n g t h e p a t i e n t
to
pay a pejrcentage o f t h e charge, people w i l l begin t o look a t c o s t s and
c o n s i d e r t h i s i n d e c i s i o n making.
( T h i s w i l l a f f e c t d o c t o r s i n t h a t they
would know t h a t t h e i r p a t i e n t s have t o pay a p o r t i o n o f t h e charge.)
2)
L e g i s l a t e t h a t c o s t s be known. P a t i e n t s would have t o be t o l d p r i o r t o
receiving a service ( o f f i c e v i s i t ,
surgery,
p r e s c r i p t i o n , X-Ray, l a b t e s t ,
e t c . ) what i t w i l l c o s t - o r a t l e a s t an e s t i m a t e .
For d o c t o r s , whenever we
r e c e i v e a t e s t r e s u l t (such as X-Ray o r l a b r e p o r t ) o r c o n s u l t a t i o n , r e q u i r e
t h a t t h e charge be i n c l u d e d .
Also,
a copy o f p a t i e n t s ' h o s p i t a l charges
c o u l d be sent t o t h e a t t e n d i n g p h y s i c i a n .
This would need f i n e - t u n i n g ...
t h i s i s J u s t t h e concept.
I b e l i e v e many p h y s i c i a n s
a r e concerned about
c o s t s and would be able t o u t i l i z e such i n f o r m a t i o n t o lower c o s t s .
�Cost Examoles - • 1
SOME EXAMPLES OF COST SAUINSS POSSIBLE IF ATTENTION PAID TO COSTS
Medicat igns
BENERICS
While t h e r e i s c o n t r o v e r s y r e g a r d i n g g e n e r i c s , i t i s c l e a r t h a t i n most
cases g e n e r i c s work Just as w e l l and have tremendous c o s t s a v i n g s .
ANTIBIOTICS - HEAD/RESPIRATORY INFECTIONS
Examples: ear i n f e c t i o n s , s i n u s i t i s ,
tonsillitis,
b r o n c h i t i s . These
are extremely common and a l e a d i n g cause f o r d o c t o r v i s i t s i n primary
care.
To somewhat s i m p l i f y t h i s ... when a n t i b i o t i c s a r e p r e s c r i b e d f o r these you
g e n e r a l l y have a c h o i c e between a n t i b i o t i c s t h a t c o s t around S 10-15 and
work ~ 90% o f t h e t i m e and ones t h a t work a l i t t l e b e t t e r Csay 95%) b u t c o s t
$ 50-100. U s u a l l y , t h e former i s recommended and i f t h e p a t i e n t doesn't improve i n a few days then t h e l a t e r i s s u b s t i t u t e d .
However,
increasingly
the expensive a n t i b i o t i c s a r e being used as f i r s t l i n e therapy ... why?
1)
Drug companies a r e pushing them Cdoctors a r e s u s c e p t i b l e t o a d v e r t i s i n g ) , 2)
I suspect
t h a t many d o c t o r s a r e n o t r e a l l y aware o f c o s t d i f f e r e n c e s , 3)
f r e q u e n t l y p a t i e n t s s p e c i f i c a l l y want t h e more expensive ones ( t h a t i s , t h e
ones whose insurance pays f o r t h e i r p r e s c r i p t i o n s ) and 4) i f a t h i r d p a r t y
i s paying f o r i t , why n o t go w i t h t h e newest, most p o w e r f u l drugs?
ANT I-INFLAMMATORY DRUGS
Another very h i g h l y p r e s c r i b e d c l a s s o f medications
a r e t h e NSAIDs
CNon-Steroidal
A n t i - I n f l a m m a t o r y Drugs).
These a r e used f o r a r t h r i t i s ,
a n a l g e s i c s Cpain r e l i e v e r s ) , f o r s p r a i n s / s t r a i n s ,
bursitis,
f o r menstrual
problems such as cramping, e t c . There a r e many C > 20) drugs i n t h i s c l a s s
to choose from. While t h e r e a r e some d i f f e r e n c e s , f o r t h e most p a r t Cat app r o p r i a t e dosages) they a r e a l l about t h e same i n terms o f e f f i c a c y and
side-effects.
But n o t i n c o s t ... v a r y i n g from around S15 t o over $ B0 f o r
one month.
As w i t h t h e a n t i b i o t i c s discussed above, more and more o f t h e
expensive ones a r e being used f o r f i r s t time therapy f o r t h e same reasons as
discussed above. C e r t a i n l y , some people do b e t t e r w i t h one than another ...
but why do most people have t o s t a r t o u t C f i r s t p r e s c r i p t i o n f o r a NSAID)
w i t h one thrEie Cor more) times more expensive than another
with
similar
l i k e l i h o o d o f being e f f e c t i v e ?
CAttached a r e c o s t s o f some a n t i b i o t i c s and NSAIDs. I have h i g h l i g h t e d
some o f t h e more commonly p r e s c r i b e d ones.
Note t h e c o s t d i f f e r e n c e s .
Also, note d i f f e r e n c e s between brand and g e n e r i c s .
These a r e from "The
Medical
L e t t e r , " a medical
n e w s l e t t e r t h a t accepts
no drug company
advertising.)
- continued -
�Cost Examples - p E
Use
o f H e a l t h Care Sustem
EMERGENCY ROOM US. OFFICE
Non-emergency care p r o v i d e d
i n emergency rooms (ER) i s extremely
expensive.
Problems t h a t c o u l d be t r e a t e d i n a primary care o f f i c e f o r under $ 50 u s u a l l y c o s t a minimum o f S E00-300 i n an ER.
In addition, f o r
v a r i o u s reasons ERs tend t o run more t e s t s than a p a t i e n t ' s r e g u l a r d o c t o r
would do i n t h e o f f i c e , adding t o c o s t s . C e r t a i n l y access t o non-ER care i s
an i s s u e f o r some p a t i e n t s .
But I suspect t h e r e i s a l o t o f i n a p p r o p r i a t e
use
o f ER by people w i t h insurance t h a t would change i f they knew what t h e
c o s t d i f f e r e n c e s are and had t o pay f o r a p o r t i o n o f them.
( F o r example,
"convenience" o f ER; not wanting t o w a i t IE hours f o r an o f f i c e v i s i t f o r
problems t h a t can c l e a r l y w a i t t h i s l o n g . )
PRIMARY CARE US. SPECIALTY
The i s s u e here i s who people see f o r . i n i t i a l e v a l u a t i o n o f a problem.
S p e c i a l i s t s o f t e n charge ~ £ 150 f o r an i n i t i a l v i s i t vs. $ 40-50 f o r your
primary care d o c t o r t o e v a l u a t e t h e problem.
S p e c i a l i s t s a l s o tend t o do
more t e s t s ,
adding t o c o s t s . I f the p a t i e n t has more than one problem, t h e
s p e c i a l i s t u s u a l l y r e f e r s t h e p a t i e n t t o another
doctor
(often
another
s p e c i a l i s t 0 S 150) f o r t h e o t h e r problem whereas t h e primary care d o c t o r
may be a b l e t o handle a l l o f t h e problems a t one t i m e .
Qi. a H Q s t i c _ T e s t i ng.
.n.
L e t ' s use an example: A p a t i e n t sees a d o c t o r f o r a problem
(example:
headaches f o r one week). The d o c t o r t a l k s w i t h and examines t h e p a t i e n t and
concludes t h a t t h e r e i s a low l i k e l i h o o d ( < 1%) o f a s e r i o u s problem t h a t
c o u l d be diagnosed by a c e r t a i n t e s t (CT scan, ~ S500 o r MRI, ~ SI,000).
The
d o c t o r e x p l a i n s t h i s t o t h e p a t i e n t i n c l u d i n g suggestions f o r t r e a t m e n t
and t h a t i f t h e problem doesn't improve i n a s h o r t t i m e , then t h e t e s t w i l l
be done.
This i s how I t h i n k i t should be handled.
However, t o o f r e q u e n t l y the
t e s t gets done immediately.
The p u b l i c i s aware o f new fancy,
expensive
medical
technology
and wants e v e r y t h i n g done immediately ... e s p e c i a l l y
s i n c e someone e l s e i s going t o pay f o r i t .
( " I p a i d f o r my insurance
premium and I expect something i n r e t u r n . " )
In
a l l o f the above, we c o u l d make changes by mandating t h i n g s (ex:
must use a g e n e r i c , must use a n t i b i o t i c X f o r c o n d i t i o n Y, e t c . ) -- t h i s
would have n e g a t i v e consequences.
I t h i n k t h e b e t t e r way i s t o do what i t
takes t o be sure people ( p a t i e n t s and d o c t o r s ) know what the c o s t s a r e and
be r e s p o n s i b l e f o r a p o r t i o n o f them.
�J Antimicrot) Chemother, 26 suppl E^S, 1990; CE Cox et al, Drugs, 42 suppl 3:41, 1991). A
randomized trial in 30 patients with uncomplicated gonorrhea found either a single 200-mg
dose of cefpodoxime or a single injection of ceftriaxone (250 mg) 100% effective (L Bonwell et
al, Annu Meet Am Soc Microbiol, 90:17, 1990).
ADVERSE! EFFECTS — Diarrhea has been the most common adverse effect of cefpodoxime, occurring in 7% of patients. Pseudomembranous colitis, fatal in one patient, has been
reported. Nausea, vomiting, and vaginal candidiasis may occur. As with other cephalosporins, patients allergic to penicillin may have allergic reactions to cefpodoxime.
DOSAGE AND COST OF SOME ORAL ANTIMICROBIALS
Drug
Dosage
FOR PHARYNGITIS
Cefpodoxime proxstil - Vantin (Upjohn)
, Penicillin V - averfige generic price (range: $2.62 to $6.54)
' Pen Wee K (Wyeth Ayerst)
FOR LOWER RESPIRATORY INFECTIONS
^ A m o x i c i l l i n - average generic price (range: $3.95 to $21.50)
A m o x i l (SK Beecham) '
,,
. Amoxicillin-clavulaiic a c \ & ^ A u g m e n t i n (SK Beecham)
Cefaclor'- ;Cec/orf'(Lilly)
Cefpodoxime proxei.il - Vantin (Upjohn)
Cefprozil - Cefzil (Bristol) ,
Cefuroxime axetil -rjjCeftin (Allen & Hanburys)
Loracarbef - Lorabid (Lilly)
, Trimethoprim-sulfamethoxazole - average generic price
Bactrim DS (Roche) "
Septra DS (Burroughs Wellcome)
100 mg b.i.d. x 10 days
500 mg q.i.d. x 10 days
500 mg t.i.d. x 14 days
r
{
FOR URINARY TRACT INFECTIONS
Amoxicillin - average generic price (range: $1.46 to $5.59)
A m o x i l (SK Beecham)
Cefpodoxime proxetil - Vantin (Upjohn)
Ciprofloxacin - Cipro (Miles)
Trimethoprim-sulfamethoxazole - average generic price
Bactrim DS (Roche)
Septra DS (Burroughs Wellcome)
FOR SKIN AND SOFT TISSUE INFECTIONS
Amoxicillin-clavulanic acid - Augmentin (SK Beecham)
Cefpodoxime proxetil - Vantin (Upjohn)
Cephalexin - average generic price (range: $3.49 to $17.97)
Keflex (Dista)
Cephradine - average generic price (range: $8.39 to $18.28)
Velosef (Apothecon)
Dicloxacillin - average generic price (range: $8.05 to $14.67)
Dynapen (Apothecon)
Erythromycin - average generic price (range: $6.16 to $8.68)
ERYC (Parke-Davis)
FOR GONORRHEA
Cefixime - Suprax (Lederle)
Cefpodoxime proxetil - Vantin (Upjohn)
Ceftriaxone - Rocephin (Roche)
Ciprofloxacin - Cipro (Miles)
Enoxacin - Penetrex (Rhflne-Poulenc Rorer)
Ofloxacin - Floxin (Ortho.i
4
2
'500' m g t.i.d. x 14 days
500 mg t.i.d. x 14 days
200 mg b.i.d. x 14 days
400 mg b.i.d. x 14 days
500 mg b.i.d. x 14 days
400 mg b.i.d. x 14 days
1 DS tablet b.i.d. x 14 days
3
250 mg t.i.d. x 7 days
100 mg b.i.d. x 7 days
250 mg b.i.d. x 7 days
1 DS tablet b.i.d. x 7 days
3
1
Wholesale cost "
$ 31.75
.'.3.90
'9.20
.rii:74
16.97 •
.,•100.45
151.42 '
84.67
139.39
.151.26
169.40
' '6:21 " M f c ^
30.50 \
27.90
3.43
4.54
22.23
34.16
Ai
3.11 • £ V T
15.25 J
13.95
2
'250' m g t.i.d. x 7 days
400 mg b.i.d. x 7 days
500 mg b.i.d. x 7 days
500 mg b.i.d. x 7 days •
250 mg q.i.d. x 7 days
250 mg q.i.d. x 7 days
400 mg once
200 mg once
250 mg once IM
500 mg once
400 mg once
400 mg once
i i r o r J L
36.33
84.67
^.OOT, q t ^ C 32.26 X W W 13.33
21.82
10.74
26.31
7.13
10.11
5.42
3.02
10.24
2.82
2.60
3.36
4
1. Cost to the pharmacist,based on.Average Wholesale Price listings in Drug Topics Red Book 1992 and November Update.
2. Each '250' mg tablet contains 250 mg amoxicillin and 125 mg clavulanic acid; each '500' mg tablet contains 500 mg amoxicillin
and 125 mg clavulanic acid.
3. Each OS tablet contains 160 mg trimethoprim and 800 mg sulfamethoxazole.
4. Given by intramuscular injection; cost is to the pharmacist for 250 mg of powder for one injection.
CONCLUSION — Cefpodoxime is a broad-spectrum oral cephalosporin that offers no
clear advantage over previously available drugs for the treatment of any infection.
108
�'ftwith food increases the rate of absorption. Serum concentrations of the active metabolite
reach a peak in five hours after a single dose or in 2.5 hours at steady state. 6-MNA has a terminal half-life of about 24 hours and undergoes little enterohepatic recirculation (MA Brett et
al, .Drugs, 40 suppl 5:67, 1990); it is degraded in the liver to inactive metabolites, which are
excreted mainly in urine and bile. In the elderly and in patients with severe renal dysfunction,
the half-life of 6-MNA may be prolonged and plasma concentrations may increase (MJ Kendall et al, Eur J Clin Pharmacol, 36:299, 1989).
COST OF SOME NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
Usual dosage range
for rheumatoid arthritis
Drug
Diclofenac. - Voltaren (Geigy)
Diflunisal - Dololvd (MSD)
Etodolac** - Lodme (Wyeth Ayerst)
:
Fenoprofen - average generic price (range: $20.66 to $34.07)
Nalfon (Dista)
Flurbiprofen - Ansaid (Upjohn)
Ibuprofen* - averuge generic price (range: $4.77 to $20.74)
Motrin (Upjohn!
Rufen (Boots)
Indomethacin - average generic price (range: $3.27 to $33.17)
IndqcinAMSD)
extended-relea se - average generic price (range: $18.34 to $47.83)
Indocin SR (MSD)
Ketoprofen - Orudis (Wyeth-Ayerst)
Meclofenamate sodium - average generic price (range: $20.40 to $56.44)
Meclomen (Parku-Davis)
_
Nabumetone - Relafen (SmithKline Beecham)
Naproxen - Naprosyn (Syntex)
Naproxen sodium -• Anaprox (Syntex)
Piroxicam - average generic,price
Feldene (Pfizer)
Sulindac - average generic price (range: $25.85 to $62.34)
Clinoril (MSD)
Tolmetin - average generic price (range: $41.48 to $46.34)
Tolectin (McNeil)
Wholesale
cost*
150 to 200 mg/day in 2
to 4 doses
250 to 500 mg bid
600 to 1200 mg/day in 2
to 4 doses
300 to 600 mg tid-qid
$ 60.65
200 to 300 mg/day in 2
to 4 doses
, 600 to 800 mg tid-qid
1
25 to 50 mg tid
51.84
57.75
28.75
48.41
65.99
.•:.,:•••]
': ;
'"'
12.94
23.78 ' J <Vv420.14
lO-SS t\OiXli.
43.63
24.86
38.90
85.36
38.74
78.32
54.00
40.53
40.40
59.38
68.61
44.83
51.67
43.10
49.60
-1
• <
i
w/'l
•- *l
(
75 mg once/day or bid
50 to 75 mg tid-qid
200 to 400 mg/day
in 3 or 4 doses
1000 to 2000 mg/day
250 to 500 mg bid
275 mg or 550 mg bid
20 mg daily
150 to 200 mg bid
200 to 400 mg tid-qid
* Cost is to the pharmacist for 30 days' treatment w i t h the lowest usual dosage, based pn Average Wholesale Price listings in
Drug Topics Red Book 1992 and April.Update.
* * Only approved for treatment of osteoarthritis
.
t Also available without prescription in 200-mg tablets
CLINICAL TRIALS — In patients with osteoarthritis, double-blind trials have found that
1000 mg/day of nabumetone, aspirin 3600 mg/day, ibuprofen 1600 mg/day, indomethacin 75
to 150 mg/day, or naproxen 500 mg/day had similar therapeutic effects (DJ Appelrouth et al,
Am J Med, 83 suppl 4B:78, 1987; MF Shadforth and PR Crook, Roy Soc Med International
Congress and Symposium Series, 69:133, 1985; AG Wade and DM Fletcher, Roy Soc Med
International Congress and Symposium Series, 69:149, 1985; EJ Pisko et al, Am J Med, 83
suppl 4B:86, 1987). In patients with rheumatoid arthritis, double-blind trials found nabumetone 1000 mg/day as effective as aspirin 3600 mg/day, indomethacin 100 to 125 mg/day, or
naproxen 500 mg/day (GC Bernhard et al, Am J Med, 83 suppl 46:44, 1987; JA Wojtulewski,
Roy Soc Med International Congress and Symposium Series, 69:79, 1985; FB Vasey et al, Am
J Med, 83 suppl 48:55, 1987).
39
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�AMERICAN COLLEGE OF INTERNATIONAL PHYSICIANS
711 Second Street, N.E. • Suite 200 • Washington, D.C. 20002
(202) 544-7498
FAX: (202) 546-71If
March 2, 1993
Ms. Hillary Rodham Clinton
Health Care Reform Task Force
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear Ms. Clinton:
We are pleased to see you at the helm of the Health Care Task Force which has the
responsibility of tackling this very sensitive social and economical issue. A solution that is
fair, acceptable, and amicable to all should be implemented. Health care spending has
eroded our economy, decreased moral and social stamina. The health care issue is very
complex and its cancerous ramifications engulf all aspects of life. If not carefully crafted,
it may devour economic well-being and create a monster. We can run but we can not hide
from this important issue. Each and every citizen and the country as a whole has to take
responsibility. Every segment of the issue has to be considered. The government,
physicians, hospitals, insurance companies, industries, lawyers, judges, and even patients
must take responsibility to make this great country a better place to live. Whatever you
implement shall be felt for generations to come.
We would like to submit some of our ideas which are the products of practical
experiences. Perhaps you would like to incorporate some of these points in your health care
plan to the nation.
1)
Reform Physician Malpractice Insurance This will save billions of dollars per year, and allow physicians to be protected by the
government similar to those in the military and the Veteran's Affairs health system.
This way, if someone wants to sue doctors they must go through the federal
government. Issue stricter guidelines for the doctors by instituting peer review. This
will eliminate defensive medical practice which is now costing multiple billions of
dollars. These two factors alone will make a difference.
18th Annual Convention
July 8-11, 1993 • New Orleans Hilton Riverside • New Orleans, Louisiana
70140
�2)
Eliminate Medicaid Transfer the present Medicaid system to private insurance but have the premium
paid by the government. Medicaid recipients are humiliated, degraded, and looked
upon by society as a burden. By shifting the Administration to the private sector we
can control rising costs and provide quality health care similar to that received by
those with commercial insurance. The rising premium charged by the companies
should be regulated.
3)
Universal Health Coverage Guarantee coverage to those who can not buy insurance either due to inability to pay
or excessive premiums are above their means. Basic health coverage should be
available to all. At the present time, insurance companies are covering only the
healthy population. They deny coverage to those with existing illnesses, no matter
what the cost of the premium. To finance universal coverage we may institute a
health care tax across the board. Even welfare recipients must pay their share.
President Clinton's plan calling for pooling of resources may enable small companies
to provide coverage without going broke. Again the premium has to be capped and
regulated. No one should be denied basic health care regardless of their income or
condition of health. We must embrace the philosophy of "prevention is better than
the cure".
4)
A Real Look at Pharmaceutical and Medical Equipment Industries By business parameters of profitability-return on equity, assets and sales, the drug
companies have ranked at the top year after year. They have reported as high as 43
cents on every dollar while other Fortune 500 companies are reporting only 26 cents.
Prescription drugs are not affordable. Older people are hit the hardest and Medicare
does not cover the cost of their prescriptions. The drug and medical equipment
vendors must be regulated. They must be held responsible. An unreasonable profit
must be deprived. To circumvent the difficulties encountered by the drug companies,
FDA must be more efficient and liberal in approving new drugs. There are several
drugs produced by American companies which are marketed safely in other countries
but banned in this country. Eliminate the unnecessary obstacles. Also, let us
approve the new drugs as they come along. Anything health care related costs more.
A needle in the hardware store costs 5 cents, but if that is used in health care it costs
$5.
5)
The Physician Physicians should be held partially responsible for rising costs. Service of physicians
can not be reduced, but the payment can be controlled. A uniform payment system
must be implemented. There is unequal distribution of physicians and their payment.
The rural and remote area practitioner is paid less. This has discouraged physicians
to practice in those areas. Rural populations do not obtain high-tech care. Price
guidelines should be published. Over-burdening the independence of the physician
will be counterproductive. Over regulation, increased paper work and the low
�payment system has produced business minded doctors rather than medical doctors.
The nation's doctors are ready to sacrifice along with the rest of the nation.
Considering their many years of education and long hours of daily work the doctor
is not being compensated. At times, their charges are far less than a lawyer, CPA,
or even a plumber.
6.
Hospitalization Cost is Rising Faster than we can Imagine The hospital administrators are paid better than the average. In some areas they
match the pay of Fortune 500 companies executives. The equipment, supplies, and
upkeep is excessively expensive. After purchasing expensive drugs, equipments and
personnel, the hospitals try to make a profit which escalates the cost of the hospital
patients. To reduce the cost we must emphasize more outpatient treatment, home
care and doctors office visits. Since implementation of DRG the over-utilization of
the hospital beds have significantly decreased. There must be some price guidelines
and standards to follow by the hospitals. The rural hospitals are paid less for the
same treatment which has led to closure of badly needed small, rural hospitals. This
is a type of discrimination. If this trend is not reversed, implementation of universal
care will be futile.
7.
Lawyers and Judges Our lawyers are irresponsible. They try to make cases out of nothing. A long
litigation, agony, frustration, loss of time from work and expense has frustrated
people. Lawyers seem to work at the other end of physicians. There is an air of
discomfort between the two. If physicians are left alone for their common sense a
large number of tests and procedures will be reduced. They are at the mercy of
proof and arguments due to lawyers. A reform in the judicial system is very
important to implement an effective health care plan. There must be a cap in
awards.
8.
Insurance Companies To have a health coverage one has to dig deep in their pocket and premiums keep
going up. This is no man's land, where there are no regulations, and where no check
and balances exist. The insurance companies write their own rules. They deny
legitimate charges. A sole motivation is profit. There must be a uniform premium
compatible with the national economy. Liability coverage for physicians is exuberant.
It ranges from $5,000 up to $100,000. This figure is just for coverage, and year after
year the premium keeps going up. If they pay for one doctor's lawsuit, an increase
in premiums can be expected by all. Due to rising costs of premium, many doctors
have stopped delivering babies.
9.
Reimbursement System The Medicare and Medicaid payment system is in disarray. Massive paper work,
poor response, delayed payment, unnecessary proof of care, high rate of denial and
irresponsible bureaucracy has plagued the system. Already the payment is much
�lower than before, and how much more can we reduce it is a matter of great
question. We must reduce bureaucracy and eliminate excessive paper work.
10.
Patients The attitudes of the patients have to be changed. They demand more and better.
They demand costly tests and scans. The patients never ask the price, or who pays,
or even if they can afford it. These questions come only after the patient leaves the
hospital or doctor's clinic. Health care providers have to write off a large percentage
of charges. The patients are one of the greatest factors of rising cost. Basic care
should be a right and privilege but not the high tech and costly procedures which do
net improve quality or prolong the life. President Qmton's plan to vaccinate all
children is a starting point. Let us spend our money and time to protect and
preserve life.
11.
Stop Subsidy to Tobacco Companies Why are we nurturing the killer? We are trying to do and undo at the same time.
We are simply exhibiting our foolishness. Exposure to toxic substances to our
children has gone unnoticed. Polluted water and air, lead toxin, mercury poison,
unsafe exposure to radiation and several health hazards are not currently addressed
in the agenda of health care.
12.
Managed Competition The concept of managed competition has to be crafted carefully to provide an
affordable access to health care. We may be creating a system where certain
segments of society will be left at a disadvantage. We may be creating undue
competition where only good negotiators can succeed. Freedom of choice which is
every American's shall be forgotten and the patients shall be forced to go only to
designated doctors. For the sake of saving or cutting cost we shall be decreasing the
quality of life.
Your town meeting and reaching out to the people is very commendable. It may be
wise to convene a health summit to hear from various segments before you conclude
your proposal. Once you involve consumers and providers in the process it becomes
easy to sell them your idea.
We wish to extend our support to you and wish you much success in this noble
endeavor. Thank you.
Sincerely yours,
Jag Devkota, M.D., FACIP
President
�Health Care for
April 1, 1993
Ms. Carolyn Gatz
Health Care Reform Task Force
Old Executive Office Building
17th Street and Pennsylvania Avenue NW
Washington, DC 20500
Dear Carolyn:
Enclosed are the Fundamentals for Access to Health Care as we discussed the other
night. I've underlined in red the section that refers to a national health personnel
policy.
I hope this is helpful to you and your work with the Task Force. We are
distributing the document for suppon of the ideas from hundreds of individuals and
national organizations.
If I can be of further assistance please feel free to contact me or Jayne Brady of the
staff at (202)546-3507.
Sincerely,
Health Care for America Policy Institute
418 C Street. NE
Washington, DC 20002
FAX 202.546.2568
202.546.3507
Harvey I. Sloane, MD
President, Health Care for
America Policy Institute
�THE FUNDAMENTALS FOR ACCESS TO HEALTH CARE
In the national debate on health care reform, much attention has been given to cost
containment and universal coverage. However, the infrastructure and personnel policy
of the nation's health care system must be revamped in order to assure access to necessary
health care services for all Americans. A national health care reform bill must include these
fundamental reforms:
Health Care for
Universal coverage for all Americans under a health care system integrating
acute and long-term care.
A national emphasis on primary, preventive, public health and long-term care in the
health and mental health delivery systems.
•
Establishment of community health centers and migrant health centers in
federally designated underserved and other areas to assure adequate distribution of
health care providers.
•
Avenues to ensure consumer involvement and freedom of choice in order to
improve patient's role in the provision of health care services.
The adoption and enforcement, through financing, of a federal health personnel
policy. The policy would provide:
Primary care education for physicians and other health care professionals;
An appropriate mix of specialists-to-generalist physicians and other
providers of health care with adequate geograpmcaistnbution in
nasi
underserved areas;
Increased geriatric training of health care and nursing personnel to
provide primary care for a growing number of seniors;
Inclusion of the National Health Corps to encourage health personnel to
work in underserved areas. Additionally, the policy should direct and
financially support health professional schools, to attract and train inner city
and rural students into the field of health care;
Training of health personnel to work with culturally diverse populations.
Reimbursement formulas which provide a financial incentive for utilization of the
most cost effective health care professionals to practice in the field of primary care
Health Care for America Policy Institute
Federal funding for primary care research and medical outcomes studies to
examine health professional practice patterns and the establishment of practice
guidelines with the goal of improving quality, effectiveness, and patient's decisionmaking role, in the provision of health care.
418 C Street, NE
Washington, DC 20002
FAX 202.546.2568
202.546.3507
Establishment of health care networks that integrate academic medical and health
centers and/or community hospitals with community-based health centers and
community mental health services for the purposes of improved access to quality
patient care, provider training, and research and to promote continuity of care for
the patient.
*
The provision of support services such as transportation and language
translation services for the elderly, disabled, and ethnically diverse citizens,
especially those residing in underserved areas.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBIECmilLE
DATE
03/27/1993
Address (Partial) (1 page)
RESTRICTION
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Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [9]
2006-0885-F
jm779
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�B A R R Y J . L A N D A U , M . D.
P6/(b)(6)-"
TELEPHONE t Z O Z l
April
Mrs. H i l l a r y C l i n t o n
C h a i r , W h i t e House H e a l t h
Care Task Force
The Wh i t e House
16 00 P e n n s y l v a n i a Avenue,
W a s h i n g t o n , H.C. 20500
362-B625
27, 1993
N.W.
Dear- Mrs. C l i n t o n :
1 am a p r a c t i c i n g p s y c h i a t r i s t .
I treat adults, children,
a d o l e s c e n t s , and f a m i l i e s .
I t r e a t people w i t h a wide v a r i e t y of
menta 1 cond i t i ons.
As h e a l t h c a r e r e f o r m t a k e s p l a c e , 1 hope t h a t you w i l l t a k e
a s t r o n g p o s i t i o n i n f a v o r o f non - d i s c r i m i na t or y coverage f o r a l _ l
p e o p l e who s u f f e r w i t h mental i l l n e s s .
Legislation that
r e s t r i c t s e q u i t a b l e b e n e f i t s to " s e v e r e " i l l n e s s o n l y c r e a t e s
ma j o r problems o f d e c i d i n g what i s severe and what i s n o t . and i t
pushes the l i n e o f s t i g m a and h u m i l i a t i o n o n t o the p a t i e n t s whose
s u f f e r i n g i s deemed n o t s e r i o u s enough t o deserve t r e a t m e n t .
Such an a r t i f i c i a l d i s t i n c t i o n a l s o encourages p e o p l e t o postpone
needed c a r e u n t i l t h e symptoms become so extreme t h a t they no
l o n g e r can be t r e a t ed as out --pa t i e n t s b u t now r e q u i r e
hospitalization.
Th i s d e l a y i n o b t a i n i n g t r e a t m e n t r e s u l t s i n
g r e a t e r c o s t s because o f t h e much g r e a t e r c o s t o f i n - p a t i e n t
treatments.
I n a d d i t i o n , t h e d e t e r i o r a t i o n i n the p a t i e n t s
c o n d i t i o n t h a t o c c u r s d u r i n g the d e l a y i n o b t a i n i n g t r e a t m e n t may
render t h e p a t i e n t c a p a b l e o f b e n e f i t t i n g o n l y from s u p p o r t i v e
assistance.
Had the p a t i e n t s been seen e a r l i e r , the p r o g n o s i s
f o r o p t i m a l b e n e f i t , os p s y c h o t h e r a p e u t i c treatment' would have
been much bet t e r.
In a l l too many i n s t a n c e s , p a t i e n t s have i n a d e q u a t e h e a l t h
i n s u r a n c e , which c r e a t e s s e v e r e problems f o r t h o s e who r e q u i r e
t r e a t m e n t beyond t h e b r i e f e s t o f t h e r a p i e s .
I n a d d i t i o n , many
p a t i e n t s have had a g r e a t deal of d i f f i c u l t y w i t h managed care
f i r m s t h a t a r e so i n t r u s i v e i n t h e i r f r e q u e n t demands f o r
p e r s o n a l i n f o r m a t i o n t h a t some p a t i e n t s a r e unable t o go on w i t h
the t h e r a p y .
E x p e r i e n c e c l e a r l y i n d i c a t e s t h a t some managed care
f i r m s a r e u n w i l l i n g t o s u p p o r t i n - d e p t h t r e a t m e n t t h a t some
p a t i e n t s need i n o r d e r t o make s u b s t a n t i a l p r o g r e s s or even t o
m a i n t a i n e q u i l i b r i u m and remain f u n c t i o n a l o u t s i d e o f a h o s p i t a l .
I u n d e r s t a n d t h e need f o r r e s p o n s i b l e management o f
u t i l i z a t i o n o f s c a r c e r e s o u r c e s . However, i t . i s e x t r e m e l y
i m p o r t a n t t h a t any system o f managed care t h a t i s p a r t o f h e a l t h
�care r e f o r m should not d i s r u p t ongoing t h e r a p i s t - p a t i e n t
r e l a t i o n s h i p s , should be a p p r o p r i a t e l y designed so t h a t i t does
not damage the treatment t h a t i t i s supposed t o oversee, should
have a f a i r and i m p a r t i a l appeals mechanism, should have p r o v i d e r
i n p u t and a mechanism t o prevent harassment, should p r o v i d e
access t o i n t e n s i v e or long-term t r e a t m e n t where needed, should
safeguard c o n f i d e n t i a l i t y and p r i v a c y , and should have no
f i n a n c i a l i n c e n t i v e s t o reviewers t o deny care.
I t i s i m p o r t a n t t o r e a l i z e t h a t t h e r e i s now a c o n s i d e r a b l e
body o f data t h a t documents t h e e f f e c t i v e n e s s of
p s y c h o t h e r a p e u t i c t r e a t m e n t s . As w e l l as the small cost of o u t p a t i e n t p s y c h o t h e r a p e u t i c treatments [ i n c l u d i n g those t h a t a r e
" l o n g - t e r m " and i n t e n s i v e ] . These s t u d i e s document t h a t the cost
of these o u t - p a t i e n t p s y c h o t h e r a p e u t i c t r e a t m e n t s i s small
r e l a t i v e t o both t h e cost of p a t i e n t ' s mental i l l n e s s w i t h o u t
t r e a t m e n t and/or w i t h inadequate t r e a t m e n t . The cost of these
o u t - p a t i e n t p s y c h o t h e r a p e u t i c t r e a t m e n t s i s a l s o small r e l a t i v e
t o h e a l t h care e x p e n d i t u r e s i n g e n e r a l . The cost of these
t r e a t m e n t s i s a l s o s t a b l e and p r e d i c t a b l e , and i s s i g n i f i c a n t l y
o f f - s e t by decreased need f o r e x p e n d i t u r e s on o t h e r forms o f
medical t r e a t m e n t s , e.g. f o r p h y s i c a l i l l n e s s e s .
I w i l l be happy
t o supply you w i t h t h e data t h a t documents t h e above p o i n t s , i f
such data i s not a l r e a d y a v a i l a b l e t o you.
The new h e a l t h care system must a l l o w p a t i e n t s t o c o n t r a c t
f o r care over and above basic s e r v i c e s w i t h o u t i n t e r f e r e n c e , a t
t h e i r own expense or w i t h supplemental insurance. Freedom of
choice o f p h y s i c i a n or t h e r a p i s t must be preserved.
I t i s i m p o r t a n t t o r e a l i z e t h a t many hours o f my
p r o f e s s i o n a l time [and t h e time of o t h e r s i n the p r o f e s s i o n s of
p s y c h i a t r y , psychology, p s y c h o a n a l y s i s , and s o c i a l work] are
devoted t o seeing p a t i e n t s a t a reduced fee (when t h i s i s needed)
and t o t e a c h i n g j u n i o r members o f t h e p r o f e s s i o n and t r a i n e e s i n
many i n s t a n c e s w i t h o u t any charge. I f l i m i t s were t o be place on
fees f o r psychotherapy and psychoanalysis t h a t were a t a l l
comparable t o t h e l i m i t s c u r r e n t l y i n e x i s t e n c e f o r medicare f e e ,
i t would be i m p o s s i b l e t o c o n t i n u e t o p r o v i d e reduced f e e
t r e a t m e n t and f r e e e d u c a t i o n a l s e r v i c e s .
F u r t h e r , the e f f e c t
fields like psychiatry,
psychoanalysis would be
the f o l l o w i n g number of
on r e c r u i t i n g i n d i v i d u a l s t o careers i n
c h i l d p s y c h i a t r y , psychology, and
c h i l l i n g . C u r r e n t l y these f i e l d s r e q u i r e
years of t r a i n i n g a f t e r c o l l e g e :
p s y c h i a t r y (medical s c h o o l , k + Residency k) = 8;
c h i l d p s y c h i a t r y (medical s c h o o l , k + Residency 5) = 9;
�p s y c h o a n a l y s i s (medical s c h o o l , U + Residency k +
p s y c h o a n a l y t i c t r a i n i n g 5-8 (average) = 13-16.
C o n s i d e r i n g t h e s a c r i f i c e o f time and money t o enter these
p r o f e s s i o n s , i t i s abundantly c l e a r t h a t laws t h a t l i m i t fees t o
u n r e a l i s t i c a 1 1 y low amounts [such as those c u r r e n t l y mandated by
Medicare laws] would very q u i c k l y t h i n t h e ranks o f people who
could a f f o r d t o enter these p r o f e s s i o n s .
/
As t h e n a t i o n proceeds w i t h t h e massive task o f health-^Qare
/reform, I hope t h a t you w i l l consider me t o be a resource i n
understanding issues t h a t have t o do w i t h mental i l l n e s s as w e l l
as h e a l t h care i n g e n e r a l . I hope I may a t some time have t h e
p l e a s u r e o f meeting w i t h you and your s t a f f , and I wish you w e l l
S i n c e r e l y j ^ o u r s ,,
i n c e r e l y j^ours
\
B a r r y (/f. L a n d a u , M . D .
�HEALTH CARE TASK FORCE SORTING SHEET
. INPUT DATE:
GENERAL SORT:
POSTCiVRD 1
:
Personal stories
General mail
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POSTCiVRD 2:
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IJETTER:
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POLICY AND PERSONA!, STORIES:
^ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
^COVERAGE (II)
working families
^unemployed/low income
benefits
providers
^ I N F R A S T R U C T U R E / W O R K F O R C E (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
^GOVERNMENT PROGRAMS (TV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
FINANCING (VII)
MENTAL H E A L T H (DO
L O N G - T E R M C A R E (X)
.PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
rural
urban
OTHER
�american society of internal medicine
February 11, 1993
Pres/denJ
RICHARD D. RUPPERT. MD
Toledo, Ohio
President-Elect
YANK D. COBLE Jr.. MD
Jacksonville, Florida
Secretary-Treasurer
KATHLEEN M. WEAVER, MD
Portland, Oregon
Immediate Past President
EUGENE S OGROD II, MD
Sacramento, California
TRUSTEES
LOUIS H. DIAMOND, MD
Washington, D.C.
WILLIAM E. GOLDEN. MD
Little Rock, Arkansas
CYRIL M. HETSKO, MD
Madison, Wisconsin
E. RODNEY HORNBAKE III. MD
Pittsford, New York
ISABEL V. HOVERMAN. MD
Austin. Texas
J. STEPHEN KROGER, MD
Longmont, Colorado
J LEONARD LICHTENFELD. MD
Baltimore. Maryland
BERNARD M. ROSOF. MD
Huntington, New York
RONALD L. RUECKER. MD
Decatur. Illinois
M. BOYD SHOOK. MD
Oklahoma City, Oklahoma
LAURENCE D. WELLIKSON, MD
Orange. California
Executive Vice President
ALAN R. NELSON. MD
Thirty-seventh Annual Meeting
Washington, D.C.
October 13-17. 1993
REPRESENTING
Internists and
All Subspecialists
of Internal Medicine
Bruce Reed
Deputy Asst. to the President for Domestic Policy
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Mr. Reed:
The American Society of Internal Medicine (ASIM) urges you to support enactment of
comprehensive health reform legislation that includes:
1. Proposals to rebuild primary care. Without action to reverse the decline in primary care,
reform will fail to assure access or control costs. Next month, ASIM will release a paper that
explains what must be done, expanding upon our 12-point legislative blueprint to rebuild
primary care that was sent to Congress in December.
2. Expanded coverage through employer-mandated insurance.
3. Market-based incentives to control costs, rather than expenditure ceilings and direct
price controls. ASIM has reviewed the Managed Competition Act of 1992, introduced last
session by Rep. Jim Cooper. Although we agree with much of the Cooper bill, ASIM has
developed its own detailed recommendations (enclosed) on market-based reform. To
summarize, ASIM supports:
• A cap on the deductibility of employer and employee contributions to health
Insurance, with the cap set at a level that promotes competition, but that does
not drive all but the wealthy into the cheapest plans.
• Health care purchasing cooperatives and standards for accountable health
plans (AHPs). Individuals should be able to choose from AHPs that include
network plans (such as staff model HMOs) and plans that offer free choice of
physician.
• Standards to assure that utilization review requirements imposed by AHPs do
not result In "mlcromanaglng" of physicians.
• Provisions to assure that physicians can compete on a level playing field with
hospitals and insurers, including no restrictions on the number of AHPs with
which physicians may contract.
We look forward to working with Congress and President Clinton on enactment of
comprehensive reform legislation that incorporates these elements.
Sincerely,
Alan R. Nelson, MD
Eixecutive Vice President
2011 PENNSYLVANIA AVENUE, NW • SUITE 800 • WASHINGTON, DC 20006-1808
TELEPHONE (202) 835-2746 • FAX (202) 835-0443
�AMERICAN SOCIETY OF INTERNAL MEDICINE
STATEMENT OF PRINCIPLES
ON
MANAGED COMPETITION
BACKGROUND
Health care reform has taken center stage with the new Clinton administration. A major reason for
the increased attention given to this issue is the recognition that spiralling health care costs are a
significant factor in the growing federal budget deficit. The importance with which President
Clinton regards health care reform was demonstrated in his emphatic statements about the need
to curb increasing health care costs at the economic summit in December and in his appointment
of Hillary Ftodham Clinton to coordinate and chair a White House Task Force charged with
bringing together all the players in health care reform to hammer out a proposal by mid-year for
introduction to Congress.
The basic approach to reform that has attracted the attention of the President and his advisors is
called "managed competition." Generally speaking, managed competition is intended to
encourage employer participation in managed care plans, to improve the ability of health care
plans to manage the total health of enrollees in the most cost-effective way and to encourage
competition between health care plans by requiring the plans to report full information about
prices and outcomes of treatments.
POSITION OF THE AMERICAN SOCIETY OF INTERNAL MEDICINE
The American Society of Internal Medicine, representing 25,000 primary care physicians in internal
medicine and internal medicine subspecialties, was among the first physician organizations to call
for comprehensive reform of the U. S. health care system. In 1990, ASIM proposed its own
comprehensive health care reform plan and included within that plan recommendations for cost
control and financing expanded access to health care. Much of ASIM's reform plan is echoed in
managed competition proposals. The following principles identify those areas of managed
competition which are in agreement with ASIM's overall policies on health care reform and offer
additional recommendations to assure that all health care providers, patients and payers are
afforded a level playing field under the new system.
Requirements for Accountable Health Plans
•
ASIM supports a pluralistic system of health insurance. Such a system allows
individuals and employers to choose from a wide variety of health insurance and
delivery options, including insurance that allows unrestricted choice of physician
(indemnity insurance), network plans (such as preferred provider organizations and
health maintenance organizations) and other managed care plans.
�ASIM supports the concept of requiring health insurance plans to meet certain
defined standards to qualify as an accountable health plan (AHPV These
standards would have to be met in order for contributions to the purchase of such
plans to be tax deductible under the federal tax code.
ASIM strongly believes that all sectors of the health care delivery svstemphysicians. hospitals, health insurers, and others-should participate in the
development of the standards for AHPs and be able to organize plans that could
qualify as an AHP. It is essential that these sectors participate with equal standing.
Anti-trust and other legal or regulatory restrictions that make it more difficult for
individual physicians to work together collectively to organize an AHP should be
modified to allow the full participation of the medical profession in the development
of AHPs. ASIM objects to any proposal that gives an implicit or explicit preference
to hospital or insurance-sponsored plans over those organized by physicians.
ASIM strongly believes that indemnity plans, as well as network and other
managed care plans, should be eligible for certification as an AHP. and that no
particular type of accountable health plan should be given preferential tax
treatment over another type of accountable health plan. The requirements to be
certified as an AHP should be consistent with the objective of allowing free and
informed choice among a variety of different health insurance options, rather than
limiting choice to only a certain type of plan.
There should be no restrictions on the number of AHPs with which a physician
may contract, subject to each plan's needs and its contractual requirements for
participation. This is essential to ensure continuity of care and to protect patients'
right to select their own physician.
ASIM urges that federally-mandated utilization review guidelines or conditions of
participation for AHPs be required. Such guidelines should include reasonable
standards on what kind of utilization review is permissible, to specify due process
rights, including appropriate appeals, for physicians and patients whose treatments
are denied by plans and to provide uniform requirements for UR so that physicians
with patients belonging to three different plans don't have to deal with three
different sets of review requirements. Private sector accreditation of AHPs should
be allowed as an alternative to federal certification of their utilization review and
due process procedures, provided that such accreditation programs have
standards that are equal to or greater than, the federal standards.
ASIM believes that AHPs should be required to pay physicians under a fee
schedule based on a nationally established resource based relative value scale.
Conversation factors used by AHPs should be based on local market forecast not
the Medicare conversation factor. Furthermore, AHP's that pay on a capitation or
salaried basis should establish payments to physicians at a level that takes into
account the resource costs of providing services to enrollees and is consistent with
the incentives created by the RBRVS.
�•
ASIM's proposal for paving physicians. "Competitive Pricing, Informed Choices", is
ideally suited for incorporation into a managed competition system. Under this
proposal:
* Non-network AHPs paying on an indemnity basis would be
required to use the RBRVS;
* These AHPs would establish an annual conversion factor to
apply to the RBRVS;
* Physicians who see patients enrolled in indemnity AHPs would
also be required to establish their own annual conversion factor;
* The AHP and physician conversion factors would be
disseminated to purchasers and enrollees to allow informed choice
of physician and to promote competition among physicians on the
fees charged for their sen/ices.
Insurance Purchasing Cooperatives
•
ASIM supports the concept of requiring small businesses and individuals to buy
insurance through a health insurance purchasing cooperative (HIPC). which would
be responsible for offering to enrollees a choice of all qualified accountable health
plans and each plan's price, quality and enrollee satisfaction data. This will assure
that small businesses and individuals attain the same market power enjoyed by
large employers.
Access to Care
•
ASIM supports retention of an expanded/reformed Medicaid program or some
federal public health program to assure that low income individuals have access to
care. Individuals eligible for the public program could be given the option of
enrolling in the public program or receiving federal subsidies to purchase coverage
through an AHP.
•
ASIM believes all employers should provide employees with health insurance
coverage and the most effective way to ensure that employers meet this obligation
is to mandate such coverage. Therefore, all employers should be required to offer
employees the opportunity to obtain health insurance through an AHP, with the
employer contributing a substantial proportion of the premium cost of the plan
selected by the employee.
•
ASIM reaffirms its support for maintaining Medicare as a separate program.
Benefits
•
ASIM supports the creation of a federally-defined set of basic health and medical
benefits to be offered by AHPs. Such a benefits package would have to promote
primary and preventive care, contain no preexisting condition exclusions, and
prohibit experience rating of premiums based on health condition of the insured.
�•
ASIM supports expanded Medicare coverage for preventive and screening
services,
National Health Care Board
•
ASIM supports creation of a national health care board with the following role and
responsibilities:
(1) establish and update the standard health benefits package,
define requirements for reporting prices, outcomes and patient
satisfaction as outlined in ASIM's policy on physician profiling;
(2) develop risk adjustment factors for AHP premiums and provide
information on AHP quality for distribution to consumers;
(3) convene negotiations with physician representatives on
expenditure goals and a conversion factor for the approved RBRVS
to be used in setting payments for the public plan, as outlined in
ASIM's alternative to all-payer rate setting, "Competitive Pricing,
Informed Choices".
•
Physicians should be prominently represented in any board or other administrative
entity that is responsible for developing standards for certification as an AHP.
Cost Containment
•
ASIM supports a cap on the tax deductibility of employer and employee
contributions for health insurance expenses. Any contributions in excess of that
limit would be taxable income to the employee or individual.
•
ASIM believes that the cap should not be set at the cost of the lowest priced
health plan. Rather, the cap should be set at a level that strikes the appropriate
balance between encouraging individuals and employers to purchase less costly
plans and maintaining a viable market for plans that offer more benefits, better
service or provide enrollees greater freedom of choice in selecting their own
physician.
•
ASIM supports establishment of uniform copavments and deductibles for all AHPs except
those based on an indemnity model. To enable indemnity insurance plans to compete
under managed competition, higher copayments and deductibles could be charged by
such plans so that patients who desire greater choice of physician and other benefits of
such insurance would assume higher levels of cost-sharing as a consequence.
•
To reduce administrative costs. ASIM supports national adoption of the following
administrative reforms:
* a uniform claim form and a standardized format for electronic
claims;
* a national, centralized data source which is electronically
accessible to verify patient insurance eligibility and benefits
coverage information;
�* a "smart card" or other technology as an efficient means to aid in
the transmission of claims;
* positive incentives to move physicians to electronic claims
processing.
•
To ensure that health care services and resources are appropriately provided.
ASIM supports profiling and feedback under a system of managed competition
under the followinc) conditions: there is sufficient physician involvement in the
davelopment of outcomes and performance data; the data is properly severity
adjusted; physicians have an appropriate opportunity to review and comment on
their profiles; and the profiling system is first conducted on a pilot test basis.
•
ASIM supports reforming the medical liability system to eliminate incentives for
unnecessary utilization of services. Such reforms include limiting awards for noneconomic damages, eliminating punitive damages, reforming the collateral source
rule (i.e., eliminating double payments to patients for certain items) and allowing
ptiriodic payments for future damages and structured settlements.
•
ASIM supports efforts to control costs by introducing incentives for cost effective
care, including managed competition, and remains opposed to imposition of a
mandatory ceiling on health care expenditures. Managed competition and other
market-based reforms should be permitted to demonstrate the ability to control
costs before a decision to impose a budget or cap on health care expenditures.
•
ASIM supports adoption of expenditure goals, as distinct from ceilings, for any
public program, as negotiated bv the national health care board and health care
community. ASIM further supports advisory, not mandatory expenditure goals, as
distinct from ceilings, for privately-financed AHPs. If expenditure goals or targets
for AHPs are required, such goals should be applied through changes in the fixed
payments per enrollee to the AHPs, rather than being linked directly to payments
to physicians and hospitals. In addition, if expenditure goals or targets are
required for AHPs, efforts to reach such goals should not include imposition of
provider taxes.
Financing
•
ASIM supports a financing plan as proposed for the Managed Competition Act
including eliminating the cap on income subject to the Medicare Health Insurance
tax and funding the National Health Board bv a small annual fee per enrolled
member in AHPs if coupled with ASIM's own financing proposals.
* ASIM current policy calls for financing health care reform as
follows:
• ASIM supports placing a reasonable limit on the amount of health insurance
premiums paid by an employer that can be deducted as a business expense and
that is tax free income to the employee.
�• ASIM supports increases in federal excise taxes on alcohol and tobacco to
finance health care for the uninsured.
• ASIM supports the use of budget savings achieved in other federal programs to
help finance expanded access to care.
• ASIM believes that the existing funds available in the health care system today
can be used more efficiently to eliminate unnecessary medical sen/ices and
excessive administrative costs.
• If other savings and revenue sources are insufficient, direct increases in the
personal income tax and payroll tax may be necessary to fund access to care fully
for all Americans.
Implementation
ASIM strongly encourages the adoption of a phase-in period for implementation,
and any necessary corrections, of a managed competition system of health care
delivery. This must take into account the appropriate steps needed to certify
health plans, organize purchasing cooperatives, evaluate release of outcomes data
and provider profiles, and establish the other elements of the plan.
�CODER:
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
OENERAL ^RT:
POSTCARE» 1:
Personal stories
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Other Health Providers
POSTCARD 2:
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.Offers to help/Employment
FORM LETFER:
Letterhead
REROUTE:
Casework
.Physicians
Policy
.Scheduling
President
Other
POLICY AND PERSON AT, STORIES:
\ / ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
^ COVERAGE (II)
working families
unemployed/low income
.benefits
.providers
^/INFRASTRUCTURE/WORKFORCE (HI)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
.veterans
_DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
FINANCING (VII)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
_AIDS
women's health
immunizations/children
rural
urban
OTHER
�Michael A- Newman, M.D., F.A.C.P.
J ^ y j ^ f
^ y - j ^ ^ C
2021 K SIRIIET N.W., SUITE 404. WASHINGTON, D.C. 20006 • TEL 1202) 466-8118 • FAX (202) 466-2408
�MICHAEL A. NEWMAN, M.D., F.A.C.P.
HEALTH CARE REFORM
REFLECTIONS OF A PHYSICIAN I N PRACTICE
Among t h e reasons t o c e l e b r a t e t h e v i c t o r y o f B i l l C l i n t o n
t h e r e i s t h i s one:
A t l a s t t h e r e i s a n a t i o n a l consensus t o make
major changes i n our h e a l t h care system.
an accomplishment.
I n and o f i t s e l f , t h i s i s
An enormous o b s t a c l e has been overcome and a
great opportunity i s available.
This
new consensus
p r e s s i n q needs:
business
exists
against
a background
o f other
Government's need t o reduce t h e d e f i c i t and t h e
community's need t o reduce c o s t s , i n c r e a s e
productivity
and enhance p r o f i t a b i l i t y .
This
o p p o r t u n i t y f o r change
precipitous action.
should
n o t be squandered by
We need t o a v o i d a " h e a l t h care Bay o f P i g s . "
J u s t as p h y s i c i a n s a r e c h a l l e n g e d t o do m e d i c a l l y o n l y what i s o f
demonstrable b e n e f i t , and j u s t as new t h e r a p i e s and t e c h n o l o g i e s
are s u b j e c t t o r i g o r o u s standards
should a p p l y t o p r o p o s a l s
o f review,
insurance
rating.
actuarial
approach
f o r h e a l t h care r e f o r m .
ACCESS should be our h i g h e s t p r i o r i t y :
t h e system.
a similar
g e t t i n g people
into
An immediate way t o improve access i s t o i n s i s t
that
be based
on community
The idea o f insurance
profile
rating
r a t h e r than
experience
i s t h a t c o s t s be r e l a t e d
t o the
o f t h e community, n o t t o t h e experience o f
i n d i v i d u a l s o r s m a l l groups.
Community r a t i n g i s i n c l u s i v e .
2021 K Street N.W., Suite 404, Washington, D.C. 20006
•
Tel (202) 466-8 I 18 •
Fnx (202) 466-2408
�experience
rating
i s e x c l u s i v e , leads
to profit
skinuning and
c r e a t e s c o s t d i f f e r e n t i a l s t h a t r e s u l t i n economic d i s c r i m i n a t i o n
a g a i n s t s e l f employed persons and s m a l l
businesses.
Employers w i t h 50 employees o r l e s s would r e c e i v e a t a x c r e d i t
based on t h e c o s t o f o f f e r i n g a mandated b a s i c b e n e f i t package t o
employees.
insurance
Persons w i t h o u t access t o o r unable
should,
according
to their
means,
t o afford health
be s u b s i d i z e d t o
purchase t h e same mandated b a s i c b e n e f i t package.
A l l applicants
would be e l i g i b l e f o r t h e b a s i c b e n e f i t coverage and t h i s coverage
would re'main t r a n s f e r a b l e , renewable and non-cancelable
because o f
i l l n e s s o r e x i s t i n g medical c o n d i t i o n s .
COST CONTAINMENT would be based on reforms and i n c e n t i v e s f o r
every component o f t h e d e l i v e r y system as o u t l i n e d below.
INSURANCE c a r r i e r s have l i t t l e i n c e n t i v e t o be e f f i c i e n t b u t
t h e y have every i n c e n t i v e t o reduce o r deny b e n e f i t s , d e l a y payment
and
n o t be h e l p f u l .
arbitrary
as w e l l
Where
they
as more c o s t l y .
have
market
During
share
they are
t h e 80's, i n s u r a n c e
c a r r i e r s , e s p e c i a l l y Medicare and Medicaid c a r r i e r s , i n c r e a s e d t h e
"hassle f a c t o r " f o r p a t i e n t s and p r o v i d e r s . O v e r s i g h t o f i n s u r a n c e
carrier
management p r a c t i c e s and c o s t s
should
be mandated.
A
u n i f o r m c l a i m form, p a t i e n t i n f o r m a t i o n cards and e l e c t r o n i c c l a i m s
submission p r o c e s s i n g would reduce b o t h " h a s s l e " and a d m i n i s t r a t i v e
costs.
�HOSPITALS need t o cooperate and c o o r d i n a t e s e r v i c e s i n s t e a d o f
competing t o d u p l i c a t e s e r v i c e s .
W i t h i n a community, h o s p i t a l s
would be a c c r e d i t e d o r l i c e n s e d as c e n t e r s
and
excellence.
Each h o s p i t a l need
secondary o r t e r t i a r y
Federal
services.
Trade Commission
would
of selected
not provide
expertise
comprehensive
The Department o f J u s t i c e and
take
a favorable
view
o f these
efforts.
PHYSICIANS need
t o charge
r e i m b u r s e d on a g l o b a l b a s i s .
permitted.
facility
less
f o r procedures
and t o be
Unbundling o f s e r v i c e s would n o t be
C u r r e n t l y a procedure f e e , a p r o f e s s i o n a l f e e and a
f e e a r e a l l reimbursed.
Patient r e f e r r a l t o f a c i l i t i e s
where t h e r e f e r r i n g p h y s i c i a n i s an i n v e s t o r o r o t h e r w i s e
benefits
f i n a n c i a l l y would n o t be p e r m i t t e d except i n d e s i g n a t e d areas.
QUALITY h e a l t h
outcomes
care.
need
are
i s cost
effective.
t o be m o n i t o r e d a g a i n s t
Variations
country
care
i n frequency,
extraordinary
endoscopy, r a d i a t i o n t h e r a p y ,
what we p r o v i d e .
Both process and
established
outcomes
standards of
and c o s t
f o r surgery,
oncology,
around t h e
imaging,
e t c . We need t o l o o k c r i t i c a l l y a t
A good outcome w i t h r e s p e c t t o m o r b i d i t y and f o r
m o r t a l i t y i s not s u f f i c i e n t .
done a p p r o p r i a t e ?
The key q u e s t i o n
i s , was what was
A h o s p i t a l may do a l a r g e volume o f c a r d i a c
c a t h e t e r i z a t i o n s and c o r o n a r y bypass g r a f t s u r g e r y w i t h e x c e l l e n t
morbidity
and
mortality
procedures should
outcomes
b u t what
have been done a t a l l ?
percent
of
these
Standards s h o u l d be
�established
nationally
adjustments
and
hospitals
and
physicians,
with
f o r comparable mixes o f p a t i e n t s s h o u l d be p r o f i l e d
a g a i n s t these s t a n d a r d s .
TECHNOLOGY overwhelms us. The c h a l l e n g e o f t e c h n o l o g y i s t o
enable
cost;
us t o do something
i t i s not just
better, or with
t o do something
less r i s k o r a t less
differently.
Medicine i s
r e p l e t e w i t h b a l l y h o o e d " t e c h n o l o g i c advances" t h a t have f a l l e n by
the
wayside.
atherectomy,
imaging)
Much
o f what
cholesterol
should
we do today
therapy,
be done
more
fertility
selectively,
(e.g. a n g i o p l a s t y ,
therapy,
endoscopy,
i f at a l l .
To
a p p r o p r i a t e l y proceed a p p r o p r i a t e l y w i t h a procedure o r t e s t , t h e
i n f o r m a t i o n o b t a i n e d s h o u l d f a v o r a b l y a f f e c t t h e management o f t h e
p a t i e n t so t h a t t h e r i s k s and c o s t s o f t h e t e s t are j u s t i f i e d .
technology
should
be l i c e n s e d a f t e r
F.D.A. and a d v i s o r y panels o f e x p e r t s .
appropriate review
New
by t h e
Reimbursement would depend
on such r e v i e w and a p p r o v a l .
PATIENTS need t o be b e t t e r educated about a p p r o p r i a t e m e d i c a l
c a r e , t h e u t i l i z a t i o n o f medical s e r v i c e s and p r e v e n t i o n .
who
engage i n h i g h r i s k
behavior,
i . e . smoking, drunk
etc.,
s h o u l d pay a premium.
(i.e.
20%) f o r e l e c t i v e h e a l t h care such as f e r t i l i t y
Persons
driving,
P a t i e n t s should bear a reasonable c o s t
treatments
and v i s i t s t o h o s p i t a l emergency rooms f o r non-emergencies.
REGULATIONS should be s u b j e c t t o an "economic impact"
b e f o r e b e i n g promulgated.
review
I n t h e 90's, h o s p i t a l s and p h y s i c i a n s
�have been overwhelmed w i t h r e g u l a t i o n s f o r OSHA, CLIA, D i s a b i l i t y
A c t , and Medicare t h a t have i n c r e a s e d c o s t s and " h a s s l e " o f h e a l t h
care.
MAlliPRACTICE c o s t s
costs.
are a s i g n i f i c a n t
factor
i n health
care
Premiums account f o r 1% and s t u d i e s suggest t h a t " d e f e n s i v e
medicine"
costs
expenditures.
"defensive
may
be
as
much as
15%
of t o t a l
health
care
H e a l t h care reforms must address t h e f a c t o r s behind
medicine."
Reforms a r e necessary
d i s c i p l i n a r y a c t i o n , t o dissuade
t o permit
timely
f r i v o l o u s s u i t s and t o e s t a b l i s h
n o - f a u l t insurance f o r vaccines, e t c .
MEDICATION c o s t s have i n c r e a s e d more t h a n any o t h e r s e c t o r o f
h e a l t h care c o s t s .
costs,
Patent p r o t e c t i o n should depend on t h e "R & D"
t h e degree o f drug
Patients
should
have
p r e s c r i b e t h e lowest
a
n o v e l t y , and
"copayment"
the p o t e n t i a l
t o pressure
c o s t a p p r o p r i a t e drug.
market.
physicians
The F e d e r a l
to
Trade
Commission should r e g u l a t e a d v e r t i s i n g t o t h e p u b l i c i n t e n d e d t o
c r e a t e demand f o r p r e s c r i b e d m e d i c a t i o n s .
PREVENTIVE
package.
services
should
be
mandated
i n every
benefit
S e r v i c e s i n c l u d e d would be b i r t h c o n t r o l , sex e d u c a t i o n ,
p r e - and p o s t n a t a l c a r e , w e l l baby c a r e , i m m u n i z a t i o n s , p e r i o d i c
s c r e e n i n g and e x a m i n a t i o n .
G u i d e l i n e s c o u l d be q u i c k l y e s t a b l i s h e d
as t h e r e i s near consensus on these m a t t e r s .
More funds need t o be
a v a i l a b l e f o r r e s e a r c h i n t o t h e cause and p r e v e n t i o n o f d i s e a s e s .
�SMOKING i s t h e most p r e v e n t a b l e f a c t o r c a u s i n g d i s e a s e and
related
health
productivity.
care
costs,
as
well
costs
of
lost
industry.
CHANGE w i l l have s e i s m i c e f f e c t s .
physicians w i l l
complain
the
Anyone f a v o r i n g h e a l t h care r e f o r m must oppose any
s u p p o r t f o r t h e tobacco
close,
as
rail
H o s p i t a l s and c l i n i c s
at interference,
t h e y a r e underserved,
communities
and Congress w i l l
l o b b i e d by v a r i o u s i n t e r e s t groups.
be
will
will
intensely
To moderate these c o n f l i c t s ,
a group such as t h e Commission on S o c i a l S e c u r i t y o f 1934 o r t h e
b i p a r t i s a n M i l i t a r y Base Review Board s h o u l d be e s t a b l i s h e d .
t h i s process o f change, consensus w i l l remain t h e c r i t i c a l
i n a c h i e v i n g t h e necessary r e f o r m s .
In
factor
�HEALTH CARE TASK FORCE SORTING SHEET
CODER
U 10
03
INPUT DATE:
GENERAL SORT:
POSTCARD 1:
General mail
Personal stories
.Letter Campaign
Other Health Providers
POSTCARD 2:
Offers to help/Employment
/
FORM LETTER:
REROUTE:
.Letterhead
Casework
Policy
\ J Physicians
.Scheduling
President
Other
POLICY AND PERSONAL STORIES:
.ORGANIZATION (I)
.insurance premiums
.insurance reform
.insurance pools
.beards and oversight
.COVERAGE (H)
working families
on employed/low income
benefits
providers
.INFRASTRUCTURE/WORKFORCE (IH)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
[COST ISSUES (VI)
—drug prices
^jmysician fees
hospital fees
medical equipment
f-^fraud & abuse
(
FINANCING (VII)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
AIDS
women's health
immunizations/children
rural
urban
OTHER
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Physician Letters] [loose] [9]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-006-005-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/12f846dd25d993505ee36137206ca927.pdf
46c9c5a57f71c4176846176836adbfe9
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edel stein
Subseries:
OA/ID Number:
2385
Folder ID:
Folder Title:
[Physician Letters] [loose] [8]
Stack:
Row:
Section:
Shelf:
Position:
S
56
3
4
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. letter
Address (Partial); Personal (Partial) (7 pages)
03/25/1993
P6/b(6)
002. letter
Address (Partial); Phone No. (Partial) (1 page)
04/21/1993
P6/b(6)
003. envelope
Address (1 page)
03/02/1993
P6/b(6)
004. letter
Address (Partial) (1 page)
03/10/1993
P6/b(6)
005a. letter
Phone No. (Partial) (1 page)
02/11/1993
P6/b(6)
005b. resume
Address (Partial); Phone No. (Partial); POB (Partial); DOB (Partial);
SSN (Partial) (I page)
n.d.
P6/b(6)
03/30/1993
P6/b(6)
03/30/1993
P6/b(6)
006a. envelope
006b. envelope
Address (1 page)
Address (1 page)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [8]
2006-0885-F
im778
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. S52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA)
b(3) Release would violate a Federal statute |(b)(3) of the FOIA|
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information 1(b)(4) of the FOIA)
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personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
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b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the F 0 1 A |
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Release would violate a Feder;»l statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
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P6 Release would constitute a c l e i r l y unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 9, 1993
F i r s t Lady H i l l a r y R. C l i n t o n
Pennsylvania Ave.
Washington, D.C. 20500
Dear H i l l a r y ,
I supported your husband from the very s t a r t of the primary
race and throughout the campaign.
I sensed a s i n c e r i t y and true
human concern about him and about you.
As a physicain and a human being I'm very concerned about the
heeilth of our n a t i o n .
curative medicine.
Preventive medicine i s , of course, b e t t e r than
But while we should be stressing good health h a b i t s ,
we do need a system that i s f a i r to the health providers and to the
health receivers. Any system that creates tension i s wrong! Managed
competition sounds l i k e an anxiety producing system that w i l l tax the
nerves of the physicians and r e s u l t i n poor p a t i e n t care.
The emphysis
w i l l be the scramble f o r the d o l l a r rather than concern f o r the p a t i e n t .
Having a global payment to the h o s p i t a l which w i l l then decide how to
d i s t r i b u t e the income to anesthesiologists, pathologists and r a d i o l o gisits, i s a system of stress that no one wins.
uation.
I t ' s a lose-lose s i t -
Older h o s p i t a l based physicians w i l l r e t i r e .
w i l l avoid these s p e c i a l t i e s .
Younger physicians
••
•
The most relaxed stress free system i s a system of n a t i o n a l health
care which covers everyone and eliminates.'all insurance companies and a
great deal of bureaucracy.
employees.
A l l physicians should become government
Their salaries should be determined by the years they have
to spend i n t h e i r t r a i n i n g and t h e i r years of c l i n i c a l
experience.
Just l i k e the people i n government employment now, they should receive
a pension when they r e t i r e .
This w i l l eliminate the d o l l a r o r i e n t a t i o n and permit physicians
to concentrate on t h e i r p a t i e n t s welfare.
There are other costs that d r i v e up health care.
I t is totally
unnecessary f o r h o s p i t a l s close to one another to 'duplicate c o s t l y
equipment.
MRI's etc. cost a great deal and are o f t e n poorly u t i l i z e d .
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3/ f
�Ne:w
drugs are o f t e n used t h a t are very c o s t l y i n p r e f e r e n c e t o
cheaper o l d e r drugs i n the mistaken b e l i e f t h a t they are b e t t e r .
' As; an A n e s t h e s i o l o g i s t I see t h i s happening o f t e n .
Drug c o s t s should be s c r u t i n i z e d and i f necessary clipped.
Equipment c o s t s should a l s o be looked i n t o .
Why
a n e s t h e s i a machine be $35,000 now when i t was
5 years ago?
The
should a
hew
so much cheaper
s t r e s s should be c o o p e r a t i o n not c o m p e t i t i o n .
Competition creates s t r e s s .
C o o p e r a t i o n makes us a l l f e e l good.
Please c o n s i d e r my a d v i s e .
I t ' s g i v e n from t h e . h e a r t w i t h
a g r e a t d e a l of p r a y e r .
Sincerely,
Ben
Sheiner,
M.D.
�FOOTHILLS FAMILY MEDICINE ASSOCIATES
Anderson Memorial Hospital/Anderson Family Practice Center
F e b r u a r y 4, 199;
Ms. H i l l a r y Rodham C l i n t o n
C h a i r p e r s o n , Task F o r c e on H e a l t h
The W h i t e House
W a s h i n g t o n , DC £0500
Care Reform
Dear Ms. Rodham C l i n t o n :
I h a v e n e v e r w r i t t e n t o a F i r s t Lady b e f o r e b u t I am w r i t i n g t o you
a b o u t t h e t a s k f o r c e on h s a l t h c a r e r e f o r m . I am u n a b l e t o l a a v e work
t o w a t c h t e l e p h o n e c a l l - i n shows o r e l e c t r o n i c t o w n h a l l m e e t i n g s so a
l e t t e r i s t h e o n l y way I hrave o f r e a c h i n g y o u p e r s o n a l l y , a s s u m i n g
t h i s l e t t e r e v e r r e a c h e s y o u r desk.
I am w r i t i n g t o s h a r e some o f my
c o n c e r n s a b o u t t h e h e a l t h c a r e s y s t e m and t h e n t o e x t e n d an i n v i t a t i o n
t o you.
I am a b o a r d c e r t i f i e d f a m i l y p h y s i c i a n i i f \ r u r a i l i o u t h C a r o l i n a . I am
a l s o a w i f e and t h e m o t h e r o f a t w o y e a r cTOfe^ja^So n o t make $200,000 a
y e a r o r e v e n one t h i r d o f t h a t amount.
I am g l a d l y payincj back
s e v e r a l s t u d e n t l o a n s and e x p e c t t o be d o i n g so f o r t h e n e x t 5-10
years.
I d i d n o t c h o o s e . rned i c i ne ais.rny c a r e e r because o f f i n a n c i a l
g a i n , b u t b e c a u s e I c o n s i d e r e d i t . a' ca i 1 i ng 1'" I l o v e my 'work,; f i n d i n g
i t extrejrne-ly i n t e r e s t i n g , c h a l l e n g i n g and furu"
However, 1 d6~have"'
some c o n c e r n s I w o u l d l i k e t o s h a r e w i t h y o u .
F i r s t , I am n o t s u r e i f you a r e aware o f t h e f a c t t h a t as a new
p h y s i c i a n i n my f i r s t f i v e y e a r s o f p r a c t i c e , I o n l y make e i g h t y p e r c e n t o f what M e d i c a r e pays o l d e r p h y s i c i a n s . I f i n d t h i s as s e r i o u s
a f o r m o f d i s c r i m i n a t i o n as t h a t p r a c t i c e d t o w a r d s w o r k i n g women i n
r e g a r d s t o t h e pay s c a l e d i f f e r e n c e .
I t i s d e f i n i t e l y n o t an
i n c e n t i v e t o go i n t o a f i e l d s u c h as p r i m a r y c a r e where one sees a
v e r y h i g h p e r c e n t a g e o f M e d i c a r e p a t i e n t s e s p e c i a l l y when one i s j u s t
s t a r t i n g o u t and h a s h i g h o v e r h e a d c o s t s .
S e c o n d l y , I am c o n c e r n e d a b o u t t h e s p e c i a l t y o f f a m i l y p r a c t i c e as a
whole.
E v e r y o n e seems t o a g r e e t h a t we need more p r i m a r y c a r e
p h y s i c i a n s but instead o f changing t h e p u b l i c ' s p e r c e p t i o n o f f a m i l y
p h y s i c i a n s o r somehow m a k i n g p r i m a r y c a r e more a t t r a c t i v e , some p e o p l e
a r e t a l k i n g a b o u t j u s t r e p l a c i n g us w i t h p h y s i c i a n ' s a s s i s t a n t s o r
nurse p r a c t i t loners.
I f i n d t h i s a l a r m i n g i n t h a t i t means t h a t I am
e i t h e r o v e r t r a i n e d f o r what I do o r t h e y ' r e g o i n g t o be a l l o w e d t o do
i t . i n s p i t e o f being u n d e r t r a i n e d .
F i n a l l y , I am v e r y c o n c e r n e d , a b o u t t h e . CX i n i c a l L a b o r a t ' o r y Improvement
Pet of' 1938. I t h i n k t h a t t h i s s t a r t ed o u t ' as a. v e r y . f i n e p i e c e o f
l e g i s l a t i o n r e g a r d i n g r e g u l a t i o n ' o f t h e l a r g e ."'pap smear mi i Is"'* w h i c h
were m i s r e a d i n g a p p r o x i m a t e l y 35 p e r c e n t o f t h e i r pap''smears.
Th i s
c l e a r l y c o n s t i t u t e d a major' h e a l t h r i s k f o r p a t i e n t s . However, when
t h e y e x t e n d e d t h i s l e g i s l a t i o n t o i n v o l v e e v e r y s i n g l e l a b t e s t done
i n an i n d i v i d u a l d o c t o r ' s o f f i c e , i t has become a b u r e a u c r a t . i c
nightmare.
Many o l d e r p h y s i c i a n s I know a r e s i m p l y s h u t t i n g t h e i r
16 Roberts Boulevard, Williamston, South Carolina 29697
Telephone: (803) 847-7323
�l a b s down c o m p l e t e l y . Most o f t h e t e s t s t h a t t h e y d i d i n t h e i r l a b s
were s i m p l e enough t o be done by a h i g h s c h o o l s t u d e n t . I n f a c t , h i g h
s c h o o l s t u d e n t s l e a r n t o do gram s t a i n s i n b a s i c b i o l o g y c l a s s e s .
U n f o r t u n a t e l y , t h i s means t h a t p a t i e n t s must d r i v e £0-30 m i n u t e s t o
t h e n e a r e s t h o s p i t a l o r l a r g e r l a b f a c i l i t y and t h e n pay $41.00 f o r a
CBC when t h e i r p h y s i c i a n o n l y c h a r g e s them $10.00. How can t h i s be
cost e f f e c t i v e ?
I n a n o t h e r i n s t a n c e , many d o c t o r s a r e now t r e a t i n g
any v a g i n a l d i s c h a r g e w i t h t w o o r t h r e e d i f f e r e n t m e d i c a t i o n s because
t h e y a r e u n a b l e t o do wet p r e p s t o c l e a r l y i d e n t i f y w h e t h e r t h i s i s a
yeast i n f e c t i o n , trichomonas or perhaps a n o n s p e c i f i c v a g i n i t i s , a l l
o f which are t r e a t e d w i t h d i f f e r e n t medications.
I am aware t h a t t h e r e a r e bad d o c t o r s , .just as t h e r e a r e bad l a w y e r s ,
n u r s e s , e n g i n e e r s and g o v e r n m e n t a l e m p l o y e e s . I d o n ' t t h i n k i t ' s f a i r
t o t r e a t us as c h i l d r e n and c o n s i d e r us a l l money-hungry,
i r r e s p o n s i b l e , d i s h o n e s t p r a c t i t i o n e t ^ s . — . - ^ e ^ i c i n e may be a b u s i n e s s ,
but i t i s _ _ a l s o , on t h e human l e v e l , f a n a r t ^ " ) My f r e e d o m t o p r a c t i c e my
a r t a t i t ' ^ h i g h e s t l-ej^eji^^s qu i ck 1 y ^ b e i - n g ^ r o d e d —
by u n n e c e s s a r y
c e n s o r s h i p , b u r e a u c r a t i c hassTesT" and l a c k o f u n d e r s t a n d i n g .
T h e r e f o r e , I w o u l d l i k e t o e x t e n d an i n v i t a t i o n t o you t o come and
spend a week i n my o f f i c e a c t u a l l y s e e i n g what I do on t h e g r a s s r o o t s
l e v e l . I djjpuld l i k e ^OLT"^'©^ meet my p r e g n a n t t e e j ^ ^ e i ^ j s i h ^ ^ n t t o keep
t h e i r babielsp""!??^^
p a t i e n t who"~*i*§~n-ow^-«n.
pregnant""""again w i t h h e r t h i r d c h i l d and r e f u s e s t o t e l l h e r sex
p a r t n e r s t h a t she i s HIV p o s i t i v e , and t h e c o u n t l e s s number o f
p a t i e n t s t h a t I see whose h e a l t h i s d i s a s t r o u s l y a f f e c t e d by t o b a c c o
use.
I w o u l d l i k e you t o meet t h e few p e o p l e who t r u l y need
d i s a b i l i t y and a r e h a v i n g a h a r d t i m e g e t t i n g i t and t h e many p e o p l e
who a r e a b l e t o w o r k b u t h a v e g o t t e n d i s a b i l i t y . P l e a s e l i s t e n t o t h e v
p e o p l e who a r e on t h e f r o n t l i n e o f p r i m a r y c a r e as you make t h i s v e r y
d i f f i c u l t d e c i s i o n on h e a l t h c a r e r e f o r m .
The a n s w e r s a r e n o t t o be
found i n t h e i v o r y t o w e r s o f academic m e d i c i n e o r j i n t h e business
o f f i c e s o f HCFfi o r t h e D e p a r t m e n t o f Human H e a l t K ^ ^ ^ S e . r v i c e s
—
t.hese d e p a r t m e n t s a r e 5COO__f^'-^jiEK€^v^€^
d o n ' t have
a i T - t t v e - ^ s w m z s ^ ^ ^ - ^ ^ v e ' ' ' m y j o b and h a t e t o see my r e l a t i o n s h i p
w i t h my p a t i e n t s become one o f p a p e r w o r k and f r u s t r a t i o n .
Thank you
v e r y much f o r y o u r t i m e and c o n s i d e r a t i o n .
>
Sincerely,
T e r r i H. T e l T e ,
MVD.
F o o t h i l l s Family Medicine
THT/rp
�Thomas M. Dean, M.D.
JERAULD COUNTY CLINIC
BOX 489
WESSINGTON SPRINGS, SD 57382
DIPLOMATE AMERICAN BOARD OF FAMILY PRACTICE
PHONE (605) 539-1778
F i r s t Lady H i l l a r y Rodham C l i n t o n , Chair
P r e s i d e n t ' s Task Force on N a t i o n a l
H e a l t h Care Reform
The White House
Washington, DC
20510
Dear Mrs. C l i n t o n :
As one who i s e x t r e m e l y pleased t o see h e a l t h care r e f o r m r e c e i v e t h e
a t t e n t i o n i t deserves, I am w r i t i n g t o express my encouragement and
best wishes f o r success i n t h e very d i f f i c u l t t a s k which l i e s ahead.
I am a f a m i l y p r a c t i t i o n e r who has p r a c t i c e d i n a town o f 1100 i n a
m e d i c a l l y underserved area on t h e Dakota p r a i r i e s f o r t h e l a s t 14
years.
I work w i t h a nurse m i d w i f e and two p h y s i c i a n s a s s i s t a n t s i n a
s m a l l , f e d e r a l l y a s s i s t e d Community H e a l t h Center.
Over t h e p a s t s e v e r a l years t h e problems o f our h e a l t h care system
have been a cause o f i n c r e a s i n g concern f o r me, both as a r u r a l
p h y s i c i a n and as a board member and subsequently as p r e s i d e n t o f t h e
N a t i o n a l Rural H e a l t h A s s o c i a t i o n . A f t e r many d i s c u s s i o n s and
c o n s i d e r a b l e r e f l e c t i o n , I would l i k e t o t a k e t h e l i b e r t y o f passing
on a few o b s e r v a t i o n s and t h o u g h t s which may be o f h e l p i n t h e
d e l i b e r a t i o n s you f a c e .
To begin w i t h t h e obvious:
The fundamental o v e r r i d i n g i s s u e has t o be
COST CONTAINMENT. Without e f f e c t i v e c o n t r o l o f c o s t s , a l l t h e o t h e r
goals o f r e f o r m a r e c l e a r l y o u t o f reach.
For a m u l t i t u d e o f reasons, we have evolved a very expensive s t y l e o f
d e l i v e r i n g h e a l t h c a r e . Some o f t h e c e n t r a l elements o f t h a t s t y l e
are:
1) A f e e - f o r - s e r v i c e system o f reimbursement f o r p r o v i d e r s which
p r o v i d e s an i n c e n t i v e f o r i n c r e a s e d u t i l i z a t i o n o f procedures and
an i n c r e a s e i n t h e i n t e n s i t y o f s e r v i c e s p r o v i d e d . This i s
aggravated by a d i s t o r t e d f e e s t r u c t u r e which g r e a t l y
over-reimburses f o r i n v a s i v e procedures as opposed t o p r i m a r y care
and p r e v e n t i v e s e r v i c e s .
�H i l l a r y Rodham C l i n t o n
March 3, 1993
page 2
2) A s p e c i a l t y - o r i e n t e d , fragmented system which a l l t o o o f t e n
leads t o a breakdown i n b o t h communication and t r u s t between
p a t i e n t s and p h y s i c i a n s , a l o s s o f c o o r d i n a t i o n o f c a r e , and
f r e q u e n t d u p l i c a t i o n o f s e r v i c e s because no one i s r e a l l y keeping
t r a c k o f what has been done b e f o r e , e t c . S u b s t a n t i a l resources
c o u l d be saved i f we c o u l d develop a system which e f f i c i e n t l y
u t i l i z e d s p e c i a l t y evaluations, discouraged d u p l i c a t i o n o f
s e r v i c e s , and made sure t h a t p a t i e n t h i s t o r i e s were c o m p l e t e l y
e v a l u a t e d b e f o r e a d d i t i o n a l i n v e s t i g a t i o n s , e t c . were c a r r i e d o u t .
3) A m a l p r a c t i c e system which leads t o d e f e n s i v e medicine and
i n c r e a s e d f e a r and c y n i c i s m on t h e p a r t o f p h y s i c i a n s .
The most
profound c o s t o f t h e m a l p r a c t i c e c l i m a t e i s n o t t h e d o l l a r s t h a t
are expended b u t r a t h e r t h e fundamental change i n a t t i t u d e i t has
produced among p h y s i c i a n s .
I n c r e a s i n g l y they have become c y n i c a l
and detached, and a r e l e s s and l e s s w i l l i n g t o go o u t on a limb
f o r p a t i e n t s whom they have o f t e n come t o view as p o t e n t i a l
adversaries.
REAL REFORM CANNOT OCCUR UNLESS THE MEDICAL
PROFESSION IS ENGAGED AND SUPPORTIVE.
4) An e n t r e p r e n e u r i a l t e c h n o l o g y development system which e x e r t s
tremendous p r e s s u r e f o r d i s t r i b u t i o n and u t i l i z a t i o n o f new
d e v i c e s , e t c . , r e g a r d l e s s o f t h e m e r i t they may o r may n o t have
been proven t o have.
5) A "more i s b e t t e r " a t t i t u d e on t h e p a r t o f t h e p u b l i c which has
o f t e n made i t d i f f i c u l t f o r p h y s i c i a n s t o p r a c t i c e a c o n s e r v a t i v e
s t y l e o f medicine. I f they a t t e m p t t o r e s t r i c t use o f t e c h n o l o g y ,
e t c . , t h e y a r e f r e q u e n t l y viewed as e i t h e r being o u t o f t o u c h o r
not w i l l i n g t o t a k e t h e i r p a t i e n t s ' concerns s e r i o u s l y . They a r e
t h e r e f o r e a t r i s k o f l o s i n g t h e p a t i e n t s t o more "concerned"
physicians.
6) Tax subsidy f o r i n s u r a n c e b e n e f i t s which encourages people t o
t a k e a g r e a t e r p o r t i o n o f t h e i r e a r n i n g s as f r i n g e b e n e f i t s and
encourages them t o u t i l i z e t h a t i n s u r a n c e coverage.
I f e e l s t r o n g l y t h a t i f we a r e t o change t h e h e a l t h c a r e u t i l i z a t i o n
p a t t e r n s o f our system, I T IS ESSENTIAL THAT WE CHANGE THE ENVIRONMENT
IN WHICH MOST CLINICAL DECISIONS ARE MADE. Over t h e l a s t decade
" c o m p e t i t i o n " w i t h a t t e n d a n t " m a r k e t i n g " and concern about t h e "bottom
l i n e " have deeply changed t h e way medicine i s p r a c t i c e d .
Profit
i n c e n t i v e s which may be p e r f e c t l y a p p r o p r i a t e i n a business
environment ( " l e t t h e buyer beware") a r e , I b e l i e v e , l a r g e l y
inappropriate i n the caring professions.
Nonetheless, they have come
t o p l a y an i n c r e a s i n g l y p o w e r f u l r o l e i n t h e p r a c t i c e o f m e d i c i n e .
T h i s p r o f i t focus has been d i s t r a c t i n g a t best and a t w o r s t has
r e s u l t e d i n p r o f o u n d c o n f l i c t s o f i n t e r e s t such as s e l f - r e f e r r a l ,
o v e r - u t i l i z a t i o n o f procedures, e t c .
�H i l l a r y Rodham C l i n t o n
March 3, 1993
page 3
I f we are t o develop a system which uses resources e f f i c i e n t l y and
which e f f e c t i v e l y responds t o t h e needs of a l l p a t i e n t s , i t i s
e s s e n t i a l t h a t we r e a d j u s t t h e f o r c e s a t p l a y each t i m e a p h y s i c i a n
decides t o o r d e r a t e s t , recommend an o p e r a t i o n , e t c . C u r r e n t l y i n
these day-to-day d e c i s i o n s , where v a s t amounts of resources are
consumed, t h e i n c e n t i v e s 1) i n terms of p a t i e n t e x p e c t a t i o n s , 2) i n
terms of p h y s i c i a n s ' p e r c e p t i o n s of t h e i r peers' e x p e c t a t i o n s , and 3)
i n terms of p h y s i c i a n f i n a n c i a l g a i n are a l l i n t h e d i r e c t i o n of u s i n g
more expensive and i n v a s i v e approaches. U n t i l we change t h a t
environment and those i n c e n t i v e s , i t w i l l be very d i f f i c u l t t o get a
handle on c o s t s .
To change t h e c u r r e n t environment we must:
1) Educate both p h y s i c i a n s and t h e p u b l i c w i t h r e g a r d t o t h e
e f f e c t i v e n e s s and rewards o f a more c o n s e r v a t i v e approach t o
medical t r e a t m e n t .
2) Obtain more o b j e c t i v e assessment of t h e a c t u a l c o n t r i b u t i o n s of
each form of technology both b e f o r e i t s i n t r o d u c t i o n and as i t i s
applied.
3) E l i m i n a t e a l l p h y s i c i a n f i n a n c i a l i n c e n t i v e s which encourage
i n c r e a s e d u t i l i z a t i o n of procedures.
This would i n c l u d e moving
away from a pure f e e - f o r - s e r v i c e system toward s a l a r i e d and
c a p i t a t i o n based arrangements.
4) Recognize as a s o c i e t y t h a t not a l l medical i n t e r v e n t i o n s are
equal i n terms of t h e b e n e f i t they p r o v i d e . We must determine a
way t o i n s u r e t h a t those i n t e r v e n t i o n s w i t h t h e l a r g e s t p a y o f f are
those t h a t we support f i r s t .
The i s s u e of r a t i o n i n g must be
c o n f r o n t e d d i r e c t l y and we must acknowledge t h a t we always have
and always w i l l r a t i o n care - t h e i s s u e i s t h e mechanism by which
we do so.
As we move t o improve t h e p r a c t i c e environment, IT IS ESSENTIAL THAT
WE FOCUS ON INCENTIVES RATHER THAN BY FURTHER REGULATION. During t h e
l a s t decade, a deluge of o f t e n a r b i t r a r y r e g u l a t i o n s has produced
h o s t i l i t y on t h e p a r t of t h e p r o f e s s i o n and an i n c r e a s i n g m o t i v a t i o n
t o "game t h e system". Some r e g u l a t i o n i s i n e v i t a b l e , but i n an
u n d e r t a k i n g such as medicine where most of t h e d e c i s i o n s are not
c l e a r c u t and where t h e e x e r c i s e o f judgment i s e s s e n t i a l , i t i s simply
not p o s s i b l e t o w r i t e r e g u l a t i o n s which c o n s i s t e n t l y and a p p r o p r i a t e l y
c o n t r o l those d e c i s i o n s . I n s t e a d , excessive r e g u l a t i o n i n c r e a s e s
c o s t s and dampens t h e c r e a t i v i t y and i n d i v i d u a l i n i t i a t i v e necessary
for high q u a l i t y , i n d i v i d u a l i z e d p a t i e n t - c e n t e r e d care.
�H i l l a r y Rodham C l i n t o n
March 3, 1993
page 4
I have watched w i t h sadness and i n c r e a s i n g f r u s t r a t i o n as t h e
c r e d i b i l i t y o f medicine as a c a r i n g p r o f e s s i o n has d e c l i n e d a t t h e
same t i m e t h a t our a b i l i t y t o i n t e r v e n e e f f e c t i v e l y f o r t h e b e n e f i t o f
our p a t i e n t s has r i s e n . P h y s i c i a n incomes have r i s e n , b u t t h e i r
s a t i s f a c t i o n and committment t o t h e p r o f e s s i o n have d e c l i n e d . I f we
are t o r e v e r s e these d i s t u r b i n g t r e n d s , we must r e v i s e t h e system t o
a l l o w h e a l t h care p r o v i d e r s t o make p r o f e s s i o n a l d e c i s i o n s which are
i n t h e best i n t e r e s t s o f t h e i r p a t i e n t s w i t h o u t t h e f i n a n c i a l and
r e g u l a t o r y d i s t r a c t i o n s which have i n c r e a s i n g l y confused and
o b s t r u c t e d good p r o f e s s i o n a l judgment.
My e x p e r i e n c e i n a s e t t i n g o f v e r y l i m i t e d resources has a l l o w e d me t o
view these problems from a p e r s p e c t i v e d i f f e r e n t from t h a t o f many o f
my c o l l e a g u e s .
From t h a t v i e w p o i n t , I am convinced t h a t t h e r e a r e
major excesses w i t h i n our system. I n my community we have l e s s access
t o t h e d i a g n o s t i c and t r e a t m e n t techniques which a r e standard i n many
areas and t h e r e f o r e we use them l e s s . Nonetheless, I am convinced
t h a t our outcomes a r e e q u a l l y good.
F i n a l l y , I would l i k e t o extend an i n v i t a t i o n t o you t o v i s i t our
community as you attempt t o become f a m i l i a r w i t h t h e wide range o f
problems and s o l u t i o n s we have i n t h i s c o u n t r y . Ours i s a s m a l l ,
somewhat i s o l a t e d , a g r i c u l t u r a l - b a s e d community where we have been
a b l e t o develop a c l i n i c , h o s p i t a l , n u r s i n g home, and congregate
l i v i n g f a c i l i t y f o r t h e e l d e r l y a l l on a s i n g l e campus. Through
c o o p e r a t i o n and s h a r i n g o f resources we have been able t o m a i n t a i n
good access t o a s u b s t a n t i a l range o f s e r v i c e s a t a reasonable c o s t .
These i n s t i t u t i o n s have remained f i n a n c i a l l y s t a b l e even though we a r e
i n a low income area w i t h a l a r g e p r o p o r t i o n o f e l d e r l y and u n i n s u r e d
p a t i e n t s . We would be d e l i g h t e d t o show them o f f .
Thanks f o r your a t t e n t i o n .
I wish you w e l l i n your endeavors and
would Jae happy t o o f f e r any f u r t h e r a s s i s t a n c e t h a t might be h e l p f u l .
: r e l y yoArs, X.
Thomas M. Dean, MD
TMD/j k
cc
�Claire DeCristofaro, M.D.
TN Lie. 014685
'
Louis DeCristofaro, PA-C
TN Reg. 009
DeCRISTOFARO MEDICAL OFFK
1903 Maple Street •
Post Office Box 780 •
White Piry^ Tennessee 37890/
White Pine (615) 674-6601
TO:
HILLARV RODHAM CLINTON, DIRECTOR
TASK FORCE ON NATIONAL HEALTH CARE REFORM
WHITE HOUSE
WASHINGTON,
D.C.
2/23/93
20510
DEAR MS.
CLINTON,
CONGRATULATIONS ON VOUR APPOINTMENT.
ALTHOUGH I AM A CARD-CARRVING
"CLINTON SUPPORTER" IT IS SOMETIMES DIFFICULT TO CONVINCE THE OTHER
PHVSICIANS
IN MV LOCAL MEDICAL COMMUNITY THAT CHANGE IS
NECESSARY.
I AM A(%U&A)_,
^OCOFAMILV
P^ySICIAN Ni.EMAlrE') WHO MOVED FROM NEW V0RK CITV
10 YEARS AGO T0^S£R11£_A_^MLL
TOWN WITHOUT A DOCTOR.
MV HUSBAND,
A PHYSICIAN
ASSISTANT,
IS THE OTHER PROFESSIONAL MEMBER OF OUR PRACTICE.
I WOULD LIKE TO KEEP ON LIVING AND WORKING HERE, BUT SOME ASPECTS
OF HEALTH-CARE REFORM MAY "LEAVE OUT" THE SOLO, RURAL
PRACTITIONER
WHO IS NOT AFFILIATED
WITH OTHER DOCTORS OR GROUPS.
IF
AT ALL POSSIBLE,
COULD YOU ADDRESS
THE FOLLOWING POLICY
ISSUES:
1.
IN A RURAL AREA, 20 MILES FROM OUR COUNTY HOSPITAL AND 60 MILES
FROM THE CLOSEST TERTIARY CARE HOSPITAL,
I NEED TO REFER TO
SPECIALISTS
FAR FROM HOME WITH GREAT REGULARITY.
WILL I BE
PENALIZED FOR REFERRING PATIENTS FREQUENTLY (I HAVE NO CHOICE)?
2.
IF ADMISSION TO THE HOSPITAL IS NECESSARY,
OFTEN THIS MUST BE DONE
BY REFERRAL TO A SPECIALIST,
60 MILES AWAY, WITHOUT MY ACTUAL
INVOLVEMENT IN THE SUBSEQUENT HOSPITAL CARE.
AGAIN, WILL THERE
BE PENALTIES
ATTACHED TO THIS DUE TO MY GEOGRAPHIC SEPARATION
FROM THE CORRECT LEVEL OF SPECIALTY
CARE?
3.
WILL I BE FORCED TO CREATE FORMAL BUSINESS ASSOCIATIONS
WITH
OTHER DOCTORS SIMPLY TO COMPETE IN THE MANAGED CARE ENVIRONMENT,
OR WILL THERE BE A MECHANISM TO PARTICIPATE
AS A SOLO
PRACTI0NER?
4.
WILL BOTH PATIENTS
AND DOCTORS BE ABLE TO ENTER AND LEAVE THE
DOCTOR/PATIENT
RELATIONSHIP
AT WILL (SOME REASONABLE
TIME-FRAME
TO SWITCH DOCTORSj ?
DOCTOR/PATIENT
THIS WILL BE VERY NECESSARY SHOULD A
RELATIONSHIP
BECOME ADVERSE OR OTHERWISE
UNTENABLE.
ALL IN ALL, I WISH YOU LUCK.
PLEASE,
PLEASE CONSIDER THAT MUCH OF THE
POPULATION LIVES IN RURAL AREAS, WITH SOLO PRACTITIONERS,
WHO MUST
NECESSARILY
HAVE DIFFERENT PRACTICE PATTERNS AND REQUIREMENTS.
IF THERE
IS ANY WAY I CAN CONTINUE TO INPUT THE REFORM POLICY,
PLEASE LET ME KNOW.
I APPRECIATE
YOUR TIME AND
YOURS,
CLAIRE
DECRISTOFARO,
MD
CONSIDERATION.
�P S Y C H I A T R I C A S S O C I A T E S , P.C.
Richard Evan J a c k s o n , M.D.
J a m e s T. Gillespie J r . , M.D.
Vijay Jethanandani, M.D.
£ a l Bldg
207 Blount P[
7920
Knoxvill£<Tennesse
(615) 5^6-1244
269 Cusick Road Suite A-2
McGhee Tyson Plaza
Alcoa, T N 37701
(615) 982-3249
RjYCHIATRIC
ASSOCIATES
February 24, 1993
Ms. H i l l a r y Rodham C l i n t o n
P r e s i d e n t ' s Task Force on N a t i o n a l H e a l t h Care Reform
The White House
1600 Pennsylvania Avenue
Washington, D.C.
20501
Dear Ms. C I i n t o n ,
My purpose i n w r i t i n g i s t o encourage you t o support i n c l u s i o n of
mental h e a l t h b e n e f i t s
in___tli£—ftew—"tomprehens i ve " Ubdl Lhprogram. ~ B u l f 1 r s t l e t m e i n t r o d u c e myself. For the past f o u r
years I have been i n p r i v a t e p r a c t i c e i n a general h o s p i t a l i n
Knoxville.
We see a l a r g e number of i n d i g e n t p a t i e n t s , working
poor, as w e l l as insured working c i t i z e n s . For t h e p r e v i o u s f o u r
years I was a t P l a t e a u Mental H e a l t h Center based i n C o o k e v i l l e ,
Tennessee.
I was t h e d e s i g n a t e d p s y c h i a t r i s t f o r a l l of Smith
County and went t o Carthage, Tennessee on a r e g u l a r b a s i s .
I
b e l i e v e t h a t I have a p r e t t y good p e r s p e c t i v e on t h e range of
p s y c h i a t r i c d e l i v e r y and problems f o r t h e middle and lower c l a s s e s .
-
As you know, p s y c h i a t r y and p a t i e n t s w i t h p s y c h i a t r i c problems have
been o v e r t l y and c o v e r t l y d i s c r i m i n a t e d a g a i n s t by t h e h e a l t h - c a r e
system. I t h i n k t h i s i s very s h o r t - s i g h t e d .
There w i l l always be
p a t i e n t s t h a t are c h r o n i c a l l y and s e v e r e l y p s y c h i a t r i c a l l y i l l t h a t
need our s e r v i c e s .
However, t h e r e are many o t h e r p a t i e n t s and
p o t e n t i a l p a t i e n t s who are i n need of p s y c h i a t r i c t r e a t m e n t but
cannot a f f o r d i t f o r one reason or another. This may be because
they are not s i c k enough or poor enough f o r Medicaid or t h a t they
work j u s t enough t o prevent them from q u a l i f y i n g f o r a d d i t i o n a l
benefits.
However, when one of these w o r k i n g people or t h e i r
f a m i l y becomes p s y c h i a t r i c a 1 1 y
i l l , a dramatic s h i f t occurs. Due
t o t h e c o s t s of i n p a t i e n t and o u t p a t i e n t t r e a t m e n t , they develop a
huge f i n a n c i a l burden, o f t e n have t o q u i t work, and t h r o u g h s o c i a l
d r i f t they become unemployable or beyond r e h a b i l i t a t i o n .
Please c o n s i d e r b a s i c p s y c h i a t r i c b e n e f i t s f o r t h e working poor i n
the new o r d e r of t h i n g s . I b e l i e v e t h a t t h i s w i l l be f a r more cost
e f f e c t i v e t o spend h e a l t h - c a r e d o l l a r s on t r e a t a b l e
conditions.
For example, j u s t one h e a r t - l u n g or l i v e r t r a n s p l a n t p a i d f o r w i t h
Medicare or Medicaid d o l l a r s would pay f o r p s y c h i a t r i c i n p a t i e n t
and o u t p a t i e n t t r e a t m e n t f o r dozens o f t h e w o r k i n g poor. Perhaps
the time f o r r a t i o n i n g of h e a l t h care has f i n a l l y come.
A PflOFCSSlONAl COHPOHAnON
�Please consider basic p s y c h i a t r i c and chemical dependency treatment
as part of primary care.
We are a l l praying f o r your success i n leading our country through
t h i s d i f f i c u l t time.
Sincerely,
James T. G i l l e s p i e , J r . , M.D.
Medical D i r e c t o r ,
Behavioral Health Center
East Tennessee Baptist Hospital
K n o x v i l l e , Tennessee 37920
JTG/j j
�S A I N T
T H O M A S
H O S P I T A L
P.O. Box 380 • 4220 Harding Read ' Nashville. Ttnncssee 37202
Department of Medical Affairs
/"CUTOTKMEATORNIB^
Directory
(615) 386-6874
Fax (615) 386-6321
Mt-mbi'i nl DAUCHTERS OF CHARITY NATIONAL HliALTH S>STEM
�ARRHYTHMIA
1211
CONSULTANTS
UNION A/CT'SUITE:
MEMPHIS.
J . G . P O R T E R F I E L D . M-DL. M .
B.
I
PORTERFIELD. PH.D.
A. S M I T H .
475
TN/38104
/
(901)
(901)
274-2643
726-4237
M.D.
A p r i l 7,
1993
Dear Mrs. Clinton:
At the suggestion of a mutual friend, Babbie Lovett, we have
decided to write to you regarding health care reform. I work with
my husband, Jim, in a private practice dedicated to cardiac
arrhythmias. I have a Ph.D. in cardiac pharmacology and he trained
at Harvard for a subspeciality of cardiac electrophysiology.
We
have been i n private practice in Memphis since 1981. Our opinions
are c l e a r l y those of health care providers. Our patient population
tends to be adults, but we see pediatric patients occasionally.
Reform for the health care system i s obviously necessary, and we
feel i t should be focused in the following areas to make the
largest impact in the shortest amount of time.
Currently, two of the largest expenditures of health care dollars
are i n the f i r s t and l a s t few months of l i f e . These are the times
when the l a t e s t medical technology i s employed for patients with a
low probability of a good outcome. There i s considerable data
available on the low success rate for resuscitating elderly
patients who have cardiac arrests while in the hospital. However,
frequently these patients are in intensive care beds for extended
periods of time at an average cost of $150,000 per patient. ( I t i s
documented that only 5% of these patients w i l l ever leave the
hospital.)
The physicians involved usually are aware of the
f u t i l i t y of these efforts, but often are afraid of the legal
ramifications. Because of the Hippocratic Oath, i t i s easier on
t h e i r conscience i f they forge ahead with heroics.
We have
personally observed many families who are unable to accept the
inevitable. A l l of us have come to expect miracles from modern
medicine and have lost sight of the fact that death i s a natural
process in the g e r i a t r i c population. Money invested in objectively
evaluating this problem and educating physicians and the lay public
could r e s u l t in substantial health care savings.
An inordinate amount of health care dollars are spent on premature
neonates born <26 weeks gestation. Two thirds of these babies w i l l
FAX
�die.
Treigically, the one third that do survive are often
permanently disabled. The short and long term costs to society are
immense. Unfortunately, this issue i s an emotionally charged one
that no one has had the courage to address. Can we r e a l l y afford
not to?
There are other patient populations which merit health care
expenditure evaluation. For example, should we hospitalize the
terminally i l l (cancer, AIDS, etc.) or should we embrace the less
expensive hospice system where a l l of these patients could be cared
for? The concept that dying patients should be hospitalized may be
an outdated one.
Fear of legal retribution has caused physicians and hospitals to
"do everything humanly possible." The public expects t h i s type of
care for t h e i r families, while the courts have confirmed that only
perfection w i l l be acceptable. Physicians are afraid to do less
and as a r e s u l t practice "defensive medicine" by ordering many
unnecessary tests and surgery (e.g. caesarean sections).
The
malpractice issue has reached the stage where even the Medicare
reform known as the resource based r e l a t i v e value scale (RBRVS)
factors in a consideration for malpractice costs. Careful scrutiny
and reform could save b i l l i o n s of health care dollars. Accepting
a potential malpractice case on a contingency basis should be
banned and a cap on awards would be prudent. Another approach
could be the use of a review board consisting of lay c i t i z e n s ,
lawyers, and physicians. This board could screen a l l potential
malpractice lawsuits and determine the cases which merit a t r i a l .
Private health insurance i s another major area i n need of drastic
reform. These corporations exist solely to make p r o f i t s . This i s
reasonable u n t i l obvious abuse occurs.
The most objectionable
practices by insurers are that of denying coverage for preexisting
conditions or terminating policies once the insured has become i l l .
Every c i t i z e n i n this country should be able to purchase health
insurance at a reasonable cost and expect to be able to keep that
policy for the rest of their l i f e .
F i n a l l y , bureaucracy i s the fasting growing segment of our health
care
system.
Governmental and private health insurers
administration costs have grown close to 400% i n a seventeen year
period.
These costs have been estimated to be as much as $80
b i l l i o n d o l l a r s . These wasted funds should be diverted to provide
the health care c i t i z e n s deserve.
In sumiriary, i t i s time to evaluate and change the health care
system. E t h i c a l decisions must be reached regarding the terminally
i l l , young or old. Insurance companies cannot be allowed to have
free reign of the system. F i n a l l y , medical malpractice lawsuits
and bureaucratic growth must be contained. Until these issues are
resolved no progress can be made. We hope you take our insights
�into f u l l consideration when examining health care reform. As
health care providers we would be glad to discuss these ideas
further with you or your colleagues.
Sincerely,
Linda M. Porterfield, Ph.D.
LMP/lch
James G. Porterfield,
M.D.
�4~
• '"i
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM TH'S DOCUMENT
3^/
•.'.;V-Vv^.V:-;;
�\
-C7C'
Feb. 17, 1993
Dean Adams,
(fl.D.
P.O.Box 311267
New B r a u n f e l s , Texas 78130
Dear F i r s t
Lady,
Let me i n t r o d u c e m y s e l f , ! ' male, WASP, 62 years o f age, an Hfl.D.
m
and a Republican who d i d n o t v o t e f o r your husband, p r e d i c t e d he
would w i n , wish him w e l l and expect him t o do w e l l .
Reason f o r w r i t i n g s
You have been g i v e n t h e h a r d e s t j o b i n A m e r i c a - H e a l t h c a r e .
I would o f f e r my h e l p .
IKIy C.V.i
36^ years o f Family p r a t i c e , r e t i r e d one y e a r ( l have t i m e ) , a
lYlember o f t h e l o c a l h o s p i t a l board f o r 12 years and a Mensa(doub l e M) so I have some e x p e r i e n c e .
I f I may be of s e r v i c e l e t me know(I don't need a j o b ) .
S incerely,
Dean Adams M.D.
z/a
�E L I Z A B E T H
BRODIE,
M.D.
psychiatry
1 7 0 0
W E S T
H O U S T O N ,
L O O P
S O U T H
T E X A S
7 7 O S 7
S U I T E
1 1 5 5
7 1 3 / 6 3 2 - 4 0 6 6
February 3, 1993
Ms. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500
Dear Ms. Clinton:
I want to emphasize that it is not the striving for personal gain that motivates me in
writing tliis letter, but the good of all fellow Americans.
I will attempt to be brief and to the point. This is my thirtieth year in a very busy
and successful solo private practice of psychiatry. I have never used paramedical personnel to look after my patients to whom I always personally provided the best medical care I
could. Also, I have done mostly outpatient practice for reasons of cost-effectiveness and
because I felt it served the best interest of my patients.
I have treated successfully thousands of patients in this country and previously in
Canada under National Healthcare. I believe in every person's basicrightand need for
good healthcare, even at the cost to myself as a physician having to bear my own sacrifice.
I would like to address two issues. Thefirstwhich applies to medicine at large,
the second which applies specifically to psychiatry.
We medical practitioners experienced a tremendous change in the health care delivery system in the last few years, unfortunately not for the better. In the past we dealt
with patients and with insurance companies. Now we (physicians and patients) are fighting ongoing and ever increasing battles with "managed care companies" and their representatives, with the respective insurance companies hiding in the background. The main
difference is that now two layers of major corporations are reaping large profits off the
skin of companies which buy their health insurance packages, people who need medical
care, and the physicians who provide it. The insurance premiums skyrocketed in spite of
their vigorous and often successful curtailing of both medical services and fees.
Now I would like to point out how this system works (or rather doesn't) in psychiatry. The company's Employee Assistance Program representatives (extra expense) direct the patient to the appropriate provider (psychiatrist), whose battle then begins with
the Managed Care Company's representative who after a lengthy telephone conversation
with the psychiatrist or after the psychiatristfillsout a four page time consuming ques-
�Pg 2
ae
Brodie
tionnaire, doles out a small, inadequate number of precertified treatment sessions. At the
same time they allow fees which are 30-50% below the usual fees in that area. Their
"package" is sold to the purchasing company on the basis that the provider (psychiatrist)
accepts their contract for the severely reduced fees. If he doesn't he runs out of patients,
because most companies have already contracted with these managed care companies for
health coverage of their employees. Managed care companies sell their products to employers at a reduced rate in comparison to the primary insurance company rates. Consequently, employees are converting to this form of insurance, not recognizing how much
inferior product they are buying.
At the same time when they severely restrict the necessary number of outpatient
visits, they allow more coverage for hospitalization, which would only be necessary temporarily in the most severe cases, but was abused for the previously mentioned reasons.
Aiiother severely disturbing aspect of the situation is the fact that the consumers
are mislead by the insurance brokering companies. The patient believes that the insurance
coverage in the mental healthfieldis at par with the rest of medicine, only tofindout that
they have to pay a several hundred dollars of deductible expenses and be allowed only an
unsatisfactorily limited number of visits when in need for treatment for emotional illness.
The practices of these new insurance brokering companies are extremely destmctive to the area of medicine as a whole. They reward procedures instead of time spent with
patients which conversely leads to an inferior practice of medicine with again higher expenses.
I think that the situation with the insurance companies is untenable and that major
changes are needed in this area as referred to earlier by President Clinton.
I believe that you are fully aware of the central importance of mental health in the
pursuit of life, in-paieining, in the woikpiace, diidiii ihe ability of our diversified people to
get along and progress well. Good mental health also prevents expenses in other areas of
medicine.
In this vein, I have to emphasize the probably well known fact that there is an urgent need to stop the discrimination against psychiatry as the stepchild of medical specialities in the interest of all people. This discrimination does not allow adequate treatment of
mental illness and is wasteful in other directions.
�Page 3
Brodie
There is much more to be known and to be said about these issues. I also would
like to emphasize that I worked for ten years under the Canadian National Health Care
system, therefore I would like to offer my expertise for personal consultation.
You and the President are like a breath offreshmountain air. We celebrate your
courage, wish you lasting success, and thank you.
Sincerely yours,
Elizabeth Brodie, M.D.
,P.S. Enclosed pleasefinda Brochure which tells you some about my background and my
practice.
EB:gf
Enclosure
�I
n today's health-conscious world, we
are striving not only to achieve optimal
physical health but also to function at
our optimal level of mental health. Only a
relatively small percentage of people suffer
from severe forms of mental illness or organic
brain disorders, but a surprisingly large percentage of people have mental and emotional
problems which severely interfere with their
enjoyment of life, and their work and personal
relationships. Emotional problems are often
dismissed and misinterpreted, but sooner or
later the adverse effects and their complications
cause severe disruption in the person's life.
In present-day society, certain psychiatric
illnesses are particularly prevalent. Depression
— characterized by feelings of hopelessness,
poor concentration, difficulty in making
decisions, and, occasionally, disturbances of
appetite and sleep — often goes
unrecognized. Anxiety disorders, which
may or may not be accompanied by
panic attacks, cause a great deal of suffering
and may lead to severe restrictions in the
person's lifestyle. Personality disorders
constitute a major group of psychiatric
problems and cause serious difficulties in
work, marital, and sexual relationships.
Eating disorders — for example, obesity,
anorexia, and bulimia — have important
psychiatric components, accompanied
by medical complications. Alcohol and
drug addiction often camouflage underlying
psychiatric disturbances.
Dr. Elizabeth Brodie
discoveries concerning the interactions
between emotions,
biochemistry, and
physiology. She uses
such advances to
her patients' fullest
benefit.
Emotional problems affect people at any
stage or age of life, from childhood to old
age. Except for young children, who are
usually treated by professionals specializing
in this area, Dr. Brodie treats all people, from
adolescence to old age. She also has
extensive experience in the treatment of
marital, sexual, and family problems.
Because of her special interest in
psychotherapy and related biochemical
treatment methods, Dr. Brodie conducts her
aractice mostly on an outpatient basis in
^ier office. In the long run, this saves time
and is less disruptive to the flow of
the patients' lives.
Office hours are 7:00 a.m. to 7:00 p.m.,
Monday through Thursday. The office
environment is pleasant, quiet, warm, and
courteous. The office location, in the Galleria
area, is easily accessible, and parking is
complimentary.
Many of the above-mentioned problems have
biochemical and medical components, with
psychiatric complications.
Dr. Brodie is on call for her patients at all times
— she does not use substitutes. When she is
out of town, this is discussed with patients
and special arrangements are made. Cooperation
with referring physicians is courteous and
professional.
Psychiatrist Elizabeth Brodie, M.D. has, in more
than 20 years of practice in psychiatry, a broad
range of experience in successful treatment of
the above-mentioned emotional and mental
disorders. As a psychiatrist, with a full medical
background, Dr. Brodie keeps pace with the
the latest advances in medicine, such as
Concerning payment of fees, Dr. Brodie and her
office manaper invite patients to discuss any
problems. They are flexible in making financial
arrangements, such as collection of the appropriate portion of fees from company-sponsored
plans or from insurance companies.
�>:••
:
[ • ; Elizabeth E3rodie,^
j
Psychiatry
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PHOTOCOPY
PRESERVATION
fr
�Frederick C. Goggans. M.D.
Diplomale, American Board
of Psychiatry and Neurology
Psychiatric M e d i t i n e Associates
1814-B8 Eightifc^venue
Fort Wortl/Texas^6110
N. Duane Purcell. M.D.
Diplomale. American Board
of Psychiatry and Neurology
FAX (8171924-1369
Robert P. Odgers. Ph.D.
Clinical Psychologist
March
31 ,
Joseph H. Burkett, M.D.
Diplomale. American Board
of Psychiatry and Neurology
William R. Billingslcy. Ph.D.
Clinical Psychologist
Rita Foust. CSW-ACP PR. CADAC
Clinical Social Worker
1993
Ms . H i 1 1 a r y Rodham C I i n t o n
The W h i t e House
1600 P e n n s y l v a n i a Avenue
W a s h I n g t o n , DC
20500
RE :
H e a 11 h C a r e R e f o r m
Dear
Ms.
the
I n my / f i r s t i j / t t e r
changing medical e t h i c s
was d»gcugs»<?a .
I n the
I s n a r e d my c o n c e r n s
a b o u t t h e p a i n and d i f f i c u T i t y we can e x p e c t i n our s o c i e t y
as we a t t e m p t t o r e s t r a i n t h e c o n s u m p t i o n o f r e s o u r c e £ - - w + + i q h
a r/s^Mo uch i n demand, t h o s e o f h e a l t h and h e a l i n g . / i n t h i :
l/fefte
r e a few t h o u g h t s on t h e s o l u t i o n p r o c e s s wnTtrri—ra^"
"ollow .
\f!e a r e f a c e d w i t h a most c u r i o u s d i l e m m a .
I n many ways, i t
c o u l d he s a i d t h a t our q u e s t f o r i m p r o v e m e n t i n q u a l i t y o f
l i f e has l e a d t o t h e d e t e r i o r a t i o n o f o u r q u a l i t y o f l i f e ,
T h i s i s t r u e i n med i c i n e i n a t l e a s t two ways. F i r s t , we
now a r e p r o v i d i. n g t h e c o n t i n u a t i o n o f l i f e f o r some beyond
any u s e f u l n e s s and i n t h e p r e s e n c e o f g r e a t s u f f e r i n g .
Second, we a r e a l s o now p r o v i d i n g h i g h l y t e c h n i c a l and
h e l p f u l remedies f or h e a l t h p r o b l e m s , b u t t h e c o s t s a r e
s a p p i n g t h e economi c v i a b i l i t y o f o u r s o c i e t y , and t h e r e f o r e
t h r e a t e n i n g t h e qua l i t y o f o u r l i v e s .
I t i s as t h o u g h o u r
p e r v a s i v e d e n i a l o f d e a t h c o n f u s e s us a b o u t t h e m a t t e r s a t
hand w h i c h demand r e a l i s t i c c o m p r o m i s e .
From t h i s p o i n t , d i s c u s s i o n o f t h e meaning o f " q u a l i t y o f
l i f e " c o u l d d i v e r g e a number o f d i r e c t i o n s d e p e n d i n g on
one's e x i s t e n t i a l o r s p i r i t u a l v i e w s .
From a C h r i s t i a n
v i e w p o i n t , t h e s o l u t i o n w o u l d l o o k t o w a r d God's e t e r n a l
p e r s p e c t i v e o f s p r e a d i n g t h e good news o f h i s l o v e and
g r a c e , h i s r e c o n c i l i a t i o n t o h i s chosen p e o p l e and an
u n e n d i n g .1 i f e h s r e a f t s r . From a human 1 s t v i e w p o i n t , t h e
f o c u s w o u l d be on t h e p o t e n t i a l goodness o f m a n k i n d , peace
and t o l e r a n c e w i t h o t h e r s , and t h e c u l t i v a t i o n o f a b e t t e r
�world f o r f u t u r e generations.
A n a t i o n a l i s t w o u l d f o c u s on
v a l u e s o f p a t r i o t i s m , peace t h r o u g h s t r e n g t h , and t h e
b u i l d i n g of a stronger country f o r f u t u r e generations.
Most
p e o p l e i n t h i s c o u n t r y w o u l d be w i l l i n g t o s u p p o r t t h e
b e l i e f s o f one o r more o f t h e s e o r i e n t a t i o n s . I t i s
s t r i k i n g t o n o t i c e t h a t t h e s e p o s i t i o n s have i m p o r t a n t
t h i n g s i n common. They a l l p u t t h e q u e s t f o r i m m o r t a l i t y i n
a more r e a l i s t i c p e r s p e c t i v e , t h e y a l l p o t e n t i a l l y i n v o l v e
p e r s o n a l s a c r i f i c e , and none o f them p r o p o s e s hedonism or
s e l f - i n f l a t i o n as an i m p o r t a n t v a l u e .
This a d m i n i s t r a t i o n
has t h e o p p o r t u n i t y , i f n o t t h e mandate, t o l e a d o u r s o c i e t y
i n t h e d i r e c t i o n o f I t s own p r o t e a n c o n v i c t i o n s .
The r e a l
r e s i s t a n c e comes n o t f r o m p h i l o s o p h i c a l or p o l i t i c a l
disagreement, but r a t h e r from greed, i n a p p r o p r i a t e f e e l i n g s
o f e n t i t l e m e n t , and i r r a t i o n a l d e n i a l o f m o r t a l i t y . I n
s h o r t , we have n o t been w i l l i n g t o c o n f o r m o u r b e h a v i o r t o
o u r con v i c t i o n s.
The move o f o u r s o c i e t y t o s u p p o r t t h e s e v a l u e s o f
r e s p o n s i b i l i t y and commitment i s s e n s i b l e and o v e r d u e , b u t
i t , i s f e a r s o m e and p a i n f u l t o i m p l e m e n t .
P l a n s w h i c h come
f o r w a r d a r e a l m o s t c e r t a i n t o p r o v e f a u l t y i n some a r e a s and
require adjustment.
I f t h e v o t e r s f e e l t h a t t h e y have been
involved i n p a r t i c i p a t i n g i n the formulation of plans, the
a c c e p t a n c e i s l i k e l y t o be b r o a d e r and t h e "sour g r a p e s "
speeches l e s s e f f e c t i v e .
The s t r u g g l e t o d e f i n e " q u a l i t y o f l i f e " i s as c r u c i a l as i t
i s i n e v i t a b l e i n discussions of health care u t i l i z a t i o n . I t
w i l l l a y t h e foundation f o r a successful process o f
Increased s o c i e t a l d i r e c t i o n of health care.
I t must g u i d e
t h e i m p l e m e n t a t i o n o f any s o l u t i o n .
Once a g a i n , I s t r o n g l y s u p p o r t d e b a t e i n an open f o r u m ,
e s p e c i a l l y r e g a r d i n g t h e s e i s s u e s o f e t h i c s and v a l u e s .
These i s s u e s m i g h t be d i s p l a y e d w e l l i n a s e r i e s o f more
formal debates; i . e . , s p e c i f i c focus, a l l o t t e d times, s e l e c t
teams o f d e b a t e r s , r e b u t t a l s , e t c . I d e a l l y , t h e s e w o u l d be
wide.1 y b r o a d c a s t , u n e d i t e d and w i t h o u t t h e " e x p e r t
commentary" t o o common i n news media t h e s e d a y s .
I t would
be a l m o s t c e r t a i n t o be p r o d u c t i v e .
I b e l i e v e we can nave
c o n f i d e n c e i n t h e a b i l i t y o f o u r peer c i t i z e n s t o u n d e r s t a n d
a n d v o t e r esp o ns i b 1 y .
A g a i n , do n o t h e s i t a t e t o c o n t a c t rne i f you w i s h f o r my
assist a nce o r f u r t he r d iscussion.
SIncereiy,
/
v
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i H . Bur k e t t ,
JHB/tdb
jos^y
M.0.
�CODER:.
HEALTH CAKE TASK FORCE SORTING SHEET
INPUT DATE:
GENERAL SQEI:
POSTCARD 1:
.Personal stories
General mail
Letter Campaign
Other Health Providers
POSTCARD 2:
Offers to help/Employment
FORM LETTER:
Letterhead
_Policy
REROUTE:
Casework
.Scheduling
.Physicians
President
Other
POTJCY AND PERSONAT. STORIES-.
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (O)
working families
unemployed/low income
benefits
providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
admi nistration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unne cessary procedures
.GOVERNMENT PROGRAMS (IV)
^medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
.FINANCING (VII)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
.women's health
.immunizations/children
.rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3s^
�Page 2
C a r l e t o n K. Thompson, M.D.
�GHOROH ANDREW
CONSTANT
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3&{ ,
.... -
.
�OinOMAT OF AMERICAN BOARD OF INHRNAL '
MCOICINE IN GASTROfNTteOOOY
., ^i. 9).
, ^ \ K March
15,
1993
The V i c t o r i a A d v o c a t e , E d i t o r
311 E a s t C o n s t i t u t i a n
V i c t o r i a , Texas' 77901
THE PERCENT SOLUTION
Dear
Editor:
Regarding American h e a l t h care;
1 . Such c a r e s h o u l d n e v e r b e
c o m p l e t e l y -free.
2. Monies p a i d f o r c o v e r a g e s h o u l d r e f l e c t an
i n d i v i d u a l ' s a b i l i t y t o pay. 3. The Feds a r e e x c e l l e n t a t
c o l l e c t i n g t a x e s b u t t e r r i b l e a t a d m i n i s t e r i n g programs.
T h e r e - f o r e , h e r e a r e some r e c o m m e n d a t i o n s ; # 1 . A c e n t r a l h e a l t h
' f u n d s h o u l d be e s t a b l i s h e d .
T h i s w o u l d be f u n d e d by a c u m u l a t i v e
p a y r o l l t a x o f 67. o f n e t income ( i n c l u d i n g n o n - t a x a b l e i n c o m e ) up
t o $50,000;; 57. b e t w e e n $50,000-$ 100,000; 47. b e t w e e n $ 1 0 0 , 0 0 0 $ 1 5 0 , 0 0 0 ; 37. b e t w e e n $150,060-$200,000; 27. b e t w e e n $ 2 0 0 , 0 0 0 V $ 2 5 0 , 0 0 0 and 17. on any i n tome above $250,000.
T h i s f u n d -would'..'be
. s u p p l e m e n t e d by a l l funds" c o l l e c t e d f r o m f e d e r a l t a x e s on a l c o h o l
.
and t o b a c c o .
#2. Coverage w o u l d be 807. o f a l l o w e d f e e s ( h o s p i t a l
and p h y s i c i a n ) w i t h o u t a d e d u c t i b l e and w o u l d r i s e t o 95/C when
t h e i n d i v i d u a l ' s / f a m i l y u n i t annual o u t - o f - p o c k e t expenses
e x c e e d e d A'/, o f ne± income. # 3 . DRG s ( h o s p i t a l r e i m b u r s e m e n t )
and RB-RVS ( p h y s i c i a n f e e s ) a r e n o t i n h e r e n t l y bad i d e a s b u t need
t o be r e f i n e d t o r e f l e c t a c t u a l c o s t s ( h o s p i t a l c h a r g e s ) and
• l e v e l o f t r a i n i n g / e x p e r i e n c e ( p h y s i c i a n s f e e s ) , #4. P h y s i c i a n
and h o s p i t a l f e e s w o u l d be n e g o t i a t e d w i t h t h e i n s u r a n c e
companies.
P h y s i c i a n s w o u l d be r e p r e s e n t e d by u n i o n s composed o f
s p e c i a l t y s o c i e t i e s ( n o t t h e AMA). #5. Moni e s f r o m t h e c en t r a1
f und wou 1 d be vCJMchered t o i n s u r a n c e campani es t h a t w o u l d i n t u r n
• d i s p e r s e -funds *:o h o s p i t a l s and p h y s i c i a n s . The premiums g i v e n
i n s u r a n c e c o m p a n i e s waul d " r e f 1 efc't t h e s i ;c? and r e l a t i v e r i s k
_
:( u p d a t e d y e a r l y ) o f cos-erage f o r each i nd i v i d u a l / f ami 1 y u n i t .
#6. T h e r e w o u l d be no e x c l u s i o n s f o r p r e - e x i s t i n g c o n d i t i o n s .
#7. I n s u r a n c e c o m p a n i e s would, o f f . e r c o v e r a g e i n e v e r y £tate. An
i n d i v i d u a l wr.iu.Id n i <:.! a company -and s t a y w i t h t h a t company even
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�March :15, J.993
The Vi c tc:r- :i. a A d v o c a t e , i.d:i. t o r
Paqe 2
etc.,
i!l(),. T o r t r c f o r m j i U B t accompany any s e r i c u E change i n o u r
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and i of.!. i' -a'"
cioul d have some o r a l l t h e i r premiums p a i d f a r them
e i. ! h e r- b y t h e g o v e r n n. e n t a r c h e i r e m p 1 cj y e r . it 13.
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n e t i n c o m e , Lhe c e n t r a l f u n d w o u l d pay SOX o f t h e c o s t o f t h r e e
e s s e n t :i. a l ( l i f e s u s t a i n i ng ) medi c a t i cms.
H 16. Charges w o u l d be
p r o c e s s e d v i a a n a t i o n a l ID c a r d .
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CKT: rnst
�^MEDICAL DRIVE. SUITE 201 - VICTORIA, TEXAS 77904 - TEL: (512) 576-4182
April
5,
1993
GEORGE A. CONSTAigT, M.D.. P.A., F.A.C.P
Neurolofly and Psychiatry
E. WAYNE GOFF, M.D.
Psychiatry
F i r s t L a d y , H i l l a r y Rodham
The W h i t e House
W a s h i n g t o n , D.C. 2 0 5 0 0
Clinton
Dear Mrs. C l i n t o n :
task
T h a n k y o u v e r y much f o r t a k i n g
- H e a l t h Care Reform.
on s u c h
an o v e r w h e l m i n g
A f r i e n d o f m i n e w r o t e a c o m p o s i t i o n t h a t m i g h t be o f
i n t e r e s t t o you r e g a r d i n g t h e t a s k b e f o r e you.
will
I am t a k i n g t h e l i b e r t y o f s e n d i n g y o u a c o p y .
b e o f some h e l p t o y o u a n d y o u r t e a m .
Here i s w i s h i n g
If
contact
there
me.
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i s anything
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M. D.
GAC/llr
Enclosure
President William Clinton
The W h i t e H o u s e
W a s h i n g t o n , D.C. 2 0 5 0 0
S e n a t o r P h i l Gramm
Room # 3 7 0 R u s s e l l B u i l d i n g
W a s h i n g t o n , D.C. 2 0 5 1 0
Honorable Lloyd Bentsen,
Secretary o f Treasury
1 5 t h S t . a n d PA NW
W a s h i n g t o n , D.C. 2 0 2 2 0
S e n a t o r Bob K r u e g e r
Room # 7 0 3 H a r t B u i l d i n g
W a s h i n g t o n , D.C. 2 0 5 1 0
H o n o r a b l e Henry C i s n e r o s
S e c r e t a r y o f Housing and
Urban
Development
W a s h i n g t o n , D.C. 2 0 4 1 0
Joycelyn Elders,
Surgeon General
200 I n d e p e n d e n c e
W a s h i n g t o n , D.C.
M.D.
A v e . S. W
.
20201
Congressman Greg L a u g h l i n
Room 2 1 8
Cannon House O f f i c e B u i l d i n g
W a s h i n g t o n , D.C.
20515
Dr. Donna S h a l a l a
S e c r e t a r y o f H e a l t h and
Human S e r v i c e s
2 0 0 I n d e p e n d e n c e A v e SW
W a s h i n g t o n , D.C.
20201
�(Homfant (Elmtc
115 MEDICAL DRIVE, SUITE 201
VICTORIA, TEXAS 77904
FIRST LADY HILLARY RODHAM CLINTON
THE WHITE HOUSE
WASHINGTON DC 2(2500
iiinfiiiiiliMiuiliimiiiu
�Baylor
College of
Dentistry
3302 Gaston Avenue
Dallas, Texas 75246-2098
(214) 828-8200
(214) 828-8496 Fax
Office of the President and Dean
25 March 1993
Hillary Rodham Clinton, JD, Chairperson
National Task Force for Health Care Reform
The White House
Washington, D.C. 02217
Dear Mrs. Clinton:
The task which you have agreed to lead regarding health care reform and for which both you and President
Clinton are strong advocates is, perhaps, one of the most important initiatives this country has undertaken this
century. At stake is the well being and welfare of the nation's citizens. As you are well aware, although this
nation has enjoyiid superb medical and dental care, there continue to be extraordinarily large gaps in needs for
health care, the demand for health care services and the access to health care.
The problem does not rest solely with those individuals who do not have health insurance, but also with the vast
majority of Americans who are under-insured and who, therefore, do not have either appropriate access or
resources to secure health care. Perhaps nowhere is this issue demonstrated any more dramatically than in the
problems associated with the oral health of the nation and the citizens' ability to access oral health care.
As you are probably aware, former Surgeon General C. Everett Koop has stated unequivocally, "If you do not
have oral health, you are not healthy." Unfortunately, many individuals tend to associate oral health with tooth
decay and the pirevention of dental cavities. Although tooth decay has declined somewhat in the lower age
population of five to twelve year-olds, it still remains a major public health problem. In fact, 75% of the total
caries is manifested in 25% of the children, indicative of a lack of access to health promotion/disease prevention
and clinical care programs. In addition, periodontal or gum disease affects more than 85% of Americans.
Perhaps most importantly, the oral cavity is often a mirror of the rest of the body, exhibiting signs and symptoms
of more serious and widespread health problems. These include oral cancer, diabetes, developmental
abnormalities, a host of chronic medical conditions, immunological disorders and autoimmune diseases.
Of particular interest, is that early indications and warning signs of HIV are also frequently detected in the oral
cavity. Thus, the dentist is a critically important individual and a first line of defense as a primary health care
provider. In this same regard, the "National Nutrition Screening Initiative" being developed by a broad alliance
of health care professional organizations, places nutrition and oral health as a priority initiative and is therefore
seeking the dentil and medical communities' active involvement in educating the public on the importance of
recognizing clinical changes in the oral cavity as important determinants of nutritionally-related systemic disease
prevention and early detection. Since patients tend to visit dentists more regularly than they visit physicians, the
dentist is a criticsJ primary health care provider recognized as such by our professional medical colleagues. There
is no doubt that oral health care is a vital part of primary health care and that escalating health care costs can be
drastically reduced by increased access to oral health promotion and disease prevention programs as well as acute
and primary clinical care.
�I am sure that you already recognize that oral disease has been characterized as a "neglected American epidemic."
While the human anguish caused by dental problems may be difficult to measure, the resulting economic loss has
been quantified. The latest data show that oral related illnesses account nationally for 3.6 million days of bed
disability, 11.8 million days of restricted activity and 1 million lost school days.
To effectively address this epidemic requires a sufficient supply of highly qualified practitioners, appropriate
reimbursement systems and a commitment to oral health as an essential component of primary health care and
public health. Unfortunately, because oral health is often over looked or neglected when health care programs
are funded, there is a growing gap between the need for, and accessibility of, oral health care services in the
nation. It may be of interest to note that a survey conducted by the Community Council of Greater Dallas
discovered that the gap is so wide and is increasing so rapidly as to require immediate action on the legislative
front with community agencies as well as with the Baylor College of Dentistry since it is the single largest
provider of oral hesalth care services in the Dallas/Fort Worth Metroplex. This picture of a growing gap in oral
health care needs and access to care can be seen in countless cities and communities in the nation. The results
are being exacerbated with the growing volume of individuals and families living at or below the poverty line and
the gap particularly affects the elderly and the lower socio-economic sector of the population. Therefore, the
country's commitment to public health, and particularly to health care reform, must embody the provision of
appropriate oral health care services to every segment of society.
Due to changing demographics, there are an increasing number of elderly patients who have a higher risk of
chronic disease, are typically on more medications and who need to have, but lack access to, appropriate oral
health care. At the other end of the age spectrum is the treatment of children including the classical diseases of
dental decay and periodontal disease, as well as developmental disorders. In addition, disabled patients and other
special needs patients lack access to appropriate oral health care.
There are multiple reasons why access issues are problematic and why oral health care needs to be included in
effective health care reform. First, the fact is that oralpharyngeal cancer is more common than leukemia,
Hodgkin's disease, melanoma of the skin and cancers of the brain, cervix, ovary, liver, pancreas, bone, thyroid
gland, testis or stomach. Second, the data are overwhelming regarding the disparity between oral health care
need and access. In addition to the data cited above, there are numerous studies which demonstrate that one of
the most serious problems confronting community and county hospital systems are the oral health care needs of
the public. Unfortunately, resources are almost universally lacking for these hospital systems to address this
significant public need.
Third, oral health care is not provided through Medicare which is seriously problematic for our growing geriatric
population. It is important to note that this population has had a lifetime investment in dental care.
Unfortunately, when they retire, they lose their dental insurance. In fact, only 15% of the elderly currently are
covered by dental insurance. Fourth, in many states Medicaid for dental care is relegated to children even though
the need exists for both adults and children. In any case, the reimbursement systems are so poor and underfunded that the Medicaid system has become an inappropriate method for people to obtain needed oral health care.
Although the Federal Medicaid program mandates comprehensive dental care for children, currently, eighty
percent of the Medicaid-eligible children in the United States receive no dental services. Fifth, there is an
absolute and clear relationship between oral health and general health. In addition to the issues I stated earlier,
it may be important to also recognize that individuals who elect or need kidney, heart, bone marrow and other
transplants, have a fundamental requirement for beingfreeof infectious disease and particularly infectious disease
in the oral cavity. On a related note, it is important to keep in mind that the oral cavity is the beginning of the
gastric track and it is the organ system by which nutrients first enter into the body and thus food selection
behaviors require adequate dentition and supporting structures. There are volumes of data that demonstrate
inadequate dentition can and does compromise systemic health.
�There are numerous additional reasons but the truth of the matter is that oral health care must be addressed or
we will risk developing an entire generation of individuals who do not have the means to be healthy when it
comes to oral healiJi and, thus, their general health status can be compromised as well.
It seems logical that acute and primary oral health care must be an integral part of any comprehensive health care
reform that you and your colleagues have accepted the responsibility for developing for this nation. It is certainly
an integral part of the problem! I am sure there are other groups, including the Coalition for Oral Health that
are informing you ;ind your committee regarding the specifics of the necessary components of acute and primary
care that are related to oral health. It is important to reiterate that the health care program must be inclusive,
is open to not just children, but to all segments of society, and must focus on acute and primary care and,
particularly, on heiilth promotion and disease prevention activities.
In this same regard, the National Institute of Dental Research estimates that every dollar used in prevention
programs saves the American consumer about four times that amount in treatment costs. At the same time, the
reimbursement systems that are available through third parties must be available for those same health promotion,
disease prevention activities. In this way, both oral health and general health will continue to improve in this
nation and among its citizens.
It has been clearfromthe discussions that you and the President have initiated with the American people that you
are deeply committed to improving the health of this nation and to improving the access to care. It is equally
clear, that in order to effect that most important goal of which I am personally supportive, that oral health care
needs to be included in this process.
Clearly, we know how difficult you task is, and stand ready to assist you in any way we can at the Baylor College
of Dentistry. In addition, I offer you my personal support and assistance and if I could provide you any further
data, testify before your committee or in any other way provide you a better understanding of the need for oral
health to be a part of the health care reform issue, I would be most pleased to do so. Two years ago I served
as the President of the American Association of Dental Schools and as a dentist and nutritionist, am keenly
interested in this important initiative from the perspective of the educational and practicing community as well
as the health of the public.
On a personal note, it is my understanding that your daughter, Chelsea's Orthodontist in Arkansas is, indeed, a
Baylor College of Dentistry trained Orthodontist. Indeed, I would encourage you and the President to talk to
dental educators and the practicing community, as well as the public health dentists, to understand the depth and
the commitment that we have in integrating oral health care into the health care reform program you and your
committee are shaping for this nation.
Thank you for your kind attention to this letter, and if I can assist you in any way, I would be most pleased to
do so. Best wishes and success in this most important task you are conducting for the nation's citizens.
Sincerely,
Dominick P. DePaolla, D.D.S., Ph.D.
President and Dean
DPD/ckw/Clinton.DPD
�Q
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. letter
SUBJECT/TITLE
DATE
03/25/1993
Address (Partial); Personal (Partial) (7 pages)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER T I T L E :
[Physician Letters] [loose] [8]
2006-0885-F
jm778
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(»)|
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute [(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRAI
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed mpon request.
Freedom of Information Act - |S U.S.C. 552(b)|
b(l) National security classified information [(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
�Robert N. Jenkins, M.D., Ph.D.
P6/(b)(6)
Hillary Rodlriam Clinton
The White House
1600 Pennsvlvania Ave
Washington" D.C. 20501
March 25, 1993
Dear Ms. Rodham Clinton:
I am sorry to hear that your father is ill and hope for his speedy recovery. I am writing to you
concerning your efforts to coordinate the Clinton administration's plan to reform our health care
system. You have probably heard all of the ideas I will express in this letter, but I hope you read
your mail and that it influences you. I am not writing at the request of any arm of organized
medicine, or "special interest," nor do my views represent the medical school of which 1 am a
faculty member. Instead, I am writing as a voter, health care consumer, part-time health care
provider, and husband of a full time practicing internist. All of us look forward to increased
health care access and decreased health care costs. Physicians are, with good reason, concerned
that reforms may make most matters worse instead of better.
There are features of our current system that are the best in the world: freedom to choose highly
trained, motivated, empathic physicians, access to the latest diagnostic and therapeutic modalities,
efficient patient care-oriented hospitals, and access to effective and prompt medical care. We all
appreciate the gravity of the problems of limited access to these benefits and their enormous cost.
However, it is tragic that most prior efforts to control the rising cost of health care by
interference and micro-management have seriously hampered the physician's autonomy as
advocates for their patients. Can you imagine justifying everything you do for the benefit of a
hospitalized patient to a nurse (or another representative of a third party payer) with far, far, far
less education and training than you have? Similarly, bureaucrats will have the right to
retrospectively scrutinize, with the presumption of wrongdoing, the actions of your father's
physician. If the physician determined that a pacemaker was necessary, he must seek approval
from a nonphysician bureaucrat to be paid for its placement. Would you tolerate such a person
questioning your choice of clothing, food, and reading material for your daughter?
�Robert N. Jenkins, M.D,, Ph.D.
• v ' P6/(b)(6).
Managed competition will make this hassle more pervasive and will likely erode the motivation
and caring of physicians. Thus, we will lose the best feature of our current system and the
quality of health care for everyone will diminish. It is often difficult to contact HMO physicians
because salaried employees are generally unmotivated and not directly accountable to the patient.
P6/{b)(6)
'
*
•r^.f-fVi,.,,',; •
potential and may have saved her life. This scenario epitomizes the best of our health care
system. Given my "insider information" on health care providers, I know that an HMO would
not have obtained a consultant in time. On that day I became convinced that the most important
component cf health care is a caring, highly skilled, highly trained, highly motivated, and, yes,
highly paid physician. It would be a grave mistake to force upon us a system where
nonphysicians, such as yourself, insert themselves into the patient-physician relationship and
dictate, in the interest of saving money, what is done for the patient. It will be far better to
reduce third-party payer interference (the primary cost containment strategy of managed
competition), and return control of health care expenditure to the patient and his physician. The
ideas outlined below maintain the best parts of health care system and stop the spiraling increase
in health care costs.
We must address the fact that increases in health care expenditure are at least 50% attributable
to increased consumption by consumers. Thus, a primary reason that health care costs the United
States so much is that it costs the individual so little. To quote Sunday's New York Times, "The
distortions created by these third-party payments are probably large. A classic experiment . .
. showed that requiring patients to write checks when they went to the doctor shaiply reduced
the demand lor routine health care. It should not be surprising then . . . that the fees currently
paid by private insurers are essentially arbitrary - virtually unrelated to actual costs." In other
words, first dollar coverage of health care expenditures by third party payers creates the
impression that health care is free and increases demand for services without regard for their
costs. For example, a woman (belonging to a managed care system with a trivial co-payment)
saw my wife because her ears were packed with wax. One week later she returned only to
ensure that her ears were still clean! Should we insure this woman against the latter expense and
spread its burden among her neighbors? I think not.
�Robert N. Jenkins, M.D., Ph.D.
P6/(bH6)
We should change the system so that it is patients' money that is being spent, and patients are
in control ol' that expenditure. The U.S. government should alter our tax policy to bring this
about. I support many ideas put forward by Physicians for Patient Power, an organization that
believes we should increase the involvement of patients in the control of health care delivery.
First, employees, not employers, should own health insurance policies. Thus, health insurance
premiums should be tax deductible for employees, not employers. The consumers of health care
services would then be the owners of the insurance policies that paid for the services. The
owners and purchasers of these insurance policies would become interested in making them
affordable. Employers would no longer be attempting to control the cost of services consumed
in large quantities at no cost to the consumers. Second, we should create medical savings
accounts modeled after IRAs. Taxpayers could deduct contributions up to $2000 per family
member per annum and apply distributions only to medical expenses. When the owner's savings
accumulate, he could increase the amount of deductible and co-payment in the insurance policy,
and enjoy a reduction in the premium.
These measures would return control of health care expenditure to the patient. Imagine the
difference in the behavior of both the patient and the physician if the first $1000-$ 10,000 spent
in a given year was the patient's money rather than the unlimited resources of a third party payer.
Perhaps patients would listen to doctors when told that viral upper respiratory infections (colds)
do not benefit from $60 antibiotic prescriptions. Perhaps patients would ask why they need $600
worth of laboratory tests every six months. Perhaps patients would ask why the hospital charged
them $90 for a bottle of normal saline that cost $0.10, or what the anesthesiologist did in 30
minutes that was worth $600. Perhaps the patient would ask the radiologist why the MRI scan
cost $1500. Fees would cease to be arbitrary and have at least some relationship to the actual
costs of deli vering health care. Patients would become less interested in futile and unproven
therapy. In order for this to work, physicians who have never spoken to the patient could not
bill the patient for their services. I agree with disallowing separate billing for radiology,
anesthesiology, and pathology services. Most important, these changes preserve the physician
role as patient advocate.
Citizens of this country own auto insurance and pay for the upkeep of their car, own
homeowner's insurance and pay the upkeep of their home, pay for rent and groceries, and
therefore can own health insurance and pay for routine health care. If we eliminate first dollar
coverage for all health care, physicians and hospitals couldn't charge fees that patients were
unwilling to pay. Moreover, health care providers would have a greater interest in the strength
of the economy. Therefore, market forces would play a powerful role in keeping costs down.
�Robert N. Jenkins, M.D., Ph.D.
P6/(b)(6) .
How would we encourage citizens to purchase health care insurance? Governments encourage
citizens to spend their dollars in certain ways through legislation. For example, in Texas we
must purchase automobile insurance to gain the privilege of driving legally. I propose that the
United States government offer a strong incentive for its citizens to purchase health insurance.
The IRS would require proof of health insurance coverage for each family member entitled to
a personal exemption. For individuals not covered by insurance, the personal exemption would
be $0.00. In addition, tax payers could deduct the first $1000 per person of health insurance
premium costs. The IRS would reduce the standard deduction by a compensatory amount. Thus,
taxpayers would have an enormous financial incentive to purchase insurance. This plan may
reduce tax re venues, but it achieves the goal of increasing tax payer access to health care without
increasing government expenditure. The government should place a high priority on increasing
access to health care without increasing government outlays and revenues. Many individuals who
currently do not have health care insurance would purchase it given these incentives. There is
no good reason to begin a value added tax to buy health care insurance for people who could buy
it themselves. Reluming control of health care expenditure to patients and their physicians, and
reversing the trend toward government payment and control of these services would serve us all
well eventually.
The alternative is to continue with the illusion that everyone is entitled to all possible health care
services at no cost to themselves. It is clearly impossible to control health care consumption
while operating under this illusion. Efforts to control costs by controlling prices, while
maintaining this illusion, will simply alienate the medical profession and result in new strategies
to maintain income. For example, when a third party payer reduces the price an internist can
charge for an office visit, the internist responds by reducing the time spent with the patient,
limiting the discussed problems at each visit, and reappointing the patient to address the
remaining problems. That would not happen if patients owned their health care insurance, paid
for routine office visits with their own hard-earned dollars, and took responsibility for controlling
costs themselves rather than relying on the intrusiveness of managed care. Quoting again from
the New York Times "immediate financial gains from squeezing health care providers could be
more than offset by the additional worthless procedures and bad will elicited in treating
physicians and hospitals as the enemy. ...focus on prices will distract from the core issue driving
medical inflation: the failure to ration ever more expensive technology."
�Robert N. Jenkins, M.D., Ph.D.
,. •
• • P6/(b)(6)
/ •'.
What would constitute the health insurance that the government is encouraging its citizens to
purchase? The insurance package should be portable, have no exclusions for preexisting
conditions, and should include everyone in a community with rates based on expenses in that
community. The government should abolish all current programs (VA, CHAMPUS, Medicaid,
and Medicare) and simply assist in the purchase of insurance for worthy recipients. What should
the plan cover and what should it not cover? 1 suggest that a minimum package which covers
catastrophic care, and does not cover ineffective measures, be developed by a federal health care
commission using the Oregon Medicaid plan as a model. We must ration health care by some
logical process. The Oregon experience tells us that it is possible to ration care, and we must
do it.
Such a system would logically promote and support outcomes research and clinical practice
guidelines. Third party payers would pay for expensive new technologies only after they have
proven beneficial by outcomes research and included in practice guidelines promulgated by
professional societies. A national health commission should determine the actual cost of services
so that hospiials set consistent, reasonable fees for their services. Currently, third party payers
pay some hospitals $2500 for a captopril renogram for which other hospitals charge only $800.
They also pay for services ordered by self-interested physicians without regard to the value (or
cost) of these services. In Dallas, a physician group purchased a hyperbaric oxygen chamber that
can hold 12 patients (still able to sip their morning coffee) to make money providing services of
marginal benefit. Why do some insurance companies pay for this? Because no one is pressuring
them to spend health care dollars wisely. Would patients spend their own money on things such
as hyperbaric chambers not included in practice guidelines? I wouldn't. It is very likely that the
shameless physicians that own this ridiculous equipment would not have purchased it and would
instead earn an honest living if consumers did not perceive health care as free.
How do we provide this health insurance package to poorer citizens? First, the government
strongly encourages them to buy insurance through legislation. The government should require
recipients of any entitlement, including social security, VA pensions, unemployment
compensation, federal pensions, student loans, food stamps, and earned income tax credits, to
purchase health care insurance to receive the benefit. The poorest of the poor may require federal
vouchers to be spent only on insurance, similar to the food stamp program. We would also
provide these vouchers to groups that a clear majority of us believe are entitled to it, such as
veterans wounded in combat. The tax incentives mentioned above and the proof of insurance
requirement for the receipt of earned income tax credits will encourage strongly all working
people to purchase insurance.
�Robert N. Jenkins, M.D., Ph.D.
P6/(b)(6)
Can we possibly afford such a system?. We can if we design the basic insurance package
carefully and limit it to what we should afford. How do we provide essential services such as
childhood vaccinations to everyone if we eliminate the idea of first dollar coverage by third party
payers? The basic minimum package should provide first dollar coverage for childhood
vaccinations, prenatal care, and other things of equally important benefit. Currently children are
not guaranteed access to vaccinations. If the basic plan offered first dollar coverage for only this
one item, it would be an improvement over the current situation. I envisage a plan that is most
generous to children because they are entitled to good health care no matter who their parents
are. How would poor people obtain other primary care services if they had to pay for it
themselves? Currently, Medicaid patients get their primary care in emergency rooms because
it costs them nothing, and because hospitals cannot turn them away. Most primary care
physicians refuse to see Medicaid patients because the government specified reimbursement is
ridiculously inadequate. A voucher system under local control is probably the best answer to this
dilemma. State governments, local governments, and charity organizations can best determine
who is in need of vouchers to pay for health care not covered by the basic policy. The vouchers
would allow access to any doctor during normal office hours and gel the patients out of the ER.
Recipients could contribute any unspent vouchers to their medical savings account.
As mentioned above, the basic insurance package must be limited in scope for the country to be
able to afford it for every citizen. Supplementary insurance packages would be available for
purchase with money from medical savings accounts, but not with tax-deductible dollars. Thus,
citizens receiving the basic plan alone would have an incentive to contribute to their medical
savings account to purchase supplemental insurance. Is this a two-tiered system? Yes. Is it fair?
Yes. Do we have a two-liered system now? Yes. Every health care system involving third party
payers rations services provided to recipients in some way and is, therefore, two-liered. Should
hard working, successful individuals have access to more health care services? They always have
and they always will. When we confront the fact that equal opportunity does not guarantee equal
results, our country will ask itself what level of health care is every American, no matter their
contribution to society, entitled to. We do not guarantee every citizen a Cadillac, or even a place
to live. Should we guarantee every alcoholic with cirrhosis a liver transplant, every 85 year old
with heart failure a heart transplant? I don't think so. Should every child have access to a polio
vaccine? We all think so. Can we afford to promise every 30 year old mother of three with
heart failure from viral myocarditis access to a heart transplant? I would vote to pay for that.
If not, at least supplemental insurance packages will offer this latter service. Citizens wanting
a supplemental policy will have an incentive to work and put their money in a medical savings
account, instead of frittering it away on unnecessary health care services.
�Robert N. Jenkins, M.D., Ph.D.
>6/(b)(6)
In summary, I believe history will show that empowering patients to control health care
expenditures is the only effective method of controlling health care costs. I hope that history will
not show that the Clinton administration destroyed the only great virtue of our current system:
the role ofthe compassionate physician as patient advocate. Rather than abandoning competitive
market principles as a means of controlling costs, we should embrace them and, in the process,
preserve the patient-physician alliance in promoting the patient's health. These ideas may be
difficult to sell to the American people, but good ideas often are. That is why I voted for your
husband, the great communicator. Remember the words of his idol: "We do these things not
because they are easy, but because they are hard." Do it before this decade is out.
Sincerely,
l&u^ii
r
I
Robert Jenkii/s, M.D.
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.FINANCING (VII)
MENTAL H E A L T H (EX)
. L O N G - T E R M C A R E (X)
.PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
.rural
urban
OTHER
�The Westmoreland
Health Care Reform Group
204 Mac§hall#3
Houston, /rexasy7006
713.1
March 23, 1993
Hillary Rodham Clinton
1600 Pennsylvania Ave.
Washington, D.C. 20500
Dear Ms. Clinton:
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On March 10, 1993, we sent you a letter outlining several points for consideration in
reforming the health care system.
Since that time we have completed the enclosed platform which we feel must be addressed
in meaningfully reforming our health care system.
It is our request that you carefully consider our platform. We would appreciate the
opportunity to discuss it with you or a member of your staff.
It is our intention to heighten the American public's awareness of these issues.
Clearly this platform is not all inclusive of the issues that your task force must address.
\ Our admiration and support of your efforts continues.
Sincerely,
Garrett R. Lynch, M.D. and James R. Machugj
Founders
�6
BAYLOR MEDICAL CENTER AT GARLAND
2300 Marie Curie
Carhind, Texas 75042
(214) 487-5000
January 28, 1993
F i r s t Lady Mrs. H i l l a r y Rodham C l i n t o n
1600 Pennisylvania Avenue
Washington, D.C.
Dear Mrs. Rodham-Clinton:
Congratulations t o President C l i n t o n and you.
e x c i t i n g and challenging time ahead of you.
You have a very
I understand t h a t President C l i n t o n has appointed you t o lead the
task f o r c e on h e a l t h care reform, and I admire your courage t o
t a c k l e t h i s c r i t i c a l issue.
This task w i l l r e q u i r e someone t o
study t h e issues w i t h a f r e s h perspective. To help you broaden
your knowledge about the health care f i e l d , I would challenge you
to experience f i r s t h a n d what a h e a l t h care provider faces on a
d a i l y basis.
I am t h e D i r e c t o r o f Quality---?^m^ncjerfM§adbcal S t a f f Support a t
Baylor Medical egTTCer "ere—e&glandV^k *g^a-be^generar~a-cute-^care
h o s p i t a l . Like most hospitals~~±Tr'this coTTET^ry today, we receive
v a r y i n g r a t e s o f reimbursement f o r our services depending on the
funding source - Medicare, Medicaid, managed care plans (HMOs,
PPOs), p r i v a t e pay, etc. To remain f i n a n c i a l l y solvent, we must
insure theit our cost o f p r o v i d i n g services t o the p a t i e n t i s not
greater than t h e amount we are reimbursed since most of our
reimbursement i s on a "discounted" basis. My j o b a t t h e h o s p i t a l
i s t o analyze each p a t i e n t ' s case from both f i n a n c i a l and c l i n i c a l
viewpoints and attempt t o balance the cost of p r o v i d i n g the best
possible care t o the p a t i e n t w i t h the amount of reimbursement we
w i l l receive f o r t h a t p a t i e n t ' s care.
For t h i s reason, my
department deals w i t h every aspect of t h e h e a l t h care d e l i v e r y
system - physicians, h o s p i t a l s t a f f , funding agents and p a t i e n t s .
An affiliate ofthe Baylor Healrli Care System
�To that end, I sincerely invite you to v i s i t our hospital and spend
a day or longer working with my department.
We provide the
monitoring functions required in today's health care f i e l d . We are
the patients' advocate as well as the watchdogs for government
funds.
Vfe also serve as the responsible party who answers to
Medicare, the Peer Review Organization, the Joint Commission on
Health Care F a c i l i t i e s and the insurance companies. The experience
of working with us w i l l provide you with a t y p i c a l , yet w e l l rounded, snapshot of America's health care system.
This cordial invitation i s an out-springing of our desire to help
improve the health care delivery system in the United States. Also,
please be aware that I as an individual have had numerous medical
needs within my own family over the past five years and am shocked
at the rapidly changing health care environment.
Our hospital i s a part of the Baylor Health Care System and i s
located 15 miles from the nationally renowned Baylor University
Medical Center in Dallas, Texas. Please consider my sincere offer
and that of my Executive Director and Chief of Medical Staff as we
open the doors of Baylor Medical Center at Garland to you.
Very sincerely yours,
Brenda Mcintosh
Director of Quality Assurance/Medical Staff Support
Gary Brock
EX^CVT^.ve Director
William Jernberg,
Chief of Staff
M.D.
�4
Task Force on National Health Care Reform
White House
Washington, D.C. 20510
Dear Members of the Task Force;
I am writing to you with my suggestions and even offer of help in any way possible
as both a patient and a newly minted physician, two viewpoints sorely needed in this
affair. I recently finished a residency in Family Practice- I ideally wanted to work in a
small town but have found that this is not possible anymore due to the current mess of
our health care system and the government forces in charge of it. Instead, I work in an
emergency room in a smaller town and daily have to deal with the system, a system so
bad that I frequently want to cry in frustration over it. Instead ofpreaching and
complaining, I instead list what I believe to be the main problems with our current health
care system. Like most physicians, believe it or not, I do wish we had a national health
insurance system so that all would be covered.
Problem 1- TECHNOLOGYThe main reason for rapidly expanding costs is the rapidly expanding technology
cf medicine that brings us everyday miracles. Unfortunately, miracles are not cheap.
And every miracle you invent causes it's own set of problems, such as how much is
enough and who deserves what treatment. 30 years ago, if Grandma had bad knee
arthritia, she got a 50 cent bottle of aspirin, $5 worth of advice and a $5 cane.
Now, Grandma gets a Titanium knee joint, thousands in surgical expenses and lots
ofphysical therapy-but she can walk again easily. We spendfar too much on terminal
care in our country, something no other country does anymore. We had a resident from
Canada spend a month with us and she was astounded that we even did anything for a
70 year old man who had a heart attack In her country, she would have patted his hand
and sent him home to eventually die. I dread to see the reaction ofAARP when our
country finally adopts a similar attitude- we all saw what happened when Social Security
was threatened- imagine their response to cutting down on their care!
�Yes, lawsuits. I could not help notice that in the State of the Union speech to
Congress, President Clinton failed to mention anything about lawsuits, not only in
Medicine but in every other area of this country. Lawsuits are interwoven so closely with
Technology, that the problems need to be considered as one. Simply put, if you don't
use all available technology to treat a patient, YOU GET SUED! Period. Not only
are Doctors living under the specter of overwhelming lawsuits, but so are every other
area of medicine from Ambulance crews to Nursing homes. In my area of work in the
Emergency room, a rough estimate of the costs of lawsuits indirectly approaches 50%
of all money spent in the ER. If a patient in a nursing home slips on the floor, the staff
immediately calls an ambulance even if the patient states they feel fine- "just to be safe",
which is another way of saying "we need to cover our buttsfroma lawsuit on the slim
chance that you did hurt yourself . The ambulance crew then puts the patient on a
backboard with a costly disposable neck brace "just to be safe" and takes the person
to the Emergency Room. This is because the nursing home called the patient's doctor on
the phone to tell them that she fell, and the doctor tells them to send her to the ER
"just to be safe". At the ER, the patient is put in a Trauma room since the person came in
by ambulance on a backboard with a neckbrace, since that is the hospital policy "just
to be safe"- a policy written by Risk Management (a.ka. the lawsuit prevention gang)
at the hospital. The ER doctor must then order neck X-rays since the patient is wearing
a collar, to cover his *** and to "be safe".
The cost of a slip andfall in the nursing home?
Ambulance transfer times two (to go back to the nursing home)
Emergency room visit, plus X-rays, plus Radiologists fees
A CTscan ($600) "just to be safe" if the patient is not 100% oriented
and alert, even if they are in a vegatative state permanently.
The extra nurses and doctors the hospital has to hire to see all the extra
patients this sort of silliness generates.
If we did not have the present Lawsuit crisis causing us to act this way, the Nursing home
staff would brush off the patient, put her back in bed and check her themselves 95%
of the time, saving everybody a lotta money!! But this will never change until the threat
of ridiculous lawsuits is cornered. Unfortunately, I have been told that there are several
lawyers on your committee but not one single physician. I do hope this is not so.
�Problems-
THE GOVERNMENT
Yes, the Government. One has only to realize that the current problems in
medicine started not long after the government got into ihe health care business, with
Medicare and Medicaid and all their bizarre regulations and Byzantine rules. In fact,
almost all cf the resistance to Nationalized Health care by doctors is because cf the way
that they have been treated by the medicare system- chronically lied to, threatened,
intruded on and bullied beyond belief. Why would they want ALL of their patients
to be under a system like this?
I did a time study at work on myself recently-1 literally spend more time doing
required paperwork than I spend time with my patients! In a 12 hour shift, that's 7.5
hours on paperwork and phone calls!!! This is one reason why our system is so slow and
expensive, just like most parts cf the government.
I recommend that if you do set up a National Health care system, you head it with
no one from the current Medicare or Medicaid system. Instead, use people from the
private sector who are used to making things work smoothly and reasonably.
Problem 4- INSURANCE COMPANIES
An insurance company is in business to make money-period. And the only way to
do that is to take in more money than you spend, by short changing patients, doctors
and hospitals. In our city, the local medical society met with the two biggest employers
to discuss their concern with the rise cf health care costs- 20% in ihe last year aione
to the two companies. But they were suprised to find that the local hospitals and
doctors had showed little gain or even losses for the previous year!! Where did the
money go? Their 20% increase in health care costs was solely due to increased
insurance premiums, not to local increased costs. I'm all in favor cf a single payer
system to eliminate the incredible profits being shown by insurance companies-just
look at Blue Cross-Blue Shield's PROFITS for the last few years to see what I mean.
Problem 5-PATIENTS
Yes, the people who utilize healthcare. The media has sold the American public
the idea that there is a shot for everything, that "Star Trek Medicine" really does exist.
�and that you should see your doctor for everything. People have come to expect miracle
cures for the common cold, flu, sickle cell and aids and are quite upset when they don't
get it. And they firmly believe that NO ONE SHOULD EVER DIE-EVER!
I recently heard the family cf a 104 year old lady who hadjust passed away, crying in
the hallway, wanting to know angrily " who killed their grandma?"! They had
demanded that everything be done to keep her alive, don't spare the expenses ( she was
on Medicare and Medicaid) and were upset that she had died and were going to sue
the hospital to find out why she died.
The other main, massive problem I see daily is the ABUSE cf Medicaid by most
of the people on it. 70% of the visits to the Emergency room by people on Medicaid
are unnecessary and could and should be handled in a regular doctor's office, but
these people will not go! They are given a card allowing themfreecare anywhere they
show up, and the hospitals have to put up signs telling them that they can't be refused
teatment, no matter how stupid their complaint is. Ask anyone who works in an
Emergency room about this- receptionists, nurses, etc... They are sick of the daily abuse
of this .system that tells them it's perfectly okay to have as many babies as you wantthe government will pay for it! Everyone who works for a living has to plan for a baby,
make sure they can afford to have a baby, feed it and raise it. Not so with Medicaid.
My suggestion is that you tell Medicaid patients that Medicaid will only pay for
ONE hzby and only if they are married. Any further babies and they will have to pay
the hospital bill themselves. Second, offer free birth control and strongly require
them to use it. Third, all hospital Emergency rooms must evaluate all patients who
seek care there, BUT if they are on Medicaid and they do not have an emergency,
but are there for a stupid, wasteful reason, that we agree to see them but inform them
that Medicaid will not pay for the visit and that they will have to- unless they choose
to see their regular doctor at his/her office where Medicaid will pay for it. I absolutely
guarantee that this will save Medicaid Tens of billions per year in unnecessary visits.
No harm will be done to anyone. Medicaid has plenty of money, if the government would
cooperate with helping us spend it wisely and cut waste by the patients. I am also
amazed at how many people on Medicaid can not afford a $2 bottle of Tylenol for
their child, but can afford $3 a day to smoke ($90 a month). The waste in the Medicaid
system is astronomical and I just can't see raising taxes to support such a wasteful
system anymore.
�Yes, I will even name the Health care industry as a problem to itself.
Unfortunately, I'm sure you've already grilled this part to death. But if you cut out
the choking regulations, and increase pay to the primary care doctors (pediatricians,
family practice and internal medicine) while cutting pay to overpaid specialists,
you'll have a system that runs much more cheaply and efficiently. Unfortunately,
some doctors have learned to cheat the very system that cheats them with medicare.
Most of my friends are suprised haw LITTLE I make as a doctor compared to what they
think I make. I am so disgusted so far with the system that I actively discourage kids
from going into medicine every chance I get-1 tell them to got to Law School like
everyone else does. Just look at your committee to see why.
Unfortunately, our system is headedfor severe times regardless of the outcome
of any health care overhaul. Most older doctors plan to retire early if we get nationalized
medicine and many foreign trained doctors tell me that they will return home, where at
least thy won't get sued. Rural America already has a severe shortage cf doctors and
everything the government has done so far has only made this situation worse.
Problem 7-SOCIAL PROBLEMS
The hardest problem to cure. Again, when one asks just when medicine got to be
such a mess is about the same time we started having severe problems with drug abuse,
gang and other violence, teenage pregnancy, lawsuit abuse, an exploding elderly
populati on, AIDS and every other social ill you can think cf. I have no suggestions to
this other than what I've said previously. Such as not paying for unlimited children,
drug rehted problems and endless high tech care for the elderly fruitlessly.
This part I shall leave to the politicians.
In closing, I again beseech you to put some Physicians on your team. I will
be happy to volunteer if you lack any other volunteers. I also suggest that you spend time
with some physicians and other health care workers to see their side of the problem and
hear their suggestions, which will be numerous and quite insightful.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Hopefully yours.
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�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND TYPE
002. letter
SUBJECmiTLE
DATE
Address (Partial); Phone No. (Partial) (1 page)
04/21/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [8]
2006-0885-F
jm778
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)l
Freedom of Information Act - |S U.S.C. SS2(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
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information 1(b)(4) o f t h e FOIA]
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concerning wells 1(b)(9) o f t h e FOIA|
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and his advisors, or between such advisors |a)(5) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�^
SLi'i
....
..
;
PETER A. OLSSON, M.D.
April 21, 1993
Mrs. Hillary Clinton, Chair
White House Health Care Task Force
The White House
1600 Pennsylvania Ave.
Washington, DC 20500
Dear Mrs. Clinton:
I am a practicing psychiatrist and a constituent. I treat people with a wide variety of
mental conditions. What they have in common is very inadequate health insurance,
which creates severe problems for those who require anything more than very brief
treatment. In addition, many patients have had a great deal of difficulty with
managed care firms that make them change therapists in the middle of treatment, or
that are so intrusive in their frequent demands for personal information that some
are unable to go on with the work. At times the intrusions seem to be nothing less
than harassment. I have been unable to work with some managed care firms because
they are simply unwilling to support the kind of in-depth treatment that patients need
in order to make substantial progress or even to maintain equilibrium and remain
functional or outside a hospital.
As health care reform takes place, I hope you will take a string position in favor of
non-discriminatory coverage for ah who suffer with mental illness. Legislation that
restricts equitable benefits to "severe" illness only creates major problems of deciding
what is sever and what is not, and it pushes the line of stigma and humiliation onto
the patients whose suffering is deemed not to be severe, i.e., second class. [S.491
(introduced by Senator Paul Wellstone)] H.R.1200 (introduced by Representative Jim
McDermott) is a comprehensive health care reform bill, with non-discriminatory
coverage for mental illness. H.J..Res.59(Repr. Eleanor Holmes Norton) is a conjoint
resolution that calls for non-discriminatory coverage for the mentally ill in any health
care legislation. [S.J..Res.l6 (Sen. Richard Shelby)] H.J..Res.52 (Repr. Mike
Kopetski) calls for equitable coverage for mental illness in any health care legislation.
Many patients would be very grateful to you if you signed on as a co-sponsor of these
bills and resolutions.
P6/(b)(6) •
�Mrs. Hillary Clinton, Chair
White House Health Care Task Force
Continued / Page 2
I understand the need for responsible management of utilization of scarce resources.
However, it is extremely important that any system of managed care that is part of
health care reform should not disrupt ongoing therapist-patient relationships, should
be appropriately designed so that it does not damaged the treatment that it is
supposed to oversee, should have a fair and impartial appeals mechanism, should
have provider input and a mechanism to prevent harassment, should provide access
to intensive or long-term treatment where needed, should safeguard confidentiality
and privacy, and should have no financial incentives to reviewers to deny care.
The new health care systems must allow patients to contact for care over and above
basic services without interference, at their own expense or with supplemental
insurance. Freedom of choice of physician or therapist must be preserved.
As the nation proceeds with the massive task of health care reform, I hope that you
will consider me to be a resource in understanding issues that have to do with mental
illness as well as health care in general. I hope I may at some time have the pleasure
of meeting with you and your staff, and I wish you well in this new term of Congress.
Sincerely yours,
Peter A. Olsson, MD
cc: Norman A. Clemens, MD, Chair
Committee on Government Relations and Insurance
PAO/ct
�I
- •*
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NOTICE
PERSONAL INFORMATION HAS BEEN REDACT]
FROM THIS DOCUMENT
�February 12, 1993
Hillary Rodham Clinton, Chairman
Task Force on Health Care Reform
1600 Pennsylvania Avenue, N.W.
Washington, DC
Dear Mrs. CIinton:
I applaud the efforts of your group. Reform of our system is mandatory at this
time. I have beep working full'time for a large Health Maintenance
Organization for five years and wish to share some thoughts.
One of the biggest obstacle to any change is the issue of "choice". But
I feel that i t is ah emotional lightning rod that is poorly understood. People .
with indemnity insurance are free to "choose" any health care provider. But
how do people u t i l i z e this choice? Very few travel around to the "best"
physician available. I f they did most doctors would be unemployed. Instead,
they select physicians based on their own experiences, recommendations from
friends and recommendations from other physicians and health care providers.
These choices are frequently based not on competence, but rather on affability
^nd congeniality. Furthermore, referring physicians may base the referral on
•/'friendship, business relationships and other non-medical issues. In our large
§rbup model HMO, we have over 400 physicians. With the exception of a few
/specialties, there is more than one physician to choose from for any
"Situation. People are not forced to remain under the care of a physician whom
,they do not get along with or trust.
Second, although medicine is based on the scientific study of human biologic
problems, very l i t t l e of the practice of medicine is scientific. That i s ,
most of what we clinicians do is empirical, based on past experience. Outcome
studies are needed to clarify and define the best manner of treatment. This
may interfere with the physicians concept of "choice" and "freedom". However,
i t is entirely possible that many treatments are not helpful and may even be
harmful.
Worker's compensation is a horrible situation not unlike medical malpractice
and third party liability. Compensable injury is the biggest deterrent to
regaining health. It also generates large amounts of additional costs in terms
of physical therapy, job re-training and administrative fees. If you could
, find a fair way to alter this situation, overall costs could be diminished.
Finally, I enjovjTiv__settinq in managed care. I an s t i l l very much a
physician, _but I do not have the responsibilities of managing an office and
collecting payments. Indeed, I have a very different relationship with my
patients because there is no direct exchange of money for services rendered.
�This does lead a l i t t l e to excess utilization. However, people are not as
angry with poor outcomes, because they have not paid for their bad results. I
earn about one third less than my colleagues in private practice. However, I
work less hard in a less stressful venue. Furthermore, my patients receive
quality care. Indeed, my group does not retain physicians who perform poorly.
Our requirements may even be higher than the community as a whole. Managed
care is not something to be feared, instead i t can actually improve the
quality of care i f done correctly.
Good Luck.
Sincerely,
Saul J. Kaplan, M.D.
�J. PHILIP K E E V E ,
M.D.
February 28, 1993
Mrs. Hillary Oldham Clinton
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
Dear Mrs. CIinton,
I have been following some of the childhood health care programs
and policies offered by your advisors and I am not aware that any
of the following suggestions have come to your attention:
1. Newborn H m Visits
oe
The United States may be the only advanced industrial nation which
does not visit the home of a newborn to make sure that the baby is
given a proper start in l i f e . These programs are very flexible,
providing a variety of home visitors which link these calls to other
community resources i f needed. This is a relatively low cost-high
return investment which deserves priority attention.
2. Day Care, Pre-School and Nursery Programs
These urgently needed family services are a maze of bewildering choices
for most parents. They range from unsupervized, unqualified caretakers to regulated facilities with high standards. Few of them
however, have adequate health care supervision despite Federal, State
and local requirements. The number and variety of these places seem
to defy esgecially the health aspects.
v
3. School Health Needs
Despite massive Federal and State attention to the health needs of
school age children, the services in most local communities are substandard because parents are suppose to assume the burden of providing
care for their own children and local public (tax) support is therefore
not provided since they are not mandated by the State. School health
around the country is a patchquilt of effort and offering which has
not responded thus far to the technical support available from official
agencies.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
1 -
�I have had 30 years of experience with the health needs of children;
Board Certified in Pediatrics and Preventive Medicine; worked in
small villages in Asia and Africa, and in the big cities of our
country. I would like to help you with your health care efforts.
Please have your staff review m resume"and let m know i f I can be
y
e
of help.
Sincerely,
i
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�JACK P H I L I P K E E V E , M . D . , M . P . H .
CONTACT:
PROFESSIONAL EXPERIENCE:
Director, Loudoun County Health Department, Leesburg, VA. 22075,
2/89 - 2/93
Director, C i v i l i a n Employees' Health Service, The Pentagon, Room
1E356, Washington, D.C. 20310-0001, 12/86-2/89
Medical-Director (Occupational Health), Naval Research Laboratory,
Washington, D.C, 7/83-12/86
C l i n i c a l Professor, Assoc. Residency Director, University of
C a l i f o r n i a , I r v i n e , 1982-1983
Medical Director, A t l a n t i c R i c h f i e l d Company, Research and
Engineering Center* Newton Square, Pennsylvania, 10/80-7/82
Medical Advisor,. Office of Research and Development, Division of
Health Effects-Environmental Protection Agency, Washington,
D.C, 6/78-9/80
Health Programs Administrator, Agency for International Development,
Department of State, 5/69-6/79
Associate Professor, School of Public Health, University of
Pittsburg, 6/66-5/69
ACADEMIC APPOINTMENTS:
C l i n i c a l Professor (Occupational Medicine), George Washington
University Medical Center, 1979-Present
C l i n i c a l Professor (Medicine), University of C a l i f o r n i a Medical
School, 1982-1983
Lecturer (Epidemiology), Yale University, 1981-83
Professor (Preventive Medicine), L i b e r i a College of Medicine, 6/752/78
Adjunct Professor (Preventive Medicine), George Washington
University Medical Center, 8/71-4/73
Lecturer (Preventive Medicine), School of Medicine, Hue, Vietnam, *>
4/73-10/73
Professor (Population Planning), University of Philippines, 5/69-.^^
8/71
.y
Associate Research Professor (MCH), Graduate School of Public
Health, University of Pittsburg, 6/66-5/69
A s s i s t a n t Professor (Preventive Medicine), New York Medical
College, 9/60-6/68
V
.
:
�HOSPITALS:
Attending
Staff:
Loudoun H o s p i t a l Center, (Hon.), Leesburg, VA.,
1989-Present
U n i v e r s i t y of C a l i f o r n i a , I r v i n e Medical Center,
1982-1983
Care Unit R e h a b i l i t a t i o n & P s y c h i a t r i c H o s p i t a l ,
1982-1983
Consulting S t a f f :
P a o l i Memorial H o s p i t a l , P a o l i , Pennsylvania,
1981-1982
Bryn Mawr H o s p i t a l , Bryn Mawr, Pennsylvania,
1981-1982
Medical L i c e n s e s :
C a l i f o r n i a , New York, Pennsylvania, Connecticut,
Washington, D.C, V i r g i n i a , and L i b e r i a
Research I n t e r e s t s :
I n t e r n a t i o n a l Health, Epidemiology, Health
P r o j e c t Design and E v a l u a t i o n , Health P o l i c y
Analysis
PROFESSIONAL MEMBERSHIPS:
Fellow:
American
American
American
American
American
Academy of P e d i a t r i c s
College of Preventive Medicine
College of Occupational Medicine
P u b l i c Health A s s o c i a t i o n
College of P h y s i c i a n s
Royal S o c i e t y of T r o p i c a l Medicine and Hygiene
DEGREES/QUALIFICATIONS:
Board C e r t i f i e d :
American Board of Preventive Medicine, 1982,
C e r t . #12522, P e d i a t r i c s , 1955, C e r t . #6620
M.P.H.:
Yale, 1958
M.D. :
N.Y.U., 1952
Internship:
Mary Hitchcock, Hanover, New Hampshire, 1952-53
Residency:
Meyer Memorial & C h i l d r e n ' s H o s p i t a l , B u f f a l o ,
New York, 1953-1955
CLINICAL AND MANAGEMENT EXPERIENCE:
U n i v e r s i t y of C a l i f o r n i a , I r v i n e : Outpatient C l i n i c s , 1982-1983
A t l a n t i c R i c h f i e l d Employees, 1980-82
U.S. & Host Country Employees Overseas, 1968-78
U.S. Navy Medical A p p r a i s a l s , 1958-80
P r i v a t e P r a c t i c e , 1955-65
Naval Research Laboratory, Pentagon C i v i l i a n s , 1983-89
�POST GRADUATE EDUCATION:
Yale:
MIT:
AID:
USNR:
EPA:
University of Pittsburg:
American Society of Law
& Medicine:
AOMA:
University of Massachusetts:
University of California:
Military Service:
Master Public Health, 1958
National Nutrition Planning, 1972
Advanced Administration, P o l i t i c a l
Science, Project Design &
Evaluation, 1975
Tropical Medicine, Medical
Administration, 1978
Chromatography, Risk Analysis, 1979
Computer Programming & Systems Analysis,
1964
Worker's Compensation, 1980
Occupational Epidemiology, 1981
Epidemiology, 1982
Treatment of Chemical Dependency, 1982
U.S. A i r Force
U.S. Naval Reserve
�PUBLICATIONS:
1.
Ototoxic Drugs and The Workplace: American Family Physician 38 (No. 3) 177-181 Sept
1988
2.
The Sun & Your Health: U S Navy Medicine 76:15 Mar 85
..
3.
Physicians at Risk: S m Epidemiologic Considerations of Alcoholism/Drug Abuse and
oe
Suicide; Occupational Hazards of the Health Provider, 1983
Journal of Occupational Medicine 26:503 July 84
4.
Epidemioloqy of Industrial Accidents, 1982
Journal of Health, Policy and L w 8:581 Fall 83
a
5.
Fertility Experience of Juvenile Girls: A Community-Wide Ten Year Epidemiologic Study
Journal A H 59:2185-98, 1975
PA
6
.
Water Supply and Diarrheal Disease and Nutrition:
Recommendations for Research:
I R - R 616.342072-W187 Vol. 1, 1975
BDAC
7.
Early Malnutrition and Mental Development Pediatric Priorities in the Developing World
War on Hunger: AID Washington, D.C, 1975
8.
Medical Nemesis: Lancet 1:1160, 1974
Letter submitted for publication.
9
.
Orgasm-Induced Abortion:
Lancet 1:970, 1973
Letter submitted for publication.
A Survey of the Literature and
10.
Observations of a Visiting Pediatrician, Philippine Journ. of Pediatrics
20 (4) 158-166, 1971
11.
The Role of the Community Hospital in Family Planning
Australian Hospital Association, Sydney, 1970
International Hosp. Federation Third Regional Conf.
12.
Overcoming Obstacles to a Creative School Health Program
Health Education, 1967
13.
Cultural Deprivation: Operational Definition.
American Orthosphychiatry 40 (1) 77-86, 1970
14.
Perpetuating Phantom Handicaps in School-Age Children
ExceptionalChildren pp. 539-44, 1967
15.
Responses to a Teacher Health Knowledge Inventory
Journ. of School Health 37:384, 1967
16.
Part-Time Service in School Health Programs
N State Journ. of Medicine 65: 1759-67, 1963
Y
Selected Social, Educational and Medical Characteristics of Primiparous 12-16 Year Old
Girls
Pediatrics 36:394-401, 1965
17.
�INVITED P E E T T O S
RSNAIN:
Unpublished Papers, copies available
1.
Consequences of Contemporary Uncontrolled Fertility, Hospital Experience:
Saigon
World Population Society, Washington, D.C, 1973
2.
Population Planning in Liberia
Seminary on Population Growth and Development Planning
IPPD/University of Ghana, 1976
3.
Social Justice, Science and Safety for Environmentalists: National Assoc. of Community
Health
Washington, D.C, 1979
4.
Emergent Themes for Child-Care Program Emphasis
Annual Meeting A H Miami, 1967
PA
5.
Principles of Preventive Medicine and U S Foreign Assistance
..
U M R Fourth Civil Affairs Group
SC:
Washington, D.C, 1972
6
.
Evaluation of Medical Research
Bureau of Medical Research
Bureau of Medicine and Surgery U N
S
Washington, D.C, 1972
7.
Science and Politics of Health Regulation
Medical Society of Washington, D.C, 1979
8.
The Epidemiology and Microbiological Aspects of Water Purity
Global Epidemiology Working Group
Washington, D C 1979
..
9
.
Feasibility Study for Health and Nutrition Benefits of N w or Improved Water Supplies
e
(Research Proposal Presentation) AID/Bu Census, 1975
10.
Project Director: Proceedings of the Scientific Review on Diesel Emission
Health Experts Research Program
E A O D Washington, Die, 1978
P/R
11.
Project Director: International Conference of Appropriate Technology to Chemical Dose
and Chemical Residue Monitoring
E A O D 1980
P/R,
12.
Employee Health Education Column in A C Chemical Research Center,
RO
Medical Aspects of Retirement Stress Management
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D O C U M E N T NO.
AND T Y P E
003. envelope
SUBJECT/TITLE
DATE
Address (1 page)
03/02/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [8]
2006-0885-F
jm778
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Freedom of Information Act - |5 U.S.C. 552(b)|
PI
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an agency 1(b)(2) of the F O I A |
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b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e F O I A |
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) o f t h e F O I A j
b(9) Release would disclose geological or geophysical information
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Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
P R M . Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CODER: Q f \
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
fiENERAL SORT:
POSTCARD 1:
Personal stories
General mail
.Letter Campaign
Other Health Providers
POSTCARD 2:
vOffers to help/Employment
FORM L E T T E R
Letterhead
REROUTE:
Casework
Physicians
_Policy
Scheduling
President
Other
POLICY AND PERSONAL STORIES:
ORGANIZATION (I)
..insurance premiums
insurance reform
insurance pools
boards and oversight
_COVEEAGE (H)
w orking families
^unemployed/low income
..benefits
_providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
^medicare
medicaid
veterans
DoD
Indian health
_COST ISSUES (VI)
drug prices
physician fees
Jiospital fees
jnedical equipment
fraud & abuse
.FINANCING (VII)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
.rural
urban
OTHER
�WORKERS' COMPENSATION COMMISSION
CHARLES G. JAMES. CH/..RMAN
ROBERT P. JOYNER, COMMISSIONER
WILLIAM E. O'NEILL, COMMISSIONER
DIVISION OF CRIME VICTIMS' COMPENSATION
LAWRENCE D. TARR, CHIEF DEPUTY COMMISSIONER
P. O. BOX 5423
RICHMOND. VIRGINIA 23220
ROBERT W. ARMSTRONG, DIRECTOR
MAIN NUMBER
(804) 367-8686
(V/TDD)
February 18, 1993
Mrs. Hillary Clinton, Chairperson
National Health Reform Committee
1600 Pennsylvania Avenue
Washington, DC 20500
Dear Chairperson:
I a following up on m letter of January 28, 1993, which I hope by
m
y
now, has been reviewed by your staff. I know you w i l l receive many
suggestions on how to accomplish your goal but I feel strongly that m
y
ideas offer some workable solutions.
Enclosed i s a copy of m original letter and a supplement expanding on
y
the suggestions contained in the original letter.
Please relay m congratulations to the President on his speech of
y
February 17, 1993. I t was well done and I support his plan.
Eully,,
\ &
Robfert' W. Armstrbng
Director
RWA
Enclosures (2)
cc:
Dan Eddy, Executive Director
National Association of Crime Victim Compensation Boards
�L$ J
COMMONWEALTH 0/ V1RQINIA
WORKERS' COMPENSATION COMMISSION
CHARLES G. JAMES, CABMAN
DIVISION OF
C R I M E VICTIMS' COMPENSATION
ROBERT P. JOYNER, COMMISSIONER
WILLIAM E. O'NEILL, COMMISSIONER
LAWRENCE D. TARR. CHEF OEFUTV COMMISSIONER
ROBERT W A R M ^ O M ^
ROBERT W. ARMSTRONG, DIRECTOR
M
P. 0. BOX 5423
RICHMOND. VIRGINIA 23220
January 28,
Mrs. H i l l a r y Clinton, Chairperson
National Health Reform Committee
1600 Pennsylvania Avenue
Washington, DC 20500
A
I
N
NUMBER
'"Ji/S!)
6 8 6
1993
Dear Chairperson:
I am writing in regards to your committee for the development of a
national health care program.
F i r s t , I would l i k e to point out that
Virginia's Crime Victims' Compensation
Formerly I served as a police o f f i c e r
Police from July 1964 to January 1979.
of my l i f e has been i n public service.
I have been the Director of
Program since January 1979.
with the Richmond Bureau of
As you can see, the majority
As Director for Crime Victims' Compensation, my daily a c t i v i t i e s
primarily include verifying the a v a i l a b i l i t y of health insurance
coverage or the lack of same for crime victims and their families.
The majority of victims are without health insurance and must pay for
their medical care directly, f i l e for bankruptcy, rely on public
assistance, or default on payment of their b i l l s . Surveys within my
own agency reveal that sixty-six percent (66%) of victims are without
any form of health insurance.
I have witnessed numerous cases wherein private hospitals s h i f t
patients to state hospitals as soon as Medicaid benefits expire,
patients who need corrective surgery including dental care, and
victims, especially children, who have suffered physical and sexual
abuse need treatment but cannot afford same.
There are many programs available that provide payment for health care
other than private insurance such as Medicaid, Medicare, Champus, FHC,
VA
Hospitals,
Hill-Burton,
Workers' Compensation,
State-Local
Hospitalization, Crime Victims' Compensation, etc.
While these
programs are helpful, they s t i l l have many shortcomings of which I can
elaborate i f requested.
I believe a National Health Care Program can be developed without
causing a lot of negative feedback and can be a p o l i t i c a l asset to the
presidency i f i t i s carefully constructed and articulated.
�Mrs. H i l l a r y Clinton, Chairperson
January 27, 1993
Page 2
The public i s worried that a national health plan will, cause an
increase in taxes and reduce the quality of health care. Both of
these concerns can be abated by pointing out how much current programs
such as Medicaid, Medicare, Champus and VA Hospitals already cost
taxpayers.
Then point out how every time a patient defaults on
payment of their medical b i l l s the costs are passed on to everyone who
seeks medical insurance or medical care through higher insurance
premiums and higher fees for medical treatment. Also, there are the
i n d i r e c t costs such as the need for courts and personnel to handle
lawsuits and judgments f i l e d by medical providers against t h e i r
patients.
Currently medical providers who treat patients under Medicaid or
Medicare are only being reimbursed at about forty-eight percent (48%)
of the actual charges, depending on whose side you l i s t e n to. Anyway,
i t i s low and a f a i r and equitable health care system could improve
t h i s condition. Medical providers also claim a national health care
program w i l l diminish their i n i t i a t i v e to improve the quality of
health care i f limits are placed on the amount providers can charge.
In e i t h e r of these cases, i f medical providers know they are going to
receive f u l l compensation from a l l patients and not j u s t a select few,
the quality of medical care should improve and there should not be a
need to pass on an increase i n the cost of health care or taxes to the
public.
There are numerous options available in creating a national health
plan. Based upon my experiences, the opinions of my colleagues and
numerous medical providers, I would prefer to see a singular health
care system i n s t a l l e d and the elimination of a l l other federal health
programs. The savings in administrative costs alone could fund a
national system, and other l i m i t s i n areas such as malpractice s u i t s
could save millions annually.
I f you feel that I may
-SBrVTceT:
"
be of value to your committee, I_ offer my
- "
"
Respectfully,
I,
11
RdBert W. Armstrong
Director
RWA/rac
cc:
Dan Eddy, Executive Director
National Association of Crime Victim Compensation Boards
�NATIONAL HEALTH PROGRAM
Eliminates current Federal Health Care Programs and replace them
with a single Federal
should be contracted
(National) health care system.
out
to Private Health Companies with
Federal management ( i . e . set standards,
etc.).
The
This program
program could
partial
covered s e r v i c e s , amounts,
operate similar to our
current Medicare
system including both Parts A & B, but every c i t i z e n of the U.S. would
be provided coverage at b i r t h .
This program should provide basic coverage to include a limited
number of days for hospital treatment, mental health, dental, eye, and
physician care.
insurance
on
Individuals could then purchase supplemental health
their
own
or
employers could
still
purchase
group
benefits for t h e i r employees at a greatly reduced price because of the
basic health care provided by the Government.
This would also reduce
the cost of Workers * Compensation Insurance for employers.
These two
reductions would stimulate growth i n business.
Use of t h i s system would provide competitive
Insurance Companies.
rates for Private
This would also prevent the loss of many health
insurance companies and jobs as the Health Program would b a s i c a l l y be
administered by Private Companies and would be competitive i n nature.
The closing of VA Hospitals would have l i t t l e impact on the number of
jobs l o s t as there i s a demand for persons trained i n health care.
Medicaid i s largely administered
by states.
Their personnel have
multiple job duties so they can be phased into other duties.
Most
other positions could be consumed through a t t r i t i o n i f the program i s
phased i n over a four year period.
�The Federal Programs could save money by providing limits on the
dollar amount one could collect on law suits for malpractice and
provide malpractice insurance at competitive rates to medical
providers.
Inappropriate charges should be eliminated such as doctors
charging over $100.00 per patient for a hospital v i s i t when they come
and spend five minutes checking on their daily progress and they have
multiple patients in the same institute, or anesthesiologists charging
for their services when i t i s not used just because they are advised
they might be needed. They already have other patients and duties at
the same institute and would be their anyway.
Another cost saver would be to put s t r i c t e r limits on lawsuits of
medical providers. I f a patient sues a provider and losses the suit,
the patient should only have to pay for the provider's attorney fees
and vice versa.
�CONSULTANTS IN CARDIOLOGY, P.C.
1615 F R A N K L I N R O A D , S.W.
ROANOKE, VIRGINIA 24016-5235
P H O N E (703) 9 8 2 - 8 2 0 4
FAX (703) 3 4 4 - 6 8 9 8
m i u r
T.
SI-IINKK.
M.D..
F.A.C.C.
:
J O H N C. I . Y S T A S H , M . D . . I . A . C C .
I. H A Y i : ) E N H O L I . I N C I S W O K n - l . M . D . , r . A c c .
P K A N K A . l i N C I . A N D . M . D . , r-.A.C C.
I O I - I N w . STAKR. M . D . , K.A.C.C.
W I L L I A M |. W E L C H , M . D . h A C C .
"
l O S C I ' l - l L. A U S T I N . M . D . , | - - . . \ . C C .
BRENT W . C H A I ' M A N , M . D . , E . A . C . C
KOUIiK'l
lAMHS M . I'AI.AZZO,
I!. R U D I ; , M . D . . K.A C C
ADMINISTRATOR
March 2, 1993
The Honorable H i l l a r y Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington, D. C. 20500
Dear Mrs. Clinton:
I am a physician p r a c t i c i n g cardiology i n Roanoke, V i r g i n i a .
Before
subspecializing i n cardiology, I d i d family practice i n a very small r u r a l
commimity i n Kentucky. I have gone from the f r o n t l i n e of medicine to a mostly
r e f e r r a l p r a c t i c e . The expense of medicine has c e r t a i n l y gotten out of c o n t r o l
and something needs to be done, including medical coverage f o r everyone.
Please, however, consider what I see as the major problem to health care
cost-cigarettes and alcohol. I cannot t e l l you the enormous medical costs that
are incurred by these two vices. Almost every young person under the age of 60,
that I see w i t h a heart attack or angina, smokes, yet nothing i s mentioned about
smoking when debates or medical expenditures are discussed. I wonder why we
cannot have a $5.00 tax on each pack of cigarettes and t h i s money applied to
health care. I know that tobacco growers w i l l be h u r t , but what about the
morbidity and m o r t a l i t y from smoking?
Are the c i g a r e t t e lobbyists that strong? Please, please make every e f f o r t
to attack the source of the medical problem. Stand up to the tobacco industry!
Of courst:, the same can be said of alcohol and the tremendous devastation i t
causes.
I am more than w i l l i n g t o have my fees reduced to help w i t h cost
containment. Please, however, target a major source of the problem. I have
never w r i t t e n a public o f f i c i a l before f o r any reason and I do not l i k e p o l i t i c s .
I do, however, f e e l strongly about t h i s and I hope my concerns are heard.
Thanks f o r l i s t e n i n g and I would l i k e a response to my l e t t e r .
Sincerely,
FRANK A. ENGLAND, M D
.
FAE/jwh
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AND TYPE
004. letter
SUB IFXT71ITLE
DATE
Address (Partial) (1 page)
03/10/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [8]
2006-0885-F
jm778
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b(2) Release would disclose internal personnel rules and practices of
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b(3) Release would violate a Federal statute 1(b)(3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
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b(6) Release would constitute a clearly unwarranted invasion of
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b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIAj
National Security Classified Information |(a)(l) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRAI
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(aK6) of the P'RA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
KR. Document will be reviewed upon request.
�Dieter ~ H.M. Groschel,
4r „ , . —
M.D.
:
.P6/(b)(6)
'
;
10 March 1993
Mrs. H i l l a r y Rodham C l i n t o n , Chair
Task Force on H e a l t h Care Reform
The White House
Washington, DC 20001
Dear Mrs. C l i n t o n ,
I t i s w i t h g r e a t a n t i c i p a t i o n t h a t I look forweard t o t h e r e p o r t o f
your Task Force on Health Care Reform i n t h e U n i t e d S t a t e s . As a
p h y s i c i a n and medical educator I b e l i e v e t h a t i t i s h i g h time t h a t
someone look s e r i o u s l y a t t h e world's best medical—care—system
which many^aTnTOt--arf*N?<^4ia^
medicine
f o r a few years, i n Germany, I have supported a s i n g l e - p a y e r system
and have been r a t h e r s c e p t i c a l about managed c o m p e t i t i o n due t o i t s
r e l i a n c e on t h e f r e e market insurance i n d u s t r y . The Reagan-Bush
years have shown t h a t t h e f r e e market f o r c e s cannot s o l v e our
s o c i a l problems because t h e " t r i c k l e " stop a t t o o h i g h a l e v e l .
However, I would be happy w i t h any government-controlled system
t h a t assures h e a l t h care f o r a l l a t a reasonable p r i c e . Our present
system ha.s f a i l e d d e s p i t e t h e assurances from organized medicine
and some o f my colleagues i n t h e u n i v e r s i t i e s t h a t - i t being t h e
best i n t h e w o r l d - i t must be r i g h t f o r t h e people o f t h e United
S t a t e s . I t no longer i s , and I hope t h a t your e f f o r t s w i l l b r i n g an
improvement.
I n your d i s c u s s i o n s you should consider t h e American Health
S e c u r i t y Act__of iggs^-Sponaored by Rep. Jim McDermc3tt~(&"WA-)-r-S«ftTPatri—WeTmrtone (D-MN) , and Rep. John Conyers (D-MI) . I support t h i s
Act and am sure t h a t t h e sponsors would be happy t o discuss i t w i t h
you and your group.
Wishing you t h e best w i t h your Task Force and hoping t h a t you and
your husband w i l l b r i n g us t h e long-awaited reform o f t h e h e a l t h care system, I am
Yours s i n c e r e l y ,
DOC\HRCLINTON.HCR
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [8]
2006-0885-F
.im778
RESTRICTION CODES
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Freedom of Information Act -15 U.S.C. 552(b)|
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P3 Release would violate a Federal statute 1(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
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P5 Release would disclose confidential advice between the President
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b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�MORRIS JUTCOV1CH, MD, PhD, FRCPC
Chief Executive Officer
CASEY j . JASON, MD, FACEP, FAAP
President
VIRGINIA OFFICE:
65:41) Braddock Road
Alexandria, VA 22312
703-354-9508
February 11, 1993
Hillary Rodham Clinton, Esq.
Office of the First Lady
Health Task Force, Room 200
Old Executive Office Building
Washington, D.C. 20.^00
Dear Ms. Clinton:
It was recommended to me that I speak to you about my interest in volunteering to work on
the Health Policy Committee. I grew up in Glenview, Illinois and attended Maine Township High
School East, Northwestern University, and Duke University Medical School. I initially came to the
Washington D.C. area under the Carter Administration near the end of his term in office, as a
medical advisor to the Environmental Protection Agency. I left the Agency after approximately three
years to go into practice. Over the past few years, our group has been directly involved in improving
inpatient health care while still saving money for all of the major HMO's and PPO's in the D.C.
Metro area. Our group not only proposes policy changes, but also uses these in the hospital practice
setting — the ultimate and most important test.
Specifically, I feel that I may be of help in the area of improving hospital healthcare without
spending as much as we currently do. I have enclosed a Curriculum Vitae and hope that this will
be of some benefit to you in looking at my previous background. Our group is currently working
with all of the major managed health care groups in the District of Columbia, Maryland, and
Virginia. We not only have familiarity with how managed health care works, but also some of the
problems unique to each.
1 would be happy to donate my time in your chalicngihg task, .if mere is any way thai I car.
be cf help, I would be happy to volunteer. Please feel free to call me either through my Maryland
office (301} 505-4512, or at my home [ , P6/(b)(6)
Sincerely yours,
Casey J. Jason, M.D., FACEP, FAAP
President
Acucare, P.C.
CJJ/kvm
Enclosure
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND TYPE
005b. resume
DATE
SUBJECT/TITLE
Address (Partial); Phone No. (Partial); POB (Partial); DOB (Partial);
SSN (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [8]
2006-0885-F
jm778
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. SS2(b)l
PI
P2
P3
P4
b(l) National security classified information |(b)(l) of the F O I A |
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOI A)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(S) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a cle:irly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CASEY J. JASON, MD, FAAP, FACEP
..
P6/(b)(6)^ "
/
...P6/(b)(6)| .. |[HOME]
(301) 505^512 [OFFICE]
PERSONAL:
PLACE OF BJRTH:
DATE OF BIKTH:
SOCIAL SECURITY NUMBER:
PRESENT EMPLOYMENT:
ACUCARE, P.C.
8201 Corporate Drive, Suite 620
L.-indover, Maryland 2078S
PRESIDENT
July 1989 to Present
UNIVERSITY AFFILIATIONS:
GEORGE WASHINGTON UNIVERSITY
Washington,, D.C.
ACADEMIC STAFF
DEPARTMENT OF EMERGENCY MEDICINE
July 1, 1990 to Present
ASSISTANT CLINICAL PROFESSOR
CHILD HEALTH AND DEVELOPMENT
1987 to Present
GEORGETOWN UNIVERSITY' HOSPITAL
Washington, D.C.
ADVANCED TRAUMA LIFE SUPPORT
INSTRUCTOR
(ATLS)
1988 to 1991
UNIVERSITY HOSPITAL
Augusta, Georgia
ADVANCED PEDIATRICS LIFE SUPPORT
INSTRUCTOR
(APLS)
04/88 to Present
CURRENT MEDICAL LICENSES:
District of Columbia
Maryland
Virginia
Pennsylvania:
California
North Carolina
#16783
#D 34526
#0101 029301
#MD-033821-E
#G37751
#20407
Date r>f Issue
August 28, 1987
December 2, 1986
April 17, 1978
July 3, 1985
August 7, 1978
October 18, 1975
BOARD CERTIFICATION AND FELLOWSHIP STATUS:
American Board of Pediatrics
American Board of Emergency Medicine
Fellow of American Academy of Pediatrics
Fellow of American College of Emergency Physicians
1982
1986
1986
1987
Date of Expiration
December 31, 1994
September 30, 1994
February 28, 1994
December 31, 1992
February 29, 1994
December 31, 1993
�Casey J. Jason, MD., FAAP, FACEP
Page 2 of S
MAIN EAST HIGH SCHOOL
Morton Grove, Illinois
1962 to 1966
NORTHWESTERN Ur
Evanston, Illinois
BAS. - 1970
Biology Major
DUKE MEDICAL SCHOOL
Durham, North Carolina
GREAT ORMOND STREET
(HOSPITAL FOF. SICK CHILDREN)
London, England
MD. - 1974
February - September, 1972
Pediatric Clinical Research Fellowship
"Energy Expenditure in Obese Children'
lOHNS HOPMNii HOSPITAL
Baltimore, Maryland
07-01-74 to 06-30-7S
Department of Pediatrics
Pediatric Internship
DUKE UNIVERSITY MEDICAL CENTER
Durham, North Carolina
1975 to 1978
Department of Biochemistry
Post-Doctoral Fellowship in Biochemistry
UNIVERSITY OF CALIFORNIA. SAN FRANCISCO
San Francisco, California
07-01-78 to 11-01-80
Department of Pediatrics
2 and 3 Yezj Residency and
Endocrine Fellowship with
Dr. Melvin Gnunbach, Chairman
Chairman, Department of Pediatrics
nd
rd
GEORGETOWN UNIVERSITY HOSPITAL
Washington, D.C.
Advanced Trauma Life Support (ATLS)
Certification
Certified to 12-05-91
Advanced Trauma Life Support
Instructor Course
1988
Advanced Cardiac Life Support (ACLS)
Certification
UNIVERSITY HOSPITAL
Advanced Pediatric Life Support
Course Instructor
Certified in 1986, 1989
Augusta, Georgia
April and November, 1988
April and November 1989
and April 1990
�Casey J. Jsson, M.D., FAAP, FACEP
Page 3 of 3
PROFESSIONAL SOCIETIES *
American Medical Association (Current)
Medical Soc iety of Virginia (Current)
Fairfax County Medical Society (Current)
Johns Hopkins Medical and Surgical Association (Current)
Duke Univeniity Medical Association (Current)
Fellow, American Academy of Pediatrics (1986 to Present)
Fellow, American College of Emergency Physicians (1987 to Present)
Viiginla Coll«>ge of Emergency Physicians (Current)
Utilization Review Board for Goodwin House Retirement Home (1985 to Present)
National Science Foundation Committee for Reproductive Health Research (1988 to 1989)
Chairman of Child Abuse Committee, Alexandria Hospital, Alexandria, Virginia (1984 to 1987)
Trauma Committee, Alexandria Hospital (1985 to 1987)
Research, Hospital Utilization, Quality Assurance, AIDS Task Force, and CDC Liaison Committees for
Washington Hospital Center, Washington, D.C. (September 1987 to July 1989)
HONORS AN13 DISTINCTIONS:
Harvard Alumni Club of Illinois Award
President and Co-Founder of Northwestern Student for a Better Environment
President and Founder of Northwestern Students for Improvement of Mental Health Standards
President of Northwestern State Mental Hospital Volunteer Workers (NOVA)
Illinois State Scholarship
Duke Trustees' Scholarship Fund
British MediccJ Award (1972)
NIH Student Research Award (1973)
AOA Research Award, Duke University (1974)
American Cancer Society Special Fellowship (1975)
NIH National Research Service Awards (1976 to 1978 and 1980)
Member of Special National Science Foundation Advisory Committee on Reproductive Risk Assessment to
Environmental Protection Agency (1985)
�Casey J. Jsison, M.D., FAAP, FACEP
Page 4 of 5
HOSPITAL APPOINTMENTS:
Washington, D.C. 20003
9/07/89 to Present
Courtesy Status
Laurel, Maryland 20707
6/16/89 to Present
Courtesy Status
Clinton, Maryland 20733
6/12/89 to Present
Courtesy Status
Washington, D.C. 20032
6/12/89 to Present
Courtesy Status
PRINCE GEORGE'S HOSPITAL CENTER
Cheverly, Maryland 20785
5/10/89 to Present
Active Status
HOWARD UNIVE RSITY HOSPITAL
Washington, D.C. 20060
8/02/89 to Present
Courtesy Status
Washington, D.C. 20010
May 1990 to Present
Courtesy Status
D.C. GENERAL HOSPITAL
Georgetown Depaitment of Medicine
GREATER LAUBEL-BELTSVILIIE HOSPITAL
Department of Family Practice
lUTHERN
HOSPITAL CENTER
Practice
ient ofFi
GREATER SOUTHEAST COMMUNITY HOSPITAL
Department off Family Practice
Department ol Family Practice
Department ol Internal Medicine
NAT'L MEDICAL CENTER
1992 to Present
Courtesy
Lanham, Maryland 20706
Washington, D.C. 20017
MONTGOMERY GENERAL HOSPITAL
Department of Internal Medicine
to Present
Courtesy
Olney, Maryland 20832
7/01/89 to 1991
THE WASHINOTON HOSPITAL CENTER
Washington, D.C.
1987 to 1989
MT. VERNQN HOSPITAL
Alexandria, Virginia
1983 to 1988
ALEXANDRIA HOSPITAL
Alexandria, Virginia
1983 to 1988
ARUNOTON HOSPITAL
Arlington, Virginia
1983 to 1988
ST. LUKES HOSPITAL
San Francisco, California
1978 to 1980
HALIFAX COMMUNITY HOSPITAL
South Boston, Virginia
1977 to 1978
Ft. Bragg, North Carolina
1976 to 1978
Emergency Room Physician (P.T.)
Emergency Room Physician (P.T.)
WOMACK: ARMY HOSPITAL
Civilian Emergency Room Physician (P.T.)
PREVIOUS EMPLOYMENT:
THE WASHINGTON HOSPITAL CENTER
110 Irving Street, N.W.
Washington, D.C. 20010
(202) 877-7632
September 1987 to July 1989
Associate Director and Director for Research and Development, Emergency Department
ALEXANDRIA PHYSICIANS GROUP. LTD.
8101 Hinson Farm Road, Suite 209
Alexandria, Virginia
(703) 780-8200
June 1984 to September 1987
Emergency Physician for Alexandria, Arlington and Mt. Vernon Hospitals
UNITED STATESI ENVIRONMENTAL PROTECTION AGENCY (EPA)
401 M Street, S.W.
Washington, D . C 20460
Office of Pesticides and Toxic Substances
Office of Research and Development
November 1980 to May 1983
May 1983 to June 1984
�Casey J. Jcison, M.D., FAAP, FACEP
Page 5 of 5
PUBLICATIONS AND PRESENTATIONS:
Jason, Case)' J., MJL Polokoff and KM. BelL Triacylglycerol synthesis in isolated fat cells. Journal of
Biolctfcal Chemistry 241: 1488, 1976.
Jason, Casey J. Surveillance of pregnancy outcomes. AssociationforVital Records and Health Statistics,
Kansas City, Missouri, July 27, 1982.
Jason, Casey J., ME. Samuhel, B. Click and AJL Welsh. Geographic (distribution of unexplained low
birthweight. Conference on Medical Screening and Biological Monitoring for Effects of Exposure
in the Workplace, Cincinnati, Ohio, July 10-13, 1984 (NIH sponsored). Journal of Occupational
Medicine 28: 728-740, 1986.
Theriault, E., V. Logrillo and C.J. Jason. Geographical distribution of unexplained low birthweight in New
York State (submitted to Journal of Chronic Disease).
Kennel, S.J., C.J. Jason, P.W. Albro, G. Mason and S.H. Safe. Monoclonal antibodies to chlorinated
dibenzo-dioxins. Toxicology and Applied Pharmacology 82: 256, 1986.
Albro, Philip, W.B. Crummett, AE. Dupuy, Jr., M i . Gross, M. Hanson, ILL. Heirless, FX>. Hileman, D. Hilker,
C.J. Jason, et al. Methods for the quantitative determination of dibenzofiuan isomers in human
adiposte tissue in the parts-per-trillion range. An interlaboratory study. Analytical Chemistry
57: 2717, 1985.
Ellish, N., H.C. Chen, C.J. Jason and D.T. Janerich. Pilot study to detect early pregnancy and fetal loss.
Conference on Medical Screening and Biological Monitoring for the Effects of Exposure in the
Workplace, Cincinnati, Ohio, July 1984. Journal of Occupational Medicine 28: 1069-1973, 1986.
Jason, C.J., B. Click, M. Samuhel and A Welsh. Assessment of potential environmental health effects using
unexplained low birthweight. Abstract American Public Health Association, November, 1984,
Anaheim, California. (Reviewed in Birth Defect Prevention News, November, 1984 by National
Network to Prevent Birth Defects, Washington, D.C).
Coordinator and Co-Chairman Pediatric Trauma Update 1987, Children's Hospital National Medical Center
and Alexandria Hospitals.
Instructor for Advanced Pediatric Life Support Course, University Hospital, Augusta, Georgia, April 1988.
Seminar: 'Acute Status Asthmatic us and Respiratory Failure,' for Northern Vuginia Consortium for Continuing
Medical Education, Doctors Hospital, Falls Church, Virginia, November, 1987.
Panelist for Workshop on Chlorinated DBD and DBF PCB's. Sponsored by the Government of Finland,
Espoo, Finland, September 19-21, 1983.
Grand Rounds for the Washington Hospital Center
'Tissue Plasminogen Activator (TPA) Use in the Acute MI'
"Acute Intervention in Mi's in Durations Greater than Six Hours"
December, 1987
March, 1988
�(Children's Hospital of The Kings Daughters
March 19, 1993
Mrs. Hillary Rodham Clinton
1600 Pennsylvania Ave.
Washington, DC 20009
Dear Mrs. Rodham Clinton:
I am very concerned about the future of pediatric health care in the United States. I respect and applaud
your attention and involvement in this crucial area of our society.
I am a pediatric emergency physician and a mother of two girls. I have worked in this primary care
setting for ten years. 1 currently work in an emergency room that primarily serves the poor and indigent
population. I am daily aggrieved at the poor correlation of medical needs and services available. Along with these
issues, I feel strongly that our existing system does not encourage either the family or medical provider to provide
quality mediciil care in a cost-effective manner.
I think that initiating positive incentives to parents who are accessing medical care would be very
beneficial. Positive incentives for medical institutions and physicians to provide appropriate level care in the
appropriate se tting would markedly decrease medical costs for the medicaid pediatric population, the medical
community has not accepted responsibility for educating this population about necessary medical interventions.
We have adopted a "we're here, come see us" attitude. This provides for poor long-term medical/family
relationships, higher cost to government and society and overall decreased quality of care.
I have avoided belonging to the medical lobby previously (AMA) and have not been politically active. But
I now feel that the children of this country have shamefully inadequate healthcare. I would like to become
involved as a physician and mother in influencing what the new alternatives will be. 1 feel strongly that simply
and cheaply enacted preventive medicine teaching on a grass roots level will not only significantly impact health
care for children but also the country's cost for providing this care. Please let me know where my knowledge,
experience r.nd expertise can be utilized.
Sincerely,
Karen Remley, M.D.
Pediatric Emergency Medicine
Children's Hospital of The King's Daughters
KR/bam
601 Children's Lane, Norfolk, Virginia 23507 (804) 628-7000
�4
HEALTH CARE TASK FORCE SORTING SHEET
fi i -a*
CODER:.
INPUT DATE:
GENERAL SORT:
POSTCARD 1:
Personal stories
.General mail
Letter Campaign
Other Health Providers
POSTCARD 2:
.Offers to help/Employment
FORM LETTER:
Letterhead
.Policy
X Physicians
REROUTE:
Casework
.Scheduling
President
Other
POTJCY AND PERSON AT i STORIES:
.ORGATOZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (ID
working families
unemployed/low income
benefits
providers
INFRASTRUCTUREAVORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
FINANCING (VII)
.MENTAL HEALTH (EX)
LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
_AIDS
women's health
immunizations/children
rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006a. envelope
SUBJECT/TITLE
DATE
Address (I page)
03/30/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [8]
2006-0885-F
ini778
Presidential Records Act - |44 U.S.C. 2204(a)|
RESTRICTION CODES
Freedom of Information Act - |5 U.S.C. 552(b)l
PI
P2
P3
P4
National Security Classified Information 1(a)(1) o f t h e PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
b(l) National security classified information 1(b)(1) o f t h e FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) o f t h e FOIA)
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006b. envelope
DATE
SUBJECT/TITLE
03/30/1993
Address (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [8]
2006-0885-F
jm778
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)]
Freedom of Information Act - |S U.S.C. 552(b)|
PI
P2
PJ
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOI A]
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) o f t h e FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the F O I A j
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) o f t h e FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the F O I A j
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 3
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Box 6
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Clinton Presidential Records: White House Staff and Office Files
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S
56
3
4
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECT/TITLE
RESTRICTION
001. letter
Address (Partial) (I page)
03/30/1993
P6/b(6)
002a. letter
Address (Partial); Phone No. (Partial) (1 page)
01/26/1993
P6/b(6)
002b. envelope
Address (1 page)
01/26/1993
P6/b(6)
003. letter
Address (Partial) (1 page)
05/11/1993
P6/b(6)
004. letter
Address (Partial); Phone No. (Partial) (1 page)
02/20/1993
P6/b(6)
005. letter
Personal (Partial) (I page)
03/17/1993
P6/b(6)
006a. letter
Personal (Partial) (1 page)
04/30/1993
P6/b(6)
006b. resume
POB (Partial) (1 page)
04/30/1993
P6/b(6)
007. letter
Phone No. (Partial) (I page)
02/23/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [7]
2006-0885-F
irn807
RESTRICTION CODES
Prcsiclenlial Records Act - |44 IJ.S.C. 2204(a)|
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PI National Security Classified Information 1(a)(1) of the PRA]
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P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
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financial information |(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3 of-
�R I C H A R D A. L I P P I N , M.D.
May 11, 1993
Ms. H i l l a r y Rodham C l i n t o n
Attn: Health Care Task Force
The White House
Room 100-OEOB
Washington, DC 20500
>
.
Dear Ms. C l i n t o n :
Regarding my two previous l e t t e r s (enclosed) to you p e r t a i n i n g to
the value of prevention and w e l l n e s s programs as a sound,
compassionate, and c o s t - e f f e c t i v e method of addressing U.S.
h e a l t h cajre reform, I am pleased to enclose the f o l l o w i n g
responses some of which s p e c i f i c a l l y support my p o s i t i o n s from U.S.
U.S.
U.S.
U.S.
U.S.
U.S.
Senator John D. R o c k e f e l l e r IV
Senator William D. Cohen
Senator H a r r i s Wofford"
Congresswoman Marjorie Margolies-Mezvinsky
Congressman James C. Greenwood (my own d i s t r i c t )
A s s i s t a n t Surgeon General J . Donald M i l l a r , M.D.,
D i r e c t o r NIOSH
C h a r l e s F. Nelson, Chief, Community Health Promotion
Branch, U.S. Center f o r Disease C o n t r o l (CDC)
Steven A. Schroeder, M.D., President, Robert Wood
Johnson Foundation
C h a r l e s R. Halpern, M.D., President, Nathan Cummings
Foundation
Ms. C l i n t o n , I am v e r y pleased t o p r e s e n t t o you and y o u r
c o l l e a g u e s c o p i e s o f correspondence from each o f t h e above n o t e d
i n d i v i d u a l s i n s u p p o r t o f t h e v a l u e o f p r e v e n t i o n and w e l l n e s s
programs.
»*
Of course, I am a v a i l a b l e f o r f u r t h e r d i s c u s s i o n .
May you and y o u r t a s k f o r c e c a r r y on w i t h your e x t r e m e l y
i m p o r t a n t work i n sound mind, good s p i r i t s and i n good h e a l t h .
May you a l s o have t h e courage t o be c r e a t i v e and b o l d a t t h i s
time i n our n a t i o n ' s h i s t o r y .
Sincerely,
R i c h a r d A. L i p p i n , M.D.^/^
Enclosures
�OHN D. ROCKEFELLER IV
WEST VIRGINIA
timted States Senate
WASHINGTON, DC 205 10-4802
March 17, 1993
Dr. R i c h a r d A. L i p p i n
Dear R i c h a r d ,
Thank you f o r t a k i n g t h e t i m e t o share t h e l e t t e r you
w r o t e r o H i l l a r y C l i n t o n regardi-ng p r e v e n t i v e m e d i c a l
p r a c t i c e s and s t r a t e g i e s .
I am c e r t a i n l y impressed w i t h jyour
knowledge o f t h e g r o w i n g h e a l t h c r i s i s i n t h i s c o u n t r y ajid I
a p p r e c i a t e h e a r i n g f r o m you on t h i s i m p o r t a n t i s s u e .
As' Chairman o f t h e Pepper Commission and t h e Senate
Subcommittee on Medicare and Long-Term Care, I ' v e seen f i r s t
hand j u s t how c r i t i c a l i t i s t h a t o u r h e a l t h c a r e system be
updated and remodeled t o f i t t h e needs o f o u r p o p u l a t i o n .
I've f e l t f o r q u i t e some t i m e t h a t o u r n a t i o n must d e v e l o p an
e f f e c t i v e , dependable s t r a t e g y f o r m e e t i n g t h e i n c r e a s i n g l y
complex m e d i c a l needs o f o u r p o p u l a t i o n . Every day I hear
f r o m p e o p l e who have been d e v a s t a t e d by t h e burden o f c a r i n g
f o r l o v e d ones i n t h e i r hour o f g r e a t e s t need and a l l t h e y ask
for i s a l i t t l e help.
America wants and deserves a c t i o n on t h i s i s s u e . And I
s t a n d committed t o f i g h t i n g f o r t h e r i g h t o f a l l Americans t o
be g u a r a n t e e d t h e c o v e r a g e , c a r e and s e c u r i t y t h a t i s
r i g h t f u l l y ours.
Again thanks f o r w r i t i n g .
H e a r i n g from you r e i n f o r c e s my
commitment t o r e f o r m , and I am t r u l y g r a t e f u l .
Best w i s h e s .
Sincerely,
ohn D. R o c k e f e l l e r IV
�RAUPPKI
MEO!CA«.
WILLIAM S. COHEN
MAINE
Unfad States S n t
e ae
WASHINGTON, DC 2 0 5 1 0
i£M
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March 15, 1993
RD
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RS
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If
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Richard A. L i p p i n , M.D.
ARCO Chemical Company
Medical Department, 3801 West Chester Pike
Newtown Square, PA 19073-2837
TOC
CR
A
Dear Rich:
Thank you f o r your recent l e t t e r .
While I appreciate your gracious i n v i t a t i o n t o t h e breakfast
f o r A r t s Advocacy Day t h i s Wednesday, I r e g r e t t h a t my schedule i s
such t h a t I w i l l be unable t o a t t e n d . I have, however, asked Paulina
C o l l i n s of my s t a f f t o be present and I look forward t o hearing about
the important issues you discuss.
I read w i t h i n t e r e s t your l e t t e r t o F i r s t Lady H i l l a r y
Rodham C l i n t o n . C e r t a i n l y , t h e reform of our nation's h e a l t h care
system i s , next t o t h e economy, t h e most c r i t i c a l issue f a c i n g the
103rd Congress. As many as 37 m i l l i o n people have no h e a l t h
insurance a t a l l , and many more have inadequate coverage. I am
encouraged t h a t President C l i n t o n has made h e a l t h care reform one o f
h i s t o p p r i o r i t i e s and look forward t o working w i t h h i s
A d m i n i s t r a t i o n on t h i s important issue.
With regard t o your comments about f e d e r a l funding f o r the
a r t s , I b e l i e v e , as you do, t h a t the N a t i o n a l Endowment f o r t h e A r t s
(NEA) has made many valuable c o n t r i b u t i o n s t o our s o c i e t y . NEA
endeavors are both e d u c a t i o n a l l y and c u l t u r a l l y important and have
enriched t h e l i v e s of Americans throughout the country. I assure you
t h a t I w i l l keep your views i n mind when NEA r e l a t e d l e g i s l a t i o n i s
considered by the Senate.
As always, Rich, i t was good t o hear from you.
With warm personal regards, I am
Sincerely,
i l l i a m S. Cohen
United States Senator
WSC:pmc
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3 0^
••.*--.'..-
•' '
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:.•
:
. ..
:
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••.v .-
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�R I C H A R D A . L I P P I N , M.D.
February
1, 1993
Mrs. H i l l a r y Rodham C l i n t o n
C h a i r p e r s o n , U.S. H e a l t h Care Refonn Task Force
The White House
1600 P e n n s y l v a n i a Avenue, NW
Washington, DC 20500
Dear Mrs. C l i n t o n :
As a p r e v e n t i v e medicine s p e c i a l i s t and as a concerned U.S.
c i t i z e n , I urge you and your t a s k f o r c e t o s t r o n g l y c o n s i d e r t h e
v a l u e o f p r e v e n t i o n and w e l l n e s s as major s t r a t e g i e s t o b o t h
reduce h e a l t h care c o s t s and improve t h e q u a l i t y o f o u r U.S.
h e a l t h c a r e system.
Mrs. C l i n t o n , s u r e l y you and y o u r a d v i s o r s a r e aware o f t h e
s h o c k i n g s t a t i s t i c s which c a t e g o r i c a l l y demonstrate t h e
p e r c e n t a g e o f i l l n e s s e s , i n j u r i e s , and h o s p i t a l i z a t i o n s w h i c h
a r e d i r e c t l y l i n k e d t o v o l u n t a r y human b e h a v i o r s such as
e x c e s s i v e tobacco and a l c o h o l use - hence, which a r e e n t i r e l y
preventable.
Mrs. C l i n t o n , we c u r r e n t l y have a p a t e r n a l i s t i c , b l o a t e d , and
e x p e n s i v e s o - c a l l e d " h e a l t h c a r e system" ( i n r e a l i t y , i t i s an
i l l n e s s c a r e system) p a r t i a l l y because U.S. c i t i z e n s have f a i l e d
t o assume r e s p o n s i b i l i t y f o r t h e i r own h e a l t h , assuming t h e
r o l e , i n s t e a d , o f h e l p l e s s and dependent v i c t i m s . Mrs. C l i n t o n ,
I b e l i e v e t h i s p a t t e r n o f b e h a v i o r i s demeaning and r o b s
i n d i v i d u a l s o f t h e i r d i g n i t y and s e l f - w o r d h which must be
regained through increased i n d i v i d u a l r e s p o n s i b i l i t y .
The American people, Mrs. C l i n t o n , a r e ready t o r e l a t e t o t h e i r
d o c t o r s as educators n o t " M . D i e t i e s " whose pronouncements go
u n c h a l l e n g e d and whose t e c h n o l o g i e s a r e promoted as omnipotent.
P r e v e n t i o n and w e l l n e s s programs,- c o n v e r s e l y , a r e a t r u e win-win
s c e n a r i o . By r e d u c i n g demand f o r i l l n e s s c a r e , i f implemented,
t h e s e programs c o u l d markedly reduce h e a l t h care c o s t s ( t h u s
f r e e i n g up needed d o l l a r s f o r i n d i v i d u a l s whose c o n d i t i o n s a r e
t r u e a c t s o f f a t e ) , and, more i m p o r t a n t l y , t h e y would empower
o u r f e l l o w c i t i z e n s t o accept t h e g i f t s o f f r e e w i l l , s e l f esteem, m a t u r i t y , and r e s u l t a n t improved h e a l t h .
Mrs- C l i n t o n , I am convinced t h a t t h e American people a r e ready
t o a c c e p t t h i s new r o l e as more mature and r e s p o n s i b l e h e a l t h
c a r e consumers.
�ttrs. H i l l a r y Rodham Clinton
February 1, 1993
Page 2
In h i s inaugural address, the President, quoting from the
Scriptures, asked us "to faint not". Please do not be afraid,
Mrs. Clinton, to be bold i n including prevention and wellness
programs as a major portion of your strategy for U.S. health
care reform. I t i s the right thing to do - i t s time has arrived
- and the American health care system can once more become the
envy of the world.
Many, including myself, stand ready to a s s i s t you.
Be well and thank you.
Sincerely,
Richard A. Lippin, M D
.
cc:
Senator William Cohen
Janet Smith, President, National Wellness Coalition
�Consumer Cost Sharing
Managed Care
Wellness
Managed care and consumer cost-sharing
are not enough to make the long-term
difference. It is time to incorporate
wellness into the total health care
management "pie",
It is tm t r d c t e n e
i e o e u e h ed
for health care!
�: •.**>.-Sf
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
307
�'OHN D. ROCKEFELLER IV
WEST VIRGINIA
flnited States Senate
WASHINGTON. DC 205 10-4802
March 17, 1993
Dr. R i c h a r d A. L i p p i n
Dear R i c h a r d ,
Thank you f o r t a k i n g t h e t i m e t o share t h e l e t t e r you
w r o t e t o H i l l a r y C l i n t o n regardi-ng p r e v e n t i v e m e d i c a l
p r a c t i c e s and s t r a t e g i e s .
I am c e r t a i n l y impressed w i t h j y o u r
knowledge o f t h e g r o w i n g h e a l t h c r i s i s i n t h i s c o u n t r y ajid I
a p p r e c i a t e h e a r i n g f r o m y o u on t h i s i m p o r t a n t i s s u e .
As" Chairman o f t h e Pepper Commission and t h e Senate
Subcommittee on Medicare and Long-Term Care, I ' v e seen f i r s t
hand j u s t how c r i t i c a l i t i s t h a t o u r h e a l t h c a r e system be
updated and remodeled t o f i t t h e needs o f o u r p o p u l a t i o n .
I've f e l t f o r q u i t e some t i m e t h a t o u r n a t i o n must d e v e l o p an
e f f e c t i v e , dependable s t r a t e g y f o r m e e t i n g t h e i n c r e a s i n g l y
complex m e d i c a l needs o f o u r p o p u l a t i o n . Every day I h e a r
f r o m p e o p l e who have been d e v a s t a t e d by t h e burden o f c a r i n g
f o r l o v e d ones i n t h e i r hour o f g r e a t e s t need and a l l t h e y ask
for i s a l i t t l e help.
America wants and deserves a c t i o n on t h i s i s s u e . And I
s t a n d committed t o f i g h t i n g f o r t h e r i g h t o f a l l Americans t o
be g u a r a n t e e d t h e c o v e r a g e , c a r e and s e c u r i t y t h a t i s
r i g h t f u l l y ours.
A g a i n thanks f o r w r i t i n g .
H e a r i n g from you r e i n f o r c e s my
coimnitment t o r e f o r m , and I am t r u l y g r a t e f u l .
Best w i s h e s .
Sincerely,
fohn D. R o c k e f e l l e r IV
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
'
FROM THIS DOCUMENT
�R I C H A R D A . L I P P I N , M.D.
March 30, 1993
Ms. H i l l a r y Rodham C l i n t o n
A t t n : Health Care Task Force
The White House
Room 100-OEOB
Washington, DC 20500
Dear Ms. C l i n t o n :
As a f o l l o w - u p t o my l e t t e r t o you o f 1 February 1993
( e n c l o s e d ) , r e g a r d i n g t h e value o f p r e v e n t i o n and wellness
programs, enclosed i s my own f i v e p o i n t p l a n f o r h e a l t h care
r e f o r m e n t i t l e d "Grow Up America". This p l a n combines
compassion w i t h an emphasis on p r e v e n t i o n , i n d i v i d u a l
empowerment and r e s p o n s i b i l i t y , and e a r l y c h i l d h o o d education.
The p l a n has the c a p a c i t y t o reduce h e a l t h care c o s t s by a t
l e a s t f i f t y percent. As i m p o r t a n t l y , however, i s i t s c a p a c i t y
t o encourage Americans t o approach h e a l t h and h e a l t h care w i t h
f a r g r e a t e r emotional m a t u r i t y .
I hope you and your colleagues f i n d "Grow Up America" h e l p f u l i n
your d e l i b e r a t i o n s .
Be w e l l .
Sincerely,
R. A. L i p p i n , MD
Enclosures
�Withdrawal/Redaction Marker
Clinton Library
DOCUMKNT NO.
AND TYPE
001. letter
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
03/30/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER T I T L E :
[Physician Letters] [loose] [7]
2006-0S85-F
jm807
RESTRICTION CODES
Presidential Records Act - |44 IJ.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)|
PI
P2
P3
P4
b ( l ) National security classified information 1(b)(1) o f t h e KOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e F O I A j
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA|
b(4) Release would disclose trade secrets or confldential or financial
information 1(b)(4) o f t h e FOIA]
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personal privacy 1(b)(6) o f t h e FOIA]
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b(8) Release would disclose information concerning the regulation of
flnancial institutions 1(b)(8) o f t h e F O I A j
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) o f t h e F O I A j
National Security Classified Information 1(a)(1) of the PRA|
Relating to Ihe appointment to Federal oflice 1(a)(2) o f t h e PRA|
Release would violate a Federal statute |(a)(J) o f t h e PRA|
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
P R M . Personal record misflle defined in accordance with 44 I'.S.C.
2201(3).
RR. Document will be reviewed upon request.
�R I C H A R D A . L I P P L N , M.D.
-mm)
March 30,
1993
Ms. H i l l a r y Rodham C l i n t o n
A t t n : H e a l t h Care Task Force
The White House
Room 100-OEOB
Washington, DC 20500
Dear Ms. C l i n t o n :
As a f o l l o w - u p t o my l e t t e r t o you o f 1 February 1993
( e n c l o s e d ) , r e g a r d i n g t h e v a l u e o f p r e v e n t i o n and w e l l n e s s
programs, enclosed i s my own f i v e p o i n t p l a n f o r h e a l t h care
r e f o r m e n t i t l e d "Grow Dp America". T h i s p l a n combines
compassion w i t h an emphasis on p r e v e n t i o n , i n d i v i d u a l
empowerment and r e s p o n s i b i l i t y , and e a r l y c h i l d h o o d e d u c a t i o n .
The p l a n has t h e c a p a c i t y t o reduce h e a l t h c a r e c o s t s by a t
l e a s t f i f t y p e r c e n t . As i m p o r t a n t l y , however, i s i t s c a p a c i t y
t o encourage Americans t o approach h e a l t h and h e a l t h care w i t h
f a r g r e a t e r emotional m a t u r i t y .
I hope you and your c o l l e a g u e s f i n d "Grow Up America" h e l p f u l i n
your d e l i b e r a t i o n s .
Be
well.
Sincerely,
<^L.^[
^_
R. A. L i p p i n , MD
Enclosures
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3^7
�HARRIS WOFFORD
ENVIRONMENT
PENNSYLVANIA
AND PUBLIC
LABOR AND H U M A N
FOREIGN
United States Senate
SMALL
WORKS
RESOURCES
RELATIONS
BUSINESS
WASHINGTON, DC 2 0 5 1 0 - 3 8 0 3
A p r i l 8, 1993
Richard A. L i p p i n , MD
Dear Dr. L i p p i n :
Thank you f o r sending me a copy of your correspondence t o the
"
President's Task Force on N a t i o n a l Health Care Reform. I appreciate your i n t e r e s t i n t h i s important subject and I am
pleased t o have the b e n e f i t of your views. The a c t i v e involvement
of i n t e r e s t e d c i t i z e n s i s v i t a l t o achieving comprehensive h e a l t h
care reform.
As you know, comprehensive h e a l t h care reform i s one of my
top l e g i s l a t i v e p r i o r i t i e s . I look forward t o working c l o s e l y
w i t h the C l i n t o n A d m i n i s t r a t i o n t o enact l e g i s l a t i o n t h a t w i l l
make q u a l i t y , a f f o r d a b l e h e a l t h care a r e a l i t y f o r every American.
Again, thank you f o r t a k i n g the time t o give me your views.
For your i n f o r m a t i o n , I have enclosed a summary of the elements
t h a t I b e l i e v e should be included i n comprehensive h e a l t h care
reform. Please f e e l welcome t o contact me on other matters of
concern t o you.
Sincerely,
H a r r i s Wofford
Enclosure
�1 PRESIDENTIAL BOULEVARD
SUITE 200
BALA CYNWYD. PA 19004
(215) 6 6 7 - 3 M M M
MARJORIE MARGOLIES-MEZVINSKY
13TM DISTRICT. PENNSYLVANIA
ENERGY AND COMMERCE COMMITTEE
SCHWENKSVILLE/SK1PPACK
(215) 2 8 7 - 5 M M M
GOVERNMENT OPERATIONS COMMITTEE
SMALL BUSINESS COMMITTEE
1516 LONGWORTH BUILDING
WASHINGTON. DC 2 0 5 1 5 - 3 8 1 3
(202) 2 2 5 - 6 1 1 1
AMBLER
(215) 5 4 7 - 7 M M M
C n r s o t e l me States
o g es f h a t d
Iftouse of T t pee t to s
Ee r s naf e
I D s i go , 2 5 55 )
H ahn t n
0 1 - 83
April 14, 1993
Dear Dr. Lippin:
Thank you for contacting my office and sharing with me your views about our
nation's health care crisis. Today, we spend approximately $930 billion on health
care services, yet more than thirty-five millions Americans are without any form of
health care insurance.
Real reform of this system requires not only a recognition of the problem, but
also a willingness on everyone's part to give up something ~ this means doctors,
lawyers, insurance carriers, providers, pharmaceutical companies, and even patients.
I will support a health care reform plan founded upon the following four
principles: 1) reducing the unnecessary duplication in the massive health care
bureaucracy; 2) emphasizing prevention of acute health care illnesses through
education; 3) eliminating abuse and fraud in the system; and, 4) setting guidelines to
ensure that every member of the medical community works toward providing quality,
affordable health care for all Americans.
As early as May, the President may deliver his health care reform package. I
look forward to working to make our health care system affordable and accessible
while maintaining the high quality of care to which we are accustomed.
-
,*
I appreciate your sharing your concerns with me. If I can be of further
assistance, please do not hesitate to let me know.
Warm regards.
Marjone Margolies-Mezvinsky
MMM:bge
j l A l i O N K B Y PHINTEO ON PAPER MADE OF RECYCLED RBEHS
�515 CANNON BUILDING
JAMES C. GREENWOOD
WASHINGTON. DC 2 0 5 1 5
8TH DISTRICT. PCNNSVLVANIA
(202) 2 2 5 - 4 2 7 6
C O M M I T T E E ON
ENERGY A N D C O M M E R C E
SUBCOMMITTEE ON HEALTH
AND THE ENVIHONMENI
SUBCOMMITTEE ON COMMERCE.
CONSUMER PROTECTION
AND COMPETITIVENESS
DISTRICT OFFICES:
Congres of tfte G mec States
U tfi
69 E. OAKLAND AVE
DOVLESTOWN. PA
$ou3e of BepreSentattbcs
1 OXFORD VALLEY
SUITE
WMtynqUm, 29C 20515-3808
April
(215| 752-77 1 1
13, 1993
-
. _
Thank you very much f o r your note o f A p r i l 1, 1993 and* the
attached copy o f your l e t t e r t o Mrs. C l i n t o n e n c l o s i n g your f i v e
p o i n t plan- f o r h e a l t h care r e f o n n e n t i t l e d "Grow Up America".
Your thoughts and comments are always appreciated. Please
r e s t assured t h a t I w i l l keep your thoughts i n mind as Congress
debates h e a l t h care reform i n the weeks and months ahead.
Sincerely,
C. Greenwood
JCGrsc
800
LANGHORNE. PA 1904 7
Richard A. L i p p i n , M.D.
Dear Dr. L i p p i n :
18901
(215)348-751 1
�DEPARTMENT OE HEALTH & HUMAN SERVICES
Public Heaith Service
National Institute for
Occupational Safety and Health
Centers for Disease Control
and Prevention (CDC)
Atlanta, GA 30333
AR I 3 . 9 3
P
19
L i p p i n , M.D.
Dear Richard,
Thank you very much for sending me your note of March 22, 1993.
I e s p e c i a l l y appreciate your writing to Mrs. Clinton, strongly
emphasizing Prevention.
Indeed, your l e t t e r was most refreshing. I t seems l i t t l e
attention, even of the " l i p s e r v i c e " v a r i e t y , i s being paid to
prevention by Mrs. Clinton's Task Force or so i t has appeared i n
sessions I've viewed on C-SPAN. As f a r as I can discern, there
has been no s p e c i f i c attention paid to occupational health,
despite the fact that more Americans of a l l ages are now at work
than ever.
Maybe your l e t t e r w i l l have a p o s i t i v e impact.
I n case you have not heard, I've recently announced my intention
to leave NIOSH on August 1, 1993, a t which time I w i l l also leave
the U.S. Public Health Service. I w i l l have served two f u l l 6year terms as Director of NIOSH, and thought i t would be
supremely arrogant to seek a t h i r d term. Therefore, I w i l l move
on to a next phase i n which I hope to mix consulting/advising,
l e c t u r i n g , and writing. I n any event, I intend t o remain a vocal
advocate of pre^ftntion in the workplace.
Thank you for thinking of me. With best personal
Sincerely,
regards.
r f)
, i J Dbna\d M i l l a r , M.Ef.
VsPfSsistant Surgeon General
Director
�D E P A R T M E N T OF H E A L T H & H U M A N SERVICES
Public Health Service
Centers for Disease Control
Atlanta GA 30333
(404) 488-5426
March 2, 1993
4
RichardxA. Lippin,
M.D
Dear Dr. Lippin:
Thank you for sharing a copy of your l e t t e r to Ms. H i l l a r y Rodham
Clinton with our Director, William L. Roper, M.D.
As the
Nation's prevention agency, the Centers for Disease Control and
Preventi-oh (CDC) i s strongly committed to developing the
s c i e n t i f i c basis for prevention programs and then promoting the
delivery of these programs to a l l c i t i z e n s . I n fact, CDC has
undertaken a number of i n i t i a t i v e s that are designed to evaluate
the efficacy, effectiveness, and economic impact of prevention
s t r a t e g i e s . These i n i t i a t i v e s include programs that address
diabetes, breast and c e r v i c a l cancer, intentional i n j u r i e s , and
childhood lead poisoning.
C l e a r l y the message i s t h a t p r e v e n t i o n works. Making p r e v e n t i o n
e f f o r t s work, however, e n t a i l s e l i c i t i n g the support and
p a r t i c i p a t i o n of a l l sectors of our s o c i e t y : i . e . , p u b l i c ,
p r i v a t e and v o l u n t a r y o r g a n i z a t i o n s , i n c o l l a b o r a t i o n w i t h the
business sector and p r i v a t e c i t i z e n s , must coordinate a wide
a r r a y of p r e v e n t i o n s t r a t e g i e s t h a t i n c l u d e environmental
measures, h e a l t h education and i n f o r m a t i o n a c t i v i t i e s , and
policy.
I appreciate your w i l l i n g n e s s t o assume an a c t i v e r o l e i n moving
p r e v e n t i o n t o tfte foreground of the h e a l t h care agenda.
Sincerely yours,
Charles F. Nelson
Chief
Community Health Promotion Branch
D i v i s i o n of Chronic Disease Control
and Community I n t e r v e n t i o n
National Center f o r Chronic Disease
Prevention and Health Promotion
�THE
^BEKTVVCDD
OHNSON
FOUNDATION
April 6, 1993
M.D.
Dear Dr. Lippin:
Thanks f o r sending ne copies of your correspondence conceming
p r e v e ^ n S c i n e . I hope that you'will be successful^ as I t t o k your
thoughts are very central to the current health care debate.
With best regards.
Sincerely,
Steven A. Schroeder, M.D.
SAS:jaf
( )/'|I,Y ,<t lin- Pn inl.-nt
�THE
• NATHAN
• CUMMINGS
- FOUNDATION
• C l u r l o R. H.ilpcm
April 27, 1993
ippin, M.D.
Dear Dr^Lippin:
Thank you for your kind remarks about my role in health care reform. I
found your materials extremely interesting and persuasive. I hope the
national leadership will go in this direction.
Best wishes.
Sincerely,
Charles R. Halpern
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1 4 0 0 YORK ROAD
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TELEPHONE
215-885-4430
March 19,
1993
H i l l a r y Rodham C l i n t o n
Task F o r c e f o r H e a l t h Care R e f o r m
c/o The W h i t e House
1600 P e n n s y l v a n i a Avenue NW
W a s h i n g t o n , DC 20500
Dear Ms. C l i n t o n :
T h i s i s my f i r s t l e t t e r t o t h e W h i t e House, a n d I c a n ' t
t h i n k o f a more i m p o r t a n t i s s u e w i t h a s many f a r - r e a e h i n g
c o n s e q u e n c e s f o r u s i n d i v i d u a l l y and a s a n a t i o n t h a n t h e
r e f o r m a t i o n o f o u r h e a l t h c a r e system.
A l t h o u g h we s h a r e t h e
same g e n e r a t i o n , I am n o t i n n a t e l y drawn t o w a r d p o l i t i c s .
We
have c h o s e n d i f f e r e n t p a t h s o f s e r v i c e t o o u r f e l l o w
A m e r i c a n s b u t I f e e l we a r e d r i v e n b y t h e same v a l u e s a n d
committments; f o r t h i s reason I w r i t e t o you t o d a y , h o p i n g
y o u w i l l s e r i o u s l y c o n s i d e r w h a t I am c o m p e l l e d i n good
conscience t o t e l l you.
B e i n g a f a m i l y p h y s i c i a n f o r a l m o s t 17 y e a r s I have
e x p e r i e n c e d f i r s t h a n d w h a t i s r i g h t and w r o n g w i t h o u r
c u r r e n t payment s y s t e m f o r d o c t o r s a s we c a r e f o r t h e s i c k
and t r y t o m a i n t a i n t h o s e who a r e n o t . U n l i k e many o f my
c o l l e a g u e s , I s u p p o r t y o u r e n d o r s e m e n t o f managed c o m p e t i t i o n
and am c a u t i o u s l y o p t i m i s t i c y o u r c o m m i t t e e w i l l a d o p t a
s t r a t e g y t h a t w i l l improve access, m a i n t a i n q u a l i t y and l i m i t
t o t a l c o s t s i n t h e l o n g r u n . I have r e a d t h a t o n l y t w o o f
t h e above t h r e e i t e m s ( c o s t c o n t r o l , q u a l i t y and a c c e s s ) a r e
p o s s i b l e a t a n y one t i m e . T h i s may n o t n e c e s s a r i l y be t r u e
g i v e n t h e r i g h t set. o f c i r c u m s t a n c e s .
F o r t h e sake o f
b r e v i t y , I w i l l n o t go i n t o them o t h e r t h a n t o l i s t a f e w :
* A d o p t i o n o f t h e B e l m o n t V i s i o n g o a l s w o u l d be
a s t a r t i n the proper d i r e c t i o n , e s p e c i a l l y
w i t h regard t o accessing the h e a l t h care
system.
T h e i r emphasis on b a s i c h e a l t h care
f o r a l l c i t i z e n s , p r e v e n t i v e medicine and t h e
nurturance o f primary care p h y s i c i a n s i s i n
keeping w i t h your p r e v i o u s l y s t a t e d o b j e c t i v e s .
�Page 2
March 19, 1993
* S t r u c t u r i n g t h e d e l i v e r y and reimbursement
systems a f t e r t h e fundamental p r i n c i p l e s o f
P a u l E l w o o d a n d t h e J a c k s o n H o l e Group w i l l
use m a r k e t f o r c e s t o c o n t r o l i n f l a t i o n down
t o a r e s p e c t a b l e 5% p e r y e a r w h i l e m e a s u r i n g
and e n s u r i n g q u a l i t y v i a t h e m a n d a t e d ,
- r e v i e w a b l e q u a l i t y assurance programs i n these
managed c a r e n e t w o r k s .
* A l l o w i n t e g r a t e d d e l i v e r y s y s t e m s t o "go a t r i s k . "
I n my o p i n i o n t h i s w i l l a l l o w t h e more e f f i c i e n t
o r g a n i z a t i o n s ( d e f i n e d as h i g h measured q u a l i t y
at low c o s t ) t o reward i t s people a c c o r d i n g l y .
I n o r d e r t o be s u c c e s s f u l and s u r v i v e , h o s p i t a l s ,
p r i m a r y c a r e d o c t o r s , and s p e c i a l i s t s w i l l have
to work t o g e t h e r i n a win/win r e l a t i o n s h i p .
* A v o i d p r i c e f r e e z i n g , g l o b a l b u d g e t s and c a p s .
They w i l l s t i f l e t h e i n n a t e c o m p e t i t i v e n e s s
among d o c t o r s a n d h o s p i t a l s , f o s t e r m e d i o c r i t y ,
and w i l l b r e a k t h e s p i r i t o f managed c o m p e t i t i t i o n .
They c a n a l w a y s be added i f m e d i c a l i n f l a t i o n i s
not
controlled.
* E x t r i c a t e t h e f e d e r a l government from t h e m i c r o '
management o f d o c t o r s o f f i c e s .
I t should oversee
the s t a t e r e g u l a t o r y programs which m o n i t o r t h e
adequacy o f t h e q u a l i t y a s s u r a n c e
committees
w i t h i n t h e i r managed c a r e c o m p a n i e s .
* Reduce t h e a d m i n i s t r a t i v e b u r d e n and i t s c o s t t o
t h e s y s t e m as w e l l as t h e " h a s s l e f a c t o r " i t
i m p a r t s upon p h y s i c i a n s . Managed c o m p e t i t i o n w i l l
c o n s o l i d a t e t h e 1500 i n s u r a n c e c o m p a n i e s .
The
s u b s e q u e n t s t a n d a r d i z a t i o n o f f o r m s and payment
c o d e s w i l l be a p p l a u d e d b y t h e m e d i c a l c o m m u n i t y .
* S i g n i f i c a n t c r e a t i v e and c o m p r e h e n s i v e t o r t r e f o r m
w i l l go a l o n g way t o n o t o n l y r e d u c e t h e c o s t o f
p r o v i d i n g m e d i c a l c a r e , b u t may d i s p e l t h e c y n i c i s m
o f many p h y s i c i a n s d i r e c t e d t o w a r d y o u r r e f o r m
m e a s u r e s , and h e l p them b e a r t h e above s a c r i f i c e s
gladfully.
* Address t h e problem o f f i n a n c i n g longterm care b u t
as a p a r a l l e l i s s u e .
* Address t h e problem o f f i n a n c i n g post-graduate
m e d i c a l e d u c a t i o n b u t as a p a r a l l e l i s s u e .
* Subsidize t h e education o f those medical students
w i l l i n g t o e n t e r p r i m a r y c a r e and s e t up t h e i r
p r a c t i c e s i n r u r a l areas.
�Page 3
March 19,
1993
F i n a n c i n g t h e above w i l l be no easy t a s k , and t h e
p a r t i c u l a r s w i l l need t o be worked out by minds smarter t h a n
mine; however, I b e l i e v e t h e r e w i l l be c o n s i d e r a b l e c o s t
s a v i n g i f t h e above p r i n c i p l e s are put i n t o p l a y . "At r i s k "
medical communities w i l l no l o n g e r s t r u g g l e w i t h t h e overu t i l i z a t i o n o f s e l f - i n t e r e s t r e f e r r a l s and s p e c i a l i s t - d r i v e n
medicine.
T o r t r e f o r m w i l l e l i m i n a t e about $20 b i l l i o n a
year.
Charging h i g h e r premiums f o r those who p r a c t i c e
u n h e a l t h y l i f e s t y l e s and l a r g e r p a t i e n t co-pays f o r highert e c h s e r v i c e s w i l l save money w h i l e r e d u c i n g t h e American
society's entitlement a t t i t u d e .
Reducing t h e a d m i n i s t r a t i v e
burden and the m u l t i p l e f e d e r a l and s t a t e "watchdog" agencies
w i l l t r i m o f f t h a t percentage o f t h e h e a l t h care d o l l a r t h a t
goes t o support these b u r e a u c r a c i e s .
Reforming t h e h e a l t h care system o f t h e U n i t e d S t a t e s i s
an i n c r e d i b l y complex process compounded by thousands o f
s e l f - i n t e r e s t l o b b y i s t s , a h a l f - c e n t u r y of i n f l a t i o n a r y
r e g u l a t i o n s and s o c i e t a l a t t i t u d e s b o t h u n r e a l i s t i c and
unaware o f t h e r e a l i s s u e s . Some o f t h e u n e n l i g h t e n e d ,
i n c l u d i n g t o o many p o l i t i c i a n s , b e l i e v e t h i s can be done by
s i m p l y f r e e z i n g h o s p i t a l c o s t s and r e d u c i n g t h e s a l a r i e s o f
doctors.
The m a j o r i t y o f p h y s i c i a n s , l i k e myself, look upon the
medical p r o f e s s i o n as a c a l l i n g or m i s s i o n t o which one
dedicates oneself f o r l i f e .
Foremost i n our minds i s the
b e t t e r m e n t o f our p a t i e n t s . U n f o r t u n a t e l y , the l a s t two
decades have had an e r o s i v e e f f e c t on t h i s sense o f
d e d i c a t i o n and i d e a l i s m . Too many o f my c o l l e a g u e s are
b i t t e r about t h e i r l o s s of autonomy and t h e i r
r e c l a s s i f i c a t i o n as p r o v i d e r s r a t h e r than as p h y s i c i a n s . I
see medical s t u d e n t s w i t h smothering amounts o f debt f a c i n g
the d a i l y t h r e a t o f HIV exposure w i t h a s h r i n k i n g hope f o r
f u t u r e success. S h a c k l i n g d o c t o r s w i t h r e g u l a t i o n s ,
e l i m i n a t i n g t h e i r e n t r e p r e n e u r i a l s p i r i t , handicapping
r e s e a r c h and t e c h n o l o g i c advances w h i l e homogenizing our
incomes w i l l d e s t r o y t h e medical persona as we know i t .
Worse y e t , i t w i l l d r i v e away the b r i g h t e s t and b e s t people
from going i n t o medicine.
T h i s i s not an i m p o s s i b l e s i t u a t i o n .
The above p o i n t s
w i l l a l l o w f o r an accountable h e a l t h system where p h y s i c i a n s
work t o g e t h e r w i t h h o s p i t a l s t o o f f e r q u a l i t y c o s t - e f f e c t i v e
care w i t h l i t t l e government i n t e r f e r e n c e because t h e y
�'
.1
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�March 19. 1993
c o l i e c t i v e i y ana c o l l a b o r a t i v e l y d e c i d e w h a t g e t s d o n e h o w
i t g e t s done, who g e t s p a i d and how much.
I f t h e y do i t
r i g h t t h e i r o r g a n i z a t i o n w i l l r e a p t h e f i n a n c i a l r e w a r d s and
a t t r a c t more o f t h e b e s t p e o p l e i n o u r p r o f e s s i o n .
C o n t r a r y t o t h e m a j o r i t y o f t h e m e d i c a l community I
b e l i e v e t h i s may be t h e dawn o f t h e f i n e s t h e a l t h c a r e s y s t e m
i n t h e world, r a t h e r than the-sunset.
Most e v e r y p e r s o n I
know a p p r e c i a t e s t h e t r e m e n d o u s and h i s t o r i c
responsibilirties
y o u and your- t a s k f o r c e must u n d e r t a k e .
I p r a y y o u have" t h e
w i s d o m and t h e c o u r a g e t o know w h a t must be done.
Sincerely
JFM/ac
Yours,
�CLINIC FOR SPECIAL CHILDREN
D. HOLMES MORTON, M.D., DIRECTOR
P.O. BOX 128
STRASBURG, PENNSYLVANIA 17579
717-687-9407
Hillary Rodham Clinton. Chairperson
Task Force on National Health Refonn
The White House
Washington, D.C. 20500
March 17, 1993
Dear Mrs. Clinton:
We write to share our approach to medical care for chronically ill children. The Clinic for
Special Children is unique in many wavs but it is essentially a non-profit pediatric service for a rural.
low income, uninsured population. The children we serve have complex medical problems due to
various inherited disorders and require highly specialized medical services as well as primary care.
Traditionalapproaches of referrals to tertiary medical centers had failed this community and children
with treatable disorders often went undiagnosed or received inadequate care.
At the Clinic we integrate specialized, highly technical services with primary care for a
comprehensive approach. This is not only cost effective but medically significant for improvement
in the quality of care for children with chronic illnesses. Most of the children we serve are from
Amish or Mennonite families who are uninsured, low-income, and for cultural and religious reasons
do not accept any form of state or federal assistance. Essentially we were challenged to create an
accessible, affordable, technically sophisticated health care service which met the needs of this
community without reliance on funding patterns through insurance, medicaid, or federal or state
grants. Four years ago this seemed nearly impossible, but ironically, avoiding these traditional
patterns of support gave us the latitude to define the services of the Clinic to meet the needs of
children in this community. The Clinic is now thriving having been "raised" next to an Amish corn
field, is gaining a sustaining level of local support, is contributing significant dinical research
findings, and most important is improving the health of children with inherited complex disorders.
We hope our experience here might inspire solutions for other communities.
Before the Clinic opened in 1990, cultural, economic, and geographic barriers to health
care and limited local medical services for special needs children too often resulted in permanent
disability or death from treatable disorders. Delayed diagnosis and badly fragmented treatment plans
contributed to poor outcome, too frequent and costly medical emergency services, prolonged
hospitalizations in distant tertiary care centers, and the need for long term care for disabled children.
Poor outcome and high costs discouraged appropriate use of specialized medical care and
undermined tbe ability of the family to provide immunizations, dental care, and other forms of
preventive primary care for the affected children and other normal siblings. Financial drain on
families and the local community was severe.
The founders of the Clinic for Special Children believed that a local non-profit clinic
dedicated to early recognition and treatment of locallv common genetic disorders would improve the
general medical care and outcome of affected children and refocus economic resources of the
community upon preventive health care. Our goal was to provide an affordable health care service
which combined sophisticated diagnostic services usually available only at large tertiary medical
centers with a primary care approach for children with chronic complex medical needs, to conduct
useful research directly related to improved treatment, to emphasize the need for basic health care
�within a community traditionally reluctant to embrace the value of preventive care (i.e.
immunizations), and to help educate other local health care providers about the value of our efforts to
aggressively treat patients with genetic disorders. The Clinic is now in its fourth year of operation
having gained remarkable acceptance and support within the community it serves. We have cared for
children in this region with a range of over fifty different syndromes. We have instituted a voluntary
newborn screening and follow up program (or early diagnosis among high risk families, and our
immunization service is increasingly effective in serving families who have traditionally avoided this
critical preventive measure. Our funding is derived from low fee schedules and local fund raising
projects sponsored by parents. Contributions from individuals and private foundations helped get us
started and also help sustain us. We do not seek or accept govemment support.
We believe our economy of scale and unique comprehensive approach of combining
primary care and highly specialized services to address locally specific chronic, complex medical
needs is medically and economically sound and is an important model for health care services
elsewhere, particularly rural settings, and underserved populations. Increasingly, the Clinic's
approach is gaining attention from other parents and pediatric specialists beyond this community. As
the Task Force examines ways to improve health care medically and economically we hope the
example of the community based Clinic for Special Children will demonstrate possibilities beyond
what the current referral loop system of tertiary specialty care offers. We strongly feel it is critical
to "answerthe calT'tobettermeetthe healthcare needs of families with chronicauy ill children.
Sincerely,
Director
^ (
/
Enclosures
c. Senator Harris Wofford
Caroline S. Morton, Ed. M.
Associate Director for Planning and Administration
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D O C U M E N T NO.
AND T Y P E
002a. letter
DATE
SUBJECT/TITLE
Address (Partial); Phone No. (Partial) (I page)
01/26/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [7]
2006-0885-K
jm807
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P2
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b(4) Release would disclose trade secrets or confidenlial or nnancial
information 1(b)(4) of the FOIA]
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b(8) Release would disclose information concerning the regulation of
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Tmancial information 1(a)(4) o f t h e PRA|
PS Release would disclose conndcntial advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misnie denned in accordance wilh 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�H A R O L D H. O R V I S .
M.D.
INTERNAL MEDICINE
M r: K . W .i. . 1. i. a m J . C . :i n t o n
1
1
The W h i l e House
W a s h i. n g t a n . D . C . 2 0 5 0 0
.
Ij e r M r s . C l i n t o n :
J a nua ry 2 6 , .. 9 9 3
1
It: i s a j.i.leasure t o welcome yon and P r e s i d e n t C l i n t o n t o the
White House and I w i s h you. success and h a p p i n e s s i n your new
positions.
I am p a r t i c u l a r l y p l e a s e d t o t h i n k t h a t you may become
the c o o r d i n a t o r o f a r e v i s e d h e a l t h program f o r t h i s c o u n t r y . I t
i s u r y e n 11 y n e e d e d .
My comments come f r o m a f a i r l y broad p r o s p e c t i v e .
I have
haught I n t e r n a i and P r e v e n t i v e m e d i c i n e f o r some t e n y e a r s a t
t h r e e u n i v e r s i t i e s ( i n c l u d i n g George W a s h i n g t o n ) .
[ have d i r e c t e d
a number o f r e s e a r c h . a bora t o r i ef? and c o o r d i n a t e d a Rehalvi I :i ta t i o n
1
Center ( a t t h e U n i v e r s i t y o f I l l i n o i s ) .
A l s o I was D i r e c t o r of
C l i n i c a l I n v e s t i g a t i o n f o r f i v e y e a r s ( S t u a r t Drug Company) and
more r e c e n t l y i n t h e p r i v a t e p r a c t i c e o f i n t e r n a l med i c i n e ( t w e n t y
one y e a r s ) . . was a g r a d u a t e p h y s i c i a n when e v e r y major medica i
1
program was d e v e l o p e d ( b e g i n n i n g w i t h Blue C r o s s ) .
I am a
consumer, h a v i n g had h e a r t by-pass s u r g e r y seven years ago.
[
s t i l l practice (part time).
May I o f f e r t h e f o i l o w i n g t h o u g h t s ?
1.
B a s i c m e d i c a l c a r e s h o u l d be a v a i l a t i l e t o e v e r y ont;.
Obviously
i t w i l l t a k e g r e a t wisdom t o d e f i n e " b a s i c " . The M e d i c a r e /
M e d i c a i d models p l u s work i n H a w a i i and Oregon may e x p e d i t e
this .
2.
T h e r e i s no way on e a r t h t h a t everyone can have e v e r y p r o c e d ure,
t e s t and t r e a t m e n t t h a t i s a v a i l a b l e .
Some a p p o r t i o n m e n t
(we don't, dare c a l i i t r a t i o n i n g ) i s i n e v i t a b l e .
This w i l l
have t o be a d j u s t e d , by age ranges and c e r t a i n p e c u l i a r i t i e s o f
diseases.
There a r e ample v a r i e t i e s o f means t o d e a l w i t h
t h i s i n many c o u n t r i e s .
We might borrow f r o m tlie b e t t e r ones.
3.
I n our c o u n t r y i f you want a b i g g e r house o r c a r you work a
l i t t l e h a r d e r and pay more. A b a s i c medical p l a n should, not
p r e c l u d e i n d i v i d u a l s o r c o r p o r a t i o n s f r o m h a v i n g supplementa .
1
benefits.
I t appears t h a t such i s the case i n many count.fi.es
whe re gene ra 1 med i c a l ca re i s u n i v e r sa 1.
4.
We have l a r g e , o n g o i n g programs i n p l a c e such as M e d i c a r e ,
b i n e Cross and c e r t a i n p r e - p a i d h e a l t h p l a n s . Group H e a l t h i n
Washington, D.C. lias been f u n c t i o n i n g f o r a t l e a s t f o r t y
years.
The K a i s e r p l a n i n C a l i f o r n i a goes back t o World War
11.
These c o u l d f o r m the b a s i s or be a model f o r a c o u n t r y -
�Mrs.
William Clinton
wide p l a n .
We s h o u l d
J a n u a r y 26, 1993
-2-
n o t have t o " r e i n v e n t t h e w h e e l . "
5.
T h e r e i s an i n o r d i n a t e amount o f p a p e r w o r k f o r p a t i e n t s ,
h o s p i t a l s and d o c t o r s .
The c r e d i t c a r d i n d u s t r y has w e l l
d e v e l o p e d methods t o e x p e d i t i o u s l y v e r i f y a c c o u n t s and b i l l
c u s t o m e r s . These mechanisms s h o u l d be a p p l i c a b l e t o t h e
h e a l t h s c e n e . A g a i n , we s h o u l d n o t have " t o r e i n v e n t , t h e
wheel."
6.
The m e d i c a 1 / l e g a l s i t u a t i o n i n o u r c o u n t r y i s a j u n g l e . I t
r e f l e c t s u n a t t a i n a b l e e x p e c t a t i o n s , f r e q u e n t l y g r e e d on t h e
p a r t o f p a t i e n t s and has been a b e t t e d by t h e l e g a l p r o f e s s i o n ,
A g a i n , t h e r e must be some r e a s o n a b l e p r e c e d e n t f o r a m e l i o r a t i n g t h i s p r o b l e m - p e r h a p s t h e s t a t e s o f H a w a i i and I n d i a n a
have had some s u c c e s s .
A t any r a t e , I f e e l t h a t t h i s s h o u l d
be a f e d e r a l n o t a s t a t e s o l u t i o n .
I t w o u l d seem a p p r o p r i a t e
f o r t h i s c o n s i d e r a t i o n t o be h a n d l e d s e p a r a t e l y f r o m t h e
p r i m a r y m e d i c a l one.
F o r g i v e me f o r b e i n g so "wordy" b u t t h e s e t h o u g h t s have been
g r a d u a l l y d e v e l o p e d o v e r some y e a r s .
Perhaps one o r t w o may
r e i n f o r c e o t h e r s t h a t y o u w i l l be r e c e i v i n g . I f e r v e n t l y hope
t h a t you can u n d e r t a k e o r a t l e a s t i n i t i a t e t h e s o l u t i o n s t o o u r
m e d i c a l needs. One c o u l d l e q v e no g r e a t e r l e g a c y .
With best
regards.
Harold
HHO/nbf
H. O r v i s , MD, FACC
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SUBJECT/TITLE
DATE
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Address (1 page)
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
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FOLDER TITLE:
[Physician Letters] [loose] [7]
2006-0885-F
jm807
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�CODER:
H E A L T H CARE TASE? FORCE SORTING SHEET
p,R OF MATRRTAT,:
_Per8onal stories
Letterhead
Casework
_Offer8 to help
_General m a i l
Employment
Other
_Advocacy
_Policy
_Letter Campaign
_Rc quests;
-speech
-meeting
Explanation:,
ADVISORY PANEL?
_phy8ician
Jarge employers
r.ru
seniors
other consumers
small business
_other health provider
Explanation:,
ERIMAfiY INTEREST:
COST ISSUES
D r u g Prices
Physician Fees
Hospital Fees
Unnecessary Procedures
Medical Equipment
F r a u d and Abuse
_PUBLIC HEALTH/SPECIAL POPULATIONS
Prevention
AIDS
Women's Health
Immunizations
Rural
Urban
COVERAGE
W o r k i n g Families
Unemployed/Low Income
Benefits
Providers
GOVERNMENT PROGRAMS
Medicar©
Medicaid
Veterans
DoD
ORGANIZATION
Insurance Premiums
Insurance Reform
Insurance Pools
Boards and Oversight
ENFRASTRUCTUREAVORKFORCE
Quality Assurance (Guidelines)
^ ^ A d m i n i s t r a t i o n , Reimbursement
& Patient I n f o r m a t i o n Systems
. Malpractice & T o r t R e f o r m
Manpower Issues (Training)
L O N G - T E R M CARE
MENTAL H E A L T H
X
OTHER
Explanation:
FT A N PREFERENCE: (Support = +; Oppose = - )
CP
SP
OP
Clinton Plan
Single Payer
Other Plan
MC
PP
CV
•f
Managed Competition
Pay or Play
Credits, Vouchers,
Medical Savings AcctA.
CA
BR
GE
Canadian
British
German
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DOCUMENT NO.
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SUBJECT/TITLE
DATE
05/11/1993
Address (Partial) (I page)
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [7]
2006-0885-F
jm807
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personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
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b(8) Release would disclose information concerning Ihe regulation nf
financial institutions |(b)(8) of the FOIAj
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C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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RR. Document will be reviewed upon request.
�K.r.ko.s - A E O O I C U C L ? 1/ 1
NT CNMC O N I ;
: 5-12-93 ; 13:38 :
SENT BY^Iytnoimi Meei Ing
FEDERATION OF ASIAN AMERICAN WOMEN PHYSICIANS
P.O. Box 106
Eagleville, PA 19408
\
(215) 525-6711
5-11-93
Va|«a Ouwph, M.D.
(215) 525-6711
Ms.
Vice President:
Rnjaui A. NtJkoiiii, M.D.
Schuneman
H e s l t h Care Trisk
Force
The W h i t e House
Stcretai-y-Trta.surer:
Mtu™ PhaUk, M.D.
Washington D.C.
20500
KMetuti»e CoiuittiM**;
Me«u Peer, M.D.
ParVMhy Mulmn. M D.
Dear Ms.
VJIM Abraham, M.D.
Schuneman:
About a week ago,
Mctitbership Coauuitltt:
Kar.:h»n Koiik, M.D.-DE
AIIC
Muco.mpc. M.D.-NJ
t
o
M r s
_
clinton,
R sm a Thoppii, M.D.-TX t a s k f o r c e .
oc m
LiAiimnmii Chneko, M.D.-NY
ShicU M h w M D - Y
m e , ..K
I sent a
letter
e x p r e s s i n g mv I n t e r e s t i n s e r v i n g
I have e n c l o s e d my C.V.
the
1 am a board c e r t i f i e d
p s y c h i a t r i s t and p r e s i d e n t o f a group o f A s i a n
American
Mcrcj Tiiomaakulty, M.D.-MD
Women P h y s i c i a n s .
Cynstitution and Hy
_
1
Uw*Committe*:
r
D
siS/M «mM D.
M revchirayath, M.D.
e
_
s u
PPort
. _
the President's
proposal
f o r h e a l t h care
reform i n t h i s country. I believe personal
r e q u i r e d f o r t h e l o n g t e r m economic s t r e n t h
y a c r i f i c e s are
of t h i s country.
1 am aware t h a t t h e h e a l t h c a r e r e f o r m p r o p o s a l w i l l
submitted
t o t h e congrese; w i t h i n few weeks. T would
t o o f f e r t o serve
the
proposal
the task force in i t s e f i o c t
and d i s s e m i n a t e
community. I itm w i l l i n g
be
like
t o promote
i n f o r m a t i o n w i t h i n t h e medical
t o p r o v i d e my s e r v i c e s w i t h o u t
c o m p e n s a t i o n . I f you have any q u e s t i o n s , I c o u l d be reached
a t 215-525-6711. Vou may send any c o m m u n i c a t i o n t o
P6/(b)(6),.
Sincerely,
V a l s a Ouseph,
Non profit organization for the advancement of Asian American Women Physicians.
M.D.
�JOSEPH W. PRICE, M.D.
514 EAST SEDGWICK STREET
PHILADELPHIA, PA 191119
FAMILY PRACTICE. FAAFP
(215) 248-4236
April 8, 1993
Dear Hillary Rodham Clinton:
The basis for a good health care system is built on a strong primary care doctor
relationship. I have been a family practitioner for the last twenty-one years and have a
great deal of concern about the health care for our people. 1 have seen the abuses of
the fee for service system become replaced by the abuses and paper blizzard of the
managed care plans. Each model that has appeared has categorically disenfranchised the
basic foundation of any decent health care plan - the family physician or the primary
care physician.
Perhaps I'm too simplistic but I've been teaching medical students and patients
that the basis for good health begins with contact and education by a caring primary care
physician. This requires time and, historically, has never been very lucrative. Hence the
pressure to perform numerous procedures and churn these into the visit. Often, this is
justified by malpractice concerns and just as often it reduces the actual doctor-patient
contact time.
Unfortunately, my own style of practice is in a minority. I always spend no less
than fifteen minutes and often more than thirty minutes with each patient. This time is
essential to develop a deep understanding of the patient's concerns and nearly always
only a single visit is necessary. Occasionally a test, or more rarely a consultation with
another physician is required. It is very unusual to need hospital intervention in these
circumstances. This style of practice does not generate a large income but even more
�Page Two
disturbing, of late, insurers have been cutting back office visit fees. Leading the way
three years ago, Medicare cut the allowable charges for office visits by nearly thirty
percent. This cost cutting measure has not changed the depletion of Medicare funds but
has reduced patient office visit payments (not including ancillary charges).
Any comprehensive plan must encourage, rather than penalize, the patient to
spend more time with the physician alone. For an accurate assessment and appropriate
care, the doctor must spend time listening and talking to the patient. If better
compensation for the office visit occurs while reducing the compensation for the
procedural services, better care at lower cost would result. The evaluation of such a plan
would require a peer-review panel to determine that each physician was actually
spending the time with his patients - this has never been audited before.
I believe that the primary care doctor is the key to a comprehensive, affordable
health plan. Economic disincentives must be removed from the office visit, house visit
and nursing home visit. I shudder over the monumental task before you and the strong
vested interests that must be overcome to place affordable health care in the community
for everyone.
Yours truly,
Joseph W. Price, M.D.
JWP:ms
P.S. As I finish this letter, I have just learned of the death of your father, please
accept my deepest sympathy at this very difficult time.
�Conner, Rich, Kearney & Torchia Associates
Internal Medicine
Kenneth B. Conner, M.D.
.James F. Rich, M.D..
^
James D. Kearney, M.D.
Joseph A. Torchia, M.D.
January 29, 1993
« <, :
,
Mrs. H i l l a r y Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20000
U
Dear Mrs. Clinton:
1
,1 am a general internist practicing medicine i n Harrisburg, Pennsylvaniaand have been very-active i n bur county .and state medical societies. I
would.like to comment on the. task force that i s being chaired by you to
evaluate healthcare reform i n this country. The committee consists of a
body of individuals who are quite knowledgeable i n many facets of medicine,
finance, and administration. My only regret i s that there are no "grass
roots" people on the committee.
v
One of the strengths of Mr. Clinton's campaign was his a b i l i t y to reach
out to people i n the mainstream of American l i f e . I t would seem, to
properly evaluate healthcare reform and i t s effects on everyone i n the
system, a person who deals with patients, who i s i n the "trenches" of
health care, should be considered as part of the organization. A physician
who practices general medicine deals with patients, deals with t h i r d party
insurance companies, deals with Medicare and has a good understanding of
the problems and the benefits of the present system. More importantly,
a physician might be able to add some i n s i g h t f u l information on making
changes i n healthcare reform. We a l l realize that healthcare reform i s
necessary and that health care should be available to everyone.
I appreciate your time and interest i n this matter and hope that you would
consider a practitioner who could show you the perspective from the "trenches"
of healthcare delivery.
Sincerely
F. Rich, M.D.
JFR/bab
207 House Avenue • Suite 101 • Camp Hill, PA 17011 • (717) 761-8331 • FAX (717) 761-5032
�THE J. EDWIN WOOD CLINIC
"
A Non-Profit Clinic Affiliated With Pennsylvania
700 SPRUCE STREET
SUITE 304
PHILADELPHIA, PA 19106
(215)829-3521
Hospital
KATALIN E. ROTH, J.D MD
Medical Director
S t , ? ™
February 12, 1993
Hillary Rodham Clinton
The White House
Washington, D.C.
Dear Hillary:
Thank you for joining us in Harrisburg yesterday . I strongly support health care
reform. I applaud your decision to lead this critical effort.
As you may know, after completing Yale Law School and practicing as a lawyer in
Connecticut, I fulfilled a lifelong dream and in 1982 graduated from the Yale Medical
School. Since 1985 I have been a practicing internist and the Medical Director of a
clinic which serves an indigent population of adult patients. My practice is primarily
concentrated in the areas of AIDS and geriatrics. My clinic is associated with a major
teaching hospital where, as Vice-Chairman of the Department of Medicine, I have
significant administrative and teaching responsibilities. I am active locally in public
health issues and have served as chair of a task force on AIDS for Mayor Rendell of
Philadelphia.
As a practicing physician who sees patients daily in the office and in the hospital, and
as one with extensive administrative experience with HMOs and other payors, I may
be able to assist your task force as a practical sounding board . Please feel free to
call on me.
As always you have my support.
Sincerely yours,
Katalin E. Roth, J.D., M.D.
Yale Law School Class of 1973
end.
Formerly Benjamin Rush Medical Associates
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
^5
.53 85
3/1
-gJjJUfc^^
�Katalin Eve Roth J.D.
M.D.
Brief Curriculum Vitae
Home Address:
700 Spruce Street Suite 304
Philadelphia, PA. 19106
Office Address:
Education:
1966-70
1970-73
1978-82
Tel: 215-829-3006
B.A. Barnard College (American Studies)
J.D. Yale Law School
M.D. Yale University School of Medicine
:
Postgraduate Training :
1982- 83
1983- 85
Intern in Medicine, Temple Hospital, Philadelphia
Resident in Medicine, Temple Hospital
Faculty Appointments:
1973-76
1979- 81
Present
Instructor, University of Connecticut School of Law,
West Hartford, CT
Instructor, Yale College, New Haven, CT
Assistant Clinical Professor, Univ. of Penn. School
of Medicine
Present Position and Hospital and Administrative Appointments:
19.85198519881990-
JWedical Director, The J.E. Wood III Clinic (formerly Benjamin
Rush Medical Associates), a nonprofit clinic affiliated with
Pennsylvania Hospital
Medical Director, Employee Health Service, Pennsylvania Hospital
Section Chief, General Medicine, Department of Medicine,
Pennsylvania Hospital
Vice-Chairman, Department of Medicine, Pennsylvania Hospital
Specialty Certification
1985
American Board of Internal Medicine
1990
American Board of Interna! Medicine - Geriatrics
�Licensure:
Medical:
Legal:
Pennsylvania
Admitted to the Bar :State of Connecticut and
admitted before Federal District of Connecticut and
Memberships in Professional and Scientific Societies:
American College of Physicians
Society of General Internal Medicine
American Society of Law and Medicine
Pennsylvania Medical Society
Philadelphia Forum of Executive Women
Fellow, Philadelphia College of Physicians
CIVIC ACTIVITIES
Board of Directors (founding member), Connecticut Womens Educational and
Legal Fund (CWEALF), 1973-1978
Board of Directors, Greater Philadelphia Womens Medical Fund (GPWMF),
1986-88
Board of Directors, ActionAIDS, Philadelphia 1986-1992
Board of Directors, Adolescent Health Partnerships, Philadelphia 1992 Chair, Philadelphia Mayor's Task Force on AIDS Prevention in Commercial
Sex Establishments, 1992
Special Advisor on AIDS Policy, Philadelphia Department of Health, 1993
�.John F. Shuman, M.D.
Kicndrd T. Bell, M.D.
Roger G. Mengel, M.D.
John A. Shapiro. M.D.
Area Code 215
Telephone: 374-4421
PULMONARY MEDICINE
ASSOCIATES, INC.
SUITE
.301 SOUTH S t f t f E N T H ^VKN'NK
WEST l { E A D I N ( / P E N N S Y L V A N I A 19611
March
Mrs. H i l l a r y Rodham C l i n t o n
H e a l t h Care Task Force
Old E x e c u t i v e O f f i c e B u i l d i n g
Room 287
Washington, D.C. 20500
Dear Mrs. C l i n t o n ;
As a p r a c t i c i n g pulmonary p h y s i c i a n who spends a major segment
of my p r o f e s s i o n a l t i m e w o r k i n g i n t h e c r i t i c a l care arena, I have
taken a keen i n t e r e s t
i n your t a s k f o r c e . I g e n u i n e l y applaud t h e
s a c r i f i c e you have made and major commitment o f your time i n an
e f f o r t t o expand t h e u m b r e l l a o f o u r h e a l t h care system t o cover
a l l o u r c i t i z e n s . Given my d a i l y a c t i v i t i e s i n c a r i n g f o r a r n t o I y
Hrl^pat'iejTts, I am most i n t e r e s t e d i n your t h o u g h t s c o n c e r n i n g
To*^—te-f-orm land t h e savings t h a t would be generated by our
l i t ^ _ t g y c u r b "defensive medicine."
However, I am w r i t i n g today i n a d i f f e r e n t v e i n . As I have
seen your t a s k f o r c e i n t h e p u b l i c media, I have n o t i c e d a g l a r i n g
o m i s s i o n . I have n o t seen any r e p r e s e n t a t i o n o f t h e c h r o n i c a l l y i l l
and s e r i o u s l y i l l p a t i e n t s .
I t seems t h a t a l l o f t h e p l a n n i n g and
d e c i s i o n s a r e b e i n g made by h e a l t h y , v i t a l , e n e r g e t i c , v e r y
s u c c e s s f u l people. The
p e r s p e c t i v e on d e l i v e r y o f h e a l t h care
changes d r a m a t i c a l l y when one becomes a p a t i e n t .
I have seen t h i s
b o t h i n my f a m i l y , and i n my p a t i e n t s . Managed care i n t h e form o f
HMO/PPO i s q u i t e s a t i s f a c t o r y , and even c o n v e n i e n t , as l o n g as
major d e b i l i t a t i n g i l l n e s s e s a r e n o t a d a i l y concern. However,
access t o m e d i c a l care seems t o become q u i t e a problem when severe,
chronic i l l n e s s e s are present.
I would be most i n t e r e s t e d i n your t h o u g h t s r e g a r d i n g t h e
p e r s p e c t i v e o f these i n d i v i d u a l s ( i . e . , s e r i o u s l y and c h r o n i c a l l y
i l l p a t i e n t s ) . Once a g a i n , I commend your commitment and p e r s o n a l
investment i n our h e a l t h c a r e .
Yours t r u l y ,
John A. S h a p i r o , M.D.
JAS jbasp
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. letter
SUB.IKCT7HTLE
DATE
02/20/1993
Address (Partial); Phone No. (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [7]
2006-0885-F
jm807
RESTRICTION CODES
Presidential Records Act - 144 U.S.C. 2204(»)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
IM Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
h(l) National security classified information [(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe I Ol \ |
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
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b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 IJ.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CLARE N. SHUMWAY, M.D.
• P6/(b)(6)
CompuScWcj_7fl25^3463
clarcn.s@aol.coin
February 20, 1993
Mrs. Hillary Clinton
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500
Dear Mis. Clinton:
I am writing with the hope of being able to help you and President Clinton aehieve your goal of
improving the delivery ofhealth care. I feel passionately that medicine can do a better job ihan il
has; my dilemma is that I don't knp.w.-wliat--I-canido to promote change.
i.
"
1 am'^a retired pediatrician (see enclosed C.V.) who gave up practice because of disillusionment
and disappointment with' financial aspects of medical care. Over the years I had seen medical
practice lose its "art" and become a business. Expenses in the office and the cost of malpractice
insurance finally made it more feasible to retire than to continue work. Medicine had been my
"mistress" and was secondary in importance only to my wife and family. The pleasure derived
from helping a patient or his family was more important to me than financial remuneration.
I had planned after retirement to contribute my experience and skill to the care of the less
fortunate but found that organizations such as the Indian Health Service were not interested in
them. In order to work locally il would have been necessary to carry malpractice insurance the
cost of which was prohibitive.
It is my feeling that medical care is overpriced in part because of greed; that of physicians who
operate their practices like businesses and practice too defensively; hospitals, drug companies,
insurance companies and suppliers of medical equipment (the cost of nuts or bolls to repair
medical equipment are greatly inflated, much as they were for the Defense Department); patients
and lawyers who utilize malpractice suits too freely, and some ofthe general public who expect
their physician lo be "Super MD", one who will guarantee them perpetual life free of discomfort.
I want very much to worlc toward making top-notch medica! care available to all, but especially
(he children, in this country. I hope that you will call upon me to assist you in some fashion.
Sincerely,
Clare N. Shumway, M.D.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
31A'
�CURRICULUM VITAE
CLARp NELSON SHUMWAY, JR., M.D.
Born:
High School:
Painted Post High School.
Premedical:
University of Buffalo - 1943 to 1945; no degree.
Medical:
University of Buffalo School of Medicine - 1945 to 1948, M.D.
Internship:
Buffalo General Hospital -1948 to 1949.
Residency:
Buffalo Children's Hospital - 1949 to 1952.
Fellowships:
Department of Hematology, University of Rochester School of Medicine 1952 to 1953 and 1955 to 1957.
Department of Medicine, University of Washington School of Medicine 1969 to 1970.
Department of Behavioral Pediatrics, University of Maryland School of
Medicine - 1982 to 1983.
Armed Service:
United States Navy Medical Corps - 1953 to 1955.
Appointments:
Miscellaneous:
-
7
Instructor of Pediatrics, University of Rochester School of Medicine 1952 to 1953 and 1955 to 1957.
Assistant Professor of Pediatrics, University of Buffalo School of Medicine
1957 to 1961.
Associate Professor of Pediatrics, University of Buffalo School of
Medicine - 1961 to 1964.
Director of Hematology, Buffalo Children's Hospital - 1957 to 1964.
Associate Professor of Pediatrics, Medical College of Virginia - 1964 to
1965.
^rt ofessor of Pediatrics, Medical College of Virginia - 1964 io 1972.
Director of Pediatrics, Polyclinic Hospital, Harrisburg, PA - 1972 to 1977.
Professor of Pediatrics,'Hahnemann Medical College - 1972 to 1974.
Clinical Associate Professor of Pediatrics, College of Medicine,
Pennsylvania State University - 1974 to 1977.
Director of College Health Services, Gettysburg College, Gettysburg, PA 1977 to 1985 "
Examiner for (he American Board of Pediatrics - 1979 to 1987.
Research Project in Medical Education, University of Buffalo - 1957 to
195S.
Private Medica! Practice, Gettysburg, PA - 1985 to I9S7.
Rclired - 19S7.
�Societies:
Alpha Omega Alpha - 1948
Sigma Xi - 1961
Certified by American Board of Pediatrics - 1953; recertified - 1977.
Certified by ABP Sub-board of Pediatric Hematology/Oncology - 1974.
American Academy of Pediatrics
New York Academy of Sciences
American Society of Hematology
American Pediatric Society
BIBLIOGRAPHY Neter, E. and Shumway, C.N.: E.Coli Serotype D433: Occurrence in intestinal and
respiratory tracts, cultural characteristics, pathogenicity, sensitivity to antibiotics. Proc.
Soc. for Exp. Biol, and Med. 75:504, 1950.
Neter, E, Webb, C.R., Shumway, C.N. and Murdock, M.R.: Study on etiology, epidemiology
and antibiotic therapy of infantile diarrhea with particular reference to certain serotypes
of Escherichia coli. Am. J. of Public Health 41:1490, 1951.
Lambert, E.G., Shumway, C.N. and Terplan, K.: Clinical diagnosis of endocardial fibrosis.
Pediatrics. 11:255, 1953.
Shumway, C.N., Miller, G. and Young, L.E.: Hemolytic disease ofthe newborn due to anti-A
and anti-B. Pediatrics. 15:54, 1955.
Miller, G. Shumway, C.N. and Young, L.E.: Auto-immune hemolytic anemias. Ped. Clin, of
North America. May 1957.
Shumway, C.N. and Miller, G.:An unusual syndrome of hemolytic anemia,thrombocytopenic
purpura and renal disease. Blood. 12:1045, 1957.
Shumway, C.N.: Spherocytic hemolytic anemia associated with acute pneumococcal infection
in rabbits. J. of Lab. and Clin. Med. 51:240, 1958.
Shumway, C.N., Bockenhauser, V., Pollock, D. and Neter, E.: Survival in immune and
nonimmune rabbits of Cr -labeled erythrocytes modified by bacterial antigen. J. of
Lab. and Clin. Med. 62:600, 1963.
51
Shumway, C.N. and Terplan, K.L.: Hemolytic anemia, thrombocytopenia and renal disease in
childhood. The hemolytic-uremic syndrome. Ped. Clin, of North America. 11:577,
1964.
Shumway, C.N.: Dissociation of bacterial O antigen from rabbit erythrocytes. Nature.
203:1081, 1964.
�Shumway, C.N. and Pollock, D.: The effect of a pneumococcal product upon rabbit
erythrocytes in vitro and in vivo. J. of Lab. and Clin. Med. 65:432, 1965.
Shumway, C.N.: Management of anemia in childhood. G.P., May, 1969.
Maurer, H.M., Valdes, 0., Shumway, C.N. and Massie, F.S.: Plasma activity of
antihemohiliac globulin (AHG) and other coagulation factors in Swiss type of
agammaglobulinemia. Blood. 34:701, 1969.
Valdes, O.S., Maurer, H.M. And Shumway, C.N.: Neuroblastoma - A review of the
experience at the Medical College of Virginia. Virginia Medical Monthly. 97:340,
1970.
Shumway, C.N.: Pneumococcal hemolysin. MCV Quarterly. 7:69, 1971.
Shumway, C.N. and Klebanoff, S.J:. Purification of Pneumolysin. Infection and Immunity.
4:388, 1971.
Valdes, O.S., Maurer, H.M., Shumway, C.N., Draper, D, and Hossaini, A.: Controlled clinical
trial of phenobarbital and light for management of neonatal hyperbilirubinemia in a
predominantly Negro population. J. of Pediatrics. 79:1015, 1971.
Shumway, C.N.: Iron deficiency in children. Ped. Clin, of North America. 19:855, 1972.
Maurer, H.M., Shumway, C.N., Draper, D and Hosaini, A.: Controlled trial comparing agar,
intermittent phototherapy and continuous phototherapy for reducing neonatal
hyperbilirubinemia. J. of Pediatrics. 82:73, 1973.
Myers, B.C., Whitaker, J.C., Maurer, H.M. And Shumway, C.N.: Failure to demonstrate a
hemolytic effect of phototherapy on erythrocytes. Virginia Medical Monthly 100:429,
1973.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Ms Hillary Rodham Clinton, Chairperson
Task Force on Health Care Retorm
The White House
Washington, DC 20510
Dear Ms. Rodham Clinton.
This is the first time that I have-written ji letter to anyone in the Whiffc House. Tt has always seemed that the opinions of individuals like myself would have little impact on those in
power. However, the youth and vitality coming from the Executive Branch of the government are
most encouraging. For the first time, T believe that my opinions might truly matter.
I am writing this letter for essentially two reasons First, I would like to express some of
my views on health care reform Second, I would like to participate in the process of reforming
our health care system, should any opportunities be available to me.
I have been a practicing physician in Pennsylvania for nearly twelve years. I am a board
certified Internist and hold board certifications in Geriatrics, and in Quality Assurance and Utilization Review. I am a very busy clinician, seeing 20 to 30 patients per day in a group practice in
suburban Philadelphia. The patients whom I see come from a broad variety of backgrounds. My
practice participates with the Medicare program as well as with various indemnity plans. I am also
seeing an increasingly large percentage of patients in a managed care setting. A small percentage
of my patients have Medical Assistance. As you can see, my experience with health care delivery
is fairly broad.
Although my clinical practice has occupied the majority of my time, over the past seven
years I have become increasingly active as the Quality Assurance Chairperson at the small community hbsgjtahwhece 1 maintain staff priYtleges,,_This,administrative position has involved me in numerous activities that ffave led me to analyze and evaluate physician behavior in some depth. My
dual role as both a clinician and administrator liave provided me with a somewhat unique perspective on health care reform, especially regarding cost containment.
In the past, physicians have been trained to ignore issues of cost and efficiency in health
care To consider cost was tantamount to the subordination of quality I believe that in my training there was the tacit implication that the quality of care would suffer if physicians concerned
themselves with the price tag of what they were doing. In addition, physicians have traditionally
regarded public scrutiny of their activities as meddlesome and inappropriate. They have felt that
"outsiders" were incapable ot" understanding what they did and have used this argument as a shield
asainst those who would criticize their activities.
�These attitudes will no longer be tolerated as health care providers are swept up in a rapidly
changing social climate. Physicians have been brought into a new age of accountability, albeit reluctantly at times. Our activity is now regularly scrutinized by any o f a number of organizations.
Pennsylvania has, as you know, been in the forefront in the collection of data regarding the cost
and quality ofhealth care. The time has come for physicians to drop their guard and freely examine their activities.
I believe that quality care and efficient care can go hand in hand. The variations in practice
styles and efficiency between physicians are extraordinary; yet T am struck by the fact that the quality ofthe care rendered is often similar. The point is that there is much money to be saved if
physicians can be taught how to practice medicine in a more efficient manner. Although physician
fees make up a relatively small percentage ofthe total cost ofhealth care in this country, physician
decision-making is responsible, on a conservative estimate, for 75% ofhealth care costs. Tf physicians can be trained to practice medicine in a more cost-conscious manner, I believe that the savings to the health care system would be considerable. These savings could, in turn, be channelled
into other areas of need, including improving access to care and a credible preventive health program for all Americans.
A more cost-conscious health care system must address many issues including public wants
versus needs, tort reform, and a hard look at just what our society can reasonably afford. Just as
important is that any tenable health care reform must squarely address how to change physician
behavior. The establishment of practice guidelines is certainly a move in the right direction, but
there is no clear evidence that such guidelines will necessarily influence physicians' practice patterns. Moving toward increased participation in a managed care environment will likely be part of
a cost-efficient system. However, I believe that the majority of physicians in this country (including those who participate in managed care programs) regard such environments as intrusions on
their practice styles that potentially threaten quality of care.
Consequently, I believe that it is vitally important to include practicing physicians from the
ground up in the design of meaningful health care reform. Those of us on the "front lines" have a
wealth of knowledge and experience that could be used positively in these efforts. Tn my activities
as a Quality Assurance Chairperson T have found the need for physician "buy-m" to be of
paramount importance. Physicians, for the most part, want to do the right thing. Tf they are convinced ofthe need for change, most will be willing to modify their behavior, especially if they can
be shown that such change will not compromise the care provided to their patients. On the other
hand, if physicians perceive the new health care system as a cost-saving imposition on their ability
to practice medicine, there will likely be widespread resistance and dissatisfaction. The new system
must, therefore, address the need for physician education. Tn particular, the principles of efficient
practice will need to be researched and incorporated into the medical school curriculum.
T would be honored to participate in any forums designedjfl_deaLw.itiq.thescand_o,ther_issues of health "care retorm, should they exist. T believe that practicing physicians such as myself
stand the best chance of influencing~col1eagues to cooperate with a new system that may at first
glance appear threatening. Tf a primary goal ofhealth care reform is the modification of physician
�behavior, it only makes sense to include those of us who take care of patients on a day-to-day
basis. I have included a copy of my curriculum vitae for your files.
Thank you for your attention to this letter.
Sincerely,
David W. Stepansky, M D
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3IH
�CURRICULUM ViTAE
DAVID WAYNE STEPANSKY, MD
HOME ADDRESS:
OFFICE ADDRESS:
580 West Mam Street, Trappe
Collegeville, Pennsylvania 19426
%
SOCIAL SECURITY NUMBER.
CITIZENSHIP:
U.S.A.
DATE OF BIRTH:
PLACE OF BIRTH:
MARITAL STATUS:
EDUCATION:
1973-78:
Pennsylvania State University/Jefferson Medical
College - 5-year accelerated medical program.
Received B.S. in Science, 1976, and M.D. in
1978.
POSTGRADUATE TRAINING:
1978- 79:
Categorical first-year resident in Internal
Medicine, Albert Einstein Medical Center,
Northern Division, Philadelphia, Pennsylvania.
1979- 81:
Resident in Internal Medicine, Albert Einstein
Medical Center, Northern Division, Philadelphia,
Pennsylvania.
1980-81:
Assistant Chief Resident, Albert Einstein Medical
Center, Northern Division, Philadelphia, Pennsylvania.
1 98 1 present:
Full-time practice of General Internal Medicine
as a member of PM A Medical Specialists.
P h o en ixv111 e, Penn sy 1 va n ia.
EMPLOYMENT:
�HOSPITAL APPOINTMENTS:
1981 present:
Staff Physician, Phoenixville Hospital,
Phoenixville, Pennsylvania.
1983present:
Staff Physician, Pottstown Memorial
Medical Center, Pottstown, Pennsylvania.
LICENSURE:
Pennsylvania (MD# 022839-E)
AWARDS, HONORS, AND
MEMBERSHIPS IN
HONORARY SOCIETIES:
1973 - Cum Laude Society from Haverford School
1976 - Bachelor's Degree awarded Magna Cum Laude
1981 - Honorable Mention for Nathan Schatz Award,
Albert Einstein Medical Center
BOARD CERTIFICATIONS:
1981 - American Board of Internal Medicine
1988 - American Board of Internal Medicine - Special
Qualifications in Geriatric Medicine
1991 - American Board of Quality Assurance and Utilization Review Physicians
NATIONAL SOCIETIES:
American
American
American
American
Medical Association
Geriatric Society
College of Physicians
College of Medical Quality
LOCAL SOCIETIES:
Pennsylvania Medical Society
Montgomery County Medical Society
HOSPITAL COMMITTEES:
Quality Assurance Chairperson, Phoenixville Hospital,
Phoenixville, Pennsylvania - 1986-1991.
Medical Director of Consinuous Quality Improvement,
Phoenixville Hospital, Phoenixville, Pennsylvania - 1991present.
Chairperson, Quality Assurance Committee, Phoenixville
Hospital, Phoenixville, Pennsylvania - 1986-1988.
Chairperson, Quality Assurance Subcommittee of Departments of Internal Medicine and Family Practice,
Phoenixville Hospital, Phoenixville, Pennsylvania - 1988present.
�HOSPITAL COMMITTEES
(CONTINUED):
Chairperson, Mandated Data Review Committee,
Phoenixville Hospital, Phoenixville, Pennsylvania - 19881991.
Chairperson, Performance Evaluation Committee,
Phoenixville Hospital, Phoenixville, Pennsylvania - 1991present.
Chairperson, Transfusion Committee, Pottstown Memorial
Medical Center, Pottstown, Pennsylvania - 1990-1992.
Member, Executive Committee, Phoenixville Hospital,
Phoenixville, Pennsylvania - 1988-present.
OTHER ACTIVITIES:
Member, Board of Directors, Or Shalom Synagogue,
Berwyn, Pennsylvania - 1988-present.
Member, Board of Directors, PMA Medical Specialists,
Phoenixville, Pennsylvania - 1990-present.
Secretary, Board of Directors, Community Music School of
Collegeville, Collegeville, Pennsylvania - 1991-present.
Member, Peer Review Committee, Freedom - An Aetna
Health Plan, Wayne, Pennsylvania - 1991-present.
SPEAKING ENGAGEMENTS:
"Geriatric Principals." Presented to Phoenixville Area Caregivers - February 1990, and to King of Prussia Area Caregivers - February 1993.
"Resource-Based Relative Value Scale." Presented to
Delaware Valley Hospital Council Regional Meeting, Valley
Forge Sheraton - June 25, 1991, and to Department of Internal Medicine & Family Practice, Phoenixville Hospital August 5, 1991.
"Medical Staff Quality Management." Presented at
Pottstown Memorial Medical Center Lecture Series September 4, 1991
�HEALTH CARE TASK FORCE SORTING SHEET
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_ L * N F IRASTRUCTURE/WORKFORCE (III)
U
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
FINANCING (VII)
.MENTAL HEALTH (IX)
.LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
_AIDS
women's health
^immunizations/children
rural
urban
OTHER
�JOSEPH P. VIGLIONE, M.D. FAAFP
CHERYL A. VIGLIONE, M.D.
ROBERT EPSTEIN, M.D.
(^])
Family Practice
PHONE: (717) 421-1460
421-1939
25 N. 8th STREET
STROUDSBURG, PENNA. 18360
�4
t
JOSEPH P. VIGLIONE, M.D. FAAFP
CHERYL A. VIGLIONE, M.D.
ROBERT EPSTEIN, M.D.
F a m i l y Practice
PHONE: (717) 421-1460
421-1939
(ytfAU* J L M A O / V ^
25 N. 8th STREET
STROUDSBURG, PENNA. 18360
^
��PENN STATE
College of Medicine
University Hospital • Children's Hospital^
The Milton S. Hershey Medical Cent
Vnsciiliir Sliidiis Siction
Meclicul Direclor—Brnm I... Thiclc. M.D.
TcLhniail Direclor—Mnisha M. Ncuinvcr. R.S.. k.V. T.
P.O. Box S5()
l-lcrshcv. Pcnnsy]\:ini;i IVO.Vi
(717) .^I-SNS:/
FAX (717) 531-XX40
March 17, 1993
H i l l a r y Rodham C l i n t o n
H e a l t h Care Reform Task F o r e
1600 P e n n s y l v a n i a Avenue
W a s h i n g t o n , DC
Mrs. C l i n t o n :
y
I am c u r r e n t l y i n my s e v e n t h y e a r o f p o s t m e d i c a l d e g r e e
t r a i n i n g as a v a s c u l a r s u r g e r y f e l l o w . _ J l y ^ - f e l l o w s h i p leasts
one more y e a r , and I w i l l e v e n t u a l l y f i n i s h my t r a i n i n g i n
June 1994, as a Board C e r t i f i e d G e n e r a l s u r g e o n and a B o a r d
E l i g i b l e Vascular surgeon.
I am a l s o an a v i d C l i n t o n
s u p p o r t e r and am i n f a v o r o f y o u r husband's p r o p o s a l s t o
b a l a n c e t h e b u d g e t and d e c r e a s e t h e t r i l l i o n d o l l a r d e f i c i t .
I a p p l a u d e d a l o n g w i t h you a t t h e S t a t e o f t h e U n i o n A d d r e s s
when P r e s i d e n t C l i n t o n f i r m l y s t a t e d and r e s t a t e d t h a t we
nust t a k e t h i s y e a r t o s o l v e o u r h e a l t h c a r e c r i s e s .
I a l s o u n d e r s t a n d t h e r e has been l i t t l e c o o p e r a t i o n between
p o w e r f u l " D o c t o r O r g a n i z a t i o n s " and W a s h i n g t o n , DC
r e g a r d i n g t h i s problem.
I am n o t w r i t i n g t h i s n o r o f f e r i n g
my v i e w s f o r any g r o u p e x c e p t m y s e l f .
As a r e s e a r c h f e l l o w
t h i s y e a r , I have s a t on a c o s t c o n t a i n m e n t t a s k f o r c e f o r my
s p e c i a l t y and have done a good d e a l o f t h i n k i n g a b o u t a
v a r i e t y o f ways t o h e l p c u r e t h i s d e a d l i e s t o f p r o b l e m s .
W h i l e t h e r e i s no q u i c k f i x t o t h e h e a l t h c a r e i n d u s t r y ,
t h e r e a r e i m p o r t a n t c o n s i d e r a t i o n s t h a t s h o u l d n o t be
forgotten.
I t h i n k t h a t t h e r e i s a m u t l i f a c t o r i a l cause f o r
the present problems, but i n order t o assure long term
s u c c e s s f o r w h a t e v e r programs a r e i m p l e m e n t e d , e d u c a t i o n a l
p r o g r a m s must be i n c l u d e d . As one o f t h e most r e c e n t l y
t r a i n e d surgeons i n t h e c o u n t r y , I w i l l admit t h a t t h r o u g h o u t
medical school a n d _ s u r g i c a l residency, cost containment i s
somethjji£u_£±La£—i-^er^^ot t r a i n e d t o w o r r y aboulT. l f _ 1
tettr
t k a l T a p a t i e n t shoulcthave a c e r t a i n t e s t , drug, or
c o n s u l t a t i o n , t h e n t h e y w o u l d g e t i t . I g u a r a n t e e you t h a t
99 % o f t h e p r a c t i c i n g p h y s i c i a n s i n t h e c o u n t r y have t h e
A n lujiuil Oppoi'lunilv U n i v c i s i l v
�same f e e l i n g .
things.
Again,
I was
n o t t r a i n e d t o t h i n k about
these
However, t h e s e i s s u e s a r e c r i p p l i n g t h e system.
Ordering
b l o o d t e s t s STAT becatrg^ I am t o o i m p a t i e n t fe-o w a i t t h e two
h o u r s f o r r o u t i n e r e s u l t s d o u b l e s and maybe t r i p l e s t h e c o s t .
O r d e r i n g many u n n e c e s s a r y b l o o d t e s t s i s a l w a y s done,
e s p e c i a l l y i n academic m e d i c i n e , s i n c e more j u n i o r t r a i n e e s
a l w a y s f e e l i t i s e a s i e r t o know t h e answer so t h e y w i l l be
" c o v e r e d " i n t h e e v e n t t h a t s o m e t h i n g goes wrong. As a
m e d i c a l s t u d e n t t e n y e a r s ago, I can remember h a v i n g t h e
p h r a s e " c o v e r y o u r s e l f , o r e l s e y o u ' l l g e t sued" shoved down
my t h r o a t t i m e a f t e r t i m e , and I s t i l l t h i n k i t a l o t .
I know
i t g u i d e s what I do, even s u b l i m i n a l l y .
As such, I know t h a t
a l l o f us who a r e r e c e n t l y t r a i n e d a r e l e s s c o n f i d e n t o f o u r
c l i n i c a l a b i l i t i e s ( h i s t o r y and p h y s i c a l exams) because t h e s e
g u t f e e l i n g s do n o t s t a n d up t o our l e g a l system. I t ' s
ridiculous.
We must be t a u g h t e a r l y i n our c a r e e r s t h a t c o s t
i s s u e s a r e t r e m e n d o u s l y i m p o r t a n t and can n o t be o v e r l o o k e d ,
b u t t h a t we a l s o can n o t be a f r a i d t o be d o c t o r s because we
a r e a f r a i d o f t h e outcome i f s o m e t h i n g goes wrong.
I t may be
t h a t some l e g i s l a t i o n must a l s o be done i n t h i s r e g a r d .
A n o t h e r i m p o r t a n t i s s u e c o n c e r n s new t e c h n o l o g y .
Diagnostic
machines and t e c h n o l o g i c b r e a k t h r o u g h s a r e h a p p e n i n g so
r a p i d l y , t h a t e v e r y t i m e a new one becomes a v a i l a b l e ,
e v e r y o n e s t a r t s u s i n g i t because i t i s new, n o t because i t i s
b e t t e r t h a n e x i s t i n g m e t h o d o l o g y . For example, i n my
s p e c i a l t y , most p a t i e n t s w i t h a r t e r i o s c l e r o s i s r e l a t e d
p r o b l e m s who need s u r g e r y a l s o have e x i s t i n g h e a r t d i s e a s e ,
w h e t h e r t h e y know i t o r n o t . There i s o b v i o u s l y a r i s k o f
c o m p l i c a t i o n s i f t h e s u r g e r y i s done w i t h o u t d i a g n o s i s and
t h e r a p y o f t r e a t a b l e c o n d i t i o n s , so most p a t i e n t s u n d e r g o
evaluation of t h e i r heart f u n c t i o n .
In j u s t the past s i x
y e a r s , t h i s has changed a number o f t i m e s .
At f i r s t ,
p a t i e n t s g o t a s t r e s s t e s t , t h e n t h e e c h o c a r d i o g r a m was used,
t h e n MUGA scans, t h e n d i p y r i d a m o l e t h a l l i u m scans, and now
s t r e s s Dobutamine e c h o c a r d i o g r a m s a r e r o u t i n e l y p e r f o r m e d i n
this institution.
I g u a r a n t e e you t h a t i t has n o t been
p r o v e n t h a t t h e need f o r t h e s e t e s t s i s r e a l l y even t h e r e ,
n o r t h a t any o f t h e s e i s b e t t e r t h a n t h e o t h e r .
I do know
t h a t i n my h o s p i t a l , t h e a n e s t h e s i o l o g i s t s w i l l n o t p u t
p a t i e n t s t o s l e e p w i t h o u t a l l t h e s e t e s t s b e i n g done f i r s t ,
r e g a r d l e s s o f t h e r e s u l t , and even i f you w o u l d n ' t change
y o u r t h e r a p e u t i c p l a n s anyway. That i s a b s o l u t e l y a b s u r d ,
d o n ' t you t h i n k ?
The o n l y way t h e s e u n f o u n d e d p r e c o n c e i v e d
n o t i o n s can be changed f o r t h e b e t t e r i s t o have w e l l - f u n d e d
outcomes r e s e a r c h p e r f o r m e d r i g h t now by w e l l - r e s p e c t e d
scientists.
There a r e many o t h e r i s s u e s w i t h a s i m i l a r n a t u r e .
For
example, we use a t y p e o f m o n i t o r i n g c a t h e t e r ( w h i c h i s
a c t u a l l y dangerous t o p u t i n p l a c e ) i n most p a t i e n t s who
i n the s u r g i c a l i n t e n s i v e care u n i t .
There i s a l o t o f
are
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. letter
SllBJECT/TITLE
DATE
03/17/1993
Personal (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [7]
2006-0885-F
jm807
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
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PI National Security Classified Information 1(a)(1) of the I'RAI
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
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P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
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b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) nf the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�e x p e n s i v e equipment i n v o l v e d as w e l l as a fee f o r i n s e r t i n g
the c a t h e t e r , need f o r X-rays, e t c .
The amazing t h i n g i s
t h a t the few papers t h a t have been w r i t t e n r e g a r d i n g t h e s e
c a t h e t e r s shov/ed t h a t t h e y DO NOT improve m o r t a l i t y and
m o r b i d i t y i n p a t i e n t s a f t e r acute h e a r t a t t a c k s .
I t has
never even been s t u d i e d i n s u r g i c a l i n t e n s i v e care p a t i e n t s .
A l s o , i t has been shown t h a t most p h y s i c i a n s become c o n f u s e d
by the a d d i t i o n a l i n f o r m a t i o n t h a t these c a t h e t e r s g i v e .
So
why do we s t i l l use them when ICU beds a l r e a d y c o s t $ 1500
per day w i t h o u t them ? Because, they are new,
exciting
machines t h a t a t l e a s t g i v e the i m p r e s s i o n t h a t you are doing
e v e r y t h i n g t h a t can be p o s s i b l y done f o r the p a t i e n t , even i f
i t does not p r o l o n g l i f e or improve outcome. T h i s may be a
q u e s t i o n o f s o c i e t y p h i l o s o p h y , but one which must be
addressed.
P h i l o s o p h i c a l q u e s t i o n s a l s o have been l a r g e l y i g n o r e d by a l l
of s o c i e t y and t h i s can no .longer c o n t i n u e .
I t may be t h a t
up t o 15-20
% o f the h e a l t h care budget i s spent i n t h e l a s t
year of l i f e .
That i s insane. We know much about the
n a t u r a l h i s t o r y of many d i s e a s e s , yet when we face a p a t i e n t
or f a m i l y w i t h a known f a t a l c o n d i t i o n , we o f t e n say t h a t
t h e r e i s always hope and Lhat we w i l l do whatever i t t a k e s t o
save t h e p a t i e n t .
Knowing what we do about t h a t p a r t i c u l a r
c o n d i t i o n makes t h i s a l l the worse. We as a group are g o i n g
t o have t o c o n f r o n t death when i t i s imminent and not
c o n t i n u e t o spend huge sums of money when 30 % o f the
p o p u l a t i o n can not get any care at a l l and t h e y have a whole
l i f e ahead of them.
I a l s o have many o t h e r s u g g e s t i o n s which i n c l u d e what
h o s p i t a l s do, how t h e y charge p a t i e n t s , and d o c t o r ' s
p r a c t i c e s and I t h i n k t h i s problem i s b e a t a b l e .
I would be
more t h a n w i l l i n g t o d i s c u s s them w i t h you a t any t i m e and I
hope t h i s has been h e l p f u l i f not at l e a s t e n t e r t a i n i n g .
These views are mine and mine o n l y and I hope t h e y w i l l be
kept c o n f i d e n t i a l and not reproduced i n any way w i t h o u t my
p e r m i s s i o n . My m o t i v a t i o n f o r w r i t i n g t h i s l e t t e r i s t h a t I
f e e l t h a t as a p h y s i c i a n , I have a r e s p o n s i b i l i t y t o d e l i v e r
the b e s t h e a l t h care t h a t I can.
T h i s w i l l not. be a l l o w e d t o
happen i f t h e r e i s no h e a l t h care system t o g i v e i t . i n and no
one can a f f o r d i t . I am t r u l y concerned but a l s o h o p e f u l .
Thank you
and
sincerely,
V a s c u l a r Surgery Fe11ow
The P e n n s y l v a n i a S t a t e U n i v e r s i t y
C o l l e g e o f Medicine
Hershev PA
17033
�CODER:
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE: '
GENERAL S R :
OT
General mail
POSTCARD 2:
.Personal stories
Other Health Providers
POSTCARD 1:
.Letter Campaign
.Offers to help/Employment
FORM LETTER:
Letterhead
.PoUcy
REROUTE:
Casework
.Scheduling
POLICY AND PERSONAL
Physicians
President
Other
SS:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (H)
working families
unemployed/low income
benefits
.providers
.INFRASTRUCTURE/WORKFORCE (HI)
quality assurance (guidelines)
administration, reimbursement
& information systems
^malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
^medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
FINANCING (VH)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
AIDS
.women's health
immunizations/children
rural
urban
OTHER
^
�THE WILLIAMSPORT HOSPITAL & MEDICAL CENTER
FAMILY PRACTICE RESIDENCY PROGRAM
February 24, 1993
Mrs. Hillary Rodham Clinton
Task Force of National Health Care Reform
Old Executive Office Building
R o 287
om
Washington, D 20510
C
Dear Mrs. Clinton:
As /a^particiiparrT^lYi last week's Pennsylvania Health Care Conference. I
was parrretH-ar^-y-- impressed by your understanding of the health care system
and your perspective on change. Your comments concerning "facing reality"
emphasize the problems of excessive cost and lack of access, while acknowledging
the almost unrealistic demands of unlimited health care for a l l . Certainly,
we will have to make choices. Everyone will not have every desire met.
I was also pleased to hear your comments about "personal responsibility"
and the need to change behaviors. The changes that might have the most
significant effects on improving the health of Americans may be those dealing
with social and economic issues rather than those changing medical care (e.g.,
changes enhancing self-esteem in children may decrease drug use, limits on
tobacco use may improve everyone's health).
I happen to share Dr. Langfitt's opinion that there is a significant amount
of waste in the health care system concerning the use of unnecessary procedures
and diagnostic modalities of limited, i f not unproven, value. I t is certainly
time that the care we physicians prescribe be scrutinized in order to determine
what is effective and whether the country is getting its money's worth.
As you and others begin to design ideas and systems to alter the health
care system, i t may become beneficial for you to receive input as to how those
changes may impact the health care establishment. O behalf of The Williamsport
n
Hospital & Medical Center, we would like to offer our services providing feedback
to you on the impact of new ideas and policies. Upon your request, we would
analyze any proposals and submit input back to you or your designee.
Your comments at the Pennsylvania Health Care^Conference have left m
e
optimistic that health care reform can be a Con" wirT^situatinn, The health
care Jiy3t * pmHnrp better quality care to all ancFuse less resources~than
at present. Good luck with your work on this project.
~~~
~
pni
r
n
Sincerely,
Jeffrey B. Wetstone, M D
..
Program Director
JBW:ldm
3D:038
699 Rural Avenue, Williamsport.
Pennsylvania
1 7701 • Telephone
(71 7) 321-2340
�The
Selected
as
a
Q u a l i t y Award, The
300-bed,
Hospital
finalist
facility
Hospital,
a
surrounding
e m p l o y e e s , Tlie
member
of
Hospital
care
more t h a n
is
the
Healthcare
Center
and
is a
community
Pennsylvania.
Voluntary
300,000 p e o p l e
With
National
Medical
Northcentral
participating
counties.
1992
conipr eh ens i ve
serving
A m e r i c a , s e r v e s more t h a n
the
Hospital k
Williamsport
not-for-profit,
teaching
for
Hospitals
of
L y c o m i n g County
from
1,2 00
and
full-time
largest
The
equivalent
employer
i n Lycoming
a r e g i o n a l leader
in providing
County.
The
Hospital
l i a s g r o w n t o be
a wide range of h e a l t h c a r e
Excellence"
that
Occupational
Health
Sports
Medicine
include
of
surgery
high-quality,
program a l s o
. of having
as by
The
includes:
are
at
participation
Hospital's
The
The
Birthplace,
Services.
services
offered
The
able
perform
s t a t e - o f - t h e - a r t open
to
local
their
care
after
distribution
22,
services.
e l i m i n a t i n g the
families
bassinets
surgery.
area p a t i e n t s w i t h
surgery
family physicians
in their
bed
providing
cardiac
by
cardiac
at
is
Hospital,
Obstetrical -
of
Center
away f r o m
their
Center,
Gibson R e h a b i l i t a t i o n Center,
Emergency
cost-effective
to travel
Lung
"Centers
Medical
now
The
k
Heart
specialty
k
numerous
C a n c e r Care C e n t e r , The
benefits patients
enabling
continue
latest
Hospital
Cardiac surgeons
heart
The
C e n t e r , and
the
Williamsport
Center,
through
The
C e n t e r , The
Tiie Women's H e a l t h
One
services
and
and
This
inconvenience
homes,
as
well
c a r d i o l o g i s t s to
surgery.
by
- 20,
clinical
services
pediatrics -
23,
�rehabilitation
6,
intensive
-
40,
care -
voluntary
12, and
psychiatry
47,000
approximately
12,500
deliveries
900
Tlie
care
and
physical
building
facilities
and
The
that
In
has
easily
do
scanning
that
and
The
pulmonary
thallium
more
than
t e a c h i n g and
Hospital
services,
1,400
patient
completed
as
well
clinical
as
a
$22-
spacious
data
through
N'uclear M e d i c i n e
nuclear
Interventional
biopsies.
s e r v i c e s i n speed)
laboratory
fluoroscopy.
ultrasonography,
i s equipped
venous
digital
duplex
subtraction
Magnetic
resonance
imaging
there i s a mobile
tube
(MRI)
lithotripter
hospitals.
Lung C e n t e r
includes a
cardiac catheterization
testing,
scanning,
i n c l u d e s percutaneous
several other
laboratory,
and
CAT
radiology
on campus, and
H o s p i t a l ' s Heart k
stress
t h e campus-wide
scanning.
include
service
e l e c t r o e n c e p h a l o g r a p h y , and
tomography, a n g i o g r a p h y ,
with
laboratory
are s t a t e - o f - t h e - a r t
scanning,
is located
i s shared
number
p r o v i d e d expanded c r i t i c a l c a r e
services
duplex
ultrasonography,
placement
that
accessible
The
Radiological
angiography.
The
electronystagmograpiiy ,
comprehensive
carotid
1988.
an e x c e l l e n t
There
electromyography.
to
averages
units.
computer system.
hearing,
including
Room
Admissions
year.
permits excellent
project
Hospital
provides
each
Emergency
the
admissions.
maternity
medical/surgical
and
plant
The
year,
pediatric
to take place.
million
visits
each
12, c o r o n a r y c a r e -
t e l e m e t e r e d n o n - u n i t beds - 6;
r e s t are acute medica1/surgica1.
approximately
-
two-dimensional
full-service
l a b , e x e r c i s e and
and
Doppler
�echocardiography,
phonocardiography,
bronchoscopy.
Invasive
cardiology
Hoiter
has
monitoring,
recently
and
been
made
aval 1 able.
The
gastrointestinal
lab
includes
endoscopic
equipment,
including
percutaneous
gastrostomy
tube placement,
sclerosis
day.
services
They
performance
In
of a r t e r i a l
has
activities.
formal
training
and
blood
range o f c o l o r
colonoscopy,
esophageal
ERCP,
s t e n t s , and
the
phlebotomy
Family P r a c t i c e
physical
therapy.
Practice
Residency
education
efforts
a v a i l a b l e 14 h o u r s
teams
as
Residency
on
of
as w e l l .
Continuing
educational
Medical Education
f o r medical students.
campus
and
f o r paramedic
ocoupaiional
departments,
are
There a r e
and c l i n i c a l
we a r e home Lo v a r i o u s
nursing,
Hospital
Program.
w e l l as
P r o g r a m , The
c o m m i t m e n t s t o numerous o t h e r
students,
fields
and
gases and 12 l e a d EKG t r a c i n g s .
clerkships
programs
education
in
and
These i n c l u d e a w e e k l y
series
interns
IV
to the
made f i r m
(CME)
pastoral
are f u l l y staffed
include
addition
Hospital
EGD.
full
papillotomy.
Ancillary
a
a
active
student
t h e r a p y , and
i n c l u d i n g the Family
i n community
health
��CLAYSVILLE FAMILY PRACTICE
P.O. BOX 451
MAIN STREET EXT. WEST
CLAYSVILLE, PA 15323
TELEPHONE: (412) 663-7731
JAY M. Z I E G L E R , M.D.
C
"
^-—^
F R E D E R I C K J. L A N D E N W I T S C H ,
M.D.
February 16, 1993
Mrs. H i l l a r y C l i n t o n
1600 Pennsylvania Avenue
Washington, D.C.
20500
Dear Mrs. C l i n t o n ,
I welcome t h e a d m i n i s t r a t i o n ' s plans f o r r e s t r u c t u r i n g
the n a t i o n ' s h e a l t h care system so a l l o f i t ' s c i t i z e n s have
access t o a f f o r d a b l e h e a l t h c a r e . Your appointment t o head
t h i s t a s k f o r c e demonstrates Mr. C l i n t o n ' s commitment t o
these necessary changes.
My f a m i J b ^ p r a c t i c e was opened i n 1980 i n C l a y s v i l l e , PA,
T h i s i s a ( r u r a l j c o m m u n i t y i n southwestern Pennsylvania. For
the f i r s t t-w<s4rVe y e a r s , i t was a s o l o p r a c t i c e . I r e c e n t l y
was f o r t u n a t e t o have another f a m i l y p r a c t i t i o n e r j o i n me.
A f t e r t w e l v e years o f d e l i v e r i n g h e a l t h care t o a s m a l l
community, I have seen t h e e f f e c t s t h e h e a l t h care i n d u s t r y
has had on people's l i v e s . These e f f e c t s have not a l l been
bad, b u t t h e r e are g r e a t i n e q u i t i e s .
I would welcome t h e chance t o d i s c u s s these i s s u e s w i t h
a member o f your s t a f f .
I would hope a "grass-iroots" p e r s p e c t i v e would be b e n e f i c i a l .
Sincerely,
Jay
JMZ/rmm
M. ^ i e g l e r ,
M.D.
�S T E P H E N Z E R N I C H , J R . , M.D., INC.
GENERAL
SUROERY
ALIQUIPPA MEDICAL
CENTER
Hospital DrWs,
ALIQUIPPA.-f ENNSYLVANIA
15001
TELEPHONE: (412^3,7
B-aB22
February 25, 1993
Mrs. H i l l a r y C l i n t o n
White House
Washington D.C.
20500
Dear Mrs. H i l l a r y C l i n t o n :
I am an a c t i v e l y p r a c t i c i n g surgeon who graduated from medical
school i n 1946 and have accumulated v a s t experience d u r i n g my 47 years
i n medical p r a c t i c e .
I f e e l t h a t I can be o f g r e a t h e l p t o you i n
s o l v i n g our c o u n t r y ' s medical problems.
The reason f o r t h i s l e t t e r
was i n i t i a t e d y e s t e r d a y when I appeared on a l o c a l r a d i o - M e d i c a l
Talk Show. One o f my c a l l e r s suggested I w r i t e t o you. At f i r s t I
thought the idea r i d i c u l o u s , c h i e f l y because I d i d n ' t f e e l you would
be i n t e r e s t e d i n a r e l a t i v e l y unknown d o c t o r ' s views. However, f o l l o w i n g f u r t h e r t h o u g h t , s u b s t a n t i a t e d by the f a c t t h a t I r e a l l y can c o n t r i b u t e , I decided t o r e c o n s i d e r and t o w r i t e t h i s l e t t e r .
I have no ax t o g r i n d and seek no r e m u n e r a t i o n .
know i f I can h e l p you.
Please l e t me
Sincerely yours,
Stephen Z e r n i c h , J r . , M.D.
SZ/jlr
1
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�;i
Hiniston M^Hiiutl Mvt.lic.t! C.fttli'r
i KJI lis
KI SOK
is sin i rs
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C v r ^ M ^
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�Harriott
6580 Fannin Slreel
Houston, Texas 77030-2796
713/796-0080
Houston Marriott Medical Center
HOTELS • RESOKTS • SUITES
1
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�NOTICE
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
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SUBJECT/TITI.E
DATE
04/30/1993
POB (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [7]
2006-0885-F
.im807
RESTRICTION CODES
Presidenlial Records Act -144 U.S.C. 2204(a)
Freedom of Information Act - [5 U.S.C. 552(b)|
Pl
P2
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b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe KOIA]
b(3) Release would violate a Kcderal statute 1(h)(3) ofthe KOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe KOIA]
b(C) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe KOIA]
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Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
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financial information 1(a)(4) ofthe PRA]
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of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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PERSONAL INFORMATION HAS BEEN REDACTED
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ADMINISTRATIVE MARKING
INITIALS:
DATE:
�WEST TEXAS
MEDICAL ASSOCIATES
3555 KNICKERBOCKER RD.
SAN ANGELO, TEXAS 76904
Phone (915) 949-9555
ANESTHESIOLOGY
JoelS. Carr, M.D.
Lorry C. Driver, M.D.
Campbell M. Gillespie III. M.D.
Bob G. Thomra,
M.D.
CARDIOLOGY
Stephen A. Korte, M.D.
James £ Neil, M.D.
DERMATOLOGY
Harvey M. Wiliama,
Jr.,
DISEASES a n d SURGERY
OF THE EYE
Douglas J. Kappelmarm,
M.D.
M.D.
GASTROEHTEROLOGY
finvc* A Heare, M.D.
GENERAL and THORACIC SURGERY
Edward E Clenwnona. M.D.
GENERAL and VASCULAR SURGERY
Patick E. Gibson, M.D.
HEMATOLOGY a n d ONCOLOGY
Fazlur Rahman.
MD.
INTERNAL MEDICINE
floss M. Carmichael, Jr.. M.D.
J. Preston Darby. M.D.
John T. Granaghan, Jr.. M.D.
MaikR
Yates. M.D.
M.D.
OBSTETRICS and GYNECOLOGY
Charles V. Bennett. Jt., M.D.
Wm D. Cravy, M.D.
O. Steriing Gillis. Ill, M.D.
Clyde A. Henke. M D.
OrloHMona&an,
M.D.
Leslie Mueller, M.D.
ORTHOPEDIC SURGERY
A. Price Burdine. M.D.
Don W. Hughes.
M.D.
Joe B. WUdnaan. M.D.
OTOLARYNGOLOGY AND ALLERGIC
DISEASES
Keith D. Wahmord. M.D.
PEDIATRICS
tori Anderson,
M.D.
Ralph Chase, M.D.
Jane Rider, M.D.
AMIon Squiera, M.D.
PSYCHOLOGY
Vance Stansel.
PhD.
RHEUMATOLOGY
J a m a s W. Yost. M.D.
UROLOGY
JohnS. Ballard III, M.D.
Donald W. Cook. M.D.
JackS. Rice, M.D.
ADMINISTRATION
Tommy J. McMahon
16.
—
s
1992
Hi'Mary C l i n t o n , F i r s t
P.O. Box 515
L i t t l e Rock, Arkansas
Dear Mrs. C l i nton,
FACIAL PLASTIC SURGERY,
OTOLARYNGOLOGY, AND ALLERGIC
DISEASES
ABen Anderson,
M.D.
Lee Paul Fry, M.D.
NEUROLOGY
Michael Michaels,
December
z^^.
Lady-Elect
Hi. c/?
V'- v \ •
72203
e.
P r e s i d e n t - E l e c t C l i n t o n was k i n d enough t o w r i t e t o me
on October 10, 1992 i n resbonse t o a l e t t e r of mine.
In r e t u r n , I sent him a r e p l y on November 4. "1992, w i t h
c o n g r a t u l a t i o n s . On both occasions, b e f o r e and a f t e r
the e l e c t i o n , I expressed my d e s i r e t o help him i n any
way I can, p a r t i c u l a r l y w i t h h e a l t h care and f o r e i g n
policy.
I n t e l l e c t u a l l y , I have t h i n g s i n common w i t h
you and P r e s i d e n t - E l e c t C l i n t o n .
I'm sure you have been swamped w i t h ideas, But I am
making t h i s e f f o r t t o g e t i n touch w i t h you to express
my views again.
I have been a p r a c t i c i n g o n c o l o g i s t X h e m a t o ! o g i s t f o r t h e
l a s t 17 years, and am f a m i l i a r w i t h t h e medical problems
of t h e day, and what goes on i n d a i l y medicine. I have
been w r i t i n g e x t e n s i v e l y on medical issues. My a r t i c l e s
h a v e a p p e a r e d i n t h e New Y o r k T i m e s , t h e W a l l S t r e e t
J o u r n a l , NEWSWEEK, t h e New E n g l a n d J o u r n a l o f M e d i c i n e ,
the
C h r i s t i a n S c i e n c e M o n i t o r and o t h e r p a p e r s and
magazines.
rece i ved.
Many o f these pieces have been w i d e l y
I have a l s o w r i t t e n on f o r e i g n p o l i c y issues. My r e c e n t
a r t i c l e on Bosnia p u b l i s h e d i n t h e Wall S t r e e t J o u r n a l
on September 17th echoes t h e views o f P r e s i d e n t - E l e c t
Clinton.
The a r t i c l e made many Republicans unhappy f o r
being c r i t i c a l o f P r e s i d e n t Bush's p o l i c i e s .
I was born i n an obscure corner o f t h e w o r l d , in what i s
now Bangladesh. I have been i n t h e USA s i n c e 1969,and
an American c i t i z e n f o r many years. I have t h r e e
daughters born i n San Angelo, Texas; t h e o l d e s t ,
Gulshan, was a c t u a l l y born on t h e B i c e n t e n n i a l Day. I
have known both w o r l d s f i r s t - h a n d .
I f I am q u a l i f i e d ,
I would l i k e t o j o i n P r e s i d e n t - E l e c t C l i n t o n and Vice
P r e s i d e n t - E l e c t Gore t o shape t h e f u t u r e o f our c o u n t r y .
I a l s o have had communications b e f o r e w i t h Senator
Bentsen and Senator Sam Nunn.
�Fazlur Rahman, M.D.
Page 2
Please g i v e our regards t o your f a m i l y and our love t o Chelsea.
Wish you a l l a Happy Hanukkah, a Merry Christmas, and a p l e a s a n t
New Year. Looking f o r w a r d t o h e a r i n g from you.
Si n c e r e l y ,
FT
F a z l u r Rahman, M.D., F.A.C.P.
C h i e f , S e c t i o n o f Hematology & Oncology
Angelo Community H o s p i t a l &
West Texas Medical A s s o c i a t e s ,
San Angelo, Texas 76904
FR: I c
�/ o
THE NEW VORK TIMES F O R U M SUNDAY, APRIL 26. W2
13
The Public's Share of Medical Research
By FAZLUR RAHMAN
42-YEAR-OLD woman with ovarian cancer
has been in and out of the hospital fm
months. Her course is complicated by anemia, which requires frequent blood transfusions.
But now she is experiencing debilitating side effects from the repealed use of blood.
A
She does not need to go through these ordeals.
Erythropoietin (EPO), a product of genetic engineering, could treat her anemia. In the past, after
taking the EPO for a few weeks, she improved. But
then she had to stop. Her health insurer refused to
cover her EPO treatment, and because of its high
cost she could not afford it. As a school teacher,
she has too much money to qualify for financial
assistance but too little to pay for her therapy.
Like many other drugs created through genetic
engineering, EPO is far too expensive. The manufacturers understandably claim ihey are entitled
to a fair return on their research and investment.
But their notion of what is fair is open to debate.
Basic biomedical research has long been heavily subsidized by United States taxpayers. The
Federal Government spends billions for the National Institutes of Health and gives numerous
grants to universities to further research. Hightech pharmaceuticals owe their or igin largely to
these investments and to Government scientists.
Dr. Fazlur Rahman is chief of hematology, and
oncology at West Texas Medical Associates and
Angelo Community Hospital in San Angelo, Tex.
The public has earned the right to buy the
products at a reasonable price. Already, abom a
dozen DNA-icchnology drugs are in the market; 21
other genetically engineered medicines are awaiting F.D.A. approval. More than 85 others — treatments for various ailments including cancer,
AIDS, Alzheimer's disease, strokes and blood clots
— are undergoing human trials.
Genetically engineered compounds are not the
only ones that are high-priced. One monthly injection of carboplatinum, an anticancer agent, may
cost $1,000; and a single capsule of VP-16, another
antitumor medication, costs $40. And they have to
be taken for months to achieve any benefit. Surely,
the $36 billion pharmaceutical industry has room
for easing prices on some products.
As a practicing physician, I wish I had better
treatments for cancel patients. But what good is a
superdrug if its cost is out of reach of our patients?
The Human Genome Project has embarked on
an effort to map all human genes. At a cost of S't
billion over 15 years, this effort could exceed in
scope (he Apollo moon-landing program. Years
from now, when il brings cures, wc should remember lhal our citizens funded the project.
•
�THE NEW YORK TIMES FORUM
SUNDAY, DECEMBER
11
23, 1990
Take the Money Out of Medicine
FAZLUR RAHMAN
IONEY is the main reason our health care
1 system has become increasingly procedure oriented rather than patient oriented.
There is no economic incentive for spending time
at the bedside, talking to patients and examining
them. Doctors get paid very little for this, while
they are compensated handsomely for performing
operations and invasive tests. High-technology and
diagnostic procedures are essential for modern
medicine, but they are also used indiscriminately
to generate income and to avoid malpractice suits.
This raises the cost of health care.
Hospitals have also contributed their share to
the excesses. They welcome physicians who have
Fazlur Rahman M.D. is chief of hematology and
oncology at Angelo Community Hospital and West
Texas Medical Associates in San Angelo, Tex.
the ability to do surgical and other high-tech
procedures. These procedures make money for the
hospital.
Drastic steps have to be taken to rectify these
problems in our health care system.
First, citizens should not foster inequities in
medicine. As a practicing physician, I have seen
this paradox time and again: patients who may
complain about a reasonable fee for life-saving
breast cancer treatment do not mind paying much
higher charges for cosmetic breast surgery.
Second, we need better methods of selecting
medical students. Money should not be the primary motivation for going into medicine. Many students incur a huge debt when they leave medical
school. This, among other factors, encourages
them to become specialists, and do procedures for
higher incomes. We should give scholarships to
those who will train to be primary care physicians,
like general internists and family practitioners.
Third, reimbursements for bedside medicine
have to be equitable. Medicare and the insurance
companies have very little respect for bedside
medicine: their meager payment for it is proof of
the point. Even with recent modifications in fee
schedules and allowing for the demanding training
of the specialists, surgeries and high-tech tests are
still more lucrative than day-to-day medicine.
There is ample room for further cuts in fees for
surgeries and other procedures. Money saved
should be redirected toward primary care and
preventive medicine.
Fourth, a lot of high-tech procedures are used as
defensive medicine. There must be a way to restrain the lawyers and to avoid frivolous malpractice lawsuits. .
Fir.r'.iy, medical organizations, like the American Medical Association and the American College
of Physicians, must set aside their quarrels and
work together to bring about a balance in our
health care expenses.
•
�®1K jtfcnt JJark Sime^
MONDAY,
FEBRUARY
20, 1989
19
Why Pound Life Into the Dying?
By Fazlur Rahman
S
SAN ANGELO, Tex.
ince
cardiopulmonary
' resuscitation was introduced in 1960, it has
k saved countless lives.
I But we are in danger today of abusing this
procedure. At some point, we must
stop adding to the suffering of dying
patients by pounding on their chests,
possibly breaking bones, just to extend their lives by a few days or
weeks.
C P R. is performed routinely in
hospitals, without regard to patients'
chances of recovering to lead normal
i'uzlur Kahmcm is chief of henuilology and oncology at Angelo C'omnuinily Hospital
lives. Why try to revive, with C.P.R. a the subject of C.P.R. soon enough.
patient who has been sick for years There is a vague hope that the probwith diabetes, hypertension, heart lem may not have to be faced soon.
disease and kidney failure, and who Then, under the duress of the mohas just had an operation for a perfo- ment, it is hard for families to make a
rated intestine? Why batter the ster- quick decision. So, the physician simnum of a drastically debilitated, 85- ply follows the routine of C:P.R.
year-old woman, who is suffering
What can we do to avoid this prefrom pneumonia?
dicament?
In terminal cases like these, the
First, we have to educate the public
idea of beating on the chest of an old and professionals. An increasing
and sick person is morally and physi- number of patients are asking for a
cally repugnant. Yet, for lack of prior peaceful death. In time, I hope that
understandings between patients, this demand will become universal.
families and physicians, the proce- Medical and nursing schools need to
dure continues to be used indiscrimi- teach more about accepting death
nately.
and dying.
Although some people will refuse
Second, patients should sign living
as long as possible to let a loved one wills. According to the Society for the
die, most families will abide by the Right to Die, 38 states and the District
medical decision on C.P.R. Trouble of Columbia have enacted laws that
arises, however, when neither the ter- recognize the terminally ill patient's
minal patient nor the doctor raises right to refuse life-sustaining treat-
C.P.R.
can be
cruel.
ment. By court decisions, 11 states
have also acknowledged such a right.
Third, patients with incurable diseases should be tactfully approached
by their families and physicians
about the use of aggressive measures. While discussing the subject,
one should not convey hopelessness;
hope is an important part of medical
care.
If the patient is opposed to resuscitation, the primary physician must
write clearly on a patient's (hail.
"No C.P.R." Simply having an understanding with the nurses on the floor
will not work. When a C.P.k. code is
activated by hospital moniiors, doctors and nurses will rush lo the victim. It the attending physician is not
around and there are no insl niel ions
on the patient's record, confusion
arises about what lo do.
In our lawyer-dominated suciciy,
hospitals have been forced to devise
bureaucratic rules that may not have
the patients' welfare foremost in
mind. Moreover, once a patient is on
the life-support system, it is not easy
to "pull the plug." Legal complexities
will override ethical justifications.
Thus, il is all the more important lo
decide ahead of time what steps are
appropriate to revive incurable patients,
n
�SbciNeUf JjjorkStmes
By Fazlur Rahman
SAN ANGI-XO. l e x . — Cancer pain
c reaies a vicious circle: Uncontrolled
pain demoralizes a patient, magnifying the severity of his physical and
mental discomfort. With careful, supervised use of narcotics, this pain
ran he eased and the circle broken.
Bul because of widespread fears
ahout drug alnisc and misconceptions
in the medical profession about the
clangers of these powerful drugs,
even responsible people are fiefluently frightened away from proper
use of narcotics, such as morphine,
that could relieve pain for cancer pa
i ients.
A recent patient of mine is a good
example of this common problem. A
'.•8-year-old woman was in agony —
her hip hones were riddled with disseminated cancer of the uterus.
I'adiatiou therapy gave her temporal y lelief. then the cxcruciaiinj;
pain retin neil wilh the relentless pro
gressitui of the malignancy. Her
•Jaughier, despite our best efforts in
pei siiading her otherwise, refused to
iillnv, her mother large doses of
hilaudid, a narcotic I had prescribed
I am not going to make, my mother a
h ug addict," she said.
Another woman, G years old, with
7
m incurable brain tumor, was tor-;
iiientcd by severe headaches. I could :
io! give: her morphine because her
;on objected. He was unable to accept
he f a d that morphine might make
Despite
doctors
fears,
a balm for
patients.
1
icr unresponsive and groggy. Only a
ii ni inlervenlion on the patient's belalf — after careful medical consul.jration. I prescribed the drug —
;aved h'T from a miserable exi'-t-
FRIDAY, JUNE 12, 1987
Narcotics for Cancer Patients
"I hese are nnt isolated occurrences.
Since drug abuse is widespread in our
society, the stigma attached to narcotics is carried into the realm of patient care. On occasion, patients
refuse to take these pain killers because of irrational fear of addiction —
but medical use of narcotics rarely
leads to addiction.
The main problem lies with the attitudes and in the education of doctors.
Some doctors prescribe insufficient
doses at irregular intervals for fear
of adverse effects or because of a
lack of knowledge about narcotics.
Academic medical centers fare no
better than community hospitals. A
study conducted in two university
hospitals showed that residenls in
training had similar misgivings and
, ordered meager doses of narcoiics
for tint ients with severe pain.
For a patient to achieve a constant
pain-free state, the drug level in his
blood has to be stable. To obtain this
condition, optimum doses should be
given in regular intervals around the
clock or by continuous infusion. Irregular doses produce erratic. levels,
with peaks and valleys, resulting in
successive painless and painful periods.
Many narcotics, combinations of
narcotics and other analgesics are
available. They have different toxicities, durations of action and metabolic effects. A number of them counteract each other outright.
There is no shortage of information,
on the subject. The scholarly reviews'
and articles on the subject, however,
tend to be theoretical rathei than sue •
cine!. pract jra! recom mem bit ions.
Politicians and governments have
also stood in the way of pain control.
There is a legislative push to legalize
heroin for medical use, yet nn pharmocologic
evidence
exists
thai
proves it is superior to morphine,
which is still the cheapest and most
effective opiate. It would be better if
we spent our energy to make the narcotics already approved more readilv
available to patients with advanced
cancer. At present, state laws intimidate doctors who prescribe narcotics.
Moreover, elderly patients get
caught between their distress and the
regulatory nightmare known as Diagnosis Related Groups. Al times p .
tients need hospitalization for the
control of acute pain, which on.e
nnligated, may enable them to live a
•i'u'Iv I'C.'irefiil life j ; , , , r.!,.,)!,
;l
peer review organizations often deny
payments for pain-killers, arguing
that the individual could have been
taken care of in a skilled-care nursing
home. Unfortunately, niosi nursing
hemes are not equipped to lake rare
of very sick people.
Of course narcotics are serious
drugs. They should be administered
for only one reason — to conn ol disabling pain. We should 1 v to iimler1
sland the difficulties of patienls with
unc in able cancer, their anguish and
despair, and strive to .'iih.inr. i | .
<|U.iliiy of their lives.
K
I'aL-lur K'n/miciM is <iurf o; hi.-imi
fofogy and o/ico/ogv al lhe .Uii'rlo
Cninnniui/v Ilospilnl in San ,\(>i,'r/e
7Vv.
�' HE NEW
YORK
TIMES,
THL7RSDAY,
JANUARY
23, 1986
Medicare Makes
A Wrong Diagnosis
By Fazlur Rahman
SAN ANGELO, Tex. — A 65-yearold woman has been lying in the hospital for six weeks. She is suffering
from complications of colon cancer—
obstruction of the bowel, severe pain,
nausea and vomiting. She has a tube
in her stomach and a urinary catheter. She is on morphine around the
clock. Surgery has been futile. Her
seven-year battle with cancer is f i nally near the end. But now she has
also become the victim of Medicare
rules — specifically, diagnosis related groups.
There are 468 diagnosis categories,
each corresponding to an illness or
disease. A hospital is reimbursed, according to the category, a fixed
amount for a specific diagnosis. If
treatment costs less than the set rate,
the hospital keeps the savings; if the
treatment costs more, it absorbs the
loss.
In the case of the 65-year-old
woman, the diagnosis grouping allows her only 5.9 days of hospitalization and $1,865 worth of medical care.
The hospital has already spent nine
times that amount.
So here I am, her physician, at a
loss about what to do with her. She is
unable to go home, the nursing home
won't take her back and she cannot
stay in the hospital. Her case is not
unique. In short, Medicare's payment
system is not working. It puts doctors
and hospitals in the awkward position
of denying crucial care or losing
money.
Although cutting costs has become
popular, some facts must be made
clear. An 85-year-old patient with diabetes, emphysema, heart disease and
pneumonia will take longer to recover
than a younger patient who simply
has pneumonia and is otherwise in
good health. Yet, in the eyes of Medicare, both have the same diagnosis
grouping, and the hospital is reimbursed the same amount.
As a cancer specialist, I often see
patients who are not candidates for
chemotherapy, radiation treatment
or surgery but nonetheless need hospital care for distressing complications. They cannot be taken care of by
home health-care services, hospices
or nursing homes., Not treating cancer is one thing, not treating a person
is another.
Medicare has created a monstrous
bureaucracy to oversee this diagnosis
payment program, which is supervised by peer review organizations.
Such organizations are also expen-
The new
payment
system
for hospitals
isn't working
sive. What Medicare saves by denying services it pays to these unnecessary bureaucrats.
While peer review panels advocate
cost conuinment, they give only lip
service to quality care. The public
urges doctors to give empathetic
medical care, but the system is encouraging us to be impersonal.
Even if I follow the guidelines set
out by the peer review panels and
admit a patient, the panel can disagree with me latet and, months
after the patient has been discharged,
disallow the admission and reimbursement. Technically, I can be labeled a "Medicare abuser."
Despite its name, a peer review organization's primary mandate is to
slash expenses. In a given region, the
panel that promises the highest cuts
gets the Medicare contract.
I could lose my hospital privilege
simply by admitting critical patients
whose care costs more. Consider, for
example, an adult with acute leukemia, one of the most serious cancers.
Medicare allows only 6.4 days of hospital treatment. This is not enough
time, however, because patients have
to undergo complicated and toxic
chemotherapy. Bleeding and infections are constant dangers. Sometimes, a few weeks elapse before a
patient can be discharged in a safe
condition.
If you are a peer review panel
member whose job is to enforce Medicare payment rules, ask an acute leukemic what ordeals he has been
through before you reject the reimbursement.
No hospital or nursing home wants
to treat an old person with an expensive illness. Medical centers everywhere now make their patients sign
an agreement to be responsible for
the bills if Medicare rejects reimbursement.
We cannot deny the need to curb
high medical Costs. But how can we
justify a remedy Hke this? As a compassionate society, we must make a
Fozlur Ratfaxan, M.D., is chief of the decision, here and now, whether we
hematology and oncology department have a commitment to the elderly or
oc ;he Angelo Community Hospital, whether we will abandon them when
they need us most.
•
in San Angelo, Tex.
�THE
HURSDAY,
NEW YORK
FEBRUARY
TIMES
6, 1986
Letters
How
e Hospital Reimbursement Works
To the Editor:
As a practicing physician, I recognize in Dr. Fazlur Rahman's criticism
of Medicare's hospital-reimbursement
system ("Medicare Makes a Wrong
Diagnosis," Op-Ed, Jan. 23) the sincere concern of a physician who regularly deals with the emotional trauma
of caring for the terminally ill. While I
appreciate and share his concern for
the medical care of our beneficiaries,
his indictment of the prospective-payment system and of the effectiveness
of medical-peer review is inaccurate
and misleading.
Central to Dr. Rahman's argument
is the repeated contention that the new
Medicare hospital-payment system
furnishes inadequate care by setting
limits on the number of days allowed
in the hospital. This is not true.
The prospective-payment system
categorizes Medicare patients into
470 diagnosis-related groups. Each
D.R.G. payment amount takes into
account the relative amount of resources used by the hospital for treatment and the average length of stay
of a patient with that diagnosis.
On the basis of the cases Dr. Rahman describes, he would have us believe that D.R.G. reimbursement is
consistently inadequate. This is seriously misleading. Because the
D.R.G. represents an average, hospital costs for treating patients with a
particular diagnosis are often less
than the fixed D.R.G. fee paid by
Medicare. This balances those patients in the D.R.G. whose treatment
costs to the hospital are more than the
D.R.G. amount.
Furthermore, the payraent system
recognizes situations when cost or
length of treatment significantly exceeds the statistical averages. In
those cases, known as outliers, we increase the hospital "s reimbursement.
Additionally, we recognize that the
age of an elderly patient and complicating conditions contribute to hospital costs and warrant additional
reimbursement. This is reflected in
separate D.R.G.'s, with higher reimbursement for medical and surgical
conditions, when the beneficiary is
more than 69 years old and may have
complications. Finally, to refine the
accuracy of the system further, we
are considering ways to modify
D.R.G.'s so that they will better discriminate the severity of illness of patients within particular D.R.G.'s.
Perhaps most important, however,
I want to emphasize that Medicare
does not specify how much hospitalization a patient can receive. Decisions regarding the patient's treatment, including determination of the
appropriate time for discharge from
ac hospital, are the responsibility of
the patient's physician.
With regard to medical review
under Medicare, our physician-peerreview organizations do much more
than "give lip service to quality
care." These panels, composed of
dedicated health professionals, have
specific quality-of-care objectives for
which we hold them accountable.
These include safeguarding against
the possibility of premature discharge from the hospital and reducing the risks associated with c e ^ i n
procedures or conditions. We beljeve
in medical-peer review, and to |n-.
crease physician confidence in tfte
system, we insist that our review
groups work closely with hospifafs
and physicians to resolve procedural
misunderstandings so that all 'can
concentrate on improving the quality
of care our beneficiaries receive. [ •
The prospective-payment system
and peer-review program were designed to improve the viability of jth'e
Medicare trust fund and, at the Skme
time, safeguard the quality of cafe.
While these systems may not be perfect and will always be subject to improvement, positive results have Eiefeh
realized both in upholding the quality
of care under Medicare and restraining unnecessary increases in healthcare costs.
OTISR.BOWEN.M;^.
Secretary of Health and Human Services
Washington, Jan. 28, -1986
�: J "...
A Doctor's
Remedy
BY F A Z L U R R A H M A N
A
n 85-year-old woman has been suffering from the
complications of acute leukemia and its treatment. By now she has received dozens of translusions of scarce blood products, and numerous
medications. Throughout her protracted hospitalization, I have performed expensive blood tests, X-rays and
CAT scans to diagnose her problems. And she may require
further hospital admissions in the future.
While there has been remarkable progress in curing the
childhood variety of acute leukemia, the adult type of the
disease is still pernicious. Treatment of the latter is
fraught with dangers to the patients, particularly the
elderly. That is why many cancer specialists give the aged
only symptomatic treatment and not "definitive" chemotherapy. But 1 must respect
the patient's choice and not j
deny chemotherapy to a patient who demands it.
In the next room 1 have a
young man. only 32 years
old, with Hodgkin's disease.
He has a good chance of being cured with intensive
treatnient. Bui cancer is
not the only problem he
faces. He is unemployed
and uninsured, like many
who worked in the oil fields
of west Texa.:. He had been feeling sick for eight months
but did not get an examination because, as he told me,
"How could I afford it'.'" Finally, when his breathing became labored, he showed up in the emergency room.
The predicament presented by these cases is not an
isolated one. The medical profession is confronted on the
one hand by the question of just how much sophisticated
medical treatment is worthwhile for the debilitated aged
and on the other by what to do about young patients who
need the sophisticated treatment but often cannot afford
it. And this predicament is only going to get worse.
The number ofthe elderly is increasing rapidly. Currently, 30 million—12 perceni of all citizens—are over 65. By
2030. the over-65 elderly will number 65 million, or 21
percent of the population. .More important, the85-plusgeneration is the fastest growing population segment in the
United States. With the rise of the aged, there will be
increased cases of heart attack, stroke, cancer and degenerative diseases. Nursing-home and hospital expenses will escalate. Contrast that with tlie numberof lhe uninsured—from
25 million 10 years ago to about 37 million now. And the
number is growing, particularly among the young.
How much high-tech medicine can we pay lor'.' How much
of it is. in fact, needed ' Does every hospital have, to have an
MRI scanner -Often a CAT scan gives as good information as
does an MRI scan and costs about hall" as much. But the
public at times falls for the publicity and demands "state of
the art" tests. Of course, hospitals sometimes promote the
use of technology to generate revenue. I have patients, men
and women in theirSOs. asking for monthly cholesterol tests
they don't need. In simple terms, it's what l do daily as a
doctor lhat determines the expenses ofhealth care. Yet. in
all the years of my medical training, 1 did not have a single
class on the cost of care. 1 was taught to give the best that
medicine could offer, and cost was not my concern.
When 1 was new in practice. I took care ofa patient with
septicemia (a blood infection! and shock. He was in the
intensive-care unit for two weeks. After he recovered, he
showed me his itemized bills from the hospital. 1 was astonished by the sheer quantity of tests we performed during his
treatment and the thousands of dollars worth of service the
hospital rendered. Duringhis illness, though, 1 did not imagine that my col leagues and 1 ordered that many procedures.
Medicare rules also encourage high-priced testing. Its
reviewers, so-called Peer Review Organizations (PROsi.
want proof of diseases; clinical diagnosis is not enough. If
Medicare rejects an admission, it denies payment to the
hospital. And I am. as the admitting doctor, caught in the
middle. So when 1 am in a quandary it is safer for me to
order a test.
How can we get around the impasse in our health care
The professional economists have complex views and predictions on the subject. But based on my practice, the most
important matters boil down to these points:
First, we have to educate
our citizens. Though we
must have an unwavering
commitment to improve the
quality of life of the suffering, it is futile to attempt lo
cure every ailment in every
patient. What is the purpose of keeping an 86-yearold man. debilitated with
Alzheimer's disease, in the
intensive-care unit'' 1 am
compounding his suffering
just because the family
wants to do everything possible for him.
1 n my own Held, cancer medicine, we have nol always been
forthright. Though we have made impressive advances in
some areas, there is a long way to go in eradicating common
cancers such as metastatic diseases of lung, colon and
breast. The constant claims of "breakthroughs" and "cures"
are misleading; many of the breakthroughs and cures do not
materialize. Even some prestigious medical journals seem
to thrive on headlines.
Second, we should restrain the indiscriminate use of hightech medicine. And for that restraint to be efiective. we need
to restrict the lawyers, because a lot of technology and
resources are wasted on defensive medicine, i.e.. to avoid a
malpractice suit.
Third, the primary responsibility of the medical schools is
to make good doctors out of our young men and women, and
the schools have done a fine job. But now. this is not enough:
the institutions must ensure that the students have a working knowledge of medical economics.
Fourth, the cumbersome Med ica re-PRO red tape has become counterproductive. A few layers of bureaucracy can be
cut out to save expenses, without sacrificing the quality of
the review process.
The cause is not hopeless, as so manv would liave us
believe. I do believe we can find an acceptable and compassionate solution In fact, we must
9
A Texas
physician on
how to get
around the
health-care
predicament
10 N EW5W Hi;K . A l ' R l l .
. rtme
Rahman is chief of hematology- and oncohgx al Angelo
C'limmunily Hospital in San Angelo. Texas.
�18
THE
Monday, October 22, 1990
C H R I S T I A N SCIENCE M O N I T O R
Care Options for the Elderly
By Fazlur Rahman
A
MERICANS must remember our
"contract" with our elderly citizens. We need a comprehensive
elderly-care plnn now to avoid a catastrophe later.
The number of the elderly in our nation is rising fast, and soon aJmost every
family will have an aged member to care
for. Currendy, 30 million Americans - 12
percent of all citizens - are over 65. By
2030, the over-65 elderly will number 65
million, or 21 percent ofthe population.
More important, the 85-plus generation
- those most in need of long-term care is the fastest growing population segment in the US.
Moreover, our life expectancy is
steadily increasing: from 1950 to 2020,
the average life span will change from 65
years to 74 years for men, and 71 years
to 82 years for women.
What can we do to prepare ourselves
for the future? When debating Medicare
funding, we have forgotten that the senior citizens have a daily life beyond doctors and hospitals. The following programs will require emphasis to midgate
suffering ofthe needy elderly.
First, a large number of the elderly
can be managed by adult day-care centers. These centers provide daytime care,
an alternative to institutionalization.
Many elderly people simply need custodial care rather than medical care; this
involves help in dressing, eating, bathing, and other everyday activities. The
family members are capable of providing
these basic needs at all times except during working hours. They are afraid of
leaving infirm relatives at home by themselves. When they do, they frequendy
use office time to call home. Or they miss
work. Their productivity suffers. A survey of 7,000 federal workers by the Department of Health and Human Services
showed that nearly half had to take care
of dependent adults, and 50 percent of
these people missed nine to 80-plus
hours of work in a year.
Adult day centers are ideal places for
these families. It relieves the family members of 24-hour responsibility, especially
when they have full-time jobs. A femily
may leave the reladve at the center at,
say, 7:30 and take him or her home at
5:30 p.m. while returning from work.
A good day center is not just a "sitting
service." It has comprehensive programs
consisting of rehabi itative and social ser-
vices. Besides, these centers cost about
half as much as nursing-home care.
Community groups, churches, and
voluntary organizations have been in the
forefront in supporting these programs,
but without a commitment from the federal government, the proerams cannot
succeed and grow. The Older Americans
Aa provides $ 1.2 billion a year for homemaking, meals-on-wheels, and adult daycare centers, but the funding has bare y
kept up with inflation. I know a number
of elderly men and women who wouldn't
have a decent meal unless provided by
the volunteers from the meals-on-wheels.
S
ECOND, home companion care is
another important program. Persons who are well enough to stay
home but limited in capabilides are
helped by the companion-care services.
Many old people don't need expertise or
equipments. They need physical assistance, which can easily be provided by
the kindly aides. These aides are much
less expensive than professional nurses
and help individuals with physical limitations to live with dignity in their own surroundings.
Third, nursiny-home care will be necessary for a large number ofthe elderly.
Currendy, 1.3 million older Americans
live in nursing homes, at an average cost
of $22,000 a year for each person. And
with the rising number ofthe aged, the
costs wilTescalate.
Money must be found for the debilitated aged. Our parents and grandparents sacrificed for us, and because of
their sacrifices, we have choices today.
Unfortunately, families have to wipe out
their lifedme savings to qualify for federal nursing-home coverage. And many
fall through the cracks in the system;
they have "too much money" to qualify
for financial assistance, but too litde to
support themselves. It is painful to watch
them groping their way through the economic hardship. Some even have divorced their spouses to be eligible for
Medicaid. It's not the affluent elderly
who suffer, but the poor and disadvantaged. Cutting the social program will hit
the most needy the hardest.
President Bush has said very little
about our contract with the elderly. We
would be better served if he showed as
much zeal for our needy citizens as he
has shown for foreign affairs.
• Fazlur Rahman, M.D., is chief of hematology and oncology at Angelo Community
Hospital and West Texas Medical Associates
in San Angelo, Tems.
�n
HE
NEW
YORK
TIMES.
TUESDAY.
AUGUST
30. 19SS
Why Not Adult Day Care?
living longer — the number of people
over the age of 80 will rise from 6.2
million today to 12.1 million in 2010.
Thus, in time, almost every family
SAN ANGELO. TX.
'W •.vris tailed to Ihe emergency will have to care for an aged relative
room lhe other day to see an with a similar medical history.
82-year-old widow, a victim of
How are we going to afford the care
a mild stroke. For ihe last )'l they will need without sacrificing
years. 1 liave seen her trans- quality? The key is adult day care.
formed from an active and inThe costs of nursing homes was $21
dependent woman, enjoying retire- billion in 1980 and may reach $70 bilment with her husband, to a person lion by 1990. Adult day care provides
who depends on others. She developed an alternative to institutionalization.
'omnlicauons irom diabetes, heart
It relieves the family members of
disease and anemia. When she tell twenty-four-hour responsibility, espeand broke her hip. she agreed to live cially when they have full-time jobs.
'.viih her son's family.
It should lie emphasized that this is
• iih ihe .idvancement in public not just a "sitting service." Properly
ilea I th and medicine. Amencans arc conceived, adult day care includes
medical care, nursing, rehabilitation
' arlur Rahmnn is chief of hema- and social services.
l-notiy 'inn o/K.nlogy <;/ Angelo C'om- Nurses play a central role, but somitmtv llospilal.
cial workers also are important. Old
By Fazlur Rahman
people often come to my office with
bundles of papers, overwhelmed with
bills and computer printouts from the
doctors, hospitals. Medicare and insurance companies. A social worker
untangles the complexities and relieves the anxieties. Psychological
support for the aged is of no use unless such matters are resolved.
To date, adult day care centers are
community
projects
supported
mostly by local resources. Churches,
voluntary organizations and private
foundations partially fund our program in San Angelo. But expanding
Federal and state aid through Medicare and Medicaid would make sense
— on average, it costs about half as
much to maintain a patient in day
care as in a nursing home.
Society has to help the dehilitatec
elderly live with dignity and hope
Dav care would do just that.
•
�THE WALL STREET JOURNAL THURSDAY, SEPTEMBER 17. 1992
A15
The New World Order Dies in Bosnia
atrocities: "Anti-tank weapons were used
to blow up Bosanki Novi's mosques. Every
night Muslim shops and cafes were blown
up. People 'disappeared,' bodies floated
down river, an outlying Muslim suburb
was shelled and then Serb forces moved in
and burned houses."
Cyrus Vance, special U.N. envoy, and
Lord Carrington and then Lord Owen
of the European Community have been
outwitted by Milosevic time and again. So,
tomorrow's scheduled conference in Geneva, even if held, will not produce anything better. Meanwhile, killings and
maimings will go on.
In a belated editorial Aug. 12, the
Journal showed little concern for the suffering of the Bosnians. It was more interested in criticizing Bill Clinton, and in
By Fazlur Rahman defending the impotent policy of George
Bush. It also displayed this callous logic:
"Hitler employed a vast force of 30 divirights for all its citizens - Muslims, Serbs sions to pacify Yugoslavia and failed."
and Croats. It's a member of the United Would we be justified to intervene if Hitler
Nations, and the U.S. and other govern- succeeded with 30 divisions? Perhaps 10
divisions? What's the use of NATO? Hitler
ments have recognized the country.
Alija Izetbegovic, the Muslim president wanted to obliterate the European Jews
of Bosnia-Herzegovina, has repeatedly ap- and their culture just as Milosevic wants to
pealed to the U.S., Europe and the U.N. to do to the Bosnian Muslims today. Then, as
help his country to stave off the Serbian now, Britain talked and talked, and the
aggression. But Mr. Bush has turned a U.S. waited until it was too late.
deaf ear. The State Department under
Where are the principles and justice
Lawrence Eagleburger is in disarray. An that, as a nation, we are supposed to
official of the department has resigned to uphold? Bosnia-Herzegovina could be a
protest the U.S. inaction in Bosnia. If the model for the Muslim-dominated secular
Serbians suspected that the U.S. might governments elsewhere in the world. Kustand up to them, they wouldn't dare to go wait is still not a free society, and Saudi
this far. Too many conferences on Bosnia women aren't even allowed to drive.
give an impression that something is being
It is disingenuous to use the ancient
done, all the while allowing the annihila- quarrels of the Balkans as an excuse to
tion of the Muslims and their culture.
deny protection to the Muslims. What is
Hasn't Milosevic destroyed enough? important is this: After World War II, for
How can his minions justify relentlessly 45 years, the Muslims, Serbs and Croats
shelling the funerals, the cemeteries, the lived together in harmony. It's Greater
hospitals, the breadlines, the libraries, Serbian imperialism that has destroyed all
and the mosques? The Economist (Aug. 1) this. Only decisive force will counter the
gave one of the many examples of Serb Serbians:
The editors of The Wall Street Journal
have used the paper's editorial page numerous times to coax President Bush to
use force against Saddam Hussein'. They
talk of the United Nations Coalition and
about the New World Order. Unfortunately, their principles falter when it
comes to calling for direct military action
to punish Serbian leader Slobodan Milosevic, an old communist and a new Hitler,
who has been slaughtering Muslim children, women and men in Bosnia-Herzegovina.
Bosnia-Herzegovina is a secular country, whose constitution guarantees equal
Counterpoint
1. Mr. Bush must take leadership in
forming a coalition again. Europe has
proved to be spineless, and Britain has
shown duplicity. It has kept Turkey out of
the European Community with the lame
excuse that Turkey has violated human
rights, while it has tolerated raping and
pillaging by the Serbs, and the concentration camps where Muslim prisoners are
tortured and starved to death.
The U.S. does not need to send ground
soldiers. Muslim countries such as Turkey
and Pakistan are willing to send troops
forget easily.
Another point is pertinent here: We
cannot exploit the Somalian tragedy to
deflect attention from the tragedy in Europe. Of course, the Arab League has
ignored Somalia. But what others do or fail
to do does not abrogate the West's responsibility in Bosnia.
2. The territorial integrity of BosniaHerzegovina must be kept intact. Otherwise, every Milosevic will believe in the
principle of "might is right."
3. The U.N. has done what the U.S. has
asked it to do in Iraq. The U.S. must lead
the U.N. to reapply the same principles
It is disingenuous to use against Belgrade. Boutros-Boutros Ghali,
U.N. secretary general, has been inept
the ancient quarrels of the thedealing with the Bosnian crisis. He is
in
without conviction. The U.N. knew about
Balkans as an excuse to
the Serbian death camps and tortures, and
deny Muslims protection.
its own report has asked for possible
war-crime trials for the atrocities committed by the Serbs. What did the Security
under U.N. auspices.
Now that the Muslim countries want to Council do? Where was the West's outhelp, the West is crying foul (WSJ editorial rage? Now, look at the swift reaction of the
Security Council to the killing of two
Sept. 10). But if a U.N. coalition of
Muslim nations and the U.S. was good French soldiers and the wounding of five
enough to liberate Kuwait, it should be attributed to desperate Bosnians. In congood enough to liberate Bosnia. If bombing trast, Serbian pogroms against Muslims
of Iraq is any guide, the U.S. Air Force can deserve only leisurely meetings in Belneutralize Serbian military installations. grade, London, Geneva or New York.
Milosevic understands force. He victimMilosevic has repeatedly made a mockized Bosnia because Muslims were the only ery of the U.N. Even the U.N. relief
group that did not have its own army. He operations depend on his whim. Serbs have
also correctly predicted Europe's hypoc- intensified the all-out war against Muslims
risy, and that Europe would not come to despite U.N. supervision of heavy Serb
defend its own Muslim citizens. He has weaponry. What's more, Serbs have
deviously played the "Muslim-Fundamen- openly challenged the U.S and Europe by
talism-in-Europe" card.
opposing the proposed "no-fly" zone over
If Milosevic goes unchecked, he will Bosnia.
descend on the Albanian Muslims and on
Finally, it is sheer deception to fly
others, bringing in wider conflict and warplanes in Iraq in the name of a New
instability in Europe. Serbs who cheer him World Order when Mr. Bush is indifferent
now will have second thoughts when he to the carnage in Bosnia.
suppresses his own people to stay in power.
Dr. Rahman is a physician in Sun AnAlso, the two million refugees, and those
who have lost their loved ones, will not gelo, Tems.
�THE WALL-STREET JOURNAL MONDAY. NOVEMBER 24. WSh
Guarded Optimism About AIDS
By FAZLUR, RAHMAN .
A 30-year-()ld man was referred to me
from a public-health clinic. He was suffering from diarrhea and fungal infection
oi the tongue. He had contracted so-called
A IDS-related complex, which might or
might not turn into the full-blown disease.
For weeks and months. I kept getting panicky phone calls from him and his family
whenever they heard dreadful things about
acquired immune deficiency syndrome.
fivery day, I hear more dire predictions
on AIDS: It is increasing by leaps and
bounds; within the next decade, we are
told, there will be thousands of victims and
thousands of deaths, with no relief in sight.
Last week's announcement by lhe World
Health Organizaton that AIDS was "a
health disaster of pandemic proportions"
and a recent report from Dr. C. Everett
Koop. the U.S. surgeon general, echo the
same theme. I wholeheartedly concur with
Dr. Koop's preventive measures—educating our children and avoiding careless sexiini practices and reckless habits-hut 1 do
not share his hopelessness. It is true that
the problem defies solution at present. But
are these grim forecasts justified?
What is forgotten in the chaos are the
remarkable achievements that have been
made within a few short years. It was only
in June 1981 that the scientists at the Centers for Disease Control in Atlanta first
suspected acquired immune deficiency
syndrome in five patients. Since then, its
cause, an infection due to immunodeficiency virus, has been identified; the virus
has been isolated and cloned; tests for general use have been introduced. And most
important, a major epidemic among bloodtransfusion recipients has been averted by
successful screening of donors.
We must, keep the whole thing in per-
spective. There was no shortage of dismal
prognostications on poliomyelitis, diptheria
and the plague. Common bacterial pneumonias and tuberculosis were once thought
to be hopeless conditions. How could we
forget the despair brought about hy Legionnaires' disease just 10 years ago? In
1976. an outbreak of pneumonia occurred
among American Legionnaires who had attended a convention in a Philadelphia hotel. There were 182 cases and 29 deaths.
Panic and confusion prevailed. A few more
small outbreaks followed. Then determined
workers from the Centers for Disease Control solved the mystery; it is a bacterial infection, which, once diagnosed, is easily
treated. This should not be a surprise. We
have an excellent track record in preventing and curing infectious diseases.
We cannot, however, be complacent.
Both the public and private sectors must
make an intense effort to raise the funds
for research, prevention and treatment. Already, a genetically engineered safe vaccine is available for ; i common viral disease, hepatitis B. In this day of recombinant-DNA technology and intense competition among the pharmaceutical companies
around the world, something of this nature
will be done for AIDS. There is at least one
animal model with which to work in developing a vaccine. An AIDS-related virus
causes an AIDS-like disease in cats; a vaccine has been developed to prevent the disorder. And AZT. the anti-viral drug, while
not a cure, has improved the survival rate
and quality of life of a small group of selected patients.
Take the case of smallpox, a deadly viral disease. It has haunted mankind for
ages and caused untold misery. When 1
was growing up in Fast Pakistan, now
Bangladesh. I saw its ravages firsthand.
The victims were men, women and children. I vividly remember their suffering,
their contaminated flesh and draining ulcers, their relentless agony and horrible
deaths. Those who survived were left with
permanent physical and psychological
scars. Now. smallpox has been wiped from
the face of the earth. The last patient, a
man from Somalia, was seen in October
1977. This stunning success was achieved
within 20 years by various national efforts
and the Smallpox Eradication Campaign
under the sponsorship of WHO, which now
believes that smallpox may never return
as an endemic disease. Therefore, vaccination is not required anywhere in the
globe.
We need lhat kind of international cooperation to control AIDS. We must have a
clear view of the problem. AIDS afflicts
people in all walks of life, of all colors, beliefs and faiths. There is a high-risk group,
for sure, but the disease does not respect
social or geographical boundaries.
But. so far, we cannot say much about
collaboration among nations. French scientists are fighting the U.S. government scientists. The dispute is about the discovery
of the AIDS virus and its commercial use.
A protracted duel in the court will increase
the frustration and distrust among the scientists and diminish the flow of ideas and.
information, hurting the search for a cure.
The Smallpox Eradication Campaign
should serve as a model for the control of
AIDS. We should remember the words of
Albert Camus in "The Plague": "We are
working side by side for something that unites us-beyond blasphemy and prayers."
Dr. Ruhinmi is chiij, section of hcinntnlofiy iimi nncoloiiy, at Anaclo Cmmrutnitii
Hospital ami West Texas •Meiiical Assnc'intas. San Anuclo. Terns.
�THE WALL STREET JOURNAL
\ « ! s 'J. 1988
u'.t
A Moslem's iJefense of the Faith
By FAZLUR RAHMAN
A Moslem, I have spent 20 years in this
country. During that time, I have observed
that of all the world's faiths, it is Islam,
with its almost one billion adherents, that
is most misunderstood in America. Daily
newspaper and TV coverage fosters the
impression that the followers of' ;lam are
a violent lot, a band of fanatics r id terrorists who incite holy wars and are ruled by
reckless men.
I also sense pervasive bias against Islam from scholars and institutions of
learning. Since Islamic studies departments as a rule are combined with Middle
Eastern studies, political beliefs taint the
way academics and students interpret the
faith. But in the Islamic world, as in the
rest of the world, politics and religion are
not usually synonymous.
Americans sometimes lose sight of the
fact that Moslems, like everyone else, can
be poor or rich, tolerant or intolerant, illiterate or scholarly, honest or dishonest. The
vast majority are busy running their daily
lives, worrying about their own futures and
those of their children. They detest injustice and extremism just as others do.
They come from many different cultures and races: From Asia. Africa, Europe :nd the Americas, from communist
and capitalist countries. Though of diverse
backgrounds, they are bound together by
five principles of Islam: Belief in one God
and his prophets: prayer; charity; fasting;
and, if possible, pilgrimage to Mecca, the
birthplace of the prophet Mohammed. In
the U.S., writers and scholars neglect to
mention those principles while discussing
Islam, and the public and the politicians,
who vote and make the policies, often are
unfamiliar with them.
V hile the wrongs of Islam have been re;
counted too many times, its positive contributions have received short shrift. Islam
once ruled vast areas of Asia, Africa and
Europe. Jacob Bronowski. the late scholarscientist, called it an "empire of spectacular strength and grace, while Europe
lapsed in the Dark Ages."
Like the Greek and the Roman before
it. Islamic civilization declined, but it contributed immeasurably to the arts, culture,
philosophy, medicine, chemistry, botany,
mathematics, physics, and astronomy. One
of the world's most beautiful buildings is
the Taj Mahal in India. This mausoleum
was built in the 17th century by Moslem
emperor Shah Jahan for his beloved wife
Mumtaz Mahal. And the 1,200-year-old
mosque of Cordoba in Spain is a testament
of the endurance of Islamic architecture.
Between the ninth and the 11th centuries, Moslems established great universities in Damascus, Baghdad, Bukhara, Seville, Cordoba and Cairo. Thousand-yearold al-Azhar University in Cairo is the
world's oldest still-functioning university.
Twelfth-century philosopher Averroes
Ubn Rushd) immensely influenced Jewish
and Christian thought. Another renowned
Moslem figure .vas Avicenna Ubn Sinai.
His nth-century masterpiece, "The Canon
of Medicine," is the- most famous book in
the history of me dcine.
Christian and Jewish scholars flourished in the Moslem courts. While Islam
converted people, 't disseminated its
knowledge to them a,.d at the same time,
it absorbed the teach tgs of others. Maimonides, the great 12th-century Jewish
thinker, studied under Moslem intellec
tuals. His writings were largely in Arabic
Above all, the Islamic Empire's high de
gree of tolerance for that time enabled sci
ence to be enriched by the combined wis
dom of Moslems, Christians, Jews, Greeks
P •rsians. Indians and Chinese. Christian
conquerors, on the other hand, were not so
tolerant of Jews and Moslems-witness the
Crusades and the Spanish reconquest.
The West uses the term "Judeo-Christian tradition." But "Judeo-Islamic tradi:ion" would be more appropriate. Judaism's civil and religious laws have more
similarities to the laws of Islam man to
those of Christianity.
The wretched worlds of violence and oppression arc ::ot the realms of the Mos ems
only. Ferdir and Marcos and Augusto 1 inochet are Uirisiians. Some Jews in Israel
use biblical injunctions to preach and practice violence i gainst the Arabs. Hindus
and Buddhists a. • at war in Sri Lanka. So
are Hindus and ^ikhs in India, and Catholics and Protestants in Northern Ireland.
Much has been made about the discord
among Moslems. But Moslem sectarianism
is minimal. Sunnites constitute 90% of the
world's Moslems, while Shiites, who are
fundamentalists, and whose fanaticism in
Iran we hear about so much, constitute
the rest.
Each religion has its strengths and
shortcomings. Christianity has splintered
into numerous sects, a few of which question the legitimacy of other factions. Hinduism has its higher and lower castes.
There is a serious disagreement among he
Orthodox, Conservative and Reform Jews
about conversion to Judaism and about
Jewish doctrine and tenets. And Buddhism
has divided itself into different schools.
Islam is the second-largest religion on
Earth. It is part of daily life of one-fifth the
world's inhabitants. We Americans, for the
benefit of all. must understand it.
Dr. Rahman, bom in what is now Banqlir.t'ish. is a physician in San Anyelo.
Tn:. as.
�V r . i . 315
No. 9
THE
NEW E N G L A N D J O U R N A L OF M E D I C I N E
THE
F U T U R E OF M E D I C A R E
To thr Editor: As a medical oncologist whose practice consists
largely of elderly sick persons, I must comment on the article by
Blumenihal et al. and the Harvard Medicare Project. Like many
reports in medical and nonmedical publications, it is primarily
concerned with the economic aspects of Medicare while ignoring
the quality of care for our aged people. I n addition, we cannot
think of the future of Medicare without addressing its present
problems.
First, our medical care system has become procedure-oriented.
Physicians are compensated far more for performing medical and
surgical procedures than ibr the time spent in taking care of critically ill patients. This compensation system has to be modified to make
it more equitable for doctors in various disciplines, such as family
practice and internal medicine. Now, even a family practitioner
receives a higher reimbursement for doing minor surgery than for
providing much-touted primary care. High surgical and radiologic
fees and expenses contribute a great deal to the high cost of medical care.
Second, there are other discrepancies. For example. Medicare,
through its rules about diagnosis-related groups, allows only 6.4
days of hospitalization for the induction therapy of acute leukemia
in adults. This amount of time is totally inadequate. Acute leukemia
aside, one administrator of a peer-review organization told me.
"There is no reason to give chemotherapy to old people." This, in
spite of the fact that age in years has little bearing on the selection of
treatment. I t is lhe patient's quality of life and functional status that
are more important determinants of treatment.
T h i r d , current Medicare policies are creating rifts between
patients and their doctors, and between physicians and hospitals.
No amount of legislation will improve the quality of care i f there
is discord between these groups. Just call a Medicare office in
your area to find out. Patients are given conflicting information.
They are not told that the doctors must follow the criieria set for
the diagnosis-related groups. T o p administrators in the Department
of Health and Human Services are no exception.' Medicare
should tell its beneficiaries ahead of time, in a straightforward manner, that it has limited resources and, therefore, can allow only
limited medical services. When patients are sick, the last thing they
want to hear about from their physicians is Medicare rules and
restrictions,
Finally, giving bonuses to physicians as an inducement so that a
hospita] can make a profit is unacceptable. As things stand now, no
nursing home or hospital wants a patient with expensive medical
problems.
2
FAZLUR RAHMAN,
San Angelo, T X 76904
Aug. 28, 1986
M.D.
Angelo Community Hospital
West Texas Medical Associates
1. Rahman F. Medicare makes a wrong diagnosis. New York Times. January
23, 1986.
2. Bowen OR. How Medicare hospital reimbureiment works. New York Times.
February 6. 1986.
The above letters were referred to Dr. Blumenthal, who offers the
following reply:
To tht Editor: Dr. M c l n t y r e argues that mandatory assignment
under Medicare would represent unjustified governmental intrusion
into transactions between elderly patienls and physicians and that it
threatens to "welfarize" Medicare. The justification for federal regulation of physicians' Medicare fees is the same as its justification
for seeking the lowest prices from defense contractors: As the taxpayers' agent, the government seeks to control the costs of an expensive, albeit essential, public service. As Dr. M c l n t y r e points out, in
exercising this prerogative the government must balance cost control with other goals, such as treating the elderly and their physicians fairly and preserving freedom of choice for both groups. Our
view is lhat a fee schedule based on a relative-value system and
including mandators' assignment provides a reasonable compromise
among these sometimes competing goals.
I f it is to be preserved at all, the fee-for-service sector within
Medicare must be made less costly. Otherwise, it will be abandoned
altogether — a far greater intrusion on Medicare patienls and
physicians than anything we propose. T o make it less costly, it is
essential to constrain fees. Once those fees are constrained, it is
essential to protect Medicare patients, especially the poor elderly,
from attempts by physicians to recoup from beneficiaries what
Medicare will no longer pay. Unlike the state of Massachusetts,
we do not propose that physicians be required to see Medicare
patients on assignment or risk the loss of their license. We do propose thai when physicians refuse assignment, neither they nor their
palients be allowed to bill Medicare. Some physicians may withdraw from participation in Medicare under these circumstances,
but given the economic pressures under which fee-for-service physicians now operate, we think most will continue to serve the elderly
and that the elderly will continue to be treated in the mainstream
of care.
We agree with D r . Rahman that preserving or improving the
quality of care should be an essential goal of Medicare reform.
Although we cannot judge the appropriate length of a hospital stay
for induction therapy for acute leukemia, we also agree with his
assessment of Medicare's current problems. Our suggested reforms
in physician payment were designed to reduce the orientation of the
medical care system toward procedures. Our proposals to simplify
the program are aimed at reducing the confusion patients experience in using Medicare, and thus the need to consult Medicare
offices.
D A V I D BLUMENTHAL, M . D . ,
M.P.P.
Center for Health Policy and Management
John F. Kennedy School of Govemment
Cambridge, M A 02138
Harvard University
�FAZLUR RAHMAN, M.D., F.A.C.P.
WEST TEXAS MEDICAL ASSOCIATES
3555 KNICKERBOCKER ROAD
SAN ANGELO, TEXAS 76904
'
H i l l a r y C l i n t o n , F i r s t Lady-Elect
P.O. Box 615
L i t t l e Rock, Arkansas 72203
A'oi'iW ^ 0 .7 5
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�Rhode Island Hospital
Division oifi/diatric Endocrinology
taoohsm
593 Eddy Street
Providence, Rhode Island 02903
Telephone 401 444-5504
Fax 401 444-8845
Rhode Island
Hospital
Brown University
School of Medicine
1/30/93
I'HILII* A. G K U l ' I ' U S O , M.H.
Director
RO H li HT S C H W A H T Z , M P ) .
M A K Y U. A R N O L D , M . D
Hillary Rodham Clinton
Head of the President's Task Force on
1600 Pennsylvania Ave. NW
Washington, D.C. 20500
1
th Care Refaimf^N
IAN OCRANT, M . D .
J O H N B. S U S A , PH.15.
Dear Mrs. Rodham Clinton:
I am writing you today as a physician, pediatrician, academician, and citizen, to offer
you some suggestions as you attempt to tackle the daunting problem of health care reform in this
country. 1 strongly support you in this overdue bold effort. Please do what is right for the
country, not what the special interests want.
Two issues need to be addressed: cost and availability. To deal with cost it is important
to 1) cut down on health insurance red tape. Simple, uniform procedures and forms for all
insurers including Medicare will save billions of dollars. 2) Reforming malpractice litigation to
eliminate the dangers and costs of defensive medicine will save billions. 3) Emphasize
.prrafrmtatiYir health care: immunizations, universal health care for children, and universal prenatal
care. These items are extremely cost-effective and will save billions. 4) Eliminate the staggering
disparity in pay between the medical professionals. Surgical specialists, radiologists, and
'anaesthesiblogists get paid far more than primary care physicians, often for less work and less
training. They do not deserve such outrageous fees which add greatly to medical care costs. 5)
The rising costs of medical education cause fewer promising students to enter Family Medicine,
Pediatrics, and Internal Medicine because they cannot pay their education debts. Decreasing or
supporting the costs of medical education which will eliminate front-end financial incentives,
leaving career satisfaction and altruism as motives for practicing medicine. 6) FDA procedures
need to be streamlined. Drugs need to be rationally priced, new drugs efficiently evaluated, and
drug companies protected from unreasonable liability costs. 7) Support for medical research is
extremely cost-effective and will eliminate the need for expensive, half-way technologies like
organ transplantation. We are on the verge of cures for cancer, diabetes, and viral diseases like
AIDS, at the same time we are undercutting this effort by undertunding the National Institutes of
Health and the National Science Foundation. This support should be include strong support for
"small science" (i.e., individual investigators), and should not necessarily be targeted to specific
diseases. Today's dazzling technologies and Nobel prize-winnint: research would not have been
fundable under today's funding priorities
Tbe availability problem will be easy to solve with money saved from the above
measures to cut costs. Streamlining insurance procedures will decrease costs and place less
burden on business to supply employees with health insurance, and decrease the burden on
taxpayers to support indigent care for all. Generally, health care systems (already rn place in a
tew states) that give indigent patients access to their own private physician promote more
satisfactory and cheaper health care than those promoting inefficient use of emergency rooms for
primary care.
�1ferventlyhope you succeed in your efforts, and hope my suggestions have been helpful
to you.
Sincerely yours,
Ian Ocrant, M.D.
Assistant Professor, Pediatrics
�•SK
Linda M. Christmann, M.D.
«m •
Pediatric Ophthalmology & Adult Strabismus
A p r i l 26, 1993
H i l a r y Rodam C l i n t o n
C h a i r p e r s o n , S p e c i a l Committee
HealthCare Reform
White House
Washington, DC
Dear Mrs. C l i n t o n :
I was most d e l i g h t e d t o see your appointment t o t h e Committee f o r
H e a l t h Care Reform. As a female p h y s i c i a n , i t i s g r a t i f y i n g t o see
o t h e r women i n p o s i t i o n s o f r e s p e c t and a u t h o r i t y .
I am w r i t i n g you, however, because o f my p e r s o n a l p e r s p e c t i v e s as
a p h y s i c i a n i n a poor s t a t e .
I n our s t a t e , l a r g e numbers o f c h i l d r e n a r e on Medicaid because t h e
mother's r e c e i v e l i t t l e o r no p r e n a t a l care and t h e r a t e o f
premature d e l i v e r y i s h i g h . We have one o f t h e h i g h e s t ( i f n o t t h e
h i g h e s t r a t e s ) r a t e s o f teenage pregnancy i n t h e c o u n t r y and
u n f o r t u n a t e l y , many o f these c h i l d r e n g i v i n g b i r t h t o c h i l d r e n , do
not admit t h e i r pregnancy u n t i l v e r y advanced.
This c e r t a i n l y
hampers d e l i v e r y o f p r e n a t a l c a r e . As a concerned p h y s i c i a n , I do
see p a t i e n t s on m e d i c a i d , however, t h e o t h e r person i n my s p e c i a l t y
i n t h i s c i t y , does n o t accept p a t i e n t s w i t h medicaid.
Medicaid
reimbursement i s so poor i n t h i s s t a t e , a p p r o x i m a t e l y 38 c e n t s on
t h e d o l l a r , t h i s i s a tremendous f i n a n c i a l burden t o my p r a c t i c e .
I c e r t a i n l y do n o t f e e l c o m f o r t a b l e r e s t r i c t i n g access o f medicaid
patients
t o my p r a c t i c e
b u t on a v e r y r e a l s c a l e , most
o p h t h a l m o l o g i s t s have overhead o f 55-60%. T h i s means t h a t every
t i m e I see a medicaid p a t i e n t I am l o s i n g money. I hope t h a t i n
t h e g r e a t e r scheme o f t h i n g s , when t h e r e i s a n a t i o n a l h e a l t h
i n s u r a n c e , those o f us who have been c a r i n g f o r these medicaid
p a t i e n t s w i l l n o t p e n a l i z e d and t h a t reimbursement f o r a l l p a t i e n t s
w i l l be a t a l e v e l t h a t we can a t l e a s t make a l i v i n g as
physicians.
I never e n t e r e d medicine because I wanted t o be w e a l t h y . I became
a p h y s i c i a n so t h a t I would have a j o b where I c o u l d h e l p o t h e r
people and be guaranteed o f a s t a b l e income f o r myself and my
children.
4 Richland Medical Park • Suite 202 • Columbia, S.C. 29203 • (803) 779-6006
�I t r u s t t h a t your committee w i l l be f a i r i n reimbursement s c a l e s
f o r a l l p a t i e n t s . I am, however, l o o k i n g f o r w a r d t o a l l p a t i e n t s
b e i n g i n s u r e d , s i n c e t h a t means when I come o u t t o care f o r a
p a t i e n t who has been i n an a l t e r c a t i o n o r an a c c i d e n t i n t h e m i d d l e
of t h e n i g h t , I w i l l n o t be p a i d a b s o l u t e l y n o t h i n g because t h e
p a t i e n t i s uninsured.
I a l s o would l i k e t o address two o t h e r i s s u e s t h a t I t h i n k a r e
e s s e n t i a l i n t h e r e f o r m process. F i r s t o f a l l , t o o many p a t i e n t s
t h a t I see a r e denied h e a l t h care coverage under a p r e - e x i s t i n g
condition clause.
I t i s e s s e n t i a l t h a t t h i s be e l i m i n a t e d .
I
e s p e c i a l l y t h i n k o f a young b l a c k mother, who d i d what we always
say we want such women t o do, she g o t m a r r i e d and g o t employed.
She purchased h e a l t h i n s u r a n c e f o r h e r s e l f and h e r daughter. When
her daughter had s u r g e r y , she was i n f o r m e d by t h e i n s u r a n c e c a r r i e r
t h a t t h i s was a p r e - e x i s t i n g c o n d i t i o n . U l t i m a t e l y , h e r daughter
accrued so much medical care c o s t s t h a t t h e women q u i t h e r j o b ,
d i v o r c e d and went back on medicaid i n o r d e r t o have h e a l t h care
coverage.
What a t r a g e d y f o r a l l o f us t h a t people a r e c a u g h t - i ;
such a t r a p .
f
f
I l o o k f o r w a r d t o n a t i o n a l h e a l t h care a v a i l a b l e f o r every p a t i e n t man, woman and c h i l d i n t h i s c o u n t r y . I applaud your e f f o r t s on
b e h a l f o f t h e w o r k i n g poor i n t h e U n i t e d S t a t e s .
W i t h warmest r e g a r d s ,
Linda M. Christmann,
LMC/de
M.D.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3/7
.'
Ti -
V' 'v"- i"-':
^* 'V'' '-"- v
�Withdrawal/Redaction Marker
Clinton Library
DOCLIMENT NO.
AND TYPE
007. letter
SUBJECT/TITLE
DATE
02/23/1993
Phone No. (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [7]
2006-0885-F
im807
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) (if the I OIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe 1 Ol A]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(S) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�^ri]E ^ D u t b Carolina Olaurt af Appeals
JOHN PICKENS GARDNER
JUDGE
F e b r u a r y 23,
P.O. B O X I 1 6 2 9
C O L U M B I A . SC 2921 1
1993
Mrs. H i l l a r y Rodham Clinton
Chairman, P r e s i d e n t i a l • H e a l t h
Care Task Force
1600 Pennsylvania Avenue
Washington, DC 20500
Dear Mrs. Clinton:
I write about a s o l u t i o n to the c o n t r o l of the cost of
d e l i v e r y of medical s e r v i c e s and prnHnrits.
T F ^ man whn knows the
most about t h j s i n South Carolina i s Cgepresentat^^t VLilliain S.
Houqk J r , m rrA [D] who i s a r e t i r e d surgeon, ^ ^ i y ^ w a s , before
711 H"(fyj^,ffiiigs?j7 vtip. preeminent surgeon i n the Pee uee-r He r e t i r e d
i n order toDecome a member of the General Assembly of South
C a r o l i n a so that he could personally lead our e f f o r t s i n health
care reform.
r
T
f
Dr. Houck i n t r o d u c e d a B i l l which was supported by the
d o g t a j ^ , and opposed by t h e h o s p i t a l s . Dr. Houck i s a b r i l l l d l l L manaTi3 has g i v e n much thought t o t h e s o l u t i o n o f t h e problem w i t h
which you a r e now w r e s t l i n g . H i s a t t i t u d e i s sympathetic w i t h t h e
g o a l o f our P r e s i d e n t and I t h i n k , i f c a l l e d upon, might make a
g r e a t c o n t r i b u t i o n t o your t h i n k i n g about t h e v a r i o u s aspects of
t h i s problem.
Dr. Houck's name and address are l i s t e d
C a r o l i n a L e g i s l a t i v e Manual t h u s l y :
i n t h e South
William S. Houck, J r . , M.D. [D] R e t i r e d Doctor
D i s t . No.-"63 — Florence Co.
(C) 314A B l a t t Bldg., Columbia, 29211
(The Whitney)
Bus.
734-3002
Home I P6/(b)(6)
007
I hope t h a t you w i l l c o n s u l t t h i s man who has s a c r i f i c e d
so much t o be i n a p o s i t i o n t o make a p o l i t i c a l c o n t r i b u t i o n t o the
g r e a t e s t c h a l l e n g e nov; f a c i n g t h i s n a t i o n .
�Mrs. H i l l a r y Rodham Clinton
February 23, 1993
Page 2
I am very proud of your husband, my President. I am
confident that he w i l l lead t h i s nation through the troubled waters
we are now i n .
Very truly yours,
JPGsr:kcb
�T H E U N I V E R S I T Y OF S O U T H C A R O L I N A
COLUMBIA CAMPUS
Harold 1. Friedman, M.D., Ph.D.
Ram Kalus, M.D.
Gale N. Coston, Ed.D.
Two Richland Medical Park
Suite 300
Columbia, SC 29203
Department of Surgery
Division of Plastic and
Reconstructive Surgery
School of Medicine
803-256-2657
Mrs. Hilary Rodham Clinton
Health Care Task Force
The White House
1600 Pennsylvania Avenue
Washington D.C.
15 March 1993
Dear Mrs. Clinton:
I am a Board CertifiedVlastic-^^eGonstoj^liya^argeon oa!&aff at the University of South
Carolina School of Medicine in Columbia. I am also a registered Democrat and am proud to say
that I voted for our president. I have several thoughts which I wanted to share with you, both
specific to my area of specialty, and to medicine in general.
As you are well aware, health care refonn is one of the most pressing issues facing Americans
today, and perhaps will be the most important issue of the next several generations. That every
American deserves access to basic affordable health care is undeniable. Unfortunately, it would
seem that Americans want state of the art care, they want it fast, and they don't want to pay
high insurance premiums for it. They also want the freedom to choose their physicians, and
they want hassle-free and dependable coverage for their health care needs. One of the critical
"problems" is that ourjechnology is not only saving lives, but prolqggiogjleath. Americans are
living longer, and theywaiflP^Sending more of their last days in etffr§mely expensive intensive
care units where, in many cases, death is being temporarily deflected rather than avoided.
This brings me to my first specific proposal. The very difficult decisions regarding who shall
live, who shall die, who shall be treated, are being tacitly avoided today for a multitude of
complex reasons which include family wishes, medicolegal concerns, and fear of responsibility,
both moral and ethical. Nevertheless, these very difficult decisions must be made if we are
going to impact on the cost of health care in this country.
No single person can or should be empowered to make such decisions, but I propose that every
hospital berecjuired to forma committee consisting of some c o m b i n a t i o n ^ ^ j ^ i c i a j f e ^ ^ g j v - *
ri^Thtat"51flTK^^
physician, and family
meffibersto makea determTnafion of the appropnatehess of a pro^^31 r^3toent,'^iTri3epd,
even an admission to the hospital. For example, in our country today there are hundreds of
thoffian'dS'of elHerly, aebilitated, vegetative patients in our nursing homes. Many have family
members who are concerned, many do not. All of these nursing homes have internists who
regularly see these patients. Those who are truly vegetative are fed by a feeding tube, must be
turned in bed every two hours to prevent pressure sores, and are completely dependent on 24 hour
care. These patients will frequently be predisposed to developing pneumonia or urinary tract
infections because of incontinence. The routine response today is for that patient to be admitted
,
USC Aiken • USC Bcaufi« • VSC Coastal Giroliiw • USC Columhia • USC Lancaster • USC Sallcehaichie • USC SpartanburK * USC Sumter • USC Uni.
An Affirmnuvt Atlion / E^u.i! Ovixiivmii} LiWitut
�to a hospital via the emergency room, undergo multiple diagnostic tests and x-rays, receive
intravenous antibiotics, and, should they recover, be sent back to the nursing home to their prehospital total care state. Should they succumb to their illness, their hospital costs will have
averaged $1000-$3000.00 per day. Multiply that by hospitalizations not infrequnetly measured
in months instead of days or weeks, and multiply that by the number of such patients in
hospitals all over this country, and compare those dollars to the ones not arriving for prenatal
care for pregnant teenagers, or childhood immunization and nutrition programs.
I would urge you to consider the establishment of strict guidelines for_adiTUSsionjand..rend_ering_of
gare/This is obviously opening a Pandora's box but I would submit to you thaTalbeit diffTcult ?
ancTpotentiaHy heart-wrenching, these decisions must be made if we are to equitably distribute
our limited resources. The physicians, however, are the most qualified group to make these
decisions, although they should never be made unilaterally. These criteria would need to be
established for the elderly, the infirmed, premature infants, the terminally ill, etc.
A^second critical issue i^^undancy^if service^. I would like to give you a couple of examples.
Wheh-a-patient arrives in the emergeiityrOSm with a broken bone, the chances are he or she
will be treated that night by either an emergency room physician or orthopedic surgeon. Each
of these physicians will be treating the fracture based on the physical findings and x-rays
obtained at that time. Both physicians, but most especially the orthopedic surgeon, are
eminently qualified to interpret the x-ray, and render treatment. However, as the system exists
today, that x-ray will also be read by a radiologist the following day (after the patient has
already been treated the night before) and a charge for the interpretation of that x-ray will be
submitted by the radiologist, even though the likelihood that the reading will have no effect
on the treatment of that patient, since the x-ray had already been interpreted by the treating
physician 12 or 24 hours earlier.
The same holds true for the interpretation of electrocardiograms. The vast majority of
physicians who obtain an urgent ECG will be interpreting it themselves. However, 24-48 hours
later, a cardiologist will also interpret that same study, and charge for it, even though that
interpretation will have little or no impact on that patient's outcome, since treatment will
have been rendered at the time by the treating physician.
Finally, I would like to address some issues specific to my specialty. Since you may not know
exactly what a plastic and reconstructive surgeon does on a daily basis, please allow me to very
briefly describe the areas in which we deal. They include surgery for skin cancer, reconstructive
surgery for congenital anomalies such as cleft lip and palate, craniofacial anomalies (abnormal
skull or facial development present at birth), post-traumatic deformities (facial fractures,
defects from tumors), breast reconstruction following mastecomy, treatment of bums (both acute
and delayed reconstruction), microsurgery (including the re-attachment of severed limbs),
surgery of the hand,management of diabetic foot infections, and chronic and difficult wounds in
general, and aesthetic surgery. Although the latter is what most people consider to be "plastic
surgery", it is in fact a very small portion of most plastic surgeons' practices.
In my particular practice, 90% of my patients are women and children and 95% of the surgery 1
perform is reconstructive in nature. I deal with craniofacial anomalies, cleft lip and palate,
and breast reconstruction. I cannot relate to you how frustrating it is for me to be spending half
my time on the phone or the dictaphone trying to persuade insurance carriers that my patient
needs this particular operation, and that it is not being performed because of vanity or
"cosmetic" reasons. Is a cleft lip "cosmetic" because it reflects on the appearance of that child? I
would submit to you that "cosmetic" surgery on an infant or small child to restore a normal
appearance is in fact "functional" since we are allowing that child a chance for a normal social
development and life experience, one that he or she would be otherwise denied if their
appeamce were not restored to normal. Furthermore, many of these children will require
�V
multiple future procedures to allow for normal facial, dental, and speech development, but the
standard insurance carrier ploy is to deny coverage for these children on the basis of a "preexistent condition'.When parents move or change jobs, they are constantly faced with this
denial process as they try to obtain coverage for their child.
Similary, my female patients who seek consultation for breast reconstruction following
mastectomy will frequently be denied, or, if the service is allowed, it will be reimbursed for the
"reconstructive" portion of the operation, not for the "cosmetic" portion. I would challenge any
woman to tell me which portion of her breast she is willing to give up because it is "cosmetic".
The concept is absurd, but is routinely employed to deny benefits.
As a responsible physician trying to provide optimal care to my patients, I render emergency
care with blinders on as to financial status. Unfortunately, the hospital is not as generous and I
cannot perform elective surgery on a patient simply because they need the surgery. Their
ability to pay the hospital will determine whether or not they will have their operation.
Approximately 35-40% of my patients are indigent and have no form of health insurance, yet,
they are never denied urgent or emergency treatment by me. For the services provided for my
patients covered by Medicaid, I am presently being re-imbursed at approximately $0.30 on the
dollar. Furthermore, I spend approximately 10-20 hours per month volunteering in a free clinic
as well as overseas. This brings me to my third proposal. I would suggest a tax incentive or
credit of some sort for physicians who provide free or voluntary care, since this service is nonincome generating while overhead expenses continue to be incurred.
In summary, I recall hearing you quoted as saying that if there is anything at all you have
learned since taking on the formidable task of heading the health care reform task force, it is
that there are some 250 million experts on health care in this country. By no means do I consider
myself to be one of those but I would invite you to contact me at any time if you wish to discuss
any of these issues further, or if I can be of assistance in any way in your daunting task.
Respectfully,
Ram Kalus, M.D.
�V
�
Dublin Core
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Title
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Health Care Task Force Records
Creator
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White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
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2006-0885-F
Text
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Paper
Dublin Core
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Title
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[Physician Letters] [loose] [7]
Creator
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
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2006-0885-F Segment 3
Is Part Of
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Box 6
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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3/16/2015
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42-t-12092992-20060885F-Seg3-006-003-2015
12092992
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https://clinton.presidentiallibraries.us/files/original/2dc0a63e658449bfcc3dfacdb86e4b45.pdf
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PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
2385
OA/ID Number:
FolderlD:
Folder Title:
[Physician Letters] [loose] [6]
Stack:
Row:
Section:
Shelf:
Position:
s
56
3
4
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECT/TITLE
RESTRICTION
001. letter
Address (Partial) (1 page)
n.d.
P6/b(6)
002. letter
Address (Partial); Personal (Partial) (1 page)
03/20/1993
P6/b(6)
003. letter
Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
004. letter
Address (Partial) (1 page)
n.d.
P6/b(6)
005. envelope
Address (1 page)
02/01/1993
P6/b(6)
006. resume
DOB (Partial); POB (Partial); Address (Partial) (I page)
n.d.
P6/b(6)
007. note
Address (Partial); Phone No. (Partial); SSN (Partial) (1 page)
n.d.
P6/b(6)
008. letter
Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
009. letter
Address (Partial) (2 pages)
02/13/1993
P6/b(6)
010. letter
Address (Partial) (I page)
03/17/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [6]
2006-0885-F
im806
RESTRICTION CODES
Presidential Records Aet - [44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI National Security Classified Information [(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute |(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information |(b)(l) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
coneerning wells [(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 IJ.S.C.
2201(3).
RR. Document will be reviewed upon request.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
or 2-
3 ^
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. letter
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [6]
2006-0885-F
jm806
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Aet - |5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
National Security Classified Information [(a)(1) of the PRA)
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Nina F . Wimpie, HP
H i l a r y Rodham C l i n t o n
The White House
160© P e n n s y l v a n i a Ave.
W a s h i n g t o n , DC 20501
Dear Ms. C l i n t o n ,
F i r s t , I want t o s a l u t e you f o r the a c t i v e r o l e you have t a k e n
i s tremendously heartening
to see
a
i i i the White House . I t
i s a genuine p a r t n e r t o the
creative,
i n t e l l i g e n t woman who
P r e s i d e n t . I t g i v e s g i r l s and women a l l over t h i s c o u n t r y a
w o n d e r f u l r o l e model.
I am w r i t i n g t o address an i s s u e on which you have assumed
l e a d e r s h i p , one t h a t i s dear t o my v e r y c o r e , h e a l t h care r e f o r m .
I u n d e r s t a n d your d e s i r e t o encourage p a r t i c i p a t i o n by the American
p o p u l a c e w h i l e d o w n p l a y i n g the i n p u t of m e d i c a l o r g a n i z a t i o n s and
t h e i r r e p r e s e n t a t i v e s . I want i t t o be c l e a r t h a t I am s p e a k i n g
only f o r myself,
(a s o l o p e d i a t r i c i a n i n p r i v a t e p r a c t i c e ) , and
f r a n k l y would be v e r y s u r p r i s e d i f any of my p o s i t i o n s resembled
t h o s e of the AHA e t c .
As I see i t , t h e r e are s e v e r a l i n t e r l o c k i n g a s p e c t s to any
r e f o r m e f f o r t , and l i k e the P r e s i d e n t s ' budget, I f e e l i t needs t o
a l l happen a t the same t i m e or i n mandated sequence. Please a l l o w
me t o s k e t c h t h i s i n o u t l i n e f o r m a t .
1) MEDICAL EDUCATION AND TRAINING.
There must be
c o n t r o l s on m e d i c a l e d u c a t i o n , b o t h m e d i c a l s c h o o l s
and t r a i n i n g programs. T h i s i n c l u d e s c u r b s on t o t a l
p h y s i c i a n s g r a d u a t i n g , b u t more i m p o r t a n t l y mandates
what r e s i d e n c y s l o t s are a v a i l a b l e f o r p r i m a r y and
s p e c i a l t y c a r e . There must be i n c e n t i v e s f o r p r i m a r y
care e n t r y , i n c l u d i n g debt f o r g i v e n e s s f o r s e r v i c e i n
a r e a s l a c k i n g p h y s i c i a n s . We a l s o need t o encourage
the t r a i n i n g of n o n - p h y s i c i a n p r o v i d e r s , such as
n u r s e - p r a c t i t i o n e r s , m i d w i v e s , and p h y s i c i a n
assistants.
2) PHYSICIAN COMPENSATION. P h y s i c i a n s s h o u l d be f a i r l y
compensated f o r c o g n i t i v e as opposed t o a c t i v e
( p r o c e d u r e - o r i e n t e d ) s e r v i c e s . Only the most d e d i c a t e d
can c o n t i n u e t o p r o v i d e t h e e x c e l l e n t o f f i c e - b a s e d
c a r e Americans deserve w h i l e o b s e r v i n g t h a t surgeons
d o i n g a f i v e - m i n u t e o p e r a t i o n earns 20 t i m e s as much
i n the same time frame.
3) HOSPITAL REGULATION. A n a t i o n a l agency w i t h broad
powers and comprehensive r e p r e s e n t a t i o n must e s t a b l i s h
the number AND KIND of s e r v i c e s needed i n each
g e o g r a p h i c a l r e g i o n , what s e r v i c e s each h o s p i t a l w i l l
o f f e r and which t e c h n o l o g i e s and machines w i l l be
p u r c h a s e d . T h i s body must have the power t o mandate
c l o s u r e s and mergers, i n an a l l - o r - n o n e f a s h i o n t h a t
I see as s i m i l a r t o the m i l i t a r y base c l o s u r e
�Clev
H i l a r y Rodham C l i n t o n
The White House
1600 P e n n s y l v a n i a Ave,
Washington, DC 20501
Dear Ms. C l i n t o n ,
F i r s t , I want t o s a l u t e you f o r the a c t i v e r o l e you have taken
i n the White House. I t i s t r e m e n d o u s l y h e a r t e n i n g t o see
a
c r e a t i v e , i n t e l l i g e n t woman who
i s a genuine p a r t n e r t o the
P r e s i d e n t . I t g i v e s g i r l s and women a l l over t h i s c o u n t r y a
w o n d e r f u l r o l e model.
I am w r i t i n g t o address an Issue on which you have assumed
l e a d e r s h i p , one t h a t i s dear t o my v e r y c o r e , h e a l t h care r e f o r m .
I understand your d e s i r e t o encourage p a r t i c i p a t i o n by the American
populace w h i l e downplaying the i n p u t o f m e d i c a l o r g a n i z a t i o n s and
t h e i r r e p r e s e n t a t i v e s . I want i t t o be c l e a r t h a t I am speaking
o n l y f o r m y s e l f , (a s o l o p e d i a t r i c i a n i n p r i v a t e p r a c t i c e ) , and
f r a n k l y would be v e r y s u r p r i s e d i f any o f my p o s i t i o n s resembled
those of the AMA e t c .
As I see i t , t h e r e are s e v e r a l i n t e r l o c k i n g a s p e c t s t o any
r e f o r m e f f o r t , and l i k e the P r e s i d e n t s ' budget, I f e e l i t needs t o
a l l happen a t the same time or i n mandated sequence. Please a l l o w
me t o sketch t h i s i n o u t l i n e f o r m a t .
1) MEDICAL EDUCATION AND TRAINING.
There must be
c o n t r o l s on m e d i c a l e d u c a t i o n , both m e d i c a l schools
and t r a i n i n g programs. T h i s i n c l u d e s c u r b s on t o t a l
p h y s i c i a n s g r a d u a t i n g , b u t more i m p o r t a n t l y mandates
what r e s i d e n c y s l o t s are a v a i l a b l e f o r p r i m a r y and
s p e c i a l t y care. There must be i n c e n t i v e s f o r p r i m a r y
care e n t r y , i n c l u d i n g d e b t f o r g i v e n e s s f o r s e r v i c e i n
areas l a c k i n g p h y s i c i a n s . We a l s o need t o encourage
the t r a i n i n g of n o n - p h y s i c i a n p r o v i d e r s , such as
n u r s e - p r a c t i t i o n e r s , midwives, and p h y s i c i a n
assistants.
2) PHYSICIAN COMPENSATION. P h y s i c i a n s should be f a i r l y
compensated f o r c o g n i t i v e as opposed t o a c t i v e
( p r o c e d u r e - o r i e n t e d ) s e r v i c e s . Only the most d e d i c a t e d
can c o n t i n u e t o p r o v i d e the e x c e l l e n t o f f i c e - b a s e d ^
care Americans deserve w h i l e o b s e r v i n g t h a t surgeons
d o i n g a f i v e - m i n u t e o p e r a t i o n earns 20 times as much
i n the same time frame.
3) HOSPITAL REGULATION. A n a t i o n a l agency w i t h broad
powers and comprehensive r e p r e s e n t a t i o n must e s t a b l i s h
the number AND KIND o f s e r v i c e s needed i n each
g e o g r a p h i c a l r e g i o n , what s e r v i c e s each h o s p i t a l w i l l
o f f e r and which t e c h n o l o g i e s and machines w i l l be
purchased. T h i s body must have the power t o mandate
c l o s u r e s and mergers, i n an a l l - o r - n o n e f a s h i o n t h a t
I see as s i m i l a r t o the m i l i t a r y base c l o s u r e
�i
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBJECT/TITLE
DATE
Address (Partial); Personal (Partial) (1 page)
03/20/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [6]
2006-0885-F
jm806
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIAj
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe I'RA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 IJ.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Margo Young C . PP . S . . M . D .
.
'
\ d,\ '' P6'(b)(6.) ''
•
.
March 20,
Dear Mrs.
1393
C11nton,
I am w r i t i n g t o s h a r e my t h o u g h t s about h e a l t h c a r e and i t s
r e f o r m i n t h e U n i t e d S t a t e s . W i t h g r e a t i n t e r e s t , I have
f o l l o w e d e v e n t s so f a r . I can no l o n g e r c o n t a i n m y s e l f and
need t o speak my two c e n t s . We are i n need of s u b s t a n t i a l
change, and I am b e h i n d t h o s e e f f o r t s a l l t h e way.
I am an i n t e r n i s t who went back t c m e d i c a l s c h o o l a t age 38
and am s c h e d u l e d t o f i n i s h rny r e s i d e n c y i n a few months. .
1
a l s o happen t o be a C a t h o l i c nun., and have been f o r over 25
years.
T h i s i s a l l to say t h a t I have been i n p u b l i c s e r v i c e
f o r many y e a r s , and d i d not go i n t o m e d i c i n e f o r t h e p r e s t i g e
or the money.
I am committed t o the w o r k i n g poor and t h o s e
w i t h i n a d e q u a t e access t o h e a l t h c a r e . My views are n o t
s h a r e d by many of my c o l l e a g u e s , b u t i t i s amazing how many
s i n c e r e p u b l i c s e r v a n t s t h e r e are among us.
The f o l l o w i n g i s my most c o n c i s e e f f o r t t o o r g a n i z e my s t r e a m
of c o n s c i o u s n e s s t h o u g h t p r o c e s s e s .
My comments are b o r n out
of e x p e r i e n c e w i t h t h e h e a l t h care system as a consumer and a
p r o v i d e r ; and out. of f r u s t r a t i o n w i t h t h e government, t h e
i n s u r a n c e companies, t h e l e g a l system, m e d i c a l s u p p l i e r s ,
d o c t o r s , h o s p i t a l s , and even p a t i e n t s .
I believe that health
c a r e r e f o r m must i n c l u d e a l l a s p e c t s of h e a l t h c a r e d e l i v e r y ,
and t o do o t h e r w i s e i s t o f a i l i n t h e end.
i g e t d e f e n s i v e w i t h t a l k of f i x i n g r a t e s f o r d o c t o r s and
t a x i n g them more.
P r i m a r y c a r e p h y s i c i a n s a l r e a d y have t a k e n
the b r u n t of r a t e c o n t r o l s .
M e d i c a i d , M e d i c a r e and many
i n s u r a n c e companies a l r e a d y have s u b s t a n t i a l l y reduced
r e i m b u r s e m e n t . To do t h a t f u r t h e r f o r p r i m a r y c a r e p h y s i c i a n s
is unjust.
Our s a l a r i e s a l r e a d y equate t o t h a t of a busy
plumber, and we went t h r o u g h a t l e a s t e i g h t y e a r s of advanced
training.
There has been an i n c r e a s e i n t h e l a s t c o u p l e or
months of new p a t i e n t s i n our r e s i d e n t s ' c l i n i c s p e c i f i c a l l y
because t h e i r p r i m a r y c a r e p h y s i c i a n s w i l l no l o n g e r care f o r
thei'n secondary r o t h e i r m e d i c a i d s t a t u s or i n a b i l i t y t o pay.
I do n o t t h i n k i t i s u n d e r s t o o d how much good c a r e t o the
u n d e r s e r v e d i s p r o v i d e d by r e s i d e n t s . That s t a t e m e n t becomes
a p l e a t o n o t j e o p a r d i z e m e d i c a l e d u c a t i o n . I t i s an
i m p o r t a n t p a r t of t h e whole.
Subspecia 1 i s t s are a n o t h e r
storv.
I t h i n k more reimbursement l i m i t s need t o be p l a c e d
�March 20, 1993
Dear Mrs. C l i n t o n ,
I am w r i t i n g t o share my t h o u g h t s about h e a l t h care and i t s
r e f o r m i n t h e U n i t e d S t a t e s . W i t h g r e a t i n t e r e s t , I have
f o l l o w e d events so f a r . I can no l o n g e r c o n t a i n myself and
need t o speak my two c e n t s . We a r e i n need of s u b s t a n t i a l
change, and I am b e h i n d those e f f o r t s a l l t h e way.
I am an i n t e r n i s t who went back t o medical school a t age 38
and am scheduled t o f i n i s h my r e s i d e n c y i n a few months. I
a l s o happen t o be a C a t h o l i c nun, and have been f o r over 25
y e a r s . This i s a l l t o say t h a t I have been i n p u b l i c s e r v i c e
f o r many y e a r s , and d i d n o t go i n t o medicine f o r t h e p r e s t i g e
or t h e money. I am committed t o t h e w o r k i n g poor and those
w i t h inadequate access t o h e a l t h c a r e . My views a r e n o t
shared by many of my c o l l e a g u e s , b u t i t i s amazing how many
s i n c e r e p u b l i c s e r v a n t s t h e r e a r e among us.
The f o l l o w i n g i s my most c o n c i s e e f f o r t t o o r g a n i z e my stream
of consciousness t h o u g h t processes. My comments a r e born out
of e x p e r i e n c e w i t h t h e h e a l t h care system as a consumer and a
p r o v i d e r ; and out of f r u s t r a t i o n w i t h t h e government, t h e
i n s u r a n c e companies, t h e l e g a l system, medical s u p p l i e r s ,
d o c t o r s , h o s p i t a l s , and even p a t i e n t s .
I believe that health
care r e f o r m must i n c l u d e a l l aspects of h e a l t h care d e l i v e r y ,
and t o do o t h e r w i s e i s t o f a i l i n t h e end.
I get d e f e n s i v e w i t h t a l k of f i x i n g r a t e s f o r d o c t o r s and
t a x i n g them more. Primary care p h y s i c i a n s a l r e a d y have t a k e n
t h e b r u n t of r a t e c o n t r o l s . M e d i c a i d , Medicare and many
i n s u r a n c e companies a l r e a d y have s u b s t a n t i a l l y reduced
reimbursement. To do t h a t f u r t h e r f o r p r i m a r y care p h y s i c i a n s
i s u n j u s t . Our s a l a r i e s a l r e a d y equate t o t h a t of a busy
plumber, and we went t h r o u g h a t l e a s t e i g h t years of advanced
training.
There has been an i n c r e a s e i n t h e l a s t couple of
months of new p a t i e n t s i n our r e s i d e n t s ' c l i n i c s p e c i f i c a l l y
because t h e i r p r i m a r y care p h y s i c i a n s w i l l no l o n g e r care f o r
them secondary t o t h e i r m e d i c a i d s t a t u s or i n a b i l i t y t o pay.
I do n o t t h i n k i t i s u n d e r s t o o d how much good care t o t h e
underserved i s p r o v i d e d by r e s i d e n t s . That statement becomes
a p l e a t o n o t j e o p a r d i z e medical e d u c a t i o n . I t i s an
i m p o r t a n t p a r t of t h e whole.
S u b s p e c i a l i s t s a r e another
story.
I t h i n k more reimbursement l i m i t s need t o be p l a c e d
on them. I r e c e n t l y needed a b r e a s t b i o p s y w i t h a stand-by
nurse a n e s t h e t i s t f o r about t h i r t y m i n u t e s , and was charged
by t h e a n e s t h e s i o l o g i s t s over $300 which was over t h e usual
and customary f o r my i n s u r a n c e .
We have become s p e c i a l i z e d
�NOTICE
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financial information 1(a)(4) ofthe PRA]
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and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
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�c o n t i n u e on and on s i n c e we a r e unable t o p i n p o i n t an e x a c t cause,
the s o l u t i o n w i l l
many b e l i e v e
it
be many y e a r s i n t h e making.
That i s why so
you a r e a r e a l symbol and f o c a l p o i n t o f hope t h a t
can be done!
I n hope and f a i t h
I am
Truly
yours,
K i m b e r l y T u s t i n , D.D.S.
Kimberly
Tustin,D.D.S.
0°^ i
�c o n t i n u e on and on s i n c e we a r e unable t o p i n p o i n t an exact cause,
the s o l u t i o n w i l l be many years i n t h e making. That i s why so
many b e l i e v e you a r e a r e a l symbol and f o c a l p o i n t o f hope t h a t
i t can be done!
I n hope and f a i t h I am
T r u l y yours,
v
Kimberly T u s t i n , D.D.S.
Kimberly Tustin,D.D.S.
�- . i V'_
-'- 'I'
NOTICE
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FROM THIS DOCUMENT
go* 2 3^
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FOLDER TITLE:
[Physician Letters] [loose] [6]
2006-0885-F
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b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
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b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
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concerning wells 1(b)(9) of the FOIA]
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�find myself requesting unnecessary tests and office visits purely to avoid the
pain of possible litigation.
I paint a grim picture. I work harder than I ever imagined, which would be
fine if the rewards of respect remained obtainable, and all people could
benefit from that work. Good medical care is truely a possession of the
cultural elite, and many large forces are working to maintain the status quo.
I hope you can change this. You and your husband have given me a glimmer
of hope. I very much appreciate the time you have spent reading this and
any time you spend thinking about it. I have many specific ideas for
methods of change. If you find yourself in need of yet more input for your
task, please contact me. I would love to help.
Respectfully,
Terry L. Woodard, M.D.
�find myself requesting unnecessary tests and office visits purely to avoid the
pain of possible litigation.
I paint a grim picture. I work harder than I ever imagined, which would be
fine if the rewards of respect remained obtainable, and all people could
benefit from that work. Good medical care is truely a possession of the
cultural elite, and many large forces are working to maintain the status quo.
I hope you can change this. You and your husband have given me a glimmer
of hope. I very much appreciate the time you have spent reading this and
any time you spend thinking about it. I have many specific ideas for
methods of change. If you find yourself in need of yet more input for your
task, please contact me. I would love to help.
Respectfully,
^^^^^
Terry L Woodard, M.D.
�N077CE
"\ •
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DOCUMENT NO.
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SU BJECT/TITLE
DATE
02/01/1993
Address (1 page)
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [6]
2006-0885-F
jm806
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Freedom of Information Act - |5 U.S.C. 552(b)]
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P4 Release would disclose trade secrets or confidential commercial or
nnancial information 1(a)(4) of the PRA]
P5 Release would disclose conFidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
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b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�...
>dard I
i
!
/
-il
•
3
^'"
,
l'
i
L (... / t
i i < U ^ L L 'C C 7 c. v
^
v'.f.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
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Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe I'RA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
('. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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RR. Document will be reviewed upon request.
�RONALD S. BANNER, M.D.
FELLOW AMHUCAN COLLEGE Of PHYSICIANS
FELLOW ACADEMY O' PSYCHOSOMAHC MEDICINE
2060 WELSH ROAD
PHILADELPHIA, PA 19115
(215)9690687
INTEftNAl MEDICINE
CURRICULUM VITAE
0
L"
Born:
Home A d d r e s s :
. P6/(b)(6).
••
M a r i t a l S t a t u s : Married 1966 - S h e l i a
C h i l d r e n - David Warren - 1968
D a n i e l H a r r i s - 1969
Sarah Ruth - 1974
Decrees:
B.S.
M.D.
from Muhlenberg C o l l e g e , Allentown, P e n n s y l v a n i a from the U n i v e r s i t y of P e n n s y l v a n i a - 1967
Postgraduate
1963
Education:
I n t e r n and F i r s t Year R e s i d e n t i n I n t e r n a l Medicine a t The
H o s p i t a l , Rochester, New York - J u l y 1967 to June 1969
Genesee
Second Year R e s i d e n t and C h i e f R e s i d e n t i n I n t e r n a l Medicine a t
t h e A l b e r t E i n s t e i n M e d i c a l C e n t e r , N o r t h e r n D i v i s i o n - J u l y 1971
t o June 1973
M i l i t a r y S e r v i c e : C a p t a i n , United S t a t e s Army -1967 to 1973
A c t i v e Duty - 1969 to 1971, i n c l u d i n g one
y e a r i n the R e p u b l i c of V i e t Nam
S t a t e of New York, 1968
Commonwealth of P e n n s y l v a n i a ,
S t a t e of New J e r s e y , 1972
1969
J
§j?A :s__an_d _Fel_l_owships :
Diplomate, American Board of I n t e r n a l Medicine, 197 3
F e l l o w , Academy of Psychosomatic Medicine,
1981
F e l l o w , American C o l l e g e of P h y s i c i a n s , 1987
H P S p i t a 1 Appointmentsj
Attending P h y s i c i a n i n I n t e r n a l Medicine a t
A l b e r t E i n s t e i n Medical Center,
Jeanes H o s p i t a l and
Moss R e h a b i l i t a t i o n H o s p i t a l
Awards:
Lillian
Rosenberg Memorial Award, A l b e r t E i n s t e i n Medical
Center,
for c o n t r i b u t i o n to the E d u c a t i o n a l Program i n I n t e r n a l Medicine,
Legion of Honor, Chapel
Who's Who
of the Four C h a p l a i n s ,
i n H e a l t h and Medical
Services,
1991
1977
1973
�•'••••-i
; RONALDS. BANNER, MD.
FELLOW AMERICAN COUEGE Of PHYSOANS
FEUOW ACADEMY Of PSYCHOSOMATIC ME DONE
aonwosHROM)
IA0E1PMA.PAI91IS
INTERNAL MEDIONE
CURRICULUM VITAfi .^fe^,:- ,
6
Degrees:
B.S. from Muhlenberg College, Allentown, Pennsylvania - 1963
M.D. from the University of Pennsylvania - 1967
Postgraduate
Education;
Intern and F i r s t Year Resident i n Internal Medicine at The Genesee
Hospital, Rochester, New York - July 1967 to June 1969
Second Year Resident and Chief Resident i n Internal Medicine at
the A l b e r t E i n s t e i n Medical Center,Northern D i v i s i o n - July 1971
t o June 1973
M i l i t a r y Service: Captain, United States Army -1967 to 1973
Active Duty - 1969 to 1971, including one
year i n the Republic of Viet Nam
Licensure:
State of New York, 1968
Commonwealth of Pennsylvania, 1969
State of New Jersey, 1972Boards and Fellowships:
Diplomate, American Board of Internal Medicine, 1973
Fellow, Academy of Psychosomatic Medicine, 1981
Fellow, American College of Physicians, 1987
H o s p i t a l Appointments:
Attending Physician i n Internal Medicine at
Albert Einstein Medical Center,
Jeanes Hospital and
Moss Rehabilitation Hospital
Awards:
L i l l i a n Rosenberg Memorial Award, Albert E i n s t e i n Medical Center,
for contribution to the Educational Program i n Internal Medicine,
Legion of Honor, Chapel of the Four Chaplains, 1977
Who's Who
i n Health and Medical Services,
1991
1973
�3-"
' . c.
NOTICE
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FROM THIS DOCUMENT
2&
.22/.
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DATE
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n.d.
RESTRICTION
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COLLECTION:
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Health Care Task Force
Steven Edelstein
OA/Box Number:
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FOLDER TITLE:
[Physician Letters] [loose] [6]
2006-0885-F
jm806
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PI
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P4
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an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
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b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) of the I'RAI
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
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RR. Document will be reviewed upon request.
�CURRICULUM VITAE
Stanley J o e l Reiser
M a i l i n g Address:
Stanley J o e l R e i s e r , M.D., Ph.D.
G r i f f T. Ross Professor of Humanities
and Technology i n H e a l t h Care
The U n i v e r s i t y o f Texas
H e a l t h Science Center a t Houston
P.O. Box 20708
Houston, Texas 7722 5
Telephone: (713) 792-5140
FAX #: (713) 792-5141
Home Address:
£oc7l
• . .P6/(b)(6)
.
Telephone:
P6/(b)(6)
S o c i a l S e c u r i t y Number:
,. P6'(b)(6)..-
�CURRICULUM VITAE
Stanley Joel Reiser
Mailing Address:
Stanley Joel Reiser, M.D., Ph.D.
Griff T. Ross Professor of Humanities
and Technology in Health Care
The University of Texas
Health Science Center at Houston
P.O. Box 20708
Houston, Texas 77225
Telephone: (713) 792-5140
FAX #: (713) 792-5141
Home Address:
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�1. i n i t i a t e U n i v e r s a l H e a l t h Care, funded by s i n and energy
and w h a t e v e r - i t - t a k e s t a x e s ;
2.
p l a c e c o n t r o l s on, and r o l l back, d o c t o r s ' f e e s , drug
p r i c e s , and h o s p i t a l . c o s t s ;
3.
decrease F e d e r a l f u n d i n g f o r o t h e r - t h a n - p r i m a r y
care
r e s i d e n c y t r a i n i n g programs; •
4.
i n c r e a s e fees f o r p r i m a r y medical care and decrease fees
f o r d i a g n o s t i c and s u r g i c a l procedures;
5.
g i v e t a x i n c e n t i v e s or cancel l o a n repayments f o r
p h y s i c i a n s who p r a c t i c e i n r u r a l or g h e t t o communities;
6.
e s t a b l i s h r e s t r i c t i v e g u i d e l i n e s f o r performance o f
expensive d i a g n o s t i c procedures;
7.
l i m i t t h e number o f imaging c e n t e r s per u n i t / p o p u l a t i o n ;
8.
remove i s u r a n c e companies from t h e a d m i n i s t r a t i v e l o o p ;
l e t a s i n g l e Federal agency c o n t r o l h e a l t h care d e l i v e r y c o s t s
and payments;
9.
encourage t o r t r e f o r m , cap m a l p r a c t i c e awards, and t a k e
m a l p r a c t i c e s u i t s out o f t h e p r i v a t e l e g a l arena and i n t o
a r b i t r a t i o n boards composed o f p h y s i c i a n s , j u d i c i a l persons,
and l a y a p p o i n t e e s ; and
10.
create
a
"basic
b e n e f i t s package"
with
serious
c o n s i d e r a t i o n t o t h e r a t i o n i n g of h e a l t h c a r e .
Every i t e m i n t h e above package w i l l have i t s opponents and
proponents.
But t h i s i s n o t a t i m e f o r f a i n t h e a r t and
v a c i l l a t i o n , and s w i f t d e c i s i v e a c t i o n i s needed.
Bandaids
and rubber bands won't do t h e j o b ; r a d i c a l s u r g e r y w i l l .
I f I can be of f u r t h e r h e l p , please l e t me know.
Sincerely,
Paul C u t l e r
M.D.,
F.A.C.P.
Honorary
Clinical
Professor of Medicine
Please r e p l y t o
P:h
residence:
�Withdrawal/Redaction Marker
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DATE
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n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [6]
2006-0885-F
jm806
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Freedom of Information Act - |5 U.S.C. 552(b)|
Pl National Securit}' Classified Information |(a)(l) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�1. i n i t i a t e U n i v e r s a l Health Care, funded by s i n and energy
and w h a t e v e r - i t - t a k e s taxes;
2.
place c o n t r o l s on, and r o l l back, d o c t o r s ' fees, drug
p r i c e s , and h o s p i t a l c o s t s ;
3.
decrease Federal f u n d i n g f o r other-than-primary
care
residency t r a i n i n g programs;
4. increase fees f o r primary medical care and decrease fees
f o r d i a g n o s t i c and s u r g i c a l procedures;
5.
g i v e t a x i n c e n t i v e s or cancel loan repayments f o r
p h y s i c i a n s who p r a c t i c e i n r u r a l or g h e t t o communities;
6.
e s t a b l i s h r e s t r i c t i v e g u i d e l i n e s f o r performance of
expensive d i a g n o s t i c procedures;
7. l i m i t the number of imaging centers per u n i t / p o p u l a t i o n ;
8.
remove isurance companies from the a d m i n i s t r a t i v e loop;
l e t a s i n g l e Federal agency c o n t r o l h e a l t h care d e l i v e r y costs
and payments;
9.
encourage t o r t reform, cap m a l p r a c t i c e awards, and take
m a l p r a c t i c e s u i t s out of the p r i v a t e l e g a l arena and i n t o
a r b i t r a t i o n boards composed of p h y s i c i a n s , j u d i c i a l persons,
and l a y appointees; and
10.
create
a
"basic
b e n e f i t s package" w i t h
serious
c o n s i d e r a t i o n t o the r a t i o n i n g of h e a l t h care.
Every item i n the above package w i l l have i t s opponents and
proponents.
But t h i s i s not a time f o r f a i n t h e a r t and
v a c i l l a t i o n , and s w i f t d e c i s i v e a c t i o n i s needed. Bandaids
and rubber bands won't do the j o b ; r a d i c a l surgery w i l l .
I f I can be of f u r t h e r help, please l e t me know.
Sincerely,
|
Paul C u t l e r
M.D.,
F.A.C.P.
Honorary
Clinical
Professor of Medicine
1
I
P|lease r e p l y t o residence:
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P^h
1
�'!'
».
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
009. letter
DATE
02/13/1993
Address (Partial) (2 pages)
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
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�PRACTICt
UMITEO
I N T£ HN A L MCfJIClNE
AND
TO
DIAGNOSIS
H A R O L D I. F A R B E R ,
M.D.
2/13/93
W3
Mrs. H i l l a r y Rodham C l i n t o n
The White House
Pennsylvania Ave.
Washington, D.C.
Dear Mrs. C l i n t o n :
I am a s e m i - r e t i r e d ' i n t e r n i s t ( I see about 25 p a t i e n t s a month,
e i t h e r i n t h e i r homes or i n 'nursing homes) who s t a r t e d my p r a c t i c e i n
Reading, Pa. i n the s p r i n g of 1947. I have becomed i n c r e a s i n g l y d i s turbed about the r a p i d l y r i s i n g cost of medical care i n the U.S. and
have w r i t t e n s e v e r a l a r t i c l e s concerning t h i s s u b j e c t f o r the Medical
Record, the monthly p u b l i c a t i o n of the Berks County Medical Society,
of which I have been e d i t o r f o r the past s i x years. I have enclosed
s e v e r s l a r t i c l e s which I b e l i e v e should be o f i n t e r e s t to you i n your
d i f f i c u l t task of t r y i n g t o determine the changes the C l i n t o n Administ r a t i o n should make i n order t o p r o v i d e access t o medical care f o r every
U.S. c i t i z e n , medical insurance f o r everyone, and decrease i n the cost
of q u a l i t y medical care.
I'm sure you have been and w i l l c o n t i n u e to be besieged by a l l the
vested i n t e r e s t i n d i v i d u a l s and groups i n the h e a l t h f i e l d b u t I f e e l
t h a t I probably have one of the best vantage p o i n t s from which a s t r i c t l y o b j e c t i v e o b s e r v a t i o n can be made__sinfre—I have l i v e d through the
changes whrcirTiSW"Tnc-crii^c^-^OiTrThe time when the c h i e f concern of the
primary care p h y s i c i a n was the h e a l t h and w e l l - b e i n g of the p a t i e n t
to the present time when the. c h i e f concern of the average p h y s i c i a n i s
how LO maximize the number of p a t i e n t s t h a t can be seen d a i l y and how
to market h i s or her s k i l l s so as to make as much money as p o s s i b l e ,
w i t h the s t a t e of h e a l t h of the p a t i e n t assuming a secondary consideration .
*
These a r t i c l e s w i l l e x p l a i n whv I._have come to the conclusion that
a N a t i o n a l Health Program i s the 'only answer t o our h e a l t h care fiasco_. _
H u ma i T j i a j T u r ^ c l i T t a t e s ~ t TjajQi o" one" wT Kr^T d^n"g^^T'~FinahcTal
i n the
h e a i t h care f i e l d w i l l v o l u n t a r i l y reduce h i s or her income, f o r the common good of the general p o p u l a t i o n . This o b s e r v a t i o n a p p l i e s e q u a l l y
to che d o c t o r s , hospita 1s,' insurance companies, and pharmaceutical
companies. To b r i n g about the changes mentioned i n the f i r s t paragraph,
a s i n g l e insurance c a r r i e r (the f e d e r a l government) i s e s s e n t i a l along
w i t h imposjin^ a cap on p h y s i c i a n and h o s p i t a l charges and r e d u c t i o n i n
the cost ui.J.fu'oduced by the pha rmace.u t i c a l i n d u s t r y . I n my o p i n i o n ,
the Canadian h e a l t h care system seerns to be the best, r o l e - model we
migliC f o l l o w . I wondered i f you or someone you might designate would
t r a v e l to Canada to observe f i r s t hand how the system works there and
'co fin-.ii determine the f ea s i b .H i i:> ef a system pa c t e rne J a f t e r i t might
.
be. . i n s t i t u t e d j n the U.S.
:
_
�PRACTICE
LIMITED
tNTtRNAL
MKDlCINC
AND
TO
DIAGNOSIS
H A R O L D I. F A R B E R ,
. P6/(b)(6)
Mrs.
Hillary
Rodliam C l i n t o n
-
M.D.
r.:irall I.. hu'Ler UU
2
I had w r i t t e n a l e t t e r to the President t e l l i n g him why I t h i n k
managed care i s not the way to go to f i x our h e a l t h care problem.
Perhaps, you might be able to r e t r i e v e t h a t l e t t e r f o r your f i l e s on
the s u b j e c t .
1 have never w r i t t e n to any previous President of the United States.
I d i d w r i t e one other l e t t e r to your husband before he assumed the p r e s i dency; t h i s one concerned my d e s i r e f o r him to l i f t the ban on gays i n
the m i l i t a r y as soon as p o s s i b l e a f t e r h i s i n a u g u r a t i o g . I d i d receive
a card acknowledging receipe of t h a t l e t t e r . What ,
,
me to suddenly
s t a r t w r i t i n g at t h i s p o i n t was t h a t the two of you have captured my
i m a g i n a t i o n . You are both so y o u t h f u l , i n t e n s e , a t t r a c t i v e , i n t e l l i g e n t ,
c a r i n g , s i n c e r e , p r o g r e s s i v e , and v i g o r o u s . During the campaign, r e p o r t e r s would c o n s t a n t l y s t a t e t h a t one cannot r e a l l y get to appreciate
your warmth and enthusiasm unless one can meet you i n person.
I can't be c e r t a i n t h a t the c o n t e n t s of t h i s envelope w i l l come
to your personal a t t e n t i o n . I f i t should and i f you would t h i n k t h a t
some b e n e f i t would be derived from a personal d i s c u s s i o n of some of the
p o i n t s I have r a i s e d , I would feel'honored to come to Washington to meet
w i t h you at your convenience.
I n c i d e n t a l l y , I f o r g o t to say t h a t the review of the book by Paul
S t a r r , Ph.D., "The S o c i a l Transformation of American Medicine," w i l l
give you what I b e l i e v e i s the best review of the h i s t o r y of medicine
i n the United States. I would recommend t h a t you o b t a i n the book f o r
your l i b r a r y . I f you have,already done so, I would also recommend t h a t
you discuss the s u b j e c t of h e a l t h care w i t h him p e r s o n a l l y .
In c l o s i n g , I would l i k e to wish President B i l l C l i n t o n and you,
H i l l a r y Rodham C l i n t o n , the very best of l u c k f o r the next e i g h t years,
T am l o o k i n g forward to the remarkable changes you both w i l l make i n
.
p r o v i d i n g the c i t i z e n s of our country w i t h a b e t t e r q u a l i t y of l i f e
and in»».\storing to me my p r i d e i n being an American.
S i n c e r e l y yours,
- ./
Harold I . Farber,
M.D.
�Low-cost dqcto^ guy . practice withiniii miles of the wayHeights
treated 10 sick Chicago
: Getting sued for being a really nice
:
, ' '
\
''; . '••
must be a legal rarity. But thait> whaiappears' !.clinic."•• '
.So hie opened, his own'office , in Frankfort:
to have happened to Dr.-William Klipfel, 36, a :
.He.says he thought it was more than 10 miles
pediatrician. : •, ' • . .'.
. away because, he had seen a highway sign that
, Klipfel used, to .work at a clinic in Frank.indicatedIt was. ,,
-' :'
fort, 111., in the far south'.. ' ...•••...<_•..-:•..
: However, his new office was about 8 miles
suburbs of Chicago. ..His ;
from the Chicago Heights clinic.',And his forclinic'was a small satdiite „..
mer associates were upset because hundreds,
oif .the .big Suburban,.,
of his:loykl and ;devoted)patients followed him.
Heights Medical .Center , jn . •
• But for some,findinghim wasn't easy.f
Chicago Heights,• which is
•run by a board of directors,,';.
. •, "When they phoned the clinic; if was as
madeupofdoctorsi' ' " .
if I had dropped off the face ofthe Earth.'J had
left forwarding phone, numbers, but the clinic
•, ..•Last November^Klipfel:-'.'.
employees were told by the board not to say
was fired, but'not because '
.'where,!. was.'So it wasdmpliedihat I'd-abanhe was incbinpetent,;ilazy,; \
dohed my. patierits, which is terrible."
disliked by his patients or
', But,many, of the patients had his .horne
dropped kids/oh the floor,.
phone'riumbef,or- found it through directory .To the' contrary, his Mike
assistance, and were able to reach hirtr when. ,
. jatients thought highly of ; Rpyko
the.clihic >Vasn'f:helpfuh •-- .,
'
lim:. • "..-'.;•
•',.,
;". .
.•
A- reporter called the clinic.and. asked for,
., _ He got the. boot jb^cause. he^wasn.' t charging
fenoiigh and•vj'd'i'dn't^ordeK^t'ests' He: thbught'' himV A woman said, '''.We.'dori't hiave a- fpf-warding : address or -riurriber..Try directory. •
•
unnecessary. j \ •
, •". . . '
' assistance.''-We don't 'have •.anythihg,'' Fof-... '"Where I work,'' -heiayi "ahqt of. faini-,^tunateiy,.the reporter wasn't.someone with a
lies are .'in trouble:' With the ecbnomy^ many 'of ' • sick kid. '
.•" . "'• •' ; ; ' " ' • - ' • v ' ' - '•":':;
my fahiilies'didn't have the; money'to cover'
You would think that-with all the.hundreds
the expensive tests and immunizations.
of thousands of pepple in thafpaft of the Chi"So "! ordered fewer tests than the other cago suburbs, there would be enough patients
doctors, and'if a patierit;came in for a recheck, to go around.
, ., ,
•'.-..,/'..
ifor example , rwouldrft charge them .'any thing'. ' But'the Suburban Heights. Medical Center,
.- "Look; some of. these people had .a large wfiich'filed the lawsuit, doesn't appear to think,-...
. so. "Now they're .claiming.''rm'.doinglirrep'ar-'
able; harm to their, cofporation, but -I never
' made up .. even L percent Of their rieveriue; '
which he said, aipouhted to about'$30 miljioh a
year.. '••.•;' : /'''.•'". '-^ i\ • \ ..^v.-'" .-.. : "
that he wash'
"they ciaim I'm violating my restrictive
their Tate^'i
iip.' They just wanted us to jack up the;fees.~ . covenant. But there are about'20 other similar
The- average office 'fee went ftorii; $334tp\ $45:! doctors between my practice and the-center.
That's a lot of money diiring a recession, When Also",. I-was fifed,, so the covenant isn't valid.
; You;'can^t-fire; Someone 'illegaiiy,; then deny
people are losing th%;m^(^{c^verage:y
them the right to make a living. And I .also
.The main clinic has"its own lab ahd X^ra^.i khowrof several .doctors' who left the clinic vol-. facilities:• .",'•.; •t' '','"
';'.'
., untarily and practice iri the area. The^corporaO
J • -'.'Because I ordered fewer^tests, I. brought tion is'iiiad b^c^use_my patients came to me.
O
1ih' ':less'-Wn#^'.th'e.:)iiore tests j''-the'more- But'I didn't .advertise. .1 did not solicit at ail.
money you make: They said whatT was-doing, j. But I'm their doctor. - "
' ; - . ' .'... „ , '
o
was' wrong. But how much ishoul.d charge was; .' .'^The'.corporat.iphclaims -it 'owns:these
LU
CO
not in my contract. I came lip' With what'i patients; that I should be barred from seeing
thought "was reasonable for the •patients,':and : 'therh.'They're trying'to take away my ability
CL
they threw me out oh my ear.":
to .make a living, and they want ah injunction
But fifing him wasn't enough fof-hisformer . slapped on the whole community from seeing
me."
- _
'
employers;
...
When, he left, he received, two months' .
severance pay. His contract included a horiMike Royko is a syndicated columnist for the
competition 'agreement that saidrhe;wouldn't • Chicago,Tribune. His column appears Saturdays:
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�Hawtey Outer
Publisher 1940-1976
1993 Reading Eagle Company, All Rights Reserved •
PHOTOCOPY
PRESERVATION
�NEW JEPf^Y
PHOTOCOPY
PRESERVATION
�Commentary i^^—m—K—m^^mmm—mmm
The Best Health Care System
in the World?
"AMERICANS eryoy the best health care system in the
world." So says President Bush, and many physicians agree
with this claim. But frequent repetition doesn't make it true.
What kind of evidence would an objective observer examine
to evaluate different systems of health care? Is it possible to
detennine the best system unambiguously, or does the choice
depend on the criteria used? The "best" health care system
may be|like the "best" spouse—it all depends on what one is
lookingfor. Physicians, for instance, may assign values to system characteristics that differ markedly from those assigned
by the public. Even within the profession, each specialty may
have a different point of view and reach different conclusions
about the system, eg, radiologists vs family physicians.
Naoki Ikegami, a Japanese psychiatrist, has suggested three
criteria for assessing "best medical practice": (1) maintenance
of technical standards in diagnosis and treatment; (2) preventive measures and reassurance of essentially healthy patients; and (3) rehabilitation and nursing care provided for the
chronically sick and disabled. In his view, Japan has chosen
to emphasize the second definition.
Three different criteria have been used by American pediatrician Barbara Starfield, MD, to evaluate 10 Western
nations: (1) access to primary care; (2) health indicators (eg,
infant mortality); and (3) public satisfaction with health care
relative to per capita cost. Shefindsthe United States lagging in all three areas.
The economic point of view suggests assessing three dimensions of the "output" of health care: technologic, public
health, and service, and then considering each of these from
the perspectives of efficiency and distributional equity.
1
2
Technology
One way to evaluate health care systems is to ask which
country is in the forefront of pushing out the technologic
frontier. In which country do we find the most advanced
medical technologies in the greatest abundance? Where do
the world's most ambitious young physicians go for advanced
training? And where do the superrich from Third World
countries go when they want high-tech medical care? The
answer to all these questions is usually the United States. In
this sense, we can accurately say that the United States has
the best health care system in the world. This country is the
source of many of the most notable technologic advances in
medicine, and even those developed abroad are usually more
rapidly diffused in the United States. New drugs are an
exception; the Food and Drug Administration's lengthy review may result in prior introduction abroad, even if drugs
were developed by US companies.
From Stanlord University and the National Bureau of Economic Research, Stanlord, Calif.
i Reprint requests to the National Bureau ol Economic Research. 204 Junipero Serra
Blvd. Stanford. CA 94305-871S (Mr Fuchs).
1916 JAMA. August 19,1992—Vol 268. No. 7
Public Health
Another way of judging the merits ofa health care system
is by the health of the population. This could be based on
simple measures, such as life expectancy, or on more complex
ones that take into account quality of life as indicated by the
absence of morbidity or disability. From this perspective, the
United States ranks below average among economically developed countries according to most measures. For example,
life expectancy at birth is 4.5 years less in the United States
than in Japan (1988).* One exception is life expectancy at the
age of 80 years, where the United States is second among all
industrialized nations.
Physicians may argue that poor health levels in the United
States are the result of social, cultural, and genetic factors.
There is much truth in this argument, but it can be used
against the medical profession. If improvement in health is an
important goal, and if physicians concede that they are not
effective in modifying diet, exercise, drinking, smoking, and
other important determinants of health, public policy may
choose to shift resources away from medical care.
Service
Health care has always meant more than improving health
outcomes. Particularly important are the caring function (sympathy and reassurance) and the validation function (provision
of professional certification of health status). Until this century, the service, caring, and validation offered by health
professionals were undoubtedly more valuable than their
therapeutic interventions. Even today most disease is either
self-limiting or incurable, but people who are sick or in pain
want access to physicians, nurses, and other health professionals. Thus, an important criterion for evaluating a health
care system is the availability of services. Is it easy to get to
see a physician? Or to reach one by telephone? How long does
a bedridden hospital patient lie in urine before someone responds to a call? Do health aides regularly visit the homebound elderly? Are dying patients treated with compassion?
Very few data are available concerning this perspective, but
countries probably differ considerably in the quantity of services provided. Germany, for instance, provides more than
twice as many physician contacts and hospital days per capita
as the United States, but there are many dimensions of service that are unmeasured. If a country were only average in
life expectancy and technology, but excelled in providing
service, some people would say its health care system is the
best.
Efficiency
At any given time, resources used for health care are not
available for education, housing, automobiles, and the thousands of other goods and services that people want. A nation's
health care system, therefore, will be judged, in part, by.h'ow
Commentary
�~ ziently jt uses the resources devoted to it. This perspec§•.{•'applies.to technology, to efforts to improve the public's
llheilth, and to the provision of services. A country can rank
f Vi^rh with respect to one or more of these criteria, but if it can
d " so only by making extraordinary claims on the country's
.
r^ources, it would rank low from an efficiency perspective.
>£:-jch of the criticism of the US health care system arises
t ^- -ause Americans spend 40% more than Canadians for health
c^re, and the excess over European countries is even greater.
E-n gland's parsimonious use of resources is particularly note—r rthy. Although high-tech medicine is severely rationed,
ZLzigland's level of public health is about the same as Ameri-^a's, and it manages to provide a considerable amount of
-^rvice while spending only $1 per capita for every $3 spent
ur. the United States.
Distributional Equity
There is another perspective that, like efficiency, can be
applied to the three dimensions of technology, public health,
i-nd service. The distributional perspective focuses on how
egalitarian the health care system is. All else held constant,
many people believe that a more equal system is a better
; ystem. Indeed, they might even be willing to sacrifice a little
rrom one of the other perspectives in order to achieve more
equality. Consider, for instance, a country that has an average life expectancy of 76 years, but that also has great ine-
quality. Some of its citizens die in childhood or as young
adults, while others live past 90 years of age. Given any
reasonable assumption aboutriskaversion, most people would
prefer to be bom in a country in which everyone lives to age
75. Similar arguments can be made about the distribution of
technology or of service. The fact that most countries provide
universal health insurance while one in seven Americans is
uninsured denies the United States a favorable ranking from
this perspective.
Conclusion
Let us return to the original question. Does the United
States have the best health care system in the world? It does
technologically, but not from any of the other four perspectives. In particular, we need to improve efficiency (control the
high cost of care) and distributional equity (provide universal
insurance). The public health and service dimensions also
need closer scrutiny. If and when we progress in those areas,
claims of superiority for American health care will be more
convincing.
Victor R. Fuchs
1. Ikegami N. Best medical practice: the case of Japan. Int J Health Plann Managt.
1989;4:181-196.
2. Starfield B. Primary care and health: a cross-national comparison. JAMA 1991;
266:2268-2271.
3. Schieber GJ, Poullier J-P, Greenwald LM. Health care systema in twenty-four
countries. Health Affairt. 1991;10:22-38.
Editorial
Is the Quality Cart Before the Horse?
Imagine, for a moment, a private corporation that affects the
lives of 32.4 million US citizens and one with yearly expenditures in excess of $113 billion. Yet, the corporation spends
less than 0.3% of thisfigureon a program to ensure the quality of the "product" it delivers. Now, senior officers in this
fictitious corporation are proposing sweeping changes that
will radically alter the methods for improving the quality
of its products; but their proposal lacks a detailed business
plan, budget, and convincing evidence of success in a test
phase.
1
See also p 900.
While some observers may object to my private-sector
analogy, I believe the article by Jencks and Wilensky (in this
issue of THE JOURNAL ) describes just such a scenario for the
Medicare program. Because this article proposes a plan based
on a fundamental shift in thinking, I will first attempt to
summarize its main points, describe the sobering realities
from my perspective in an academic medical center, and offer
an alternative plan for the future.
2
From TTiomas Jefferson University, Philadelphia, Pa.
The opinions presented here are solely those of the author and do not represent
official policy of the American Medical Review Research Center in Washington, DC,
where Or Nash is the current chairperson of the Board of Directors.
Reprint requests to TTiomas Jefferson University. 1015 Walnut St, 621 Curtis, Philadelphia. PA 19107-5099 (Dr Nash).
JAMA. August 19, 1992—Vol 268, No. 7
Jencks and Wilensky have described a grand strategy to
hitch the peer review process within the peer review organizations (PROs) nationwide, under the so-called draft Fourth
Scope of Work (SOW), to the tenets of continuous quality
improvement (CQI). This hitch would be loaded up using
several new evaluative tools including the Uniform Clinical
Data Set (UCDS), pattern analysis, improved feedback to
clinicians, and the Patient Care Algorithm System (PCAS),
all under the heading ofa new Health Care Quality Improvement Initiative (HCQII).
While those of us outside of the Washington Beltway
may scoff at the aforementioned alphabet soup of organizations and methods, let me briefly describe each in tum.
To fulfill its responsibility under the Peer Review Improvement Act (Title I , Subtitle C, of the Tax Equity and
Fiscal Responsibility Act of 1982, Public Law 97-248), the
Health Care Financing. Administration (HCFA) contracts
with PROs in each state to monitor the quality of care for
Medicare patients.
The draft Fourth SOW describes the early stages of an
ambitious nationwide plan to eventually capture 1600 elements from a 10% sample of inpatient discharges and then to
link these elements with the PCAS to select cases for physician review. Only six PROs currently actively participate in
the pilot test of UCDS. Finally, the concepts of CQI stress the
evaluation of the processes of care using statistical tools to
continuously strive for the elimination of variation. The applicability of these tools to health care has been well described.
8
8
4
Editorial 917
�An editorial with the above title,
written by George D. Lundberg,
M.D., editor of the JAMA, appeared
in the January'5, 1990 issue of the
JAMA.
Doctor Lundberg reminds us that,
in 1985, he had written an editorial
entitled "Medicine — A Profession in
Trouble?" However, in 1990, he is of
the opinion that the question mark in
that title has come off. He feels that
we physicians continue to get more
deeply mired in questions of value for
money. Outcome indicators do not
demonstrate value consonant with the
ever increasing percent of our gross
national product that is consumed for
medical and health care and
government intrudes more every day,
micromanaging routine activities in
the physician's life.
The editor points out that, from
antiquity, medicine has been and
continues to be both a business and a
profession. Physicians are, by
definition, both entrepreneurs and
professionals. In an oral
communication on 4/24/89, Christine
K. Cassel, M.D. listed 10 features that
distinguish a learned profession from
others: self-governance individually
and as a group; service to the poor
without expectation of compensation;
deliverance of iquality; not ripping
people off; high level of learning;
autonomy of activity; altruism with a
certain threadbare nobility;
self-sacrifice; heroism as needed;
ethical practice with public
accountability.
There are powerful economic
incentives operating to make the
Call a Specialist
in Real Estate
practice of medicine more a business
than it ever has been and there are
ever-increasing powerful govemment
disincentives interfering as well.
A millennium is defined as a period
of 1000 years. At the end of the 20th
century, we will not only be entering
the 21st century, but we will also be
entering the next millennium. The
1990s represent an extremely
important, even crucial, decade in the
history of medicine. During this time,
it is our opportunity and responsibility
to take steps necessary to deliver this
old learned profession of ours into the
next millennium intact as a true
profession — not merely as a trade or
a business. Dr. Lundberg believes
there is real doubt as to whether we
will be able to do that.
Dr. Lundberg calls the issue one of
balance and he calls this balance
Medicine's Rocking Horse. There are
two coexisting components — business
and professionalism. At the extreme
end of the business side are the
"money grubbers" and at the extreme
end of professionalism are the
"altruistic missionaries." We are now
at a time in our society's history when
greed has become too dominant an
ethic. From some Wall Street junk
bond traders to certain midwest sports
millionaires to many California real
estate developers, greed is in fashion.
Physicians are not immune to the
pandemic caused by the greed virus.
It is well known that physicians can be
impaired by physical infirmities,
alcohol, and psychoactive drugs; it is
also now being recognized that
physicians can also be impaired by
WERTZ
HOFFMAN
PARKS
REALTORS
greed. The business people and money
grubbers components of Medicine's
Rocking Horse have increased and
have been tipping the Rocking Horse
too far; if this tipping should increase,
the Rocking Horse will fall and it will
take a very long time to be righted.
Dr. Lundberg feels that we must put
a stop to the Rocker's momentum
because it is dangerously close to
tipping over. He would like to move it
in the opposite direction. To
accomplish this there has to be a very
strong appeal to the fundamental good
that rests within almost all who were
originally attracted to medicine as a
service profession. There has to be a
demand that professionalism include
self-governance, self-determination,
and self-policing, and that this
professionalism be performed
successfully in good faith. Since
governmental control countermands
professionalism, order in this process
can only be achieved by organized
medicine if we are to remain a
profession.
There really is no other choice.
Organized medicine up to and into the
next millennium must be obviously in
the public interest and of worldwide
scope. It must ensure access to care of
acceptable quality for all, practice
economic soundness, balance health
fairly against all other societal needs,
emphasize good communications, and,
most of all, require'and demonstrate
good will toward all people.
By doing so, we can preserve our
profession into the next millennium for
future generations of physicians.
HIF
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Tel: 926-7800
59
�The radio, television, and print
media have had an increasing number
of warnings about the fact that health
care costs are spinning out of control,
an increasing number of people have
no health insurance coverage
(especially the elderly), many people
are afraid to move on to better jobs
for fear that the newer jobs will not
include health insurance coverage, an
increasing number of people are
seeking nursing home insurance
coverage in case they might develop a
catastrophic 'illness which could wipe
out lifetime savings, but then discover
that they are already paying so much
for current health insurance that they
cannot afford the nursing home
insurance coverage. The following are
some headlines that attest to these
problems: "Rescuing Health Care: A
Herculean Task For Congress In 90's";
"Cowering Before Medical Costs";
"Medical Technology 'Arms Race'
Adds Billions' To The Nation's Bills";
"Soaring Health Costs Pressure
Elderly."
j
The possibility that Medicare's
hospital trust fund, or Medicare Part
A, is going broke is raised in a report
issued by the | government's Social
Security Advisory Council, a group of
private citizens appointed every four
years to examine Social Security and
recommend changes. The report,
which was drafted by a panel of
technical experts, predicts bankruptcy
only for that specific fund, citing a
"serious imbalance between long range
costs and revenues." Part A, which
pays hospital bills for 34 million aged
and disabled p'ersons is financed by a
fixed-rate payroll tax of 2.9 percent
per worker. A'ccording to the report,
that rate won't generate enough
reserve funds to cover future costs.
By the year ^OO!), for example,
Medicare will need 3.82 percent of
every worker's salary to pay that
year's bills. |
Costs are climbing even more
swiftly for Medicare's Part B, which
pays doctor bills for Social Security
beneficiaries, but its financial situation
differs from part A's. Three quarters
of Part B's expenditures are financed
from the government's general
revenues, and the rest are picked up
by premiums from beneficiaries. The
report indicates that the present
$29.90-a-month Part B premium will
have to increase to $131.50 (in current
dollar terms) by 2005 to finance
projected medical fee increases.
Judith Lave, who chaired the
technical panel, stated, "The council's
report is a potent warning for
Congress that it has got to start
thinking about making real decisions
about Medicare's future." The
Advisory Council added that the next
few years offer a window of
opportunity for policy-makers to
consider how best to meet that
challenge. It offered a range of options
that include both tax increases and
benefit cuts. Among the suggestions:
taxing employer-provided health
insurance to both workers and retirees
as normal cash income.
However, Robert M. Ball, former
Social Security Commissioner who
served on this year's Advisory
Council, agreed with the report's
critics that the eventual solution will
involve more than tinkering with taxes
and benefits. He told the Washington
Post, "Well before 2006, Medicare will
become part of a larger plan for health
care and will have strong cost
controls, not these benefit cuts and
increases in charges to beneficiaries."
The article with the headline,
"Medical Technology 'Arms Race' adds
billions to the nation's bills," was
written for the New York Times and
described the recent acquisition by the
Palo Alto Veterans Administration
Hospital of a positron emission
tomography scanner (PET), one of
only 50 in the nation. This instrument
is said to be able to peer into the
workings of internal organs, providing
doctors with previously unobtainable
information. However, such
information does not come cheaply.
"You're talking about a
five-and-a-half-million-dollar
investment," said Dr. George M.
Segall, deputy chief of nuclear
medicine in the hospital and assistant
professor at Stanford Medical School,
who was referring to the cost of the
scanner and of a cyclotron that makes
the radioisotopes administered to the
patient for the test. "It's by far one of
the most expensive technologies
available now."
Once, an advance like the PET
would have been welcomed into the
nation's arsenal of medical tools. After
all, Americans want, and feel entitled
to, the best medical care, regardless of
cost, and doctors want to provide it.
And with insurance companies or
government programs paying the bills,
neither patient nor physician has had
much reason to weigh the costs and
benefits. But the future of the PET
scanner in medical care is far from
assured. A move is afoot, driven by
strapped Federal health agencies and
insurance companies, to rein in what
some have called a medical technology
arms race. Their hope, a revolutionary
one for American medicine, is to limit
the uses of costly machines and
procedures to instances in which the
benefits have been shown to be
commensurate with the expense.
Fueling this move is a growing
recognition that the uncontrolled use
of high technology medical equipment
and procedures, from coronary bypass
surgery to new scanning machines to
lithotripters that blast kidney stones
with shock waves, helps drive the
relentless increase in medical costs,
which now account for 12 percent of
the gross national product. PET
scanning comes on the heels of other
major advantages in diagnostic
imaging. CAT or CT scanning
appeared in the 1970s and represented
a great advance over convential
x-rays, but at a cost of up to $500 per
scan. Magnetic resonance imaging
(MRI scanning) (Original name —
NMR — nuclear magnetic resonance
was changed to MRI because people
were uncomfortable with the term
"nuclear") appeared in the mid-1980s
and offered advantages over CT scans,
but again at a higher cost, up to
$1,000 a scan. PET scans are higher
still, reaching $2,500.
In addition, there is widespread
agreement that many advanced,
expensive medical procedures are
overused. Coronary bypass surgery,
(Coutinned on Next Page)
135
�for instance is performed 300,000
times a year in the United States and
accounts for about $1 of every $50
spent on health care. A study by the
Rand Corporation a few years ago
found that more than 40% of such
operations did very little, if anything,
for the patients. MRI scans are often
done to rule out a minute chance of
brain injury, and perhaps, most of all,
to protect the doctor from malpractice
suits. The United States relies far
more heavily on technology than other
advanced nations. A 1989 study by the
American Medical Association found
that, on a per capita basis, the United
States had four times as many MRI
machines as Germany and eight times
as many as Canada. American doctors
performed open-heart surgery 2.6
times as often as Canadian doctors and
4.4 times as often as German doctors.
The pressure of the introduction of
new technologies is inexorable. Every
day there is a claim of a new
breakthrough. The National Institutes
of Health spend billions of dollars each
year on medical research, precisely to
develop medical insights and
techniques. A huge medical technology
is also in place, spewing out streams
of innovations and marketing them
heavily, with profit rather than social
utility often its prime motivator. The
case of medical imaging is an example
of of how technology can spread
virtually unchecked by considerations
of cost. One reason PET machines are
undergoing scrutiny is that the last
great innovation in diagnostic imaging,
the magnetic resonance imager,
spread rapidly after it appeared in the
middle 1980s. There are now 2,000
such-MR I machines which cost $1
million to $2 million each in the United
States. Analysts estimate that more
than five million MRI scans were
performed in the nation last year at
prices of $600 to $1,000 each. That
means that magnetic imaging alone is
adding $5 billion to the nation's health
bill . . . "People want this smart test,"
said Dr. John Caronna, professor of
clinical neurology at New York
Hospital/Cornell Medical Center in
Manhattan. "There's no way to shut it
off. The doctors crave it, it's
reassuring and the patients crave it."
However, some critics say the test is
overused and is often used
inappropriately; according to John L.
Cova, director of medical technology
assessment for the Health Insurance
136
Association of America, a trade group
representing 300 insurance companies,
"There was never any effort on the
part of payers or providers or society
in general to develop a rational policy
on how to use MRI scanners." Since
Medicare agreed to reimburse patients
for MRI scans in 1985, the machines
have spread rapidly, leading to sales
of about $500 million a year in the
United States. Hospitals, sometimes
under pressure from their own
doctors, pushed to buy machines to
retain their competitive status as
full-service, modern health care
centers. Some states tried to limit the
spread of machines under programs
that require hospitals to obtain a
certificate of need before buying new
equipment. But private imaging
centers, which were not subject to
those controls, sprang up. Spurring
the formation of these centers was the
possibility of big profits. A 1988 letter
seeking investors for an imaging
center forecast a return to investors in
excess of 25 percent per year. A New
York company solicited investors for
several imaging centers with the
promise of a cash distribution of 400
percent over ten years. The way to
realize these profits is to run many
tests. To provide themselves with a
steady stream of customers, imaging
centers often sold part ownership to
doctors, who could refer patients for
tests. A recent survey for Florida's
Health Care Cost Containment Board
found that 75 percent of the imaging
centers in the state had doctors as
part or full owners. Critics say this
practice gives doctors a financial
incentive to order tests that might not
otherwise be called for. "It's going to
give all medicine a black eye before
it's over," said Dr. Daniel P.
Chisholm, a radiologist in Little Rock,
Ark. "There are too many studies
being performed that are not
necessary." A study by Bruce J.
Hillman of the University of Arizona
published in the New England Journal
of Medicine in December found that
doctors who owned x-ray or
ultrasound machines did 4 to 4.5 times
as many tests as doctors who referred
patients to radiologists and also
charged more for each test than
radiologists did. Starting next
January, however, it will become
illegal for doctors to refer Medicare
patients for blood, urine, at;d other
tests to clinical laboratories in which
they own an interest. Representative
Pete Stark, Democrat of California,
who wrote the law, has vowed to try
to expand it to cover imaging centers
as well.
A New York Times editorial stated,
"Clearly the nation's system of medical
insurance cries out for reform but the
Bush Administration barely listens,
content to bury the issue in an
internal working group with no
compelling mandate and no specific
timetable." The editorial agrees that
there are no easy solutions but it
recommends that a Bush initiative
could focus on certain essentials:
Universal Coverage; all Americans
must be covered by basic insurance at
a price they can afford; Backup
Insurance; no matter how the system
is reformed, some individuals will not
find affordable private insurance, so
the Federal or state governments will
have to guarantee carriers that will
take all comers at an affordable price;
Cost Containment; doctors, hospitals,
clinics and, yes, patients must have
incentives to cut costs; at a minimum
that means forcing individuals to pay
for part of their medical costs, giving
them the incentive to make prudent
decisions; Managed Care; many
experts believe that costs can't be
contained unless sponsors — like large
employers or government agencies —
negotiate with insurers on behalf of
large numbers of individuals over
prices, enrollment, and treatment;
that would rein in excessive testing
and high-tech treatment — a powerful
brake on runaway costs. The editorial
concludes, "Unless the reform process
begins in public and with vigor,
medical insurance will be as
haphazard, chaotic, and cruel at the
end of the Bush Administration as it is
now. The problem needs bold
leadership. This is not the time for the
President to cower."
There is still no consensus on how to
restructure the health care system in
the United States which has been
aptly described as a fiendishly tangled
thicket of traditions, expectations, and
special interests that has long defied
rational controls. Many of the
proposed solutions would require new
tax dollars and all would mean
wrenching change for someone; and
remedies will almost certainly mean
new constraints, limits on choice in an
area where Americans are accustomed
to demanding the best, regardless of
�price. "We are inconsistent," said Gail
Wilensky, who as head of the Health
Care Financing Administration
presides over the increasingly costly
Federal medical programs for the
elderly and for the poor. "We want
everybody to have everything, and we
don't want to wait for it. But we
certainly don't want to increase
taxes." Congress is said to be taking
up health care! with a fervor not seen
since the 1960s, when creation of the
Medicare and Medicaid programs
brought a temporary reprieve. Partial
measures to extend health insurance
to more people could be adopted in the
next year or two, lawmakers predict.
Broader measures that guarantee care
for everyone, or reorganize the way
care is paid for or delivered, seem
more distant, though that could
change as runaway costs shake up
more parts of society.
Dr. Arnold S. Relman, the former
editor of the New England Journal of
Medicine and a leading critic of
American health care states, "We
have a badly organized, improperly
motivated delivery system, and an
inefficient, wasteful payment system."
In his opinion, the type of health care
practiced in the Seattle, Washington
area serves as his model of the future.
Group Health Cooperative, medical .'
care by democracy, is the nation's
largest consumer-governed health care
organization, with 470,000 members.
As other health maintenance
organizations have floundered, or run
into financial trouble, Group Health
turned a $19 million surplus last year.
With its healthy balance sheet and
growing membership, it is attracting
national attention. With patients right
on the board of directors monitoring
them, doctors are committed to the
highest quality of care; there's no
incentive for doing more tests than
indicated, but every incentive to do all
that is indicated. It has taken the
cooperative more than 40 years to
work out its kinks. It keeps costs
down by eliminating unnecessary
surgery and procedures and by
stressing preventive care. Dr. Phillip
M. Nudelman, president and chief
executive officer of Group Health
contends that about 30 percent of all
surgery in the United States is not
needed; on average, the cooperative
performs about 40 percent fewer
cardiac operations than are done in
other health systems. Twice as many
Group Health members receive flu
immunization injections as the national
average. There is an aggressive
screening program to detect colon,
skin, and breast cancer at early
stages. The cooperative's program for
smokers who want to quit succeeds at
a rate twice the national average.
Consulting nurses are available 24
hours a day by telephone to answer
questions. Complaints have to do with
waiting periods for certain doctors and
certain procedures. Group Health has
more than 700 staff physicians.
Members choose their own doctors.
The doctors are paid anywhere from
$60,000 to $220,000 a year and the
turnover rate is about three percent a
year, well below the industry average.
Membership in Group Health is
slightly more expensive than the local
average; a 40-year-old with full
coverage will pay about $100 a month,
but most members pay no deductible;
payment may be less if the member
does not smoke, does not use alcoholic
(Continued on Next Page)
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EMPLOYEE HI NI i ns
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Bertholon-Rowland
INMJKANCr: OI.YKt.OJ'Mfc'NT C K O I / I '
137
�beverages excessively, and does not
gain weight. Dr. Nudelman indicated
that the concept of Group Health may
not be easily transplanted because it
grew out of a Scandinavian tradition of
pooling costs and talent; for this to
work elsewhere, there has to be a
culture willing to accept something
that goes against the grain of most
American health care.
In the recent past, because of the
increasing dissatisfaction with health
care delivery in the United States,
many articles have appeared
suggesting that a program similar to
the Canadian health-care system be
adopted by our country. Dr. Bernard
Leo Remakus is an internist in private
practice and the author of "The
Malpractice Epidemic." The following
information was exerpted from an
article he wrote for Internal Medicine
World Report. Approximately 40
million Americans have no health-care
insurance. As such, the United States
joins South Africa as the only other
developed nation without universal
access to health care. Every Canadian
citizen is covered under the country's
national health-insurance program. In
the United States, approximately
$2,500 is spent yearly per person on
health care, but 25 percent of all
Americans have either no health-care
insurance or inadequate health care
insurance, and approximately one
million Americans are denied health
care yearly because of their inability
to pay. In Canada, approximately
$2,000 is spent yearly per person on
comprehensive universal-access health
care. The United States spends three
percent more of its Gross National
Product on health care than Canada
and a whopping five times more to
administer its health-care programs
than Canada. In the United States, 75
percent of women receive prenatal
care during their first trimester of
pregnancy, compared with 95 percent
of Canadian women. Although the
United States ranks number 1 in the
world in health-care spending, it ranks
a dismal 20th in infant mortality;
conversely, Canada ranks number 2 in
world health-care spending and 5th in
infant mortality. In more vivid terms,
American infants have nearly a 40
percent greater chance of dying in
their first year of life than Canadian
infants. Canada's national health-care
program is clearly aimed at preventive
medicine and primary care. The
138
Canadian philosophy toward medicine,
as with many of their national
programs, is clearly one that attempts
to help the most people with each
health-care dollar and to spend more
of each health-care dollar on patient
care rather than administrative fees.
On 4/30/91, a comprehensive report
on the Canadian health-care system
appeared in the New York Times. It
stated that, at a time that some 33
million Americans lack health
insurance, the Canadian health-care
system serves as a taunting reminder
that, with a few compromises, it is
possible to provide quality care to
everyone, and for less money.
"Canada is an embarrassment to the
United States," said Vickery
Stoughton, an American who is
president of Toronto Hospital. But a
majority of Americans, accustomed to
receiving the most advanced medical
care in an instant, without regard to
price, may not be embarrassed enough
to accept Canadian-style compromises.
Every Canadian, rich or poor, is
promised equal access to doctors and
hospitals through provincial insurance
plans that cover nearly all medical
expenses. To make sure the country
lives within its allotted means, the
Canadian Federal and provincial
governments control hospital
operating budgets with an iron fist
and doctors' fees through bargaining
with provincial medical associations.
To rein in costs, the government limits
the number of specialists who are
trained, limits purchases of expensive
equipment, and restricts costly
procedures, like open heart surgery,
to a few university hospitals. To get
the most for its money, the system is
slow to offer expensive new machines
and procedures, waiting until their
medical value is solidly proved — and,
critics say, proved again. And so the
price of universal access is a degree of
inconvenience and delay and, in
fast-changing fields, sometimes
settling for last year's treatment.
Lawsuits are very rare, in part
because Canadian lawyers must work
for a fee rather than a share of
malpractice settlements and patients
can't sue for punitive damages. While
the quality of care remains generally
high, Canada's health system is
showing signs of distress. Doctors
predict that a barrage of expensive
new technologies and an aging, sicker
population will strain finances in the
coming decade, leaving patients with
longer waits, out-dated technology,
and even overt rationing. One example
of tight budgetary control is the fact
that there are just 15 MRI scanners in
all of Canada, compared with 2,000 in
the United States.
In the February 1991 issue ofthe
Mayo Clinic Proceedings there
appeared a commentary titled
"Reflections on the Canadian and
American Health-Care Systems" by
Robert R. Orford, M.D., C M . , a
former Deputy Minister of Community
and Occupational Health of Alberta,
Canada. Dr. Orford was a Canadian
physician who had moved to the
United States two years ago. This has
given him the opportunity to reflect on
the differences between the
health-care systems in these two
countries in a personal way. He made
the point that the Canadian
health-care system is not a new
creation and that it had evolved in
four stages during a period of almost
50 years. He described its evolution in
great detail. He enumerated the many
advantages for a physician practicing
under the Canadian system; however,
he notes that these advantages come
at a cost to the practitioner, the most
notable disadvantage being the
restriction on available technology; use
of high tech equipment is largely
restricted to specialists, to whom
patients must be referred for medical
care (patients are not allowed to
consult specialists directly — they
must be referred by a primary care
practitioner). This constraint
inevitably frustrates both patients and
physicians; nevertheless, it encourages
more effective use of medical
resources. In his discussion of the
future of American health-care, Dr.
Orford outlines all the problems with
our present system which have been
enumerated at the beginning of this
article. He then concludes that he does
not believe that the United States
government can impose a
"Canadianized" health-care system on
the American people. He feels that the
extent of investment of private capital
in the health insurance industry as
well as in hospitals, clinics, and
equipment would preclude such a
change. He further observes that a
conservative government is currently
at the helm, private wealth is
abundant, and the wide geographic
diversity of the population complicates
�the situation. These factors all
contribute to a strong inertia in the
American system. He reminds us that
the United States in the 1990s differs
considerably fi]om Britain and Canada
in the 1940s. There were, in fact,
movements toward a national health
system in the United States in the
1940s, as reflected in a report on the
nation's health that was transmitted to
President Truman on 9/2/48 by Oscar
R. Ewing, Federal Security
Administrator.! In that report was the
following recommendation: "A system
of insurance should make it possible
for everyone to have comprehensive
care without worrying about meeting
sudden bills out of current pay,
without exhausting savings or going
into debt and without being dependent
on charity care." Dr. Orford observed
that this proposal sounds remarkably
like the current health-care system in
Canada. For various reasons, these
movements did not result in a national
health insurance program in the
United States,'although they did lead
to the current Medicare and Medicaid
programs. He went on to describe
what others ha,ve mentioned in other
articles, a fundamental difference that
exists in the ethos of Americans and
Canadians. Americans distrust
monopolies and monopsonies and
strongly believe in competition and
individual freedom, whereas
Canadians value strong social
institutions and are generally willing
to accept a greater degree of
governmental control. He predicted
that the United States will eventually
modify its current health-care system,
but will do so ih its own way and in its
own time. In the process, American
physicians and I health-care
administrators'can learn from the
nature and thejongoing evolution of
the provincially based health-care
system in Canada. Comparative
studies of heahh-care delivery
between states and provinces would
be of particular value, especially in the
important areas of access and
utilization. Such studies are clearly
needed.
,
As I was writing this article, I
began to visualize what the practice of
medicine in the United States today
has become — a runaway train that is
gaining speed and momentum and will
either crash on become derailed if
nothing is done; soon to bring it under
control. In 1947, when I first started
to practice in Reading, medical life
was relatively uncomplicated. The
populace was being served mainly by .
general practitioners (a handful of
specialists was here) who practiced a
reasonably good brand of medicine;
everyone received medical care; the
indigent were taken care of in clinics
and hospital wards; the doctor-patient
relationship was commendable; there
were no homeless people; drug
addiction was no problem; diagnostic
problem cases were referred to
specialists in Philadelphia; some people
had private health insurance but Blue
Cross and Blue Shield had not
appeared on th,e scene as yet;
laboratory tests and x-ray studies
were basic and inexpensive;
pharmacies were few and far between
(most of the general practitioners
dispensed medication; few
prescriptions were written);
pharmaceutical companies were small
and inconspicuous; the
electrocardiogram was the test of
cardiac function; there were no such
innovations as doctors practicing as a
group. Today, medical practice has
been turned topsy-turvy: group
practice is the rule; patients usually
see several super-specialists; some
patients don't have primary care
physicians to sort things out for them
when medical matters become too
confusing; the number of laboratory
tests has mushroomed as has their
cost; all sorts of endoscopies are
performed frequently; cardiovascular
testing has become astronomical and
extremely expensive; physicians' fees
have increased because of the
economic situation and malpractice
insurance premiums; as the result of
the invention of computers, body
scanning has appeared (this subject
has been discussed earlier in this
report); health insurance is not
affordable; millions of people do not
receive medical care; every city has its
share of homeless people sleeping on
sidewalks; pharmaceutical giants have
sprung up and the cost of medications
is out of sight. Government intrusion
has taken all the joy out of the
practice of medicine.
Shortly after I had arrived in
Reading, I had become involved in
debates with some socialists
concerning the subject of socialized
medicine. At that time, I strongly
opposed the idea of
government-controlled medicine.
However, we already have some
governmental control and we are
going to need further control because
the high tech industry will surely
introduce more sophisticated gadgets
in the future which will be more
expensive but which we will feel we
must have in order to provide the
most modern kind of medical care to
patients who will not be able to afford
it. We have become addicted to high
tech medicine which is fueling the
runaway train mentioned above.
Somehow, that train will have to be
brought under control. Will Rogers
once said about the weather,
"Everybody talks about it but no one
does anything about it." This is true
about American medicine today. The
government doesn't seem inclined to
do anything. Organized medicine
should lead us in this struggle. I think
a good place to start would be with
Dr. Robert Orford's recommendations
that leaders of organized medicine in
the United States make a
comprehensive study of the Canadian
system of health-care and try to
incorporate at least some of the
sensible ideas of that system into the
United States health-care system.
HIF
Nc^tenF^BiMiess:
The A M i e H ti e
M mb r oln .
Reserved exclusively fpfAMA members, to get in
membership status, defray of your JAMA, and all your <
i fast about
i benefits, {i
18 0A A3 1
-0- M -21
139
�In the June 1991 issue of The
Medical Record, there appeared an
article titled: "The Etiology and
Treatment of the Spiralling Cost of
Health Care." The opening paragraph
set the stage for the discussion of this
subject by noting that the radio,
television, and print media had been
warning that health costs were
spinning out | of control and that an
increasing number of people had no
health insurance coverage (especially
the elderly). |The article then
proceeded to outline the causes of the
ever increasing cost of medical care in
the United States, and ended with the
observation that neither the federal
govemment nor organized medicine
(The AMA) seemed interested in
finding an equitable solution to this
vexing problem.
The above-described article was at
the Reading Eagle Press, waiting to
be published I when the May 15, 1991
issue of JAMA was published. This
issue was devoted entirely to what
had gone wrong with the American
Health Care System and what possible
solution or solutions might provide
better access of all citizens to proper
medical care 'and affordable insurance
to cover health care costs. An editorial
by then editor, George D. Lundberg,
M.D., "National Health Care Reform
— An Aura of Inevitability Is Upon
Us," stated that access to basic
medical care for all of our inhabitants
is still not a reality in this country,
and that there are many reasons for
this, not the least of which is
long-standing, systematic,
institutionalized racial discrimination.
It was his opinion that it is not a
coincidence that the United States of
America and the Republic of South
Africa — the | only two developed
industrialized countries that do not
have a national health policy ensuring
that all citizens have access to basic
health care -7 also are the only two
such countries that have within their
borders substantial numbers of
underserved people who are different
ethnically from the controlling group.
A high percentage of these
underserved people in the United
States are unemployed and thus have
less employment-related health
insurance, or are in low-level or
part-time employment that provides
fewer health insurance opportunities.
Medicaid coverage by poverty-line
demarcations and physician payments
are the lowest in many states that
have the largest population of the
underserved; mainstream private
medicine, particularly in large cities,
such as our nation's capital, has turned
its back on the poor and most
physicians refuse even to see such
patients.
Another editorial in the 5/15/91 issue
of JAMA summarized 13 broad-based
proposals for needed reforms which
had been selected from eighty which
had been submitted, at the request of
editors of the Journal, by authors from
a variety of professional backgrounds.
These proposals represented the
political and economic spectrum, from
the far left to the far right, from
Atlantic to Pacific, from urban to rural
settings, from academia, from labor,
from consumers, from government,
and from organized medicine.
Extraordinarily diverse in concept, the
proposals all share a common thread
— a serious intention to find a way to
meet our professional and societal
responsibilities of caring well for the
basic health of all our people. These
proposals follow one of four
approaches: (1) a compulsory,
employer-based private insurance
program, with the government
insuring non-workers and the poor; (2)
a plan that requires employers to
provide their employees with health
insurance or pay a tax, with the
govemment insuring non-workers and
the poor; (3) a program of
income-related tax credits for
individuals, independent of their
employers, for the purchase of private
insurance; and (4) an all-government
insurance system. A series of national
opinion surveys asked a random
sample of the general public, corporate
executives, and labor union leaders
about their preference for two of the
four types of proposals described
above (all government national health
plan; compulsory private insurance
plan, with govemment providing for
the unemployed). The findings
indicated that, although most people
favored some type of universal plan,
there was no majority supporting
either approach. This lack of
agreement on any specific plan is
similar to the dilemma faced in the
1970s. During the early part of that
decade, more than a dozen initiatives
for universal health coverage were
introduced in Congress. However,
leaders of key groups and the public
were unable to reach agreement on
any single approach to reform.
Because the problem of adequately
caring for the uninsured has been
worsening, it is hoped that the
discussion generated by this theme
issue will make it easier to reach a
national consensus.
However, the authors of this
editorial (Robert J. Blendon, ScD and
Jennifer N. Edwards, MHS) stated:
"When considering the various
proposals, it is important to keep in
mind the caveat raised by Ginzberg
and Ostow in their article in this issue.
Eli Ginzberg, PhD and Miriam Ostow,
MA were skeptical of the likelihood of
early action toward a scheme of
universal insurance at the federal or
federal-state level, or at the
government-private level, in view of
the resistance of the American people
to further large-scale taxation and the
perilous budgetary situation of the
federal govemment and most state
governments. Perhaps the most
powerful deterrent to early large-scale
health reform is the preoccupation of
the public with educational reform,
drug control, crime reduction,
environmental issues, and — not to be
overlooked — the consequences
following the successful prosecution of
the war against Iraq. Faced with
insurmountable obstacles to the early
establishment of universal health care
coverage, the United States should
use the next years to experiment with
removing discrete barriers that
currently impair the access of many
millions of Americans to proper
(Continued on Next Page)
�medical care. Such experimentation
should contribute to designing a more
effective system of universal coverage,
if and when the opportunity arises.
In addition to the May 15, 1991
issue of JAMA, there has been a
veritable torrent of articles addressing
this problem of the increasing health
care cost and the inability of millions
of Americans to obtain or afford even
the minimum amount of health care.
During the time I have waited to
write this article, I have myself
clipped out over 100 articles from
various print media sources. The
subject has been discussed on several
TV programs and on radio talk-show
stations. It would take volumes to try
to summarize just the articles I have
accumulated but the following samples
of headlines will offer some idea as to
how this very important matter is
being addressed on a daily basis all
over the country: "Ringing: The
Health Care Alarm;" "We Need a
National Health Plan for Everyone;"
"Health Spending in U.S. Continues to
Soar;" "The Canadian Experience;"
"Heeding Elections, Lawmakers Offer
Health-Care Ideas;" "Washington
Tries to Sort Out Health Insurance
Proposals;" "Health Care and the
Class Struggle;" "Democrats Unveil
National Health Plan;" "On National
Health Insurance;" "Governors Urge
U.S. to Take Over Health Care '
Costs;" "Putting Doctors Into
Cost-Containment;" "Pay-or-Play For
Health;" "How to Solve the
Health-Care Crisis;" "Many Doctors
See Cost-Curb System As Ominous
Trend;" "Physicians Urged to Help
Expand Access to Care;" "We Need
Informed Discussion of Health Plans;"
"Health Care Without Pain;" "Medical
Costs Draw Scrutiny of Wall Street;"
"Canada-Style Plan Might Save $67
Billion;" "Include Doctors in
Cost-Containment Decisions;" "Health
Care for Everyone;" "High Cost is
Forcing Many Families to Drop
Health Care Insurance;" "Putting
Brakes on MD Fees;" "A New
Medicare Crunch?;" "A Sick System."
A New York Times lead editorial
stated that "Harris Wofford's striking
victory over Dick Thornburgh in
Pennsylvania's Senate race makes
health care reform Topic A on the
domestic agenda. Mr. Wofford's
rousing declaration that 'working
people should have the right to a
doctor when they are sick' contributed
mightily to his triumph." This event
sent shock waves througout both
political parties and democrats and
republicans alike (especially those who
are coming up for re-election in 1992)
have gotten the message, loud and
clear, that they had better come up
with some workable plan to reform the
health care system in the United
States if they want to hold onto their
jobs. I f the situation were not so
serious, it would be laughable to
watch as each federal legislator
suddenly comes up with his or her
fool-proof plan to save our health care
system. Most of the plans seem to deal
with ways and means of having
employers pay for health care costs;
they rarely mention cost-containment
or access of the uninsured and
underinsured to adequate health care.
Marty Russo, Democratic
congressman from Illinois is the only
legislator I know who is pushing for a
national health care program.
Former Surgeon General Dr. C.
Everett Koop has recommended the
IMS.
We-fight nonmeritoriolis claims. It wpuld be easier to
settle, and often less expensive fopus. But we're not just
insuring your financial future\We're guarding your professional reputation, an asset ncramount of insurance could
replace. So we put it uywritinq that we'll never settle
without your consepr We hire the best lawyers, back
em up with the/itation's largest malpractice law departmW^and wjp^lf we didn't, we couldn't call ourselves
The Wl^dicai Protective Company. Put us in your corner
and C^IKSSIT general agent today.
>t>f*\
William Waldron. RobbtlL Ignasiak
Suite 265. Commerce Plaza. 5lfib Tilghman Street
Allenlown. PA 18104
(215) 395-8888
�establishment of a Presidential
Commission, composed of physicians,
hospital administrators, insurance
people, and Republican and
Democratic members of Congress,
which would be expected to come up
with a workable solution to the health
care crisis. In my experience,
commissions and committees meet,
pontificate, procrastinate, and end up
appointing other committees which
eventually lead to non-productive
dead-ends.
A new rallying cry is "Play-or-Pay."
The idea is to create universal health
coverage by requiring employers to
play, by providing insurance for
workers, or else to pay a payroll tax
toward insuring their workers in a
public plan. The advantage to
"Play-or-Pay" is that it provides
universal coverage without scrapping
the existing employer-based insurance
system. However, that advantage is
mainly one of political appearances. In
any case, the problem of cost control
would remain unsolved.
Another buzz-word lately has been
"Managed Care." This would involve
health care through health
maintenance organizations, or
H.M.O.s. These are for-profit
organizations so that physicians must
get prior approval before hospitalizing
patients, prescribing expensive
medications, ordering expensive
laboratory and x-ray procedures,
referring patients for consultations;
the first consideration is the making of
profits; the welfare of patients is a
lower priority; also, "Managed Care"
does not improve the access of
uninsured and underinsured to
adequate medical care.
Organized medicine has not had
much to offer. The AMA has not
addressed cost' containment or
increased access to adequate medical
care. Historically, the AMA has
consistently thwarted efforts on the
part of Congress to pass National
Health Plan legislation. In 1943,
speaking of health insurance,
President Franklin D. Roosesvelt
stated, "We can't go up against the
State Medical Societies; we just can't
do it." After Truman's surprise
victory, the AMA thought
Armageddon had come. I t assessed
each of its members an additional $25
just to resist health insurance and
hired Whitaker and Baxter to mount a
public relations campaign that cost
$1.5 million in 1949, at that time the
most expensive lobbying effort in
American history.
Two editorials by John W. Mills,
M.D. in the October and November
issues of Pennsylvania Medicine, the
Official Journal of the Pennsylvania
Medical Society, illustrate how the
Pennsylvania Medical Society attempts
to come to grips with the problems
confronting the health care of this
Commonwealth by speaking all around
the issues but failing to come up with
a comprehensive plan which would
benefit every person living in it. In
the October 1991 issue, Dr. Mills
describes the work of commissions and
committees and attempts to devise
alternate solutions to access to health
care. He concludes with the
statement, "Only if the medical
community supports the Society's
proposals with a strong commitment
will we be able to demonstrate to the
citizens of Pennsylvania that we can
assume a leadership role in solving
health care issues in our state." In the
November issue, the title of Dr. Mills'
editorial is, "We Are Not the Cause of
Soaring Costs." He was prompted to
write a second consecutive editorial on
the health care crisis because new
Democratic presidential hopefuls had
raised the health care issues high
enough that the general public will
have to take note. He warns the
American public to take a careful look
at these issues in order to address
them at the polls. He refutes the
statements that, "We need to cut
costs, doctors' fees are the problem;
the medical profession needs to be
more efficient; unnecessary surgery
accounts for huge expenditures, etc.,
etc., etc." He expresses concern about
the exorbitant amount of money spent
by the huge bureaucracy of
govemment in Health and Human
Services, and its subsidiary, the
Health Care Financing
Administration, in running Medicare,
financing Peer Review Organizations
in each state, and also in running a
SuperPRO to oversee all the other
fifty. Dr. Mills also mentions that, in
Pennsylvania, our Department of
Public Welfare is a prime example of
wasteful money spent in a
bureaucratic nightmare. He says that
;
he is tired of doctor-bashing and that
doctors are not the cause of the
soaring health care costs in this
country. In his opinion, the real
culprits are "we the people."
Americans want the best medical care
and they want it now and, as a nation,
we cannot afford all the medical care
our system is capable of delivering.
He agrees that the health care in this
country is not evenly distributed and
suggests that the issue of proper
distribution of health care needs to be
addressed by some very wise people.
Dr. Mills ended his editorial with a
quote from a June 1990 article in
Pennsylvania Medicine, entitled
"Dissecting Canadian Health Care,"
by David Woods: ". . . should
Americans fund a national
comprehensive medical care system
federally or through state
governments? Yes, if Americans are
prepared for large tax increases,
diminished choice, lowered standards,
eroded professional freedoms, and the
sort of dinosaur that only public
enterprise can create." These
statements are typical of the criticisms
that are used by organized medicine to
denigrate comprehensive national
health insurance plans when our
present health care plans have been
found wanting as regards cost
containment and universal access to
medical care.
The cover story ofthe 11^5^1 issue
of TIME deals with "10 WAYS TO
CURE THE HEALTH CARE
MESS." The story starts with the
statement that there are two kinds of
prices in America today: regular prices
and health care prices. The first kind
seems to follow some sensible laws of
supply and demand. But America's
medical bills are something else. They
flow from a surreal world where
science has lost connection with
reality. The prices, like the system
that issues them, are out of control.
For the Federal Government, medical
costs have become the fastest-growing
major item, increasing at more than
8% annually at a time when inflation is
only about 5%. For corporate
America, health care has become a
crippling expense. General Motors laid
out $3.2 billion last year, more than it
spent on steel, to provide medical
coverage for 1.9 million employees,
(Continued on Next Page)
�dependents, and retirees. Unchecked,
the U.S. medical bill will more than
double in the next 10 years, to $1.6
trillion, crowding out spending for
other urgent needs. How did
America's health care slip into such a
critical condition? It's all so
paradoxical. We're the medical miracle
workers. We're the picture of health.
We live decades longer than we did
before. We've harnessed the body's
natural defenses with antibiotics,
defeated plagues and diseases, learned
how to make spare parts for almost
every organ except the brain.
However, medicine's amazing new
tools have made decent health care a
rich man's privilege, too expensive for
the working poor and even many
middle-class people. We have let
ourselves to be seduced by the idea
that there is no such thing as enough
health care. Americans used to take
health care for granted. Now, millions
in this country are starving for care in
the midst of plenty. The prospect of
an additional 30% increase in medical
costs next year has prompted many
employers to cut their work force,
reduce health benefits, or both. At the
same time, insurance companies are
raising premiums to nigh unaffordable
levels. Millions of workers are
terrified of losing their coverage. Until
now, attempts at reform have run into
a gridlock of powerful constituencies:
giant corporations, doctors, hospitals,
insurance companies, and the highly
organized senior-citizens lobby. But
popular opinion may break the
impasse. In a TIME/CNN poll of 1,000
adults, 91% said that our health-care
system needs fundamental change.
The U.S. can do a much better job
with the money it is spending by
balancing compassion with realistic
notions of what can be done. It is not
possible to offer unlimited medical
care to everyone, nor fair to cushion
the well-to-do with vast
public-health-care subsidies while
millions of American children and their
parents go without. There is a
growing consensus that it's time for a
cure.
The TIME article proceeded to
describe ten of the most important
problems in the American way of
medical care: problem number 1 — 1
out of 9 American working families (a
total of 37 million people — including 8
10
million American children) has no
health insurance at all; most of the
uninsured are the families of workers
in small firms that do not offer such
coverage: more and more working
Americans earn too much money to
qualify for Medicaid but too littlfe to
afford care; SOLUTION — establish a
universal health care plan covering
basic preventive treatment for all
Americans who cannot pay for their
own insurance; to help pay for it,
Congress should eliminate the $53,400
income cap on the payroll tax that
funds Social Security — this would
provide an estimated $25 billion in
new funds for the universal plan; to
control costs, care must be delivered
through tightly managed private
systems and high-cost medical
procedures would be closely screened
for their anticipated value in
extending life and health.
Problem number 2 — Medicaid,
which will dispense $158 billion in
federal and state funds this year to
provide health care to 27.3 million
Americans; costs are careening out of
control; moreover, many doctors
refuse to treat Medicaid patients
because of rock-bottom reimbursement
and the snarl of bureaucratic rules; the
program is also a sitting duck for
thieves because of poor administration
— Medicaid pays billions in fraudulent
insurance claims for nonexistent
patients; SOLUTION — shut it down
— Medicaid patients can receive
better care, and the federal
contribution would be better spent,
under the simplified universal plan
proposed above.
Problem number 3 — Medicare;
this $110 billion program — which
started out 26 years ago with a budget
of $5 billion — was designed to
provide decent care for the elderly,
but the program gives the same
benefits to those who are well-off as to
the elderly poor; though the elderly do
pay some of the costs, nearly 90% of
Medicare funds come from payroll
taxes on workers, so that the burden
falls partly on laborers who have no
health insurance of their own and may
have trouble making ends meet;
SOLUTION — return the program to
its original goal — taking care of
people who need financial help; people
who can afford to pay more for their
own health care should do so; in
addition, subsidies should be more
carefully rationed when it comes to
extremely complex and costly medical
procedures for very old patients.
Problem number 4 — Fraud and
Abuse; Fraud may account for as
much as $75 billion of annual U.S.
health care expenditures, according to
the National Health Care Anti-Fraud
Associaiton; the biggest single medical
fraud to date occurred in June 1991 in
California where a $1 billion rip-off
was carried out by thieves operating
clinics on wheels; in New York City, a
doctor billed Medicaid for $50,000
worth of lab tests for a single patient;
innumerable smaller crimes are
committed daily in labs, hospitals, and
doctor's offices to inflate the costs of
care; in a survey of Aetna Life and
Casualty customers, 4 out of 10
consumers said their doctors had
cheated insurance companies;
physicians often have conflicts of
interest that contribute to vast waste;
in a study released in August, Florida
officials reported that doctors owned
93% of the diagnostic-imaging centers
surveyed, 78% of the
radiation-therapy centers, 60% of the
clinical labs, and 38% of the
physical-therapy and rehabilitation
centers; Miami doctors prescribe MRI
scans (cost: $800) and various lab tests
about twice as often as doctors in
Baltimore, where very few own the
equipment; lab charges are more than
twice as high at facilities owned by
doctors; SOLUTION — tougher
enforcement; insurance companies and
public authorities should pool
information on fraud via computer
networks; doctors should be required
to disclose to patients their
investments in testing centers and
laboratories and to offer an alternative
in which the doctor does not have a
financial interest. (That proposal has
already been recommended by the
AMA's Council on Ethical and Judicial
Affairs.)
Problem number 5 — Disappearing
Doctors; more than 570,000 physicians
practice medicine in the U.S. today,
almost double the number 20 years
ago; yet, huge areas — 18 counties in
Texas alone — have none. Rural
America, like many inner cities, is
facing a crisis in primary care;
communities need about 35,000 more
general practitioners; doctors typically
�prefer more lucrative practices as
specialists and surgeons (who can earn
more than $300,000 a year, compared
with the average family practitioner's
income of $96,000); the shortage of
general practitioners leads to wasteful
use of medical resources; without a
family doctor to keep track of their
overall health, people are left to fmd
their way through a costly medical
system, ache by ache, often seeking
high priced help where the skills of a
generalist would more than suffice;
SOLUTION — federal money pays for
half of graduate medical education;
redirect as much as 50% of that $3.6
billion federal contribution to students
who aim to practice primary medicine;
expand a three-year pilot project
authorized by Congress last year —
the program provided up to $50,000 in
matching funds for communities that
finance medical education for
physicians (cost of training: about
$75,000) as well as other medical
professionals; for doctors who have
already finished school, waive taxes on
the first $40,000 in income for those
who treat patients in designated
neglected areas.
Problem number 6 — Physician
Compensation; back when doctors
were paid out of patients' pockets,
doctors knew their decisions could •
devastate a family'sfinances;but
concerns over costs diminished over
the past 40 years as vast insurance
pools were created through company
benefits plans and the huge Medicaid
and Medicare systems; under the
circumstances, insurance is like a
blank check; research has shown that
doctors paid in fee-for-service
programs order 50% more
electrocardiograms and 40% more
x-rays than physicians in
managed-care groups. Medicare and
insurance companies have tried to
make sense of medical charges by
establishing maximum fees for
hundreds of surgeries, tests, and
procedures; but the medical
establishment is winning the
accounting war; some doctors attend
seminars on "creative billing," learning
how to describe medical treatment in
terms that will yield the highest
prices; SOLUTION — managed care;
providers of group insurance should
insist that doctors treating their
;
patients be paid salaries or flat fees;
doctors bound by such strictures
would still be free to earn extra
income by treating other,
higher-income patients in private
practice.
Problem number 7 — Unnecessary
Care; fear of malpractice lawsuits
drives doctors to perform many extra
procedures to protect themselves
against accusations of negligence; The
AMA estimates that defensive
medicine adds $21 billion to the U.S.
health-care bill every year; many
doctors and hospitals overtreat
patients simply because they have a
blank check to do so under many
insurance programs; as much as 20%
of all medical procedures and
treatment is completely unnecessary
according to Dr. Robert Brook,
director of health sciences for the
Rand Corporation — cost of the
waste: $132 billion a year; Rand
studies have found that, in some
regions of the country, as many as
44% of coronary by-pass surgeries and
64% of artery-clearing carotid
endarterectomies were either
(Continued on Next Page)
REHABILITATIVE SERVICES
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1170 Berkshire Blvd.
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Provides activities to improve speech clarity, word^finding and
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• Occupational Therapy
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11
�unnecessary or highly questionable; in
a separate review for the Philadelphia
Professional Standards Review
Organization, Dr. Allan Greenspan
found that about 25% of
heart-pacemaker implants performed
in the Philadelphia region were
inappropriate; SOLUTION — for
malpractice cases, cap noneconomic
awards for factors like pain and
suffering at about $250,000; California
placed a limit on such awards in 1975,
and it now has some of the lowest
malpractice premiums in the U.S. (one
reason: ambulance-chasing lawyers
have less incentive to bring
questionable claims); devote more
research to finding out which
procedures and drugs are most
effective; this could be a difficult
project since, according to Dr. Robert
Heyssel, president ofthe Johns
Hopkins Hospital, "Doctors disagree
all the time about whether a carotid
endarterectomy or a coronary bypass
will offer a patient the best shot at
recovery; there are no absolutes
around these things."
Problem number 8 — The Hospital
Glut; America has too many hospitals;
on average, U.S. hospitals are
operating at 64.5% capacity; to fill
their beds, some hospitals buy
physicians' practices and then pay the
doctors under so-called census-based
compensation, which is geared to the
number of patients the physicians send
to the mother ship and the number of
procedures they perform; SOLUTION
— remove the more blatant conflicts
of interest governing the relationships
between doctors and hospitals; outlaw
census-based compensation for
doctors; require physicians to disclose
their financial relationships with the
hospitals to their patients; eliminate
tax subsidies for underused and
obsolete hospitals.
Problem number 9 — Fairness;
taxpayers, even those who have no
insurance, spend an estimated $84
billion a year to subsidize medical care
for mostly middle- and upper-class
Americans: that is because companies
can write off every dollar they spend
on health care as a business expense,
which may help explain why corporate
America did so little to contain the
costs until they got out of hand; at the
same time, employees who enjoy
12
generous benefits plans pay no taxes
on the thousands of dollars in health
care coverage that their companies
provide for them; SOLUTION —
reduce the corporate write-off for
medical costs and impose a tax on
employee health benefits at a
moderate rate for well-compensated
workers.
Problem number 10 — Waste; the
U.S. has more than 1500 different
health-insurance programs, each with
its own marketing department,
complex forms, and regulations;
doctors, nurses, and clerks are buried
in the paperwork needed to keep track
of whom to bill for every aspirin
tablet; it's a massive waste of time;
U.S. health care providers will spend
as much as $90 billion this year on
record keeping, according to a
Harvard study; SOLUTION —
standardize insurance fees; Maryland
did so 20 years ago; Louis Sullivan,
the Secretary of Health and Human
Services, proposed a national plan
recently to standardize
health-insurance forms; if his program
is carried out by the end of the
decade, Americans could save as much
as $20 billion a year; just as
important, eliminating wasteful
paperwork would leave doctors and
nurses more time and resources to
care for patients.
The TIME article concludes that
cleaning up the health-care system will
be an epic adventure in compromise.
No one wants to give up his share of
medicine's glittering promise, whether
it comes in the form of pills or
paychecks. But the problems won't
wait; health care has emerged as the
most important domestic issue of the
'90s. "At some point," says Missouri
Congressman Richard Gephardt, "no
one will be able to afford health care.
We have got to act."
This is the present battle cry —
"We have got to act!" However, there
appears to be no consensus as to how
we should act. Democratic and
Republican politicians are scrambling
to come up with plans which are
couched in general terms, do not
address the main problems, and are
designed more to get themselves
elected or re-elected than to solve the
health care crisis. The TIME magazine
article does a good job of presenting
the chief problems besetting oui;
system of health care and providing a
separate solution for each problem;
however, each solution does not help
solve any of the other problems
mentioned. Joan Beck, a syndicated
columnist for the Chicago Tribune,
quotes Dr. James S. Todd, AMA
executive vice president, as saying
that 87% of Americans are satisfied
with their health care so the AMA's
basic plan focuses on the uninsured
and underinsured; it calls for
reforming Medicaid, making insurance
available and affordable to the
medically uninsurable, a new Medicare
catastrophic illness benefit program,
improving financing of long-term care
and encouraging individuals to buy
private nursing-home insurance (quite
expensive), requiring employers to
provide health insurance for all
full-time employees and their families,
with tax incentives and risk pools to
help new and small businesses pay for
the coverage (never mind that many
businesses already find health
insurance costs so high they affect
their competitiveness in the
marketplace). Peter Diamond, a
professor of economics at the
Massachusetts Institute of Technology
has a plan where individuals could be
grouped independent of their health
needs and work status and everyone
would automatically receive basic
coverage; he compares this to The
Federal. National Mortgage
Association (Fannie Mae) which
groups individual mortgages together
into securities that are sold to private
investors; in the same way, his
proposal would have the government
bundle families, any one of whom
could face catastrophic medical bills,
into relatively large groups; it has
been suggested that the plan be called
"Fannie Medic" or "Healthy Mae."
The Critically 111 Patient —
American Medicine The Cure —
National Health Care Reform, will be
continued in the February issue of the
Medical Record.
�"The Simplest, Best Cure for Our
Health Care Crisis." This is the title
of an article that appeared in the
November 1991 issue of Medical
Economics; it had first appeared (in
longer form) in The Atlantic Magazine;
its author is Regina E. Herzlinger,
Ph.D., Nancy R. McPherson
Professor of Business Administration
at Harvard University, who feels that
there is no need for national health
insurance or any other grand scheme;
all that is needed is the injection of a
little competition. She is of the opinion
that hospitals are partly to blame for
our troubles; The industry operated at
only 65% of capacity for three
consecutive years (1985 to 1987) and
that the causes of the decline in
hospital use will not soon be reversed.
She reports that some national health
insurance advocates cite hospital costs
as evidence of the overall failure of
competition in the health care system;
but, in her judgment, competition has
never been attempted in the health
care industry; a competitive market
requires many buyers and sellers, who
freely interact to reach an equilibrium
level of prices, costs, and quality; the
hospital market has none of these
characteristics. According to Dr.
Herzlinger, employers face a hopeless
battle in trying to control hospital
costs; she calls her solution "simple:"
require employees to buy their own
medical insurance; every year,
employers would transfer the money
they now spend on health insurance to
their workers, who would use it to
buy their own policies; the amount
transferred would not be the average
cost per employee but would be
adjusted for age, sex, and family
structure, and increased annually by a
medical price index. In addressing the
plight of the 34 million uninsured
Americans, Dr. Herzlinger feels that,
while many of them are poor, a large
number of them could well afford to
pay for health insurance; the poor
uninsured should receive funding for
health insurance. She refutes
health-policy experts who doubt her
proposal's practicality and who say
that it isn't politically feasable.
In the December 4, 1991 issue of
JAMA is an article titled: "A National
Long-term Care Program for the
United States." Its source is the
Working Group on Long-term Care
Program Design, Physicians for a
National Health Program. Its premise
is that American medicine often cures
but too rarely cares. Technical
sophistication in therapy for acute
illnesses coexists with neglect for
many of the disabled. New hospitals
that lie one-third empty house
thousasnds of chronic-care patients
because even the shabbiest nursing
homes remain constantly full. There is
a growing recognition that the crisis in
long-term care, as in acute care, calls
for bold and fundamental change. The
authors propose the incorporation of
LTC into a publicly funded national
health program (NHP). They
borrowed from the experience in the
Canadian provinces of Manitoba and
British Columbia, where LTC is part
of the basic health care entitlement
regardless of age or income. This
proposal has been designed as a major
component of the NHP proposed by
Physicians for a National Health
Program. The NHP would provide
universal coverage for preventive,
acute, and LTC services for all age
groups through a public insurance
program, pooling funds in existing
public programs with new federal
revenues raised through progressive
taxation. This approach would improve
access to the acute care that could
ameliorate much disability, eliminate
the costly substitution of acute care
for LTC, prevent unnecesssary
nursing home placements, and provide
a genuine safety net, both medical and
financial, for people of all ages. Our
nation has the resources to provide
better care for the disabled and
elderly, and it has the responsibility to
develop a reasonable system of LTC.
The public supports this type of
approach. Health and human service
professionals and the makers of public
policy need the vision and courage to
implement such a system.
Drew E. Altman, president ofthe
Henry J. Kaiser Family Foundation, a
philanthropy concerned with health
wrote an article titled: "Health Care
without Pain" which appeared on the
Op-Ed page in the New York Times.
In it, he describes how we can control
health care costs and cover virtually
all of the uninsured without raising
taxes and turning the system upside
down. First, put our health care
system on one overall budget; to do
so, Congress should pass legislation
placing a national limit on the annual
rate of increase of spending for all
insurers — Medicare, Medicaid, Blue
Cross, commercial carriers; with such
a plan, the nation could have saved
$25-$30 billion in 1991 alone — enough
to cover just about all of the 34 million
Americans without health insurance.
The biggest thorn in the side of most
doctors is the Big Brother attitude of
the public and private review
programs that second-guess decisions
on when they should admit patients to
the hospital, order tests, and send
patients home. A credible move would
be to repeal the $300 million
Professional Review Organization
Program, through which the
Government has established 54
bureaucracies around the country to
look over physicians' shoulders and
review their decisions. Obviousy, some
check on doctors' decisions is needed
but the present system adds endless
red tape and is the wrong way to
handle the job. Mr. Altman's
conclusion is that a national cap on
spending increases will control costs
and help cover the uninsured without
abandoning the pluralistic public and
private system that has been the
hallmark of American health care.
Jack Sheinkman, president of the
Amalgamated Clothing and Textile
Workers Union, also wrote on "How
to solve the Health Care Crisis" on
the Op-Ed page of the New York
Times; his approach was similar to
that of Drew E. Altman. He stated
that the scope of the problem was
enormous. Business and labor both
know that health care costs are
excessive and both see, admittedly
from different perspectives, that the
increasingly inequitable distribution of
health care costs needs addressing. In
his opinion, the way out is becoming
clear — government must get into the
act by setting firm annual national
health care budgets and establishing
the regulatory framework for
controlling provider reimbursement.
(Continued on Next Page)
35
�Then, it must use the tax system to
distribute costs fairly across the
economy. Virtually every other
industrialized nation budgets its health
care with great success and, unless we
do, too, our attempts to compete
globally will flounder. Mr. Sheinkman
does not feel that we need socialized
medicine. However, he writes that,
under our present health care system,
the health care providers — not
business and not individuals — control
costs. They are the ones who order all
the diagnostic tests, schedule all the
surgeries, and buy all the
technologies. But if Government were
to regulate reimbursement rates, that
would force providers of health care to
be more cost effective. He observes
that there has been a flurry of health
care reform initiatives in recent
months but he knows that the
politicians won't lead the Government
into health carefinancing;real
leadership will have to come from
business and labor.
Anthony Lewis is a regular
contributing columnist for the New
York Times. One of his recent columns
was titled: "A Sick System," with a
subtitle of: "The Crazy Quilt of Health
Insurance." He was reporting on an
article by Drs. Steffie Woolhandler
and David U. Himmelstein of the
Harvard Medical School which had
appeared in a recent issue of the New
England Journal of Medicine. The
authors were reporting on the high
cost of administering health care in
the United States; they stated that, in
1987, this cost amounted to between
$96.8 billion and $120.4 billion. The
higher figure was nearly a quarter of
total spending on health care. And,
state the authors, the burden of
administration is growing. Between
1970 and 1987, the number of health
administrators in this country rose by
nearly 400%; at the present rate of
growth, administration will consume a
third of all our health spending by the
year 2003, and half by 2020! The cost
of health paperwork and bureaucracy
is especialy striking compared with
other countries. The New England
Journal article made detailed
comparison with Canada;
administration cost at most $156 for
each Canadian, compared with $497
per capita in this country. If health
care had been managed as efficiently
here as in Canada in 1987, the United
States could have saved as much as
$83 billion; by now, the saving would
be on the order of $100 billion a year.
The reason for the staggering
U.S. - Canadian difference is no
secret: Canada has a genuine national
health system, covering everyone; we
have a crazy quilt of Medicare for the
elderly, Medicaid for some of the poor,
and 1500 private health insurers.
Fragmentation is what makes U.S.
medical insurance complicated and
expensive. As an example of "the scale
of waste among private carriers," the
New England Journal article cites
Blue Cross/Blue Shield of
Massachusetts; to cover 2.7 million
subscribers it employs 6,682 workers
— more than in the health services for
all of Canada, covering more than 25
million people. The article concludes
that "universal comprehensive
coverage under a single, publicly
administered insurance program is the
key to administrative simplification."
Michael Dukakis, former
Massachusetts governor and
Democratic Presidential contender
recently delivered a lecture on health
care in the Pacific and Asia at the
University of Hawaii. He praised
Pacific Rim nations that provide
universal health care insurance: New
Zealand, Japan, Singapore, and South
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36
�Korea. He also had some very
complimentary things to say about the
health care system in the state of
Hawaii which he held up as a model
for the rest of the nation; he stated
that Hawaii is the only state where
nearly everyone has access to health
care and added that its system will
play an important role in the national
debate on health care. He quoted
State Health Director John Lewin as
saying, "90% of full-time employees in
Hawaii have health coverage, and
another 7% are covered through
Medicaid. The state will soon provide
coverage to the remaining 3%; that
program covers part-time employees,
the unemployed, and small business
owners. About two-thirds of those
eligible have signed up for the plan."
Mr. Dukakis called universal health
insurance the nation's most significant
domestic priority and added, "while
our health seems to be improving, we
aren't even close to the standards that
are being set by others; the nation
cheered when our infant mortality
dropped to 9.1 per 1,000 — in Japan,
it was 5.1 per cent."
Dr. Bernard Leo Remakus is an
internist in private practice and author
of "The Malpractice Epidemic." An
article by him, "On National Health
Insurance," appeared in the August
1991 issue of Internal Medicine World
Report. His opening paragraph reads
as follows: "Yet another national
health insurance bill has reached the
floor of Congress. Introduced by
Representative Marty Russo, an
Illinois Democrat, the latest plan
would be funded through taxes and
. would cover physicians' services,
hospifalizations, preventive care, long
term care, dental care, and
prescription drugs, all without
copayments or deductibles. Thus far,
the ambitious program has garnered
the endorsement of various labor
unions, including the United Auto
Workers; American Federation of
State, County, and Municipal
Employees; American Postal Workers
Union; International Ladies' Garment
Workers Union; Amalgamated
Clothing and Textile Workers Union;
International Association of Machinists
and Aerospace Workers; Oil,
Chemical, and Atomic Workers
International; and Communications
Workers of America." Dr. Remakus
makes the point that it should come as
no surprise that organized labor has
been so quick to endorse national
health insurance since 50% of
American corporate profits are
consumed yearly in health care and
75% of American labor disputes and
strikes are over health care benefits'.
He also feels that the willingness of .
Congress to once again listen to talk of
national health insurance should come
as no surprise, because the
government-sponsored health care
programs are in the process of
self-destructing, and the private
insurance sector has been sent into a
tail spin by health care costs that
continue to rise twice as fast as
inflation. More and more people are
starting to talk about national health
insurance and more and more people
are starting to listen to such talk. Dr.
Remakus concludes his article with the
observation that, "the question of
national health insurance in the United
States has become more a matter of
'when' than 'if.' It would appear that
the time has come for all of us to
gather our collective genius and create
the kind of health care delivery
system that will benefit both patients
and physicians alike."
When one is presented with all the
information documented in this article,
there would seem to be no doubt that
this country will eventually have a
national health care program. Dr.
Bernard Leo Remakus stated in his
article that, "when all the variables
are plugged into the equation, it would
appear that national health insurance
will become an accomplished fact in
the United States by the end of the
century." However, the issues of cost
containment and universal access to
adequate medical care cannot wait
that long for solutions to be attained.
The wheels of progress move slowly in
Congress in ordinary times; since 1992
is an election year, I wouldn't bet on
any positive legislation being passed; if
one is optimistic, one might anticipate
the possibility of some form of a
national health insurance plan being
acted upon by Congress in 1994 at the
earliest.
It would seem to be prudent for 49
of the State Medical Societies to
review Hawaii's health care program
to see if all or parts of that program
might be incorporated into their health
care programs. They might also
review the Medicaid program in
Arizona; known for years as a
contrary holdout, the only state
without Medicaid, Arizona belatedly
started a program in 1982 that has
become a model; as in other states,
Medicaid in Arizona covers only the
very poor, excluding many people who
still cannot afford health insurance;
but for those who are included, the
program, unlike others, is run like a
giant health maintenance organization;
every patient joins a "managed care"
plan, a group of doctors and hospitals
that receives a fixed monthly sum for
each patient; every patient has a
personal doctor. Many years ago,
before third party carriers began to
pay for hemodialysis, committees were
formed in many cities to make
decisions concerning which patients
were the most deserving of having
this procedure done on them since
funds that were available would not
cover performing the procedure on all
of them. These committees consisted
of representatives of all walks of life in
the community (doctors, lawyers,
clergy, merchants, teachers,
industrialists, homemakers, media
personnel, psychologists). Utilizing
committees of this sort might have to
be considered as a means of cost
containment; decisions might have to
be made concerning the purchase of
expensive high tech equipment, the
use of very expensive medication;
excessive performing of very
expensive diagnostic procedures and
very expensive surgical procedures;
unrealistic prolongation of life in the
very elderly. I can hear the howl of
protest from the medical community,
but these are critical times that
deserve potent measures. The conflict
of interest situation (see Problem
number 4 — Fraud and abuse) should
be resolved; the primary goal of the
physician should still be "healing the
sick" and not "the amassing of
wealth." Every County Medical
Society should discuss the increasing
health care crisis and should try to see
what its members can do to help
alleviate the problems facing each
respective community.
Earlier in this article, Jack
Sheinkman, president of the
Amalgamated Clothing and Textile
Workers Union, was quoted as saying,
"But the politicians won't lead the
Government into health care financing.
Real leadership must come from
business and labor." It would seem
more appropriate for the medical
community to assume a leadership role
in the resolution of the present health
care crisis. I f we don't, the federal
government is apt to create another
federal health care program that is
sure to benefit neither patients nor
physicians, but only itself.
H.I.F.
37
�Theodore R. Marmor, co author of
"America's Misunderstood Welfare
State," is a fellow in the population
health program of the Canadian
Institute for Advanced Research. John
Godfrey, former editor of The
Financial Post, a Canadian
newspaper, is institute vice president.
Critics of Canada's medical care
system contend that it is no model
for America and that its good
reputation vastly exceeds its mixed
performance. Their claims that
Canada's program is less effective
and no less costly than America's,
and that it is beset by horrific
waiting lists and unhappy doctors,
arc caricatures.
This myth-making is predictable.
Because Canada has restrained its
health care costs more successfully
than we have, those who feed at
America's $800 billion medical feast
are frightened. Hence, Canadabashing by special interests like the
American Medical Association and
Health Insurance Association of
America, a trade association. After
all, cost control means reducing the
medical providers' income—the one
unassailable axiom of medical
economics.
Actually, Canada provides an
attractive model for American
reform. Canada (like most
industrial democracies) combines
universal health insurance with
clear political accountability for
raising and spending money for
health services, and for the quality
of the care the money buys.
Yes, Canada has its problems
and, no, its national health
insurance program (known as
Medicare) cannot be directly
transplanted. But Canada balances
access, cost and quality in ways the
U.S. should find instructive.
Primary and emergency care,
universally insured, are readily
available. No financial or
administrative barriers prevent
patients from seeking the services
of any family doctor. Canadians are
not assigned doctors from approved
lists, but rather choose them: It is
that simple.
Canadians visit physicians more
often than Americans do and are
highly satisfied with the service and
the system. With a single insurer,
the provincial government, there is
far less paperwork for patients and
doctors. More important is the
widespread sense of security that
comes from knowing that illness,
however catastrophic, never results
in financial disaster.
Are some high-tech items in
shorter supply in Canada than in
America? Undoubtedly. Were
America to disappear, Canada
would have the world's most ample
supply of intensive care units and
diagnostic machinery. The real
question is whether the U.S. is
oversupplied with marginally
effective high technology, not
whether Canada is in the medical
stone age.
Are there delays and waiting
lists? Some, particularly for non
emergency heart surgery and hip
replacement. The waiting is,
however, hardly serious:
Govemment statistics show that 96
percent of Canadians over the age
of 15 get their care within seven
days of requesting it.
Nevertheless, critics in
conservative American think-tanks
such as the Heritage Foundation
propagandistically tell stories of
endless waiting in Canadian
medicine. The reality is far less
worrisome, but the media
communicate the misinformation by
repeating its anecdotes.
Is Canadian care as expensive as
ours? In 1991, Canada spent about
9.2 percent of its national income
for medical care while the U.S.
spent 12.3 percent; the proportions
for 1971, the year Canadian
Medicare became universal, were
7.3 percent and 7.4 percent,
respectively. So, over two decades
Canada learned how to insure
everyone while spending less.
Doubters will object that Canada
achieved this result by faster
economic growth, not by less
medical spending; this is partly
true, but so what?
Controlling costs means living
within one's means. Canada, with a
health budget, decides what to
spend for care. Budgetless America
learns about its health costs only
after the fact; few celebrate the
result.
Those who attack Canadians'
health insurance claim that their
nation's social circumstances are so
different from ours that nothing can
be profitably learned by looking
north. Such arguments are wildly
exaggerated or simply inaccurate.
We are told Canada has
proportionately fewer costly
patients—the old and the poor. In
fact, 11 percent of Canada's
population and 12.2 percent of ours
is over 65, a trivia difference,
especially when contrasted with
those of Germany and Sweden
(where 16 and 17 percent of the
citizenry, respectively, is old), which
provide less costly medical care
than we do.
Yes, there are proportionately
fewer poor Canadians. But the
implication that our exploding
medical costs are caused by treating
the poor - millions of whom are not
insured and received little care - is
mistaken.
We read that the Canadian
medical system works well because
of the country's disciplined
parliamentary democracy. Yes, it
does work well, but not primarily
for that reason. Canada's
supposedly disciplined Govemment
has a budget deficit comparable to
ours, and its federal system is in
danger of collapse from Quebec
separatism. Most Canadians love
their Medicare but view govemmeni:
no more favorably than we do.
Canada is the country closest to
ours in wealth, geography, ethnic
diversity and patterns of medical
practice. If we cannot leam from
Canada, we cannot learn from any
country.
Copyright 1992, The New York Times.
Distributed by The New York Times
Special Features.
259
�R. JEAN FLECKENSTINE. M.D., F.A.A.P.
CHIPMUNK CROSSING
R. D. 2, BOX 110 ORANCEVILLE, PA.
17859
March 8, 1993
The Honorable H i l l a r y Rodham C l i n t o n
F i r s t Lady
Chairman, Task Force on H e a l t h Care Reform
The White House
Washington, DC
20000
lonorable Lady:
You are t h e c h i e f reason why I was an e a r l y c o n t r i b u t o r
and e n t h u s i a s t i c backer o f t h e C l i n t o n - G o r e t i c k e t i n our l a s t
presidential election.
I g r e a t l y admire your courage and d e t e r m i n a t i o n
Your c r e d e n t i a l s are most i m p r e s s i v e . I am c o n f i d e n t t h a t
i f anyone can f i g h t t h e horrendous organized crime racguet
t h a t our n a t i o n ' s h e a l t h care i n d u s t r y has become, you w i l l
do i t .
I am a r e t i r e d female p e d i a t r i c i a n .
I want t o suggest
t h r e e areas where your t a s k f o r c e might be able t o make a d i f f e r e n c e .
I.
Upgrade medical e d u c a t i o n . American medical schools
are no l o n g e r e d u c a t i n g p h y s i c i a n s ; they are s i m p l y diploma
m i l l s where i n c r e a s i n g numbers of mediocre s t u d e n t s are being
i n d o c t r i n a t e d i n t o t h e scandalous h e a l t h care r a c g u e t . Get
laws passed t h a t would make t h e f e d e r a l government, ( n o t s t a t e s ) ,
responsible f o r a l l :
A. Medical school admission standards and admission examination
B. Medical school c u r r i c u l a
C. P h y s i c i a n l i c e n s u r e examinations
Give no f e d e r a l g r a n t money t o any medical school t h a t
does n o t meet new f e d e r a l s t a n d a r d s . P u b l i s h a l i s t of approved
medical schools and shut down any t h a t are n o t f e d e r a l l y approved.
H i r e p h y s i c i a n s t r a i n e d i n Canada, England, or Scotland t o
d e s i g n a t e admission reguirements and examinations and a 4-year
c u r r i c u l u m f o r approved medical schools as w e l l as f o r p h y s i c i a n
l i c e n s u r e e x a m i n a t i o n s . Make sure t h e person t a k i n g every
�r e q u i r e d examination i s t h e person they c l a i m t o be. I t i s
now p o s s i b l e i n some s t a t e s t o h i r e people t o take medical
l i c e n s u r e examinations f o r you. Make t h a t a f e d e r a l crime
p u n i s h a b l e by a p r i s o n sentence and heavy f i n e .
II.
Medical Records.
I am sure t h a t M i l l i o n s o f d o l l a r s are wasted because
p h y s i c i a n s do n o t a l l o w themselves time t o p e r s o n a l l y take
or even read adequate p a t i e n t s ' medical h i s t o r i e s .
I n some
h o s p i t a l s c u r r e n t l y approved f o r t e a c h i n g i n t e r n s and r e s i d e n t s ,
p a t i e n t s ' medical records are voluminous and so p o o r l y organized
t h a t s t a f f p h y s i c i a n s f i n d them almost u s e l e s s . S t a f f p h y s i c i a n s
a l l o w themselves t e c l i t t l e time t o read c u r r e n t medical h i s t o r i e s
l e t alone i n f o r m a t i o n o b t a i n e d d u r i n g p r e v i o u s v i s i t s or admissions.
I t i s f a s t e r and e a s i e r t o order redundant x - r a y s , l a b t e s t s ,
e t c . . . , than t o f i n d t h a t expensive i n f o r m a t i o n i n a p a t i e n t s '
h o s p i t a l r e c o r d . Any p h y s i c i a n w o r t h h i s s a l t should be able
t o diagnose pneumonia w i t h a s t e t h o s c o p e , b u t today he spends
thousands o f d o l l a r s on x-ray and l a b t e s t s b e f o r e he i s able
t o make even t h a t simple d i a g n o s i s . I n a d e q u a t e l y s u p e r v i s e d ,
i n e x p e r i e n c e d , and u n l i c e n s e d i n t e r n s should n o t be a l l o w e d
t o order expensive d i a g n o s t i c t e s t s .
P a t i e n t s ' h o s p i t a l records
should be computerized and a l l t h a t very expensive i n f o r m a t i o n
c o n t a i n e d t h e r e i n should be i n s t a n t l y r e t r i e v a b l e .
That alone
might save " T h i r d P a r t y Payers" m i l l i o n s o f d o l l a r s d a i l y .
III.
Federal l e g i s l a t i o n i s needed t o p r o t e c t c h i l d r e n
from c h r o n i c a c c u m u l a t i v e lead p o i s o n i n g which causes s e r i o u s
r e n a l damage and d e s t r o y s l e a r n i n g a b i l i t y i n i n f a n t s and young
children.
I can f i n d n o t h i n g i n c u r r e n t American medical l i t e r a t u r e
t h a t i n d i c a t e s a thorough u n d e r s t a n d i n g o f t h a t v e r y complex
disease.
I do read about compulsory lead s c r e e n i n g t e s t s ordered
by some s t a t e h e a l t h departments.
I do read i n p r i n t e d media
about f a m i l i e s being e v i c t e d from t h e i r r e n t e d homes and/or
apartments because lead p a i n t was found on t h e premises.
Families
w i t h young c h i l d r e n are s l e e p i n g i n t h e i r cars as a r e s u l t
of such scare t a c t i c s ! No where do I read about compulsory
t e s t i n g o f t h e water coming o u t o f s p i g o t s i n those homes or
anywhere e l s e , and y e t t h e most 1 i k e l y p l a c e t o f i n d t h e source
(2)
�of c h r o n i c a c c u m u l a t i v e lead p o i s o n i n g i n c h i I d r e n i s i n t h e i r
water s u p p l y . Blood lead s c r e e n i n g t e s t s are m i s l e a d i n g because
o n l y d u r i n g p e r i o d s when t h e c h i l d i s i n a s t a t e o f a c i d o s i s
w i l l lead be found i n t h e i r c i r c u l a t i n g b l o o d . Routine blood
s c r e e n i n g t e s t s on w e l l c h i l d r e n are t h e r e f o r e dangerously
m i s l e a d i n g . Please c o n s u l t r e a l e x p e r t s i n t h a t f i e l d .
Hire
e x p e r t s from Scotland or A u s t r a l i a where t h i s problem was d i s c o v e r e d
and p r o p e r l y d e a l t w i t h over f i f t y years ago! Do n o t l e t greedy
i g n o r a n t American p h y s i c i a n s make a bonanza o u t o f t h i s extremely
s e r i o u s p u b l i c h e a l t h problem.
There should be s t r i c t l y enforced
f e d e r a l laws r e q u i r i n g a l l p u b l i c water companies t o prove
t h a t t h e water they d e l i v e r t o every customer's b u i l d i n g i s
lead f r e e . At t h e present time they are r e q u i r e d o n l y t o t e s t
water b e f o r e i t goes t h r o u g h t h e i r water mains t o reach consumers.
Lead s o l d e r and "pipe dope" i n metal pipes are t h e p r i m a r y
sources o f lead p o i s o n i n g i n t h i s c o u n t r y . Wherever s p i g o t
water i s used f o r d r i n k i n g or cooking purposes, i t must be
t e s t e d f o r l e a d t h a t comes from t h e plumbing i n t h a t b u i l d i n g .
There i s no such t h i n g as a " s a f e " l e v e l o f lead i n d r i n k i n g
water or i n any c h i l d ' s b l o o d . Some device t h a t removes a l l
i m p u r i t i e s c o u l d and should be i n s t a l l e d .
Federal law should
make i t i l l e g a l f o r any manufacturer or anyone e l s e t o a d v e r t i s e ,
s e l l or r e n t any device c a l l e d a "water p u r i f i e r " t h a t does
not e f f i c i e n t l y remove a l l h a r m f u l i m p u r i t i e s . That would
mean a l l heavy m e t a l s , a l l h a r m f u l b a c t e r i a and p r o t o z o a , a l l
t o x i c and/or c a r c i n o g e n i c chemicals and a l l r a d i o a c t i v e substances
from d r i n k i n g water.
Every b u i l d i n g , whether p u b l i c l y or p r i v a t e l y
owned, must be i n c l u d e d . I t should be a g a i n s t f e d e r a l law
f o r any p r o p e r t y t o be r e n t e d , leased or s o l d unless t h e owner
can prove t h a t t h e water coming o u t o f t h e s p i g o t s i n t h a t
b u i l d i n g i s safe f o r human consumption. That, o f course, would
mean lead f r e e .
Federal law p r o h i b i t i n g t h e s a l e o f leaded
g a s o l i n e and lead-based p a i n t are steps i n t h e r i g h t d i r e c t i o n
but are by no means s u f f i c i e n t i n themselves.
Mrs C l i n t o n , you have a unique o p p o r t u n i t y t h a t no one
e l s e has ever had t o c l e a n up our n a t i o n ' s water supply which
has been allowed t o compromise t h e l e a r n i n g a b i l i t y and kidney
(3)
�f u n c t i o n of g e n e r a t i o n s of American C h i l d r e n . Whatever i t
c o s t s t o guarantee c l e a n d r i n k i n g water f o r every American
w i l l be cheaper than t o a l l o w t h i s tragedy t o c o n t i n u e .
P r o v i d i n g r e a l l y pure d r i n k i n g water f o r a l l Americans
would not o n l y h e l p t o p r o t e c t our p o p u l a t i o n from lead p o i s o n i n g ,
i t would a l s o s h a r p l y reduce the i n c i d e n c e of cancer, c h r o n i c
r e n a l disease, h e p a t i t i s and a host of o t h e r water-born i n f e c t i o n s
t h a t are e n t i r e l y too p r e v a l e n t i n t h i s c o u n t r y .
Compulsory
p r e v e n t i v e measures s u r e l y should be p a r t of any government
h e a l t h care p l a n because p r e v e n t i o n of disease i s always cheaper
and more e f f i c i e n t than any medical t r e a t m e n t .
S i n c e r e l y Yours,
R. Jean F l e c k e n s t i n e , M.D.,
(4)
F.A.A.P.
�ROBERT M. FRIEDMAN, M.D., F.A.C.O.G.
Medical Office Building North
Suite 107
830 Old Lancaster Road
Bryn Mawr, PA 19010
(215) 527-7940
March 9, 1993
Ms. H i l l a r y Rodham C l i n t o n
The White House
1600 P e n n s y l v a n i a Avenue
Washington.. D.C. 20500
Dear Ms. C l i n t o n :
W i t h a n t i c i p a t i o n and hope o f change I v o t e d f o r your husband t h i s
p a s t November. I am r e l i e v e d t h a t t h e White House a f t e r 12 years
has someone who s u p p o r t s i s s u e s such as a woman's r i g h t t o choose,
equal r i g h t s , b a l a n c i n g t h e budget, and i m p r o v i n g t h e d e l i v e r y o f
h e a l t h care.
As an i n d i v i d u a l w i t h a c o m f o r t a b l e income I knew
t h a t Mr. C l i n t o n ' s e l e c t i o n would mean i n c r e a s e d t a x e s f o r my
f a m i l y , b u t I , l i k e many o t h e r Americans today, f e e l i t i s t i m e
f o r us a l l t o p u t these m a t t e r s t o work.
I am a p r a c t i c i n g O b s t e t r i c i a n - G y n e c o l o g i s t i n Bryn Mawr,
Pennsylvania.
I l o v e my j o b , and I p r o v i d e a good r e s p o n s i b l e
s e r v i c e t o my many p a t i e n t s . These p a s t few weeks, however, I have
grown n o t o n l y s e n s i t i v e t o t h e many a c c u s a t i o n s t o w a r d my
p r o f e s s i o n , b u t t o be honest, q u i t e scared as w e l l . I applaud your
e f f o r t s t o improve t h e h e a l t h care system.
No p h y s i c i a n c o u l d
h o n e s t l y say t h a t i t does n o t need improvement. However, m y s e l f
and many o f my c o l l e a g u e s are b e g i n n i n g t o f e e l t h a t t h e p u b l i c i s
b e i n g l e d t o b e l i e v e t h a t n o t o n l y i s t h e h e a l t h c a r e problem
s o l e l y o u r f a u l t (which i t i s n o t ) b u t t h a t we a r e t h e v i l l a i n s ,
t h e bad guys, so t o speak, and now we a r e asked t o be h e l d
a c c o u n t a b l e f o r t h e f e d e r a l d e f i c i t r e d u c t i o n by once a g a i n
l o w e r i n g p h y s i c i a n reimbursement.
I would l i k e t o share w i t h you some background on m y s e l f t h a t i s
n o t u n l i k e many o t h e r p h y s i c i a n s . I o f f e r t h i s background n o t f o r
someone t o l o o k upon me (and my c o l l e a g u e s ) w i t h sympathy b u t
perhaps more r e s p e c t .
I began my quest f o r medicine a t t h e age o f 18. For t h e n e x t f o u r
y e a r s I spent enormous t i m e and energy t o achieve e x c e l l e n t grades
i n t h e hope o f e n t e r i n g medical s c h o o l . While i n m e d i c a l s c h o o l ,
I a g a i n p u t f o u r more years i n t o i n t e n s e s t u d y and t i m e t o m a i n t a i n
good s t a n d i n g and knowledge i n medicine.
A l l o f t h i s so f a r was
n o t w i t h o u t i t s enormous f i n a n c i a l burden.
I am g r a t e f u l t h a t I
�attended a medical school t h a t was able t o support p a r t of my
education, and I consider myself lucky t h a t I now, a t the age of
36, pay only $310 per month f o r the next several years t o o f f s e t
my student loans. A f t e r years of college and medical school I
entered i n t e r n s h i p and residency f o r 4 more years t o t r a i n and
s p e c i a l i z e i n O b s t e t r i c s and Gynecology. During t h i s time w h i l e
working over 80 hours per week (many through the n i g h t and through
the next day) I received an income averaging $24,000 a year. I was
responsible f o r many p a t i e n t s , and the experience was of enormous
value t o my f u t u r e years as a p r a c t i c i n g physician. Again l e t me
say t h a t I review t h i s not f o r you t o pat me on the back but i n the
hope of understanding the years (18 through 31) and expense t h a t
I i n c u r r e d so t h a t I may c a l l myself an O b s t e t r i c i a n . I challenge
anyone t o f i n d a l i n e of work, a f i e l d of e x p e r t i s e , t h a t demands
so much time, f i n a n c i a l commitment, and academic excellence f o r
p r e p a r a t i o n . There i s none.
I am c u r r e n t l y i n my 5th year of p r a c t i c e . I have a solo p r a c t i c e ,
thus I am on c a l l and a v a i l a b l e t o my p a t i e n t s 24 hours a day.
People t e l l me I am a dying breed, I w i l l be swallowed up by l a r g e r
managed care plans or h o s p i t a l s — I hope they are wrong. I not only
take care of my own p a t i e n t s but as an accepted r e s p o n s i b i l i t y as
a s t a f f p h y s i c i a n I need t o care f o r p a t i e n t s when I knowingly
receive no compensation yet I assume f u l l r e s p o n s i b i l i t y (and
accountability).
A f t e r a l l , I am a Doctor of M e d i c i n e — t h i s
p r a c t i c e I understand and accept as expected of me.
I also give
time t o the l o c a l High School t o discuss w i t h students t o p i c s such
as b i r t h c o n t r o l , sexually transmitted diseases, and gynecologic
care i n general. There i s no fee f o r t h i s r e s p o n s i b i l i t y t o the
community.
To have the a b i l i t y t o p r a c t i c e what one always wanted t o do i s
t r u l y a dream t h a t few people can r e a l i z e . I am f o r t u n a t e t h a t I
enjoy what I do.
I also need t o pay approximately $30,000 t o
$40,000 a year f o r medical malpractice so t h a t I can continue t o
provide medical care.
I have a monthly overhead i n my small
p r a c t i c e t h a t approaches $13,000 per month not i n c l u d i n g my salary.
Everyone i s looking t o lower physician reimbursement, yet the
demands and expenses of maintaining a physician p r a c t i c e continue
to r i s e out of our c o n t r o l .
As I s t a t e d e a r l i e r , I do make a comfortable l i v i n g . My c h i l d r e n
are kept warm, w e l l fed, they go t o camp, and I can a f f o r d t o pay
the $6,000 per year f o r family medical insurance. Do I deserve my
salary?
I b e l i e v e I do.
Am I ashamed of what I do or what I
charge f o r my services? Absolutely not. I am, as I have stated
�before, s t i l l paying several hundred d o l l a r s per month f o r my
education.
And no s i n g l e profession requires the demands and
e x p e r t i s e and a c c o u n t a b i l i t y as the p r a c t i c e of medicine.
I w r i t e t o you because I support the current a d m i n i s t r a t i o n . I am
w i l l i n g as a taxpayer t o p u l l my weight. I c r e d i t you f o r t a k i n g
on t h e challenge of reviewing and possibly improving t h e health
care system. But I f e e l I need t o remind you, everyone else, and
myself t h a t I am not the enemy.
Sincerely,
Robert M. Friedman, M.D.
RMF/dko
cc:
cc:
Senator H a r r i s Wofford
The Philadelphia I n q u i r e r
�M I L T O N
THE
J.
F R E I W A L D ,
PHILA.DELPHIAN
2401
SUITE
PENNSYLVANIA
PHII-ADEI.PHIA,PENNA.
M.
D.
2A4
AVE.
19130
232-2482
4/19/93
Mrs. H i l l a r y Redman Clinton
Attorney At Law
The White House"
1600 Pennsylvania Avenue
Washington, D.C.
Dear Mrs. Clinton
Because of the awesane task facing you with health refonji,
and no doubt you know a l l about this,enclosed, seme material
which you may desire be brought t o your attention t o aid you
i n your deliberations and decisions.
My sincere condolence on the passing of your beloved father.
May the godd l o r d i n his i n f i n i t e mercey give you and yours,
confort and strenth i n t h i s hour of sorrow and great loss
Respectfully,
.-^
7/UJL
Milton J.^FReiwald, M.D
MJF/ab
�Reprinted from AMERICAN PRACTITIONER AND DIGEST OF TREATMENT. Vol. 10, No. 6, June, 1959
Copyright © 1959 by J. B. Lippincott Compmy
Printed in U. tj?A.
graduated from New
University College of Medicine.
He has done graduate work in several
European Hospitals. He served as a
Major in World War I I . He is a
Diplomate of the American Board of
Ophthalmology, Fellow of the International College of Surgeons, and serves
on the staff of the Albert Einstein
Medical Center of Philadelphia and
the American Oncologic Hospital of
Philadelphia.
/1
IJ
M e m b e r , B o a r d off D i r e c t o r ' s
Philadelphia County M e d i c a l
jS ociety, Former Chief Medical
V
Off i c e r , H e a l t h & Human S e r v i c e s ^
Causes
Social Secui*^ A d m i n i s t r a t i o n ,
3rd Reginal Office U.S. . A d v i s o r
MILTON J. FREIWALD,'Mt).^ F o r H e a r i n g s & A p p e a l s H & H S g
Philadelphia, Pennsylvania ' ^ . S . 2nd & 3 r d R e g i o n a l
Blurred Vision:
Some Common
;
W/ieh a patient complains of "blurred vision," a
number of diseases or abnormalities must be entertained in the diagnosis.
The history and the ophthalmoscope are the main tools for the diagnosis.
B
L U R R E D vision resulting from a variety of
causes is a symptom which may tax the ingenuity of the most able physician.
Like so many isolated symptoms occurring from
time to time, particularly unaccompanied at the outset by associated or other related sensations, blurred
vision is frequently unnoticed; hence proper explanation or help is neglected for a long time. Because of
the importance of this visual sensation and its interpretation i n terms of general well being we should be
aware of, and understand, the many facets involved.
- --
U i f i c e
The physical phase begins witli an external stiimilus—light—which carries the images of objects, iiecause the human eye can only discern a very small
region of the entire spectrum of light waves, we sec
only a small part of the world about us. These light
rays enter and pass through the important transparent
and refracting structures of the eye ball, where they
are brought to a focus on the perceptive retina, similar to the film in a camera. The anatomic pliase (Fig.
Before taking up the causes of visual blurring, one
should have a clear picture of the mechanism of vision.
Vision is a sensation whereby the impressions of the
world about us are recorded i n that part of the brain
responsible for the act of seeing and its related areas
of integrated memory and thought. Like any other
sensation, a complex system of uninterrupted simultaneous phases exist making possible the visual act.
These phases, for convenience of discussion, may be
conveniently grouped as follows:
1.
2.
3.
4.
5.
A P-DT
Physical phase
Anatomic phase
Chemical phase
Physiologic phase or electrical phase
Interpretation or psychologic phase
June 1959
Fic. 1. Normal eyeground.
1023
U . S .
�teries and arterioles, fullness of the veins and a cherryred spot is seen in the macula. The retina like any
other part of central nervous system tissue cannot
tolerate a lack of oxygen f o r more than six to eight
minutes without undergoing degeneration (Fig. 3).
Acute inflammations of the optic nerve, chiasm or
tracts, results i n a sudden, silent, usually unilateral
blurring of vision, but may, however, be associated
with pain on ocular movements. T h e pathologic
process is caused by bacterial invasion or its toxic
products, chemical poisons, allergy or demyelinating
disease. T h e eye grounds reveal, if the visible part
of the optic nerve is involved (papilla), papillitis and
acute swelling with hemorrhages (Fig. 4). Should
that part of the nerve or pathway beyond the eye ball
be involved, referred to as retrobulbar neuritis, the
familiar aphorism applies—the physician sees nothing
except a normal eye ground and the patient sees nothing, symbolic of a short circuited sensory nerve.
Fic. 2. Visual pathway (showing various locations
of lesions).
I t is important to note that edema of tlie optic
nerve may result from elevated intracranial pressure
and that vision usually does not become disturbed t i l l
late. T h e usual causes of such swelling of the nerve
head, w i t h hemorrhages, known as choked disc, are
space taking lesions, such as neoplasms or subdural
hematomas, and the associated symptoms are headache, nausea and/or vomiting. When the intracranial
pressure is raised the increased pressure is transmitted
down the meningeal sheath of the optic nerve. When
there is an abrupt and severe onset of increased intra-
Alter a complicated
reaction, the chemical
phase,
whereby the image is transformed
into an electrical
impulse which travels along the vital visual
pathway
—the physiologic phase (Fig. 2)—to finally end in the
visual center in that geographically
located
region
known as area 17, the striated area of Gennari of the
cortex-in the occipital lobe of the brain—the
psychologic phase.
Obviously, should any impairment of these phases
occur, vision becomes distorted or cloud-like or lost,
depending on the type and severity of insult, progressive or sudden i n onset, either silently and alone, or
in association with other significant symptoms.
Classes of Blurred Vision
The classification of blurred vision may be conveniently
divided into three main groups—the organic, inorganic and physical.
I n the former, occlusion of the central retinal arteiy strikes suddenly, silently, usually i n one eye as
the result of thrombosis, spasm or embolism. Because
this is an end artery the circulation is cut off; the eye
grounds appear pale with collapse of the retinal ar-
1024
Fic. 3. Central retinal occlusion.
Vol. 10, No. 6 A P D T
T
�like an undulating cloud. There is always a tear or
hole in gross retinal separation and the bright red
color of the choroidal circulation is clearly seen. The
common causes of this painless episode are nearsightedness (myopia) of moderate to severe degree,
in which the retina is either cystic or thin from stretching as a result of enlargement of the eye ball, or injury by a direct or contra-coup blow, or by tumor
either localized or metastatic.
Among the metabolic causes of blurring of vision,
the most important is diabetes, particularly because
of its rising incidence and the verv serious consequences of visual disability. The findings in this
chemical disease are hemorrhage, exudate and venous
aneurysms into the substance of the retina, leading
to irreversible changes (Fig. 6, 7).
Fic. 4. Optic neuritis (papillitis).
cranial pressure, from two to three days pass before
swelling of the nerve head becomes visible by the ophthalmoscope. The swelling of the optic nerve can be
measured (3 diopters of plus power of the ophthalmoscope equals 1 mm. of swelling) (Fig. 5).
Retinal separation gives rise to blurred vision and
here the delicate receptive layers of the inner eye tear
away from their moorings and bulge into the vitreous,
Fic. 5. Papilledema (choked disc).
On the nonorganic side, the junctional or psychic
phase plays an ever increasing role in the production
of blurred vision. Sight is frequently experienced as
tubular. Acute spasm of the retinal vascular tree may
be seen on inspection of the eye ground. Other associated symptoms of tension are in evidence. In many
of these patients, due to an instability of the balance
in the central nervous system, an acute attack of glaucoma may occur (Fig. 7). Then the trigeminal pain
of unrelenting type, severe prostration and vomiting
are associated with a steamy cornea and markedly elevated intraocular tension, easily felt by finger pres-
FIG. (i. Retinal separation.
AP- DT
June 1959
Figurcs 2, 3, and 8 reproduced by permission of Sir Stewart Duke-Elder and
Henry Kimpton. Figures 1,4, 6, and 7 from Textbook of Ophthalmology.
Arnold Sorsby. Butterworth & Co., Lt'd.
1025
�••\i>
FIG. 8. Glaucoma.
FIG. 7. Diabetic retinopathy.
sure, or the patient may embark upon a slow insidious
progressive elevated intra ocular pressure finally leading to the classical picture of cupping of the optic
nerve head with atrophy and blindness. This is
chronic simple glaucoma.
Improper focus of the rays of the light image, as a
result of abnormalities of refraction, namely, hyperopia, myopia or astigmatism or improperly fitted
glasses, causes blurred vision. There are, as a general
rule, no associated symptoms.
C h a i r m a n a n d Head of the D e p a r t m e n t of O p h t h a l m o l o g y
W o m a n ' s Hospital of P h i l a d e l p h i a
222 Rittenhouse Square West
P h i l a d e l p h i a , Penna.
1026
Vol. 10, No. 6 A P - D T
�Eye
U.S.S.R.
Care
in
the
the
,4
MILTON
and
United
Comparison
J! FREIWALD.
M.D..
States
F.I.C.S.
Richard M.
Nixon
Lyndon
B.
Johnaon
John F.
Kennedy
Ronald
Reagan
C a s p e r W.
Weinberger
S p e c i a l c o rr, m e n d a t i •> n f r o m T h r e e
•
Presiden
ts
of The
United
S t a t e s and
D i r e c t o r of
Medical
Education,
of The
.American Medical
A s s o c i a t i o n
f o r the
A d b a n c e m e n t of M e d i c a l
S c i e n c e and
Medical
Education. ,
1
Reprinted
from:
International
»
Surgery.
Section
II, J a n u a r y
1970
�Lecture given at The F i l a t o v I n s t i t u t e ^ Odessa, USSR, by I n v i t a t i o n on September JtStrh,'•1963,
at 2:00 p.m. Milton J . Freiwald, M.D. F . I . C . S .
fSubject-1.
The Surgical Management o f Epi-Bulbar Malignant Melanoma, w i t h Special
Consideration t o Lymphangiography w i t h S l i d e s .
2.
t r e a t With New A n t i - v i r a l Drug " S t o x i l " ( I d o x u r i d i n e , Smith, Kline & French
Laboratories USA.) f o r ! Herpes Simplex K e r a t i t i s .
3.
Problems Concerning Glaucoma, w i t h S l i d e s .
Professor D i r e c t o r , Madegda Puchkovskay, distinguished p r o f e s s o r s , f e l l o w physicians,
s c i e n t i s t s , and f r i e n d s
I n benalf o f the Honorable Mr. Anthony J . Celebrezze,
Secretary of the Department o f H e a l t h , Education and Welfare o f the United S t a t e s ,
The Honorable Mr. Foy D. Kohler, United States Ambassador t o the USSR, Miss Frances
E. Cutter, Mr. Howard K l i n e , Mr. Johnne Sisk of the O f f i c e o f I n t e r n a t i o n a l Health
Medical Exchange Program between the USA and USSR and American Medicine. I am very glad
and consider i t a singular p r i v i l e g e and honor t o be i n v i t e d by your M i n i s t e r o f Health
of the USSR. The Honorable, Professor Sergey Vladimirovich Kurashov, t o study and work
t h i s past month with a l l you d i s t i n g u i s h e d and wonderful people here at t h i s great and
splendid F i l a t o v I n s t i t u t e , i n your charming and h i s t o r i c a l c i t y o f Odessa, as w e l l as w i t h
the distinguished professor D i r e c t o r Alexander Vassilyevich Roslavtsey o f the Helmholtz
State S c i e n t i f i c I n s t i t u t e f o r Eye Disease i n Moscow.
W i n America, as w e l l as i n other parts of the world have heard much o f the splendid
e
work you do here, but I know now, what F i l a t o v r e a l l y means. Great t r i b u t e i s r e f l e c t e d
by your distinguished founder-professor D i r e c t o r Vladimir F i l a t o v and the work c a r r i e d on
by a l l of you dedicated and outstarding people.
• I am sorry I do not speak. Russian, j u t one t h i n g i s c e r t a i n , we speak a common language
of medicine. Good medicine i s a task f o r a l l physicians i n a l l parts o f the w o r l d , so
necessary i n b r i n g i n g r e l i e f to the s u f f e r i n g and r e s t o r i n g the b l i n d t o u s e f u l and
productive l i f e - t o b r i n g people ir-. a l l walks of l i f e the j o y t o enable them t o pursue
t h e i r journey i n happiness. To use the L a t i n p'iiWie - "Ex Obscurus Lux" - "From out o f the
darkness cometh l i g h t . " The medical measures t o a i d people i n t h e i r quest f o r a b e t t e r l i f e
are preventive, medical, s u r g i c a l , -"nd extensive research. Such f i n e work i s c e r t a i n l y i n
evidence here at F i l a t o v and at Helmholtz, equal to any place i n the w o r l d . Your work on
Kerapoplasty, Cataract, Glaucoma surgery, t i s s u e therapy and a l l other aspects o f Ophthalmology with such large masses of p a t i e n t s both young and o l d from ' a l l over the Soviet Union
and other parts o f the world who come here f o r h e l p , i s e s p e c i a l l y worthy of p r a i s e . You
may f e e l j u s t l y proud of your wonderful accomplishments and i n s t i t u t i o n . I am sorry indeed
I cannot remain longer among my njewly acquired f r i e n d s and colleagues, but l i k e a l l p l e a s ant and good things .that must come t o an end, I must r e t u r n home. Besides, my visa expires
bn October 2nd.
Subject matter of the lecture
t i l l 4:30 p.m.
In c l o s i n g , meeting, working and b n ^king bread w i t h a l l you warm and wonderful people has
been f o r me a r a r e , most pleasant a" 1 f r u i t f u l experience and I wish t o take t h i s l a s t opp o r t u n i t y on behalf of the splendid o f f i c i a l s o f my govemment who made my v i s i t p o s s i b l e ,
a long l i f e f i l l e d w i t ^ a n abundance o f h e a l t h , happiness and p r o s p e r i t y . May good f o r t u n e
permit our paths tq'Mifcr^ss again, soc.;.. I hope our medical exchange program w i l l be the beginning f o r your professors and physicians t o v i s i t the United States.
De Svedania
Special commendation f o r a r e a l c o n t r i b u t i o n
from Secretary of State and Secretary of Health
United States Ambassador t o Russia, Toy D. Kohler
1
MILTON J. FREIWALD, M.D.
222 Rittenhouse Square West
Philadelphia 3, Penna., USA
The Albert Einstein Medical*
Center o f Philadelphia
�T h e a b o v e o i l p a i n t i n g g l o r i f i e s o n e o f t h e e a r l y successful c o r n e a l t r a n s p l a n t s in S o v i e t o p h t h a l m o l o g y b y V l a d i m i r F i l a t o v
( 1 8 7 5 - 1 9 5 6 ) , w h o s e m a j o r c o n t r i b u t i o n s w e r e i n t h e f i e l d o f t r a n s p l a n t a t i o n . T h e o i l p a i n t i n g , w h i c h hangs i n t h e F i l a t o v I n s t i t u t e
i n Odessa, was p h o t o g r a p h e d b y D r . F r e i w a l d .
Eye Care In The U.S.S.R. and The United States:
A Comparison
by MihonQ
Freiwald, M.D., F.I.C.S.
Dr. Millon J. Freiwald, F.I.C.S., rec'rh'tly stayed
al the Filatov Eye Institute, in the Soviet Union as
the American representative to the first medical exchange program in ophthalmology between the United
States and the U.S.S.R. The program was sponsored
by the ojfice oj International Health, Department oj
Health, Education and Welfare of the United Stales.
Although the United States has made greater strides
in therapeutic areas and in methods of ophthalmic
medicine, the U.S.S.R.'s developments in the field are
of the highest quality; in many areas of the specialty,
the two countries are quite comparable.
Much time, energy and research is devoted to the
prevention of blindness and the restoration of sight in
the Soviet Union. Two outstanding institutions have
been established for this purpose: The Helmholtz Eye
Institute in Moscow, under the direction of the late
Dr. Alexander Roslotsev, an outstanding physician
and scientist, and the Filatov Eye Institute in Odessa
12
on the Black Sea. The Filatov Eye Institute operates
under the direction of a fine woman physician. Dr.
Nadegda Puchkovskaya. Women make up 85 percent of the staff at these two institutes.
One of the most prominent figures in Soviet ophthalmology was the late Vladimir Filatov, whose major
contribution was in the field of corneal transplantation. Corneal transplantation was first successfully performed by Von Hippie in 1906, and by Zirm and
Elschnig in 1908. Although Filatov first began corneal
grafting in 1912, World War I interrupted his work
and he was not able to resume his studies until 1922.
By 1949 he had performed some 1,000 transplants,
and by 1955 he and his coworkers had performed
some 3,500 corneal operations. When one considers
the enormity of the statistics, this work is extremely
significant. Some 35 percent of all causes of blindness
are due to leucoma which prevents the image-carrying
rays of light from entering the perceptive retina and
ihen back to area seventeen of the brain.
International Surgery
�•H
Tt
O
O
bO
J
Eye Care in the
TJ
U.S.S.R. and the United States
Q
J
U
A Comparison
cu
•H
U
CO
u
ni
M I L T O N J. FREIWALD,
M . D . , F.I.C.S.
^
oj
o
•H
•JJ
ni
o
w
W
Tl
0
D
H
4J
^
fi
^
Oi
s
Reprinted f r o m :
International Surgery, Section
^ -fi
II, J a n u a r y
1970
a) a
o ^
m -Q
N o m i n a t e d f o r the s e c o n d t i m e to r e p r e s e n t t h e U . S .
to t h e
USSR, i n M o s c o w , by i n v i b - a t i o n of the M i n i s t e r
of H e a l t h
o f t h e U S S R . S e p t e m b e r 2 9 t h to ( p c t o b e r k4t.h ,
1972
Special commendation f r o m President Richard M. Nixon
and
D i rector
M e d i c a l E d u c a t i o n of the A . M . A. f o r
contribution
£o
i;
t
h
„
�Retinal Separation Surgery
Dr. Vladimir Shevelev is one of the leaders in the
field of retinal separation in the Soviet Union. Surgical
repair in the U.S.S.R. is similar to that in the United
States, and successes and failures are somewhat similar
in both countries. It must be remembered that the
results of retinal repair in separation will depend on
several factors: The location of the separation and
tear; the extent of the separation and severity of degenerative changes setting in prior to the patient's
coming for aid, and the duration of time elapsed from
onset of the retinal damage^ Regardless of the surgical
skill or method, an unfavorable location will yield no
dramatic recovery.
While working on his own, Dr. Shevelev worked out
a rerouting of Stenson's Duct to the fornix conjunctiva
for the substitution of parotid gland secretion for tears
in cases of lacrimal gland deficiency. To my knowledge,
this has never been duplicated.
Surgical Methods
A number of special instruments have been devised
throughout the years by Soviet physicians. I was particularly impressed with their corneal-scleral suture
stapler, which may save time and reduce complications
in the healing of incisional wounds. This stapler is a
smaller version of a stapler developed in the U.S.S.R.
for use in thoracic and abdominal surgery.
Cryosurgery for cataract extractioi.- whicli was pioneered and brought to fruition by Krwawitz of Lublin,
Poland, is used in the U.S.S.R. The late Dr. Roslotsev
gave me the instrument, then used wilh melhyl alcohol
and C02 for the desired hypolherniia and menlionrd
lo me at the time that he believed this method ivould
one day prove to be the safest method for cataract
extraction. His prediction was so true. The most modern apparatus for use in cryosurgery has, however,
been perfected in the United States--by such leaders
in the field as John Bellows, M.D., F.I.C.S., of Chicago,
Kelman of New York, and others.
The Soviet scientists are familiar with the names
and works of my esteemed friends, the late Temple
Fay, M.D., and his protege, Henry T. Wycis, M.D.,
both neurosurgeons of Temple University Medical Center who pioneered in freezing methods in neurosurgery. Dr. Wycis first induced hypothermia in three
critical cases of cerebral trauma successfully in 1946.
The success of glaucoma surgery is about as great in
the Soviet Union as elsewhere. The closed angle type is
usually managed by surgery, while the open angle
cases are predominantly managed medically.
Dr. Irene ;Kluka of the Filatov Institute uses an
ingenious machine for determining refractive formulae
Section I I , January, 1970
when dealing with large numbers of patients. By manipulations of dials, the machine gives the formula quickly and accurately. I recall seeing a similar apparatus
when I studied in London, but it was seldom used.
Soviet specialists have a complete understanding of
the broad subject of neuro-ophthalmology, and the
mechanisms of the physio-pathologic aspects of Strabismus and its surgical corrections are well known.
Therapeutic Management
The gap in knowledge between the Soviet Union and
the United States on the subject of therapeutic management is great. For instance, "tissue therapy" is used
in the U.S.S.R. to treat ocular inflammatory disease.
This consists of subcutaneous and intramuscular injections of distillates of such substances as lagoon mud
containing microscopic flora and fauna, aloe leaves
and beet and placenta extracts. Mascerated skin, at
first human and later animal, are also injected beneath
the skin of the patient.
According to the teaching of Filatov, tissue therapy
is based on the belief that these substances are rich in
biogenic stimulation which promotes healing of diseased uveal, retinal and optic nerve tracts. It is also
claimed these methods cure relinilis pigmentosa. I do
not recall any significant intra-ocular disease cure
with these methods. There appears to be no specific
scientific basis for ibis method of therapy.
Leeches are slill used for treating ocular disease
as well as traumatic problems in the U.S.S.R. It is
noteworthy that, when lhe leech sucks blood, a substance called hirudin, an anti-unagulaut, is secreted
into the wound.
From observation il appears thai iu medical management the United States is more advanced and has
a number of pharmaceutical products, including anti
biotics and steroids which increase the opportunity for
successful medical management, t he
. ,„' •.-.ticrj. ol
steroid therapy in the cure of Herpes Zoster Ophthalmicus was accepted with great acclaim by Soviet physicians.
The free exchange of medical thinking between scientists and physicians in the U.S.S.R. and the United
States permitted the visit to be most enjoyable and
rewarding. •
Tlie .abdve article is based on material which appeared in Pennsylvania Medicine, July, 1969, Vol. 72.
pages 101-102, and the Alcon Ophthalmic
Observer,
Vol. 2, No. 4, Pebriwry, 1969.
n
�W
H
B
H
H
9
They once were up..6-0.Jhey..won on a Hollin$ homer: Sports.'
Warehouses of Wealth:
Itie Tax-Free Economy
: J
'Second in a series?'"''"' ' •'
I'., ^
:
'
...,..;*..•,.;
'
In return for free care for the poor, hospitals
didn't have'to pay taxes. Now, there's lessrity care. But hospitals are still exempt.
•• - •
:-<.,•
^
'•• .
.Tribute fpr a team revered, a win fora.teanrvscor'ned. Sport's.
J .
•'.
.
...
' •..
Tho PHlluclolphln'InqulrorV JIM r n ^ S T O N
, . '
Graduate HeaUh System:has"renovated.a 112-yeaT;"old'English Gothic church a't'22d""and Chestnut Streets for'its'corpdrat'e "^''•"l
offices,.The cost: $4,miir!on. Graduate.ohairrrian Harold Cramer said it vyas,cheaper.than-|e'asing.qffice,.space. .
-.-,;>. ' . , ;
i
nr^i
•'.•'•'•;•'.•.'.••' • A „'
"
mm
' .-m
v
'.'.'.•'."»'•
L':>J
' ritjrfMlherl M.Ciiiil C
' • : - and Neill.A. Uorowski
1993 The PJilladalplilh.l'nqulror
r
PHOTOCOPY
PRESERVATION
,'
.hundreds .ofinohprofii hospitals across America,
,1 using"lhe|r tax subsTdies^have-boen-'iruh'sfbriricd.:
•from", small .charitable inslilutions -into, modern.
^
I'mliinlo ItiispMul oncu wjis. ;i slrn'ygliiiji-L'Oiii- fncdical''oiTipircs.. ' •
'
.
• Mm inimiiy liiisiiiiiil-in Simili' l»liil.nlol|ihiii wfihiii' • At a'-cost of more than SS-billioii a year in' lost,
.%m diinr-qit mission: 'icf.uire Jor-'tlic poor uinl .-.'federal and state/taxes. t_ . : ' ! • . . . - ,.',.- ,..
' help irniii "dficioVs.'-;
• "''' ' 'V " • ; •
•
'
That tax subsidy, pius others, have'spiirrcd the
Mosl.df.its beds were.occupied by palients who . phenomenal growth jih iionprolil hospitals. As.a,
cmildii.'i pay..Inrecogiiiiioiiof its charity, Graduaic 'group, - they tripled 'iii -size during the'1986s.'' •'• '
was exempted from paying taxes.
HospUals now are tlie single largest segment'of
> .More llimi a cc'n.lnry later, •i'liiiadtilpliiuns stili . the $850 billion tax-free cconimiy, accounting for. subsidize tlie hospital thnmgh 'tboir-'iaxcs..Dui:i'he nearly bnc-quarter of all assets. Since 1950,'their
isiinllaniy^ends, there'.. . . \ .-•. .
assets have grown .Ieiifohlr;irbm>$19-billi6n t0'$l95.
Today; Gradua'te Hospilnl' is pari of a. sprawling' billion, after'adjusting for inflation. ' .
S400 million healthcare conglomerate that inDecause they pay no taxes, many hospitals.have
• chides seven'hospilals/'ii pi'Ofit-makiiig.HMO/ ddz; 'accumiilafed^huge profits anil'used them.io build
•ens' of subsidiaries, 5,300 employees, a well-paid • -new hospital wings, to buy expensive equipment
.executive staff and lavish boadquarlor's in'a -reiio-' and"to diversify-into oilier'businesses.
>' •',' ' . vaied Gothic church.
. •• ^ ' •
That' lias led to overbuilding.and overstaffiirg of
Donations, once u hospital .inainslay,- account for, hospitals and has helped push health-care costs out.
less than I perceni• of .Graduhte's revenue now. of sight. On any given night,fane-thirdof all hospi'Most-of ils monoj; comes, from .fees lhe hospital . lal.bcds in America-are empty. , . . .
charges, jiist like any'commcrcial business. - "
In lhe last two deca'des, lhe average-cost'of a
And there is relatively litt'le-charily. Less Ihan .1 hospital slay has gone from £615 in 1970 to $1,900 in
• percent pf its SI20 inlliion'Hlidge'l in 1990 wenl lo .. l9kMo.*5;000 in im\+- a rise.bf 713 percent'. That
'• providing .free medical treatment..
, •• '
' •
See HOSPITALS on A12 '
••
'.•
,
t
em"
L
:
Tho Ptiila<1ol|]hid lnquiroi.
�' ^ r ^ S ^ W i s U i o n s a n d ;
uh S e s ' w e r e part of a .master plan to
build a regional health-care network
-That's what I have been trying to put
logether We'waht to have a vemcjUy ^
.
grated heahh-care ^ ^ ^ ^ t r
'
fhis will allow us to provide health care tar
-ilimcantly lower cost's than anyone else.
- Cder this plan'.'patients with less severe ,
problehis will be treated at 9 " * " ^ ^ . • •
„sl suburban hospitals, while
m° . J
volved cases will be .referred to the more
«fied so widelv.in the 1980s.that it drew the
a emion of local tax assessors and a
«
judge H e a l t h mc. .had invested *5 m ^
lion 61 hospital profits in 13 commercial
H ' S s t owned a pharmacy,) fetephone
. ' HOSPITALS fram-AI. .
6
Si
• t ^ , h ' r cMgesAO pdnenis . « no .lower
r e
n
T
' ^ S a m i c Z ^ m e h t s this strategy because it g ves' Graduate another source of „
referrals And Graduate's many for-profit
' nd nohprofit subsidiaries allow it to provide,,
patients the equivalent of one-stop shopping,
• ^ ^ a Sg business,-a very big compucated ;
felevision production company.
.
' ' 'Vhe bonventional wisdom durmg.the 80s
was
bV being competitive and using com
petnive economic the cost % r : , 7 care.
effect drive down P . " » " r of health care
l e
h
o-<
J
d
pum^d more than • « « billion Into non-.
C S S
granted for provtaing free care... •
Sound too good to be true?
g
ton , ^ ^ S ^ o h n t y Orphan,.
. •
•
K. ' Young. d ^ K ^ P
.
-^
g ; o f ' " t h e stewardship of the con
l n
R o b
e n
g
co
untin
SSE* - n o - W W ^
^Graduate is one'of the most expensive
'study iasted morethan a,ear. In
«r»;,or^
ChlWren-s-Hospital of Philade^hja h a s ^ S ^ ^ ^ ^ S a t t o n .
'
build ^f $i 17.'million research center and parking garage.
wrcent — are covered by. Medicare ana
emulated huge .surpluses. Most of this
^ m s from government under.these pro^ ^ S e & u n d e r i v r i
t h e ;.
- bulk of Us-expansion and ^quismons_
.
p
. ^r^ho pi ^ce^te
g
4
r
health, care at afforde'r's. IB-month examinaable rates, .and not-be
lion of nonprofits: .
overly concerned with
• Hospitals have moved
turning a profit.'-' • ' ; ••.
more than. S3 .billion
- -Since the judges r e into tax^xempt foundaport, HealthEast has
tions and holding com-shed at least eight of the
panies, where they have ,
'. for-profit " businesses.
financed acquisitions,
Mso its name. The nonuaid big salaries, and
. profit business, is now.
underwritten
investcalled" •Lehigh. Valley
ments in for-profit bu i
Health' Network.
nesses..'On'e effect of.
' Belatedly.' the Interthese transfers is to
nal, Revenue Service
make the hospitals aphas begun to,look.more
pear less wealthy than
Ihey really are. Officials
.. closely'at-the. diversifi, cation, too.
say the funds are used
/•There's no quesuon,
i to buv- equipment and
hospitals are-a good ex- o ^ h ^ i n e s s i n c o r p o ^ d i n A ^ s , ^ .
..replace old .building.
ample of bow-.some
3 But little seems to flow
•large nonprofits. have
i back.to the hospitals. In
changed,
becoming
* 1990 hospital - foundaServices 1 ^
.
businesslike,-., even in- ^i^ehabaitation
- tions in Pennsylvania"
vesting in for-profit-. Krprofit physical therapy service incorpo . j S ^
plowed back just S perVentures. They, present,
- ce'nt-of'tbeir money, an
one. of .'the most chalanalysis of tax returns
lenging areas- for us,'
of 52 hospital, founda- - m
of 52 hospital founda
r ^ f i W ^ w o ^ said Marcus S, Owens,
tions .shows. Thirqr
tions .shows. Thirty
* I S ^ J ' ^
^
director ot the-tRS's Ex- . r H Holding 'C6rp:,-.a' for-profit holding
nine-'percent of the
nine-'percent of the
± ^ S U ^ r ^ ' - •
empt - .Organizaiions.- corip^rfdr sLe/or Graduate's-con^rcial e r ^ l n
V money went for founda \
~ £ ^ j .
^ Technical Division. j.-iioiia
'"..-Hes-; •
'
'- • • TnePhaaaapm.^.^ , . . . j j
. .jhe'IRS anventure, incorporated in August W
^ , ^ ^ c
t
S
e
boTds has gone to fund equipment, buildings .
and parking garages.
~ « t e has '.
r
d u
subsidized this transaction m severa. waj ..
t S V y , Graduate officials used an 51U
million bank, loan to purchase: the 2 0 w _
S
(
1
.
^
^
^
c
^
S
^ currcd at the same lime my crystal ball said
l i m . T n n t ^ ™ ^ ™ ^ . we should be developing a regional health^v^^eractoowledg.^ry^;:
v
A
1 9 9 )
:
•'-vide rodioloa:service?-. - Z V
"-'-«- •
^
^-pa-n.-of "a. non cash'merger,
« ^
^
H e , ^ Founda-
^«»«rS''
h ' operates medical centers ,n Riv- . . ^ S ^ t a l
J
~ ~
afloat. Graduate offi^ -
�^ nine percent of the.
said- Marcus S. Owens, venture with SmithPGine Bio-Science Labora-"income taxes. Some were later .abandoned.
£ money went for,founda-.
, In the late WSOs/'Cfaduate'also began, to
director of the IRS's Ex- lories.incorporated in.'July:1986. •;
v .tions'. administrative.
empt.
-Organizations • G^H. Holding Corp«;a for-'profit-hblding". -.buy other hbspitalSj'and health-care provid-.
\ overhead and salaries;
company for some 'of-Graduate's-comm^rciar; ^'ers: In 1987, as part-'of a'noh'-cash'mefger;
• / nie PhiladeipJita Inqurw jfechnicah Division,
.., -56 percent went into;
..^Graduate.acquired.Zurbrugg Health-Founds
v. In- 1991, the IRS aii-i venrures, incorporated' fn August 1986!
^ slocks, bonds ahd certificatesVof deposit.
•nouncedit was changing the'way it audits- f-Mt.-Sinai-Radiology Inc., a-.fof.-profit'.com-- - tion,.which'Operates-medical centers in-Riv^
• More than S40 billion-was. used to build nonprofit hospitals to.t.ake.mto account th'eir pany;.incorporated in February'1988 to-pro- -j' erside and Willingboro, N:J. . ' . . • '
,^ hospital towers, offices and parking garages, increasing, complexity and.commcrcial na- vide radiology services.; • ': ' -;,. ''..J'. In 1988;.Gradua'te,paid S11.2 million'for Mt.
Graduate. Health System Inc., a nonprofit V Sinai Hospital, a financially'ailing facility at
v At the time of. .this expansion, the 1980s, .ture. Since then,, the agency has begun 23
management firm'set up.'in
hospital use was declining by 13 percent: comprehensive-audits. • . : .
- Fifih and. Reed-'.'Streets in
V Patients are paying for this; overbuilding: ' ' I expect.based on.lhe information to date, 1988 to oversee the expand. South .Philadelphia: owned
rs Between 1984 and 1988 thesportion ofipatienl that we will see'sonie revocations'' of hospi- '.Lng network. It is'the parent tax forms showed
by.. :th'e Albert Einstein
V bills "that covers hospital capital costs" in: -tals'tax-exempt status. Owens, said. company of Graduate Hospi- hospitals haying
.' Healthcare Foundation.
'' - a •
creased on average from S3U to S523. ^ •
tal and its spinoff busmesses.
.. A-year later. Graduate pur• Billions of dollars were used to expand"hos-.
When charity patients arrived at.the hospi- • U/G Holding Corp., a.'non- shares in travel
chased* .John . Hancock
pitals' corporate networks. Lutheran General -lal at 18th and Lombard Streets in Philadel- profit firm incorporated in agencies,, parking '. HealthPlans Inc:,.a for-profit
<) -Health Care System, a S600 milljonconglomep phia a century ago, it was called The Poly- the late-1980s lo pay key exHMO with about'40.000 memN ate near Chicago, in the' 1980s, diversified. clinic Hospital.
ecutives of Graduate HealtH lots, laundries
bers. It paid 'SI.8 million in
\ widely, operating 65 subsidiaries, including a
By the early-1920s, it had become-the clini- System. These salaries to- — even a duck .
cash, assumed' liabilities pf
^ nationwide chain of dru^and alcohol rehabili- cal; training facility for the University of taled $1.5 million in 199b: inSU.8 million .and agreed to
^ tatiomgnters. This agg^eS^t^str5tEg)^atSi- Pennsylvania's new Graduate School of cluding Cramer's.$350,749.
hunting lodge.•pay^anqther S1.7 million that
backfired; forcing officials to reduce lhe value Medicine; called Graduate Hospital.
- Another. S million was
4
. • .. . - _
-the.health plan owed to an-'
of their holdings bv Si03 million.
But the.-mpdern history of the 103-year-old usedjo buy and renovated 112-year-old Eng- other, company. The-:HMO :was renamed
• At least SI billion has been invested in hospital begins in 1977, when the University
- ^ commercial spinoffs: Exampies'from-lhe 250 of Pennsylvania decided to spin off Graduate lish Gothic church at .22d. and 'Chestnut Greater Atlantic Health Plan:
Streets — now corporate, headquarters* for
in a'related transaction;'Graduate-bought
- hospital IRS forms The Inquirer examined as a separate corporation'.
Graduate Health Syslem.'The award-winning Philadelphia. Health Associates Inc.. a for_ . .
. ..
Enter Harold Cramer.'a Philadelphia law-,
include amo-l'easing^cpmpaniesl book .publishers. hotels, laundries, pharmacies. restau . yer specializing in. health care, and a small building features a great hamraerbeam roof, profit corporation that provides- physician
.65-foot glass wall overlooking, aii atrium., services to the'HMO. It-cost more than'S3.6
rants, parking lots; Iravol. agencies,, a duck ' group-of .associates. .hunting lodge and, in the'case of.th'e'Mayo j Under its new leadership, Graduale'ob- cherry, wood-paneied rooms/and a.gas-fire- million, including-iiabilities'of'SJ.l million.
Graduate officials guaranteed payment of anClinic. an airport management company...- \ .tained.S38" million in tax-exempt bonds to place in the executive offices.
Why would a hospital invest in an airport? | build a ne'w.pa'tient care tower. Its'revenues '• Cramer, chairman and chief-'executive, $8.4" million • mortgage!.on a medical office
• The Mayo ClLnic_has patients come from - • increased. And for the first-time ill years, if said that purchasing-.'and renovating the property as part of the" transaction.
all over the world. To make sure-they could showed a .profit.
church was cheaper than leasing office
In 1991. Graduate acquired. Community"
get here, we had to have an-airport," said . In fact, after rec'ording.a loss of S676.815 in space. Still.;he'declined to be photographed Genera] Hospital in Reading .-in a "non-cash
Chris Cade, a spokesman for the niedical 1980. Graduate posted profits in each of the there because of concern 'that outsiders merger, with-the 164-bed facility becoming a
facility in Rochester. Minn. ',
might look at.-the' church ."as.a'Taj Mahal." subsidiary of Graduate Health System. ,
next 11 years. They totaled 'S47 million.
As nonprofit hospitals have moved further
The profits-helped underwrite a rapid exGraduate's expanding, network'also in."And this year", Gradu'ate'bought two hospiafield, competitors and taxing agencies have pansion in the 1980s. Among dozens of sub- cluded medical.office buildings, parking lots, a tals from Osteopathic Medi'cal'Center of Philbecome concerned.'
-.- •
sidiaries that Graduate created were:
sports medicine center.ian occupational ther- adelphia for $16.million, plus a S12 million
In Allenlown. a healih conglomerate diver- •• X-RAY.Associates Lid., a commercial radi- ^apy clinic, a limited partnership to develop note. The $16 millionrcame from a refinanc1
3
-
I
,
:
-
;
7
care network;" '•
It,was, Cramer "acknowledges, "very risky.
. TheTosses_we*re much bigger than^we knew."
. Between-Feljruary.1988 an"d"June.l99iV.MC'
Sinai lost neariy;S32 mi.ilion;.according.to tax
returns and financial records.- Iri 1990 alone,"
.it losfSldS million.
:' .-' • . V
To" keep'the'.hospital afloat, Graduate o'ffi-xials advance'd Mt. 'Sinai :S20'.'million, with
.most of incoming from.Graduate Hospital.
. Ih May. 1989. Cramer'resigned as.a.senior
•partner of Mesirqv, Geimah, Jaffe,.CTamer &
JamiesonHhis ibtigtime.'law-firm; to become
chief executive "officer of .Graduate Health
System. He" had been. its. board'chairman. '
"The board lof Graduate Health System]
asked me to db.it.'The Mt. Sinai situation was
killing us." he said.••Gradnate officials soon decided to slop
operating Mt: Sinai as a community hospital.
In-a series, of steps, they shut its emergency'
room, slopped doing' general surgery and
ended routine se'rvices.-Later. they marketed
the hospital as a specialty center for cosmetic,
surgery, drug and alcohol detoxification, n
habilitation services and psvchiatrl^lservices — in effect,- a-bouuque medical-center.A key strategy behind tKese moves.was to
attract more private-paying patients, and to
maximize; reimbursements from'_Medicare
and_ilgdicaid''fhe way to'do'this, GfaduaTe
onicialsHeci'ded; was to offer ..services that
are not subjectto the government's stringent
payment systems.' ' , . . ' ' ' ..'
Unlike most services,-the government 'pays
hospitals their full costs on detox.Tehab and
psychiatric services. " - . " . . '
. The Mt,Sinai strategy; was.outlined in,'a
December' 1991 document submitted-to-the'
Hospitals 'Authority'bf-Philadelphia.
• Continued on next page
:
,
:
r
it c m s to tnuisplants
o e
The high-tech procedures are.w expensive that hospitals require patients io make sizable .deposits.
By.G'ilhprt M.Gaul
and Ncill A. Burrnvski .
cent of the "hospital's .charges. '-' ; -' ••' The. hospital and the family were,"nego"tiat|ng with
, "As you are aware, it is the:policy of the University., insurers, when Wilson died ori Sept. 6. 1985.
of Pittsburgh Medical Center that a patient be both_
Four days later, .'Dr. Thomas Starzl, a' transplant'
'hese days, many medical miracles carry hefty -, medically and financially cleared to be eligible" for*" specialist at.Presbyterian, decried the:hospital's hah-'
-price tags. Some high-tech. procedures are-so, transplantation." Barbara-Gannon, transplant credit • dling of the Wilson case during a staff meeting. Notes
expensive that hospitals won't.give them away.as' manager, wrote Zeller on Feb. 12.,- ~
'• 'of. that session, which'arc part of the" court recordcharity... .'
..-; - Prebyterian University Hospitaris.part of the Uni-.' reflect Starzl saying the case'"show'ed an insensitivity
Liver transplants, for example. -.
- versity of Pittsburgh-Medical Center. . - , '~ : ... as.well.as.bad moral'judgment..'..-.in'light.qf.the.
Linda Demko. a 38-year-oI'd mother from the Pitls- - "Medical. Assistance of Maryland does not provide money the'program'brings to .the-hospital:" ^"
burgh area, .learned-in 1991 that her-liver was so* adequate payment for transplants performed at hospi- ' Lawyers'for-Presbyterian have appealed'tlie Wilson
diseased'she needed-.a transplant .to -survive.- But tals outside the State-of^Maryland." Gannon.,wrote. . verdict-and say lhat Wilson was. not rejected-because
Demko's husband, John, an unemployed steelworker;-. "The required deposit .'for'a liver 'transplant, is . of financial.concerns.-A hearing'is.pending.' '*
had no health insurance.
$208,000. Please be advised. however,.that this amount
"When it comes to. medical miracles like transAnd the couple' didn't have anywhere near the . does not represent ah estimate of your total charges. plants: charitypften fails to survive the wallet biopsy
$208,000 deposit.required for a transplant by Presbvte- You may "find-that your." total charges- significantly . tesC'said University of Minnesota medical: ethicist
rian University Hospital, a nonprofit medical facility > exceed the deposit- amount.".
Arthur,!.. Caplan. "I call i i the 'Green'Screen.' What
in Pittsburgh that specializes in liver transplants.
" I don't have lhat kind:of money and neither-do do hospitals do with' high-tech procedures? They
.. Linda- Demko .died on Dec. 29. 1991. before her. - hundreds.,of other people." said Keefer Zeller. Eve- make sure only those with the ability tb pay.get them.
husband could arrange.financial assistance. "She just; lyn'shusband, a pressman.at the Baltimore Sun news"Transplantation is. where.the world of nonprofit
went too fast," Demko- said recently.
paper. "They-dp cases that make national hea'dlines.
altruism intersects with the
• Bonnell Sirott. Presbyterian's associate director of. but cases like my wife's, they turn iheir. backs." ' . and high profits. Organs.thatare world of high .prices .
and
donated"by.generbus
finance, said. "We do not have'a specific policy which ' .Evelyn Zeller. 54. is still looking for a hospital that families are m'agically transform'ed ihto.engines of
provides for free transplants. However. We do work- will perform a transplant.
'-.' • profits," Caplan said:. - ;-' ' . . . .'. ." .
with patients to help'them arrange-payment." -.'
In. November, a jury awarded'S3 million.-'-to the
Presbyterian spokeswoman . Jane" Diiffield said the
She said the hospital had tried to gel the Demkos on. family of another Baltimore resident, Hugh E. Wilson, medical center "dbes.pr'oyide.agood amount of chariMedicaid. "For reasons 1 don't .know, the Demkos. after concluding that Presbyterian had denied Wilson ty care, but not necessarily for transplants."- •
didn't start this process until very late," she said.a timely.-liver transplant.
The hospital's IRS filing shows it gave away charity
Even having Medicaid sometimes isn't enough..In' , The. family contended that Wilson was passed over care valued at S2.620;136 in 1991, That was less than.l
February, Evelyn Zeller of Baltimore was turned twice 'fur an available liver, even though he had percent of its S.376 million operating'expenses. The.
down for a-liver-transplant by Presbyterian officials health,insurance. Their suit said-that'hospital offi-. .hospital's 1991 profit of nearly S32'million was more .
because Maryland Medicaid would pay only 70 per-' cials were concerned they would not get paid in full. than 12 times what it spent on charity care.
INQIJIKEH STAFK WK1TERS
-
-
(
The Philadelphia Inquire: / MICHAEL U A L L Y
Evelyn Zeller needs a liver transplant but cannot
afford the $208:000 deposit. "I don't have that kind:of
money," her husftandi Keefer Zeller, says. •
Is
5 o
93
�/
The Philadelphia Inquirer
• /Conti
'Continued from preceding page
"H'- Sinai ;has an increased percentage of
^inai
TO
co -n
m o
§3
A13
president Jeff Flood.
Indeed, hospitals are. an important ecocpst-b/sed payers oyer the prior years," the
nomic force , in the region. But their tax
document, reads, "the majority [50-60. per. breaks.are based on their charitable commucentrof inpatient acute care and -skilled
nity service, not the jobs they provide.
nuTsing beds are currently exempt from ttie
And the profits that some have accumuprospective payment'system, resulting in delated makes it hard to argue persuasively '
creases in bad debt and free care and other
lhat they are trying to. control costs.
administrative adjustments."
Consider these examples from tax filings
The keys io the new Mt. Sinai strategy were
with the IRS for Ihe years 1989 through 1991:
ito "limit.competition with neighboring facil;
• The Mayo Foundation in Rochester, Minn.,
[ties; de^mphasize location through specialowned S53] million in stocks, bonds and
ized product lines and regionalize the refersecurities and controlled. property worth
rarbase," the document says.
$773 million. In 1986 and 1987, Mayo accom- .
' the approach apparently worked. Iri 1991,
modated palients who were retiring to warm- '
Ml. Sinai reduced its operating loss to about
er climates by building a $27 million clinic
5800,000. And in.1992,-the revamped hospital
near Jacksonville, Fla.; and another $65 mil- .
made a 537.000 profit, Cramer said.
lion facility in Scottsdale, Ariz.
How does this strategy jibe with Mt. Sinai's
• The Cleveland Clinic Foundation held $207
status as'a charitable, tax-exempt community
million in cash and investments, plus prop- ;
hospital?.
erty worth $627 million. Clinic officials *
'.'There's a real need for these services. Oiir
opened a $150 million satellite facility in Fort >
adolescent psych and geriatric rehab proLauderdale in 1987. They. too. said tPey were ,
grams are. full. And we've added a skilled
following their patienls south. .
nursing-'facility; which is also in-great de• The Methodist Hospital System in Houston' -•
mand," Cramer said.
• held investments worth $600 million and prop-,
. As for'charity, Cramer said Mt..Sinai and
erty valued at $408 million. Among its many Graduate System's other hospitals "never
investments: the Chez Eddy, a self-described .1
.turn anyone away. We take everyone who
highly acclaimed gourmet restaurant," and a t,'
shows up ... including AIDS.patients who
duck lodge, since sold. Between 1986 and 1990,
other hospitals send.-us by cab."
its diversified holdings generated $100 mil- u
For taxpayers, the Mt. Sinai saga doesn't
lion, yet only $3 million was returned to the
end here.
hospital. Meanwhile, the hospital's prices rose
In late 1991. Graduate sold $112-million in
an average df 7 percent a year.
"tax-exempt bonds through' the Hospitals Au• Thomas Jefferson University in Philadelthority of..Philadelphia.as part of a systemphia had investments worth $247 million."
wide refinancing.
.
and owned property and equipment worth H
According to an offering statement, bond
nearly $356 million.
: ..
proceeds were to be used to refinance earlier
-.
i - . - The Philadelphia Inquirer / MICHAEL MALLY
• Main Line Health System, which includes •
debts; fund various capital projects, includoryn Mawr. .Lankenau and Paoli- Hospitals
ing an underground garage; and pay back Under chairman.and-chief executive officer Harold Cramer, Graduate Health System Inc. has grown into.a regional health-care
Graduate Hospital.and Graduate Health Sys- network. "It's a big business,a very big complicated business.'^Cramer said.."But if you don't run'it like a business; you won't plus 21 other affiliates, held $230 million in „
investments and $411 million iu property. «
tem the S20 million ahey had advanced Mt. be around to service the community."
'
' ., • •
• Children's Hospital of Philadelphia and its .
Sinai to. keep it .afloat. .
affiliates owned nearly $190 million in
Ordinarily, tax-exempt bonds are used to
stocks, bonds and other investments, plus
pay" for new hospital construction, 'not to '
$175 million in property and equipment.
insulate a hospital from the consequences of
Like other hospitals, Children's has used '
an investment gone bad'.
its surplus .to expand rather than hold the •
Yet, .in this-instance, that is what .took '
line on patient charges. Those keep going up.
place/Graduate officials were able to recoup
averaging 7 percent a vear for the last five
a substantial-portion of their operating losses
years. Says Children's President Edmond No- •
at Mt. Sinai — and to do it .with the help of
tebaert. "Our increases have been lower than :
lhe public, whose taxes make up for the
those of other comparable hbspiitals."
interest lost on tax-exempt bonds.
In 1989, Children's opened, a $48 million -i
Cramer said using tax-exempt bonds to pay
building for outpatient care and administraback Graduate is not unusual. "Federal poltion. Ust year, the hospital sold about $200 •
icy allows for it: This is hot something that
million in tax-exempt bonds to renovate
was created for Graduate." he said, "this is
Children's Hospital and build a $ll7-million
not.something I'm-borrowing and am not
research center and parking garage.
able to pay. back."
The-hospital said it would contribule $69 .
In essence, the risky Mt. Sinai purchase
million. Patients and taxpayers will pay for
became a" risk-free venture — thanks to tax- •
the rest in at least five ways:
payers.
Patients will pay higher charges to help
cover increased overhead-and debt; federal •
„
For.years, hospitals earned, their tax extax dollars will underwrite much of the •
emption by giving away a substantial amount
medical research;' investors who buy the .
of care; • " .
•
hospital's tax-exempt bonds will receive tax .:
. Until 1969, they were required to provide
breaks, resulting in a loss to the Treasury; a free medical care to the extent of their
low-interest $9 million loaii from the state .
financial resources — what was known as
will help pay for the. project; and the new .the "finaricial ability" standard.
research facility will be off the cily.'s prop- •
It reflected .the long-held position of the
erty tax rolls, which means the public wil] .,
government that charity should benefit the
shoulder a larger share of the tax burden. poor,' hot an indefinite class: of people.
a
ln.1969,' fRS officials dropped the financial
. How much'charity care do nonprofit hospiability-standard in favor of a "community
tals provide?'-Does it equal the value of their service" standard, which defined charity-in
$8 billion tax exemption?
broader terms. Hospitals how qualified as
The American Hospital Association says
tax-exempt charities -because-they.promoted-^
"that hospitals provided.S8.9 billion worth-of
.health .services for their communities.
free treatment in 1989:
"Like -the relief of poverty and' the ad"The problem is one in which we are
vancemem of education and ..religion [the
seeing the indigent and- the uninsured paprovision of heaith care by hospitalsiis one
jM.' Osteopathic
. tients that are showing.un.at our. hosnitals at .. .
1
•
1
\
The Tax-Fjee Economy Monday, April 19; 1993
J
�- aoimy sianoara in •!avor"Oi-a~" commuDiry ,tals provide? Doe's iVequal the value of their "
service" standard, which defined charity in"
$8 billion..tax•exemption?/. •
-.
broader terms. Hospitals now. qualified as..
JThe .American HospitaK"Association-says ^
tax-exempt charities. because-they-promotedthat hospitals provided S8.9<billion worth of ~
health sen'ices' for their communities.- • ."•
free treatment in 1989, ,•
. ,•• .
"Like the relief of poverty, and the ad-"
"The problem is one'iri' which we" are" .
vancement of education andlreligion Ithe
seeing theUndigent and "the uninsured pa-' ••
provision of health care'by hospitals] is one
. -tients that are showing u'p at our hospitals at ."
of the purposes in. the general law of charity "
a greater aid greater number, with nowhere *.
that is deemed^beneficial to the.community,
lo shift that" cost," Jack iW. Owen, a'ctirig t
as a whole, even-though the class of benefipresident of the.American Hospital Associa-. ;
ciaries eligible to receive a direct, benefit
from its activities does not include-all mem• tion, told Congress in-,July 1991..
" " •"
. bers pf the community, such ;as iindigent
But-some'critics-say the-hospitals' figures" '
members, of. the commuhity,"(.the IRS riiled.
are inflated; because they_include bad debt
, In.other words, just being there is enough
and other costs that are not charity.,
"The'hos'pitals are playing with the niim— whether'podr people are-helped or not.
. bers. and-'in.some cases'their 'charity "care J
Nonprofit hospitals had beenMobbying for.
doesn't come close to. the .value of their ~
such a change for years. In discussions .with
exemption." said Donnellyythe former con- .
IRS officials and testimony before congresgressman.-. .
'" sional panels, hospital-officials contended-,
A 1990 st'udy.of nonprofit, hospitals in-five •
that most Americans had government or
slates by the General "Accounting' Office ;
priyate health coverage. There.just weren'tshowed that 57 percent provided less charity '
that many charity cases, they said.
care than'the tax'benefits they derived.
In 1968. Congress appeared-to be on the
Overall,-industry data shbw charity-care'.^
threshhold of-passing legislation adopting
' accounts for. about .'6 percent of nonprofit
the hospitals point of view. But differences
hospitals': budgets. In Pennsylvania, the aver- •.,
between House and Senate committees over;
age is about 3 percent- •
-.
;
an acceptable definition bf charity proved
Those numbers -have^declined.
irreconcilable, and the.issuevwas dropped. .
. Enter the IRS'.
..„•_ • • . '
In l?8.6. .hospitals spent.Pn'average 6.5'.per- .,
cent of their budgets" bn-charity" care,' the ?
The tax agency also had beeh.studying the =
American Hospital Association'says. By 1990,
issue'and interviewing hospital administra- .
the number was 5.9 perce'nt?,In Pennsylvania,
lors. Rather than wait for Congress to pass a
it fell .from 3:5 percent to 2:9 percent, accordlaw, IRS rewrote its.own regulations, loosen- ing to the Hospital Association of Pennsylvaing its definition.of.charity: •
nia.'
•'.
'
• • "They accepted the hospital industry's
. Some spend even.less. Methodist Hospital'-''
point of view that there was no more charilyThe Philadelptte Inquirer/C. CHAMQERUN System ip Houston made a combined profit bf
problem." said Daniel C. Schaffer, a professor
$76 million in 1991, and gave.away $5 million
. of lax |aw at.Northeastern University. "On - • "It's very difficult politically to raise these
The number of nonprofit-hospital employ- the basis of their representations, the service, issues. Hospitals are very powerful and have ees reporting.income.over $30,000 rose 10 • Commerce-Department cited the labor inten- in charity care — or 1 percent-of its gross f
sity of the healthcare industry and the high patient revenue.-Its federal, state and local
decided lo discharge hospitals of their re- an array- of lobbyists." said Donnelly, who times.as fast.'
earnings for professional, administrative
sponsibilities."
retired in January after 16 years in WashingAt specific hospitals, the growth" was more and technical workers as the'most important tax exemptions were worth 536 million.
In the fivfrcountyPhiladelphia'area,.hospi-.Schaffer said IRS attorneys believed that ton. "You don't get any votes for taking on dazzling:
reason medical expenditures increased by tals say they prov ided more than $169 m illion
Medicaid would cover most uninsured and ' the hospitals."
At Thomas Jefferson University, the num- 11.5 percent ih-1992-to S838.billion.
in charity care in 1991, including nearly $127
indigent Americans. Again, that's what the . "Congress was asleep on this, issue." said ber increased from 295 to 3.307 employees..
million in Philadelphia. They say these eashospilals had said.
Daniel M. Fox, president of' the nonprofit
At Pennsylvania Hospital., it- increased ' • Perry J. Leon, 64. pf Northeast Philadelphia ily dwarf the estimated $80 million in proplu fact, Medicaid never came close to cov- Millbank Memorial Fund and.a colleague of from 57 to 1,027.
'. ' has strong views about siich costs.
erty taxes they are excused from paying.
ering all of the nation's poor.
Schaffer's. "It allowed IhelRS to set both tax
At Children's llospital.'the number swelled
In November 1991 Leon was' charged
That's- only one of their tax exemptions,
Congress left it up to individual states to and health policy and then provided no over- from 21 to 694.
.$6,373.50 for. an operation to remove a cata-: however. And the $127 million includes bad'
set the financial eligibility criteria. Most sight. For the last 20 years, hospitals have
At Graduate Hospital', it rose from 24 to 657:'ract in-one eye. The outpatient procedure at debt — uncollected bills' that the hospitals
states set them so stringently that'the stand- essentially had.a free ride."
"Hospitals a.re the. new steel mills of the -Rolling Hill Hospital lasted "about-one',
ards excluded-many of the poor.
•90s." said Tom Chakurda-Spokesman for -hour." I^on said. Including recovery time', contend is chanty.
In Philadelphia, which has more poor than
Today, 28 years after Medicaid s enactment.' ' It has been a great ride, unmatched by all Allegheny General Hospnal. which runs five '• he spent five hours at the. hospital. •
any other county in tlie state, over 96 percent
the -program covers fewer than half — 49 but a handful of other indusfiospitals in. Philadelphia.
Leon's insurer, Travelers-Insurance'Co'..:' of all care. is .paid for .by patients, .insurers
percent, in fact — ofthe estimated 32 million. tries.
..
•Officials sometimes over-' paid the hospital 55.576.50. The hospital billed.
government.
of hospi-'
Americans living below the'-poverty level.
• At a time when many busi- In Philadelphia,
.look that when they go look- • Leon for the balance. He refuses to pay.". ", and 53.5 billion inOnly 3.6 percentfor charity.expenses went
Despite such glaring holes in the nation's nesses have-been in retreat, where many poor
mg for hospitals ' lo. pay.' "The hospitals are committing a- 'crime tals'
"The fact- is, there aren't many charity
.health-care safety net, the IRS did not revisit- shutting plants and laying
taxes."
..
against the sick.'and this has an effect on the . cases in the hospitals.-IPatierits] are paying
its 1969 charity decision until -Congress off workers, the hospital in- people live, only
The reason for such' dra- 'nation's•economy, on working,people and. 'for almost ".everything.".;said Allegheny
raised the issue'.in 1991. Even: then, Michael dustry booms:'.
. unions," Leon said. "I'm lucky..I.have insur-matic increases, lies in the
County solicitor Ira. Weiss; who won settleJ. Craetz. an assistant secretary of the Treas- • Hospital employment more 3.6 percent of
changing, nature of hospi- ance thrbugh.wofk. But lots of-people don't:". ments iri lieu of taxes-from several Pittsury, said-there was no reason to change.
than doubled' nationally, hospitals'$3.5
"How a-oufrhour procedure on one eye can burgh-area 'hospitals. , "
tals: With the adoption of
"A community benefit standard reflects .from. 1.8 million workers to
ever-more complicated tech '. cost so much, is fantasy. That's-what I told- , "Most; nonprofit'institutions were founded
the longstanding proposition-that the promo- 3.7 million, in the last two. billion in expenses
nology. their need for more' them. I said. 'This is a fantasy. I am not going.' by philanthropic people to.take.care of the
tion of health is a charitable purpose and decades — making it one of went for free care.
highly skilled workers hns- - to pay. If you want to go to court, let's-goV-It's poor. But I'm afraid the old.brahmins would be
recognizes-the potential for a variety of the econbmy's.most dynamic
' been more than a year and I haven't heard grown. .-' '•-'
rolling-over in their graves if they could see
.means of fulfilling that purpose." he told the performers.
Today, more than 65 percent of nurses iii from IbemV-' he said.
House Ways arid Means Committee in 1991.
some of'these hospitals-today," Donnelly said. •
Hospital officials say criticism like Leon'shospilals are registered .nurses, who typK.
"The days.of the nonprofit-'bospital are
In an interview; Schaffer was more blunt: .• In.metropolitan Philadelphia, hospital em'is unfair. Yes. their costs are high, but that's
"The IRS.has basically been in denial for lhe ployment climbed from 78,700 in 1979 to cally earn between S3S.000 and 565.000. That's, because of the,sophisticated procedures and over. They are vestigial institutions whose
nonprofit-formriolonger has-meanihg." said'
last quarter-century. It's as though they 111.200 in 1991. About half these employees up from 49 percent a decade ago.
elaborate technology. Instead of. criticizing,,
turned their heads so they wouldn't see what work in the city, where they received S1.7
Increased demand.for therapists and tech;' patienls and'politicians ought to' be thankful . Henry Hansmann,an attorney and economist
billion in wages and benefits in 1990, accord- nicians also has pushed, up-salaries. And"' •forthe important role hospitals.play in-the.", at Yale University who has written exten-.
was happening: It's disgraceful.'-'
Congress did not hold follow-up hearings ing to the Delaware Valley Hospital Council.. salaries of hospital administrators now often.'.economy:-they .say.
• • -'. sively about tax'law and hospitals.
on the IRS's 1969 decision. Nor did it examine .• Hospital wages more than tripled between exceed executive pay at comparable-sized ; "One in every/eight workers' in.-the Dela- . "As a matter of tax policy,,we may nol want
to do away.with nonprofit hospitals, but that,
tbe link between charity care and the tax 1977 and 1990, — to. $70 billion. That was companies. •
ware Valley owes his or her job-to hospitals."- '
breaks awarded nonprofit, hospilals until double the general-rate of inflation.
All- of this — spurred by the enormous the Delaware Valley Hospital Council said doesn't mean we still want to subsidize them"
Rep. Brian J. Donnelly (D.. Mass.) and Rep.
And those rising wages are one of the key- growth of tax-exempt hospitals — has helped'' last year. Citing a S40,000 study, paid for. by
Edward R. Roybal (D.. Calif.)-introduced factors in higher health costs.
drive up prices. It is.the health-care monster the council, it said hospitals 'contribute more,
••.Tomorrow:. Tax-exempt private
bills to tighten charity care' standards in:
The number of Americans reporting -in-' that the White House task force is trying to than:$5.5 billion a year to the economy.
colleges made millions on investments in
1991. Neither proposal advanced past the come between 530.000 and $40,000 rose 48 .wrestle to the" ground.
"Hospitals are to the Delaware Valley what
the 1980s.— while doubjlng tuition.
committee stage.
percent in the 1980s.
In. a report issued in January, the U.S. • cars are to Detroit." said Hospital Council'
J
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�TIMOTHY L PESCI, MEMBER
HERITAGE SQUARE
170 LINCOLN STREET
SUITE 4
VANDERGRIFT, PENNSYLVANIA 15690
PHONE: (412) 568-2387
HOUSE POST OFFICE BOX 115
MAIN CAPITOL BUILDING
HARRISBURG, PENNSYLVANIA 17120-0028
PHONE: (717)787-1407
COMMONWEALTH OF PENNSYLVANIA
HARRISBURG
February 17, 1993
Honorable H i l l a r y C l i n t o n
President's Task Force
on National Health Refonn
The White House
1600 Pennsylvania Avenue
Washington, D. C. 20500
Dear H i l l a r y :
Having read o f t h e c r e a t i o n of the President's Task Force on National
Health Refonn, i t i s an honor and a pleasure t o recommend a doctor who
would l i k e t o volunteer t o serve on such a committee. Dr. Kal
Ghoshhajra i s a board c e r t i f i e d r a d i o l o g i s t w i t h s p e c i a l t y c e r t i f i c a t i o n
as a n e u r o r a d i o l o g i s t and was also t r a i n e d as a surgeon i n England.
Dr. Ghoshhajra s t r o n g l y f e e l s t h a t retorm i s imperative. His experience
as a physician and consumer of health care i n t h e f o l l o w i n g s e t t i n g s
enhances h i s a b i l i t y t o c o n t r i b u t e t o t h e work ahead:
State Government Health Care System i n I n d i a
National Health Service i n England
United States Health Care System
Dr. Ghoshhajra's t h i r t y years i n medicine have included several venues,
h i s perspective i s not l i m i t e d . Some of h i s experience has included
work as a:
U n i v e r s i t y based physician
S t a f f a t a p r i v a t e community h o s p i t a l
Independent o f f i c e based p r a c t i c e
Dr. Ghoshhajra believes t h e complexities and i n e q u a l i t i e s of medical
insurance coverage demand immediate a t t e n t i o n . Securing medical
coverage can be a study of "excess" coverage f o r those covered i n a
large employee group. On the other hand f o r small companies or i n d i v i d u a l s "access" t o basic care can be e l u s i v e . And f i n a l l y as one
who has t r e a t e d those unable t o a f f o r d or obtain medical insurance he
can address t h e problems associated w i t h p r o v i d i n g u n i v e r s a l access
t o care i n a health system t h a t does not allow f o r i t .
�Page Two
February 17, 1993
Dr. Ghoshhajra i s a naturalized c i t i z e n of t h e United States and he
would be very proud t o add h i s t a l e n t s and ideas t o improve the U.S.
Health Care System.
H i l l a r y , I have included Dr. Ghoshhajra's impressive resume. I f you
have any questions, please contact me a t your e a r l i e s t convenience.
Timothy L. Pesci
State Representative
60th L e g i s l a t i v e D i s t r i c t
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�k. Ghoshhajra, IVI.I).
CUXRK.'UMfM
KALYANMAY
VI'I'Ar:
( K A L ) GHOSHHAJRA, M.D.
�CURRICULUM V.I.'i'AK
KALYANMAY (KAL) C I K )SI 1 1 A. I R A , M . I.).
.
1
PERSONAL INFORMATION
Birtndate:
. •
Birthplace:
Visa Status:
S o c i a l S e c . No.
Address:
\
\
2801 F r e e p o r t Road, N a t r o n a
( 4 1 2 ) 224-1840 ( O f f i c e )
Hgts.,PA
15065
Marital Status:
EDUCATION AND TRAINING
U n d e r g r a d u a be
1956-1958
I In i vo i r, i I y o f Cn I < - u I I vi
.1. iid i a
I nl.erincd.i.atp
1.950
Graduate (Medical)
1958-1963
University of Calcutta
India
M.B.B.S.
19 6 3
Post
Royal
Rrimary
1968
Graduate
C o l l e g e o f Surgeons
FRCS
Science
(Dublin]
Postgraduate
Medical Training
1963- 1964
( s i x months)
N.R.S. M e d i c a l C o l l e g e
Calcutta, India
1964
(6 m o n t h s )
N.R.S. M e d i c a l C o l l e g e Hosp. S u r g i c a l R e s i d e n c y
Calcutta, India
(General)
Hosp.
Rotating
Internship
1964- 1969
(5 y e a r s )
England
S u r g i c a l Residency
(General, Orthopedic,
P l a s t i c , Urology)
1969- 1970
(13 months.)
Holy Name H o s p i t a l
Teaneck, New J e r s e y
Rotating
1970- 1973
(3. y e a r s )
University of Pittsburgh
Department o f Radiology
School o f Medicine
P i t t s b u r g h , .Pennsy.l v a n i a
Diagnostic Radiology
( I n c l u d e s 6 months i n
Vascular Radiology)
1973-1974
(4th year
University of Piffslmrgh
Department; o f R a d i o l o g y '
Schoo I o f Med i. c i no
P i t t s b u r g h , Ponn:; y 1 v.i n i
Neu r o r a d i o l o g y
Internship
�K.G.
-2APPOINTMENTS AND POSITIONS
July,1973-June,1974
University of Pittsburgh
Department o f Radiology
School o f Medicine
P i t t s b u r g h , Pennsylvania
Clinical
July,1974-June,1976
U n i v e r s i t y of Pittsburgh
Department o f Radiology
School o f Medicine
Pi t t s b u r g h , Pennsylvania
Assistant Professor
of Radiology
(Neuro-Vascular
Radiology)
July,1976-Jan.,1977
Albany Medical C o l l e g e
Department o f Radiology
Albany, New York
Associate Professor
i n Radiology
(Neuroradiology)
Feb.,1977-June,1980
Mercy H o s p i t a l
Depa i: tmon I. o f Radiology
Pi I., tsbu r:g h , Pe nns y . va nia
1
Staff
S e p t . , 1980-Juiie, 1981
U n i v e r s 11 y o f P i t; (. s b u t. g 1 V i s i t i n g A s s o c i a t e
:
1
Department, of: Radiology
P r o f e s s o r i n Radiology
Schoo j. o f Medicine
(Neuroradiology)
P i t t s b u r g h , Pennsylvania
July,1981-March,1992
A l l e g h e n y V a l l e y Medical
Neuro-Interventional
Imaging
Radiologist
Allegheny V a l l e y H o s p i t a l
Natrona H e i g h t s , P e n n s y l v a n i a
Oct.,1987-Present
Magnetic Imaging A s s o c i a t e s
1000 Ardmore Boulevard
P i t t s b u r g h , Pennsylvania
Staff
Radiologist
Nov.,1991-Present
C e n t r a l Magnetic Imaging
Institute
Greensburg, Pennsylvania
Staff
Radiologist
June,1992-Present
R a d i o l i g i c a l Imaging Assoc.
Medical D i r e c t o r
Instructor
Neuroradiologist
2801 F r e e p o r t Road
Natrona H e i g h t s , Pennsylvania
SPECIALTY CERTIFICATION
Board C e r t i f i e d i n D i a g n o s t i c Radiology
1974
Sub-specialty
MEDICAL LICENSURE
1971 - Present
Pennsylvania S t a t e Board o f Medical Education
and L i c e n s u r e
1976 - Present
The U n i v e r s i t y o f tlie S t a t e o f New York
�K.G.
-3PROFESSIONAL ORGANIZATIONS
S o c i e t y o f Magnetic Resonance Imaging
American S o c i e t y o f N e u r o r a d i o l o g y
R a d i o l o g i c a l S o c i e t y o f North America
American C o l l e g e o f Radiology
American Roentgen Ray S o c i e t y
American M e d i c a l A s s o c i a t i o n
Pennsylvania R a d i o l o g i c a l S o c i e t y
Pennsylvania M e d i c a l S o c i e t y
P i t t s b u r g h Roentgen S o c i e t y
A l l e g h e n y County M e d i c a l S o c i e t y
Tri-County Medical Society
American I n s t i t u t e o f U l t r a s o u n d i n Medicine
EXHIBITS
Ghoshhajra, K. , T s a i RY, Oastu.r K. and I'li.i. I . l i p s :
"Computed Tomography o f
O r b i t . " Pennsylvania R a d i o l o g i c a l S o c i e t y Meeting a t Seven S p r i n g s , PA,
on May 19 - May 22, 19 77.
Ghoshhajra, K. and S c o t t i , I , . :
"CT i n S k u l l and F a c i a l Bone Trauma.
Pennsylvania R a d i o l o g i c a l S o c i e t y Annual Meeting a t Host Farm, L a n c a s t e r ,
P e n n s y l v a n i a , May 17 - May 20, 1979.
PUBLICATIONS
Ghoshhajra, K.: "Spontaneous Thymic Hemorrhage i n A d u l t s "
CHEST, V o l 72: 666-668, November, 1977.
Ghoshhajra, K.: B a g h a i - N a i i n i , Pa., Hahn, S.C., Pena, C E . and Hayat, S.:
"Spontaneous Rupture o f a P i n e a l Teratoma" NEURORADIOLOGY V o l 17: 215-217,
1979.
Ghoshhajra, K., S c o t t i , L., Marasco, J., and B a g h a i - N a i i n i , P.: "CT D e t e c t i o n
of I n t r a c r a n i a l Aneurysm i n Subarachnoid Hemorrhage" AJR 132:
613-616,
A p r i l , 1979
Ghoshhajra, K.: "Metrizamide CT C i s t e r n o g r a p h y i n t h e Diagnosis and L o c a l i z a t i o n o f CSF R h i n o r r h e a " JOURNAL OF COMPUTERIZED ASSISTED TOMOGRAPHY, V o l
A, No. 3: 306-310, June, 1980.
Ghoshhajra, K.: "CT i n t h e Trauma o f t l i e Base o f t h e S k u l l and I t s
Complications"CT OF THE JOURNAL OF COMPUTERIZED TOMOGRAPHY, V o l 4,
No. 4: 271-276,December, 1980.
Ghoshhajra, K. and Rao, C.V.G.: "CT i n the S p i n a l Trauma"
CT. OF THE JOURNAL OF COMPUTERIZED TOMOGRAPHY, V o l 4, No. 4:
December, 1980.
309-318,
Ghoshhajra. K.: "High R e s o l u t i o n CT C i s t e r n o g r a p h y i n S e l l a r and P a r a s e l l a r
A b n o r m a l i t i e s " JOURNAL OF NEUROSURGERY, 54: 232, February, 1981.
�•
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PUBLICATIONS, c o n t i n u e d
K.G.
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Ghoshhajra, K.:
" C r a n i o - F a c i a l Trauma" CRANIAL COMPUTED TOMOGRAPHY,
|'j
E d i t o r s Lee and Rao, McGraw H i l l , 1981.
Kennerdell, J . and Ghoshhajra, K.:
"Extraocular O r b i t a l Tumors"
• .
>
INTERNATIONAL OPHTHALMOLOGY CLINICS, L i t t l e , Brown and Company, 1981' X( Press) -"v^
Ghoshhajra, K.:
" B l i s t e r i n g of the Odontoid Process by Meningioma"
:j.
Accepted f o r P u b l i c a t i o n i n NEURORADIOLOGY ( P r e s s ) .
^
t
Ghoshhajra, K. : "Radiologic Techniques for I d e n t i f i c a t i o n and L o c a l i z a t i o n '
of Cerebrospinal F i s t u l a e " SEMINARS IN NEUROLOGY, Vol 2, No.2, June, 1982. f|
:i
Meyer, J.D., Latchaw, R.E., Roppolo, H.M., Ghoshhajra, K., Deeb, Z.L.:
"Computerized Tomography and Myelography of t h e P o s t o p e r a t i v e Lumbar Spine"
YEARBOOK OF DIAGNOSTIC RADIOLOGY, 1984.
Gold, L., Latchaw, R.E., and Ghoshhajra, K.:
Myelographic Features" RADIOLOGY, .1982.
"Redundant Nerve Root Syndrome:
Ghoshhajra, K.:
"Work on CSF F i s t u l a . "
Part of the paper was r e p u b l i s h e d
i n "CURRRENT CONCEPTS IN RADIOLOGY" and "YEAR BOOK IN RADIOLOGY": 1 9 8 2 - F a l l
Ghoshhajra, K., Latchaw, R. E. , Roppolo, II.M., Deeb, Z.I..., Meyer J.D.:
"CT
i n t h e D i a g n o s i s and E v a l u a t i o n of Tethered Cord i n C h i l d r e n " AJNR 3: 94,
Jan./Feb., 1982.
PRESENTATIONS
Ghoshhajra, K., and T s a i , FY:
"C.A.T. i n Huntington's Disease"
I n t e r n a t i o n a l Symposium on Computer A s s i s t e d Tomography at the National
I n s t i t u t e of Health, Bethesda, Maryland, October, 1976.
T s a i , FY, Garner, F.S., H i p u r i c h , J.E., Quinn, M.F. and Ghoshhajra, K.:
" S p i n a l Lipomas" Western N e u r o - r a d i o l o g i c a l S o c i e t y Meeting, Palm S p r i n g s ,
C a l i f o r n i a on October 6, 1977.
Ghoshhajra, K., S c o t t i , L., Dastur, L., Marasco, J . : "CT Detection of I n t r a c r a n i a l Aneurysm i n Subarachnoid Hemorrhage" I n t e r n a t i o n a l Symposium and
Course on CT by Massachusetts General H o s p i t a l at Miami, F l o r i d a on March
24, 1978.
Ghoshhajra, K.:
Part 1-- "High Resolution CT Cisternography i n S e l l a r and
P a r a s e l l a r Abnormalities" R.S.N.A. meeting at A t l a n t a , Georgia, Nov., 1979.
Ghoshhajra, K.:
P a r t I I - - "Diagnosis and P r e c i s e L o c a l i z a t i o n of CSF
Rhinorrhea"R.S.N.A. meeting i n A t l a n t a , Georgia, Nov., 1979.
Ghoshhajra, K.:
" C e r e b r o v a s c u l a r A c c i d e n t " Annual Meeting of I n d i a n
R a d i o l o g i c a l A s s o c i a t i o n , Bombay, I n d i a , January 6, 1979.
Ghoshhajra, K.:
" E v a l u a t i o n of P i t u i t a r y Lesions by CT C i s t e r n o g r a p h y "
Annual Meeting o f I n d i a n R a d i o l o g i c a l A s s o c i a t i o n , Bombay, I n d i a , Jan. 6,1979.
Ghoshhajra, K.:
"CT C i s t e r n o g r a p h y i n P o s t e r i o r Fossa Neoplasm"
I n t e r n a t i o n a l Symposium and Course on CT at. Las Vegas, Nevada, A p r i l ,
1980.
�. •.
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K.G.
-5
PRESENTATIONS, Continued
Ghoshhajra, K.: "Diagnosis and P r e c i s e L o c a l i z a t i o n o f CSF R h i n o r r h e a "
I n t e r n a t i o n a l Symposium and Course on CT a t Las Vegas, Nevada, A p r i l , 1980.
Ghoshhajra, K., Latchaw, R.E., Roppolo, H.M., Deeb, Z.L., Meyer, J.D.:
"Unassisted CT Scanning f o r Diagnosis and E v a l u a t i o n o f Tethered Cord i n
C h i l d r e n " American S o c i e t y o f N e u r o r a d i o l o g y Meeting i n Chicago, I l l i n o i s ,
A p r i l 6, 1981.
Ghoshhajra, K. , Deeb, Z. .L., Latchaw, J<. E. , Roppolo, I I . M., Meyer, J.D.:
"CSF F i s t u l a "
American S o c i e t y o f N e u r o r a d i o l o g y Meeting i n Chicago,
I l l i n o i s , A p r i l 6, 1981.
Meyer, J.D., Ghoshhajra, K., Deeb, Z.L., Roppolo, H.M., Latchaw, R.E.:
"Computed Tomography and Myelography of the Postoperative Lumbar Spine"
American Society of Neuroradiology Meeting i n Chicago, I l l i n o i s , Apri1,6,1981.
Roppolo, H.M., Meyer, J.D., I.atchlaw, R.E., Ghoshhajra, K., C u r t i n , I I . and
Deeb, Z.L.: "High R e s o l u t i o n Computerized Tomographic E v a l u a t i o n and
Comparison o f Normal P i t u i t a r y Gland and P i t u i t a r y Microadenoma."
American S o c i e t y o f N e u r o r a d i o l o g y Meeting i n Chicago, I l l i n o i s , Apr.9,1981.
Ghoshhajra, K. , Roppolo, I I . M., Deeb, Z. I,. , Latchaw, R.E., Meyer, J.D.:
"High R e s o l u t i o n CT C i s t e r n o g r a m f o r E v a l u a t i o n o f t h e I n t r a c r a n i a l Subarachnoid Space."
XVtli I n t e r n a t i o n a l Congress o f R a d i o l o g y , B r u s s e l s , Belgium,
June 25, 1981.
�K . G.
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LECTURES
Ghoshhajra, K.:
"Angiographic Changes i n I n t r a c r a n i a l Neoplasm."
Neuro-Science Conference.
U n i v e r s i t y of P i t t s b u r g h , P e n n s y l v a n i a ,
September 17, 19 75.
Ghoshhajra, K.:
" I n d i c a t i o n of Crania], CT"
Two-way Radio c o n v e r s a t i o n
f o r P h y s i c i a n s of S t a t e of New York H o s p i t a l s and Albany Medical C o l l e g e ,
Albany, New York, January 25- January 27, 1977.
Ghoshhajra, K.:
" R a d i o l o g i c a l Examination of C r a n i o - F a c i a l Trauma."
Medical O r i e n t a t i o n Lecture, Mercy H o s p i t a l , Pittsburgh, Pennsylvania,
August 11, 1978.
Ghoshhajra, K.:
"Technique and I n d i c a t i o n s of C r a n i a l Computed Tomography"
K.J. H o s p i t a l , Madras, I n d i a , March 23, 1979.
Ghoshhajra, K.:
"Recent:. Advances in Non r o r a d i o I ogy"
Neuro-Science Conference, A l l e g h e n y Gen era.I. H o s p i t a l , P i t t s b u r g h ,
v a n i a , March 23, 1979.
Ghoshhajra, K.:
"Recent Advances i n N e u r o r a d i o l o g y . "
C u r r e n t Topics i n M e d i c i n e , Grand Rapids, Michigan, A p r i l 1,
Pennsyl-
1979.
Ghoshhajra, K.:
"CT C i s t e r n o g r a p h y " C u r r e n t Topics i n Medicine
Grand Rapids, M i c h i g a n , A p r i l 1, 1979.
Ghoshhajra, K.:
" C o n v e n t i o n a l and CT Examination of S p i n a l Cord."
C u r r e n t Topics i n M e d i c i n e , Grand Rapids, Michigan, A p r i l 1, 1979.
Ghoshhajra, K.:
I n v e s t i g a t i o n of S p i n a l I n j u r y , Neoplasm & Disc Disease
by Non-Ionic Water-Soluble Contrast: Agent
A p p l i c a t i o n CT. "
Orthopedic Grand Rounds, Mercy H o s p i t a l , P i t t s b u r g h , Pennsylvania, May 12,
1979.
Ghoshhajra, K.:
"Metrizamide (Amipaque) Myelography & CT C i s t e r n o g r a p h y . "
27th Mid-Eastern Conference of R a d i o l o g i c T e c h n o l o g i s t s a t the M a r r i o t I n n ,
P i t t s b u r g h , P e n n s y l v a n i a , November 15- November 16, 1979.
Ghoshhajra, K.:
" C r a n i a l CT"
P i t t s b u r g h , P e n n s y l v a n i a , May
Medical Grand Rounds, Mercy H o s p i t a l ,
15, 1980.
Ghoshhajra, K.:
"Vascular A b n o r m a l i t i e s & I n f e c t i o n . "
C.T., Review Course, Radiology Grand Rounds, U n i v e r s i t y of Pittsburgh on
October 23, 1980.
Ghoshhajra, K. : "Pneuinoencephalog ram and CT Cisternogram."
N e u r o s u r g i c a l Conferences a t P r e s b y t e r i a n - U n i v e r s i t y H o s p i t a l ,
P e n n s y l v a n i a , February 14, 198.1.
Pittsburgh,
�• ••
.
.
K.G.
-7
SCIENTIFIC MEETINGS, POSTGRADUATE COURSES OR OTHER CONTINUING MEDICAL
EDUCATION .(C.M.E.) ACTIVITIES
American Roentgen S o c i e t y Annual Meeting fc Symposium a t San F r a n c i s c o ,
C a l i f o r n i a , March, 1974
I n t e r n a t i o n a l Symposium and Course on CT (Massachuset t:s General H o s p i t a l )
Bermuda, March, 19 7 5
R.S.N.A. annual meeting a t Chicago, I l l i n o i s ,
November, 1975
I n t e r n a t i o n a l Symposium on CAT a t San Juan, Puerto Rico, March, 1976
I n t e r n a t i o n a l Symposium on CAT a t N a t i o n a l I n s t i t u t e o f H e a l t h ,
Bethesda, Maryland, October, 1976
R.S.N.A. annual meeting a t Chicago, I l l i n o i s ,
November, 1976
I n t e r n a t i o n a l Symposium and Course on CT a t Miami, F l o r i d a ,
March 1977
Pennsylvania R a d i o l o g i c a l S o c i e t y Meet .ing a t Seven S p r i n g s , Pennsylvania
on May 19-May 22, 1977
R.S.N.A. annual meeting a t Chicago, I ll.i.no.is, November, 1977
I n t e r n a t i o n a l Symposium and Course on CT a t Miami, F l o r i d a ,
March 19- March 24, 1978
The American Society of Neuroradiology, Annual Meeting, February 26
March 2, 1978
XI Symposium N e u r o r a d i o l o g i c u m .
June 4- June 10, 1978
R h e i n - M a i n - l l a l l e , Weisbaden, FRG
I n t e r n a t i o n a l Symposium and Course on Cl', Las Vegas, Nevada,
A p r i l 1 6 - A p r i l 20, 1979
The American Society of Neuroradiology, annual meeting, May 16
May 20, 1979
R.S.N.A. annual meeting, November 25- November 30, 1979
I n t e r n a t i o n a l Symposium and Course on CT, Las Vegas, Nevada, A p r i l 7
A p r i l 11, 1980
The American S o c i e t y o f N e u r o r a d i o l o g y , annual meeting, March 16
March 2 1 , 1980
R.S.N.A. annual meeting, November.- . . - November: 20, 1900
16
Embolization Society Meeting a t Park C i t y , Utah, March 30- A p r i l 2,
1981
�'
.
.
K.G.
-8
'
SCIENTIFIC MEETINGS, POSTGRADUATE COURSES OR OTHER CONTINUING MEDICAL
EDUCATION- (C.M.E.) ACTIVITIES, Continued
CREDIT HOURS
The American S o c i e t y o f N e u r o r a d i o l o q y annual meeting, A p r i l 5
A p r i l 7, 1981
R.S.N.A. 67th Annual Meeting and S c i e n t i f i c Assembly, November 1 ,
1981., Category I
15 h r s .
"The C l a s s i c s and t h e F r o n t i e r s i n R a d i o l o g y " , Dutch Resort H o t e l
Lake Buena V i s t a , F l o r i d a , AMA, sponsored by tlie Dept.of Radiology
at M t . S i n a i M e d i c a l Center o f Greater Miami, Dr.Manuel Viamonte,
J r . — P r o g r a m D i r e c t o r , Categor I , January 29- February 1, 1982
15 h r s .
" S i x t h Annual S p r i n g Weekend Symposium i n D i a g n o s t i c U l t r a s o u n d " ,
sponsored by Downstate M e d i c a l Center, Depart, o f R a d i o l o g y ,
Dr. Byron G. Brogdon, Chairman, AMA, Category I , A p r i l 16- t o
A p r i l 18, 1982
.. h r s .
16
" I n t e r v e n t i o n a l Radiology Seminar" sponsored by tlie Dept. o f
Radiology o f t h e U n i v e r s i t y o f Pennsylvania, a t Martha's V i n e y a r d ,
Massachusetts, AMA, Category .1, J u l y 20- J u l y 23, 1902
17 h r s .
" X I I Symposium N e u r o r a d i o l o g i c u m " h e l d a t t h e Washington H i l t o n
H o t e l , Washington, D.C, Category I , October 10- October 16, 1982
35 h r s .
R.S.N.A. 68th Annual Meeting and S c i e n t i f i c Assembly, November,
1982, Category I
14 h r s .
A l l e g h e n y V a l l e y H o s p i t a l C o n t i n u i n g E d u c a t i o n a l S e r i e s , luncheon
meetings, Natrona H e i g h t s , P e n n s y l v a n i a , Category I I , YEAR 1982
(See a t t a c h e d sheet f o r l i s t i n g s )
12 h r s .
"46th Annual Meeting and S c i e n t i f i c Session", Sponsored by t h e
Canadian A s s o c i a t i o n o f R a d i o l o g i s t s w i t h co-sponsor by t h e
American C o l l e g e o f R a d i o l o g y , Quebec-Hilton I n t e r n a t i o n a l , Quebec,
Canada, Category I , Dr. Byron G. Brogdon--Chai.rman, June 20
June 2 1 , 1983
15 h r s .
Michigan F a l l y Radiology Conference a t W i l l i a m Beaumont H o s p i t a l ,
Royal Oak, M i c h i g a n , AMA, Category 1 , October 7- October 8, 1983
14 h r s .
A l l e g h e n y V a l l e y H o s p i t a l C o n t i n u i n g E d u c a t i o n a l S e r i e s , luncheon
meetings, Natrona H e i g h t s , P e n n s y l v a n i a , Category I I , YEAR 1983,
(See a t t a c h e d sheet f o r l i s t i n g s )
8 hrs.
R.S.N.A. 69th Annual Meeting and S c i e n t i f i c Assembly, November,
1983, Category I
•
11 h r s .
Bowman Gray School o f Medicine o f Wake Forest U n i v e r s i t y
"Advanced U l t r a s o u n d Seminar", Category I , Dr. E.G. M i l l e n
January 19- January 2 1 , 1984
14 h r s .
Chairman,
8th Annual Meeting o f t h e U n i v e r s i t y o f C a l c u t t a M e d i c a l Assoc.
of America a t I n n on t h e Park, T o r o n t o , Canada, Category I
sponsored by Mount Carmel Mercy H o s p i t a l , D e t r o i t , M i c h i g a n , Dr.
Paul R o m a n e l l i - C o o r d i n a t o r , J u l y 26- J u l y 30, 1984
9 hrs.
�K.G.
•SCIENTIFIC MEETINGS, POSTGRADUATE COURSES, UR O'l'HEK CONTINUING
MEDICAL EDUCATION (C.M.E.) A C T I V I T I E S , C o n t i n u e d
CREDIT HOURS
R.S.N.A. 7 0 t h A n n u a l M e e t i n g and S c i e n t i f i c A s s e m b l y , November
1984, C a t e g o r y I
10.5 h r s .
Allegheny Valley Hospital Continuing Educational Series,luncheon
m e e t i n g s , N a t r o n a H e i g h t s , P e n n s y l v a n i a , C a t e g o r y .1.1, YEAR 1984
7 hrs.
A l l e g h e n y V a l l e y H o s p i t a l S e m i n a r / C o n f e r e n c e on " R e h a b i l i t a t i v e
Needs o f t h e E l d e r l y " s p o n s o r e d by t l i e W e s t e r n Penna. H o s p i t a l ,
D r . . Hannna, D i r e c t o r , C a t e g o r y I , November 16, 1984
7 hrs.
American S o c i e t y o f N e u r o r a d i o l o g y , 23rd Annual Meeting, Category
I , New O r l e a n s M a r r i o t t H o t a l , New O r l e a n s , F e b r u a r y 18- F e b r u a r y
23, 1985
32 hrs.
"Seminars i n U l t r a s o u n d " , AMA, S p o n s o r e d by t h e U n i v e r s i t y o f U t a h
S c h o o l of M e d i c i n e C o n t i n u i n g M e d i c a l E d u c a t i o n a t Hyannis, MA.,
A u g u s t 5- A u g u s t 7, 1985, C a t e g o r y I
13.5 h r s .
Harvard Medical School, Boston, Massachusetts,
Workshop", AMA, C a t e g o r y .1, O c t o b e r 24, .1.985
"Breast
Imaging
R.S.N.A. 7 1 s t A n n u a l M e e t i n g and Sc.i.en I. i C i c A s s e m b l y , November,
1985, C a t e g o r y I
6 hrs.
10 h r s .
Allegheny V a l l e y H o s p i t a l C o n t i n u i n g E d u c a t i o n a l S e r i e s , luncheon
m e e t i n g s , N a t r o n a H e i g h t s , P e n n s y l v a n i a , C a t e g o r y I I , YEAR 1985
(See a t t a c h e d s h e e t f o r l i s t i n g s )
7 hrs.
"Update i n I n t e r n a l M e d i c i n e - 1986", AMA, C a t e g o r y I , I n s i t i t u t e
f o r Continuing Medical Education, Hurley Medical Center, F l i n t ,
M i c h i g a n , J a n u a r y 10, 1986
20 h r s .
" C l i n i c a l N u c l e a r M e d i c i n e " H a r v a r d M e d i c a l Schoo]., B o s t o n , Mass.,
C a t e g o r y I , AMA, A p r i l 7- A p r i l .10, .1.986
26 h r s .
1 0 t h A n n u a l S c i e n t i f i c M e e t i n g by t h e U n i v e r s i t y o f C a l c u t t a
M e d i c a l A s s o c . o f A m e r i c a , s p o n s o r e d by Mount C a r m e l Mercy
H o s p i t a l , D e t r o i t , M i c h i g a n , Category I , Dr. Paul R o m a n e l l i
C o o r d i n a t o r , J u l y 3 1 - A u g u s t 3, 1986
9 hrs.
G e o r g e t o w n U n i v e r s i t y S c h o o l o f M e d i c i n e , AMA, C a t e g o r y I ,
"Update o n E d o u r o l o g y a n d E x t r a c o r p o r e a l Shockwave L i t h o t r i p s y
(ESWL)", November 1 , 1986
7 hrs.
Allegheny V a l l e y H o s p i t a l C o n t i n u i n g E d u c a t i o n a l S e r i e s , luncheon
m e e t i n g s , N a t r o n a H e i g h t s , P e n n s y l v a n i a , C a t e g o r y I I , YEAR 1986
1 hr.
�K.G.
-10
SCIENTIFIC MEETINGS, POSTGRADUATE COURSES, OR OTHER CONTINUING
MEDICAL EDUCATION (C.M.E.) ACTIVITIES, Continued
CREDITS HOURS
Society f o r Maganetic Resonance Imaging (SMRI) 6th Annual
Meeting, Westin Copley Place H o t e l , Boston, Massachusetts,
February 27- t o March 2, 1987, Category I
16 h r s .
"A PROGRAM ON THE BASICS OF MAGNETIC RESONANCE" sponsored by
the C l e v e l a n d C l i n i c a l E d u c a t i o n a l Foundation, AMA, Category
I , March 16- March 20, 1987
46 h r s .
The A l e x a n d r i a H o s p i t a l / N o r t h e r n V i r g i n i a Consortium f o r C.M.E.
4600 King S t r e e t , S u i t e 4J, A l e x a n d r i a , VA 22302, " T u t o r i a l i n
Percutaneous T r a n s l u m i n a l A n g i o p l a s t y " , Category I , AMA, A p r i l
6- A p r i l 8, 1987
20 h r s .
American S o c i e t y o f N e u r o r a d i o l o g y , 25th Annual meeting on
May 10- May 15, 1987 a t t h e New York H i l t o n H o t e l i n New York
C i t y , Category I
28.5 h r s .
Harvard M e d i c a l School, Boston, Massachusetts, "C I.. IN I CAL
MAGNETIC RESONANCE", .June 3- June 5, 1.987, Category I , AMA
20 h r s .
U n i v e r s i t y o f C a l c u t t a o f America, I.l.tli Annual Meeting a t
Wilson's Lodge a t Oglebay, W V i r g i n i a , August 6- August 9,
.
1987, sponsored by Mount Carmel Mercy H o s p i t a l , D e t r o i t ,
M i c h i g a n , Category I
9 hrs.
U n i v e r s i t y o f V i r g i n i a School o f M e d i c i n e , C h a r l o t t e s v i l l e ,
VA, "PRACTICAL RADIOLOGY" a t Boar's Head I n n , V i r g i n i a , October
12- October 15, 1987, AMA, Category I
17 h r s .
R.S.N.A. 73rd Annual Meeting and S c i e n t i f i c Assembly, Chicago,
I l l i n o i s , Category I , 1987
15 h r s .
U n i v e r s i t y o f C a l i f o r n i a , San Diego School of: Medicine, "DUPLEX
IMAGING", January 2 1 - January 23, 1988, AMA, Category I
21 h r s .
American Roentgen Ray S o c i e t y , 88th Annual Meeting, San
F r a n c i s c o , Category I , Mary 8- May 13, 1988
38 h r s .
U n i v e r s i t y o f C a l i f o r n i a / S a n Diego School o f M e d i c i n e , San
Diego, C a l i f o r n i a , 4 t h Annual Sonography Uptake and Review,
September 9- September 1 1 , 1988, AMA, Category I
18 h r s .
U n i v e r s i t y o f Wisconsin-Madison, School o f M e d i c i n e , 2715
M a r s h a l l C o u r t , Madison, Wisconsin 53705, "13th Annual Nuclear
C a r d i o l o g y Symposium and Workshop" h e l d i n Milwaukee, Wisconsin,
September 14- September 16, 19 08, AMA, Category I
17 h r s .
�K.G.
SCIENTIFIC MEEl'INGS, POSTGRADUATE COURSES, O OTHER CONTINUING
R
MEDICAL EDUCATION (C.M.E.) ACTIVITIES, Continued
CREDIT HOURS
S o c i e t y f o r Magnetic Resonance Imaging, Los Angeles, CA.,
February 21 t o March 1 , 19 89, at; the Century Plaza M o t e l ,
Category I , ACR
" C h o l e s t e r o l and Coronary Disease...Reducing t h e R i s k " p r e s e n t e d
by Dr. E l i o t A. B r i n t o n , Sponsor: The c o l l e g e o f P h y s i c i a n s
and Surgeons o f Columbia U n i v e r s i t y , Category I , AMA, h e l d a t
A l l e g h e n y V a l l e y H o s p i t a l , N a t r o n a Heights,PA, March 17, 1989
30.5 h r s .
1.5 h r s .
American S o c i e t y o f N e u r o r a d i o l o g y , 27th Annual Meeting, Orlando,
F l o r i d a , Category I , March 18 t o March 24, 1989
35 h r s .
American Roentgen Ray S o c i e t y , 89th Annual Meeting, May 7- t o
May 12, 1989, New O r l e a n s , LA., Category I , ACR
42 h r s .
American I n s t i t u t e o t U l t r a s o u n d i n M e d i c i n e , Bethesda, Maryland,
AIUM S p r i n g E d u c a t i o n a l Meeting held i n Phoenix, A r i z o n a , A p r i l 7
t o A p r i l 10, 1989, Category I. ( C o n v e n t i o n a l K Color-Flow Doppler
13.5 h r s . ; Endovaginal 10 h r s . )
23.5 h r s .
RSNA '89, 75tli S c i e n t i f i c Assembly fc Annual Meeting, Chicago, I L L .
Nov. 26-28, 1989, Events: #2RC103 M Imaging o f tlie C a r d i o v a s c u l a r
R
System ( 1 . 5 ) , #2RC202 P r a c t i c a l Aspects o f MR Image I n t e r p r e t a t i o n
( 1 . 5 ) , #2RC302 MRI o f t h e Shoulder ( 1 . 5 ) , #2RC402 MRI o f t h e Knee ( 1 . 5 ) ,
#E00 F i l m I n t e r p r e t a t i o n Session ( 1 . 5 ) , #SSC02 Bone ( W r i s t / S h o u l d e r )
(1.5),SSSF12 N e u r o r a d i o l o g y (Spine: S p i n a l Cord 1.5), #SSH02 Bone (TMJ
1.5),#SSJ14 G a s t r o i n t e s t i n a l (MR Imaging Abd. 1.5), Category 1 , AMA
13.5 h r s .
S o c i e t y f o r Magnetic Resonance Imaging, Reston, V i r g i n i a , Feb. 24
t o Feb. 28, 1990, ACR, "SMRI 8 t h Annual Meeting: E d u c a t i o n a l and
S c i e n t i f i c Programs, Category I
33 h r s .
American S o c i e t y o f N e u r o r a d i o l o g y , Los Angeles, C a l i f o r n i a , 28th
Annual Meeting o f ASNR, Category I , March 17- March 23, 1990
31.5 h r s .
RSNA '90, 7 6 t h S c i e n t i f i c Assembly fc AnnuaL Meeting, Chicago, 111.
Nov. 27- Nov. 29, 1990, Events: it2RC404 Imaging o f t h e Shoulder ( 1 . 5 ) ,
#2RC502 S e c i a l Course: MR 1990-Chest and Abdomen ( 1 . 5 ) . #J00 Annual
O r a t i o n & Gold Medal Awards ( 1 . 2 5 ) , #N00 Annual O r a t i o n i n R a d i a t i o n
Oncology ( 1 . 2 5 ) , #SSH01 C a r i o v a s c u l a r ( S t e n t s / A t h e r e c t o m y ) ( 1 . 5 ) ,
#SSH01 Bone ( A r t h r i t i s MR Imaging ) ( 1 . 0 ) , ffSSMlO C a r d i o v a s c u l a r
(Vascular MR I m a g i n g ) ( 1 . 5 ) , #SSP01 G a s t r o i n t e s t i n a l ( L i t h o t r i p s y )
( 1 . 0 ) , #SSR01 Bone (Knee M Imaging) ( 1 . 5 ) , Category I , AMA
R
12.0 h r s .
�K.G.
' •.•,
.
.
-12
SCIENTIFIC MEETINGS, POSTGRADUATE COURSES, OK OTHER CONTINUING
MEDICAL EDUCATION (C.M.E.) ACTIVITIES, Continued
CREDIT HOURS
American I n s t i t u t e o f U l t r a s o u n d i n M e d i c i n e , R o c k v i l l e ,
MD., Feb. 23- Feb. 24, 1991, Course: "Color Doppler
U l t r a s o n o g r a p h y " h e l d i n A t l a n t a , Georgia, Category I
10.5 h r s .
S o c i e t y f o r Magnetic Resonance Imaging, A c t i v i t y : "SMRI
9th Annual Meeting: E d u c a t i o n a l and S c i e n t i f i c Program",
sponsored bu the American College of Radiology, Category I ,
A p r i l 1 3 - A p r i l 17, 1991
33 h r s .
American Roentgen Ray S o c i e t y sponsored by t h e American
C o l l e g e o f R a d i o l o g y - 1991 Annual Meeting i n Boston, Mass.,
Category I , May 6, 7, and 8, 1991
12 h r s .
American S o c i e t y o f N e u r o r a d i o l o g y , Washington, D.C, 29th
Annual M e e t i n g , June 9- t o June 14, 1991, Category I
34 h r s .
R a d i o l o g i c a l S o c i e t y o f North America, 7/1.h S c i e n t i f i c
Assembly, Chicago, I I I . , Nov. 30- Dec. 3, I ')') I Category I.
20.5 h r s .
S o c i e t y o f Magnetic Resonance .Imaging Educa I i o n a l and
S c i e n t i f i c Program sponsored by ACR, Apr i I. 25- A p r i l 29,
1992, Category I
American S o c i e t y o f N e u r o r a d i o l o g y , S t . L o u i s , M i s s o u r i ,
Mary 30- June 4, 1992
"
26.5 h r s .
28 h r s .
�PEDIATRIC OPHTHALMOLOGY
CHILDREN'S SURGICAL ASSOCIATES, LTD.
DAVID B SCHAFFER, M.D.
CHAIRMAN
JAMES A. KATOWITZ, M.D.
GRAHAM E. QUINN, M.D. '
'
SHERYL J. MENACKER, M.D.
MICHAEL E. BRETON, PH.D.
RICHARD W. HERTLE, M.D.
DAVID B. GRANET. M.D.
JOANNE E. LOW, M.D.
JOSEPH D. NAPOLITANO, M.D.
LAWRENCE F. HANDLER, M.D.
THE CHILDREN'S HOSPITAL OF PHILADELPHIA
ONE CHILDREN'S. CENTER
• 34TH & CIVIC CENTER BOULEVARD .. . .. ,
PHILADELPHIA, PA 19104-4399
PHONE: (215) 590-2791
FAX: (215) 386-4036
Hillary Clinton
The White House
2600 Pennsylvania Ave.
Washington D.C. 2.6d3~i;
583 SHOEMAKER ROAD
KING OF PRUSSIA, PA 19406
(215) 337-3232 & 337-3233
301 OXFORD VALLEY ROAD
SUITE 801A
YARDLEY, PA 19067
(215) 321-7333
February 9, 1993
Dear Mrs Clinton:
I know that the new path that you and Mr. Clinton have chosen for the
American people will be a challenge. The responsibilities and burden of governing are
overwhelming, but I believe that this time of change holds great potential. This,
combined with your faith in the American people will lead you to success.
I am writing this letter, realizing full well the abundance of daily communication
that you receive, in the hope that a message from one of the people with his pulse on
a portion of the american medical system will be heard. I have been intimately
involved with deliverance of pediatric subspecialized health care to a large suburban,
urban, and referral population. The financial, technical, administrative, legal, and
educational aspects of the health care industry in this country are among the most
sophisticated and complex in the world. This allows us to routinely perform medical
and surgical treatments on patients which were inconceivable to physicians, even as
short as ten years ago. These attributes have forced clinicians to become more
socially conscious about larger health care issues. These include issues such as
health care costs, expenses, and mechanisms of delivery.
I am specifically involved with the health and treatment of disorders of the
visual system in infants and children. This is a fairly new subspecialty with about 450
of us in the United States and Canada. What is obvious to all of us is the need for
this care. We are equally divided among those whose practice primarily in the
community and those who practice in referral centers.
At the Children's Hospital of Philadelphia I am privileged to have a unique
perspective on the deliverance and administration of this health care to children. The
availability of specialty care is often out of control of the primary care physician or the
patient. Our daily decisions about patient diagnosis and care are influenced by many
things other than patient's needs. In many situations the patient's disease is the least
influential factor in the decision to obtain other consultations, specialized testing or
diagnostic procedures. Outside influences (hospital policies, insurance companies,
fear of litigation etc.) play a large role in the "practice" of subspecialty medicine. As a
consequence of these pressures a national "standard" of care is almost impossible to
�...... I.
obtain. The standard evolves more from geographic location, institutional policies, the
patient's economic status, and local regulations. This results in large inconsistencies
in available subspecialty care and patient management from community to community.
I do not pretend to understand the complexities and larger economic issues
facing the health care industry in America. The task you will be undertaking in the
near future needs this attention quickly. I am happy that the president has appointed
you to a major role in maximizing the potential of the great health care system
available in this country. I know that this will require help from some of the best and
brightest legal, administrative, economic, and medical minds in the country. It will also
require sacrifice by physicians, hospitals and other services intimately connected with
health care. I have no doubt that under your supervision this can be accomplished.
There are no quick answers for the problems of the health care industry in this
country. I have thought for some time about the most efficient and economic way to
provide health care to the American people. These ideas and plans have revolved
around the structured delivery of health care beginning with primary care. Through
the efforts of these caretakers, educated guidance of patients through the tertiary and
quaternary care system could minimize the time and money involved with
undisciplined and disorganized establishment of patient physician matching. Although
some fundamental health care processes may need to be restructured, I believe that
reorganization may be the best way to meet the future. If there is any capacity in
which the knowledge and experience I have can be useful in your campaign, I
volunteer my service. Involvement, even this letter, allows me to support the need for
health care reform. I think that it becomes even more urgent for those of us who care
for infants and children. It is this way because with each patient we see the future is
with us.
Sincerely,
Richard W. Hertle, M.D.
Assistant Professor of Ophthalmology
The Children's Hospital of Philadelphia and
The Scheie Eye Institute
The University of Pennsylvania
Philadelphia, PA
�1900 SOUTH BROAD STREET, PHILADELPHIA, PENNSYLVANIA 19145
215/339-4100
Joseph M. Hogan, M.D.
President, Medical Staff
February 17, 1993
Mrs. H i l l a r y Rodham Clinton
Hie White House
1600 Pennsylvania Hospital
Washington, DC 20500
Dear Mrs. Clinton:
I want t o thank you, again, f o r choosing Saint Agnes Medical Center f o r the f i r s t
s i t e v i s i t i n your monumental undertaking t o rehabilitate our national health
care delivery system. We were delimited t o entertain and, hopefully, inform you
i n some small way. We are grateful f o r the opportunity.
In the b r i e f moments I had t o address you d i r e c t l y , I made some comments which
might have seemed somewhat cryptic. I would l i k e t o expand upon them, b r i e f l y ,
at t h i s time. I don't think my comment concerning physician's frustrations i n
functioning within a system not of t h e i r making requires further elucidation.
My remark about the system propagating mediocrity and punishing excellence might
have been somewhat less clear t o you. I referred t o the DRG system which, while
i t i s intended t o regulate payments t o hospitals, impacts d i r e c t l y on physicians
i n that they tend t o become i d e n t i f i e d i n terms of length of stay of t h e i r
patients for various diagnoses. I n t h i s circumstance, a conscientious physician,
who treats as many patients as possible as outpatients, w i l l , of necessity, have
a sicker inpatient population and longer length of stay. He i s castigated by
both hospital administrators and oversic^it committees, despite expending fewer
health care dollars. Thus, punished f o r excellence. As t o the oversight
ccmrtittees, which physicians f i n d sc offensive, I have been unable t o determine,
from professional and lay press, that they have accomplished anything substantive
despite expending b i l l i o n s of dollars.
When I commented about professors and chairmen, I d i d not mean t o i n f e r that they
are not estimable people, of substance and quality, but, rather, t h a t they
achieve t h e i r l o f t y positions primarily because of the volume of t h e i r
contributions t o the professional l i t e r a t u r e and the magnitude of the research
grants they engender f o r t h e i r i n s t i t u t i o n s .
Pedagogic a b i l i t y i s a
consideration, c l i n i c a l excellence a lessor one. I doubt social consciousness
i s considered i n the selection process.
There are, of course, numerous issues of concern f o r physicians. Thank you f o r
the opportunity t o comment, on these few. God bless your e f f o r t s .
Very t r u l y yours,
M. Hogan, M D C
../
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3^
. -fiMstt^o
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�Withdrawal/Redaction Marker
Clinton Library
D O C U M K N T NO.
AND T Y P E
010. letter
DATE
SUBJECT/TITLE
Address (Partial) (1 page)
03/17/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [6]
2006-0885-F
jm806
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)
Freedom of Information Act - [5 IJ.S.C. SS2(b)|
Pl
P2
I'i
IM
b ( l ) National security classified information 1(b)(1) of the F O I A j
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA)
b(4) Release would disclose trade secrets or confldential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) o f t h e FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(8) Release would disclose information concerning the regulation of
flnancial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the F O I A |
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confldential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confldential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Katherine Murray Leisun
:
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i r;
:
1
'P6/(b)(6) •V; ^*
''
r
(workT7T7 270- 7738, mornings)
March 17, 1993 (St. Patrick's Day)
Hillary Rodham Clinton, Esq., Chair, White House Health Care Reform Task Force
The White House
Pennsylvania Avenue
Washington, DC 20500
Dear Mrs. Clinton,
. •
Thank you for your service to the nation tackling the health care delivery
problem while acting as First Lady and continuing your responsibilties to your
daughter and family. Your pro bono public service is much appreciated and, as you've
stated, not at all unusual for many professional women. Your thoughtful public
addresses (to the Children's Defense Fund, etc.) and press comments about what the
grass-roots life of a working mother is all about are most appreciated by all hard
-working, including professional, parents. I only wish that the press, including the New
York Times, would print the unedited text of more of your speeches.
I am a graduate of Wellesley College (1974) and Harvard Medical School
(1978). We're proud of your high visibilty as an intelligent young woman and
successful Wellesley graduate -- professional, mother, volunteer, and statesman /
public servant. I graduated from Wellesley High School and my family and relatives
still live there. (My brother-in-law, Atty. Leo Boyle, is past president of the Mass. Bar.
Association and president now of the New England Bar Association). The town of
Wellesley is apolitical, however, and hosted Barbara Bush and Raza Gorbachev
in June, 1990, for commencement. I've enclosed two photoes (Attachment A) of the
welcoming banners hung over the former "Hathaway House" bookstore in uptown
Wellesley then. Perhaps your staff could send one of these to Mrs. Bush, with grateful
appreciation for her^isits to the college and the Wellesley public schools.
I too am an ex-New Engtander now. living happily with my husband and 2
children in Hershey, PA, close to my in-laws in Harrisburg, PA. I was pleased to see
that Penn. State Harrisburg was able to host your meeting February 11, 1993, with
Senator Wofford and the PA. Medical Society, among other groups. For your
information, perhaps as a souvenir for your daughter Chelsea and your family, I've
enclosed my copy of Pennsylvania Medicine , with your photo on the front cover, for
you, commemorating the event (Attachment B).
My friend and colleague, also a Wellesley College graduate, Dr. Suzanne
Worrilow, has been in Family Practice for decades. In February, she and her
husband (their 5 children are grown) invited you by letter to visit them in their lovely old
�Georgian homestead in Lebanon, PA. She could also show you her personal,
downtown office practice. And, after a hearty Virginia-style breakfast with ham and
grits, you may accompany her for 7 AM nursing home rounds and 8 AM hospital
rounds, before she opens her office at 9 AM. Her conscientious, efficient, and caring
family practice situation is one of the most cost-effective gems of the present health
care system which must be preserved.
I am also a scientist and physician, an infectious diseases consultant with
several dozen articles and publications. I am just one among many physicians who
has saved lives and yet at times I have to struggle to recoup from the poor, young
women, children, and AIDS patients, among others, perhaps $50 - $200 of
reembursement for hours of complicated medical work spread over one or two weeks.
On the other hand, the terminally-ill elderly, especially men who are veterans, even if
they are in a vegetative state, are well-insured or covered fully. They can receive
extraordinarily expensive, high-technology care that young women and children can
rarely afford. Such resource expenditures on the vegetative elderly are rarely useful,
and many families (especially when self-paying) and patients themselves have
admitted when further tests and expensive procedures are futile. Wouldn't it be better
to provide subsidized pre-natal care and free vitamins for pregnant women? We
physicians would like to render these services without the hassles of paperwork.
[EDICINE NEWS & CARDIOLOGY NEWS
37
SM
U
Internal Medlcini News""
"For a half-hour treatment, I did
three hours of paperwork!"
If any group, however, sees "free care" as their right, they will by human nature
abuse the opportunities. People can clog up the clinics with trivial complaints. And
hospital facilities deteriorate if managed by outside providers. Look at the patient
rooms and non-administrative corridors in the veterans hospitals in order to see
socialized medicine at work. All these considerations must be weighed in trying to
formulate a rational health care policy for the future.
2.
�One easy way to avoid useless health care expenditures in offices and
hospitals and shrink big government is to remove infection control responsibilities from
Occupational Safety and Health (OSHA) and confine regulations and guidelines to the
Centers for Disease Control (CDC) or the Food and Drug Administration (for products
and devices). Although I am very concerned about effective infection control
measures and precautions in the health care setting, as shown by this local
newspaper column I wrote recently forthe public (Attachment C), I am also concerned
about excess regulations. For example, dust-mist masks, particulate respirators, or
"gas masks" are not necessary to control tuberculosis or TB. Hospital waste
regulations will not prevent junkies from disposing of loose, HIV-contaminated needles
or tampons in the general municipal trash. Likewise, onerous, absurd clinical
laboratory regulations from CLIA have increased costs to physician's offices and
provided great inconvenience to patients for performing simple urine or blood tests.
(Many of these regulations were enacted during recent Republican administrations).
On the cover of Pennsylvania Medicine, what a pleasure to see active public
officials who are both men and women, young and old, including our generation, who
dress and look like those of us "working in the trenches". We are the taxpayers,
pouring almost one-third of our paychecks into Social Security and taxes, paying alot
at the gas pumps to generate the Highway Trust Fund revenues, assisting our aging
parents in some cases, nurturing our children, schools, and communities, etc., and it is
wonderful to see our generation now represented in Washington DC. I hope we can
invest in more responsible government, better business opportunities, and more
infrastructural improvements for ourselves and future generations. I voted for you and
Bill Clinton because of your intelligence, dedication to hard work, and your visions that
we might balance the budget and pass onto future generations a stronger, rebuilt
America.
I also encouraged my five brothers and sisters to consider candidate Bill Clinton
seriously last year after this article appeared in Newsweek by a former family friend
and mountaineering companion, Robert MacNamara, also ex-Secretary of Defense
under Jack Kennedy's administration (Attachment D).
I am proud to be an American, particularly when abroad, and proud of the
nation's scientific and technical achievements. My father, Dr. Joseph E. Murray, of
Wellesley Hills, MA., and Harvard Medical School, was a co-recipient of the Nobel
Prize in Medicine or Physiology in December, 1990, for his work with kidney or renal
transplantation performed largely in the 1950's and igSO's. I've enclosed an extra
photograph of our family at the awards ceremony in Stockholm, Sweden, December
10,1990; I am on the far right, seated in a black-topped, white-skirted dress
(Attachment E). Investment in education, scientific research, and development is
invaluable for future progress.
My final point is directed to your campaign manager James Carville. Is he
3.
�from the town of Carville, Louisiana? After medical school, I (Dr. Katherine Murray)
repaid my National Public Health Service Corps Scholarship obligation by working at
the national leprosarium, now called the Gillis W. Long Hansen's Disease Center, in
Carville, Louisiana . I was introduced to the facility through my father's contacts with
missionary surgeon Dr. Paul Brand. My 2 1/2 years there under Dr. Jacobson and Dr.
Brand attracted me to the field of infectious diseases. I wrote several scientific
publications. Off hours, I returned to my love of painting and drawing, and I printed and
sold note cards from local scenes that Mr. Carville would recognize (Attachment F).
Could your staff send them on to the Carvilles with a copy of this letter? If his is the
family that ran the local post office, I may have met him or his sons, as I used to ride my
bike down there frequently for groceries. "It's a small world after all".
Best wishes to you and your husband as you tackle the enormous agenda
ahead. Your contacts with Congress and so many Americans are wonderful.
However, please be careful of security considerations, remembering Jack and Robert
Kennedy and all that was lost with them. Also, as a physician, I ought to warn you and
your husband that all people, including workaholics, must sleep, rest, and relax (with
the saxophone?) at times in order to remain productive over the long run and avoid
"burn-out". In the meantime, rest assured that many of us, particularly working
women, are grateful for your services, dedication, and leadership abilities which
you've given to the nation, gratis, so far. Thank you again.
S l n c e r e l y ,
j<^flu^H^
fa^s^^jju^
Katherine Murray Leisure, (MD \ U
Infectious Diseases & Epio&mtdogy
c:
Dr. Murray
Mr. Boyle
Dr. Worrilow
4.
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a d e ^ MA.
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�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3®H "
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�RICHARD
February
1,
A. LIPPIN.
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M.D.
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1993
\
Mrs. H i l l a r y Rodham C l i n t o n
C h a i r p e r s o n , U.S. H e a l t h Care Reform Task Force
The White House
1600 P e n n s y l v a n i a Avenue, NW
Washington, DC 2 0500
Dear Mrs. C l i n t o n :
As a p r e v e n t i v e medicine s p e g j A l i s t and as a concerned U^S.
c i t i z e T r ; 1 urge you and y o u r t a s k f o r c e t o s t r o n g l y c o n s i d e r t h e
v a l u e o f p r e v e n t i o n and w e l l n e s s as major s t r a t e g i e s t o b o t h f f ^ ^ fcyt
reduce h e a l t h c a r e c o s t s and improve t h e q u a l i t y o f o u r U.S. ^ - '—
h e a l t h c a r e system.
Mrs. C l i n t o n , s u r e l y you and your a d v i s o r s a r e aware o f t h e
s h o c k i n g s t a t i s t i c s which c a t e g o r i c a l l y demonstrate t h e
p e r c e n t a g e o f i l l n e s s e s , i n j u r i e s , and h o s p i t a l i z a t i o n s
a r e d i r e c t l y l i n k e d t o v o l u n t a r y human b e h a v i o r s such as
excessive t c
excessive tobacco and alcohol use - hence, which are entirely
preventable.
'/ ^iSj
Mrs. C l i n t o n , we c u r r e n t l y have a p a t e r n a l i s t i c , b l o a t e d , and
e x p e n s i v e s o - c a l l e d " h e a l t h care system" ( i n r e a l i t y , i t i s an c j *
i l l n e s s c a r e system) p a r t i a l l y because U.S. c i t i z e n s have f a i l e d / L ' /^o.
t o assume r e s p o n s i b i l i t y f o r t h e i r own h e a l t h , assuming t h e
c
r o l e , i n s t e a d , o f h e l p l e s s and dependent v i c t i m s . Mrs. C l i n t o n ,
I b e l i e v e t h i s p a t t e r n o f b e h a v i o r i s demeaning and r o b s
i n d i v i d u a l s o f t h e i r d i g n i t y and s e l f - w o r t h which must be
regained through increased i n d i v i d u a l r e s p o n s i b i l i t y .
r
•M
The American people, Mrs. C l i n t o n , a r e ready t o r e l a t e t o t h e i r
d o c t o r s as e d u c a t o r s n o t " M . D i e t i e s " whose pronouncements go
u n c h a l l e n g e d and whose t e c h n o l o g i e s a r e promoted as o m n i p o t e n t .
P r e v e n t i o n and w e l l n e s s ' programs, c o n v e r s e l y , a r e a t r u e w i n - w i n
s c e n a r i o . By r e d u c i n g demand f o r i l l n e s s c a r e , i f implemented,
t h e s e programs c o u l d markedly reduce h e a l t h c a r e c o s t s ( t h u s
f r e e i n g up needed d o l l a r s f o r " i n d i v i d u a l s whose c o n d i t i o n s a r e
t r u e a c t s o f f a t e ) , and, more i m p o r t a n t l y , t h e y would empower
our f e l l o w c i t i z e n s t o accept t h e g i f t s o f f r e e w i l l , s e l f esteem, m a t u r i t y , and r e s u l t a n t improved h e a l t h .
Mrs. C l i n t o n , I am convinced t h a t t h e American people a r e ready
t o a c c e p t t h i s new r o l e as more mature and r e s p o n s i b l e h e a l t h
c a r e consumers.
�Mrs. H i l l a r y Rodham C l i n t o n
February 1, 1993
Page 2
I n h i s inaugural address, the President, quoting from t h e
S c r i p t u r e s , asked us " t o f a i n t not". Please do not be a f r a i d ,
Mrs. C l i n t o n , t o be bold i n i n c l u d i n g prevention and wellness
programs as a major p o r t i o n of your strategy f o r U.S. h e a l t h
care reform. I t i s the r i g h t t h i n g t o do - i t s time has a r r i v e d
- and t h e American health care system can once more become t h e
envy of the world.
Many, i n c l u d i n g myself, stand ready t o a s s i s t you.
Be w e l l and thank you.
Sincerely,
/
Richard A. L i p p i n , M D .Ccc:
^-O
Senator W i l l i a m Cohen
Janet Smith, President, National Wellness C o a l i t i o n
�Consumer Cost Sharing
Managed Care
Wellness
•Managed care and consumer cost-sharing
are not enough to make the long-term
difference. It is time to incorporate
wellness into the total health care
management "pie".
It is tm t r d c t e n e
i e o e ue h ed
for h at care!
e lh
�
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Health Care Task Force Records
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White House Health Care Task Force
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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[Physician Letters] [loose] [6]
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 3
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Box 6
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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3/16/2015
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42-t-12092992-20060885F-Seg3-006-002-2015
12092992
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https://clinton.presidentiallibraries.us/files/original/b11120e73984b32cf54b49ee8e0996ed.pdf
9018d81f893677e3ee76b4ae9de9967c
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Text
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2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
2385
FolderlD:
Folder Title:
[Physician Letters] [loose] [5]
Stack:
Row:
Section:
Shelf:
Position:
S
56
3
4
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001a. letter
Address (Partial); Phone No. (Partial) (1 page)
01/24/1993
P6/b(6)
001b. letter
Phone No. (Partial) (1 page)
01/24/1993
P6/b(6)
002. letter
Address (Partial) (1 page)
02/21/1993
P6/b(6)
003. letter
Address (Partial) (I page)
02/10/1993
P6/b(6)
004. envelope
Address (1 page)
04/01/1993
P6/b(6)
005. letter
Address (Partial); Phone No.'s (Partial) (I page)
03/14/1993
P6/b(6)
006a. letter
Address (Partial) (1 page)
03/15/1993
P6/b(6)
006b. resume
Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
007. letter
Address (Partial) (1 page)
03/10/1993
P6/b(6)
008. letter
Address (Partial) (I page)
02/18/1993
P6/b(6)
009. resume
DOB (Partial); POB (Partial) (1 page)
01/27/1993
P6/b(6)
010. letter
Address (Partial) (I page)
03/24/1993
P6/b(6)
011. envelope
Address (1 page)
03/27/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
im788
RESTRICTION CODES
Presidential Records Act - |44 I'.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA)
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
012. letter
Address (Partial) (1 page)
02/25/1993
P6/b(6)
013. letter
Address (Partial) (1 page)
n.d.
P6/b(6)
014a. letter
Address (Partial); Phone No. (Partial) (I page)
02/05/1993
P6/b(6)
014b. letter
Phone No. (Partial) (I page)
02/05/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
im788
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
Pl National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the I'RA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the I'RA]
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(K) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Greenspring Pediatric Associates
Sinai Hospital of Baltimore
5101 Lanier Avenue
Baltimore, Maryland 21215
301-578-5800
March 1.7, 1993
Mrs. H i l l a r y Rodham C l i n t o n
Chairperson, Task Force On Health Care Reform
The White House
Washington D.C., Washington 20500
Dear Mrs. C l i n t o n :
.vrel
I know t h a t you are f a r along i n the process of working on health care
reform, but I wanted t o give you the benefit of my perspective as a health
care provider. 1 am the Medical Director of the P e d i a t r i c Outpatient
Department of a community h o s p i t a l i n Baltimore; our o f f i c e serves a
predominantly inner c i t y c l i e n t e l e . I also p r a c t i c e p e d i a t r i c s w i t h working
class and middle class c h i l d r e n and adolescents.
As you draw up your
proposals f o r health care reform, I hope t h a t you keep the f o l l o w i n g 2
p r i n c i p l e s i n mind:
F i r s t , there are 2 major ways t o lower health care costs: one method i s t o
continue t o deny a p o r t i o n of the population access t o health care; the other
method i s t o provide access t o everyone, but t o l i m i t the scope and cost of
h e a l t h care services t h a t are provided t o everyone. I strongly believe t h a t
the 2nd method i s the only e t h i c a l way t o go. I f t h i s means less h e a l t h care
services, or less money t o doctors, h o s p i t a l s , drug companies, etc. - so be
i t . I ' l l be very w i l l i n g t o t i g h t e n my b e l t f o r t h i s cause.
Second, as a p e d i a t r i c i a n , I've got t o beat the drum f o r preventive,
public health oriented i n t e r v e n t i o n . Research takes a long time t o be
performed i n t h i s area, but more and more, we are learning that "an ounce of
prevention i s worth a pound of cure." We need the organ transplant operations
and other high-tech i n t e r v e n t i o n s , but don't f o r g e t how very important i t i s
t o immunize an i n f a n t , check a toddler f o r lead poisoning, counsel an
adolescent on c i g a r e t t e smoking, and send a public health worker out t o the
home of a tuberculosis p a t i e n t t o help him take his medications c o r r e c t l y .
Prevention i s medically e f f e c t i v e and cost e f f e c t i v e .
Thank you f o r your a t t e n t i o n t o t h i s l e t t e r .
task force.
Good luck t o you and your
Sincerely,
Oscar M. Taube, M.D.
Medical Director
P e d i a t r i c Outpatient Department
Greenspring P e d i a t r i c Associates
Sinai Hospital of Baltimore
m W S c Xr-AykDOLESCENT MEDICINE: Paul Hursan, M.D. . Margaret E. Cesslcr, M.D. • Susan K. Moriarty, M.D. . Oscar M.Taubc, M O D |oycc K lucius C R N P . Teresa
M. Weedon. C.R.N.P. . Laarni S. Bihay, M.D. • Kami) Hilar, M.D. . Cecil W. Gaby, M.D. . Kurt Wm. Hcintzelman, M U. • Mary McCaugh, M.D. • Henri F. Merrick M D • Charul
Parshad, M.B.B.S. . Vicki C. Rose, M.D. . (ancllc Sandfurd, M.D. . ]. lulianna Singleton. M.D. . Eric Sundell, M.D. . Susan E. Wandishin, M.D. SOCIAL SERVICES Rebecca Polen
M.S.W., L.C.S.W. • MEDICAL DIRECTOR: Oscar M. Taube, M.D.
1
�CODER:.
HEALTH CARE TASK FORCE SORTING SHEET
DIPUT DATE:
GENERAL SORT:
POSTCARD 2:
General mail
Personal stories
Other Health Providers
POSTCARD 1:
Letter Campaign
.Offers to help/Employment
FORM LETTER:
Letterhead
.Policy
REROUTE:
Casework
.Scheduling
.Physicians
President
Other
POLICY AND PERSONAL STORTES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
working families
unemployed/low income
.benefits
.providers
.INFRASTRUCTURE/WORKFORCE (HI)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
FINANCING (VH)
.MENTAL HEALTH (IX)
.LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
.women's health
.immunizations/children
.rural
urban
OTHER
�NOTICE
* *
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�John M. W i l l i
Mrs. H i l l a r y Clinton
The White House
1600 Pennsylvania Ave
Washington, DC 20500
March 13, 1993
Dear Mrs. Clinton:
Having been i n the practice of dentistry for almost twenty-four
years now, i t has come to my attention that some input from me to
your o f f i c e might be of value to you as you hammer out d e t a i l s for a
health insurance plan for our people. In particular I am concerned
that you might be planning to use an HMO type of plan and I would
l i k e to try and dissuade you from considering a plan of this sort.
When I graduated from dental school i n 1970 I f e l t a c a l l to do
more than just open a business, see patients and make lots of money.
I f i r s t t r i e d to join the Public Health Service and I applied for
dental internships at San Francisco General and Denver General
Hospitals. Having been passed over for these positions, I joined the
Summit Medical Center Group in Ann Arbor, Michigan and set up a free
c l i n i c i n conjunction with the Model C i t i e s Program. I oversaw a l l
phases of the development of this c l i n i c ordering a l l supplies,
equipment and even a s s i s t i n g i n the construction of the office and
i n s t a l l a t i o n of equipment.
I recruited two of my classmates to work in this office and we
a l l worked for a salary of $10,000 each, as the budget would not
allow anymore and we f e l t that we needed three doctors i n order to
keep our o f f i c e open from 9AM to 9PM.
At the end of one year one of
my colleagues got into an unresolvable argument with our
administrator and we quit i n s o l i d a r i t y .
I then worked as an associate for Dr. Milan K. Glover who had
broken h i s collarbone and needed someone to work his practice while
he recuperated.
After he was back on the job on a regular basis, I .
was approached by Summit Medical again and asked to set up another
c l i n i c under the auspices of a Revenue Sharing grant which they had
received from the Democratically controlled c i t y government. This
time I was the sole doctor and instead of being a free c l i n i c we had ^_
a s l i d i n g scale with the wealthier c l i e n t s e s s e n t i a l l y paying for the
poorer ones. Our o f f i c e was i n the black after a year of operation
but at that time the Republicans managed to take control of the city
and our c l i n i c money was used to repair roads and bring down c i t y
—
debts.
At t h i s point i n time I bought the equipment and good w i l l from
the c l i n i c and opened my own practice. I participated in the
medicaid program and s t i l l offered a s l i d i n g scale u n t i l my debt was
paid off to Summit Medical. At this time I decided to discontinue
taking medicaid as the government kept reducing benefits and as these
�r e d u c t i o n s were always r e t r o a c t i v e from t h e date o f the r e d u c t i o n , I
found I c o u l d n ' t c a r r y a t r e a t m e n t p l a n t o c o m p l e t i o n . For example I
had a p a r t i a l denture t r e a t m e n t planned w i t h f i l l i n g s and Medicaid
stopped paying f o r f i l l i n g s . Another time they cut a l l payments by
1/3.
Anyway I operated t h i s p r a c t i c e i n Ann Arbor u n t i l 1981 a t
which time the economy took one o f i t s nosedives and most of my
f a c t o r y p a t i e n t s l o s t t h e i r b e n e f i t s as the f a c t o r i e s i n Y p s i l a n t i
layed o f f almost everyone. I decided t o s e l l my p r a c t i c e i n Ann
Arbor and move t o t h e Washington D.C. area which i s somewhat
i n s u l a t e d from these types o f economic problem's and began r a i s i n g my
fami1y.
I t was a t t h i s t i m e t h a t I f i r s t came i n c o n t a c t w i t h HMO's. I
came here and s t a r t e d again from s c r a t c h on the ground f l o o r o f an
h i s t o r i c house i n C l a r k s b u r g , MD. This t i m e I worked alone w i t h my
w i f e s e r v i n g as a p a r t time r e c e p t i o n i s t and even w i t h a j o b as an
a d m i n i s t r a t o r o f a shopping c e n t e r d e n t a l o f f i c e was r e a l l y i n need
of a c l i e n t base f o r income. I r e c e i v e d a number o f c a l l s from
v a r i o u s HMO's and became i n v o l v e d w i t h Dental B e n e f i t P r o v i d e r s ,
Randmark, D e n t i c a r e and MDIPA.
The p h i l o s o p h y o f the f i r s t t h r e e
plans was t o get a l a r g e number of c l i e n t s i n t h e hopes t h a t o n l y a
small number would ever present f o r t r e a t m e n t and as such the d o c t o r
would make up f o r making almost n o t h i n g on each s u b s c r i b i n g f a m i l y on
the ones t h a t never came. At the time I f e l t t h a t the a t t i t u d e I
noted a t t h e i r seminars added a cheapening aspect t o my p r o f e s s i o n
but I was hungry and I had signed a c o n t r a c t f o r a year and had no
o t h e r choice but t o work w i t h i t . I am i n a r u r a l s e t t i n g and as
such never got more than about 100 p a t i e n t s which l o and behold a l l
showed up f o r t r e a t m e n t . A t an average o f 5.00 per month per f a m i l y
c a p i t a t i o n I was making a whoping $60.00 f o r a f a m i l y of as many as 6
f o r two c l e a n i n g s xrays exams and f i l l i n g s f o r a year.
MDIPA wasn't much b e t t e r . They wanted me t o pay $250.00 t o
join.
I was then t o be g i v e n r e f e r r a l l s which I would t r e a t a t a
d i s c o u n t e d f e e . I had heard t h a t p h y s i c i a n s were g e t t i n g 75% of
t h e i r usual and customary fees and I f e l t I c o u l d l i v e w i t h t h i s .
Well wouldn't you know when the fee schedule came out the bread and
b u t t e r of d e n t i s t r y , c l e a n i n g , xrays and examinations were t o be
charged as $18 per person f o r a s e r v i c e t h a t would n o r m a l l y generate
from $40 f o r a c h i l d w i t h no xrays t o $85 f o r an a d u l t w i t h 2 xrays
exam and c l e a n i n g . I j u s t c o u l d n ' t do t h i s and c o n t i n u e t o o f f e r the
q u a l i t y o f care t h a t I am accustomed t o g i v i n g my p a t i e n t s .
I was a t a seminar w i t h a number o f d e n t i s t s who a l l were
p a r t i c i p a n t s i n MDIPA. I asked one of these c o l l e a g u e s of mine how
he managed t o make out on $18 per c l e a n i n g and severe r e d u c t i o n s i n
f i l l i n g c o s t s t o boot and was t o l d t h a t he " f i n d s a t l e a s t one p e r i o
p a t i e n t i n each f a m i l y " which generates a p p r o x i m a t e l y $400 f o r a
c l e a n i n g on t h a t p a t i e n t , and t h a t he hadn't done a 4 s u r f a c e f i l l i n g
s i n c e he got on the p l a n . A n y t h i n g b i g g e r than 3 s u r f a c e s
a u t o m a t i c a l l y became a crown.
Now t h i s might be seen as a s c a t t e r e d i n c i d e n c e i f i t hadn't
been f o r the looks I r e c e i v e d from the o t h e r d e n t i s t s I spoke t o who
were MDIPA p a r t i c i p a n t s when I q u e s t i o n e d these procedures. I ' v e
heard many s t o r i e s from my p a t i e n t s who signed up f o r HMO's and
r e t u r n e d t o my o f f i c e l a t e r ; s t o r i e s o f harsh t r e a t m e n t , unreasonable
time schedules and work t h a t was done t h a t I knew was not c a l l e d f o r .
�I am sickened by t h e s t a t e of my p r o f e s s i o n brought on by t h e s e l l i n g
of these HMO d e n t a l plans by i n s u r a n c e companies. I n f a c t I r e f u s e
t o belong t o t h e ADA because t o p o f f i c i a l s i n "my" o r g a n i z a t i o n are
u n d e r w r i t e r s of these r i p o f f i n s u r a n c e p l a n s . I n t h e end t h e o n l y
one who makes out i n these plans a r e t h e i n s u r a n c e companies. The
p a t i e n t loses because he/she e i t h e r gets poor t r e a t m e n t or more
t r e a t m e n t than i s c a l l e d f o r or b o t h . The d o c t o r loses because
he/she e i t h e r makes l e s s than he or she can a f f o r d t o make on t h e
s e r v i c e p r o v i d e d or he/she becomes l e s s than t h e p r o f e s s i o n a l he or
she was t r a i n e d t o be.
I have no problem w i t h t a k i n g a c u t i n my fees i f t h i s i s what
the c o u n t r y needs i n order t o p r o v i d e care f o r a l l c i t i z e n s but I
j u s t hope and pray t h a t you don't a l l o w i n s u r a n c e companies t o p a i n t
any g l o s s y p i c t u r e s of these HMO p l a n s . I f we want t o c o n t i n u e
p r o v i d i n g q u a l i t y care i n t h i s c o u n t r y t h i s i s n o t t h e road t o
fol1ow.
I don't know i f you are l o o k i n g f o r p r o f e s s i o n a l s t o serve on
your c o m m i t t e e ( s ) , but I would be proud t o o f f e r my s e r v i c e s i n t h i s
r e s p e c t as a p r o f e s s i o n a l d e d i c a t e d t o h i g h q u a l i t y care f o r a l l
people r e g a r d l e s s of economic s t a t u s .
e r e l y yours, ,
xn M. W i l l i a m s D.D.S.
P.S.
This l e t t e r i s a l s o being sent t o Mr. C l i n t o n
�DRS. P O W E R S a BERGIN, R A .
5 5 5 0 FRIENDSHIP BOULEVARD
SUITE 2 0 0
CHEVY C H A S E . M A R Y L A N D
DIPLOMATES
OF
AMERICAN
OBSTETRICS
JAMES
FRANCIS
S.
AND
BOARD
20815
/
OBSTETRICS,
POWERS.
T. B E R G I N
ADVANCED
M.D.
JR.,
GYNECOLOGICAL
TELEPHONE
M.D.
FAX
X..
Ms. H i l l a r y C l i n t o n
The White House
1600 Pennsylvania Ave., N.W.
Washington, Dc 20500
Dear Ms. C l i n t o n :
I would f i r s t o f a l l l i k e t o t a k e t h i s o p p o r t u n i t y t o
welcome you t o Washington, D.C, and t o c o n g r a t u l a t e you
and your husband on your most r e c e n t accomplishment as
being e l e c t e d t o t h e highest o f f i c e i n t h e United States.
I n a d d i t i o n now t h a t you a r e p a r t o f t h e Washington
community, you w i l l be s e a r c h i n g f o r r e l i a b l e e x p e r t s
i n t h e f i e l d o f medicine.
As i n t h e s m a l l communities
where I grew up i n N o r t h C a r o l i n a i t has always been
i m p o r t a n t t o welcome a newcomer t o t h e neighborhood and
I would l i k e t o extend t o you my b e s t regards as w e l l
as o f f e r i n g you any a s s i s t a n c e which I might be a b l e
t o provide as f a r as g y n e c o l o g i c a l s e r v i c e s t o you o r t o
your f a m i l y members. I remain a v a i l a b l e t o you a t any
t i m e should you have t h e need f o r c o n s u l t a t i o n f o r o t h e r
i s s u e s as they may a r i s e i n members o f your f a m i l y .
Once a g a i n , d u r i n g t h e n e x t f o u r years I wish you t h e
v e r y b e s t o f success i n what may a t sometimes be an
arduous t a s k b u t n e v e r t h e l e s s always promises exh i l a r a t i n g p r o s p e c t s f o r f u t u r e change. I remain
1
IT "'Powers, M.D.
JSP:rm
(3011
SURGERY
9 8 6 - 9 3 9 0
(301) 9 8 6 - 5 2 5 8
January 2 1 , 1993
Sincerely yours,
GYNECOLOGY,
INFERTILITY. AND
GYNECOLOGY
�i
NOTICE
PEHSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�(2>C>X6-\G\ O
David Zimrin
February 2, 1993
Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington D. C. 205000
Dear Mrs. Rodham Clinton,
I am a cardiologist in private practice and Director of Interventional Cardiology
at Sinai Hospital in Baltimore. I have a longstanding interest in health care policy and
cost control and recently read the enclosed monograph by Paul Starr. If you haven't
yet read it, I think it would be worth your time.
Though this plan would "hurt me" financially, I think it is necessary for the overall
fiscal health of the country and would support it.
I would be pleased to donate some of my time and expertise to your efforts in
health care reform if needed. Thanks tor your interest and good luck in your very
difficult task.
Sincerely,
David Zimrin
�CITY OF BOSTON
DEPARTMENT OF HEALTH AND HOSPITALS
1010 Massachusetts Avenue
f-yrv
Boston, MA 02118
D ^ ^ ^ ^ ^ o
.
Tel. No. (617) 534-4717
BUREAU OF COMMUNITY DENTAL PROGRAMS
February 5, 1993
H i l l a r y Rodham C l i n t o n , JD, Chairperson
National Task Force f o r Health Care Reform
White House
Washington, D. C. 02217
Dear Mrs. C l i n t o n ,
I am very pleased t h a t you have been selected t o Chair the
National Task Force f o r Health Care Reform. The American people
have s u f f e r e d too long because of the lack of p o l i t i c a l w i l l t o
respond t o the h e a l t h needs of our n a t i o n .
I would s t r o n g l y recommend t h a t you wouk Loward n a t i o n a l
"health" care reform not j u s t n a t i o n a l "medical" care reform.
Prevention must also be an i n t e g r a l component of t h i s reform i f you
wish t o make an impact on the h e a l t h status of the American
people.
Health Care Reform should be designed so t h a t a person w i t h
i n f e c t i o n or pain i n any p a r t of the body, whether i t be the l e g ,
arm, stomach or mouth, can receive the appropriate h e a l t h
service.
As Dental D i r e c t o r f o r the C i t y of Boston, my o f f i c e
must respond t o people w i t h pain or i n f e c t i o n who are unable t o
obtain services because they do not have h e a l t h coverage or are
unable t o pay f o r services.
Unfortunately, dental care and
treatment of pain or i n f e c t i o n s of the mouth are u s u a l l y excluded
from n a t i o n a l h e a l t h proposals and most h e a l t h insurance programs.
Over 150 m i l l i o n Americans do not have d e n t a l insurance and
those who do, f r e q u e n t l y are underinsured.
Thus, the general
population and e s p e c i a l l y vulnerable populations, such as the-—j
medically
compromised,
minorities,
children,
elderly,
developmentally disabled, the homeless or persons w i t h AIDS, must
s u f f e r unnecessarily. As PresiJ £iit-jalUie__^erican Public Health:
A s s o c i a t i o n — i-n- 1^90. I jdelTneated tTTTs "rre-gi-ected American y
e p i d e m i c ^ i n the Nation's Health. See Appendix A.
>
!
c
LONG ISLAND
CHRONIC DISEASE HOSPITAL
BOSTON HARBOR. MASSACHUSETTS 02169
COMMUNITY H E A L T H SERVICES
816 HARRISON AVENUE
BOSTON. MASSACHUSETTS 0 2 1 1 8
M A T T A P A N CHRONIC DISEASE HOSPITAL
249 RIVER STREET
MATTAPAN, MASSACHUSETTS 02126
�Prevention on the i n d i v i d u a l and community-based l e v e l should
also be an e s s e n t i a l component f o r any proposed n a t i o n a l h e a l t h
care reform.
Why should we spend m i l l i o n s of d o l l a r s f o r the
treatment of diseases which can be prevented e a s i l y w i t h such coste f f e c t i v e preventive measures as dental sealants, immunizations
and f l u o r i d a t i o n .
Over 100 m i l l i o n Americans do not l i v e i n
f l u o r i d a t e d communities and 92% of c h i l d r e n have not had dental
sealants.
D e n t i s t r y must be included i n n a t i o n a l h e a l t h care reform i f
the p u b l i c ' s best i n t e r e s t i s t o be served.
I have enclosed two
such proposals, one from the American Public Health Association,
Appendix B, and the other from the American Association of Public
Health D e n t i s t r y , Appendix C.
I f I can be of any f u r t h e r
assistance, please l e t me know.
Sincerely,
Myron A l l u k i a n , DDS,
MPH
Assistant Deputy Commissioner
MA/ejc
�PETER E. BENTIVEGNA M.D.
5\ Main Street
Hyannis, Massachusetts 02601
Plastic and Reconstructive Surgery
Surgery Of The Hand
/1/\<ZA.S%^J
)
L^"' ^ '
Q £
-
(508) 771-4263
February 16, 1993
Mrs. H i l l a r y R. C l i n t o n
Task Force on N a t i o n a l H e a l t h Care Reform
The White House
Washington, D. C. 20510
Dear Mrs. C l i n t o n :
I have r e c e n t l y opened my p r a c t i c e here on Cape Cod, Massachusetts, much a g a i n s t
the advice o f many o f my c o l l e a g u e s . I have t h e " t y p i c a l " , s t a g g e r i n g post graduate debt and as a r e s u l t , p r e s e n t l y r e n t a s m a l l house f o r my young and growing
family.
Cape Cod has an e l d e r l y p o p u l a t i o n and my p r a c t i c e i s a p p r o x i m a t e l y 60% Medic^are^
p a t i e n t s . My reimbursement i s 30 - 35c on t h e d o l l a r . , n o t t o mention t h e 20%
p e n a l t y f o r b e i n g a new p h y s i c i a n .
-
We r e c e n t l y dipped i n t o savings t o pay household b i l l s , something I never imagined
would happen t o a w o r k i n g p h y s i c i a n . Of these b i l l s , my h e a l t h care premiums are
particular-l-y~-burdensome. I pay_o.ur own famij y_premium plus_o,ne-for—my—son_Matt.hew,
who ha^Ilmm-L&-Syndrome^ I have been unable t o i n c l u d e him i n our f a m i l y p l a n
a l t h o u g h he i s as h e a l t h y as t h e r e s t o f us. H i s COBRA p l a n e x p i r e s i n one year
a f t e r which he w i l l be w i t h o u t h e a l t h i n s u r a n c e .
:
I have many concerns about t h e h e a l t h care system f o r o u r / e l d e r l y and c h i l d r e n . \
I am r e c e i v i n g m i n i m a l reimbursement f o r t o p q u a l i t y care~oir~one-ha-nd—and—pay- out
s i g n i f i c a n t premiums f o r t h e care o f my f a m i l y and my " s p e c i a l needs c h i l d " .
Perhaps your t a s k f o r c e would care t o speak t o someone l i k e m y s e l f ; a " s m a l l p o t a t o
farmer" new t o t h e system, dependent on the system, p a r t i a l l y abandoned by t h e system b u t by no means i n v e s t e d i n the system; f o r new ideas and i n s i g h t s .
I t would be an honor and my duty t o p a r t i c i p a t e ,
Sincerely yours.
Peter E. B e n t i v e g n a , M. D.
PEB:cam
enclosure
�PETER EDWARD BENTIVEGNA, M D
..
51 Main Street
Hyannis, Massachusetts 02601
v
POST GRADUATE TRAINING
UNIVERSITY OF UTAH. Salt Lake City, Utah
Hand/Microsurgery Fellowship (1991-1992)
Graham D. L i s t e r , Preceptor
Instructor - Orthopedics and P l a s t i c Surgery
NASSAU COUNTY MEDICAL CENTER, East Meadow, New York
P l a s t i c Surgery Residency (1989-1991)
Burn Fellowship (1988-1989)
HARTFORD HOSPITAL. UNIVERSITY OF CONNECTICUT
General Surgery Residency (1985-1988)
Instructor in Surgery: Senior Resident (1987-1988)
MEDICAL EDUCATION
N W YORK MEDICAL COLLEGE. Valhalla, New York
E
M D June^ 1985
..
Wilfred Ruggiero Surgery Award
Cor Et Manus Service Award
RESEARCH
Fairieigh Dickenson University, St. Croix, U.S. Virgin Islands
Hydrolab, Undersea Habitat - Summer, 1982
Hyperbaric Chamber Assistant - Summer, 1982
EXTRACURRICULAR ACTIVITIES
Academic Standards Committee
Vice President. St. Luke's Medical Society
Freshman Orientation Committee
Phonathon Participant N.Y.M.C. Fund Raising
Co-Director N.Y.M.C. F o l l i e s
Organized Annual N.Y.M.C. Coffee House/Cabaret
CERTIFICATIONS
Cardio-Pulmonary Resuscitation
Instructor C e r t i f i c a t e Advanced Trauma Life Support
Advanced Burn L i f e Support
New York State License #168668-1
Utah License # 1054910010
Massachusetts License # 76228
COWUCCTICVAT
uuewst
^
ozz&of
SOCIETIES
Diplomate, American Board of Medical Examiners
American Medical Association
Associate Group, American College of Surgeons
American Burn Association
Candidate American Society for P l a s t i c & Reconstructive Surgeons
Utah State Medical Society
Massachusetts Medical Society
COURSE CERTIFICATIONS
Certificate in Microsurgery: Harry J . Buncke Microsurgical Laboratory,
Davies Medical Center, San Francisco, California
C e r t i f i c a t e in Microsurgery: University of L o u i s v i l l e , L o u i s v i l l e ,
Kentucky
�. Page 2
v
COLLEGE EDUCATION
SOUTHAMPTON COLLEGE. Southampton, New York
B.S. Marine Science/Biology, Cum Laude, May, 1980
T r i Beta B i o l o g i c a l Society
UNDERGRADUATE RESEARCH PROJECTS
Springtime C i r c u l a t i o n P a t t e r n s of Shinnecock Bay. Southampton. New York
A Survey of Crustaceans I n h a b i t i n g C o r a l l i n e A l g a l Mats i n C e n t r a l
California
Moss Landing Marine Labs, C a l i f o r n i a
N.O.A.A. Funded O t t e r Grant Study
Species I n h a b i t i n g Abandoned S h e l l s of Strombus gigas, Coral Bay, S t . John,
^U.S. V i r g i n I s l a n d s
UNDERGRADUATE EXTRACURRICULAR ACTIVITIES
Academic Standards Committee
Laboratory A s s i s t a n t f o r Marine Operations/Marine Ecology
Reconstruction of Marine Mammal Skeletons f o r Permanent E x h i b i t i n Natural
Science B u i l d i n g , Southampton College, Southampton, New York
HOBBIES
Guitar Composition and Performance
Scuba Diving
Surf F i s h i n g
Hiking/Skiing
PUBLICATIONS
1)
Bentivegna. P.E.; "ADDRESSING THE RESIDENT SHORTAGE" L e t t e r t o the
E d i t o r , AMA News, January 20, 1988.
2)
Briones, R.; Lineaweaver, W ; Bentivegna. P.E.; Buncke. H.J.;
.
"MICROVASCULAR TRANSFER OF THE SERRATUS ANTERIOR OF THE RAT" P l a s t i c
Surgery Forum (1988) 11:129.
3)
Bentivegna, P.E.; THE VITACUFF AND INTRAVASCULAR RELATED INFECTION,
JAMA (1989) 262:614.
4)
Lineaweaver. W.C.; Buncke. G.M.; Bentivegna, P.E.; Buncke, H.J.;
"TRANSPELVIC RECTUS ABDOMINUS ISLAND FLAP F 6 R TREATMENT OF
OSTEOMYELITIS OF THE POSTERIOR SUPERIOR ILIAC SPINE" Annals of P l a s t i c
Surgery (1989) 22:539.
5)
Bentivegna, P.E.; Humphrey, C.; "ARTERIO-VENOUS FISTULA OF THE INTERNAL
MAMMARY ARTERY AFTER MEDIAN STERNOTOMY" J . C a r d i o v a s c u l a r Surgery
(1989) 30:375.
Bentivegna, P.E.; TRANSPORT OF THE BURN PATIENT, Emergency Care
Quarterly (1989) 4:29.
6)
7)
Bentivegna, P.E.; SILVADENE AS AN ADJUNCT TO CENTRAL LINE MAINTENANCE,
C r i t i c a l Care Med. (1990) 18:120.
8)
Bentivegna, P.E.; Deane, L.M.; CHEMICAL BURNS OF THE UPPER EXTREMITY,
HAND CLINICS (1990) 6:253.
9)
Bentivegna, P.E.; Greenburg, B.M.; THE USE OF AN INFERIOR BASED RECTUS
MUSCLE FLAP IN FLANK WOUND COVERAGE, Annals of Plastic Surgery (in
Press).
3
K
�• Page^. 3
VIDEOS
Briones, R.; Lineaweaver, W.; Newlin, L.; Bentivegna, P.E.; Buncke, H.J.;
"MICROVASCULAR TRANSFER OF THE SERRATUS ANTERIOR OF THE RAT" - Presented at
the American Society of P l a s t i c & Reconstructive Surgeons, October 5, 1988Session 5.
W R S IN PROGRESS
OK
1) Bentivegna, P.E.; Brewer, B.W.; Gunnlaugson, S.; Greenberg, B.;
Simpson, R.L.; "LIMB SALVAGE IN THE MULTIPLE TRAUMA PATIENT"
2) Bentivegna, P.E.; Eaton, C.J.; L i s t e r , G.D.; "PITFALLS IN MICROSURGERY"
3) Bentivegna, P.E.; L i s t e r G.D.; "DORSAL TRANSPOSITION FLAP FOR FIRST WEB
SPACE RECONSTRUCTION"
CONFERENCES & COURSES
American College of Surgeons, San Francisco, 1987
American Burn Association, New Orleans, 1988
New York Academy of Medicine Lipoplasty Symposium, 1989
U n i v e r s i t y of Massachusetts, D i f f i c u l t Fractures of the Hand and Wrist,
Sturbridge, Massachusetts, 1989
Cornell Medical Center, Hand Review Course, 1989
New York Academy of Medicine, Nasal Reconstruction Symposium, 1990
American College of Surgeons, Chapter Meeting, Garden C i t y , New York,
1990
PRESENTATIONS
Nassau Surgical Society; The Mangled Lower Extremity, Salvage vs.
Amputation - December, 1990.
New York Academy of Medicine; Limb Salvage i n the M u l t i p l e Trauma Patient May, 1991.
U n i v e r s i t y of Utah Microsurgical Course - I n s t r u c t o r - P i t f a l l s i n
Microsurgery - February, 1992.
�J O H N W. B L U T E , JR.,
DEAN C
HOWARD,
M.D.
M.D.
CONCORD ORTHOPEDICS, INC.
2 9CrBXT5E.QA V E N U E
CONCORDI MASSACHUSETTS
01742
TELEPHpNE <5Q8f 3 6 9 - 1 3 3 7
February 19, 1993
F i r s t Lady H i l l a r y Rodham C l i n t o n
The White House
1600 Pennsylvania Ave.
Washington, DC 20500
Re:
Dear Mrs.
Healthcare Reform
Clinton:
To introduce myself, I am a 45 y r . o l d orthopaedic surgeon
p r a c t i c i n g i n Concord, Massachusetts a t a 200 bed community
h o s p i t a l and have been i n p r a c t i c e f o r over twelve years.
I am
married w i t h three c h i l d r e n and from what I have read about you and
Mr.
C l i n t o n , have had very s i m i l a r l i f e and p r o f e s s i o n a l
experiences over the past t w e n t y - f i v e years.
I am w r i t i n g t o you as t h e Chairperson of t h e Committee on
Healthcare Reform.
This i s a very d i f f i c u l t and s i g n i f i c a n t
r e s p o n s i b i l i t y and the challenges are almost herculean. Hopefully,
t h i s was a j o i n t r e s p o n s i b i l i t y t o take on t h i s task between you
and Mr. C l i n t o n . Since I f e e l very s t r o n g l y about the issues o f
healthcare reform and have spent my e n t i r e a d u l t l i f e working
w i t h i n the healthcare system, I would l i k e t o share w i t h you some
of my thoughts and recommendations:
1. Excellence: For those Americans and f o r other peoples o f
the world who can f i n d t h e i r way i n t o our healthcare system
and can navigate t h e i r way w i t h i n i t , without question the
United States Healthcare System i s the best i n the world and
continues t o make t e c h n o l o g i c a l and f r o n t i e r - b r e a k i n g
progress. Nothing t h a t i s done i n the reform should change
t h a t r e a l i t y or t h a t promise f o r the f u t u r e .
The American
people and the people of the world look t o America t o continue
t h i s excellence.
2. C l i n i c i a n s : As I can see from the e a r l y r e p o r t s , you have
l i s t e n e d t o physicians, nurses,
and other healthcare
professionals and workers.
We do medicine and surgery
e s s e n t i a l l y every day of our l i v e s and I t h i n k have t h e
primary i n p u t i n t h i s s i t u a t i o n . However, physicians have not
done a very good job of organizing some of the ways we provide
care. We need t o j o i n w i t h others t o b r i n g about a b e t t e r
system. Please continue t o l i s t e n c a r e f u l l y t o those who take
care of p a t i e n t s .
cont:
�F i r s t Lady H i l l a r y Rodham C l i n t o n
February 19, 1993
Page Two
3.
Cost:
The t o t a l h e a l t h c a r e c o s t i s f a r t o o h i g h and
r e s o u r c e s are n o t a p p r o p r i a t e l y a l l o c a t e d . While I doubt t h a t
t h e demand f o r h e a l t h c a r e by t h e American people w i l l
decrease, I t h i n k t h e r a t e o f i n c r e a s e can be s i g n i f i c a n t l y
a l t e r e d and, h o p e f u l l y , should be i n t h e r a t e o f 3-5% per
year.
We cannot a f f o r d t h e s i g n i f i c a n t y e a r l y i n c r e a s e s o f
t h e l a s t t e n y e a r s . I n any "insurance system", however, every
p a t i e n t s h o u l d have a d i r e c t o u t o f pocket expense. T h i s w i l l
have a s i g n i f i c a n t i n p u t on p a t i e n t s ' d e c i s i o n making.
4.
The u n i n s u r e d :
The t h i r t y - f i v e t o f o r t y m i l l i o n people
who are u n i n s u r e d r e c e i v e v e r y l i t t l e , inadequate, o r poor
h e a l t h c a r e . T h i s has t o change. I n s u r i n g those people must
be a p a r t o f t h e r e f o r m and p r o v i d i n g them w i t h b a s i c
h e a l t h c a r e i s a r e q u i r e m e n t . I n t h e l o n g r u n , i t w i l l be l e s s
expensive f o r t h e c o u n t r y .
5.
Administration/bureaucracy:
The c o s t o f a d m i n i s t r a t i n g
our h e a l t h c a r e system, s p e c i f i c a l l y t h e bureaucracy and t h e
paperwork i s f a r , f a r t o o h i g h . I s t r o n g l y b e l i e v e t h a t t h e
l a r g e s t area o f savings i n t h i s system t h a t c o u l d be found
would be c u t t i n g t h e c o s t o f a d m i n i s t r a t i o n t o h a l f o f i t s
c u r r e n t r a t e . I t has been e s t i m a t e d t h a t t h e Canadian system
spends 3 1/2 t o 5% o f t h e h e a l t h c a r e d o l l a r on a d m i n i s t r a t i v e
c o s t s w h i l e t h e U n i t e d S t a t e s spends an e s t i m a t e d 30-35%,
a c c o r d i n g t o t h e r e c e n t New England J o u r n a l o f Medicine
article.
6.
Competition:
The 1986/8 e n t r e p r e n e u r i a l , b u s i n e s s - l i k e
c o m p e t i t i v e h e a l t h c a r e system was, I b e l i e v e , a v e r y poor
d i r e c t i o n t o have t r a v e l e d . We must change from a decade o f
competition
which
i n healthcare
d r i v e s up
costs
to
cooperation, w i t h a l l p a r t i e s working together t o solve
problems and n e g o t i a t e agreement between i n t e r e s t e d p a r t i e s t o
c o n t r o l costs. I believe t h a t t h i s i s achievable.
At t h e r e c e n t American Academy o f Orthopaedic Surgeons
M e e t i n g i n San F r a n c i s c o , I l i s t e n e d t o P r o f e s s o r A l a i n
E i n t h o v e n d i s c u s s t h e concept o f managed c o m p e t i t i o n and
w h i l e I t h i n k many o f t h e concepts sound v e r y i n t e r e s t i n g , I
need t o l e a r n a g r e a t d e a l more about t h i s b e f o r e I can
comment f u r t h e r on i t a l t h o u g h many, b u t n o t a l l , o f t h e
concepts seem e m i n e n t l y l o g i c a l .
7. H o s p i t a l / p h y s i c i a n o r g a n i z a t i o n : A mechanism needs t o be
d e l i v e r e r d t o a l l o w h o s p i t a l and p h y s i c i a n o r g a n i z a t i o n s t o
set up s t r u c t u r e s t o d i r e c t l y p r o v i d e h e a l t h c a r e t o p a t i e n t s ,
businesses, and governmental groups w i t h o u t r e q u i r i n g a m i d d l e
cont:
�F i r s t Lady H i l l a r y Rodham C l i n t o n
February 19, 1993
Page Three
agent such as i n s u r e r HMO.
This probably should be a
n o n p r o f i t e n t i t y . Without the requirement of a middle agent,
I t h i n k savings of 15-20% of the healthcare d o l l a r would be
e n t i r e l y possible.
These organizations should not be
jeopardized by a n t i t r u s t laws and r e g u l a t i o n s .
8.
Resources:
I believe we need t o take 60-70% of the
resources spent i n the l a s t s i x months of our e l d e r l y
p a t i e n t s ' l i v e s and put them i n t o the f i r s t f i v e years of our
c h i l d r e n s ' l i v e s . Some of these e t h i c a l choices w i l l be
extremely p a i n f u l and extremely d i f f i c u l t , but the b e n e f i t s
w i l l be enormous. As someone w i t h parents approaching t h i s
age and as someone who works w i t h p a t i e n t s suddenly f a c i n g
these problems every day ( e l d e r l y p a t i e n t s w i t h h i p f r a c t u r e s
and other challenging traumatic i n j u r i e s ) , I t h i n k t h i s
concept can be accomplished.
9. Outcome studies and resources: American medicine needs t o
continue t o look very c a r e f u l l y a t the r e a l outcome of how we
achieve diagnosis and provide treatment t o b e t t e r understand
and t o optimize what we do. My suspicion i s t h a t there w i l l
be b e t t e r medicine by t h i s approach and t h a t there w i l l also
be s i g n i f i c a n t cost savings. We cannot neglect research and
education of healthcare p r o f e s s i o n a l s . I t i s grossly overs i m p l i s t i c t o t h i n k t h a t s i g n i f i c a n t savings should be
achieved i n t h i s area. We must plan f o r the f u t u r e .
10. A n c i l l a r y healthcare: As a recent New England Journal of
Medicine a r t i c l e delineated, t h i s country spends an enormous
amount of i t s resources
on m o d a l i t i e s which are o f
questionable b e n e f i t .
Whether Medicare of Medicaid funds
should be spent i n health insured d o l l a r s and should be
a l l o c a t e d t o these m o d a l i t i e s , I b e l i e v e , i s a very r e a l
question.
11. Trauma care: This i s a long neglected, c e r t a i n l y very
poor area of care i n which a b e t t e r care system could be
achieved. Improving care and, e s p e c i a l l y , prevention of these
i n j u r i e s could r e s u l t i n s i g n i f i c a n t improvement i n the l i v e s
of many p a t i e n t s and s i g n i f i c a n t d o l l a r savings.
Educational programs such as the American Academy's
Patient Program of " L i v i n g I t Safe" emphasize the preventive
aspects of healthcare t h a t I t h i n k are q u i t e important.
12.
Tort reform: While I t h i n k the p r e d i c t e d d o l l a r cost
savings i n t h i s area are not t e r r i b l y high, reform i n t h i s
area would provide r e a l improvement i n the climate i n which
cont:
�F i r s t Lady H i l l a r y Rodham C l i n t o n
February 19, 1993
Page Four
physicians, surgeons, and h o s p i t a l s f u n c t i o n .
Physicians
should not have t o do t e s t s , etc. f o r lawyers, but i n the best
i n t e r e s t o f p a t i e n t - c a r e . We need t o emphasize q u a l i t y o f
care, not punishment, and a t the same time t o l e r a t i n g poor
care i s unacceptable. I t h i n k the country's a t t i t u d e towards
t h i s area of "misfortune megabucks" i s changing and steps
should be taken t o continue t h a t t r e n d .
13. Preserving choice: The American p a t i e n t wants t o be able
to have a choice o f physician and h o s p i t a l f o r healthcare and
we shouldn't change t h i s concept.
I wish you and your committe wisdom, a sense o f humor, and
perspective during the coming months i n the d e l i b e r a t i o n s ahead.
Your committee's e f f o r t w i l l c e r t a i n l y d i r e c t l y a f f e c t the l i v e s o f
every American c i t i z e n and, c e r t a i n l y , w i l l very d i r e c t l y a f f e c t my
p r o f e s s i o n a l career.
I f there i s anything f u r t h e r t h a t I can do t o a s s i s t you,
l e t me know.
Thank you.
Sincerely,
W Blute,\Jr., M
.
JWB/cn
please
�I.
^
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
1
wx:
�BRIGHAM
AND
WOMEN'S
H O S P I T A L
Ot'/j.ii'l/iif/il o/ Ant'slhcs/ii
75 hanas i'lfeel
Boston, Massachusetts 02 M 5
(617) 732-7310
Mrs. Hillary Rodham Clinton
The White House
Washington D C
AllenBurton, M.D.
April 10, 1993
Dear Mrs. Clinton:
As a young doctor (second year of a four or five year residency
program), let me start by wishing you luck in developing a health
care plan that will meet the challenges of the future. I have some
concerns and ideas regarding future health policy.
My first concern is the expense of a medical education. In my
particular circumstance, I am 80,000 dollars in debt after medical
school. This debt is called into repayment during residency training
without regard to the young doctor's precarious financial position.
The 600 dollar per month payment is made difficult by several
factors. First, the debt should be deferrable until the end of
residency training. This is an easy, painless step for the lenders who
could continue to accrue inteiest. while it would protect residents
from a real financial threat. Second, the interest on student loans,
which used to be deductible, could again be made deductible-even if
only during the residency period. Third, and perhaps most stressful
to young doctors, is the uncertain future we face, hearing about
cutbacks to come in every aspect of our future livelihood. Many are
starting or planning to start families in the near future. We feel
squeezed between our tremendous debt (some of my colleagues owe
as much as 200,000 dollars) and our impending slash in income. We
did not go into medicine for monetary gain, but neither did we enter
�i
i
:
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1
medicine to bankrupt our families paying back enormous debt on a
limited income.
After working hard my entire life (and incurring massive educational
debt) to earn my medical degree, I decided to pursue a career in
anesthesiology. I am a resident at a Harvard anesthesia program,
and I take pride in this profession. Physicians specializing in
anesthesia guide patients safely through major surgical procedures,
assist in a caring and expert fashion with pain management, and
assist other physicians with intensive care management of critically
ill patients. Imagine my dismay at hearing of President Clinton's
proposed "RAP-DRG" payment system for anesthesia physicians. This
proposal, to compensate anesthesiologists with one lump payment to
the hospital based on the patient's diagnosis-regardless of time
spent with the patient, is demeaning to the profession of
anesthesiology. Anesthesiology is to be relegated to the status of an
institutional service, and I fear morale and eventually quality of care
w i l l suffer. In 1993, even very ill patients undergo major surgery on
a routine basis with very low rates of morbidity and mortality. This
is due, in large part, to the professionalism and dedication of
anesthesiologists, and I feel strongly that to continue this tradition of
progress and excellence we must be recognized as specialized
physicians, run as some amorphous hospital service.
Thank you for your time, and feel free to call on me anytime.
Sincerely
Allen Burton, M.D.
Resident, Department of Anesthesia
Brigham and Women's Hospital
75 Francis Street
Boston MA 02115
cc:
President Clinton
Senator E. Kennedy
Senator Kerry
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
)
�1
Ms. Hillary Rodham Clinton
Chairwoman, President's Task Force on National Health Refonn
The White House
Pennsylvania Avenue
Washmgton D.C.
Dear Hillaiy:
Congratulations on your challenging appointment to lead the President's Task Force on
National Health Refonn. As an enthusiastic supporter of Bill Clinton's campaign and a
Wellesley College alumna (class of 78) I have watched this new administration unfold
with high hopes, and I am delighted that you are utilizing your talents and directing your
energy towards this significant problem confronting our nation.
lam a pediatrician practicing in a neighborhood health center in Cambridge MA, and
confront the issues of access to care, cost control, managed competition and health care
bureaucracy on a daily basis. By sharing some anecdotes from my professional life I can
best illustrate some of the key problems with our system and some avenues for change.
We, as a nation need to be inspired to work together towards the common and just goal of
universal access to health care. We also need to accept that high quality care for all will
cost money, require some sacrifices, and require that we must ail accept some limitations
as to how that care is offered. The value of a trusted primary care physician who knows
his or her patients well can not be overlooked, both in terms of continuity of care and
containment of costs. As a board-certified pediatrician I am quite comfortable in serving
as a "gatekeeper" for judicious referrals, and yet am constantly challenged by parents
demanding to see a "specialist " for their children regardless of who is paying for their
medical care, andregardlessof whether there is a true need for subspecialty consultation.
Reserving referrals to subspccialists for those who truly need them would conserve
resources.
Families must also learn that non-emergent care should not be provided by emergency
rooms. In the middle of the night throughout my weekends on call I always speak to
several parents whose children have been sick for several days, and want to have them
seen now, i.e. 3 a.m. They are all offered the option of an appointment in the office the
next day; however most chose to go ahead into the emergency room for these non-acute,
common childhood illnesses. Regardless of whether these families have third-party
insurance. Medicaid or are applying forfreecare from the hospital, a middle of the night
emergency room visit is expensive, unnecessary and not in the best interests of the patient
in that good continuity of care provided by someone who knows the patient and has
access to his or herrecordsis not possible.
We need to use our govemment programs to encourage and reinforce what is most healthy
for our patients, rather than providing inappropriate incentives. WIC, the Women, Infant
and Children supplemental nutrition program provides vouchers for food for nursing
�mothers, formula for babies and food for a limited number of children over the age of one.
Many mothers give up nursing in order to receivefreeformula! We need to use this
program to encourage mothers to breastfeed, rather than discourage it. An additional
irony is that iron-deficient anemia is a diagnosis that will enable older children to qualify
for WIC; however Medicaid and most third-party insurance will not cover the cost of iron
supplements. Many children might not become anemic if they could continue to be
eligible for WIC and receive adequately nutritious and iron-rich foods.
We have a clear need for malpractice reform. As a pediatrician, my premiums are relatively
low; my colleagues in surgery and obstetrics are not so fortunate. We all find ourselves
practicing "defensive" medicine; ordering those extra tests even though they add nothing to
the patient's course of therapy. I am totally in favor of just compensation for true
negligence; in fact as a medical student I did the research which formed the basis of an
out of court settlement in favor of a member of my family upon whom a procedure had
been performed without informed consent. It is the spurious suits without foundation, and
the compensatory damages for disease processes or untoward outcomes that are absolutely
not under the control of any physician, that must be curtailed.
My final area of concern is that of the managed care approach to increasing competition
and decreasing costs. I am leary that it will do little to decrease the mammoth healthcare
beaurocracy now in place and may in fact increase it. I have a whole file drawer devoted
to the many different health care plans I participate in, and a dozen different provider
numbers to use on a myriad of forms. Our small clinic has boxes and boxes of the many
different referral forms and other paperwork required by each plan; our paperwork is
overwhelming even though we are fortunate to have our billing handled centrally by the
hospital. In addition, I fear that managed care will remove us as physicians farther away
from the patients who need us most. I serve a needy, mostly low-income population who
look to the clinic for help with many tasks, both medical and non-medical. In the course
of a week I may refer families to attorneys, write recommendations for high school
seniors applying to college, speak multiple times to teachers and social workers, and help
unsnarlfinancialproblems. Will managed care leave time and space for primary care docs
like me to help their patients with these kind of problems? I can't do a good job of
managing a child's asthma if her parents are preoccupied with being evictedfromtheir
apartment!
I love my profession, and fmd it a priviledge to work in a field that provides intellectual
challenges and many opportunities to serve. In a sense, I put to practice "Non ministrari,
sed ministrare" every time I go to my office. It is in that spirit that I offer these thoughts
on avenues for change in health care.
My sympathy to you and your family on the recent death of your father. Loosing a parent
is never easy no matter when or how, and it seemed especially poignant to me that you
were faced with your own family health care crisis in the midst of heading up the task
force.
My very best wishes to you, Bill, and Chelsea.
Sincerely,
Lisa Dobberteen M.D.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
^ fcAaV^ta i n - ./.27-
�^-March 36,
Ms. H i l l a r y Rodham Clinton, Chairperson
Task Force on National Health Care Reform
The White House
j
1600 Pennsylvania Avenue N W
..
Washington, D.C. 20500
Dear Ms. Clinton,
i
Please hear my s i n g l e , i f not unique, voice on health care costs.
I am a physician with f i f t e e n years of p r a c t i c e experience, f i r s t
as a g e n e r a l i s t , now as a s p e c i a l i s t . I have a degree i n public
health based on my i n t e r e s t i n health care delivery. I have worked
in health maintenance I organizations, teaching h o s p i t a l s , and a
small o f f i c e p r a c t i c e . A l l have administrative drawbacks, but the
solo o f f i c e i s , s u r p r i s i n g l y , the most cost e f f i c i e n t , despite
requiring two f u l l time employees to handle insurance and b i l l i n g
for one physician.
These costs, multiplied by thousands of
doctors, added to the I expense of many insurers promulgating new
plans, w i l l make managed competition an economic nightmare.
I
Since before medical school, I have believed i n health care as a
r i g h t rather than a privledge. I s t i l l believe Americans should
have the r i g h t to basjic care, and e s p e c i a l l y preventative care.
Limited resources w i l l n e c e s s a r i l y r e s t r i c t access to increasingly
expensive procedures of marginal benefit. A l l of us involved i n
health care need to contribute to improve access and to lower the
economic burden. Physicians should promise more than the voluntary
r e s t r a i n t s proposed by the American Medical Association.
i
The t o t a l cost of health care w i l l remain high unless the morass of
insurance plans i s s i m p l i f i e d i n some way, such as a single payor
system. Encouraging more complexity under the catchword of managed
competition w i l l only [increase administrative costs a t a l l l e v e l s .
Less w i l l be spent on actual delivery of care to Americans.
�You have been confronted w i t h many proposed s o l u t i o n s t o our health
care c r i s i s . None i s p e r f e c t . Managed competition w i l l only b r i n g
about more of a maze of health f i n a n c i n g schemes and greater costs.
Please help reduce t h i s a d m i n i s t r a t i v e burden as one p a r t o f cost
containment.
Very t r u l y yours.
N. Alan H a r r i s , M.D., M.P.H.
cc:
Senator Edward Kennedy
Senator John Kerry
Representative Peter Blute
�Elizabeth's
D
_fl_
•
of Boston
736 Cambridge Street
Boston, Massachusetts 02135
617/789-3000
A p r i l 8, 1993
Ms. H i l l a r y Rodham C l i n t o n
The Whitehouse
1600 Pennsylvania Avenue
Washington, D.C.
Dear Ms. Rodham-Clinton:
C o n g r a t u l a t i o n s on your appointment t o head t h e Task
Force on H e a l t h Care — and good l u c k . We a r e a l l l u c k y P r e s i d e n t
C l i n t o n has a p p o i n t e d such a competent woman t o head t h i s
i m p o r t a n t m i s s i o n . Your husband's i n a u g u r a t i o n was i n s p i r i n g
and i n h i s f i r s t two months i n o f f i c e he has expressed a genuine
concern f o r t h e American people by addressing t h e importance
of c o n t r o l l i n g h e a l t h care c o s t s . I am v e r y i n t e r e s t e d i n
h e a l t h care r e f o r m and I would l i k e t o become i n v o l v e d w i t h
your t a s k f o r c e and any o t h e r r e l a t e d p r o j e c t s .
To i n t r o d u c e m y s e l f , I suppose I am a t y p i c a l young d o c t o r .
I grew up i n a s i n g l e p a r e n t w o r k i n g c l a s s household and was
i n s t i l l e d w i t h a f i r m b e l i e f i n t h e American dream.
Scholarships,
work-study and loans g o t me t h r o u g h T r i n i t y College i n Washington,
D.C. I attended m e d i c a l school i n Syracuse, New York. I
s u r v i v e d i n t e r n s h i p , r e s i d e n c y , c h i e f r e s i d e n c y and am c u r r e n t l y
i n my f i r s t year o f a t h r e e year c a r d i o l o g y f e l l o w s h i p . I
am on c a l l f r e q u e n t l y , sometimes 72 hours s t r a i g h t on weekends.
I b a r e l y break even w i t h r e n t and repayment o f a $75,000.00
debt.
I am 30 years o l d and w i l l n o t o f f i c i a l l y j o i n t h e
work f o r c e f o r two o r t h r e e more y e a r s .
U n f o r t u n a t e l y , I am e n t e r i n g an environment v e r y u n f r i e n d l y
to p h y s i c i a n s . What have I worked so hard f o r ? What have
I wasted my y o u t h t o o b t a i n ? What o t h e r p r o f e s s i o n has such
a strenuous t r a i n i n g program and what o t h e r v o c a t i o n i s under
such a t t a c k ?
Not o n l y do d o c t o r s have t o a t t e n d t o t h e p h y s i c a l c o m p l a i n t s
of t h e i r p a t i e n t s , they have t o d e a l w i t h t h i r d p a r t y payers,
c o n f u s i n g Medicare-Medicaid changes, t h e s p e c t r e o f m a l p r a c t i c e ,
h e a r t - w r e n c h i n g e t h i c a l dilemmas and n e g a t i v e p u b l i c i t y . Who
i s going t o go i n t o medicine, i f t h i s continues?
My g e n e r a t i o n
of young p h y s i c i a n s i s v e r y d i s h e a r t e n e d and r e s e n t f u l o f
current public opinion.
-1Mcimber Hospital of Carltai ChrUtl-A Catholic Hoalth Care System
A Major Teaching Affiliate of Tbfts University School of Medicine
�-2There has been much t a l k blaming d o c t o r s f o r t h e c u r r e n t
problems i n medicine.
H o n e s t l y , p h y s i c i a n s are n o t s o l e l y
r e s p o n s i b l e f o r t h e h e a l t h care c r i s i s .
The problem i s m u l t i f a c t o r i a l (as, I am s u r e , you are becoming aware).
I suppose
d o c t o r s are t o blame f o r abandoning t h e business o f medicine
t o " f o r - p r o f i t " o r g a n i z a t i o n s . There i s excessive f i n a n c i a l
g a i n i n r u n n i n g h o s p i t a l s , l a b s and HMO's. I n t h e b e s t p o s s i b l e
w o r l d , n o t h i n g i n medicine should be " f o r p r o f i t " , and, indeed,
such o r g a n i z a t i o n s should be s t r i c t l y r e g u l a t e d .
There a r e many o t h e r s t r i k i n g problems. Laws g o v e r n i n g
the i s s u e o f m a l p r a c t i c e need t o be reviewed.
We are l e a r n i n g
d e f e n s i v e medicine i n m e d i c a l school and r e s i d e n c y .
Every
p a t i e n t has a l i s t o f p o s s i b l e d i a g n o s i s . Medical t r a i n i n g
prepares us t o choose t h e proper d i a g n o s i s and t r e a t t h e
p a t i e n t a c c o r d i n g l y . Fear o f being sued pushes aside o u r
t r a i n i n g and causes us t o o r d e r many expensive t e s t t o r e c o n f i r m
our s u s p i c i o n and g i v e us evidence t c stand up i n c o u r t .
This burden t o t h e h e a l t h care system cannot be u n d e r e s t i m a t e d .
A l s o , drug companies need t o be reformed.
I remember
d i s c u s s i n g w i t h a p a t i e n t which o f her s i x medicines was
most i m p o r t a n t because she c o u l d o n l y a f f o r d t o take one.
I then r a n i n t o a drug r e p r e s e n t a t i v e o f f e r i n g me t i c k e t s
t o a Red Sox game. Lunches, books, t r i p s are thrown a t p h y s i c i a n s
i n t h e name o f e d u c a t i o n , w h i l e drug p r i c e s and drug company
p r o f i t s go t h r o u g h t h e r o o f . Many o f t h e p h a r m a c e u t i c a l
i n d u s t r y ' s t a c t i c s are u n e t h i c a l and d i s t u r b i n g .
I v e r y s t r o n g l y b e l i e v e i n r e f o r m and a n a t i o n a l program
f o r h e a l t h c a r e . I t would be d i f f i c u l t , though, t o r e f o r m
the m e d i c a l i n d u s t r y w i t h o u t adequate medical r e p r e s e n t a t i o n .
I agree t h a t t r a d i t i o n a l medical o r g a n i z a t i o n s r e p r e s e n t
p h y s i c i a n s who l i v e i n " i v o r y towers".
You need i n p u t from
my g e n e r a t i o n which understands t h e s t r u g g l e o f becoming
a p h y s i c i a n w i t h o u t b e i n g t a i n t e d by years o f u n f a i r p r a c t i c e .
I would d e f i n i t e l y be i n t e r e s t e d i n c o n t r i b u t i n g t o your
t a s k f o r c e and i n any o t h e r c a p a c i t y I c o u l d .
Thanks f o r your t i m e .
Sincerely.
KATHLEEN HOGAN, M.D.
KH:ds
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
s
�New England Medical Center
D e p a r t m e n t of Medicine
Division of C a r d i o l o g y
April 20, 1993
Carey D. K i m m e l s t i e l , M.D.,
Mrs. Hillary Rodham Clinton
The White House
Washington .DC 20500
F.A.C.P., F.A.C.C.
Assistant Director, Cardiac.
Calhetmzation
Laburntory:
Assistant l\off!.\sar nf Mr/licinc
RE:
HEALTH CARE REFORM
Dear Mrs. Clinton:
750 Washington Street
N E M C #264
Enclosed please find a copy of a letter that I sent to to President Clinton and his
transition team in January of this year. Unfortunately, ! have never received a
response or an acknowledgement concerning the receipt of this communication.
Boston, Massachusetts 02111
I continue to be concerned about the lack of input from practicing physicians
with respect to evolving health care reform proposals. It is my belief that
physicians as the providers of health care should be intimately involved in any
proposals which will alter the way that health care is currently dispensed in
this country.
I would, of course, be pleased to discuss these issues with your representatives
at any time.
Very truly yours,
Carey D. Kimmelstiel, M. D.
CDK/ch
CC:
Donna Shalala
Secretary of Health & Human Services
Mr. Ira C. Magaziner
Senator Edward Kennedy
Senator John Kerry
Congressman Edward J. Markey
The principal teaching hospital for
Tufts University School of Medicine
�©
New England Medical Center
Department of Medicine
Division of Cardiology
January 6, 1993
The Honorable William Clinton
President Clinton Transition Team
105 West Capitol
Suite 400
Little Rock, AK 72201
RE:
HEALTH CARE REFORM
Dear President-elect Clinton:
Carey D. Kimmelstiel, M.D.,
F.A.C.P., F.A.C.C.
Assislanl Oirp.c.Utr. Gudiac
CattirteriztUion Uibomtmy:
Assistant frafessm of Medicine
750 Washington Street
NEMC #264
Boston, Massachusetts 02111
I am a cardiologist on staff at the Tufts University and New England
Medical Center Hospitals in Boston, Massachusetts. I have been
following the discussions in print and visual media concerning health
care reform with great interest. Through my direct involvement in
patient care in a salaried non-private practice setting, and my daily
discussions with my colleagues in the community who are in private
practice, I believe I am in a position to objectively comment on health
care delivery as relates to both those receiving and those dispensing
medical care. The purpose of this letter is to highlight my perceptions
of the failings of our current system and to suggest some solutions.
The causes of ongoing growth and spending on health care in the United
States are many and varied. The average age of Americans has been
increasing yearly for many years. A disproportionate percentage of
health care dollars are spent on hopelessly-ill elderly people in their
last days of life, depriving these patients the right to die in a dignified
manner while siphoning off funds which could be used in a more
compassionate, constructive and cost effective manner for uses such as
preventative medicine, i.e. vaccinations for childhood infectious
diseases.
A tremendous amount of health care resources are expended in so-called
'defensive medicine"; although the precise cost of this is difficult to
determine, a recent publication from the C. Everett Koop Research
Center at Dartmouth estimated that 50% of health care costs were
related to the practice of defensive medicine. Although in my eleven
years as a physician I have not been sued, and though I am fairly
insulated in a tertiary referral and university setting, I find myself
ordering tests that have a small likelihood of uncovering clinicallyunrecognized disease; I do this in an effort to obviate the risk of future
potential litigation. This practice is undoubtedly even more prevalent in
community based physicians.
The principal teaching hospital for
Tufts University School of Medicine
�- 2The rapidly escalating cost of malpractice insurance adds enormously to
the cost of health care delivery as well as leading to physician shortages
in various specialties when the costs of purchasing medical liability
insurance makes the practice of said specialty untenable. Indeed, the
cost of such insurance is unlikely to decrease in the near future given
the unfettered proliferation of frivolous litigation, no doubt stimulated
by the egregious practice of television advertising by lawyers offering
their services to sue physicians for perceived poor outcomes.
Practicing physicians under the current insurance framework are
deluged by ever increasing amounts of paperwork. Over 8,000 different
insurance forms exist, mandating complex computer systems and
trained staff working full-time in an effort to document services
rendered. The effect of such a system on health care costs is obvious.
Additionally, the proliferation of review organizations often leads to
unacceptable delays of providing needed services to ill patients. I often
find myself explaining the need for a particular diagnostic exam, most
often to a nurse hired by an insurance carrier. Not infrequently, these
conversations take up to one half hour, wasting valuable time during my
always busy day.
The incoming administration must consider the issue of physician
reimbursement. As I am sure you are aware, Medicare reimbursement
for physician-rendered services has been decreased enormously over
the past several years while the costs to physicians of providing these
services has continued to increase. As private insurers often follow the
lead of Medicare, the result has been a significant reduction in net
physician income. As has been documented by a variety of authors,
physician reimbursement accounts for well less than 10% of health
care costs. It therefore follows that the ongoing reductions in physician
reimbursement have not led to a diminution in the continued increases
in national health care expenditures. Rather, in my opinion, these
reductions significantly detract from the quality of the health care
services rendered, as medical practitioners find themselves spending
ever decreasing amounts of time with patients in an effort to increase
volume so that they may survive financially.
Finally, no discussion of health care reform is complete without
discussing medical education. Presently, our medical students at Tufts
University graduate owing an average of approximately $82,000. After
graduation, a required residency training period of anywhere from three
to nine years (at low pay) is mandatory. Obviously, physicians'
salaries need to be at a level that justifies the debt incurred by financing
a medical education. Moreover, we need to continue to attract the most
academically qualified students, not just those most financially qualified.
With the preceding discussion in mind, I offer the following suggestions:
(1) Establish uniform and reasonable quidelines regarding
availability of medical care as was attempted previously in Oregon.
�-3(2) Reform the current malpractice system so as to remove the
stimulus for unwarranted litigation.
Possible solutions are the
elimination of the contingent fee basis by which the majority of the legal
fees for these cases are paid. Cap pain and suffering awards. Establish
local committees consisting of physicians,
ethicists and other
professionals to adjudicate malpractice claims in a more timely, cost
effective and informed manner.
(3) Institute a single payer system with uniform coding to
replace the pedantic and redundant system that currently exists.
(4) Reinstitute the availability of low interest loans to finance
medical education.
These are only a few suggestions to help improve and control costs in our
health care delivery system. I strongly encourage you to involve
physicians in any discussions relating to this important topic.
Sincerely yours,
Carey D. Kimmelstiel, M. D.
CDK/ch
CC:
Office Files
�'PPR 12 ' 9 3 1 3 : 2 2
.
P.2/4
Children's Hospital
Fegan 10
300 LonK»114Hl~A¥enue
lioston
CMIdrcrfs Hospital
A p r i l 5,
Clinical Genetics Program
Brocc R. Korf, M.U., Ph.U.
Director
Uirih Dtltcis Service
Mtrilyao Ktynie, M.D. MS .
Ncilda Hobbs, M.C3.
Joann. Mi.cbe.i, M.D.
Medical Genetics ServicFAX
Mallhew Wnrman, M.D.
1993
H x l l a i y RodhaTO-ClIHtOn
W h i t e HOUSS
.
. .
ttashingt on/
D
C
(202 ) -456-6218
Joseph Wagstiiff, M.D.
David Whitcmtn, M.D.
Dear Ms. Rodham-Clinton,
Inborn Errors of
M«k s K™W«, M.D.
!
I ^ t me begin by expressing my sincere condolences t o
you and your family over the decent passing of your father. I wish
you a l l strength during t h i s d i f f i c u l t time, and a complete healing
of s p i r i t .
Consider a disease that once doomed i t s child
victims to severe mental retardation.
A dietary treatment i s
developed that prevents this complication, and these individuals
grow up healthy vith an opportunity to have their own families.
Hew tragic the disappointment for women with this illness to learn
that, while they escaped the devastation of their disease, this
condition oould go on to cause mental retardation and heart disease
in their children. This i s the story of phenylketonuria or FKU.
W A 18 PKU?
HT
PKU i s an inherited disorder of protein
metabolism i n which the body i s unable t o
break down phenylalanine, an amino acid or building block of
protein. I f not controlled, phenylalanine levels r i s e t o a point
that i s toxic t o a developing brain, causing severe, i r r e v e r s i b l e
mental retardation.
Treatment involves maintaining a severely
r e s t r i c t i v e , low protein d i e t , s t a r t i n g i n early childhood. Such
a d i e t prohibits the ingestion of meat, poultry, f i s h , eggs, milk
or dairy products, beans and legumes, and nuts. Only measured
amounts of vegetables, f r u i t s and other foods that are naturally
low i n protein are allowed.
I n addition, a d a i l y n u t r i t i o n a l
supplement ("PKU formula") i s required t o ensure that adequate
n u t r i t i o n a l needs are properly met. Despite the hardship of t h e i r
d i e t and the bad taste of the formula, these children changed not
only the natural history of t h e i r disease but t h e i r own destinies
as w e l l . This conquest of a disease that affects about one c h i l d
i n 10,000 led t o the f i r s t implementation of a newborn screening
program f o r the early i d e n t i f i c a t i o n of
�APR 12 '93 13:22
P.3/4
children with treatable diseases. Newborn screening f o r PKU and
the successful prevention of i t s effects represent an international
health care success story.
APPARENT 8DCCE88
U n t i l about twelve years ago, the
medical community believed that brain
development was essentially complete by f i v e or s i x years of age,
and most children with PKU discontinued therapy at that
time, resuming a normal, unrestricted d i e t by mid-childhood.
Previously, women with PKU were i n s t i t u t i o n a l i z e d ; with few
exceptions, they did not bear children (because of t h e i r severe
degree of mental retardation). Here then was a new generation of
"PKU women", able t o study and work, t o marry and have children.
M W CONCERHS
E
I t became apparent/ however, that these
children were at great r i s k f o r having
s i g n i f i c a n t problems. Greater than 90% were mentally retarded,
many grew poorly i n utero, and about 15% developed heart defects.
The cause of t h i s tragedy... the high phenylalanine levels i n
these women (who by now were long o f f t h e i r PKU d i e t s ) . Just as
excessive phenylalanine endangers a young child's brain, so too i t
i s toxic or teratogenic t o a baby's developing central nervous
system (no similar f e t a l r i s k exists f o r fathers with PKU). This
r e l a t i v e l y recent syndrome, i r o n i c a l l y a product of the combined
success of newborn screening and effective dietary therapy, i s
termed maternal PKU.
LOOKING FOR A SOLUTION
With increased recognition
of maternal PKU, attempts were
made t o locate adolescent and adult women with PKU, many long l o s t
t o follow-up by t h e i r local c l i n i c s , and educate them about these
new issues. Specifically, however, the importance of restarting a
PKU d i e t p r i o r t o conception and maintaining such a d i e t throughout
pregnancy was emphasised. However, educational attempts f a i l e d t o
change the behavior i n most women a t r i s k .
Further c l i n i c a l
research suggested that peer support and empowerment of a woman to
take control of her disease were better indicators of success.
CAMP!
With t h i s approach, the Northeast Regional
Maternal PKU Camp was conceived.
This year
marks the t h i r d consecutive year f o r the f i v e day camp, which
offers t h i r t y adolescent and young women (twelve years of age and
up) each year the opportunity t o meet other women with PKU, and
learn through supportive discussions and workshops a strategy f o r
l i v i n g successfully with PKU. Using various measures - knowledge
�R R 12 '93 13=23
P
P44
./
about maternal PKU, maintenance of a low protein diet after camp,
and continued contact with a peer support network developed at the
camp - the project has been enormously successful. During t h i s
past year, a written manual was compiled and made available to PKU
c l i n i c s i n other regions, offering details regarding how t o go
about setting up a new camp.
I invite you to come and see our Camp up close.
It's a place of oourage by young women determined to take control
of their illness and their lives, of dedication by professional
staff (froa many parts of the O.fl. and Canada) who have made PKU
their l i f e ' s work, and of spirit and enthusiasm by a l l who
partioipate in those five magical days. The Camp runs this year
from Saturday, June 26th through Thursday, July 1st in Fraaingham,
KA, just outside of Boaton.
I f I can provide you with further information about
PKU or maternal PKU, or oar camp, please l e t me know.
Very t r u l y wurs,
•—lUpjJUm^—
Mark Korson, n.D.
Director, Maternal PKU Camp
Director, PKU/Metabolism Clinic
Children's Hospital, Boston
�I
NOTICE
PEHSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
3dx 2 '3 #5
�February
T a s k F o r c e On N a t i o n a l H e a l t h C a r e
The White House
Washington, D.C. 20510
Dear
Reform
Sirs,
As i n v i t e d I , a p r i v a t e c i t i z e n , s h o u l d l i k e t o r e n d e r
opinion a s regards the c a l l f o r h e a l t h c a r e reform.
my
As a r e c e n t l y r e t i r e d d o c t o r o f m e d i c i n e I am i n f u l l
agreement f o r s u c h r e f o r m . My b a s i s f o r agreement i s s i m p l e
and a s f o l l o w s .
Upon c o m p l e t i o n o f my m e d i c a l e d u c a t i o n a t Y a l e U n i v e r s i t y
and i n t e r n s h i p a f t e r w a r d s I went d i r e c t l y t o work a t t h e
student h e a l t h s e r v i c e a t the U n i v e r s i t y of Connecticut.
T h e r e I was a b l e t o d e v o t e a l l o f my e n e r g i e s t o t h e p r a c t i c e
of m e d i c i n e . The r e a s o n f o r t h i s i s b e c a u s e I was on a s a l a r y
with housing b e n e f i t s , a comprehensive h e a l t h i n s u r a n c e
package, and a good r e t i r e m e n t program. U n l i k e t h e p r i v a t e
p r a c t i t i o n e r s o f m e d i c i n e I n e v e r had t o s h a r e my time and
e n e r g i e s w i t h d a b b l i n g i n t h e s t o c k market, r e a l e s t a t e , and
o t h e r a t t e m p t s a t s e c u r i n g a r e t i r e m e n t package f o r m y s e l f . I
have s e e n d o c t o r a f t e r d o c t o r i n p r i v a t e p r a c t i c e go from an
i d e a l i s m and a n o b l e approach t o t h e p r a c t i c e o f m e d i c i n e t o
p e r s o n s n e a r p r e o c c u p i e d w i t h t h e a c q u i s i t i o n o f money.
We have an o l d s a y i n g i n m e d i c i n e t o t h e e f f e c t t h a t some
d o c t o r s s a y t h a t t h e y have p r a c t i c e d m e d i c i n e 30 y e a r s .
A c t u a l l y t h e y p r a c t i c e d m e d i c i n e 1 y e a r 30 t i m e s and most
n e v e r even know i t !
Now a few f a c t s f o r you t o c o n s i d e r .
1) Time cannot be s h o r t e n e d o r l e n g t h e n e d . 2) M e d i c i n e i s
becoming more and more complex a s r e g a r d s t h e l e a r n i n g o f and
t h e p r a c t i c i n g o f . 3) P e o p l e a r e n o t machines t o be t r e a t e d
l i k e v e h i c l e s on a g a r a g e l i f t . T h e i r e x p e r i e n c e w i t h d o c t o r s
i s u s u a l l y one a s s o c i a t e d w i t h a n x i e t y i f n o t f r a n k f e a r and
�"February
T a s k F o r c e On N a t i o n a l H e a l t h C a r e
The White Houae
Washington, D.C. 20510
Dear
25, 1993
Reform
Sirs,
As i n v i t e d I , a p r i v a t e c i t i z e n , s h o u l d l i k e t o r e n d e r
opinion a s regards the c a l l f o r h e a l t h c a r e reform.
my
As a r e c e n t l y r e t i r e d d o c t o r o f m e d i c i n e I am i n f u l l
agreement f o r s u c h r e f o r m . My b a s i s f o r agreement i s s i m p l e
and a s f o l l o w s .
Upon c o m p l e t i o n o f my m e d i c a l e d u c a t i o n a t Y a l e U n i v e r s i t y
and i n t e r n s h i p a f t e r w a r d s I went d i r e c t l y t o work a t t h e
student h e a l t h s e r v i c e a t the U n i v e r s i t y of Connecticut.
T h e r e I was a b l e t o d e v o t e a l l o f my e n e r g i e s t o t h e p r a c t i c e
o f m e d i c i n e . The r e a s o n f o r t h i s i s b e c a u s e I was on a s a l a r y
with housing b e n e f i t s , a comprehensive h e a l t h insurance
p a c k a g e , and a good r e t i r e m e n t program. U n l i k e t h e p r i v a t e
p r a c t i t i o n e r s o f m e d i c i n e I n e v e r had t o s h a r e my t i m e and
e n e r g i e s w i t h d a b b l i n g i n t h e s t o c k market, r e a l e s t a t e , and
o t h e r attempts a t s e c u r i n g a r e t i r e m e n t package f o r m y s e l f . I
h a v e s e e n d o c t o r a f t e r d o c t o r i n p r i v a t e p r a c t i c e go from an
i d e a l i s m and a n o b l e a p p r o a c h t o t h e p r a c t i c e o f m e d i c i n e t o
p e r s o n s n e a r p r e o c c u p i e d w i t h t h e a c q u i s i t i o n o f money.
We have an o l d s a y i n g i n m e d i c i n e t o t h e e f f e c t t h a t some
d o c t o r s s a y t h a t t h e y have p r a c t i c e d m e d i c i n e 30 y e a r s .
A c t u a l l y t h e y p r a c t i c e d m e d i c i n e 1 y e a r 30 t i m e s and most
n e v e r e v e n know i t !
Now a few f a c t s f o r you t o c o n s i d e r .
1) Time c a n n o t be s h o r t e n e d o r l e n g t h e n e d . 2 ) M e d i c i n e i s
becoming more and more complex a s r e g a r d s t h e l e a r n i n g o f and
t h e p r a c t i c i n g o f . 3 ) P e o p l e a r e n o t m a c h i n e s t o be t r e a t e d
l i k e v e h i c l e s on a g a r a g e l i f t . T h e i r e x p e r i e n c e w i t h d o c t o r s
i s u s u a l l y one a s s o c i a t e d w i t h a n x i e t y i f n o t f r a n k f e a r and
�/.
NOTICE
, *
#
PERSONAL INFORMATION HAS BEEN REDACTED
•FROM THIS DOCUMENT
So A 2 3'fS-i J a / . •
�April 28, 1993
Mrs. Hillary Rodham Clinton
White House
1600 Pennsylvania Ave., N.W.
Washington, D.C. 20006
Dear Mrs. Clinton:
The world has really changed since I grew up in the 40's and 50's in a small town in
West Virginia! I maintain some very core values from those early years and I've attempted
to bring these values into the practice of medicine in Massachusetts.
I entered Medical School at the age of 37, with a great deal of resolve, dedication and
purpose. I needed all of that for the next nine years to keep me on track with academic and
clinical duties as well as the responsibility of being a mother to my two children.
I am now a Board Certified Psychiatrist with additional certification in Addiction
Medicine with particular interest in program development for females who have been sexually
abused. I'm anxious to have input about these particular areas of Mental Health Care.
It's "my time" to serve and use my life experiences and credentials for the benefit of
my patients and to support myself. Much to my surprise, I'm having a tough time doing
either one of these things!
One of the core values from West Virginia that I need to "bse" is my belief that
voicing negative assessments is complaining. I'm ready to be political with my good ideas
because being quiet hasn't helped me or the system.
I believe in the integrity of women and I support you in your public and private
strength. With the recent death of your father and your respectful and humane pause for
Krievine. vou emeree even more a leader and role model.
I look forward to hearing from you or your staff if you think I may be of any
assistance in your development of policy for mental health needs.
Respectfully,
Lou Gene.McCabe, M.D.
''cc: Task Force on Health Care Reform
�April 28, 1993
Mrs. Hillaiy Rodham Clinton
White House
1600 Pennsylvania Ave., N.W.
Washington, D.C. 20006
Dear Mrs. Clinton:
The world has really changed since I grew up in the 40's and 50's in a small town in
West Virginia! I maintain some very core values from those early years and I've attempted
to bring these values into the practice of medicine in Massachusetts.
I entered Medical School at the age of 37, with a great deal of resolve, dedication and
purpose. I needed all of that for the next nine years to keep me on track with academic and
clinical duties as well as the responsibility of being a mother to my two children.
I am now a Board Certified Psychiatrist with additional certification in Addiction
Medicine with particular interest in program development for females who have been sexually
abused. I'm anxious to have input about these particular areas of Mental Health Care.
It's "my time" to serve and use my life experiences and credentials for the benefit of
my patients and to support myself. Much to my surprise, I'm having a tough time doing
either one of these things!
„ One of the core values from West Virginia that I need to "bse" is my belief that
voicing negative assessments is complaining. I'm ready to be political with my good ideas
because being quiet hasn't helped me or the system.
I believe in the integrity of women and I support you in your public and private
strength. With the recent death of your father and your respectful and humane pause for
grieving, vou emerse even more a leader and role model.
I look forward to hearing from you or your staff if you think I may be of any
assistance in your development of policy for mental health needs.
Respectfully,
Gene McCabe, M.D.
cc: Task Force on Health Care Reform
�1
1
• 1
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
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Address (Partial); Phone No. (Partial) (1 page)
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
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2006-0885-F
jm788
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�&izr
yzLUiU^
jxuu. trf pMH^u*^. ^ <n^e
^^-^;R6/(b)(g);
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Clinton Library
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DATE
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01/24/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
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2006-0885-F
jm788
RESTRICTION CODES
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NOTICE
^
#
PEHSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
.Oil*?"
1
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Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
02/21/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
im788
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 22(l4(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or conndcntial commercial or
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P5 Release would disclose conHdential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOI A)
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
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personal privacy 1(b)(6) ofthe FOIA)
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purposes 1(b)(7) ofthe FOIA)
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financial institutions 1(b)(8) ofthe I O I A|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misnie defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�3ruce I i . Slau^luiiiKoupl:,
M.D.
, P6/(b)(6)••. : /
F e b r u a r y 2 1 , 1993
Mrs. H i l l a r y Rodham C l i n t o n
The White House
1600 P e n n s y l v a n i a Avenue
W a s h i n g t o n , D.C.
20008
Dear F i r s t Lady,
I w o u l d l i k e t o b e g i n by s a y i n g t h a t I have
never w r i t t e n t o t h e W h i t e House b e f o r e .
I have
never f e l t c o m p e l l e d t o do so b e f o r e t o d a y .
I am a t h i r t y - t w o y e a r o l d s u r g i c a l r e s i d e n t
a t a t e a c h i n g h o s p i t a l i n Boston, Massachusetts.
I " i r r o n ^ r y - g T j p p o r t you i ^ ~ y o T r r - ^ r t i ' g g l ^ ^ o ~ r e T o r m
t h e h e a l t h c a r e d e l i v e r y system i n A m e r i c a .
I agree t h a t we have t h e p o t e n t i a l t o p r o v i d e
the best h e a l t h care i n t h e w o r l d .
However,
i t ' s a p p r o p r i a t i o n has been s o r e l y m i s g u i d e d .
Rather than i n v e s t i n t h e youth of our
c o u n t r y w i t h e d u c a t i o n on n u t r i t i o n and p h y s i c a l
f i t n e s s , we a r e s p e n d i n g o u r h e a l t h c a r e d o l l a r s
on r e n a l d i a l y s i s f o r o c t o g e n a r i a n s . I once c a r e d
f o r a n i n e t y - t w o - y e a r - o l d male n u r s i n g home
r e s i d e n t who s u f f e r e d f r o m b l i n d n e s s as w e l l
as A l z h e i m e r ' s d e m e n t i a , and was s t i l l
undergoing
d i a l y s i s t r e a t m e n t . He no l o n g e r had any l i v i n g
f a m i l y members t h a t c o u l d make t h e d e c i s i o n t o
stop therapy.
S i n c e h i s d i a l y s i s was b e i n g
r e i m b u r s e d w i t h M e d i c a i d f u n d i n g , t h e r e was no
i n c e n t i v e f o r t h e p h y s i c i a n s i n v o l v e d t o re-assess
his condition.
A l t h o u g h most o f my t r a i n i n g t a k e s p l a c e
at a u n i v e r s i t y h o s p i t a l , I also r o t a t e out t o
a p r i v a t e h o s p i t a l i n t h e community. On a d a i l y
b a s i s , I see w e a l t h y i n t e r n i s t s p r o v i d e t h e w o r s t
q u a l i t y medical care imaginable t o e l d e r l y n u r s i n g
home r e s i d e n t s . When t h e y become t o o i l l t o
l i v e i n t h e n u r s i n g home, t h e y g e t t r a n s f e r r e d
t o t h e h o s p i t a l where t h e y s t a y f o r a s e t number
o f days as a l l o t t e d by t h e i r D.R.G. The i n t e r n i s t
w r i t e s a q u i c k d a i l y note i n t h e c h a r t w h i l e
the p a t i e n t i s provided w i t h nominal care.
�r
*.
Bruce L. Slaugkenhoupt,
M.D.
February 2 1 , 1993
Mrs. H i l l a r y Rodham C l i n t o n
The White House
1600 P e n n s y l v a n i a Avenue
Washington, D.C.
20008
Dear F i r s t Lady,
I would l i k e t o b e g i n by s a y i n g t h a t I have
never w r i t t e n t o t h e White House b e f o r e . I have
never f e l t compelled t o do so b e f o r e today.
I am a t h i r t y - t w o year o l d s u r g i c a l r e s i d e n t
a t a t e a c h i n g h o s p i t a l i n Boston, Massachusetts.
I s t r o n d f l y s u p p o r t you i n your s t r u g y l ^ t o reForm
the h e a l t h c a r e d e l i v e r y system i n America.
I agree t h a t we have t h e p o t e n t i a l t o p r o v i d e
t h e b e s t h e a l t h care i n t h e w o r l d . However,
i t ' s a p p r o p r i a t i o n has been s o r e l y misguided.
Rather t h a n i n v e s t i n t h e y o u t h o f our
c o u n t r y w i t h e d u c a t i o n on n u t r i t i o n and p h y s i c a l
f i t n e s s , we a r e spending our h e a l t h c a r e d o l l a r s
on r e n a l d i a l y s i s f o r o c t o g e n a r i a n s . I once c a r e d
f o r a n i n e t y - t w o - y e a r - o l d male n u r s i n g home
r e s i d e n t who s u f f e r e d from b l i n d n e s s as w e l l
as A l z h e i m e r ' s dementia, and was s t i l l undergoing
d i a l y s i s t r e a t m e n t . He no l o n g e r had any l i v i n g
f a m i l y members t h a t c o u l d make t h e d e c i s i o n t o
s t o p t h e r a p y . Since h i s d i a l y s i s was b e i n g
reimbursed w i t h M e d i c a i d f u n d i n g , t h e r e was no
i n c e n t i v e f o r t h e p h y s i c i a n s i n v o l v e d t o re-assess
his condition.
A l t h o u g h most o f my t r a i n i n g t a k e s p l a c e
at a u n i v e r s i t y h o s p i t a l , I also rotate out t o
a p r i v a t e h o s p i t a l i n t h e community. On a d a i l y
b a s i s , I see w e a l t h y i n t e r n i s t s p r o v i d e t h e w o r s t
q u a l i t y m e d i c a l care i m a g i n a b l e t o e l d e r l y n u r s i n g
home r e s i d e n t s . When t h e y become t o o i l l t o
l i v e i n t h e n u r s i n g home, t h e y g e t t r a n s f e r r e d
t o t h e h o s p i t a l where t h e y s t a y f o r a s e t number
o f days as a l l o t t e d by t h e i r D.R.G. The i n t e r n i s t
w r i t e s a quick d a i l y note i n t h e c h a r t w h i l e
t h e p a t i e n t i s p r o v i d e d w i t h nominal c a r e .
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�WILLIAM B. S T A S O N
February 10,
A.M . - -
"
1993
Ms. H i l l a r y Rodham C l i n t o n
White House
Washington, D.C.
Dear H i l l a r y :
Health care reform provides a wonderful o p p o r t u n i t y f o r the C l i n t o n
a d m i n i s t r a t i o n to make an important c o n t r i b u t i o n to the q u a l i t y of l i f e i n the
United States. My sincere hope i s t h a t you w i l l be able to take f u l l
advantage of t h i s o p p o r t u n i t y . The key, as I see i t , w i l l be to achieve
l i m i t e d gains r e l a t i v e l y q u i c k l y w h i l e , a t the same time, examining the
various i d e o l o g i c a l p o s i t i o n s so t h a t you can move ahead w i t h more fundamental
long-term reform. I n i t i a l successes w i l l be v i t a l to c r e a t i n g much needed
momentum.
This l e t t e r i s to express my reservations about some of what I have heard from
your advisors or read i n the newspapers and to o f f e r my sense o f key
p r i o r i t i e s . I r e a l i z e t h a t you have a wealth of input from your task force
and other experts. Nonetheless, I hope t h a t these words from the h i n t e r l a n d s
represent a u s e f u l perspective.
I am w r i t i n g as a p r i v a t e c i t i z e n who i s a physician involved i n the q u a l i t y
improvement movement, a h e a l t h p o l i c y researcher who, among other t h i n g s , was
the co-creator o f the resource-based r e l a t i v e scale methodology f o r paying
physicians, and a long-standing member of the f a c u l t y of the Harvard School of
Public Health.
My reservations center on p l a c i n g primary r e l i a n c e on managed competition to
achieve cost savings, the high estimates o f the incremental costs of insuring
the uninsured t h a t have been a t t r i b u t e d t o your t r a n s i t i o n team, and the
suggestion t h a t s e t t i n g l i m i t s on insurance premiums i s the way to c o n t r o l
expenditures. I am also concerned whether f u r t h e r attempts to cut Medicare
and Medicaid i s an appropriate d i r e c t i o n .
A few b r i e f comments on each of these issues w i l l h i g h l i g h t my thoughts.
F i r s t , managed competition, while conceptually appealing and no doubt p a r t of
the puzzle, i s not l i k e l y by i t s e l f to c o n t r o l costs. A d d i t i o n a l measures
w i l l be needed. Moreover, the effectiveness o f managed competition w i l l vary
widely i n d i f f e r e n t h e a l t h care markets. Second, the a d d i t i o n a l costs of
i n s u r i n g the uninsured w i l l derive p r i m a r i l y from increased use o f o u t p a t i e n t
and preventive services and d i s c r e t i o n a r y i n p a t i e n t care. The costs of
e s s e n t i a l i n p a t i e n t care are already being paid out-of-pocket or through costs h i f t i n g . I would be very surprised i f these costs would be anywhere near
those t h a t were p r o j e c t e d . T h i r d , the proposal to l i m i t expenditures by
capping insurance premiums i s wrong-headed. Insurers w i l l respond to such
l i m i t s by reducing b e n e f i t packages and increasing (already expensive and
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
02/10/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
,im788
RESTRICTION CODES
Presidential Records Act -144 Ll.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOI A]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�W I L L I A M B. S T A S O N
A.' V • •
.;
1
P6/(b)(6)
February 10, 1993
Ms. H i l l a r y Rodham C l i n t o n
White House
Washington, D.C.
Dear H i l l a r y :
Health care reform provides a wonderful o p p o r t u n i t y f o r the C l i n t o n
a d m i n i s t r a t i o n t o make an i m p o r t a n t c o n t r i b u t i o n t o the q u a l i t y of l i f e i n the
U n i t e d S t a t e s . My s i n c e r e hope i s t h a t you w i l l be able t o take f u l l
advantage o f t h i s o p p o r t u n i t y . The key, as I see i t , w i l l be t o achieve
l i m i t e d gains r e l a t i v e l y q u i c k l y w h i l e , a t the same time, examining the
v a r i o u s i d e o l o g i c a l p o s i t i o n s so t h a t you can move ahead w i t h more fundamental
long-term reform. I n i t i a l successes w i l l be v i t a l t o c r e a t i n g much needed
momentum.
This l e t t e r i s t o express my r e s e r v a t i o n s about some o f what I have heard from
your a d v i s o r s or read i n the newspapers and t o o f f e r my sense o f key
priorities.
I r e a l i z e t h a t you have a wealth o f i n p u t from your task f o r c e
and o t h e r e x p e r t s . Nonetheless, I hope t h a t these words from the h i n t e r l a n d s
represent a u s e f u l p e r s p e c t i v e .
I am w r i t i n g as a p r i v a t e c i t i z e n who i s a p h y s i c i a n i n v o l v e d i n the q u a l i t y
improvement movement, a h e a l t h p o l i c y researcher who, among o t h e r t h i n g s , was
the c o - c r e a t o r o f the resource-based r e l a t i v e scale methodology f o r paying
p h y s i c i a n s , and a l o n g - s t a n d i n g member o f the f a c u l t y o f the Harvard School o f
Public Health.
My r e s e r v a t i o n s center on p l a c i n g primary r e l i a n c e on managed c o m p e t i t i o n t o
achieve cost savings, the h i g h estimates o f the i n c r e m e n t a l costs o f i n s u r i n g
the uninsured t h a t have been a t t r i b u t e d t o your t r a n s i t i o n team, and the
suggestion t h a t s e t t i n g l i m i t s on insurance premiums i s the way t o c o n t r o l
expenditures.
I am also concerned whether f u r t h e r attempts t o c u t Medicare
and Medicaid i s an a p p r o p r i a t e d i r e c t i o n .
A few b r i e f comments on each o f these issues w i l l h i g h l i g h t my thoughts.
F i r s t , managed c o m p e t i t i o n , w h i l e c o n c e p t u a l l y appealing and no doubt p a r t o f
the p u z z l e , i s n o t l i k e l y by i t s e l f t o c o n t r o l c o s t s . A d d i t i o n a l measures
w i l l be needed. Moreover, the e f f e c t i v e n e s s o f managed c o m p e t i t i o n w i l l vary
w i d e l y i n d i f f e r e n t h e a l t h care markets. Second, the a d d i t i o n a l costs o f
i n s u r i n g the uninsured w i l l d e r i v e p r i m a r i l y from Increased use o f o u t p a t i e n t
and p r e v e n t i v e s e r v i c e s and d i s c r e t i o n a r y i n p a t i e n t care. The costs o f
e s s e n t i a l i n p a t i e n t care are already being p a i d o u t - o f - p o c k e t or through c o s t shifting.
I would be very s u r p r i s e d i f these costs would be anywhere near
those t h a t were p r o j e c t e d . T h i r d , the proposal t o l i m i t expenditures by
capping insurance premiums i s wrong-headed. I n s u r e r s w i l l respond t o such
l i m i t s by reducing b e n e f i t packages and i n c r e a s i n g ( a l r e a d y expensive and
. .
�NOTICE
PEHSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT ^
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. envelope
SUBJECT/TITLE
DATE
04/01/1993
Address (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act -15 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
National Security Classified Information |(a)(l) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�FoWatrmeovertopotenveropetothe
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�v
NOTICE
PEHSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
Sox
2?0.;^
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. letter
SUBJECT/TITLE
DATE
Address (Partial); Phone No.'s (Partial) (1 page)
03/14/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Presidential Records Act - |44 IJ.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�\
Morton Paul Klein, M.D.
,P6/(b)(6)
March 14,1993.
0 OS
1
' P6/(b.)(6)
Presidents' Task Force on Health Care Reform
Ms. Hillary Rodham-Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Ms. Hilary Rodham-Clinton:
My sincerest wishes are with you and your co-workers for success in the monumental
task you have undertaken. I would venture a suggestion for your task force to consider
that most health care providers are well aware of but are loathe to broach.
There are unspoken and unaddressed issues of over consumption of health-care funds
in two specific areas:
1) sustaining and salvaging very premature and/or AIDS infected or drug addicted
newborns with subsequent maintenance costs of these survivors.
2) prolongation of dying of irreversibly deteriorated, extremely aged in hospital.
What can be done ethically and morally in these areas is, quite frankly, beyond my
limited capacity to determine. I do know, however, that unless these issues are
adequately resolved an inordinate proportion of health funds w i l l be ineffectual;
unproductively used and irreplaaceable. That these areas of provision of care represent
a vast bottomless pit insatiably devouring dollars is a known certainty.
This aspect of the problem must be solved, lest there be an ever reducing well from
which to draw to sustain the rest of our population in instances of recoverable illness
and curable disease.
I pray that there is a reasonable solution to this terrible dilemma, and that the positions
are not mutually exclusive.
Sincerely,
/
./
Morton Paul Klein, M.D.
�Morton Paul Klein, M.D.
Presidents' Task Force on Health Care Reform
Ms. Hillary Rodham-Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Ms. Hilary Rodham-Clinton:
My sincerest wishes are with you and your co-workers for success in the monumental
task you have undertaken. I would venture a suggestion for your task force to consider
that most health care providers are well aware of but are loathe to broach.
There are unspoken and unaddressed issues of over consumption of health-care funds
in two specific areas:
1) sustaining and salvaging very premature and/or AIDS infected or drug addicted
newborns with subsequent maintenance costs of these survivors.
2) prolongation of dying of irreversibly deteriorated, extremely aged in hospital.
What can be done ethically and morally in these areas is, quite frankly, beyond my
limited capacity to determine. I do know, however, that unless these issues are
adequately resolved an inordinate proportion of health funds will be ineffectual ;
unproductively used and irreplaaceable. That these areas of provision of care represent
a vast bottomless pit insatiably devouring dollars is a known certainty.
This aspect of the problem must be solved, lest there be an ever reducing well from
which to draw to sustain the rest of our population in instances of recoverable illness
and curable disease.
I pray that there is a reasonable solution to this terrible dilemma, and that the positions
are not mutually exclusive.
Sincerely,
^
Morton Paul Klein, M.D.
�v-v. •
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
6/ 2
-
2$7
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006a. letter
SUBJECT/TITLE
DATE
Address (Partial) (I page)
03/15/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (H)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�00
H i l l a r y Rodham C l i n t o n
The F i r s t Lady of the United States
The White House
Washington, D.C. 20500
Dear Ms.
Clinton,
I am w r i t i n g t o request an o p p o r t u n i t y t o work w i t h you
i n r e s t r u c t u r i n g the h e a l t h care system of the United States.
I am p a r t i c u l a r l y i n t e r e s t e d i n the areas of p h y s i c i a n
reimbursement, d e l i v e r y of "basic" health care f o r every
c i t i z e n , medical education, and post-graduate medical
training.
U n t i l r e c e n t l y , I was an resident at the Massachusetts
General H o s p i t a l i n Boston. However, I was extremely
d i s i l l u s i o n e d and discontented w i t h the p h y s i c i a n t r a i n i n g
process. Consequently, I have taken a leave-of-absence. I am
now working as a medical e d i t o r for^iJE^.ime Medical
T e l e v i s i o n t o gain ex.pexienee' in communication. However, I
b e l i e v e the p o l i t i c a l process is-j^co-o-g—thermost effecjLivje.
ways t o i n f l u e n c e the l i v e s of a larqe_n.utnb.e.r.—Q-f-.people and I
wantr-txrlSe i n v o l v e d i n t h a t process. I n a d d i t i o n , t o a
medical degree I have a masters i n p u b l i c h e a l t h and have
worked on a number of p u b l i c health p r o j e c t s .
I am aware t h a t you are extremely busy, however, I
assume t h a t you can use every capable and motivated person t o
achieve your goals. I am both of these t h i n g s and hope t o
have an o p p o r t u n i t y t o prove i t t o you. I have enclosed my
resume f o r you t o review. I eagerly await your r e p l y and hope
f o r n o t h i n g less than a chance t o share my v i s i o n f o r a new
h e a l t h care system w i t h you. Thank you f o r your time and
concern.
_-
Sincerely,
Mary Ehgenia Theodore, MD,
MPH
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006b. resume
SUBJECT/TITLE
DATE
Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-()885-F
jm788
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(1) of (he FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOI A]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(S) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA]
National Security Classified Information |(a)(l) ofthe PRA|
Relating to the appointment to Federal office |(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�MARY EUGENIA THEODORE
P6/(b)(6) ' ;.-
Education:
Yeshiva University
Albert Einstein College of Medicine
M. D.,June 1991
Bronx, New York
Harvard University
School ol" Public Health
Boston, Massachusetts
S. M. in Epidemiology and Biostatistics, June 1986
Cornell University
College of Arts and Sciences
A. B. in Mathematics, May 1984
Bronx High School of Science
Graduated in June 1980
Ithaca, New York
Bronx, New York
Experience:
Lifetime Medical Television
This Week in the New England Journal of Medicine
Medical Editor (1993- present)
Massachusetts General Hospital
Harvard Medical School
Clinical Fellow in Anesthesiolosv (1992-1993)
Montefiore Medical Center
Albert Einstein College of Medicine
Clinical Intern in Internal Medicine (1991-1992)
Albert Einstein College of Medicine
US-USSR Medical Student Comparative Study (1990-1992)
Conducted a comparative epidemiologic study of medical students in Moscow
and the United States with publications pending.
Research Assistant (1987-1992)
Conducted research on the restructuring of the Soviet health care system under
perestroika.
Soviet Field Trips (1988,1990,1992)
Visited health care facilities and medical schools in Moscow, Leningrad and
Minsk with a six member health care delegation.
John's Hopkins Medical College
J990 Nenal Medical Expedition (1990)
Participated in a medical expedition to a rural village in Nepal, to provide basic
medical care to the inhabitants and to conduct an epidemiologic survey.
�/
S~L
-iL.
H i l l a r y Rodham Clinton
The F i r s t Lady of the United States
The White House
Washington, D.C. 20500
Dear Ms. Clinton,
I am writing to request an opportunity to work with you
in restructuring the health care system of the United States.
I am p a r t i c u l a r l y interested i n the areas of physician
reimbursement, delivery of "basic" health care for every
c i t i z e n , medical education, and post-graduate medical
training.
Until recently, I was an resident at the Massachusetts
General Hospital in Boston. However, I was extremely
d i s i l l u s i o n e d and discontented with the physician training
process. Consequently, I have taken a leave-of-absence. I am
now working as a medical editor for Lifetime Medical
Television to gain exfi££i»ftee~in communication. However, I
believe the p o l i t i c a l proce ff jfj ™~ ~* ^-hP most gffestive
ways t o i n f l u e n c e the l i v e s of a large number of people and I
want Liroe involved i n that process. In addition, to a
medical degree I have a masters i n public health and have
worked on a number of public health projects.
I am aware that you are extremely busy, however, I
assume that you can use every capable and motivated person to
achieve your goals. I am both of these things and hope to
have an opportunity to prove i t to you. I have enclosed my
resume for you to review. I eagerly await your reply and hope
for nothing less than a chance to share my vision for a new
health care system with you. Thank you for your time and
concern.
0
Sincerely,
Mary Etigenia Theodore, MD,
MPH
�MARY EUGENIA THEODORE
Education:
Yeshiva University
Albert Einstein College of Medicine
M. D., June 1991
Bronx, New York
Harvard University
School of Public Health
Boston, Massachusetts
S. M. in Epidemiology and Biostatistics, June 1986
Cornell University
College of Arts and Sciences
A. B. in Mathematics, May 1984
Bronx High School of Science
Graduated in June 1980
Ithaca, New York
Bronx, New York
Experience:
Lifetime Medical Television
This Week in the New England Journal of Medicine
Medical Editor (1993- present)
Massachusetts General Hospital
Harvard Medical School
Clinical Fellow in Anesthesiolosv (1992-1993)
Montefiore Medical Center
Albert Einstein College of Medicine
Clinical Intern in Internal Medicine (1991-1992)
Albert Einstein College of Medicine
US-USSR Medical Student Comparative Study (1990-1992)
Conducted a comparative epidemiologic study of medical students in Moscow
and the United States with publications pending.
Research Assistant (1987-1992)
Conducted research on the restructuring of the Soviet health care system under
perestroika.
Soviet Field Trios (1988,1990,1992)
Visited health care facilities and medical schools in Moscow, Leningrad and
Minsk with a six member health care delegation.
John's Hopkins Medical College
J990 Nepal Medical Expedition (1990)
Participated in a medical expedition to a rural village in Nepal, to provide basic
medical care to the inhabitants and to conduct an epidemiologic survey.
�-V
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. letter
S U B.I F.CT/T I TL E
DATE
Address (Partial) (I page)
03/10/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - [S U.S.C. 552(b)]
Pl National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�1
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'5 •
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
^
2385
2o
?
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. letter
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
02/18/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. S52(b)|
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PR\|
b(l) National security classified information |(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(S) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�;
:;
P6/(b)(6)
February 18, 19~9T"
Ms. Hillary Rodham Clinton
The White House
Pennsylvania Avenue
Washington, DC 20500
Dear Ms. Clinton:
I am writing to you because of your position as chair of the committee
that will examine our the health care system of the United States.
According to several news reports, you are open to input from many
segments of our society and I am very hopeful that you will personally
read and reflect on my views. While I am a teacher (with many things I
would like to share about my views of education policies), my husband is a
physician and I am writing primarily about our concerns about health care
issues.
My husband, Robert, is a family physician whose central motivation has
been to provide comprehensive health care to all who need it, regardless
of their ability to pay. He graduated magna cum laude from medical
school at the Oregon University of Health Sciences in 1979. His interest
in practicing family medicine in an underserved area led us to Asheville,
North Carolina, which is nestled in the heart of southern Appalachia. He
completed a family practice residency at the Mountain Area Health
Education Center here in Asheville in 1986.
Upon completion of Robert's training, he chose to work in an underserved
community north of Asheville. While this was very rewarding work, as an
employee of a community-operated health care system he had limited
decision-making power over policies that determined the quality of his
care. After three years, he decided to try private practice in order to have
more control over the kind of health care he delivered.
Finding physician partners who were similarly motivated by altruistic
rather than economic interests was difficult. He did find two women
physicians who shared similar values, and they have been in a private
�February 18, 1993
Ms. Hillary Rodham Clinton
The White House
Pennsylvania Avenue
Washington, DC 20500
Dear Ms. Clinton:
I am writing to you because of your position as chair of the committee
that will examine our the health care system of the United States.
According to several news reports, you are open to input from many
segments of our society and I am very hopeful that you will personally
read and reflect on my views. While I am a teacher (with many things I
would like to share about my views of education policies), my husband is a
physician and I am writing primarily about our concerns about health care
issues.
My husband, Robert, is a family physician whose central motivation has
been to provide comprehensive health care to all who need it, regardless
of their ability to pay. He graduated magna cum laude from medical
school at the Oregon University of Health Sciences in 1979. His interest
in practicing family medicine in an underserved area led us to Asheville,
North Carolina, which is nestled in the heart of southern Appalachia. He
completed a family practice residency at the Mountain Area Health
Education Center here in Asheville in 1986.
Upon completion of Robert's training, he chose to work in an underserved
community north of Asheville. While this was very rewarding work, as an
employee of a community-operated health care system he had limited
decision-making power over policies that determined the quality of his
care. After three years, he decided to try private practice in order to have
more control over the kind of health care he delivered.
Finding physician partners who were similarly motivated by altruistic
rather than economic interests was difficult. He did find two women
physicians who shared similar values, and they have been in a private
�NOTICE
PEHSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. resume
SUBJECT/TITLE
DA I E
DOB (Partial); POB (Partial) (1 page)
01/27/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Prcsiclenlial Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal ofnee 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b( I) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�TEL : 1-216-729-3144
6. r . LACKEY
Jan 27 ,93
20 :44 No .002 P.03
CURRICULUM VITAE
G e r a l d F r a n c i s Lackey, Ph.D., D.O., F.A.CC
Born:
Military
status:
Eciiica t i o n :
P6/(b)(6) . /
Veteran
( h o n o r a b l e d i s c h a r g e 1965)
N o r t h C a r o l i n a S t a t e U n i v e r s i t y , R a l e i g h , N.C
B.S. E l e c t r i c a l E n g i n e e r i n g 1962
The Bowman Gray School o f Medicine a t Wake F o r e s t
U n i v e r s i t y , Winston-Salem, N.C.
C a r d i o v a s c u l a r Graduate T r a i n e e , P h y s i o l o g y
Department 1962-1965
The Bowman Gray School o f Medicine a t Wake F o r e s t
U n i v e r s i t y , Winston-Salem, N.C.
Graduate S t u d e n t , P h y s i o l o g y Department,
1962-1968, Ph.D. - Juno 1968
The Bowman Gray School o f Medicine a t Wake F o r e s t
U n i v e r s i t y , Winston-Salem, N.C.
N a t i o n a l I n s t i t u t e s o f Health P r e d o c t o r a l Fellow
P h y s i o l o g y Department, 1965-1968
The Bowman Gray School o f Medicine a t Wake F o r e s t
U n i v e r s i t y , Winston-Salem, N.C.
P o s t d o c t o r a l C a r d i o v a s c u l a r Graduate T r a i n e e
P h y s i o l o g y Department, 1968-1969
Kirksville
Kirksville,
Medical
D.O. -
College of Osteopathic
MO
Student 1974-1970
June 1978
Richmond H e i g h t s General H o s p i t a l ,
R o t a t i n g I n t e r n s h i p 1970-1979
Medicine
Richmond H e i g h t s , OH
Richmond H e i g h t s General H o s p i t a l , Richmond Height.*;, OH
I n t e r n a l M e d i c i n e Residency 1979-1982
The Mt. S i n a i M e d i c a l Center, C l e v e l a n d , OH
A.O.A. Approved Non-Invasive C a r d i o l o g y F e l l o w s h i p
1981-1983
Di s s e r t a t i o n :
Ph.D. - "The Development o f a Technique f o r t h e
Measurement o f I n c i d e n t and R e f l e c t e d Components o f
Pressure i n F l u i d T r a n s p o r t Systems."
�G. F. LACKEY
TEL:1-216-729-3144
Jan 27,93
20:44 No.002 P.03
CURRICULUM VITAE
Gerald F r a n c i s Lackey, Ph.D., D.O., F.A.CC
Dorn:
M i l i t a r y Status:
Education:
Veteran
( h o n o r a b l e discharge 1965)
North C a r o l i n a S t a t e U n i v e r s i t y , R a l e i g h , N.C
B.S. E l e c t r i c a l Engineering 1962
The Bowman Gray School o f Medicine a t Wake Forest
U n i v e r s i t y , Winston-Salem, N.C.
C a r d i o v a s c u l a r Graduate T r a i n e e , Physiology
Department 1962-1965
The Bowman Gray School o f Medicine a t Wake Forest
U n i v e r s i t y , Winston-Salem, N.C
Graduate Student, P h y s i o l o g y Department,
1962-1968, Ph.D. - June 1968
The Bowman Gray School o f Medicine a t Wake Forest
U n i v e r s i t y , Winston-Salem, N.C
N a t i o n a l I n s t i t u t e s o f Health P r e d o c t o r a l Fellow
P h y s i o l o g y Department, 1965-1968
The Bowman Gray School o f Medicine a t Wake Forest
U n i v e r s i t y , Winston-Salem, N.C.
P o s t d o c t o r a l C a r d i o v a s c u l a r Graduate Trainee
P h y s i o l o g y Department, 1968-1969
K i r k s v i l l e C o l l e g e o f Osteopathic
K i r k s v i l l e , MO
Medical Student 1974-1970
D.O. - June 1978
Medicine
Richmond H e i g h t s General H o s p i t a l , Richmond H e i g h t s , OH
R o t a t i n g I n t e r n s h i p 1970-1979
Richmond H e i g h t s General H o s p i t a l , Richmond Height.-., OH
I n t e r n a l Medicine Residency 1979-1982
The Mt. S i n a i Medical Center, C l e v e l a n d , OH
A.O.A. Approved Non-Invasive C a r d i o l o g y F e l l o w s h i p
1981-1983
Dissertationi
Ph.D. - "The Development o f a Technique f o r t h e
Measurement o f I n c i d e n t and R e f l e c t e d Components o f
Pressure i n F l u i d T r a n s p o r t Systemo."
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Withdrawal/Redaction Marker
Clinton Library
DOCliMENT NO.
AND TYPE
010. letter
SUBJECT/TITLE
DATE
03/24/1993
Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Presidential Records Act - |44 IJ.S.C. 2204(a)
Freedom of Information Act - |S U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal oflice 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
IM Release would disclose trade secrets or conndcntial commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
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h(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misnie defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�George D. Penick, M. D.
Idol
•'.
• P6/(b)(6)
March 24, 1993
Ms. Hillary Rodham Clinton
The White House
Washington, D. C.
Dear Ms. Rodham Clinton:
I began this letter to you last month, but its completion got
delayed by my wife's and my moving our place of residency from
Iowa City to Wilmington, N.C. But I am sufficiently interested in and
concerned about the problems related to our existing Health-Care
Systems that I thought I would try to finish it in hopes that maybe a
constructive idea or two might be worth sharing with you and the
Task Force that you are heading to deal with these problems.
Let me begin by telling you how pleased I am that The
President gave you this assignment and that you were willing to take
it on. I have been aware of your personal talents for some time now,
and have the hfgTieirrelip^
I am
grateful that the Task Force is being directed by someone who is
likely to approach the problems from something of an objective point
of view. So many times, I have witnessed the appointment of
health-planning groups that have been composed of those who would
be most affected by resulting decisions, e.g., physicians, insurers,
hospital administrators, politicians, etc. As a member of the family
of "providers" myself, I am painfully aware that a large part of the
problem is US!
To give you some idea of my own perspective, I have just
^retired frorh a professorship of Pathology after teaching and
^praGtieihg' for abouFfoft^fiVe-year-s—a-t-t-he^Umversity^of North
Carolina at Chapel Hill and at the University of Iowa in Iowa City. As
both a participant and observer of the ways in which health-care
services are delivered in this country (as well as in other countries),
I am convinced that, to be successful, revisions in the systems must
address a great deal more than simply devising better ways to
�nick, M D.
.
March 24, 1993
Ms. Hillary Rodham Clinton
The White House
Washington, D. C.
Dear Ms. Rodham Clinton:
I began this letter to you last month, but its completion got
delayed by my wife's and my moving our place of residency from
Iowa City to Wilmington, N.C. But I am sufficiently interested in and
concerned about the problems related to our existing Health-Care
Systems that I thought I would try to finish it in hopes that maybe a
constructive idea or two might be worth sharing with you and the
Task Force that you are heading to deal with these problems.
Let me begin by telling you how pleased I am that The
President gave you this assignment and that you were willing to take
it on. I have been aware of your personal talents for some time now,
and have thelilghest respect fof~QiOse abilities,---EuiUJiermore, I am
grateful that the Task Force is being directed by someone who is
likely to approach the problems from something of an objective point
of view. So many times, I have witnessed the appointment of
health-planning groups that have been composed of those who would
be most affected by resulting decisions, e.g., physicians, insurers,
hospital administrators, politicians, etc. As a member of the family
of "providers" myself, I am painfully aware that a large part of the
problem is US!
To give you some idea of my own perspective, I have just
/retired from a professorship of Pathology after teaching and
^practicing^ for about foi ty flve~-y€ars at -the^Umversity of North
Carolina at Chapel Hill and at the University of Iowa in Iowa City. As
both a participant and observer of the ways in which health-care
services are delivered in this country (as well as in other countries),
I am convinced that, to be successful, revisions in the systems must
address a great deal more than simply devising better ways to
:
r
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
2
23ZS
frJehJc
2-1
n
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
Oil. envelope
SUBJECT/TITLE
DATE
Address (I page)
03/27/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. S.S2(b)l
Pl National Securit)' Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal ofnee 1(a)(2) ofthe I'RA]
P3 Release would violate a Federal statute [(a)(3) ofthe PRA|
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financial information 1(a)(4) of the PRA|
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personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or conHdential or financial
information |(b)(4) ofthe FOIA|
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personal privacy 1(b)(6) of the FOIAj
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purposes |(b)(7) ofthe FOIA)
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financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misnie denned in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�JAMES
T.
BQULUS,
M.D
P6/(b)(6) • •, :
February
25 ,
1993
H i 1 .Ui r y C i i. I'I t o n
c/o ]'•'resident: 's Task Force on
N a t i o n * 1 H e a l t h Care Reform
UJ i v l t e House
UJashington , D.C .
20b00
Dear Mrs . Clinton•
1 Ncirn: t o c o n g r a t u l a t e you on your
new appoi ntment . I know t h a t
the .Uitest j o k e i c t h a t HCFA s t a n d s f o r " Hi],Lary Can F i x Anythin<:j". I
c o n s i d e r t h i s not a j o k e . i t h i n k you can do i t . T am w i l i i n g t o work
.
w i t h you
on o h a n g i n g
some o f t h e many p r o b l e m s i n the h e a l t l i
cere
s y s t e m , and t h i s i s j u s t a s h o r t l e t t e r t o t e l l you j u s t one
o f those
changes .
One t h i n g i s t h a t wo need t o s i m p l i f y the p a p e r w o r k .
P r i m a r y care
p r o v i d e r s e r e b e i n g k i l l e d i n p a p e r w o r k , as i s a l l i n d u s t r y .
I
think
s t r e a m ) i n i n g t h e paperwork w i l l
lead to
less f a t i g u e
by
primary
p r o v i d e r s , t h u s making us more e f f e c t i v e t o d e l i v e r p a t i e n t
care.
The
r u l e s concer ni ng n u r s i n g homes., s p e c i a l c a r e f a c i 1 i t i e s , and h o s p i t a l s
ate;; sometimes u n r e a l i s t i c as f a r as how o f t e n o r d e r s have t o be s i g n e d .
T am w r i t i n g t o you From a hea 1 t h c a r e f a c i M t y f o r the
mentally
r e t a r d e d which T
v i s i t once a week.
I n my absence, I g i v e v e r b a l
orders.
For some recison i t i s f e l t necessary t h a t
these have t o
be
s i g n e d w i t Inin Un h o u r s .
be f e e l t h a t t h e s e o n i y need t o be s i g n e d once
a week.
T h i s would
save the expense o f s e n d i n g t h e s e
forms f o
my
o f f i c e t o be
signed, etc.
1 also
n o t i c e t h a t n u r s i n g homes have
s i m i i a r po l i e : e.s . They have t o have t h e d o c t o r s s i g n t h e o r d e r s w i t h i n
48 h o u r s .
Host n u r s i n g home f a c i l i t i e s a r e not v i s i t e d by
the d o c t o r s
more than once a month.
I t h i n k t h a t o r d e r s s h o u l d have t o be s i g n e d
once a month or when she d o c t o r v i s i t s t h e n u r s i n g home .
I hope you w i l l t a k e t h i s i n t o c o n s i d e r a t i o n i n your d e l i b e r a t i o n s .
T h i s w i l l save a l o t o f money, and i t . i s a s t a r t i n c u t t i n g down on the
paperwork bar-rage.
T'his w i l l c u t down on t h e f a c i l i t y ' s
postage b i l l s
and s t a f f
time
I t w i l l make the d o c t o r s more e f f i c i e n t and
less
s t r e s s e d by
a l l t h e excess paperwork
that, has
been encumbering
our
s/stem f o r so l o n g .
I feel, s i n c e phone messages a r e
not r e i m b u r s e d items arid a r e
done
g r a t i s by t h e p h y s i c i a n s t o the f a c i l i t y , you
can accommodate us
on
t h i s matter.
I f the government
continues to r e q u i r e the present
time
f r amies , they s h o u l d pay f o r such s e r v i c e , namely a. phone c o n s u l t a t i o n
fee.
We
can't
afford
t o promu3 g a t e
the
"something f o r n o t h i n g
a t t i t u d e " on
p r i m a r y c a r e p h y s i c i a n s or they
w i l l be
d r i v e n out
of
p r a c t i c e i n t o more c o s t l y s p e c i a l t i e s .
�/A^*^
:•!
•A
Oo
6t<*U*^
CJ^T^
�'1
••— • •
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
(^3c2£•/ ^3<2~l >?
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
012. letter
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
02/25/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. S52(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe F O l \ \
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells Kb)(9) ofthe FOIA)
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office |(a)(2) of the PRA|
Release would violate a Federal statute [(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
1 5 Release would disclose confidential advice between the President
*
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PR\|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 IJ.S.C.
2201(3).
RR. Document will be reviewed upon request.
�JAMES
T.
BOULUS,
M.D..
I
February
25,
1993
Hillary Clinton
c/o P r e s i d e n t ' s Task Force on
N a t i o n a l H e a l t h Care Reform
White House
UJashington, D.C.
20500
Dear Mrs . C l i n t o n :
I want t o c o n g r a t u l a t e you on your
new appointment.
I know t h a t
the l a t e s t j o k e i s t h a t HCFA stands f o r " H i l l a r y Can Fix A n y t h i n g " . I
c o n s i d e r t h i s not a j o k e . I t h i n k you can do i t . I am w i l l i n g t o work
w i t h you
on changing
some o f t h e many problems i n the h e a l t h care
system, and t h i s i s j u s t a s h o r t l e t t e r t o t e l l you j u s t one
of those
changes .
One t h i n g i s t h a t we need t o s i m p l i f y the paperwork.
Primary care
p r o v i d e r s are being k i l l e d i n paperwork, as i s a l l i n d u s t r y .
I think
s t r e a m l i n i n g the paperwork w i l l
lead t o l e s s f a t i g u e by
primary
p r o v i d e r s , thus making us more e f f e c t i v e t o d e l i v e r p a t i e n t
care.
The
r u l e s c o n c e r n i n g nursing-homes, s p e c i a l care f a c i l i t i e s ,
and h o s p i t a l s
are sometimes u n r e a l i s t i c as f a r as how o f t e n o r d e r s have t o be s i g n e d .
I am w r i t i n g t o you from a h e a l t h care f a c i l i t y f o r the m e n t a l l y
r e t a r d e d which I
v i s i t once a week.
I n my absence, I g i v e v e r b a l
o r d e r s . For some reason i t i s f e l t necessary t h a t these have t o
be
s i g n e d w i t h i n 24 hours.
We f e e l t h a t these o n l y need t o be signed once
£ week.
t
T h i s would save the expense o f sending these
forms t o rny
o f f i c e t o be s i g n e d , e t c .
I a l s o n o t i c e t h a t n u r s i n g homes have
similar policies.
They have t o have the d o c t o r s s i g n the o r d e r s w i t h i n
48 hours.
Most n u r s i n g home f a c i l i t i e s are not v i s i t e d by
the d o c t o r s
more than once a month. I t h i n k t h a t o r d e r s s h o u l d have t o be s i g n e d
once a month or when t h e d o c t o r v i s i t s the n u r s i n g home.
I hope you w i l l take t h i s i n t o c o n s i d e r a t i o n i n your d e l i b e r a t i o n s .
T h i s w i l l save a l o t o f money, and i t i s a s t a r t i n c u t t i n g down on the
paperwork b a r r a g e .
T h i s w i l l c u t down on the f a c i l i t y ' s
postage b i l l s
and s t a f f
t i m e . I t w i l l make the d o c t o r s more e f f i c i e n t and
less
s t r e s s e d by
a l l the excess paperwork t h a t has
been encumbering
our
system f o r so l o n g .
I f e e l s i n c e phone messages are not reimbursed items and are done
g r a t i s by the p h y s i c i a n s t o the f a c i l i t y , you
can accommodate us
on
t h i s matter.
I f the government c o n t i n u e s t o r e q u i r e the present
time
frames, they s h o u l d pay f o r such s e r v i c e , namely a phone c o n s u l t a t i o n
fee.
We
can't a f f o r d
t o promulgate
the
"something f o r n o t h i n g
a t t i t u d e " on prirnary care p h y s i c i a n s or they w i l l be d r i v e n out
of
p r a c t i c e i n t o more c o s t l y s p e c i a l t i e s .
�NOTICE
*
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
013. letter
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Presidential Records Act - |44 IJ.S.C. 2204(a)|
Freedom of Information Act - |5 L'.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PR\|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
IM Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 IJ.S.C.
2201(3).
RR. Document will be reviewed upon request.
�I
-1
K s . H i 1 1 a r y Rodham C l i n t o n
,
1 h o W In t ( H o u 0
.
>
i 6 ( 0 I' c n n s y 1 v o n i .i A v L'
J
W,I s h i ng ton , D.C.
c0j 0 0
l
Dear- M s . C 1 i n t o n :
F r a n k l i n Delano R o o s e v e l t w i l l be remembered in American
h i s t o r y as the p r e s i d e n t wno gave the n a.t i o n S o c i a l S e c u r i t y .
W i l l i a m J e f f e r s o n C l i n t o n may w e l l be remembered i n American
h i s t o r y as the p r e s i d e n t who gave the n a t i o n N a t i o n a l
Health
Care.
As c i t i z e n s who v o t e d Mr. C l i n t o n i n t o o f f i c e , we are now
asking the p r e s i d e n t to i q n o r e the dooms-sayers ( t h e American
Medical A s s o c i a t i o n , the p h a r m a c e u t i c a l companies, e t c . ) who
oppose N a t i o n a l H e a l t h Care f o r s e l f i s h reasons and w i t h u t t e r
d i s r e g a r d f o r the n e a l t n f u l w e l l being of a l l Americans.
We are a s k i n g t h a t ynur c o a l i t i o n recommend to the p r e s i d e n t
in your r e p o r t , due by Ma y 1 9 9 5 , t h a t the c i t i z e n s of t h i s
c o u n t r y want n o t h i n g l e s s than a S i n g l e Payer N a t i o n a l H e a l t h
Care B i l l t h a t must p r o v i d e access to q u a l i t y h e a l t h care f o r
a l l i n d i v i d u a l s , r e g a r d l e s s of a b i l i t y to pay, of age, or o f
p r e - e x i s t i n g h e a l t r, c o n d i t i o n .
Sincerely,
013
Siqn )
Print
Name
bel'crp-
^
j < f - f f - > e v N ^ c ^ M ^ o inr- M ,
.
••P6/(b)(6)
• " P6/(b)(6)
'
A
•-••
"
�M s . H i l l a r y Rodham C l i n t o n
The White House
Id U 0 Pennsylvania A v e
Washington, 0.C.
20 50 0
Dear M s . C l i n t o n :
F r a n k l i n Delano R o o s e v e l t w i l l be remembered i n Ame r i c a n
h i s t o r y as the p r e s i d e n t who gave the na.tion Social S e c u r i t y
W i l l i a m J e f f e r s o n C l i n t o n may w e l l be remembered i n American
h i s t o r y as the p r e s i d e n t who gave the n a t i o n N a t i o n a l Health
Care.
As c i t i z e n s who voted Mr. C l i n t o n i n t o o f f i c e , we are now
asking the p r e s i d e n t to ignore the dooms-sayers ( t h e American
Medical A s s o c i a t i o n , the pharmaceutical companies, e t c . ) who
oppose N a t i o n a l Health Care f o r s e l f i s h reasons and w i t h u t t e r
d i s r e g a r d f o r the h e a l t h f u l w e l l being of a l l Americans.
We are asking t h a t your c o a l i t i o n recommend to the p r e s i d e n t
in your r e p o r t , due by May 1993, t h a t the c i t i z e n s of t h i s
country want n o t h i n g less than a Single Payer N a t i o n a l Health
Care B i l l t h a t must p r o v i d e access to q u a l i t y h e a l t h care f o r
a l l i n d i v i d u a l s , r e g a r d l e s s of a b i l i t y to pay, of age, or of
pre-existing health c o n d i t i o n .
Sincerely,
(Sign)
Print
j .
bej
Nm Jfff
a e
Ad d r e s
STATE
Zip.
�1
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
014a. letter
SUBJECT/TITLE
DATE
Address (Partial); Phone No. (Partial) (I page)
02/05/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
im788
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |S IJ.S.C. S52(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(y) ofthe FOIA]
National Security Classified Information |(a)(l) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�F e b r u a r y 5/
1993
H i l l a r y Rodham C l i n t o n
The Wftite House
16 P e n n s y 1 v a n i a ?Vv e ri u 2
Washington,
B.C.
Dear Ms.
Clinton:
F i r s t , a l l o v j me t c e x p r e s s my r e s p e c t and a d m i r a t i o n f o r you and
y c u r work.
I , t o o , am f o r t y - f i v e , a w i f e , and wor3;ing mother, and
I know w e l l f r o m e x p e r i e n c e t h e d i f f i c u l t i e s and c r i t i c i s m t o
w h i c h we a r s s u b j e c t .
I am w r i t i n g t o e x p r e s s my c o n c e r n o v e r t h e h e a l t h c a r e c r i s i s ' .
I
am a p h y s i c i a n w o r k i n g i n an emergency d e p a r t m e n t o f a s m a l l
community h o s p i t a l .
I have seen and e x p e r i e n c e d f i r s t hand t h e
abuses and s h o r t c o m i n g s o f t h e p r e s e n t system.
However, I t r u l y
b e l i e v e i t would he a g r a v e m i s t a k e t o i n s t i t u t e a n a t i o n a l h e a l t h
c a r e program w i t h f i r s t d o l l a r coverage f o r e v e r y o n e .
The c o s t s
c f h e a l t h c a r e would e s c a l a t e p r e c i p i t o u s l y as everyone would
demand C a d i l l a c c a r e on a s h o e s t r i n g b u d g e t .
Then government
would have t c s t e p i n and r a t i o n c a r e i n o r d e r t o m a i n t a i n some
semblance o f c o s t c o n t r o l , 'which w o u l d be a v e r y d i f f i c u l t and
u np o pu 1 a r un d e r t a I i n g .
Our n a t i o n i s grounded i n t h e c o n c e p t o f f r e e e n t e r p r i s e .
We
abhor and d e c r y s o c i a l i s m , y e t we a r e w i l l i n g t o c o n s i d e r p l a c i n g
one o f our -.aost i m p o r t a n t c o m m o d i t i e s i n t o a s o c i a l i s t
arrangement.
I agree t h a t we need t c address t h e i s s u e o f h e a l t h
c a r e c o v e r a g e f o r t h o s e Americans who p r e s e n t l y a r e n o t c o v e r e d .
However, l e t us n o t r u s h i n t o a h a s t y s o l u t i o n w h i c h we would
i a t e r r e g r e t and w h i c h would remain a. b l a c k mark on t h e C l i n t o n s '
p r e s i d e n t i a l careers.
1 have f a i t h i n t h e American p e o p l e t h a t we
can d e v e l o p a s u p e r i o r and i n n o v a t i v e , s o l u t i o n w h i c h w i l l be
b e t t e r t h a n a i l t h e o t h e r p r e s e n t models.
Though 1 have no s o l u t i o n t o p r o p o s e , my own p r e s e n t l e a n i n g i s
t o w a r d u n i v e r s a l c a t a s t r o p h i c h e a l t h coverage w i t h s l i d i n g - s c a l e
d e d u c t i b l e and co-payment r e q u i r e m e n t s . The o n i y way wa can
c o n t r o l h e a l t h c a r e s p e n d i n g i s t o i n v o l v e t h e consumer as we do
i n e v e r y o t h e r a s p e c t o f our f r e e - m a r k e t e n t e r p r i s e system.
Free
h e a l t h c a r e i s abused, u n a p p r e c i a t e d , and d e s t r o y s t h e sense o f
r e sp on s i b i. 1 i t y .
I would be g l a d t o v o l u n t e e r my t i m e t o h e l p e s t a b l i s h an
e q u i t a b l e , workable s o l u t i o n .
I f I can be o f any h e l p , p l e a s e
c o n t a c t me a t t h e above address o r c a l l me a t lV' • ee/fbMei
--.
^
Sincerely,
Chci r 1 o f t.e
Bowen V?a gamon , M . D .
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
014b. letter
SUBJECT/TITLE
DATE
Phone No. (Partial) (1 page)
02/05/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [5]
2006-0885-F
jm788
RESTRICTION CODES
Presidential Reeords Aet - |44 ll.S.C. 2204(a)|
Freedom of Information Act -15 ll.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�P6/(b)(6)
0
F e b r u a r y 5, 1993
H i l l a r y Rodham C l i n t o n
The W h i t e House
16 P e n n s y 1 v a n i. a A v c n u e
.
W a s h i n g t o n , D.C.
Dear Ms. C l i n t o n :
F i r s t , a l l o w me t c e x p r e s s my r e s p e c t and a d m i r a t i o n f o r you and
y c u r work.
I , t o o , am f o r t y - f i v e , a w i f e , and 'working mother, and
1 know w e l l f r o m e x p e r i e n c e t h e d i f f i c u l t i e s and c r i t i c i s m t o
•which we a r e s u b j e c t .
I am w r i t i n g t o e x p r e s s my c o n c e r n o v e r t h e h e a l t h c a r e c r i s i s ' . 1
am a p h y s i c i a n w o r k i n g i n an emergency d e p a r t m e n t o f a s m a l l
community h o s p i t a l .
1 have seen and e x p e r i e n c e d f i r s t hand t h e
abuses and s h o r t c o m i n g s o f t h e p r e s e n t system.
However, I t r u l y
b e l i e v e i t would be a g r a v e m i s t a k e t o i n s t i t u t e a n a t i o n a l h e a l t h
c a r e program w i t h f i r s t d o l l a r coverage f o r e v e r y o n e .
The c o s t s
of h e a l t h care, 'would e s c a l a t e p r e c i p i t o u s l y as everyone would
demand C a d i l l a c c a r e on a s h o e s t r i n g b u d g e t .
Then government
would have t o s t e p i n and r a t i o n c a r e i n o r d e r t o m a i n t a i n some
semblance o f c o s t c o n t r o l , w h i c h w o u l d be a v e r y d i f f i c u l t and
nnpcpu i a r under ta k i n g .
We
Our n a t i o n i s grounded i n t h e c o n c e p t of f r e e e n t e r p r i s e .
abhor and d e c r y s o c i a l i s m , y e t we a r e w i l l i n g t o c o n s i d e r p l a c i n g
one c f o u r most i m p o r t a n t c o m m o d i t i e s i.nto a s o c i a l i s t
arrangement.
I agree t h a t we need t o a d d r e s s t h e i s s u e o f h e a l t h
c a r e c o v e r a g e f c r t h o s e Americans who p r e s e n t l y a r e n o t c o v e r e d ,
However, l e t us n o t r u s h i n t o a h a s t y s o l u t i o n w h i c h we would
l a t e r r e g r e t and w h i c h would r e m a i n a b l a c k mark on t h e C l i n t o n s ' .
p r e s i d e n t i a l careers.
1 have f a i t h i n the American p e o p l e t h a t w?
can d e v e l o p a s u p e r i o r and i n n o v a t i v e s o l u t i o n w h i c h w i l l be
b e t t e r t h a n a l l t h e o t h e r p r e s e n t mode
Though I have no s o l u t i o n t o p r o p o s e , my own p r e s e n t l e a n i n g i s
t o w a r d u n i v e r s a l c a t a s t r o p h i c h e a l t h coverage w i t h s l i d i n g - s c a l e
d e d u c t i b l e and co-payment r e q u i r e m e n t s . The o n l y way we can
c o n t r o l h e a l t h c a r e s p e n d i n g i s t o i n v o l v e t h e consumer as we do
i n e v e r y o t h e r a s p e c t o f o u r f r e e - m a r k e t e n t e r p r i s e system.
Free
h e a l t h c a r e i s abused, u n a p p r e c i a t e d , and d e s t r o y s t h e sense o f
r e s p o n s i b i. 1 i t y.
1 w o u l d be g l a d t o v o l u n t e e r my t i m t o h e l p e s t a b l i s h an
e q u i t a b l e , workable s o l u t i o n .
I f Ican be o f any h e l p , p l e a s e
c o n t a c t me a t t h e above address o r c a l l
at
P6/(b)(6)
Sincerely,
si. &
Ch a r 1 o 11 e B owe n Wa g a mon, M.0.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Physician Letters] [loose] [5]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-006-001-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/0dc870da09a56b6ed57f4090e583c8e6.pdf
67297ddd6f24323944cc2eb73de4d9a8
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
2385
FolderlD:
Folder Title:
[Physician Letters] [loose] [4]
Stack:
Row:
Section:
Shelf:
Position:
S
56
3
4
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. letter
Personal (Partial) (2 pages)
03/24/1993
P6/b(6)
002. letter
Address (Partial); Phone No. (Partial) (I page)
04/28/1993
P6/b(6)
003. letter
Address (Partial); Phone No.'s (Partial) (1 page)
01/26/1993
P6/b(6)
004. letter
Address (Partial) (1 page)
02/20/1993
P6/b(6)
005. letter
Address (Partial); Phone No. (Partial) (2 pages)
01/26/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [4]
2006-0885-F
im787
RESTRICTION CODES
Presidential Records Act - [44 ll.S.C. 2204(a)|
Ereedom of Information Act - [S ll.S.C. S52(b)|
PI National Security Classified Information [(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
nnancial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
Pf) Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or conndcntial or financial
information |(b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe KOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misnie defined in accordance with 44 U.S.C.
2201<J).
RR. Document will be reviewed upon request.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. letter
SUBJEC 17111 LE
DATE
Personal (Partial) (2 pages)
03/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [4]
2006-0885-F
jm787
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
h(4) Release would disclose trade secrets nr confidential or nnancial
information 1(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
nnancial institutions 1(b)(8) ofthe KOIA]
b(0) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 24. 1993
Hillary Rodham Clinton
Chairperson. The Presidential Task Force on
Health Care Reibrm
1600 Pennsylvania Ave. NW
Washiimton. DC 20500
Dear Mrs. Clinton.
I am writing concerning your work in health care reform, a topic on
which I am passion a te_I am a physician and currently in the final phases of
nn^tja+nTrrg nfcardiologVp I have a great interest on the topic of reform and
llid-^aiWH?orrrrntf!ees work fascinating. Our health care system is
extremely complex and your attempts at correcting the inequities in the
system are indeed laudable. I am somewhat disturbed however by the
recurring theme of cost containment by merely controlling the actions and
reimbursement ofthe providers. AJthough I freely admit, as a physician, we
have to accept some ofthe responsibility for the problem it is naive to believe
we are the sole source ofthe problem. It has been estimated that physician
reimbursement makes up only 10-20 o of our annual health care
expenditure. In brief, if one were to force physicians to work without
compensation on any kind, the system would still be headed for disaster.
o
Before you w rite me off as another physician trying to protect my
pocketbook and high standard of living, let me explain my situation. I feel I
am in a rather unique position in that not only am I a health care provider
but also a reluctanl utilizer of our svstem. Mv dauahler v\as diannosed wilh
leuk-ciimit-ivW-K 190?. oiu'. moillll shv^of her sornTirl hinliH.-iy
TUc^r l.-^t i,- _
months have taught me more about our health care system than all of my
formal education. I ha\c learned to deal with physicians, hospitals.
M1
�insurance companies and home health care providers, virtually ever)' aspect
of our complex system. The one thing I have learned above all else is the
complexity of our system and the depth of our health care problems.
Our system is so complicated, that any attempt at correcting the
system by isolating a single component is destined to failure. A true solution
must address every component ofthe problem. Health care providers, the
health insurance industry, the pharmaceutical industry, malpractice litigation
and patient expectations must all be reformed if a true solution is to be
realized.
The insurance industry has shifted from a philosophy of spreading the
risk to one where it will only insure low risk patients. Patients with
preexisting conditions or those deemed high risk are unable to obtain
affordable health coverage because of this industry wide practice. My
daughter will join the ranks ofthe 38 million Americans who do not have
health insurance because of her leukemia. The inefficiencies and
bureaucratic red tape inherent in dealing with over 1500 insurance
companies nationwide make up a large portion ofthe problem. It has been
shown that the average physician must employ 2.5 full time employees
merely to deal with the paperwork generated by the insurance companies. It
has also been estimated that we could save billions of dollars annually by
using a single standardized insurance form. This proposal was extensively
criticized by the insurance lobby. Wholesale insurance reform must take
place if a true solution is to be realized.
I anplnud thgjresidents attempt to make the pharmaceutical industry
aixoiml^ablejbr its product pricing. WithouTHqirsstrern they must also accept
some ofthe responsltntftyibr our crisis. In their defense however, the
process of getting a new product to the market is extremely costly, complex,
and time consuming. It takes an average of twelve years to get a new
product form the research bench to the marketplace. This whole process
must be reexamined and reformed if we are truly serious about system wide
reform.
liaiactice litigation) has skyrocketed in the last several decades and
must also be considered a major contributor to our problems. A conservative
estimate is that 10% of our annual medical expenditure is due to defensive
medical practices in an attempt to avoid litigation. Malpractice premiums
�h;l\C ;»is< i sks HHJS'.'UV- i ^ K u u ; SniU'.- p ! i \ '••!v.:I;Ins l-.> k*:!\c Uv-TtaiSl ' i i ^ ' l IISK
s I (v-i u!)!
ui' CL.;^ iii i lie ovuh! i \. rAi\\\ >i i oil i clot ill ar.J nUil|»r;R liCc
inMirancc relornt a).j also ncccssap. io coiroct oui ptoblcins
l uiali'. an riiijMi'i !o eJuvak oar aaiiou aad iciorni oui c\\"j-clahon.s
nuis; l v i;nikr!ak;-n. Without vjucstion. wc arc blessed willi lhe best medical
'.ane in 'he worM aiKi lee-lmf •!OL:\ has inJeeJ aiaue nuraeles a dailv
oeeurrciiec. i lo\\t.-\vr. i beliese we can inj longer oiier c\ep. available
iev.!ii)•• .'K "-iuiidei v \er\ v..ii\.iiin.>!.aiiec no inatier whal ihe e- <.•.!. «ii lhe
projected oiilcome. W'e mt::;i v-ome lo ihe reati^ati-an tlial dealh is indeed
i-,;u1 o! lilt.' aaul ihai lo pruioou dving process wit Is luiile llieiaiw is not oni;'
ii- »caib. irre.-jpi>n.sii>lv: bu! itihaniuiie..
The problem o it.d..v<' c^nwvrv w iih n-ar- a'a eis and iiul«M-Uin ilcly
n.am siveiai inicrcsts. \ i.io II.M tMi\ \ \f.iir coitimillcc. \ <>tilv a-.k ilia! y>>u
i,.,,1 [ ,:',\
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•.. ..IJI- pi. .M, ,•••,:(Ij • -.nnde pv:•!ii ieaP proinisu:'.?. porii - T: o! ih ' pr ibicu'!.
•\n\ iitiu^ sh. ;! »•! :. • leai • .Me tee 'im is desliiie-.! ioi iaiiine. i oiler HI\
innii' '"'e ; > u v •• !• i a.'< ••; -oia (. omiiiiiiet in air. v.. is j ^issil'le niv-liiding LOSI
. .
c.-:i!i\.'s
as- e.ci:tu,>! income as long as it i.; p.arl of a sy-dem wide reiorm.
! tin i!.. r ; H'.-- i.r. shonm.i ;:n,l sirav.-rs lor yout u>inniillre *l hi- oliie: lhi:>i;
i iiavc I'-arned .nei im.'sc a.-.l ien monilis \-> the pos.\e!'ot ix!!i! ^a lia/sc.
'jiiaai- »iui I'H
iaii'- aiiJ e-'n.»ider:itiv*ii m this most mipotja.-H ut-iilcr.
-
K
v
1
v
;
�DRS.
DONALD
W.
BICKLEY,
M.D.
BICKLEY
" z a a i
\..
BJCKLEY
K I M B A L L ^. V e t + t W E
BALL
W A T E R LDidTlDWA
M a r c h 25.
Mrs.
&
MARK
L.
BICKLEY,
D.O.
^ )
1993
H i l l a r y Rodham C l i n t o n and her Task Force
More power t o y o u j The r e f o r m o f h e a l t h care i s l o n g o v e r due.
The waste a l o n e - i f c o n t r o l l e d - c o u l d p r o v i d e m e d i c a l care t o
most of t h e 37.000.000 who do not have i t .
As a p r i m a r y p h y s i c i a n f o r 59 years now, who made 412 house
c a l l s l a s t y e a r , e x c l u d i n g h o s p i t a l v i s i t s and o f f i c e c a r e , I
have shuddered at the waste i n m e d i c i n e .
Consider house c a l l s , s i n c e I make two or t h r e e on any day.
The s p e c i a l i s t s sneer a t them because t h e y cannot c a r r y a CT
scanner w i t h them! t h e young f a m i l y p r a c t i c e graduates know
n o t h i n g o f t h e need, and w i l l not make house c a l l s .
Countless v e r y i l l p e o p l e , e s p e c i a l l y t h e e l d e r l y and t h e d i s a b l e d , b e n e f i t from these v i s i t s , which can d i r e c t l y , i n many
cases, s t a v e o f f a t r i p t o the-Emergency Room, or a s t a y i n t h e
h o s p i t a l , b o t h o f which are o u t r a g e o u s l y expensive.
Too o f t e n t h e
phoned d i r e c t i o n i s : "Take her t o t h e Emergency Room."
Here t h e e n t r y f e e i s $60.00, p l u s . A s i m p l e sore t h r o a t
l e a d s t o t h r o a t c u l t u r e s , complete b l o o d c o u n t , c h e s t x - r a y i f
t h e r e i s any mucous or cough, EKG i f t h e r e i s a t w i n g e o f c h e s t
p a i n , CT scan i f t h e r e i s a back ache.
A r e c e n t o u t - p a t i e n t ended w i t h a charge o f $265.00 f o r a
s i m p l e c o n s t i p a t i o n . T h i s l a d y had l o s t her appendix l o n g ago,s6,
t h a t w o r r y was not p r e s e n t . Then i f a s p e c i a l i s t i s w i t h i n reaca
of c a l l , one n e u r o l o g i s t sent a b i l l f o r $250.00 f o r a v e r y b r i e f
t a l k w i t h a p a t i e n t w i t h a h e a d a c h e — n o e x a m i n a t i o n , no n e u r o l o g i c a l ,
j u s t f o r o r d e r i n g a CT o f her head, and r e a d i n g i t as
"negative:"
The h o s p i t a l charge was e x t r a .
The too obvious t h r u s t t o make Emergency Care a source o f
h o s p i t a l p r o f i t was o n l y t o o c l e a r l y d e f i n e d when an Emergency
P h y s i c i a n was r e c e n t l y t o l d t h a t he was making much l e s s per
p a t i e n t seen, t h a n t h e o t h e r Emergency P h y s i c i a n s . For t h e
hospital, that i s .
So he r e s i g n e d from t h a t
hospital.
O u t - p a t i e n t s u r g e r y i s s i m i l a r l y over p r i c e d and beyond the
reach o f anyone w i t h o u t i n s u r a n c e . A s i x year o l d w i t h r e c u r r e n t
severe t o n s i l l i t i s , e n t e r e d t h e h o s p i t a l a t 9 AM, had her
t o n s i l l e c t o m y about 11AM, s t a y e d u n t i l 1 PM.
Her h o s p i t a l b i l l h e a v i l y padded-was $1,361.00. T h i s d i d n o t i n c l u d e t h e surgeon's
fee
k
�DRS.^-BICKLEY
DONALD
W.
B I C K L E Y , M.D.
2D01
'
v
&
BICKLEY
KIMBALL AVENUE
WATERLOO,
MARK
L.
BICKLEY,
D.O.
IOWA
Page 2
T h i s u n r e a s o n a b l y h i g h c o s t of Emergency Care has l e d John
Deere Co. t o b u i l d f r e e s t a n d i n g o u t - p a t i e n t c l i n i c s of i t s ownone a l r e a d y o p e r a t i o n a l i n M o l i n e , 111. and a second j u s t b e i n g
b u i l t a t W a t e r l o o , Iowa. Three more are planned.
Deere e s t i m a t e s t h a t t h e s a v i n g s w i l l pay
program and b u i l d i n g w i t h i n two y e a r s .
f o r the
entire
The encouragement of f r i v o l o u s s u i t s by t h e l e g a l p r o f e s s i o n
has r u i n e d the p r a c t i c e o f o b s t e t r i c s , which I g r e a t l y enjoyed f o r
t h e f i r s t 30 y e a r s of my p r a c t i c e . The p r e s e n t c h a r g * o f $2,000.00
or more f o r a normal d e l i v e r y i s u n c o n c i o n a b l e , when many of these
p a t i e n t s are m u l t i p a r o u s and t h e i r l a b o r s v e r y easy. But t h e f e a r
and a c t u a l i t y of s u i t has l e f t v e r y few p h y s i c i a n s brave enough t o
do o b s t e t r i c s .
Because t h i s same u n r e a s o n a b l e t o r t system has d r i v e n almost
a l l f a m i l y p h y s i c i a n s out o f o b s t e t r i c s , t h e r e i s n o t one p h y s i c i a n
d e l i v e r i n g babies between Sioux C i t y and Mason C i t y , and from
Mason C i t y t o P r a i r i e duChien, i n t h e n o r t h e r n t i e r of Iowa c o u n t i e s .
And l o c a l h o s p i t a l s are c a l l i n g f o r nurse midwives. Home d e l i v e r i e s
are n e x t , t a k i n g me back 60 years t o my own home d e l i v e r i e s .
The excuse f o r Emergency Room c o s t s i s made t h a t d e f e n s i v e
m e d i c i n e must be p r a c t i c e d ad i n f i n i t u m , i n view o f t h e p r e s e n t
day t o r t system, e n c o u r a g i n g s u i t f o r any u n f o r t u n a t e outcome.
The t h i r t y b i l l i o n d o l l a r s t o be saved, i f d e f e n s i v e medicine
c o u i d be r e a s o n a l l y l i m i t e d , goes back a t once t o t h e t o t a l l y
i l l o g i c a l awards g i v e n by' soft-headed' (and h e a r t e d ) j u r i e s and
j u d g e s , who awarded 105 m i l l i o n d o l l a r s t o t h e p a r e n t s of t h e boy
i n t h e c r a s h of a General Motors t r u c k . One m i l l i o n d o l l a r s would
see them t h r o u g h l i f e c o m f o r t a b l y , and t h e 104 m i l l i o n b a l a n c e
would have e s t a b l i s h e d and funded a p r i m a r y care c e n t e r i n a l a r g e
city.
Or the r i d i c u l o u s award of 4 m i l l i o n d o l l a r s t o t h e Iowa
couple because a two-way m i r r o r o v e r l o o k e d t h e i r n u p t i a l bed. I t
was n o t even proven t h a t anyone was w a t c h i n g b e h i n d t h e m i r r o r J
Then t h e r e i s t h e Peer Review system, c o s t i n g m i l l i o n s of
d o l l a r s a n n u a l l y and no l o n g e r d o i n g what i t was o r i g i n a l l y designed
t o do.
The s i n c e r e hope was t h a t d o c t o r s would be encouraged t o
t a k e b e t t e r care of t h e p e o p l e ;
i n s t e a d the Iowa Foundation and
c o r r e s p o n d i n g b o d i e s i n o t h e r s t a t e s became a g g r e s s i v e l y p u n i t i v e
and a d v e r s a r i a l , sending out thousands of l e t t e r s on o r d e r s from
Washington t o harass t h e m e d i c a l p r o f e s s i o n . And t o prove on
paper t h a t t h e y were d o i n g a good j o b .
L a t e r i t was l e a r n e d t h a t t h e Department's d i s b u r s e m e n t
e x e c u t i v e ' s s a l a r y was i n c r e a s e d i n p r o p o r t i o n t o t h e number of
m i l l i o n s of d o l l a r s t h a t Medicare saved i n r e f u s e d p a y m e n t s — a
�DRS.
DDNALD
W.
B I C K L E Y . M.D.
BICKLEY
20DI
&
BICKLEY
KIMBALL AVENUE
WATERLOO,
MARK
L.
BICKLEY.
D.D.
IOWA
Page 3
r e v e l a t i o n i m m e d i a t e l y quashed and
suppressed.
The i n c l o s e d l e t t e r comes from one v e r y good h o s p i t a l i n
Waterloo.
A number o f o l d e r p h y s i c i a n s l e f t p r a c t i c e r a t h e r t h a n
c o n t i n u e under t h i s s y s t e m a t i c h a r r a s s m e n t .
Young r e s i d e n t s , when
h o p e f u l l y q u e r r i e d about p o s s i b l y s t a y i n g i n Iowa, s t a t e d f r a n k l y
t h e y would n o t l i v e and p r a c t i c e i n t h i s s t a t e as l o n g as t h e Iowa
Foundation f u n c t i o n e d .
Then the o b s t r u c t i v e adoption system needs a complete renovation.
In the 30s and 40s, a teenage s i n g l e mother, whom we knew to be
h e a l t h y , simply signed the necessary adoption consent, a judge
depended on our choice of adopting parents, who then went with us
to the nursery and c a r r i e d the baby home. T h e i r only c o s t was
t h a t of the h o s p i t a l , and the court, about £100.00.
foday a " l u c k y " b u t b a r r e n couple w i l l w a i t 2 t o 3 years
b e f o r e g e t t i n g a baby from C a t h o l i c C h a r i e t i e s , f o r $9,000.00.
Or t h e y might g e t a Korean w a i f d i r e c t l y from t h e O r i e n t , w i t h
t o t a l l y unknown background, f o r $10,000.00 and up. And these
b a b i e s are i n e v i t a b l y f u l l o f worms.
No wonder our orphanages are o v e r - l o a d e d .
The t o t a l l y
group i s a n o t h e r
funded babies t o
number o f y e a r l y
into poverty, i f
u n r e a s o n i n g m i l i t a n t marching o f t h e P r o - L i f e
waste I They would add 1,6000,00 unwanted and undert h e w e l f a r e system each y e a r - t h e approximate
a b o r t i o n s . Most o f these mothers would a l s o f a l l
w i t h o u t a very s u p p o r t i v e f a m i l y .
Having l i v e d t h r o u g h t h e y e a r s o f t h e two g r e a t e s t n a t i o n a l
b l u n d e r s o f our s o - c a l l e d peacetime w o r l d - P r o h i b i t i o n and o u t lawed a b o r t i o n - I c l e a r l y see t h a t " we cannot o u t l a w a l c o h o l any more
t h a n we can o u t l a w the p r i m e v a l urge f o r sex, i.^hich a l l o w e d f o r
s u r v i v a l o f mankind even t h r o u g h t h e d i s a s t e r s o f war, t h e M i d d l e
Ages, and t h e o p r e s s i o n o f d i c t a t o r s .
Sadly, needed a b o r t i o n i s n o t now a v a i l a b l e i n l a r g e areas o f
our c o u n t r y , d e s p i t e t h e law.. E i g h t y - s i x p e r c e n t o f t h e c o u n t i e s
i n t h e U n i t e d S t a t e s have no c l i n i c or p h y s i c i a n p r o v i d i n g t h i s
c a r e . And even fewer p h y s i c i a n s w i l l now r i s k t h e gun f i r e o f t h e
s e l f annointed zealot.
We do indeed need RlMSe.'
What a boon i t w i l l hel
What a s a v i n g s ]
Thenthere i s the paper waste-3 to 10 b i l l i o n d o l l a r s per year,
according to the Canadian H o s p i t a l A s s o c i a t i o n , which points a few
accurate f i n g e r s at us. Two to three inches of papers land on our
�DRS.
DONALD
W. B I C K L E Y ,
M.D.
BICKLEY
2001
&
BICKLEY
KIMBALL AVENUE
WATERLOO,
MARK
L. B I C K L E Y ,
D.O.
IOWA
Page 4
desk d a i l y j u s t from n u r s i n g homes, w i t h papers t o be signed,because
phone o r d e r s a r e n o t p e r m i s s a b l e by law. H o s p i t a l o r d e r s are i n
triplicate.
So, w i t h o u t a d d r e s s i n g t h e second and t h i r d o p i n i o n s r e q u i r e d
f o r s u r g e r y , t h e i l l o g i c a l percentage o f C - s e c t i o n s done because
the OB man, wants t o p l a y g o l f a t . O'clock, t h e MRIs done atop a
2
CT o f an obvious h e r n i a t e d d i s c , , i t i s b o t h t h e m e d i c a l and t h e
j u d i c i a l system v/hich are r e a l l y b e h i n d a l a r g e p a r t o f t h e waste
i n medicine.
Before World War I I , we p r a c t i c e d medicine w i t h o u t
threat of s u i t .
There, were almost no s u i t s except i n t h e l a r g e c i t i e s
And waste i n o u r h i g h t e c h n o l o g y was no f a c t o r .
We g r e a t l y
o v e r - u t i l i z e t h i s advanced technology,, and g i v e d i a l y s i s t o t h e 80
year o l d man t o t h e day he d i e s , do open h e a r t s u r g e r y on c o u n t l e s s
c a r d i a c s who s h o u l d be t r e a t e d m e d i c a l l y , p l a c e a $10,000.00 c a r d i a c
pace maker-guaranteed f o r 5 y e a r s - i n an 80 year o l d p a t i e n t who
d i e s i n one month.
.
T h i r d p a r t y pay i s another d i s a s t e r which I w i l l n o t address.
No p a t i e n t understands Medicare b i l l i n g o r payment. NoYdo t h e
doctors.'
S i m i l a r l y , t h e g r i m j o k e o f "Why do they p u t n a i l s i n t h e
c o f f i n ? " Ans; "To keep t h e o n c o l o g i s t o u t . "
Very t r u l y
yours,
J)0VV^ ^ ^ \ Q \ ^ ^ p
r
1
DONALD W. BICKLEY, M. D.
P. S. One f i n a l remark: C o g n i t i v e l i f e and s o u l does n o t b e g i n
at c o n c e p t i o n . Even t h e C a t h o l i c Church does n o t belieo<? t h i s
misguided pronouncement o f a c i r c u i t j u d g e ] The j e l l y bag o f a
f i r s t o r second month's pregnancy i s n o t a w e l l dressed c h i l d
bouncing around i n a c o l o r f u l n u r s e r y , as P h y l l i s S c h l a f l y would
have us b e l i e v e . Many i n t e l l i g e n t people are misletS by t h i s
picture^misrepresentation.
�Allen Memorial Hospita
June 12, 1990
Donald Rodawig, M D
..
President
Iowa Medical Society
1001 Grand Avenue
West Des Moines, IA 50265
Dear Doctor Rodawig:
We, the Medical Staff of Allen Memorial Hospital, wish to take this
opportunity to express our collective frustration and irritation toward
the process of Peer Review in the State of Iowa. W find i t necessary
e
to speak as a unified body to the Iowa Medical Society in the hope that
effective change can be brought about to rectify the inadequacies of the
Iowa Foundation for Medical Care.
Oyer the past few years, serious concerns have been discussed among our
Medical Staff regarding the accusational and punitive nature of the
IFMC. I t is our understanding that the IFMC is a peer review
organization mandated by the Health Care Financing Administration, and
endorsed by the Iowa Medical Society in its conception as a physician
administered organization. Contrary to this original intent, the
Foundation has expanded far beyond the purpose for its existence, i.e.,
to monitor the care of Medicare and Medicaid recipients.
I t has now
contracted with Blue Cross, out-of-state third party payers, and serves
as the reviewer of Health Maintenance Organizations for the State of
Iowa.
.
As the number of contracts has increased, the quality and
appropriateness of their review process has definitely diminished.
Letters regarding "quality of care concerns" are being generated and
sent to physicians at an alarming rate, and i t is doubtful that many of
these issues are being raised by physician reviewers. Rather, the
letters are composed generically when a guideline is not met or an
abnormality in the chart is not corrected or otherwise addressed. While
every physician on our Medical Staff would welcome effective peer review
as an educational and a corrective process, we must protest the
voluminous and often petty concerns which are raised by the IFMC. For
example, Dr. Maroc has personally stated that a letter should not have
been written to a physician when a laboratory value was minutely
elevated, and yet the P O Issued an indictment that the physician had
R
placed his patient in serious detriment.
*
Continued
r
lH2 i l.()j;;m
Avfiuii'
• VV.iU'iluo, lnw.i
Siirn'l
(
• .W > 235-MM
..••I.-.:
�President, Iowa Medical Society
Page 2.
June 12, 1990
The unfortunate result of this failed attempt to provide adequate peer
! review for H F has been the evolution of a large ( f o r - p r o f i t )
CA
bureaucracy which no longer provides true peer review by physicians; and
when doctors are providing such review, i t is uncertain i f they are
knowledgeable
about
the
specialty
which they are critiquing.
Furthermore, the attitude taken by the IFMC has been that the physician
is gui1ty unti1 proven innocent. The time required to reply to these
accusations has been enormously
costly,
both
financially
and
emotionally.
More importantly, i t has resulted in a sense of mass
paranoia among many, i f not a l l , of the physicians on our Medical Staff,
and we are probably correct in saying that this feeling extends beyond
Allen Memorial Hospital. Because of the fear of penalization which
potentially might result in formal sanction, the quality of patient care
may actually suffer as patients are exposed to more testing and longer
hospital stays in order to meet guidelines and avoid an "early readmission". Clearly, the costs of medical care and the length of
hospitalizations have greatly increased as a result of our determination
to ensure that our personal records are not tainted.
A recent a r t i c l e in the Wai1 Street Journal indicated that Iowa
physicians were issued a large share of the "quality concerns" and wereresponsible for an inordinate number of re-admissions when compared with
other physicians across the county. Since i t is obviously unlikely that
Iowa physicians are collectively practicing at a lower standard of care,
then i t follows that the peer review process which is currently in place
is inappropriate, and therefore, is ineffective.
Because of these
concerns, we request that the Iowa Medical Society, as a representative
body for the physicians of Iowa, survey i t s members to determine the
extent of the frustration which we believe exists throughout the state.
Furthermore, we request your support and influence in changing the
present system of peer review in the State of Iowa.
Sincerely,
Medical Staff
(Signature page attached)
cc.
Congressman David Nagle
Senator Thomas Harkin
Senator Charles Grassley
Governor Terry Branstad
Black Hawk County Medical Society
Medical Staff, Covenant Medical Center, Waterloo, Iowa
Medical Staff, Sartbri Memorial Hospital, Cedar Falls, Iowa
Administrator, Covenant Medical Center, Waterloo, Iowa
Administrator, Sartori Memorial Hospital, Cedar Falls, Iowa
�1315 High Slreel. Des Moines. Iowa 50309. (5151 2^ 1-6731
POWELL CHEMICAL DEPENDENCY CENTER
An loiva Methodist Medical Center Service
March 23, 1993
Hillary Rodham Clinton, Chair
President's Task Force on National Health Care Reform
The White House
1600 Pennsylvania Avenue, N W
..
Washington, D C 20500
..
Dear Ms. Clinton:
W are writing as members of the National Association of Addiction Treatment
e
Providers to request the inclusion of comprehensive coverage for alcoholism
and other drug addiction treatment in any and all national health care
reform.
Alcohol and other drug addiction is a serious health problem, the costs and
consequences of which affect all Americans. The cost of untreated alcohol
and drug problems is enormous. A 1991 Health and Human Services estimate
put the known cost to our society of addiction at $200 billion. This did
not include the hidden (but no less strongly felt) costs of crime,
accidents, AIDS, and family trauma and their impact on healthcare.
O the positive side, study suggests that for every $1.00 we invest in
n
treatment of the addicted and of those affected by a loved one's addiction,
$11.54 in other costs are saved.
Those of us who work directly with addicted Americans know that effective
prevention and treatment saves lives as well as dollars. Not only does
treatment offer hope and recovery to those suffering from addiction, i t also
reunites families, reinstates valuable employees and contributes to the
safety and health of all Americans.
National health care reform must include a comprehensive alcoholism and
other drug treatment benefit i f access to healthcare is to be a meaningful
reality.
I f we can be of future service, please let us know.
Sincerely,
o nicer c i y ,
Stan Haugland, M D
..
Medical Director
KS/pc
LTRS/CLINT0N
Kathy Stone \
irector ^ J
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
,ckx.
�George C. X a k e l l i s , M
D
Strategies to Increase Supply of Generalist Physicians to Rural Americans
PROBLEM:
There are i n c r e a s i n g l y fewer medical students e n t e r i n g g e n e r a l i s t
s p e c i a l t i e s , and a growing shortage of g e n e r a l i s t s choosing t o p r a c t i c e
i n small towns and r u r a l areas.
CURRENT AVAILABILITY OF RURAL PHYSICIANS
G e n e r a l i s t t o p o p u l a t i o n Ratio i n Iowa: 1/2569
Rural Counties: 52 counties have g e n e r a l i s t p h y s i c i a n r a t i o greater than
1/2500, 27 have r a t i o greater than 1/3000
Desirable G e n e r a l i s t R a t i o : 1/2,000
Family Physicians are 3x more l i k e l y t o enter r u r a l p r a c t i c e than any
other primary care p h y s i c i a n . 30% o f family physicians p r a c t i c e i n r u r a l
locations.
IMPACT POINTS
1) Medical School Admissions Process
A t t e n t i o n could be p a i d t o admission c r i t e r i a t h a t encourage the
s e l e c t i o n of students l i k e l y t o enter family p r a c t i c e and r u r a l p r a c t i c e :
Higher p r o p o r t i o n s o f students from small towns and r u r a l areas choose
f a m i l y p r a c t i c e and r u r a l l o c a t i o n s f o r t h e i r p r a c t i c e . Women and
African-American students are more l i k e l y t o choose g e n e r a l i s t f i e l d s but
are not n e c e s s a r i l y more l i k e l y t o p r a c t i c e i n r u r a l s e t t i n g s .
2) Medical Student Education: Recently, the f e d e r a l government has
focused i t s e f f o r t s and resources on residency education and research,
not on medical student education and s p e c i a l t y s e l e c t i o n . Education
of the medical students has been the r e s p o n s i b i l i t y of the s t a t e s .
30-40% o f e n t e r i n g medical students n a t i o n a l l y express a preference f o r
f a m i l y p r a c t i c e . At the U n i v e r s i t y of Iowa we work t o minimize the
e r o s i o n o f t h i s i n t e r e s t through a combination of e x t r a c u r r i c u l a r and
c u r r i c u l u m i n t e r v e n t i o n s . A l l a c t i v i t i e s are designed t o show the
student t h a t f a m i l y physicians are i n t e l l i g e n t , competent, humanistic
doctors who enjoy what they do.
Our c u r r e n t Curriculum: Ml year - MECO, L i v i n g Anatomy, Human Dimensions
�March 30, 1993
Hillary Rodham Clinton
Head, Task Force on Health Care Reform
The White House
600 Pennsylvania Avenue
Washington, DC
Dear Ms. Clinton:
I feel honored to have participated in your "Conversations on Health" in Des Moines, and I am
especially pleased that you came to Iowa despite the bad weather on the East Coast.
I am an associate professor of family medicine at the University of Iowa College of Medicine, and I
am responsible for the medical student teaching programs in family medicine here. We did very
well in this year's residency match with 31% of our graduates choosing a career in family medicine,
but I am continually striving to enhance student interest. I have identified three impact points in the
process of medical education for support of careers in family medicine and have enclosed some
suggestions for your task force.
I have an additional thought which was not voiced at our hearing. There is no incentive to include
family physicians in research at tertiary care oriented research universities, so academic family
physicians are encouraged to concentrate only on teaching and patient care activities. Since
"research activity is considered the criteria for success at academic institutions, family physicians
often must settle for clinical positions while their peers are awarded tenure track appointrrfents.
Under these circumstances, family physicians do not receive full acceptance from their peers, and
medical students are not encouraged to emulate them. I propose that priority points be awarded to
grants on research in the primary care setting which include a family physician as a co-investigator.
This would encourage more primary care research and would give family physicians the opportunity
to establish their value as equal partners in the research mission of academic institutions.
Thank you for the opportunity to participate in your health care reform process. I fully support yijur
efforts and remain interested in helping you in any way possible. Please feel free to contact me if I
can be of any further assistance.
Sincerely,
George C. Xakellis, MD
�o f M e d i c i n e ; M2 year - I n t r o d u c t i o n t o C l i n i c a l M e d i c i n e , M2 year
e l e c t i v e s ; M3 year - r e q u i r e d f a m i l y medicine p r e c e p t o r s h i p ; M4 year electives
Our c u r r e n t e x t r a c u r r i c u l a r a c t i v i t i e s : Family P r a c t i c e c l u b sponsors 1215 e v e n t s p e r year. A p p r o x i m a t e l y 300 s t u d e n t s a r e members o f t h i s c l u b .
These e v e n t s b r i n g t o g e t h e r s t u d e n t s , r e s i d e n t s , p r a c t i c i n g f a m i l y
p h y s i c i a n s , and f a m i l y p r a c t i c e f a c u l t y from t h e U n i v e r s i t y and from
community-based r e s i d e n c y programs.
F e d e r a l government c o u l d do s e v e r a l
things:
-one would be t o t i e e x i s t i n g graduate medical e d u c a t i o n money ( r e s i d e n t
e d u c a t i o n monies) t o performance c r i t e r i a f o r m e d i c a l s t u d e n t s p e c i a l t y
s e l e c t i o n . T h i s would demonstrate t h a t t h e f e d e r a l government s u p p o r t s a
change i n t h e s p e c i a l t y d i s t r i b u t i o n o f p h y s i c i a n s .
-The second would be award p r i o r i t y p o i n t s t o g r a n t a p p l i c a t i o n s i n t h e
areas o f h e a l t h s e r v i c e s r e s e a r c h , g e r i a t r i c r e s e a r c h , and r e s e a r c h on
prevention i f a family practice f a c u l t y i s a co-investigator.
T h i s would
serve t o i n t e g r a t e f a m i l y p r a c t i c e f a c u l t y more c l o s e l y w i t h t h e i r
s p e c i a l t y colleagues.
- F i n a l l y earmark some o f t h e graduate medical e d u c a t i o n f u n d i n g f o r t h e
purpose o f t r a i n i n g r e s i d e n t s i n ambulatory l o c a t i o n s away from t h e
University Hospital.
T h i s would support i n f r a s t r u c t u r e changes needed t o
a l l o w f o r m e d i c a l s t u d e n t s t e a c h i n g i n these remote l o c a t i o n s .
These i n t e r v e n t i o n s should h e l p address t h e RESPECT f a c t o r : M e d i c a l
s c h o o l s t e n d t o be t e r t i a r y care c e n t e r s , which have no r e a l r o l e f o r
g e n e r a l i s t s , and be s t a f f e d by r e s e a r c h - o r i e n t e d s p e c i a l i s t s who r e g a r d
g e n e r a l i s t s w i t h a low l e v e l o f r e s p e c t .
These i n t e r v e n t i o n s would move
some m e d i c a l s t u d e n t t r a i n i n g o f f t h e U n i v e r s i t y H o s p i t a l campus and
would i n v o l v e g e n e r a l i s t f a c u l t y i n c o l l a b o r a t i v e r e s e a r c h a c t i v i t i e s .
3) P r a c t i c e D e s i r a b i l i t y : The p r a c t i c e o f g e n e r a l i s t s p e c i a l t i e s must be
viewed as d e s i r a b l e by t h e m a j o r i t y o f medical s t u d e n t s when compared
t o t h e i r o t h e r c a r e e r o p t i o n s i f they a r e t o choose t h i s o p t i o n i n
s i g n i f i c a n t numbers.
Methods t o i n c r e a s e p r a c t i c e d e s i r a b i l i t y :
- C u r t a i l t h e funding f o r residency t r a i n i n g i n non-generalist t r a i n i n g
programs.
-Modify f i n a n c i n g and reimbursement o f h e a l t h care d e l i v e r y system t o
encourage t h e p u b l i c t o u t i l i z e p r e v e n t i v e medicine and g e n e r a l i s t
p r o v i d e r s and t o reward p r o v i d e r s f o r p r a c t i c i n g p r e v e n t i v e and
g e n e r a l i s t medicine.
�CODER:_
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
GENERAL SORT:
General mail
.Personal stories
Other Health Providers
POSTCARD 1:
.Letter Campaign
POSTCARD 2:
Offers to help/Employment
FORM LETTER:
Letterhead
REROUTE:
Casework
Physicians
_Policy
Scheduling
President
Other
POLICY AND PERSONAL STORIES:
.ORGANIZATION (I)
insurance premiums
^insurance reform
insurance pools
boards and oversight
.COVERAGE (H)
working families
unemployed/low income
benefits
providers
.INFRASTRUCTURE/WORKFORCE (IH)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
^medicare
medicaid
veterans
.DoD
Indian health
_COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
.FINANCING (VH)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
_AIDS
women's health
immunizations/children
rural
urban
OTHER
�C. SHAFFIA
LAUE, M.D.
CHILD AND ADULT PSYCHIATRY
PO. BOX ISB* asz.
LAWRENCE, KS 66044
913-841-1243
Hillary Rodham Clinton
1600 Pennsylvania Ave.
Washington, D.C.
April 8, 1993
Dear Hillary,
Although I am writing to you specifically because you are heading the Task Force
on Medical Care, I want you to know that I have great confidence in the four
persons comprising the Clinton/Gore team. When I refer to "you" in this letter
most often I will mean you collectively, because you encompass the values to
which I aspire. Each of you touch specifically something that is very important to
me. Hillary in the Children's Defense Fund, Tipper speaking out for Mental
Health issues (and violence in music and on TV), Al in his focus on the
environment, and President Clinton in his team building approach giving the
United States back to the citizens rather than continuing to court the special
interests.
Yet, I write to you with my own special interests, which arejl}£_chUd*e«-o£-our_
nation. I am so hopeful, because foTTfrg-fn'st time+ir-mT~2Tyear voting history,
there is someone in power who shares my concern and I hope will listen to me.
One of my patients, a 16 year old high school jr., told me about her history class
this past week and you need to know what she said! The class had divided into six
groups for the purpose of discussing the priorities of the Clinton Administration.
Yes, the deficit, AIDS, jobs and the economy were all important to them, but
independently each of the six groups chose the same problem for your #1 Priority.
Addressing the hate and violence between the members of their generation. I
was not surprised, perhaps you aren't either. The students in jr. and sr. high are
under siege not from gangs or drugs or alcohol, although these contribute to the
problem, but they are under siege from each other. It starts early in life, gets
rolling in the primary grades and by 7th grade it's becoming solidified.
But perhaps I'm getting off on a tangent, this subject is so big I have a 400 page
manuscript discussing it. I apologize that it is too rough to share in the short time
frame we are working with before May 1, so I will try to make my points more
succinctly and directly to your purpose than the book would and hope that they
make sense to you.
There are many pressing issues at hand which in my opipioa-aJijjit^^tB^vHth the
medical reforms towards which you are working. As ^ c h i l d psychiatrisTlJrave
made many observations such as the one above anofrave- notecHtow they
interface with long term health and productivity. A very brief summary includes:
�1. The gross neglect of preventative medidrre-a-ncLtbe effect on long term costs.
2. The connection between community, early childhood experience and later
health problems.
3. The connection between community, early childhood experience and
increasing crime rates.
4. The desperate need for mental health benefits in order to bring down long
term costs.
5. The bottom line is heajth care cannot be separated from education,,
and education cannot be separated from the crime rate and prison crowding.
And all three cannot be separated from the ecological web in which we live. It
will take people of your foresight and planning to understand this and attempt to
implement long term goals to accomplish it. However even the desire to remove
unequal care and create one standard (which I agree with, by the way) carries
with it aspects that could create just the opposite: a stifling of innovation.
I will address each of these in more detail.
1. Although I have heard a lot of finger pointing between insurance companies,
hospitals, and doctors, I haven't heard anyone address preventative medicine.
Now the "managed care" groups will try to convince you that this is their forte, but
financially their heart is in the wrong place. They need to hold the bottom line
for this year first and foremost. Planning for savings 5 or 10 years down the road
simply doesn't jive when there is no guarantee that they will still be around to
reap the financial benefits, so they basically do short term goals.
In Kansas the insurance companies are lobbying to get out of paying certain
mental disorders, such as substance abuse, saying that they can't afford it. Yet they
can afford liver transplants and other medical treatment for the sequelae of drug
and alcohol addiction. Yes, they have played the game to make it difficult to treat
by limiting hospital stays to 30 days and helping to create the revolving door that
they now want to close. A Medicaid patient I had last year was concerned that
she was going to start using a prescription drug she could buy on the street. But
she could not be admitted on her medical card until she was suffering physical
symptoms from her abuse of the drug she was attempting to avoid. In the
bureaucracy of trying to get help she was finally pushed into a psychosis and
committed to the state hospital for 2 months. So whose interest was served?
Certainly not hers!
Another patient with private managed care insurance had made two very serious
suicide attempts over a one year period. He was only alive by the grace of God. I
had managed him on an out patient basis because he had refused hospitalization
and I could not commit him. When there was a chance of a third attempt he was
admitted, but after 7 days the insurance company declared the crisis was over
and demanded that he be discharged since they only cover crisis intervention.
(Saves money in the short run, very expensive in the long haul.)
�As you are probably well aware, those without insurance don't get help until the
problem is so big it takes much more in the way of resources to help, if it's even
still possible to do so. In addition, those at the bottom of the totem pole such as
the migrant farm workers who handle all our food, get the least care of all. If we
can't look at it from a humanitarian side then hopefully the numbers will speak to
those of influence. TB is on the rise in California because of our neglect, and
hepatitis has been contracted by individuals across the country eating food
handled by infected harvesters.
2. The connection between community, early childhood experience and later
health problems. I'm not sure if I can do this subject justice in just a couple
paragraphs, but I will try. The latest theories in childhood which have been
written by Stanley Greenspan M.D. delineate early development as a series of
stages rather than concrete milestones such as sitting up or walking. The 6 stages
can be condensed into four processes that include: 0-4 months; the ability to
attend to the environment and to experience pleasure and comfort, dependency
and warmth with the caregiver.
Between 4-8 months they go beyond
connectedness into two way communication, which he describes as opening and
closing circles of communication. Dr. Greenspan states that "A difficulty in twoway communication processes in older children may show up as a problem in
controlling aggression. The core problem may be that gestural communication
was never negotiated." Although a child is considered "pre-verbal" important
groundwork is laid down necessary for healthy interpersonal communication. The
third level goes up to 18 to 24 months involving the learning of shared meanings.
Now the child is learning to use representations (symbols or emotional ideas) to
understand the surrounding environment. This involves pretend play and using
words to make requests. Representational differentiation or emotional thinking
is the fourth process which generally takes place between 2 1/2 or 3 to 4 1/2 to 5
years of age. Here children learn to categorize shared meanings as well as
integrate feelings and thoughts. They can think in dimensions of time which is
important for limit setting and impulse control. Actions can now be more easily
connected to feelings through the interval of time.
To further complicate the tasks at hand these processes are mastered through the
child's individual constitutional-maturational patterns which include: 1. Sensory
reactivity (including hypo- and hyper-reactivity in each sensory modality). 2.
Sensory processing in each sensory modality (the nervous systems decoding of
patterns). 3. Sensory affective reactivity and processing in each modality (the
capacity to react to various affective intensity in a stable manner). 4. Motor tone
(a laid back vs. an active child), and 5. Motor planning (the competency to carry
out actions as intended).
This multidimensional view of development can give us a better idea of the
complexity of the tasks that a child is mastering as well as identifying more
accurately where the breakdowns on the road to adulthood occur. Bernie Segal,
a well known surgeon, once wrote that what is behind every illness is a problem
with the ability to love, the ability for affiliation in a caring non conditional way. By
giving more support to early childhood development and the development of
interpersonal relationships, I believe that much physical illness (especially that
which we call idiopathic) can be ameliorated or prevented. But extensive
�research over the past 15 years has also shown that a healthy emotional state and
feelings of community and connectedness can not only prolong life but increase
the level of well being.
If we are going to work with the causes of medical problems to greatly decrease
the cost over the long haul then it is imperative to address these issues. Head start
is an important program, but it is not enough. A parent who has never
experienced an empathetic and nurturing relationship is not going to learn how
to parent from a c ass or a book. (Please confer with Selma Freiberg's paper,
"Ghost's in the Nursery".) Although the research is still in process it is very clear to
me as a psychiatrist that unexpressed intense feelings do not just go away or
evaporate, but rather get buried in different organ systems to come back later as
idiopathic or auto immune illness. Which is not to say it is the individual's fault for
getting sick either. They developed coping skills in childhood that fit the
environment but are now working against them in later life. By providing more
extensive support for parents in becoming empathetic to their child's feelings
while at the same time providing consistent limits and structure for the child, we
would not only repair some of the parents wounds from childhood, but also
"vaccinate" the current children against having to suffer the exact same
deficiencies or worse.
Our need for affiliation and its connection to medical illness is not as well
documented as some would prefer. However I refer you to the work of Rene
Spitz who studied babies that were physically cared for without nurturing while
their mothers were incarcerated and the babies invariably died. More recently
Spiegel's research in California with patients who had breast cancer. In his study
the experimental group had group therapy and lived more than twice as long.
The preliminary explanation is that they had a safe place to openly express their
inner feelings and the group's cohesion gave them a caring community.
In some ways the metaphor of a toxic cleanup
have to spend some money up front to clean up
reap the benefits of lower costs down the road,
then four or even eight years. Hopefully in eight
to continue the process.
is applicable. We are going to
the mess of neglect, but we will
unfortunately this will take more
years enough would be apparent
3. The connection between community, early childhood experience and
increasing crime rates.
Here is the place to address several problems at once. They are all intertwined,
you know they are, yet no one has previously addressed it in a comprehensive
way. And Janet Reno is a strategically placed ombudsman for your administration.
The same issues of connectedness and affiliation apply here. It has little to do
with loving your child, many children are loved, but because the parent expresses
the hyper criticism more pointedly than the love, the later is not perceived by the
child.
In her confirmation hearings Reno was queried regarding juvenile
detention centers. Her response was brief and to the point. We can identify
many of these children at age 7, sometimes less, why do we ignore them until
they are such a problem to someone that they have to be locked away. (My
paraphrase, but the gist is there.) Beat out the Republican "Tough on crime"
smoke screen that has us spending much more money to incarcerate these
�people who as children were the victims and we ignored them. (Don't get me
wrong, we need to hold people accountable for their actions, however if we
don't like living in fear then we need to get to the root of the problem, jail and
death sentences are not a deterrence to these people.) However, again the short
term community building programs where individuals work together with
increased police forces while simultaneously we work on toxic cleanup to
diminish the need for gang affiliation because there is community affiliation
already in place to subvert it.
Another consideration is a program that the Transcendental Meditation people
in Iowa used in an African country. The prisoners were offered a meditation
course during their incarceration. Not only did they gain parole faster for good
behavior, but they stayed out once they got out. Because of the low recidivism
rate over half of their prisons were closed. Now that's saving money! One of the
things that meditation taught them was how to be connected to each other and
a higher source, whatever name you care to use.
4. The desperate need for mental health care benefits in order to bring down
long term costs.
Managed competition is an oxymoron. The reason they can give care for less is
because they give less care. Insurance companies have always reimbursed
procedures rather than caring. (A quick glance at fee structures tells that story.) If
someone doesn't get well we order more tests and procedures. Surgical removal
of the stomach cures ulcers in the stomach more than 99% of the time. But if
the ulcers were caused by the vagus nerve over stimulating the secretion of acid,
then we have only removed one of the symptoms. Whatever was causing the
hyperactivity of the vagus nerve is still ongoing in the patient and will cause other
problems down the road. Some of these managed care organizations wish to use
my skills only to write prescriptions while they have someone with considerably
less training, especially in child psychology, do the therapy. Luckily I have plenty
to keep me busy without any business from these organizations. But I worry about
the kids who are sometimes over medicated to "manage" their aggression, when
by all rights they have good reason to be angry. What they need is someone to
work with them and the parents so that the anger can be communicated in
socially acceptable ways rather than sedated!
Psychiatrists were slow to do the research to justify their existence, but it is
becoming available. If you don't already have reams of studies that show how
psychiatric care reduces overall cost in many different medical situations, contact
the American Psychiatric Association office there in D.C. They will be happy to
provide you with the data. As a psychiatrist and medical doctor I have diagnosed
many non psychiatric problems that were overlooked by primary care physicians
who didn't have time to talk to their patients. Persona ly my experience with
managed care has been so bad, I would much prefer a National Health Care
system that has one payer (you know who) and everyone has their own choice.
Many communities in Kansas have either no one who will take Medicaid obstetric
patients, some have one who is compassionate and good. Others have the one
who has such poor bedside manners that the only way he has any practice at all is
to take all the ones who have no other choice. I have always tried to have
�Medicaid patients, but it is hard. They are often the most challenging (as well as
needy) families. Because of my own health I had to cut back to two days a week,
so to give the Medicaid "discount" and still cover my overhead is very tight. I am
frustrated because I can see the difference it can make in their lives and future
productivity as citizens, which is the bottom line financially for our nation.
5. The bottom line. Perhaps Sylvia Ann Hewlett is already one of your
consultants. If not I suggest that you look at her book, When the Bough Breaks,
the cost of neglecting our children. I went into Child Psychiatry because I feel
very strongly about protecting all children (not just the unborn). It will take time
but once the majority of our children grow up feeling loved and connected the
problem of abortions will fall away because we will respect ourselves and others
too much to continue. Since we are not yet to that level of respect, it is not a
problem that will be legislated away and I stand behind your efforts to give
women choices until we do have a generation that grew up feeling respected.
Which brings me back to the beginning of this letter when I mentioned the high
school students who want you to address the violence in which they find
themselves trapped. We need to guide them not by beating them with "the
rod", but rather by continuing the wonderful momentum which you have started
towards building community.
Use your staff to further educate Americans on the points I have made. That
rather than covering symptoms you will go to the "cause behind the cause" to
create solutions that will work in the long run, even though they will appear to
cost more in the first few years. Just like your program to vaccinate children,
which can be used as a metaphor, our country can be vaccinated against crime
and violence if we would only be ready to invest in our children. There is data
available that shows when class size for first through third grade is held down to 15
or less, the children are still doing significantly better in school 10 years later, even
if class size increases after third grade. Most teachers could have told you that
without a study, but politicians want the numbers to prove it. Most classes of
these young children have between 22 and 30 students. Many never have a
chance to get off the ground, and frustrated teachers leave because the job is too
hard to do it adequately with those numbers. The benefits in human productivity
in ten years can be calculated and have to be made a priority. In addition there
will be less stress related illness to further run later costs up. As the saying goes,
you can pay now or pay later, we've almost waited too long don't stop now. I will
be writing a letter to Senator Dole about his "Pork Lock" comments. The
community projects are critically important in my opinion. Not only do they
create jobs where needed but they create the community and affiliation that I
have been discussing.
I support all of you in the changes you are attempting. I send you my prayers and
hope that you will succeed for all of us.
Sincerely,
//
C. Shaffia Laue, MX)
�P.S. Hillary-I have been meaning to write to you a letter of general support since
before the election. Although your talents and expertise had to be downplayed
during the campaign, I was able to use them quite effectively with the people to
whom I spoke, (i.e. If one of my friends hedged on voting for Bill on any one of
the several minor issues that plagued him, I would just say "vote for Hillary, she's as
qualified as anyone running." I am sorry we couldn't carry the state of Kansas for
you. I support you in the decisions you made for Chelse and taking time to be
with your father at this critical transition. My heartfelt sympathy goes out to you
knowing that in the wake of feelings of loss you have tremendous work to do.
�Dear H i l l a r y Rodham C l i n t o n ,
President B i l l C l i n t o n ,
March 6, 1993
We want t o thank you f o r v o l u n t e e r i n g your services i n
t a k i n g on the enormous challenge of d i r e c t i n g the reformation
of our c u r r e n t health care system. As physicians we want t o
personally r e l a t e a few of our concerns.
We recognize that our current health care system i s i n
i t s present state of disarray as a r e s u l t of multiple factors
(hospitals, physicians, insurance companies, pharmaceutical
companies, patients, and lawyers.) A l l of us must be part of
the solution i f our new system w i l l be successful. We are
prepared to make s a c r i f i c e s , perhaps painful ones, but we
demand that everyone else should be making similar s a c r i f i c e s
-there should be no "sacred cows." As lawyers, we know you
are well aware of the escalating settlements that are being
won i n malpractice courts. I f you expect a more cost
e f f i c i e n t health care system, t o r t refonn must be enacted.
Another p a r t of the c u r r e n t problem r e s t s w i t h the
d i s t r i b u t i o n of physicians - too may physicians i n urban
areas and not enough i n r u r a l areas. We l i v e i n a community
of -65,000 people i n the northeast corner of Kansas. T h i r t y
miles t o our east and west l i e two much l a r g e r communities
t h a t have f u l l representation of a l l h o s p i t a l services and
physician s p e c i a l t i e s . We f i n d i t very f r u s t r a t i n g t h a t our
colleagues w i t h the exact same t r a i n i n g and s k i l l s can
c o l l e c t up t o 30% more f o r the same procedures as we do.
The basis f o r t h i s i n e g u i t y r e l a t e s t o the concept t h a t urban
business costs are greater than r u r a l costs. Our personal
business experiences have proved t o be e x a c t l y opposite.
Because physicians and h o s p i t a l s i n urban areas are o f t e n
grouped together, they can e f f e c t i v e l y negotiate more cost
e f f e c t i v e purchases of supplies, drugs e t c , and t h e i r
overhead may a c t u a l l y be lower. The smaller physician groups
and r u r a l h o s p i t a l s do not have such e f f e c t i v e bargaining
power and t h e r e f o r e o f t e n have higher costs. I f you want t o
r e c t i f y the problem of m a l d i s t r i b u t i o n of physicians, t h i s
i n e g u i t y must be corrected. Taking t h i s concept another step
f u r t h e r , consideration should be given t o reimbursing a t a
higher r a t e those physicians who do p r a c t i c e i n r u r a l areas.
To summarize, under the new system we must f i n d a way of
making i t f i n a n c i a l l y a t t r a c t i v e t o p r a c t i c e medicine i n
r u r a l areas, r a t h e r than a detriment.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
^
^ciaA-M-ci
— / /5:
�L a s t l y we agree w i t h t h e concept t h a t a l l Americans are
entxfc-3:t;d- Lu bauie h o a l t h ^ g a r e c o v e r a g e . U n f o r t u n a t e l y , t h i s
may r e s u l t i n loss o f curren^TJeneriLb Lu those who p r e s e n t l y
enjoy e x c e l l e n t insurance coverage. We need t o h e l p many
people change, ancLJ^saen^current e x p e c t a t i o n s ( i . e . n o t
everyone can* receive i-onaiHTaTy^ i ^ p ^ ^ ^ p r i c , ^ t ^
v e n t i l a t o r , o r organ t r a n s p l a n t a t i o n e t c . ) And f i n a l l y , we
must embrace t h e concept t h a t every bad outcome i s n o t t h e
r e s u l t o f improper medical care. We must q u i t a s s i g n i n g
blame f o r undesirable r e s u l t s .
Lj
1 i r r
r
a
We hope you w i l l g i v e these few ideas thorough
consideration.
Respectfully,
V
lina 'MD
Patricia McRae-Denning'MD
Dale P. Denning MD
r
v
�1
W A L T E R F. RICC !.
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A p r i l 28, 1993
Mrs. H i l l a r y C l i n t o n , Chair
White House H e a l t h Care Task Force
The White House
1600 Pennsylvania Avenue
Washington, D.C.
20500
Dear Mrs. C l i n t o n :
As a c o n s t i t u e n t ^ a p r a c t i c i n g p s y c h i a t r i s t and psychoanalyst i n Shawnee M i s s i o n , Ks.,
I am a p p e a l i n g t o you t o take a s t r o n g p o s i t i o n concerning h e a l t h care issues t h a t
concern t h e m e n t a l l y i l l .
I know t h a t i n t h e past you have been very i n v o l v e d i n such
issues and I am c o u n t i n g on you t o c o n t i n u e your d e v o t i o n t o t h i s cause.
As a former Superintendent o f an urban community mental h e a l t h c e n t e r f o r seven
years (Western M i s s o u r i Mental H e a l t h Center, K.C.Mo.), I f e e l t h a t I have worked
t o promote u n d e r s t a n d i n g o f t h e i r cause and t h e r i g h t s they deserve. Working c l o s e l y
w i t h such people as Jim Mongan a t Trumen Medical Center, we endeavored t o serve a l l
people i n need, whether o r n o t they had t h e means t o pay. The m e n t a l l y i l l remain
very c o s t l y t o s o c i e t y because o f t h e i r needs f o r h o s p i t a l i z a t i o n , m e d i c a t i o n , and t h e
c o s t o f l i v e s l o s t because o f t h e i r d i s t o r t e d t h i n k i n g . Recent examples such as
Koresch, Chapman, H i n c k l e y , Dahmer, B e r d e l l a , Bundy, a r e p a i n f u l reminders o f a h e a l t h
care system gone awry. E a r l y i n t e r v e n t i o n and t r e a t m e n t remain i n v a l u a b l e .
I n my p r i v a t e p r a c t i c e I t r e a t many p a t i e n t s who range from p e r s o n a l i t y problems t o
s e v e r e l y d i s o r g a n i z e d i n d i v i d u a l s . Most o f them a r e p h y s i c i a n s , l a w y e r s , o r c o r p o r a t e
e x e c u t i v e s . A d d i t i o n a l l y , I work as a s u p e r v i s o r o f p s y c h i a t r i c r e s i d e n t s , medical
s t u d e n t s , and s e n i o r medical s t a f f , which a f f o r d s me t h e o p p o r t u n i t y o f having an
impact on t r e a t m e n t and e d u c a t i o n .
I wish t o emphasize t h a t t h i s r o l e reaches
p r o f e s s i o n a l s who a r e t r e a t i n g t h e p h y s i c a l l y i l l as w e l l .
Common t o a l l o f t h e p a t i e n t s
t h a t I t r e a t and whose care I s u p e r v i s e , i s an inadequacy o f h e a l t h insurance funds.
This has grave i m p l i c a t i o n s f o r those w i t h severe problems ( p h y s i c a l and mental) t h a t
do n o t respond t o b r i e f t r e a t m e n t . Managed care systems f o r c e them t o r e l i n q u i s h
t h e i r r i g h t t o choose a p r o v i d e r on t h e i r own, and many times a f t e r t r e a t m e n t b e g i n s ,
they must change t h e p r o v i d e r i n t h e middle o f t r e a t m e n t . For t h e p a t i e n t who i s
c h r o n i c a l l y l a t e t o work, c h r o n i c a l l y misses because o f i l l n e s s , e t c . , t h i s burdens
employers w i t h t h e l o s s of d o l l a r s due t o n o n - p r o d u c t i v i t y . B e t t e r t o e n l i s t
p r o f e s s i o n a l s e r v i c e s t o c u t t h i s waste.
My experience i s t h a t managed care f i r m s a r e u n w i l l i n g t o support i n - d e p t h t r e a t m e n t
which would o t h e r w i s e a l l o w p a t i e n t s t o f u n c t i o n o u t s i d e h o s p i t a l s e t t i n g s f o r l o n g
p e r i o d s o f t i m e , and i s c o s t e f f i c i e n t .
I n a d d i t i o n t o denying b e n e f i t s f o r those
who happen t o be f o r t u n a t e enough t o be i n s u r e d , t h e volume of paperwork t h a t must be
completed f o r s h o r t p e r i o d s o f t r e a t m e n t i s a s t r o n o m i c a l . Much paperwork and e x t r a
telephone c a l l s a r e generated because t h e people d e c i d i n g whether t o pay claims are
t o t a l l y uneducated on t r e a t m e n t issues and v o c a b u l a r y .
�W A L T E R F . R I C C 1 M.D.
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The stigma and h u m i l i a t i o n t h a t t h e m e n t a l l y i l l s u f f e r a l l o w s f o r d i s c r i m i n a t o r y
and o f t e n times a r b i t r a r y coverage d e c i s i o n s . I t i s t r u e t h a t no e l a b o r a t e e l e c t r o n i c
equipment e x i s t s t o help t h e m e n t a l l y i l l .
Y e t , those o f us who have d e d i c a t e d our
careers t o them f e e l t h a t we a r e u s i n g t h e most h i g h l y s o p h i s t i c a t e s s t a t e - o f - t h e - a r t
equipment a v a i l a b l e t o anyone's r e c o v e r y ( p h y s i c a l o r m e n t a l ) , remains t h e t h e r a p e u t i c
us o f o u r s e l v e s .
During t h i s t r a n s i t i o n i n h e a l t h c a r e , I would encourage your support o f a l l t h e
b i l l s i n t h e House and Senate p e r t a i n i n g t o mental h e a l t h r e f o r m . S. 4 9 1 , HR 1200,
H.S.Res. 59, S.J. Res. 16, and H.J.Res. 52.
Mrs. C l i n t o n , I do understand t h e need f o r r e s p o n s i b l e management o f r e s o u r c e s , y e t
i t i s v e r y i m p o r t a n t t h a t ANY system o f managed care NOT d i s r u p t ongoing
therapist-patient relationships.
This would be t r u e o f any s u r g e o n - p a t i e n t , o r
i n t e r n i s t - p a t i e n t r e l a t i o n s h i p . My answer t o t h i s v e r y i n t r u s i v e dilemma on t h e
p a r t o f managed care has been t o m a i n t a i n a s l i d i n g s c a l e o f fees so t h a t therapy
may c o n t i n u e w i t h o u t d i s r u p t i o n . Freedom o f choice must be preserved.
You, as F i r s t Lady and a valued p r o f e s s i o n a l , a r e i n a p i v o t a l p o s i t i o n t o a f f e c t
t h e f u t u r e o f our n a t i o n ' s h e a l t h care r e f o r m . Please consider me t o be a resource
f o r u n d e r s t a n d i n g and c l a r i f y i n g issues t h a t have t o do w i t h mental i l l n e s s . Many
d o l l a r s can be saved i n t r e a t i n g a d d i c t i o n s , c h i l d abuse, psychosomatic i l l n e s s e s ,
the p s y c h o t i c homeless, teenage d i l e n q u e n c y , l o s t work time due t o unfounded i l l n e s s e s ,
i f we can be g i v e n t h e mandate we a r e seeking.
/
C o n g r a t u l a t i o n s t o you and P r e s i d e n t C l i n t o n f o r your hard work i n w i n n i n g t h e e l e c t i o f f .
IT'S ABOUT TIME we b r i n g g r a s s - r o o t s p o l i t i c i a n s i n t o power. Best wishes f o r your
tenure i n o f f i c e .
Sincere!
WFR:ks
Walte
M.D.
�Withdrawal/Redaction Marker
Clinton Library
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�LAUREN A. W E L C H ,
IrML- HA!.
M.D.
K'AIMRAL FAMILY I ^ A M ^ I f j C
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f
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cf. •'• 'i I-.OM::. C.f
NAIUHIL
F-'-'-'.'L- PL A .-J N I N O
A p r i l 28, 1993
H i l l a r y Rodham-Clinton, Chairperson
Health Reform Task Force
Old Executive O f f i c e B u i l d i n g
Washington, DC 20004
Dear Mrs. C l i n t o n :
F i r s t I would l i k e t o commend you on your e f f o r t s t o help solve the problems
we have i n our country r e l a t e d t o medical care. Vou are c e r t a i n l y t o be
admired f o r t h i s .
I am w r i t i n g t o mention N a t u r a l Family Planning t o you. N a t u r a l Family
Planning i s one of the s p e c i a l t i e s t h a t I p r a c t i c e . I would hope t h a t you
w i l l i n c l u d e a c c e s s i b i l i t y t o p r o f e s s i o n a l s e r v i c e s i n N a t u r a l Family
Planning when you deal w i t h f a m i l y planning issues.
As you are probably aware, N a t u r a l Family Planning of the 1990's has been
s c i e n t i f i c a l l y shown t o be 99% e f f e c t i v e i n a v o i d i n g pregnancy. This compares
w e l l w i t h the e f f e c t i v e n e s s of the a r t i f i c i a l methods of f a m i l y planning.
There are p r e s e n t l y two s p e c i f i c types of N a t u r a l Family Planning a v a i l a b l e .
These are both i n the 99% e f f e c t i v e n e s s range: the Ovulation Method, which
i s promoted by the American Academy of N a t u r a l Family Planning, and the
Sympto-Thermal Method, which i s promoted by Couple t o Couple League.
Cost containment i s obviously one of our great concerns. One of the b i g
advantages of N a t u r a l Family Planning i s t h a t i t i s q u i t e inexpensive t o
l e a r n and once i t has been learned, i t r e q u i r e s no f u r t h e r f i n a n c i a l
investment, and can be used throughout the e n t i r e span of n a t u r a l f e r t i l i t y .
For a d d i t i o n a l i n f o r m a t i o n about N a t u r a l Family Planning, I would recommend
t h a t you contact The American Academy of N a t u r a l Family Planning, 615 South
New B a l l a s Road, St. L o u i s , M i s s o u r i 63141, telephone (314) 569-6495, and
The Couple t o Couple League, P.O. Box 111184, C i n c i n n a t i , Ohio 45211, telephone
(513) 661-7612.
Mrs. C l i n t o n , thank you very much f o r your concern and tremendous e f f o r t f o r
the people of our country. I want you t o know t h a t I appreciate you very much.
Very s i n c e r e l y yours.
Lauren A. Welch, M.D.,
FACS*, CNFPMC**
LAW:Ike
*Fellow, American College of Surgeons
* * C e r t i f i e d N a t u r a l Family Planning Medical
Consultant
�HOUSE OF REPRESENTATIVES
JACK L. COLEMAN
STATE REPRESENTATIVE
Box 20
Burgm. Kentucky 40310
^ ^ ^ ^
JT
-•^ ^ \
H
Bj
- ' .JK'
CAPITOL ANNEX
Room 21
Frankfort. Kentucky 40601
(502)564-8100
55TH DISTRICT
J a n u a r y 26, 1993
Miliary Clinton
Health Care Task Force
1600 P e n n y s l v i n i a A v e n u e
W a s h i n g t o n , D.C. 20500
Dear Ms. C l i n t o n ,
C o n g r a t u l a t i o n s on b e i n g a p p o i n t e d t o head t h e Task Force t o
d e v e l o p a s t r a t e g y f o r o u r National Health Care P l a n .
As a S t a t e R e p r e s e n t a t i v e i n K e n t u c k y , w h e r e we a r e c u r r e n t l y
a d d r e s s i n g Health Care i n an up c o m i n g s p e c i a l s e s s i o n , I have done a
s t u d y on o u r Medicaid S e r v i c e s . I f e e l t h e most i m p o r t a n t p a r t o f Health
Care Reform, w h e t h e r d e a l i n g w i t h K e n t u c k y o r t h e U.S., is c o s t
containment.
What has caused i d e n t i c a l d r u g s i n Canada t o be 3 0 * less?
What is t h e p r o b a b l e e f f e c t o f t h i s v e h i c l e we p r o d u c e t o d r i v e o u r new
h e a l t h c a r e s y s t e m ? What c o u l d h a p p e n t o h e a l t h c a r e w h e n a l l o f t h e
u n i n s u r e d population suddenly have a health insurance policy?
The r e a s o n Dr. Jack Gross a n d I s t u d i e d Medicaid i s because we
f e l t t h i s s y s t e m i s a r e p l i c a o f t h e v e h i c l e t h a t c o u l d be c r e a t e d t o d r i v e
h e a l t h c a r e . I h a v e s e n t y o u a c h a r t t h a t deals w i t h a c o m p a r i s o n
b e t w e e n 1988 a n d 1992 Medicaid Data as i t r e l a t e s t o " K e n t u c k y " , a n d I
w a n t t o be as b r i e f as p o s s i b l e .
1. Between 1988 a n d 1992 t h e medicaid r e c i p i e n t s r o s e f r o m 202,844 t o
295,104 ( 4 5 . 5 * ) The most common m i s c o n c e p t i o n w h e n we t e s t i f i e d
b e f o r e o u r Health a n d Welfare committee was t h a t t h i s was due t o
p o v e r t y a n d u n e m p l o y m e n t . The c h a r t o n page 1 & 2 show t h e t o p 30
c o u n t i e s i n K e n t u c k y f o r medicaid r e c i p i e n t s . In 26 o f t h e 30 c o u n t i e s
u n e m p l o y m e n t w e n t d o w n ; a t t h e same t i m e in 17 o f t h e 30 c o u n t i e s
p o p u l a t i o n o f t h e c o u n t i e s w e n t d o w n . Fewer u n e m p l o y e d , f e w e r
r e s i d e n t s y e t an i n c r e a s e of medicaid r e c i p i e n t s b y 50, 60, o r as much
as 7 0 * means t h e r e l a x a t i o n of F e d e r a l g u i d e l i n e s b r o u g h t many o f t h e
w o r k i n g p o o r , e v e n t h o u g h t h e y d i d n ' t h a v e i n s u r a n c e , u n d e r health
care!
The w o r k i n g poor t h a t have now come u n d e r Medicaid s h o u l d g i v e
an i n d i c a t i o n o f a p o s s i b l e t r e n d . On page 3, y o u can see w h a t hapfbeped
t o h e a l t h c a r e c o s t a t a r o u n d 1988 when t h e h e a l t h c a r e i n d u s t r y ^kw
t h i s i n f l u x o f new r e c i p 4 e n t s . You w i l l see t h a t e v e r y l i n e almost
immediately s t a r t s s t r a i g h t u p . A c o u p l e o f q u i c k r e a s o n s m i g h t be
�c r e a t i v e t a x i n g t o t a k e a d v a n t a g e of f e d e r a l m a t c h e s , w h i c h has b a c k f i r e d
w i t h l i t t l e hope o f a n y r o l l b a c k , o r c o u l d i t be w i t h no r e s p o n s i b i l i t y
t i e d t o usage t h e r e c i p i e n t s , d o c t o r s , p h a r m a c i e s , h o s p i t a l s , e c t . have
gone on a s p e n d i n g s p r e e .
Jack Gross is a Doctor o f P h a r m a c y . In o u r s t u d y we dealt mostly
w i t h p h a r m a c y s e r v i c e s , a n d f o u n d many f l a w s . How many p r e s c r i p t i o n s
do y o u a n d P r e s i d e n t C l i n t o n f i l l i n a y e a r ? In K e n t u c k y , w i t h 295,104
medicaid r e c i p i e n t s , t h e a v e r a g e is " 1 6 " each. T h i s is u n b e l i e v a b l e ! A one
d o l l a r a n d f i f t y c e n t i n c r e a s e i n p r e s c r i p t i o n d i s p e n s i n g fees c o s t o u r
medicaid f u n d o v e r e l e v e n m i l l i o n d o l l a r s l a s t y e a r .
Our medicaid r e c i p i e n t s w e n t up 49% s i n c e 1988 w h i l e o u r p h a r m a c y
u t i l i z e r s w e n t up 63%. In 1988 each u t i l i z e r s p e n t $375.00, i n c r e a s i n g t o
$830.00 per u t i l i z e r i n 1992 f o r p h a r m a c y s e r v i c e s . ( 1 2 1 * i n c r e a s e )
Pharmacy medicaid d o l l a r s w e n t f r o m f o r t y - t w o m i l l i o n i n 1988 t o one
h u n d r e d a n d f i f t y one m i l l i o n i n 1992. ( 3 6 1 * i n c r e a s e ) F r a u d a n d a b u s e
is e v e r y w h e r e w i t h no i n c e n t i v e f o r a n y o n e t o s t o p .
F i n a l l y , on page 4 we made a c o m p a r i s o n of 5 sets of c o u n t i e s f r o m
d i f f e r e n t r e g i o n s o f t h e s t a t e w i t h s i m i l a r medicaid r e c i p i e n t s . You can
see t h e c o n t r a s t i n g n u m b e r s t h a t we need t o be able t o b e t t e r
u n d e r s t a n d b e f o r e we b e g i n h e a l t h c a r e r e f o r m , n o t o n l y i n K e n t u c k y ,
b u t t h e U.S.
I hope t h e s e c h a r t s a n d i n f o r m a t i o n w i l l be of h e l p . A l t h o u g h we
a r e d e a l i n g w i t h K e n t u c k y Medicaid Data, I b e l i e v e t h e p r i n c i p l e s a r e
similar f r o m s t a t e t o s t a t e . We need c o n f i d e n c e i n t h e v e h i c l e we b u i l d t o
d r i v e o u r Health Care S y s t e m ; s t r i c t c o s t c o n t a i n m e n t , a n d r e s p o n s i b i l i t y
from u t i l i z e r s , p r o v i d e r s , doctors, pharmacists, and hospitals. Until all
p a r t i e s come t o t h e t a b l e w i t h d o l l a r s t o p u t back i n t o t h e p o t , we c a n n o t
a f f o r d any s y s t e m .
T h a n k y o u f o r y o u r t i m e . I d i d n o t t o u c h on s p e c i f i c areas o f f r a u d
a n d abuse i n K e n t u c k y , b u t i f I can be of f u r t h e r a s s i s t a n c e , please c a l l .
Sincerely,
Jack L. Coleman
State R e p r e s e n t a t i v e
�2i
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�Withdrawal/Redaction Marker
Clinton Library
DOCI MENI NO.
AND TYPE
003. letter
SUBJECT/TITLE
DATE
Address (Partial); Phone No.'s (Partial) (1 page)
01/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [4]
2006-0885-F
,jm787
RESTRICTION CODES
Prcsiclenlial Reeords Ac! - |44 U.S.C. 2204(a)|
Freedom of Information Aet - |5 ll.S.C. 5S2(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA|
P3 Release would violate a Federal statute [(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of Ihe PR.\|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PR\|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
b(l) National security classified information |(b)(l)of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe F01A|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(bK8) ofthe F01A|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Cut
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Jack L. CfilsnjB
State Representative
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�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
.2/3
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�WILLIAM SONNIER, JR.,
MD
.
OPHTHALMOLOGY
25 Feb. '93
Ms. H i l l a r y C l i n t o n
The White House
Washington, D.C.
Dear Ms. C l i n t o n :
I f my spouse appointed me t o the same job t h a t ycur husband d i d ,
I would consider t h a t extreme mental c r u e l t y and apply f o r an
immediate d i v o r c e . I admire you f o r your courage t o t a c k l e the
seemingly hopeless task o f reforming medical care. I am sure you
w i l l r e c e i v e enough advice and suggestions w i t h o u t me adding t o
i t . However, f o r whatever i t i s worth, I wish t o o f f e r the f o l lowing comments, observations, and suggestions.
1. The present Medicare system i n t h i s country i s beyond salvat i o n . The tough remedy necessary would not be agreed upon by you,
the P r e s i d e n t , Congress, o r the people. The r e g u l a t i o n s are so
complicated t h a t a P h i l a d e l p h i a lawyer cannot f i g u r e them out.
Even the bureaucrats don't know what they propose. Yet, p h y s i cians are expected t o f o l l o w every r u l e and l e t t e r o f the law, as
i t may be i n t e r p r e t e d a t t h a t moment, under t h r e a t o f j a i l o r
u n j u s t p e n a l t i e s . The whole t h i n g needs t o be repealed and s t a r t ed a l l over again. Anything else w i l l be counterproductive.
2. Before any changes are made, the most important t h i n g t h a t can
be done i s t o i n c o r p o r a t e a l l government employees, the P r e s i dent, you, the Armed Forces, Congress, Medicare workers, e t c . ,
i n t o the Medicare program as t h e i r sole medical insurance. Any
extras would be paid f o r out-of-pocket. I f Medicare i s good
enough f o r the e l d e r l y , why i s n ' t i t good enough f o r government
employees? This alone would i n s u r e t h a t the f u t u r e process would
be streamlined and abuses minimized. This might be the t h i n g t h a t
w i l l get t h e congressional b a l l r o l l i n g .
3. The p h y s i c i a n s ' SMALL p i e i s not being p r o p e r l y d i v i d e d . Even
w i t h the new RBRVS, e t c . , surgeons and hospital-based physicians
receive more than t h e i r f a i r share and the tough job of o f f i c e
work i s g r o s s l y underpaid. I know as I have been on both sides o f
the fence. Generally speaking, physicians are not responsible f o r
the b u l k o f the increases and t o t a l costs o f medical care.
4. I n e q u i t i e s i n payment should be r e c t i f i e d . As an example, i f I
go t o the o f f i c e a t n i g h t t o remove a f o r e i g n body from an eye, I
�am l u c k y i f Medicare pays me $40. However, i f t h a t same p a t i e n t
goes t o t h e h o s p i t a l , h i s medical b i l l w i l l be $70 o r more, p l u s
t h e h o s p i t a l w i l l t a c k on another $50 f o r use o f t h e f a c i l i t i e s .
To make m a t t e r s worse, t h e p a t i e n t r e c e i v e d o n l y f i r s t a i d a t t h e
h o s p i t a l and must see an o p h t h a l m o l o g i s t t h e next day. Why n o t
pay t h e p h y s i c i a n f o r DEFINITIVE o f f i c e care a t a h i g h e r r a t e
t h a n h o s p i t a l f i r s t aid? Another example i s t h a t home-bound
nurses a r e p a i d more f o r home v i s i t s t h a n p h y s i c i a n s ' . That i s
why t h i s s e r v i c e i s m u l t i p l y i n g l i k e r a b b i t s . (Anytime t h a t you
see a g r e a t i n c r e a s e i n Medicare s e r v i c e s you can be assured t h a t
program i s o v e r l y g e n e r o u s — a s f o r example: r e h a b i l i t a t i o n and
drug t r e a t m e n t c e n t e r s . ) Simple, non-emergency ambulance charges
are over $300. There a r e so many more t h a t I c o u l d f i l l a l a r g e
book and n o t l i s t a l l o f them.
5. Much t o o much money and t a l e n t a r e being spent on p e r i n a t a l
c a r e , t e r m i n a l i l l n e s s e s , and t r e a t m e n t o f hopeless diseases.
T h i s s h o u l d be brought t o an abrupt h a l t . T h i s money c o u l d be
b e t t e r used f o r r e s e a r c h and p r e v e n t a t i v e medicine.
6. Non-physician, independent p a r a p r a c t i o n e r s should be e l i m i n a t ed o r g r e a t l y reduced i n scope. Non-physicians and n o n - p r a c t i c i n g
p h y s i c i a n s should n o t be i n p o s i t i o n s t o render any judgment
c o n c e r n i n g p h y s i c i a n s ' medical a c t i v i t y . They a r e n o t q u a l i f i e d
t o do t h i s . Many a r e persons who wished t o be p h y s i c i a n s and
c o u l d n ' t f o r one reason o r another, so they may h o l d grudges.
Others such as nurses who u s u a l l y t a k e o r d e r s from p h y s i c i a n s
' r e l i s h ' these t a s k s . Everyone wants t o be a p h y s i c i a n , b u t few
are w i l l i n g t o p u t i n t h e t i m e and e f f o r t . They should n o t be
made p h y s i c i a n s by e d i c t .
7. The e n t i r e c o u n t r y should be brought under one system w i t h
o n l y one l e v e l o f s u p e r i o r s e r v i c e a v a i l a b l e . S e v e r a l , b u t n o t an
u n l i m i t e d number o f vendors, should be a v a i l a b l e . They would
compete on s e r v i c e and c o s t and n o t by c r e a t i v e v a r i a t i o n s i n
their individual policies.
8. Do n o t r e s t r i c t r e s e a r c h , e s p e c i a l l y i n b a s i c s c i e n c e s , as o u r
hopes a r e dependent on t h i s . Present-day medical care w i l l i n t h e
f u t u r e be looked on as p r i m i t i v e and b a r b a r i c . B e t t e r t h i n g s a r e ,
h o p e f u l l y , around t h e c o r n e r .
9. Do n o t t i e p h y s i c i a n s i n t o s t r i c t g u i d e l i n e s . Many o f t h e
advances i n medicine have been made by s l o w l y v e n t u r i n g o u t o f
e s t a b l i s h e d p a t t e r n s . This must be a l l o w e d t o c o n t i n u e .
10. I t i s u n f a i r t o lower and f r e e z e p h y s i c i a n s ' income and n o t
o t h e r p r o f e s s i o n s ' . A few p h y s i c i a n s a r e o v e r p a i d , b u t t h e v a s t
m a j o r i t y a r e u n d e r p a i d when compared t o o t h e r s i n our consumer
economy. G u i d e l i n e s from o t h e r p r o f e s s i o n s and a r t s should be
i n c l u d e d i n d e t e r m i n i n g p h y s i c i a n s ' pay. For i n s t a n c e , i n t h i s
c i t y a t t o r n e y s charge $150 an hour f o r o f f i c e work, more f o r t h e
courtroom. I t takes t w i c e as l o n g and much harder work t o become
a m e d i c a l s p e c i a l i s t . T h e r e f o r e , these p h y s i c i a n s should be p a i d
at l e a s t f o u r t i m e s as much as a t t o r n e y s . So, why p i c k on p h y s i -
�cians? Why n o t i n s t i t u t e A t t o r n e y c a r e , Autocare, Foodcare, Rentc a r e , e t c . ? They a r e a l l e s s e n t i a l t o our w e l l - b e i n g .
11. A l l h o s p i t a l s and medical c o r p o r a t i o n s should be r e q u i r e d t o
open t h e i r books t o t h e p u b l i c and have t h e i r charge schedule
a v a i l a b l e . Cross r e f e r e n c e s t o charge schedules f o r s i m i l a r
s e r v i c e s elsewhere should be r e a d i l y a v a i l a b l e .
12. P h y s i c i a n s should be a u t o m a t i c a l l y c r o s s - l i c e n s e d t o p r a c t i c e
i n every s t a t e .
13. Grounds f o r m a l p r a c t i c e should be g r e a t l y c u r t a i l e d . Everyone
who sues and l o s e s should f o r f e i t THREE times t h e c o s t o f t h e
defense o f which t w o - t h i r d s w i l l go t o t h e p h y s i c i a n . I n a d d i t i o n , t h e r e should be l a r g e r p e n a l t i e s f o r f r i v o l o u s s u i t s — m u c h
larger.
14. Drugs s h o u l d be i n c l u d e d i n t h e new program. P h y s i c i a n s
should be r e q u i r e d t o dispense common m e d i c a t i o n . These s h o u l d be
bought on b i d from t h e drug companies. I t i s e a s i e r t o dispense a
medication than t o w r i t e a p r e s c r i p t i o n . Patients then get t h e
d e s i r e d medicine ( n o t always t h e case when one goes t o a pharmac y ) . D e t a i l persons (and p r o b a b l y o t h e r s ) should be d i s c o n t i n u e d .
Any p h y s i c i a n who has t o l e a r n about drugs from d e t a i l persons i s
not w o r t h h i s s a l t . Drug companies and medical manufacturers
s h o u l d be p r o h i b i t e d from e x h i b i t i n g a t and s u b s i d i z i n g m e d i c a l
meetings. There i s t o o g r e a t a c o n f l i c t o f i n t e r e s t . I f drug
companies w i s h t o c o n t r i b u t e t o e d u c a t i o n , t h e y should donate t o
a c e n t r a l f u n d where proper a l l o c a t i o n s can be made, o r b e t t e r
y e t , reduce t h e p r i c e o f t h e drugs. I b e l i e v e t h a t t h i s suggest i o n would reduce t h e c o s t o f drugs by a t l e a s t h a l f . Costs o f
c o n t i n u e d , mandatory, and m e a n i n g f u l p h y s i c i a n e d u c a t i o n s h o u l d
be i n c l u d e d i n t h e i r f e e s . T h i s w i l l d i s p l a c e many m e d i c a l worke r s , b u t t h e y should be a b l e t o f i n d work i n o t h e r s e c t o r s o f t h e
h e a l t h f i e l d . A f t e r a l l , I don't b e l i e v e t h a t you can m a t e r i a l l y
reduce t h e c o s t o f h e a l t h care w i t h o u t some l o s s o f j o b s and
displacement.
15. P h y s i c i a n s should be h e l d blameless f o r v a c c i n a t i o n and
medicine r e a c t i o n . Orphan drugs should be encouraged.
16. Do n o t be m i s l e d by s t a t i s t i c s from o t h e r c o u n t r i e s . They
not use t h e same c r i t e r i a as we do.
do
17. To p l a c e a cap on m e d i c a l e x p e n d i t u r e s based on gross n a t i o n a l p r o d u c t i s m i s l e a d i n g . Would you p l a c e a cap on your own medic a l e x p e n d i t u r e s , i n r e l a t i o n t o your income, i f you t h o u g h t t h a t
a more c o s t l y t r e a t m e n t would enhance o r save your l i f e ? No, you
would have t h e t r e a t m e n t and make s a c r i f i c e s elsewhere, wouldn't
you?. Why expect governmental medical care t o be otherwise?
18. The i n f l a t i o n r a t e p r e s e n t l y being p u b l i s h e d by t h e government i s d e c e i t f u l . The r e a l i n f l a t i o n r a t e i s p r o b a b l y a t l e a s t
three times t h e published r a t e . Publish t h e r e a l r a t e , not t h e
one t h a t makes t h e government l o o k b e t t e r .
�19. D i s c o n t i n u e adding burdens t o p h y s i c i a n s w i t h o u t e x t r a
p a y — s u c h as e l e c t r o n i c b i l l i n g , excess documentation, OSHA, l a b
fees, e t c .
20. P h y s i c i a n s a r e backed i n t o t h e c o r n e r as f a r as t h e y can be
pushed. W i t h o u t r e l i e f o f burdensome r e g u l a t i o n s and b e t t e r
d i s t r i b u t i o n o f a v a i l a b l e money, t h e r e w i l l n o t be enough p h y s i c i a n s t o care f o r t h e s i c k . I n t h i s m e d i c a l - c e n t e r c i t y , i t i s
almost i m p o s s i b l e t o g e t new Medicare, n o n - s u r g i c a l , non-emergency p r i m a r y medical c a r e . The next push on p h y s i c i a n s
will
r e s u l t i n many e a r l y r e t i r e m e n t s and avoidance o f u n s a t i s f a c t o r y
t h i r d p a r t y i n s u r e r s , e s p e c i a l l y Medicare.
21. Most p h y s i c i a n s do n o t recommend t h a t t h e i r c h i l d r e n e n t e r
t h e f i e l d o f medicine. The q u a l i t y and q u a n t i t y o f medical school
a p p l i c a n t s has dropped dangerously.
22. When p h y s i c i a n s becauie " p r o v i d e r s , " t h e y began t o a c t l i k e
providers.
23. I t i s n o t g e n e r a l l y r e a l i z e d how much t i m e , e f f o r t , money,
b l o o d , and t e a r s a r e necessary t o become p h y s i c i a n s . And, t h e n ,
t o have your work s u p e r v i s e d by l o w - l e v e l , non-medical p e r s o n n e l
i s p r o b a b l y t h e s t r a w t h a t w i l l break t h e camel's back.
24. I t might be a good i d e a t o a p p o i n t a medical "Czar" w i t h
broad powers t o make b u d g e t - n e u t r a l medical d e c i s i o n s t h a t w i l l
become e f f e c t i v e i n t h i r t y days unless o v e r - r u l e d by t w o - t h i r d s
of t h e Congress AND The P r e s i d e n t . I t may be t h e o n l y way.
25. E l i m i n a t e d u p l i c a t i o n . There i s p l e n t y o f i t . For i n s t a n c e —
t h e r e a r e b o t h s t a t e and f e d e r a l n a r c o t i c r e g i s t r a t i o n s f o r
p h y s i c i a n s . One o r perhaps b o t h a r e unnecessary and t h i s c o u l d be
c o n t r o l l e d by o t h e r means. Medicaid i s an unnecessary and c o s t l y
d u p l i c a t i o n . J u s t p u t every Medicaid e l i g i b l e i n t h e Medicare
program w i t h o u t co-insurance o r d e d u c t i b l e s . More p h y s i c i a n s
would accept t h e "Medicaid" p a t i e n t s under these c o n d i t i o n s .
26. Consider t a k i n g Medicare and S o c i a l S e c u r i t y o u t o f t h e
budget and have i t r u n by a c o r p o r a t i o n t s i m i l a r t o , b u t much
b e t t e r t h a n , t h e p o s t a l system. Of course, t h i s i d e a has no
chance as I do n o t b e l i e v e t h a t Congress w i l l g i v e up c o n t r o l o f
t h e S o c i a l S e c u r i t y funds.
27. I n s t i t u t e an e f f e c t i v e p r e v e n t a t i v e and p u b l i c h e a l t h p r o gram. Present p o l i c i e s seldom pay f o r t h i s . They r a t h e r w a i t
u n t i l someone becomes i l l r a t h e r than p r e v e n t t h e i l l n e s s i n t h e
f i r s t and l e s s expensive manner.
28. When d e n i a l o f medical care i s r e q u i r e d by t h e government
(and i t i s ) , have someone o t h e r t h a n p h y s i c i a n s t e l l t h e p a t i e n t
and f a r . i i l y t h a t t h e care i s n o t a v a i l a b l e because i t i s USUALLY
i n e f f e c t i v e o r t h a t i t c o s t s TOO much.
�2-9. A l l o w a l l persons t o use t h e p h y s i c i a n o f t h e i r c h o i c e .
O f t e n when p a t i e n t s a r e d i r e c t e d t o p h y s i c i a n s n o t o f t h e i r
c h o i c e , i t r e s u l t s i n e x t r a v i s i t s because t h e p a t i e n t does n o t
have c o n f i d e n c e i n t h a t p h y s i c i a n o r he w i l l r e t u r n t o t h e
p h y s i c i a n of h i s choice f o r treatment of t h e o r i g i n a l ailment.
30. D i s c o n t i n u e t h e growth and s a l e o f tobacco i n t h i s c o u n t r y .
31. I n s t i t u t e a graded r e d u c t i o n o f compensation t o
p h y s i c i a n s — s a y those n e t t i n g over $1,000,000. That
t h a t The P r e s i d e n t suggests f o r c o r p o r a t e o f f i c e r s .
c o n s i d e r i n g t h e d i f f e r e n c e s i n t h e product of t h e i r
p h y s i c i a n s should p r o b a b l y have a much h i g h e r cap.
h i g h income
i s t h e cap
I n fact,
labors,
32. Require p r i v a t e insurance companies t o operate on r e g u l a t e d
overhead and p r o f i t , such as p u b l i c s e r v i c e companies do.
33. U n t i l everyone i s covered by heath i n s u r a n c e , i n s t i t u t e some
t y p e o f income t a x credir. f o r those p h y s i c i a n s who w i l l care f o r
the uninsured.
34. Create REAL i n c e n t i v e s f o r p h y s i c i a n s t o serve i n m e d i c a l l y
depressed areas.
35. Have t h e SAME laws, r u l e s , and r e g u l a t i o n s apply
This i s not p r e s e n t l y t h e s i t u a t i o n .
nationwide.
36. Immediately d i s c o n t i n u e PROs. They a r e p r e s e n t l y n o t w o r t h
a n y t h i n g , much l e s s t h e huge funds p r e s e n t l y a l l o c a t e d t o them.
36. D i s c o n t i n u e a d v e r t i s i n g by i n d i v i d u a l p h y s i c i a n s and h o s p i tals .
37. C u r t a i l t h e r o l e o f h o s p i t a l s t o i n p a t i e n t care o n l y . They
are l i k e octopuses and a r e t r y i n g t o c o n t r o l e v e r y t h i n g i n c l u d i n g
continued high p r i c e s . R e s t r i c t the a b i l i t y of open-staff hospit a l s t o f u r n i s h medical c a r e — t h a t i s t o h i r e p h y s i c i a n s . When
h o s p i t a l s f u r n i s h medical care they c r e a t e a monopoly t h a t would
not be a l l o w e d i n o t h e r i n d u s t r i e s . F i x s a l a r i e s and wages o f
h o s p i t a l a d m i n i s t r a t o r s and employees. Many a r e over o v e r p a i d . I f
p h y s i c i a n s ' fees and h o s p i t a l VRGs ajre merged, t h e n , by a l l
means, l e t t h e p h y s i c i a n s have c o n t r o l . To l e t t h e h o s p i t a l have
c o n t r o l w i l l r e s u l t i n t h e toughest p h y s i c i a n r e s i s t a n c e EVER
imagined.
38. Require a l l p h y s i c i a n s t o serve i n m e d i c a l l y d e f i c i e n t areas
or f a m i l y p r a c t i c e b e f o r e t h e y can s p e c i a l i z e .
39. Require a l l government c o n t r o l l e d h o s p i t a l s t o p u b l i s h t h e i r
p a t i e n t c o s t s and r e s u l t s . Probably, i t might be b e s t t o c l o s e
n o n - m i l i t a r y government h o s p i t a l s . Less expensive and b e t t e r care
can be p r o v i d e d i n t h e c i v i l i a n market. T h i s i s e s p e c i a l l y t r u e
of t h e Veterans A d m i n i s t r a t i o n H o s p i t a l s .
40. C o n s o l i d a t e governmental medicine i n t o one a g e n c y — t h a t i s
�merge t h e Armed Forces, P u b l i c H e a l t h , I n d i a n S e r v i c e s , and
Veterans H o s p i t a l s i n t o one EXCELLENT, w e l l - r u n i n t e g r a t e d u n i t .
You c a n ' t expect savings o u t s i d e of t h e government i f t h e government doesn't do i t f i r s t . Observation #39 may be b e t t e r t h a n t h i s
one.
41. E l i m i n a t e t h e lower Medicare fees f o r new p h y s i c i a n s . Even
those who have served i n t h e Armed Forces r e c e i v e these reduced
f e e s . I f t h e purpose of t h i s was t o keep p h y s i c i a n s i n t h e Armed
Forces, I b e l i e v e t h a t i t w i l l be c o u n t e r p r o d u c t i v e . Many p h y s i c i a n s f a c i n g t h i s d i s c r i m i n a t i o n w i l l s i m p l y no l o n g e r serve i n
t h e Armed Forces. A l s o , p h y s i c i a n s who are not " p a r t i c i p a t i n g "
should be g i v e n lower fees i n s t e a d of h i g h e r ones as i s now t h e
case. I f t h e r e i s b u t one n a t i o n w i d e h e a l t h system, t h e n p h y s i c i a n s should be a l l o w e d t o o r g a n i z e and b a r g a i n f o r t h e i r fees
and c o n d i t i o n of t h e workplace.
42. N a t i o n a l gatekeeper medicine would p r o b a b l y be c o u n t e r p r o d u c t i v e . I t makes l i t t l e sense when someone w i t h an eye symptom
must see a gatekeeper and then a g e n e r a l p h y s i c i a n b e f o r e he sees
an o p h t h a l m o l o g i s t . The reason t h a t t h e r e are s p e c i a l i s t s i s t h a t
medicine has become much t o o c o m p l i c a t e d f o r one person ( o r
gatekeeper) t o master even a SMALL p a r t of i t . Ophthalmology has
ten or more s u b - s p e c i a l i t i e s and t h e r e are over a hundred, m o s t l y
monthly, o p h t h a l m o l o g i c a l medical j o u r n a l s . E i g h t y p e r c e n t of
p a t i e n t s s e l f - r e f e r themselves c o r r e c t l y ( p r o b a b l y , gatekeepers
are n o t as a c c u r a t e as t h i s ) and r e c e i v e d e f i n i t i v e care i n t h e
f i r s t instance. I believe t h a t t h i s i s cost e f f e c t i v e .
43. Make some k i n d of arrangement so t h a t p r o v i d e r s do not have
t o d e a l w i t h co-insurance and d e d u c t i b l e s . Many p a t i e n t s do n o t
understand t h i s . The f r e q u e n t low b i l l balances may r e q u i r e
double or t r i p l e b i l l i n g which i s not c o s t e f f e c t i v e .
44. D u r i n g t h e f i r s t 30 years of my p r a c t i c e I never a t t e n d e d a
m e d i c a l meeting t h a t discussed "economics, (read ' c r e a t i v e codi n g ' ) . " We o n l y discussed p a t i e n t c a r e . The l a s t 10 years has
seen t h e growth of economic meetings t o where t h e y now dominate.
A whole i n d u s t r y has developed t o i n s t r u c t i n proper ( h i g h )
c o d i n g . Some of t h e speakers appear t o be ex-bureaucrats who made
t h e r u l e s and know t h e l o o p h o l e s . Sad, i s n ' t i t ? A l a r g e number
of m e d i c a l employees have t h e s o l e t a s k of ' c r e a t i v e ' c o d i n g .
45. D i s c o n t i n u e t h e c e n t r a l computer f i l e on p h y s i c i a n s . I t i s n ' t
c o s t e f f e c t i v e or u s e f u l and w i l l l e a d t o many abuses.
46. Documentation has become such a burden t h a t i t i s now b e i n q
recommended t h a t a t r a n s c r i p t i o n i s t accompany t h e p h y s i c i a n a:...
r e c o r d a l l c o n v e r s a t i o n w i t h t h e p a t i e n t and a l s o tape i t . I
h a r d l y b e l i e v e t h a t t h i s i s c o s t e f f e c t i v e . But, bureaucracy
demands i t .
47. Perhaps, ALL medical s e r v i c e s should be removed from t h e
economic s e c t o r and everyone work on a n o n - p r o f i t b a s i s . Workers
would e n t e r t h e system w i t h vows of p o v e r t y and have t h e i r needs
�c a r e d f o r as w i t h r e l i g i o u s o r d e r s . I n a few years a l l progress
would cease and t h e n i t would r e g r e s s .
48. A v e r y h i g h p o r t i o n o f medical c o s t s do n o t i n v o l v e p a t i e n t
c a r e . They a r e i n s u r a n c e , documentation, bureaucracy, t h i r d p a r t i e s , d e f e n s i v e medicine, poor c o l l e c t i o n s , l a g - t i m e b e f o r e
payment, e t c .
49. Almost a l l o f t h e medical advances d u r i n g t h e p a s t f i f t y
years have o r i g i n a t e d i n t h e U n i t e d S t a t e s . To d e s t r o y t h i s would
be f o o l h a r d y . Perhaps, i n s t e a d o f e x p o r t i n g i t f r e e l y we s h o u l d
s e l l i t l i k e o t h e r s s e l l automobiles and t e l e v i s i o n s . That would
no doubt h e l p our balance o f t r a d e payments.
50. One would presume t h a t b e f o r e you proceed w i t h your m i s s i o n
t h a t you w i l l read ALL o f t h e governmental r e g u l a t i o n s p e r t a i n i n g
t o m e d i c a l c a r e . However, unless t h e P r e s i d e n t i s e l e c t e d t o
a n o t h e r t e r m , I do n o t t h i n k t h a t you w i l i have t i m e t o do t h i s .
T h i s s h o u l d i n d i c a t e t o you t h e oppressiveness and h i g h c o s t s o f
the bureaucracy and p r o p e l you t o e r a d i c a t e i t . Unless t h i s i s
done t h e r e can be no MEANINGFUL r e f o r m .
51. The b e s t medical care i s rendered by w e l l - t r a i n e d , w e l l m o t i v a t e d , and w e l l - p a i d i n d i v i d u a l p h y s i c i a n s . T h i s i s what most
people choose f o r themselves and t h e i r f a m i l i e s , b u t t h e y a r e
r e l u c t a n t t o have t o pay f o r o t h e r s t o have t h i s same l e v e l o f
service.
52. L a s t l y , remember t h a t man prospered l o n g b e f o r e m e d i c a l care
existed. I n the long run, the e l i m i n a t i o n of s u r v i v a l of the
f i t t e s t as we a r e now d o i n g may n o t be i n t h e best i n t e r e s t o f
mankind. We might do b e t t e r w i t h o n l y t h e p r e v e n t i o n o f disease
and i m m u n i z a t i o n s .
I am w i l l i n g and a b l e t o h e l p i n any manner t h a t you may
My p r a y e r s a r e w i t h you.
Thanking you,
I /epi^in, y / ^
i l l i a m Sonnier, J r .
let.475
require.
�CODER:.
HEALTH CARE TASK FORCE SORTING SHEET
5
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INPUT DATE:
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Other Health Providers
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POLICY AND PERSONAL STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
working families
unemployed/low income
benefits
providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
^medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
FINANCING (VH)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
_AIDS
women's health
.immunizations/children
rural
urban
OTHER
�NOTICE
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Clinton Library
D O C U M E N T NO.
ANDTYPR
004. letter
DATE
SUBJECT/TITLE
Address (Partial) (1 page)
02/20/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [4]
2006-0885-F
jm787
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RR. Document will be reviewed upon request.
�February 20, 1993
Dear Mrs. Clinton:
I am a physician-in-training at the University of Kentucky conpleting a program i n Pulmonary^, .and C r i t i c a l C^e Medicine if'-We deal with patients suffering
frcm lung cancer and emphysema as a result of tobacco abuse. I find that many
people have a d i f f i c u l t time trying to quit smoking and when they do, their
lung disease i s far-advanced. I am writing to express my support for a major
tax increase on cigarettes..in this country. The money raised could be used for
health care and vaccines for indigent children as well as for fanners tp
assist i n crop diversification. Polls have showed that over 75% of Americans
support such a tax. Canada and other industrialized countries have a much
higher tax on tohacco than the U.S. does. The higher taxes have been shewn
to prevent young people fron starting the habit of smoking.
I am also i n favor of policies that support Planned Parenthood Agencies and
address reproductive health care for a l l wemen. Such policies w i l l save
millions of dollars i n future social, environmental, and health care costs.
I might add that I voted for the Republican Party i n elections prior to 1992.
I voted for the Clinton-Gore ticket because of the new and intelligent ideas
expressed-duri-ng-the- Gainpaign_and_ the_realistic approacHTl^en-inrde^ingir
with problenis. At this point my expectations have been surpassed. I support
th'e"Clin€bn Administration's bold approach on d e f i c i t reduction and wish
you a l l the best of luck and health i n 1993 and beyond.
Very Sincerely,
Mr. Chris Stauber, M.D.
P6/(b)(6) '. '
':
�February 20, 1993
Dear Mrs. Clinton:
I am a physician-in-training at the University of^I^tudcy conpleting a program in Pulmonary,.and. Critical' Care Medicinel^We deal vdth patients suffering
frcm lung cancer and anphysema as a result of tobacco abuse. I find that many
people have a difficult time trying to quit smoking and when they do, their
lung disease i s far-advanced. I am writing to express my support for a major
tax incxease on cigarettes in this country. The money raised oould be used for
health cafe and vaccines for indigent children as well as for farmers tip
assist in crop diversification. Polls have shewed that over 75% of Americans
support such a tax. Canada and other industrialized countries have a much
higher tax on tohacco than the U.S. does. The higher taxes have been shewn
to prevent young people frcm starting the habit of smoking.
I'am also in favor of policies that support Planned Parenthood Agencies and
address reproductive health care for a l l wemen. Such policies will save
millions of dollars in future social, enviroonraental, and health care costs.
I might add that I voted for the Republican Party in elections prior to 1992.
I voted for the Clinton-Gore ticket because of the new and intelligent ideas
expgessed dm ing the campaiqn__and the realistic aEBrQadrtaktm iiudmnnaJI
with problems. At this point my expectations have been surpassed. I support
the^HrrBon Administration's bold approach on deficit reduction and wish
you a l l the best of luck and health in 1993 and beyond.
Very Sincerely,
Mr. Chris Stauber, M D
..
�[NE MEDICAL C
January 27, 1993
Mrs. Hillary Clinton, Esq.
The White House
Washington, D.C. 20500
MAR 8
Dear Mrs Clinton:
I am writing to you as a^emor resident in internal medidne'who is concerned about the
future of health care in America, i am a graauate ofSMtlTCollege and in addition to
receiving my medical degree at the University of VennojiUjxiceived a Master of Science
degree in Health Policy and Management at t h e j ^ P u b l i c Health. I have a
keen interest in health policy and currently "Belong to the American CSttegerofPhysicians,
where I sit on the National Council of Associates and on the Steering Committee on
Access/Health System Reform. Currently I am completing my residency as a generalist
and have accepted a hematology fellowship at the University of Washington for 1994. For
the 1993-94 year I will stay on as Chief Medical Resident at Maine Medical Center.
I feel very strongly about the changes that need to be made in the health care system. We
need collective input and cooperation from all participants, many whose goals and
objectives conflict. Physicians historically have been a divided and individualistic group;
this along with our nearsightedness and sometimes arrogance has led to the control of
health care by insurance companies, proprietary review organizations, business people and
government. There exists now an environment overrun with rules and regulation,
ridiculous amounts of paperwork, obscene costs and general disillusionment among health
care providers.
I know that you have studied the health care problem and understand its complexity. I am
writing to you with one plea^leasejook tq^ouiig4ihysicians,ahQgeJn^ trai ni ng and those
early in their careers, forJiglp and irtpa'srwFiaciiitelv le^l lll^ nt-ed
welcome it^but worry tfiatifthere is not enough physician involvement iTTthe process, the
change may come in the form of increased constraints on the doctor-patient relationship and
our ability to provide good care. Especially consider looking to physicians in primary care
fields such as internal medicine, pediatrics and family practice, because the current system
is most burdensome to them.
Come into our hospitals and offices; spend time with us and experience the practice of
medicine. The complexity of the business aspect of health care is daunting. We have
approached health care entirely as if il were a business, with some terrible consequences.
We now have the opportunity and the support of the people to make radical changes in
health care. It is imperative that the reformers understand the complexity involved in
making clinical decisions in the best interest of our patients while trying to be mindful of
costs and the public good. I am hopeful that a system can be created that will meet the
objectives of excellent care at reasonable costs, accessible to all Americans. Younger
physicians have much more in mind than solely their paychecks and want to be included in
health care reform. Il is our professional future at slake.
As a strong supporter, I appreciate your leadership in health care reform.
Sincerely,
Jacqufelyn AO Hedlund, M.D.
22 Bramhall Street, Portland, Maine 04102 (207) 871-0111
�REDINGTON M!";I.)1CAL ASSOC.1A l'I;S, INC.
•4 l-AIRVIEW A V t N U t
SKOWHIIGAN. MAIN1: 04976
PEDIATRIC MEDICINE
T E L E P H O N E (207) 474-fc2<-?
474.5074
TER ESE WENCKUS. M.D.
M I C H A E L H O E M A N N . M IX
J u l y 26,
M A U I \ N'.'VAI., M.D
1993
Mrs. H i l l a r y C l i n t o n
W h i t e House
1600 P e n n s y l v a n i a Avenue
W a s h i n g t o n , DC 20510
Re:
ACCESS TO HEALTH CARE
Dear Mrs. C l i n t o n :
I have i n f r o n t o f me a l e t t e r f r o m t h e G o l d e n R u l e I n s u r a n c e
Company, 7440 Woodland Dr. , I n d i a n a p o l i s , I N 46278-1719.
This
l e t t e r i s t o i n f o r m me t h a t a s i x y e a r o l d g i r l p a t i e n t o f mine i s
b e i n g d e n i e d h e a l t h i n s u r a n c e c o v e r a g e because s h e was b o r n w i t h
a bicuspid a o r t i c valve.
T h i s i s a c:ommon b u t m i n o r b i r t h d e f e c t
of t h e m a j o r h e a r t v a l v e w h i c h l e a d s f r o m t h e h e a r t i n t o t h e m a j o r
b l o o d v e s s e l t o t h e body.
Becasue o f t h e p r e s e n c e
of this
c o n d i t i o n Jade r e q u i r e s p e r i o d i c e v a l u a t i o n h e r e .
She h a s s e e n a
h e a r t s p e c i a l i s t on one o c c a s i o n , who f e l t t h a t h e r p r o b l e m c o u l d
easily
be managed by h e r p r i m a r y c a r e d o c t o r , m y s e l f .
He
recommends o n l y t h a t s h e t a k e a n t i b i o t i c b e f o r e d e n t a l v i s i t s t o
p r e v e n t b a c t e r i a f r o m s t i c k i n g on t h i s v a l v e , and t h a t he s e e h e r
once more i n t h e d i s t a n t f u t u r e .
T h i s I t h i n k i s an e x a m p l e o f v h a t ' s wrong w i t h o u r h e a l t h
c a r e s y s t e m , t h a t a p r o f i t m a k i n g i n s u r a n c e company c a n c h o o s e t o
deny c o v e r a g e f o r a r e a l l y h e a l t h y c h i l d i n o r d e r t o p r o t e c t t h e i r
bottom l i n e .
I t r u s t t h a t y o u a r e c o n t i n u i n g t o work on a h e a l t h
c a r e r e f o r m p r o g r a m , w i t h t h e P r e s i d e n t , w h i c h w i l l a s s u r e t h a t no
c h i l d i s e x c l u d e d f r o m h e a l t h i n s u r a n c e c o v e r a g e because o f a p r e existing condition.
�/
/
- 2 ACCESS TO HEALTH CARE
JULY 26,
1993
I look forward t o hearing o f your support f o r changing o u r
d y s f u n c t i o n a l A m e r i c a n h e a l t h c a r e s y s t e m , and a s a l w a y s , I o f f e r
my s e r v i c e s ,
and t h e s e r v i c e s
o f t h e American
Academy o f
P e d i a t r i c s , Maine C h a p t e r and N a t i o n a l O r g a n i z a t i o n , t o a c h i e v i n g
these goals.
Respectfully
submitted,
0
M i c h a e l P. Hofmann,
F. A. A. P.
MPH/pd
cc
Enclosure
c c : Rep. O l y m p i a Snowe
Rep. Tom Andrews
Sen. George M i t c h e l l
Sen. W i l l i a m Cohen
Mrs. H i l l a r y C l i n t o n
AAP Dept. o f Government
Family
Liaison
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�/ k l f i A s y ^fenMsUK f ^ r / t r ^
£<,a.
^t^je^juLj (Jen***,
�Perverse Incentives, Statesmanship, and the Ghosts of Reforms Past
have entered one of those refonn moments when
the impossible seems possible. Although health care is
the leading candidate for reform, Henry Aaron, an
economist at the Brookings Institution and coauthor of
the prescient Painful Prescription (1), has counseled
against expecting passage of comprehensive legislation
during the first hundred days of President Clinton's
term of office (2). The period may be too short to
achieve a consensus among the competing factions (3,
4), even given the favorable climate. Pure and simple,
true refonn will require compromise and statesmanship
by all concerned.
Most proposals are aimed at two competing goals:
reducing costs and increasing access for the millions of
uninsured. They principally involve some form of budget limitation or "managed competition" and the man-
I Fcbruarv I W • Annals of Init-nutl Medicine • Volume I IS • Number 3
227
�dating of a yet to be defined universal minimum benefit
package. Other possible reforms include insurer consolidation to reduce administrative overhead and thf "hassle factor," tax code changes to promote more equitable health insurance subsidies, and tort reform to
decrease defensive medicine and to compensate fairly
iatrogenically injured patients.
None of these proposals deals directly with the most
fundamental and sensitive issue, namely how to achieve
a more rational deployment of health care providers and
services. Anyone asked to design an optimal health care
system would not come up with our present system.
Clearly, when the right patients meet the right doctors
in the right settings, the results can be magical, but too
often they are far from magical. Primary care and emergency medical services are not well distributed and are
too often substandard. Long-term care, despite some
improvements, is expensive and not a source of national
pride. At the same time, full-service tertiary and even
quaternary care centers compete within a few square
miles of one another for the same insurance dollar. Still,
there are few if any villains; indeed, as Gruenberg has
said, many of our perceived failures are products of our
enormous successes (5). In addition, previous well-intentioned reforms created incentives that were initially
helpful but became perverse in the 1980s, an era that
championed greed, glitz, and activism.
One legacy of these reforms was a health care system
based on acute care hospitals rather than on a primary
care network. Indeed, until the early part of this century, most affluent individuals chose to be cared for and
to die at home. Increased life expectancy from improved social conditions, immunizations, and antimicrobial agents along with advances in anesthesia, blood
replacement, surgical techniques, and the like, changed
society's perceptions of hospitals (6). Conditions once
regarded as fatal became curable. By 1929, teachers in
Dallas were so concerned about acute-care hospital
availability that they paid 50? a month to assure receiving 21 days of care at Baylor's hospital, if needed; this
small plan eventually became Blue Cross. In 1932, a
Commission on the cost of medical care issued a final
report confirming that many Americans simply could
not afford medical care, even though catastrophic costs
were measured in hundreds not thousands of dollars (7).
Debate about national health insurance was slowed
by the Depression and interrupted by World War II. In
1947, the Hill-Burton Act redressed the maldistribution
in acute care hospitals (Table 1), by initiating an enormous wave of construction. This act provided jobs,
increased access to hospitals, and enhanced community
pride. In the early 1950s, the need for national health
insurance was a high school debate topic. Yet, by then,
it seemed no longer pressing because of the growth of
private insurance systems. Indeed, the ideologic tenor
of the time equated national health insurance with "socialized medicine," something still heard today. Instead, employees were given pretax dollars to buy private health insurance (essentially for acute hospital
care). This idea, which provided a proportionately
higher benefit for the affluent, was eagerly embraced by
employers, insurers, and the medical establishment. It
worked well for a while but left in its wake an overbuilt
228
Table 1. Percentage of Counties without Registered General Hospital Facilities in 1942, by State*
Statet
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Michigan
Massachusetts
Minnesota
Mississippi
Missouri
Montana
Percent
State
Percent
45
56
0
18
46
0
0
43
63
45
32
33
27
49
71
50
0
17
18
0
15
43
63
43
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
42
47
0
6
32
2
31
27
39
25
15
40
37
59
54
42
52
8
45
28
38
13
19
* Tuberculosis and mental disease hospitals are not included,
t There are no entries for Alaska. Hawaii, North Dakota, and Washington, DC
Adapted from the Proceedings of the Hearings before the Committee on
Education and Labor. U.S. Senate Bill S-191. Febniaiy and March
1945. Washington, DC: Govemment Printing Office.
and unintegrated acute hospital system, vulnerable to
technology-driven cost inflation.
After the death of John F. Kennedy, decades of hard
work by Wilbur Cohen and others came to fruition
during another reform moment with the passage of
Medicaid and Medicare. Although falling short of national health insurance, these programs addressed the
needs of the poor and the elderly. Despite early successes, their emphasis on payment for acute care, and
for long-term care only after impoverishment, no longer
suits the needs of an increasingly older and chronically
ill population. A compromise necessary to obtain support for Medicaid and Medicare has also come back to
haunt us, namely the institutionalization of the fee-forservice system with its wide disparities in compensation
and higher rewards for procedures. No one denies that
those skilled and competent at curative or restorative
procedures should be justly compensated. However, as
medicine has become more specialized, marginally useful tests, drugs, and procedures that Lewis Thomas
once called "halfway technologies" (8) have proliferated. With them have come concerns not just about
overutilization and iatrogenesis but about the prolongation of dying and the creation of a technologic divide
between patients and loved ones at a crucial moment.
Ironically, some affluent people are again choosing to
die at home.
Finally, in the 1970s, Congress mandated capitation
payments to increase medical school class size aimed at
correcting a perceived physician shortage (really a
maldistribution in numbers and types of physicians).
Given the large student debt and the disincentives to
1 February 1993 - Annab o f Internal Medicine • Volume 118 • Number 3
�praclicing primary care especially in (lie iimer cily and
'rural areas, capitaiion's major effect may have been to
produce more subspccialists. This program illustrates
how ideas arc often implemented out of context and
with no means of self-correction. In this case, there was
no easy way to initiate student debt abatement, to increase primary care reimbursement, or even to pay
medical schools to reduce class size (decapitation if you
will). Still, it took more than the skewing of the delivery
and training systems by these perverse incentives to
reach our present health care situation. The dismantling
and starvation of the municipal and state health care
systems (including mental health facilities) as well as
the accompanying increase in AIDS, drug abuse, violence, unemployment, homelessness, and tuberculosis
were the coups de grace.
As we enter this "reform moment" then, wc need to
consider how wc got here, and that many of the perverse incentives in the health care system mirror those
in our society. One major factor is what Professor
Rence Fox called the medicalization of society (9).
When once we turned to our families or the clergy to
help us with certain problems, or even took personal
responsibility for them, now wc tum to medicine for absolution or a quick technologic fix. Furthermore, we did
not invent greed. In a pluralistic society with fewer and
fewer shared values, money has become a unifying goal
and standard of worth. It is commonly believed that anyone who does not maximize his or her income is a fool.
Finally, it is the doers not the preventers who reap
rewards. Prevention is too invisible and even boring.
Watching a fire is more exciting than watching a smoke
detector. Accidents make news, not the tire-marked medians indicating that another motorist did not cross into
oncoming traffic or careen off an exit ramp. Billions of
dollars are available for military interdiction of drug shipments and for care after drug users destroy their bodies,
but only a pittance is available to help people kick the
habit or to revitalize drug-infested neighborhoods (10).
Similarly, paying for tests is easier to justify than
paying for a primary care physician's time. The x-ray
and test results are tangible evidence of "health"—
never mind that the marginal information gain may be
zero and that the costs may outweigh the benefits. We
live in a "just-do-it" society. Some of our activity is
legitimate but much, as in the rest of our commercial
society, involves meeting induced demand. Clearly,
having something completely paid for lowers the threshold for its use by patients as well as by physicians.
Enactment of even necessary reforms has been accompanied by a lowering of this performance threshold.
The end-stage renal disease program, instituted to make
access to renal dialysis more equitable, spawned a
growth industry. The program, estimated to cost only a
few millions, has cost billions. However, who can blame
subspccialists for emphasizing potential benefits and doing
what they are trained to do, like to do, and get paid to do,
especially when restraint is unrewarded and may be seen
as posing moral as well as legal hazards (11).
In summary, we need to take into account these
perverse incentives, not only because of what they tell
us about the present but also of what they tell us about
the likely unintended effects of new initiatives. They
also warn us about the danger of hubris and the need to
revisit any reforms in a timely manner. Many who preceded us thought they had the answers too and they
may have for a while. Furthermore, the need fo/ statesmanship cannot be overestimated. Many reforms arc
..likely to directly affect health caregivers and specific
consumer groups; others will affect them indirectly. For
example, the greatest cost reduction and health improvement will come through programs aimed at nurturing children and curbing violence, joblessness, drug
abuse, and undereducation. To accomplish these goals,
fewer dollars in the short-term will be available to the
health sector.
Amitai Etzioni has suggested that President Clinton
gather all the lobbyists in one stadium and ask that they
give up one privilege before they leave (12). Though
idealistic, it underscores that what is most needed arc
changes in attitudes and priorities, not laws. Mr.
Clinton appears ready to move us away from "meness" and the mortgaging of our children's futures by
uniting us rather than dividing us by generation, income, race, and geography. Such statesmanship will be
necessary at the regional and local level when institutional
representatives are asked to put aside long-standing rivalries and to cooperate in sharing a reduced pie, using
measures of effectiveness, efficiency, and quality rather
than self-interest as guides. It will be easier for communities, like Rochester, New York, that have already
started down that road; for others, it may be rancorous.
Yet we Americans arc championing far more difficult revolutionaiy reforms in Eastern Europe and the former Soviet Union. Should wc ask less of ourselves?
Peter E. Dans, M D
Deputy Editor
Annals o f Internal Medicine
Philadelphia, PA 19106
Requests f o r Reprints: Peter E. Dans, MD, American College of Physicians, Sixth Street at Race, Philadelphia, PA 19106.
Annals o f I n t e r n a l Medicine. 1993;118:227-229.
Refcrences
1. Aaron HJ, Schwartz W. The Painful Prescription: Rationing Hospital Care. Brookings Institution. Washington, D.C. 1984.
2. Aaron HJ. What's the rush on hcallh care? The New York Times;
14 Nov 1992. 142:p:15.
3. Redman E. Dance of Legislation. New York: Simon and Schuster;
1973.
4. Dans PE. Physicians and health policy. J A M A 1980;243:1451-3.
5. Gruenberg EM. The failures of success. Milbank Mem Fund Q
Health Soc. 1977;155:3-24.
6. Stoline A, Wtlner JP, Dans PE, Geller C, Mussman MG. The New
Medical Marketplace. A Physician's Guide to the Health Care Revolution. Baltimore. Johns Hopkins University Press. 1988:6-31.
7. Committee on the Costs of Medical Care. Medical Care for the
American People—Final Report. Chicago: University of Chicago
Press; 1932.
8. Thomas L . On the science and technology of medicine. Daedalus.
1977;106:35-46.
9. Fox RC. The medicalization and demedicalization of American Society. Daedalus. 1977;106:9-22.
10. Dans PE, Matricdani RM, Otter SE, Reuland DS. Intravenous drug
abuse and one academic health center. JAMA. 1990;263:3173-6.
11. Daniels N . Why saying no to patients in the United States is so
hard: Cost containment, justice and provider autonomy. N Engl J
Med. 1986;314:1380-3.
12. Etiloni A. Clinton's fitsl job: lobbyists. Philadelphia Inquirer. November 13, I992:A29.
I February 1993 • Annals o f Internal Medicine • Volume 118 • Number 3
229
�|k| C l A / ^
I ^ B H
Annals of Internal Medicine
W W
Published by American College of Physicians
FOR IMMEDIATE RELEASE
July 6, 1992
CONTACT: Lynda N. Teer, (215) 351-2646 or (800) 523-1546, ext. 2646
Peter Dans Named Deputy E d i t o r of Annals of I n t e r n a l Medicine
PHILADELPHIA—Peter E. Dans, MD, has been named deputy e d i t o r of
Annals of I n t e r n a l Medicine, the world's most widely cited medical
s p e c i a l t y j o u r n a l . Published twice-monthly by the American College of
Physicians, Annals includes o r i g i n a l a r t i c l e s and reviews of recent
progress i n medical research and practice, essays on medicine and public
issues, e d i t o r i a l s , and s p e c i a l departments.
Dans i s an i n t e r n i s t w i t h special i n t e r e s t s i n infectious diseases,
health p o l i c y , q u a l i t y assurance, and ethics. As deputy e d i t o r , he assists
w i t h e d i t i n g and processing o f manuscripts f o r p u b l i c a t i o n .
Annals e d i t o r s Robert H. Fletcher, MD, and Suzanne W Fletcher, MD, i n
.
a notice t o Annals' readers welcoming Dans, say, "Those who know him can
a t t e s t t o the energy, high standards, good w i l l , and i n t e l l i g e n c e t h a t
characterize h i s work."
A graduate of Manhattan College, Dans earned h i s medical degree from
Columbia U n i v e r s i t y College o f Physicians and Surgeons i n 1961. He trained
at the Johns Hopkins H o s p i t a l i n Baltimore, Md., where he became assistant
resident i n medicine. During residency, he spent three months on a r o t a t i o n
caring f o r cholera p a t i e n t s a t the Infectious Disease Hospital i n Calcutta.
After a year as assistant resident i n medicine a t Presbyterian Hospital i n
New York, and three years i n a common-cold-virus
research laboratory at the
National I n s t i t u t e s of Health, he completed a research fellowship i n
i n f e c t i o u s diseases at Harvard Medical School.
—more—
News Bureau: Independence Mall West, Sixth Street at Race, Philadelphia, P 19106-1572 ; 215-351-2651/800-523-1546
A
�Peter E. Dans, MD/2
of 2
Dans became assistant professor of medicine and preventive medicine at
the U n i v e r s i t y of Colorado Medical Center i n 1969. During his seven years
i n Colorado, he was founding d i r e c t o r of a migrant health c l i n i c , a
sexually transmitted diseases c l i n i c , and an a d u l t walk-in c l i n i c . He also
directed student and employee health services f o r the University of
Colorado Medical Center. I n 1976, he spent a year i n the U.S.
Senate as a
Robert Wood Johnson health p o l i c y fellow at the I n s t i t u t e of Medicine i n
Washington,
D.C.
In 1978, Dans returned to Hopkins to e s t a b l i s h an o f f i c e of medical
practice evaluation, and f o r the next 13 years i n i t i a t e d a number of
projects to improve patient care and decrease costs. For eight years
beginning i n 1983, he also d i r e c t e d the required f i r s t - y e a r medical student
course e n t i t l e d "Ethics i n Medical Care." He continues to hold the rank of
associate professor of medicine and associate professor of health p o l i c y
and management at Johns Hopkins University School of Medicine. He serves as
secretary of the Board of Physician Quality Assurance, the l i c e n s i n g and
d i s c i p l i n i n g body f o r the State of Maryland, and as q u a l i t y management
medical d i r e c t o r f o r Blue Cross and Blue Shield of Maryland.
Dans i s a member of the Alpha Omega Alpha Honor Medical Society, the
American Federation f o r C l i n i c a l Research, and a f e l l o w of the American
College of Physicians. He l i v e s i n Cockeysville, Md., with his w i f e ,
Colette. They have four c h i l d r e n .
/ # #
/
Annals of I n t e r n a l Medicine i s published by the American College of
Physicians (ACP), a n o n p r o f i t organization of physicians trained i n
i n t e r n a l m e d i c i n e — t h e diagnosis and nonsurgical treatment of disease and
i l l n e s s i n adults and young a d u l t s . ACP's membership of more than 75,000
includes p r a c t i t i o n e r s providing primary care, medical s p e c i a l i s t s i n
f i e l d s such as cardiology, neurology and oncology, and medical researchers
and teachers.
#1421/7-2-92
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& information systems
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.GOVERNMENT PROGRAMS (IV)
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.COST ISSUES (VI)
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FINANCING (VII)
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LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
.women's health
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.rural
urban
OTHER
�1
2
Srboiil of Medicine
DEPARTMENT OF PEDIATRICS
UNIVERSITY OF MARYLAND
AT
BALTIMORE
Mrs. H i l l a r y C l i n t o n
The White House
Washington, D.C. 20500
Dear Mrs. C l i n t o n :
I was delighted t o read t h a t President C l i n t o n asked you to
lead the Task Force on Health Care Reform. Besides bringing your
considerable o r g a n i z a t i o n a l and l e a d e r s h i p s k i l l s t o the Task
Force, you w i l l obviously bring your deep commitment t o c h i l d r e n
and i t i s r e f r e s h i n g t o know t h a t c h i l d r e n ' s i s s u e s w i l l not be
overlooked i n t h i s p a r t i c u l a r arena.
I am w r i t i n g to ask t h a t adolescents not be forgotten as
w e l l . I n my 20 years experience as a s p e c i a l i s t i n Adolescent
Medicine, I have noticed t h a t youth, ages 12-21 years, a r e
frequently the orphans of the medical care system i n both the
p u b l i c and p r i v a t e s e c t o r s . With the r i s i n g r a t e s of teen
b i r t h s , s e x u a l l y transmitted d i s e a s e s , HIV i n f e c t i o n , v i o l e n c e r e l a t e d i n j u r i e s , drug use or abuse, eating d i s o r d e r s , and mental
h e a l t h problems i n the young, q u a l i t y h e a l t h care must be
a v a i l a b l e and a c c e s s i b l e t o youth.
The D i v i s i o n of Adolescent Medicine a t the U n i v e r s i t y of
Maryland i s one of the o l d e s t adolescent medicine programs i n the
country and i s f e d e r a l l y funded by the Maternal and C h i l d Health
Bureau t o t r a i n leaders i n adolescent h e a l t h care. I f I or any
of our f a c u l t y members may be of a s s i s t a n c e i n your d e l i b e r a t i o n s
please know t h a t we s h a l l r e a d i l y do so.
Good luck i n t h i s important work!
Sincerely,
Marianne E. F e l i c e , M.D.
Professor and V i c e - C h a i r
Department of P e d i a t r i c s
D i r e c t o r , Adolescent Medicine
MEF:vcr
cc:
Michael A. Berman, M.D.
Donald E. Wilson, M.D.
c:cMnton-h. I t r
Division of Adolescent Mcdidne
Mwlkal Tithnology Building
Jl South Greene Street. Jrd Hoor
Italtimon:, Maryland 2I2(>1-I50i
410 32H M95 / 410 328 0131 wx
Marianne H. Felice, M.D.
Professor of Hediatrics
Vice Chair, Department of Pediatrics
Director, Division of Adolescent Medicine
�CODER:.
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Other
POLICY AND PERSONAL STORIES:
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insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
working families
unemployed/low income
benefits
.providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
medical equipment
fraud & abuse
FINANCING (VII)
.MENTAL HEALTH (EX)
.LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
rural
urban
OTHER
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. letter
SUBJECT/TITLE
DATE
Address (Partial); Phone No. (Partial) (2 pages)
01/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [4]
2006-0885-F
jm787
RESTRICTION CODES
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Pl
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P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
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PRM. Personal record misfile defined in accordance with 44 ll.S.C.
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RR. Document will be reviewed upon request.
�R o k e r i P. Fields, M . D .
r 00 s
Januaiy
A
26,1993
T'ask Force on National
Health Care Reform
c/o The White Mouse
1600 Pennsylvania Avenue
Washington, D.C. 20050
Dear Task Force members,
I am a 34 year-old general internist in Maryland. I wanted to
write to you concerning the issues I feel strongly about as you
consider how best to restructure the American health care system.
1) Exclusions for pre-existing conditions have to go. People
didn't want to get cancer, or MS, or heart disease, or anything else
for that matter, and offering them "insurance" which excludes
coverage for the problems they suffer from is pointless. It punishes
them for having a disease, and it risks that these unfortunate people
will bankrupt their families caring for their health, or may become
even sicker by not being able to obtain needed treatment, [n some
cases, these people will have no choice but to default on their
obligations and thereby shift their costs to hospitals or government.
Some of these people will become homeless. Exclusions are unfair,
and cruel, and have no place in a society now committed to caring for
its citizens.
2) Tort reform. As long as patients can threaten to sue their
doctors over anything, with or without justification, it will be
impossible to expect doctors to limit costs.
For example, while only 1 in 500 people seeing a doctor for
a headache has a brain tumor, it seems that virtually every trip to a
neurologist (at least here in suburban Washington) will generate an
MRI scan at $7,000 lo $2,000 per study. Even' headache! Even
though the odds of missing that tumor arc low, and no other
countiy would spend the ec|uivalent of several families' health
insurance premiums for a whole year on a headache, doctors feel
their careers will hc destroyed if they ever miss anything.
Obviously, no one is always perfect, and the attempt to go
from 98% correct using good faith and clinical judgement to 99%
correct by "scanning" everyone is "breaking the bank" in a manner
which is emblematic of the whole health care mess. This is just one
example, but the same can be said of many other costly procedures,
such as cardiac catheterization, or Cacscrian section. Jn short, the
legal profession currently holds doctors to an impossible standard of
perfection, for every visit, and every problem. Costs can never be cut
�without protecting doctorsfromthe very widespread and legitimate
fear of inappropriate malpractice litigation. Arbitration panels, caps
on awards, and other innovative and fair solutions must be
implemented if we are to control costs.
3) Elderly people who are able to pay for their insurance
should. It is criminal tnat millionaires over 65 can receive Medicare
for ridiculously low premiums while at the same time young
families, some making as little as $1800 per year in some states, are
judged not poor enough] While a sliding scale or means test for
Medicare would be politically unpopular with the senior lobby, the
strong fact remains that this "entitlement" program covers many
people far better able to pay their medical insurance than the young
working families, often themselves without insurance, whose taxes
subsidize them. It is wrong to subsidize the elderfy wealthy at the
expense ofpoor young parents and children.
4) We have to find a way to accept that life does not go on
forever. In fact, we spend hundreds of billions of dollars canng for
people in their last year of life, offering them nothing except pain, a loss
of dignity, and an agonizing prolonged death. We could immunize
everybody, buy every school child a hot breakfast and lunch, and do
all sorts of wonderful things that we can't afford to do now because
we too often feel compelled "to do everything", without thinking.
Are we as a society really able to perform bypass surgery on people
over 85, or cataract surgery on people in their 90's, regardless of
their functional status? In a society starting to painfully realize that it's
resources arefinite,and that every dollar we spend is one that can't be
spent somewhere else, we must look critically at the way we implement
high technology in our health care system.
5) Change the way doctors are paid. The "Resource Based
Relative Value Scale" (RBRVS) has not done what it was intended
to do, and is cumbersome and unfair.
Significant problems remain in our system in large part
because reimbursement strategies for physicians reward the wrong
things, and have created the wrong incentives. Why should a doctor
make $3,000.00 for a half-hour cataract procedure, or $6,000.00 to
pin a broken hip while cost-effective preventive counseling, regular
check-ups, mammograms, pap smears and essential tests are either
inadequately covered by insurance or commonly, not at all. Surgical
fees are much too high in many cases, while primary care doctors
(pediatricians, family physicians, and internists) make afractionof
the income of their surgical and subspecialty colleagues. It is often
cited in the paper that doctors earn an average of over $160,000 per
year, and when reported in that manner it is understandable that
that statistic doesn't earn sympathyfromtoo many people. But in
reality, specialists earn two to five times more than primary care
�doctors, while rendering often unnecessary care much more
expensively. Adjust the salaries, and the excess of specialists will
correct itself over time. With huge discrepancies in reimbursement, it
is therefore not surprising that the country has a critical shortage of
primary care doctors, ana most everyone who hopes to solve this crisis
knows that needs to change.
6) Pay for medicines that people need. It is intolerable for
the government to pay $10,000 or $20,000 for a hospital intensive
care stay for a 7 year-old asthmatic because the family couldn't pay
$25 for the medicine. That $25 "saved" because the state felt it
couldn't afford to pay for it is simply another example where a little
money spent sensibly in prevention would save a lot of money in
high-cost, high-tech care.
7) Pay for preventive health. Why will we as a society fly
patients by helicopter to a trauma or cardiac center, perform a liver
transplant on a person irretrievably ill, all at astronomical cost, but
not pay for prenatal visits, childhood immunizations, or adult
preventive health? The American hospital system makes it easy to
perform extremely expensive and often marginal interventions - why
can we not do easy and inexpensive things that will yield much more
good down the line?
8) Provide fair coverage for mental illness. Mental illness
and depression are extremely common, and the insurance system
treats people who suffer from these illnesses differently than people
with other conditions. Their health expenses are typically not
covered the way they would be if they had cancer or heart disease.
Thesefinancialand policy decisions perpetuate the stigma of these
common illnesses and cost our society untold heartache and countless
billions because people can't afford to be treated or are ashamed to ask
for help.
9) Streamline the administrative mechanisms. With literally
thousands of insurance plans, some estimates indicate that we spend
over $100,000,000,000 per year just pushing paper. This is
unconscionable.
10) Everyone has to contribute. It seems that everyone is in
favor of reducing the health care costs of other people', the American
)ublic will need to understand that some treatments really don't
lelp very much, or tests are only marginal or equivocal in what they
reveal, and that indeed cost is sometimes an issue. This will require
an attitude of cooperation for the common good, and an appeal b y
the President and other respected leaders. It may gam slow
acceptance from the tens of millions of people who currently d o
�have comprehensive insurance, and are accustomed to having every
test and every prescription and every subspecialty consultation,
regardless of the cost or benefit.
To conclude, I feel that with the resources our nation
already allocates toward health care we can do better by making
important changes in key areas. [ hope you will consider my
thoughts as you listen to America on this vital matter.
Sincerely,
P.S. I would be honored to serve on committees addressing the
issues related to health care refonn. 1 feci that as a communityoriented family physician my perspective would be valuable, and I
would work hard to contribute to the process in a fair and balanced
manner. Please do not hesitate to call on me.
! - \ c „ ft
•A- '.
P6
b
6
,;. {! )( )
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unemployed/low income
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providers
.INFRASTRUCTURE/WORKFORCE (III)
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administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
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medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
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physician fees
hospital fees
medical equipment
fraud & abuse
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.LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
AIDS
.women's health
.immunizations/children
.rural
urban
OTHER
�MICHAEL A. PATMAS. M.D., M.S.,F.A.C.P.
(908)255-9300
DIPLOMATE.AM. BOARD OF INTERNAL MEDICINE
FELLOW, AMERICAN COLLEGE OF PHYSICIANS
1749 HOOPER AVENUE, SUITE 101
TOMS RIVER, NJ 08753
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�NOTICE
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FROM THIS DOCUMENT
�Herbert S.
March 4, 1993
Mrs. Hillary Rodham Clinton, Head,
Task Force on Health Care Delivery Reform
Executive Office Building,
17 and Pennsylvania Ave. N.W.,
Washington, D.C,
Dear Mrs. Clinton,
As a physician I am concerned about the resistance that will be faced by any
reform program for health care delivery and financing and the purpose of this letter is
present an understanding of that resistance from the perspective of a teacher, a practitioner
and Director of Mental Health and Addictions in a large county Department of Health.
Such resistance to organized health care in America is not new; in 1849 the author of
the first book on the Doctor-Patient relationship noted that the American public was both
overweeningly dependent on and hypercritical of American Medicine. More than most
people, Americans resent being dependent and will reject programs that don't give them
power and choice.
The non-system we now have, the one that is bankrupting us, has evolved because
the Federal, State and Local governments were unwilling to face up to the resentment that
any rational plan would encounter. Governmental denial was the path of least resistance
and policy makers have avoided facing health and illness accurately. We use euphemisms
that obscure what we feel. For example, we call our system health care when it is
primarily an illness system. We use one language when we talk policy and another when
we get sick. But the decisions that cost the system most money are made about very sick
people. If the system is to be effectively constrained, the constraints devised will need
to accurately reflect how costly decisions are made.
From the time I graduated Medical School in 1960 until today the practice of
Medicine has become part of a "health" care delivery system that has lost touch with the
humility we used to feel as patients and doctors in the face of serious illness. The
helplessness we felt as physicians enabled sympathy and empathy with our patients helpless
feelings. Having listened to the helpless feelings of Americans trying to cope with our
non-system, you must be feeling what we used to feel thirty years ago. Our
grandparents would not be feeling so helpless. Americans have been set up to feel
helpless by a false belief in the power of technology and unlimited third party support.
�Third party support and advances in technology have shifted our feelings
furthering the belief that we can do whatever we set out to do. The "can do" attitude
in "health care" fits very well with the self-reliant American values; but it does not fit
with the realities of illness care. The bottom line in the care and cost of most illnesses
is that in spite of what we believe functions deteriorate and the more rapid the
deterioration, the more costly the illness, technology notwithstanding.
Denial of the realities of illness and deterioration prevents effective management;
many costs cannot be contained because doctors and patients have lost the licence to yield
in the face of enough evidence that further treatment is unwarranted. The values
controlling American Medicine today sacrifice the law of diminishing value on a very
costly altar of false hope.
As I noted in a letter to the New England Journal, (New England Journal of
Medicine,Vol.323,December 20, 1990,p.l770) money spent to enhance the "quality" of
the dying process of one patient denies health care to another. Since I graduated and
as a result of a huge spending binge, we have rediscovered that there are only a finite
number of dollars available to finance health care and spending dollars on one patient
denies another. I argued in the Journal that the Hippocratic oath should be redefined
so that a physician at the bedside sees more than the individual patient. Rather the
physician and the patient need to be helped to see a community of people and their
needs, as well as the needs of the individual patient. Any gardener knows that if you
just add fertilizer the weeds will eventually kill the flowers. By just adding resources
we have permitted the tangible big ticket items to crowd out the more fragile and much
less costly preventive treatments. I am given resources for tertiary care but I have to
fight like the dickens for every dollar I spend on early detection and treatment.
In order to be accepted and to be successful health care reform must take the
helplessness felt in all parts of the system into explicit account. You need to reflect
back to the American people the helplessness they have communicated to you and use that
helplessness as a dignified adversary, a subjective outcome measure of the success of
reform. To endure, health care reform will need to gradually empower the players and
provide them with opportunities to feel progressively less helpless.
Physicians and their patients need to be helped, not coerced or controlled to see
the needs of a community of people, so that the needs of the individual being treated
can be considered along with the insured community to which that individual belongs.
Providing information and an incentive structure so that doctors and patients can predict
the way the system will respond to decisions made in clinical settings would empower
doctors and patients and help them be informed and responsible consumers of health care
resources. The Doctor-Patient relationship is where the action is and if doctors and
patients are given the tools and incentives to make realistic choices the cost of illness will
stop its vicious spiral.
�Patients and physicians should know what their alternatives are and what the costs
of care will be. Managers should enable patients and doctors to choose from prepared
menus. The work of managers to contain costs should occur prior to the need to make
clinical decisions. Plans that require centralized clinical managers to make clinical
decisions during "real-time" lead to adversary attitudes toward cost containment. The best
managers empower others on the firing line to make decisions by preparing the
infrastructure. Managers should be evaluated by how well they prepare patients and
physicians to make cost effective decisions.
This preparation includes keeping on top of the jumbo cost items and planning for
them. In a discussion with the Emergency Room Directors they noted how often they
were called upon to do expensive and highly questionable procedures for nursing home
residents that they knew nothing about. They worry about that more than they worry
about inappropriate primary care. One test of a proposed plan should be how that plan
assigns responsibility for the cost incurred when a feeding tube is placed in a moribund
senior. We have a communal responsibility to assure ourselves that such decisions are
made by prepared people that know each other. Keeping the decision making in the hands
of prepared people that know each other means "right-sizing" the managed group. I
don't know what an optimum size group would be but the monstrous inefficiencies of
monstrous sized groups is all too familiar and the inefficiency promotes irresponsibility.
President Clinton is leading the country toward a new balance between entitlement
and responsibility. The plan to reform health care delivery presents an opportunity to
advance that balance. Because we have too long denied the fact that we have a nonsystem of health care we created the current mess. Getting out of the mess will also
encounter resistance because each player in health care takes responsibility and wants
reward for only part of health care delivery. The physician won't really step into the
shoes of the manager, nor will the manager really step into the shoes of the physician.
Levels of government play with tax dollars as if they come out of the pockets of
different people. My tax dollars support both the State and Federal halves of the
Medicaid resources that pay for the care of patients in the clinics I manage.
For health care delivery reform to succeed, the plan will need to take an analytic
view of the resistance it will encounter. That resistance primarily derives from the
helplessness people feel when they face the threat of illness. Feelings of helplessness
foster denial and resentment of everything to do with health and illness. Denial has in
turn led to the development of a non-system that has not surprisingly decreased the power
of anyone to manage the system. How we created the health care delivery mess needs
to be taken into consideration as we develop a prescription to get ourselves out. A
prescription that includes enhancing the real power of every participant in the health care
delivery system will succeed.
�Following the President, real power will be developed in the plan by balancing
each participant's fiscal entitlement with that participant's fiscal responsibility. Every
participant will have to accept that the amount of public resources available to support
health care is finite and agree to accept limits on the power to encumber afixedamount.
The limits accepted by each participant will permit empowering that participant to
encumber a clearly stated portion of those limited resources. Participants with differing
roles have a responsibility to the entire system and plans need to build in consequences
for irresponsible or ineffective managing.
We should not shy away from using clearly stated financial goals as outcome
measures. I would gladly trade in the current quality assurance system that has nothing
to do withfinancefor measures that explain the cost of care. One has to know one's
patient very accurately to be able to show why the care of this one cost twice as much
as that one. In a similar fashion fiscal outcome measures need to be specified for the
cost of managing, of licensing and certification, of assuring quality, of insuring, of
billing and collecting.
The cost of Governmental policies should not be excluded from the plan.
Mandating programs by government without funding them is a symptom of an
irresponsible system. The rigidity of top down Federal policy development and
management has been part of the health care delivery problem and not the solution.
Clinicians in the public sector spend half their workday doing paperwork to satisfy
demands imposed on our State by Federal Medicaid policy. A child in my clinics would
not have to wait a month for an appointment were it not for such policy.
Federal policy ought to enable the States to experiment with variations on a
broadly outlined health care delivery system. There are many competing proposals and
it would be very risky to pick any one as the best model. By enabling experimentation,
the Federal Government would be enhancing the acceptance of the proposed plan by
enlarging the real power of the States. Your Health Care Task Force should point out
the destination; the States should figure out how to get there.
We now suffer because centralized planners have acted as if policy and procedure
and regulation could be a substitute for managing. We have learned that policy that
constrains is more costly than policy that empowers. Policy that derives from contracts
openly negotiated and executed between equal parties is the most empowering, and
responsibly empowering the parts of the system according to the above analysis would be
the most likely to succeed.
ferbert S. Gross, M.D.
cc. I. Magaziner
�HEALTH CARE TASK FORCE SORTING SHEET
CDR_
OE:
INPUT DATE:
GENERAL SORT:
POSTCARD 1:
General mail
Personal stories
Letter Campaign
_Other Health Providers
POSTCARD 2:
Offers to help/Employment
FORM LETTER:
Letterhead
_Policy
REROUTE:
Casework
.Scheduling
Physicians
President
Other
POLICY AND PERSONAL STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
working families
unemployed/low income
benefits
providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
.FINANCING (VH)
.MENTAL HEALTH (DO
.LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
rural
urban
OTHER
�The Johns Hopkins Medical Institutions
Carol Johnson Johns, M.D.
Associate Professor of Medicine
Director, Office of Continuing Education
February 24, 1993
H i l l a r y Rodham C l i n t o n
Chair
President's Task Force on Health Care Reform
The White House
1600 Pennsylvania Avenue, N.W.
Washington, DC 20500
Dear H i l l a r y ,
This i s the second time I have occasion to w r i t e t o you because o f a shared
Wellesley connection and concern. As a Wellesley (1944) and Johns Hopkins M.D
(1950) graduate, I obviously share your great i n t e r e s t i n Health Care Reform.
I am t h r i l l e d t h a t you are c h a i r i n g t h i s e f f o r t .
I want t o urge you t o consider seriously the opportunity t o be the Keynote
Speaker a t the Centennial Symposium on Health Care Reform on Thursday. June 10.
1993 a t 2:30 P.M.. Johns Hopkins was one o f the f i r s t major Schools o f Medicine
to "admit women on the same terms as men" from the time o f i t s beginning. Our
medical school class o f 1950 had 19 women i n a class o f 75 students. I f I had
gone t o Harvard, i t would have been the second class t o admit women. I found the
t r a d i t i o n o f women "on the same terms as men", to be e s p e c i a l l y appealing, hence
my decision t o attend Hopkins.
Johns Hopkins continues to be an outstanding School of Medicine, as you are
w e l l aware. I t has been my p r i v i l e g e to have my e n t i r e p r o f e s s i o n a l career here
at Johns Hopkins (except f o r my leave o f absence to be A c t i n g President o f
Wellesley i n 1979-1981) . I t would surely honor and please us i f you would accept
the i n v i t a t i o n o f Dean Michael Johns (no r e l a t i o n but a good f r i e n d and
colleague) t o present some o f the issues i n h e a l t h care reform a t the Centennial
Symposium honoring the 100th Anniversary o f the founding o f Tne Johns Hopkins
U n i v e r s i t y School of Medicine.
I ' l l keep my f i n g e r s crossed t h a t i t can be
f i t t e d i n t o your busy schedule.
With warmest regards,
Carol Johnson Johns, M.D.
Assistant Dean and D i r e c t o r ,
Continuing Medical Education
720 Rutland Avenue, Turner 17, Baltimore, Maryland 21205
955-5928
�CODER:_
H E A L T H C A R E TASK F O R C E SORTING S H E E T
INPUT DATE:
GENERAL SORT:
P O S T C A R D 1:
.General mail
.Personal stories
Other Health Providers
P O S T C A R D 2:
.Letter Campaign
.Offers to help/Employment
FORM L E T T E R :
Letterhead
REROUTE:
Casework
Policy
Physicians
.Scheduling
President
Other
POLICY AND PERSONAL STORIES:
ORGANIZATION (I)
.insurance premiums
insurance reform
.insurance pools
.boards and oversight
. C O V E R A G E (II)
working families
unemployed/low income
benefits
providers
. I N F R A S T R U C T U R E / W O R K F O R C E (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
^malpractice & tort reform
manpower issues (training)
^unnecessary procedures
. G O V E R N M E N T PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
.FINANCING (VII)
MENTAL H E A L T H (IX)
L O N G - T E R M C A R E (X)
PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
.AIDS
.women's health
.immunizations/children
.rural
urban
OTHER
�Shady Grove Radiology
Shady Grove Radiological Consullanls, I'A
Diagnostic Radioloj^ of Shady Grove, PA
Shady Grove M.R.I. Associates, PA
301 .948-570(1
December 8, 1992
H i l l a r y Rodham C l i n t o n
1600 Pennsylvania Avenue, N W
..
Washington, D.C. 20500
Attention:
P r e s i d e n t ' s Task Force
On N a t i o n a l H e a l t h Reform
Dear Mrs. C l i n t o n :
I am a l o c a l p r a c t i c i n g p h y s i c i a n i n t h e R o c k v i l l e / G a i t h e r s b u r g ,
Maryland area.
I agree w i t h you t h a t s i g n i f i c a n t comprehensive
h e a l t h c a r e r e f o r m i s a must f o r o u r c o u n t r y a t t h i s t i m e .
However, we must a l t e r our system c a r e f u l l y so t h a t as we
i n c r e a s e access t o a l l Americans and c o n t r o l c o s t s we a r e n o t
s a c r i f i c i n g t h e h i g h q u a l i t y o f care t h a t i s a v a i l a b l e i n o u r
g r e a t c o u n t r y . A l t h o u g h many Americans t r a v e l abroad f o r v a r i o u s
s e r v i c e s , you almost never hear o f an American t r a v e l i n g anywhere
outside o f our country t o o b t a i n q u a l i t y h e a l t h care.
I n fact,
l e a d e r s o f o t h e r n a t i o n s , and f o r e i g n c e l e b r i t i e s and h e a l t h c a r e
p r o f e s s i o n a l s come t o t h e U n i t e d S t a t e s when t h e y a r e i n need o f
top q u a l i t y care.
Because o f t h e e x t e n s i v e d i s c u s s i o n and e x c e l l e n t i d e a s a l r e a d y
promulgated about c e r t a i n aspects o f h e a l t h care r e f o r m , I w i l l
l i m i t my remarks t o you t o s p e c i f i c areas t h a t I do n o t t h i n k
have been addressed adequately o r p r o p e r l y . These i n c l u d e t o r t
r e f o r m , t h e concept o f "access" versus " u t i l i z a t i o n " and c o s t
c o n t r o l t o t h e h e a l t h care p r o v i d e r .
As t o t o r t r e f o r m , o b v i o u s l y s i g n i f i c a n t comprehensive
m a l p r a c t i c e r e f o r m would produce g r e a t savings because o f t h e
number o f expensive t e s t s t h a t p r o b a b l y would n o t be o r d e r e d , as
w e l l as t h e overwhelming c o s t o f l i t i g a t i o n .
I n o r d e r t o achieve
t h i s change, however, t h e r e has t o be a w e l l - p e r f o r m e d s t u d y o f
"outcomes" f o r v a r i o u s diseases, i n j u r i e s and t e s t s . T h i s i s t h e
s i n g l e most c r i t i c a l p i e c e o f i n f o r m a t i o n necessary f o r
m e a n i n g f u l r e f o r m and decreased u t i l i z a t i o n t o t a k e p l a c e . Such
a s t u d y has n o t been performed and r e p o r t e d t o d a t e . I n
a d d i t i o n , l i m i t a t i o n o f a t t o r n e y s ' f e e s , a b i l i t y t o counter-sue
t h e p a t i e n t as w e l l as t h e a t t o r n e y f o r f r i v o l o u s s u i t s and
r e a l i s t i c caps on f i n a n c i a l rewards would a l s o be v e r y h e l p f u l .
Maiting Address
MnntKtHiwry Villagi.
• Edmunstnn Crossing
• North Lakr
• Shady Grove
• M./dicil I'l.iz.i I
I'mlissionjl'Center
101 W lidmonslun Dnve
Mrdiral I'arls
Magnetic Resnrunce Imaging
Computed Tomfigr.iphv
W241 Mnnlgornery Village Ave.
Knckville. MD 211852
IWOK Doctors Drive
1711 Medical CenCer Drive
"715 Medical Cenler Drive
S (e I--I3
(301) 762-I81H
Germantown. MD 20B7-1 Suite 101
Suite 127
Gailherslmrg, MD 20H7"
(301) 42H-365H
Rockville, MD 2(lHSli
Knckville, MD 2US30
(301)'I4H-64M
(301) 7<i2-KI55
(3111) 7h2-1 I Ih
ul
BMedfeil N I M II
• Shady Crow
"71 1 Medical Center Drive
Adventist I lospital
Suite 3111
Will Medical Center Drive
Knckville, MD 20K5I1
Knckville, MD 2IIK.Stl
(31111 702-2^0
(301) 271-6054
�As a h e a l t h c a r e p r o f e s s i o n a l , I have n o t i c e d t h a t many h e a l t h
c a r e p l a n n e r s i n t e r c h a n g e and confuse t h e two terms "access" and
"utilization".
U n i v e r s a l access t o b a s i c h e a l t h c a r e f o r a l l our
c i t i z e n s s h o u l d be p a r t o f t h e American system. D e t e r m i n i n g
e x a c t l y what t h i s l e v e l o f care should i n c l u d e , however, i s v e r y
difficult.
I t most p r o b a b l y should be based on b o t h f i n a n c i a l
and "outcome" f a c t o r s . Obviously, i n c r e a s i n g access t o
i n d i v i d u a l s who do n o t have i t now w i l l i n c r e a s e t h e c o s t o f
h e a l t h c a r e i n and o f i t s e l f .
This i s a "good" and necessary
i n c r e a s e . However, o v e r u t i l i z a t i o n o f h e a l t h c a r e s e r v i c e s i s
p r o b a b l y t h e s i n g l e most i m p o r t a n t f a c t o r i n t h e s p i r a l i n g
i n c r e a s e o f h e a l t h c a r e c o s t s . Even HMO's and o t h e r Managed Care
Payors have been unable t o c o n t r o l h e a l t h care u t i l i z a t i o n
t h r o u g h t h e i r p r i m a r y care gatekeepers.
T h e i r c o s t s have been
p r i m a r i l y c o n t r o l l e d by t h e f a c t t h a t t h e y t e n d t o i n s u r e and
accept a younger h e a l t h i e r p o p u l a t i o n . As t h e i r s u b s c r i b e r s age
and t h u s become more i l l , t h e y t o o w i l l experience i n c r e a s i n g
h e a l t h c a r e c o s t s which w i l l be out o f t h e i r c o n t r o l .
A
s i g n i f i c a n t example would be t h e Medicare r i s k p o o l concept i n
Florida.
U t i l i z a t i o n s h o u l d be c o n t r o l l e d by o t h e r means. I t appears t h a t
t h e most e f f i c a c i o u s method i s p r o b a b l y f i n a n c i a l .
Increasing
copayments and d e d u c t i b l e payments, ( p o s s i b l y u t i l i z i n g a s l i d i n g
s c a l e depending upon t h e income o f t h e i n d i v i d u a l o r f a m i l y ) ,
seems t o have a g r e a t e f f e c t on u t i l i z a t i o n .
When an i n d i v i d u a l
o r f a m i l y must pay a p a r t o f t h e i r h e a l t h care b i l l , t h e y t e n d t o
make sure t h a t t h e h e a l t h care v i s i t i s necessary.
A system t h a t c o n t r o l s c o s t s t o t h e r e c i p i e n t o f s e r v i c e s w i t h o u t
attempting t o c o n t r o l the cost of materials, supplies, r e n t ,
p e r s o n n e l and equipment t o t h e p r o v i d e r o f those s e r v i c e s i s
u l t i m a t e l y doomed t o f a i l u r e .
I f t h e h e a l t h care f i e l d i s t o be
r e g u l a t e d by t h e government, whether d i r e c t l y o r i n d i r e c t l y , t h e n
t h e h e a l t h c a r e p r o v i d e r (whether p h y s i c i a n s , h o s p i t a l o r
a n c i l l a r y ) must a l s o be p r o t e c t e d by t h a t same government
r e g u l a t i o n from t h e s p i r a l l i n g u n r e g u l a t e d c o s t s o f s u p p l i e s and
s e r v i c e s r e q u i r e d t o provide the q u a l i t y h e a l t h care which i s
demanded by t h e p u b l i c . This may t a k e t h e form o f a c t u a l payment
caps ( e . g . , an MRI machine can c o s t no more t h a n X d o l l a r s ; a
14X17 x - r a y f i l m can c o s t no more t h a n Y d o l l a r s ) .
I t might a l s o
t a k e t h e form o f a l l o w i n g and encouraging h e a l t h care p r o v i d e r s
t o band t o g e t h e r w i t h o u t f e a r o f r e s t r a i n t o f t r a d e r e g u l a t i o n s
t o d e a l w i t h s u p p l i e r s as much l a r g e r consumer e n t i t i e s .
Somehow, i n some way, t h e s u p p l i e r s must a l s o f e e l t h e e f f e c t s o f
cost containment.
As a d e d i c a t e d , c a r i n g p h y s i c i a n , I am v e r y concerned about t h e
q u a l i t y o f c a r e our c i t i z e n s r e c e i v e . U n i v e r s a l access i s
e x t r e m e l y i m p o r t a n t . We must be c a r e f u l t h a t we do n o t d e s t r o y
t h e q u a l i t y o f medical care w h i l e t r y i n g t o c o n t r o l t h e c o s t o f
it.
P h y s i c i a n s a r e e n t e r i n g p r a c t i c e w i t h v e r y l a r g e debts from
m e d i c a l s c h o o l and, f r a n k l y , deserve t o make a s u b s t a n t i a l l y
decent income, commensurate w i t h t h e i r e d u c a t i o n and t r a i n i n g .
�L i m i t i n g t h e f e e s t o these p h y s i c i a n s and o t h e r h e a l t h c a r e
providers without also l i m i t i n g t h e i r operational costs w i l l
d r i v e many b r i g h t and c a r i n g p h y s i c i a n s o u t o f our f i e l d .
We
have a l r e a d y seen a l a r g e egress o f middle aged p h y s i c i a n s who
are e x t r e m e l y e x p e r i e n c e d and c a r i n g b u t who were unable t o cope
w i t h t h e system as i s now stands. Over t i m e , t h i s exodus w i l l
r e p r e s e n t a tremendous decrease i n t h e q u a l i t y o f c a r e f o r our
citizens.
We have t h e f i n e s t h e a l t h care system i n t h e w o r l d , d e s p i t e some
of t h e s t a t i s t i c s quoted by o t h e r s . There are many s o c i e t a l
problems t h a t t e n d t o obscure t h i s f a c t , such as i n f a n t m o r t a l i t y
r a t e , teenage d e a t h r a t e and o v e r a l l l o n g e v i t y . Our h e a l t h c a r e
system may c o s t 30 p e r c e n t more t h a n o t h e r c o u n t r i e s , b u t i t
seems t o me we r e c e i v e 30 p e r c e n t b e t t e r q u a l i t y as w e l l .
We
s h o u l d be v e r y c a r e f u l t h a t we do n o t "throw o u t t h e baby w i t h
the b a t h w a t e r " ,
I a p p r e c i a t e your t a k i n g t h e t i m e t o correspond w i t h me.
I would
a l s o l i k e t o make myself a v a i l a b l e t o you and/or t o t h e C l i n t o n
t r a n s i t i o n team and/or t h e Department o f H e a l t h and Human
S e r v i c e s t o serve as a c o n s u l t a n t and/or a d v i s o r i n t h e h e a l t h
care f i e l d .
O b v i o u s l y , I have o n l y been a b l e t o express v e r y
l i m i t e d i d e a s i n t h i s l e t t e r . H o p e f u l l y , we w i l l be a b l e t o g e t
i n t o more d e t a i l i n t h e f u t u r e . I am a concerned c i t i z e n who i s
a s i g n i f i c a n t consumer o f h e a l t h c a r e (my two daughters have
T o u r e t t e Syndrome and my son has had seven s e p a r a t e s u r g i c a l
p r o c e d u r e s ) . I have an u n d e r s t a n d i n g o f what i t i s l i k e t o be a
p a t i e n t and t o be poor (my f a m i l y had l i t t l e o r no money when I
was g r o w i n g u p ) . I a l s o understand what i t means t o be a
concerned, c a r i n g h e a l t h care p r o v i d e r who wants t o do t h e b e s t
f o r h i s p a t i e n t s i n a c o s t e f f e c t i v e manner.
Someone w i t h
t h e s e v a r i e d e x p e r i e n c e s must be i n v o l v e d w i t h h e a l t h c a r e p o l i c y
decisions.
I l o o k f o r w a r d t o h e a r i n g from you.
Sincerely,
B r i a n N. M e r i n g o f f ,
BNM:tc
MVD.
��NOTICE
» *
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
z 3.r'>
�March 4, 1993
Mrs Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear Mrs. Clinton:
I strongly support the measures you have taken to start the United States on a more
fiscally responsible track. As a measure of my support, I have been writing a list of costsaving suggestions to you on a frequent basis. In addition, I have been urging all of my
colleagues and patients to think of cost-saving suggestions to send to you. Today, however,
I would like you to consider another issue:
The achievement of satisfaction in the physician-patient relationship.
The reason most people and most physicians prefer freedom of selection in
development of physician-patient relationships ties in closely with the achievement of
satisfaction in those relationships. Aside from the improvement in medical care in an
atmosphere of rapport, good relationships reduce medical costs because good
communication reduces the need for unnecessary testing and treatment based on
misperception and misdirection. Any system of health care delivery which intereferes with the
freedom of physicians and patients to choose these relationships independent of insurance
company lists, interferes with a natural process of selection which reduces health care costs.
As a patient, I know I have been most satisfied when I know my complaints have been
understood in context. Indeed, I had to try several physicians myself before I found one who
heard me the way I wanted to be heard. After that, the testing decreased. As a physician, I
can assure you that money is not the most important motivation to practice medicine. When
I ask physicians how much money they made in any given day, week, or month, most have
no idea. But they can instantly tell you if their patients are doing well, what went wrong with
their care, and what they are doing about it. In other words, the major satisfaction comes from the exercise of the profession, the positive feedback from satisfying relationships.
Recommendations:
1) Do not develop a Health Care Reform package which is based on the development,,
of provider lists which exclude freedom of choice.
2) Do not prevent physicians from achieving job satisfaction by developing rules which
constrain their ability to exercise judgment and match their treatment plans to their own
perceptions of patients needs.
3) Do not develop a health-care system in which personal relationships are
discouraged.
4) Do develop systems which reward cost-conscious physicians for appropriate
decision-making based on time-consuming listening and hearing skills.
5) Do include practicing physicians in the development of health care plans. They can
tell you how those plans look from the point of view of people who work with them every day.
�6
> 0° Keep ,
r y i n g
. Y
o u r
^
Sincerely,
Daniel Rosenb/i
um, MD
is/mportant to
us.
�CODER:.
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
GENERAL SORT:
POSTCARD 1:
Mi 11 ;v*
.General mail
.Personal stories
.Letter Campaign
Other Health Providers
POSTCARD 2:
.Offers to help/Employment
FORM LETTER:
Letterhead
.Policy
REROUTE:
Casework
.Scheduling
'hysicians
President
Other
POTJCY AND PERSONAL STORTES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (H)
working families
unemployed/low income
.benefits
.providers
INFRASTRUCTURE/W ORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
FINANCING (VII)
MENTAL HEALTH (IX)
.LONG-TERM CARE (X)
.PUBLIC HEALTH;
SPECIAL POPULATIONS (XII)
prevention
AIDS
.women's health
.immunizations/children
.rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Dean S
March 13. 1993
Mrs. Hillary Rodham Clinton
Director, Presidential Task Force on
National Health Care Reform
The White House
Washington. D.C. 20500
Dear Mrs. Clinton.
I am a psychiatrist who worked for your husband s election and who
shares vour advocacy for children's needs, particularly with regard to health.
I am writing to you to advocate some principles relevant to your work in restructuring the delivery of health care.
I do mostly short-term psychotherapy and prescribe medication (for
some patients ) appropriate to treat anxiety and depressive disorders. In
addition. I am the author of a short book ("A Practical Guide to Cognitive
Therapy ) about a short-term approach to doing psychotherapy. I sem a
copy of my book to vour husband during the campaign.
I believe strongly (and I have seen the evidence in my practice over
twenty years) that adequate mental health care at the right time can save
money otherwise spent on medical diagnosis and treatment. The investment
is returned to society when the affected member returns to the work force.
A Basic Benefits Package must mclude equivalent access to care for
emotional and physical disorders.
Emoiional problems in children represent an opportunity to "catch
problems early and prevent later disability in adults. Mental health care for
children must, therefore, be provided for in a national health program.
A key element in successfully overcoming an anxiety or depressive
disorder lies in ihe relaiionship between the patient and his or her therapisi
In a "typical clinic arrangement in which there is no provision for the
continuity involved in choosmy and then keeping a therapist, this vital
element is compromised. The insurance company must not choose the
provider—that is the prerogative of the patient. While the company might
monitor the appropriateness of the treatment and the number of contacts,
the provider s opinion must be given full weight. Too often in lhe recent
�past, necessary treatments (in my view) have been denied my patient by a
poorly informed employee of a Health Maintainance Organization.
With more and more layers of paperwork needed to accomplish the same
treatment, the doctor's time is often misdirected, and the patient loses out.
The process of gathering information must be carefully thought out to limit it
to what is needed for decision making, and to maintain the patient's
confidentiality. Today, in my practice, confidentiality is frequently
threatened. On many occasions, I have refused to "blanketly release" medical
records to insurance companies requesting them, even when the patient has
signed consent. A brief summary that maintains confidentiality is usually all
that is needed for decision making. The blanket release often seems to be a
way to make it unnecessary for the managed care agent to think through
and specify what they are interested in.
Review of care should occur for clearly specified reasons, and not as a
nuisance at poorly thought out intervals. The patient should be made aware
of the process for which they are asked to give permission.
Some mental conditions, for example some of the schizophrenias, some
forms of depression, and some of the personality disorders (eg.. Borderline
Personality) may require continuous treatment or periodic treatment. They
do not fit well into the model of short-term care. In addition, some forms of
treatment (eg., some types of psychoanalysis) mandate sessions "for years"
often at a frequency of several times a week. There is little efficacy for these
approaches, in my opinion.
Herein lies a major problem to resolve in creating a new system. How do
you know the treatment plan is a reasonable one, and the care is worth
paying for? This is still a field in which different practitioners, with different
backgrounds often support different prescriptions for treatment.
Acknowledging this by throwing up one's hands, however, means
abandoning people who often most need care, take up a large share of
therapist time and much of the cost.
My suggestion would be to specify the disorder carefully for which you
are defining adequate treatment. Differing disorders (eg., an acute
schizophrenic episode and an acute depressive episode) often need different
prescriptions.
Speaking now as a private practitioner, it is clear to me that fees will
have to be regulated to contain costs. That should be applied to hospitals as
well as practioners of all cloths. This is consistent with the sacrifices many
�Americans are being asked to make in the interest of an improved economy,
access to basic services for ail, and coverage for basic health care needs for
all Americans.
If I can be of help in conceptualizing your proposals, please call on me.
Sincerely yours,
I
Dean Schuyler, M.D.
�H E A L T H C A R E TASK F O R C E SORTING
CODER:.
SHEET
INPUT DATE:
GENERAL SORT:
P O S T C A R D 1:
.Personal stories
.General mail
.Letter Campaign
Other Health Providers
P O S T C A R D 2:
.Offers to help/Employment
FORM LETTER-
Letterhead
.Policy
.Physicians
REROUTE:
Casework
.Scheduling
President
Other
POLICY AND PERSONAL STORIES:
.ORGANIZATION (I)
.insurance premiums
.insurance reform
.insurance pools
boards and oversight
. C O V E R A G E (II)
working families
unemployed/low income
benefits
providers
. I N F R A S T R U C T U R E / W O R K F O R C E (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
. G O V E R N M E N T PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
FINANCING (VII)
MENTAL H E A L T H (EX)
L O N G - T E R M C A R E (X)
.PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
.rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
QL-
cii-n
�.V
March13,1993
Health Care Task Force
1600 Pennsylvania Avenue
Washington,D.C.
Dear Mrs. Clinton,
Our prayers and hopes are with you as your task force works to make health care
available for a reasonable cost to every American. I believe the following should be an
integral part of your plan:
I.Tort Reform
The threat of malpractice is a major factor in the ordering of unnecessary
diagnostic labs, exams, procedures and consults. Accident litigation and claims result
in tremendous medical costs with unnecessary radiology exams, orthopaedic and
neurologic evaluations and physical therapy treatments. Add to this the legal costs,
insurance costs, and the burden on our judicial system-all of which drain our
economy.
2.Limit access to unnecessary medical care
A large percent of medical costs are incurred in the last six months of a
patient's life. We have an obligation to keep patients comfortable and without pain.
Excessive tests, procedures, and treatments which do not change management or
prolong quality life should be discouraged. Too often, I am begged by terminally ill
patients not to perform tests which their doctors order and their families demand.
Our society must leam to accept and allow terminally ill patients to die.
3.National effort to reduce smoking, alcohol consumption, drugs and
violence.
4.Coordinating on a state level individuals, families, and small businesses"*
into larger groups to negotiate with HMO's, PPO's and private insurers for affordablehealth insurance options.
—
5.Standardize insurance coding and billing forms to reduce overhead cost
throughout the health care industry. Currently, two billing specialists per physician
are required due to the maze of paperwork.
6.Do not regulate professional fees.
- 1-
�The Medicare fee schedule now in place reimburses physicians $.30-.40
per dollar billed. Physicians cannot even meet overhead costs. Medicare patients are
being turned away because physicians lose money whenever a Medicare patient walks
through the door. Medicaid is worse. Most physicians I know perform a tremendous
amount of gratis work. They cannot remain in practice if the government controls fees
in the manner of Medicare.
HMO's, PPO's.and private carriers are already negotiating with medical
professionals . Fees are being reduced, in many instances 30-50%. The fee side of the
health care system is coming under control without the need for government
intervention.
7.Allow a tax deduction for health care premiums paid by the individual
and keep health care benefits provided by employers from being taxed.
I am a physician and have practiced Diagnostic Radiology for ten years. I paid
for medical school by serving active duty at Bethesda Naval Hospital. I was privileged
to participate in the care of President Reagan. I currently practice in Silver Spring.Md.
in both a large community hospital and private outpatient center. My husband is an
orthopaedic surgeon in solo practice.
I helped organize and participate in Montgomery County Medical Society's
Physician in the Classroom program. Our goal is to educate students regarding the
hazards of smoking to the individual and the cost to society. I have been involved in
helping state prosecutors and social service agencies obtain medical evidence in child
abuse cases.as well as, been available as an expert witness. The group with which I
practice provides radiology services for Catholic Charities. I am on the Board of
Directors for Holiday Hearts, a non-profit organization providing food, clothing,
books, toys and Santa to D.C. indigent children each Christmas. I am active in the PTA
at our ten year old son's elementary school and the Woodside Neighborhood
Association.
I firmly believe our health care system needs to be changed. It must be
accessible, affordable, and practical. I would be glad to contribute my time,
knowledge, and experience, as well as a physician's perspective, to your health care
task force.
Sincerely,
,
Patricia P. Shapiro, M.D.
- 2 -
�CODER:
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
GENERAL SORT:
POSTCARD 1:
.General mail
Personal stories
.Letter Campaign
Other Health Providers
POSTCARD 2:
.Offers to help/Employment
FORM LETTER:
Letterhead
.Policy
.Physicians
REROUTE:
Casework
.Scheduling
President
Other
POLICY AND PERSONAL STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (H)
working families
__unemployed/low income
.benefits
.providers
.INFRASTRUCTURE/WORKFORCE (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
.FINANCING (VII)
.MENTAL HEALTH (EX)
.LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
AIDS
.women's health
.immunizations/children
.rural
urban
OTHER
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
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White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
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2006-0885-F
Text
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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[Physician Letters] [loose] [4]
Creator
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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Reproduction-Reference
Date Created
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3/16/2015
Source
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42-t-12092992-20060885F-Seg3-005-011-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/186d0c92f70b20fc7ef1b39091997a4d.pdf
1bb03243826fd5b59890e39c5acaf651
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
2385
OA/ID Number:
FolderlD:
Folder Title:
[Physician Letters] [loose] [3]
Stack:
Row:
Section:
Shelf:
Position:
S
56
3
4
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. form
SSN (Partial) (1 page)
n.d.
P6/b(6)
002a. statement
re: Medical records worksheet (1 page)
n.d.
P6/b(6)
002b. statement
re: Explanation of Medicare benefits (2 pages)
03/04/1993
P6/b(6)
002c. statement
re: Health care claim summary (1 page)
03/10/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [3]
2006-0885-F
im786
RESTRICTION CODES
Presidential Records Act - (44 U.S.C 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) nf the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�UAVID L. Si'] Ni'l-'H M.D
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March 2, 1993
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Mrs. Hillary Rodman-Clinton
Chairman of Health Care
Task Force of The White House
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Mrs. Clinton,
I am writing to volunteer my services in any way i can to your health care task force.
I am a private practitioner in orthopedic spine surgery in Park Ridge at Lutheran
General Hospital. In view of the fact, that I have an exceptionally lucrative practice with
a net yield income of over $2,000000.00 per year, I am iri an excellent position to know
where the excesses are to give my perspective on what would be able to be done to
eliminate the excesses in the particular nitch of medicine that I am involved in,
particularly spine and back surgery care,
incerely,
M
DAy i D L. iSPENQER, M.D.
DtS/ban
KEL..-.,.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�January 26,1993
Dear Mrs. C l i n t o n ,
I j u s t wanted t o take t h i s o p p o r t u n i t y t o congratulate you
on your recent appointment t o head the task force t o look i n t o
changing the h e a l t h care system. Needless t o say, i t i s a mess
and s o r e l y i n need of major, d r a s t i c surgery. I would l i k e t o
o f f e r my services t o you i n t h i s endeavor. I o f f e r no s p e c i a l
experience other than being a p r a c t i c i n g p h y s i c i a n who has seen
and had t o deal w i t h the i n e q u i t i e s of the present system. My two
areas of p r a c t i c e are Family Medicine ( I have a p r i v a t e p r a c t i c e
w i t h two other physicians) and A d d i c t i o n Medicine ( I am the
Medical D i r e c t o r of an Alcohol and Drug Treatment Program).
Please f e e l f r e e t o c a l l on me, should the need a r i s e .
The r e a l reason behind t h i s l e t t e r , however, i s t h a t I
promised my 6 1/2 y r . o l d daughter, A l l i s o n t h a t I would send the
attached l e t t e r t o your husband. Please forward t h i s on ( i f you
should see him any time soon !) a t your convenience.
There are a l o t of doctors out here who are j u s t w a i t i n g f o r
t h i s t h i n g t o be f i x e d . We went i n t o medicine t o take care of
people and have been saddled w i t h the excesses of p r i o r (and
present) generation's abuses of the system. As a primary care
doc, I have seen the de-humanization of medicine go hand i n hand
w i t h the increase i n high tech, m a l p r a c t i c e , p a t i e n t d i s s a t i s f a c t i o n , and high costs. Medical school t r a i n i n g emphasizes the
pathology and disease and r a r e l y t a l k s about the p a t i e n t t h a t
surrounds the problem. Sorry, d i d n ' t mean t o get going on t h i s .
Once again, best of luck, and please l e t me know i f there i s
anything t h a t I can do f o r you group.
Sincerely yours,
Gary C. Wainer,
D.O.
��CODER:
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:
A.
OENERAL SORT:
POSTCARD 1
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_General mail
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FORM L E T T E R :
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REROUTE:
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POLICY AND PERSONAL STORIES:
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. C O V E R A G E (II)
working families
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benefits
providers
I N F R A S T R U C T U R E / W O R K F O R C E (III)
quality assurance (guidelines)
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& information systems
malpractice & tort reform
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^unnecessary procedures
. G O V E R N M E N T PROGRAMS (IV)
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_COST ISSUES (VI)
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MENTAL H E A L T H (IX)
L O N G - T E R M C A R E (X)
PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
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OTHER
��IRONWOOD FAMILY PRACTICE
920 Ironwood Drive
Coeur d'Alene, Idaho 83814
DONALD R. CHISHOLM, M.D.
DAVID L. CHAMBERS, M.D.
TIMOTHY F. BURNS, M.D.
(208) 667-4557
THOMAS A. NEAL, M.D.
HAROLD R. THYSELL, M.D.
(208) 664-8251
A p r i l 1, 1993
Ms. H i l l a r y Rodham C l i n t o n
Health Care Task Force
The White House
1600 Pennsylvania Avenue
Washington, D.C.. 20500
Re:
CLIA Program
Dear Ms. C l i n t o n ,
I am w r i t i n g t o you out of f r u s t r a t i o n from the Government regulations of
the CLIA program that have been put upon us over t h i s past year. I n the
normal ways of bureaucracy, they have inundated us w i t h forms and more forms
to be f i l l e d out i n order to maintain our laboratory.
These regulations may be important f o r the large laboratories that are
doing thousands of tests on a regular basis. However, physician groups
such as ours maintain a very small laboratory, doing a few tests that
would be p e r t i n e n t to help quickly i d e n t i f y problems f o r p a t i e n t s , so
that we can t r e a t them appropriately and i n a timely manner. Please
believe me when I say that we have chosen simple t e s t s that are quite easy
to perform and stay w i t h i n the range of our expertise as physicians and not
laboratory technologists.
However, because a t e s t f o r streptococcal i n f e c t i o n s has been deemed a
moderately complex t e s t by the CLIA program, we have been regulated to
f i l l out m u l t i p l e forms. I am including those forms, HCFA-114, HCFA-116,
as w e l l as a copy of the forms that accompanied these, t o explain what
they were f o r and how they were to be f i l l e d out, as w e l l as the benefits
to the patients that w i l l occur because of t h i s .
I f you a c t u a l l y take the time t o go through these forms and f i n d yourself
confused, going back and f o r t h amongst them while t r y i n g to understand
them, please f i n d comfort i n that you are not alone.
�A p r i l 1, 1993
Mrs. H i l l a r y Rodham C l i n t o n
Health Care Task Force
Re: CLIA Program
Page Two
Our group was lucky enough to be blessed w i t h a couple of o t h e r . a d d i t i o n a l ,
confusing f a c t o r s . One i s t h a t we were issued two separate CLIA numbers,
which required a few phone c a l l s and a d d i t i o n a l l e t t e r s i n t r y i n g to get
t h i s cleared. This was f i n a l l y accomplished and a l l the forms were mailed
out i n December. I n March of 1993, I received the next l e t t e r , which I
have enclosed and labeled " L e t t e r B", i n d i c a t i n g that they had not received
the forms which were sent to them i n December.
I understand that mistakes can be made by anyone. But as our bureaucratic
system becomes more complex, there are more areas i n which mistakes can be
made. Thank goodness i n t h i s case I had made a copy of each of the forms
that I had f i l l e d out, predated and w i t h my signature because, i f I had
not done t h i s , not only would I have needed to take the three hours to
again read and f i l l out the forms a p p r o p r i a t e l y , I also would have had to
reorder the forms as they d i d not include them w i t h t h e i r second l e t t e r .
I aplologize f o r t h i s lengthy l e t t e r , but I hope you understand the f r u s t r a t i o n that we physicians w i t h a small laboratory have had w i t h CLIA regulations.
I f t h e i r goal i s to close us down and have only the large l a b o r a t o r i e s
a v a i l a b l e , I hope they keep i n mind that these large l a b o r a t o r i e s are not
available 24 hours and on weekends i n smaller towns such as ours.
I know t h a t the health system i s complex. I r e a l i z e and believe that changes
must be made f o r the good of a l l that are involved. I wish you only the
best i n your endeavors t o make those changes f o r the good of a l l Americans,
including those who work i n the health care f i e l d . I f I , as a family
physician i n a small p r a c t i c e , from a small to medium sized c i t y , can be of
any service t o you, please f e e l free to contact me, as I would l i k e to take
an active r o l e i n helping t o formulate the changes i n health care.
Sincerely,
Timothy F. Burns, M.D.
TFB:cj
�IRONWOOD FAMILY PRACTICE
920 Ironwood Drive
Coeur d'Alene, Idaho 03814
DONALD R. CHISHOLM, M.D.
DAVID L. CHAMBERS, M.D.
TIMOTHY F. BURNS. M.D.
(208) 667-4537
April
5,
THOMAS A. NE7VL, M.D.
HAROLD R. THYSELL, M.D.
(208) 664-8251
1993
Region X
DHHS/HCFA/DHSQ/CLIA Program
2201 Sixth Avenue, RX-42
Seattle, Washington 98121
Dear Sirs:
Once again, I f i n d myself wasting my time i n responding to bureaucratic
mistakes. I t has become.very apparent to me that the CLIA Program
(Big Brother Approach) i s very i n e f f i c i e n t and w i l l help only i n r a i s i n g
our cost of health care, not making sure i t i s safe f o r the p u b l i c .
On re-examining your l e t t e r sent i n March I see that the CLIA ID number
that you have us l i s t e d under i s 13D0711718 which i s not our correct
CLIA ID number. As you w i l l see i n one of the enclosed l e t t e r s we.had
received two ID numbers. A f t e r various telephone c a l l s and l e t t e r s i t
was corrected w i t h your department that our c e r t i f i c a t e number would be
13D0679680 not the number addressed on your March 11th l e t t e r . Please
make sure that t h i s i s corrected once again i n your f i l e s so that we do
not have to go through t h i s process once again.
I am including copies of forms HCFA-114 and HCFA-116. As you w i l l note
on. the dates that were f i l l e d out and signed, t h i s was done i n December
of 1992, as per your f i r s t request. I am also including copies of l e t t e r s
that I sent, not only to your o f f i c e but the Office of Management and
Budget as w e l l as the Office of Financial Management at the time. I
hope you w i l l f i n d these forms complete and that gradually you w i l l come
to -understand the f r u s t r a t i o n i t causes physicians such as our group
which t r y to maintain a very small o f f i c e laboratory f o r the convenience
of the p a t i e n t s .
Sincerely,
Timothy F. Burns, M.
TFB:ii
enclosures
D.
�a«»
v , r
8
».t.,
DEPARTMENT OF HEALTH & HUMAN SERVICES
Health Care Financing AdmB
Clinical Laboratory Improvement Amendments of 1988
P.O. Box 26689
Baltimore, MD 21207-0489
March 11, 1993
IRONWOOD FAMILY PRACTICE PA
920 W IRONWOOD DR
COEUR D ALENE ID 83814-2643
CLIAID#: 13D0711718
II..I,„II,I..IM„II,I..IMI,I,II,..I„IMII.„.III
Dear Laboratory Director:
A few months ago you should have received application materials concerning the Clinical
Laboratory Improvement Amendments (CLIA) program. This material consists of two forms, the
HCFA-114 and HCFA-116, and explanatory information to assist you in completing these forms.
To date, we have not received your completed materials.
If you intend to continue laboratory testing, the filing of this application material is required under
Section 353 of the Public Health Service Act. You are required to submit the HCFA-114 and
HCFA-116 fonns which collect specific information required in the CLIA regulations published
February 28, 1992. This information is essential to complete your registration under CLIA and to
accurately calculate the compliance fee if your laboratory performs nonwaived tests and is subject
to an onsite survey. As required by law, these fonns must be completed and returned without
delay even if you have already submitted the HCFA-109 questionnaire used initially to identify
laboratories for CLIA and received a CLIA Registration Certificate or Certificate of Waiver.
If you no longer perform laboratory testing at this site, or if the testing performed at this site is
reflected under another certificate, please provide us with written notification so that our records
can be corrected. Such notification should be sent to:
CLIA Program
P.O. Box 26689
Baltimore, Maryland 21207-0489
If you need additional application materials, you may contact your State agency (usually a
component of the State health department for licensure), your HCFA regional office (see reverse
side of this letter) or call (410) 290-5850. You can also write to the address listed above to obtain
this material. Note that no payment should be submitted with the application materials. Payment
will be requested at a later date.
IQBRS
�^ lllVK-,,
DEPARTMENT OF HEALTH & HUMAN SERVICES
Health Care Financing Administration
Clinical Laboratory Improvement Amendments of 1988
P.O. Box 26689
Baltimore, MD 21207-0489
HCFA REGIONAL OFFICES
Region I
DHHS/HCFA/DHSQ/CUA Program
Room 1211
JFK Federal Office Building
Boston, Massachusetts 02203
(617) 565-1307
(CT, ME, MA, NH, RI, VT)
Region II
DHHS/HCFA/DHSQ/CUA Program
26 Federal Plaza
New York, New York 10007
(212) 264-2003
Region HI
DHHS/HCFA/DHSQ/CUA Program
P.O. Box 7760
Philadelphia, Pennsylvania 19101
(215) 596-4144
Region IV
DHHS/HCFA/DHSQ/CUA Program
101 Marietta Tower
Atlanta, Georgia 30323
(404) 331-0083
(DE, DC, MD, PA, VA, WV)
(AL, F L , GA, K Y , MS, NC, SC, TN)
Region V
DHHS/HCFA/DHSQ/CUA Program
105 West Adams Street, 15th Floor
Chicago, Illinois 60603
(312) 886-4392
(IL, IN, MI, MN, OH, WI)
Region VH
DHHS/HCFA/DHSQ/CUA Program
Federal Office Building
601 East 12th Street
Kansas City, Missouri 64106
(816) 426-2011
(IA, KS, MO, NE)
Region VI
DHHS/HCFA/DHSQ/CUA Program
1200 Main Tower Building
Dallas, Texas 75202
(214) 767-6301
(AR, LA, NM, OK, TX)
Region VIH
DHHS/HCFA/DHSQ/CUA Program
Federal Office Building
1961 Stout Street
Denver, Colorado 80294
(303) 844-4721 ext. 451
(CO, MT, ND, SD, UT, WY)
Region IX
DHHS/HCFA/DHSQ/CUA Program
75 Hawthorne Street, 4th Floor
San Francisco, California 94105
(415) 744-3695
(AZ, CA, HI, NV)
Region X
DHHS/HCFA/DHSQ/CUA Program
2201 6th Avenue, RX-42
Seattle, Washington 98121
(206) 553-8165
(AK, ID, OR, WA)
(NJ, NY, PR, VI)
�DEPARTMENT OF HEALTH AND HUMAN SERVICES
I
I f f
HEALTH CARE FINANCING ADMINISTRATION
Dear Laboratory Director:
This i s t o ackncwledge receipt of your HCFA-109 "Information t o Implement the C l i n i c a l
Laboratory Improvement Amendments of 1988 (CLIA)." I f you have received your remittance
fee coupon and paid your fee, but have not received your appropriate c e r t i f i c a t e , i t w i l l
be forwarded shortly. I f you have not yet paid t h i s fee, you should do so as soon as
possible since the c e r t i f i c a t e w i l l not be issued u n t i l such payment i s received.
Enclosed are CLIA application forms (HCFA-116 and HCFA-114) which must be ccnpleted and
returned w i t h i n 30 days of receipt. As required by law and as part of the application
process, a l l laboratories must ccmnplete both forms. These forms collect information about
your laboratory's operation that i s essential to update the national database and t o
calculate the compliance fee i f your laboratory performs non^waived testing. In addition,
t h i s information w i l l provide the laboratory surveyor an overview of the laboratory
operations f o r those f a c i l i t i e s subject to onsite survey.
Please remove the preprinted label frcm the envelope and place i t on the f i r s t page of the
HCFA-116 over the space provided f o r the CLIA i d e n t i f i c a t i o n number and laboratory name and
address (upper l e f t comer). Indicate any changes i n the appropriate area on the form.
The information sutmitted should r e f l e c t your laboratory operations (hours of operation,
number of testing personnel, qualifications of director, etc.) as of September 1, 1992, or
the date the form i s carpieted, whichever i s later.
When coqpleting information on laboratory personnel, indicate a l l individuals involved i n
laboratory testing. You should include individuals who are not direct employees of the
laboratory, but rather who work under a per diem or contractual arrangement.
I f we have not received your c e r t i f i c a t e fee or i f you are subject to survey and must pay a
compliance fee, a fee remittance coupon w i l l be mailed to you upon receipt of the completed
application forms. I f you are currently accredited by a major accrediting organization or
your State has applied for exemption, we may hold t h i s coupon for a period of time to avoid
duplication of payment.
In addition t o the application forms we are also enclosing a glossary of terms to assist
you i n conpleting the application. This glossary c l a r i f i e s terms used on the forms,
p a r t i c u l a r l y focusing on personnel and the specific responsibilities of each laboratory
position required by CLIA. We have also provided a basic explanation of the survey
process.
Thank you f o r your cooperation. I f you need additional information concerning CLIA, or i f
you have questions not addressed i n the instructions, c a l l (410) 290-5850 or w r i t e t o the
following address:
HCFA CLIA Program
P.O. Box 26679
Baltimore, MD 21207-0479
Enclosures
�BASIC EXPLANATION QF IHE SURVEY PROCESS
W O WILL BE SURVEYED?
H
Laboratories not seeking a c e r t i f i c a t e of accreditation frcm an approved accreditation
organization, a c e r t i f i c a t e of waiver, or laboratories that are located i n States with
approved licensure programs, are required t o pay a ccnpllance fee based on t h e i r annual
test volume and the number of laboratory specialty areas. Subsequent t o the payment of the
compliance fee t o the Health Care Financing Administration (HCFA), a laboratory w i l l be
scheduled for survey.
NOTE: Laboratories with a c e r t i f i c a t e of waiver are not subject t o routine surveys;
however, they may be surveyed by HCFA or i t s agent t o investigate conplaints or t o v e r i f y
that only waived tests are being performed. A small percentage of laboratories with a
c e r t i f i c a t e of accreditation may be surveyed by HCFA or i t s designee t o investigate
conplaints as well as t o validate the accreditation organizations' survey process,
laboratories i n States with approved licensure programs are surveyed f o r State licensure
requirements, not the C l i n i c a l Laboratory Improvement Amendments of 1988 (CLIA)
requirements. However, a percentage of such laboratories w i l l be subject t o validation
surveys performed by HCFA. You w i l l be n o t i f i e d by your State laboratory licensure program
i f your State i s approved for exenption from CLIA.
W O CONDUCTSTOESURVEYS?
H
Surveys are conducted by individuals from HCFA or i t s agent (usually State survey agencies
i n the State Department of Health). Surveyors are generally health professionals
experienced i n laboratory medicine, who have received specialized training and are
knowledgeable about the regulations implementing CLIA. Surveyors w i l l make every effort, t o
minimize the impact of the survey on the laboratory operations and patient care a c t i v i t i e s .
The survey process i s designed t o be e f f i c i e n t , but complete.
SURVEY AND CERTIFICATION PROCESS
Upon a r r i v a l a t the f a c i l i t y the surveyor(s) w i l l meet with pertinent s t a f f , p a r t i c u l a r l y
the laboratory director i f available, t o explain the purpose of the survey, the time
schedule and the survey process. The survey w i l l include v e r i f i c a t i o n of infonration
submitted on the application forms, a tour of the laboratory areafs), observance of
performance of testing ( i f possible), interviews with s t a f f , review of records ( i . e . , test
results, requisitions, q u a l i t y control data, proficiency testing data) and v e r i f i c a t i o n of
personnel qualifications. The laboratory may also be required t o corplete additional forms
during or following the survey. This infontation w i l l be used t o assist i n determining
whether the laboratory meets the CLIA requirements. Upon completion of the survey the
surveyor w i l l hold an e x i t conference with appropriate laboratory s t a f f . I n t h i s meeting
the surveyor w i l l discuss his/her findings and w i l l permit the laboratory t o provide
additional information t o resolve differences regarding deficiencies (areas where the
laboratory does not meet the CLIA regulations). The surveyor w i l l also provide
instructions t o the laboratory for submitting information on hew the deficiencies w i l l be
corrected (referred t o as a plan of correction or POC). I t i s the responsibility of the
laboratory t o determine the action necessary t o remedy the problem.
The surveyor w i l l reconmend t o t h e i r supervisor whether or not the laboratory has been
found i n conpliance with the regulations. The HCFA regional o f f i c e w i l l make the f i n a l
determination.
Once i t i s determined the requirements are met, the laboratory w i l l receive
i t s CLIA c e r t i f i c a t e . The c e r t i f i c a t e i s v a l i d for two years.
�DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTH CARE FINANCING ADMINISTRATION
Dear Laboratory Director,
Thank you for your response to the Clinical Laboratory Improvement Amendments of 1988 (CLIA) questionnaire. On February
28, 1992, the U.S. Department of Health and Human Services (HHS) issued final regulations, as required by law, implementing
CLIA. These regulations require all U.S. clinical laboratories to possess a CLIA certificate as of September 1, 1992. A laboratory is
defined as a facility performing testing of materials derived from the human body for purposes of diagnosis, prevention, treatment,
or health assessment. This definition includes offices of physicians conducting patient testing.
All laboratories subject to CLIA must obtain either a CLIA certificate of waiver or a CLIA registration certificate. To determine
which certificate is appropriate for your laboratory, please review the Certificate Schedule on the reverse of this letter.
^ If your laboratory performs only tests listed on the waived list, it qualifies for a certificate of waiver.
• All other laboratories must obtain a registration certificate. These laboratories are divided into Schedules A through J according to the number of laboratory testing specialties and annual testing volume.
CLIA legislation requires financing of all regulatory program costs through fees assessed to laboratories. To determine your
certification fee, please complete the enclosed CLIA FEE REMITTANCE COUPON. Check the coupon box indicating your
laboratory's certificate classification, and enter the corresponding fee amount in the "amount due" box. Please follow the important
instructions on the back of the coupon, and mail your coupon and payment in the enclosed envelope.
Following receipt of your coupon and fee payment, the Health Care Financing Administration (HCFA) will issue your laboratory
a CLIA certificate valid for up to two years.
,
The law requires that you have a certificate to allow yoii to continue testing under CLIA. If you do even one test, you must
register with the Health Care Financing Administration or you will not be in compliance with the law. This includes even commonly performed tests, such as KOH prep, rapid strep (strep kits), nasal smears, initial culture inoculation, analysis of skin scraping,
etc.
Laboratories issued a certificate of waiver will not be subject to biennial inspections to determine compliance with CLIA requir
ments; however, they may be subject to random inspectiofe to ensure that tests cohducteH'ale only in%e v/aivM 'category'' £fif£r
laboratories will be issued a registration certificate and wWlfe"subject to b i e ^ i M M i t t S ! ' r " " -' ' J
R
'
jralonea io possess u "A cmmcate •
S-jptev
t. 1992. A laboratory is
CLIA permits more than one laboratory to operate UndmiSingle eertificate.ifct^eypprfeprm limited^e.g.^feiW-types: of .tests)ipubiic
health testing and are directed by a common not-for-profrit,r(i^Federal;.State, or localigovemment organization. In addition, laboratories within a hospital that are under common direction and ^ated.at the same street ad^re^s can^apply, at their.discretion^for a ,
single certificate to cover all testing sites at the same address'or apply for separate^certificates for e&h
'^p^^nr6f:xrvi^ "
However, if neither of these exceptions applies to your opfeVafioris, each site must havePits own certificate. If additforml coupons are
required, contact the HCFA CLIA program at the address below."
"
If you conduct laboratory testing and are covered by the Clinical Laboratory Improvement Amendments of 1988, you
must comply with this letter to receive your CLIA certificate or you are subject to penalties under the law.
1
a
e t , l
r £
b
h
w
i,n
e
,,emcnli,1
,ein,in(
If you do not conduct laboratory testing subject to CLIArplease sign below, and send this letter to:
HCFA CLIA Program
P.O. Box 26687
Baltimore, MD 21207-9487
If you need additional information concerning CLIA, write to the above address or call (410) 290-5850.
I DO NOT CONDUCT LABORATORY
TESTING SUBJECT TO CLIA.
•
^ •
(signature)
Enclosure: HCFA-35A CLIA Fee Remittance Coupon
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•
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�WAIVED TESTS LIST
• Fecal Occult Blood
• Ovulation Test - visual color comparison
• Urine Pregnancy Test
- visual color comparison
• Erythrocyte Sedimentation Rate
- nonautomated
• Hemoglobin - copper sulfate,
- nonautomated
• Spun Microhematocrit
• Blood Glucose, using monitoring devices cleared by
the FDA specifically for home use
• Dipstick or Tablet Urinalysis, for:
-bilirubin
-glucose
- hemoglobin
- ketone
- leukocytes
- nitrite
- specific gravity
- pH
- protein
- urobilinogen
If you conduct only testing from the WAIVED TESTS list, you must obtain and pay for a certificate of waiver. The certificate cost is $100
and is valid for two years or until you begin conducting tests not included in the WAIVED TESTS list. To obtain a certificate of waiver,
please check the block indicating that you are requesting a certificate of waiver and enter $100 in the "Enter Amount Due" block on the
enclosed coupon. Submit the coupon and a check for $100 to the address shown.
. SCHEDULES FOR DETERMINING REGISTRATION CERTIFICATE USER FEES
If you conduct tests not on the waived tests list, you must determine under which schedule your laboratory fits based on the number of
specialties and the volume of testing.
The main specialty areas for laboratory testing include: Histocompatibility, Microbiology, Diagnostic Immunology, Chemistry,
Hematology, Immunohematology, Pathology, Radiobioassay, and Clinical Cytogenetics.
NOTE: Do not include tests run for quality control, quality assurance or proficiency testing when estimating total volume. Also note that
each profile (group of tests) is counted as the number of separate procedures or examinations; for example, a chemistry profile consisting of
18 tests is counted as 18 separate procedures or tests.
If the testing you conduct falls within Schedules A (Low-volume) through C, below, the registration certificate will cost $100.
Please enter $100 in the "Enter Amount Due" block on the enclosed coupon.
•
•
•
•
Schedule
Schedule
Schedule
Schedule
A (Low-volume) - not more than 2,000 tests annually;
A - no more than 3 specialties of service with annual volume of more than 2,000 but not more than 10,000 tests;
B - at least 4 specialties of service with annual volume of not more than 10,000 tests;
C - no more than 3 specialties of service with annual volume of more than 10,000 but not more than 25,000 tests.
If the testing you conduct falls within Schedules D through G, below, the registration certificate will cost $350.
Please enter $350 In the "Enter Amount Due" block on the enclosed coupon.
•
•
•
•
Schedule
Schedule
Schedule
Schedule
DEF G-
at least 4 specialties of service with annual volume of more than 10,000 but not more than 25,000 tests;
more than 25,000 but not more than 50,000 tests annually;
more than 50,000 but not more than 75,000 tests annually;
more than 75,000 but not more than 100,000 tests annually.
If the testing you conduct falls within Schedules H through J , below, the registration certificate will cost $600.
Please enter $600 in the "Enter Amount Due" block on the enclosed coupon.
• Schedule H - more than 100,000 but not more than 500,000 tests annually;
• Schedule I - more than 500,000 but not more than 1,000,000 tests annually; and
• Schedule J - more than 1,000,000 tests annually.
�DEPARTMENT OF HEALTH & HUMAN SERVICES
OHice of the Secretary
''•mni.*'
Washington, D C.
September 1,
20201
1992
STATEMENT BY SECRETARY LOUIS W. SULLIVAN,
Regarding CLIA I m p l e m e n t a t i o n
M.D.
The C l i n i c a l L a b o r a t o r y Improvement Amendments o f 1988 are
among t h e most complex and c h a l l e n g i n g r e g u l a t i o n s which t h e
Department o f H e a l t h and Human S e r v i c e s has ever had t o
implement. The i n t e n t i o n of t h e CLIA law i s one t h a t i s shared
s t r o n g l y by t h e A d m i n i s t r a t i o n , Congress and h e a l t h care
p r o f e s s i o n a l s : t o ensure t h e q u a l i t y and r e l i a b i l i t y o f m e d i c a l
t e s t s performed by c l i n i c a l l a b o r a t o r i e s t h r o u g h o u t t h e n a t i o n .
However, t h i s law mandates a s i g n i f i c a n t i n c r e a s e i n f e d e r a l
r e g u l a t o r y o v e r s i g h t , and a l l o f those i n v o l v e d i n implementing
t h e s t a t u t e r e c o g n i z e t h e p o t e n t i a l f o r u n i n t e n d e d consequences
which c o u l d a c t u a l l y h i n d e r r a t h e r t h a n improve p a t i e n t care.
The Department i s committed t o implementing CLIA and
a c h i e v i n g i t s d e s i r e d e f f e c t s w i t h a minimum o f d i s r u p t i o n t o
h e a l t h care p r o f e s s i o n a l s and w i t h o u t n e g a t i v e impacts on
p a t i e n t s . Over t h e past''months and y e a r s , we have c o n s u l t e d
c a r e f u l l y w i t h p h y s i c i a n s , l a b o r a t o r y p r o f e s s i o n a l s and o t h e r s
t o achieve a p r o p e r balance i n our r e g u l a t i o n s . I n p a r t i c u l a r ,
we have sought approaches t h a t would ensure t h e r e l i a b i l i t y of
t e s t s w i t h o u t r e d u c i n g p a t i e n t access t o t e s t s .
The development o f CLIA r e g u l a t i o n s has been an e v o l v i n g
process. Problems i n t h e i n i t i a l p r o p o s a l s were r e c o g n i z e d and
e x t e n s i v e changes were made, e s p e c i a l l y i n response t o comments
by p h y s i c i a n s .
F i n a l r e g u l a t i o n s were p u b l i s h e d February 28, but
because t h e Department r e c o g n i z e d t h a t t h e r e were s t i l l concerns
about t h e r e g u l a t i o n , i t i n c l u d e d an a d d i t i o n a l comment p e r i o d t o
s o l i c i t f u r t h e r p u b l i c i n p u t . Based on these comments, t h e
Department w i l l be making f u r t h e r changes t o t h e r u l e s . I have
sought t o make c l e a r , and I reemphasize today, t h a t we w i l l
c o n t i n u e t o l e a r n more as we phase i n t h e new CLIA s t r u c t u r e .
The Department of H e a l t h and Human S e r v i c e s i s committed t o
making t h e changes and a d j u s t m e n t s t o t h e c u r r e n t r u l e t h a t prove
necessary t o achieve t h e d e s i r a b l e g o a l s o f CLIA w i t h o u t imposing
unnecessary burden on h e a l t h care p r o f e s s i o n a l s and w i t h o u t
i m p a c t i n g n e g a t i v e l y on p a t i e n t care.
As CLIA p r o v i s i o n s go i n t o e f f e c t today, i t i s i m p o r t a n t f o r
p h y s i c i a n s and o t h e r s t o keep i n mind t h e e v o l v i n g n a t u r e o f t h i s
r e g u l a t o r y s t r u c t u r e . The Department w i l l c o n t i n u e t o accept and
analyze comments on t h e impacts and e f f e c t s o f CLIA p r o v i s i o n s .
I t i s our hope t h a t CLIA i m p l e m e n t a t i o n w i l l i n v o l v e an ongoing
p a r t n e r s h i p w i t h t h e p h y s i c i a n community.
�Page 2
I n p a r t i c u l a r , t h e Department i s r e v i e w i n g comments on t h e
c l a s s i f i c a t i o n s o f s p e c i f i c t e s t s . Some 10,000 t e s t procedures
were assigned c o m p l e x i t y r a t i n g s , and some o f t h e s e
c l a s s i f i c a t i o n s a r e b e i n g reviewed based on i n f o r m a t i o n made
a v a i l a b l e d u r i n g t h e comment p e r i o d . We a n t i c i p a t e t h a t when t h e • ' • '
f i n a l i z e d c o m p l e x i t y l i s t i s p u b l i s h e d t h i s f a l l , t h e r e w i l l be
some changes i n c l a s s i f i c a t i o n s based on i n f o r m a t i o n r e c e i v e d , f i j,.,.
I n a d d i t i o n , we a r e e s p e c i a l l y concerned t h a t f u r t h e r •
•
m o d i f i c a t i o n o f t h e CLIA r e g y i a t i o n s may be necessiary' f o r some ' I • -J-UX .
microscopy t e s t s .
I t i s not. c l e a r t h a t CLIA' 'oversight w i l l add
t o r e l i a b i l i t y o f t h i s work when performed by t h e p h y s i c i a n , and
f u r t h e r m o d i f i c a t i o n o f t h e r e g u l a t i o n s may w e l l be necessary.
I f necessary, we w i l l i n v i t e , comment f o r t h i s area s p e c i f i c a l l y .
Necessary changes t o t h e f i n a l r e g u l a t i o n s w i l l be p u b l i s h e d w i t h
responses t o comments on t h e r e g u l a t i o n s l a t e r t h i s y e a r . I n t h e
meantime, e x i s t i n g p h y s i c i a n p r a c t i c e s and p a t i e n t c a r e w i l l n o t
be a f f e c t e d .
:
1
v
!
W i t h r e g a r d t o t h e mechanics o f CLIA i m p l e m e n t a t i o n , s e v e r a l
p o i n t s a r e o f importance f o r t h e p h y s i c i a n who w i l l be a f f e c t e d
by CLIA over t h e next two y e a r s :
The process o f s u r v e y i n g c l i n i c a l l a b o r a t o r i e s w i l l
begin w i t h t h e l a r g e s t f a c i l i t i e s .
Thus most o f t h e
surveys t h i s year w i l l i n v o l v e ' those commercial and
h o s p i t a l l a b o r a t o r i e s which were a l r e a d y s u b j e c t t o
f e d e r a l o v e r s i g h t . The f i r s t b i a n n u a l i n s p e c t i o n s o f
p h y s i c i a n s ' f a c i l i t i e s w i l l t a k e p l a c e i n 1993 and
1994 .
The purpose of the initial inspection of physiciian- • -...y y^y--M
f a c i l i t i e s w i l l be, p r i m a r i l y e d u c a t i o h a l . " ' i f
-y
inspectors f i n d t h a t a physician's o f f i c e laboratory ; ' does n o t meet c e r t a i n CLIA s t a n d a r d s a t t h e time' o f ' the-'••'
i n s p e c t i o n , t h e l a b w i l l be asked'to come i n t o
compliance w i t h t h e s t a n d a r d s and w i l l be p r o v i d e d
t e c h n i c a l a s s i s t a n c e i n e x p l a i n i n g o p t i o n s f o r meeting
the standards.
S a n c t i o n s would o n l y be a p p l i e d i f
c o n d i t i o n s posed immediate j e o p a r d y t o p a t i e n t h e a l t h .
S a n c t i o n s w i l l n o t be a p p l i e d due t o a f a i l u r e t o meet
t e c h n i c a l CLIA standards as o f September 1. The
purpose i s t o a s s i s t p h y s i c i a n s i n meeting CLIA
s t a n d a r d s and a s s u r i n g a c c u r a t e t e s t r e s u l t s .
i:
H
!
L a b o r a t o r i e s l o c a t e d i n p h y s i c i a n s ' o f f i c e s , where
unannounced i n s p e c t i o n s c o u l d d i s r u p t p a t i e n t c a r e ,
w i l l be surveyed on an announced b a s i s , so t h a t d o c t o r s
can schedule t i m e f o r meeting w i t h i n s p e c t o r s .
( C u r r e n t l y r e g u l a t e d commercial l a b o r a t o r i e s w i l l
c o n t i n u e t o be i n s p e c t e d on an unannounced b a s i s , as
w i l l i n s p e c t i o n s a r i s i n g from unusual suspected
problems o r c o m p l a i n t s . )
:
�Page 3
Even though l a b o r a t o r i e s should have r e g i s t e r e d w i t h
HCFA under CLIA by Sept. 1, HCFA w i l l c o n t i n u e t o pay
l a b o r a t o r y c l a i m s w i t h o u t r e g a r d t o CLIA r e g i s t r a t i o n
u n t i l Dec. 1. During t h i s phase-in p e r i o d ,
laboratories (including physicians' offices) f i l i n g
c l a i m s w i l l be n o t i f i e d o f t h e need t o r e g i s t e r , i f
t h e y have n o t a l r e a d y done so.
I n a d d i t i o n , CLIA q u a l i t y standards have been developed
t a k i n g i n t o account t h e s p e c i a l circumstances o f p h y s i c i a n s '
o f f i c e s . These p r o v i s i o n s as w e l l w i l l be phased i n over a
reasonable t i m e p e r i o d :
Requirement t o p a r t i c i p a t e i n p r o f i c i e n c y t e s t i n g
programs begins i n 1994, a l l o w i n g t i m e t o s c a l e up
these programs and e n r o l l p h y s i c i a n f a c i l i t i e s .
Sanctions f o r f a i l i n g p r o f i c i e n c y t e s t i n g begin i n
1995.
Almost a l l p h y s i c i a n s w i l l q u a l i f y a u t o m a t i c a l l y as a
lab d i r e c t o r by v i r t u e o f t h e i r experience i n r u n n i n g
t h e i r own l a b o r t h e i r t r a i n i n g i n r e s i d e n c y .
For t h e
few d o c t o r s who do n o t f a l l i n t o these c a t e g o r i e s , a
year w i l l be a l l o w e d t o o b t a i n c o n t i n u i n g medical
e d u c a t i o n i n these areas.
A l l p h y s i c i a n l a b s , i n c l u d i n g those d o i n g t h e most
complex t e s t s , can c o n t i n u e u s i n g t h e i r c u r r e n t t e s t i n g
p e r s o n n e l as l o n g as t h e personnel have a t l e a s t a h i g h
school diploma and t r a i n i n g f o r t h e l a b t e s t work they
p e r f o r m , and a r e a p p r o p r i a t e l y s u p e r v i s e d . A t t h e end
of f i v e y e a r s , personnel d o i n g t h e most complex t e s t s
would be expected t o complete an a s s o c i a t e degree i n
medical t e c h n o l o g y .
F i n a l l y , a number o f s m a l l r u r a l h o s p i t a l s commented t h a t
t h e February 28 CLIA r e g u l a t i o n s would impose a g r e a t h a r d s h i p on
t h e i r laboratories. Specifically, the hospitals said that the
p e r s o n n e l r e q u i r e m e n t s f o r i n d i v i d u a l s p e r f o r m i n g h i g h l y complex
t e s t s and t h e r e q u i r e m e n t f o r 24-hour s u p e r v i s i o n o f t h e
personnel would mean t h a t many o f t h e i n d i v i d u a l s who have been
p e r f o r m i n g t e s t s i n these f a c i l i t i e s f o r many years would n o t be
a b l e t o c o n t i n u e t o p e r f o r m t h e t e s t s , p r i m a r i l y because t h e r e
would be no s u p e r v i s i o n f o r n i g h t s h i f t s i n t h e l a b s .
I n r e c o g n i t i o n o f t h i s problem, HHS r e v i s e d t h e r e g u l a t i o n s
t o p e r m i t i n d i v i d u a l s c u r r e n t l y employed and p e r f o r m i n g h i g h l y
complex t e s t s t o c o n t i n u e , u n t i l we i s s u e f u r t h e r r e g u l a t i o n s , t o
work i n t h e absence o f o n - s i t e s u p e r v i s i o n , p r o v i d e d t h e work
performed i s checked w i t h i n 24 hours. T h i s w i l l g i v e us t i m e t o
r e e v a l u a t e t h i s r e q u i r e m e n t , and a t t h e same t i m e w i l l p r e v e n t
d i s r u p t i o n o f l a b o r a t o r i e s , e s p e c i a l l y those i n r u r a l areas.
�Page 4
An e x i s t i n g CLIA r e q u i r e m e n t t h a t p r o v i d e s some r e l i e f t o
s m a l l r u r a l h o s p i t a l s , as w e l l as o t h e r l a b o r a t o r i e s , i s t h e
p r o v i s i o n t h a t those t e s t i n g p e r s o n n e l who a r e r e q u i r e d t o have
an a s s o c i a t e degree i n o r d e r t o c o n t i n u e t o p e r f o r m t e s t i n g w i l l
have f i v e years t o o b t a i n t h e degree. T h i s p r o v i s i o n as w e l l was
designed t o b l e n d r e q u i r e m e n t s f o r q u a l i t y w i t h a concern f o r
m i n i m i z i n g t h e d i s r u p t i o n i n t h e l a b o r a t o r y community,
p a r t i c u l a r l y i n t h e r u r a l community.
***
Today's p a t i e n t b e n e f i t s s i g n i f i c a n t l y from t h e a v a i l a b i l i t y
o f h i g h q u a l i t y l a b o r a t o r y t e s t i n g , made p o s s i b l e e s p e c i a l l y due
t o advancing t e c h n o l o g y . An i n c r e a s i n g number and v a r i e t y o f
l a b o r a t o r y t e s t s a r e a c c e s s i b l e today, w i t h i n c r e a s i n g
convenience and o f t e n a t lower c o s t , t h r o u g h t h e performance o f
t e s t i n g and a n a l y s i s i n p h y s i c i a n s ' o f f i c e s .
Because o f t h e
growth o f such t e s t i n g , t h e CLIA s t a t u t e has extended f e d e r a l
r e g u l a t i o n s t o l a b o r a t o r y f a c i l i t i e s o f a l l s i z e s . However, i n
implementing t h i s law, t h e Department o f H e a l t h and Human
S e r v i c e s seeks t o a v o i d unnecessary r e g u l a t i o n s which would
d i s c o u r a g e p h y s i c i a n s from o f f e r i n g t h e t e s t i n g i n t h e s e t t i n g o f
t h e i r o f f i c e s o r o t h e r w i s e impede good p a t i e n t care.
We pledge
t o work w i t h p h y s i c i a n s , l a b o r a t o r y p r o f e s s i o n a l s , p a t i e n t groups
and o t h e r s t o achieve t h e g o a l s o f CLIA w i t h o u t i n f l i c t i n g
u n a n t i c i p a t e d and unnecessary n e g a t i v e impacts on h e a l t h care
professionals or t h e i r patients.
###
�^
I
DEPARTMENT OF HEALTH & HUMAN SERVICES
/ f l /
Health Care Financing Administration
Clinical Laboratory Improvement Amendments of 1988
P.O. Box 26689
Baltimore, MD 21207-0489
September 1, 1992
IRONWOOD MEDICAL LABORATORY
920 IRONWOOD DR
COEUR D' ALENE, ID 83814
Dear Administrator:
Re: Federal Certification of Laboratories Under the Clinical Laboratory Improvement
Amendments of 1988
The Clinical Laboratory Improvement Amendments of 1988 (Public Law 100-578) establish Federal
Requirements for the regulation and certification of clinical laboratories. With few exceptions, CLIA
applies to all laboratories performing testing of human specimens for diagnosis or treatment. The law
takes effect on September 1, 1992.
Our records indicate that you are the type of provider that does laboratory testing, and that you are not
currently enrolled in the CLIA program. If you have not applied for a CLIA certificate it is unlawful
to perform laboratory testing after September 1, 1992. All claims for Medicare and Medicaid
laboratory services provided on or after September 1, 1992 are subject to recovery, should you fail to
register for a CLIA certificate. The statute further provides, at Section 353 (1) for fines and/or
"
imprisonment for any person who intentionally violates CLIA requirements.
To obtain information on how to participate in the CLIA program, please call (410)290-5850, or write
to:
""^
HCFA CLIA PROGRAM
P.O. Box 26689
Baltimore, Maryland 21207-0489
If you have recently completed and submitted an enrollment application, please ignore this notice. If
not, you should file immediately. Thank you for your cooperation.
Anthony J. Tirone, Director
Office of Survey and Certification
Health Standards and Quality Bureau
\-i\mxfm
�NEW FKDEKAI, RliQUIRKMENTS FOR REGULATION AND CERTIFICATION OF
CLINICAL LABORATORY TESTING
This is to advise you of a new Federal program established hy the Congress to improve the quality and
reliability of clinical laboratory testing, and to notify you of new legal requirements that will apply to
you if you conduct any laboratory tests that fall under the law.
We ask that you complete the enclosed request for information in order for us to begin planning.
There will be no fees collected until you have had an opportunity to review the CLIA standards regulation and determine whether vou want to continue to provide laboratory testing.
WHAT IS THE PURPOSE OF THE NEW FEDERAL REQUIREMENTS?
The Clinical Laboratory Improvemenl Amendments of 1988 (CLIA), P.L. 100-578 (42 U.S.C. 263a), require
all clinical laboratories to meet quality standards and to be ceililied by the U.S. Department of Health and
Human Services. The law also requires that the administration and enforcement of this law be financed by
fees paid by laboratories for this purpose.
DOES THE NEW LAW APPLY TO ME?
CLIA applies to virtually all laboratory testing of human specimens. For example, a physician's office, health
fair, school, nursing home, and any facility perfonning any laboratory test used for,heajthj.|JUipj)ses,i^oniatter
how simple or routine, are subject to the CLIA requirements. s
(
Specifically, the law applies to any
"biological, microbiological, serological, chemical, immunohematological, hematological^biophysical,
cytological, pathological, or other examination of materials derived from the human body for the
purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings."
.... ,.
ARE THERE ANY EXCEPTIONS TO THE CLIA LAW?
;
There are very limited exceptions. CLIA does NOT apply to:
•
any laboratory that conducts testing solely for forensic purposes;
•
research laboratories that test human specimens but do not report any patient-specific results for the
diagnosis, treatment, or assessment ofthe health of individual patients;
9 persons, such as home healih agency employees, who only assist patients in their home wilh testing
kits approved by the Food and Drug Administration for personal use; or
•
individuals or entities which serve as collection stations, but which send all specimens out to a
certified laboratory for analysis.
'
"'^
1
r v
1
WHAT IF 1 OPERATE LABORATORIES AT SEVERAL LOCATIONS?
A
Each geographic location will be treated separately, with the following exceptions: a hospital with multiple " '
laboratories may complete one questionnaire to encompass its multiple locations or one for each location.
Also, a Public Health laboratory which conducts testing at multiple locations has the option of completing one
for all locations or one for each location.
�DID T H E CONGRESS ESTABLISH OTHER REQUIREMENTS?
The law requires laboratories to meet quality standards established in regulations. We expect to issue final
regulations setting quality standards by early 1992. (A proposed set of Federal standards was published in the
Federal Register on May 21.1990.) Once these standards are in effect, almost all laboratories will be required
to comply with them and will be subject to inspection and verification of laboratory procedures.
W I L L F E E S BE C O L L E C T E D ? WHAT W I L L THEY B E USED FOR?
At this time, no fees will be collected until you have had an opportunity to review the CLIA standards regulation and detennine whether you want to continue to provide laboratory testing. When fees are collected, they
will be cost-based, and will include administrative, inspection and other costs associated with CLIA. Fees
will vary based on the volume of tests and type of tests performed, and related factors. Only nominal lees will
be assessed for certain laboratories doing very simple, low risk types of tests, and for small, low volume
laboratories;
WHERE CAN I G E T ADDITIONAL INFORMATION ABOUT T H E C L I A PROGRAM?
The definition of a laboratory, the requirements for certification, legal penalties for failure lo comply, the
authority for fees, and most other CLIA matters are set forth in detail in the law as enacted by the Congress.
Many libraries have copies of Federal laws.
In addition, we plan to issue final regulations in the near future. These will be published in the Federal
Register. They will be entered in the Code of Federal Regulations at 42 CFR Part 493, Subpart F. You may
view and photocopy the Federal Register document at most libraries. If your local library does not have it,
you can call the Federal Register order desk operator at (202) 783-3238 for the location of the Government
Depository Library near you.
Alternatively, if you learn ofthe publication date(s) of these rules from the newspaper, a professional journal,
or another source, you may order copies ofthe Federal Register containing this document by sending your
request to the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 204029325. Specify the date of Ihe issue requested and enclose a check payable to the Superintendent of Documents, or enclose a VISA or MASTER CARD number and expiration dale. Credit card orders can also be
placed by calling the order desk on (202) 783-3238 or by faxing to (202) 275-6802. The cost for each copy is
$ 1.50.
IF I AM SUBJECT TO CLIA, WHAT SHOULD I DO AT THIS TIME?
Please read this announcement carefully if you conduct laboratory testing and detennine that the law applies
to you. Please complete lhe request for information and return it in the enclosed envelope. If after reviewing
the announcement, you detennine that the law does not affect you, you need do nothing.
HOW CAN I G E T ANSWERS TO MY SPECIFIC QUESTIONS ABOUT HOW THIS LAW
AFFECTS ME?
If you have specific questions about whether the law applies to you or how to fill out the fonn, you may
address a written inquiry to:
HEALTH C A R E FINANCING ADMINISTRATION
ATTN: C L I A LABORATORY INQUIRY
P.O. BOX 26687
BALTIMORE, MD 21207-0487
�|
Jtt
/yp
HealthCare
Financing Administration
November 29, 1991
Dear Laboratory Director:
The Clinical Laboratory Improvement Amendments of 1988 (CLIA) establish Federal requirements for the
regulation and certification of clinical laboratories. With few exceptions, CLIA applies to all laboratories
performing testing of human specimens for diagnosis and treatment. Essentially all laboratories that test human
specimens for the purpose of diagnosis andNor treatment are subject to the provisions of CLIA.
The Department of Health and Human Services is currently developing regulations to implement this law. In
the near future, we plan to publish in the Federal Register the regulations establishing the standards laboratories
must meet. As a first step in implementing the law, it will be necessary for all laboratories to complete the
enclosed form. The information from the form is necessary for the administration of the CLIA program.
CLIA mandates that the Federal regulatory program be financed through user fees; that is, charging each
laboratory its appropriate share of the costs of the program. However, no fees will be solicited or collected at
this time. Once the regulations specifying the standards are published, you will have the opportunity to review
the standards and determine whether you wish to continue to provide laboratory testing. If you decide to
continue testing, you will be subject to Federal regulations and must complete the application for a certificate
and pay the appropriate user fee.
Enclosed is a brief explanation ofthe law including some questions and answers to assist you in determining
whether or not your laboratory is subject to CLIA. If the laboratory you direct appears to be subject to CLIA,
please complete the enclosed form and return it to the Health Care Financing Administration. This information
should be sent in the enclosed envelope within 60 days ofthe date of this letter.
Some individuals or organizations may receive this letter even though they perform no laboratory testing since
we are using comprehensive mailing lists to identify all laboratories. If you do not conduct testing subject to
CLIA, please disregard this Idler.
Thank you for your cooperation.
Enclosures:
1. Explanation of the Law
2. Information Fonn
�IDAHO MEDICAL
ASSOCIATION
P.O BOX 2668 • 305 W JEFFERSON • BOISE, IDAHO • 83701 • (206) 344 7888
SPECIAL REPORT - 4
06/10/92
HCFA Issues Final CLIA Rules
The Health Care Financing Administration (HCFA) has published final rules impiementing the Clinical
Laboratory Improvement Act of 1988 (CUA '861), The |aw subjects all labs, including physician office
labs (POLs), to federal standards. Most of the rpqijlrements in the new regulations, which cover quality
assurance, proficiency testing, ahd personnel requirements, will be phased in gradually starting
September 1, 1992. This Special Report provides a general overview of the rules and outlines steps
physicians can take to assure they comply with tham.
'
In November 1991, HCFA distributed approjdfna^ely 625,000 survey forms entitled "Information to
implement the Clinical Laboratory Improvement Amendments of 1988' (form HCFA-109). Recipients ^
were directed to complete and return the form by January 29. 1992. Physicians who did not comple*^'- * *
the survey or who misplaced it should obtain another by writing to the Health Care Financial
Administration, Attn: CUA Laboratory Inquiry, PO Box 26687, Baltimore, MD, 21207-0487. There is^h^
penalty for physicians who complete and return the survey promptly.
HCFA is currently reviewing survey responses and began billing each lab for the registration fee in May.
Each individualized bill will be based on Information from-completed surveys. Upon receipt of the CLIA
registration fee, HCFA will provide POLs with a registration certificate, which will remain in effect for two
years or until the state sun/ey ing body has inspected and licensed each lab.
Physicians who do not have the registration certificate by September 1 will have payment withheld for
Medicare lab services. Those who do not have the certificate by January 1,1993 will be subject to civil
monetary penalties.
Standards in the final rules are based on the complexity of lab testing. HCFA will issue four types of
certificates: a certificate of waiver; a certificate for labs performing moderately or highly complex testing-irr,;
a certificate of accreditation; and a registration certificate, issued on an interim basis until HCFA can--,
determine the laboratory meets applicable CUA requirements.
CERTIFICATES OF WAIVER
A laboratory that limits itself to performing tests on the waiver list is essentially exempt from most CUA
requirements. It does not have to participate in proficiency testing, meet the quality control/quality assurance standards of the rules, or comply with the personnel standards. Waivered labs are required'?
to follow manufacture's instructions ^nd are subject to unannounced Inspections under certain
circumstances. Labs in this category must pay a $100 biennial certificate of waiver fee.
HCFA estimates that out of more than 10,000 laboratory tests currently performed, about 75 percent
are In the moderately complex category, 24 percent are highly complex, and one percent or less are
waived. To date, HCFA has classified about 5,000 tests. The remaining 5,000 will be categorized prior
to the rules' September 1 effective date. This means some labs will be unable to determine their
categorization until the additional tests are published in the Federal Register.
�Certificate of Waiver Tests
*Dlpetlck or Tablet Reagent Urlnalysla (nonautomated) for: bilirubin, leukocytes, protein, glucose, nitrate, specific gravity,
hemoglobin, pH, urobilinogen, ketone
*Fecal occult blood
'Ovulation tests - visual color tests for human luteinizing hormone
•Urine pregnancy tests - visual color comparison determination
'Erythrocyte sedimentation rate (nonautomated)
''Hemoglobin (by copper sulfate)
'Spun microhematocrit
'Blood glucose (FDA-cleared home use devices)
The rules allow test manufacturers to apply to the Food and Drug Administration to have specific tests
categorized as part of their pre-market approval process. New tests coming on the market wilt then
have a CUA categorization.
,
PERSONNEL STANDARDS (waived labs exempt)
Personnel standards for laboratories vary under the regulations depending upon the type of testing.
Moderate Complexity:
Under the moderately complex category,' personnel standards are defined for the lab director, clinical
consultant, technical consultant and testing personnel. Physicians will qualify as lab directors If they
have had a least one year of experience directing or supervising non-waived tests. This "grandfather*
provision should cover most physicians. If physicians do not have the experience, they are allowed to
take a 20-hour continuing medical education course in laboratory practice to qualify. Physicians can
also meet the standard if they had lab training during medical residency.
The rule provides that a lab director can oversee up to five laboratories. This means one Individual
could serve as director for a group practice with several satellite labs (however, each lab location must
apply for a separate certificate). Lab directors are responsible for the overall operation and
administration of the laboratory including the employment of competent personnel to perform testing.
They must be available to the lab to provide on-site telephone or electronic consultation as needed.
The requirements for technical consultants are the same as for lab directors. Their responsibilities
include technical and scientific oversight. The lab must employ one or more Individuals qualified as
a technical consultant in each of the specialties and subspecialties of testing performed. Technical
consultants are not required to be on site at all times, but must be available on an as needed basis.
Clinical consultants are to serve as the liaison between the lab and its clients in matters relating to
reporting and interpreting results. Generally, physicians will serve in this role. Testing personnel are
responsible for specimen processing, test performance and for reporting test results. Educational
requirements include, at minimum, a high school diploma and documentation of appropriate training.
High Complexity:
-.. . . .
CUA rules require more stringent personnel standards for laboratories performing highly complex tests.
The rules set personnel standards for the director, technical supervisor, general supervisor, clinical
consultant and testing personnel.
,,
Physicians will qualify to serve as director only If they are board certified as a pathologist or If they have
at least two years experience directing or supervising high complexity testing. Physicians who had at
least one year of laboratory training during medical residency (certified, in either hematology or
hematology and medical oncology by the American Board of Internal Medicine) will also qualify.
�Technical supervisor requirements range form a bachelor's degree In one of the sciences plus four
years of training or experience to a board certified pathologist. There are additional requirements for
labs that perform tests in certain subspecialties.
General supervisors must have a doctoral, master's or bachelor's degree in medicine or the sciences,
and one year of appropriate laboratory training or experience. Associate degrees are allowed only if
the individual possesses two years of experience or training.
Personnel performing complexity testing without supervision must have at least an associate degree in
laboratory science. High school graduates who do not have an associate degree have until September
1, 1997, to obtain the degree while they continue working. However, a general supervisor must be onsite to-provide direct supervision when they perform high complexity tests.
PROFICIENCY TESTING (waived Sabs exempt)
All moderately complex and highly complex labs must participate in an approved proficiency testing (PT)
program for each specialty in which they perform testing. Newly regulated laboratories will have until
January 1, 1004 to enroll in a PT program and will have one year to participate before enforcement
begins. Labs will not be penalized for unsuccessful participation in PT until 1995. HCFA estimates the
annual cost of PT for physician office labs will be about $900. Labs already subject to federal
regulation must continue to participate in PT, with no grace period penalties.
PT consists of five samples for each analyze or test and will take place three times per year. A lab
must score 80 percent on two out of three testing events to meet CUA standards. If a lab fails PT,
it can lose the ability to perform testing until the standard is met.
QUALITY CONTROL (waived labs exempt)
Each laboratory must have written quality control (QC) procedures for the analytic testing process of
each test method. There are separate QC procedures for cytology. During the first two years the
regulations are in effect for tests in the moderately complex category, laboratories can follow the
manufacturers's quality control instructions for instruments, kits, or test systems which are cleared by
the FDA for in vitro diagnostic use. Labs must have a procedure manual, perform calibration at least
every six months and perform QC with two levels of control each day the test system is used.
The FDA will evaluate products and test to see if they meet CUA requirements. By September 1, 1994,
laboratories can rely on manufacturer instructions for the tests cleared by the FDA. If a test is not
cleared by the FDA, full CUA QC requirements will apply.
PATIENT T E S T MANAGEMENT (waived labs exempt)
Each laboratory is required to employ and maintain a system that provides for proper patient
preparation; proper specimen collection; identification, preservation, transportation and processing; and
accurate result reporting. This rule also requires that test records be maintained for five years.
QUALITY ASSURANCE (waived labs exempt)
Laboratories are required to follow written policies and procedures as part of a comprehensive quality
assurance program. Programs must include policies on patient test management; quality control;
proficiency testing; comparison of test results; relationship of patient information to test results;
personnel; communications; complaint investigations; QA review with staff; and QA records.
�INSPECTIONS
Laboratories with a CUA certificate will be inspected every two years. HCFA will contract with the
Oregon Health Division to conduct the inspections. L abs with certificates of accreditation, or state
exempt labs whose state regulations are comparable to CUA, will be inspected only in response to
complaints or as part of HCFA's sample validation inspections. Waived labs may be subject to
unannounced compliance inspections. During inspections, the laboratory is required to allow Interviews
with employees; access to all testing areas; access to observe employees performing tests, data
analysis and reporting; and a review of all information and data necessary to determine compliance.
Failure to permit an inspection will result in the suspension of Medicare and Medicaid reimbursement
or termination of participation in these programs.
USER FEES
CLIA requires that HCFA fund implementation and enforcement through user fees. Registration fees
are payable every two years and range from $100-$600, depending upon the scope and volume of
testing. Certificate of waiver and certificate of accreditation labs pay a $100 fee every two years
regardless of the volume of testing. Inspection fees will vary since they are based on the amount HCFA
must pay each state to conduct inspections.
APPLICATION PROCESS
Laboratories that completed the sun/ey will receive the necessary information and forms from HCFA to
register the lab. The sun/ey is still available from HCFA at the address listed on page one.
Laboratories must apply for the applicable certificate utilizing forms prescribed by HCFA. Each
laboratory location must apply for a certificate, except hospital labs located in the same physical
location, or not-for-profit, federal, state or local government labs with multiple locations engaged in
limited public health testing. In submitting an application, a laboratory must agree to permit inspections,
make records available and submit reports required by HCFA, treat proficiency testing sample the same
as patient samples, and operate the laboratory in accordance with CUA regulations.
Laboratories are required to notify HCFA within 30 days of changes in ownership, laboratory name,
location, or of certain management personnel; prior to performing tests not listed int he waived category
if the laboratory has a certificate of waiver; or within six months of any change in testing.
The IMA will continue to follow the implementation of CUA '88 and will notify membership as to any
additional requirements relative to claims submission to Medicare.
�GLOSSARY OF TERMS
The f o l l o w i n g i s a b r i e f c l a r i f i c a t i o n o f terms t h a t a r e used i n
t h e CLIA r e g u l a t i o n s and on t h e CLIA a p p l i c a t i o n forms (HCFA-114
and HCFA-116). T h i s g l o s s a r y has been prepared t o a s s i s t i n your
c o m p l e t i o n o f t h e a p p l i c a t i o n forms.
HCFA-116. "General
Information"
I n s e c t i o n s I V and V t h e term " l o c a t i o n / s i t e " r e f e r s t o t h e area
where l a b o r a t o r y t e s t i n g i s performed.
I n s e c t i o n IX " t y p e o f c o n t r o l " r e f e r s t o t h e o v e r a l l a f f i l i a t i o n
of t h e l a b o r a t o r y ' s operation.
I n s e c t i o n X " t y p e o f ownership" r e f e r s t o t h e s t r u c t u r e o f t h e
e n t i t y u l t i m a t e l y responsible f o r operating t h e business
enterprise.
I n t h e s e c t i o n l a b e l e d Consent, "reasonable t i m e " r e f e r s t o any
t i m e d u r i n g which l a b o r a t o r y t e s t i n g i s performed.
HCFA-114, " L a b o r a t o r y Personnel Report"
On t h e HCFA-114 t h e f o l l o w i n g i n f o r m a t i o n r e p r e s e n t s t h e
r e s p o n s i b i l i t i e s o f l a b o r a t o r y p e r s o n n e l p e r f o r m i n g non-waived
t e s t i n g as s e t f o r t h i n t h e r e g u l a t i o n s . We a r e p r o v i d i n g t h i s
i n f o r m a t i o n as w e l l as an e x p l a n a t i o n o f t r a i n i n g and e x p e r i e n c e ,
where a p p r o p r i a t e , t o a s s i s t you i n t h e c o m p l e t i o n o f t h e
HCFA-114. S e c t i o n s and codes a r e r e f e r e n c e d t o t h e "Key t o t h e
Q u a l i f i c a t i o n Codes" found on pages 6-12 o f t h e HCFA-114.
LABORATORIES PERFORMING WAIVED TESTS
While l a b o r a t o r i e s p e r f o r m i n g o n l y waived t e s t s do n o t have t o
meet p e r s o n n e l r e q u i r e m e n t s , we a r e r e q u e s t i n g i n f o r m a t i o n
r e g a r d i n g t h e l a b o r a t o r y d i r e c t o r ( t h e person w i t h o v e r a l l
r e s p o n s i b i l i t y f o r l a b o r a t o r y t e s t i n g ) and t h e t e s t i n g p e r s o n n e l
( i n d i v i d u a l s who a r e i n v o l v e d i n p e r f o r m i n g l a b o r a t o r y t e s t s ) .
T h i s i n f o r m a t i o n w i l l complete t h e d e p i c t i o n o f a l l e n t i t i e s
conducting laboratory t e s t i n g .
LABORATORIES PERFORMING MODERATE OR HIGH COMPLEXITY TESTS
(The r e s p o n s i b i l i t i e s o f l a b o r a t o r y p e r s o n n e l can be found i n
s e c t i o n M o f t h e CLIA r e g u l a t i o n s p u b l i s h e d February 28, 1992.)
�LABORATORY DIRECTOR RESPONSIBILITIES
The d i r e c t o r must meet t h e q u a l i f i c a t i o n r e q u i r e m e n t s l i s t e d i n
S e c t i o n I o f t h e HCFA-114 f o r t h e l e v e l o f t e s t i n g p e r f o r m e d .
The t y p e o f e x p e r i e n c e r e q u i r e d under t h e r e g u l a t i o n i s c l i n i c a l
i n nature.
T h i s means d i r e c t i n g o r s u p e r v i s i n g p e r s o n n e l who
examine and p e r f o r m t e s t s on human specimens f o r t h e purpose o f
p r o v i d i n g i n f o r m a t i o n t h a t i s used i n d i a g n o s i n g , t r e a t i n g , and
m o n i t o r i n g a p a t i e n t ' s c o n d i t i o n . T h i s e x p e r i e n c e may i n c l u d e
the l a b o r a t o r y d i r e c t o r p e r s o n a l l y examining and p e r f o r m i n g t e s t s
on p a t i e n t specimens. P a t i e n t care o r m e d i c a l l y o r i e n t e d
e x p e r i e n c e , which i s d e f i n e d as t h e o r d e r i n g o f t e s t s and
i n t e r p r e t i n g and a p p l y i n g t h e r e s u l t s o f these t e s t s i n
d i a g n o s i n g and t r e a t i n g a p a t i e n t ' s i l l n e s s , i s u n a c c e p t a b l e t o
meet t h e r e q u i r e m e n t f o r l a b o r a t o r y t r a i n i n g o r e x p e r i e n c e .
Teaching e x p e r i e n c e d i r e c t l y r e l a t e d t o a m e d i c a l t e c h n o l o g y
program, c l i n i c a l l a b o r a t o r y s c i e n c e s program o r a c l i n i c a l
l a b o r a t o r y s e c t i o n o f a r e s i d e n c y program i s c o n s i d e r e d
a c c e p t a b l e e x p e r i e n c e . Research e x p e r i e n c e i s a l s o a c c e p t a b l e
e x p e r i e n c e i f i t i s o b t a i n e d w h i l e p e r f o r m i n g t e s t s on human
specimens.
For moderate c o m p l e x i t y t e s t i n g , t h e 20 CMEs may be o b t a i n e d
c o n c u r r e n t l y w h i l e a c t i n g as l a b o r a t o r y d i r e c t o r u n t i l
August 2, 1993. T h e r e a f t e r , t h e 20 CMEs must be o b t a i n e d p r i o r
t o q u a l i f y i n g as a l a b o r a t o r y d i r e c t o r . Courses r e l a t e d t o
l a b o r a t o r y reimbursement and CPT c o d i n g would n o t f u l f i l l t h i s
requirement.
Laboratory d i r e c t o r r e s p o n s i b i l i t i e s —
Moderate Complexity T e s t i n g (see 493.1307)
The l a b o r a t o r y d i r e c t o r i s r e s p o n s i b l e f o r t h e o v e r a l l o p e r a t i o n
and a d m i n i s t r a t i o n o f t h e l a b o r a t o r y , i n c l u d i n g t h e employment o f
p e r s o n n e l who a r e competent t o p e r f o r m t e s t p r o c e d u r e s , r e c o r d
and r e p o r t t e s t r e s u l t s p r o m p t l y , a c c u r a t e l y , and p r o f i c i e n t l y t o
assure compliance w i t h t h e a p p l i c a b l e r e g u l a t i o n s .
(a) The l a b o r a t o r y d i r e c t o r , i f q u a l i f i e d , may p e r f o r m t h e
d u t i e s o f t h e t e c h n i c a l c o n s u l t a n t , c l i n i c a l c o n s u l t a n t , and
t e s t i n g p e r s o n n e l , o r d e l e g a t e these r e s p o n s i b i l i t i e s t o
p e r s o n n e l meeting t h e a p p r o p r i a t e q u a l i f i c a t i o n s ,
respectively.
(b) I f t h e l a b o r a t o r y d i r e c t o r r e a p p o r t i o n s performance o f h i s
o r h e r r e s p o n s i b i l i t i e s , he o r she remains r e s p o n s i b l e f o r
e n s u r i n g t h a t a l l d u t i e s a r e p r o p e r l y performed.
(c)
The l a b o r a t o r y d i r e c t o r must be a c c e s s i b l e t o t h e l a b o r a t o r y
t o p r o v i d e o n s i t e , t e l e p h o n e o r e l e c t r o n i c c o n s u l t a t i o n as
needed.
(d) Each i n d i v i d u a l may d i r e c t no more t h a n f i v e l a b o r a t o r i e s .
(e) The l a b o r a t o r y d i r e c t o r must —
�(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Ensure t h a t t e s t i n g systems developed and used f o r each
o f t h e t e s t s performed i n t h e l a b o r a t o r y p r o v i d e
q u a l i t y l a b o r a t o r y services f o r a l l aspects o f t e s t
performance, which i n c l u d e s t h e p r e a n a l y t i c , a n a l y t i c ,
and p o s t a n a l y t i c phases o f t e s t i n g ;
Ensure t h a t t h e p h y s i c a l p l a n t and e n v i r o n m e n t a l
conditions of the laboratory are appropriate f o r t h e
t e s t i n g performed and p r o v i d e a s a f e environment i n
which employees a r e p r o t e c t e d from p h y s i c a l , c h e m i c a l ,
and b i o l o g i c a l hazards;
Ensure t h a t —
(i)
The t e s t methodologies s e l e c t e d have t h e
capability of providing the q u a l i t y of results
required f o r p a t i e n t care;
(ii)
V e r i f i c a t i o n procedures used a r e adequate t o
d e t e r m i n e t h e accuracy, p r e c i s i o n , and o t h e r
p e r t i n e n t performance c h a r a c t e r i s t i c s o f t h e
method; and
(iii)
Laboratory personnel are performing t h e t e s t
methods as r e q u i r e d f o r a c c u r a t e and r e l i a b l e
results;
Ensure t h a t t h e l a b o r a t o r y i s e n r o l l e d i n an HHS
approved p r o f i c i e n c y t e s t i n g program f o r t h e t e s t i n g
performed and t h a t —
(i)
The p r o f i c i e n c y t e s t i n g samples a r e t e s t e d as
r e q u i r e d under s u b p a r t H o f t h e r e g u l a t i o n s ;
(ii)
The r e s u l t s a r e r e t u r n e d w i t h i n t h e timeframes
e s t a b l i s h e d by t h e p r o f i c i e n c y t e s t i n g program;
(iii)
A l l p r o f i c i e n c y t e s t i n g reports received are
reviewed by t h e a p p r o p r i a t e s t a f f t o e v a l u a t e
t h e l a b o r a t o r y ' s performance and t o i d e n t i f y any
problems t h a t r e q u i r e c o r r e c t i v e a c t i o n ; and
(iv)
An approved c o r r e c t i v e a c t i o n p l a n i s f o l l o w e d
when any p r o f i c i e n c y t e s t i n g r e s u l t s a r e found
t o be unacceptable o r u n s a t i s f a c t o r y ;
Ensure t h a t t h e q u a l i t y c o n t r o l and q u a l i t y assurance
programs a r e e s t a b l i s h e d and m a i n t a i n e d t o assure t h e
q u a l i t y o f l a b o r a t o r y s e r v i c e s p r o v i d e d and t o i d e n t i f y
f a i l u r e s i n q u a l i t y as they occur;
- Ensure t h e e s t a b l i s h m e n t and maintenance o f a c c e p t a b l e
l e v e l s o f a n a l y t i c a l performance f o r each t e s t system;
Ensure t h a t a l l necessary r e m e d i a l a c t i o n s a r e t a k e n
and documented whenever s i g n i f i c a n t d e v i a t i o n s from t h e
l a b o r a t o r y ' s e s t a b l i s h e d performance s p e c i f i c a t i o n s a r e
i d e n t i f i e d , and t h a t p a t i e n t t e s t r e s u l t s a r e r e p o r t e d
o n l y when t h e system i s f u n c t i o n i n g p r o p e r l y ;
Ensure t h a t r e p o r t s o f t e s t r e s u l t s i n c l u d e p e r t i n e n t
information required f o r i n t e r p r e t a t i o n ;
Ensure t h a t c o n s u l t a t i o n i s a v a i l a b l e t o t h e
l a b o r a t o r y ' s c l i e n t s on m a t t e r s r e l a t i n g t o t h e q u a l i t y
o f t h e t e s t r e s u l t s r e p o r t e d and t h e i r i n t e r p r e t a t i o n
concerning s p e c i f i c p a t i e n t c o n d i t i o n s ;
�(10)
(11)
(12)
(13)
(14)
Employ a s u f f i c i e n t number o f l a b o r a t o r y p e r s o n n e l w i t h
t h e a p p r o p r i a t e e d u c a t i o n and e i t h e r e x p e r i e n c e o r
t r a i n i n g t o provide appropriate c o n s u l t a t i o n , properly
s u p e r v i s e and a c c u r a t e l y p e r f o r m t e s t s and r e p o r t t e s t
r e s u l t s i n accordance w i t h t h e p e r s o n n e l
responsibilities;
Ensure t h a t p r i o r t o t e s t i n g p a t i e n t specimens, a l l
p e r s o n n e l have t h e a p p r o p r i a t e e d u c a t i o n and
experience, receive the appropriate t r a i n i n g f o r the
t y p e and c o m p l e x i t y o f t h e s e r v i c e s o f f e r e d , and have
demonstrated t h a t t h e y can p e r f o r m a l l t e s t i n g
o p e r a t i o n s r e l i a b l y t o p r o v i d e and r e p o r t a c c u r a t e
results;
Ensure t h a t p o l i c i e s and procedures are e s t a b l i s h e d f o r
m o n i t o r i n g i n d i v i d u a l s who conduct p r e a n a l y t i c a l ,
a n a l y t i c a l , and p o s t a n a l y t i c a l phases o f t e s t i n g t o
assure t h a t t h e y are competent and m a i n t a i n t h e i r
competency t o process specimens, p e r f o r m t e s t
procedures and r e p o r t t e s t r e s u l t s p r o m p t l y and
p r o f i c i e n t l y , and whenever necessary, i d e n t i f y needs
f o r remedial t r a i n i n g or c o n t i n u i n g education t o
improve s k i l l s ;
Ensure t h a t an approved procedure manual i s a v a i l a b l e
t o a l l p e r s o n n e l r e s p o n s i b l e f o r any a s p e c t o f t h e
t e s t i n g process; and
S p e c i f y , i n w r i t i n g , t h e r e s p o n s i b i l i t i e s and d u t i e s o f
each c o n s u l t a n t and each person, engaged i n t h e
performance o f t h e p r e a n a l y t i c , a n a l y t i c , and
p o s t a n a l y t i c phases o f t e s t i n g , t h a t i d e n t i f i e s which
examinations and procedures each i n d i v i d u a l i s
a u t h o r i z e d t o p e r f o r m , whether s u p e r v i s i o n i s r e q u i r e d
f o r specimen p r o c e s s i n g , t e s t performance o r r e s u l t s
r e p o r t i n g , and whether c o n s u l t a n t o r d i r e c t o r r e v i e w i s
required p r i o r t o reporting patient t e s t results.
Laboratory d i r e c t o r r e s p o n s i b i l i t i e s —
High Complexity T e s t i n g
(see 493.1445)
The l a b o r a t o r y d i r e c t o r i s r e s p o n s i b l e f o r t h e o v e r a l l o p e r a t i o n
and a d m i n i s t r a t i o n o f t h e l a b o r a t o r y , i n c l u d i n g t h e employment o f
p e r s o n n e l who are competent t o p e r f o r m t e s t p r o c e d u r e s , r e c o r d
and r e p o r t t e s t r e s u l t s p r o m p t l y , a c c u r a t e l y and p r o f i c i e n t l y ,
and f o r a s s u r i n g compliance w i t h t h e a p p l i c a b l e r e g u l a t i o n s .
(a) The l a b o r a t o r y d i r e c t o r , i f q u a l i f i e d , may p e r f o r m t h e
d u t i e s of the t e c h n i c a l supervisor, c l i n i c a l c o n s u l t a n t ,
g e n e r a l s u p e r v i s o r , and t e s t i n g p e r s o n n e l , o r d e l e g a t e these
r e s p o n s i b i l i t i e s t o p e r s o n n e l meeting t h e a p p r o p r i a t e
qualifications.
(b) I f t h e l a b o r a t o r y d i r e c t o r r e a p p o r t i o n s performance o f h i s
o r her r e s p o n s i b i l i t i e s , he o r she remains r e s p o n s i b l e f o r
e n s u r i n g t h a t a l l d u t i e s are p r o p e r l y p e r f o r m e d .
�(c)
(d)
(e)
The l a b o r a t o r y d i r e c t o r must be a c c e s s i b l e t o t h e l a b o r a t o r y
t o p r o v i d e o n s i t e , t e l e p h o n e or e l e c t r o n i c c o n s u l t a t i o n as
needed.
Each i n d i v i d u a l may d i r e c t no more t h a n f i v e l a b o r a t o r i e s .
The l a b o r a t o r y d i r e c t o r m u s t —
(1) Ensure t h a t t e s t i n g systems developed and used f o r each
o f t h e t e s t s performed i n t h e l a b o r a t o r y p r o v i d e
q u a l i t y l a b o r a t o r y s e r v i c e s f o r a l l aspects o f t e s t
performance, which i n c l u d e s t h e p r e a n a l y t i c , a n a l y t i c ,
and p o s t a n a l y t i c phases o f t e s t i n g ;
(2) Ensure t h a t t h e p h y s i c a l p l a n t and e n v i r o n m e n t a l
c o n d i t i o n s o f t h e l a b o r a t o r y are a p p r o p r i a t e f o r t h e
t e s t i n g performed and p r o v i d e a s a f e environment i n
which employees are p r o t e c t e d from p h y s i c a l , c h e m i c a l ,
and b i o l o g i c a l hazards;
(3) Ensure t h a t —
(i)
The t e s t methodologies s e l e c t e d have t h e
c a p a b i l i t y of p r o v i d i n g the q u a l i t y of r e s u l t s
required f o r p a t i e n t care;
(ii)
V e r i f i c a t i o n procedures used are adequate t o
determine t h e accuracy, p r e c i s i o n , and o t h e r
p e r t i n e n t performance c h a r a c t e r i s t i c s o f t h e
method; and
(iii)
L a b o r a t o r y p e r s o n n e l are p e r f o r m i n g t h e t e s t
methods as r e q u i r e d f o r a c c u r a t e and r e l i a b l e
results;
••
•
(4) Ensure t h a t t h e l a b o r a t o r y i s e n r o l l e d i n an
HHSapproved p r o f i c i e n c y t e s t i n g program f o r t h e . t e s t i n g
performed and t h a t —
(i)
The p r o f i c i e n c y t e s t i n g samples are t e s t e d as
r e q u i r e d under Subpart H o f t h e r e g u l a t i o n s ;
( i i ) The r e s u l t s are r e t u r n e d w i t h i n t h e t i m e f r a m e s
e s t a b l i s h e d by t h e p r o f i c i e n c y t e s t i n g program;
(iii)
A l l p r o f i c i e n c y t e s t i n g r e p o r t s r e c e i v e d are
reviewed by t h e a p p r o p r i a t e s t a f f t o e v a l u a t e
t h e l a b o r a t o r y ' s performance and t o i d e n t i f y
any problems t h a t r e q u i r e c o r r e c t i v e a c t i o n ;
and
(iv)
An approved c o r r e c t i v e a c t i o n p l a n i s
f o l l o w e d when any p r o f i c i e n c y t e s t i n g r e s u l t
i s found t o be unacceptable or
unsatisfactory;
(5) Ensure t h a t t h e q u a l i t y c o n t r o l and q u a l i t y assurance
programs are e s t a b l i s h e d and m a i n t a i n e d t o assure t h e
q u a l i t y o f l a b o r a t o r y s e r v i c e s p r o v i d e d and t o i d e n t i f y
f a i l u r e s i n q u a l i t y as t h e y occur;
(6) Ensure t h e e s t a b l i s h m e n t and maintenance of a c c e p t a b l e
l e v e l s o f a n a l y t i c a l performance f o r each t e s t system;
�(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
Ensure t h a t a l l necessary r e m e d i a l a c t i o n s are t a k e n
and documented whenever s i g n i f i c a n t d e v i a t i o n s from t h e
l a b o r a t o r y ' s e s t a b l i s h e d performance c h a r a c t e r i s t i c s
are i d e n t i f i e d , and t h a t p a t i e n t t e s t r e s u l t s are
r e p o r t e d o n l y when t h e system i s f u n c t i o n i n g p r o p e r l y ;
Ensure t h a t r e p o r t s o f t e s t r e s u l t s i n c l u d e p e r t i n e n t
information required for interpretation?
Ensure t h a t c o n s u l t a t i o n i s a v a i l a b l e t o t h e
l a b o r a t o r y ' s c l i e n t s on m a t t e r s r e l a t i n g t o t h e q u a l i t y
o f t h e t e s t r e s u l t s r e p o r t e d and t h e i r i n t e r p r e t a t i o n
concerning s p e c i f i c p a t i e n t c o n d i t i o n s ;
Ensure t h a t a g e n e r a l s u p e r v i s o r p r o v i d e s o n s i t e
s u p e r v i s i o n o f h i g h c o m p l e x i t y t e s t performance by
t e s t i n g p e r s o n n e l q u a l i f i e d under S e c t i o n I V ,
q u a l i f i c a t i o n code TPH7;
Employ a s u f f i c i e n t number o f l a b o r a t o r y p e r s o n n e l w i t h
the a p p r o p r i a t e e d u c a t i o n and e i t h e r e x p e r i e n c e or
t r a i n i n g to provide appropriate consultation,
properly
s u p e r v i s e and a c c u r a t e l y p e r f o r m t e s t s and r e p o r t t e s t
r e s u l t s i n accordance w i t h t h e p e r s o n n e l
responsibilities;
Ensure t h a t p r i o r t o t e s t i n g p a t i e n t s ' specimens, a l l
p e r s o n n e l have t h e a p p r o p r i a t e e d u c a t i o n and
experience, receive the a p p r o p r i a t e t r a i n i n g f o r the
t y p e and c o m p l e x i t y of t h e s e r v i c e s o f f e r e d , and have
demonstrated t h a t t h e y can p e r f o r m a l l t e s t i n g
o p e r a t i o n s r e l i a b l y t o p r o v i d e and r e p o r t a c c u r a t e
results;
Ensure t h a t p o l i c i e s and procedures are e s t a b l i s h e d f o r
m o n i t o r i n g i n d i v i d u a l s who conduct p r e a n a l y t i c a l ,
a n a l y t i c a l , and p o s t a n a l y t i c a l phases o f t e s t i n g t o
assure t h a t t h e y are competent and m a i n t a i n t h e i r
competency t o process specimens, p e r f o r m t e s t
procedures and r e p o r t t e s t r e s u l t s p r o m p t l y and
p r o f i c i e n t l y , and whenever necessary, i d e n t i f y needs
f o r r e m e d i a l t r a i n i n g or c o n t i n u i n g e d u c a t i o n t o
improve s k i l l s ;
Ensure t h a t an approved procedure manual i s a v a i l a b l e
t o a l l p e r s o n n e l r e s p o n s i b l e f o r any a s p e c t o f t h e
t e s t i n g p r o c e s s ; and
S p e c i f y , i n w r i t i n g , t h e r e s p o n s i b i l i t i e s and d u t i e s o f
each c o n s u l t a n t and each s u p e r v i s o r , as w e l l as each
person engaged i n t h e performance o f t h e p r e a n a l y t i c ,
a n a l y t i c , and p o s t a n a l y t i c phases o f t e s t i n g , t h a t
i d e n t i f i e s which e x a m i n a t i o n s and p r o c e d u r e s each
i n d i v i d u a l i s a u t h o r i z e d t o p e r f o r m , whether
s u p e r v i s i o n i s r e q u i r e d f o r specimen p r o c e s s i n g , t e s t
performance or r e s u l t r e p o r t i n g and whether s u p e r v i s o r y
or d i r e c t o r r e v i e w i s r e q u i r e d p r i o r t o r e p o r t i n g
patient test results.
�CLINICAL CONSULTANT RESPONSIBILITIES
The c l i n i c a l consultant must meet the q u a l i f i c a t i o n requirements
l i s t e d i n S e c t i o n I I of the HCFA-114 f o r the l e v e l of t e s t i n g
performed.
C l i n i c a l consultant r e s p o n s i b i l i t i e s —
Moderate and/or High Complexity T e s t i n g
(see
493.1419 o r 493.1457)
The c l i n i c a l c o n s u l t a n t p r o v i d e s c o n s u l t a t i o n r e g a r d i n g
t h e a p p r o p r i a t e n e s s o f t h e t e s t i n g o r d e r e d and i n t e r p r e t a t i o n o f
t e s t r e s u l t s . The c l i n i c a l c o n s u l t a n t m u s t —
(a) Be a v a i l a b l e t o p r o v i d e c l i n i c a l c o n s u l t a t i o n t o t h e
laboratory's c l i e n t s ;
(b) Be a v a i l a b l e t o a s s i s t t h e l a b o r a t o r y ' s c l i e n t s i n e n s u r i n g
t h a t a p p r o p r i a t e t e s t s a r e o r d e r e d t o meet t h e c l i n i c a l
expectations;
(c)
Ensure t h a t r e p o r t s o f t e s t r e s u l t s i n c l u d e p e r t i n e n t
information required f o r specific patient i n t e r p r e t a t i o n ;
and
(d) Ensure t h a t c o n s u l t a t i o n i s a v a i l a b l e and communicated t o
t h e l a b o r a t o r y ' s c l i e n t s on m a t t e r s r e l a t e d t o t h e q u a l i t y
o f t h e t e s t r e s u l t s r e p o r t e d and t h e i r i n t e r p r e t a t i o n
concerning s p e c i f i c p a t i e n t conditions.
TECHNICAL CONSULTANT RESPONSIBILITIES
:e2.ent;a
The t e c h n i c a l c o n s u l t a n t must meet the q u a l i f i c a t i o n
l i s t e d i n S e c t i o n I I I of the HCFA-114.
requirements
The t y p e o f e x p e r i e n c e r e q u i r e d under t h e r e g u l a t i o n i s c l i n i c a l
in nature.
T h i s means, e x a m i n a t i o n and t e s t performance on human
specimens f o r t h e purpose o f o b t a i n i n g i n f o r m a t i o n f o r t h e
d i a g n o s i s , t r e a t m e n t and m o n i t o r i n g o f p a t i e n t s , o r f o r p r o v i d i n g
i n f o r m a t i o n t o o t h e r s who w i l l do t h e d i a g n o s i n g and t r e a t i n g o f
the p a t i e n t ' s c o n d i t i o n . Patient o r medically o r i e n t e d
e x p e r i e n c e , which i s d e f i n e d as t h e o r d e r i n g o f t e s t s and
i n t e r p r e t i n g and a p p l y i n g t h e r e s u l t s o f these t e s t s i n
d i a g n o s i n g and t r e a t i n g a p a t i e n t ' s i l l n e s s i s u n a c c e p t a b l e t o
meet t h e r e q u i r e m e n t f o r l a b o r a t o r y t r a i n i n g o r e x p e r i e n c e .
The t e r m " l a b o r a t o r y t r a i n i n g o r e x p e r i e n c e " means t h a t t h e
i n d i v i d u a l q u a l i f y i n g has t h e t r a i n i n g i n and e x p e r i e n c e w i t h t h e
s p e c i a l t i e s and s u b s p e c i a l t i e s i n which t h e i n d i v i d u a l i s
performing t e c h n i c a l consultation.
Teaching e x p e r i e n c e d i r e c t l y r e l a t e d t o a m e d i c a l t e c h n o l o g y
program, c l i n i c a l l a b o r a t o r y s c i e n c e s program o r a c l i n i c a l
l a b o r a t o r y s e c t i o n o f a r e s i d e n c y program i s c o n s i d e r e d
a c c e p t a b l e e x p e r i e n c e . Research e x p e r i e n c e i s a l s o a c c e p t a b l e
e x p e r i e n c e i f i t i s o b t a i n e d w h i l e p e r f o r m i n g t e s t s on human
. .
specimens.
�Some examples o f how t h e t r a i n i n g or e x p e r i e n c e can be met
include:
m e d i c a l t e c h n o l o g y i n t e r n s h i p ; 1 year o f e x p e r i e n c e
p e r f o r m i n g non-waived t e s t s i n a p a r t i c u l a r s p e c i a l t y or
s u b s p e c i a l t y ; o r performance o f non-waived t e s t i n g i n a
p a r t i c u l a r s p e c i a l t y or s u b s p e c i a l t y on a p a r t - t i m e b a s i s
e q u a l i n g 2080 h o u r s .
T e c h n i c a l consultant r e s p o n s i b i l i t i e s —
Moderate complexity t e s t i n g (see 493.1413)
The t e c h n i c a l c o n s u l t a n t i s r e s p o n s i b l e f o r t h e t e c h n i c a l and
s c i e n t i f i c o v e r s i g h t of the l a b o r a t o r y .
The t e c h n i c a l c o n s u l t a n t
i s n o t r e q u i r e d t o be o n s i t e a t a l l t i m e s t e s t i n g i s p e r f o r m e d ;
however, he or she must be a v a i l a b l e t o t h e l a b o r a t o r y on an as
needed b a s i s t o p r o v i d e c o n s u l t a t i o n .
(a) The t e c h n i c a l c o n s u l t a n t must be a c c e s s i b l e t o t h e
l a b o r a t o r y t o p r o v i d e o n s i t e , t e l e p h o n e , or e l e c t r o n i c
c o n s u l t a t i o n ; and
(b) The t e c h n i c a l c o n s u l t a n t i s r e s p o n s i b l e f o r —
(1) S e l e c t i o n of t e s t methodology a p p r o p r i a t e f o r t h e
c l i n i c a l use o f t h e t e s t r e s u l t s ;
(2) V e r i f i c a t i o n o f t h e t e s t procedures performed and t h e
e s t a b l i s h m e n t o f the l a b o r a t o r y ' s t e s t performance
c h a r a c t e r i s t i c s , i n c l u d i n g t h e p r e c i s i o n and accuracy
o f each t e s t and t e s t system;
(3) E n r o l l m e n t and p a r t i c i p a t i o n i n an HHS approved
p r o f i c i e n c y t e s t i n g program commensurate w i t h t h e
services offered;
(4) E s t a b l i s h i n g a q u a l i t y c o n t r o l program a p p r o p r i a t e f o r
t h e t e s t i n g performed and e s t a b l i s h i n g t h e parameters
f o r a c c e p t a b l e l e v e l s of a n a l y t i c performance and
e n s u r i n g t h a t these l e v e l s are m a i n t a i n e d t h r o u g h o u t
t h e e n t i r e t e s t i n g process from t h e i n i t i a l r e c e i p t o f
t h e specimen, t h r o u g h sample a n a l y s i s and r e p o r t i n g o f
test results;
(5) R e s o l v i n g t e c h n i c a l problems and e n s u r i n g t h a t r e m e d i a l
a c t i o n s are t a k e n whenever t e s t systems d e v i a t e from
t h e l a b o r a t o r y ' s e s t a b l i s h e d performance
specifications;
(6) E n s u r i n g t h a t p a t i e n t t e s t r e s u l t s are not r e p o r t e d
u n t i l a l l c o r r e c t i v e a c t i o n s have been t a k e n and t h e
t e s t system i s f u n c t i o n i n g p r o p e r l y ;
(7) I d e n t i f y i n g t r a i n i n g needs and a s s u r i n g t h a t each
i n d i v i d u a l performing t e s t s receives regular in-service
t r a i n i n g and e d u c a t i o n a p p r o p r i a t e f o r t h e t y p e and
complexity of the laboratory services performed;
(8) E v a l u a t i n g t h e competency o f a l l t e s t i n g p e r s o n n e l and
a s s u r i n g t h a t t h e s t a f f m a i n t a i n t h e i r competency t o
p e r f o r m t e s t procedures and r e p o r t t e s t r e s u l t s
p r o m p t l y , a c c u r a t e l y and p r o f i c i e n t l y .
The p r o c e d u r e s
f o r e v a l u a t i o n o f t h e competency o f t h e s t a f f must
i n c l u d e , b u t are not l i m i t e d t o —
8
�(i)
(9)
D i r e c t observations of r o u t i n e p a t i e n t t e s t
performance, i n c l u d i n g p a t i e n t p r e p a r a t i o n , i f
a p p l i c a b l e , specimen h a n d l i n g , p r o c e s s i n g and
testing;
(ii)
M o n i t o r i n g t h e r e c o r d i n g and r e p o r t i n g o f t e s t
results;
(iii)
Review o f i n t e r m e d i a t e t e s t r e s u l t s o r
worksheets, q u a l i t y c o n t r o l r e c o r d s , p r o f i c i e n c y
t e s t i n g r e s u l t s , and p r e v e n t i v e maintenance
records;
(iv)
D i r e c t o b s e r v a t i o n o f performance o f i n s t r u m e n t
maintenance and f u n c t i o n checks;
(v)
Assessment o f t e s t performance t h r o u g h t e s t i n g
p r e v i o u s l y analyzed specimens, i n t e r n a l b l i n d
t e s t i n g samples or e x t e r n a l p r o f i c i e n c y t e s t i n g
samples; and
(vi)
Assessment of problem s o l v i n g s k i l l s ; and
E v a l u a t i n g and documenting t h e performance o f
i n d i v i d u a l s r e s p o n s i b l e f o r moderate c o m p l e x i t y t e s t i n g
a t l e a s t s e m i a n n u a l l y d u r i n g t h e f i r s t year t h e
i n d i v i d u a l t e s t s p a t i e n t specimens. T h e r e a f t e r ,
e v a l u a t i o n s must be performed a t l e a s t a n n u a l l y u n l e s s
t e s t methodology o r i n s t r u m e n t a t i o n changes, i n which
case, p r i o r t o r e p o r t i n g p a t i e n t t e s t r e s u l t s , t h e
i n d i v i d u a l ' s performance must be r e e v a l u a t e d t o i n c l u d e
t h e use o f t h e new t e s t methodology o r i n s t r u m e n t a t i o n .
TESTING PERSONNEL RESPONSIBILITIES
The t e s t i n g personnel must meet the q u a l i f i c a t i o n requirements
l i s t e d i n s e c t i o n IV of the HCFA-114 for the l e v e l of t e s t i n g
performed.
The e x p e r i e n c e r e q u i r e d i s c l i n i c a l i n n a t u r e .
T h i s means,
e x a m i n a t i o n o f and t e s t performance on human specimens f o r
purposes o f o b t a i n i n g i n f o r m a t i o n f o r t h e d i a g n o s i s , t r e a t m e n t ,
and m o n i t o r i n g o f p a t i e n t s , o r f o r p r o v i d i n g i n f o r m a t i o n t o
o t h e r s who w i l l diagnose and t r e a t p a t i e n t s .
T r a i n i n g may i n c l u d e , b u t i s not l i m i t e d t o , a t t e n d a n c e a t :
seminars g i v e n by e x p e r t s i n t h e f i e l d , e.g., a l e c t u r e about
a n t i b i o t i c r e s i s t a n c e g i v e n by t h e i n f e c t i o n c o n t r o l o f f i c e r o f a
l o c a l h o s p i t a l ; o n s i t e or o f f - s i t e i n s t r u m e n t t r a i n i n g g i v e n by
m a n u f a c t u r e r , e.g., a week long t r a i n i n g course g i v e n a t t h e
m a n u f a c t u r e r ' s h e a d q u a r t e r s , or t r a i n i n g by m a n u f a c t u r e r ' s
t e c h n i c a l r e p r e s e n t a t i v e on an i n s t r u m e n t j u s t purchased by a
physician o f f i c e l a b o r a t o r y ; t e c h n i c a l t r a i n i n g sessions,
workshops, o r conferences g i v e n by a p r o f e s s i o n a l l a b o r a t o r y
o r g a n i z a t i o n , e.g., CAP, ASMT, AACC, ASCT; t e c h n i c a l e d u c a t i o n
c l a s s e s o r s p e c i a l t y courses t h a t i n c l u d e s hands-on t e s t
performance, e.g., p a r a s i t o l o g y , b a c t e r i o l o g y , c y t o l o g y , g i v e n by
CDC, t h e S t a t e h e a l t h department o r p r o f e s s i o n a l l a b o r a t o r y
�o r g a n i z a t i o n s ; a f o r m a l l a b o r a t o r y t r a i n i n g program; or i n o f f i c e i n s e r v i c e s o f f e r e d by a l o c a l h o s p i t a l l a b o r a t o r y s t a f f ,
p a t h o l o g i s t , or m e d i c a l t e c h n o l o g i s t t o p h y s i c i a n o f f i c e
p e r s o n n e l . For moderate c o m p l e x i t y t e s t i n g , t h e r e g u l a t i o n
r e c o g n i z e s an o f f i c i a l m i l i t a r y m e d i c a l l a b o r a t o r y p r o c e d u r e s
course of 50 weeks d u r a t i o n .
S i m i l a r m i l i t a r y t r a i n i n g courses
w i t h d i f f e r e n t t i t l e s may meet t h i s r e q u i r e m e n t as l o n g as such a
course p r o v i d e s e f f e c t i v e t r a i n i n g f o r a m e d i c a l l a b o r a t o r y
s p e c i a l i s t . R e f e r t o A Guide t o t h e E v a l u a t i o n o f E d u c a t i o n a l
Experiences i n t h e Armed S e r v i c e s . American C o u n c i l on E d u c a t i o n ,
Washington,
D.C.
T e s t i n g personnel r e s p o n s i b i l i t i e s
—
Moderate complexity t e s t i n g (see 493.1425)
The t e s t i n g p e r s o n n e l are r e s p o n s i b l e f o r specimen p r o c e s s i n g ,
t e s t performance, and f o r r e p o r t i n g t e s t r e s u l t s .
(a)
Each i n d i v i d u a l performs o n l y those moderate c o m p l e x i t y
t e s t s t h a t are a u t h o r i z e d by the l a b o r a t o r y d i r e c t o r and
r e q u i r e a degree o f s k i l l commensurate w i t h t h e i n d i v i d u a l ' s
e d u c a t i o n , t r a i n i n g or e x p e r i e n c e , and t e c h n i c a l a b i l i t i e s .
(b)
Each i n d i v i d u a l p e r f o r m i n g moderate c o m p l e x i t y t e s t i n g must(1)
(2)
(3)
(4)
(5)
(6)
F o l l o w t h e l a b o r a t o r y ' s procedures f o r specimen
h a n d l i n g and p r o c e s s i n g , t e s t a n a l y s e s , r e p o r t i n g
and
m a i n t a i n i n g r e c o r d s of p a t i e n t t e s t r e s u l t s ;
M a i n t a i n r e c o r d s t h a t demonstrate t h a t p r o f i c i e n c y
t e s t i n g samples are t e s t e d i n the same manner as
p a t i e n t samples;
Adhere t o t h e l a b o r a t o r y ' s q u a l i t y c o n t r o l p o l i c i e s ,
document a l l q u a l i t y c o n t r o l a c t i v i t i e s , i n s t r u m e n t and
p r o c e d u r a l c a l i b r a t i o n s and maintenance p e r f o r m e d ;
Follow the l a b o r a t o r y ' s e s t a b l i s h e d c o r r e c t i v e a c t i o n
p o l i c i e s and procedures whenever t e s t systems are not
w i t h i n the l a b o r a t o r y ' s e s t a b l i s h e d a c c e p t a b l e l e v e l s
of performance;
Be capable o f i d e n t i f y i n g problems t h a t may a d v e r s e l y
a f f e c t t e s t performance or r e p o r t i n g o f t e s t r e s u l t s
and e i t h e r must c o r r e c t the problems or i m m e d i a t e l y
n o t i f y the t e c h n i c a l c o n s u l t a n t , c l i n i c a l c o n s u l t a n t or
d i r e c t o r ; and
Document a l l c o r r e c t i v e a c t i o n s t a k e n when t e s t systems
d e v i a t e from t h e l a b o r a t o r y ' s e s t a b l i s h e d performance
specifications.
Testing personnel r e s p o n s i b i l i t i e s —
High Complexity T e s t i n g ( e x c l u d i n g cytology)
(see 493.1495)
The t e s t i n g p e r s o n n e l are r e s p o n s i b l e f o r specimen p r o c e s s i n g ,
t e s t performance and f o r r e p o r t i n g t e s t r e s u l t s .
(a)
Each i n d i v i d u a l p e r f o r m s o n l y those h i g h c o m p l e x i t y t e s t s
t h a t are a u t h o r i z e d by t h e l a b o r a t o r y d i r e c t o r and r e q u i r e a
10
�(b)
degree o f s k i l l commensurate w i t h t h e i n d i v i d u a l ' s
e d u c a t i o n , t r a i n i n g o r experience, and t e c h n i c a l a b i l i t i e s ,
Each i n d i v i d u a l p e r f o r m i n g h i g h c o m p l e x i t y t e s t i n g
must—
(1) F o l l o w t h e l a b o r a t o r y ' s procedures f o r specimen
h a n d l i n g and p r o c e s s i n g , t e s t analyses, r e p o r t i n g and
maintaining records of p a t i e n t t e s t r e s u l t s ;
(2) M a i n t a i n r e c o r d s t h a t demonstrate t h a t p r o f i c i e n c y
t e s t i n g samples are t e s t e d i n t h e same manner as
p a t i e n t specimens;
(3) Adhere t o t h e l a b o r a t o r y ' s q u a l i t y c o n t r o l p o l i c i e s ,
document a l l q u a l i t y c o n t r o l a c t i v i t i e s , i n s t r u m e n t and
p r o c e d u r a l c a l i b r a t i o n s and maintenance performed;
(4) Follow t h e l a b o r a t o r y ' s e s t a b l i s h e d p o l i c i e s and
procedures whenever t e s t systems are n o t w i t h i n t h e
l a b o r a t o r y ' s e s t a b l i s h e d acceptable l e v e l s of
performance;
(5) Be capable o f i d e n t i f y i n g problems t h a t may a d v e r s e l y
a f f e c t t e s t performance or r e p o r t i n g o f t e s t r e s u l t s
and e i t h e r must c o r r e c t t h e problems o r immediately
n o t i f y the general supervisor, t e c h n i c a l supervisor,
c l i n i c a l c o n s u l t a n t , or d i r e c t o r ;
(6) Document a l l c o r r e c t i v e a c t i o n s t a k e n when t e s t systems
d e v i a t e from t h e l a b o r a t o r y ' s e s t a b l i s h e d performance
s p e c i f i c a t i o n s ; and
(7) I f q u a l i f i e d under s e c t i o n IV, q u a l i f i c a t i o n code TPH7,
must p e r f o r m h i g h c o m p l e x i t y t e s t i n g o n l y under t h e
o n s i t e , d i r e c t supervision of a general supervisor
q u a l i f i e d under s e c t i o n V s u p e r v i s o r q u a l i f i e d under
s e c t i o n V.
GENERAL BUPERVIBOR RESPONSIBILITIES (EXCLUDING CYTOLOGY)
The general s u p e r v i s o r must meet the q u a l i f i c a t i o n requirements
l i s t e d i n s e c t i o n V of the HCFA-114.
The t y p e o f e x p e r i e n c e r e q u i r e d under t h e r e g u l a t i o n i s c l i n i c a l
i n n a t u r e . T h i s means, examination and t e s t performance on human
specimens f o r t h e purpose o f o b t a i n i n g i n f o r m a t i o n f o r t h e
d i a g n o s i s , t r e a t m e n t and m o n i t o r i n g o f p a t i e n t s , o r f o r p r o v i d i n g
i n f o r m a t i o n t o o t h e r s who w i l l diagnose and t r e a t t h e p a t i e n t .
Teaching e x p e r i e n c e d i r e c t l y r e l a t e d t o a m e d i c a l t e c h n o l o g y
program, c l i n i c a l l a b o r a t o r y sciences program, o r a c l i n i c a l
l a b o r a t o r y s e c t i o n o f a r e s i d e n c y program i s c o n s i d e r e d
acceptable experience.
Research e x p e r i e n c e i s a l s o a c c e p t a b l e
e x p e r i e n c e i f i t i s o b t a i n e d w h i l e p e r f o r m i n g t e s t s on human
specimens. A year o f l a b o r a t o r y t r a i n i n g and e x p e r i e n c e i s
e q u i v a l e n t t o 2080 hours. These hours c o u l d i n c l u d e work on a
p a r t - t i m e b a s i s and e x t e n d over more t h a n one 12 calendar-month
period.
11
�General s u p e r v i s o r r e s p o n s i b i l i t i e s —
High complexity t e s t i n g (see 493.1463)
The g e n e r a l s u p e r v i s o r i s r e s p o n s i b l e f o r day-to-day s u p e r v i s i o n
or o v e r s i g h t o f t h e l a b o r a t o r y o p e r a t i o n and p e r s o n n e l
performing
t e s t i n g and r e p o r t i n g t e s t r e s u l t s .
(a) The g e n e r a l s u p e r v i s o r —
(1) Must be a c c e s s i b l e t o t e s t i n g personnel a t a l l times
t e s t i n g i s performed t o p r o v i d e o n s i t e t e l e p h o n e o r
e l e c t r o n i c c o n s u l t a t i o n t o r e s o l v e t e c h n i c a l problems
i n accordance w i t h p o l i c i e s and procedures e s t a b l i s h e d
e i t h e r by t h e l a b o r a t o r y d i r e c t o r o r t e c h n i c a l
supervisor;
(2) I s r e s p o n s i b l e f o r providing day-to-day s u p e r v i s i o n of
high complexity t e s t performance by t e s t i n g personnel
q u a l i f i e d under s e c t i o n IV;
(3) Must be o n s i t e t o p r o v i d e d i r e c t s u p e r v i s i o n when h i g h
complex t e s t i n g i s performed by any i n d i v i d u a l s
q u a l i f i e d under s e c t i o n I V , q u a l i f i c a t i o n code TPH 7;
and
(4) I s r e s p o n s i b l e f o r m o n i t o r i n g t e s t a n a l y s e s and
specimen e x a m i n a t i o n s t o ensure t h a t a c c e p t a b l e l e v e l s
o f a n a l y t i c performance a r e m a i n t a i n e d .
(b) The d i r e c t o r o r t e c h n i c a l s u p e r v i s o r may d e l e g a t e t o t h e
general supervisor the r e s p o n s i b i l i t y
. for-(1) A s s u r i n g t h a t a l l r e m e d i a l a c t i o n s a r e t a k e n whenever
t e s t systems d e v i a t e from t h e l a b o r a t o r y ' s e s t a b l i s h e d
performance s p e c i f i c a t i o n s ;
(2) Ensuring t h a t p a t i e n t t e s t r e s u l t s a r e n o t r e p o r t e d
u n t i l a l l c o r r e c t i v e a c t i o n s have been t a k e n and t h e
t e s t system i s p r o p e r l y f u n c t i o n i n g ;
(3) P r o v i d i n g o r i e n t a t i o n t o a l l t e s t i n g p e r s o n n e l ; and
(4) A n n u a l l y e v a l u a t i n g and documenting t h e performance o f
a l l t e s t i n g personnel.
TECHNICAL SUPERVISOR RESPONSIBILITIES(EXCLUDING CYTOLOGY TESTING)
The t e c h n i c a l s u p e r v i s o r must meet the q u a l i f i c a t i o n requirements
l i s t e d i n s e c t i o n VI of the HCFA-114 f o r the a p p l i c a b l e
specialty/subspecialty
areas.
The t y p e o f e x p e r i e n c e r e q u i r e d under t h e r e g u l a t i o n i s c l i n i c a l
i n n a t u r e . T h i s means, e x a m i n a t i o n and t e s t performance on human
specimens f o r t h e purpose o f o b t a i n i n g i n f o r m a t i o n f o r t h e
d i a g n o s i s , t r e a t m e n t and m o n i t o r i n g o f p a t i e n t s , o r f o r p r o v i d i n g
i n f o r m a t i o n t o o t h e r s who w i l l diagnose and t r e a t t h e p a t i e n t .
P a t i e n t o r m e d i c a l l y o r i e n t e d e x p e r i e n c e , which i s d e f i n e d as
d i a g n o s i n g and t r e a t i n g a p a t i e n t ' s i l l n e s s i s u n a c c e p t a b l e t o
meet t h e r e q u i r e m e n t f o r l a b o r a t o r y t r a i n i n g o r e x p e r i e n c e .
The
term " l a b o r a t o r y t r a i n i n g and e x p e r i e n c e " means t h a t t h e
i n d i v i d u a l q u a l i f y i n g has t h e t r a i n i n g i n and e x p e r i e n c e w i t h t h e
s p e c i a l t i e s and s u b s p e c i a l t i e s i n which t h e i n d i v i d u a l i s
12
�p e r f o r m i n g t e c h n i c a l s u p e r v i s i o n . The requirement f o r t r a i n i n g
o r e x p e r i e n c e can be met t h r o u g h any c o m b i n a t i o n o f t r a i n i n g
and/or e x p e r i e n c e i n h i g h c o m p l e x i t y t e s t i n g . T h i s can be
a c q u i r e d subsequent t o , c o n c u r r e n t w i t h , o r p r i o r t o o b t a i n i n g
academic r e q u i r e m e n t s .
The s p e c i f i e d t r a i n i n g or experience may be a c q u i r e d
s i m u l t a n e o u s l y i n more t h a n one s p e c i a l t y / s u b s p e c i a l t y . I n o r d e r
t o q u a l i f y under each s p e c i a l t y / s u b s p e c i a l t y , t h e i n d i v i d u a l must
have had c o n t i n u o u s r e s p o n s i b i l i t i e s i n t h e
s p e c i a l t y / s u b s p e c i a l t y , beyond p e r f o r m i n g an o c c a s i o n a l t e s t .
Teaching e x p e r i e n c e d i r e c t l y r e l a t e d t o a medical t e c h n o l o g y
program, c l i n i c a l l a b o r a t o r y sciences program, or a c l i n i c a l
l a b o r a t o r y s e c t i o n o f a r e s i d e n c y program i s c o n s i d e r e d
acceptable experience.
Research experience i s a l s o acceptable
e x p e r i e n c e i f i t i s o b t a i n e d w h i l e p e r f o r m i n g t e s t s on human
specimens. A year o f l a b o r a t o r y t r a i n i n g and e x p e r i e n c e i s
e q u i v a l e n t t o 2080 hours. These hours c o u l d i n c l u d e work on a
p a r t - t i m e b a s i s and extend over more t h a n one 12 calendar-month
period.
Technical supervisor r e s p o n s i b i l i t i e s —
High c o m p l e x i t y t e s t i n g ( e x c l u d i n g c y t o l o g y )
(see 4 9 3 . 1 4 5 1 ( a ) - ( b ) )
The t e c h n i c a l s u p e r v i s o r i s r e s p o n s i b l e f o r t h e t e c h n i c a l and
s c i e n t i f i c o v e r s i g h t o f t h e l a b o r a t o r y . The t e c h n i c a l
s u p e r v i s o r i s not r e q u i r e d t o be o n s i t e a t a l l t i m e s t e s t i n g i s
performed; however, he or she must be a v a i l a b l e t o t h e l a b o r a t o r y
on an as needed b a s i s .
(a)
The t e c h n i c a l s u p e r v i s o r must be a c c e s s i b l e t o t h e
l a b o r a t o r y t o p r o v i d e o n s i t e , t e l e p h o n e , or e l e c t r o n i c
c o n s u l t a t i o n ; and
(b)
The t e c h n i c a l s u p e r v i s o r i s r e s p o n s i b l e f o r —
(1)
S e l e c t i o n o f t h e t e s t methodology t h a t i s a p p r o p r i a t e
f o r t h e c l i n i c a l use o f t h e t e s t r e s u l t s ;
(2)
V e r i f i c a t i o n o f t h e t e s t procedures performed and*
e s t a b l i s h m e n t o f t h e l a b o r a t o r y ' s t e s t performance
c h a r a c t e r i s t i c s , i n c l u d i n g t h e p r e c i s i o n and accuracy
of each t e s t and t e s t system;
(3)
E n r o l l m e n t and p a r t i c i p a t i o n i n an HHS approved
p r o f i c i e n c y t e s t i n g program commensurate w i t h t h e
services offered;
(4)
E s t a b l i s h i n g a q u a l i t y c o n t r o l program a p p r o p r i a t e f o r
the t e s t i n g performed and e s t a b l i s h i n g t h e parameter
f o r a c c e p t a b l e l e v e l s o f a n a l y t i c performance and
e n s u r i n g t h a t these
l e v e l s are m a i n t a i n e d t h r o u g h o u t t h e e n t i r e t e s t i n g
process from t h e i n i t i a l r e c e i p t o f t h e specimen,
t h r o u g h sample a n a l y s i s and r e p o r t i n g o f t e s t r e s u l t s ;
(5)
R e s o l v i n g t e c h n i c a l problems and e n s u r i n g t h a t r e m e d i a l
a c t i o n s are t a k e n whenever t e s t systems d e v i a t e from
13
�t h e l a b o r a t o r y ' s e s t a b l i s h e d performance
specifications;
(6) Ensuring t h a t p a t i e n t t e s t r e s u l t s are n o t r e p o r t e d
u n t i l a l l c o r r e c t i v e a c t i o n s have been t a k e n and t h e
t e s t system i s f u n c t i o n i n g p r o p e r l y ;
(7) I d e n t i f y i n g t r a i n i n g needs and a s s u r i n g t h a t each
i n d i v i d u a l performing t e s t s receives regular i n - s e r v i c e
t r a i n i n g and e d u c a t i o n a p p r o p r i a t e f o r t h e t y p e and
complexity of the l a b o r a t o r y services performed;
(8) E v a l u a t i n g t h e competency o f a l l t e s t i n g p e r s o n n e l and
a s s u r i n g t h a t t h e s t a f f m a i n t a i n t h e i r competency t o
p e r f o r m t e s t procedures and r e p o r t t e s t r e s u l t s
p r o m p t l y , a c c u r a t e l y and p r o f i c i e n t l y .
The procedures
f o r e v a l u a t i o n o f t h e competency of t h e s t a f f must
i n c l u d e , b u t are not l i m i t e d t o —
(i)
D i r e c t observations of r o u t i n e p a t i e n t t e s t
performance, i n c l u d i n g p a t i e n t p r e p a r a t i o n , i f
a p p l i c a b l e , specimen h a n d l i n g , p r o c e s s i n g and
testing;
(ii)
M o n i t o r i n g t h e r e c o r d i n g and r e p o r t i n g o f t e s t
results;
(iii)
Review o f i n t e r m e d i a t e t e s t r e s u l t s o r
worksheets, q u a l i t y c o n t r o l r e c o r d s , p r o f i c i e n c y
t e s t i n g r e s u l t s , and p r e v e n t i v e maintenance
records;
(iv)
D i r e c t o b s e r v a t i o n o f performance o f i n s t r u m e n t
maintenance and f u n c t i o n checks;
(v)
Assessment o f t e s t performance t h r o u g h t e s t i n g
p r e v i o u s l y analyzed specimens, i n t e r n a l b l i n d
t e s t i n g samples o r e x t e r n a l p r o f i c i e n c y t e s t i n g
samples; and
(vi)
Assessment o f problem s o l v i n g s k i l l s ; and
(9) E v a l u a t i n g and documenting t h e performance o f
i n d i v i d u a l s responsible f o r high complexity t e s t i n g at
l e a s t semiannually d u r i n g the f i r s t year the i n d i v i d u a l
t e s t s p a t i e n t specimens. T h e r e a f t e r , e v a l u a t i o n s must
be performed a t l e a s t a n n u a l l y u n l e s s t e s t methodology
or i n s t r u m e n t a t i o n changes, i n which case, p r i o r t o
r e p o r t i n g p a t i e n t t e s t r e s u l t s , the i n d i v i d u a l ' s
performance must be r e e v a l u a t e d t o i n c l u d e t h e use o f
t h e new t e s t methodology or i n s t r u m e n t a t i o n .
CYTOLOGY TESTING
For c y t o l o g y t e s t i n g t h e g e n e r a l s u p e r v i s o r , t e c h n i c a l s u p e r v i s o r
and c y t o t e c h n o l o g i s t must meet t h e q u a l i f i c a t i o n r e q u i r e m e n t s
l i s t e d i n s e c t i o n V I I f o r the a p p l i c a b l e l a b o r a t o r y p o s i t i o n .
For t h e g e n e r a l s u p e r v i s o r , t h e 3 years o f f u l l - t i m e e x p e r i e n c e
as a c y t o t e c h n o l o g i s t can a l s o be f u l f i l l e d i f t h e i n d i v i d u a l has
been: t e a c h i n g i n schools o f c y t o t e c h n o l o g y ; t e a c h i n g
c y t o t e c h n o l o g y f o r r e s i d e n c y programs i n academic i n s t i t u t i o n s ;
14
�or, p a r t i c i p a t i n g i n r e s e a r c h d i r e c t l y r e l a t e d t o c y t o t e c h n o l o g y ,
which i n c l u d e s s c r e e n i n g s l i d e s , l i b r a r y r e s e a r c h , and
documentation.
The
r e s p o n s i b i l i t i e s f o r each p o s i t i o n are as f o l l o w s :
Technical
(1)
(2)
(3)
(4)
(5)
(6)
s u p e r v i s o r r e s p o n s i b i l i t i e s — (see 493.1451(c))
May p e r f o r m t h e d u t i e s of t h e c y t o l o g y g e n e r a l
s u p e r v i s o r and t h e c y t o t e c h n o l o g i s t , r e s p e c t i v e l y ;
Must e s t a b l i s h t h e w o r k l o a d l i m i t f o r each i n d i v i d u a l
examining s l i d e s ;
Must reassess t h e workload l i m i t f o r each i n d i v i d u a l
examining s l i d e s a t l e a s t every 6 months and a d j u s t as
necessary;
Must p e r f o r m t h e f u n c t i o n s s p e c i f i e d i n t h e q u a l i t y
c o n t r o l r e q u i r e m e n t s i n subpart K o f t h e r e g u l a t i o n s ;
Must ensure t h a t each i n d i v i d u a l examining g y n e c o l o g i c
p r e p a r a t i o n s p a r t i c i p a t e s i n an HHS approved c y t o l o g y
p r o f i c i e n c y t e s t i n g program and achieves a passing
s c o r e ; and
I f responsible f o r screening cytology s l i d e
p r e p a r a t i o n s , must document t h e number o f c y t o l o g y
s l i d e s screened i n 24 hours and t h e number o f hours
devoted d u r i n g each 24-hour p e r i o d t o s c r e e n i n g
cytology slides.
C y t o l o g y g e n e r a l s u p e r v i s o r r e s p o n s i b i l i t i e s — ( s e e 493.1471)
(a) The c y t o l o g y g e n e r a l s u p e r v i s o r i s r e s p o n s i b l e f o r t h e dayto-day s u p e r v i s i o n or o v e r s i g h t of the l a b o r a t o r y operation
and personnel p e r f o r m i n g t e s t i n g and r e p o r t i n g t e s t r e s u l t s .
(b) The c y t o l o g y g e n e r a l s u p e r v i s o r m u s t —
(1) Be a c c e s s i b l e t o p r o v i d e o n s i t e , t e l e p h o n e , o r
e l e c t r o n i c c o n s u l t a t i o n t o r e s o l v e t e c h n i c a l problems
i n accordance w i t h p o l i c i e s and procedures e s t a b l i s h e d
by t h e t e c h n i c a l s u p e r v i s o r o f c y t o l o g y ;
(2) Document t h e s l i d e i n t e r p r e t a t i o n r e s u l t s o f each
g y n e c o l o g i c and nongynecologic c y t o l o g y case he o r she
examined or r e v i e w e d ;
(3) For each 24-hour p e r i o d , document t h e t o t a l number o f
s l i d e s he o r she examined o r reviewed i n t h e l a b o r a t o r y
as w e l l as t h e t o t a l number o f s l i d e s examined o r
r e v i e w e d i n any o t h e r l a b o r a t o r y o r f o r any o t h e r
employer; and
(4) Document t h e number o f hours spent examining s l i d e s i n
each 24-hour p e r i o d .
Cytotechnologist r e s p o n s i b i l i t i e s — (see 493.1485)
The c y t o t e c h n o l o g i s t i s r e s p o n s i b l e f o r d o c u m e n t i n g —
(a) The s l i d e i n t e r p r e t a t i o n r e s u l t s o f each g y n e c o l o g i c and
n o n g y n e c o l o g i c c y t o l o g y case he o r she examined o r r e v i e w e d ;
(b) For each 24-hour p e r i o d , t h e t o t a l number o f s l i d e s examined
o r reviewed i n t h e l a b o r a t o r y as w e l l as t h e t o t a l number o f
15
�s l i d e s examined or reviewed i n any other l a b o r a t o r y or f o r
any other employer; and
( C )
peJiSd
n i b e r
0 f
S P e n t
e x a m i n i n <
16
3 s l i d e s i n each 24-hour
�FORM APPnOVF.D
OMB NO. 0938 0581
De:" I W j I Mt N r pr I IP A l l 11 AND IIUMAN SE fl VICES
ML AL 1 1 CAPE FINANCING ADMINISI H M ION
1
LABORATORY PERSONNEL REPORT
CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988
Public roporling burdon lor this collection ot intormation Is estimated at nvornge 30 minutes to 8 hours per response, including time tor reviewing instructions,
searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of intormation. Send comments regarding
this burden estimate or any other aspect ot this collection ol information, including suggestions for reducing the burden, to HCFA, Ottice ot Financial Management,
P.O. Box 26684, Baltimore, MD 21207; and to the Office of Management and Budget, Paperwork Reduction Project (OMB 0938-0581), Washington. D C. 20503.
LABORATORY NAME "
CLIA IDENTIFICATION NUMBER
I r o n w o o d F a m i l y P r a c t i c e , PA
LABORATORY ADDRESS (NUMBER AND STREET)
13D0679680
CITY
920 I r o n w o o d
Dr.
Coeur
STATE ZIP CODE
d'Alene.
83814
ID
PLEASE NOTE: The authority for the solicitation of the requested information is Section 353 of the Public
Health Service Act (PHSA) (42 U.S.C. 263a). The principal purpose for collecting the names and Social Security
numbers (SSN) of persons directing laboratory testing is to assure that requirements of CLIA are met. Your
SSN Is helpful for identification, but you are not required to indicate it if you do not desire to do so. HCFA
will not be maintaining this inlormation in a system of records.
WAIVED TESTING
Laboratories performing only waived tests do not have to meet CLIA personnel requirements, but must identify and submit to the Secretary
information on individuals directing, supervising and performing laboratory testing as required by 353 (d)(2)(A)(i) of the PHSA.
If you perform ONLY waived tests, complete Information below. All other laboratories proceed to page 2.
DIRECTOR
Instructions (or completion: List the name, SSN and the appropriate codes (listed below) for education and laboratory training/experience for
the primary director (i.e., individual responsible for overall performance of laboratory testing).
CODE
01
02
03
04
05
EDUCATION(ED)
MD/DO
PhD
MS/MA
BS/BA
Other (specify)
CODE
01
02
03
04
DIRECTOR'S NAME
SSN
TRAINING/EXPERIENCE (T/E)
0-1 yr
1-2 yrs
2-4 yrs
Over 4 yrs
T/E CODE
ED CODE
Instructions: For each column under "Education" indicate the total number of individuals who perform laboratory testing and their
corresponding years of laboratory experience by placing the appropriate number in the row (1-4) linking the education and training and
experience of the personnel in the laboratory.
""^
EDUCATION
LABORATORY
TRAINING/EXPERIENCE
MD/DO
PHD
MS/MA
BS/BA
ASSOC.
DEGREE
HS/GED
OTHER (specify)
1. 0-1 YR
2. 1-2 YRS
3. 2-4 YRS
4. OVER 4 YRS
ATTESTATION: I ATTEST THE ABOVE INFORMATION ACCURATELY REFLECTS THE OPERATION OF THIS LABORATORY.
SIGNATURE OF DIRECTOR (individual with overall responsibility for laboratory testing)
FORM HCFA-t 14 (8-92)
DATE
Page 1 ol12
�Withdrawal/Redaction Marker
Clinton Library
DOCLIMENT NO.
AND TYPE
001. form
SUBJECT/HTLE
DATE
SSN (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [3]
2006-0885-F
jm786
RESTRICTION CODES
Prrsidcnlial Records Acl -144 IJ.S.C. 2204(fl)|
Freedom or Information Acr -15 ll.S.C. 552(b))
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) or the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the F01A|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the F01A|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) or the F01A|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�COMPLETE PAGES 2 THnOUGH 5 FOR PERSONNEL PERFORMING MODERATE AND HIGH
COMPLEXITY TESTING. A KEY FOR THE QUALIFICATION CODES FOR EACH LEVEL OF
PERSONNEL BEGINS ON PAGE 6. IF YOU HAVE PERSONNEL WHO DO NOT MEET THE QUALIFICATIONS IN SECTIONS l-VII, PLEASE COMPLETE SECTION VIII, "OTHER," ON PAGE 5.
NOTE: One Individual may be serving In more than one position/function In the laboratory.
(Example Pathologist serving as director, technical supervisor and general supervisor.) This
Individual w o u l d be rellected In three separate sections of the form, annotating the appropriate
quallllcatlon code In each section.
SECTION I. DIRECTOR QUALIFICATIONS - MObfettAtfc AM HIGH COMPLfeKITY TESTING
NOTE: A LABORAIORY THAT PERFORMS BOTH MODERATE AND HIGH COMPLEXITY TESTING MUST HAVE A DIRECTOR WHO
MEETS THE QUALIFICATIONS FOR HIGH COMPLEXITY TESTING.
Instructions: Listed in section I on page 6 are the qualification codas for the requirements that individuals serving as directors of laboralories
performing moderate or high complexity lesting must meet. Specific codes have been assigned to each possible way a director may meet the
qualifications spocilied in the regulation. Please indicate tho name, Social Security number and applicable code Irom section I on page 6 for the
director ol the laboralory. Select the highest applicable qualification code that relates lo tho highest level ol testing performed in your laboratory.
Only ono Individual may be listed as director. Note. Tho laboratory director must possess a current license as a laboratory director issued
by the State in which tire laboratory is located, il such licensing is required.
Example: An individual wilh a PhD in chemistry dirocts a laboratory performing only moderate complexity testing. This individual has been
serving as a director for 2 years. Alter completing the name and Social Security number, the appropriate qualification code would be M03.2.
DIRECTOR'S NAME
Timothy
F.
Burns,
SSN
M.D.
••
oc>t
P6/(b)(6)
,
L l
QUALIFICATION CODE
M02.1
SECTION II. CLINICAL CONSULfANT QUALIFICATIONS
Instructions: By the Highest level ol qualilicalions, indicate the total number ol individuals performing In the laboratory as clinical consultants by
placing the appropriate number in lhe box corresponding lo the qualification codes. See section II on page 7 lor key to qualification codes.
HIGH
MODERATE
Qualification Code
Total No. of Individuals
Qualification Code
CC 1
CCH 1
CC2.1
CCH 2
CC 2.2
CCH 3
CC 2.3
CCH 4
CC 3
Total No. of Individuals
CCH 5
CC 4
SECtiON III. TECHNICAL CONSULTANT QUALIFICATIONS- MODfeRAtfe COMPLEXlTV f ESTlNG
Instructions: By the highest level of qualifications, indicate the total number of individuals performing in the laboratory as technical consultanls
by placing the appropriate number in the box corresponding to the qualilication codes. Note: Technical consultant(s) must possess a current
license issued by the State in which the laboratory is located, if such licensing is required. See section III on page 7 for key to qualification
codes.
Qualification Code
Total No. ol Individuals
TC 1
TC 2
it
TC 3
TC 4
TC 5
FOllM I t e r A-1 14 (B-SiZ)
Page 2 o l 1 2
�SECTION IV. TESTING PERSONNEL QUALIFICATIONS
Instructions: By the highest qualification code, indicate the total number of individuals performing laboratory testing and their years ol
laboratory training/experience by placing the appropriate number in the column linking laboratory training/experience to the qualification code.
Note: Testing personnel must possess a current license issued by the State in which the laboratory Is located, il such licensing is required. See
section IV on page 8 for key lo qualification codes.
HIGH COMPLEXITY TESTING (EXCLUDING CYTOLOGY)
MODERATE COMPLEXITY TESTING
Qualification
Code
Laboratory Training/Experience
0-1 YEAR 1-2 YEARS 2-4 YEARS OVER 4 YEARS
Qualification
Code
TP 1
TPH 1
TP 2
TPH 2
TP 3
Laboratory Training/Experience
0-1 YEAR 1-2 YEARS 2-4 YEARS DVER 4 YEARS
TPH 3
TP 4
1
7
TP 5
TPH 4
TPH 5
TP 6
TPH 6
TP 7
TPH 7
TPH 8
TPH 9
-
TPH 10
TPH 11
TPH 12
SECTION V. GENERAL SUPERVISOR QUALIFICATIONS • HIGH COMPLEXITY TfeSTING (EXCLUDING CYTOLOGY)
Instructions: By the highest level of qualifications, indicate the total number of individuals performing in the laboratory as general supervisor(s)
by placing the appropriate number in the box corresponding to the qualification code. Note: General supervisor(s) must possess a current
license Issued by the State In which the laboratory is located, if such licensing is required. See section V on page 9 for key to qualification
codes.
Qualification Code
Total No. of Individuals
Qualification Code
GS 1
GS 8
GS 2
GS 9
GS 3
GS 10
GS 4
GS 11
GS 5
GS 12
GS 6
GS 13
GS 7
Total No. ol Individuals
GS 14
ronMMCFA-IM(8-92)
Pag«3ol 12
�ACTION VI. TECHNICAL SUPERVISOR QUALIFICATIONS - HIGH cowifLfexlTY TESTING (EXCLUDING CYTOLOGY)
Instructions: For all areas of testing indicate by the highest level of qualification the total number of individuals functioning as technical
supervisors) by placing the appropriate number in the box corresponding to the qualification code for specialty/subspecialty testing area. Note:
Technical supervisor(s) must possess a current license Issued by the State in which the laboratory is located, i( such licensing is required. See
section VI on pages 10 and 11 lor key to qualification codes.
FOR ALL SRECIAUTY AREAS EXCEPT HlSTQCOMPATIBILITY AND CLINICAL CYTOGENETICS QpP;^
Qualification Code
Total No. of Individuals
TS 1A
JGY, MYCOLC
5GY WHICH INCLUDES THE SUBSPECIALTIES OF BACTERIOLC
MYCOBACTERIOLddlV. PARASITOLOGY ANb VIROLOGY i
Total No. of Individuals
Qualification Code
TS 2A
TS 2B
TS 2C
TS 2D
TS 2E
^OSTIC IMMUNOLOGY, CHEMISTRY, HEMATOLOGY AND RADIC
)BIOASSAY
Qualification Code
Total No. of Individuals
TS 3A
TS3B
TS 3C
TS 3D
TS 3E
l^lli
'mm&mimmi&mmmmml l l P i l l l l l l i i l l ]
Qualification Code
Total No. of Individuals
TS 4A
TS4B
:
F O R ORAL PATRC
)LOGY AND TESTING IN PE^MATOPATHOLOGY AND OPHTHALMIC PATHOLOGY
Qualification Code
;
Total No. of Individuals
TS 5A
TS5B
TS5C
Qualification Code
Total No. of Individuals
Qualification Code
TS 6A
Total No. ol Individuals
TS 7A
TS6B
iliiilNiiiiiiilii
TS 7B
Qualification Code
Total No. of Individuals
TS 8A
TS 8B
TS8C
TS8D
FORM HCFA-114 (8-92)
Pago 4 of 12
�Instructions: For all areas ol cytology indicate by the highest level ol qualilication the total number of individuals functioning as technical
supervisorfs), general supervisor(s) and cytotechnologist(s) by placing the appropriate number in the box corresponding to the qualilication
code. Note: Individuals involved in cytology testing must possess a license issued by the State in which the laboratory is located lor their
respective position(s), if such licensing is required. See section VII on page 12 for key to the qualification codes.
TECHNICAL SUPERVISOR
Qualilication Code
Total No. of Individuals
CYT 1
CYT2
CYT 3
CYT 4
GENERAL SUPERVISOR
Qualilication Code
Total No. of Individuals
CYG 1
CYG 2
CYTOTECHNOLbGISf
Qualilication Code
Total No. of Individuals
Qualification Code
CYO 1
CYO 5
CY0 2
CYO 6
CYO 3
CYO 7
CYO 4
Total No. of Individuals
CYO 8
SECTION VIII. OTHER (Individuals who do hot meet the qualifications In Sections I - VII)
Instructions: Indicate the total number of individuals for each appropriate laboratory position in which they function, but do not meet the
applicable qualifications.
Laboratory Position
Total No. ot Individuals
Laboratory Position
Director
Testing Personnel
Clinical Consultant
General Supervisor
Technical Consultant
Total No. of Individuals
Technical Supervisor
CYTOLOGY TESTING
Laboratory Position
Total No. of Individuals
General Supervisor
Technical Supervisor
Cytotechnologist
I ATTEST THAT I HAVE VERIFIED THE QUALIFICATIONS OF ALL INDIVIDUALS IN SECTIONS I • VII INVOLVED IN ALL
MODERATE AND/OR HIGH COMPLEXITY TESTING PERFORMED BY THIS LABORATORY AND THAT ALL PERSONNEL
CONDUCT, CONSULT, SUPERVISE OR DIRECT ONLY TESTING FOR WHICH THEY ARE QUALIFIED. THE PERSONNEL
INFORMATION REPRESENTS TO THE BEST OF MY KNOWLEDGE CURRENT INFORMATION ON LABORATORY PERSONNEL.
SIGNATURE OF DIRECTOR.(meets director requirements and responsibilities) (sign in ink)
FORM HCFA-114 (8-92)
DATE
Page 5 of 12
�KEY TO QUALIFICATION CODES FOR PERSONNEL
PERFORMING MODERATE AND HIGH COMPLEXITY TESTING
Listed on lhe following pages is the key lo the qualification codes used on form HCFA-114. Each section contains the codes for a
specific level ol personnel performing testing in the laboratory. The specific codes reflect the education, training and experience
required for each level ol personnel.
NOTE; DO NOT SUBMIT THESE PAGES WITH COMPLETED FORMS.
Qualification
Code
MO 1
MO 2.1
Qualifications (Education, Training and Experience)
M.D.,D.O. w/current medical license in State of laboratory's location and certified in anatomic and/or clinical pathology by ABP or
AOBP or equivalent qualifications
OR
M.D.,D.O. w/current medical license In State of laboratory's location and laboratory training/experience consisting of:
•1 year directing or supervising nonwaived tests
or
MO 2.2
MO 2.3
MO 3.1
•20 CME credit hours in laboratory practice commensurate with director responsibilities. (Effective 8/2/93)
or
•Equivalent laboratory training (20 CMEs) obtained during medical residency
OR
Doctorate in chemical, physical, biological or clinical laboratory science and certification by ABMM, ABCC, ABB, ABMLI
OR
MO 6
Doctorate in chemical, physical, biological or clinical laboratory science and 1 year directing or supervising nonwaived testing
OR
Masters in clinical laboratory science, medical technology or chemical, physical, or biological science and 1 year laboratory
training/experience and 1 year supervisory experience in a laboratory
OR
Bachelors in medical technology, or chemical, physical or biological science and 2 years laboratory training/experience and 2 years
supervisory experience in a laboratory
OR
ON OR BEFORE 2/28/92 qualified or could have qualified as a director under the laboratory regulations published March 14, 1990
(55 FR 9538)
MO 7
ON OR BEFORE 2/28/92 qualified as a director by the State in which the laboratory is located
MO 3.2
MO 4
MO 5
OR
|:|!|i:|^IIi||ilREM
Qualification
Code
Qualifications (Education, Training and Experience)
HO 2.1
M.D.,D.O. w/current medical license in State of laboratory's location and certified in anatomic and/or clinical pathology by ABP or
AOBP or equivalent qualifications
OR
M.D.,D.O. w/current medical license in Stale of laboratory's location and 1 year laboratory training during medical residency
HO 2.2
M.D.,D.O. w/current medical license in State of laboratory's location and 2 years experience in directing/supervising high
complexity testing
HO 1
OR
OR
HO 3.1
HO 3.2
Doctorate in chemical, physical, biological or clinical laboratory science and certification by ABMM, ABCC, ABB, ABMLI, or other
board deemed comparable by HHS
OR
UNTIL 9/1/94 Doctorate in physical, chemical biological or clinical laboratory science and 2 years laboratory training/experience
and 2 years directing/supervising high complexity testing. On 9/1/94 must meet doctorate requirements listed above in H03.1
OR
HO 4
HO 5
ON OR BEFORE 2/28/92 serving as a laboratory director and must have previously qualified or could have qualified as a
laboratory director under laboratory regulations published March 14, 1990 (55 FR 9538)
OR
ON OR BEFORE 2/28/92 qualified as director by the State in which the laboratory is located
FORM HCFA-1 M (8-92)
Page Sol 12
�SECTION II. CLINICAL CONSULTANT QUALIFICATIONS
MODERATE COMPLEXITY TESTING
Qualilication
Code
CC 1
CC 2.1
Qualifications (Education, Training and Experience)
M.D.,D.O. w/current medical license in State of laboratory's location and certified in anatomic and/or clinical pathology by ABP or
AOBP or equivalent qualifications.
OR
——
M.D.,D.O. w/current medical license in State of laboratory's location and laboratory training/experience consisting of:
•1 year directing or supervising nonwaived tests
or
•20 CME credit hours in laboratory practice commensurate with director responsibilities. (Elleclive 8/2/93)
CC2.2
,
.
.
or
•Equivalent laboratory training (20 CMEs) obtained during medical residency
CC 2.3
CC 3
Doctorate in chemical, physical, biological or clinical laboratory science and certification by ABMM, ABCC, ABB, ABMLI
CC 4
M.D.,D.O. w/current medical license in State ol laboratory's location
OR
HIGH COMPLEXITY TESTING
Qualilication
Code
CCH 1
^ ^ ^ ^ H
Qualifications (Education, Training and Experience)
M.D.,D.O. w/current medical license in State of laboratory's location and certified in anatomic and/or clinical pathology by APB or
AOBP or equivalent qualifications
OR
CCH 2
CCH 3
M.D.,D.O. w/current medical license in State of laboratory's location and 1 year laboratory training during medical residency
OR
M.D.,D.O. w/current medical license in State of laboratory's location and 2 years experience in directing/supervising high
complexity testing
OR
CCH 4
Doctorate in chemical, physical, biological or clinical laboratory science and certification by ABMM. ABCC, ABB, ABMLI, or other
board deemed comparable by HHS
CCH 5
M.D.,D.O. w/current medical license in State of laboratory's location
OR
SECTION III. TECHNICAL CONSULTANT QUALIFICATIONS • MODERATE COMPLEXITY TESTING
Qualification
Code
TC 1
TC 2
Qualifications (Education, Training and Experience)
M.D.,D.O. w/currenl medical license in State of laboratory's location and certified in anatomic and/or clinical pathology by ABP or
AOBP or equivalent qualifications
OR
M.D.,D.O. w/current medical license in State ol laboratory's location and 1 year laboratory training/experience in the designated
specialty/subspecialty of responsibility
OR
TC 3
TC 4
TC 5
Doctorate in chemical, physical, biological or clinical laboratory science or medical technology and 1 year laboratory training/
experience in the designated specialty/subspecialty of responsibility
OR
Masters in clinical laboratory science, medical technology or chemical, physical or biological science and 1 year training/
experience in the designated specialty/subspecialty of responsibility
OR
Bachelors in medical technology, or chemical, physical, or biological science and 2 years laboratory training/experience in the
designated specialty/subspecialty of responsibility
POFIM HCPA-t 14 (8-92)
Page 7ol 12
�SECTION IV. TESTING PERSONNEL QOALIPICATIONS
MODERATE COMPLEXITY TESTING
Qualilication
Code
TP 1
TP 2
TP 3
TP 4
TP 5
TP 6
TP 7
Qualifications
(Education)
M.D.,D.O. w/current medical license in State of laboratory's location
OR
Doctorate, laboratory science or chemical, physical or biological science
OR
Masters in medical technology, laboratory science or chemical, physical or biological science
OR
Bachelors in medical technology or chemical, physical or biological science
OR
Associate degree in chemical, physical or biological science or medical laboratory technology
OR
High School graduate or equivalent and successfully completed military training of 50 or more weeks and served as a medical
laboratory specialist
OR
Academic high school diploma or equivalent and appropriate training/experience as specified'jr^Part 493 )
HIGH COMPLEXITY TESTING (EXCLUDING CYtOLOGY)
Qualilication
Code
H^^HH
H ^ H H
TPH 7
Qualifications
(Education)
M.D.,D.O. w/current medical license in State of laboratory's location
OR
Doctorate in clinical laboratory science or chemical, physical or biological science
OR
Masters in medical technology, clinical laboratory science or chemical, physical or biological science
OR
Bachelors in medical technology, clinical laboratory science or chemical, physical or biological science
OR
Associate degree in laboratory science or medical laboratory technology
OR
ON OR BEFORE 2/28/92 qualified or could have qualified as a technologist under laboratory regulations published March 14,
1990 (55 FR 9538)
OR
UNTIL 9/1/97, academic high school degree or equk ilent with appropriate training as specified in Part 493
TPH 8
FOR BLOOD GAS ANALYSIS - Individuals must meet one ol the qualilication codes THP 1-7
OR
Bachelors degree in respiratory therapy from an accredited institution
TPH 9
Associate degree related to pulmonary function from an accredited institution
TPH 1
TPH 2
TPH 3
TPH 4
TPH 5
TPH 6
FOR HISTOPATHOLOGY - M Testing Personnel must meet one ot the lollowlng:
TPH 10
TPH 11
TPH 12
M.D.,D.O. w/current medical license in State of laboratory's location and certified in anatomic pathology by APB or AOBP or
equivalent qualifications
OR
Resident in a program leading to ABP or OABP certification in anatomic and clinical pathology or anatomic pathology who
performs duties delegated by the technical supervisor for histopathology
OR
M.D.,D.O. w/current medical license in State of laboratory's location and certified in anatomic and/or clinical pathology by ABP or
AOBP or equivalent qualifications except for clinical cytogenetics and histocompatibility
ronMncFA-tt<i(n-92)
Page 8 0(12
�SECTION V. GENERAL SUPERVISOR QUALIFICATIONS - HIGH dOMPLEKltV TESTlMG (EXCLUDING cVTOLOGV)
Qualilication
Code
GS 1
GS 2
Qualilicalions (Education, Training and Experience)
Qualify as laboralory director of high complexity testing
OR
Quality as technical supervisor of high complexity testing
GS 4
OR
M.D.,D.O. w/current medical license in State of laboratory's location and 1 year training/experience in high complexity lesting
OR
Doctorate in clinical laboratory science or chemical, physical or biological science and 1 year training/experience in high
complexity testing
GS 5
Masters in clinical laboratory science, medical technology or chemical, physical or biological science and 1 year training/
experience in high complexity testing
GS 6
Bachelors in medical technology, or chemical, physical or biological science and 1 year training/experience in high complexity
testing
GS 3
OR
OR
OR
GS 7
GS 8
Associate degree in laboratory science or medical laboratory technology and 2 years training/experience In high complexity testing
OR
ON OR BEFORE 2/28/92 qualified or could have qualified as a general supervisor under laboratory regulations published March
14, 1990 (55 FR 9538)
EXCEPTIONS (BLOOD CAS ANALYSIS, HISTOPATHOLOGY, DERMATOPATHOLOGY, OPHTHALMIC PATHOLOGY, A ORAL PATHOLOQY
For blood gas analysis, Individuals must meet one of the qualilication codes GS 1 - GS 8 or either ol the following to
qualify as a general supervisor
GS 9
•Bachelors in respiratory therapy and 1 year training/experience in blood gas analysis
GS 10
•Associate degree related to pulmonary function and 2 years of training/experience in blood gas analysis
For histopathology, oral pathology, dermatopathology, & ophthalmic pathology general supervisors
must meet the following:
GS 11
•For histopathology, qualifies as a technical supervisor in histopathology
GS 12
•For dermatopathology, qualifies as a technical supervisor in dermatopathology
GS 13
•For ophthalmic pathology, qualifies as a technical supervisor in ophthalmic pathology
GS 14
FORM IICFA-114 (9-92)
•For oral pathology, qualities as a technical supervisor in oral pathology
P O B » B O I 12
�SECTION VI. TECHNICAL SUPERVISOR QUALIFICATIONS - HlfeH COMPLErtitY TESTING (EXCLUDING CYTOLOGY)
Qualilication
Coda
Qualifications (Education, Training and Experience)
FOR ALL SPECIALTY AREAS EXCEPT HISTOCOMPATIBILITY AND CLINICAL CYTOGENETICS
TS IA
_
;
M.D.,D.O. w/current medical license in State of laboratory's location and certified in anatomic and/or clinical pathology by ABP or
AOBP or equivalent qualifications except for clinical cytogenetics and histocompatibility
// the technical supervisor(s) does not meet the above qualifications, such individuals must meet one of the following qualifications
for the applicable areas of testing:
TS 2A
M.D.,D.O. w/current medical license in State of laboratory's location and certified in clinical pathology by ABP or AOPB or
equivalent qualifications
TS2B
M.D.,D.O. w/current medical license in State of laboratory's location and 1 year training/experience in high complexity testing in
microbiology, with minimum 6 mos. in the respective subspecialty
OR
OR
TS 2C
TS 2D
TS 2E
TS 3A
TS3B
TS 3C
TS 3D
TS 3E
TS 4A
TS 4B
Doctorate in clinical laboratory science or chemical, physical or biological science and 1 year training/experience in high
complexity testing in microbiology, with minimum 6 mos. in the respective subspecialty
OR
Masters in medical technology, clinical laboratory science, or chemical, physical or biological science and 2 years training/
experience in high complexity testing in microbiology, with minimum 6 mos. in the respective subspecialty.
OR
Bachelors in medical technology, or chemical, physical or biological science and 4 years training/experience in high complexity
testing in microbiology, with minimum 6 mos. in the respective subspecialty
M.D.,D.O. w/current medical license in State of laboratory's location and certified in clinical pathology by ABP or AOBP or
equivalent qualifications
OR
M.D.,D.O. w/current medical license in State of laboratory's location and 1 year training/experience in high complexity testing in
the respective specialty
OR
Doctorate in dinical laboratory science, chemical, physical or biological science and 1 year training/experience in high complexity
testing in the respective specialty
OR
Masters in medical technology, clinical laboratory science, or chemical, physical or biological science and 2 years training/
experience in high complexity lesting in the respective specialty.
OR
Bachelors in medical technology, or chemical, physical, or biological science and 4 years training/experience in high complexity
testing in the respective specialty
M.D.,D.O. w/current medical license in State of laboratory's location and certified in anatomic pathology by APB or AOBP or
equivalent qualifications
OR
.
Resident in a program leading to ABP or AOBP certification in anatomic and clinical pathology or anatomic pathology who
performs duties delegated by the technical supervisor for histopathology
TECHNICAL SUPERVISOR QUALIFICA TIONS (CODES CONT. ON NEXT PAGE)
FORM HCFA-114 (8-92)
Pag« 10 of 12
�Qualilicalion
Code
Qualifications (Education, Training and Experience)
FOR ORAL PATHOLOGY AND TESTING IN DERMATOPATHOLOGY AND OPHTHALMg PATHOLOGV
M.D.,D.O. w/current medical license in State ol laboratory's location
.
TS5A
TS5B
TS 5C
and.
Certilied in anatomic pathology by APB or AOBP or equivalent qualifications
or
Certified In the corresponding areas as follows:
dermatology (ABD); dermatopathology (APD and ABP); ophthalmic pathology (ABO); oral pathology (ABOP) or
possess equivalent qualifications required for such certification
OR
Resident in a program leading to certification in the respective areas listed above who performs duties delegated by the
appropriate qualified technical supervisor for dermatopathology, ophthalmic pathology or oral pathology
TS 6B
M.D.,D.O. w/current medical license in State of laboratory's location and certilied in clinical pathology by ABP or AOPB or
equivalent qualifications
OR
M.D.,D.O. w/current medical license in State laboratory's location and 1 year training/experience in high complexity testing in
immunohematology
TS 7A
M.D.,D.O. w/current medical license in State ol laboratory's location and 4 years training/experience in genetics, including 2 years
ol training/experience in clinical cytogenetics
TS 7B
Doctorate in clinical laboratory science or biological science and 4 years training/experience in genetics including 2 years of
training/experience in clinical cytogenetics
TS 6A
FOR CLINICAL CYTOGENETICS
OR
TS 8A
TS8B
M.D.,D.O. w/current medical license in State of laboratory's location and 4 years training/experience in histocompatibility
OR
M.D.,D.O. w/current medical license in State of laboratory's location and 2 years training/experience in general immunology and 2
years training/experience in histocompatibility
OR
TS 8C
Doctorate in clinical laboratory science or biological science and 4 years training/experience in histocompatibility
TS8D
Doctorate in clinical laboratory science or biological science and 2 years training/experience in general immunology and 2 years
training/experience in histocompatibility
OR
FORM HCFA-1 l i (8-92)
Page 11 ol 12
�SECTION VII. CYTOLOGY TESTING
Qualilication
Code
Qualifications (Education, Training and Experience)
TECHNICAL SUPEHVlSdR
CYT 1
|
M.D.,D.O. w/current medical license in State ol laboratory's location and certilied in anatomic and clinical pathology by ABP or
AOBP or equivalent qualifications
OR
CYT 2
CYT 3
M.D ,D.O. w/current medical license in State ol laboratory's location and certilied in anatomic pathology by ABP or AOBP or
equivalent qualifications
OR
M.D.,D.O. w/current medical license in State of laboratory's location and certilied in cytopathology by ASC
OR
CYT 4
Individual, in final year ol training program leading to ABP or AOBP certification in anatomic and clinical pathology or anatomic
pathology, who performs duties delegated by a qualified technical supervisor
CYG 1
Qualifies as a technical supervisor in cytology
CYG 2
Cytotechnologist with 3 years ol full-time experience (2080 hours per year) within the preceding 10 years
GENERAL SUPERVISOR
OR
CYTOTECHNOLOGIST
CYO 1
CYO 2
CYO 3
CYO 4
Qualifies as a technical supervisor in cytology
OR
Graduated Irom a CAHEA-accredited school ol cytotechnology
OR
Certilied in cytotechnology by certifying agency approved by HHS
OR
BEFORE 9/1/92
•Completed 2 years in an accredited institution with at least 12 semester hours in science, 8 hours ol which are in biology, AND
•Completed 12 months of training in a school of cytotechnology accredited by an accrediting agency approved by HHS;
or
CYO 5
CYO 6
•Completed 2 years in an accredited institution with at least 12 semester hours in science, 8 hours of which are in biology, AND
•Received 6 months of formal training in a school of cytotechnology accredited by an accrediting agency approved by HHS and 6
months of full-time experience in cytotechnology;
OR
Achieved a satisfactory grade to qualify as a cytotechnotogist in a proficiency examination approved by HHS;
OR
CYO 7
BEFORE 9/1/92
•Have at least 2 years of full-time or equivalent experience within the preceding 5 years examining slide preparations under
supen/ision and before January 1,1969 must have•graduated from high school
•completed 6 months of training in a laboratory directed by pathologist or physician providing cytology services, and
• completed 2 years of full-time supervised experience
OR
ON OR BEFORE 9/1/93
CYO 8
Have at least 2 years of full-time experience or equivalent examining cytology slide preparations within the preceding 5 years in
the U.S. and on or before September 1, 1994 have either completed a CAHEA-accreditied training program or become certified
by an HHS-approved accrediting agency
POflM HCFA-114 (0 92)
Pogo 12 o l 12
�FORM APPROVED
OMB NO. 0938 0581
DE PART MENT OF HEALTH AND HUMAN SEFIVICES
HEALTH CAflE FINANCING ADMINISTHATION
CLINICAL LABORATORY APPLICATION
CLINICAL L A B O R A T O R Y IMPROVEMENT AMENDMENTS O F 1988
Public reporting burden lor this collection o l inlormation is estimated lo vary between 30 minutes to 2 hours per response . including time tor reviewing
instructions, searchirtg existing data sources, gathering and maintaining data needed, and completing and reviewing the collection ol inlormation. Send
any comments including suggestions tor reducing the burden to the OHice ol Financial Management, HCFA, P.O. Box 26684, Baltimore, MD 21207; and
lo the Office of Management and Budget, Paperwork Reduction Project (0938-0581). Washington, D C. 20503.
I. GENERAL INFORMATION
Please check any preprinted information on this part of the form and make any necessary corrections. Complete the resl of the form
according lo the directions.
CLIA IDENTIFICATION NUMBER
FEDERAL TAX IDENTIFICATION NUMBER
13D0679680
82-0408339
LABORATORY NAME
Ironwood
TELEPHONE NO. (include area code)
Family
Practice,
208-667-4557
P.A.
LABORATORY ADDRESS (number, slreelj
CITY
920 Ironwood D r .
MAILING ADDRESS
STATE
Coeur d ' A l e n e
different Irom above)
ID
CITY
STATE
ZIP
83814
ZIP
same as above.
NAME OF DIRECTOR (please print or type)
'
a s f
Burns,
first
Timothy
M
F.
Indicate changes below as needed.
LABORATORY NAME
TELEPHONE NO. (include area coda)
LABORATORY ADDRESS (number, street)
CITY
STATE
ZIP
MAILING ADDRESS (if different from above)
CITY
STATE
ZIP
NAME OF DIRECTOR (ptease print or type)
last
first
Ml
I. APPLICATION IS FOR: (check one box)
S I Cerlificale
•
Renewal ol Certificate
•
"Certilicate of Waiver
•
Renewal of Certilicate of Waiver
•
Cerlilicale of Accreditation
•
Renewal of Certificate of Accreditation
*IF YOU CONDUCT ONLY THE FOLLOWING WAIVED TESTS (ONE OR MORE), YOU MAY APPLY FOR A CERTIFICATE OF WAIVER:,
•Dipstick or tablet reagent urinalysis (nonautomated) for:
-bilirubin
-glucose
-hemoglobin
-ketone
-leukocytes
-nitrite
-protein
-pH
-specific gravity
-urobilinogen
•Fecal occult blood
•Ovulation test-visual color comparison tests for human
luteinizing hormone
•Urine pregnancy lest-visual color comparison tests
•Erythrocyte sedimentation rate (nonautomated)
•Hemoglobin-copper sulfate (nonautomated)
•Blood glucose, by glucose monitoring devices cleared by
the FDA specilically lor home use; and
•Spun microhematocrit
If applying for a certificate of waiver, complete all sections of this form except section VIII.
FORM HCFA-116 (8-9?)
Pago 1 ol •I
�III. TYPE OF LABORATORY (check the ons. most descriptive of facility type)
01 Ambulalory Surgery Cenler
08 Home Health Agency
15 Mobile Unit
02 Community Clinic
09 Hospice
16 Pharmacy
03 Comp. Outpatient Rehab. Facility
10 Hospital
17 School/Student Health Service
04 Ancillary Testing Site in Health Care
11 Independent
Facility
18 Skilled Nursing Facility/Nursing Facility
X 19 Physician Oflice
12 Industrial
05 End Stage Renal Disease Dialysis Facility
13 Insurance
20 Other Practitioner (soecilv)
06 Health Fair
14 Intermediate Care Fac. lor Mentally
21 Tissue Bank/Repositories
07 Health Main. Organization
22 Blood Banks
Retarded
23 Other (specify)
Was this laboratory previously regulated under the Federal Medicare/Medicaid and/or
CLIA progcamfe? (Regulations published March 14,1990 at 55 FR 9538)
•
Yes
E No
IV. H O U R S O F ROUTINE OPERATION
List days and hours during which laboratory testing is performed
SUNDAY
FROM:AM
MONDAY
TUESDAY
9:00
WEDNESDAY
9:00
THURSDAY
FRIDAY
SATURDAY
9:00
9:00
9:00
9:00
6:00
6:00
12:00
PM
TO: AM
PM
6:00
6:00
6:00
(For multiple sites attach the additional inlormation using the same lormat)
V. MULTIPLE S I T E S
Are you applying for one certificate for multiple sites?
(X] No If no, go to next section.
D Yes 1 yes, total number of sites.
1
and complete
appropriate section below.
Identify which of the following exception requirements applies to your laboratory operation.
Is this a non-profit or Federal, State or local government laboratory
Is this a hospital with several laboratories at the same street
engaged In limited (e.g., few types of tests) public health lesting and address and under common direction that is tiling for a single
filing for a single certificate for multiple sites?
• Yes • No
certificate for these locations?
• Yes • No
If yes, list name, address and tests performed for each site below.
If yes, list name or department, location within hospital and
specialty/subspecialty areas for each site below.
If additional space is needed, check here
and attach the additional information using the same format.
TESTS PERFORMED / SPECIALTY / SUBSPECIALTY
NAME AND ADDRESS / LOCATION
Name ol laboratory or hospital department
Address/location (number, street, location if applicable)
City, State, ZIP
Telephone No.
(
)
Name ol laboratory or hospital department
Address/location (number, street, location if applicable)
City, State, ZIP
Telephone No.
(
)
Name of laboralory or hospital department
Address/location (number, street, location if applicable)
City, Stale, ZIP
Telephone No.
(
FOPMHCFA 11B|8 92)
)
Pnge 2 ot A
�VI. ACCREDITATION INFORMATION
• Yes 12 No
If yes, check all that apply:
Is your laboralory presently accredited by any private nonprofit organization
Accredited by:
•
•
JCAHO
AOA
•
•
•
•
AABB
COLA
ASC
•
ASHI
•
CAP
Other (specify).
VII. WAIVED TESTING
Indicate total annual test volume for all waived tests performed. Approximately 5,000
VIII. NONWAIVED TESTING
If you perform testing other than or in addition to waived tests, complete the information below. If applying lor
one certificate for multiple sites, Include Information for all sites.
Place a check (^) in the box preceding each specialty/subspecialty in which the laboratory peiiorms testing. Enter the test
volume for the previous calendar year for each specialty. If you are a new laboratory or have added new specialties/
subspecialties, for test volume, enter your estimated annual test volume. Do nol include testing nol subject to CLIA,
waived tests, or tests run tor quality control, quality assurance or proliciency testing when estimating total volume. Each
prolile, panel or group of tests usually performed simultaneously is counted as the total number of separate tests or
procedures of whirh it is comprised. Calculations such as A/G ratio, MCH, MCHC and T are an exception and should not
be included in the total count. Examples: A chemistry profile consisting of 18 separate procedures is counted as 18
separate procedures. In the same manner, a CBC is counted as each individual measured (not calculated) analyte and
as one test for the differential. For microbiology, susceptabilily testing is counted as one test per group of antiobiotics
used to determine sensitivity for one organism.
7
If applying for certificate of accreditation, indicate name of current accrediting body beside applicable specially/
subspecialty.
SPECIALTY / SUBSPECIALTY
•
ACCREDITED
PROGRAM
ANNUAL
TEST VOLUME
C]
Non-transplant
Microbiology
Bacteriology
strep antigen/cultqre
Mycobacteriology
•
Mycology
•
Other
•
500
•
•
Virology
•
ANNUAL
TEST VOLUME
Immunohematology
ABO Group & Rh
Group
Antibody Detection
(transfusion)
Antibody Detection
(nontransfusion)
Parasitology
•
ACCREDITED
PROGRAM
Hematology
Histocompatibility
Transplant
•
SPECIALTY / SUBSPECIALTY
•
Diagnostic Immunology
Antibody Identification
O
Compatibility Testing
•
Other
Syphilis Serology
General Immunology
•
Chemistry
Pathology
O
Histopathology
•
Oral Pathology
Cytology
Routine
•
Urinalysis
•
Endocrinology
•
Toxicology
CH
•
Other
TOTAL ANNUAL TEST VOLUME
FonMiicr-A-iiRifl.n?)
Radiobioassay
Clinical Cytogenetics
500
Pnge 3 of 4
�IX. TYPE OF CONTROL
X. TYPE OF OWNERSHIP
Enter Ihe appropriate two digit code Irom the list
below
(enter only one code)
Enter the appropriate two digit code trom the
list below
0
2
(enter only one code)
Govemment
05 City
06 County
07 Slate
08 Federal
09 Other Government
Voluntary Nonprofit
01 Religious Affiliation
02 Private
03 Other
For Profit
04 Proprietary
01
02
03
04
Sole Proprietorship
Partnership
Corporation
Other (specify)
XI. DIRECTOR AFFILIATION WITH OTHER LABORATORIES
If the primary direclor of this laboratory serves as primary director for laboratories that are separately certified, please
complete the following:
NAME OF LABORATORY
CLIA IDENTIFICATION NUMBER
ADDRESS
XII. INDIVIDUALS INVOLVED IN LABORATORY TESTING
Indicate the total number of individuals involved in laboratory lesting (directing, supervising, consulting or testing). Do not
include individuals who only collect specimens or perform clerical duties. For nonwaived testing, only count an individual
one lime, at the highest laboratory position in which Ihey function. (Example Pathologist serves as director, technical
supervisor and general supervisor. This individual would only be counted once (under director)).
A. Waived TOTAL
No. of Individuals
B. Nonwaived TOTAL No. of Individuals
Direclor. 1
Clinical consultant 1
Technical consultant
12
Technical supervisor
General supervisor
Testing personnel
1
8
ATTENTION: R E A D T H E F O L L O W I N G C A R E F U L L Y B E F O R E SIGNING APPLICATION
ANY PERSON WHO INTENTIONALLY VIOLATES ANY REQUIREMENT OF SECTION 353 OF THE PUBLIC HEALTH SERVICE ACT AS AMENDED OR ANY REGULATION PROMULGATED THEREUNDER
SHALL BE IMPRISONED FOR NOT MORE THAN ONE YEAR OR FINED UNDER TITLE 18, UNITED
STATES CODE OR BOTH, EXCEPT THAT IF THE CONVICTION IS FOR A SECOND OR SUBSEQUENT
VIOLATION OF SUCH A REQUIREMENT SUCH PERSON SHALL BE IMPRISONED FOR NOT MORE
THAN 3 YEARS OR FINED IN ACCORDANCE WITH TITLE 18, UNITED STATES CODE OR BOTH.
CONSENT: THE APPLICANT HEREBY AGREES THAT SUCH LABORATORY IDENTIFIED HEREIN WILL BE
OPERATED IN ACCORDANCE WITH APPLICABLE STANDARDS FOUND NECESSARY BY THE SECRETARY
OF HEALTH AND HUMAN SERVICES TO CARRY OUT THE PURPOSES OF SECTION 353 OF THE PUBLIC
HEALTH SERVICE ACT AS AMENDED. THE APPLICANT FURTHER AGREES TO PERMIT THE SECRETARY,
OR ANY FEDERAL OFFICER OR EMPLOYEE DULY DESIGNATED BY THE SECRETARY, TO INSPECT THE
LABORATORY AND ITS OPERATIONS AND PERTINENT RECORDS AT ANY REASONABLE TIME.
PER^I
SIGHA5WlrOFT5WNEn/AUT|
lirst
FOUM IICPA 116(6^2)
DATE
2ED REPRESENTATIVE OF LABORATORYfs/gn in ink)
Ml
PagiToR
�1
' 4
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
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�ROBERT H. LeBOW, M.D.
380 12th AUCIIUL Ruud P-o.
Nampa, Idaho 83653
C
FAMILY MEDICINE
PREVENTIVE MEDICINE
PHONE: 208-467 t
4I\<\ 43
6 : Mfevl-fK OJ^ Refer
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�Idaho Press-Tribune, Sunday, April 11,1993
Health care: What's happening?
Bureaucracy. Bureaucra^. Bureaucracy. ... So reads a billboard I
passed last week. It was advertising a Washington state health plan
which claimed to have "Less of
it." But increased bureaucracy
seems to be where health-care
reform is headed — if we can
believe the leaks from Hillary's
secretive health-care reform
group.
"Managed competition" — an
almost totally untested concept —
is the chief buzzword of the day. A
recent guest speaker at Mercy
Medical Center described what
this "managed competition"
might look like. He told of a
pediatrician's office with a wall
rack full of referral forms. The
forms corresponded to an array of
specialists to whom referrals
would be made depending upon
which "managed care" plan the
patients belonged to. The plans
each had different deductibles,
different co-payments, different
benefits and different instructions.
Yet Vice President Gore last week
promised less paper work in the
new system.
The invention of economists,
"managed competition" would
apply free-maiket principles to the
business of health care, but on a
"big business" scale. Doctors and
hospitals would be organized into
large groups, like the current
health maintenance organizations
(HMOs). Health care consumers
— they used to be called patients
— would also be organized into
large groups, perhaps whole industries or communides, to be able
to negotiate with organizations
like HMOs for the best health-care
package at the best price. That's
the theory.
Current political and economic
reality — mainly the clout of
interest groups like the insurance
industry and the medical profession — have made the Canadian-style "single payer" health
system unacceptable. Or at least,
so we are told. Bill Clinton is
against it; he likes "managed
competition." Or so we're told.
There are "single payer" health
reform bills in Congress right
now, and they have significant
support. A survey done two weeks
ago showed that 59 percent of the
American public preferred the
Canadian-style "single payer"
plan over managed competition.
But speak to anyone "in the
know," and they will tell you that
the "single payer'' is dead.
Those vested interests, like the
insurance industry and a major
part of organized medicine, fear a
Canadian-style system. And they
did a real PR hatchet job — with a
substantial dose of disinformation
— on Canada's system. Their goal
was to discourage the pursuit of
"single payer" as a solution to
our own health-care mess. So now
the insurance industry, the health
care business people, and the
economists are sitting pretty, ready
to reap the profits of a move to
managed competition.
But what about the U.S. public?
Who can understand what is going
on? Who knows what some of
these new terms and concepts
mean? Are the economists taking
advantage of us all? Will we agr ee
to pay more taxes for the vision of
"health care for all" and get, in
exchange, even more confusion
than there already is — with more
rationing, more impersonal medicine, more administrative costs,
more bureaucracy? If Medicare
looks bad, what will the Greater
Podunk Managed Care Conglomorate Cooperatives look like?
We physicians may have sold
ourselves a bill of goods. Doctors
are hardly even being listened to
by Hillary's commission. Even in
Idaho, most physicians wrote off
the "single payer" concept, with
its total choice of provider,
fee-for-service basis, and empowerment of health-care pro-
viders to negotiate reimbursement
— albeit with a budget "cap."
We physicians have in effect
abandoned our fate to the whims
of the insurance industry, the
economists and the politicians. So
angered were we by the indignities
of Medicare and our fear of ' 'big
govemment," that we now face
even bigger administrative hassles,
bigger bureaucracy and much less
autonomy.
President Clinton deserves credit for his commitment to do
something about our health care
non-system, which has become a
monster in both economic and
human terms. Perhaps the plan he
has promised to unveil in May will
serve as a valid and serious
starting point for change. Unfortunately, health-care reform appears
to be headed away from simplicity, choice and patient concerns.
And it's sad that physicians seem
to have been relegated to the role
of "bit players" in the change
process.
Is "managed competiton" truly
a free-enterprise so ution? As it
appears at present, the big prizes
in health-care reform would go to
the swift and the powerful —
primarily the insurance companies
and health-care industry bureaucrats. Medicare may look good in
comparison.
Bob LeBow is a Nampa physician.
�CODER:
H E A L T H C A R E TASK F O R C E SORTING S H E E T
INPUT DATE:
(S
GENERAL SORT:
P O S T C A R D 1:
Personal stories
General mail
.Letter Campaign
Other Health Providers
P O S T C A R D 2:
..Offers to help/Employment
FORM L E T T E R :
.Letterhead
REROUTE:
Casework
Policy
^--Pliysici
[ysicians
.Scheduling
President
Other
POLICY AND PERSONAL STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE ( I I )
working families
.unemployed/low income
.benefits
.providers
. I N F R A S T R U C T U R E / W O R K F O R C E (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
. G O V E R N M E N T PROGRAMS (IV)
medicare
medicaid
veterans
.DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
FINANCING (VII)
MENTAL H E A L T H (IX)
L O N G - T E R M C A R E (X)
PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
rural
urban
OTHER
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�Justin StormoGi
1-1600
March 30, 1993
Ira Magaziner
Senior White House Policy Advisor
The White House
Washington, D.C.
20510
Re:
New Health Care Financing System
Dear Mr. Magaziner,
Thankyou for attending the Task Force public hearings yesterday. I
was very impressed by your questions
to the panel members which
allowed me to see
your sincere i n t e r e s t in designing a rational
reformed health care system.
Your repeated question of how to quickly get
costs under control
can be answered by acutely increasing c o s t consciousness.
This
will dramatically reduce utilization as shown by the Rand Health
Insurance Study. Please read the enclosed a r t i c l e which describes
how to increase c o s t consciousness without posing an undue burden
on poorer citizens.
You
expressed
concern
about preserving the
doctor-patient
relationship and balancing that with networking care.
The
enclosed proposal outlines
how patient choice can be preserved
while providing
strong
incentives
to
stimulate
efficient
"networks" as you c a l l them - or managed care systems.
You indicated a priority on decreasing paperwork so as to build a
more administratively efficient system.
This a r t i c l e describes
such a streamlined system.
You, as well as the r e s t of us, are concerned about how to fairly
pay for such a system. Again, the enclosed proposal describes a
method by which comprehensive care - from preventive, to acute to
long term care - can be paid for f a i r l y , relative to each
household's income.
You have posed very important questions.
All of which are
possible to solve!
I would strongly encourage
you to carefully
examine the enclosed proposal and to allow me to discuss it
further with you or your s t a f f .
Most Sincerely,
�"INDIVIDUAL RETIREMENT/MEDICAL ACCOUNT" (IRMA)
A Proposal For A New Health Care Financing System
1
D. Justin StormoGipson, M.D. , Peter D. Mazonson, M.D., M B A.
2
�A new health care financing system
3-12-93
"INDIVIDUAL R E T I R E M E N T / M E D I C A L ACCOUNT" (IRMA)
A Proposal For A New Health Care Financing System
1
D. Justin StormoGipson, M.D. , Peter D. Mazonson, M.D., M B A.
2
•Kootenai Medical Center, 700 Ironwood Drive Suite 202, Coeur d'Alene, ID 83814
technology Assessment Group, 490 2nd Street, San Francisco, CA 94107
Author responsible for reading proofs:
D. Justin StormoGipson, M.D.
Kootenai Medical Center
700 Ironwood Drive, Suite 202
Coeur d'Alene, ID 83814
(208) 765-5267
FAX (208) 664-1600
Running head:
A new health care financing system
Submitted for Publication March 9, 1993
PAGEI
�A new health carefinancingsystem
3-12-93 PAGE 2
INTRODUCTION
The need for health carefinancingreform is currently being debated on the national level with
great intensity. This proposal provides theframeworkfor a new, simplified, and easily
understood health carefinancingplan that covers every citizen. It is comprehensive, sharply
contains costs, and is paid for fairly across all levels of society. Its fundamental incentives work
to foster patient and doctor morale, and will allow individual choice ofhealth care provider.
Many changes in our health care system have been proposed. This proposal is different in
fundamental ways from those currently under consideration. It will institute true market-based
competition in the health care sector, stimulate continued high quality health care, provide the
strongest incentives to keep costs under control, and provide universal coverage for every citizen
regardless of income.
The central theme of this proposal is to increase cost consciousness in the utilization of medical
care by establishing mandatory savings accounts that will either pay for medical care or be saved
for retirement for every household of United States citizens. Medical IRA's have been proposed
1
before, but only on a limited voluntary basis . This proposal would provide an easily administered
method of fairly paying for medical services while providing powerful cost control incentives
within our private medical care system.
�A new health carefinancingsystem
3-12-93
PAGE 3
METHODS
IRMA
As noted above, the central theme of thisfinancingscheme is the establishment of an Individual
Retirement/Medical Savings Account (IRMA) for each household of United States citizens.
Every United States citizen with a social security number, along with his/her dependents, will be
covered as a single household. Each household will have approximately 14% of its adjusted gross
income (AGI) set aside, as a payroll deduction, in a tax-free "Individual Retirement/Medical
Account" (IRMA). (See Figure 1 and Table I.)
Standard Health Care Insurance
A portion of the Annual Payroll Deduction, which we will call "X%," will be used to pay for a
Comprehensive Health Insurance Plan (CHIP) (See Figure 1). This plan will cover all necessary
medical care once the household deductible has been met each year. Patients, clinicians, health
policy experts, legislators, and other citizens will all be involved in the process of defining the
services that must constitute this Comprehensive Health Insurance Plan. This notion of a health
insurance plan with stipulated and defined benefits is consistent with the approach advocated by
2 3
proponents of managed competition - . Insurance providers and HMO's will compete within
geographic areas for contracts to provide this comprehensive health insurance plan. As noted
above, this package will encompass a legislated coverage requirement that all competing
insurance providers must guarantee. All United States citizens will be covered by this
comprehensive health insurance plan once their annual deductible has been met (see below).
There will be no exclusions based on prior medical conditions.
An annual open enrollment will allow each insurance provider or HMO to compete for clients
simultaneously. Households will choose the comprehensive health insurance plan they desire.
�A new health care financing system 3-12-93
PAGE 4
F I G U R E 1: IRMA Health Care Financing System
HOUSEHOLD ADJUSTED
GROSS INCOME
(AGI)
ANNUAL
PAYROLL
Insurance Providers Compete for Clients
DEDUCTION
(- x % )
t
CHIP*
Premium
(Pooled Funds);
Payment of Health Expenses up to Annual Deductible ('See a. Below).
Withdrawals:
1. Medical Expenses
a. Annual Deductible =
(Annual Payroll Deduction
Minus X% to Pay For CHIP) Or
(10% of Total in IRMA Savings)
Whichever is Greater.
b. Expenses Beyond Annual Deductible That Are Not Covered by
Comprehensive Health Insurance Plan.
2. Non-Medical Retirement Expenses After Age 65. (Maximum 10% of
IRMA Total Annually.)
* CHIP = Comprehensive Health Insurance Plan.
1-
ti-
X%
= Cost of Comprehensive Health Insurance Plan.
IRMA = Individual Retirement / Medical Savings Account.
�A new health carefinancingsystem
3-12-93
PAGES
The funds will be placed in a regional pool and then allocated to each insurance provider or HMO
using a formula based on the number of households that choose each competing provider. The
average cost of each plan may diflfer and will be presented to each household as costing a
percentage of their annual IRMA payroll deduction (See Figure 1).
Example: An indemnity insurance provider may offer a comprehensive health insurance plan that
covers all federally mandated care. The company determines that the premium will be 23% of the
average annual IRMA investment (Option A - see below). At the same time, an HMO offers the
same coverage for 19% of the average annual IRMA investment (Option B).
Each household would have the ability to choose their comprehensive health insurance plan on an
annual basis:
Option A:
Indemnity Insurance Provider
23%
Option B:
HMO
1%
9
If the Jones Household chooses Option A then 23% of their IRMA payroll deduction will be used
to pay the premium for their Comprehensive Health Insurance Plan (CHIP). If the Smith
household chooses the HMO (Option B), then 19% of their IRMA payroll deduction will be used
to pay the premium for their CHIP. These funds are then pooled regionally. Each insurance
company receives a portion of the pooled funds based on the number of households that choose
their policy and the percentage of the IRMA payroll deduction for which they offered their
coverage.
Hence, cost-conscious competition for the comprehensive health insurance plan (CHIP) will be
integral to the system. Each household's cost for standard health care coverage will be
proportional to their income, and each household will be able to choose the plan that best suits its
needs. Using the formula described above, poor households and retirees with zero Adjusted
�A new health carefinancingsystem
3-12-93 PAGE 6
Gross Income would pay nothing for the CHIP. However, their annual deductible would be equal
to 10% of any IRMA savings they have accumulated. In this way, the IRMA system will continue
to provide cost-consciousness incentives even for those without current income.
Deductible
All medical expenses will be deducted from the ERMA account up to a maximum annual
deductible equal to:
1. the annual IRMA payroll deduction, minus the CHIP Premium:
i.e., (14% X AGI)-(CHIP)
QR
2. 10% ofthe total accumulated in the IRMA,
whichever is greater.
All medical services of the patient's choice will be paid for initially with IRMA funds up to the
household's deductible. The deductible is determined as a percentage of household income. As
noted previously, the services covered under the comprehensive health insurance plan will be
determined under legislative guidelines. These should be wide in scope. The price of the CHIP
premium will be determined through cost-conscious competition, as described above, but will
reflect the scope of services provided under the Comprehensive Health Insurance Plan.
Households interested in buying additional coverage to pay for services not included within CHIP
may do so, but a waiver of the deductible will not be allowed.
Funds which are not used for medical care remain in each household's private retirement account
for personal use after age 65. Therefore, the maximum outlay that any household will have to pay
for all necessary medical care in any year is either 14% of their household AGI or 10% of the
�A new health carefinancingsystem
3-12-93 PAGE 7
accumulated savings in their IRMA, whichever is greater.
Deductible Waiver
Preventive medical services that have been convincingly shown to decrease overall health care
costs (e.g., immunizations) would be exempt from the deductible and paid for under the CHIP
premium.
Payment for Medical Services
The IRMA shall represent an individual retirement savings account established for each household
that shall be administered like any other ERA except that withdrawals may be made by authorized
medical care facilities with the approval of the patient.
Additional Insurance
Additional health insurance may be purchased that will cover medical expenses above and beyond
those covered by the health care package guaranteed by the CHIP. However, in no case can
additional health insurance be allowed that waives any part of the patient's deductible as outlined
above.
Withdrawal
After age 65, withdrawal from the IRMA account may begin for non-medical purposes. Ten
percent of the ERMA total shall be the maximum annual withdrawal allowed for non-medical
purposes. The patient may choose to exceed the 10% withdrawal cap only for medical expenses.
The deductible for medical expenses will continue as described above. Withdrawal for nonmedical purposes will be taxed as income as with current ERA's.
Rationale for Calculations Used in Table I
Table I uses available economic statistics to summarize health carefinancingunder the IRMA
�A new health care financing system 3-12-93 PAGE 8
TABLE I
Health Care Financing Under the IRMA System
Cumulative
COVERAGE
1992 Cost
%of
X 70%
=
($ Billions)
All Hospital and Physician Services
AGI
(3,766)"
336.1
=>
8.9 %
+ All Other Professional Services
521.8
365.3
=>
9.7 %
+ All Non-Durable Medical Products
588.2
411.7
=>
10.9%
+ All Durable Medical Equipment
601.4
421.0
=>
11.2%
+ All Nursing Home Care
668.7
468.1
=>
12.4 %
+ All Home Health Care
681.4
477.0
=>
12.7 %
+ All Dental Services
721.8
505.3
=>
13.4%
+ All Other Personal Health Care
738.8
517.2
=>
13.7%
+ Administration
787.4
551.2
=>
14.6 %
+ Construction
798.7
559.1
=>
14.8 %
+ Govemment Public Health Activity
825.2
577.6
=>
15.3%
+ Research
*
480.1
838.5
586.9
=>
15.6%
Estimated total AGI for 1992 = Total AGI for 1991 plus 4.2% adjustment to 1992 dollars (average
4
increasefrom1988-1991) plus $149 billion in employer-paid health expenses.
�A new health carefinancingsystem
3-12-93 PAGE 9
5 6
system - . It assumes a 30% reduction in health care expenditures as a result of the
implementation of IRMA. We feel that this estimate is conservative because savings will be
derivedfromthree sources:
1.
Decreased utilization due to increased cost consciousness.
7
Direct experimental evidencefromthe Rand Health Insurance Experiment showed that
increasing cost sharing (up to a maximum of $1,000) decreased expenditures by more
than 30%. It convincingly showed that patients (and their providers) utilize fewer
and/or less expensive diagnostic tests and therapies when the patient must share costs.
2.
Decreased price through cost-conscious competition.
The degree of cost savings due to market pressures controlling prices in a new cost
conscious system is likely to exceed the cost savingsfromdecreased utilization. The
Rand Health Insurance Experiment did not evaluate this related and likely more
significant reduction in expenditures that will occur when virtually the entire patient
population becomes acutely "cost-conscious" by having higher deductibles. This will
result in medical practices, laboratories, radiology facilities, pharmacies, and all other
components of the health care system becoming responsive to patients' cost expectations
in order to compete in a true market.
Potential difficulties in constraining prices and utilization arise when a patient is
hospitalized. The hospitalized patient is a "captive" patient and many of the health care
decisions cannot be directly evaluated by him or her. Also, costs take on a lower
priority to the patient in time of urgent medical need. However, the cost of hospital care
is largely an accumulation of smaller charges that are provided for urgent and nonurgent (elective) patient care. In order to ensure that hospital costs remain in line with
other health care costs, some restrictions would apply. Hospital charges for services to
�A new health carefinancingsystem
3-12-93 PAGE 10
acutely ill patients would be required to be equal to charges for equivalent services for
non-acutely ill patients. For example, a patient hospitalized for an acute appendicitis
could not be charged more for the laboratory work, ECG, medications, or hospital bed,
than would be charged for a patient admitted for elective surgery. Justified additional
charges above these non-urgent charges could be allowed for care given when additional
personnel hours are required to provide urgent services. In addition, many of the
charges in the hospital can be tied to services provided to outpatients, e.g., ultrasounds,
X-rays, MRI's, laboratory tests, and medications. The effect of competition in the
outpatient and elective hospitalization realm between neighboring hospitals will
effectively work to restrain cost increases in the acute care setting.
As noted previously, many of the attractive aspects of managed care will be encouraged
under the IRMA system. The comprehensive health insurance plan will be less
expensive for well-managed providers and will be offered to the public for a lower
premium and thereby attract more clients.
3.
Administrative costs would be reduced under the IRMA system.
Standardization and simplification of payments will reduce costs. IRMA will greatly reduce
the paperwork and oversight activities currently used to monitor expenditures. Screening
criteria for govemment programs and private insurance will be eliminated. It is estimated
8
that administrative costs account for 19 to 24% of the current health care budget .
Reducing this expense will contribute greatly to controlling the cost ofhealth care.
Justification for Percentage of AGI Withheld Under IRMA
The percentage of total U.S. adjusted gross income (AGI) in 1992 that would have been required
to cover health care expenses depends on which services are included under the IRMA system
5
(Table I) . If coverage is limited to all hospital and physician services, then an 8.9% payroll
�A new health care financing system
3-12-93
PAGE 11
deduction would be sufficient to cover all costs. However, more comprehensive coverage could
include drugs, prostheses, home health care, long-term care, and dental services. When
administrative and construction costs are added, an estimated 14.8% of the total U.S. AGI would
be required to cover all of these health care costs. Funding for government public health activities
and research would probably continue to be paid for out of general taxes or "toxin taxes" on
cigarettes, alcohol, etc.
We have chosen the 14% figure to indicate our preference for comprehensive coverage including
long-term care under the IRMA system. A portion of the 14% will be used to pay the premium
for a comprehensive health care plan. The remainder will be saved in Individual Retirement
Savings Accounts unless used for medical purposes. For those citizens who incur large medical
expenses, the maximum annual household outlay will not exceed 14% of their adjusted gross
income, or 10% of their IRMA savings, whichever is greater.
Dr. Philip Lee and his colleagues have demonstrated the impact of healtli care costs on the
4
average U.S. family . For example : The Smiths are an "average" U.S. household of four with
two wage earners together making approximately $32,000 per year. The Smith's employers pay
an average combined total of $1,580 per year for health care benefits. Additionally, the family
pays $3,130 each year in taxes for health care. Out of pocket medical expenses and health
insurance premiums average $2,300 per year. All together, this family pays over $7,000 per year
in health care expenses, not including general tax increases to make up for health-care-related
subsidies. Many of these costs are "hidden," either because they are paid by employers or come
out of general tax revenues.
With the IRMA system, the Smith family's employer would pay their current health care benefit
($1,580) directly to them as salary. This would increase their adjusted gross income to $33,580.
Fourteen percent of their AGI (i.e., $4,701) would be their annual payroll deduction to be saved
�A new health carefinancingsystem
3-12-93
PAGE 12
in a taxfreeIRMA and to cover the cost of the Comprehensive Health Insurance Plan (CHIP)
premium. Even if the Smith family spent all of its IRMA payroll deduction on health care the
family would still save more than $2,000 per year in health care costs compared to what they
currently spend. By reducing utilization of medical tests and services, they would save even more
in their IRMA account for retirement.
�A new health carefinancingsystem
3-12-93 PAGE 13
IMPLICATIONS
Taxes
In its purest form, the IRMA system would eliminate aU health-care-related taxes. However,
govemment funding for cost-effective preventive care, public health programs, and research
would not be precluded. Any health-care-related taxes retained in the system would decrease the
payroll deduction calculation proportionately (See Table I).
Employer-Based Health Insurance
Employer-basedfinancingof medical insurance would be replaced by the IRMA system. Current
premiums paid by employers for health insurance will be required to be paid directly to employees
in the form of higher salaries. The average worker with current health care coverage would
substantially benefit from such a change. Employers currently paying health care benefits would
pay no more than their current outlays and increased consumer cost consciousness will reduce
inflation in the health care sector.
Medicaid
Under the IRMA system, all U.S. citizens will have medical insurance that covers necessary
medical care. Therefore, the current Medicaid system will become obsolete. Each household will
have their choice of provider, and each provider will receive "hassle-free" reimbursement from
every patient. All patients will have equal access to necessary medical care services.
Medicare
Currently, patients receiving Medicare assistance pay for medical services proportional to the cost
of the care utilized without regard to income. Those patients with supplemental insurance pay
fixed premiums and have nofinancialincentive to be cost conscious.
�A new health care financing system
3-12-93
PAGE 14
The IRMA system ofhealth carefinancingwould inevitably replace the Medicare system.
Deductibles would be solely based on income (or IRMA savings) as outlined above. Patients over
65 would have the additional advantage of being able to withdraw their IRMA savings at a
maximum rate of 10% per year for non-medical purposes. The transition period from the current
Medicare system to the IRMA system could be abrupt or could be gradual over years. There are
advantages and disadvantages to both scenarios and multiple political considerations will
determine the pace of the transition to IRMA among current Medicare recipients.
Criteria for Evaluation
9 11
Table II lists popular criteria for evaluating proposals for health care reform ' . This proposal
accomplishes ALL of the objectives listed in Table II. The ERMA system is coherent and
relatively simple in concept and implementation. It covers all medically indicated health care for
every citizen and is paid for proportional to household income. IRMA combines the powerful
incentives of increased individual cost consciousness, by utilizing deductibles proportionate to
income, plus managed competition in providing the comprehensive health insurance plan. This
should sharply and rapidly reduce health care expenditures. Through increased cost
consciousness, patients will evaluate value in relation to price and physicians will be rewarded for
providing high quality care at competitive prices. In addition, all households will be able to freely
choose their health care provider and comprehensive health insurance plan.
�A new health care financing system 3-12-93 PAGE 15
TABLE H
Criteria For Evaluating a Health Care System
A HEALTH PLAN SHOULD:
1.
Be coherent and as simple as possible.
2.
Be universal - every citizen should be covered according to medical need, not ability to
pay.
3.
Be comprehensive - all medically-indicated health care should be provided.
4.
Be paid for fairly.
5.
Be structured to contain costs.
6.
Foster the morale of doctors and patients.
7.
Foster patients taking individual responsibility for their health.
8.
Foster competition to provide the best care at the best price.
9.
Allow each individual to choose his or her own health care provider and desired level
of resource utilization.
�A new health carefinancingsystem
3-12-93
PAGE 16
CONCLUSION
We believe the IRMA health care system applies common sense toward solving our nation's health
care crisis. No solution will be perfect for everyone, but this system will spread the burdens,
risks, and benefits more equitably among all citizens. It will give equal access for comprehensive
health care services to every citizen, while allowing each individual to choose his or her health
care provider and make cost-conscious decisions about utilization of those services.
�A new health care financing system 3-12-93
PAGE 17
REFERENCES
1
Goldman RL, Barker W, Clark Z, Fadusko JA, George G, Held S, et al. Marketing a
Practical Health Care Policy for the United States. Health Marketing Quarterly.
1989;6(4): 113-126.
2
Enthoven A Kronich R. A Consumer Choice Health Plan for the 1990's: Universal Health
Insurance in a System Designed to Promote Quality and Economy (Pt. 1 of 2). N Engl J
Med 1989;320:29-37.
3
,
Enthoven A, Kronich R. A Consumer Choice Health Plan for the 1990s: Universal Health
Insurance in a System Designed to Promote Quality and Economy (Pt. 2 of 2). N Engl J
Med 1989;320:94-101.
4
Lee PR, Soffel D, Luft HS. Costs and Coverage - Pressures Toward Health Care Reform.
WestJMed. 1992;157:576-583.
5
U.S. Department of Commerce. Health and Medical Services: U.S. Industrial Outlook
1993. Department of Commerce, 1993;(Chpt 43): 1-6.
6
Internal Revenue Service Statistics of Income Division. Individual Income Tax Returns 1991:
Advance Data Table 1. Internal Revenue Service; 1992.
7
Newhouse JP, Manning WG, Morris CN, et al. Some interim resultsfroma controlled trial of
cost sharing in health insurance. NEnglJMed. 1981:305:1501-1507.
8
- Woolhandler S, Himmelstein DU. The Deteriorating Administrative Efficiency of the U.S.
Health Care System. NEnglJMed 1991;324:1253-1258.
9
Angell M. The Presidential Candidates and Health Care Reform. NEnglJMed.
1992;327:800-801.
1 0
Clinton B. The Clinton Health Care Plaa NEnglJMed 1992;327:804-807.
11
Sullivan LW. The Bush Administration's Health Care Plan. NEnglJMed. 1992;327:801804.
�INDIANA UNIVERSITY
DEPARTMENT OF MEDICINE
University Hospital Room 5420
926 West Michigan Street
Indiana University Medical Center
Indianapolis, Indiana 46202-5250
(317) 274-3841
SCHOOL OF MEDICINE
30 March 1993
H i l l a r y Rodham C l i n t o n
C h a i r , P r e s i d e n t ' s Task Force
on H e a l t h Care Reform
1600 Pennsylvania Avenue NW
Washington, DC 20510
Dear Mrs. C l i n t o n :
I am a f u l l - t i m e p h y s i c i a n a t I n d i a n a U n i v e r s i t y and I am sure
t h a t many people a r e w r i t i n g t o t r y t o o f f e r you a d v i s e on t h e
h e a l t h care system. I want you t o know t h a t I pray f o r change
to take p l a c e , i t i s needed and i t must be done.
What I am f o c u s i n g on i n t h i s l e t t e r i s a l i t t l e b i t
different.
I am u t i l i z i n g my experience as a p h y s i c i a n along
w i t h t h a t o f having been my mother's p o w e r - o f - a t t o r n e y and now
h e r e i e a u ^ o r and t h e t e r r i b l e c o n f u s i o n t h a t must e x i s t w i t h
eTcfer pppp*^ and t h e i r medical and h o s p i t a l b i l l s .
My mother
r e c e i v e s n o t i c e s and b i l l s from Medicare on t h e one hand, and
Blue Cross/Blue S h i e l d f o r her co-payment.
The Medicare b i l l i n g is t e r r i b l e ; they o f t e n send o u t a twot o - f o u r page long b i l l t o r a srmgi-e p h y s i c i a n s t a t i n g what t h e
p h y s i c i a n charged, what Medicare i s p a y i n g , what they a r e n o t
p a y i n g , d e d u c t i b l e s , e t c . A l l o f t h i s i s o f course looked
upon by t h e p a t i e n t as v e r y c o n f u s i n g . The need t o send f o u r
pages o f t y p e w r i t t e n m a t e r i a l f o r a s i n g l e b i l l i s t y p i c a l
b u r e a u c r a t i c o v e r k i l l . Watson and C r i c k ' s Nobel p r i z e - w i n n i n g
paper on t h e d e s c r i p t i n o f t h e DNA molecule was s i x pages
long!
In a d d i t i o n , when t h e Blue Cross/Blue S h i e l d payment does
a r r i v e , i t i s i n t e r e s t i n g t h a t t h e c l a i m numbers between
Medicare and t h e copayment [Blue Cross] don't correspond, even
the names o f t h e p h y s i c i a n o r t h e p h y s i c i a n s ' group a r e o f t e n
d i f f e r e n t . Medicare o f t e n pays under t h e p h y s i c i a n ' s name and
the co-payment c a r r i e r pays under a group name and t h e r e i s no
c o r r e l a t i o n between t h e c l a i m s . For a person who doesn't
understand t h e system v e r y w e l l - - t h e y must have a g r e a t deal
of c o n f u s i o n about who's p a y i n g what, when. I know t h a t o l d e r
people a r e v e r y confused by t h i s .
[Please see t h e enclosed as
w e l l as a work sheet o f f o f my computer f o r an example o f how
bad t h i s problem i s . ]
cont inued....
�H i l l a r y Rodham C l i n t o n
C h a i r , P r e s i d e n t ' s Task Force on H e a l t h Care Reform
30 March 1993
- page 2 -
H o s p i t a l s , Medicare, and d o c t o r s have t h i s t e r r i b l e h a b i t o f
sending out b i l l s t o p a t i e n t s marked T h i s i s Not a B i l l ,
I f you
read t h e f i n e p r i n t , i t says t h a t i t has been r e f e r r e d t o , o r
sent t o , t h e i r insurance c a r r i e r and then they keep sending you
t h i s This is
Not a B i l l
every month.
T h i s i s Not a
Bill,
suddenly becomes a b i l l and o f t e n t i m e s , i s f o l l o w e d r i g h t a f t e r
t h a t w i t h t h e t h r e a t o f some type o f c o l l e c t i o n agency i f you
don't pay. I t h i n k t h a t whole process needs t o be improved over
what i t i s . I n my o p i n i o n , t h i s i s a l l j u s t t y p i c a l o f t h e
t e r r i b l e amounts o f b i l l i n g bureaucracy t h a t I t h i n k e x i s t i n t h e
system t h a t c o u l d be s i m p l i f i e d .
I t h i n k another s i t u a t i o n t h a t needs t o be addressed i n t h e
b i l l i n g b u s i n e s s , i s t h a t t h e r e i s a g r e a t deal o f c o n f u s i o n
between what a charge i s and what i s approved and how much i s
d i s a l l o w e d . I t h i n k t h a t t h e p u b l i c i s under t h e assumption t h a t
t h e i r insurance o r Medicare pays f o r t h e i r care. I t h i n k i n
a c t u a l i t y , we see a l o t o f b i l l s s t a r t i n g a t one f i g u r e , so much
b e i n g d i s a l l o w e d , so much not approved, so much not covered by
d e d u c t i b l e t h a t p r e t t y soon a b i l l o f $100.00 c o u l d end up w i t h
o n l y $30.00 being p a i d . I t h i n k t h e r e i s a l o t o f r e a l l y
c o n f u s i o n and m i s p e r c e p t i o n on o l d e r people when t h a t occurs.
Once a g a i n , I laud your e f f o r t s .
I want t o thank you f o r
a l l o w i n g me t o share t h e above w i t h your and I wish you t h e best
in t h i s regard.
Yours t r u l y .
IES C
JCfD: nn
DILLON, M . D .
�H
V S I C I A N
l> A
Y
This conser\ niive analysis shows an
annual dilTercncc of over .SSOO.OUO per
year in pi'actice revenue in 1996, as
compared to 1991 using only four c o m m o n l y p e r f o r m e d procedures in a
volume consistent with LI moderate size
cardiology practice.
These intensely negative financial pressures certainly pose a problem for
maintenance of present practice incomes, ll is clear thai all interventional
cardiology practices will experience
losses in Medicare revenue per procedure, with many practices experiencing
substantial losses over the next four
to five years. It is also quite clear lhal
other third party payors will adopt
at least part of the reforms insiitured
by Medicare.
All of these changes in reimbursement
put intense pressures o n cardiologists
to change practice patterns. The t w o
basic changes all practices should consider in order to improve the bottomline are: 1 ) revenue enhancement and
2) cost reduction. The table below lists
ways lo enhance revenue.
\1 I
N I
A N (,
i: s
Ways Practices Can Increase
Revenue
1) Increased volume of sen-ices.
2) Increased dollar charge
per unit ot services.
3) Increasing reimbursement by add
ing technical component charges.
•4) Increasing practice efficiency by:
a) Capturing lost charges.
b) I m p r o v i n g coding etliciency.
c) Pre v e n t i n g c l a i m
denial
ihrough documentation and
diagnosis-procedure code
matching.
F.ven though volume performance standards may inhibit future payment
increases, cardiology practices must
continue to grow to increase revenue.
In addition, although revenue per unilo f - w o r k w i l l not increase — and w i l l , in
f a d . decrease under the new KBRVS
system, increasing utilization ol the
lechnical component of services can
effeciively increase the unit dollar
value of each procedure.
Again, i m p r o v i n g practice efficiency is
one of the most important areas a
�I'
I-I
Y S I C I A N
V A Y \|
I- N 1
C 1 A N ( ', !
1
s
Table 4:
KBRVS Financial Impact Analysis *
CPT
Procrtlurcs
Code
#
Proc
1992
1993
l S v i . ^ 1 It M HI I
( S S S . •o'S | l i )
1994
1995
1996
/yc-.ir
r ri :A snmi^-
-ii n ]
i S H I.I ~ l
i S I'l^.TVf J i n
i sj iv.vjn fi.-; i
I lnl.l7~.Jni
IA-M 1 k-:iri (
•um
1 JO. ( l l l l l . l l l l l
1^'i. 9--|..iJ I
i ' A r J ^ i i ~i 1
1
( 1 2 7 . j | . - i IK))
( M i i i h i i K x l NX-I.
•'ii i()
1 'il I.I II )l I.I II) 1
l l > ^ . 7 i 'i.( ' J 1
i ^ 1. J.-^i i.^'J i
i 1 I7.ln.-i
i',',7 J.S.ni I I
i M . i n " lin
I I'.i.^ic.Vdl
1> 1 III.JJS.lllll
I SJJS.^ll.l.di
(S.i'n.fiS ).';!,)
SwMn-t i ; i n / (
l i ) l Al.
Ji i n
7
;
1
A-;I
i J-i/ion. i i i
i.S i n i . n n
li'niii I'livsickm I'.wwK-\il I I K I M U O I*>','_!. S(!IMI .l) l.ilV- Sssicms. Inc.. u.sud In- per
|7i
i 1 'i J . n 7 n . i ' 7 i
i j n . - i i-i .-is i
1 S ^ i S . i . ^ 1 S. i 7 1
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002a. statement
SUBJECT/TITLE
DATE
re: Medical records worksheet (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 2385
FOLDER TITLE:
[Physician Letters] [loose] [3]
2006-0885-F
im786
RESTRICTION CODES
Presidential Reeords Acl - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe F01A|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
h(9) Release would disclose geological or geophysical information
concerning wells |(b)(y) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating lo lhe appointment lo Federal office 1(a)(2) of the PRA)
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
Hnancial information 1(a)(4) ofthe I'RA]
PS Release would disclose confidential advice between the President
and his advisors, or bclwccn such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA1
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002b. statement
SUBJECT/TII I E
DATE
re: Explanation of Medicare benefits (2 pages)
03/04/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [3]
2006-0885-F
jm786
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�This part of the notice answers some common questions that people ask about collecting Medicare benefits.
If you have other questions, see your copy of The Medicare Handbook or call us for more information.
1. What should I do if I have questions about this
notice?
If you have questions about this notice, call, write,
or visit us and we will tell you the facts we used to
decide what and how much to pay. Turn to the
front of this notice; our address and phone
number are on the bottom of the page.
2. Can I appeal how much Medicare paid for these
services?
If you do not agree with what Medicare approved
for these services, you may appeal our decision.
To make sure that we were fair to you, we will not
allow the same people who originally processed
these services to conduct this review.
However, in order to be eligible for review, you
must write to us within 6 months of the date of
this notice, unless you have a good reason for being late (for example, you had an extended illness
which kept you from being able to file on time).
Turn to the front of this notice, the deadline date
and our address are on the bottom of the page. It
may help your case if you include a note from
your doctor or supplier (provider) that tells us
what was done and why.
If you want help with your appeal, you can have a
friend, lawyer or someone else help you. Some
lawyers do not charge unless you win your appeal.
There are also groups, such as legal aid services,
who will give you free legal services if you qualify.
3. How much does Medicare pay?
The details on the front of this notice explain how
much Medicare paid for these services. See your
copy of The Medicare Handbook for more information about the benefits you are entitled to as a
beneficiary in the Medicare Part B program. If
you need another copy of the handbook, call or
visit your local Social Security Office.
Medicare may make adjustments to your payment.
We may reduce the amount we pay for services by
a certain percentage (Balanced Budget Law). If
your provider accepted assignment, you are not
liable to pay the amount of this reduction. We pay
interest on some claims not paid within the required time.
All Medicare payments are made on the condition
that you will pay Medicare back if benefits are
also paid under insurance that is primary to
Medicare. Examples of other insurance are
employer group health plans, automobile medical,
liability, no fault or workers' compensation.
Notify us immediately if you have filed or could
file a claim with insurance that is primary to
Medicare.
4. How can I reduce my medical costs?
Many providers have agreed to be part of
Medicare's participation program. That means
that they will always accept the amount that
Medicare approves as their full payment. Write or
call us for the name of a participating provider or
for a free list of participating providers.
A provider who accepts assignment for covered
services can charge you only for the part of the
annual deductible you have not met and the
copayment which is 20 percent of the approved
amount.
If you are treated by one of these doctors, you can
save money. See The Medicare Handbook for
more information about how you can reduce your
medical costs.
Generally a doctor who has not accepted assignment may not charge more than 120 percent of the
Medicare approved amount for services provided in
1992, or more than 115 percent for services provided
in 1993. This is known as the limiting charge. Contact
us if assignment was not accepted, and you think
your doctor charged more than the limiting charge.
5. How can I use this notice?
You can use this notice to:
• Contact us immediately if you think Medicare
paid for services you did not receive;
• Show your provider how much of your deductible
you have met;
• Claim benefits with another insurance company.
If you send this notice to them, make a copy of
it for your records.
Keep this notice for your records.
Health Care Financing
Administration
�This part of the notice answers some common questions that people ask about collecting Medicare benefits.
If you have other questions, see your copy of The Medicare Handbook or call us for more information.
1. What should I do if I have questions about this
notice?
If you have questions about this notice, call, write,
or visit us and we will tell you the facts we used to
decide what and how much to pay. Turn to the
front of this notice; our address and phone
number are on the bottom of the page.
2. Can I appeal how much Medicare paid for these
services?
If you do not agree with what Medicare approved
for these services, you may appeal our decision.
To make sure that we were fair to you, we will not
allow the same people who originally processed
these services to conduct this review.
However, in order to be eligible for review, you
must write to us within 6 months of the date of
this notice, unless you have a good reason for being late (for example, you had an extended illness
which kept you from being able to file on time).
Turn to the front of this notice, the deadline date
and our address are on the bottom of the page. It
may help your case if you include a note from
your doctor or supplier (provider) that tells us
what was done and why.
If you want help with your appeal, you can have a
friend, lawyer or someone else help you. Some
lawyers do not charge unless you win your appeal.
There are also groups, such as legal aid services,
who will give you free legal services if you qualify.
3. How much does Medicare pay?
The details on the front of this notice explain how
much Medicare paid for these services. See your
copy of The Medicare Handbook for more information about the benefits you are entitled to as a
beneficiary in the Medicare Part B program. If
you need another copy of the handbook, call or
visit your local Social Security Office.
Medicare may make adjustments to your payment.
We may reduce the amount we pay for services by
a certain percentage (Balanced Budget Law). If
your provider accepted assignment, you are not
liable to pay the amount of this reduction. We pay
interest on some claims not paid within the required time.
All Medicare payments are made on the condition
that you will pay Medicare back if benefits are
also paid under insurance that is primary to
Medicare. Examples of other insurance are
employer group health plans, automobile medical,
liability, no fault or workers' compensation.
Notify us immediately if you have filed or could
file a claim with insurance that is primary to
Medicare.
4. How can I reduce my medical costs?
Many providers have agreed to be part of
Medicare's participation program. That means
that they will always accept the amount that
Medicare approves as their full payment. Write or
call us for the name of a participating provider or
for a free list of participating providers.
A provider who accepts assignment for covered
services can charge you only for the part of the
annual deductible you have not met and the
copayment which is 20 percent of the approved
amount.
If you are treated by one of these doctors, you can
save money. See The Medicare Handbook for
more information about how you can reduce your
medical costs.
Generally a doctor who has not accepted assignment may not charge more than 120 percent of the
Medicare approved amount for services provided in
1992, or more than 115 percent for services provided
in 1993. This is known as the limiting charge. Contact
us if assignment was not accepted, and you think
your doctor charged more than the limiting charge.
5. How can I use this notice?
You can use this notice to:
• Contact us immediately if you think Medicare
paid for services you did not receive;
• Show your provider how much of your deductible
you have met;
• Claim benefits with another insurance company.
If you send this notice to them, make a copy of
it for your records.
Keep this notice for your records.
Health Care Financing
Administration
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002c. statement
SUBJECT/TITLE
DATE
re: Health care claim summary (I page)
03/10/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [3]
2006-0885-F
jm786
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b))
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
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�CODER: 'Ri^—
HEALTH CAKE TASK FORCE SORTING SHEET
y
INPUT DATEP ? ' 1 5 1
5S
GENERAL SORT:
POSTCARD 1:
General mail
j^C Personal stories
Other Health Providers
Letter Campaign
POSTCARD 2:
Offers to help/Employment
FORM LETTER:
Letterhead
REROUTE:
Casework
_Policy
.Physicians
Scheduling
President
Other
POLICY AND PERSONAT. STORIES:
/C
ORGANIZATION (I)
insurance premiums
A insurance reform
insurance pools
boards and oversight
K ' COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
.COVERAGE (II)
working families
unemployed/low income
benefits
providers
FINANCING (VH)
MENTAL HEALTH (IX)
.INFRASTRUCTURE/WORKFORCE (HI)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
/ K ) GOVERNMENT PROGRAMS (IV)
medicare
medicaid
.veterans
_DoD
Indian health
LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
AIDS
women's health
immunizations/children
rural
urban
K OTHER gffcfe.'
1
(el
�March 29, 1993
Endocrinology
Specialists
Incorporated
H i l l a r y Rodham C l i n t o n
D i r e c t o r , H e a l t h Care Reform Committee
1600 Pennsylvania Avenue
Washington, D.C.
Dear Mrs. C l i n t o n :
Your e f f o r t s and those o f t h e o t h e r members o f
t h e C l i n t o n a d m i n i s t r a t i o n t o s o l v e t h e h e a l t h care
c r i s i s a r e t r u l y a d m i r a b l e . The t a s k i s f o r m i d a b l e
and t h e need g r e a t . My involvement i n t h e h e a l t h
care
field
i s both
t h a t -of p h y s i c i a n
and
longstandiTrcj
consumer".
I
am
a
practicing
M.D./diabetologist/endocrinologist
as w e l l as a
juvenile-onset
diabetic.
This
dual
role
has
p r o v i d e d me w i t h a unique p e r s p e c t i v e r e g a r d i n g t h e
h e a l t h care needs o f t h e e s t i m a t e d
14 m i l l i o n
d i a b e t i c s i n t h e U n i t e d S t a t e s and t h e inadequacies
of t h e c u r r e n t h e a l t h care system i n d e a l i n g w i t h
d i a b e t e s . I would l i k e t o c o n t r i b u t e t o t h e cause
o f h e a l t h care r e f o r m be i t a t t h e n a t i o n a l ,
regional,
or local
level.
Perhaps my unique
perspective
would be o f some s e r v i c e
i n the
f o r m u l a t i o n o f a new American h e a l t h care p l a n . I f
I can be o f s e r v i c e , please l e t me know. Thank you
f o r your t i m e and c o n s i d e r a t i o n .
Sincerely,
Stephan Kowalyk
Slephan Kowalyk, M.D.
Munsler Medical Cenler
761 Forty-Filih Slreel
Smie 1 0
1
Munsler. Indiana < 6 ?
131
1219) 922-3020
F X (219) 922-3003
A
M.D.
�W077CH
fx
^3
�CURRICULUM VITAE
Stephan Kowalyk, M.D.
Place and Date of Birth:
Marital Status:
Married
Home Address:
Social Security Number:
Education:
1977 - 1981
Brown U n i v e r s i t y , Providence, Rhode Island, A.B.
Biochemistry-Departmental Honors, Magna cum laude
1981 - 1985
UMDNJ - N e Jersey Medical School, Newark, N e Jersev,
'w
'w
M.D.
Appointments:
1985 - 1986
1986 - 1988
1988 - 1989
I n t e r n s h i p , I n t e r n a l Medicine, Cleveland C l i n i c
Foundation, Cleveland, Ohio
Residency, I n t e r n a l Medicine, Cleveland ClinicFoundation, Cleveland Ohio
Fellow, Department o f Medicine, D i v i s i o n of Metabolism.
Endocrinology and N u t r i t i o n , U n i v e r s i t y of
Washington School o f Medicine, and Veterans
A d m i n i s t r a t i o n Medical Center, S e a t t l e , Washington
1989 - 1991
Senior Research Fellow, Department of Medicine, D i v i s K
of Metabolism, Endocrinology and N u t r i t i o n ,
U n i v e r s i t y of Washington School of Medicine and
Veterans A d m i n i s t r a t i o n Medical Center, Seattle,
Wash ington
1990
Diabetes Physician, Camp Sealth-American Diabetes ^
Association Summer Camp, Vashon Island, Washington
1991 - present
Physician, Indiana Endocrinology S p e c i a l i s t s , Ii:C.",__
Munster, Indiana
1991 - present
Medical D i r e c t o r - Diabetes Center,
Saint Margaret Mercy, South Campus
Dyer, Indiana
1991 - present
Medical D i r e c t o r - Diabetes, Thyroid
and Endocrinology C l i n i c ,
Saint. Anthony Medical Center
Crown Point, Indiana
�Teaching P o s i t i o n s :
1978
- 1979
Teaching A s s i s t a n t , Brown U n i v e r s i t y E n g l i s h Department
1983
- 1984
B i o c h e m i s t r y T u t o r , M o n t c l a i r S t a t e C o l l e g e , New Jersey
1988
- 1991
Medical I n s t r u c t o r , Diabetes P a t i e n t H e a l t h Education
Program, VA Medical Center, S e a t t l e , Washington
1988
- 1990
D i s c u s s i o n Group L e a d e r , U n i v e r s i t y o f Washington Medical
School Human B i o l o g y Course 54 4
Honors & Awards:
1981
A.B. B i o c h e m i s t r y - D e p a r t m e n t a l
Brown U n i v e r s i t y
1977
- 1981
Brown U n i v e r s i t y S c h o l a r s h i p
1977
- 1981
Honors, Magna cum laude,
New Jersey S t a t e S c h o l a r s h i p
1981 - 1982
N a t i o n a l I n s t i t u t e o i Mental H e a l t h Undergraduate
T r a i n i n g Grant
1983
Bunbury S c h o l a r s h i p
1990
N a t i o n a l I n s t i t u t e o f H e a l t h - N a t i o n a l Research S e r v i c e
Award
Board C e r t i f i c a t i o n :
1982
- 1985
N a t i o n a l Board o f Medical
Examiners, Parts I , I I ,
Sept 1990
American Board o f I n t e r n a l
Medicine
March 1992
Endocrinology,
& III
Metabolism
Diabetes, &
Licensure:
1991.
I n d i a n a Medical L i c e n s i n g Board - P h y s i c i a n No 01039259
P r o f e s s i o n a l Memberships/
Education:
Member, American College o f Physicians
Member, American Diabetes A s s o c i a t i o n
Member, The Endocrine
Society
Member, American A s s o c i a t i o n o f C l i n i c a l
Endocr.i no 1 og i s t s
Member, Lake County Medical
Society
Member, The T h y r o i d Foundation
o f America
�Member, American Medical A s s o c i a t i o n
Jan-March 1980
C a r d i o l o g y E l e c t i v e - - U n i v e r s i t y o t Melbourne, S t .
Vincent's H o s p i t a l , F i t z r o y , A u s t r a l i a
March 1.980
Royal F l y i n g Doctor S e r v i c e o f C e n t r a l A u s t r a l i a , A l i c e
Springs H o s p i t a l , Northern T e r r i t o r y , A u s t r a l i a
1981 - 1985
Student Associate-Academy o f Medicine NJ -F.-idocr.i ne
Secti on
1984
R e p r e s e n t a t i v e f o r the New ietsey Medical S c h o o l —
Diabetes Research i n I.lie 80's: I n t r o d u c t i o n f o r
Potential Investigators, University of
Massachuset t s
Research
Experience:
1980
Use o f impedance plethysmography i n the measure o f
p e r i p h e r a l v a s c u l a r c o m p l i a n c e - - w i t h J. VanDewater,
M.D., Vascular Surgery Department, Providence,
Rhode I s l a n d VA Medical Center
i 979
E f f e c t o f o p i o i d a n t a g o n i s t s on a d d i c t i v e b e h a v i o r s - w i t h
J.D. C o r b i t , Ph.D., Department o f Psychology, Brown
U n i v e r s i t y , Providence, Rhode I s l a n d
1980
Development o f standard e r r o r c a t e g o r i z a t i o n f o r
computer a n a l y s i s o f prose w r i t i n g - T h e Center f o r
Research i n W r i t i n g , Providence, Rhode I s l a n d
Summer 1980
Hemodynamic e f f e c t s o f s e l e c t e d p r o s t a g l a n d i n and
p e p t i d e analogues-Brown U n i v e r s i t y Chemistry-German
Program, Hoechst Pharmaceuticals, Pharmacology
Department, F r a n k f u r t , West Germany
1981 - 1982
Dexamethasone dynamics i n depressed
patients--National
I n s t i t u t e o f Mental H e a l t h - Mental H e a l t h
Undergraduate T r a i n i n g Grant, w i t h N. E r t e l , M.D.,
Chairman, Department of Medicine, East Orange, New
Jersey VA Medical Center
1982
A n a l g e s i c e f f e c t s o f l a s e r b i o s t i m u l a t i o n w i t h Wen-Hsien
Wu, M.D., Chairman, Department o f A n e s t h e s i o l o g y ,
New Jersey Medical School
Presentations:
Brown U n i v e r s i t y Student Research Symposium
Compliance, March, 1980 ( o r a l ) .
"Impedance Plethysmography
and Vascular
B u t l e r P s y c h i a t r i c H o s p i t a l , Department o f C l i n i c a l Psychology Seminar: "HypothalamicP i t u i t a r y - A d r e n a l Axis A b n o r m a l i t i e s i n Primary Depression", March, 1981 ( o r a l ) .
New Jersey Medical School Student Research Symposium:
"Dexamethasone Dynamics i n
�Depressed P a t i e n t s " , June 1982 ( o r a l ) .
The Endocrine S o c i e t y 68th Annual Meeting, Anaheim, C a l i f o r n i a : " C l i n i c a l , D i a g n o s t i c
and O p e r a t i v e Features o f I n s u l i n o m a s " , June, 1986 ( p o s t e r ) .
Endocrine Grand Rounds, C l e v e l a n d C l i n i c Foundation:
I n s u l i n o m a Experience", September, 1986 ( o r a l ) .
"Hypoglycemia i n the Adult-CCF
Endocrine Grand Rounds, Cleveland C l i n i c Foundation:
1988 ( o r a l ) .
" E c t o p i c ACTH Syndromes", March
N a t i o n a l American Diabetes A s s o c i a t i o n Meeting, Washington D.C: "Galanin i s released
from t h e canine l i v e r d u r i n g sympathetic a c i t i v a t i o n . "
1991 ( o r a l ) .
Publications:
Kowalyk, S. and Hechel, H.: S e l e c t i o n and performance o f medical s t u d e n t s and
r e s i d e n t s w i t h Type I d i a b e t e s m e l l i t u s . J Med Educ, 61:181-183, 1986.
Ahren, B., G o t t c h e r , G., Kowalyk, S., Dunning, B.E., Sundler, F., Taborsky, G.J., J r . :
Galanin i s c o - l o c a l i z e d w i t h noradenergic and n e u r o p e p t i d e Y (NPY) i n dog pancreas and
c e l i a c g a n g l i o n . C e l l and Tissue Res, 261:49-58, 1990.
Saad, M.F., Kahn, S.E., Nelson, R.G., P e t i t t , D.J., Knowler, W.C., Kowalyk, S.,
Bennett, P.H., P o r t e , D., J r . : D i s p r o p o r t i o n a t e l y e l e v a t e d p r o i n s u l i n l e v e l s i n Pima
I n d i a n s w i t h NIDDM. J C l i n E n d o c r i n o l Metab, 70:1247-53, 1990.
Kowalyk, S., V e i t h , R., Boyle, M., Taborsky, G.J., J r . The l i v e r r e l e a s e s g a l a n i n
d u r i n g sympathetic nerve s t i m u l a t i o n . Am J P h y s i o l
262 (5 p t 1 ) : E671-8, 1992.
McKnight, G.L., K a r l s e n , A.E., Kowalyk, S., Mathewes, S.L., Sheppard, P.O., O'Hara,
P.J. and Taborsky, G.J., J r . Sequence o f Human Galanin and I t s I n h i b i t i o n o f GlucoseS t i m u l a t e d I n s u l i n S e c r e t i o n From RIN C e l l s .
Diabetes 41 ( 1 ) : 82-87, 1992.
Abstracts:
Kowalyk, S. and Sheeler, L.R.: C l i n i c a l , d i a g n o s t i c and o p e r a t i v e f e a t u r e s o f
i n s u l i n o m a s . 68th Annual Endocrine S o c i e t y Meeting, Anaheim, C a l i f o r n i a , June, 1986,
A b s t r a c t #321.
Kahn, S.E., Nelson, R.G., Schwartz, M.W., Kowalyk, S., P o r t e , D. , J r . : P r o i n s u l i n
l e v e l s a r e d i s p r o p o r t i o n a t e l y e l e v a t e d i n Pima I n d i a n s w i t h NIDDM. Diabetes 38 (Suppl
2 ) : 223A, 1989.
Kahn, S.E., Schwartz, M.W., Bergman, R.N., Taborsky, G.J., J r . , Kowalyk, S., P o r t e , D.,
J r . Hyperglycemia produced by a prolonged glucose i n f u s i o n i n c r e a s e s i n s u l i n
s e n s i t i v i t y b u t does n o t a l t e r i n s u l i n - i n d e p e n d e n t glucose e f f e c t i v e n e s s i n normal
s u b j e c t s . C l i n Res 38:122A, 1990.
Kowalyk, S. and Taborsky, G.J., J r . Galanin i s r e l e a s e d from t h e canine l i v e r d u r i n g
sympathetic a c t i v a t i o n . C l i n Res 39 ( 1 ) : 100A, 1991.
Kowalyk, S. and Taborsky, G.J., J r . Galanin i s released from the canine l i v e r d u r i n g
sympathetic a c t i v a t i o n . Diabetes 40 (Suppl 1 ) : 155A, 1991.
�Prigeon, R.L., Kowalyk, S., Porte, D., Jr. Failure of B-cell adaption to experimental
i n s u l i n resistance i n older i n d i v i d u a l s . C l i n Res 39 ( 1 ) : 101A, 1991.
Prigeon, R.L., Kowalyk, S., Porte, D., Jr. Failure of B-cell adaption to experimental
i n s u l i n resistance i n older i n d i v i d u a l s . Diabetes 40 (Suppl 1): 16A, 1991.
Boyle, M., Kowalyk, S., Humes, J., Taborsky, G., Veith, R. Galanin i s a Sympathetic
Neurotransmitter i n the Canine Liver. Diabetes 41 (Suppl 1): 51A, 1992.
Verchere, C.B., Kowalyk, S., Schwartz, M W , Baskin, D.G., Taborsky, G. J. Major
..
species v a r i a t i o n i n the expression of galanin m N i n mammalian celiac ganglion.
RA
Endocrine Society 1993 (Submitted).
Manuscripts Submitted/In
Preparation:
Kowalyk, S. and Sheeler, L.R.: Insulinomas: C l i n i c a l , diagnostic and operative
features of 50 consecutive cases at the Cleveland C l i n i c Foundation.
Taborsky, G.J., Brown, M., Veith, R., Kowalyk, S. The canine l i v e r releases
Neuropeptide Y during sympathetic nerve s t i m u l a t i o n .
Kowalyk, S., Hoogwerf B. Ketoconazole therapy of ectopic ACTH syndrome secondary to
prostate carcinoma.
Taborsky, G.J., Kowalyk, S. Human galanin stimulates arginine-induced release of growth
hormone i n primates.
Patent, pending:
McKnight, G., Kowalyk, S., e t a l . Methods for detecting galanin antagonist.
(Application # 07/816, 285).
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
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2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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[Physician Letters] [loose] [3]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
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3/16/2015
Source
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42-t-12092992-20060885F-Seg3-005-010-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/6f8ad9dccb8c49cbb69c5675f26b02af.pdf
a8062a37ead6b88b41983f8b153ad0b9
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
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�Withdrawal/Redaction Sheet
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DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. letter
Address (Partial) (5 pages)
03/18/1993
P6/b(6)
002. note
Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [2]
2006-0885-F
im785
RESTRICTION CODES
Presidential Records Act -144 IJ.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
IM Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors la)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
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purposes |(b)(7) ofthe FOIA]
b(K) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe KOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
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�CODER.
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POMCY AND PERSONAL STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
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unemployed/low income
benefits
providers
.INFRASTRUCTURE/WORKFORCE (HI)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
.unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
_DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
.FINANCING (VH)
MENTAL HEALTH (IX)
.LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
AIDS
women's health
immunizations/children
.rural
urban
OTHER
�TT
i *
i
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
X
^38.5
�George T. Whittle, M.D., F.A.C.S.
1 Executive Drixe
Tinton Fall<Nj7i)T701
90&-741-3«58___—
January 28, 1993
Hillary Clinton
Task Force on National Health Care Reform
The White House
Washington, D.C. 20510
Dear Mrs. Clinton;
As chairwoman of the Task Force of National Health Care Reform, you have assumed
a position of awesome responsibility. Since your background is not the discipline of medicine,
you will require an extensive medical education prior to making any intelligent decisions.
Unfortunately, in the past, quick politicalfixeshave been applied to very complex problems
and the long term effect has in large part created the "crisis" you are dedicated to fix.
You will have to gather informationfrommany sources and you must realize that any source is
biased. Beware of the expert who has never practiced medicine. Beware of the quick fix
that will create new problems.
The Medicare program was enacted as a political expedient without even defining the problem
and against good medical advice. All of the problems that it created were predicted by intelligent
physicians, except the problems were even worse than were initially realized.
I have been a physician for forty two years. I have lived through the transition of medicine as
a dedicated, honorable profession to what has become a crass, commercial enterprise where the
huckster is rewarded and the dedicated, compassionate physician is being brutalized. I don't
profess to know the entire solution to the medical dilemma, but I do know how some facets of the
problem should be re-directed and what our objectives should be.
I am nearing the end of a productive medical life. I am a responsible physician and I have the
expertise and judgement necessary to be a valuable asset to you and your committee in your
awesome undertaking.
�George T. Whittle, M.D., F A C. S.
Diplomate American Board of Urology
CURRICULUM VITAE
GEORGE
WmEjTLE, M.D.,F.A.C.S.
Sraduate: P r i n c e t o n U n i v e r s i t y , AB.
Graduate: University of Pennsylvania Medical School, 1950.
Interned Graduate Hospital, University of Pennsylvania, 1950 to 1951.
S u r g i c a l Resident: Jersey City Medical Center, July to November 1950.
General Surgical Resident: Bronx Veteran*s Hospital, 1952 to 1953.
Medical O f f i c e r , U.S. Navy: 1952 to 1954.
Surgical and Urologic Resident: Bronx Veteran's Administration Hospital,
October 1954 to January 1, 1957 v i t h one
year rotation through Presbyterian ,
Medical Center as Urologic Resident.
Private Practice of Urologic Surgery, Monmouth County: January 1957
^
to the present time.
Attending Urologist, Jersey Shore Medical Center, Neptune, N.J.
Attending Urologist, Monmouth Medical Center, Long Branch, N.J.
•;
Director of Department of D i a l y s i s , 1960to 1972 at Monmouth Medical
Center, Long Branch, N.J.
Attending Urologist, Riverview Medical Center, Red BanlcNJ.
L i t h o t r i p s y and Urology privledges, Robert Wood Johnson, New Brunswick,NJ
Diplomate of the American Board of Urology, 1960.
Fellow of the Ameri9an College of Surgeons, 1960.
Member of the New York Urologic Society and Member of the American
Urologist Association.
Monmouth County Medical Society.
�HEALTH CARE TASK FORCE SORTING SHEET
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POLICY AND PERSONAL STORIES:
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insurance premiums
insurance reform
^insurance pools
boards and oversight
. C O V E R A G E (H)
working families
unemployed/low income
benefits
providers
. I N F R A S T R U C T U R E / W O R K F O R C E (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
^unnecessary procedures
. G O V E R N M E N T PROGRAMS (IV)
^medicare
medicaid
veterans
DoD
Indian health
. C O S T I S S U E S (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
.FINANCING (VII)
. M E N T A L H E A L T H (IX)
. L O N G - T E R M C A R E (X)
PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
AIDS
women's health
immunizations/children
.rural
urban
OTHER
�I
NOTICE
PEHSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
'Sox.
^385
'• .
�DR. COLLEEN B. WALTON
j I
,
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�Withdrawal/Redaction Marker
Clinton Library
DOCliMENT NO.
AND TYPE
001. letter
SUBJECT/Tl I LE
DATE
Address (Partial) (5 pages)
03/18/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
2385
FOLDER TITLE:
[Physician Letters] [loose] [2]
2006-0885-F
im785
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Inrormation Act -15 IJ.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
h(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOI A|
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA|
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�DR. COLLEEN B. WALTON
•
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�Jersey
March 7, 1993
Ms. H i l l a r y Rodham C l i n t o n
White House
Pennsylvania Avenue
Washington, D.C.
Dear Ms. C l i n t o n :
I am w r i t i n g t o express my support f o r your e f f o r t s t o reform our
h e a l t h care system. I am a p e d i a t r i c endocrinologist who practices
mainly i n the c i t y of Newark, New Jersey, a c i t y notorious f o r i t s
poverty, high prevalence of drug abuse and AIDS, and high rates of
v i o l e n t crime. Daily I see how these s o c i a l i l l s impact upon the
medical care of c h i l d r e n and adolescents. Increasingly though, I
am also seeing how the lack of adequate health insurance i s
a f f e c t i n g the middle c l a s s ' a c c e s s i b i l i t y t o health care, t o o .
Trying t o o f f e r good medical care i n t h i s environment and balance
the problems of being an i n n e r - c i t y h o s p i t a l w i t h the need t o see
c h i l d r e n of underinsured parents i s f r u s t r a t i n g and morally
confusing.
I am sure I am not t e l l i n g you anything you do not already
appreciate; however, I am so encouraged by the hope of a b e t t e r
health care f u t u r e f o r our p a t i e n t s t h a t I must w r i t e t o you my
words of support.
Sincerely,
Irene N. S i l l s , MD
Associate D i r e c t o r , D i v i s i o n of
P e d i a t r i c Endocrinology
UMD-New Jersey Medical School and
Children's Hospital of New Jersey
United Hospitals Medical Center
A major teaching affiliate of The College of Medicine and Dentistry of New Jersey
15 South Ninth Street, Newark, N.J. 07107
201/268-8760
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POUCY AND PERSONAL STORIES:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
. C O V E R A G E (H)
working families
unemployed/low income
benefits
providers
. I N F R A S T R U C T U R E / W O R K F O R C E (III)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
. G O V E R N M E N T PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
_COST ISSUES (VI)
drug prices
physician fees
hospital fees
.medical equipment
fraud & abuse
FINANCING (VII)
. M E N T A L H E A L T H (DO
. L O N G - T E R M C A R E (X)
.PUBLIC HEALTH/
S P E C I A L POPULATIONS (XII)
prevention
AIDS
.women's health
.immunizations/children
.rural
urban
OTHER
�v- ^
•tie
.-«
NOTICE
PEHSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�-.1
*1
Mrs. Hillary Rodham Clinton
Office ofthe First Lady
Health Care Reform Task Force
white House
Old Executive Office Building
Washington, DC 20500
Dear Mrs. Clinton:
I am a physician who graduatedfromthe^uenos Aires Medicaf)School in Argentina. I
obtained my license to practice medicine in theTTS.A. irt V))l after training at Glen Cove
Hospital in Glen Cove, "NTYr I have worked in coronary care units as well as emergency
rooms. At the-preserit time I am working for a^ptiarmaceutical company.; I am writing
you as a physician and a citizen, not on behalf of the company I work for. The reason I
am writing you is health care.
1.
I agree with you and the President that everybody should have medical care.
2.
My concern is that health care will fall under the control of insurance companies and
become strictly a business. As a consequence, people who need it most—those not seen by
insurance companies as their best customers—will not be able to afford it.
People may purchase insurance for major surgery and hospitalization, and not be
able to afford plans that cover physicians' visits, mammograms, pap smears, prenatal care,
etc. . . They will then be admitted to hospitals for sicknesses i.r\d treatnieiiis thai couid
have been prevented.
I believe that many small businesses, which cannot afford to buy health benefits for
their employees, will hire people on a temporary basis. Many of these people do not have
the income to buy health insurance, because they need it to pay for their rent, food, and
utilities. They and their children will continue to go to emergency rooms for otitis, sore
throats, etc. . . This is our problem now. It will continue if we tum medical coverage
over to the insurance companies.
3.
I recommend a health care program similar to the Canadian and Scandinavian
programs, with medical care under the control of the govemment and the states. It will be
simpler and I think most people will be willing to pay taxes for health care for the entire
population. 1 think the time to do this is here.
�4.
Another concern I have is the common practice of suing physicians. It has triggered
physicians to order unnecessary tests to protect themselves, and as a result medical
expenses and malpractice insurance have become needlessly costly. If the abuse of this
practice of suing physicians is not addressed, the vicious cycle of health costs will not be
broken.
In summary, I would like to stress again that I am in agreement with you and the
President. Medical care should be available to everybody. Medical care should be under
the control of the government or states. This will be simpler and will reach everybody. If
it is left in the hands of business people, it will not reach where it is needed the most and
your goal and the President's will not be accomplished.
At the same time, I would like to congratulate you for your dedication to this very
complex and difficult problem. As a professional woman I feel very proud that this
challenging task is under the responsibility of another professional woman.
Your
Ann'
�Cooper HospitaB/University Medical
One Cooper
Plaza
• Camden,
New Jersey
Center
08103-1489
• ••
••
•• •
•• •
•
•• •
•
•• •
•
••
••
Hillary Rodham Clinton, Esq.
Task Force on National Health Care Refonn
The White House
1600 Pennsylvania Avenue
Washington, DC, 20510
Februarys, 1993
Dear Mrs. Clinton:
As a citizen and taxpayer, I welcome your intention, with the support of the President, to attempt
reform of the American healthcare system. As a "provider" within that system, I clearly recognize the
difficulties you will encounter, the conflicting views and interests of various segments of society, and the
unwillingness of much of the population to accept basic systemic reform. Balanced against these problems
are certain issues which I feel are basic, butfrequentlynot discussed. Prior to commenting on these issues,
a brief comment on my background may be appropriate.
I completed training in Radiation Oncology in 1972, following which I served in the U.S. Army
for two years directing a radiation oncology program. In 1974,1 joined a medical school faculty and since
that time have had an opportunity to practice (and observe practices) in primary, secondary and tertiary
settings. I have served on economic commissions of the American College of Radiology, on scientific
panels of the National Cancer Institute, on research funding commissions of the State of New Jersey, on
an advisory panel to HFCA's Prospective Payment Review Commission, and currently serve as President
of the New Jersey Division of the American Cancer Society. Recently I assumed the chairmanship of an
American College of Radiology panel charged with initiating studies of cost-effectiveness of various
procedures and practices. I provide this brief resume of my career only to support my credentials as a
thoughtful observor of our unique system of delivering health care.
As I indicated, there seem to be certain basic flaws in our current system of health care delivery.
Wealthy Americans have instant access to the most technologically advanced system in the world but no
better life expectancy or reduction of morbidity than less expensive systems. The vast majority of our
population, the middle class, have less and less access, increasing costs, and tremendous fear of loss of
access. The segment of our population covered by Medicare and Medicaid have increasingly reduced
access to lowering quality of care, and approximately 37 million Americans have essentially no access.
Our maternal and fetal mortality is among the highest in the developed world, our preventative medicine
practices are inappropriate and yet we drag our feet implementing change. It seems to me that the issues
may, to a certain extent, be considered as:
1. Profit - Our current system is driven to a large extent by profit at the provider level. By
provider, in this context, I include hospitals, physicians, insurance companies, managed care suppliers,
durable medical equipment suppliers, drug manufacturers, etc. Even in a managed care system,
reimbursement is reduced to doctors and hospitals, but is substituted by profit to the managed care
provider (HMO, etc.).I beleive that a health care system that allows profit is possible, but can see no
reason why that level of profit should not be totally controlled. Those who cry that this is impossible in a
capitalistic economy should look to the public utility industry as a model. We have the finest power system
in the world, with almost universal access at reasonable price, but with total public control. Public utilities
are profitable, pay a good rate of return to their investors and are run in a business-like manner. There
University of Medicine and Dentistry of New Jersey/Robert
Wood Johnson Medical School at Camden
�seems to me to be no reason that health care could not be managed in a similar fashion. Our current
system allows medical care provider companies such as hospital chains, to earns profits of 20% and more,
at the same time as inner city hospitals with just as good management, may be losing millions. Physicians
add to this burden when a primary care provider working 60 hours per week may earn $50,000.00 and a
cardiac surgeon working 60 hours per week may earn millions. The move toward physician prospective
payment will help in this regard, but the current steps in this system are slow and cumbersome.
2. Excess capacity - Within 20 miles of my office there are more MRI machines than in Canada
and more cardiac surgery programs than in England. We have argued that this proliferation is justified
based on the needs of our population and that patients should not have to "leave their home communities"
for certain kinds of care. Reducing these facilities is labeled as "rationing". While it is true that in Europe
and Scandanavia, as examples, patients may wait months for some types of procedures (such as cardiac
bypass surgery), there is absolutely no evidence that this delay is harmeful, and indeed, these individuals,
except for the possibility of some delay related stress, do just as well. Our overproliferation of high-cost
services has increased cost, reduced efficiency and produced hospital and physician competition similar to
the arms race. We must control proliferation with true regional planning. Much of the excess capacity in
ambulatory services is generated by physician -generated business ventures such as free-standing MRI,
radiology, radiation oncology, physical therapy, etc. The practice of physician self referral must be
abolished entirely.
3. Problem-solving - In the past, changes in health care policy and legislation have been directed
by special interest groups or by policy planners within the power structure who have not actually lived
and worked within our health care "trenches". This type of decision making apparatus does not serve us
well.
4. Tort reform -1 do not believe that the "actual" costs of our litigation system are a tremendous
part of the problem, but that fear of the system drives costs higher. Doctors practice defensive medicine
ordering unnecessary tests and hospitalization based on "how they will look in court" rather than actual
medical necessity. This defensive ordering actually covers up much sloppy medical practice, increases
reliance on expensive studies, and reduces reliance on good medical skills and judgement. Some of these
issues could be alleviated by use of "standards of care" in many clinical situations which would shield a
physician from litigation if good practice leads to a bad outcome. At the same time, we must deal with
exorbitant and inappropriate jury awards for "pain and suflfering", etc. If physicians are ever to become
allies in this process, the legal community must also respond.
5. Administrative costs - Costs to health care providers to bill, comply with regulations, collect,
etc. are becoming overwhelming. These costs are uniformly passed on to the payor. Standardization of
forms is simple and essential. The costs of regulatory compliance can be reduced and much waste in the
system eliminated.
6. Fraud and abuse - This problem is rampant and either undetected or ignored. Individuals or
organization who steal from the health care system steal from each and every one of us. This white-collar
crime must be dealt with harshly, quickly, and uniformly.
V.Physician/family/patient decision-making - The percent of our total lifetime health care
expenditure spent in the last year of life is obscene, especially when we spend so little caring for pregnant
women and children. We as physicians, in cooperation with patients and families.should be allowed to
discontinue certain aspects of care without fear of legal implications. On a routine basis, I see elderly
patients with advanced disease and "do not resuscitate" orders, being cared for in an extraordinarily
expensive intensive care setting. Availability of improved nursing home and home care arrangements
would very much reduce the costs and increase the humanity of ourfinaldays.
7. Preventative medicine - We are the only country in the developed world where preventive
medicine is still a topic of political debate and cost containment. The facts are simple. Preventative
�medicine of all types, eg. immunizations, nutritional support for pregnant women and children, smoking
reduction, etc. save money and morbidity.
Obviously the issues I cite are not all-inclusive or simple. We are faced with a heterogeneous
population which has extraordinary self-destructive tendencies, eg. drugs, smoking, unsafe sex, multiple
pregnancies, excessive alcohol, handguns and other weapons, trauma, etc. All of these factors weigh on
our ability to provide appropriate, affordable health care to all of our population. We must, of necessity
deal with the issues of health care simultaneously, at many of these levels, since "patch-work" solutions
may go the way of our past failures.
I wish you well in your task and would be happy to provide assistance in your efforts.
Sincerely,
Paul. E. Wallner, D.O., F.A.C.R.
Clinical Professor and Chief
Department of Radiation Oncology
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insurance reform
insurance pools
boards and oversight
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working families
unemployed/low income
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.providers
RASTRUCTURE/WORKFORCE (HI)
.quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
.unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
^medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
hospital fees
medical equipment
fraud & abuse
FINANCING (VH)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
.PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
AIDS
.women's health
.immunizations/children
rural
urban
OTHER
�I Ml)
NEW
| E R S E Y
University of Medicine & Dentistry of New Jersey
Office of the Director
New lersey Trauma Center
Phone: (201) 456-4900
Fax:
(201) 456-7108
150 Bergen Street, E-245
University Heights
Newark, N) 07103-2406
March 18, 1993
Ms. Hillary Rodham Clinton, Esq.
Chairman:President's Task Force on
National Health Care Reform
The White House
1600 Pennsylvania Avenue
Washington, DC 20007
Dear Ms. Clinton:
It is with the greatest expectations and hopes for success that my wife and I voted for, and
now applaud the victory of the Clintons' campaign. We fervently believe that the lack of
leadership and national drift of the last 12 years can be reversed by the intelligent
govemment being assembled and lead by President Clinton.
I am personally greatly pleased that President Clinton is so greatly committed to reversing
the inequitable and excessively costly health care system in the United States that he has
permitted you to oversee this critical effort, with all of the personal and political risks that
this endeavor involves. It takes great courage on your part to assume this burden and I wish
you well.
Since you have undertaken this task, I feel obliged to share with you my concerns about the
fate of necessary trauma care services in a managed health care system. My nearly 30 years
of professional and academic involvement in treating and studying the medical, physiological
and economic aspects of this disease have lead me to the conclusion that a regional system
of Emergency Medical Care linked by an echelons of care protocol to a network of Level
I and Level n Trauma Centers is necessary for quality care for all members of society,
regardless of income status. To meet the urgent care demands of this disease, some special
considerations must be taken as the comprehensive health care financing plan which you are
coordinating is developed. I have tried to address the more important of these in the
enclosed statement.
HMUNI
The University is an affirmative action/equal opportunity employer
�Hillary Rodham Clinton, Esq.
March 2, 1993
Page 2 of 2
I realize that the enormous demands on your time make it unlikely that you will be able to
read this statement yourself. However, I hope that you will refer it to one of your advisors
to consider as the Clinton Health Care Plan is formulated.
Thank you for your consideration and best wishes for your and President Clinton's success
in enacting your program.
Sincerely-yours,
M.D.,:
JojHf H.. Siegel, M.D.,FACS, FCCM
Lesley J. Howe Professor of Surgery
Director, New Jersey Trauma Center
Chairman, Department of Anatomy, Cell Biology
and Injury Sciences
JHS:bj
Enclosure
�STATEMENT ON TRAUMA CARE SERVICES IN A MANAGED
HEALTH CARE FINANCING PLAN
John H. Siegel, M.D.,FACS,FCCM
Wesley J . Howe Professor of Surgery
Director, New Jersey Trauma Center
Chairman, Department of Anatomy, Cell Biology
and Injury Sciences
New Jersey Medical SchoohUMDNJ
Traumatic injury is America's most expensive disease, both in dollars and loss of
productivity. It is estimated that there are approximately 2.3 billion hospitalized injuries and
nearly 140,000 deaths per year. This results in an average of 36 life years lost per trauma
death amongst citizens of the United States. Trauma costs more than $44 million dollars
a year in direct medical costs and is estimated to total more than 158 billion dollars annually
in terms of the lifetime costs of injury. As a result, the proportion of health insurance cost
related to the need to compensate for all forms of injury to employees represents a major
non-business expense amongst American manufacturers.
When we look at the various
segments of the American people, injury related to violent crime most heavily affects the
urban poor, where death or injury by gunshot has become a plague amongst black and
hispanic youths. Conversely, the middle class is disproportionately affected by injuries
related to motor vehicle crashes whose health care costs have caused automobile insurance
rates to rise to the highest point in the history of the United States. The disease of trauma
has medical and sociologic implications with special organizational and cost related features
which need to be considered differently than those of other illnesses when restructuring the
health care system in America.
-1-
�Statement of Trauma Care Services in
a Managed Health Care Financing Plan
Trauma, among the major disease categories which affect the American public, has a unique
need for urgency of therapy by a team of highly trained specialists. This, and the
requirement for a complex multi-layered system of emergency medical and hospital services
for medical service has lead to the creation of systems of Trauma Centers in various regions
of the United States. A number of studies of the effectiveness of the Trauma Center
concept in the United States have shown that counties where a system of echelons of trauma
care (based on the transport of patients not to the nearest hospital, but rather to a
designated Trauma Center), was put in place had a significant reduction in preventable
mortality of between 20 and 40 percent. Moreover, the effectiveness of such a Trauma
Center system is predicated on the use of an emergency medical EMS services system, which
transports the more severe cases to a specific Trauma Center based on its category of
sophistication, with Level I Centers being the most comprehensive and Level n Centers
having the capacity to handle all but the most severe injuries.
This type of case selection and triage from the field means that the distribution of injury
severities of patients admitted to Level I and Level n Centers does not have a normal bellshaped curve. Rather, the distribution of severities, and costs are skewed, and most closely
approximates a log normal distribution, (Figure I) with the more sophisticated Centers
having a disproportionate number of cases of the greatest complexity, the longest length of
stay, and the greatest acute medical care costs.
�ACUTE CARE COST
N = 142
Frequency
M e d i a n » $54,200
M e a n » $74,310
<1
l
2
3
4
5
6
7
B
9
10
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 26 29 30 31
Acute Care Cost (SlCOOOs)
FIGURE 1
Acute Care Costs o f M u l t i p l e Trauma P a t i e n t s
�Statement of Trauma Care Services in a
Managed Health Care Financing Plan
In our study of motor vehicle crash (MVC) patients' trauma severities carried out in
Maryland, the mean acute care cost for the top 1% of multiple trauma, motor vehicle
accident victims was $74,310. This 1% of patients accounted for nearly 10% ofthe total inhospital acute care costs for all motor vehicle crash victims in that State. A number of
studies, as well as our own, have suggested that the top 3% of all MVC Trauma patients
account for between 25% and 40% of the medical care cost of all MVC trauma.
Furthermore, when one examines hospitals that serve large urban centers, it can be seen
that Level I Centers with the greatest trauma load due to violence as well as MVC injuries
bear the highest cost and the greatest percentage of unreimbursed, or under-reimbursed
care.
For example, one institution alone, the University Hospital of the New Jersey Medical
School in Newark incurs 20% of all the unreimbursed costs for trauma care for the entire
State of New Jersey which contains 8 million people. Not only does this magnitude of
service for the severely injured require a comprehensive facility working 24 hours a day, 7
days a week, but it also mandates a cadre of dedicated full time trauma surgeons who are
willing to care for high intensity cases, whose level of reimbursement averages less than 15 %
of the private practice fees for far less complex medical care services. It will be impossible
to continue this level of service to the public if a mechanism cannot be found under the
proposed managed care framework to support such urban Trauma Centers and to replicate
the required medical personnel who serve such a large percentage of the medically
underserved population.
�Statement of Trauma Care Services in a
Managed Health Care Financing Plan
Given this skewed distribution of high level and high intensity services for which prospective
medical care authorizations are not possible, it appears that the ordinary model for managed
care competition is not appropriate for trauma services. Neither is it appropriate to classify
severely injured trauma patients under ordinary diagnosis related groupings since it is
common that there are multiple injuries and the interactions between injuries appear to be
as important in determining length of stay and costs as the individual injuries themselves.
Moreover, our studies strongly suggest that with some exceptions (notably fractures which
impair mobility for prolonged periods), the costs of trauma care are not so much a function
of the injury classification itself, but rather are due to complications of that injury such as
acute respiratory insufficiency, severe infections and the organ failure syndromes which are
responsible for the prolonged intensive care Unit (ICU) lengths of stay in this disease
(Figure 2). It is important to emphasize that the most important single variable in
determining cost is not the injury severity (ISS), but rather is patient survival (SRV) which
implies good care for these serious trauma victims. Therefore, there is a need to mesh the
managed care philosophy with a system which will reimburse trauma care for severe
injuries on audited costs, or on regression equations such as the ones which we have
developed based on the presence or absence of iiyury complications (Figure 3) or on length
of stay (Figure 4) in those institutions designated as Level I or Level H Trauma Centers.
2
These regression equations can explain approximately 60% of the variability (r ) in hospital
cost and length of stay in multiple trauma patients.
�LENGTH OF STAY
Contribution of Independent Variables
r2 = 0.589 p ( 0.0001
Contribution to LOS (days)
30
i
Mean
i
i
i
i
i
i
SRV
ISS
PLF
SEP
i
PNU HIP
i
SRG
i
i
i
r
ELB ABS MOF INT
Independent Variables
FIGURE 2A
S i g n i f i c a n t F a c t o r s I n f l u e n c i n g Length o f Stay i n M u l t i p l e Trauma
Patients
�HOSPITAL COSTS
Contribution of Independent Variables
r2 = 0.611
p ( 0.0001
Contribution to Hosp. Costs ($1000s)
6 0 I $54,300
Mean
SRV
ISS
PLF SEP PNU SRG HIP SFX ELB INT
Independent Variables
FIGURE 2B
S i g n i f i c a n t Factors I n f l u e n c i n g Hospital
Costs i n M u l t i p l e Trauma
Patients
�HOSPITAL COSTS - Actual vs. Predicted
r2 = 0.611
Predicted Costs
300
p < 0.0001
($1000s)
Hosp Cost • 46.9Srv + 959ISS + 49.1Plf + 31.1Sep + 19.1Pnu +
26.7Srg + 28.7Hip + 21.4SFx + 76.3Elb - 41.2
250 200 -
150
100 50 0
-50
0
50
100
Actual Costs ($1000s)
150
200
FIGURE 3
P r e d i c t i o n o f H o s p i t a l Costs by Regression E q u a t i o n based on S i g n i f i c a n t
F a c t o r A n a l y s i s : Note Residuals from Regression and n o r m a l l y d i s t r i b u t e d
�LOG LENGTH OF STAY- Actual vs. Predicted
r2 - 0.687
p < 0.0001
LogLOS-Actual
LOS • 0.54Sep + 2.3Srv + 0.02ISS + 0.76Plf + 0.53Pnu
5 - + 0.79MOF + 0.38Hip • 1.59Elb + 0.4Srg - 0.46
4 e
B
3 2 -
0
i
0
2
3
LogLOS-Predicted
4
FIGURE 4
P r e d i c t i o n o f Length o f Stay by Regression Equation on S i g n i f i c a n t F a c t o r
A n a l y s i s : NOTE Residuals from Regression and n o r m a l l y d i s t r i b u t e d
�Statement of Trauma Care Service in a
Managed Health Care Financing Plan
K E Y TO FIGURES:
SRV
=
SURVIVAL
ISS
=
INJURY SEVERITY SCORE
PLF
=
PULMONARY FAILURE
SEP
=
SEPSIS
PNU
=
PNEUMONIA
SRG
=
SURGICAL COMPLICATION
HIP
=
HIP FRACTURE
SFX
=
SECOND FRACTURE IN SAME EXTREMITY
ELB
=
ELBOW DISLOCATION
ABS
=
ABSCESS
MOF =
MULTIPLE ORGAN FAILURE
INT
UNEXPLAINED VARIABILITY
=
�Statement of Trauma Care Services in a
Managed Health Care Financing Plan
Since Trauma Centers tend to be regional, one solution might be to mandate that all
managed health care plans in a given region contract with the Trauma Center, or the
regional system of Level I and Level H Trauma Centers to pay the actual audited costs of
care for their patients, without discounting, so that all Health Insurance Plan Consortia
(HIPCs) in the region share in the total costs in a fashion proportionate to their caseload.
Individual HIPCs would not be allowed to negotiate special contracts, but rather a
comprehensive rate for multiple trauma care should be established for all users in a given
region. Within this model, the distribution of trauma patients would be based on EMS
criteria triage to the appropriate Level I or Level H Trauma Center and trauma care cost
reimbursement to these centers would be based on adherence to quality assurance and cost
effectiveness protocols for the specific injuries, and injury related complications which the
patient develops.
Since both injury related, as well as physiologic predictors of severity have been developed
to a greater extent in Trauma than most diseases, the medical quality assurance and cost
effectiveness of each diagnostic and therapeutic modality can now be evaluated in Level I
and Level n Centers on an ongoing basis by a peer group, with respect to those patients
who fall outside the Trauma Center norms.
�Statement of Trauma Care Services in a
Managed Health Care Financing Flan
To assure that these QA standards are met, the managed care system should tie together
both the specific institution and the physicians practicing there, as interdependent in the
maintenance of true quality assurance and cost effectiveness controls. This adherence to
quality medical and cost effectiveness could be assessed by an annual outside review of the
ongoing QA process and cost effectiveness control process, with emphasis placed on the
institutional process of "closing the loop" for each case whose outcome or therapeutic
process falls outside the agreed upon quality assurance or log normal cost distribution
standard. As a model for this outside review, one might use an independent peer review
audit carried out in a fashion similar to that now done by the American College of Surgeons
review for Trauma Centers.
As applied generally to all health care units, this type of professional review of the care
process, combined with a Health Care Financing Administration review of management
procedures and accounting could assure a uniform high level for both medical and financial
management standards at each institution.
Payments to both the hospitals and their
physician providers would be reduced, if the process was not effectively carried out and
increased somewhat if QA and cost effectiveness goals were exceeded. This would insure
that both the hospitals and the physicians would have a vested interest in seeing that the
QA and cost effectiveness standards are met.
�Statement of Trauma Care Services in a
Managed Health Care Financing Plan
A general care audit and cost control system such as this would permit the virtual
elimination of the redundant, ineffective and excessively costly use of case managers by
insurance companies and other health carefinancingagencies. This reduction in third party
payer bureaucracy alone would make a substantial dent in reducing the 28% overhead costs
now burdening medical care, since it would eliminate both the unnecessary personnel and
the overhead and profit margin now charged for their use. By using a much smaller group
of overall managers at the Health and Human Services Department to organize and
supervise the yearly accreditation process at individual hospitals and by using supervised
contract peer reviews by the same medically appropriate agencies which now accredit
specific medical care programs such as the American College of Surgeons, the American
College of Physicians, the Joint Commission on Accreditation on Accreditation of Hospitals,
etc., we could have a targeted system of cost effectiveness review directed at quality
assurance by those who best understand the mechanisms of health care delivery for specific
disease entities.
Such a process would be consistent with the best medical care delivery standards of the
profession, not the lowest common denominator bureaucratic standard. This process could
also make an objective medical care quality assurance standard and true therapeutically
oriented cost effectiveness part of the hospital and service accreditation process, which
would involve all of the physicians and administrators working in a given hospital as a
�Statement of Trauma Care Services in a
Managed Health Care Financing Plan
functional unit. It would also establish the use of outside peer review and inside peer
pressure to gain conformance with standards, since all individuals would be penalized for
the failure of any individual physician or hospital administration to conform to the medical
QA and quality based cost effectiveness standards.
Under this system the private insurance companies, HIPC's and the federal govemment
health service group would serve only as fee collectors, financial auditors and as payors who
would contract with specific institutions to provide the cost effective service, given the
distribution of their service population. There also should be federal controls on limits of
profit markup costs by the insurance company payors which take into account their
investment income from the use of the health insurance premium money. In this model of
managed health care, competition between HIPC's to be agents of the most cost and quality
efficient hospital-physician units should be stimulated based on the results of their peer
review audits.
To make this work, it may also be necessary to limit the range of physician fees through the
establishment of a uniform fee schedule adjusted regionally by malpractice insurance costs
and cost of living factors. The multiplier relating the Medicare and the non-Medicare
private insurance fee for the same procedure or service should be reduced by raising the
former and limiting the latter to between 1.5 and 2 times the Medicare fee, to encourage
all physicians to accept a reasonable socio-economic patient mix.
8
�Statement of Trauma Care Services in a
Managed Health Care Financing Plan
Free choice of a physician outside of a given HIPC group would be allowed, but only if the
patient pays a co-payment of 10-20% (excluding Trauma Center Care where full costs would
be covered.
The return for doing this would be to raise the lowest fees, while reducing the highest fees,
with the standard for fee setting being based on the complexity of the surgical procedure or
medical service, and the risk, duration and intensity of acute care required; rather than
being based on historic norms, which are often unrelated to these factors as they presently
apply. As an example, the fees for coronary bypass surgery in patients without myocardial
dysfunction and for most laser retinal procedures are higher than necessary. They were
originally set based on the level of risk and the duration of care required for patients having
these procedures when they were first developed, whereas at present, actual risk factors and
care intensity levels have dropped to very low levels as clinical experience and better new
techniques have been evolved. In contrast, fees for the very complex care needed by
multiple trauma patients who are at great risk of death and who require a high intensity of
ICU care (which may last for 30-60 days after injury) presently fail to adequately reflect the
true risk, duration and complexity of the physician care required.
�Statement of Trauma Care Services in a
Managed Health Care Financing Plan
Another key factor in the containment of medical care costs is to limit malpractice and
general negligence awards, either by reducing contingency legal fees, or by utilizing some
sort of no-fault schedule for bad results due to errors in care, except for gross malpractice
or criminal negligence cases which should result in effective disciplinary actions. As an
example of an immediately beneficial effect, this change would reduce the legal costs of
injury for motor vehicle crash trauma, which are now higher than the medical care costs.
Since up to 40% of the malpractice and negligence awards are diverted from the injured
patient to the legal counsel, it is clear that neither the health care system, nor the patient
benefits by the present medical malpractice tort system which promotes "fishing expeditions"
and frivolous suits which unnecessarily raise the cost of health care. It would be better to
build a cost factor into the system to appropriately care for and compensate injured patients
for their disability and to develop a legal process for removing incompetent and unethical
physicians from practice through a due process mechanism.
Finally, or firstly, each dollar spent in the prevention of disease, especially the disease of
trauma, will yield a much larger dividend in the reduction of health care costs. These
preventional issues must be addressed across Federal and State agencies by a comprehensive
approach involving the medical establishment and local, State and Federal governments.
10
�Statement on Trauma Care Services in a
Managed Health Care Financing Plan
At the Federal level for instance, stronger motor vehicle safety construction standards issued
by the National Highway Traffic Safety Administration will reduce severe injuries in motor
vehicle crashes. As demonstrated by our and other studies of the effects of crash induced
passenger compartment collapse and intrusion as a major cause of polytrauma injuries, these
new regulations should involve stronger motor vehicle construction standards to prevent side
door intrusion and thus reduce chest and pelvis injuries. New NHTSA standards need to
be made to protect the feet and lower extremities from toepan and instrument panel
contacts and compartment intrusions in frontal offset crashes, (since extremity injuries now
account for 40% of the medical cost of injury due to motor vehicle crashes), and regulations
must be put in place which will reduce the chance of brain injury in lateral T-bone types of
crashes (in which the occupant's head is not protected by a frontal air bag). These types of
prevention standards will not only reduce acute care costs, but will also markedly reduce the
costly post trauma disability which is associated with brain and lower extremity injuries
secondary to motor vehicle crashes.
In the area of injuries caused by violent crime, effective national handgun registration and
licensure for gun use laws, and drug control legislation with common principles of
enforcement by Federal and State agencies will reduce the incidence of weapon crimes,
especially gunshot injuries among teenage and young adult male urban youth, since these
are frequently drug related.
11
�Statement on Trauma Care Services in a
Managed Health Care Financing Plan
Effective enforcement of these laws will make a substantial reduction in the care needs and
medical care costs of violence. However, these problems must be addressed by a motivated
Congress with a comprehensive
support program from the Justice Department, the
Commerce Department and the Health and Human Services Department acting together,
so that the enforcement issues are solved in a coordinated fashion across agencies as part
of a single process, rather than being parochialized so that there is reduplication and
counterproductive efforts. Such an effort to reduce the costs of violent drug-related crime
may require an inter-agency task force with a single Cabinet level leader who has the power
to make overall policy and implementation decisions.
The last consideration in prophylaxis against traumatic injury is the need to promote basic
and applied research by allocating increased funding for Trauma research through the
National Institutes of Health, the Centers for Disease Control, and the National Highway
Traffic Safety Administration, and other funding agencies. In particular, applied research
into the mechanisms of motor vehicle crash injury and the psychosocial basis of teenage
violence will support clinical prevention activities.
12
�Management of Trauma Care Services in a
Managed Health Care Financing Plan
Basic research studies of host defense mechanisms after trauma will be the most effective
lines of investigation to help in developing newer therapeutic modalities to deal with the
severe complications of injury, which as noted before are the major reason for prolonged
lengths of stay and increased acute care costs. Both basic science and applied science
Trauma research funding has lagged far behind the research support given for Cancer,
AIDS, heart disease or stroke, yet in terms of lost productivity and health care costs, this
disease entity exceeds any of the others in annual cost. With the recent new advances in
molecular biology and computer systems research, it seems very likely that major
breakthroughs in preventing and controlling the costly complications of traumatic injury can
be achieved by very modest, but real increases in Trauma research funding. A small
investment in the future here will pay very large dividends in reducing future health care
costs in this near epidemic disease.
13
�CHIROPRACTIC - A MANIPULATION OFTOEAMERICAN
HEALTH CARE SYSTEM
by
Michael A. Patmas, M.D.
C l i n i c a l Assistant Professor of Medicine
Department of Internal Medicine
University of Nevada School of Medicine
loannis Lougaris Veterans Administration Medical Center
1000 Locust Street
Reno, Nevada 89520
/ ^ f a
MICHAEL A P T A , M S , M D , F A C P
. A M S .. .. . . . .
1749 HoopeijAvenue, Suite 101
Toms Rive/, NJ 08753-8135
Telephone: (908) 255-9300
�ABSTRACT
Chiropractors have enjoyed steady, although not unopposed, progress in the
integration of their
discipline into the American health care delivery system.
Considerable uncertainty remains, however, regarding ehiroprnctic's theoretical basis.
Herein, the origin, present status and major investigations of chiropractic are reviewed.
Furthermore, a discussion and collation of chiropractic hazards, including radiation
exposure is provided.
Of the principal studies of chiropractic, the majority have concluded that there
is no documentation of chiropractic efficacy in the treatment of any systemic disease.
Analysis of chiropractic hazards yields a wide spectrum of complications, although
significant radiation exposure is an infrequently recognized risk of chiropractic spinal
radiography. It is concluded that one cannot justify the current status, cost and risks
of chiropractic.
�INTRODUCTION
"No democratic delusion is more fatuous than that which holds that all men are
capable of reason, and hence susceptible to conversion by evidence."*
H.L. Mencken, 1923
Nearly a century has passed since the inception of chiropractic theory, and
despite vigorous criticism,
1 1 1
it has flourished.
Opposition has tempered in recent
years however, " and some have suggested chiropractic be embraced as a "limited
medical" profession.
Such a view is not in concert with critical review of the
literature which raises serious concerns about chiropractic's theoretical basis, potential
risk to patients and substantial cost.
OVERVIEW OF CHIROPRACTIC
23 7
The definition of chiropractic varies depending on the group quoted. ' '
Despite
a schism within chiropractic ranks, the notion that most diseases result from
impingement upon nerves, which if relieved allows restoration to health, is central to
o oc7
chiropractic philosophy and treatment. ' ' '
Although D.D. Palmer is often stated to be the discoverer of chiropractic in
14 H.L. Mencken wroteIS that the pinched nerve theory was "...launched upon
1895,
the world by an old quack named Andrew T. Still, the father of osteopathy."
As
osteopathy became more scientific, Mencken maintains, there was gradual abandonment
of this idea until it was "...seized by the chiropractors, led by another quack, one
Palmer."
15
Today, there are over 23,000 chiropractors treating nearly eight million Americans
annually. Some 2,000 chiropractors are graduated each year and can obtain licensure
13
in all 50 states.
Chiropractors are said to be on the U.S. Olympic council on Sports
1 fi
Medicine
and serve on state health boards.
In some locales, they perform minor
1 fi
surgery, deal with obstetrics, serve as coroners, and treat patients in state hospitals.
Chiropractic services are covered by Medicare, Medicaid, Workmen's Compensation,
Blue Cross, Blue Shield and other insurance companies.
In 1978, the Medicare bill
�13
alone for chiropractic treatment was in excess of 30 million dollars.
Their schools
are now recognized as accredited by the U.S. Office of Education.^ The current thrust
of chiropractic is to broaden its scope, and for its practitioners to function as primary
5 17
care physicians able to diagnose and treat most ailments. '
INVESTIGATIONS OF CHIROPRACTIC
There have been several studies of chiropractic and these have been reviewed
previously.2-5,10,18,19,21,22
T
h
e
m
a
j
o
r
i q i i
n
U
r
e s
deserve comment however. In 1960,
The Stanford Research Institute undertook a study of California chiropractic and
concluded, "The number of chiropractic practitioners is declining. Chiropractors...serve
less than one thirtieth of the market for healing services.
internal dissension among chiropractors.
There is a high degree of
Chiropractic education has not succeeded in
obtaining financial support...from government sources."
It would appear that the chiropractors studied this reoort most carefully. Today,
of the Stanford conclusions, only internal dissension still befits chiropractic, especially
in California.
In 1965, the Quebec government asked Justice Lacroix of the Superior Court to
4
undertake a comprehensive study of chiropractic.
They determined that manipulation
can be effective when correctly indicated, stressing that proper differential diagnosis
is "...an imperative preliminary to manipulative treatment."
Justice Lacroix indicted
chiropractic training as inadequate in differential diagnosis and its' instructors as
"inferior" and having "no valid experience in scientific research." The Lacroix study
was the most thorough of its time and correctly noted that chiropractic manipulation
can be dangerous. Notably lacking in their conclusions, however, is any comment about
radiation exposure, the scientific basis of chiropractic, or experimental documentation
of efficacy.
In 1967, the 90th Congress of the United States requested that the Deparment
of Health, Education and Welfare conduct a study relating to the inclusion under
�Medicare of licensed practitioners performing health services in independent practice.
A year later, then HEW Secretary, Wilbur J. Cohen transmitted to the Congress its
23
conclusions and recommendations. '
Like the Canadian study, HEW noted that
manipulations may be useful in some cases but that "research in this area is inadequate."
Also critical of chiropractic education, the HEW study clearly challenged the chiropractic
theory of disease etiology and rebuked the entire discipline as unscientific and potentially
dangerous. Finally, they recommended that chiropractic not be included in the Medicare
program.
Quite disturbingly, the Congress succumbed to the chiropractic lobby and
ignored the HEW report it had requested.
Consumers Union reviewed the history of chiropractic practices and the expansion
1
of their services in a 1975 article in Consumer Reports. ^ They reported that "Consumers
Union believes that chiropractic is a significant hazard to many patients.
Current
licensing laws lend an aura of legitimacy to unscientific practices of chiropractic. In
effect, these laws allow persons with limited qualifications and inadequate training and
background to practice medicine under another name".
In 1977, an Australian Government Committee of Inquiry also noted that there
19
were no scientific studies evaluating the chiropractic theory,
and commissioned
20
Parker
to conduct a controlled trial.
The results of their study on the treatment
20
of migraine by manipulation were published in 1978.
No significant difference in
frequency, duration, disability or outcome was found between
manipulated
group,
the
physiotherapist
manipulated
group
and
the chiropractic
the controlled
(mobilization - treated) group.
In 1979, the government of New Zealand established their own Commission of
20
Inquiry, composed of 3 non-physicians.
They considered the Parker trial
and
21
testimonial evidence, among other data, and concluded
that there was "no doubt that
chiropractic treatment is effective for musculo-skeletal spinal disorders."
Moreover,
�the Commission felt that the Parker trial "clearly establishes that cervical manipulation
or mobilization is an effective treatment for migraine." The Commission's interpretation
of the Parker data is at variance with the author's own conclusions!
Despite evidence
to the contrary, the Commission concluded chiropractic was "safe", and recommended
they be "accepted as partners in the general health care system".
It is curious that
the commission was able to conclude so favorably for chiropractic while acknowledging
that there is a "dearth" of hard evidence for chiropractic efficacy. The New Zealand
Inquiry is often cited by chiropractors as validation of their efficacy and thus
justification for inclusion of their services under federal and private health insurance.
This Inquiry may be, as some have said, "the most comprehensive and detailed
13
examination of chiropractic ever undertaken...",
but it is nevertheless a suspect
22
investigation.
The success of chiropractic in the legislative arena is astonishing in view of its
feeble, preposterous and unscientific theoretical basis.
Perhaps the reason may lie, in
part, upon the observation of Mencken in his essay, "The Foundations of Quackery."
He observed that "The agents of such quackeries gain their converts by reducing the
inordinately complex to the absurdly simple. Unless a man is already equipped with
a considerable knowledge of chemistry, bacteriology and physiology, no one can ever
hope to make him understand what is meant by the term anaphylaxis, but any man,
if he only be idiot enough, can grasp the whole theory of chiropractic in twenty
minutes."
1
CHIROPRACTIC HAZARDS
Although touted as a safe therapeutic modality, a number of complications have
23~6 5
been reported
(table 1). Familiar to most physicians perhaps, are the tragedies
of seriously missed or fatally delayed diagnoses at the hands of chiropractors.
"
2,3,5,8
10,24,25,29,30,49,56,57,64
49
Livingston
attempted to evaluate chiropractic-associated injury in a general
medical practice. Over a three year period, he examined 676 patients with back pain.
�Of these, 172 (25%) had seen a chiropractor previously with 12 (7%) having received
some sort of injury, primarily soft tissue.
Of greater concern, there are now 41 reported cases of brain or spinal cord
infarction associated with chiropractic cervical manipulation.
The exact incidence
fifi
of this complication is unknown, although it may be far more common than reported.
In 1981, the members of the Stroke Council of the American Heart Association were
67
surveyed and related 360 cases of stroke associated with manipulation!
A discussion
of the pathophysiology of manipulation-induced infarction has already been
34 38
provided,
'
and basically relates to the course of the vertebral arteries through the
osseous cervical vertebral foramina and ligamentous structures.
Another inadequately recognized hazard of chiropractic evaluation is radiation
35
exposure.
Chiropractic spinal analysis consists of palpation and radiography. '
Radiation exposure to a phantom patient during simulated chiropractic spinal x-rays
68
has been measured previously
(table 2). There is cause for concern if a single
chiropractic anteroposterior full spine film exposes the thyroid to between 126 and
69
300 mRad. Mazzaferri has reviewed the relationship between thyroid cancer and
radiation exposure. The risk of cancer to the population is proportional to the thyroid
69
dose with a risk coefficient of 3.0/year/million people exposed to one Rad.
Since
serial radiographic studies are often employed in chiropractic evaluation and treatment,
radiation exposure is not inconsequential and should be cause for alarm.
Considering
CO
gonadal and other exposure
, and the chiropractic proclivity for serial radiography,
the total production of neoplasm and congenital defects may far exceed that feared
70
due to the widely publicized Three Mile Island Incident.
CONCLUSION
Chiropractic is a popular "healing art" utilized by millions of Americans.
Chiropractors are licensed throughout the U.S. and market their services as those of
primary care physicians. It is based upon the primitive notion that most human diseases
derive from vertebral subluxation with consequent impingement upon nerves.
There
�remains no valid evidence to support this theory, although there is some evidence that
spinal manipulation may have a limited role in the treatment of some musculoskeletal
disorders. There is no evidence to justify the use of such therapy in the treatment
of any systemic disease.
Chiropractic evaluation may include significant radiation
exposure, while spinal manipulation is dangerous and can cause a variety of serious
neurological, cardiovascular and musculoskeletal injuries, including major stroke. The
subsidization of chiropractic by the Federal government and private insurance carriers
contributes significantly to the high cost of health care and is a monument to the
flaws in our legislative process. Not just the spinal column, but now also government
must be listed among the preferred objects of chiropractic manipulation. In summary,
one may reasonably question the present status, continued growth and expansion,
radiation exposure, risk of stroke and other complications, for a modality with no
scientific basis or documented efficacy in the treatment of any systemic disease, and
only meager evidence for efficacy in the treatment of certain musculoskeletal disorders.
�Table 1
REPORTED COMPLICATIONS OF CHIROPRACTIC MANIPULATION
Intervertebral disk rupture
25
23 52
'
Dislocation of the atlas
Brainstem thrombosis
27 34 57
Posterior inferior cerebellar artery syndrome of Wallenberg ' '
28
Vertebral artery insufficiency
28
Cerebellar infarction
31
Basilar artery thormbosis
32
Vertebral artery pseudoaneurysm
Vertebrobasilar distribution
infarction
24,26-35,38-42,45-48,50,51,54-63,65,66
3fi
Cardiac arrest
37
Pseudoaneurysm of the ascending cervical artery
40
Internuclear ophthalmoplegia
A O
Dissecting hematoma of the internal carotid artery
Cervical cord injury^
4
52
Cauda equina syndrome
53
Spinal meningeal hematoma
RA
Rupture of a brain tumor
49
Various soft tissue injuries
�10
Table 2
(Levine et al )
AVERAGE RANGE OF RADIATION EXPOSURE TO VARIOUS SITES
DURING SIMULATED CHIROPRACTIC SPINAL RADIOGRAPHY*
Thyroid
Male Gonad
Female Gonad
Eye
AP full spine
126.6 - 229.3
16.9 - 440.2
23.8 - 115.5
8.5 - 176.7
AP lumbar regional
2.3 - 9.2
6.4 - 36.8
104.6 - 133.8
0.5 - 1.7
AP thoracic regional
4.5 - 26.7
1.7 - 1.8
3.3 - 5.4
1.7 - 2.7
AP cervical
71.5 - 74.4
0.0 - 0.4
0.2 - 0.3
5.7
*A11 average ranges given in mRad
85.3
�11
ACKNOWLEDGEMENTS
The author would like to thank the following individuals: Gerald H. Whipple,
M.D., G. Kim Bigley, M.D. John H. Peacock, M.D., Ernest L. Mazzaferri, M.D., Walter
Treanor, M.D., Jack Douglas, M.D., Barbara Potts, Chief, Library Service, Reno VA
Medical Center, Teresa Moynihan and Marti Patmas for technical assistance and
encouragement in the preparation of this manuscript.
�1.2
REFERENCES
1.
Mencken HL. The foundations of quackery. In: Mencken HL. ed. A Mencken
Chrestomathy. New York: Alfred A. Knopf, 1949; 353-54.
2.
Ballantine HT Jr. Will the delivery of health care be improved by the use of
chiropractic services? N Engl J Med. 1972; 286:237-42.
3.
Cohen WJ. Independent
practitioners under medicare. A report to congress.
Washington, DC. United States Department of Health, Education and Welfare.
1968.
4.
Lacroix G. Chiropraxy. Vol. I I . Quebec. Royal Commission, Chiropraxy and
Osteopathy, 1965.
5.
Chiropractors: Healers or quacks? The eighty year war with science. Del Med
J. 1977; 49: 277-300.
6.
Chiropractic. The camel in the tent. Editorial. NY State J Med. 1978; 78: 1381-2.
7.
Report on Chiropractic: The nature of chiropractic. Med J Aust. 1966; 2: 1059-60.
8.
Smith RL. At your own risk: The case against chiropractic. New York: Simon
and Schuster, 1969.
9.
Barrett S, Knight G. The health robbers - How to protect your money and your
life. Philadelphia: George F. Stickley. 1976.
10.
Chiropractors: Healers or quacks? Consumer reports, September and October,
1975.
11.
Crelin ES. A scientific test of the chiropractic theory. Am Sci. 1973; 61: 574-80.
12.
Relman AS. Chiropractic: recognized but unproved. N Engl J Med. 1979; 301:
659-60.
13.
Wardwell WI. The future of chiropractic. N Engl J Med. 1980; 302: 688-90.
14.
Palmer DD. The science, art and philosophy of chiropractic. Portland, Oregon:
Portland Printing House. 1966: 17-19. (reprint of 1910 edition).
15.
Mencken HL. Chiropractic. In: Mencken HL, ed. A Mencken Chrestomathy. New
York: Alfred A. Knopf, 1949: 346-7.
�16
16.
Blumberg L. The future of chiropractic. Letter. N Engl J Med. 1980; 303:
399-400.
17.
Manber MM. Chiropractors. Pushing for a place on the health care team. Med
World News. 1978; Dec 11: 57-72.
18.
Stanford Research Institute. Chiropractic in California. Los Angeles: The Haynes
Foundation, 1960.
19.
Report of the Austrialian Government Committee of Inquiry on Chiropractic,
Osteopathy, Homeopathy and Naturopathy. Canberra: Australian Government
Printing Office, 1977.
20.
Parker G, Tupling H, ^ryor D. A controlled trial of cervical manipulation for
migraine. Aust NZ J Med. 1978; 8: 589.
21.
Report of the Commission of Inquiry into Chiropractic in New Zealand. Wellington:
Government Printer, 1979.
22.
Parker G, Pryor D, Tupling H. Point of view. New Zealand Inquiry into
Chiropractic. Med J Aust. 1980: 1: 103-5.
23.
Fischer ED. Ruptured intervertebral disc following chiropractic manipulation:
case. J Ky Med Assoc. 1943: 41: 14.
24.
Pratt-Thomas HR, Berger KE. Cerebellar and spinal injuries after chiropractic
manipulation. JAMA. 1947; 133: 600.
25.
Blaine ES. Manipulative (chiropractic) dislocation of the atlas. JAMA. 1925; 85:
1356.
26.
Kunkle EC, Muller JC, Odom GL. Traumatic brainstem thrombosis: report of a
case and analysis of the mechanism of injury. Ann Intern Med. 1952; 36: 1329.
27.
Schwarz GA, Geiger JK, Spano AV. Posterior inferior cerebellar artery syndrome
of Wallenberg after chiropractic manipulation. Arch Intern Med. 1956; 97: 352-4.
�14
28.
Kanshepolsky J, Danielson H, Flynn RE. Vertebral artery insufficiency and
cerebellar infarct due to manipulation of the neck. Report of a case. Bull Los
Angeles Neuro Soc. 1972; 37: 62-5.
29.
Miller RG, Burton R. Stroke following chiropractic manipulation of the spine.
JAMA. 1974; 229: 189-90.
30.
Zimmerman AW, Kumar AJ, Gadoth N, Hodges FJ. Traumatic vertebrobasilar
occlusive disease in childhood. Neurology. 1978; 28: 185-8.
31.
Ford FR, Clark D. Thrombosis of the basilar artery with softenings in the
cerebellum and brainstem due to manipulation of the neck. Johns Hopkins Med
J. 1956; 98: 37-42.
32.
Davidson KC, Welford ED, Dixon GD. Traumatic vertebral artery pseudoaneurysm
following chiropractic manipulation. Radiol. 1975; 115: 651-2.
33.
Mehalic T, Farhat SM. Vertebral artery injury from chiropractic manipulation
of the neck. Surg Neurol. 1974; 2: 125-9.
34.
Schellhas KP, Latchaw RE, Wendling LR, Gold LHA. Vertebrobasilar injuries
following cervical manipulation. JAMA. 1980; 244: 1450-3.
35.
Schmitt HP. Manual therapy of the cervical spine and its dangers. Rupture and
occlusion of the vertebral artery. Man Med. 1978; 16: 71-7.
36.
Gorman RF. Cardiac arrest after cervical spine mobilization. Med J Aust. 1978;
2: 169-70.
37.
Lennington BR, Laster DW, Moody DM, Ball MR. Traumatic pseudoaneurysm of
the ascending cervical artery in neurofibromatosis: complication of chiropractic
manipulation. AJNR. 1980; 3: 269-70.
38.
Krueger BR, Okazaki H. Vertebral basilar
distribution infarction following
chiropractic cervical manipulation. Mayo Clin Proc. 1980; 55: 322-32.
39.
Parkin PJ, Wallis WE, Wilson JL. Vertebral artery occlusion following manipulation
of the neck. NZ Med J. 1978; 88: 441-3.
�15
40.
Schmitt HP. Manual therapy in the region of the cervical spine and its dangers:
ruptures and occlusions of the vertebral artery.
ZFA (Stuttgart). 1978; 54:
467-74.
41.
Easton JD, Sherman DG. Cervical manipulation and stroke. Stroke. 1977: 8:
594-7.
42.
Zauel D, Carlow TJ. Internuclear ophthalmoplegia following cervical manipulation.
Ann Neurol. 1977; 1: 308.
43.
Beatty RA. Dissecting hematoma of the internal carotid artery following
chiropractic cervical manipulation. J Trauma. 1977; 17: 248-9.
44.
Rinsky LA, Reynolds GG, Jameson RM, Hamilton RD. A cervical spinal cord
injury following chiropractic manipulation. Paraplegia. 1976: 13: 223-7.
45.
Schmitt HP, Tamaska L. Dissecting rupture of vertebral artery with fatal
thrombosis of the vertebral and basilar arteries. Z Rechtsmed. 1973: 73: 301-8.
46.
Lorenz R. Vogelsang H. Complications following chiropractic manipulations. Dtsch
Med Wochenschr. 1972; 97: 784-5.
47.
Lewitt
K. Complications following chiropractic manipulations. Dtsch Med
Wochenschr. 1972; 97: 784.
48.
Lorenz R, Vogelsang HG. Thrombosis of the basilar artery following chiropractic
manipulation of the cervical spine. Dtsch Med Wochenschr. 1972; 97: 36-43.
49.
Livingston MC. Spinal manipulation causing injury. A three year study. Clin
Orthop. 1971; 81: 82-6.
50.
Wood MJ, Land EK, Woolhandler GJ, Faludi HK. Traumatic vertebral artery
thrombosis. J La State Med Soc. 1971; 123: 413-14.
51.
Nick J, Contamin F, Nicolle MH, Des Lauriers A, Zeigler G. Neurologic incidents
and accidents due to cervical manipulations.
1967; 118: 435-40.
Bull Mem Soc Med Hop Paris.
�16
52.
Richard J. Disk rupture with cauda equina syndrome after chiropractic adjustment.
NY State J Med. 1967; 67: 2496-8.
53.
Dabbert 0, Freeman DG, Weis AJ. Spinal meningeal hematoma, warfarin therapy
and chiropractic adjustment. JAMA; 1970; 214: 2058.
54.
Maigne R. Vertebral manipulations and vertebrobasilar thrombosis. Angeiologie.
1969; 21: 287-8.
55.
Bureau of Legal Medicine and Legislation. Malpractice: death resulting from
chiropractic manipulation for headache. JAMA. 1937; 109: 233-4.
56.
Green D, Joynt RJ. Vascular accidents to the brainstem associated with neck
manipulation. JAMA. 1959; 1970: 522-4.
57.
Smith RA, Estridge MN. Neurologic complications of head and neck manipulations:
report of two cases. JAMA 1962; 192: 528-31.
58.
Pribeck RA. Bainstem vascular accident following neck manipulation. Wis Med
J. 1963; 62: 141-3.
59.
Lyness SS, Wagman AD. Neurologic deficit following cervical manipulations. Surg
Neurol. 1974; 2: 121-4.
60.
Bladin PF, Merory J. Mechanisms in cerebral lesions in trauma to high cervical
portion of the vertebral artery-rotation injury. Proc Aust Assoc Neurol. 1975;
12: 35-41.
61.
Muellar S, Sahs AL. Brainstem dysfunction related to cervical manipulation:
report of three cases. Neurology. 1976; 26: 547-50.
62.
Easton JD, Sherman DG. Cervical manipulation and stroke. Stroke. 1977; 8:594-7.
63.
Nyberg-Hansen R, Loken AC, Tenstad O. Brainstem lesion with coma for five
years following manipulation of the cervical spine. J. Neurol. 1978; 218: 97-105.
64.
Bureau of Legal Medicine and Legislation. Chiropractors: rupture of brain tumor
following adjustment. JAMA. 1952; 148: 669.
�17
65.
Sherman DG, Hart RG, Easton JD. Abrupt change in head position and cerebral
infarction. Stroke. 1981; 12: 2-6.
66.
Robertson JT. Neck manipulation as a cause of stroke. Editorial. Stroke. 1981;
12: 1.
67.
Robertson JT. Neck manipulation as a cause of stroke. Authors' rebuttal. Stroke.
1982: 13: 260-1.
68.
Levine JI, Howe JW, Rolofson JW. Radiation exposure to a phantom patient
during simulated chiropractic spinal radiography. Radiol Health Data Rep. 1971;
12: 245-51.
69.
Mazzaferri EL. Thyroid carcinoma following therapeutic and accidental radiation
exposure. In: Cohen MP. and Foa PP. eds. Special topics in endocrinology and
metabolism. New York: Alan R. Liss, 1981; 103-46.
70.
Lewis HW. The safety of fission reactors. Sci Am. 1980: 242: 53-65.
�' - ' W UNIVtRr'.l'l Y 01" NEVADA SC'f-iOOL OF MEDICINE.
Department oi Mcdir.int:
January ?, 1985
,,,,,, ,
fii ;i
..
,
(•/;:•, vt-..', .-,!,-:
Arnold S. Relman, M.D.
E d i t o r , New England Journal o f Medicine
10 Shattuck St.
Boston, Massachusetts 02115
Dear Dr. Relman:
THE CHIROPRACTIC CONTRIBUTION TO HEALTH CARE COSTS
The high cost of health care has led t o a radical change i n i t s financ i a l structure. Prospective payment has altered incentives that w i l l force
reallocation of limited resources. Physicians have been increasingly asked
t o evaluate and modify t h e i r prescribing and practice habits. Furthermore,
we are being asT^ed t o "launch a major e f f o r t t o identify the benefits that
patients receive frcm the various ccmponents of the 400 b i l l i o n dollars
that i s spent annually for health care" (1).
Not a l l components o f the health care budge-c have received equal
attention i n t h i s new cost conciousness. Review of a major govemment
docunent u t i l i z e d by the Congress during i t s consideration of prospective
payment suggests one such instance. I n "Background Data on Physician Reimburseinent Under Medicare", i t states:
"Covered physician's services under Medicare include those
provided by doctors of medicine and osteopathy (M.D.'s and
D.O.'s)... Also included are services provided by ... chiropractors ..." (2)
The document also discloses that Medicare expenditures for these "physician" s services" totalled 9.4 b i l l i o n dollars i n 1982. However, no speci f i c specialty breakdown i s provided. I t i s unclear exactly how much i s
spent on chiropractic services, for example.
I n d i r e c t estimation of t h i s ocrponent of Medicare expenditures based
upon other data i n the docunent. i s i n the range of 116 m i l l i o n dollars for
chiropractic services. Most ^ n o i e ^ a r t y payers and workmen's cenpensation
programs also cover chiropractic. I t i s conceiveable that the t o t a l national expenditure for chiropractic services could exceed 1-2 b i l l i o n dollars annually.
Although a proportionally small amount, this expenditure beccmes more
important i n l i g h t of an HEW study (3) which concluded that "chiropractic
services not be covered under the Medicare program", c i t i n g the lack of
s c i e n t i f i c evidence of chiropractic efficacy, among other reasons.
Despite the extensive l i t e r a t u r e on the problem of health care costs,
the chiropractic contribution seems t o have been spared much attention.
Certainly, the impact of prospective payment has been directed at the medical contribution.
�As ecxjncnic constraints on medicine intensify, we can reasonably quest i o n the j u s t i f i c a t i o n for a 1W m i l l i o n dollar annual Medicare expenditure
on a "medical specialty" H W concluded should not be covered.
E
I f we are indeed planning t o launch a major e f f o r t t o determine the
benefit of various ocmponents of our health care expenditures, i t wDuld
seem prudent t o scrutinize every conponent.
Chiropractic has managed t o incorporate i t s e l f into the mainstream of
the American health care system despite an inadequate s c i e n t i f i c basis.
Perhaps we need t o look a b i t more closely at t h i s expenditure.
Sincerely,
%<thUtflS&for,tub
Michael A. Patmas, M.D.
C l i n i c a l Assistant Professor
MAP/js
�NOTICE
PEHSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
"T^y.
\2 3QS -
�LATERAL M D L A Y INFARCTION
EULR
FOLLOWING CERVICAL MANIPULATION
By
MICHAEL A. P T A , M S J L u F A C P
A M S ..iB.-...
ne
Clin
U. rvxm L)i>-ji~j-r-
Assistant Professor of Internal Medicine
Neurology Division
John H. Peacock, M D , Ph.D.
..
Associate Professor of Internal Medicine
Director, Neurology Division
University of Nevada School of Medicine
Department of Internal Medicine
Veterans Administration Medical Center
1(500 locust Street
Reno, Nevada 89520
�Introduction
C h i r o p r a c t i c m a n i p u l a t i o n has been a s s o c i a t e d w i t h a number o f c o m p l i c a t i o n s
i n c l u d i n g i n t r a c r a n i a l hemorrhage, d i s l o c a t i o n o f the a t l a s and q u a d r i p l e g i a ,
1,2
among o t h e r s .
R e c e n t l y , two papers have drawn a t t e n t i o n t o v e r t e b r o b a s i l a r
1,2
d i s t r i b u t i o n i n f a r c t i o n caused by s p i n a l m a n i p u l a t i o n .
H e r e i n , we r e p o r t a
case o f l a t e r a l m e d u l l a r y i n f a r c t i o n f o l l o w i n g v i g o r o u s c e r v i c a l m a n i p u l a t i o n
by a masseur.
Case P r e s e n t a t i o n
A 60 year o l d , n a t i v e American male w i t h a h i s t o r y of t y p e I I d i a b e t e s m e l l i t u s and a t h e r o s c l e r o t i c c a r d i o v a s c u l a r d i s e a s e , b u t no p r i o r h i s t o r y o f c e r e b r o v a s c u l a r d i s e a s e , presented t o t h e Reno Veterans
Center i n February,
One
1982,
A d m i n i s t r a t i o n Medical
c o m p l a i n i n g o f headache and d i f f i c u l t y
month p r i o r t o admission, t h e p a t i e n t noted headache, t i g h t n e s s o f t h e
p o s t e r i o r c e r v i c a l muscles and a " k i n k " s e n s a t i o n i n h i s neck.
the
swallowing.
regional t r i b a l
h e a l t h c e n t e r and was
He was
seen a t
prescribed analgesics without
relief.
The p a t i e n t then sought c h i r o p r a c t i c care b u t was
unable t o o b t a i n an a p p o i n t -
ment p r o m p t l y because, "they were a l l booked up".
He then c o n s u l t e d a masseur
who
t o l d him t h a t h i s headache was
caused by a "pinched nerve" i n h i s neck,
and t h a t i t c o u l d be cured by an "adjustment".
Over t h e n e x t few weeks, the
p a t i e n t had f o u r t r e a t m e n t s c o n s i s t i n g o f massage and
t a t i o n o f t h e neck.
The morning a f t e r the f i n a l
awakened w i t h a r i g h t h y p e s t h e s i a , dysphagia,
upper e x t r e m i t y and l e f t
forceful lateral ro-
adjustment, the p a t i e n t
and p a r e s t h e s i a o f t h e r i g h t
face.
P h y s i c a l e x a m i n a t i o n r e v e a l e d a h e a l t h y appearing male w i t h normal
signs.
There was
a p a r t i a l l e f t Horner's syndrome w i t h m e i o s i s and
vital
ptosis,
l e f t lower motor neuron f a c i a l weakness, .and l a t e r a l i z a t i o n o f t h e Weber t e s t
to
the
the l e f t .
Sensory exam r e v e a l e d a r i g h t panhypesthesia
r i g h t upper e x t r e m i t y and l e f t
face.
with paresthesia i n
Motor f u n c t i o n i n c l u d i n g s t r e n g t h .
�coordination and d e x t e r i t y was w i t h i n normal l i m i t s .
Muscle s t r e t c h r e f l e x e s
were symmetrically diminished and graded as 1+. There were no Babinski signs.
On the basis of the f i n d i n g s , we l o c a l i z e d the lesion i n the l e f t
medullary area of the brainstem.
lateral
On c l i n i c a l grounds, we suspected an i n f a r c -
t i o n and i n v e s t i g a t e d possible causes f o r t h i s .
Laboratory evaluation disclosed a normal blood count, urea n i t r o g e n ,
c r e a t i n i n e and e l e c t r o l y t e s .
Fasting blood sugar was 170 mg%, and the serum
t r i g l y c e r i d e and c h o l e s t e r o l levels were 266 and 433 mg% respectively.
chemistry panel was otherwise normal.
The
U r i n a l y s i s was weakly p o s i t i v e f o r
glucose and s y p h i l l i s serology was negative.
The electrocardiogram revealed
a previous anteroseptal i n f a r c t i o n , while the echocardiogram d i d not disclose
the presence of thrombus.
and oculoplethysmography
Non high r e s o l u t i o n computerized
were normal.
a x i a l tomography
The esophagogram revealed paresis of
the l e f t hypopharyngeal c o n s t r i c t o r muscles.
In summary then, the h i s t o r y and laboratory data f a i l t o disclose other
evidence of cerebrovascular disease.
S i m i l a r l y , there i s no evidence f o r
embolization from a cardiac source.
Therefore, the e t i o l o g y of t h i s b r a i n -
stem i n f a r c t i s most l i k e l y secondary t o contusion of the v e r t e b r a l a r t e r y
during c e r v i c a l manipulation followed by embolization t o the brainstem.
Comment
To the best of our knowledge, t h i s represents the 42nd reported case of
2
c e r v i c a l manipulation-related stroke.
rare since f i r s t described i n 1947.
This complication had been considered
I n recent years, however, p o s t e r i o r c i r c u -
l a t i o n i n f a r c t i o n secondary t o c h i r o p r a c t i c - t y p e manipulation i s being reported
1,2
more f r e q u e n t l y .
The true incidence of t h i s complication i s unknown, a l 3
though some f e e l i t i s f a r more common than reported.
A recent survey of the
American Heart Association's Stroke Council disclosed some 360 cases of stroke
4
associated w i t h c e r v i c a l manipulation!
The pathophysiology of t h i s compli-
�cation has been reviewed previously
and, fundamentally, related t o the course
1,2
of the v e r t e b r a l a r t e r i e s through the osseous c e r v i c a l v e r t e b r a l foramina.
In view of the growing popularity of c h i r o p r a c t i c and connective tissue
massage, the incidence of manipulation-related
stroke may increase.
should be a l e r t t o , and report, t h i s complication,
Physicians
so a b e t t e r assessment of
i t s true incidence can be obtained, and the future role of c h i r o p r a c t i c determined i n view of i t s hazards.
�References
1.
Krueger BR, Okazaki H:
Vertebrobasilar d i s t r i b u t i o n i n f a r c t i o n
c h i r o p r a c t i c c e r v i c a l manipulation.
2.
Sherman DG, Hart G, Easton JD:
infarction.
3.
Robertson JT:
Stroke.
Mayo C l i n . Proc.
following
55:322-332, May
Abrupt change i n head p o s i t i o n
1980.
and cerebral
12:2-6, Jan-Feb 1981.
Neck manipulation as a cause of stroke.
Editorial.
Stroke.
12:1, Jan-Feb 1981.
4.
Robertson JT:
Stroke.
Neck manipulation as a cause of stroke.
13:260-261,
1982.
Author's r e b u t t a l .
�'
I,' ft
THE EMORY CLINIC
1441 Clifton Road, N.E.
SECTION OF REHABILITATION MEDICINE
Atlanta, Georgia 30322
Physical Medicine & Rehabilitation
(404) 727-5486
Brigitta Jann, MD
Gerald S. Bilsky, MD
AlanM.Harben,MD
David Schiff, MD
Dale C. Strasser, MD
JJS^V
' ^.
Cardiac Rehabilitation
(404) 727-7865
RWAMV
Gerald F. Fletcher, MD
Mary tllen Sweeney, MD
Psychology
(404) 727-0724
Michele Rusin, PhD
Deborah Gideon, PhD
Marsha Lucas, PhD
Anthony Stringer, PhD
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�s
NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
�CURRICULUM VITAE
GERALD S. BILSKY,
Hone Address:
M.D.
Office Address:
1441 C l i f t o n Road, N.E.
Atlanta, Georgia 30322
(404) 727-5486
Date of B i r t h :
S o c i a l Security:
Spouse:
EDUCATION
1988-1989
Chief Resident
Physical Medicine and R e h a b i l i t a t i o n
University of Rochester
1985-1988
Residency
Physical Medicine and R e h a b i l i t a t i o n
University of Rochester
1984-1985
Internship
Obstetrics and Gynecology
University of Rochester
1980-1984
University of Rochester
School of Medicine and Dentistry
Received Doctor of Medicine 1984
P r e - c l i n i c a l Curriculum Committee
Editor-in-Chief of l a t r o s '84
1976-1980
Brown University
Received Bachelor of Arts i n Economics
Magna Cum Laude, 1980
Histology Teaching A s s i s t a n t 1978-1980
Resident Counselor 1977-1979
Society of Sigma X i
EXPERIENCE
Emory University Hospital
Center for R e h a b i l i t a t i o n Medicine
1989- present
A s s i s t a n t Professor of Physical Medicine
and Rehabilitation
1990- present
Associate Residency Program Director
1990-present
Medical Director, R e h a b i l i t a t i o n Day Program
at Emory University
�PROFESSIONAL MEMBERSHIPS
American Medical Association
American Academy o f Physical Medicine and R e h a b i l i t a t i o n
Association o f Academic P h y s i a t r i s t s
American Association o f Electrodiagnostic Medicine
Southern Medical Society
Georgia Society o f Physical Medicine and R e h a b i l i t a t i o n
PUBLICATIONS
Banja,
JD, B i l s k y ,
GS.
Discussing
Cardiopulmonary
Resuscitation w i t h E l d e r l y R e h a b i l i t a t i o n
Patients:
E t h i c a l and C l i n i c a l Considerations Toward the Formation
of Policy. Am J Phys Med Rehabil (accepted)
B i l s k y , GS, Banja, JD. Outcomes Following Cardiopulmonary
Resuscitation i n an Acute R e h a b i l i t a t i o n
Hospital:
C l i n i c a l and E t h i c a l I m p l i c a t i o n s . Am J Phys Med Rehabil
1992;71:232-235.
B i l s k y , GS, Lou, A. Acute P o l i o m y e l i t i s :
Diagnostic and
R e h a b i l i t a t i o n management Issues. Arch Phys Med Rehabil
1990;71:825 ( a b s t ) .
Aggarwal, U, B i l s k y , GS.
D i s t a l Ulnar Neuropathy:
A
W e i g h t l i f t i n g Complication.
Arch Phys Med Rehabil
1988;69:784 ( a b s t ) .
B i l s k y , GS.
R e h a b i l i t a t i o n Day Program:
Successful New
I n i t i a t i v e . Emory Univ J Med 1992;6:21-22.
B i l s k y , GS, Segal, RL. Electrodiagnostics i n R e h a b i l i t a t i o n .
I n : Fletcher,
GF, (ed.) R e h a b i l i t a t i o n Medicine:
Contemporary C l i n i c a l Perspectives. Philadelphia, Lea
& Febiger, 1992:419-443.
B i l s k y , GS. The Challenging Residual Limb: Managing Skin
D i f f i c u l t i e s . Arch Phys Med Rehabil 1992:10:1010.
B i l s k y , GS, Schwartz, CA, Segal, RL. D i s t a l Upper Extremity
Nerve Conduction Studies: E f f e c t of Wrist F l e c t i o n , ( i n
preparation).
�PRESENTATIONS
The Challenging Residual Limb: Managing Skin D i f f i c u l t i e s .
American Academy o f Physical Medicine and R e h a b i l i t a t i o n
Annual Meeting. November 16, 1992, San Francisco, CA.
A Perspective on O r t h o t i c s i n t h e E l d e r l y . Presented a t the
American Academy
of Orthotists
and P r o s t h e t i s t s
Continuing Education Conference. March 7, 1992, A t l a n t a ,
GA.
Therapeutic and Pharmacologic Management o f Upper Extremity
Pain and Dysfunction. Presented a t Medical Management
and D i s a b i l i t y Related Issues i n Poultry
Producing
Plants.
February 7, 1992, A t l a n t a , GA.
The Right t o Die: Whose Decision i s I t ? Presented a t the
American Academy o f Physical Medicine and R e h a b i l i t a t i o n
Annual Meeting. October 21, 1990, Phoenix, AZ.
The Post-Polio Syndrome. V i r g i n i a Lee F r a n k l i n Annual
Lecture. 1990, A t l a n t a , GA.
Acute P o l i o m y e l i t i s : Diagnostic and R e h a b i l i t a t i o n Management
Issues.
Poster Presented a t t h e American Academy of
Physical Medicine and R e h a b i l i t a t i o n Annual Meeting.
October 24, 1990, Phoenix, AZ.
Neurologic Complications o f AIDS. U n i v e r s i t y o f Rochester
R e h a b i l i t a t i o n Medicine Grand Rounds. 1989, Rochester,
NY.
Chronic Complications of Spinal Cord I n j u r y . Emory U n i v e r s i t y
R e h a b i l i t a t i o n Medicine Grand Rounds. December 7, 1988,
A t l a n t a , GA.
D i s t a l Ulnar Neuropathy:
A W e i g h t l i f t i n g Complication.
Poster presented a t t h e American Academy o f Physical
Medicine and R e h a b i l i t a t i o n Annual Meeting. November 2,
1988, S e a t t l e , WA.
TEACHING
Coordinator,
Sophomore
Medical
R e h a b i l i t a t i o n Medicine
Coordinator,
Senior
Medical
R e h a b i l i t a t i o n Medicine
student
Student
Elective
Electives
Faculty Advisor f o r R e h a b i l i t a t i o n Medicine Residency
Program Lecture Series
in
in
�SERVICE
1993
American
Academy
o f Physical
Medicine
R e h a b i l i t a t i o n : M e d i c a l E d u c a t i o n Committee
1992-1993
P r e s i d e n t , Georgia S o c i e t y o f P h y s i c a l M e d i c i n e
and R e h a b i l i t a t i o n
1991-present
A r t h r i t i s F o u n d a t i o n , Georgia Chapter:
Board o f D i r e c t o r s
1990-present
A r t h r i t i s F o u n d a t i o n , Georgia Chapter:
M e d i c a l - S c i e n t i f i c Committee
1989- p r e s e n t
Emory U n i v e r s i t y H o s p i t a l M e d i c a l Records
Committee
1990- p r e s e n t
Center f o r R e h a b i l i t a t i o n M e d i c i n e P o l i c y
Committee
1991- p r e s e n t
Emory U n i v e r s i t y H o s p i t a l L i b r a r y Task Force
1990-present
Center f o r R e h a b i l i t a t i o n M e d i c i n e Long-Range
P l a n n i n g Committee
1990-1991
Georgia Head I n j u r y A s s o c i a t i o n C h a r i t y G o l f
Co-Chairman
BOARD CERTIFICATION
1990
American Board o f P h y s i c a l M e d i c i n e and
R e h a b i l i t a t i o n , C e r t i f i c a t i o n No. 3190
LICENSURE
Diplomate, N a t i o n a l Board o f M e d i c a l
291703
Georgia M e d i c a l License - 031701
Examiners
and
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
^
±38S
'ICS
�March 23,
1993
H i l l a r y Rodham-Clinton
Chairperson, Health Care Task Force
White House
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Mrs.
Rodham-Clinton,
I am writing you today with a heavy heart. I am currently a
s p e c i a l i s t in Internal Medicine serving i n the m i l i t a r y at Fort
Benning, Georgia. I had looked forward to moving back home and
p r a c t i c i n g Internal Medicine when my commitment ended. However,
when I look at my role i n health care through the eyes of my
' c i v i l i a n ' peers I develop s i g n i f i c a n t second thoughts about my
chosen s p e c i a l t y .
Almost every day I read or watch news reports that state that
g e n e r a l i s t s are severely lacking i n the United States.
I can
understand whyl
Potential g e n e r a l i s t s such as myself become
f r u s t r a t e d early on by a lack of respect and value that society
places on t h e i r role i n patient care. How i s i t that a generalist
can spend an hour s k i l l f u l l y , yet gently, extracting h i s t o r i c a l
data, perform a complete physical exam, interpret laboratory data
garnered to evaluate multiple organ systems, and f i n a l l y assimilate
a l l t h i s data i n working towards a diagnosis, and yet be
compensated a f r a c t i o n of what i s received by the s u b - s p e c i a l i s t ,
who t y p i c a l l y has a very limited area of expertise and spends a
s i g n i f i c a n t l y l e s s amount of time with the patient. The most cost
e f f e c t i v e t e s t i n health care today i s the history and physical
exam performed by a competent g e n e r a l i s t . Yet society devalues
t h i s d i f f i c u l t to master a r t by disproportionately reimbursing
those who opt to become p r o f i c i e n t i n technical procedures that
require a fraction of the time, cognitive challenge, and humanity.
Thus, medical students, residents, and Board C e r t i f i e d I n t e r n i s t s
such as myself often loose the w i l l to devote t h e i r careers to
mastering t h i s e s s e n t i a l a r t .
I n t e r n a l Medicine used to be the prize which the top students
cherished. In the l a s t several decades i t has become nothing more
than a stepping stone to "greater glory" i n the sub-specialties of
I n t e r n a l Medicine (cardiology, gastroenterology, etc
).
In
medical school, I was p o s i t i v e l y reinforced by my attending
physicians for choosing I n t e r n a l Medicine but the next question was
always, "What kind of s u b - s p e c i a l i s t w i l l you be?"
Respect of
one's peers i s often more important than personal income. Yet the
g e n e r a l i s t has l o s t both. Certainly, we are not without f a u l t .
Over the years we have l e t the sub-specialties erode our own grand
niche from that of the consummate physicians, to consultation
generators. This occurs, not because of a change in training, but
because of a change in economics.
�I plan on moving t o the Northeast region where medicine i s
very compartmentalized and t u r f i s sacred. As an i n t e r n i s t , my
t u r f i s what no one else wants, the dreaded complete h i s t o r y and
physical exam. Far be i t f o r me t o f e e l competent enough t o d r a i n
f l u i d from the pleura space by performing a thoracentesis, look f o r
coronary i n s u f f i c i e n c y by doing a t r e a d m i l l t e s t , evaluate a
p o t e n t i a l arrythmia by reading a h o i t e r monitor, f l o a t a pulmonary
a r t e r y catheter i n t h e i n t e n s i v e care u n i t t o monitor t h e
management of a complicated myocardial i n f a r c t i o n , or look f o r an
u l c e r by doing endoscopy. The l i s t goes on and on. Yet, the f a c t
of the matter remains, t h a t upon completion of my residency, t h e
procedures t h a t I have been t r a i n e d t o do, and c e r t i f i e d as being
competent t o perform, are no longer i n the purview of my expertise.
Instead, the s u b - s p e c i a l i s t s such as the c a r d i o l o g i s t ( t r e a d m i l l
t e s t , h o i t e r monitor, pulmonary a r t e r y c a t h e t e r ) , pulmonologist
( t h o r a c e n t e s i s ) , and g a s t r o e n t e r o l o g i s t (endoscopy) have undisputed
domain over these procedures.
The r e s u l t i s the generation of
COUNTLESS needless c o n s u l t a t i o n s and a mountain of m i s - u t i l i z e d
resource c a p i t a l .
The m i l i t a r y , f o r a l l i t s f a u l t s , a c t u a l l y u t i l i z e s i t s
g e n e r a l i s t s more e f f i c i e n t l y (the lack of a n c i l l a r y support
notwithstanding) . This has been forced upon i t by a r e l a t i v e lack
of s u b - s p e c i a l i s t s . As a r e s u l t , my p r a c t i c e r e f l e c t s what I was
t r a i n e d t o do, and the Army has saved a great deal of money by only
u t i l i z i n g the s u b - s p e c i a l i s t s when we, the g e n e r a l i s t s , f e e l t h e i r
expertise w i l l help i n p a t i e n t care, not t o p r o t e c t a r e f e r r a l
pattern.
I t i s not worth complaining unless one can o f f e r reasonable
s o l u t i o n s . The f o l l o w i n g i s my attempt a t reason...
1. EXPAND the r o l e of the g e n e r a l i s t t o encompass s k i l l s and
procedures t h a t he/she was t r a i n e d t o do.
2. RE-VALUE the g e n e r a l i s t i n both words ( i n medical school
c u r r i c u l a ) and deeds (reimbursement).
3.
DECOMPARTMENTALIZE medicine i n urban areas t o support
h e a l t h care t h a t can be d e l i v e r e d by one primary physician,
not a team of sub-specialty physicians who o f t e n do not see
the b i g p i c t u r e (the whole p a t i e n t ) .
I am w a i t i n g anxiously t o hear how your task force w i l l
r e s t r u c t u r e h e a l t h care i n the United States. C e r t a i n l y , i t w i l l
a f f e c t the decision of countless present and p o t e n t i a l g e n e r a l i s t s
as we contemplate our f u t u r e s .
Sincer
i n a l d J. Blaber, M.D.
�A T L A INI T A E V E C Q I M S U L T A I M T S , P . C .
Caring . . . Complete . . . E Y E C A R E
SHELBY R. WILKES. M.D.
Vitreous. Macula & Retina Surgery
Diabetic Retinopathy
Laser Surgery
ERG. EOG. and VER
JETTIEM. BURNETT. M.D.
Cataract Surgery
Corneal Surgery
Laser Surgery
ALFRED L. ANDUZE, M.D.
Pediatric Opthalmology
Oculoplastics
Glaucoma
ROBIN McGHEE. O D.
Contact Lenses
Preventive Vision Care
Ocular Therapy
A p r i l 6, 1993
Ms. H i l l a r y Rodham C l i n t o n
Chair - P r e s i d e n t ' s Task Force
on H e a l t h Care Reform
The White House
1600 Pennsylvania Avenue
Washington, D.C.
Dear Ms. C l i n t o n :
As an A f r i c a n - A m e r i c a n female p h y s i c i a n , I applaud your
e f f o r t s ~ t b secure__ad.e.quate, a t t o r d a o i e n e a i t h care f o r
a l l Americans. A t t h i s t i m e o f change and adjustment
f o r p h y s i c i a n s , I t h i n k we a l l r e a l i z e t h a t some
m o d i f i c a t i o n o f our p r e s e n t system i s i n order so t h a t
adequate h e a l t h care i s a v a i l a b l e f o r a l l Americans,
and t h a t we a r e a l l r e l i e v e d o f t h e u n c e r t a i n t y t h a t
p o t e n t i a l l o s s o f h e a l t h care b e n e f i t s b r i n g t o many
individuals.
Recently I was most heartened t o read t h a t t h e
p a t i e n t ' s a b i l i t y t o choose between p h y s i c i a n s and
h o s p i t a l s may be a p a r t o f t h e new h e a l t h care p l a n .
At t h e p r e s e n t t i m e t h e c o m p e t i t i v e r e a l i t i e s o f t h e
American market place have n o t been i n o p e r a t i v e i n t h e
c o n s t i t u t i o n o f many c l o s e d panel HMO and PPO p r o v i d e r
panels.
I would l i k e t o suggest t h a t t h e managed care sys
dch may be adopted a p r o v i s i o n be made t h a t any
w e l l - q u a l i f i e d , competent, t r a i n e d p h y s i c i a n w i l l be
a b l e t o p a r t i c i p a t e i n plans as l o n g as p h y s i c i a n s
agree t o abide by t h e c o s t containment measures
i n t r i n s i c t o a g i v e n p l a n . The p r o l i f e r a t i o n of^Ts-lQsec
"panel HMO's and PPO's works t o t h e advantage o f longei
e s t a b l i s h e d p h y s i c i a n s and t o t h e e x c l u s i o n o f t h e most
r e c e n t p l a y e r s on t h e medical and h e a l t h care scene. I
am h o p e f u l t h a t any n a t i o n a l l y mandated p l a n w i l l have
as one o f i t s f e a t u r e s , an openness i n terms o f i t s
p r o v i d e r s — a g a i n , as l o n g as a l l p r o v i d e r
q u a l i f i c a t i o n s meet c e r t a i n h i g h standards and a r e
6170 O l d National Highway • College Park, GA 30349 • (404) 996-0700
615 P e a c h t r e e Street • #815 • A t l a n t a , G A 30308 • (404) 8 8 1 - 6 4 1 7
�H i l l a r y Rodham C l i n t o n
A p r i l 6, 1993
Page 2
maintained.
I b e l i e v e t h i s a l a r m i n g tendency toward
renewed d i s c r i m i n a t i o n i n t h e f i e l d o f h e a l t h care
should be h a l t e d b e f o r e i t becomes f i r m l y entrenched.
Enclosed i s a copy o f my c u r r i c u l u m v i t a e .
I would be
happy t o c o n s u l t w i t h your t a s k f o r c e on t h i s o r any
o t h e r i s s u e p e r t a i n i n g t o q u a l i t y h e a l t h care a t any
p o i n t i n t h e p l a n n i n g o r implementation process.
Sincerely,
J e ^ t t i e M. B u r n e t t ,
M.D.
JMB/bp
Enclosure
cc:
Ms. L i l l i a n Lewis
Director of External A f f a i r s
O f f i c e o f Research and Sponsored
Programs
Clark-Atlanta University
A t l a n t a , GA
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
^ci^l
'sAo,o
- J.
�Curriculum Vitae
JETTIE M. BURNETT, M.D.
Home Address:
Business Address:
615 Peachtree Street
Suite 815
Atlanta, GA 30308
(404) 881-6417
Born
Education
1966-1970
Vassar College, Poughkeepsie, NY
A.B.
1971-1975
Johns Hopkins U n i v e r s i t y School o f Medicine
Baltimore, MD
M.D.
Training
1975- 1976
Medical I n t e r n s h i p
Parkland Memorial H o s p i t a l
D a l l a s , TX
1976- 1979
Residency i n Ophthalmology
U n i v e r s i t y o f I l l i n o i s Eye and Ear I n f i r m a r y
Chicago, I L
7/80-6/82
C l i n i c a l Fellow i n Ophthalmology
Massachusetts Eye & Ear Infirmary/Harvard Medical
School
Boston, MA
Research Appointments
7/80-6/82
Research Associate, Department of Cornea Research, ^
Eye Research I n s t i t u t e of Retina Foundation,
Boston, MA
Faculty Positions
1972
I n s t r u c t o r and Member o f Executive Committee
Cooperative O r i e n t a t i o n t o Medical Education
John Hopkins U n i v e r s i t y , School o f Medicine
Baltimore, MD
�JETTIE M. BURNETT, M.D.
PAGE 2
1977-1979
I n s t r u c t o r i n Ophthalmology
Abraham L i n c o l n School o f Medicine
Chicago, I L
1982-1983
Adjunct C l i n i c a l S c i e n t i s t
Eye Research I n s t i t u t e o f R e t i n a Foundation
Boston, MA
1982-1983
C l i n i c a l Associate
Department o f Ophthalmology
Massachusetts Eye and Ear I n f i r m a r y
Harvard Medical School
Boston, MA
1984-Present
A s s i s t a n t C l i n i c a l P r o f e s s o r i n Ophthalmology
Emory U n i v e r s i t y School o f Medicine
A t l a n t a , GA
1985-Present
A s s i s t a n t C l i n i c a l P r o f e s s o r i n Surgery
Morehouse School o f Medicine
A t l a n t a , GA
Honors and Awards
1966
N a t i o n a l Achievement Scholar
N a t i o n a l M e r i t S c h o l a r s h i p s , Vassar C o l l e g e
1974
1973
1979
Robert Wood Johnson Foundation S c h o l a r s h i p
Achievement Reward f o r C o l l e g e Students
Resident Research Award, U n i v e r s i t y o f I l l i n o i s
Eye and Ear I n f i r m a r y , Chicago, I L
1980-1982
R e c i p i e n t — N a t i o n a l Eye I n s t i t u t e o f N a t i o n a l
I n s t i t i t e s o f H e a l t h N a t i o n a l H e a l t h S e r v i c e Award
"Corneal R e p a r a t i v e Response t o E p i t h e l i a l I n j u r y "
R e c i p i e n t — N a t i o n a l Eye I n s t i t u t e Small Grant Award
f o r New P r i n c i p a l I n v e s t i g a t o r s
1980-1982
1988
R e c i p i e n t — C h a i r m a n Award o f E x c e l l e n c e
Morehouse C o l l e g e o f Medicine
1990
Young P h y s i c i a n o f t h e Year Award, A t l a n t a Medical
A s s o c i a t i o n , A t l a n t a , GA
Community and C i v i c A f f a i r s
1990-Present
1990-Present
Board Member, Board o f D i r e c t o r s , F a m i l i e s F i r s t
P r e s i d e n t and Founder, F r i e n d s o f Romar ( s u p p o r t
group f o r p r i v a t e academy)
�JETTIE M. BURNETT, M.D.
1991- Present
1992- Present
1990-Present
PAGE 3
Jack and J i l l o f America, I n c .
Leadership A t l a n t a , Class o f 1993
Hoosier Memorial U n i t e d M e t h o d i s t Church, Member
o f t h e H e a l t h and W e l f a r e Committee
S c i e n t i f i c Meetings and Continuing Education
1981
1981
1981
1981
1982
1982
1983
1983
1984
1984
1984
1985-1992
1987-1991
1985- 1992
1986- 1992
1985-1992
A s s o c i a t i o n f o r Research i n V i s i o n and
Ophthalmology, Sarasota, FL
American Academy o f Ophthalmology, A t l a n t a , GA
Corneal Research Meeting, Boston, MA
C a s t r o v i e j o S o c i e t y , A t l a n t a , GA
A s s o c i a t i o n f o r Research i n V i s i o n and
Ophthalmology, Sarasota, GL
N a t i o n a l M e d i c a l A s s o c i a t i o n , San F r a n c i s c o , CA
New England Ophthalmology S o c i e t y , Boston, MA
Georgia S t a t e Medical A s s o c i a t i o n
Georgia O p h t h a l m o l o g i c a l S o c i e t y I n t e r i m
Meeting
American Academy o f Ophthalmology, A t l a n t a , GA
Georgia S t a t e M e d i c a l A s s o c i a t i o n , H i l t o n Head, SC
American Academy o f Ophthalmology
Georgia S o c i e t y o f Ophthalmology
Georgia S t a t e Medical A s s o c i a t i o n
A t l a n t a S o c i e t y o f Ophthalmology
N a t i o n a l M e d i c a l A s s o c i a t i o n Ophthalmology
Section
Professional Societies
1975-1987
1979- 1985
1980- 1983
1981
1981
1983- 1992
1984- 1992
1985- 1992
1988-1989
American M e d i c a l A s s o c i a t i o n
Contact Lens A s s o c i a t i o n o f O p h t h a l m o l o g i s t s
A s s o c i a t i o n f o r Research i n V i s i o n and
Ophthalmology
Board C e r t i f i e d by American Board o f Ophthalmology
American Academy o f Ophthalmology, F e l l o w
A t l a n t a Medical Association
Medical A s s o c i a t i o n o f A t l a n t a
A t l a n t a Ophthalmology A s s o c i a t i o n
Chairperson Ophthalmology on Cornea, N a t i o n a l
Medical A s s o c i a t i o n
Medical L i c e n s u r e
Georgia
Texas
024783
E9453
�JETTIE M. BURNETT, M.D.
PAGE 4
Hospital Appointments
Crawford Long H o s p i t a l o f Emory U n i v e r s i t y
Metropolitan Hospital
Piedmont H o s p i t a l
South F u l t o n M e d i c a l Center
Southwest H o s p i t a l and M e d i c a l Center
West Paces H o s p i t a l
Major Research I n t e r e s t s
1.
L o c a l i z a t i o n and r o l e o f a c e t y l c h o l i n e i n mammalian c o r n e a l
corneal e p i t h e l i a l layer.
2.
Mechanism o f a c t i o n o f g r o w t h f a c t o r s on mammalian c o r n e a l
epithelium.
3.
Role o f p r o t e a s e s and polymorphonuclear l e u c o c y t e s i n c o r n e a l
stromal loss.
Publications
1.
Sugar, J . , B u r n e t t , J . , and F o r s t o t , K.L. Scanning E l e c t r o n .
Microscopy o f I n t r a o c u l a r Lens and E n d o t h e l i a l C e l l
Interaction.
American J o u r n a l o f Ophthalmology. 86:157, 1978.
2.
B u r n e t t , J . , T e s s l e r , M., I s e n b e r g , S., and Tso, M: C l i n i c a l
T r i a l o f Fenoprofen i n t h e Treatment o f Aphakic C y s t o i d Macular
Edema.
Supplement t o I n v e s t i g a t i v e Ophthalmology and V i s u a l Science.
18:4, A p r i l 1979.
3.
B u r n e t t , J.M., Smith, L.E., Prause, Jan U., Kenyon, K.K.:
Acute I n f l a m m a t o r y C e l l s and Collagenase i n Tears o f Human
M e l t i n g Corneas.
Supplement o f I n v e s t i g a t i v e Ophthalmology and V i s u a l Science.
20:3, March 1981.
4.
Knox, D.L. Chen, M.F. G u i l a r t e , T.R., Dang, C.V., and B u r n e t t ,
J.M.: N u t r i t i o n a l amblyopia: F o l i c A c i d , V i t a m i n B-12, and
Other V i t a m i n s . R e t i n a . 2:4, F a l l , 1982
5.
B u r n e t t , J . , T e s s l e r , M., I s e n b e r g , S. and TSO, M.:
Double
Masked T r a i l o f Fenoprofen Sodium: Treatment o f Chronic
Aphakic C y s t o i d Macular Edema. Ophthalmic Surgery. 14.2,
February 1983.
�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
23
�Helen M. Gofdon, M.D.
March 18, 1992
Hilary Rodman Clinton
Committee on Health Care Reform
The White House
Dear Mrs. Clinton:
As a member of a medical residency program that involves work both
at a large innercity public hospital and private hospitals, I am happy to
see the attention being focused on health care reform. However there is
an issue that is almost never discussed publicly, yet which underlies a
large portion of our exploding costs. It is not discussed because
questioning it would seem to be questioning our American ideal of
individual rights, and because it requires an examination of attitudes and
beliefs, not merely facts.
We have developed extraordinary medical and scientific capacities
for saving and prolonging life, many of which are very expensive. By
prolonging I mean frequently extending by 6 months or less the life of a
patient who at best will never be sufficently rehabilitated to enjoy life,
and at worst will remain trapped in the Intensive Care Unit to die of the
same disease that brought them there. This process is as expensive as it
is pointless. It expands the suffering and loss of patient and family. Why
do we do it? 1.) the litigenous medical legal climate 2.) families and
patients have no idea what they are letting themselves in for in terms of
suffering in the hands of modern high tech medicine in an attempt to treat
a disease, nor has the prognosis ever been fully explained so consequently
3.) despite, or because of, a dismal prognosis the patient or family
desires "everything possible be done," and because of the risk, at times
imagined, of a lawsuit, it is. Finally, medical professionals become
seduced by the ready availablity of technology and ground breaking
pharmacology, and in an honest desire to help and cure they lose sight of
the best interests of the patient.
Why do we try so hard as it is becoming obvious it is too late? The
Doctor, quite rightly, is no longer supposed to play God. Now he or she is
supposed to be the educator, explaining what's going on, and helping the
patient be involved in health care decision. Unfortunately, despite the
ready availability of medical information, an explanation is not equivelent
�to years of experience. Supposedly, the decision to be aggressive and try
everything is left to the distraught family, which is rarely capable of
making it at the time. In fact it is already made, de facto, until the
family adamantly opposes it. Doctors rarely stress a grim prognosis.
First of all they can't swear it's true, can't swear this will kill the
patient in "X" amount of time. Secondly, if they don't want to try
something dramatic and expensive, another MD undoubtably will so the
first loses business. Third, no one enjoys watching patients die. Fourth,
after the patient dies how can they prove to a nonmedical jury that
putting the patient into the intensive care unit would only have prolonged
the life by three very expensive weeks? Medicine is practiced very
defensively in modern America. An example of this is that your living will
is worth almost nothing if, after you are incapacitated, any one of your
relatives states that he or she wishes "every thing done." Consequently,
for these reasons and for others, it has become very difficult, as well as
expensive, to die in modern America (note that Kavorkian is contacted
daily).
Society has been adamant that the doctor is not supposed to act as
God, so decisions about how much treatment to give are left to those with
little or no medical training or experience. Rarely does an individual
family make decisions, at least initially. They are abdicated to the nation
at large, and are made based on some of our fundamental beliefs and
attitudes, both good and bad: Everyone deserves a chance, fight for the
underdog (ie the one whose body is succombing to an irreversable
process), everyone deserves equal treatment, everything can be fixed if
we try hard enough. Our characteristics of perserverance and
~~
determination for fairness have brought our country a long way in it's 200
some years, but they are not very helpful during the last six months of
life. We might be more realistic about the final six months if not for our
dislike of old age and infirmity: the elderly are sent away - to the nursing
home, to the hospital, to somewhere. Death is considered unnatural.
These modern American sentiments, combined with the normal human fear
of death, grief at loss of loved ones, and the described medical attitudes,
all work together to practically necessitate inappropriate and expensive
health care to be dispensed all the time.
The following are situations in which I would suggest that ICU care
and extraordinary measures should universally be limited. It is a sketch,
which needs to be analysed and filled in by the medical community. Many
of these are essentially black and white scenarios, where if there is a
relationship between family and doctor, patient care is already quietly
s
�directed at comfort measures only. They need to be publically discussed
and codified for several reasons. First, for the unfortunate but common
situation where the doctor and family have never before met. Second, for
the doctors and families who insist on continuing lifesaving efforts to the
grave. Finally, and vitally, to permit discussion of the common and more
difficult gray area decisions.
1. ) Patients with metastatic cancer or cancer with a less than 4 mos
prognosis, irreversible lung disease requiring home oxygen (except,
perhaps, in certain circumstances for time limited trials in case of
pneumonia), irreversible over atleast six months congestive heart failure
with an ejection fraction less than 20%.
2. ) Progressive, incurable and fatal diseases: AIDS, CJD, ALS, CF to
name a few.
3. ) Dementia sufficient to prevent the simple tasks of self care in a
nursing home patient. I would argue in many of these situations,
particularly in patients who have suffered strokes preventing them from
being responsive at all, that hospitalization and antibiotics themselves
should be limited: that pnuemonia should again be allowed to be "the old
person's friend," bringing a peaceful and relatively quick death.
4. ) Certain types of disease in premature infants, and particular
congenital defects. Here I would ask those with greater experience than I
in pediatrics to name specifics.
When we begin to limit our waste of high tech medicine, and have a
public climate reinforcing the recoginition that life ends in death, often
from a specific disease, and everyone is entitled to as much comfort as
possible with the dying process, but not to heroic life saving attempts, we
will begin to have the needed money available for universal coverage,
increased low cost clinics and home nursing. In becoming more realistic
about what is actually helpful with chronic diseases we will reduce the
suffering of the patients and the suffering of their families. The other
aspects of health care that are in need of reform are being publicly
discussed. Until we address the uneducated and unrealistic attitudes that
are being permitted to drive treatment decisions we will not be able to
slow spending, only able to bankrupt ourselves.
Sincerely,
Helen M. Gordon, MD.
�CODER
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:_l/
CTENRRAT . SOPT-
POSTCARD 2:
General mail
Personal stories
Other Health Providers
POSTCARD 1:
Letter Campaign
.Offers to help/Employment
FORM LETTER:
Letterhead
.Policy
REROUTE:
Casework
.Scheduling
President
Other
POTJCY AND PF.RSnNTAT. ?yrnRTF,S:
.ORGANIZATION (I)
insurance premiums
insurance reform
insurance pools
boards and oversight
.COVERAGE (II)
working families
unemployed/low income
benefits
providers
.INFRASTRUCTURE/WORKFORCE (HI)
quality assurance (guidelines)
administration, reimbursement
& information systems
malpractice & tort reform
manpower issues (training)
unnecessary procedures
.GOVERNMENT PROGRAMS (IV)
medicare
medicaid
veterans
DoD
Indian health
.COST ISSUES (VI)
drug prices
physician fees
.hospital fees
.medical equipment
fraud & abuse
FINANCING (VH)
MENTAL HEALTH (IX)
LONG-TERM CARE (X)
PUBLIC HEALTH/
SPECIAL POPULATIONS (XH)
prevention
_AIDS
women's health
immunizations/children
rural
urban
OTHER
�•1.0
Advanced Laparoscopy
Training Center
February 9, 1993
The Honorable First Lady
Hl!!.'ir\' Rodham CHiitor;
The White House
Washington, D.C. 20500
Dear Mrs. Clinton:
Congratulations to you and President Clinton on a wonderfully managed campaign. We, in the
medical profession, feel very confident that you will represent not only yourselves but all of the
people in America the way lhat we wish to be represented over the upcoming years.
I am very excited about the fact that you have taken on the task of dealing will', health care ::•
America. 1 have been very involved in training physicians, surgeons, gynecologists and
urologists in the new field of laparoscopic surgery at the Advanced Laparoscopy Tiaining Cemei
here in Marietta, Georgia since June of 1990. Since that date, we have trained approximately
10,000 surgeons in our facility. I feel that health care costs, as well as proper training of
physicians, is very important to the future of medicine in the United States. I vvnuld like to
offer the services of the Advanced Laparoscopy Training Cenler here in Marietto, Georgia lo
work with you in any way possible to reach the surgeons in accomplishing belter patient care
from a cost standpoint, as well as the quality of medicine provided to our people in the United
States. We are very receptive to any suggestions that you might have, and if there is any way
we can be of service to you, piease do not hesitate to let me knew.
Sincerely,
William B. Saye, M.D., F.A.C.O.G., F.A.C.S
CEO/Medical Director
Advanced Laparoscopy Training Center
WBS:jm
790 Church Street Extension, Suite 380 • Mariett^Georgia 30060 '(404) 429-9253 • FAX (404) 421-8945
�ADVANCED LAPAROSCOPY
TRAINING CENTER
S
ewMiil yc:;ii's afjn, Ccoi ^ i ; ! ((yuecDlo^isI D i : W i l l k i i i i Dryiiiil Sayu a n d N;islivilli? f>i!ii<!i';il siii'K(M)ii Dv. T j l d i c SIH- K r c l d i r k li-avelcnl l h e U n i t i i d Slales,
( r a c h i i i ^ as i n a n y doctoi's as t h e y c o u l d h o w lo p r r r o r i n l a p a r o s c o p y
T h e y spent t h e i r w e e k e n d s c o i H l i i c l i n n " h o l c l c o u r s e s — l e c l u r c - b a s e d oi ient a l i o n s that l l i e y h o | ) e d w o u l d e n c o u r a g e t h e p h y s i c i a n s to si-r.k l u i ' t h e r ,
hands-on training.
Now, l l i e i r s l u d e n t s c o m e to l l i e n i . A l i h e i r I w o y e a r - o l d A d v a n c e d Lapai'oscopy I h i i n i n g C e n t e r (Al.'lt:) i n M a r i e t t a , t i a , d o c t o r s g a i n not o n l y classr o o m I r a i n i n f ; , h u t I h e s u r g i c a l e x p e r i e n c e t h e y n e e d to s u c c e s s f u l l y use t h e
lcelijii(|ue on l l i e i r patients.
t)r. Willium Hryunl Saye, CEO ami Medical Direclur
W h e n the c e n l e r o p e n e d i n J u n e
1!)'J0, its i n i t i a l s l u d e n t s w e r e general surgeons anxious to l e a r n h o w they
c o u l d use l a p a r o s c o p y l o r e m o v e I h e
gallbladder. Since t h e n , Drs. Saye a n d
Kcddick have t r a i n e d m o n ' (hail 8200
physicians I r o m a variety o f surgical
specialties, i n c l u d i n g u r o l o g y , thoracic s u r g e r y a n d g y n e c o l o g y . I h e i r target m a r k e l has g r o w n f r o m a g r o u p
o f a p p r o x i m a t e l y HO.OOO s u r g e o n s l o
m o r e I h a n 70,000.
" W e ' v e w o r k e d seven days a w e e k
f o r a h o u l l h e past f o u r years," said Ur.
Saye, C L O a n d m e d i c a l d i r e c t o r o f
Physicians also t r a i n i n " d r y labs,"
o n devices that s i m u l a t e l h e p e r i toneal c a v i t y o f an a d u l t . The t i a i n ing u n i t s a r e b u i l t to s i m u l a t e various
p a r t s o f t b e hotly, a n d a r e d e s i g n e d
so tiiat o n e p e r s o n c a n o p e r a t e t h e
e n t i r e u n i t . T h e u n i t s , called A L I C
SOOl Series'IVainers, w e r e d e v e l o p e d
hy A L i t employees, a n d a r e f u l l y
C(|uipped w i t h cameras, l i g h t i n g a n d
monitors.
U o c t o r s i n I h e courses can p r a c t i c e
t h e i r k n o w l e d g e in the center's anim a l lab, w h i c h bouses 10 o p e r a t i n g
r o o m s . A n d because A L I t serves as
a l e s t i n g f i e l d f o r s t a l e o f - l h e a r t surgical e ( | u i p m e n t , t h e p h y s i c i a n s have
a c h a n c e l o c o m p a r e d i f f e r e n t types
o f s u r g i c a l tools as t b e y a r e l e a r n i n g .
"We are constantly investigating
new operations and applying Ibem lo
l a p a r o s c o p i c p r o c e d u r e s , " said Dr.
H e d d i c k , w h o is c o - m e d i c a l d i r e c l o r
of A L I t . "Ily constantly r e f i n i n g the
training techniques and the teaching
i n s t m m e n l s , A L I C courses r e m a i n
unparalleled."
AL'IV lias
physicians.
(rained
/More
than HZUU
A L I t . " W h e n y o u like w h a t y o u ' r e doi n g , y o u d o n ' l n e e d m u c h resl."
The I w o d o c t o r s m e l i n 1U88, w h i l e
h o i h w e r e l e a c h i n g a c o u r s e o n laser
s u r g e r y in A u g u s t a , Cla. They soon
h e c a m e close f r i e n d s .
" W c s p c n l some t i m e t a l k i n g a h o u t
w h a l we c o u l d tlo l a p a r n s c o p i c a l l y ,
a n d the g a l l h l a d d c r c a m e up," Or.
Saye said. Later, Ur. Saye a n d a n o t h e r d o c t o r w o u l d he Ihe first l e a m to
p e r f o r m a l a p a r o s c o p i c cholecystocl o m y in t h i ! U n i t e d States. Ul'. Kcddick
a n d his p a r l n e r at t h e t i m e w e n ; t h e
second l e a m .
W i l h l h e m e t e o r i c rise i n p o p u l a r ity o f laparoscopic s u r g e r y , A l i l l - has
become a major Iraining g r o u n d ,
g r o w i n g f r o m a h a n d f u l o f staff m e m b e r s l o lit; e m p l o y e e s a n d SO p a r t t i m e medical a n d lechnical specialists.
l he t r a i n i n g c e n l e r o f f e r s Hvo-day
courses, u s u a l l y g i v e n o n t h e weekend, thai leach cither laparoscopic
h y s t e r e c l o m y o r basic a n d a d v a n c e d
laparoscopy for general surgeons.
O u r i n g each c o u r s e , d o c t o r s w a t c h
t h e tcchni<|ues o n a 10-foot v i d e o
s c r e e n — o f t e n live, as the o p e r a t i o n is
b e i n g p e r f o r m e d i n a s u r g i c a l suite
elsewhere in the building.
T h e fact t h a t l a p a r o s c o p i c s u r g e r y
evolved o u t s i d e o f t h e t r a d i t i o n a l
u n i v e r s i t y s e t t i n g has n o t h a m p e r e d
t h e t e c h n i q u e ' s p o p u l a r i t y o r ALTC's
a b i l i t y to t e a c h it, Ur. Saye said. "1
s o m e t i m e s have I w o d e p a r l m c n l
heads call m e , w a n t i n g to k n o w h o w
w e ' r e l e a c h i n g i l , " he said.
" T h i s hit the general s u r g e r y w o r l d
w i t h o u l warning," Iu; explained.
" M o s t o f the d e p a r t m e n t c h a i r s w e n ;
n e v e r t a u g h t laparoscopy. So b e f o r e
!!)«!), less t h a n . >% o f i n s l i l u t i o n s i n
t h e U n i t e d Slales l h a l I r a i n e d general s u r g e o n s gave t h e m l a p a r o s c o p y
t r a i n i n g . N o w e v e r y o n e w i l l o f f e r il
lo I h e i r residents."
i n g special courses o n c o m p l i c a t i o n s ;
it w i l l p r e s e n t videos o f s u c h c o m p l i c a t i o n s as Drs. Heddick a n d Saye exp l a i n h o w to b o t h avoid a n d h a n d l e
them.
" T h e makers o f thti e q u i p m e n t have
r e a l l y c o m e to t h e f r o n t , so t h a t today, t e c h n o l o g y is really a h e a d o f t h e
techniques," Ur. Saye said. " The i n j u r y
c u r v e n o w is a d o w n w a r d slope."
ALTC's d i r e c t o r s also suggest that
surgeons n e w l y t r a i n e d i n laparoscopy be assisted by e x p e r i e n c e d physicians d u r i n g t h e i r first t h r e e to l i v e
operations.
I'hysicians w h o have c o m p l e t e d a
w e e k e n d basic session a r e e n c o u r aged to slay a n o t h e r d a y o r I w o l o
e n r o l l i n o n e o f several p r e c e p l o r s h i p s , w h i c h o f f e r i n - d e p t h exp e r i e n c e i n fields s u c h as p e d i a t r i c
l a p a r o s c o p y a n d l a p a r o s c o p i c laser
c h o l e c y s t e c t o m y . ' l i i u g h t by l e a d i n g
specialists i n each f i e l d , t h e p r e c e p t o r s h i p is d e s i g n e d to be a b r i d g e
b e t w e e n a d v a n c e d c o u r s e s i n lapa r o s c o p i c s u r g e r y a n d t h e surgeon's
f i r s t a p p l i c a t i o n o f these t e c h n i q u e s
o n patients.
T h e t y p i c a l cost o f t h e basic, t w o day c o u r s e is b e t w e e n $2800 a n d
$3000. T h a t i n c l u d e s h o t e l expenses,
all meals b u l o n e a n d use o f I h e
laboratory animals. I'receptorships
cost a b o u t $1500.
I've h a d d o c t o r s c o m p l a i n a b o u t
I h e cost b e f o r e i h e y g e l h e r e , b u l
o n c e I h e y leave, i h e y say it's a bargain," Ur. Saye said. Some s u r g i c a l
r
O n c e laparoscopy b e c a m e p o p u l a r ,
r e p o r t s b e g a n lo s u r f a c e o f c o m p l i c a t i o n s d e v e l o p i n g d u r i n g t h e surgery, i n c l u d i n g h e m o r r h a g i n g , vascul a r p e r f o r a t i o n s a n d c o i n n i o n bile
d u e l severances a n d ligations. I n
m a n y cases, t h e i n j u r i e s r e q u i r e d
o p e n s u r g i c a l repair.
/*..
--9 I
l he r e p o r t s s p u r r e d Ihe N e w York
Slate D e p a r t m e n t ol H e a l t h r e c e n t l y
l o issue an a d v i s o r y c a l l i n g f o r stricI c r physician c r e d e n t i a l i n g p r o g r a m s
a m i elevated t r a i n i n g s l a n d a r d s l o r
p r o g r a m s l h a l leach the procedure.
T h e c o n t r o v e r s y has s t e e r e d A L I C
l o c a r e f u l l y teach d o c t o r s i n its p r o grams how lo handle any complicat i o n s t h a t m a y arise.
In October, A L I C w i l l b e g i n o f f e r -
Dr. Saye Iraining surgeons in lhe U.H.
i n s t r u m e n t a n d laser c o m p a n i e s w i l l
s u p p l e m e n t d o c t o r s ' expenses, a n d
some u n i v e r s i t y m e d i c a l c e n t e r s w i l l
pay f o r the courses. Course graduates
also receive C o n t i n u i n g M e d i c a l Kducalion accreditation.
Urs. H e d d i c k a n d Saye a r e discussing opening short-term, regional
I r a i n i n g c e n t e r s s i m i l a r l o A L I C , to
give d o c t o r s f a r f r o m ( i e o r g i a b e l t e r
access l o l a p a r o s c o p i c t r a i n i n g .
Dr. Saye e n v i s i o n s one-day v i d e o
t r a i n i n g courses, u s i n g b o t h state-oft h e - a r t c o m p u t e r a n i m a t i o n a n d act u a l o p e r a t i o n s , that w o u l d o f f e r
laparoscopic surgical education for
physicians i n any area o f t h e c o u n t r y .
A L I C also serves as a c o n s u l t a n t to
insurance companies a n d hospital
q u a l i t y assurance c o m m i t t e e s . T h e
center's doctoi's l u v i e w video la]>es of
operations w h e r e injuries occurred,
a n d advise Ihe c o m p a n i e s o r c o m m i t tees o n h o w t h e i n j u r i e s c o u l d have
b e e n p r e v e n t e d . T h o s e v i d e o tapes
also a r e u s e d l o t r a i n d o c t o r s t a k i n g
A L I O courses.
Since s t a r t i n g ALTC, b o t h Drs. Saye
a n d Heddick have developed interests
q u i t e apart f r o m the surgical field. Ur.
Saye b r e e d s a n d sells q u a r t e r h o r s e s
o n a f a r m n e a r M a r i e t t a , w h i l e Dr.
Heddick has e s t a b l i s h e d h i m s e l f as a
successful c o u n t r y - m u s i c w r i t e r a n d
p u b l i s h e r i n Nashville. Hut Ihey remain true lo Iheir original mission.
" O u r goal is to teach e v e r y s u r g e o n
i n A m e r i c a safe e n d o s c o p i c surgery,"
Ur. Saye said.
— I n u l a /)ii(er/«iiig/i
�1
M
THE BEST OF BOTH WORLDS
lhe old world traditions of
skilled medical practice...The new world
techniques and technologies that enhance
surgeons' skills and patients' lives...
These worlds come together at the Advanced
Laparoscopy Training Center(ALTC) near Atlanta.
State-of-the-art laparoscopic techniques are taught by
leading surgeons in a practical approach.
Founded by laparoscopic pioneers, Drs. Eddie Joe
Reddick and William Bryant Saye, ALTC provides a
pragmatic learning environment.
The success of ALTC is based on a combination of
classroom instruction employing the latest audio-visual
teaching techniques with inanimate and animate
laboratory practice, employing the Reddick-Saye
method of laparoscopic surgery.
Accredited course work and laboratory instruction can
be tailored to meet the needs of surgeons requiring
advanced or specialized training. To meet the growing
demand for training in this advanced technology, our
expanded curriculum offering now includes:
1
Cholecystectomy
Advanced Suturing Techniques
Vagotomy
Thoracoscopy
Herniorrhaphy
Hysterectomy
Pediatric Laparoscopy
Colon and Rectal Surgery
Pelvic Lymphadeneclomy
ALTC is the leading training
center in laparoscopic surgery. Nearly four thousand
surgeons have participated in workshops at ALTC. The
standard has been set in facilities, staff, instruction and
technique. The goal is developing safe laparoscopic
surgical techniques for your surgical practice.
Yesterday, today and tomorrow...
At ALTC, the finest traditions of medicine are joined
wilh the latest advances in technology to serve
surgeons and their patients.
For more information and registration, please call
(800) 762-3499
The Advanced Laparoscopy Training Center
790 Church Street Extension
Suite 380
Marietta, Georgia 30060
(404) 429-9253
7 ^
Advanced Laparoscopy
Training Center
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The White House
1600 Pennsylvania A v e . , N.W.
Washington, D.C. 20500
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Dear Mrs. C l i n t o n :
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Since we met at the Robert Kennedy memorial mass, I ' v e
had some very good news that I ' d l i k e to share with you.
THE BEST REHABILITATION HOSPITAL IN THE COUNTRY.
T h a t ' s how the R e h a b i l i t a t i o n I n s t i t u t e of Chicago (RIC)
was ranked for the t h i r d year i n a row by the U . S . News
& World Report l i s t i n g of "America's Best H o s p i t a l s . "
Our t h i r d consecutive #1 ranking r e f l e c t s the e x c e l l e n t
reputation of RIC among p h y s i c i a n s from across the
country.
With t h i s r e c o g n i t i o n , however, comes the r e s p o n s i b i l i t y
not to r e s t on our l a u r e l s .
Our commitment to s e r v i n g
c h i l d r e n and a d u l t s with p h y s i c a l d i s a b i l i t i e s - - through
quality
patient
care,
scientific
research
and
professional training
remains our number one p r i o r i t y .
Because of your i n t e r e s t and support, I b e l i e v e t h i s i s
an honor we a l l share.
As we continue our e f f o r t s to
make RIC the best i t can be, we know that we can count on
your ong/ing a s s i s t a n c e .
Sincere'
;
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�NOTICE
PERSONAL INFORMATION HAS BEEN REDACTED
FROM THIS DOCUMENT
/or
�I have nucn i n cimmon w i t h B i l l
C l i n t o n , and ptrhrnps t h a t i s why I waa so drawn t c h i s
. t o o , s t u d i e d i n Europe l i: 197
campaign f o r F r e s i d e n t .
and waa f a s c i n a t e d by t r a v e l in.o t o t h e East B l o c and
T
speaking w i t h students t h e r e .
CI wasn't a spy e i I he r
t o o , a:! e n j o y i n g h e l p i n g my e i g h t h g r a d e d a u g h t e r w i t h her
:"
a 1bebra homework.
W h i l e I am n o t l o o K i n g f o r a j o b i n t h e
C l i n t o n : a d w i n i s t r a t i o n , I c e r t a i n l y w o u l d f e e l i t uiy d u t y
and an honor t o p r o v i d e i n f o r m a t i o n or f r e e a d v i c e , i f you
s h o u l d need any r e g a r d i n g my s p e c i a l t y of o p h t h a l m o l o g y .
I
am n o t a c a p t i v e o f o r g a n i z e d m e d i c i n e , and ny o p i n i o n s
o u i d no t be no t i v a t e d oy pe r sona 1 f i na nc l a l g a i n .
T h a n k yo u f o r y o u r a t t e n t i o n .
I a m h a p p y t o .1 a v e
somebody o f your i n t e l l i g e n c e and c o n c e r n i n power . a s k i n g
.
t h e r 1 o h t •< u e s t i o n s .
:
11 nee r e1v,
Richard
T.
Kasheer
M.D.
�Withdrawal/Redaction Marker
Clinton Library
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COLLECTION:
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Health Care Task Force
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�a]
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*5
�Joint Commission
on Accreditation ol Heallhcaie Organizations
March 3, 1993
Ms. H i l l a r y Rodham C l i n t o n
C h a i r p e r s o n , N a t i o n a l Task Force
on H e a l t h Care Reform
The White House
1600 P e n n s y l v a n i a Avenue, NW
Washington, DC 20500
Dear Ms. C l i n t o n :
On b e h a l f o f t h e J o i n t Commission on A c c r e d i t a t i o n o f H e a l t h c a r e
O r g a n i z a t i o n s , I am w r i t i n g t o express our s u p p o r t f o r your e f f o r t s
towards t h e f o r m u l a t i o n o f a comprehensive and f a i r p l a n f o r h e a l t h care
reform.
We a r e p l e a s e d t o o f f e r t h e J o i n t Commission as a p o t e n t i a l
major r e s o u r c e t o you i n s e r v i c e o f t h i s o b j e c t i v e .
The J o i n t Commission i s t h e n a t i o n ' s o l d e s t and l a r g e s t h e a l t h care
a c c r e d i t i n g body. I n t h a t r o l e , we have been s o l e l y d e d i c a t e d t o
measuring, e v a l u a t i n g and i m p r o v i n g t h e q u a l i t y o f h e a l t h care s e r v i c e s
f o r more t h a n 75 y e a r s .
Today, t h e J o i n t Commission a c c r e d i t s almost
9000 h e a l t h care o r g a n i z a t i o n s , i n c l u d i n g a p p r o x i m a t e l y 80% o f t h e
nation's hospitals.
T r a d i t i o n a l l y , we have e v a l u a t e d e l i g i b l e h e a l t h care o r g a n i z a t i o n s
every t h r e e years based on an approach which has emphasized t h e adequacy
o f t h e i n s t i t u t i o n ' s resources and procedures. However, d u r i n g my
s i x - y e a r t e n u r e h e r e , t h e s i t e v i s i t and e v a l u a t i o n have become o n l y t h e
most v i s i b l e p a r t o f an i n c r e a s i n g l y s o p h i s t i c a t e d methodology f o r
continuous q u a l i t y monitoring.
I n the near-term f u t u r e , a c c r e d i t e d
o r g a n i z a t i o n s w i l l p r o g r e s s i v e l y be h e l d a c c o u n t a b l e f o r t h e i r p a t i e n t
outcomes and f o r t h e i r a c t u a l performance. T h i s contemporary e v a l u a t i o n
approach i s f i r m l y couched i n t h e p r i n c i p l e s o f T o t a l Q u a l i t y
Management.
Among upcoming changes a r e t h e i n i t i a t i o n o f unannounced a c c r e d i t a t i o n
survey v i s i t s , s t a r t i n g i n J u l y o f t h i s year, and t h e e s t a b l i s h m e n t o f a
r e f e r e n c e database and performance m o n i t o r i n g system i n which
p a r t i c i p a t i o n by a l l a c c r e d i t e d h o s p i t a l s w i l l be mandatory bv
mid-decade. Our a b i l i t y t o remain on t h e c u t t i n g edge, i n i t i a l l y as
d e v e l o p e r s o f performance standards and i n r e c e n t y e a r s , as t h e major
d e v e l o p e r o f h e a l t h care performance measures, i s based on our
l o n g - s t a n d i n g a b i l i t y t o serve as an o b j e c t i v e convenor o f a p p r o p r i a t e
e x p e r t s and r e l e v a n t i n t e r e s t groups. I n t h i s r o l e , we have c o n s i s t e n t l y
been able t o h a r v e s t c u r r e n t knowledge and e x p e r t i s e and b u i l d consensus
among d i v e r s e groups toward t h e o b j e c t i v e o f i m p r o v i n g care f o r p a t i e n t s .
T h i s h i s t o r i c a l backdrop has de f a c t o made t h e J o i n t Commission the
n a t i o n ' s conscience f o r h e a l t h care q u a l i t y .
One Renaissance Bouleviml
Oakbrook Terrace IL 60181
708'916-5600
Member Orgnmz.ilions
Amencnn College ol Phvsicuns
American College ol Smgeons
American Dcnuil Associalion
American Hospnal Associalion
American Medical Associalion
�Ms. H i l l a r y Rodham C l i n t o n
Health Care Reform
Page Two
As we look a t the q u a l i t y issues a f f e c t i n g the f u t u r e o f t h i s country's
health care and, s p e c i f i c a l l y , the reform process, several issues and
o p p o r t u n i t i e s stand out i n our view. We f e e l strongly t h a t the q u a l i t y
issue cannot be separated from the debates on cost and access. And, we
believe t h a t cost containment and improved access cannot be successfully
achieved, nor w i l l they be p o l i t i c a l l y acceptable, unless the q u a l i t y of
h e a l t h care--measured on an objective b a s i s - - i s maintained and, i n f a c t ,
improved.
I t i s therefore c r i t i c a l t h a t systems f o r measuring, assessing, and
improving q u a l i t y be an i n t e g r a l p a r t o f health care reform. Given the
c o n f l i c t i n g pressures and i n t e r e s t s involved i n reworking our h e a l t h care
system, the only f a i r t e s t i s whether an a c t i v i t y or service maximizes
the value received f o r the resources expended. I n p a r t i c u l a r , purchasers
(such as h e a l t h insurance purchasing cooperatives) must be able t o make
meaningful comparisons i n order t o judge r e l a t i v e value, rather than
simply accepting the lowest bids.
A c o r o l l a r y i s t h a t q u a l i t y assessment systems must have, as a component.
a mechanism f o r gathering and disseminating meaningful information. A l l
p a r t i c i p a n t s i n the h e a l t h care system, i n c l u d i n g purchasers, p a t i e n t s
and providers, need t o know more than they do now about the q u a l i t y o f
h e a l t h care. Only through increased information on q u a l i t y can:
o
p a t i e n t s knowledgeably choose health care organizations
and p r a c t i t i o n e r s ;
o
payers knowledgeably determine which services t o pay f o r and
w i t h which health care organizations t o contract f o r services;
o
h e a l t h care organizations assess and improve t h e i r performance;
and
o
developers of p r a c t i c e guidelines I d e n t i f y the most e f f i c a c i o u s
procedures.
F i n a l l y , the changes I n the health care system brought about by the
h e a l t h care reform process w i l l need t o be e x t e r n a l l y evaluated t o assure
t h a t they are achieving the intended b e n e f i c i a l impacts. I d e a l l y , the
evaluation program should be set up i n advance t o assure that i t can
generate the information that w i l l be needed by government and the
general public t o provide:
o
ongoing, unbiased assessments o f the o v e r a l l effectiveness
of health care reforms i n c o n t r o l l i n g costs, increasing
access, and maintaining or improving q u a l i t y .
o
an e a r l y warning system t o i d e n t i f y unintended increases i n
costs, reductions i n access, or d e t e r i o r a t i o n i n q u a l i t y .
�Ms. H i l l a r y Rodham C l i n t o n
Health Care Reform
Page Three
I n a l l of these areas, we suggest that the J o i n t Commission could serve
as a primary resource to you and the National Task Force. We would
r e s p e c t f u l l y suggest that our c a p a b i l i t i e s are applicable i r r e s p e c t i v e of
the s p e c i f i c reform options you u l t i m a t e l y decide upon. I n a d d i t i o n ,
much of what we do forms an important basis f o r d e f i n i n g acceptable cost
reductions or l i m i t a t i o n s i n h e a l t h care.
We would welcome the opportunity to b r i e f the Task Force on our
c a p a b i l i t i e s w i t h respect t o measuring h e a l t h care q u a l i t y and t o lend
our expertise i n any way that we can. I f you or your s t a f f have any
questions, or need more information from us, please c a l l me d i r e c t l y at
(708) 916-5650.
Sincerely,
Dennis S. O'Leary,
President
cc:
M.D.
Members, National Task Force on Health Care Reform
�
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Health Care Task Force Records
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White House Health Care Task Force
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<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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[Physician Letters] [loose] [2]
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 3
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Box 5
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
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https://clinton.presidentiallibraries.us/files/original/78c52080dc7eb7196255b86bf90804f5.pdf
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Edelstein
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56
3
4
3
�STEVEN JONAS M.D.
�F i r s t Draft
Not for Circulation or Citation
Without the Written Permission
of the Author
It
/
On National Insurance for Health. 92;
The Personal Health Care System
by
Steven Jonas, M.D., M.P.H.
Professor, Department of Preventive Medicine
School of Medicine, State University of New York at Stony Brook
11794-8036; (516) 444-2190, 2147
December 16, 1991
Copyright, Steven Jonas,
1992
�/
On NHI 92; Jonas
N.B.
Page 2
As noted at various points in the text, t h i s work i s drawn i n
part from material previously published by the author (each
used with the permission of the respective p u b l i s h e r ) :
Chaps. 1, 7, and 8 of An Introduction to the U.S. Health Care
Svstem. 3rd Ed., New York: Springer Publishing Co., 1992.
"View Point: How to Incorporate Health Promotion into
National Health Insurance," American Journal of Health
Promotion. Vol. 3, No. 4, Spring 1989, p. 73.
This work i s also drawn in part from unpublished but previously
prepared materials by the author:
"A National Policy for Cost-Containment in Health Services,"
written at the request of the Mondale-for-President Campaign,
dated January 6, 1983.
"On Canada," presented at the National Health Forum of the
National Council of Senior Citizens, Queens College, NY, June
2, 1989.
"Strengths and Limitations of the New Federalism: Regional
Diversity and Financing," presented at the Conference Health
Policy in the 21st Century; Global Issues. National
P r i o r i t i e s . State and Local Solutions, of the George Mason
University Center for Health Policy, Arlington, VA, May 22,
1990.
About the author: Steven Jonas, M.D., M.P.H. i s a Professor of
Preventive Medicine i n the School of Medicine, State University of
New York at Stony Brook. A graduate of Columbia College, Harvard
Medical Schhol and the Yale School of Public Health, he i s BoardC e r t i f i e d i n Preventive Medicine, a Fellow of the American College
of Preventive Medicine and the New York Academy of Medicine, PastPresident of the Association of Teachers of Preventive Medicine, a
past member of the New York State Board of Medicine, and an
Associate Editor of Preventive Medicine and the American Journal
of Preventive Medicine.
He has been working on and writing about health policy for
about twenty-five years. He created the f i r s t textbook on the
U.S. health care delivery system. Health Care Delivery in the
United States. (New York: Springer Publishing Co.), and coauthored and edited the f i r s t three editions of i t (1977, 1981,
1986). He has published on national health insurance and other
health policy topics in such journals as The New England Journal
of Medicine. The Lancet. The New York State Journal of Medicine.
Medical Care. Hospitals, and the American Journal of Public
Health. In addition to the above-mentioned An Introduction to the
U.S. Health Care System, he has also recently published The New
Americanism: How the Democratic Party Can Win the Presidency, with
a Foreword by George McGovern, (Monroe, NY: Thomas Jefferson
Press/Library Research Associates, 1992).
�On NHI '92: Jonas
Page 3
An Executive Summary
(Qualitative, Not L i t e r a l )
National Insurance for Health: A P o l i t i c a l Program
The ever-mounting costs.
system of care.
The appearance of cracks i n the
The Wofford win i n Pennsylvania.
focus of several Presidential candidacies.
A principal
A r i s i n g concern of a
majority of the American people.
That majority recognizes that v i t a l l y needed i s a much
improved, much more e f f i c i e n t mechanism for transferring the money
to pays for health services from the people who receive them to
the health professionals who give them.
Also needed i s a system
that w i l l f i n a l l y work e f f e c t i v e l y to bring those ever-mounting
costs under control.
Further, that majority recognizes the
necessity of providing health care cost coverage for both the uncovered and the under-covered.
This must be done i f for no other
reason than that i t i s the presently covered who pay for the costs
of that care which the presently uncovered do receive, inadequate
as i t i s .
The s i x t y year experiment with primarily private, primarily
non-compulsory, so-called "free market" financing, predicted by
many at i t s s t a r t to be a potential f a i l u r e , has lived up to the
predictions.
I t i s not only a f a i l u r e .
I t i s a very costly
failure.
And so, as has happened so many times before i n our history,
everyone i s once again talking about National Health
Insurance.
There i s increasing agreement that we i n the United States do need
that which every industrialized country other than South Africa
and ourselves has: a national health insurance program.
�/
On NHI 92: Jonas
Page 4
But what fewer observers recognize i s that as much as we need
reform of the health care financing/payment system, we need reform
of the health care services system i t s e l f .
For while i n terms of
percent Gross National Product spent our system i s the most
expensive i n the world, i t does not buy us anywhere near the best
health levels i n the world ( S t a r f i e l d ) .
I n any of the ways we can
presently measure health levels, we are d e f i c i e n t : o v e r a l l
mortality rates, infant mortality rates, prevention of preventable
disease, promotion of promotable health, a v a i l a b i l i t y of and
a c c e s s i b i l i t y to the right kind of health services (such as
primary care), i n the right places, for everyone, and so on.
Fear i s unhealthy.
A great paradox i n the United States i s
that a principal cause of fear i n the minds of many of our
c i t i z e n s i s the knowledge that now, i n the near future, or i n the
distant future, they or a family member, old, young, or middleaged, j u s t might not be able to get health care, get to health
care, get the right kind of health care, or pay for health care,
because i t ' s not there, i t ' s not good enough, or i t has become
unaffordable,
for one reason or another.
Thus, as we face the growing need to reform our system of
paying for care, i f we do not at the same time face our need to
reform the system of care i t s e l f , we w i l l have gone through a
great deal of p o l i t i c a l turmoil, not for nothing, but for much
l e s s than we deserve.
I f major changes in the way our health professionals,
especially the physicians, deliver health care to our people are
not made, while we w i l l have f i l l e d gaps i n f i n a n c i a l coverage, as
�On NHI
'92:
Jonas
Page 5
contrasted with health care payment, we w i l l have done l i t t l e to
address the problems in health care and the l e v e l s of health.
Those problems w i l l s t i l l be with us.
And because the present
patterns of medical practice and physician payment are major
upward drivers of costs, i f we do not make changes in those
patterns the costs w i l l continue to r i s e , e s s e n t i a l l y unabated.
Thus, as t h i s monograph w i l l attempt to show, we need not
j u s t National Health Insurance.
for Health.
We need also National Insurance
Herein presented i s a proposal called the Personal
Health Care System, PHCS for short.
Combining reforms in finan-
cing and health care delivery, i t i s offered as an approach to
providing both National Health Insurance and National Insurance
for Health.
Further, in t h i s election year the Personal Health
Care System plan might be able to help a candidate win the
Presidency.
And,
i f implemented, i t might be able to s i g n i f i -
cantly improve health and health care in the United States while
saving money at the same time.
The principal features of the PHCS are:
1.
I t establishes a single, clear, primary goal for the
U.S. health care delivery system: to serve and improve
the health of a l l Americans.
Thus, among other things,
major changes w i l l be made in the system to address the
burden of preventable disease and wasteful medical
interventions.
Health w i l l become a principal feature
of the health care delivery system.
To support t h i s
aim, the medical education and biomedical research
�On NHI '92-. Jonas
Page 6
establishments w i l l be encouraged i n a v a r i e t y of ways
to become health as well as disease-oriented.
2.
I t w i l l be c l e a r l y recognized that to achieve t h i s goal,
comprehensive planning w i l l be necessary, and that the
only way planning can be e f f e c t i v e i s to l i n k i t to
financing.
The PHCS c l e a r l y establishes that l i n k by
introducing into the payment system for health services
the t r i e d and true American method of contracting, with
operational specifications as the primary means of
paying providers for the services they d e l i v e r .
3.
To f a c i l i t a t e t h i s essential development, a single-payor
system w i l l be instituted.
I n addition to i t s most
important function of linking planning and financing,
the single-payor system w i l l produce savings that w i l l
make i t possible to pay for health services for that 15
percent of the population i s presently not covered,
without increasing taxes or health insurance premiums.
4.
Cost-containment w i l l be achieved by such mechanisms as:
the single-payor system i t s e l f ; separation of the capit a l and expense sources of funds and budgets; increased
emphasis on ambulatory and home, as contrasted with
hospital, care; creating a major focus on health
promotion/disease prevention services, improved controls
on fraud and abuse, and over-utilization by physicians
(these controls made much easier by i n s t i t u t i n g a singlepayor system); eliminating "balance b i l l i n g "
(charging
beyond what insurance pays) by physicians, and encourag-
�On NHI
'92: Jonas
Page 7
ing physicians to convert to salaried service.
(Supplementary private insurance w i l l be permitted.)
5.
Everyone w i l l have the same coverage, and the benefits
package w i l l be reasonably comprehensive.
There may
be
some income-related co-payments.
6.
Geographic maldistribution of f a c i l i t i e s and personnel
w i l l be addressed by a combination of incentives and
regulation.
7.
F i n a l l y , i t w i l l be recognized that the p o l i t i c a l key to
adoption, and the key to the success of any reform plan
instituted are one and the same: there must be major
elements in the plan that bring very s i g n i f i c a n t health
and health care benefits to those who presently have
health insurance coverage.
Otherwise they, the majority
of the American people, w i l l have no incentive to
support change.
In t h i s context, then, i t must be stressed that the
reforms proposed w i l l :
a.
Prevent loss of health care coverage that can
accompany loss of job.
b.
Guarantee f u l l family coverage.
c.
Eliminate potential i n e l i g i b i l i t y for health
insurance upon change of employment, i f one has a
serious chronic
d.
illness.
Prohibit any necessity to "pay the doctor more,"
( i . e . , balance b i l l i n g ) .
�On NHI '92:
e.
Jonas
Page 8
E l i m i n a t e m u l t i p l e forms, p a t i e n t paperwork,
the
"pay f i r s t / w a i t f o r the insurance company's check"
system.
f.
Address the undersupply of personnel and
facilities
i n both urban and r u r a l areas, and the c o s t l y
oversupply of h o s p i t a l beds i n c e r t a i n areas, and
the under supply of proper care f o r t h e l d e r l y i n
many areas.
g.
Through the planning mechanism address problems i n
treatment, such as: g a p s / d e f i c i t s i n h e a l t h
promotion/disease prevention services long w a i t s i n
w a i t i n g rooms, no c o o r d i n a t i o n of care among
s p e c i a l i s t s (the so-called "group-practice i n the
head"), defects i n d o c t o r - p a t i e n t
h.
communication.
Broaden the spectrum of covered i n t e r v e n t i o n s ,
i n c l u d i n g long-term care and c a t a s t r o p h i c i l l n e s s .
What's Covered
I n t h i s monograph, a f t e r the N a t i o n a l Health Insurance stage
i s s e t , the problems of the U.S.
b r i e f l y reviewed.
h e a l t h care d e l i v e r y system are
Then the PHCS i s described and the major
arguments j u s t i f y i n g i t are presented.
The references f o r the
whole t e x t are provided a t the end of the main body of the work.
There are also s i x Appendices, each covering c e r t a i n t o p i c s i n
more d e t a i l , each w i t h i t s own l i s t of a d d i t i o n a l references
list.
I t i s hoped t h a t readers w i l l f i n d t h i s w r i t i n g both
i n f o r m a t i v e and u s e f u l i n t h e i r work.
�On NHI '92: Jonas
I.
Setting the Stage
A.
Page 9
An Overviev
What many authorities have known for quite some time i s now
generally recognized: the U.S. health care delivery system i s i n
serious d i f f i c u l t y (Castro). Poll after poll shows c l e a r l y that a
majority of the American people want major changes to be made.
However, while the situation may be coming to a head because of
the seemingly uncontrollable cost-escalation, the problems are
intensifying only quantitatively. Qualitatively, the situation
has changed l i t t l e i n the l a s t sixty years or so.
The problems receiving the most public attention are:
*
The continually r i s i n g costs and the gradually
increasing proportion of the the Gross National Product
(GNP) devoted to payment for health services.
*
The large number of people (estimated currently at about
37 million) who have no coverage for health care costs,
and the even larger number who have s i g n i f i c a n t gaps i n
t h e i r coverage.
However, as w i l l be detailed below (see Part B of t h i s Section and
Sections I I and I I I ) , i n addition to the problems with financing
and payment, there are many other health and health care problems
which should be attended to as well.
One of the most prominent i s
the system's f a i l u r e to promote health and prevent disease to
anywhere near the s c i e n t i f i c a l l y achievable l e v e l .
Now i t happens that problem-list assembly i s f a i r l y simple.
Over a period of many years many "what's wrong" studies and
reports have been done (see Part B of t h i s Section and Appendix
�On NHI '92: Jonas
II).
Page 10
Many e l o q u e n t s t a t e m e n t s on t h e problems o f t h e U.S. h e a l t h
c a r e d e l i v e r y system have been w r i t t e n ( f o r a s a m p l i n g see
Appendix I I I ) .
Many p r o p o s a l s f o r r e f o r m have been made (see
Appendices I - I I I ) .
Less f r e q u e n t have been t h e a n a l y s e s o f causes
o f t h e l i s t e d problems and t h e development o f r e f o r m s t h a t address
t h o s e problem causes.
There i s a g r e a t d e a l o f evidence t h a t t h e f o r m and c o n t e n t
o f m e d i c a l p r a c t i c e i s a p r i n c i p a l cause o f many o f t h e problems
t h e system f a c e s , from e v e r - r i s i n g c o s t s t o t h e d e f i c i t s i n h e a l t h
p r o m o t i o n / d i s e a s e p r e v e n t i o n (see S e c t i o n I I I ,
below).
Thus any
new system must be capable o f r e f o r m i n g m e d i c a l p r a c t i c e , i n a
p o s i t i v e way.
Another major f a c t o r i n t h e e v e r - r i s i n g c o s t s , t h e
i n e f f i c i e n c y and waste i n p a p e r - p r o c e s s i n g and money exchange, and
t h e f a c t t h a t U.S. spends a s i g n i f i c a n t l y h i g h e r p r o p o s i t i o n o f
i t s GNP on h e a l t h s e r v i c e s t h a n any o t h e r c o u n t r y i s t h e m u l t i p l e
payor system (around 1400, count 'em) based i n t h e p r i v a t e
ance i n d u s t r y .
The i n s t i t u t i o n o f a s i n g l e - p a y o r system would
p r e s e n t any new h e a l t h c a r e d e l i v e r y system w i t h v e r y
advantages.
insur-
significant
Those advantages i n c l u d e c o n s i d e r a b l e c o s t - s a v i n g s ,
e s t i m a t e d i n t h e $90 b i l l i o n range (Woolhandler and H i m m e l s t e l n ,
1991).
That 15% s a v i n g s c o u l d enable t h e expansion o f coverage t o
t h a t 15% o f t h e p o p u l a t i o n who p r e s e n t l y do n o t have i t
without
any i n c r e a s e i n t a x e s o r h e a l t h i n s u r a n c e premiums.
F i n a l l y , i t must be r e c o g n i z e d t h a t t h e " f r e e market" cannot
f u n c t i o n i n t h e h e a l t h c a r e d e l i v e r y system.
First of a l l , t o
e x i s t such a market r e q u i r e s t h a t t h e p u t a t i v e buyer, t h e p a t i e n t ,
�On NHI '92: Jonas
Page 11
i s reasonably well-informed about the product he/she i s buying.
This i s seldom the case.
Furthermore, unlike i n any other market,
the putative buyer makes only a few of the decisions on the
expenditure of resources by the system.
Once a patient has
decided to enter the system, the bulk of the buying decisions made
thereafter are made by the putative s e l l e r , the physician.
Thus
in t h i s peculiar instance, the s e l l e r becomes to a s i g n i f i c a n t
degree the buyer.
I f a buyer and a s e l l e r are to any s i g n i f i c a n t
degree one and the same, the "free market" does not e x i s t .
%
What can be called the "medical f r e e market' myth" i s also a
major cause of health care delivery system problems.
I n any
economic system, i t i s the market which i s supposed to introduce
r a t i o n a l i t y and e f f i c i e n c y . But there i s no free market here.
Thus, the rampant i r r a t i o n a l i t y and i n e f f i c i e n c y . I n the absence
of a free market, economic e f f i c i e n c y can be achieved only by,
horror of horrors, planning.
And to be e f f e c t i v e i n an on-going,
but not free, market, planning must be linked to financing.
Thus we are looking at some biggies here, beyond assembling
problem-lists: changing medical practice, d r a s t i c a l l y increasing
the attention paid to health promotion/disease prevention (one
Presidential candidate who has seriously addressed t h i s issue i s
Senator Tom Harkin [1991]), i n s t i t u t i n g a single-payor system
(thereby closing down a whole industry and putting hundreds of
thousands people out of work [although many could be retrained and
rehired i n an expanded health care delivery system]), i n s t i t u t i n g
(actually r e i n s t i t u t i n g and s i g n i f i c a n t l y expanding) health
services planning.
This i s no small undertaking.
�On NHI '92: Jonas
B.
Page 12
An H i s t o r i c a l Perspective on Problems
Campaigns f o r n a t i o n a l h e a l t h insurance (NHI) have been
p e r i o d i c a l l y a p a r t of the p o l i t i c s of t h i s country since e a r l y i n
t h i s century (see Appendix I ) .
I n f a c t , Teddy Roosevelt had an
NHI plank i n h i s B u l l Moose Party p l a t f o r m f o r the
Presidential election.
time t o time?
1912
Why has NHI been such a hot t o p i c from
Because the U.S.
h e a l t h care d e l i v e r y system has
faced serious problems throughout t h i s time and many a u t h o r i t i e s
have thought t h a t NHI would be a good way t o go about f i x i n g them.
As f a r back as 1932, the f i n d i n g s of the f i r s t comprehensive
study of h e a l t h care d e l i v e r y i n the United States were summarized
i n these terms (Committee on the Costs of Medical Care):
"The problem of p r o v i d i n g s a t i s f a c t o r y medical s e r v i c e t o a l l
the people of the United States a t costs which they can meet
i s a pressing one. At the present time, many persons do not
receive service which i s adequate e i t h e r i n q u a n t i t y or
q u a l i t y , and the costs of service are inequably d i s t r i b u t e d .
The r e s u l t i s a tremendous amount of preventable p h y s i c a l
pain and mental anguish, needless deaths, economic
i n e f f i c i e n c y , and s o c i a l waste. Furthermore, these c o n d i t i o n s
are, as the f o l l o w i n g pages w i l l show, l a r g e l y unnecessary.
The United States has the economic resources, the o r g a n i z i n g
a b i l i t y , and the t e c h n i c a l experience t o solve t h i s problem"
(p. 2 ) .
The committee, chaired by Ray Lyman Wilbur, a past p r e s i d e n t
of the American Medical Association, had been created i n 1927 t o
look i n t o problems of h e a l t h care d e l i v e r y .
S t r i k i n g l y , some
would say u n f o r t u n a t e l y , s i x t y years l a t e r the statement s t i l l
has
a remarkably contemporary r i n g t o i t .
C.
A Current Perspective on Problems
I t i s a depressing observation t h a t t o b r i n g the b r i n g the
CCMC's problem l i s t r i g h t up t o date, one would not d e l e t e any of
i t s elements (which means, of course, t h a t none of them have been
�On NHI '92: Jonas
successfully dealt with).
Page 13
One would simply add the following
elements to the l i s t :
*
An ageing population and an ever-more technology-driven
approach to health care which spends a great deal of
money keeping very sick, uncomfortable,
unhappy people
a l i v e i n hospitals.
*
An urban hospital system overwhelmed with patients who
have drug-related i l l n e s s e s : for example, cigarette
smoking now causes 400,000 deaths per year.
The i l l e g a l
drugs also create many problems, many of which, unlike
the situation with the legals, are caused by t h e i r
i l l e g a l status, not by the actions of the drugs
themselves.
*
The AIDS epidemic, which i s quickly leaving the
homosexual population and entering the drug-addict
population, one in which prevention could do much.
*
A hospital system drowning i n paper-work and regulation
brought on by an attempt to contain costs which does not
deal with the real reasons why costs are so high and so
out of control.
*
Procedure-based,
lab-test based, technology-driven
medicine, ever more focused on drugs and surgery and
machines and devices, useless for many human i l l s .
*
Ever-poorer doctor-patient communication.
*
General inattention to health promotion and disease
prevention, which have much to offer for health and
possibly for helping contain costs.
�On NHI
*
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Jonas
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A cost-containment
system t h a t does not work, t h a t does
not contain costs, t h a t a c t u a l l y adds problems, because
i t cannot work: i t i s not d i r e c t e d a t the causes of
r i s i n g costs.
(Our cost-containment
system, c o n s i s t i n g of many v a r i a n t s of
f i n a n c i a l i n p u t c o n t r o l , i s based on monetarist/supply
side
economic theory: c o n t r o l the money supply and you w i l l c o n t r o l
cost increases.
I t ' s something l i k e our approach t o i l l e g a l drugs
c o n t r o l supply and the problem w i l l be solved.
t h a t t h a t i s no s o l u t i o n .
We know w e l l
I t j u s t makes t h i n g s worse.
Monetarism
i s as useless i n h e a l t h care cost containment as i t i s i n c o n t r o l
of the drug problem as i t i s i n t r y i n g t o run an economy.
To
c o n t r o l h e a l t h care costs as t o c o n t r o l the drug problem, one must
do something about demand.
And demand i n the h e a l t h care d e l i v e r y
system i s created p r i m a r i l y by the doctors, who j u s t happen t o be
the p r i n c i p a l s e l l e r s of h e a l t h services and the best paid of the
many h e a l t h care providers.)
D.
W i l l Change Come?
With the i n t e n s i f i c a t i o n of the problems of the U.S.
health
care d e l i v e r y system, as noted above there i s c e r t a i n l y increasing
i n t e r e s t among the general p u b l i c i n making major changes i n i t ,
at l e a s t t o the extent of i n t r o d u c i n g some k i n d of n a t i o n a l h e a l t h
insurance
(NHI) scheme.
And there i s even a r i s e of i n t e r e s t i n
such a plan i n some sectors of the medical p r o f e s s i o n , the
h o s p i t a l i n d u s t r y , and the p r i v a t e insurance i n d u s t r y .
Over the
past two years, a f l u r r y of proposed programs has been released.
I t would seem then, t h a t NHI i s j u s t around the corner.
However,
�On NHI '92: Jonas
Page 15
one predicts the passage of National Health Insurance i n the U.S.
at one's p e r i l .
For example, over 15 years ago an observer wrote (Jonas,
1974):
"The United States of America i s the only major country i n
the developed, c a p i t a l i s t world without some form of national
health insurance programme. The struggle for national health
insurance i n the U.S., a long and b i t t e r one, has been well
described. I t now appears as i f there w i l l be some form of
national health insurance l e g i s l a t i o n i n the U.S. before the
Presidential elections of 1976 (emphasis added)."
There wasn't.
In the 1976 Presidential campaign, Candidate Jimmy Carter
said, i n h i s only speech on health policy (The Nation's Health,
1976, p. 7 ) :
" e must have a comprehensive program of national health
W
insurance. . . . The coverage must be universal and
mandatory. We must lower the present barriers, i n insurance
coverage and otherwise, to preventive and primary care and
thus reduce the need for hospitalization. We must have
strong cost and quality controls, and . . . rates. . . should
be s e t i n advance. . . . We must phase i n the program as
rapidly as revenues permit, helping f i r s t those who need
help, and achieving a comprehensive program well defined i n
the end.
His Administration never submitted comprehensive NHI l e g i s l a t i o n
to Congress.
�On NHI
E.
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Page 16
Should Change Come, and I f So, What Kind?
T h i s monograph i s not based on the assumption t h a t
s i g n i f i c a n t w i l l happen anytime soon.
anything
As s e c t i o n s I I and I I below
w i l l show, making changes t h a t w i l l do anything more than
rearrange the flow of d o l l a r s from the u l t i m a t e payors, t h a t i s
the people, to the p r o v i d e r s , the doctors, the other h e a l i n g
p r o f e s s i o n s , and the h e a l t h care i n s t i t u t i o n s , r e q u i r e s making
major changes i n how
the doctors and the h o s p i t a l s i n p a r t i c u l a r
do business and c a r r y on t h e i r p r o f e s s i o n a l work.
Doing anything
l e s s than the l a t t e r i s nothing more than
rearranging the l i f e b o a t s on the deck of the T i t a n i c , before
h i t the iceberg (or i n t h i s case, p o s s i b l y a f t e r ) .
she
But to make
those changes w i l l r e q u i r e a t i t a n i c b a t t l e , indeed.
The
opposition c o n s i s t s of: the insurance industry, some s e c t o r s of
the h o s p i t a l industry, and e s p e c i a l l y s i g n i f i c a n t , l a r g e , although
c e r t a i n l y not a l l ,
s e c t o r s of the medical p r o f e s s i o n (and
standing
behind them, l i t t l e known to the p u b l i c but very powerful indeed,
the medical education
and biomedical
research establishments).
C o l l e c t i v e l y , t h i s opposition i s very powerful and
highly
r e s i s t a n t to s i g n i f i c a n t change.
Now
one can understand why
t h i s i s so, i n each case.
For
example, to make any changes t h a t w i l l get a t the causes of the
major problems i n the h e a l t h care d e l i v e r y system, one must move
to what i s c a l l e d a " s i n g l e payor system."
That i s , t h e r e would
be some s i n g l e n a t i o n a l body (most l i k e l y i n p r a c t i c e
d e c e n t r a l i z e d to the s t a t e s or new
r e g i o n a l a u t h o r i t i e s ) which
pays a l l of the h e a l t h care b i l l s ,
i n whatever form they
are
�On NHI '92: Jonas
presented.
Page 17
The private insurance industry would be e s s e n t i a l l y
put out of business. While physicians would be relieved of almost
a l l paperwork, would have no bad debt to worry about, and would no
longer have any reason to post those "please pay before you leave
the doctor's o f f i c e " signs i n t h e i r waiting rooms, they would lose
some autonomy and for those presently at the upper end of the pay
scale, incomes would go down.
The private hospitals would have to convert from the present
cost-based reimbursement (piece-work of one kind or another)
system, to a global annual budget.
The medical education and
biomedical research establishments would have to become responsive
to public need and, to some extent, public policy direction.
would be a new, and for some, a painful experience.
That
And i n terms
of what the system needs i n order to make i t work right, going to
a single-payor system i s j u s t for openers.
We w i l l also need a major change i n the system's focus from
disease to health, affecting the medical education and biomedical
research establishments in major ways.
dare I say the word, planning.
to l i n k i t to financing.
the system.
Man,
We w i l l need to i n s t i t u t e ,
And to make i t work, we w i l l have
i s that threatening to many inside
But, as I say more than once i n t h i s monograph, i f we
don't change what the system does, along with the way we pay for
services, we might as well not bother doing anything at a l l other
than finding some way to pay for care for the presently uninsured.
To accomplish a l l t h i s requires enormous p o l i t i c a l
skill,
w i l l , and leadership. I t w i l l be a very d i f f i c u l t , and at times
painful, task.
But the President (and i t w i l l take nothing short
�On NHI '92: Jonas
Page 18
of Presidential leadership) who can p u l l i t off successfully w i l l
be well remembered i n the h a l l s of American history for a very
long time.
�On NHI '92: Jonas
Page 19
II.
Problems i n the U.S. Health Care Delivery System
A.
Overview
For a l l of i t s resources, personnel, f a c i l i t i e s ,
skills,
knowledge, money, and a b i l i t y to do wondrous things to and with
the human body, the U.S. health care delivery i s plagued with
problems.
Some observers c a l l the situation a " c r i s i s " (see
Appendix I ) .
Part of the definition of the word " c r i s i s " i s that
there i s a sudden worsening of the situation to which the term i s
being applied.
However, there i s no sudden worsening of the
health of the U.S. health care delivery system.
As shown by the
quote from the Final Report of the Committee on the Costs of
Medical Care from 1932 cited i n Part I above, the problems have
been with us for a very long time.
Thus i t cannot be said that
the health care delivery system i s i n " c r i s i s . "
Rather i t can be
said that i t has serious problems of long-standing,
some of which
are seemingly intractable, many of which are getting (much) worse.
I t i s fascinating that these problems are not of a technical
nature and/or of a s c i e n t i f i c i n a b i l i t y to deal with diseases or
other health d e f i c i t s .
such as AIDS.
(There are a few exceptions to t h i s rule,
But even i n t h i s case only some of the d i f f i c u l t i e s
in controlling i t s spread are traceable to lack of knowledge or
tools.
For example, AIDS transmission among intravenous
recreational mood-altering drug users could be cut sharply i f a)
the drugs of choice of those users were obtainable legally, with
controls against adulteration and/or b) a comprehensive, national
clean needle-exchange program were instituted.
The choice not to
do either i s made on p o l i t i c a l , not medical or epidemiological,
�On NHI '92: Jonas
grounds.)
Page 20
Nor i s the problem one of lack of money, as i t i s i n so
many other countries.
In the U.S., the principal problems are that:
*
We are spending too much, not too l i t t l e .
*
The r i s e i n costs has been uncontrollable by any
interventions t r i e d to date.
*
The distribution of health services i s highly variable
throughout the population.
*
Much that could be done to prevent disease and promote
health using available knowledge and techniques i s not
done.
*
Many health care needs are undermet (e.g., not enough
home health care for the infirm e l d e r l y ) , while others
are overmet (e.g., too many hospital beds).
In short, the problems are not those of lack of resources,
but rather of t h e i r misuse and misallocation.
The problem i s
certainly not lack of money, but how that money i s spent.
Neither
providing more money nor a r t i f i c i a l l y capping the amount of money
spent i s the solution.
the t r i c k .
Nor w i l l simple problem-identification do
Over the years that has been done to a fare-thee-well
(some would say ad nauseum) (see Appendix I I ) .
As i have noted
previously, needed now i s to identify the causes of the misuse and
misallocation of resources, the causes of the overspending with
underwhelming outcomes, address reforms to them (see Section I I I
below).
�On NHI '92: Jonas
B.
Page 21
The Present Situation*
As i s a l l too well known, U.S. health care costs have
continued to r i s e .
I n 1990, (Levit, et a l ) $666 b i l l i o n was spent
for health care, 12.2 percent of the gross national product.
The
corresponding figures for 1960, 1970, and 1980 were $27
b i l l i o n / 5 . 3 % ; $75 billion/7.6%; $248 billion/9.4% (USDHHS, 1984,
p. 137, Table 72).
Despite these expenditures, i t was estimated
that 37 million people
about 15% of a l l Americans, lacked
health insurance coverage of any kind, while 56 million "have
insurance so inadequate that a serious i l l n e s s could throw them
into bankruptcy"
(Bodenheimer).
Health care costs have been r i s i n g faster than the i n f l a t i o n
rate at least since 1960, and the U.S. spends more of i t s GNP on
health services than any other country i n the world.
For many of
the years since 1970, the r i s e i n health care costs exceeded the
r i s e of consumer price index by 100-200 percent (ONCE, Table 13;
USBoC, Table 757).
Since 1985, the former has outstripped the
l a t t e r by a factor ranging from 2.4 to almost 4.
Nevertheless, the United States t r a i l s many of the world's
i n d u s t r i a l nations on such health indicators as l i f e expectancy
and infant mortality rate (USBoC, Table 1440).
In fact i n 1988,
l i f e expectancy i n the United States actually decreased compared
with that i n 1987, the f i r s t time that has occurred since World
War I I (MVSR).
*
This was apparently due to d e f i c i t s i n the
For a more detailed description, see Appendix IV.
�On NHI '92'. Jonas
Page 22
quantity and quality of health services provided to blacks for
diseases which are preventable
at a l ) .
to a s i g n i f i c a n t degree
(Schwartz,
The health of s i g n i f i c a n t portions of the black
population
i n p a r t i c u l a r was declining sharply
(Rosenthal).
Hospital beds, the principal physical resource i n the system,
are geographically maldistributed.
There i s an oversupply of beds
in voluntary and proprietary hospitals i n many parts of the
country and undersupply of beds i n public general hospitals i n
many c i t i e s .
There i s a problem too with physician oversupply i n
certain of the procedure-based s p e c i a l i t i e s , while the onward
march of physician s p e c i a l i z a t i o n continues unabated.
The medical
education system to has been seen as being i n serious d i f f i c u l t y
by by i t s own principal academic society (AAMC, 1984).
For some observers, the possible rationing of health services
was a major concern (Fuchs; Levinsky; Wennberg).
There are
deficiencies i n the quality of medical care, as well as i n the
measures designed to control quality (IOM, 1990).
continuing tendency, p a r t i c u l a r l y among
There i s a
teaching-hospital-based
physicians, to stress the unusual at the expense of the
commonplace, to focus on patients with acute physical problems at
the expense of patients who are chronically i l l or have mental
problems, and to emphasize treatment rather than prevention
(Jonas, 1978).
F i n a l l y , several different public opinion
surveys
done i n the 1980s a l l showed that upwards of 75% of the people
believed that the health care delivery system i s i n need of major
overhaul (Blendon; Blendon & Altman).
�On NHI
Few,
new.
size.
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Page 23
i f any, of these problems of our h e a l t h care system are
Over time they have simply undergone gradual changes i n
Indeed, many of the major problems considered by the
Committee on the Costs of Medical Care (1932) and s t i l l
pressing
today o r i g i n a t e d i n our country and those of our European
forebears i n the seventeenth,
(Freymann, pp. 3-97).
eighteenth, and nineteenth centuries
The problems are not only of longstanding.
They are embedded i n the whole f a b r i c of American s o c i e t y .
As s t a t e d above, we do not, by d e f i n i t i o n , face a " h e a l t h
care c r i s i s . "
however.
This f a c t should not be cause f o r complacency,
As modern medical p r a c t i c e i t s e l f i l l u s t r a t e s , i t i s
o f t e n easier t o deal w i t h a c r i s i s , even a major one, than w i t h
long-standing, chronic problems.
Some consider t h a t a major cause of the problems of the
h e a l t h care d e l i v e r y system i s i t s h i g h l y permissive
p l u r a l i s t i c character.
U.S.
and
The p o l i t i c a l , economic, and s o c i a l
environment created by the Reagan A d m i n i s t r a t i o n i n the 1980s has
only i n t e n s i f i e d them.
A s p e c i a l aspect of i t s ideology has been
t o encourage p r i v a t i z a t i o n of the h e a l t h care system (Salmon).
increasing number of v o l u n t a r y h o s p i t a l s have been bought out by
commercial h o s p i t a l chains.
Voluntary and even p u b l i c h o s p i t a l s
have been turned over t o management by p r i v a t e corporations, i n
the expectation t h a t t h i s w i l l enhance e f f i c i e n c y and
productivity.
Up t o t h i s w r i t i n g , evidence of such e f f e c t s has
not been demonstrated.
An
�On NHI '92: Jonas
Page 24
To stem the tide of r i s i n g medical and hospital costs, major
reliance has been on promoting "competition" i n the health care
delivery system.
However, for competition to be e f f e c t i v e i n
lowering prices and improving quality, the consumer must have some
reasonable knowledge of what he/she i s buying.
he/she must make most of the purchases.
Furthermore,
I n health care, consumers
know v i r t u a l l y nothing about what they are buying, and i t i s the
s e l l e r s , not the consumers, who make the majority of the decisions
about what s h a l l be purchased at which price i n any case.
C
I s NHI in the U.S.'s Future?
"National Health Insurance" (NHI) by i t s very name means
government participation at one or more j u r i s d i c t i o n a l l e v e l s
throughout the country i n the health care financing system.
NHI
proposals have been on the national p o l i t i c a l agenda with more or
l e s s attention paid to them since, as noted above, Teddy Roosevelt
made NHI one of the planks of h i s Bull Moose Party platform i n the
Presidential election of 1912.
(For a brief history of national
health insurance proposals i n the United States, see Appendix I ) .
In the 1980s, under the regressive Reaganite agenda, NHI faded
almost completely from the health care p o l i t i c a l agenda.
As we
enter the 1992 election campaign, i t i s quite obviously
experiencing a r e v i v a l .
One meaning of a l l t h i s i s that more deliberate planning of
the U.S. health care system to improve the quantity and quality of
services and more rational regulation to promote quality and avert
abuse w i l l have to be carried out.
The "free market," so beloved
by Reaganite and other right-wing ideologues, simply does not
�On NHI '92: Jonas
Page 25
operate i n the health care delivery system.
And we have many
years of r i s i n g costs and questionable quality i n certain sectors
of the system to prove i t .
The World Health Organization's goal of "Health For A l l by
the Year 2000" should certainly be attainable i n the United
States.
The heterogeneity and pluralism of the U.S. health
culture w i l l certainly not vanish.
But goals-focused organization
and coordination w i l l be required to achieve harmonious
performance and equity i n the years ahead.
And to introduce
effective planning to the system w i l l require both a plan to do
that and the p o l i t i c a l w i l l to see the process through.
The key
here i s a plan that links planning to the financing and payment
mechanisms.
I n Section IV of t h i s monograph, one such plan i s
presented.
But before we get to plans and planning, we have to consider
what the plans and planning are for. What problems are they
intended to solve?
achieve?
What goals and objectives are they intended to
And to achieve that end, we must consider the causes of
the problems i n the system, especially the problem of r i s i n g
costs.
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I I I . Rising Costs, Costs Containment, and the Patterns of Medical
Practice: Problems, Causes, and Solutions
A.
Introduction
Many words have been written about the problem of r i s i n g
costs.
The question why what we spend provides neither the
world's highest health levels nor coverage for everyone, has been
frequently asked.
Many interventions have been developed i n the
attempt to deal with the problem.
None have been very e f f e c t i v e .
This discussion of the "cost-containment" problem i s from a
perspective somewhat different from the usual one. I t i s based on
the following premises:
1.
The reason the various interventions have generally
f a i l e d i s that they have addressed the substantive (as
contrasted with the formalistic) causes of the problem.
(The word "substantive" i n t h i s context concerns who i s
doing what to whom, i n what p l a c e ( s ) , focusing on which
health/disease problems, at what cost, the money being
paid out i n what way, and what health/disease problems
are not being dealt with and why. "Formalistic"
solutions include fee schedules, payment caps, and
reimbursement formulas.)
2.
Nothing effective can be done i n cost-containment u n t i l
the substantive causes of the problem of r i s i n g costs
are identified and addressed.
3.
I t i s unlikely that the substantive causes of everr i s i n g costs can be effectively addressed i n the absence
of comprehensive health care delivery system reform.
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which also addresses the other major problems of the
system.
B.
Previous Attempts to Control Costs
Many of the attempts at cost containment have focused simply
on the dollars paid i n ; that i s they have been "supply-side
11
approaches:
*
Freezing a l l health care prices.
the Nixon Presidency.
(This occurred during
Prices exploded after the freeze
was l i f t e d . )
*
Capping hospital expenditures on a voluntary basis.
(This occurred during the Carter Presidency a f t e r the
President had t r i e d and f a i l e d to get Congress to pass a
mandatory cap.
One can imagine how well that approach
worked.)
*
Changing from an unit-of-care payment system (per diem
rates) for hospitals to an episode-of-care system
(DRGs).
(This change occurred during the Reagan
Presidency.
The gap between the health care cost and
the overall i n f l a t i o n rates has never been higher.)
As a l l non-substantive and supply-side analyses do, i n
whatever context, these attempts assumed i t i s simply the amount
of dollars flowing i n that determines prices.
c e r t a i n l y not the case.
This i s almost
The alternative i s to begin with an
analysis of the system's substantive problems.
This approach i s
based on the concept that i t i s what the system does and does not
do to and for patients, and others, that i s the major driver of
costs, not simply how many dollars are paid into i t .
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The Problem L i s t , Revisited and Updated
I t i s both depressing and instructive to observe that, as
noted previously, the United States i s not much further along in
dealing with i t s health care delivery system problems than i t was
in 1932.
Unfortunately, the terms of the opening of the F i n a l
Report of the Committee on the Costs of Medical Care (1932) s t i l l
apply.
To bring the CCMC's l i s t up to date, almost 60 years
l a t e r , one need only add:
1.
Costs are astronomical and routinely outstrip the
general i n f l a t i o n rate.
2.
Nowhere near what could be done in health
promotion/disease prevention i s done.
3.
Medical manpower i s poorly distributed by specialty and
geography; there i s an i n e f f i c i e n t , i n e f f e c t i v e
distribution of labor between the several health
professions/occupations.
4.
I n s t i t u t i o n a l care i s neither organized nor used i n an
effective manner.
5.
The high-tech t a i l i s wagging the health care dog.
6.
The deficiencies in primary care, already i d e n t i f i e d i n
the CCMC era when 90% of physicians were general
practitioners (AAMC, 1932, pp. 23-24, 114-119), have
worsened s i g n i f i c a n t l y .
7.
Deficiencies in doctor-patient communication are
s i g n i f i c a n t and a major concern of patients.
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In the late 1980s, there were many proposals on the table
intending to "do something" about solving the problems, from such
disparate groups as: the American Medical Association (1990), the
Committee on Labor and Human Resources of Senator Edward Kennedy
(1988, pp. 3-4), the Committee for National Health Insurance
(1989, pp. 1-3), the Heritage Foundation
(Butler and Hailsmaier,
pp. v - v i ) , the National Association of Manufacturers
(1989, pp. 1-
3), the National Leadership Commission on Health Care (1989, pp. 123),
and the O i l , Chemical and Atomic Workers (1989, pp. 1-5).
The problem l i s t s found i n each of these documents are
familiar. And i t i s interesting to note that, allowing for some
differences i n emphasis related to the background and
political/economic interests of t h e i r authors, the l i s t s are
remarkably similar to each other.
But not only are these reports
similar i n t h e i r problem-lists. They are also s i m i l a r i n what
they generally do and do not do, once having assembled the probleml i s t s : they do not engage i n very much, i f any, causal analysis.
They do not deal with the substance of the system and i t s
problems.
origins?
Why do we have these problems?
What are t h e i r
Why have we not been able to solve them i n 60 years?
What i s i t , within the system, that drives costs ever higher?
Just what does the system do and not do, to and for patients?
in the system i s doing what and why?
Who
How do those a c t i v i t i e s
contribute to and/or ameliorate the identified problems?
For example, what i s the role of the emphasis on hospitalbased acute care i n driving costs higher?
Could a major increase
in the provision of health promotion/disease
prevention services
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in the ambulatory setting not only improve health but also save
money?
I f yes, what has to be done substantively, i n the system,
to achieve that goal?
Where does the resistance to change l i e ?
Why do those who r e s i s t change r e s i s t change?
What could be done
to overcome the resistance?
D.
Form and Substance
F a i l i n g to undertake substantive analysis, each organization
above has come up with some formalistic solutions for dealing with
the problems on t h e i r l i s t .
Subscribed to by one or more of these
organizations are: expand Medicare, eliminate Medicare, expand
Medicaid, eliminate Medicaid, require a l l employers to cover t h e i r
workers, substitute comprehensive coverage for the t o t a l
population for employment-based coverage, expand catastrophic
coverage, expand long-term care coverage, set up some kind of
national health service, establish a single (monopsony) payor
system, maintain a multiple payor system, e s t a b l i s h fee schedules,
eliminate deductibles and co-insurance, expand deductibles and coinsurance, cap hospital reimbursement, expand DRGs, eliminate
DRGs, set up global budgets, separate c a p i t a l construction
budgets, create consumer-generated competition,
generated competition,
create provider-
eliminate tax-deductibility for employer-
paid health insurance premiums, strengthen planning mechanisms,
eliminate any vestiges of health systems planning, and so on.
As can be seen, most of these recommendations deal with
structural, formalistic, matters, not substantive ones.
Further,
most of them have l i t t l e relationship to i d e n t i f i a b l e causes of
the identified problems.
And many of those problems have a direct
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bearing on r i s i n g costs.
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For example, i t i s not Medicare per se
that drives costs upward, but how the Medicare benefit package
(which favors acute hospital care), and the physician payment
method (which u n t i l the mid-1980s paid "usual and customary
fees,") influenced the substance of the system: the type, quantity
and cost of the care delivered.
Furthermore, i t should by now be
clear that i t i s impossible to deal e f f e c t i v e l y with the problem
of r i s i n g costs without dealing with the other major problems on
the l i s t as well.
That exercise involves some pain.
I t requires examining an
i n s t i t u t i o n that many feel uncomfortable or intimidated i n
examining, for personal, psychological, and p o l i t i c a l reasons.
That exercise, looking for substantive causes, requires looking at
the structure and function of the medical profession.
D.
Examining Causes
I f our car i s n ' t running right we don't usually deal with
that problem by simply examining the design of the body and
evaluating the comfort of the seats.
i s l i k e l y to be: the engine.
We go to where the trouble
I f i t i s necessary to f i x the engine
to make the car run properly, that must be done, whether the task
i s hard or easy. Otherwise, the car w i l l continue to not run
right.
For better or worse, the engine of the U.S. health care
delivery system i s the medical profession.
Health care system
problem-solvers must turn their attention to i t , i f the changes
they make are to be effective.
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1.
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Current Examinations: Scratching the Surface
Let us look more closely at a standard problem-list, with the
customarily proposed solutions for each element.
Following the
common U.S. predilection, when they are assigned a t a l l , both the
attributed causes and suggested solutions are of the f o r m a l i s t i c
type.
And so:
a.
Problem: continually r i s i n g costs.
Formalistic cause:
continually expanding money supply coming into the
system.
b.
Solution: c u r t a i l the money supply.
Problem: inequity; the undersupply of health care to
certain Americans due to the presence of f i n a n c i a l
barriers to care.
fairness."
Formalistic cause: a "lack of
Solution: create fairness by providing
access for everyone to the present system of medical
care.
c.
Problem: deficiencies i n the quality of care.
Formalistic cause: the system for assuring quality
leaves much to be desired.
Solution: make the quality-
assurance system better.
d.
Problem: the oversupply of care i n some cases.
Formalistic cause: inadequate " u t i l i z a t i o n controls."
Solution: improve u t i l i z a t i o n controls.
e.
Problem: the ever-increasing focus on acute-care,
tech medicine.
high-
(This produces the ever-increasing focus
on the high-tech preservation of f r a g i l e b i o l o g i c a l l i f e
at both ends of the age-range.
This focus gives l i t t l e
consideration to quality of l i f e factors, or investment
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in methods which could improve the quality of l i f e
without expensive high-tech interventions.)
cause: the "technological imperative."
Formalistic
Solution: there
i s no solution; t h i s i s a problem we j u s t have to learn
to l i v e with (Ginzberg).
f.
Problem: the mal-organization of the health care
i n s t i t u t i o n a l sector.
Formalistic cause: either poor
planning, or the absence of effective free-market
mechanisms.
Solution: either f i x up the planning system
or l e t the free-market r i p .
g.
Problem: primary care i s deficient.
Formalistic cause:
not enough financial support for primary care training
in medicine.
Solution: provide some additional funds
for primary care training.
Alternatively, specify a
certain number of publicly funded residency training
s l o t s for primary care.
h.
Problem: the continued presence of the "preventable
physical pain and mental anguish" referred to by the
1932 Committee on the Costs of Medical Care.
(Since we
know so much more about prevention than we used to t h i s
problem has intensified over the years.
For example, we
know how to prevent or diminish the occurrence/impact
of:
unwanted pregnancies, abortion, low birth-weight
babies, prematurity, [and thus mental retardation], and
at the other end of the age range, heart disease,
certain cancers, chronic lung disease, stroke,
hypertension, debilitation/low-quality long l i f e , and i n
�/
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between, sexually transmitted disease, intentional and
unintentional personal injury d i s a b i l i t y and death,
among other diseases and conditions [USPHS, 1990].)
Formalistic cause: most policy makers pay l i t t l e
attention to t h i s one.
Those who do usually r e f e r to
lack of reimbursement for preventive services as the
principal cause of the problem (Davis, e t a l ) .
This
leads to the conclusion that the provision of
reimbursement i s the solution.
1.
Problem: doctor-patient communication i s d e f i c i e n t .
Formalistic cause: as for the d e f i c i t s i n prevention,
most policy makers pay l i t t l e attention to t h i s one.
And as with prevention, those who do usually refer to
lack of reimbursement for effective communication, and
recommend provision of such payment as the solution.
2.
Delving Deeper
Some of the proposed solutions have been t r i e d , without much
success.
For example at one time or another we have: c u r t a i l e d
the
money supply, expanded coverage, contracted coverage, changed
the
reimbursement system, t r i e d to check up better on quality,
controlled u t i l i z a t i o n , planned or not planned.
Why do these
formalistic solutions, so reasonable-seeming on paper, not work?
Perhaps because, to borrow a phrase from the medical
s c i e n t i s t / w r i t e r Lewis Thomas, they are "half-way technologies."
They don't get at the substantive causes of the problems.
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3.
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The Medical Profession: the Engine of the System
The medical profession i s at the center of the health care
delivery system, whether that i s a desirable state of a f f a i r s or
not.
I t i s the system's engine.
Furthermore, to extend the
analogy, i t i s an engine which happens to have much control over
the car's steering wheel.
cannot go anywhere.
Without the profession the system
And, when the system does go, the direction
that i t takes i s largely determined by the engine, not the owner
of the vehicle, which happens to be the people of the United
States.
There are four principal reasons accounting for the
c e n t r a l i t y of the medical profession to the structure and function
of the health care delivery system (Jonas, 1988).
F i r s t , the
medical licensing system gives physicians control over the present
central c l i n i c a l functions of the health care delivery system:
making diagnoses, performing surgery, and prescribing medications
from a r e s t r i c t e d l i s t .
Second, because of the special nature of
the health care market, physicians are the primary determinants of
about two thirds of the system's expenditures (Dyckman; Fuchs and
Kramer).
Third, among a l l health care providers, i t i s physicians
who have the highest level of training i n biomedical science,
which provides the s c i e n t i f i c basis for most health services.
Fourth, for many people, the physician s t i l l has the role of
healer, which for some assumes mystical proportions.
The view that the medical profession i s central to the system
and bears major responsibility for some of i t s major problems i s
supported by Dr. Leighton Cluff, former President of the Robert
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Wood Johnson Foundation.
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I n an a r t i c l e e n t i t l e d "A Challenge to
America's Physicians" which appeared i n the Foundation's 1989
Annual Report, Dr. Cluff considered t h i s issue a t some length
(1989) .
"[P]hysicians i n 1990 have a choice: either help address the
problems facing the nation's health care system, or r e j e c t
t h i s obligation and l e t others make the attempt . . . . [T]he
twin obligations of medicine to serve individuals and society
have drifted apart. Some way must be found to make these
issues concordant. The issues seem obvious enough to
everyone else: at the community, state, regional and national
l e v e l s , people are alarmed. Too many physicians, i t seems,
are fiddling t h e i r familiar tune while the e d i f i c e s of
medicine are set ablaze by
outsiders. . . .
"There are no simple or easy solutions to the problems
outlined e a r l i e r , and physicians cannot resolve them alone.
S t i l l , appropriate action that protects the best of what the
nation has i n personal medical care cannot occur without the
c o l l e c t i v e involvement of physicians. For example:
"*
Physician choices about how they practice medicine
account for a majority of health care expenditures and
contribute s i g n i f i c a n t l y to r i s i n g health care costs;
»*
The increasing number of highly specialized physicians
and medical services i n suburban settings, contrasted
with the u n a v a i l a b i l i t y of personal medical services i n
many rural and inner-city areas, depends very much on
physicians' personal and career choices;
"*
Unnecessary duplication of medical services i n hospitals
and by physicians i n communities and regions i s
s i g n i f i c a n t l y influenced by doctors;
H*
The fragmentation of medical services
which often
requires patients to become t h e i r own diagnosticians and
to seek care from multiple, non-integrated providers
could be largely remedied by physician leadership;
"*
D i s p a r i t i e s i n the use of technology and medical
procedures between regions and hospitals can be
addressed by physicians enlarging t h e i r concentration on
the care of individuals to include the impact of how
t h e i r actions affect the community;
11
Inequity i n access to personal medical services,
although i t has many roots and although many physicians
conscientiously try to provide services to people i n
*
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need, has not been addressed adequately by physicians as
a group; and
"*
The nation's health care problems are changing: the r i s e
in chronic health problems and AIDS, the demands of
alcohol and drug abuse, the problems of mental i l l n e s s ,
the t o l l of violence
a l l c a l l for physicians to take
the forefront i n amelioration e f f o r t s . "
I t i s c l e a r from t h i s analysis that i f we are to correct the
defects of the system, we must determine what's wrong with the
engine.
go.
We must find out why
i t doesn't take us where we want to
We must be prepared to repair i t and/or even to change i t s
design,
(hopefully in a way that w i l l maintain professional
control of professional functioning).
Dr. Cluff makes the point
that i f the medical profession does not do a better of job of
steering, some outside agency i s going to come along and take
control of that function completely.
This analysis i s of course a metaphor for saying that to find
the causes of many, although c e r t a i n l y not a l l , of the problems of
the health care delivery system, we must look at the medical
profession and how
we w i l l be able to
i t functions.
Once we do that causal analysis
make substantive rather than formalistic
changes in the system, thus seriously addressing the problems.
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The Problem L i s t Revisited
As a f i r s t approximation of that a n a l y t i c a l e f f o r t , l e t us
return to the l i s t of problems, supposed causes, and recommended
solutions presented above.
Then, putting the understanding of the
physician as the engine of the system into the analysis, l e t us
consider some different action recommendations that might be made
for each stated problem.
a.
Problem: continually r i s i n g costs.
Usually-given
cause:
continually expanding money supply coming into the
system.
Usually-proposed solution: c u r t a i l the money
supply.
Medical practice-based
cause: piece-work (fee-for-
service) system for paying physicians with resultant
high income possibilities/expectations.
Alternative
solution: gradually change that system to the one used
for the majority of health care workers
b.
salary.
Problem: inequity; the undersupply of health care to
certain Americans due to the presence of f i n a n c i a l
barriers to care.
fairness."
Usually-given
cause: a "lack of
Usually-proposed solution: create fairness
by i n one way or another providing access for everyone
to the present system of medical care.
Medical practice-based
cause: f i n a n c i a l b a r r i e r s
are created at least i n part by the private
entrepreneurial nature of much medical practice.
Alternative solution: gradually phase out that system.
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Problem: deficiencies i n the quality of care.
Formalistic cause: the system for assuring quality
leaves much to be desired.
Solution: make the quality-
assurance system better.
Medical practice-based cause: physicians are not
trained to keep e f f e c t i v e track of the quality of t h e i r
own care.
Neither are they trained to work c o l l e g i a l l y
to maintain uniformly standards of practice within the
group.
Alternative solution: change the training for
and practice of quality assurance.
d.
Problem: the oversupply of care in some cases.
Usually-
given cause: inadequate " u t i l i z a t i o n controls."
Usually-
proposed solution: improve u t i l i z a t i o n controls.
Medical practice-based cause: To a s i g n i f i c a n t
extent, private-practicing physicians create t h e i r
own
demand (Eisenberg; Fuchs and Hahn; Hillman, et a l ;
Leape, et a l ) .
They offer a product of which patients
have l i t t l e knowledge (nor do most of them want to
acquire i t , even i f they could). Because of the piecework system of payment, physicians have every incentive
to create t h e i r own demand. Alternative solution: as
above, gradually phase out the piece-work system of
payment.
e.
Problem: the ever-increasing focus on acute-care,
tech medicine.
high-
(This produces the ever-increasing focus
on high-tech preservation of f r a g i l e biological l i f e at
both ends of the age-range.
This focus gives l i t t l e
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consideration to quality of l i f e factors, or investment
in methods which could improve the quality of l i f e
without expensive high-tech interventions.)
Usually-
given cause: the "technological imperative." Usuallyproposed solution: there i s none; t h i s i s a problem we
j u s t have to learn to l i v e with (Ginzberg). Medical
practice-based cause: rather than being an "imperative,"
(implying that i t somehow has a l i f e of i t s own),
galloping high-tech medicine has been created by a
combination of perfectly controllable research, e t h i c a l ,
medical education funding, tax, and reimbursement
policies.
These have had a major influence on medical
practice.
Alternative solution: change these p o l i c i e s ,
to stress health promotion, disease and harmful
condition prevention, the analysis of cost-benefit and
ethical considerations before high-tech research and
development i s undertaken, and the rational planning of
the distribution and use of high-tech services,
f.
Problem: the mal-organization of the health care
i n s t i t u t i o n a l sector.
Usually-given cause: either poor
planning or the absence of effective free-market
influences.
Usually-proposed solution: f i x up the
planning system or l e t the free-market r i p .
Medical practice-based cause: not a major factor i n
t h i s one, although the overwhelming acute-care
bias/emphasis of medical education c e r t a i n l y feeds into
it.
(Further, many physicians invariably have a gut-
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l e v e l , negative response whenever the word "planning" i s
mentioned i n connection with the health care delivery
system.)
education.
Alternative solution: re-orient medical
(But i t i s surely true that i f proactive not
reactive, i n s t i t u t i o n a l planning with a separation of
i n s t i t u t i o n a l capital formation from service
reimbursement i s not introduced into the system t h i s
problem i s insoluble.)
g.
Problem: the deficiencies i n primary care.
Usually-
given cause: not enough financial support for primary
care training i n medicine.
Usually-proposed solution:
provide some additional funds for primary care
training.
Alternatively, specify a certain number of
publicly funded residency training s l o t s for primary
care.
Medical practice-based
cause ( p a r t i a l ) : an
undergraduate and graduate medical education system that
emphasizes the specialty approach to medicine, not only
in i t s c l i n i c a l but also i n i t s discipline-based basic
science teaching.
Alternative solution: introduce
integrated, problem-based learning for the basic
sciences and emphasize the practice of medicine, not the
diagnosis of organ-based disease, at l e a s t i n the
undergraduate c l i n i c a l years (AAMC, 1984).
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h.
Page 42
Problem: the continued presence of "preventable physical
pain and mental anguish."
Usually-given cause: lack of
reimbursement for preventive services.
Usually-proposed
solution: provision of reimbursement.
Medical practice-based cause: the lack of training
in health promotion/disease prevention.
I f a physician
doesn't know how to do i t , and no interest i n i t has
been generated i n the course of t h e i r training and
experience, he/she i s n ' t going to do i t , or c e r t a i n l y i s
not going to do i t correctly, whether i t ' s paid for or
not.
Alternative solution: change medical education to
feature, i f not emphasize, health promotion/disease
prevention (Jonas, 1978, 1988).
i.
Problem: deficiencies i n doctor-patient communication.
Usually-given cause: lack of reimbursement for e f f e c t i v e
communication.
Medical practice-based cause: s i m i l a r to that for
health promotion/disease prevention: lack of training i n
effective doctor-patient communication.
Alternative
solution: change medical education to teach and
emphasize the importance of patient communication s k i l l s
in a l l spheres of medical practice (AAMC, 1984) .
E.
Obstacles to Making Effective Change
I f t h i s analysis i s correct, making change means taking on
two of the most powerful institutions i n the United States:
organized medicine and the possibly even more powerful medical
education establishment.
(Whether or not the l a t t e r i s more
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Page 43
powerful than the former, i t i s certainly much l e s s i n the public
awareness.
I t s influence on and responsibility for the defects i n
medical practice, as well as i t s great achievements, are poorly
understood by the general public, most p o l i t i c a l leaders, and most
of the medical education leadership i t s e l f .
This may make i t and
i t s i n e r t i a even more d i f f i c u l t to change than that of organized
medicine.)
This i s a d i f f i c u l t and daunting task to say the
least.
Neither of the American Presidents who had even a notion to
take on the medical profession were successful.
both strong men.
And they were
Franklin Roosevelt, l i k e h i s cousin Teddy i n h i s
Bull Moose configuration before him, wanted national health
insurance.
But when the AMA threatened to sink Social Security
(an interesting moral choice for the representatives of a healing
profession) i f he did not eliminate NHI from the package,
Roosevelt acquiesced before i t s strength. Even i n a seemingly
favorable post-war climate, Harry Truman went down to defeat on
the NHI issue.
I f and when the struggle to change the nature of the practice
of medicine does occur, those who lead i t are sure to be accused
of "doctor-bashing."
This charge can be dismissed for what i t i s :
a p o l i t i c a l t a c t i c designed to put the reformers on the defensive
and divert attention from the real problems at hand.
But beyond
that response, i n r e a l i t y the kind of analysis engaged i n here i s
not "doctor-bashing" i n terms of individuals.
Nothing i s being
blamed on particular medical practitioners or particular medical
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educators.
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The problems are with the systems of payment and
education, not with e v i l or malign people.
A l l physicians get caught up i n health care delivery system
problems i n one way or another.
moral one.
However, the argument i s not a
I t i s not about right and wrong.
"fairness" and "equity."
I t i s n ' t even about
As Dr. Robert M. Sade i s fond of
pointing out (1989), what one man considers f a i r another may
consider quite unfair.
Rather the argument i s t r u l y about what
works and what doesn't work, for the health and the pocketbook of
the people of the United States.
F.
Patterns of Medical Practice, Health Promotion and National
Health Insurance
The January 5 and 12, 1989, issues of The New England Journal
of Medicine carried an e d i t o r i a l and three a r t i c l e s on NHI
(Enthoven and Kronick; Himmelsteln and Woolhandler; Relman).
The
principal focus of both the "National Health Program for the
United States" (Himmelsteln and Woolhandler) (NHP), developed by
the organization Physicians for a National Health Program, and the
"Consumer-Choice
Health Plan for the 1990s" (Consumer-Choice),
submitted by Enthoven and Kronick, i s the same: paying for the
care of the presently uninsured and controlling r i s i n g health care
costs.
While the two plans present different ways of achieving
t h e i r objectives, i f implemented neither would lead to any major
changes i n the content or functions of American medicine.
In the
main, they would each simply pay for the health care products we
are now buying in a more equitable and possibly more e f f i c i e n t
way.
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Both proposals recognize the existence of some other health
care delivery problems, such as: geographic maldistribution of
f a c i l i t i e s and personnel, the i n e f f i c i e n c i e s and bureaucratic
waste of the present reimbursement system, uncontrolled
technocracy i n medicine, and the disorientations caused by fee-forservice payment.
However, neither proposal deals substantively
with any of these problems.
Neither proposal d i r e c t l y addresses other health care system
service problems that are also important: developing a rational
biomedical research policy, improving and assuring quality of
care, creating a rational system for health manpower supply and
use, the disjunction between health sciences education and the
roles/functions of health care providers.
Both proposals would
deal with these problems on the side, with advisory boards,
suggestions,
recommendations, and exhortation.
I t should be noted that a l l of these problems whether
addressed by the new proposals or not, are organizational i n
nature.
However, as I have noted more than once, there are also
many problems arising from the defects i n the functioning of the
health care delivery system i n relation to health.
There i s a
s i g n i f i c a n t burden of morbidity and mortality borne by our people,
from, for example, heart disease, cancer, stroke, and personal
injury, that i s preventable
(MVSR; Rosenthal; Schwartz, et a l ) .
And there i s the l e s s than optimal level of wellness which i s
c h a r a c t e r i s t i c of so many members of our society.
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At the most, the proposals mention only i n passing the
importance of health promotion/disease
dealing with these problems.
prevention services i n
Neither proposes the creation of
mechanisms i n the health services financing system which could be
used to effect the radical changes i n the content and function of
the health care delivery system that are necessary i f e f f e c t i v e
health promotion i s to become a r e a l i t y i n the United States. That
t h i s defect i s present should not come as a surprise, however.
No
major national health insurance proposal receiving s i g n i f i c a n t
attention ever began with a focus on health, even though that word
i s the proposal's middle name.
In t h i s country, we spend enormous sums on health ( r e a l l y
medical) services, l i t t l e on health.
This i s true even though
preventable or modifiable r i s k factors for many of the leading
k i l l e r s and causers of i l l n e s s are well-understood
(USPHS, 1990).
Our knowledge of how to effectively intervene with primary or
secondary preventive measures i s improving a l l the time.
I t could
improve at a much more rapid rate i f adequate funds were allocated
to the necessary research and development.
But even given our
existing knowledge and s k i l l s i n health promotion we do but a
fraction of what we could do for health.
Our f a i l u r e to f u l l y tap the potential of health promotion
should come as no surprise.
The present U.S. health care system
i s simply not designed to carry out those functions on any great
scale.
I t does not have the personnel, f a c i l i t i e s , or financing
mechanisms required to meet the need for these services.
most importantly, the "mind-set" i s not there.
Perhaps
The whole system,
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with physicians at i t s center, i s disease-oriented (Jonas, 1978) .
I t focuses on trying to help people when they get sick, not on
trying to help them not to get sick.
A very important influence on the structure and function of
any system i s how
i t i s paid and what i t i s paid to do.
I f in
medical practice s i g n i f i c a n t sums were offered and paid for health
promotion, i t would be done.
I f the standards of such care were
set at an appropriate l e v e l , high quality health promotion
programs would be provided.
At the core of both the National Health Program and Consumer
Choice, as well as most of the other contemporary NHI
proposals,
are systems for routing more equitably the money presently passed
from payors to providers for health services. But i f we are going
to make major changes in the organization of and financing
mechanisms for health services, should we simply get more of the
same old product, even i f i t i s more equitably distributed?
Should we not change the product too, to meet evident needs?
I f the nation's health i s to be improved, health must be put
f i r s t on the agenda.
We must buy health service as well as
disease service. We must provide the necessary funds and we must
e x p l i c i t l y plan for the necessary services. We must do something
that we have never done in t h i s country: l i n k planning for and
financing of health services. To put health in national health
insurance we must design and implement a system which w i l l
e x p l i c i t l y permit us to do i t .
This i s a major goal of the
program design outlined in the next section.
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IV.
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National Insurance for Health: the Personal Health Care
System
A.
The Contract Mechanism
As I have said more than once i n t h i s text, i f problems are
to be successfully solved, t h e i r causes must be i d e n t i f i e d .
Proposed solutions, then, should address problem causes. The
solutions themselves should be couched i n terms of c l e a r goals and
objectives, as i s done i n the Executive Summary and Part V of t h i s
monograph.
A c l a s s i c a l approach to the achievement of stated goals and
objectives i s the contract mechanism.
The buyer and s e l l e r of a
product agree on product or service specifications and costs,
written i n the contract.
enforcement of i t s terms.
The contract usually contains means of
A small scale, p a r t i a l prototype of
such an approach to the financing, planning, and evaluation of
health services existed i n New York City during the 1970s (Jonas,
1977), known colloquially as "ghetto medicine."
Based on t h i s experience, an "NHI by Contract" proposal was
developed (Jonas, 1981, 1984).
More recently i t has been c a l l e d
the Personal Health Care System (PHCS).
I n s t i t u t i n g a contracting
system rather than a reimbursement system s h i f t s the primary focus
from meeting the providers' financial needs to establishing systemwide health and health services goals. As of 1991, the PHCS had
yet to be put into l e g i s l a t i v e language.
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The Personal Health Care System
Under "NHI by c o n t r a c t , " the PHCS, the Federal government
would be responsible f o r r a i s i n g the funds, from a combination of
employer/employee c o n t r i b u t i o n s , special and general tax revenues,
and d i r e c t user fees where appropriate, (as under the National
Health Program).
The funds would be a l l o t t e d by s t a t e or region
based on past experience and f u t u r e p r o j e c t i o n s .
Contract s p e c i f i c a t i o n s would be developed through a
cooperative e f f o r t of the payor/planners, the p r o v i d e r s ,
consumer representatives.
and
Contracts would be negotiated between
the payor agents and the providers.
The agents could be s t a t e or
l o c a l governments, or new r e g i o n a l h e a l t h a u t h o r i t i e s , or the
e x i s t i n g h e a l t h insurance companies.
The agents would then
negotiate a series of contracts w i t h providers.
The l a t t e r would agree t o o f f e r a set of services t o the
population f o r a given d o l l a r amount.
Most e x i s t i n g p r o v i d e r s ,
whether i n s t i t u t i o n a l or i n d i v i d u a l , would be e l i g i b l e t o become
e i t h e r primary contractors or subcontractors.
I n t h i s , NHI
by
c o n t r a c t has much i n common w i t h the Health Care Corporation
concept of the mid 1970s, an American Hospital Association plan.
A l l h e a l t h care providers would be e l i g i b l e t o b i d on the
contracts.
Most geographic areas would have two or more a c t i v e
c o n t r a c t o r s , thus c r e a t i n g competition (as under Consumer Choice),
and p r o v i d i n g people w i t h a choice f o r care.
Persons would have
t o s e l e c t a c o n t r a c t o r f o r some minimum time period, but would be
allowed t o change provider p e r i o d i c a l l y .
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The c o n t r a c t i n g providers would be paid through some
combination o f lump sum and c a p i t a t i o n . Fee-for-service would not
be used by t h e c o n t r a c t i n g agency, b u t c o n t r a c t o r s could pay t h e i r
providers on a f e e - f o r - s e r v i c e basis i f they wished t o .
Contract
enforcement would be c a r r i e d out by t h e c o n t r a c t i n g agencies
assisted by consumer boards.
They would focus on t h e achievement
of t h e stated contract goals and o b j e c t i v e s , not on
administrative/process
issues.
The composition o f t h e service packages would be determined
by h e a l t h planning mechanisms.
There would be f r e e competition
among t h e providers f o r t h e c o n t r a c t s , w i t h bidders o f f e r i n g t o
provide the s p e c i f i e d services a t varying p r i c e s .
c o n t r a c t o r s would be paid on a g l o b a l budget basis.
Primary
Much as group
p r a c t i c e and independent p r a c t i c e a s s o c i a t i o n h e a l t h maintenance
organizations do now, a l l c o n t r a c t o r s would then market t h e i r
services t o consumers.
A l l persons would be covered by a b e n e f i t package t h a t would
be determined n a t i o n a l l y . Consumers would have f r e e choice o f
c o n t r a c t o r . But once having made t h e i r choice, as i n present dual
choice s i t u a t i o n s , p a t i e n t s would have t o stay w i t h t h e selected
provider f o r a minimum period of time.
Advisory boards c o n s i s t i n g
of p a t i e n t s served by each c o n t r a c t o r would be formed.
The
consumer r o l e would focus on t h e evaluation o f outcomes, t h a t i s ,
the extent t o which contractors met t h e i r c o n t r a c t
specifications.
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The boards would be party to contract negotiation and
enforcement.
There would be graded financial penalties for
f a i l u r e to meet contract specifications, and rewards for excellent
performance.
Private ownership of the health services sector,
including private medical practice, would be maintained.
But the
people, through both the government and the advisory boards, would
have a strong voice i n deciding how t h e i r money would be spent.
Government would have three principal roles: r a i s e r of funds,
negotiator of contracts, and enforcer of contracts i n concert with
the advisory boards.
Government r e s p o n s i b i l i t i e s would be
distributed among the national, state, and local j u r i s d i c t i o n s .
The system would be supported by a combination of employer/employee contributions and general tax revenues.
Technology
assessment, carried out at the Federal l e v e l , would provide
important data for health planning and p r i o r i t y setting.
Insurance companies could be used as f i s c a l intermediaries.
I t i s the requirement to develop stated contract goals and
objectives that links planning and financing, that places the
focus of the system on service content, not service payment, that
provides the opportunity to change the focus of the health care
delivery system to health.
Further, contract specifications could
be used to emphasize primary and ambulatory care, improve quality
of care, control provider-initiated u t i l i z a t i o n , r a t i o n a l i z e the
d i v i s i o n of labor and the geographic distribution of services,
control the use of new technologies, develop service-oriented
education and research p o l i c i e s , and control capital formation.
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The Advantages of the PHCS
NHI-by-contract provides the opportunity to deal d i r e c t l y
with most of the principal problems presently facing the U.S.
health care delivery system, including cost control; quality
improvement; implementing a comprehensive health promotion and
disease prevention program; introducing r a t i o n a l i t y into the
planning, development, and use of personnel and physical
resources; and achieving equity of access.
focusing of effort and payment.
I t enables the direct
A f a i r degree of fine tuning can
be accomplished.
The Personal Health Care System i s goal-oriented.
It is
regulatory, but i t s regulations focus on health care needs and
program outcomes, as did the health-planning
the l a s t days of the Carter Administration
implemented.
guidelines issued i n
(USPHS, 1980) but never
I t would assure equity while providing a c l e a r
mechanism for focussing the Health Care Delivery System on
health.
There are certainly other ways of achieving t h i s goal.
But whatever mechanism one might espouse, i t i s important for
those concerned with health to make t h e i r voices heard as the
l a t e s t edition of the 80 year-old debate on national health
insurance
continues.
The PHCS leaves behind the present reliance on regulation and
prayer to achieve program goals and objectives.
I t does not begin
with benefit packages and decisions on co-payment, which so many
other approaches to NHI do. Rather i t s t a r t s with the
establishment
of planning principles.
I t assumes that benefit
packages w i l l be developed and decisions on co-payment made after
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needs are assessed, goals and objectives are set, and the amount
of available funds i s determined.
Then the contract
specifications w i l l be written, balancing needs, p r i o r i t i e s , and
available funds.
In summary, the PHCS would:
1.
Maintain the present pattern of ownership of health
facilities.
2.
Probably but not necessarily change the employment
patterns of personnel presently engaged i n fee for
service practice.
3.
Provide for the continued existence of the insurance
companies i n reduced s i z e .
4.
Place government at arms's length from the direct
operation of health services.
5.
Provide a s i g n i f i c a n t role for consumers of services i n
t h e i r evaluation, by outcomes.
The system would probably be quite cumbersome, e s p e c i a l l y for
the f i r s t few years.
Negotiations would be extremely complex.
Long lead times, to which few Americans are accustomed, would be
required for t h e i r conclusion.
The providers would be called upon
to make functional and psychological changes, although not of the
same magnitude as would be required under the national health
service approach.
Behavioral change would be required among
patients as well, although experience with HMOs indicates that
patient behavioral change would come more e a s i l y than provider
behavioral change.
From the perspective of most patients, the
PHCS would look a great deal l i k e a v a s t l y expanded H O system.
M
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There would be a large pool o f s t a f f i n t h e h e a l t h insurance
i n d u s t r y t h a t would have t o be l a i d o f f or reassigned as
i n d i v i d u a l claims processing became a t h i n g o f t h e past.
However,
there would be many new p o s i t i o n s i n n e g o t i a t i n g bodies a t many
l e v e l s and i n inspectorates.
Of course there i s no guarantee t h a t any o f t h i s would
happen.
But t h e p o t e n t i a l f o r s i g n i f i c a n t change would be there
without government ownership or d i r e c t r e g u l a t i o n o f t h e
a d m i n i s t r a t i v e process.
The p o t e n t i a l would be much g r e a t e r than
t h a t of a reimbursement-focused plan l i k e Consumer Choice o r t h e
National Health Program.
D.
The PHCS and Health Care Planning
Proposals f o r problem s o l u t i o n abound, as noted above.
None
of them are p e r f e c t i n anyone's eyes; however, some o f them have
more p o t e n t i a l f o r s o l v i n g t h e major problems than do others.
Those w i t h t h e most p o t e n t i a l have one key c h a r a c t e r i s t i c i n
common: p r o a c t i v e , not r e a c t i v e , planning, l i n k e d t o f i n a n c i n g , i s
a major element.
As Henrik Blum (1983) has asked, however, "Can
there be meaningful h e a l t h planning [ i n t h e United States] when so
l i t t l e else i s planned?"
The resistance t o planning i n the h e a l t h care i n d u s t r y i s
p a r t i c u l a r l y strong.
For example, i n t h e f a l l o f 1985, then
Senator Dan Quayle (R, IN) proposed t h e c r e a t i o n o f a n a t i o n a l
advisory c o u n c i l t o make recommendations
f o r minimum percentages
of primary care s p e c i a l t y residency p o s i t i o n s i n t h e several
classes o f teaching h o s p i t a l s .
This system would have been
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e n t i r e l y voluntary (when, in fact, a mandatory health personnel
supply, distribution, and allocation system i s needed).
The united reaction from the American Medical Association,
the American Hospital Association, and the Association of American
Medical Colleges was a resounding and vehement "No"
(AAMC, 1985).
The present personnel situation i s chaotic and wasteful.
I t has
been created by 50 years of individually isolated, unplanned
action.
But the three leading health care organizations rejected
even an advisory system, dealing with only one piece of the pie.
F i n a l l y , one can ask, i f there i s no planning, no system, no
national program, what w i l l happen?
catastrophe and c r i s i s .
Some predict major
But in spite of predictions of impending
doom going back 20 years and more (see Appendices I I and I I I ) ,
no
national catastrophe has occurred (although millions of
individuals have been hard done by).
The system j u s t keeps
barreling along, getting ever more expensive, and showing major
defects in both the quality and the quantity of service provided.
Will there indeed be a c r i s i s ?
Will there be a catastrophe?
w i l l we j u s t continue to experience more of the same?
Or
The outcome
of t h i s drama i s one that no one can predict.
The PHCS would provide for an integral l i n k between the
planning and financing of health services.
As Rashi Fein, Chair
of the I n s t i t u t e of Medicine's Committee on Health Planning Goals
and Standards noted, in h i s Preface to the Committee's Report,
t h i s i s essential to problem solving (IOM, 1981, Vol. I , p. i i i ) :
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"The committee believes that the forces a t work i n the
American health care system, including the various
reimbursement mechanisms, cannot be countered by a health
planning effort that i s divorced, among other l i m i t i n g
factors, from the flow of funds."
Using epidemiological methods i n health services planning,
the PHCS would carry out ongoing needs assessments,
set p r i o r i t i e s
based on them, and, within the l i m i t s of available resources, make
continual program adjustments to meet identified needs. The
approach would allow for the direct application of planning
information to health services system operation.
Thus the focus
on meeting identified needs could always be maintained without
direct government services operation.
The assumption i s made that the numerous individual health
care providers are incapable of doing rational planning on t h e i r
own (the history of "voluntarism" i n health planning has shown
that t h i s i s true).
necessary.
Thus, government action i n t h i s area i s
I t also i s assumed, as i t i s i n most other NHI
proposals, that government w i l l play an increasingly important
role i n the financing of health services, whether through taxation
or the imposition and collection of uniform employer/employee
contributions to pay for the cost of health s e r v i c e s .
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The Relevance of the "Canadian System" for the the US*
The present Canadian system has been in place for about 20
years (Evans, et a l ; Fuchs and Hahn; Goodman; Hospitals; Igelhart,
1986, 1990; Linton; Woolhandler and Himmelstein, 1989).
I t is
founded on four principles:
1.
There s h a l l be universal coverage for a l l Canadians,
with low or no co-payments, and reasonable access to
care.
2.
The benefits for each covered person s h a l l be portable
from province to province.
3.
A l l medically necessary services s h a l l be covered.
4.
Administration s h a l l be by not-for-profit, public
agencies.
Cost-containment has been achieved by:
1.
Eliminating the payment middle-man or reducing t h e i r
number to one.
2.
Eliminating the private insurance companies from any
piece of the action other than supplementary insurance.
*
For more d e t a i l on NHI in Canada, please see Appendix V,
(with which t h i s section shares some language).
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Having a single source of payment (the "monopsony
payor"), which can set l i m i t s on t o t a l payments while
making some choices about what the payments are made
for.
4.
Separating out hospital capital formation.
(Hospital
operating p o l i c i e s therefore do not have to be t a i l o r e d
to create capital funds or pay off loans, for example by
encouraging reimbursable procedure-based interventions.
Capital investment then can be planned on the basis of
unmet need analysis.)
5.
A reimbursement system for hospitals, global budgeting,
which rewards neither over- nor under-utilization, and
encourages "prudent" management, although extraordinary
payments are in extraordinary circumstances.
6.
Controlling payments to physicians through use of a fee
schedule and mandatory assignment.
The key features of the Canadian system that d i f f e r from that
of the U.S. are:
1.
Global budgeting for hospitals.
2.
A combination of fee-for-service private practice, with
mandatory assignment, no balance b i l l i n g , and possible
income caps.
3.
Elimination for the insurance companies.
4.
Prospective, external, community needs-based planning
for capital investment decisions and separation of
capital expenditure from operational expenditures.
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The major lessons to learn from the Canadian experience are
not the d e t a i l s of the system, (what level of government runs i t ,
who administers i t , exactly what the benefits are, exactly what
the sources of revenue are, exactly how services are b i l l e d , and
so forth).
They are, f i r s t , that government has a major role to
play i n the operation of any smoothly functioning health care
delivery system, although i t certainly does not have to own and
run the system.
Both ownership and operating responsibility can
remain in private hands, as long as everyone i s on the same page
and government assembles the resources and sets the l i m i t s (rather
than having the "free market" set them).
I t appears to be most use the Canadian experience as a guide,
not as a template.
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V.
National Health Insurance, '92, and P o l i t i c s
A.
Looking Ahead
I t i s popular i n some c i r c l e s t o say t h a t NHI i s t o o
expensive, t h a t the n a t i o n cannot a f f o r d i t . According t o
proponents o f the comprehensive plans the t r u t h i s j u s t t h e
opposite.
They say t h a t w i t h the skyrocketing costs, questionable
q u a l i t y , increases i n preventable death i n c e r t a i n segments o f t h e
population (MVSR; Rosenthal; Schwartz, e t a l ) , and massive
m i s a l l o c a t i o n o f resources t h a t occur under the present v o l u n t a r y ,
" f r e e " system, the n a t i o n cannot a f f o r d not t o have i t .
However,
i t must be recognized t h a t any NHI plan t h a t does not t a c k l e t h e
causes of the problems head on, any plan t h a t j u s t pays i n a
d i f f e r e n t way f o r the system we now have, w i l l i n the long r u n
l i k e l y make t h i n g s worse, not b e t t e r .
We must not j u s t pay
d i f f e r e n t l y f o r t h i n g s ; we must pay f o r d i f f e r e n t t h i n g s .
As I have noted before, making change i n the U.S. h e a l t h care
d e l i v e r y system i s very d i f f i c u l t , as h i s t o r y has taught us again
and again.
The provider groups are very powerful.
powerful are the physicians and the h o s p i t a l s .
The two most
I n the past, major
changes i n the system have taken place when the physicians and/or
the
h o s p i t a l s wanted or needed those changes.
Examples i n c l u d e
the
r e i n s t i t u t i o n o f medical l i c e n s i n g laws and the r e d u c t i o n i n
the
number o f medical schools i n the l a t e nineteenth and e a r l y
t w e n t i e t h c e n t u r i e s , and the development o f v o l u n t a r y h o s p i t a l
insurance during the Great Depression.
NHI w i l l most l i k e l y come
when one or the other or both o f those groups want i t or need i t .
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The private hospitals w i l l want i t when an increasing number
of them go bankrupt in the face of uncontrolled cost increases and
declining occupancy rates, as happened i n Great B r i t a i n j u s t
before the i n s t i t u t i o n of t h e i r National Health Service.
The
physicians w i l l want i t when t h e i r numbers are so large that they
w i l l no longer be able to s e l l a l l the product they can
c o l l e c t i v e l y produce, as they can now.
I f a majority of them were
s t i l l private entrepreneurs at that time, the competition would be
chaotic (Consumer Commission).
The shelter of a secure, i f
somewhat smaller income would be sought i n salaried service.
B.
The P o l i t i c a l Program for Health Care Delivery System Reform
The goal of p o l i t i c a l program development i s to come up with
a functional program for the health care delivery system that w i l l
(a) solve or s i g n i f i c a n t l y ameliorate the major health delivery
system problems, and (b) be p o l i t i c a l l y salable to a majority of
the American people.
In developing t h i s program, i t must be
recognized right at the outset that p o l i t i c a l campaign i s not the
place to write l e g i s l a t i o n .
I t i s the place to establish
principles upon which l e g i s l a t i o n can be drawn.
I t must be recognized that half-way measures, such as tax
credits (this one shouldn't be g l o r i f i e d by the term "half-way
measure," i t ' s a no-way measure), Medicare/Medicaid expansion, a
"play or pay" system of employment based health insurance, a
voucher system to buy private health insurance, w i l l not work.
In
fact, since none of them address any of the causes of the
problems, they can only make things worse.
I f we only change the
way the money i s collected, while increasing the number of people
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covered and increasing the numbers and types of services covered
for everyone, a l l we w i l l have done i s broaden service and further
increase
expenditures.
Having said that, the major features of a program that can
help a candidate to win and, i f implemented, can save money and
improve health and health care, are (as stated in the Executive
Summary):
1.
I t establishes a single, clear, primary goal for the
U.S.
health care delivery system: to serve and improve
the health of a l l Americans.
Thus, among other things,
major changes w i l l be made in the system to address the
burden of preventable
interventions.
disease and wasteful medical
Health w i l l become a p r i n c i p a l feature
of the health care delivery system.
To support t h i s
aim, the medical education and biomedical research
establishments w i l l be encouraged in a variety of ways
to become health as well as disease-oriented.
2.
I t w i l l be c l e a r l y recognized that to achieve t h i s goal,
comprehensive planning w i l l be necessary, and that the
only way planning can be e f f e c t i v e i s to l i n k i t to
financing.
The PHCS c l e a r l y establishes that l i n k by
introducing into the payment system for health services
the t r i e d and true American method of contracting, with
operational specifications as the primary means of
paying providers for the services they deliver.
�On NHI '92: Jonas
3.
Page 63
To f a c i l i t a t e t h i s e s s e n t i a l development, a single-payor
system w i l l be i n s t i t u t e d . I n addition to i t s most
important function of linking planning and financing,
the single-payor system w i l l produce savings that w i l l
make i t possible to pay for health services for that 15
percent of the population
i s presently not covered,
without increasing taxes or health insurance premiums.
4.
Cost-containment w i l l be achieved by such mechanisms as:
the single-payor system i t s e l f ; separation of the capit a l and expense sources of funds and budgets; increased
emphasis on ambulatory and home, as contrasted with
hospital, care; creating a major focus on health
promotion/disease prevention services, improved controls
on fraud and abuse, and o v e r - u t i l i z a t i o n by physicians
(these controls made much easier by i n s t i t u t i n g a singlepayor system); eliminating "balance b i l l i n g "
(charging
beyond what insurance pays) by physicians, and encouraging physicians to convert to salaried service.
Supple-
mentary insurance w i l l be permitted
5.
Everyone w i l l have the same coverage, and the benefits
package w i l l be reasonably comprehensive.
There may be
some income-related co-payments.
6.
Geographic maldistribution of f a c i l i t i e s and personnel
w i l l be addressed by a combination of incentives and
regulation.
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Page 64
F i n a l l y , i t w i l l be recognized that the p o l i t i c a l key to
adoption, and the key to the success of any refonn plan
instituted are one and the same: there must be major
elements in the plan that bring very s i g n i f i c a n t health
and health care benefits to those who presently have
health insurance coverage.
Otherwise they, the majority
of the American people, w i l l have no incentive to
support change.
In t h i s context, then, i t must be stressed that the
reforms proposed w i l l :
a.
Prevent loss of health care coverage that can
accompany loss of job.
b.
Guarantee f u l l family coverage.
c.
Eliminate potential i n e l i g i b i l i t y for health
insurance upon change of employment, i f one has a
serious chronic i l l n e s s .
d.
Prohibit any necessity to "pay the doctor more,"
( i . e . , balance
c.
billing).
Eliminate multiple forms, patient paperwork, the
"pay f i r s t / w a i t for the insurance company's check"
system.
f.
Address the undersupply of personnel and f a c i l i t i e s
in both urban and rural areas, and the costly
oversupply of hospital beds in certain areas, and
the under supply of proper care for th elderly in
many areas.
�On NHI
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Jonas
Page 65
Through the planning mechanism address problems i n
treatment, such as: g a p s / d e f i c i t s i n h e a l t h
promotion/disease
prevention services long waits i n
w a i t i n g rooms, no c o o r d i n a t i o n of care among
s p e c i a l i s t s (the so-called "group-practice i n the
head"), defects i n d o c t o r - p a t i e n t communication.
h.
Broaden the spectrum of covered i n t e r v e n t i o n s ,
i n c l u d i n g long-term care and c a t a s t r o p h i c i l l n e s s .
The way forward i s a c t u a l l y f a i r l y s t r a i g h t f o r w a r d .
What has
been l a c k i n g t o date i s the p o l i t i c a l w i l l t o s t a r t down the
road.
The n a t i o n w i l l f i n d out i f Campaign '92
f o r the Presidency
w i l l i d e n t i f y a candidate, and then h o p e f u l l y a President, who
it.
has
�On NHI '92: Jonas
References: On NHI,
Page 66
'92
AAMC: A s s o c i a t i o n of American Medical C o l l e g e s , F i n a l Report of
the Commission on Medical Education, New York: 1932.
AAMC: A s s o c i a t i o n of American Medical C o l l e g e s , GPEP (General
P r o f e s s i o n a l Education of t h e P h y s i c i a n Panel) Report:
" P h y s i c i a n s f o r t h e T w e n t y - F i r s t Century." J o u r n a l of Medical
Education, 59 (11) (plus appendices), 1-208, 1984.
AAMC: A s s o c i a t i o n of American Medical C o l l e g e s . "AMA/AHA/AAMC
Object t o B i l l on Medical Education." Weekly Report,
September 26, 1985, p. 2.
AMA: American Medical A s s o c i a t i o n . Health Access i n America,
Chicago, I L : 1990.
Blendon, R.J., "Three Systems: A Comparative Study," Health
Management Quarterly, F i r s t Quarter, 1989, p. 2.
Blendon, R.J., & Altman, D.C. " P u b l i c A t t i t u d e s about Health Care
Costs." New England J o u r n a l of Medicine, 311, 613, 1984.
Blum, H.L. "Health Planning: Lessons f o r t h e Future. By Bonnie
Lefkowitz." Book Review. I n g u i r y , 20, 390, 1983.
Bodenheimer, T., "The Way t o Real Health S e c u r i t y , " The Nation,
December 16, 1991, p. 772.
B u t l e r , S.M. and Haislmaier, E.F., A National Health System f o r
America, Washington, DC: The Heritage Foundation, 1989.
Castro, J . , "Condition: C r i t i c a l , " Time, November 25, 1991, p. 34.
C l u f f , L. "A Challenge t o America's P h y s i c i a n s , " 1989 Annual
Report, Princeton, NJ: Robert Wood Johnson Foundation, 1989,
pp. 8-11.
Committee on the Costs of Medical Care. Medical Care f o r t h e
American People. Chicago: U n i v e r s i t y of Chicago P r e s s , 1932.
Reprinted, Washington, D.C: USDHEW, 1970.
Committee on Labor and Human Resources. Background Information on
S. 1265, The Minimum Health B e n e f i t s f o r A l l Workers. Act of
1988, Washington, DC: US Senate Committee on Labor and Human
Resources, A p r i l 29, 1988.
Committee f o r National Health Insurance. The Health S e c u r i t y
P a r t n e r s h i p , Washington, DC: 1989.
Davis, K., e t a l , "Paying f o r Preventive Care: Moving t h e Debate
Forward." American J o u r n a l of P r e v e n t i v e Medicine, 6, No. 4,
Supplement, 1990.
Dyckman, Z. A Study of P h y s i c i a n s ' Fees, Washington, DC: US
Government P r i n t i n g O f f i c e , 1978.
Eisenberg, J.M., Doctors' D e c i s i o n s and the Cost o f Medical Care,
Ann Arbor, MI: Health A d m i n i s t r a t i o n Press P e r s p e c t i v e s ,
1986.
Enthoven, A. and Kronick, R. "A Consumer-Choice Health Plan f o r
the 1990s." The New England J o u r n a l of Medicine, 320, 29-37,
94-101, 1989.
Evans, R.G., e t a l , " C o n t r o l l i n g Health Expenditures
The
Canadian R e a l i t y . " New England J o u r n a l of Medicine, 320,
571, 1989.
Freymann, I . G. The American Health Care System: I t s Genesis and
T r a j e c t o r y . New York: Medcom Press, 1974.
Fuchs, V.R. "The ^Rationing' of Medical Care." New England
J o u r n a l of Medicine, 311, 1572, 1984.
�On NHI
'92:
Jonas
Page 67
Fuchs, V.R. and Hahn, J.S., "How Does Canada Do I t ? " New England
J o u r n a l of Medicine, 323, 884, 1990.
Fuchs, V. and Kramer, M.
Determinants of Expenditures f o r
P h y s i c i a n s ' S e r v i c e s i n the United S t a t e s , 1948-68,
Washington, DC: USDHEW Pub. No. (HSM) 73-3013, 1973.
Ginzburg, E. "High-Tech Medicine and R i s i n g Health Care c o s t s , "
J o u r n a l of the American Medical A s s o c i a t i o n , 263, 1820-22,
1990.
Goodman, W.E.,
"Canada's Health-Care System: You Get What You Pay
For." P r i v a t e P r a c t i c e , October, 1989, p. 11.
Harkin, T., "Another Pound of Cure," J o u r n a l of the American
Medical A s s o c i a t i o n , 266, 1692, 1991.
Hillman, B.J., e t a l , "Frequency and Costs of D i a g n o s t i c Imaging
i n O f f i c e P r a c t i c e . " New England J o u r n a l of Medicine, 323,
1604, 1990.
Himmelstein, D. U. and Woolhandler, S., "National Health Program
for the United S t a t e s . " The New England J o u r n a l of Medicine,
320, 102-108, 1989.
H o s p i t a l s , "The d e l i v e r y challenges posed by Canada: a b i l a t e r a l
view." November 5, 1990, p. 58.
I g e l h a r t , J . , "Canada's Health Care System." P a r t s 1, 2, 3, New
England J o u r n a l of Medicine, 315, 202, 778, 1623, 1986.
I g e l h a r t , J . , "Canada's Health Care System Faces I t ' s Problems."
New England Journal of Medicine, 322, 562, 1990.
IOM: I n s t i t u t e of Medicine, Committee on Health Planning Goals and
Standards, Health Planning i n the United S t a t e s : S e l e c t e d
P o l i c y I s s u e s , two volumes. Washington, DC: National Academy
P r e s s , 1981.
IOM: I n s t i t u t e of Medicine, Lohr, K.N., ed., Medicare: A S t r a t e g y
for Q u a l i t y Assurance, V o l s . 1 & 2. Washington, DC: National
Academy P r e s s , 1990.
Jonas, S. " I s s u e s i n National Health Insurance i n the United
S t a t e s of America," The Lancet, J u l y 20, 1974, p. 143.
Jonas, S., Q u a l i t y Control of Ambulatory Care. New York: Springer
P u b l i s h i n g Co., 1977.
Jonas, S., Medical Mystery: The T r a i n i n g of Doctors i n the United
S t a t e s , New York: W.W. Norton, 1978.
Jonas, S., "Planning f o r National Health Insurance by O b j e c t i v e :
The Contract Mechanism." I n R. S t r a e t z (Ed.), C r i t i c a l
P e r s p e c t i v e s and I s s u e s i n Health P o l i c y , Lexington, MA:
Lexington Books, 1981.
Jonas, S. "The Personal Health Care System." New York S t a t e
J o u r n a l of Medicine, 84, 187, 1984.
Jonas, S. "Health Promotion i n Medical Education." American
J o u r n a l of Health Promotion, 2/ /
1988.
Leape, L.L., e t a l , " R e l a t i o n Between Surgeon's P r a c t i c e Volumes
and Geographic V a r i a t i o n i n the Rate of C a r o t i d Endarterectomy," New England Journal of Medicine, 321, 653, 1989.
Levinsky, N. C. "The Doctor's Master." New England Journal of
Medicine, 311, 1573, 1984.
L e v i t , K.R., e t a l , "National Health Expenditures, 1990," Health
Care Financing Review, F a l l 1991, Vol. 13, No. 3, pp. 29-54.
3 7
�On NHI '92: Jonas
Page 68
Linton, A.L., "The Canadian Health Care System: A Canadian
P h y s i c i a n ' s P e r s p e c t i v e . " New England J o u r n a l of Medicine,
322, 197, 1990.
MVSR: Monthly V i t a l S t a t i s t i c s Report, "Advance Report of F i n a l
M o r t a l i t y S t a t i s t i c s , 1988." Vol. 39, No. 7, November 28,
1990.
National A s s o c i a t i o n of Manufacturers.
Meeting t h e Health Care
Crisis,Washington, DC: 1989.
National Leadership Commission on Health Care. For t h e Health of
a Nation: A Shared R e s p o n s i b i l i t y , Ann Arbor, MI: Health
A d m i n i s t r a t i o n Press P e r s p e c t i v e s , 1989.
O i l , Chemical and Atomic Workers. National Health Care: Pass i t
On!
Lakewood, CO: 1989.
ONCE: O f f i c e of National Cost E s t i m a t e s , "National h e a l t h
expenditures, 1988," Health Care F i n a n c i n g Review, Summer
1990, Vol. 11, No. 4, pp. 1-54.
Relman, A. S. " U n i v e r s a l Health Insurance: I t s Time Has Come."
The New England J o u r n a l of Medicine. 320, 117-118, 1989.
Rosenthal, E., "Health Problems of Inner C i t y Poor Reach C r i s i s
Point." The New York Times, December 24, 1990, p. 1.
Sade, R.M. "A Health-Care F a i r y T a l e , " P r i v a t e P r a c t i c e , August
1989, pp. 9-17.
Salmon, J.W., The Corporate Transformation of Health Care,
A m i t y v i l l e , NY: Baywood P u b l i s h i n g Co., 1990.
Schwartz, E., e t a l , "Black/White Comparisons of Deaths
Preventable by Medical I n t e r v e n t i o n : United S t a t e s and the
D i s t r i c t of Columbia 1980-1986." I n t e r n a t i o n a l J o u r n a l of
Epidemiology, 19, 591, 1990.
S t a r f i e l d , B., "Primary Care and Health: A Cross-National
Comparison," Journal of the American Medical A s s o c i a t i o n ,
266, 2268, 1991.
The Nation's Health, " C a r t e r Addresses Annual Meeting." November,
197 6, p. 1. USBoC: US Bureau of t h e Census, S t a t i s t i c a l
A b s t r a c t of the United S t a t e s : 1990 (110th e d i t i o n . )
Washington, DC: USGPO, 1990.
U.S. Department of Health and Human S e r v i c e s . Health United
S t a t e s , 1984. USDHHS Pub. No. (85)-1232. Washington, D.C:
U.S. Government P r i n t i n g O f f i c e , 1984.
USPHS: United S t a t e s P u b l i c Health S e r v i c e : National G u i d e l i n e s
for Health Planning. Washington, DC: US Department of Health
and Human S e r v i c e s , November 25, 1980.
USPHS: United S t a t e s P u b l i c Health S e r v i c e , Healthy People 2000:
National Health Promotion and Disease Prevention O b j e c t i v e s ,
Conference E d i t i o n : Summary. Washington, DC, September,
1990.
Wennberg, J.E., "Outcomes Research, Cost Containment, and t h e Fear
of Health Care Rationing." The New England J o u r n a l of
Medicine, 323, 1202, 1990.
Woolhandler, S. and Himmelstein, D.U., "Resolving the Cost/Access
C o n f l i c t . " Journal of General I n t e r n a l Medicine, 4, 54,
1989.
Woolhandler, S., and Himmelstein, D., "The D e t e r i o r a t i n g
A d m i n i s t r a t i v e I n e f f i c i e n c y of the U.S. Health Care System,"
The New England Journal of Medicine, 324, 1253, 1991.
�Appendix I *
National Health Insurance: Some H i s t o r i c a l Background
I.
The World H i s t o r i c a l Background
In the United States there has been controversy over the issue
of national health insurance** (NHI) since the beginning of the 20th
century. The NHI concept f i r s t appeared on the world stage over 100
years ago. Some might be distressed to learn that both the content
and form of the arguments for and against i t have remained largely
fixed. This has been the case regardless of changed circumstances
or new information.
The f i r s t NHI l e g i s l a t i v e program was introduced by Otto von
Bismarck, the "Iron Chancellor" of Prussia, and, after 1871, of the
unified German state. Shortly after the bourgeois revolution of
1848, he had said: "The s o c i a l insecurity of the worker i s the r e a l
cause of t h e i r being a p e r i l to the state" (Sigerist, p. 127). In
1881, the German Kaiser, Wilhelm I , in a speech written by Bismarck,
said: "The healing of s o c i a l e v i l s cannot be sought in the
repression of s o c i a l democratic excesses exclusively but must
equally be sought in the positive promotion of the workers welfare"
( S i g e r i s t , p. 129).
Various fragmented accident, workmen's compensation, and
sickness schemes, both compulsory and voluntary, had come into
existence i n the several German states over the previous half
century. Building on them, in 1883 Bismarck succeeded in ushering a
Sickness Insurance Act through the German Reichstag (Parliament)
( S i g e r i s t , pp. 121-131). Bismarck had wanted a uniform, national
system, excluding the private, profit-making "sickness s o c i e t i e s "
had much i n common with the present U.S. health insurance
*
This Appendix i s drawn from Chapter Eight, "National Health
Insurance," of An Introduction to the U.S. Health Care System,
New York: Springer Publishing Co., 1992, by Steven Jonas,
M.D.,
M.P.H. Used with the permission of the publisher.
**
The term "health insurance" i s actually a misnomer for the
system i t i s commonly used to describe. Insurance i s the
periodic collection of r e l a t i v e l y small sums of money from
large numbers of people to protect each of them against the
f i n a n c i a l consequences of a r e l a t i v e l y rare event. However,
over the course of a lifetime, using health services i s not a
r e l a t i v e l y rare event. Thus "health insurance" i s not
"insurance" in the conventional sense. Rather i t i s a system
for the c o l l e c t i v e , long-range prepayment for health services.
Furthermore, not much "health insurance" money actually pays
for health and i t s promotion. Rather, most of i t goes to cover
the costs of care during sickness. Nevertheless, as the term
i s commonly used, so s h a l l i t be used in t h i s chapter.
�Appendix I : NHI Hist. Back.
Page 2
(private insurance companies, some p r o f i t making, some not).
_
Understandably those companies objected to the prospect of being pu^A
out of business. Sounds familiar, doesn't i t . In t h i s regard t h e y ^ ^
companies. Understandably as well, the U.S. private insurance
companies protest strongly against any NHI plan which has no role
for them.
Bismarck settled for a plan that used the e x i s t i n g network of
sickness s o c i e t i e s . Nevertheless, i t was a national program that
paid for medical care and provided cash support during periods of
sickness and accidental injury for certain categories of workers.
Two-thirds of the premiums were paid by the employees, one t h i r d by
the employers. Thus the f i r s t national health insurance scheme was
created, not by a progressive democratic or s o c i a l i s t government but
by a conservative monarchy.
By the 1920s, most European industrialized countries and Japan
had some kind of national health insurance system. I t usually began
as a p a r t i a l and/or voluntary system, generally progressing to a
comprehen-sive and compulsory one (Douglas-Wilson & McLachlan, pp. 1123, 211-230; Fry & Farndale; Glaser; Roemer). After World War I I ,
the English-speaking B r i t i s h Commonwealth countries gradually
followed s u i t (Fry & Farndale; Lynch & Rapheal; Roemer). The United
States i s the only industrialized country in the world, other than
South Africa, not to have some sort of NHI system.
II.
A Brief History of NHI in the United States
The f i r s t campaign for a national health insurance program in
the United States was undertaken by the American Association for
Labor Legislation (AALL), a middle c l a s s , l i b e r a l , reform-minded
group founded in 1906 (Anderson, Part 2; Burrow, 1963, 1977, pp. 138153). Proposals for a broad s o c i a l insurance plan were part of
Teddy Roosevelt's Bull Moose (third) Party platform in 1912 (Burrow,
1963, p. 135). In 1916, aiming at state l e g i s l a t u r e s , the AALL put
forward a standard b i l l for compulsory medical care and sickness
benefits insurance. The AALL proposed that the several states adopt
the program independently. I t would have covered persons earning
below a certain income level and would have used e x i s t i n g insurance
c a r r i e r s . Employers, employees, and the states would have shared
the costs (Anderson, pp. 62-65; Burrow, 1963, p. 136).
At f i r s t , there was widespread support for the proposal,
extending even to the American Medical Association and the National
Association of Manufacturers (Burrow, 1963, pp. 138-145). Beginning
in 1917, however, when the U.S. entry into World War I was deflating
the Reform Movement generally, opposition began to surface from
several quarters. Among the opponents were the American Federation
of Labor and the commercial insurance industry (Anderson, p. 67;
Burrow, 1977,
pp.
148-153).
Within the AMA, a battle ensued (Anderson; Burrow, 1963, pp.
146-151). In 1920, the AMA House of Delegates passed the following
resolution (Burrow, 1963, p. 150):
�Appendix I ; NHI Hist. Back.
Page 3
"Resolved, that the American Medical Association declares i t s
opposition to the i n s t i t u t i o n of any plan embodying the system
of compulsory contributory insurance against i l l n e s s , or any
other plan of compulsory insurance which provides for medical
service to be rendered contributors or t h e i r dependents,
provided, controlled, or regulated by any state or the Federal
government."
As part of a general takeover of power by the practitioner wing from
the academic wing, the conservative faction had won out (Harris,
p.30).*
In toto, that remained the AMA position u n t i l the late 1960s
(Harris). Even in the mid 1970s, by which time the AMA had adopted
an NHI proposal of i t s own that ran counter to the bulk of the 1920
resolution, the "noncompulsory" p r i n c i p l e was retained (Committee on
Ways and Means). By 1990, the AMA had dropped the noncompulsory
principle as well (AMA, 1990).
Serious consideration was next given to national health
insurance during the development of the Social Security Act of
1935. This consideration was stimulated i n part by the F i n a l Report
of the Committee on the Costs of Medical Care (1932; see also
Anderson; Stevens, pp. 183-187). In 1934, President Franklin
Roosevelt created
the Committee on Economic Security to consider the whole question of
s o c i a l insurance.
NHI did not l a s t long on the agenda. The p r i n c i p a l opposition
came from the American Medical Association (Burrow, 1963, p. 193).
The Committee's Executive Director, Edwin E. Witte, wrote (Anderson,
p. 108) :
"When i n 1934 the Committee on Economic Security announced that
i t was studying health insurance, i t was at once subjected to
misrepresentation and v i l i f i c a t i o n . In the original s o c i a l
security b i l l there was one line to the effect that the Social
Security Board should study the problem and make a report
thereon to Congress. That l i t t l e l i n e was responsible for so
many telegrams to the members of Congress that the entire
s o c i a l security program seemed endangered u n t i l the Ways and
Means Committee unanimously struck i t out of the b i l l . "
*
Both Burrow's book and the Harris a r t i c l e s contain detailed
h i s t o r i e s and analyses of the AMA's involvement in l e g i s l a t i v e
battles over NHI.
The 1963 Burrow book d e t a i l s them through
the 1950s. The Harris a r t i c l e s cover the Medicare struggles.
An excellent overall h i s t o r i c a l perspective i s provided by Falk
(1977) .
�Appendix I : NHI Hist. Back.
Page 4
The President wanted the basic Social Security Act, one of the
cornerstones of the New Deal. I t was passed with no reference to
NHI.
Senator Robert F. Wagner, Sr. of New York State i n i t i a t e d the
next major l e g i s l a t i v e foray.** His landmark Wagner Act of 1938 had
established the right to c o l l e c t i v e bargaining for a l l nonpublic
employees in the United States. In 1939, he introduced a b i l l
( S i g e r i s t , pp. 189-190):
"to provide for the general welfare by enabling the several
states to make more adequate provision for public health,
prevention and control of disease, maternal and c h i l d health
services, construc-tion, and maintenance of needed hospitals
and health centers, care of the sick, d i s a b i l i t y insurance, and
training of personnel."
The b i l l , S. 1620, proposed to subsidize state public health
programs (this later became Federal policy through a s e r i e s of
a c t s ) ; the construction of hospitals (legislated i n 1946 as the H i l l
Burton Act); and state programs for medical care for the poor
(eventually enacted in part in 1960 as the "Kerr/Mills" Medical
Assistance for the Aged Act, then expanded as Medicaid i n 1965).
The b i l l also offered cash sickness benefits (a standard feature of
the European/Japanese approach to NHI that has never made headway i n
the United States). As well, there was to be a program of federal
subsidies to those states enacting comprehensive health insurance
programs (Harris, pp. 31-32; S i g e r i s t , pp. 190-191). The b i l l died
in committee, after being vigorously attacked by the AMA (Harris,
pp. 38-40).
Senator Wagner t r i e d again in 1943, t h i s time i n concert with
Senator Murray and Representative Dingell (the father of the present
Congressman from Michigan). Their S. 1161 "advocated a national
( i . e . , Federal) compulsory system of health insurance, financed from
payroll taxes and providing comprehensive health and medical
benefits through entitlement to specified medical service benefits"
(Stevens, p. 272). This was the f i r s t major l e g i s l a t i v e proposal
for a Federal rather than a state based system.
Once again, the AMA responded with vigor (Harris, pp. 40-42).
The b i l l never got very far, although i t was reintroduced in several
successive Congresses (Anderson, pp. 112-113). In 1947, Senator
Robert Taft, Sr., f i r s t introduced a Medicaid-like proposal for
Federal subsidies to the states to pay for medical care for the poor
(Stevens, p. 273). Though sponsored by a conservative Republican,
i t also got nowhere.
**
The d e t a i l s of a l l major NHI proposals made between 1935 and
1957 have been summarized by A. W. Brewster, Health Insurance
and Related Proposals for Financing Personal Health Services
(Washington, DC: U.S. Government Printing Office, 1958).
�Appendix I ; NHI Hist. Back.
Page 5
In 1949 Harry Truman was reelected President with Democratic
majorities i n both houses of Congress. He decided to make enactment
of NHI a major goal of h i s Administration. He proposed a national,
compulsory system, to be paid for by a combination of Social
Security and general taxation. I t was to be based upon the
following principles, which he had o r i g i n a l l y enunciated in 1945
(Truman, 1958, pp. 629-630):
"Everyone should have ready access to a l l necessary medical,
hospital, and related services. . . . A system of required
prepayment would not only spread the costs of medical care, i t
would also prevent much serious disease. . . . Such a system of
prepayment should cover medical, hospital, nursing, and
laboratory services. I t should cover dental care [as far as]
resources of the system permit. . . the nation-wide system must
be highly decentralized m administration. . . . Subject to
national standards, methods and rates of paying doctors and
hospitals should be adjusted l o c a l l y . . . . People should
remain free to choose t h e i r own physicians and hospitals. . . .
Likewise physicians should remain free to accept or r e j e c t
patients. . . . Our voluntary hospitals and our c i t y , county,
and state general hospitals, in the same way, must be free to
participate in the system to whatever extent they wish.
. . . what I am recommending i s not socialized medicine.
Socialized medicine means that a l l doctors work as employees of
government. . . . No such system i s proposed.
Does t h i s statement not have a highly contemporary ring to i t ?
The AMA mounted a furious attack on the plan, based primarily
on the thesis that i t was indeed "socialized medicine" (Harris, pp.
40-62). The AMA used a major public relations firm and a war chest
of over $2 million, a very substantial sum in those days. With
a l l i e s from the drug and insurance industries (Stevens, pp. 273274), i t was once again successful. With the election qf a
Republican government in 1952, the AMA was able to breathe e a s i l y
once again (Burrow, 1963, pp. 361, 385).
In the Post-World War I I climate of domestic and foreign a n t i communism (Freeland), i t was d i f f i c u l t for Truman to win support at
home for a program consistently attacked as "communist," or at least
" s o c i a l i s t , " but in any case "red" (Harris, p. 50). Thus, in 1951,
on the recommendation of Oscar Ewing, then Federal Security
Administrator, the Truman Administration withdrew i t s support for
NHI and began the campaign that led to the passage of Medicare,
limited health insurance for the aged, in 1965 (Harris, pp. 58-60;
Stevens, p. 274).
The campaign for Medicare was long and arduous (Harris;
Stevens, pp. 432-443). I t met with success in 1965 (Committee on
Finance, 1970). Both Medicare, and i t s afterthought companion
Medicaid (Friedman), had their h i s t o r i c a l antecedents. In most
countries i n which the central government has undertaken NHI, i t
began by taking care of only part of the population, usually low-
�Appendix I : NHI Hist. Back.
Page 6
income persons, (as in Medicaid). I n the United States, the
e a r l i e s t AALL proposals contained the concept of beginning with
p a r t i a l coverage. However, the AALL programs were aimed at the
working poor, whereas Medicaid covers primarily the nonworking
poor. Medicaid-like proposals had appeared in Senator Wagner's
prewar b i l l and Senator Taft's postwar b i l l s .
Determination of an
e l i g i b l e population by age was, however, a new twist, going back
only to 1950.
I I I . National Health Insurance in the 1960s and 70s
Once Congress had passed Medicare and Medicaid, beginning in
the late 1960s many new l e g i s l a t i v e proposals for NHI were made,
(Burns; E i l e r s ; Falk, 1977; New York Academy of Medicine). In the
1970s, they were summarized by the Ways and Means Committee of the
House of Representatives (e.g., Committee on Ways and Means, 1974),
the Senate Finance Committee (Committee on Finance, 1979), and Karen
Davis (1975). As noted above, in the wide ranging debate on NHI the
basic arguments of the several sides had changed l i t t l e over time
(Boas; Falk, 1973; McKittrick; H. Schwartz).
As of 1975, a time when the passage of some sort of NHI seemed
imminent to many observers, there were four major proposals before
Congress. The constituencies represented were: organized labor, the
American Hospital Association, the Health Insurance Association of
America, and (by t h i s time) the AMA i t s e l f . Since a l l of the major
actors were on stage, i t was believed that surely one of these
proposals or some compromise among them would find i t s way through
Congress.
As noted in the Prologue to t h i s monograph, one predicts the
passage of National Health Insurance in the U.S. at one's p e r i l ,
however. For example, in 1974, an observer wrote (Jonas, 1974):
"The United States of America i s the only major country in the
developed, c a p i t a l i s t world without some form of national
health insurance programme. The struggle for national health
insurance in the U.S., a long and b i t t e r one, has been well
described. I t now appears as i f there w i l l be some form of
national health insurance l e g i s l a t i o n in the U.S. before the
Presidential elections of 1976 (emphasis added)."
There wasn't.
In the 1976 Presidential campaign, Candidate Jimmy Carter said,
in h i s only speech on health policy (The Nation's Health, 1976, p.
7):
"We must have a comprehensive program of national health
insurance. . . . The coverage must be universal and mandatory.
We must lower the present barriers, in insurance coverage and
otherwise, to preventive and primary care and thus reduce the
need for hospitalization. We must have strong cost and quality
controls, and . . . rate. . . should be set in advance. . . .
�Appendix I : NHI Hist. Back.
Page 7
We must phase i n the program as rapidly as revenues permit,
helping f i r s t those who need help, and achieving a
comprehensive program well defined i n the end.
His Administration never submitted comprehensive NHI l e g i s l a t i o n to
Congress.
IV.
National Health Insurance Proposals in the 1980s
In 1979, the Congressional Research Service of the Library of
Congress (Cavalier) state that the major policy issues to be
addressed i n designing and NHI program were:
1.
The r i s i n g costs of health care.
2.
The gaps i n present health insurance coverage, i n terms
of
both services and populations.
3.
Geographic maldistribution of personnel and f a c i l i t i e s .
4.
Access to service by a b i l i t y to pay, s o c i a l c l a s s , age
group, and geography.
5.
The impact or lack thereof of NHI on the population's
health status.
A familiar sounding problem l i s t .
No one attended to i t .
In 1980, the same major players were s t i l l on the f i e l d
(Committee on Finance, 1979; Kimble; and pp. 448-453 of Jonas,
1981). But with the election of Ronald Reagan i n 1980, the whole
movement j u s t ran out of gas.
A measure of the enormous loss of energy suffered by the proNHI forces i n the 1980s can be found i n the contents of .the "reform
package" offered i n 1985 by Senator Kennedy (with Representative
Fortney "Pete" Stark, House Ways and Means Committee Health
Subcommittee Chair). They proposed (Washington Report on Medicine &
Health, 1985):
1.
To reduce the number of persons uninsured for health care
costs by requiring employers to make health insurance
available to former employees at group rates.
2.
To reduce or eliminate "patient dumping" by hospitals.
3.
To r e s t r a i n increases in Medicare Part A premium costs.
4.
To hold down Medicare payments to hospitals.
This was a f a r cry from the sweeping changes proposed by Kennedy in
several major b i l l s he offered in the 1970s.
�Appendix I : NHI Hist. Back.
V.
Page 8
National Health Insurance in the 1990s
For a variety of reasons, (primarily, continually escalating
costs, a growing pool of uninsured persons, and declining health for
certain portions of the population [see also Part I I of t h i s
monograph), NHI i s once again on the national agenda. Once again,
there are a s e r i e s of proposals on the table, from such disparate
groups as: Senator Kennedy's Committee on Labor and Human Resources
(1988), the National Association of Manufacturers (1989), the
Heritage Foundation (1989), the National Leadership Commission on
Health Care (co-chaired by former Presidents Nixon, Ford, and
Carter) (1989), the O i l , Chemical, and Atomic Workers (1989), the
Committee for National Health Insurance ( a f f i l i a t e d with the AFLCIO) (1989), the American Medical Association (AMA), the American
Public Health Association (The Nation's Health), the U.S. Bipartisan
Commission on Comprehensive Health Care of the U.S. Congress (known
as The Pepper Commission) (1990), and the Physicians for a National
Health Program (Woolhandler and Himmelstein; Himmelstein and
Woolhandler).
As noted in Part V, these proposals are primarily f o r m a l i s t i c
rather than substantive. That i s , they deal with the conditions of
medical practice, not with medical practice i t s e l f . Among many
reformers there seems almost to be a fear of taking on the medical
profession. Well-known promoters of change look almost anywhere
else for the cause of the problems. For example, the l i b e r a l
p o l i t i c a l commentator Barbara Ehrenreich (1990) labeled the
insurance industry as the v i l l a i n of the piece, as i f i t practiced
medicine and directed the spending of health care d o l l a r s , instead
of j u s t transferring them from patient-payor to provider.
Given the history outlined above, and the singular, b i t t e r ,
tenacious, long-term opposition of the American Medical Association
to any change that could put any kind of l i m i t a t i o n on private, feefor-service medical practice, who can blame reformers for looking .
anywhere but at the medical profession for potential opponents. But
as noted in Part I I I , the patterns of medical practice are the
leading cause of many of the health care delivery system problems
facing the American people. I f those patterns are not changed, i t
doesn't matter what new financing mechanisms are put i n place. The
problems caused by those patterns w i l l remain. To f i x them requires
nothing more or less than taking on at least some of the doctors,
and the medical education and biomedical research establishments as
well.
�Appendix I : NHI Hist. Back.
Page 9
References, Appendix I (additional)
AMA: American Medical Association, Health Access America. Chicago,
I L : March 1990.
Anderson, O W
. . The Uneasy Equilibrium: Priyate and Public
Financing of Health Services in the United States, 1875-1965.
New Haven, CT: College and University Press, 1968.
Boas, F. P. Why Do We Need National Health Insurance? Society for
E t h i c a l Culture, 1945. Reprinted i n Committee on Medical Care
Teaching of the Association of Teachers of Preventive Medicine,
Readings in Medical Care. Chapel H i l l , NC: University of
North Carolina Press, 1958.
Burns, E. M. "Health Insurance: Not I f , or When, But What Kind?"
American Journal of Public Health, 61, 2164, 1971.
Burrow, J . G. AMA: Voice of American Medicine. Baltimore: Johns
Hopkins University Press, 1963.
Burrow, J . G. Organized Medicine in the Progressive Era.
Baitimore, MD: Johns Hopkins University Press, 1977.
Cavalier, K. National Health Insurance. Washington DC:
Congressional Research Service, Library of Congress, 1979.
Committee on Finance, United States Senate. Medicare and Medicaid:
Problems, Issues and Alternatives. Washington, DC: DTsT
Government Printing Office, 1970.
Committee on Finance, United States Senate. Comparison of Maj or
Features of Health Insurance Proposals. Washington, DC: U.S.
Government Printing Office, 1979.
Committee on Ways and Means, House of Representatives. National
Health Insurance Resource Book. Washington, DC: U.S.
Government Printing Office, 1974.
Davis, K., National Health Insurance: Benefits, Costs, and
Consequences. Washington, DC: The Brookings I n s t i t u t i o n ,
19'75. (b)
Douglas-Wilson, I . , & McLachlan, G. Health Service Prospects: An
International Survey. Boston: L i t t l e , Brown, 1973.
Ehrenreich, B., "Our Health-Care Disgrace." Time, December 10,
1990, p. 112.
E i l e r s , R. D. "National Health Insurance: What Kind and How
Much?" Parts 1 and 2. New England Journal of Medicine, 284,
881, 945, 1971.
Falk, I . S. "Medical Care in the USA, 1932-1972. Problems,
Proposals and Programs from the Committee on the Costs of
Medical Care to the Committee for National Health Insurance."
Health and Society, 51, 1, 1973.
Falk, I . S. "Proposals o^Nation Health Insurance in the USA:
Origins and Evolution, and Some Perceptions for the Future."
Health and Society, Spring 1977, p. 161.
Freeland, R. M. The Truman Doctrine and the Origins of
McCarthyism. New York: Knopf, 1975.
Friedman, E. "Medicaid." Part 1. Hospitals. 51, August 16, 1977,
p. 51, ( a ) ; Part 2. Hospitals, 51, SeptemEer 1, 1977, p. 59,
(b) ; Part 3. Hospitals, 51, Sep^mber 16, 1977, p. 73 (c) ; Part
4. Hospitals, 51, October 1, 1977, p. 61, (d); Part 5.
Hospitals, 51, November 1, 1977, p. 77, ( e ) .
�Appendix I : NHI Hist. Back.
Fry,
Page 10
J . , & Farndale, W A. J . (Eds.). International Medical Care.
.
Oxford, England: MTP, 1972.
Glaser, W A. Health Insurance Bargaining. New York: Gardner
.
Press, 1978.
Harris, R. "Annals of Legislation: Medicare." The New Yorker,
July 2, July 9, July 16, July 23, 1966.
Heritage Foundation. C r i t i c a l Issues: A National Health System for
America, Washington, DC: The Heritage Foundation, 1989.
Jonas, S., ed., Health Care Delivery i n the United States, 2nd ed.,
New York: Springer Publishing Co., 1981.
Kimble, C., "Special Report: Comparing the Carter and Kennedy
National Health Insurance B i l l s . " Washington Report on
Medicine and Health,
November, 1979.
Lynch, M. J . , & Raphael, S. S. Medicine and the State.
Springfield, I L : Charles C. Thomas, 1963.
McKittrick, L. S. "Medical Care for the American People: I s
Compulsory Health Insurance the Solution?" New England Journal
of Medicine, 240, 998, 1949. Reprinted i n Committee on Medical
Care Teaching of the Association of Teachers of Preventive
Medicine, Readings in Medical Care. Chapel H i l l , NC:
University of North Carolina Press, 1958.
New York Academy of Medicine. "Toward a National Health Program."
B u l l e t i n of New York Academy of Medicine, 48, January 1972.
Roemer. M.I., "I.S. Falk, the Committee on the Costs of Medical
Care, and the Drive for National Health Insurance. American
Journal of Public Health, 75, 841, 1985.
Schwartz, H. The Case for American Medicine: A R e a l i s t i c Look at
Our Health Care System! New York: David McKay, 1972.
S i g e r i s t , H.E., On the Sociology of Medicine, M.I. Roemer, (Ed.).
New York: M Publications, 1960.
D
Stevens, R. American Medicine and the Public I n t e r e s t . New Haven,
CT: Yale University Press, 1971.
The Nation's Health, "Insurance Plan Stresses Reform, Prevention."
March, 1990, p. 1.
Truman, H.S., Message from the President of the United States, 79th
Congress, 1st Session. Washington, DC: USGPO, 1945. Reprinted
in, Committee on Medical Care Teaching, Readings i n Medical
Care. Chapel H i l l , NC: University of North Carolina Press,
T958, p. 629.
U.S. Bipartisan Commission on Comprehensive Health Care, (The Pepper
Commission) A C a l l for Action. Washington, DC: USGPO,
September, 1990.
Washington Report on Medicine and Health, "Stark, Kennedy to Propose
Health Reforms. June 17, 1985.
�Appendix I I *
L i s t of c r i t i c a l reports/analyses of the U.S. Health Care Delivery
System, 1927-831
Business Week. "The $60-Billion C r i s i s over Medical Care." Special
reprint, January 17, 1970.
Citizen's Board of Inquiry into Health Services for Americans. Heal
Yourself (Report). Washington, D.C: Citizen's Board of Inquiry
into Health Services, for Americans, 1971.
Ehrenreich, B., & Ehrenreich, J . The American Health Empire: Power,
P r o f i t s , and P o l i t i c s . New York: Vintage Books, 1971.
Harper's Magazine. "The C r i s i s in American Medicine." October 1960,
p. 123.
Healthline. "American Health Care: A System in C r i s i s . " October
1983, p. 7.
Health Task Force of the Urban Coalition. Rx for Action (Report).
Washington, D.C: 1969.
Jonas, S. Medical Mystery: The Training of Doctors in the United
States:
New York: W. W. Norton, 1^79.
Kennedy, E. M. In C r i t i c a l Condition. New York: Simon and Schuster,
1972.
Knowles, J . H. (Ed.). Doing Better and Feeling Worse. New York:
W. W. Norton, 19771
Moskin, J . R. "The Challenge to Our Doctors." Look, November 3,
1964, p. 26.
National Commission on Community Health Services. Health I s a
Community A f f a i r . Cambridge, MA: Harvard University Press.
1966.
Ribicoff, A., with Danaceau, P. The American Medical Machine. New
York: Saturday Review Press, 1972.
Schorr, D. Don't Get Sick in America. Nashville, Tenn.: Aurora
Pub1ishers, 1970.
S i l v e r , G. A. A Spy in the House of Medicine. Germantown, MD: Aspen
Systems Corporation, 1976.
~
Somers, A. R., & Somers, H. M. Health and Health Care. Germantown,
MD: Aspen Systems Corporation, 1977.
Sidel, V. W., & Sidel, R. A Healthy State (Revised and Updated). New
York: Pantheon Books, 1983.
*
This Appendix taken from i s Appendix I in Jonas, S., An Introduction to the U.S. Health Care System, (New York: Springer
Publishing Co., 1992), and i s used with the permission of the
publisher.
�Further, in a review of John and Barbara Ehrenreich's The
American Health Empire; Power, P r o f i t s , and P o l i t i c s , (New York:
Vintage Books, 1971), which appeared in the International Journal o
Health Services, (2, 119, 1972), Dr. Milton Roemer l i s t e d a s e r i e s
of other " c r i s i s type" reports going back many years. He said (p.
119) :
"Every few years, more recently in the l a s t decade, there
appears a book analyzing the serious defects of health care in
America. In 1927, Harry H. Moore produced American Medicine and
the People's Health, in the 1930's were the magnificent 27
volumes of the Committee on the Costs of Medical Care, in 1939
there was James Rorty's American Medicine Mobilizes, and i n
1940 Hugh Cabot's The Patient Dilemma. After World War I I ,
Carl Malmberg wrote~r40 Million Patients in 1947, Michael Davis
wrote Medical Care for Tomorrow in 1955, and Richard Carter
wrote The Doctor Business in 1958. In 1965 there was S e l i g
Greenberg's excellent The Troubled Calling: C r i s i s in the
Medical Establishment. The year after Medicare, 1966, saw two
c r i t i c a l outputs: The" American Health Scandal by Raul Tunley
and The Doctors by Martin L. Gross. In 1967 there was Fred J .
Cook" "s~~I?lot Against the Patient and in 1970 Ed Cray's In
F a i l i n g HealtH."
y
—
�Appendix I I I *
"We've Got Problems," 1968-1990
In the 1960s and 1970s, observers of the U.S. health care
system, of d i f f e r i n g p o l i t i c a l persuasions, often spoke of
" c r i s i s . " Indeed there has been a long l i n e of c r i t i c a l reports and
studies going back many years. (For an introductory bibliography of
such reports, see Appendix I I . )
For example, i n 1968, an a r t i c l e called " C r i s i s in American
Medicine" i n the B r i t i s h journal The Lancet began ( B a t t i s t e l l a &
Southby, p. 581) :
"In terms of gross national product the U.S.A. spends more on
health than does any other country. But costs are r i s i n g at
such a rate that more and more people w i l l find i t d i f f i c u l t to
get complete health care. This p a r t i c u l a r l y applies to the
poor, the old, the Negroes, and other disadvantaged groups.
Doctors and hospital beds are distributed most unevenly both i n
broad geographic regions and between States. There are
indications, too, that the quality of care has been i n f e r i o r ,
especially i n terms of antenatal and infant mortality. The
whole organization of medical care i n the U.S.A. has f a i l e d to
respond to changing disease patterns, the move from country to
c i t i e s , i n d u s t r i a l i z a t i o n , and the increasing proportion of old
people i n the population."
In 1970, the editors of Fortune Magazine wrote (p. 9 ) :
"American medicine, the pride of the nation for many years,
stands now on the brink of chaos. To be sure, our medical
practitioners have their great moments of drama and triumph.
But much of the U.S. medical care, p a r t i c u l a r l y the everyday
business of preventing and treating routine i l l n e s s e s , i s
i n f e r i o r i n quality, wastefully dispensed, and inequitably
financed. Medical manpower and f a c i l i t i e s are so
maldistributed that large segments of the population,
especially the urban poor and those i n r u r a l areas, get
v i r t u a l l y no care at a l l even though t h e i r i l l n e s s e s are most
numerous and, i n a medical sense, often easy to cure."
In a s i m i l a r vein, Senator Edward M. Kennedy, speaking to an
audience of doctors i n New York City i n 1971, said (Klaw, p. x i ) :
*
This Appendix i s drawn from Chapter One, "The U.S. Health Care
Delivery System: An Overview" of An Introduction to the U.S.
Health Care System, New York: Springer Publishing Co., by
Steven Jonas, M.D., M.P.H. Used with the permission of the
publisher.
�Appendix I I I : "Problems" Quotes
Page 2
"America i s beginning to r e a l i z e that we have a health care
c r i s i s on our hands, and that the magnitude of the c r i s i s i s
enormous. . . . I challenge even the most reactionary p i l l a r s
of organized medicine, even the most affluent physicians i n the
most affluent suburbs of t h i s r i c h c i t y , to deny that a c r i s i s
e x i s t s , or that i t e x i s t s for a l l Americans
not j u s t the
poor, not j u s t the black, but each and every one of us."
In 1973, the Research and Policy Committee of the Committee for
Economic Development, the board of which i s composed of
representatives of many of the leading American corporations and
banks, came to the following conclusions concerning the present
system (p. 17):
" F i r s t , faulty allocation of resources i s a major cause of
inadequacies and inequalities in U.S. health services that
r e s u l t today in poor or substandard care for large segments of
the population.
Second, the task of assuring a l l people the
a b i l i t y to cope f i n a n c i a l l y with the costs of health care has
been made r e a l i z a b l e by the substantial base of coverage now
provided by both private and public insurance plans. Third,
unless step-by-step alterations are made i n the means of
delivering services and paying providers, closing the gaps in
financing would overburden an inadequate system and offer
l i t t l e prospect of materially improving the quality and
quantity of medical services of the health of the American
people."
In 1979, Congressman Ronald Dellums introduced a b i l l to create
the National Health Service, with a statement that said, i n part
(Dellums):
"We have in t h i s country today a health delivery system where
the quality of health care received i s determined by race,
language, national origin, or income l e v e l . Healtt\ i s viewed,
as a commodity to be bought and sold in the marketplace, i t i s
not viewed as a right of the people; a service to be provided
by the Government. However, financing i s not the only problem
facing the people when i t comes to the delivery of health
care. Other, equally important, problems are the
maldistribution of health manpower, the unequal access to
services, the unreliable quality of care, and the lack of
public control over health care. No matter how much we
guarantee the payment of services to the people, i t i s of
l i t t l e comfort to them i f there i s no one around to provide the
service."
And f i n a l l y , in 1990, perhaps the most prominent of a spate of
reports and program proposals for health care delivery reform issued
that year had t h i s to say (Pepper Commission, p. 2 ) :
"The American health care system i s approaching a breaking
point. Rapidly r i s i n g medical costs are increasing the numbers
of people without health coverage and straining the system's
�Appendix I I I ; "Problems" Quotes
Page 3
capacity to provide care for those who cannot pay. The gap i s
widening between the majority of Americans, who can take
advantage of the best medical services i n the world, and the
r e s t , who find i t hard to get even basic needed care. As the
gap increases, the weight of financing care for those without
adequate coverage i s undermining the s t a b i l i t y of our health
care i n s t i t u t i o n s . Even for the majority, the explosive growth
in health care costs i s steadily eroding the private insurance
system
the bulwark they count on as t h e i r defense against
f i n a n c i a l r i s k i n case of i l l n e s s . "
Perhaps Commission member Senator David Durenberger of
Minnesota said i t best (Pepper Commission, p. 2 ) :
"The American health care system . . .
and want . . . "
[ i s ] a paradox of plenty
�Appendix I I I ; "Problems" Quotes
Page 4
References, Appendix I I I (additional)
B a t t i s t e l l a , R., & Southby, R. " C r i s i s i n American Medicine." The
Lancet, March 16, 581, 1968.
Dellums, R. "The Health Service Act: H.R. 2969," Congressional
R e c o r d , 1 2 5 , ( 3 3 ) , 1979.
Fortune Magazine editors. Our Ailing Medical System: I t ' s Time to
Operate"! Hew York: Harper & Row, 1970.
Klaw, S., The Great American Medicine Show. New York: Viking, 1975.
Pepper Commission, A C a l l for Action, Executive Summary, Washington,
DC: US Government Printing Office, September, 1990.
Research and Policy Committee. Building a National Health-Care
System. New York: Committee for Economic Development, 1973.
�Appendix IV*
The U.S. Health Care Delivery System; A Brief Description
I.
Major Defining Characteristics
There are several major c h a r a c t e r i s t i c s of the system of health
care i n the United States which distinguish i t from that of most of
the world's 160 or so other nations. F i r s t , an affluent
industrialized country, the United States has chosen to spend much
money on health services. In fact i t spends a higher proportion of
i t s Gross National Product, 12.2% in 1990 (Levit, et a l ) , than any
other country in the world. Second, since the U.S. i s a federated
nation, the system's governance i s decentralized to many states,
counties, and communities. Third, t h i s nation has a freer market
economy than most other countries. Thus, in the operations of most
of the system's components, permissive l a i s s e z f a i r e concepts have
been the norm, at least u n t i l very recently.
There are, of course, other affluent and industrialized
nations, other federated republics, and other r e l a t i v e l y l a i s s e z
f a i r e econo-mies. The degree to which these national attributes
have influenced the structure and function of the U.S. health care
system i s s i g n i f i c a n t . The system's pluralism and complexity
produces much in the way of s c i e n t i f i c innovation. However, these
two c h a r a c t e r i s t i c s are also major causes of the fact that the
system's product varies widely in quantity and quality by geographic
region and the s o c i a l c l a s s of i t s recipients.
Throughout our history, national p o l i t i c a l and health
professional leaders alike have generally been dedicated to free
market principles. Yet in spite of that, many interventions in the
operation of the market for health services have become necessary.
I t i s in fact impossible for a free market to operate in a system in
which the beneficiaries have very l i t t l e knowledge of the guality,
quantity, or need of the product they are buying, most buying
decisions are in fact not made by the beneficiaries but .rather by .
the providers/sellers of the services, and in many cases a t h i r d
party pays a l l or part of the b i l l . But in certain p o l i t i c a l and
professional quarters the myth continues to be perpetuated.
Additionally, the expectations of people for recovery from
disease and the maintenance of good health have r i s e n . As t h i s has
occurred, more i n i t i a t i v e s to change the system's contours have
become necessary. Societal actions have been taken to increase the
quantity and quality of resources produced, to plan for and change
system management, to a l t e r the overall system structure, to
*
This Appendix i s drawn from Chapter One, "The U.S. Health Care
Delivery System: An Overview" of An Introduction to the U.S.
Health Care System, New York: Springer Publishing Co., 1992, by
Steven Jonas, M.D., M.P.H. Used with the permission of the
publisher.
�Appendix IV: US Health Care System
Page 2
strengthen mechanisms of f i n a n c i a l support and control, and to
r a t i o n a l i z e and improve the delivery of services.
American medical practice i s organized primarily on the p r i v a t S ^
entrepreneurial model. Although with the advent of Health
Maintenance Organizations the pattern i s changing, medical care i s
s t i l l provided primarily on the basis of a private, d i r e c t , usually
unwritten, contract between physician and patient.
Since medical
care
that i s , the treatment of sick persons by physicians
is
the focus of the U.S. health care delivery system, and primarily
private, the organizational framework of the health care delivery
system i s rudimentary compared to that found in other countries.
But before reviewing some of the d e t a i l s of the system i t s e l f , l e t
us consider some of the c h a r a c t e r i s t i c s of the population which i t
serves.
II.
The Health Status of the U.S. Population*
In 1988 the United States population was about 246 m i l l i o n
(Stat., Table 2 ) . The population i s aging: the proportion of
persons 65 and over i s over 12% (Stat., Table 13). Many ethnic and
national groups are represented. There i s a broad range of s o c i a l
classes, and large income d i f f e r e n t i a l s e x i s t . There are also great
inequities in the amount and quality of health care received and in
health status. Much of the excellent health service of which the
nation i s capable i s not accessible to everyone. Proportionately,
there are more nonwhite-persons in the lower s o c i a l - c l a s s and income
groups than in the general population. Unemployment or the threat
of i t , substandard housing, and dysnutrition are major socioeconomic
problems in r u r a l as well as urban areas.
In 1988 overall l i f e expectancy for U.S. residents was 74.9
years at birth (Stat., Table 103). For men i t was 71.4 years while
for women i t was 78.3 years. There was a marked difference i n l i f e
expectancy at birth by race: 75.5 for whites, 71.5 for blacks.
(Ominously, in 1989 for the f i r s t time in many years, U^S. l i f e
expectancy declined [ H i l t s ; MVSR]. As well, the black-white gap
widened. At that time i t was of course too early to know whether
t h i s was a one-time only a r t i f a c t or an event of h i s t o r i c a l
significance.) The black-white difference in l i f e expectancy i s
thought in part to r e f l e c t differences in the standard of l i v i n g , as
well as access to health services (Schwartz, et a l ) .
*
Unless otherwise referenced, the data presented in the balance
of t h i s chapter come from the S t a t i s t i c a l Abstract of the
United States, 110th ed. (Washington, DC: U.S. Bureau of the
Census, [USBoC] 1990), (cited in the text as S t a t . ) , and Health
United States, 1989, (Hyattsville, MD: U.S. Department of
Health and Human Services [USDHHS], Pub. No. [PHS] 90-1232,
March, 1990), (cited in the text as Health). Some of the data
presented here are for 1988, other data for 1990. The former
can be readily updated when, as, and i f necessary.
�Appendix IV; US Health Care System
Page 3
In 1988 the U.S. infant mortality rate was 9.9 per 1000 l i v e
births (Stat., Table 80). While t h i s i s low, of course, i t i s
s l i g h t l y higher than that of some 14 other countries, mainly in
Western Europe, but including Australia, Canada, and Japan (Stat.,
Table 1440). I t i s perhaps s i g n i f i c a n t that i n 1987 other than
Switzerland, Japan, and Germany, these countries had a lower per
capita gross national product
than does the U.S. However, they a l l have systems of national
health care which make services accessible to v i r t u a l l y everyone at
l i t t l e or no cost at the time of service. The white/black infant
mortality rate difference in the U.S. i s s t r i k i n g . In 1987, i t was
8.6 for whites, 15.4 for blacks (Stat., Table 110). However, the
black infant mortality rate has been double that for whites since
1915 when the rate was f i r s t recorded, and i t was 99.9 overall
(Grove and Hetzel).
In 1988 the crude death rate was under 9 per 1,000 population,
9.4 for males, 8.3 for females (Stat., Table 107). Again, there was
a major d i f f e r e n t i a l by ethnic group. The crude (that i s the
simple) death rate was higher for whites, 9.1, than i t was for
blacks, 8.5. But the age-adjusted death rates, ("age-adjusting" i s
a s t a t i s t i c a l correction to the the crude figure which takes into
account the observed fact that black l i f e expectancy i s shorter)
were 5.1 for whites, 7.1 for blacks.
The major causes of death in the general population are heart
disease, cancer, stroke, personal injury, and chronic obstructive
lung disease and pneumonia (Stat., Table 115). The major causes of
morbidity (sickness) are upper respiratory infections, influenza,
i n j u r i e s , heart conditions, hypertension, a r t h r i t i s , impairments of
the lower limbs, impairments of the back and spine, asthma and hay
fever, and mild emotional disorders (Adams and Hardy, Tables 1-10).
There i s no consistent association between family income and .
the number of acute conditions per 100 persons per year. However,
there i s an inverse correlation between family income and the number
of days of r e s t r i c t e d a c t i v i t y associated with acute conditions
(Adams and Hardy, Tables 4, 19). I t i s interesting to note that
blacks report both fewer acute conditions and fewer days of
r e s t r i c t e d a c t i v i t y related to them than do whites (Adams and Hardy,
Tables 3, 18). There are no s t a t i s t i c a l l y s i g n i f i c a n t differences
in the proportion of acute i l l n e s s e s receiving medical attention by
either ethnicity or income (Adams and Hardy, Tables 13, 14).
I l l . The Elements of the System
A.
Introduction
Any health care delivery system has five major components: the
several health care i n s t i t u t i o n s , the personnel who work in them,
the firms producing "health commodities" such as pharmaceutical
drugs and hospital equipment, the institutions that produce
biomedical knowledge and health personnel, and the financing
�Appendix IV: US Health Care System
Page 4
mechanism. The components interact with each other through an
organizational structure standing at the system's center, l i k e the
trunk of a tree. (In the U.S. i t happens there i s not one central
trunk, but multiple ones. Think Banyan tree, not oak.)
I t i s this
structure which enables the components to produce health services
for the people.
As noted above, among the industrialized countries of the world
the U.S. system i s unique. There i s no national Ministry of Health
playing a central role in either or both the financing and operation
of health services. In other countries, even i f the ministry does
not operate the system d i r e c t l y , i t at the l e a s t creates and
supervises the structure within which i t functions. There i s no
equivalent in the United States. There i s of course a system; there
are l o c i of power and control, but they are sometimes d i f f i c u l t to
recognize and to describe.
B.
Health Services Components
1.
Health Care I n s t i t u t i o n s .
Various types of i n s t i t u t i o n s provide health care s e r v i c e s . The
most frequently used type of care i s "ambulatory," that which i s
provided to patients other than those in i n s t i t u t i o n a l beds. About
60% of ambulatory care i s delivered in private doctors' o f f i c e s ;
other s i t e s include hospital ambulatory services (about 13%), by
telephone (about 14%), the home (about 1.5%), and "other," (group
practices, health maintenance organization, neighborhood health
centers, and local health department health centers), about 13%
(Health, Table 64).
Of the i n s t i t u t i o n s housing and caring for patients in bed,
acute-care hospitals are the most numerous. In 1989, there were
about 5,800, with about 1.04 million beds (AHA, Table 1). Hospitals
are categorized in a variety of ways: by ownership, s i z e , function,
and average length of stay. There are three p r i n c i p a l types of
ownership: government (federal, state, and l o c a l ) ; private, not for
p r o f i t (voluntary); and private, for p r o f i t (proprietary). There
are four functional categories for hospitals m the United States:
general, tuberculosis, mental, and other s p e c i a l . The American
Hospital Association also defines the "community h o s p i t a l " : a
nonfederal, short-term general or other special h o s p i t a l . I t i s the
predominant type in the United States. As of 1986, there were about
16,000 nursing homes and other nonmental-condition long-term care
institutions.
2.
Health Manpower. In 1988, about 8.8 m i l l i o n people worked
in the health care delivery system (Health, Table 83). The largest
groups are the nurses, c l e r i c a l s t a f f , hospital manual workers,
physicians, dentists, pharmacists, and technicians. The physicians,
of whom there were more than 560,000 active in 1987, are the most
powerful, and indeed the dominant group.
�Appendix IV: US Health Care System
Page 5
3.
Health Commodities. A wide variety of commodities i s used
in the health care delivery system. Many kinds of equipment and
supplies for the diagnosis and treatment of disease are produced by
the hospital and medical supply manufacturers. These items range
from gauze pads, s t e r i l e needles, laboratory chemicals, and
anesthetic gases, to diagnostic imaging and laboratory equipment,
surgical instruments, orthopedic appliances, eyeglasses, hearing
aids, dental prostheses, hospital furniture. The other major
category of health commodity i s the pharmaceutical drugs.
4.
Health Personnel and Knowledge Reproduction. Every health
care system depends on knowledge about health and disease, and the
application of that knowledge to prevention and treatment through
various technologies. A vast store of knowledge, of course, has
been gathered from the observations and experience of past
centuries, but in the modern world new knowledge i s constantly being
acquired by s c i e n t i f i c research. Knowledge must be activated by the
education and training of people to use i t . Health sciences
education plays a c r i t i c a l role in forming the health care delivery
system.
5.
Health Care and Financing. As noted elsewhere, in 1990
the United States spent about 5666 b i l l i o n on health services, more
than 12% of i t s GNP (Levit, et a l ) . An estimated $733 b i l l i o n ,
$23,000 per second, more than $2 b i l l i o n per day was spent in 1991
(Castro). Since the 1965 enactment of Medicare, i n f l a t i o n in health
care costs has consistently outstripped general i n f l a t i o n (Levit, et
a l . Figure 2 ) .
Ultimately, a l l money paid for health services comes from the
people. There are three major means by which money i s transferred
from them to the providers for the provision of health services: (1)
via government (in 1990 about 42% of t o t a l expenditures); (2) v i a
insurance companies (about 33% of the t o t a l ) ; and (3) v i a direct
payment (about 25% of the total) (Levit, et a l , Figure \ ) .
Government expenditures are for both services that i t operates
d i r e c t l y and services patients receive from independent providers.
In t h i s case government i s a "third-party" payor (that i s , i t i s
neither the provider nor the patient but simply the payor). The two
major factors in the private insurance sector are Blue Cross/Blue
Shield (not for p r o f i t ) and the commercial (for-profit) companies.
The major recipients of funds are the hospitals (38%),
physicians (19%), nursing homes ( 8 % ) , other personal health care
(23%), and other spending (12%) (Levit, et a l , Figure 1). The
majority of health care personnel are paTH on salary, while the
private practitioners are usually paid on a fee-for-service basis.
I n s t i t u t i o n s for the most part operate on a global budget or on a
cost-reimbursement basis.
�Appendix IV: US Health Care System
C.
Page 6
Health Programs
The output of any health care delivery system i s often
described i n terms of i t s major "health programs."
The forms and
proportionate role of each program d i f f e r among national systems.
In the United States, as i n most countries, there are f i v e major
types of health program, those of: the p r i n c i p a l governmental health
authority, other agencies of government with health functions,
voluntary health agencies, commercial enterprises with health
functions, and the private health care sector. I t i s within the
health programs that the five components, f a c i l i t i e s , personnel,
commodities, knowledge, and money interact to produce health
services.
1.
Government i n Health Services. Although the U.S. Federal,
state, and local governments by themselves operate no program of the
health care system i n i t s entirety, c o l l e c t i v e l y the government i s
closely involved i n one way or another i n a l l of them, by:
collecting and disseminating information, educating and t r a i n i n g
personnel d i r e c t l y and by providing f i n a n c i a l support for t r a i n i n g
and education, operating health care i n s t i t u t i o n s , providing other
direct health services, participating i n financing, supporting and
carrying out research, planning, evaluating, and regulating.
When the need to protect people from hazards of the environment
and of epidemic diseases was recognized, public health agencies were
developed. Social insurance began as a movement to protect the
economic position of low paid workers, who could be ruined by the
costs of sickness
both lost earnings and the costs of medical
care. Almost everywhere, therefore, the locus of s o c i a l insurance
in the structure of government has been different from that of
public health.
The U.S. Department of Health and Human Services i s responsible
for the Federal Social Security program, the Federal role i n the
state-run public assistance programs, and the main Federal programs
in health services, research, regulation, and financing. Many of
the Department's r e s p o n s i b i l i t i e s are met by allocation of money and
delegation of authority to many other public and private e n t i t i e s
throughout the nation. Because t h i s country i s a federation of
states, the U.S. Constitution grants the states a great deal of
autonomy and r e s p o n s i b i l i t y i n a l l s o c i a l a f f a i r s , including
health. I t should be noted that many other Federal government
departments, from Agriculture to the Treasury, have some health
responsibilities.
In each of the 50 states there i s a major health agency. I n
some states, as at the Federal l e v e l , i t i s combined with
authorities for s o c i a l welfare or other functions. The
administrative configuration and scope of functions of the state
health agencies are highly variable. The heads of these agencies
are ordinarily appointed by the state's governor. They are
responsible e n t i r e l y to the governor and not at a l l to the U.S.
Department of Health and Human Services. Only insofar as c e r t a i n
�Appendix IV: US Health Care System
Page 7
standards must be met, as a condition for receipt of c e r t a i n Federal
monies, must the state accept national direction. (Of course, under
the Federal Supremacy doctrine, the states may not undertake any
actions that are contrary to the provisions of the U.S.
Constitution.)
Similarly, below the level of state government, there are units
of l o c a l government, counties, c i t i e s , and occasionally s p e c i a l
d i s t r i c t s , that also have a major health agency. Most of these have
great autonomy, although on certain health matters the l o c a l health
department may carry out functions delegated by the state agency.
2.
Voluntary Agencies. In a l l countries there are
nongovernmental agencies that play a role in health care systems.
Commonly known as voluntary agencies (e.g. American Heart
Association, American Cancer Society, V i s i t i n g Nurse Association),
they have a wide variety of functions: to perform a service not
rendered by other agencies, to pursue a certain research or service
objective with special vigor and dedication, to advance or protect
the i n t e r e s t s of a certain population group, and sometimes even to
carry out certain tasks at the behest of o f f i c i a l bodies.
Like any corporation, in order to stay in business they must
take i n more money than they spend. In the "voluntary" agency,
however, the excess of income over expenses does not accrue to any
individual(s) but rather supports the expansion of the agency's
work. These corporations are thus a l t e r n a t i v e l y termed "not-forp r o f i t " or "nonprofit."
In the United States there are hundreds of agencies that r a i s e
funds and carry out programs for fighting certain diseases
cancer, tuberculosis, mental i l l n e s s ; focusing on the health of
certain population groups
children, Native Americans, war
veterans; providing certain types of health service, such as
v i s i t i n g nurse care, hospitalization, or r e h a b i l i t a t i o n .
The
voluntary agency may be devoted exclusively to health purposes, or
health services may be incidental to certain larger purposes, such
as those of church groups or religious missions (domestic or
foreign).
A subset of the voluntary health agency i s the health
professional organization, e.g., the American Medical Association,
the American Nurses Association, the American College of Preventive
Medicine, the Academy for Health Services Marketing. They are
financed by membership dues, journal subscriptions and advertising
fees, and on occasion research grants and contracts. They are
primarily concerned with advancing the perceived professional and
economic i n t e r e s t s of their members, through public education,
continuing professional education, l i t i g a t i o n , l e g i s l a t i v e and
p o l i t i c a l action, and, on occasion, trade union-like a c t i v i t y . As
well, they may also focus on advancing s c i e n t i f i c knowledge and
understanding, setting and maintaining professional standards, and
educating the public about health and disease.
�Appendix IV: US Health Care System
Page 8
3.
Private Professional Practice. The U.S. health care
delivery system i s dominated by private professional practice. A s ^ B
of the 1990s, though system trends have been changing many of t h e s ^ ^
relationships, o f f i c e and in-hospital medical care (both general and
specialized), dental care, chiropractic, pharmacy, o p t i c a l , medical
and non-medical psychotherapeutic, speech and audiology services,
the f i t t i n g of prosthetic appliances, as well as others, are
furnished primarily by private practitioners.
I t i s especially noteworthy that, even when the f i n a n c i a l
support for health services has been c o l l e c t i v i z e d , as i n the
various public or voluntary health insurance programs or i n the tax
supported Medicaid program for the poor, the provision of services
remains substantially i n the private market. For care i n the
doctor's private o f f i c e , t h i s i s quite obvious, but even i n a
hospitalized case, the service i s rendered to a private patient, and
the responsible t h i r d party payor, i f any, pays a private fee.
This concludes t h i s brief overview of the structure and
principal functions of the U.S. health care delivery system.
�Appendix IV: US Health Care System
Page 9
References: Appendix IV (additional)
Adams, P.F., and Hardy, A.M., "Current Estimates from the National
Health Interview Survey," V i t a l and Health S t a t i s t i c s , Series
10, No. 173, October, 1989.
AHA, American Hospital Association, Hospital S t a t i s t i c s , 1990-91
Edition, Chicago, I L : 1990.
Grove, R.D. and Hetzel, A.M., V i t a l S t a t i s t i c s Rates i n the United
States: 1940-1960, Washington, DC: National Center for Health
Statistics,
USDHEW, 1968.
H i l t s , P.J., " L i f e Expectancy for Blacks i n U.S. Shows Sharp Drop."
The New York Times, November 29, 1990, p. A l .
MVSR:~H"onthly V i t a l S t a t i s t i c s Report, "Advance Report of Final
Mortality S t a t i s t i c s , 1988." Vol. 39, No. 7, Supplement,
November 28, 1990.
USBoC: U.S. Bureau of the Census, S t a t i s t i c a l Abstract of the United
States, 110th ed. Washington, DC: U.S. Government Printing
Office.
USDHHS: U.S. Department of Health and Human Services, Health United
States, 1989, USDHHS Pub. No. [PHS] 90-1232. Washington, D.C:
U.S. Government Printing Office, 1990.
�Appendix V*
On the Canadian System
I.
Why Look at Canada
We look at Canada to help us understand our system and our
problems better and, possibly, to find some help and inspiration i n
solving our problems. But the Canadian system and experience should
be considered a guide for us, not a template. Canada i s a vast, but
vastly different country from ours even i f we share much, from the
world's longest unguarded border to major league hockey and
baseball. We should learn lessons from Canada, not t r y to imitate
i t . And those reformers who look to Canada for guidance should do
j u s t that, look for guidance, both positive and negative. I t i s not
helpful to get caught up i n defending the Canadian system against
i t s c r i t i c s , both in Canada and t h i s country. That i s a task for
the Canadians.
II.
NHI i n Canada: Basic Features
What eventually became a national health insurance program for
Canada began i n one province, Saskatchewan, i n 1947.
Nationwide
coverage for hospital care was introduced in 1957, followed by
coverage for physicians' services i n 1971. The Canadian experience
with NHI has generated much interest in the U.S., and has generated
many evaluations, pro and con (Evans, et a l ; Fuchs and Hahn;
Goodman; Hospitals; Igelhart, 1986, 1990; Linton; Woolhandler and
Himmelstein).
The present Canadian system has been i n place for about 20
years. I t i s founded on four principles:
1.
There s h a l l be universal coverage for a l l Canadians, with
low or no co-payments, and reasonable access to care.
2.
The benefits for each covered person s h a l l be portable
from province to province.
3.
A l l medically necessary services s h a l l be covered.
*
This Appendix i s drawn i n part from Chapter Eight,
"National Health Insurance," ( i t s e l f based i n part on a
personal communication from Dr. Milton Roemer dated February 5,
1991), of An Introduction to the U.S. Health Care System, New
York: Springer Publishing Co., 1992, by Steven Jonas, M.D.,
M.P.H. Used with the permission of the publisher. I t i s also
based i n part on a presentation the author made at the National
Health Forum of the National Council Of Senior Citizens, Queens
College, NY, June 2, 1989, which i n turn was based i n part on:
Wollhandler, S. and Himmelstein, D., "Resolving the Cost/Access
Conflict," Journal of General Internal Medicine, 4, 54, 1989.
�Canada
Page
4.
2
Administration s h a l l be by not-for-profit, public
agencies.
In practice, t h i s means that a l l acute care and certain longterm care services are covered. The provincial governments run the
program and pay for about 65% of a l l hospital and medical care.
Private insurance i s limited to those services not covered by NHI,
e.g. some dental and some long-term care. The program i s funded i s
primarily from progressive taxation at both the Federal and
provincial l e v e l s . Several provinces do charge t h e i r c i t i z e n s
premiums, either at a f l a t rate or in proportion to wages (up to a
maximum).
Most hospitals are private, not-for-profit. Most doctors are
in private practice. The plans pay the hospitals with a lump-sum
budget to cover a l l operating expenses. (The actual payments are
made every few weeks.) Capital funds come from the insurance fund,
but are allocated to hospitals separately from t h e i r expense
budgets. (In that way, the plan keeps control of hospital c a p i t a l
expenditure, an e s s e n t i a l element of any e f f e c t i v e cost-containment
program.) Patients are b i l l e d only for items deemed to be "luxury,"
such as e l e c t i v e private rooms.
Physicians are paid on a fee-for-service basis, according to a
fee-schedule negotiated between the provinces and the medical
s o c i e t i e s . They can b i l l only for their personal services, not the
c a p i t a l costs of machinery in their private o f f i c e s or the work of
other health professionals. Physicians cannot "balance-bill, (that
i s , charge a patient extra for any service covered by the plan). In
American terminology, Canadian physicians must "accept assignment,"
(that i s agree to be paid by the plan, not the patient).
11
Patients have freedom of choice of provider. Access to care
has improved dramatically over the years. Most measures of health
are as good or better than those in the U.S.
Cost increases have .
been r e l a t i v e l y modest. In the 1960s, the percent of GNP spent for
health care was about the same in Canada and the U.S.
By 1989, i t
was over 30 percent higher in the l a t t e r . Medicine has remained a
desirable profession i n Canada. In 1987, the r a t i o of applicants to
available medical school spaces was 4.7 in Canada, compared with 1.8
in the U.S.
In r e l a t i v e terms, Canadian physician incomes have remained
about where they were before NHI: abount 4.8 times the average
i n d u s t r i a l wage. That level i s about the same as [reported]
physician income here. Income d i f f e r e n t i a l s between primary care
and s p e c i a l i s t physicians are rather low, (unlike the situation in
the U.S.). There i s considerably less bureaucratic interference in
c l i n i c a l practice in Canada, and b i l l i n g i s considerably simpler.
Out of about 50,000 physicians in Canada, in 1985 fewer than 400
chose to emigrate to the United States.
�Canada
Page
3
I I I . Problems
Of course there are problems. Any system has problems. I t i s
of interest that the only one which U.S. c r i t i c s of the system
hammer away at i s excessive waiting time for certain investigative
and operative procedures. That i s a problem which can be solved
very simply by setting a higher p r i o r i t y on those interventions.
There i s no necessary connection between monopsony payment and long
waits for elective procedures. There i s a necessary connection
between employment-based health insurance and lack of coverage for
major segments of the population, between f i s c a l l y - s t a r v e d municipal
hospitals and under-service for the urban poor.
In Canada there has been some rationing (some c a l l i t "prudent
use") of certain hi-tech services. There has been some overservicing by physicians, (responded to by the i n s t i t u t i o n of a t o t a l
income pool and physician income caps). There i s some geographic
maldistribution of physicians, but i t has been reduced.
(Responses
to that problem have been the two t r i e d and true methods of national
health care systems: bonuses for going to underserved areas and
banning from overserved areas.) Long-term care i s uneven among the
provinces, but generally i t has been improved. Prevention s t i l l
does not receive adequate attention, although i t s status i s better
too. The nurse/popula-tion ratio i s the highest i n the world. Thus
there i s l i t t l e use of a l l i e d health professionals.
IV.
How Cost-Containment Was Achieved
Cost-containment has been achieved by:
1.
V i r t u a l l y eliminating the payment middle-man by reducing
t h e i r number to one.
2.
Eliminating the private insurance companies from any piece
of the action other than supplementary insurance.
3.
Having a single source of payment (the "monopsony payor"),
which can set l i m i t s on t o t a l payments while making some
choices about what the payments are made for.
4.
Separating out hospital c a p i t a l formation. (Hospital
operating p o l i c i e s therefore do not have to be t a i l o r e d to
create c a p i t a l funds or pay off loans, for example by
encouraging reimbursable procedure-based interventions.
Capital investment then can be planned on the basis of
unmet need analysis.)
5.
A reimbursement system for hospitals, global budgeting,
which rewards neither over- nor under-utilization, and
encourages "prudent" management, although extraordinary
payments are in extraordinary circumstances.
�Canada
Page
6.
V.
4
Controlling payments to physicians through use of a fee
schedule and mandatory assignment.
Key Differences from the
U.S.
The key features of the Canadian system that d i f f e r e n t i a t e i t
from that of the U.S. are:
1.
Global budgeting for hospitals.
2.
A combination of fee-for-service private practice, with
mandatory assignment, no balance b i l l i n g , and possible
income caps.
3.
Elimination for the insurance companies.
4.
Prospective, external, community needs-based planning for
c a p i t a l investment decisions and separation of c a p i t a l
expenditure from operational expenditures.
These four major changes are aimed at the causes of escalating
costs as well as at other, functional problems in the system.
VI.
Learning Lessons
The major lessons to learn from the Canadian experience are not
the d e t a i l s of the system, (what level of government runs i t , who
administers i t , exactly what the benefits are, exactly what the
sources of revenue are, exactly how services are b i l l e d , and so
f o r t h ) . They are, f i r s t , that government has a major role to play
in the operation of any smoothly functioning health care delivery
system. To achieve the l a t t e r goal, government c e r t a i n l y does not
have to own and run the system. Both ownership and operating
r e s p o n s i b i l i t y can remain in private hands, as long as everyone i s
on the same page and government assembles the resources .and sets the
l i m i t s (rather than having the "free market" set them).
Second, we should learn that i f changes we make are to have any
u t i l i t y , we must f i r s t determine and analyze the true causes of the
problems we are setting out to solve. We must aim our solutions at
those causes, as the Canadians have done. U.S. reformers only
weaken t h e i r position by extolling the virtues of the Canadian
system to the extent that they must spend most of t h e i r time
defending that system. Rather, i t appears to be more useful to
undertake a causal analysis of the problems in the U.S. system,
perhaps as has been done in Section I I I of t h i s monograph, and
develop U.S. solutions to them, using the Canadian experience as a
guide.
�Appendix VI*
A National Policy for Cost Containment in Health Services
I.
Introduction
"There are no v i l l a i n s in the story of r i s i n g health care
costs. instead i t i s a c l a s s i c example of the famous Pogo
cartoon, in which the character announces, We have met the
enemy and i t i s us.' As. . . pointed out, our present health
are system has no incentive to cut costs. I t rewards spending
and penalizes efficiency. Our hospitals compete for doctors
and patients, not by offering lower prices but by offering more
expensive equipment, new hospital wings, and every conceivable
hospital service.
x
"Such a system encourages over building. We have 100,000 empty
hospital beds in t h i s country, which cost $2 b i l l i o n a year to
maintain. I t encourages duplication of expensive equipment
from hospital to hospital, which i s underused. I t encourages
overhospitalization. One person in seven could be more cheaply
treated at home in a l e s s costly setting.
"No single individual i s responsible for t h i s waste and
duplication, but a l l of us pay for the consequences. I f we do
not
act to halt i n f l a t i o n in hospital costs, t o t a l spending for
hospital care w i l l balloon to $220 b i l l i o n in l e s s than ten
years (from an estimated $66 b i l l i o n in 1977), and the cost of
a hospital stay w i l l be more than $5,000 (as compared to an
estimated $1,400 in 1977). Clearly, the time has come indeed
i t has been here for a long time to bite the b u l l e t on hospital
costs." ( 1 ) * *
Vice President Mondale made t h i s statement i n 1977.
It
identified major causes of the seemingly uncontrollable r i s e i n
health care costs which has been occurring in our country since
health care cost data were f i r s t collected on a national basis in
*
This Appendix i s based on an essay prepared for the 1984
Mondale-for-President Campaign, dated January 6, 1983.
The
data are out-of-date and there are a few other anachronisms in
i t . However, i t i s presented e s s e n t i a l l y unedited. For, sad
to say, l i k e the opening paragraph of the F i n a l Report of the
Committee on the Costs of Medical Care, in both the findings
and the recommendations most of i t i s s t i l l v a l i d .
**
Unlike in the balance of the text of t h i s monograph, the
references in t h i s Appendix are numbered. A l l of the
references for t h i s Appendix are presented separately, at the
end of t h i s text.
�-21929.
The statement i s s t i l l appropriate and applicable. The only
thing that has happened to the health care cost problem since the
statement was made i s that i t has gotten worse. We are currently
spending about $300 b i l l i o n per year on health services,
approximately 10% of the Gross National Product.
During the 1970's era of high i n f l a t i o n rates i t was customary,
and s e l f comforting, for defenders of the status quo in the health
services industry to blame general i n f l a t i o n for the bulk of the
r i s e . However, current data show that somehow the cost experience
of the industry i s largely independent of prevailing i n f l a t i o n
rates. For example, in November 1982, while the Consumer Price
Index was r i s i n g 0.1 percent, hospital prices (which happen to be
the p r i n c i p a l driver of health care c o s t s ) , rose 1.4 percent (2).
Unfortunately, the bullet was not bitten when the Vice
President suggested that i t be s i x years ago. The response of the
Congress to the i n i t i a t i v e of the l a s t Democratic Administration to
begin in some way to contain health care costs was to do nothing new
(3).
Under the present Administration, while a useful i n i t i a t i v e
which could lead to savings in the Medicare program has been taken,
many other programs which d i r e c t l y and i n d i r e c t l y a f f e c t cost
containment have been dismantled or c r i t i c a l l y weakened.
In t h i s paper, the causes of r i s i n g health care costs and
proposed "solutions" which have not or cannot work s h a l l be examined
b r i e f l y . The groundwork for a general health care cost containment
policy s h a l l be l a i d and a set of s p e c i f i c proposed components for
i t s h a l l be outlined. The proposed policy w i l l be comprehensive,
problem focussed, and can be expected to work i f properly funded,
staffed and implemented.
II.
A.
What are the Causes of the Rise in Health Care Costs?
Hospitals
Expenditures on hospital services account for more than 40
percent of the national health b i l l . Some of these expenditures are
unnecessary. Bed supply i s a major problem, as well documented in a
major study by the I n s t i t u t e of Medicine which i s s t i l l very much on
target ( 4 ) . Since the maintenance of an empty hospital bed costs
about 70 percent of the cost of a bed occupied by a patient, the
100,000 or so excess hospital beds constitute a severe cost drain.
There i s also the problem of unnecessary u t i l i z a t i o n of existing
beds, which may account for another 100,000 unnecessary beds, these
beds being operated at f u l l cost.
The basic problem i s related to c a p i t a l formation in the
hospital industry. As long ago as 1930, Dr. Rufus Rorem, working
with the national Committee on the Costs of Medical Care, identified
uncontrolled c a p i t a l formation in hospitals as a principal driver of
hospital costs (5). Even then, Dr. Rorem, a CP.A. with an eye on
costs, recom-mended that: "The public might well exercise better
control over the provision of c a p i t a l investment." Dr. Rorem's
�-3findings have been repeated many times, most recently by a
comprehensive study of 3,000 hospitals c a r r i e d out under the
auspices of the National Center for Health Services Research (6).
Put simply, hospitals and t h e i r equipment are expensive.
Unnecessary building and equipped can lead to both duplication of
services and f a c i l i t i e s and unnecessary u t i l i z a t i o n , both expensive.
The manner in which most hospitals are paid for most of t h e i r
services i s also a factor in health care cost increases. The common
system i s called "retrospective reimbursement." Under i t , hospitals
spend money, incur costs and add them up. Then, except i n those few
states which have hospital rate control systems, they are paid on
the basis of costs incurred. This i s simply an i n v i t a t i o n to
spend. Even many leaders of the hospital industry agree "that
retrospective cost reimbursement i s a root cause of i n f l a t i o n a r y
cost increases of the hospital industry." (7)
B.
Physician Behavior
The health care market i s a peculiar one.
In fact, i t i s the
only major one in which the major supplier of service, the
physician, i s the major determinant of demand and u t i l i z a t i o n .
Physician decision making controls about 70 percent of the t o t a l
expenditures in the system, although only about 20 percent of the
t o t a l expenditures go to physicians d i r e c t l y . Thus physician
behavior has a major influence on costs. Both type and amount of
care used as determined by the physician, obviously have a
s i g n i f i c a n t influence on the t o t a l amount of money being spent.
Related to t h i s independent decision making authority i s fraud and
abuse by physicians and other independent providers as well in manyi
programs under which care i s paid for by t h i r d p a r t i e s . Although
not a huge factor in r i s i n g costs, i t i s both s i g n i f i c a n t and
controllable (8).
Another dimension of physician behavior, although c e r t a i n l y not
in any way e n t i r e l y the r e s p o n s i b i l i t y of the medical profession, i s
the malpractice l i t i g a t i o n situation, a highly controversial one (911). Regardless of whose r e s p o n s i b i l i t y the problem i s , and there
are many actors in t h i s p a r t i c u l a r drama, i t i s a costly one.
Malpractice premiums, ultimately paid for by the patients and t h e i r
insurers, are r i s i n g faster than i s the overall cost of health
care. An even more pernicious influence of the current malpractice
l i t i g a t i o n experience on health care costs i s the practice of
"defensive medicine." That i s , in order to protect themselves
against any possibly malpractice l i t i g a t i o n , physicians perform
t e s t s and procedures which would be considered unnecessary on purely
medical grounds. This i s an expensive practice.
C.
Focus on Acute Care
Physician behavior and the heavy emphasis in the hospital
sector on acute care focuses the e f f o r t s of the whole system on
hospital based, acute care. This i s high cost care. The system
concentrates a great deal of effort on dealing with late stage.
�-4expensive i l l n e s s . Only 5 percent of nonpoor, nonelderly families
in our country have medical expenses of more than $5,000.00 i n any
one year. However, such families incur half the medical expenses of
a l l these families taken together (12). Tended to be neglected by the system to a greater or
lesser extent are prevention, early intervention, comprehensive
primary care, the performance of certain hospital t e s t s that can
safely be done on an out patient basis, ambulatory surgery, and the
like.
Furthermore, the focus of acute, complex, late stage, hospital
based care tends to emphasize the introduction of expensive
interventions based on the use of high technology. There have been
numerous instances, some recent, some not so recent, where high tech
interventions have been developed, loosely evaluated, and introduced
widely into medical practice, only to have l a t e r investigation show
that the interventions had s i g n i f i c a n t l y less value than o r i g i n a l l y
thought, that they were being incorrectly or wastefully used, or
that i n some cases they were even harmful (13).
D.
Focus on Nursing Homes
Just as care of intermittent i l l n e s s i s focussed on an
i n s t i t u t i o n with beds, so i s long term care of the chronically i l l
and the infirm elderly. The nursing home dominates the long term
care scene i n our country. Nursing homes are not nearly as
expensive as hospitals, but a s i g n i f i c a n t proportion of patients i n
them could be taken care of at home, i f appropriate support services
were available, at considerably less expense. Furthermore, the
reliance on nursing homes for long term care creates a secondary
problem i n certain parts of the country where there i s a r e l a t i v e
nursing home bed shortage. On Long Island i n New York State for
example, the nursing homes are generally f u l l . Thus patients who
would otherwise not need hospitalization but who do require nursing
home care stay i n expensive hospital beds awaiting nursing home
placement.
E.
Summary
In summary, the principal causes of health care system cost
escalation are over bedding, over u t i l i z a t i o n of hospitals,
uncontrolled hospital c a p i t a l formation, retrospective cost based
reimbursement of hospitals, completely independent physician
decision making, provider fraud and abuse, the malpractice
l i t i g a t i o n situation, the focus of the system on acute, hospital
based care, the uncontrolled introduction of high tech
interventions, and the nursing home focus on long term care.
Ill.
Unsuccessful Attempts at Health Care Cost Containment
The worst thing that can be said about the history of t h i s
experience i s that i n fact no one has ever enunciated a clear,
comprehensive, rational, objectives based cost containment policy,
much l e s s implemented one. The major cause of t h i s state of a f f a i r s
i s the very complexity of the health care delivery system i t s e l f .
�-5I t i s one which has multiple l o c i of power operating together within
no clear national framework. Thus there are the physicians and
other health care providers, the hospitals and other health care
i n s t i t u t i o n s , government at many levels, insurance companies, drug
and hospital supply companies, the research and educational
i n s t i t u t i o n s , and yes, even the consumers of health s e r v i c e s , a l l of
whom have both interests and power. Thus on the one hand, i t
appears to be very d i f f i c u l t the figure out how the system r e a l l y
works, while on the other hand, i f one does develop a "big picture,"
there are so many competing interests to be served when problem
solving i s attempted.
In an a r t i c l e published on March 28, 1982 concluding a s e r i e s
on health care cost containment, The New York Times
"effectively summarized the state of current expert thinking
and experience with regard to dealing with the problem of ever
r i s i n g medical care costs. To summarize the summary:
Meaningful programs to r e s t r a i n medical care costs would
require extensive alterations i n the f i n a n c i a l and other
incentives of patients, physicians, hospitals, and medical
schools, as well as major changes in the i n s t i t u t i o n a l
structure through which most medical care i s delivered and paid
for. These changes would meet considerable resistance from
v a r i e t i e s of vested interests and long established behavior
patterns of providers, patients, and t h i r d party payers. A
question would remain as to the possible medium and long term
deleterious effects such changes might have on the health
status of major segments of the American public. The f i n a l
tone, especially i f one also considers the lack of success i n
controlling health care costs in most other advanced industrial
nations, i s pessimistic." (14)
I t happens that there have been numerous e f f o r t s on the micro
l e v e l which have been successful i n containing costs. I t can be
done. Such programs include the Health Maintenance Organization
experience, hospital rate setting and control i n several states,
certain health f a c i l i t i e s C e r t i f i c a t i o n of Need programs, c e r t a i n
i n d u s t r i a l health promotion programs, surgical second opinion
programs, u t i l i z a t i o n review when operated by well run Professional
Standards Review Organizations, and the introduction of required
ambulatory surgery and hospital pre admission t e s t i n g . The problem,
i s that these programs have been implemented on a piece meal basis.
No one has ever t r i e d to put together a comprehensive, consistent,
objectives based cost containment program and implement i t
nationally.
The hospital industry's response to the Carter Administration's
unsuccessful attempt to impose a "cap" on hospital expenditures, the
"Voluntary E f f o r t " to have hospitals control t h e i r own expenditures,
has been a dismal f a i l u r e . However, even a mandatory cap would not
solve the problem. Anyone knows that as long as the f i r e i s going,
i t i s impossible, short of welding, to keep the l i d on a pot of
boiling water. And even in the face of a welded l i d , with a going
f i r e the pot w i l l eventually explode. To contain health care costs,
�-6we must turn off, or at least turn down, the f i r e . We must deal
d i r e c t l y with the causes of escalating health care costs.
IV.
What Can be Done
A. The National
Perspective
F i r s t and foremost, we must develop a national policy and a
national program. We i n the United States have done t h i s before.
We have mobilized successfully to fight wars and currently are the
strongest m i l i t a r y power on Earth. We are the only country to have
put men on the Moon. We have b u i l t a comprehensive national highway
system and have implemented a policy under which most transport i s
carried out by rubber t i r e d vehicles. Despite having huge supplies
of coal, following World War I I we implemented a policy which made
o i l and natural gas our chief sources of energy. We have made the
owner occupied single family home the p r i n c i p a l mode of residence.
A l l of these successful e f f o r t s involved governments and private
enterprise working i n a cooperative relationship. They a l l involved
the use regulation, competition, and voluntary i n i t i a t i v e together.
We must do the same sort of thing for health care cost containment.
As Walter McNerney, past president of the Blue Cross Association has
put i t :
"the point i s that neither the continued regulation of
planning, use, reimbursement, and other components of the
health care process nor the introduction and promotion of
competitive incentives i n the market for health care services
can exert the needed controls [alone]. Both regulation and
competition are necessary, but a balance between them must be
worked out and tested i n combination with the underlying forces
of voluntarism, especially with the s e l f regulatory i n i t i a t i v e s
and community focus that have been the central resources i n
health care development for generations.
Regulation and
competition also need to be combined with new directions i n
health care, especially with the emphasis on preventive
services, health education, and improved health that has been
gaining support for the past few years i n the health
professions, i n industry, and i n government." (15)
The constitution c l e a r l y states that i t i s the Federal
government which has the national r e s p o n s i b i l i t y to solve national
problems. No President would rely on state National Guards to fight
the country's wars. No President can rely on the States alone to
solve national economic and s o c i a l problems. This does not mean
that a l l actions w i l l be either Federal or national. We have a
large and varied country. Local i n i t i a t i v e and variance can be very
creative and productive.
But to be useful i t must be carried out
within the framework of a national program. Thus e f f e c t i v e cost
containment w i l l be achieved by a combination of d i r e c t Federal
government action, State and local government action taken i n
response to Federal i n i t i a t i v e s and inducements, and for p r o f i t and
not for p r o f i t i n s t i t u t i o n a l actions taken i n response to Federal
i n i t i a t i v e s and inducements.
�-7Second of a l l , any national cost containment program, must, int
order to be e f f e c t i v e , be problem focussed. That i s i t must address.
the problem l i s t outlined above and must have components designed to
solve each one. P o l i t i c a l considerations w i l l be taken into account
to be sure. However, t h i s w i l l be done after problems are
described, causes are determined, objectives are defined.
Priority
setting, developing timetables for phasing in programs are
a c t i v i t i e s which w i l l be undertaken in the context of p o l i t i c a l
considerations.
Third of a l l , short term components of the cost containment
program must be consistent with a long term program designed to
solve the basic problems of planning, organizing, and financing the
U.S. health care delivery system which w i l l be in the development
state concurrently. The cost containment program elements
themselves are designed to become operational within a period
ranging from s i x months to two years, depending in part on the speed
with which necessary new l e g i s l a t i o n can be passed by the Congress.
But the program i s designed with an eye on long range considerations
as well.
The program w i l l have something old, something new, something
borrowed, but hopefully nothing blue. The implementation of certain
program components w i l l require only the rewriting of regulations,
proper s t a f f i n g and leadership, and suitable appropriations under
existing l e g i s l a t i o n . Others w i l l require amendments to e x i s t i n g
l e g i s l a t i o n or the resurrection of old, useful l e g i s l a t i v e programs
k i l l e d or allowed to die by the present Administration.
Still
others w i l l require e n t i r e l y new l e g i s l a t i o n . F i n a l l y , there are
program components which do not reguire l e g i s l a t i o n at a l l but
rather w i l l , inspiration, leadership. However, a l l the pieces must
be taken together i f the objectives are to be achieved.
One of the
few useful i n i t i a t i v e s of the present Administration was to get the
Congress to consider i t s 1981 "tax reform" package as a whole, on a
take i t or leave i t basis. In the face of the p o l i t i c a l power of
the various affected power groups, with however, t h e i r lack of
complete congruence of interest, t h i s approach should be considered
for the health care cost containment l e g i s l a t i v e program as well.
B.
A Review of the Problems and a Setting of the Objectives
There are too many hospital beds and health industry c a p i t a l
formation in general i s out of control. The objective i s to
r a t i o n a l i z e health care industry c a p i t a l formation on the basis of
meeting i d e n t i f i a b l e health care needs. Hospitals are paid in a
manner which encourages waste and i n e f f i c i e n c y . The objective i s to
develop a hospital reimbursement system which w i l l give the
hospitals themselves incentives to control t h e i r costs while
maintaining high levels of quality.
In the peculiar health services market, the s e l l e r s determine a
great deal of the demand. The objective i s to place controls on
u t i l i z a t i o n and on the personal f i n a n c i a l gain which the s e l l e r s can
�-8achieve by inducing u t i l i z a t i o n . The malpractice l i t i g a t i o n
situation i s getting worse and contributes to high cost and lower
quality i n a number of ways. The objective i s to return the
malpractice l i t i g a t i o n system to i t s original purpose of providing
monetary damages to patients who are victims of physician gross
negligence, not as i s sometimes done today to provide compensation
who have suffered bad outcomes from otherwise good quality medical
care.
The health care delivery system focuses i t s e f f o r t s and
expenditures on high cost, acute care services. The objective i s to
begin to adjust the balance in the direction of primary care and
prevention. Furthermore, there must be some evaluation of
expensive, high tech interventions as they are introduced as widely
used and entirely reimbursable items. Long term care i s focussed on
the nursing home. The objective i s to develop a comprehensive long
term care policy which w i l l strengthen the nursing home system while
also vastly expanding and improving a whole range of additional,
available, and useful long term care services.
F i n a l l y , the health sciences education and research system
tends to support the health care delivery system as i t i s now
constituted. The objective i s to change the health sciences
education and research system so that i t can be more effective than
i t presently i s in shaping the health care delivery system into a
cost effective industry.
C.
The Program and i t s Components
1. A l l hospitals should be placed on a prospective budgeting
system. Congress has required that the Department of Health
and Human Services develop such a system for Medicare payments,
and the Department i s complying (16). However, i f such a
system i s confined to Medicare payments, i t becomes a Medicare
expenditure control program, not a hospital cost containment
program as hospitals s h i f t costs to other payors. Jteecled i s a
comprehensive prospective payments system covering a l l sources
of hospital payments as has been adopted in one form or another
in Massachusetts, New York, New Jersey and several other states
(7). The General Accounting Office has endorsed the concept as
applicable to a l l states and a l l payors (17).
An o f f i c i a l of the Congressional Budget Office has pointed
out some of the limitations of prospective reimbursement which
would have to be attended to in l e g i s l a t i o n :
" I f prospective payments were set low, access could be reduced
through two potential avenues. F i r s t , some hospitals with a
predominantly private c l i e n t e l e could turn away public
patients. Second, some hospitals with a predominantly Medicare
and Medicaid caseload, with few privately insured patients to
s h i f t costs to, might not be able to reduce costs rapidly
enough to remain f i n a n c i a l l y viable. The second development
could occur under payment systems covering a l l payers as well,
however, unless provision was made for spreading the burden of
�-9the large number of uninsured patients that these hospitals
tend to have." (18)
However, these problems, as well as other, can be dealt with.
Prospective reimbursement, generally applied, has a great deal
to offer as a cost containment measure (7).
2. Control of health services industry c a p i t a l formation must
be achieved. Health planning must be r e v i t a l i z e d and
strengthen, not starved and then k i l l e d . The p r i n c i p a l problem
attendant to the health planning l e g i s l a t i o n of the mid 70's
was not that i t was flawed in concept, but rather that i t was
never properly funded, staffed and implemented. Regulation
need not necessarily s t i f l e i n i t i a t i v e , put people in s t r a i t
jackets and f a i l to recognize local differences. Regulation of
process and s p e c i f i c a t i o n of d e t a i l s can e a s i l y do that of
course. But regulation by outcomes, c r i t e r i a , standards, and
goal setting can be a marvelously stimulative experience. At
the end of the Carter Administration, a set of very creative,
outcome oriented planning guidelines were issued (19). They
were immediately rescinded by the present Administration.
C e r t i f i c a t i o n of need, has bee shown to be an e f f e c t i v e cost
control measure (6, 20), must be a part of t h i s e f f o r t as well.
The 1976 report from the I n s t i t u t e of Medicine provides a sound
basis on which to develop a r a t i o n a l hospital bed supply program (4). I t s basic recommendations were:
a. To establish "a national planning goal for reducing the
hospital bed supply."
b.
To include "government hospitals in national planning."
c.
To strengthen "area/state [planning] structures."
d.
To "eliminate excess hospital beds."
e. To provide "incentives to the private sector to control
bed supply."
This report i s s t i l l very applicable to the problem areas of
health services planning and c a p i t a l formation.
3. Effective u t i l i z a t i o n review w i l l have to be r e i n s t i t u t e d
for physicians. The Professional Standards Review Organization
achieved many good r e s u l t s in areas in which e f f e c t i v e l y
managed PSROs were created (21). The PRO system has the
potential to be effective as well (22). I t must be properly
implemented, appropriately funded and e f f e c t i v e l y led. Like
prospective reimbursement, i t must be applied on a mandatory
basis to a l l sources of payment. F i n a l l y , the penalties for
incurring unnecessary use of services must f a l l on the
physicians ordering those services as well as the i n s t i t u t i o n s
providing them.
�-104. Physicians must be put on a fee schedule for a l l
reimburseable a c t i v i t i e s . The present "usual and customary"
fee system i s an open invitation to cost i n f l a t i o n . A fee
schedule combined with effective u t i l i z a t i o n review would be a
powerful cost containment measure, affecting both physician and
i n s t i t u t i o n a l payments.
5. A variety of proven effective measures to change the
pattern and locus of u t i l i z a t i o n should be i n s t i t u t e d . These
include ambulatory surgery, pre admission (to hospital)
testing, and requiring a second opinion for e l e c t i v e surgery.
6. The Federally supported Health Maintenance Organization
program should be reintroduced, with appropriate funding,
staffing,and developmental support services. HMOs should be
encouraged to provide a t r u l y health oriented form of medical
practice.
7. The use of the now growing Preferred Provider Option (PPO)
should be supported.
Under the PPO system (23), t h i r d party
payors contract with providers to offer complete service at
reduced prices i n return for guaranteed payment i n f u l l and
assurance of a regular c l i e n t e l e .
8. Reform of the malpractice l i t i g a t i o n system i s urgently
needed. Although they have been out for some time, the reports
of the Secretary's Commission on Medical Malpractice (24), and
the Special Advisory Panel of the State of New York (the McGill
Commission) (25) are very good starting points for developing a
detailed program i n t h i s area.
9. A comprehensive policy on long term care, care of the
elderly, and g e r i a t r i c medicine should be developed. The
emphasis w i l l be on supporting the care of the eldejrly and the
infirm i n t h e i r own homes or i n the homes of family members i f
that i s appropriate.
10. Preventive medicine must be encouraged with money and
programs as well as rhetoric. Some preventive programs, such
as cigarette smoking cessation, weight reduction, the promotion
of exercise, substance abuse control, proper nutrition, and
s t r e s s management have a medium to long term pay off (26).
However, there are others which can have a pay off i n one to
two years.
These include: the reestablishment of a comprehensive,
nationwide immunization program; the development of a large
scale sexually transmitted disease program; the redevelopment
of family planning and sex education programs; the renewal of
effective, meaningful support of state and l o c a l health
departments for such programs as well baby care, public health
nursing, health education, v i t a l s t a t i s t i c s collection and
analysis, and communicable disease control; the encouragement
�-11of i n d u s t r i a l health promotion programs which have been shown
to be cost e f f e c t i v e (26); redevelopment and strengthening of
maternal and c h i l d nutrition programs; the complete end to a l l
government support of tobacco growing, and further increases in
tobacco tax with the proceeds going to growers and
manufacturers to subsidize conversion to other a c t i v i t i e s ;
comprehensive alcoholism program support, increase in alcohol
taxation, further strengthening of drunk driving laws;
redevelopment of NIOSH and OSHa and t h e i r functions;
redevelopment of the EPA and i t s functions; renewal of the
automobile safety program, enforcement of the 55 mile per hour
speed l i m i t , i n s t i t u t i o n of mandatory seat belt use and
motorcycle helmet laws; gun control. I t i s recognized that
some of the items in t h i s l i s t are p o l i t i c a l hot potatoes
beyond the confines of the health care delivery system i t s e l f .
They have to be approached with care.
1
11. Health sciences education i n s t i t u t i o n s must be a s s i s t e d in
developing t h e i r growing interest in t r a i n i n g health
professionals to be health oriented and cost and quality
conscious. Cost containment w i l l not be possible unless the
people who are actually doing the work are cost conscious.
Continuing education for those already in the work force w i l l
be equally important. Also v i t a l in the educational area w i l l
be training and technical assistance for persons s t a f f i n g and
setting policy for health planning agencies, quality assurance
and u t i l i z a t i o n review organizations. Health Maintenance
Organizations and the l i k e . This was an area of neglect in the
l a t t e r days of the Carter Administration.
The neglect
seriously harmed program development.
12. A research policy must be developed that i s consistent
with cost containment, quality assurance, and health
promotion. This has important implications for the National
I n s t i t u t e s of Health. The National Centers for Health Services
Research and Health S t a t i s t i c s need to be redeveloped and
strengthened. The National Center for Health Care Technology
needs to be reestablished (27). The r a t i o n a l assessment of new
health care techniques and interventions, ( i n addition to the
work on new drugs and devices now done by the FDA), i s an
e s s e n t i a l element in any e f f e c t i v e cost containment program.
This even dozen of recommendation together forms the basis for
a cost containment program which would work.
V.
Conclusion
Vice President Mondale was right when he quoted Pogo in 1977.
Walter McNerney was right in 1980 when he said that any e f f e c t i v e
cost containment program must combine l e g i s l a t i o n , regulation, and
voluntary i n i t i a t i v e . The New York Times was right in 1982 when i t
described the many powerful, vested i n t e r e s t s which are against the
meaningful changes in the organization and operation of the health
care delivery system in t h i s country which must be undertaken i f
�-12costs are to be brought under control. However, the technical means
to do j u s t that e x i s t . What has been lacking so f a r i s the
p o l i t i c a l w i l l and organizing a b i l i t y to see that i t gets done. A
national program, operated by the Federal and state governments
working together, can achieve the stated goals.
�-13References, Appendix V I
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Mondale, W. i n " C o n t r o l l i n g Health Costs, Conference
Proceedings," National J o u r n a l , March, 1978, p. 67.
Washington Report on Medicine and Health, Vol. 37, No. 1,
January 3, 1983, p.4.
Abernethy, D.S. and Pearson, D.A. Regulating H o s p i t a l Costs:
The Development of P u b l i c P o l i c y . Washington D.C.: AUPHA
P r e s s , 1979.
I n s t i t u t e of Medicine.
A P o l i c y Statement: C o n t r o l l i n g t h e
Supply of H o s p i t a l Beds. Washington D.C: N a t i o n a l Academy of
Sciences, October 197 6.
Rorem, C R . C a p i t a l Investment i n H o s p i t a l s . Washington
D.C:
Committee on the Costs of Medical Care, 1930.
Bentkoven, J . , e t a l . "Development of an E v a l u a t i o n Methodology
for Use i n A s s e s s i n g Data A v a i l a b l e t o the C e r t i f i c a t e of Need
and Health Planning Program." Washington, D.C: N a t i o n a l
T e c h n i c a l Information S e r v i c e , 1982.
I g e l h a r t , J.K. "The New E r a of P r o s p e c t i v e Payment f o r
H o s p i t a l s . " The New England J o u r n a l of Medicine.
307, 1288,
1982.
Medical World News. "HHS Computers are Cracking Down on
B i l l i n g Fraud by Doctors." November 8, 1982.
B a i l e y , C. "Beyond M a l p r a c t i c e . " The New York S t a t e J o u r n a l
of Medicine.
February, 1981, p. 24FI
S i e g e l , D. "Medical Malpractice L e g i s l a t i o n i n t h e United
S t a t e s . " The New York S t a t e J o u r n a l of Medicine. November,
1981, p. ISTTI
Blackman, N.S. " P r o f e s s i o n a l L i a b i l i t y Insurance and P r a c t i c e
of Medicine."
The New York S t a t e J o u r n a l of Medicine. Augusts
1982, p. 1387.
Washington Report on Medicine and H e a l t h / P e r s p e c t i v e s . "How
C a t a s t r o p h i c are Medical Expenses?"
December 20, r58'2.
Banta, H.D., Behney, C.J., and Williams, J.S. Toward R a t i o n a l
Technology i n Medicine.
New York: Springer P u b l i s h i n g Co., .
1981.
K r i s t e i n , M.E. "Health Care Costs and P r e v e n t i v e Medicine."
Preventive Medicine, 11, 729, 1982.
McNerney, W.J. "Control of Health Care Costs i n t h e 1980's."
New England J o u r n a l of Medicine.
303, 1088, 1980.
Washington Report on Medicine and H e a l t h / P e r s p e c t i v e s .
"Schweiker Sends DRG Based Plan t o Congress."
January 3, 1983.
C o n t r o l l e r General. R i s i n g H o s p i t a l Costs Can Be R e s t r a i n e d by
Regulating Payments and Improving Management. Washington,
D.C.:
General Accounting O f f i c e , HRD 80 72, September 19,
1980.
Ginsburg, P.D. " I s s u e s i n Medicare H o s p i t a l Reimbursement."
National J o u r n a l , 14, 934, 1982.
P u b l i c Health S e r v i c e . National G u i d e l i n e s f o r Health
Planning. Washington D.C: U.S. Department of Health and
Human S e r v i c e s , November 25, 1980.
Howell, J.R. Regulating H o s p i t a l C a p i t a l Investment: The
Experience i n Massachusetts.
H y a t t s v i l l e , MD: National Center
for Health S e r v i c e s Research, USDHHS Pub. No. (PHS) 81-3298.
1981.
" P r o f e s s i o n a l Standards Review Organization, 1979 Program
E v a l u a t i o n . " Health Care Financing Research Report, USGPO,
1980, 311, 168/418.
�-1422.
23.
24.
25.
26.
27.
Frabotta, J . "Feds' New PROs dismay peer Review's Fans and
Foes." Medical World News, December 6, 1982, p. 58.
Washington Report on Medicine and Health/Perspectives.
"Preferred Providers: Discount Health Care." July 12, 1982.
Secretary's Commission on Medical Malpractice. Medical
Malpractice. Washington, D.C. USDHEW Pub. No. (OS) 73-88,
1973.
Special Advisory Panel on Medical Malpractice, Report. New
York: State of New York, January 5, 1976.
Cunningham, R.M., "Wellness at Work." Hospitals, June 1, 1982,
Perry, S., "The Brief L i f e of the National Center for Health
Care Technology." The New England Journal of Medicine, 307,
1095, 1982.
�
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Health Care Task Force Records
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White House Health Care Task Force
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
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<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 3
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Box 5
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
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Clinton Presidential Records: White House Staff and Office Files
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Health Care Task Force
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Edelstein
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OA/ID Number:
3679
FolderlD:
Folder Title:
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52
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7
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
002. letter
Personal (Partial); Address (Partial) (I page)
n.d.
P6/b(6)
003. letter
Personal (Partial) (1 page)
04/06/1993
P6/b(6)
004. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
005. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
03/19/1993
P6/b(6)
006. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
007. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
008. letter
Personal (Partial); Address (Partial) (I page)
n.d.
P6/b(6)
009. note
Phone No. (Partial) (1 page)
n.d.
P6/b(6)
010. resume
SSN (Partial); Address (Partial); Phone No. (Partial); DOB (Partial)
(I page)
07/1992
P6/b(6)
011. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
012. letter
Personal (Partial); Address (Partial) (1 page)
02/22/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
imSlO
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Presidential Records Act - |44 IJ.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the I OIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA)
National Security Classified Inforination 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or conndcntial commercial or
Financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECT/TITLE
RESTRICTION
013. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
014. letter
Personal (Partial); Address (Partial) (I page)
02/12/1993
P6/b(6)
015. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
016. letter
Personal (Partial); Phone No. (Partial) (1 page)
04/19/1993
P6/b(6)
017. photograph
Personal (1 page)
n.d.
P6/b(6)
018. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
019. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/16/1993
P6/b(6)
020. letter
Personal (Partial); Address (Partial) (2 pages)
09/23/1992
P6/b(6)
021. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
022. letter
Personal (Partial); Address (Partial) (1 page)
01/26/1993
P6/b(6)
023. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
08/02/1993
P6/b(6)
024. letter
Personal (Partial); Address (Partial) (1 page)
06/10/1992
P6/b(6)
025. letter
Personal (Partial) (I page)
12/23/1991
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Leners] [loose] [3]
2006-0885-F
im810
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)l
P!
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating tn the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
026. letter
Personal (Partial); Address (Partial) (2 pages)
05/13/1992
P6/b(6)
027. letter
Personal (Partial); Address (Partial) (I page)
06/10/1992
P6/b(6)
028. letter
Personal (Partial); Address (Partial) (2 pages)
06/09/1992
P6/b(6)
029. form
Personal (Partial); SSN's (Partial); Address (Partial); Phone No.
(Partial): (1 page)
12/05/1991
P6/b(6)
030. letter
Personal (Partial); Address (Partial) (1 page)
04/30/1993
P6/b(6)
031. letter
Personal (Partial); Address (Partial) (1 page)
10/31/1992
P6/b(6)
032. letter
Personal (Partial); Address (Partial) (I page)
04/30/1992
P6/b(6)
033. letter
Personal (Partial); Address (Partial) (1 page)
11/30/1991
P6/b(6)
034. statement
Personal (Partial); Address (Partial) (1 page)
01/15/1991
P6/b(6)
035. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
036. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/26/1993
P6/b(6)
037. note
Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
im810
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning w ells 1(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCliMENT NO.
AND TYPE
DATE
SlBJECmTIXE
RESTRICTION
038. letter
Address (Partial); Phone No. (Partial) (2 pages)
05/05/1993
P6/b(6)
039. note
Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
040. letter
Address (Partial); Phone No. (Partial) (I page)
08/25/1993
P6/b(6)
041. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
042. letter
Personal (Partial); Address (Partial) (1 page)
04/19/1993
P6/b(6)
043. note
Personal (Partial); Address (Partial) (I page)
n.d.
P6/b(6)
044. letter
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
045. note
Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
046. letter
Address (Partial); Phone No. (Partial) (1 page)
03/04/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
im810
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)]
Freedom of Information Act - |S ll.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Kcderal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. note
SUBJEC 171111.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTI FICATION OF WRITER
NAME
. . ;.•«• ' ' # '
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ADDI
ADD 2 'f -r;"„..; . ' '
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CITY
STAT
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,
:
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V ' ( K ). . .
'
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.
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.
. J.
.
.
'
00
BRIEF SYNOPSIS OF LETTER
IDENTIFICATION OF PRIMARY LETTER CONTENT (CHOOSE <0R« THRE
INSURANCE COST ISSUES SYSTEMS RELATED
MEDICAL COSTS - EXCESSIVE
HIGH DEDUCTIBLES
MEDICATIONS/PRESCRIPTIONS
HIGH PREMIUMS
HOSPITAL CHARGES
FORCED TO W R
OK
EES
DOCTORS :
UNABLE TO PAY
UNNECESSARY PROCEDURES
HIGH CO-PAYMENTS
PROCEDUR S NOT PERFORMED
OTHER
GOVERNMENT-RELATED HEALTH CARE
PROGRAMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
COBRA'8
COV RAGE TOO SHORT
PRE-EXISTING CONDITION
INC EASED CO-PAYMENT
COVERAGE DENIED
LACK OF PORTABILITY
MEDICAID
SPEEDING D W POOR
ON
LOSS OF COVERAGE
LOS I COVERAGE/
FROM PARENT'S POLICY
GA NFUL EMPLOYED
FROM CONTINUED CARE
MEDICARE
LON TERM CARE
LIMITED BENEFITS
OTH R COVERAGE
COST CAPS - CEILINGS
BENEFIT NOT OFFERED
SOCIAL S CURITY/
CLAIM DENIED
DISABI ITY
HOME HEALTH CARE
DIS ONTINUATION
LONG TERM CARE
COV RAGE TOO SHORT
MENTAL HEALTH
OTH R COVERAGE
SPECIFIC DISEASES
HIGH CO-PAYMENTS
VETERAN' PROGRAMS
EQUIPMENT
DELAYS IN COVERAGE
PRESCRIPTIVE DRUGS
OVERPAYMENTS/
UN IERPAYMENT
OTHER
OTHER PROGRAM
QUALITY OF CARE
LIMITED STAYS
OTHER CONTENT
LACK OF SERVICES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
JmSlO
RESTRICTION CODES
Presidential Reeords Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - [S ll.S.C. S52(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6)of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIAj
National Security Classified Information |(a)(l) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute |(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�v
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"
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
SUBJECT/TITLE
DATE
Personal (Partial) (I page)
04/06/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 I'.S.C. 2204(a)]
Freedom of Information Act - |S IJ.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(h)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 IJ.S.C.
2201(3).
RR. Document will be reviewed upon request.
�HAGUE PHARMACY
AT THE MEDICAL TOWER
400 Gresham Drive
Norfolk. Virginia 23507
Phone: 622-0222
Fax: 623-9010
A p r i l 6, 1993
3
Mrs. H i l l a r y Rodham C l i n t o n
1600 Pennsylvania Avenue
Washington, D. C. 20006
Dear Mrs. C l i n t o n ,
I had the pleasure of meeting you l a s t October
burg, Va a t a round t a b l e d i s c u s s i o n concerning t h e
n Williamseed f o r
P6/(b)(6)
F?6/(b)(6)
003
as the w i f e of a small inaepenuent
pharmacist.
My husband, Steve, and I have owned a small pharmacy for the
past 13 years. During t h i s time we have seen many changes, While
we have not become r i c h , we have had the s a t i s f a c t i o j n of helping
r
many customers w h i l e making enough money t o l i v e , Howevej during
the past year or so, we have seen d r a s t i c changes wh ch w i l l
probably lead t o the demise of small community ph
larmiic ies'. The
powerful insurance i n d u s t r y are p r a c t i c a l l y h o l d i n g us hostage,
They t h r e a t e n i f we do not sign t h e i r c o n t r a c t s the);- w i l l require
t h e i r customers t o go "mail-order". The reimbursement they offer
i n many cases i s so s l i g h t t h a t there i s not p r o f i t , However
i
these same insurance companies o f f e r i n c e n t i v e s f o r nai.l order
p r e s c r i p t i o n s a t a very small copay. These m a i l ordte r companies
are r e c e i v i n g huge discounts which we cannot q u a l i f y for. I t i s
t e r r i b l y u n f a i r . This money then goes out o f the c cfifununity or
s t a t e , revenue i s l o s t l o c a l l y f o r taxes and jobs arlt threatened. .
1
Did you know t h a t pharmacists are the most respscted o f a l l
professions? Yet the insurance companies do notre:: iburs e f o r
the i n f o r m a t i o n , c o n s u l t i n g and time a pharmacist g i res a p a t i e n t ,
Also many insurance companies r e s t r i c t which pharmac es you can
take your Rx t o - thereby talcing away our freedom ol choice. •
Then there are those p h y s i c i a n s t h a t have founc loop-holes
t o b i l l Medicare f o r medication and the a d m i n i s t r a t i sn of v a r i o u s
drugs when these drugs could be purchased a t a pharnj^cy f o r f a r
l e s s money. Many of the doctors have formed buying jroups!
I i n v i t e you t o come t o N o r f o l k and spend somf time i n our
small pharmacy and see the s e r v i c e we p r o v i d e and t t h a s s e l s
i
we encounter from the insurance companies. The i n s i ranee companies,
the medical p r o f e s s i o n s and the drug manufacturers c Ll have such
powerful l o b b i e s , but the small independent pharmacJst i s j u s t
t r y i n g t o make a l i v i n g . We j u s t want t o educate o i t kids and
have a b e t t e r l i f e than our parents. I s i n c e r e l y hepe you w i l l
consider my i n v i t a t i o n t o v i s i t and l e a r n f i r s t hanc the plight
of the independent pharmacist.
Sincerely,
Nancv Schreier
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-r
jm8IO
RESTRICTION CODES
Presidential Reeords Act -144 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
Pl National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal ofnee 1(a)(2) ofthe PRA1
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
rmaneial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe KOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe KOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IPENTiriCftTIQE OF WRITER
v.
!
v., «"P6/(bj(6)
.\ < , •
•• ,
>
PHISF SYNQPSIS QF LETTER
Good l e t t e r by self-employed businessman who must pay own h salth insurance.
After heart attack faced large increase i n premium ($260 t o4P81 monthly) and
increased deductible. Economy has hurt business and hard to pay medical
b i l l s . Must possibly s e l l home f o r medical b i l l s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
FORCED TO W R
OK
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
MEDICAL COSTS - EXCESSIVE
DOCTORS FEES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
03/19/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jm810
RESTRICTION CODES
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Freedom of Information Act - [S U.S.C. 5S2(b)|
PI
P2
P3
P4
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b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 19, 1993
Mrs. H i l l a r y R. Clinton
C O The White House
/
1600 Pennsylvania Ave., NV
Washington, DC 20500
RE: HEALTH CARE REFORM
Dear Mrs. Clinton:
Reference the above captioned, please let me take a few noments of your
time to convey my thoughts regarding the health care c r i i i s in our country.
"'Perhaps I should begin by t e l l i n g you that I am a self etpployed real estate
broker and pay a l l of my families' health insurance cost* In November of
1990, I suffered a severe heart a*tack from which I am continuing to recover. Prior to the attack my monthly health insurance premium for family
coverage was $260.00 per month. In the twenty seven months since my heart
attack my insurance premium has risen to $981.00 per mon h. in order to
be able to continue my coverage, I-have increased my deductible to $5000.00
and "dTopped my youngest son from our policy.
A d d i t i o n a l l y , because the economy has impacted the real state industry
severly, my l i f e savings are just about depleted and I hive obtained a
second mortgage on my home simply to pay medical.-J5iLis...
a.idL-hftfll th Insurance
premiums., i f - t h i n g s don't change i n the near- future , I w 1-1—be-farced to
•
s e l l my home and cash i n my retirement IRAs in order to Maintain my health
insurance.
Mrs. Clinton, I didn't write this letter to s o l i c i t your sympathy, but
rather to encourage you to continue your struggle to mak affordable health
care a reality for a l l Americans. I dori't believ.e that-m l|ddle_class
citizens such as myself or anyone else for that matter s ulU be without
adequate health care when we live in the greatest countr on earth.
Thanking you for your kind consideration and wishing you much success, I
remain
S.i.n.c.e.r.e.Lv_Y.o.u.r.s_.^_^
oo 5
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RESTRICTION
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COLLECTION:
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Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIAJ
b(3) Release would violate a Federal statute 1(b)(3) of the FOI A]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
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b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
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Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
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financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
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RR. Document will he reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
.
• 'P6/(b)(6),
l :
?6G
BRIEF SYNOPSIS OF LETTER
Small business owner. OpernVc-s »
salvage y a r d f o r 2 years. Cannot
The owner and
a f f o r d h e a l t h insurance due to cost o f business o p e r a t i o n s
w i f e need t o see doctor but cannot a f f o r d t o . Doctor wi .1 n o t see them
w i t h o u t insurance. Good quotes. Good l e t t e r .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TC C - "
..
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
DOCTORS FEES
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DOCUMENT NO.
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Personal (Partial); Address (Partial) (1 page)
n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
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Freedom of Inrormation Act - |5 U.S.C. 552(b)|
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P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe F01A|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe F01A|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTI FICATION CF WRITER
NAME
ADDI .,, ,-. ;-. •.- . •;•
' •^
'
""
ADD2 « < •. • ' J ' ' ' • • '
CITY
STAT
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BRIEF SYNOPSIS OF LETTER
/Vrrij/
L-u-rv-r-
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titiff.
(A rr) (hi'
0,u h r a,\l p i Sr:r,"'u/VK a
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IDENTIFICATION OF P R I M A R Y " L E T T ^ CONTENT ' ( CHOOSE <OR- THRi
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH D E : ! ? : . . ?
HIGH FREV.
.
FORCED TC W R
OK
UNABLE TO PAY
HIGH CO-PAYMENTS
OTHER
INSURANCE COVERAGE EXCLUSIONS TO CARE
X
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
r
LOSS CF CCVEV.AJ-L
FROM PARENT'S POLICY
FROM CONTINUED CARE
LIMITED BENEFITS
COST CAPS - CEILINGS
BENEFIT NOT OFFERED
CLAIM DENIED
HOME HEALTH CARE
LONG TERM CARE
MENTAL HEALTH
SPECIFIC DISEASES
HIGH CO-PAYMENTS
EQUIPMENT
PRESCPIPTIVF ! R . "
:''?
OTHER
QUALITY OF CARE
LIMITED STAYS
LACK OF SERVICES
r
1
MEDICAL COSTS - EXCESSIVE
MEDICAT 3NS/PRESCRIPTIONS
HOSPITAH- CHARGES
X DOCTORS FEES
,
UNNECESS ^RY PROCEDURES
PROCEDUI:IS NOT PERFORMED
GOVERNMENT-R?|LATED HEALTH CARE
PROGRAMS
COBRA'S
COYfERAGE TOO SHORT
INCREASED CO-PAYMENT
MEDICAID
ON
SPENDING D W POOR
LOST COVERAGE/
GAlINFUL EMPLOYED
MEDICAR;
LONG TERM CARE
OTiER COVERAGE
SOCIAL SECURITY/
DISAB[LITY
DIiCONTINUATION
CO,ERAGE TOO SHORT
OTHER COVERAGE
VETERAN S PROGRAMS
DEftAYS IN COVERAGE
OV RPAYMENTS/
U DERPAYMENT
OTHER PROGRA'I
1
OTHER CONTEN
�c
i-^.-va 'I. /-^^ "T.,
t^b^-.... ^ r i ^ ^ ^ . ^ . ^ L i X f
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.._ L-'<\ vC -Tc ,. ('^.v^,.... .1'- v (y,-. .
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J<*s*Jr< Xdf^nX
bdb
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DATE
SUBJECT/TITLE
n.d.
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jm810
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)]
Freedom of Information Aet - |5 U.S.C. 5S2(h)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
nr n i
-i yvr
b(l) National security classified information [(h)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
his advisors, or between such advisors |a)(5) of the PRA)
lase would constitute a clearly unwarranted invasion of
onal privacy 1(a)(6) ofthe PRA]
Closed in accordance with restrictions contained in donor's deed
if gift.
•ersonal record misfile defined in accordance with 44 ll.S.C.
1201(3).
)ocument will be reviewed upon request.
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose inforination compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA]
ant
P6Re
pei
C.
PRM.
RR.
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.p6/(b)(6);
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Clinton Library
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SllBJEOYnTLE
DATE
Phone No. (Partial) (1 page)
n.d.
RESTRICTION
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COLLECTION:
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Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jm810
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Freedom of Information Act - [5 U.S.C. 552(b)|
Pl
P2
P3
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b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
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b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
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P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�(S9
7ih ;
PERSONAL STORIES DATABASE
1/7'tip* -
IDENTIFICATION OF WRITER
P6/(b)(6)
//• (7^
BRIEF SYNOPSIS OF LETTER
IDENTIFICATION OF PRIMARY LETTER CONTENT
^2^4
�LOYOLA
IS
:
UNIVERSITY
' • '
j 2 CHICAGO
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.llo!! Soiiili l irM Avi'iun.
Umonul. lllmuis 60153
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�LOYOLA
S l f f l ^ i UNIVERSITY
,.! CHICAGO
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I i h ' ! M . .-Mii'iM-h.-rv.. M . I ).
1 JiflVll M
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Mi'ilk-al Siiuk-iH lulin-aiion
1
.As^r h'iah' I ! ' Hl'SSt ?!'
2160 South First Avenue
May wood, Illinois 60153
Telephone: (708) 216-3272
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DOCUMENT NO.
AND TYPE
010. resume
SUBJECT/TITI.E
DATE
SSN (Partial); Address (Partial); Phone No. (Partial); DOB (Partial)
(1 page)
07/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jm810
RESTRICTION CODES
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Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe I O I A ]
b(9) Release would disclose geological or geophysical information
concerning wells [(h)(9) ofthe FOIAj
National Security Classified Information |(a)(]) of the PRA|
Relating to the appointment to Ecdcral office [(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Jul}
1992
JOEL MAXIM SILBERBERG, M.D.
Associate Professor of C l i n i c a l Psychiatry
Department of Psychiatry
Loyola University Medical Center
2160 south F i r s t Avenue
Mayvood, I L 60153
PERSONAL DATA:
S o c i a l Security Number:
State Medical License Number:
American C i t i z e n s h i p :
Board c e r t i f i c a t i o n :
P6/(b)(6)
036-062924
1986
Psychiatry.
Novenber 1985
Address:
Phone Numbers:
Work (708) 21( -3272
Birthdate:
S u c c e s s f u l l y passed the ECFMG (82%):
P6/(b)(6)
J u l y 1978
U n i v e r s i t y o f Witwatersrand, Johannesburg, South k f r i c a ,
Bachelor o f Medicine and Bachelor of Surgery: N^ember 1978
Residency T r a i n i n g , PGYI Year: Coronation Hospil.il
Newclare, Transvaal, which i s an o f f i c i a l t e a c h i i j i ^ h o s p i t a l
of t h e U n i v e r s i t y o f t h e Witwatersrand:
Surgery (Professor
C.G. Bremmer) - s i x months and I n t e r n a l Medicine (Professor
S. Grieve) - s i x months: January 1 t o December 1, 1979.
Senior House O f f i c e r (PGYII) i n Anesthetics (Dr. b.S.
Sennet) a t Coronation Hospital: January 1 to Mafph 31,
1980.
P a r t - t i m e A n e s t h e s i o l o g i s t a t Coronation Hospita (Dr.
Sennet): A p r i l 1 t o May 31, 1980.
G.S.
�Joel Maxim Silberberg, M.D.
Curriculum Vitae Page 3
Medical D i r e c t o r of Madden Mental Health Center, 1200 South
F i r s t Avenue, Mines, I I . A p r i l 1992 t o present
r9fliii»gftg
EXPERIENCE:
I have given my expert opinion to various sources on
d i s a b i l i t y , workman's compensation, and malpractice cases.
January 1986: I t e s t i f i e d in court in California as an
expert witness on the divorce proceedings of Gallagher v s .
Hays for Sandra Musser, Attorney at Law, 361 Oak Street, San
Francisco, CA. I worked with Kathleen Ryan.
A p r i l 198 6 t o present: Member of Expertnet, Milwaukee, WI.
May 1986: I gave my expert opinion on the case of Noel v s .
Masserman for Hinshaw, Culbertson, Moelmann, Hoban, and
F u l l e r . This was a malpractice case. I worked with Debra
Davy.
August 1986 t o present: D i s a b i l i t y Consultant f o r t h e
I l l i n o i s Department of R e h a b i l i t a t i o n Services.
February 1987: I gave my expert opinion on the case of
Harrington vs. Rush Presbyterian, et «1. for Lord, B i s s e l ,
and Brook. This was a malpractice case. I worked with M.J.
Yardley.
A p r i l 1987: I acted as an expert on the case of James vs.
Lyons Federal Savings and Loan for Guerard and Drenk. This
was a c i v i l rights s u i t . I worked with Barbara Young.
November 1987: I acted as an expert on the case of Courbier
vs. Kershul and Yun for Mossner, Majoras and Alexander.
This was a malpractice case. I worked with Kerry D.
Alexander.
February 1988: Psychiatric Consultant for E.P.S.
Rehabilitation Incorporated, 20 South Route 45, Suite 2G, :
Frankfort, I L 60423
June 1988: I acted as an expert on the case of Termini v s .
1202 Ridgewood Avenue Associates/ et a l for Modesto,
Reynolds and McDermott. This was a c i v i l lawsuit. I worked
with Michael Lulitch.
�Joel Maxim Silberberg, M.D.
Curriculum Vitae Page 4
July 1988: I acted as an expert on the case of Robert Clark
vs. Saint James Hospital, et a l for Ruff, Weidenaar and
Reidy, LTD. This was a malpractice case. I worked with
Charles E. Reiter, I I I .
December 1988: I acted as an expert on the case o f Rich v s .
Scott, e t a l f o r Modesto, Reynolds and McDermott. This was
a c i v i l lawsuit. I worked w i t h Richard M. Jacobson.
May 1990: I acted as an expert witness on the case of Micic
vs. Thies for Williams and Montgomery Ltd. This was a c i v i l
lawsuit. I worked with James P. Buchholz.
November 1990: I acted as an expert witness on the case o f
Pabst vs. Ace Hardware f o r Williams and Montgomery Ltd.
This was a c i v i l lawsuit. I worked w i t h James P. Bucholz.
November 1991: I am presently acting as an expert witness
on the case of Gilman vs St. Mary's Hospital, et a l for
Husch and Eppenberger. This i s a malpractice case. I am
working w i t h Robert M. Owen.
February 1992: Member of Review Panel f o r the F r a t e r n a l
Order of Police, Chicago Lodge No. 7
PROFESSIONAL SERVICES:
Supervisor i n Dr. Domeena Renshaw's Sexual Dysfunction
C l i n i c at Loyola University Medical Center i n Maywood,
I l l i n o i s . 1983-1985
P s y c h i a t r i c Consultant t o the Loyola U n i v e r s i t y Medical
Student Peer Counselling Group: October 1982 t o present
Senior Consultant, Loyola University Affective Disorders
Program: October 1985 to present
Coordinator o f Loyola U n i v e r s i t y Medical Center's ECT
Program. Three years experience administering ECT: J u l y •
1984 t o June 30, 1987
D i r e c t o r o f Loyola U n i v e r s i t y ' s Obsessive-Compulsive
Disorder C l i n i c : May 1989 t o present
�J o e l Maxim S i l b e r b e r g , M.D.
Curriculum V i t a e Page 5
EDITORIAL APPOINTMENTS:
A s s i s t a n t E d i t o r o f "The Leech", which i s the o f f i c i a l
student j o u r n a l of the U n i v e r s i t y of the Witwatersrand
Medical School: June 1974 t o June 1976
E d i t o r of "The Leech":
June 1976 t o June 1977
Member o f the E d i t o r i a l Committee on "The Leech":
t o June 1978
June 1977
Peer Reviewer f o r American P s y c h i a t r i c Press, Incorporated:
September 1989 t o present
Reviewer f o r " E t h n i c i t y and Disease":
present
August 1990 t o
PANELS. STUDY SECTIONS, ETC.:
South A f r i c a n Medical Association:
1979
F u l l r e g i s t r a t i o n w i t h the General Medical Council, London:
1980
I l l i n o i s P s y c h i a t r i c Association:
1981
Member o f the Program Committee of the I l l i n o i s P s y c h i a t r i c
Society: June 1992
American P s y c h i a t r i c Association:
Status since A p r i l 1985.
1981. General Member
The President's Club, Loyola U n i v e r s i t y o f Chicago:
1984
Association o f D i r e c t o r s of Medical Student Education i n
Psychiatry: J u l y 1987
A s s o c i a t i o n o f Mental Health P r i v a t e P r a c t i t i o n e r s - Oak
Park and River Forest, I l l i n o i s : 1988
Corporation f o r the Advancement o f Psychiatry:
1989
A s s o c i a t i o n f o r Academic Psychiatry:
November
February 1990
Chairman, 3-South Planning Committee, Loyola U n i v e r s i t y
Medical Center. Reconfiguration of t h e I n p a t i e n t
P s y c h i a t r i c U n i t : January 1985 t o June 30, 1987
�Joel M. Silberberg, M D
..
Curriculum Vitae Page 6
Examiner'at Loyola U n i v e r s i t y , Department o f Psychiatry's
MOCK BOARDS: March 1986, March 1987, March 1989, March
1990, March 1991, and March 1992.
Member of the Adult Committee, HCA Riveredge H o s p i t a l :
A p r i l 1987 t o December 1990.
Member of the Adolescent Committee, HCA Riveredge Hospital:
June 1987 to March 1989
Course D i r e c t o r of "Behavior Science" a t Loyola U n i v e r s i t y
Medical Center: July 1987 t o present
Member of the Curriculum Committee (both the basic science
and c l i n i c a l sections) at Loyola University Medical Center:
July 1987 to present
Sub-unit Chairman for the psychiatry section of the Organ
Systems course at Loyola University Medical Center: July
1987 to present
Member of the Educational Committee of the Department of
Psychiatry at Loyola University Medical Center: July 1987
to present
Chairman of Faculty Survey Committee, Loyola U n i v e r s i t y
Medical Center: July 1988
Chairman of Psychiatry Expansion Committee, Loyola
University Medical Center: October 1988
HONORS AND AWARDS:
Recipient of Michael Miller Bursary ( f u l l academic
scholarship for medical school - s i x yearp): 1973 to 1978
Physician's Recognition Award f o r p a r t i c i p a t i o n i n
c o n t i n u i n g medical education issued by the American Medical
Association: A p r i l 1992
Achieved tenure as a Faculty Member of the Department of
Psychiatry at Loyola University Medical Center: July 1,
1991.
�Joel M. Silberberg, M.D.
Curriculum Vitae Page 7
Recipient of the American P s y c h i a t r i c Association's Second
Annual Nancy C. A. Roeske, M.D. C e r t i f i c a t e of Recognition
f o r Excellence i n Medical Student Education: January 1992.
Chosen for the Faculty of the Year Award by the Loyola
University Department of Psychiatry Residents: July 1992.
CLINICAL AND RESEARCH INTERESTS:
I was a research assistant i n a study, " I n Search o f
B i o l o g i c a l Markers i n Anxiety States", together w i t h Drs.
Robert deVito and Sidney Chang: February 1983. This work
was presented as a new research paper a t the 19|84 APA
Meeting i n Dallas.
In 1986 Drs. deVito and Chang presented a new research paper
at the APA Meeting in Washington entitled, "Total Seizure
Time and Treatment Response to ECT".
I was a member of the
research team and a co-author of the paper.
In 1987 Dr. Sydney Chang and I presented a new research
paper at the APA meeting in Chicago entitled, "Modified
Muller's Position for Unilateral ECT".
I was a member of
the research team and a co-author of the paper.
Investigator status i n the FDA approved Anafranil Protocol
67 for the treatment of Obsessive-Compulsive Disorder, March
1989.
Consultant i n the Burroughs Wellcome e v a l u a t i o n program o f
Bupropion Hydrochloride ( W e l l b u t r i n ) .
Review committee approval (percentile: 19.3 and p r i o r i t y
score: 121) of application for National I n s t i t u t e of Mental
Health (NIMH) grant support for project t i t l e d " M Study of
NR
Lithium Interactions in Human Erythrocytes"
(Application
number: 1 R29 MH45926 - 01). I am one of three
collaborators on the project. The Principal Investigator i s
Dr. Mota de Freitas (Department of Chemistry, Loyola
University of Chicago). This NIMH funded project i s
proceeding favorably at present.
�J o e l M. S i l b e r b e r g / M.D.
Curriculum V i t a e Page 8
CLINICAL INTERESTS:
Medical Student and Resident Education
Outpatient I n d i v i d u a l Psychotherapy
Inpatient Psychiatry
Administration
S o c i a l and Community P s y c h i a t r y
F o r e n s i c Psychiatry
Emergency Room P s y c h i a t r y
Psychopharmacology
Consultation-liaison Psychiatry
Family and Couples Therapy
PUBLICATIONS:
Paper author of "The V i c i o u s Cycle of Poverty".
Published
i n The 1987 Loyola Symposium on Values and E t h i c s , by Loyola
U n i v e r s i t y Press, 1988: (69-73)
Second author of paper i n the j o u r n a l , B i o l o g i c a l
P s y c h i a t r y . J u l y 22, 1989, e n t i t l e d "Measurement of Lithium
Transport i n RBC from P s y c h i a t r i c P a t i e n t s on Lithium
Therapy and Normal Controls by 7Li NMR Spectroscopy". Dr.
Duarte Mota de F r e i t a s (Department of Chemistry, Loyola
U n i v e r s i t y of Chicago) i s the f i r s t author of t h i s paper
I am an a u t h o r on a c h a p t e r on s e x u a l i t y i n t h e t e x t ,
B e h a v i o r a l Science f o r Students (c 1989, W i l l i a m s and
W i l k i n s , f o r 1991 p u b l i c a t i o n )
PRESENTATIONS:
L e c t u r e s t o the Peer C o u n s e l l i n g Group a t Loyola U n i v e r s i t y
Medical Center on "When t o Refer a Medical Student f o r
Immediate P s y c h i a t r i c Care": January to June 1983
Introductory l e c t u r e s t o medical students a t Loyola
U n i v e r s i t y Medical Center s t a r t i n g t h e i r p s y c h i a t r i c
c l e r k s h i p : September 1983 t o present
P r e c e p t o r t o medical s t u d e n t s a t Loyola U n i v e r s i t y M e d i c a l
Center: October 1983 t o p r e s e n t
Course t o family p r a c t i c e i n t e r n s a t C h r i s t H o s p i t a l on
Sexual Dysfunction: February 1984
�Joel M. S i l b e r b e r g , M.D.
Curriculum V i t a e Page 9
Presentation of a paper at NAPHT's 15th Anniversary Meeting
a t the Chicago M a r r i o t t Hotel on "Sexual Dysfunction i n
Renal Transplant and Hemodialysis Patients": November 13,
1984
Consultant and discussant f o r numerous o u t p a t i e n t and
q u a l i t y assurance case conferences at Loyola U n i v e r s i t y
Medical Center: July 1984 t o present
Lecture on "Chemicals Causing/Coping w i t h Stress" a t Loyola
U n i v e r s i t y Medical Center's symposium on "Stress and I t s
Disorders": October 1986
Presenter of CME courses at Loyola U n i v e r s i t y Medical Center
e n t i t l e d , "Resistance t o Therapy": November 1986.
"Childhood Truancy and Depression": March 1987.
"Psychodynamic Formulation": A p r i l 1989. "Case
conference": A p r i l 1990. "NMR and Genetic Studies of RBC
Li+ and NA+ Exchange": September 1990.
"Obsessive
Compulsive Disorder": October 1991.
Lecture on "Current Trends i n the Treatment of A f f e c t i v e
Disorders" t o the Santos Medical Association, Sao Paulo,
B r a z i l : January 9, 1987
Conducted Grand Rounds a t the U n i v e r s i t y of South F l o r i d a ,
Department of Psychiatry and Behavioral Science,: J u l y 1988
Seminar on "Refractory Depression" t o the A s s o c i a t i o n of
Mental Health Private P r a c t i t i o n e r s - Oak Park and River
Forest - December 1988
Course of l e c t u r e s on "Refractory Depression" t o the
Psychiatry Sub-Group of the U n i v e r s i t y of the Witwatersrand,
Johannesburg, South A f r i c a : February 1989
Presentation on "Differential Diagnosis of Dissociative
Reactions" at Loyola University Medical Center's symposium
on "Child Abuse and Dissociative Reactions": A p r i l 1989
Seminar on "Adolescent Depression"
Consortium, Inc.: A p r i l 1989
t o the DuPage
Numerous presentations f o r CIBA-GEIGY Pharmaceuticals as a
guest l e c t u r e r i n the "Medical Lecture Series": February
1990 t o present
Guest Faculty f o r the U n i v e r s i t y of Chicago's "Comprehensive
Psychiatry Review" Course: March 1992.
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COLLECTION:
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Health Care Task Force
Steven Edelstein
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[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
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PI
P2
PJ
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b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
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Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL S T O R I E S DATABASE
9 oV
F I F I C A T I O N OF WRITER
P6/(b){6)
PRIBF SYNOPSIS OF LETTER
A f t e r being l a i d o f f , became self-employed and unlnsurab e due t o heart
problems and cancer (pre-existing conditions). D i f f i c u l t t o Dbtain insurance
and, i f so, very high premiums.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
FORCED TO W R
OK
UNABLE TO PAY
HIGH CO-PAYMENTS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
LOSS OF COVERAGE
FROM CONTINUED CARE
MEDICAL COSTS - EXCESSIVE
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02/22/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl
l'2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the I OIA|
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(K) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office [(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�o|3
P6/(b)(6)
2 2 F b u f "" "
" " e 7 ay l 9 5
Mrs. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C.
Dear Mrs. Clinton:
We are writing you to let you know of our health insurance problem.
This past week we learned the term for a policy of which we have been the victirr On the MacNeillLehrer News Hour we heard of what was called "cherry picking".
We have been the victims of this practice.
lifter 27 years of steady employment in the defense industry, my husband was laid and became self)ff
employed, and uninsurable. It seems ironic, that after 21 years (including thi year-and-a-half on
COBRA), that we were deemed uninsurable by our present carrier.
Six years ago this coming April, I had a cancerous tumor burst in my body. A ter eight months of
chemotherapy I became an uninsurable person. We have applied to ten insurance< ompanies and have
been turned down by all ten.
At the age of 36, seventeen years ago, my husband had a heart attack. He has exferienced no further
related problems and was never under medication.
jBut when we apply for insurance, we are always told I must be 10 years from ny cancer incident,
VSeveral companies also declined coverage for my husband because of the heart atltack.
We are currently paying $600.00 monthly for a COBRA plan. Last year I m d $7,800.00 working
ae
as an intermittent employee for the Census Bureau. You can see that this dn't leave me any
discretionary income after my PICA and taxes were deducted.
We were fortunate to hear of the California Major Risk Medical Insurance Progim. We have been
accepted and will be picked up by them on April 1 this year, with a 3 month'prfe-existing exclusion.
This plan will cost us $550.23 monthly.
Our journey to this point has been fraught with frustration and sleepless nights t the idea of being
willing to pay for insurance and being turned down at every point. The practice 3f "cherry picking"
should not be allowed to continue.
.'""ft*""^ •' ''i-
'• ' " ^ ' pe/fbx'e) ' '
• ,; • .' >
)
.
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n.d.
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P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jm810
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Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or conndcntial commercial or
Financial information 1(a)(4) of the PRA]
P.S Release would disclose conndcntial advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
"BRIEF~SYN0PSIS OF~LETTER
Man with l i v e r disease who had used up h i s medical leave was :orced to r e t i r e
e a r l y so that he wouldn't lose h i s insurance.
Wife c a m o t make career
advances because he i s covered under her plan. He i s r e t i r e ^ but gives back
to the community through several c h a r i t a b l e p o s i t i o n s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
OTHER CONTENT
Forced t o r e t i r e e a r l y so wouldn't l o s e h i s insurance
��^ ^ ^ ^ vf- JJ
T
.
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DOCUMENT NO.
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SUBJECT/TITLE
DA I E
02/12/1993
Personal (Partial); Address (Partial) (I page)
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
imSIO
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Presidential Records Act - [44 U.S.C. 2204(a)
Freedom of Information Act -15 U.S.C. 5.S2(b)|
Pl National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the F01A|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�tk+i ^w-L
f
X-ZX-U.
P6'(b)(6) .
-.0
'jisv*^- batj~
jL^-y
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SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
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COLLECTION:
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Health Care Task Force
Steven Edelstein
OA/Box Number:
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FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jm81()
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Pl National Security Classified Information 1(a)(1) of the PRA|
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financial information 1(a)(4) ofthe PRA|
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and his advisors, or between such advisors |a)(5) ofthe PRA|
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personal privacy |(a)(f)) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA)
h(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
P6/(b)(6)
6/5"
CP 4BRIEF S N P I Q LETTER
YOSS F
Writer works i n a one-person ( h e r s e l f ) o f f i c e , with no bene .ts. Husband i s
s e l f employed. They have one i n d i v i d u a l p o l i c y covering t em and a second
covering 2 daughters, one of whom has cerebral palsy. The t h e i r premiums
t o t a l e d $600/mo., plus deductible and co-pay o f $2500/yr. 0scheduled costs
for the family of $9,000/yr.) They tried to switch carriers;. Parents were
accepted but not the c h i l d r e n .
They cannot a f f o r d dental are f o r anyone,
Gross income of $50,000, but hostage t o daughter's current: c a r r i e r . They
could be forced i n t o poverty. Currently pay 20% of gross f o i medical and 20%
f o r taxes, and carry an increasing debt.
Families w i t h d|s a b i l i t i e s need
more coverage.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�4/19/93
Ms. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue. N.W.
Washington, D.C. 20500
Dear Ms. Clinton,
I am writing in regard to your plan for health care. I would like to
thank you for your stance that al! people will be covered and that
there will be no more pre-existing condition exclusions in your
national health care reform package.
We have a number of concerns with the health care system and are
eager to hear how they may be addressed in the reform. We are a
ffumljWQfsd. My husband-i^self-emplbyed in a~ one-person-office. I
wprk^for a grass roots non-profit serving families who have children
with disabilities l^sisiingr::them::3
for their
children and families. I am the only full time employe^ of the
organization and: there are np^benefits provided. We have to
purchase individual policies for health coverage. Our daughter
Rachel«as^6'yearsvoid vandr?has^cerebral.vpalsy. We have a 3~year«old
daughter who has hadua* S9rie^Q^^.dd3i!^j|rjy^|||^^s over the past
18 months. Last year we tried to switch, insurance ..cameis_wheii_the
monthly- premium went up to $606.00/month. The company we
applied to would take my husband and myself, but would not take
either of the girls because of their preexisting conditions. We
cuCTently^pay^$2^/^
We pay
$0^^inonthii^fetbLftiiitw,o«giri». We just received notice that Hwgafe
P^ijcjfeiSi'going up to_$326/month^'a? ot June - Ut. On top of this are a
dedu^ible"and"a co-payment that "add up to anothert$2500/year. At
a minimum, iM)avid*and*my premiums did ••not fb^¥p ^^^^aia*i n'o>
useatheftpolicyg^dpincur^
w»M^0QQ,G0»a'»yeap» Thi8~,rW.Bv.:npty inf>,iii^^h^^nn^ ™ » ° n^t&.
we incur from^Rachel'S'disability. We'rarerunablercto^eees&f^gflfalseryice^for?. anyone in the family due to the costs. We have no
choices available to us. We are a middle income family, with a gross
income of just under $50,000.00. We do not qualify for any public
programs, and are hostages^towouriidaughtersaECurrent^insuranoe
(miaiei^ue^o^hemdisabiljtyjL/ Wescouldwfeventuallywbeaiforcedwinto
PflKfirtysswithrescalating-health^care costs. We are still paying off
debts incurred at Rachel's birth and from surgery and hospitalization
1
:
;
>:i
,
:
ftft
?
1
tffa
ff
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DOCLIMENT NO.
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016. letter
SUBJECT/TITLE
DATE
04/19/1993
Personal (Partial); Phone No. (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
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PI
P2
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P4
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h(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
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h(6) Release would constitute a clearly unwarranted invasion of
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purposes 1(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
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Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) of the I'RAI
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financial information 1(a)(4) ofthe PRA|
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and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
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�,
>
costs not covered by our insurance. We cun ently pay^20%aiifc«our
grpssjncome to health care and another 20% to taxes. Wefcreleftwith .increasing debt and a declining standard of living whi
attempting : to - maintain a; modest home and life for our fam
I am very interested in what your definition of "basic" heaJ h
benefits will be. I know that for our family, "basic" include! things
like durable medical equipment, occupational and physical therapy,
and assistive technology devices. For many of the families work
with it includes Speech therapy, Cognitive, YisionjaandsbehUvior
theJapie^^ew^healthwcar^serYices^preseriintinnwIniiTft—m dioaL
^ppjigs^utpatienfr^mentalTheal^^
These
are typically "basic" health care to persons with disabilities Dr
chronic health conditions, Will these be included in your health
reform package as "basic"?
dramatically^ impacts Rachel's,'"and- subsequently-'onr^familyt^KqufttUy
ofelife^ She needs a wheelchair and walker or crutches just ;.9.get
around. She requires physical and occupati on al" therapy on a weekly
basis- torspreyent; contractures and other deformities as rwell as^to
leamrioswallj, dress herself, use a computei^fon^ritteojidani luigp,
and increase her ability to function independently. WitWOTFtheise
basicsviishe will be dependent as an adult on public assistan e
programs. Given these basics now, Rachel has the potential 6' be an
independent,^,contributing member of society. She is bright
energetic, full of hope for her own future. Without "basic" icalth
care, which we are increasing challenged to provide, I am i ncertain
how bright her future will be.
Thank-you for your willingness to tackle this issue. I hope thatithe
informational have proyidQdiyou will help in -your..efforts;..t:*ds/ipe
fthasiOfflFhealth^care'forepersons:-withv disabiUtie.s» Having yoi in the
White House has given many of us connected to the disability
community new hope for the future of our children and fan lies. I
hope that you can fulfill the promise of health care for all.
would
appreciate a response to my concerns.
I would be honored to be of
further assistance; please feel free to contact me. I am enc jsing my
business card, or my home phone # is [
P6/(b)(6). '
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DOCUMENT NO.
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SUBJECT/TITLE
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Personal (1 page)
n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jm810
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 5S2(b)|
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purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
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DOCUMENT NO.
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n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
imSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)]
Pl
P2
P3
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b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
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b(9) Release would disclose geological or geophysical information
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Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA)
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P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Self-employed, 63-year-old Berkely resident turned out c e her home and
business I n the Oakland Fire, subsequently developed breas cancer and now
must take Tamoxifen (presently $1000/hr.) the rest of herl i f e . This, as
"outpatient p r e s c r i p t i o n " and the e n t i r e premium of $64 2/yr. (includes
dental) comes out of her pocket. This year she spent about d3 much on things
not covered ($3,099) as on her coverage ($3314). T e l l s o f Another woman i n
Since she had
r a d i a t i o n but whose doctor wanted her t o have chemotherapy
£out pay, losing
used up her sick leave, she would have had t o take leave wit:
both her income and her medical coverage. So she had t of o i ' jo the treatment
that might save her l i f e .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
OTHER loss of income
recommended f o r treatment
and coverage
i f insured
:akes the time
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DOCUMENT NO.
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DATE
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AND T Y P E
019. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/16/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-1jm8IO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act -15 U.S.C. 552(b)|
PI
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b(7) Release would disclose information compiled for law enforcement
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h(8) Release would disclose information concerning the regulation of
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b(9) Release would disclose geological or geophysical information
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Release would violate a Federal statute 1(a)(3) o f t h e PRA|
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financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 16, 1 )93
Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D. C. 20016
Dear Ms. Clinton:
:
I am delighted that President Clinton has appointed you chair of the task )rce on health
care. This letter addresses some of the health care issues that need to be considered and dealt
with, including health insurance that does not cover all aspects of medical care, health
insurance that is tied to employment and sick leave, and the extraordinarily higqlcosts of
prescription drugs and of hospital care
I have since had surgery and radiation
and am now taking tamoxifen, a hormone treatment that deters the recurrence 4 cancer. During
the past sixteen months I have learned more than I ever wanted to know about isurancehealth and homeowner's--and about cancer and taxes. Changes are needed. ,Tc llustrate this,
let me tell you about my experience and about a woman I met while we were botr going through
radiation treatments.
i^swnwissniRsn^
premium*ifoR#1992 totaled $2,652*(plus an additional $662 for dental insuran :e). No
employer contributes to, no less pays for, this coverage-it all comes out of my aocket. This
medical insurance does nofccover^outpatient prescriptions" and it does require repayments for
visits to the doctor, for radiation treatments, and for hospitalization (and perhi )s for other
things I have not yet needed).
Thus, even though I have both medical and dental insurance, my total co< for medical and
dental care in 1992 was $6,412,61. That does not include a recent bill for rac ation
copayments of $828. Nor.-does it accurately reflect the cost of the tamoxifen^
$2:9.8
pei»ttoy4or»more*than;$ 1,000 a year)/which rdid'not start taking uhtif Decenfperan
lw^riMikfl^fl(rtiiQsrest:ofimy3life. In 1992 Itpp^nLialmo^gs^^h^^.O.
�page 2
Hillary Rodham Clinton
March 16, 1993
CC t iderably
The cost of prescription drugs is preposterously high and is evidentlyISI
issential that
higher in the United States than in other countries for the same drugs. It seems
the pharmaceutical companies be audited. I recognize that the development ofdrugs is
new
ihd purchased
expensive. But I. question the need for advertising drugs that will be prescribed
does
as the-only:available drugs for a particular condition, Such advertising probably little to
ose t
increase the sales of such essential drugs but probably does increase the cost ofdrugs. And
e profits of the
I believe that the cost of that otherwise useless advertising does reduce the taxab
pharmaceutical companies. When the cost of a drug prevents some patients using and
frorr
is awry.
benefiting from it but provides substantial profit to the manufacturer, somethir h
Similarly amazing is the cost of hospitalization. I was in the hospital'fopttboufrZZ
iJaounj. The bill for that came to $9,435.82; of which I had to pay $500. If my
Iibuse had not
burned down, I would not have had the money in the bank to pay the bills resulting
from my
treatment for cancer. And vet 1 will have to pav taxes on any of^hftjnsurapcfttpni j
ifiedsuusedifor
flaedicaUcata. That dilemma is explained in the enclosed copy of a letter
I wrote 4st fall to then
Senator Lloyd Bentsen.
Now let me tell you about a woman I met while going through radiation tr^btments, She
is not someone who.does not have medical insurance, nor is she unemployed or receiving any
kind of financial assistance. She has been a full time civilian employee of the U,!i Navy for 30
years, and as such has health insurance. She, too, had breast cancer and had hacJsurgeiy. When
she was about half way through radiation, her doctor told her that he wanted her: i go through a
course of chemotherapy. And she was devastated. In order to undergo the chemojtfierapyjsshe
wouldJbayft.had to be away from work for several weeks, but she had already uphersiclc
used
leaue. That meant that she would have had to go on leave without pay. Had she e that, she
do
would.have-lost both her income and her medical coverage. She couldjiQkSlfprcl,
kloseueitker,
andiS©~although she has worked full time all of her adult life and has medical coverage -she
l«Ktae*forega>the chemotherapy that could have'extended her life.
I realize that these two stories illustrate only a few of the many of things that are wrong
with our health care system, and that these problems are not as dire as those fac kiby people
who have no health insurance. But it is clear that even having such insurance doebnot guarantee
needed health care, nor does it guarantee affordable care.
I would be pleased to provide any additional information that would be useful. And I look
forward to learning about the plan that your task force develops.
P6/(b)(6)'
cc: Senator David Pryor, Arkansas
Representative Pat Williams, Montana
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•
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DOCUMF.NT NO.
AND TYPE
020. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
09/23/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 IJ.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office |(a)(2) of the PKA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�o5
' P6/(b)(6)
0
September 2 3, 199
Senator Lloyd Bentsen
Chairman
Senate Finance Committee
Dear Senator Bentsen:
Oakland/Berkeley firestorm
On October 20, 1 991, my home burned to the ground in the
that killed 25 people, destroyed more than 3,000 homes, and irrevocablydisruf ed the lives of
thousands of men, women, and children.
M home contained my tangible past--the possessions I accumulated dur m>
y
ng
years, the books and art I treasured, the few reminders I had of my mother who lied in 1948. It
also contained the office in which I earned my living as a freelance, sslfcejtnR)]
(jjggg^gjl^ and theifruits of'three year^bfresearch*
f
to
In the eleven months since the fire, I have learned more than I ever wanted know about
company. This
insurance and have worked diligently to fulfill the requirements of my insurancf
has included preparation of a detailed inventory of the invisible contents of my rhvisible house,
This painful process evokes memories of precious and irreplacable possessions js well as those
of monetary value. No amount of insurance funds can replace the cookbook with jotes in my
mother's handwriting, or the papers and drawings that my children brought hon|)|5 from
elementary school, or the books written by friends and inscribed with love and ippreciation, or
the bedspreads crocheted long ago by my grandmother,
In May, I was diagnosed with breast cancer. Much of my time since has ;n lost to
medical treatment, including surgery and radiation. Now I also know more than sver wanted to
about cancer, and I have learned some unpleasant things about medical insuranc Mine, which
has become increasingly expensive, has proved reasonably satisfactory so far. SLt now I am
faced with the prospect of taking a drug-tamoxifen-for the rest of my life, ar (I my insurance
does not cover such "outpatient" drugs. The cost to me will be in excess of $1 000 per year,
although I already paying nearly $3,000 for medical insurance.
Yetftffi*hbWfacedwith Wprospectof having to pay 'taxesofrm^y^fdxS^ * 1
W
•IrtfUHlWSPCThpanSflyiiB^
I do not understand howsmh funds can be
considered either "income" or "capital gains," especially since they result frorr no action of
mine and since my involvement in this disaster was totally involuntary-l left ( ily when my
house was filled with smoke, lit with the orange glow of flames just outside the vfndows, and
surrounded by fire that was about to leap across the only road along which I coul escape. Am I
to pay taxes for my failure to risk my life to save a house already on fire?
�Senator Lloyd Bentsen
September 23, 1992
I am faced with high and perpetual medical expenses for the rest of my lif i and the
prospect of minimal Social Security income should I have to stop working. AfttaUwaLthe
1km
jife~tho»9hOfel<^nd 5tress-of the experience^the need-to spend hundredsvofdioaiMMMngMMi
pap§£Vyfir)<..qji<3l.bureacracies and shopping both to replace the essentials fonl(y|n ranci^^btaiP
pBplacemeaLJSfi§i:.fl9
the inventory of my vaporized possessions-maoe'lTvirtually
Irpjagssibl'QiiQLine to work at a profession that requires concentration and the at i ity to meet*
daadlines/ And if the insurance settlement-which now seems but weeks away, i ifter eleven
months-is adequate, I will be spending hundreds more hours on the planning ar < I construction
of a house, in compliance with the insurance policy. It is likely that as much as :wo years will
have passed between the moment when I saw the first red hot ember in my patio id the moment
when I can turn the key in the door of a rebuilt, refurnished home and office.,
:i
ures f o r
Even if my health were perfect, it is unlikely that I would live more than mother twenty
years. The cancer may significantly shorten that. Yet I am faced with requirem* fits to spend all
of the insurance proceeds to replace material possessions, many of which canno^ be replaced, or
to pdjauiBW^nyrofahe^lrisurancennone
^mpKWflKthwquality of a life that has been Irreparably damaged.v The logic of this jscapes me.
And yet it applies to many, and to more with each such disaster.
It is my understanding that S. 3123 addresses these problems. I will ip: reciate your
efforts toward passage of legislation that will correct these inequities.
Sincerely,
P6/(b)(6)
cc: Representative Ron Dellums
Senator Alan Cranston
Senator John Seymour
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DOCUMENT NO.
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SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
PJ Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
I'5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA|
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�c:j
CONSENT GIVEN 08/26/' CD: MI-11 & 12
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
...
^,
P6/(b)(6)
-»•
".••ji
.
BRIEF SYNOPSIS OF LETTER
Husband owns small c o n s t r u c t i o n company w i t h on f u l l - t i m e efjip 1 oy ee.
I ncome
i n $20,000 range - f a m i l y o f 6. Had t o take insurance w i t h
,500 deductible
and 50% co-pay a t $300 per month. Needs laparoscopy b u t san' t afford i t
because t h e 45 minute procedure costs $5,000.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
MEDICAL COSTS - EXCESSIVE
DOCTORS FEES
�Withdrawal/Redaction Marker
Clinton Library
DOC UMENT NO.
AND TYPE
022. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (I page)
01/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Prcsiclenlial Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |S IJ.S.C. 552(b)l
PI
P2
P3
P4
b( I) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOlA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4)orthc FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of Ihe F01A|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAJ
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
rmaneial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
(.'. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�0
>
January 26,1993
Mrs. Hillary Rodham Clinton
Task Force on National Health Care Reform
The White House
Washington, DC 20510
Dear Mrs. Clinton,
While reading my newspaper this morning I wasencouraged to read that you re encouraging
wf
Americans to write with their suggestions and concerns regarding health care
Obviously, the
two major issues you will be addressing are the availability ofhealth care to all
\mericans and
the reduction ofhealth care costs. I hope the following account of my individual
situation will
give you further insight to the problems that need to delt with.
My husband owns a small construction firm and he employs one full time person. Our income
the past two years has been in the $ 20,000 range. (Due to an ailing Michigai i economy, but
that letter goes to another task force!)
In selecting health care for our fam'. y of six and for
his one employee, we did do our homework, and we interviewed compames th 1 specialized in
1
insurance for small businesses. To our dismay, we soon discovered that if yoi want any kind
. of comprehensive coverage, your premium is going to be in the $700\mo. rang:and even that
^—fias so many disclaimers and strings attached you would be amazed. Because fl00\mo. is what
$
we can afford to pay for our house payment, and not health insurance, we opt s i for $300\mo.
premium which includes a $2500 deductible and 50% co-pay on the next $5000. To us,
$300\mo. is a lot of money, and in this case it is a lot of money for basically othing.
Which takes us to the next problem...
Earlier this month, having some minor health problems, I learned the realitiei ofthe costs of
our health care system.My doctor had recommended a laprascopy, a relativ:ly simple outpatient procedure, taking approximately forty-five minutes. The costs invoh i id would have
totaled slightly under $5000, with $3800 of that coming from the operating rooi i il Now lets get
real and try tofigureout just how 45 minutes in that little room could possibly be so
expensive.This is something that you need to address. To end my tale of lair < :nt, we simply
could not afford to go through with the procedure, and I decided to live with tl ; pain, hoping
that, as promised, the Clinton administration would make affordable, adequate health care
available to all Americans.
Sincerely,
. . . , • P6/(b)(6).
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
023. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
08/02/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security' Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe I'RAI
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information [(b)(1) ofthe I <)1A|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�li/'.-2-93
President Clinton and Hilary Clinton
We are a family of f i v e and our daughter 3 $ yea: s ago
1
was diagnosed with Diabetes. At that time are Health Insurance
premium was 234.00 a month, since then they have increased
our premium every 6 months and now i t has reached a h gh
of 934.00 a month.
I t i s at the point where we can not afford to pay this
monthly cost, but at the same time i f something happens to
her we can not afford to lose everything we have worked so
hard for, for the last 17 years of our marriage;.
^V)^49^wn.^a'*sfnaUl'.,Construction.-Co..
aqfL It..is^hara^td
get a policy .through the business , our employee number
"changes so quickly every month depending on work.
,
We have t r i e d t o change Health Insurance Companios but
we cannot f i n d another Company that w i l l cover our daughter
Our hands are t i e d and i t seems l i k e i t s a frustrating) and
no win situatuion f o r our family.
We have t r i e d to go through our States Insurance ! m
om
ission but there i s nothing they can do f o r our s i t u a t on.
I f e e l we have been discriminated by our Insuranc 9
Company and they have not paid out i n a years time wnet
our premium has cost us i n a month.
Diabetes i s very easy t o control, and these peop]
can and do l i v e normal lives without complications.
We would appreciate any kind of information t h a t 3ould
help us a t t h i s time.
Attached are l e t t e r s we have ant
to our Senators and a l l of our rate increases i n the ist
3 5 years since our policy began.
5
Thank You
X
.
vi
. • •. P6/(bK6)
>
-
073
/ •. •
•
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
024. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
06/10/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) ofthe I O l \ |
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(l»(8) of the KOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Itttnxieb Elates ^cnaic
W A S H I N G T O N . D.C.
20510
June 10, 1992
••|-f.--;j.. • . - a - -
:
.
•+',•!» 1""',
' P6/(b)(6)
;
„ •'•
,t
; ;''
,"
y
• , A'
u
Thank you for sending me a copy of your l e t t e r tlo Governor
M i l l e r regarding accessible and affordable health car^ f o r a l l
Amer icaris;. I , coo, am concerned about t h i s matter.
Everywhere we t u r n , people are discussing the hilalth care
c r i s i s facing our country and proposing possible solutions,
Meanwhile, m i l l i o n s of Americans are uninsured and receiving
l i t t l e health care, and countless others are undtr insured.
Insurance premiums are skyrocketing, as are health ca: e costs,
Too many Americans are not receiving the health cart; that they
require.
The tragedy of our health care system as i t e x i s t i today i s
one of inequitable rationing: certain groups get morj care than
others. The wealthiest Americans get the most and highest
q u a l i t y health care.
Poor Americans receive less
and the
care i s of a lower q u a l i t y . This system, and i t s . c<ire
:iecipients,
suffer from i n e f f i c i e n c y and inequality.
Several proposals exist for eradicating our natioiji •s health
care c r i s i s .
Some favor permitting the current ree market
approach t o providing health care t o p r o l i f e r a t e ; others advocate
a
tax-supported
national
provider; s t i l l othe
require
businesses and employers t o supply health insurance,
Each of
these proposals has good and bad features. Any healt care plan
that passes, though, must have aspects of several plan
As we
debate these policy questions, however, a l l Americans Aire bearing
the burden of the inadequacies of the present health care
system.
�Page 2
For my p a r t , I w i l l do my utmost t o expedite the l e g i s l a t i v e
process t l ^ c c i m p l i s h the important goals of f a i r costs and
q u a l i t y care for a l l Americans.
With a l l best wishes,
Sincerely,
/United States Senator
HMR/niani
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
025. letter
SUBJECT/TITLE
DATE
12/23/1991
Personal (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jin810
RESTRICTION CODES
Presidential Records Act - |44 IJ.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or conndcntial commercial or
rmaneial information 1(a)(4) of Ihe PRA|
P5 Release would disclose conndcntial advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile diTmcd iu accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�TRANSPORT LIFE
INSURANCE COMPANY
714 MAIN STREET FORT WORTH. TX 76102-5252 1817) 390-81
December 23, 1991
Ms. Patsy A. Crawford-Waits, R.H.U,
Compliance I n v e s t i g a t o r
Nevada D i v i s i o n of Insurance
2501 Sahara Avenue
Las Vegas, Nevada 89158
Re:
• - • . .P6/(b)(6) '
.
.
Dear Ms. Crawford-Waits:
This l e t t e r i s i n response t o your i n q u i r y of Decembe^: 11, 1991, on
behalf o f , . p6/(b)(6)
We would l i k e t o assure you and
• mm)-' t h a t h i s i imily has not
been singled out f o r premium increases f o r any reason. A l l
insureds covered by the same c e r t i f i c a t e form who arie i n the same
c l a s s i f i c a t i o n and l i v e w i t h i n a given geographic area receive
i d e n t i c a l percentage premium changes. I n d i v i d u a l claijms or changes
i n health a f t e r the e f f e c t i v e date of coverage are not considered
when r a t e adjustments are made.
P6/(b)(6)
concern 4frout premium
W share and appreciate
e
increases. We impose those increases only when i t s absolutely
necessary i n order t o meet our o b l i g a t i o n s t o our nsureds. We
recognize the impact these adjustments have on an i n d i v i d u a l • s
budget, and we r e a l i z e t h a t these increases cause p:ople t o look
elsewhere f o r less expensive coverage.
As you requested, enclosed i s a duplicate of the Novel i ber 30, 1991,
Notice of Increase l e t t e r sent t o
P6/(b)(6)"
Plea;e note, t h a t
notice was provided w a l l i n advance cf ycur s t k t e •s 60-day
requirement. I have also included a copy of the Aptfil 30, 1991,
l e t t e r g i v i n g notice of an increase scheduled f o r Ju y 15, 1991.
Your i n t e r e s t i n t h i s matter i s appreciated, r a d d i t i o n a l
information o r assistance i s reguired, please contjict us. Our
t o l l - f r e e number i s (800) 433-7090; my extension i s 1921.
Sincerely,
TRANSPORT LIFE INSURANCE COMPANY
Warren W Schellhase, Senior Analyst
.
Consumer A f f a i r s Department
PRIMERICA
W S 1 f/Enclosures
W::
�Withdrawal/Redaction Marker
Clinton Library
DOCUMF.NT NO.
AND TYPE
026. letter
SUBJECT/TITLE
DATE
05/13/1992
Personal (Partial); Address (Partial) (2 pages)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jm8IO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 ll.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe I'RAI
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
PC Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information [(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�May 13, 1992
36>
Dear Governor Miller,
It has becona a great concern for all the residents in the itate of
Nevada regarding the .alarming rate of increase in health insurance
premiums. Scmething has to be done about tha rising costs Hf we are
to survive. W have had a Group Health Insurance plan for ur family
e
with the American Health Advisory Association. The oariginaf premium
was $237.00 monthly. On February 1, 1990, our eight year old daughter
Cara, was diagnosed with diabetes, sinoe that time our insvianoe rates
have been raised every six months. This is ridiculous and Unwarranted,
I feel^that because of m daughters condition, we are beingj discriminated
y
against. Our insurance premiuns starting July 15, 1992 wili. be $666.00
a month, an increase of 280% in the short period of twenty-: dne months.
W do not know what to look forward to in the future with ro controls
e
enacted on tha Insurance Ccmpanies. W are to the point vrtfxe we can
e
not afford protection for our family and feel because oftthexcessive
increases, will be forced financially to cancel. Our firm lelief is
that this is what the Insurance Ccrpany is aiming at, to re: uce their
liability. This puts us in a no win situation, (1) we can not afford
the continuous increases, without a controlled ceiling, a d (2) we can
n
not afford to cancel because other Health Insurance plans• i:» not
available to vis because of our daughters existing diabetes <jondition.
Enclosed are copies of our premium increase notices. This s a group
policy with the American Health Advisory Association, in wi. ch our
policy clearly states, "an individual may not be singled o : for rate
v
increases''. On December 5, 1991, I filed a letter of ccrnp:,tint with
the Nevada State Department of Insurance because of the exclusive rate
increases. The results of this letter wete negative, N Hjfl.P N R
O
O
A Y ADVISEMENT.
N
�As a working "Middle Class" family we are disturbed that out tax dollars
are supporting a multitude of programs, such a welfare, fre£ medical
services, food stanps, subsidized housing and many other programs that
r
benefit the minority class. Yet our elected officials do vn:y little
to help control the rising Health Care and Health Insurance 30St8.
W can not understand h w this situation can continue without drastically
e
o
affecting our family and many other Nevada families in our iqane sitas s
uation. It is requested that you provide us with seme a--i it ance or
guidance in this area, and if there is a solution in the near future.
CC!
Senator Reed
Senator Bryan
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
027. letter
SUBJECT/TITLE
DATE
06/10/1992
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Rox Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PKA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of Ihe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�319 CANNON H O U M O M I C I BOILOINO
WAIHINOTON. DC JOS 16
(202) 226-5986
JAMES H. BILBRAY
H T DISTRICT, NIVAOA
COMMITTEE ON
DISTRICT OFFICE:
ARMED SERVICES
1 7 M E. SAMAHA # 4 4 6
LAtVlOAt, NV 89104
(702) 7 * 2 - 2 4 2 4
COMMITTEE ON
SMALL BUSINESS
Congress o tfje ®mfeb fetate* H a l l
f
Cilty
SELECT COMMITTEE
ON AO ING
^ousie of fteptesientattoetf
3Ka£{f)tnston 3BC 20515
HelJiderson, NV 89015
65-4788
f
June 10,
- R6/(b)(6)V • • - - r .
•>
,
1992
o
ail
..... U
Thank you f o r sending Congressman Bilbray
copy of
your correspondence regarding health insurance preniums,
Unfortunately, there i s no government agenc
regulates the costs of i n s u r a n c e — t h i s i s contro
states, although you must be given notice of incre
would suggest sending a l e t t e r t o a l l state senate
assemblymen, especially those who were a c t i v e l y st
insurance reform l a s t session, and request a ch
legislation.
To that end, I am returning your coi
to forward to one of your representatives.
r which
through
I
ises
rs and
iking
through
respondence
I f you need assistance regarding any Feder4|L matters,
please do not hesitate t o c a l l or w r i t e .
Sincerely,
. Rig^i/
D i s t r i c t Representati\
Henderson
�Withdrawal/Redaction Marker
4
Clinton Library
DOCUMENT NO.
AND TYPE
028. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
06/09/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. S52(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating tn the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
rmaneial information 1(a)(4) ofthe PRA|
P5 Release would disclose conHdential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
I'f) Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misnie defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�STATE OF NEVADA
- DOB MILLER
Ooctrnor
TERESA P. IONCEK RANKIN. J.D.. CPCU
Co r mltdoncr of Inturancm
\ iMELA A. MACKAY
) iputy CommlMlencr
DEPARTMENT OF INSURANCE
State Mallroom
2501 E. Sahara Avenue
Us Vegas, Nevada 89158
(702) 486-4009
June 9, 1992
^
45"."
P6/(b)(6)
RE:
Dear
Transport: L i f e
[16 23
I n s u r a n c e Co.
' P6/(b)(6)
Your l e t t e r dated Mav 13. 1992, addressed to Governor M i l l e r and
e x p r e s s i n a you)- ccnicerns in M':e rir^a of h e a l t h insuran':
has: been
d i r e c t e d to thi. s Deua r tnuint. for reKuonse .
As e x p l a i n e d i n vour l e t t e r , vou d i d address these same concerns i n
the form o f a c o m p l a i n t t o o u r o f f i c e l a s t v e a r .
I ha''e r e v i e w e d
the f i l e and f i n d t h a t t h e i n f o r m a t i o n q i v e n you was alfccurate and
r e g r e t f u l l y i n thi?: i n s t a n c e , we were unable t o q i v e v o i any r e l i e f
i n t h e m a t t e : o t voui i.Tpmiuni r a t e , nor any a d v i c e t h a t c o u l d
r e s o l v e your problem.
The p r o d u c t you purchased i s no l o n q e r m a r k e t e d , t h r e f o r e t h e
p o t e n t i a l f o r l a r o e r numbers of h e a l t h y p o l i c y h o l e j r s
oayinq
premiums t o s u p p o r t t h e qroup members i n c u r r i n g c l a i m s tips aone. We
must assume that, i.hnae who remain w i t h t h e a roup do so I^cause l i k e
y o u r s e l f , t h e v hcive onaoino medical
problems and c aims v/hich
p r e c l u d e them 1 rum s h • v o i n a
: >
•
I. s-ewhe r** f o r i n s u r a n c e , h u s more
T
isremiums must be charcjed t o those peovjle who r e t a i n t h e :overaqe i n
o r d e r t o s e t t l e i n u i: re d c l a i m s .
As e x p l a i n e d i n ou l e t t e r o f
F e b r u a r y 3, 1992, vou were n o t s i n q l e d o u t because o f yc f a m i l v ' s
Ur
c l a i m e x p e r i e n c e , t h e r a t e s o f t h e whole qroup were injitreased
�P a q e two
June 9.
1192
? • - • P6/(b)(6) ;
The c o s t of h e a l t h insurance i 5
^
ton p r i o r i t y i s s u e i n Nevada and
there are i n t e r i m c o m in . r. t. ^ e s v/ork inn between l e a i s l a t i s e s s i o n s
1
^e
to f i n d s o l u t i o n s in such
; * ••
•< s h e a l t h c a r e c o s t cont inment and
ways to provide a f f o r d a b l e b a s i c cove race to small emplo 'ers.
This
ci'ies not a s s i s t in your immediate s i t u a t i o n but r e s t a sured
the problem i s beinq addressed as a matter of urqency.
A q a i n , I req r e t t h a t t h i s o f f i c e
f a m i l y i n t h i s area, b u t do hooe
t o r vou a l l i n the f u t u r e .
Very
truly
yours,
P um 1 a c k ay
1
Deputy Commissioner
c . c, Governor Bob
Miller
i s unable t o h e l p v J | and v o u r
<>u
that, c i r c u m s t a n c e s w 11 improve
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
029. form
SUB.IECT/TTIT.E
DATE
Personal (Partial); SSN's (Partial); Address (Partial); Phone No.
(Partial): (1 page)
12/05/1991
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Aet - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal ofnee 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
nnancial information 1(a)(4) ofthe PRA|
P5 Release would disclose conndcntial advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOI A]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe KOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOI A)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�STATE OF N V D
EAA
DEPARTMENT OF INSURANCE
COMPLAINT FORM
slIL
Capi
2501 E.
MAII, 'It)!
U l Vcgu,
Curiun
Avtnui'
21 E . Sahara Ava.
aoi) . IMM9
accurattly as pottlble and nturn to Ihe offlct 11 icM abort —
...'•Oi..-
• ... t.
,•(.
P6/(b)(6)
"
..•i.-.'uji- •
• .y;
1
.
,
'
•,.'u'.'* v. - ., -
, ; ... . v l - ^ "
:..
f'ri'-:>..,..j'-
attach a separate sheet, Include
Please provide below i summary of the inrormation concerning your compMrMfTuncceiur).
copies of all correspondence and Information relating lo your problem, A copy of your policy > II assist us.
t
START COMPLAINT HERE:
Ef??.?.?.^...^....^.^.?.?.!
P>gcto 8^ B0l icy <>n l-lS-gO
i
ii
i
ii
ii
^^..P^tilff
SWS.pO
Added New Born Son 1-19-91 ... Total Pd4mian S236.00
Premium Rate Increaae l - l S ^ g i
i
Total
Premiun Rate Increase 7-15-91
Total
Premivm Rate Increase 2-15-92
_5320SL
Total
$543.00
J.._!^5y...S5f^.?.S.^
rate J^cr^es
.
..excessive.
Since our daughter Cara. age 10 gpt . diabetp8
t|iii
i i
i
.122&^ansBOEt..
Life Insurance has raised our rate frcm $236.00.per month to $54: 00 per month.
i
TMs .« ^ . increase of ^ U
I feel this ccmpany has raised our insurance because of our daugHer's diabetes
intentionally to the point that we can not afford health insuranc ( .
Thank You,
P6/(b)(6).
- IfaMliloncI ipttt It Mlt>4, Pli'it t l l i d i a m a n l t i h u l —
�Withdrawal/Redaction Marker
Clinton Library
DOCUMF.NT NO.
AND TYPE
030. letter
SUBJECT/TITLE
DATE
04/30/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe I'RAI
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion nf
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
bf')) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will hc reviewed upon request.
�TRANSPORT LIFE
INSURANCE COMPANY
7 14 UAW i T H t t T
FORT WORTH.
*X
I f
1100) <<1-2!SI
April 30, 1993
o 3^
Dear Group Member:
Isn't It exciting to be living at a time when science and medicine are discovering
remedies that will prolong our lives and cure some of our most drs led' diseases?
'
No doubt about it. this highly effective hospital and medical care is #rtastic But as
you know, Ita slso expensive. This greater cost, combined with the iporeaMd use of these
advancements by health care providers, forces the cost of health ca i delivery to continue
to rise. Premiums for insurance plans that are sensitive to medical ijt lation also rise,
Thus, in order to continue your current level of coverage, we must ihain raise the premiums
on your insurance.
We wish this action was not necessary. The decision to increase ydi}r pre
premiums was made
only after careful analysis of benefits paid to members of the group) f insureds who
purchased this plan of insurance. Your plan of insurance, your age in d the cost of health
"i care in the area where you reside all play a role in determining the < >8t of your coverage
^ " Unfortunately,
examination of these factors revealed that a rate icreaae could no
longer be avoided.
o u r
If you have any questions about your premiums or vour coverage, I ivlte you to call our
Customer Services Department at 1-800-441-2251. You are a vall+d" certlficateholder.
and we are here to help you in any way we can.
Sincerely,
Alan A. Bowman
Vice President
Customer Services
NOTICE OF PREMIUM CHANGE
Your current premium Is:
Your new premium will be:
S
$
The change is effective 07/1^/93
Your premiums are paid monthly
by preauthorized check.
t
ijo«init!
A PRIMERICA COMPANY
808.00
934.00
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
031. letter
SUBJECT/TITLE
DATE
10/31/1992
Personal (Partial); Address (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. SS2(b)|
Pl National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
Pd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will hc reviewed upon request.
�TRANSPORT LIFE
INSURANCE COMPANY
If" • •
• •,
JI4 HAW fTMIT FOIIT WOM».
1 0 1 UI-USI
10
TX JeiOJ S l l l
October 31. 1992
Dear Group Member:
,
We regret that we must advise you of another increase in the p r e l u m rates for your
coverage.
As previously explained, the principal factors in a premium rate indfease are the .
number of claims incurred, the increasing risk of serious illness at we grow older,
and the Increasing cost of hospital and medical care The rates, ait not based upon
the claims of any one individual or family, but on the cost of claif|s for large numbers
of persons in a geographic area
Your notice of the change appears below, We have tried to hole
minimum.
to an acceptable
'Sincerely,
Alan A. Bowman
Vice President
Customer Services
NOTICE OP PREMIUM CHANGE
11
666.00
Your current premium is:
Your new premium will be:
1
The change Is effective 01/19^
Your premiums are paid montr|
by preauthorized check.
u•
IP'
it
niivnil
& W V A PRIMERICA COMPANY
808.00
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
032. letter
SUBJECT/TITLE
DATE
04/30/1992
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe I'RAI
P5 Release would disclose confidential advice between the President
and his advisors, or hctween such advisors |a)(5) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�TRANSPORT LIFE
INSURANCE COMPANY
April 30, 1992
" .'.'.C i *
Dear Group Member.
Isn't it exciting to be living at a time when science and medicine ar discovering
remedies that will prolong our lives and cure some of our most drc i ded diseases?
'
No doubt about it, this highly effective hospital and.medical care Is mtastic. But as
you know, it's also expensive. This greater cost, combined with tha ncreased use of these
advancements by health care providers, forces the cost of health cifr delivery to continue
to rise. Premiums for insurance plans that are sensitive to medical flatlon alto rise,
Thus, in order to continue your current level of coverage, we must i gain raise the premiums
on your insurance.
We wish this action was not necessary. The decision to increase ybjur premiums was made
only after careful analysis of benefits paid to members of the grout> of insureds who
purchased this plan of insurance. Your plan of insurance, your age i nd the cost of health
care in the area where you reside all play a role in determining the cost of your coveraga
Unfortunately, our examination of these factors revealed that' a rate I tcrease could no
longer be avoided.
If you have any questions about your premiums or your coverage, I nvite you to call our
Customer Services Department at 1-800-44 1-2251. You are a va i ed certlficateholder,
and we are here to heio you in any way we can.
Sincerely,
Alan A. Bowman
Vice President
Customer Services
NOT'CE OF PREMIUM CHANGE
Your current premium is:
Your new premium will be:
S
$
The change is effective 07/15/9;
Your premiums are paid monthly
by preauthoriied check.
A PRIMERICA COMPANY
543.00
666.00
m.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
033. letter
DATE
SUBJECT/TITLE
1/30/1991
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. S52(b)|
PI
P2
PJ
P4
b(l) National security classified information 1(b)(1) o f t h e FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e F O I A |
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the F'OIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) o f t h e FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) o f t h e FOIA]
National Security Classified Information 1(a)(1) o f t h e PRA|
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�TRANSPORT LIFE
INSURANCE COMPANY
711 MAIN STREET FORT WORTH.
Tfc 76 102'&15J
IIOOI tu-mt
November 30. 1991
4 & . Despite the efforts of the government, the health care industry and Ie insurance industry
V-fll^ to control the cost of health care delivery In America, the cost has : mtinued to rise,
:
v
Modern medical technology has greatly increased the capacity of our ioctors to save the
lives of infants born prematurely and to prolong the lives of elderly ersons who become
critically ill. Severely injured persons who might not have survived 11 lir injuries 10 years
ago, can now be restored to good health and productive lives. O r g i transplants have
become commonplace, and some diseases that once were terminal c f i now be cured. But
the cost of these modern miracles is enormous.
l&
jp
p.h
'A'Jf*".
As the cost of quality hospital and medical care continues to rise, ptftmiums for insurance
plans that are sensitive to medical inflation must keep pace. Your p i Tiiums are determined
pi
by the benefits paid for all of the members of the group of insure to which you belong,
a
Your plan of insurance, your age and the cost of health care in the rea where you tive
entirely different
enter into the cost of your coverage Your claims experience may
from the group, but we must base your premium on the experience f the group.
Your notice of premium change appears below. We regret that an
Qji£< continue the level of coverage we provide for you.
:rease is necessary to
'Alan A. Bowman
Vice President
Customer Services
Notice of Premium Change
Your current premium is:
Your navy premium will be:
S
$
The change is effective 02/15/92,
Your premiums are paid monthly
by preauthorized check.
'
s*..:
A PRIMERICA COMPANY
410.00
543.00
�Withdrawal/Redaction Marker
Clinton Library
DOCliMENT NO.
AND TYPE
034. statement
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
01/15/1991
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
IM Release would disclose trade secrets or confidential commercial or
financial information |(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe I OIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(h)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 IJ.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PLEASE RE 4 0 THC ENCLOSED LETTEf.
*«**•
THIS IS NOT A B I L L
**••*
PREMIUM PAYM
MODE I S MONT
PREAUTH CHEC*
CURRENT PREM UM:
NEW PREMIUM
r
237.00
320.00
E F F E C T I V E DA E OF CHANGE!
'-..
..Hv
P6/(D)(6)
01/15/91
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
035. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
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PI
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purposes 1(b)(7) ofthe FOIA]
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and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
V'
.iv'.-v^r- .;c,.",,,^:.P6/(b)(6)
;
1
L 3<I
0
i
BRIEF SYNOPSIS OF LETTER
A woman whose husband i s a d e n t i s t , t h e r e f o r e considered s e l -employed, must
pay $607.60 per month f o r t h e i r h e a l t h care premium. She has a p o s s i b l y r e c u r r e n t meningioma (a benigh tumor behind her eye) whici . h e r insurance
company w i l l never cover. Her l a s t surgery (one-day h o s p i t a s t a y ) c o s t them
almost $20,000.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
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DOCUMENT NO.
AND TYPE
036. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2()06-0885-F
jm810
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*
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concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
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�P6/(b)(6)
January 26
T9"9~3
Mrs. H i l l a r y Rodham C l i n t o n
Health Care Reform Task Force
The White House
Washington, D.C.
Dear Mrs. C l i n t o n :
What a proud, proud day tor us -• a woman e n t r u s t e d wilth t h i s
nation's most enormous and most complex c r i s i s . This .s an
issue near and dear t o my h e a r t and I would l i k e t o he .p. What
can I do? So t h a t you w i l l understand my s e r i o u s and sonstant
concern, l e t me provide you w i t h my v e r s i o n of a s i t u a j i i o n so
common across t h i s countrv.
My husband i s a dent; i s t , there 1 ore con
:
sidered self-emp .oyed.
We pay $607.60 per month f o r our h e a l t h care premium, I have
a p o s s i b l y - r e c u r r e n t meningioma (a ben ign tumor behind my eye)
which my insurance company w i l l never cover. My l a s t »urgery
t o have i t removed ( A p r i l 1991) cost u s n e a r l y $20,000 o u t - o f pocket ( i t was a one-day stav in thn h o s p i t a l ) . But, '•our and
my tax d o l l a r s pay for a "-xi: " : d oa t ent to have t h i s same
i
surgery at no cost. I begrudge h e a i t h care t o no one; however,
t h i s system i s g r o s s l y u n j u s t and a te r r i b l e burden fc : so many
•
m i l l i o n s of us.
A friend of mine has described the hospital/insurance )usiness
perfectly -- e v i l and obscene. During that h o s p i t a l \ . s i t an
Anacin cost me $11.00; I '-'s - • > : •jeri $50.00 to be take from my
..a • - .
hospital room to the operating room; the doctors' gowrfe (3) each
cost $36.00, the price of a s i l k gown at Macy s or anj other good
department store. Something must be done and, again,
want to
help.
1
I've w r i t t e n rry Conqr essnen; ^r . Cramer r e p l i e d w i t h
somewhat
s a t i s f a c t o r y l e t t e r , Senate
•.( 1 i r: -::id Shelby answe jd w i t h
••.
«>
t o t a l l y useless and p o l i t i c a l niumbo-;j umbo l e t t e r s , anc President
Bush never bothered t o answer at a l l . Where else can ie t u r n ?
;
r
I n t h i s endeavor I wish f o r you wisdom and s t r e n g t h , Please do
not h e s i t a t e t o c a l l upon my f a m i l y i f we may be of ar f s e r v i c e
to you, your committee, or the P r e s i d e n t .
mm)
xc:
Administrator,
Brookwood Medical Cen! o. r
Representative Bud Cramer
Senator Howell H e f l i n
Senator Richard Shelby
R.I rmingham
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DOCUMENT NO.
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037. note
SUBJECT/TITLE
DATE
Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3079
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
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�' •///;
"District, T/A
PERSONAL STORIES DATABASE
r i F I C A T I O N QF WRITER
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SYNOPSIS OF LETTER
IPENTIFICATTON
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
038. letter
SUBJECT/TITLE
DATE
Address (Partial); Phone No. (Partial) (2 pages)
05/05/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
imSIO
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI
P2
P3
P4
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b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
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b(7) Release would disclose information compiled for law enforcement
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h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
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concerning wells 1(h)(9) ofthe FOIA]
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Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) of the PRA]
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financial information 1(a)(4) ofthe PRA]
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and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
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�lUL,
I
IN**-
��G*A~
v4
i
- -*"
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P6/(b)(6)
�1
U5*~
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Lawrence R. Walsh
Vice President, Globe Manufacturing Company
456 Bedford S t r e e t
F a l l River, MA 02720
BRIEF SYNOPSIS OF LETTER
Small business concerned t h a t h e a l t h reform include unique aspects o f
worker's compensation. Urges management of workmen's compensation be l e f t t o
employer-employee, not insurance companies and r e g u l a t o r s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
OTHER CONTENT Workmen's compensation
�® RlG
EXTRUDED
LATEX T H R E A D
A\AN U FACTU RI NG CO
456
BEDFORD
STREET
. r » u o IJ r <np R •
.
FALL
RIVER.
: M. r v Q ? t) 4 3 9 G L O B F L A S T
MASS.
SAX 5 0 8
02720
674-3580
April 19, 1993
Ms. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington, DC 20500
RE:
National Health Care Reform Task Force
Dear Ms. Rodham Clinton:
Globe Manufacturing Co. has recently completed an intense and successful effort to control
Workman's Compensation costs and, at the same time, reduce accidents and the potential for
accidents.
Globe is concerned that the upcoming National Health Reform proposal does not take into
consideration the unique aspects of Workman's Compensation. The success of our efforts is in
our ability to return employees to work before lost wages have to be paid. We do this through
the use of selected medical providers who understand our company and have helped us formulate
claims management. Our employees are made aware of their rights under the law, but are happy
because the company manages the complicated and unyielding process.
Occupational medicine needs to be managed by the employer and employee, not by lawyers and
bureaucrats. Employers should be able to deal with providers that know the company, its
management, its employees, and any special characteristics and employment needs.
Allowing the company to directly pay the medical bills strengthens our ability to ensure that the
provider acts intelligently and swiftly when one of our employees is injured.
I support a reform of this country's medical care. I also support the management of workman's
compensation efforts by the employee and employer, not by lawyers and insurance companies.
Tiosjizism
�Letter to H. Rodham Clinton
April 19, 1993
page two
Please do not destroy the progress that we and many other employers have made toward turning
an unhappy experience for the employee, employer, and the government into a program which
both the employer and employee can take pride in.
Regards,
GLOBE MANUFACTURING CO.
Lawrence R. Walsh
Vice President
Finance & Administration
CC:
T. Rodgers, Chairman - Globe Mfg. Co.
T. Rodgers III, President - Globe Mfg. Co.
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DOCUMENT NO.
AND TYPE
039. note
SUBJECT/TITLE
DATE
Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jm810
RESTRICTION CODES
Presidential Records Act - |44 IJ.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
h(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
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b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Tom Wassenich
I
BRIEF SYNOPSIS OF LETTER
Small business man with 9 f u l l time and 60 part time employe < )s Covers f u l l
time employees and would l i k e to cover part time employees but the cost i s
prohibitive.
Stresses need for employees to share co-paymeftts of insurance
premiums.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
HIGH CO-PAYMENTS
�Dear Ms. Clinton:
I feel compelled to write you regarding your health care study. J
feel I have a unique perspective as I consider myself a rather "liberalVy
smallbusinessman and a supporter of you and your husband's ideas.
~ ~ I sincerely want your plan to work but I feel it might go astray due
to a few different angles that I'm not sure are being considered.
First is the idea that business should and can cover all of its employees
with medical insurance. I realize that my perspective as a.jcestaucant.
ovyner is in many ways different from other industries, but with 70
employees and 250,000 customers a year I feel there must be some
realities I share with other businesses.
I do cover any employee who will work 40 hours a week every week
and take vacations when they fit into the company's schedule,,„ This
happens to be a minority in the restaurant cbusiness which^attra^
young part-time workers who have other interests such as school'and
second jobs or simply don't desire to fully commit themselves to a job.
Approximately 60 of my 70 employees are part-time with the majority
working between 1 7 - 2 5 hours a week. It is this lack of commitment that
I fincLdjfficult to deal with considering Jull medical cpyerajge.^ If I were
to cover all my employees it would cost an additional $36,000 a year. My
corporate profit last year was $52,000. That would be a 70% reduction of
my profit in a year when I only drew $47,000 salary and didn't have a
retirement plan . The restaurant customer has grown accustomed to
certain price structures and were we to have to suddenly assume the
burden of all medical insurance it would be devastating.
Let me give you examples of some of the situations that now exist
to maintain coverage for the 9 full time employees including myself.
I cover myself with $1500 deductible insurance to try. and save money.
I have a senior employee who has worked for me since my opening 17
years ago and is the only part-time employee I cover. She has developed a
diabetic condition and can get no other coverage except the original group
policy which I wanted to get rid of years ago because they kept going up. I
left the group along with other employees who could get coverage
elsewhere. We have had to keep the group in force to keep coverage for
this employee, Result-her insurance of $260 a month is 62% of her $420*8^
month gross. I buy individual policies for all other employees. That way
when the costs go up 1 5-30% a year I can more easily switch companies
than if had to move all 9 at once. As you can see I'm constantly moving
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
040. letter
SUBJECT/TITLE
DATE
Address (Partial); Phone No. (Partial) (I page)
08/25/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jm810
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [S U.S.C. S52(h)|
PI
P2
P3
P4
b(l) National security classified information [(b)(1) of the FOI A|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security' Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�companies and shopping for insurance. I wonder if this is whafl business
people are supposed to spend their time doing?
Obviously if Business was absolved of the responsibility of carrying
health insurance it would be a very large windfall that would hive to be
dealt with. Since it is unfortunately an established role it prcpably can't
be completely abolished without significant economic upheava
I'm
assuming you aren't proposing a completely socialized system which is a
whole other issue.
Now comes the part that I feel would make a plan really Jvork to
generate revenue to cover the 30 million uncovered Americans Whatever
the cost it HAS to show up on every Americans paycheck. They have got to
know what health care costs so they will become involved wit the issues.
For too long the American worker has -been • protected^jC)igd|h( j ,££31^165 of
.
the health care system. The ones who are covered don't "count t*3s*wages
they're not aware of its increasing costs and as a result they n't getr
involved with national issues related to medical insurance or y to drive
prices down and do competitive shopping. We also have to tak this
competitive benefit package system out of employee salary an benefit
packages. If individuals want better coverage than whatever sllandandUed
package the government mandates, it should be bought by the individual
not the company. Those with better health insurance should nd* be able to
deduct it.
I think our country would be much more productive if business
owners didn't spend so much time shopping for and keeping tr*<:k of this
ever burdensome health insurance system. Please consider th<
businessman, please get everyone covered, and please make sn e every
American is financially involved in the cost of his or her insur nee as
well as the coverage of the 30 million uninsured.
>
Sincerely,
Tom Wassenich
T
P6/(b)(6) ' •
0^0
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DOCUMENT NO.
AND TYPE
041. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [3]
2006-0885-F
jmSIO
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
A 45 year old woman who owns a small o f f i c e supply and p r i n t i n g store with
her husband are struggling with insurance. She s t r e s s e s the importance of
preventive health care.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
OTHER--People owning t h e i r own business
�A p r i l 19, 199 3
Mrs. Hilary Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C.
Dear Mrs. C l i n t o n :
I know you're worUi ng verv hard on t h i s monumental problem
of h e a l t h care or h e a l t h insurance r e f o r m / I wish you the best
of l u c k and I'm very happy t h a t i t ' s f i n a l l y being addressed. I
f e e l i t i m p e r a t i v e t h a t I t e l l you our concerns, t h e concerns of
a middle c l a s s f a m i l y owning a s m a l l business. I'm c e r t a i n t h e r e
are many i n our circumstances and perhaps you've heard s i m i l a r
concerns b e f o r e .
My husbanc and I are both f o r t y - f i v e and have three c h i l d r e n
under 11. We are s e l f employed in a small o f f i c e supply and
p r i n t i n g s t o r e . We only have two other employees at t h i s time,
and f o r t u n a t e l y they are covered by t h e i r spouses' employers.
We
have owned t h i s store for eleven years and we work very hard; we
even have our children work on t h e i r school v a c a t i o n s . Business
i s d e c l i n i n g as we are slowly being squeezed out by the super stores
and club operations. We pay more for much of our merchandise than
the super s t o r e s charge and our expenses are constantly i n c r e a s i n g .
We offer s e r v i c e with a personal touch, but the p u b l i c today seems
to be p r i m a r i l y interested in p r i c e .
Currently, we are insured bv Golden Rule with a $1,000.00 ded u c t i b l e . We are paying -\ pprox .i ma t e l y $450.00 per month and without any age change, i t ' s been going up 17% every 6 months. P r i o r
to Golden Rule, we had I n t e r n a t i o n a l Forum of F l o r i d a Trust.
We
had a small group as we had a couple of other employees we covered.
Insurance r a t e s had been going up so rapidly that a salesman approached us and we purchased the I F F plan. A c t u a l l y he sold us
a d i f f e r e n t PPO which went bankrupt immediately, so we were autom a t i c a l l y changed to TFF.
don't know i f you heard about t h i s
f i a s c o , but a f t e r approximately 2 years of paying premiums, I F F
went under.
During those 2 years, IFF began paying claims more
slowly and changing a d m i n i s t r a t o r s . I c a l l e d our Insurance
Commissioner's Consumer h o t l i n e 5 times over the 2 years to find
out the s t a t u s of the company. I was repeatedly assured that
i t was f i n e u n t i l my f i f t h c a l l when the r e p r e s e n t a t i v e told me
he didn't know because nny problem- were in another room and they
weren't computerized.
Shortly s f t e r my f i f t h c a l l , the company
went under due to fraud. The people running i t took the money
and f a l s i f i e d records. This l e f t 7000 members i n F l o r i d a uninsured.
Because i t was a t r u s t , the s t a t e came back to us and told us our
share of the t o t a l claims unpaid was $3,000.00 i f we paid i n 3
months. Otherwise, i t would be $6,000.00. I haven't heard anything about the t r i a l n Hiose people who committed t h i s t e r r i b l e
fraud, so they're probably enjoying l i f e on our money.
7
c
We had to find new insurance. Many of the 7,000 people had
developed s e r i o u s i l l n e s s e s and became uninsurable. We applied
with another company and they r e j e c t e d us saying that s e v e r a l of
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�Mrs . Cl i n t o n
( co^. ( . ^
:
us had i n f o r m a t i o n on our h e a l t h records t h a t could cauiie us problems
l a t e r on. According t o F l o r i d a law, they d i d n ' t have t o say what
i t was. We were i n good h e a l t h and knew of no problems
Our covered
employees l e f t , so we purchased our own p o l i c y .
A f t e r ifiy experience,
my major concern was t h a t the company be r e p u t a b l e . I lave always
been f e a r f u l t h a t shoulc a h e a l t h problem a r i s e and thij$ company become too expensive or i f they p u l l e d out of F l o r i d a , we would be
uninsurable. In January, I went t o my g y n e c o l o g i s t f o rmy y e a r l y
exam (because I am lucky enough t o be able t o a f f o r d tl-<! $100.00
exam). He found a cyst on my ovary and I had a t o t a l
sterectomy.
I t turned out t o be ovarian cancer; I was so lucky thai'; I went f o r
that exam ( and that T could a f f o r d the $2,000.00 I hac t o pay
before the surgery f c r exams, t e s t s and surgeon's fees
because
the cancer was found extremely e a r l y and was a l l remove)* s u r g i c a l l y .
Preventive care i s of the utmost importance and i s not
covered by
most p r i v a t e insurance p o l i c i e s . Golden Rule i s now dc ng an i n v e s t i g a t i o n t o make sure t h a t t h i s was not p r e - e x i s t i n c and t h a t
I was completely t r u t h f u l which I was. I wonder why
didn't
i n v e s t i g a t e p r i o r t o surgery when I c a l l e d them f o r p r d t e r t i f i c a t i o n
which they gave me.
Now I f e e l c r i p p l e d by a fear of what i f something happens t o
my insurance; where would I turn? Before we signed up V i t h Golden
Rule, one of my seven year o l d t w i n daughters had had
urinary
t r a c t i n f e c t i o n s . The p e d i a t r i c i a n had sent us f o r f u i ;her t e s t s
to make sure a l l was okay. Everything was f i n e , hoveve : Golden
Rule d i d n ' t want, to cover her at a l l j u s t because of tHtse 2 simple
i n f e c t i o n s . The p e d i a t r i c i a n wrote them a l e t t e r . The u n d e r w r i t e r
said her u r i n e had something ( I f o r g e t what) i n i t . Tl i p e d i a t r i c i a n
said every c h i l d has a trace of t h i s i n t h e i r u r i n e , T ley f i n a l l y
f
covered her but r i d e r e d out anything t o do w i t h t h a t ai ba. I
wonder i f I should t r y t o f i n d other coverage f o r h e r . I'm c o l l e g e
educated, run a business but am t o t a l l y b a f f l e d by t h i s insurance
mess .
I do hope you can accomplish something.
Please rt nember
p r e v e n t i v e care by a g u a l i f i e d p r o f e s s i o n a l i s very im^|Drtant
It' s
a matter of l i f e or death. We also need t o have every r e n d i t i o n
covered. We can't be a f r a i d t o go t o the doctor f o r f ( r he/she
i
may f i n d something wrong. I know you're very busy, but I would
enjoy hearing your thoughts on, t h i s very complex subjec at any
time. I also want t o extend my sympathv t o you on t h e massing of
your dad.
1°
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Long time employee ( l l y r s ) o f small business which provided f u l l y
subsidized BC/BS insurance has w i t h i n past 4 years been s h i t e i n g t h e cost
more and more onto t h e employees. He i s c o n s i d e r i n g droppijijig h i s insurance
a l t o g e t h e r t o have more take home pay.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
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7
•ay.
�March 4, 1993
Dear Hillary,
One of the things I like about you and Bill is that, despite your
education, you still seem to value small town common sense, and you seem
to be interested in the thoughts of ordinary people. So as you ponder the
future of the American health care system with the insurance moguls,
medical school deans, and the AMA, I would like to offer some random
thoughtsfroma small town family doctor.
I read that the cure to America's woes is more preventive care and
more primary care doctors. But, you see, most doctors don't want to do
what I do. Why? Well there are a lot of reasons, and they go a long way
towards explaining our current health care mess.
Being a family doctor takes a lot of time. People get sick on
weekends and holidays. Babies' fevers are highest in the middle of the
night. Pregnant women deliver when they will. This makes for a messy
lifestyle with disrupted dinners and leaving during your daughter's school
play. With modern conveniences of beepers and cellular phones, there is
no place where you cannot be found. All doctors used to accept this
burden as part of the responsibility of being a physician. But nowadays
there are plenty of specialties which offer bankers' hours, along with a fair
share ofthe bank, I might add, so why inconvenience yourself?
Primary care is a messy business. People come in with all array of
symptoms and problems, and frequently a bunch at a time. As a family
doctor , it is all your turf. Some late afternoons, seeing Mr. Jones, with
his emphysema, and drinking problem, and high blood pressure, and
depression and eczema, I fancy what it would be like to say, "Mr. Jones,
I'm a specialist, I only take care of your rash. You'll have to talk to your
family doctor about all your other problems."
While we go about our business caring for our patients, we are be
buried in paperwork. Every day my two foot high mailbox is filled with
bulletins, directives, new regulations, and papers to sign. The truth is , if I
^actually read all my mail, there would be no time left to see patients^A
/reprieve tromjhisjs a must^J
Do you know that a doctor with a swank office on Central Park
South gets paid more, for the identical service, than a rural physician?
�This explains why there are more doctors on Central Park South than in
some rural counties. Doctors practicing in underserved areas should be
paid more not less.
Why is a doctor with a gizmo so much more valuable that a doctor
without a gizmo? Doctors have found that the key to financial success is to
have some technological device. Stick a scope up the nose, or wave an
ultrasound wand over the abdomen, or laser the lesion, and you are paid
ten times what you get for just using your brain. This week's New
England Journal of Medicine reports that 85% of newly trained internists
are choosing subspecialties. Why? To get a gizmo.
All our technological diagnostics do get quite expensive. We order
tests for many reasons: to reach a diagnosis, to reassure a patient, to satisfy
our curiosity, to protect ourselves medicolegally. But, in truth, a lot of
testing has very little impact on ultimate disease outcome.
Whose responsibility is it to see that the country trains enough family
physicians? Certainly not the medical schools! In fact some prestigious
medical schools do not train family physicians at all. Medical schools may
be the last bastion of feudalism in the United States. Departmental
chairmen reign with a power that would make a Kuwaiti prince smile.
They want their department to have the best technology, the biggest
faculty, the most fellows and the brightest resident physicians and the
largest hospital service. They do what is best for their department. The
health care needs of the nation are not their responsibility. So every bright
young idealistic medical student who professes a desire to be a family
doctor is taken aside, as I was, and is told "You're much toobright to go
into primary care."
Money talks. In Canada, primary, care physicians earn 75% of what
specialists earn. In the United States, it'Snore like 40-$0%. Now I would
like torecommendthat family doctors get paid what dermatologists or
opthamologists get, but seeing that the treasury has already been raided, I
know this is not possible. Still the income gap needs significant
narrowing.
Reading all this, you might surmise that Iregretbecoming a family
physician. I do not. My commitment to my community is paid back in
countless ways, as my patients let me share in what matters most in their
lives. But family practice will not flourish in this nation without the reform
that, I hope, you will create.
Jules Zysman M.D.
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�P.S. Enclosed is a recent article from M.D. magazine on healthare m
;
Rochester, New York which features our practice. We are four
physicians composed of two married couples/ One^p^Sier^Ig^
Ness isljpMflAleslev alumnus^graduating the year before Hillary
freshman year.
Jules Zysman M.D.
o
3
�*.v.'*S/-iir -;•••!.•-.
mm
Rochester,
New York
9
By Douglas S. Barasch
ighr off the bat,
jnearly every physician in Rochester
,' w i l l , first, defend
"• the'weather ("It's
just not as bad as
everyone says") and, second, lament
the "tremendous penetration by
HMOs." Still, these same physicians
will claim they are happy live and' ;
practice in Rochester. W h y ? . ^ ' . . V •
The answer is not immediately:
;
i:
DOUGLAS S. BAKASUI, a frcclantf
writer in New York, has covered
health care for The New York Times
and other publications.
M D C M E 1992
D E E BR
r
ters'are 16ngia)id graya^bftetiVery^^
bitter. But the summers are'suhny
and beautiful (and almost never
unbearably hot or humidjj ^'X^}''.
37
;
�The metropolitan area's spiderweb of modern (and efficient) highways crisscross a dull, flat terrain
riddled with countless modern
buildings that seem to have been
carelessly slapped onto the landscape, only yesterday. Yet the city's
history is old and rich, and a mere
20-minute drive from downtown
brings one to fertile farmlands,
friendly villages, green valleys
nourished, by waterfalls and
streams, and elegant homes tucked
in shady coves overlooking the vast
crystal blue of Lake Ontario.
Rochester is a small city with a
population of 231,636, down 4.2
percent from 1980. But smallness
does not protect it from big-city
urban blight, not to mention
administrative corruption—the
local police chief was recently con-
vicred of embezzling police funds.
Its cultural offerings are anything but modest for a city of its
size. They include the Rochester
Philharmonic Orchestra and tHe^v
Eastman School of MusicJ whichv- :
have helped make this city in the
western quadrant of the state a
mecca for serious musicians and
music lovers. The University of
Rochester, founded in 1850, if.alsp^
a strong cultural presence.vM y ; | ^ ^
The medical environment,'too, is >
a study in counterpoint. The atmosphere is collegial, yet its intellectual standards are rigorously:
maintained at a high professional,
level through the strong and ubiquitous influence ofthe university's
School of Medicine and Dentistry,
long in the forefront of medical
care research. The school's primary
URMC
teaching hospital, Strong MemoAndy Olenick
rial, is a referral center for nine up- out! Rochester is one of the few
state counties and specializes:.in%.remaining U.S.- cities, with a com• ofthopedic medicine, cardiac care,; ^muhity-rated insurance^system
burn treatment, and newborn —another mark of the strong ininrensive care.
fluence that local business leader"Rochester medicine is among ship exerts—and the number of
the best in the country," claims uninsured patients (six percent of
internist Philip Bonanni, president- , the population) is substatitially
of the Monroe County Medicaid lower• than the national average
"Society. "That's one of the reasons^ (14percent).
.
so many residents and students
Phyllis Leppert, who came from
who train here elect to stay."
New York City's Columbia-PresIndeed, the city has been held up byterian Medical Center to assume
.-.-as a national model of rational her current position a? chief of
i health care planning because of-its.,;: obstetrics and gynecology at Roclv-.
• long history of cooperation among fester General Hospital, says one''
hospitals, insurers, and powerful of Rochester's attractions fpr'herlocal industry—Kodak and Xerox was its "long tradition of being in
both have their corporate head- the forefront of health care financquarters there.
ing." But many physicians have
Rochester has also shored up its long complained of feeling powernational reputation by, so far, hav- less and left out of the process.
ing successfully staved off the rockConcerted corporate interests
eting escalation ofhealth care costs paved the way for the strong presexperienced by most of the country. ence of managed care—Monroe
"Traditionally, the cost of medical County's HMOs serve about 60
care here has been about a third to percent ofthe county's insured resia half of other areas in the coun- dents—another factor in the city's
This 1822 lighthouse once guided boate
try," notes pediatrician Edward overall low health costs. And most
on Lake Ontario into port at the mouth of
the Genesee River. It is now a museum. Lewis, and the statistics bear him doctors are not happy about it. "As
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An'*Aw'»
********>*-m.S%w««'
* n x ' l *
Atm
M D C M E 1992
D E E BR
�The Univeraity of Rochester Medical;
Center includes the School of Medicine
and Dentistry, the School of Nursing, and
Strong Memorial Hospital—a referral
: . center for nine counties and the:
's prima
;
1
1
icd'^fj'' -'' '''''"'
.... by threetierepftehn^see
columns. Rochester bought die 1880s
building from the federal govemment
for one dollar and converted it to ;
'.municipal use in
1975.)^M^^-:^Z,.
.j'-Wlbll'KlH *i C-'t't!?'! ":>.'•.''(!!{ I'linW. f:c!:i-' :>'.["(
^•nath^J-and there,are-epbugh patients for just about everybody."
Hospital admitting privileges are
easily accessible to most physicians.
"Just about every doctor in the
greater Rochester area is a member
-of one hospital staff or .another,"
Vnqtes BonannilT (-.ii/; ^mrHii/i ho
Physicians also praise Rochester
. as an ideal place to raise.a family,
with its abundance of nearby parks
and lakes, good schools, museum, sponsored education programs
1 (including a planetarium), and
-iEittractiv6suburbs. .(It'isiiot,'however, a good place to meet someone
if you're single, complained one
unmarried physician.) • ..-.-i .
,
;
physicians, we feel that we've lost a
lot of control over the situation,"
says Joseph Kurnath, an internist in
private practice. "It's made a lot
more work for us, and I don't think
it's provided any more efficient or
: better care than patients were getting before."
M D C M E 1992
D E E BR
!
Commercial Roots no ..i v.-..
TSince the:1930s, Rochester has
been a company town, .dominated
Yer the benefits of a Rochester by the legacy of one man: George
medical practice, and the town's Eastman, founder of Eastman
family-life orientation, seem to Kodak, which still.employs nearly
outweigh the disadvantages. The one out of every 12 residents in
medical atmosphere is more coop- -Rochester and surrounding Monerative than competitive. "There's roe County. However,- the :Xerox
an atmosphere among physicians i Corporation and Bausch :8c Lomb
of working together," says Kur- also wield significant economic
39
�The Main Street Bridge (1812) is Rochester's oldest crossing on the Genesee River.
In the background, "Mercury" and "Wings of Progress" dominate the city's skyline.
clout and have deep historical roots
in the area. (Indeed, John Jacob
Bausch and Henry Lomb are buried side by side in Mt. Hope Cemetery, renowned for its Victorianera funerary art.) The Universiry of
Rochester, the Delco Division of
General Motors, and the health
care sector are other major employers^ • •
:" The city's commercial origins
date back to 1803, when Colonel
Nathaniel Rochester and two business partners purchased and settled
the area, then known simply as the
One Hundred Acre Tract. The attractive site contained several
waterfalls on the Genesee River
(one of the few rivers in the world
that flow south to north), providing a natural power source for a
| burgeoning new industry of grain
mills. By the 1830s, milling had
vitecunwrtW rtjwrrir irrairr industry,
-earning Rochester its early title as
"The Flour City."
Construction of the Erie Canal
(completed in 1825) further con-
40
IM,'.! V-'-:.'
solidated Rochester's position as a the nation's leading advocate of the
center of commerce, chiefly for ^women's suffrage movement. Her
flour and men's apparel. By 1856, a v home is now a local museum. Dou-' ^ r
•profusion of nurseries and the glass and Anthony, who joined
export of flowers and^plants earned forces for common causes during
the city its new title,:"The Flower their years in Rochester, are also
City." Today the rrtany parks in buried in M t . Hope Cemetery
bloom—and the annual Lilac Festi- (along with General George Mapval in May—help Keep that title shall, publisher Frank Gannett j and
alive. By the end of the century, the;
canal had outlived if s commerciia
usefulness. Now knoWn as the Erie
Still, it is George Eastman whose '
Canal Heritage Trail, it has been influence is most deeply rooted. He
revitalized as a public park and gave Rochester the Eastman Therecreation area that stretches along atre (where the Rochester Philhara meandering route through Roch- monic Orchestra performs))-the
ester and the suburbs of Fairport Eastman School of Music (one of \
and Pittsford, where shops and the nation's finest cohsereatories)^;
restaurants have reclaimed original the Eastman Dental Center, and
buildings on its banks.
thousands of acres of public parks.
Rochester was once home to two His former mansion on fashionable
of the nation's most influential East Avenue houses the lnternapolitical reformers: Frederick Dou- ' tional Museum of Photography,
glass, whose weekly journal'The 'the largest photography collection
North Star was published from a in the world (see TheEastman
church basement, and Susan B. House Collection," page 57). EastAnthony, who arrived in town as a man's residence has been restored
schoolteacher and later emerged as to its original glory to give visitors a •
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iMD D C M E 1992
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�ROCHESTER
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sense bf this eccentric millionaire
who entertained frequently and
lavishly (and always with music)
yet remained a bachelor, living out
his.adult.years.alone with his
. mother and servants; ::
The company he left behind still
anchors the community's economy, employing 39,000 area residents, and occupies a ZjOOO-acre
plot at the northern end of Rochester known as Kodak Park, complete with its own train system;
(electrical generating' plant, and fire
department.
Rochester's medical history has
been partially molded by this immense corporate presence. Marion
Folsom, a Kodak vice president
who served President Eisenhower
as Secretary of Health, Education,
and Welfare, and Joseph C. Wilson,
founder of the Xerox Corporation,
gained national.prominence in the
area of health care, often using
Rochester to launch their health
policy initiatives; Folsom, in particular, influenced Rochester's health
care through the organization of a
council of industry leaders (the
Industrial Management Council,
which still exists today), whose
purpose.was to shape the city's network of hospitals into a more cohesive whole through area-wide
planning and resource allocation.
Resources and technology still
undergo regional planning to deter
the unnecessary surplus of services.
: Open heart surgery, for instance, is
performed only at Strong Memorial and Rochester General. The
chief executive officers, physicians,
and trustees of several of Rochester's hospitals still meet regularly
under the auspices of the Rochester
Area Hospital Corporation. •
forcefully ushered in managed care
in the 1 970s, a movement instigated by Wilson at Xerox. Now
doctors generally report that from :
50 to 80;
belong to c
open-par
either Preferred Care or Blue
Cross/Blue Shield's Blue Choice.
With penetration so high, it is difficult for any doctor to.say i
ticipation, although some f
been-willingtoxakethem^
:
:
;
foresight in health plariningf"Ahy^ ' .v
physician who has the idea that we:
can just keep on adding technology, ,:
ob-gyn in private practicej muse;
philosophically that "we're just afew years ahead of everybody else." ;
Despite burdensome
state regulations
X:
Rochester wins
top marks for
collegiality and,
medical standards
.-.'One doctor, who requests anonymity, reports that her husband
and his partners in a suburban internal medicine practice left the
HMOs because ''they didn't want
people breathing over their shoulders, telling them how to practice
medicine." Financially, she says)'
"they took a hit..". Meanwhile^ she
herself has left private practice for. a
salaried academic position at one of
the University of Rochester's affiliate hospitals, in part because she,
too, was fed up with managed care.
Coral Surgeon, an ob-gyn in
an all-woman practice, also complains that with HMOs "you feel
Dominance of HMOs
like you're always being moniThe close ties between industry and tored." Still, she sees a "good side":
Rochester's medical providers and "There are always quality assurpayers (Blue Cross has been the ance checks; you really have to
dominant.insurer since the. 1930s) practice good medicine." But.ishe
M D C M E 1992
D E E BR
adds, "there could'be a happier
medium."
';'''.;^"V-;
Jules Zysman, who practices
family medicine in Honeoye Falls, a : .
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--
officers and the'pe6ye^6^5e;iri^:^.v
power We also have •committees of
r'
local docs working with the HMOs
to implement programs that will
..ouhtyj
Medical Society,' which includes
nearly half of the 2,600 physicians
in the county, primary care physicians constitute about 20 percent of
the overall membership (there are
215 internists,-32:FPs, and six GPs).
There areno shortages inany ofthe
specialties, but "there's always a
need for primary care," says
Edward Lewis, past president of the
medical society. Philip Bonanni, the
current president, describes'the
medical community as "well bak
anced."; Most primary-care, phy si-;.
cians are in group practices, though
some are in solo practice and share
office space and insurance coverage
with several colleagues. •?'..!.' ••.! \
.Six of the area's hospitals—led
by Strong Memorial, Rochester's
largest with 722 beds-dire teaching affiliates of the medical school,
and many of the attending physicians have clinical appointments.
"We have the best town-gown relations of any city rve.eyeriseen,"
43
�Andy Olenick
such as making sure that residency
training hours are not unduly excessive and implementing qualityassurancbprogramsiin hospitals. But, he adds, "we ha^e a lot of
paperwork that is probably unnecessary."
1
Rochester is not a place for doctors to make a lot of money. "The
• physicians here are interested in
providing good care and making an
adequate livihg," says'Borianni.
But Rochester wins top marks for
collegiality, high standards of
medicine, and a family-oriented
- way of life j in^bviti < •iaHOttjo.;-;
•
" .Wni.^irb
f.>:?i/I:'<m vIlMJicq ivsa'.
In and AroundTown'oqrif>'j wvy.w
Most physicians live in the network
of suburbs immediately to the east
and south of Rochester. Pittsford,
Penfield, Henrietta, and Brighton
arc all within a 10- to'SO-minute
drive/from the;center of towh.'The
commute is hassle-free~what is
fretfully considered "traffic" in
Rochester would make denizens of
The Lilac Festival in Highland Park gets off to a running start (10K) eacfi May.
any major metropolis chuckle.
The school systems are universays Poleshuck, a clinical associate physicians near thefity, like Kur- : sally and unhesitatingly praised by
professor of obstetrics and gynecol- nath, may see patients from the Rochester physicians} especially
ogy at the universiry. Strong inner city as well as Jural towns 50 those in the suburbs,' and national
Memorial, Rochester General, miles nway. Because ofthe corpo- statistics bear them out;.Rochester
Highland, Genesee, St, Mary's (the rate presence of F.astman Kodak, has instituted educational reforms
oldest), and Monroe Community Xerox, Bausch Sc Lomb, and sev- that have gained national attention
(for the chronically ill) hospitals are eral other smaller high-tech compa- over the past several years. In a
all within the city. They are linked nies, there is a preponderance of unique community-wide program,
by the medical school, since all are . white-collar health Consumers, and teachers; parents,' and' business
affiliated with the university, and the region is ahove average in the leaders have successfully worked
also partly by the habit of coopera- proportion of patients who carry together to improve the quality of
tion and joint planning. The staffs insurance. "This patient popula- education in public schools. Housof the hospitals are open, but hospi- tion is medically sophisticated," ing values, too, compare favorably
;
: >
tal physicians must have a clinical notes Bonanni.
with those in small cities elsewhere;
appointment at the university. Park
Rochester physicians must also comfortable suburban homes go
Ridge Hospital, to the west of the bear the sometimes burdensome for $150,000 to $200,000. Choice
city in the town of Greece, is the oversight of New York State gov- residentiaT areas - range' from
only major suburban hospital and ernment. "The regulatory at- charming neighborhoods in the
is not affiliated with the university. mosphere is pretty significant, city itself to rural areas still within
Internists in private practice find sometimes overpowering," says easy commuting distance.'As far as
their patients are drawn from a Lewis. The Department of Health,' work goes, many physicians have
diverse geographic and socioeco- he notes, has historically had a established their practices in ofnomic mix. Rochester is a center of heavy hand. Bonanni believes some fide parks just outside the city. (It
medicine for the entire region, so ofthe regulations are worthwhile, takes only 10 to 15 minutes to get
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M D C M E 1992
D E E BR
�.:':!;^.-»^^-;::;;-U-
r'v '-'.J almost anywhere needed.)
club for the Baltimore Orioles, and;; -(depending on which lake). Cayu- -•
;^f^||^' ;Rochesterians have a passion for the Rochester Americans, a mem- ^galSenieca;^
^ ^ l ^ g o i f / t e n h i s , and'bbwlirig, as evi- ber of the American Hockey'VSWaneate^
X'^-'X'y- denced by the available number of League and a farm club for the Buf- smaller lakes offer plentiful woods
-Vc/^' greens, courts, and lanes. The spec- falo Sabres.
and water for hiking, campingi ..
:
tator crowd has two professional
The long wintenseason gives boating, and swimming; The sur^ :
i l j & i ^ : : ' teams to follow: the Rochester Red skiers ample time to hone their ; rounding hillsides are.covered with
rafe^^^Wings, a member of the Interna-: cross-country and downhill s k i i n g | ^
;Ef||?|^5tional Baseball Leiague and a farm'' 'technique.' Roche$terians are:'sof^^
accustomed to snowy weather that' ' this
getting around, even in serious . ger Lakes," page 69):T\i6 Rochesstorms, is still fairly routine (al- ter Philharmonic Orchekra takes . .. .
: though a freak ice storm in March, up residence at the Finger Lakes , V
1992 did considerable damage,:.;-: Performing Arts Center iiiCanv
:
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ROCHESTER
^.nwircsiefK..'. ; V . .: 231,636
days (on average, 198 days a year) River, flowing north toward RochLfMorirbe County. ; . . ... 713,968
are a way of life.
ester, has created a gorge 600 feet
IMedian percapita Income
;.>:,:
: The milder months (generally deep and 17 miles long in.I^tch-• ..
fc^dSt^vf^;^:.
$14,420) v
April through October) are best i;^worth State Parki k n o m a ^ h e ; ^ ^
SwwrageTefnperature
" :'
f ^ a ^ a r 0 f ^ r . \ : high Sl'/low 16*
^Juty^.^....,;.high 82'/low 60*
the annual Lilac Festival, which: ture and shoppihgj'matiy physiattracts upwards of 200,000 visi- cians make an annual pilgrimage
tors each May. Twenty-two of the to Toronto, on the opposite shore
park's 150 acres are devoted to : of Lake Ontario. By car the drive is
flbtal (est.^^^.; v...... 2,609 i
: Rochester's favorite:
than 1,200 specimens •
eties, many hybridized
— ,:,
- . ^ „ ^ . . „ . .......
vast Durand-Eastman Park, do- York City is a370-mile^yen-h'our V.^:
JP^ints^bf Entry
nated to the city by George East- drive from Rochester aind thus not >
i ^ V ^ ' ^ - iMoiiro^'jcoun^ Medical Society
. man, offers scenic vistas along the ;, a big draw.)M- •^\:f:£\ffi^:&'#^Z -W&ffi^
^i^ll^Aveouei-^V
^.^^
shores of Lake Ontario. In recent • All iri all, says Bonarini^Roch-' •} .//;.
times the lake itself, like the othei:||;t:ster.proyides most of ^^needs^: ^
Great Lakes, has been choked b ^ ^ f e
pollution, but environmental able'standaWbf {jvirig^ fbu'r s^
•
edical Society bf the State
cleanups have gradually turned sons, enough attractions to keep a ^bfNew.York J
things around. Now Ontario Beach growing family busy,'and ease in
V|420LUakevilldRoad / /•.: :y-4...
, Park and the many private beaches getting around. It's simply a great
: are "gorgeous and swir
• throughout the summer,
.' Poleshuck. Fishing on Ontaww, — .__ ,
_
v*-.^
ient"?
adds, is "absolutely spectacular." M a i y a n d D a v i d ^ ^ S ^ c
|D^^f^fe«»i6nal
However, because of lingering Nadette J a c o b a r i d - "
^.Ucenslrig •, ,
•
chemical contaminants, some J u l e s Z y s m a n ^:.:'----^'?'''^.•
• ;New York State Education
i D e p ^ e h t ^ ^ ^ ? : : . • ' ^ ^ • species should be eaten only once or..
.
•
-^^'M^v-^'X''
" - - — ' EducaUpn
«' .:twice a month and others not at all/;,..-. "Don't practice wit^f^ends, and.
StatSW-^
. > The Finger Lakes, soriaifned; be^don|tpractice;^
' cause of their clbngaUd sH^'p'es.^
(which, according to folklore, bear David
'twh^^ :/S'fi^ ::
the imprint of a god's hands), are a Nadette Jacob and her'husband, • y:
^Esectitiye^ pire'ctor-iMediCal
20- to 60-minute drive to the south Jules Zysman, have fairly.flouted >';.•;
:
;
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:
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DCM E 19 ; .
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;
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:
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�ROCHESTER
'•,::n>;t:£;:
Four doctors lini the house: (left to right) David Ness, Mary Ness, Nadette Jacob,
and Jules Zysman. Despite dire predictions, the two married couples have run a joint
practice successfully for 13 years tn the village of Honeoye Falls.
ar ••••.}
.vii.ri
..
— .
mm
when the water is high,.David
Ness, an avid canoer,' will push off
and paddle down the creek, reports
his wife.) Their medical offices are
downstairs, while the Ness family
lives upstairs, as they have since
David started the practice in 1974.
The building was once a hospital
and since the 1930s has housedthe
town's physicians, j
"When we first came here, the
owners gave us a ridiculously low
rent," explains Mary Ness; "Then
when we bought the place, they
gave us all the equipment, much of
which dated from hospital days, for
one dollar. It was exceptionally convenient to have home and practice
in the same building when we had
small children. We never considered
living anywhere else." Now their
three children—Erik, 27; Keta,'25;
and Julie, 23—are gone; and the
couple still enjoy hiking, birdwatching, and, of course, canoeing.
Zysman, 40, and Jacob, 45, live
with their three daughters—Emily,
11; Alicia,TO; and Claire, eight-rr-in
a country-style Victorian homci a
few minutes' walk awayj on a'small
. . The Federal-style brick building road that winds along the creek
(circa 1860) where the four now past fragrant honeysuckle and
practice sits beside a small grass lilacs. "Not a bad commute," quips
field on the banks of Honeoye Zysman, who is originally from
'••' r--'^.^.- < Creek;:(Once or twice a season, Newark, New Jersey. Like many
. . .
\•:?!
that bit of advice. The four family
physicians have been in practice
together for 13 years in the village
of Honeoye Falls, a mere 30minute drive south of Rochester
along a road that passes rolling
farms and grazing cattle. During
that time, the two couples ha ve got. ten along together,"remarkably
well," says Mary Ness.
David Ness, 50, and his wife,
Mary, 49, came to Rochester first
as schoolteachers. They grew up
together in Wilmington, Delaware,
./ and were married during college
;.;•;•>•.
while he was at Harvard and she at
Wellesley. In 1967, David decided
to change his profession and entered medical school at the University of Rochester. Mary, intrigued
by her husband's courses and the
[• :-:.
medical journals that began ar:;'
. riving in the mail, made the same
decision five years later. During David's third year of residency, an
orthopedic surgeon at a Rochester
hospital gave him a useful tip: "You
X s h o u l d think about moving to
; ' , .'w, ' Honeoye Falls; The doctor there
'
just moved out."'
.
• ••,
Liposomes: 'Realizing
;
PalpablePu^Ura:*Identifying^^use
;
;
;
:
M D C M E 19
D E E B R 92
by Modestino
:: and Herber|: J.!Lwine,i<.
49
�other Rochester-area physicians,
the couple also have a cottage in the
nearby Finger Lakes.
.: Zysman and Jacob met at Rutgers Medical School, were married
in 1977 (the year they graduated),
and then came to the Universiry of
Rochester to do their family practice residencies. There they met
Mary Ness, also a resident. In
1979, Zysman and Jacob were
invited to join the Ness practice in
Honeoye Falls.
The practice, says Mary Ness,
"is, technically speaking, a loose
partnership but functions as a
;group practice, since we rotate
calls; see each other's patients, and
take turns doing rounds with their
hospital patients."
Zysman clearly takes pride in
serving as the "town doc" for
Honeoye Falls, although he admits
that "living with your patients takes
some getting used to. Everyone
knows you;" Indeed, the group has
10,000 patients, and there is no
other practice within a 10-mile radius. But more importantly, he says,
"you gain a sense of serving a community. We are the doctors of this
town—period. It's a big commitment, but we ger a lot back from it,"
Philip and Anita Bonanni relax with a friend (right) at their Finger Lakes retreat, ".,
close to fishing, antiquing, and the vineyards.
y. i ^ V p ^ 0 ^ . • :
private practice, an attending with new housing developments,
physician at Strong Memorial Hos- arid minutes away, the.landscape
pital, and a clinical associate pro- becomes entirely rural.
fessor of medicine at the University • Bonanni and his family.spend
of Rochester. He shares office space part of the summer at their; cottage
with three other internists in.an on Keuka Lake, one of the "smallarea of Rochester well populated est and prettiest" of the Finger
with medical office parks;."We Lakes.:"But don't print that," he
have a cross-covering system," he jokes, "because everybody:will
explains, "bur we each have our want to go there." The cottage
own individual practice." The road draws its water supply from the
outside the office leads directly past lake. Bonanni enthusiastically ticks
dairy farms. "It's kind of nice to see off a list of his favorite Keuka atthose cows out there,";he. says,- tractions: hiking, camping, fishing,
"right in'the middle of whatlis boatingj'and f a lot of antiquing."
presumably an urbarf-area."
And the Finger Lakes vineyard reBonanni, 53, was born and gion, he claims, produces wines
raised in Brooklyn, and after com- "comparable to some of the best
Philip Bonanni
pleting his undergraduate degree California or European wines." . • •;
For eight years Philip Bonanni in biology at Brooklyn College, he
hosted.a radio call-in show titled , decided it was time to leave New .
; "Ask'the Expert"." And until fund- ' York City. He chose the Universiry Victor P o l ^ t f ^ j ; ^ :
ing was cut, he was the medical of Rochester for his medical educorrespondent for "Rochester cation and residency, and apart Victor Poleshuck, an ob-gyn in a
Journal," a weekly television pro- from a two-year fellowship in private group practice in Greece, a
gram. A frequent op-ed contributor Cleveland, he has been in Roches- suburb to the city's northwest,
; .,).;.- / \. ., describes Rochester as a pjace with
.to Rochester's two major newspa- • ter ever since.
pers, the Democrat and Chronicle I v Bonanni and his wife, Anita; a / I'cbriseryiative family: values.and
:and ihe'Times-Union"(both mem- schoolteacher, live in Pittsford, a liberal politics.?' He describes his
bers of the Gannett chain), Bonanni few minutes southeast of the city. medical practice as idyllic:."! have a
clearly enjoys moonlighting as They have four children: James, 29; private practice where I really
a medical journalist. At present he Chris, 28; Elena, 26; and Felicia, know my patients, and ! practice
is coeditor of the Monroe County • 18. The Erie Canal runs through at a small community hospital;
'
Medical Society Bulletin, as well as ; the village, and small shops have Genesee, which is fully integrated
reclaimed the historical buildings with the university.'VI -aHi h'b i. ! . '.
the society's president.
.... By day, Bonanni is an internist in along its banks. Nearby farms vie
The only downside is^the high •
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SO
M D C M E 1992
D E E BR
�• T F i S S A L O N
a
lbL'n/onal;jrt'USPl ujr,
DESCItlPTION
TESSALONVanon-narcoticoralanlitussiveaROn!. i : . ^ . s . ; i
14. l7,20.23.26-nonaoxaoclacosan-28-ylp-lbu!yl.iminoibcnzoate; with a molecular weight ol 603 7
Each TESSALON Petle contains
Benionatate, USP100 mg
TESSALON Pedes also contain. D6C Yellow 10. gelatin.
. glycerin, methylparaben and propylparaben
. CUNICAL PHARMACOLOGY
.TESSALON acts peripherally by anesthetizing the stretch
;.. receptora located In the respiratory passages, lungs, and
pleura by dampening their activity and thereby reducing ihe
cough reflex at Its souite. It begins toact within I5to20minuies
and Its effect lasts lor 3 to8 hours. TESSALON has no inhibitor v
effect on the respiratory center In recommended doMgp
INDICATIONS AND USAGE
TESSALON Is Indicated lor the symptomatic relief ol cough.
CONTRAINDICATIONS
Hypersensitivity to benionatate or related compounds
WARNINGS
Severe hypersensitivity reactions (Including bronchospasm,
laryngospasm and cardiovascular collapse! have been reported which are possibly related to local anesthesia from
•ucklngorchewlngtheperielnsteadofswallowlngli. Severe
reactions have required Intervention with vasopressor agents
' and supportive measures. Isolated Instances of bizarre be. havior, Including mental confusion and visual hallucinations,
have also been reported in patients taking TFSSAi.ON in
combination with other prescribed drugs.
PRECAUTIONS
Benzonatate Is chemically related to anesthetic agents ol the
para-aminobenzoic acid class leg. procaine, tetracaine! and
has been associated with adverse CNS effects possibly re. . latedtoapriorsensltlvlty to related agentsorlnteraction with
eoncomlunt medication.
,: Information (or pattantu Release of TESSALON from the
perie In the mouth: can .produce a temporary local anes-.
•;- theslaoftheoralmucosaandchoklngcouldoccur. Therefore.
'. the pedes should be swallowed without chewing
Usage In pregnancy: Pregnancy Category C. Animal reproduction studies have not been conducted with TESSALON. It
Is also not known whether TESSALON can cause ictal harm
when administered to a pregnant woman or can affect reproductlon capacity. TESSALON should be given to a pregnant
woman only If clearly needed
Nursing raothera: It Is not known whether this drug is excreted in human milk. Because many drugs are excreted in
human milk, caution should be exercised when TESSALON Is
. administered to a nursing woman. . . . .
Carclnofeneals. mutageneala, Impairment of fertility: Cardnogenldty, mutagenicity, and reproduction studies have
not been conducted with TESSALON.
Pediatric U M : Safety and effectiveness In children below the
age of 10 has not been established
ADVERSE REACTIONS
Potential adverse reactions to TESSALON may include: hypersensitivity reactions Including bronchospasm. laryngospasm.
cardiovascular collapse possibly related to local anesthesia
Irom chewing or sucking the perle.
CNS: sedation, headache.dizziness, mental conlusion. visual
hallucinations.
GI: constipation, nausea, GI upset.
Dermatologlc: pruritus, skin eruptions.
Other: nasal congestion, sensation of burning in the eyes,
vague •chilly" sensation, numbness of the chest, hypersensitivity. Rare Instances of deliberate or accidental overdose
have resulted In death.
OVERDOSAGE
Overdose may result In death. The drug Is chemically rclaied
to tetracaine and other topical anesthetics and shares vanous
Hi
aspects of Iheir pharmacology and toxicology. Drugs oi this
type are generally well absorbed alter ingestion
Signs and Symptoms
If perles are chewed or dissolved In the mouth,
oropharyngeal anesthesia will develop rapidly. CNS stimu- .
lation may cause restlessness and tremors which may
.proceed to clonic convulsions followed by profound CNS
' depression. .
/ .'.
j •
Traatment
-.—•
'
!'••••,
' Evacuate gastric contents and administer copious
amounts ol activated charcoal slurry. Even in the conscious patient, cough and gag reflexes may be so depressed as to necessitate special attention to protection against
. .
aspiration of gastric contents and orally administered
materials. Convulsions should be treated with a short-aciing
barbiturate given Intravenously and carefully titrated for the
smallest effective dosage. Intensive support ol respiration
and cardiovascular-renal function isan essential featureolthe
treatmentof severe Intoxication from overdosage. Do not use
; .
CNS stimulants.
, •- i•'••JV;... DOSAGE AND ADMINISTRATION
V
i- ; v
Adults and children over 10: Usual dose Is one 100 mg pede 11 d
- astequlred. llnecessary.upto6pedesdailymaybegiven.
HOWSUPPUED
Perles. 100 mg lyellowl; bottles of 100 NDC 0456-06IW.OI.
Pedes. 100 mg lyellowl: bottles ol 500 NDC OJSb-OhHK-o:!.
Store at controlled room temperature (S^-Sb V. I V o o ' C i .
. Manufactured by:
R. P. Scherer-North America. St. Petersburg. Florida 3371 &
for
Forest PharmaceudcaU, Inc.
... Subsidiary of Forest Laboratories. Inc, SL Louis, MO 63043-9979
• '
Printed In U.S.A.
Rev. 11/92
0
ROCHESTER
Joyce, daughters Laura and Ellen; and Victor Poleshuckfindno <
description of Rochester's "conservative family values and liberal politics.^
level of managed care in his prac- family takes advantage ofthe many
tice. "I'm totally at the mercy of recreational offerings in the area;
the insurance companies," he com- About.20 miles south, Poleshuck
plains. "Eighty percent or morenotes, are the BristQl.Hills,,west of.;,
of the obstetrics I do is for the Canandaigua Lake, "a beautiful
HMOs." Yet, he notes, "people are area for both hiking and skiing."
looking at Rochester as a model."
The arts are also important to
Despire lower-than-average med- Poleshuck. He attends every conical fees, Poleshuck, 51, is able to cert by the Rochester Philharmonic
maintain a high standard of living, and is an active supporter of the
partly because of Rochester's lower orchestra. An avid record collector,
cost of living. "The screws are being he has even taken theory courses at
turned very slowly,'i he observes. the Eastman School of Music to
"The fees are conrimving to rise, but help him follow along with the
nor as fast as my expenses, so there's score while listening to his 1,800
a squeeze. The net income every recordings of classical music.
year is just a little less."
Poleshuck also speaks highly of
i Poleshuck came to Rochester in Rochester's local theater Company,
1967 for his internship at Strong' 'called GeVaJ'arid the^emorial Art
Memorial Hospital following med- Gallery, where his-wife works as a
ical school at the University of Cali- decent. Culturally speaking, he
fornia, Irvine. He then spent two says, "there's a lot going on for a
years in the air force as a general small city."
medical officer during the Vietnam .... •
. .
"
'
War. Luckily, he says, he was as1
signed to duty in Athens, Greece, Joseph Kurnath^
where there was a shortage of
skilled gynecologists to care for the "Even in private practice," says
wives and daughters of the military. internist Joseph Kurnath, "I'm not
Poleshuck returned to Strong my own boss; ! have Medicare
1,
FOREST PHARMACEUTICALS, INC '
at. Leu*, UMourl o o o - m t . ; .
UAD LABORATORIES
Jaduon. UUMilppl m n
References: I: Results of an Independent, random,
national surveyor 198 physicians. February 1992. conducted
by Beta Research Corporation. Data on file. Forest Laboratories. 2. Facts and Comparisons*. 3. AHFS, Drug Information, 1988. 4. Results of a national Gallup study ol 1000
adults, October 1991, conducted by Manning, Selvage, and '
Lee. Data on Ille, Forest Laboratories.
24, and Laura, 21 . in Brighton,
another suburb to the south. The
:
but I think it's a little worse here."
Kurnath, 39, like most physi- ^
MD D C M E 1992
E E BR
�^ : : . ROCHESTER
:
j l i f e ^ S Shades of a summer past: Undsey, Joseph senior; and Patrice Kurnath prefer Uj f i l d e ^
||^|^i;!^ ld(mattM at the beach, while Joseph Junior can only squint ^ ^ - ^ V ^ j ^ i S
:
:
His free time is mostly reserved
cians in Rochester, laments the
K
. incursion of open-panel HMOs. for his children: Lindsey, 10;
fe-'-X "Industry runs things, not the med- Patrice, eight; and Joseph, six.
C .. • ical profession," he says. "When Weekends together may be spent
te***.*'
• - 1 9 8 2 , camping on Keuka Lake (one of the r
HMO Finger Lakes) or attending geolog$|
-r-, - - - , s a y s and crafts classes at the Rochester
f / : X - : K u r n a t h , his income has gone Museum and Science Center. In
{',,::. .:• • • "from 80 percent fee-for-service to Rochester, he says, there are "fam^ ' - ^V; - niaybe 20 percent fee-for-service, ily-oriented activities going'on all •.
E ^ i ^ l ^ a n d the rest of it comes from Medi- . the time." His family lives in nearby Pittsford, whereii he; says^the|
^ ^ ^ • f e B u t like other doctors in the area, schools are excellent but the prop-'r
^•!»>;$;. Kurnath is too enamored of life in erty taxes are steep—he.pays
y:'.;:Rochester to consider heading else- $5,000 a year.
where. He came to Rochester from
Kurnath is still an'active sportsman (he played rugby while in
medical school at the University ipf-,:
Medicine and Dentistry of Nev^!;]
^ 7 - 3 ^ ^ 8 " a great place to live;" he sayiv. Jersey), skiing in the winter;-bicy^V:'
"
Kurnath's group practice empha- cling and sailboarding (on Lake
ffi X':y: sizes geriatric medicine. " I have Ontario or one of the Finger Lakes)
> . . . more patients than I can handle. in the good-weather months.
•ffl-i iffi&t-Out third partner just came on with, The mention of weather elicits
J ^ ^ M ^ r U two years ago, and she has pretty • Kurnath's own views on the topic:
S
"IKumath; . "My contention is, if Rochester had '
linical weather like San Diego, there• '•
Jicme at would be three million people living
is heavily here, and then we would have all
university
'f&^:'if.-involved with the Monroe County the problems of a three-millionj j r ^ : Medical Society.
. population city."
. ,
!
:
:
;
;
1
:
;
»f#--«(^»al«) DCM E 1 9
E E BR 9 2
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Personal Stories Database : Additional Small Business Letters] [loose] [3]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-005-007-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/1f84f9a9e887e6a8ab86c7c672a8e4ac.pdf
58802f8d928e8ada16891b2a158e23dd
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3679
FolderlD:
Folder Title:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
7
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
002. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/23/1993
P6/b(6)
003. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
004. letter
Personal (Partial); Address (Partial) (1 page)
03/14/1993
P6/b(6)
005. letter
Personal (Partial); Address (Partial) (1 page)
01/27/1989
P6/b(6)
006. letter
Personal (Partial); Address (Partial) (1 page)
12/29/1989
P6/b(6)
007. letter
Personal (Partial); Address (Partial) (1 page)
11/30/1990
P6/b(6)
008. letter
Personal (Partial); Address (Partial) (I page)
01/03/1993
P6/b(6)
009. letter
Personal (Partial); Address (Partial) (1 page)
04/30/1993
P6/b(6)
010. letter
Personal (Partial); Address (Partial) (I page)
12/31/1992
P6/b(6)
011. letter
Personal (Partial); Address (Partial) (1 page)
01/28/1993
P6/b(6)
012. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
013. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/26/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
im809
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) ofthe PRA|
1 2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
*
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
h(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
014. statement
Personal (Panial); DOB (Partial) (2 pages)
04/1993
P6/b(6)
015. note
Personal (Panial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
016. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
06/20/1993
P6/b(6)
017. statement
Personal (Partial); Address (Partial) (2 pages)
04/12/1993
P6/b(6)
018. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
019. letter
Personal (Partial); Address (Partial) (1 page)
05/24/1993
P6/b(6)
020. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
021. letter
Personal (Partial) (2 pages)
12/10/1992
P6/b(6)
022. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
023. letter
Personal (Partial) (1 page)
04/01/1993
P6/b(6)
024. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
025. letter
Personal (Partial); Address (Partial) (2 pages)
05/26/1993
P6/b(6)
026. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Eiox Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
iin809
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Kreedom of Information Act - |5 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
027. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/09/1993
P6/b(6)
028. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
029. letter
Personal (Partial); Address (Partial) (2 pages)
03/14/1993
P6/b(6)
030. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
031. note
Personal (Partial); Address (Partial) (1 page)
n.d.
P6/b(6)
032. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/11/1993
P6/b(6)
033. note
Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
034. letter
Address (Partial) (1 page)
02/13/1993
P6/b(6)
035. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
036. letter
Personal (Partial) (1 page)
03/18/1993
P6/b(6)
037. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/22/1993
P6/b(6)
038. letter
Personal (Partial); Address (Partial) (1 page)
02/12/1993
P6/b(6)
039. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
im809
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)
Kreedom of Information Act - |5 U.S.C. 552(b)l
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe KOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
h(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe KOIAj
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Kcderal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
040. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/27/1993
P6/b(6)
041. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
042. letter
Personal (Partial); Address (Partial) (1 page)
01/29/1993
P6/b(6)
043. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
044. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
045. letter
Personal (Partial); Address (Partial) (I page)
01/31/1993
P6/b(6)
046. note
Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
047. letter
Address (Partial); Phone No. (Partial) (1 page)
07/19/1993
P6/b(6)
048. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
049. letter
Personal (Partial); Address (Partial) (2 pages)
01/24/1993
P6/b(6)
050. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
051. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/01/1993
P6/b(6)
052. statement
Personal (Partial); SSN (Partial) (3 pages)
02/19/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
im809
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)|
Pl National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information |(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
h(3) Release would violate a Federal statute 1(h)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
053. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
054. letter
Personal (Partial); Address (Partial) (2 pages)
03/29/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
im809
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)l
Freedom of Inrormation Act - |S U.S.C. 552(b))
PI National Security ClHssificd Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information |(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIAj
C. Closed in accordance w ith restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
ypENTIFICATI
RY LETTER CONTENT
yz.o-2^t>
JLfetpiJr*
�BETH ISRAEL MEDICAL CF.NJTER
FIRST AVF.NUE AT 1ATH STREET, NEW YORK, NY 10003 (212) 420-2000
Adrienne M. FUckman, M.D., Associate Director
Associate Professor of Medicine
Mount Sinai School of Medicine
Department of Medicine
(212) 420-4097
Februarys, 199 3
Mrs. H i l l a r y Rodham Clinton
Office of the F i r s t Lady
White House, Room 100
OEOB
Washington, D.C. 20500
Dear Mrs. Clinton:
I would l i k e to share some thoughts on paying for health care.
I have spent two-thirds of my medical l i f e in public hospitals,
and the l a s t several years in an excellent large c i t y private
hospital. I firmly believe that health care should be available
to a l l individuals l i v i n g in our country.
Not usually very
chauvinistic, but having a lot of exposure to physicians trained
in other countries, I believe we have the world's best health
care. However, United States style health care i s expensive.
We are very technology driven. This i s not bad, actually i t ' s
good. W t r y hard to get precise diagnoses and work, toward
e
precise treatment. But you have to pay for technology. Even
Canada and Germany are busting t h e i r health care budgets.
W also (currently) largely subscribe to an ethic to t r e a t a l l
e
individuals who haven't e x p l i c i t l y refused medical therapy. This
means that we do not ration care for anyone. including
individuals who have spent years without knowing who or where
they were. We give the best possible treatment for infections of
the lung, kidneys, blood stream or skin to individuals who
haven't been out of a nursing home bed in months or years. We
also t r e a t individuals who may have less than months to l i v e , i n
the hopes of adding days to that lifespan, and often spending
thousands and even hundreds of thousands of health d o l l a r s i n the
l a s t days of l i f e for such problems as end stage heart, lung, and
l i v e r disorders, and for patients i n t r u l y end-stages of cancer
or HIV disease. Change i n these aspects of health care system
can only take place after long and thoughtful debate as a nation.
We have an economicallY
diverse p o p u l a t i o n .
Aggressive
preventive h e a l t h care f o r the whole population should c e r t a i n l y
:
AFFILIATED WITH MOUNT SIN! AI SCI IOOI (M MI I Mt [\!
VII.MBrR OF FEDERATION OF JEWISH PHILANTHROPIES.
�reduce the cost of h e a l t h care o v e r a l l . But not immediately, and
perhaps not d r a s t i c a l l y except f o r improved p r o d u c t i v i t y and
c o n t r i b u t i o n t o society.
Inner c i t y housing improvements may also some day reduce h e a l t h
care costs. "City asthma", f o r example, i s e s s e n t i a l l y a disease
of the poor.
Curbing abuses by h e a l t h care providers may help some, but the
cost of p o l i c i n g the commonest abuses would be i n o r d i n a t e l y
c o s t l y and i n t o l e r a b l y i n t r u s i v e . Managed care i s a "boondoggle"
- a game played by providers t h a t provides the lowest common
standard of care.
Managed competition i s another game p r i m a r i l y one of r e s t r i c t i n g options.
One simple measure t h a t would help on h o s p i t a l i z a t i o n i s t o apply
the "DRG" p r i n c i p l e t o physician reimbursement t o encourage r a p i d
"work-up" and discharge from the h o s p i t a l . The p h y s i c i a n would
then have the same i n c e n t i v e s as the h o s p i t a l t o discharge
p a t i e n t s t o home, f r e e i n g needed beds and reducing b u i l d i n g
costs.
I HAVE ANOTHER IDEA THAT MIGHT HELP OFFSET COSTS :
For those diseases that we know are related to vices that people
enjoy, there should be a pay as you go svstem. This i s not a
"sin tax".
The r e a l (not punitive) health costs of smoking
(including costs of passive smoking) should be calculated: the
costs of lung cancer, emphysema, chronic bronchitis, excess
asthma, cardiac disease, lost productivity, excess pneumonia,
etc. costs should include the research done and needed on the
diseases and the medications and bureaucracy necessary to t r e a t
them. This cost should then be "amortized" to each pack of
cigarettes. There should then be a s p e c i f i c targeted health tax
on each pack of cigarettes. The more you smoke, the greater
likelihood of disease, the more you contribute. Insurance w i l l
not then have to be increased for the smoker. He/she w i l l have
already PAID THEIR OWN
WAY.
The same i s true for alcohol. I f someone drinks a l i t t l e , they
pay a l i t t l e . The more they drink, the more they pay. That way,
when you're ready for your l i v e r transplant, you r e a l l y earned
it.
The same could be done with junk food.
Diabetes and heart
disease are largely l i f e - s t y l e diseases. Every time I chose to
have a Big Mac and three candy bars for lunch, I know that I'm
simultaneously contributing the proper proportion to the health
care for diseases potentially a r i s i n g out of t h i s l i f e s t y l e
choice. Then I can truly be e n t i t l e d to my $26,000 t r i p l e bypass
plus ICU costs for those self-induced bouts of chest pain.
�Obviously, t h i s plan won't pay for the untaxable i n f l i c t e d
diseases such as drug abuse (unless legalized, or unless the
c i v i l penalties when caught include some requirement to pay a
health care contribution), nor for f a i l u r e to seek preventive
care, nor for diseases that s t r i k e without regard for l i f e s t y l e .
But at least there would be some offset for the costs of the
major diseases affecting our Western society.
Anyway, I'm behind you 100 %!!!!!!!!!!!!!!!!!
Sincerely,
Adrienne M. Fleckman,
M.D.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Persona) record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Small business owner, o r i g i n a l l y was paying $239.93/ u a r t e r f o r
insuruance, now costs $1,166.69/quarter w i t h $1,500 e d u c t i b l e ,
f i r m i s locked i n t o insurance company because w i f had nonmalignant lumpectomy several years ago
PlflCATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
LOCKED INTO INSURANCE COMPANY
IJL
P6/{b)(6)
•
'
'/.z
c, ?
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
02/23/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
.im809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between (he President
and his advisors, or between such advisors |a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe KOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�' P6/(b)(6)
• .. '1
.yJ
. ..'
V "
• i '''
February
• •
•
23, 1993
F i r s t Lady H i l l a r y C l i n t o n
White House
Pennsylvania Avenue
Washington, D. C.
Dear Mrs. C l i n t o n :
This i s an unusual t h i n g f o r me t o do but I and others
l i k e me need h e l p . My w i f e and I have h e a l t h insurance.,
through Golden Rule Insurance Company. We we f irst s t a r t e d
w i t h t h i s company.our premium was $239i93^ q u a r t e r l y and
each time i t kept i n c r e a s i n g . We are now
q u a r t e r l y w i t h a $1500.00 d e d u c t i b l e per person ^ This
i s $4666.76 per year r i g h t now.
I have a small watch and j e w e l r y r e p a i r shop he e i n
v.- - P6/(b)(6)...., 'and business i s good but i t i s g e t t i n t o t h e
p o i n t t h a t we cannot a f f o r d any more. Three yeflrs ago,
my wife| P6/(b)(6) [had a lumpectomy but i s .now.do ng j f i n e
and no t r a c e of cancer and because of t h i s no o her
insurance company w i l l even t a l k t o us.
Please help us and other people i n t h i s s i t u a t i o n
cannot a f f o r d these high h e a l t h insurance r a t e s
who
Yours t r u l y ,
-
P6/(b)(6) .
.• •\
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
im809
RESTRICTION CODES
Prcsiilcntial Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Pi Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(h)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
3
>
jjaaPEjuEiiaflapw
QF WRITER.
• P6/(b)(6)
BRIEF SYNOPSIS OF LETTER
She and husband have small business, employ son. Their Annual s a l a r y i s
$30,000.00. Premiums for t h e i r family went from $143.00 i r '86 ($500.00
deductable) to $607.00 i n '90. Changed deductable to $2 500.00 dropping
premiums to $427. In January '93 i t was $660.00!
"Noway we could afford
t h i s . " " I r e a l l y f e e l the insurance company wanted us to c incel because we
were reaching an age [55-60] when we might s t a r t f i n a l l y usiWg i t , we've paid
a l l these years and now when we might need i t we can't a f f q d i t . "
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
UNABLE TO PAY
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
03/14/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
.im809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |S U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal offlce 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
1 4 Release would disclose trade secrets or conndcntial commercial or
*
rmaneial information 1(a)(4) ofthe PRA]
PS Release would disclose conndcntial advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�>,:,;
P6/(b)(6)
kpnJJL ] 4 , 1993'
M*4. HUXoxy Rodham Clinton
CkalnwomcLn on Na&Loncd Heafth RQ.io,^
WkUz Howe
7 600 ?e.ntu>yl\)a.>Ua. Avenue
WaAfu.ng.ton, P. C 20500
.
h
Pecu M/L6. Clinton:
My kuAband tvJintd 60 in Pe.bnia*.ij. 1 tuMtd S5 i n .MaAch, .,1 ^e£p y husband
he QYtly?
ou^i ''6WHjo4m<tt£ ba6x.Kie44. OUA annual -ialcLXy ii aboiut ' $'30'JOOO.
o.thzK .mploycz ii OUA t>on.
%
:
Thank^vuity we have. nzveA had a teAiouA HtneAi but OUA fiedtCWIiH*: Juinct
*.1&tjnitm6zk&v.ettpiKaitjd. In-? 1.9*6 OLW. monthly pnvnim MJCU ft.4iafft5« 1500 deducti b l z ) . By January, :l9t9 -thz monthly pfizmium had gone ap io;.$35.7^
deduettb^e
J989 *o $557..«6 and WouembeA, 7 990 J O $607.33. W #iert changed
C
e
$2, 500 which dtiopptd OUA. monthly paymznt to $426,94 but -then 't Ap^e, J.992,
that <U wcw
iX IAXU icutizd to: $525.42, In December 0^ 1 992 we -tece/cved notice
QOAMQ-j}tV;-&,i$S$l.29 -.and one mo«*/i £a<eA um told
^imd>!U^ CJi^id':tot^U(&:2^
:
tW'VCo / ca.nc.eJL? b ecaua e we weAe eac fcing an ag e- when - we mig fet"4t?AiSqi
-tt, We have pax.d
thzAZ ytaM and now when we might nzzd it?
Vti, we canceled ihe Goldzn Raie lKL6uAance and went with tht onliotheA -cn^tyiance
company we. <etC.we cooed a^o^id - $2, 500 diiductibl<L cU $3S4.-6h ar lo^h^bu^^ie
AiWijBg^iflaiing.^
-not vviy good. With OUA luck, i^ we eueA doneed to go to
the ho^p^ta^, the in&uAance. company will go undeA.
I don't have any aMw&hi ^on thU pfiobltm but tomthing needi to ie done. Many
people OAe in woue. ihape. than we re?? w.<'th the^
imuAancz.
Plvue. do whatzwi you can to make intuAancz a^oidablz &0A. the. tyeAage. p m o n .
W don't want -ct ^oi nothing but we want i t to be a^o^dab^e.
e
VOUAA
tAulu,
P6/(b)(6)
/ !
Inclo&uKU
1' •
••"
..
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
01/27/1989
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jin809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(t>)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA)
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information |(b)(l) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�GddenFlule
January
7, 1989
Policyholder:
•
P6/(b)(6)
New Premium: / $
357.61
Effective:
I 03/01/89
About a week ago, I sent you information on whal i s
happening i n regard to health insurance. I t ' s happening
throughout the health insurance industry.
In that l e t t e r , I n o t i f i e d you of an upcoming
in your rates.
increase
Your new premium is stated at the top of t h i s pftge.
I'm enclosing with t h i s l e t t e r some a d d i t i o n a l informat i o n that w i l l probably be valuable t o you.
Golden Rule has done everything possible to cut operational costs in order to minimize the amount of your
rate increase. S t i l l , due to continually rising claim
costs, you have received repeated rate increase!.
We are concerned about how our policyholders f e j f l about
the decisions we make.
A l i t t l e over a month ago, Golden Rule die indepth
interviews with two groups of policyholder \ — a
group of women, followed a few hours l a t e t by a
group of men. We gave them a l l of the i n f >rmation
that we sent to you i n the l e t t e r you recejlved a
few days ago and i n t h i s l e t t e r .
Golden Rule Insurance Company
Home Office
Golden Rule Building
Lawrencevtlle. Illinois 62439
Telephone (618) 943-8000
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
12/29/1989
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force '
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Aet - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA|
C. Closed in accordance wilh restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�G l e ^ Me
od n
<o(t>
Decembi r
RE:
Policy [ P / b ( )
6()6.
New Premium Amount: $
Effective Date: 02/01/90
Dear
29,
1989
557
P6/(b)('6)
At the time of your last standard rate incrn a se we
sent you a great deal of material concerning What was
happening in the marketplace with increasing <:la im
costs causing rates to skyrocket. Our goal Wi i s — and
is — to return to stable rates, or at least, to implement smaller increases,
helping
The rate in creases that we have implemented a
us to reach rate s t a b i l i z a t i o n . However, inc rea sed
claim costs are s t i l l taking t h e i r t o l l . Pie se realize
you were no t singled out for t h i s rate increase
We do
not charge one policyholder more premium becase many
claims were incurred, nor do we charge anothe: policyholder less premium because few or no claims iere
incurred. The rates are based on the t o t a l number of
policyholde rs in the block of business and r e i l e c t
experience in your state or region of the country
We are working hard to control costs so that e can
provide you the very best major medical p o l i c at a good
value. Even though we realize t h i s increase i a y seem
sizable to you, i t i s much less than the l a s t increase
we implemented, and that i s important to everk one.
I t i s important that everyone maintain a majo i medical
plan with adequate coverage in order to be prct ected
from the very great cost of a large h o s p i t a l - i u r g i c a l medical claim,
1
Sincerely,
Pat
MofdUi
Patrick W. Mazelin, Manager
Policyholder Service
Golden Rule Insurance Company
Home Office
Golden Rule Building
Lawrenceville, Illinois 62439
Telephone (618) 943-8000
RLTR91
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. letter
SUBJECT/TITI.E
DATE
Personal (Partial); Address (Partial) (1 page)
1/30/1990
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
im809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)l
Freedom of Information Act - |S U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute 1(h)(3) ofthe KOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe I'RAI
Release would violate a Federal statute 1(a)(3) ofthe PRA)
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Gddenliile
oo
Novembe
30,
1990
*P6/(b)(6),.
New Premium: S
Effective Date:
697.33
01/01/91,,-'
Dear [_
In a June 1990 issue of Barron's newspaper, thtjre i s a
giant headline on the f r o n t page e n t i t l e d , "Tht Sickening
Spiral in Health Care Cost."
From 1988 to 1990, the r i s i n g cost of health cure
devastated health insurance companies — many went broke.
In order to keep up with the r i s i n g cost of hef 1th care,
i t i s necessary to increase your premium at t h s time.
This is not a general i n f l a t i o n a r y problem bectluse o v e r a l l
i n f l a t i o n in America is low.
This i s a problem of health care costs. Healt care costs
have been going up more rapidly than anything Ise in the
economy — and they continue to go up.
I'm sure you don't l i k e i t .
increase is t e r r i b l e .
We agree with you
The cost
One major reason is that there has been a grea' increase
in the use of much more technologically advancnd procedures.
While CAT scans and MRI's are more advanced, they are also
far more expensive.
Costs have also increased because some doctors do additional
tests and procedures to be certain they cover 11 p o s s i b i l i t i e s , and therefore, protect themselves from awsuits.
(See reverse side)
Golden Rule Insurance Compnnv
Home Office
Golden Rule Building
Lawrencevillc, Illinois 62439
Telephone (618) 943-8000
RLT162
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. letter
SUBJECT/TITLE
DATE
01/03/1993
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office [(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
rmaneial information 1(a)(4) ofthe PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Golden R l
ue
0 0%
3,
Janua y
RE:
P6/(b)(6)
Dear
1991
±Mb)i6)_
W are pleajred you have decided\to change you
e
ible from £
500 to S 2,500.
deduct-
9 pf f p r t - " * ^ ? " " ' y
1 91
This change wi
should realize a substantial savings i n premi
t h i s change. Enclosed i s a rider-amendment
your new deductible.
i
a
,
Your coverage i s currently paid to February
With your new deductible, your new premiuitkis
I f the deductible change does not meet with y
approval, please n o t i f y us in w r i t i n g w i t h i n 0 days
from the date of t h i s l e t t e r .
W are happy that we could be of service to ytyu and hope
e
to continue meeting your insurance needs.
Sincerely,
Alice Judy
Policyholder Service
Enclosure:
Rider-amendment
Golden Rule Insurance Company
Home Office
Golden Rule Building
Lawrencevillc, Illinois 62439
Telephone (618) 943-8000
PLT021
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
04/30/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
im809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe I OIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning the regulation nf
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Securit) Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or conndcntial commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�GoldenFlule
April
0, 1992
• P6/(b)(6)
Kew Premium: $525.42
Effective Date: 06/01/92-'
Dear
P6/(b)(6),:;;,
\
This i s an announcement of an increase in your health
insurance premium.
Many l i v e s are being saved through wonderful mdical
advances, but costs keep r i s i n g .
Medical care costs have continued to rise at arapid
rate even though the o v e r a l l i n f l a t i o n rate i n America
has calmed down a good b i t .
continued
I t i s generally agreed that the reason f o r the
rise in medical care costs i s due to the continued
advances in high cost medical technology.
America continues to develop astounding medica advances
which save the l i v e s of people l i k e you and me But
these wonderful medical advances are more expensive and
a f f e c t your rates, W regret the necessity of raising
e
your rates.
Sincerely,
PcU
MafeUn
Patrick W Mazelin, Manager
.
Insurance Services Division
Golden Rule Insurance Company
Home Office
Golden Rule Building
Lawrencevillc, Illinois 62439
Telephone (618) 943-8000
RLT245
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. letter
SUBJECT/TITLE
DATE
12/31/1992
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Aet - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(I) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
h(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�GoldenRule
[0
.
P6/(b)(6)
l° .
'
1
••„••
Decern er 31, 1992
New Premium: $597.29
Effective Date: 02/01/93
Severa
premium increase.
our policyholders received a
U n t i l now, we have put into effect only a portion of the
increase that was f i l e d with the Insurance Departments
throughout the nation.
The remainder of the increase w i l l take effec when your
premium is due on the effective date shown ab ve.
The reason for the increase taking place in tUosteps
(the f i r s t part e a r l i e r t h i s year and the remi inder now)
was a desire to make the increase less painful for you.
While we understand you w i l l never be pleased about
increased rates, we have put o f f increasing
e rates
as long as possible.
We are working very hard to control costs so fe can
provide you the very best medical policy at a good value.
I t i s important that everyone maintain a majo medical
plan with adequate coverage in order to be pr Hected from
the enormous cost of a serious i n j u r y or i l l n ss.
We are shocked at how much i t costs i f a pers on has a
serious injury or i l l n e s s .
Golden Rule Insurance Compan\
Home Office
712 Eleventh Street
Lawreneeville, Illinois 624?y-23P5
Telephone (618) 943-8000
RLT29C
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
Oil. letter
SUBJECI7HTI.E
DATE
Personal (Partial); Address (Partial) (1 page)
01/28/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Prcsklcntial Records Act - |44 U.S.C. 2204(M)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
IM
b(l) National security classified information 1(h)(1) ofthe FOIAj
h(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) nf the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIAj
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(H)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C, Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR, Document will be reviewed upon request.
�Golden Rule
Coil
J a n u a r y 28, 1993
Effective Date: 03/01/93
New Premium: $660.22
The premium rates for your coverage are basej; on several
factors. One of the factors i s the attained age:of a l l
adult members covered under your coverage.
Your premium rates are scheduled i n f i v e (5) year i n crements for each adult member (e.g., 30, 35 40, 45,
e t c . ) . The change in premium i s e f f e c t i v e
e premium
due date after the adult member's birthday.
You
now
and
top
or your spouse's portion of the premium ate w i l l
increase due to an age change. The e f f e c t ive date
new premium of your policy i s l i s t e d f o r you at the
of the page.
We believe i t is important to maintain adeqt^te insurance coverage. Your current policy provide ONE MILLION
DOLLARS of l i f e t i m e coverage for each covered person on
your policy.
James LaBounty
Policy Revisions
Coordinator
Golden Rule Insurance Company
Home Office
712 Eleventh Street
Lawreneeville, Illinois 62439-2395
Telephone (618) 943-8000
RLTF
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
012. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Aet - |44 U.S.C. 22()4(a)
Ereedom of Information Act - |S U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Eederal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
b( I) National security classified information [(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA)
h(9) Release would disclose geological or geophysical information
concerning wells KbK'J) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�7.
PERSONAL STORIES DATABASE
BRIEF SYNOPSIS OF LETTER
IDENTIFjrCATION QF PRIMARY LETTER CONTENT
. ,
/
7^7
^
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
013. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jin809
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)
Freedom of Information Act - [5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the I O I A ]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe I O I A ]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
coneerning wells |(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA)
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice hctween the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�P6/(b)(6) •
March 26, 1993
Ms. Hillary Rodham-Clinton
Health Care Task Force
1600 Pennsylvania Avenue
Washington, DC 20500
Dear Ms. Rodham-Clinton,
I am a Family Physician practicing in a medium sized city (Binghamton, NY) and t w nearby
o
rural towns (Deposit and Windsor, NY). My group has worked diligently over the past 10 y ars to insure
that the rural communities we serve have reliable, comprehensive, quality health care. We now that you
are now working to achieve the same goals on a much larger scale. As you struggle in sear n of a
compromise I wanted to share with you some of our concerns.
I have enclosed a copy of the report I made to m partnersregardingoptions for thtj Health
y
Insurance we provide our employees. Currently, we feel obligated to provide insurance to 1 > ml employees
and their families. We receive a great deal of comfort knowing that our employees have a i latively good
Health Insurance Plan. Our ability to continue has been severely eroded. Our projected 19' > I premium
will be $54,000. This is only the Employer's part. The Employee will also share the cost a i i pay $5,300.
In 1992 our Health Insurance cost was $36,000. In 1991 it was approximately $25,000. W i are faced
with a difficult choice. Fortunately, through the diligent work of our employees we will be \ ble to provide
a different program which is a bit of a compromise and will cost the Employer between $46 50,000.
On the other hand, we are also struggling with reimbursements of 50% from Medi: ire, 25%
from Medicaid, and increasing pressure to discount our fees to insurance companies. Addi i anally,
despite the majority of my colleagues and all of m partners working very hard to provide c i ality, cost
y
effective care we have been battered by a system which accuses us of practicing poor quality medicine, and
being paid too much. For a small percentage this indeed may be true. But, for the majorit), it is not.
Over the past several years we have been practicing under the rule and assumptions of Dr., * xelrod,
former Commissioner of Health in New York State. He believed that 1 % of the Physicians >racticing in
0
NYS were bad and it was his job to hunt them down and getridof them, Needless to say, t is has not
been pretty for the majority of us who are very conscientious and deeply concerned about thji
well-being of
our patients.
Thank you for your time and good luck with your endeavor to reshape Health n America. I
Can
am fully confident that we all will once again be proud of our system and ourselves. I woulto
like
''
extend an invitation to you and/or any member of your Task Force to visit us, a Network of Health Care
Professionals, providing cost-effective, comprehensive, coordinated Health Care to the comniunities we
have the honor and pleasure of serving.
_Smcerelv.iL2
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
014. statement
SUBJECT/TITLE
DATE
Personal (Partial); DOB (Partial) (2 pages)
04/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Prcsiclenlial Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�HERLTH INSURANCE
Effective A p r i l 1993
EMPLOYEE
—
Current
Guard.HI Guard. De
- '-: Z
'. 3
240.56
234.82
234.82
240.56
106.87
138.74
240.56
70.65
196.30
61.28
7S_ 90
196.30
234.02
,
BC/BS
42.45
42.45
42.45
42.45
14.50
42.45
42.45
14.50
42.45
14.50
14.50
42.45
42.50
134.05
134.05
134.05
134.05
57.15
134.05
134.05
57. 15
134.05
57. 15
57. 15
134.05
134.05
TOTflL
HNN. TDT -
Neu
Guard.HI Guard. De.
297.37
297.37
297.37
297.37
109.33
205.79
297.37
108.33
297.37
108.33
108.33
237.37
297.37
3018.07
36.-:l6.84
44.57
44.57
44.57
44.57
15.23
44.57
44.57
15.23
44.57
15.23
15.23
44.57
44.57
462.05
5544.60
INCREASE DEPUC TIBLE TO i l O O u
EMPLOYEE
•s
-
::
• ^s
" *t' ' '
TOTflL
ANN. TOT.
Or:/BS Guard.HI I ;i.i.ard. Dei :M . 05
i •:i4. ij5
134.05
134.05
57. 15
134.05
134.05
57. 15
1 34.05
57. 15
57. 15
134.05
134.05
249.79
249.79
249.79
249.79
91.00
172.86
249.79
91.00
249.79
91.00
91.00
249.79
249.79
44.57
44.57
44.57
44.57
15.23
44.57
44.57
15.23
44.57
15.23
15.23
44.57
44.57
462.05
5544.60
I• 1 to
.
r-mp 1 OLjee EBFMH
428.4 1
0.00
428.41
0.00
428.41
0.00
428.41
0.00
163.38
0.00
351.48
0.00
420.41
0.00
163.38
0.00
295.94
132.47
163.38
0.00
163.38
0.00
295.94
132.47
295.94
132.47
397.41 4034.87
4768.92 48418.43
Cost t o empl
Neu
Current
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
128.64
0.00
0.00
128.64
97. 76
355.04
4260. 4fi
Cost t o EBFMA
Neu
Current
0.00
417.06
0.00
411.32
0.00
411.32
0.00
417.06
0.00
178.52
0.00
315.24
0.00
417.06
0.00
142.30
147.64
244.16
0.00
132.93
0.00
151.55
147.64
244.16
147.64
313.61
442.92 3796.29
5315.04 45555.48
475.99
475.99
475.99
475.99
180.71
384.41
475.99
180.71
328.35
180.71
180.71
328.35
328.35
4472.25
53667.00
�EMPLOYEE PAYS FOR FAMILY
Cost t o
EMPLOYEE
BC/BS Guard.HI Guard
134.05
134.05
134.05
134.05
57. 15
134.05
134.05
57. 15
134.05
57. 15
57. 15
134.05
134.05
TOTflL
ANN. TOT.
297.37
297.37
297.37
297.37
108.33
205.79
297.37
108.33
297.37
108.33
108.33
297.37
297.37
3018.07
3t.216.84
De.
44 57
44. 57
44. 57
44. 57
15. 23
44. 57
44. 57
15. 23
44. 57
15. 23
15. 23
44. 57
44. 57
462. 05
5544. 60
Employee EBFMA
0.00
475.99
0. 00
475.99
0.00
475.99
295.28
180.71
0.00
180.71
97.46
286.95
295.28
180.71
0.00
180.71
295.28
180.71
0. 00
180.71
0.00
180.71
0.00
475.99
295.28
180.71
1278.58 3636.59
(^15342.9bJ> 43639.08
EMPLOYEE PAYS FOR 1/2 FAMILY
Cost tc
EMPLOYEE
;
.^ '
TOTAL
ANN. TOT.
BC/BS & j . 3 r d . H I Guard. Oe.
134.05
134.05
134.05
134.05
57. 15
134.05
134.05
57. 15
134.05
57. 15
57. 15
134.05
134.05
297.37
297.37
297.37
297.37
108.33
205.79
297.37
108.33
297.37
108.33
108.33
297.37
297.37
3018.07
36216.84
44. 5/
44. 57
44.57
44.57
15-23
44.57
44.57
15.23
44.57
15.23
15.23
44.57
44.57
462.05
5544.60
Employee- EBFMA
0.00
475.99
0.00
475.99
0.00
475.99
147.64
326.35
0.00
180.71
48.73
335.68
147.64
328.35
0.00
180.71
147.64
328.35
0.00
180.71
0.00
180.71
0.00
475.99
147.64
328.35
, 6 3 5 - 2 9 4275.88
("7671^49 51310.56
\
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
015. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 5.S2(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Securit)' Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
Hnancial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
0
P6/(bK6) ,
' -*,*.
;i
BRIEF SYNOPSIS OF LETTER
Owner o f small business o f 25 f u l l and p a r t time employees •an o n l y a f f o r d
t o cover 3 people under c u r r e n t system; premium has gone f±om $737.00/month
t o $l,100.00/month. SUPPORTS p a y r o l l t a x even up t o 10%t o cover d e n t a l
and p r e s c r i p t i o n s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
OTHER CONTENT
SUPPORTS-payroll t a x , t o i n c l u d e d e n t a l and p r e s c r i p i o n s , up t o 10%
�Withdrawal/Redaction Marker
Clinton Library
DOCUMF.NT NO.
AND TYPE
016. letter
SUB.JF.CmTTI.F
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
06/20/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - 15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
t)(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation nf
financial institutions 1(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA|
National Security Classified Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(.S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�u a N u i rt
s
r i i i- c
^
j'.>
i.
HU
.
i
r .y i
1
o
D<K^ Mrs. Clinlov -
f f a
lit
m
-6M
Vqulcti*
- ^
^7>L7o
Hr
/toy*//
fax^
t» + *Y. I
^^H^/li
U),M Swll Susies ?^ r
ft6 61> Luck To
A
P6/(b)(6).
K.t.
r.L.II
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
017. statement
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
04/12/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�K U . HC BATE
VOl^J
:--D
- ai
'•3
STA7DOT OF ACCOUNT
1NUMZ FOUMS
Mtmr
4/W/93
o
aWmTHfflUBH 2/2B/V3
SEZXIVCD
V
PMET A C
854.79
0.00
GUVEOT CHMBCB
|OIE>L CWCR*GE
E)flOYEE LIFE INS,
fiERVlCr FEE
TBfiL BUE
K M
-4:
05/01^3 ffHUEH OS/31/93
c
6B&36
29.40
20.00
W « O C D S MTMLE TO;
THE WTE RiW
p.o. jnr TUT
BUBLIK, IKXO 43017
WtDr
•v. .
••..•V^V-
- 1$
�kjf. OAIE tnwfi
tJLL £UE DATE
7/0L/93
c; • • •
• •
STATDtNT OF A C U T
CON
PftYMEHT RECEIVED
VZVn
.
737,96
FftST SUE
CURHEMT CWfSES
MEDICAL COURAGE
E>fUlYE LIFE DC.
SERVICE FEE
TOTAL SUE
PIEAEE H*E OEXS MYASLE TO:
E-U MXQXMiE
"HE RITE FLAK
P.O. B X TIB?
O
BUBUM, O I 43017
HO
YGUR PRKf7 PftYJQIT W U BE tfTREClATED.
1,062.90
40.90
20.00
1,131.70
�2751 EAST JEFFERSON • SI TIT. 555 Or.TROlT. Ml 4S2i)7 . f?ni 259-9176 . FAX 259-0975
duxs M^y-,
jfa /ujt a^/ z^/A^.
t Uwut^ jUisjXu^j^^M?. ^^ / ^
4Ms .
EVELYN JOHNSTON RtRisitrtd Repnutenlalivr (fjjering Securities Through
MARINER FINANCIAL SERVICES, INC.
SccuritlM Riokcf/Dcafcr Htmhtt NASIVSirt'
SupervMni BrniK-h Ofltcr l^vclrtf Al: W W. Ann Artwr TV. • Suite 205 Ptymnulh. Ml 411170 , (313) 45f-24t2
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
018. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 22()4(a)|
Freedom of Information Aet - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment lo Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance w ith 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
«
7
BRIEF SYNOPSIS OF LETTER
Self-employed couple pay $4000/yr for coverage; husband had la heart attack 5
years ago. Deductible i s $600. Recent chest pain requirec $1286 t e s t (out
Next time
patient).
C a r r i e r wouldn't pay since he wasn't hospital: zed.
t h e y ' l l go to h o s p i t a l with ingrown t o e n a i l . They f e e l
off.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
LIMITED BENEFITS
CLAIM DENIED
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
�- & ^ £
^c^^tJjt
JLCI^L£:
^ ^ ^ ^ ^ ^
&LC£
^S^tft*..^StCasaZ-
t f <4
-L
dU^/tf ^ Z ^ ^ ^ X u £ •
-
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
019. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (I page)
05/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)
Freedom of Information Act - |S U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or conndcntial commercial or
rmaneial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe I O l \ |
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
h(8) Release would disclose information coneerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-C^ULA^^c^.--<2jcujLeA*^^
J^Ju,
1
eU-A-.
UJJL,
As-^dLf
L^CLU^
4^ <4
r
; , P6/(b)(6).:
r 0
>
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
IDENTIFICATION OF PRIMARY LETTER CONTENT
7/7 : %
m
�MARK II. KEW, M.D., P.C.
240 CENTRAL PARK SOUTH, SUITE 2-P
NEW YORK. NEW YORK 10010
212 245-8010
March 5, 1993
Mrs. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington. D.C. 20006
Dear Mrs. Clinton:
I am very pleased that you will be heading the effort to reform health care In
America. I am thrilled to see this administration breaking down the artillclal social
barriers which keep talented men and women trom making an impact on our society.
Unfortunately, as a practicing physician, I share the feelings of powerlessness in regards
to the coming changes in our health care system as many of my fellow citizens have felt
In Important parts of their lives. I therefore wish to relate my thoughts and concerns
about Implementing health care reform.
I am an office based, primary care physician board certified in internal medicine
and geriatric medicine and teach clinical medicine at St. Luke's-Roosevelt Hospital on
114th Street in the inner city. My Manhattan practice encompasses the wide spectrum
of people with whom I share my city: the elderly inner city poor, middle class workers,
upper class executives and people with AIDS from all classes. There is not a day that
goes by. because of my committed care to my patients, that I do not save the health
care system money.
Central to our Inefficient health care system Is the Inappropriate use ol our truly
wonderful and expensive medical technology. 0 Include here not only high tech
diagnostic and therapeutic systems but also hospitalization, emergency room use and
long term care facilities.) The internist, when using his skills to the fullest, utilizes this
technology most efficiently. Central to Internal medicine is clinical diagnosis: the use of
the patient's history and physical examination as the essential diagnostic tools. The
overwhelming majority oi problems the internist sees needs only his/her time, expertise
and clinical judgement for diagnosis and management. Even in the more complex
cases where technological assistance is required these principles remain paramount.
In addition, by this process you have learned a great deal about your patient as a
person and have created a relationship. The internist's continued availability to each
patient guarantees on going, efficient health care. Indeed, in countries with Ilscally
efficient health care systems, 50% of all doctors practice primary care specialties,
whereas in our country the number is a mere 12-20%.
Poor reimbursement for cognitive skills and high reimbursement for procedures
are major reasons for this discrepancy in the number of doctors choosing procedure
oriented specialties rather than primary care. Of equal. If not more Importance, Is that
these low reimbursement rates undermine whatever quality primary care we do have.
Poor reimbursement lor time forces the doctor to spend less time with each patient.
�Mrs. Hillary Clinton
The White House
March 5, 1993
Page Two
Expensive technology may be chosen where time would have been sulllclent. The
patient suflers as cold metal replaces (he doctor's hand.
I lear that "managed care" Is felt to be the magic bullet to cure what ails our
health care system. By lowering primary care reimbursement below already depressed
values (despite asking the internist for his full management skills as well as his
participation in a huge Increase in bureaucracy to coordinate patient care) the above
scenario Is again forced to be played out. All managed care has succeeded In doing
is ratcheting down individual reimbursements, Imposing a management tee and profit
while maintaining the heights ol our wasteful system. Managed care generously
rewards Its brokers, marketers, executives and investors and diverts money to their
pockets from health care delivery.
We all agree that health care reform is necessary. However, to be at all effective,
the system must recognize the importance of, and the patient's right to, meaningful
primary care. In the language ol policy I believe this means:
Reimbursement schedules that encourage not discourage time intensive clinical
problem solving.
If an overall health care budget ts enacted cognitive skills must be budgeted
separately from the more expensive, potentially wasteful technology. Cognitive skills
must also be given to highest priority.
Each person must be able to choose and maintain his primary care doctor.
In conclusion. I am proud to be a primary care physician who, everyday, in the
trenches with my patients, fulfills your campaign pledge of not having a single person
to waste. Please do not let this conviction be lost in a health care system ol algorithms
and equations. It should be at its very core.
Sincerely yours,
Mark H. Klnn, M.D.
Assistant Clinical
Professor of Medicine
Columbia College of
Physicians and Surgeons.
Assistant Attending
Physician, St. Luke'sRoosevelt Hospital Center
MHK/df
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DOCUMENT NO.
AND TYPE
020. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
im809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA)
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IPfimriCATXQP or W^TTB^
cP
if
BRIEF BYM0PBI8 OF LETTER
Granddaughter has diabetes, daughter-in-law l o s t j o b , n ide COBRA
payments, but her former employer d i d not send payments t o
insurance company, she l o s t her insurance coverage, comitlained to
government agency responsible f o r COBRA but no action yks taken,
treatment costs f o r granddaughter are very high
EDEKTIFICATION OF PRIMARY LETTER CONTENT
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
GOVERNMENT-RELATED HEALTH CARE P O R M
RGAS
COBRA•s
GOVERNMENT W U D NOT ENFORCE
OL
J
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
021. letter
SUBJECT/TITLE
DATE
12/10/1992
Personal (Partial) (2 pages)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Uox Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Inrormation Act -15 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office |(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
h(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(h)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Mrs. Hillary Clinton
Governors Mansion
Little Rock, AR.
Dear Mrs. Clinton:
You don't know me, but m brother P6/(b)(6)
y
from Sulphur Spring; Texas
traveled with David Senter and //am Joe Somers during the campaign making n lio commercials, etc. to influence the thinking of the Agriculture community toward the Clin
:)n/Gore ticket
It's been a long time since I really took on a cause, but a number of things happened
i ave
in the past couple of years in the health and insurance industries alone.which m i ce me angry
when it is so obvious that particular programs have been created by lawmakers the sole purfoi
pose of being able to say to their constituents "look what we've done for you!' the waste
side
and how the American public is paying for that waste.. .so, I have decided to tafle a page from
my brother's book in getting involved.
First, let me say "I don't want anything personally, although I would likebelieve that
u}
you would have a personal interest in the following matters.
There are a number of enclosures. The one on me is to say that, like you,'. do a lot
;oo
more than bake chocolate chip cookies (however, I bake great cookies when I • to do so).
cho(|
e
The enclosure on
P6/(b)(6)
(our 5 year old granddaughter) is a b part of the
'cause' I am talking about, and it tells a lot of the story. The rest is in this letter.
A year aftei^&pwas diagnosed with diabetes,raydaughter-in-law lost he • job and with
itlp6/(b)(6)insurance coverage. However, they were told by the insurance company ti at they could
convert to the Cobra Plan which is administered under a Federal Program (see atta: led copy of
the rules and regulations concerning Cobra) and, by the way, this information is a £ irt of all
employee benefit booklets, regardless of the type of business or industry.
Not wishing to lose the insurance coverage,raychildren followed the Cobrtl i
instructions
to the letter of the law. That was the 'good news' the bad news is that the insurant
premiums
were paid through her previous employer. In the event you are unfamiliar with the this is
^an,
the only way Cobra will except the premium payments. There is no cost to the emj joyer, it's just
a pass-through. Several months after making the payments (thinking all the whileatip6/(b)(6)was
t•
covered), the insurance agent who had written the coverage for^bue) -Iprevious er
;
c a U ^ w •P6/(b)(6) -i to tell them "the employer. had not passedlhe payments throiployer the
r-^
.
^
i gh for
past three (3) months" and all insurance had been cancelled. Since my husband is J n Insurance
Agent, he felt it was a Federal requirement and that a company would be held accc intable for
their negligence. Conferences with other agents lead us to believe that indeed this ivas true.
1
L
P6/(b).(6)
�i
Page 2
Dec 10, 1992
H. Clioioo
To our surprise when we contacted the Cobra people, they said "to bad, but we c: n't do
anything about it, we are powerless and without authority." We contacted the Justice D<; 5artment,
same answer. We then called the IRS for lack of anything better to do. We don't know v tat they
did but the former employer did return the last premium payment that the children m d The
ae
company is still in business, they still have the money they didn't pass through, but wha the
"hell" kind of justice is this. So the Cobra plan, like the Medical Insurance Portion of thi Earned
Income Credit Program, are nothing more than programs designed to give bragging rigl s to the
lawmakers. There is no conceivable way for the Health Insurance Portion of the EIC Pr: gram to
work. The employers will not cooperate in passing this benefit on.. .and the Insurance ] i idustry
will not write coverage for this group of low income people. These ill-conceived
programs are costing the American people millions of dollars to support the promotion
ndthe
agencies. These programs and agencies should be corrected or abolished.
The rest of)'pegbmstory is this, theyfinallygot some expensive, not so good cov :rage.
Sincep6/(b)(6]has Type I Diabetes the cost of her supplies just to survive are unbelievable tiny
The
glucose stix which are used to monitor her sugar are $52 for 100 stix, these lastl6 days i
that's
$104 per month), her monitor was $150, she has had to have two of those. She has to h jve two
types of insulin at $15 a bottle, that's another $30 per month, then there's incidentals w: ich run
about $20 per month. She is also in private kindergarten with only 10 children in her cli ss
because there is someone at her school capable of dealing with the problem. In additio |,
, she
attends a summer diabetes camp. When all is totalled, it is a great deal more than most
oung
couples can afford.
It's tough enough on parents and children to deal with this problem — what haj))pens when
there are no parents, or family who can help,
I know that President Clinton will be faced with the overall problem of govemttg and
making the changes he promised the American People. And you will be inundated as > 'ell:
However, he has stated publically on television that you have always advised him on e\ erything.
So how about kicking (I don't believe 'knocking' will do it) on a few doors and letting agenthe
cies know that someone who has a hell-of-a-line-of-coimnunication to the President asking
ijs
for a complete plan of clarification as to their existence.. .and, if there is no workable jf then
an,
abolish the program and the agency and do something else with the money.
Hillary, a lot of us voted for you as much as we did for Bill — so give them he .
...Mrs.
Roosevelt might not have been as popular as Jackie!... but God, what a difference she
nade.
.P6/(b)(6);.
,
1
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DOCUMENT NO.
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022. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Pox Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm8()9
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning Ihe regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information |(a)(l) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
O
3
BRIEF SYNOPSIS OF LETTER
Turned down f o r heal^^insurance a t small business because o f p r e - e x i s t i n g
asthma. Had t o pay f o r g a l l b l a d d e r o p e r a t i o n h e r s e l f . I s a s i n g l e mother
and needs coverage f o r her son.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
023. letter
SUBJECT/TITLE
DATE
Personal (Partial) (I page)
04/01/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/l3ox Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Prcsiclenlial Records A d - |44 U.S.C. 2204(a)
Freedom of Information Act -15 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOI A]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�A p r i l , 1, 1993
Me. H i l l a r y RorJham C l i r t o r ;
1600 Pennsylvania Av^nurWashington D. C.
20004
Me. C l i n t o n :
I am 37 years o l d and a s i n g l e parent t r y i n g t o r i . e
a«|
my c h i l d on rny nwn =ind T h^v^ had nat.hma since I wa<i
6 years o l d ,
T s t i l l • • vr- w i h my parents and r a i e Jfig
•
my c h i l d .
+
When I had my son i n 1989, I was a temporary employ^
at a company f o r 4 years and couldn't get medical
insurance w i t h the temporary s e r v i c e T was under, 'hey
had medical i nsu r^.r^-f f o r fi r^onthp a t a time only i the
person had not. '-e^n turne-d down bv other companies, I was
turned down because I have had ar-.thma and have takef a m i l d
form of a s t e r i o d t o help w i t h my asthma.
_P6/(b).(6L
3 now have a f u l l time j o b , and I ave
received medical benefits from the company I work f : r
In January of 199? T had my (?:•, 1 ' Madder removed an at
!
t h a t time I didn't, have medical insurance but I was employed
ae a temporary employe. I t i s c o s t i n g me $12,000 o t of my
own pocket.
When I was a temporary employe, I was making $5/hr [And the
Welfare Dept. said tha-' T r--.<ld use the Food Stamp i'rogram.
I used i t for I y w - unn r.- t^w f T have a f u l l tims job
).w
.
and Et.il 1 don't make above the poverty level the Welfare
Dept took them away. I think there i s something wrpng with
the system. I also get the WIC Program for my son.
I j u s t hope t h a t a Health Care Program can be estab ished
t h a t w i l l be of s-.m^ b e n e f i t to people i n the same i t u a t i o n
t h a t I was i n Any
n r; i r m ' : •-.•r; oonof; rn i ng my pred
cament
w i l l be g r e a t l y appreciated.
Thank you f o r l i s t e n i n g and reading my l e t t e r .
Sincerely,
P6/(b)(6)
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DOCUMENT NO.
AND TYPE
024. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
.jm809
RESTRICTION CODES
Presidential Records Act - 144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. .S52(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IPENTIFSCmQN O
F
1 a*/^
WRITER
O
BRIEF SYNOPSIS OF LETTER
Husband has s t a r t e d a small business with 6 employees, but cannot possibly
carry health insurance for a l l of them (most insured throug . spouses). She
has taught part time 12 years but can't get insured throug school system,
even i f she pays for i t h e r s e l f . Benefits should be a v a i l a b l e to part time
Because of preemployees. I n s u r e r s need s t r i c t e r guidelines, p o l i c i n g ,
Copping
e x i s t i n g condition, now she can't get any coverage a t a l l .
malpractice claims would leave more money f o r needed health core.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUYS
OTHER Insurance companies need p o l i c i n g ; s t a t e s aren ; doing enough,
1
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED f o r anything
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
025. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
05/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Pox Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
Presidential Records Act - [44 U.S.C. 22(l4(a)|
RESTRICTION CODES
Freedom of Information Act - |S U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
IM Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
h(3) Release would violate a Federal statute 1(b)(3) ofthe IOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe I <)1A|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
�r 07^
P6/(b)(6)
May 26, i<)<)3
Hilary Rodham Clinton
The White House
Washington, D.C.
Dear Mrs, Clinton:
1 hav? a probUrm qualifying tor liealth insurance and would ike to share
some thoughts with you. Myhusband, who has been the major b cad winner
top
during our marriage, wM&laidrofcby Coors aycacage; H
T
himself and at this point it-is^out of-the'question towan^lfi!
six.-.employees br^ausr most of them are covered through another kind of
insurance (basically From their spouses' employers). My husbanc s Cobra health
insurance comes to an end in August; we are currently paying $3 2 a month.
Fivcycai;?.ago when I donated blood for a friend having su yexytttlrantQiri
that lyi&ysJirQ^ul^^
During this time I *
gut
blood;tcsting, to keep an eye on the probiem^burCTviMtmi'^'liffltWlMli. When I was
turned down by an insurance company in January I decided to ha.e VSL\umt
biopsy. At thai lime I was diagnosed as having chronic active heiiatltiwand am
currently taking prednizone. This is a non-contagious type of hepatitis but in the
first month with medication.the enzyme count went down. (My frnily
practitioner probably should have recommended the biopsy much earlier and I
probably should have been on medication earlier than five and a talf years after
discovering the irregularity but that is another story.) I^i^i^bfliSlCWiWe^
second time for insurance T'lus means that if I have a heart attapk or am struck
by an uninsured motorist while 1 am a pedestrian, I have no hosp alizatioji
coverage. This is certainly.unfair and a real predicament.
I teach 15 hours a week in an adult education program for e local school
district. %!5ftUft^-<io,noUe^hyiuxunjmtt:
insurance coverage E V E N IF I P A Y FORvIT MYSEfcir* This is jJ/here I would
like to make a suggestion to yon I would not suggest that Jefferson County
schools pay for all rny msurance, bul it might be possible that Xht\' pay the
percentage of a full-time job. that I w o r ^ 7 1/5%) or.tb^slt)QH|(j;|tfJeMfelllilAce
^ » ^ ^ t 9 i m - ircmployerehave partTti^p y ^
illi^iiaadfeto
**.te-.~^ISS^ii!!?^ ??^.^ppefits. This ..
«,uu ;,>o..^a^»^. t . — T U : „
J
i_TITT. ^ ^ - ^ J : . . — •
.
would aid many people in n , predicament
who d^' t wo*ic''fuirtime and don't have benefits. I am not askin the schools to
carry my husband and ::? . bnt ! ha\ c found it impossible to get 1 ie insurance for
•• >)
myself through the schools, despue ihe fact lhat I have taught foMhem on a parttime basis for twelve years. I believe my suggestion keeps the federal
government out of going into the insurance business and puts thfj responsibility
on the employers, where it should be in the first place.
Another suggestion I might make is to implementsomc^tliiGteilguidfiiioes
to govern the insurance business. I have twice applied for insure,tee, at my
expense, with misleading promises from agents, It is obvious ti it insurance
m
1
,, w
�companies only warn to insure people who are perfectly healthy ar i have no
need for insurance. Their profits are reaching the ridiculous stage )ecause they
are carrying only healthy people and dropping people who have pr blcms, In
addition, putting caps.on claims made by injured parties and their iwyers'wbuld
teEi&MWtffcc losses that insurance companies'-have'ta^a^, thus Ii edngjrtheir
fundftflLCKpayiifQr-nceded-health cartf. I know that many suggestion;\ have been
made along these lines.
Thank you for your attention. I hope that you will seriously ; onsider my
suggestion of forcing employers to make insurance available to paflt-timc
.employees,
Sincerely,
mm)
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
026. note
SUBJECT/TITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jin809
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classillcd information [(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or rmaneial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
rmaneial institutions 1(b)(8) ofthe KOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information |(a)(l) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or conndcntial commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(a)(f>) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 Ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 0 7 2 3 / 9 3 CD: MI-12
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
o
P6/(b)(6)
;
BRIEF SYNOPSIS OF LETTER
husband and wife own small printing company with three emploj-aes sent copy of
l e t t e r to health i n s . co complaining about 24% increase i n ;remiums
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Central Reserve Life
INSURANCE COMR^NY
February 23, 1993
Dear CRL Insured Policyholder:
While many insurers pass on huge cost increases indiscriminately to their customers, we constantly
monitor rates, inflationary trends, and medical cost controls to ensure that you consistently receive
the best value for your health insurance premiums.
Current cost evaluation has determined that, in order to maintain the level of protection your plan
provides, with no reduction in benefits, it is necessary for us to increase your monthly premium rate
by 24%, effective April 1, 1993. This new premium will be in effect for the next 12 MONTHS.
If you currently have a full maternity benefit, you can save on your renewal premiums by replacing
your maternity benefit with a graded schedule of maternity benefits. Federal laws and certain state
laws may require an employer to provide the same coverage for pregnancy as is provided for an
illness. If you are uncertain of the requirements, please consult your own legal advisor.
Also, you can change to a higher calendar-year deductible, if available, resulting in a reduction in
your renewal premium.
An authorized written request is necessary to process all policy benefit changes you request to
initiate.
We believe that your group medical plan continues to be ^n excellent value, and we pledge our
continued efforts to keep the cost of your plan as low as possible, while maintaining superior benefits
and services.
Should you have any questions regarding this notice or your medical insurance coverage with CRL,
please contact your Home Office Customer Service Representative at 1-800-362-0673 (in Ohio) or 1800-321-3997 (all other states),
Sincerely,
Your Customer Service RepresentativesJoyce, Char, Pam, Terri
RA-3A (24%)
C R L PLAZA • 17800 R O Y A L T O N
ROAD
• S T R O N G S V I L L E . OHIO 44136-5197 • 2 1 6 - 5 7 2 - 2 4 0 0
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
027. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/09/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
,im809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA|
National Security Classified Information |(a)(l) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
Financial information 1(a)(4) ofthe PRA|
PS Release would disclose conndcntial advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�• P6/(b)(6)
031
March 9,1993
The Chairman of the Board c/o
Central Reserve Life
17800 Royalton Road
Strongsville, Ohio 44136-5197
Reference: Policy #
P6/(b)(6)
Dear Sir:
We have just received your company's letter RA-3A (24%) dated February 23, 1993.
%
This letter asks us to absorb a cost increase of 2 % after a previous incr€ < .se of 9 last
4
i
year.
As a very small business (3 people), we have never heard of such an ir Tease m one
year. Nor have anv of our suppliers or customers. If any of us did su:ti a thing we
would shortly be out of business.
We cannot believe that anything we did deserved such a rate inqtease.
experience with us has been excellent with very few claims.
Your
We believe that this increase is primarily due to price gouging before legislation is
enacted to stop just such practices.
We are so upset with this unconscionable increase that we are now ac: veiy seeking
legislative assistance from all who will listen. Note we have cop id our local
Chamber of Commerce, the State of Michigan Health Insurance Agdicy and The
President of the United States with your notification.
We fully expect to hear from you recinding such an increase to a reasonable level.
cc:
Madison Heights, MI Chamber of Commerce
Michigan Health Insurance Agency
The President of the United States of America
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
028. note
SUBJEC 171 ITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-t)885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute [(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) ofthe FOIAj
h(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
6(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�0^
PERSONAL STORIES DATABASE
riFICATION OF WRITER
P6/(b)(6)
-''.pT ', , 1
1
1
1
'"
• . ',
BRIEF SYNOPSIS OF LETTER
They
56-year-old couple, her husband has been self-employed f o r i 126 years.
have c a r r i e d i n d i v i d u a l insurance u n t i l r e c e n t l y t o l d th«ip.r coverage, a t
$9,200, w i l l continue t o r i s e w i t h age and usage. They car t afford i t and
have dropped i t . They a l s o can no longer a f f o r d d o c t o r ^ or medication,
T h e i r f r i e n d s speak o f moving t o Canada o r Germany, where ley won't
l o s e t h e i r homes i f they get s i c k .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
MEDICAL COSTS - EXCESSIVE
MEDICATIONS/PRESCRIPTIONS
DOCTORS FEES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
029. letter
SUBJEC ITTH I.E
DATE
Personal (Partial); Address (Partial) (2 pages)
03/14/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe I OIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
Financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
���Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
030. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Pox Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |S ll.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or conndcntial commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
o3 £3
1
: :,
;^*^V! .'^- ' 'isf n^'i'i- •'.'-W / P6/(b)(6)' K\
BRIEF SYNOPSIS OF LETTER
S e l f employed owning a small c o r p o r a t i o n .
Group o f 2 pay i;iO,000/year for
h e a l t h insurance.
Owner has a p r e - e x i s t i n g c o n d i t i o n aiVp cannot change
c a r r i e r s . Pleas f o r n a t i o n a l h e a l t h e.g. Germany.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
LACK OF PORTABILITY
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
031. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 22()4(a)|
Freedom of Information Act - [5 U.S.C. S52(h)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOI A]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIAj
National Security Classified Information [(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or conndcntial commercial or
Financial information 1(a)(4) ofthe PRA|
P5 Release would disclose conFidential advice between the President
and his advisors, or between such advisors [a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misnie deFmcd in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTI FICATION OF WRITER
NAME
ADDI
' '
P6/(b)(6)
ADD 2
CITY
STAT
HONE
BRIEF SYNOPSIS OF LETTER
Id wo
4
o
IDENTIFICATION OF PRIMARY LETTER CONTENT (CHOOSE <OR» THRI il
»^INSURANCE COST ISSUES , SYSTEMS RELATED
MEDICAL COSTS - EXCESSIVE
IGH DEDUCTIBLES
MEDICATlDNS/PRESCRIPTIONS
HIGH PREMIUMS
HOSPITAL CHARGES .
FORCED TO W R
OK
DOCTORS ' E S
'E
'
UNABLE TO PAY
UNNECESJ \RY PROCEDURES
PROCEDUI; SS NOT PERFORMED
HIGH CO-PAYMENTS
OTHER
GOVERNMENT-RtlLATED HEALTH CARE
PROGRAMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
COBRA'S
COVERAGE TOO SHORT
•
PRE-EXISTING CONDITION
INCREASED CO-PAYMENT
^COVERAGE DENIED
l/" LACK OF PORTABILITY
MEDICAID
LOSS OF COVERAGE
FROM PARENT'S POLICY
FROM CONTINUED CARE
LIMITED BENEFITS
COST CAPS - CEILINGS
BENEFIT NOT OFFERED
CLAIM DENIED
HOME HEALTH CARE
LONG TERM CARE
MENTAL HEALTH
SPECIFIC DISEASES
HIGH CO-PAYMENTS
EQUIPMENT
PRESCRIPTIVE DRUGS
OTHER
QUALITY OF CARE
LIMITED STAYS
LACK OF SERVICES
SPJl^DI[NG DOWN POOR
LOSfT COVERAGE/
GAINFUL EMPLOYED
MEDICAR]:
LOUS TERM CARE
OTHER COVERAGE
CURITY/
ITY
ONTINUATION
RAGE TOO SHORT
ER COVERAGE
S PROGRAMS
DE AYS IN COVERAGE
RPAYMENTS/
UNDERPAYMENT
OTHER PROGRAJ'
OTHER CONTENV
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
032. letter
SUBJEC 171 ITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/11/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm8()9
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
Pl
P2
P3
P4
b(l) National security classified information [(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the F01A|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
6(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office |(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�0
12
!?\jn
,I
1
" :' .S''» ! .1.
;
P6/(b)(6)
March 11, 1993
Hillary Rodham Clinton
1600 Pennsylvania Ave. NW
Washington D.C, 20500
Dear Mrs. Clinton:
While you are deliberating on health insurance, consider our plight. We a e self employed,
owning our small corporation which consists of one salaried employee - Gary As far as health
insurance is concerned, we are a group of two. We pay a grossly dispropcrtional amount nearly $10,000 (ten thousand dollars) a year - for our insurance. Gary las a preexisting
condition and therefore cannot change carriers, leaving us literally at the mere of our insurance
company. We are not big enough for an HMO. FHP, for example, require^ a minimum of 3
participants. Our outrageous premiums pay for people on medication who* "coverage" does
not pay the full costs, and pay the overage for those on public assistance. In sj^ort, we are being
robbed.
Our monthly premium is only a few dollars less than our house payment! V ; understand you
are concerned with helping the uninsured, but what will you do for the overcharged?
We need a national health program. Germany has a good model, because it i ses local control,
A national plan could involve private insurance companies, and HMO's as long as they are
willing to keep their fees in bounds and accept preexisting conditions. Costs inust come down,
A standardized form, strong caps on malpractice awards, and restrictions on unnecessary
hospital
equipment duplication in a community need to be instituted.
We understand you are considering higher taxes on tobacco and alcohol. Thi is a good move,
\
but it is not enough. Heart disease, our number one killer also involves whi we eat. People
who eat high fat and cholesterol foods; are overweight and don't exercise, inc lease their risk of
heart disease and this increases our health care costs. Surtaxes need to be pu on such foods so
people can pay for their "sins" of poor eating habits and thus higher health costs. Poor eating
examples are comingfromthe seat of our govemment. Danish pastry served ajtj
cabinet meetings
and the President's fast food habits are inappropriate models.
�Health (3/11/93)
We would appreciate your reaction to our ideas.
Sincerely,
cc:
Senator Dennis DeConcini
Senator John McCain
Rep. Jim Kolbe
Rep. Ed Pastor
Page 2
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
033. note
SUBJECT/TITLE
DATE
Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA]
P2 Relating lo the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information [(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(h)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) nf the FOIA|
h(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information coneerning the regulation of
financial institutions 1(b)(8) nf the FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
JCPBNTiriCftTXW OF WRITER
M. Allen McVeigh
V
,P6/(b)(6)
^BRITSF-BYNOPSIS OF L E T T E R '
r e t i r e d small businessman, restaurant and bar owner, 10 emjiloyees, provided
,
health and welfare benefits f o r employees, was $5.85 per.
4|nployee 39 years
ago, f i n a l l y reached $160/month, believes that employees should share i n
paying some of the costs.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
034. letter
SUBJECT/TITLE
DATE
Address (Partial) (1 page)
02/13/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Leners] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - \$ U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
h(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) of the I OIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�MR. AND M R S . M. A L L E N M C V E I G H
I?
3
•P6/(b)(6)
HILLARY RODHAM CLINTON
The White House
Washington, D.C.
February 13,1993
Dear Mrs. Clinton,
I am a retired small business- man who ran a restaurant and bslf for thirty nine
years. My tavern employed about ten people. I watched as the cost of my heath and
wefare contribution for each employee rosefrom$5.85 per month unt It had reached
$160.00 when I retired in 1985 It is probably at least $180.00 by now.
The point I want to make with you, Mrs. Clinton, is that when I hi someone I am
not adopting him or her. If my employee is hurt on the job or is sick ffor ] related
a job
cause then as an employer I am responsible for the employee's care ad I have
»
insurance for this responsibility. However, what an employee does on freetime Is
lis
none or my business unless I can prove thefree-timebehavior interfer
swfchthe
employee's ability to wory.
ITan employee sky-dives, bungee-jumps, races mototcycles, rk#s wild horses,
or even practices unsafe sex, it is none of my business. His or her hea
health of their families is not my responsibility. I raised five children of (|iy own and they
were my responsibility.
. The
As my health and welfare costs escalated I realized my dilemmi. money for
• employees pa W
health and welfare was mailed directly to the Fund. I paid it all and my
/ees
nothing. While I was being squeezed by the increased costs my empl<( thought
the health and welfare was free. It was free to them.
The main reason I retired early was to getawayfromthe ImposiSble demands
made on an employer. I'm sure many others have retired or quit for th< •: reason. A
same
person would be foolish to start a small business today unless he couj<jl make ita
family affair.
Mrs. Clinton, I want you to be aware ofthe plight of the small business-man. You
must find a way to encourage people to hire more employees. Remerrlper, the person
is hired, not adopted!
Unless the employee is paying a percentage of the health and * welfare costs.
the new Family Leave Act will have problems. Many employees will alfluse It and many
employers will refuse to hire more than forty nine full time employees.
Sincerely,
M.A. McVeigh
�Withdrawal/Redaction Marker
Clinton Library
DOCIMENI NO.
AND TYPE
035. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)|
PI National Security Classified Information [(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
—
•
...
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'. ^
.
'V'
.•••K"
P6/(b)(6)
•
— 7 -
-Tp-
^ *' ; -ft •. •-:r
:
' ... . . . i i
«... ...
.;
"
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0
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BRIEF SYNOPSIS OF LETTER
He and p a r t n e r s t a r t e d r e t i r e m e n t plans busniess i n 1990,•ave always paid
e n t i r e premium f o r employees' ( n o t dependents') h e a l t h insuvlance. No claims
i n 3 years, b u t premiums increased t w i c e by 21.7%. Attemptt to get coverage
w i t h another c a r r i e r were r e j e c t e d . Business hard pressed lit recession, have
grown from 205 employees, and can't g e t c r e d i t u n t i l i n b s i n e s s 3 years.
Help!
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
036. letter
SUBJECT/TITLE
DATE
03/18/1993
Personal (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
PrcsidcntiHl Records Act - |44 IJ.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�.^-'^'^
:A;
-
••
•
" P6/(b)(6) '
Mar
18,
1993
H i l l a r y Rodham C l i n t o n
The Presidential las'- ^orcx cr
Health Care Reform
The White House
1600 Pennsylvania Ave.
Washington, D. C. 20500
Dear Ms.
Rodham C l i n t o n ,
After a layoff in 1990 my partner & I set up our smalll business.
From the f i r s t day we have provided a t y p i c a l health ansurance
plan for our employees with our company paying the enoire premium
for each employee but the employee paying the cost fop,dependents.
This information i s a background for my problem. Ovekl the l a s t
three years none of our employees has f i l e d a s i n g l e olaim for
even $1 of payment from our insurance company Guarantee Mutual.
During the l a s t eight months our premiums have been increased
twice for a t o t a l of 21.7% with s t i l l no claims ever failed.
A f t e r the second r a t e increase I contacted my insuranile broker
and requested other bids f o r our h e a l t h insurance. He obtained
a t o t a l of ten and we e l e c t e d to apply f o r coverage fram the
lowest from P a c i f i c Mutual and to increase our deduct] 3le t o
$500 from $250 ( w i t h my company p i c k i n g up the d i f f e r e ice at
claim time f o r the employee).
This new coverage woulc have
lowered our premiums back t o where they were before tpe f i r s t
r a t e increase l a s t August.
Just today 1 got off the phone with my broker. He c a l l e d to
inform me that P a c i f i c Mutual was r e j e c t i n g our group iind we
should keep our coverage with Guarantee Mutual, This whole
process f r u s t a t e s me, What i s the small business owner supposed
to do?
We opened our doors j u s t as the recession was beginnin
We have
grown from two employees to five and paid our b i l l s on time.
We are told by the banks we can't get c r e d i t u n t i l we' e been in
business three years when we don't need them anymore, Now the
health insurance industry passes t h e i r increased costs along to
us and we have no recourse for competitive bids. Pleafcle f i x t h i s
mess before i t bankrupts our nation.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
037. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
02/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)]
Pl National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe F01A|
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�" iv;-
•: •
J
' P6/(b)(6)
February 22,1993
CD 10
F i r s t Lady H i l l a r y
White House
Washington D.C.
Clinton
Dear Ms. C l i n t o n :
I am a small business, s e l f employed and have t o supjply my own
Health Insurance. Last year (1992) I paid Nationwide Insurance
$4,981.92 i n premiums.
I w i l l be s i x t y years o l d t h i s year, have never had|n o p e r a t i o n ,
never been admitted t o a h o s p i t a l and never missed a days work.
As you can see from the enclosed l e t t e r I received f : o Nation:m
wide dated Feb.12,1993, regardless of my r e c o r d , my remiums
w i l l be r a i s e d on or a f t e r A p r i l 01,1993.
I don't know about the r e s t of the country but t h i s increase
has me t o the p o i n t of dropping a l l insurance and le|i t h e
Government take the r e s p o n s i b i l i t y .
What would you do ? ? ?
Best Regards,
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND TYPE
038. letter
SUBJEC 17111 LE
DATE
Personal (Partial); Address (Partial) (I page)
02/12/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
O A / B o x Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
Pl
P2
P3
P4
b ( l ) National security classified information 1(b)(1) o f t h e FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA|
h(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of Ihe FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office [(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
P R M . Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�HOME OFFICE; ONE NATIONWIDE PLAZA .
FEBRUARY
12,
COLUMBUS OHIO. 43216
ft
WIONWIDE
IN URANCE
Natlo fide le on your tide
1993
RE: HEALTH MAJOR MEDICAL POLICY
POLICY NUMBER
mm)'
Dear PolIcyholder2
You undoubtedly p l a c e great value on your Major Medical o l i cy, and we
a p p r e c i a t e the p r i v i l e g e of providing you with t h i s prot c t i o n a g a i n s t
f i n a n c i a l loss due to s i c k n e s s or a c c i d e n t . Therefore, •fe urge you to
read t h i s l e t t e r very c a r e f u l l y .
Due to r i s i n g medical c o s t s , we have experienced l a r g e I ttsses over the
l a s t s e v e r a l y e a r s . In order to reduce these l o s s e s , we f i n d i t necessary
to i n c r e a s e the premium r a t e . T h i s a c t i o n i s in accorda ce wi th the
p r o v i s i o n s of your p o l i c y . Your premium w i l l be increasHd to
s
$2741.50. The increase w i l l be e f f e c t i v e with the f i t premium due on
or a f t e r APRIL
01, 1993, r e g a r d l e s s of your c u r r e n t liode of payment.
T h i s i n c r e a s e i s not a r e s u l t of any c l a i m s you personal ly have f i l e d ,
or any changes in your h e a l t h . I t i s simply a r e s u l t of the high t o t a l
c o s t s we have experienced for a l l p o l i c y h o l d e r s who have p o l i c i e s s i m i l a r
to yours, and i t w i l l apply to a l l p o l i c i e s in that grou
We r e g r e t
the n e c e s s i t y for making t h i s change, but in today's wor Id of higher
p r i c e s , we b e l i e v e you w i l l find that your p r o t e c t i o n i s s t i l l a good
investment.
Sincerely,
Sue Lyons,
I n d i v i d u a l L i f e and
Health A d m i n i s t r a t i o n
32 1103054
ILH 343-1 A
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
039. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
im809
RESTRICTION CODES
Presidential Reeords Aet -144 U.S.C. 2204(a)
Freedom of Information Aet - |5 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
IM Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(.S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
, '. <a
:
•>
•<
• p6/(b)(6)" '
:
••
BRIEF SYNOPSIS OF LETTER
Writer manages health coverage for small business, cffnstruction
company, rates are very high, company can now afford o pay only
50% of employeee premiums, tried ot^change plans, but ofte meployee
i s handicapped which locks in entire group
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH PREMIUMS
HIGH CO-PAYMENTS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
LACK OF PORTABILITY
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND TYPE
040. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/27/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
j m809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA)
h(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e F O I A |
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) o f t h e F O I A |
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) o f t h e FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�v.
0^0
i
' ' P6/(b)(6)'.
January 27, 1993
Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C.
• •.
'•
f v.
'
'../fiV •
;: ••
•>
;
Dear Mrs. Clinton:
I was very pleased by the announcement of your appointment to head the
committee responsible for coming up with a health care propose that would
enable all Americans to enjoy affordable and adequate health caie I feel
optimistic that we finally have an advocate in place who truly h?b a chance to
get positive results.
I work for a small'construction company in Westchester County NY, and part
of my job is to serve as g'roup administrator for our health insurifice plan, The
president of the company)„„>. peimej" ^ -•'• jand I have had many de ressing and
frustrating discussions relating'to the enormous costs for our he Ith plan, with
New York's Empire Blue Cross Blue Shield, A year ago,| • P6/(b)(6) realized he
could no longer shoulder the full cost of covering his employees and instituted
a contributory policy whereby the company is now paying only 0 % of the
premium, the balance being the responsibility of each employee
(My own
costs now equal 25% of my net salary!) We have investigated •pany
alternative plans, however, they are all impossible because one : f our
employees is handicapped and is deemed unacceptable by all of the private
insurance companies.""We also suggested that we would be wil ng to pay for
her insurance leaving her with Blue Cross and taking the rest of )ur group to
another insurer (the benefits being equal or better for her), howtiver, we were
told that this would represent discrimination. In fact, we, merrhers of an
otherwise healthy group, are the victims of discrimination by virtjue of being
excluded from any possibility of improving our situation becaus^ of one person
considered a bad risk.
66/(b)(6),.. [suggested that I relate this story to you because he f It you may not
be aware of this rather reverse discrimination aspect to the health care crisis.
He had occasion to meet with a local government official, Benj a lin Gilman,
who expressed surprise at our experience. We are certain that 'Ar. Gilman
cannot be the only government official ignorant of this situation We wanted
you to understand our experience and to use this knowledge in he proposals
you will soon be making.
You are now in a position to use your power to truly better the ves of al
Americans and to help in making a reality the promises of your usband. I am
very hopeful that my vote was well cast.
Sjncerely,
�Withdrawal/Redaction Marker
Clinton Library
DOCliMENT NO.
AND TYPE
041. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
,im809
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAj
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
6?
q
l
1
BRIEF SYNOPSIS OF LETTER
Small business owner, w i t h r i s i n g cost o f medical insurance lie may be forced
t o do w i t h o u t . S t r u g g l i n g t o keep small business r u n n i n g .
annot a f f o r d t o
Increase h i s p r i c e s t o keep up w i t h t h e i n c r e a s i n g cost o f h i a l t h insurance.
Medical p o l i c y went up 77% w i t h $10,000 d e d u c t i b l e .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES
SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
MEDICAL COSTS - EXCESSIVE
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
042. letter
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial) (1 page)
01/29/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
PrcsidcntiHl Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
1*2 Relating to the appointment to Federal oflice 1(a)(2) o f t h e PRA|
P3 Release would violate a Federal statute 1(a)(3) o f t h e PRA|
P4 Release would disclose trade secrets or conndcntial commercial or
Financial information [(a)(4) of the PRA]
PS Release would disclose conndcntial advice between the President
and his advisors, or between such advisors |a)(S) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA]
b(l) National security classified information [(b)(1) o f t h e FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA|
6(3) Release would violate a Federal statute [(b)(3) o f t h e FOIA|
h(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) o f t h e I O I A |
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e F O I A j
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) o f t h e FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�January 29, 1993
Hillary Clinton
THE WHITE HOUSE
Washington, DC
RE: LOWERING THE COST OF HEALTH INSURANCE
NATIONAL MORATORIUM ON FURTHER INCREASES FOR 12 i )NTHS
Dear Mrs. Clinton:
I am a small business owner. At the rate the cost of
insurance increases every year, I a giving thought 1
m
without. I am struggling to keep my small r e t a i l FTI
shop alive in this current NYC/NYS depression; I car
increase my prices to match the ever increasing cost
health insurance.
health
5doing
flower
not
My personal major medical pQ.l.i.c_v_uii.h The Equitable I fe
P6/(b)(6)-with a $10,0(
Insurance Company (policy:
deductible just went up 77%. With a ten thousand do! ar
deductible, I have this plan to provide for a catastijpphic
i l l n e s s ; but who can afford a 77% increase.
n
The health insurance my business provides for me and or my
partner just went up 3 5% from last year. (EPI TRUST/fJW York
.P6/(b)(6).
Life Insurance plan:
N,
e
increase is due us again in N S in D they Who can a nid-year
Y A AprU, tell m ai
!ord
this?
These health insurance rate increases must stop!
I would like to see an Executive Order declare a natibnal
moratorium on a l l health insurance rate increases foi' at
least 12 months while the entire issue i s examined in favor
of a nation health care plan. [Truthfully, I'd l i k e to see
the rate increases for the past four months rolled-bi jskl ]
Please, get these insurance costs lowered before the lentire
middle class goes on welfare just to survive.
„6()6
P(b{)
cc: President B i l l Clinton
Robert Rubin, National Economic Council
Sen. Daniel P. Moynihan
Sen. Edward M. Kennedy
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
043. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA]
h(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e F O I A |
b(8) Release would disclose information concerning the regulation of
financial institurions |(b)(8) o f t h e FOIA|
h(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of Ihe FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) o f t h e PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
STATUS
1
' • . \
. ..... . -y" '•i/" •
^i/
. P6/(b)(6) \ • ••
.i
"
i
. r
i
"'
BRIEF SYNOPSIS OF LETTER
Couple o p e r a t i n g small business cannot a f f o r d $7,000/yr. l e a l t h insurance
premiums. Wife can use s o c i a l s e c u r i t y . When husband use emergency room,
Trying to pay
h o s p i t a l b i l l s and doctor fees ended up a t c o l l e c t i o n agenc
from income o n l y .
IDENTIFICATION
OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
SOCIAL SECURITY/DISABILITY DISCONTINUATION
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
044. note
DATE
SUBJECT/TITLE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
O A / B o x Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2()()6-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. 552(b)|
Pl
P2
P3
P4
b ( l ) National security classified information 1(b)(1) o f t h e FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) o f t h e FOIA|
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) o f t h e FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) o f t h e FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
P R M . Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Small business employee w i t h o u t group insurance.
A f t e r :i t r i e s , f a m i l y
accepted w i t h e x c l u s i o n s f o r back t r o u b l e and a l l e r g i e s f o r b o t h husband and
wife.
The problem was a h e a l t h y f a m i l y w i t h n o t enough i surance h i s t o r y
from PruCare.
Husband l a i d o f f . Encloses l e t t e r t o l o c a l h o s p i t a l about
c h i l d r e n ' s emergency. Very low l i f e time coverages.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH CO-PAYMENTS
OTHER Low l i f e time coverages
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
A N D TYPE
045. letter
DATE
SUBJECT/TITLE
01/31/1993
Personal (Partial); Address (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/l3ox Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
,jm809
RESTRICTION CODES
Presidential Reeords Aet - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information |(b)(l) o f t h e FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e F O I A |
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the F O I A j
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) of the FOI A]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment lo Federal office |(a)(2) o f t h e PRA|
Release would violate a Federal statute |(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�January 31,
1993
\\
Mrs. H i l l a r y C l i n t o n
F i r s t Lady
White House
Washington, D. C.
Dear Mrs.
Clinton:
We would l i k e t o expose our u n f o r t u n a t e insurance s i t t i o n t o
emphasize the urgent necessity of a n a t i o n a l medical Health care
program. We have included f o r you a copy of our l e t t i ^ : t o Dr. F e i g i n ,
A d m i n i s t r a t o r of Texas C h i l d r e n H o s p i t a l t o i n f o r m yoi} of our unique
situation.
I s t a r t e d a permanent, sob last. August and a p p l i e d f o r i n d i v i d u a l h e a l t h
insurance through my job on October. My employer i s
small company,
w i t h o u t group insurance.
The insurance company I app ied w i t h , United
I n t e r n a t i o n a l L i f e Insurance, r e j e c t e d the a p p l i c a t i o n on the basis of
lack of medical i n f o r m a t i o n . They could not b e l i e v e i.hat our f i v e
f a m i l y members had been h e a l t h y f o r the l a s t twelve morths. We r e a p p l i e d and f i n a l l y were accepted, w i t h an e x c l u s i o n f p r a year f o r my
husband and I , and subject t o t h e i r review and approv^fL
The f a c t i s
t h a t we have been very healthy. We are not under any n e d i c a t i o n or
medical a t t e n t i o n . We l i v e a simple and h e a l t h y l i f e I t i s very
d i s c r i m i n a t o r y t h a t because of our age, and the p r o f i concern of the
insurance i n d u s t r y we have t o pay high premiums f o r iilsurance, y e t
r e c e i v e very l i m i t e d p r o t e c t i o n .
PLEASE, HELP EVERYONE TO OBTAIN PROTECTION, AS A HIGH
NOT CHARITY,
The h e a l t h insurance can no longer be i n the hands of p r o f i t - m i n d e d
companies.
Sincerely
'•
• P6/(b')(6)
fit" •'•%( ' .•:-<•
.i
yours,
..
;*
'
i .'ft''*'.
;
'
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
/Jt't/L+i/
Afct^J,
M2> ,
BRIEF SYNOPSIS OF LETTER '
.
r
m /
\J S
"> Z^Y^+y
<fi /rfu^fa*,.
/h£^»^A.t
Ly^^^.
IDENTIFICATION QF PRIMARY LETTER CONTENT a^Jl
Xrv
^
j
J
^
-/d^U.
Z
^
6^A.
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cJ^'/i^
�North Atlanta Pediatric Associates, P.C.
NORTHSIDE HOSPITAL DOCTORS CENTRE
?UITE 500
OfcO l O i r g s O N FERRY ROAD, N.E..
VTI.-WTY GEORGIA 30.142-1 fitlt
23f>-.11
1
MICHAEL R. PAPCIAK, M.D.
SUSAN W. HARRELL, M.D-
. JOHN C. KNOX, M.D.
TAMA FULLER, M.D.
PEDIATRIC AND ADOLESCENT MEDICINE
March 3, 1993
OIPLOMATES. AMERICAN BOARD OF PEDIATRICS
FELLOWS. AMERICAN ACADEMY OF PEDIATRIC'S
H i l l a r y Rodham C l i n t o n
The W h i t e House
1600 P e n n s y l v a n i a Ave. N.W.
Washington, D.C. 20500
Dear Mrs. C l i n t o n ,
I would l i k e t o t a k e t h i s o p p o r t u n i t y t o express some v i e w s
r e g a r d i n g t h e h e a l t h c a r e s t a t u s and problems i n t h e U n i t e d S t a t e s
t o d a y . I am v e r y pleased and e x c i t e d t h a t we have p l a c e d someone
o f y o u r s t a t u r e and i n f l u e n c e i n a l e a d i n g p o s i t i o n t o f i n a l l y
i m p a c t t h e most s e r i o u s and most c o s t l y s o c i a l problem i n o u r
c o u n t r y . C o n g r a t u l a t i o n s on y o u r appointment and good l u c k i n y o u r
work. Every c i t i z e n needs t h e P r e s i d e n t s Task Force on N a t i o n a l
H e a l t h Care Reform t o be a success.
I am a p e d i a t r i c i a n who has been i n p r i v a t e p r a c t i c e f o r 20
y e a r s . I am an Army v e t e r a n , a p u b l i c s c h o o l and s t a t e u n i v e r s i t y
g r a d u a t e , and a c h i l d h o o d r e c i p i e n t o f w e l f a r e and a i d t o dependent
c h i l d r e n . I have u t i l i z e d , p r o v i d e d , and observed a l l p u b l i c and
p r i v a t e h e a l t h c a r e p l a n s and s i t u a t i o n s a v a i l a b l e i n t h e U.S. and
w o u l d l i k e t o o f f e r some ideas f o r t h e t a s k f o r c e t o c o n s i d e r .
I
am n o t a member o f any p o l i t i c a l group n o r am I even a member o f
t h e American M e d i c a l A s s o c i a t i o n . The c r i s i s i s h e r e ; we need
d e f i n i t i v e p l a n s , programs, and a c t i o n .
When I examined t h e l i s t o f 47 p e d i a t r i c i a n s on t h e N a t i o n a l
H e a l t h L e a d e r s h i p C o u n c i l (a copy o f w h i c h i s e n c l o s e d ) , I was
s u r p r i s e d t o f i n d no p r i m a r y c a r e p h y s i c i a n s , l i k e m y s e l f , who work
l o n g d a i l y hours i n c l u d i n g weekends and n i g h t s p r o v i d i n g d i r e c t
�healthcare f o r 40 t o 50 f a m i l i e s each day. I n a d d i t i o n , p r i v a t e
p r a c t i c e primary care physicians administrate small i n d i v i d u a l
businesses w i t h t h e f i n a n c i a l burdens and concerns o f business
ownership. I n my case I have 15 employees, and the success o f my
practice d i r e c t l y affects t h e i r livelihood.
Physicians who
a c t u a l l y diagnose and t r e a t the masses i n t h i s country are the ones
who best know the problems and maybe some of the s o l u t i o n s . Please
add some t o the Council i f possible.
I have many ideas and wishes; some of which I w i l l share w i t h
you i n t h i s l e t t e r . My plea i s t h a t you l i s t e n t o us, t h e " f r o n t
l i n e troops"
before f i n a l i z i n g your changes and programs. Thank
you very much f o r your involvement and f o r reading my l e t t e r . I am
confident t h a t the "new optimism" your a d m i n i s t r a t i o n has brought
t o t h e medical community w i l l provide t h e impetus f o r p o s i t i v e
change.
The f o l l o w i n g are j u s t three examples of programs or ideas t h a t
would have economic, medical, and an immediate impact on primary
healthcare i n our country.
#1
Homecare For I n f a n t s B i r t h Through Two Years.
Emotional, psychological, and monetary incentives must be
given t o young mothers t o spend time w i t h t h e i r i n f a n t s
during e a r l y childhood. Home v i s i t s by p r i v a t e and p u b l i c
healthcare personnel, a "grandmother corps" of neighborhood
health advisors, home v i s i t s f o r counseling and
immunizations by public health s p e c i a l i s t s , neighborhood
education programs, and many more ideas could be
implemented. F i n a n c i a l help t o f a m i l i e s could be r e l a t e d t o
maternal p a r t i c i p a t i o n t h a t reward mothers f o r c a r i n g and
l o v i n g t h e i r c h i l d r e n at home rather than p u t t i n g t h e i r
c h i l d r e n i n p u b l i c l y funded day care centers. I n the e a r l y
months of l i f e i n f a n t s and small c h i l d r e n have very
immature immunological systems which makes them c o n s t a n t l y
s i c k when exposed t o other c h i l d r e n . This f u r t h e r burdens
the parents w i t h health care decisions, medication
�expenses, p a r t i a l h e a r i n g losses i n t h e c h i l d r e n from
c h r o n i c o t i t i s media, and subsequent l e a r n i n g problems. The
consequence of t h i s e a r l y i n s u l t t o t h e g r o w i n g c h i l d i s
o f t e n poor school performance, poor s e l f esteem,
e d u c a t i o n a l drop o u t s , drug and a l c o h o l abuse, and
u l t i m a t e l y a n o n - p r o d u c t i v e person i n our s o c i e t y . The
young mothers i n t h i s c o u n t r y must have enthusiasm f o r
c a r i n g f o r t h e i r c h i l d r e n a t home. Most c h i l d r e n t h r i v e i n
a q u i e t , c l e a n , and s t a b l e environment. T h e i r maximum
p o t e n t i a l w i l l be r e a l i z e d o n l y a t home w i t h l o v e and sound
m e d i c a l c a r e . P a r e n t i n g s k i l l s must be t a u g h t and u t i l i z e d
nationally.
#2
B r e a s t f e e d i n g Must Be Promoted On A National B a s i s .
Besides t h e known i n h e r e n t b e n e f i t s and p s y c h o l o g i c a l
advantages of b r e a s t f e e d i n g and n u r s i n g , t h e r e i s a
tremendous medical advantage from improved immunity and
h e a l t h i e r c h i l d r e n . I n a d d i t i o n , increased breastfeeding
i n t h i s c o u n t r y w i l l l e a d t o t h e r e d u c t i o n of e x p e n d i t u r e s
on p u b l i c l y f i n a n c e d f o r m u l a and f e e d i n g programs f o r
c h i l d r e n such as t h e WIC program. The p r o m o t i o n o f
b r e a s t f e e d i n g c o u l d come from b o t h government and l o c a l
agencies as e a r l y as middle school and h i g h s c h o o l . Please
c o n s i d e r t h i s most simple and n a t u r a l process as a major
c o n t r i b u t o r t o t h e t o t a l h e a l t h c a r e and l o n g t e r m
development of t h e c h i l d r e n i n t h i s c o u n t r y .
#3
P r e s i d e n t i a l Award.
I think
out and
working
l i f e to
i t i s time i n t h i s country for p h y s i c i a n s to speak
l e t the public know that most of us are hard
and c a r i n g i n d i v i d u a l s who have dedicated t h e i r
p a t i e n t c a r e . We are not the wealthy,
arrogant persons as portrayed so often by the media. Family
p r a c t i t i o n e r s , o b s t e t r i c i a n s , and p e d i a t r i c i a n s are the
p r o v i d e r s of d a i l y primary health care and should be
�recognized f o r t h e i r c h a r i t a b l e e f f o r t s . One of my ideas
f o r r e c o g n i t i o n would be a PRESIDENTIAL AWARD FOR
CHARITABLE CARE t o be given t o each physician t h a t accepts
immediately w i t h i n his p r i v a t e p r a c t i c e f i v e f a m i l i e s o r
i n d i v i d u a l s f o r free c h a r i t a b l e care. I b e l i e v e t h e
medical community would embrace t h i s idea w i t h a chance t o
show the p u b l i c t h a t we r e a l l y do care and spend time
helping people. I f each primary care physician accepted
f i v e f a m i l i e s or i n d i v i d u a l s , the immediate impact would be
over one h a l f m i l l i o n persons would be provided t h e
b e n e f i t s of new technology, counseling, and therapy. The
award could simply be a y e a r l y c e r t i f i c a t e and p e r i o d i c a l l y
a formal presentation t o some r e p r e s e n t a t i v e primary care
physicians. The award could be c a l l e d the PRESIDENT'S AWARD
or the HILLARY RODHAM CLINTON AWARD or the NATIONAL
HEALTHCARE REFORM AWARD FOR CHARITABLE W R or something
OK
such as t h a t .
I am enclosing a l i s t of the p e d i a t r i c i a n s on the leadership
c o u n c i l f o r you t o see, and as I mentioned none of them are primary
care p r o v i d e r s . Please consider naming four or f i v e p e d i a t r i c i a n s ,
f a m i l y p r a c t i t i o n e r s , and o b s t e t r i c i a n s from d i f f e r e n t regions i n
the country t o get a more balanced input f o r the task f o r c e .
Good luck w i t h your National Health Care Reform Progrsun, and
please take t h e time t o l i s t e n t o us; we are very supportive o f
your e f f o r t s . Thank you very much.
Sincerely,
Michael R. Papciak, M.D.
MRP/pd
�Pediatricians on the Leadership Council
These 4 7 pediatricians were a m o n g the 282 p h y s i c i a n s , nurses, health p o l i c y
a m J y s t s , a n d attorneys w h o woriced on B i l ! C l i n t o n ' s N a t i o n a l H e a i t h L e a d e r s h i p C o u n c i l d u r i n g the p r e s i d e n t i a l c a m p a i g n . T h e s e p e d i a t r i c i a n s c o u l d
w e l l b e a m o n g those people w h o have the c a n o f the n e w a d m i n i s t r a t i o n .
ir.HLO.
Oknalon of Community Pediatrics
Afcart anstam-MonieAoie Medical Center
New York. N.Y.
(Dr. Redlener is chair ol the council and is
on its steering committee)
Joycetyn Elder*. M.D.
Director. Arkansas Deoartment of Health
UMe Rock. Ark.
(Dr. Elders is also on t r * swertng committee)
Featua O. Adeponojo, M.O.
Chair, Department of Pediatrics
Jamas H. Quftlen Collage of Madlone
Johnaon City, Tenn.
Raymond 0 . Adalman. M.D.
Chairman. Department ol Pediatrics
Eastern Virginia Medical Scnool
Norfolk. Va.
Billy P. Andrews. M.D.
Chamnen. Department ol Pediatrics
Urnveraity ol Louisv*B School ol Medldne
Louisville. Ky.
Mary Elian Avery. M.D.
Thomas Morgan Rolen Proleaaor of Pediatrics
Harvard Madteal School
Boston. Masa.
D a n M S. Blumenthet, M.O.
Chairman, Community Health and Preventive Medldne
Morehouse School of Medicine
Atlanta. Oa.
Thomas F. Boat, M.O.
Chairman. Department of Pediatrics
Univsrtay of Nonh Carolina at Chapel Hill
Chapel Hill. N.C.
Wtltiam B. Caray, M.D.
' CIMeal Profeasor ol Pediatrics
University of Pennsylvania School of
PhHadetphla. Pa.
Rusaetl W. Cheaney, M.D.
Chairman, Deoanmenl of Paolatncs
Universrty ol Tennessee
Memphis College of Medicine
Memphis, Term.
Barton Chllds, M.D.
Emeritus Professor of Pediatries
Johns Hopkins Universrty
Baltimore, Md.
David A. Ctmlno, M.D.
Director, Adolescent Medicine
All Children's Hosoital
SL Petersburg, Ra.
Louis Z. Cooper, M.D.
Director ol Peowtnca
SL Luke's-Roosevelt Hospital Canter
New York, N.Y.
Frances J . Duaton, M.O.
Former New Jersey Commissioner of
Haalth. West Trenton, N.J.
Laurenea Ftnperg, M.O.
Chairman, Department ol Pediatrics
SUNY/Brooktyn
Brooklyn, N.Y.
Robert Ftaer, M.O.
Chairman. Deoartment ol Peoiatric;
Umversity ot Arkansas
Uttle RocX. Ark.
Jaime <_ Frtaa, M.O.
Chairman. Department ol Pediatrics
University of South Fionas
Tampa. Fla.
Lawrence M. Oartner. M.O.
Chaiman. Deoartment ol Pedlatrtcs
Msocai Director, Wyur Chttren's Hospital
. UnrveraHy of Chicago
Chicago, ill.
Myron Ganai, M.O.
Professor of Pediatrics
Yale Universitv School ol Meolcino
New Haven. Conn.
Samuel P. Qotoff, M.D.
Chairman. Department of Pedlatrtcs
Rush Medical College
Chicago, 11
Robert Haggany, M X .
Professor of Pediatrics Emerttue
University of Rochastar School of Meddne
Rochester, N.Y.
Blrt Harvsy, M.D.
Prolessor ol Peolatrtcs
Stanlon) Untversity Scnool of Medteme
Palo Alto, Cam.
Robert A. Ho<rieelman. M.D.
Chairman. Department ol Pedlatrtcs
Uiwenfty o* Rocheswr Scnool of Me<fcne
HoehMtar. N.Y.
C u t E. Hunt, M.D.
Chalfman. D«panm«nt ol PwHatrtes
Medical Cotega ol Ohio
Toledo. Ohio
Vlnea l_ H u t c h l m , M.D.
Executive Director
National Raaoy to Laam Council
Betheeda. Md.
Oeorge Megnua Johnaon, M.D.
Chairman. Department ot Pedlatnca
Univeraity ot North Dakota School ot
Madtdne. Faigo, N.D.
Stephen C. Joaaph. M.D.
Oaan. School ot Pudllc Health
Untvemty ot Minnesota
Mlnneapolia. Minn.
Michael M. Kaback. M.D.
Proleaaor ol Pediatrics and Reoroducstve Medicine
Umversity o( California at San Diego
San Diego, Call).
M l c h a ^ S. Kappy. M.D.
Medical Director. Children's Medical
Center. SU Joaaph's Hospital
Phoenix, A m .
Robert P. Kaleh, M.D.
Chairman. Department bl Pediatrics
University ol Michigan Medical Center
Ann Aroor. Mich.
David A. Ktndlg, M.D.
Protessor ot Health Management
Untversity ol Wisconsin
Madison, Wis.
Maurice 0. K o g u t M.D.
Vice Praaidem of Medical Affairs
The ChlkJran'a Medical Center
Dayton, Ohio
PWHpJ. Landrtgan,M.D.
Chair. Community Madldne
Mount Slnal School of MedWne
New Yortc. N.Y.
Lenore S. Lavtna. M.D.
Deputy Director of Pediatrics
S t Luke's-Roosevelt Hospital Canler
New York. N.Y.
Qeorge I. Lythcott. M.D.
Assistant Commissioner and Director
Bureau ol School Children and Heaith
New York City Department of Health
I. H. Mauaa. M.D.
Pralaaaor Emeritus of Clinical Pedlatrtcs .
Cornell Untverstty College ol Medicine
Valley Stieam. N.Y.
11_ Naedleman, M.D.
Prolessor ol Psychistry and Pediatrics
Urnversitv of PWsOurgn School ol Medione
Plttsourgn. Pa.
Frank A. Ostd. M.D.
Chaiman. Deoartment ol Pediatrics
Johns Hopkins University
Baltimore. Md.
Jack L Paradise, MJ}.
Prolessor ol Pediatrics
Unvamty of Ptttstwr^i School of MadUna
Pmsdungh. Pa.
Owen M. Hennert. M.D.
Chairman, Department ol Pediatrics
ChiWien'a Meoical Canter
Georgetown University
Washngton. D.C.
Jane G. Schaller. M.D.
Chairman ol Pediatrics
Tults University Scnool ol Medicine
Boston. Mass.
Steven P. Shetov, M.D.
vice Chairman of Pedlatrtcs
Albert Einstein College ol Medicine
Bronx. N.Y.
Aaron Shirley, M.D.
Director. Jackson Hlnes Comorehensive
Health Canter
Jacfcson. Miss.
David R. Smith. M.D.
Slate Commissioner ol Heslth
Austin. Tax.
Barbara S t a i f M d . MJ}.
Head. Division of Haalth. Policy
J o h n s Hopkins University School of
Public Health
Baltimore. Md.
Josirpn B. Warshaw, M.O.
Chairman. Deoartment of Padiatncs
Yale University School of Medicine
New Haven. Conn.
Barry Zuckerman, M.D.
Professor ol Pediatrics
Boston University Scnool ol Medione
Boaton. Mass.
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�7f
PERSONAL STORIES DATABASE
IDENTIFICATION OF VTPITER
NAME /ZoS/sV
G.
R I SCH felET& tL
ADDI
ADD 2
CITY
STAT
P6/(b)(6)
BRIEF SYNOPSIS OF LETTER
IDENTIFICATION OF PRIMARY LETTER CONTENT (CHOOSE <OR» THREE
INSURANCE COST ISSUES SYSTEMS RELATED
MEDICAL COSTS
EXCESSIVE
HIGH DEDUCTIBLES
MEDICATIONS/PRESCRIPTIONS
HIGH PREMIUMS
HOSPITAL CHARGES
FORCED TO W R
OK
DOCTORS F lES
UNABLE TO PAY
UNNECESSA tY PROCEDURES
HIGH CO-PAYMENTS
PROCEDURE \ NOT PERFORMED
OTHER
GOVERNMENT-RELATED HEALTH CARE
PROGRAMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
COBRA's
COVE LAGE TOO SHORT
PRE-EXISTING CONDITION
INCR JASED CO-PAYMENT
COVERAGE DENIED
LACK OF PORTABILITY
MEDICAID
LOSS OF COVERAGE
FROM PARENT'S POLICY
FROM CONTINUED CARE
LIMITED BENEFITS
COST CAPS - CEILINGS
BENEFIT NOT OFFERED
CLAIM DENIED
HOME HEALTH CARE
LONG TERM CARE
MENTAL HEALTH
SPECIFIC DISEASES
HIGH CO-PAYMENTS
EQUIPMENT
PRESCRIPTIVE DRUGS
OTHER
QUALITY OF CARE
LIMITED STAYS
LACK OF SERVICES
S P E ^ I NG DOWN POOR
LOST COVERAGE/
GAI|<JFUL EMPLOYED
MEDICARE
LONG) TERM CARE
OTHElR COVERAGE
SOCIAL SEltURITY/
DISABII :TY
DISC )NTINUATION
COVE IAGE TOO SHORT
OTHE \ COVERAGE
VETERAN'S PROGRAMS
DELAYS IN COVERAGE
OVEF AYMENTS/
UNI ERPAYMENT
OTHER PROGRAM
OTHER CONTENT
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�July 19, 1993
First Lady Hillary Clinton
The White House
Washmgton, D.C.
Dear Mrs. Clinton:
I am writing regarding the national health care policy. Though I admit the I am neither
politically active nor an ardent follower of domestic policy, I feel I must a d yet another
voice of support for your efforts.
My husband and I are both self-employed: he is a partner in a small conttmter business
while I do part-time educational consulting from our home. We are be h 27-year-old
college graduates, have an 18-momh-old son. and recently purchased our fpst house. We
currently buy private health insurance.
I am seething with anger over our personal health care dilemma. With n warning, our
health insurance rates were recently increased from $340 per month to
r $400. This
figure is almost 25% of our monthly income, and the insurance company is i till nickel-anddiming us with deductibles, co-payments, and no well-baby-care, Since 01 r mortgage is
almost 50% and part-time child care is another 20% of our income, you Ci 1 do the math
to see that making ends meet is difficult. The President's phrase, "work h d and play by
the rules," rings over and over in my head. In a country where a third of oi • gross income
goes to taxes, it outrages me that a healthy family must scrape to protect 6 ir selves in the
event of serious illness or injury.
I count my blessings: we are indeed healthy, we live comfortably, and we re so far living
the American Dream as we make our own way in business. I look forward, owever, to the
security of a national health care system to protect both my family and th&e who cannot
afford to protect themselves.
Sincerely,
Robin G. R fcchbieter
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personal privacy 1(b)(6) o f t h e FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) o f t h e FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
National Security Classified Information |(a)(l) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) o f t h e PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(H)(4) o f t h e PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 IJ.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONSENT GIVEN 08/23/93 CD: MA-7 & 8
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
0
OrA
BRIEF SYNOPSIS OF LETTER
Small business owner has t o pay very high rates f o r iriaurance
cover h i s family and h i s partner's family, but cannot shange
insurance companies due t o h i s wife's p r e - e x i s t i n g M.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
LOCKED INTO INSURANCE COMPANY
to
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
049. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
01/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm8()9
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of Ihe FOIA|
h(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
National Security Classified Information |(a)(l) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA)
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and hi.s advisors, or between such advisors [a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�/
P6/(b)(6)
. P6/(b)(6)
7Z.
/ /
�sic-* •><.*•
^..^
,™
^U^y
Cif?yc^^^X^
^ZO^u*- ^yC^i^L ^2C<_
^/J^Jt^U^
Jo^r^
s^sup {svyte*- J ^ ^ -
�7
C^y^-
^ l ^ ^ t r ? ^
o-/
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
050. note
SUB.IIXl/TITI E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
.im809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Ereedom of Information Act -15 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA|
h(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe F01A|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information |(a)(l) of the PRA|
Relating to the appointment to Federal ofnee 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or conndcntial commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose conndcntial advice between Ihe President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IPENTIFICATIQN QF WRITER
£
,
.V.
'<
• P6/(b)(6|
• ^V, :
oho
CP
BRIEF SYNOPSIS OF LETTER
Writer's company, UPI, o f f e r s medical insurance through Comprehensive
Benefits, Inc. Company, which works up claims only. UPI then sends out
checks. UPI has been b a t t l i n g bankruptcy; sold again i n Juru. Writer had a
heart procedure costing $25,000 and no b i l l s were paid. U r i t e r then sent
open l e t t e r t o management asking why not paid,
Insurance i n v e s t i g a t i o n
entered case and w r i t e r was f i r e d the next day.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE OTHER B i l l s not paid by Co. Writer f i r e d f o r w r i t i n g i.etter about i t .
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
051. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/01/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 IJ.S.C. 2204(a)|
Freedom of Information Act - |S IJ.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice hctween the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 IJ.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March
r
1993
Mrs. Hillary Rodham Clinton
White House Task Force on Health Care Re-form
White House
1600 Pennsylvania Ave.
Washington, D.C. 20500
Dear Mrs. Clinton:
I hope that as you work through the many problems that need to DB addressed
11 spend some
in efforts to reform the health care system of this country you
tiae~looking into companies that provide medical insurance for tJHsir empioyRBBrh,
but *(JminiBter i t themselves.
;
United Press International, my company for 23 years until F r i di v , Feb. 26,
offers medical insurance through Comprehensive Benefits Service (15 Inc. of
Easton, Pa. Insurance premiums are deducted each month from my pi 7 check and
the company - UPI - pays into the policy as well.
However, Comprehensive Benefits only works up the claims and approves the
payments. I t i s then up to United Press International to send ou^
cover the claims.
There's the rub. The checks go out to the providers only.as.faiijt as UPI wapts
,.to send them out. Comprehensive i s out of the picture. UPI, whicli. has beenrf
battling bankruptcy and has come under several owners, w»s bough ; once again •
last June.28. Since than, on Oct. 27, 1992, I underwent a?heart ifcrocedur e-to
correct a misfiring heart. I ran up nearly *25,000 in b i l l s . ToT:i
failed to pay any of those b i l l s , despite repeated requests from ne and
threatening letters from hospitals to me.
Last week, frustrated at the silence from UPI, I sent an open stter to thp
management asking why b i l l s were not being paid. The next day an Insurance^
inyw^Agator asked; the company .the same thing. That' atternoon>I ^ is;,firBd;^:'
This i s another angle that I think should be addressed as you j | t together
>u
your health care reform package. Good luck.
Sincerely,
P6/(b)(6)
.. •
rr .'1' .'h
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
052. statement
SUB.IECTAIIII.E
DATE
Personal (Partial); SSN (Partial) (3 pages)
02/19/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/l3ox Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)
Freedom of Information Act - [5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIAj
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
bl')) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�viwpOOOAS
geirnanri
i t h a s riow b e e n a w e e k s i n c e i ii'iforrned you t h a t f a i r f a x
a ' ' f i n a l notice''
t o pay i t s
b i l l in f u l l or f a c e t h e i r c o l
a t t o r n e y , t h i s i s w h e r e t h e w h o l e mess s t a n d s on rny h e a r t pr
comprehensive approved p a i
agency
b i l l
fairfax hospital
*12,589.61
*1,£96.10
pr wm. h o s p i t a l
blood work
* 101.50
surgeon's b i l l s :
initial office
$150.00
heart ablation
»7, 840. 00
d o c t o r B report
post-op o f f i c e v i s i t S1E5.00
post-op s t r e s s t e s t
*330.00
anesthesia
*1,456.00
review
•11,577.19
* l 2 9 6 . 10
$101.50
f
l o s p i t a l has sent r e
n
e c t i o n agency or
ceduret
to date
not ing
not ing
noth|i
* 120.00
•ISO.00
s t i l l being reviewed 45 d l i y s a f t e r
receiving
1
total
...
$£3,948.21
$125.00
$390.00
being h e l d up pending
13, 609. 79
hing
nol h i n g
ow c o m e o f
surgeon
i l £ 0 . 00
i need t o know, and d e s e r v e t o know, what t h i s company i s c>ing about g e t t i n g
t h e s e medical b i l l s paid, t h e procedure began w i t h t h e i n i t i »1 o f f i c e v i s i t oct
6, t h e s u r g e r y o c t . £7, t h e emergency room o c t . £9, t h e a l l e »gic r e a c t i o n t o t h
h e a r t m e d i c a t i o n nov. 9, t h e post-op v i s i t nov. 3 and t h e pc »t-op s t r e s s t e s t
dec;. 8. c l a i m s were sent t o comprehensive immediately a f t e r ?ach s e s s i o n : i t ha
been 4 1/2 months s i n c e t h e i n i t i a l v i s i t , 3 1/2 months sine
the s u r g e r y , 3 1/
months s i n c e t h e post-op v i s i t and 2 1/2 months s i n c e t h e f t a l s t r e s s t e s t ,
t h e n t h e r e i s t h e v i s t rny w i f e made t o t h e p r i n c e w i l l i a r j i emergency room on
oct.
1 _ $117.64, o f which comprehensive approved $94. 11. ©ti j a n . 15,
comprehensive s a i d they c o u l d not understand why payment had not been made, i
c a n ' t e i t h e r and p r i n c e w i l l i a r n s a y s i t wants payment i n f u 1. i t h a s o n l y beer.
4 l/£ months!
im/.(b)(6Ll
upi
02-19-93 07:55 a e s
�medical
Patient:
P6/(b)(6V
Heart procedure - Dr. ATbert A. Del Negro
3020 Hamaker Court #300
Fairfax, Va., 22031
(703) 849-0770
10-6-92 initial office visit, consultati
3150.6d a-l-U
QrcuwJfy'r*/&
Lon
10- 7-92 date billed insurance, account ft :P6/(b)(6)
10- 27-92 ablation, Fairfax Hospital
$7840.00) -fct'^
•+lV't»!tf'G-»r il
4Jr?>TT.^ date Insurance billed.
11- 3-92 office visit
Jeo'oo \
•'tf/>r^^l>t/Ui^lu^a
11-3-92 ecg, UR
11- 6-92 date Insurance billed
total:
6115.00
On 1-4-93, Comprehensive Benefits, claim » [ ' P6/(b)(6)' . | not 1 fie Del Negro
Dr.
that it had the claim for his bills, but ad'ded, "Please forwar a copy of
operative report for the ablve service, W have received patho ogy report that
e
you had sent. However, ve need operative report."
Dr. Dftl Negro's office said the report they sent vas the oper tive report.
they
vas the o
There vas no patholoy report. -f/tyiSP f*s~?J 'Vsve^Wuo )^k( O^RC
On 1-6-93 Comprehensive notified that a b i l l for $7,640.00 frm Dr. Del Negro
vas In review by medical consultant.
W y did Comprehensive wait until 1-4-93 to respond to bills t at had been sent
h
by ll-(i-92?
J
. n 12-8-92, Comprehensive notified that a b i l l for $1,456.00 f : anesthesia
O
(cldim t F.^R6/(b)(6): ""j) vas being held up until they received th operative
report from Del Negro and processed the surgery b i l l .
On 1-7-93, Comprehensive notified that anesthesia b i l l of $1,4
|6.00 was s t i l l
pending resolution of surgery bill (claim I
t
'
P6/(b)(6) .~'>
)
Fairfax Hospital
P.O. Box 16013
Falls Church, Va. 22040-1613
(703) 321-4320
10-27-92, 10-28-92
$12,589.61
Comprehensive was billed 11-10-92 acct 11
wmm
Celeste Morton, assistant director, patients accounts, 703-321 11320
Statements mailed 11-9-92, 11-16-92, 12-29-92, 1-9-93
N statements from Comprehensive as of 1-23-93.
o
_
—
—
—
w -
-
i
�Prince William Hospital
8700 Sudley Rd.
Manassas/ Va., 22110
(703) 369-8000
Stephanie Boone, 703-369-8018
10- 29-92, emergency room and one-day admittance
n
$1,296 .10 - \Ut*f>\-& ItfuJ'W Ofp^tviA
p<l<rfi*(. JNo action taken
,
Cff (-ir-93 tttifit+U suCd (ki+y rtUusSu' tU4itA.<4> (-7-93 f k ^ ^ I etc Wcd<$ ttw c in
11- 9-92, blood vork due to alergic reaction to heart medication
$101.50 - frn«/r6tttUS''fe t f p r n ' i A ' PO-ftv*^ i *
'•
1-6-93 Prince William Hospital notifies that Comprehensive had be n billed for
the $101.50 "30 days ago" but no action taken on claim.
TOTAL FOR HEART W R :
OK
Dr. Albert Del Negro
10-6-92 office visit
10- 27-92 heart ablation
11- 3-92 office v i s i t , ECG, I&R
$150.00
$7, 840.00
$125.00
Fairfax Hospital
10-27/28-92 admittance, surgery
$12,589.61
Anesthesia
10-27-92
$1, 456.00
Prince William Hospital
10- 29-92 emergency room, admittance
11- 9-92-blood vork
$1, 296 .10
$101.50
TOTAL
C23,5S0.-tt
P6/(b)(6)'
Prince William Hospital
emergency room - dog bite
10-1-92, acct I I • • P6/(b)(6)
$117.64
'— ~~
10- 21-92 Comprehensive Benefit returned claim with no payment requesting "date,
time, place, description of injury."
11- 21-92 reminder by Prince William
12- 3-92 resubmitted claim
1-12-93 Prince Wiliam seeks payment in full
1-15-93 called Comprehensive Benefits, told claim had been procesHed for $94.11
"some time ago," cannot understand vhy payment has not been made
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
053. note
SUB.IECT/TITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Leners] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(f>) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
r o " -3
53
BRIEF 8YNQPSIS QF
LETTER
Unemployed, struggling to s t a r t business as freelance t e x t i l e designer. When
COBRA ended from losing her job, she paid $241 and 20ii co-insurance,
including p r e s c r i p t i o n s , and $250 deductible. When that r - t e went up 30%,
she couldn't afford i t . Managed care gave her only one choice of OB/GYN. So
she has only c a t a s t r o p h i c coverage, $150/mo., plus $150/mo pi ascriptions, and
$2000 deductible. Her medical costs w i l l equal her f e d e r a l income taxes.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
HIGH PREMIUMS
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
OTHER managed care o f f e r e d o n l y one o p t i o n f o r OB/Gyil
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
054. letter
SUBJECIYIITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
03/29/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [2]
2006-0885-F
jm809
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Ereedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) o f t h e FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e F O I A j
b(3) Release would violate a Federal statute |(b)(3) o f t h e F O I A j
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e F O I A j
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e F O I A j
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e F O I A j
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the F O I A j
National Security ClHssificd Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute [(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�P6/(b)(6)
March 23 ,
1993
Mrs. H i l l a r y r"<odnan: >.,!: '• • •••
•••
The White House
IB00 Pennsylvania ftvenue , N.W.
WashinQton, D.C, 20500
Dear Mrs,
Clin*on:
1 aM w r i t i n g to ' e : i .
.
v
• • ••- / w i f h h s a l t h
:;.
.
insurance and to urge your support fo« ing 1 e-payer -syst
similar.,.to the Canadian plan.
Aciy.ear.rago February I-'- loot
IJot.
maintalried ny health
insurance under the COBRA 3D Is". h' •.:^it to
was $241. a
month. 1 -it ] o T<
? e ? and prescript io
.
costs after payj ng « SZ'i;?! d o v ^ : r.-!. I f December of 1992
;
1 received a n o t i c e from the insurance company that ny
rogynitjUy. payments . f o r the sane coverage - were -go ing^up^by.^no
than^thipy.!..percentf. I^.could-not .af ford'to^pay such a high
premium c o n s i d e r i n g that my only income at the time was
unemployment i nsu'-anre .
T
r
The options &vai :obie t c »e jsere:
cent moe on the
t r a d i t i o n a l plan which allowed me to choose my own doctors
and pay the 3 ' . increase each month) 2) choose a managed
0/
care p l a n , s e l e c t i n g my physicians from a l i s t provided by
the insurance c a r r i e r ! 3) select the c a t a s t r o p h i c care p l a
w i t h a $2 ,000 deduct i b l e .
The managed oare plan of f e.-ed DV * 17, : n sur ence company d i
not include my physicians on i t s l i s t of doctors. My
i n t e r n i s t also cared f o r my f a t h e r through h i s i l l n e s s and
death from bone cancer as w e l l as seeing my mother through
two strokes. He has been my personal p h y s i c i a n f o r the l a
six years.
Ir- my coytt v *• he msnacmd csirft pian named only
one gy ne'. o 1 oq i 5 *
:
•
-z • zc ii>K< lftp h y s i c i a n s ,
much of a choice 'ne''^.
;
i:
T r « l n y , PicD-^tha.LjflSy.L«LaAi5W-rO.Q-^-ftPO.nt.h 1 y-paytnent tHat'•"l
fBf,j.
couiji*po.pj>ibiy*of f o r d to• pay- and at 11 Ivjnai-niSSrWittbaP
Phy.*Afi ians . pf . my. choice , ; waa . thevcatastrOphi'e^^ar^TSl'i'n^
now pay S1B0 a month f o r my insurance as w e l l a s
approximately $150 a month for p r e s c r i p t i o n drugs f o r
hypertens i on 3nd I hove « X 2'Ii30 d & d u c t i b i e .
r
i
r
At this r a t e , my tota.L yearly. me,d.ical..^o.?.l3 .wil l-be-almoat
equal to the^total ^ripun^.,of.Jf'jUPMi.Jj^RS^fl-tH^amaipaytr4*
fonmUH&Zt This seesm pretty incredible to me.
u
tt
0^
>
�1
i
I know thet oeoc le i "-* cc-r.c*-""^ "bour " J i g m f icant
increase j n tave.? if. : * I D ; 5
•
. .
• i-1 rr.le-paye'- insurance
•
plan , but I can't I^OGI " e t ' ; t >j?t:
"
.
ne i ng worst than
the one I'm i n now. In f a c t , 1. an convinced that • i n 'the'
l£ng..run,.. 1. would pay less each year w i t h a-aingle-payer'
syj9.tein.,^even..i f . my . taxes: were.. increassed."
The church 1 belong • • r
:
•
N : f *"- r ? d a *?ruM on the
>
«.
health insurance
n sc • " i " • j o n * being considers) (|l
•
•
•
was c a r e f u l ly e'-pie mss *n;.: . r n : ^" r-J . ! i -.f?.wi q u i t s c lee
:
that a u n i v e r s a l , s i ng 1 e-pa.y er pian ; s the best and
u l t i m a t e l y least c o s t l y system and I urge you t o give i t
your fu11 support .
In June of t h i s yes.-, my COpP- : ! ? r . ! .'. «xp i r e . I am st 1
i
unemployed arc i't-...qq:
own business as a
freelance t e / . t i i e designer . -iov I w; 1 ' nay f o r continued
.
h e a l t h insurance 1 don't Know, uuth a f a m i l y h i s t o r y of
hypertension and s t r o k e , I need r e g u l a r medical check-ups
and medication. I wonder how I am going t o pay f o r them.
• P6/(b)(6)
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Personal Stories Database : Additional Small Business Letters] [loose] [2]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-005-006-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/df6079f69478b3dc3af3f7942f7bb594.pdf
cccfc210ae5f266c01e2650838e7a677
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff [Member:
Edelstein
Subseries:
OA/ID Number:
3679
FolderlD:
Folder Title:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
7
3
�Withdrawal/Redaction Sheet
Clinton Library
D O C U M E N T NO.
AND T Y P E
SUBJECT/TITLE
DATE
RESTRICTION
001. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
002. letter
Personal (Partial); Address (Partial) (I page)
07/21/1992
P6/b(6)
003. letter
Personal (Partial); Address (Partial) (1 page)
06/10/1992
P6/b(6)
004. letter
Personal (Partial) (1 page)
07/21/1993
P6/b(6)
005. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
06/29/1992
P6/b(6)
006. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/24/1993
P6/b(6)
007. letter
Personal (Partial); Address (Partial) (2 pages)
02/24/1993
P6/b(6)
008. letter
Personal (Partial); Address (Partial) (I page)
10/01/1991
P6/b(6)
009. form
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
07/17/1991
P6/b(6)
010. letter
Personal (Partial); Address (Partial) (2 pages)
03/28/1992
P6/b(6)
011. letter
Personal (Partial); Phone No. (Partial) (2 pages)
05/21/1992
P6/b(6)
012. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
08/01/1993
P6/b(6)
013. note
Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
O A / B o x Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-()885-F
im808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) o f t h e FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute ((b)(3) o f t h e FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(h)(4) o f t h e FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e F O I A |
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA|
National Security Classified Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confldential commercial or
fmHiicial information [(a)(4) of the I'RAI
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile denned in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECmilLE
DATE
RESTRICTION
014. note
Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
015. letter
Address (Partial); Phone No. (Partial) (1 page)
03/18/1993
P6/b(6)
016. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
017. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/08/1993
P6/b(6)
018. statement
Personal (Partial); Address (Partial) (1 page)
02/02/1993
P6/b(6)
019. statement
Personal (Partial); Address (Partial) (I page)
02/02/1991
P6/b(6)
020. note
Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
021. note
Address (Partial) (1 page)
03/25/1993
P6/b(6)
022. letter
Address (Partial) (I page)
02/01/1993
P6/b(6)
023. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
03/17/1993
P6/b(6)
024. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
025. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
06/29/1993
P6/b(6)
026. note
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [ I ]
2006-0885-F
im808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)]
PI
P2
P3
P4
h(l) National security classified information 1(h)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(bK9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe I'RAI
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
027. letter
Personal (Partial); Address (Partial) (1 page)
03/15/1993
P6/b(6)
028. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
029. letter
Personal (Partial); Address (Partial) (2 pages)
06/03/1993
P6/b(6)
030. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
031. letter
Personal (Partial); Address (Partial) (I page)
02/20/1993
P6/b(6)
032. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
033. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
08/25/1993
P6/b(6)
034. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/27/1993
P6/b(6)
035. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
036. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
P6/b(6)
037. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
038. letter
Personal (Partial); Address (Partial) (2 pages)
04/23/1993
P6/b(6)
039. note
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-1im808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) ofthe PRA]
1 2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
*
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCI MENI NO.
AND TYPE
SMBJECIAIITLE
DATE
RESTRICTION
040. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/01/1993
P6/b(6)
041. letter
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/31/1993
P6/b(6)
042. rider
Personal (Partial) (I page)
n.d.
P6/b(6)
043. rider
Personal (Partial) (1 page)
n.d.
P6/b(6)
044. rider
Personal (Partial) (I page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [I]
2006-0885-F
im808
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)
Freedom of Information Act -15 U.S.C. .S52(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe I OIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
��Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jmSOS
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOI A]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office [(a)(2) of the I'RAI
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe I'RAI
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
; -
• ; • ' P6/(b)(6)
r
0°
p
BRIEF SYNOPSIS OF LETTER
W r i t e r and husband are self-employed w i t h sometimes a p a r t tlime employee and
cannot a f f o r d coverage f o r themselves and 2 daughters. S h i f e e l s that the
self-employed a r e f o r g o t t e n and overlooked r e g a r d i n g t a x e s , insurance, e t c .
They had a p r a c t i c e i n h e a l t h care p r o f e s s i o n ( c h i r o p r a c t i t } ; ) f o r 10 years.
Thinks we should look a t why medical costs are so h i g h , nc j u s t t r y i n g to
cover them. M a l p r a c t i c e i s one area. Opposed t o s e t t l i n g t ese cases out of
c o u r t . Feels i t ' s not m o r a l l y r i g h t and damages c r e d i b i l i t y of doctors. Her
personal problem i s being t u r n e d down by Medicaid because they deemed her
"employable" a t home i n t h e i r business.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH DEDUCTIBLES
UNABLE TO PAY
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
MEDICAID coverage denied
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBJECmULE
DATE
Personal (Partial); Address (Partial) (1 page)
07/21/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1
2006-()885-F
.jm808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
IM Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(h)(1) of the FOIA]
h(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�H U E O R P E E T TV S
O S F ERSNAIE
LANSING
IM iM ins i me i
BILL BOBIER
1IGAN
r o H i u M f n s . MINOHITV VICE CHAIR
STATE CAPITOl
AOMtuLlUflE
L A N S I N G . M I C H I G A N 48<1I3
FOHESTRV ANO MINERALS
1
ECC OMIC DEVELOPMENT ANO ENfRGV
I S W I 3 7 3 08JS
TOLF SM. FISHERIES ANO WILDLIFE
July 21, 1992
Dear
P6/(b)(6)
Since receiving your correspondence to request assistance in paying your ospital bills we
have contracted the DSS in Benzie county about your denial from Medica and were told
that in your case, it is probable that you were rejected on the grounds t:at you are not
totally disabled according to Medicaid's eligibility requirements, (you need to prove
otherwise) For this reason, you were unable to receive assistance in this manner, We then
called the Medicaid Hotline to determine if you could reapply for Medicaid md if so, would
it cover the past expense? Apparently, your chances of receiving the assistanceis decreased
if you are between the ages of 1 and 62, and you must not be able to lo any work for
8
money, including a desk job. Also, if you were accepted, Medicaid would : jver the cost of
the bills only if you had a retroactive eligibility.
As another approach, we spoke with Janice Vasher in Patient Accounts at the U of M
Hospital about your bill. She verified that the bills for your treatment h ive been turned
over to a collection agency since the hospital cannot accept payments of .00 per month.
She also stated that the hospital had offered you a settlement of waiving2:;% of the bill if
you would pay 75% in a lump sum which is ridiculous - if you had that kirkof money, you
would pay them off to begin with. We did inquire if a different agreementcould be made
od
in which you would be allowed to continue the $5.00/mo payments for a pe of one more
ey
year and then increase the required amount. Ms, Vasher informed us that t have already
given you one year and could not accept these terms on the grounds tfoat your current
payments have not been consistent.
At this point, it might be a good idea to contact legal aide, (l-i800-96^0856) for their
assistance in working out a payment plan between you and thehospital/cqllection agency,
even if it means going to court. I would also encourage you to apply fo Social Security
njdommon to take
benefits even though we are talking a long drawn out process. It is not u
two years or more to receive Social Security benefits and that is after a : i unimum of two
®
�denials and an appearance before a court administrator. The good part about Social
Security is that compensation would be retroactive. Because it is administered at the federal
level, you should contact Congressman VanderJagt's office at (616) 733-3131 for assistance.
In the meantime, I am going to make one more attempt and personally write the Board of
Directors at the U of M Hospital asking for special consideration.
Bill Bobier
State Representative
98th District
BB/cl
enc
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
06/10/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1
2006-0885-F
jm808
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security' Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�JOHN A. LANDREVILLE
Attorney
30700 Telegraph Road, S u i t e 2520
Bingham Farms, Michigan 48025
1
;P6/(b)(6), ,
„
June 10, 1992
o°3 3
.
Dear
P6/;b)(6)
I r e c e i v e d a c a l l from the b i l l i n g department 3f U. o f M.
Hospital.
They have merely r e i t e r a t e d t h e i r offer of 75% as a
settlement figure.
They also said that the monthl paymenWyou
we€fiisfl!A.S.in9-''Was.;. i n s u f f i c i e n t for them - to-accept.
1
I i n q u i r e d about the assistance program.
I was t I d t h a t t h i s
would not be an o p t i o n f o r you a t t h i s time.
Th program was
e i t h e r out of money or was being phased out.
I n any event, t h e h o s p i t a l was u n w i l l i n g t o n e g o t i a t ^ any f u r t h e r
or p r o v i d e any other a l t e r n a t i v e .
I presume t h a t t l j j i r next step
would be t o f i l e a c o l l e c t i o n a c t i o n o f some s o r t ( C they decide
t o t o anything a t a l l ) .
Please l e t me know what you might want t o do next.
I am s o r r y t h a t we d i d not have any success i n t h i s
ohn A. L a n d r e v i l l e
ffort,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. letter
SUBJECT/TITLE
DATE
Personal (Partial) (1 page)
07/21/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the FOIA]
h(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA|
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(H)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will he reviewed upon request.
�H U E O REPRESENTATIVES
OS F
LANSING, ,M&IGAN
BILL BOBIER
iLlMfBS M I N n d U ' VICf CMAIB
S I » T [ C4P11CH
A O R j d u i T u n t . f o n t s ' " ' AND M I N f O A l S
LANSING. MICHIGAN 48913
I5I7I:73
O M I C OEVKOPMtNT AND ENEBCv
0»;S
TOuh SM FISHERIES ANO WILDllFE
July 21, 1992
Board of Directors
University of Michigan Hospital
Ann Arbor, MI 48109
Dear Board of Directors:
This letter is in reference to
) a constituent from my d , trict and a past
mm)
patient of your hospital who is havingfinancialdifficulties in paying her >ill. (Enclosed
please find copies of correspondence giving further history).
My staff has contacted Janice Vasher, Patient Accounts, to try and work dikt some type of
Unfortunately,! P6/(b)(6)
payment arrangement for^
,P6/(b)(6),
is i >nly able to pay
a small amount each month which is not acceptable to the hospital accordin to Ms. Vasher.
Therefore, I am requesting special consideration, given the circumstances, that she be
allowed to pay a small token payment on a monthly basis until such time hat she and her
family are back on their feet,
It is very easy to be judgmental of others when you personally have not xperienced thhorror of extreme illness andfinancialsetbacks. Obviously, to offer her i 25% reduction
in her total bill means nothing, if she can't even afford to make 10% payn snts, Whatever
happened to hospitals looking at special cases and writing off the costs to charity or
research?
I realize this bill has already been turned over to a coUection agency, but would urge the
P6/(b)(6)
hospital to reconsider its position and that of
1
Sincerely,
fell i W
Bill Bobier
State Representative
98th District
BB/cl
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
06/29/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Reeords Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
h(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose (rade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. letter
SUBJEC 171 ITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [ I ]
2006-0885-F
jmSOS
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Kreedom of Information Act -15 U.S.C. 552(b)|
PI
P2
PJ
P4
b(l) National security classified information 1(b)(1) ofthe FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
h(3) Release would violate a Federal statute |(bK3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(X) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute [(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors la)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�r
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
02/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [I
2006-0885-F
iin808
RESTRICTION CODES
Presidential Reeords Act -144 U.S.C. 22(l4(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe F'OIAI
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information |(a)(l) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
1 6 Release would constitute a clearly unwarranted invasion of
*
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. letter
SUBJECT/TITLE
DATE
10/01/1991
Personal (Partial); Address (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1
2006-0885-F
jm808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Kreedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
IM
b(l) National security classified information 1(b)(1) o f t h e KOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e F O I A |
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the KOIA|
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the KOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(K) Release would disclose information concerning the regulation of
financial institutions |(h)(8) o f t h e FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) o f t h e FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Kcderal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information |(a)(4) o f t h e PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�603
Octobef
rrrysrr
Dear S i r s ,
As you are probably aware I had been t r y i n g t o getiome medical
assistance f o r my stay a t your h o s p i t a l . A f t e r going around and
around w i t h these people I have been turned down because I wasn't
i n the h o s p i t a l long enough. Cost was not an issue w i t h them
nor was our lack of insurance, finances, or assets.
Looking over our budget, the best I can do a t t h i s ime i s $5.00
a month since there were many d i f f e r e n t departments i n v o l v e d
can increase
w i t h my h o s p i t a l stay. When one gets paid i n f u l l
the o t h e r s . I f circumstances change f o r the b e t t e r i t w i l l help
a l l of us.
I have worked i n a health care o f f i c e and I am fami|ljiar w i t h , m
p a r t i c u l a r , the way BCBS and Medicaid pay. Their p rcentages
ince I am
and "reasonable and customary" are not very good,
one of the people who " f a l l s through the c r a c k s " wo Id your
department work w i t h me and accept a percentage of 'y b i l l ?
Please l e t me know.
Sincerely,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. form
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
07/17/1991
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jm808
RESTRICTION CODES
Prcsiclenlial Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�APPLICATION ELIGIBILITY NOTICE
Michigan Department of Social Services
_/
Ei I'mu d» esu loima it Jvisa sotiif i « -.isiones qut lomO su lubaiadoila) para
t
JO'obji 0 nf ga' su apiicaciG" pflu los tiendic s y pat a inldfmarlesobfB $u ayuda mensual
Purds osj' la patit rtt airis de ia lorma 1 ia ptdn una aud>encia con un juti de ley
aamimsiraliva 5 no etli i t acuerdo con la :Cisi6n (omida soOre I U I benelicioa.
1
.^jiji ^ U J
jil
»^lk- j t l I J ^ V I .a> J s J * - !
Si no eniiendt n i l loma, comuniquett con ohcma local i t lirvlctw lOClaltJ al numero
dt iiltlono tn Mil lorma.
i^-li
If you do not understand this form, contact your local social services office at the telephor 1 number on the form.
,
^• . •
• 'P6/(b)(6) ' . '
;
.
• ,"' L'
I
On.
> 1c -ll-ei
• you applied for Michigan's assistance
>———^——
• .
>
programs (Aid to Dependent Children, Food Stamps, General Assistance and'Medicaid). Your i sw'worker.'if known, Is shown
above. This letter Is about your eligibility for those programs. Please read the FRONT and BAOI i of<ttif.|j|^r. <^refulty.
v
A.
Th> Information next 1 the box(es) checked (/) applies to you Disregard the Inlormatlon next to the bo 1 s thal^are nol chectiid/
0
APPROVALS You are eligible for:
B. BUDGET
Your monthly grant Includes I ie following:
• 1. Aid to Dependent Children effective
.and
Shelter Allowance
Medicaid effective
Personal Needs
. effective
• 2.
Basic Heating Allowance
* Winter Heating Increment
• 3. General Assistance effective
Utilities
• 4. Your budget Is Itemized in Item B
Special Needs
.
• 5. Medicaid beginning
TOTAL NEEDS
through
• e. Medicaid for the period
Total Budgetable Income
• 7. General Aaaletance Medical effective
AMOUNT OF GRANT
• 8. Food Stamps. See Item E for more details.
Administrative Recoupm^ft
Total Amount Vendored
YOUR MONTHLY CASH I ENEFIT
* Thti tllowtnct ' i Q'vtn only during the winter monthf of Novumwr through April. Tnii \ •utom*Uc*)'y wnovad M*y l each p >«r without tdvsnc* notfct
%
C. DENIALS You are NOT eligible for
• 1. Aid to Dependent Children for the following reason(s):
The
Program for the following reason^)
General Assistance for the following reason(s):
Medicaid for the following reason(s): " T ^ / ^ r ^ /
General Assistance Medical for the following reason(s).
Food Stamps lor the following reason(s):
^ A
J^&pE'
D. MORE ABOUT MEDICAID
A separate evaluation of the type of long-term care you need has been (or will be) made. Y< have or will receive a letter telling
• 1.
you what type of care you need. If you do not receive the type of care you need, Medlq^ld may not pay any ol the cost of
per month
long-term care. II you receive the type of care you need, you must pay $
to
toward the cost of your care beginning
toward the
You must pay $
\
to
• 2.
cost of care you received in this hospital.
A separate evaluation of the type of long-term care you needed then has been (or will be)ntide. You have or will receive a letter
• 3.
telling you what type of care you needed. If you did not receive the type of care you needed, \ ledicaid may not pay any of the cost
to
of long-term care during this period. If you did receive the type of care you needed, you 1 ust pay $
toward the cost of care you received c t ring the period Indicated in Item A
You must pay $
to
• 4.
. toward the cost of the care you received in this hospital c iring the period indicated in item A
E.
MORE ABOUT FOOD STAMPS
i stamn benefits riqht away, we postponed asking you to give 11 certain information. We now need
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. letter
SUBJECT/TITLE
DATE
03/28/1992
Personal (Partial); Address (Partial) (2 pages)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jm808
RESTRICTION CODES
Prcsiilcntial Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security' Classified Information 1(a)(1) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOI A]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe I ()IA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�o
>
3-28-92
Mr. John Forsyth
University of MI Hospital
300 N. Ingles Building
NI4A04
Ann Arbor, MI 48109
Dear Mr. Forsyth:
I'm hopihg you may have some helpful suggestion for me.
Last spring I went through about two weeks of concert rated stress
that was off the scales. Easter weekend my 6 year
d daughter
came down with the f l u . April 2, my two daughters a d I talked
to my parents before they l e f t to do their morning e rands. That
afternoon my mother called and my dad was dead. I 1 f t my
husband and daughters to go help with this c r i s i s ,
y parents
are about 60 miles away. My 8 year old came down wi h the f l u
the following night. I returned home to work in our o f f i c e
Friday. After work we packed our things and returns for the
v i s i t a t i o n at the funeral home. My fathers funeral as Saturday
at which time the younger daughter had a relaps of t e f l u . That
evening we received word that my husbands grandmothe passed away
that same afternoon. The grandmothers funeral was o Wednesday,
A p r i l 10th again 60 miles away. This was also our y ungest
daughters birthday and the l a s t snowstorm of the sea on. School
was delayed two hours, birthday treats had to go to chool, g i r l s
had to go to the s i t t e r , we headed to the funeral,
here were
numerous cars in the ditch and we came within second and inches
of being in an apple orchard ourselves. How we gain d control
and back on the road neither of us know.
These are j u s t the highlights of the short p
>eri d of time,
I have a history of u l c e r a t i v e c o l i t i s which w i l l f l re up in
s t r e s s f u l l c i t u a t i o n s . In a short time I became mor : i l l and
dehydrated than ever before and ended UP In the U of LM_Ho.s.Di.tal..
P6/(b)(6)
~ pe/tbXsrT"""" "S'l nee f ITi"s~i s a s m aTl p o pu r a t i on a rea",' "and our major
manufacturer in the area closed l a s t spring putting 50 people
out of work, you can't support a family doing one th ng or with
one parent working.
When I was in the hospital I f i l l e d out a l l the paperwork
for medical assistance and your people thought there wouldn't be
a problem, I spent 2 weeks in the hospital, talked o my Lam44y
by phone but never saw them. I was rejected for ass stanofe with
the_ statement that even though I had_two young children^iS&waanJit
silsaedkoingtEenough. Even i f this wasn't true because we have our
own business, according to them I am employable. I questioned
this decision, the case was reviewed and the re^ectijin held
�There i s a b i g d i f f e r e n c e between employed and
employed. We barely get by. We don t keep up and v re not
ahead. You do what you need to to keep the business going and '
basic n e c e s s i t i e s .
ttaHh&%£xnfichea I t h - i ns.urance; v>.e(MU9A£Wft»fiftfiai__ .jMfce,
n)j8^t^Y p cemium5. We don't own our o f f i c e , we r e n t , We don't
own* a ndnie. A 1985 i s the newest car we own. We hi re no savings
accounts. We do not get paychecks. Our adjusted gi )SS income
f-or::1990 was $14,606.
In c o n j u n c t i o n w i t h the c o l i t i s , 4 years ago ar autoimmune
c o n d i t i o n became present, Linear IGA b u l l o u s
i s . When
the c o l i t i s was extreme i n A p r i l and May the dermatdbis cleared
ttOUAtiB^han
up. Whena-the. c o l i t i s - improved ^thej«lermatosiaistftkufij;, id
ever before. The enclosed p i c t u r e was taken l a s t NqVember
Since the holidays the c o l i t i s had f l a r e d so the ski wasn't as
sadly broken
bad as i n the p i c t u r e . At t h i s time my legs are so
out I've hardly been able to walk f o r a w h i l e . The point i s JPirotiQfcxemp1 oy able. Would you h i r e someone who looked Lke t h i s or
would be f r e q u e n t l y running t o the bathroom and dro|what they
are doing. Neither w i l l anyone around t h i s area.
I'm doing what I can w i t h these b i l l s which I iflealize i s
very l i t t l e .
Some of the departments have been und< r s t e n d i n g
called a
others l i k e I n t e r n a l Medicine have n o t . The' h o s p i t
w h i l e back and I understand your p o s i t i o n but I don t know what
else I can do. U n f o r t u n a t e l y because^..of., the^naturelb.fe the
diAaaae-nthesencalls a n d ^
iaA&Atf* I
d i d n ' t ask, p l a n , or want t o be s i c k . I d i d n ' t wan to be i n the
h o s p i t a l but i t happened, I t ' s not r i g h t t h a t my f i h i l y should
s u f f e r because T was s i c k .
The Dr. I had there t o l d me I need to have the scope done
again because I was so inflamed at the time they coiji Idn t see too
much and because of p o s i b i l i t i e s of colon cancer.
ire-good
^CT8S^nQ:e~fcv^an ^ r h a v e - t h a t - done-r
OKW^his-muchTinv b i l l s ^ ' a h
Please, i f you have any suggestions I' "can"*'fb" olw up on l e t
me know. Also, i f Medicaid had covered t h i s what d o l l a r amount
would the h o s p i t a l and other departments received? This i s not
f a i r to your h o s p i t a l or to me, but I don't know wh re to go from
here. Thank you f o r any help you can give me.
r
:
Sincerely.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
Oil. letter
SUBJECT/TITLE
DATE
Personal (Partial); Phone No. (Partial) (2 pages)
05/21/1992
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose]
2006-0885-F
im808
RESTRICTION CODES
Prcsidc-nlial Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
h(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion nf
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�O
JOHN A. LAKDREVILLE
Attorney
30700 Telegraph Road, Suite 2520
Bingham Farms, Michigan 48025
P6/(b)(6) •
•
May 21, 1992
UNIVERSITY OF MICHIGAN HOSPITALS
1500 East Medical Center Drive
Ann Arbor, MI 48109-0060
ATTN: John Forsyth - Hospital Administrator
and
B i l l i n g / P a t i e n t Accounts Department
Re:
R6/(b)(6) "
Date of Admission:
5/13/91
Dear Mr. Forsyth and personnel of the b i l l i n g departme t
P6/(b)(6)
was admitted to your hospjital on May
My c l i e n t ,
and the
She was s u f f e r i n g from ulcerative c o l V.is
13, 1991.
Her
i n t e r r e l a t e d condition of linear IGA bullous dermatcHs i s .
Qondition was described as " f a i l i n g " .
ear
At the time of admission, |• • P/b()' • | made i t ci. t o the
•
6()6,,
admissions staff that she did not have insurance or s u f f i c i e n t
personal assets to pay for extended and extensive t r e a t m e n t .
Because of her f i n a n c i a l condition, the patier : accounts
department assisted her in applying for Medicaid,
During her
stay, she continually expressed her concern over the ccumulation
of debt for her treatment. The staff repeatedly assu ed her that
payment was not an issue.
The .-ho6pital.~gft.Y§._£.ad
•' P6/(b)(6) •
/
Eaca±ved7"*'services under-the - assumption—that^hargaa^ni
nourvrad*. for
thoae-servlces'-would be' substantially^paid«ibyj«M«dl'eaiU.
I f this
had not been the case, the length of her h o s p i t a l i z a l [ion and the
number and types of treatment options could have, an4 would have
been, s u b s t a n t i a l l y d i f f e r e n t .
Further, had Medicaid not rejected her claim, the ho spital would
have taken the Medicaid c r e d i t s as payment-in- fv L 1 f o r the
s e r v i c e s rendered to | ^ pe/tbue)
!
•
�P / b ( ) J was stunned to learn that Medicaid had r jected her
6()6
application.
She was- even- more•distressed^tb^d'ls'febve^aJthatiMyour
bi'H-for.;$16,874.90 reflected the f u l l price of servicejfwrendMTjsd,
a.v,.price., certainly far in excess of what the hospital would-havf
accepted'-.from Medicaid or any other insurance carrier.
Understandably, the hospital wishes to c o l l e c t fopf s e r v i c e s
rendered. | :,P6/(b)(6) ' ] has offered to pay in accordan with her
e
means and has made a good faith effort to do so. The hospital
rejected this offer and has begun a process of "debt enforcement".
Further collection efforts by the hospital w i l l be considered
undue harassment. You are on notice that I
p/bi
efw)
I condition
is directly related to stress.
The hospitaT'"s r e j e ition of a
reasonable l e v e l of charges and a reasonable payment p l in, and i t s
e f f o r t to
continued d i r e c t c o n t a c t with the
; P6/(b)(6)•
dition and
collect this b i l l i s aggravating an already serious co:
we w i l l hold the hospital responsible for i t s actions.
This matter should be resolved short of litigation,
f you wish
to explore terms for a resolution of this matter, pl<etse contact
me within the next ten (10) days.
. Landreville
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
012. lener
SUBJECT/TITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
08/01/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - (5 U.S.C. 552(b)]
Pl
P2
P3
P4
h(l) National security classified information 1(b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(S) Release would disclose information concerning the regulation of
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h(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
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�l>l
CARC3L IJARMEIT-MIZRAI-II
a
:
fAoguit^ l ' ^ f'9?3
.^..V'^.vMrs. . Mi l l a r y Cl i rr'r..i
*BI(.i^The..White House
iWashington, D.C. 20500
MK^Miss^'Clintoh: •
•::.:nriin 1 etod a cbu Ie' of' ^va-!'^ v
^.1 sent you a copy o v
.
r diorG; and more about :
Viivjf^^weeks ago, and,' s i no*
/
•"IS^iC^ t h e - e f f e c t o f t a x i n g very small bu$i i n £ . c s t o pay for.
e-s»
iationa.l,xjr(U<
* ' ( h e a l t h ' ' i n s u r a n c e wi l l have on a small businesS; (my:^o
r
v
r
^ '"' taen?;. ?
• ^
•••'•'""^^^
11, I voted for Mr. Clinton in the electibn?'
him financially tc the d^gi-pp t t T r^lt our f ami ly crbjuld, afi-yr^ij..
;:tH--'. I. share the; iiame pr inc. ip .!•:•; vi- i,-.:.::. :..:.\r&-p. tiiat all citizen; af th
" ^ "'*''' %J'country' shoul d be guaranteed — at the very least — minimal health'
^c'are.,' But, obviously, how to pay for it? Like. the. res: ..-of ^.yp}^t^^J~:--- --'.;,
»^^^^^knw<;.-the
answer to that. .•
^ ^^j|ij||^|^^H^^^^^^^^^'^'^'''''''''
rnowY*'however, t h a t a business as smal 1 *as mine ^With t h r e e f u l l — t i m s employees;, cannot a f f o r d to' be t a
:
:
:
. t ^ ^ ^ g r e a t e r e;:tent t h a t
a l r e a d y pay more f o r s a l a r i e s .
:r-*^^^-than i s u s u a l l y recommendea (basing those d e c i s i o n s on g r o s s , s a l e s ) .
WiSs^S^'Wy.-./margin of p r o f i t i s low
as i t i s f o r 'most s m a l l retaM^etfotes
fedi^Al.-ikjp^what•; I ' m doing, and I can keep
?
^ I f ' ' ! am' taxed to r?ny f u r t h e r degree (ye-i, adding an ad i t ibr
- tax to cover msdicai i nr.-; urn: v::!--J v-iil.'L undaubtedly c l s- my bus i ness."
c?
^g^^^.I.'.am' 56'-' y e a r s o l d , and going out of busine-^r. may not b the'worst t h i n g
t . t h e world :— but what I S bad as t h a t I had -fajlly ex acted-.tcts
^,sell.? my b u s i n e s s when I r e t i r e d . - ,. These> 13^.y(^f^j
^ l ^ ^ ^ ^ ^ p m - s c r a t c h • was an i nvestment'- FDRTr^t wisj,
:
,
i
^ ' d e m o n s t r a t e that, thw v^.v.t owno" c^n mr>V:-3 a p r o f i t —• a|l beit ';' 5?
one —- 1 doubt t h a t
w i. .:. :;.
: v,- ou v !:: r .. I d i d not work these".past'
-••
..:;.^ -- , -IS years
huildincj
a business.
x.o liavt- to eicl'ior
give
it away or t o
"
^liquidate.
But that's
basically
what it will
come dow t o i f
'fe^y^f_ur;thetv
than I already
.am..,:.; •• '••••\&ri^m '
:
:
rajt^p^^'fe-::'-''.';-'-' ,^-I have w i t h small
:^f.v..;i;v^^^p^jp||
r b r i e f , ' i 3 t h e problem
«
<
-fdr h a t i o n a l h o a l t h i DM' ••ancrv
D ! r":'r-i'j, o f course, y u have'-gl;^
M
t.^,
or a r e w i l l i n g t o y i v s
- •x.r.ic. ir!:. h. cu;::tinr| one f t h e more
-o
Workmen's,
^ H ^ ^ o b n o x i b u s -'taxes already put on buiiiness — t h a t o f t h e
yZoirip^ensatipn t a x . I wish I were more schooled, i n t h e ,
>>of. t'his t a x , but from my.-perspaq.td.j
10$$;^have '. heard,;through; t h e i ^ y ^ i ^ t f y ^ ^
^.
_
_ _
?''"wbr'5t taxes on t h e books. I n my s t o r e
for
'•one'"'pert e p p i(me) t o o l a l l y f i l e d a c• a \i m v-i h J and ashh,t and cjo ', ng f or a -son n g s a c t u
off a s
c :t'.. l
.
. [ 1 t a was
:
'
•^S^"--. ' medical check. A l l was f i ne i n two weeks,
p
:
:
. ^ i v ^ ^ , ... -.
�0• '
^MS^^^&^m^sA
:
,
,
^l^p^P^bow • i t - ' works i n oi-|-HM- -rhatos) n r r i s t h e r a t e based -on" an'y'' \ '£T?^g{^^^r^.|
'
• p ^ / per f a r ma r'ic: c
,:
a:. ::i :r:"M r,/.,:
;.
A,
,
I n o t h e r words, I am " fn i 1 ked*'^'?;'' ..•i^^l^fl'roy'al l y : — a l o n g w i t h hundri-jd:;;-; o f thousands o f o t h e r s ---.••with a flat..'.!
MMSi^Pefcc.grctage . on t h o payro). 1.
:
: |
;
i
'''^ai^Ria^w^'W**"*'-'^'^ i i"
. •, • _
.•.
,
.
'':. •••-•'•-''-vr^':'2,"^i^^tS&%i^^
MHllin7i V^
?
n - • s - Comp and-.*i-nc 1 ude,. c o v e r a g e a f o H ^ i l K p r ^ R ^ I nhp^r— ~-*-^- *>-***
l ^ g ^ g ^ J ^ B J W f t-tfi'n--ybur " n a t i o n a ' i "i n s u r a n c e - p l"an—- a n d T p ^ i r M M i ^ g ^
bW 'B'e*'u'
' I f i l ^ ^ ^ - a n d ' ' f b r " how l o n g p e o p l e oan c o l l e c t on bu 11 s h :i. t „
T h e n . Wmall^bCfli n s s s ' - y s
:
B C Q U f c
M
o
r
k m e
T
!t
;
• . would be i n a
:
t o he], p w i t h n a t i o n a l
•UC
.
hea 11 h"cover ag e. £
• • .v.'.i^l.. - •
•
^ o i i have-gat to cut the garbage out of the s y s t e m . a m p a - j D e ^
ii i t
h n g h v an e
ha
v ou c anno
^l E^ S thhb rr o u n h l1y p a g r e e : t h a t : . y o u c a n n o tt
1
^llfp^^-^hd' destroy the incent i
v • a n d y o u w i l l s e e •!•
:
n:
..•:-S^- ;p :'.peop 1 e
w i l l
jo i n
| ^ ^ ^ | a l ready . e x i s t i n g
filO;
" <:.;a f t
businesses
:
^ ^ ^ ^ | N Q | T i e e d ^ o f e s o m e o n e to
----
e e n a rirl i ' n r i ^'ifr^v'iB
k -e e p , addinc);?ti'WKB8
\s you i n c r e a s i n g l y d e c r e a s e ^ v p ' ^ ' f . i ^ s ^ ' * ^ ; ^
'• •''•••: bus:i r i e s s e s e m e r g i n g . More a n d ' ' m o r e
I
and . F e c J o r a i b u r e a u c r a c i e s ) o r
i f t h e y w i l l be h i r i n g .
. • • / ' ^ i ^ | | ~ ^ ; , ; r H ' . . '^
reply. .All
;
I- r e a l l y - w a n ' £ ^ ^
v^'Si n c e r e l y
. / ^ ^ ^ ^ ^ | p | | | . | a g n e t t ^ M i z r a h i-. - ;
;
;
:
"H^- ^i*-*-'':'' ^'"'"' ^ . . j ^ . . . .
;
iy^i^^-YVS; v''••'' " "
j^^'ISH^S"i-rv''.
.• •
:
'.. .•
'•'.
'.•v.:'':'
�ATLANTIC MANUFACTURING CORPORATION^
P.O. BOX 1403
WILMINGTON, DELAWARE 19899
PH. 302-654-5367 . . - ^ .
' FAX 302-655-8402.^•^•TJe^.,. - •, • ; :
5
Mrs. H i l l a r y Rodham-Clinton
The White House
•.. .>:y Pennsylvania Ave
;'T^Washington, DC 2000A
p-
:
y::-::#:ife6^16^
Dear Mrs. Rodham-Clinton;
d ^ d ' M i . A s t h e owner of a s m a l l m a n u f a c t u r i n g f i r m , employing
^^fePS^«s*f"* 8 V t o - • 12 p e o p l e , ! f e e l compelled t o w r i t e .to'.you
- - . ^lu.'- • '
The idea of a mandatory H e a l t h c a r e plan i s p r i n c i p a l l y w - ^ ^
a good one and, under given c i r c u m s t a n c e s , i t could work.
,
.
But from our p o i n t of view i t w i l l add a g r e a t f i n a n c i a l
/
burden to our already stagnant industry.
^J'-'^iS^r^f'^Ji - ^ '
can o n l y a f f o r d a " catastrophic'-' H e a l t h c a r e p l a n .
J ^ I ^ ^ ^ J ^ ^ w i t h V a ' / ; s u b s t a n t i a l d e d u c t i b l e ./- Sinee'/- v e . i r a . l s Q t i m u f r t p p r o y t d ^ . • • ^ ^ ^ ^ M ^ ^ ^ h
'••^J'x'i- • ' Workman's Compensation , another b i l l every m 6 n t h w i i l ^ 6 n l y ^ W ' - /
*
i n c r e a s e our s t r u g g l e , unless t h e economy and m a n u f a c t u r i n g
''
•
"
i n t h e U n i t e d States improve r a p i d l y .
. I t should be looked i n t o r o l l i n g Workman' is Compensation .
. ' and H e a l t h c a r e i n t o one Insurance Plan f o r t h e i n d u s t r i e s
•V' oncerned . e have been ' f o r t u n a t e . not t b have had t o use/' ^ '-'' ^^
W
l'^
^ • j ^ f s ^ - ^ o u r . V p b l i c y - ' due t o i n j u r i e s . A l l those 'unused premiums . c o u l d v ^ «
°- t
have been a p p l i e d t o a H e a l t h c a r e p l a n . I can i m a g i n e t h a t i i ^ ^ " - , ? > ' '
w i t h proper " p o l i c i n g " , the misuse of Workman's Compensation
would improve t o o , as i t seems t o be rampant.
:
:
;
e
n o w
:
:
; r /
t , % t
:
c
!
;;
:
;;
s
r
At t h i s p o i n t , a l l I can foresee once a g a i n , Small Business
. ' . ; - a n d E n t T e p r e n e u r s , such as m y s e l f , w i l l have t o c a r r y the ...:,. ^;.:
:, : ~
•
v p l l i ^ ^ i ^ g r e a t e r ; burden o f our s o c i e t y . . • . . . p - : ' ^ ' ^ : ^ ^
*;
I j u s t know t h a t i f a mandatory Healthcare' p i a n ^ a d d s | : t ( y < ^ ^ ^ ^ | ^ f i ^ ^ \ :
•
t-v
much t o our f i n a n c i a l s i t u a t i o n , I w i l l have t o l a y o f f people,
and h i r e temporary help when needed, as a l l t h e o t h e r s m a l l
•"''..
"••-.
' • S h : - / b u s i n e s s e s do. That s t r a t e g y i s a p p a l l i n g t o me, as our, f i r m ,
*•*;'•• '
•../';
i s l i k e a f a m i l y and our employees are very l o y a l t o us. - C Y
.
''^Wi^^'V'^''"" ' •'• "
i y would n o t be President-, C l i n t o n ' B - i d e a : of'''''\-.^>r-;;•,/,•.• '•
^^^^P^I^'MpreTwork,-. more jobs ." I n f a c t .many -'small.'. .bu'siness.es;;.now ^ f - V ^ »
' ^ Y ' - ' - keep o n l y t h e core people , have them work more h o u r s ( O v e r t i m e ) > : "
•^.'
^z •
' '
..and h i r e a d d i t i o n a l help only as t e m p o r a r i e s .
•-v^
::;.
I would a p p r e c i a t e i f t h i s l e t t e r reaches you p e r s o n a l l y , .
. although I realize you must receive an abundance of mail on :
; ; this subject, ,and could not possibly answer everyone ...'.v.. •:;.J[f' '
?
;
i
H
1
:
t
c
e
r
t
a
n
l
; :
:
:
A
:
;
y
incerely, /
l a r i k k a W, Beach
President
;
- - ^*??i\t ^ ;:v-
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
013. note
SUBJECT/TITLE
DATE
n.d.
Address (Partial); Phone No. (Partial) (I page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [I]
2006-()885-F
jm808
RESTRICTION CODES
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b(!) National security classified information 1(b)(1) ofthe FOIA]
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an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
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purposes [(b)(7) ofthe FOIA|
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financial institutions 1(b)(8) ofthe FOIA|
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�i41)/s^nc6,
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
0^
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B R I E F BYNOPSIS"~OF~L"ETTER
HfffVrS*g
BETTER
^ I P P T T I F I C A T I O N OF PRIMARY LETTER CONTENT
•,.-.;....;^v..:. •
: ;
/- ^
PB/(b)'(ej
-*rv.-^.- •
�February 25. 1993
TO: HILARY RODHAM CLINTON, J D.
HEALTH CARE TASK FORCE
FROM: REBECCA BINGHAM, M.D.
Dear Ms. Clinton:
WOW! I am so excited to have a smart woman in the White House at last!
And to have you working on reforming health care is even more exciting.
Most of the physicians in my hospital are terrified that a "trial lawyer" is
in charge of "our future", but I continue to believe that you and Mr. Clinton
really do have the well-being of all of us at heart.
y
C_
I am not afraid of change in the health care delivery system. In fact, I
welcome it. I worked for many years in a British-type socialized/private
medical system in Rhodesia, and loved it. I am quite happy to make less
money, PROVIDED THE HASSLE FACTOR ts TAKF.N C A R R ' T W ^ M , frar is r
that doctors will be singled out (we're all rich, right! ha!) when our income
is 14% of the the health care dollar. So much of the "cover-your-assmedicine" in this country in stimulated by a fear of law-suits and the
general expectation of Americans that we will have the best of all medical
care at a moments' notice, irrespective of the cost or ultimate usefulness
of that intervention. I would be t h r i l l e d to work in nationalized health
environment, and Just get to teach my Family Practice Residents, and take
care of my patients, if you can take of three things for me:
1. Keep the lawyers at bay...we can't be responsible for every
negative outcome. We're only human, we make genuine mistakes and
have to make good-faith Judgement calls, some of which don't work out.
2. Get rid of the paper-work-that runs-up-the-adrolnlstratlve costs_
of billing, including~the three or four re-submlsslons necessary to geT >
reimbursed for every simple medicaid and medicare visit.
3. Educate the public to change expectations. Not every 90-year
old can, or should, recover to walk and enjoy life again. Most babies born
before 30 weeks are left with permanent disabilities. Can we continue to
spend the bulk of our LIMITED health care dollars on the two extremes of
life, and allow poor children to go unimmunized, and without enough food
to eat, and continue to sleep in the streets!! Most of us know that what we
do to 'premies' and the elderly Is wasteful and useless, but feel we cannot
do otherwise because a law-suit is waiting for us if we let nature take it's
course.
As a Family Practitioner, I know that my part of the medical profession Is
always the mainstay of really good, cost-effective care. I moved to South
Georgia to try to train more rural family physicians for the underserved
areas here in the United States. However, the specialist-oriented,
/
Za^^
JJT^
�page 2
hassle-laden, lawyer-dominated aspects of medicine in this country make
it such an uphill struggle, that I frequently consider returning to
Zimbabwe where they practice "civilized" medicine. There, I worked
hard, did the best I could and felt great personal satisfaction that the
patient was cared for as well as they could be with limited means; I had a
comfortable but not opulent standard of living; I treated whoever came
through the door the same; I sent one bill to one (government controlled)
insurance company at the end of the month, and was paid appropriately
for my services; I could go home at the end of the day and leave work
behind me, knowing that everything I did was not being analyzed for what
could have been done differently; older people with terminal Illness were
given medicine and allowed to die comfortably at home with their family
around them;
I practiced family-oriented obstetrics w i t h o u t
sub-specialists trying to undermine me because I represented
competition--in fact I was valued and treated with respect because I
represented referrals to them, and that was the only way they generated
income!; I knew I would not be sued unless I did something truly
negligent, which I know I will never do
in short, I looked forward to
work every day. I cannot say that here in the United States.
I support whole-heartedly what you are doing, and am perfectly willing to
pay more taxes and make less money
IF I CAN SEE A DIFFERENCE IN
HOW MEDICAL IS RENDERED TO EVERYONE, IRRESPECTIVE OF
INCOME
and not just an increase in paper-work, as most government
"improvements" seem to generate (ie., CLIA and OSHA regulations, which
seem motivated by the assumption that all doctors are trying to rip off
their patients....so we put in place programs which cost more to
administrate than the few physicians doing the the "ripping" were costing
anyway! A patient used to be able to get a CBC in my offlce for $15....now
they must go to a lab and be charged S98 for the same test...all paid by
Medicare. Good money management
thank goodness I'm not "ripping off
the system" for the $8.00 my office would make on the procedure.
Sorry...! know sarcasm isn't useful....but sometimes it seems to help me!)
Enough advice. Thank God you are there. GO FOR IT, HILARY!!!
Sincerely,
Rebecca Bingham
�Sued for 'being there,' MD laments the pressure to settle
By Richard E. Waltman, MD
AMN CONTRIBUTOR
FIRST PERSON
ACOMA, Wash — In the next
Tew weeks it appears I will settle
a malpractice claim Tor a sixfigure amount, although I'm convinced
that I did a very good job for my pamy malpractice?
tient and 1 sincerely believe that I'm
There is none. The experts brought
completely innocent of the malpracin by the prosecution could make no
tice chaise.
criticism of my care. Most physicians
Why wis I sued?
who have reviewed the case feel my
care was teller than community stanBecause i university hospital predard. One prosecution expert praised
maturely discharged a young man who
my care as being exceptionally good.
received a serious head injury in a car
The nursing home stated in writing
accident, and because they did not
make good recommendathat I had done a wonderful
tions regarding his future
job. The patient's mother
care. (The hospital has acstaled in her deposition that
cepted responsibility and has
I was the only physician who
settled.)
ever showed real concern
for her son and that she
Because the nursing
didn't undentand why 1.
home that received him m
was being sued.
transfer wai simply not
So why might I settle?
equipped and staffed to deal
Because a physician who
with his problems. (The
hasn't taken care of patients
nursing home also has acfor more than 10 years is
cepted responsibility and
Or. Waltman is a
willing to state for a large
has settled.)
tamily physician
fee — that my care was inAnd, most of all, because
and gariatrtdan.
adequate and contributed to
I accepted the patient, feeling
" " " ^
my patient's poor outcome.
thai in our community at
" ~"
(Our system allows him to state his
that time I was the physician most
likely to help him and that 1 had an ob- opinion but does not require him to
suppon that opinion with fact.) A
ligation to help this nursing home
sutement from him: "No patient
with someone I knew would be a diffishould ever get a bedsore. A bedsore
cult patient for them. I volunteered
alone is proof of malpractice."
for what I knew would be a difTicult
job, because I felt it was my responsiBecause a university-based pharbility to do so.
macist who has never practiced clinical
medicine or pharmacy is willing to be
I would make the same choice tocritical of my care — also for a large
day.
fee. One of his most remarkable state1 am accused of not following the
ments: "A good physician doesn't worrecommendations ofthe university
ry about what drugs are approved or
hospital — recommendations we nevrecommended for a particular condier received — and for not making sure
tion; he uses what he decides is right."
that my orders in the nursing home
were carried out — though 1 would
Because the prosecuting attorney
have had to be there around-the-clock
knows the system well and is using evto have done that.
ery trick in the book to diston the
facts of the cast and cast guilt on me.
I am also being accused of giving
He has also threatened to request far
poor care because I was not paid
more than my policy limits and cause
enough. That one really hurts. I see
my bankruptcy if I lose. "Homeless"
my patients without paying any attenand "penniless" are the words he used
tion to their ability to pay. Thai this
in his letter lo me. How can 1 make
patient was on public assistance did
T
getting him into a rehabilitation center—where I believe he should have
gone in the first place — 1 helped
him. He is actually doing belter now,
and I honestly believe that pan of his
recovery is due to the care 1 gave him. I
am absolutely convinced I did the
very best I could for him. And given
the circumstances, I don't think any
physician could have done better.
So how do I feel about settling my
first malpractice case in more than 10
years of practice?
I still have a tremendous marriage,
two great kids and many wonderful pa-
tients. I have had a challenging and
rewarding life. I am healthy. The sun
will still come up tomorrow morning.
But I feel terrible. I feel abused, violated and betrayed. I am tired, but I
can't sleep. I am angry. I am afraid. I
am very sad. For the first time in my
career, I am starting to ace every patient as a potential lawsuit. Right now I
feel like hanging up my stethoscope,
dosing my office and opening up a
faat-food franchise.
I hope I change my mind. I love
medical practice. I'm a good doctor,
and I would really miss my patients.
—
— —
/ am starting to see every patient as a potential
lawsuit. 1 feel like hanging up my stethoscope,
closing my office and opening a fast-food franchise.
not affect how I cared for him. In
fact, due to problems with the publicaid office, I never received any payment at all for this patient. His pay status did, however, cause the university
hospital to discharie him earlier than
they would have had be been private
pay, and it did cause him to be sent to
a lower-quality nursing home. With
better financial resources he would
have been sent to a better nursing
home or to a rehabilitation center.
But most of all, I am being sued became he was my patient and had some
problems beyond my control. Or, as
the attorney hired by my insurance
company said to me at our first meetiog, "You are accused of being there."
And I am being sued because that is
what our legal system encourages. As
the prosecuting attorney told me, offthe-record of course. "Being sued goes
along with being a doctor. That's why
you buy malpractice insurance. Don't
take it personally. You did a good job
for the kid." (He. by the way, gets 35%
of any settlement and h u already collected more than $230,000.)
And what is the evidence of
my family take that risk?
Because I am reluctant to close my
office and give my patients up for a
four-week trial to be held in a city 90
minutes away from my home and office. In more than 10 years I have
never taken more than a five-day vacation. I can't afford the time — financially or professionally. Our attorney
suggested I rent an apanmem in the
city where the trial would be held How
can I stay away from my family for
that long?
And because the constant flow of
phone calls, letters, depositions and legal actions has taken me away from
my practice and from my family.
Moreover, the stress of the process is
giving me headaches, heartburn and
sleepless nights. I am doing less well
for my family and for my patients, and
I simply can't allow that.
I am a father of two sons, and I fee!
very bad for my patient and his family.
I cried the first night I saw him. He is
a young man with many years of sadness ahead of him. But nothing I did
contributed to bis troubles. Indeed, by
treating him as well as I did and by
IT HURTS
TO BE
NUMBER
ONE.
37 million Americans suffer from arthritis. That
makes it the number one crippling disease in this country.
It attacKs in over one hundred differentforms.Some
forms disable. Some disfigure. All of them hurt
The Arthritis Foundation is ttw only voluntary
health organiiationfightingarthritis on every front. WB
sponsor research, self-help programs, and professional
and public education.
If you need help, or want to help contact your local
chapter or call 1-800-283-7800.
A
Vtour Source (orH»*iandHbp»#
AMERICAN UtUCAL NEWS/SOTEMSfH T. T092
45
�0
4
Cor -oVO W
^
^-^-^
^
�t^rv^X.,^
^o-^-eX^
J^y^juj-^t
O-UJX
^
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DOCUMENT NO.
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014. note
SUBJEC ITTITI.E
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Address (Partial); Phone No. (Partial) (1 page)
n.d.
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
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FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose]
2006-0885-F
jm808
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Ereedom of Information Act - |S U.S.C. 552(b)]
PI
P2
P3
P4
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b(2) Release would disclose internal personnel rules and practices of
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h(4) Release would disclose trade secrets or conHdential or financial
information 1(b)(4) of the FOIA|
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personal privacy |(b)(f>) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
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financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
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Relating to the appointment to Federal office [(a)(2) of the PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
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financial information 1(a)(4) of the PRA|
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and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Mary M. Bono
BRIEF SYNOPSIS OF LETTER
Self-employed professional forced to d r a s t i c a l l y cut back on medical coverage
as premiums r i s e . With high premiums and deductible, canno afford doctor's
visit.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
�Withdrawal/Redaction Marker
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DOCUMENT NO.
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015. letter
SUB.IECT7IITLE
DATE
Address (Partial); Phone No. (Partial) (I page)
03/18/1993
RESTRICTION
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COLLECTION:
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Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [I]
2006-0885-F
im808
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Presidential Records Act - |44 U.S.C. 2204(a)
Ereedom of Information Act -15 U.S.C. 552(b)|
Pl
P2
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b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile denned in accordance wilh 44 U.S.C.
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�Mnrr.h 1 8. 1 993
Ms Hillary P,oc1h:i
The While I louse'
Wa'jhirialoi'i. OC:
Dear Ms. Rodham-Clmion.
support t o voi i— a womsri wt"io has alreaty redefined the sharing
to !%vjr.y i v.v.. •• •.''•.,.-•!• hfir.irirl hor l k.now iere is an anti-feminist
isfaction of following
..'•1 'l^.M'y.' . ^iy ! applaud
pr'ont;' that atvvays gets
'I- '- like i rtivi oplirvnst that it will remain your
First, let me extend my unqualified
of p o w e r - w h o holds thio loor .•.ri'-rconlmgonl who rtrridi' • *' !:•;•••:
Iheir own initiaiives). iji.ii V'.. /
•
your appointmeni io nsaci
nec»itrdeferred by terrorisi tiorntm KIS mte•' •
first priority until it it luily iHSOiv&a
As a self-employed graphic artist and as
followed the health care crisis in'.-.niiv- r
.drastically on coverncie- j . i./r.r ,-..
r
mernbers: t h t plans it IT- .•••.!••'•-• •>•••
"red-lined" bv the inouraricr.r-. •
-ni
:
president ot the New York Chapter of the G r^Ahic Artists Guild. I have
has fcirrod n-.e -Tnrt rnanv -.tf^r self-omployed P if eesionals t o ^ w f back
(ictive group plans to its
fiirii.i s.yyteiTiaticaliv
mqh prr.-r.-.n.irT! .-.r,:-! (.if.ouciibif t h j t i can't affo.rd.to iee a.doctor once in a
My own situation is lyP""-* • i.'n: .;i
i iiqh prr.-r.'in.iiT!
svhile. or get regular preveritativ^ lab tes As
M ! c ;nfih:r r,reIE thus oi i an emergency-only b a s i ; l might as well be
UQinsured. as are rriany oi my ftsrilow
teover. there is no substantial tax d »auction to alleviate
the cost. The self-employed aren't treated [T like other businesses by the IRS. The 2 5 % allowah e deduction for health
professionais. Moieovi
insurance costs wns in fact. hsK'
r<>.m> •••-!:•
•
-v. i.n u-.rh health msura ce premiums finally
exceeaed Q'jari<?riy r-e.-d---' ••:••••<-••••
1
- \S -'"' " '
^
The Graphic Attisis viuuci aoe:-. r..v :
«•
insurance and pharmaceutics! mdu? i'lr--.
Medicare, they have taken cornptitiiioi i :toi
•••.v
• ••:
•••'!•••(•: -.oil i t i ^ n t o ' h i
rnsif. Tho medical,
h^ve t-iardl;. pr-.tv^ri goor! -it h.qiaricirig each others nterests Together with
tfn-v vast sums sper.t on health care) to new height
W h e n you draft new health care legislation
to circumstances of cmpioyrrienv Cc-v*'
hensive benefits. |..revf *n ''-"7•'.-(•••• •
deductiblos. and "pr.:- ..• • • =
make surf, people car. <.:•••:•>•:•<•
American Health ij^curiiv Ad oi • -I'-rj rn •••
please keep workers like me in mind Make health i a r e a right, not tied
eve.o.'one unrie ?. pinnlp. proqreREivety financed pl ih Provide compre" -T
••»<:. rir,-,ip=s».-- • i r . a r ^ j j ! -^bstaC:
like co-payments.
r. " r f -li-.r-i! costs. A n d
••r .-, hill l l ! • ^i.s-iirv "lhe
nr.o tr; ••irci real restructuring.
The Graphic Artists Guild will continue its
representatives last June, in Washington,
early summer. 1994 It is my hope to meet
of health care reform and its e f (••.•.'
• •
possibility of schedulir-.:! ? -. -•' !••
lobbying e f orts on this issue Many of us spoke v i h our senators and
during a Guld-wide convention Our next c o n v e n t l i n will take place in
you then, with a delegation of Guild members. t i discuss t h e progress
»rr. ,|f.y«s.-! r,r*'T'*'-.e.!<-.r ||
i V ' l l l r O n t r j C t Y O U r orfice to determine the
•-i.i nnd Mr. Clinton
;
,
r
r
I ?
S
Very truly yours.
Mary M Bono
/
President
N Y Chapter / Graphic Artist-- Gini-;
* Hwiiih." irweti uniVition Oct/Nov 1991
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016. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jtn808
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or coiifldential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
PC) Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOI A]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
04
BRIEF SYNOPSIS OF LETTER
h
Raecently s u f f e r e d heart a t t a c k and f e e l s t h a t charges o f t h i : o s p i t a l s have
been excessive and p o s s i b l y f r a u d u l e n t .
Provides examplej^ and s p e c i f i c s
includes b i l l s .
IDENTIFICATION OF PRIMARY LETTER CONTENT
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
017. letter
SUBJECT/TITLE
DA I E
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
03/08/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [ I ]
20()6-0885-F
jm808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) ofthe FOIA]
h(3) Release would violate a Federal statute 1(b)(3) ofthe KOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
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�UJ±L
P6/(b)(6)
ARCA CODt SO*
on*)
Mrs. H i l l a r y C l i n t n p
1600 Pennsy 1 van i ?•
Wash i n g t o n , n.r
Dear Mrs.
Cl i n t o n :
Everyone knows that healthcare is the most c r i t i c a l problem i r our country,
and I am pleased thar efforts are beine made to r e c t i f y this s tuation.
1
I s u f f e r e d a ' < < : -. • •
*•>'
•
•
and am now hav i \% respirat o r y problems. Beca::->r of :- •
'.
h«v'i :.>-•••*•:. c.: ? i t a I ized i n t * m i l i t a r y
-i
h o s p i t a l s and three c i v i l i a n h o s p i t a l s svnce June of 1992.
Fc rtunately,
I have Medicare, Medicare Part B and f u l l supplemental c o v e r a j \ with
USAA L i f e Insurance Company. I t seems t h a t because of t h i s
charges
at the three c i v i l i a n h o s p i t a l s have been evcessive, and, i n my opinion,
f r a u d u l e n t i n SOT ? rpsn'---'. =
1
The most g l a r i n g exarr 1 v
rr.
ri'-rina a h o s p i t a l cdifinement
at U n i v e r s i t y Medical Center, Lubbock, Texas, f o r a period fr< a December
18, 1992, to December 22, 1992.
1 was sent from Cannon A i r F< :ce Base
H o s p i t a l , C l o v i s , New Mexico, to see a s p e c i a l i s t there and't< have
a t e s t w i t h respect to my r e s o i r a t o r y problems. Despite the : i c t t h a t
p r i o r arrangement••• T V
rr-*" . • - t :\ v : wn ? only to be adt Ltted
? • .
:
to the h o s p i t a l
•
•
• : " i -inc! to have the t e s t
.
I was taken d irec 11 v :o the emergen :v r .;>- there, where I had aeen trans-•:.
ported by ambulance from Cannon Air Force Base, and several hi idred
d o l l a r s in expenses were again, in my opinion, needlessly mad
:
-
I was then sent to the I n t e n s i v e Care Unit r a t h e r than on t h f l o o r ,
'
n H.v.' r a t h e r than $ 50.00
so that the ••nssi • • ' - -•: -i -oo
; >
• '• . - .s?? wns a charge f o Che services
•
on Che floor
P. •.- • • •• - •
r
>• •
of a Dr. Stephen H. Norris, cf the Tex?..' ".e.:h Health Sciences Center.
The f i r s t morning I was in the Intensive Care Unit I noticed hat t h i s
Dr. Norris had assembled eight to ten i n t e r n i s t s or medical students
outside my room where he gave them a few minutes c r i t i q u e , A f t e r t h i s
he came in with a l l of the students or i n t e r n i s t s in attendan e and
told them about my c^nd • - i -n
'
h * i
one of them examine
me.
This
was continued for r"«
:
•
= . « tnat I was in the Intens ive
1
Care Unit. I was aware that Tey.a~ " e t " Vni .-ers icy was using e as a
subject in their training procedures. I re3ented this but di not say
anything about i c because I thought i t might be h e l p f u l i f I ould a s s i s t
in some way in training students.
:
I
�Page 2.
The t o t a l charges for Dr. Kenneth Nugent, the s p e c i a l i s t to whojt I was
referred, for the entire five day stay was $320.00, When I recived
a copy of my b i l l 1 r"':'c = : •.a t
? had charged $350.00 for each of
the three days chat ho : r^ncu t: =
,
, for a t o t a l of 1,050.00.
The b i l l indicated that the charges were for " c r i t i c a l care: f |Urst
hour". This is ridiculous, as the only thing that was done by r . Norris
was training students, and using m in that respect, and gave mt no
e
care whatsoever.
f
I have enclosed a c?-;;' ~ -iv e . :.•- a -.<
Center with Dr. Nugent. ' < and ">~ . N
•
T
• m i x a s Tech Health S iences
o
-.•hrrges highlighted.
I hope t h i s , i n some respect, w i l l assist you i n eliminating t h excessive
and fradulent charges that are unfortunately being made by ourcbLvilian
fifealth' care centers'!"'Should you need further examples of t h i s , (TOU
may give me a c a l l and I w i l l be happy to c i t e more instances.
.• P r v
v,
•
• rif
.- .'.
FB/mfj
End:
1.
(,,,"••'1;•
'
P6/(b)i6)
.
•
"
F,
'
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
018. statement
SUBJEC 171 ITI.E
DATE
Personal (Partial); Address (Partial) (1 page)
02/02/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1
2006-0885-F
JmSOS
RESTRICTION CODES
Presidential Records Act - \44 U.S.C. 2204(a)|
Freedom of Information Act - |5 ll.S.C. S52(b)|
Pl National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
1 4 Release would disclose trade secrets or confidential commercial or
*
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
I'd Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe I OIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
h(K) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�STATEl\
1
I ATtENT NAME
s
t
-/•"^.T :
• ••
,
_i>|T IS POP
^C'" :=? 0")-*'..
^0 BY THE FACU'.."-' '
>rtS TECH UNIVERSITY
SC.".'.*I
O VE^iC
IT DOES NOT INCLUDE HOSPITAL
CHARGES
WHICH WILL BE BILLED SEPARA TEL Y.
r
x:-
. l A ; ' M U T PAID
W-> * A O O
P6/(b)(6)
!(f0o-743-24b3 Q 800-872-2956
*
TcXAS TECr- UNIVERSITY
HEALTH SCI iNCES CENTER
P.0.8GX 58^5
LUBdOCK/TX 7 9 ^ 1 7
TAXPATcR
••••••
OATB OF SERVICE
12/21/92
12/21/92
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12/19/92
lii/18/92
12/18/92
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12/18/92
12/19/92
Ifl)*:
75-600262iW
- v. v ^ . j s OAVMEN'T IN ENVELOPE PBOVIOE^
RETAIN LOWER PORTION POR YOUR RECORDS ANO TAX PURPOSES
OEScmpnoN OP SERVICE
t
rrew i ON BACiCf •itutii* PA-hEWT put
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\YMENTS RECEIVED AFTER THIS DATE
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PLEASE WRITE YOUR ACCOUNT NUMBER ON YOUR CHECK
MAKECHCHKS
PAYABLE 1
TEXAS TECH UNIVERSITY
HEALTH BOENCE8 CENTER
IMPORTANT MESSAGE REGARDING YOUR ACCOUNT'.^
XAS TECH UNIVERSITY HEALTH P.O.BOX 53o5
LU6B0CK/ rix 79417
SlOE FOR BILLING 1 CHANGE OF ADDRESS / HEALTH INSURANCE INPORMAMON
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
019. statement
SUBJECTAHTLE
DATE
Personal (Partial); Address (Partial) (1 page)
02/02/1991
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [I]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
h(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOI A]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(S) Release would disclose information concerning the regulation of
rmaneial institutions 1(b)(8) ofthe FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or conndcntial commercial or
financial inforination 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�STATEMENT
. . . r H E A L T H S C I E N L t i C b U L 'PATIENT I AME
. ,.ei STATEMENT IS FOR PROFESSIONAL SERVICES
RENDERED BY THE FACULTY MEMBERS OF THE
TEXAS TECH UNIVERSITY SCHOOL OF MEDICINE.
IT DOES NOT INCLUDE HOSPITAL CHARGES
WHICH WILL BE BILLED SEPARA TEL Y
P6/(b)(6)
8 0 6 - 7 4 3 - 2 8 9 8 t|R 8 0 0 - 8 7 2 - 2 9 5 6
TEXAS TECH UNIVERSITY
HEALTH SCIENC S CENTER
on
P.O.BOX 5865
LU930CK/TX 79 17
lOn: 75-O002622W
TAXPAYER
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT IN ENVELOPE PROVIDED
RETAIN LOWER PORTION FOR YOUR RECORDS AND TAX PURPOSES
M T H O F SERVICE
2/20/92
2/19/92
2/21/92
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DESCRIPTION OF SERVICE
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PLEASE SEE REVERSE SIDE FOR BILLING & CHANGE OF ADDRFSS / HEALTH INSURANCE INPOR , ATION
794t7
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
020. note
SUBJEC m i T I E
DATE
Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [I]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl National Security Classified Information |(a)( I) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute [(a)(3) of the PRA)
IM Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information [(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe KOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�t f ^_
/^
^"^O
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Sandra T. Carpenter
ir-f/ P6/(b)(6) :
BRIEF SYNOPSIS OF LETTER
Lives i n an
Small business owner who pays employee' s insurance i n f \ i . 1.
economically depressed area.
Wants f u l l amount o f Health Insurance t o be
d e d u c t i b l e a g a i n s t f e d e r a l income t a x .
IDENTIFICATION OF PRIMARY LETTER CONTENT
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
021. note
SUBJECT/TITLE
DATE
Address (Partial) (I page)
03/25/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jin808
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)l
PI National Security' Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute [(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information |(»)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIAj
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
/ IDENTIFICATION OF WHITER
NAME Sciftdn]
ADD1
ADD 2
CITY
STAT
f . Itmrnkl
,.P6/(b)(6)..
PHONE
% BRIEF SYNOPSIS OF LETTER
I S nl \mt&MM M m fMfafts tmmt (OMM
m/
i
o
i
« rLdinhiUli
s^fnsr-R^ "4^r
-
_
S
_
IDENTIFICATION OF PRIMARY LETTER CONTENT (CHOOSE < R THRE 11
OINSURANCE COST ISSUES .SYSTEMS RELATED
MEDICAL COSTS - EXCESSIVE.
HIGH DEDUCTIBLES
MEDICATlbNS/PRESCRIPTIONS
HIGH PREMIUMS
HOSPITAK CHARGES^ .
FORCED TO W R
OK
DOCTORS 'EES' •
'"
'
UNABLE TO PAY
UNNECES!5|ARY PROCEDURES
PROCEDURES N T . PERFORMED
O.
HIGH CO-PAYMENTS
OTHER
G O V E R N M E N T - R : oATED HEALTH CARE
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
LOSS OF COVERAGE
FROM PARENT'S POLICY
FROM CONTINUED CARE
if?'
li
. TV-
•'li':;
LIMITED BENEFITS
COST CAPS - CEILINGS
BENEFIT N T OFFERED
O
CLAIM DENIED
H M HEALTH CARE
OE
LONG TERM CARE
MENTAL HEALTH
SPECIFIC DISEASES
HIGH CO-PAYMENTS
.
EQUIPMENT
PRESCRIPTIVE DRUGS
OTHER
QUALITY OF CARE
y
LIMITED STAYS
LACK OF SERVICES
PROGRAMS . -
COBRA'S
CO'llERAGE TOO SHORT
INCREASED CO-PAYMENT
MEDICAI
SPENDING D W POOR
ON
LO T COVERAGE/
s GiINFUL EMPLOYED
MEDICAR
LOG TERM CARE
OT ER COVERAGE
SOCIAL i ECURITY/
DISABILITY
DI CONTINUATION
CO\ERAGE TOO SHORT
OTHER COVERAGE
VETERAN S PROGRAMS
DECAYS IN COVERAGE
OVERPAYMENTS/
UNDERPAYMENT
OTHER PROGRAW
OTHER CONTEND
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
022. letter
SUBJECT/TITLE
DATE
Address (Partial) (I page)
02/01/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [ I ]
2006-0885-F
jmSOS
RESTRICTION CODES
Presidential Records Act - [44 ll.S.C. 2204(a)
Kreedom of Information Act - |5 Ll.S.C. 552(b)]
Pl
P2
P3
P4
b(l) National security classified information [(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Sandra T. Carpenter
P6/(b)(6)
1 February 1992
Mrs Hillary Rodham Clinton
1600 Pennsylvania Ave
Washington, DC
Dear Mrs. Clinv.on,
I read in the daily nev.'spaper wliich we receive, that Americans were
invited to vrite regarding health care, etc. So, here goes!
My husband and I run a small insurance agency in the Adirondack Mountain
beauty
area of New York State (an economically depressed area, of gre
and over-regulatio". bv S!-Tito rtcvornnent). We employ 12 people, exeluding ourselves. We provide health benefits for a l l those vljio need
them (6) and DO NOT ASK OUR EMPLOYEES TO CONTRIBUTE anything to this
coverage. Of course, we also buy our own health coverage in tJn same
group plan. It is very costly for us to provide this benefit and I
feel very strongly that the fp-Jeral government continue to allow a
business to deduct the FULL cost of health insurance and otheq benefits.
I also feel that the employer should be allowed to deduct the tULL cost
of his own health coverage. It is totally unfair to restrict this expense or not nllrr.; i 1 -i- -"i K> 'loci net 3 on.
:
ry
I would also ask that the problems of small business people (*!) employees
or less) be seriously considered when any policies are made. Vo are the
•back-bone' of this country and i t gets more difficult to opeiate a
business each year, especially in rural areas such as the Adii|<j)ndacks.
I would also like
cerrer.:- o" i h r sucigested 'energy taxes',
..
taxes on gasoline and fuel oil will hurt most those who can idist afforid
i t . Rural areas have no public transportation. Most people imj^t drive
many miles to work and to purchase necessities. For example, qi|ir daughter
and her husband drive 35 and 45 miles one way to work each da; in
opposite directions, car poolinc; is impossible. Daughter is a l|$o taking
graduate courses - at the nearest college, 75 miles away! Or. way!
Taxing fuel oil is a cruel way to way raise revenue/
x
I am very unhappy with what I hear out of Washington, i t seemd that the
solution to r-ii] ri nanci-ii nrobl oms Cncod by the government - i * to increase taxes or remove allowances nnd deductions on our tax re-.urns .
�2.
Of course, the middle-class and upper middle-class are the groups that
will bear the burden. There must be a better way!
I also feel thfit mor.? dollars ne°d ho be out into education, with more
help going to pnmll rtiraj --rt.-hooi 'Ji-tricts. This should be based on need
not on local property values. You see, NYS has overvalued the land
here in the Adirondacks and this has placed an enormous tax burden on
the people, who simply cannot afford i t .
Furthermore, j h . o n1v;nyH voto.-l Rnpub] icnn, but in 1992 I voted for
pv
change - change for the better, 1 hope. Most, people that I talk to
do not have a problem with a woman of Hillary Rodham Clinton's caliber
having a responsible place in this administration.
Best Wishes,
(7
Sandra T. Carpenter
/
�Sunday. Jan. 24, 199.
Opinion
Some Ciirmudgeonly advice for the new p
Dear Mr. President,
Having watched your career, culminating
in the ceremonies and celebrations of the
past 24 hours, with interest, I am moved to
offer you some advice. Most people would
be too modest to give the president advice,
but lam a journalist.
1 am further emboldened by the fact that
Jerry Solomon suggested, as recently as
yesterday, that the best thing that you could
do is take his and George Bush's advice.
Mr. Solomon seems to be trying, like Mr.
Bush, to stake out his place in history: in his
case, as the congressman with the greatest
chutzpah
As a maner o! tact, my first piece of advice
is "Be careful tivm whom you take advice."
You certainly shuuldn't holdagmduc. on
lhe other haiui vou don't need to turn ihe
other cheek i« > itic extent that you acccpi
counselfromiiH>se who were, a fev. wt.cks
ago, calling yeu ;in unAmerican bozo
You were elccied by those of us u lio
believed thai the country was on the. wrong
track. Now tl,;.; you are in Washington, you
will be besiege,I with advice from those
who got us w hen: we are. This includes not
.'illy Messrs Solomon and Bush, bin almost
all the Washington insiders, on both sides .
ofthe aisle.
I know what they'll say: "You're the new
guy around here; you don't know the ropes
yet; be careful, careful what you say, careful
what you do. We know best; listen to us." •
We didn't elect you to conduct business •
as usual. We didn't even elect you to be
careful. If you believe in your heart that a
policy is right, pursue it. If you know
something is wrong, end it.
Some of your actions so far trouble us.
They include one ot'the most expensive,
inaugurations in history, with motorcades.
Secret Service, flags, soldiers, artillery,
balls, and so forth. We don't need an
emperor: we've already had too many. We
like you better when you jog into a
McDonald's and press the flesh. Again,
don't listen to those "experienced advisors"
who urue caution in this regard Lei me put
it bluntly, if someone wants to shoot you,
he will probably succeed, in spite oi the .
Secret Service. We all pray that it won't
happen: meanwhile, we are tired of looking
up at presidents who are standing in the
doorway o! Air Force I .
We are iroubled, too, by the appointment
country is divided, more than ever before,
between the few very rich and the many
very poor. Some of this was brought on by
12 years of leadership that told us: "Greed
is good. America was founded on greed."
We want change, real change, not yvnical
^pan^ermg to spectaf interest PACs.
Tax cuts are good, but jobs are better.
Most people m this country aren't worrying
about paying their taxes; they're worrying
about losing their jobs, and with them their
healih care. Too many of us can't afford to
get sick. We need a sweeping reform of
The Washington County
health care, and to achieve it, you'll have to
Curmudgeon
stare down the medical and insurance and
drug company fat cats and their hirelings m
Congress. You'll have some help; we sent
oi uood old boys like Llovd Bentsen. The
some good new people to Congress this
TacnfiaTthe Senate comnnttee~vot&d
> ear, but you'll have to lead, and you can
lllllmiimously to_en3orei.• him before asking
only do that if you take, and deserve, the
him single question ducsn'i encourage us:
moral high ground
it si an ius.
It indicates that he is an integral part of
.We need jobs, no; minimum wage jobs at
the system we want you to end. Some of
VlcDonald's, but 20 dollar an hour jobs.
your other appointmems yive us more hope'•Ve can get them by putting real money into
that you are who you said you were, during Tnucatlqtv research, and training, and nv
the campaign.
""encouraging corporations to do the same.
We can't solve the problem bv pavring
"Be sure you're righi: then go ahead."
~\merican businesses to send still more jobs
Stick to what you said ym would do. This
Mark
Freeman
toM
TCIcE
envii
ordir
abou
That
In
and
hand?
being
really
Ever>
show
surpri
blow!
lot of
the Le
unfort
Husse
somet
peace
We;
in Hail
want il
dream:
you. D
�Sunday. Jan. 24. 1993 The Post-Star. Glens Falls. N.Y. — F3
Opinion
advice for the new
ers, on both sides
/: "You're the new
n't know the ropes
hat you say, careful
iest; listen to us."
conduct business
. elect you to be
i your heart that a
If you know
i it.
•o far trouble us
mostexpensive _
with motorcades,
diers, artillery.
on't need an
iiad too many. We
. jog into a
.c flesh. A. :am.
•erienccd advisors"
regard. I.-.•! me put
nits to shoi.i you.
i. in spile oi the
ay thai u v. on't
ne tired
looking
standiii!'. ai the
:
y the apj-ointmenl
•is-
w
Mark
Freeman
The Washington County
Curmudgeon
of good old boys like Lloyd Uenisen. The
' l i c t thaTrhejgenate committeeTot^d
unamniously to endorse him before asking
him a single question doesn't encourage us;
it scjire ^ ,;s
It indicates that he is an integral part of
the system we want you to em! Some of
your other appointments give us more hope
that you are who you said ynu were, during
the campaign.
"Be sine you're right; then go ahead."
Stick io what vou said you would do This
country is divided, more than ever before,:
between the few very rich aqd the many
very poor. Some of this was brought on by
12 years of leadership that told us: "Greed
is good. America was founded on greed."
_We want change, real change, not ^yr^ical
"pancienng to special interest PACs.
Tax cuts are good, but jobs are better.
Most people in this country aren't worrying
about paying their taxes; they're worrying
about losing their jobs, and with them their
health care. Too many of us can't afford to
get sick We need a sweeping reform of
health care, and to achieve it. you'll have to
stare down the medical and insurance and
drug company fat cats and their hirelings in
Congress. You'll have some help; we sent
some good new people to Congress this
yea;. but you'll have to lead, and you can
onK do that if you take, and deserve, the
moral high ground.
W e need jobs, not minimum wage jobs at
Mel >onald's, but 20-dollar an hour jobs.
We can get them by putting real money into
iTchTeanon. research, aiuTiraining, and by
eneouraging corporations to do the same.
We can't solve the prohlernbv paving
American businesses to send still more jobs
;
V
to Mexico, where people work for less than
McDonald's pays, and total pollution is the
environmental standard. Most of us
ordinary slobs are totally unenthusiastic
about NAFTA, but GM and GE love it.
That ought to tell you something.
In foreign policy, as well, consult your
Jlgad and your heart (and maybe your wife
jmd daiighter\ and do what they tell you is.
light, rather than listening to all the old
hands? You said something recently about
Being willing to listen to Saddam i f he
really wanted a change in relations.
Everybody jumped all over you: "Mustn't
show weakness, bad. bad " You'd be
surprised how many of us don't feel that
blowing up a dormant factory and killing a
lot of Iraqi civilian- in lhe process is "doing
the Lord's work in war, people get killed;
unfortunately, the\ are never the Saddam
Husseins. As you loi merly knew,
sometimes it takes greater courage to talk
peace than to wage war.
We don't want business as usual, in Iran,
in Haiti, in China Most of all we don 'i
want it in our own country. Our hopes, our
dreams, our prayers, and our trust reside in
vou. Don't let us down
�WIS. HILLARY RADDOIN CLINTON
HEALTH CARE PLANNING COMMITTEE
WASHINGTON DC
MARCH 17 1993
DEAR MS. CLINTON & COMMITTEE MEMBERS:
I REALLY WANTED TO SOMEHOW TOUCH BASE WITH MS CLINTON ON HER
RECENT TRIP TO BOSTON, BUT BEING MY LAST DAY AT W R MADE THE
OK
LOGISTICS QUITE IMPOSSIBLE. THUS THE REASON FOR WRITING THIS
LETTER. THE REASON I LEFT W R IS A CRUCIAL MISSING LINK IN
OK
THE HEALTH CARE DELIVERY SYSTEM IN THESE UNITED STATES.
ItWAS . REGISTERED NURSE WHEN IN. 1976 I * A ' A SWINE -FLU SHOTA
HDWHICH WITHIN DAYS PRECIPITATED TINGLING IN MY RIIGHT FOOT.
EIGHT YEARS LATER, I WAS DIAGNOSED AS MULTIPLE SCLEROSIS AND N W
O.
IN 1993 I AM A QUADRIPLEGIC IN A MOTORIZED CHAIR AND DEPENDENT
ON PRIVATELY PAID FOR PCA'S TO GET ME OUT OF BED AND INTO BED
WITH A MECHANICAL LIFT.
I HAVE ALWAYS WORKED AND CARRIED MY OWN HEALTH INSURANCE. IN
ORDER TO REMAIN WORKING I DID GET TO A POINT WHERE" I NEEDED
PCA'S AND I PURCHASED A LIFT TO HELP THEM MOVE ME WITHOUT- HUftTING THEMSELVES. MY INSURANCE WOULD PAY FOR NEITHER ONE.' A
RECENT HOSPITALIZATION MADE MY LEG SPASMS MUCH WORSE AND WHILE
RECUPERATING I GOT PHYSICAL THERAPY TO HELP PREVENT
CONTRACTURES. SPASMS CAUSE CONTRACTURES AND VISA VERSA.
THINGSWENT WELL, I WENT BACK TO WORK AND' THEN-MY' VNA INFORMS
ME. . .NO MORE THERAPY BECAUSE I AM NOT HOMEBOUND'. I TRIED TO
CONTINUE TO WORK, BUT I WAS BECOMING MORE & MORE SPASTIC,'
CONTRACTED AND PAINED. I ENDED UP QUITTING. I WILL APPLY FOR
SSDI AND RETIRE. I AM 59 SO I GUESS I HAVE EARNED THAT TOO.
:
THE INSURANCE ALSO WOULD NOT COVER THE L I F T WHICH WAS ALSO A
[WAYIN WHICH I,COULD STAY WORKING TO PAY FOR MY PCA'SJ- SO HERE
IWE" HAVE A FEMALE HIGHLY EDUCATED PERSON WHO AFTER LOSING A L I F E
""CAREER (NURSING) GOES OUT & AND GETS WHATEVER WORK SHE CAN DO,
MANAGES HER OWN HEALTHCARE UNTIL AFTER 30 YEARS OF PAYING
INSURANCE SHE REALLY NEEDS SOME HELP TO KEEP WORKING, AND I S
TOLD..NO WE WILL NOT HELP. NO PCA NO LIFT AND FINALLY NO
^STRETCHING. WE WANT YOU TO QUIT WORK GO HOME AND BLEED THE
^YSTEM. CATCH 22?
;
SIMPLY PUT...THE POWER OF AN INSURER TO DICTATE THIS SORT OF
CONDITION TO COVERAGE IS OBCENE, UNFAIR AND PURELY RIDICULOUS
WOULD. IT.-NOTMAKE SENSE TO KEEP ME WORKING AND BEING A TAXPAYER
VERSUS'A TAX USER? ANYTHING WE CAN DO TO KEEP PEOPLE AWAY FROM
"ENTITLEMENTS" WOULD SEEM MUCH MORE COST EFFECTIVE, NOT TO
SPEAK OF THHE THERAPEUTIC EFFECT OF WOORKING.
I AM AN RN. NOW UNEMPLOYED. I WOULD OFFER MY HELP ON A VOLUNTEER BASIS I F I THOUGHT IT WOULD HELP UNDO THE INSURANCE
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03/17/1993
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h(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA|
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�CRIPPLED SYSTEM W HAVE N W
E
O
SINCERELY
•y.-',
tte^irtdL
' : P6/(b)(6)
,
0
:
SfU.^- t o o i " ^ in Order
4o r e c e C J ^
permes&o^.
7/7/731#
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COLLECTION:
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Health Care Task Force
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OA/Box Number:
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[Personal Stories Database: Additional Small Business Letters] [loose] [ I ]
2006-0885-F
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Pl
P2
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b(2) Release would disclose internal personnel rules and practices of
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b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
National Security Classified Information 1(a)(1) ofthe PRA]
Relating to the appointment to Ecdcral office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA]
Release would disclose trade secrets or conHdential commercial or
rmaneial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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�faiJU'
fclMO****
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
IDENTIFICATION OF PRIMARY LETTER CONTENT (CHOOSE <OR- THREII
INSURANCE COST ISSUES SYSTEMS RELATED
\
MEDICAL COSTS - EXCESSIVE
HIGH DEDUCTIBLES
MEDICATICWS/PRESCRIPTIONS
HIGH PREMIUMS
HOSPITAL : H A R G E S
FORCED TO W R
OK
DOCTORS tSES
UNABLE TO PAY
UNNECESSARY PROCEDURES
HIGH CO-PAYMENTS
PROCEDURJ13 NOT PERFORMED
OTHER
GOVERNMENT-RENTED HEALTH CARE
PROGRAMS
INSURANCE COVERAGE EXCLUSIONS TO CARE
COBRA'S
COVftfcAGE TOO SHORT
PRE-EXISTING CONDITION
INCHEASED CO-PAYMENT
COVERAGE DENIED
LACK OF PORTABILITY
MEDICAID
SPEI13ING DOWN POOR
LOSS OF COVERAGE
LOS COVERAGE/
FROM PARENT'S POLICY
GA MFUL EMPLOYED
FROM CONTINUED CARE
MEDICARE
LONti TERM CARE
LIMITED BENEFITS
OTHfiR COVERAGE
COST CAPS - CEILINGS
BENEFIT NOT OFFERED
SOCIAL SECURITY/
CLAIM DENIED
DISABI ITY
HOME HEALTH CARE
DI S(t ONT INUATI ON
LONG TERM CARE
COVl 1 RAGE TOO SHORT
MENTAL HEALTH
OTHliR COVERAGE
SPECIFIC DISEASES
HIGH CO-PAYMENTS
VETERAN'S PROGRAMS
EQUIPMENT
DELhYS IN COVERAGE
PRESCRIPTIVE DRUGS
OVEI 'AYMENTS/
UNI iRPAYMENT
OTHER
OTHER PROGRAM
QUALITY OF CARE
LIMITED STAYS
OTHER CONTENT
LACK OF SERVICES
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DOCUMENT NO.
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025. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
06/29/1993
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [I]
2006-()885-F
im808
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Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
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h(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOI A]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) ofthe PR A]
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute |(a)(3) ofthe PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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RR. Document will be reviewed upon request.
�:
"
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June 2S, 19'J3
CP*
H i l l a r y Rodham Cl : :"i t on
;
C/O The Win':.- Ho:
1600 Pennsyl vari : i i-' [•: :
.
•' ;
Washington, DC
Re:
Medical
Costs
Dear Mrs. F i r s t 1. ad • :
..
/
We are
wvitincj
th:-:,
:i et i,<
i n j u s t i c e r e g a r d i n g cur Medical
Insurance.
vig^^jajie^n^the.. I n s u r a n c e . . i n d u s t r y o p e r a t i n g
i £ U i e p . e n d e n t * ; a g e n c y on L o n g I s l a n d f o r o v e r
pl et e
As you
an s e e ,
a--small
30 y e a r s
E n c l o s e d , y o u w 11 ' i r-'d a c o p y o f a 1 r - t t e r t h a t my i . i f e s e n t
t o t h e Un -j
i > MO'M.; i
i : •• : ;,T.:vr a .. I-, F l o r i d a
••
p e r t <Jin ing t o
h e r s u r g e r y o n 'ejbv u a v y 27; n
his
Af ter
receiving
absurb b i l l
i n t h e amount of ^ 7 , 3 5 2 . 9 9 0 f n r a f - s u r - hour'
g u t r p a t i e n t • p r o c e d u r , we wr o t e t o t h e H e a l t h.U<ac e
A d m i o - i g ^ j a t ,3, o n ^ . H O S P i.t a l . . C o s t . ..Cpnt.a i n m . e n . W S Q i i K ^
>ally
h ^ v e ^ n o w j u r i s d i c t i o n wHat'soeveT-.
1
|
A f t e r c onir.-1 j . n t Li&n
r e c e i v e d t h e e n c .i .
explaining their
•
•
<
.:. r>l.
w h o
im May 2 0 t h
si t y
Hospit
we
position.
The b o t t o m l i n e i s t h a t
tt\e^dox.What;^P&££$}&Stte&QS
T h i s m e a n s t h a t a c c o r d i n g t o t h e a r t i c l e t h e y sePTT iifith t h e l e t t e r , t h e y c a n " " c h a r g e • ou'tTa'cj e o u s " p F r c e ^ ; . t t-oVc-Slfiprgff! aWK^y^
*o?ifS!f!P
p a t i e n t s - w h o p a y n o t h i n g "or l e s s t h a h " 'the"" c os».t f o
heir
I q u e s t i ori
11-, :i H
ov n o t , .
care.
:. ea E:
1
T
I n my b u s i n e s s , I cannot c h a r g e more i n s u r a n c e prem ums for
someone who can a f f o r d t o pay more f o r someone who cannot
a f f o r d t o pay or pay l e s s .
I have e n c l o s e d t h e per inent
data.
I f e e l i t i s my d u t v t o b r i n g t h i s t o your a t e n t ion,
I f you do not r e^non" ' > • M-. : ,
:
:
-i-!-?•.• I w i l l u n d e r\nd.
st
!
Good Luck on your
Sincerely yours,
•P6/(b)(6) " T
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�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
026. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [ I ]
2006-0885-F
im808
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b(2) Release would disclose internal personnel rules and practices of
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b(3) Release would violate a Federal statute |(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of Ihe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
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�PERSONAL STORIES DATABASE
IDENTIFICATION QF WRITER
0
PR3tBF gY^OPSIS OF LETTER
Doctor's wife, 54, has been denied health coverage since CO RA elapsed after
husband moved t o p r i v a t e practice-self-employed because o f one f a i r l y minor
coronary angina attack—common t o most people a f t e r 50. Tlkay wouldn't even
insure her excluding heart issues. Carriers should be required to take a l l
applicants and any exclusion dropped a f t e r a year or twolif no claims for
that problem. Also t h e i r daughter has worked 36 hours/wk f: 10 years for a
research l i b r a r y part time. They keep saying t h e y ' l l make h r f u l l time, but
can't a f f o r d i t . This also i s immoral.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LOSS OF COVERAGE
LIMITED BENEFITS
�March 15, 199 3
Dear Mrs. C l i n t o n ,
I am w r i t i n g about my personal problem w i t h the healthcare system
and hope that i n your recommendations, you w i l l f i n d a s o l u t i o n .
I am c e r t a i n t h a t my set of circumstances are not unique, but t h a t
would be of l i t t l e comfort i f I were t o face bankruptcy i f I were
to have a major medical problem.
^ ^ ^ ^ ^
coverage wi€h the group under the
18 months Tllowed byf'COBRAlregulation u n t i l we became established
i n our new l o c a t i o n . Unfortunately, <3uritiq??the*' ffi
a^bout vof angina and was admitted t o trie ^ p s ^
b^M^c^orkiap." I t showed that i ' - h ^ ^
however , ~it i s very • minimal and limited to one vessel ^and requires"
•
no surgical intervention.' I have no other{risk factors, as I do
not smoke, drink only a glass of wine occasionally. " I exercise
~
regularly and have greatly modified
diet to that of a low-fat,
high fiber diet over the past year. ¥ have no chronic health
conditions and have been exceptionally healthy allImy^adult^li^e.
I - m 54, years old. I worked for 22 years prior to our move 2 years
a
ago""ahcf was always.: covered"'by^'.medical''insurance through my employer
and rarely had a claim. My husband has never had any serious health
problems and has never been hospitalized. What has happened i s #hgn$
T
ri
They have agreed t o cover my husband and a dependent c h i l d and
grandchild
but not me. Although we d i d not t h i n k i t f a i r , we
o f f e r e d t o exclude any cardiac problems I might have f o r coverage
i f the company would cover me f o r other medical or .surgical problems.
Their r^spori^e&was^thatv: itl;would be"-too'-haird&td^
5xSi5giJ^b^||l.a3 p'Ql'i'cy
which I f i n d d i f f i c u l t t o believe since ,
they a£ready administer policies which exclude "pre-existing"
conditions for any of their policyholders. The'upshb'tHTs^t
Iv have some type of accident, and break a bon§. or..need..rny£gallbladd(
Temov^^TT^will-have to pay for it completely
out•:.ofcmy/0\ij^gy^^^
i
i
4
tOJEAjall-' Our i i vesT" W " are wi 11 irig ' to "pay a "tiigtier"^pfiemium^i'f^^ee^* ^
e
be, but f e e l we are being u n f a i r l y t r e a t e d by the insurance,company
by being shut out from any coverage at a l l on me.
The i r o n y of the s i t u a t i o n i s t h a t my husband i s a physician." ' He
sees and t r e a t s many people on a d a i l y basis f o r whom he receives
l i t t l e or no pay because they e i t h e r have no j o b or money, or they
are covered by Medicaide, which i s almost the same as having no
insurance. He has never turned away a p a t i e n t because o f t h e i r
i n a b i l i t y t o pay. l ^ t h ' e ^
'to: see one Medicaide payment, so I'm not certaiin a'government^
�1
StJESBS^
don't know what the
answers are t o the many and v a r i e d problems; but I do know t h a t they
ajrefinot-solely because of high physiciarr'fees (my- husband-does;;npt;.
&ti!t^BlVffl&$&^
pfolSlem. I f they are
e l i m i n a t i n g p^ple^B'^b'e^i^iured f o r p r e - e x i s t i n g c o n d i t i o n s — t h e n
I'm surprised anyone over the age of 50 can get insured because most
of us have had a t least one h o s p i t a l i z a t i o n or i l l n e s s by t h a t age.
I know no one i s going t o have much sympathy f o r a doctor's w i f e
who i s without medical insurance, but we are j u s t average c i t i z e n s
l i k e anyone else and we have the same problems as a l o t o f people.
We pay high taxes, we pay very high p r o f e s s i o n a l l i a b i l i t y insurance
premiums because of the healthcare c r i s i s , and we get s i c k and i n j u r e d
j u s t l i k e anyone else
so where do we f i t i n t o the issue. We are
another set of people who f a l l through the cracks
we are
Sel'f-BCiployed, we make too much money t o be bh Medicaid^, we are
t'oo xyoung .; f or • Medi,car^, and I /cannot., o l p t a i ^
1
I t h i n k anyone who wants t o be medically insured has the r i g h t t o
be and there should be coverage extended t o them regardless of pree x i s t i n g c o n d i t i o n s , major or minor. I am w i l l i n g t o pay and can
pay a reasonable premium, but I ^ h i n k t t i ^
4 l ^ ^ S S ^ ^ y ^ 9 i ^ ^ 9 ^ The insurance companies want only "healthy"
mrg^Wt^tiey^won't^have to pay out.
W6imi!mm!8&£&BnmH&
ny^usband^could;: pick: and
:,P.^
^.ould'^
I think Insurer sT should "be ••'requE^cu^©§|^S rj
cbV^^e^t'bTalf^phe''"who a pp 1 i e s r - - at a ir e a s bhab 1 y <' cc^e1 er a t ed^preiOvVrn'
a
4pj:^|t;hose^whpj'have pre-existirigP*d'i'sea"se^ but M d u c e d ^ ^ ^ t i e r ^ r ^ ^
e r
e
c
h
o
o
s
e
h i s
,
1
There.is something d r a s t i c a l l y wrong i n t h i s country when people
who work hard and d a i l y give back t o the system, yet are denied
coverage f o r which they are w i l l i n g t o pay.
I wish you w e l l i n your p u r s u i t o f answers t o the many faceted problem
of healthcare
i t i s everyone's problem. Please l i s t e n t o a l l . t h e ,
voices—-each have v a l i d concerns—both doctors and p a t i e n t s ,
h o s p i t a l s and employers, insurers and government healthcare agencies.
No s i n g l e one has the answer, but h o p e f u l l y , by l i s t e n i n g t o each,
you w i l l f i n d some common ground.
;
flfcpJthexi^
the system a r ^ x ^ m n ^ ^ S ^ h ^ P ! ^ b u t do
not q u a l i f y by salary f o r Medicaide and whnaa^mnl^^feyta^ ^—-•«
113
iBve afffaitt§lj%r who h5S*"worJced~ior "a •prIy^ie:Vrei£arbS5lSfaxfy f o r
t O g ^ M l S a n d works 36 Hours a week^--not enough t o q u a l i f y f o r the
b e n e f i t o f medical insurance. Each year they: imply-th'^y-will^pixt!!
he»fcpn;?ful;l^
r e s t r i q t i Q j j s f o r not
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DOCUMENT NO.
AND TYPE
027. letter
SUBJEC m i l I E
DATE
Personal (Partial); Address (Partial) (1 page)
03/15/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
Pl National Security Classified Information |(a)(l) ofthe PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
h(1) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe KOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�doing so. Consequently, she has to pay f o r private i ns ur ance^-'T: a •
'
.
whplej^lpt^;-Qt;"njoney';/f.or •'a'-'-very minimal policy..? Not a i r . I ve'"'been
pl(|)|yees so they
£6Td many employers"hire nothing but part-time emdon' t have to pay benef i t s - -ntftis U s VimMgsajrt'
,
I guess
willing
stories
more of
i t gets down t o everyone wanting something but no one being
to give up anything. There are much sadder and more desperate
than mine which you have had cross your desJ: and they deserve
your energy and consideration
I only ask l a t you r e a l i z e
Sincerely,
"- "
• »
1
.. , • ;
> , •r- . - •(
.•
^• • i •ije
• .
r
t
P6/(b)(6)
' "
•
;.
...
..V
-.ll.- ' ^ - '
'
*
-•
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
028. note
-
SUBJECT/ ! I T I . E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [I]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Reeords Act -144 U.S.C. 2204(a)]
Freedom of Information Act - |S U.S.C. 552(b)|
PI
P2
PJ
P4
b(t) National security classified information 1(b)(1) o f t h e FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA]
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
h(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion nf
personal privacy 1(b)(6) o f t h e FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe F O I A j
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or conndcntial commercial or
financial information 1(a)(4) o f t h e PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) o f t h e PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Writer's husband i s self-employed and so cannot be covered by any "group
insurance."
Three years ago they found a p o l i c y t: i rough "National
Association of the S e l f Employed. They found coverage of $628 a month for
family of 3, having increased $194 each of the f i r s t 3 y i a r s
No claims
submitted u n t i l 12/92 when son had emergency h o s p i t a l i z a t i o r for chest pains,
Cost was $1500 plus, reimbursed $350. Yet she has paid c a r r er over $30,000.
Please consider those w i l l i n g to pay but unable to be accented
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
OTHER Minimal
reimbursements.
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
OTHER CONTENT suggests l e g a l i z i n g c o n t r o l l e d euthanasia
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
029. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
06/03/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
Pl National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment tn Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information [(b)(1) ofthe FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIAj
b(3) Release would violate a Federal statute |(h)(3) ofthe FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
h(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�n
f OR !
0
. P6/{b)(6) ;
June 3, 1993
Mrs, H i l a r y Rodham C l i n t o n
Chairman
Health Care Program
1600 Pennsylvania Ave. N. W
.
Washington, D. C. 20500
Dear Mrs. C l i n t o n :
I have l i s t e n e d t o and researched much i n f o r m a t i o n reg rding
the s t a t u s of c u r r e n t h e a l t h care, not only i n the pasbut
w i t h regard t o our personal c u r r e n t s t a t u s . Many aspe t s
apply t o t h i s problem w i t h i n our country and I wish t o
address each s e p a r a t e l y .
F i r s t o f f , my •husband/iis:?;sel-f?',:emplbyed and thevetovmec innot"
^^P9\aF^jiilJ.DjL .T;vu?rXj ,"rtT»P'- nfmr-tinr.^" . I am a housew f e and
am not employed as I take care of my mother, my mother i n law, and my aunt. While they are not housed w i t h us, It am
s t i l l a t t h e i r beck and c a l l a t a l l times.
P!
m
For two years, we did not carry any insurance, 'ft&Rtt-H >
tihj^gh«ifftJ&.ional Association of th?. Selfrrempl.Qy^,, we rere
abJiife^ft«1^^fetAirx,- some .basic .health insurance , W now >ay
e
HMsMttawmmi^^ f oiSK.aw^a»i4»H-.ofw3s wi th* an .>increase^f
W^Mrfl^Eftfis^atixsjpver^the^lst?: thre^&piuaayfiftfie •
v;
fi^fifiwSHlfni^bjR^ to the insurance company
December
swyear.- when^pui^sc^who^
a id
covered by the policy was admitted to the. hospistal-.^in ,an
ft#P8«no««=w,ith.-chest: pains . His t o t a l b i l l amounted t > over
ItJ^fldP.OO and yi^^£^9eiyft<ittr.e.i,robW^iBSnie.r\t of approximate!
la^flftOO; meanwhile
e
IBftjeij&xiwfoxTnewsspiiiBUTance with the hopes of reducing
our costs and receiving better coverage with l e s s loop » o l e s .
Tonight I was informed we have been denied coverage^a redsso/i
t&4&tt&&«iQUWU^j&^
• I personally, have-.^no.t^aeij.
Hfaftft he was *at^r,uolpyiTPrthe-*leg in a volley b a l l game ttl i t
^ml^SfiLfcin^a minor., blood c l o t .
I cannotv a g f ^ r d ^ ^ k * L
iS^^MAnMnpS.ra^because we do not . ^ v e ^ g c ; jft^e,
£1 What 1i111e current insurance we'have f o r ' i6Z8
per mon
_
h o p e f u l l y I have
I read i n the paper and see on TV a l l the appteals f o i women
t o be examined f o r cancer of the u t e r u s , breasts e t c . ;
�however u n t i l these exams are federally funded, t h i s d sease
and others are going to k i l l our population.
In addition to our own personal problems attempting to obtain
insurance coverage, I have an additional problem which cannot
be t r u l y solved, but can be addressed in the future.
My aunt i s almost 95 years of age. She i s in a convaldscent
home here in V i r g i n i a , not knowing anyone, incontinent, and
requiring 24 hour care. She w i l l never get any better logic
and common sense t e l l s everyone that. Meanwhile, she is
c o l l e c t i n g her Social Security of $547 per month which she
has collected since 1963 when she r e t i r e d . Never havi g been
married nor owning a home, she i s shortly to be placed under
Medicaid. At present I am paying over $4500.00 per mo th to
keep her in t h i s home, that i s about half the price of the
one she was i n i t i a l l y in in Connecticut.
Theagoveaanaaflt
Timnlrtarnrrmwrawtirr
'
— r i — f — " m - 1 ' I T ' irm'tifrnT
1
1
y's
frMyaitadbMirtilmit In wr nnBenturefag^i&te^ To prevent fami
from doing t h i s act needlessly, enact a law that the m ney
remaining must go to a legitimate charity; i . e . Cancer Fund,
Heart Fund, etc. so that the family would not benefit rom
the deceased, My mother i n s i s t s on v i s i t i n g her s i s t e
frequently and a l l i t i s doing to my 84 year old mothekf i s
depressing her and causing her to have greater short tflrm
memory l o s s .
I believe you are in a position to aid the middle clasH to
obtain better health coverage with the ultimate goal o( f u l l
coverage for a l l ; above a l l think of stop spreading d i i e a s e s
among the masses. Should an epidemic of anything brea out
i n t h i s country, God Forbid, the average person could Hot
afford to be treated.
I implore you to cp.naider, .the..- averagev-personilwtto^i'iiir*
tja^AX-suasuiiance.-, but .cannot,, even - be. accept.ejJ.X, We rare-,
OUlhealthy»people. We do not go to doctors for two rea ons,
one we do not need to go, and two i f we did, we could Aot
afford to pay the p r i c e s . Something needs to be done tow,
not s i x months from now, or a year from now.
At prese tit i the
only people benefitting from the current p o l i c y are th
doctors and the insurance companies,
PLease consider my l e t t e r in earnest and should you wiHh
Rerspnal comments please feel free to c a l l me at
P6/(b)(6)
r
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
030. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute [(a)(3) ofthe PRA|
Release would disclose trade secrets or confidential commercial or
Financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
W r i t e r ' s s i s t e r w i t h h e a r t disease worked f o r a small bus ;.ness, a winery,
which went o u t o f business i n t h e recession, t h e r e was no ;OBRA because i t
was a small business, and t h e s i s t e r cannot get new insurancj^ due t o her preexisting condition.
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK OF PORTABILITY
GOVERNMENT-RELATED HEALTH CARE PROGRAMS
COBRA * S
NOT FOR SMALL BUSINESS
six
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
031. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (1 page)
02/20/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National .Security ClHssificd Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA]
P > Release would constitute a clearly unwarranted invasion of
C
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA |
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOI A]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Feb r u a r y' 2"0TT9'9'3'
Mrs . H i l a r v CI i ^ t c P e n n s v 1 van - ' ,
•
W a s h i n g t o n , DC
Dear M r s .
Clinton;
I am v e r y p l e a s e d t h a t you were c h o s e n to head up t h e
Although
the
ask
commi t t e e t h a t w i l l re-form H e a l t h C a r p .
fa
•' i •!••• : : !• ^ '
•' •!••
•
• .
i t . w i l l be.
done i r l y
is
mo numen ! ^ i 1
.
.
efficiently.
1
and
I am w r i t i n g t o you t o s h a r e my s i s t e r s s t o r y , she i s t h e
$7 y e a r
t y p e o f p e r s o n t h a t your r e f o r m w i l l saye. Kathy i s
Hei h u s b a n d
o l d women who h a s had h e a r t d i s e a s e f o r two y e a r s ,
d i e d s u d d e n l y o f a h e a r t a t t a c h onp and a h a l f y e a r s alio . K a t h y
has a l w a y s we: > ec: , -v-c-!
••>••.(•• : r- n n tier own
she MUS t
c o n t i n u e t o woi v. de*sD i '.e
a-- -r-r
P'-i t h e G e n e r a 1 H a n g e r o f
a C a l i f o r r i i a W i n e r y her j o b i s s t r e s s f u l and
t i r e s o m e , K a t h y has
had
a
number
of
very
expensive
procedures
and
ests
(and
m e d i c a t i o n s ) t o t r y to h e l p her p r o b l e m .
U n f o r t u n a t e ! none have
b e e n v e r y s u c c e s s f u l and she i s e v e n t u a l l y f a c i n g a H e j ^ r t B y p a s s ,
Because
o f her
sqe
he'Do'-trjr i =•
:
trying
to
t r e a her
with
medicines in
~
•" • '
• • "
f. \ \ } d e v e l o p
non .
:
The r e c e s s i o n hac-i h : t manv qeonle- i n manv ways and K a t h y
was n o t s p a r e d .
The w i n e r y she manages has had t o c l O' >e i t s
doors.
I n M a r c h K a t h y w i l l be w i t h o u t any
i n s u r a n c e , $ecause
t h e W i n e r y i s s m a l l i t d o e s n o t o f f e r t h e C o b r a o p t i o r to i t s
insurance.
BecausK? o f no i o h . •' hu'-r.ba'-'d , and no i n s u r a n c e ,, my
"O
s i s t e r has der i a
' • • • i • i ' '••'.<•••. ' ••>••.:•:•':• ; w h i c h she
.
•
h a s ,a l o s s )
and move b a c k t o
rTn = «
. J i ' « .-I'-ir*,
{^,e r e s t o f my f i 1 v
1ives.
an
1
1
:
Kathy's f u t u r e i s bleak r i g h t
now.
I'm
pleasejd that
she
w i l l be c l o s e r t o us b u t I am w o r r i e d a b o u t h e r .
What a r e h e r
chances of
finding a
job?
I f she f i n d s
a job,
wi 1 the
new
insurance c a r r i e r
cover her w i t h a
n r e - e x i s t i n q c o n d t i o n ? What
D o c t o r o r Hosp i t a ! v' > 1 : *
.
•
»-c t • => a t her w e l l
..? thout
any i n s u r a n c e ' :
K-S'-'Y •
rf .
> • Q>~ snd a smal 1 i n c
(tme f r o m
ler h u s b a n d but i t wouldn' t c o - e r one of her Ho s o i t a l s t a y s .
T
My e n t i r e f a m i l y w o u l d l i k e t o o f f e r o u r s u p p o r t ^nd h e l p
to you.
We w a n t t o h e l p K a t h y and a l l t h e o t h e r s 1 i k
her
who
h a v e f a l l e n b e t w e e n t h e c r a c k s o f t h e I n s u r a n c e I n d u s t r y , and
who a r e u n i P=.
er '? c • ..- r:
.
c
• 0 9 » the? i f j o b s
.
hatever
we c a n d o , we 3'T: ••-• c ' •• :r
•»•
.
1
_S.i.o.c.e.ce.l_y
r
P6/(b)(6) -
r
r
M ,
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Clinton Library
D O C U M E N T NO.
A N D TYPE
032. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1
2006-0885-F
jmSOS
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) of the F O I A j
b(2) Release would disclose internal personnel rules and practices of
an agency [(h)(2) o f t h e F O I A |
b(3) Release would violate a Federal statute 1(b)(3) o f t h e I O I A ]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) o f t h e FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the F O I A |
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) o f t h e PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
P R M . Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�nTin oc
PERSONAL STORIES DATABASE
9
IDENTIFICATION OF WRITER
BRIEF SYNOPSIS OF LETTER
Employees of small business, premiums deducted from pay, emp .oyer never sent
them to insurance company. Then employer closed business, They had to pay
b i l l s over $10,000.00. Then, employer f i l e d for bankruptcy
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
OTHER-Payro11 deduction,
�Withdrawal/Redaction Marker
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DOCUMENT NO.
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033. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
08/25/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/l3ox Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jrn808
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 5S2(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA)
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
h(l) National security classified information 1(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA)
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 ll.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
BRIEF SYNOPSIS OF LETTER
IDENTIFICATION OF PRIMARY LETTER_C0NTENT. CHOOSE <OR': THRI Li
l / INSURANCE COST ISSUES SYSTEMS RELATED
MEDICAL COSTS - EXCESSIVE
HIGH DEDUCTIBLES
MEDICATi )NS/PRESCRIPTIONS
HIGH PREMIUMS
HOSPITAL CHARGES
FORCED TO WORK
DOCTORS 'EES
UNABLE TO PAY
UNNECESJ ^RY PROCEDURES
HIGH CO-PAYMENTS
PROCEDU! SS NOT PERFORMED
OTHER i-C^- ;i
- It; %t'. C i'l, . v. "
/VLt'A.t.^-t'W'-r-
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
LACK Or PORTABILITY
LOSS OF COVERAGE
FROM PARENT'S POLICY
FROM CONTINUED CARE
LIMITED BENEFITS
COST CAPS - CEILINGS
BENEFIT NOT OFFERED
CLAIM DENIED
HOME HEALTH CARE
LONG TERM CARE
MENTAL HEALTH
SPECIFIC DISEASES
HIGH CO-PAYMENTS
EQUIPMENT
PRESCRIPTIVE DRUGS
OTHER
QUALITY OF CARE
LIMITED STAYS
LACK OF SERVICES
GOVERNMENT-RELATED HEALTH CARE
PROGRAMS
COBRA'S
COVfeRAGE TOO SHORT
INCREASED CO-PAYMENT
MEDICAID
SPUDDING D W POOR
ON
LOSIT COVERAGE/
GAINFUL EMPLOYED
MED I CAR]
LOIlb TERM CARE
IER COVERAGE
ECURITY/
LITY
NTINUATION
RAGE TOO SHORT
OTMER COVERAGE
VETERAN S PROGRAMS
DE AYS IN COVERAGE
OVERPAYMENTS/
U DERPAYMENT
OTHER PROGRAM
OTHER CONTENI
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DOCUMENT NO.
AND TYPE
034. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/27/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1
2006-0885-F
jm808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl National Security' Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
1 5 Release would disclose confidential advice between the President
*
and his advisors, or between such advisors |a)(5) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(h)(8) ofthe FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�4/
o34
P6/(b)(6)
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.P6/(b)(6)-
�Withdrawal/Redaction Marker
Clinton Library
DOCliMENT NO.
AND TYPE
035. note
SUBJECT/TITI.E
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jmSOS
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or conndcntial commercial or
rmaneial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA]
Pfi Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA1
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed iu accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�(Or,
PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
'
.sr.-' -
• P6/(b)(6)
3^
•1
,..
4?
BRIEF SYNOPSIS OF LETTER
23 year o l d woman worked for small business that could r.at a f f o r d h e a l t h
?e I
trie t
i n s . , neither could she, then discove^f she had diabetes I^RP® I ', "triedd too
apply f o r i n s w i t h present employer, e i t h e r former f i r m n d o f f e r e d i n s . o r
new f i r m , b u t was turned down due t o p r e - e x i s t i n g c o n d i t i o ,
1 1
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
UNABLE TO PAY
INSURANCE COVERAGE EXCLUSIONS TO CARE
PRE-EXISTING CONDITION
COVERAGE DENIED
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
036. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1
2006-0885-F
jm808
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Aet - [S U.S.C. 5S2(b)|
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA)
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(a)(6) ofthe PRA|
b(l) National security classified information [(b)(1) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA|
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance wilh 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-A
Attn: Mrs. Hillary Clinton
Office of the First Lady
1600 Pennsylvania Ave. N.W.
Washington, DC 20500
Dear Mrs. Clinton,
I am writing to you regarding the health care issue you are addr sslng as a result of
the campaign promise made by President Clinton,
I am a 23 year old female working a full time job, plus a art time job, while
struggling to put myself through college. I started my full time J b about a year ago
for a relatively small company that couldn't afford to put me on (their insurance plan.
I couldn't afford to insure myself with my current cost of living expense etc. v 1
In October of this past year I became very ill and was hospitali ted; diagnosed with
Diabetes Type II Insulin Dependent.
After getting out of the hospital I applied for
insurance, because my employer offered to cover me under their cpmpany plan. I was
denied icoyerage because my Diabetes was a "Pre-Existing Condition".
Currently I owe the hospital and doctors approximately $2500.00 th it I am struggling to
pay off.
I also want to mention the $15.00 per bottle of insu n I must buy, plus
regular scheduled doctor visits I must pay cash for in order for t h i doctor to even see
me.
As you can see I am very concerned about health care reform because it directly affects
my situation. I hope the plan you propose will help me, and peop j like me, elsewhere
in the U.S.
If you have any suggestions, or know of any agencies that could hel
current situation, I would appreciate a reply. Good Luck!
Warmest Regards,
•;
; . P6/(b)(6)
cc; Sen. Robert C. Smith
.. Sen. Judd Gregg
Rep. Bill Zeliff
me get through my
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DOCUMENT NO.
AND TYPE
037. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (I page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1
2006-0885-F
jmSOS
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act • |5 U.S.C. 552<b)|
PI
P2
P3
IM
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the F O I A |
b(3) Release would violate a Federal statute 1(b)(3) o f t h e FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
h(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) o f t h e FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) o f t h e FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute [(a)(3) o f t h e PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) o f t h e PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
IDENTIFICATION OF WRITER
Worker i n small business w i t h 17 employees charged w h shopping for
a f f o r d a b l e insurance.
The business i s r a p i d l y approac ng point where
p r o f i t a b i l i t y w i l l be s a c r i f i c e d t o insurance. Relates p e r onal story about
d i f f i c u l t i e s w i t h emergency care and b i l l i n g .
IDENTIFICATION OF PRIMARY LETTER CONTENT
INSURANCE COST ISSUES SYSTEMS RELATED
HIGH PREMIUMS
MEDICAL COSTS - EXCESSIVE
HOSPITAL CHARGES
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
038. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial) (2 pages)
04/23/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1
2006-0885-F
jm808
RESTRICTION CODES
Presidential Reeords Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�A p r i l 23,
1993
Mrs. H i l a r y C l i n t o n
1600 Pennsylvania Ave.
Washington, D.C.
20500
Dear Mrs.
Clinton:
I am a n x i o u s l y a w a i t i n g your h e a l t h care reform proposal fo(i our Country,
I s i n c e r e l y hope you can help w i t h what seems t o be two s e l ish and greedy
i n d u s t r i e s , the insurance i n d u s t r y and the medical i n d u s t r y
II consider myself somewhat f o r t u n a t e i n the sense t h a t the j m a l l company t h a t
I am employed w i t h can s t i l l a f f o r d t o o f f e r group h e a l t h insurance coverage
to our 17 employees. Over the past t h r e e years our corpora t f ! premium has
increased a s t r o n o m i c a l l y f o r c i n g a l l employees t o c o n t r i b u t i ! a g r e a t e r p a r t of\
\
the cost o f the premium each year. Since I am the i n d i v i d u l ^ l r e s p o n s i b l e
for "shopping" f o r h e a l t h insurance coverage I f e e l persona l y r e s p o n s i b l e
for m a i n t a i n i n g reasonable coverage, at an a f f o r d a b l e r a t e , so t h a t we a l l
can sleep a t n i g h t knowing t h a t should we have the need f o r medical care f o r
ourselves or our f a m l i e s the g r e a t e r p a r t of the expense w i I be handled
by the insurance company. The o p t i o n o f dropping h e a l t h carjc coverage,
due t o the expense, c e r t a i n l y has crossed my mind a few timss but the
p r i c e t o be p a i d by the c o r p o r a t i o n f o r t h a t o p t i o n , I f e e l i s f a r g r e a t e r
than the increased expense f o r insurance coverage. We a l l
rk very hard t o
m a i n t a i n a l e v e l of p r o f i t a b i l i t y to handle the i n c r e a s i n g wo nsurance .
expense, but I t h i n k we are r a p i d l y approaching a l i m i t whe e i t w i l l not
matter how hard or smart we work, the insurance companies w I I want more
than we can a f f o r d t o g i v e .
H o s p i t a l s , emergency care centers and doctors are a l l i n on the a c t too.
I r e c e n t l y took my son one evening to a neighborhood emergency care center
for an i n f e c t e d thumb. My thoughts were not t o go t o t h e . h o s p i t a l emergency
room since I b e l i e v e they do more than i s r e a l l y necessary n order to increase
t h e i r revenues, but t o get him treatment t h a t evening t o re ieve the p a i n
and perhaps I would a v o i d him missing school the f o l l o w i n g flay. T h a t ' s
the l a s t time I ' l l make t h a t mistake. We went t o a p l a c e cal 1 the MED CENTER
and my son's thumb was t r e a t e d and he was able t o a t t e n d s c t o o l the
f o l l o w i n g day. Then came the b i l l . A f t e r numerous d i s c u s s i o n s w i t h
the MED CENTER and my insurance company I found t h a t the MED CENTER
charged me $86.00 over "usual and customary f o r my area
I|!ow, I can
almost understand an e x t r a $5.00 maybe $10.00 but $86.00 to me i s h i g h l y
unreasonable and q u i t e greedy. Needless t o say the MED CENTER and I
are i n c o n t e n t i o n over the balance due and a d d i t i o n a l l a t e i charges.
I don't mean t o appear as though I am whinning, but i am on*! o f thousands
of s i n g l e parents who are out there every day b a t t l i n g t o k fep food on the
t a b l e , our c h i l d r e n h e a l t h y and t r y i n g t o be both Mom and D d 24 hours
every day. I consider myself f o r t u n a t e i n many ways. I know t h e r e are o t h e r s
much worse o f f than myself and others who are doing much be ;ter, however
NONE o f us should be robbed!
�P
8
1
t 0
y O U
b e g i n
s o m e
f a i r
?L
V ! "
'
equitable ref< reformation to help me
those who have no healthcare coverage at a l l as well Ss tftose of us who
are t r y i n g to maintain coverage at a reasSnab" cost
P6/(b)(6) »-.>•
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND T Y P E
039. note
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
jm808
RESTRICTION CODES
PrcsidcnliHl Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI
P2
P3
P4
h ( l ) National security classified information 1(b)(1) of the FOI \ |
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) o f t h e FOIA)
b(3) Release would violate a Federal statute |(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) o f t h e FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) o f t h e FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe F O I A |
b(9) Release would disclose geological or geophysical information
concerning wells 1(h)(9) of the FOIA|
.National Security Classified Information | ( a ) ( l ) o f the PRA|
Relating to the appointment to Federal office [(a)(2) o f t h e PRA|
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) o f t h e PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONAL STORIES DATABASE
riFICATION OF WRITER
v»'k'
P6/(b)(6)
o3<n]
.
.
BRIEF SYNOPSIS OF LETTER
M»t J»
^•«^r' rr«M+
IPENTIFICAflON OF PRIMARY LETTER CONTENT
U J . €, Ur»fW t c « ^ I f / I
"
ye^.
y9i
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
040. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (2 pages)
02/01/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [1]
2006-0885-F
im808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. SS2(b)|
Pl National Security Classified Information [(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of Ihe PRA]
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) ofthe PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information 1(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Febmaiy 1, 1993
Mrs. Hillary Rodham Clinton
The White House
1600 Pensylvania Avenue
Weshington, D.C. 20600
Dear Hillary:
My name is| , 'p6/(b)(6) I and I reside in Marietta, Georgia. I wantec Ito
write yoa & letter in support of your being nemed to lead the challenge
fbrmlng a new health cere program fbr our nation - and I have a very
personal reason fbr which to give that support,
My brother, Bobby, died on July 17 at the age of 27, I believe rny
brother would be alive today if there would have been a health care progftem
available to him that would not discriminate by pre-existing health
conditions and would be affordable,
Bobby was born with Cystic Fibrosis- a genetic lung disease with no
known cure presently, For 27 years, he was on my father's insurance
coverage through his employer, But, suddenly, last March, Bobby received a
letter stating the company was changing insurance carriers and that he
would be droppedfromthis insurance coverage effective immediately. Jhe
reason? He was working and making too much money to stay on the po cy.
Why the sudden change in the policy? The insurence company didn't k ow.
4
My brother was a general manager fbr a construction company here < in
Marietta fbr almostfouryears. He moved to Georgia eight years ago anc had
enjoyed very good health during the entire time, exceptforone
hospitalizationfora stomach operation. He was self supportive and hole
down a M-time job, lived independently in an apartment, and just neec d
some help when he was hospitalized, He was very distraught about this ; rop
in coverage, because he knew he could never get health insurence on hi i
own with a pre-existing condition like Cystic Fibrosis even if he could
afford to pay the premiums.
Two months later, around thefirstpart of June, Bobby became ill. fee
was coughing, losing weight end justfeelingwribl, W urged him to go
e
the doctor, but he decided to try to get better in bed at home with his ui ual
regimen of medicines, After about a week and a half, my mom took him
down to Emory University Hospital where his CF doctor took a look at him
and, unbelievably to us, sent him home with oral antibiotics. Two days Ifjter,
barely able to breathe, he drove himself to the emergency room at
Kennestone Hospital and was admitted with severe pneumonia.
Would Bobby h r e gone to the doctor sooner if he would hero had
ev
insurance coverage? Did the doctor at Emory not admit him because hi [was
uninsured? These questions will haunt usforever,but why should anyoi. 9 in
this county be put in that position? Why are people punishedforwantij^g to
be independent Instead of iving off the govemment?
Our health care system often rewards peopleforlying, My brother
could have lied about his income, about having a job at all, and about livii^ on
his own, but his pride end self-esteem wouldn't let him, But it probably
would have allowed him to stay on my father's insurence,
�Bobby's disease was not a result of smoking, bad eating habits, sexua
misconduct or drug misuse. He was just born with afcajidisease - and b i
seemed to be punished fbr it, W y can't we help other Americans help
h
themsehres with their health care needs - no matter what the reason fbr the
need?
Bobby was transferred from Kennestone to Emory University Hospit?
because his pneumonia had worsened, and so that his Cystic Fibrosis docti irs
could take over his treatment. Throughout his two-weekfightat Emory, :pe
respiratory therapists who worked night and dav to save his life said they
were amazed that a 27-year-old CF patient could hold down a M-time jot}
and be living alone,
Bobby was Qflt an exception to the rule - he was the only one who
would admit it. Other CF patients have had to become dependent upon thbir
parents fbr living arrangements and turn down jobs when indeed they we i e
able to work - just to meet the criteria to get insurance coverage fbr the!:
medical needs. Did my brother's pride and high self-worth kill him? You|
tell me.
I urge you tofightfora health plan that would include persons with
pre-existing medical conditions. Bobby was blessed with good health so Ue
f
could work, but what about those who can't work? Does our state orfedeal
government offer programs to take care of them, or does the family htm to
bear the burden? There are good people in this country who, through no
fault of their own, have serious medical conditions and "fell through the
cracks" when it comes to health care programs needed to aid in catastro^jic
illness and major hospitalizations,
I miss my brother very much, but I'm very proud of him. Proud of hij
courage to be independent and to enloy working end earning an honest
living. He paid his taxes and believed in hard work, He also believed in
getting the chance to live a long, normal life. He didn't get that chance,
Please give it to someone else's brother,
I have been verv active in speaking out at hearings regarding QeorgiJjj
Reform Insurance Plan (GRIP) program, which we hope will be passed th >
month in the Georgia General Assembly, I would be very willing to speak H
o
any persons or committees on the national level concerning my brother's
story and the needfora change in this industry,
As a working mother myself, I applaud your enthusiasm and
involvement in the new administration, and I hope you and the President
CAN make a difiference, But, in order to do so, I know you need individua
examples of how the present health care system has failed, Americans lik
myself can help you accomplish this, M prayers ere with you both, and I
y
thank: you fbr teJcing your time to read this,
you
Sincerely,
��Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
041. letter
SUBJECT/TITLE
DATE
Personal (Partial); Address (Partial); Phone No. (Partial) (1 page)
01/31/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [I]
2006-0885-F
jm808
RESTRICTION CODES
Presidential Records Act - |44 ll.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
Pl National Security Classified Information 1(a)(1) of the PRA]
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
P3 Release would violate a Federal statute |(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA]
b(l) National security classified information |(b)(l) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�January 31, 1993
Dr. Ralph F e i d i n
Administrator
Texas C h i l d r e n H o s p i t a l
P.O. Box 100726
Houston, Texas 77212-0726
Dear Dr. F e i d i n :
I would l i k e t o take t h i s o p p o r t u n i t y t o thank a l l o f thedoctors
who showed so much care and concern f o r my daughter . „ v P6/(b)(6).
1
I t was because of each of t h e team members e f f o r t s t h a t "tJhe removal
of t h e f o r e i g n o b j e c t i n her stomach was s u c c e s s f u l .
;
I would f i r s t l i k e t o acknowledge the generous help of Dr Ralph F e i d i n ,
Who made t h e procedure p o s s i b l e by d e f f e r i n g t h e c o s t s , Kext, I would
l i k e t o thank Dr. Carol Redel, and Dr. Mark G i l g e r who, through
o u t s t a n d i n g perseverance, were able t o e x t r a c t "the quart >r w i t h o u t
having t o make an i n c i s i o n . F i n a l l y , I would l i k e t o thaUik Dr. Robert
Bloss, who stood by i n case of necessary surgery. Our f a n i l y f e e l s
e s p e c i a l l y blessed t o have had such an e x c e p t i o n a l team Working t o g e t h e r
t o make P6/(b)(6) w e l l .
Recently we have sustained some u n f o r t u n a t e events: unemti .oyment o f
both my husband and I , and t h e r e j e c t i o n o f our a p p l i c a t i | ^ n f o r h e a l t h
This company
insurance by United I n t e r n a t i o n a l L i f e Insurance Company
r e j e c t e d our insurance a p p l i c a t i o n because they could not b e l i e v e our
f a m i l y had been h e a l t h y f o r those !-we]ve months. They c l iimed t h a t they
could not f i n d enough i n f o r m a t i o n about our f a m i l y from cjipr previous
i n s u r e r s , Prucare.
I b e l i e v e t h a t t h e r e are many t h i n g s t o thank our Lord f c r The advanced
medical technology o f today and t h e d e d i c a t i o n o f so many d o c t o r s , are
best examples. We p r a i s e our Lord f o r opening many door
and s p e c i a l l y
f o r Dr. Michael Maloney and Pr: Rebecca Schwanecke who s imported and
encoraged me i n searching f o r help. The p e n e r o s i t y of the many persons
i n v o l v e d i n our problem, w i l l never be f o r g o t t e n i n ourpr ayers.
God bless each one o f you.
Sincerely,
c c :
Marvin Z i n d l e , Channel 13
H i l a r y C l i n t o n , White House
�Withdrawal/Redaction Marker
Clinton Library
DOCliMENT NO.
AND TYPE
042. rider
SUBJECT/TITLE
DATE
Personal (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [ I ]
2006-0885-F
im808
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 220400]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(h)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(h)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office [(a)(2) ofthe PRA|
Release would violate a Federal statute 1(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
�GUARANTEED RENEWABLE FOR YOUR LIFE AND THE LIFE OF EACH FAMILY
MEMBER SUBJECT TO THE LIFETIME MAXIMUM AMOUNT. COMPANY /IAY CHANGE
PREMIUM RATES BY CLASS AS PROVIDED IN THE GUARANTEED RENEWAL
AGREEMENT
SET
:
LIMITED BENEFIT BASIC HOSPITAL-SURGICAL-MEDI : : A L
EXPENSE COVERAGE
United International
Life Insurance Company
A Stipulated Premium Company
Administrative Office: Fort.W )1h, Texas
10-DAY RIGHT TO EXAMINE POLICY
If You are not satisfied with this policy for any reason, return it to Us within 10 days after Your^;eive it. Any premium
You paid will be refu/ided. The policy will be void from the beginning. It will be as if no policy hac )een issued.
GUARANTEED RENEWAL AGREEMENT
You can continue this policy in force by paying appropriate renewal premiums before the end o he grace period, subject to the lifetime maximum amount. The appropriate renewal premiums will be those under (:jur applicable table of
premium rates that is in effect on the respective due dates of such premiums.
We have the right to change the renewal premiums for this policy when We change, and in acc^ dance with, Our table
of premium rates applicable to all policies of this form and class in Your state.
THE INSURING CLAUSE
The Company hereby insures You and all the eligible Family Members namr>ri ^nri anor
UTIAL PREMIUM:
aH
io tK~
INITIAL TERM E) PIRES:
$239.34
1 M0NIH
DEDUCTIBLE - PART 1 AND PART 2
-ST CALENDAR YEAR - $ 600.00
2ND CALENDAR YEAR - $ 400.Ho
JRD CALENDAR YEAR - $ 200.00
4TH CALENDAR YEAR b THER : AFTER - $ 100.00
The Deductible will be deducted once from the eligible expenses for each Family
Member. However, once two Family Members have met their deductible amounts
n one calendar year, no further deductible must be met that year.
'ART 1 CO-INSURANCE PERCENTAGE:
100?,
'ART 2 CO-INSURANCE PERCENTAGE:
100%
JIFETIME
MAXIMUM AMOUNT:
$2,000,000
AGGREGATE AMC] UNT:
RENEWAL PREMIUMS
2 MONTHS
6 MONTHS
3 MONTHS
1 10NTH
$2 9.34
•IAME OF THE INSURED:
P6/(b)(6)
tonal
$250,000.00
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
043. rider
SUBJECT/TITLE
DATE
Personal (Partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose]
20()6-0885-F
im808
Presidential Records Act - [44 U.S.C. 2204(a)|
RESTRICTION CODES
Freedom of Information Aet - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
P3 Release would violate a Federal statute 1(a)(3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe I'RAI
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
b(l) National security classified information [(b)(1) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) ofthe FOIA)
h(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)( )) of the FOIA]
1
�United International
Life Insurance Company
A Stipulated Premium C 'mp;i;iv •!• /Vimiosirative OMice: FDI Worth, TI.'A.'IS
r
This rider amends and is made a part of lhe policy to which it is attached. It is subject t all provisions, conditions, exclusions and limitations of the policy which arc nol in conflict with those of ihi ider.
r
Effective Date (same as policy effective date i! no dam p'-^wn.)
This rider applies to (Insured if no one shown):
P6/(b)(6)
In consideration of the issue or the renewal of the policy to which Hut, rider is allached, is understood and
agreed that We will not pay benefits under the policy lor loss resulting from the following
"Any i n j u r y t o , or disease or d i s o r d e r o f , the spine, i t s muscles Iigaments,
discs or nerve r o o t s ; or any complications t h e r e o f . "
A f t e r 6 months t h i s r i d e r w i l l be considered for renyivnl nt Mw: ro uest
of the a p p l i c a n t and upon r e c e i p t of a current and favorabli; modici 1 report.
M United International
Life Insurance Company
A Stipulated Premium Company
A.-irr.iri.sifaiivf! Oflice: Fo' Wonh. V .
This rider amends and is made a part of the policy to winch 1 is c'liuchoci. 1 ^- '.uj^ieci tall provi'iions, con1
1
ditions, exclusions and limitations of the policy which ar... not m conf'.in with thoso oi ihi« ider.
Effective Date (same as policy effective date if no datr? snowi.
This rider applies to (Insured if no one shown):
P6/(b)(6)
In consideration ot the issue or the renewal of the policy 10 •.vmch :MI>, r.cici is nitached. is under.: .-od and
agreed that We will not pay benefits under the polirv for less u-•..•«'«•.>; tiom ihe loilowmr;
"Any disease or disorder of the female reproduct ivc organs; or anv :onipl i ! i ons
thereof."
A f t e r 6 months t h i s r i d e r w i l l be considered f o r removal at the recjiliest
of the applicant and upon r e c e i p t of a current and favorable medic« repor1.
Secretary
Preside-
Form RR
M V V
ITIAL PREMIUM:
1
W
W
$239.34
EDUCTIBLE - PART 1 AND PART 2
INITIAL
TKKIV] 1-X
; MONTH
�Withdrawal/Redaction Marker
Clinton Library
D O C U M E N T NO.
AND TYPE
044. rider
DATE
SUBJECT/TITLE
n.d.
Personal (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number: 3679
FOLDER TITLE:
[Personal Stories Database: Additional Small Business Letters] [loose] [ I ]
:
2006-0885-l
jmSOS
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(h)|
Pl
P2
P3
P4
b(l) National security classified information [(b)(1) of the F O I A |
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) o f t h e FOIA|
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) o f t h e FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) ofthe FOIA]
h(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) o f t h e PRA|
Relating to the appointment to Federal office 1(a)(2) o f t h e PRA|
Release would violate a Federal statute [(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) o f t h e PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) o f t h e PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
P R M . Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�United International
Life Insurance Company
North. Texas
A StipulaM Premium Company + Adminislialive Ofliee-. Fort 1
provisions, conber.
This rider amends and is made a part ol W pCcy m vvi,r> „ ,s
ditions. exclusions and limitations of lhe policy which arc no. -n conflict w,th those ol this
Effective Date (same as policy effective date if no date shown).
P6/(bX6)
This rider applies to (Insured if no one shown):
s understood and
t i l a p p ? i ^ ; I r t upon receipt of a current and TavoraMe med.cal r f c r t .
ll^esi
resident
Secretary
United International
Life Insurance Company
A Stipulated Premium Company
Adminisiraiivo Office: Fori torth, Texas
This rider amends and is made a part of the policy to which it is attached. II is subject to
provisions, conditions, exclusions and limitations of the policy which arc not in conflict with those ol this iHler.
Effective Date (same as policy effective date if no dale shown)'
This rider applies to (Insured if no one shown)
P6/(bK6).
In consideration of the issue or the renewal of the policy to which this rider is attached, it understood and
agreed that We will not pay benefits under the policy lor loss resulting Irom the following:
"Any disease or d i s o r d e r of the heart or c i r c u l a t o r y system; or any c o m p l i c a t l o n s ,
thereof."
A f t e r 12 months t h i s r i d e r w i l l be considered for removal at the request of
the a p p l i c a n t and upon r e c e i p t of a current and favorable medical r e p o r t .
JL
F lesi
esident
Form RR
TAL
PREMIUM:
S***
�
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Health Care Task Force Records
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White House Health Care Task Force
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
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<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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[Personal Stories Database : Additional Small Business Letters] [loose] [1]
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White House Health Care Task Force
Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 3
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Box 5
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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3/16/2015
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42-t-12092992-20060885F-Seg3-005-005-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/42288969b55fcadc5fd275c392f2f2bd.pdf
2c280b422d9e3b9327ce37ad23b01e2a
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Health Care Task Force
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Edelstein
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OA/ED Number:
3681
FolderlD:
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S
52
3
8
2
�PHOTO
CONGRESSMAN TOM JEFFERSON'S
SPECIAL REPORT ON THE
PRESIDENT'S HEAITH SECURITY RAN
Dear Friend:
President Clinton recently released details regarding one of the most important pieces on legislation in our lifetime - health care reform.
TEXT OF LETTER LETTER TEXT OF LETTER TEXT OF LETTER TEXT OF LETTER TEXT OF LETTER TEXT OF LETTEXT OF LETTER LETTER TEXT OF LETTER TEXT OF LETTER TEXT OF LET
Sincerely,
Tom Jefferson
W H Y REFORM HEALTH CARE?
GROWING INSECURTIY
Millions of Americans live in fear that they'll lose
their health coverage. In fact, one of every four of us
will lose our health insurance at some point over the
next two years. If your child gets sick or you have an
accident during this period, your family's savings
could disappear overnight.
Today's system isriggedagainst families and small
businesses. Insurance companies pick and choose
whom they cover. Then they can drop you if you.get
sick, if you switch jobs, if you move, or if you start a
small business.
percent each year. And large businesses can't compete
globally against countries that control their health care
costs.
INCREASING CONFUSION.
Our health care system forces doctors and nurses
to spend more time filling out insurance company
forms and less time taking care of their patients. We're
all tired of the endless, confusing paperwork and fine
print you have to wade through so you don't get stuck
with a bill. The number of hospital administrators is
growing four times faster than the number of doctors.
And we're all paying.
RNNGCOSIS.
Our health care bills are spiraling out of control.
Insurance companies are raising premiums,
companies are charging outrageous prices for
prescription drugs, and paperwork and fraud are
sending the costs of the system through the roof.
Rising costs also threaten American jobs, burden
American businesses, strain state budgets, and drive
up our federal deficit. Small businesses are
bankrupted by health care premiums thatrise35
DECREASING QUMIIY& CHOICES.
The quality of America's health care is threatened.
Today, doctors and hospitals are guaranteed payment
to treat you after you get sick — but not to keep you
healthy in thefirstplace. And more and more
Americans are losing something we all hold dear: the
right to choose our own doctors. In fact, only three
out of every ten small employers offer their employees
any choice of a health plan at all.
�1
REFORM MEANS COVERAGE THAI CANNOT BE TAKEN A A
WT
After reform, every American will receive a Health
Security card. The card guarantees you a comprehensive
package ofbenefits that can never be taken away.
Once you get your card, you can never lose your
health coverage — no matter what. If you get sick, you're
covered. If you change jobs, you're covered. If you lose
your job, you're covered. If you move, you're covered. If
you start a small business, you're covered.
You'll be able to choose your own doctor. Everyone
will have a wide choice ofhealth plans, organized in at
least three different ways: You will be able to (I) choose a
traditional fee-for-service plan, (2) join a network of doctors and hospitals, or (3) join an HMO.
Like today, almost all of us will be able to sign up for a
health plan where we work. You'll get brochures that give
you easy-to-understand information on the health plans in
your area, including an evaluation of the quality of care
and a consumer satisfaction survey. If you're self-employed
or unemployed, you can sign up at the health alliance in
your area. Consumers and local business owners — not
the govemment and not the insurance companies — will
run the alliance and bargain for affordable health care for
you.
Health plans will be required to use standard forms to
replace the thousands of different forms insurance companies use today. So when you get sick, you won't be buried
in forms — and neither will your doctor, nurse, or hospital.
EVERYONE SHARES, EVERYONE'S COV
aim
Reform will get skyrocketing health inflation under
control while guaranteeing you health security and giving
you a comprehensive package ofbenefits that can never
be taken away.
Everyone will be responsible for contributing
something to the cost of their health care, even if they can
only afford a small amount. Premiums will vary — as they
do today — from plan to plan and state to state, but the
system will be much simpler and much fairer.
Today, your premium depends on many factors
beyond your control: you are being charged more if
you're sick, if you've ever been sick before, if your child
has an illness, if you're older, or if you work in a small
company. This will change.
Everyone will pay the same price for the same plan —
no matter whether you are sick or healthy, whether you
are old or young, whether you work for a small company
or a large company. Your premium depends only upon
your family status (see chart below), where you live, and
the type of plan you choose. Low-income Americans will
be eligible for discounts on their premiums.
Families with a full-time worker will be responsible for
paying an average of 2 9 of the premium. Their
06
employers will pay the rest. And employers who now pay
100% may continue doing so.
M O N T H I ^ H E A E I H C A R E RRI^VDDLIZVIS
T O O A V AISTD VCVl'T-l R l i F O R M
( k d o n n KCMIIIX I I.IVL- IScL-n Sludal)
TWOPARENT
FAMIIY
(With
(Hinge is $0-1180)
children)
SINGLEPARENT
FAMILY
(With
Average
^
$76
chilcirm)
X >
Average
$76
(Range is $0-$ 180)
Average
$73
;(Rahge.wUbe$0-$91;.
dNJOuntav-aisiblfif
income under $22.2001
A
^
8
P
$64
(Range wii lie $0-$80;
discount available if
income under $18,400).
MARRIED
COUPLE
(No
children)
Average
$76
(Range is $0-$ 180)
Average
•
$64
..F(Rangewinbe$Q-$80;
discii.m available if
itiiome under $14,600)
SINGLE \• Average | Average
^
PERSON
$25
(Range is $0-$60)
•Prdiminarv average estimates, based on 1994 numbers; will varyfromstate to state.
L
ii
;
I
$32
(Range will be. $6-$40; .
discount available if
income under $10,800)
�YOUR BENEFITS MUST BE COMPREHENSIVE & GUARANTEED
All Americans must be guaranteed a comprehensive
most Fortune 500 companies. The Health Security plan
package ofbenefits that is as generous as those offered by
puts no lifetime limits on your coverage.
PREVEMON: BEnmHEAiM, LOWER Com
preventive services for women, men, adolescents, and
In today's system, if you become ill, your insurance
may cover you. But most plans won't pay a penny to keep young children — including well-baby care,
immunizations, prenatal care, cholesterol screenings,
you healthy in the first place. The Health Security plan
guarantees that you won't have to wait until you're really influenza shots, mammograms, and Pap smears — are
provided at no extra charge to you. In return, you'll be
sick to visit your doctor.
The comprehensive benefits package covers a wide responsible for taking advantage of these services to keep
range of services that detect and prevent illness. Dozens of yourself healthy.
COMPREHENSIVE COVERAGE
Preventive Care
Prescription Drugs
Expanded Home Care
Visits To Doctors & Other
Health Professionals
Hospital Services
Surgical Services
Emergency Care
Ambulance Services
Lab & Diagnostic Services
Mental Health Treatment
Substance Abuse Treatment
Children's Dental Care
Vision & Hearing Care
Prosthetic &
Orthotic Devices
Rehabilitative Services
Hospice Care
Health Education Classes
Your co-payments — the amount you pay out-of-pocket when you DOCTOR NETWORK (PPO): This plan offers low co-payments
go to a doctor — will be limited and uniform, protecting you finan- ($ 10) — with no deductible — if patients use the doctors within the
cially and making it easier to choose among health plans. Co-pay- network ("preferred providers"). If patients choose doctors outside
ments vary according to the plan you choose. For a wide range of the network, they have higher co-payments (20% of each visit) —
preventive services, there will be no co-payments in any plan. Low- once they've paid the $200 individual deductible or the $400 family
deductible. They pay nothing once they've reached the out-ofincome Americans may receive discounts on their out-of-pocket
pocket maximum ($1,500 for an individual; $3,000 for a family).
costs.
FEE-FOR-SERVICE: Patients pay 20% of the cost of each visit after HEALTH MAINTENANCE ORGANIZATION (HMO): Patients pay
the $200 individual deductible or $400 family deductible. They pay $10 for each doctor visit. There are no co-payments for hospital care
and no deductible must be met.
nothing after they reach the annual out-of-pocket maximum of
$1,500 for an individual or $3,000 for a family.
�COMPARISON
BEYOND
Tim
NUMBERS
Before comparing what you pay today with what you will pay under Health Security, remember this: The Health
Security Act guarantees you something no amount of money can buy today — true health security, no matter what happens to you. Ask yourself these questions about your plan today. Every "no" indicates a better value under the Health
Security Act.
• Do you have a comprehensive benefits package — with preventive services and prescription drug coverage at no additional cost?
• Are you guaranteed that you won't pay a larger share of your premium next year?
• Do you get coverage that kicks inrightaway, after only a small deductible?
• Are you free from "lifetime limits," so you'll have coverage no matter what?
• Does your insurance company charge you the same even if you are older or have a pre-existing condition?
OR
OfDKK:
Older Americans will continue to receive their health care under the Medicare
program, as they do today — with the added security of prescription drug coverage.
Workers over age 65 and their spouses will receive the same comprehensive benefits
as other working Americans through the health alliances
UNEMPLOYFO
P E O P L E AND
T H E I R FAMDJES:
Unemployed people would still have health coverage without intenruption, paying
only their'portion of the premium — with discounts based on their income. Those
with non-wage income, such as interest payments, would also be responsible for
some or all of the employer's unpaid share.
65
PARI-TEME
WORKERS:
Part-time workers will pay for a portion of their health insurance premiums. As long as
they are working, their employers will also pay part of their premiums and, depending on their income, part-time workers may receive discounts for the remainder.
SELFHEMPLOYFO/
INDEPENDENT
CONTRACTORS:
Today, the self-employed are allowed to deduct only 25% of their health care
Dremiums from their taxes. Under refonn, they will be able to deduct 100% of their
icalth care costs. As with any business, thev pay the employer's share, and are
eligibleforany discounts that apply They also pay the individual or family share, and
may be eligible for discounts on that as well, depending on their income.
RETIREES,
Faced with rising health costs, many companies have been dropping the health
coverage that their retired workers depend on. Under reform, the 80% share of the
average premium will be covered, and retired American workers will be responsible
onlyforthe remainder. Former employers may choose to cover that share, or may
be required to do so under collective bargaining contracts.
55-65:
Congress Of The United States
House of Representatives
Washington, DC
Official Business
�/
I
/
/
WHY WE NEED CHANGE ?
RISING INSECURITY
• 37 Million Americans have no health insurance coverage - including 9.5 million
children.
• One out of every four Americans -- 63 million people -- will lose their health
insurance coverage over the next two years.
•
The current system denies health security to millions of Americans. Many are
rejected by the insurance industry as "uninsurable" because of a preexisting
condition, a sick family member, or the job they hold.
SKYROCKETING COSTS
• Today the average worker would be earning $1000 more a year if the cost of
health insurance had not risen faster than wages over the previous 15 years. If
current trends continue, workers may lose another $650 in wages by the year
$2000.
•
Health care and insurance costs are eating up profits, limiting hiring, hindering
productivity and threatening the competitiveness of American business.
•
Health care costs add $1,000 to the price of every car made in America - double
the cost added to Japanese imports. U.S auto makers spend more on health care
than they do on steel.
•
Over the last decade, the amount the average American family has spent on
health care has more than doubled, from $1,742 to $4,296.
GROWING COMPLEXITY
• Nearly 1,500 insurance companies, each with their own procedures and
regulatory requirements are forcing doctors to spend timefillingout forms when
they could be seeing their with patients.
•
Administrative costs add to the cost of each hospital stay, with a number of
health care administrators increasing four times faster than the number of
doctors.
DECLINING CHOICES
• With a growing number of insurers using exclusions for pre-existing conditions,
arbitrary cancellations and hidden benefit limitations, Americans are facing
increasingly less choices for health insurance coverage.
•
Only 29% of companies with fewer than 500 employers offer any choice of
health care plans.
�DECREASING QUALITY
• Doctors are not receiving the information that would enable them to improve
health care coverage. Today, we have no clear sense of what treatments work
best and which treatments should be used in different situations.
•
The neglecting of preventive care not only increases costs, but means that
Americans are not as healthy as we should be. Instead of promoting preventive
care, the current system waits until people are sick before providing care -forcing everyone's cost to rise.
GROWING IRRESPONSIBILITY
• Irresponsibility permeates the health care industry increasing costs and affecting
coverage.
•
Insurance companies search for the healthiest people to cover while excluding
the sick and the elderly.
•
Pharmaceutical companies charge Americans three times the amount they
charge citizens of other nations for the same prescription drugs.
•
The uninsured and inadequately covered receive emergency care they can't pay
for, causing everyone's costs to rise.
�THE HEALTH SECURITY ACT OF 1993
HEALTH CARE THAT'S ALWAYS THERE
Under the Health Security Ac t, every American will receive a Health Security Card
that guarantees a comprehensive package of benefits that can never be taken away.
THE CLINTON HEALTH CARE PLAN IS BASED ON SIX NON-NEGOTIABLE
PRINCIPLES
SECURITY
The Health Care Security Act guarantees comprehensive health care benefits for all
Americans regardless of health or employment status. Even if you lose your job, or
change jobs your comprehensive benefits can never be taken away. Under the new
system, insurers will no longer will be able to deny anyone coverage or impose a
"lifetime limit" on those who are seriously ill. Limits will be set on what consumers
pay for health care coverage and access to quality care will expand, so that people
know that there will always l>c a doctor and hospital that will treat them.
SAVINGS
The Health Security Act will bring health care costs under control, and make sure
they stay under control. Consumers and businesses will be protected from runaway
health care premiums, because increases will be modest and predictable. Costs will
be controlled through increased competition, the strengthened buying power of
consumers and businesses, a simplified bureaucracy and a fail-safe limit on
premium increases.
QUALITY
Most Americans report beiny satisfied with the quality of their present health care.
The Health Security plan embraces those aspects of today's health care that work
and then goes one step further. The Health Security Act will arm doctors and
hospitals with the best information and latest technology. Health reform will invest
in new research initiatives and emphasize preventive care - putting a new emphasis
on keeping people healthy, nol just treating them after they get sick.
CHOICE
One of the fundamental principles of the Health Security Act is consumer choice of
doctors and health plans. The Health Security Act will give you the choice ofhealth
care plans -- not your employers or insurance companies. Every American will be
able to choose from a wide variety of health plans offered in their area. The Health
Security will also make it more possible for elderly and disabled Americans to
choose to continue living in their homes while receiving long-term care.
SIMPLICITY
�In order to simplify the Americiin health care system we must reduce paperwork,
streamline the current administrative burden and strip away the unnecessary layers
of regulation and oversight. The Health Security Act will reduce paperwork by
giving everyone a Health Security Card and requiring all plans to adopt a uniform
claim form. The plan will cut red tape by standardizing billing procedures,
eliminating fine print and creating a uniform benefits package. The new system will
hold health plans and providers accountable for results and make our system less
daunting and frustrating for consumers and more supportive and flexible for the
doctors, nurses, and hospitals on the front lines.
RESPONSIBILITY
Responsibility is central to every one of the principles of the Health Security Act.
For insurance companies, responsibility means no longer casting people aside when
they get sick. For doctors, responsibility means a halt to ordering unnecessary
procedures. For drug companies, responsibility means keeping prices down. For
employers -- both large and small -- responsibility means following the lead of our
nation's most successful businesses and helping to provide health security to every
employee. And for every American, responsibility means taking care of your health,
and paying something, even il the contribution is small, to health coverage.
�SMALL BUSINESS STANDS 10 GAIN FROM HEALTH CARE REFORM
TODAY:
The present health care system is stacked against small businesses. Small
businesses, who are too small to have benefits departments, are burdened by high
administrative costs - as much as 40 cents of every dollar of their premiums. Small
businesses are charged higher premiums because they lack the bargaining power to
get the lowest prices from insurance companies.
Despite these obstacles, many small businesses provide insurance to their workers.
And most of those that don't want to but can't, in a health care system with an
uneven playing field balanced against them.
THE HEALTH SECURITY ACT:
The Health Security Act will even the playingfieldallowing small business to
provide affordable coverage without being discriminated against because of their
company size.
•
Small business owners who now provide health care coverage will pay less,
because they will no longer have to pay more to cover uninsured workers.
•
Small business will be charged the same rate as large businesses to provide
coverage.
•
Small businesses will join logether to get the same benefits - in terms of
bargaining power and administrative simplicity - as large businesses.
•
Health care reform will streamline the workers' compensation system - which is
a never ending source ol Trustration, fraud and higher costs for small businesses
today.
�HOW DOES THE HEALTH CARE PLAN AFFECT YOU ?
Full-Time Workers
Under the Health Security Act, employers will pay 80% of health care premiums with
full-time workers picking up (he other 20 %. Those who choose a lower cost plan - will
pay a little less than 20 % and those who choose a higher cost plan will pay a little more.
Employers who currently pay 100% of health benefits will continue to do so.
Families
Two parent families with children will pay a maximum of 20% of the family premium
offered by the average plan in their area. If both parents work they can choose to pay the
family share either through a check to the local alliance or have the amount deducted
monthly out of either paycheck.
Part-Time Workers
Part-time workers will pay 20% of the average premium plan, but will have their
premiums pro-rated by the number of hours they work. Depending on their income, parttime workers may also receive discounts towards their health care costs.
Self-Employed Workers
Under the Health Security Act. self-employed workers and individual contractors can
deduct from their taxes, 100% ol their health care costs. They will also receive small
business discounts that will cap premium levels based on their income.
Unemployed
Unemployed people will still have health care coverage without interruption, paying only
their 20% portion of the premium with discounts based on their income. Those with nonwage income - such as interest payments - may also be responsible for some of the (80%)
share
Senior Citizens and Medicare Beneficiaries
Older Americans will continue io receive their health care through the Medicare program,
as they do today. Medicare will continue primarily as a fee-for-service health program but
will offer beneficiaries a wider range ofhealth plans, including the option to enroll in a
preferred provider networks, or a health maintenance organizations. Beneficiaries will
receive coverage on prescription drugs by paying only 20 percent ofthe cost of drug
prescriptions up to a $1,000 annual cap. Prescription costs in excess of $1,000 will be
fully covered by the new bene iii
Early Retirees
Retirees, like working Americans, will be responsible for no more than 20% of the
average cost of health premiums. Retired people between the ages of 55 and 65 who
have worked for at least 10 years but are not yet eligible for Medicare will receive
financial assistance from the federal government to cover the employer's share of their
�premium.
Federal Employees
Under the Health Security Act, federal employees and early retirees will join with the
other members of the communincs in which they live and choose from among the health
plans offered by the regional health alliance in their area. However, they will continue to
enjoy comprehensive health cai e since the benefits package provided in the Health
Security Act are based on today's best plans, including those offered through federal
employee benefit packages.
Veterans
Health care reform will continue to honor the nation's commitment to providing
comprehensive health care to its veterans. Under the Health Security Act, the Department
of Veterans Affairs will either organize its health centers and hospitals into health plans
or allow them to act as health providers and contract with health plans to deliver services.
All veterans may choose to jon a VA health plan if one exists in their area,
Military Personnel
Under the Health Security Act, die Department of Defense will continue to fulfill its
obligation to provide health care to military personnel, their dependents and retirees.
The Secretary of Defense will develop a plan for health care reform and may establish
military health plans centered around military hospitals and clinics. Military personnel
who are eligible for CHAMPUS will have the added choice of selected civilian health
plans. In areas in which a military health plan is established, active-duty personnel will
automatically enroll. Family members of active duty personnel and retirees who are
under the age of 65 will have the opportunity to choose a military health plan or a civilian
plan.
Indian Health Service
Under the Health Security Act; ihe Indian Health Service will operate outside the regional
alliance allowing tribal govemmcnis to exercise their full autonomy to devise health care
delivery that works for them. American Indians and Alaskan Natives will have the option
of receiving care through the Indian Health Service or through a health plan in their
regional alliance.
Small Businesses
Small businesses of less than 75 employees with an average wage of less than $24,000
will receive discounts of 30% to 80%, depending on their average wage. These
premiums replace what businesses pay today. Small businesses that currently provide
health benefits will likely pay substantially less under reform, due to falling
administrative costs and lower premium rates. Small businesses who today are only able
to provide bare bones insurance will be able to provide a comprehensive package of
benefits to their employees and iheir own families at a reasonable price.
�SURVEY:
1. Do you currently have insurance ?
Yes
No
2. Are you satisfied with your current health care insurance ?
Yes
No
3. Are you satisfied with America's current health care system ?
Yes
No
4. Do you think America's health care system needs to be changed ?
Yes
No
5. Did the amount of money you paid for health care increase last year ?
Yes
No
Let me read you a number oi ideas that may be proposed by the President. Please
indicate whether you favor or oppose each one.
1. Government controls, on price increases for insurance, hospitals and doctors.
2. Requiring employers to provide health insurance.
3. A comprehensive benefits package available to all Americans.
4. A cigarette tax to finance health care reform
5. Extending prescription drug coverage and long term care to seniors under
Medicare.
6. Extending a comprehensive benefits package to include preventive care.
7. Funding reform with a payroll tax (with the employee paying 11/2 % of wages
and the employer paying 6 1/2% of wages), instead of the current insurance
premiums.
8. Guaranteeing all Americans health care coverage.
�Congressman
Murray Neimand
Special Report on Health Care Reform
District Office: 9353 Roslyndale Avenue, Pacoima, CA 91331, 818/988-2989
Washington Office: 000 Rayburn House Office Bldg., Washington, DC 20515, 202/225-0000
Health Care Reform and Your Family.
Developing a fair and effective plan
for access to quality health care.
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Containing Costs.
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Doctors, Insurance Companies and You.
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Small Businesses and Health Care Reform.
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Access to Quality Care.
What are your views?
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CAR-RT PRESORT
BULK RATE
POSTAL CUSTOMER
XTH CONGRESSIONAL DISTRICT
PACOIMA, CA
Special Report on Health Care Reform.
�BASIC BENEFITS PACKAGE
PART-TIME WORKERS
Most people in the country would obtain health insurance through a new entity — a local health alliance.
Exceptions would be current Medicare recipients, military personnel, veterans, and Native Americans who would
continue to be covered under their existing programs. Illegal aliens would not be covered under any program.
Three basic types of plans would exist: (1) low cost sharing (HMO-style), (2) high cost sharing (fee-for-service styles),
and (3) combination (preferred provider style). HMO-style
plans would have the lowest premiums, and fee-for-service
plans would have the highest premiums.
Employers would pay 80 percent of the premiums for
full-time workers, and the workers would pay the remaining 20 percent. Employers would pay a smaller percentage
of the cost for part-time workers, depending upon how many
hours per week they work. Most low income workers and
the unemployed would have their share of insurance premiums, at least partially, subsidized by the government.
Deductibles and co-payments would vary, depending
upon the type of plan selected by the beneficiaries. HMO's
typically would have a $10 co-payment for doctor's visits
and a $5 co-payment for prescription drugs. Fee-for-service
plans would have a 20 percent co-payment for doctor's fees
and hospital visits. Fee-for-service plans would also have
a $200 per person and $400 per family deductible.
Combination plans would have a low co-payment, if you
are treated by a preferred provider doctor or hospital, and
a higher co-payment if you are treated by a provider outside the preferred network. (For a comparison of benefits
under the three types of basic plans, see the chart on p.
4 of this newsletter.
All of the plans would cap out-of-pocket expenses at
$1,500 per person and $3,000 per family each year, regardless of deductibles or co-payments.
Part-time workers are responsible for the 20 percent employee share of the premium, and workers with incomes
below 150 percent of the poverty level receive discounts.
The number of hours an employee works determines the
ratio of the premium percentage paid by the employee and
the employer, with discounts provided for low-income employees. Employers pay a pro-rated amount for employees
who work between 10 and 30 hours per week.
Employees working less than 10 hours per week would
be responsible for their own permiums, but they would also
likely be eligible for subsidies.
FULL-TIME WORKERS
Employers would be required to pay 80 percent of the
average health plan premium in their area, with full-time
workers paying the other 20 percent. The projected average annual cost of a plan for an individual would be about
$1,800; thus, the employer would pay about $1,440 (80%)
and the employee $360 (20%).
Family premiums (husband, wife and children) are estimated to cost about $4,200. Thus, the employer would
pick up $3,360 (80%) and the family $840 (20%). Individuals and families with incomes below 150 percent of the federal poverty level — $21,525 for a family of four — are
eligible for discounts on the employee's 20 percent share
of the premium. A full-time worker is defined as someone
working at least 30 hours a week.
UNEMPLOYED
Individuals who currently receive welfare benefits and
currently receive Medicaid will be insured through local
health alliances, with Medicaid picking up all of the costs.
Other low income, unemployed people will also receive insurance through their local alliance — but at a discount, depending on what income sources they may have.
Unemployed persons with substantial sources of income,
such as investments, may pay the full cost of insurance
through their local alliance.
SENIOR CITIZENS
Medicare will remain a separate program under the new
system. Those people currently on Medicare (already over
65) will continue to receive their health care in that program.
Beneficiaries would also receive a new prescription drug
benefit. It would carry a $250 annual deductible.
Once the deductible has been met, beneficiaries would
pay 20 percent of the cost of each prescription with an annual limit on out-of-pocket expenditures of $1,000. The cost
of this new prescription drug benefit would be added to your
current Part B premium and likely would run about $11 per
month for the first year. The current Medicare Part B premium for 1993 is $36.60 per month.
People who turn 65 in the future would have the option of enrolling in Medicare or remaining in the health plan
they were already in, with the government paying most of
WHAT'S COVERED IN THE PLAN
Here is what's covered by all health plans under the Clinton proposal:
Treatment i n hospital or doctor's office; prescription drugs; dental work
for c h i l d r e n ; m e n t a l health and substance abuse treatment;
out-patient exams; eyeglasses for children; ambulances; pregnancy
services, including abortion; hospice and home care; rehabilitation
services; medical devices. Deductibles and co-payments vary according to
which plan is used.
the premium. If you remain in your health plan, you would
continue to receive the nationally guaranteed comprehensive benefit package with the full range of options available
to individuals younger than age 65. Coverage under Medicare is similar, but not identical, to the fee-for-service option under the Clinton plan for individuals younger than 65.
EARLY RETIREES
For those retirees between the ages of 55 and 65 and
who are not yet eligible for Medicare, the federal government will assume the 80 percent employer share of the
premium. If a company's retirement plan, as of January 1,
1993, covered the entire cost of the health insurance premium for early retirees, the former employer must cover the
remaining 20 percent. If there were no such agreement, the
early retirees are liable for the remainder of the premium
but are eligible for federal subsidies if their income is below
150 percent of poverty.
FEDERAL EMPLOYEES
Federal employees and retirees are treated like all other
workers. The separate federal health insurance system is
abolished and federal workers obtain their insurance through
local alliances and are responsible for 20 percent of the cost.
Federal retirees who are also eligible for Medicare will
have a choice of remaining with the alliance they are already
in or of enrolling in Medicare. In either case, the government will pick up some of the premium.
SMALL BUSINESS
Small businesses (those with less than 50 employees)
will be offered insurance at a discounted rate. Under President Clinton's plan, no employer in a regional alliance will
pay more than 7.9 percent of payroll for health care coverage annually. Small businesses will be eligible for caps on
percent of payroll varying from 3.5 percent to 7.9 percent,
depending on the average wage paid to all employees.
The Clinton plan provides for a permanent 100 percent
tax deduction for the cost of the comprehensive benefits
package for the self-employed individuals. All employer contributions for their employees' health premium are fully
deductible as a business expense.
SUPPLEMENTAL COVERAGE
Individuals may purchase plans that provide benefits in
excess of those specified in the chart on page 4; but, they
must pay for all of the additional premium unless their employer voluntarily agrees to do so. Employer-paid coverage for these supplemental benefits for current workers and
retirees are tax free to the employee for 10 years, if they
were offered by the employer as of January 1, 1993.
�A
PROPOSED HEALTH-CARE
BftlSURAft9CE OPTBOftiS
Low cost
sharing
(HMO-style)
C
Combination
(PPO-style)
Patient pays $200
indmdual/$400 family
deductible; insurance
pays 80% of medical
bills
Patient pays only $20 co-p ayment if in-network
providers are used; insuran ce covers 80% of bill if
out-network providers used
In network
Out of network
Full coverage
Insurance pays 80%
Full coverage
Insurance pays 80%
• Professional services,
outpatient hospital services
$10 per visit
Insurance pays 80%
$10 per visit
Insurance pays 80%
•
$25 per visit
Insurance pays 80%
$25 per visit
Insurance pays 80%
Basic benefits package
Limitations
•
Private room only when medically
necessary
Patient pays $10 copayments for outpatient
services: no co-payment
for hospital stay
B
High cost
sharing (fee-forservice style)
Inpatient hospital
Emergency services
• Preventive services including
well-baby, prenatal
Preventive adult services include
pelvic exams, cholesterol screening
and mammograms every 2 to 5
years
Full coverage
Full coverage, no
deductible
Full coverage
Full coverage
•
Hospice
As hospital alternative for
terminally ill
Full coverage
Insurance pays 80%
Full coverage
Insurance pays 80%
•
Home health care
As inpatient alternative; coverage
reassessed at 60 days
Full coverage
Insurance pays 80%
Full coverage
Insurance pays 80%
• Extended care facilities (Skilled
nursing, rehabilitation facilities)
As hospital alternative; 100-day
limit
Full coverage
Insurance pays 80%
Full coverage
Insurance pays 80%
• Outpatient physical,
occupational, speech therapy
Only to restore function or
minimize limitations: reassessment
at 60 days; additional coveragae if
improving
$10 per visit
Insurance pays 80%
$10 per visit
Insurance pays 80%
MARTIN FROST
W S I G O OFFICE:
A HN T N
24tli District Toas
2459 Raybutn House Office Building
Washiniton. D.C. 20515
(202) 225-3605
R LS C M ITE
U E O MT E
Full coverage
• Medical equipment, outpatient
lab, ambulance
• Routine eye and ear exams,
eyeglasses
•
Eyeglasses for children only
Insurance pays 80%
Full coverage
Insurance pays 80%
$10 per exam or one
set glasses
Insurance pays 80%
$10 per exam or one
set glasses
Insurance pays 80%
$10 per visit
Insurance pays 80%
$10 per visit
Insurance pays 80%
Dental services
Initial:
Prevention
Only for under 18
Added in 2001:
No age limit
$20 per visit
$50 deductible;
insurance pays 60%;
$1,500 annual max.
$20 per visit
$50 deductible;
insurance pays 60%
Orthodontia
Only to avoid reconstructive surgery
$20 per visit
Insurance pays 60%;
$2,500 lifetime max.
$20 per visit
Insurance pays 60%
$5 per prescription
$250/yr. deductible;
insurance pays 80%
$5 per prescription
$250/yr. deductible;
insurance pays 80%
H U E ADMINISTRATION
OS
C M ITE
O MT E
(Sangreas of UTE Uniteii States
HOUBE nf SlepreBentattueB
BiaBhington. S.(C. 2D515
F O R WHIP
LO
Dear Friends:
President Clinton, on September 22nd, called on Congress to enact
a major reform ofhealth care that will guarantee that every American
will have access to basic health care.
This special report examines the Clinton proposal in detail and gives
you the opportunity to express your opinion of the plan by filling out
a short questionnaire on the enclosed card. Additionally, during the
months ahead, I will hold a series of public meetings to discuss the
President's plan. The first of these meetings will be held in Fort Worth,
Corsicana, and Kerens on Saturday, October 23rd — then in Oak Cliff
and Waxahachie on Saturday, November 6th. (See box on this page.)
:
•
Prescription drugs
•
Mental health/substance abuse
Initial:
Inpatient services
30 days per episode; 60 days per
year maximum
Full coverage
Insurance pays 80%
Full coverage
Insurance pays 80%
Hospital alternatives
120 days maximum
Full coverage
Doesn't apply
Full coverage
Insurance pays 80%
Nonresidential
intensive services
120 days maximum
Doesn't apply
Insurance pays 80%
Doesn't apply
Doesn't apply
$10 per visit
All outpatient;
insurance pays 80%
All outpatient; $10 per
visit
All outpatient;
Insurance pays 80%
$25 per visit
Insurance pays 50%
Doesn't apply
Full coverage
Insurance pays 80%
Full coverage
Insurance pays 80%
Hospital alternatives
Full coverage
Doesn't apply
Doesn't apply
Doesn't apply
Nonresidential
intensive services
Doesn't apply
Insurance pays 80%
Full coverage
Insurance pays 80%
Outpatient including 1-12
psychotherapy visits
$10 per visit
Unlimited visits;
insurance pays 80%
$10 per visit
Insurance pays 80%
SATURDAY, OCTOBER 23, 1993
10:00 AM Martin Luther King Multipurpose Center
5565 Truman Drive
Fort Worth
1:00 PM City Commission Chambers
200 North 12th Street
Corsicana
3:00 PM Kerens Bank
1101 N.W. 2nd (Hwy. 31)
Kerens
SATURDAY, NOVEMBER 6, 1993
10:00 AM BaylorWorx Occupational Health
& Wellness Center
507 N. Hwy. 77 (at Hwy. 287)
Suite 700
Waxahachie
Doesn't apply
Added in 2001:
Inpatient services
Portions of President Clinton s plan are controversial, such as the
requirement that small businesses pay a significant part of their employees' insurance premiums. Certainly, some changes will be made;
and, I would like to receive your views before I decide how to vote
on these sweeping proposals.
Sincerely,
SPECIAL TOWN HALL
MEETINGS ON
HEALTH CARE
Brief office visit for
medical maintenance
Psychotherapy
30 visits maximum
MARTIN FROST
Member of Congress
1:30 PM Weiss Auditorium
Methodist Medical Center
1401 Stemmons Avenue
(Beckley & Colorado)
Oak Cliff (Dallas)
FOUR DISTRICT O F F I C E S TO S E R V E Y O U
Fort Worth Office
3020 S E. Loop 820
Fort Worth, Texas 76140
(817) 293-9231
1-800-846-6213 (toll-free)
Oak Cliff/Dallas
NationsBank, Suite 1319
400 South Zang Blvd.
Dallas, Texas 75208
(214) 948-3401
1-800-937-2056 (toll-free)
Arlington Offlce
318 W. Main St., Suite 102
Arlington, Texas 76010
(817) 795-3291
Corsicana
IOO N. Main Street, Room 534
Corsicana, Texas 75110
(903) 874-0760
1-800-292-4423 (tollrfree)
�The Cutting Edge
The House
Republican
Conference
Rep. Dick Armey
Chairman
October 8, 1993
Target Mail Program
Dear Republican Colleague:
Attached you will find a generic congressional newsletter on the Qinton health care plan and
the House Republican Affordable Health Care Now Act. This newsletter can be adapted and
personahzed by your office or used as a source of information for targeted constituent letters.
Although recent public opinion polls show that support for the Clinton plan is diminishing, a
majority of Americans still support i t Once the Clinton Administration puts its proposal into
legislation and the details become better known, I believe support for his plan will erode even further.
Republicans who oppose Clinton's massive takeover of a major part of our economy must
clearly convey to their constituents the reasons for their opposition and define what policies and
programs they support The attached newsletter is an effort to justify opposition to a big-government
approach to health care and support for the GOP health care initiative.
The sample newsletter was tentatively approved by the Franking Commission's minority staff.
If your office uses this sample newsletter, it must obtain the approval of the Franking
Commission.
It is my hope this newsletter is useful to you and your staff. If you have any questions about
this or other Conference services, please contact Brian Gaston, Director of Member Services, at x55107.
<
'AAA
DICK ARMEY
Chairman
1618 Longworth House Office Building, Washington, D.C. 20515 (202)225-5107
�Photo
Reports on Health Care
Congressman Jones Supports Health Care Reform
That Expands Coverage, Retains Choice, Controls
Cost and Preserves Jobs
n a speech to Congress on September 22, 1993, President Bill
Clinton outlined a "one-sizefits-all" prescription to reform
America's health care system. While
supporting efforts to provide quality
care to all Americans, Congressman
John Jones opposes a sweeping government takeover of a major part of
the economy.
"The President's proposal will
cost at least $700 billion - larger
than the entire federal budget in only
1981 - and add 50,000 government
workers to the bureaucracy. This
government-run social program is
the wrong medicine for what ails our
health care system. We can fix
specific problems without scrapping
the best health care system in the
I
Inside:
0
Details on
Health Plan
Clinton
0
Details on Affordable
Health Care Now Act
world," said Congressman John
Jones.
Congressman Jones recognizes
that American health care has some
serious problems and that attention
should be focused on areas that need
to be fixed. "American health care
is like a house with faulty wiring.
The prudent course of action is to
make the necessary repairs while
preserving the fundamentally sound
structure. Rather than tear down the
house with a wrecking ball and bulldozer, we should repair the faulty
wiring."
Accordingly, Congressman Jones
is supporting
the Affordable
Health Care
Now Act to expand coverage
to the uninsured, control
health care
costs, provide
health security,
preserve jobs,
and promote
consumer
choice.
With 125 cosponsors, the Affordable Health Care Now Act (H.R.
3080) has the most support of any
health care reform measure introduced so far in Congress. The bill is
paid for and does not add to the
budget deficit. In addition, unlike
the Clinton proposal, the Affordable
Health Care Now Act does not impose heavy-handed, job-killing mandates on small business.
Of fundamental importance, H.R.
3080 maintains choice. Consumers,
not the federal govemment, would
retain the right to choose how they
get their care and from whom.
�r/7e Clinton Health Plan
More Big Government: The President's plan has the federal government taking virtual control of the nation's health care system. It creates
59 new bureaucracies and programs. The two largest bureaucracies are:
;
l National Health Board - Seven Clinton appointees would
set price controls, issue regulations, and oversee all U.S.
health care services, and could even take control over the
state system.
^ Regional Health Alliances-Oversee consumer purchasing pools, collect all payroll taxes and premiums, and negotiate with insurance providers.
Less Consumer Choice: All Americans would have to accept the
mandated standard benefits package and many would no longer get to
choose their own doctors. Fee-for-service plans would be limited, and
acceptance to a fee-based plan could literally be based on a lottery. The only
other alternative to the White House plan is a single-payer system.
Paying More and Getting Less: Many middle class families will see
mandated increases in their health care costs. Families that had all their
health care costs covered by their employer will now have to pay a
percentage of the premium, as well as co-payments and deductibles.
Global Budgets = Price Controls: Premium caps could delay access
to routine health care, as well as slow down the introduction of new drugs,
treatments, and medical technologies.
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3
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Where He
o
X
c
0
e Money Came From in 1992
When you consider that
Medicare covers over 30 million older Americans, Medicaid covers 19 million poor
people, 160 million workers
and their dependents are covered by employers and other
private insurance, over 3 million have coverage from the
military, and over 2 million
receive health benefits through
the federal government, who
are the uninsured?
V^33.4 million Americans
were without any form of
health insurance in 1989.
>/ 17 million of the uninsured
hold jobs. They tend to be
small business, self-employed, part-time, or seasonal workers.
S 40% are under age 25.
S 3.8 million have family incomes of $50,000 or more
a year.
v ' 6.2 million have family incomes between $30,000
and $50,000 a year.
M
r
o
a
«
c
c
^ Not having insurance is a
temporary situation for
many people: 51% are
uninsured for less than 4
months; 72% are uninsured
for less than one year.
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E
o
o
a
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Who Are the
Uninsured?
Sourc*: Congrssafonal Budget Offlc*
�More
Spending
Despite the fact that the
American people want spending cuts first, the President's
health package calls for $177
billion in new entitlement
spending. This includes at
least $25 billion to pay 80
percent of the health insurance costs for all 55-64 year
olds who retire early, regardless of income. Thus, if
wealthy individuals retire at
age 55, the government (i.e.,
taxpayers) would pick up 80
percent of their insurance
through age 64.
Although the President
claims his health plan is paid
for, some private analysts estimate the proposal will increase the budget deficit by
$50 billion a year. And a
former chairman of the Council of Economic Advisers estimates the President's plan will
cost $120 billion more in its
first year than Clinton claims.
Health Reform We Can
Enact Now
The Affordable Health Care Now Act is a reasonable, common sense
health care plan that can be implemented quickly on a bipartisan basis. Its
reforms address the health concerns of the American people.
Expands health insurance access and coverage to the uninsured
by reforming the small group insurance market, increasing the number of
community health centers, giving the self-employed a 100 percent health
insurance deduction, and establishing Medisave Accounts.
Medisave - Allows individuals to control their own health care
spending by making tax deductible contributions to Medisave Accounts.
Interest in the accounts accumulates tax free.
Provides health security by limiting pre-existing condition restrictions. Individuals would not lose their insurance when they move from one
job to another.
Controls costs by reforming medical malpractice laws, simplifying
health care billing, and reducing paperwork.
Preserves jobs by imposing no mandated payroll taxes on employers.
iliji?
Small Busmess
Takes Big Hit
Small business owners are
already reeling from the
President's tax hikes, which
are retroactive to January 1,
1993. Now they will get hit
with a mandated 7.9% payroll tax on employers, and
these taxes could go even
higher. Some economists estimate the President's plan
could result in job losses as
high as 3 million. This is a tax
on hiring our already-weakened economy cannot afford.
Clinton's Solution: Spend$700 billion more and offer $177
* ilf&l^
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Tnnes'
Solution:
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o
$1,400
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tt
1980
Souro*: Congressional Budget Otflca
1985
1990
1993
1995 ; 2000:
5
o
DI
�How You Could Pay More Under the Clinton Plan
Example: You are a worker in a mid-size manufacturing company, earning $35,000 a year and have extensive family coverage.
Without Clinton's Plan: You don't have to pay an
insurance premium, which costs your company $5,550
a year. Your plan also has low cost sharing, so you pay
little when visiting the doctor.
Under Clinton's Plan: Your firm would have to buy
coverage for its employees through a regional health
alliance. You would pay 20 percent of the $4,200
premium, or $840. Your new plan would also provide
$210 less in benefits.
The Cost to You: Pay $1,050 more out of pocket for
fewer benefits.
CONGRESSMAN JONES OPPOSES A GOVERNMENT-RUN
HEALTH CARE SYSTEM
Congressman John Jones opposes President Clinton's
proposal to turn control of your health care over to a big
federal government bureaucracy. He supports a proposal that:
4 Guarantees you won't lose your insurance
>
when you change jobs by limiting pre-existing
condition restrictions.
h
Protects the middle class from paying more for
health care and getting less in coverage.
h
Curbs rising health care costs by implementing
medical malpractice laws, simplifying health care
billing, reducing paperwork, and combatting fraud
and waste.
Preserves jobs by imposing no mandated payroll taxes on employers.
& Isfiscallyresponsible by not adding more redink spending to the budget deficit.
& Promotes consumer choice by allowing families to continue to choose their own doctors.
Congmtf of tt)t Umttt) &tatrtf
ftouaf ot RtprrttnUtibrt
UJastiinjIon. DC 20313-0344
M.C.
OfFlClAi. B U S I M S I
Postal Patron
Xth Congressional District. State of Anywhere, USA
�4
Congresswoman
"
ROSA
DELAURO
QUESTIONNAIRE
ON HEALTH
CARE
^^^nm^mmmam^^mmJS^s^ Represehtihg South Central Connecticut
Congress ofthe United States
House of Representatives
Dear Friends:
In the next few months, Congress will take up President Clinton's proposals to
change the health insurance system in America. This will be a major debate that
affects every family. It is important that Congress weigh the issues very carefully
and make the right decisions for America.
I have included a "health care questionnaire" which I hope you will take the time
to fill out. It asks questions about your health insurance situation and your views
about possible health care reforms. These are important decisions ahead, and I
would like to hear from you personally. I want the kind of health care reform that
best serves the needs of people in our area.
I sent out a questionnaire last year and shared the results with those that
responded. Unfortunately, last year Congress and the President were in gridlock
and nothing happened on health care. But this year there is a new urgency and
both the President and Congress are sure to move ahead. I believe the leaders of
both parties want change. Please keep the pressure on and help me make the right
choices for our area by sending in this questionnaire. Your views matter.
I look forward to hearing from you.
Sincerely,
�CONGRESSWOMAN
1. Do you have health insurance?
• yes
ROSA
DELAURO
• no
2. If you are covered, is your coverage through
• an employer
Q Medicare
• purchased yourself
Q Medicaid
Q other
3. Are you generally satisfied or dissatisfied with the coverage provided by your current insurance?
•
satisfied
Q dissatisfied
4. Are you currently satisfied or dissatisfied with the health insurance system in the United States?
Q satisfied
Q dissatisfied
5. How much does your family spend for health care each month including your health insurance and any out
of pocket expenses for medical or drug bills?
•
•
less than $300
$500-600
•
•
$300-400
over $600
•
$400-500
6. Did the amount of money you paid for health care last year
Q remain steady
Q increase a little
Q increase a great deal
Please teU me whether each of the following is no problem, a minor problem or a major problem for you
and your family.
Minor
Major
No
Problem
Problem
Problem
1. Being denied health insurance because of a pre-existing condition.
u
u
u
2. Losing insurance coverage when changing jobs or becoming
unemployed.
LJ
•
•
3. The cost of health insurance.
•
u
4. The cost of prescription drugs.
U
5. Not having any health insurance coverage.
u
u
u
u
u
u
•
•
6. The cost of a major illness or hospital stay.
7. Overcharging or billing fraud by a hospital or doctor.
•
u
•
u
�QUESTIONNAIRE
ON HEALTH
CARE
President Clinton will soon be proposing major health care reform. Which of the following is
more important for you:
(choose one)
Making sure people have health care security, that they never lose health coverage again.
•
Making sure rising health care costs are brought under control.
Q
Let me read you a number of things that may be proposed by the President Please indicate
whether you favor or oppose each one.
Favor
Oppose
1. Government controls, limiting price increases for insurance, hospitals and doctors.
•
•
2. Requiring that all employers provide health insurance coverage to their employees.
•
•
3. The govemment establishing a comprehensive benefits package that must be
available to all Americans.
•
4. A big cigarette tax increase to help finance health care refonn.
•
•
5. Making insurance available to everyone through HMOs and doctor's networks
which may limit people's ability to choose any doctor.
•
•
6. Funding refonn with a payroll tax (with the employee paying 1 1/2 % of wages
and the employer paying 6 1/2 % of wages), instead of the current insurance premiums.
•
•
7. Health care caps or budgets that limit the increase ofhealth care costs to the
rate of inflation.
•
•
8. Extending prescription drug coverage and long term care to seniors under Medicare.
•
•
9. Extending the comprehensive insurance package to include mental health treatment.
•
Finally, if you were a member of Congress, which approach would you choose?
To vote for the President's major health care reform proposal after it is debated and amended
Q
To support a different and smaller package of changes that would improve health care but not
make so many drastic changes and that would be less costly for taxpayers.
Q,
QR
1. Some people say that health care reform could mean layoffs and job losses in the insurance industry in Connecticut. If
this were true, would you still favor or oppose health care reform?
| | favor
•
oppose
2. Some people say that requiring employers to provide health insurance will hurt small businesses and mean increased
unemployment. If this were true, would you now favor or oppose health care reform?
I I
favor
oppose
�NAME
ADDRESS
TOWN
Congresswoman Rosa DeLauro
327 Cannon House Office Building
U.S. House of Representatives
Washington, D.C. 20515
Please fold here so return address shows, stamp and mail.
Please include any ideas or thoughts on health care that
might help when thinking about how to change health
insurance in the United States. I would also welcome a
letter sharing your views.
U.S. Representative Rosa DeLauro discusses health care
at a recent "Neighborhood Office Hours"
Congresswoman.
RQSl
DELAURO
Congress of the United States
House of Representatives
Washington, DC 20515
Official Business
I.
/ / 4 dbuuCX-JM.C.
Bulkrate
Car. rt. Presort
WASHINGTON OFFICE
327 Cannon Building
Washington, DC 20515
(202) 225-3661
CONNECTICUT OFFICE
265 Church Street
New Haven, CT 06510
562-3718
Clinton Area
669-1181
Durham Area
344-1159
Stratford Area
378-9005
Postal Patron
Local Customer
Third District, Connecticut
�Financing Health Care Reform
Sources and Uses of Federal Funds *
500
Deficit Reduction $58
$389
Total Cost = $331
400
Revenue Gains $72
300
Tobacco Tax/Corp Asmnt $89
200
100
Medicaid Savings $64
Premium Discounts For
Business and Families $ 116
Stflf-Eiiiployt?d Tdx Dtfdct$tQ|
Medicare Drug Benefit $66
Medicare Sayings $124
PubUc Health/Admin. $29"
0
Sources of Funds
* Billions of Dollars; Five Year Totals (1995-2000)
Uses of Funds
�peter Hoagiand: H E A L T H C A R E F O R N E B R A S K A F A M I L I E S
Affordable Health Care
Why We Need Change
Special Needs of Seniors
National spending for health is increasing more rapidly than
national income. The average Nebraska family now spends 13 percent of
its family income on health care. And that figure is going up!
I am working to contain costs without diminishing the quality of
care by encouraging hospitals and clinics to share expensive, high-tech
devices like $2 million lithotriptors which pulverize kidney stones. It is
senseless to duplicate expensive medical technology when one piece of
equipment will do rather than engage in what some people call a
"medical arms race" among hospitals and clinics.
In addition, I support cutting insurance costs by developing a
simplified universal insurance form to reduce paperwork and the cost of
administering insurance plans.
We must control the escalating cost of health care to ensure that
families have high quality, accessible health care at an affordable price.
>/( Health care and health insurance costs are skyrocketing.
As our population ages, seniors are forced to shoulder a greater
burden of their health care needs. Medicare only pays for about 50
percent of seniors' health care expenses. Seniors must either purchase
costly insurance to bridge the coverage gap (so called "Medigap" insurance) or make do without coverage.
Families spend an average of $1,700 per year on out-of-pocket
health care costs.
Health insurance policies often cover less than we anticipate.
Vj' Small businesses have difficulty finding affordable insurance.
vf^ Access to our own doctors may be threatened.
^
Senior citizens are plagued by the soaring costs of critical
prescription drugs.
\ { Many Americans are calling for health care reform.
Preventive Health Care
Not receiving care often costs us lives and dollars. Breast cancer is a
good example. Late diagnosis and treatment of breast cancer frequently
results in premature death and adds as much as $60,000 to the cost of
treatment. One in nine women today will be diagnosed with breast cancer.
I am cosponsoring legislation to provide Medicare coverage for
routine, annual screening for breast cancer, and I support efforts to boost
research for diseases like osteoporosis, breast cancer and prostate cancer.
"/ am cosponsoring legislation to provide Medicare
coverage for routine, annual screening for breast
cancer."
Hoagiand discussing the need for affordable health care with other Nebraskans.
I have introduced a bill to provide Medicare coverage for an annual
preventive physicalexam to catch problems early. Using preventive care
to stay healthy is good common sense and needs to be included in any
health care reform.
re
s
A bill to p
services u,
"I am pressing for the development of long-term
care that is effective, affordable and accessible."
Because long-term and catastrophic health care insurance are
necessities, we need more affordable plans providing those types of
coverage. I am pressing for the development of long-term care that is
effective, affordable and accessible. I have introduced a bill to provide
more home health services when sick.
Everyone wants the dignity of self-sufficiency and the comfort of
being in one's own home.
Keeping our Children Healthy
>
home whe
^
A bill to p
annual pn
help catch \
vf A bill to re
information
newborns a
"super vacc
One ofthe most important things Congress can do is to ensure that
America's children get a healthy start in life. I have introduced two bills
to facilitate and encourage the immunization of children. While we have
been largely successful in vaccinating school-aged children, we have not
done so well with pre-schoolers.
vf A billto de.
Studies show that only 61 percent of our kindergarten-age children
in the Omaha-Sarpy County area were properly vaccinated at age two.
Studies also show that every dollar spent on immunizations saves as
much as $12 in later treatment costs. Immunizations save money and
keep kids healthy.
vf ' A bill' to esl
hospitals an
medical tech
'insurance ti
�D ME ABOUT HEALTH C A R E
What Nebraskans Told
Peter Hoagiand About
Health Care
'our views on health care in
\at you told me and I have
e of the problems.
2 of mind and a healthy life,
e security of knowing that
and affordable. We must all
Respondents
to 1992
MAKING HEALTH CARE AFFORDABLE
Questionnaire
v f 61% feel the current health care system is
inadequate.
v f 66% believe Congress's top priority in reforming the health care system should be to
ensure that all Americans have access to
health insurance.
v f 59% believe people should be able to choose
their own physicians.
[vf 76% want to keep the quality ofhealth care at
the highest possible level.
of the United States
of Representatives
ishington, D.C.
Official Business
Congressman V e t e X H o a g l a t l d
M.C.
Bulk Raie
�OCT"
e -93 10:40 FROM GREENBERG RESEARCH
TO 45G23G2-175
PAGE.002/003
MEMORANDUM
TO:
Steve E d e l s t e i n
FROM!
Joe Goode
RE:
Suggested questions
DATE:
October 6, 199 3
Here are some questions we have used and that p u b l i c p o l l s
Choose as you see f i t .
use.
1. Are you personally very s a t i s f i e d , somewhat s a t i s f i e d , somewhat
d i s s a t i s f i e d or very d i s s a t i s f i e d w i t h your own h e a l t h insurance
plan, or are you uninsured a t t h i s time?
Very s a t i s f i e d
Somewhat s a t i s f i e d
Somewhat d i s s a t i s f i e d
Very d i s s a t i s f i e d
No insurance a t t h i s time
(Not sure)
2. Think about the cost of your own h e a l t h care -- what you have t o
pay f o r insurance, out-of-pocket expenses, such as p r e s c r i p t i o n
drugs and doctor and h o s p i t a l b i l l s .
Are you personally very
s a t i s f i e d , somewhat s a t i s f i e d , somewhat d i s s a t i s f i e d o r very
d i s s a t i s f i e d w i t h the cost of your own h e a l t h insurance plan?
Very s a t i s f i e d
Somewhat s a t i s f i e d
Somewhat d i s s a t i s f i e d
Very d i s s a t i s f i e d
No insurance at t h i s time
(Not sure)
�OCT
6 '93 10:41
FROM GREENBERG RESEARCH
TO 4562362-175
PAGE.003/003
3. Think about the s e c u r i t y o f your own health care -- the
p o s s i b i l i t y o f l o s i n g or being denied insurance coverage or o f
having a p o l i c y that doesn't cover major expenses.
Are you
personally
very
satisfied,
somewhat
satisfied,
somewhat
d i s s a t i s f i e d or very d i s s a t i s f i e d w i t h the s e c u r i t y of your own
h e a l t h insurance plan?
Very s a t i s f i e d
Somewhat s a t i s f i e d
Somewhat d i s s a t i s f i e d
Very d i s s a t i s f i e d
No insurance a t t h i s time
(Not sure)
4. Are you very s a t i s f i e d ,
somewhat s a t i s f i e d ,
somewhat
d i s s a t i s f i e d or very d i s s a t i s f i e d w i t h the health insurance system
i n the United States generally?
Very s a t i s f i e d
Somewhat s a t i s f i e d
Somewhat d i s s a t i s f i e d
Very d i s s a t i s f i e d
5. Which of the f o l l o w i n g do you agree w i t h most:
A. On the whole, the health care system i n America works
w e l l but some changes are necessary.
B. There are some good things.about the health care s y s t e m
America, but some major changes are needed.
pretty
in
C. America's h e a l t h care system i s so inadequate
and has so many problems t h a t we need t o completely r e b u i l d i t .
6. Do you favor o r oppose changing the h e a l t h care system t o
guarantee t h a t a l l Americans have h e a l t h insurance?
Favor
Oppose
Undecided
7. Do you favor or oppose changing the health care system so that
people w i t h p r e - e x i s t i n g conditions cannot be denied insurance or
have t h e i r premiums raised j u s t because they are sick?
Favor
Oppose
Undecided
�LU
D
:£ * Why time is running out for local families, business owners
^ j:.. * What Congress must do to enact affordable health care^
Z |:
^ " " ^ :x: :v: ^ " : ^
_ •:. * How you can make sure they do the job right
M&MZy^
; ;::::::::::::::::
:::
:::::
:
:
;
:
:
: :
HEAL TH CARE REFORM NO Wi
A Family Action Update From Congressman John Doe
September, 199:
i-'^iivniiiiiiiiiiijfc
"Why do I believe that access to health care in America should be a
right and not a privUege? Because I've listened to the daily struggles of
working families and small businessmen."
- Congressman John Doe
mm
•V.*' V . ' .
�. •
•
%
..;'\V, ' ;
v
I*'*-*.'
We just can't afford to get
sick, Congressman. What kind
of life is that?"
August 20, 1993
Dear Congressman Doe,
Text o f c o n s t i t u e n t
letter.
Text o f l e t t e r . Text o f l e t t e r . Text
of l e t t e r . Text o f l e t t e r .
Text o f l e t t e r . Text of l e t t e r .
Text' o f l e t t e r . Text o f l e t t e r . Text
of l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text of l e t t e r . Text o f
l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r .
Text o f l e t t e r . Text o f l e t t e r .
Text o f l e t t e r . Text o f l e t t e r . Text
o f l e t t e r . T e x t o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r .
T e x t o f l e t t e r . Text o f l e t t e r . Text
o f l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text of l e t t e r . Text o f
l e t t e r . Text of l e t t e r .
Text o f l e t t e r . Text of l e t t e r .
Text o f l e t t e r . Text o f l e t t e r . Text
of l e t t e r . Text of l e t t e r . Text of
letter.
Text of l e t t e r . Text o f
l e t t e r . Text of l e t t e r . Text o f
l e t t e r . T e x t of l e t t e r . Text o f
l e t t e r . Text of l e t t e r . Text o f
l e t t e r . Text o f l e t t e r .
Text o f l e t t e r . Text o f l e t t e r .
Text o f l e t t e r .
Sincerely,
Constituent
Town o f r e s i d e n c e
These are but two of thousands
of similar stories from people all
over our state. Sotries that tell
the painful truth about the need
for rea/ health care reform.
- Congressman John Doe
�Dear fellow (State) citizen,
As these two stones confirm, the reality of the health
care crisis in America is shocking.
In our state alone, 1 million people are currently
without even basic coverage. Small businesses laid off 23,000
workers last year because they were unable to afford coverage
tor their employees. Prescription drug costs have risen 12%
in the last 6 months alone. Every day the possibility grows
that catastrophic illness could wipe out a t'airuly's entire lite
savings. It's past time we cured the health care crisis.
Now, my colleagues and I in Congress are faced with
the challenge of our lives — overhauling America's health care
system. There are many different people with many different
ideas about how to go about streamlining the system and
cutting costs. But any national health care plan must guarantee
".ccess to health care as a right, not a privilege.
I ' l l work to make sure health care reform includes...
Choice of doctor and hospital
Coverage for prescription drug, eye-care, and dental costs
No denial for pre-existing conditions
No deductible and no-copayments
Long-term nursing home care
Preventative health care services
Reduced paperwork
Protection for Social Security and Medicare
Please join me in supporting health care reform. It
you have any thoughts, suggestions, or comments about health
care reform, please feel free to write or call uic at the
HEALTH CARE HOTLINE phone number listed below.
I look forward to hearing from you.
*
*
*
*
*
*
*
*
John Doe
U.S. House of Representatives
l-202-IVlEMBER#
1-000-DISTRICT^
�Making sure
everyone's covered
You probably already know what you want
for yourself in health care reform:
affordability, accessability, and quality care.
But how do your neighbors feel about health
care reform? Or doctors? What's their
viewpoint?
And small busmess owners - how do they
feel? Or salespeople? Auto factory managers?
Workers? Teachers? Technicians?
"Making Health Care Reform
Work for Everyone"
The one thing we know about the health care
crisis is that it affects everyone — and
everyone has a stake in the success of health
care reform.
A panel of citizens with
Congressman John Doe
Tfiufsday, SepftmBer 15; 1993, 7:00 p.m.
Main Student Center Auditorium at the
State University
1000 University Avenue
City
Congressman John Doe and his colleagues
have assembled panels of citizens from all
occupations -- doctors, managers, insurance
executives, workers, teachers — to discuss
what health care reform must include, and to
hear what you have to say.
Please come to your night of "Making Health
Care Reform Work for Everyone" on
Thursday, September 15.
Please call the
HEALTH CARE HOTLINE
for more information
1-202-M
ER# or l-(999)-DISTRICT
Congress of the United States
House of Representatives
Washington, D.C. 20515
Official Buiiness
TARGETTED MAIL
LABEL HERE
M.C.
BIk. Rt.
CAR-RT-SORT
�CONGRESSMAN
Ron Coleman
�WORKING FOR THE HEALTH
OF WEST TEXAS FAMILIES
T
he thought of getting sick or hurt but being unable
to pay the medical bills is frightening. It's a scenario
that more and more Americans are having to face.
Today, more than 35 million Americans have no health
insurance and an additional 26 million will be without health
insurance at any one time this year. Additionally, 60 million
others have inadequate coverage. That
means more than 121 million people,
about half the people in our country,
have no insurance or are underinsured!
IK
Health costs are too
high
The bill for America's health care
last year was $675 billion. That's more
than double the defense budget!
Compared with other countries, our
health care costs: 171% more than
Great Britain; 124% more than Japan;
88% more than Germany; and 38%
more than Canada. And though we
have the best health care professionals
in the world, we're not delivering
health care very well.
Our health care system is in critical
condition. Instead of a President who
plays doctor to the world, we now need
a doctor for America.
What can be done?
Here is a brief summary of the different health care
proposals we are currently considering in Congress. Please
take a moment to read the summary, fill out the questionnaire on the back and send it to my office. Or bring it with
you to the Health Care Town Hall Meeting on January 14.
An invitation to the town meeting is on the back of the
questionnaire.
I need to hear your thoughts on Health Care, so our views
will be taken into account as Congress votes on these and
other proposals.
Three Basic Ideas
also be covered under the public plan.
The bills outline minimum benefits that would be provided by employer-sponsored plans, and by the public plan.
These proposals also include provisions to keep overall
health costs down with ideas such as the creation of a
Federal Health Expenditure Board to monitor overall health
care spending, and major reforms of
the private insurance market.
The Canadian Model
Many Americans have been looking
to the Canadian system of health care
as a model to reform our own system.
Under a plan like Canada's, the
govemment would become the "single
payor" provider of all of the nation's
health insurance. Some of these types
of plans suggest a federal/state
partnership to finance health insurance.
Others provide that the federal
govemment will be the main source of
funding.
Under this model, the delivery of
health care services would remain in
private hands — the same doctors and
hospitals you rely on now. Proponents
claim that a national health insurance
plan would reduce health care costs by
cutting administrative costs.
Building on the current system
The third type of proposal would build on the existing
health care system instead of rebuilding it. For example,
Medicare and Medicaid programs could be expanded to
reach a larger number of Americans. Another option is to
provide tax incentives to encourage employers to provide
health care coverage, and to make it easier for the selfemployed to afford insurance. State insurance pools could
be created to provide for those not insured through their
employers.
To control costs, optional payment rates could be
established for hospitals, physicians, and other medical
services based on current Medicare rates.
There are many different health care reform bills we are
considering in Congress. They fall into three basic categories.
Each plan addresses the same issues of insuring the
uninsured and cutting health care costs.
Congressman Coleman —
Listening to West Texas
on Health Care
The "Pay or Play" Idea
We need to create a health care system that delivers
quality health care at a reasonable cost to all people. Before
we move ahead, we need to decide which type of plan would
best serve the families of West Texas. Please take a minute
to fill out the questionnaire on the back, and send it to me
or bring it to the town meeting. I look forward to hearing
from you.
Several bills outline slightly different variations of a socalled "pay or play" system. Under this plan, businesses
would have a choice of either paying for an employee's
health insurance or paying into a public plan that would
cover the uninsured. People who are not currently working,
and low income people now covered by Medicaid, would
�CONGRESSMAN COLEMAN'S
Health Care Questionnaire
Please take a minute to fill out, clip, and mail this questionnaire. By listening to your ideas on
health care, I can better represent West Texas families.
1)
O f the health care r e f o n n plans o u t l i n e d i n this newsletter, w h i c h do y o u feel is the best?
(Please circle one answer)
a) The "pay or play" system in which businesses would provide employee insurance or pay into a federal
system that would cover all uninsured citizens.
b) A Canadian-style health care system in which everyone is insured through the govemment but care is
provided through private doctors and hospitals.
c) Other:
2)
Please tell me about your health insurance coverage.
(Please circle one answer)
a) I am one of the 35 million Americans who is currently uninsured.
b) I have health insurance, but would like better coverage, and/or lower rates.
c) I have good quality, affordable health insurance.
3)
Please rate the issues that are most i m p o r t a n t to y o u about a health care r e f o r m plan.
(Please circle three choices)
a) lowering cost of insurance
b) lowering costs of procedures
c) simplified insurance forms
d) making sure businesses are not harmed by higher insurance costs
e) making sure all Americans have health insurance regardless of their ability to pay
f)
keeping the quality of health care at the highest possible level
g) making sure people still get to choose their own doctors
4)
Comments: Please w r i t e d o w n any other thoughts or comments y o u have about the problems
and solutions of America's health care, i n c l u d i n g problems y o u may personally have w i t h the
system.
�Name _
PLEASE
Address
PLACE
29C
STAMP
HERE
Congressman Ron Coleman
440 Cannon HOB
Washington, DC 20515
(please (old here, this panel out, stamp and mail)
RESPONDING T O T H B ^
HEALTH CARECRISISS^
IN AMERICA: A^ERSaS
WEST T E X A S S ^ i l
Town MeetinfriH^^
Tuesday,-January 14^^^^^
5:30 p.m.,
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Congressman Ron Coleman knows that for our children
to grow up strong, independent, and successful, they first
need to grow up healthy.
Congress of the United States
House of Representatives
Washington, D.C. 20515
M.C.
Bulk Rate
Car-Rt. Presort
Official Business
Postal Patron
16th Congressional District
Texas
PRINTED ON 100% RECYCLED PAPER WITH SOY INK
media *™-2168
�IThe Cutting Edge
^
The House
Republican
Conference
Rep. Dick Armey
Chairman
October 8, 1993
Target Mail Program
Dear Republican Colleague:
Attached you will find a generic congressional newsletter on the Qinton health care plan and
the House Republican Affordable Health Care Now Act. This newsletter can be adapted and
personahzed by your office or used as a source of information for targeted constituent letters.
Although recent public opinion polls show that support for the Clinton plan is diminishing, a
majority of Americans still support iL Once the Qinton Administration puts its proposal into
legislation and the details become better known, I believe support for his plan will erode even further.
Republicans who oppose Clinton's massive takeover of a major part of our economy must
clearly convey to their constituents the reasons for their opposition and define what policies and
programs they support The attached newsletter is an effort to justify opposition to a big-government
approach to health care and support for the GOP health care initiative.
The sample newsletter was tentatively approved by the Franking Commission's minority staff.
If your office uses this sample newsletter, it must obtain the approval of the Franking
Commission.
It is my hope this newsletter is useful to you and your staff. If you have any questions about
this or other Conference services, please contact Brian Gaston, Director of Member Services, at x55107.
C
'AAA
DICK ARMEY
Chairman
1618 Longworth House Office Building, Washington, D.C. 20515 (202)225-5107
�4
Photo
.. ^ . ^ _ _ _
^
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Congressman Jones Supports Health Care Reform
That Expands Coverage, Retains Choice, Controls
Cost and Preserves Jobs
n a speech to Congress on September 22, 1993, President Bill
Clinton outlined a "one-sizefits-all" prescription to reform
America's health care system. While
supporting efforts to provide quality
care to all Americans, Congressman
John Jones opposes a sweeping government takeover of a major part of
the economy.
"The President's proposal will
cost at least $700 billion - larger
than the entire federal budget in only
1981 - and add 50,000 government
workers to the bureaucracy. This
government-run social program is
the wrong medicine for what ails our
health care system. We can fix
specific problems without scrapping
the best health care system in the
I
Inside:
0
Details on
Health Plan
Clinton
0
Details on Affordable
Health Care Now Act
world," said Congressman John
Jones.
Congressman Jones recognizes
that American health care has some
serious problems and that attention
should be focused on areas that need
to be fixed. "American health care
is like a house with faulty wiring.
The prudent course of action is to
make the necessary repairs while
preserving the fundamentally sound
structure. Rather than tear down the
house with a wrecking ball and bulldozer, we should repair the faulty
wiring."
Accordingly, Congressman Jones
is supporting
the Affordable
Health Care
Now Act to expand coverage
to the uninsured, control
health care
costs, provide
health security,
preserve jobs,
and promote
consumer
choice.
With 125 cosponsors, the Affordable Health Care Now Act (H.R.
3080) has the most support of any
health care reform measure introduced so far in Congress. The bill is
paid for and does not add to the
budget deficit. In addition, unlike
the Clinton proposal, the Affordable
Health Care Now Act does not impose heavy-handed, job-killing mandates on small business.
Of fundamental importance, H.R.
3080 maintains choice. Consumers,
not the federal govemment, would
retain the right to choose how they
get their care and from whom.
�r/7e Clinton Health Plan
More Big Government: The President's plan has the federal government taking virtual control of the nation's health care system. It creates
59 new bureaucracies and programs. The two largest bureaucracies are:
< National Health Board - Seven Clinton appointees would
?
set price controls, issue regulations, and oversee all U.S.
health care services, and could even take control over the
state system.
< Regional Health Alliances - Oversee consumer purchas?
ing pools, collect all payroll taxes and premiums, and negotiate with insurance providers.
Less Consumer Choice: All Americans would have to accept the
mandated standard benefits package and many would no longer get to
choose their own doctors. Fee-for-service plans would be limited, and
acceptance to a fee-based plan could literally be based on a lottery. The only
other alternative to the White House plan is a single-payer system.
Paying More and Getting Less: Many middle class families will see
mandated increases in their health care costs. Families that had all their
health care costs covered by their employer will now have to pay a
percentage of the premium, as well as co-payments and deductibles.
Global Budgets = Price Controls: Premium caps could delay access
to routine health care, as well as slow down the introduction of new drugs,
treatments, and medical technologies.
£
a
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8
Where Hi
x
c
o
When you consider that
Medicare covers over 30 million older Americans, Medicaid covers 19 million poor
people, 160 million workers
and their dependents are covered by employers and other
private insurance, over 3 million have coverage from the
military, and over 2 million
receive health benefits through
the federal government, who
are the uninsured?
^33.4 million Americans
were without any form of
health insurance in 1989.
S 17 million of the uninsured
hold jobs. They tend to be
small business, self-employed, part-time, or seasonal workers.
40% are under age 25.
v ' 3.8 million have family incomes of $50,000 or more
a year.
S 6.2 million have family incomes between $30,000
and $50,000 a year.
(fl
r
£
c
o
V' Not having insurance is a
temporary situation for
many people: 51% are
uninsured for less than 4
months; 72% are uninsured
for less than one year.
-J
o
u
0.
Who Are the
Uninsured?
Source: Congrssalonaf Buiget Office
�More
Spending
Despite the fact that the
American people want spending cuts first, the President's
health package calls for $177
billion in new entitlement
spending. This includes at
least $25 billion to pay 80
percent of the health insurance costs for all 55-64 year
olds who retire early, regardless of income. Thus, if
wealthy individuals retire at
age 55, the government (i.e.,
taxpayers) would pick up 80
percent of their insurance
through age 64.
Although the President
claims his health plan is paid
for, some private analysts estimate the proposal will increase the budget deficit by
$50 billion a year. And a
former chairman of the Council of Economic Advisers estimates the President's plan will
cost $120 billion more in its
first year than Clinton claims.
Small Business
Takes Big Hit
Health Reform We Can
Enact Now
The Affordable Health Care Now Act is a reasonable, common sense
health care plan that can be implemented quickly on a bipartisan basis. Its
reforms address the health concerns of the American people.
Expands health insurance access and coverage to the uninsured
by reforming the small group insurance market, increasing the number of
community health centers, giving the self-employed a 100 percent health
insurance deduction, and establishing Medisave Accounts.
Medisave - Allows individuals to control their own health care
spending by making tax deductible contributions to Medisave Accounts.
Interest in the accounts accumulates tax free.
Provides health security by limiting pre-existing condition restrictions. Individuals would not lose their insurance when they move from one
job to another.
Controls costs by reforming medical malpractice laws, simplifying
health care billing, and reducing paperwork.
Preserves jobs by imposing no mandated payroll taxes on employers.
llSlliliiPt:
Clinton's Solution: Spend $700 billion more and offer $177
Jones'Solution: Medk^mcdpractker^onm and less bureaucracy
a
Small business owners are
already reeling from the
President's tax hikes, which
are retroactive to January 1,
1993. Now they will get hit
with a mandated 7.9% payroll tax on employers, and
these taxes could go even
higher. Some economists estimate the President's plan
could result in job losses as
high as 3 million. This is a tax
on hiring our already-weakened economy cannot afford.
?
3
3
a
w
!
2
a
O
Source: Congreestonal Budgat Office
0)
�How You Could Pay More Under the Clinton Plan
Example: You are a worker in a mid-size manufacturing company, earning $35,000 a year and have extensive family coverage.
Without Clinton's Plan: You don't have to pay an
insurance premium, which costs your company $5,550
a year. Your plan also has low cost sharing, so you pay
little when visiting the doctor.
Under Clinton's Plan: Your firm would have to buy
coverage for its employees through a regional health
alliance. You would pay 20 percent of the $4,200
premium, or $840. Your new plan would also provide
$210 less in benefits.
The Cost to You: Pay $1,050 more out of pocket for
fewer benefits.
CONGRESSMAN JONES OPPOSES A GOVERNMENT-RUN
HEALTH CARE SYSTEM
Congressman John Jones opposes President Clinton's
proposal to turn control of your health care over to a big
federal government bureaucracy. He supports a proposal that:
4> Protects the middle class from paying more for
health care and getting less in coverage.
& Curbs rising health care costs by implementing
medical malpractice laws, simplifying health care
billing, reducing paperwork, and combatting fraud
and waste.
Guarantees you won't lose your insurance
when you change jobs by limiting pre-existing
condition restrictions.
Preserves jobs by imposing no mandated payroll taxes on employers.
& Is fiscally responsible by not adding more redink spending to the budget deficit.
& Promotes consumer choice by allowing families to continue to choose their own doctors.
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�'
J
CONGRESSMAN
Ron Coleman
�WORKING FOR THE HEALTH
OF WEST TEXAS FAMILIES
T
he thought of getting sick or hurt but being unable
to pay the medical bills is frightening. It's a scenario
that more and more Americans are having to face.
Today, more than 35 million Americans have no health
insurance and an additional 26 million will be without health
insurance at any one time this year. Additionally, 60 million
others have inadequate coverage. That
means more than 121 million people,
about half the people in our country,
have no insurance or are underinsured!
Health costs are too
high
The bill for America's health care
last year was $675 billion. That's more
than double the defense budget!
Compared with other countries, our
health care costs: 171% more than
Great Britain; 124% more than Japan;
88% more than Germany; and 38%
more than Canada. And though we
have the best health care professionals
in the world, we're not delivering
health care very well.
Our health care system is in critical
condition. Instead of a President who
plays doctor to the world, we now need
a doctor for America.
What can be done?
Here is a brief summary of the different health care
proposals we are currently considering in Congress. Please
take a moment to read the summary, fill out the questionnaire on the back and send it to my office. Or bring it with
you to the Health Care Town Hall Meeting on January 14.
An invitation to the town meeting is on the back of the
questionnaire.
I need to hear your thoughts on Health Care, so our views
will be taken into account as Congress votes on these and
other proposals.
Three Basic Ideas
also be covered under the public plan.
The bills outline minimum benefits that would be provided by employer-sponsored plans, and by the public plan.
These proposals also include provisions to keep overall
health costs down with ideas such as the creation of a
Federal Health Expenditure Board to monitor overall health
care spending, and major reforms of
the private insurance market.
The Canadian Model
Many Americans have been looking
to the Canadian system of health care
as a model to reform our own system.
Under a plan like Canada's, the
govemment would become the "single
payor" provider of all of the nation's
health insurance. Some of these types
of plans suggest a federal/state
partnership to finance health insurance.
Others provide that the federal
govemment will be the main source of
funding.
Under this model, the delivery of
health care services would remain in
private hands — the same doctors and
hospitals you rely on now. Proponents
claim that a national health insurance
plan would reduce health care costs by
cutting administrative costs.
Building on the current system
The third type of proposal would build on the existing
health care system instead of rebuilding it. For example,
Medicare and Medicaid programs could be expanded to
reach a larger number of Americans. Another option is to
provide tax incentives to encourage employers to provide
health care coverage, and to make it easier for the selfemployed to afford insurance. State insurance pools could
be created to provide for those not insured through their
employers.
To control costs, optional payment rates could be
established for hospitals, physicians, and other medical
services based on current Medicare rates.
There are many different health care reform bills we are
considering in Congress. They fall into three basic categories.
Each plan addresses the same issues of insuring the
uninsured and cutting health care costs.
Congressman Coleman —
Listening to West Texas
on Health Care
The "Pay or Play" Idea
We need to create a health care system that delivers
quality health care at a reasonable cost to all people. Before
we move ahead, we need to decide which type of plan would
best serve the families of West Texas. Please take a minute
to fill out the questionnaire on the back, and send it to me
or bring it to the town meeting. I look forward to hearing
from you.
Several bills outline slightly different variations of a socalled "pay or play" system. Under this plan, businesses
would have a choice of either paying for an employee's
health insurance or paying into a public plan that would
cover the uninsured. People who are not currently working,
and low income people now covered by Medicaid, would
�1
4
?v.JiR«W(S6Sf:
CONGRESSMAN COLEMAN'S
Health Care Questionnaire
Please take a minute to fill out, clip, and mail this questionnaire. By listening to your ideas on
health care, I can better represent West Texas families.
1)
O f the health care r e f o r m plans o u t l i n e d i n this newsletter, w h i c h do y o u feel is the best?
(Please circle one answer)
a) The "pay or play" system in which businesses would provide employee insurance or pay into a federal
system that would cover all uninsured citizens.
b) A Canadian-style health care system in which everyone is insured through the government but care is
provided through private doctors and hospitals.
c) Other:
2)
Please tell tne about y o u r health insurance coverage.
(Please circle one answer)
a) I am one of the 35 million Americans who is currently uninsured.
b) I have health insurance, but would like better coverage, and/or lower rates.
c) I have good quality, affordable health insurance.
3)
Please rate the issues that are most i m p o r t a n t to y o u about a health care r e f o r m plan.
(Please circle three choices)
a) lowering cost of insurance
b) lowering costs of procedures
c) simplified insurance forms
d) making sure businesses are not harmed by higher insurance costs
e) making sure all Americans have health insurance regardless of their ability to pay
f)
keeping the quality of health care at the highest possible level
g) making sure people still get to choose their own doctors
4)
Comments: Please w r i t e d o w n any other thoughts or comments y o u have about the problems
and solutions of America's health care, i n c l u d i n g problems y o u may personally have w i t h the
system.
�Name _
Address
Congressman Ron Coleman
440 Cannon HOB
Washington, DC 20515
(please fold here, this panel out, stamp and mail)
RESPONDING-^CSSffl^S
•.'.' MisenKimCT-Au^toiS^^^f^ll
;
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(behind'
Congressman Ron Coleman knows that for our children
to grow up strong, independent, and successful, they first
need to grow up healthy.
Congress of the United States
House of Representatives
Washington, D.C. 20515
M.C.
Bulk Rate
Car-Rt. Presort
Official Business
Postal Patron
16th Congressional District
Texas
PRINTED ON 100% RECYCLED PAPER WITH SOY INK
media • 58 216«
�Congressman
Murray Neimand
Health Care Reform:
Special Report to Small Businesses.
District Office: 9353 Roslyndale Avenue, Pacoima, CA 91331, 818/988-2989
Washington Office: 000 Rayburn House Office Bldg., Washington, DC 20515, 202/225-0000
Health Care Reform and Your Business.
Survey results find Small Business support for
health care refonn.
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Containing Medical Costs.
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An eye on payroll expenditures.
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Special Incentives for Small Businesses.
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A gradual shift In service delivery.
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What are your views?
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�ow It Work:
BASIC BENEFITS PACKAGE
PART-TIME WORKERS
Most people in the country would obtain health insurance through a new entity — a local health alliance.
Exceptions would be current Medicare recipients, military personnel, veterans, and Native Americans who would
continue to be covered under their existing programs. Illegal aliens would not be covered under any program.
Three basic types of plans would exist: (1) low cost sharing (HMO-style), (2) high cost sharing (fee-for-service styles),
and (3) combination (preferred provider style). HMO-style
plans would have the lowest premiums, and fee-for-service
plans would have the highest premiums.
Employers would pay 80 percent of the premiums for
full-time workers, and the workers would pay the remaining 20 percent. Employers would pay a smaller percentage
of the cost for part-time workers, depending upon how many
hours per week they work. Most low income workers and
the unemployed would have their share of insurance premiums, at least partially, subsidized by the government.
Deductibles and co-payments would vary, depending
upon the type of plan selected by the beneficiaries. HMO's
typically would have a $10 co-payment for doctor's visits
and a $5 co-payment for prescription drugs. Fee-for-service
plans would have a 20 percent co-payment for doctor's fees
and hospital visits. Fee-for-service plans would also have
a $200 per person and $400 per family deductible.
Combination plans would have a low co-payment, if you
are treated by a preferred provider doctor or hospital, and
a higher co-payment if you are treated by a provider outside the preferred network. (For a comparison of benefits
under the three types of basic plans, see the chart on p.
4 of this newsletter.
All of the plans would cap out-of-pocket expenses at
$1,500 per person and $3,000 per family each year, regardless of deductibles or co-payments.
Part-time workers are responsible for the 20 percent employee share of the premium, and workers with incomes
below 150 percent of the poverty level receive discounts.
The number of hours an employee works determines the
ratio of the premium percentage paid by the employee and
the employer, with discounts provided for low-income employees. Employers pay a pro-rated amount for employees
who work between 10 and 30 hours per week.
Employees working less than 10 hours per week would
be responsible for their own permiums, but they would also
likely be eligible for subsidies.
FULL-TIME WORKERS
Employers would be required to pay 80 percent of the
average health plan premium in their area, with full-time
workers paying the other 20 percent. The projected average annual cost of a plan for an individual would be about
$1,800; thus, the employer would pay about $1,440 (80%)
and the employee $360 (20%).
Family premiums (husband, wife and children) are estimated to cost about $4,200. Thus, the employer would
pick up $3,360 (80%) and the family $840 (20%). Individuals and families with incomes below 150 percent of the federal poverty level — $21,525 for a family of four — are
eligible for discounts on the employee's 20 percent share
of the premium. A full-time worker is defined as someone
working at least 30 hours a week.
UNEMPLOYED
Individuals who currently receive welfare benefits and
currently receive Medicaid will be insured through local
health alliances, with Medicaid picking up all of the costs.
Other low income, unemployed people will also receive insurance through their local alliance — but at a discount, depending on what income sources they may have.
Unemployed persons with substantial sources of income,
such as investments, may pay the full cost of insurance
through their local alliance.
SENIOR CITIZENS
Medicare will remain a separate program under the new
system. Those people currently on Medicare (already over
65) will continue to receive their health care in that program.
Beneficiaries would also receive a new prescription drug
benefit. It would carry a $250 annual deductible.
Once the deductible has been met, beneficiaries would
pay 20 percent of the cost of each prescription with an annual limit on out-of-pocket expenditures of $1,000. The cost
of this new prescription drug benefit would be added to your
current Part B premium and likely would run about $11 per
month for the first year. The current Medicare Part B premium for 1993 is $36.60 per month.
People who turn 65 in the future would have the option of enrolling in Medicare or remaining in the health plan
they were already in, with the government paying most of
WHAT'S COVERED IN THE PLAN
Here is what's covered by all health plans under the Clinton proposal:
Treatment in hospital or doctor's office; prescription drugs; dental work
f o r c h i l d r e n ; m e n t a l h e a l t h and substance abuse treatment;
out-patient exams; eyeglasses for children; ambulances; pregnancy
services, including abortion; hospice and home care; rehabilitation
services; medical devices. Deductibles and co-payments vary according to
which plan is used.
the premium. If you remain in your health plan, you would
continue to receive the nationally guaranteed comprehensive benefit package with the full range of options available
to individuals younger than age 65. Coverage under Medicare is similar, but not identical, to the fee-for-service option under the Clinton plan for individuals younger than 65.
EARLY RETIREES
For those retirees between the ages of 55 and 65 and
who are not yet eligible for Medicare, the federal government will assume the 80 percent employer share of the
premium. If a company's retirement plan, as of January 1,
1993, covered the entire cost of the health insurance premium for early retirees, the former employer must cover the
remaining 20 percent. If there were no such agreement, the
early retirees are liable for the remainder of the premium
but are eligible for federal subsidies if their income is below
150 percent of poverty.
FEDERAL EMPLOYEES
Federal employees and retirees are treated like all other
workers. The separate federal health insurance system is
abolished and federal workers obtain their insurance through
local alliances and are responsible for 20 percent of the cost.
Federal retirees who are also eligible for Medicare will
have a choice of remaining with the alliance they are already
in or of enrolling in Medicare. In either case, the government will pick up some of the premium.
SMALL BUSINESS
Small businesses (those with less than 50 employees)
will be offered insurance at a discounted rate. Under President Clinton's plan, no employer in a regional alliance will
pay more than 7.9 percent of payroll for health care coverage annually. Small businesses will be eligible for caps on
percent of payroll varying from 3.5 percent to 7.9 percent,
depending on the average wage paid to all employees.
The Clinton plan provides for a permanent 100 percent
tax deduction for the cost of the comprehensive benefits
package for the self-employed individuals. All employer contributions for their employees' health premium are fully
deductible as a business expense.
SUPPLEMENTAL COVERAGE
Individuals may purchase plans that provide benefits in
excess of those specified in the chart on page 4; but, they
must pay for all of the additional premium unless their employer voluntarily agrees to do so. Employer-paid coverage for these supplemental benefits for current workers and
retirees are tax free to the employee for 10 years, if they
were offered by the employer as of January 1, 1993.
�Low cost
PROPOSED HEALTH-CARE
sharing
(HMO-style)
Patient pays $10 copayments for outpatient
services; no co-payment
for hospital stay
B
High cost
sharing (fee-forservice style)
Combination
(PPO-style)
Patient pays $200
individual/$400 family
deductible: insurance
pays 80% of medical
bills
Patient pays only $20 co-payment if in-network
providers are used; insuran ce covers 80% of bill if
out-network providers used
In network
Out of network
Full coverage
Insurance pays 80*
Full coverage
Insurance pays 80%
• Professional services,
outpatient hospital services
$10 per visit
Insurance pays 80%
$10 per visit
Insurance pays 80%
•
$25 per visit
Insurance pays 80%
$25 per visit
Insurance pays 80%
Basic benefits package
Limitations
•
Private room only when medically
necessary
Inpatient hospital
Emergency services
• Preventive services including
well-baby, prenatal
Preventive adult services include
pelvic exams, cholesterol screening
and mammograms every 2 to 5
years
Full coverage
Full coverage, no
deductible
Full coverage
Full coverage
•
Hospice
As hospital alternative for
terminally ill
Full coverage
Insurance pays 80%
Full coverage
Insurance pays 80%
•
Home health care
As inpatient alternative; coverage
reassessed at 60 days
Full coverage
Insurance pays 80%
Full coverage
Insurance pays 80%
• Extended care facilities (Skilled
nursing, rehabilitation facilities)
As hospital alternative; 100-day
limit
Full coverage
Insurance pays 80%
• Outpatient physical,
occupational, speech therapy
Only to restore function or
minimize limitations; reassessment
at 60 days; additional coveragae if
improving
$10 per visit
Insurance pays 80%
MARTIN FROST
W S I G O OFFICE:
A HN T N
24th Distfict Texas
2459 Rayburn House Otf.ce Building
Washmgton OC 20515
.
(202) 225.3605
R LS C M ITE
U E O MT E
• Medical equipment, outpatient
lab, ambulance
• Routine eye and ear exams,
eyeglasses
•
Full coverage
$10 per visit
Insurance pays 80%
H U E ADMINISTRATION
OS
C M ITE
O MT E
IHOUBE of SepreBEntattuea
ffiashingtnn, 9.(E. 20515
Insurance pays 80%
Insurance pays 80%
Full coverage
Insurance pays 80%
$10 per exam or one
set glasses
Insurance pays 80%
$10 per exam or one
set glasses
Insurance pays 80%
$10 per visit
Insurance pays 80%
$10 per visit
Insurance pays 80%
Dental services
Initial:
Prevention
Only for under 18
Added in 2001:
No age limit
$20 per visit
$50 deductible;
insurance pays 60%;
$1,500 annual max.
$20 per visit
$50 deductible;
insurance pays 60%
Orthodontia
Only to avoid reconstructive surgery
$20 per visit
Insurance pays 60%;
$2,500 lifetime max.
$20 per visit
Insurance pays 60%
$5 per prescription
$250/yr. deductible;
insurance pays 80%
$5 per prescription
$250/yr. deductible;
insurance pays 80%
Insurance pays 80%
Full coverage
President Clinton, on September 22nd, called on Congress to enact
a major reform of health care that will guarantee that every American
will have access to basic health care.
This special report examines the Clinton proposal in detail and gives
you the opportunity to express your opinion of the plan by filling out
a short questionnaire on the enclosed card. Additionally, during the
months ahead, I will hold a series of public meetings to discuss the
President's plan. The first of these meetings will be held in Fort Worth,
Corsicana, and Kerens on Saturday, October 23rd — then in Oak Cliff
and Waxahachie on Saturday, November 6th. (See box on this page.)
Insurance pays 80%
•
Prescription drugs
•
SPECIAL TOWN HALL
MEETINGS ON
HEALTH CARE
SATURDAY, OCTOBER 23, 1993
Dear Friends:
Full coverage
Eyeglasses for children only
(Eongreaa of ti)t llnitei) gtatEB
Mental health/substance abuse
Initial:
Inpatient services
30 days per episode; 60 days per
year maximum
Full coverage
Hospital alternatives
120 days maximum
Full coverage
Doesn't apply
Full coverage
120 days maximum
Doesn't apply
Insurance pays 80%
Doesn't apply
Doesn't apply
$10 per visit
All outpatient;
insurance pays 80%
All outpatient; $10 per
visit
All outpatient;
Insurance pays 80%
$25 per visit
Insurance pays 50%
Doesn't apply
Full coverage
Insurance pays 80%
Full coverage
Insurance pays 80%
Hospital alternatives
Full coverage
Doesn't apply
Doesn't apply
Doesn't apply
Nonresidential
intensive services
Doesn't apply
Insurance pays 80%
Full coverage
Insurance pays 80%
Outpatient including 1-12
psychotherapy visits
$10 per visit
Unlimited visits;
insurance pays 80%
$10 per visit
Insurance pays 80%
1:00 PM City Commission Chambers
200 North 12th Street
Corsicana
3:00 PM Kerens Bank
1101 N.W. 2nd (Hwy. 31)
Kerens
SATURDAY, NOVEMBER 6, 1993
10:00 AM BaylorWorx Occupational Health
& Wellness Center
507 N. Hwy. 77 (at Hwy. 287)
Suite 700
Waxahachie
Doesn't apply
Added in 2001:
Inpatient services
Sincerely,
Insurance pays 80%
Nonresidential
intensive services
Portions of President Clinton's plan are controversial, such as the
requirement that small businesses pay a significant part of their employees' insurance premiums. Certainly, some changes will be made;
and, I would like to receive your views before I decide how to vote
on these sweeping proposals.
10:00 AM Martin Luther King Multipurpose Center
5565 Truman Drive
Fort Worth
Brief office visit for
medical maintenance
Psychotherapy
30 visits maximum
MARTIN FROST
Member of Congress
1:30 PM Weiss Auditorium
Methodist Medical Center
1401 Stemmons Avenue
(Beckley & Colorado)
Oak Cliff (Dallas)
FOUR DISTRICT O F F I C E S TO S E R V E Y O U
Fort Worth Office
.3020 S E. Loop 820
Fort Worth, Texas 76140
(817) 293-9231
1-800-846-6213 (toll-free)
Oak Cliff/Dallas
NationsBank, Suite 1319
400 South Zang Blvd.
Dallas, Texas 75208
(214) 948-3401
1-800-937-2056 (toll-free)
Arlington Office
318 W. Main St., Suite 102
Arlington, Texas 76010
(817) 795-3291
Corsicana
100 N. Main Street, Room 534
Corsicana, Texas 75110
(903) 874-0760
1-800-292-4423 (toll-free)
�Congressman
Murray Neimand
Special Report on Health Care Reform
District Office: 9353 Roslyndale Avenue, Pacoima, CA 91331, 818/988-2989
Washington Office: 000 Rayburn House Office Bldg., Washington, DC 20515, 202/225-0000
Health Care Reform and Your Family.
Developing a fair and effective plan
for access to quality health care.
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga calistoga
minyaret bigstuva. Solo singelemente avec
tiataniumuno, singo sololomente cooper hurtada
finger costinme afortuna. Whana coopa fallena
downa hescrappa dahead unna goa boomey.
Hizdad pickenhimup, givend ahug butit
donwork becausdekidis obviosupset anddaz
whanisee dabinki fallen outen demouth aniplugit
backin. Que lastima coopa.
Containing Costs.
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga calistoga
minyaret bigstuva. Solo singelemente avec
tiataniumuno, singo sololomente cooper hurtada
finger costinme afortuna. Whana coopa fallena
downa hescrappa dahead unna goa boomey.
Hizdad pickenhimup, givend ahug butit
donwork becausdekidis obviosupset anddaz
whanisee dabinki fallen outen demouth aniplugit
backin. Que lastima coopa.
donwork becausdekidis obviosupset anddaz
whanisee dabinki fallen outen demouth aniplugit
backin. Que lastima coopa.
Doctors, Insurance Companies and You.
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga
calistoga minyaret bigstuva. Solo singelemente
avec tiataniumuno, singo sololomente cooper
hurtada finger costinme afortuna. Whana coopa
fallenadowna hescrappa dahead unna goa
boomey.
Small Businesses and Health Care Reform.
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga
calistoga minyaret bigstuva. Solo singelemente
avec tiataniumuno, singo sololomente cooper
hurtada finger costinme afortuna. Whana coopa
fallena downa hescrappa dahead unna goa
boomey.
Hizdad pickenhimup, givend ahug butit
donwork becausdekidis obviosupset anddaz
whanisee dabinki fallen outen demouth aniplugit
backin. Que lastima coopa.
Access to Quality Care.
What are your views?
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga calistoga
minyaret bigstuva. Solo singelemente avec
tiataniumuno, singo sololomente cooper hurtada
finger costinme afortuna. Whana coopa fallena
downa hescrappa dahead unna goa boomey.
Hizdad pickenhimup, givend ahug butit
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga
calistoga minyaret bigstuva. Solo singelemente
avec tiataniumuno, singo sololomente cooper
hurtada finger costinme afortuna. Whana coopa
fallena downa hescrappa dahead.
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�Congressman
Murray Neimand
Health Care Reform:
Special Report to Small Businesses.
District Office: 9353 Roslyndale Avenue, Pacoima, CA 91331, 818/988-2989
Washington Office: 000 Rayburn House Office Bldg., Washington, DC 20515, 202/225-0000
Health Care Reform and Your Business.
Survey results find Small Business support for
health care reform.
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga calistoga
minyaret bigstuva. Solo singelemente avec
tiataniumuno, singo sololomente cooper hurtada
finger costinme afortuna. Whana coopa fallena
downa hescrappa dahead unna goa boomey.
Hizdad pickenhimup, givend ahug butit
donwork becausdekidis obviosupset anddaz
whanisee dabinki fallen outen demouth aniplugit
backin. Que lastima coopa.
Containing Medical Costs.
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga calistoga
minyaret bigstuva. Solo singelemente avec
tiataniumuno, singo sololomente cooper hurtada
finger costinme afortuna. Whana coopa fallena
downa hescrappa dahead unna goa boomey.
Hizdad pickenhimup, givend ahug butit
donwork becausdekidis obviosupset anddaz
whanisee dabinki fallen outen demouth aniplugit
backin. Que lastima coopa.
An eye on payroll expenditures.
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga calistoga
minyaret bigstuva. Solo singelemente avec
tiataniumuno, singo sololomente cooper hurtada
finger costinme afortuna. Whana coopa fallena
downa hescrappa dahead unna goa boomey.
Hizdad pickenhimup, givend ahug butit
donwork becausdekidis obviosupset anddaz
whanisee dabinki fallen outen demouth aniplugit
backin. Que lastima coopa.
Special Incentives for Small Businesses.
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga
calistoga minyaret bigstuva. Solo singelemente
avec tiataniumuno, singo sololomente cooper
hurtada finger costinme afortuna. Whana coopa
fallenadowna hescrappa dahead unna goa
boomey.
A gradual shift In service delivery.
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga
calistoga minyaret bigstuva. Solo singelemente
avec tiataniumuno, singo sololomente cooper
hurtada finger costinme afortuna. Whana coopa
fallena downa hescrappa dahead unna goa
boomey.
Hizdad pickenhimup, givend ahug butit
donwork becausdekidis obviosupset anddaz
whanisee dabinki fallen outen demouth aniplugit
backin. Que lastima coopa.
What are your views?
Galblofda morta tortones ipsem lorem didact,
forum locatuminium lotsa loosa gostoga
calistoga minyaret bigstuva. Solo singelemente
avec tiataniumuno, singo sololomente cooper
hurtada finger costinme afortuna. Whana coopa
fallena downa hescrappa dahead.
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�Congressman WTU^
Murray Neimand
Special Questionnaire on Health Care Refo
District Office: 9353 Roslyndale Avenue, Pacoima, CA 91331, 818/988-2989
Washington Office: 000 Rayburn House Office Bldg., Washington, DC 20515, 202/225-0000
Your Opinions on Health Care Reform.
1. Galblova soma sitor mayor major minor, it mmsut
sito mifuti monk dido winkkt masor si pep?
A.
• Shabashaba shoo sirt mert tert vert harcorten.
B.
• Shabashaba shoo sirt mert tert vert harcorten.
C.
• Shabashaba shoo sirt mert tert vert harcorten.
D.
• Shabashaba shoo sirt mert tert vert harcorten.
6. Galblova soma sitor mayor major minor, it mmsut
sito mifuti monk dido winkkt masor si pep?
A.
• Shabashaba shoo sirt mert tert vert harcorten.
B.
• Shabashaba shoo sirt mert tert vert harcorten.
C.
• Shabashaba shoo sirt mert tert vert harcorten.
D.
• Shabashaba shoo sirt mert tert vert harcorten.
2. Galblova soma sitor mayor major minor, it mmsut
sito mifuti monk dido winkkt masor si pep?
A.
• Shabashaba shoo sirt mert tert vert harcorten.
B.
• Shabashaba shoo sirt mert tert vert harcorten.
C.
• Shabashaba shoo sirt mert tert vert harcorten.
D.
• Shabashaba shoo sirt mert tert vert harcorten.
7. Galblova soma sitor mayor major minor, it mmsut
sito mifuti monk dido winkkt masor si pep?
A.
• Shabashaba shoo sirt mert tert vert harcorten.
B.
• Shabashaba shoo sirt mert tert vert harcorten.
C.
• Shabashaba shoo sirt mert tert vert harcorten.
D.
• Shabashaba shoo sirt mert tert vert harcorten.
3. Galblova soma sitor mayor major minor, it mmsut
sito mifuti monk dido winkkt masor si pep?
A.
• Shabashaba shoo sirt mert tert vert harcorten.
B.
• Shabashaba shoo sirt mert tert vert harcorten.
C.
• Shabashaba shoo sirt mert tert vert harcorten.
D.
• Shabashaba shoo sirt mert tert vert harcorten.
8. Galblova soma sitor mayor major minor, it mmsut
sito mifuti monk dido winkkt masor si pep?
A.
• Shabashaba shoo sirt mert tert vert harcorten.
B.
• Shabashaba shoo sirt mert tert vert harcorten.
C.
• Shabashaba shoo sirt mert tert vert harcorten.
D.
• Shabashaba shoo sirt mert tert vert harcorten.
4. Galblova soma sitor mayor major minor, it mmsut
sito mifuti monk dido winkkt masor si pep?
A.
• Shabashaba shoo sirt mert tert vert harcorten.
B.
• Shabashaba shoo sirt mert tert vert harcorten.
C.
• Shabashaba shoo sirt mert tert vert harcorten.
D.
• Shabashaba shoo sirt mert tert vert harcorten.
9. Galblova soma sitor mayor major minor, it mmsut
sito mifuti monk dido winkkt masor si pep?
A.
• Shabashaba shoo sirt mert tert vert harcorten.
B.
• Shabashaba shoo sirt mert tert vert harcorten.
5. Galblova soma sitor mayor major minor, it mmsut
sito mifuti monk dido winkkt masor si pep?
A.
• Shabashaba shoo sirt mert tert vert harcorten.
B.
• Shabashaba shoo sirt mert tert vert harcorten.
C.
• Shabashaba shoo sirt mert tert vert harcorten.
10. Galblova soma sitor mayor major minor, it mmsut
sito mifuti monk dido winkkt masor si pep?
A.
• Shabashaba shoo sirt mert tert vert harcorten.
B.
• Shabashaba shoo sirt mert tert vert harcorten.
C.
• Shabashaba shoo sirt mert tert vert harcorten.
D.
• Shabashaba shoo sirt mert tert vert harcorten.
Please send me more information on Health Care Refo
I am most interested in how Health Care
Reform will affect:
flfSem
Name.
Address
:
:
:
;
:'v #:- .. ::;::!::!::; \:.;:;::;:::>-v
:
_Zip_
• Professional Health Care Providers
(Psychologists, Nurses, etc.)
Mailing Instructions: Please fold this questionnaire inside but* with m return address on the
y
top. Make sure you affix a stamp.
�VO 'VIAIIOOVd
±OldlSia -IVNOISS3H9NO0 HIX
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STSOZ ID I
Name and Address (optional)
To return the questionnaire, fold so this panel is on the
ourside. Remember to affix postage.
..Health Care Su^Y.
Attn
Congressman Murray Neimand
0000 Longworth House Office Building
Washington, DC 20515
'uinfiuttyiBB
��LU
Q
* Why time is running out for local families, business owners
* What Congress must do to enact affordable health care
* How you can make sure they do the job right
HEALTH CARE REFORM NOW!
A Family Action Update From Congressman John Doe
September, 1993
"Why do I believe that access to health care in America should be a
right and not a privilege? Because I've listened to the daily struggles of
working families and small businessmen."
- Congressman John Doe
••v
�These are but two of thousands
of similar stories from people all
over our state. Sotries that tell
the painful truth about the need
for real health care reform.
-- Congressman John Doe
�August 20, 1993
Dear Congressman Doe,
Text o f c o n s t i t u e n t
letter.
Text o f l e t t e r . Text o f l e t t e r . Text
of l e t t e r . Text o f l e t t e r .
T e x t o f l e t t e r . Text o f l e t t e r .
Text o f l e t t e r . Text o f l e t t e r . Taxt
of l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r .
Text o f l e t t e r . Text o f l e t t e r ,
of l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r .
T e x t o f l e t t e r . Text o f l e t t e r .
Text o f l e t t e r . Text o f l e t t e r . Text
of l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r . Text o f
l e t t e r . Text o f l e t t e r .
Text o f l e t t e r . Text o f l e t t e r .
Text o f l e t t e r .
Sincerely,
Constituent
Name o f business
Town o f r e s i d e n c e
"Either I lay workers off to
give the rest health coverage,
or everybody works without
coverage. I can't afford both."
Dear fellow (State) citizen,
As these two stones confirm, the reality of the health
care crisis in America is shocking.
In our state alone, 1 million people are currently
without even basic coverage. Small businesses laid off 23,000
workers last year because they were unable to afford coverage
tor their employees. Prescription drug costs have risen 12 9c
in the last 6 months alone. Every day the possibility grows
that catastrophic illness could wipe out a family's entire life
savings. It's past time we cured the health care crisis.
Now, my colleagues and I in Congress are faced with
the challenge of our lives -- overhauling America's health care
system. There are many different people with many different
ideas about how to go about streamlining the system and
cutting costs. But any national health care plan must guarantee
;;ccess to health care as a right, not a privilege.
I'll work to make sure health care reform includes...
Choice of doctor and hospital
Coverage for prescription drug, eye-care, and dental costs
No denial for pre-existing conditions
No deductible and no-copayments
Long-term nursing home care
Preventative health care services
Reduced paperwork
Protection for Social Security and Medicare
Please join me in supporting health care reform. If
you have any thoughts, suggestions, or comments about health
care reform, please feel free to write or call nic at the
HEALTH CARE HOTLINE phone number listed below.
I look forward to hearing from you.
*
*
*
*
*
*
*
*
John Doe
U.S. House of Representatives
l-202-MEMBER#
l-flflO-DISTRTrT-
�Making sure
everyone's covered
You probably already know what you want
for yourself in health care reform:
affordability, accessability, and quality care.
But how do your neighbors feel about health
care refonn? Or doctors? What's their
viewpoint?
And small business owners - how do they
feel? Or salespeople? Auto factory managers?
Workers? Teachers? Technicians?
"Making Health Care Refonn
Work for Everyone"
The one thing we know about the health care
crisis is that it affects everyone — and
everyone has a stake in the success of health
care reform.
A panel of citizens with
Congressman John Doe
TBursday, September 15", 1993, 7:00 p.m.
Main Student Center Auditorium at the
State University
1000 University Avenue
City
Congressman John Doe and his colleagues
have assembled panels of citizens from all
occupations - doctors, managers, insurance
executives, workers, teachers - to discuss
what health care reform must include, and to
hear what you have to say.
Please come to your night of "Making Health
Care Reform Work for Everyone" on
Thursday, September 15.
Please call the
HEALTH CARE HOTLINE
for more information
l-202-MEMBER# or l-(999)-DISTRICT
Congress of the United States
House of Representatives
Washington, D C. 20515
Official Busmen
TARGETTED MAIL
LABEL HERE
M.C.
Blk. Rt.
CAR-RT-SORT
��RESPONDING TO THE
HEALTH CARE CRISIS IN
AMERICA AND NEW JERSEY
A Town Meeting with
Congressman Rob Andrews
Due to a delivery problem at the post office, you may
not have received an invitation to my January health
care meeting.
Your opinion is important to me. I have scheduled
another meeting for May 2 and I would like to hear
from you. I hope you can join us.
it
SATURDAY, MAY 2,10:00 a.m.
Harry E. Williams BM*.
Black Horse Pike and Broadway Ave.
Runnemede, NJ
Congress of the United States
House of Representatives
Washington, D.C. 20515
Official Business
M.C.
Bulk Rate
Car-Rt. Presort
Postal Patron Local
1st Congressional District
New Jersey
PRINTED WITH SOY INK
media • I V V 2 . W
�District Town Meetings
The Health Care Crisis
• Portland
7 p.m., Monday
January 13th
Deering High School
• Biddeford
9:30 a.m., Saturday
January 18th
Biddeford Middle School
• Gardiner
1 p.m., Saturday
January ISth
Gardiner High School
\Congressman Tom Andrews
$9,000-r
Average Yearly Health Care
Spending By Maine Families
$8,640*
J|
$7,000
$5,000$3,000$1,0001
1
1980
1
1
1991
1
1
'Projected
2000
Toll Free 1-800-445-4092
�Congressman Tom Andre!W8
Dear Friend,
177 Commercial Street
Health care used to be a problem Portland, Maine 04101
only for the poor. Now even people
Official Business
with good jobs and good benefits
M.C.
Bulk Rate
are threatened by rising health care
CAR-RT SORT
costs. They are paying higher
premiums for less coverage.
They're afraid that if someone in
their family gets sick, their
insurance won't cover enough of
Resident
the costs to keep them from going
bankrupt And the lingering recession has many people deeply
First Congressional District
wonied that they could suddenly lose their job along with
Maine
their health insurance.
It's a national disgrace. How can anyone in America feel
secure when they know their entire life savings can get wiped out
by a single illness or accident? How can businesses expand when
hiring a new worker costs more in health care than the worker
will bring in profits? Why should people be trapped in jobs they
can't change for fear of losing health coverage?
This is a problem that demands action now. Please join me
at one of the district town meetings I'm holding to talk about
this critical issue. It's time for all of us toraiseour voices and
District Town Meetings
demand quality, affordable health care for all Americans.
Hope to see you there,
The Health Care Crisis
�Congressman William D. Ford
House of Representatives
Washington, D.C. 20515-2213
OFFICIAL BUSINESS
M.C.
Bulk Rate
CAR-RT SORT
C O N G R E S S M A N
WILLIAM D
INVITES
YOU
TOA
WOMEN'S HEALTH ISSUES FORUM
�Don't forget to mark your calendar and
plan to attend the . . .
Women's Health
Issues Forum
Saturday, October 23, 1993
University of Michigan
Dearborn Campus
10:00 a.m.-4:00 p.m.
KEYNOTE ADDRESS:
Directions to the University of M i c h i g a n , Dearborn, Recreation & Organization Center (ROC)
F r o m 1-94: From 1-94 East, exit n o r t h o n t o M-39
(Southfield Freeway). Proceed north for approximately
2 miles. Exit onto Michigan Avenue West. Proceed
west on Michigan Avenue. Turn right onto Evergreen
Street. From Evergreen, turn left to enter the main
entrance of the University of Michigan, Dearborn. After
entering the University, proceed for approximately 1/4
mile. The Recreation & Organization Center (ROC) is
on the left.
Public parking is available in the parking structure
adjacent to the ROC.
For more i n f o r m a t i o n please call 7 2 2 - 1 4 1 1 ,
4 8 2 - 6 6 3 6 or 7 4 1 - 4 2 1 0 .
U.S. Health and Human Services
Secretary, Donna Shalala
Join health care experts at a free forum sponsored by
Representatives Bill Ford and John Dingell which will
provide information and answers on women's health
care issues such as breast, cervical and ovarian cancer,
heart disease, menopause, stress & depression, reproductive and maternal health, nutrition, weight control
and eating disorders, AIDS and STD's, minority
women's health issues and insurance.
�Congress of the United States
House of Representatives
Washington, D.C. 20515
M.C.
OFFICIAL BUSINESS
Bulk Rate
CAR-RT SORT
POSTAL PATRON—Local
11th Congressional District
Virginia
C O N G R E S S W O M A N
LESLIE
BYRNE
INVITES
YOU
TO
A
HEALTH CARE R E F O R M
TOWN MEETING
�WN M E E T I N G
Dear nth District Res«!^|»i
^
H e a l t h
C a r e
T a s k
On September l l n ^ W ^ ^ ^ m M ^
Force unveiled a plan toMMlMtfk OWMV^ilQMMrie medical care to
every American.
The proposal marks
legislative proc
you to Help with
TH
most important
*
rtake, and I am inviting fv^' 8 : 0 0 a . m . - 1 2 : 3 0
M.
On October 9ti|^^t<host a public seagratf on health care
reform^} have invttec^peak9*i f?b^the Clinton Abninistration as wt
local health care professfmals.i'he seminar will ftrovide answers
questions about health care reform ^and will |ive you the
to discuss our current-system and effortlto improve it.
join me at this important meeting. Youipd|stions and
are important to me, and I look forward to hearing from
.^JSrvpfctoberQth.
C O N G R E S S W O M A N
mx
SATURDAY
LESLIE BYRNE
p.m.
Falls Church High School
7521 Jaguar Trail \
Falls Church, VA *
InterpjiBfer for the hearing
(red will be provided.
�HEALTH CARE FORUM
Reforms
Affect
Join Rep. Pallone Monday, October 4th
�Frank is coming to your
neighborhood and'wants
to hear about your health
care concerns.
FRANK
Congress ofthe United Stales
House of Representatives
Washington. DC 20515
Official Business
Postal Patron—Local
6U1 Congressional District
New J e r s e y
M.C.
Bulk Rate
Car-rt Presort
MONDAY
OCTOBER 4 , 1993
Comrnnnity Meeting Room
Monmouth Medical Center
300 2nd Avenue
Long Branch
7:30 p.m. - 9:00 p.m.
•
media + 1.W27M
-A
PRINTED WITH SOY INK
�W m i s Health Care W r s o
o e^
o kh p
I would like to invite you to a women's
health care workshop that I am
sponsoring on Saturday, April 11, 8:30
am to 12:30 pm at Mira Loma High
School, 4000 Edison Ave. in Sacramento.
There is a growing awareness on the
federal level of issues concerning women's
health care. We will explore these
important health care issues and hear
from several experts in our area. Our
featured speaker will be Gail Westrup, the
host ofthe KXTV health show "Pulse."
I look forward to seeing you there.
Scheduled Workshops
Stress and Women's Mental
Health
Learn more about stress and depression and
effective strategies for managing them.
Nutrition and Dieting
Discuss ways to maintain good nutrition. In
addition, we'll talk about weight control,
osteoporosis and heart disease.
Women Growing O/der
Learn about the special health needs of older
women.
Reproductiw Health
Explore the issues associated with a women's
reproductive cycle. Included in the discussion
will be infertility problems, cervical and
ovarian cancer, and menopause.
For more information, or to make a
reservation, call (916) 978-4381.
'Self'Defense
An introduction to self-defense techniques.
B c ue you h v arightto be healthy!
ea s
ae
mmmmmmm
Congressman
VIC FAZIO
Congress of the United States
House of Representatives
Washington, D.C. 20515
Official Business
*
M.C.
Blk. Rt.
You are invited to
a women's health
care workshop
i m i l i j • MH) -MOT
PRINTED WITH SOY INK
�CONGRESSMAN V I C FAZIO
In Touch With People
W m ns Health Care Workshop
o e'
�How
WELL
PAY
FOR
HEALTH
CARE
No one knows better than you.
The cost of getting sick gets worse with
each medical bill. But how much will it
cost you in the future? Will you be able
to pay for the care you and your family
will need?
Congressman Rob Andrews and his
colleagues have called Town Meetings
across the country in January. They
want to hear what you go through to
pay for health care. And they'll lay out
options for affordable health care in the
future.
Come to your Town Meetings on
Tuesday, January 14 and Saturday,
January 18.
-* £
U
4
4
Congressman Rob Andrews listens to the health care concerns of New
Jersey families.
"Responding to the health care
crisis in America and Neu; Jersey"
Two Town Meetings with
Congressman Rob Andrews
Tuesday, January 14, 1992, 7:00 p.m.
John F. Kennedy Hospital
Gerontology Center - Conference Room
30 E. Laurel Road
Stratford, New Jersey
Saturday, January 18, 1992, 11:00 a.m.
Palmyra Borough Hall
20 West Broad Street
Palmyra, New Jersey
Call (609) 627-9000 for further information
Because you have a right to be hecdthy.
2<
C
in >
3
oa
c o
m
c
3
•
�THEY'VE GOT ONE
v*^' cm
T
H
I
N
G
I
N
C
O
M
M
O
N
• •
•
...THEY CAN T AFFORD
TO GET SICK
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Newsletters
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-005-004-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/d41a815f93aa5b0e2afc1afb9b29d5ac.pdf
1ea7796505794d29943cb072a9f1146b
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
3664
OA/ID Number:
FolderlD:
Folder Title:
Folder #2: The House Wednesday Group
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
2
3
�. L 29 '93 10:41
PAGE.002
FROM HOUSE WEDNESDAY GRP.
THE HOUSE WEDNESDAY GROUP
CONGRESS OF THE UNITED STATES
586 Fold House Office Building, Washington, D.C. 20515
Office: 202-226-3236
Pax: 202-225-3637
MEMBERS
1993
— Doug Beremer^j&JOH}
-^Tom DeLay^U^
—DavulJ>Jse}eK\fc>3
^ Hamilton Fish ^
-Wayne Gilchresro H"^- ^
^ Porter Goss^/
v/Fred Grandy^ ^
Steve Gundersoni/
Jawl Heary
is David Hobson
L
^ Amo Hoaghton ^
JemyHyde^^o
Jghn Kasi^
^(Jact Kingston
^Jim Kolbe, Cha»«m*it ^
Rjck Lazio ^
^ Jim Leach ^
-—Bob Uvin^ston^l.
—Jim McCreiy^
Joe McDade
v./ Scott Mclnnls'/
Dan Miller ^
Connie Morella ^
\y Tim Petri ^
v^Rob Portman^
^ Jim Ramstad ^
v Ralph Regula ^
u Marge Rookcma^
^Oay Shaw ^ i V )
- Lamar Smith aiS
^ Olympia Snowe ^
^ Bill Thomas ^
<-Craig Thomas \3<=A'^
^-Frcd Upton ^
�J:.
15
1 fUlpH ^eq^icc . Off"
t;;
�'
v
"AUG
3
'93
16:39
FROM HOUSE
THE
WEDNESDAY
GRP.
Ule'D.
O IR. T.
PflGE . 0 0 8
HOUSE WEDNESDAY GROUP
CONGRESS OF THE UNITED STATES
386 Ford House Office Building, Washingron, D.C. 20515
Office: 202-226-3236
Fax: 202-225-3637
BRIDGING THE GAP
Health Care Coverage for Low-Income Families
March 30, 1992
*
Summary a t t a c h e d .
I f you would l i k e f u l l
c o n t a c t Joyce McGarry a t (202) 225-4324.
documnent, please
�AUG
3
'93
1G:40
FROM HOUSE
UIE DNE SDR Y G R P .
PAGE . 0 0 9
EXECUTIVE SUMMARY
The shortcomings of today's Medicaid program call for a meaningful restructuring to
better serve low-income individuals and families. This paper attempts to focus the debate over
heaith care refonn by highlighting several inherent problems of the Medicaid program and
proposing a strategy for improving access to health care for the nation's poor.
The ideas in this paper provide a more detailed discussion of reform initiatives which
were first raised in the Wednesday Group paper "Moving Ahead: Initiatives for Expanding
Opportunity in America," released in October, 1991. Improving access to health care for lowincome families furthers a central theme of the reforms presented in that paper - that of
promoting independence from welfare.
In this paper, we have concluded that two design innovations are imperative: 1) the
Medicaid program or its replacement must be severed from its eligibility links with other cash
assistance and entitlement programs; and 2) there must be a stronger public and private
partnership to administer and deliver health care for the poor and near poor.
The direction for public policy suggested here is an attempt to bridge the gap between all
erjvate or allfcubjjghealth insurance. We believe that having either all private or all public
coverage should not stand as mutually exclusive alternatives to having no coverage at all.
Specifically, this paper calls for state projects to be established to show the effectiveness of a
sliding-scale health insurance allowance program that would have Medicaid work with private
insurance, rather than substitute for private insurance. We believe that a sliding-scale health
insurance allowance will address the basic problems with Medicaid and make the program work
better.
A health insurance allowance is a subsidy payment from the state government to an
individual, employer, or insurer, to purchase health insurance. In conjunction with state income
tax changes, a tax credit would provide each individual or household a reduction in tax dollars or
a tax refund after they purchase health insurance. Alternatively, the states could pay subsidies to
individuals, employers, or insurers to purchase health insurance. Our proposal suggests that
matching federal dollars should be available through the current Medicaid program to
demonstrate the value and workability of such health insurance allowance schemes.
The current gap between all-or-nothing Medicaid eligibility and private insurance
coverage can be bridged with a seamless program of support adjusted for income. The concept
of "seamless" refers to eliminating the current gap between those who have Medicaid and those
who have private coverage. With support on a sliding-scale, the transition from public to private
insurance is facilitated for those whose incomerisesabove the threshold for the full health
allowance.
In our proposal, states would establish their own health allowance programs. Managed
care providers, particularly heaith maintenance organizations, would bid to participate in the
program with payment at a predetermined capitated rate. This capitated rate would be indexed
with inflation. The proposed health insurance allowance would be used by beneficiaries to
purchase health care coverage from one of a group of state-approved plans. Because of the cost
containment benefits, states would be required to offer at least one managed care plan.
�AUG
3 '93 16:41 ' FROM HOUSE WEDNESDAY GRP.
PAGE.011
Control Cant Better - The state's costs should be easier to control under a health insurance
allowance system, because the state will no longer participate in the open-ended fee-forservice system of health care. In addition, the incentives inherent in prepaid care plans to
avoid unnecessary care and to coordinate care lead them to control costs and ensure
access.
Enhance Individual Responsibility - Providing a health insurance allowance directly to
individuals gives them greater control over their lives. The state governments will
provide the necessary educational information so that individuals will be able to make
responsible choices in purchasing health insurance.
Ul
�'AUG
3 '93 16:41
FROM HOUSE WEDNESDAY GRP.
PAGE.010
Eligibility for the program would be based on income and family size and be independent
of other entitlement programs - greatly simplifying the current eligibility rules and thus helping
the many Americans now without health insurance. States would reform their eligibility criteria
over time; a goal could be for individuals and families with incomes less than 100 percent of the
federal poverty level to use the full voucher amount to participate in the contracted plans.
Those whose income qualifies them for the sliding-scale voucher amount, would also be able to
participate in the state-approved plans, or they could choose to use the credit towards the
purchase of their own insurance.
The speed of reform would depend on the capacity of the individual states and their
providers to absorb the changes. Each state would control its own pace of change, with the
flexibility to suit its own circumstances. An important part of this proposal is that states would
move beyond the limited demonstrations of pilot projects that are presently underway.
W propose to establish statewide projects immediately, in order to document the
e
effectiveness of various health insurance allowance programs as well as to identify their
weaknesses. The federal role would be one primarily of oversight and providing partial matching
funds; the plan would be administered by the individual states. If proven effective on the state
level, aspects of the state programs would deserve attention on a national level.
W believe that our proposal addresses many of the problems of Medicaid, because it
e
would do the following:
•
Expand Elioihintv - A system offering the states both flexibility and federal matching
dollars for a health insurance allowance to all individuals and families will allow states to
eliminate Medicaid's restrictive eligibility categories. The use of a gradually diminishing
subsidy ~ rather than the present all-or-nothing eligibility « will make the program
available to those needy individuals who are now frequently excluded from Medicaid.
•
Improve Access to Care and Offer More Choice to Consumers - Currently, Medicaid
beneficiaries cannot use physicians who do not accept Medicaid; because of this, there
are significant limitations on choice of care providers. While the individual amount of the
state health insurance allowance will determine which plans individuals can buy, their
access to care can be contractually required. Also, the insurance allowance will stimulate
competition among providers of health care; this should increase choice to Medicaid
consumers. Additionally, individuals or their employers have the option to supplement
the allowance to buy a more complete insurance policy.
Offer a Seamless Fabric of Public-to-Private Insurance - The sliding-scale subsidy
facilitates movement between public and private support, so that low-income workers
whose incomes rise above the threshold for the full health insurance allowance will still
qualify for a percentage. This partial allowance could be used in any health insurance
which is offered by an employer. The sliding-scale health allowance removes what some
would argue is an incentive to staying on welfare continued Medicaid coverage ~
because health insurance will be available independent of other welfare programs. A
family could purchase, with the government's help, the same health care coverage it had
when receiving the allowance.
it
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36 Million People Below Poverty Level
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17 Million people
47%
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.7 Million people
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4 Million people
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5 Million people
13%
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Folder #2 : The House Wednesday Group
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-005-003-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/7e4462839727b23e0da739a448d2e7b2.pdf
4a1618ddbfc6ad79da28d53c4a5795bb
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3664
FolderlD:
Folder Title:
Folder #2: Democratic Study Group
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
2
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SUBJECT/TITLE
DATE
Phone No.'s (Partial) (1 page)
02/23/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3664
FOLDER TITLE:
Folder #2: Democratic Study Group
2006-0885-F
iin784
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Kreedom of Information Act - |5 U.S.C. 552(b)]
Pl
P2
P3
P4
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(bK2) ofthe FOIA]
b(3) Release would violate a Federal statute 1(b)(3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) ofthe FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) of the FOIA]
National Security Classified Information 1(a)(1) ofthe PRA|
Relating to the appointment to Federal office 1(a)(2) ofthe PRA]
Release would violate a Federal statute 1(a)(3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SUB.IECI7HII.E
DATE
Phone No.'s (Partial) (1 page)
02/23/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steven Edelstein
OA/Box Number:
3664
FOLDER TITLE:
Folder #2: Democratic Study Group
2006-0885-F
jm784
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 22n4(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(a)(l) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA|
P3 Release would violate a Federal statute 1(a)(3) ofthe PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information |(a)(4) ofthe PRA|
PS Release would disclose confidential advice between the President
and hi.s advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) ofthe PRA|
b(l) National security classified information 1(b)(1) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(b)(2) of the FOIA]
b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) ofthe FOIA]
b(S) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells 1(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
ofKift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�03/05/93
©002
DSG
12:49
T H E WHITE M O U S E
WASHINGTON
TO
U.S. House of Representatives Offices
FR
TasK Force on National Health Care Refonn
DT
February 23, 1993
RE
Health Care Overview
i -
i\ _
As we proceed with the 103rd Congress, i t would be extremely
h e l p f u l t o us i f you would provide our o f f i c e with some
background information.
Please provide us with the names, work phone, home phone and fax
nvuabers of the f o l l o w i n g :
1. • f t ^ ^ C h i r g rfr» ? -fl <; gfrf+
P6/(b)(6)
2. L e g i s l a t i v e Director:
--•
P6/(b)(6)
3. Health Care
. i,. . /i e. "
•
v
,
P6/(b)(6)
Also, please share any p a r t i c u l a r concerns of your Representative
and your home d i s t r i c t as they r e l a t e t o health care and health
care reform.
Please return this form, along with any comments, v i a facaimili«
to 456-6241 or through the mail to the attention of the Taak
Force on National Health Care Reform, old Executive Office
Building, Room 287, Washington, DC 20500.
Thank you f o r your a t t e n t i o n and cooperation.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Folder #2 : Democratic Study Group
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg3-005-002-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/158fb07b0b1e0b03cc94047e6b30cf95.pdf
ffb1172a811553c38cdd570039404529
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
2385
OA/ID Number:
FolderlD:
Folder Title:
[Center for National Policy: "Managed Competition Healthcare Forum" 1/29/93] [VHS Tape]
Stack:
Row:
Section:
Shelf:
s
56
3
4
Position:
�Clinton Library Transfer Form
1
i Case #, if applicable
2006-0885-F
,,
,, Accession #
jjlCollection/Record Group
I, Subgroup/Office of Origin
1 Series/Staff Name
.
Clinton Presidential Records
Health Care Task Force
:
; j
V
S u b s e r
'
jEdelstein
2385
[[Center for National Policy: "Managed Com_:iJci'OA Number
'iFolder Title
r'j
e s
. Box Number
: p '•!.
_
.
! • Description of 1 videocassette tape, Center for National Policy, "Managed Competition Healthcare Forum", 1/29/1993. Stored in AV regular storage on -.'>
12-5-2-5
'. Item(s)
Donor Information
"r-i'
Affiliation:
Transferred to:
; Other (Specify):
Phone (Hm):
; Phone (Wk):
City:
j Street:
: Title:
f' Middle Name:
• First Name:
Last Name:
1
' State (or Country):
[
Zip:
jAudio/Visual Department
f
•. M.IIT., - T - J ^•^tr '<•"..-, .t. ,
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[ ! Transfer Point
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_ \ ' < r T ' : ^ D a t e o f Tranfer
|j
8/9/2012
^ ^ ' . W ^ ' ' ^ '/^ • . r s V ^ . v : ^ : ; ^ ^ ^ " i ^ ^ f ' T C ? ^ ; ; ^ ^ n / j - ? ^ ' . ]
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Center for National Policy: “Managed Competition Healthcare Forum” 1/29/93] VHS Tape]
Creator
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White House Health Care Task Force
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�THE WHITE HOUSE
O f f i c e of the Press Secretary
For Immediate Release
January 25, 1994
STATE OF THE UNION ADDRESS
BY THE PRESIDENT
The House of Representatives
9:15
P.M. EST
THE PRESIDENT: Thank you very much. Mr. Speaker, Mr.
President, members o f the 103rd Congress, my f e l l o w Americans:
I'm not a t a l l sure what speech i s i n t h e TelePrompter
t o n i g h t — (laughter) — but I hope we can t a l k about the s t a t e o f
the Union.
I ask you t o begin by r e c a l l i n g the memory of the g i a n t
who presided over t h i s Chamber w i t h such force and grace. T i p
O'Neill l i k e t o c a l l h i m s e l f "a man of the House." And he surely was
t h a t . But, even more, he was a man of the people, a b r i c k l a y e r ' s son
who helped t o b u i l d the great American middle class. Tip O'Neill
never f o r g o t who he was, where he came from, or who sent him here.
Tonight he's s m i l i n g down on us f o r the f i r s t time from the Lord's
G a l l e r y . But i n h i s honor, may we, t o o , always remember who we are,
where we come from, and who sent us here.
(Applause.)
I f we do t h a t we w i l l r e t u r n over and over again t o the
princpiple t h a t i f we simply give ordinary people equal opportunity,
q u a l i t y education, and a f a i r shot a t the American Dream, they w i l l
do e x t r a o r d i n a r y t h i n g s .
We gather t o n i g h t i n a world of changes so profound and
r a p i d t h a t a l l nations are tested. Our American h e r i t a g e has always
been t o master such change, t o use i t t o expand o p p o r t u n i t y at home
and our leadership abroad. But f o r too long, and i n too many ways,
t h a t h e r i t a g e was abandoned, and our country d r i f t e d .
For 30 years, family l i f e i n America has been breaking
down. For 2 0 years, the wages of working people have been stagnant
or d e c l i n i n g . For the 12 years of t r i c k l e - d o w n economics, we b u i l t a
f a l s e p r o s p e r i t y on a hollow base as our n a t i o n a l debt quadrupled.
From 1989 t o 1992, we experienced the slowest growth i n a h a l f
century. For too many f a m i l i e s , even when both parents were working,
the American Dream has been s l i p p i n g away.
I n 1992, the American people demanded t h a t we change. A
year ago I asked a l l of you t o j o i n me i n accepting r e s p o n s i b i l i t y
for t h e f u t u r e of our country. Well, we d i d . We replaced d r i f t and
deadlock w i t h renewal and reform. And I want t o thank every one o f
you here who heard t h e American people, who broke g r i d l o c k , who gave
them the most successful teamwork between a President and a Congress
i n 3 0 years.
(Applause.)
This Congress produced a budget t h a t c u t the d e f i c i t by
h a l f a t r i l l i o n d o l l a r s , cut spending and raised income taxes on only
the w e a l t h i e s t Americans. (Applause.) This Congress produced t a x
r e l i e f f o r m i l l i o n s o f low income workers t o reward work over
w e l f a r e . I t produced NAFTA. I t produced the Brady b i l l , now the
Brady law. And thank you, Jim Brady, f o r being here, and God bless
(Applause.)
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�- 2 -
T h i s Congress produced t a x c u t s t o reduce t h e t a x e s o f
n i n e o u t o f 10 s m a l l businesses who use t h e money t o i n v e s t more and
create jobs.
I t produced more r e s e a r c h and t r e a t m e n t f o r AIDS, more
c h i l d h o o d i m m u n i z a t i o n s , more s u p p o r t f o r women's h e a l t h r e s e a r c h ,
more a f f o r d a b l e c o l l e g e loans f o r t h e m i d d l e c l a s s ; a new n a t i o n a l
s e r v i c e program f o r those who want t o g i v e something back t o t h e i r
c o u n t r y and t h e i r communities f o r h i g h e r e d u c a t i o n ; a d r a m a t i c
i n c r e a s e i n h i g h - t e c h i n v e s t m e n t s t o move us f r o m a defense t o a
domestic h i g h - t e c h economy. T h i s Congress produced a new law, t h e
Motor V o t e r b i l l , t o h e l p m i l l i o n s o f people r e g i s t e r t o v o t e . I t
produced Family and M e d i c a l Leave.
A l l passed. A l l s i g n e d i n t o l a w w i t h n o t one s i n g l e
veto.
(Applause.) These accomplishments were a l l commitments I made
when I sought t h i s o f f i c e . And, i n f a i r n e s s , t h e y a l l had t o be
passed by you i n t h i s Congress.
But I am persuaded t h a t t h e r e a l
c r e d i t belongs t o t h e people who s e n t us h e r e , who pay o u r s a l a r i e s ,
who h o l d our f e e t t o t h e f i r e .
But what we do h e r e i s r e a l l y b e g i n n i n g t o change l i v e s .
Let me j u s t g i v e you one example. I w i l l never f o r g e t what t h e
F a m i l y and M e d i c a l Leave law meant t o j u s t one f a t h e r I met e a r l y one
Sunday morning i n t h e White House.
I t was unusual t o see a f a m i l y t h e r e t o u r i n g e a r l y
Sunday morning, b u t he had h i s w i f e and h i s t h r e e c h i l d r e n t h e r e , one
of them i n a w h e e l c h a i r . I came up, and a f t e r we had o u r p i c t u r e
t a k e n and had a l i t t l e v i s i t , I was w a l k i n g o f f and t h a t man grabbed
me by t h e arm and he s a i d , "Mr. P r e s i d e n t , l e t me t e l l you something.
My l i t t l e g i r l here i s d e s p e r a t e l y i l l . She's p r o b a b l y n o t g o i n g t o
make i t . But because o f t h e F a m i l y Leave law, I was a b l e t o t a k e
t i m e o f f t o spend w i t h h e r — t h e most i m p o r t a n t t i m e I ever spent i n
my l i f e — w i t h o u t l o s i n g my j o b and h u r t i n g t h e r e s t o f my f a m i l y .
I t means more t o me t h a n I w i l l ever be a b l e t o say. Don't you
p e o p l e up here ever t h i n k what you do doesn't make a d i f f e r e n c e . I t
does."
(Applause.)
Though we a r e making a d i f f e r e n c e , o u r work has j u s t
begun. Many Americans s t i l l h a v e n ' t f e l t t h e impact o f what we've
done. The r e c o v e r y s t i l l h a s n ' t touched e v e r y community o r c r e a t e d
enough j o b s . Incomes a r e s t i l l s t a g n a n t ; t h e r e ' s s t i l l t o o much
v i o l e n c e and n o t enough hope i n t o o many p l a c e s . Abroad, t h e young
democracies we a r e s t r o n g l y s u p p o r t i n g s t i l l f a c e v e r y d i f f i c u l t
t i m e s and l o o k t o us f o r l e a d e r s h i p . And so t o n i g h t , l e t us r e s o l v e
t o c o n t i n u e t h e j o u r n e y o f r e n e w a l ; t o c r e a t e more and b e t t e r j o b s ;
t o guarantee h e a l t h s e c u r i t y f o r a l l ; t o reward work over w e l f a r e ; t o
promote democracy abroad; and t o b e g i n t o r e c l a i m o u r s t r e e t s f r o m
v i o l e n t crime and drugs and gangs; t o renew o u r own American
community.
(Applause.)
L a s t y e a r we began t o p u t our house i n o r d e r by t a c k l i n g
the budget d e f i c i t t h a t was d r i v i n g us t o w a r d b a n k r u p t c y . We c u t
$255 b i l l i o n i n spending, i n c l u d i n g e n t i t l e m e n t s , and over 340
s e p a r a t e budget i t e m s . We f r o z e domestic spending and used honest
budget numbers.
Led by t h e V i c e P r e s i d e n t , we l a u n c h e d a campaign t o
r e i n v e n t government.
We c u t s t a f f , c u t p e r k s , even trimmed t h e f l e e t
o f f e d e r a l l i m o u s i n e s . A f t e r y e a r s o f l e a d e r s whose r h e t o r i c
a t t a c k e d bureaucracy b u t whose a c t i o n s expanded i t , we w i l l a c t u a l l y
reduce i t by 252,000 people o v e r t h e n e x t f i v e y e a r s . By t h e t i m e we
have f i n i s h e d , t h e f e d e r a l b u r e a u c r a c y w i l l be a t i t s l o w e s t p o i n t i n
3 0 years.
(Applause.)
Because t h e d e f i c i t was so l a r g e and because t h e y
b e n e f i t t e d from t a x c u t s i n t h e 1980s, we d i d ask t h e w e a l t h i e s t
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�- 3 -
Americans t o pay more t o reduce the d e f i c i t . So on A p r i l 15th, the
American people w i l l discover the t r u t h about what we d i d l a s t year
on taxes. Only the top 1 — (applause) — yes, l i s t e n — t h e top 1.2
percent o f Americans, as I said a l l along, w i l l pay higher income tax
r a t e s . Let me repeat — (applause) — Only the w e a l t h i e s t 1.2
percent o f Americans w i l l face higher income tax rates and no one
else w i l l . And t h a t i s the t r u t h .
(Applause.)
Of course, t h e r e were, as there always are i n p o l i t i c s ,
naysayers who s a i d t h i s plan wouldn't work. But they were wrong.
When I became President the experts p r e d i c t e d t h a t next year's
d e f i c i t would be $3 00 b i l l i o n . But because we acted, those same
people now say the d e f i c i t i s going t o be under $180 b i l l i o n — 40
percent lower then was p r e v i o u s l y p r e d i c t e d .
(Applause.)
Our economic program has helped t o produce the lowest
core i n f l a t i o n r a t e and the lowest i n t e r e s t r a t e s i n 20 years.
And
because those i n t e r e s t r a t e s are down, business investment and
equipment i s growing a t seven times the r a t e of the previous four
years; auto sales are way up; home sales are a t a record h i g h .
M i l l i o n s o f Americans have refinanced t h e i r homes, and our economy
has produced 1.6 m i l l i o n p r i v a t e sector jobs i n 1993 — more than
were created i n the previous four years combined.
(Applause.)
The people who supported t h i s economic plan should be
proud of i t s e a r l y r e s u l t s . Proud. But everyone i n t h i s chamber
should know and acknowledge t h a t there i s more t o do.
Next month I w i l l send you one of the toughest budgets
ever presented t o Congress. I t w i l l cut spending i n more than 300
programs, e l i m i n a t e 100 domestic programs, and reform the ways i n
which governments buy goods and services. This year we must again
make the hard choices t o l i v e w i t h i n the hard spending c e i l i n g s we
have set. We must do i t . We have proved we can b r i n g the d e f i c i t
down w i t h o u t choking o f f recovery, without punishing seniors of the
middle c l a s s , and w i t h o u t p u t t i n g our n a t i o n a l s e c u r i t y a t r i s k . I f
you w i l l s t i c k w i t h t h i s p l a n , we w i l l post three consecutive years
of d e c l i n i n g d e f i c i t s f o r the f i r s t time since Harry Truman l i v e d i n
the White House. And once again, the buck stops here.
(Applause.)
Our economic plan also b o l s t e r s our s t r e n g t h and our
c r e d i b i l i t y around the world. Once we reduce the d e f i c i t and put the
s t e e l back i n t o our competitive edge, the world echoed w i t h the sound
of f a l l i n g t r a d e b a r r i e r s . I n one year, w i t h NAFTA, w i t h GATT, w i t h
our e f f o r t s i n Asia and the National Export Strategy, we d i d more t o
open world markets t o American products than a t any time i n the l a s t
two generations.
That means more jobs and r i s i n g l i v i n g standards f o r the
American people; low d e f i c i t s ; low i n f l a t i o n ; low i n t e r e s t r a t e s ; low
trade b a r r i e r s and high investments. These are the b u i l d i n g blocks
of our recovery. But i f we want t o take f u l l advantage of the
o p p o r t u n i t i e s before us i n the g l o b a l economy, you a l l know we must
do more.
As we reduce defense spending, I ask Congress t o invest
more i n t h e technologies of tomorrow. Defense conversion w i l l keep
us strong m i l i t a r i l y and create jobs f o r our people here a t home.
(Applause.)
As we p r o t e c t our environment, we must i n v e s t i n the
environmental technologies of the f u t u r e which w i l l create jobs.
This year we w i l l f i g h t f o r a r e v i t a l i z e d Clean Water Act and a Safe
Drinking Water Act and a reformed Superfund program. And the Vice
President i s r i g h t — we must also work w i t h the p r i v a t e sector t o
connect every classroom, every c l i n i c , every l i b r a r y , every h o s p i t a l
i n America i n t o a n a t i o n a l i n f o r m a t i o n super highway by t h e year
2000.
(Applause.)
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�- 4 -
Think of i t — i n s t a n t access t o i n f o r m a t i o n w i l l
increase p r o d u c t i v i t y , w i l l help t o educate our c h i l d r e n . I t w i l l
provide b e t t e r medical care. I t w i l l create jobs. And I c a l l on the
Congress t o pass l e g i s l a t i o n t o e s t a b l i s h t h a t i n f o r m a t i o n super
highway t h i s year.
(Applause.)
As we expand o p p o r t u n i t y and create j o b s , no one can be
l e f t out. We must continue t o enforce f a i r lending and f a i r housing
and a l l c i v i l r i g h t s laws, because America w i l l never be complete i n
i t s renewal u n t i l everyone shares i n i t s bounty.
(Applause.)
But we a l l know, too, we can do a l l these t h i n g s — put
our economic house i n order, expand world t r a d e , t a r g e t the jobs of
the f u t u r e , guarantee equal o p p o r t u n i t y — but i f we're honest, w e ' l l
a l l admit t h a t t h i s s t r a t e g y s t i l l cannot work unless we also give
our people the education, t r a i n i n g and s k i l l s they need t o seize the
o p p o r t u n i t i e s of tomorrow. (Applause.)
i
We must set tough, world-class academic and occupational
standards f o r a l l our c h i l d r e n and g i v e our teachers and students the
t o o l s they need t o meet them. Our Goals 2000 proposal w i l l empower
i n d i v i d u a l school d i s t r i c t s t o experiment w i t h ideas l i k e c h a r t e r i n g
t h e i r schools t o be run by p r i v a t e c o r p o r a t i o n s , or having more
p u b l i c school choice — t o do whatever they wish t o do as long as we
measure every school by one high standard: Are our c h i l d r e n l e a r n i n g
what they need t o know t o compete and win i n the g l o b a l economy?
(Applause.)
reforms.
Goals 2 000 l i n k s world-class standards t o grass-roots
And I hope Congress w i l l pass i t w i t h o u t delay.
Our School t o Work I n i t i a t i v e w i l l f o r the f i r s t time
l i n k school t o the world of work, p r o v i d i n g a t l e a s t one year of
apprenticeship beyond high school. A f t e r a l l , most of the people
we're counting on t o b u i l d our economic f u t u r e won't graduate from
c o l l e g e . I t ' s time t o stop i g n o r i n g them and s t a r t empowering them.
(Applause.)
We must l i t e r a l l y transform our out-dated unemployment
system i n t o a new reemployment system. The o l d unemployment system
j u s t s o r t of kept you going while you waited f o r your o l d job t o come
back. We've got t o have a new system t o move people i n t o new and
b e t t e r jobs because most of those o l d jobs j u s t don't come back. And
we know t h a t the only way t o have r e a l job s e c u r i t y i n the f u t u r e , t o
get a good j o b w i t h a growing income, i s t o have r e a l s k i l l s and the
a b i l i t y t o l e a r n new ones. So we've got t o streamline today's
patchwork of t r a i n i n g programs and make them a source of new s k i l l s
for our people who lose t h e i r jobs.
Reemployment, not unemployment, must become the_
centerpiece of our economic renewal. I urge you t o pass i t i n t h i s
session of Congress. (Applause.)
And j u s t as we must transform our unemployment system,
so must we also r e v o l u t i o n i z e our w e l f a r e system. I t doesn't work.
I t d e f i e s our values as a n a t i o n . I f we value work, we can't j u s t i f y
a system t h a t makes welfare more a t t r a c t i v e than work i f people are
w o r r i e d about l o s i n g t h e i r h e a l t h care. (Applause.) I f we value
r e s p o n s i b i l i t y , we can't ignore the $34 b i l l i o n i n c h i l d support
absent parents ought t o be paying t o m i l l i o n s of parents who are
t a k i n g care of t h e i r c h i l d r e n . (Applause.) I f we value strong
f a m i l i e s , we can't perpetuate a system t h a t a c t u a l l y penalizes those
who stay together.
Can you b e l i e v e t h a t a c h i l d who has a c h i l d gets more
money from the government f o r l e a v i n g home than f o r s t a y i n g home w i t h
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�- 5 -
a parent or a grandparent?
And we ought t o change i t .
That's not j u s t bad p o l i c y , i t ' s wrong.
(Applause.)
I worked on t h i s problem f o r years before I became
President, w i t h other governors and w i t h members of Congress of both
p a r t i e s and w i t h the previous a d m i n i s t r a t i o n of another p a r t y . I
worked on i t w i t h people who were on welfare — l o t s o f them. And I
want t o say something t o everybody here who cares about t h i s issue.
The people who most want t o change t h i s system are the people who are
dependent on i t . They want t o get o f f welfare. They want t o go back
t o work. They want t o do r i g h t by t h e i r k i d s .
I once had a hearing when I was a governor and I brought
i n people on welfare from a l l over America who had found t h e i r way t o
work. The woman from my s t a t e who t e s t i f i e d was asked t h i s question:
What's the best t h i n g about being o f f welfare and i n a job? And,
w i t h o u t b l i n k i n g an eye, she looked a t 4 0 governors and she said,
"When my boy goes t o school and they say what does your mother do f o r
a l i v i n g , he can give an answer." These people want a b e t t e r system
and we ought t o g i v e i t t o them. (Applause.)
Last year we began t h i s . We gave t h e s t a t e s more power
t o innovate because we know t h a t a l o t of great ideas come from
outside Washington, and many states are already using i t . Then t h i s
Congress took a dramatic step. Instead of t a x i n g people w i t h modest
incomes i n t o poverty, we helped them t o work t h e i r way out of poverty
by d r a m a t i c a l l y increasing the earned income t a x c r e d i t . I t w i l l
l i f t 15 m i l l i o n working f a m i l i e s out of poverty, rewarding work over
w e l f a r e , making i t possible f o r people t o be successful workers and
successful parents. Now t h a t ' s r e a l welfare reform. (Applause.)
But t h e r e i s more t o be done. This s p r i n g I w i l l send
you a comprehensive welfare reform b i l l t h a t b u i l d s on the Family
Support Act of 1988 and restores t h e basic values of r e s p o n s i b i l i t y .
We'll say t o teenagers, i f you have a c h i l d out o f wedlock, we w i l l
no longer give you a check t o set up a separate household. We want
f a m i l i e s t o stay together. Say t o absent parents who aren't paying
t h e i r c h i l d support, i f you're not p r o v i d i n g f o r your c h i l d r e n , w e ' l l
garnish your wages, suspend your l i c e n s e , t r a c k you across s t a t e
l i n e s , and i f necessary, make some of you work o f f what you owe.
(Applause.)
People who b r i n g c h i l d r e n i n t o t h i s world cannot and
must not walk away from them. But t o a l l those who depend on
w e l f a r e , we should o f f e r u l t i m a t e l y a simple compact. We'll provide
the support, the j o b t r a i n i n g , the c h i l d care you need f o r up t o two
years. But a f t e r t h a t , anyone who can work must — i n the p r i v a t e
sector, wherever p o s s i b l e ; i n community services, i f necessary.
That's the only way w e ' l l ever make welfare what i t ought t o be — a
second chance, not a way of l i f e .
(Applause.)
I know i t w i l l be d i f f i c u l t t o t a c k l e welfare reform i n
1994 a t the same time we t a c k l e h e a l t h care. But l e t me p o i n t out, I
t h i n k i t i s i n e v i t a b l e and imperative. I t i s estimated t h a t one
m i l l i o n people are on welfare today because i t ' s the only way they
can get h e a l t h care coverage f o r t h e i r c h i l d r e n . Those who choose t o
leave welfare f o r jobs without h e a l t h b e n e f i t s — and many entry jobs
don't have h e a l t h b e n e f i t s — f i n d themselves i n the i n c r e d i b l e
p o s i t i o n of paying taxes t h a t help t o pay f o r h e a l t h care coverage
f o r those who made the other choice t o stay on w e l f a r e . No wonder
people leave work and go back t o w e l f a r e t o get h e a l t h care coverage.
We have got t o solve the health care problem t o have r e a l welfare
reform.
(Applause.)
So t h i s year, we w i l l make h i s t o r y by reforming the
h e a l t h care system.
And I would say t o you, a l l of you, my f e l l o w
p u b l i c servants, t h i s i s another issue where the people are way ahead
of t h e p o l i t i c i a n s .
(Applause and laughter.) That may not be
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popular w i t h e i t h e r p a r t y , but i t happens t o be the t r u t h .
(Laughter.)
You know, the F i r s t Lady has received now almost a
m i l l i o n l e t t e r s from people a l l across America and from a l l walks of
life.
I'd l i k e t o share j u s t one of them w i t h you.
Richard Anderson of Reno, Nevada, l o s t h i s j o b and, w i t h
i t , h i s h e a l t h insurance. Two weeks l a t e r , h i s w i f e , Judy, s u f f e r e d
a cerebral aneurysm. He rushed her t o the h o s p i t a l , where she stayed
i n i n t e n s i v e care f o r 21 days.
The Andersons' b i l l s were over $120,000. Although Judy
recovered and Richard went back t o work, a t $8 an hour, the b i l l s
were too much f o r them and they were l i t e r a l l y forced i n t o
bankruptcy.
"Mrs. C l i n t o n , " he wrote t o H i l l a r y , "no one i n the
United States of America should have t o lose everything they've
worked f o r a l l t h e i r l i v e s because they were u n f o r t u n a t e enough t o
become i l l . "
I t was t o help the Richard and Judy Andersons of America
t h a t the F i r s t Lady and so many others have worked so hard and so
long on t h i s h e a l t h care reform issue. We owe them our thanks and
our a c t i o n .
(Applause.)
I know there are people here who say there's no h e a l t h
care c r i s i s . T e l l i t t o Richard and Judy Anderson. T e l l i t t o the
58 m i l l i o n Americans who have no coverage a t a l l f o r some time each
year. T e l l i t t o the 81 m i l l i o n Americans w i t h those p r e e x i s t i n g
conditions — those f o l k s are paying more or they can't get insurance
at a l l , or they can't ever change t h e i r jobs because they or someone
i n t h e i r f a m i l y has one of those p r e e x i s t i n g c o n d i t i o n s . T e l l i t t o
the small businesses burdened by the skyrocketing cost of insurance.
Most small businesses cover t h e i r employees, and they pay on average
35 percent more i n premiums than b i g businesses or government. Or
t e l l i t t o t h e 76 percent of insured Americans, t h r e e out of f o u r
whose p o l i c i e s have l i f e t i m e l i m i t s . And t h a t means they can f i n d
themselves w i t h o u t any coverage a t a l l j u s t when they need i t the
most.
So i f any of you b e l i e v e there's no c r i s i s , you t e l l i t
t o those people — because I can't. (Applause.)
There are some people who l i t e r a l l y do not understand
the impact of t h i s problem on people's l i v e s .
And a l l you have t o
do i s go out and l i s t e n t o them. Just go t a l k t o them anywhere i n
any congressional d i s t r i c t i n t h i s country. They're Republicans and
Democrats and independents — i t doesn't have a l i c k t o do w i t h
p a r t y . They t h i n k we don't get i t . And i t ' s time we show them t h a t
we do get i t . (Applause.)
From the day we began, our h e a l t h care i n i t i a t i v e has
been designed t o strengthen what i s good about our h e a l t h care
system: the world's best h e a l t h care p r o f e s s i o n a l s , c u t t i n g edge
research and wonderful research i n s t i t u t i o n s . Medicare f o r o l d e r
Americans. None of t h i s — none of i t should be put a t r i s k .
But we're paying more and more money f o r less and less
care. Every year fewer and fewer Americans even get t o choose t h e i r
doctors. Every year doctors and nurses spend more time on paperwork
and less time w i t h p a t i e n t s because of the absolute b u r e a u c r a t i c
nightmare the present system has become. This system i s r i d d l e d w i t h
i n e f f i c i e n c y , w i t h abuse, w i t h f r a u d , and everybody knows i t .
the shots.
I n today's h e a l t h care system, insurance companies c a l l
They p i c k whom they cover and how they cover them. They
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can cut o f f your b e n e f i t s when you need your coverage the most.
are i n charge.
They
What does i t mean? I t means every n i g h t m i l l i o n s of
w e l l - i n s u r e d Americans go t o bed j u s t an i l l n e s s , an accident or a
pink s l i p away from having no coverage or f i n a n c i a l r u i n . I t means
every morning m i l l i o n s of Americans go t o work w i t h o u t any h e a l t h
insurance a t a l l — something the workers i n no other advanced
country i n the world do. I t means t h a t every year, more and more
hard-working people are t o l d t o p i c k a new doctor because t h e i r boss
has had t o p i c k a new plan. And countless others t u r n down b e t t e r
jobs because they know i f they take the b e t t e r j o b , they w i l l lose
t h e i r h e a l t h insurance.
I f we j u s t l e t the h e a l t h care system continue t o d r i f t ,
our country w i l l have people w i t h less care, fewer choices and higher
bills.
Now, our approach p r o t e c t s the g u a i i t y of care and
people's choices. I t b u i l d s on what works today i n the p r i v a t e
sector — t o expand employer-based coverage, t o guarantee p r i v a t e
insurance f o r every American. And I might say, employer-based
p r i v a t e insurance f o r every American was proposed 20 years ago by
President Richard Nixon t o t h e United States Congress. I t was a good
idea then, and i t ' s a b e t t e r idea today.
(Applause.)
Why do we want guaranteed p r i v a t e insurance? Because
r i g h t now nine out of 10 people who have insurance get i t through
t h e i r employers. And t h a t should continue. And i f your employer i s
p r o v i d i n g good b e n e f i t s a t reasonable p r i c e s , t h a t should continue,
too.
That ought t o make the Congress and the President f e e l b e t t e r .
Our goal i s h e a l t h insurance everybody can depend on —
comprehensive b e n e f i t s t h a t cover preventive care and p r e s c r i p t i o n
drugs; h e a l t h premiums t h a t don't j u s t explode when yo get s i c k or
you get o l d e r ; the power no matter how small your business i s t o
choose dependable insurance a t the same c o m p e t i t i v e rates governments
and b i g business get today; one simple form f o r people who are s i c k ;
and, most of a l l , the freedom t o choose a p l a n and the r i g h t t o
choose your own doctor.
Our approach p r o t e c t s older Americans. Every p l a n
before the Congress proposes t o slow the growth of Medicare.
The
d i f f e r e n c e i s t h i s : We b e l i e v e those savings should be used t o
improve h e a l t h care f o r s e n i o r c i t i z e n s . Medicare must be p r o t e c t e d ,
and i t should cover p r e s c r i p t i o n drugs, and we should take t h e f i r s t
steps i n covering long-term care.
(Applause.)
To those who would cut Medicare w i t h o u t p r o t e c t i n g
seniors, I say the s o l u t i o n t o today's squeeze on middle-class
working people's h e a l t h care i s not t o put the squeeze on middleclass r e t i r e d people's h e a l t h care. We can do b e t t e r than t h a t .
When i t ' s a l l s a i d and done, i t ' s p r e t t y simple t o me.
Insurance ought t o mean what i t used t o mean — you pay a f a i r p r i c e
f o r s e c u r i t y , and when you get s i c k , h e a l t h care's always t h e r e , no
matter what.
Along w i t h the guarantee of h e a l t h s e c u r i t y , we a l l have
t o admit, t o o , t h e r e must be more r e s p o n s i b i l i t y on the p a r t of a l l
of us i n how we use t h i s system. People have t o take t h e i r k i d s t o
get immunized. We should a l l take advantage of preventive care. We
must a l l work together t o stop the v i o l e n c e t h a t explodes our
emergency rooms. We have t o p r a c t i c e b e t t e r h e a l t h h a b i t s , and we
can't abuse the system. And those who don't have insurance under our
approach w i l l get coverage, but t h e y ' l l have t o pay something f o r i t ,
too.
The m i n o r i t y of businesses t h a t provide no insurance a t a l l ,
and i n so doing, s h i f t the cost of the care of t h e i r employees t o
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others, should c o n t r i b u t e something. People who smoke should pay
more f o r a pack of c i g a r e t t e s . Everybody can c o n t r i b u t e something i f
we want t o solve the h e a l t h care c r i s i s . There can't be any more
something f o r n o t h i n g . I t w i l l not be easy but i t can be done.
(Applause.)
Now, i n the coming months I hope very much t o work both
Democrats and Republicans t o reform a h e a l t h care system by using the
market t o b r i n g down costs and t o achieve l a s t i n g h e a l t h s e c u r i t y .
But i f you look at h i s t o r y we see t h a t f o r 60 years t h i s country has
t r i e d t o reform h e a l t h care. President Roosevelt t r i e d . President
Truman t r i e d . President Nixon t r i e d . President Carter t r i e d .
Every
time t h e s p e c i a l i n t e r e s t s were powerful enough t o defeat them. But
not t h i s time.
(Applause.)
I know t h a t f a c i n g up t o these i n t e r e s t s w i l l r e q u i r e
courage. I t w i l l r a i s e c r i t i c a l questions about the way we finance
our campaigns and how l o b b y i s t s y i e l d t h e i r i n f l u e n c e . The work of
change, f r a n k l y , w i l l never get any e a s i e r u n t i l we l i m i t the
i n f l u e n c e of w e l l - f i n a n c e d i n t e r e s t who p r o f i t from t h i s c u r r e n t
system. So I also must now t o c a l l on you t o f i n i s h the j o b both
Houses began l a s t year by passing tough and meaningful campaign
finance reform and lobby reform l e g i s l a t i o n t h i s year.
(Applause.)
You know, my f e l l o w Americans, t h i s i s r e a l l y a t e s t f o r
a l l of us. The American people provide those of us i n government
service w i t h t e r r i f i c h e a l t h care b e n e f i t s a t reasonable costs. We
have h e a l t h care t h a t ' s always there. I t h i n k we need t o g i v e every
hard-working, tax-paying American the same h e a l t h care s e c u r i t y they
have already given t o us.
(Applause.)
I want t o make t h i s very c l e a r . I am open, as I have
said repeatedly, t o t h e best ideas of concerned members of both
p a r t i e s . I have no s p e c i a l b r i e f f o r any s p e c i f i c approach, even i n
our own b i l l , except t h i s : I f you send me l e g i s l a t i o n t h a t does not
guarantee every American p r i v a t e h e a l t h insurance t h a t can never be
taken away, you w i l l force me t o take t h i s pen, veto the l e g i s l a t i o n ,
and w e ' l l come r i g h t back here and s t a r t a l l over again.
(Applause.)
But I don't t h i n k t h a t ' s going t o happen. I t h i n k we're
ready t o act now.
I b e l i e v e t h a t you're ready t o act now.
And i f
you're ready t o guarantee every American the same h e a l t h care t h a t
you have, h e a l t h care t h a t can never be taken away, now — not next
year or the year a f t e r — now i s the time t o stand w i t h the people
who sent us here. Now.
(Applause.)
As we take these steps t o g e t h e r t o renew our strength a t
home, we cannot t u r n away from our o b l i g a t i o n t o renew our leadership
abroad. This i s a promising moment. Because of the agreements we
have reached t h i s year, l a s t year, Russia's s t r a t e g i c nuclear
m i s s i l e s soon w i l l no longer be pointed a t the United States, nor
w i l l we p o i n t ours a t them. (Applause.) Instead of b u i l d i n g weapons
i n space, Russian s c i e n t i s t s w i l l help us t o b u i l d t h e i n t e r n a t i o n a l
space s t a t i o n .
(Applause.)
Of course, t h e r e are s t i l l dangers i n the world —
rampant arms p r o l i f e r a t i o n , b i t t e r r e g i o n a l c o n f l i c t s , e t h n i c and
n a t i o n a l i s t tensions i n many new democracies, severe environmental
degradation the world over, and f a n a t i c s who seek t o c r i p p l e the
world's c i t i e s w i t h t e r r o r . As the world's g r e a t e s t power, we must,
t h e r e f o r e , maintain our defenses and our r e s p o n s i b i l i t i e s .
This year, we secured indictments against t e r r o r i s t s and
sanctions against those who harbor them. We worked t o promote
environmentally s u s t a i n a b l e economic growth. We achieved agreements
w i t h Ukraine, w i t h Belarus, w i t h Kazahkstan t o e l i m i n a t e completely
t h e i r nuclear arsenal. We are working t o achieve a Korean Peninsula
free o f nuclear weapons. We w i l l seek e a r l y r a t i f i c a t i o n of a t r e a t y
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to ban chemical weapons worldwide. And e a r l i e r today, we j o i n e d w i t h
over 3 0 nations t o begin n e g o t i a t i o n s on a comprehensive ban t o stop
a l l nuclear t e s t i n g .
(Applause.)
But nothing, nothing i s more important t o our s e c u r i t y
than our nation's armed f o r c e s . We honor t h e i r c o n t r i b u t i o n s ,
i n c l u d i n g those who are c a r r y i n g out the longest humanitarian a i r
l i f t i n h i s t o r y i n Bosnia; (applause) — those who w i l l complete
t h e i r mission i n Somalia t h i s year and t h e i r brave comrades who gave
t h e i r l i v e s there. (Applause.)
Our forces are the f i n e s t m i l i t a r y our n a t i o n has ever
had. And I have pledged t h a t as long as I am President, they w i l l
remain the best equipped, the best t r a i n e d and the best prepared
f i g h t i n g f o r c e on t h e face of the Earth. (Applause.)
Last year I proposed a defense plan t h a t maintains our
post-Cold War s e c u r i t y a t a lower cost. This year many people urged
me t o cut our defense spending f u r t h e r t o pay f o r other government
programs. I said, no. The budget I send t o Congress draws the l i n e
against f u r t h e r defense cuts. I t p r o t e c t s the readiness and q u a l i t y
of our f o r c e s .
U l t i m a t e l y , the best s t r a t e g y i s t o do t h a t . We must
not c u t defense f u r t h e r . I hope the Congress without regard t o p a r t y
w i l l support t h a t p o s i t i o n .
(Applause.)
U l t i m a t e l y , the best s t r a t e g y t o ensure our s e c u r i t y and
to b u i l d a durable peace i s t o support the advance o f democracy
elsewhere. Democracies don't a t t a c k each other, they make b e t t e r
t r a d i n g partners and partners i n diplomacy.
That i s why we have
supported, you and I , the democratic reformers i n Russia and i n the
other s t a t e s of the former Soviet b l o c . I applaud the b i p a r t i s a n
support t h i s Congress provided l a s t year f o r our i n i t i a t i v e s t o help
Russia, Ukraine, and the other states through t h e i r epic
transformations.
Our support of reform must combine patience f o r the
enormity of the task and v i g i l a n c e f o r our fundamental i n t e r e s t and
values. We w i l l continue t o urge Russia and the other s t a t e s t o
press ahead w i t h economic reforms. And we w i l l seek t o cooperate
w i t h Russia t o solve r e g i o n a l problems, while i n s i s t i n g t h a t i f
Russian troops operate i n neighboring s t a t e s , they do so only when
those s t a t e s agree t o t h e i r presence and i n s t r i c t accord w i t h
i n t e r n a t i o n a l standards.
(Applause.)
But we must also remember as these nations chart t h e i r
own f u t u r e s — and they must chart t h e i r own f u t u r e s — how much more
secure and more prosperous our own people w i l l be i f democratic and
market reform succeed a l l across the former communist bloc. Our
p o l i c y has been t o support t h a t move and t h a t has been the p o l i c y of
the Congress. We should continue i t .
That i s why I went t o Europe e a r l i e r t h i s month — t o
work w i t h our Europeans p a r t n e r s , t o help t o i n t e g r a t e a l l the former
communist countries i n t o a Europe t h a t has a p o s s i b i l i t y of becoming
u n i f i e d f o r the f i r s t time i n i t s e n t i r e h i s t o r y — i t s e n t i r e
h i s t o r y — based on the simple commitments of a l l nations i n Europe
to democracy, t o f r e e markets and t o respect f o r e x i s t i n g borders.
With our a l l i e s we have created a Partnership For Peace
t h a t i n v i t e s states from the former Soviet bloc and other non-NATO
members t o work w i t h NATO i n m i l i t a r y cooperation. When I met w i t h
Central Europe's leaders i n c l u d i n g Lech Walesa and Vaclav Havel, men
who p u t t h e i r l i v e s on the l i n e f o r freedom, I t o l d them t h a t the
s e c u r i t y of t h e i r r e g i o n i s important t o our country's s e c u r i t y .
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This year we must also do more t o support democratic
renewal and human r i g h t s and sustainable development a l l around the
world. We w i l l ask Congress t o r a t i f y the new GATT accord. We w i l l
continue standing by South A f r i c a as i t works i t s way through i t s
bold and hopeful and d i f f i c u l t t r a n s i t i o n t o democracy. We w i l l
convene a summit of the Western Hemisphere's leaders from Canada t o
the t i p of South America. And we w i l l continue t o press f o r t h e
r e s t o r a t i o n of t r u e democracy i n H a i t i .
(Applause.)
And as we b u i l d a more c o n s t r u c t i v e r e l a t i o n s h i p w i t h
China, we must continue t o i n s i s t on clear signs of improvement i n
t h a t nation's human r i g h t record. (Applause.)
We w i l l also work f o r new progress toward the Middle
East peace. Last year the world watched Y i t z h a k Rabin and Yassir
A r a f a t a t the White House when they had t h e i r h i s t o r i c handshake of
r e c o n c i l i a t i o n . But there i s a long, hard road ahead. And on t h a t
road I am determined t h a t I and our a d m i n i s t r a t i o n w i l l do a l l we can
to achieve a comprehensive and l a s t i n g peace f o r a l l the peoples of
the region.
Now, t h e r e are some i n our country who argue t h a t w i t h
the Cold War, America should t u r n i t s back on the r e s t of t h e world.
Many around the world were a f r a i d we would do j u s t t h a t . But I took
t h i s o f f i c e on a pledge t h a t had no p a r t i s a n t i n g e t o keep our n a t i o n
secure by remaining engaged i n the r e s t of t h e w o r l d . And t h i s year,
because of our work t o g e t h e r — enacting NAFTA, keeping our m i l i t a r y
strong and prepared, supporting democracy abroad — we have
r e a f f i r m e d America's leadership, America's engagement. And as a
r e s u l t , the American people are more secure than they were before.
(Applause.)
But w h i l e Americans are more secure from t h r e a t s abroad,
I t h i n k we a l l know t h a t i n many ways we are l e s s secure from t h r e a t s
here a t home. Every day the n a t i o n a l peace i s shattered by crime.
I n Petaluma, C a l i f o r n i a , an innocent slumber p a r t y gives way t o
agonizing tragedy f o r the f a m i l y o f Polly Klaas. An o r d i n a r y t r a i n
r i d e on Long I s l a n d ends i n a h a i l of 9 - m i l l i m e t e r rounds. A t o u r i s t
i n F l o r i d a i s n e a r l y burned a l i v e by bigots simply because he i s
black. Right here i n our Nation's C a p i t a l , a brave young man named
Jason White, a policeman, the son and grandson of policemen, i s
r u t h l e s s l y gunned down. V i o l e n t crime and t h e fear i t provokes are
c r i p p l i n g our s o c i e t y , l i m i t i n g personal freedom and f r a y i n g the t i e s
t h a t bind us.
The crime b i l l before Congress gives you a chance t o do
something about i t — a chance t o be tough and smart. What does t h a t
mean? Let me begin by saying, I care a l o t about t h i s issue. Many
years ago, when I s t a r t e d out i n p u b l i c l i f e , I was the a t t o r n e y
general of my s t a t e . I served as a governor f o r a dozen years; I
know what i t ' s l i k e t o sign laws increasing p e n a l t i e s , t o b u i l d more
p r i s o n c e l l s , t o carry out the death penalty. I understand t h i s
issue. And i t i s not a simple t h i n g .
F i r s t , we must recognize t h a t most v i o l e n t crimes are
committed by a small percentage of c r i m i n a l s who too o f t e n )preak the
laws even when they are on parole. Now those who commit crimes
should be punished. And those who commit repeated, v i o l e n t crimes
should be t o l d , when you commit a t h i r d v i o l e n t crime, you w i l l be
put away, and put away f o r good. Three s t r i k e s , and you are out.
(Applause.)
Second, we must take serious steps t o reduce v i o l e n c e
and prevent crime, beginning w i t h more p o l i c e o f f i c e r s and more
community p o l i c i n g .
(Applause.) We know r i g h t now t h a t p o l i c e who
work the s t r e e t s , know the f o l k s , have the respect of the
neighborhood k i d s , focus on high crime areas — we know t h a t they are
more l i k e l y t o prevent crime as w e l l as catch c r i m i n a l s . Look a t the
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experience of Houston, where the crime r a t e dropped 17 percent i n one
year when t h a t approach was taken.
Here t o n i g h t i s one of those community policeman — a
brave, young d e t e c t i v e , Kevin J e t t , whose beat i s e i g h t square blocks
i n one o f the toughest neighborhoods i n New York. Every day he
restores some s a n i t y and s a f e t y and a sense of values and connections
t o the people whose l i v e s he p r o t e c t s . I ' d l i k e t o ask him t o stand
up and be recognized t o n i g h t .
Thank you, s i r .
(Applause.)
You w i l l be given a chance t o give the c h i l d r e n of t h i s
country, t h e law-abiding working people of t h i s country — and don't
f o r g e t , i n the toughest neighborhoods i n t h i s country, i n the highest
crime neighborhoods i n t h i s country, the vast m a j o r i t y o f people get
up every day and obey the law, pay t h e i r taxes, do t h e i r best t o
r a i s e t h e i r k i d s . They deserve people l i k e Kevin J e t t . And you're
going t o be given a chance t o give the American people another
100,000 o f them w e l l t r a i n e d . And I urge you t o do i t . (Applause.)
You have before you crime l e g i s l a t i o n which also
e s t a b l i s h e s a p o l i c e corps t o encourage young people t o get an
education and pay i t o f f by serving as p o l i c e o f f i c e r s ; which
encourages r e t i r i n g m i l i t a r y personnel t o move i n t o p o l i c e forces, an
i n o r d i n a t e resource f o r our country — one which has a safe schools
p r o v i s i o n which w i l l give our young people the chance t o walk t o
school i n safety and t o be i n school i n safety instead of dodging
bullets.
These are important things.
(Applause.)
The t h i r d t h i n g we have t o do i s t o b u i l d on the Brady
B i l l — t h e Brady Law.
(Applause.) To take f u r t h e r steps t o keep
guns out o f the hands of c r i m i n a l s .
I want t o say something about t h i s issue. Hunters must
always be f r e e t o hunt. Law-abiding a d u l t s should always be free t o
own guns t o p r o t e c t t h e i r homes. I respect t h a t p a r t o f our c u l t u r e ,
I grew up i n i t . But I want t o ask the sportsmen and others who
l a w f u l l y own guns t o j o i n us i n t h i s campaign t o reduce gun violence.
I say t o you, I know you d i d n ' t create t h i s problem, b u t we need your
help t o solve i t . There i s no s p o r t i n g purpose on E a r t h t h a t should
stop the United States Congress from banishing assault weapons t h a t
out-gun p o l i c e and cut down c h i l d r e n .
(Applause.)
Fourth, we must remember t h a t drugs are a f a c t o r i n an
enormous percentage of crimes. Recent studies i n d i c a t e , sadly, t h a t
drug use i s on the r i s e again among our young people. The crime b i l l
contains — a l l the crime b i l l s contain — more money f o r drug
treatment f o r c r i m i n a l a d d i c t s , and boot camps f o r y o u t h f u l offenders
t h a t i n c l u d e incentives t o get o f f drugs and t o stay o f f drugs.
Our a d m i n i s t r a t i o n ' s budget w i t h a l l i t s cuts can paint
a large increase i n funding f o r drug treatment and drug education.
You must pass them both. We need them desperately. (Applause.)
My f e l l o w Americans, the problem of v i o l e n c e i s an
American problem. I t has no p a r t i s a n or p h i l o s o p h i c a l element.
Therefore, I urge you t o f i n d ways as q u i c k l y as p o s s i b l e t o set
aside p a r t i s a n d i f f e r e n c e s and pass a strong, smart, tough crime
bill.
(Applause.) But f u r t h e r , I urge you t o consider t h i s : As you
demand tougher p e n a l t i e s f o r those who choose v i o l e n c e , l e t us also
remember how we came t o t h i s sad p o i n t .
I n our toughest neighborhoods, on our meanest s t r e e t s ,
i n our poorest r u r a l areas, we have seen a stunning and simultaneous
breakdown o f community, f a m i l y and work — the heart and soul of
c i v i l i z e d society. This has created a v a s t vacuum which has been
f i l l e d by v i o l e n c e and drugs and gangs. So I ask you t o remember
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t h a t even as we say no t o crime, we must give people — e s p e c i a l l y
our young people — something t o say yes t o . (Applause.)
Many of our i n i t i a t i v e s — from job t r a i n i n g t o w e l f a r e
reform t o h e a l t h care t o n a t i o n a l service — w i l l help t o r e b u i l d
d i s t r e s s e d communities, t o strengthen f a m i l i e s , t o provide work. But
more needs t o be done. That's what our community empowerment agenda
i s a l l about — c h a l l e n g i n g businesses t o provide more investment
through empowerment zones; ensuring banks w i l l make loans i n the same
communities t h e i r deposits come from; passing l e g i s l a t i o n t o unleash
the power of c a p i t a l through community development banks t o create
jobs — o p p o r t u n i t y and hope where they're needed most.
I t h i n k you know t h a t t o r e a l l y solve t h i s problem,
w e ' l l a l l have t o put our heads together, leave our i d e o l o g i c a l armor
aside and f i n d some new ideas t o do even more. And l e t ' s be honest;
we a l l know something else too: Our problems go way beyond the reach
of government. They're rooted i n the lose of values, i n the
disappearance of work and the breakdown of our f a m i l i e s and our
communities.
My f e l l o w Americans, we can cut the d e f i c i t , create
jobs, promote democracy around the world, pass w e l f a r e reform and
h e a l t h care, pass the toughest crime b i l l i n h i s t o r y , but s t i l l leave
too many of our people behind.
The American people have got t o want t o change from
w i t h i n i f we're going t o b r i n g back work and f a m i l y and community.
We cannot renew our country when w i t h i n a decade more than h a l f of
the c h i l d r e n w i l l be born i n t o f a m i l i e s where t h e r e has been no
marriage. We cannot renew t h i s country when 13-year-old boys get
semi-automatic weapons t o shoot 9-year-olds f o r k i c k s . We can't
renew our country when c h i l d r e n are having c h i l d r e n and the f a t h e r s
walk away as i f t h e kids don't amount t o anything. We can't renew
the country when our businesses eagerly look f o r new investments and
new customers abroad, but ignore those people r i g h t here a t home who
would give anything t o have t h e i r jobs and would g l a d l y buy t h e i r
products i f they had the money t o do i t . (Applause.)
We can't renew our country unless more of us — I mean
a l l of us — are w i l l i n g t o j o i n the churches and the other good
c i t i z e n s — people l i k e of the black m i n i s t e r s I've worked w i t h over
the years, or the p r i e s t s and the nuns I met a t Our Lady of Help i n
East Los Angeles, or my good f r i e n d , Tony Campollo i n P h i l a d e l p h i a —
unless we're w i l l i n g t o work w i t h people l i k e t h a t , people who are
saving k i d s , adopting schools, making s t r e e t s s a f e r — a l l of us can
do t h a t . We can't renew our country u n t i l we r e a l i z e t h a t
governments don't r a i s e c h i l d r e n , parents do.
(Applause.)
Parents who know t h e i r c h i l d r e n ' s teachers and t u r n o f f
the t e l e v i s i o n and help w i t h the homework and teach t h e i r kids r i g h t
from wrong — those kinds of parents can make a l l the d i f f e r e n c e . I
know, I had one.
(Applause.)
I'm t e l l i n g you, we have got t o stop p o i n t i n g our
f i n g e r s a t these k i d s who have no f u t u r e , and reach our hands out t o
them. Our country needs i t , we need i t , and they deserve i t .
(Applause.)
So I say t o you t o n i g h t , l e t ' s give our c h i l d r e n a
f u t u r e . Let us take away t h e i r guns and give them books. Let us
overcome t h e i r despair and replace i t w i t h hope. Let us, by our
example, teach them t o obey the law, respect our neighbors, and
cherish our values. Let us weave these sturdy threads i n t o a new
American community t h a t can once more stand strong against the forces
of despair and e v i l because everybody has a chance t o walk i n t o a
b e t t e r tomorrow.
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Oh, there w i l l be naysayers who fear t h a t we won't be
equal t o the challenges of t h i s time. But they misread our h i s t o r y ,
our h e r i t a g e . Even today's headlines — a l l those t h i n g s t e l l us we
can and we w i l l overcome any challenge.
When the earth shook and f i r e s raged i n C a l i f o r n i a , when
I saw t h e M i s s i s s i p p i deluge t h e farmlands of t h e Midwest i n a 500year f l o o d , when the century's b i t t e r e s t cold swept from North Dakota
t o Newport News, i t seemed as though t h e world i t s e l f was coming
apart a t the seams. But the American people — they j u s t came
together. They rose t o the occasion, neighbor h e l p i n g neighbor,
strangers r i s k i n g l i f e and limb t o save t o t a l strangers — showing
the b e t t e r angels o f our nature.
Let us not reserve the b e t t e r angels only f o r n a t u r a l
d i s a s t e r s , l e a v i n g our deepest and most profound problems t o p e t t y
political fighting.
(Applause.) Let us instead be t r u e t o our
s p i r i t — f a c i n g f a c t s , coming together, b r i n g i n g hope and moving
forward.
Tonight, my f e l l o w Americans, we are summoned t o answer
a question as o l d as the r e p u b l i c i t s e l f : What i s the state o f our
union? I t i s growing stronger, but i t must be stronger s t i l l . With
your help, and God's help, i t w i l l be.
Thank you and God bless America.
END
(Applause.)
10:18 P.M. EST
�THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
February 1, 1994
REMARKS BY THE PRESIDENT
TO THE NATIONAL GOVERNORS ASSOCIATION CONFERENCE
J.W. Marriott
Washington, DC
11:46 A.M.
EST
THE PRESIDENT: Thank you very much. I f anyone ever ask
you what do Carroll Campbell and B i l l Clinton have i n common, you
could say they have the same throat disease. (Laughter.) He's doing
better today than he was yesterday. I'm doing s l i g h t l y worse. The
good news i s you get a shorter speech.
I want to thank you a l l for being here and for your
common concerns. Yesterday we had a good meeting, and especially I
thought a very good discussion about the problem of crime i n our
country and the crime b i l l ; the necessity to put more well-trained
police o f f i c e r s on our street and to take repeat violent criminals
off the streets forever; but also the necessity to be smart about the
crime b i l l — to do things that make sense to you and to your law
enforcement o f f i c i a l s .
Today, I want to t a l k a l i t t l e b i t about two other
fundamental challenges that we face — health care reform and welfare
reform. They are linked inextricably to each other. And i n order to
meet these challenges, we w i l l have to have an open and honest
partnership both i n passing the laws and, perhaps even more
important, i n implementing them.
We began our partnership, at l e a s t with me i n t h i s new
job, about a year ago today when we had a very long and f r u i t f u l
meeting at the White House. I think i t ran i n excess of three hours.
That meeting resulted, among other things, i n the approval of every
major waiver for state health care reform that you have requested.
There have been five of them and about 90 smaller waivers to enable
different changes to be made at the state l e v e l . In addition to
that, we've now granted waivers to nine states i n the area of welfare
reform.
I do believe the states are the laboratories of
democracy. I do believe that where people are charged with solving
the r e a l problems of r e a l people, r e a l i t y and truth i n p o l i t i c s often
i s more l i k e l y to give way to making progress.
Last August you a l l said. Democrats and Republicans
a l i k e , that our health care system i s i n c r i s i s . In the l a s t several
days we've had a big l i n g u i s t i c battle i n Washington about whether we
have a c r i s i s or a serious problem. I think i t ' s better since we're
at the governors meeting to focus on the facts. We do have a system,
unlike any other i n the advanced countries i n the world, i n which
insurance companies decide whose covered and who i s n ' t , what the cost
of insurance i s and what's covered i n s p e c i f i c p o l i c i e s . We do have
a system i n which the number of uninsured people i s going up
s i g n i f i c a n t l y . We do have a system i n which more and more Americans,
therefore, who have insurance are at r i s k of losing i t i f they get
sick or i f t h e i r job goes away.
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We c l e a r l y have a system, as our SBA Director Erskine
Bowles, from North Carolina, never t i r e s of t e l l i n g me, where small
businesses have premiums that, on average, are 35 percent higher than
large businesses or government. We have a system i n which state
budgets have been extraordinarily burdened by the exploding costs of
t h e i r Medicaid match, so that l a s t year for the f i r s t time ever,
state's spent more money on health care than on state-funded higher
education.
We have a system i n which the lowest estimate of
uncompensated care burdens on hospitals i s $25 b i l l i o n ; i n which 58
million Americans, according to the Medical Association, are without
coverage at some time during the year; i n which 81 million Americans
have a preexisting condition, which means either that t h e i r premiums
are higher or that they can't get insurance or that they can't ever
change jobs, which i s an enormous burden i n a system i n which labor
mobility i s , I am convinced, the key to personal and family
prosperity as we move toward the 21st century.
Finally, we have a system i n which three out of four
insurance p o l i c i e s have lifetime l i m i t s , which mean i f you get r e a l l y
sick, you might run out of insurance i n the middle of the time when
you need i t most.
Now, those are facts. They can be seen i n the million
l e t t e r s almost that the F i r s t Lady has received since we started t h i s
whole effort to deal with health care. On the way i n I was
describing b r i e f l y to Governor Campbell a l e t t e r I got from — or she
got from Jo Anne Osteen of Sumter, South Carolina, who owns a small
business, works s i x days a week, raised three children by herself,
with diabetes and a r t h r i t i s .
Although she had diabetes and
a r t h r i t i s , when she wrote us she hadn't been to the hospital one time
in the 12 years that she'd been through the insurers. But her
insurance rates went up to $306 a month, even though she was only
taking home only $205 a week from her business. Her doctors told her
that the answer was to quit and go on d i s a b i l i t y .
So she wrote, "Those high premiums are going to force
people l i k e me to the welfare and food stamp l i n e s with no insurance.
I am a proud American and I don't want t h i s to happen to me. I have
thought about nothing but t h i s problem, and I don't know where to
turn."
Well, I think we ought to heed her c a l l for help. A l o t
of you do, too, and that's why you've t r i e d to reform your health
care systems. After a l l , t h i s woman has values that keeps t h i s
country together. They're the ones that b u i l t our nation. And we
shouldn't force people l i k e that to consider seriously whether they
should go on to public assistance in order to take care of t h e i r
children.
There's a f l i p side to t h i s , too, t h i s connection
between welfare and health care, which I want to mention. I talked
about i t a l i t t l e in the State of the Union address. But we often
say to people they should leave welfare and go to work. And we know
that welfare benefits themselves i n real dollar terms are lower today
than they were 2 0 years ago i n most state. So that the welfare check
has almost nothing to do with why people stay on welfare. They stay
because of the medical care and because of c h i l d care and because
they have low s k i l l s .
But we have t h i s incredible situation i n our country
where i f someone on welfare leaves welfare to take an entry-level job
that doesn't have health insurance, as soon as the coverage of the
Family Support Act runs out, you have people making low wages paying
taxes to pay for health care for people who stayed on welfare and
didn't make the same decision they did.
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So these two issues are c l e a r l y t i e d together, and we
need to see them together as a part of what i t would take to make
America a place where people who work hard, play by the rules and
believe in the kind of values that permeate the efforts that a l l the
governors around t h i s table are making are rewarded for that.
Now, we've made a beginning. Last year, the Congress
passed i n the context of the budget act a huge increase in the earned
income tax credit, which l i f t s families with children on modest wages
out of poverty. When tax b i l l s come due t h i s A p r i l , 15 million
families with a t o t a l of about we estimate 50 million Americans w i l l
be l i f t e d beyond the poverty line by getting tax reduction under the
earned income tax credit. That means that there w i l l no longer be an
income incentive for people to choose welfare over work.
But the welfare system has a l o t of other problems as
well. Too often i t s t i l l rewards values other than family and
personal responsibility. Instead of encouraging those to stay
together as we should, i t often encourages families to break apart.
Instead of encouraging children who have children to l i v e with their
parents or grandparents, i t often encourages them to leave home.
Instead of enforcing child support and asking those who bring
children into the world to take responsibility for them, i t too often
ignores i t ' s too d i f f i c u l t to c o l l e c t the $34 b i l l i o n absent parents
should be paying for t h e i r children.
Perhaps most important — we were talking about t h i s on
the way i n — an enormous part of t h i s problem i s the explosion of
births to people who have never been married at a l l . And there i s
nothing in the present system except where the states have taken the
i n i t i a t i v e to do i t , to stop teen pregnancy from occurring i n the
f i r s t place. Even in the Family Support Act of '88 — and I want to
say more about that because I'm r e a l l y proud of what we did on i t —
there was nothing to stop the condition from occurring i n the f i r s t
place.
And we need to devote, as t h i s debate takes place, an
enormous amount of attention to some of the decisions that we ought
to make, some of them quite p o l i t i c a l l y courageous.
Governor
Campbell was talking about some of the things they're doing in South
Carolina which mirror some of the things we t r i e d to do at home to
try to stop these things from occurring in the f i r s t place.
This year I have committed — and Senator Moynihan, I
think and Senator Dole probably both talked about t h i s — to offer in
the springtime a comprehensive welfare reform b i l l to restore these
values of responsibility and family. We want to help those who are
on welfare to get on t h e i r feet. We want to help them for up to two
years with training and child care and other supports. But after
that, we need to have a system that says, anybody who can work and
support themselves and t h e i r families must do so — i n the private
sector where possible; with a community service job i f that's the
only work available — to make welfare a second chance, not a way of
life.
Now, those of us in t h i s room have worked on t h i s issue
for years. I was privileged, along with then-Governor of Delaware,
Mike Castle, to be the representatives of the governors who work with
Senator Moynihan and with Congressman Ford and others on the welfare
reform effort that became the Family Support Act of 1988. Mike
Castle i s now in the Congress having changed jobs with Tom Carpenter.
Guess who thinks he got the better deal out of that?
We never f u l l y implemented that act. You know i t and I
know i t . So we ought to begin asking ourselves: Did we do a good
job then? What progress has been made i n the states? There's a l o t
of evidence that s i g n i f i c a n t progress has been made i n the states
that have been most aggressive.
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Why was i t never f u l l y implemented? Partly because
Congress never f u l l y funded i t ; partly because — as you w i l l never
hear the end of i t — t h e y ' l l say, well, but the states never f u l l y
used a l l the money we came up with. States must not have r e a l l y
cared about t h i s because they never provided the state match to use
a l l the funds. You know why the states never provided the state
match, don't you? You had to spend a l l your money making the
Medicaid match — which was not optional, i t was mandatory — and
building prison c e l l s . That's where we spent a l l of our new money in
the 1980s and the early '90s.
So I point t h i s out not to do any finger-pointing, but
j u s t to say one of the things we need to do i s to go back and look at
that b i l l , see what's good about i t , figure out what w i l l be
necessary to change so that the states can take f u l l advantage of
that b i l l , because i t had incentives to work, i t had supports for
families. I t was never f u l l y implemented because you had to spend
a l l your money on mandatory explosions and medical costs, and
building prison c e l l s , many of which were also mandated by the
federal courts, not the Congress. So we need to begin there.
We also need to know that — to recognize again —
though I w i l l say we estimate that about one i n five, j u s t under one
in five people who get back on welfare after they get off do so for a
health-related reason. Because so many people on welfare, v i r t u a l l y
everyone has younger children, the loss of the health care coverage
for the younger children for people who leave welfare i s an enormous
disincentive to get off of i t .
That's why I think that a year ago i n the winter
meeting, the governors h i t the n a i l on the head when they said the
kinds of structural changes that must occur i n the health care system
can't be effective u n t i l every legal resident of America has health
insurance. I believe that the health care solution and the welfare
solution are inextricably linked.
Let me say j u s t a few words about health care. I'm
encouraged by what I understand was said by the speakers before I got
here today. And again, I wish I could keep you i n constant session
here. You seem to have a leveling effect on the p o l i t i c a l rhetoric
of the Nation's Capital. Guaranteed private insurance for every
American i s the only way we'll ever be able to control the cost of
t h i s system, simplify i t , and provide the American people with
security of health benefits that can never be taken away. Unless we
do that, too many w i l l continue to get t h e i r care i n emergency rooms,
which w i l l add b i l l i o n s of dollars to the health care b i l l ; too many
w i l l continue to not have certain things covered; too many, for
example, w i l l be part of the Americans who add an estimated $21
b i l l i o n to our health care b i l l s every year because they can't afford
medicine that would keep them out of hospitals so they wind up going
to the hospitals and costing the American people much more. We
certainly won't be able to simplify the system and reduce the
unnecessary bureaucracy.
One of the things that I challenge a l l the folks to do
who believe that the beginning of health care reform i s to tax the
benefits of middle-class workers who have generous health care
packages, i s to say, how can we do that — how can we s t a r t with that
when we know we have a system where we spend 10 percent more on
paperwork, bureaucracy and insurance premiums than any other nation
in the world? And these things have nothing to do with health care.
We j u s t have a system that i s organized so that we spend a dime on
the dollar more on paperwork than any other country i n the world —
paperwork i n the insurance office, paperwork i n the hospitals,
paperwork i n the doctor's o f f i c e .
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I j u s t l e f t the American Hospital Association, and they
have said, c l e a r l y , the only way you'll ever f i x t h i s i s to have a
system that provides basic coverage to everybody — so that you can
have a single claims form which w i l l imposed on the patients, single
claims form for the hospitals, single claims form for the doctors.
I t i s imperative that we do that.
There was a study i n the New England Journal of Medicine
a year or so ago, two hospitals — one i n the United States, one in
Canada, same number of beds, same rate of occupancy, same general mix
of treatment — one of them had 2 00 people i n t h e i r c l e r i c a l
department, the other had s i x . Now, I don't advocate going to the
single-payer system for other reasons — there are other problems in
the Canadian system. And i t i s the second most expensive i n the
world. I think managed competition w i l l work better. But i t i s
clear that we cannot j u s t i f y , i n my view, taking something away from
the working people of t h i s country before we clean up the
administrative costs of the present system. (Applause.)
I also w i l l say without f u l l coverage, I don't see any
way to avoid the conclusion that states w i l l continue to bear a
disproportionate burden of skyrocketing health care costs. The Lewin
study showed that states would pay l e s s under our approach than i f we
j u s t l e f t things they way they are, and that health care would
improve.
I s t i l l believe i n the requirement for employers to
cover t h e i r employees. F i r s t of a l l , that's the way most people get
t h e i r health insurance today. Under our approach people would have a
choice i n t h e i r health care program. There's been a l o t of
discussion about t h i s . Let's go beyond the rhetoric to the r e a l i t y
today — today.
F i f t y - f i v e percent of a l l employers and 40 percent of
a l l employees who are covered with health insurance through the
workplace have no choice i n the health care plan of the doctors they
get, they are selected by the employer today. Under our plan, every
employee would have to get at least three choices once a year, one of
which would be j u s t picking your doctor and having fee-for-service
medicine.
So I'm a l l for choice, but we need to recognize that i f
we want the benefits of competition and the benefits of choice, we
have to move away from the trend that we are setting now. We are
moving i n the direction of getting the benefits of competition and
market power for big business and government. And some of you have
asked for reforms — Governor McWherter among others — to put
Medicaid into a managed competition environment to get the benefits
of that. But the problem i s some people w i l l get the benefits of
that, other people on the other end w i l l lose choice. So i f you want
to pursue both values at once, we plainly have to change the
direction i n which we are going. And we have to have a different
framework i f you wish to have both.
Now, i n spit'e of some of the interesting a r t work that
you've seen i n the l a s t couple of weeks. The Washington Post said
that our approach would create — and I quote — "a surprisingly
simple world for consumers. You make a decision once a year, among
at l e a s t three plans, based on what you want." I wish we could even
have more choice. We haven't figured out how to do that yet. But
federal employees have a great deal, for example, and many of you in
states have given your state employees more and more choices. And
because you have market power, you can do that, which i s why you have
to give some framework for the small businesses to have the same
market power that big business and government does.
Now, a l o t of t h i s approach builds on what I have seen a
lot of you do i n the states. Hawaii proved a long time ago that i f
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you did i t right, you can have an employer requirement to cover
employees without bankrupting small business, but providing better
coverage, stronger work force, and lowering health care costs because
of the way the market can be organized. The Governor of Hawaii has
spoken eloquently about t h i s .
You can say, well, Hawaii i s geographically isolated
and, besides that, we a l l l i k e to go there and surf and play golf or
whatever. Well, that's why we want to do i t for the whole country
instead of j u s t impose i t on one state or another.
We learned from Minnesota that health care cost targets
can be set and met through strong leadership, market forces
competition and high quality. And I must say. Governor Carlson, that
the Mayo C l i n i c stands — i f there were no other example i n t h i s
country, and there are — but i f you j u s t take that one example, i t
i s a s t e r l i n g and a stunning rebuke to those who say you cannot
provide the world's highest-class health care and control costs.
We learn from the example of Washington State and of
Florida, and most recently, of Maryland that you can pool businesses
and families together to change the David and Goliath equation, and
then small businesses and families can get affordable health
insurance that covers the things which need to be covered. We learn
from Pennsylvania — we learn two things from Pennsylvania. The
f i r s t thing i s that the Governor of Pennsylvania proves that you can
do anything i n the health care system. (Applause.)
We also learn that better tracking of costs and outcomes
improves the quality and lowers the cost. This i s an amazing thing
they did, and our approach encompasses t h i s . Whatever the Congress
does, t h i s should be a part of i t . Pennsylvania actually took the
time to study and report on the cost of different procedures i n
different hospitals i n different parts of the state, and then
measured the cost against the results, proving that there was not a
necessary connection i n many areas between cost and guaiity, and
changing the whole environment i n terms of what consumers then could
ask for and get.
This sounds l i k e a simple thing, but i n a system t h i s
complicated t h i s information, available i n a way that people can act
on i t , i s a r a r i t y , not the rule, i n American health care.
So I believe that i f we at the federal l e v e l can learn
from these things and f i n a l l y solve t h i s problem i n a comprehensive
way, we w i l l go a long way toward dealing with the welfare reform
issue, and we w i l l lay to rest one of the biggest problems for
American families and for the long-term s t a b i l i t y of our society.
Now, what normally happens around here i s that everybody
gives t h e i r speeches and then we have Washington-style reform —
where we tinker at the edges, expand the Medicaid program a l i t t l e
more. That's what we've been doing for years, you know, j u s t kind of
backing toward universal coverage by expanding Medicaid mandates.
And then at the same time, we t r y to ratchet down the federal
spending a l i t t l e more and pass some other incremental reforms. You
know what's going to happen? We do that, more mandates on you and
l e s s money for you to pay. That's what's going to happen. More
state money put into a system that i s fundamentally broken, without
enough security where someone else i s making the fundamental policy
decisions.
I talked to you a few moments ago about Joanne Stein*
from Sumter, South Carolina. She wrote us l a s t June, struggling to
hang on to both her small business and her insurance. She had to
make a choice and she chose her business and l o s t her coverage.
After decades and decades, i t ' s time to solve that woman's problem,
because her problem i s our problem. And her problem i s now the state
government's problem.
�- 7-
We r e a l l y can do things around here when we put our
minds to i t . We've got the d e f i c i t going down instead of up. We a l l
got together — some of you mentioned i t yesterday — i n a bipartisan
and federal, state way and passed NAFTA when i t was given up for
dead. That enabled us to get a GATT agreement which was s t a l l e d for
seven years. Congress passed the Brady B i l l after a seven-year
s t a l l . We actually can do things around here when people work at i t
and they keep pushing us to make a decision and they keep us a l l i n
the right frame of mind and they keep us thinking about real things.
You cannot escape the real world and the rhetoric; we can't do i t
because you're too close to your folks.
Here, we communicate most often with the American people
through an array of intermediaries. And most times — too many times
people can't get to us with t h e i r real problems. So there i s always
a danger here that the policy apparatus w i l l j u s t s l i p the tracks and
that we'll forget what t h i s i s about.
Yesterday, Families USA issued t h i s report, which I urge
you a l l to get and read. I t j u s t takes 10 t y p i c a l health care
situations that actually happen to real Americans and i d e n t i f i e s how
those things would be dealt with under the major b i l l s pending before
Congress. I n other words, i t ' s not about p o l i t i c s and rhetoric and
theory, i t ' s about real l i v e s .
So I ask you to help us do t h i s . You a l l d i f f e r among
yourselves; we have some differences with you. That's fine, that's
good, that's what t h i s i s a l l about. But I remember i n 1987 and
1988, we were struggling to deal with welfare reform. And every
governor i n the country wanted to do something about i t . And the
p o l i t i c a l rhetoric — the governors were converging around an issue,
but the p o l i t i c a l rhetoric i n Washington was diverging right and
l e f t . And we sat around here and talked;we t r i e d to get agreement on
a policy position. And Governor Campbell had j u s t l e f t the Congress
where he had been the minority leader of the subcommittee that dealt
with welfare. And he said to the Democrats and Republicans alike,
"Look, I had to go t a l k to a bunch of people on welfare and here i s
the way t h i s works. Here i s the intersection of welfare, health
care, food stamps, the whole thing."
I t was an incredible moment where a l l of us had to say,
t h i s i s not about rhetoric, t h i s i s about real people. And we went
on and passed the Family Support Act, which Senator Moynihan said was
the most s i g n i f i c a n t piece of s o c i a l reform i n the welfare area i n
three decades.
Now, we can do t h i s on health care. I don't believe we
can do i t unless everybody gets coverage. But we can do i t , and you
can help us do i t — i f you push the thing together around r e a l
problems, r e a l facts and real issues and don't l e t Washington
rhetoric p u l l the country apart. The country needs you, and I hope
you'll stay with us u n t i l the job i s done.
Thank you very much. (Applause.)
END
12:15 P.M. EST
�THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
March 22,
1994
REMARKS BY THE PRESIDENT
AT SMALL BUSINESS HEROES HEALTH CARE EVENT
Room 450
Old Executive Office Building
10:46 A.M.
EST
THE PRESIDENT: Ladies and gentlemen, f i r s t l e t ne thank
a l l of you for coming here. We have several members of the United
States Congress up here in the front. We're very glad to see a l l of
them and we thank them for t h e i r presence. And we have small
businesspeople here from a l l over America, and we thank you for your
presence. We're here primarily to hear from the small businesspeople
who are here on the panel, and perhaps some other i f time permits.
I j u s t want to make a couple of comments. F i r s t of a l l ,
I very much appreciate the work that Erskine Bowles has done as
Director of the Small Business Administration. I am proud of the
fact that I was atole to appoint someone to t h i s job who was not j u s t
someone who had run unsuccessfully for o f f i c e or was otherwise
looking for a patronage appointment. This man has spent 20 years
helping to finance small business creations and expansions. And
therefore, he has a clearer understanding and grasp of what small
businesses are r e a l l y up against and the difference between the
rhetoric of supporting small business and the r e a l i t y of i t than
perhaps anyone who has held t h i s job i n a very long time.
Secondly, I want to thank my good friend. Congressman
LaFalce, for h i s leadership on small business issues.
F i n a l l y , l e t me say that everybody, I think, understands
that one of the reasons that the United States has not succeeded in
providing health security for a l l i t s people while every other
advanced economy has done so i s the d i f f i c u l t y posed by the greatest
strength of our economy, which i s that an inordinate percentage of
our workers work for small businesspeople — very small business —
and increasingly, more and more of the new jobs are created by small
businesses.
So that presents us with a dilemma. However, we also
know i f we look at the r e a l facts that almost a l l the job creators
among small business are making some e f f o r t to provide health
insurance, and that those that do tend to have more stable work
forces and higher productivity and greater success.
Just t h i s week I had a good friend of mine up here with
h i s family. He's a car dealer in my home state and he was talking
about how he'd always insured a l l of h i s employees and none of h i s
competitors had. And i n the l a s t 20 years, three of them had come
and gone and. he was s t i l l there. And one reason was, he never had
any employee turnover because he always took care of h i s employees
and t h e i r health care problems. But how they struggled to get a
bigger pool of insured people so that he could get h i s insurance cost
down was a continuing one for him.
Anyway, that j u s t brings me to t h i s point: This
administration could not i n good conscience have advocated, and I
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could not support a plan that I thought would be, on balance, bad for
small business. I believe t h i s plan i s , on balance, good for small
business. I f I didn't, I wouldn't be supporting i t . And I w i l l not
sign any b i l l passed by the Congress that I do not believe i s good
for the small business economy because we have to create more jobs in
t h i s countryOur plan builds on the system we have now; guaranteed
private insurance. I t provides more choices to employees than they
now have under most health care plans, at least three a year, every
year. I t contains real insurance reforms that are very important to
small businesses — no discriminations for preexisting conditions, or
based on the age of the work force. I t protects Medicare. I t does
provide for both Medicare people and for the work force and their
families, prescriptions benefit and a phased-in, long-term care
benefit for service at home, for example, for disabled people or
elderly people, as well as in i n s t i t u t i o n a l settings. And i t does
have an employer mandate, but with strong discounts for small
businesses with modest payrolls and modest p r o f i t margins.
Now, there w i l l be countless discussions about what the
proper d e t a i l s of that should be, but i t seems to me that that i s the
only approach that has a reasonable chance of being successful in
t h i s environment. And as I said, there are people who w i l l propose
variations on i t , but that, i t seems to me, i s what we ought to be
doing.
My purpose today i s to show that there i s a great
difference in the rhetorical pronouncements of some organized groups
and the r e a l l i f e experiences of a l o t of business people. And we
have here people who have been affected by the present health
conditions, and I am frank to say that while most of the people who
are on t h i s panel who are providing health insurance today would
actually pay l e s s under our plan. Some would pay more, and they know
i t . But they also know that for the f i r s t time t h e i r competitors
would as well, putting them on a more even footing.
So l e t ' s get in to the panelists, hear t h e i r s t o r i e s ,
and give them a chance to comment.
Q
Thank you, Mr. President. We are a 22-year-old
company and through the years, I have sought out the best of the best
employees and have competed with majority companies. By that I mean
I have covered our employees 100 percent as an a t t r a c t i v e package to
work with us. However, in the l a s t few years, we've encountered some
problems, and the problems are that two of our employees ar
uninsurable. Why? One i s over the weight scale according to the
insurance companies. And I have gotten insurance p o l i c i e s that are
— for s i x months, renewed them a second time and then at the t h i r d
time they're dropped. And so, therefore, I have two wonderful
employees that are uninsured.
And what's happening, they f e e l discriminated against.
I want to continue insuring them, but how can I do i t ? Our payroll
— i t takes about 15 percent of our payroll, which i s a l o t for a
small company. We want to grow. Where do we get the money? As you
a l l know, small businesses — the d i f f i c u l t y i s getting
c a p i t a l i z a t i o n for running your company.
So, Mr. President, I f e e l that t h i s i s something that
your program-would hopefully resolve and would benefit our situation.
MR. BOWLES: Mr. President, Betty Hall i s also here,
from the Hall Manufacturing Company i n New Hampshire. And I think
you've experienced some of these s i m i l a r problems. I think you've
also been dropped from your insurance a couple of times.
Betty, would you l i k e to comment on i t ?
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Q
Yes, I would. Thank you, Mr. President, for giving
us t h i s opportunity. I've been i n business for 43 years. When my
husband and I started our business we j u s t assumed that we would
provide health benefits for our employees and for ourselves. And we,
very shortly thereafter, started with Blue Cross-Blue Shield. That's
back i n the 1960s. And when the Matthew Thornton Health Plan HMO
came on board, we also offered that group to our employees.
And then about three years ago, both of those companies
decided that they couldn't offer health insurance groups to companies
as small as mine. Under 25 employees — they don't even think you're
a business at a l l . And so, I was very disturbed. I t r i e d to
convince them that they should continue to insure my employees
because I f e l t I was w i l l i n g to pay my share of t h e i r insurance and I
ought to be allowed to do that.
So Blue Cross-Blue Shield was unmoved, but Matthew
Thornton did continue to cover my employees. But some of them don't
want to be covered by Matthew Thornton, they wanted to stay with
t h e i r own doctors. And ultimately, they had to go off of the group
plan that was dissolved and go into a nongroup insurance.
And I think i t ' s — my employees have been around for 43
years with me, and I think one of the reasons they stayed with me so
long was because of offering health insurance. And I think that's
very, very important to a l l of us.
So I hope we can resolve t h i s problem, and those of us
who want to do i t can do i t . I think the Clinton health plan w i l l
probably cost me l e s s than what I'm paying right now with my Matthew
Thornton and helping those nongroup employees to have insurance.
.
MR. BOWLES: And probably of equal importance, Mrs.
Hall, IS that your employees will get choice and they'll have choice
among many different providers in three different types of plans.
And they'll be able to follow their doctor and the hospital they go
to, to the plan that they belong to. So that this will really bring
the doctor and the patient closer together. And many, many people
have said that.
^ ^ ^
I think we also have here today Spence Putnam, who, Mr.
President, i s head of the Vermont Teddy Bear Company up i n Vermont.
He was the 1993 winner of the NFIB award for company of the year.
/T
PRESIDENT:
(Laughter and applause.)
I hope they don't take i t back from him.
MR. BOWLES: Spence, I think you've experienced some of
the same problems of r i s i n g cost and lack of r e a l market muscle out
there.
Q
Yes, we have. And, Mr. President, one of the
reasons that we received that award i s that every Vermont teddy bear
comes with a lifetime health plan. (Laughter.) We operate America's
only teddy bear hospital, and should any Vermont teddy bear need
r e h a b i l i t a t i o n , we do i t free of charge. (Laughter.) There i s only
one insurance company. There i s no paperwork. I f i t looks l i k e our
teddy bear we w i l l replace limbs, replace eyes ~ doesn't matter how
old you are. We t r u l y have universal access for teddy bears. And
i t ' s f r u s t r a t i n g that we have d i f f i c u l t y providing that for our
employees.
^
company was a struggling company only four — a
inH
f?"""" ^t^""^
^®
t ^ * " t^'o dozen employees,
i^t
^^^^.Jijne, I would say the most vexing business problems was
how to provide coverage for our employees. We now have over 200
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employees, and the most vexing business problem we have today, i s how
to provide coverage for our employees.
We feel that health care i s a national problem and i t
needs a national solution. And that's why Vermont Teddy Bear i s
supportive of the Clinton plan. (Applause.)
THE PRESIDENT:
Thank you very much.
Let me just t r y to emphasize a couple of the points that
were made here. F i r s t of a l l — because they are different issues.
Mr. Putnam wants to insure a l l of h i s employees; today can only
insure about two-thirds of them. So he would actually pay more i f
our plan passed, but he'd get to insure of a l l of h i s employees and
they would also have more primary and preventive care than they have
now and lower deductibles. But he would be, again, on an even scale
with h i s competitors.
Betty Hall talked about — I wanted to make sure you
understand what she meant when she talked about her situation in New
Hampshire, because she doesn't have Blue Cross options for her
business, but does have the matching Thornton option, she has an HMO
option. And the HMO has a very good reputation i n New Hampshire and
throughout New England — I think everybody would admit that. But
the individuals who work for her now don't have the choice that i f
our plan passed, every year her employees would get to choose either
the HMO or one of two other options. And under our plan, she would
pay the same no matter what. But i f the employee wanted to pay a
l i t t l e more for fee-for-service medicine, the employee would have
that right. So that's how that would work.
I f you go back to what Mona said about two of her
employees being uninsurable, i t ' s important here, I think, to
recognize a certain truth about the insurance business i t s e l f . While
certainly I have been c r i t i c a l of insurance practices of which I do
not approve, I think i t i s also important or us to understand that
given the organization of the insurance business today, i t i s
economically impossible for a l o t of these health insurance companies
to do other than they do because they are dealing with a very small
pool of people.
So i f you insure, l e t ' s say, an employee unit the s i z e
of her company and two of them are r e a l l y s i c k or they have two kids
who have been r e a l l y sick, then that can double the cost of whatever
your annual premiums are i n a year which i s why we have worked so
hard to find a mechanism — and I ' l l say more about t h i s i n a minute
— to l e t insurance companies insure people the way groceries stores
make money -- a l i t t l e b i t of money on a l o t of people. And that's
what a l l t h i s — and I'm going to say more about t h i s toward the end
of the hour because I don't want to interrupt the flow of the people
talking — but that's the dilemma we face about whether there should
or should not be a health a l l i a n c e , a buyer's co-op or something.
You've got to have these folks able to go into big
enough pools so that the insurance companies themselves do not go
broke. They're i n business, too. And the economics have to work
out.
And the only way the economics can work out i s i f the r i s k s
which a l l small businesses are sxibject to, can be widely spread over
a bigger pool. So we'll come back to that.
Q
As a pawnbroker, I represent one of the most
misunderstood industries i n the country. (Laughter.)
THE PRESIDENT:
Want to come to work up here?
(Laughter.)
Q
Fortunately, our industry i s changing d r a s t i c a l l y .
People don't r e a l i z e i t , but a large percentage of Americans have no
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credit and have no access to credit, and pawnbrokers are the only
source of credit to them. And we t r y to provide insurance for our
employees. And I was one of those people who got a l e t t e r from my
insurance company that said, we are happy to say we are only going to
r a i s e your rates 48 percent. And what we're having to do are things
l i k e d r a s t i c a l l y increase our deductibles, switch companies to find
better p o l i c i e s , but the overriding problem i s those employees that
we have that are not insurable.
And we've got a very valued employee right now, an
assistant manager who has preexisting conditions, and we can't get
insurance. We've t r i e d everything. And, you know, we don't lose the
employee. And we spend so much of our productive time, and he spends
so much of h i s time and our s t a f f spends time j u s t dealing with his
health care problems that, you know, i f he had insurance, those
problems wouldn't be there.
And we've sat down and we've looked at the numbers and
with your plan, we would be able to insure a l l of our people which we
can't do now, we don't do, at almost the same cost that we're
spending now for half of our employees.
THE PRESIDENT: Same thing — 81 m i l l i o n Americans have
preexisting conditions of some kind or other. This i s not a small
problem; t h i s i s a big problem. Those who are i n families that are
insured through goverrunent or larger employers are okay except that
most of them couldn't change jobs and go to work for any of you or
couldn't s t a r t t h e i r own business. You know, a l o t of people, that's
a lifetime dream — to s t a r t t h e i r own business. I t takes enough
courage, as a l l of you know, to do that i f you don't have to worry
about t h i s .
So you've got 81 m i l l i o n Americans, some in the
situation of your employee who can't get insurance, others who pay
very much higher rates, and millions and millions — no one knows
exactly how many, but l i t e r a l l y , tens of millions — who are locked
in the jobs they are now in because they can't afford to give them up
and losing coverage. So i t ' s a s i g n i f i c a n t issue. Congressman would
you l i k e to say something about any of t h i s . I haven't heard from
you since the beginning.
CONGRESSMAN LAFALCE: I think t h i s i s so important. I
have town meeting a f t e r town meeting, and I go before Chambers of
Commerce a l l the time, and I usually ask the businessmen, well how
many of you do provide coverage for your employees? And, not to my
surprise, but maybe to the public's surprise, a vast majority of
small businesses do provide coverage. And the problems they are
experiencing are t h e i r premiums are going up astronomically. I t ' s
been double-digit i n f l a t i o n for the l a s t h a l f dozen years or so with
the possible exception of t h i s past year when we had t h i s , sort of,
controls over the heads of the insurance companies, drug companies,
et cetera.
They're limiting t h e i r choices, too. Before, they used
to offer three or four options to t h e i r employees and now, they don't
offer an option they say, we'll cover you, t h i s i s i t . Or, the costs
are getting so great that they're saying, sorry, we can't cover you
any more. Very often when they f i l l job openings, they search for an
individual whose spouse gets coverage at a larger place of
employment. So those who are disadvantaged who don't have spouses
who are employed and covered become more disadvantaged.
The other thing I find that small business Iff dainq i n
addition to subsidizing through cost s h i f t i n g , those small businesses
that don't provide coverage, i s they're s h i f t i n g the taxation more
and more on the employees. Before there used to be an 80-20 s p l i t .
Then i t gets to be 70-3 0; then 50-50 s p l i t . And the employee has no
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choice but to pick i t up. And these small businesses, too, there's
no negotiation, there's no bargaining power.
But then there's additional premiums above and beyond
the clear premiums that the employees of small businesses have to
pay. There i s the deductibles that are increasing constantly.
Before i t used to be $50 per person, and then $100, then $150, then
$250 per person. These are enormous. For a family of four they're
already at $1,000.
The copayments are increasing. These are the fine
prints. Before i t used to be, well, we'll cover 85 percent, then 80
percent, then 75 percent. And i t ' s not of whatever the charge i s ,
i t ' s what the UCR i s — what the usual customary regional fee i s .
And i f you look at the fine print of the contracts, the usual
customary regional fee has been reduced while the fees have gone up,
which means again, your copayment increases astronomically.
And most importantly, you're limiting coverage. Again,
t h i s i s the fine print of the insurance contract, but your a b i l i t y to
access a mammogram goes down. Your a b i l i t y to achieve X rays, CAT
scans, MRIs even when needed goes down considerably.
I think we're getting l e s s and l e s s health care at
greater and greater cost. And the chief casualty of a l l t h i s i s not
big business that has a strong union to negotiate on behalf of the
employees. The chief casualty of t h i s i s both the small
businessperson and the employees of the small businessperson.
THE PRESIDENT: We have someone here from your home
state, Elaine Stone, of American Aviation i n New York, who has gone
to extraordinary e f f o r t s to cover her employees at very high cost.
I'd l i k e to ask her to explain her s i t u a t i o n and what the
consequences have been.
Q
F i r s t I would l i k e to thank you, Mr. President, for
putting the health care issue right on the front burner of the
national agenda and keeping i t there, despite the heat.
We are a small business. We export overseas a i r c r a f t
hardware, small parts and components. We were a f a i r l y substantial
sized firm and we have been affected not only by health care but by
the recession — the aerospace industry has been severely affected.
But I f e e l that i t i s essential for a l l people to have access to
health care coverage.
And i n that l i g h t , we have done with our increasing
costs, done evaluations. We used to be f u l l y insured through the
insurance company, and after checking into preferred, into HMOs and
into other plans, we decided to take what r e a l l y i s an enormous r i s k ,
but based on our experience rating at the time, we f e l t i t would save
money, and that was to go into a self-insured plan — s p l i t funding,
whereby the company would assume the r i s k of $5,000 i n medical claims
before the insurance company kicked i n .
Now, that i s an enormous r i s k i f you have a great number
of people coming down with serious, lengthy, d e b i l i t a t i n g i l l n e s s e s .
We were lucky in the beginning, and our premiums d e f i n i t e l y have been
contained. But we don't think in terms of a premium payment, we
think i n terms of what i s i t costing us at the end of the year when
we count i n the claims. And we have had several i l l n e s s e s that have
gone — f a l l e n over into the insurance company, and, fortunately,
they have been spread out over the past few years.
However, we are facing new increases i n Blue Cross and
in our premiums, and we have to evaluate again whether we can s t i l l
afford the plan we have. I would be the l a s t one, or I f e e l my
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company would be the l a s t one to take a move of reducing the benefits
that we have. As i t happens, our deductible i s very low.
Congressman, you mentioned figures. We only have a $100
per individual, and $300 per family, which i n today's marketplace i s
very good, and we could not replace. We also undertake the 80-20
option, and i n today's marketplace, i f we were to change our plan, we
couldn't — I mean to other than a Clinton-type plan, health care'
plan — we couldn't do i t .
So that I feel that we must, we must continue to try to
reduce — or to produce a health care plan that a l l , a l l people can
afford; that employers — I also feel i t should be done through the
workplace because i t ' s something that we are used to. Most of us,
from the day we started working, have been covered through the
workplace. I t ' s what we're used to. That would be the least
dramatic change i f there are other changes, and I strongly feel that
we should have universal health care operating v i a the workplace for
everyone.
And, again, we are very grateful that you are taking
t h i s issue to heart.
(Applause.)
THE PRESIDENT:
Thank you very much.
Let me say because of the unique, sort of, semi-selfinsured system that Elaine has, and because she's had some
s i g n i f i c a n t i l l n e s s e s i n her work force, she would actually, at least
based on the l a s t year or two's experience, pay considerably l e s s
than she i s paying because of the s e l f insurance schemes kicked i n .
I t ' s works, again, l i k e everything else ~ i t may work very well for
large employers, but for someone with a couple of dozen employees, i t
a very high-risk strategy that can work r e a l well u n t i l i t doesn't
anymore.
I'd l i k e to now t a l k about people who are kind of the
other side of that equation — people who l i k e to cover a l l t h e i r
employees but can't, and therefore, only cover a portion of them, or
have had to give up coverage. And I'd l i k e to begin with Judith
Wicks who owns the White Dog Cafe i n Philadelphia. Because, as I'm
sure a l l of you know, the people i n the restaurant business have been
among those most concemed about t h i s health care plan because there
are so many people who work for restaurants and d e l i s and other
eating establishments who are young, who are single, who don't have
health insurance, and who are s t i l l w i l l i n g workers there. But there
are an awful l o t of people who want to cover folks.
4 « I w
And the press w i l l remember, we were i n a establishment
in Columbus, Ohio, j u s t a couple of weeks ago, where by accident —
we didn't plan to go there for health care, but where we had a whole
health care seminar because only half the employees were covered, and
the person covering them wanted to cover them a l l .
,^
^
situation?
So, Judith, why don't you t a l k a l i t t l e b i t about your
Q
Thank you, Mr. President, for giving me t h i s
opportunity. I've been a l i t t l e surprised at the reaction from the
restaurant community against the health care reform plan because I'm
very much i n favor of i t . The White Dog Cafe i s a very labort!J«*S?«nJ
J!^
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called
hnS ?J"Jo^^-?f,^r *n«^,that'8 our logo over there. (Laughter.) And we
buy d i r e c t l y from l o c a l farmers, so we have a l o t of people i n the
kitchen picking l i t t l e leaves off fresh herbs, and making our own
desserts and our own i c e creams.
4.V. ^.
^° ^® employ 96 people, considering part-time people ~
that's the equivalent of 75 full-time employees. We cannot afford to
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�- 8-
provide h e a l t h insurance f o r a l l those employees. I t would be
impossible f o r us t o do so. We do provide h e a l t h insurance f o r
around 15 employees.
The t h i n g t h a t r e a l l y e x c i t e s me about the h e a l t h care
plan i s t h a t under t h a t plan we would be able t o provide f o r a l l o f
our employees without t h a t much of an increase. My h e a l t h care costs
would double, but I am very happy about t h a t because i f you look at
the whole p i c t u r e , we would only have t o r a i s e our p r i c e s no more
than around two percent t o make up t h a t d i f f e r e n c e because of the cap
t h a t t h i s program puts on the percentage of p a y r o l l t h a t we would
have t o pay t h a t p r o t e c t s businesses such as restaurants t h a t are
very l a b o r - i n t e n s i v e , t h a t h i r e so many people, e s p e c i a l l y e n t r y level positions.
So the way I f i g u r e i t , i f a l l the restaurants together
r a i s e t h e i r p r i c e s about two percent, we're not an i n d u s t r y t h a t ' s
going t o lose our customers t o Mexico. (Laughter.) So I t h i n k t h i s
i s a grand opportunity. I t h i n k the r e s t a u r a n t business i n general
i s one t h a t ' s been undervalued by our economy. I t h i n k t h a t we don't
r e a l l y now charge the general population what i t r e a l l y costs t o run
a r e s t a u r a n t , which should include covering h e a l t h insurance f o r
every worker. I don't see why h e a l t h insurance i s not a v a i l a b l e t o
restaurant workers where i t i s a v a i l a b l e t o most other i n d u s t r i e s .
So t h i s i s a great chance f o r the r e s t a u r a n t i n d u s t r y t o
r e a l l y be i n competition w i t h others. So'I thank the President f o r
coming up w i t h t h i s . I t h i n k i t ' s a great idea. (Applause.)
CONGRESSMAN LAFALCE: I ' d l i k e t o j u s t i n t e r j e c t a few
comments. What you had t o say, Judy, was music t o my ears. I t shows
t h a t you're s o c i a l l y conscious i n a d d i t i o n t o being economically
conscious.
I t h i n k the two c h i e f opponents t o h e a l t h care reform
f o r the business community have been the NFIB and the N a t i o n a l
Restaurant Association. We were able t o t a l k q u i t e reasonably f o r a
w h i l e w i t h the National Association of Manufacturers, the United
States Chamber of Commerce, e t cetera. I mean, they changed t h e i r
r h e t o r i c t o t a l l y — they t a l k e d about shared r e s p o n s i b i l i t y of a l l ,
i n c l u d i n g a l l employers. And then when push came t o shove, they had
t h e i r own p o l i t i c a l considerations d e a l i n g w i t h other business
associations, t h e r e was some backtracking.
But I have the g r e a t e s t respect f o r the NFIB, but you
have t o understand, they not only opposed an increase i n minimum
wage, they opposed the concept of a minimum wage. They'd l i k e t o see
the minimum wage repealed. And when i t comes t o the N a t i o n a l
Restaurant A s s o c i a t i o n , again I have nothing but the highest regard
f o r them. But the f a c t of the matter i s , i s t h a t what t h i s law would
do i s put a l l restaurants i n the United States i n the same
competitive p o s i t i o n . And r i g h t now the good guys are disadvantaged.
The good guys are t r y i n g so hard, as you are doing, t o provide f o r as
many of your employees as you can. Others are not as s o c i a l l y
conscious.
And a r e s t a u r a n t would only be competing against another
restaurant on equal terms. A l l r e s t a u r a n t s would have t o provide the
exact same b e n e f i t s ; t h e r e would be no disadvantage.
And w i t h t h i s
cap on what you'd have t o pay, most r e s t a u r a n t s , I b e l i e v e , would
wind up paying less or not much more. And the increase t h a t those
would experience who do get an increase would be considerably less
than a cost o f l i v i n g increase i n the minimum wage would be, and we
haven't witnessed t h a t f o r about three years now.
that?
THE PRESIDENT: Do you t h i n k he f e e l s s t r o n g l y about
(Laughter.) Thank you.
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�- 9 -
MR. BOWLES: Mr. President, we also have another
restauranteur here — who runs the Burrito Brothers chain here.
They're three Mexican fast food restaurants. Eric's also experienced
some of these same problems that small businesses face in trying to
provide health care coverage. And, Eric, you might want to comment
on how you would react i f i t was a level playing field and you could
provide reasonable coverage at reasonable cost.
Q
notwithstanding,
First l e t me say that, what Judy said
I hope jobs are lost to Mexican food. (Laughter.)
THE PRESIDENT: Well, i f I'm setting the pace, you've
got a good chance of achieving that objective. (Laughter.)
Q
I should f i r s t mention that the restaurant industry
has very small profit margins. I t makes i t very difficult for us to
afford to insure our employees fully. We desperately want to do that
because i t ' s good for business and because i t ' s the right thing to
do. Currently, we offer insurance to our employees, but we can only
afford to pay about 50 percent of the premiums. That means that most
of them can't afford to go on the plan at a l l . Only about a third of
our employees are insured at this point.
We want our employees to be insured and the reason they
say i t ' s good for business i s that employees who are on health care
and have health care insurance miss fewer days of work, they are more
productive when they are at work, and also, i f their families are
insured, that's even more so the case. They miss fewer days of work
and they are more productive when they are at work because they are
not worrying about family members who can't get treatment.
I would just add that the issue of rhetoric versus
employment. I can assure you that there's not going to be a single
job lost i f the insurance plan that you are proposing goes into
effect. The fact i s we w i l l pay more. And we're willing to do that
because we want our employees insured. But under the plan you're
proposing, we'd s t i l l be paying half of what i t would cost right now
to fully insure our employees.
THE PRESIDENT: Thank you. I just want to say that Eric
and Judy represent an interesting thing that we have seen basically
around the country with people who really are trying to do the right
thing by their employees. I f you are in the restaurant business and
you insure part of your employees, you are in the worst of a l l
worlds. You're s t i l l at a competitive disadvantage to people who
don't insure anybody, and you feel terrible that you can't insure
everybody. That's basically what they face.
MR. BOWLES: Mr. President, unfortunately, some of the
small businesses in this country have experienced such absolutely
skyrocketing costs and the cost of health care experiencing these 20
to 50 percent annual rises in health care, that they simply just no
longer can afford i t . Garth Sheriff i s here from Los Angeles. I
know he has had to drop his coverage a couple of years ago when the
cost just went so high you couldn't afford i t .
Q
One point before — in the food industry, chances
are your average wage per employee i s going to be about $12,000 or
lower. And you would qualify for the maximum subsidy. So you would
probably have a cap of around 3.5 percent of payroll, and that i s an
unbelievable-bargain and probably less than you are paying now i f you
are covering even a third of your employees.
. ,
^
Q
I'm an architect in Los Angeles, and I've had my
business for 19 years. And, Mr. President, for 16 of those 19 years,
I covered every one of my employees and their spouses 100 percent
through thick and thin. The last three years as the recession took
over in Los Angeles, costs averaged 30 percent inflation per year
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u n t i l at the end of that, my payroll percentage exceeded 13 percent
as my employees went from 12 to 6 and threatened to go lower in the
depths of the recession. And in 1991 I was faced with the following
choice: do I drop one more employee or health insurance? Do I l e t
one family stay employed and have food on t h e i r table or do I provide
health care for the other five.
So I kept my employee, and I dropped health insurance.
And i t hurt me deeply because I think that's a responsibility in this
country and I deeply am appreciative the support you've showed small
business because we provide much of the engine that drives job
creation in t h i s country.
But we have a preexisting condition. I t ' s a s i l e n t
preexisting condition. I t ' s not talked about in the media, and i t ' s
seldom talked about in the corridors of power. And my friends here
from the American I n s t i t u t e of Architects and Architects, Designers,
Planners for Social Responsibility can t e l l you that i t ' s age.
We
have exactly the high technical, high-skilled kind of positions that
you, President Clinton, and the Vice President have talked about are
so c r i t i c a l for the 21st century, but with i t comes experience and
age and the technical s k i l l s to do a job l i k e rebuilding after the
Los Angeles earthquake or after Hurricane Andrew i n Florida.
The average age of my s t a f f over the years has been
between 35 and 60 — the range of my s t a f f — and the average i s over
40. The actuarial tables are l i k e a l a s e r beam in the insurance
industry. They show no mercy, and when i t got to over 13 percent of
my payroll, I had no choice.
I would be delighted to have the Clinton health care
plan in effect. I t would cap my costs at 7.9 percent. And 7.9
percent i s not the figure I think of. Like Judy, I would l i k e to
t a l k about a new figure, and i t ' s my two cents worth, because most
service professionals' salary i s one-third of t h e i r gross receipts.
And one t h i r d of 7.9 percent i s r e a l l y two percent of gross and a
l i t t l e b i t more.
So t h i s i s my two cents worth i n endorsing the Clinton
health security act, and my group feels the same way.
We are 3,000
businesspeople strong, and l a s t night the board of d i r e c t o r s voted to
unanimously endorse the Clinton health act.
(Applause.)
THE PRESIDENT:
Thank you.
Thank you very much.
I'd l i k e to, f i r s t of a l l , thank you and thank your
group and thank you for sharing your painful experience with us. I'd
l i k e to go on and sort of pursue t h i s theme a l i t t l e more and c a l l on
Brian McCarthy, who owns the McCarthy Flowers, a large f l o r i s t in
Scranton, and ask him to t e l l us a l i t t l e about h i s s i t u a t i o n .
Brian.
Q
Thank you, Mr. President. I thank you for the
opportunity to be here today. The f l o r a l business a t t r a c t s a great
number of unskilled workers in our economy, and our p a r t i c u l a r
metropolitan area where I h a i l from i n the Scranton-Wilkes-Barre,
Pennsylvania, market, j u s t on a March 11th survey on USA Today,
ranked fourth highest i n the highest percentage of u n s k i l l e d workers
in the United States, behind c i t i e s that you might understand l i k e
Miami and some other more — c i t i e s that a t t r a c t more immigrants.
The problem i s that i f the f l o r a l business i s to t r u l y
a t t r a c t people and take them from the welfare r o l l s , e s p e c i a l l y those
that are unskilled, we have to be able to not scare people into
thinking they're going to be able to lose benefits to leave the
welfare r o l l s . That's been a s i g n i f i c a n t problem for us. We have
families where the heads of the household want to come to work for
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�- 11 -
us. They have three or four lovely children, and t h e i r problem that
they're constantly facing i s , "Brian, I can't come to work for you
unless I can have f u l l coverage for my children." And, of course, as
many of the other panelists have addressed here today, some of the
problems they are facing are preexisting conditions which make
matters even worse.
And i f we're truly going to be a source of job growth in
the future, i f the small business sector t r u l y i s f i l l e d with
talented people l i k e I believe we have in t h i s room today — and as
they say, i f small businesses are j u s t waiting to be large businesses
with great ideas — we have to be able to get these people to leave
the welfare r o l l s and come with us.
The other problem that seems to be a s i g n i f i c a n t one for
ours — our company has been i n a great, great growth position in the
r e t a i l flower business — we, too, have recognized the value of
becoming bigger to get better buying power. The same principle that
President Clinton's plan i s advocating today. He's saying l e t ' s bond
together and make small businesses one group to be able to go out and
use some muscle in order to be able to employ better buying power in
the marketplace.
One of the problems that we face i s that i n order for us
to grow as we've been growing — we've grown 500 percent, our
company, over the l a s t seven years i n p a r t i c u l a r ~ i f we're going to
continue to grow we have to a t t r a c t also talented people. And
there's a l o t of downsizing i n t h i s company, as you know, so there's
a great deal of management people, very, very s k i l l e d , seasoned
managers out there, who we can very c l o s e l y meet the s a l a r i e s which
they l e f t i n those previous positions. The greatest problem
continues to be the health care issue. Once we f i n a l l y s i t down, we
match the d o l l a r for dollar, i t comes down to, well, i n my l a s t job
we were a l l covered ~ we had dental, we had eye glass, we had
prescription ~ myself, my family. We can't do that.
F i r s t of a l l , we can't discriminate against the rest of
our s t a f f to offer i t singly to one. And next, i t would be
absolutely cost-prohibitive for us to t r y to do that. So a company
l i k e ours that's poised for growth — McCarthy Flowers i s poised for
growth into the next century — i f we're poised for that type of
growth, I think we need to be able to l e t that health care issue not
be a wall between myself and some very, very talented people. And as
I said e a r l i e r , I don't want i t to be a wall between those unskilled
workers who are dying to get into the marketplace and make themselves
s k i l l e d workers.
So I strongly endorse t h i s p a r t i c u l a r health care
security act. In fact, I think the strongest word of the health
security act i s the word security. Thank you.
(Applause.)
THE PRESIDENT: Thank you very much. I j u s t want to
emphasize one comment Brian made, and i f I might, go back to what our
restauranteurs also said there. One of the arguments that the
Restaurant Association makes against our doing t h i s i s they say
well, we have a l o t of young single workers that are healthy, they're
strapping. They don't want insurance, or i f they do have i t , they
ought to be able to get i t much more cheaply than older workers.
Because young single workers w i l l pay higher per person
ir;irnurn«L?"^P'rcommunity r i t m g i s 111 abou??
l U r ^ ?«J ^ ?
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°l«^«^ people, and with families
with a l o t of kids and the kids have been siSk, yoi average i t out.
so they w i l l pay a modestly greater amount, and therefore? the
employer contribution for them w i l l be modestly greater.
I'd l i k e to make two arguments i n response to that. One
IS one Brian made. A l o t of the young single people we want to be
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�- 12 -
workers in t h i s country are on welfare. They a l l have health
insurance for themselves or their children through the Medicaid
program, which i s as generous as most health insurance programs. And
yet, we want them to move from welfare to work and take jobs in our
small businesses and give up health insurance for t h e i r children so
they can then s t a r t paying taxes to pay for the health care of people
who made the other decision to stay on welfare.
I mean, i t ' s j u s t a — we cannot reform t h i s welfare
system unless we f i x t h i s problem. So there are a l o t of young
single potential workers out there we cannot even get i n the
workplace unless we deal with t h i s .
The second point that I'd l i k e to make i s that the
fastest growing group of people in America are older Americans. And
people are going to working l a t e r and l a t e r and l a t e r i n t h e i r l i v e s .
Indeed, the gradual phase-up of the Social Security retirement age
s t a r t s in a couple of years as a r e s u l t of the Social Security Reform
Act of 1983, raising retirement age by a month a year over several
years to go up to 67. And i f you don't want discrimination, i f we
need older people, i f we know they're very good employees and they're
very r e l i a b l e , and you don't want discrimination against them in the
workplace, one sure way to avoid i t i s to make sure that t h e i r health
insurance premiums are not discriminatory.
I see a l o t of older people who work i n eating
establishments, too. So t h i s thing, I think, w i l l balance out and i t
ultimately f a i r . I especially thank Brian for h i s statement because
he does cover a l l h i s employees today. And i t shows you, I think he
r e a l l y i s thinking towards the future.
ADMINISTRATOR BOWLES: Mr. President, we also have here
Chris Maas, who has experienced some of these same problems of trying
to compete for labor with absolutely skyrocketing costs i n health
care.
Chris, do you want to t a l k about i t a second?
Q
We're a small computer consulting firm here i n
Washington. We do most of our work with Washington area lawyers, and
we need professional help. And the one competitive advantage that we
have as a l i t t l e firm — (laughter.)
THE PRESIDENT: Everyone of you has a one-liner for
that, don't you?
(Laughter.)
Q
We need professional help. (Laughter.) One of the
things that we found — I guess you were mentioning, t a l k i n g about
the older people — and my four partners and I , we need to be nimble.
We need to be able to hire people and get people and put them to work
for us. That's our competitive strength. That's our only one, i n
fact.
A small example, we set out to hire a r e c e p t i o n i s t a
year or so ago, and we met a 60 year old male that we l i k e d .
We
spent 15 minutes interviewing him, decided we l i k e d him and wanted to
hire him; and then we spent about four hours figuring out how to get
him covered with the health care plan so i t didn't mess up the r e s t
of us. That's not right. And i t j u s t shouldn't work that way.
We
found that our premiums were going to go through the roof. We s t i l l
hired him anyway, and we love old Bob, but that's got to stop.
On the other end of the spectrum, we're passing up
business because we want to grow and there's people we want to hire
and we can't hire them. We know a person i n p a r t i c u l a r we'd love to
hire who's got a couple of kids; and they've got some congenital
b i r t h defects. We carmot t a l k to t h i s person because we understand
that i t ' s going to destroy our a b i l i t y to have health care for the
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whole company. And that's not right. That's hurting us and i t ' s
hurting our business. And t h i s stuff has got to stop.
Our partners are a l l over the l o t p o l i t i c a l l y . Some of
them didn't even vote for you, Mr. President. (Laughter.) And we
don't see t h i s as a p o l i t i c a l issue. We see this as a business
issue. And I don't care about t h i s from a p o l i t i c a l standpoint. I
care about getting my business to run. And the quicker, i n my mind
that you can get t h i s stuff through the p o l i t i c a l process and get i t
back to business where i t belongs, and we can get on with our l i f e
and we get health care off the table as an impediment to my a b i l i t y
to do business, the happier I'm going to be and the happier our
business i s going to be. (Applause.)
THE PRESIDENT: Good for you. Believe you me, nothing
would make me happier than to do exactly what you've said, i t should
not be a partisan p o l i t i c a l issue. And i f you get beyond the fog of
rhetoric to the hard facts of what people's actual individual
circumstances are, i t ' s very much easier for i t not to be a p o l i t i c a l
issue. Thank you very much. That was very impressive.
I want to talk a l i t t l e b i t by giving these folks a
chance to t a l k about how we give small business people the a b i l i t y to
have competitive prices i n the insurance market.
, Q
Thank you, Mr. President. And I'd l i k e to s t a r t
out by saying that having been i n business for about 37 years I've
stood on a couple of shoulders, and I'd l i k e to acknowledge and say
hello to you from my parents — which I am a second generation
business.
We started, and as a child, I grew up watching
employees. We were not always i n the medical f i e l d , we were not
always a durable medical equipment company, we were i n the j a n i t o r i a l
business when we started out. And we grew into that business to
where at sometime we had up to 150 employees. One hundred percent of
them were not insured. Probably most of them were teeter-tottering
between staying on welfare and working 20 — l e s s than 40 hours per
W6GJC •
4.V 4.
^ -^•''S ^^as"'*^ until about, I want to say about 10 years ago,
that we started developing our company to the degree that we were
able to provide health insurance and at that point in time is when we
started to see a change in the type of people that we were able to
attract as a business. And until that took place, until we were able
to offer benefits, we were not able to get people that would stay.
We were not able to get quality people. And our business just became
more and more competitive as we were able to provide these types of
insurance.
if
Now today, out of the 10 full-time people that we have
that we provide insurance, our insurance i s running us over 14
percent of our payroll. And i n addition to that, workers' comp i s
about 4.5 percent, but that could be as high as seven percent i n our
state. And I know how hard i t i s for me to meet that insurance
premium every month, that i f we had the opportunity to keep those
employees and provide them the number one deterrent right now being
health insurance
and I can't say enough that welfare reform and
health insurance i s so t i e d together when you look at part-time
people being able to leave one thing and go to the other ~ I r e a l l y
f e e l that we are going to be able to be more competitive because my
costs are going to reduce under t h i s health care plan. And I see i t .
And at the same time, I am going to be able to give better coverage
to coverage to my employees and be able to a t t r a c t better employees.
^ ^
^ r e a l l y applaud you for looking at the big picture
™i?
?5 ^ ^ i " " ' narrow and j u s t keeping on surface things that
r e a l l y don t make a difference i n people's l i k e myself's l i v e s and my
MORE
�- 14 -
community, the African American community, the people that I see that
are doing without health insurance a l l over t h i s country.
Thank you.
(Applause.)
THE PRESIDENT:
I'd l i k e to now to go to a small family
business.
Q
Thank you. President Clinton, and i t ' s good to be
here in Washington, D.C. today.
There have been so many important things said t h i s
morning and what I would guess a l l of us up here are doing are being
sponges. We're kind of soaking in a l l t h i s information, these
comments from a l l the various participants and I r e a l l y am amazed
that there's two f l o r i s t s here, the very big and the very small.
Brian and I j u s t met t h i s morning, and he has an outstanding business
and was able to do something we're not and that's offer health care
insurance for employees. At one time we did. At the time we had to
drop our benefit for our employees — we have le&s than 10 employees
— i t was approximately 20 percent of payroll. Obviously, we
couldn't compete in the flower market at that rate.
The Small Business Administration has been very
proactive in the health care debate. And I think, from our
viewpoint, what we see as a massive education problem to r e a l l y
inform and educate small business people because, as I get out and
v i s i t with other people, I use the Small Business Administration form
that was developed for Congress, and when people can s i t down and
crunch t h e i r own numbers — most small businesses are l i k e ours,
there are maybe 8 or 10 employees — they w i l l find, I am sure, what
we found, that our family insurance policy right now i s l e s s than
$400 per month. We could insure a l l of our families with the Clinton
plan — a l l families i n our business for l e s s than $400 a month with
the cap and because of the lower income and the smaller number of
employees.
So I would encourage people who have questions to
contact an SBA office, to contact t h e i r congressional o f f i c e and to
work the numbers because I r e a l l y feel that when they work the
numbers they w i l l see that t h i s i s a win-win s i t u a t i o n for small
business.
Beyond that, what we personally appreciate and why we
have worked so hard i s the Clinton reform l e g i s l a t i o n w i l l do away
with l i f e t i m e maximum benefits. And we happen to be a family who has
a c h i l d with a l i f e t i m e i l l n e s s , and we can a c t u a l l y anticipate the
point where we w i l l meet our l i f e t i m e maximum benefit and our c h i l d
w i l l not be an adult at that time. So t h i s i s something that i s of
great concern to a l l families. I f your f i n a n c i a l future i s
threatened because of the way you are treated i n the health care
system, you w i l l r e a l l y be wanting to see t h i s piece of l e g i s l a t i o n
passed.
There's two kinds of people, I figured out, that don't
want to change. And those are people who have someone e l s e paying
the whole b i l l for them, and people who have never been s i c k .
Otherwise, pretty much across the board, people want change.
(Applause.)
THE PRESIDENT: Yesterday when I was i n Miami, I met, as
I often do when I'm traveling around the country, with some children
and t h e i r families from these ffake-A-Wish programs, where the kids
are desperately i l l and one of the things they want to do i s meet the
President. And I met with a family, a very impressive family of
three children — two sons and a daughter — where both sons had a
very rare and apparently genetically-transmitted propensity to have a
very rare form of cancer. And t h i s family has a l i f e t i m e l i m i t on
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�- 15 -
their policy, as three out of four Americans do.
Americans have lifetime limits.
Three out of four
And they're in a real pickle. Because they are going to
run up against the limit long before the second child — assuming
that both the boys survive, and they've done pretty well so far but
i f they do both survive their illness and they're plugging along —
then they'll run up against their limit long before the second child
IS out of the house. And then they have a third youngest child and
thank goodness, the child so far has not contracted the disease and
of course, they hope she won't. But i f she does, then you can just
double whatever their problem i s .
Again, I would say — I want to emphasize, though, the
only way this works with the private health insurance business i s
that you have to find a way not to bankrupt private health insurance.
And a lot of these things — I've had a lot of employers — i had a
restaurant owner I mentioned in Columbus, Ohio, who was very
complimentary of her personal health insurers. She said, these
people are doing the best they can for me under the circumstances
given the way their business i s organized and the way the market i s
organized. That's why you have to reorganize the market and put
people into larger units and insure people on a community basis.
^w.
°^
controversial things ~ l just want to
Sfon
--one Of the most controversial aspects of our plan has
been the provision for small and medium-sized businesses to be in
these big buying alliances. People have treated i t as i f i t were
some big new government bureaucracy.
I have seen i t , quite the contrary, as a way of
enforcing community rating. That i s , you can ~ there are some
l l 3on
mandating community rating. But
ttogether,
L J ? L ^ the law i t s e lf^^^^"
"'^^^^
^'^^^^community
^ « l i t t l erating.
g^ys can buy
f won't
guarantee
^
.
yesterday ~ l just want to read you something —
^?f?^n^!^}"
^^^^^^
there i s this i r t i c l e , "l?!te
c i M ? o ? ^ ? Hn«H
thousand work4rs at small
California businesses w i l l get an extraordinary piece of good news on
Tuesday" - that's today. "At a time when health insu?anle cos?s in
the country are climbing at six to eight percent a year, their
premiums w i l l actually be reduced, starting July 1st. ihese
fortunate few are members of the state's unheralded health alliance
a purchasing agency that gives companies with between five and IS
c?o^r?v,*\°P??r^"^^^
^^"^ together to achieve the saSe Suying
clout the health care market gives to giant corporations.
, ,
^
"fven as President Clinton's proposal for alliances i s
being denounced in Washington as a blueprint for a menacing new
toae^SS^.^'^nJvf
^^^^ "
i» SacrSSe^So Sas put
together a working alliance, the f i r s t in the nation, and the
customers seem delighted."
hn«Hno=«.o=
Florida they've got now buying pools of small
?ast nigh? S l a t ^ S ^ s t ' ^ ^ i ^ i ' " ' ? " "
the Governor told me
these ai?L^5««
I T^^^ businesses had experienced - that joined
^"740 ^''^
experienced declines in premium costs of
between ii"
five and
percent.
wi
guestion^® combative,
but just
to don't
ask this
question. As^^hL^SYi5^^*
As this b i l l moves through
the Congress,
i f thev
iays
S el i^t tJl ^e "guys
^ thebigallilnces,
you?ve git to f I ^ d sSme
ways lo%17e
to give tthe
buying power.
— «nd T wi^h^'
Mr. President, a l l these buying groups do
Ialliances,
l n S n c e s but
but a l l these buying "^^^^
groupsthem
do buying groGps^instead of
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�- 16 -
THE PRESIDENT: I do, too.
NATO an a l l i a n c e .
(Laughter.)
They liked i t when we called
MR. BOWLES: — i s , truly, they s h i f t the power of the
marketplace. They change that supply and demand equation from
favoring the supplier of health care to favoring us, the consumer and
the small business owner. I t ' s j u s t identical to what Mr. McCarthy
was here saying about what happens i n the flower business. I t gives
us, the small business owner, some market muscle so that we can cut a
good deal for our employees. That's what i t does.
Q
Could I ask a question? One of the big arguments
that I have heard in talking to other businesses i s that everybody i s
concerned about the quality of health care, what's going to happen.
They're afraid — right now they may have choices, they have certain
choices, and that's sort of the unknown out there. What i s the —
how i s the quality of health care going to change.
THE PRESIDENT: I think there are two concerns about the
quality of health care that I've heard. One i s , are you going to cut
down on how much you spend on health care so much that there won't be
enough for medical research, for technology, for things to progress?
The other i s , i f you deprive people of choices, i s n ' t that a backdoor way of undermining quality?
a l l like
quality.
don't do
here and
choice.
you w i l l
I mean, people — i n America I think people equate — we
to make our own decisions. So people equate choice with
To that I would respond in two ways: Nxamber one, i f you
anything, i f we j u s t l e t t h i s alone, i f we walk away from
don't do anything, you w i l l see dramatic reductions in
And many of you i n t h i s room w i l l contribute to that because
have no choice.
That's what happened to our friend from New Hampshire
here. She wished to give her employees the choice between being in
the HMO or insuring with fee-for-service medicine through Blue Cross.
Now she has only the HMO option. She i s now i n the majority of
employers i n America who cover t h e i r employees. Now, a s l i g h t
majority does not provide any choice for the employee but, i n fact,
makes the choice for the employee because they have no choice. You
know, one of our panelists here, i f he were able to get back into the
health insurance market, would have — probably would have to j u s t
make the best deal he could and the employees would have to take i t
or leave i t .
So on the question of quality i n terms of choice, under
our plan, again because of marketing power, we would give your
obligation as an employer would be constant. You would pay the same
no matter what. But your employees every year, because of the
cooperative buying power, would be able to choose from among at l e a s t
three programs.
And we estimate that in most places they would always
have access to an HMO.
And as I said, many of them are very good,
but t h e y ' l l be better i f they have competitive pressure. Then,
probably there would be a PPO — that i s a professional group where
doctors get together and they organize health care delivery, and
normally those have many more doctors and sometimes l e t people in who
are w i l l i n g to provide the service for an approved p r i c e , so you get
even more choice — and the fee-for-service medicine. And that would
come up every year. So that's my answer.
And the second thing i s , i f you do nothing, you w i l l
continue to see a squeeze on the quality of medicine i n terms of what
goes into the teaching hospitals and medical research. Why do I say
that? I was in Boston l a s t week, and I met with the heads of a l l the
teaching hospitals after which they came out and endorsed our plan.
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�- 17 -
And they said — every one of them said, i f we don't do anything,
we're going to get less and less money because the people who come
into our hospitals are increasingly i n managed care plans where they
put the squeeze on us and they cut down on the money we get for
patient care. So under our plan, we increase medical research, we
increase support for teaching hospitals, and that's what we have to
do.
So my argument i s quality w i l l suffer i f we do nothing.
Choice w i l l be r e s t r i c t e d i f we do nothing. I f we move, we can
increase quality and choice i n a f a i r and balanced way.
I know we got to wrap up. We have one more person to
hear from, and the Congressman wants to make a comment.
CONGRESSMAN LAFALCE: I j u s t want to add to what you
said, Mr. President, about the quality of care. Not only would you
have far more choice under the President's proposal, but I think you
would have much better quality care. I don't thing we have a health
care system right now, I think we have a sick care system. Our
primary deficiency, i t seems to me, i s we don't have primary care.
We don't have preventive medicine. And the emphasis of the
President's proposal i s on preventive medicine.
I f you look to the state of Hawaii, which about 20
years ago, mandated the health care benefits for a l l employees,
you'll see that businesses flourished i n Hawaii. You'll also see
that health outcomes flourished, too. By v i r t u a l l y any health
s t a t i s t i c you could point to, Hawaii i s doing better than most any
other state. This i s not because of the climate out there, too,
because you could compare Hawaii's climate to Florida's, to Puerto
Rico's, et cetera, et cetera. But when you look to b i r t h s t a t i s t i c s ,
weight s t a t i s t i c s , l i f e expectancies, e t cetera, the preventive care
that they're able to get i n Hawaii because of the fact that a l l
employers must provide coverage for t h e i r employees has increased the
quality of health care immeasurably.
THE PRESIDENT: I'd l i k e to hammer that home because a
lot of people say, w e l l . B i l l , everybody goes to Hawaii on vacation.
I t ' s a r i c h state. Hawaii has a very, very large percentage of
people i n i t s health care system who are low income people — native
islanders, people come i n from surrounding islands — about a 20
percent load there, quite a high load. So the health outcomes for
Hawaii include a very large niunber of people who have to be paid for
in t r a d i t i o n a l ways who aren't even i n the employment system. So you
j u s t can't make that argument. I'm j u s t trying to reinforce what he
said.
Our l a s t speaker i s John Sorenson, from the Weco Supply
Company, i n Fresno, C a l i f o m i a . He wrote to me about one of h i s
employees.
And I thought i t would be good to kind of l e t him close
because of the concem that t h i s employer had for h i s employee, and
how i t affected h i s business.
Q
Well, f i r s t I'd l i k e to thank you for i n v i t i n g me,
and thank you for caring. I was invited here because of an employee
I have by the name of Randy Walker. But before I t a l k about him, I
wanted to thank the health care industry and the insurance industry.
Four years ago t h i s month, we discovered my father had a
brain tumor about s i z e of a baked potato, and i t didn't look good.
In fact, i f you've ever had anybody i n your l i f e l i k e that, you'd
know how scary that was. About a month or so a f t e r we discovered i t ,
they performed the operation, and he's fine. A year l a t e r , they had
to do I t a l l over again, and he was fine again. Insurance paid for
a l l of i t , and Dr. Brian Claig i n Fresno was absolutely a marvelous
surgeon.
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�- 18 -
And with that in mind, when t h i s situation happened with
Randy Walker, I was j u s t angry. And what happened was that, as a
salesman for my company, he was married, had two children, and one of
the children was born prematurely, and the insurance b i l l s were 3 0some thousand dollars. And they occurred right at the time where he
had l e f t h i s previous employer and come to work for my company, and
he thought he had a 60-day grace period that i t was going to pay for
the coverage. I t didn't, and we a l l advised him to seek advice. And
i t came up that the best solution was to f i l e bankruptcy.
And two years after the second child was born, a third
child came along and we had j u s t started a new insurance plan. And
the new insurance plan — because of the cost of insurance, and
because of the complaints I get every time somebody at my company has
a health problem — they come to me as i f I wrote the policy — I
advise them to see the insurance man.
And i n t h i s case I said, well,
I'm not going to step in the middle of t h i s one — we're going to
pick i t c o l l e c t i v e l y .
So the employees picked the insurance plan, and we voted
on i t . And I represented j u s t one of — at the time, I think i t was
18 votes. I told them that unless three-fourths of us agreed to i t ,
we weren't going to pass i t . So the employees were r e a l curious;
they asked a l o t of questions; they wanted to make sure i t would
cover certain situations.
Randy didn't have the money to go to the doctor, but
apparently h i s wife was already barely pregnant. And they hadn't
been to the doctor to find out, although I'm sure they probably
suspected i t . Well, the baby was born zQjout f i v e months after the
coverage had started. The insurance had taken the premiums. The
insurance company had said, yes, i t ' s covered. They paid for, I
believe, some of the doctor v i s i t s .
But when the baby was bom
premature by two months, i t incurred $150,000 i n medical b i l l s ; and
he was j u s t devastated. He was trying to focus on a new baby that
was barely a l i v e . He was trying to focus on the r e s t of h i s family,
and t r y to do a job for me and avoid creditors. And i t made i t
v i r t u a l l y impossible.
So, about a year ago at t h i s time, we t r i e d to go buy
him a vehicle. And h i s credit was so bad that the only way he could
get one was with somebody's help. And I decided that I probably
stood the biggest chance of helping him of anybody i n h i s l i f e — I
was h i s boss. So we went out to a car dealership to t r y to buy him a
car with the idea that I would co-sign on i t because my c r e d i t was
okay. We picked i t out, and we got a l l the n i c e t i e s out of the way
at the car dealership; and then they looked at h i s c r e d i t report.
And h i s credit report said everything t e r r i b l e that you could imagine
— and every single one of them was a health care expense that he
couldn't begin to pay. We had told them that ahead of time.
They treated us l i k e we had AIDS. And I had never been
treated that way.
I've never been poor. I went home that night and
I was j u s t angry; I knew I couldn't help t h i s guy. I've always been
able to help anybody that I r e a l l y set forth to t r y to help. So
about 11 p.m. at night, I started to write a l e t t e r to H i l l a r y .
(Laughter.)
(Laughter and
THE PRESIDENT:
applause.)
I've done that myself a time or two.
Q
I t took me about three hours to write i t , and I
sent the f i r s t draft off to 1600 Pennsylvania Avenue without a zip
code, figuring I'd probably never hear anything. And I was almost
embarrassed that I'd written i t because i t sounded a l i t t l e corny. I
talked about everything I've talked about today and then some; i t was
about three pages. By the time i t was done, I f e l t that I j u s t had
to at l e a s t show Randy that I'd written the l e t t e r . I thought, at
MORE
�- 19 -
least I wanted to show him I was trying. I figured I couldn't do
much, but I could t r y . And he made me a batch of cookies the next
morning, so I guess I touched him.
When I heard from the White House and actually heard
that i t had been read, I was saddened because he had already quit.
He had been chased by people trying to c o l l e c t from him. And they
had attached h i s wages, and we had t r i e d to dodge that bullet by
c a l l i n g him a self-employed salesman and everything we could think of
to t r y to retain h i s income. And he f i n a l l y couldn't take i t , and I
can't say I blame him.
So, when the White House called, he was off in a place
where no one could find him, avoiding creditors. And one of the guys
that works for me was s t i l l friends with him and did contact him.
And Ron Brown from the Commerce Department came out and met me about
a month and a half ago. And we got Randy on the phone that evening,
and about 20 minutes before we had that conference, I got a c a l l from
Randy's wife. And I thought i t was icing on the cake of t h i s story
— she said, are you aware that we've s p l i t up? And I thought that
we did everything possible to t r y to make t h i s event work. We had
health care coverage. We had — we did everything we thought
possible, and i t s t i l l f a i l e d . And I thought that preexisting
conditions was the whole cause.
THE PRESIDENT:
for
I t was.
Q
And i f you can accomplish that, you've got my vote
the next 20 times. (Laughter.)
THE PRESIDENT: Well, l e t me t e l l you what the votes —
the votes that r e a l l y matter here. F i r s t of a l l , l e t ' s give him a
hand. I think that was quite a moving — (applause).
I wanted to end with that because I was so moved by the
l e t t e r that he wrote to H i l l a r y . And i t seemed to sort of capture so
many of these things that we t a l k about i n kind of esoteric terms —
preexisting conditions; people f a l l i n g i n between the gaps; why you
can't change jobs; a l l that kind of s t u f f . And you hear a story and
you r e a l i z e that t h i s i s the business of America.
But the votes that r e a l l y matter here are the votes of
the members of Congress. So before we leave, I'd l i k e to ask the
members of Congress who sat through t h i s entire panel to please stand
and be recognized. I see Congresswoman DeLauro there and
Congresswoman Eshoo there, who are standing, so they can't stand; and
Congressman Serrano's i n the back. Would a l l the members of Congress
who are here please stand so you can see them. (Applause.)
Thank you, Mr. Bowles. Thank you. Congressman. And
that you most of a l l to these fine members of our small business
family i n America.
Thank you.
We're adjourned.
END
(Applause.)
12:00 Noon EST
�'
^'^-'t-'^'
913 432 0142
P.Q01
THE WHITE HOUSE
(Kansas c i t y , Missouri)
For Immediate Release
A p r i l 7, 1994
REMARKS BY THE PRESIDENT
IN
TOWN HALL MEETING WITH PRESIDENT CLINTON
KCTV Television Studios
Kansas City, Missouri
7:05
P.M. CDT
with President B i n c ^ I ^ L Welcome to News 5's Town Hall Meeting
talk about tSe health o a ^ r c r J ? S ' f ^
President joins us to
reform the health caJe system
'^'"^"^''^
^^^"^
people in the m i d w e s ^ t r ^ L ^ ^ f aL^ to%a^^rab^-rt^S2i^^c^n^Lrns .
President of
IT.lZ
S^ftr'I^J^p^i.L'e'^r
Ann.
Thank you' ladi'e'f and alS??''
^^^^^ ^O"'
those in Tulsa ToSeka
O J^^""®.
'^itV ^nd
i u i s a , TopeKa, and Omaha, who are also j o i n i n g us.
about my hopes for^p^^•^H^°''^^^^
"^^^^
« l i t t l e bit
and learn f?om yoS and to lrl%''r,^^''^''
America, and to l i s t e n '.
to make a br?ef open?na «i-^^L^^^''?r ^''"^ q^iestlons. I'd l i k e
summarize what i s ?^ o,^^
^ anight, and sort of
marize what i s in our administration's health care proposal.
in health care^^ ?nno^?^"
^^^^""^ ^^^^ ^
^^en Interested ;
I grew UP around W n . ^ T '
""""^^^^
^ ""^^^ anesthetist,
dlversifv
r
J^^lf^^^ watched health care change and
rights orc^ui J L ^ ^ attorney general when I had to fight for the
thin for Tdozan J e a r f ^ f
"""''"^ ^""^^
^^'^^
our state have
^ff, '
^ governor when I saw, every year,
program -- ?hat^« W
^nd more and more in the Medicaid
elderly peopJe in
^ ^^'"^^^'^
f^^l'^^
three a ^ n ^ ? ? - ^ - e ^ ? i ^ ^ r ^ ? r J f \ " n f l ^ I ^ J j ^ i ^ ^ ^ ^ ^ ^ ^ ^ ^ ^
^
reasons.
Anf ift ^ j J s t l r r ^ r ^ ^ ? ^ ^ ^ ^ . J ^ ^ ^ ^ ^ S ^
^^^^^-^ ^
country in t h e ^ w o r l f thiJ'do.'' ? f ^ " t r y i s the only advanced
for all of its citizens
Provide health care security
\
the weal?Sier oointr!es' o r o i i d ^ ^ r ? ? ? ' ' ^ ^ "
''^^^^^^
united states does not dn Jh!^
security. Only the
i.«i:es aoes not do that. And we pay a dear price for i t . '
given time arm^fi^nn^nf"n."*^
m i l l i o n people. At any
million a r ; uniSsired
Eiah/""^ uninsured.
m every year, 58
families SSere ?he?e^s s o m ? S J j r ' ' ? . r A m e r i c a n s l i v e in
condition whJre tSerf.o h S ^ ""i!? ^ so-called preexisting
With a W t aJ?^^?
^ " ^ ^ i ^ * ^ " i t ^ diabetes or a daddy
nar tney can t either get insurance, or they pay much
MORE
�r>-'^ than ^nybn-fv pip., or they can never change jobs again,
-'^..•'•^ jo,,3 t'.?.y'xl xosu tn«»lr in.~u. cuce.
. . ,
^ There are so many Americans who have special
problems, i met a young woman again at the airport here 1-f>4<...a„> ..).\;y tcda^
^ :':ond6rful young women named ';ick< w-^.ir
b^Mlia'^hi
'"'"'^
She'oaL ^;'s-ee me ' ^
m«?C^? i ^
campaign, and I was glad to see her again. Her
J w ^ H r a i ; ! '''^ J
^^^'^ °^ talking about their hor<>B a r f
omn^S ?
^"'^ ^^^^"^ worries about the health car^ syLem,
:
could t e l l you a l o t of stories about that.
pw«,-.-i ^
^^^.^ think we have got to find a way to cover
STsBou^f^H '^''"^^^ '^^"^ ^ ^ ^ t you w i l l recognize here in
a^P rhlnr.?
If^u ^""'^ ""^^
Changing job market, people
are changing jobs more than ever before. And i t ' s very important
care ' ' t V ' l t f f .
"^'"^^
^ ' " ^ • ^ " t losing t h e j ^ hSaJth '
Pro^s^^^.losing i t . Even though since I became
t^«? n f c L 7
^^''''^
^^^^
'^^'^^ "^'^
economic program
thf
economy has created 2.5 m i l l i o n new j o b i in
tn l a s t 15 months, more than in the previous four years. But
nff
^"^'^
^ ^''t of big companies are s t i l l laying
off even as smaller companies create jobs.
^
,
we going to guarantee that people w i l l
?i?J^of^^J^H ^ ^ ^ ^ ^ J i"^^^^"^«? I t ' s a huge problem."^ There are
h«!?tK
problem.^ with our system — 133 million of us have
health insurance p o l i c i e s with lifetime l i m i t s , which means that
i n i - ^ i S Vfu^?''® children with long-term i l l n e s s e s , we can run
out of health insurance j u s t when we need i t most. The main
tning i s almost no American i s secure unless you work for big
government or big business.
^
K„„4
Another thing I'd l i k e to point out i s most small
?hf;"Jfv
want to provide health insurance and many do, but
that rates tor small businesses and self-employed people and
fJZ^y^
average, are 3 5 to 40 percent higher than -he
same insurance rates for big business and government; and that's
? h h ?iiV r
f° ^ ^^^"^ ^^'^^ "^ot to do something to turn
this around. Now, l e t ' s look at what our choices are.
n^Mv^,„ 4.1?^*^ ^ ^^"^
i ^ to guarantee private insurance,
Son
S
government take over the program, and I ' l l r.ell
you why.
we have b a s i c a l l y three choices today, we can j u s t do
away with private health insurance a l l togetheJ and pass a ?ax
c^nH^r^L?^^''^*^''^^ through a tax, l i k e the Medicare progra.v tor
senior c i t i z e n s , i don't favor doing that.
^ y
I t would be administratively simple, but i t would
W P ^Lr''^'''""^?^/''*
^'^^^ too much, I think, and we'd
wf^.^^u® competition and therefore l e s s control over p r i c e s . Or
we can have more conxpetitlon, but guarantee private health
insurance to everybc.'y. That's what i want to do with a
D?^SfJ5?wf r ^t^^^^"" Package that includes primary and
preventive health care, with no lifetime l i m i t s and with
«nn,^^T?
^^^^ s i c k . because a worker gets "-i^uer
older or
someone i n^^^^
your "^^"'^
family gets
i-hinv
?
propose in our plan to keep choice because i
think choice i s very important for quality. People should be
able to choose their doctors or a high-quality health care plar.
^ni^^S^
'^"^ insurance companies shouldn't be able to deny
wSJk
NOW, today, more and more Americans Insured at
^u^^""
to choose. Fewer than half of
t S ^ ^ i ^ L V ? ^ ^""^ ^''V® ^""^ "^^^^^^ ^ t a l l over t h e i r do-tors or
evprJ v f ! i ''^''^ ^^^"^
^^^"^ would guarantee that
Snd
L
^
v
L^'^^^L""''^^"^
^
^
^
l
"*
* t l e a s t three cho.L ..-^
ana picK among them.
Hn^...' T
^ "®
to make some insurance reforms. I t wc»uld bbPn.!fTr="U,^rK°''f
^^"^ anyone to be dropped or to have t h e i r '
benefits cut by insurance companies; for rates t ^ be increased
�yi3 43i k)i4. p. 003
- 3 -
just because somebody in the family had been sick; for lifetime
limits to be used to cut off benefits; or for older workers to be
charged more than younger ones. This i s a big deal, folks. I've
met people in their late 50s and mld-60s who are losing their
jobs, who have to get new Jobs, who are good and reliable workers
but employers are scared to hire them because their rates are
higher.
Now, l e t me say, we'll come back to this. The only
way we can do this f a i r l y i s to reform the insurance market,
oecause i f you have 1500 separate companies writing thousands of
different policies, i t ' s hard to afford to be fair to small
business people. The only way you can be fair to small business
people i s let small business people and self-employed people go
into big, big pools and be insured the way big business and
government people are.
.
I want to preserve Medicare, leave i t like i t i s ;
I t 6 working for elderly people. Except we ought to add a
prescription drug benefit which i s very important to elderly
people and w i l l save money for our health care system over the
long run. And l think we should cover things other than nursing
home care, including in-home care, because the fastest growing
groups of Americans are people over 80 and we need to provide for
their care and help their families.
This i s the most controversial part of our plan, I
suppose, at least among organized groups. I think the benefits
Should be guaranteed at work. That i s , I think employers and
employees who presently aren't covered should contribute to their
health insurance; and then the government should cover the
unemployed, should cover part-time employees when they're not
working and should help to provide discounts to small businesses
that have low payrolls, low profit margins and relatively high
costs now.
I f we cover employees at work and give discounts to
fS? i ousiness and have the govemment help the unemployed, I
think that's the fairest way. why? Because nine out of ten
Americans who have health insurance have i t through their
workplace. And eight out of ten Americans, believe i t or not,
who are uninsured have someone in their family who works. So I
just want to build on what we've got now — guaranteed private
insurance; preserve the right to choose a doctor or health care
plan; change the insurance practices that don't work but also,
don't put the insurance companies out of business, l e t them
Insure people in bigger pools; preserve Medicare; and guarantee
tne health benefits through the workplace. That's our plan.
There may be other ideas and better ones, but l e t me
say, I'm absolutely convinced i f we don't do anything, we're
going to continue to have millions of Americans in misery,
millions of Americans insecure; we're going to pay 40 to 50
percent more than any other country In our income in health care
and have less to show for i t . i don't think that's an acceptable
solution. So for those who don't agree with me, I hope they have
an idea about how we can provide health security to a l l of our
people. America can do i t i f every other country can do i t .
Thank you. (Applause.)
MR, ANSCHUTZ: Mr. President, as you just heard of
course, has answered some basic questions about his plan. And I
know i t has raised some questions in the minds of our viewers as
well, and that's what we want to get to now.
We have in our studio about 160 people from the
Kansas City area who have questions for the President. We also ,
have three other c i t i e s that w i l l join us in tonight's town hall
meeting via s a t e l l i t e : From Tulsa, Oklahoma, and CBS station
KOTV, we are joined by our host Glenda Sllvy. From the capital ,
city of Kansas, Topeka, and the studios of wiBWr-TV, we are joined,
by host, Ralph Hipp, a man from our neighbor state to the north
�913
•*
^
432
0142PT004
M
hos? ?Sere' forpfJ^A "^ f
^^^"^'^
^MTV-TV and our
?n!7 r ? ? ' -^^^^tta Carroll, so that i s kind of the cast for
coLffrom'^JJ^r^;
^^^^
questioning ' T h f a r
the f i r s r i a d "
Peterson, my co-host, and she has
^r>^
Cltv
PETERSON: Welcome, Mr, President to Kanszs
she npoLS
\ ^ e d i c a l emergency, she didn't get the care
S,,L??
? because she was worried about cost, what Is your
question to the President?
^
Pv«nH,.,. X,
S
.f^^^^^ °^ ^11' I would like to say, good
f a l l s ta ^ n r ^ i f
explain why Washington continually
t h i i K^? ^
H country's priorities back in the order in which
they belong and why our o f f i c i a l s can't or won't take a SerloHs
and compassionate look at our health care reform?
^^J^ious
fnr- ho^
y.
"^l?? PRESIDENT: Well, I didn't write that question
t h af^.5oI-^Ki
t ^ r A o f s o».
' - ' - *="^t's
^ t h a i ' raf l i t t l e more' "objective,
^^'^^
^^^^
y o unot
^ a r aquite
i^Ser
so
maybe
w^ote
S?f ^J^""
IssSe.
wrote usSs aa letter, didn't
you? ^^'^
Didn't ^youcomplicated
write a letter
to my Xol
Q
Yes, I did.
late Avr,«n.-i™^ PRESIDENT: And your mother got health care
late, expensive, because she was afraid she couldn't afford i t ?
Q
Yes, exactly.
THE PRESIDENT: This i s something i should tPli
litems s'^v'^^s'al'l^^J"' ' t''''''^ ^^^^
my o ^ e L n f ^ema^k b i t
l l o ^ l l in^'f^JLl,^
^ " ^ t from common sense, most
?he?\^e
""^l t'^'tl^ ^'^^ insurance get health'care i f
exSL«?w^
-T.?^^^they get i t when i t ' s too late, too
aid
J ^ ^ ? usually get i t at an emergency room. 'They dop't
Shether t-J^5"^
emergency room at the hospital has to decid.3
1^11 l l they're going to pass the cost along to the rest of us so
absorb I?^,!;H''^V,^^^2
Whether they are going to
heaJ^h o^;p n^^.i?^'"^^''^^'
the financial condition of our
health care providers in our communities. So l want to set that
.r^^"^' "^^^ hasn't this been done?
i-r-vm^ 4=
Msto?icanv J T '
^^^^^
^li'
People have been
America
.
^^""^ antigovernment. We think the government
atrltd f l l
^ ^"^"^^^ P^"'^^' f^'^'^ghter.) And so, we a?e
afraid for the government to do anything involving health care. .
i
^
^
^-u. ,
go^I?nmeif
n^v?^S I
paying a lot
chan^J^'^?'^?
Secondly, because small business people in oenerai
Thl.'^r^
^"'^^^
^^'^ rlqSire^eJ^s^^^^m"''
They're paying a lot for worker's comp; they're
for social Security; they have a lot of costs
Th^v
^^"^^^^ ^^^^^
do%his
And I hope we'gera''
^^^''t this, because i beUeve most small buslne4 *
ShT'^hii^s^HroSLf
^^^'^
^'^
?o'e^pla??-^ ,
_
Third, because the thing that's wrona with th#»
2S'Je''aSt''?he'L«rd ^ r ' " "
^^^^th I T r l providers,
medical L c S L ^ o a v fn^'^S'"^ t""^ ""^^^^^
medical research and
meaic^l technology in the whole world. The thing that's wronn
With flOur system i s the way i t ' s financed. But a lot of goSd
;?e''iS/''%^'"^'•^^^^
i t ' s financed now.
you k?ow we
i l L l ^ ^ """^^ country in the world with 1,500 separate health
iSlcr'^fn tS^r^'i""
thousands of' differenrpoUcles
!!viS '
" f " ' require l i t e r a l l y hundreds of thousands of
c l e r i c a l workers in doctor's offices, hospitals and ?nlu?ance
offices to figure out -vhat's not covered. Right?
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'
�yiJS 4j:2 0142
P. 005
- 5 -
1^.. J I t ' s not a good way to spend money, but there are a
i n L o L l ^ n ? r ^ ^ ^ ^ ^^^"^
'^^^
« l ^ t of good people,
insurance agencies, for example, that are do^-r
cSt baSv^.S''?>,^''^.^?^J-^
^^^^^^^^ ^^t»^i" this syat^ni. ,. _ ...
Seal?h
tiie administrative costs and spend the money on
VJ!: ? ?
' ^ t ^ ^ create more jobs i n health care, but we'll
ioA v,5?T^
paperwork end of health care. We spend about
fnd n^ioiSJ^Vv
^"
""^^^^ States, more on administration
and paperwork than any country would under any other system.
an^r^^A ^ ^.
^ ^°t of thlngs w i l l get changed. People are
''anS^^A/^^''^i^^^
''^
government,
small w ibusiness
is
rsena??ivf
h L ^ i f ^ '..v
? . ^ \ ^ ^ ^ ^ t h insurance
financing system
l l be
the a J a n . J ^ f ?
f^' ^ against our changing the system, i think
h^rd^^^^r J
""'V,^^
""^^^^ '"^"'^ powerful, but oftentimes, i t ' s
S^V^SM^S "^^^7?^
^ t i s to stay the same. That's why
haven I done i t . That's why we need stories l i k e your mother's
story out there to remind us of the human issues at stake.
Q
Thank you.
MR. ANSCHUTZ: Let's get on now to our s a t e l l i t e
t Z l l l ^ ' ^ t ^ ^ ^ tonight's town h a l l meeting. As you know, we have
three other stations who are involved. And l e t ' s go to the f i r s t
one i n Tul.sa, Oklahoma, where Glenda Silvy i s standing by.
I
Hello, Glenda.
Q
Hello, Wendall. Thank you. And Tulsa also
welcomes you, Mr. President, our f i r s t question comes froui a ma:*:
who has a question r e l a t i n g to r u r a l health care.
„,, ^
Q
Mr. President, I am a physician i n a small town
in Oklahoma, i wonder i f the health care i n the r u r a l areas w i l l
continue to be provided by physicians or by other trained
individuals such as physician's assistants, nurse p r a c t i t i o n e r s , '
et cetera, as opposed to continued physician care for our
patients, i think t h i s i s an important issue, and I'd l i k e an
idea of the Clinton approach to the plan.
THE PRESIDENT: Well, f i r s t , s i r , I think that
medical professionals should be able to do what they are trained
and properly q u a l i f i e d to do. But what i hope we can do i s to
put more physicians out i n r u r a l America.
Under our plan, there are some very special
incentives to t r y to get more doctors to go into r u r a l areas and
to small towns. We want to revive the National Health service
corps and put another 7,000 doctors out paying o f f t h e i r medical
school b i l l s by practicing i n underserved areas over the next
f i v e years.
In addition to that, we propose to give s i g n i f i c a n t
tax credits to people as income incentives to go out and prac't-ic^
in r u r a l areas, i n shortage areas. Physicians get quite a b i t .
And where there's a nurse shortage, nurses and other health
professionals can get some as well.
And the t h i r d thing we're going to t r y to do i s to
give more support to physicians i n r u r a l areas, do more to
connect them with medical centers through technology, do m^re to
provide tax incentives f o r them to buy t h e i r own equlpmsnt so
they can provide high q u a l i t y care.
So my goal i s to have more people l i k e you i n small
towns and r u r a l areas. I just came back from Troy, North
Carolina, where I was t a l k i n g to doctors there about the t e r r i b l e
medical shortage. And I met a woman who t o l d me that she had
worked 100 hours a week for two or three months i n a row, and sh^
was now down to her slow season where she was down to 80 hours a
week, because they didn't have anymore doctors. so I think that
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�KHNbMb LllV
OF-
913 432 0142
P.006
- 6-
rura?^maviii'^?r "^'f ^'^^^
^« to try to K(.ep the doc.o.a m
rural America i f we're going to keep rural America alive.
Tonek;.
nn to
^r^^li.
Thank you, Tulsa.
iopeka, up
theANSCHUTZ;
north.
We go now to
Presidpnt
w?.,^
evening, Wendall. And good evening, Mr.
mee?lno S.ra ?n ^u'^^i^^^'^^^
^ P^^t of your town hall
?ou^da?lon
l^d
capital, home of the Meninger
sneSia?^":..^
llJ^e to introduce this gentleman, who has a
special question of interest about that field.
needs tn he
U ^^^^Ident, mental health insurance coverage
Sove?aa^ W i l ) ''''^ ^ ^^""^^^ ^^th physical health insurance
coverage. Has Tipper Gore discussed the importance of this with
talk about it-TiJ'wf^K^'r;
(t-a^ghter.) You want me to
hire in K a n s L ^ i J j " ' ' ^^^^ ''^'^ T
^ ^ ^ t curious, we're
tha? i o J ^ S r ^^^^
^^'^ "'^^y '^^ y'^^ ^'^^^^ with what he said —
coveraSS as t T , T T ' ' \ ' ^ ' ' ] ^ ' ' \ ' ' ^ "^^^^^ i"^^^d« "^^^tal health
(Applause )
Physical coverage? How many of you agree?
rrsmc. .1
^^^^ to See I t . I think i t shows our country's
P ^ S b l ^ m s ^ ^ L r L r i ? ? ' ' . ' r ^ f . ; - '^^^ ^^^^^ ^'^^ ^ l o t ^ f T n t L
soSettmL
^^J^?^""^^^^ illnesses that can be treated,
thTn^o
?
medicine, sometimes in other ways, one of the
maie^Ln^di«^nf ^
^^^^
"
? want tS
;
h e a l t r c L f n^in^""" ^^""^ ^"
^^^^^ '"^"tal health under our
to be PS? In"^^?? r f P^'^tected benefit. But i t ' s not required .
and T S^nV ?
health insurance policies until the year 2000,
and I want to explain why.
/ ,
vrti, n,^r.^ "^^f ^^^^ thing in the world I want to do is to cost '
Jo^ked too h!L'f "^r^
^^y^
""^"^y '^^i^^^ this. I have
see It «o „^ ^ ° ^""^ '^'^ ^""^"^ the government deficit down to
have LSpr
J''^ ^""^"l^l^'
iDecause mental health benefits '
have never been provided on a comprehensive basis before, th^re
bee"Sou^?h?r"^ IT""^
experts about what i t w i l l cost. £'11
menta? hi^i?h^H''''^!?r' "^^^ the Meninger Foundation believes
n l l ^ ^ benefits over the long run will save money in the
an?n^
system, i do, too. But we can't prove i t . So ' r e
?ea?^2ooo
"^•^'^tal health benefits in. But by'thS
benefits anrf^/^-"' ^^^^^^^^^^^ just like physical health
^
?f ?his Plan piLes!"'"
^'"''^ packages for a l l Americans
what f-h» nr..J^ Vi'?^'*® """^^
^ t quicker, but we can't prove
Se'Je
aoina
^.
^^
^^"'^
we re going to have to phase i t in.^^t the budget at risk. So 1
going up to omaha^^NSka.'"''" '"""'"'^
Mr Pr,.«i.^nnt-^ x.^*^?^ evening, Wendall. An Omaha good evening,
famll^oc who^; ^ 2 ^ ? f ^ talking with this woman, she helps
families who have family members with Alzheimer's. And Karen
you've been there yourself with your own dad.
' •
when shP w«=
^
President, i helped my mother at one time
What I'd
^^I^^^'
that was sometime ago.
I l l l l^tJ:^
y*"" i ^ that my experience with meeting with
not c^J m^nh^"'^?"^ T ^ ^ ^! Alzheimer's patients i s that the? do •
Somef T S o n ^ i i ^ ^ ' / S ? they become prisoners in their own
nomes. ,.,8 you know. Medicare does not cover Alzheimer's rare ^n
^
^ W l l T l ' l
have ™uoh rehab'poientiSl! ' w " t \ u i
hav« some ?e^?el?
"
^°
'^^^^ "^^'^ c^re-glvers so they c...-.
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�- i l l
I r.c--
ijrL
=113 432 0142
P. 007
V
-.
u n d ^ r « t - . « ^ ^v,^S^ PRE^^IDENTt
I
-
I t h i n k proba.^ly aLTOEt
i. jf
cSntlxt
Ai^h^Sf
to put i t i n a larger
oSr oon.n.JJ^n ^^' ^
growing very rapidly i n our country as
a^wf??
^ 3"^ ^ ^ f ^ ^ ^""^ ^
of other i n f i r m i t i e s are growing
peop?e norm^?T; Medicare, the government's program f o r eider:
ii tt -o part
n^r? of a ^
^^""^ she
°f said.
in-home care unless
r e ^''K??^
h a b i l i t a t i o n program,
under M^di.^^vI^^'^S
l i m i t e d coverages for nursing home care
unaer Medicare. Most of our older people who get anv help from
lpovcirty
o L t Z ' so
l T tthey
T can
""^"^^^^
^'^"'the
^^ ^^^^
t o sp^nS
?hemselves ?nto
get into
Medicaid
program.
ov«r fi« ^® J ^ l i ^ v e
i f you look at the fact that people
giowlno'arnnn''i^^'"
^^'^"P' ^"^^^^ ^^^^
'
the fastest
eiroJ?Ln^on?f
P^P^l^tion in percentage terms - we want to
Who wan? t^ ? i K^'' ^^^^
^^^t to encourage people
means ?s ±f
'^'"^
independent as they can. But what that
means i s , i f children are w i l l i n g to take care of t h e i r parents
l 2 t t T A T ' , ' n \ ' "^^'^
of money that ^Sly'coJJd cof? the
Ittli^l it
spending t h e i r parents into poverty and
of hP?n
nursing home, we should give them a l i t t l e b i t
hAin in i i ?
°^ respite care and help when they're providing
help i n t h e i r homes or i n the community,
carp ^h^r.y. .^'^
would, j u s t l i k e mental health
care'benefit L'^Jh^?
' ' ^ ^ t few years a long-term
pa^Sntf ?^
K
^""5 children who are taking care of t h e i r
?
?
^^'"^
t o use your example - who have
^cun?^Tfv?
"^'^
^''^ ^ stroke, f o r example - I met a
hr6?iof
T a s ^™? o ^ ethe
^ ^ f other day^^^^'^
^ t e r she
— they'"^'^^^^
would be ^^^^^
able ^^^^-^
t o get^some
n^ron^J
^^"^ ^^tch the parent, take care of the'
parent on a regular basis while they took some time o f f , got to '
2on?S ^^'^^"^^
whatever needed to be done - so t h ^ t Se
our c o u n t ? v ' a ^ ? o r ' r ^^'^^^^^^ staying together. i t would save "
?ecocni?««^wLi? f
°''^'" the long run. And I think i t
recognizes what's happening to our population. Thank you.
and WPMI
^^^CHUTZ: Thank you, Omaha, f o r the question,
tlLi. l l J
^^''w
^""^ ^" ^
minutes. Now back to our om;
studio audience, Mr. President, and Ann has another question,
is a canrpr Jl^.,,
* P ^ ^ ^ i ^ ^ ^ t , I'd l i k e you t o meet a woman who
ieauS'lSsir^ncrpJL'""
^'^^ ^"^"^^^"^ ^^^"^^^
the
Would you explain?
was d*i;,x,<=^
Welcome, President Clinton. My surgery
was delayed for approximately two months because o r i g i n a l l y I'd
B u r L l l '"LS^^^'^^' ^ ^''"^
'^'^
sen? me to a
fVn^
: f v ^ ^ ^ ^ " the. mammograms and so f o r t h . And then when you
f i n d out that you're going t o have t o have surgery to then stop
;Mch'ls"prov?dfd^b'"'
insurance c a r r i e r !
wnicn 16 provided byrayemployer. ^^^^
.,^*.v..
^
"^^^
t o stop and choose doctors that vou know
«n Ji*"^
the disease i s devastating but then to choose
i H o w ^ f r ' ^ ' ' nL^"""^
devastating. And 2hat 1 wanted to know
hea??h Sfan^and'^? Percent ensure or guarantee that under your
woulS h ^ i ! .ho
^^^^
employer would choose, that we
would have the choice of our own doctors?
THE PRESIDENT: I want t o make sure everyone here
^?d^^;^^^;^^
"""^ ' " l ^ " ' ' studios understood what she said. ;.h^
^^i,^.^^'' previous doctor, her personal choice, was off-plan. W>^v
dSn t know^'''''^^"
everybody what that means, i n case^tSey
"
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�4j,i U142
P. 0QS
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don't pay anything°ft~an"^nr^^h'''*" ^^^^^^ ^® off-plan where they
50, 60, 70 percen?.
'
^^^^
^"^te a bit less - elthef
chose an lnsurance'\'lLf
yoS'that'd?S"
^^^'^^^^
the doctor that you had been S L ? ?
"°t permit you to keep
serious
c o n d i t i o r r i ^ r ccancer,
ancer i
l«s terrifying
?^
new
doctor.
to have to go ^^^ve
to a a
Q
Correct.
want to make
eveJvbodv
^^^^ ^^^'^^ trying - i just
charges that's been leJe?ed aSfln^?'"^"
^^^^"^^
tSe
untrue i s that I'm trying ?o ?es??ic?''fh''^^? f^^^^
absolutely
a. The American people
people.
peon 1° arZ
J , ^ fh^rM
^ J ^ , " !''"f,"Choice
? - " ^ ^ ^ l ^ ^ of the American
Americaii
NOW, let me just say some?h?n^ ''^ "^^^^'^ choices restricted
employer and many o t L ? s a to? n f ^ ^ ^ ^ ^ ^ f i ^ '
^^^^"^^ o
"«y, that's a l l I can afford i s a i I n ^^5^^
employer says,
can and i think they'll p?^vid!
<^*=*1^5 the best i
Plan works.
^
Provide quality care. Here's how our
Obligation to^SontrJb^te^f^pr^^f ^""'Pl^y^^ would have an
i t would not chaSge"^;;i\:t?e%"whSt'S?an'v'°
insurance, and :
year, your employer would be L r ? ^nJ?
^^^^ every
unless i t ' s a very large emploje^.
^^^^ "''^^^ than <3
I t ' s a small company.
"^^S PRESIDENT-
Tf
«
company, then, would be part " a hfa h m e m p l o y e r , the small
lower rates and choices. A^d you wn.nST'' f
to guarantee
co-operative, at least thr^^ ? ? ^ould be given, through this
an HMO like ihe onfy^u' ^ e S o f hi?!'' J ^ ^ ' ' ^
^^^^ to buy into :
pay a small premium so i f yoS wanted t f ' ^^"'^
^^^^ to
get the services from th^
rt^^.*.
to, you could opt out and
eame contribution —
"""^.^t your choice with exactly the ^
could buy fee-for-servLe medialnf
^°"^^t the premium. You
doctor; you'd pay a l i t ? ^ mo^P
^^^'^
^ " ^ t keep your ^
have Ito have at least one tSJ^d'choLr
- ^^"''^ ^'^^^^ ^
be able to reClfe'^Jhat, ""vou^d^i; i^i^^^^^^®^' ^^^^^ ^^ar you'd )
"'ould always have the riaht t o ^ h f ^
reconsider i t . But you
'pay a - l i t t l e more for f e e - L J «
^^'^h though you might
would not be dlsadJanta^^d -ll^rpav"'??!'''^"' ^""^ employer
'
and you would pay less than vr.n\, f!^ the same, regardless —
business would^r I T t of'a I T , SSye?' ^ 0 0 ! ? ' " ' ^
^'"^^^
woula ije, m a?i^probaMU?v''°?'' the most expensive choice i t
you'd be part of a big pooJ!^'
P^^l"^ now because •
Q
less?
That would be wonderful.
Thank you.
ANSCHUTZ: And the small business would pay
Most people i f L e r L ' f ' ^ r o u r ' ^ l a r ' ' ^"^""^^ ^ ^ t depends,
better health care fo? the Z l / o r int^^^"^' T"^^ ^ ^ t the same or
businesses would pay more i ? L n L i
""P^^^- ^^'^^ small
have to know, .e? m^e Tult t e \ ? ^ r b r ? ^ f ? l ; ^ ^ ^ ! r ^ L L ^ ^ ^ - ' '
nine percent of^ay^ojrfor'heafth'in'^"^'^^ '^^^^ ^^^^ ^^^ht to
^y^F^^ody would pay a maximum of 7 Q n^r^'''^^ "'^'^^^ '^^^ sjstem,
^ith fev,«r than 70 employees ani LfvS^'"''^"^' ^'"^^^ businesses '
year or lee.
wo^1l5^L\T?lSL"?^rdL^^oS.°?.? •
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�'
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/
going down to as low as 3.5 percent of payroll on a s l i d i n g
scale. That's how i t would work.
MR. ANSCHUTZ:
That answers your question?
Thank you. And now back to the t e l e v i s i o n monitors,
another c i r c u i t here. We'll go back to Tulsa, Oklahoma.
T .
Q
Mr. President, I'm a full-time college student.
1 nave a part-time job and I have no health insurance. How w i l l
your plan help me? And how w i l l I be able to pay for i t ?
THE PRESIDENT:
How many hours a week do you work?
Q
I work 25 to 30 hours a week, s i r .
currently taking 13 hours at a college here in town.
And I'm
THE PRESIDENT: Good for you. When you get your
degree, you'll be glad that you worked for i t l i k e that —
(laughter) — i f you can get i t ; and I think you can.
P l ^ " ' the cost of insuring part-time
workers would be shared between the employer, the employee and
cne government, so i f you work
l e t ' s j u s t say you work 20
hours a week, which i s half-time, your employer would pay half
the premium that the employer would pay i f you worked 40 hours a
week. And you would s i m i l a r l y pay your obligation, then the
difference would be made up with help from the government. But
you would have to pay, and so would your employer, i f you work
u°^f^J^*" ten hours a week; but you would be e l i g i b l e to get
health care coverage.
Let me say that one of the most interesting and
controversial parts of any health care plan i s how you treat
younger workers. And here's a young many who wants health care
coverage. But there are a l o t of young folks who don't, who
don t want to be forced to pay anything because they say, hey,
I m young and I'm healthy and I'm not married and I have no
r e s p o n s i b i l i t i e a to anybody; and I ought to have the right not to
pay. And you can say that, but the truth i s i f they have a car '
accident or a skiing accident or they, goodness God forbid, get
sick, they s t i l l go the hospital and then the rest of you s t i l l
1?^^®*:^?
they don't have any insurance. So I think t h i s is •
tne f a i r way to do i t , and you would be able to be insured under
our plan.
.,
ANSCHUTZ: Mr. President, even at a town h a l l
meeting, the wheels of American commerce keep r o l l i n g , so i f
you'll excuse us, we'll break for a commercial break and we'll be
right back. (Applause.)
* * * * *
MR. ANSCHUTZ: Once again, Mr, President, i t ' s a
pleasure to have you here at our town h a l l meeting. And our next
question i s v i a s a t e l l i t e again from Topeka.
Q
Thank you, wendall. And, Mr. President, we'd
l i k e tor you to meet this young woman, she i s a single mother
with a small c h i l d . And she simply could not find a doctor.
Now, you've reconciled with your husband, right about that? So
you'll be covered by h i s insurance i n May. And your question has
to do with access to health care and the problems you've had
Why don't you t e l l the President about those.
Q
Right. Mr. President, my daughter and 1 ware
on state assistance for 10 months. And when you're on
assistance, you get the medical card to help you out i f you heve
T K?^
doctor for anything. And when my daughter got sick,
I nad a hard time finding a doctor i n the Topeka area that would
accept her because she was on the medical card. And I was told
by a caseworker that i t was j u s t unfortunate because we had — we
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•'Hi.oHo L l ! r PKtba UhL
913 432 0142
P:0l0
Jsn't
wL^'i^;
^^''y
that usually i t i s
that af-e fr^^f^;^
Unfortunately, there just aren't any doctors
that are accepting new patients with that type of coverage.
low-income fam??^.!
lifii-^nin«
wen
w
on
p
i
b
r>.\,i7 U c
to you i s , what can you do to help
^ ™ ^ PRESIDENT: I want to make sure everyone who's
Tw^ni-T^"?^^'^"
^
1 understand I t very
aassistance,
s ^ ^ s t a ^ L " " ^ ?i ff' you're
" ' ' ^ ^ ' 'not
°' employed and you're
^ ^ ^ ^ i ^ ' on^^e ^as
goveJnmen?'S^d^?nH^°:;'5" ^''^^^^^
^^^^th lnsu?ancrf?om the
?he cSSn^Jv
i ^ ^ / ^ f i " ^ ^ ^ ^ program, in almost every state i n
t S e l ^ c S s t ^ ^ f S!J?dJnJ^?H^''''^'^'? reimburses doctors a^ less than
hassle so a i S i ^ f i
service. And i t ' s a paperwork
nassie, so a l o t of doctors don't take Medicaid patients.
view hnt
understand i t from the doctor's point of
makes vol T i r t ^ T r ^^t ^ ^'^'"''^ ^^'"^^ ^^th a baby l i k e that i t
i s -! ^kav ? L d ^ r ' ' ^ ^ ^'''^ ^^""^
2° ^h^t's she's asking
i e going
^ix ^ h i ? ^ " " ' ^ '
"^'^''^^
""^ ^ ^ ^ ^ y '
Medicaid would^ho^!?^''^'"
^5^^ ""^^^ "'^^ program people on
a?e p?ivate?i^m^inSI^-^'^'^ 'fS^^'^
^^^^ P^^'^^ that people who
Mad-iriJd ^ J T ? employed would, so, for example, we would put
^'^th others into these big buying pools and
terns'"'"i^d^b^ " ^ " " ' i ?
^^"^ ^^^^^^^^ o n ^ x a c t l y ?he s^me
the same^av ? h r ^ h v ^ ^ doctors would be reimbursed in exactly
pe?son L r ^ ; the physician might not even know whether the
SoS?d be the
/ r ' f ^"J^
^
the plans
happen L a ^ n in ?h» f"? what happened to you, ma'am, would not
think
?
''^''''^
this plan were to pass. And l
tninK I t ' s quite important.
tonight
tonignt.
Th^nJ'vJ^!^^?™!!'^'
/^'""^
that
question came up
Thank
you in Topeka.
GO^^^^
up to
Omaha.
Mor-i-h n.^ ^A ^
Thanks, Wendall. Mr. President, Tuesday in
servJce i n d i s ^ r f ^^^^^^ f <'"t the cost of health care reform for
i s ^ h i s i.nMo^^^^'.f^^^^^^^^^^^ restaurants. Here with me now
c™/:SJit''?j;;t'''
Godfather's Plz^a. He has some
very much for^his^Spp^r^Sni?^!^ Z T . w^^ld^^!?^f Jlke'tr' ''''
lState
l T t T of
o / l the
L ° f Union
. r ' ' ^speech,
^ ^""'^^
^^^^
- national
J ^out
r i t ^of' lo
I'n your
you
Indicated
that p 9
?SII":SSloverr''Ld^r
insurance%?^ma?Uy°throuah
peopL Sho do nA^ ^"""^ tonight you indicated that out of those "
fo? som^Snp
JSH ^""^ insurance, eight out of lO of them work
tor someone. And your plan would force employers to pav this
iou^d^S^i-'"? l^'^t^
*^^^t they current^J do ^ot'^^over
I
would content that employers who do not cover employers, do not
for one simple reason, and i t relates to cost.
°° "°t
the impact of^vnn^^ ^^^^
through the rigors of c a l c u l a t i n g
th?ouShon? t L ^ n
""."'^ business, which has about 525 -units
tnroughout the country, and we employ i n t o t a l over 10 000
p e o i ? r ' f n d ?h^"r"
'"^f^^ "^^^ LndredB of o?her business
w?;!'
they've also calculated the cost impact on t h e i r
ousmesses.
r-An f i ^
o, ^.^c*'®'^^®^® ^ ^ ^ t this i s something that we should and
5^n».
?
for many, many businesses l i k e mine, the cost of
?n
simply a cost that w i l l cause us to «il«±nate jobs,
in going through my own r^alr.nTat1on«. trhc number of jobs that wo
would have to eliminate to try and absorb t h i s cost i s a l o t
greater than I ever anticipated. Your averages about tha impact
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913 432 0142
pToiT
4
- 11 -
f
-Che averages"?ep?es'ent a'^wfd
""^^ ^tended. But a l l of
impacted
^^P^^^ent a wide spectrum in terms of the businesses
in a situation^s^m^fi^
I'm forced to do this wSat wni""?
w i l l have to eliminate?
business owners that are
'^'^^te simply, i f
P'^^P^^ ^^'^^^ ^^^^ I
would have to'^do
a n vof
\ fyour
' ' employees
^ ""'""te
about
what you
ao. ""^Arf
Are any
Insured
now?
employees are^insured'nSw^'
^PP^^^i'^^tely one-third of my
insured now what'oercenf''.
one-third that are
a now, What percent of payroll does their insurance cost?
about two .nd\n.-ZullllT^
ITllyroll''''
theyjr DUdire
Share thfcost'^IS^^r^
^^^^ like that?
P^*^^^^^ them? Do
tne cost 50-50 or """^
something
percent paid for bv^'tL^Ln?'"''^''^ ^^^^
company and 25
employees are Dar?^?
employee. Now, two-thirds of my
clLs'th^t'yoVIdent'i^ied^am^;'^^'"
'^^^ ^^^^
short-term workers^^fSS'^'^' iS'"?^"
they are part-time or
wouldn't^ave to p^v ? h l wouldn't add a l l that much. You
don'rwork a?l ?he Lme
'
^^^^"^^ they
service busin«ici?^^' ^ ^ t me ask you this — on average, food
of doJng
busJnels
?Ifs?that
h ^ i about
^^^'^^
one-third
vAuxng Dusmess.
what
i t i s ? of the t i t a l cost
Q
That i s an adequate estimation, yes s i r .
time workers
some'wouldn'
AaJe^'^rb;
'^^^ T''so you P"^""
wouldn't
fTr^ ^^Ind
v-^n. ^
wouj.an tf nave
to be covered,
percent
Yol Tialrnf:''? one-half percent of payroll to 7.9
six ^Srcenfof plyrol?
^^Jfth^"^ l^l^e six percent, i f you had
one-half
T «J - c F
.
'jt's just say — instead of two and
nSmbe?
YOU have ? o u r ^ '"^ one-half percent, that's a good even
of yoSr to?al Sosts L^S'^^^""" ?S P^y^oU, And that's one-third
percent to t L ?n^!i'
y^^ would add about one and one-half
percent to the total cost of doing business.
off
.11
"ould that really cause you to lay a lot of people
stop'eat'iL'^o^J '°?ra\'r""^
^ t too? ^Only ^f°pe?p?f"
cost Of dSinc hn«iif/
^^""^ competitors had to do i t , and your
tha? ?eav2 ?ou ?n ^ h f s a m f n'^^.
^''^ one-half percent, wouldn't
they a l l be ?n t L ™ !
position you are in now? why wouldn't
able to r a L e the oJf^f PJ^^^^on, and why wouldn't you a l l be
customer
I Va^ ekeep
e p buying
hnvin from you.
^''^ percent?
I'm a satisfied
u^Loiner. I
(Laughter.)
say - this if 4 llrv^lliTl'
J^^^
wouldn't you
ll\rTt,"Hl?'^°"
respect
vouAairn?^?;^^^'""'"' ?^
MORB
^ ^^^^ important - let me
P^sWent, with a l l due
�-
-^-^
,HNbK. u i v Phtbb Uh,
913 432 0142
P.012
through my c a l c J i a t J o ^ ^ ^nL^"""?^^?' "^^^ ^ ^ ^ t t h a t a f t e r I went
six percent o r the 7
in^Sv''''^'' °"
^'^^"'P^^ °^ the
percent
Mow i l ^ . i ' ^
^'^ ""^ case, i t works out t o 7.9
?abo?^'osts? 7 . 9 ^ mesX?'wou?d' I '
'^^^ts are
percent t h a i you aJe r e f e r r i n g Jo.
""^"^^^^
t h a t those, mosJ o r ^ i S ^ / ^ J ^
c a l c u l a t i o n , s i r , i s the f a c t
zero, so ^hen J c f l ^ n ? f ? .
^JJ''^!?^
the people c u r r e n t l y have
coverage on t L s e emD^o;^L^^n ^ ^ f ' * ^ ^ "^^^^ ' ^^^^ t o go frSm no
r a t e , I t a c t u a l l y w S s out I n u""^^ ooverage a t the 7.9 percent
d c t u a i i y works out t c be approximately 16 percent.
my customers ^ r t h r c o m p ^ ^ ^ f f f ^ ° " ^ ^^^^"^ t o pass I t on t o
work tbefore
h a r j a y Secauseu?he
^^^^^^
power
f llarapr'"^^^^^?^!^^
a r g e r competitors "have more
s t a^y^i^n^ g^ ' t
have morf staff La? thSf^"^S^'^'^ " ^""^^^^^ competitor.
marketplace'Jfest'abLshL" T t f e t / . ' ^ ^ ' '
^'^'^"^ ^"^^^
They
assumptions a b o u y ^ f L ^ i " " ^ ^ l ^ " " ^ ^'''^ suggesting i s t h a t the
not c o r r e c t W ^ n
^""P^""^ '''' ^ business l i k e mine are simply
SSmbe? o? par?-??me a n d ^ l L ^ ^ l
i n t e n s i v e , we have a laJge
f o r one simcfp I t ^ t
short-term employees t h a t we do not cover
P?of?? f o J ? i e [ a s r ? w ; '
f"^^'^
«y bottom l i n e ne?
top-linrL^es'.''Shen''Se'ca!cura?e'?he l ^ . l r 1' ^P^^""^
under your plan 7!- ^rrv^I^f f5
^°®t j u s t f o r my company,
p r o f i t ^ U i t y ?;.
^
^^^^^ ^^""^^ ^ ^ ^ t my bottom l i n e
the f a c t that"a^^o™L2"^-,°f
biggest misconceptions, s i r , i s
three percent of ?op
^^^^ '"^^^^ between one and
p o p u l a t i o n Sf P L ^ ^
because we have a l a r g e
^ h H ^ n L a c s ou^bSsln^
T ^ ^ ' ^ ^ t simply
proposed plan
^"^^^^^^^ ^111 not allow us t o do t h a t under your
send t o
n J " ^ PRESIDENT: Let me ask you a f a v o r . Would you
got t o aS on?;
"^^loulations? Because I know we've
added 4"^? per?en^ t ^ ^ j j ^ ^ t i o n s ; b u t l e t me remind you, i f t t
cos?s we?e SnW o n f t i ^ r d ^ ' ' ? ^ ? ^
business and h i s labor
to do i s mul?iSiS
? J.'"^
t o t a l costs, then a l l you have
o? P ? y J J u
i S d ^ i J i - L v ^ ^ ^ ^ ' > ^ ^^^^'^ ^^^^ t o be 13.5 percent
can'? uSt thP^S t h a t maximum i s 7.9 percent. So i t ' s dust - we
can t get there. Send i t t o me, w e ' l l work on i t .
debate
o i L ttr o
. ^ ibe
' ^ over numbers.
^ ^""t o f t h i s h e a l t h care reform
ueoate i
is
s ogoing
THE PRESIDENT: That's r i g h t .
That's what -2
^^^^ "^^^
'^^"^^ ^ ^ t i n the wash.
are l i s t e n l n a T
^^^^N^; ^ e t me also j u s t say, f o r those who
?.,7i
? ^ t o us
p a r t - t i m e employees, you don't pav thP
A n i t h i n r ess""iSr
"'"^'^^^^ - - - ^ - ^0 hoJrs a Seek^oJ ^o?e.
premium
'
«™Ployer pays a smaller percentage o f the
son and dai,rr>.?
."^^ President, t h i s gentleman i s h e l p i n g h i s
he?p ?hem
t h ^ ; J h ^ ^ ^ ^ ^ r . ^ ^ ^ s k y r o c k e t i n g medical b l l l l t o
explain
^
^
f i n a n c i a l l y , why do you
compllcation^^fr-,^™"^' President, we have a daughter-in-law w i t h
She canno? work « two ^aoc s u r g e r i e s . She's a t a p o i n t now t h a t
Tn!„^
^ l o s i n g her j o b , and t h e r e f o r e her
P?ee":?ina condJ^f^"''''.^"^^""^^ won't'pick 1? Sp because i t ' s
give you a?
oJ^ho'
^^^^"'^
$1,080.'^ And j u s t t o
give you an idea o f how t h i s cost r a f l e c t a , Sharon has therapy
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4Jc:' 0142
t h r ^ e tiwes a week f o r 15 t o 20 minutes -- ph'/.xCai
Each session coste $438.
P. 0 1 :
'L-J
Right now they're over $12,000 i n debt, an5 D+'.Climbing
What can you t e l l a f a m i l y l i k e t h i s ? Why k i n d of
hope do they have?
nas
^r.^
V^^ PRESIDENT:
insurance?
Q
Let me ask you a question.
Your son
Yes.
K^,..
r
™ ^ PRESIDENT: But they won't p i c k up the f a m i l y
because o f your daughter-ln-iaw's p r e e x i s t i n g c o n d i t i o n .
2
I t wouldn't pay the p r e e x i s t i n g c o n d i t i o n s , so
t,-^,,^
i"^?^ PRESIDENT:
your son works?
How b i g i s the company f o r which
Q
w e l l , i t ' s the l a r g e s t , f i r s t o r second l a r g e s t
company i n my town — a very large business.
d^f^:^^„l•.
"^"^ PRESIDENT: See, even f o r a l a r g e business, i t ' s
?n
: "Zi. ^'^''t t o e x p l a i n why — i t ' s not so many — the bad
the r i L ^ n . ,
r,"*^^
f i n a n c i n g i s organized, not n e c e s s a r i l y
??S„J! h f e ^ ; "I^^^J^
Plan, your son would have a r i g h t t o
R^f
^^J^^y
P^^"
now and i n the f u t u r e .
insurance company who provides the insurance
^Z^l
"^t
^^oke even w i t h your daughter-in-law's problems,
because they would be i n a very l a r g e p o o l .
h«rn u,^i-y. 4.V, ^"^/^
^^^^ t o the gentleman who was on t e l e v i s i o n
nere w i t h the pizza company, insurance companies would make money
o^ i T r L
fn^'"''^^ o r i g i n a l l y d i d and the way food stores do now
of l l ^ t t
1 ? establishments - a l i t t l e b i g of money on a l o t
Sour
,^,
people. And t h a t - s how we would do i t . But
insSreS a? ?SL°'f'>.P^^" T'^^^ ^'^^^ ^ ^ ^ ^ ^ t t o have h i s f a m i l y
b?oke ?rS?na
t''^
^^^"^ °ther. But the company wouldn't go
t^p ?n^f^ ^
provide the employer's share of the premium, and
Je?v S i c nno? '^'''"5^^^ wouldn't go broke, because they'd be i n a
very b i g p o o l , and the r i s k would be broadly spread.
Tni«. nvt.».
ANSCHUTZ: Mr. President, l e t ' s move on t o
Tulsa, Oklahoma, again i f we can,
w i t h ^ m^na^oS
' ^ ^ ^ ^ i d e n t , t h i s gentleman i s an i n t e r n i s t
rebates
?oo medical
m!di^jr.''''r'\^^^^^°"
^^'^^
question
relates t
technology.
Q
Thank you. This w i l l be a piece of pizza
h?s''?rdo'° t r ' ' ^ . (Laughter.) President ? l i n ? S n , V q u e s t i o n
So?k ?or aiS w'"^^'^^^ technology. Organizations l i k J the one I
Se def? ^ n T d r f i . r T ' " ? ^ ^ ^ ^ i ' ^ ^ f o l k s and Medicare r e c i p i e n t s .
^L^n^i
t t ^ ^ ^ ^^^^^ *'^th tough decisions about medical
technology. There was a l e t t e r t o a medical d i r e c t o r of an
nT{lZ\lT''^Zd^Z
^ ^^^^ respect S e d L a l j o u r n a l
and o?£!r
probably saw t h a t l e t t e r . And h o s p i t a l s
? a r t i f ^^ ?! ^ ^ " " ^ organizations s t r u g g l e w i t h t h i s as w e l l .
Part of i t i s wrapped up I n t o r t issues and malpractice cor-erns
t h a t payer organizations have, t h a t h o s p i t a l s have
^on.ern*.
And the question l have for you is, in looklno at
S^ff^^^"*^^^'"^
technologies and^echnoloSies tha? Ira
d i f f u s e d i n our country, throughout our country, and those
o? ?S:i?^ML'^whn''r^^'
"^^^'"^
^^^^^
- t ?he end
SfiI
^f''® r e a l l y no meaningful hope o f recovery; and
rea[w'wond2r?n'",^°" "^^'^ '° continue t o do t h i n g s . A^d
I m r e a l l y wond6i.ing
how y o u r h e a l t h p l a n a d d r e s a e e t h a t
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issue.
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;,hont ^>,^
is«n^
know T ?u
dil^'iLl
would
would l i k e
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yi3 432 0142
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* THE PRESIDENT: Well, l e t me mention — 1-^^ f ^ ^ t
ff?""
three different points. This
a i.: j
i ^
^^^"^ t h a t r m very s e n s i t i v e t o now. As you
mother a few months ago; my f a t h e r - i n - l a w
f ^ ^ l l y ' s been through t h i s p e r s o n a l l y . And I
t o say three or four t h i n g s about i t .
•
•
medical
?^ t } ^ '
balance, we l i k e having the best
?f we i J r ^ ? ^""F/" ^^'^ ^ ^ ' ^ l ' ^ ^'^^
^«nt t o have access t o i t
invest^or^''
'''''' P^^" a c t u a l l y continues a commitment t o
t S I s t e c h ^ o i ' ^ J ^ y P l ^ ' m academic medical centers t h a t have
we should
nn^h2
^^f^<^-^^ research, g e n e r a l l y ; and I t h i n k
monev ««fn^
the other hand, we don't want to have a lot of
Sen?ion^?SL«\J^^^''°^f?\^^ ^t's totally useless. Let me just
aUu'dSS t'f ?wo of"?hem'''^
'^'''^
msinT-,,-*-^
^ -^^t of doctors are w o r r i e d about
Satien? i f L f ti™"
^^^^ "^^^
t e s t s whether they t h i n k the
?? i n i . = f ?K ^
"°t, j u s t so l a t e r on they can say they d i d
there's no r ^ l ^ . ^ ^ J ^ i ' ^ ^ ' " ^ ^ ^ t costs a l l o f us a l o t o f mJney i f
would ? e a u i ^ ! t h "
^ • ' t ' s the answer t o t h a t ? Our plan
nrni,!^!?
n a t i o n a l p r o f e s s i o n a l associations t o
?oSTd Sse^ and
g u i d e l i n e s t h a t then the doctors
Sould i n ' . ? ? L i J^^'^
these g u i d e l i n e s , those g u i d e l i n e s
case
T? w^n?S
^ f ^ ^ ' ^ ^^^^ °^ defense i n a malpractice
had not
^^^^^ ^^^^^ the presumption t h a t the doctor
naa not been n e g l i g e n t .
one anoth^^r ; , n d ° ? i f \ h o s p i t a l s get t o competing w i t h
one another and they're a f r a i d i f one has an MRI they're a f r a i d
S f e s s i t a e ? ^ ! ^ SoeP"-'^^'" ^^^^^^ ^ t won't get any p a t i e n t s
tSo so eJe?v^od5
^
''^^^^
and Winds up w i t h
su?e ? h ! r ? h ^ r f ^ "^^"^ compete w i t h one another, we t r y t o make
do^'t f e a i
tv,^*^"?^ ^''"^^
technology, b u t t h a t h o s p i t a l s
?«^>,n«;
i
^^''^ t o do t h a t — double the cost o f
technology t o everybody - when the f a c i l i t i e s could be p r o p e r l y
t h a t i« th« rrl""^^^, number three i s the r e a l l y d i f f i c u l t one, and
or ^he?r
?^ "'^^^ ^^^"^'^ P^-^Pl^ 1 " t h e i r l a s t months,
th«^ 1 , f i f f
^ 1 ^ 1 ' f^''® ""P expensive technology?
My own view of
thoLii,
\ \ ^ ° t of people have made t h a t d e c i s i o n f o r
S i n e s we';.^f
'^^"''^ f o r m a l i z e i t . And so one o f the
l i l i n a Z t i i t t r y i n g t o encourage people t o do i s t o make sensible
be^te?
A. ? ""^ke these d e c i s i o n s . I t h i n k t h a t ' s a l o t
n t i l V than having medical p r o f e s s i o n a l s t r y t o get between a
g J i e f ' s ^ J i ^ ^ r ^'^^^^^"^^ parent on l i f e support, or sometimes a
g r i e f - s t r i c k e n parent and a c h i l d on l i f e support. So I t h i n k
eScouraof? a i ? i f
encourage the'^Sse o f l ? v L g w J u s ,
?hJnk A ^ f r f ^ f
^^^^ ^^°"t t h i s i n honest ways. And I
saied
d is tJ it li lV ^ ikeep
^ "^''y,^
the money t h a t can be
saved ^
and
the b e ^^^^
n e f i t^'^^
s of^^^^
technology.
vo'i ^ ; , r n ^ ^ n**; '^NfCHUTZ: Thank you, Mr. President. As we t o l d
hxyt ?n^=i 4. ^ K " " ^ t a l k i n g w i t h f o u r communities; not only ours,
back ?o ? o p e k r
^""^
^-^^^ P^-^"^'
^^^^y t o go
has Hv»d ir.
OJtay, wendall. Mr. President, t h i s gentleman
d o e s i ^ r ^ . i ^ I f c a p i t a l o f Kansas f o r 18 years. And Paul
to adm^n?«^L^i!^^^^
^ ^ ^ n k l y , m the government's a b i l i t y
5ou?^i?
^ ''^''^ ^""^ ^ ^ ' ^ ^ ^ t a question about t h a t f o r
government's ? a s s e f poor^Jer^or^a^?:" T r ^ ^ ^ o c i a ? s e c ^ r t t y ' " '
c t i ;:u'e^;?:^n^^"^"^''
^eflclt'and porfba^ref'speidlAg,
h e a l t h ca^e i ^ o ^ ^
^'""^
f e d e r a l government can manage
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- 15 -
THE PRESIDENT: Well, I have two things to say about
i t . Number one i s , the federal government's not going to manage
this program, under our program, i f my program passes, the
private sector w i l l manage i t . The only thing the federal
government w i l l do i s two things basically. We w i l l require
everybody to have health Insurance, and employers and employees
to share responsibility for i t . That includes good primary and
preventive benefits.
we w i l l then say that insurance has got to be what
i t used to be when i t started — you can't cut people off because
somebody in the family got sick; you can't charge old folks too
much i f they're s t i l l working and they're healthy; and small
business people and farmers and self-employed people have the
right to be in big buying groups so that they can get the same
kind of deal that government employees and that big business
employees get today. That's not a big government program.
Let me give you one example, s i r . The state of
California just set up a small business buying group with 40,000
businesses in i t . And the businesses that entered actually got a
reduction in their health insurance costs by going into the
buying pool. And there was no big government bureaucracy — they
hired 13 people to run the insurance buying and handle the
paperwork for these 40,000. So I don't want the government to
run i t .
Q
Is there going to be less paperwork, instead of
more?
THE PRESIDENT: Absolutely. I f you have — right
now we've got the most expensive — right now, s i r , we have the
most expensive system in the world in America. We have 1500
separate companies writing thousands of different policies, and
then the two government programs for older people and for poor
people on top of that, so we've got more bureaucracy and more
paperwork and more money spent on that and less on health care
than any other country in the world. So i don't want the
government to run the health care system. I just want to make
sure the system works for the benefit of everybody.
question.
MR. ANSCHUTZ: Well, we hope that answered your
We're moving on to Omaha now.
THE PRESIDENT: But I'm not going to l e t Social
Security get in trouble, either. And the deficit's coming down,
not going up. Go ahead.
Q
This gentleman was diagnosed as having f u l l blown AIDS back in 1991. He i s now disabled, and he has really
had a tough time with the current health care system.
Q
Thank you, Mr. president. As she said, I'm a
person who's living with full-blown AIDS. When I was f i r s t
diagnosed HIV-positive in 1989, I was part of an HMO program of
which I had to fight tooth and nail to get to an Infectious
disease doctor. I was forced to see a family practice doctor who
was not educated or interested in treating my symptoms of the
illness. I'd like to know from you with health care reform,
we've already voted to reform Medicaid in Nebraska to start
charging patients for co-payments. Will health care reform
enhance, or i s i t going to restrict, the availability of quality
care, the availability of low-cost prescriptions and the access
to doctors who are educated and interested enough to treat HIV
infections without having caps on expenditures and thoco oorts o£
services that we need to survive?
THE PRESIDENT: Health car© reform w i l l enhance the
quality and range of services you can get. I t w i l l require
everybody to pay something, but i t w i l l place limits on that
something. Let me just say, one of the things that people who
a r e HIV-poeltiv© o r p e o p l e who
have MDS
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will
g e t out
of
this
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913 432 0142
P. 016
- 16 -
plan« nr.c^rV^i} '^'"''^I' ^""^ the f i r s t time, in a l l health care
S:^!^
r^P^^°" medicines. And there will be a co-pay and a
deductible, but there w i l l also be an annual limit.
moH-i,,,! i.^T.
someone like you who has very expensive
?hat becaise'of%'hS'^'''""'
^^'^^^ ^ ^ ^ ^ ^ ^ t enJrmoSsly f?om
annual ??mit
r
''^'"^ reasonable co-pay and deductible and
of us wm^Tj
something in your behalf. A l l the rest
?h^o
too, for this reason — a lot of people like
aSd a?rfo?c^S'or?° ^^r.'
""'^'^ ^ ^ t health insu?an?e ^n^oJe
Off Ifp^arSon f
workplace. And a l l of us are better
be indepJnJI^? .
position can work as long as possible, can
lone fs no««?ni^
possible, can be self-supporting as
emSlovfrS ^f^""^!*
"^^'^ ^ ^^^^th care system where
w??ioX? ao^nl^
properly and fully insure their employees
possible
^°
^^^^ '^''^ ^^^^
^^'^^ ^'^^
wSll as
bac«n«« x,^M
f-^^u^?" ^'^"^'^ ^'^ ""'^'^ better off under our plan
medicine Sn„?d K*'^''^"
doctor, adequate care and prescription
medicine would be covered after a modest effort required on your
cht^rv ;,nH
?
J ^ ^ ^ ' ^^th a l l due respect, with my disability
\ v ? l^^vlng to pay rent and u t i l i t i e s and food and
iha?^tha??«^if' I
i ^ ^ ^ ''^^^
^ '"^"th, and I do not think
do^Lr^
^"""^^ to have to pay more payments to go to the
doctor or pay for prescriptions.
^
your incon,A i I ! ! f =
^""^ ^'"^ talking about not now. At
your iS^J"*^ level now, you probably have no responsibility at
?ou needed mSdiMni"? ^^out back when you were working - suppose
heal?h incnr!? ^'^'^
maintain your condition. Even then, every
Sodes? cS pav ^o E^?^^^^
^''^^
to cover medicine ^ i t h
Soefi^Mr~^wyti ^^^P ^^"P^^ ^^^y
independent as long as
be dra™«;i.!l? T'^^ Present income, those responsibilities would
wonfdn?? 1
^""^
y^^^ income i s what you say, you
wouldn't have any co-pay responsibility.
Q
I f I could not pay, would I be denied services?
denied serv-i^Ic^ PRESIDENT: No. Nobody who cannot pay would be •
something
^^"^^^ "'^'^ ^^"^ P^^ ^^^^ ^^^^ to pay
^
hon^
ANSCHUTZ: Okay, we'll have to move on now. I
toS^ h ^ n ^ r f j f " ^ your question, s i r . We will continue with our
fi^t
^ ^ " ^ "^^^^ President Clinton in just a moment. But
r i r s t , this time out. (Applause.)
* * * * *
far with aue«tf;nc^^^'?r^
^^^hg for about an hour so
PrLT'dant?
? • , ^ t doesn't seem that long, does i t , Mr.
qqJo.sr.-..ns
S n s J - n f i to
- o ^go.
r ' ' So
t ^^^^
left to
and
I studios.
know we have a lot of
let's^^"^
return
our
d^r.*-^ r
MS. PETERSON: Mr. President, I'd like you to meet a
S ' ^ t h l T o ? ? ^ ^ ^ " ^ ^ ^ ^ Hospital. She's very c^ncerneS
S ? naitiSn
/dhi?''''^
^^^^"^
^^^^th care industry and
our nation as a whole, and especially our young people.
for -;^Vi^n
i.. ^'^'t'^ evening. President Clinton, and thank you
0? " ^ S i L ^ r ^ r^f^
'^^'"^
""^^t With us in Kansas city,
^ ^ l . - ; - ! : H ^^^^^ ^ ^® ^^®n many changes inraypractice as a
So6r1^iSh?^n^^J''7 medicine physician. By far and away, the
oS? c ^ i d ^ i n io?>,^^
escalation of violent injuries involvina
vo«
?th as victims and as witnesses. My question for
t h i acute ?Ira J>.*'^ ^S^S?. ?f
to provlde these children .
sirv?^
' ^5® rehabilitation, and the mental health
y
w Splan
i l for ihealth
^ ^ t r care
^""threform?
the victims and the witnesses - under
y. our
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913 432 0142
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•>
THE PRESIDENT: The short answer i s yes; the long
answer i s what I said e a r l i e r about mental health benefits. We
phase them in and we don't f u l l y have them covered u n t i l tho y^?r
2000. so that, except in extreme circumstances, they wouldn't
a l l be covered under a l l health insurance practices.
Now, some children's hospitals w i l l be
certain payments that w i l l permit that to be done.
answer i s : Yes, the comprehensive services w i l l be
we won't have f u l l mental health coverage u n t i l the
under the plan as i t i s presently drawn.
e l i g i b l e for
But the short
provided, but
year 2000
But l e t me j u s t say to a l l of you.
I know we're
running out of time, and I want to be quick. But violence i s one
of the biggest health problems we have. And you need to know
that even though I believe we can bring down the cost of health
care in terms of things that we're out of l i n e with other
countries on
p r i n c i p a l l y in paperwork and unnecessary
procedures and undue fear of malpractice -- as long as we are the
most violent country in the world and we've got more kids getting
shot up and cut and brutalized, we're going to have higher
medical costs than other countries and busy emergency rooms.
I t ' s a human problem. I t ' s also a horrible public
health problem which i s why I hope we can pass t h i s crime b i l l
and do some other things that w i l l drive down the rate of crime
and violence in our country because i t i s swallowing up a l o t of
your health dollars as well tearing the heart out of a l o t of
your children.
And a l o t of the doctors.
Thank you,
Mr,
President,
THE
PRESIDENT:
Thank you.
Thank you for doing i t .
though.
MR. ANSCHUTZ: Mr. President, Glenda S i l v y in Tulsa
has another question to ask you. And Glenda, I would ask you in
the interest of time — we're getting toward the end and we have
a l o t of ground we'd l i k e to cover — so i f we could kind of keep
i t f a i r l y condensed.
Q
Mr. President, t h i s i s a woman with a question
about services to the elderly.
Q
Mr. Pi C'.^iident, I'd li]:e to ask you about the
transportation for the t r . t i l elderly because i t has become a very
serious problem in Tulca .-.nd other c i t i e s . Limited personal
resources rule out hiriio' naxis to take people in for doctors
appointments and d i a l y s i i . and also adult day care centers and
other therapeutic a c t i v i t i e s . Does the plan address t h i s growing
problem?
THE PRESlDslNT: I have to t e l l you the truth.
I'm
r-.ire what's covered and what's not with transportation.
And
what I w i l l do i s , after this i s over, I ' l l get your name and
address, and I ' l l gat you an answer. And I wish I could give you
an an.swer ou the a i r , but I don't want to say the wrong thing,
and I don't want to mislead you. So, I w i l l write you as soon as
I find out, I'm sorry, I don't remember.
Q
I ' l l look for i t , Mr. President.
THE PRESIDENT:
MR. ANSCHUTZ:
on to Topeka — Ralph.
(Laughter.)
I ' l l sure get i t then.
I'm Sure She'll get i t . Let's move
THE PRESIDENT: I Wish I had hor- in my o£€ice,
that's for sure.
(Laughter.)
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913 432
Q142
- 18 -
ready, Ralph?"'*'
r,„oc-n« ^
^
school ^n f ^ ^ ^ ? ^ ' ' ^
people her age° ""'
^^^'^
pretty sharp.
Are you
wendall and Mr. President, we have a raho-t
"^^"^ ^^^^^ • ^ ' l ^ '
to central Grade
^ question of concern to
nou, >,<^.i#.i. ^
President, I would like to know how your
net ^ ^ f j t h care program w i l l help to make sure that a l l children
get their immunizations,
MR. ANSCHUTZ: Good question.
help in t^^ J " ^ PRESIDENT: That's a great question. I t w i l l
nndL
two ways. First of a l l , immunizations w i l l be covered
cS??5ren^7i:^,^:f " ^ f f i n s u r a n c e policies for families so ?hat
insurance poUc?
''^
covered under the family health
make sur^ i-h J^^^^*""""??. ^^^^^
^^^^
"^^^^^
Pl^n i s to
which dJ«?J^ the public health offices a l l over the country,
to do t L t i ? t of immunizations for children, have enough money
A ? k f n / ^ ^ ' ' ' ' ^ overcharging the parents. In my state of
ArKansas, for example, 35 percent of our children — 85 percent
t S f p2b'J?c'hea??ro^J"'"
'^^'^'^^
ge?\heif sS;?r?n'
tne public health offices. So we do i t in those two ways
And a
lot more children w i l l be immunized i f this plan passes
Thank you.
Great question.
MR. ANSCHUTZ: Thank you.
Up to Omaha.
whirh «mrM«„,.^^ ^^P*"^^^* "^^^^ ^'^'"^n i s with Mutual of Omaha,
n^J^LtTSi"*^^
P^^Pl^
m Omaha, 4,000 agents
nationwide,
opportnnHf^ ^-S 4 v^^^; President, thank you so much for the
^oS SoS t L ^
^""^
provide input. We wanted to let
inlvor««i
'^'^ support universal coverage, as well as
aSrlfi^fJi
comprehensive health care reform. Given our
disa?poin^^S in '"^^y ^ r ^ ' '
^ ^^^^ to say that we're
of Smaha
^'^^^ employees who work very hard at Mutual
«L?^? ?
personal attacks that we felt by the
? S f can!
^""^
^^^^ '^^^ ^^^^'^^ ^ ' ^ i ^ ^ the best job that
approach-.
f i r s t question i s , why have you taken this
?e?; and o t w ^ ^ ^ ^ ^ ^ ^ l ^ '
we try to build consensus with your
positive l l l l l ^ S ^ r
congress, w i l l you acknowledge that the
fac^ t h ^ ^ ^ r ! that we've taken to reduce costs as well as the
fact that we support many of your basic goals as well?
„y,,.:, * i r - " ' ' r o n i ' ; ^ ^ ' ' ' \
^ ^ J / ^ " ""^
to defend
mv ..^v t o i ; ; , . J
^^^^^ tlm^s tomght did l go out of
po^ut of v - J '
^'''^^^^''•^
the insurance companies'
s?
T w^nrt; ^..^APPlf'^^'^ -) A lot, right? And, let me furtner
c^n-"- o^
e a l t r ?insurance
S c n r ' ' " ' ^^'^
^^^^^
^hich
s the
Ox ihealth
companies,
where
five i of
th^other
siv big
Z Z " ' ^ - - ' i ^ " " dollar
^^j-xai attack
attacK on
On our
our health
neaitn
l complimented those companies for what
A^^^ / L ^ J ^ i ^ ^ to do. So I believe that we have a lot in common
I : . : : . . ' ' ^ , r A ^ ^ ^ insurance companies support universal
wit->rthem
'"'''^^ ^^"^^ ^"^PPy
continue to work
c^>-F- rofnrm a^f!^rs*.^
our Plan bv rhl t^l
""f^^ to do i s to answer the attacks on
doS'? hSv«^i«
multi-million dollar ad campaign, that i
don t have tha noney to answer in paid ads yet — i hope l do
someday - from the health ln«uranS« aaeocl.a?Ln. No?h?ng would
Please me more than to tone down the rhetoric, to
SrSund ?ike
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P:019
p a r t t c u ? a r ? v T T ^ i ^ r ^ ^ ^ f " ' ^ recognize that a lot of companies,
heln Poi?rir ^ ^^lu""^
^^^^^^ companies, have done a lot to
neip control health care costs.
i n i t i a t i v e , t i ?^®2^what I want to do i s to try to take the
can taJp to l ^ f l
''^ already taken and that you've proved we
to h p ? n ^
companies, to help government employees,
to a?J^™!^?i control health care costs and make those avallabl4
^ates
^ people
nioo?' who
"T ^ have
i ^ ^ ^ ^^^^
and f i r s t with affordable
rates ffor
small coverage
businesses.
think w*. n^r. ^
believe we can't reach agreement on this, i
conSers!t?nn wHtJ!'^ nothing would please me more than to have this
amoll?^
everybody in your business a l l over
America. And I thank you for what you said.
Q
to our studio"*^'
We'll take you up on that,
°^ay.
Thank you in Omaha. And
now
Merrill n^... ^
^^^sident, thls gentleman i s with Marion
r?fv
u2 ^^
pharmaceutical company based here in Kansas
city. What i s your question for the President?
.9
President, good evening. I appreciate the
app^^ud ° ^^«^t ^ I t h you. I'd like to begin by saying that I
n!?ion
efforts to bring health care to the top of the
national agenda, i think that's very important.
concerned
^ ^ l that, at the same time, I'm somewhat
soSe o? ? h f f " " ? ^ ""^
provisions of the b i l l , particularly
ln?LvLJ?L^r''J;^°u^ ^^^^ ^^^^te to government control and
woJld d?ci.^cc
business. Things like the committee that
thSi th=^?
appropriateness of new drug prices. I believe
conL^nf^
t fv"''?^''''
the open market, and I'm very
concerned about the implications there,
eorrern-.^ .V.
appears that the investment community i s also
pS2?«^^!?^f ""^^ l^^^- "^^^ '"^^^^t has taken the value of
bi?^?oSr^i°^\ f ^"''^^
biotechnology stocks down by many
GonsiS«r;.Sf ^^Hars over the past 18 months. And there's been a
considerable loss of jobs in our industry.
B.m^^i^
^y question i s , what assurances can you give the
^ d l l t r ^ Sh^^i'^-^^^^ r ? " " . ^ ^ ^ ^ ^^^1 "*^t permanently damage this
aSd aJ?L« n« t ' ' ^^.^•^^Pf^l and brings cures to so many people.
?he maiv di«foontinue the research that we're doing to solve
the many diseases that we've heard spoken about here tonight?
evni.-f
u .
PRESIDENT: First of a l l , l e t me say — l e t me
explain what he was talking about to the rest of you
The
'
us'^'noroJiS^L'"^^"'^^
"^^^"^^^
to a?l of
because we want
to get the^^^V
bestimportant
in emerging
ecSno^i'' Se
I t ' s also a big part of our high-tech
the wS?id
ri^r
the dominant pharmaceutical Industry in
helDfi ^« t^ I t provides enormous numbers of jobs in America and
neips us to s e l l our products overseas,
s e l l r.rod„.^o^? you know, a l l around the world, sometimes you can:
becLSo of
countries quicker than you can here
because of the government regulation, which I'm trying to speed
,.o«m4*4.
Under the health care plan as i t i s presented, a
g?ven Srua^'Si^V^ ^^^^
^^'^^ ^^^ther or not ?he price of a
the?2'?«
''^K^^^''®' "^^^ res^son that provision was put in
Am!J?.^^ because there are so many drugs that are made in
r2sei?ri; t^^J® Americans have paid in a l l kinds of ways for the
thanks ^
f
^'^^'^^ ^^^^'ts much less m other countrleo
tnan they do in America.
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^ut What the pharmaceutical industry, nowever, i s
iegitimately concerned about i s that they have to go out and
raise huge amounts of money in the biotechnology area to raise
money to develop new ground-breaking drugs, and they belio.^
those drugs ought to be able to charge for the enormous cost of
their development in the f i r s t place, which i agree with.
^ .
. And what l think we have to do, s i r , i s to work that
out.
You know, last year the biotechnology industry asked me to
give special incentives in terms of capital gains taxes for
investment in that area. We did. i was trying to build them up
marketr
disturbed as you have by what's happened to the
„r,^..^„*.
^ ^ ^ t we have to do i s enter into some sort of
S
"^^"^.^^ '^^
protect the right to develop and market
new drugs. I'm very concerned about i t myself. I do not want to
do anything to hurt i t . And i t ' s a very important part of our
economy.
A
•,
"^^t me also say that generally, pharmaceuticals
w i l l ao well because so many more people are going to have drug
coverage. That's why the Pharmacists Association strongly
endorse our health plan. We can work this out.
4.U
^ i,.^
ANSCHUTZ: Let's move along now and get back to
the satellites in Tulsa.
Q
This woman has a question about Native American
health care.
.
_,
^ Q
Mr. President, I have Medicare and insurance
Denefits from retirement, but I'm real concerned about the Native
^ ^ i ' i ' ^ r ^ ^^''i"?
''^ty. I live - in the city that I live
in that do not have the benefits that i have, what w i l l happen
to their urban clinics that they go to now for medical care?
THE PRESIDENT: For the people at a l l the other
Places? Native Americans have a Native American health service
funded through federal funds. It's a separate health service,
sort of like the Veterans Administration network i s separate,
our plan, ma'am, w i l l put more resources into that network, w i l l
strengthen i t , w i l l enable Native Americans to choose to use the
Native American network and to bring whatever insurance policies
and support they have to that network in addition to taking the
extra money we put in i t .
. ..
... So the Native American network, we believe, w i l l be
oetter off i f our plan passes. And I have committed that to the
leaaers of tribes a l l over the country. We're going to keep
working on i t until they're absolutely satisfied that that's
what s going to happen. That i s an obligation we have; we cannot
oreak i t .
* * * * *
MR. ANSCHUTZ: Welcome back, we have about another
15 minutes on the program, and we want to cover as much ground as
we can. President Clinton, so far, how do you feel about the
questioning? Has i t bee -«a.
u
. .
job.
THE PRESIDENT: 1 think the people have done a good
And we've gotten a broad range of questions.
MR. ANSCHUTZ: Some agree. Some argumentative. But
that's the kind of thing we want,
THE PRESIDENT: It•fi a complicated issue.
have an argument.
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th-i- r^^v,*., !!^' ANSCHUTZ; Okay, I think we uave Omaha ue:.t.
that right? Topeka. Let's go to Topeka and Ralph Hipp. Ralph
loet
^
?^
Wendall and Mr. President, this i s a woman who
t?«L!^?L^^^^^^^^ ^ ^ ^ t year to complications from a bone marrow
transplant from an unrelated donor that cost $350,000. And i f
it^«\f«r"L f^^^*^ fP°t about you losing your daughter last year,
fL?i?!! ^
^^''^ become an advocate for other transplant
contiin?n« to
J^ast there's something going on that you are
continuing to work with this. And you did have insurance for
'^^^'t you t e l l the President about your
situation and your question.
this evening.^
"^^^"^
^^^^^l^^nt, for your gift of time
,.o„«^, a
f'ortunately, our daughter 's insurance provided
S«t?fn?®
transplant. But we also realize there are many
So no^ S
'^'^^^^ transplants. And their insurance companies
for t J Provide coverage for them, nor do they provide coverage
process
® expenses which i s also part of the transplant
in tro. u
1*?^ question to you, Mr. President, i s : What w i l l be
®f^th care program that w i l l help provide coverage for
dono?'s Ixpensesf
^"""^
transplants and also for their
.
PRESIDENT; Transplants are covered when they
t i l appropriate, when i t ' s an appropriate medical procedure and
^^JnoS?
f^f'^w^ ^^'^ appropriate, i t gets recommended, the
;nr^ot?!!5 ^ ' ^ ^ i
covered. And there are no lifetime limits on
fo^i
"'^^^^^ ni'^st policies now. Three out
. r>;oK? P^11<=1^^ now have lifetime limits, so that would not be
a problem.
«v«-:.n=^=
r,?,^^^®
t e l l you, I don' t know about the donor's
!w
^^^^ to check on that. I can't answer that. But
When i t i s an appropriate medical recommendation, i t would be
covered. I t ' s a normal thing that would clearly be warranted by
T Jh^^r^r''^
doctor's treatment of the patient. And
ti,^ i V.
should be, and again, there are no lifetime limits on
the policy, so that won't be a problem.
«teiii^
ANSCHUT7,: Thank you, Topeka.
s a t e l l i t e now to Omaha, Nebraska.
We go by
^„. . ,
Q
Thanks Wendall. This gentleman i s a veteran,,
and he's very healthy righu now, but h^'s also concerned about
^happening at the local Va hospitals and other hospitals
just like i t .
, Q
Mr. President, Commander, a l l veterans, as well
t L l A ^JPloyees of a l l the VA hospitals, are very concerned on
What i s happening at the hospitals. They keep reducing the
budget, keep pushing the employees out the door. Consequently,
tnat i s reducing the care for the veteran. How w i l l your new
plan affect the VA?
THE PRESIDENT: I'm glad you asked that. Jack,
because we were talking about i t during the last break. And l e t
1°^ ^"""^ service, for wearing your cap tonight. You
look fine, and I appreciate you asking the question.
Let me also back up and t e l l the rest of you, the
veterans hospital network has been suffering in recent years
because we have had a reduction in the number of patients coing
into these hospitals, leading to a reduction in the budgetwhiol.
means that those who are l e f t behind don't have ana oEteutimt-s
tne quality or tho range of care that they want.
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f
One r e a l problem i s that the veteran can go i n and
qualify to be cared for i n the veterans hospital. But the only
money the hospital gets i s whatever the budget i s from the
government. So that a veteran has another hospital policy, an
insurance policy, or i s covered by Medicare or whatever, that
money can't flow to the hospital. So what we have done, s i r , i s
to make sure that veterans on a p r i o r i t y basis, then their family
members, can be cared for through the veterans health care
network, and that a l l sources, including this Insurance policy,
can go in income to the hospitals and to the doctors i n the
veterans health care network so that they can get adequate funds.
the Veterans Administration i s quite excited
apout t h i s , the veterans health care network, because they think
tney are going to be able to get these veterans into these
hospitals and that f i n a l l y they're going to be able to be
reimbursed i n an appropriate way j u s t as any other hospital would
oe able to. so we don't want to continue to cut t h e i r budget; we
want to give them access to other different funds. And I think
i t s going to be the salvation of the veterans health care
network myself.
MR. ANSCHUTZ: Does that answer your question, s i r ?
THE PRESIDENT: Do you understand ~ I mean, l i k e i f
you have medicare or i f you have an insurance policy or -whatever now, none of that money flows to the hospital now,
under our plan, you'd be able to go t h e i r , take your insurance
?K
^®t the hospital reimbursed that way, as well as
through whatever budget we get d i r e c t l y from the hospitals
through the Congress.
MR. ANSCHUTZ:
Q
Quickly your follow-up, s i r .
Thank you, Mr. President,
MR. ANSCHUTZ:
studios here at TV 5,
Okay, good.
Let's move back to our
. ,
Q
Mr. President, I'd l i k e you to meet t h i s woman,
sne i s 16 years old and has l o s t s i x of her adoptive r e l a t i v e s to
smoking-related i l l n e s s e s , what i s your question?
Q
As a high school student, i see the heightening
use of tobacco among my age range. And l feel i t ' s not only the
r e s p o n s i b i l i t y of the government to help those that have existing
health complications, but also to prevent i t . So my question
tonight i s why do we continue to use subsidiaries for ~ to help
support tobacco growers when tobacco i s harmful to us?
(Applause,)
THE PRESIDENT: We don't use direct government
SUDSidles to support tobacco; we do organize the market with nontaxpayer funds actually to keep growers out of the market. I t
Keeps the prices higher and does provide an income for the people
who are i n tobacco farming now. i think i f you abolish the
present federal program -- I want to talk about what we're trying
to do to reduce smoking i n a minute — but i think i f you
abolished the federal program what would happen I s the big
tobacco companies would come In and actually plant more tobacco
at lower prices and t r y to make i t more readily available.
Now, what we are doing i s , the only tax we propose
to r a i s e i n this program i s a 75 cent tax on tobacco, to pay for
the medical care of the unemployed uninsured. And we ask big
companies that get a big windfall — that i s whose insurance
rates w i l l drop way down — to pay a l i t t l e b i t , too. We have
proposed i n federal buildings t o t a l l y smoko-^fre© areas unless the
looins are separate and completely separately ventilated. The
1^"!!.?'''^ v""^ Admi niRt tat ion le conducting an investigation, even
t
re here tonight, on the nicotine content of cigarettes and
whether there's been any d i r e c t attempt to increase tbe nicotine
MORE
�ft.. .
ImokT^
^^^^
y i J 43^ 0 1 4 2 P . 0 2 3
^ "'^^"^ i^ddictivft
_
•-ell „^
doing our best to be aggressive in trying fo
daige^s ?o ?mof^'
'5^^ ^^^"^^ ^°t smoke - that there a?e
clofpd
^"'oking - and that those who are around smokers in
die from'^lSno '"^'^
exposed. A few thousand people a year
nonsmokers
^^^"^^^
though they're
soSe st?onc
fit^if
fu''^'"^ serious problem, and we're taking
?Se issSe
^
direction; and I appreciate you r a i s i n g
one more round^;oh5'n'^T^*'
^ ^ ^ ^ l ^ ^ n t , we're going to t r y for
Tulsa
'''^'^^'^'•'^obin of our remote stations, we go again to
public health d^r^.S?
fvenmg, Mr. President. As you know,
millions t i ^nJ^^^"'"^?^^ provide preventive health services to
heaUh seJSi^et ^""^^^
^""^
^^^^ ^ e l l know, the preventive
t r e a t l n c «n ??? ^""^ '"'''^^ "'^^^ cost-effective to give than
proCJi?on o.
"'^^^ y^"'^ ^^««lth care plan affect the
provision Of our services related to public health?
moments aoo al?fd^??^^?^*^'^\
^^^^ " *'^«n the young lady a few
?n oSr p l l n ?Sere
immunization question, l alluded to t h i s .
I t ' s arounS'.
provision for the expenditure of I think
p u b l i f h e S f t h uiii«°"if
^ y^^^ ""^^^
tederal funds to
we^re proSid?n^
a l l around the country - every year - than
s l r J ? c e s proJS^eS
""^""^
preventive and primary
ji
a^d
and In
^ds "
we are
we are
As I said, I know in my state, we r e l i e d verv
"^2 ^"^^^^ ^^^^^^ c l i n i c s , ind i n ; ?ot of r u r l l L e a s
underserved inner-city areas, they are very important
s o " L ? i r c o n t ? ' ^ ^ ^ ' ^ ^ ^ ^ they'provLe the J L i n ? z a t ? S J ; for
now ! f Jhf i^?^"""^'
support them at a higher l e v e l than
now i f the plan passes as i t i s .
NOW,
l e t ' s go on to Topeka and Ralph Hipp.
f i n a l ouestloS
vr^^S''^
Wendall, and this i s probably our
in
Kan«.« ;on^^^J'^^''^'.''^'^^ enjoyed being with you here
in Topeka, Kansas, tonight, A doctor has our next question.
a maioritv n A h o
SeSicarsIvJnafniSn
unhealthy l i f e s t y l e s contribute to
''^^ diseases we treat today. How would
refJSniib^rSn^S ^ ^ ^ ^ o n ^ a " m ^ : r r S a ? t ^ i r l J ? e ^ ? 5 ? : ?
that would m a i J f a t : ^ ^ ? ^ ? - - . - - ; , ^ - - - , " ^ - ^ ^ ^ ^
P l (laughter ) No, don't laugh, this i s a very serious Question
me
?o'\S?: T a t vou%'{;i"? '"^^
^ n i t l V m p l t l i l T . ^ ^ f J^St o ^ a ^ a ^ ^ l ^ t l S f o n n ^ ? f o^rh^a^JtS^i^s^S^^nc^^^" " - - - ^ ^ ^-P^^
incentives. S h i ^ w f h l ^ J f ^^^^ i f ^ r S i ^ ^ ^ l t e ^ t ^ n ^ t f
these'heal?J'aiir^
'^f?'^^ ^^°"P w ? ? h i n % J e ' s t i ? e ! ^ e a c r o f
encouraae emnfiiir''*'^?' "^^^ themselves undertake InceAttves to
encourage employers, for example, to provide exercise f a c i l i t i e s
of h ^ v ^ n ^ ^ a t ^ o n i r ^ 'd'^'^'S'
"'^ ^ " ^ t h education -- i^sJead
incentives ?o SS } t ?o ?e^^'.^''''
^^^^ these a l l i a n c e s the
a^ve^Jt^v^r^im^o^Ln? I t l ^ l l I T
'^^'^^
think th.
inc^St^r
^ ^ ^ t : ^ ^ ^
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^ J ^ ' J ^ : ^ ^
^
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/
rKhbb UhC
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lown i i ?h ^^^F^'h^lo'lng to t r y to keep the cost of health care
I'm a i L ^ o . K^""": ^"^
« vej^y important question,
I m glad you brought i t up before we got off the a i r .
Topeka tonicht^* J f ^ ^ ^ ' ^ ^ V J^lP^' thank you for being with us in
the?e a^d i?V ;H
W r e c i a t e your - there's a large crowd
from nm^h.
ir 5® questions that we've had. We also appreciate
fS? one ?ast anf^^^'^'^^''^i^;
^°"'t ^^^^ time to return to them
toLaht
rl^T
i"""'. ^""t I think we've covered a l o t of ground
s C r i ^ t ^ a t a n o^^^nJ'"
heen ar. interesting discussion. And I'm
t h e v ' L a i d , L T L t^""^^^ ^^"'^ learned quite a b i t from what
they ve heard tonight because a l o t of ground has been covered.
final uxorH.
we close, Mr. President, do you have some
t i n a l words you'd l i k e to say?
are li^tenin^"^?^ PRESIDENT: Just that i hope that a l l of you who
qiestJo^s JSJt S S i f J K ^ ' ^ ^ . ^ i ^
^^'^ ^^'^^'^ questions aid had
ifisup
o, ?5 weren't asked w i l l agree with me that t h i s i s an
answers o? ? ^ L ' ? h ^ ^ ^ ^ ''^'^^
^<^t that anybody has a l l the
there
CO
^""^"'^ ^^'"^ tough decisions to be made, i f
ha?e b e l ^ Sp^f^^t^^'''^.^^''^^^^"^ to be made, this c r i s i s would
t h i s fo? 60 years
^
^^"^" ^'^'''^ ^^^"^ ^^^^"^
Conciress w i t w t ^ ^^'^^^ 3^^^
y*^'" to urge your members of
to dIJJuis ih5«o /^^^'•'^ I ' ' P^""^^'
^^^^ this issue t h i s year,
raised tonia^t ^ i ^ f ^
''^th the problems that have be4n
bSt to ar?
the questions people have about my proposal,
?nsuJance for t i T ? ^
P^°^^^^ P^^^^te guaranteed health
nrnJJ^^eL=%K ^
Americans, we w i l l not solve a l o t of the
Suh'tnflat?on''or^ mentioned here tonight or bring costs
line
ever uni?? S2 H""
""^^^ s e c u r i t y to working families,
ever, u n t i l we do t h i s , we w i l l not do i t .
important for^*;^^^ important for our economy, but i t ' s most
ao?na ?o h!
who we are as a people and what kind of l i f e we're
?he nex? centnrS ^ ^ ^ ^ ^ ^ f ^
working people as we move into
n e c e s s a r i w ^o
f i ^ ^ ^ ^""^^ ^^"^ members of Congress, not
moment to L ^ o ^ f ^ K ? ''^^^ T °" ^^^^^^ d e t a i l , but to seize t h i s
Seop?^ «nd onf
^^''H profoundly Important for the American
children
^^^^^"tee health s e c u r i t y to a l l of us and to our
Thank you.
(Applause.)
And we th;,nv ^ f i '
I want to thank the President again.
SSo we cou?Sn^J wo v^^''
Z^""^' ^""^
apologize to everyone
of time hi^^nL^!''^ ^" ^° t h i s smalL. studio, t h i s small amount
i l our coSSt?^
JSd'^r^v^J^ePie ^'^^^ questions about health care
questions?
^^^""^
that^they do have
because he h ; , r / h ^ ! ? ^ r ^ f ^ ^ ^ " ^ Clinton to come here t h i s evening
Plan
T^^t wLn.? f i ^ ^ S^^"^^'^"'t say, i t ' s the right
tha2'he coiid ?2 ?
Idea. The idea was to give him a forum so
in a 5ai??v
everything he could about h i s health plan
1?
The^ L Jre
J?"""^
^^'"^
that you could get a grasp of
say anS looic
^° ^°
"^^^^ ^hat he has had to
so (ha? voS
™
? ! ''^^^^ a l t e r n a t i v e s that are out there
express l o l "yll ^ J ^ ? / " inforr^ed opinion when i t comes time to
ft«inio«^ ^.^ ^® i n v i t e you to send your questions and your
?hosi S^i^Tor^^J ^'^"^^^^^'"en, to your U.S. senator, and make
those opinions knowns. Right, Mr. President?
weren't ^n^w.r^^ PRESIDENT: I f anybody has any questions that
weren t answered tonight, write US and we'll anBwer them.
better than t w
better than that.
^"^^^: Good. There you are. We can't do
Again, th^nk you, Mr. President.
(Applause.)
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�- 25 -
Thank you a l l for being here tonight. And thank you for jolnlno
us via television. Good night everyone. (Applause.)
END
8:28 P.M.
CDT
�SAMPLE STUMP SPEECH
Remarks for the Health Care Forum with Dr. Koop
Hillaiy Rodham Clinton
Philadelphia, PA
Febmaiy 5, 1994
[Acknowledgments]
The President and I have now been in Washington for just over a year, and I cannot
help but think about how far we have all come. During this past year, we have worked to
move our economy in the right direction, restore our sense of security and renew America's
spirit.
And thanks to the dedication of millions of Americans, we have made real progress
over these last 12 months.
Passing the Family and Medical Leave Act so good workers can be good parents.
Expanding the eamed income tax credit to reward work over welfare. Launching a new
national service initiative that helps more young people go to college. Reducing the deficit.
Expanding trade with NAFTA.
These measures -- which the President submitted and Congress approved during the
past year -- all reflect a fundamental change that has taken place in our nation. The days ol
drift and gridlock are over. We have all taken responsibility for the future of this countr\ .
�We have shown that when the American people set their minds and their hearts to doing
something, it gets done.
And 1 know that our resolve will grow stronger still as we move forward in this ncu
year -- a year that holds the hope and promise of achieving the most important legislation ol
a generation: health security for every American.
A year ago, as 1 began working on this problem, I met a doctor at St. Agnes Hospital,
right here in Philadelphia, who summed up the problem so simply. He said: "You know,
there's an old saying: If it ain't broke, don't fix it. Well, Mrs Clinton, our health care system
is 'broke' and I'm begging you to make sure that it gets fixed.'"
In the past year, 1 have learned we have the best health care professionals and roscarcli
institutions in the world. I have seen doctors in inner city emergency rooms battling to sa\c
lives hour after hour, day after day. I have seen talented young doctors donate their serMccs
to people in rural areas who cannot afford to pay for them.
Just this moming I took a tour of the Children's Hospital of Philadelphia. 1 was
so
proud to see the first--and still one of the best -- pediatric hospitals in our nation. Proud to
see the temfic work that goes on in their Oncology Unit and their Primary Care Center.
Proud of the incredible advances the Joseph Stokes Jr Research Center has made in the
prevention, diagnosis and treatment of childhood diseases.
�But in speaking to and reading letters from people all across America - farm families,
small business owners, older Americans, and, yes. medical professionals. I have heard one
message loud and clear: our health care system is broken and it needs to be fixed.
And to those in Washington who still deny that we have a crisis in our health care
system today, I say: Tell that to the single mother who wants to work but has to stay on
welfare to get health benefits for her child. Tell it to the older American who has to choose
each month between food and medicine. Tell it to the family that hit the 'lifetime limit' on
their insurance coverage and was forced into bankruptcy. Tell it to the nurse who is forced to
spend more of her time on paperwork than on patient care.
Tell them there's no crisis. Because I won't -- and neither will the President. We'i
re
going to take on this challenge, we're not going to just tinker at the edges, and we're going to
bring about real reform for the American people.
This crisis didn't happen overnight. And it didn't happen by accident. It is the direct
result of the insurance company control over the system.
Let's face it -- today's health care system is rigged against families and small
businesses, and the insurance companies are in charge. They pick and choose whom they
cover - and they've decided that 81 million Americans under the age of 65 have medical
problems for which they should pay higher premiums or be denied coverage. They use
"lifetime limits" to cut off your benefits - and although people may not know it, three out (.f
�four insurance policies have these things hidden in the fine print.
And they drop you when you get sick -- leading to 58 million Americans without
insurance at some point during the year.
If someone with a lifetime limit or worse yet. no coverage at all. becomes seriousls ii:
their entire family's savings could be wiped out. In fact, every year over 100,000 middleclass families declare bankruptcy because of a serious illness or injury.
And while the insurance companies compete to cover only the healthiest Americans,
you struggle to heal the sick. And you've leamed the results of a system where the insurance
companies call the shots.
Because you have to tell the parent that you can't do anything about the fact that her
employer switched insurance plans, and the new plan won't reimburse you if you treat her
child. You have to explain to the parent of a sick child that yes, there is such a thing as a
lifetime limit that can deny you benefits when you need them most. And you have to create
your own mini-bureaucracy in your office to deal with the insurance company red tape.
1 know that no one here went to medical school and through intemships and residcncN
requirements so that you could spend your time filling out forms or hiring people to negotiate
with insurance companies. You went so that you could practice medicine. So that you could
�care for people. And when insurance companies keep you from doing that, something is
horribly wrong. And it has to change.
We must return our health care system to the people who should be in the dri\er's scat
- patients and their doctors. And our approach does that by outlawing the insurance ct)nipan\
discrimination that is so common today. It makes it illegal for the insurance companies to
decide who gets coverage. Illegal to charge people more if they're older or sick. Illegal to put
lifetime limits on coverage.
We want to phase in reform over a few years to make sure it's done right. But \shcn
we're done, insurance ought to mean what it used to mean. You pay a fair price for security,
and when you get sick, health care's always there, no matter what.
The President's goal is this: guaranteed private insurance to every American. And 1 want to he
clear about what that means because there's a lot of misinformation out there. Most people
will get insurance the same way they do today, through their employer. Each consumer -- not
their employer, not a bureaucrat - will have a choice of health plans and doctors --and plans
will enroll everyone who applies.
Once someone's picked a plan, if they need to go to the doctor for a check-up or get sick,
they'll simply take their Health Security card, show it at the doctor's office or the hospital,
and get the care they need. Then they'll fill out one standard form, and they're done. That
�way, we can go back to using doctor's offices as places of healing, not monuments to
paperwork and bureaucracy.
The President's approach would guarantee a comprehensive benefits package that includes
coverage for preventive care and prescription dmgs. Immunizations, well-baby care, and
check-ups for children - all covered free of charge. I know many of you are particularly
concerned about how the proposal will affect children with disabilities, and I want to point
out that under the President's approach, families of children with disabilities will no longer be
denied health coverage or charged outrageous premiums.
And the President's approach will be good for physicians. It puts power and choice back in
the hands of individuals and physicians - so you will be able to choose what plans to jom.
and your patients will have their choice of plan and provider. A single claims form and
standard, comprehensive benefit package will make your life simpler. And guaranteed prnate
insurance will mean that you won't have to worry about whether the insurance companv will
decide to reimburse you, or whether your patients have insurance at all.
We also agree that local community care networks must be the centerpiece of a reformed
system ~ groups of providers who see their mission as keeping people well and have the riiiht
incentives to do exactly that. With our approach, pediatricians will play an especially vital
�role in providing the primary and preventive care needed to keep children healthy.
The President's approach also protects older Americans ~ something that's very important
personally to the President and myself - by preserving Medicare and by adding new co\crauc
for prescription drugs and some long-term care.
As this debate on reform moves forward, you will start to hear a lot about other approaches. I
ask you to think carefully about those altematives. And ask their proponents the same tough
quesdons you're about to ask me.
Because there are some key differences between our approach and the altematives. We use
savings in the growth of Medicare for better health coverage for older Americans; others use
it to pay other bills unrelated to health care. Our approach provides a comprehensive benellts
package with low deductibles that is spelled out in law; others provide just a basic package
with high deductibles, or leave it to a govemment board to decide after the law is passed.
We outlaw insurance company discrimination completely; others may say they prevent
insurance companies from dropping people, but they still let them double or triple your
premiums when you get sick.
We believe that the proposal we put forth best achieves the goal of guaranteed private
insurance for every American that can never be taken away. However, as we've said from the
beginning, we are ready to listen to serious proponents of health reform who think thev ha%c
�a better way of achieving that goal.
Nearly 46 years ago [July 1948], Harry Tmman accepted the Democratic nomination for
President here in Philadelphia in this very convention center. And in his acceptance speech.
Truman did not mince words about the problems facing the country, chief among them health
care.
"The nation suffers from lack of medical care," he said. [But] "that situation can be remedied
any time the Congress wants to act upon it."
Hany Tmman never got the health care refonn he fought for. Neither did FDR before h im
or
President Carter after. Twenty years ago, President Richard Nixon proposed employer-based,
private insurance for every American with shared responsibility among employers and
employees. It was a proposal that closely resembles ours. But he also did not succeed.
So why hasn't it happened? Why has the history of health care reform in this country been a
history of missed opportunities? Because special interest groups have been just too powerful
to overcome. But this time, if we work together, 1 am convinced things will be different.
This time, we will make history and guarantee private insurance to every American. I ask \ou
to join with me and do what is right for America. Thank you.
�THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
February 1, 1994
REMARKS BY THE PRESIDENT
TO THE AMERICAN HOSPITAL ASSOCIATION
Washington Hilton
Washington, D.C.
10:18 A.M. EST
THE PRESIDENT: Thank you very much Thank you, Dick; and thank you,
Carolyn. And thank you also for bringing my tea out here The Hospital Association is
giving care to the President for his sick voice today. (Laughter.) I thank you.
I appreciate so much what both Dick and Carolyn said, and I want to begin by
thanking all of you here who have ever had me in your hospitals — (laughter) — which is a
large number of people. Especially all the people who represent my native state and who
have done so much to help educate me on these issues over the years.
The time that I have spent in hospitals since I was a small boy has made a very
big impression on me. I always leam something I always leave with a sense of inspiration
about the dedication of the people who work there. And I want to say a special word of
thanks to this association for the work that you have done with our administration over the
last year, in a very constructive way, in helping us to try to develop an approach which would
solve the problems of the American health care system and protect and enhance what is good
about it.
I know that there will still be some issues on which there will be disagreement as
we go forward, but I think it's important that we clarify today, as Dick did so well in his
introduction, that we agree on the most important issue: We have to preserve what is right,
we have to fix what is wrong; we have to guarantee private insurance to every American so
that everybody will be covered. That is the only way to stop cost shifting; the only way to be
fair; the only way to solve this problem. (Applause.)
The problem with the health care system in this country did not just happen
ovemight. It happened because of the way this system is organized. Anybody who thinks
there are no serious problems, no crisis in the health care system I would say go visit your
local hospital. (Applause.)
Over the years, because of the insurance system we have in America, which is
unlike any in the world and which, I will say, is irrelevant to the fact that we have the highest
quality care in the world for the people who can afford it and access it, we have created a
system which often makes it impossible for hospitals to do their jobs. While insurance
companies have set up a system which enables them to slam the door on people who aren't
healthy enough to get covered, hospitals open the door to everyone, whether they're covered
or not.
We have created in this country, through the systems of hundreds of different
�insurance companies writing thousands of different policies, a giant bureaucracy which, on the
insurance side, sorts the hedthy from the sick, the old from the young, the geographically
desirable from the undesirable. And as more and more insurance companies sell more and
more customized insurance policies to smaller and smaller groups, each of them has created
its own set of forms and different sets of what would cover, spelled out in endless fine print
The result, as all of you know, has been a bureaucratic nightmare.
And what about the hospitals? You have had to create your own bureaucracy to
deal with the insurance bureaucracy, and the govemment's as well - to fight red tape, close
loopholes and to try to get reimbursed somehow And that only covers the patients who have
good insurance. For those without insurance or with bare-bone coverage, you're forced to
jump through a whole lot of other hoops And you probably still often don't get any
reimbursement.
Hospitals did not invent this system. You didn't choose a system which has
resulted in hospitals hiring clerical workers at fourrimesthe rate of doctors being added to
hospital staffs in the last 10 years You did it because of the red tape of the present system the insurance red tape and the govemment program red tape.
Meanwhile, your missions didn't change - it's srill to treat the people who are sick
who need to be in the hospital Regardless of their age or medical history, of what may or
may not be covered, you have to deal with the people that the insurance industry decides are
not profitable You can't ask whether an illness was a preexisting condirion, it's srill an
illness.
So what are we left with today? A system where we're mled by forms and have
less time to make people healthy A system that forces doctors and nurses and clerical
workers in hospitals to write out the same informarion sixrimesin six different ways just to
sarisfy some distant company or agency. It doesn't make sense, and you shouldn't have to put
up with it anymore. (Applause.)
Just listen to Joan Brown, a registered nurse who works at a teaching hospital in
Chapel Hill, North Carolina. She wrote to the First Lady that she spends -- and I quote "more rime with paperwork than with any other aspect of health care." They've got a joke at
her hospital, she said, "We'll do the parient care after we finish the paperwork, if we have
time." It's not just a joke, it's a sign of a cnsis, and one we've got to do something about
I visited Children's Hospital here in Washington last year. The pediatrician, who
is from this community and who is dedicated her life to the children of this community, told
me she spends up to 25 hours a week filling out forms instead of tending sick children "It's
not what we trained all these years to do," she said. "Reducing paperwork would enable me
to pracrice medicine again. It would free me," she said, "free me from the shackles and the
burdens of the paperwork maze."
Let's be honest. In his wildest dreams. Rube Goldberg could never have designed
a system more complex than the present health care system. (Applause.)
You in this room understand this better than anyone else in the worid today You
see the crisis when people without insurance come to emergency rooms with serious injuries
or illnesses. Many of those illnesses could have been prevented if only they had been
covered and had access to a doctor, to primary and prevenrive care. The emergency room is
the most expensive place to treat people. It should be reserved for emergencies. I know you
believe that and you can make sure it happened if everybody had access to health care
coverage.
�You see the crisis when people come in who aren't fully insured and you become
loaded up with what's called uncompensated care. The smallest estimate of that is $25 billion
a year. It either come out of your budgets, which hurts your ability to provide health care at
a high quality, or you have to shift the cost on to the bills of those who can pay them
A lot of people who complain about hospitals overcharging, about inflated bills,
have no idea how much of this cost shifting occurs simply because of the insurance setup
that we have in the United States. No other country in the world is burdened with it. And
we should not tolerate it any longer (Applause.)
You also see it because a lot of the people who come to you, either before they
come or somerime during their treatment, deal with the problems of preexisring condirions or
lifetime limits on insurance policies. Three out of four policies have such liferime limits. I
know a lot of rimes you wind up having to send a collecrion company after a patient that you
know is not going to be able to pay the bill anyway because of these problems.
You see this crisis when a doctor prescribes prescription drugs, but then a person
comes back to the hospital three or four weeks later because she couldn't afford to> fill the
prescriprion. So the illness got worse. One study says that problems related to the lack of
appropriate medication lie at the root of up to 25 percent of all hospitalizarions and cost over
$21 billion a year. Our plan is the only one that takes account of this and covers prescription
drugs along with other medical services
You see it with the crisis of violence in the emergency room. We have to leam to
treat violence as a public health problem. Billions of dollars a year again are loaded onto the
health care system because we are the most violent country in the world. Many people in
health care supported the Brady Bill, support our attempts to restrict assault weapons, to put
more police officers on the street. That also will help alleviate the health care problem. So I
hope you'll be out there after we deal with this the best we can also supporting what the
administration is trying to do on crime. (Applause.)
I came here today once again to thank you for the work you have done with us
and to appeal once again for your support, for the real battle is now being joined in Congress
And though we may disagree about the details, we all agree the time has come to do
something. We have to do it now \.nd what we have to do includes providing guaranteed
pnvate insurance to every single American. That is what I need your help to do. (Applause )
I implore you to go to Capitol Hill and tell your members of Congress again what
is going on in your hospitals. Go home and talk to your friends and neighbors about it, and
the people who come in to your hospitals. Talk to business leaders in your communities and
local media people.
One of the biggest problems we have in this fight today is that this issue is so
complex and people are naturally enough so concemed that they don't want to lose anything
good that they have now, that it is easy to confuse people about what the real issues and the
real facts are.
I love having a discussion with your representatives, even i f there is some
disagreement around the edges of policy. We come to the table with an accumulated
knowledge of how the world really works. Our biggest problem m passing this is that there
are too many people even in the Congress who have not had the opportunity to study this
program in all of its complexity This is a tough, tough issue.
And as I could tell from your applause, you know that the most complex system
�that could ever be designed is not the one
in the administration's bill, it's the one you're living with right now. (Applause.)
Our approach is not to tell you how to deliver health care, not to build barriers or
bureaucracy. What we want to do is to establish a framework in which people are covered,
provide the right incentives, help to remove the barners to access, and get out of the way
We agree that local community care networks must be the center of any reform system
(Applause.) Groups of providers who see their mission as keeping people well, treating the
sick when they are sick, and having the right incentives to do exactly that. We need to look
no further that your own NOVA award winners for examples of providers who come together
and make collaborarion work.
One example, the Health Farmers of Philadelphia, where six urban teaching
hospitals came together and worked together to deal with violence and dmgs and teen
pregnancy in one community -- this is a very moving sort of thing. This can be done
throughout America. And we could do more of it if we covered everybody. It would lower
the cost to the overall health care system if we did it because we could pracrice prevention,
we could give more primary care The system as a whole would be less burdened, and we
could have more networks like the one in Philadelphia you have honored.
I know that many of you are already finding incredibly crearive ways to serve
your community and are forming these networks That approach will be quite consistent with
the administration's approach We helped to do that with clear incenrives for people to join
together in networks and guarantees that when they do there will be compensarion there for
the services that are provided. And we agree that reform must simplify the system for you by
reducing the paperwork burden. There's no excuse for not having a single standard form to
replace the thousands of forms that exist today. And we want to help you move forward with
electronic billing, less regulation by the govemment, and other ways to help get rid of some
of this paperwork hassle.
I am tired of trying to explain why we spend a dime on the dollar more on
paperwork, regulation and premiums than any other country in the world and we srill don't
even cover everybody It cannot by explained so it should be changed. (Applause.)
And I want you to help me do something else, too, when you go up to Congress
Ask every member of Congress, the next rime somebody comes to them and says, what we
really ought to do is tax the benefits, the health care benefits of middle class working people - say, well, before you tax the benefits of working people whose wages have been stagnant
for 20 years, why don't you ask how we can justify spending a dime on the dollar more on
paperwork, regulation and insurance premiums/than anybody else? That is waste. Why take
something away from hardworking people before you squeeze the system and its
unconscionable burdens on hospitals, doctors, nurses and the American people themselves?
That is where we ought to start. (Applause)
I also want to talk a little bit about the guarantee of private insurance. Most
people, under our approach, would get insurance the same way they do today, through their
employer. Each consumer - not an employer, not a bureaucrat — would have a choice of
health care plans and doctors
Let me point out something else on this choice. Today — today, 55 percent of the
companies who insure their employees and 40 percent of the total work force insured through
their employer have no choice today in doctors or health plans. They take the plan the
employer has chosen. Under our plan, everybody would have at least three choices of plans,
including the right to simply pick a doctor and have fee-for-service medicine. That is more
�choice than exists today, not less. Again, the rhetoric of people who have attacked change
defies the reality of what people face and deal with in their daily lives in the health care
system today
Once someone has picked a plan, i f they need to go to a doctor for a checkup or
if they get sick, they'll simply take a health care security card, show it, and get the care they
need. Then they'll fill out one standard form, and they're done. That way, we can go back to
seeing hospitals as places of healing, not monuments to paperwork and bureaucracy.
I have heard so many stories in so many hospitals, I could keep you here all day
laughing, but it would be like preaching to the saved. (Laughter.) The only thing I want you
to do is to go tell the Congress about it, and that we can do better.
Last week when 1 spoke to Congress, I said that I would veto any legislation that
did not cover every American with guaranteed insurance. (Applause.) Now, again I want to
say that I did that because you know that unless we do that we can't have everybody playing
by the same rules, using the same forms, ending the cost shifting and getting people the
preventive and primary care they need so they don't simply wind up in the emergency room
That is, all the systematic problems that the Hospital Association brought to the
administration when we began this discussion will conrinue unless we provide coverage to
everyone
Now, again, I know there are issues to work out. There are differences about
what level of Medicaid savings can be achieved. I'll tell you this — our plan is the only one
that takes the Medicare savings and puts it back into the health care system, which is very,
very important. But the biggest thing you need to do, I would argue, to get a good health
care bill out of Congress is make sure that the people in the Congress understand how the
system works today and what these various approaches would do i f they were passed.
Yesterday, Families USA issued a very valuable document which I just received a
copy of this moming which takes 10 different families, 10 different health situations and goes
through in practical terms how they would be affected i f each of the major plans now pending
in the Congress were the law of the land. I would urge you to read it. But it won't surprise
any of you because you know how the system works today.
Again, I implore you to take this debate to Congress, get beyond the rhetonc, get
beyond the ideology, talk to people in the Congress about the American people and how the
American health care system affects them. That is the only way we can work through the
real problems as opposed to the imagined one.
One distinguished member of the House of Representatives who represents a
district with a wonderful teaching hospital and who has been required by virtue of his
membership — his consrituency - t o become an expert on health policy over the years, read
our plan the other day and he said, "It's the only one that really takes account of so many
different problems that most people don't even know about. But I have no idea how to get
my colleagues in the Congress to take this issue seriously and spend all the rime it would take
to absorb it all."
You can do that. Every member of Congress has a lot of hospitals in his or her
district. Every member of Congress basically cares a lot about health care. And you can
come to this debate with a perspective that is not ideological, not partisan, has no axe to
grind, doesn't care who wins except the American people and the American health care
system That's what you can bring to this debate.
�So I would ask you, at a time when some say we just need a littlerinkeringand
others sav there are ideological'barriers to changing it. I just want to say that Dick Davidson,
vour President, in my view, said it as well as it could be said last December. He said,
"Comprehensive reform is what the American people are asking us to do. To do nothing -or
worse; to fall back on simplisric solunons - only postpones and complicates our task And
that's the tmth.
Let us stand together for the health care of the American people. We have a
chance finally for the first nme in decades to do this nght. You know what needs to be done
I pledge to you an open door, a listening ear, a firm partnership Let's go out there and solve
this problem for the American people
Thank you very much, and God bless you. (Applause.)
END10:40 A M EST
�
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Health Care Task Force Records
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White House Health Care Task Force
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
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<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
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Box 9
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Clinton Presidential Records: White House Staff and Office Files
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https://clinton.presidentiallibraries.us/files/original/ae6aa1110d3a66658d3e92c559d06b81.pdf
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1 Icaitii Care Task l-'orce
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8
2
�1982
Oct. 3 I Administration of William J. Clinton, 1993
rity and savings and simplicity, that preserves
the kind of choice and quality these doctors
talked about tonight, and that asks all of us
to be more responsible.
We can do this and we can also turn the
Califomia economy around if we'll take it one
day at a time, one project at a time, and keep
at these things until they're done. We can
do it. Thank you veiy much.
of the cold war, in the effort to promote democracy abroad, to guarantee the right of
people freely to join their own unions, and
to work for freedom within their own countries. In that context most of you, I know,
have strongly supported and looked with
great favor on the movement toward democracy in Russia.
The United States continues to stand firm
in its support of President Yeltsin because
NOTE: The town meeHng began at 6:33 p.m. at
he is Russia's democratically elected leader.
KCRA television studio. A tape was not available
We
very much regret the loss of life in Mosfor verification of the content of these remarks.
cow, but it is clear that the opposition forces
started the conflict and that President Yeltsin
had no other altemative than to try to restore
order. It appears as of this moment that that
Remarks to the A F L - C I O
has been done. I have as of this moment abConvention in San Francisco,
solutely no reason to doubt the personal
Califomia
commitment that Boris Yeltsin made to let
October 4,1993
the Russian people decide their own future,
to secure a new Constitution with democratic
Thank you very much. President Kirkland, values and democratic processes, to have a
distinguished platform guests, and to the new legislative branch elected with demomen and women of the American labor cratic elections, and to subject himself, yet
movement, let me tell you first I am glad again, to a democratic vote of the people.
to be here. I feel like Pm home, and I hope That is all that we can ask.
you feel like you have a home in Washington.
I think also, most of you know that in a
For most of the 20th century the union military action yesterday, the United States
movement in America has represented the sustained the loss of some young American
effort to make sure that people who worked soldiers in Somalia. I deeply regret the ' )ss
hard and played by the rules were treated of their lives. They are working to ensure tnat
fairly, had a chance to become middle class anarchy and starvation do not retum to a u icitizens, raise middle class kids, and give tion in which over 300,000 people have lost
their children a chance to ha\e a better life their lives, many of them children, before the
than they did. You ha\'e worked for that. You United States led the U.N. mission there,
have done that.
starting late last year. I want to offer my proFor too long, in the face of deep and pro- found condolences to the families of the
found problems engulfing all the world's ad- United States Army personnel who died
vanced nations, you ha\e been subjected to there. They were acting in the best spirit of
a political climate in which you were asked America.
to bear the blame for forces you did not creAs you know, the United States has long
ate, many times when you were trying to
had plans to withdraw from Somalia and
make the situation better. I became Presileave it to others in the United Nations to
dent in part because I wanted a new partnerpursue the common objecti\es. I urged the
ship for the labor movement in America.
United Nations and the Secretary-General in
Before I get into the remarks that I came my speech at the United Nations a few days
here to make about all of our challenges at ago to start a political process so that the
home and the economic challenges facing us, country could be turned back over to Somalis
I ha\ e to make a few remarks this moming
who would not permit the kind of horrible
about developments in the world in the last
bloodshed and devastation to reoccur. And
48 hours.
I hope and pray that that will happen. In
The labor movement has been active, par- the meanwhile, you may be sure that we will
ticularly in the last few years with the end do whatever is necessarv- to protect our own
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Administration of William J. Clinton, 1993 I Oct. 4
iTt to promote demtee the right of
" own unions, and
n their own coun.t of you, I know,
and looked with
•nt toward democ-
forces in Somalia and to complete our mission there.
From the stmggle against communism in
Eastern Europe to the stmggle against apartheid in South Africa, the union movement
in America has always answered the challenges of our time. It must be a source of
great pride to you to see these elections unfold, to see the remarkable movement toward
a genuine multiracial society within a democratic framework in South Africa. It must,
likewise, be a source of continuing fmstration
to you to see that even as the ideas and the
values that you have espoused now for decades are being embraced around the world,
here in our country and in virtually every
other wealthy country in the world, middle
class workers are under assault from global
economic forces that seem beyond the reach
of virtually any govemment policy.
nueis to stand firm
it Yeltsin because
lily «;lected leader,
loss of life in Mos' opposition forces
,t President Yeltsin
an to try to restore
moment that that
'f this moment ab)ubt the rjersonal
eltsin made to let
their own future,
)n with democratic
xjesses, to ha\'e a
ected with demoibje<;t himself, yet
)te of the people.
)u know that in a
the United States
^ young American
ply regret the loss
king to ensure that
not retum to a na) people have lost
hildren, before the
N. mission there,
at to offer my proe families of the
sonnel who died
1 the best spirit of
*d States has long
rom Somalia and
United Nations to
•tives. I urged the
cretary-General in
^lations a few days
ocess so that the
ick over to Somalis
e kind of horrible
) to reoccur. And
it will happen. In
e sure that we will
o protect our own
We now know that every wealthy countiy
in the world is having trouble creating jobs.
We now know that in the last several years,
inequality of income got worse in every major
country. We know that we had more growing
inequality in America than anyplace else because we actually embraced it. I mean, the
whole idea of trickle-down economics was to
cut taxes on the wealthiest Americans, raise
taxes on the middle class, let the deficit balloon, and hope that the investment from the
wealthy would somehow expand opportunity
to everybody else.
We know that didn't work, and it made
the situation worse. It left us with a $4 triHion
debt. It left us with a deficit of over $300
billion a year. It left us with a legacy of weakened opportunities for workers in the workplace, too little investment, a paralyzed budget, and no strategy to compete and win in
the global economy, and more inequality in
America than any of the other wealthy countries. But we also know that the same problems we have are now being found in Germany, in Japan, in all of Europe, in the other
advanced nations.
So we have to face the honest fact that
we are facing unprecedented challenges in
our own midst to the very way of hfe that
the labor movement has fought so hard to
guarantee for others around the world for
decades. And therefore, it is important that
we think through these issues, that we take
1983
positions on them, that we agree and that
we disagree in the spirit of honest searching
for what the real nature of this world is we're
living in and where we are going.
The most important thing to me today is
that you know that this administration shares
your values and your hopes and your dreams
and the interest of your children, and that
together—[applause]—and that I believe together we can work our way through this very
difficult and challenging time, recognizing
that no one fully understands the dimensions
of the age in which we live and exactly how
we are going to recreate opportunity for all
Americans who are willing to do what it takes
to be worthy of it.
The labor movement, historically, has always been on the cutting edge of change and
the drive to empower workers and give them
more dignity on the job and in their lives.
Almost a half a century ago, at the end of
World War I I , labor helped to change America and the world. At home and abroad, labor
helped to create a generation of prosperity
and tr- oreate the broad middle class that we
all cherish so much today.
Now we ha\e to do it again. We're at a
time of change that I am convinced is as dramatic as the dawning of the Industrial Age.
We can no longer tell our sons and daughters—we know this now—that they will enter
a job at the age of 18 or 21, enjoy secure
paychecks and health benefits and retirement benefits for the rest of their working
lives and retire from the same job with the
same company at the age of 65 or 62.
Our changing economy tells us now that
the average 18-year-old will change work
seven times in a lifetime even if they stay
with the same company and certainly if they
change; that when people lose their jobs now,
they really aren't on unemployment, they're
looking for reemployment; that most unemployment today is not like it used to be:
When people got unemployed for decades,
it was because there was a temporary downtum in the economy, and when the economy
tumed up again, most people who were unemployed were hired back by their old employer. Today, most people who are unemployed eventually get hired back usually by
a different employer for a different job and
unless we are very good at what we do for
«!
il
�1984
Oct. 4 I Administration
them, often at lower wages and less benefits.
So it is clear that what we need is not an
unemployment system but a reemployment
system in recognition of the way tne world
works today.
We know, too, that most American working people are working harder than they ever
have in their lives; that the average work
week is longer today than it was 20 years ago;
that real hourly wages adjusted for inflation
peaked in 1973, and so most people are
working harder for the same or lower real
wages than they were making 20 years ago.
We know that in the eighties there was
a dramatic restructuring of manufacturing;
that being followed in the nineties with a dramatic restmcturing of the service industries.
We know that for the last 12 years, in every
single year, the Fortune 500 companies lowered employment in the United States in six
figures, and that in the years where we have
gained jobs, they've come primarily from
starting new businesses and from companies
with between, say, 500 and 1,000 workers expanding, as the whole nature of this economy
changes.
We know that the cost of health care has
increased so much that millions of American
workers who kept their jobs ne\ er got a pay
raise because all the increased money went
to pay more for the same health care. We
know that some of our most powerful industrial engines, especially in industries hke
autos and steel have shown breathtaking increases in productivity with deep changes in
the work force supported by the labor movement, and still are having trouble competing
in the world, in part, because their health
costs may be as much as a dime on the dollar
more than all of their competitors.
We know, as I said at the beginning, that
all the wealthy countries in the world are now
having trouble creating jobs. I f you look at
France, for example, in the late 1980's, they
actually had an economy that grew more rapidly than Germany's, and yet their unemployment rate never went below 9.5 percent.
So what are we to do? It seems to me that
we clearly have to make some changes in the
way we look at the world and the way we
approach the world. And in order to make
those changes, we have to ask ourselves, what
do we have to do to make the American peo-
(rf William J. Clinton, 1993
ple secure enough to make the changes? One
of the things that has really bothered me in
the late, latter stages of this era that we're
moving out of is that so few people have been
so Uttle concemed about rampant insecurity
among ordinary American middle class citizens. It is impossible for people in their personal lives to make necessary changes if they
are wildly insecure.
You think about that in your own life. You
think about a personal challenge you faced,
a challenge your family has faced. The same
thing is tme in the workplace. The same
thing is true of a community. The same thing
is tme of a team. The same thing is true of
our country. We have to struggle to redefine
a new balance between security and change
in this country because i f we're not secure,
we won't change, and i f we don't change,
we'll get more insecure, because the circumstances of the world will continue to
grind us down.
And that's what makes this such a difficult
time, because we have to rethink so many
things at once. I ran for President because
I was tired of 20 years of declining living
standards, of 12 years of trickle-down economics and antiworker policies, and rhetoric
that blamed people who are working harder
for the problems that others did not respond
to, and because I believe that we needed a
new partnership in America, a new sense of
community, not just business and labor and
govemment but also people without regard
to their color or their region or anything else.
I thought we didn't have anybody to waste,
and it looks to me like we were wasting a
lot of people and that we needed to put together. I thought the country was going in
the wrong direction, and we should tum it
around. But I was then and am now under
no illusions that we could do it ovemight or
that I could do it, unless we did it together.
The beginning of the security necessary to
change, I think, is in having a Govemment
that is plainly on the side of working Americans. I believe that any of your leaders who
work with this administration will tell you
that we are replacing a Gov emment that for
years worked labor over, with a Govemment
that works with labor. We have a Secretary
of Labor in Bob Reich who understands that,
at a time when money and management can
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Administration of William J. Clinton, 1993 I Oct. 4
the changes? One
ly bothered me in
his era that we're
V people have been
rampant insecurity
middle class citieople in their perary changes if they
travel across the globe in a microsecond, our
prosperity depends more than anything else
on the skills and the strengths of our working
people. No one can take that away from us.
And our people are still our most important
asset, even more than they were 20 years ago.
We have nominated a Chair of the National Labor Relations Board in Bill Gould,
and a new member, Peggy Browning, who
believe in collective bargaining. We nave a
Director of the Occupational Safety and
Health Administration in Joseph Dear who
comes from the labor movement and believes
that workers should be protected in the
workplace. We have two people in executive
positions in the Labor Department in Joyce
Miller and Jack Otero who were on your executive council. We have two people in the
SEIU in executive positions in Karen Nussbaum and Jerry Polas who are leading us to
make progress.
This administration rescinded President
Reagan's order banning all reemployment of
PATCO workers forever. And we rescinded
President Bush's orders with regard to Govemment-funded contracting and one-sided
information given to workers in the workplace. And this week I will sign the Hatch
Act Reform Act to give Govemment employees political rights they have been denied for
too long.
One week ago yesterday, on a Sunday
moming, I came in from my early moming
run, and I tumed to my right as I walked
into the White House, and I saw a family
standing there, a father, a mother, and three
daughters, one of whom was in a wheelchair.
And the person who was with them who
worked for me said, "Mr. President, this little
girl has got terminal cancer, and she was
asked by the Make A Wish Foundation what
she wanted to do, and she said she wanted
to come to the White House and visit you.
So we're giving her a special tour."
So I went over, and I shook hands with
them and apologized for my condition and
told them I'd get cleaned up and come back,
and we'd take a picture. And a few minutes
later I showed up, looking more like my job.
And I visited with this wonderful child, desperately ill, for a while. And then I talked
to her sisters, and then I talked to her mother. And I talked to her father. And as I tumed
your own life. You
allenge you faced,
IS fac(;d. The same
kplace. The same
ty. The same thing
ne thing is true of
tmggle to redefine
"curity and change
we're not secure,
we don't change,
because the cirwill continue to
his such a difficult
rethink so many
President because
f declining living
t-ickle-down ecolicies, and rhetoric
ire working harder
rs did not respond
that we needed a
ca, a new sense of
less and labor and
jle without regard
m or anything else,
anybody to waste,
ve were wasting a
needed to put tontry was going in
we should tum it
nd am now under
do it ovemight or
Me did it together.
curity necessary to
ing a Govemment
of working Ameriyour leaders who
ition will tell you
nerr ment that for
Ath £1 Govemment
have a Secretary
) understands that,
1 management can
%•
1985
around to go off, the father grabbed me by
the arm and he said, he said, "Let me tell
you something. If you ever get to wondering
whether it makes a difference who's the
President," he said, "look at my child. She's
probably not going to make it, and the weeks
I've spent with her have been the most precious time of my life. And if you hadn't been
elected, we wouldn't have had a family and
medical leave law that made it possible for
me to be with my child in this time."
Now, I believe, in short, that it ought to
be possible to be a good parent and a good
worker. I believe that it ought to be possible
for people to make their own judgments
about whether they want to be organized at
work or not and how they're going to be—
[applause]. And I believe if we're really going
to preserve the American workplace as a
model of global productivit)', we have to let
people who know how to do their jobs better
than other people do have more
empowerment to do those jobs and to make
those changes in the workplace.
That's why, as we work on the Vice President's reinventing Govemment initiative, we
work so closely with Federal employees and
their unions. When the Vice President spwke
with business leaders and workers who had
changed their companies, they all said the
same thing: You've got to have the workers;
you have to have them do it, tell you how
to do it, tell you how to make the companies
more productive.
Now, that's why yesterday I signed an Executive order—on Friday—creating a National Partnership Council. For the next several months the leaders of Federal employee
unions, including John Sturdivant, the president of the American Federation of Govemment Employees, who is here today, will
work with the leaders of our administration
to make our Govemment more effective, cost
less, and more importantly, to make the jobs
of the rank and file Federal employees more
interesting, more stimulating, more customer-oriented, by doing things that they
have been telling us they should be able to
do, but that the system has not permitted
them to do in the past. I applaud John and
the other pteople in the unions representing
Federal employees for what they have done.
�1986
Oct. 4 I Administration of William}. Clinton, 1993
This is an unprecedented partnership that I
think will benefit every American.
We want to make worker empowerment
and labor-management cooperation a way of
life in this country, from the factory floor to
the board room. We've created a commission
on the future of labor and management relations, with leaders from labor, business, and
the academy, chaired by former Labor Secretary John Dunlap. And I've asked Secretary
Reich to create a commission to study and
improve relationships in govemment workplaces at every level, at the State and county
and local level, as well as at the Federal level.
I believe this is something that a person
like Bob Reich is uniquely situated to do.
And it's the kind of thing that we ought to
be promoting because we have to use this
opportunity we have to try to take what has
worked for workers and their businesses and
spread it around the country.
For the last 12 years we've had a lot of
finger-pointing and blame-placing, and we've
got these stirring examples of success that
we could be trying to replicate. That's what
we ought to be doing, taking what works. And
it always is a workplace in which workers
have more say. And we're going to do what
we can to get that done.
Now, on the security issue, let me just
nention some other things. In addition to
the family leave act, the budget bill which
passed by such a landslide in the Congress
contained what may well be the most important piece of economic reform for working
people in 20 years, by expanding the eamedincome tax credit so that you can say to people, if you work 40 hours a week and you
have children in your home, you will not be
poor. We are bringing new hope and new
dignity into the lives of 15 million working
families that make $27,000 a year or less.
They'll no longer be taxed into poverty.
There won't be a Govemment program to
try to lift them out of poverty. Their own
efforts will lift them out of poverty because
the tax system will be changed to reward
them. And there will never again be an incentive for people to be on welfare instead of
work because the tax system will say, if you're
willing to go to work and work 40 hours a
week, no matter how tough it is, we will lift
you out of poverty. That is the kind of
prowork, profamily policy this country ought
to have.
Something else that was in that bill that
most Americans don't even know about yet
that will benefit many, many of you in this
room and the people you represent is a dramatic reform of the student loan system that
will eliminate waste, lower the interest rates
on student loans, make the repayment terms
easier so that young people can repay their
loans no matter how much they borrow as
a percentage of their income, limited so they
can repay it. Even though we'll have tougher
repayment terms, they'll be able to do it.
We'll collect the money, but people will be
able to borrow money and pay it back at
lower interest rates, at better repayment
terms. And therefore, no one will ever be
denied access to a college education because
of the cost.
When you put that with our Goals 2000
program, the education reform program for
the public schools, and the work that the
Education Secretary Dick Riley is doing with
Secretary Reich to redo the worker training
programs in the country, you have a commitment to raise standards in education and
open opportunities to our young p>eopIe.
We need higher standards in our public
schools. Al Shanker has long been a voice
for that. He now has allies in the NEA and
other places in the country who are saying,
"Let's have national standards and evaluate
what our kids are leaming and how our
schools are doing."
I believe we need to give our young people
more choices within the public school system, and I have advocated letting States try
a lot of things within districts. Let kids choose
which schools they attend. Let school districts decide how they want to set up and
organize schools. I think that a lot of changes
need to be made in a lot of school districts.
But let me say that we don't want to throw
out the baby with the bath water. There are
also a lot of school districts that are doing
a great job under difficult circumstances.
There are a lot of schools within school districts that are performing well under difficult
circumstances.
And if we've leamed anything, we've
leamed that the best way to increase the
quality of education is to find better prin-
�I
Clinton, 1993
country ought
that bill that
now about yet
of you in this
esent is a draan system that
interest rates
)ayment terms
in repay their
ley borrow as
imited so they
i have tougher
able to do it.
people will be
)ay it back at
er repayment
' will ever be
cation because
•jr Ckjals 2000
n program for
work that the
y is doing with
• orker training
lave a commit"ducation and
I g people,
in our public
been a voice
the NEA and
ho are saying,
s and evaluate
and how our
r young people
lie school systing States try
^ t l<Jds choose
-et school disto set up and
. lot of changes
chool districts,
want to throw
iter. There are
that are doing
circumstances,
hin school disunder difficult
lything, we've
) increase the
d better prin-
Administration
of William ]. Clinton, 1993 I Oct. 4
cipals, get better leaders among the teachers,
let them have more say over how school is
mn, and evaluate them based on their results
rather than telling them how to do every last
jot and tiddle of their job every day.
We have leamed these things—and i f I
might, since we're in Califomia, say a spiecial
word—therefore, I believe that having
worked for 12 years for higher standards,
more choices and greater changes in public
education, I'm in a little bit of a position to
say that i f 1 were a citizen of the State of
Califomia, I would not vote for Proposition
174, The Private Voucher Initiative.
Now, and let me tell you why. Let me tell
you why. First of all, keep in mind a lot of
the schools out here are doing a good job.
I can sav' this, you know, I never was part
of the Califomia education system. I have
studied this system out here for more than
a decade. They have undertaken a lot of very
impressive reforms and many of their schools
are doing a good job. I was interviewed last
night by two people from a newspaper in Sacramento, and one of them just volunteered
that he had two children in the publii schools
there, and they were getting a terrific education.
This bill would start by taking $1.3 billion
right off the top to send a check to people
who already have their kids in private
schools, and who didn't need any Govemment money to do it, and taking it right off
the top away from a school system that
doesn't have enough money to educate the
kids it's got in it in the first place.
Second thing it would do is to impose no
real standards on the quality of the programs
which could be funded: who could set up
a school; what standards they'd have to meet;
what tests the kids would have to pass. Just
take your voucher, and who cares whether
a private school is a legitimate school or not.
That is a significant issue. And all you have
to do is to work in this field for a few years
to understand that that is a significant issue.
Wouldn't it be ironic that at the very moment we're finally trying to find a way to
measure the performance and raise the
standards of the public schools, we turn
around and start sending tax money to private schools that didn't have to meet any
standards at all. When we're trying to get one
1987
part of our business, we're going to make the
other part worse.
And finally, let me just say, I have always
supported the notion that American schools
ought to have competition and the fact that
we have a vibrant tradition of pluralistic education and private schools and religious private schools was a good thing, not a bad thing
for America. But all the years when I grew
up, and all the times I saw that, and for a
couple years of my life when I was a little
boy, when I went to a Catholic school, when
my folks moved from one place to another,
and we lived way out in the country and
didn't know much about the schools in the
new area where we were, no one ever
thought that the church would want any
money from the taxpayers to run their
schools. In fact, they said just the opposite,
"We don't want to be involved in that."
That's what the First Amendment is all
about.
So I think we have to really think
through—I have spent 12 years before I became President overwhelmingly obsessed
with reform of the public school system,
wanting more choices in the system, wanting
more accountability, wanting more flexibility
about how schools were organized and established and operated. But I can tell you that
this is not the way to get it done, and the
people will regret this i f they pass it. I hope
the people of Califomia don't do that.
Now, you can educate people all you
want—and I wanted to say a little more about
that. The Labor Secretary and I are working
on trying to take all these 150 different Govemment training programs and give local
communities and States the power to consolidate them, working with you, and just fund
the things that work on a State-by-State basis,
and to set up a system of lifetime education
and training.
I don't know how many of you saw the
television program I did last night in California, but one man, looked to be in his early
fifties, saving, "We need a training program
that gives my company some incentives to
retrain me, not just people who are 25, but
people who are 55." And we are trving to
do that. We're trying to set up a lifetime education and training program that starts when
young people are in high school, so if they
�1990
Oct. 4 I Administration of William ]. Clinton, 1993
don't ask you to agree, but I ask you to make
the same arguments inside your own mind,
because I would never knowingly do anything to cost America jobs. I'm trying to create jobs in this country.
Now, I'll tell you what I really think. What
I really believe is that this is become the symbol of the legitimate grievances of the American working people about the way they've
been worked over the last 12 years. That's
what I think. And 1 think those grievances
are legitimate. And I think that people are
so insecure in their jobs, they're so uncertain
that the people they work for really care
about them, they're so uncertain about what
their kids are looking at in the future, that
people are reluctant to take any risks for
change.
And so let me close with what I started
with. I have got to lay a foundation of personal securitv' for the working people of this
country and their families in order to succeed
as your President, and you have to help me
do it. We have got to reform the job training
system of this country, to make it a reemployment system, not an unemployment system,
and to give it to kids starting when they're
in high school.
We have got to have an investment strategy that will create jobs here. And that's why
we removed all those export controls that
were cold war relics on computers and
supercomputers and telecommunications
equipment, opening just this month $37 billion worth of American products to exports.
That is important.
That's why I want to pass a crime bill to
put 50,000 more police officers on the street,
pass the Brady bill and take those automatic
weapons out of the hands of the teenagers
that are vandalizing and brutalizing our children in this country. And, my fellow Americans, that is why we have got to pass a comprehensive health care bill to provide security to all Americans. And we've got to do
it now.
How many Americans do you know who
lost their health insurance because they lost
their jobs? Who never got a pay increase because of the rising cost of their health care?
Who can never change jobs because they
have a sick child? Millions of them. How
many companies are represented in this
room who could be selling more everywhere
across the board, more abroad and more at
home, if their health care costs were no
greater than their competitors around the
world?
Let's face it folks, we're spending over 14
percent of our income on health care. Canada's at 10. Germany and Japan are under
nine. The Germans went up toward 9 percent of their income on health care, they had
a national outbreak of hysteria about how
they were losing control of their health care
system. And yet they all cover everybody and
no one loses their health insurance. And
when I say we can do that and we can do
it without a broad-based tax increase, people
look at me like I have slipped a gear. [Laughter]
But I have spent over 3 years studying this
system. And the First Lady and her task force
have mobilized thousands of experts in the
most intense effort to examine social reform
in my lifetime. And they have recommended
that we adopt a system which, first of all,
builds on the system tl. it you enjoy: an employer-based system v^'^ ere the employer
contributes and, in some cases, the employee
does and some not; a system that is focused
on keeping what is gmd about American
health care—doctors, and nurses, and medical research and technology—and fixing what
is wrong—not covering everybod)-, kicking
them off after they have a serious illness, not
letting people move their jobs, having some
people in such tiny groups of insurance that
40 percent of their premium goes to profit
and administrative costs, and spending a
dime on the dollar, a dime on every dollar
in a $90 billion system goes to pajjerwork
that wouldn't go in any other system in the
world—$90 billion a year on that alone.
Never mind the fraud and the abuse, and
the incentives in this system to chum it, to
perform unnecessary procedures just because the more you do the more you cam.
We can do better than that. So I want to
just say, this system will be a good one. Everybody will get a health care security card
like this. I feel like that guy in the ad. I'm
supposed to say, "Don't leave home without
it," when I pull it out. [Laughter] But I want
everybody to have a health care security card
like this. Just like a Social Security card. And
•
�/. C//n(fm, 1993
ore everywhere
id and more at
costs were no
3rs around the
>ending over 14
alth care. Canipan are under
toward 9 per1 care, they had
ria about how
leir health care
everybody and
nsurance. And
ind we can do
icrease, people
a gear. [Laughrs studying this
d her task force
experts in the
e social reform
recommended
ch, first of all,
1 enjoy: an emthe employer
the employee
[that is focused
l)out American
rses, and mediland fijdng what
Ivbodv, kicking
lous illness, not
Is, having some
insurance that
goes to profit
Id spending a
hn every dollar
to paperwork
system in the
|)n that alone.
Ihe abuse, and
Ito chum it, to
lures just bejiore you eam.
So I want to
I good one. Ev security card
lin the ad. I'm
I home without
r] But I want
• security card
lirity (;ard. And
Administration of William ]. Clinton, 1993 I Oct. 4
1991
I want people to have their health care access new businesses, and to smaller established
whether they're working or unemployed, businesses with lower wage employees that
whether they work for a little business or a are operating on narrow margins.
How are we going to pay for this? Twobig one.
Under the system we have proposed, if thirds of it will be paid for by employers and
you've got a better deal now, you can keep employees contributing into the system that
it. If your employer pays 100 percent of ben- they get a free ride in now. One-sixth of it
efits now, you can keep it. And we don't pro- will be paid for with a cigarette tax and with
pose to tax any benefits that are above the a fee on very large companies who opt out
minimum package. We told those who want- of the system so they can pay for the cost
ed that to give us 10 years before we put of insuring the poor and the discounts to
that provision in because within 10 years small business, and most important, for the
we'll nave the minimum benefit package we health education and research that makes us
start with, plus full dental benefits and full all richer because we are going to pay for
mental-health benefits and full preventive- that and for expanded public health clinics.
care benefits, so it will be as good or better And one-sixth of it will come from slowing
than any package now offered by any em- the rate of growth. When you hear people
ployer in America. Then, if somebody wants say, "Oh, Clinton wants to cut Medicare and
to buy something over and above that, we Medicaid, let me tell you something folks,
can talk about it. But we are not going to we're cutting defense. We've held all domestake anything away from you, you have.
tic investment that's discretionary' flat, which
What we are going to do is two things for means if I want to spend more money on
you if you have a good policy. We're going job training, on defense conversion, or on
to make it easier for your employer to keep Head Start, I have to go cut something else
these benefits you have now by slowing the dollar for dollar for the next 5 years. That's
rate of health care cost inflation, not by cut- what we've done. We've cut defense as much
ting health care spending, by slowing the rate as we possibly can right at the edge, held
of inflation in health care cost, and by remov- everything else flat.
ing the enormous burden of retiree benefits
You know what Medicare and Medicaid
from our most productive companies. That
are doing? They're going up at 3 times the
will stabilize the health care benefits of workrate of inflation. What have I proposed to
ing people and good plans.
do? Let them go up at twice the rate of inflaThe other thing we're going to do for you tion. They say in Washington I can't do it.
is to limit what can be taken away from you
I don't talk to a single doctor who underwhich is worth something. So by saying that
stands what we're going to do who doesn't
for people who don't have any insurance
think we can achieve those savings without
now, their employer will pay 80 percent and
hurting the quality of health care. If we can't
the employees will pay 20, we are saying that
no matter what happens to you, there's a get down to twice the rate of inflation from
limit to what can be taken away from you. 3 times the rate of inflation, there's someSo it will be easy for you to keep, easier for thing wrong somewhere.
Now, that's how we propose to finance
your employer to keep what you've got, and
for you, and there will be a limit to what this. And I am pleading with you to help me
pass this bill. No matter how good your
can be taken away.
Is it fair to ask all those employers and health care plan is now, don't you believe
employees who don't have any coverage now for a minute you could never lose it, or at
to contribute something? You bet it is. Why? least get locked into your present job. And
Because your premium's higher than it oth- I am pleading with you to do it so that we
erwise would be because you're paying for can give to the rest of America, as well as
to you and your families, the kind of personal
them now.
Can we do that without bankmpting small security we have got to have to face the bebusiness? Of course, we can. We have a plan wildering array of challenges that are out
that gives a significant discount to smaller there before us.
�him
1992
Oct. 4 I Administration of William J. Clinton, 1993
You know as well as I do that we are hurthng toward the 21st century into a world
that none of us can fully perceive. But we
have to imagine what we want it to be like.
We want it to be a world in which the old
rules that you grew up believing in apply in
a new and more exciting age, in which, if
you don't have job security, you at least have
employment security; in which the Govemment puts the people first, and in which people have security in their homes, on their
streets, in their education benefits, in their
health care benefits so that they are capable
of seizing these changes and making life richer and more different and more exciting than
it has ever been.
That is the great challenge before us. And
if we don't adopt the health care reform, we
won't get there. If we do, it will open the
way to the most incredible unleashing of
American energy that we have seen in more
than a generation. Together we can do it,
and I need your help.
Thank you very much, and God bless you.
NOTE: Tlie President spoke at 11:,30 a.m. in the
Grand Ballnwm of the San Francisco Hilton
Hotel. In his remarks, he referred to Albert
Shanker, president, American Federation of
Teachers.
Exchange With Reporters in
San Francisco
October
4,1993
Russia
Q. Did Yeltsin have a choice in using force
in Moscow?
The President. I doubt it. Once they were
armed, they were using their arms, they were
hurting people. I just don't see that they had
anyplace—he had those police officers instructed not to use force, and in fact, deployed in such a way that they couldn't effectively use force, and they were routed. I don't
see that he had any choice at all.
Q. Does this taint the move toward democracy in Russia?
The President. No. I think, first of all,
as I said today in my remarks, clearly, he
bent over backwards to avoid doing this. And
1 think he may even wonder whether he let
it go too far. But I think as long as his c-ommitment is clear, to get a new constitution,
to have new legislative elections, and have
a new election for the Presidency, so he puts
himself on the election block again, I don't
think it does taint it.
Somalia
Q. [Inaudible]
The President. The only thing that I have
authorized so far—and I want to say I'll be
doing a lot more work on this today, later
today, when I've got some time set aside to
go back to work on it—the only thing I have
done so far is to authorize the rangers that
are there who are wounded or exhausted or
done more than their fair share to be replaced, to roll over that group and then to
send some more people there with some armored support so that we can have some
more protection on the ground for our people. None of this happened when we had
28,000 people there. And even though there
are lots of U.N. forces there, not all of them
are able to do what our forces did before.
So I'm just not satisfied that the folks that
are there now have the protection they need.
So all I've authorized is a modest increase
to provide armored support, to provide greater protection for the people over there trying
to do their job.
This is not to signify some huge new commitment or offensive at this time, but I'm
just not satisfied that the American soldiers
that are there have the protection they need
under present circumstances. So I've authorized, after consultation with the Secretar)' of
Defense, a modest increase to get some more
armored protection for them.
Q. Were any American soldiers taken hostage or taken captive by Aideed's forces?
The President. It is possible, and if it happened, we want there to be a very clear waming that those young soldiers who are there
legally under intemational law, on behalf of
the United Nations, and they are to be treated according to the rules of intemational law,
which means not only no torture and no beating, but they're to have food and shelter and
medical attention. They're to be treated in
a proper way. And the United States will take
a very firm view of anything that happens
�THE WHITE HOUSE
Office of the Press Secretary
(Bryn Mawr, Pennsylvania)
For
Immediate Release
December 13, 1993
REMARKS BY THE PRESIDENT
IN ADDRESSING THE FUTURE OF ENTITLEMENTS CONFERENCE
I
Bryn Mawr College
Bryn Mawr, Pennsylvania
J
10:45 A.M.
EST
THE PRESIDENT:
Thank you very much.
Ladies and gentlemen, i t ' s a pleasure for me to ba
here, i have looked forward to this conference with great
anticipation for some time, i want to thank Congresswoman
Margolies-Mezvinsky for getting this together and for inviting me
here, i thank President McPherson and this wonderful i n s t i t u t i o n
for hosting us. (Applause.) I'm delighted that Speaker Foley
and Congressman Penny are here for the Congress; and Senator
Kerrey and Senator Walker, your own senator, are here to talk
about these important issues.
I want to also thank a l l the people who helped to
put t h i s conference together and to a l l the people i n our
administration who were invited and are here participating, we
pretty much shut the town down in Washington today and just sort
of came up here to Pennsylvania to talk about entitlements.
(Laughter and applause.)
This i s a very serious subject, worthy of the kind
of thoughtful attention that i t w i l l be given today. I hope
there w i l l be a great national discussion of the issues that we
discuss today, and I hope that this w i l l be the beginning of a
debate that w i l l carry through for the next several years.
I ran for President because I thought our nation was
going In the wrong direction economically, and that our society
was coming apart when i t ought to be coming together. I wanted
to work hard to create jobs and raise incomes for the vast mass
of Americans; and to t r y to bring our country back together by
restoring the bonds of family and c i v i l i t y and community, without
which we cannot hope to pass the American dream on to the
students who are here at Bryn Mawr or the students who w i l l come
behind.
To do t h i s , we must a l l — without regard to party
or philosophy — at least agree to face the real problems of this
country: 20 years of stagnant wages; 30 years of family decline,
concentrated heavily among the poor; 12 years i n which our debt
has quadrupled, but investment in our future has lagged leaving
us with twin d e f i c i t s , a massive budget d e f i c i t and a less
publicized investment d e f i c i t
the gap between what we need to
invest to compete and win, and what we are receiving in terms of
new s k i l l s and new opportunities.
These things are linked. Creating jobs in growth
requires that we bring down both the budget d e f i c i t and the
investment d e f i c i t . High government d e f i c i t s keep invest —
interest rates high, they crowd out private demands for c a p i t a l ,
they take more government money to service the debt. A l l this
tends to reduce investment, productivity, jobs and ultimately,
l i v i n g standards.
The d e f i c i t increased so dramatically over the l a s t
12 years because of things that happened on tho spending side and
�- 2-
on the revenue side. Defense increased dramatically until 1987,
but i t ' s been coming down since then quite sharply. However, the
place of defense, as we'll see later, has been more than
overtaken by an explosion in health care cost going up for the
government at roughly three times the rate of Inflation.
Interest on the debt i s obviously increased more when interest
rates were high than now, but always when the accumulated
national debt goes up. And the larger number of poor people in
our country has inevitably led to greater spending on programs
that are targeted to the poor.
On the revenue side, the tax cut of 1981 wound up
being roughly twice the percentage of our income that was
o r i g i n a l l y proposed by President Reagan as the President and the
Congress entered into a bidding war. And then in 1986 we adopted
indexing, a principle that i s c l e a r l y f a i r , but reduced the rate
of growth of federal revenues by adjusting people's taxes
downward as i n f l a t i o n pushed their incomes upward. And f i n a l l y ,
a prolonged period of very slow growth has c l e a r l y reduced
government revenues and added to the d e f i c i t .
I f you look at this chart, you w i l l see that we
inherited a d e f i c i t that was projected to be actually
when I
took o f f i c e , for the f i s c a l year that ended at the end of
September — above $300 b i l l i o n . I t was obvious that — and i t
was headed upward. This was the line — the blue line here i s
what I found when I became President. I t was clear that
something had to be done. I asked the Congress to pass the
largest d e f i c i t reduction package in history. I t had $255
b i l l i o n in real enforceable spending reductions from hundreds of
programs. Now, l e t ' s make i t clear what you mean, when you hear
the word spending reductions or cuts in Washington terms, i t can
mean two things. One i s a reduction in the rate of increase in
government spending from the previous five-year budget, which i s
s t i l l an increase i n spending, but not as much as i t would have
been had the new reduction not taken place.
The second thing i t might mean i s what you mean when
you say cut, which i s you spend less than you did before you used
the word. (Laughter.) And i t i s important to know which one
you're talking about. However, both are good in terms of
reducing the d e f i c i t over a five-year period. We not only
reduced the rate of increase, but actually adopted hundreds of
cuts this year. The budget year that started on October 1st has
less spending than the previous year in 342 separate accounts of
the federal budget.
Adjusted for i n f l a t i o n , this means a discretionary
spending cut of 12 percent over the next five years, more than
was done under the previous two administrations. I f this
continues, according to the Wall Street Journal, then by 1998,
discretionary spending — that i s the non-entitlement spending
and discounting interest on the debt, the things that we make
decisions on every year — w i l l be less than 7 percent of our
annual income; about half the level i t was in the 1960s.
In addition to tha discretionary spending cuts, our
budget did reduce entitlements, making reductions in agricultural
subsidies, asking upper-income recipients of Social Security to
pay more tax on their income, lowering reimbursements to Medicare
providers, making other adjustments in Medicaid and in veterans'
benefits. Now, a l l these cuts are already on the books. We are
also cutting — with the help of the Vice President's National
Performance Review — over 250,000 positions from the federal
payrolls, largely by a t t r i t i o n and early retirement over the next
five years. We're f i n a l l y attempting to reform the system in
ways that w i l l permit us to save b i l l i o n s of more dollars in
discretionary spending through reform of personnel budgeting and,
most importantly, procurement systems -- i f the Congress w i l l
authorize a l l three of those systematic reforms.
�- 3 -
We also passed some taxes — a modest 4.3 cents-agallon gas tax which, so far, has been barely f e l t because we
have the lowest price in o i l in many, many years so the price of
gasoline has actually dropped since the gas tax was put on.
We
also asked the top 1.2 percent of Americans to pay higher income
taxes because their incomes went up the most and their taxes
dropped the most in the previous 12 years. The corporate income
tax on corporations with incomes above $10 million a year was
raised. Middle-class families w i l l pay s l i g h t l y less taxes
because, again, of the adjustments for i n f l a t i o n . And taxes were
cut for 15 million families who worked for very modest wages as a
dramatic incentive to get them to continue to chose work over
welfare.
When Congresswoman Mezvinsky and her colleagues
voted for this economic plan, they voted for your economic
future, for lower d e f i c i t s , higher growth and for better jobs.
They did vote to cut spending. They did not vote to raise taxes
on the middle c l a s s . And, frankly, the kinds of radio ads that
have been -- this i s the only p o l i t i c a l thing I'm going to say
today (laughter) -- but the kind of radio ads that have been run
against here in this d i s t r i c t do not serve the public interest
because they do not t e l l the truth. (Applause.)
I f somebody wants to say that we should not have
raised income taxes on the top 1.2 percent of the American
people, l e t them advertise that on the radio. I f someone wants
to say that the corporate income taxes above $10 million a year
in income should not have been raised, l e t them advertise that on
the radio, i f someone wants to say that the gas tax was unfair,
let them advertise that on the radio. But do not try to t e l l th«
American people there were no budget cuts and they paid a l l the
tax increases, because that i s simply not true. And we have a
lot of work to do in this country and a lot of honest
disagreements to have, we need not expend our energy on other
things. And i f you don't believe that read the front page of the
Wall street Journal this morning. That i s hardly the House organ
of my administration. (Laughter.)
Read the front page of the Wall Street Journal t h l i
morning talking about the unprecedented cuts that this budget
made, i t does not do anybody any good to continue to assert
things about that economic plan that are not true. The markets
had i t figured out. That's why interest rates are down and
investment i s up. That's why inflation i s down and more jobs
have come into this economy in the l a s t 10 months than in the
previous four years. The markets figured i t out. A l l the saoke
and mirrors and radio ads in the world couldn't confuse the
people that had to make investment decisions and read the fine
print.
(Applause.)
That's the good news. Now l e t ' s talk about the
continuing problems, the real problems. The economic plan which
the Congress adopted represents the red line. That's how much
less the d e f i c i t w i l l be. And the aggregate amount between these
two lines i s how much less our total debt w i l l be by 1998.
The
yellow line represents where we can go, by conservative
estimates, i f the health care plan i s adopted. You s t i l l have an
operating d e f i c i t , and the national debt w i l l s t i l l increase by
this amount, but not by that amount.
So we are c l e a r l y better off with the economic plan.
We w i l l have to make further cuts, by the way, to meet this red
l i n e . We're not done with that. We w i l l be better off s t i l l i f
we do something about health care -- I ' l l say more about that in
a minute — but there i s s t i l l more to be done. The debt of this
country now i s over $4 b i l l i o n . That means our accumulated debt
i s more than two-thirds our annual income, i t i s important that
the debt, as a percentage of our annual income, go down. I t i s
way too high, much higher than i t has been outside of war time.
I t i s important that the annual d e f i c i t , as a percentage of our
income, go down. I t w i l l go down under this plan, but we can do
MORE
�.i
- 4 -
more to try to reduce the aggregate debt and the d e f i c i t as a
percentage of our income. Both of them are too high.
»n V
l e t ' s look at the next chart here, i think vou
where^vou'Lnf
audience. This chart just baslJaUy shows
«ovo^.^ .
federal taxes, or when the
? n nSrnLr^°''
-- borrows money, in debt, we spend
JhAii^^rS
entitlements - that i s what we're here to talk
5^nV^^°'^^^r" ^^""^ 2^ percent on defense, i t ' s going down, as
you'll see in a minute; about 18 percent on non-defense,
?n
i f ^^^"^debt.
^^^^ constant; and about 14 percent
in ?nter««ro;
interest on I^J^'^^
the national
J ^ ^ K ^ 1°°^
^^^^^
This chart gives
? ^^^""^ spending categories are headed in which
wh^?
^^^'^^^^ ^ " " " a l real growth - now, i want to t e l l you
what this means, i haven't lived in Washington very long so l
s t i i i use ordinary meanings for words. (Laughter.) When you see
yftirrS?.^ government chart, that means adjusted for inflation.
wt«h^?J
''^''^^ ^^"^ ^ ^ ^ t
a dictionary, but that i s
n i ^ / ! ? " ^ ' ^" "^^^^^ words, these are the numbers adjusted
2
u ?! ^ projected inflation growth of more or less
^ o ^ f n o f ? ^ ^^^^ percent a year, i f you look at that you see
?hfnS !
going down. Frankly, we're reducing i t as much as I
^®JP°"sibly can; and, in fact, more than we responsibly
can unless Congress w i l l pass the procurement reform so the
Defense Department can buy what i t needs for our national defense
at more e f f i c i e n t prices. But i hope that w i l l happen.
vou an
^>,«-
entitlements — we'll come to that in a minute
entitlements are - they're also going down
r e l a t i v e to i n f l a t i o n . That i s b a s i c a l l y the entitlements for
the poor and the veterans' benefits and agriculture benefits.
,r«„
N°"-^ffense discretionary i s a l i t t l e under zero, as
? C J^'^at's a l l the investments for education, for training,
for technology
for defense conversion, for you-name-it, anything
h2L o
^^'^
anything we spend money on that we
nave an option not to spend money on that -- we'll come back to
tnat
i s going down r e l a t i v e to Inflation, i f there were no
i n f l a t i o n numbers here, i t would actually be just a tiny b i t
above the l i n e , but i t i s functionally zero. For a l l p r a c t i c a l
purposes, i f i want to increase the amount of money, for example,
we spend on Head s t a r t in Pennsylvania by a million dollars, we
have to cut something else by a million dollars. We are not
increasing the aggregate amount of this kind of discretionary
spending. Net Interests w i l l go up and, again, this i s adjusted
i vZ^r
^°
continuing to r i s e because the amount of
the debt i s continuing to r i s e .
^r,^l»^^
inflation
security w i l l go up, again, adjusted for
This i s about — this i s the population increase,
social security. There aren't new benefits being
aaaed, so there w i l l be a couple of percent growth in population
between now and 1998. so i t w i l l go up by the amount of
increasing numbers of people on Social security.
And look what happens to health entitlement. I t ' s
going up more than twice as much as social Security, more than
three times as much as net interest, and everything else i s going
down. Now that's what's happening. Let's go on to the next
chart.
^
As the chart shows here, this i s the new revenues
we re getting in this year. Now, the new revenues include the
tax increases that we just talked about. They're about 40
percent of that revenue growth. The rest of i t ' s just ordinary
increases in tax revenues to the government coming from
increasing employment or increasing incomes. So i t ' s -- every
year
and inflation -- so every year we get some revenue
growth. This revenue chart i s about 60 percent ordinary revenue
growth, 40 percent new taxes. As you can see, the whole thing
�- 5-
goes to d e f i c i t reduction, interest increases and entitlement
increases. That's where the money went.
Eighty percent of the new revenues, including taxes
and revenue growth went to d e f i c i t reduction and interest
increases; 20 percent of i t went to entitlement increases. As
you can see, that does not leave a great deal of room for any
kind of future investments. This i s something that presumably
both Senator Kerrey and Congressman Penny w i l l talk about today.
But there i s , I think i t ' s f a i r to say, a broad consensus in the
Congress among Republicans and Democrats, among l i b e r a l s and
conservatives, that there are some things on which we are not
spending enough money to get us to the 21st century. We have put
ourselves in a box after the l a s t -- trying to work our way out
of this d e f i c i t business, so that we do not have the f l e x i b i l i t y
to make those kind of growth-oriented investments in the public
sector.
That i s a dilemma. So we have two continuing
dilemmas, i f you w i l l
one, we s t i l l got a d e f i c i t and a debt
problem; two, there are things which l i t e r a l l y over 80 percent of
the Congress -- both parties -- would agree we should invest more
in that we simply cannot invest more in because of the problem we
have with the budget.
Could we go on now into the next chart?
go into the next chart.
Now, t h i s gives you a
spending. And I know Alice R i v l i n
before — and she knows a lot more
but I think i t ' s worth going back
entitlements conference,
so i t ' s
entitlement i s . And when you hear
they are.
Let's
picture of entitlement
talked about this a l i t t l e
about i t than I ever w i l l —
over because this i s an
worth focusing on what an
people use that term, what
So look at t h i s . These entitlement programs are
programs that provide benefits for people that have certain
c h a r a c t e r i s t i c s . People who meet the test of e l i g i b i l i t y for the
program get i t , notwithstanding some previously budgeted amount
for that program. That's why they're called entitlements.
For example, someone who has paid into the Social
Security Trust Fund, along with his or her employer, who i s 65
becomes "entitled" to Social Security. You just go to the Social
Security office with the documents that prove you're e l i g i b l e and
you're going to get the check no matter how many other people
qualify for Social Security. Since i t ' s hard to know in advance
exactly how many people w i l l apply for benefits. Congress doesn't
set aside a specific amount of money as i t does for the
discretionary spending programs. Instead, i t simply directs to
Treasury to make payments to everybody who applies and q u a l i f i e s
for the benefits under the laws.
There are two main kinds of entitlements. And you
can just see by looking up here what they are. They are the
contributory entitlements; that i s , you're e n t i t l e d to something
because you paid into i t . I t ' s contract oriented. social
Security i s a contributory entitlement. Medicare i s a
contributory entitlement. Federal retirement i s a contributory
entitlement. You did the work, you put the money aside, you get
i t back.
Then there are the entitlements for those in need,
or entitlements that are in a special category because you can't
predict how much i s going to be needed every year. The
entitlements for those in need would include AFDC, supplemental
security income, the Medicaid program, medical care for the poor.
Agriculture i s in a separate category. I t has been treated as an
entitlement partly because i t ' s so caught up in the global
economy, i t ' s impossible to predict from year to year how much of
the support subsidies w i l l be needed.
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�- 6 -
r^^^^^A
contributory retirements are sometimes
!7,^5i
entitlements because they benefit everybody.
I h l l t t i r \ t \ ^ ^ l ' ?^
Will t e l l you in a few minutes,
h^?S
°^
wealthy - i f you pay in, you get
^^^^ ? ""^^^ °^ ^^^^"5 increase. Now, the poor people's
f^;i
' ^ J ^ ^ ^ ' are mostly in the category of l i k e AFDC and
IfS,^""^ Medicaid. But l e t me show you something about
entitlements, because most people, I think, don't know
18 oercfn? i J r ^ ' f i ^ y
percent of the total. Medicare i s
'
i s 11 percent, federal retirement i s 8
do^S
J:n^nS?^^°^^''^
^ percent - obviously i t goes up or
nponi'o ^ "'^^''^
""^^^
unemployment rate i s and how long
n!J?:!unemployed. Food stamps are 4 percent, other i s 11
B„«rM^«« 4. 1 ^"
Other you have agriculture, veterans,
nooSi!
^^..^^''''''^^y ^"^^^^
which i s for lower-income elderly
n a J ^ i n / " SS"^
welfare program of this 11 percent i s 2
S^^.^!?r
average monthly welfare benefit in America i s
actually lower today, adjusted for i n f l a t i o n , than i t was 20
years ago. The program i s more expensive because there are more
ou?
^ ^^^"^
^uit« interesting to point that
?o I K ? ! people are surprised to know that the welfare budget
tthe
L ^ uoverall
a ^ . ^ r / ^ 'federal
' ' ' ^ ^ ? ^ budget. entitlements, or about one percent of
, N®**' the entitlement programs for the needy, as you
S^J!
^"''^ ^2 percent of the whole budget; or about a
?^!^JL°T o
entitlement spending. The biggest entitlements
111
^ ^^^"'^•ity and Medicare. They are about 61 percent of
tne total
when you add federal c i v i l i a n retirement and military
retirement, you've got over two-thirds of the retirements there
— of the entitlements there.
na««sn« ^y. J ^ Z ^ l . ^ . ^ ^ ^ ^ ^ ^^'^ important to point out, just in
S!^!:^'
^ behind every one of these entitlements there's a
rnlnVl'a
? 5 ^ ^'^^ ^^'^
controversial when they're debated In
i f
^^^^ organized interest groups, there are
^^mSiK/^^'w^^i^®''^ ^^^"^
l i t e r a l l y entitled to receive
«n??^?i^^ back that they paid into. I t i s the middle-class
entitlements, that have united us and brought us together, that
aiso have the strongest constituencies and provoke the biggest
controversies when we get into dealing with t h i s . And these
programs are also very important in human terms. And I just
might mention, too, the — i f you look at Medicare, before
rlTSiS^"'
was a good chance that Americans, when they got
riro
SSI^
need charity care, would simply do without health
m!^?' /^'^^y nearly 34 million people go to see a doctor, or get
medical care because of the Medicare program.
maa«o ^ V,
f a c i a l Security has changed, l i t e r a l l y , what i t
onr
beginning of 1985, for the f i r s t time In
our nistory, the percentage of our elderly people who were above
/ S h ^ ? " ^ i"® "^^^ better than the percentage of the population
? L L
\u
words, the poverty rate for the elderly was
lower than the poverty rate of the general population.
...
.
I t i s very d i f f i c u l t to say that this waa a bad
^'v.
" ^ ^^9"®
a good thing, we should not view
this whole program, in other words, as welfare, i t i s not a
welfare program. Does that mean that there should be no changes
i? f
means that we should be very sensitive about
the fact that this i s something that has worked. Because of
these programs, we are a h e a l t h i e r people. We are a more unified
country, we treat out e l d e r l y with greater dignity by having
mli^V
r "
^ decent retirement and to maintain a
i??;®"^
standard of l i v i n g , independent of whatever their
cnildren are required to do, and to make them more independent
over the long run. This i s a huge deal in a country where the
fastest growing group of people, in percentage terms, are people
over 80 years of age.
(AppLause.) This i s a big deal.
(Applause.)
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�- 7 -
...
_
I recommended exposing more of the incomes of
the top 10 or 12 percent of Social security recipients, somewhere
in that range, to taxation, and Congress adopted a modified
version of that plan. That was an entitlements move, i thought
i t was an appropriate thing to do because a lot of people in
upper-income levels, by definition, have other sources of income,
too, and w i l l get back what they paid into Social Security plus
reasonable interest growth in a reasonably short period of time,
so I thought i t was f a i r to do that.
We recommended upper-income people pay more for
Medicare benefits, i think that i s reasonable to do because the
Medicare payment i t s e l f only covers a small percentage of the
total cost of Medicare, where i think we should draw the l i n e ,
however, i s in trying to have happen to the elderly middle class
What i s happening to the non-elderly middle c l a s s . A l l over the
world today, and certainly in a l l the advanced countries of the
world, the middle class i s under assault. Earnings inequality
SfLj^'^^!^!®^
^^^^ ^2 years. I t i s becoming very
d i f f i c u l t for working people to sustain a middle-class way of
ll£e. we are going to have to a l l change. We've got to change
our government p o l i c i e s . People are going to have to acquire
much higher levels of s k i l l and be committed to training for a
lifetime. There are a lot of things that have to be done. But
the general policy point, i think, i s v a l i d . We do not want to
? ^ problem l i k e the d e f i c i t which i s aggravated because '
middle-class people's incomes have stagnated by having the same
sort of income stagnation for the middle-class elderly.
...
^
So I think there are things we can do to deal with
V:f'.^
^^^^ ^® discussed l a t e r . We did some things to deal"
with the entitlements in the l a s t budget. But l e t us not say
that i t was a bad thing to dramatically reduce poverty among
elderly people, or that i t i s a bad thing for our consumer
economy to maintain a large number of middle-class people in
their retirement years. That means that we have to have honest,
s p e c i f i c and clear discussions of t h i s , as unencumbered as
possible by these sort of rhetorical bombs flying in the a i r frow
the l e f t and the right.
Just talking i t through and listening to each other
and asking ourselves what w i l l be the p r a c t i c a l impact of
proposed change A, B or C; and w i l l we a l l be more secure, w i l l
our children and our grandchildren be better off; w i l l this help
to s t a b i l i z e and increase the middle class bSillast of our
^K^i^^y^
^ think we are on the verge, perhaps, of having
that discussion in no small measure because of this kind of
conference..
Now, l e t ' s go on and l e t ' s look at what I think the
real problem in the entitlements i s , i s c l e a r l y the danger signal
for the long run. Let's look at the next chart. As you can see,
20 years ago health spending and entitlements -- Medicare and
Medicaid -- 13 percent of the t o t a l ; 1983, 19 percent of tha
total; 1993, 30 percent of the total; 2003, 43 percent of the
total.
Keep in mind -- and this i s with the number of elderly
people going up l i k e crazy, so the population of people drawing
Social security i s going way up, right? And s t i l l , look at that.
So, c l e a r l y , that i s the portion of government
spending that i s out of control. That i s the portion of
entitlement spending that i s out of control, NOW l e t me just
i l l u s t r a t e i t by a couple more charts, real quickly. Let's go to
the next one.
Non-defense discretionary outlays are going down as
a percent of our income, s o c i a l Security outlays as a percentage
of our income i s solid, stable here. I t could go up some in the
next century, i s projected to when a l l the baby boomers go in, I
heard Ms. R i v l i n refer to that as the President's generation.
(Laughter,) I am the oldest of the baby-boomers.
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�- 8-
But s t i l l , you see, i t ' s a stable as a percentage of
the gross national product. And the Congress, in 1983, after the
Bipartisan commission on Social security made recommendations for
fixing Social Security, attempted to keep this number stable by
gradually raising the retirement from 65 yo 67, by about a month
a year over a prolonged period of time starting just in the next
century.
Now l e t ' s go on to the l a s t one. This chart shows
you that unlike social Security and discretionary spending,
medical spending i s going up l i k e a rocket. Medicare and
Medicaid have t r i p l e d since 1982. Medicare and Medicaid w i l l
soon cost more than s o c i a l Security, And next year for the f i r s t
time -- i n large measure because Medicaid i s a state-federal
matching program, so that every state has to put in money along
with the federal government -- next year, for the f i r s t time,
states w i l l spend more money on health care than education. And
since we -- and since I supported t h i s , I see other present and
former governors around this table -- in the 1980s we said to the
national government, "You've got a problem with the d e f i c i t ,
we'll spend more on education. You do what you have to do to
deal with your other problems," This i s a very serious danger
signal, i f you want the states to spend more educating people,
getting children to the point where they can compete, training
the work force -- to have the states a l l of the sudden spending
more on health care than education i s a very serious danger
signal for the distribution of r e s p o n s i b i l i t i e s between the state
and the federal government.
Now, we have some options, i f we want to control
Medicare and Medicaid spending, b a s i c a l l y we have some options.
And to be f a i r , again I want to say during the 1980s under tha
Reagan and Bush administration
the two administrations and tha
United States Congress did try to cooperate on several things to
control Medicare and Medicaid spending. They took total pricing
controls away from hospitals and doctors. They t r i e d to do a
number of things. But what happened? I f you control the price
of a given product in this environment, what happens? Providart
can provide more products, i mean, more of the same product,
right? You increase the volume i f you lower the price, and tha
money s t i l l goes up. That's one problem. Secondly, poverty
increased i n the '80s and i s continuing to increase among tha
poor and the -- both the idle and the working poor -- and that
drives the Medicaid budget up. so controlling unit prices didn't
work. The other thing you could argue that we could do i s to try
to control the categories within Medicare and Medicaid;
b a s i c a l l y , just spend less, i n other words, even though they're
entitlements, just say we are going to spend less on certain
categories by both controlling volume and price, i s there a
problem with that? Yes there i s . what i s i t ? Any doctor or
hospital w i l l t e l l you that there has been a l o t of cost shifting
in this health care system, and i t ' s one of the causes of r i s i n g
prices and inefficiency, cost shifting largely occurs in two
ways
when hospitals have to care for people who don't have any
insurance, or when they provide government funded health caro at
less than their cost of providing the service, they s h i f t the
cost onto the private sector.
So we could bring this d e f i c i t down — we could do
this — I want to -- l e t ' s 'fess up, we could do t h i s , we could
just cut how much we're going to spend on Medicare and Medicaid,
even though i t ' s an entitlement, in terms of price per unit and
volume, we can just take 'er down. But i f we do that, what w i l l
happen? Those costs w i l l be shifted by the health care providers
to the people who already are providing insurance; with the
impact that i t w i l l be a hidden tax increase on businesses and on
employees. Employees w i l l probably see i t in not getting pay
raises they otherwise would have gotten. Businesses w i l l see i t
in spending more on health insurance premiums and having less to
reinvest i n the business or to take in profits, i don't think i t
i s f a i r thing to do. That i s why our administration has argued
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�- 9 -
that i f you r e a l l y want to solve this problem, you have to go
back and have comprehensive health care reform. This i s the only
country in the world that doesn't find a way to solve that issue,
that doesn't give -- the only advanced nation, that i s -- that
doesn't give basic health care to a l l i t s citizens within a
framework that controls costs in the public and private sector.
We're spending 14.5 percent of our income on health
care. Nobody else i s over ten; Germany and Japan are at nine.
The health outcomes of other countries are roughly similar to
ours. We can't get down to where they are because we spend more
on technology and more on, b a s i c a l l y , costly treatments than
other countries do, and more on medical research. And that's
fine. And we can't get down to where they do because we have
more violence and higher rates of AIDS and other very expensive
diseases than other countries. But we could do better. And
unless we do better in an overall way, in my judgement, we are
going to be in trouble.
Now we had a nonpartisan analysis by the respected
firm of Lewin-VHI l a s t week about our health care plan. This
company does research on the economics of health care for
businesses, unions, consumer groups. I t includes people who
served in the Reagan and Bush administrations as budget and
health o f f i c i a l s . They say that our plan w i l l reduce the
d e f i c i t , we think i t w i l l reduce i t even more than they w i l l . I
won't get into the details of that today, we're here to talk
about entitlements. The point I want to make i s I believe you
don't entitlement control, you don't get ultimate d e f i c i t control
unless you do something about Medicare and Medicaid. I believe
you don't get that done just by cutting Medicare and Medicaid
unless you want to hurt the private sector. Therefore, I think
we have to have some sort of health reform. That's what I
believe. You have to decide i f you believe that, but I think
i t ' s important. (Applause.)
Let me just close with t h i s . This i s the lead
e d i t o r i a l in this morning's Washington Post, I t says — on tha
entitlements mess — and i t says as follows: "Nor have a l l tha
entitlements been badly behaved in recent years in terms of
costs. The health care programs are the budget busters. By
contrast Social security costs have risen in "stately fashion"
with population and i n f l a t i o n . And the costs of a l l the other
entitlements taken together, including those that support the
poor has declined in real terms"
remember what "real" means
in Washington, less than the rate of inflation, "The real
federal budget problem" -- that's the normal word " r e a l " . Hera
they mean real l i k e you do. (Laughter,)
"The real federal budgatt
problem i s n ' t entitlements, i t ' s health care."
so I say to you we can talk about these other
entitlements and we should. As we talk about them, l e t us not
make our middle-class squeeze problem worse than i t i s already.
That's one of the profound problems that i s driving this countryOne of the reasons that Senator wofford i s in the senate today,
i s because of the anxieties of middle-class workers in
Pennsylvania.
Let us continue to work on this d e f i c i t . Let ua
r e a l i z e the d e f i c i t i s too big and the debt i s much too large as
a percentage of our gross national product. Let us realize that
there are two problems with i t . One i s the d e f i c i t and the other
i s we aren't investing enough. But on the entitlements issue, I
would argue the real c u l p r i t i s health care costs, and we can
only address i t i f we have comprehensive health care reform.
And l e t me close by saying one more time, i f Marge
Mezvinsky hadn't voted for that budget, we wouldn't be here
celebrating economic progress or talking about entitlements.
We'd s t i l l be back in Washington throwing mudballs at each other.
And I respect her for that and I'm glad to be here today.
(Applause.)
END
11:24 A.M.
EST
�THE
WHITE HOUSE
O f f i c e o f t h e Press Secretary
For Immediate Release
REMARKS BY THE FIRST LADY
TO THE AMERICAN MEDICAL ASSOCIATION
June 13, 1993
Chicago, I l l i n o i s
MRS. CLINTON: Thank you v e r y much, Mr. Speaker; a l l o f
t h e members o f t h e House o f Delegates, t h e o f f i c e r s and t r u s t e e s o f
t h e AMA, and a l l whom you r e p r e s e n t . I t i s an honor f o r me t o be
w i t h you a t t h i s meeting and t o have t h e o p p o r t u n i t y t o p a r t i c i p a t e
w i t h you i n an ongoing c o n v e r s a t i o n about our h e a l t h care system and
t h e k i n d s o f c o n s t r u c t i v e changes t h a t we a l l wish t o see brought t o
it.
I know t h a t you have, t h r o u g h H e a l t h Access America, and
t h r o u g h o t h e r a c t i v i t i e s and programs o f t h e AMA been deeply i n v o l v e d
i n t h i s c o n v e r s a t i o n a l r e a d y , and a l l o f us are g r a t e f u l f o r your
contribution.
I'm a l s o pleased t h a t you i n v i t e d s t u d e n t s from t h e
Nathan Davis Elementary School t o j o i n us here t h i s a f t e r n o o n .
(Applause.) I know t h a t the AMA has a s p e c i a l r e l a t i o n s h i p w i t h t h i s
s c h o o l , named as i t i s f o r the founder o f t h e AMA, and t h a t t h e AMA
p a r t i c i p a t e s i n i t s c o r p o r a t e c a p a c i t y i n t h e Adopt a School program
here i n Chicago. You have made a r e a l c o n t r i b u t i o n t o these young
men and women. And not only have you p r o v i d e d f r e e immunizations and
p h y s i c a l s and l e c t u r e s and h e l p about h e a l t h and r e l a t e d m a t t e r s , b u t
you have served as r o l e models and mentors. I t i s very i m p o r t a n t
t h a t a l l o f us as a d u l t s do what we can t o g i v e young people t h e
s k i l l s t h e y w i l l need t o become r e s p o n s i b l e and s u c c e s s f u l a d u l t s .
And I c o n g r a t u l a t e you f o r your e f f o r t s and welcome t h e s t u d e n t s here
today.
A l l o f us respond t o c h i l d r e n . We want t o n u r t u r e them
so t h e y can dream t h e dreams t h a t f r e e and h e a l t h y c h i l d r e n should
have. T h i s i s our p r i m a r y r e s p o n s i b i l i t y as a d u l t s . And i t i s our
p r i m a r y r e s p o n s i b i l i t y as a government. We should stand behind
f a m i l i e s , t e a c h e r s and o t h e r s who work w i t h t h e young, so t h a t we can
enable them t o meet t h e i r own needs by becoming s e l f - s u f f i c i e n t and
r e s p o n s i b l e so t h a t t h e y , i n t u r n , w i l l be a b l e t o meet t h e i r
f a m i l i e s and t h e i r own c h i l d r e n ' s needs.
When I was growing up, not f a r from where we are today,
t h i s seemed an e a s i e r t a s k . There seemed t o be more s t r o n g f a m i l i e s .
There seemed t o be s a f e r neighborhoods. There seemed t o be an
o u t l o o k o f c a r i n g and c o o p e r a t i o n among a d u l t s t h a t stood f o r and
behind c h i l d r e n .
I remember so w e l l my f a t h e r saying t o me t h a t i f
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�- 2 -
you g e t i n t r o u b l e a t s c h o o l , you g e t i n t r o u b l e a t home -- no
q u e s t i o n s asked — because t h e r e was t h i s sense among t h e a d u l t
community t h a t a l l o f them, from my c h i l d ' s p e r s p e c t i v e , were
i n v o l v e d i n h e l p i n g t h e i r own and o t h e r s ' c h i l d r e n .
Much has changed s i n c e those days. We have l o s t some o f
t h e hope and optimism o f t h a t e a r l i e r t i m e . Today, we t o o o f t e n meet
our g r e a t e s t c h a l l e n g e s , whether i t i s t h e r a i s i n g o f c h i l d r e n o r
r e f o r m i n g t h e h e a l t h care system, w i t h a sense t h a t our problems have
grown t o o l a r g e and unmanageable. And I don't need t o t e l l you t h a t
k i n d o f a t t i t u d e begins t o undermine one's sense o f hope, optimism,
and even competence.
We know now — and you know b e t t e r t h a n I — t h a t over
t h e l a s t decade our h e a l t h care system has been under e x t r a o r d i n a r y
stress.
I t i s one o f t h e many i n s t i t u t i o n s i n our s o c i e t y t h a t has
e x p e r i e n c e d such s t r e s s . That s t r e s s has begun t o break down many o f
t h e r e l a t i o n s h i p s t h a t should s t a n d a t t h e core o f t h e h e a l t h care
system. That breakdown has, i n t u r n , undermined your p r o f e s s i o n i n
many ways, changing t h e n a t u r e o f and t h e rewards o f p r a c t i c i n g
medicine.
Most d o c t o r s and o t h e r h e a l t h care p r o f e s s i o n a l s choose
c a r e e r s i n h e a l t h and medicine because t h e y want t o h e l p people. But
t o o o f t e n because our system i s n ' t w o r k i n g and we haven't taken f u l l
r e s p o n s i b i l i t y f o r f i x i n g i t , t h a t motive i s clouded by p e r c e p t i o n s
t h a t d o c t o r s a r e n ' t t h e same as t h e y used t o be. They're n o t r e a l l y
d o i n g what they used t o do. They don't r e a l l y care l i k e they once
did.
You know and I know t h a t we have t o work harder t o renew
a t r u s t i n who d o c t o r s a r e and what d o c t o r s do. That i s a l s o n o t
u n i q u e t o t h e medical community. J u s t as our i n s t i t u t i o n s across
s o c i e t y a r e under a t t a c k and s t r e s s , a l l elements o f those
i n s t i t u t i o n s are f i n d i n g t h a t t h e y no l o n g e r can command t h e t r u s t
and r e s p e c t , whether we t a l k o f p a r e n t s o r government o f f i c i a l s o r
o t h e r p r o f e s s i o n a l s -- p o l i c e o f f i c e r s , t e a c h e r s -- t h a t should come
w i t h g i v i n g o f themselves and d o i n g a j o b w e l l t h a t needs t o be done.
But f o c u s i n g t h i s a f t e r n o o n on those concerns t h a t a r e
y o u r s — what has happened w i t h medicine, what i s l i k e l y t o happen —
we need t o s t a r t w i t h a fundamental commitment t o making t h e p r a c t i c e
o f m e d i c i n e again a v i s i b l e , honored l i n k i n our e f f o r t s t o promote
t h e common good. And t h e way t o do t h a t i s t o improve t h e e n t i r e
system o f which you are a p a r t . We cannot c r e a t e t h e atmosphere o f
t r u s t and r e s p e c t and p r o f e s s i o n a l i s m t h a t you deserve t o have, and
t h a t many o f you who a r e i n t h i s room remember from e a r l i e r y e a r s ,
w i t h o u t changing t h e i n c e n t i v e s and t h e way t h e e n t i r e system
o p e r a t e s . That has t o be our p r i m a r y commitment. I f we do n o t p u t
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�- 3 -
(
medicine and those who operate w i t h i n medicine i n t h e f o r e f r o n t of
the r e s p e c t t h e y deserve t o have, no m a t t e r what we do t o t h e system
on t h e margins w i l l not make t h e d i f f e r e n c e s t h a t i t s h o u l d .
(Applause.)
As you know, t h e P r e s i d e n t i s i n t h e process o f
f i n a l i z i n g h i s p r o p o s a l f o r h e a l t h c a r e r e f o r m , and I am g r a t e f u l t o
speak w i t h you about t h a t process and where i t i s today and where i t
i s g o i n g . I had o r i g i n a l l y hoped t o j o i n you a t your meeting i n
March i n Washington, D.C.
And I , a g a i n , want t o a p o l o g i z e f o r my
absence. I v e r y much a p p r e c i a t e d V i c e P r e s i d e n t Gore a t t e n d i n g f o r
me, and I a l s o a p p r e c i a t e d t h e k i n d words from your e x e c u t i v e
o f f i c i a l s on b e h a l f of t h e e n t i r e a s s o c i a t i o n because o f my absence.
My f a t h e r was i l l and I spent s e v e r a l weeks w i t h him i n
the h o s p i t a l b e f o r e he d i e d . D u r i n g h i s h o s p i t a l i z a t i o n a t St.
V i n c e n t ' s H o s p i t a l i n L i t t l e Rock, Arkansas, I w i t n e s s e d f i r s t h a n d
the courage and commitment of h e a l t h c a r e p r o f e s s i o n a l s , b o t h
d i r e c t l y and i n d i r e c t l y .
I w i l l always a p p r e c i a t e t h e s e n s i t i v i t y
and t h e s k i l l s t h e y showed, not j u s t i n c a r i n g f o r my f a t h e r , not
j u s t i n c a r i n g f o r h i s f a m i l y — which, as you know, o f t e n needs as
much c a r e as t h e p a t i e n t , but i n c a r i n g f o r t h e many o t h e r s whose
names I w i l l never know. I know t h a t some of you worry about what
the impact o f h e a l t h care r e f o r m w i l l be on your p r o f e s s i o n and on
your p r a c t i c e . Let me say from t h e s t a r t , i f I read o n l y what t h e
newspapers have s a i d about what we are d o i n g i n our p l a n , I ' d
p r o b a b l y be a l i t t l e a f r a i d m y s e l f , t o o , because i t i s v e r y d i f f i c u l t
t o g e t o u t what i s going on i n such a complex process.
(
But t h e simple f a c t i s t h i s :
The P r e s i d e n t has asked
a l l o f us, r e p r e s e n t a t i v e s o f t h e AMA, o f every o t h e r element of the
h e a l t h care system, as w e l l as t h e a d m i n i s t r a t i o n , t o work on making
changes where they are needed, t o k e e p i n g and improving those t h i n g s
t h a t work, and t o p r e s e r v i n g and c o n s e r v i n g t h e best p a r t s of our
system as we t r y t o improve and change those t h a t are n o t .
T h i s system i s not w o r k i n g as w e l l as i t d i d , or as w e l l
as i t c o u l d — f o r you, f o r t h e p r i v a t e s e c t o r , f o r t h e p u b l i c or f o r
the n a t i o n . The one area t h a t i s so i m p o r t a n t t o be understood on a
m a c r o n a t i o n a l l e v e l i s how our f a i l u r e t o d e a l w i t h t h e h e a l t h care
system and i t s f i n a n c i a l demands i s a t t h e c e n t e r of our problems
f i n a n c i a l l y i n Washington. Because we cannot c o n t r o l h e a l t h care
c o s t s and become f u r t h e r and f u r t h e r behind i n our e f f o r t s t o do so,
we f i n d our economy, and p a r t i c u l a r l y t h e f e d e r a l budget, under
i n c r e a s i n g pressure.
J u s t as i t would be i r r e s p o n s i b l e , t h e r e f o r e , t o change
what i s w o r k i n g i n the h e a l t h care system, i t i s e q u a l l y
i r r e s p o n s i b l e f o r us not t o f i x what we know i s no longer w o r k i n g .
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So l e t us s t a r t w i t h some b a s i c p r i n c i p l e s t h a t are remarkably l i k e
the ones t h a t you have adopted i n your statements, and i n
p a r t i c u l a r l y i n H e a l t h Access America. We must guarantee a l l
Americans access t o a comprehensive package of b e n e f i t s , no matter
where t h e y work, where t h e y l i v e , or whether they have ever been s i c k
before.
I f we do not reach u n i v e r s a l access, we cannot d e a l w i t h our
o t h e r problems.
^
And t h a t i s a p o i n t t h a t you understand t h a t you have t o
h e l p t h e r e s t o f t h e c o u n t r y understand -- t h a t u n t i l we do p r o v i d e
s e c u r i t y f o r every American when i t comes t o h e a l t h c a r e , we cannot
f i x what i s wrong w i t h t h e h e a l t h care system. Secondly, we do have
t o c o n t r o l c o s t s . How we do t h a t i s one o f t h e g r e a t c h a l l e n g e s i n
t h i s system, b u t one t h i n g we can a l l agree on i s t h a t we have t o c u t
down on t h e paperwork and reduce t h e bureaucracy i n both t h e p u b l i c
and p r i v a t e s e c t o r s .
(Applause.)
We a l s o have t o be sure t h a t when we l o o k a t c o s t s , we
look a t i t n o t j u s t from a f i n a n c i a l p e r s p e c t i v e , b u t a l s o frora'a
human p e r s p e c t i v e . I remember s i t t i n g i n the f a m i l y w a i t i n g area of
St. V i n c e n t ' s , t a l k i n g t o a number o f my p h y s i c i a n f r i e n d s t o stop by
t o see how we were d o i n g . And one day, one o f my f r i e n d s t o l d me
t h a t , e v e r y day, he d i s c h a r g e s p a t i e n t s who need m e d i c a t i o n t o
s t a b i l i z e a condition.
And a t l e a s t once a day, he knows t h e r e i s a
p a t i e n t who w i l l n o t be a b l e t o a f f o r d t h e p r e s c r i p t i o n drugs he has
p r e s c r i b e d , w i t h t h e r e s u l t t h a t t h a t p a t i e n t may d e c i d e not t o f i l l
the p r e s c r i p t i o n when t h e h o s p i t a l s u p p l y runs o u t . Or t h a t p a t i e n t
may d e c i d e t h a t even though t h e d o c t o r t o l d him t o t a k e t h r e e p i l l s a
day, h e ' l l j u s t t a k e one a da;,^ so i t can be s t r e t c h e d f u r t h e r .
And even though St. V i n c e n t ' s has c r e a t e d a fund t o t r y
t o h e l p s u p p o r t t h e needs o f p a t i e n t s who cannot a f f o r d
p r e s c r i p t i o n s , t h e r e ' s n o t enough t o go around, and so every day
t h e r e i s someone who my f r i e n d knows and you know w i l l be back i n the
h o s p i t a l because o f t h e i r i n a b i l i t y e i t h e r t o a f f o r d t h e care t h a t i s
r e q u i r e d a f t e r they l e a v e , or because t h e y t r y t o c u t t h e corners on
i t , w i t h t h e n e t r e s u l t t h a t t h e n you and I w i l l pay more f o r t h a t
person who i s back i n t h e h o s p i t a l t h a n we would have i f we had taken
a s e n s i b l e approach toward what t h e r e a l c o s t s i n t h e medical system
are.
T h a t i s why we w i l l t r y , f o r example, t o i n c l u d e p r e s c r i p t i o n
drugs i n t h e comprehensive b e n e f i t package f o r a l l Americans,
i n c l u d i n g t h o s e over 65, t h r o u g h Medicare.
(Applause.)
We b e l i e v e t h a t i f we h e l p c o n t r o l c o s t s up f r o n t , we
w i l l save c o s t s on t h e back end.
That i s a p r i n c i p l e t h a t runs
t h r o u g h our p r o p o s a l and which each o f you knows from f i r s t h a n d
e x p e r i e n c e i s more l i k e l y t o be e f f i c i e n t i n b o t h human and f i n a n c i a l
terms.
We w i l l a l s o p r e s e r v e what i s b e s t i n t h e American h e a l t h
care system t o d a y .
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We have looked a t every o t h e r system i n t h e w o r l d . We
have t r i e d t o t a l k t o every e x p e r t whom we can f i n d t o d e s c r i b e how
any o t h e r c o u n t r y t r i e s t o p r o v i d e h e a l t h c a r e . And we have
concluded t h a t what i s needed i s an American s o l u t i o n f o r an American
problem by c r e a t i n g an American h e a l t h care system t h a t works f o r
America.
(Applause.) And two o f t h e p r i n c i p l e s t h a t u n d e r l i e t h a t
American s o l u t i o n a r e q u a l i t y and c h o i c e .
(Applause.)
We want t o ensure and enhance q u a l i t y . And i n o r d e r t o
do t h a t , we're g o i n g t o have t o make some changes, and you know t h a t .
We cannot, f o r example, promise t o r e a l l y achieve u n i v e r s a l access i f
we do n o t expand our supply o f p r i m a r y c a r e p h y s i c i a n s , and we must
do t h a t .
(Applause.) And you w i l l have t o h e l p us determine t h e
b e s t way t o go about a c h i e v i n g t h a t g o a l .
I've spoken w i t h r e p r e s e n t a t i v e s o f our medical schools,
and we have t a l k e d about how t h e f u n d i n g o f graduate medical
e d u c a t i o n w i l l have t o be changed t o p r o v i d e i n c e n t i v e s f o r t h e
t r a i n i n g o f more p r i m a r y care p h y s i c i a n s .
(Applause.) I have t a l k e d
w i t h r e p r e s e n t a t i v e s o f many o f t h e a s s o c i a t i o n s , such as t h i s one,
about how c o n t i n u i n g e d u c a t i o n a l o p p o r t u n i t i e s c o u l d h e l p even midc a r e e r p h y s i c i a n s , once we have a r e a l s u p p l y o f primary care
p h y s i c i a n s who a r e adequately reimbursed and adequately supported,
how t h e y might even go back i n t o p r i m a r y c a r e .
(Applause.)
We have a l s o very much p u t c h o i c e i n t h e c e n t e r o f our
system so t h a t we w i l l have n o t j u s t c h o i c e f o r p a t i e n t s as t o which
p l a n t h e y choose t o j o i n , b u t c h o i c e f o r p h y s i c i a n s as t o which p l a n
t h e y choose t o p r a c t i c e w i t h , i n c l u d i n g t h e o p t i o n o f being p a r t o f
more t h a n one p l a n a t t h e same t i m e .
(Applause.)
Now, as we work o u t a l l o f t h e d e t a i l s i n t h e many
p r o p o s a l s and i t s p a r t s t h a t must come t o g e t h e r , I am n o t s u g g e s t i n g
t h a t you w i l l agree w i t h every recommendation t h e P r e s i d e n t makes. I
don't expect any group t o do t h a t .
I n f a c t , I suppose t h a t i f
everybody's n o t a l i t t l e p u t o u t t h a t means we probably haven't done
i t right.
But I do hope and expect t h a t t h i s group, as w i t h o t h e r
groups r e p r e s e n t i n g p h y s i c i a n s and nurses and o t h e r h e a l t h care
p r o f e s s i o n a l s w i l l f i n d i n t h i s p l a n much t o be applauded and
supported.
And I a l s o b e l i e v e t h a t g i v e n t h e c o m p l e x i t i e s o f t h e
problem we f a c e , i t would be d i f f i c u l t t o a r r i v e a t a s o l u t i o n t h a t
was u n i v e r s a l l y accepted.
But t h e reason I have c o n f i d e n c e t h a t t h i s house, t h e
AMA, and o t h e r s w i l l be s u p p o r t i v e o f t h e P r e s i d e n t ' s p r o p o s a l i s
because we have b e n e f i t e d so much from what you have a l r e a d y done and
from t h e involvement o f many o f you and o t h e r s around t h e c o u n t r y .
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Again, c o n t r a r y t o what you may have heard scores of
p r a c t i c i n g p h y s i c i a n s served on t h e w o r k i n g groups t h a t were s t u d y i n g
h e a l t h c a r e r e f o r m . I am deeply g r a t e f u l on a p e r s o n a l l e v e l t h a t
members o f t h e AMA's l e a d e r s h i p spent i n v a l u a b l e t i m e coming t o
m e e t i n g a f t e r meeting, day a f t e r day s h a r i n g t h e i r i d e a s , r e a c t i n g t o
i d e a s a t t h e White House. And, of course, i n the course of t h a t we
l e a r n e d we had many common g o a l s and o b j e c t i v e s .
We w i l l n o t o n l y s t a n d f o r u n i v e r s a l coverage, but i n
a d d i t i o n t h e f o l l o w i n g : community r a t i n g so t h a t we can assure a l l
Americans t h e y w i l l be t a k e n care o f — ( a p p l a u s e ) ; e l i m i n a t i n g
r e s t r i c t i o n s based on p r e e x i s t i n g c o n d i t i o n s so t h a t every American
w i l l be e l i g i b l e — ( a p p l a u s e ) ; a n a t i o n a l l y guaranteed comprehensive
b e n e f i t s package t h a t w i l l emphasize p r i m a r y and p r e v e n t i v e h e a l t h
c a r e as w e l l as h o s p i t a l i z a t i o n and o t h e r care — ( a p p l a u s e ) ; the
k i n d o f c h o i c e and q u a l i t y assurances t h a t we w i l l need t o have t o
make s u r e t h i s new system n o t o n l y operates w e l l d u r i n g t h e
t r a n s i t i o n b u t g e t s a f i r m f o o t i n g as i t moves i n t o t h e f u t u r e and we
w i l l t h e r e f o r e be emphasizing more on p r a c t i c e parameters and
outcomes r e s e a r c h so t h a t you, t o o , can know b e t t e r what works.
One of t h e g r e a t i n t e r e s t i n g experiences I have had
d u r i n g t h e p a s t months i s as I've t r a v e l e d around from s t a t e t o s t a t e
i s h a v i n g d o c t o r s coming up t o me and t e l l i n g me t h a t they need more
i n f o r m a t i o n ; t h a t a l l t o o o f t e n t h e i n f o r m a t i o n they r e c e i v e doesn't
come t o them i n forms t h a t t h e y b e l i e v e are p r a c t i c a l i n t h e i r
p a r t i c u l a r c o n t e x t . And what we want t o do i s by w o r k i n g w i t h
o r g a n i z a t i o n s l i k e yours i s be sure t h a t t h e q u a l i t y outcomes and the
k i n d o f r e s e a r c h t h a t w i l l done w i l l be r e a d i l y a v a i l a b l e t o every
p r a c t i c i n g physician i n the country.
We a l s o b e l i e v e t h a t i t w i l l be e s s e n t i a l t o continue
m e d i c a l r e s e a r c h and t o use t h e breakthroughs i n medical research,
a g a i n , n o t j u s t t o a l l e v i a t e human s u f f e r i n g but t o save money,
because you know b e t t e r t h a n I t h a t o f t e n times a breakthrough i n
r e s e a r c h , a new drug, a new procedure i s the q u i c k e s t way t o take
c a r e o f t h e most people i n a c o s t - e f f e c t i v e manner. So we w i l l
c o n t i n u e t o s u p p o r t medical r e s e a r c h .
(Applause.)
A l l o f these p r i n c i p l e s a r i s e from t h e same common
a s s u m p t i o n — t h a t t h e s t a t u s quo i s unacceptable. And i t i s not
r e a l l y even any l o n g e r a s t a t u s quo because we do n o t stand s t i l l , we
d r i f t backwards. Every month people l o s e t h e i r i n s u r a n c e ; every
month you have more micromanagement and r e g u l a t i o n t o p u t up w i t h ;
e v e r y month our h e a l t h care system becomes more expensive t o f i x .
I know t h a t many o f you f e e l t h a t as d o c t o r s you are
under s i e g e i n t h e c u r r e n t system.
And I t h i n k t h e r e i s cause f o r
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you t o b e l i e v e t h a t , because we are w i t n e s s i n g a d i s t u r b i n g a s s a u l t
on t h e d o c t o r / p a t i e n t r e l a t i o n s h i p . More and more employers are
b u y i n g i n t o managed care p l a n s t h a t f o r c e employees t o choose from a
s p e c i f i c p o o l of d o c t o r s . And t o o o f t e n , even when a d o c t o r i s
w i l l i n g t o j o i n a new p l a n t o m a i n t a i n h i s r e l a t i o n s h i p w i t h
p a t i e n t s , he, or she I should say, i s f r o z e n o u t .
What we want t o see i s a system i n which t h e employer
does n o t make t h e c h o i c e as t o what p l a n i s a v a i l a b l e f o r t h e
employee, t h e employee makes t h a t choice f o r him or h e r s e l f .
(Applause.)
But i f we do not change and i f t h e p r e s e n t p a t t e r n
c o n t i n u e s , as i t w i l l i f we do not a c t q u i c k l y , t h e a r t of p r a c t i c i n g
m e d i c i n e w i l l be f o r e v e r t r a n s f o r m e d .
Gone w i l l be t h e p a t i e n t s
t r e a s u r e d p r i v i l e g e t o choose h i s or her d o c t o r . Gone w i l l be t h e
c l o s e t r u s t i n g bonds b u i l t up between p h y s i c i a n s and p a t i e n t s over
the years.
Gone w i l l be t h e s e c u r i t y of knowing you can s w i t c h jobs
and s t i l l v i s i t your l o n g t i m e i n t e r n i s t or p e d i a t r i c i a n or OB/GYN.
We cannot a f f o r d t o l e t t h a t happen. But the e r o s i o n of
t h e d o c t o r / p a t i e n t r e l a t i o n s h i p i s o n l y one p i e c e of t h e problem.
Another p i e c e i s t h e r o l e t h a t insurance companies have come t o p l a y
and t h e r o l e t h a t t h e government has come t o p l a y along w i t h them i n
second-guessing medical d e c i s i o n s .
I can understand how many of you must f e e l . When
i n s t e a d o f b e i n g t r u s t e d f o r your e x p e r t i s e , you're expected t o c a l l
an 800 number and g e t a p p r o v a l f o r even b a s i c medical procedures from
a t o t a l stranger.
(Applause.)
F r a n k l y , d e s p i t e my best e f f o r t s of t h e l a s t month t o
u n d e r s t a n d every aspect of t h e h e a l t h care system, i t i s and remains
a m y s t e r y t o me how a person s i t t i n g a t a computer i n some a i r c o n d i t i o n e d o f f i c e thousands of m i l e s away can make a judgment about
what s h o u l d or s h o u l d n ' t happen a t a p a t i e n t ' s bedside i n I l l i n o i s or
Georgia o r C a l i f o r n i a . The r e s u l t of t h i s excessive o v e r s i g h t , t h i s
p e e r i n g over a l l of your shoulder's i s a system of backward
i n c e n t i v e s . I t rewards p r o v i d e r s f o r over p r e s c r i b i n g , o v e r t e s t i n g ,
and g e n e r a l l y o v e r d o i n g .
And worse, i t punishes d o c t o r s who show
p r o p e r r e s t r a i n t and e x e r c i s e t h e i r p r o f e s s i o n a l judgment i n ways
t h a t t h o s e s i t t i n g a t t h e computers d i s a g r e e w i t h .
(Applause.)
Dr. Bob B a r r i n s o n , one of t h e p r a c t i c i n g p h y s i c i a n s who
spent h o u r s and hours working w i t h us w h i l e a l s o m a i n t a i n i n g h i s
p r a c t i c e , t o l d us r e c e n t l y of an experience t h a t he had as one of
many. He a d m i t t e d an emergency room p a t i e n t named J e f f .
Jeff
s u f f e r e d from c i r r h o s i s of t h e l i v e r and --.
Dr. B a r r i n s o n put him
i n t h e h o s p i t a l and w i t h i n 24 hours r e c e i v e d a c a l l from J e f f ' s
i n s u r a n c e company. The insurance company wanted t o know e x a c t l y how
many days J e f f would be i n t h e h o s p i t a l and why.
Dr. B a r r i n s o n
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r e p l i e d t h a t he c o u l d n ' t p r e d i c t t h e p r e c i s e l e n g t h o f s t a y . A few
days l a t e r t h e insurance company c a l l e d back and q u e s t i o n e d whether
J e f f would need s u r g e r y . Again, Dr. B a r r i n s o n s a i d he wasn t y e t
I
sure,
And what was Dr. B a r r i n s o n ' s reward f o r h i s honesty and
h i s p r o f e s s i o n a l i s m ? He was p l a c e d on t h e insurance company's
"special exceptions" l i s t .
You know, t h a t ' s a l i s t o f troublesome
d o c t o r s who make t h e i n s u r a n c e company w a i t a few days o r a few weeks
t o d e t e r m i n e t h e bottom l i n e on a p a r t i c u l a r p a t i e n t .
From t h a t p o i n t on, t h e insurance company c a l l e d Dr.
B a r r i n s o n s i x times i n two weeks. Each time he had t o be summoned
away from t h e p a t i e n t t o t a k e t h e c a l l .
Each t i m e he spoke t o a
d i f f e r e n t insurance company r e p r e s e n t a t i v e . Each t i m e he repeated
the same s t o r y .
Each t i m e h i s r o l e as t h e p h y s i c i a n was subverted.
And each t i m e t h e t r e a t m e n t o f t h e p a t i e n t was impeded.
Dr B a r r i n s o n and you know t h a t medicine, t h e a r t of
h e a l i n g , doesn't work l i k e t h a t .
There i s no master c h e c k l i s t t h a t
can be a d m i n i s t e r e d by some f a c e l e s s b u r e a u c r a t t h a t can t e l l you
what you need t o do on an h o u r l y b a s i s t o take care o f your p a t i e n t s ;
and, f r a n k l y , I wouldn't want t o be one o f your p a t i e n t s i f t h e r e
were.
(Applause.)
Now adding t o t h e s e d i f f i c u l t i e s d o c t o r s and h o s p i t a l s
and nurses, p a r t i c u l a r l y , a r e b e i n g b u r i e d under an avalanche o f
oaoerwork. There are mountains o f forms, mountains o f r u l e s ,
mountains o f hours spent on a d m i n i s t r a t i v e m i n u t i a e i n s t e a d o f c a r i n g
f o r t h e s i c k . where, you m i g h t ask y o u r s e l f , d i d a l l t h i s
bureaucracy come from? And t h e s h o r t answer i s , b a s i c a l l y ,
everywhere.
There are forms t o ensure a p p r o p r i a t e c a r e f o r t h e s i c k
and t h e d y i n g ; forms t o guard a g a i n s t unnecessary t e s t s and
nrocedures.
And from each i n s u r a n c e company and government agency
t h e r e a r e forms t o r e c o r d t h e d e c i s i o n s o f d o c t o r s and nurses. I
remember going t o Boston and h a v i n g a p h y s i c i a n b r i n g i n t o a hearing
I h e l d t h e r e t h e stack o f forms h i s o f f i c e i s r e q u i r e d t o f i l l o u t .
And he h e l d up a Medicare form and next t o i t he h e l d up an insurance
company form. And he s a i d t h a t t h e y a r e t h e same forms t h a t ask t h e
same q u e s t i o n s , b u t t h e i n s u r a n c e company form w i l l n o t be accepted
by t h e government, and t h e government form w i l l n o t be accepted by
the i n s u r a n c e company. And t h e insurance company b a s i c a l l y took t h e
government form, changed t h e t i t l e t o c a l l i t by i t s own name and
r e q u i r e s them t o have i t f i l l e d o u t . That was t h e t i p o f t h e
iceberg.
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(
One nurse t o l d me t h a t she entered t h e p r o f e s s i o n
because she wanted t o care f o r people. She s a i d t h a t i f she had
wanted t o be an accountant, she would have gone t o work f o r an
a c c o u n t i n g company i n s t e a d .
(Laughter.) But she, l i k e many o t h e r
nurses, and as you know so w e l l , many of the people i n your o f f i c e s
now, are r e q u i r e d t o be bookkeepers and a c c o u n t a n t s , not c l i n i c i a n s ,
not c a r e g i v e r s .
(Applause.)
The l a t e s t s t a t i s t i c I have seen i s t h a t f o r every
d o c t o r a h o s p i t a l h i r e s , f o u r new a d m i n i s t r a t i v e s t a f f are h i r e d .
(Applause.) And t h a t i n t h e average d o c t o r ' s o f f i c e 80 hours a month
i s now s p e n t on a d m i n i s t r a t i o n .
That i s not t i m e spent w i t h a
p a t i e n t r e c o v e r i n g from bypass surgery or w i t h a c h i l d or teenager
who needs a checkup and maybe a l i t t l e e x t r a TLC t i m e of l i s t e n i n g
and c o u n s e l i n g , and c e r t a i n l y not spent w i t h a p a t i e n t who has t o run
i n q u i c k l y f o r some k i n d of an emergency.
B l a n k e t i n g an e n t i r e p r o f e s s i o n w i t h r u l e s aimed a t
c a t c h i n g those who are not l i v i n g up t o t h e i r p r o f e s s i o n a l standards
does n o t improve q u a l i t y . What we need i s a new b a r g a i n . We need t o
remove f r o m the v a s t m a j o r i t y of p h y s i c i a n s these unnecessary,
r e p e t i t i v e , o f t e n uneven read forms and i n s t e a d s u b s t i t u t e f o r what
they were a t t e m p t i n g t o do — more d i s c i p l i n e , more peer review, more
c a r e f u l s c r u t i n y of your c o l l e a g u e s . You are t h e ones who can t e l l
b e t t e r t h a n I or b e t t e r t h a n some b u r e a u c r a t whether the q u a l i t y of
m e d i c i n e t h a t i s being p r a c t i c e d i n your c l i n i c , i n your h o s p i t a l , i s
what you would want f o r y o u r s e l f and your f a m i l y .
(Applause.)
Let us remove t h e k i n d of micromanagement and r e g u l a t i o n
t h a t has n o t improved q u a l i t y and has wasted b i l l i o n s of d o l l a r s , but
t h e n you have t o h e l p us s u b s t i t u t e f o r i t , a system t h a t the
p a t i e n t s o f t h i s c o u n t r y , the p u b l i c of t h i s c o u n t r y , the d e c i s i o n makers o f t h i s c o u n t r y can have c o n f i d e n c e i n . Now, I know t h e r e are
l e g a l o b s t a c l e s f o r your being able t o do t h a t , and we are l o o k i n g
v e r y c l o s e l y a t how we can remove those so t h a t you can be p a r t -(applause) — of c r e a t i n g a new s o l u t i o n i n which everyone, i n c l u d i n g
y o u r s e l f , can b e l i e v e i n .
I n every p r i v a t e c o n v e r s a t i o n I've had w i t h a p h y s i c i a n ,
whether i t ' s someone I knew from St. V i n c e n t ' s or someone I had j u s t
met, I have asked: T e l l me, have you ever p r a c t i c e d w i t h or around
someone you d i d not t h i n k was l i v i n g up t o your standards?
And,
i n v a r i a b l y , t h e answer i s , w e l l , yes, I remember i n my t r a i n i n g ;
w e l l , yes, I remember t h i s emergency room work I used t o do; yes, I
remember i n t h e h o s p i t a l when so-and-so had t h a t problem. And
I've
s a i d , do you b e l i e v e enough was done by t h e p r o f e s s i o n t o deal w i t h
t h a t problem and t o e l i m i n a t e i t ? And, i n v a r i a b l y , no matter who the
d o c t o r i s , I've been t o l d , no, I don't.
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(
We want you t o have t h e chance so t h a t i n t h e f u t u r e you
can say, yes, I do b e l i e v e we've been d e a l i n g w i t h o u r problems. I t
i s n o t something we should leave f o r t h e government, and, c e r t a i n l y ,
we cannot leave i t t o t h e p a t i e n t . That i s t h e new k i n d o f
r e l a t i o n s h i p I t h i n k t h a t we need t o have.
F i n a l l y , i f we do n o t , as I s a i d e a r l i e r , p r o v i d e
u n i v e r s a l coverage, we cannot do any o f what I have j u s t been
speaking about because we cannot f u l f i l l our b a s i c commitment you as
p h y s i c i a n s , us as a s o c i e t y , t h a t we w i l l care f o r one a n o t h e r . I t
s h o u l d no l o n g e r be l e f t t o t h e i n d i v i d u a l d o c t o r t o d e c i d e t o probe
h i s c o n s c i e n c e b e f o r e d e t e r m i n i n g whether t o t r e a t a needy p a t i e n t .
I cannot t e l l you what i t i s l i k e f o r me t o t r a v e l around t o hear
s t o r i e s from d o c t o r s and p a t i e n t s t h a t a r e r i g h t on p o i n t .
But t h e most p o i g n a n t t h a t I t e l l because i t s t r u c k me
so p e r s o n a l l y was o f t h e woman w i t h no i n s u r a n c e ; w o r k i n g f o r a
company i n New Orleans; had worked t h e r e f o r a number o f y e a r s ; t r i e d
t o t a k e good care o f h e r s e l f ; went f o r t h e annual p h y s i c a l every
year; and I s a t w i t h her on a f o l d i n g c h a i r i n t h e l o a d i n g dock of
her company a l o n g w i t h o t h e r s — a l l o f whom were u n i n s u r e d ; a l l of
whom had worked numbers o f years — w h i l e she t o l d me a t h e r l a s t
p h y s i c a l h e r d o c t o r had found a lump i n h e r b r e a s t and r e f e r r e d her
t o a surgeon. And t h e surgeon t o l d h e r t h a t i f she had i n s u r a n c e , he
would have b i o p s i e d i t b u t because she d i d n o t he would watch i t .
(
I don't t h i n k you have t o be a woman t o f e e l what I f e l t
when t h a t woman t o l d me t h a t s t o r y . And I don't t h i n k you have t o be
a p h y s i c i a n t o f e e l what you f e l t when you heard t h a t s t o r y . We need
t o c r e a t e a system i n which no one ever has t o say t h a t f o r good
cause o r bad, and no one has t o hear i t ever a g a i n .
(Applause.)
I f we move toward u n i v e r s a l coverage, so t h e r e f o r e
everyone has a payment stream behind them t o be a b l e t o come i n t o
your o f f i c e , t o be a b l e t o come i n t o t h e h o s p i t a l , you w i l l a g a i n be
a b l e t o make d e c i s i o n s t h a t should be made w i t h c l i n i c a l autonomy,
w i t h p r o f e s s i o n a l judgment. And we i n t e n d t o t r y t o g i v e you t h e
t i m e and f r e e you up from o t h e r c o n d i t i o n s t o be a b l e t o do t h a t .
One s p e c i f i c issue I want t o mention, because I f e e l
s t r o n g l y about i t — i f my husband had n o t asked me t o do t h i s , I
would have f e l t s t r o n g l y about i t because o f t h e impact i n my s t a t e
of Arkansas — we have t o s i m p l i f y and e l i m i n a t e t h e burdensome
r e g u l a t i o n s c r e a t e d under *CLEA — (applause) — a w e l l - i n t e n t i o n e d
law w i t h many u n i n t e n d e d consequences t h a t have a f f e c t e d n o t o n l y
those o f you i n p r i v a t e p r a c t i c e b u t p u b l i c h e a l t h departments l i k e
ours i n Arkansas around t h e c o u n t r y .
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�11 -
But again we need t h a t new b a r g a i n . You have t o help us
know what should be e l i m i n a t e d so t h a t we then can j u s t focus i n on a
v e r y s m a l l p a r t o f t h i s whole s i t u a t i o n and e l i m i n a t e t h e r e s t of t h e
r e g u l a t i o n s t h a t were thrown on t o p .
So those a r e t h e k i n d s o f i s s u e s i n which we t h i n k we
can make i t more p o s s i b l e f o r you t o p r a c t i c e i n a more e f f i c i e n t ,
humane, b e t t e r manner. We a l s o b e l i e v e s t r o n g l y t h a t we have t o
emphasize p r e v e n t i v e c a r e . And we have t o p r o v i d e a b a s i c p o l i c y o f
p r e v e n t i v e care. And we have t o be sure t h a t a l l o f you and those
who come a f t e r you i n t o medicine a r e t r a i n e d w e l l i n medical school
t o a p p r e c i a t e t h e importance o f p r e v e n t i v e c a r e .
(Applause.)
Much o f what i s now c o n s i d e r e d o u t s i d e t h e scope o f
mainstream medicine i s crowding i n . Many o f us i n t h i s room I know
e x e r c i s e , t r y t o watch our d i e t s , do t h i n g s t o t r y t o remain
h e a l t h i e r . And y e t o f t e n m e d i c a l e d u c a t i o n and medicine as i t ' s
p r a c t i c e d ' d o e s n o t i n c l u d e t h o s e new k i n d o f common-sense approaches
t o h e a l t h . We need t o be a system t h a t does n o t t a k e care of t h e
s i c k b u t i n s t e a d promotes h e a l t h wherever we can i n whatever way we
p o s s i b l y can do i t . (Applause.)
And f i n a l l y , l e t me say t h a t we w i l l o f f e r a s e r i o u s
p r o p o s a l t o curb m a l p r a c t i c e problems f o r a l l o f you. (Applause.)
But l e t me add t h a t i t , t o o , must be p a r t o f t h i s new c o n t r a c t . I n
o r d e r t o do t h a t and t o do i t i n a way t h a t engenders t h e confidence
of t h e average American, we must have o r g a n i z e d medicine s t a n d i n g
ready t o say we w i l l do a b e t t e r j o b o f t a k i n g care o f t h e problems
w i t h i n us. (Applause.)
I have read o r t r i e d t o read e v e r y t h i n g I can f i n d about
a l l o f t h i s . And you know as w e l l as I do t h e r e a r e s t u d i e s a l l over
the f i e l d .
I t depends upon who w r i t e s i t and who i t ' s w r i t t e n f o r
and t h e l i k e .
But we know t h e r e ' s a problem. We know we're going t o
d e a l w i t h i t . But one o f t h e s t a r k s t a t i s t i c s from these s t u d i e s i s
t h a t a l l t o o o f t e n t h e l a r g e s t number o f m a l p r a c t i c e s u i t s i s brought
a g a i n s t t h e same p h y s i c i a n s on a r e p e t i t i v e b a s i s .
Now, i t may be t h a t f o r some t h a t i s an u n f a i r
a c c u s a t i o n , and we need t o d e a l w i t h t h a t t h r o u g h r e f o r m . But f o r
o t h e r s you need t o weed them o u t o f your p r o f e s s i o n i f they cannot
p r a c t i c e t o t h e q u a l i t y t h a t you expect your f e l l o w c o l l e a g u e s t o
p r a c t i c e t o . So we w i l l propose s e r i o u s m a l p r a c t i c e r e f o r m , and we
w i l l have t o l o o k t o you t o h e l p us make sure t h a t t h e problems t h a t
w i l l s t i l l f l o w from people who should n o t be making d e c i s i o n s w i l l
be e l i m i n a t e d . That way we can g i v e c o n f i d e n c e back t o you as a
p r o f e s s i o n , t h a t you w i l l n o t be second-guessed o r u n f a i r l y c a l l e d
i n t o c o u r t . And we w i l l g i v e c o n f i d e n c e t o t h e p u b l i c t h a t they w i l l
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�- 12 -
be p r o t e c t e d i n s o f a r as humanly p o s s i b l e . So t h a t i s what we w i l l
have t o l o o k f o r when we come f o r w a r d w i t h t h a t .
(Applause.)
Now, r e a c h i n g consensus on a l l t h a t should be done and
p u t t i n g i t i n t o a p i e c e of l e g i s l a t i o n and moving i t t h r o u g h t h e
Congress i s n o t g o i n g t o be easy. There w i l l be many groups t h a t
w i l l n i b b l e a t t h e edges of i t , n o t l i k e t h e whole idea o f i t want
t o c o n t i n u e t o t h e s t a t u s quo.
But i f we do not have t h e courage t o
change now, i f we do not move toward a system t h a t once a g a i n g i v e s
you back your p r o f e s s i o n a l i s m t o p r a c t i c e prudent, p r a c t i c a l ,
i n t e l l i g e n t medicine a g a i n ; i f we do n o t move toward r e s t o r i n g t h e
d i g n i t y a g a i n t o t h e d o c t o r - p a t i e n t r e l a t i o n s h i p , and t h a t encourages
young p e o p l e t o become p h y s i c i a n s because they want t o p a r t i c i p a t e i n
t h a t w o n d e r f u l process of h e a l i n g and c a r i n g , then t h e e n t i r e
s o c i e t y , b u t most p a r t i c u l a r l y medicine, w i l l s u f f e r .
The reason we are d o i n g any of t h i s i s because o f
c h i l d r e n l i k e those who are here from Nathan Davis.
Most o f us i n
t h i s room are a t l e a s t halfway t h r o u g h .
(Laughter.) And most o f us
m t h i s room have s a t i n dozens and dozens of meetings j u s t l i k e
this.
We've s a t and l i s t e n e d t o people t e l l us what was wrong w i t h
h e a l t h c a r e or what medicine or w i t h whatever, and we've t a l k e d about
t h e problems a t l e a s t s e r i o u s l y s i n c e t h e 1970s. And we've produced
proposals; l i k e yours f o r H e a l t h Access .'.-eri^d.
But While we have t a l k e d , our problems have g o t t e n
worse, and t h e f r u s t r a t i o n on t h e p a r t o f a l l of you and o t h e r s has
i n c r e a s e d . Time and again, groups, i n d i v i d u a l s , and p a r t i c u l a r l y the
government, has walked up t o t r y i n g t o r e f o r m h e a l t h care and t h e n
walked away.
There's enough blame t o go around, every k i n d o f
p o l i t i c a l s t r i p e s can be i n c l u d e d , but t h e p o i n t now i s t h a t we c o u l d
have done something about h e a l t h care r e f o r m 20 years ago and s o l v e d
o u r problems f o r m i l l i o n s of d o l l a r s , and we walked away. L a t e r we
c o u l d have done something and s o l v e d our problems f o r hundreds o f
m i l l i o n s , and we walked away.
A f t e r 20 years w i t h r a t e o f medical i n f l a t i o n g o i n g up
and w i t h a l l o f t h e problems you know so w e l l , i t i s a h a r d e r and
more d i f f i c u l t s o l u t i o n t h a t c o n f r o n t s us.
But I b e l i e v e t h a t i f one
l o o k s a t what i s a t s t a k e , we are n o t t a l k i n g j u s t about r e f o r m i n g
t h e way we f i n a n c e h e a l t h care, we are n o t t a l k i n g j u s t about t h e
p a r t i c u l a r s o f how we d e l i v e r h e a l t h c a r e , we are t a l k i n g about
c r e a t i n g a new sense o f community and c a r i n g i n t h i s c o u n t r y i n which
we once a g a i n v a l u e your c o n t r i b u t i o n , v a l u e the d i g n i t y o f a l l
people.
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How many more meetings do we need? How many a l e r t s ?
How many more plans? How many more brochures? The t i m e has come f o r
a l l o f us, n o t j u s t w i t h r e s p e c t t o h r ^ ^ i t h r a r p , b u t w i t h respect t o
a l l o f t h e d i f f i c u l t i es our c o u n t r y faces t o s t o p w a l k i n g away and t o
We a r e supposed t o be
s t a r t s t e p p i n g up and t a k i n g r e s p o n s i b i l i t y .
t h e ones t o l e a d f o r our c h i l d r e n and our g r a n d c h i l d r e n . And the way
we have behaved i n t eh l a s t y e a r s , we have r u n away and abdicated
t h a t r e s p o n s i b i l i t y , And a t t h e c o r e o f t h e human e x p e r i e n c e i s
r e s p o n s i b i l i t y f o r ch i l d r e n t o l e a v e them a b e t t e r w o r l d t h a n the one
we found.
We can do t h a t w i t h h e a l t h care. We can make a
d i f f e r e n c e now t h a t w i l l be a legacy f o r a l l o f you. We can once
a g a i n g i v e you t h e c o n f i d e n c e t o say t o your grandsons and
granddaughters, yes, do go i n t o medicine; yes, i t i s t h e most
rewarding profession there i s .
So l e t ' s c e l e b r a t e your p r o f e s s i o n by i m p r o v i n g h e a l t h
c a r e . L e t ' s c e l e b r a t e our c h i l d r e n by r e f o r m i n g t h i s system. Let's
come t o g e t h e r n o t as l i b e r a l s o r c o n s e r v a t i v e s o r Republicans o r
Democrats, b u t as Americans who want t h e best f o r t h e i r c o u n t r y and
know we can no l o n g e r w a i t t o g e t about t h e business o f p r o v i d i n g i t .
Thank you a l l v e r y much.
END
(Applause.)
�THE WHITE HOUSE
O f f i c e o f t h e Press S e c r e t a r y
For Immediate Release
September 22, 1993
ADDRESS OF THE PRESIDENT
TO THE JOINT SESSION OF CONGRESS
U.S. C a p i t o l
Washington, D.C.
9:10 P.M. EOT
THE PRESIDENT: Mr. Speaker, Mr. P r e s i d e n t , members o f
Congress, d i s t i n g u i s h e d guests, my f e l l o w Americans. Before I b e g i n
my words t o n i g h t I would l i k e t o ask t h a t we a l l bow i n a moment o f
s i l e n t p r a y e r f o r t h e memory o f those who were k i l l e d and those who
have been i n j u r e d i n t h e t r a g i c t r a i n a c c i d e n t i n Alabama today. (A
moment o f s i l e n c e i s observed.) Amen.
My f e l l o w Americans, t o n i g h t we come t o g e t h e r t o w r i t e a
new c h a p t e r i n t h e American s t o r y . Our f o r e b e a r s e n s h r i n e d t h e
American Dream -- l i f e , l i b e r t y , t h e p u r s u i t o f happiness.
Every
g e n e r a t i o n o f Americans has worked t o s t r e n g t h e n t h a t legacy, t o make
our c o u n t r y a p l a c e o f freedom and o p p o r t u n i t y , a p l a c e where people
who work h a r d can r i s e t o t h e i r f u l l p o t e n t i a l , a p l a c e where t h e i r
c h i l d r e n can have a b e t t e r f u t u r e .
From t h e s e t t l i n g o f t h e f r o n t i e r t o t h e l a n d i n g on t h e
moon, ours has been a c o n t i n u o u s s t o r y o f c h a l l e n g e s d e f i n e d ,
o b s t a c l e s overcome, new h o r i z o n s secured.
That i s what makes America
what i t i s and Americans what we a r e . Now we are i n a t i m e o f
p r o f o u n d change and o p p o r t u n i t y . The end o f t h e Cold War, t h e
I n f o r m a t i o n Age, t h e g l o b a l economy have brought us b o t h o p p o r t u n i t y
and hope and s t r i f e and u n c e r t a i n t y . Our purpose i n t h i s dynamic age
must be t o change -- t o make change our f r i e n d and n o t our enemy.
To achieve t h a t g o a l , we must face a l l our c h a l l e n g e s
w i t h c o n f i d e n c e , w i t h f a i t h , and w i t h d i s c i p l i n e -- whether we're
r e d u c i n g t h e d e f i c i t , c r e a t i n g tomorrow's j o b s and t r a i n i n g o u r
people t o f i l l them, c o n v e r t i n g from a h i g h - t e c h defense t o a h i g h t e c h domestic economy, expanding t r a d e , r e i n v e n t i n g government,
making o u r s t r e e t s s a f e r , o r r e w a r d i n g work over i d l e n e s s . A l l these
c h a l l e n g e s r e q u i r e us t o change.
I f Americans a r e t o have t h e courage t o change i n a
d i f f i c u l t t i m e , we must f i r s t be secure i n our most b a s i c needs.
T o n i g h t I want t o t a l k t o you about t h e most c r i t i c a l t h i n g we can do
t o b u i l d t h a t s e c u r i t y . T h i s h e a l t h care system o f ours i s b a d l y
broken and i t i s t i m e t o f i x i t .
(Applause.)
Despite the d e d i c a t i o n o f l i t e r a l l y m i l l i o n s o f t a l e n t e d
h e a l t h care p r o f e s s i o n a l s , o u r h e a l t h care i s t o o u n c e r t a i n and t o o
expensive, t o o b u r e a u c r a t i c and t o o w a s t e f u l . I t has t o o much f r a u d
and t o o much greed.
�At l o n g l a s t , a f t e r decades o f f a l s e s t a r t s , we must
make t h i s our most u r g e n t p r i o r i t y , g i v i n g every American h e a l t h
s e c u r i t y ; h e a l t h care t h a t can never be t a k e n away; h e a l t h care t h a t
i s always t h e r e . That i s what we must do t o n i g h t .
(Applause).
On t h i s j o u r n e y , as on a l l o t h e r s of t r u e consequence,
t h e r e w i l l be rough spots i n the road and honest disagreements about
how we s h o u l d proceed.
A f t e r a l l , t h i s i s a c o m p l i c a t e d i s s u e . But
every s u c c e s s f u l j o u r n e y i s guided by f i x e d s t a r s . And i f we can
agree on some b a s i c v a l u e s and p r i n c i p l e s we w i l l reach t h i s
d e s t i n a t i o n , and we w i l l reach i t t o g e t h e r .
So t o n i g h t I want t o t a l k t o you about the p r i n c i p l e s
t h a t I b e l i e v e must embody our e f f o r t s t o r e f o r m America's h e a l t h
care system -- s e c u r i t y , s i m p l i c i t y , s a v i n g s , c h o i c e , q u a l i t y , and
responsibility.
When I launched our n a t i o n on t h i s j o u r n e y t o r e f o r m t h e
h e a l t h care system I knew we needed a t a l e n t e d n a v i g a t o r , someone
w i t h a r i g o r o u s mind, a steady compass, a c a r i n g h e a r t . L u c k i l y f o r
me and f o r our n a t i o n , I d i d n ' t have t o l o o k v e r y f a r .
(Applause.)
Over t h e l a s t e i g h t months, H i l l a r y and those w o r k i n g
w i t h her have t a l k e d t o l i t e r a l l y thousands o f Americans t o
understand t h e s t r e n g t h s and the f r a i l t i e s o f t h i s system o f o u r s .
They met w i t h over 1,100 h e a l t h care o r g a n i z a t i o n s . They t a l k e d w i t h
d o c t o r s and nurses, p h a r m a c i s t s and drug company r e p r e s e n t a t i v e s ,
h o s p i t a l a d m i n i s t r a t o r s , i n s u r a n c e company e x e c u t i v e s and s m a l l and
l a r g e businesses.
They spoke w i t h s e l f - e m p l o y e d people. They t a l k e d
w i t h people who had i n s u r a n c e and people who d i d n ' t . They t a l k e d
w i t h u n i o n members and o l d e r Americans and advocates f o r our
c h i l d r e n . The F i r s t Lady a l s o c o n s u l t e d , as a l l o f you know,
e x t e n s i v e l y w i t h governmental l e a d e r s i n b o t h p a r t i e s i n t h e s t a t e s
of our n a t i o n , and e s p e c i a l l y here on C a p i t o l H i l l .
H i l l a r y and t h e Task Force r e c e i v e d and read over
700,000 l e t t e r s from o r d i n a r y c i t i z e n s . What t h e y wrote and t h e
b r a v e r y w i t h which t h e y t o l d t h e i r s t o r i e s i s r e a l l y what c a l l s us
a l l here t o n i g h t .
Every one o f us knows someone who's worked hard and
p l a y e d by t h e r u l e s and s t i l l been h u r t by t h i s system t h a t j u s t
doesn't work f o r t o o many people. But I ' d l i k e t o t e l l you about
j u s t one.
K e r r y Kennedy owns a s m a l l f u r n i t u r e s t o r e t h a t employs
seven people i n T i t u s v i l l e , F l o r i d a . L i k e most s m a l l business
owners, he's poured h i s h e a r t and s o u l , h i s sweat and b l o o d i n t o t h a t
business f o r y e a r s . But over the l a s t s e v e r a l years, a g a i n l i k e most
s m a l l business owners, he's seen h i s h e a l t h care premiums s k y r o c k e t ,
even i n y e a r s when no c l a i m s were made. And l a s t year, he p a i n f u l l y
d i s c o v e r e d he c o u l d no l o n g e r a f f o r d t o p r o v i d e coverage f o r a l l h i s
workers because h i s i n s u r a n c e company t o l d him t h a t two o f h i s
workers had become h i g h r i s k s because o f t h e i r advanced age.
The
problem was t h a t those two people were h i s mother and f a t h e r , t h e
people who founded t h e business and s t i l l worked i n the s t o r e .
T h i s s t o r y speaks f o r m i l l i o n s o f o t h e r s . And from them
we have l e a r n e d a p o w e r f u l t r u t h . We have t o p r e s e r v e and s t r e n g t h e n
�t o solve t h i s problem w i l l go a l o n g way toward d e f i n i n g who we a r e
and who we i n t e n d t o be as a people i n t h i s d i f f i c u l t and c h a l l e n g i n g
era.
I b e l i e v e we a l l u n d e r s t a n d t h a t .
And so t o n i g h t , l e t me ask a l l o f you -- every member o f
the House, e v e r y member o f t h e Senate, each Republican and each
Democrat -- l e t us keep t h i s s p i r i t and l e t us keep t h i s commitment
u n t i l t h i s j o b i s done. We owe i t t o t h e American people.
(Applause.)
Now, i f I might, I would l i k e t o r e v i e w t h e s i x
p r i n c i p l e s I mentioned e a r l i e r and d e s c r i b e how we t h i n k we can b e s t
f u l f i l l those p r i n c i p l e s .
F i r s t and most i m p o r t a n t , s e c u r i t y . T h i s p r i n c i p l e
speaks t o t h e human m i s e r y , t o t h e c o s t s , t o t h e a n x i e t y we hear
about e v e r y day -- a l l o f us -- when people t a l k about t h e i r problems
w i t h t h e p r e s e n t system.
S e c u r i t y means t h a t those who do n o t now
have h e a l t h care coverage w i l l have i t ; and f o r those who have i t , i t
w i l l never be t a k e n away. We must achieve t h a t s e c u r i t y as soon as
possible.
Under o u r p l a n , every American would r e c e i v e a h e a l t h
care s e c u r i t y c a r d t h a t w i l l guarantee a comprehensive package o f
b e n e f i t s over t h e course o f an e n t i r e l i f e t i m e , r o u g h l y comparable t o
the b e n e f i t package o f f e r e d by most Fortune 500 companies. T h i s
h e a l t h care s e c u r i t y c a r d w i l l o f f e r t h i s package o f b e n e f i t s i n a
way t h a t can never be t a k e n away.
So l e t us agree on t h i s : whatever e l s e we d i s a g r e e on,
b e f o r e t h i s Congress f i n i s h e s i t s work next year, you w i l l pass and I
w i l l s i g n l e g i s l a t i o n t o guarantee t h i s s e c u r i t y t o every c i t i z e n o f
t h i s c o u n t r y . (Applause.)
W i t h t h i s c a r d , i f you l o s e your j o b o r you s w i t c h j o b s ,
you're covered. I f you leave your j o b t o s t a r t a s m a l l b u s i n e s s ,
you're covered. I f you're an e a r l y r e t i r e e , you're covered. I f
someone i n your f a m i l y has, u n f o r t u n a t e l y , had an i l l n e s s t h a t
q u a l i f i e s as a p r e e x i s t i n g c o n d i t i o n , you're s t i l l covered. I f you
get s i c k o r a member o f your f a m i l y g e t s s i c k , even i f i t ' s a l i f e
t h r e a t e n i n g i l l n e s s , you're covered. And i f an i n s u r a n c e company
t r i e s t o drop you f o r any reason, you w i l l s t i l l be covered, because
t h a t w i l l be i l l e g a l .
T h i s c a r d w i l l g i v e comprehensive coverage.
I t w i l l cover people f o r h o s p i t a l care, d o c t o r v i s i t s , emergency and
l a b s e r v i c e s , d i a g n o s t i c s e r v i c e s l i k e Pap smears and mammograms and
c h o l e s t e r o l t e s t s , substance abuse and mental h e a l t h t r e a t m e n t .
(Applause.)
And e q u a l l y i m p o r t a n t , f o r b o t h h e a l t h care and economic
reasons, t h i s program f o r t h e f i r s t t i m e would p r o v i d e a broad range
of p r e v e n t i v e s e r v i c e s i n c l u d i n g r e g u l a r checkups and w e l l - b a b y
visits.
(Applause.)
Now, i t ' s j u s t common sense. We know -- any f a m i l y
d o c t o r w i l l t e l l you t h a t people w i l l s t a y h e a l t h i e r and l o n g - t e r m
costs o f t h e h e a l t h system w i l l be lower i f we have comprehensive
p r e v e n t i v e s e r v i c e s . You know how a l l o f our mothers t o l d us t h a t an
ounce o f p r e v e n t i o n was w o r t h a pound o f cure? Our mothers were
right.
(Applause.) And i t ' s a l e s s o n , l i k e so many lessons from o u r
mothers, t h a t we have w a i t e d t o o l o n g t o l i v e by. I t i s t i m e t o
�what i s r i g h t w i t h t h e h e a l t h care system, b u t we have got t o f i x
what i s wrong w i t h i t .
(Applause.)
Now, we a l l know what's r i g h t . We're blessed w i t h t h e
best h e a l t h care p r o f e s s i o n a l s on E a r t h , t h e f i n e s t h e a l t h care
i n s t i t u t i o n s , t h e best medical r e s e a r c h , t h e most s o p h i s t i c a t e d
technology.
My mother i s a nurse.
I grew up around h o s p i t a l s .
Doctors and nurses were t h e f i r s t p r o f e s s i o n a l people I ever knew o r
l e a r n e d t o l o o k up t o . They a r e what i s r i g h t w i t h t h i s h e a l t h care
system. But we a l s o know t h a t we can no l o n g e r a f f o r d t o c o n t i n u e t o
i g n o r e what i s wrong.
M i l l i o n s o f Americans a r e j u s t a p i n k s l i p away from
l o s i n g t h e i r h e a l t h i n s u r a n c e , and one s e r i o u s i l l n e s s away from
l o s i n g a l l t h e i r s a v i n g s . M i l l i o n s more a r e l o c k e d i n t o t h e j o b s
they have now j u s t because t h e y o r someone i n t h e i r f a m i l y has once
been s i c k and t h e y have what i s c a l l e d t h e p r e e x i s t i n g c o n d i t i o n .
And on any g i v e n day, over 3 7 m i l l i o n Americans -- most o f them
w o r k i n g people and t h e i r l i t t l e c h i l d r e n -- have no h e a l t h i n s u r a n c e
at a l l .
And i n s p i t e o f a l l t h i s , our medical b i l l s a r e growing
at over t w i c e t h e r a t e o f i n f l a t i o n , and t h e U n i t e d S t a t e s spends
over a t h i r d more o f i t s income on h e a l t h care than any o t h e r n a t i o n
on E a r t h . And t h e gap i s growing, causing many o f our companies i n
g l o b a l c o m p e t i t i o n severe disadvantage.
There i s no excuse f o r t h i s
k i n d o f system. We know o t h e r people have done b e t t e r . We know
people i n o u r own c o u n t r y a r e d o i n g b e t t e r . We have no excuse. My
f e l l o w Americans, we must f i x t h i s system and i t has t o b e g i n w i t h
congressional a c t i o n .
(Applause.)
I b e l i e v e as s t r o n g l y as I can say t h a t we can r e f o r m
the c o s t l i e s t and most w a s t e f u l system on t h e face o f t h e E a r t h
w i t h o u t e n a c t i n g new broad-based t a x e s .
(Applause.) I b e l i e v e i t
because o f t h e c o n v e r s a t i o n s I have had w i t h thousands o f h e a l t h care
p r o f e s s i o n a l s around t h e c o u n t r y ; w i t h people who a r e o u t s i d e t h i s
c i t y , b u t a r e i n s i d e e x p e r t s on t h e way t h i s system works and wastes
money.
The p r o p o s a l t h a t I d e s c r i b e t o n i g h t borrows many o f t h e
p r i n c i p l e s and ideas t h a t have been embraced i n p l a n s i n t r o d u c e d by
b o t h Republicans and Democrats i n t h i s Congress. For t h e f i r s t t i m e
i n t h i s c e n t u r y , l e a d e r s o f b o t h p o l i t i c a l p a r t i e s have j o i n e d
t o g e t h e r around t h e p r i n c i p l e o f p r o v i d i n g u n i v e r s a l , comprehensive
h e a l t h care.
I t i s a magic moment and we must s e i z e i t . (Applause.)
I want t o say t o a l l o f you I have been deeply moved by
the s p i r i t o f t h i s debate, by t h e openness o f a l l people t o new ideas
and argument and i n f o r m a t i o n . The American people would be proud t o
know t h a t e a r l i e r t h i s week when a h e a l t h care u n i v e r s i t y was h e l d
f o r members o f Congress j u s t t o t r y t o g i v e everybody t h e same amount
of i n f o r m a t i o n , over 320 Republicans and Democrats signed up and
showed up f o r two days j u s t t o l e a r n t h e b a s i c f a c t s o f t h e
c o m p l i c a t e d problem b e f o r e us.
Both s i d e s a r e w i l l i n g t o say we have l i s t e n e d t o t h e
people.
We know t h e cost o f g o i n g f o r w a r d w i t h t h i s system i s f a r
g r e a t e r t h a n t h e c o s t o f change. Both s i d e s , I t h i n k , understand t h e
l i t e r a l e t h i c a l i m p e r a t i v e o f d o i n g something about t h e system we
have now. R i s i n g above these d i f f i c u l t i e s and our past d i f f e r e n c e s
�s t a r t doing i t .
(Applause.)
H e a l t h care s e c u r i t y must a l s o a p p l y t o o l d e r Americans.
This i s something I imagine a l l of us i n t h i s room f e e l v e r y deeply
about.
The f i r s t t h i n g I want t o say about t h a t i s t h a t we must
m a i n t a i n t h e Medicare program. I t works t o p r o v i d e t h a t k i n d o f
security.
(Applause.) But t h i s time and f o r the f i r s t t i m e , I
b e l i e v e Medicare s h o u l d p r o v i d e coverage f o r the cost of p r e s c r i p t i o n
drugs.
(Applause.)
Yes, i t w i l l cost some more i n the b e g i n n i n g .
But,
again, any p h y s i c i a n who deals w i t h the e l d e r l y w i l l t e l l you t h a t
t h e r e are thousands o f e l d e r l y people i n every s t a t e who are not poor
enough t o be on Medicaid, but j u s t above t h a t l i n e and on Medicare,
who d e s p e r a t e l y need medicine, who makes d e c i s i o n s every week between
me;dicine and f o o d . Any d o c t o r who deals w i t h the e l d e r l y w i l l t e l l
you t h a t t h e r e are many e l d e r l y people who don't get medicine, who
get s i c k e r and s i c k e r and e v e n t u a l l y go t o the d o c t o r and wind up
spending more money and d r a i n i n g more money from the h e a l t h care
system t h a n t h e y would i f t h e y had r e g u l a r t r e a t m e n t i n the way t h a t
o n l y adequate medicine can p r o v i d e .
I a l s o b e l i e v e t h a t over t i m e , we should phase i n l o n g term care f o r t h e d i s a b l e d and the e l d e r l y on a comprehensive b a s i s .
(Applause.)
As we proceed w i t h t h i s h e a l t h care r e f o r m , we cannot
f o r g e t t h a t t h e most r a p i d l y growing percentage of Americans are
those over 80. We cannot break f a i t h w i t h them. We have t o do
b e t t e r by them.
The second p r i n c i p l e i s s i m p l i c i t y . Our h e a l t h care
system must be s i m p l e r f o r the p a t i e n t s and s i m p l e r f o r those who
a c t u a l l y d e l i v e r h e a l t h care -- our d o c t o r s , our nurses, our o t h e r
medical p r o f e s s i o n a l s . Today we have more than 1,500 i n s u r e r s , w i t h
hundreds and hundreds of d i f f e r e n t forms.
No o t h e r n a t i o n has a
system l i k e t h i s .
These forms are time consuming f o r h e a l t h care
p r o v i d e r s , t h e y ' r e expensive f o r h e a l t h care consumers, t h e y ' r e
e x a s p e r a t i n g f o r anyone who's ever t r i e d t o s i t down around a t a b l e
and wade t h r o u g h them and f i g u r e them o u t .
The medical care i n d u s t r y i s l i t e r a l l y drowning i n
paperwork. I n r e c e n t y e a r s , t h e number of a d m i n i s t r a t o r s i n our
h o s p i t a l s has grown by f o u r times t h e r a t e t h a t the number of d o c t o r s
has grown. A h o s p i t a l ought t o be a house of h e a l i n g , not a monument
t o paperwork and bureaucracy.
(Applause.)
J u s t a few days ago, t h e Vice P r e s i d e n t and I had t h e
honor o f v i s i t i n g t h e C h i l d r e n ' s H o s p i t a l here i n Washington where
t h e y do w o n d e r f u l , o f t e n m i r a c u l o u s t h i n g s f o r v e r y s i c k c h i l d r e n .
A
nurse named Debbie F r e i b e r g t o l d us t h a t she was i n the cancer and
bone marrow u n i t .
The o t h e r day a l i t t l e boy asked her j u s t t o s t a y
at h i s s i d e d u r i n g h i s chemotherapy. And she had t o walk away from
t h a t c h i l d because she had been i n s t r u c t e d t o go t o y e t another c l a s s
t o l e a r n how t o f i l l out another form f o r something t h a t d i d n ' t have
a l i c k t o do w i t h t h e h e a l t h care of the c h i l d r e n she was h e l p i n g .
That i s wrong, and we can s t o p i t , and we ought t o do i t .
(Applause.)
We
met
a v e r y c o m p e l l i n g d o c t o r named L i l l i a n Beard, a
�p e d i a t r i c i a n , who s a i d t h a t she d i d n ' t get i n t o her p r o f e s s i o n t o
spend hours and hours -- some d o c t o r s up t o 25 hours a week j u s t
f i l l i n g out forms.
She t o l d us she became a d o c t o r t o keep c h i l d r e n
w e l l and t o h e l p save those who got s i c k . We can r e l i e v e people l i k e
her o f t h i s burden. We l e a r n e d -- the Vice P r e s i d e n t and I d i d -t h a t i n t h e Washington C h i l d r e n ' s H o s p i t a l alone, the a d m i n i s t r a t o r s
t o l d us t h e y spend $2 m i l l i o n a year i n one h o s p i t a l f i l l i n g out
forms t h a t have n o t h i n g whatever t o do w i t h keeping up w i t h t h e
tireatment o f t h e p a t i e n t s .
And t h e d o c t o r s t h e r e applauded when I was t o l d and I
r e l a t e d t o them t h a t t h e y spend so much time f i l l i n g out paperwork,
t h a t i f t h e y o n l y had t o f i l l out those paperwork requirements
necessary t o m o n i t o r the h e a l t h o f the c h i l d r e n , each d o c t o r on t h a t
one h o s p i t a l s t a f f -- 200 o f them -- c o u l d see another 500 c h i l d r e n a
year. That i s 10,000 c h i l d r e n a year.
I t h i n k we can save money i n
t h i s system i f we s i m p l i f y i t . And we can make the d o c t o r s and t h e
nurses and t h e people t h a t are g i v i n g t h e i r l i v e s t o h e l p us a l l be
h e a l t h i e r a whole l o t h a p p i e r , t o o , on t h e i r j o b s .
(Applause.)
Under our p r o p o s a l t h e r e would be one s t a n d a r d i n s u r a n c e
form
not hundreds o f them. We w i l l s i m p l i f y a l s o -- and we must
the government's r u l e s and r e g u l a t i o n s , because t h e y are a b i g
p a r t o f t h i s problem.
(Applause.)
This i s one o f those cases where
the p h y s i c i a n s h o u l d h e a l t h y s e l f . We have t o r e i n v e n t the way we
r e l a t e t o t h e h e a l t h care system, a l o n g w i t h r e i n v e n t i n g government.
A d o c t o r s h o u l d not have t o check w i t h a b u r e a u c r a t i n an o f f i c e
thousands o f m i l e s away b e f o r e o r d e r i n g a simple b l o o d t e s t .
That's
not r i g h t , and we can change i t . (Applause.)
And d o c t o r s , nurses
and consumers s h o u l d n ' t have t o worry about the f i n e p r i n t .
I f we
have t h i s one simple form, t h e r e won't be any f i n e p r i n t .
People
w i l l know what i t means.
The t h i r d p r i n c i p l e i s s a v i n g s . Reform must produce
savings i n t h i s h e a l t h care system. I t has t o . We're spending over
14 p e r c e n t o f our income on h e a l t h care -- Canada's a t 10; nobody
e l s e i s over n i n e . We're competing w i t h a l l these people f o r t h e
f u t u r e . And t h e o t h e r major c o u n t r i e s , t h e y cover everybody and t h e y
cover them w i t h s e r v i c e s as generous as the best company p o l i c i e s
here i n t h i s c o u n t r y .
Rampant medical i n f l a t i o n i s e a t i n g away a t our wages,
our s a v i n g s , our investment c a p i t a l , our a b i l i t y t o c r e a t e new j o b s
i n t h e p r i v a t e s e c t o r and t h i s p u b l i c Treasury.
You know t h e budget
we j u s t adopted had steep c u t s i n defense, a f i v e - y e a r f r e e z e on t h e
d i s c r e t i o n a r y spending, so c r i t i c a l t o r e e d u c a t i n g America and
i n v e s t i n g i n j o b s and h e l p i n g us t o c o n v e r t from a defense t o a
domestic economy. But we passed a budget which has Medicaid
i n c r e a s e s o f between 16 and 11 p e r c e n t a year over the next f i v e
y e a r s , and Medicare i n c r e a s e s o f between 11 and 9 p e r c e n t i n an
environment where we assume i n f l a t i o n w i l l be a t 4 p e r c e n t o r l e s s .
We cannot c o n t i n u e t o do t h i s . Our c o m p e t i t i v e n e s s , our
whole economy, t h e i n t e g r i t y o f the way the government works and,
u l t i m a t e l y , our l i v i n g standards depend upon our a b i l i t y t o achieve
savings w i t h o u t harming t h e q u a l i t y o f h e a l t h care.
Unless we do t h i s , our workers w i l l l o s e $655 i n income
each year by t h e end o f t h e decade. Small businesses w i l l c o n t i n u e
t o face s k y r o c k e t i n g premiums. And a f u l l t h i r d o f s m a l l businesses
�now c o v e r i n g t h e i r employees say t h e y w i l l be f o r c e d t o drop t h e i r
insurance.
Large c o r p o r a t i o n s w i l l bear v i v i d disadvantages i n
g l o b a l c o m p e t i t i o n . And h e a l t h care c o s t s w i l l devour more and more
and more o f our budget. P r e t t y soon a l l of you o r the people who
succeed you w i l l be showing up here, and w r i t i n g out checks f o r
h e a l t h care and i n t e r e s t on t h e debt and w o r r y i n g about whether we've
got enough defense, and t h a t w i l l be i t , unless we have the courage
t o achieve t h e s a v i n g t h a t are p l a i n l y t h e r e b e f o r e us. Every s t a t e
and l o c a l government w i l l c o n t i n u e t o c u t back on e v e r y t h i n g from
e d u c a t i o n t o law enforcement t o pay more and more f o r the same h e a l t h
care.
These r i s i n g c o s t s are a s p e c i a l nightmare f o r our s m a l l
businesses -- t h e engine o f our e n t r e p r e n e u r s h i p and our j o b c r e a t i o n
i n America today.
H e a l t h care premiums f o r s m a l l businesses are 35
p e r c e n t h i g h e r t h a n those of l a r g e c o r p o r a t i o n s today. And t h e y w i l l
keep r i s i n g a t d o u b l e - d i g i t r a t e s unless we a c t .
So how w i l l we achieve these savings?
Rather t h a n
l o o k i n g a t p r i c e c o n t r o l , o r l o o k i n g away as the p r i c e s p i r a l
c o n t i n u e s ; r a t h e r t h a n u s i n g t h e heavy hand of government t o t r y t o
c o n t r o l what's happening, o r c o n t i n u i n g t o i g n o r e what's happening,
we b e l i e v e t h e r e i s a t h i r d way t o achieve these savings.
First, to
g i v e groups o f consumers and s m a l l businesses the same market
b a r g a i n i n g power t h a t l a r g e c o r p o r a t i o n s and l a r g e groups of p u b l i c
employees now have. We want t o l e t market f o r c e s enable p l a n s t o
compete. We want t o f o r c e these plans t o compete on t h e b a s i s o f
p r i c e and q u a l i t y , not s i m p l y t o a l l o w them t o c o n t i n u e making money
by t u r n i n g people away who are s i c k o r o l d o r p e r f o r m i n g mountains of
unnecessary procedures.
But we a l s o b e l i e v e we should back t h i s
system up w i t h l i m i t s on how much p l a n s can r a i s e t h e i r premiums y e a r
i n and y e a r o u t , f o r c i n g people, again, t o c o n t i n u e t o pay more f o r
the same h e a l t h c a r e , w i t h o u t r e g a r d t o i n f l a t i o n or t h e r i s i n g
p o p u l a t i o n needs.
We want t o c r e a t e what has been m i s s i n g i n t h i s system
f o r t o o l o n g , and what every s u c c e s s f u l n a t i o n who has d e a l t w i t h
t h i s problem has a l r e a d y had t o do:
t o have a c o m b i n a t i o n o f p r i v a t e
market f o r c e s and a sound p u b l i c p o l i c y t h a t w i l l support t h a t
c o m p e t i t i o n , but l i m i t t h e r a t e a t which p r i c e s can exceed the r a t e
of i n f l a t i o n and p o p u l a t i o n growth, i f t h e c o m p e t i t i o n doesn't work,
e s p e c i a l l y i n the e a r l y going.
The second t h i n g I want t o say i s t h a t u n l e s s everybody
i s covered -- and t h i s i s a v e r y i m p o r t a n t t h i n g -- u n l e s s everybody
i s covered, we w i l l never be able t o f u l l y put the breaks on h e a l t h
care i n f l a t i o n .
Why i s t h a t ? Because when people don't have any
h e a l t h i n s u r a n c e , t h e y s t i l l get h e a l t h care, but t h e y get i t when
i t ' s t o o l a t e , when i t ' s t o o expensive, o f t e n from t h e most expensive
p l a c e o f a l l , t h e emergency room. U s u a l l y by the time t h e y show up,
t h e i r i l l n e s s e s are more severe and t h e i r m o r t a l i t y r a t e s are much
h i g h e r i n our h o s p i t a l s t h a n those who have i n s u r a n c e .
So t h e y c o s t
us more.
And what e l s e happens? Since t h e y get the care but t h e y
don't pay, who does pay? A l l the r e s t of us. We pay i n h i g h e r
h o s p i t a l b i l l s and h i g h e r insurance premiums. This cost s h i f t i n g i s
a major problem.
The
t h i r d t h i n g we can do t o save money i s s i m p l y by
�s i m p l i f y i n g t h e system
-- what we've a l r e a d y discussed. F r e e i n g t h e
h e a l t h care p r o v i d e r s from these c o s t l y and unnecessary paperwork and
a d m i n i s t r a t i v e d e c i s i o n s w i l l save tens o f b i l l i o n s of d o l l a r s .
We
spend t w i c e as much as any o t h e r major c o u n t r y does on paperwork.
We
spend a t l e a s t a dime on the d o l l a r more t h a n any o t h e r major
c o u n t r y . That i s a s t u n n i n g s t a t i s t i c .
I t i s something t h a t e v e r y
Republican and e v e r y Democrat ought t o be able t o say, we agree t h a t
we;'re g o i n g t o squeeze t h i s o u t . We cannot t o l e r a t e t h i s . T h i s has
n o t h i n g t o do w i t h keeping people w e l l o r h e l p i n g them when t h e y ' r e
s i c k . We s h o u l d i n v e s t t h e money i n something e l s e .
We a l s o have t o crack down on f r a u d and abuse i n t h e
system.
That d r a i n s b i l l i o n s o f d o l l a r s a year. I t i s a v e r y l a r g e
f i g u r e , a c c o r d i n g t o every h e a l t h care e x p e r t I've ever spoken w i t h .
So I b e l i e v e we can achieve l a r g e s a v i n g s . And t h a t l a r g e savings
Ccin be used t o cover t h e unemployed u n i n s u r e d , and w i l l be used f o r
people who r e a l i z e those savings i n t h e p r i v a t e s e c t o r t o i n c r e a s e
t h e i r a b i l i t y t o i n v e s t and grow, t o h i r e new workers o r t o g i v e
t h e i r workers pay r a i s e s , many of them f o r the f i r s t t i m e i n y e a r s .
Now, nobody has t o take my word f o r t h i s .
You can ask
Dr. Koop. He's up here w i t h us t o n i g h t , and I thank him f o r b e i n g
here.
(Applause.)
Since he l e f t h i s d i s t i n g u i s h e d t e n u r e as our
Surgeon General, he has spent an enormous amount o f t i m e s t u d y i n g our
h e a l t h care system, how i t o p e r a t e s , what's r i g h t and wrong w i t h i t .
He says we c o u l d spend $200 b i l l i o n every year, more t h a n 20 p e r c e n t
of t h e t o t a l budget, w i t h o u t s a c r i f i c i n g t h e h i g h q u a l i t y o f American
medicine.
Ask t h e p u b l i c employees i n C a l i f o r n i a , who have h e l d
t h e i r own premiums down by a d o p t i n g the same s t r a t e g y t h a t I want
every American t o be a b l e t o adopt -- b a r g a i n i n g w i t h i n t h e l i m i t s o f
a s t r i c t budget.
Ask Xerox, which saved an e s t i m a t e d $1,000 per
worker on t h e i r h e a l t h i n s u r a n c e premium. Ask the s t a f f o f t h e Mayo
C l i n i c , who we a l l agree p r o v i d e s some o f the f i n e s t h e a l t h care i n
the w o r l d . They are h o l d i n g t h e i r c o s t i n c r e a s e s t o l e s s t h a n h a l f
the n a t i o n a l average.
Ask t h e people o f Hawaii, t h e o n l y s t a t e t h a t
covers v i r t u a l l y a l l o f t h e i r c i t i z e n s and has s t i l l been a b l e t o
keep c o s t s below t h e n a t i o n a l average.
People may d i s a g r e e over t h e best way t o f i x t h i s
system.
We may a l l d i s a g r e e about how q u i c k l y we can do what -- t h e
t h i n g t h a t we have t o do. But we cannot d i s a g r e e t h a t we can f i n d
tens o f b i l l i o n s o f d o l l a r s i n savings i n what i s c l e a r l y t h e most
c o s t l y and t h e most b u r e a u c r a t i c system i n t h e e n t i r e w o r l d . And we
have t o do something about t h a t , and we have t o do i t now.
(Applause.)
The f o u r t h p r i n c i p l e i s c h o i c e . Americans b e l i e v e t h e y
ought t o be a b l e t o choose t h e i r own h e a l t h care p l a n and keep t h e i r
own d o c t o r s . And I t h i n k a l l o f us agree. Under any p l a n we pass,
t h e y ought t o have t h a t r i g h t . But today, under our broken h e a l t h
care system, i n s p i t e o f t h e r h e t o r i c of c h o i c e , the f a c t i s t h a t
t h a t power i s s l i p p i n g away f o r more and more Americans.
Of course, i t i s u s u a l l y the employer, not the employee,
who makes t h e i n i t i a l choice o f what h e a l t h care p l a n t h e employee
w i l l be i n . And i f your employer o f f e r s o n l y one p l a n , as n e a r l y
t h r e e - q u a r t e r s o f s m a l l o r medium-sized f i r m s do today, you're s t u c k
w i t h t h a t p l a n , and t h e d o c t o r s t h a t i t covers.
�We propose t o g i v e every American a choice among h i g h q u a l i t y p l a n s . You can s t a y w i t h your c u r r e n t d o c t o r , j o i n a network
of d o c t o r s and h o s p i t a l s , o r j o i n a h e a l t h maintenance o r g a n i z a t i o n .
I f you don't l i k e your p l a n , every year y o u ' l l have t h e chance t o
choose a new one. The choice w i l l be l e f t t o t h e American c i t i z e n ,
the worker -- n o t t h e boss, and c e r t a i n l y n o t some government
bureaucrat.
We a l s o b e l i e v e t h a t d o c t o r s s h o u l d have a choice as t o
what p l a n s t h e y p r a c t i c e i n . Otherwise, c i t i z e n s may have t h e i r own
choices l i m i t e d . We want t o end t h e d i s c r i m i n a t i o n t h a t i s now
growing a g a i n s t d o c t o r s , and t o p e r m i t them t o p r a c t i c e i n s e v e r a l
d i f f e r e n t p l a n s . Choice i s i m p o r t a n t f o r d o c t o r s , and i t i s
a b s o l u t e l y c r i t i c a l f o r o u r consumers. We've g o t t o have i t i n
whatever p l a n we pass.
(Applause.)
The f i f t h p r i n c i p l e i s q u a l i t y .
I f we reformed
e v e r y t h i n g e l s e i n h e a l t h care, b u t f a i l e d t o p r e s e r v e and enhance
the h i g h q u a l i t y o f o u r medical care, we w i l l have t a k e n a s t e p
backward, n o t f o r w a r d . Q u a l i t y i s something t h a t we s i m p l y can't
leave t o chance. When you board an a i r p l a n e , you f e e l b e t t e r knowing
t h a t t h e p l a n e had t o meet standards designed t o p r o t e c t your s a f e t y .
A:rid we can't ask any l e s s o f o u r h e a l t h care system.
Our p r o p o s a l w i l l c r e a t e r e p o r t cards on h e a l t h p l a n s ,
so t h a t consumers can choose t h e h i g h e s t q u a l i t y h e a l t h care
p r o v i d e r s and reward them w i t h t h e i r business. A t t h e same t i m e , o u r
p l a n w i l l t r a c k q u a l i t y i n d i c a t o r s , so t h a t d o c t o r s can make b e t t e r
and smarter c h o i c e s o f t h e k i n d o f care t h e y p r o v i d e . We have
evidence t h a t more e f f i c i e n t d e l i v e r y o f h e a l t h care doesn't decrease
quality.
I n f a c t , i t may enhance i t .
Let me j u s t g i v e you one example o f one commonly
performed procedure, t h e c o r o n a r y bypass o p e r a t i o n . Pennsylvania
d i s c o v e r e d t h a t p a t i e n t s who were charged $21,000 f o r t h i s s u r g e r y
r e c e i v e d as good o r b e t t e r care as p a t i e n t s who were charged $84,000
f o r t h e same procedure i n t h e same s t a t e . High p r i c e s s i m p l y don't
always equal good q u a l i t y . Our p l a n w i l l guarantee t h a t h i g h q u a l i t y
i n f o r m a t i o n i s a v a i l a b l e i s a v a i l a b l e i n even t h e most remote areas
c f t h i s c o u n t r y so t h a t we can have h i g h - q u a l i t y s e r v i c e , l i n k i n g
r u r a l d o c t o r s , f o r example, w i t h h o s p i t a l s w i t h h i g h - t e c h urban
medical c e n t e r s . And o u r p l a n w i l l ensure t h e q u a l i t y o f c o n t i n u i n g
progress on a whole range o f i s s u e s by speeding t h e search on
e f f e c t i v e p r e v e n t i o n and t r e a t m e n t measures f o r cancer, f o r AIDS, f o r
A l z h e i m e r ' s , f o r h e a r t disease, and f o r o t h e r c h r o n i c d i s e a s e s . We
have t o s a f e g u a r d t h e f i n e s t medical r e s e a r c h e s t a b l i s h m e n t i n t h e
e n t i r e w o r l d . And we w i l l do t h a t w i t h t h i s p l a n . Indeed, we w i l l
even make i t b e t t e r .
(Applause.)
The s i x t h and f i n a l p r i n c i p l e i s r e s p o n s i b i l i t y .
We
need t o r e s t o r e a sense t h a t we're a l l i n t h i s t o g e t h e r and t h a t we
c i l l have a r e s p o n s i b i l i t y t o be a p a r t o f t h e s o l u t i o n .
R e s p o n s i b i l i t y has t o s t a r t w i t h those who p r o f i t from t h e c u r r e n t
system.
R e s p o n s i b i l i t y means insurance companies s h o u l d no l o n g e r be
a l l o w e d t o c a s t people a s i d e when t h e y g e t s i c k .
I t should apply t o
l a b o r a t o r i e s t h a t submit f r a u d u l e n t b i l l s , t o lawyers who abuse
m a l p r a c t i c e c l a i m s , t o d o c t o r s who o r d e r unnecessary procedures. I t
means drug companies s h o u l d no l o n g e r charge t h r e e times more p e r
p r e s c r i p t i o n drugs made i n America here i n t h e U n i t e d S t a t e s t h a n
�they charge f o r t h e same drugs overseas.
(Applause.)
I n s h o r t , r e s p o n s i b i l i t y should a p p l y t o anybody t o
abuses t h i s system and d r i v e s up t h e cost f o r honest, h a r d - w o r k i n g
c i t i z e n s and undermines c o n f i d e n c e i n t h e honest, g i f t e d h e a l t h care
p r o v i d e r s we have.
R e s p o n s i b i l i t y a l s o means changing some b e h a v i o r s i n
t h i s c o u n t r y t h a t d r i v e up our c o s t s l i k e crazy. And w i t h o u t
changing i t w e ' l l never have t h e system we ought t o have. We w i l l
never.
Let me j u s t mention a few and s t a r t w i t h t h e most
i m p o r t a n t -- t h e outrageous c o s t o f v i o l e n c e i n t h i s c o u n t r y stem i n
l a r g e measure from t h e f a c t t h a t t h i s i s t h e o n l y c o u n t r y i n t h e
w o r l d where teenagers can r o u t t h e s t r e e t s a t random w i t h semia u t o m a t i c weapons and be b e t t e r armed t h a n t h e p o l i c e .
(Applause.)
But l e t ' s n o t k i d o u r s e l v e s , i t ' s n o t t h a t s i m p l e . We
a l s o have h i g h e r r a t e s o f AIDS, o f smoking and excessive d r i n k i n g , o f
t e e n pregnancy, o f low b i r t h weight babies. And we have t h e t h i r d
worst i m m u n i z a t i o n r a t e o f any n a t i o n i n t h e western hemisphere.
We
have t o change o u r ways i f we ever r e a l l y want t o be h e a l t h y as a
people and have an a f f o r d a b l e h e a l t h care system.
And no one can
demy t h a t .
(Applause.)
But l e t me say t h i s -- and I hope every American w i l l
l i s t e n , because t h i s i s n o t an easy t h i n g t o hear -- r e s p o n s i b i l i t y
i n our h e a l t h care system i s n ' t j u s t about them, i t ' s about you, i t ' s
about me, i t ' s about each o f us. Too many o f us have n o t t a k e n
r e i s p o n s i b i l i t y f o r o u r own h e a l t h care and f o r our own r e l a t i o n s t o
the h e a l t h care system.
Many o f us who have had f u l l y p a i d h e a l t h
care p l a n s have used t h e system whether we needed i t o r n o t w i t h o u t
t h i n k i n g what t h e c o s t s were. Many people who use t h i s system don't
pay a
whether we needed i t o r n o t w i t h o u t t h i n k i n g what t h e c o s t s were.
Memy people who use t h i s system don't pay a penny f o r t h e i r care even
though t h e y can a f f o r d t o . I t h i n k those who don't have any h e a l t h
i n s u r a n c e s h o u l d be r e s p o n s i b l e f o r p a y i n g a p o r t i o n o f t h e i r new
coverage.
There can't be any something f o r n o t h i n g , and we have t o
demonstrate t h a t t o people. T h i s i s n o t a f r e e system.
(Applause.)
Even s m a l l c o n t r i b u t i o n s , as s m a l l as t h e $10-copayment when you
v i s i t a d o c t o r , i l l u s t r a t e s t h a t t h i s i s something o f v a l u e . There
i s a cost t o i t . I t i s not f r e e .
And I want t o t e l l you t h a t I b e l i e v e t h a t a l l o f us
s h o u l d have i n s u r a n c e . Why s h o u l d t h e r e s t o f us p i c k up t h e t a b
when a guy who doesn't t h i n k he needs insurance o r says he can't
a f f o r d i t g e t s i n an a c c i d e n t , winds up i n an emergency room, g e t s
good c a r e , and everybody e l s e pays? Why should t h e s m a l l
businesspeople who a r e s t r u g g l i n g t o keep a f l o a t and t a k e care o f
t h e i r employees have t o pay t o m a i n t a i n t h i s w o n d e r f u l h e a l t h care
i n f r a s t r u c t u r e f o r those who r e f u s e t o do anything?
I f we're g o i n g t o produce a b e t t e r h e a l t h care system
f o r every one o f us, every one o f us i s g o i n g t o have t o do o u r p a r t .
There cannot be any such t h i n g as a f r e e r i d e . We have t o pay f o r
it.
We have t o pay f o r i t .
T o n i g h t I want t o say p l a i n l y how I t h i n k we s h o u l d do
�t h a t . Most o f t h e money we w i l l -- w i l l come under my way o f
t h i n k i n g , as i t does today, from premiums p a i d by employers and
i n d i v i d u a l s . That's t h e way i t happens today. But under t h i s h e a l t h
care s e c u r i t y p l a n , every employer and every i n d i v i d u a l w i l l be asked
t o c o n t r i b u t e something t o h e a l t h care.
T h i s concept was f i r s t conveyed t o t h e Congress about 20
years ago by P r e s i d e n t Nixon.
And today, a l o t o f people agree w i t h
the concept o f shared r e s p o n s i b i l i t y between employers and employees,
and t h a t t h e b e s t t h i n g t o do i s t o ask every employer and every
employee t o share t h a t . The Chamber o f Commerce has s a i d t h a t , and
t h e y ' r e n o t i n t h e business o f h u r t i n g s m a l l business.
The American
Medical A s s o c i a t i o n has s a i d t h a t .
Some c a l l i t an employer mandate, b u t I t h i n k i t ' s t h e
f a i r e s t way t o achieve r e s p o n s i b i l i t y i n t h e h e a l t h care system. And
i t ' s t h e e a s i e s t f o r o r d i n a r y Americans t o understand, because i t
b u i l d s on what we a l r e a d y have and what a l r e a d y works f o r so many
Americans. I t i s t h e r e f o r m t h a t i s n o t o n l y e a s i e s t t o understand,
but e a s i e s t t o implement i n a way t h a t i s f a i r t o s m a l l business,
because we can g i v e a d i s c o u n t t o h e l p s t r u g g l i n g s m a l l businesses
meiet t h e c o s t o f c o v e r i n g t h e i r employees. We should r e q u i r e t h e
l e a s t b u r e a u c r a c y o r d i s r u p t i o n , and c r e a t e t h e c o o p e r a t i o n we need
t o make t h e system c o s t - c o n s c i o u s , even as we expand coverage. And
we s h o u l d do i t i n a way t h a t does n o t c r i p p l e s m a l l businesses and
low-wage workers.
Every employer should p r o v i d e coverage, j u s t as t h r e e q u a r t e r s do now. Those t h a t pay a r e p i c k i n g up t h e t a b f o r those who
don't today.
I don't t h i n k t h a t ' s r i g h t . To f i n a n c e t h e r e s t o f
r e f o r m , we can achieve new savings, as I have o u t l i n e d , i n b o t h t h e
f e d e r a l government and t h e p r i v a t e s e c t o r , t h r o u g h b e t t e r d e c i s i o n making and i n c r e a s e d c o m p e t i t i o n . And we w i l l impose new taxes on
tobacco.
(Applause.)
I don't t h i n k t h a t should be t h e o n l y source o f
revenues. I b e l i e v e we s h o u l d a l s o ask f o r a modest c o n t r i b u t i o n
from b i g employers who o p t o u t o f t h e system t o make up f o r what
those who a r e i n t h e system pay f o r medical r e s e a r c h , f o r h e a l t h
e d u c a t i o n c e n t e r , f o r a l l t h e s u b s i d i e s t o s m a l l business, f o r a l l
the t h i n g s t h a t everyone e l s e i s c o n t r i b u t i n g t o . But between those
two t h i n g s , we b e l i e v e we can pay f o r t h i s package o f b e n e f i t s and
u n i v e r s a l coverage and a subsidy program t h a t w i l l h e l p s m a l l
business.
These sources can cover t h e cost o f t h e p r o p o s a l t h a t I
have d e s c r i b e d t o n i g h t . We s u b j e c t e d t h e numbers i n o u r p r o p o s a l t o
the s c r u t i n y o f n o t o n l y a l l t h e major agencies i n government -- I
know a l o t o f people don't t r u s t them, b u t i t would be i n t e r e s t i n g
f o r t h e American people t o know t h a t t h i s was t h e f i r s t t i m e t h a t t h e
f i n a n c i a l e x p e r t s on h e a l t h care i n a l l o f t h e d i f f e r e n t government
agencies have ever been r e q u i r e d t o s i t i n t h e room t o g e t h e r and
agree on numbers. I t had never happened b e f o r e .
But, o b v i o u s l y , t h a t ' s n o t enough. So t h e n we gave
these numbers t o a c t u a r i e s from major a c c o u n t i n g f i r m s and major
Fortune 500 companies who have no stake i n t h i s o t h e r t h a n t o see
t h a t our e f f o r t s succeed. So I b e l i e v e our numbers a r e good and
achievable.
�Now, what does t h i s mean t o an i n d i v i d u a l American
c i t i z e n ? Some w i l l be asked t o pay more. I f you're an employer and
you a r e n ' t i n s u r i n g your workers a t a l l , y o u ' l l have t o pay more.
But i f you're a s m a l l business w i t h fewer than 50 employees, y o u ' l l
ge:t a subsidy.
I f you're a f i r m t h a t p r o v i d e s o n l y v e r y l i m i t e d
coverage, you may have t o pay more. But some f i r m s w i l l pay t h e same
or l e s s f o r more coverage.
I f you're a young, s i n g l e person i n your 20s and you're
a l r e a d y i n s u r e d , y o u r r a t e s may go up somewhat because you're g o i n g
t o go i n t o a b i g p o o l w i t h middle-aged people and o l d e r people, and
we want t o enable people t o keep t h e i r insurance even when someone i n
t h e i r f a m i l y g e t s s i c k . But I t h i n k t h a t ' s f a i r because when t h e
young g e t o l d e r , t h e y w i l l b e n e f i t from i t , f i r s t , and secondly, even
those who pay a l i t t l e more today w i l l b e n e f i t f o u r , f i v e , s i x , seven
ye;ars from now by o u r b r i n g i n g h e a l t h care c o s t s c l o s e r t o i n f l a t i o n .
Over t h e l o n g r u n , we can a l l win. But some w i l l have
t o pay more i n t h e s h o r t r u n . N e v e r t h e l e s s , t h e v a s t m a j o r i t y o f t h e
Americans w a t c h i n g t h i s t o n i g h t w i l l pay t h e same o r l e s s f o r h e a l t h
ca.re coverage t h a t w i l l be t h e same o r b e t t e r than t h e coverage t h e y
h3.ve t o n i g h t . That i s t h e c e n t r a l r e a l i t y .
(Applause.)
I f you c u r r e n t l y g e t your h e a l t h insurance t h r o u g h y o u r
job, under o u r p l a n you s t i l l w i l l .
And f o r t h e f i r s t t i m e ,
everybody w i l l g e t t o choose from among a t l e a s t t h r e e p l a n s t o
belong t o . I f you're a s m a l l business owner who wants t o p r o v i d e
h e a l t h i n s u r a n c e t o you f a m i l y and your employees, b u t you can't
a f f o r d i t because t h e system i s stacked a g a i n s t you, t h i s p l a n w i l l
g i v e you a d i s c o u n t t h a t w i l l f i n a l l y make insurance a f f o r d a b l e . I f
you're a l r e a d y p r o v i d i n g i n s u r a n c e , your r a t e s may w e l l drop because
w e ' l l h e l p you as a s m a l l business person j o i n thousands o f o t h e r s t o
get t h e same b e n e f i t s b i g c o r p o r a t i o n s g e t a t t h e same p r i c e t h e y g e t
those b e n e f i t s .
I f you're self-employed, y o u ' l l pay l e s s ; and you
w i l l g e t t o deduct from your taxes 100 p e r c e n t o f your h e a l t h care
premiums.
(Applause.)
I f you're a l a r g e employer, your h e a l t h care c o s t s won't
go up as f a s t , so t h a t you w i l l have more money t o p u t i n t o h i g h e r
wages and new j o b s and t o p u t i n t o t h e work o f b e i n g c o m p e t i t i v e i n
t h i s tough g l o b a l economy.
Now, these, my f e l l o w Americans, a r e t h e p r i n c i p l e s on
which I t h i n k we s h o u l d base our e f f o r t s :
security, simplicity,
savings, c h o i c e , q u a l i t y and r e s p o n s i b i l i t y . These a r e t h e g u i d i n g
s t a r s t h a t we s h o u l d f o l l o w on our j o u r n e y toward h e a l t h care r e f o r m .
Over t h e coming months, y o u ' l l be bombarded w i t h
i n f o r m a t i o n from a l l k i n d s o f sources.
There w i l l be some who w i l l
s t o u t l y d i s a g r e e w i t h what I have proposed -- and w i t h a l l o t h e r
p l a n s i n t h e Congress, f o r t h a t m a t t e r . And some o f t h e arguments
w i l l be g e n u i n e l y s i n c e r e and e n l i g h t e n i n g . Others may s i m p l y be
scare t a c t i c s by those who a r e m o t i v a t e d by t h e s e l f - i n t e r e s t t h e y
have i n t h e waste t h e system now generates, because t h a t waste i s
p r o v i d i n g j o b s , incomes and money f o r some people.
I ask you o n l y t o t h i n k o f t h i s when you hear a l l o f
these arguments: Ask y o u r s e l f whether t h e cost o f s t a y i n g on t h i s
same course i s n ' t g r e a t e r t h a n t h e cost o f change. And ask y o u r s e l f
when you hear t h e arguments whether t h e arguments a r e i n your
�i n t e r e s t o r someone e l s e ' s .
do t o g e t h e r .
T h i s i s something we have g o t t o t r y t o
I want a l s o t o say t o t h e r e p r e s e n t a t i v e s i n Congress,
you have a s p e c i a l d u t y t o l o o k beyond these arguments. I ask you
i n s t e a d t o l o o k i n t o t h e eyes o f t h e s i c k c h i l d who needs care; t o
t h i n k o f t h e face o f t h e woman who's been t o l d n o t o n l y t h a t h e r
c c n d i t i o n i s m a l i g n a n t , b u t n o t covered by her insurance.
To l o o k a t
the bottom l i n e s o f t h e businesses d r i v e n t o b a n k r u p t c y by h e a l t h
care c o s t s . To l o o k a t t h e " f o r s a l e " s i g n s i n f r o n t o f t h e homes o f
f a m i l i e s who have l o s t e v e r y t h i n g because o f t h e i r h e a l t h care c o s t s .
I ask you t o remember t h e k i n d o f people I met over t h e
l a s t y e a r and a h a l f -- t h e e l d e r l y couple i n New Hampshire t h a t
broke down and c r i e d because o f t h e i r shame a t having an empty
r e f r i g e r a t o r t o pay f o r t h e i r drugs; a woman who l o s t a $50,000-job
t h a t she used t o support h e r s i x c h i l d r e n because her youngest c h i l d
was so i l l t h a t she c o u l d n ' t keep h e a l t h insurance, and t h e o n l y way
t o g e t care f o r t h e c h i l d was t o g e t p u b l i c a s s i s t a n c e ; a young
couple t h a t had a s i c k c h i l d and c o u l d o n l y g e t insurance from one o f
the p a r e n t s ' employers t h a t was a n o n p r o f i t c o r p o r a t i o n w i t h 2 0
employees, and so t h e y had t o face t h e q u e s t i o n o f whether t o l e t
t h i s poor person w i t h a s i c k c h i l d go o r r a i s e t h e premiums o f e v e r y
employee i n t h e f i r m by $200. And on and on and on.
I know we have d i f f e r e n c e s o f o p i n i o n , b u t we a r e here
t o n i g h t i n a s p i r i t t h a t i s animated by t h e problems o f those people,
and by t h e sheer knowledge t h a t i f we can l o o k i n t o our h e a r t , we
w i l l n o t be a b l e t o say t h a t t h e g r e a t e s t n a t i o n i n t h e h i s t o r y o f
the w o r l d i s powerless t o c o n f r o n t t h i s c r i s i s .
(Applause.)
Our h i s t o r y and o u r h e r i t a g e t e l l us t h a t we can meet
t h i s challenge.
E v e r y t h i n g about America's past t e l l s us we w i l l do
it.
So I say t o you, l e t us w r i t e t h a t new chapter i n t h e American
s t o r y . L e t us guarantee every American comprehensive h e a l t h b e n e f i t s
t h a t can never be t a k e n away.
(Applause.)
I n s p i t e o f a l l t h e work we've done t o g e t h e r and a l l t h e
p r o g r e s s we've made, t h e r e ' s s t i l l a l o t o f people who say i t would
be an o u t r i g h t m i r a c l e i f we passed h e a l t h care r e f o r m .
But my
f e l l o w Americans, i n a time o f change, you have t o have m i r a c l e s .
And m i r a c l e s do happen. I mean, j u s t a few days ago we saw a simple
handshake s h a t t e r decades o f deadlock i n t h e Middle East. We've seen
the w a l l s crumble i n B e r l i n and South A f r i c a . We see t h e ongoing
brsive s t r u g g l e o f t h e people o f Russia t o s e i z e freedom and
democracy.
And now, i t i s our t u r n t o s t r i k e a blow f o r freedom i n
t h i s country.
The freedom o f Americans t o l i v e w i t h o u t f e a r t h a t
t h e i r own n a t i o n ' s h e a l t h care system won't be t h e r e f o r them when
t h e y need i t . I t ' s hard t o b e l i e v e t h a t t h e r e was once a time i n
t h i s c e n t u r y when t h a t k i n d o f f e a r g r i p p e d o l d age. When r e t i r e m e n t
was n e a r l y synonymous w i t h p o v e r t y , and o l d e r Americans d i e d i n t h e
s t r e e t . That's u n t h i n k a b l e today, because over a h a l f a c e n t u r y ago
Americans had t h e courage t o change -- t o c r e a t e a S o c i a l S e c u r i t y
system t h a t ensures t h a t no Americans w i l l be f o r g o t t e n i n t h e i r
l a t e r years.
F o r t y y e a r s from now, our g r a n d c h i l d r e n w i l l a l s o
find
�i t u n t h i n k a b l e t h a t t h e r e was a time i n t h i s c o u n t r y when h a r d w o r k i n g
f a m i l i e s l o s t t h e i r homes, t h e i r savings, t h e i r businesses, l o s t
e v e r y t h i n g s i m p l y because t h e i r c h i l d r e n g o t s i c k o r because t h e y had
t o change j o b s . Our g r a n d c h i l d r e n w i l l f i n d such t h i n g s u n t h i n k a b l e
tomorrow i f we have t h e courage t o change today.
T h i s i s o u r chance. This i s our j o u r n e y . And when o u r
work i s done, we w i l l know t h a t we have answered t h e c a l l o f h i s t o r y
and met t h e c h a l l e n g e o f o u r t i m e .
Thank you v e r y much.
And God b l e s s America.
(Applause.)
END
10:02 P.M.
EOT
�THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
September 21, 1993
PRESS BRIEFING
BY
DIRECTOR OF COMMUNICATIONS MARK GEARAN,
ASSISTANT TO THE PRESIDENT ON ECONOMIC POLICY BOB RUBIN,
OMB DIRECTOR LEON PANETTA,
TREASURY DEPUTY SECRETARY ROGER ALTMAN,
COUNCIL OF THE ECONOMIC ADVISORY CHAIR LAURA TYSON
The Briefmg Room
1:16 P.M. EDT
MR. GEARAN: Let me start out with giving you a road map of what
we're about to do today. We have Bob Rubin ~
Q
Mark, before you do that could we just get a little reaction to
what's happening in Russia?
MR. GEARAN. I'm going to do that, yes. Yes. I'm going to do road
map, then reaction. It's not alphabetical.
Bob Rubin, Leon Panetta, Laura Tyson, and Roger Altman, who will
give a briefing on some of the questions that have been raised in terms of the fmancing of
the health care system. They have a limited amount of time, so we'll go to them quickly.
Let me give you just a preliminary on events in Russia. We are just
learning of the events unfolding in Russia ourselves at this time. We're in the process of
getting more information and will be assessing it as the hours progress. We expect to have
a statement later on in more detail and with more information than we're receiving at this
point.
Q
So we were not informed before the action by Yeltsin?
MR. GEARAN: No. Mr. Pickering was called in with some of the
other foreign ministers in advance of it.
Q
In advance of it?
Q
How far in advance?
MR. GEARAN: Soon in advance of it. It was not ~
�Well, they're saying in Moscow less than an hour. Is that
correct?
MR. GEARAN: I think that's con-ect.
Q
What were they informed? The details of what Yeltsin would
say, or just that Yeltsin would speak?
MR. GEARAN: They were informed of the speech. Let me leave it at
that. That's about all we can provide.
Q
When was the President informed?
MR. GEARAN: As the events were proceeding.
Q
Mark, what form will the statement be?
MR. GEARAN: I'm sony.
Q
What form will his statement —
MR. GEARAN: We're waiting to see who will best respond or how
Vv'e'll do that ~ and whether it will be someone from the White House or Secretary
Christopher will ~
Q
Do you know who told the President of these developments?
MR. GEARAN: The national security staff.
Q
Before or after the National Service event?
MR. GEARAN: It was - I'll have to confirm that. My understanding
— I think it was afterwards. Let me confirm that for you in terms of when he was told.
Bob.
MR. RUBIN: Thank you, Mark. I'm Bob Rubin, the Assistant to the
President for Economic Policy. We're going to discuss the financing of the health care
plan, which seems to be a subject of some interest. And let me start with a few general
comments, and then we'll get into the specifics of the financing.
As was true in the economic plan ~ and you heard the President say
this in reference to the economic plan ~ he'll say the same thing about the health care plan.
From the very beginning, he insisted that we take enormous care with the numbers with
respect to accuracy; that we have accurate, conservative, valid numbers, and that our
policy decisions be based on such numbers so that there will never be a question about our
numbers.
With the economic plan and again with the health care plan, his
�position was that he's happy to have all the debates people want to have about policy, but
he does not want to have anybody validly questioning the validity of his numbers. And it's
on that ~ with that mandate that these numbers were developed.
There obviously will be a debate ~ a national debate on health care
policy, and there will be all kinds of issues. But what there shouldn't be any debate on is
the validity of these numbers. They were developed with enormous care and enormous
carefulness with respect to making sure that we had numbers that would withstand any
kind of challenge.
I've been involved in my own career with enormous numbers of
number developing processes. (Laughter.) I guess that fits together. And I can tell you,
this was an exhaustive process. HHS, OMB, Treasury, CEA, actuaries, internal within the
government involved with developing the numbers. And then there were external ~
accountants and actuaries reviewed the models and reviewed the development of the
numbers.
I can remember early in the process when there would be
disagreements and there would be debates about the numbers. And Ira's position
throughout it was that we had to have accurate numbers and then we make our policy
decisions and these differences will eventually narrowed and brought down to numbers
that everybody could agree on.
Finally, let me make one more comment on the process, itself. This
was an exhaustive process of debate and discussion. We had endless meetings amongst
ourselves, and then with the President. Well, the ones with the President weren't endless,
but we had endless meetings amongst ourselves and a goodly number of very lengthy
meetings with the President. We all the ability to state whatever it is we wanted to state.
There were healthy debates, there were lengthy debates, there were real differences of
opinion just as there were with the economic plan. The groupings would be different over
each issue. We had one grouping on one issue, another grouping on another issue. And
out of it all came a plan, as was true in the economic plan, that all of us felt was a good
I)lan and that realized the purposes that the President started out with, which was to
develop a way of reducing or eliminating the enormous excess expenditure, which is I
think unquestionable in our health care system, and then utilize those savings to fiind the
realization of his objectives. And that's what this plan is all about.
With that, let me turn it over to Leon Panetta, who will get much more
involved in the specifics of the numbers.
DIRECTOR PANETTA: Let me again, preface these remarks by
trying to compare a little bit of this to the economic plan. I mean, the fact is with the
economic plan, there were models that were in place over the years. We had very good
estimates about various proposals, either on the tax side or on the cut side, that have all
been estimated before. There are economic consequences that have pretty well been
estimated. So we basically had models in place that made us much more comfortable,
obviously, with the numbers that we're dealing with.
In this instance, we're dealing with an unprecedented effort at reform
of the entire health care system in this country. And the problem we had from the
�beginning is obviously to develop models that could estimate the impact of that kind of
broad reform with regards to health care. What happens when you suddenly pick up
almost 60 million Americans who are uninsured or under-insured, and bring them into a
health care system? What are the costs of that? What is the impact on the health area?
What are the behavioral consequences of bringing people into that kind of system? Then
determining the cost impact, not only on business, but on employees, individuals as well
as the health industry, as well as the Treasury. So, obviously, those were the questions that
v/e had to develop approaches to if we were going to try to develop the most accurate
numbers that we could develop in the reform plan.
Over the last six months, we have basically been involved in trying to
develop that kind of modeling system. We've had representatives from OMB, from
Treasury; economists who have been part of that, HHS, the various actuaries that are
involved with health care issues generally have participated in that effort. And so at the
conclusion of that, we tried to develop the most credible and conservative kind of
estimates of the impact of health care reform as we could. You have to look at again, what
~ if you develop a basic benefit plan, what does that look like? What are its impacts?
What are the characteristics of the people that we're dealing with? What are the
households that we're going to be impacting, employers, employees, and obviously just the
whole cost issues.
After six months, we believe we've developed I think the most
sophisticated models in the business of analyzing health care costs. They are the best in
the business. There aren't any others, really, out there. And that was our problem. But 1
think that as a result of the work that we've done, we've got the best in the business. And
so the estimates that we have here, I believe, are credible and I believe, again, can be
defended when we present the plan itself to the Congress.
Like the economic plan, I think it's important to understand that people
can question the policies, they can question the politics. And, obviously, that's a process
we're going to go through after we've presented the plan to the Congress and to the
country, and that's legitimate. But if, in fact, we can get all of these elements passed by
the Congress, then we believe we can hit these numbers.
Now, let me speak a little bit about the specific numbers that we're
working with in terms of the elements of the program and thefinancingfor those
elements. Let me begin with a very important promise here that 1 think a lot of people are
losing sight of. The most important premise that we're operating with is that most of the
money comes from where the money now comes from to pay for health care, which is the
contribution by employers and individuals into a premium process to pay for their health
care plans. That process is still there. That premium base is still there. People who are
now paying for health care will continue to pay health care premiums. So that is a base
that's there and that is going to continue to be funded through the premium process.
With regards to the federal side of it, let me describe what those
elements are, because that's where legitimate question can be asked: how is the federal
government then going to pay for those benefits? Again, I want to condition all of this to
say that it's subject to continuing adjustments. We're still looking at these numbers and
there will be, 1 think, minor modifications in the final numbers that appear in the bill. But
right now, the numbers that I'm going to present to you are estimates between largely 1995
�and the year 2000. Some of these numbers basically will ratchet-in, depending on the
particular program that you're looking at.
On the new benefits, let me describe the new benefits that will be part
of the program. The new benefits include a long-term health care program for the elderly,
and that program largely targets on home health care, community-based health care for
seniors. The estimate on that is about $80 billion.
Q
Over?
DIRECTOR PANETTA: That is between - it ratchets in starting in I
believe 1995 ~ '96, and goes to the year 2000.
Q
Is that an annual number?
DIRECTOR PANETTA: That's the total number for that period of
time and it ratchets in.
Q
Four years?
DIRECTOR PANETTA: Five-year numbers.
Q
Does it start low and grow? I mean, that's ~
DIRECTOR PANETTA: Essentially, in this area it ratchets in and it
starts to escalate in terms of the costs.
On the Medicare drug benefit, it's the same over that period of time.
That's about $72 billion. That basically provides for drug benefits to those on Medicare
with a deductible, small deductible. That's $72 billion.
The third piece of it is that there are public health care investments that
are part of this, in which there are targeted increases, particularly for rural clinics and
community clinics that try to serve those at the low income levels. And there will be
about ~ in addition to that piece, there are start-up costs for the basic system itself that will
come to $29 billion over that period of time.
We will be providing a 100 percent self-employed deduction for those
v^'ho pay in, those who are self-employed with regards to their payments. They'll have a
100 percent deduction. That costs $9 billion.
And then lastly is the largest portion here, which are the discounts for
subsidies, as they've been called, to businesses and the employees at the low income level
who would qualify. And the price tag on that is $160 billion. And that's the one, very
frankly, that continues to ~ we need to continue to scrub that number, because we need to
analyze just exactly who's going to receive those subsidies as we work through the plan.
B'Ut that's ~ $160 billion is the estimate right now. So that the total cost we're looking at
of the new benefits that will be provided by the federal government are $350 billion.
How do we pay for this in terms of trying to make sure that each of
these is covered? The first area, obviously, deals with the two principal health care
�programs that are the costliest at the federal level: Medicare and Medicaid. And let me
preface this by saying that, again, all of you know that we're dealing with programs that, in
terms of the federal budget, are escalating at double and triple the costs. We're looking at
taking these programs from roughly three to four times the rate of growth in the economy
down to about two times the rate of growth. So we're basically trying to reduce the very
high level of growth that we're seeing in these programs.
On Medicare, we're looking at about $124 billion in savings over that
s£imefive-yearperiod. These savings will be specific. We're not talking about a cap. As
you know, there's often times been a discussion in the Congress about setting some kind of
arbitrary cap with regards to these expenditures. We are going to present specific
proposals to achieve these savings. An example of some of those proposals would be
requirements for additional co-pays, competitive bidding with regards to medical
e(^uipment, some lab co-insurance requirements. These are proposals that have been in the
mix in terms of the discussions on Medicare savings as long as I've been involved in the
budget process. And we are selecting, we think, they policies that make sense, both from a
substantive point of view as well as a savings point of view.
The same thing is true on Medicaid, which will be $114 billion in
savings over that period of time. Most of that will come from a reduced cost on the
disproportionate share, which is basically what we now pay hospitals that are the targeted
hospitals that serve an excess number of individuals on Medicaid. We think we obviously
v/ill be able to reduce that disproportionate share provision as a result of the other
elements of health care reform.
The second area is the savings that we hope will flow, and we were
confident will flow from the fact that other federal programs that serve people, people will
be moving gradually into the health care system itself, into the alliances, and we estimate
that we will get savings from veterans programs, from Department of Defense programs,
and also, obviously, from the federal employee health programs where we now cover all of
those costs, federal employees will be part of the new health care system. We expect
savings there of about $47 billion.
The fourth area of savings relates to our ability to move away from taxfree benefits, which we now provide in large measure, obviously, through deductions in
which we cover health care payments. Our hope is that obviously as we reduce the cost of
those payments, that not only will we reduce the amount of benefits we have to provide
through the tax system, but in addition, we will incur some additional revenues from those
who receive profits and additional wages as a consequence of that. And that's a pretty fair
estimate that we generally use. It's a little bit like looking at a mortgage deduction, and as
you reduce interest rates obviously the consequence of that is to produce more money to
the individual which then becomes subject, hopefully, to additional taxes flowing to the
federal government.
The estimate there is $51 billion, what we estimate in that area. And
this one that we, again, in terms of our own process we're trying to nail down with
Treasury and with OMB looking at these numbers continually.
The last area is sin taxes. Sin taxes are approximately $105 billion.
The final decision on the exact elements of that have not been decided, but ~
�Q
You're kidding.
DIRECTOR PANETTA: Whose kidding? (Laughter.) No, I'm not
kiidding. They have not been decided. We're looking obviously at cigarette taxes, and
whether we go beyond that, or how much the cigarette taxes will be is still being
discussed.
Q
How can you come up with $ 105 billion figure without
knowing precisely what is involved?
DIRECTOR PANETTA: Well, there are proposals that are on the
table and we estimate that we have to look at somewhere between $100 billion to $105
billion in order to make these numbers work. And that's what needs to be done.
Q
How big does the cigarette tax have to be without some other
kind of taxes in order to come up with that amount of money?
DIRECTOR PANETTA: Well, if you're just looking at cigarette taxes
you're probably looking at somewhere around $1 a pack. But if you were doing less on
cigarettes then you've got to make it up elsewhere.
The total number on that from what we estimate in income is $441
billion from what I've just described, meeting a cost, as I said, of about $350 billion, and
that is what leads us to a hoped-for deficit reducfion of around $91 billion over that period
of time. And that's particularly important from my perspecfive because I think I've often
argued that if you're going to get the deficit down further you've got to be able to get this
kind of return on health care.
Now, let me just conclude by saying that as always, you know, when
you're putting numbers like this together based on the models that we've developed, the
numbers fit just as they did in the economic plan. But just as what we faced in the
economic plan, obviously, there will be political implications of a continuing consultation
process with the Hill, the concems that are raised on Capitol Hill as we go through the
process, and that will obviously require some adjustments as we work through the
legislative process.
Secondly, there is going to be a continuing assessment on the numbers
themselves. We are currently in the process, between OMB and Treasury, over these next
two weeks, where we are going to be scrubbing all of the numbers I've just presented to
> ou. And we do not expect ~ 1 should make clear ~ we do not expect any major changes
from that process, but there may indeed be some adjustments that will have to be made as
we again revisit these numbers.
I think the President's goal is to begin this process. And this is the
beginning of the process of the debate on health care reform in this country. He has
presented ~ and I think it was his intention and the First Lady's intention to present a bold
plan for health care reform to the country. But like any smart negotiators we know that
there are going to be bargaining that's going to have to be done with the Congress. We're
going to face a number of special interests who are going to force us to fight this battle.
�And our view is that it's much better to start with a bold approach as we begin that process.
DEPUTY SECRETARY ALTMAN: I'm so happy to be here that I'm
compelled to be brief Secretary Bentson would have been doing this instead of me,
except that he is in New York, on his way to speak to the Economic Club of New York
tonight.
As Leon alluded. Treasury has responsibility for estimating the
revenue issues, the revenue impacts of this plan. The sin taxes, the revenue effects of the
mandate, the self-employed deduction, and the others. I simply want to say that we're
using the same Treasury estimating model and the same methodology that was used in the
economic plan and that is always used to assess possible changes in tax policy or
legislative initiatives.
We are continuing to scrub these numbers. It will be a couple of weeks
before we finally finish doing so, together with OMB and others. There may be some
moderate changes before the final details are released. But I'm confident that the numbers
we do release will withstand the scrutiny ~ which will be very tough -that, of course,
they'll be subject to.
I think we've been very cheered so far by the congressional reaction. A
lot of us have been up on the Hill for the last couple of days in various workshops, which
have been extraordinarily well attended, I might add. Extraordinary how many members
of Congress have come for hours on end. And they've all said, among other things, even
some that aren't happy with the plan, that we've put forth the most-detailed and the bestresearched health care plan that's ever been put on the table by a lot.
As Leon said, the congressional process is just beginning. It will take
quite a few months, there will be undoubtedly changes in the proposal that we put forward
and we welcome that process.
The only point I'd add in addition is that in the event that anyone does
point out a true flaw in our numbers ~ can prove to us that they're off, well, then, of course
we'll adjust them. And we'll adjust them on the cost side. In other words, if it turns out
that people convince us that something we've estimated at X will cost more than that, well,
we'll reduce costs in some other area. What we will not do, beyond the sin tax proposal
that will be made shortly, what we will not do, is to propose any further changes on the
revenue increasing side, on the tax side.
I think Laura's next.
MS. TYSON: I will just end by reaffirming or emphasizing, the
comments made by Bob Rubin at the begiiming. The process by which these numbers was
developed was a process which was exhaustive and inclusive. The CEA and other
agencies of government were involved in the process from the very beginning. We did not
just rely on internal experts, however. We consulted a wide variety of external experts on
all aspects of the health care system. So it really was, as the First Lady has correctly said,
an unprecedented process in terms of inclusiveness, exhaustiveness and precision. So I
don't think there really is any question about the numbers.
�Now, it's been reported in a number of places that I have raised
questions about these numbers and that the CEA has raised questions about the numbers.
That, in one sense, is true and in one sense is misleading. It is true in the sense that it is
the role of the CEA to raise questions. We love to raise questions, that's one of our jobs ~
we raise questions. The reports are misleading because they seem to indicate often that
our questions were not answered. That is not correct. Our questions have been answered.
They have been answered as part of this exhaustive process. So, for example, if we raised
a question about Medicare and where the Medicare savings would come from, there are
now precise, specific policy proposals backing up the Medicare savings.
So the process has been unprecedented and exhaustive and, I believe,
has moved the information base on how the current health care system is functioning and
v/hat we heed to do forward by an order of magnitude relative to anything anyone knew
v/hen we started. So I think one should, at this point, welcome debates about policy and
v/elcome debates about politics. But really, the numbers, it seems to me at this point, are
not really debatable. They came from a very credible process and a very exhaustive
process. And that's really all I wanted to say.
Q
Despite the fact that you insist that there aren't going to be new
taxes, we have a poll out today that says 80 percent of Americans still believe that that's
how it's going to be paid for.
DIRECTOR PANETTA: Well, interestingly enough, we ran into the
same problem with the economic plan. I mean, obviously, everybody felt that when you
debate any kind of revenues or indicate that even if there's going to be sin taxes, that
people automatically assume that somehow there's going to be some sort of broad-based
tax. And, as we pointed out in the economic plan, 80 percent of that affected those of
$200,000 and above. I think people are beginning to understand that now. And as we go
through the debate on this, I think people will also understand that there is no broad-based
tax here.
Now, again, having said that, the premium is here. Let's make clear
that the premiums that people are paying now, that most of the money in this process for
this health care reform, is going to come from the same area that it comes from now,
which is businesses and people paying taxes on health care. That needs to be made clear
now, because 1 think there's a sense that there's these other taxes. It's based largely on the
premium base.
Q
You presumably realize some savings from the elimination of
cost shiftings since everyone is now included. Under which number, or numbers, is that
included? Where is that number reflected?
DIRECTOR PANETTA: You're basically in the ~ I think it's going to
be in the reductions. While the reductions in federal programs will probably be part of
that, 1 think the Medicare to the extent — I mean, we're going to be doing specific savings
on Medicare, so you ~
Q
1 know, but that's going to affect nearly ~ that cost shifting is
paid for by all the private consumers of health care insurance. Presumably there will be a
saving to them of some untold sum of money. What is the sum and where is it reflected
�here?
DIRECTOR PANETTA: Okay, we think that when the plan is fully
implemented, that there's about $25 billion in uncompensated care that's currently
embedded in what private insurance and what private payers pay. That is, everybody gets
C(3verage so that money will go away over time. So the dollars are really reflected in the
premiums that we are estimating. So they're not specifically shown in this line item here
that the Director has talked about. But rather, if you reduce uncompensated care, the
premiums that people will have to pay for health insurance, those costs will fall.
Q
Do you really think that you're going to see $91 billion in
deficit savings at the end of five years? Do you think that these models clearly estimate
people's behaviors?
DIRECTOR PANETTA: I don't think ~ no, it's not a problem of the
models. 1 think that if we achieve these kinds of savings with regards to these kinds of
costs, then I think we can produce that much in savings in terms of deficit reduction. I
mean, that's our goal. Our goal was basically to start with making sure that we achieve
deficit reduction over this period.
Obviously, I have to tell you ~ as I think we found out on the
economic plan, where our investments were vulnerable, I think the deficit reduction
number is going to be vulnerable on Capitol Hill. The large question for Capitol Hill to
answer is do you want to achieve this much in terms of deficit reduction, or do you want to
lessen the amount of deficit reduction and lessen the hit in terms of some of the other
programs. You're going to see some trade-off here.
Q
In terms of trade-offs, it was so difficult to get to the $57
billion in Medicare savings. What makes you think you're going to reach $124 billion?
DIRECTOR PANETTA: As long as I've dealt in the budget process,
every time we've dealt with Medicare and Medicaid savings, 1 have heard all of the
expressions of fear ~ that the hospitals are going to close, that the doctors are going to go
out of business, et cetera, et cetera, et cetera. And it hasn't happened. The fact is that there
are tremendous cost increases that are taking place in the Medicare and Medicaid program.
V/e know that. We see that in the budget. And I think as a result of that, we have been
able to outline a whole series of very specific proposals that from a policy point of view I
think makes sense.
Now, you're asking me really what I think is more a political question
than a substantive question, because sitting in that room people are always nervous ~ do
v/e want to cut Medicare this much? Can we cut Medicaid this much? But ultimately, if
you can justify the policies based on substance, then I think we can come very close to
these numbers. And that's going to be the test.
Q
Mr. Panetta, can I ask you a question about ~ you started your
account by saying that the bulk of the money was, of course, going to come from where it
now comes from ~ from the private sector. And yet, what all of you have said addresses
only the public portion of this. We need to give the American people a picture of the
v/hole thing. Could you tell us what the private portion of this is going to look like? And
�it would be very helpfiil if it was year-by-year what the business sector is going to pay,
what the household sector is going to pay, and what you either think they're going to save
or net ~ have to pay to make this system work?
DIRECTOR PANETTA: Oh, Ken? (Laughter.)
MR. THORPE: We didn't pass that out? (Laughter.) Of course, we're
— as we continue to go through this, we focus first in terms of our ~ first step of an
estimate is to try to get a handle on what the federal and state and local piece of this is.
And we're in the process right now of doing exactly what you've asked. As you've seen
from your documents, that's ~ I'm sure that you've read through. We do have a table in the
hack that looks at the change in national health expenditures under the proposed plan. We
will, during the course of the next several weeks, be developing exactly what you're
talking about ~ a sector-by-sector impact during that time period.
Q
That chart at the back is entitied National Health Expenditures.
Is that the chart you're referring to?
MR. THORPE: Right.
Q
It appears to show that in the first three years of this, if I
understand how to read it, that the private sector in aggregate is going to bear — one year
it's $23 billion in extra costs, the next year it's $50 billion in extra costs, the next year it's
$30 billion. And only in the very end of thefive-yearperiod are you going to see it ~ the
savings, in effect, be greater than the costs. Is that true? In essence, the private sector is
going to bear increased costs during the early years?
MR. THORPE: No, we think that due to the fact that we're covering
$37 million under uninsured and we're providing comprehensive benefits not only to that
population but to individuals that don't have as comprehensive benefits ~ that is, you can
see from the chart that for the first two or three years that the amount of spending in the
system will rise slightly. But by 1998 ~ I don't have thefigureswith me. It's in the back
ofyour ~
Q
The point is that the private sector is going to bear ~
MR. THORPE: No, that's total spending ~ public and private. What
•we don't have and what you could not infer from that chart would be the specific publicprivate impacts which we are still working on.
Q
Ms. Tyson, could you tell us whether or not the proposal will
increase —
MR. THORPE: I don't have thefigureswith me.
Q
Mr. Panetta, could you tell us ~
DIRECTOR PANETTA: Could I ~ Andrea, let me just add another
point that I think is important on the Medicare and Medicaid aspect of this. Normally, the
cuts in Medicare and Medicaid have usually been done for the sake of deficit reduction in
�the sense that you basically are doing it as part of an economic plan. In this instance,
yciu're doing it as part of comprehensive health care reform with a long-term health care
element as well as a drug benefit element. And I think that gives us a little better arguing
point with regards to those that are concemed about who's going to be impacted by that.
Q
Mr. Panetta, one of the central features of your plan is cost
controls on the growth of insurance premiums. How can you convince the public that
their services aren't going to be held down, constrained, rationed by the doctors and
hospitals as they're living under these insurance caps at a time when you're trying to cut
inflation and health care in half?
MR. THORPE: Well, again, we think that if you take -again, you
can't just look at the cost containment piece. I think it's important to look through and
look at the plan in its entirety. Because what we're proposing in the health reform
proposal is really comprehensive change in the delivery system. We believe that there are
substantial administrative savings in hospitals and physicians, as well as insurance
companies that we've talked about. We've talked a little bit about reductions and
uncompensated care that's sitting out there.
And one thing I think that will be useful to do is that if you look at the
dollar savings, don't look at the percent changes, but actually look at the dollar savings in
the private sector associated with what we're proposing. And if you look at what we think
is going to happen in the system in terms of cost conscious selection of health plans,
administrative savings, reductions in uncompensated care, moving toward a delivery
system that is no longer an open ended, uncoordinated delivery system. It is really
something to focus on much more effective and we believe, not only cost effective, but
better quality medical care. That any one of those, individually or serially, will develop
and create the types of underlying cost reductions that the plan is talking about.
Q
But you and Mr. Rubin can stand here today and assure people
there will be no rationing of care under this Clinton package?
MR. RUBIN: Let me try as a nonprofessional to take a shot at that.
Having sat through, 1 guess it's six or seven months now of meetings with enormous
numbers of health care professionals on, as you know, a very complex subject ~ when you
hear them come through all this, I think where you come out is it sounds from what
they've said ~ let me put it differently. I came away persuaded having listened to them,
that this thing ought to work, that the odd ought to be very, very high that there is very
substantial excess expenditure in the system. And you compare the 14 percent of GDP
that we spent on health care with less than 10 percent in any other developed country, and
I think it sort of validates that notion. And it ought to be possible to create a plan that does
that without creating untoward effects.
But if there are problems there is a contingency in these numbers,
number one. Number two, as you know, it's going to be phased in somewhat gradually so
the first dates, hopefully, will come in '95, and they will continue to come in through '97.
So if you start to see problems you can correct course.
thirdly;, and I find personally most importantly, there is^
tremendous.'^ixibili^ ^n this system and there is tremendous flexibilrtyjwithin each state
�mechanTSnTfproblems develop.
^ think you have, in effect, a self-correcting
Q
Laura, can you comment on the job impact, what your models
have shown in terms of ~
DR. TYSON: We're actually going to have a briefing on that issue on
Thursday. We'll talk about the employment effects on Thursday. Secretary Reich will ~
we are trying to sort of have a discussion today of financing, and a discussion on Thursday
of ~
Q
What is the hold up in figuring out how the sin taxes are going
to be apportioned and are there discussions going on with, for example, representatives
from tobacco states as you're figuring out how these taxes are going to be apportioned?
DIRECTOR PANETTA: I think it's - you know, it's obviously ~ the
is;sues are on the table with regards to the elements of sin taxes. The one question is this
corporate assessment and whether or not we will look to this corporate assessment for
additional revenues as part of that package. And that - frankly, h's that element that's
being evaluated right now. We have not come to any conclusions on that. But depending
on whether or not you include that element, that tells you a lot about what you do then on
the sin tax.
How much might that produce, the one percent corporate
assessment?
DIRECTOR PANETTA: I mean, again, it depends on how many
corporations are going to be impacted, and that's something we're analyzing right now.
Because it depends to some extent on which ones are dropping out of the process and
which ones stay in the process.
Q
The goal was to ~
Q
Can we just clear up the payroll tax?
DEPUTY SECRETARY ALTMAN: We're not going to give you an
exact number, because we're continuing to refine that. But it's not a huge number in the
context of this plan. You have to make certain assumptions about which businesses opt
into the alliances and which businesses, 5,000 and over, employees may opt out and so on.
But it's not a gigantic number.
Q
There may be no decision on alcohol tax by tomorrow night, is
that correct?
DEPUTY SECRETARY ALTMAN: I don't know the answer to that.
Someone asked that question earlier about when the sin tax decision was going to be
made.
Q
more?
Are you deliberately not deciding to not ignite the lobbyists
�DEPUTY SECRETARY ALTMAN: I heard somebody say the
President's upstairs having a drink and a cigar and would make that decision shortly.
(Laughter.)
Q
You said the President's goal was to have a situation where
people could argue politics and policy, but not about the numbers. It hasn't been hard for
people here to find economists and politicians who are arguing about the numbers. What
is the problem? Where is the disconnect?
MR. RUBIN: Let me take one shot at that and let other people take
another shot at it. You know, when you read the reports and then you speak to some of the
people ~ and I've done both ~ I think there is a bit of a muddling here. And I think
sometimes when people talk about concems about the numbers, they're really talking
about the politics or they're talking about the policies. And 1 think if you take somebody
and you say, okay, you've said you have concerns about the numbers, what do you really
mean?
Usually, at least in my experience, it has turned out to be either they
simply need more information, or they're really raising a question about political
feasibility or policy impacts. And that, I think, is ~ to an awful lot of it.
Q
Well, to what extent did you ~
MR. RUBIN: Can I make just one more comment? These are very
complex calculations. I've heard a lot of it developed, and I'll tell you ~ and I've had a lot
of experience in developing numbers — these are very complex numbers developments.
And I think what's going to happen over time is, people who have serious questions about
numbers as opposed to policy or politics, they'll sit down with the people who developed
it, and 1 think they'll come out satisfied on the numbers.
Q
To what extent did you factor in political feasibility in creating
your models?
MR. RUBIN: Well, numbers are one thing and political feasibility, I
think, 1 would argue, a separate one.
DIRECTOR PANETTA: There is no model you can develop for that.
(Laughter.)
MR. RUBIN: Leon has a perfect model for political feasibility, and he
comes out with — (laughter) ~
Q
obviously, there are policy assumptions that are going into the
numbers. 1 mean, you seem much more optimistic than a lot of independent experts about
how quickly waste can be gotten out of the system, for example. I mean, those
assumptions are built in ~
MR. RUBIN: Those assumptions are in here, as we said. You've got
an interactive process with OMB, Treasury, HHS, you've had outside actuaries and outside
�accountants, and enormous numbers of them, and they've come out and concluded that
these kinds of savings can be achieved in these kinds of time periods.
Q
Mr. Altman, you said in your remarks that if you were
convinced your numbers were wrong, you would make adjustments on the spending fight,
not the revenue side. Does that mean if Senator Moynihan is correct, that it's not
politically possible to achieve this level of Medicare savings, that would put at risk these
proposals for new long-term and dmg benefits for seniors?
DEPUTY SECRETARY ALTMAN: No, I didn't say that. 1 didn't say
that at all. I simply said that if anyone can prove to us that there areflawsin our estimates
of the costs of this, I mean, really prove it, which I doubt, I strongly doubt, as I mentioned
eEirlier ~ we would make adjustments on the cost side. We would ~
Q
You're talking about a technical thing, you're not talking about -
DEPUTY SECRETARY ALTMAN: Well, if someone could prove to
us; that we've underestimated the cost of X or the cost of Y, you know, really win the
argument ~
Q
But it's all based on predictions of future behavior of all kinds.
Q
You're saying ~
Q
— what would you cut, then ~
Q
~ which is kind of an interesting standard, isn't it?
DEPUTY SECRETARY ALTMAN: ~ in some other area the costs to
of fset that. All I'm trying to say is, we would not tum to the revenue side of the equation.
Q
But would that affect the core benefit package then?
DIRECTOR PANETTA: Let me mention - you've got - all of the
pieces are here now. And, obviously, there's going to be some adjustment on these pieces
as we go through the political process and as we go through, obviously, the discussions
with regards to the accuracy of the numbers and what have you. But there are key pieces
now that you can work with here.
If we decide, for example, that we want to do a phase-in, a longer
phase-in on this, we have some phase-in already built into the process. That's something
obviously that can be looked at. It doesn't mean you're reducing the benefits; you're
reducing the benefits in the short term for some, but in the long run everyone's going to get
the same benefit.
But we have the ability now with the plan that we're working on to
give us the flexibility to make those kinds of adjustments without impacting on the basic
principles that the President wants to present in the health care plan.
�Q
Given the record of economic modeling over the last 10 or 12
years, don't you approach the modeling of this entire sector of the economy with some
humility?
DIRECTOR PANETTA: Humility and trepidation.
Q
Can you tell us, is there any reaction from the President on the
Moscow coup?
MR. GEARAN: In terms of events in Russia, we have no fiirther
reaction to that.
Q
The President did not react at all?
MR. GEARAN: We'll just leave it at that. We'll keep you posted
whether there will be a further statement.
END1:55 P.M. EDT
�THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
September 22, 1993
ADDRESS OF THE PRESIDENT
TO THE JOINT SESSION OF CONGRESS
U.S. Capitol
Washington, D.C.
9:10 RM. EDT
THE PRESIDENT: Mr. Speaker, Mr. President, members of Congress,
distinguished guests, my fellow Americans. Before 1 begin my words tonight I would
like to ask that we all bow in a moment of silent prayer for the memory of those who
were killed and those who have been injured in the tragic train accident in Alabama
today. (A moment of silence is observed.) Amen.
My fellow Americans, tonight we come together to write a new chapter in the
American story. Our forebears enshrined the American Dream — life, liberty, the pursuit
of happiness. Every generation of Americans has worked to strengthen that legacy, to
make our country a place of freedom and opportunity, a place where people who work
hard can rise to their full potential, a place where their children can have a better fiiture.
From the settling of the frontier to the landing on the moon, ours has been a
continuous story of challenges defined, obstacles overcome, new horizons secured. That
is what makes America what it is and Americans what we are. Now we are in atimeof
profound change and opportunity. The end of the Cold War, the Information Age, the
global economy have brought us both opportunity and hope and strife and uncertainty.
Our purpose in this dynamic age must be to change ~ to make change our friend and not
our enemy.
To achieve that goal, we must face all our challenges with confidence, with
faith, and with discipline - whether we're reducing the deficit, creating tomorrow's jobs
and training our people to fill them, converting from a high-tech defense to a high-tech
domestic economy, expanding trade, reinventing govemment, making our streets safer, or
rewarding work over idleness. All these challenges require us to change.
If Americans are to have the courage to change in a difficult time, we must
first be secure in our most basic needs. Tonight I want to talk to you about the most
critical thing we can do to build that security. This health care system of ours is badly
broken and it is time to fix it. (Applause.)
Despite the dedication of literally millions of talented health care
professionals, our health care is too uncertain and too expensive, too bureaucratic and too
wasteful. It has too much fraud and too much greed.
At long last, after decades of false starts, we must make this our most urgent
�priority, giving every American health security; health care that can never be taken away;
health care that is always there. That is what we must do tonight. (Applause).
On this joumey, as on all others of tme consequence, there will be rough
spots in the road and honest disagreements about how we should proceed. After all, this
is a complicated issue. But every successfiil joumey is guided by fixed stars. And if we
can agree on some basic values and principles we will reach this destination, and we will
reach it together.
So tonight I want to talk to you about the principles that I believe must
embody our efforts to reform America's health care system - security, simplicity,
savings, choice, quality, and responsibility.
When I launched our nation on this joumey to reform the health care system 1
knew we needed a talented navigator, someone with a rigorous mind, a steady compass, a
caring heart. Luckily for me and for our nation, I didn't have to look very far.
(Applause.)
Over the last eight months, Hillary and those working with her have talked to
literally thousands of Americans to understand the strengths and the frailties of this
system of ours. They met with over 1,100 health care organizations. They talked with
doctors and nurses, pharmacists and dmg company representatives, hospital
administrators, insurance company executives and small and large businesses. They
spoke with self-employed people. They talked with people who had insurance and people
who didn't. They talked with union members and older Americans and advocates for our
children. The First Lady also consulted, as all of you know, extensively with
governmental leaders in both parties in the states of our nation, and especially here on
Capitol Hill.
Hillary and the Task Force received and read over 700,000 letters from
ordinary citizens. What they wrote and the bravery with which they told their stories is
really what calls us all here tonight.
Every one of us knows someone who's worked hard and played by the mles
and still been hurt by this system that just doesn't work for too many people. But I'd like
to tell you about just one.
Kerry Kennedy owns a small fumiture store that employs seven people in
Titusville, Florida. Like most small business owners, he's poured his heart and soul, his
sweat and blood into that business for years. But over the last several years, again like
most small business owners, he's seen his health care premiums skyrocket, even in years
when no claims were made. And last year, he painfully discovered he could no longer
afford to provide coverage for all his workers because his insurance company told him
that two of his workers had become high risks because of their advanced age. The
problem was that those two people were his mother and father, the people who founded
the business and still worked in the store.
This story speaks for millions of others. And from them we have leamed a
powerful tmth. We have to preserve and strengthen what is right with the health care
system, but we have got to fix what is wrong with it. (Applause.)
�Now, we all know what's right. We're blessed with the best health care
professionals on Earth, thefinesthealth care institutions, the best medical research, the
most sophisticated technology. My mother is a nurse. 1 grew up around hospitals.
Doctors and nurses were the first professional people I ever knew or leamed to look up to.
They are what is right with this health care system. But we also know that we can no
longer afford to continue to ignore what is wrong.
Millions of Americans are just a pink slip away from losing their health
insurance, and one serious illness away from losing all their savings. Millions more are
locked into the jobs they have now just because they or someone in their family has once
been sick and they have what is called the preexisting condition. And on any given day,
over 37 million Americans ~ most of them working people and their little children have no health insurance at all.
And in spite of all this, our medical bills are growing at over twice the rate of
inflation, and the United States spends over a third more of its income on health care than
any other nation on Earth. And the gap is growing, causing many of our companies in
global competition severe disadvantage. There is no excuse for this kind of system. We
know other people have done better. We know people in our own country are doing
better. We have no excuse. My fellow Americans, we must fix this system and it has to
begin with congressional action. (Applause.)
I believe as strongly as I can say that we can reform the costliest and most
wasteful system on the face of the Earth without enacting new broad-based taxes.
(Applause.) I believe it because of the conversations I have had with thousands of health
care professionals around the country; with people who are outside this city, but are
inside experts on the way this system works and wastes money.
The proposal that I describe tonight borrows many of the principles and ideas
that have been embraced in plans introduced by both Republicans and Democrats in this
Congress. For the first time in this century, leaders of both political parties have joined
together around the principle of providing universal, comprehensive health care. It is a
magic moment and we must seize it. (Applause.)
I want to say to all of you I have been deeply moved by the spirit of this
debate, by the openness of all people to new ideas and argument and information. The
American people would be proud to know that earlier this week when a health care
university was held for members of Congress just to try to give everybody the same
amount of information, over 320 Republicans and Democrats signed up and showed up
for two days just to leam the basic facts of the complicated problem before us.
Both sides are willing to say we have listened to the people. We know the
cost of going forward with this system is far greater than the cost of change. Both sides, I
think, understand the literal ethical imperative of doing something about the system we
have now. Rising above these difficulties and our past differences to solve this problem
will go a long way toward defining who we are and who we intend to be as a people in
this difficuk and challenging era. I believe we all understand that.
And so tonight, let me ask all of you ~ every member of the House, every
member of the Senate, each Republican and each Democrat ~ let us keep this spirit and
let us keep this commitment until this job is done. We owe it to the American people.
(Applause.)
�Now, if I might, I^vould like to review the six principles I mentioned earlier
and describe how we think we can best fiilfill those principles.
First and most important, security. This principle speaks to the human
misery, to the costs, to the anxiety we hear about every day ~ all of us - when people
talk about their problems with the present system. Security means that those who do not
now have health care coverage will have it; and for those who have it, it will never be
taken away. We must achieve that security as soon as possible.
Under our plan, every American would receive a health care security card that
will guarantee a comprehensive package of benefits over the course of an entire lifetime,
roughly comparable to the benefit package offered by most Fortune 500 companies. This
health care security card will offer this package of benefits in a way that can never be
taken away.
So let us agree on this: whatever else we disagree on, before this Congress
finishes its work next year, you will pass and I will sign legislation to guarantee this
security to every citizen of this country. (Applause.)
With this card, if you lose your job or you switch jobs, you're covered. If you
leave your job to start a small business, you're covered. If you're an early retiree, you're
covered. If someone in your family has, unfortunately, had an illness that qualifies as a
preexisting condition, you're still covered. If you get sick or a member of your family
gets sick, even if it's a life threatening illness, you're covered. And if an insurance
company tries to drop you for any reason, you will still be covered, because that will be
illegal. This card will give comprehensive coverage. It will cover people for hospital
care, doctor visits, emergency and lab services, diagnostic services like Pap smears and
mammograms and cholesterol tests, substance abuse and mental health treatment.
(Applause.)
And equally important, for both health care and economic reasons, this
pn)gram for the first time would provide a broad range of preventive services including
regular checkups and well-baby visits. (Applause.)
Now, it's just common sense. We know ~ any family doctor will tell you that
people will stay healthier and long-term costs of the health system will be lower if we
have comprehensive preventive services. You know how all of our mothers told us that
an ounce of prevention was worth a pound of cure? Our mothers were right. (Applause.)
And it's a lesson, like so many lessons from our mothers, that we have waited too long to
live by. It is time to start doing it. (Applause.)
Health care security must also apply to older Americans. This is something I
imagine all of us in this room feel very deeply about. The first thing I want to say about
that is that we must maintain the Medicare program. It works to provide that kind of
security. (Applause.) But thistimeand for the first time, I believe Medicare should
provide coverage for the cost of prescription dmgs. (Applause.)
Yes, it will cost some more in the beginning. But, again, any physician who
deals with the elderly will tell you that there are thousands of eldedy people in every state
who are not poor enough to be on Medicaid, but just above that line and on Medicare,
who desperately need medicine, who makes decisions every week between medicine and
�food. Any doctor who deals with the elderly will tell you that there are many elderly
people who don't get medicine, who get sicker and sicker and eventually go to the doctor
and wind up spending more money and draining more money from the health care system
than they would if they had regular treatment in the way that only adequate medicine can
provide.
I also believe that over time, we should phase in long-term care for the
disabled and the elderly on a comprehensive basis. (Applause.)
As we proceed with this health care reform, we carmot forget that the most
rapidly growing percentage of Americans are those over 80. We carmot break faith with
them. We have to do better by them.
The second principle is simplicity. Our health care system must be simpler
for the patients and simpler for those who actually deliver health care ~ our doctors, our
nurses, our other medical professionals. Today we have more than 1,500 insurers, with
hundreds and hundreds of different forms. No other nation has a system like this. These
forms are time consuming for health care providers, they're expensive for health care
consumers, they're exasperating for anyone who's ever tried to sit down around a table
and wade through them andfigurethem out.
The medical care industry is literally drowning in paperwork. In recent years,
the number of administrators in our hospitals has grown by four times the rate that the
number of doctors has grown. A hospital ought to be a house of healing, not a monument
to paperwork and bureaucracy. (Applause.)
Just a few days ago, the Vice President and I had the honor of visiting the
Children's Hospital here in Washington where they do wonderful, often miraculous things
for very sick children. A nurse named Debbie Freiberg told us that she was in the cancer
and bone marrow unit. The other day a little boy asked her just to stay at his side during
his chemotherapy. And she had to walk away from that child because she had been
instmcted to go to yet another class to leam how to fill out another form for something
that didn't have a lick to do with the health care of the children she was helping. That is
wrong, and we can stop it, and we ought to do it. (Applause.)
We met a very compelling doctor named Lillian Beard, a pediatrician, who
said that she didn't get into her profession to spend hours and hours — some doctors up to
25 hours a week just filling out forms. She told us she became a doctor to keep children
well and to help save those who got sick. We can relieve people like her of this burden.
We leamed ~ the Vice President and I did —that in the Washington Children's Hospital
alone, the administrators told us they spend $2 million a year in one hospital filling out
forms that have nothing whatever to do with keeping up with the treatment of the
patients.
And the doctors there applauded when I was told and I related to them that
they spend so much time filling out paperwork, that if they only had to fill out those
paperwork requirements necessary to monitor the health of the children, each doctor on
that one hospital staff - 200 of them - could see another 500 children a year. That is
10,000 children a year. I think we can save money in this system if we simplify it. And
we can make the doctors and the nurses and the people that are giving their lives to help
us all be healthier a whole lot happier, too, on their jobs. (Applause.)
�Under our proposal there would be one standard insurance form ~ not
hundreds of them. We will simplify also ~ and we must - the govemment's mles and
regulations, because they are a big part of this problem. (Applause.) This is one of those
cases where the physician should heal thyself We have to reinvent the way we relate to
the health care system, along with reinventing govemment. A doctor should not have to
check with a bureaucrat in an office thousands of miles away before ordering a simple
blood test. That's not right, and we can change it. (Applause.) And doctors, nurses and
consumers shouldn't have to worry about the fine print. If we have this one simple form,
there won't be any fine print. People will know what it means.
The third principle is savings. Reform must produce savings in this health
care system. It has to. We're spending over 14 percent of our income on health care ~
Canada's at 10; nobody else is over nine. We're competing with all these people for the
future. And the other major countries, they cover everybody and they cover them with
services as generous as the best company policies here in this country.
Rampant medical inflation is eating away at our wages, our savings, our
investment capital, our ability to create new jobs in the private sector and this public
Treasury. You know the budget we just adopted had steep cuts in defense, a five-year
freeze on the discretionary spending, so critical to reeducating America and investing in
jobs and helping us to convert from a defense to a domestic economy. But we passed a
budget which has Medicaid increases of between 16 and 11 percent a year over the next
five years, and Medicare increases of between 11 and 9 percent in an environment where
we assume inflation will be at 4 percent or less.
We cannot continue to do this. Our competitiveness, our whole economy, the
integrity of the way the govemment works and, ultimately, our living standards depend
upon our ability to achieve savings without harming the quality of health care.
Unless we do this, our workers will lose $655 in income each year by the end
of the decade. Small businesses will continue to face skyrocketing premiums. And a full
third of small businesses now covering their employees say they will be forced to drop
their insurance. Large corporations will bear vivid disadvantages in global competition.
And health care costs will devour more and more and more of our budget. Pretty soon all
of you or the people who succeed you will be showing up here, and writing out checks for
health care and interest on the debt and worrying about whether we've got enough
defense, and that will be it, unless we have the courage to achieve the saving that are
plainly there before us. Every state and local govemment will continue to cut back on
everything from education to law enforcement to pay more and more for the same health
care.
These rising costs are a special nightmare for our small businesses - the
engine of our entrepreneurship and our job creation in America today. Health care
premiums for small businesses are 35 percent higher than those of large corporations
today. And they will keep rising at double-digit rates unless we act.
So how will we achieve these savings? Rather than looking at price control,
or looking away as the price spiral continues; rather than using the heavy hand of
government to try to control what's happening, or continuing to ignore what's happening,
we believe there is a third way to achieve these savings. First, to give groups of
consumers and small businesses the same market bargaining power that large
corporations and large groups of public employees now have. We want to let market
�forces enable plans to compete. We want to force these plans to compete on the basis of
price and quality, not simply to allow them to continue making money by turning people
away who are sick or old or performing mountains of unnecessary procedures. But we
also believe we should back this system up with limits on how much plans can raise their
premiums year in and year out, forcing people, again, to continue to pay more for the
same health care, without regard to inflation or the rising population needs.
We want to create what has been missing in this system for too long, and
what every successfiil nation who has dealt with this problem has already had to do: to
have a combination of private market forces and a sound public policy that will support
that competition, but limit the rate at which prices can exceed the rate of inflation and
population growth, if the competition doesn't work, especially in the early going.
The second thing I want to say is that unless everybody is covered ~ and this
is a very important thing ~ unless everybody is covered, we will never be able to fully put
the breaks on health care inflation. Why is that? Because when people don't have any
health insurance, they still get health care, but they get it when it's too late, when it's too
expensive, often from the most expensive place of all, the emergency room. Usually by
the time they show up, their illnesses are more severe and their mortality rates are much
higher in our hospitals than those who have insurance. So they cost us more.
And what else happens? Since they get the care but they don't pay, who does
pay? All the rest of us. We pay in higher hospital bills and higher insurance premiums.
This cost shifting is a major problem.
The third thing we can do to save money is simply by simplifying the system
~ what we've already discussed. Freeing the health care providers from these costly and
unnecessary paperwork and administrative decisions will save tens of billions of dollars.
We spend twice as much as any other major country does on paperwork. We spend at
least a dime on the dollar more than any other major country. That is a sturming statistic.
It is something that every Republican and every Democrat ought to be able to say, we
agree that we're going to squeeze this out. We cannot tolerate this. This has nothing to
do with keeping people well or helping them when they're sick. We should invest the
money in something else.
We also have to crack down on fraud and abuse in the system. That drains
billions of dollars a year. It is a very large figure, according to every health care expert
I've ever spoken with. So I believe we can achieve large savings. And that large savings
can be used to cover the unemployed uninsured, and will be used for people who realize
those savings in the private sector to increase their ability to invest and grow, to hire new
workers or to give their workers pay raises, many of them for the first time in years.
Now, nobody has to take my word for this. You can ask Dr. Koop. He's up
here with us tonight, and I thank him for being here. (Applause.) Since he left his
distinguished tenure as our Surgeon General, he has spent an enormous amount of time
studying our health care system, how it operates, what's right and wrong with it. He says
we could spend $200 billion every year, more than 20 percent of the total budget, without
sacrificing the high quality of American medicine.
Ask the public employees in Califomia, who have held their own premiums
down by adopting the same strategy that I want every American to be able to adopt ~
bargaining within the limits of a strict budget. Ask Xerox, which saved an estimated
�$1,000 per worker on their health insurance premium. Ask the staff of the Mayo Clinic,
who we all agree provides some of thefinesthealth care in the world. They are holding
their cost increases to less than half the national average. Ask the people of Hawaii, the
only state that covers virtually all of their citizens and has still been able to keep costs
below the national average.
People may disagree over the best way to fix this system. We may all
disagree about how quickly we can do what ~ the thing that we have to do. But we
cannot disagree that we can find tens of billions of dollars in savings in what is clearly the
most costly and the most bureaucratic system in the entire world. And we have to do
something about that, and we have to do it now. (Applause.)
The fo urth principle is choice. Americans believe they ought to be able to
choose their own health care plan and keep their own doctors. And I think all of us agree.
Under any plan we pass, they ought to have that right. But today, under our broken
health care system, in spite of the rhetoric of choice, the fact is that that power is slipping
away for more and more Americans.
Of course, it is usually the employer, not the employee, who makes the initial
choice of what health care plan the employee will be in. And if your employer offers
only one plan, as nearly three-quarters of small or medium-sized firms do today, you're
stuck with that plan, and the doctors that it covers.
We propose to give every American a choice among high-quality plans. You
can stay with your current doctor, join a network of doctors and hospitals, or join a health
maintenance organization. If you don't like your plan, every year you'll have the chance
to choose a new one. The choice will be left to the American citizen, the worker — not
the boss, and certainly not some govemment bureaucrat.
We also believe that doctors should have a choice as to what plans they
practice in. Otherwise, citizens may have their own choices limited. We want to end the
discrimination that is now growing against doctors, and to permit them to practice in
several different plans. Choice is important for doctors, and it is absolutely critical for
our consumers. We've got to have it in whatever plan we pass. (Applause.)
The fifth principle is quality. If we reformed everything else in health care,
but failed to preserve and enhance the high quality of our medical care, we will have
taken a step backward, not forward. Quality is something that we simply can't leave to
chance. When you board an airplane, you feel better knowing that the plane had to meet
standards designed to protect your safety. And we can't ask any less of our health care
system.
Our proposal will create report cards on health plans, so that consumers can
choose the highest quality health care providers and reward them with their business. At
the same time, our plan will track quality indicators, so that doctors can make better and
smarter choices of the kind of care they provide. We have evidence that more efficient
delivery of health care doesn't decrease quality. In fact, it may enhance it.
Let me just give you one example of one commonly performed procedure, the
coronary bypass operation. Pennsylvania discovered that patients who were charged
$21,000 for this surgery received as good or better care as patients who were charged
$84,000 for the same procedure in the same state. High prices simply don't always equal
�good quality. Our plan will guarantee that high quality information is available is
available in even the most remote areas of this country so that we can have high-quality
service, linking rural doctors, for example, with hospitals with high-tech urban medical
centers. And our plan will ensure the quality of continuing progress on a whole range of
issues by speeding the search on effective prevention and treatment measures for cancer,
for AIDS, for Alzheimer's, for heart disease, and for other chronic diseases. We have to
safeguard thefinestmedical research establishment in the entire world. And we will do
that with this plan. Indeed, we will even make it better. (Applause.)
The sixth and final principle is responsibility. We need to restore a sense that
we're all in this together and that we all have a responsibility to be a part of the solution.
Responsibility has to start with those who profit from the current system. Responsibility
means insurance companies should no longer be allowed to cast people aside when they
get sick. It should apply to laboratories that submit fraudulent bills, to lawyers who abuse
malpractice claims, to doctors who order unnecessary procedures. It means dmg
companies should no longer charge three times more per prescription dmgs made in
America here in the United States than they charge for the same dmgs overseas.
(Applause.)
In short, responsibility should apply to anybody to abuses this system and
drives up the cost for honest, hard-working citizens and undermines confidence in the
honest, gifted health care providers we have.
Responsibility also means changing some behaviors in this country that drive
up our costs like crazy. And without changing it we'll never have the system we ought to
have. We will never.
Let me just mention a few and start with the most important ~ the outrageous
cost of violence in this country stem in large measure from the fact that this is the only
country in the world where teenagers can rout the streets at random with semi-automatic
weapons and be better armed than the police. (Applause.)
But let's not kid ourselves, it's not that simple. We also have higher rates of
AIDS, of smoking and excessive drinking, of teen pregnancy, of low birth weight babies.
And we have the third worst immunization rate of any nation in the westem hemisphere.
We have to change our ways if we ever really want to be healthy as a people and have an
affordable health care system. And no one can deny that. (Applause.)
But let me say this ~ and I hope every American will listen, because this is
not an easy thing to hear ~ responsibility in our health care system isn't just about them,
it's about you, it's about me, it's about each of us. Too many of us have not taken
responsibility for our own health care and for our own relations to the health care system.
Many of us who have had fully paid health care plans have used the system whether we
needed it or not without thinking what the costs were. Many people who use this system
don't pay a
whether we needed it or not without thinking what the costs were. Many people who use
this system don't pay a penny for their care even though they can afford to. I think those
who don't have any health insurance should be responsible for paying a portion of their
new coverage. There can't be any something for nothing, and we have to demonstrate
that to people. This is not a free system. (Applause.) Even small contributions, as small
as the $10-copayment when you visit a doctor, illustrates that this is something of value.
There is a cost to it. It is not free.
�And I want tcrtell you that I believe that all of us should have insurance.
Why should the rest of us pick up the tab when a guy who doesn't think he needs
insurance or says he can't afford it gets in an accident, winds up in an emergency room,
gets good care, and everybody else pays? Why should the small businesspeople who are
stmggling to keep afloat and take care of their employees have to pay to maintain this
wonderful health care infrastmcture for those who refuse to do anything?
If we're going to produce a better health care system for every one of us,
every one of us is going to have to do our part. There cannot be any such thing as a free
ride. We have to pay for it. We have to pay for it.
Tonight I want to say plainly how I think we should do that. Most of the
money we will - will come under my way of thinking, as it does today, from preniiums
paid by employers and individuals. That's the way it happens today. But under this
health care security plan, every employer and every individual will be asked to contribute
something to health care.
This concept was first conveyed to the Congress about 20 years ago by
President Nixon. And today, a lot of people agree with the concept of shared
responsibility between employers and employees, and that the best thing to do is to ask
every employer and every employee to share that. The Chamber of Commerce has said
that, and they're not in the business of hurting small business. The American Medical
Association has said that.
Some call it an employer mandate, but I think it's the fairest way to achieve
responsibility in the health care system. And it's the easiest for ordinary Americans to
understand, because it builds on what we already have and what already works for so
many Americans. It is the reform that is not only easiest to understand, but easiest to
implement in a way that is fair to small business, because we can give a discount to help
struggling small businesses meet the cost of covering their employees. We should
require the least bureaucracy or dismption, and create the cooperation we need to make
the system cost-conscious, even as we expand coverage. And we should do it in a way
that does not cripple small businesses and low-wage workers.
Every employer should provide coverage, just as three-quarters do now.
Those that pay are picking up the tab for those who don't today. I don't think that's right.
To finance the rest of reform, we can achieve new savings, as 1 have outlined, in both the
federal govemment and the private sector, through better decision-making and increased
competition. And we will impose new taxes on tobacco. (Applause.)
I don't think that should be the only source of revenues. I believe we should
also ask for a modest contribution from big employers who opt out of the system to make
up for what those who are in the system pay for medical research, for health education
center, for all the subsidies to small business, for all the things that everyone else is
contributing to. But between those two things, we believe we can pay for this package of
benefits and universal coverage and a subsidy program that will help small business.
These sources can cover the cost of the proposal that I have described tonight.
We subjected the numbers in our proposal to the scmtiny of not only all the major
agencies in govemment ~ I know a lot of people don't tmst them, but it would be
interesting for the American people to know that this was the first time that the financial
�experts on health care in all of the different govemment agencies have ever been required
to sit in the room together and agree on numbers. It had never happened before.
But, obviously, that's not enough. So then we gave these numbers to
actuaries from major accounting firms and major Fortune 500 companies who have no
stake in this other than to see that our efforts succeed. So I believe our numbers are good
and achievable.
Now, what does this mean to an individual American citizen? Some will be
asked to pay more. If you're an employer and you aren't insuring your workers at all,
you'll have to pay more. But if you're a small business with fewer than 50 employees,
you'll get a subsidy. If you're a firm that provides only very limited coverage, you may
have to pay more. But some firms will pay the same or less for more coverage.
If you're a young, single person in your 20s and you're already insured, your
rates may go up somewhat because you're going to go into a big pool with middle-aged
people and older people, and we want to enable people to keep their insurance even when
someone in their family gets sick. But 1 think that's fair because when the young get
older, they will benefit from it, first, and secondly, even those who pay a little more today
will benefit four, five, six, seven years from now by our bringing health care costs closer
to inflation.
Over the long mn, we can all win. But some will have to pay more in the
short mn. Nevertheless, the vast majority of the Americans watching this tonight will
pay the same or less for health care coverage that will be the same or better than the
coverage they have tonight. That is the central reality. (Applause.)
If you currently get your health insurance through your job, under our plan
you still will. And for the first time, everybody will get to choose from among at least
three plans to belong to. If you're a small business owner who wants to provide health
insurance to you family and your employees, but you can't afford it because the system is
stacked against you, this plan will give you a discount that will finally make insurance
affordable. If you're already providing insurance, your rates may well drop because we'll
help you as a small business person join thousands of others to get the same benefits big
corporations get at the same price they get those benefits. If you're self-employed, you'll
pay less; and you will get to deduct from your taxes 100 percent of your health care
premiums. (Applause.)
If you're a large employer, your health care costs won't go up as fast, so that
you will have more money to put into higher wages and new jobs and to put into the work
of being competitive in this tough global economy.
Now, these, my fellow Americans, are the principles on which I think we
should base our efforts: security, simplicity, savings, choice, quality and responsibility.
These are the guiding stars that we should follow on our joumey toward health care
reform.
Over the coming months, you'll be bombarded with information from all
kinds of sources. There will be some who will stoutly disagree with what I have
proposed ~ and with all other plans in the Congress, for that matter. And some of the
arguments will be genuinely sincere and enlightening. Others may simply be scare tactics
by those who are motivated by the self-interest they have in the waste the system now
generates, because that waste is providing jobs, incomes and money for some people.
�I ask you only to think of this when you hear all of these arguments: Ask
yourself whether the cost of staying on this same course isn't greater than the cost of
change. And ask yourself when you hear the arguments whether the arguments are in
your interest or someone else's. This is something we have got to try to do together.
I want also to say to the representatives in Congress, you have a special duty
to look beyond these arguments. I ask you instead to look into the eyes of the sick child
who needs care; to think of the face of the woman who's been told not only that her
condition is malignant, but not covered by her insurance. To look at the bottom lines of
the businesses driven to bankruptcy by health care costs. To look at the "for sale" signs
in front of the homes of families who have lost everything because of their health care
costs.
I ask you to remember the kind of people I met over the last year and a half the elderiy couple in New Hampshire that broke down and cried because of their shame at
having an empty refrigerator to pay for their dmgs; a woman who lost a $50,000-job that
she used to support her six children because her youngest child was so ill that she couldn't
keep health insurance, and the only way to get care for the child was to get public
assistance; a young couple that had a sick child and could only get insurance from one of
the parents' employers that was a nonprofit corporation with 20 employees, and so they
had to face the question of whether to let this poor person with a sick child go or raise the
premiums of every employee in the firm by $200. And on and on and on.
I know we have differences of opinion, but we are here tonight in a spirit that
is animated by the problems of those people, and by the sheer knowledge that if we can
look into our heart, we will not be able to say that the greatest nation in the history of the
world is powerless to confront this crisis. (Applause.)
Our history and our heritage tell us that we can meet this challenge.
Everything about America's past tells us we will do it. So I say to you, let us write that
new chapter in the American story. Let us guarantee every American comprehensive
health benefits that can never be taken away. (Applause.)
In spite of all the work we've done together and all the progress we've made,
there's still a lot of people who say it would be an outright miracle if we passed health
care reform. But my fellow Americans, in a time of change, you have to have miracles.
And miracles do happen. I mean, just a few days ago we saw a simple handshake shatter
decades of deadlock in the Middle East. We've seen the walls cmmble in Berlin and
South Africa. We see the ongoing brave stmggle of the people of Russia to seize
freedom and democracy.
And now, it is our tum to strike a blow for freedom in this country. The
freedom of Americans to live without fear that their own nation's health care system
won't be there for them when they need it. It's hard to believe that there was once a time
in this century when that kind of fear gripped old age. When retirement was nearly
synonymous with poverty, and older Americans died in the street. That's unthinkable
today, because over a half a century ago Americans had the courage to change -- to create
a Social Security system that ensures that no Americans will be forgotten in their later
years.
Forty years from now, our grandchildren will also find it unthinkable that
�there was a time in this country when hardworking families lost their homes, their
savings, their businesses, Host everything simply because their children got sick or
because they had to change jobs. Our grandchildren will find such things unthinkable
tomorrow if we have the courage to change today.
This is our chance. This is our joumey. And when our work is done, we will
know that we have answered the call of history and met the challenge of our time.
Thank you very much. And God bless America. (Applause.)
END10:02 P.M. EDT
�THE WHITE HOUSE
O f f i c e o f t h e Press S e c r e t a r y
Internal Transcript
May 26, 199 3
REMARKS BY THE FIRST LADY
AT SEIU
MRS. CLINTON: T h i s must have been some c o n c e r t i n here
— (inaudible).
(Laughter.)
I'm j u s t p r o b a b l y g r a t e f u l I wasn't
here i n t h e b e g i n n i n g .
(Laughter.)
But I am v e r y honored t o be here, and honored t o be
i n t r o d u c e d by P r e s i d e n t Sweeney. There i s n o t anyone whom I have met
i n t h e months t h a t I have worked on h e a l t h care r e f o r m who i s more
knowledgeable, more committed, and more c o n v i n c i n g about t h e needs o f
change t h a n P r e s i d e n t Sweeney.
I a l s o want t o thank a l l o f you, because i n t h i s room
are h e a l t h care workers and h e a l t h care l e a d e r s . And many o f you
know from t h e f r o n t l i n e why t h i s campaign f o r h e a l t h care r e f o r m i s
l o n g overdue.
(Applause.) You see i t every day. And I remember so
w e l l d u r i n g t h e Democratic Convention t h e s i g n t h a t read " A f f o r d a b l e
H e a l t h Care For F a m i l i e s . " That was a good slogan t h e n and i t ' s a
good slogan today.
(Applause.)
You have k e p t h e a l t h care r e f o r m on t h e n a t i o n a l agenda,
never w a v e r i n g .
Everywhere I went d u r i n g t h e campaign and s i n c e , I
have seen s i g n s h e l d up by many o f you and your c o l l e a g u e s . The
h e a l t h a c t i o n teams have been t h e r e everywhere we have gone. And t h e
reason i t ' s been so s i g n i f i c a n t i s because your c o n s t a n t presence
speaks volumes about what i s a t s t a k e .
I f t h e people who a r e c a r i n g f o r our f e l l o w c i t i z e n s i n
h o s p i t a l s and n u r s i n g homes and so many o t h e r s e t t i n g s understand so
w e l l why we need r e f o r m , you can lead t h e way f o r so many o f our
o t h e r c i t i z e n s who understand what i s a t s t a k e . T h i s i s a debate n o t
j u s t about r e f o r m i n g our h e a l t h care system; i t i s a debate about
s e t t i n g t h e d i r e c t i o n f o r our c o u n t r y . We have t o change t h e way we
p r o v i d e h e a l t h care n o t j u s t because o f an economic i s s u e — b u t i t
i s a v e r y b i g one; n o t j u s t because i t ' s an i n d i v i d u a l human i s s u e —
b u t i t i s . You see i t every day. But because a t t h i s p o i n t i n our
h i s t o r y , t h i s c o u n t r y can no longer stand alone among i t s major
c o m p e t i t o r s o f i n d u s t r i a l i z e d c o u n t r i e s i n t h e w o r l d and n o t p r o v i d e
health security — (inaudible).
(Applause.)
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You know b e t t e r than most t h e problems f a c i n g you and me
and every o t h e r American. You know t h a t one out o f every f o u r of you
i n t h i s room r i s k s l o s i n g t h e h e a l t h insurance you now have, i n t h e
n e x t two y e a r s . J u s t s t o p and t h i n k about t h a t . You a r e i n t h i s
room among t h e i n s u r e d , by and l a r g e . And y e t you c a n ' t be secure
t h a t you w i l l have your i n s u r a n c e . Every year, m i l l i o n s o f Americans
are on t h e b r i n k o f l o s i n g t h e i r insurance and two m i l l i o n a year do.
They may l o s e i t f o r a month o r two o r s i x months o r a year b e f o r e
t h e y f i n d a way back on t o some insurance r o l l s .
They may — u s u a l l y
do — pay a l o t more t o be a b l e t o g e t back t o being i n s u r e d . And
every month, 100,000 Americans don't make i t back on those h e a l t h
insurance r o l l s .
J u s t t h i n k o f how you w i l l f e e l because you have seen
t h i s i n your work. A l l o f us know p e r s o n a l examples o f people who
are i n between i n s u r a n c e , were l a i d o f f , were l e t go, found t h e c o s t
too h i g h . And i t was j u s t a t t h a t moment i n t i m e t h a t f a t e s t r u c k .
I t was t h e n t h a t t h e c h i l d g o t s i c k .
I t was t h e n t h a t t h e p a r e n t s
f a c e d some t e r r i b l e t r a g e d y . I t was t h e n t h a t they needed insurance,
and t h e y d i d n ' t have i t anymore.
And t h e n , when they t r i e d t o go back t o g e t i t , maybe
t h e y g o t a new j o b , maybe they were brought back t o work a f t e r t h a t
l a y o f f , t h a t t h e y found t h e employer's c o s t - c u t t i n g r u l e s had changed
p o l i c i e s on them. Not o n l y had c o s t s gone up, b u t now p r e e x i s t i n g
c o n d i t i o n s s t o o d i n t h e way o f being i n s u r e d . That c h i l d was a
problem.
That spouse w i t h t h e i l l n e s s c o u l d n ' t even be covered, o r ,
i f covered, o n l y a t a v e r y h i g h c o s t .
Think about what m i l l i o n s o f i n s u r e d Americans go
t h r o u g h every month. And t h i n k about how many more o f us a r e no
l o n g e r secure, we can no l o n g e r t a k e f o r g r a n t e d t h a t we a r e employed
and our employer p r o v i d e s i n s u r a n c e , t h a t i t w i l l always be t h e r e f o r
us when we need i t . We a l s o no l o n g e r can count on i n s u r a n c e
c o v e r i n g us i n t h e event t h a t a w f u l a c c i d e n t s o r u n p r e d i c t a b l e
i l l n e s s w i t h o u t grave f i n a n c i a l c o s t and even t h e p r o s p e c t o f
bankruptcy.
S e c u r i t y i s what t h i s h e a l t h care debate i s a l l about.
Can your f a m i l y f i n d peace o f mind? Can you, o r your c h i l d , o r your
p a r e n t s g e t t h e q u a l i t y o f care when you need i t most? That's what
we have t o be f o c u s i n g on every s i n g l e day. We have enough
i n s e c u r i t i e s i n our w o r l d today. We see i t a l l around us. Americans
who work f o r a l i v i n g , who pay t h e b i l l s , t a k e care o f r a i s i n g t h e i r
f a m i l i e s s h o u l d n o t be burdened by t h e i n s e c u r i t y o f now knowing
whether t h e y w i l l have h e a l t h i n s u r a n c e .
(Applause.)
Those o f you who a r e on t h e f r o n t l i n e w i t h h e a l t h care
workers have a tremendous amount a t s t a k e i n h e a l t h care r e f o r m . You
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�- 3 -
know t h a t b e t t e r t h a n I . You see i t every day — your j o b , your
l i v e l i h o o d , t h e q u a l i t y o f your workplace. But you know more about
t h e problems i n our system t h a n most o f your f e l l o w Americans.
And I
ask you t o t a l k about those problems w i t h t h e people you see. T a l k
about i t a t t h e c o f f e e shop, a t t h e supermarket o r a t church o r a t
d i n n e r . Make sure t h a t what you see every day i n a system t h a t i s
not a system any l o n g e r , i n which people f a l l t h r o u g h t h e c r a c k s
t h r o u g h no f a u l t o f t h e i r own, make sure t h a t comes a l i v e f o r
everyone you reach.
T a l k about t h e hard c h o i c e s you see b e i n g made.
People
b e i n g d i s c h a r g e d from h o s p i t a l s w i t h p r e s c r i p t i o n s i n t h e i r hand t h a t
t h e y cannot a f f o r d t o f i l l .
(Applause.) How, when t h e y t r y t h e n t o
s e l f - p r e s c r i b e f o r themselves by s a y i n g , w e l l , I'm supposed t o t a k e
f o u r o f t h e s e , b u t I can o n l y a f f o r d t o t a k e one o f t h e s e , maybe t h a t
w i l l h e l p — how t h e y end up back i n t h e h o s p i t a l , which c o s t s us a l l
and t h e i n s u r e d more money.
(Applause.)
T a l k about t h e t i m e you spend f i l l i n g o u t forms i n s t e a d
of t a k i n g care o f people -- (applause.) You know b e t t e r t h a n any
t h a t a paperwork h o s p i t a l and a paperwork n u r s i n g home and a
paperwork d o c t o r ' s o f f i c e i s growing f o u r t i m e s f a s t e r t h a n a
h o s p i t a l — ( i n a u d i b l e ) -- (applause.)
Make a l i t t l e experiment sometimes. C o l l e c t up blank
c o p i e s o f a l l t h e forms you have t o f i l l o u t . Okay? Take them and
show them t o your f r i e n d s and n e i g h b o r s . Hold them up and say, i f
you l o o k a t a l l these forms — ( i n a u d i b l e ) — 1,500 d i f f e r e n t
i n s u r e r s and t h e government, t h e y a l l ask f o r about t h e same k i n d o f
i n f o r m a t i o n , b u t you have t o f i l l them a l l o u t i n d i v i d u a l l y because
t h e y won't t a k e somebody e l s e ' s form. T a l k about t h e hours and waste
and i n e f f i c i e n c y t h a t causes t o you. I ' d r a t h e r have those o f you
who a r e f r o n t - l i n e h e a l t h care workers making sure t h a t I and my
f a m i l y and y o u r s g e t b e t t e r i n s t e a d o f d o t t i n g every I and c r o s s i n g
every T.
(Applause.)
And one o f t h e promises o f h e a l t h care r e f o r m i s we're
g o i n g t o e l i m i n a t e t h e r i d i c u l o u s paperwork and a d m i n i s t r a t i v e —
( i n a u d i b l e ) — (applause.) T a l k t o your f r i e n d s and n e i g h b o r s about
what you see every day i n terms o f p r i c e gouging, c o s t s h i f t i n g ,
u n c o n s c i o n a b l e p r o f i t e e r i n g . E x p l a i n how you see t h e system i s being
— ( i n a u d i b l e ) — and r i p p e d o f f because i t has no r e a l d i s c i p l i n e —
( i n a u d i b l e ) — (applause.)
P a r t o f t h e reason we a r e i n t h i s s p i r a l i n g c o s t
e x p l o s i o n which makes i t i m p o s s i b l e f o r us t o f e e l secure t h a t we
w i l l be i n s u r e d even i f we c u r r e n t l y a r e , because t o o many -( i n a u d i b l e ) — people have made t o o much money o f f o f e l i m i n a t i n g
o p p o r t u n i t i e s f o r c a r i n g f o r people i n s t e a d o f expanding them. We
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need — (applause) — t o g e t back t o a system t h a t v a l u e s added —
( i n a u d i b l e ) — t h e q u a l i t y o f care t h a t i s a v a i l a b l e t o every
American. And we need t o have a budget f o r our h e a l t h care system
j u s t l i k e we budget e v e r y t h i n g e l s e , so t h a t people w i l l know t h e i r
p r i m a r y r e s p o n s i b i l i t y i s t o t a k e care o f people, n o t t o enhance t h e
p r o f i t s o f a l l — ( i n a u d i b l e ) — (applause.)
You a r e a l s o , though, consumers o f h e a l t h c a r e . And we
want t o make you b e t t e r informed consumers. We want you t o be a b l e
t o choose your h e a l t h p l a n , n o t t o be r e q u i r e d t o choose o n l y t h e
h e a l t h p l a n o f f e r e d by your employer b u t t o make r e a l c h o i c e s . We
want t o g i v e you good i n f o r m a t i o n so t h a t you can make good consumer
c h o i c e s among h e a l t h p l a n s .
Most people have h e a l t h insurance t h a t t h e y don't
u n d e r s t a n d as w e l l as t h e c a r they d r i v e .
(Applause.)
(Inaudible)
— c a r t h a n you do f o r your h e a l t h i n s u r a n c e . And I wouldn't want t o
embarrass m y s e l f o r any o f you, b u t I b e t we c o u l d n ' t r e a l l y e x p l a i n
e v e r y t h i n g about our h e a l t h i n s u r a n c e p o l i c y t o each o t h e r i f we
tried.
We don't g e t t h e i n f o r m a t i o n i n u n d e r s t a n d a b l e forms.
We
cannot comparison shop. We c a n ' t make good d e c i s i o n s t h a t may be
r i g h t f o r my f a m i l y b u t wouldn't f i t your f a m i l y .
So we need a
system t h a t promotes consumer awareness, i n f o r m a t i o n and c h o i c e .
The system t h a t w i l l be proposed w i l l do a l l o f t h a t .
Because among t h e a b s o l u t e bedrock p r i n c i p l e s t h a t we want t o abide
by i s consumer c h o i c e as much as p o s s i b l e w i t h i n t h e h e a l t h care
system.
You know, t h e s u r e s t way t o g e t an i n s t i t u t i o n o r an
i n d i v i d u a l t o change i n business i s t o walk away when you a r e —
( i n a u d i b l e . ) R i g h t now, we can't do t h a t i n most i n s t a n c e s . I n a
new p l a n , every year y o u ' l l be a b l e t o comparison shop and j o i n t h e
p l a n t h a t you t h i n k i s best f o r you. And t h a t w i l l send a v e r y good
messages t o t h o s e p l a n s you do n o t choose t o j o i n t h a t t h e y had
b e t t e r change t o g e t your business. An educated consumer i n a h e a l t h
care f i e l d i s one o f t h e s u r e s t ways o f c o n t r o l l i n g c o s t s and
maintaining quality.
And we i n t e n d t o have Americans be educated
consumers and make good d e c i s i o n s f o r t h e i r own h e a l t h — (applause.)
We want s e c u r i t y f o r every American. We want t o c o n t r o l
the c o s t s i n t h e system so t h a t we can r e a l l o c a t e t h e money t h a t i s
t h e r e so i t c o u l d be used f o r t a k i n g care o f people. We want t o
ensure q u a l i t y and g i v e you good i n f o r m a t i o n so t h a t you can be
judges o f t h e q u a l i t y o f your h e a l t h c a r e . We want t o g i v e you
c h o i c e among h e a l t h care p l a n s so t h a t you can d e c i d e what i s best
f o r your f a m i l y based on t h e comprehensive b e n e f i t s package t h a t w i l l
be a v a i l a b l e t o every American. And t h e n you can d e c i d e i f you want
fee f o r s e r v i c e l i k e you have now, i f you want an HMO l i k e you have
now. Do want a p a r t i c u l a r k i n d o f s e r v i c e t h a t may be a v a i l a b l e i n
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�5 -
one p l a n b u t n o t i n another?
choices.
You w i l l be a b l e t o make those k i n d s of
Now, i s t h i s g o i n g t o be easy? No. The s t a t u s quo
e x i s t s because t h e r e a r e people who b e n e f i t from i t . There a r e
i n t e r e s t s who see t h e same s t a t i s t i c s and hear t h e same s t o r i e s t h a t
we do; who meet people who a r e a f r a i d t h e y ' r e going t o l o s e t h e i r
i n s u r a n c e o r who t h r o u g h no f a u l t o f t h e i r own a l r e a d y have, b u t they
— ( i n a u d i b l e ) — j u s t t h e p r i c e o f d o i n g business.
We have t o be w i l l i n g t o commit o u r s e l v e s t o these
fundamental v a l u e s about what t h e American h e a l t h care system should
be founded on. We have t o be w i l l i n g t o t a k e on every s p e c i a l
i n t e r e s t group. We have t o be w i l l i n g t o stand up and say we a r e
g o i n g t o p u t t h e American people and t h e i r h e a l t h f i r s t .
(Applause.)
We have t o be w i l l i n g — ( i n a u d i b l e ) — what w i l l be a v e r y h a r d f o u g h t b a t t l e over changing t h i s — ( i n a u d i b l e . )
And you know as w e l l as I do t h a t t h e r e w i l l be many
arguments m a r s h a l l e d a g a i n s t r e f o r m . The s t r o n g e s t w i l l be t h a t i f
we change i t c o u l d g e t worse. I t ' s s o r t o f hard t o imagine t h e c o s t
g o i n g up $100 b i l l i o n a year, w i t h m i l l i o n s o f people a t r i s k o f
l o s i n g t h e i r i n s u r a n c e and a 1.2 m i l l i o n every year l o s i n g i t , w i t h
i t c o s t i n g more and more and d e l i v e r i n g l e s s and l e s s ; i t ' s hard t o
imagine how these proponents o f t h e s t a t u s quo w i l l be s u c c e s s f u l
w i t h t h a t argument. But don't ever u n d e r e s t i m a t e t h e i r c a p a c i t y t o
confuse t h e i s s u e , t o scare people, t o use t a c t i c s t h a t w i l l be very
difficult to —
(inaudible.)
But we have a l o t o f arguments on our s i d e . You know
you can be t h e l e a d e r i n g e t t i n g t h i s argument a c r o s s , because we
know t h a t i f we do n o t h i n g , we w i l l n o t stand s t i l l , we w i l l go
backwards. We know i f we do n o t h i n g , t h e r e w i l l be people who w i l l
c o n t i n u e t o p r o f i t from our e x i s t i n g system — ( i n a u d i b l e ) — w i l l go
w i t h o u t c a r e , have t o postpone c a r e , be bankrupt by o b t a i n i n g c a r e .
So I ask each o f you t o c o n t i n u e what you have begun.
Stand up f o r t h e k i n d o f h e a l t h care system t h a t makes sense, t h a t
w i l l save money, w i l l e l i m i n a t e f r a u d and abuse, w i l l focus on
q u a l i t y , w i l l p r o v i d e a c h o i c e , and w i l l i n t h e l o n g r u n make t h i s
c o u n t r y and everyone i n i t more secure and h e a l t h i e r .
I f t h e debate
i s f o u g h t o u t on those terms, t h e n by t h i s t i m e n e x t year, I w i l l be
g e t t i n g ready f o r t h e c e l e b r a t i o n — ( i n a u d i b l e ) — P r e s i d e n t meeting
and s i g n i n g t h i s .
(Applause).
Thank you.
END
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�CriA
THE WHITE HOUSE
O f f i c e o f the Press Secretary
June 10, 1993
For Immediate Release
REMARKS BY THE FIRST LADY
TO CATHOLIC HEALTH ASSOCIATION
VIA SATELLITE
JUNE 9, 1993
MRS. CLINTON: ( I n progress) M i l l i o n s of other
a™^ricans are gripped by fear t h a t a t any time they could lose t h e i r
b ^ n e f ' s 'And'ev^?y y e L , two m i l l i o n Americans do lose them
They
mav lose them f o r a month or two or s i x months or a year before tney
f i ^ d a way back on some insurance r o l l . And they usually pay a l o t
i o r t l o l l insured again. S t i l l , every month, 100,000 Americans f a l l
^ o ? r t h : K a l t h insurance r o l l s ^ - h e r s stay - ^ j o hat - e y want
^ L i ^ ^ ^ m i i r e r f L d ' t L r S a n ' t ^ g e t ' S ^ v e r f g e f o r t h i very.problem they
Teed ca^e f o r , because t h a t i l l n e s s i s stamped a "preexisting
condition."
Americans who work f o r a l i v i n g , who pay the b i l l s and
take care of r a i s i n g t h e i r f a m i l i e s should not be burdened by the
insScS?Uy of not knowing whether they w i l l have health insurance.
Secu?i^y i s what t h i s h e a l t h care debate i s a l l about.
Once the new health care plan i s up and running,
everyone w i l l get a h e a l t h s e c u r i t y card which w i l l guarantee a l l
fmoJicans access t o a comprehensive package of b e n e f i t s , no matter
. . . . . . ca.e ^ t ^ t ^ ^ ^ f ^ ^ T o n ^ r ^ c r f ^ - r S F ^ ^ " ^ "
neaiT-n
hoaifh care i s priced out of the reach of many
x^^nSans
I ? f i r c e s j o u to'^absorb »ora red i n k , and i.any other
Americans.
system t o s h i f t costs, and a l l of us bear
^ h f b u r d e n ' L l f ? " i c K e " e d , Jlealth care costs w i l l continue t o hurt
ou? f a m i l i e s , bankrupt businesses, and d r i v e the federal d e f i c i t t o
ever g r e a t e r h e i g h t s .
our reforms will rein in health care costs thrcugh
ro-"^
ro-o-ire-te^i^^nr^^oSrfs!
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^
I
^
^
^
^
l
�- 2 -
and Where decisions - - - ^ r - ^ ^ t J l f ^ l f,\=°rfor'^'a ^ a t l e n l
We
reimbursed, but what a doctor
^ ' | „ " n t \ h a t bloats our
w i l l reduce the bureaucracy ^J<^^^^"°f J^f^^Ce complained about
h e a l t h care system and t h a t so many UL y
because i t adds unnecessary costs.
F i n a l l v we w i l l say t o a l l health care i n s t i t u t i o n s and
providers, j u ^ ^u^^ecommend^^^
S i t h i n a budget, and we must
a d m i n i s t r a t i o n , insurance
wcosts,
i t h i n ti hn at to budget
away
f^°"P^P^^V°^^^or
We're
going t o ask
w^at matters most c a r i n g f o r people.
pep
^^^^^^^
everybody pa?rfor ^.^^^
health care.
And^^^^
to
hospitals
-- r^'^^"'.^Pi^^^^^hei?
to chip in and do their part
^^^^
I t ' s only f a i r .
c o n d i t i o n . And every ^ay there i s a t least
^P^^ ^^^^^ happens i s
cannot a f f o r d the drugs he p r e s c r i b e s ^ expensive drugs, or t o s e l f t h a t p a t i e n t decides not t o take those expens
^
to
n^edicSte. Instead of the four a day J ^ ^ ^ ^ ^ ^ ^ ^ ^ / i ^ ^ s not too long
s t r e t c h them a l i t t l e f^^^^^J^'.^^'^'tKe h o s p i t a l costing a l l of us
before t h a t p a t i e n t ends up back i n the nospii: ,
even more
TO the businesses who don't cover t h e i r - r K e r s today,
yet take advantage of y o - ^ ^ ^ - P ^ ^ ^ , i ; / J ^ ; i r r o ; J r r s ; we'^^ going t o
i o s t s f o r t h e businesses
t o take r e s p o n s i b i l i t y . I t ' s
sav i t ' s time f o r everyone i n America t o
F
only f a i r t h a t we a l l pay our f a i r share.
TO the individuals ^hothink they can get by^w^^^
coverage and have that terrible accident or that unpred^
and end up in the emergency room or in the i
,
^ i ' f i ; 7 ! ; " o r i S a t e ? e ? ^ i u ' c a ; a ^ f i r d , you mist c o n t r i b u t e ,
f r i ? . V w i U a n ' b e L f i t i f we a l l take r e s p o n s i b i l i t y
for our h e a l t h and f o r each o t h e r .
y-<:.duce the waste t h a t eats up our
Third, our reform ^ ^ ^ ^ ^ ^ ^ ^ ^ f y ^ J ^ time. Another key
h e a l t h care d o l l a r s now -eduction i n the f r u s t r a t i n g
component of reform w i l l be a wholesale redu
^ ^^^^^
and wasteful paperwork that eats up the n
^^^^
^^^^^^
know very w e l l what the load i s l i k e , and wn
y
^^^^^^
of r u l e s , the volumes of r e g u l a t i o n s ,
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�- 3-
forms, you have t o ask y o u r s e l f , where d i d a l l t h i s bureaucracy
from?
come
The s h o r t answer i s i t comes from everywhere.
I t comes
from p r i v a t e i n s u r e r s , i t comes from government. Forms were c r e a t e d
t o make sure t h a t t h e most v u l n e r a b l e people were g e t t i n g proper
c a r e . Then more forms were c r e a t e d t o make sure d o c t o r s and
h o s p i t a l s d i d n ' t p e r f o r m unnecessary t e s t s and procedures.
Then t h e
i n s u r a n c e companies have t h e i r own s e t s o f r u l e s f o r d o c t o r s and
nurses t o f o l l o w , so t h e y c r e a t e t h e i r own forms. And as t h e number
of h e a l t h insurance companies grew -- today t h e r e are more than 1,500
— so d i d t h e number o f forms. The r e s u l t :
I n s t e a d o f a system
where forms e n f o r c e t h e r u l e s , we have a system r u l e d by t h e forms.
P a t i e n t s d o n ' t know how t o read t h e i r b i l l s o r make
sense o f t h e i r insurance p o l i c i e s , and worry t h e y ' l l be l e f t hanging
because t h e y d i d n ' t u n d e r s t a n d t h e f i n e p r i n t . Doctors and nurses,
e s p e c i a l l y nurses, spend as much time d o t t i n g I s and c r o s s i n g Ts as
t h e y do t a k i n g temperatures and c a r r y i n g f o r p a t i e n t s . One of t h e
n u r s e s I spoke w i t h t o l d us she e n t e r e d n u r s i n g because she wanted t o
c a r e f o r people. She s a i d t h a t i f she had wanted t o be an
a c c o u n t a n t , she would have gone t o work f o r an a c c o u n t i n g f i r m .
And f o r every new d o c t o r an average h o s p i t a l h i r e s , i t
h i r e s f o u r new a d m i n i s t r a t o r s .
I t ' s a bad case o f t h e t a i l wagging
the dog. And we're g o i n g t o t a k e t h a t a d m i n i s t r a t i v e mess we now
have and c l e a n i t up f o r you and f o r everyone.
We'll see a h e a l t h
c a r e system t h a t i s made easy. One insurance form f o r everybody.
A
q u a l i t y check form — no h i d d e n f i n e p r i n t . And we're going t o
reduce t h e paperwork and s t r e a m l i n e t h e r e g u l a t i o n s . Doctors and
nurses w i l l be a b l e f i n a l l y t o do what t h e y were t r a i n e d t o do. At
the same t i m e , we w i l l m a i n t a i n and enhance t h e q u a l i t y o f American
h e a l t h care by measuring q u a l i t y based on r e s u l t s , n o t based on
micromanagement and forms.
F o u r t h , t h i s r e f o r m w i l l make a s e r i o u s s t a r t a t
a d d r e s s i n g t h e growing l o n g - t e r m care problems our c o u n t r y faces.
Now many w i l l argue we s h o u l d p u t o f f c o n s i d e r a t i o n o f t h i s i s s u e .
W h i l e i t would be t o o c o s t l y t o t r y t o meet a l l o f America's l o n g t e r m c a r e needs a t once, i t would be i r r e s p o n s i b l e f o r us n o t t o make
a s t a r t , t o t r y t o g e t ahead o f t h e a g i n g curve. Today t h e r e are t o o
few o p t i o n s f o r people h o p i n g t o s t a y a t home and o u t o f
i n s t i t u t i o n s , and t o o l i t t l e h e l p f o r f a m i l i e s d o i n g t h e i r best t o
care f o r a i l i n g r e l a t i v e s .
I n d i v i d u a l s and t h e i r f a m i l i e s , as you
know, a r e o f t e n bankrupted by t h e c o s t o f l o n g - t e r m c a r e , o r a t l e a s t
f o r c e d t o spend themselves i n t o p o v e r t y and t u r n t h e i r backs on t h e i r
o l d e r r e l a t i v e s . They c a n ' t g e t h e l p u n t i l t h e y have almost n o t h i n g
left.
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�- 4 -
The system i s complex and d i s j o i n t e d and i t f. gments
the c a r e people r e c e i v e . I f t h e l o n g - t e r m care system^ as ... f t
unchanged a l l t h a t w i l l o n l y g e t worse.
Most o f you know Monsignor Charles Fahey.. Morsignor
Fahev s e r v e d on our w o r k i n g group on e t h i c s , the group,-charged w i t h
making s u r e t h a t t h e system we develop i s d r i v e n by fu;ndamcntal
v a l u e s , shared r e s p o n s i b i l i t i e s , s o c i a l j u s t i c e . Monsiiqnor Fahey has
c o n f r o n t e d t h e f r a g m e n t a t i o n and backward i n c e n t i v e s o j f our long-term
ca?e system f i r s t h a n d . He t o o k a month o f f t h i s year ^ t . care f o r
b o t h h i s p a r e n t s , s e r i o u s l y i l l , i n o r d e r t o keep them, out of a
h o s p i t a l o r a n u r s i n g home. As he s t r u g g l e d t o nurse Ihis parents
hack t o h e a l t h i n ways t h a t met t h e i r needs and m a i n t a i n e d t h e i r
dianitv
he t o o k on a system t h a t l o o k e d a t t h e movingj parts but
never a t t h e whole person. As t h e Monsignor p u t i t , -'Ifc've got a
system t h a t cares f o r t h e eye or t h e f o o t or t h e nose^ *ut never f o r
C h a r l i e or E l i z a b e t h . "
Our r e f o r m w i l l r e v e r s e t h e i n c e n t i v e s amfl expand the
o o t i o n s f o r care a t home and improve c o o r d i n a t i o n of s«vices.
Another example from my v i s i t t o S t . Agnes: That hospatal. as many
o? your does, runs an a d u l t day c a r e c e n t e r . And what they found i s
t h a t t h e y c o u l d n ' t g e t reimbursed on even a s l i d i n g scale to h e l p
keeo t h e i r p a t i e n t s and t h e i r f a m i l i e s from t h e n e i g h b ^ o o d a t home.
And so what o f t e n happened i s t h a t , a l t h o u g h n u r s i n g hoK care was so
much more e x p e n s i v e , t h e $35 a day f o r a d u l t day care i . a h o s p i t a l
s e a t i n g was beyond t h e f i n a n c i a l r e a c h o f so many famj^las t h a t they
T e l l ahead, met t h e Medicaid r e q u i r e m e n t s and, v e r y r e ^ t f u l l y , p u t
t h e i r r e l a t i v e i n a n u r s i n g home.
I t wasn't t h e c h o i c e t h e y wanted and i t cort us more
money. How much more s e n s i b l e we w i l l be i f t h e S t , Acpeses and t h e
St V i n c e n t s and t h e o t h e r h o s p i t a l s i n your a s s o c i a t i o , are able .,o
r e a c h o u t and h e l p f a m i l i e s make t h i s c o n n e c t i o n t o be able t o serve
t h e i r older relatives.
W e ' l l make a s e r i o u s s t a r t on i m p r o v i n g l a i ^ t e r m care
coverage f o r t h e e l d e r l y and d i s a b l e d Americans by e x p a ^ n g home and
community-based c a r e . People w i t h s e v e r e d i s a b i l i t i e s ^ 1 1 have
access t o a broad a r r a y o f s e r v i c e s , c o o r d i n a t e d by a case manager,
? a n o r e d t o i n d i v i d u a l needs. By e x p a n d i n g t h e a v a l ] . ^ I x t y of home
and community-based c a r e , we w i l l g i v e s e n i o r s and div.aWed c i t i z e n ,
who c a n ' t manage on t h e i r own t h e o p p o r t u n i t y t o rer, -Bin t h e i r
community f o r as l o n g as p o s s i b l e .
L a s t l y we w i l l improve t h e a v a i l a b i l i t
-in t h e areas t h a t hkve been t r a d i t i o n a l l y underserve
communities, u r b a n c e n t e r s and o t h e r p a r t s o f t h e c.
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i health care
-rural
iry where a
�- 5
h e a l t h care card alone w i l l mean l i t t l e t o people unless we guarantee
t h a t s e r v i c e s w i l l be there f o r them.
Americans everywhere need t o know there ^ i ^ J ^ ^ ^ ^ ^ f
A =. h^;,lth f a c i l i t v a v a i l a b l e t o them. This i s a problem t h a t the
?a?holic i e a l t h A s s o c i a u i n knows very w e l l because your members have
helped ?o SSdress the problem i n many —
^
'
'
i F iilabeth
h e a l t h care providers have abandoned.
For the 1,500 r e s i d e n t s o f a community l i k e Gould out i n
tsvus
t h a t community ever s i n c e .
The P r e s i d e n t ' s
-.a
plan w i l l b o l s t e r these e f f o r t s by
nnSen??vrs1rr%K
sfrvfcrifrp ^
h^
^ r o g « m s ?o encourage doctors to p r a c t i c e i n remote parts of our
country.
T h i s plan w i l l make
t^f^/l^^^^IIry^etSortrwhere'
^ r i ^ r o r ; ^ ; v I ™ S o ? i r r r n d ' r r f e f a n d ' : i h e r s ' w i l l be connected
^^\o%?"v ? a r e in a eas t h a t t r a d i t i o n a l l y - v e been^overlooked.
li;:tJlrirn/:il
^ r s t ; n c r u r f r o r t h e human c a r i n , that needs
t o be a t t h e r o o t of any h e a l t h care system.
try t o r e c o n n : : t ! - ; \ r % h a r ? i ^ : r b e r f tjev^^^^^^^^^^^
£ If i?f^i^ ?Lrrar^Lr^rithed
'?i^:rrce^^^^^^^^^^^
we f i n d ourselves, as I have, dependent on each other.
This i s what I hope: t h a t i n a few years we w i l l not
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�- 6
j u s t be h e a l t h i e r , although that's a tremendous goal i n i t s e l f , but
w e ' l l a l l be p a r t of a community of c a r i n g again.
Thank you very much f o r being part of t h a t community
now, f o r t h i n k i n g hard about how we can expand i t t o every American,
and by standing behind the reforms t h a t need t o be made. Thank you
a l l again.
END
�JOHN 0. ROCKEFEUER IV
WIST VIROINM
lam'td States Senate
WASHINGTON. 00 20S10-4802
National Federation of Independent Businesses
Washington, D.C.
June 28, 1993
Uke the rest of America, you have watched the health care issue move to the top of the
agenda. From a lime not that long ago when it was someone else's problem - to the suuation
today, when the vast majority of Americans - especially small business owners - say it is die
problem that wonics them emotionally, burdens diem fmancially. and scares them ftom head to
toe. In chairing the Pepper Commission, and in my travels through my state, that is what small
businesspeople have told me over and over again.
Let mc describe somcdiing really terrifying. Let me describe for you the health cart
systemrfhat is the likeliest altemative to the President's proposal - the status quo. Bear with
me, because it is a lot more complicated to explain thai) "competidon within a budget"
What benefits will be covered? For most people wiUi coverage now, a little bit less than
last year. Sdff co-payments and deductibles. Less of everything at much higher premiums.
Insurers will continue to charge you whatever diey want - based on health status, where
you live, where you work, or whatever.
Cost controls? It will be eveiy-man-for-himself. Big employers and die govenunent
will have die clout that comes widi size, to force price controls on health care providers. But
those providers will just tum around and jack up rates on everyone else to compensate.
Insurers also will pressure docton and hospitals by micro-managing and secondguessing every decision, aivd by making diem jump through complicated administradve hoops sort of rationing byredtape - with every insurer designing its own forms and claims
procedures, thousands in all. Small business will continue to pay up to 40 percent man than
big businesses just to cover die administrative overhead and die cost-shifting.
Policing the system against incompetence will be left to a medical malpractice system
diatrewardsmany frivolous claims and ignores diousands of legitimate ones.
The status quo plan is employer-based, so most people will continue to get covered
tiirough wheretiieywoxk. It goes witiiout sayingtiiaitiiereis no universal coverage under tiie
stanis quo plan. Businesses diat ^ offer coverage - which is die vast majority - will continue
to give those who don't, a fret ride. Up to a quarter of those on welfare willremainstuck
diere solely to keep Medicaid benefits.
What willtinsall cost? An extra $100 biUion in die tot year, even more in die future.
Il doesn't call for new taxes at die moment - it just adds to deficits. In fact, government's
share of diis system's cost will eat up more than 60 cents of every new dollar of federal
revenue over the next five years. But die bulk of these new costs will fall squarely on
business. The biggest can expect their costs to go up 12 percent to 15 percent a year, smaller
businesses, more like 20 percent to 30 percent •- if dicy're lucky.
-MORE-
�Some plan,right?Well, I promise you, dial is what we'll get if the President's plan
fails. If anyone widi any clout insists on changing die status quo only in waystiiatprotect their
sole interests, that is the altemative that will win in die end.
Itiiinktiiatwhen die President's plan is introduced,tiierewill be a huge national sigh of
relief. As we all begin to explore it and analyze it in terms of what it will personally mean to
us, I think we will be able to put die costs and the sacrifices in perspective widi what we stand
to gain. I'm convinced most Americans will conclude that it's a pretty good deal for tiiem
personally and a great deal for our nation as a whole. Most of all, I hope that small business
leaders and owners like you will judge the plan in terms of altematives like the status quo, or
nibbling at die edges.
Yes, it will be complicated and tough to grasp at first Simple solutions to complicated
problems are rarely fair, and what's fair is rarely simple. The President's plan will be fair. It
will be inelegant and complex because it is rooted in an idea that is itself a grand compromise,
what
President has called "competition under a budget" It proposes a marriage <rf ftecmarket dynamics and regulatory discipline diat gives totalreignto neither, but rather seeks to
balance each witii the otiier - a very American approach, giventiiatAmericans, in poll after
poll, say they trust neitiier govemment nor private enterprise enough to hand health care
completely over to either one.
It should be clear when die President's plan is put forwardtiiathe haarejecteddie idet
of socialized medicine, of govemment assigning you to a doctor, of long waiting lines. The
healtii care system will remain privately run and largely privatelyfinanced.Incentives will be
changed around to get the private healtii care system to wodc more effectively and efSdendy and torespondto demands of newly empowered consumerstiiatquality and satisfaction go up
and costs stay down.
These are the same demands consumers make of every other industry. As every other
industry knows: run up prices too much and you price yourself out of customer's reach; cut
quality in die name of cost and you lose customerstiiatway, too. Health care providers will
prosper only by performingtiiatsame balancing act. Theregulators'job will be to see to it
they cannot compete in otho', more desouctive ways.
Willtiierebe new costs? Of course. This new system is designed to squeeze out waste
and abuse, but that takes time. For one thing, most of those "wasted" dollars go into
somebody's paycheck somewhere in die healtii care system. Changing to a new system will
mean shifting many health care jobs around - fewer paper pushers and more healtii educators,
for example. That will take years. But bringing all Americans into die system is something
tiiat cannot waittiiatlong, for compelling moial reasons, let alone political ones.
This plan will not be perfect But dial's an unreasonable test We should concentrate ca
expecting a basic framework, direction and principles that will produce sound results. We
must not let fear of the unknown ~ or bickering over ideology - paralyze us again.
-MORE-
�-3-
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«##
�PRESIDENT WILLIAM JEFFERSON CLINTON
REMARKS TO THE NATIONAL GOVERNORS ASSOCIATION
AUGUST 16, 1993
TULSA, OKLAHOMA
Good morning.
I n t h e p a s t two weeks, o u r n a t i o n has t a k e n a b o l d f i r s t
s t e p toward a new economic d e s t i n y . Thanks t o t h e courageous
members o f Congress who s u p p o r t p r o g r e s s and change, I s i g n e d
i n t o law l a s t week a budget b i l l t h a t reduces t h e d e f i c i t and
embraces t h e core v a l u e s o f America —
t h e values o f t h e middle
c l a s s , o f s m a l l business, o f r e w a r d i n g hard work and g i v i n g t h e
n e x t g e n e r a t i o n as b r i g h t a f u t u r e as o u r p a r e n t s gave us.
T h i s was a c r u c i a l f i r s t s t e p i n r e s t o r i n g growth and
v i b r a n c y t o o u r economy, l i f t i n g an u n f a i r t a x burden o f f t h e
backs o f w o r k i n g Americans, c r e a t i n g j o b s , and s t r e n g t h e n i n g o u r
n a t i o n ' s s t a t u s as a w o r l d economic l e a d e r .
Now t h a t we have begun t o break t h e g r i p o f g r i d l o c k w i t h
passage o f my economic p l a n , we must t a k e t h e n e x t s t e p . As I
s a i d l a s t February, we cannot t r u l y s t r e n g t h e n o u r economy o r
p r o t e c t t h e w e l l - b e i n g o f every c i t i z e n u n t i l we r e f o r m a h e a l t h
care system t h a t i s o u t o f c o n t r o l .
When I became P r e s i d e n t , I e n v i s i o n e d a p a r t n e r s h i p i n
which t h e f e d e r a l and s t a t e governments would share ideas and
i n n o v a t i o n s and j o i n t o g e t h e r t o promote l a s t i n g change. Not
piecemeal change. Not i n c r e m e n t a l change. But fundamental change
t h a t w i l l p r o p e l us i n t o t h e 2 1 s t c e n t u r y .
The coming months w i l l be a t e s t o f t h a t p a r t n e r s h i p . What
a w a i t s a l l o f us now i s no l e s s u r g e n t t h a n p a s s i n g t h e f e d e r a l
budget.
We must r e f o n n a h e a l t h care system t h a t i s d r a i n i n g t h e
n a t i o n ' s c o f f e r s and r o b b i n g t o o many Americans o f t h e s e c u r i t y
t h e y need and deserve. And we must g e t beyond p a r t i s a n p o s t u r i n g
and d i s t o r t i o n s and work t o g e t h e r t o ensure l o n g - t e r m s e c u r i t y
f o r o u r c i t i z e n s , o u r s t a t e s and o u r n a t i o n .
I n t h e months ahead, we cannot l e t h e a l t h c a r e f a l l v i c t i m
t o p a r t i s a n b i c k e r i n g . Reform i s n o t a Democratic c h a l l e n g e , n o t
a Republican c h a l l e n g e , n o t a l i b e r a l o r c o n s e r v a t i v e c h a l l e n g e .
I t ' s an American c h a l l e n g e t h a t we must f a c e t o g e t h e r .
For t h e p a s t 12 y e a r s , you and your s t a t e s have b a t t l e d o u r
h e a l t h c a r e c r i s i s a l o n e , as Medicaid c o s t s have mushroomed and
�federal mandates have rained down on you l i k e the worst flooding
in the Midwest.
Let me t e l l you: Nobody knows those frustrations better than
I do. I remember what i t was l i k e to write and enforce a state
budget while the federal government looked the other way — or
acted as i f state money grew on trees.
When I became President, one of the f i r s t things I did was
meet with you in Washington to talk about a new partnership
between the state and federal governments. 1 remember that day in
February when we sat in the East Room at the White House — i t
seems l i k e 40 years ago now — and exchanged ideas about health
care.
I knew then — and I know now — that even as unemployment
and declining incomes have depleted your revenues, you have
devised innovative p o l i c i e s and programs to control escalating
health care costs and swelling welfare r o l l s .
That's why I envision a new federal-state partnership that
i s good for you and good for the nation. A partnership where we
come together — whatever our p o l i t i c a l persuasions — and work
for a common goal. A partnership l i k e the one we're experiencing
with NAFTA, where the majority of governors support free and f a i r
trade. I ask your help as we campaign t h i s f a l l for passage of
t h i s important trade agreement, which w i l l gear our economy for a
changing world.
I'm heartened that, since the beginning of my
Administration, the NGA has joined with us in Washington on a
bipartisan basis to c r a f t reforms that w i l l give states the
f l e x i b i l i t y they need to improve our health care system.
No one embodied that s p i r i t of bipartisanship more than
George Mickelson, whose tragic death l a s t spring was a loss to
South Dakota and to the whole nation. I think i t ' s appropriate
that we remember h i s energetic commitment to health care reform
and h i s invaluable contributions to our efforts.
Our health care system weaves
society, touching a l l of our l i v e s
inspiring confidence in our people
flourish, i t i s eating away at our
through every thread of
and businesses. But instead of
and helping our nation
core.
Year after year, health care costs have been allowed to soar
— to the point where we are spending 14 percent of our GDP on
health care with no c e i l i n g in sight.
Year after year, c i t i e s and states have l a i d off teachers,
closed l i b r a r i e s , abandoned transportation projects, and reduced
police forces to compensate for mounting health care costs.
�Year a f t e r year, as the cost o f insurance premiums has
r i s e n , m i l l i o n s of our f r i e n d s and neighbors have l o s t t h e i r
coverage simply because they switched jobs, moved t o a d i f f e r e n t
c i t y , or got s i c k .
Now we have an h i s t o r i c o p p o r t u n i t y t o change a l l t h a t . We
have a chance t o harness these costs and streamline the
bureaucracy and do what the American people have asked us t o do:
change what i s wrong w i t h the h e a l t h care system and b u i l d on
what i s r i g h t .
The f e d e r a l government has much t o l e a r n from the s t a t e s and
from the tough decisions some of you have made already about
health care.
Gov. Waihee's Hawaii i s a compelling example o f the merits
of h e a l t h care insurance and primary care. Nearly the e n t i r e
population of Hawaii ~ 98 percent ~ receives h e a l t h insurance.
Yet h e a l t h care costs are lower t h e r e , even though more people
are v i s i t i n g doctors each year.
In Colorado, Gov. Romer's Colorado Care program confronts
s p i r a l i n g h e a l t h care costs head on, something the f e d e r a l
government has never been w i l l i n g t o do f o r the l a s t 12 years.
In Washington, Gov. Lowry has championed i n n o v a t i v e and
pragmatic approaches t o f i n a n c i n g , insurance and cost c o n t r o l
reform t h a t w i l l help achieve h e a l t h s e c u r i t y f o r a l l s t a t e
residents.
And we a l l appreciate the example set by Gov. Dean
i n Vermont, whose s t a t e has c l e a r l y b e n e f i t e d from having a
doctor i n the State House.
These energetic approaches have brought many o f you t o
Washington over the past e i g h t months — t o help shape reforms
t h a t w i l l work a t the s t a t e l e v e l . Some of you have l e n t your
s t a f f s t o our e f f o r t . Some of you have held r e g u l a r discussions
w i t h our White House working group. And from your experiences, we
have learned t h a t what works i n North Dakota w i l l not necessarily
work i n New York.
Just yesterday [Sunday], your executive committee pledged t o
support h e a l t h care reform w i t h i n a comprehensive f e d e r a l
framework. That's important because the only way h e a l t h care
reform w i l l succeed i s i f the f e d e r a l government b u i l d s the
foundation of the house — and allows the s t a t e s t o
pick the f u r n i s h i n g s .
W i t h i n a f e d e r a l framework t h a t guarantees u n i v e r s a l
coverage and enforceable cost c o n t r o l s , we w i l l work w i t h s t a t e s
to phase i n reform and help you work out problems i f they a r i s e .
�And, as you know, our plan w i l l not be a bag of surprises that
catches you off guard with new regulations and expenditures.
We must begin the process now because nothing i s more sacred
to our c i t i z e n s than the security of good health. The plan that I
w i l l outline to Congress next month w i l l offer hope for a l l
Americans who want to work and take r e s p o n s i b i l i t y and create
opportunities for their families and their children.
Our plan s t a r t s from a simple premise: that a l l Americans
must be guaranteed the security of knowing they w i l l never lose
their health coverage even i f they switch jobs, lose a job, get
sick, move to a new c i t y or start a small business.
Security must be the guiding principle of health care
reform.
We w i l l offer a comprehensive package of benefits to every
American, no matter their income, that places new emphasis on
preventing i l l n e s s rather than waiting u n t i l a person gets sick.
We w i l l cut nightmarish red tape and paperwork that smothers
hospitals, doctors, and nurses and forces them to spend more time
completing forms than caring for patients. And we w i l l simplify
the system for consumers, who too often are overwhelmed by jargon
and fine print that l i m i t s their coverage.
We w i l l control costs by curbing overcharging and
encouraging the right incentives. Instead of rewarding doctors
for ordering extra t e s t s and procedures, we w i l l reward doctors
and hospitals for making sure you stay healthy. Instead of
allowing drug companies to charge Americans three times the^
amount for drugs as they charge overseas, we w i l l demand f a i r
pricing. And instead of allowing individuals and companies who
don't purchase insurance to get a free ride, we w i l l demand that
they contribute.
We w i l l expand options for long-term care so that more
Americans — p a r t i c u l a r l y the elderly and those with d i s a b i l i t i e s
— can l i v e in their homes and communities while receiving care.
Reforming our health care system i s not only the best way to
reduce costs, rein in the d e f i c i t , and provide security for_
c i t i z e n s , i t ' s also the best way to cure an array of other i l l s
that plague our economy and threaten the s o c i a l fabric of our
nation.
Consider t h i s : I f health care costs had been held i n check
since 1980, states and l o c a l i t i e s would have been able to add 75
percent more funding to t h e i r public school budgets. Seventy-five
percent more. In f i s c a l 1993, states spent more on Medicaid than
on higher education. In fact, state spending on Medicaid i s
�expected to jump from $31 b i l l i o n i n 1990 to $81 b i l l i o n i n
1995.
Health care reform w i l l slow the d r a i n on your s t a t e budgets
by producing r e a l savings and helping you implement new programs
and i n f r a s t r u c t u r e .
I t w i l l help the p r i v a t e s e c t o r by boosting job c r e a t i o n and
o f f e r i n g a l e v e l p l a y i n g f i e l d to small businesses t h a t are
hardest h i t by u n f a i r p r i c i n g p r a c t i c e s i n the insurance markets
and by paperwork t h a t e a t s up t h e i r h e a l t h care d o l l a r s .
Reforming h e a l t h care w i l l a l s o be a c r i t i c a l f i r s t step i n
our e f f o r t to reward work over w e l f a r e . Right now, our h e a l t h
care and welfare systems are feeding o f f each other —
and
c o s t i n g your s t a t e s and our nation staggering sums of money.
When I was governor of Arkansas and we were working on the
Family Support Act i n 1988, the biggest b a r r i e r we faced i n
welfare reform was our own h e a l t h care system. Too many times, we
heard s t o r i e s of young mothers who proudly l e f t the w e l f a r e r o l l s
and took jobs — only to f i n d t h e i r employers provided no medical
coverage. One t r i p to the pharmacy for medicine they couldn't
a f f o r d , one expensive b i l l from the doctor was enough to s h a t t e r
t h e i r p r i d e and force them back onto the welfare r o l l s — where
at l e a s t they knew they would be covered.
With h e a l t h care reform we can begin to r e v e r s e the backward
i n c e n t i v e s i n our welfare system and get people back on the job.
F i n a l l y , reforming h e a l t h care w i l l help r e s t o r e our i d e a l s
of i n d i v i d u a l and c i v i c r e s p o n s i b i l i t y . We w i l l reward — not
p e n a l i z e — Americans who engage i n r e s p o n s i b l e behavior by
providing them with opportunities for a b e t t e r l i f e . And to those
who take advantage of the system and expect others to pay t h e i r
f a r e , we w i l l send a strong message: No more something f o r
nothing. No more f r e e r i d e .
I t ' s p a r t of the bargain. I n exchange for h e a l t h coverage,
people must take r e s p o n s i b i l i t y . No more something f o r nothing.
No more f r e e r i d e .
In the coming weeks and months, as we introduce s p e c i f i c
reforms, the s p e c i a l i n t e r e s t s w i l l t r y to c h i s e l away a t
elements of our plan. They w i l l say they support reform —
and
then w i l l take exception to one p a r t or another. They w i l l t a l k
about the need f o r change, and then w i l l r e s i s t any change t h a t
takes excess p r o f i t s out of t h e i r pockets.
Well l e t me suggest to the naysayers and c r i t i c s and s p e c i a l
i n t e r e s t s t h a t they consider the consequences of our doing
nothing. Consequences t h a t should be obvious.
�I f we do nothing, more and more people w i l l lose t h e i r
coverage, and those who don't w i l l pay much more f o r t h e i r
premiums. And t o cover a l l those uninsured and underinsured
Americans, s t a t e and l o c a l governments w i l l continue t o spend
b i l l i o n s of d o l l a r s and the r e s t of us w i l l pay higher p r i c e s a t
the doctor's o f f i c e , the h o s p i t a l and i n our businesses.
I f we do nothing, insurers w i l l continue t o d i c t a t e p r i c e s ,
charging whatever they want t o whomever they want. That w i l l mean
denying coverage t o someone who comes down w i t h an i l l n e s s , or
moves t o another c i t y or switches jobs.
I f we do nothing, insurance representatives and anonymous
bureaucrats w i l l keep peering i n t o every h o s p i t a l and doctor's
o f f i c e , second-guessing decisions and making h e a l t h care
professionals spend hours f i l l i n g out forms and jumping through
a d m i n i s t r a t i v e hoops.
I f we do nothing, p o l i c i n g the system against incompetence
w i l l be l e f t t o a flawed malpractice system t h a t rewards many
f r i v o l o u s claims and ignores thousands of l e g i t i m a t e ones.
Just how much w i l l doing nothing cost?
More than 60 cents of every new d o l l a r of f e d e r a l revenue
over the next f i v e years. A t h r e e f o l d increase i n s t a t e and l o c a l
spending by the end of the decade. Added costs of 12 t o 15
percent each year f o r large businesses, and 20 t o 30 percent f o r
small businesses. No wage increases f o r m i l l i o n s of workers. Not
to mention the most important t h i n g — more f e a r , anxiety and
i n s e c u r i t y on the p a r t of our c i t i z e n s .
When i t comes t o h e a l t h care, more of the same i s e x a c t l y
what Americans don't want.
Americans are asking f o r change. They are asking f o r reform.
They are asking f o r a c t i o n . That's why they e l e c t e d every one of
us i n t h i s room.
Already, i n a matter of months we have hurdled p a r t i s a n
road blocks and overcome years of g r i d l o c k i n Washington. We have
mapped a new d i r e c t i o n f o r our n a t i o n t h a t o f f e r s o p p o r t u n i t y i n
exchange f o r hard work and responsible c i t i z e n s h i p . We have
embarked on a program of r e - i n v e n t i n g government t h a t w i l l
streamline the f e d e r a l bureaucracy and save money. We have begun
to put our nation's economic house i n order.
With h e a l t h care reform, we can do even more. Americans are
not asking us t o r e - i n v e n t the wheel here. They are not asking us
t o s t a r t from scratch and b u i l d a whole new system. They are
simply asking us t o p r o t e c t the f i n e s t h e a l t h care system i n the
world — so t h a t we may also strengthen our economy, unburden
�state governments, re-invigorate American businesses and provide
security for our c i t i z e n s .
F i f t y years ago, we had the chance to change and we l e t i t
s l i p away. Twenty-five years ago, we had the chance to change and
we l e t i t s l i p away. Ten years ago, we had the chance to change
and we l e t i t s l i p away.
Now we have the chance again. Are we going to surrender to
special interests and p o l i t i c a l opportunists? Or w i l l we r i s e to
the challenge and ensure a healthy and prosperous future for the
next generation of Americans?
This time, we must be bold. This time, we must say: Let's
not l e t our chance s l i p away.
Thank you very much.
###
�REMARKS FOR NATIONAL ASSOCUTION OF CHAIN DRUG STORES
Good Morning Although I can't be there in person, I'm pleased to have this opportunity to speak with
you. I want to first acknowledge the work of the Commumty Retail Pharmacy Health
Care Reform Coalition formed earlier this year by the National Association of Chain
Drug Stores and the National Association of Retail Druggists. Led by Ron Ziegler and
Charlie West, the principles developed by the Coalition on behalf of these 62,000
community retail pharmacies and 112,000 community pharmacists have been especially
helpful to the Admimstration's effort to reform our health care system.
I also want to acknowledge the pharmacy educators who are in attendance today. The
contributions of pharmacy educators and retailers to a reformed health care system
become even greater when you work together.
Year after year, pharmacists are ranked the most trusted professionals. A recent survey
found that to be the case once again. Why is that? As you well know, its because the
local pharmacist is always available to help people take care of minor medical problems
and answer questions about medications; they are often the first to know that a patient is
not feeling well or is having a problem with their medications; they interact with
physicians to alert them to these problems, and help detect and avert medication
problems.
The pharmacist is the most accessible health care professional in the whole health care
system. And since pharmacists are too often underutilized in our health care system, the
President's plan calls for integrating pharmacy services as much as possible.
We know you're not to blame for the skyrocketing medication prices that have increased
three times the rate of inflation for the past twelve years ~ the manufacturers are. And
we know it's not the manufacturers who have to look into the eyes of an older customer
and explain that prices have gone up ~ again. You do. And recent data show that retail
pharmacists only make on average about 50 cents for each prescription that they
dispense. Over 70 percent of the cost of each prescription goes to the drug makers. The
rest goes to pharmacists, but they do not put that in their pockets. Most of it goes to
paying for salaries, rent and other costs of doing business. Pharmacy is certainly one of
the most efficient providers in the entire health care system.
So you who are on the front lines of health care know better than anyone else that
change is needed. The American health care system is the finest in the world for those
who can afford it, and we must protect that vigorously. But as fine as it is, there's a lot
that's wrong.
�We know that many local community pharmacists are getting hit from all sides: mail
order, dispensing physicians, and third party programs. While the drug industry is
racking up record-breaking profits year after year, the retail sector is just barely getting
by. Retail pharmacies, however, have to do a better job of selling its services to health
care plan administrators. The future of pharmacy lies in your ability to provide services,
not just drugs.
Under the President's health care reform package, we will level the playing field. We
recognize that many manufacturers don't offer you the same discounts that they offer to
other large purchasers. This has obviously put you and the patients you serve at a
disadvantage. To address this situation, we are developing policy approaches that ensure
that discounts are given for tme economic reasons, rather than just the class of trade the
purchaser represents. So it won't matter if you're an HMO, a pharmacy or a hospital; if
you produce the same economic advantages to the manufacturer, you will get the same
discount.
The President's plan will have a Medicare drug benefit and a universal prescription drug
program. This means more older Americans will be coming into your pharmacy to have
their medications needs met. We also want to recognize the value of pharmacists under
Medicare for their counseling.
Many will see health reform as a threat. For pharmacy, it is an opportunity.
Pharmacists are essential in controlling drug expenditures and assuring that patients
receive the best medicine at the lowest cost. I predict that health care plans will be
turning to pharmacists to help them manage their overall drug budgets.
In order to make reform happen ~ and to make reform successful ~ we need your help.
As trusted health professionals you are essential to this process. So let us join together
to support the changes we need for our businesses, for our communities and for our
country.
�/
I
E X E C U T I V E
O F F I C E
16-Aug-1993
OF
T H E
P R E S I D E
01:17pm
TO:
(See Below)
FROM:
J e f f r e y L. E l l e r
O f f i c e o f Media A f f a i r s
SUBJECT:
NGA t r a n s c r i p t
THE WHITE HOUSE
O f f i c e o f t h e Press S e c r e t a r y
(Tulsa, Oklahoma)
For Immediate Release
August 16, 1993
REMARKS BY THE PRESIDENT
TO THE OPENING PLENARY SESSION OF THE
85TH ANNUAL MEETING OF THE
NATIONAL GOVERNORS ASSOCIATION
Tulsa Convention Center
Tulsa, Oklahoma
10:50 A.M. CDT
THE PRESIDENT: Thank you v e r y much. Governor
Romer; Governor Campbell; our host Governor, Governor W a l t e r s .
I'm r e a l l y g l a d t o be here t o d a y . The l a s t t i m e t h e governors
met i n Oklahoma was i n 1981, r i g h t a f t e r I had j u s t become t h e
youngest former governor i n American h i s t o r y .
I've never been t o
an NGA meeting i n Oklahoma, so I would have showed up here even
i f you hadn't i n v i t e d me t o speak.
I want t o say t h a t H i l l a r y and I a r e b o t h v e r y g l a d
t o be here t o be w i t h you a g a i n . We're l o o k i n g f o r w a r d t o our
meeting a f t e r t h i s where we can t a l k about t h e h e a l t h care i s s u e
and o t h e r i s s u e s i n g r e a t e r d e t a i l . I t r e a s u r e t h e p a r t n e r s h i p
t h a t I have had w i t h so many o f you and which we a r e t r y i n g t o
develop and l i t e r a l l y imbed i n f e d e r a l p o l i c y t o d a y . I know t h a t
�you have already received an update on the progress t h a t we have
made together working on more r a p i d processing o f the governors'
waiver request i n many d i f f e r e n t areas and a number o f other
issues, which I hope w e ' l l be able t o t a l k more about l a t e r .
I know, too, t h a t the Vice President has already
been here and taken a l l my easy l i n e s away. He even t o l d you the
ashtray story, I know, yesterday — (laughter) — which I
understand Governor Richards said was one of those issues t h a t
her mother i n Waco could understand.
(Laughter.)
Today I come t o t a l k t o you about the issue of
health care. I would l i k e t o put i t i n t o some context. When I
became President i t was obvious t o me, based on j u s t the
announcements and evidence which had come i n t o play since the
November e l e c t i o n , t h a t the federal d e f i c i t was an even bigger
problem than I had previously thought, and t h a t unless we d i d
something about i t , we would not have the capacity t o deal w i t h
MORE
�- 2 the whole range of other issues — that forever, at least during
the term of my service we would be nibbled away at the edges in
trying to deal with health care reform, or defense conversion, or
welfare reform, or any other issue by the fact that we simply
were not in control of our own economic destiny.
And so we devoted the f i r s t several months of this
administration to trying to pass an economic plan that would
reduce the d e f i c i t by a record amount; that would have at least
as many spending cuts as new tax increases — in fact, we wound
up with more spending cuts — and that would give some incentives
where they were needed, particularly in the small business, in
the high-tech, and the new business area, to t r y to grow more
jobs for the American economy. That has, I believe, l a i d a very
good foundation for the future.
This morning I was reading in the morning newspapers
that long-term interest rates are now at a 20-year low, the
lowest they've been since 1973. And we have the basis now to
proceed on a whole range of other issues. When the Congress
�- 3 comes back next month, I b e l i e v e t h a t t h e Senate w i l l r a p i d l y
pass t h e n a t i o n a l s e r v i c e l e g i s l a t i o n , which many o f you are very
f a m i l i a r w i t h and which many o f you have supported.
I t w i l l pass
on a b i p a r t i s a n b a s i s and w i l l enable tens o f thousands o f our
young people t o earn c r e d i t f o r t h e i r c o l l e g e e d u c a t i o n by
s e r v i n g t h e i r communities a t home and s o l v i n g problems t h a t no
government can s o l v e alone.
We are w o r k i n g on defense c o n v e r s i o n i n i t i a t i v e s
from n o r t h e r n C a l i f o r n i a t o South C a r o l i n a and a t a l l p o i n t s i n
between. I hope we can do more on t h a t . We w i l l have a major
w e l f a r e r e f o r m i n i t i a t i v e coming up a t t h e f i r s t o f t h e year,
which I hope a l l o f you w i l l not o n l y s t r o n g l y support b u t w i l l
be a c t i v e p a r t i c i p a n t s i n , and meanwhile keep d o i n g what you're
d o i n g and a s k i n g f o r t h e waivers you t h i n k you need.
There i s now b e f o r e t h e Congress a crime b i l l , which
can have a b i g impact i n every s t a t e here, t h a t w i l l add 50,000
more p o l i c e o f f i c e r s on t h e s t r e e t , support i n n o v a t i o n s l i k e boot
camps f o r f i r s t o f f e n d e r s , h e l p us t o pass t h e Brady B i l l and
d e a l w i t h a number o f o t h e r issues f a c i n g us t h e r e .
There w i l l be i n i t i a t i v e s t o expand t h e economic
range o f Americans, As I know t h a t you a l l know now, and I wish
he c o u l d be here w i t h us today, our Trade Ambassador Mickey
Kantor s u c c e s s f u l l y concluded t h e NAFTA n e g o t i a t i o n s j u s t a few
days ago w i t h some h i s t o r i c — some h i s t o r i c p r o v i s i o n s never
b e f o r e found i n a t r a d e agreement anywhere, i n c l u d i n g t h e
agreement by t h e government o f Mexico t o t i e t h e i r minimum wages
t o p r o d u c t i v i t y and economic growth and t h e n t o make t h e i r
compliance w i t h t h a t t h e s u b j e c t o f a t r a d e agreement, which
means t h a t i t can be reviewed, t h a t i f t h e r e are v i o l a t i o n s t h e y
can be s u b j e c t t o f i n e , and, u l t i m a t e l y , t h e t r a d e s a n c t i o n s can
be imposed. N o t h i n g l i k e t h i s has ever been found i n a t r a d e
agreement b e f o r e . I t ensures t h a t workers on b o t h s i d e s o f our
b o r d e r can b e n e f i t . And I a p p r e c i a t e t h e support o f t h e
governors f o r t h e whole i s s u e o f expanding t r a d e . We are now i n
Europe t r y i n g t o get t h e GATT n e g o t i a t i o n s back on t r a c k , and I
hope we can do t h a t .
F i n a l l y , l e t me say t h e r e w i l l be a whole push
toward t h e end o f t h e year on a whole range o f p o l i t i c a l r e f o r m
i s s u e s . One o f t h e o t h e r House o f Congress have a l r e a d y passed a
campaign f i n a n c e r e f o r m b i l l , a lobby l i m i t a t i o n b i l l , and t h e
m o d i f i e d l i n e i t e m v e t o , which I know t h a t — I t h i n k t h a t 100
p e r c e n t o f you t h i n k t h a t t h e P r e s i d e n t ought t o have.
(Applause.)
I n a d d i t i o n t o t h a t , t h e V i c e P r e s i d e n t w i l l issue a
r e p o r t t o me v e r y s h o r t l y on t h e r e i n v e n t i n g government p r o j e c t ,
which he d i s c u s s e d w i t h you i n g r e a t d e t a i l y e s t e r d a y .
The o n l y
t h i n g I can t e l l you i s t h a t e v e r y t h i n g I ever s u s p i c i o n e d about
t h e way t h e f e d e r a l government operates t u r n e d out t o be t r u e ,
p l u s some. The a s h t r a y s t o r y i s o n l y i l l u s t r a t i v e .
�The fundamental problem i s not that there are bad
people in the federal government or that the payrolls have been
swollen by people who just want to pad them. That i s not true.
In fact, many of the federal agencies didn't grow at a l l in the
1980s. What has happened i s that for the last 60 years one thing
has been added on to another and people with the best of
intentions have just piled one more requirement on to the federal
government, and the fundamental systems that operate t h i s
government have gone unexamined for too long — whether i t ' s
personnel, or budgeting, or procurement. And we are trying to do
that in ways that I think would free up a lot of money and
improve the efficiency and service that the American people are
entitled to expect from a l l of us.
Now, having said a l l that, I want to make two
comments. I don't think that any of i t w i l l take American where
we need to go unless we also reform the health care system —
MORE
�- 4 which i s t h e b i g g e s t o u t s t a n d i n g c u l p r i t i n t h e f e d e r a l d e f i c i t
-- and i n p r o m o t i n g economic d i s l o c a t i o n s i n t h i s economy. And
secondly, I don't t h i n k we can do i t , unless we do i t on a
bipartisan basis.
(Applause.)
I never want t o go t h r o u g h another s i x months where
we have t o get a l l o f our v o t e s w i t h i n one p a r t y and where t h e
o t h e r p a r t y has people t h a t want t o v o t e w i t h us and t h e y f e e l
l i k e t h e y got t o s t a y — and t h e whole i s s u e r e v o l v e s around
process i n s t e a d o f p r o d u c t , p o l i t i c a l r h e t o r i c i n s t e a d o f
p e r s o n a l concern f o r what's g o i n g t o happen t o t h i s c o u n t r y .
There's p l e n t y o f blame t o go around — as f a r as I'm concerned
t h e r e w i l l be p l e n t y o f c r e d i t t o go around — I don't much care
who g e t s t h e c r e d i t f o r t h i s h e a l t h care r e f o r m as l o n g as we do
it.
But I am convinced that what t h i s nation r e a l l y
needs i s a v i t a l center; one committed to fundamental and
profound and r e l e n t l e s s and continuing change i n ways that are
c o n s i s t e n t with the b a s i c values of most Americans and that move
a l l of us along a path. And I don't think you can do i t unless
we can s i t down together and t a l k and work.
Many o f t h e s k i l l s which are h i g h l y p r i c e d among
you, b o t h i n your own s t a t e s where you serve and work w i t h people
who t h i n k d i f f e r e n t l y t h a n you do on some i s s u e s , who belong t o
d i f f e r e n t p a r t i e s t h a n you do, and t h e way you work around t h i s
t a b l e . Those s k i l l s are not o n l y not v e r y much p r i z e d , sometimes
t h e y ' r e a b s o l u t e l y demeaned i n t h e N a t i o n ' s C a p i t a l .
When we come here and we t r y t o work on something
l i k e we worked on t h e w e l f a r e r e f o r m b i l l i n 1988, we t a l k e d
about: How does t h i s r e a l l y work? How are people r e a l l y g o i n g
t o be a f f e c t e d by t h i s ? How can we d e a l w i t h our d i f f e r e n c e s o f
o p i n i o n and reach r e a l consensus t h a t r e p r e s e n t s p r i n c i p l e d
compromise? And how can we be judged n o t j u s t on what we say,
but on what we do?
Back East, where I work, consensus i s o f t e n t u r n e d
i n t o cave i n ; people who t r y t o work t o g e t h e r and l i s t e n t o one
another i n s t e a d o f beat each o t h e r up are accused o f b e i n g weak,
not s t r o n g . And t h e process i s a hundred t i m e s more i m p o r t a n t
t h a n t h e p r o d u c t . Beats a n y t h i n g I ever saw.
(Laughter,) And
the people t h a t r e a l l y score are t h e people t h a t l a y one good
l i c k on you i n t h e newspapar every day i n s t e a d o f t h e people t h a t
get up and go t o work, never care i f t h e y ' r e on t h e evening news,
never care i f t h e y ' r e i n t h e paper, and j u s t want t o make a
difference.
(Applause.)
And so I say to you, anything that you can do to
help me and the Congress to t r y to r e c r e a t e the mechanisms by
which you have to function i n order to do anything at the s t a t e
l e v e l , and by which we have worked together here to move forward
on a whole range of i s s u e s , I w i l l be g r a t e f u l f o r . This country
�has too many words and too few deeds on too many issues, and we
can do better than that.
Now, l e t ' s t a l k about the health care issue. We a l l
know what's r i g h t w i t h our h e a l t h care system. For those who
have access t o i t , i t i s the f i n e s t i n the world. Not only i n
terms o f the i n c r e d i b l e t e c h n o l o g i c a l advances, but i n terms o f
having choice o f our physicians, ready access t o h e a l t h care and
o v e r a l l high q u a l i t y t h a t l a s t s throughout a l i f e t i m e . We can
a l l be g r a t e f u l f o r t h a t .
My Secretary of Housing and Urban Development Henry
Cisneros and I were t a l k i n g the other day — h i s son j u s t had a
profoundly important and d i f f i c u l t operation. Just a few years
ago he was t o l d t h a t about a l l he could hope f o r f o r h i s boy was
a comfortable l i f e and eventually h i s time would run out,
probably sooner rather than l a t e r . And because o f the r e l e n t l e s s
MORE
�- 5 p r o g r e s s o f medical t e c h n o l o g y , h i s son now has a whole new
on l i f e .
lease
Nobody wants t o mess up what i s good w i t h American
h e a l t h care. We must p r e s e r v e i t and p r e s e r v e i t w i t h a
vengeance. But we a l s o know what i s not so good. We know t h a t
i n a w o r l d i n which we must compete f o r every j o b and a l l t h e
incomes we can, we are spending over 14 p e r c e n t o f our income on
h e a l t h care, and o n l y one o t h e r n a t i o n i n t h e w o r l d , Canada, i s
over 9 p e r c e n t . They're a t about 9.4 p e r c e n t . Our major
c o m p e t i t o r s i n t h e high-wage chase f o r t h e f u t u r e , Japan and
Germany, are down around 8 p e r c e n t . So t h e y ' r e a t 8 p e r c e n t and
we're a t 14 p e r c e n t .
More t r o u b l i n g , i f we don't do a n y t h i n g t o r e v e r s e
t h e b a s i c t r e n d s t h a t are now r i f l i n g t h r o u g h our system, by t h e
end o f t h i s decade w e ' l l be a t 19 p e r c e n t o f GDP on h e a l t h care.
No one e l s e w i l l be over 10 p e r c e n t , and w e ' l l be b a s i c a l l y
s p o t t i n g our c o m p e t i t o r s 9 cents on t h e d o l l a r i n every avenue o f
economic endeavor. I don't t h i n k t h a t i s something t h a t ' s r i g h t .
We know t h a t t h i s p l a c e s enormous p r e s s u r e on
businesses.
I ' l l come back t o some o f t h e comments made by Mr.
M o t l e y * along toward t h e end o f my remarks, b u t t h e t r u t h i s t h a t
about 100,000 Americans a month are l o s i n g t h e i r h e a l t h insurance
because t h e y ' r e employers can no l o n g e r a f f o r d t o c a r r y i t under
the p r e s e n t system we have, and o t h e r s , h o l d i n g on f o r dear l i f e ,
are never g i v i n g t h e i r employees pay r a i s e s . And i t i s
e s t i m a t e d , unless we do something about t h i s system, t h a t t h e
i n c r e a s e d cost o f h e a l t h care between now and t h e end o f t h e
decade w i l l l i t e r a l l y absorb a l l o f t h e money t h a t might
o t h e r w i s e be a v a i l a b l e i n t h i s economy t o r a i s e t h e s a l a r i e s o f
our w o r k i n g people.
We see employers u n e q u a l l y t r e a t e d by t h e c r u e l hand
o f t h e system t h a t we have. We know now we are spending f a r more
money, about a dime on t h e d o l l a r p r o b a b l y , a d m i n i s t r a t i v e l y j u s t
on paperwork, pushing paper around, t h a n any o f our c o m p e t i t o r s
are.
A decade ago, t h e average d o c t o r took home about 75 cents
on t h e d o l l a r t h a t came i n t o t h e c l i n i c .
Today t h a t ' s down t o 52
cents on t h e d o l l a r -- i n o n l y 10 years — because we are awash
i n paperwork imposed, a, by t h e government, and, b, f o r t h e f a c t
t h a t o n l y t h e U n i t e d S t a t e s has 1,500 separate h e a l t h insurance
companies, w r i t i n g thousands and thousands o f d i f f e r e n t p o l i c i e s .
I have a d o c t o r f r i e n d i n Washington who r e c e n t l y
h i r e d somebody not even t o do paperwork, b u t j u s t t o s t a y on t h e
phone t o c a l l i n s u r a n c e companies every day t o beat them up t o
pay what has a l r e a d y been covered — money r i g h t out o f t h e
pockets o f t h e nurses t h a t work i n h i s c l i n i c . And t h e r e ' s a
s t o r y l i k e t h a t i n every h e a l t h care e s t a b l i s h m e n t i n America
today.
We know we s t i l l have almost 40 m i l l i o n people
u n i n s u r e d , and more every month, not fewer. We know t h a t s t a t e
�governments are l i t e r a l l y being bankrupt by the r i s i n g costs of
Medicaid, money t h a t used t o go t o education, money t h a t used t o
go t o economic development, money t h a t could have gone t o law
enforcement going every year j u s t shoveling out the door not f o r
new health care, more money f o r the same health care. And even
when we c o n t r o l the p r i c e of c e r t a i n things, t h a t extra
u t i l i z a t i o n or more people coming i n t o the system, because t h e
r e s t of i t i s broken down are d r i v i n g the costs up.
We know that there are s t i l l serious access problems
and we know, as I said, that the federal d e f i c i t i s i n t e r r i b l e
shape because of health care. I f you look at t h i s budget the
Congress just adopted, defense goes down, discretionary spending
i s f l a t . That means we spend more money on defense conversion,
on Head Start, on pregnant women, on a few other things — every
dollar that we spend more on that something else was cut. The
only thing that's going up are the retirement programs — and
MORE
�- 6 S o c i a l S e c u r i t y taxes produced a $60 b i l l i o n s u r p l u s f o r us even
w i t h t h e cost o f l i v i n g allowances — and h e a l t h c a r e . E v e r y t h i n g
e l s e i s e i t h e r f l a t or down.
And under a l l s c e n a r i o s proposed by a l l people who
p r e s e n t e d any budgets l a s t year, t h e d e f i c i t went down f o r f o u r
years and then s t a r t e d going up again because o f h e a l t h c a r e . So
t h e o n l y way we can keep our commitments, you and I , t o t h e
American people t o r e s t o r e r e a l c o n t r o l over t h i s budget i s t o do
something about h e a l t h care.
Now, I would argue t h a t i f you know you've g o t a
l i s t o f what's r i g h t and you know you've g o t a l i s t o f what's
wrong, and what's wrong i s going t o e v e n t u a l l y consume what's
r i g h t , you cannot c o n t i n u e t o do n o t h i n g . And I don't t h i n k most
people want t o c o n t i n u e t o do n o t h i n g .
I want t o thank t h e NGA and e s p e c i a l l y t h e governors
who have worked w i t h us t h r o u g h o u t t h i s process.
Many o f you
have met w i t h t h e F i r s t Lady and I r a Magaziner and t h e people
t h a t — l i t e r a l l y hundreds and hundreds o f people who have worked
w i t h them on a b i p a r t i s a n b a s i s t o t r y t o c r a f t a h e a l t h care
r e f o r m package t h a t w i l l ensure t h a t t h e s t a t e s a r e r e a l p a r t n e r s
i n our e f f o r t s t o p r e s e r v e q u a l i t y , cover everyone, c o n t r o l
c o s t s , and enable t h e s t a t e s and t h e f e d e r a l government t o r e g a i n
some c o n t r o l over t h e i r f i n a n c i a l f u t u r e s .
No one embodied t h a t s p i r i t o f b i p a r t i s a n s h i p on
t h i s i s s u e more t h a n our l a t e f r i e n d , George M i c k e l s o n .
And I
j u s t want t o t a k e a work here t o say how v e r y much I a p p r e c i a t e d
him as a f r i e n d , as a governor, and as someone who had t h e s o r t
of s p i r i t t h a t i f i t c o u l d embrace t h i s c o u n t r y on t h i s i s s u e , we
c o u l d s o l v e t h i s problem i n good f a i t h .
(Applause.)
The n a t i o n a l government has a l o t t o l e a r n from t h e
s t a t e s i n t h e tough d e c i s i o n s t h a t some o f you have made a l r e a d y .
I can h o n e s t l y say t h a t along toward t h e end o f my t e n u r e as
Governor, t h e most f r u s t r a t i n g p a r t o f t h e j o b was s i m p l y w r i t i n g
b i g g e r checks every year f o r t h e same Medicaid program, when I
d i d n ' t have t h e money t h a t a l l o f us wanted t o spend on e d u c a t i o n
and economic development and t h e o t h e r i m p o r t a n t issues b e f o r e
us.
There have been phenomenally i m p o r t a n t c o n t r i b u t i o n s
made t o t h i s debate a l r t a d y by t h e governors o f many s t a t e s i n
both p a r t i e s .
I won't mention one, f i v e o r t e n f o r f e a r I ' l l
leave o u t someone I s h o u l d have mentioned, b u t l e t me say t h a t I
am v e r y g r a t e f u l t o a l l o f you f o r t h e work t h a t you have a l r e a d y
done. I a l s o want t o say a s p e c i a l word o f r e g r e t about t h e
absence here o f t h e Governor from my home s t a t e , Jim Guy Tucker,
who h i m s e l f has been g e t t i n g some w o r l d - c l a s s medical c a r e . And
I t a l k e d t o him l a s t n i g h t ; he's f e e l i n g q u i t e w e l l and he
promises t o be a t t h e next meeting.
�But a l l o f you have a r o l e t o play i n what we're
about t o do. Over the l a s t eight months, I've met w i t h many of
you personally i n Washington; many of you have l e n t your s t a f f s
to the e f f o r t s t h a t we're making on health care reform, and we've
learned c l e a r l y t h a t what works i n North Dakota may not work i n
New York. Just yesterday, your Executive Committee pledged t o
support health care reform w i t h i n a comprehensive f e d e r a l
framework t h a t guarantees u n i v e r s a l coverage and c o n t r o l s costs.
We w i l l work w i t h the states t o phase i n reform, and we w i l l help
you t o work out problems as they a r i s e . And we have t o have an
honest discussion about what t h a t framework ought t o look l i k e .
I want today t o t e l l you what I t h i n k we should do.
Next month I w i l l o u t l i n e a plan t o Congress t h a t w i l l o f f e r r e a l
hope f o r a l l Americans who want t o work and take r e s p o n s i b i l i t y
and create o p p o r t u n i t i e s f o r themselves and t h e i r c h i l d r e n . I
t h i n k the elements of t h a t plan ought t o be as f o l l o w s :
MORE
�- 7 One, we've got to provide health care security to
people who don't have i t . That means not just those who don't
have health insurance coverage now, but those who are at risk of
losing i t . I don't know how many people I met l a s t year a l l over
t h i s country, a l l kinds of people, who knew they would never be
able to change jobs again because someone in their family had
been sick. I don't know how many other people I met who couldn't
afford their health insurance package because there was someone
in their job unit that they needed to get r i d of in order to be
able to afford i t . We have got to have a system of universal
coverage that provides security to Americans.
Second, I think we have to have a system of managed
care that maintains the private sector, organizes Americans in
health alliances operated within each state, contains significant
new incentives for prevention and for wellness and against
overutilization, and that has a budget so that the competition
forces should keep things within the budget, but, ultimately,
especially in the early years, there must be some l i m i t , I w i l l
say again, i f we don't change this, we're going to go from 14 to
19 percent of our income going to health care by the end of the
decade. I t i s going to be very d i f f i c u l t for us to compete and
win in the global economy with that sort of d i f f e r e n t i a l .
Second — third, excuse me — there must be
insurance reform. There has to be a basic package of benefits.
There needs to be community rating. There has to be some
opportunity — I heard Governor Wilson talking about this before
I came out — for pooling for small employers. We cannot permit
price d i f f e r e n t i a l s that exist today to get worse instead of
better simply because of the size of the work units.
F i n a l l y , in t h i s connection, i f we do these things,
there w i l l be massive cuts in paperwork because you won't have to
have every health unit in this country trying to keep up with
thousands of different options and a l l the myriad complexities
that flow from that. We won't have another decade when c l e r i c a l
employment in the health care area goes four times faster than
health care providers. No one believes that that i s a very sound
investment in our nation's future.
Next, we have to have significant — significant
increases, not decreases in investment and research and
technology.
Next, in my judgment, we should attempt to take the
health care costs of the workers comp system and the auto
insurance system into t h i s reform. That might be the biggest
thing we could do for small businesses. I t would also perhaps be
the biggest thing we could do to reduce some of the inequalities
— some of you might not l i k e t h i s , and others would love i t
— b u t the inequalities in economic incentives that various states
can offer because of dramatic differences in works comp costs
from state to state, occasioned more than anything else by the
�h e a l t h care burden o f workers comp.
Next, I t h i n k t h a t we should have 100 percent t a x
d e d u c t i b i l i t y , not 25 percent t a x d e d u c t i b i l i t y , f o r
self-employed people. And t h a t w i l l be a part of the plan we
w i l l o f f e r t o Congress — something t h a t w i l l increase the
capacity of people who are self-employed t o maintain h e a l t h
insurance, whether they're farmers or independent businesspeople.
F i n a l l y , I t h i n k the states must have a strong r o l e
and e s s e n t i a l l y be charged w i t h the r e s p o n s i b i l i t y and given the
opportunity t o organize and e s t a b l i s h the health groups of people
who w i l l be able t o purchase health care under the managed care
system.
I t h i n k we should expand options f o r people of low
incomes on Medicare but not poor enough t o be on Medicaid t o get
a p r e s c r i p t i o n drug b e n e f i t phased i n over a period of years.
MORE
�- 8 S i m i l a r l y , I t h i n k we must do the same t h i n g w i t h long-term care.
But as we provide more long-term care opportunities f o r the
e l d e r l y and f o r persons w i t h d i s a b i l i t i e s , we must also expand
the option so t h a t they can get the least cost, most appropriate
care. We must remove the i n s t i t u t i o n a l i z e d biases t h a t are i n
the system now which keep a l o t of people from having access t o
home care, f o r example.
And f i n a l l y , I t h i n k there has t o be some
r e s p o n s i b i l i t y i n t h i s system f o r everyone. There are a l o t of
people today t h a t get a free r i d e out of the present system who
can a f f o r d t o pay something, I t h i n k there should be i n d i v i d u a l
r e s p o n s i b i l i t y , I t h i n k every American should know t h a t health
care i s not something paid f o r by the t o o t h f a i r y , t h a t there i s
no free r i d e , t h a t people should understand t h a t t h i s system
costs a l o t of money — i t should cost a l o t of money, i t ought
t o be the world's best, but we should a l l be acutely aware of the
cost each of us impose on i t .
But I also believe t h a t i n order t o make i n d i v i d u a l
r e s p o n s i b i l i t y meaningful and i n order t o c o n t r o l the cost of
t h i s system, there has to be some means of achieving universal
coverage. I f you don't achieve universal coverage, i n my
judgment, you w i l l not be able t o c o n t r o l the costs adequately.
Why? Well, f o r one t h i n g , you w i l l continue to have cost
s h i f t i n g . I f you have uncompensated care, the people who give i t
w i l l s h i f t the cost t o the p r i v a t e sector or t o the government.
And t h a t w i l l create s i g n i f i c a n t economic d i s l o c a t i o n s .
Now, i t seems t o me we have four options.
I f you
believe -- you have t o decide — i f you believe everybody should
be covered, you have only four options. And I would argue t h a t
three of them are not, at least based on what I have seen and
heard, very good options i n p r a c t i c e as opposed t o i n theory.
Option number one i s to go t o a single-payer system,
l i k e the Canadians do, because i t has the least administrative
cost. That would require us t o replace over $500 b i l l i o n i n
p r i v a t e insurance premiums w i t h nearly t h a t much i n new taxes. I
don't t h i n k t h a t ' s a p r a c t i c a l option. I don't t h i n k t h a t i s
going t o happen. And you t a l k about — t h a t would be
s i g n i f i c a n t l y d i s l o c a t i n g i n the sense t h a t overnight, i n a
nation t h i s size, you'd have a l l the people who are i n the
insurance business out of i t unless they were i n the business of
managing the health c a r t plans themselves, as more and more are
doing.
Option number two would be t o have an i n d i v i d u a l
mandate rather than a mandate t h a t applies t o employers and t o
employees, saying t h a t every i n d i v i d u a l ' s got t o buy health
insurance and here are some insurance reforms t o make sure you
can get i t . This approach has found some favor i n the United
States Congress, p r i m a r i l y among Republicans, but not
e x c l u s i v e l y , because i t has the appeal of not imposing a business
�mandate which has a bad sound t o i t .
Here's the problem w i t h t h a t , i t seems t o me. I f
you have an i n d i v i d u a l mandate, on whom i s i t imposed? And don't
you have t o give some subsidy t o low-income workers, j u s t the way
y o u ' l l have t o give some subsidy t o low-income businesses i f
there's an employer mandate Who gets i t and who doesn't? And i f
you impose an i n d i v i d u a l mandate, what i s t o stop every other
employer i n America from j u s t dumping h i s employees or her
employees, t o have a sweeping and extremely d i s l o c a t i n g set of —
a chain of events s t a r t ?
So i t seems t o me t h a t there are a l o t o f questions
t h a t have t o be asked and answered before we could embrace the
concept of an i n d i v i d u a l mandate.
The t h i r d t h i n g you could do i s not worry about i t .
You could j u s t say, w e l l , w e ' l l have a l l these other reforms and
MORE
�- 9j u s t hope t h a t everybody, i f you could lower the cost o f
insurance and s i m p l i f y t h e premiums and have b i g pools, t h a t
sooner or l a t e r somehow everybody w i l l be covered.
The problem i s t h a t there i s a l o t of evidence t h a t
some people w i l l s t i l l seek a free r i d e . And make no mistake
about i t , people t h a t never see themselves as free r i d e r s s t i l l
r i d e the system, because everybody i n t h i s country who needs
h e a l t h care eventually gets i t . I t may be too l a t e , i t may be
too expensive. But i f someone who works i n a workplace where
there i s no insurance has a c h i l d t h a t gets h i t i n a car wreck or
j u s t gets sick or has an acute appendix or something happens,
t h e y ' l l get health care. And t h a t w i l l be paid f o r by someone
else.
And, indeed, even f o r the employers and employees
t h a t may go a whole year and never use the health care system,
i t ' s there w a i t i n g f o r them. I t ' s an i n f r a s t r u c t u r e j u s t as much
as the i n t e r s t a t e highway system i s . Every medical c l i n i c , every
h o s p i t a l , every nursing home, a l l these things are the health
care i n f r a s t r u c t u r e of the country a l l being paid f o r by someone
else, but s t i l l a v a i l a b l e t o be used f o r those f o l k s .
So I don't t h i n k we can r a t i o n a l l y expect t o stop
cost s h i f t i n g or t o have a f a i r system i f we say we're going t o
organized a l l t h i s and j u s t hope everybody w i l l get i n t o i t . That
leaves the f o u r t h a l t e r n a t i v e which i s t o b u i l d on the system we
now have. The system we now have works f o r most Americans. Most
Americans are insured under a system i n which employers pay f o r
part of the health insurance and employees pay f o r part of the
h e a l t h insurance, and i t ' s worked p r e t t y w e l l f o r them except f o r
the laundry l i s t of problems t h a t we t a l k e d about.
But most Americans are covered under i t . What are
the problems w i t h doing t h i s ? Well, f i r s t of a l l , i f you j u s t
passed an employer mandate and d i d nothing else, there would be a
ton of problems i n doing i t , because the most vulnerable
businesses would have the highest premiums and a bunch of them
would r e a l l y be i n deep t r o u b l e . No one proposes t o do t h a t .
In other words, an employer mandate i t s e l f would not
be responsible unless you also had s i g n i f i c a n t insurance reforms,
a long period of phase-in, and a l i m i t a t i o n on how much the
premium could be f o r very small businesses or businesses w i t h
very low-wage workers t h a t obviously are operating on narrow
p r o f i t margins.
But I would argue t o you t h a t based on my analysis
of t h i s — and I've been t h i n k i n g about t h i s s e r i o u s l y now f o r
more than three years, ever since the Governors Association asked
me and the Governor of — the then Governor of Delaware, now a
Congressman from Delaware t o look at the health issue. And I
have thought about i t and thought about i t . There may be some
other issue, but I see only those four options f o r dealing w i t h
�t h i s . And i t seems to me the shared responsibility i n a f a i r way
of employer and employee, building on the system we have now
which works — taking proper account of the need to phase i t in
and to maintain limits on lower-income and lower-wage employment
units -- i s the f a i r e s t way to go.
Now, i t seems to me that a l l this w i l l be discussed
and debated in the Congress; the governors w i l l be a part of i t .
The f i r s t decision we have to make i s whether we can fool around
with this for another ten or 20 years or whether the time has
come to act. Just consider this one fact: I f health care costs
had been held in check — that i s to inflation plus growth
--since 1980, state and local governments would have, on average,
75 percent more funding for public school budgets. In 1993,
f i s c a l year 1993, states spent more on Medicaid than on higher
education for the f i r s t time. And state spending on Medicaid i s
MORE
�- 10 expected t o jump from $31 b i l l i o n
i f we don't change t h i s system.
i n 1990
t o $81 b i l l i o n
in
1995
I b e l i e v e t h a t h e a l t h care r e f o r m w i l l boost j o b
c r e a t i o n i n t h e p r i v a t e s e c t o r i f i t i s done r i g h t .
I believe i t
w i l l o f f e r a l e v e l p l a y i n g f i e l d t o a l l those s m a l l employers who
are c o v e r i n g t h e i r employees r i g h t now and p a y i n g t o o much f o r
it.
I b e l i e v e i t w i l l be a c r i t i c a l f i r s t s t e p i n r e w a r d i n g work
over w e l f a r e .
When we d i d t h e f a m i l y support a c t i n 1988, those o f
you who were here t h e n w i l l a l l remember what a l l o f us
concluded.
And t h e Governor o f South C a r o l i n a , s i n c e he had once
been t h e r a n k i n g member o f t h e a p p r o p r i a t e subcommittee on t h e
House Ways and Means Committee, p l a y e d as b i g a r o l e i n
u n d e r s t a n d i n g t h i s as anybody e l s e — t h a t a l o t o f people stayed
on w e l f a r e not because o f t h e b e n e f i t s , because t h e b e n e f i t s had
not kept up w i t h i n f l a t i o n ; t h e y d i d i t because t h e y c o u l d n ' t
a f f o r d c h i l d care f o r t h e i r k i d s and because t h e y were g o i n g t o
l o s e h e a l t h insurance f o r t h e i r c h i l d r e n .
We have gone a l o n g way, I t h i n k , toward r e d u c i n g
i n c e n t i v e s t o s t a y on w e l f a r e w i t h t h i s new economic p l a n ,
because t h e earned income t a x c r e d i t has i n c r e a s e d so much t h a t
now people t h a t work 4 0 hours a week and have c h i l d r e n i n t h e
home w i l l be l i f t e d above t h e p o v e r t y l e v e l . That was t h e most
major p i e c e o f economic s o c i a l r e f o r m i n t h e l a s t 20 years.
But
we s t i l l have t o d e a l w i t h t h e h e a l t h care i s s u e ,
I r e c e n t l y had a v e r y sad c o n v e r s a t i o n w i t h a woman
who became a f r i e n d o f mine i n t h e campaign who was a d i v o r c e d
mother o f seven c h i l d r e n and her youngest c h i l d had a h o r r i b l e ,
h o r r i b l e and v e r y expensive h e a l t h care c o n d i t i o n . The o n l y way
she c o u l d get any h e a l t h care f o r t h i s k i d was t o q u i t a j o b
where she was making $50,000 a year, p r o u d l y s u p p o r t i n g these
c h i l d r e n , t o go on p u b l i c a s s i s t a n c e so she c o u l d get Medicaid t o
t a k e care o f her c h i l d . And t h e young c h i l d j u s t r e c e n t l y passed
away. And so I c a l l e d and t a l k e d t o t h e woman and I was t h i n k i n g
about t h e i n c r e d i b l e t r a v a i l t h a t she had gone t h r o u g h , and
wondering i f now she would ever be a b l e t o get another j o b making
t h a t k i n d o f money t o support her remaining c h i l d r e n and t o
r e s t o r e her sense o f d i g n i t y and empowerment.
Let me say one l a s t t h i n g about t h i s .
I t h i n k i f we
do t h i s r i g h t i t w i l l r e s t o r e our sense o f i n d i v i d u a l and common
responsibility,
I w i l l say a g a i n , I do not b e l i e v e anybody
s h o u l d get a f r e e r i d e i n t h i s d e a l . I t h i n k we have a l l , a t
l e a s t I've been p a r t o f i t , have made a mistake i n t r y i n g t o say
t h a t people s h o u l d pay a b s o l u t e l y n o t h i n g f o r t h e i r h e a l t h care
i f t h e y c o u l d a f f o r d t o pay something. People ought t o pay i n
p r o p o r t i o n t o what they can a f f o r d t o . But I t h i n k t h a t t h e
system we have i s so r i d d l e d w i t h those who don't have any
r e s p o n s i b i l i t y a t a l l t h a t i t i s chock f u l l o f l o o p h o l e s .
�And l e t me say again, everybody who says, w e l l , t h i s
i s j u s t too complicated and i t ' s too much trouble and i t ' s too
hard t o t h i n k about, ought t o consider the consequences of doing
nothing. Doing nothing means more people lose t h e i r coverage.
And those who don't w i l l pay too much f o r t h e i r coverage. Doing
nothing means t h a t a l l those uninsured and underinsured Americans
w i l l be covered by vast outlays by state, l o c a l and f e d e r a l
governments. The rest of us w i l l pay more at the doctor's
o f f i c e , the h o s p i t a l and our own businesses. Doing nothing means
insurers w i l l continue t o be able t o charge prices t h a t are too
high t o those who don't have the good fortune of being i n very
large buying cooperatives, and t h a t the paperwork burden of the
t h i s system, I w i l l say again, w i l l continue t o be a dime on the
d o l l a r more than any other country i n the world. We cannot
sustain t h a t s o r t of waste and i n e f f i c i e n c y .
(Applause.)
More than 60 cents of every new dollar going to the
federal Treasury over the next five years under our reduced
MORE
�- 11 budget w i l l go t o h e a l t h care — a f t e r we had a $54 b i l l i o n
r e d u c t i o n i n Medicare and Medicaid expenses over t h e e s t i m a t e d
cost o f t h e p r e v i o u s budget — 12 t o 15 percent added c o s t s every
year f o r l a r g e businesses; 20 t o 30 p e r c e n t f o r s m a l l businesses;
no wage i n c r e a s e s f o r m i l l i o n s , indeed tens o f m i l l i o n s o f
workers; and c o n t i n u e d f e a r and i n s e c u r i t y . P o l i c i n g t h e system
a g a i n s t incompetence w i l l be l e f t t o a flawed system o f
b u r e a u c r a t s , o f insurance o v e r s i g h t and m a l p r a c t i c e t h a t rewards
t h i n g s t h a t don't deserve t o be rewarded and i g n o r e s l e g i t i m a t e
problems.
Now, l e t me t a l k about t h i s jobs i s s u e one more
t i m e . I f you j u s t imposed a mandate and d i d n o t h i n g e l s e , would
i t c o s t jobs? Yes, i t would. Any study can show t h a t . That i s
not what we propose. I f you r e f o r m t h e insurance system and a l l
these b i g employers t h a t are p a y i n g way t o o much now, and a l l
these s m a l l employers t h a t are p a y i n g way t o o much now, wind up
w i t h r e d u c t i o n s or no i n c r e a s e s i n t h e years ahead, t h a t i s more
money t h e y ' r e g o i n g t o have t o i n v e s t i n c r e a t i n g new jobs i n t h e
private sector.
(Applause.)
I f you r e f o r m t h e insurance system, you phase i n t h e
r e q u i r e m e n t s , and you l i m i t t h e amount o f p a y r o l l t h a t someone
can be r e q u i r e d t o put out i n an insurance premium, you're going
t o l i m i t t h e j o b l o s s on t h e downside w h i l e you're i n c r e a s i n g i t
d r a m a t i c a l l y on t h e u p s i d e .
I f you reduce t h e paperwork burdens, yes, you won't
have t h i s huge growth i n people d o i n g c l e r i c a l works i n d o c t o r s
o f f i c e s and h o s p i t a l s and i n insurance o f f i c e s . But you w i l l
have more people g o i n g i n t o o l d f o l k s ' homes and g i v i n g them good
p e r s o n a l h e a l t h care, t r y i n g t o keep them a l i v e i n ways t h a t are
more l a b o r i n t e n s i v e b u t l e s s expensive.
So t h e r e w i l l be s h i f t s
here.
But who can say, i f you t r u s t , i f you t r u s t t h e
p r i v a t e s e c t o r t o a l l o c a t e c a p i t a l i n ways t h a t w i l l make America
most c o m p e t i t i v e and t o t a k e advantage o f lower h e a l t h care costs
by r e i n v e s t i n g i t i n t h i s economy, who c o u l d p o s s i b l y say t h a t i f
we move c l o s e r t o t h e i n t e r n a t i o n a l average i n t h e percentage o f
our income g o i n g t o h e a l t h care, i t wouldn't l e a d t o more
p r o d u c t i v e investment and more jobs i n America? I t h i n k t h a t i s
c l e a r l y what would happen.
(Applause.)
We have focused t h i s debate o n l y on t h e m i n o r i t y o f
people who don't have h e a l t h insurance and don't cover t h e i r
employees and assume t h a t we would l a y some mandate on them and
make no o t h e r s t r u c t u r a l changes. I wouldn't be f o r t h a t .
You
c o u l d n ' t be f o r t h a t , a l t h o u g h a t l e a s t t h a t would s t o p t h e c o s t
shifting.
I t would not be enough. That i s not what we propose.
But i f you do t h i s r i g h t and we phase i t i n so t h a t as we d e a l
w i t h problems, we f i n d them we can c o r r e c t them, i f t h e s t a t e s
are d e a l i n g w i t h t h e management s i d e o f t h i s t h r o u g h these h e a l t h
a l l i a n c e s , we can make t h i s work.
�I t j u s t defies common sense t o say t h a t we can't
maintain the world's f i n e s t -health care system, stop a l l t h i s
cost s h i f t i n g , b r i n g our costs back at some competitive l e v e l ,
cover everybody and create jobs. We'll s t i l l — no matter what
happens w e ' l l be spending a l o t more than any other country on
h e a l t h care at the end of the decade. But w e ' l l be p r o t e c t i n g
people, and w e ' l l be working w i t h them,
I'm convinced t h a t the biggest problem we've got
r i g h t now i s the fear of the unknown and the exaggeration i n t o
the unknown of what, i n f a c t , i s already known. To say t h a t
we're t a l k i n g about some u n t r i e d , untested t h i n g ignores the
experience of Hawaii, ignores the experience of every other
country t h a t we're competing w i t h , ignores what we know about how
our p r i v a t e sector could a c t u a l l y manage the problem b e t t e r i n
some ways than Germany and Japan have managed i t , and b a s i c a l l y ,
i s rooted i n somehcw our lack of b e l i e f t h a t we can overcome a l l
MORE
�- 12 the i d e o l o g i c a l divides and the r h e t o r i c a l barbs and the fears
t h a t are g r i p p i n g us.
So I w i l l say again, I don't pretend t o have a l l the
answers, but I am absolutely sure t h i s i s the problem t h a t
America cannot l e t go, t h a t we cannot walk away from. And I am
absolutely convinced t h a t we can solve i t i f we can meet around a
t a b l e without regard t o party and l i s t e n t o the f a c t s and work
through i t . I am convinced of t h a t .
I want t o close by t e l l i n g you a s t o r y . When the
Pope came t o Denver, and I was given the opportunity t o go out
there and meet him and have a p r i v a t e audience t h a t I w i l l
remember and cherish f o r the rest of my l i f e , we arranged f o r a
young g i r l t o come there and j u s t stand i n the audience. And a l l
she d i d was have the Pope put h i s hand on her head and say a word
of blessing. This c h i l d i s 13 years old.
She's from Wisconsin.
Her f a t h e r we met i n the course of the campaign. She was born
w i t h a rare bone disease which caused the bones i n her body t o
break continuously so t h a t by the time she a c t u a l l y came out of
her mother's womb she had already had about more than a dozen
bones break i n her body.
Just a few years ago anybody l i k e t h a t could never
have grown up and had anything l i k e a normal l i f e . They j u s t
would have been helpless, j u s t c o n t i n u a l l y crumbling. Now, t h i s
g i r l has gone t o the National I n s t i t u t e o f Health every three
months f o r her e n t i r e l i f e . And even though she's j u s t 13 years
old, i f she were here t a l k i n g t o you, she would speak w i t h the
presence, the m a t u r i t y , the command o f someone more than twice
her age. And she looks a l i t t l e d i f f e r e n t because the bones i n
her s k u l l have broken, the bones i n her legs have broken, t h e
bones i n her back have broken. But she can walk and she can
f u n c t i o n and she can go t o school. And even though she's only
four feet t a l l and weighs only 60 pounds, she can f u n c t i o n .
And she asked her father t o take her t o Iowa so she
could help people i n Iowa t o f i g h t the f l o o d . And she went t o
Iowa and loaded sand i n the sandbags, knowing t h a t any one o f
those bags could have broken her l e g above the knee, could have
put her away f o r a year. She said, I cannot l i v e i n a c l o s e t .
This i s something t h a t ' s there. I want t o l i v e . I want t o do my
life.
I want t o do what other people do.
And I was u overcome by i t — I brought the g i r l t o
see me and then we j u s t q u i e t l y arranged f o r her t o be there when
the Pope was there. I say t h a t t o make t h i s p o i n t . I asked her
why i n the world she would have done t h a t — why she would have
r i s k e d l i t e r a l l y breaking her body apart t o be there w i l l a l l
these big, husky college kids f i g h t i n g t h i s f l o o d . And she said,
"Because I want t o l i v e . And i t ' s there, and I have t o go on. I
have t o do t h i n g s , "
I f a child l i k e that can do something l i k e that.
�surely t o goodness, we can stop wringing our hands and r o l l up
our sleeves and solve t h i s problem. And surely we can do i t
without the kind o f r h e t o r i c and a i r - f i l l i n g b u l l t h a t we hear so
o f t e n i n the Nation's C a p i t a l , We can do i t , (Applause,)
I miss you, I miss t h i s . I miss the way we make
decisions, I miss the sort o f heart and soul and f a b r i c o f l i f e
t h a t was a p a r t of every day when I got up and went t o work i n a
state c a p i t a l . Somehow we've got t o b r i n g t h a t back t o
Washington.
Think about t h a t l i t t l e g i r l and help us solve t h i s
health care problem.
Thank you,
(Applause.)
END11:36 A.M. CDT
Distribution:
MORE
�E X E C U T I V E
O F F I C E
OF
16-Aug-1993
01:17pm
TO:
(See Below)
FROM:
J e f f r e y L. E l l e r
O f f i c e o f Media A f f a i r s
SUBJECT:
NGA t r a n s c r i p t
T H E
P R E S I D E
THE WHITE HOUSE
O f f i c e o f t h e Press S e c r e t a r y
(Tulsa, Oklahoma)
For Immediate Release
August 16, 1993
REMARKS BY THE PRESIDENT
TO THE OPENING PLENARY SESSION OF THE
8STH ANNUAL MEETING OF THE
NATIONAL GOVERNORS ASSOCIATION
Tulsa Convention Center
Tulsa, Oklahoma
10:50 A.M. CDT
THE PRESIDENT: Thank you v e r y much.
Governor
Romer; Governor Campbell; our host Governor, Governor W a l t e r s .
I'm r e a l l y g l a d t o be here today. The l a s t t i m e t h e governors
met i n Oklahoma was i n 1981, r i g h t a f t e r I had j u s t become t h e
youngest former governor i n American h i s t o r y .
I've never been t o
an NGA meeting i n Oklahoma, so I would have showed up here even
i f you hadn't i n v i t e d me t o speak.
I want t o say t h a t H i l l a r y and I a r e b o t h v e r y g l a d
t o be here t o be w i t h you a g a i n . We're l o o k i n g f o r w a r d t o our
meeting a f t e r t h i s where we can t a l k about t h e h e a l t h care i s s u e
and o t h e r i s s u e s i n g r e a t e r d e t a i l . I t r e a s u r e t h e p a r t n e r s h i p
t h a t I have had w i t h so many o f you and which we a r e t r y i n g t o
develop and l i t e r a l l y imbed i n f e d e r a l p o l i c y t o d a y . I know t h a t
�you have a l r e a d y r e c e i v e d an update on t h e progress t h a t we have
made t o g e t h e r w o r k i n g on more r a p i d p r o c e s s i n g o f t h e governors'
waiver r e q u e s t i n many d i f f e r e n t areas and a number o f o t h e r
i s s u e s , which I hope w e ' l l be able t o t a l k more about l a t e r .
I know, t o o , t h a t t h e Vice P r e s i d e n t has a l r e a d y
been here and taken a l l my easy l i n e s away. He even t o l d you t h e
a s h t r a y s t o r y , I know, yesterday — ( l a u g h t e r ) — which I
understand Governor Richards s a i d was one o f those issues t h a t
her mother i n Waco c o u l d understand.
(Laughter.)
Today I come t o t a l k t o you about t h e i s s u e o f
h e a l t h c a r e . I would l i k e t o p u t i t i n t o some c o n t e x t . When I
became P r e s i d e n t i t was obvious t o me, based on j u s t t h e
announcements and evidence which had come i n t o p l a y s i n c e t h e
November e l e c t i o n , t h a t t h e f e d e r a l d e f i c i t was an even b i g g e r
problem t h a n I had p r e v i o u s l y t h o u g h t , and t h a t unless we d i d
something about i t , we would n o t have t h e c a p a c i t y t o d e a l w i t h
MORE
�- 2 t h e whole range o f o t h e r issues -- t h a t f o r e v e r , a t l e a s t d u r i n g
t h e t e r m o f my s e r v i c e we would be n i b b l e d away a t t h e edges i n
t r y i n g t o d e a l w i t h h e a l t h care r e f o r m , o r defense c o n v e r s i o n , o r
w e l f a r e r e f o r m , o r any o t h e r i s s u e by t h e f a c t t h a t we simply
were n o t i n c o n t r o l o f our own economic d e s t i n y .
And so we devoted t h e f i r s t s e v e r a l months o f t h i s
a d m i n i s t r a t i o n t o t r y i n g t o pass an economic p l a n t h a t would
reduce t h e d e f i c i t by a r e c o r d amount; t h a t would have a t l e a s t
as many spending c u t s as new t a x i n c r e a s e s — i n f a c t , we wound
up w i t h more spending c u t s -- and t h a t would g i v e some i n c e n t i v e s
where t h e y were needed, p a r t i c u l a r l y i n t h e s m a l l business, i n
t h e h i g h - t e c h , and t h e new business area, t o t r y t o grow more
jobs f o r t h e American economy. That has, I b e l i e v e , l a i d a very
good f o u n d a t i o n f o r t h e f u t u r e .
This morning I was r e a d i n g i n t h e morning newspapers
t h a t l o n g - t e r m i n t e r e s t r a t e s are now a t a 20-year low, t h e
lowest they've been s i n c e 1973. And we have t h e b a s i s now t o
proceed on a whole range o f o t h e r i s s u e s . When t h e Congress
�- 3 comes back next month, I b e l i e v e t h a t t h e Senate w i l l r a p i d l y
pass t h e n a t i o n a l s e r v i c e l e g i s l a t i o n , which many o f you are very
f a m i l i a r w i t h and which many o f you have supported.
I t w i l l pass
on a b i p a r t i s a n b a s i s and w i l l enable tens of thousands o f our
young people t o earn c r e d i t f o r t h e i r c o l l e g e e d u c a t i o n by
s e r v i n g t h e i r communities a t home and s o l v i n g problems t h a t no
government can s o l v e alone.
We are w o r k i n g on defense c o n v e r s i o n i n i t i a t i v e s
from n o r t h e r n C a l i f o r n i a t o South C a r o l i n a and a t a l l p o i n t s i n
between. I hope we can do more on t h a t . We w i l l have a major
w e l f a r e r e f o r m i n i t i a t i v e coming up at t h e f i r s t o f t h e year,
which I hope a l l o f you w i l l not o n l y s t r o n g l y support but w i l l
be a c t i v e p a r t i c i p a n t s i n , and meanwhile keep d o i n g what you're
d o i n g and a s k i n g f o r t h e waivers you t h i n k you need.
There i s now b e f o r e t h e Congress a crime b i l l , which
can have a b i g impact i n every s t a t e here, t h a t w i l l add 50,000
more p o l i c e o f f i c e r s on t h e s t r e e t , support i n n o v a t i o n s l i k e boot
camps f o r f i r s t o f f e n d e r s , h e l p us t o pass t h e Brady B i l l and
d e a l w i t h a number o f o t h e r issues f a c i n g us t h e r e .
There w i l l be i n i t i a t i v e s t o expand t h e economic
range o f Americans. As I know t h a t you a l l know now, and I wish
he c o u l d be here w i t h us today, our Trade Ambassador Mickey
Kantor s u c c e s s f u l l y concluded t h e NAFTA n e g o t i a t i o n s j u s t a few
days ago w i t h some h i s t o r i c — some h i s t o r i c p r o v i s i o n s never
b e f o r e found i n a t r a d e agreement anywhere, i n c l u d i n g t h e
agreement by t h e government o f Mexico t o t i e t h e i r minimum wages
t o p r o d u c t i v i t y and economic growth and t h e n t o make t h e i r
compliance w i t h t h a t t h e s u b j e c t o f a t r a d e agreement, which
means t h a t i t can be reviewed, t h a t i f t h e r e are v i o l a t i o n s they
can be s u b j e c t t o f i n e , and, u l t i m a t e l y , t h e t r a d e s a n c t i o n s can
be imposed. N o t h i n g l i k e t h i s has ever been found i n a t r a d e
agreement b e f o r e . I t ensures t h a t workers on b o t h sides o f our
b o r d e r can b e n e f i t . And I a p p r e c i a t e t h e support o f t h e
governors f o r t h e whole i s s u e o f expanding t r a d e . We are now i n
Europe t r y i n g t o get t h e GATT n e g o t i a t i o n s back on t r a c k , and I
hope we can do t h a t .
F i n a l l y , l e t me say t h e r e w i l l be a whole push
toward t h e end o f t h e year on a whole range o f p o l i t i c a l r e f o r m
i s s u e s . One o f t h e o t h e r House o f Congress have a l r e a d y passed a
campaign f i n a n c e r e f o r m b i l l , a lobby l i m i t a t i o n b i l l , and t h e
m o d i f i e d l i n e i t e m v e t o , which I know t h a t — I t h i n k t h a t 100
p e r c e n t o f you t h i n k t h a t t h e P r e s i d e n t ought t o have.
(Applause.)
In a d d i t i o n t o t h a t , the Vice President w i l l issue a
r e p o r t t o me v e r y s h o r t l y on t h e r e i n v e n t i n g government p r o j e c t ,
which he d i s c u s s e d w i t h you i n g r e a t d e t a i l y e s t e r d a y .
The o n l y
t h i n g I can t e l l you i s t h a t e v e r y t h i n g I ever s u s p i c i o n e d about
t h e way t h e f e d e r a l government operates t u r n e d out t o be t r u e ,
p l u s some. The a s h t r a y s t o r y i s o n l y i l l u s t r a t i v e .
�The fundamental problem i s not t h a t t h e r e are bad
people i n t h e f e d e r a l government or t h a t t h e p a y r o l l s have been
s w o l l e n by people who j u s t want t o pad them. That i s n o t t r u e .
I n f a c t , many o f t h e f e d e r a l agencies d i d n ' t grow a t a l l i n t h e
1980s. What has happened i s t h a t f o r t h e l a s t 60 years one t h i n g
has been added on t o another and people w i t h t h e b e s t o f
i n t e n t i o n s have j u s t p i l e d one more requirement on t o t h e f e d e r a l
government, and t h e fundamental systems t h a t o p e r a t e t h i s
government have gone unexamined f o r t o o l o n g — whether i t ' s
p e r s o n n e l , or b u d g e t i n g , or procurement. And we are t r y i n g t o do
t h a t i n ways t h a t I t h i n k would f r e e up a l o t o f money and
improve t h e e f f i c i e n c y and s e r v i c e t h a t t h e American people are
e n t i t l e d t o expect from a l l o f us.
Now, h a v i n g s a i d a l l t h a t , I want t o make two
comments. I don't t h i n k t h a t any o f i t w i l l t a k e American where
we need t o go u n l e s s we a l s o r e f o r m t h e h e a l t h care system —
MORE
�- 4 which i s t h e b i g g e s t o u t s t a n d i n g c u l p r i t i n t h e f e d e r a l d e f i c i t
-- and i n p r o m o t i n g economic d i s l o c a t i o n s i n t h i s economy. And
secondly, I don't t h i n k we can do i t , u n l e s s we do i t on a
bipartisan basis.
(Applause.)
I never want t o go t h r o u g h another s i x months where
we have t o get a l l o f our v o t e s w i t h i n one p a r t y and where t h e
o t h e r p a r t y has people t h a t want t o v o t e w i t h us and t h e y f e e l
l i k e t h e y got t o s t a y — and t h e whole i s s u e r e v o l v e s around
process i n s t e a d o f p r o d u c t , p o l i t i c a l r h e t o r i c i n s t e a d o f
p e r s o n a l concern f o r what's g o i n g t o happen t o t h i s c o u n t r y .
There's p l e n t y o f blame t o go around -- as f a r as I'm concerned
t h e r e w i l l be p l e n t y o f c r e d i t t o go around — I don't much care
who g e t s t h e c r e d i t f o r t h i s h e a l t h care r e f o r m as l o n g as we do
it.
But I am convinced t h a t what t h i s n a t i o n r e a l l y
needs i s a v i t a l c e n t e r ; one committed t o fundamental and
p r o f o u n d and r e l e n t l e s s and c o n t i n u i n g change i n ways t h a t are
c o n s i s t e n t w i t h t h e b a s i c v a l u e s o f most Americans and t h a t move
a l l o f us a l o n g a p a t h . And I don't t h i n k you can do i t u n l e s s
we can s i t down t o g e t h e r and t a l k and work.
Many o f t h e s k i l l s which are h i g h l y p r i c e d among
you, b o t h i n your own s t a t e s where you serve and work w i t h people
who t h i n k d i f f e r e n t l y t h a n you do on some i s s u e s , who belong t o
d i f f e r e n t p a r t i e s t h a n you do, and t h e way you work around t h i s
table.
Those s k i l l s are not o n l y not v e r y much p r i z e d , sometimes
t h e y ' r e a b s o l u t e l y demeaned i n t h e N a t i o n ' s C a p i t a l .
When we come here and we t r y t o work on something
l i k e we worked on t h e w e l f a r e r e f o r m b i l l i n 1988, we t a l k e d
about: How does t h i s r e a l l y work? How are people r e a l l y g o i n g
t o be a f f e c t e d by t h i s ? How can we d e a l w i t h our d i f f e r e n c e s o f
o p i n i o n and reach r e a l consensus t h a t r e p r e s e n t s p r i n c i p l e d
compromise? And how can we be judged not j u s t on what we say,
but on what we do?
Back East, where I work, consensus i s o f t e n t u r n e d
i n t o cave i n ; people who t r y t o work t o g e t h e r and l i s t e n t o one
another i n s t e a d o f beat each o t h e r up are accused o f b e i n g weak,
not s t r o n g . And t h e process i s a hundred t i m e s more i m p o r t a n t
t h a n t h e p r o d u c t . Beats a n y t h i n g I ever saw.
(Laughter.) And
the people t h a t r e a l l y score are t h e people t h a t l a y one good
l i c k on you i n t h e newspaper every day i n s t e a d o f t h e people t h a t
get up and go t o work, never care i f t h e y ' r e on t h e evening news,
never care i f t h e y ' r e i n t h e paper, and j u s t want t o make a
difference.
(Applause.)
And so I say t o you, a n y t h i n g t h a t you can do t o
h e l p me and t h e Congress t o t r y t o r e c r e a t e t h e mechanisms by
which you have t o f u n c t i o n i n o r d e r t o do a n y t h i n g a t t h e s t a t e
l e v e l , and by which we have worked t o g e t h e r here t o move f o r w a r d
on a whole range o f i s s u e s , I w i l l be g r a t e f u l f o r . T h i s c o u n t r y
�has too many words and too few deeds on too many issues, and we
can do b e t t e r than t h a t .
Now, l e t ' s t a l k about the health care issue. We a l l
know what's r i g h t w i t h our health care system. For those who
have access t o i t , i t i s the f i n e s t i n the world. Not only i n
terms of the i n c r e d i b l e technological advances, but i n terms of
having choice of our physicians, ready access t o h e a l t h care and
o v e r a l l high q u a l i t y t h a t l a s t s throughout a l i f e t i m e . We can
a l l be g r a t e f u l f o r t h a t .
My Secretary of Housing and Urban Development Henry
Cisneros and I were t a l k i n g the other day — his son j u s t had a
profoundly important and d i f f i c u l t operation. Just a few years
ago he was t o l d t h a t about a l l he could hope f o r f o r h i s boy was
a comfortable l i f e and eventually h i s time would run out,
probably sooner rather than l a t e r . And because of the r e l e n t l e s s
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�- 5 p r o g r e s s o f medical t e c h n o l o g y , h i s son now has a whole new
on l i f e .
lease
Nobody wants t o mess up what i s good w i t h American
h e a l t h c a r e . We must p r e s e r v e i t and preserve i t w i t h a
vengeance. But we a l s o know what i s not so good. We know t h a t
i n a w o r l d i n which we must compete f o r every j o b and a l l the
incomes we can, we are spending over 14 p e r c e n t o f our income on
h e a l t h care, and o n l y one o t h e r n a t i o n i n t h e w o r l d , Canada, i s
over 9 p e r c e n t . They're a t about 9.4 p e r c e n t . Our major
c o m p e t i t o r s i n t h e high-wage chase f o r t h e f u t u r e , Japan and
Germany, are down around 8 p e r c e n t . So t h e y ' r e a t 8 p e r c e n t and
we're a t 14 p e r c e n t .
More t r o u b l i n g , i f we don't do a n y t h i n g t o reverse
the b a s i c t r e n d s t h a t are now r i f l i n g t h r o u g h our system, by t h e
end o f t h i s decade w e ' l l be a t 19 p e r c e n t o f GDP on h e a l t h care.
No one e l s e w i l l be over 10 p e r c e n t , and w e ' l l be b a s i c a l l y
s p o t t i n g our c o m p e t i t o r s 9 cents on t h e d o l l a r i n every avenue o f
economic endeavor. I don't t h i n k t h a t i s something t h a t ' s r i g h t .
We know t h a t t h i s places enormous p r e s s u r e on
businesses.
I ' l l come back t o some o f t h e comments made by Mr.
M o t l e y * along toward t h e end o f my remarks, but t h e t r u t h i s t h a t
about 100,000 Americans a month are l o s i n g t h e i r h e a l t h insurance
because t h e y ' r e employers can no l o n g e r a f f o r d t o c a r r y i t under
t h e p r e s e n t system we have, and o t h e r s , h o l d i n g on f o r dear l i f e ,
are never g i v i n g t h e i r employees pay r a i s e s . And i t i s
e s t i m a t e d , u n l e s s we do something about t h i s system, t h a t t h e
i n c r e a s e d c o s t o f h e a l t h care between now and t h e end o f t h e
decade w i l l l i t e r a l l y absorb a l l o f t h e money t h a t might
o t h e r w i s e be a v a i l a b l e i n t h i s economy t o r a i s e t h e s a l a r i e s o f
our w o r k i n g people.
We see employers u n e q u a l l y t r e a t e d by t h e c r u e l hand
o f t h e system t h a t we have. We know now we are spending f a r more
money, about a dime on t h e d o l l a r p r o b a b l y , a d m i n i s t r a t i v e l y j u s t
on paperwork, pushing paper around, than any o f our c o m p e t i t o r s
are.
A decade ago, t h e average d o c t o r took home about 75 cents
on t h e d o l l a r t h a t came i n t o t h e c l i n i c .
Today t h a t ' s down t o 52
cents on t h e d o l l a r — i n o n l y 10 years — because we are awash
i n paperwork imposed, a, by t h e government, and, b, f o r t h e f a c t
t h a t o n l y t h e U n i t e d S t a t e s has 1,500 separate h e a l t h insurance
companies, w r i t i n g thousands and thousands o f d i f f e r e n t p o l i c i e s .
I have a d o c t o r f r i e n d i n Washington who r e c e n t l y
h i r e d somebody not even t o do paperwork, b u t j u s t t o s t a y on t h e
phone t o c a l l i n s u r a n c e companies every day t o beat them up t o
pay what has a l r e a d y been covered — money r i g h t out o f t h e
pockets o f t h e nurses t h a t work i n h i s c l i n i c . And t h e r e ' s a
s t o r y l i k e t h a t i n every h e a l t h care e s t a b l i s h m e n t i n America
today,
We know we s t i l l have almost 40 m i l l i o n people
u n i n s u r e d , and more every month, not fewer. We know t h a t s t a t e
�governments are l i t e r a l l y being bankrupt by the r i s i n g costs of
Medicaid, money t h a t used t o go t o education, money t h a t used t o
go t o economic development, money t h a t could have gone t o law
enforcement going every year j u s t shoveling out the door not f o r
new health care, more money f o r the same health care. And even
when we c o n t r o l the p r i c e of c e r t a i n things, t h a t extra
u t i l i z a t i o n or more people coming i n t o the system, because the
rest of i t i s broken down are d r i v i n g the costs up.
We know t h a t there are s t i l l serious access problems
and we know, as I said, t h a t the federal d e f i c i t i s i n t e r r i b l e
shape because of health care. I f you look at t h i s budget the
Congress j u s t adopted, defense goes down, d i s c r e t i o n a r y spending
i s f l a t . That means we spend more money on defense conversion,
on Head S t a r t , on pregnant women, on a few other things — every
d o l l a r t h a t we spend more on t h a t something else was cut. The
only t h i n g t h a t ' s going up are the retirement programs — and
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�- 6 S o c i a l S e c u r i t y taxes produced a $60 b i l l i o n s u r p l u s f o r us even
w i t h t h e c o s t o f l i v i n g allowances — and h e a l t h c a r e . E v e r y t h i n g
e l s e i s e i t h e r f l a t o r down.
And under a l l s c e n a r i o s proposed by a l l people who
p r e s e n t e d any budgets l a s t year, t h e d e f i c i t went down f o r f o u r
years and t h e n s t a r t e d going up again because o f h e a l t h care. So
t h e o n l y way we can keep our commitments, you and I , t o t h e
American people t o r e s t o r e r e a l c o n t r o l over t h i s budget i s t o do
something about h e a l t h care.
Now, I would argue t h a t i f you know you've g o t a
l i s t o f what's r i g h t and you know you've g o t a l i s t o f what's
wrong, and what's wrong i s going t o e v e n t u a l l y consume what's
r i g h t , you cannot c o n t i n u e t o do n o t h i n g . And I don't t h i n k most
people want t o c o n t i n u e t o do n o t h i n g .
I want t o thank t h e NGA and e s p e c i a l l y t h e governors
who have worked w i t h us t h r o u g h o u t t h i s process.
Many o f you
have met w i t h t h e F i r s t Lady and I r a Magaziner and t h e people
t h a t — l i t e r a l l y hundreds and hundreds o f people who have worked
w i t h them on a b i p a r t i s a n b a s i s t o t r y t o c r a f t a h e a l t h care
r e f o r m package t h a t w i l l ensure t h a t t h e s t a t e s are r e a l p a r t n e r s
i n our e f f o r t s t o preserve q u a l i t y , cover everyone, c o n t r o l
c o s t s , and enable t h e s t a t e s and t h e f e d e r a l government t o r e g a i n
some c o n t r o l over t h e i r f i n a n c i a l f u t u r e s .
No one embodied t h a t s p i r i t o f b i p a r t i s a n s h i p on
t h i s i s s u e more t h a n our l a t e f r i e n d , George M i c k e l s o n .
And I
j u s t want t o t a k e a work here t o say how v e r y much I a p p r e c i a t e d
him as a f r i e n d , as a governor, and as someone who had t h e s o r t
o f s p i r i t t h a t i f i t c o u l d embrace t h i s c o u n t r y on t h i s i s s u e , we
c o u l d s o l v e t h i s problem i n good f a i t h .
(Applause.)
The n a t i o n a l government has a l o t t o l e a r n from t h e
s t a t e s i n t h e tough d e c i s i o n s t h a t some o f you have made a l r e a d y .
I can h o n e s t l y say t h a t along toward t h e end o f my t e n u r e as
Governor, t h e most f r u s t r a t i n g p a r t o f t h e j o b was s i m p l y w r i t i n g
b i g g e r checks every year f o r t h e same Medicaid program, when I
d i d n ' t have t h e money t h a t a l l o f us wanted t o spend on e d u c a t i o n
and economic development and t h e o t h e r i m p o r t a n t issues b e f o r e
us.
There have been phenomenally i m p o r t a n t c o n t r i b u t i o n s
made t o t h i s debate a l r e a d y by t h e governors o f many s t a t e s i n
both p a r t i e s .
I won't mention one, f i v e o r t e n f o r f e a r I ' l l
leave o u t someone I should have mentioned, b u t l e t me say t h a t I
am v e r y g r a t e f u l t o a l l o f you f o r t h e work t h a t you have a l r e a d y
done. I a l s o want t o say a s p e c i a l word o f r e g r e t about t h e
absence here o f t h e Governor from my home s t a t e , Jim Guy Tucker,
who h i m s e l f has been g e t t i n g some w o r l d - c l a s s medical care. And
I t a l k e d t o him l a s t n i g h t ; he's f e e l i n g q u i t e w e l l and he
promises t o be a t t h e next meeting.
�But a l l o f you have a r o l e t o p l a y i n what we're
about t o do. Over t h e l a s t e i g h t months, I've met w i t h many o f
you p e r s o n a l l y i n Washingtorv; many o f you have l e n t your s t a f f s
t o t h e e f f o r t s t h a t we're making on h e a l t h care r e f o r m , and we've
l e a r n e d c l e a r l y t h a t what works i n N o r t h Dakota may n o t work i n
New York, J u s t y e s t e r d a y , your E x e c u t i v e Committee pledged t o
support h e a l t h care r e f o r m w i t h i n a comprehensive f e d e r a l
framework t h a t guarantees u n i v e r s a l coverage and c o n t r o l s c o s t s .
We w i l l work w i t h t h e s t a t e s t o phase i n reform, and we w i l l h e l p
you t o work o u t problems as they a r i s e . And we have t o have an
honest d i s c u s s i o n about what t h a t framework ought t o look l i k e .
I want today t o t e l l you what I t h i n k we should do.
Next month I w i l l o u t l i n e a p l a n t o Congress t h a t w i l l o f f e r r e a l
hope f o r a l l Americans who want t o work and t a k e r e s p o n s i b i l i t y
and c r e a t e o p p o r t u n i t i e s f o r themselves and t h e i r c h i l d r e n . I
t h i n k t h e elements o f t h a t p l a n ought t o be as f o l l o w s :
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�- 7 One, we've g o t t o p r o v i d e h e a l t h care s e c u r i t y t o
people who don't have i t . That means n o t j u s t those who don't
have h e a l t h insurance coverage now, b u t those who a r e a t r i s k o f
l o s i n g i t . I don't know how many people I met l a s t year a l l over
t h i s c o u n t r y , a l l k i n d s o f people, who knew they would never be
a b l e t o change jobs again because someone i n t h e i r f a m i l y had
been s i c k .
I don't know how many o t h e r people I met who c o u l d n ' t
a f f o r d t h e i r h e a l t h insurance package because t h e r e was someone
i n t h e i r j o b u n i t t h a t they needed t o g e t r i d o f i n o r d e r t o be
a b l e t o a f f o r d i t . We have g o t t o have a system o f u n i v e r s a l
coverage t h a t p r o v i d e s s e c u r i t y t o Americans.
Second, I t h i n k we have t o have a system o f managed
care t h a t m a i n t a i n s t h e p r i v a t e s e c t o r , organizes Americans i n
h e a l t h a l l i a n c e s operated w i t h i n each s t a t e , c o n t a i n s s i g n i f i c a n t
new i n c e n t i v e s f o r p r e v e n t i o n and f o r w e l l n e s s and a g a i n s t
o v e r u t i l i z a t i o n , and t h a t has a budget so t h a t t h e c o m p e t i t i o n
f o r c e s s h o u l d keep t h i n g s w i t h i n t h e budget, b u t , u l t i m a t e l y ,
e s p e c i a l l y i n t h e e a r l y years, t h e r e must be some l i m i t .
I will
say a g a i n , i f we don't change t h i s , we're g o i n g t o go from 14 t o
19 p e r c e n t o f our income going t o h e a l t h care by t h e end o f t h e
decade. I t i s g o i n g t o be v e r y d i f f i c u l t f o r us t o compete and
win i n t h e g l o b a l economy w i t h t h a t s o r t o f d i f f e r e n t i a l .
Second — t h i r d , excuse me — t h e r e must be
i n s u r a n c e r e f o r m . There has t o be a b a s i c package o f b e n e f i t s .
There needs t o be community r a t i n g . There has t o be some
o p p o r t u n i t y — I heard Governor Wilson t a l k i n g about t h i s b e f o r e
I came o u t — f o r p o o l i n g f o r s m a l l employers. We cannot p e r m i t
p r i c e d i f f e r e n t i a l s t h a t e x i s t today t o g e t worse i n s t e a d o f
b e t t e r s i m p l y because o f t h e s i z e o f t h e work u n i t s .
F i n a l l y , i n t h i s c o n n e c t i o n , i f we do these t h i n g s ,
t h e r e w i l l be massive c u t s i n paperwork iDecause you won't have t o
have every h e a l t h u n i t i n t h i s c o u n t r y t r y i n g t o keep up w i t h
thousands o f d i f f e r e n t o p t i o n s and a l l t h e myriad c o m p l e x i t i e s
t h a t f l o w from t h a t . We won't have another decade when c l e r i c a l
employment i n t h e h e a l t h care area goes f o u r times f a s t e r than
h e a l t h care p r o v i d e r s . No one b e l i e v e s t h a t t h a t i s a v e r y sound
investment i n our n a t i o n ' s f u t u r e .
Next, we have t o have s i g n i f i c a n t — s i g n i f i c a n t
i n c r e a s e s , n o t decreases i n investment and r e s e a r c h and
technology.
Next, i n my judgment, we s h o u l d attempt t o t a k e t h e
h e a l t h care c o s t s o f t h e workers comp system and t h e auto
i n s u r a n c e system i n t o t h i s r e f o r m . That might be t h e b i g g e s t
t h i n g we c o u l d do f o r s m a l l businesses.
I t would a l s o perhaps be
t h e b i g g e s t t h i n g we c o u l d do t o reduce some o f t h e i n e q u a l i t i e s
— some o f you might n o t l i k e t h i s , and o t h e r s would l o v e i t
— b u t t h e i n e q u a l i t i e s i n economic i n c e n t i v e s t h a t v a r i o u s s t a t e s
can o f f e r because o f d r a m a t i c d i f f e r e n c e s i n works comp c o s t s
from s t a t e t o s t a t e , occasioned more t h a n a n y t h i n g e l s e by t h e
�h e a l t h care burden o f workers comp.
Next, I t h i n k t h a t we should have ICQ percent tax
d e d u c t i b i l i t y , not 25 percent t a x d e d u c t i b i l i t y , f o r
self-employed people. And t h a t w i l l be a part of the plan we
w i l l o f f e r t o Congress — something t h a t w i l l increase the
capacity of people who are self-employed t o maintain health
insurance, whether they're farmers or independent businesspeople.
F i n a l l y , I t h i n k the states must have a strong r o l e
and e s s e n t i a l l y be charged w i t h the r e s p o n s i b i l i t y and given the
opportunity t o organize and e s t a b l i s h the health groups of people
who w i l l be able t o purchase health care under the managed care
system,
I t h i n k we should expand options f o r people of low
incomes on Medicare but not poor enough t o be on Medicaid t o get
a p r e s c r i p t i o n drug b e n e f i t phased i n over a period of years,
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�- 8 S i m i l a r l y , I t h i n k we must do the same t h i n g w i t h l o n g - t e r m care.
But as we p r o v i d e more l o n g - t e r m care o p p o r t u n i t i e s f o r the
e l d e r l y and f o r persons w i t h d i s a b i l i t i e s , we must a l s o expand
t h e o p t i o n so t h a t they can get the l e a s t cost, most a p p r o p r i a t e
c a r e . We must remove the i n s t i t u t i o n a l i z e d b i a s e s t h a t are i n
t h e system now which keep a l o t of people from h a v i n g access t o
home care, f o r example.
And f i n a l l y , I t h i n k t h e r e has t o be some
r e s p o n s i b i l i t y i n t h i s system f o r everyone. There are a l o t of
people today t h a t get a f r e e r i d e out of the p r e s e n t system who
can a f f o r d t o pay something. I t h i n k t h e r e s h o u l d be i n d i v i d u a l
responsibility.
I t h i n k every American s h o u l d know t h a t h e a l t h
care i s not something p a i d f o r by the t o o t h f a i r y , t h a t t h e r e i s
no f r e e r i d e , t h a t people should understand t h a t t h i s system
c o s t s a l o t of money — i t should cost a l o t of money, i t ought
t o be the w o r l d ' s b e s t , but we should a l l be a c u t e l y aware o f the
c o s t each o f us impose on i t .
But I a l s o b e l i e v e t h a t i n order t o make i n d i v i d u a l
r e s p o n s i b i l i t y m e a n i n g f u l and i n o r d e r t o c o n t r o l the cost o f
t h i s system, t h e r e has t o be some means o f a c h i e v i n g u n i v e r s a l
coverage. I f you don't achieve u n i v e r s a l coverage, i n my
judgment, you w i l l not be able t o c o n t r o l the c o s t s adequately.
Why? W e l l , f o r one t h i n g , you w i l l c o n t i n u e t o have cost
shifting.
I f you have uncompensated care, the people who g i v e i t
w i l l s h i f t t h e cost t o the p r i v a t e s e c t o r or t o the government.
And t h a t w i l l c r e a t e s i g n i f i c a n t economic d i s l o c a t i o n s .
Now, i t seems t o me we have f o u r o p t i o n s .
I f you
b e l i e v e — you have t o decide — i f you b e l i e v e everybody should
be covered, you have o n l y f o u r o p t i o n s .
And I would argue t h a t
t h r e e o f them are n o t , a t l e a s t based on what I have seen and
heard, v e r y good o p t i o n s i n p r a c t i c e as opposed t o i n t h e o r y .
O p t i o n number one i s t o go t o a s i n g l e - p a y e r system,
l i k e t h e Canadians do, because i t has the l e a s t a d m i n i s t r a t i v e
cost.
That would r e q u i r e us t o r e p l a c e over $500 b i l l i o n i n
p r i v a t e i n s u r a n c e premiums w i t h n e a r l y t h a t much i n new t a x e s . I
don't t h i n k t h a t ' s a p r a c t i c a l o p t i o n .
I don't t h i n k t h a t i s
g o i n g t o happen. And you t a l k about — t h a t would be
s i g n i f i c a n t l y d i s l o c a t i n g i n t h e sense t h a t o v e r n i g h t , i n a
n a t i o n t h i s s i z e , you'd have a l l the people who are i n the
i n s u r a n c e business out o f i t u n l e s s they were i n t h e business o f
managing t h e h e a l t h care p l a n s themselves, as more and more are
doing.
O p t i o n number two would be t o have an i n d i v i d u a l
mandate r a t h e r t h a n a mandate t h a t a p p l i e s t o employers and t o
employees, s a y i n g t h a t every i n d i v i d u a l ' s got t o buy h e a l t h
i n s u r a n c e and here are some i n s u r a n c e reforms t o make sure you
can get i t . This approach has found some f a v o r i n t h e U n i t e d
S t a t e s Congress, p r i m a r i l y among Republicans, but not
e x c l u s i v e l y , because i t has the appeal o f not imposing a business
�mandate which has a bad sound t o i t .
Here's t h e problem w i t h t h a t , i t seems t o me. I f
you have an i n d i v i d u a l mandate, on whom i s i t imposed? And don't
you have t o g i v e some subsidy t o low-income workers, j u s t t h e way
y o u ' l l have t o g i v e some subsidy t o low-income businesses i f
t h e r e ' s an employer mandate Who gets i t and who doesn't? And i f
you impose an i n d i v i d u a l mandate, what i s t o s t o p every o t h e r
employer i n America from j u s t dumping h i s employees o r her
employees, t o have a sweeping and e x t r e m e l y d i s l o c a t i n g s e t o f —
a c h a i n o f events s t a r t ?
So i t seems t o me t h a t t h e r e are a l o t o f q u e s t i o n s
t h a t have t o be asked and answered b e f o r e we c o u l d embrace t h e
concept o f an i n d i v i d u a l mandate.
The t h i r d t h i n g you c o u l d do i s n o t worry about i t .
You c o u l d j u s t say, w e l l , w e ' l l have a l l these o t h e r reforms and
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�- 9 j u s t hope t h a t everybody, i f you c o u l d lower t h e c o s t o f
i n s u r a n c e and s i m p l i f y t h e premiums and have b i g p o o l s , t h a t
sooner o r l a t e r somehow everybody w i l l be covered.
The problem i s t h a t t h e r e i s a l o t o f evidence t h a t
some people w i l l s t i l l seek a f r e e r i d e . And make no mistake
about i t , people t h a t never see themselves as f r e e r i d e r s s t i l l
r i d e t h e system, because everybody i n t h i s c o u n t r y who needs
h e a l t h care e v e n t u a l l y g e t s i t . I t may be t o o l a t e , i t may be
too expensive. But i f someone who works i n a w o r k p l a c e where
t h e r e i s no i n s u r a n c e has a c h i l d t h a t g e t s h i t i n a c a r wreck or
j u s t g e t s s i c k o r has an acute appendix o r something happens,
t h e y ' l l g e t h e a l t h care. And t h a t w i l l be p a i d f o r by someone
else.
And, indeed, even f o r t h e employers and employees
t h a t may go a whole year and never use t h e h e a l t h care system,
i t ' s t h e r e w a i t i n g f o r them.
I t ' s an i n f r a s t r u c t u r e j u s t as much
as t h e i n t e r s t a t e highway system i s . Every m e d i c a l c l i n i c , every
h o s p i t a l , every n u r s i n g home, a l l these t h i n g s a r e t h e h e a l t h
care i n f r a s t r u c t u r e o f t h e c o u n t r y a l l b e i n g p a i d f o r by someone
e l s e , b u t s t i l l a v a i l a b l e t o be used f o r those f o l k s .
So I don't t h i n k we can r a t i o n a l l y expect t o s t o p
c o s t s h i f t i n g o r t o have a f a i r system i f we say we're g o i n g t o
o r g a n i z e d a l l t h i s and j u s t hope everybody w i l l g e t i n t o i t . That
leaves t h e f o u r t h a l t e r n a t i v e which i s t o b u i l d on t h e system we
now have. The system we now have works f o r most Americans. Most
Americans a r e i n s u r e d under a system i n which employers pay f o r
p a r t o f t h e h e a l t h i n s u r a n c e and employees pay f o r p a r t o f t h e
h e a l t h i n s u r a n c e , and i t ' s worked p r e t t y w e l l f o r them except f o r
the l a u n d r y l i s t o f problems t h a t we t a l k e d about.
But most Americans a r e covered under i t . What are
the problems w i t h d o i n g t h i s ? W e l l , f i r s t o f a l l , i f you j u s t
passed an employer mandate and d i d n o t h i n g e l s e , t h e r e would be a
t o n o f problems i n d o i n g i t , because t h e most v u l n e r a b l e
businesses would have t h e h i g h e s t premiums and a bunch o f them
would r e a l l y be i n deep t r o u b l e . No one proposes t o do t h a t .
I n o t h e r words, an employer mandate i t s e l f would n o t
be r e s p o n s i b l e u n l e s s you a l s o had s i g n i f i c a n t i n s u r a n c e r e f o r m s ,
a l o n g p e r i o d o f p h a s e - i n , and a l i m i t a t i o n on how much t h e
premium c o u l d be f o r v e r y s m a l l businesses o r businesses w i t h
v e r y low-wage workers t h a t o b v i o u s l y a r e o p e r a t i n g on narrow
p r o f i t margins.
But I would argue to you that based on my a n a l y s i s
of t h i s — and I've been t h i n k i n g about t h i s s e r i o u s l y now f o r
more than three years, ever since the Governors A s s o c i a t i o n asked
me and the Governor of — the then Governor of Delaware, now a
Congressman from Delaware t o l o o k a t t h e h e a l t h i s s u e . And I
have thought about i t and thought about i t . There may be some
other i s s u e , but I see only those four options f o r d e a l i n g with
�t h i s . And i t seems t o me the shared r e s p o n s i b i l i t y i n a f a i r way
of employer and employee, b u i l d i n g on the system we have now
which works — t a k i n g proper account of the need t o phase i t i n
and t o maintain l i m i t s on lower-income and lower-wage employment
u n i t s — i s the f a i r e s t way t o go.
Now, i t seems t o me t h a t a l l t h i s w i l l be discussed
and debated i n the Congress; the governors w i l l be a p a r t of i t .
The f i r s t decision we have t o make i s whether we can f o o l around
w i t h t h i s f o r another ten or 20 years or whether the time has
come t o act. Just consider t h i s one f a c t : I f health care costs
had been held i n check — t h a t i s t o i n f l a t i o n plus growth
--since 1980, state and l o c a l governments would have, on average,
75 percent more funding f o r p u b l i c school budgets. I n 1993,
f i s c a l year 1993, states spent more on Medicaid than on higher
education f o r the f i r s t time. And state spending on Medicaid i s
MORE
�- 10 expected t o jump from $31 b i l l i o n
i f we don't change t h i s system.
i n 1990
t o $81 b i l l i o n
in
1995
I b e l i e v e t h a t h e a l t h care r e f o r m w i l l boost job
c r e a t i o n i n t h e p r i v a t e s e c t o r i f i t i s done r i g h t .
I believe i t
w i l l o f f e r a l e v e l p l a y i n g f i e l d t o a l l those s m a l l employers who
are c o v e r i n g t h e i r employees r i g h t now and paying t o o much f o r
it.
I b e l i e v e i t w i l l be a c r i t i c a l f i r s t step i n rewarding work
over w e l f a r e .
When we d i d t h e f a m i l y support act i n 1988, those of
you who were here t h e n w i l l a l l remember what a l l o f us
concluded.
And t h e Governor o f South C a r o l i n a , s i n c e he had once
been t h e r a n k i n g member o f t h e a p p r o p r i a t e subcommittee on the
House Ways and Means Committee, p l a y e d as b i g a r o l e i n
u n d e r s t a n d i n g t h i s as anybody e l s e — t h a t a l o t o f people stayed
on w e l f a r e not because o f t h e b e n e f i t s , because t h e b e n e f i t s had
not kept up w i t h i n f l a t i o n ; t h e y d i d i t because t h e y c o u l d n ' t
a f f o r d c h i l d care f o r t h e i r k i d s and because t h e y were g o i n g t o
l o s e h e a l t h insurance f o r t h e i r c h i l d r e n .
We have gone a l o n g way, I t h i n k , toward r e d u c i n g
i n c e n t i v e s t o s t a y on w e l f a r e w i t h t h i s new economic p l a n ,
because t h e earned income t a x c r e d i t has i n c r e a s e d so much t h a t
now people t h a t work 40 hours a week and have c h i l d r e n i n t h e
home w i l l be l i f t e d above t h e p o v e r t y l e v e l . That was t h e most
major p i e c e o f economic s o c i a l r e f o r m i n t h e l a s t 20 years.
But
we s t i l l have t o d e a l w i t h t h e h e a l t h care i s s u e .
I r e c e n t l y had a v e r y sad c o n v e r s a t i o n w i t h a woman
who became a f r i e n d o f mine i n t h e campaign who was a d i v o r c e d
mother o f seven c h i l d r e n and her youngest c h i l d had a h o r r i b l e ,
h o r r i b l e and v e r y expensive h e a l t h care c o n d i t i o n . The o n l y way
she c o u l d get any h e a l t h care f o r t h i s k i d was t o q u i t a j o b
where she was making $50,000 a year, p r o u d l y s u p p o r t i n g these
c h i l d r e n , t o go on p u b l i c a s s i s t a n c e so she c o u l d get Medicaid t o
t a k e care o f her c h i l d . And t h e young c h i l d j u s t r e c e n t l y passed
away. And so I c a l l e d and t a l k e d t o t h e woman and I was t h i n k i n g
about t h e i n c r e d i b l e t r a v a i l t h a t she had gone t h r o u g h , and
wondering i f now she would ever be able t o get another j o b making
t h a t k i n d o f money t o support her remaining c h i l d r e n and t o
r e s t o r e her sense o f d i g n i t y and empowerment.
Let me say one l a s t t h i n g about t h i s .
I t h i n k i f we
do t h i s r i g h t i t w i l l r e s t o r e our sense o f i n d i v i d u a l and common
responsibility.
I w i l l say a g a i n , I do not b e l i e v e anybody
s h o u l d get a f r e e r i d e i n t h i s d e a l . I t h i n k we have a l l , a t
l e a s t I've been p a r t o f i t , have made a mistake i n t r y i n g t o say
t h a t people s h o u l d pay a b s o l u t e l y n o t h i n g f o r t h e i r h e a l t h care
i f t h e y c o u l d a f f o r d t o pay something. People ought t o pay i n
p r o p o r t i o n t o what t h e y can a f f o r d t o . But I t h i n k t h a t t h e
system we have i s so r i d d l e d w i t h those who don't have any
r e s p o n s i b i l i t y a t a l l t h a t i t i s chock f u l l o f l o o p h o l e s .
�And l e t me say again, everybody who says, w e l l , t h i s
i s j u s t too complicated and i t ' s too much trouble and i t ' s too
hard t o t h i n k about, ought t o consider the consequences of doing
nothing. Doing nothing means more people lose t h e i r coverage.
And those who don't w i l l pay too much f o r t h e i r coverage. Doing
nothing means t h a t a l l those uninsured and underinsured Americans
w i l l be covered by vast outlays by state, l o c a l and federal
governments. The rest of us w i l l pay more at the doctor's
o f f i c e , the h o s p i t a l and our own businesses. Doing nothing means
insurers w i l l continue t o be able t o charge prices t h a t are too
high t o those who don't have the good fortune of being i n very
large buying cooperatives, and t h a t the paperwork burden of the
t h i s system, I w i l l say again, w i l l continue t o be a dime on the
d o l l a r more than any other country i n the world. We cannot
sustain t h a t sort of waste and i n e f f i c i e n c y .
(Applause.)
More than 60 cents of every new d o l l a r going t o the
federal Treasury over the next f i v e years under our reduced
MORE
�- 11 budget w i l l go t o h e a l t h care — a f t e r we had a $54 b i l l i o n
r e d u c t i o n i n Medicare and Medicaid expenses over t h e e s t i m a t e d
cost o f t h e p r e v i o u s budget — 12 t o 15 percent added c o s t s every
year f o r l a r g e businesses; 20 t o 30 p e r c e n t f o r s m a l l businesses;
no wage i n c r e a s e s f o r m i l l i o n s , indeed tens o f m i l l i o n s o f
workers; and c o n t i n u e d f e a r and i n s e c u r i t y . P o l i c i n g t h e system
a g a i n s t incompetence w i l l be l e f t t o a f l a w e d system o f
b u r e a u c r a t s , o f insurance o v e r s i g h t and m a l p r a c t i c e t h a t rewards
t h i n g s t h a t don't deserve t o be rewarded and i g n o r e s l e g i t i m a t e
problems.
Now, l e t me t a l k about t h i s jobs i s s u e one more
t i m e . I f you j u s t imposed a mandate and d i d n o t h i n g e l s e , would
i t c o s t jobs? Yes, i t would. Any study can show t h a t . That i s
not what we propose.
I f you r e f o r m t h e insurance system and a l l
these b i g employers t h a t are p a y i n g way t o o much now, and a l l
these s m a l l employers t h a t are p a y i n g way t o o much now, wind up
w i t h r e d u c t i o n s or no i n c r e a s e s i n t h e years ahead, t h a t i s more
money t h e y ' r e g o i n g t o have t o i n v e s t i n c r e a t i n g new jobs i n the
private sector.
(Applause.)
I f you r e f o r m t h e insurance system, you phase i n t h e
r e q u i r e m e n t s , and you l i m i t t h e amount o f p a y r o l l t h a t someone
can be r e q u i r e d t o put out i n an insurance premium, you're going
t o l i m i t t h e j o b l o s s on t h e downside w h i l e you're i n c r e a s i n g i t
d r a m a t i c a l l y on t h e u p s i d e .
I f you reduce t h e paperwork burdens, yes, you won't
have t h i s huge growth i n people d o i n g c l e r i c a l works i n d o c t o r s
o f f i c e s and h o s p i t a l s and i n insurance o f f i c e s . But you w i l l
have more people g o i n g i n t o o l d f o l k s ' homes and g i v i n g them good
p e r s o n a l h e a l t h care, t r y i n g t o keep them a l i v e i n ways t h a t are
more l a b o r i n t e n s i v e but l e s s expensive.
So t h e r e w i l l be s h i f t s
here.
But who can say, i f you t r u s t , i f you t r u s t t h e
p r i v a t e s e c t o r t o a l l o c a t e c a p i t a l i n ways t h a t w i l l make America
most c o m p e t i t i v e and t o t a k e advantage o f lower h e a l t h care costs
by r e i n v e s t i n g i t i n t h i s economy, who c o u l d p o s s i b l y say t h a t i f
we move c l o s e r t o t h e i n t e r n a t i o n a l average i n t h e percentage o f
our income g o i n g t o h e a l t h care, i t wouldn't l e a d t o more
p r o d u c t i v e investment and more jobs i n America? I t h i n k t h a t i s
c l e a r l y what would happen.
(Applause.)
We have focused t h i s debate only on the minority of
people who don't have h e a l t h insurance and don't cover t h e i r
employees and assume that we would lay some mandate on them and
make no other s t r u c t u r a l changes. I wouldn't be for t h a t .
You
couldn't be for that, although at l e a s t that would stop the cost
shifting.
I t would not be enough. That i s not what we propose.
But i f you do t h i s r i g h t and we phase i t i n so that as we deal
with problems, we f i n d them we can c o r r e c t them, i f the s t a t e s
are dealing with the management side of t h i s through these health
a l l i a n c e s , we can make t h i s work.
�I t j u s t defies common sense t o say t h a t we can't
maintain the world's f i n e s t health care system, stop a l l t h i s
cost s h i f t i n g , b r i n g our costs back at some competitive l e v e l ,
cover everybody and create jobs. We'll s t i l l — no matter what
happens we'11 be spending a l o t more than any other country on
health care at the end of the decade. But w e ' l l be p r o t e c t i n g
people, and w e ' l l be working w i t h them,
I'm convinced t h a t the biggest problem we've got
r i g h t now i s the fear of the unknown and the exaggeration i n t o
the unknown of what, i n f a c t , i s already known. To say t h a t
we're t a l k i n g about some u n t r i e d , untested t h i n g ignores the
experience of Hawaii, ignores the experience of every other
country t h a t we're competing w i t h , ignores what we know about how
our p r i v a t e sector could a c t u a l l y manage the problem b e t t e r i n
some ways than Germany and Japan have managed i t , and b a s i c a l l y ,
i s rooted i n somehow our lack of b e l i e f t h a t we can overcome a l l
MORE
�- 12 the i d e o l o g i c a l d i v i d e s and t h e r h e t o r i c a l barbs and t h e f e a r s
t h a t a r e g r i p p i n g us.
So I w i l l say again, I don't p r e t e n d t o have a l l t h e
answers, b u t I am a b s o l u t e l y sure t h i s i s t h e problem t h a t
America cannot l e t go, t h a t we cannot walk away from. And I am
a b s o l u t e l y convinced t h a t we can s o l v e i t i f we can meet around a
t a b l e w i t h o u t r e g a r d t o p a r t y and l i s t e n t o t h e f a c t s and work
t h r o u g h i t . I am convinced o f t h a t .
I want t o c l o s e by t e l l i n g you a s t o r y . When t h e
Pope came t o Denver, and I was g i v e n t h e o p p o r t u n i t y t o go o u t
t h e r e and meet him and have a p r i v a t e audience t h a t I w i l l
remember and c h e r i s h f o r t h e r e s t o f my l i f e , we arranged f o r a
young g i r l t o come t h e r e and j u s t stand i n t h e audience. And a l l
she d i d was have t h e Pope p u t h i s hand on h e r head and say a word
of b l e s s i n g . This c h i l d i s 13 years o l d .
She's from Wisconsin.
Her f a t h e r we met i n t h e course o f t h e campaign. She was born
w i t h a r a r e bone disease which caused t h e bones i n h e r body t o
break c o n t i n u o u s l y so t h a t by t h e t i m e she a c t u a l l y came o u t o f
her mother's womb she had a l r e a d y had about more t h a n a dozen
bones break i n h e r body.
J u s t a few years ago anybody l i k e t h a t c o u l d never
have grown up and had a n y t h i n g l i k e a normal l i f e .
They j u s t
would have been h e l p l e s s , j u s t c o n t i n u a l l y c r u m b l i n g . Now, t h i s
g i r l has gone t o t h e N a t i o n a l I n s t i t u t e o f H e a l t h every t h r e e
months f o r h e r e n t i r e l i f e .
And even though she's j u s t 13 years
o l d , i f she were here t a l k i n g t o you, she would speak w i t h t h e
presence, t h e m a t u r i t y , t h e command o f someone more t h a n t w i c e
her age. And she looks a l i t t l e d i f f e r e n t because t h e bones i n
her s k u l l have broken, t h e bones i n h e r l e g s have broken, t h e
bones i n h e r back have broken. But she can walk and she can
f u n c t i o n and she can go t o s c h o o l . And even though she's o n l y
f o u r f e e t t a l l and weighs o n l y 60 pounds, she can f u n c t i o n .
And she asked her father to take her to Iowa so she
could help people i n Iowa to f i g h t the flood. And she went to
Iowa and loaded sand i n the sandbags, knowing that any one of
those bags could have broken her l e g above the knee, could have
put her away f o r a year. She s a i d , I cannot l i v e i n a c l o s e t .
This i s something t h a t ' s there. I want to l i v e .
I want to do my
life.
I want to do what other people do.
And I was so overcome by i t — I brought t h e g i r l t o
see me and t h e n we j u s t q u i e t l y arranged f o r h e r t o be t h e r e when
the Pope was t h e r e . I say t h a t t o make t h i s p o i n t . I asked her
why i n t h e w o r l d she would have done t h a t — why she would have
r i s k e d l i t e r a l l y b r e a k i n g h e r body a p a r t t o be t h e r e w i l l a l l
these b i g , husky c o l l e g e k i d s f i g h t i n g t h i s f l o o d . And she s a i d ,
"Because I want t o l i v e . And i t ' s t h e r e , and I have t o go on. I
have t o do t h i n g s . "
I f a c h i l d l i k e that can do something l i k e t h a t .
�s u r e l y to goodness, we can stop wringing our hands and r o l l up
our s l e e v e s and solve t h i s problem. And surely we can do i t
without the kind of r h e t o r i c and a i r - f i l l i n g b u l l that we hear so
often i n the Nation's C a p i t a l . We can do i t .
(Applause.)
I miss you. I miss t h i s .
I miss t h e way we make
d e c i s i o n s . I miss t h e s o r t o f h e a r t and s o u l and f a b r i c o f l i f e
t h a t was a p a r t o f every day when I got up and went t o work i n a
state capital.
Somehow we've got t o b r i n g t h a t back t o
Washington. Think about t h a t l i t t l e g i r l and h e l p us s o l v e t h i s
h e a l t h care problem.
Thank you.
(Applause.)
END11:36 A.M.
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CDT
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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White House Health Care Task Force
Steven Edelstein
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Box 9
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
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Clinton Presidential Records: White House Staff and Office Files
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Health Care Task Force
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FolderlD:
Folder Title:
First Lady's Hearing Testimony 9/93
Stack:
Row:
s
52
Section:
Shelf:
Position:
8
2
�/.
EXECUTIVE
OFFICE
OF
THE
PRESIDENT
!:
28-Sep-1993 02:51pin
TO:
(See Below)
FROM:
Jeffrey L. EUer
Office of Media Affairs
SUBJECT: HRC Transcript from A.M. HiU testimony
THE REUTER TRANSCRIPT REPORT
HEARING OF THE HOUSE WAYS AND MEANS COMMITTEE
SUBJECT: THE CLINTON HEALTH CARE PROPOSAL
CHAIRED BY: REPRESENTATIVE DAN ROSTENKOWSKI (D-IL)
WITNESS: FIRST LADY HILLARY CLINTON
LONGWORTH HOUSE OFFICE BUILDING, ROOM 1100, WASHINGTON DC
TUESDAY, SEPTEMBER 28,1993
REP. ROSTENKOWSKI: (Sounds gavel.) The conmiittee will come to
order.
Mrs. Clinton, I want to compliment you. I hope that you set the
pace for the rest of the cabinet when they testify before our committee. It's
very unusual that a witness comes in early to testify. (Laughter.)
Today the committee embarks upon an historic mission to ensure
health security for all Americans. Tragically, far too many Americans are
afraid to seek the care they need because they can't afford it. Without
health insurance, any encounter with the health care system presents a
devastating financial burden to most American families.
Last Wednesday, our president outiined sbc simple basic objectives
for the reform of our health care system. They are security, savings, quality,
simplification, choice, and responsibility. The president then challenged the
Congress to enact reform legislation that achieves these goals. Today I
pledge that I will commit all of my energy and resources to meet this
challenge and to enact health care reform legislation before this Congress
adjourns next year.
Many are skeptical. But it can be done. It would be a tragedy for
this country not to do it, to fail in this endeavor.
It is appropriate that we begin an historic task with an historic
event for this committee. Today it is my extreme pleasure and honor to
welcome to the committee the First Lady, Hillary Rodham Clinton. This is the
'
�first time that a first lady has testified before the House of
Representatives' oldest standing committee.
Mrs. Clinton, you have developed a very sigmficant, comprehensive
proposal. You and your staff are to be congratulated. At the same time, you
and I are both aware that many members of Congress and many Americans have
honest concems about the plan you have developed. These concems must be
addressed during the legislative process.
�3
As just one example, I have concems about how your plan will affect the many small
employers in my district. We must assure that health care reform does not impose *
an unfair or crippling burden on struggling small employers, while recognizing that
many employers can and should meet their obligations to help their employees pay
for health insurance.
This and other issues will have to be carefully analyzed and
solutions developed. We expect to work closely with you as we go through this
process.
Before you testify, I will ask Congressman Bill Archer to make a
short opening statement to be followed by short statements by Congressmen
Pete Stark and Bill Thomas, chairman and ranking minority member of the
Health Subcommittee.
Mr. Archer.
REP. BILL ARCHER (R-TX): Thank you, Mr. Chairman. And welcome to
the committee, Mrs. Clinton. I join Chairman Rostenkowski in that sincere
welcome.
Yours has been a unique role, really, in shaping the
administration's national healtn care proposal, and your appearance today is
certainly unique in the history of this committee.
I'm glad we can now begin to explore the details of the president's
proposal, and so thanks for being with us as we start this process.
No other issue touches the lives of each and every American so
personally and so directly. Clearly, the current system has problems that
need to be addressed, and we all agree on that. We must provide for security
of health care coverage, protecting those who change jobs or have a
preexisting condition. We need to reduce the growth of health care costs and
simplify and streamline the system. We need to ensure that individuals take
greater responsibility for their own health care decisions. Above all, we
must maintain the quality of care and guarantee Americans the right to choose
their own doctors and their health plans. Sometimes you don't know the
benefits that you have until you lose them.
There are fundamental disagreements, however, on how we achieve
these worthy goals, and this is the room in which many of those decisions
will be made. So it's fitting that we begin the process right here. There are
a number of reform proposals on the table, as you know. They take a variety
of approaches. None of the others place such reliance on an overwhelming new
bureaucracy as the plan that you've laid before us, and it is very complex,
as you know.
�And you understand it extremely well, but it has never been
tried anywhere else in the world. Our task is develop a package that has the
broad support and the confidence of the American people, and I must say that
I have sincere concern as to whether massive government intervention arising
from dozens of new government agencies can achieve that consensus.
I was bora and raised in Texas, and I've lived there all my life.
But today I'm going to join my colleague, Mel Hancock, and adopt Missouri as
my temporary residence. Someone has to show me why we should put at risk the
health of our people and that of our economy, which is embodied in such a
complete, incredibly complex overhaul of our health care system without an
empirical pilot program test. There are 10 miUion Americans employed in
health-relatedfieldstoday. Nearly all their jobs would be changed to some
extent under your plan, and many would be eliminated. We don't yet know how
many jobs, particularly in small business, will be lost as a result of the
$275 billion tax increase in the recent budget. And now the admimstration is
talking about employer mandates and a new tax on small businesses as health
care costs are shifted to that job-producing sector of our economy.
I'm personally genuinely skeptical about the claim that the
president's plan will create new jobs at all. Because evidence is that it
will do just the opposite. Martin Feldstein (sp) last week estimated the
president's plan will cause a 6.4-percent decline in worker take-home pay,
$115 billion decline in aggregate wages, and the disparity between the
administration's in-house analysis and Dr. Feldstein's is certainly alarming.
You know, we've got to reflect back, too, that Lyndon Johnson was
told back in the '60s, according to a Washington Post article last week, that
the Medicare program would only cost a half billion dollars when fully
implemented.
Health care reform isn't a product to be packaged and sold like a
toaster on the Home Shopping Network. We've got to know how it works, what it
will really cost ~ both government and the private sector, and how those
costs are going to be paid for, and we must be sure the American people read
the warning labels and that the information that they're given is accurate.
And that's what this conmiittee is all about. I know that's why you're here
today, not as the first lady per se, but rather as lead architect of the
administration's approach to health care.
I do believe this process will ultimately result in changes to our health
care system that will benefit the American people, and I intend to do my part
to help bring that about. And I commend you for personally taking on what I
think is the single most daunting domestic problem facing this country in the
next ten years.
�f
REP. ROSTENKOWSKI: Mr. Stark?
REP. STARK: Thank you, Mr. Chairman, and good moming, Mrs.
Clinton. It's an honor to join Chairman Rostenkowski and the members of the
Ways and Committee to welcome you to our committee this morning.
The administration has put forward a bold and comprehensive health
plan which embraces the goals of universal coverage, cost control, and a fair
way to pay for it. For years, we've stmggled to address the problems of
health care system, and only intermittent, incremental and limited successes
have been ours. At long last, we have a president and a first lady in the
White House who understand the need for a comprehensive solution and are
committed to real reform.
The ball now comes to our court. It's up to us to enact a plan
that will achieve the goals enunciated so well by you and the president. This
will be the most important and far-reaching challenge ever tackled by any
sitting member of Congress.
The president's plan includes many positive features which
I support and will work to retain in the final legislation. In particular, I
support the president's courageous decision to impose responsibility for
financing on all individuals and all employers.
None of this will work unless we limit the rate of growth, however,
in public and private health spending.
Of course, in a plan as complex as has been suggested, there are
areas in which there may be some questions and doubts. For example, I don't
believe that states should be given the primary responsibility to enact,
implement and enforce the provisions of the national plan. Our CaHfomia
governor, for instance, the Honorable Pete Wilson, has already issued a
release to announce that the president's plan is unnecessary and he will
oppose it. So much for his concern for millions of Califomians with no
health insurance.
I can't in good conscience ask my constituents to put their health
security in the hands of a governor who appears to have no desire or
commitment to carry out President Clinton's plan. We must have a definitive
federal plan from which any state may opt out if they match or improve upon
the federal standards of cost, quality and coverage.
I look forward to continued cooperation with the administration
over the next year to resolve the technical differences and to achieve
significant reforms in our health care system. Thanks very much for being
with us this morning.
�REP. ROSTENKOWSKI: Mr. Thomas.
REP. BILL THOMAS (R-CA): Good moming, Mr. Chairman.
Mrs. Clinton, I join my colleagues in welcoming you here today to
discuss the president's proposal for health reform. I commend you and the
president for undertaking this enormous task.
The president's proposal for health care reform has laudable goals
-health security for all, controlled costs, improved quality, less
bureaucracy and waste ~ goals, I think, that we can all agree upon. We
could, I'm sure reach agreement quickly on several important aspects of the
president's plan, including insurance market reform, administrative
simplification, antitmst, malpractice reform, and the reduction of fraud and
abuse.
There are, however, for me several areas of concern. First,
I believe the regional aUiances as currently stmctured will result in
micromanagement of health care plans and providers participating in those
plans. The proposal delegates a tremendous number of functions to the
regional alliance, and I snare the concern of my colleague about the
governing board, which will not include representatives from the health care
community whose participation will be critical to the success of any plan.
Second, I doubt the assumed effectiveness of premium caps for
controlling the growth of health care costs. Furthermore, I beUeve that this
policy could result in a harmful reduction in health care quaUty.
Third, this plan contains an employer mandate that wiU likely
compromise to a degree our economic recovery.
Fourth, I'm concerned that the plan relies too heavily on Medicare
and Medicaid cuts that in all Ukelihood will be unattainable. The remaining
financing elements are equally problematic. Senator Moynihan called them a
fantasy. Regardless of the nomenclature, the mandatory premium payment will
have the net effect of a payroll tax.
Fifth, I worry about the plan requiring states to perform critical
responsibilities that will be aU but impossible for some states to meet.
Sixth, I'm troubled by the potential of this proposal for stifUng
innovative new technologies and treatments.
�7
While each of these concems is serious, none is insurmountable.
The AjTierican people are counting on us to sit down and work out our
differences. I'm optimistic that we wiU not disappoint them, but we do need
to be honest with the American people about what meaningful reform wiU
entail. We need to be honest about the financing of these changes. No new
benefits until after real savings have been achieved, no desserts before the
vegetables.
The American people desire and deserve a health care deUvery
system that wiU hold costs down and keep quality high. Each of us beheves
we have the answer. All of us need to dedicate ourselves to the proposition
that we will not let the good or the better sUp away because it does not
meet our particular definition of the best.
Thank you for putting health care reform in the spotlight.
Together, we can turn promise into a reality.
REP. ROSTENKOWSKI: Let me close out the opening statements, Mrs.
Clinton, by saying that in my opinion, we have already come an enormous
distance in this long journey. The president has succeeded in changing the
debate from whether we should have reform to what type of reform it should
be. He has put a bold and comprehensive plan before the Congress. Now, it is
up to us to respond with the same sense of urgency and commitment which he
has demonstrated. I intend to do no less.
Mrs. Clinton, welcome to the committee. After you have spoken,
members will be able to ask questions. However, because you must leave by
noon, I will ask the members of the committee to observe a Umit of one
question in order that the question and your response will take no longer
than two minutes for each member. Mrs. Clinton, please proceed with your
statement.
MRS. CLINTON: Thank you, Mr. Chairman.
I want to thank you and all of the members of the committee for
the many hours of meetings and consultation, review and good advice that you
have provided us throughout this process. It has been a real personal
pleasure for me to get to know many of you personaUy and to work with you
and to watch all of us move toward the realization that health care reform
must be achieved for the good of our country.
During the past months, as I have worked to educate myself about
the problems facing our nation and facing American citizens about health
care, I have learned a great deal. The official reason I am here today is
because I have had that responsibiUty. But more importantly for me, I'm here
as a mother, a wife, a daughter, a sister, a woman.
�.»
\
I'm here as an American citizen concemed about the health of her family and
the health of her nation.
Like so many Americans, I have seen first-hand the strengths of
our health care system as well as its frailties. I know what it's like to be
overwhelmed with forms and regulations and confusing medical choices when a
family member is dying. I know the anguish that comes when it is impossible
to weigh choices or make rational decisions, to understand what the
government regulations or insurance fine print might say. I know the
fmstrations that are felt when judgments about health care too often seem
divorced from common sense and human experience.
I know from my own experiences and from the conversations I've been
privileged to have with thousands of our fellow citizens across this country
that something is wrong with our health care system and that it needs to be
fixed.
I realize that we all have our own perspectives on how to solve
the health care crisis. Each of us brings our own personal perspective to
this issue.
Let me say, though, that when the president set up the health care
task force and began this journey, he was committed to a simple principle:
to build on what works in our current system and tofixwhat is broken.
Throughout this process, we have not lost sight of that goal. The
president's plan honors and preserves the high quality of care Ajnericans have
come to know - our unparalleled doctors, nurses and other health care
professionals, our hospitals and sophisticated technology. It also honors and
preserves every family's ability to chose a doctor and other care givers. But
we must acknowledge that parts of the system are broken and if we go on
without change the consequences will be even more costly for milUons of
Americans and even more disastrous for the nation in both human economic
terms.
While we do look forward to the discussion on the details of the
reform, and I am so grateful for your willingness to engage in this process
with the seriousness and commitment you bring to it, the president wiU
insist on certain overriding principles: security, simplicity, choice,
savings, quality and responsibility. Each detail we discuss should be
measured against how far a resolution of that detail moves us toward
achieving one or more of those principles.
�t
We may disagree on the exact formula for achieving reform, but I
hope we can, and tmst we will, agree on one thing from the outset: that when
our work is done, when the Congress has done what only the Congress can do to
bring all of the disparate voices of America into these rooms to hammer out
the choices that confront us, every American will receive a health security
card guaranteeing a comprehensive package of benefits that can never be taken
away under any circumstance.
I have Ustened, as you have, to thousands of ordinary Americans
across our country talk about health care. I know about the tragedies of
hard-working families and innocent children who are locked out of our health
care system for all the wrong reasons. As a mother, I can understand the
feelings of helplessness that must come when a parent can't afford a
vaccination or a well-child exam or cannot pay for that x-ray or prescription
for a sick chUd.
As a wife, I can imagine the fear that grips a couple whose health
insurance vanishes because of a lost job, a layoff or an unexpected illness.
I can see, as a sister, the inequities and inconsistencies of a health care
system that offers widely-varying coverage, depending on where a family
member lives or works. And as a daughter, I can appreciate the suffering that
comes when a parent's treatment is determined as much by bureaucratic mles
and regulations as by a doctor's expertise. And as a woman who has spent many
years in the work force, I can empathize with those who labor for a Ufetime
and still cannot be assured they will always have health coverage.
If we put ourselves in the position of people around our country
who face these issues every day, if we recognize that the upcoming debate is
not about any one set of citizens but about all of us, if we recognize that
every single month, 2.25 million Americans who are insured lose their
insurance for some period of time, then we know when we talk about security,
it is not about security for someone else; it is about security for all of
us.
I've had a rare opportumty to meet with Uterally thousands of
Americans across our country. I've sat in living rooms talking to farm
famihes in Iowa. I've sat on loading docks talking to uninsured workers
who've worked in the same place for 10,15, 20 years without insurance. I've
sat in hospital waiting rooms talking to doctors, nurses, pharmacists. I've
had a unique opportunity to hear firsthand about what is right and what is
broken.
I have read letter upon letter of the more than 700,000 that we've
received from citizens all over the country who took the time to sit down and
share their concerns.
�lo
The president's plan is not the product of any one person's work,
nor even of the group that he asked to do it. It is Uterally the product of
the work of thousands of people who shared their ideas, their research, and
their personal experiences and time with us. Their overriding message to all
of us is that Americans can no wait for health care reform.
As we sit here today, Uterally hundreds and hundreds of Americans
will lose their health care insurance. Hundreds and hundreds of famUies wiU
make a decision to postpone getting that primary or preventive health care
because they cannot afford it. Thousands more will show up at the doors of
our emergency rooms to seek help because it is the only place avaUable to
them. Business owners both large and small wiU be stmggling with insurance
premium increases and trying to figure out how to keep doing the right thing
for themselves and their employees.
The task confronting us is complex, but it is urgent. The American
people rightly are watching all of us. They are impatient, but they are also
hopeful. They want change, they expect change, they deserve change. And they
want to see the government at the highest levels work for them. They want to
know that we have heard their stories.
Last week, the president outlined for Congress a plan that will
provide health care for every American, health care that can never be taken
away. As the president said and as he believes, this is not a partisan issue,
it is not an ideological battle, it is a problem to be solved that affects
all of us. And if all of us put it beyond politics as usual, open ourselves
up to look at whatever evidence comes our way to scmtinize that and to
analyze it, we will respond to the needs the American public have.
I know that you on this committee share these goals. As stewards
of the public tmst, this is your responsibility. And I'm looking forward
over the next weeks and months to not only working with you, but to watching
you craft the most important social policy that our nation will have
confronted in many decades. This is the chance for the Congress, this is the
chance for all of us to make a difference for every American no matter how
rich or how poor, whether employed or not, whether living in the country or the city. This is a
chance to make a statement that we know what is important in our country and we're about the
business of getting it done.
Thank you very much.
REP. ROSTENKOWSKI: Thank you, Mrs. CUnton.
I want to underscore the fact that I'm going to try to limit the
question to one question and an answer in a two-minute frame period.
�II
^
^
Mrs. Clinton, last week at the White House when we met, the
president made the observation that he would have a bUl to submit to the
Congress in the next two or three weeks. Is that still the same time frame?
MRS. CLINTON: That's what we're trying to accomplish, Mr.
Chairman.
REP. ROSTENKOWSKI: Thank you very much. Mr. Gibbons will inquire.
REP. GIBBONS: First of all, Mrs. CUnton, a very fine
presentation, and I am ~ I beUeve that the system that has been put forward
by the president satisfies security problems ~ health security. It satisfies
the quality of choices that are provided for individuals. I am concemed that
as a nation we're spending 14 percent of our gross domestic product for
health care which doesn't measure up very weU with the other industrial
competitors we have out there in the world.
What I want to hear from you is how do we expect to achieve
national savings in this program?
MRS. CLINTON: Mr. Gibbons, let me begin by asking the chairman if
I can have more than a minute to respond to that ~ (chuckles) ~ because I
think that not only is that a critical issue for the country to understand
and work over, but it is the key issue for this committee, whose
responsibility extends to matters of financing and revenues.
Let me begin by saying that the primary source of payment for the
health care system will remain as it currently is ~ employers and employees
contributing to their own health care. And I think it's important to stress
that there will be additional revenues coming from employers and employees
who do not now make contributions into any kind of health insurance plan.
We have adopted this approach because we believe it builds on what
is already available for most Americans. More than 90 percent of Americans
who are insured are insured through their employment, and rather than
creating any new system, we have buUt on that system.
However, we are also very sensitive to the fact that many
businesses and individuals will face some burdens that they have never
had before. That is why we intend to provide discounts for lower
wage employees and small businesses and those that employ low-wage employees
so that we can keep the cost of health care that wiU be required to as low
an amount as possible.
�11^
Now in order to achieve that, we believe there are savings in both
the private and the public systems that can be realized and better used, and
let me just give you one example of that. Currently, because we have so many
uninsured Americans who do show up at the emergency room to achieve care at
the last possible moment, we provide ~ as you weU know on this committee ~
something that's called disproportionate payment to hospitals that have a
disproportionate burden of individuals who are neither privately nor publicly
insured.
Once everyone is insured, we wiU no longer have to be spending
those federal dollars to reimburse hospitals that wiU now be able to obtain
reimbursement through the insurance that everyone wiU be required to have.
That money then can be used to help provide the kind of support and subsidy
for low-wage workers and their employers that wiU enable everyone to be in
the system. So, we think that it's these kinds of reaUocations within the
system that will make a difference. And we could go on, but my redtightis
on, Mr. Gibbons.
REP. ROSTENKOWSKI: Mr. Archer.
REP. BILL ARCHER (R-TX): Thank you, Mr. Chairman.
It's pretty hard to get into this health care thing in ten-second
soundbites. I agree with you, Mrs. Clinton, that we need to do something now
to solve some of the real problems for coverage and for preexisting illness
and portability and that sort of thing. Can you tell the committee what the
timetable is for the implementation of your program? I understand that the
first state will not be required to come on board untU 1996. Is that
correct? And if so, when would it be fully implemented under your program
across the nation?
MRS. CLINTON: Mr. Archer, it will depend, of course, as to when
the legislation is passed and becomes law. Assuming that we are able to do
that before the end of this Congress next year, we do believe that having two
years to set up the system while we have some transition reforms, including
some of the insurance market reforms you talked about, would enable states to
start meeting their obligations starting in '97. Some states, as Mr. Stark
pointed out, are more willing and also more ready to meet those obligations,
and we expect they would be coming into the system before others. We would
like, however, to have all the states in by the end of '97-'98, somewhere in
that area. We will look at those years, though, and the phase-in, depending
upon what the final legislation looks like. But we are firmly committed to
the belief that the sooner we can achieve universal coverage, the better our
system will function, both in terms of the savings we can derive from it and
the overall economic impact at both the federal and state budgetary levels.
�»
REP. ARCHER: Thank you.
REP. ROSTENKOWSKI: Mr. Pickle.
REP. J.J. PICKLE (D-TX): Thank you, Mr. Chairman.
Mrs. CUnton, we are proud to have you here today and proud of
your leadership. Now, I'm deeply concerned about the effect it wiU have on
smaU business and about how we pay for it, but
I think that's going to be a common denominator through this whole hearing.
So, I want to jump ahead and ask you a question down the Une
about the alUances where, under the state program, if you're under 5,000,
they'll all pool their resources. Now, in my district, many of my employers
are using a third-party administrator. They contend strongly that they save
30 to 40 percent. They're lean, they're mean, and they're local. Yet, your
plan would say any under that level of 5,000 would be done away with. Now,
they're doing locally exactly what you want to do nationally. And it seems to
me that it's not enough to say, well, you pool it, they can do it cheaper. We
ought to have an alternative. So, I'm speaking now for the third-party
administrators. Why don't we have a choice, an alternative?
MRS. CLINTON: Mr. Pickle, there wiU be roles for third-party
administrators in the new system. Their roles, though, will be attached to
the accountable health plans.
What they will be doing is working with accountable health plans,
the providers, those who are actually delivering the services to make sure
that the services required to be delivered are done so in the most
cost-effective way. Because, you're right, what third-party administrators
have been able to do is to serve as kind of an intermediary between the
purchaser of insurance and the provider of services. What we would like to do
IS see their expertise located in the accountable health plan arena, where
they can continue to help the providers work to get their costs as low as
possible to be efficient.
REP. PICKLE: Allright.Now, Mrs. CUnton, I don't see anywhere
in the proposed plan a specific provision where the third-party
administrators can operate along the lines you say.
I hope we can make that clear, because to me they are making a real savings,
and we ought not to do away with that choice if it's a practical approach to
take.
MRS. CLINTON: Thank you.
O I thank you.
�REP. ROSTENKOWSKI: Mr. Rangel?
REP. CHARLES RANGEL (D-NY): Thank you, Mr. Chairman.
Madam First Lady, if I had more than two minutes, I would spend
more time congratulating you and the president for having brought this issue
to where it is. I think what we're saying in the Congress is that the nation
knows we have to do it and we've never got to this advanced stage before. Now
the question is: How do we do it, how do we pay for it, and how do we reach
a consensus?
I'm concerned about the impact on medically-underserved
communities, as weU as what we call just disaster communities. The Ulnesses
that are related to poverty, dmg and alcohol abuse will not even allow us to
be considered to be entering any risk pool. In addition to that, my state ~
and the question I'm asking now ~ suffers an inequity in the distribution of
Medicaid funds. It's a 50- 50 spUt, where some states get up to 75 percent
of reimbursement. And there's hardly a relationship between the cost cf our
care and the income of our people along poverty lines. In this plan, have you
considered a more equitable split between the federal share and the state
share?
MRS. CLINTON: Well, Mr. Rangel, let me just quickly say, as to
your first about underserved communities, because it's related to the share
that would be required for Medicaid, we share your concern. And that is why
we want to have large pools in which all risks are rated at the same
community level and you do not, therefore, eliminate whether it's an
individual with a preexisting condition or a population area with a
concentration of medical problems from coverage.
We think by pooling all people in these large risk pools, which is
the way insurance used to be done, where we were community rated instead of
experience rated, we will fairly bring in people who up until now have been
denied insurance or rejected tor it. And I think that will be particularly
beneficial in underserved urban and mral areas which have a
disproportionately high number of uninsured people, because even in your
district, Mr. Rangel, there are many, many hardworking people who cannot get
insurance. They are not privately insured and they're not publicly insured.
They will all have insurance streams now that will go with them, which will
enable them to be better taken care of.
As we fold in the Medicaid system, we will not be distinguishing
any longer between Medicaid recipients and others. The Medicaid stream wiU
follow the Medicaid recipients into the overall alliance, but they will not
be identified as a Medicaid recipient.
�If
0
I
And because they wiU no longer be in what is an ancUlary health program
only for those who are means tested and eligible, they wiU have the benefits
that will flow to all Americans, and we think that will eliminate some of the
problems we've had in the past about states having to pay a certain percentage
and the Uke because we will bring more resources into the entire insurance
coverage pool.
REP. RANGEL: WiU the ~
REP. ROSTENKOWSKI: The time of the ~
REP. RANGEL: ~ formula change?
MRS. CLINTON: I'm sorry; what?
REP. RANGEL: WiU the formula change at all?
MRS. CLINTON: For the initial period, we're looking at a
maintenance of effort, but we think that that can be made to work because of
the new funding that wiU come in through the pubUc health system, through
identifying providers as essential providers and having them part of the
*
network of care, and I'd be glad to put that into more detail for you.
REP. RANGEL: Thank you.
REP. ROSTENKOWSKI: Mr. Thomas.
REP. THOMAS: Thank you, Mr. Chairman.
Mrs. Clinton, the president's plan not only changes the health
care system but envisions a $91 billion reduction in the deficit, as well.
It's clear that this plan could shift from a deficit reducer to a deficit
increaser in the twinkling of an eye if Congress votes benefit increases in
the plan but doesn't vote the Medicare and Medicaid reductions. Can you join
me today in promising the American people that no new benefits wiU be
adopted and implemented untU after real and sufficient, banked savings have
been achieved?
MRS. CLINTON: We think, Mr. Thomas, the savings go hand in hand
with the benefits. Under the president's plan, the reduction in the rate of
increase in Medicare and Medicaid would be used in part to fund new benefits,
namely, prescription dmgs for the elderly and a beginning on a long-term
care proposal.
�They go hand in hand. One doesn't precede or foUow the other. But
clearly, in answer to your question, if we did not have the reduction in the
rate of increase in the public programs, we could not offer those benefits.
And I would only add one additional point. As we reduce the rate
of increase in the pubUc programs of Medicare and Medicaid, we have to have
some means to try to restrain the growth in the private sector, otherwise we
wUl merely have cost-shifting.
So either savings in the absence of some effort to control in the
private sector or no savings and new benefits would not work under our plan.
REP. THOMAS: If we vote the benefits and don't vote the
reductions, we will have failed.
MRS. CLINTON: Unless you have another revenue source, Mr. Thomas,
but you're right. If we do not bring down the rate of increase and vote the
benefits, our plan would not be able to support that.
REP. THOMAS: If we do it in that order, I'm with you.
REP. ROSTENKOWSKI: Mr. Stark wiU inquire.
REP. PETE STARK (D-CA): Thank you, Mr. Chairman.
Mrs. Clinton, our committee and the Health Subcommittee are very
proud of the success of the Medicare program. It's popular, it has an
overhead of only three cents on the dollar, and it leads the nation in
reducing the burden on providers in the use of electronic bilUng. It took
the lead in initiating hospital cost containment in the '80s, and real growth
in hospital spending was only 3.2 percent last year as opposed to 5.4 percent
nationally. In the first full year of physician payment reforms. Medicare
spending for physician services grew only 4.3 percent, about half the rate of
the private growth in physician spending. Overall, Medicare is a program
about which the federal government and the federal employees who mn it can
be very proud.
Now, you mentioned personal reference, and my reference is my mom.
And she's concerned that you want to cut 200 billion bucks out of Medicare
from providers and beneficiaries.
She knows she's going to get a pharmaceutical benefit and some
minor increase in long-term care, but she'U have a benefit that's worth
about thousands of dollars less than mine and yours under this plan, and her
costs are going to go up - Part B premium and her Medigap.
�n
^
y
I said, "Mom, tmst me. Tmst Mrs. Clinton." But what can you
add to reassure mother? (Laughter.)
MRS. CLINTON: Well, let me start ~ I have a mother, too, Mr.
Stark, so if we can't pass the mother test we're not going to be able to
succeed, are we?
REP. STARK: (Laughing.) We're in trouble! (Laughter.)
MRS. CLINTON: I do want to say that this committee, and
particularly your subcommittee, certainly do deserve an extraordinary amount
of honor and respect for what has proven to be our only universal health care
program, namely for those citizens over 65. And
I think there are many good lessons to be leamed from the efforts you have
engaged in over the years to make the Medicare program even better.
What I would look to, though, and what I wiU teU my mother and
hope to tell your mother is that one of the stmggles that you have had, and
the federal employees who have mn the Medicare system, is that although it
is a system that does provide care, it does so at very different rates in
different parts of the country. And we have countless examples of this, which
you know better than I, where you have, for example. Medicare recipients in a
city like New Haven, Connecticut being served at one half the cost as a
Medicare recipient in Boston just 100 miles away. You can look at a 300
percent differential in the service cost provided to Medicare recipients
between Miami, Florida and Milwaukee, Wisconsin.
Now, there is something that is not working in the Medicare
system to make the delivery of health care to our mothers cost- effective
while remaining high quality. And what we beUeve is that as we begin to
organize our health care delivery system better, as we put some of the
initiative into the hands of physicians and hospitals to make some of these
choices and move away from what we've tried to do, which is to tell them
exactly how much to charge but then give them a big bump if they say they're
in an area that costs more even though it's hard to justify that differential
in cost, that we can reduce the rate of increase in the Medicare program
without in any way undermining quality.
Now if all we were to do, though, is to say go out and reduce it
without on the private side trying to make some of these changes which the
Medicare people have been on the forefront of trying to figure out how to
initiate and reward, that would not work. So they go hand in hand ~ the
changes in the public system and the changes in the private system.
But I feel very comfortable telling my mother that the kind of
care that I want her to have can be delivered in a cost-effective,
high-quality way, and there are many places around this country that are
doing a better job, and we need to be rewarding them and we need to be
changing our system so that more providers do that instead of what is
currently much too costly care that has no discernible difference in quality
in the Medicare system.
�18
REP. STARK: Thanks, I'll pass it on.
REP. ROSTENKOWSKI: Mr. Jacobs.
REP. JACOBS: When Otis Bowen was secretary of HHS, he made
a study of the cigarette tax. The cigarette tax then was one-fourth what it
was in 1952 on account of inflation. In real copper pennies, it is stiU
substantially less than it was in '52 before anybody knew the dangers of the
use of tobacco. Teenage smoking fell off 17 percent merely and apparently as
a consequence of moving the tax up from 8 to 16 cents per pack. I say that
for the Record because I know that this is part of the proposal to do even
more.
Somebody said in a town meeting to me last night, "WeU, what if
people quit smoking? We wouldn't be able to collect any tax." And I said,
"Horrors," ~ (laughter) - "that would really be a substantial loss to
the nation, wouldn't it? How much would you pick up in cost ~ health cost
savings?"
The president mentioned violent crime as a health problem and some
critics have taken him to task for that. I agree with him. I'm a former
police officer. I know what he's talking about except for the ones who are
doing it. And by chance, you and I corresponded in the late 1970s about early
intervention ~ childhood intervention of cognitive training to break a chain
of educational deprivation in the early years of life, and I submit that that
very program is probably the best housing program, probably the best crime
program, and probably the best health program if you believe ~ and I know
you do, as I do - that an ounce of prevention is worth lots of biUions of
dollars.
My point is that in 1988 in the welfare reform, we adopted an
amendment which require HHS to have pilot programs in the ten AFDC regions
which would cost practically nothing, giving coUege credit to students who
would participate on a voluntary program of visiting in poor homes for the ^
purpose of helping the moms and the ultimate purpose of inculcating correct
linguistics and, well, really, social grace. That has never been implemented.
It was not implemented during the past four years. Secretary Shalala said
before the committee at the beginmng of the year, I believe, that she would
implement it. Is she going to?
MRS. CLINTON: I REP. ROSTENKOWSKI: How about a one-word answer, Mrs. Clinton.
MRS. CLINTON: Yes. (Laughter.)
�11
REP. ROSTENKOWSKI: Mrs. Johnson.
REP. NANCY JOHNSON (R-CF): Thank you, Mr. Chairman, and welcome,
Mrs. Clinton. Whether the payroU tax cap holds or increases as social
security taxes have an other such taxes, and whether the global budget is a
benign backstop or a hostUe and arbitrary eroder of quality and access
depends on whether your plan wiU in reality develop the savings you
anticipate.
As a member of the Health Care Subcommittee that has stmggled
hard to control the cost of Medicare, and rarely seen us be able to exceed 2
percent ~ I think maybe one year we got as far as 3 percent ~ it troubles
me that in the single year between '95 and '96 you're going to assume we're
going to be able to control ~ reduce Medicare costs for 4 percent and that
over three years we're going to be able to more than cut triem in half And
the same you're assuming in Medicaid. Now, those are two programs that
Congress has 100-percent power over in recent years, and they have ~ the
costs in those two programs have risen far faster than in the private sector,
where there have been very creative and aggressive efforts at both prevention
and wellness programs and a lot of things that have progressively cut costs.
So, given your assumptions in those areas, could you back them up?
Because, when coupled with your assumption that growth wiU be 5 percent in
the economy, I wonder whether or not we wiU be able to avoid an absolutely
skyrocketing payroll tax or the global budget as a heavy-handed backstop to
make your projections came tme.
MRS. CLINTON: WeU, Congresswoman, I think that those are very
important questions, but the way that we look at this is starting from a base
that is much higher than it needs to be. When we spend 14 percent of our GDP,
we know we're spending more than we need to spend. When we have a Medicare
program that, even after the budget, wiU grow at 11 percent and a Medicaid
program that will grow at 16 percent next year, when neither the populations
nor the morbidity statistics affecting those populations groups are growing
anywhere like that, we know we can get savings.
Now, the real issue is: How much and how fast? When can we
realize them, and how much can they be stabilized over time? And
I think that the lessons that we've learned in the private sector in those
areas where we have been successful in beginning to get a handle on costs
should be applied to the public sector. And I just want to make one quick
example of this, because I this is a very key point. I brought with me just
one of the millions of pieces of paper that we've looked at over the last
months. And it's a consumer guide to coronary artery bypass graft surgery
that is put out by the Pennsylvania Health Care Cost Containment CouncU.
�Now, this group here in Pennsylvania, before the president was
even elected, had been coUecting information about this particular operation
and others. If one looks at this and realizes that, if you first of aU take the differing costs so
that the cost of this particular surgery ranges from $21,000 to $84,000 in one state and then if
you look at the mortality in each of the hospitals that charges somewhere between 21 and 84,
there is no quality difference beti^een the 21,000 and the 84,000. In fact, if I remember
correctly, the 21,000 actually had a better-than-average survival rate and quality outcomes t h ^
some of those at the upper end.
There are so many lessons to be leamed. There are no incentives
in our current system overall in the private or in the pubUc to move
hysicians and hospitals toward making decisions that wiU result in
etter-delivered, higher-quaUty, cheaper coronary bypass surgery, when if we
had a system that, in both the Medicare and the private sector, began to push
toward making some of those decisions, we could actually in the state of
Pennsylvania provide more coronary bypass surgery at a cheaper cost than we
currently are to more people and retain quality.
g
And those are some of the issues that we want not only the country
to be talking about but we want our whole reform, through using market and
competitive forces, to help move providers toward making those decisions, and
that's why we don't think any kind of budget cap would tmly be enforceable
in most instances but would serve as a backstop so that there would be some
overall budget discipline but much of the work will be done in the doctors'
offices and in the hospitals as better information becomes available so that
these better decisions can be made.
REP. ROSTENKOWSKI: Mr. Matsui will inquire.
REP. ROBERT T. MATSUI (D-CA): Thank you, Mr. Chairman.
Mrs. Clinton, I would like to commend you, the president and your
staff for the tremendous job that you and all of you have done in terms of
putting this package together. I think it's a tremendous package. It's not
only a first start but it's
a basis upon which all of us can add to make sure we have affordable health
care in America during this session of Congress.
I'd like to ask you a question regarding the mandated benefits.
�^
We're going to receive a lot of opposition from so-called small businesses on
that particular issue, and I think it's essential to this program if, in
fact, we continue to have health care delivered on an employer-based system
as you have proposed, it's my hope that during the course of this debate, you
and the president and others that will be speaking on this wiU explain to
the American pubUc the benefits and the justice involved in making sure that
all employers insure all their employees, because now there's a
cross-subsidization, as we know, insurance premiums go up, because of the
fact that some employees are not covered by their employers.
Perhaps you can comment on that because I thought your explanation
at the conference we had at the beginning of our session from the August
recess was very, very helpful to many of us.
MRS. CLINTON: Well, Mr. Matsui, as you pointed out, what we have
is a situation in which the majority of our businesses, both small and large,
do provide some insurance. For them, the cost is not only the direct cost
that comes from making their contribution to their employees' insurance, but
it is the indirect costs they assume because other businesses do not provide
any assistance for their employees.
Now, if you go down any Main Street in America, you can go by a
store where they provide insurance and then a store that doesn't and then a
store that does, and you can just go on down the block. WeU, when the
employees of the store that does not provide any insurance and there's no
opportunity because of the wage level of the employees for them to enter the
market to buy their own insurance, when those employees get sick, they go to
the same hospital in the same town that is paid for with the health care
premiums that are paid by the employers and employees of the two stores on
both sides. The result is that the uninsured, then, shift the cost of their
care onto the health care premiums paid by those businesses and individuals
who do bear the burden in our society. It doesn't strike us as fair that
those businesses that have made the commitment to health care should not only
bear the burden for their own employees but literally the burden of the
employees of others who have not made the same choice.
Yet at the sametime,we are sensitive to the costs that confront
some of those who have not. And one of the problems in this debate about
small business is that many small business owners are looking at the
insurance market as it currently exists. And they are saying "How on earth
could I afford to go into this market and pay the average going rate for
insurance that I know is what is being charged?"
�We are talking about a reorganized, re-formed insurance market
that businesses would be in. They would not only be part of a very large
purchasing pool, which we know wiU bring down their costs, but for the small
businesses and the low-wage employees, they would be given a discount,
because we want all businesses to be fairly treated, which means all should
contribute, but it also means we should cap the costs at the lower end for
the small businesses. And we have mn now some computer simulations, and
we've had actually a number of businesses go into the SmaU Business
Administration and sit down with their spread sheets and their balance sheets
and they've mn those figures themselves. And for many small businesses that
currently ensure, they will see very large decreases. And for those that do
not, the costs will be affordable as we have laid them out.
REP. ROSTENKOWSKI: The chair is going to make the observation
that we're mnning a little behind schedule in hopes that members wUl
shorten the question as opposed to making the statement. We wiU get back on
track.
Ms. Kennelly.
REP. BARBARA B. KENNELLY (D-CN): Thank you, Mrs. Clinton, for
cormng.
Mrs. Clinton, under the president's plan, he specifically mentions
reproductive health services. Currently under most insurance plans, they are
silent concerning this. They leave those decisions up to the doctor, up to
the patient. And under current law ~ and I cite specificaUy the PubUc
Health Service Act ~ there is a conscience clause, and that, for example,
would apply to a Catholic hospital. My question to you: Is it possible that
this conscience clause could cover an entire health plan?
MRS. CLINTON: Yes, because in our conversations with the CathoUc
Hospital Association, which presented a plan very similar to the one that we
are coming forward with, even again before the president was elected, we
anticipate that their will be, for example, catholic health plans in many
areas that will link hospitals and mayoe even teaching hospitals and
providers, and we do think that that would be possible and would be
permitted.
REP. KENNELLY: Well, then, take it a step further. Could a
conscience clause cover an entire alUance?
MRS. CLINTON: In a whole state?
REP. KENNELLY: Or a large alliance?
�MRS. CLINTON: I don't beUeve so, because I think that what we
are attempting to do is to provide the same kind of access to
pregnancy-related services that is currently in force now. And, certainly,
some states have constitutionally protected regulations that govem abortion,
which would be abided by, but
I don't think any state or any region of a state that's set up an alUance
would, under current constitutional law, be able to prohibit that.
REP. KENNELLY: Thank you, Mrs. Clinton.
REP. ROSTENKOWSKI: Mr. Houghton.
REP. AMO HOUGHTON (R-NY): Thank you very much, Mr. Chairman.
Mrs. Clinton, when I was a Uttle boy, I used to look up at the
wall and see those wonderful Normal Rockwell paintings, "The Four
Freedoms," and you're really instituting a fifth freedom, the freedom from
care, the freedom from the ability to worry about health considerations. The
thing that I would like to ask you is this. We have a very deUcate system
here, and it's called democracy. And why is it that the whole concept of
managed competition has moved away from the original thought proposed by the
Jackson Hole group towards mandates and federal controls and price controls,
away from the federal government spelling out the basic outlines and then
stepping back and letting private industry, private individuals, communities,
have incentives and have tax credits and things like that to accompUsh the
same thing?
MRS. CLINTON: Mr. Houghton, we believe that we have taken what
managed competition has developed theoretically and analyzed it and actuaUy
come up with a plan that rests on competitive and market forces, but
recognizes that there are certain problems within our health care system that
competition alone either could not handle or could not handle in a timely
enough manner to deal with the extraordinary budget and economic pressures we
are facing.
And one example is universal coverage, that the theorists of
managed competition who have worked on this for a very long time wiU
admit that it is not clear at what point we could reach universal
coverage under a pure managed competition theory.
Yet, if we do not reach universal coverage, then we continue to have
cost-shifting, and among the problems that would then be faced in any managed
competition system is how to deal with the continuing health care costs of
the uninsured and how to adjust risks for them. We beUeve, if we have
everybody in the system, that will give us, for the first time, a tmly
competitive health care system, which we have never had up untU now.
�You know, many industries, like the ones that you're intimately
familiar with, have had to become more efficient in the last decades because
of external competition ~ a threat from Europe, a threat from Asia. So they
had to look hard at where their costs were and make some hard decisions. We
don't have external competition in the health care industry in our country.
We have to create it, and we beUeve that the plan the president's proposing
takes the best of a competitive approach and puts that to work. And we do
want the govemment to get out of the way, but we think everybody needs to be
in the system as an example for the competitive forces to work most
efficiently.
REP. ROSTENKOWSKI: Mr. Andrews.
REP. MICHAEL ANDREWS (D-TX): Thank you, Mr. Chairman.
And good morning, Mrs. Clinton. I'd Uke to foUow up on what my
friend from New York asked you about and just visit with you about a concem
I have about your proposal. And that is that what I think may well be an
inordinate amount of government regulation and ultimately micromanagement,
which is exactly where we want to move away from. The idea of global budgets
and premium caps, it seems to me, may well cause our providers not to compete
to keep their costs down but to maybe game the system to get to the cap. And
with a situation like global budgets, where different states give different
amounts to Medicare recipients, some as widely as disparate as two to one,
don't we mn the risk, by these kinds of controls, undermining the very kind
of competition we're trying to create in the marketplace?
MRS. CLINTON: Well, Congressman, you know, that is one of the
sort of great theoretical debates we will have in the coming months, because
I certainly appreciate your concerns. But it is very difficult to understand
why this particular industry should essentially be without any kind of
budgetary discipline, since every other industry has some kind of discipline
built in, whether it's competition from the Japanese on how much a car costs
or competition from the retailer down the street to see whether or not you get
a good deal.
�Now, in order for us to move from the kind of system we've had,
which has basically been a blank-check system, without any kind of effort to
rein in costs in any reasonable way over time to where you and I both want to
get, which is high-quaUty providers competing on the basis of quaUty and
price and not necessarily the kind of continuing micromanagement,
overregulated approach that we have seen that does not control costs but
continues to reward inefficiency, we believe that the premium cap provides a
balance between the micromanagement and over-regulation we do want to
eliminate from the system in order to simpUfy it, and the danger that in the
absence of some kind of budget targets, we wiU continue to have a system
that is out of control, that pushes on political levers instead of
competitive ones.
But as you and I have talked in the past, we want to make sure that
the way we stmcture this works the way we intend for it to stmcture, and to
that end, we're continuing to have very fmitful discussions with many of the
original theorists behind managed competition, with the American Hospital
Association, the AMA, other groups that are very concemed as weU.
But from our perspective, the country has been basically not
facing up to what health care costs and not creating a system in which health
care providers were encouraged to make cost-effective, quality- driven
decisions. Therefore, we have a lot of practice styles out there among
providers that are responsive to the continuing kind of flow of money from
the public or private sector. In order to change that, we think we need some
kind of budget discipline against which they will measure their
decision-making.
REP. ROSTENKOWSKI: Mr. (Levin ?) will inquire.
REP. SANDER LEVIN (D-MI) (?): Thank you.
Mrs. Clinton, this is a special moment for the committee and, I
think, a very special moment for women in this country, including my wife and
two daughters.
Could I ask you: You've combined a deep commitment with a
willingness to negotiate. Give us a further gUmpse of your priorities. What,
as you negotiate, do you hold most dear?
MRS. CLINTON: Well, Congressman, the way that I would say that is
pretty much the way that the president has said now on several occasions in
his public appearances.
�Vo
f
We beUeve that we have to achieve universal coverage
as soon as possible, as one example, in order to achieve security, but I
think that as we work through the details on this, how soon we get there,
what the level of benefits are, you know, we want to make sure that the
pieces of the system that will get us to universal coverage can work.
Another example might be the whole issue of quality. We want to be
sure that the information available to consumers so that they can make good
choices is quality driven, and we want to do that in as straightforward and
simple a way as possible so that we can sit down and every one of us can know
how to choose a health plan that we think is better for us and our famihes.
But there are many ways of getting to that end point. We want this
system to be as familiar as it can be to Americans. That's why we buUt it on
the employer-employee system that already works for so many. But there are
many details about the actual way it would function that we want to have a
good conversation about, but we want to measure it against the goals that the
president has laid out.
REP. LEVIN (?): Thank you.
REP. ROSTENKOWSKI: Mr. McCrery will inquire.
REP. JIM MCCRERY (R-LA): Thank you, Mr. Chairman.
Welcome, Mrs. CUnton. I look forward to future hearings when we
have more time so that those of us who are lawyers on the committee can
practice our art of develop a line of questioning which is designed to eUcit
responses to shed light on a particular area of the debate that we think the
jury - in this case, the pubUc - needs to know about. But in the two
minutes that we have, just as a point of information, I hope that this debate
revolves around facts.
There are problems in the system. And I hope we discuss the facts
about those problems and the cost of solving those problems. Immunization,
for example: in my state of Louisiana,
a poor state by any standard, there's no excuse for someone not getting
immunization. In our community health centers anybody can walk in and get
their child immunized for $5. And if they say they can't afford the $5, it's
waived.
So that's not a problem in Louisiana. If it's not a problem in
Louisiana, as poor as we are, I submit it shouldn't be a problem in any state
under the current funding.
�>7
One problem in the system, though, is the escalation of insurance
premiums. That means a lot of people can't afford insurance, smaU businesses
can't afford to provide it. What in your research through your task force
have you found is a primary reason for those insurance premiums going up? Let
me answer it: the cost of medical services going up. So what is the
underlying cost drivers that you've found, if you could just name three or
four, that get to those medical costs going up, driving those insurance
premiums up?
MRS. CLINTON: WeU, there are a number of costs, and I share your
hope that we will continue to have this kind of a dialogue because I do want
the facts to get out. I'm very confident that when the facts about what works
and what doesn't work get out, the American people and the Congress wiU make
a better decision. So that is something that I am committed to.
There are a number of issues. One is the kind of reimbursement
system that we have. WTien you reimburse on the basis of procedures
and tests as opposed to a per capita rate in which a plan or a
provider is given a certain amount of money to provide all services, you have
a difference in both motivation and incentive. If the way that you can be
paid is by ordering more and more tests, then it's human nature to order more
and more tests. And as Dr. Koop said the other day, he believes there is
about $200 billion in our system of unnecessary costs driven largely by what
he views as unnecessary kinds of tests and procedures.
The second issue I alluded to earlier is what is called practice
styles. Now, some of that I would argue is a result of different kinds of
pressures in a region or different kinds of training. But if you take certain
kinds of procedures and you try to determine why one is hospitalized in one
community and not hospitalized in another for the same kind of illness or
accident, you will find that practice styles of physicians determine often
how much a community pays for medical care when in a neighboring community a
practice style that, for example, wouldn't hospitalize somebody for the same
disease will keep the costs lower. So those two are major reasons.
Thirdly, the way that we have created a system in which some
people are paid for in certain ways and other people are not paid for or paid
for less causes the whole system to be trying to figure out how to get the
most return they possibly can from eveiybody who's got any money who walks in
the door. So it's not just the issue of shifting costs from the uninsured to
the insured, it is the issue of trying to figure out how many more patients
you can get into a hospital or a clinic who are insured.
�And then you're got the problem that we see in the insurance
market and the related costs associated with that in the providers of health
care, which is that once you don't insure everybody, you essentially, as they
say, "cherry pick" among people. Then you've got all different kinds of
policies with all different kinds ofriskfactors associated and costs, and
then you raise costs within the insurance market in order to decide who is
insured at what cost, and then you raise costs within the doctors' offices
and the hospitals to try to figure out how to get under whatever policy words
are written so that you can get reimbursed for the services you've provided.
You know, 15 years ago, give or take a few years, most physicians
were not spending more than 20 to 25 percent of their income onfiUingout
forms and paperwork. Today it is closer to 50 percent. Now, if you have to
hire more clerical workers and bookkeepers, if you have to hire, as many
doctors do, a person to sit on the phone to argue with insurance companies as
to who will get paid how much for providing which service, you then charge
more for the service you've provided because you have to pay for the
bookkeeping costs.
So aU of these things together have helped to create the kind of
atmosphere in which we see costs continuing to go up.
REP. ROSTENKOWSKI: Mr. Cardin.
REP. BENJAMIN L. CARDIN (D-MD): Mrs. Clinton, thank you for your
leadership in this area. First an observation on coverage, and then a
question on state flexibility.
There are very reasons to be very pleased by the initiative as to
the coverage. I am particularly pleased to see references to lead poisoning
with our children both in the public health initiative as well as screening
being part of the coverage package. Senator Bradley and I have come forward
with a way tofinancea program to try to prevent lead poisoning with our
children, and I would request that we work with you and you designate someone
on your staff that we can try to expand the lead poisoning initiative.
Question, though, on stateflexibility.I'm very pleased about the
stateflexibilityissues, and while we can be proud of some of the
accomplishments in Medicare, some of that has been at the cost of shifting to
the private sector. In your draft document, you mention exemptions or
exceptions to the ERISA statute to allow states to have all-payer rate
systems. My specific question is, will the initiative aUow a state like
Maryland to continue its all-payer rate system on hospital care? Maryland's
looking at expanding that to physician care ~ aU payer rates. Would that be
permitted? And would the authority be exercised either by the state or by the
alliance?
�r
MRS. CLINTON: WeU, congressman, that would be permitted if that
were an option that the state chose, and it would be up to the state to
determine how that would be implemented within the state. And I think that's
the kind offlexibihtythat we're talking about. But I'm very conscious of
Chairman Stark's concern, because Maryland, to take Maryland as an example,
is much further along in devBC-HWMC-H CLINTON 23THADD
\
XXX year?
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How do you do that since he is not an employee so there is no cap on
his premium of 20 percent? He has to pay the entire premium himself
MRS. CLINTON: WeU, Congressman, there wiU be a cap because he
is ~ we are treating the self-employed and the independent contractor as
though they were smaU businesses. We think that is the fairest way to do
this.
REP. MCDERMOTT: So the cap wiU be 80 percent or 20?
MRS. CLINTON: The cap will be appUed to the independent
contractor and the small business person who is self-employed. We wiU give
them the 100 percent tax deductibility, but we wiU also treat them as though
they were a small business with only one or two employees, because if the
independent contractor uses his wife on some jobs, or his son on some jobs,
that will be treated as a small business unit, so they wiU be entitled to
the discounts and caps available to small businesses plus the 100 percent tax
deductibility.
REP. MCDERMOTT: And if he can't pay it or doesn't pay it, or she
can't or doesn't pay it, what are the enforcement mechanisms?
MRS. CLINTON: Well, we do not want to create some large
bureaucracy to go chasing Americans who have not paid their health insurance
premiums, which is one of the reasons why we favor the employer-employee
system because then it will become automatic for most individuals.
For those individuals who are outside of any other employment
relations and are self-employed or an independent contractor, we beUeve that
the incentives and the opportunity to have affordable health care will be
very difficult for people to turn away from. And if they show up for care and
they cannot show their health security card, then there will be a process put
into motion to collect what is due for the care that they have received, so
they will be in a sense billed at the point of service, and it will be either
deducted from their wages or obtained through tax deductions in some other
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way.
REP. MCDERMOTT: Thank you.
REP. ROSTENKOWSKI: Mr. Shaw wiU inquire.
REP. SHAW: Thank you, Mr. Chairman. Mrs. Clinton, I'd too like to
express my appreciation for you being here today.
Mr. Stark raised his mother's question a few moments ago and it
seemed like we were going right along the line of everybody being concerned
about their mother. I do want to retum to that in that my mother is now one
of my constituents in the 22nd Congressional District of Florida.
You ~ in response to Mr. Stark's question, you made reference to
the comparison between Milwaukee and Miami. Miami is one of my ~ is part of
my new district which stretches from the southern part of Miami Beach up the
Atiantic Coast north of Palm Beach to Jupiter. This constitutes the most
elderly population of any congressional district in the country. This makes
me very concerned about the question of cuts in Medicare. Quite frankly, and
to be very blunt, a $200 billion cut in Medicare is totally unacceptable to
the 22nd Congressional District of Florida. It may even be unacceptable to
the Congress.
The hospital I was born in ~ St. Francis Hospital in Miami Beach
~ that was in business for over 70 years, a Catholic hospital, recently went
broke, and it went broke because it was
a high Medicare hospital. In other words, they had so many Medicare patients
who weren't paying their full way now under the formulas set up by this
Congress that they just did not have
a universal population to spread this expense over.
There are many other hospitals in my district, non-tax-supported
hospitals that are holding on by theirfingernails.Quite frankly, a
substantial cut in Medicare as it applies to the payment of hospitals wiU do
these hospitals under and we will no longer have non-tax supported hospitals
in the 22nd congressional district of Florida.
This is also tme across much of the Sunbelt and many areas that
have a high elderly population.
Assuming this is tme and that we are unable to pass the cuts in
Medicare that you have suggested in your plan, where would we go to make up
the shortfall of $200 billion and how is that shortfall projected in your
formula as it would apply to hospitals versus physicians?
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MRS. CLINTON: Well, Mr. Shaw, let me start by saying we project
$124 billion in cuts over seven years, not $200 bUlion in Medicare. And of
that $124 billion, we intend to provide new benefits from not cuts but
reductions in the rate of growth of Medicare. Because I think as we aU know,
we are not talking about taking the Medicare currently available and cutting
below that amount. We are talking about beginning to reduce the rate of
increase in Medicare of $124 bilUon, which would bring us down from about 11
percent increase annually to about 6 or 7 percent increase annuaUy.
Now, we believe that there are several advantages to your mother
and your other constituents in the 22nd congressional district. The first is
that with the reductions in the rate of increase, we wiU for the very first
time be providing a prescription dmg benefit for the elderly.
Much of the hospitalization costs and much of the large costs of
Medicare are due in no small measure from people either being inadequately or
wrongly dealt medication that they caimot afford and that they then end up
self-medicating themselves. This is a particular problem among the elderly
where you often have elderly patients on Medicare being discharged from the
hospital with a prescription in hand which they cannot afford to fUl, which
means then they don't take the prescription, they end back up in the hospital
which costs us more money and we're caught in a vicious circle. We think
providing this prescription dmgs will help both hospitals be more efficient
and individuals be better taken care of.
Secondly, we want to provide a long-term care benefit for the
elderly. Those two, prescription dmgs and long-term care, are the single
biggest issues to the elderly that we have encountered, whether it's
individual anecdotes or from ARP and other groups that represent the
interests of the elderly.
Specifically as to hospitals like the one that you are talking
about, we want those to be considered essential community providers,
and we have funds in this system to provide money for them because
they do provide a service that would otherwise not be available if they were
not there. So we intend to shore them up.
REP. ROSTENKOWSKI: The chair will make the observation that if
the question is going to be a two-minute question he's going to suggest that
the witness submit the answer in writing at a future time.
Mr. Kleczka will inquire.
REP. GERALD KLECZKA (D-WI): Thank you, Mr. Chairman.
Mrs. Clinton, I join my coUeagues in congratulating your
�leadership on this most important issue. And in reading the material that has
been presented to us, there's so much that I agree with. However, the three
areas which I'm having a problem with is the basic benefit package, which I ,
think is more a Cadillac plan than basic. In fact, I'm told that the cost
could be $6,000 for a family plan in 1985 instead of your $4,200. The
National Health Care Board ~ my fear there is that it's going to be a
bureaucracy; where on the one hand we're trying to cut the paperwork in the
private sector and for the providers and we're going to set up this National
Health Care Board which is going to grow. And my question is, what is the %
size of that or what do you envision the size to be and what is the cost?
The last concern is the 80 percent federal pickup for early
retirees. I think that's going to be a gigantic cost, which we're going to ~ '
(inaudible word) ~ cover, and I think it's probably an employer
responsibility in the early retiree years, and it's going to be kind of
unique when this early retiree turns 65 and he or she will have to pay 25
percent of the premiums, wherein for the last 10 years they're only paying
20.
MRS. CLINTON: Well, I can't possibly answer those questions in
this time period, but let me just quickly say on the benefits package, we
have priced that out very carefully, Congressman, and are willing to sit down
and show you what the figures are. We have a total agreement among aU of the
actuaries inside the government who have pounded out these figures. It's the
first time that the government actuaries have all sat in the same room and
actually stmggled over exactly what benefits would cost. And we think that
the benefits package is a fair one, particularly because it emphasizes
primary and preventive health care, which is not usually included in
insurance policies but which we think will save us money over the long mn.
So I'd be glad to sit down and show you that in detail and also give you
additional information about the national board and about the retirees.
REP. KLECZKA: Thank you very much.
REP. ROSTENKOWSKI: Mr. Lewis will inquire.
REP. JOHN LEWIS (D-GA): Thank you, Mr. Chairman.
Mrs. CUnton, I want to say to you what I've said before. As a
nation and as a people, we're more than lucky, but we're very blessed to have
you leading this effort for comprehensive and universal health care. I reaUy
believe when the historians pick up their pen and write about this period,
they will say that you were largely responsible for health care reform in
America.
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Now, my question is very simple. In the inner cities, providers
must face high crime and serious health problems. In mral areas, also as in
the inner cities, resources are limited
So I'm deeply concerned about how the proposed plan wiU impact both iimer
city and mral citizens. How do we ensure, how do we guarantee that these
people receive universal and quality health care?
MRS. CLINTON: WeU, Mr. Lewis, that's one of the key issues
facing this country because in our underserved urban and mral areas,
we have literally millions of Americans who are basicaUy denied
health care because there are not providers there and they have no insurance
to give them the resources to be able to pay for their care. We have a series
of proposals, including once again reinstituting and strengthening the
National Service Corps of health care providers so that doctors and nurses
and others wiU have their loans paid back and wiU be encouraged to go into
urban and mral areas where there are not health care professionals now.
We also want to see technology used to link areas where there are
not enough providers with those where there are, to provide the kind of
specialty care. But mostly, we think we will for the first time have a market
in which everyone will bring with him or her adequate funding so that they
will be able to therefore create a demand which will be met by health care
providers.
We also beUeve, though, we must look at making sure that
aUiances and accountable health plans do not discriminate against any area
geographically or any population, and we intend to put in protections against
that.
REP. ROSTENKOWSKI: (Off mike.)
REP. RICK SANTORUM (R-PA): Thank you, Mr. Chairman.
Thank you, Mrs. Clinton. Two quick follow-up questions. You
responded to one of the earlier questioners that your full plan would not be
implemented for several years and that there would be certain reforms that
could take place immediately, Uke insurance reform and others that we could
act on. Would you be amenable, would the administration be amenable to
actually doing that in two phases, doing something immediately, getting
something up and going that we can implement right away, and then waiting
down the road possibly for a longer debate, maybe later next year or the
following year, to pass a more comprehensive reform of the program ~ of the
system?
MRS. CLINTON: No.
�REP. SANTORUM: Okay. (Laughter.) See, I ask easy questions, Mrs.
~ number two, you ~ in foUow-up to Mr. McDermott's question about the
number of people who may, in fact, fall through the cracks in this system,
have you folks done any analysis of what percentage of the people m America
will still be uninsured under your proposal ~ homeless people, people who
have dropped out of the system? Wliat percent are stiU going to end up at the
emergency room without care, without an insurance card?
MRS. CLINTON: A very smaU percentage. Congressman, and we have
done the best analysis we can on that, and we've also looked at Hawau, which
as you know, has an employer/employee mandate, and they cover aU but about 2
or 3 percent of their population. And what we know wiU happen is there wiU
be people who are homeless, who have perhaps mental health problems, who have
not gotten into the system. But as they show up for care, they wiU be. And
we have enough funding in the system, we believe, to be able to take care of
their needs.
REP. SANTORUM: Under time, Mr. Chairman. (Laughter.)
REP. ROSTENKOWSKI: (Off mike) ~ Payne.
REP. LEWIS PAYNE (D-VA): Thank you very much, Mr. Chairman.
And thank you very much, Mrs. Clinton, for taking up the task of
reforming our nation's health care system. And I look forward to working with
you and with the administration to ensure that implement this within this
Congress.
I represent a very diverse congressional district. The University
of Virginia's Medical Center is in my district, one of the finest in the
country. I have 13 of 17 mral counties, though, that have been classified by
HHS as medically-underserved areas. And I'm pleased that the plan does look
at mral areas and the special needs that exist there.
I'm troubled, though, by one aspect of the president's plan, and
that is the reliance on the tax of tobacco and tobacco products m order to
finance health care reform, and I beUeve that there are some fundamental
questions as to the fairness and equity of singling out one product grown in
mral areas in one section of the country which will bear the burden of paying for and
generating new revenues for the health care system. I have some 5,000 tobacco farmers in my
district who rely on their product to support their families, and I would like this question: Can
we continue to work together? WiU the administration be open to discussing the source of
financing for the health care system and open to discussing the amount of the increase on ~ of
tax on tobacco and tobacco products?
�f
MRS. CLINTON: Mr. Payne, I want to assure you and the tobacco
growers in your district that the president and the administration are
sensitive to the economic burdens that they will confront when faced with
additional taxation. That's one of the reasons, as you know, that the
administration supported the domestic content legislation that was part of
the budget reconcUiation biU, to try to ensure that domestic tobacco
growers were treated fairly by the big tobacco manufacturing concems. And I
hope that the growers in your district know your support of that and the fact
that the president supported it, so that we can try to have at least a more
level playing field against imported and foreign tobacco.
But it is the president's belief that, even though we want to be
sensitive and we want to do things like domestic content to try to understand
and support the growers, that tobacco is the only product that, if used as
directed, can have such damaging health consequences.
And it's particularly damaging to young people. And we hope that
price sensitivity about tobacco products wiU discourage young people from
using them.
So we've tried very hard to balance our concerns about the tobacco
growers -- whom I know and you know often are not big growers, but small
growers with, you know, several dozen acres of tobacco ~ against both the
health consequences of tobacco use, the need to discourage use among young
people, and the beUef that tobacco taxes are a fair way to support health
care. But as always, this president will have an open door and will be
willing to talk, but there will be a tobacco tax as part of this legislation
for the reasons I've just enumerated.
REP. ROSTENKOWSKI: Mr. Hoagland will inquire.
REP. HOAGLAND: Let me add my kudos, Mrs. Clinton, to the efforts
of you and your staff on the health care task force that have placed health
care reform on the national agenda where it belongs.
I have long felt that one of the major defects of the Medicare
program is a lack of emphasis on preventive care. For instance. Medicare does
not pay for annual preventive physical exams. It waits untU our senior
citizens are sick before providing physician services, and by then, of
course, their condition is often advanced, it's more expensive to treat, and
less likely to be cured.
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I've introduced legislation for three years now to expand the
Medicare program to include a physical exam. I'm particularly interested in
the aspects of your program which encourage preventive care and lifestyle
changes to make people healthier, and I wonder if you might elaborate on
those.
MRS. CLINTON: Mr. Hoagland, we beUeve so strongly in primary and
preventive health care. We think it is good for the individual, and we think
It is good for the health care system, and it is both physically very good
and also economically because we think we will save money, which is why in
the benefits package that we are proposing to be guaranteed to every
American, we emphasize primary and preventive health care. It is also why we
are going to encourage medical schools to begin doing what they can to
encourage more young people to go into primary care. We have examples around
the country where that wiU make a difference. In fact, if you look at the
Medicare admissions and if you look at admissions of the under-65
population, hospital admissions often correlate with the number of
specialists that are in a particular area. And there is often no discernible
difference in the kind of treatment that is given in one community and
another community in terms of quaUty and outcome except that in one
community there are more primary and preventive care physicians as opposed to
specialists so that our balance has gotten wrong. We have 70 percent
specialists, 30 percent primary care physicians. We need to move toward
50-50, and we believe we can do that without in any way undermining either
quality or care and access for the entire population.
REP. ROSTENKOWSKI: Mr. Bunning will inquire.
REP. JIM BUNNING (R-KY): Thank you, Mr. Chairman. Mrs. Clinton, I
do agree with you that something needs to be done. I just have serious doubt
that the administration's plan, as we have discussed it, is the way to go.
But I will wait for the plan in biU form to make any kind of decision on
what's going on.
My concern is - the humorist P.G. Rourke (sp) mentioned recently
if you think health care is expensive, wait till you get it for free. The
administration claims that it wants to tax ~ and I'm following up on Mr.
Payne ~ smokers to make them pay for part of the new system, about $105
billion over five years or the $730 billion of the total cost.
If revenues from taxing cigarettes decline, do you think the
administration would consider taking other Uke substances, like caffeine,
cholesterol, salt, sugar, alcohol, and putting a tax on those like
substances?
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MRS. CLINTON: WeU, Mr. Bunning, there is nofi-eelunch in this
health care plan. It is not going to be free; everybody is going to be paying
something. Even people who are on Medicaid now wiU be paying somethmg if
they work, unlike today. And we think that is a big step forward for
responsibiUty.
Secondly, we don't take just taxes on tobacco, we are also looking
at assessing those corporations that are going to continue to be self-insured
because there wiU be certain benefits in the health care system, such as the
funding for academic health care centers that we believe they should be part
of supporting. If there is a way that you can ever come up with to tax
substances like the ones you've just named, we'U be glad to look at it.
I've not seen any that would be realistically implemented. But,
again, I would repeat that tobacco, insofar as we are aware, is the only
substance that if used correctly, as directed, has these health care
benefits. Neither alcohol nor caffeine nor the others, if used in moderation
or in small amounts, are proven to have the same kind of effects.
REP. ROSTENKOWSKI: Mr. McNulty.
REP. MICHAEL R. MCNULTY (D-NY): Thank you, Mr. Chairman.
Mrs. Clinton, I want to join with my colleagues in commending you
for your outstanding work and also in saluting the president for having the
guts to tackle this very complicated issue.
In our previous discussions, I have raised with you the issue of
treatment for the disease of addiction to alcohol and other dmgs, and I
think that the evidence is very clear that lack of such treatment results in
tremendously increased health care costs, loss of productivity on the job,
lost wages, and, heaven forbid, if someone gets involved in the criminal
justice system, tremendous costs there. I know I've mentioned to you before
in New York state, in the new prison cells that we've been building in the
past several years, it costs $100,000 per cell for every new ceU we're
building, between $25,000 and $30,000 a year per inmate to keep them
incarcerated. And it just seems to me that if we're catching people in the
earlier stages of their addiction, that we could save a lot of these costs.
Now, I understand that there is some coverage provided in your
proposal which will be expanded in later years. And I just wanted to ask for
the record if you could briefly explain what that coverage would be.
�(
MRS. CLINTON: Mr. McNulty, we agree with you 100 percent that if
we do not provide for substance abuse treatment and we don't provide for
mental health treatment, we are not dealing with health care problems. And
for too long, they have been put out on the margins and viewed as not related
to the overall health care issues confronting us.
And, in fact, it's not just the problems themselves; it's the
impact they have on underlying healtn problems, you know, and I think that
needs to be emphasized, that oftentimes hospital admissions and length of
stay are determined not just by whatever the physical ailment is, but by the complications
caused by underlying alcoholism or dmg abuse. And so, we think we need to treat those in
order to get health care costs down, as weU as to treat the individual problems that they
represent.
And in the comprehensive benefits package, we are proposing that
there will be for the first time guaranteed coverage for mental health and
substance abuse. We have worked very hard to make it a good beginning. It is
not adequate to meet the demand that is out there, but it wiU at least
provide a guaranteed base, and then I would imagine there would be a
supplemental insurance market, as weU as the public health system, that will
be available to add on to that for individuals that have particular needs.
REP. MCNULTY: Thank you.
REP. ROSTENKOWSKI: Mr. Reynolds will inquire.
REP. MEL REYNOLDS (D-IL): Thank you, Mr. Chairman.
Mrs. Clinton, let me join my colleagues in saying that I think
you've done an outstanding job, and the administration is to be really
rewarded for its efforts in this area. For too long in this country, we
haven't had this kind of a system.
I do have some concerns, however. I've hstened to your testimony
this morning, and I've heard a particular phrase in relating to Mr. Payne's
question about tobacco. You said if used as directed, that cigarette smoking
and tobacco has a severe impact on our health care system. If a Tech-9
semiautomatic weapon is used as directed, it will have a severe impact on our
health care system. Last year, there was $1.5 bUlion to $4 billion in health
care impact on our system. Has the administration, or is the administration
considering including a tax on firearms?
And, if not ~ to include in paying for the health care system? And,
if not, can we work together to look at this further down the road?
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MRS. CLINTON: Mr. Reynolds, we very much respect the proposal
that you've come with and have really worked to develop. And we will continue
to work and consult with you about it. We are not including it. I think the
president's preference is to get semiautomatic weapons out of the hands of
people who are killing themselves and each other with them and to take the
kind of steps that we need as a nation to put an end to this senseless
violence that is not only causing great human tragedy, but as you correctly
point out, causing unnecessary health care costs. Violence is a pubUc health
problem, and in many respects, it ranks at the very top because the leading
cause of death among young men of a certain age now is murder. And then we
have all of those costs associated with the individuals who are not kiUed
but who suffer grievous wounds and long-term injuries that we then pay for
one way or the other.
So we are committed, as you are, to trying to eliminate the level
of violence in this country, both as a moral matter but also as a health care
imperative.
REP. REYNOLDS: Thank you, Mr. Chairman.
REP. ROSTENKOWSKI: Mr. Grandy will inquire.
REP. FRED GRANDY (R-IA): Thank you, Mr. Chairman.
Mrs. Clinton, as we move from the principles articulated by the
president last week to the program that you designed with your staff that we
will consider, I want to say that I am impressed not just with the awareness
that you have created on this program, but with the understanding that has
begun even at the grass root level of the details of this program. And that
leads me to want to ask a responsibility question, taking the six principles.
There are two areas that were addressed this weekend at town
meetings that I would like you to at least answer a little bit. One is the
10-year grace period for corporations and unions to extend very generous
health benefit plans for a much longer period than a contract negotiation.
And the second is the transfer of responsibility from corporations to the
public sector to fund early retirees. And those are two tenets in your
proposal.
Here's the question: What is the cost of those two attempts to
transfer responsibility and, in some cases, forego revenue? And are these
items negotiable in terms of perhaps scaling them down to pay for benefits or
otherwise provide access earlier?
�6
MRS. CLINTON: Mr. Grandy, yes, how we do these are certainly
negotiable, because what we are attempting to do in the first instance with
the grace period is to avoid imposing a tax on people who have basically
foregone wage increases by having health benefits increase. And it's a very
difficult problem that we confront. Because what we have seen in our economy
over the last decade is that real wages have stayed largely flat and where
the increase in compensation has come has come in increasing benefits which
have had to increase faster than they should have because of the inflated
cost of those benefits.
We don't want to tax the middle class, and it's not just
negotiated bargaining contracts. It's many employers who have been wUling as
a competitive device to provide benefits that they would not otherwise have
had to and which may, for some period of time, exceed the guaranteed benefits
package. So we believe the fair thing to do is to give notice to these
employers and employees that, at a date certain, they wiU no longer get tax
preference for any benefits above the comprehensive benefits package. How
soon we get there and how quickly we can implement that without the kind of
tax increase that it would result in to many people is something we wiU show
you ourfigureson and talk about, because we want to reach a fair and
equitable resolution.
With respect to the retirees, we have costed that out at about
$4&l/2 billion. And there are several ways of looking at this issue. One is
that, for many employers who have large retiree costs, they have been the
most responsible businesses in our country. They have basically assumed a
huge social cost, not only in direct dollars in terms of insuring their
employees and their retirees, but in subsidizing many other sectors of the
economy that refuse to or neglected to insure their employees because those
employees were married to people who were taken care of by employers who bore
more responsibiUty.
So, there's been a direct cost and an indirect cost. Huge sectors of
our economy have been subsidized and able to provide either very low or no
benefits because they have hired spouses of people who have been given big
benefits. And we even have companies that nave been giving cash bonuses to
spouses not to go on their plan, but instead to let their employers, the
spouse's employer, bear the full cost.
So, we think there's been a real showing of responsibility that
has distorted the economy to the disadvantage of many of the businesses that
have borne the larger costs. Now, how fast we do that, the number of retirees
that are covered, the extent of the coverage, the sharing of the
responsibility, all of that is something that we want to be sure works out
and we'll be happy to talk to you about.
�HI
REP. GRANDY: Thank you.
REP. ROSTENKOWSKI: Mr. Coyne will mquire.
REP. WILLIAM J. COYNE (D-PA): Thank you, Mr. Chau-man.
Welcome, Mrs. CUnton, and thank you for your testimony and your
very comprehensive statement.
I see no reference in the preUminary reports of the plan to the
National Institute of Health or biomedical research, and it has been
suggested that possibly a $5 surcharge on monthly policies, health insurance
policies, might be a route to go to be able to provide for our medical
research costs. And beyond that, what is our plan for the unemployed, the 20
million unemployed that we have in our economy today?
MRS. CLINTON: WeU, Mr. Coyne, we believe in enhancing our
research capacity and we do have funds earmarked for that. But I agree with
you that if we can get a steady stream of funding into our research
institutions, we are likely to save money again in the long mn by finding
cures and by making other decisions that will enhance health. And we'll be
glad to look at the idea you just presented, as well as any others.
The unemployed wiU be federally subsidized because the unemployed
will sometimes work part of the year, but not all of the year. WTien they
work, they and their employer will make a proportionate payment into the
health alliance. The time of the year when they are unemployed, they wiU have a federal
subsidy. But we think a lot of the unemployed are seasonally unemployed. They are
periodically unemployed. They come in and out of the labor market. So that there will be some
money coming in from them and their employers to help match the federal money that will
make sure that they are fully covered.
REP. COYNE: But, as you know and everyone knows, there's a lot of
unemployed that have been unemployed for an awful long time, beyond even the
52 weeks of benefits that they get in compensation. And I think they need to
be attended to.
MRS. CLINTON: They will be. They wiU be members of the alUance,
and their share will be paid for by the federal government.
REP. ROSTENKOWSKI: Mr. Jefferson will inquire.
REP. WILLIAM J. JEFFERSON (D-LA): Thank you, Mr. Chairman.
�/
^
Mrs. Clinton, I , Uke the rest of the committee members, want to
thank you for your leadership in this area and for your personal investment,
particularly coming to my district and the others around the country to
inquire of our citizens.
CharUe Rangel and John Lewis have asked questions about the
reform - how reform affects the inner-city residents. I want to ask a
question that has two aspects. One is, most of the primary health care that's
being provided (in inner ?) cities is being provided by minority physicians,
particularly through the Medicaid program. They have combined themselves as
smaU cooperatives. They're concerned about how they'U be able to manage
their affairs when it looks as if the smaU groups are going to be squeezed
in this plan. The second is, there's a promise in the outline that I have
seen of infrastmcture support for pul?Uc hospitals and clinics. Could you
please tell me how the details of that might be developed and then comment on
the earlier part about how the small physician groups might operate in the
larger plan?
MRS. CLINTON: Mr. Jefferson, let me answer the first question
orally and then the second in writing because I can't possibly meet the
chairman's deadline trying to do both of those, if that would be aU right.
With respect to minority providers, solo practitioners, others in
both mral and urban areas, we anticipate several advantages in the proposal
that we have. The first is that in every region of the country, there will be
guaranteed in every alUance a network for all physicians to be members so
that no physician will be shut out from being able to compete for the
business of all of us who wiU put our health insurance premiums into these
large pools. There will be a guaranteed network on a fee-for-service model,
just as current medicine operates in most areas.
Secondly, there wiU be no permitted discrimination against any
physicians from joining more than one plan, if that physicians chooses to do
so, so that a physician could be both a member of the fee-for- service
network, and a PPO, for example ~ a preferred provider organization, and
there would be no penalty or prohibition against that.
We also anticipate and have had conversations with the National
Medical Association, with representatives of Hispanic physicians and others
as to how - when accountable health plans come in a bid for our business.
They will find it in their interest to make aUiances with and to have those
physicians as part of their networks because in order to serve the
populations that are already used to receiving care from certain physicians,
they will want those physicians to be affiliated with them so that it is more
likely when an individual comes to sign up for a plan, if they know the name
of the doctor or the name of the clinic that they are familiar with, they are
�more likely to sign up for that plan. So there wiU be, as I leamed when I
was in New Orleans and talking with representatives from some of the large
hospitals and clinics there, an incentive that has never existed before to
create partnership and relationships with iimer city physicians and mral
physicians to make them parts of these networks.
REP. ROSTENKOWSKI: Mr. Camp wiU inquire.
REP. DAVE CAMP (R-MI): Thank you, Mr. Chairman, and thank you,
Mrs. Clinton. My question - I have a two-part question involving primarily
farm families. Specifically, how wiU seasonal and migrant workers be
covered, and who will be responsible for their participation in a regional
plan?
And secondly, many farm families faU under the self-employed
category, and will the payroll tax be required even in unprofitable years,
often not a result of anything they've done but because of weather or other conditions, so that
they can continue to have, maybe, the smaU number of employees they have and continue in
business?
MRS. CLINTON: Well, in our work on behalf of health care needs of
farm families in particular, we believe that treating a farm family as a
small business, giving them 100 percent tax deductibility for their health
insurance costs, and capping the amount of money they have to contribute will
make health care affordable for farm families in ways it has never been
before.
In many of the instances where I've sat down and actually looked
at the bills of farm families and sat and looked at their records, what I
have been stmck by is how they are among the most responsible people in our
whole country. Oftentimes, they make enormous sacrifices to be insured. Often
they send a member of the family off to work in a business where insurance is
offered which then hurts the farm, but they at least are insured. And I think
that what we're offering will be very beneficial.
Now with respect to seasonal and migrant workers, the health care
benefits will be available to legal residents and citizens of this country,
and that is a decision that we have made, looking at all the numbers.
Certainly the public health facilities, the emergency rooms ~ as they are
now - will be available to those who are not currently citizens.
Now seasonal employees - just as now, when a farm family pays a
seasonal employee who is a citizen, they make some kind of report or the
responsibility shifts to the individual to make the report to the IRS about
wages. If the individual is an individual contractor as opposed to an
employee, then that individual will be responsible for his or her health
�/
'
care. If it is an employee, then the farmer wiU be responsible for the
proportion of time that the individual works for him, just as he would be
with FICA or Social Security or any other payments that are now required, but
the caps and the discounts would, of course, apply because of the wage of the
worker.
REP. ROSTENKOWSP: Mr. Deal wUl inquire.
REP. NATHAN DEAL (D-GA): Thank you, Mr. Chairman, and thank you,
Mrs. CUnton. I think aU would agree you've done a superb job this moming
of answering the questions. I would guess in your next Ufe that we ought to
submit your name for Jeopardy. (Laughter.)
One of the perceptions we're going to have to overcome in this
debate, those of us who are proponents of restmcturing the health care
system, is the suggestion in some quarters that we are going to be
subtracting from the quality of health care for
a percentage of our population.
In Massachusetts, we have many of the best hospitals in the world,
and this is going to be part of the debate. But Uke Mr. Rostenkowski and Mr.
Gephardt, Congressman McCrery and Speaker Foley, I have a Shriners' hospital
in my hometown in Springfield. They don't accept any government money, no
insurance payments. They're funded exclusively through charitable
contributions. There is no other totally free hospital system in this country
that I'm aware of And the Shriners have petitioned me on behalf of that
hospital that gives extraordinary care to anybody to raise the question of
you whether or not they're going to be subjected to a host of new mles,
regulations, or paperwork requirements that don't make sense for a hospital
that doesn't charge its patients. And if you could speak to that question
this morning, that would be much appreciated.
MRS. CLINTON: This is the firsttimeI've ever been asked that,
Mr. Neal, and my response ~
REP. NEAL: I'm moved, I have to tell you. Thank you. (Laughter.)
MRS. CLINTON: But my response is I surely hope not. You know,
that is one part of the system that's not broke, and we ougnt not to try to
fix it. And if they are totally subsidizing the care that they provide
without any government assistance of any sort, then we will certainly do what
we can to make sure that continues.
REP. NEAL: And I hope I might extend an invitation to you to
visit a Shriners' hospital, although I assume that the chairman wiU lobby
hard for Chicago. (Laughter.) He might prevaU over me.
�MRS. CLINTON: I've actually visited the Shriners' hospital in
Chicago. I share that hometown with the chairman, so ~ .
REP. NEAL: Thank you very much, Mrs. Chnton.
REP. ROSTENKOWSKI: (Laughs.) Mr. Brewster wUl inquire.
REP. BILL BREWSTER (D-OK): Thank you, Mr. Chairman.
First, I would like to applaud your efforts in this monumental
task. As a person who spent most of my life in health care, I know there's no
issue more complicated than this one.
For many of us, the small business mandates wiU be a very
difficult part. As a person who's been in smaU business, I know
workers' comp is also a problem for small business. I would hope
that you would look at the possibility of roUing the two together. I think
it can be very workable.
But the small business subsidy in the plan I notice also is
temporary. I don't see a timeframe listed. What is the timeframe you're
considering on subsidizing small business, low-income-type business in this
plan?
MRS. CLINTON: Mr. Brewster, we may very weU have to extend that
beyond what is normally thought of as temporary because we want to get the
system on stable footing, as a friend of mine said, sort of stabilize the
patient, and make sure that we get the kinds of savings and efficiencies that
we know will come once we have a better organized health care system. But we
certainly don't want to do anything that would impose unnecessary burdens on
small business at any point in this process. The whole hope and what many
people like Dr. Koop and others who have studied this really beUeve is that
once we get better organized systems of care, then a lot of these costs wiU
continue to decUne even though we are in the short mn ~ and I think this
is an important point to make - we are in the short mn going to be
increasing health care expenditures.
You know, that is something that when people talk about the impact
on small business is not a factor that is often looked at carefully. We are
going to be putting bilUons of new doUars into this system largely from the
employer-employee contribution, but also we're going to be very soon lowering
the cost to other employers so that jobs will be created, new hires will be
made, wages will be increased, and then at the same time if we are able to
add the prescription dmg benefit and the home health and long-term care
benefit there will be more jobs opening up for people in health care.
�0
^
So this is an issue in which there are many factors at work at one
time. And we are very confident that small business wiU in the medium and
long mn and most small businesses in the short mn be advantaged by what we
are doing and other small businesses wiU be created by what we are doing.
So we intend to look very carefully at how we protect small
businesses and give them the kind of fair, affordable health care they
deserve to have.
And I can't help but add, Mr. Brewster, as a pharmacist, you know
that one of our primary problems is getting affordable costs of prescription
dmgs avaUable to everybody, whether they're small business, big business,
individuals. And we want very much for this health care reform to make retaU
pharmacy, discount pharmacy, pharmaceuticals in general more avaUable at
. more affordable costs. That, we think, will help bring down costs in the long
mn.
REP. BREWSTER: Thank you.
REP. ROSTENKOWSKI: Mr. Hancock wiU inquire.
REP. MEL HANCOCK (R-MO): Mr. Clinton, one of the greatest
strengths of our society has been ~ and our system of government - is that
it has historically stressed individual responsibility and initiative. Now,
during the long period of development of the president's health care plan,
was there any consideration given to the inclusion of a "Medisave" type
account, which would be similar to a 40IK or an individual IRA, but dedicated
to pay to the individual's health care expenditures? Was this considered?
And, if not, why not?
MRS. CLINTON: Yes, it was, Mr. Hancock. We looked, I beUeve, at
every proposal for a "Medisave" or a medical IRA that we're aware of And
we do believe that it does promote individual responsibiUty, but we had
several questions after analysis that we had that we could not adequately
answer. One is that the medical IRA concept, in which individuals basically
put aside money that they will then be able to keep so long as they do not
use it, does nothing to encourage primary and preventive health care.
In fact, it is a continuation of one of the real weaknesses, we
think, in our current system, which is that many people are insured only for
catastrophic encounters and they, therefore, postpone seeking help as long as
possible. We want people actuaUy to get in and get good primary and
preventive health care so that their diabetes, for example, doesn't end up
with having to amputate a foot or whatever the other kinds of problems will
come from not being taken care of.
�c
And that was one of our problems with the
medical IRA concept, is that it did not provide the kind of incentives that
we think are necessary to reverse what has been one of the real problems in
the health care system of emphasizing catastrophic and medical emergency over
primary and preventive health care.
And the second issue is how we would ensure that aU persons were
covered. Many people wiU not be encouraged, unless required, to be
responsible, so that the medical IRA might work for some members of the
society who would either be encouraged to do so by their employer or would
understand the tax benefits. But for milUons and miUions of other
Americans, without some kind of mandatory system, either the kind of
individual mandate that the Senate Republicans have talked about or the
employer/employee contributions that is in our plan, we are afraid we will
still continue to have milUons of uninsured and underinsured Americans and
the costs wiU continue to be shifted and wUl continue to go up.
And those were our two primary problems.
REP. ROSTENKOWSKI: Mr. Kopetski wiU inquire.
REP. MIKE KOPETSKI (D-OR): Thank you, Mr. Chairman.
Welcome. I understand and appreciate the fact that under the
president's plan, the mental health component of the benefit package wiU
reach parity with the physical injury care by the year 2001. In spite of
this, we need to provide a wide range of services to the mentally ill, and in
most cases the least-restrictive treatment setting is the cheapest and, in
many cases, the most effective. Given the need for a shift in focus from
inpatient settings to outpatient settings, why are there 60 days of inpatient
hospitalization coverage avaUable in the mental health package but only 30
visits for outpatient psychotherapy?
MRS. CLINTON: The reason for that, Congressman, is that we are
trying to start with emphasizing the care of the most severely mentally iU,
those who do require the kind of inpatient intervention that often is linked
to the most severe kinds of mental illness. We thought that would be our
first responsibility, to provide that kind of system. And we intend to build
on the 30 days of outpatient treatment as we go forward. We also believe that
with a prescription dmg benefit, the costs of medication wiU be more
readily available for all different degrees of mental Ulness, and that the
30 days outpatient treatment combined with more affordable and accessible
medication is an adequate benefit. It is not where we think we should end up
as a country; that's why we have additional benefits that we would recommend
be phased in as we realize savings. But we think it is a very good and strong
beginning for mental health coverage.
�0
REP. KOPETSKI: Thank you.
REP. ROSTENKOWSKI: Mr. Herger?
REP. WALLY HERGER (R-CA): Thank you, Mr. Chauman.
Mrs. Clinton, as you're weU aware, we have a very major iUegal
immigration problem in our nation today, and regrettably, there isn't any
state where this is more pronounced than my own home state of Califomia.
It's been estimated that between $400 milUon and $500 million a year is
spent on Medicaid for iUegal immigrants. Could you teU me, under the
president's program, to what degree states would be mandated to continue this
unfunded coverage?
MRS. CLINTON: Well, Congressman, you're right that this is
a very serious problem, and in fact, one of the reasons why we have adopted
the position we have, which is that only legal residents and citizens wiU be
entitled to the comprehensive benefits and the health security card, is so
that we do not do anything to encourage even more Ulegal immigration in
return for trying to get those kinds of benefits. And that s why we have
drawn the line as we have drawn it. But we are left, as you rightly point
out, with a serious problem because we have a number of undocumented workers
and illegal aliens in the country right now, and they do show up at our
emergency rooms and they do use our pubUc health facilities.
We are hoping to work out a more equitable sharing of that
responsibility, and that is something that we will be looking at, and we
would welcome your advice about how best to do that so that individual states
don't bear the entire national burden for this cost.
REP. HERGER: So in other words, you're saying that where a state
like our state is paying the biU themselves ~ again, of almost a half
billion dollars a year -- that you would be looking at a way to finance this?
I've heard that perhaps there might be a pool. I don't know if you are
famiUar with that, if there's been any talk that's gone on on that extent or
to what the cost you felt this might be.
MRS. CLINTON: Well, congressman, we are looking at a variety of
alternatives, because we share your concern about this issue and the burden
that it places on local hospitals as well as state budgets. And we don't have
a final recommendation on that. But we do wish to work with you and others
who represent the affected states to try to come up with a more equitable
solution to those costs.
REP. HERGER: Thank you.
�REP. ROSTENKOWSKI: Mrs. Clinton, it's very difficult here trymg
to keep the trains mnning on time. I know what your schedule is, and I want
to make an observation.
I hope that your experience here has been as pleasant as I found
you a pleasant witness. I'm tempted to applaud you, but then again, that
would be only ~ (applause) ~ that would tmly be orUy if you didn't perform
as exceptionally as you did. And you were marvelous. You're a marvelous
witness.
I've been here for a few years. And I've seen not exclusively this
committee, but members of other committees wrestle with the health problem of
this country. One of the reasons I ran for reelection was so that I could try
in my little way to help solve this problem.
I think you and your husband are certain going to be the catalysts
in this. We need leadership. We have on both sides of this aisle tried to
solve this problem, but we needed somebody strong in the White House that was
wilUng to bite the bullet. I think in the very near future the president
will be known as your husband. Who's that fellow? That's HiUary's husband.
(Laughter.) With the outstanding job that you've done here, my compUments
to you, my compUments to the President of the United States for addressing
this problem, and I hope that by the end of this Congress it wiU be on the
president's desk, you standing at his side, for signature.
Thank you very much for joining us this morning.
MRS. CLINTON: Thank you, Mr. Chairman. (Applause.)
END
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�EXECUTIVE
OFFICE
OF
THE
PRESIDENT
29-Sep-1993 08:52am
TO:
(See Below)
FROM:
Jeffrey L. EUer
Office of Media Affairs
SUBJECT: HRC afternoon transcript from 9/28
THE REUTER TRANSCRIPT REPORT
HEARING OF THE HOUSE ENERGY AND COMMERCE COMMITTEE
SUBJECT: THE CLINTON HEALTH CARE PROPOSAL
CHAIRED BY: REPRESENTATIVE JOHN DINGELL (D-MI)
WITNESS:
FIRST LADY HILLARY CLINTON
2123 RAYBURN HOUSE OFFICE BUILDING
WASHINGTON DC
TUESDAY, SEPTEMBER 28, 1993
REP. DINGELL: (Sounds gavel.) The committee wiU come to order.
Today the committee is honored and happy to launch its hearings on the
president's health care reform proposal.
We welcome today most warmly the first lady, Mrs. Hillary Rodham
Clinton, as the lead-off witness in these hearings and as lead-off witness on
behalf of the administration.
Before we begin, the chair wishes to address a few housekeeping
matters. These were outlined in the memorandum which I sent to my colleagues
yesterday, but for the record, they will be repeated.
First, the chair will not be making an opening statement today,
and other opening statements today will be dispensed with so that the time
that the committee has can be used by Mrs. Clinton in the most efficient and
best fashion. Members may insert written statements for the record if they so
desire. And without objection, all members will be afforded rights at this
time to insert an appropriate opening statement in the record. Opportunity
will be later available for members to make oral opening statements at a
future hearing. The chair wishes to thank the members tor their cooperation
on this point.
Second, in order to enable the broadest possible participation of
members today, it is the intention of the chair to observe the mles of the
' .•
' . i, * ' .. " r''
�f -Tommittee strictiy because Mrs. Clinton's time with us today is most Umited.
* 1 know members wiU be fair to their colleagues who are waiting patiently for
an opportunity to question Mrs. CUnton by limiting their dialogue with the
witness to the allocated time.
Finally, and consistent with committee mle 4(c), members present
at the time the hearing was caUed to order will be recognized in order of
seniority, alternating, as is the custom, between the majority and the
minority. In light of the fact that we have two subcommittees who wiU be
�3-
0 vorking on this legislation, the chair will treat the chairwoman and the
^ ranking minority member of the commerce subcommittee, Mrs. CoUins and Mr.
Stearns, as having seniority immediately foUowing that of Mr. Waxman and Mr.
BUley respectively. The mle also provides that members not present at the
hearing when it was caUed to order will be recognized in order of their
appearance, and staff wiU be making careful note of the arrival of members
for this purpose.
The chair wants to thank the members of the committee for their
cooperation.
The chair thanks you, Mrs. Clinton, for your patience and for your
being present with us today. This is a rare occasion for both you and for the
committee. You are orUy the third first lady in history to testify before the
Congress, and this is the first time since 1986 that we have convened a fuU
committee hearing, which we have done to hear you. We are honored to have you
here today. I understand that you are appearing today without a formally
prepared text, so you are invited to proceed in any manner that you seem
appropriate.
MRS. CLINTON: Thank you very much, Mr. Chairman. I want to thank
you and the members of this committee for giving me this opportunity. But
more than that, I want to thank you for the time that you have spent with me
over the last months as we have worked through a lot of the issues that will
affect the future health care well-being of our country.
I would also particularly like to thank the chairman for the good
counsel that he has given to me as I have pursued the issues related to
health care reform. I think that is very appropriate for the chairman to have done because,
as we all know, 50 years ago the chairman's father introduced the Dingell-Murray-Wagner
BiU, the first national health insurance legislation ever put before the Congress. The
chairman's father understood the importance of providing health security for all Americans.
He fought vigorously to keep the idea alive in Congress for 15 years. And you, Mr.
Chairman, have continued that fight by introducing similar legislation in every session
since you succeeded your father in the House of Representatives. You both proved to
be men ahead of your time.
Although parts of your father's bill have been incorporated into
subsequent reform efforts, such as Medicare and Medicaid, we have yet to
fulfill your father's dream and the dreams of many other Americans of
providing comprehensive health care for all of our citizens.
Health care reform is not a new idea nor a revolutionary concept.
But while most Americans favor reform, we have failed as a nation to make
much progress when it comes to providing health security for every citizen.
Sadly, health reform in this country is less a story of the typical American
�"can do" attitude than a story of procrastination and parochialism and all
too often greed, fraud, waste and abuse.
Thomas Jefferson was the first president to talk about the
importance of individual health. Franklin Roosevelt hoped that health
security would be the other half of the Social Security system. But political
realities forced President Roosevelt to discard that dream, and the result,
as we know, has been ongoing insecurity for miUions of hardworking
Americans.
When Harry Tmman campaigned for a comprehensive health program in
1945, he told Congress, and I quote, "MiUions of our citizens do not now
have a full measure of opportunity to achieve and enjoy good health. Millions
do not now have protection or security against the economic effects of
sickness." But President Tmman's pleas for health security feU victim to
the politics of the day and scares about socialized medicine.
Dwight Eisenhower came before the Congress in 1955 and said that
health insurance could be improved by expanding the scope of the benefits
provided. John F. Kennedy proposed expanding coverage to the elderly and the
mentally ill. By the early 1960s, both Presidents Eisenhower and Kennedy
could not say that their hopes of health security had gone forward but,
instead, they saw once again the familiar sight of a dream of health security
being stalled by outside interest groups andpartisan bickering in the
Congress.
Then came Presidents Lyndon Johnson, Richard Nixon and Jimmy
Carter. There was progress made on Medicare and Medicaid. President Nixon
came forward with a comprehensive health care reform proposal that built on
the employer-employee system. President Carter proposed a number of advances,
and particularly Mrs. Carter championed the cause of mental health benefits.
They, too, envisioned reforms that would give Americans more health security
and our nation more economic security. But like their predecessors, their efforts and
their hopes were not realized.
So here we are in 1993, 50 years after the chairman's father
introduced the first legislation. We are still wrestling with many of the
same issues and the same problems that previous generations have worked on.
The difference is that today our system has many problems that have gotten
increasingly expensive, and the difficulties of delivering health care in a
cost-effective way is making a challenge to the fiscal integrity of the
federal and state governments, to businesses, to individuals across the
country. Now is our chance to beat the historical odds and give the American
people the health security they need and deserve.
For the past 12 years, this committee has fought to extend health
�r ':are benefits to every American. For years, this committee has tried to
' i Oot-out fraud and abuse in the health care system. For years, this committee
has been ahead of its time.
Now I hope that all of our time has come. I hope that this
committee, building on its rich tradition and many contributions, wiU help
this president and this congress and this country pass health reform
legislation so that we can control health care costs and provide every
American with affordable, high quality medical care. I nope that during this
session of Congress we will finally give Chairman Dingell's father the
tribute he deserves; this committee will see the realization of the work it
has done; but most importantly, as pubUc stewards, the people you represent
will know that their government has listened and heard and acted on their
behalf
Thank you very much, Mr. Chairman.
REP. DINGELL: Mrs. Clinton, the committee thanks you for a very
fine statement, one which I take great pride and pleasure in, your mention or
my old dad, who would have certainly been proud to have heard you say these
things today. It was his hope and his dream and his prayer that we would one
day provide a decent measure of health security in this country for all of
our people. And I'm sure that he would have been very proud that you were
taking the leadership on it, and he'd be very pleased that you would mention
him today, as indeed am I .
I'm only going to say that I intend to do my best to help you push
through the best possible form of health security legislation for all the
people at the earliest time, and you have my pledge to that. And having said
that, the chair is going to recognize my colleagues for questions in the
order in which the mles proscribe.
The chair will recognize then, for five minutes exactly, first the
gentleman from California, Mr. Waxman, chairman of the subcommittee.
REP. HENRY WAXMAN (D-CA): Thank you very much, Mr. Chairman.
Mrs. Clinton, I'm really delighted to see you here. My father just
passed away, as did yours, and we started going through his papers. We found
a letter he wrote around 50 years ago complaining about the fact that a
doctor wouldn't come to my mother because they couldn't afford to pay the bill. She
suffered for the rest of her life because of an illness that might have been controlled.
So I know it was my father's dream as weU, and others around this
country, that we finally have guaranteed access to care for all Americans.
That's really what the core of the president's proposal is all about. And
some of us who have worked in this area for a long time have felt that we
needed a president who was wiUing to take the bold leadership to deal with
�*his difficult issue. I used to think that would be enough. Now I know that
what we needed more was also a first lady like yourself to give us the
expertise and guidance you have given us in preparing this plan before us.
The crux of the whole issue is that we have everybody get a
comprehensive set of benefits. Your proposal would have us do that through
the jobs side, through employer/employee contribution. Everybody's giving Up
service to universal coverage, but some people are just simply saying
employers ought to just offer it but without making a contribution. Some
others are saying that what we ought to do is require each individual to go
out and buy insurance and, again, no requirement that employers play any
role.
How is it that you came to this conclusion that we needed to
require employers, large and small, and aU employees to participate in
paying for health insurance?
MRS. CLINTON: WeU, Mr. Waxman, I think that you've pointed out
what is one of the critical features of the president's plan. And for all of
the members of this committee who have stmggled with the costs of health
care and how we would achieve universal coverage, you know that there are
really only three general ways to approach this, and we have looked at all
three.
The first would be a large broad-based tax that would replace the
existing private sector contributions. That would mean it would replace the
existing employer/employee system and any individual contributions. For a
number of reasons, the president rejected any kind of broad-based tax that
would substitute for the system that we currently have.
A second possibility that you alluded to is to put the burden on
individuals as some states currently do with respect to auto insurance; to
essentially mandate that individuals would be responsible for their own
health care insurance, and in order to make that affordable there would be
some insurance market reforms and some kind of support through financial
payments of some fashion to low-wage individuals who otherwise could not
afford it.
We looked very closely at that and we are continuing to work with
those who advocate that position, particularly the Senate Republicans who
have advocated an individual mandate. But we have a number of questions about
it. One is that we worry that it would undermine the existing
employer/employee system in which on a voluntary basis, as a matter of either collective
bargaining or employer choice for competitive purposes, employers have responded over
the last decades in increasing numbers to provide health insurance. And that employer/employee
system has served as the basis for insuring more than 90 percent of the people in this
country who have private insurance. And we would worry that shifting the burden wholly
�f over to the individual would result in many employers who currently insure ceasing to do
^ so, or maybe only insuring their high-wage workers and not their low-wage workers. And
we would worry that if we subsidized individuals below a certain income level that there
would be pressure on employers to keep wages below the subsidy level so that they
would continue to be paid for by the government. So we have a number of problems
with the individual approach.
What we concluded is that what we want to do is preserve what's
right about our system and fix what's wrong. We think one of the things which
isrightis the employer/employee system, which does work well for most
Americans. Its biggest problems have been that the cost of insurance has made
it more and more difficult for many businesses to be able to participate. If
you build on the employer/employee system, you are already building on what
is available and familiar to most Americans. And if you do as we propose to
do, to provide discounts for smaU businesses and to subsidize low-wage
workers, we think that is the fairest and most responsible way to get
everybody into the system, and it's a system that is already working for most
Americans, and that's among the reasons why we concluded it would be the best
approach for us to take at this time.
REP. WAXMAN: Thank you very much.
REP. DINGELL: The time of the gentieman has expired.
The chair recognizes now the gentleman from Virginia, Mr. BUley,
the ranking minority member of the subcommittee, for purposes of questions.
REP. THOMAS J. BLILEY, JR. (R-VA): Thank you, Mr. Chairman.
Mr. Chairman, under the mles of the committee, I ask unanimous
consent to be able to distribute to the members copies of two graphs that I
intend to use during my question.
REP. DINGELL: Without objection, so ordered.
REP. BLILEY: Mrs. Clinton, first let me add my personal thanks
for the job that you, the president and the task force have done in preparing
your health care plan and beginning the national debate on the issue. I also
want to thank you for the time that you and Ira Magaiziner, though I wish he
wouldn't meet at 7:00 in the morning, have spent with the House Republican
Task Force during the past several months.
Mrs. Clinton, like many others, we are currently working with a
draft of the president's health reform proposal. To enable members to more
fully understand this very complicated plan, I would ask that you make
�(
ivaUable to the committee the task force quantitative working papers
concerning financing, premium caps, actuarial analysis of benefits, job
impact, and the national health expenditure data.
Mrs. Clinton, the early evaluation of the president's plan by a
wide range of experts, including economists and members of Congress, is that
the plan will not cut costs nearly as much as forecast, and that the federal
budget deficit will dramatically increase, as a result. That is because the
success of the president's plan depends upon unprecedented cuts in the
Medicare and Medicaid programs. The cuts generate $285 biUion in savings,
which represent almost two- thirds of the plan's financing. A cap is also
placed on both private health insurance premiums and the federal
entitiements. When fully phased in, the cap is equal to CPI plus the annual
percentage growth in population. And your own data projects the annual growth
in population at less than 1 percent, or eight-tenths of^ 1 percent, to be
precise.
Mrs. Clinton, this chart to your left shows an international
comparison of the average annual growth rate of health expenditures adjusted
for inflation for the years 1985-1991. For example, in this period, German
health expenditures actually grew by 2.87 percent above the inflation rate.
The Canadian single-payer system grew at 4.8 percent above the inflation rate
annually. And the British nationalized system grew at 4.07 percent above
inflation. All of these countries are showing significant real annual
increases above inflation. In contrast to the experience of these
nationalized systems, your cap on health expenditures allows real growth
above inflation of less than 1 percent.
Mrs. Clinton, this data shows that nationalized single-payer
systems such as Britain and Canada have not come even remotely close in
limiting health expenditures to less than
1 percent above inflation. In fact, except for Germany, they have been
growing at least at 4 percent per year above inflation, and even Germany has
been growing at close to 3 percent annually.
In the case of Britain and Canada, we are talking about systems that
explicitly ration care. Now, my question is, how is the president's plan
going to accomplish these extraordinary reductions in health care
expenditures when even systems that ration care have not remotely approached
these growth limits?
MRS. CLINTON: Mr. Bliley, that's an excellent question. I really
appreciate your asking that, because this is one of the cmcial issues that
we have confronted. And let me start ~ and
I hope the chairman may give us just a Uttle bit of leeway on time, because
it's such a critical inquiry.
Let me start by saying that we anticipate realizing some
substantial one-time only savings over the next several years. For example,
�ij'^e beUeve that insurance market reform, particularly in the non-group and
^ small group market, will result in substantial savings. We believe that
moving toward a single form system wiU result in substantial savings. We can
outline in more detail and will gladly do so the kinds of changes that we
anticipate begiruiing to bring down our base level of expenditures.
Secondly, we think that the crux of achieving the kinds of savings
and then stabilizing those savings over time into the out years wiU result
from changes in the way we organize and deliver health care. And there are
many examples of that around the country that we can point to. And let me
just quickly mention a few.
In the Medicare system we know that Medicare expenditures vary
greatly between different localities in our country without any difference in
quality outcomes for the patients, largely because of differences in the way
health care is organized in a particular area and because of differences in
practice styles and decisions of doctors. Currently there are no incentives
in our fee for service reimbursement system that will move those decisions
from being high- cost, inefficient ones toward being lower-cost, efficient
ones. But we have substantial data to prove that if we change the way we
provide incentives and reimbursement to providers, we wiU begin to reduce
the costs that are currently continuing to escalate within our system.
In fact, the public-private model that we propose is, if anything,
closer to Germany than closer to any of the single-payer national systems
because it's a joint system of employer and government payments joined by
individual contributions.
So to try to, with the red lightflashingat me. Congressman, to
say that we will give you a more complete answer in writing, we believe there
are some first-time savings that would be realized that would begin to reduce
the base on which we are growing. We beUeve that we can change the internal
dynamics of this system to move it closer toward more cost-effective,
quality-driven deUvery of health care, and we believe further that we start
with so much waste and unnecessary costs in the system -- Dr. Koop has
estimated maybe $200 billion worth ~ that we can get this system stabUized
and begin to reduce the increases in the rate of growth in a reasonable
manner over time.
And we will be happy to share with you all of the data that you
requested, all of our calculations, our economic models and the like. We have
worked as hard on this particular question. Congressman, as any because,
you're absolutely right, it is the key. And we believe we've got enough
leeway that if we decide a GDP growth rate as low as we think can be
accomplished should be phased in more gradually, we think we can do that; but
we want to start with the firm conviction there is waste in this system.
�*here is better utilization that we can obtain in this system, there is
oetter quality to be given to the citizens of this country if we reorganize
the way we deliver health care more efficiently.
REP. BLILEY: Thank you.
Thank you, Mr. Chairman.
REP. DINGELL: The time of the gentleman has expired.
The chair recognizes now the gentlewoman from Illinois, the
chairman of the subcommittee, Mrs. Collins.
REP. CARDISS COLLINS (D-IL): Thank you, Mr. Chairman.
I, too, want to extend my heartfelt thanks that you are here
before our hearing, Mrs. Clinton. As always, you bring a certain perspective
with you that we certainly learn from.
Let me say that one of the things that I'm concerned about right
now in a number of issues is redlining, what I caU medical redUning, at
this point in time. As I look at what I perceive to be the kind of plan that
we're looking at, if we are, it seeks to address redUning by health
alliances by preventing states from drawing those health alliances in a manner that would
discriminate against segments of the population on the basis of ethnicity or economic status.
But I wonder how the plan would prevent individual health plans within the aUiance from
attempting to draw service areas that would, in fact, be redlining against those kinds of situations.
MRS. CLINTON: Well, Congresswoman, we have worried about that
because we do not want to in any way permit discrimination against providers
or against patients, and we think as part of the framework for determining
what an accountable health plan is, there should be buUt-in protections
against the kind of redlining and discrimination that you are talking about.
It happens too frequently now in the insurance industry when people are
eliminated from coverage because of who they are or whether they've been sick
or where they live or who they work for. And we think that both by combining
the changes in the insurance market that we intend to propose, plus
protections built in so that accountable health plans will be offering their
services in geographic areas and to everyone who's in that area, and there
won't be discrimination against people who live in different areas, we will
be able to protect against the dangers that you rightly have pointed out.
REP. COLLINS: There is a community health center in my district
called the ~ I can't think of the name of it right now, but it's a health
center just outside of downtown Chicago, and it was closed for a long period
of time and has been reopened. All the people in that health center ~ in
�11
•hat neighborhood use that health center for primary care for chUdren and
everything else. And so I wondered if that is the kind of center ~ Martin
Luther King Health Center ~ the kind of center that would be sort of an
essential provider center, and more about that would be helpful to me.
MRS. CLINTON: Yes, that is what we anticipate, that community
health centers that serve underserved populations in both urban and mral
areas will be considered essential providers, and they wiU become part of
larger networks that will serve the entire population, but they wiU have
relationships with hospitals and cUnics and others so that the people who
use the community health centers as the primary care givers wUl therefore be
able to be referred on to a specialist or to a more compUcated kind of care
that they might need; whereas now, for too many people who use our commuiuty
health centers, they may go to the community health center for primary care,
but because they are uninsured or underinsured, they have no real recourse
except the emergency room, which is their entry into the additional health
services that they may need. So we do intend for those linkages to be
developed.
REP. COLLINS: Thank you. I gave the wrong name. It's the (Miles
Greer ?) Health Center. It doesn't make that much difference, but that is the
name of the health center.
Finally, I have great concerns about the power that insurance
companies can gain in the program - in the plan that I've seen so
far, and I believe that during his speech, the president noted that
there were some 1,500 companies that are now providing health insurance in
the United States today. But some of the reports that I have received suggest
that a number of the insurers may eventually shrink to about 100. Now, if
that happens, that puts an awful lot of power in the hands of just a few
insurance companies.
I have had personal experience with insurance companies. Blue
Cross/Blue Shield, tor one, when I had to have cataract surgery. They decided
that I couldn't have it done in the hospital even though my doctor wanted to
do it in the hospital for various medical reasons. Some clerk in their office
said no, they weren't going to allow that, and they overmled my doctor. I'm
concerned about that kind of thing happening when you have so few. I'm
wondering if there are going to be antitrust laws to keep these few from
becoming, one, an oligopoly, and from, two, having too much power for the
insurance providers.
MRS. CLINTON: Well, what you're describing is what's happening
right now, that insurance companies are very often overriding doctors'
opinions and making decisions based on insurance coverage instead of clinical
judgment that the doctor would like to bring to bear. That is happening right
�(
now. We beUeve that moving toward the system that we've envisioned, there
will be less of that, and in fact, doctors will, we hope, regain some of the
autonomy and authority that they have had to give up. But the antitmst laws
wiU stUl guard against monopoUstic practices.
Now we do, though, want to make some changes in antitmst to
permit doctors and hospitals to have the same kind of opportunity to organize
You know, we want to have alternatives to insurance company-governed
plans. We want to have the CathoUc Hospital Association or the Mayo Clinic
or the local medical school to have the same kind of opportunity to join
together with physicians to present services to the communities that wiU be
covered, and we hope that we can strike the right balance in the laws to
permit that.
REP. COLLINS: Thank you very much.
REP. DINGELL: The time of the gentlewoman has expired.
The chair recognizes now the gentleman from Florida, Mr. Stearns.
REP. CLIFF STEARNS (R-FL): Thank you, Mr. Chairman, and thank you
for allowing me the courtesy of offering my questions as the ranking member
on commerce-consumer protection and competitiveness.
Let me first of aU say, Mrs. Clinton, I want to congratulate you.
I've watched Federal Reserve Chairman Greenspan show up to tables Uke that
with a whole Ust of people helping him, and I've seen cabinet officers from
the Bush administration. So you're making a winning statement by showing up
aU by yourself on this table, and I want to compliment you on that.
My question goes a littie bit further than my colleague from
Virginia's question concerning the limit on insurance premiums to the CPI and
to the population. And we move that when we start talking about insurance
premiums in the commercial sector. You are, in effect, limiting the amount
that doctors and hospitals can reimburse for hospital cares. And my concern
is by this limit that you're doing, aren't you going to make the patients get
less care, and in the end this wiU lead to higher cost sharing on the part
of the patient?
MRS. CLINTON: Well, Mr. Stearns, we do not believe so, and let me
give me just a couple of examples of the great mass of evidence that would
support our beliefs
First of all, there is such a wide disparity of costs of health
care right now in this country. And there has been a great deal of research
�13.
ione to try to determine whether there are significant differences in quality
or access between regions or communities that provide care at a higher price
or a lower price. What we have found in looking at aU of the available
research is that there is no discernible difference in quaUty between a lot
of the high-priced care and more moderately-priced care that is available in
the country.
At a hearing earUer today, I held up a booklet as just one
example of the countless kinds of evidence we will share with you as the
course of this debate goes forward, which is a consumer's guide to coronary
artery by-pass graft surgery that was put out by the Pennsylvania Health Caie
Cost Containment Council. Pennsylvania started before the president was even
elected for a number of years to collect information to try to answer the
question that you are posing and which is very important.
If you look at just this one simple booklet, which outUnes how
much it costs at every hospital in Pennsylvania to perform this surgery, you
will find that the cost ranges from $21,000 to $84,000. Then if you look at
quality indicators, including the number of patients who died and who were
expected to die given the severity of their illness, you wiU find that there
is no correlation between the high cost and better outcomes. In fact, the
lowest cost of the operation in one hospital has some of the best results.
Now, what does this mean? It means that in just one state you have
a range of costs for the same kind of operation from $21,000 to $84,000. Yet
there is no incentive in our current system to move those hospitals and
doctors that charge more toward a more reasonable cost because they don't get
penalized, there's no budget that they have to in any way account for, they
get all kinds of automatic pass- throughs, and if they aggregate all the
different tests and procedures, they get more money than if they say here's
the cost for a bypass in total.
What we beUeve is that if we could begin to reorganize our health
care system so we brought down the cost, we would not in any way undermine
quality; in fact, we would enhance it because we could afford in one state,
and, therefore, across the country, to perform more operations Uke this for
more people.
And there are countless examples of this. Congressman, aU over
the country where we are not delivering the kind of quality health care for
�1^.
he price we are charging ourselves.
REP. STEARNS: But in aU deference to you, wouldn't you think it
would be easier and more appropriate to bring it down through competition
than through the government itself pushing and mandating and limiting?
MRS. CLINTON: That's what we're doing. That's exactly what we
beUeve wiU work. We believe that through competition and market forces,
hospitals will begin to make these adjustments so that they wiU move toward
lower costs and they will be motivated at the same time to take a hard look
at what they are doing. What we believe is that there should be a federal
framework that sets forth certain kinds of guidelines about how this system
should operate, and then the government should get out of the way.
But we also believe that, given how much unnecessary costs, to be
charitable, there is in the current system, to get from where we are to where
we need to be, that if we have some kind of premium cap and if we have some
kind of budget targets, there will be a real incentive for hospitals and
doctors and others to make the changes that so many others have done within
the marketplace. In the absence, though, of some kind of budgetary discipUne
to move some of our regions which are 300 percent more costly than other
regions to anything like a national average, in the time we need in order to
get this system under control with its costs, we think we've got to have
those extra tools. But we'U be glad to talk about how they're defined and
how they would be enforced.
REP. STEARNS: Thank you, Mr. Chairman.
REP. DINGELL: The time of the gentleman has expired.
The chair recognizes now the gentleman from Indiana, Mr. Sharp,
and then the gentleman from Califorma, Mr. Moorhead.
REP. PHILIP SHARP (D-IN): Thank you very much, Mr. Chairman.
Ms. Clinton, you and your task force are to be highly complimented
for the extraordinary work in reaching out, learning, and the rigor and
thoroughness with which you have put together these proposals in what
everyone agrees is one of the most complicated and the most profoundly
personal issues that we've ever had in the United States Congress. And as the
president and the vice president and the Congress and others try to reinvent
government, we all have your model to follow for quality work, which is what
the American people want from the taxpayers and, I think, are unquestionably
getting.
�I must say, too, that I think that leadership has put us into a
position that we can tmly do something about this issue.
But I think the onus is now on us to follow that example, do the
same kind of thorough, rigorous work, and, most importantly, consult with our
people at home. And you and the president have again led in this in a
critical way because the lesson we learned from catastrophic health insurance
was, with a Republican president and a Democratic Congress committed to the
same goal, we repealed the act one year later. And the reason we did that is
because of the massive failure in this country to bring into the process the
very people who would receive the services and have to pay the biU, and they
were extremely confused and extremely upset as a result oi that exclusion.
So, to make this work, it is incumbent upon all of us to make a part of the
process those people.
I certainly applaud and support the broad goals that you and the
president have outUned.
We must provide health security for our people. All of us have had
hundreds of conversations with people who thought they were in good financial
straits only to find that their families were tortured and tormented by the
absence of coverage or the loss of insurance. And I'll be submitting and
talking with you and your task force about the circumstances of very specific
individuals that we're hearing in our office, how they wiU be affected, how
their businesses will be affected, because we have to examine it through
their eyes as we judge this.
But there are broader systems questions that have been asked here,
and we'll be asking about how the system will work, the incentive stmcture.
And let me just put to you very quickly one of the questions that wiU come
up that there's been a lot of quick criticism by people that --1 don't how
they could have possibly analyzed the proposal, but quick criticism, and it's
the question of bureaucratization, and that is whether or not with the plans,
the health alliances, the national board we simply wiU be adding new layers
of bureaucracy that might restrict individual choice or doctor choice or
whatnot in the process when, clearly, one of your goals and the president's
is simpUfication. Could you just comment on that?
MRS. CLINTON: Yes, congressman.
Well, of course, we think that this wiU simplify and debureaucratize, if that is such a word, the system because we are doing two
things. We are eliminating a lot of the micromanagement and overregulation
that comes from both the pubUc and the private insurance systems right now.
The health alliances as we envision them are to be the conduits
�It".
"^or premiums that will be paid into them, and then health plans wUl bid for
the business by putting out their services and each of us individually wUl
choose, so that the way it would work is, under our plan most Americans, as
they are now, would have their premiums paid from their employment. The
employer's contribution and the employee's contribution would go into the
health alliance. And then accountable health plans would come much as the
federal employee health benefits plan works now with brochures and
presentations so that each of us individually would then choose the plan that
we thought was best for us.
We don't envision much bureaucracy attached to that. We beUeve
that every qualified health plan should be permitted to compete for my
premium dollar. And we don't envision the alliance eliminating any
health
neaii plan so long as it is qualified.
The National Health Board is a feature that is found in both the
Senate Republicans' approach as well as the president's because we beUeve
there needs to be someplace where a lot of the decisions about benefits how they're actually defined in individual cases, when a treatment moves from
being experimental to clinically provable -- those kinds of decisions need to
be taken out of this body. They need to be taken out of politics. And that's
one of the roles we see for the National Board, as does the Senate Republican
version. And again, we don't anticipate a lot of extra bureaucracy or extra
staff needed because there will be a lot of the staff already in place in HHS
and elsewhere in the government that will be reporting to this board, and the
board will be kind of acting like a board of directors, to be making
decisions that will then be implemented by the rest of the government.
REP. SHARP: Thank you.
REP. DINGELL: The time of the gentleman has expired.
The chair recognizes now the gentleman from California, Mr.
Moorhead. Five minutes.
REP. CARLOS J. MOORHEAD (R-CA): Well, thank you, Mr. Chairman.
Mrs. CUnton, you've certainly been generous of your time over the
last few months in coming to the Congress. I don't know of any witness that's
come to us and to as many different groups on the Hill as often as you have
done. So some of these questions I'm sure that you've been asked before.
But the question that's coming up time and time again ~ on the
radio, on television, the press - is thefinancing.And I know you've been
asked similar questions before. But there was one broadcaster this morning ~
Charles Osgood ~ said that if you thought you could save - if you'd spend
�17
S300 biUion more in the next ten years and stiU be able to cut $400 billion
I out
of it, he has a car that will mn only on water that he'U be happy to
sell you. And that's the kind of a sale you have to be able to make, because
the public is very, very concerned about that particular issue.
I was particularly stmck by the comments recently made in
a radio interview by a well-known Uberal economist: Henry Aron (sp) of the
Brookings Institute. He expressed concern over the impact of the stringent
restrictions on health care spending and what they would mean in the real
world, particularly at a time when new technologies are becoming more and
more expensive and the number of very old Americans is dramatically rising.
He drew what I thought was a very down-to-earth analogy between these
spending limits and a family budget.
Dr. Aron (sp) said "If you and your spouse have ten children and
your family budget's growing very rapidly because you're having more chUdren
and because the consumption of each child is rising, you're planning on
having more children, but you're told that your budget cannot grow at aU,
what are you going to do?
We know that your spending on the children's going to have to
dramatically decline." In terms of the health care system, Henry Aron (sp)
beUeves these budget Umits mean fewer diagnostic services, fewer
therapeutic services. He states that the real question is whether a
sufficient quantity of services, physicians now provide for patients are just
purely wasteful and unnecessary and can be done away with, with absolutely no
loss in health benefits. Could you please comment on this?
MRS. CLINTON: Yes. I would be pleased to, Mr. Moorhead. I would
just ask that the commentators and others look at examples in our country
that are doing exactly what we think should be done on the national level.
For example, if you look at Mayo Clinic, Mayo Clinic has one of the finest
reputations in the world. It has kept it's cost increases for last year below
4 percent. That's inflation plus a very Uttle bit, at 3.8 or 3.9 percent. If
you look at the very large California pension and retirement system, it has
kept its increases the last two years even below that. If you look at
Rochester, New York, which has a number of large employers and a dominant
insurer in that community, they have kept their costs down. If you look at
the state of Hawaii, which insures nearly everyone through an
employer/employee system, they have kept their cost increases and the total
amount that they spend on a per capita basis for health care far below the
rest of the country. And I could go on and on, because there are many
isolated examples.
If you look at the Medicare system, you can see that, in many
communities that are relatively close together, like if you compare New
�If.
Haven, Connecticut, and Boston, Massachusetts, a Medicare recipient in New
Haven costs the federal government about one-half of what a Medicare
recipient in Boston costs with no discernible difference in the quality of
care. There are so many examples in both our Medicare and Medicaid systems
and in our private system which show, I think, conclusively that, if we
better organize how we deliver health care, if we are smarter about making
the decisions that should be made, if we eliminate the urmecessary tests and
procedures that too often drive up the cost, if we root out the waste and the
fraud and the abuse that is a very large amount of money that can be better
allocated within the existing system.
And one of the things which has stmck me repeatedly is the
difference between the people who are commentators inside Washington and the
people who mn health care plans, hospitals, multi-speciality clinics, the
Puget Sound Health Cooperative, and many others all around the country, they
look at me and they say, "This can be done because we have been doing it
without any kind of help, and what we would Uke is for the rest of the
country to get in and help us get it done right."
So I am very confident that the kind of proposals we are putting
forth are doable because I have literally visited and talked with people who
have done exactly what we are proposing.
REP. MOORHEAD: Thank you.
REP. DINGELL: In accordance with the mles and the announcement
of the chair as to how they will be administered, the chair recognizes now
the gentleman from Oklahoma, Mr. Synar, for five minutes.
REP. MIKE SYNAR (D-OK): Thank you, Mr. Chairman.
Mrs. Clinton, building upon what's right in America's health care
system and correcting what's wrong is a message that
I think Oklahomans and Americans have embraced overwhelmingly. But there are
unique problems in rural Oklahoma and mral America. There are three
characteristics: one, they're older; secondly, they're poor; and finally,
they have probably the least leverage of anyone in the health care system to
negotiate with providers as well as insurers. They fear that we won't be able
to reverse the trends of deterioration of health care in the future with this
plan, and they also fear that they will be left behind and become second
class citizens.
Describe for us the thinking of the task force with respect to
mral health care and how it will better serve mral America.
MRS. CLINTON: WeU, Congressman, I'd be happy to. And I don't
�n.
think the president and I could go home to Arkansas, which is next door to
^ Oklahoma, if we had not paid a lot of close attention to mral health care,
which is something that actually my husband has worked on ever since 1978 and
'79, because everything you have said is absolutely right. In fact, a much
higher proportion of mral residents are uninsured than urban residents. So
we not only have the poverty but we have less of a capacity for mral
residents being able to get care.
.ay^
3
want to do a number of things which we think will improve
'^T access to care. And we have tried to strike the right balance between
j I creating some kind of market in mral America, which is very difficult - I
'i mean that is one of the real challenges because there aren't that many
N providers who are wilUng to compete for the mral health care dollar ~ and
creating an environment through some government-assisted programs to create
good health care facilities and providers in mral areas.
First of all, we think the fact that everyone would be insured
will be a very big improvement in mral areas, because if we can begin to
provide a stable funding base so it's not just the Medicare and Medicaid
programs that are out there but it's also the uninsured who now have funding
streams, that we will begin to create a marketplace. It won't be as big in you know ~ some of the small towns in Oklahoma as it will be in Tulsa or
Oklahoma City, but there will be incentives for providers now to offer care
where before there weren't.
We also believe that by creating alliance areas that will cover
both urban and mral populations that the health care providers who want to
compete for the urban dollar will also then feel compelled to compete for the
mral dollar and they will provide opportunities for mral providers and
hospitals to become part of networks so that we will have connections between
mral providers and urban providers we've never had before. And I've seen
that already happerung where some large hospitals in the state of Minnesota,
for example, or some of the large providers there are now making linkages and
providing contracts with mral providers.
Secondly, we want to encourage more physicians and nurses to
practice in mral areas, and we want to do that through increasing the
opportunities for them to pay back their loans and for having loan
forgiveness if they will go into mral areas.
Thirdly, we want to improve the technology between mral areas and
urban medical care, and I've seen some extraordinary examples of that, where
we now have some programs in an experimental stage where you can be 400 miles
from the medical school in a state like Texas, out in west Texas, and you
literally can hold up an x-ray to a screen which then can be read in the
medical school 400 miles away. So that the specialists can be right there on
\
�^0.
*he spot helping the mral hospital or the mral physician take care of that
patient.
And finally, I would say that part of what we beUeve is necessary
is identifying community hospitals and clinics, community health centers, as
essential providers, because we know that during this transition, unless we
protect the providers and hospitals that are already in mral areas, they may
go out of business and there may not be anybody there to take their place. So
we have some funds targeted to keep them going so that they can be there when
the urban hospital and the network of providers wants to contract with
somebody, so that we'll have that essential service available in mral areas.
And I just think it's so important because I've visited, as you
have, in so many mral communities that are getting less and less medical
care than they used to have. It used to be 10 or 15 or 20 years ago they'd
maybe have a doctor or they maybe would have a hospital, and now they don't
anymore. And what we want to do is to create the environment in which they
will again.
REP. SYNAR: Thank you.
REP. DINGELL: The time of the gentleman has expired.
The chair recogruzes now the gentleman from Texas, Mr. Barton.
REP. JOE L. BARTON (R-TX): Thank you, Mr. Chairman.
Mrs. Clinton, it's an honor and a delight to have you here before
our committee. I come at this problem a little bit differently than most
members. I'm a registered professional engineer, and I believe that one must
identify the problem before one tries to develop a solution. I've also been
very involved in providing health care in a limited way back in the past. In fact, the
last time I saw you, in the late 1970s, I helped found and pay for a voluntary ambulance
in Houston County, Texas, to deliver people that needed health care to the local community
hospitals, and did so for three years. So I have not been involved as a professional
physician like another member of the committee, but I have been involved in attempting
m a limited fashion to provide health care.
I notice in the president's book that you use the number of 37
miUion Americans who do not have health insurance. Interestingly, nowhere
else is that number as high as it is in the president's plan. The Census
Bureau said that 32 milUon are uninsured at some point in time, and 16
million as of 1987 had no insurance for the entire year. The Agency for
Health Care Policy said that 24.5 million had no insurance for an entire
year, and 23.3 million were uninsured for part of the year. The Harvard
School of Public Health in 1992 said that 21 million were without health
�9-1
f 'nsurance for an entire year, and the Congressional Research Service says
^ that 35.4 milUon lack insurance at a given point in time.
Could you explain or provide to this committee where the number
that is used in the administration's official documents of 37 milUon comes
from?
MRS. CLINTON: Yes, I'd be happy to give you that information
specifically, but let me perhaps point out what some of the differences in
timing and in analysis are that would lead to different figures at different
points in time. If you're looking at the census figures for 1990, there is a
difference in terms of where we were when those figures were collected and
where were are today. And the growth that, for example, you would buUd on
top of the Congressional Researchfigurethat you just had would get us
closer to the 37 milUon.
Others look at different points of time, and they take a ~ what is
called a kind of monthly or rolling average as to how many people are out of
insurance at a particular time and for how long. It is our belief, based on
all of those different kinds of estimates and how they're arrived at and the
point of time at which they are taken and how they aggregate, that the 37
million is accurate figure, in large measure because it counts both those who
are employed and uninsured, the family members of those who are employed and
uninsured, and the unemployed and uninsured. And we think ~ we will be glad
to give you the very specific calculations that got us to the 37 milUon.
The most recent work that was just completed was done by Families
USA looking at every one of the statistics that you have cited, plus trying
to determine how to make it an understandable figure for people. They have
pointed out that what we are now in the process of seeing because of
increasing layoffs and people losing jobs and downsizing in the economy that
accelerated in the last two-year period, and that may in part count for the
difference between the 35 million and 37 million, is there are people who are
losing their insurance now every month, who unlike in the past are not being
reemployed and, therefore, regaining insurance. And their figure is that 2.25
million lose insurance every month. Some may get it back in
a month; some may get it back in a year. But based on their projections, they
believe that, by this year next - by this time next year, in the absence of
our doing anything, we will be closer to 40 million uninsured. And I'll be
happy to lay all that out and give you all of the statistics and the cites
behind that as to how we have calculated it.
REP. BARTON: Thank you. And as a subset of that, we'd like to
have, of the numbers that don't have insurance how many of them don't have it
because they don't want it, or, conversely, how many of them desperately want
it and flat can't get it. Because the Heritage Foundation and some of those
groups have indicated that the number of Americans that don't have health
�i
insurance that do want it and just simply caimot get it for any reason is a
much smaUer number, somewhere between 10 milUon and 16 miUion.
MRS. CLINTON: WeU, let me just add. Congressman ~ we wiU
certainly get that for you ~ we have a difference in approach about defining
the problem, to get back to your first point. We think that, for those who
say they do not have it and do not want it, they put an unnecessary burden on
the rest of us, because they are often young, they are often in their
twenties. They are often people who don't beUeve they wUl ever be sick or be hurt. And
too often, when something does happen to them, whether it's the unexpected automobUe
accident or the unpredicted illness, they, like every American, eventually get health care.
And then, because they have been uninsured, the rest of us pay those costs.
So we don't think the distinction between those who want it and
can't get it and those who don't want it is a good one, because the lack of
insurance puts burdens on the whole system and burdens the private sector in
ways that we don't think should be allowed to continue.
REP. BARTON: My time is expired. Thank you.
REP. DINGELL: The time of the gentlemen has expired. The chair
recognizes now the gentleman from Oregon, Mr. Wyden.
REP. RON WYDEN (D-OR): Thank you, Mr. Chairman.
Mrs. Clinton, I'm especially pleased that you and the president
are going after these drug company and insurance rip-offs. What we have seen
in our hearings is that some of these dmg companies think they've got a
god-given right to charge whatever they can get and some of the insurance
companies only want you if you're healthy and wealthy.
But what I'd like to ask you about is the matter of the insurance
premium Umits. Because I think, while the government proposal, your
proposal, clearly rejects explicit rationing, as we've heard from our
colleagues, I think some oi•the insurance companies, when premium limits
start, some of the insurance companies may try to go back-door, sneaky, and
do unaccountable rationing. The way it would work, say, on a middle-class
person, and that's, of course, the bulk of the people, is they might say,
well, you might normally get seven tests, but under this you'U only get
three. Or if your appointment is going to be at the beginning of the month,
they'll just put you off a few more weeks so that they could do this sneaky,
back-door rationing.
Now, I know you're opposed to it and have heard you speak in favor
of it, but I wonder if we could look at two other ideas in addition to the
plan that could help us stop this kind of back-door approach. One of them
�2.3.
would be to say that when you have a closed panel, a health maintenance
' organization, that panel would also have to give people the right to go
outside the panel and get what they want by paying a Uttie bit more. That
would be one proposal. And the second would be in the area of technology,
where we know that new products are fueling the cost increases so
dramatically, whether we could look at a way to give the companies an
incentive to provide up front information that would show why their product
is superior to what's actuaUy out there.
And my (question to you would be, I'd just Uke to pursue both of
those because I think that would be the way to lock out these insurance
companies who are trying back-door, sneaky, almost de facto efforts to
undermine what it is you're trying to do in terms of protecting consumers.
MRS. CLINTON: Well, Congressman, I'm open to anything that stops
sneaky, back-door attacks. (Laughter.) And I'U sure look at both of those
ideas, and I think that the idea of having a referral out of a closed-panel
HMO or any organized delivery system is one that we should look closely at
because I think there's a real need on our part to be sure that referrals to
specialists are as available as they need to be to all citizens. And I think
you've got a good idea, and we'll follow up on both of those.
REP. WYDEN: Well, I very much appreciate that because I think the
prism that you and the president are using is what does this mean for my
family. And that's what people all across this country are asking, and I
think that there are ways that we can balance cost containment and real freedom of choice, a
nd I appreciate your willingness to pursue these and look forward to it.
Thank you, Mr. Chairman.
MRS. CLINTON: Thank you.
REP. DINGELL: The time of the gentieman has expired. The chair
recognizes now the gentleman from North Carolina, Mr. McMillan.
REP. ALEX MCMILLAN (R-NC): Thank you, Mr. Chairman.
Mrs. Clinton, I want to add my welcome and express publicly what
I've said to you in other meetings, my appreciation for the hard and
effective work you've done in defining the problems and advancing effective
solutions. I have been a part of a Republican task force, as you know, that's
met with you on occasion and with Mr. Magaziner at 7:30 every Thursday
morning for the better part of nine months, and I appreciate your willingness
to listen. I'm not sure that you've heard everything that we've had to say,
but I mean that constmctively because I think that we all understand that
the solution is probably going to require a broad bipartisan base of support.
�/' And so, I'm hopeful that before we're throughwith this dialogue that we wiU
^ oe able to achieve that. And I mean that.
Some 20 years ago, I set up in a fairly substantial company
comprehensive health care, over 7,000 employees in that company. And I had
worked a lot with small business in doing hkewise. So, I'm particularly
concerned about how this impacts small and large business and how that
interrelates with the very important issue of bringing the uninsured into
universal coverage. And so, I want to ask you, if fmay, a couple of questions on that.
Under the proposed financing scheme offered by the administration,
corporations that choose to opt out of the regional health alUances and
instead choose to operate under ERISA or Taft- Hartley alUances wiU be
required to pay a 1 percent payroll charge over and above their health care
costs into alliances of which they are not a part.
Furthermore, these ERISA and Taft-Hartley aUiances do not have the
protection which is afforded to smaller companies of only paying 7.9 percent
of their gross payroll for health care costs. So presumably their cost base,
in addition to the 1 percent extra charge, could go well above that, which
creates an imbalance among large and smaU in that respect.
And with that in mind, I'm interested to leam your feeUngs on
why any large corporation would (either barter ?) to create an ERISA or
Taft-Hartley alliance. And in addition, for what purpose is the 1 percent
payroll charge, and to whom will that money go or what part of the program
will it go and for what purpose?
MRS. CLINTON: Congressman, the companies with whom we have spoken
over the last months that would most likely want to continue to be
self-insured believe that their costs either now are below the cap that you
mentioned for employers or would be if they were in an insurance market with
the kind of reforms we're talking about, and if they were able to control
their own costs. Those are the economic decisions that they're making their
conversations with us which lead them to believe that it is a better deal for
them to continue to try to be self-insured.
We have pointed out, however, that there are certain system costs
which they will be able to enjoy that would not be part of their premium
base. And the one that we're most concerned about is our academic health
centers, the medical schools of this country that train our physicians, that
provide a lot of the tertiary care at the most speciaUzed level for people,
and which under our plan would have primary responsibUity for serving as
kind of quality guardians, if you will, for the entire health care system.
So the assessment that we would be asking the corporate alUances
�\Q make would go primarily to fund these academic health centers, because if
we do not have some support from them to do so, they would be able to enjoy
the benefits of all the services that the health centers are going to be
providing without bearing any of the costs.
Now, in our conversation ~ and this is something that we wiU
want to continue and that I'm sure this committee wiU want to engage in as
weU ~ we have had a number of corporations teU us that even with the
assessment that we would want them to pay into the alliance to help fund
these purposes, they still beUeve they can deliver health care more cheaply.
And so it wiU be a strictly an economic calculation that compames wiU make and we wiU
work very hard with them to make sure that if there are any features of the plan that
would unfairly disadvantage them that we will take a look at those. But up until now, we
have not had a lot of opposition among those companies that are likely to have their own
alliances.
REP. DINGELL: The time of the gentleman has expired. The chair
recognizes the gentieman from Kansas, Mr. Slattery.
REP. JIM SLATTERY (D-KS): Thank you, Mr. Chairman.
Mrs. Clinton, I've been on this committee now for 10 years, and I
must observe that I don't think I can recall another occasion when this many
members on both sides of the poUtical aisle have been so attentive for so
long. (Laughter.) You have tmly tested our attention span here, I suppose,
today, and I think it's a real tribute to you and to the president that both
sides of the poUtical aisle are so engaged on this issue. And I think that
it's a good sign for the months ahead as we really engage in this very, very
important debate.
I have three very specific questions that I'd like to squeeze in
in the five minutes that I have.
Number one, it is clear that you're attempting to give the states
as much flexibility as possible in the implementation of this plan. I applaud
that. I think that's a very good idea and extremely important for those of us
who come from mral parts of the country where our Medicare reimbursement
rates are lower than the national average.
I would like to know specifically, though, about Medicaid and what
kind of specific flexibility you propose to give the states that will enable
them to better utilize Medicaid dollars.
MRS. CLINTON: WeU, Congressman, let me start by recognizing the
extraordinary work that this committee, and particularly the subcommittee
chaired by Mr. Waxman, has done over the years in trying to provide a medical
�safety net for millions of Americans through the Medicaid program.
And you have done so against great odds, and I think you are to be
commended for looking out for those least able to take care of themselves in
our health care system. But we beUeve that we want to merge the Medicaid
system into the universal health care coverage system, to end any kind of
separate identification of Medicaid recipients and to essentially blend the
funds that would follow the Medicaid recipient to those that would foUow you
or me into a local alliance, so that individuals would no longer be either
discriminated against or identified as being a Medicaid recipient even though
the state and federal govemment would continue to pay into the alUances the
portion of the Medicaid cost that each Medicaid recipient would carry with
them.
We think by eliminating the Medicaid program and integrating those
recipients, we will end up giving better care to the recipients over the long
mn; we will, we hope, realize the kind of savings we think will come from
having more Medicaid recipients in primary and preventive health care
networks, the kind of reorganization that we anticipate; and we believe that
we will eliminate a lot of the gross discrimination that currently exists
against Medicaid recipients.
REP. SLATTERY: Okay, thank you.
The second question I have goes to the aUiances and how they wUl
be stmctured. I'm just curious. Do you envision anything that would prevent
states from contracting with private entities to perform the function that
you envision for the aUiances to do?
MRS. CLINTON: No.
REP. SLATTERY: So theoretically, the states could contract with
an insurance company, for example, to provide the kind of function that you
envision that would be performed by the alUances.
MRS. CLINTON: Yes, but we would want the decision-making to be
clearly the responsibility of either the non-profit organization that a state
might set up or the state, because ultimately the state would have to bear
the responsibility. So REP. SLATTERY: But they could have a private entity that would be
established that would actually do the negotiating and do whatever
administrative function that the state might designate that would be
performed by the alliances.
MRS. CLINTON: But under the direction of the state. I mean, it
could be an intermediary kind of fiscal and negotiating collection function
�would be performed, but the ultimate responsibiUty would have to rest at the
aUiance level.
REP. SLATTERY: How much time is it going to take, do you think,
for the president to present to the Congress the detailed programmatic
changes in the Medicare program and Medicaid that will enable us to achieve
the kind of savings that you envision? And let me, before you answer that,
let me just observe that Congressman Synar and I share a deep concem about
how these cuts are going to affect mral areas, and our hospitals out there
~ I don't need to tell you this - are extremely worried about the prospect
of dealing with these kind of cuts of this magnitude. And I know that you're
aware of that problem and you're committed to the mral health care needs,
but could you answer my previous question about the time line we're looking
at? And any hints that you might have as to what these programmatic changes
will be would be appreciated, too.
MRS. CLINTON: Well, we anticipate coming forward with specific
recommendations in areas where we can reduce the rate of growth in Medicare.
We are not proposing a cap that does not make the hard decisions. We think
that we ought to try to specify, both for purposes of clarity with the
Congress but also for providers, where we think those reductions in the rate
of growth can come. So we will come forward with specific programs that we
think can be delivered more efficiently at less cost, and we will lay those
out for you.
REP. SLATTERY: Do you know by when?
MRS. CLINTON: Within the next couple of weeks as we present the
legislation.
REP. SLATTERY: Okay. Thank you.
REP. DINGELL: The time of the gentleman has expired.
The chair recognizes now the gentleman from Illinois, Mr. Hastert.
REP. DENNIS HASTERT (R-IL): Thank you, Mr. Chairman.
Mrs. Clinton, we appreciate you being here and certainly
appreciate your openness and the work of Ira Magaziner and his staff over the
last nine months and the ability that we've had to carry on a dialogue and
really lay out our parameters and see some of your ideas, as weU. I think
that's been a very helpful situation and a good relationship.
There are some questions that we need to ask and to understand so
that we can continue that work.
�In my district I have the back and forth and the town meetings,
and constantly I've had people in my district come up and say, "You know, I
like the health plan" that they're currently in. " I Uke my Blue Cross/Blue
Shield plan," or if they work for CaterpiUar Tractor, which happens to b_
over 5,000 employees, they Uke that plan. And the question is, "WiU I be
able to keep the specific plan that I already have?"
MRS. CLINTON: We anticipate that in the vast majority of cases,
the answer will be yes because those who are currently delivering health care
in a region are more than Ukely to be those who wiU form the accountable
health plans that will be presented in a region, so they will have the same
doctors, the same hospitals, the same features that they currently see as
consumers now.
REP. HASTERT: But it's conceivable there would be more than two
or three health plans in a region, right?
MRS. CLINTON: Yes.
REP. HASTERT: And maybe more than that, possibly.
MRS. CLINTON: Yes.
REP. HASTERT: So if I have my pediatrician, who is joined up wdth
one health care plan, and my internist, who signs up with another health
plan, really I have to make a choice there; is that correct?
MRS. CLINTON: Not necessarily. Congressman, for the following
reasons. Unlike what has happened up until now, where choice has been
increasingly limited because doctors have been told who they can practice
with if they expect to be reimbursed by this insurance company poUcy, we are
going to end that kind of discrimination against doctors. Doctors will be
able to join more than one plan, and every doctor in a region will be in what
wiU be a fee-for-service network in addition to any other plan that the
doctor is in. So there will be many more options for doctors as well as for
consumers.
I'm not saying that in every single instance every doctor wiU
choose to be in the plan that will correspond to the doctor that you also
want for another specialty, but in most communities I think it will be more
likely than not that a person like me or you or one of your constituents will
be able to join a plan that will have all of the doctors you are accustomed
to having. And where that doesn't happen it wiU be because of the doctor's
choice as to which plan the doctor wishes to be in.
�REP. HASTERT: So aU the doctors wiU probably sign up for aU
the plans?
MRS. CLINTON: Well, either ~ they will certainly all be in the
fee-for-service network because we're going to require that every single
community have one of those. Every alUance wiU nave to have that. So every
doctor will be in that. And then, in addition, it wiU be up to the doctor.
Now, some doctors may decide they don't want to practice in any
other plans, but I would bet that doctors in addition to the fee-for- service
network will sign up for at least one more plan, and maybe more than one. And
it will be their option to do so.
REP. HASTERT: Many people in my district go to, for instance, the
Mayo Clinic, which a lot of people do, and you use that in your reference,
saying they have a very good ability to hold down cost. And, you know, a very
unfortunate situation turned out - turned out was fine. A young man in my
district ~ in my district? On my staff ~ was diagnosed as having cancer.
And he found a doctor at the tJniversify of Indiana ~ another state ~ that
he was able to go to and was cured. Will those choices be -- if you sign up
with a plan in Illinois, are those type of choices of people to be able to go
to the Mayo Clinic or the University of Indiana's Health Care Center, can you
StiU do those types of things?
MRS. CLINTON: Yes. And that ties into Representative Wyden's
question. We want there to be what is called in the insurance trade a point
of service option. In other words, even though you're in a plan, whether it's
a closed panel HMO or a fee-for-service network in Illinois, you should have
the opportunity to be able to pick a specialist outside of that plan.
Now, what we're looking at is how do we try to make sure that
there really are tme specialists? Nobody would argue with going to
Mayo Clinic or going to the University of Indiana. Somebody would
clearly have a choice to do that because they would both be considered, you
know, centers of excellence. And so we do want there to be some perhaps
qualification so it's not just picking anybody, but picking the Mayo Clinic,
the university, the academic health centers, which goes back to Congressman
McMillan's point: one of the reasons we need to be sure that everybody helps
support these academic medical centers is so that they will be available for
/
young men like the one you just mentioned so that that wiU be an option. ^ ^ ^ . ^ ^ ^
REP. HASTERT: One other point since you mention Mr. Wyden, and
Mr. Wyden brought out, I think, something that is in the back of aU our
minds. He talked about sneaky companies that are going to try to ration
through the back door. And one of our questions, what happens in Mr. Wyden's
own state of Oregon and how they deal with Medicaid recipients?
�Actually, Oregon has made an explicit decision to ration care
using a ratiorung list. And Oregon has brought thousands more people into the
Medicaid system - a bigger pool. But they have done it by rationing care. Is
there a Ukelihood or a fear out there among a lot of people that we talked
to that health care in this country wiU be rationed in the future when our
health care system will be growing by less than 1 percent?
MRS. CLINTON: Well, congressman, let me answer that in two ways.
I would argue that right now we have rationed care throughout this
country. There are literally millions of Americans who don't have access to
the same quality or quantity of health care as milUons of others. I heard
Dr. Koop say the other day that an uninsured person who enters a hospital
with the same problem as an insured person is three times more likely to die
than the insured person. Now, that's a shocking statistic. So right now,
because of our non- system of health care, we are rationing care all the
time, every single day.
We believe, by getting everybody into the system, making everybody
in a sense carry their weight by having some funding that follows them, that
there will, for the first time, be incentives to reorganize care so that it
is delivered more efficiently at higher quality.
And I would go back to my example of the coronary bypass surgery
in Pennsylvania. If a high-quaUty bypass surgery can be done in one hospital
in Pennsylvania for $21,000, then don't we need incentives in our system to
convince those who are giving the same surgery at the cost of $84,000 to
figure out what they're doing that costs so much that doesn't add one bit to
the improved health of the patient and to start bringing their costs down?
And that's what we think will happen as we kind of get more market and
competitive forces at work, but within a broad federal guideline so that we
protect against exactly the kind of problem that you're talking about.
REP. HASTERT: Thank you very much.
REP. DINGELL: The time of the gentleman has expired. The chair
recognizes now the gentleman from Georgia, Dr. Rowland.
REP. J. ROY ROWLAND (D-GA): Thank you, Mr. Chairman.
I want to commend you and the president for the time and energy
that you have spent in trying to resolve some of the problems that we have in
our health care delivery system in our country. It's long been a feeling of
mine for over 20 years now that we really have a severe problem in the
delivery of health care. I don't think that you will find very many people in
�f
our country who will argue against the fact that we have the best quality
care of any country in the world, but there is part of our system that is
broken. As you have already pointed out, there are millions of people who do
not have access to the care and are not able to pay for the care. That is the
part of the system, it seems to me, that we need to look at in trying to fix.
Two federal programs that we now have in place for the general
pubUc ~ Medicare and Medicaid program, both of which have cost far more
than was ever anticipated at the time of their inception ~ and this has been
a particular concern of mine, because, since I have been in the Congress and
before I came to the Congress, attempts have been made to hold down the cost
of care under these programs. And in recent years, we have seen the Congress
acting to try to reduce our budget deficit problem by focusing on Medicare to
the extent now that we find the micromanaging of health care in our country
to be something that those people who are providing the care find very
difficult to deal with.
You're talking about having some savings under the Medicare
program to help finance the new plan that you are going to put in place. In
view of that, how would you explain that, if you're going to try to have
additional savings, there wiU not be additional micromanaging of the
delivery of health care to the detriment of those people that receive the
care?
MRS. CLINTON: Well, Dr. Rowland, I think that what we see is what
you have seen throughout your career, and what your colleagues have seen, and
that is that all too often the decisions about how care is delivered and to
whom and at what cost are made on factors other than what is best for the
atient as to, for example, what will Medicare pay for this, this and this if
add them altogether instead of just trying to deal with the patient and get
the patient well. And as we look around the country, we can see that Medicare
for many patients in different parts of the country is delivered at less of a
cost with no difference in quality than you will find in a neighboring state
or community.
F
The difference, as you and your medical colleagues know, is that
all too often the government has set prices for certain procedures which have
not been in line necessarily with what a doctor's judgment would be, but
determines often what the doctor does, because that's how he gets paid.
Instead of being paid on
a per capita or per citizen basis to take care of Medicare patients, he's
paid on how many procedures he can mn up, and it's just human nature. If
that's how you're going to be paid, then that's how you're going to mn your
office and that's how much care is going to increase.
In very carefully comparing the cost of Medicare in areas that
�10 have better organized how they deliver care to Medicare patients, and I would
V give, for example, the state of Minnesota, we beUeve that we can actually
deliver better care to more Medicare patients by decreasing the rate of
growth in the way we are currently funding Medicare, taking that money,
paying for a prescription dmg benefit for older Americans, and paying for
the beginnings of long-term care for older Americans. And I say that,
because, if you look at the hospital and physician costs, if they range from
one to three times the cost from different parts of the country, we know
there's a lot of difference that can be made in there.
And what we believe is, if we can provide some better incentives
in our Medicare system, which has done a good job getting everybody covered
but not in controlling the cost increases, we can move more people in
high-cost areas to do what they do in Minnesota or in Rochester, New York, to
provide lower-cost care for Medicare, and then with the prescription dmg
benefits, we think in the long mn we wiU save money. Because too many older
Americans leave the hospital with a prescription they cannot afford to fill
or they fill it and then they self-medicate themselves. You teU them they're
supposed to take four a day; they figure if they take one a day it'U last
four times as long. They encl up back in the hospital. That costs us more
money instead of less.
So putting these pieces together is why we think we can deliver
the kind of savings in the Medicare system with increased benefits that will
be better for older Americans.
REP. ROWLAND: Thank you.
Thank you, Mr. Chairman.
REP. DINGELL: The time of the gentleman has expired. The chair
recognizes now the gentleman from Coimecticut, Mr. Franks.
REP. GARY FRANKS (R-CT): Thank you, Mr. Chairman.
Madam First Lady, I , too, would like to commend you for your
efforts in putting forth this health care package. You have tmly given us,
as members of Congress, a major challenge.
I have just three questions. One, during these very difficult
times, why not cut health care costs before adding new health care
benefits? And my second question would be: What aspects of tort
reform would you embrace? And my third question would have to do with the
iUegal aliens. Though I come from Connecticut, we do have a major problem in
Connecticut - in Danbury, Connecticut, in particular ~ with illegal aliens.
And my question to you would be: How will they be dealt with in your ^
�35.
f
proposal? They represent, obviously, an additional cost. They wiU have no
msurance card, not being an American citizen obviously. And they also
represent an additional burden to our overall system.
MRS. CLINTON: Congressman, let me try to answer those quickly
within the time that we are allowed. The question about cutting costs before
benefits is a kind of a "chicken and a egg" issue. And we have looked at
this very carefully because, certainly if there were a way to capture aU the
savings from the public and private system and kind of sequester them and
then take care of adding more people and adding benefits, you know, that does
seem to have a certain logical appeal to it. The problem, as we look at it,
is that the health care system is all intermingled parts which affect one and
the other. And so, untU we get everybody into the health care system, we
cannot control costs and we certainly cannot control cost-shifting.
If we reduce the rate of increase in Medicare but we don't provide
the kind of prescription dmg benefits and long-term care, we will not be
dealing with some of the continuing problems of the Medicare population that
we think will help us save money in the long right. Because ~ let me just
give you a quick example.
You know, right now. Medicare will pay the hospitalization bills,
by and large, of a hospitalized recipient.
If that person is very seriously ill, but does not any longer need
hospital care, the family and the doctor are faced with a difficult problem.
Do they keep them in the hospital at very high costs even though they may not
need it, or do they discharge them to be either sent home or put into a
nursing home where we don't provide any kind of help for most families to be
able to deal with that cost.
So instead, often what we do, in your district and around the
country, there are many people who are kept longer in hospitals under
Medicare than even the doctors think they should because the doctors don't
want to burden the families because there is no alternative. So this aU is
interrelated. As we provide alternatives to that, we will bring hospital
costs down, we will get savings. And there are many examples of that.
Furthermore, as we reduce the cost increases in Medicare and Medicaid, we
cannot let the private sector simply add those costs to their insurance
burden, or else businesses and individuals will find themselves paying even
higher insurance premiums, so there has to be some reorganization within the
private sector, which is why we think an employer-employee requirement, where
everybody is in and where there are incentives, better organized care, will
help us prevent that cost shifting. And there are many other examples of that
which I would be happy to share with you.
�f
Secondly, we beUeve in reforming the malpractice system, and we
*• nave recommended a number of steps that we would like to see the Congress
take, including some kind of a required certificate of merit so that before a
malpractice lawsuit were brought, there had to be an independent doctor or an
independent board which certified to the merit of that lawsuit.
We would like to see the health plans have some kind of
alternative dispute resolution so that problems could be worked out before
they get to court and cost a lot of money and put a lot of people to the time
and worry of a malpractice case. We also beUeve we should limit attomeys
fees in malpractice cases.
And then finally as to iUegal aliens, we agree with you that we
do not think the comprehensive health care benefits should be extended to
those who are undocumented workers and iUegal aliens. We do not want to do
anything to encourage more illegal immigration into this country. We know now
that too many people come in for medical care as it is. We certainly don't
want them having the same benefits that American citizens are entitled to
have.
At the same time, when anyone in this country gets sick, they're
going to come to our hospitals. If there is an outbreak of tuberculosis,
we're going to treat all of those who might be involved in it, whether or not
they are citizens. So there will continue to be costs in the system that will
have to be addressed in order to deal with the emergency and public health
needs of illegal aUens. But we want to draw the line as to who is entitled
to have that health security card, and that should be only our citizens and
legal residents.
REP. FRANKS: Thank you.
REP. DINGELL: The time of the gentleman has expired. The chair
recognizes the gentleman from New York, Mr. Manton.
REP. THOMAS J. MANTON: Thank you, Mr. Chairman. Madam First Lady,
at the outset, let me say we are honored to have you here today, and I think
you and your president, our great president for bringing to fmition,
hopefully very soon, the long-held ideal of universal health care. I had the
pleasure this Sunday of spending several hours with the president in my
hometown, in the borough and county of Queens in New York, where he had a
sort of a mini-town hall in a diner. Somehow diners are important in our
social life in Queens and also in our poUtical Uves. And we heard from
people ~ horror stories about the pre-existing condition limitation, about
people who, because they are in a small pool in small businesses, pay
extraordinarily high premiums. And one of my constituents who was there who
was a college- educated woman who had had a kidney transplant had to
�(
'"mpoverish herself and not be employed so that she could qualify for medical
care and not be above the so-called poverty line. We recognize that this is
very, very irrational.
I am privileged to represent a district which has one of the
highest numbers of senior citizens than of any of the 435 congressional
districts. I wonder what we can say under this plan to our semor citizens
who fear for their prescription medicine coverage and long-term health care,
where the fear, again, of having to spend down or impoverishment is something
that they find difficult to live with.
MRS. CLINTON: Congressman, I really appreciate your asking that,
and also, reminding all of us about what we're really doing here, and that is
trying to help the people that you and the president visited with in the
diner, and people like those who've come to every one of the members of this
committee over the last years.
In working with the senior community in our country, we have heard
over and over again that although they are grateful for Medicare, they stiU
face overwhelming medical challenges having to do with the cost of
prescription dmgs and the absence of adequate long- term care opportunities,
particularly for home- and community-based care.
And in a community like the one you represent, where families like
to try to stay together and help each other out, there is just no help. I
mean, I have visited so many homes and hospitals and community centers that
just ask me, why are we so penny wise and pound foolish? I was in a hospital,
St. Agnes Hospital, in Philadelphia earUer this year and they tried to mn
an adult day care center so that the families in the neighborhood who wanted
to stay in the neighborhood, but had older relatives, could send their family
members to the hospital during the day while everybody was out working. But
the cost was about $35, $40 a day. And many of the families, which themselves
were uninsured, hard-working families, couldn't even afford that and could
get no care or no compensation.
So, they had to do exactly what you're saying, which is to spend
themselves or spend their ~ have their adult parents spend themselves into
poverty so they could qualify for a nursing home. They didn't want to be in a
nursing home. They wanted to be at home, and they wanted to be able to spend
the day at the local hospital where they could get good medical care. We
didn't provide for that.
Under the president's proposal, prescription dmgs and long-term
care will for the first time become available to senior citizens, and we
think that's a very important feature and one which will not only ease the
anguish of a lot of older Americans, but save us money as we try to provide
�^ ^hese services in a more cost-effective way.
MORE
REP. MANTON: Thank you.
I yield back the balance of my time, Mr. Chairman.
REP. DINGELL: The time of the gentleman has expired.
The chair recognizes now the gentlemen from Pennsylvania, Mr.
Greenwood.
REP. JIM GREENWOOD (R-PA): (Off mike.)
Welcome, Mrs. Clinton, and let me make unanimous the bipartisan
sense of respect and admiration that we've all expressed for the work that
you and your task force have done. But, beyond that, I think that after the
good feeling that's engendered by your presence passes and we move on to some
of the hearings and the markups and the sharp differences of opinion that
will emerge, I hope that when it comes time to report this biU from
subcommittee that I , as a RepubUcan, can vote yes. And I recognize that we have a lot to hammer out and
compromise before we can get to that point.
And I think uppermost among them is the concern that is probably
expressed by our side of the aisle a little bit more frequently, and that is
the concern for the impact of this proposal on employrnent, particularly on
small employers, and the ability of a small employer with relatively low
wages, labor-intensive business with small profit margins ~ restaurants talk
about having margins of 1 or 2 percent ~ even at the highest rate of
subsidy, and therefore the lowest rate of contribution by the employer of 3.5
percent, there are employers who express to us that it isn't there, that
there isn't 3.5 percent available to them, particularly in years when they're
losing money, there are no profits whatsoever.
I'd like you to respond to your concerns about what happens to
those businesses, how we deal with them. I know that there will be savings on
the worker's comp side, maybe on the automobUe side that might accme to
their benefit, even in their own personal health care premiums if they go
down, but it seems inevitable that when you impose a mandate such as this on
employment, you have to have a downward pressure on employment. There have to
be hundreds of thousands of decisions about should
I expand my workforce beyond 50 or not? Should I bring on a part-time
employee, a temporary employee? All of those decisions have to be reweighed
in consideration of the cost of providing health care, and I'd like your
�-2,7.
comments on that.
MRS. CLINTON: Thank you. Congressman. And I want to assure the
committee, and particularly the RepubUcan members who have been so helpful
in this process, that if we did not beUeve this was a net job increaser, we
would not be here. We believe very strongly that removing the unnecessary and
burdensome costs of health care from this economy will result in new and
growing employment.
But having said that, I think I also want to stress how sensitive
we are to the small business side of this. I mean, we come from a state of
Arkansas where small business is the business economy in our state. And I
come from a family where my father was a small businessman all of his life,
and we never had health insurance, ever. And we were just very lucky that no
one ever got seriously ill during those growing-up years because we never,
ever had health insurance.
So, I'm very sensitive to what we are asking, and we have tried
the best we know how to be as careful as we can. But, of course, we want your
advice and suggestions about this as we move forward.
And let me just make a couple of points. First of all, we think
that there will be a great benefit for those small businesses who have been
providing some kind of health insurance, and they are the majority. It's not
a big majority, but they are the majority. And we think that if you look at
the fast-growing job sector in our economy of small businesses, they are the
ones more likely to be offering extra benefits. And the Small Business
Administration has been doing a survey of small businesses around the country to
find out exactly who is offering insurance, how much it costs, so that we have some
really good data, which we will share with you.
We also believe that as we lower the costs of health care to allsized businesses, but particularly medium and large businesses, that wiU
have a very positive impact on the economy.
I have spoken with the CEOs of major employers who have said that as
we lower their burden they're going to be putting that money into new hires,
into more wages, into more profits, into more contracts with small
businesses.
I would also add that in addition to helping the fastest-growing
small businesses and the small businesses that already provide insurance, we
will be increasing health care jobs, a sector of the small business communify
that will just take off like a shot out of the night because there will be so
much more money there for things like home health care.
�Now, with respect to what wiU happen, if you look at HawaU,
which has during this entire time that it's had an employer mandate had an
unemployment rate below the national average and has had some of the
fastest-growing small business job creation, you know, we certainly can't
look to Hawaii as supporting the concerns that a lot of small business
advocates have presented. Also, if we look at the minimum wage increzise over
the past years under both Republican and Democratic presidents, it has never
had the kind of depressing impact on small business development as some
people have feared. And what we are talking about is much less than the usual
increase in the minimum wage.
And finally, I would say that the 3&1/2 percent is a cap. Some
small businesses will be paying 1 percent, 1&1/2 percent. And for many smaU
businesses that are on the margins, as you're describing, we would like the
opportunity to know more about their individual circumstances, because based
on the scenarios that we have been mnning we think that this will be
affordable given the worker's comp decreases that we would like to foresee,
the auto insurance-health care decreases we would like to buUd in, the kind
of cap that we would put on that would top out at 3&1/2 but be below that for
a number of small businesses.
So in general we think there is no evidence on either a national
level or a specific business sector level that would support the kind of dire
concerns that some have voiced, but we want to be sensitive and work through
that with you and others.
REP. GREENWOOD: Thank you.
Thank you, Mr. Chairman.
REP. DINGELL: The time of the gentleman has expired.
The chair recognizes now the gentiewoman from California, Ms.
Schenk.
REP. LYNN SCHENK (D-CA): Thank you, Mr. Chairman, and Mrs.
Clinton, I want to add my thanks to you for the fundamental and substantive
work that you have done in this. I know that I speak for everyone when I say
you have the admiration and the respect and the appreciation of the entire
country. After aU, you don't get paid to do this. And we couldn't pay you
for this singular act of public service.
Before I ask my question, I'm going to take the liberty of giving
you a message from my mother. She said I must do this when I talk to you.
�0
And that is she wanted me to tell you that not since Eleanor
{ Roosevelt has she so admired an American woman in public life. And this is
from a woman whose admiration is not easily earned. So I can teU her I
delivered the message. (Laughter.)
MRS. CLINTON: I hope my mother is watching! (Laughter.)
REP. SCHENK: Oh, she's very proud of you!
I would like to ask you about the section of the plan which deals
with the regulation of prices of breakthrough dmgs and new dmgs. Most of
these, as we all know, are developed not by the giant pharmaceutical
companies but by the smaU biomed firms. And in the interest of full
disclosure, I will tell you there are hundreds of them in my district.
Under the plan, as I understand it, these breakthrough dmg prices
are going to be regulated by the National Heahh Board through a breakthrough
dmg committee, and the committee would have the authority to, quote, "make
public declarations regarding the reasonableness of the initial launch prices
for these dmgs." Some of the biomed executives have expressed concern to me
that this kind of regulation, as proposed, would have a chilling effect on
research and development in the industry. And, of course these types of dmgs
not only have the potential for enormous cost savings in the long mn but, of
course, have enormous potential benefit for humamty.
So could you clarify for me sort of the rationale relative to
pricing the breakthrough dmgs, and especiaUy what consideration was given
to motivating future research and development in the industry?
MRS. CLINTON: Well, Congresswoman Schenk, this is one of the
really difficult areas because on the one hand we know that breakthroughs in
medical research and pharmaceutical development can often be life-saving and
certainly cost-reducing over the long mn in terms of the medical costs. We
also anticipate, as I have said previously, providing a prescription dmg
benefit that will greatly enhance the money going into our pharmaceuticals
and dmg manufacturers. We also want to enhance the federal government's
research capacity that will be done both by government agencies and in
partnership with companies like those that are found in your district.
But I don't think anyone can any longer doubt that we do have
problems with the pricing of dmgs in this country. And what we're
trying to do is to strike the right balance between encouraging and
motivating research but not permitting the public, either through govemment
programs or through private insurance, to bear more than a fair share of the
costs of any company recouping its research and development investment.
I don't know if any of you heard, as I did the other day, on
�i
National Public Radio, the physician from Mayo Clinic who was talking in
great detail about a dmg that had been developed for deworming animals that
was determined to have some beneficial use for colon cancer in human beings.
And this physician at Mayo worked closely, hand in hand, with a dmg
manufacturer to make sure all of the testing was done so that it could be
used for human beings. When it came on the market, the dmg manufacturer
started charging $6 a piU when you had basically the same dmg being charged
at 6 cents a pill for use in animals. And this physician at Mayo said, you
know, this has got to stop.
And yes, you could say maybe that was a breakthrough dmg because
it had a different use than it had because it was no longer just being used
for animals but being used for humans. But at least according to this well
respected doctor there was no justification whatsoever for that increase in
cost.
What we've tried to do is to strike a balance in which more money
is going into the pharmaceuticals through the prescription dmg benefit,
through additional research dollars. But somebody, somebody has to have some
way of saying you cannot charge this much. And what the national board wiU
do is not regulate prices but will publish information about what it
considers to be a fair price for a dmg based on its cost of development. And
if we have any better ideas about how to sustain the good development of
dmgs, have the dmg manufacturers and the biomed research companies get a
fair return, but somehow put a brake on what are the unfair and in many
respects totally unjustifiable costs that are still being asked in the
pharmaceutical industry for us as the public and individuals to pay, we're
open to that. But we believe strongly there has to be some method for trying
to get a handle on these prices.
And we'll be glad to work with you further on it because we don't
want to inhibit research, but we don't want to reward what are unnecessary
prices and demands about pricing, either.
REP. SCHENK: I appreciate your willingness to work with me. Thank
you.
REP. : Recognize the gentleman from Ohio, Mr. Brown.
REP. SHERROD BROWN (R-OH): Thank you, Mr. Chairman.
Mrs. Clinton, your work especially with preventive care has been
particularly outstanding, and we want to thank you for that. Erskine Bowles,
speaking during the day after you addressed all of us in the health
university, talked about some losers that would come about in terms of the
payroll payment, and he said those companies particularly that can lose would
�Ml.
be those that have a lot of young workers that have aggressively tried to
V l atchet down, if you will, health care costs, and those companies, especially
those that have real good wellness programs, aggressive anti-smoking
campaigns, exercise on the premises, that sort of thing.
Putting aside how ~ if you would, answer two questions. One, how
do you seU this program to those companies and to those employees when, in
fact, they probably, at least in the beginning, wiU pay more? And second,
how do we as a govemment provide incentives to those companies to continue
the kinds of wellness programs they do? You have talked about relying on
employers for so much of this whole new health care program. How do we kind
of merge that together and help to provide those incentives?
MRS. CLINTON: WeU, Congressman, I think that one of the reasons
that costs will go up for some Americans is because they have benefited from
the kind of insurance practices that have eUminated other Americans from
insurance or priced it so high that they could barely afford it. And by that,
I mean that many of the people who choose not to be insured or who get good
rates for insurance are young, predominantly single, healthy Americans, and
they right now are either paying less than the rest of us because they are
young and healthy, or are choosing not to be insured. They are among the
category of Americans ~ and we estimate this is about 10 to 12 percent of
Americans ~ who will pay more for about the same kind of benefits.
But the reason we think it's fair to ask them to do that is
because if you look at the entire population, between 63 and 65 percent of
Americans will pay the same or less for better benefits; about 20 or 22
percent will pay a little bit more for better benefits; and then we're left
with this group that is young and they have benefited from what's called
experience rating because they are young.
Now, we have several alternatives, and what we have chosen to do
is to say to young people, yes, you will pay a Uttie bit more now to get
guaranteed, comprehensive benefits that will always be there for you, but as
you age, which will happen, whether you believe it or not ~ (laughter) ~
you will have the benefits of that because you wiU not then pay more for
those same benefits.
And I have told some of the young people who ~ you know, we have
a lot of young people around the White House, in case you haven't noticed,
and some of them have come up to me and they've said, "Now, you mean I'm
going to have to pay more?" And I've said, "WeU, yes, because we have this
old-fashioned idea that young people and old people and sick people and weU
people all ought to be insured because you all will get old and none of you
icnow whether tomorrow you could be sick or lying in the emergency room
because of a motorcycle accident." And so we think that the basic principles
�of faimess mean that everybody has to be in the system and that some young
{ people now who pay less will pay a Uttie bit more, but that is an investment
that will pay off for them as they get older and have chUdren and do what
the rest of us do.
So, we think if you look at aU of thefigures,we are being as
fair as we can, but I want to be honest about it and say that there are some
who will pay more for about the same benefits.
The other point you make, about prevention, there have been some
employers who have really led the way and have had some benefits in their
insurance rates because of the programs that they have implemented. We want
to see those programs implemented across the whole society through health
plans that encourage primary and preventive health care and encourage better
opportunities for people who want to give up smoking or who want to change
their diet. And we think no individual employer can have anything but, you
know, the limited effect on his employees, but that if we take what we have
learned from employers who have been successful with prevention and we move
it to the national level and we move it to the accountable health plan level,
we will have benefits that far outweigh what any individual employer could
achieve for his or her employees.
REP. : The time of the gentleman has expired.
I noticed when I took the chair over from Chairman Dingell
a note on the podium, and it says, "John" - meaning John DingeU ~ it
says, "It's 50 years since your father introduced health reform legislation,
and it is my 50th birthday today. Being here now is a great birthday present.
May we meet with success for aU Americans."
Happy birthday, Mike Kreidler. Recognize you for five minutes. And
I might just note, on your time, it's attributed to Vernon Jordan that anyone
who waices up over 50, who wakes up in the morning without an ache or a pain,
is dead. (Laughter.)
REP. MIKE KREIDLER (D-WA): Thank you, Mr. Chairman. It ~
REP. : Mike. I mean mike.
REP. KREIDLER: Thank you, Mr. Chairman.
It is indeed a pleasure to be here and to be a part of this
presentation today, Mrs. Clinton. I might point out that another group, a
group that you mentioned earlier. Group Health Cooperative of the Puget
Sound, is one of the exemplary examples of what can be done with managed
competition and managed care.
�This is an organization 21 years ago I began work with. And for 20
years, they give you this Uttle utiUty knife with their logo on it, and I'm
a recipient of that for 20 years of service with Group Health. And I have to
agree with you; it is an exemplary organization. I went to work for them
because I'd just completed a master's in public health and realized that when
I started the master's I wanted to work in health administration, and I went
to earn it because then-President Richard Nixon had proposed an employer
mandate for health reform. And by the time
I completed my degree, it was quite apparent that we weren't going to see the
health reform that President Nixon was proposing at that time. So it's a
pleasure to be here for that reason, too.
I have two questions ~ or three questions here that are rather
specific to the state of Washington. As you weU know, it is the only state
right now that has been as dramatic and bold in health care reform, closely
paralleling that with that of the administration's. And it is also one that,
as I say, has an employer mandate as a part of that program. It appears right
now that the president's plan relies on major savings in Medicare, but it
apparently does - but does not try to change the basic fee-for-service
stmcture of Medicare. Washington state has an enacted health plan, as I
said, that parallels that proposal, but the state plan would include Medicare
in its managed competition system. Do you think states should have the option
to stmcture Medicare around competing managed care plans the way our state's
plan would stmcture the system?
MRS. CLINTON: Yes, I do. I think that, by trying to encourage and
move toward more organized care systems for Medicare patients, we would be
doing a better job at a more efficient cost in preserving the quality health
care. Too many Medicare patients now are being shut out of care because the
existing fee-for-service networks will no longer take care of them at the
price that Medicare will offer. And I think many Medicare recipients would be
happier and have more security and be better taken care of if we could move
them into more managed care settings. And I applaud the state of Washington
for moving in that direction.
REP. KREIDLER: Great. Thank you. I was also encouraged to see how
closely the - in another respect that the president's plan parallels our
state plan. But one difference is that our state plan does not require all
health care coverage to be purchased through health aUiances. Our plan has
an exemption for large firms as the president's plan does, but it also allows
smaller employers to buy coverage directly from plans without going through the aUiance.
Why do you feel that all but the largest purchasers should obtain coverage through alUances?
MRS. CLINTON: Because we want to get the maximum purchasing
power. Congressman, and this is something that we have thought about a lot.
�Many employers believe that they could strike a good bargain for themselves,
fhe problem is that, if you don't have a large number of employers and
employees in the purchasing pools, then you begin to have the kind of risk
adjustment that works to the disadvantage of the whole system. And we're very
concerned about that. If we could buUd m adec^uate protections against that,
we would be glad to -- you know, to look at options like what Washington has
done.
But on a national level, we are afraid that you would not have the
kind of protection against what they caU in the insurance trade
cherry-picking, and you'd have, you know, younger, healthier people being
hired by employers and, therefore, the employers being able to negotiate a
better deal because there wouldn't be any protection against doing that. And
we think that might cause even worse kinds of outcomes for people than we
currently have. So it's an area that we're open to discussing, but it's one
that gives us a lot of concern.
REP. KREIDLER: Thank you, Mr. Clinton.
Thank you, Mr. Chairman.
REP. : Mrs. Clinton, Mr. DingeU is on his way back from the
vote, and he would Uke to close the meeting. We'd promised you you'd be out
at 3:00. Could you take a few more questions until he arrives?
MRS. CLINTON: Fd be glad to. I'd be glad to.
REP. : Thank you very much.
I recognize the gentlewoman from Pennsylvania.
REP. MARJORIE MARGOLIES-MEZVINSKY (D-PA): I would like to add my
voice to those who appreciate and respect what you've done. And welcome.
My question has to do with Pap smears and mammograms. How do you
reconcile the Pap smear and mammogram regimen in the basic benefits package
that falls short of the recommendations from the American Cancer Society and
other women's health groups? In particular, I'm concerned that women should
receive annual or biannual Pap smears and annual or biannual mammograms after
40, not 50.
MRS. CLINTON: Well, I'm so glad you asked that, because there has
been so much misinformation and misunderstanding about this feature.
And I am happy to have the opportunity, Congresswoman, to clarify
that.
�As you know, there are many insurance policies now that do not
cover diagnostic services like Pap smears and mammograms, which means that
the woman bears the entire cost if she should obtain such a service. What we
have done is to absolutely include them in the comprehensive benefits
package. Mammograms and Pap smears are covered services. That means that you
can never be denied insurance coverage for those particular diagnostic tests.
What we have further done, and what we have done in Une with a
recommendation from the United States Preventive Services Task Force, which
was created under the previous administration under the previous head of the
National Institutes of Health, is to adopt their recommendation. Their
recommendation was that women over 50 should have a mammogram every other
year. So, what we have done is to say aU women are covered.
Every woman for whom any doctor believes it is medically necessary
or appropriate can start at whatever age is the age that that doctor thinks
is the one that she should begin. But for women over 50, the service wiU be
completely free. Now, what that means is that if I have - belong to a health
plan that has no co-payment requirement, then I can start getting my
mammograms and Pap smears before I am 50 on a medically necessary or
appropriate basis without any cost. If I belong to one where I have a $10
co-pay, that's all I will pay, but I can start anytime before 50 and do it as
many times as my doctor thinks is necessary.
But every single American woman, when she reaches 50, which is the
age that was recommended by this very extensive task force that looked at all
of the evidence, no matter what plan she is in, she will have that service
absolutely free. So, the co-payment will not be necessary. It will not count
in any kind of deductible. It will be absolutely free.
We think that is the right balance to strike. If, in the coming
weeks and months, the Congress believes that we should try to extend that
free coverage below the age of 50, we will look at the cost of doing that.
But I want to assure every woman ~ you know, my mother-in-law has
had a stmggle with breast cancer over the last several years. I , like most women, have
tried to do what I should do with respect to mammograms, and I've paid the full cost
because they were not a covered service in the past. And so, I take this very personally.
They will be covered. No woman will be turned away. TTiey will be part of the guaranteed
benefits package. And then, for women most at risk over 50, as a further inducement for
women to come in and do it, they wiU be absolutely free as part of the preventive services
we provide.
REP. MARGOLIES-MEZVINSKY: So, if there is famify history involved
or something like that, according to the doctor's wishes, they will be
covered.
�MRS. CLINTON: If it is medically necessary or appropriate, and
that is a standard that would certainly cover women with a family history or
any kind of suspicious growth, it would not be in any way prevented or
eUminated from coverage. If a woman believes it is appropriate, she wiU be
entitled to have that service, and it will be covered as an insured service.
REP. MARGOLIES-MEZVINSKY: I suspect this next answer may have
something to do with a report card, but wiU there be a compUance element
involved here also? I feel that it isn't enough for an insurer of any sort to
just have this service available.
REP. DINGELL: The chair advises the time of the gentlewoman has
expired. The chair recognizes ~
MRS. CLINTON: Mr. Chairman, I don't mind answering that. If you
would Uke me to, I don't mind answering it.
REP. DINGELL: If that's your wish, then please, Mrs. Clinton.
MRS. CLINTON: Because I think the congresswoman has asked
a very important question about insuring quality and making sure that
information is accessible to real people and not just, you know, folks who
read medical journals.
We're going to do everything we can, and that's why I applaud your
state so much, because this kind of consumer guide is exactly the kind of
information we are going to need. And that will be part of the report card
process. But I also believe that there will be a great interest in making
sure that consumers get good information.
I would imagine that all kinds of consumer groups and maybe even a
whole new industry will grow up to provide information so that every year
when you and I make our choice about what health plan to join we wiU be
looking at all kinds of information that will help us make the best choice.
And I will look first, as I know you will, at what is the quality. You know,
what kind of treatment do they get and what kind of outcomes do they have and
how good a job are they doing? That's what my bottom Une is, and I think
that's what most Americans feel as weU.
REP. MARGOLIES-MEZVINSKY: Thank you very much.
REP. DINGELL: The time of the gentlewoman has expu-ed.
The chair recognizes now the gentiewoman from Arkansas, Ms.
�HI
Lambert.
REP. BLANCHE LAMBERT (D-AR): Thank you, Mr. Chairman.
As you can see, we members are into preventive care. If we mn
back and forth enough ~ (laughter) ~ we'U get our exercise for the day.
I'd like to join my colleagues, certainly, in their applause to
you and to the president, to the administration, and your task force in
taking on such a well-needed and long-waited-for task in reforming health
care in this nation. I'm also pleased to have seen ~ early in the spnng I
introduced H.R. 2336 ~ to have seen that included in your package, which not
only is a tremendous incentive to see health care but also to see people
taking the responsibility of health care and offering them 100 percent
deductibility for self-employed people. I share your goals in certainly
looking for quality health care, affordable and available, but also lending
itself to encourage responsibiUty in the American public and once again
taking on the responsibility of their own health care.
I have about four questions and I'U be quick, and you can just
choose whichever you'd like to speak about, first being malpractice reform. I
see, really, basically in the proposal ~ or at least my feeling is it hasn't
gone far enough. It simply is an impediment, perhaps, not really the
strengthening needs that we need in order to decrease defensive medicine
that's being practiced in other areas, and we'd Uke to see if there are any
other proposals or, certainly, additions that the administration would be
amenable to as far as further malpractice reform.
The other, I hear a tremendous amount from my small mral
hospitals, the disadvantage that they're put at because of the certain CLIA
(sp) regulations and others. I'm hoping that there are certain CLIA (sp)
regulation reforms that will certainly level the playing field hopefully, or
at least put these hospitals in a position where they can be capable of
competing with the larger urban hospitals.
And I guess that moves on to the next, which is the protection of
the client base for the small mral hospital. Probably 15, 20 years ago we
saw a move to try to eliminate mral hospitals and concentrate more of the
tertiary care or, really, the care predominantiy in urban areas where people
felt like they could care for it more. And now today we're looking almost at
a 180 from that movement, which is to try and preserve some of the mral
health care because we do find that not orUy does it provide a better qualify
of life, but it's also more cost effective. I think many of my mral
hospitals are frightened that they will lose that client base, that it will
choose to go to the urban areas if they've got the choice, and that the urban
areas are mandated to be able to provide it in the same way that the smaller
hospitals are. So I'm hoping that there are some precautions there.
And also the state Unes for the alUances. You, probably better
�f
\
•han anybody in this room, understand my district, and very often, for OBGYN
coverage, for ~ whether it's dialysis, or other things, many of my
constituents have to cross either the Missouri line, the Termessee, or the
Mississippi Une, and how wiU the alliances be able to work together in
order to provide those people that care?
MRS. CLINTON: WeU, Congresswoman, I do understand your district.
I've spent many, many days and happy times in that district, and I ~ often
when I think about mral care, I think about your district because I know it
so well.
Let me just quickly try to mn down these points, and then we can
give you additional information. We think we've stmck a good balance with
respect to malpractice reform between trying to limit unnecessary, frivolous
lawsuits that do have a chilUng effect and drive up the cost of defensive
medicine against the legitimate needs of victims who have to have some kind
of compensation in order for them to have their life needs met, but again,
you know, we're putting this forward as our best effort at trying to deal
with some very real problems.
Secondly, with respect to smaU mral hospitals and CLIA (sp), we
look forward to working with this committee, which pioneered the lands of
protections that CLIA (sp) put into law to make sure that where adjustments
and reforms might be called for, they can be made in a thoughtful way. And I
know that the committee will welcome your specific suggestions based on the
real-life experiences because I , like you, have heard that sometimes when we
try to do the right thing we have unintended consequences have been
particularly difficult in mral areas so that, for example, hospitals and
clinics no longer feel free even to do a strep test for strep throat because
they feel like they have to send it off and then it takes two days, and you
could have beaten the strep infection if you had just been able to do it on
site. So those are some of the practical considerations that I think this
committee will be very sensitive to.
With respect to state Unes for aUiances, we anticipate health
\
plans crossing lines, and so the health plans wiU be coordinating services
^
across state lines, just as they do now, so that even though you might be
insured by an insurer in Arkansas, you are free to use your dollars in
Memphis or some other state, and we anticipate that that vriU become
available, even though alliances wiU be confined within states as a way for
states to ht able to monitor their financial solvency and make sure that they are mn
correctly. We anticipate health plans bidding for business across state lines all over
the country.
REP. LAMBERT: But if the aUiances don't have the same programs,
then there shouldn't be a problem?
i
'
�c
MRS. CLINTON: No, there shouldn't be a problem because what wiU
happen is that you will have providers joining together. In east Arkansas you
will have, I would imagine, providers ~ and in Arkansas and Tennessee
networking together to bid on business in both Arkansas and Tennessee. Or you
will have a Mississippi provider coming across the river to bid on business
in southeast Arkansas. We anticipate that happening and think it will be very
good for the kind of opportunities for enhanced care in mral areas Uke your
district.
REP. LAMBERT: Thank you.
REP. DINGELL: The chair advises the time of the gentiewoman has
expired.
Mrs. Clinton, we want to express our thanks to you for a superb
presentation today. This is, I'd say, about the third or fourth time this
month that I've had the privilege of listening to you and we ~ I've learned
a great deal each time. I want to tell you what a superb job I thought you
did when you met with all the members informally in the learning session
which we had earUer, and I reiterate to you my personal thanks for your
kindness to us today, and I also reiterate to you the appreciation we have
with regard to the superb job which you have done in explaining this.
I can assure you of my personal support and that of many others in
connection with your efforts to move this program forward. I believe it's a
good one, and I believe it's necessary, and I beUeve it's in the pubhc
interest.
The chair announces that the time that Mrs. Clinton had available
to us expired 15 minutes ago, and so we express again to you our thanks for
your kindness in that particular. Without objections, all members will be
permitted to insert opening statements in the Record. The chair advises that
our time here has expired and there will be no time for further questions at
this time, but if members choose, Mrs. Clinton has indicated that she and her
staff would respond to questions which we would not only make avaUable to
the members it they ~ the response which we would not only make available to
the members, but would insert in the Record.
So, Mrs. Clinton, we give you our sincere thanks for a sincere
performance today. We thank you, and we wish you weU, and we v^U do our
best to be of help to you.
MRS. CLINTON: Thank you, Mr. Chairman.
REP. DINGELL: Committee stands adjourned to the call of the
�HEARING OF THE SENATE LABOR AND HUMAN RESOURCES COMMITTEE
SUBJECT: THE CLINTON HEALTH CARE PLAN
CHAIRED BY: SENATOR EDWARD M. KENNEDY(D-MA)
WITNESS: FIRST LADY HILLARY RODHAM CLINTON
RUSSELL SENATE OFFICE BUILDING, ROOM 325, WASHINGTON DC
WEDNESDAY, SEPTEMBER 29^,T"t993 "
SEN. KENNEDY: (Sounds gavel.) We'll come to order.
We're now beginning the most significant domestic policy debate
since Medicare was enacted almost 30 years ago, and i t ' s appropriate that as
the Senate begins i t s action on t h i s issue we're meeting i n t h i s caucus room
that has witnessed so many h i s t o r i c hearings going back to the e a r l i e s t years
of t h i s century. Congress enacted Medicare i n 1965 because the nation had
reached a consensus that action was essential-to end the health care c r i s i s
affecting senior c i t i z e n s . Today a comparable c r i s i s faces every American
family, and action i s j u s t as urgent.
The key to success i n t h i s undertaking i s bipartisanship. Going
back over many years, no major reform has been enacted without bipartisan
support.
This committee has had a tradition of bipartisanship, a tradition
which I'm confident w i l l be extended to consideration of the Health Security
Act. A l l of us intend to work closely together and with the administration.
The f i n a l b i l l that Congress approves needs and deserves the support of both
Democrats and Republicans,,and the coiintry expects that kind of participation
and consideration. No individual has contributed more to the development of
the president's plan than our witness t h i s morning, the F i r s t Lady, H i l l a r y
Rodham Clinton. And she's worked t i r e l e s s l y wit^ great s k i l l to shape t h i s
plan. I n doing so she has reached out to a large niutber of c i t i z e n s , to
experts on a l l sides of the debate, and to a l l of us i n Congress. Her
leadership has been extraordinary, and we're bo|iored by her presence here
t h i s morning.
^
I am looking forward to working with a l l the members of t h i s
committee, the Finance Committee, and the other committees i n the Senate with
j u r i s d i c t i o n over the many complex aspects of our health care system. Today,
Mrs. Clinton t e s t i f i e s here before the Labor and Human Resource Committee.
Tomorrow s h e ' l l t e s t i f y before the Finance Committee. I know that under the
guidance of Majority Leader George Mitchell and Republican Leader Bob Dole
we'll work as closely as possible together to pass a bipartisan b i l l that
meets the goals the president has s e t and that the American people deserve.
Nancy.
i
SEN. NANCY LANDON KASSEBAUM (R-KS): Mr. Chairman, I certainly
agree with you that Mrs. Clinton has provided extraordinary leadership, and
i t ' s a pleasure to welcome»you here t h i s mornijng i n our f i r s t formal hearing.
The task before us i s numbing i n i t s c o i ^ l e x i t y , which you know
a l l too well. I t ' s also, I think, r i c h i n opportunities for p o l i t i c a l
conflict.
For some of us the challenge w i l l be to make sure our concerns
about the s p e c i f i c s of reform do not overwhelm the commitment to making i t
happen. For others the challenge w i l l be to rey^rse, to temper eagerness i n
moving the b i l l with recognition that lasting ;reform cannot occur without
careful deliberation and sincere compromise.
�But Mr. Chairman, ± agree.
I think that obviously we cannot achieve t h i s overnight, but I
have great confidence that bipartisan compromise w i l l ultimately be achieved.
And welcome.
I would l i k e to ask my f u l l statement be made a part of the
record, Mr. Chairman.
SEN. KENNEDY: Mrs. Clinton, we'll be glad to hear from you, and
we'll have a five-minute time limitatrlon'ifor the members.
Thank you very much.
MRS. CLINTON: Thardc you, Mr. Chairman. Thank you. Senator
Kassebaum.
I want to begin by thanking the members of t h i s committee for the
consultation and advice that you have given me over the l a s t months. I have
met not only with t h i s committee several times but with many of the members
individually numerous times, and I'm very grateful for the assistance that
you have given me.
I t i s an h i s t o r i c opportunity as we come together in t h i s Senate
caucus room. This i s a place where much of America's history has been played
out. I t i s a place where years ago President Kennedy announced h i s cauapaign
for the presidency. Eight years l a t e r . Senator Robert Kennedy announced h i s
own presidential candidacy here. Your family, Mr. Chairman, and your
commitment to health care reform bears special notice. I t i s a commitment
that goes back 25 years. And you have added your own stamp to our history in
t h i s room, and your name has been attached to every piece of health
l e g i s l a t i o n that has passed through Congress. So I'm especially grateful that
we would have t h i s opportunity to begin t h i s discussion about the future of
health care reform before t h i s committee i n t h i s room.
I am also grateful because t h i s committee has shown a welcome and
courageous s p i r i t of bipartisanship when addressing d i f f i c u l t s o c i a l
problems. For the good of the nation on many occasions, you have put aside
partisan and ideological differences. That tradition of open- mindedness and
courage w i l l be b e n e f i c i a l to a l l of us as we work toward lasting,
substantive health care reform in the months ahead.
Like you, I have had the opportunity to t r a v e l around the country
and l i s t e n to thousands and thousands of ordinary Americans t a l k about health
care . I have listened to the employed, the self-employed, the unemployed,
those who labor in our factories, on our farms and our o f f i c e s , those who
never have had to worry about health care because of t h e i r f i n a n c i a l
affluence. I have read l e t t e r s from, I think, every state represented here
that ceune i n amongst the more than 700,000 pieces of mail received at the
White House from c i t i z e n s pouring t h e i r hearts out, sharing t h e i r stories and
offering t h e i r suggestions.
Nothing i s more important to our nation than ensuring that every
American has comprehensive health care benefits that can never be taken away.
When the president l a i d out h i s goals for health care reform, he was
committed to building on what i s right i n our current system and fixing what
i s wrong. That p r i n c i p l e w i l l guide us throughout t h i s debate.
We want to preserve and strengthen the high quality of medical
care that i s a trademark of our nation — our unrivaled doctors, nurses,
hospitals and sophisticated technology.
We also want to honor every family's desire to choose a doctor
and other health care providers. At the same time, we have to be equally
committed to f i x i n g what in c l e a r l y broken. Each month, more than 2 million
�I.
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people lose t h e i r health insurance for some period of time. Every day,
thousands discover that, despite years of working hard and providing for
their families, they are no longer covered. And every hour, hundreds who need
care wind up in our emergency rooms because they have no health care
Insurance.
These are not isolated and Individual tragedies, because every
person who loses health benefits who i s denied health insurance i s part of a
growing national problem, and that i s a problem that you know so well i s not
only causing human tragedies, but underMiming 0!Ur~B"OClal fabric, reducing our
nation's productivity, draining our federal and state budgets, as well as
denying hard-working Americans the kind of wage increases that they deserve
to have because t h e i r compensation i s so heavily weighted now toward benefits
Instead of wages. You have, as I have, heard the stories about those
insurers, 40 percent of whom, refuse coverage to people with so-called
preexisting conditions. Up to 30 percent of employees report they are afraid
to switch jobs for fear they w i l l lose their health insurance . And hundreds
of thousands of people are locked into our-unproductive welfare system
because to leave welfare would mean giving up Medicaid benefits.
The harmful effects of the r i s i n g health care costs on our
workforce and our nation cannot be overestimated. I think a l l of us, as we
move through t h i s debate, have to put ourselves into the l i v e s and into the
stories that we hear about to r e a l l y know what i t feels l i k e to be the most
qualified applicant for a job but be told you can't be hired because your
child has an i l l n e s s that w i l l drive up the company's health care premiums;
to be told that, i f you leave the job you have to take a better opportunity,
which i s the American dream — to move to another c i t y , to move up the ladder
of success — you w i l l lose your health coverage. And imagine the
disillusionment of those people who have worked so hard a l l t h e i r l i v e s who
now, because of economic changes, lose that job, are l a i d off and find
themselves without health care coverage.
Today, the average worker pays $7,423 for health care each year.
I f we don't change our system now, that amount w i l l r i s e to $12,386 by the
year 2000. And as the average worker's b i l l for health care goes up, h i s or
her r e a l wages w i l l decrease by about $655 a year by the end of the decade.
Today, the trade we are offering American workers i s to give up any wage
increases that they desezrve and that they have earned i n return for l e s s
health care coverage and l e s s health security.
When I was with you i n Massachusetts l a s t spring, Mr. Chairman,
we met a number of small business otmers and had a conversation with them.
One man p a r t i c u l a r l y stays i n my mind. He owned a small family bowling alley.
He also manufactured great i c e cream, homemade, right there at the a l l e y . He
had one long-time employee. That i s the only person he employed. And that
man's son became seriously i l l . As a r e s u l t of the boy's i l l n e s s , the cost of
that very small business' health insurance premiums went up. As I'm sure you
remember, Mr. Chairman, that bowling a l l e y owner told us with tears i n h i s
eyes how confounded and confused he was by being l e f t with the choice of
either f i r i n g h i s long-time employee, denying the man coverage for h i s fzuaily
when he needed i t most, or continuing to pay the r i s i n g cost of health
premiums, knowing that that increase in cost could undermine the success of
his family business.
In our current system, stories l i k e these have become too common.
That i s why we must f i n a l l y ensure that every American c i t i z e n has
comprehensive health benefits that can never be. taken away, not when you lose
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I. . )-•
�I job, not when you change jobs, not when you move, and not when someone i n
'our family gets sick.
We have a l l learned probably more about the t e c h n i c a l i t i e s and
i e t a i l s of health care and the way i t i s delivered i n t h i s country i n the
Last months than any of us ever knew before. But what I know most and what I
:are about most i s what I have learned from personal experience, because when
iTou s t r i p a l l the technical d e t a i l s away, what r e a l l y matters i s what i s
ihere for you when you need i t . And those of us who are well-insured, those
3f us who do not have to worry aboutr^xfettlng" the best care that can be
offered anywhere i n the world,
[ hope w i l l always keep i n mind the mothers and the fathers and the s i s t e r s
and the brothers and the children of t h i s country who do not share that sense
9f security.
We want to emphasize primary and preventive health care as well
because we think that w i l l save us money and provide more security for a l l
Amciricans.
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We want to extend prescription drug benefits to a l l Americans,
but: p a r t i c u l a r l y older Americans, because we have heard more about the costs
of prescription drug increases than probably any other issue from older
Americans.
,
We want to be sure that we begin to provide long-term care for
older Americans. The choices we now pose to families are j u s t unconscionable
in many instances: spend yourself into poverty i n order to find a safe,
secure nursing home for your family; you can't get care for tzdcing care of
that family member i n yourihome; you can't get reimbursed for a much cheaper
fo]rm of care i n your community; a l l that i s available i s a nursing home, and
they are not available i n enough numbers for enough older Americans.
We also want to be sure that everyone's health care needs are
taken care of, and I want to say a p a r t i c u l a r word about women's health care
needs.
For too long, women have been relegated to the fringes of medical
research and medical care. The leading cause of death among women i n our
country i s coronary disease, but u n t i l recently women were routinely excluded
from major coronary c l i n i c a l t r i a l s . And I want to thank t h i s committee for
i t s leadership i n including women where they r i g h t f u l l y belong, a t the
forefront of being taking care of i n our health care system. But we s t i l l
have a ways to go. We need to focus on other diseases, such as osteoporosis.
We need to provide diagnostic t e s t s l i k e mammography and Pap smears. We need
to be sure that women who are the primary caretakers of ovir families are
taken care of.
By ensuring comprehensive benefits to a l l Americans, by
emphasizing primary and preventive health care that saves money and keeps
people healthy, and by devoting more attention to the special health problems
of women, we can control costs and build a healthier nation and medce our
economy and oiir workforce more productive.
I want to thank you for the assistance you've already given to us
and thank you zdiead of time for what I know w i l l be a very productive and
f r u i t f u l working relationship as we move forward to solve t h i s problem. SEN.
KENNEDY: Thank you very much, Mrs. Clinton. I think, as we exeusine the
piroposal, there i s obviously a long l i s t of detailed questions that come to
mind, a number of which we'll examine today. But I think i t ' s important that
we don't lose sight of the r e a l importance of t h i s progreua, how i t ' l l affect
families a l l over the country.
�r
And I was wondering i f you could r e a l l y elaborate for j u s t a
moment about what t h i s program w i l l mean to most American feunilies. I don't
like to use the word *^average" because no one's average, but how would you
describe for most working families what t h i s program r e a l l y means to them in
terms of themselves and in terms of their future?
MRS. CLINTON: Well, Mr. Chairman, I think that's exactly the
right question to ask because we have to look at what we want to do to try to
increase security for Americans, and particularly American families. And I
would describe the impact on most fawtltear in teras" of "security and breadc i t
down into several different kinds of security. I would s t a r t by the obvious:
that we w i l l be able to look every American in the eye and say that they are
guaranteed health security.
You know, the health security card that the president held up
during h i s speech i s a symbol of what we mean when we w i l l be able to say
that. Every American who i s entitled to that card w i l l have one, and standing
behind i t w i l l be a guaranteed set of benefits.
I think we w i l l also be able to t e l l American-families that they
w i l l be more economically secure. Right now what has happened over the past
decades i s that most American families have seen their standard of l i v i n g
either stagnate or begin to diminish because wage increases have not been
able to keep up with i n f l a t i o n at the rate that they did i n the decades
previous to the 1970s and '80s.
Many American families f e e l Immense economic insecurity, and what
they may not r e a l i z e i s how our r i s i n g health care costs, the burdens that
have been imposed on both government and p a r t i c u l a r l y business, i s d i r e c t l y
related to the kind of economic insecurity that too many Americans f e e l . We
believe that we w i l l be able to s t a b i l i z e the euaount of money that we w i l l
spend on health care, and because of that we w i l l be able to bring costs down
for many businesses, and we hope we w i l l begin to see wages react to that and
economic security once again become a cornerstone of American working l i f e .
And I guess I would f i n a l l y say, Mr. Chairman, that I think we
w i l l provide a l o t of psychological security.
You know, one of the issues that worries me a great deal i s how
alienated and how insecure many of our people seem to be. Clearly, i n
material ways they are not less well off than my parents and grandparents
were during the Depression. But i n psychological ways they f e e l that the
future i s closing in on them, that they aren't taken care of, that they can't
count on t h e i r children having the same kind of opportunities as they did.
And I don't think there's anything more important to e s t a b l i s h than the fact
that they w i l l not have to worry about health problems that come up and that
might undermine t h e i r sense of security.
So i n those very important respects, I think we w i l l find through
health care reform not only what we w i l l be^talking about i n terms of
benefits and cost containment and the l i k e , but we w i l l find a s h i f t i n
attitude among our people that w i l l render them more secure and, I therefore
believe, more productive, more w i l l i n g to face the future with the kind of
confidence that we need in America.
SEN. KENNEDY: Well, that's certainly an enormously important
change i n attitude among the American people, going back to sort of a
community of caring, which I think i s a central challenge to society. And I
think as the president has pointed out in h i s speech — and you have — that
you can be for t h i s program because i t gets a handle on costs on the federal
d e f i c i t , you can be concerned about i t because of the bureaucracy that
�u
providers have, you can be concerned about the issue because of the
increasing p r o f i t s that are taken away from American businesses.
But I think for many that are concerned about i t , i t i s because
of their out of pocket costs to doctors amd to providers — hospitals. And I
think many people w i l l want to know whether t h i s r e a l l y i s going to do
something about those factors, which I think i s of enormous concern to most
Americans, perhaps those that have i t — health care — and those that don't.
And what kind of impact do you think t h i s program w i l l have on those working
Americans and others who have seen thtt'extraordlliiryr Increase i n out of
pocket costs?
MRS. CLINTON: Our estimate i s , Mr. Chairman, that for Americans
who are currently Insured, about 65 percent w i l l have the same or better
benefits at l e s s cost or the same cost. And that includes out of pockets, i t
includes deductibles. And individual consumers w i l l be able to medce choices
that w i l l drive those costs down even low^r because we w i l l , we believe,
through t h i s reform enhance the number of choices available to c i t i z e n s . I f
they want to choose an organized network of-doctors or a health maintenance
organization that has very low or no co-pays, they w i l l be able to do that.
Another issue that i s very Important to many families i s that we
want to eliminate the lifetime l i m i t kinds of considerations that i n too many
insurance p o l i c i e s have required people once they have exhausted t h e i r limits
to pay out of t h e i r own pockets. We think that i f you're insured, you should
be insured across the board.
We also believe that we should bring do%m the cost of
deductibles. Deductibles w i l l s t i l l be present, but at a much lower level
than they have been up u n t i l now.
So i f we take a l l of these costs, we w i l l have, we believe, a
significant decrease i n ou>; of pocket expenditures both for the premium share
as well as co-pays and deductibles for most people who are currently insured.
For about 20 to 22 percent of those who are insured, they w i l l
pay a l i t t l e b i t more, but they w i l l be getting more comprehensive benefits
because they are now paying too much for catastrophic or major medical
policies, often with a very, very large deductible. Those deductibles w i l l be
dropped. Their benefits w i l l increase. So, over a lifetime, they w i l l also
r e a l i z e cost savings, even though i n i t i a l l y may pay a l i t t l e more.
And for about 12 percent of the people, they w i l l pay more for
about the same benefits. Those are largely young, single people who now
benefit from an insurance system that i s r e a l l y skewed i n t h e i r direction.
Because those of us who are older, anyone who's ever been sick pays much more
than they should while young and single people pay l e s s than they should i n
terms of being part of an entire community pool. So they w i l l pay a l i t t l e
more i n these early years. But they, too, w i l l r e a l i z e benefits over their
lifetime.
SEN. KENNEDY: Thank you.
Senator Kassebaum?,
SEN. NANCY LANDON KASSEBAUM (R-KS): Mrs. Clinton, as you know,
I've been concerned about the health alliance structure and have worried
about the size, the monopolistic purchasing power potentially and sweeping
regulatory authority, and I wonder if I could just go through some questions,
and maybe it might clear up some of my questions and maybe others have as
well.
\
In Kansas, for instance, there are only s i x employers who have
5,000 or more employees. Now, i t ' s my understanding 5,000 eiq;>loyees i s the
�cutoff and everyone below that must be registered and work through the
alliance.
MRS. CLINTON: Senator, i t ' s 5,000 nationwide. So, i f there
employers in Kansas who are part of larger companies, even though their
employment l e v e l s in Kansas may be less than 5,000, I f the aggregate
nationwide i s 5,000 or above, they can be part of a s e l f - insured alliance.
SEN. KASSEBAUM: Do a l l insurance dollars, when you make t h i s
contribution both as employers and employees, go into the alliance?
MRS. CLINTON: Yes, for the guaranteed benefits'~package. Now,
there w i l l be, we anticipate, not only supplemental insurance, but new
insurance markets for prodi^cts l i k e long-term care. And those w i l l go
directly to insurers or if'an alliance wants to contract with an insurer in
order to handle those dollars, i t could be done that way. But there w i l l
s t i l l be an insurance market outside of the a l l i a n c e .
SEN. KASSEBAUM: For, you say, long-term care? Will i t be
designated what type of care there would be additional markets for?
MRS. CLINTON: For anything that is-outsd<le the guaranteed
benefits package, so that, for example, i f a person wanted more mental health
benefits or long-term care, the alliance would be able to offer those through
health plans. But there would also, we anticipate, be an independent
insurance market as well for benefits that people wanted to buy with their
own dollars i n addition to the premium dollars.
SEN. KASSEBAUM: Well, for Instance, i f you're with Blue
Cross/Blue Shield and that had been your long-time c a r r i e r , but they did not
opt to go into the a l l i a n c e or the alliance didn't want to, I suppose, have
them as part of the insurers participating, do you have any choice at that
point of where you go?
MRS. CLINTON: Well, Senator, what we would anticipate i s that
Blue Cross and other insurers would be in the business of running the
accountable health plans, so that although the a l l i a n c e i s the collection
point for the premium dollars, i t i s not the delivery point for care or the
management of care.
And i n our conversations with a number of insurance companies,
what they are moving toward i s what they are already doing, which i s to help
organize networks of physicians and hospitals into the delivery points; so
they would i n effect become the managers of the accountable health plans. So
i f you were part of Blue Cross, Blue Shield now and the Blue Cross, Blue
Shield health plan were one of yovur choices, much as we now have with the
federal employees' plan, the money a l l i s i n the federal government; that's
where the money i s paid out of, but you get a big l i s t of those plans that
you can sign up for, and Blue Cross, Blue Shield i s one of them. In the
future, i n the a l l i a n c e s , i t w i l l be j u s t the same kind of model. The money
w i l l go into the a l l i a n c e , as i t does now with the federal government, but
the choices available w i l l be perhaps, you know, the local HMO, the Blue
Cross, Blue Shield health plan, maybe the local hospitals have created, you
know, the Lawrence Kansas plan, or whatever i t might be; so that there w i l l
not only continue to be a role for insurance companies i n managing and
delivering care, but we anticipate that i t may even be an expanded role in
that area.
SEN. KASSEBAUM: So you could go outside the a l l i a n c e for the
purchase of your insurance?
MRS. CLINTON: Well, no, l e t me make sure that — l e t me walk
through t h i s . I f you are an employee now, or an employer, you make your
premium payments d i r e c t l y to the insurer and the insurer then decides, i n
�some instances, which doctors or hospitals you can attend, or you have a
fee-for-service plan, and then you pick and the insurance company reimburses
your doctor.
In what we are proposing, the a l l i a n c e i s the body to which the
money i s paid. But the accountable health plans are what you now think of as
your health plan, whether i t ' s Blue Cross, Blue Shield or some health
maintenance organization or some other form of health plan. So even though
the money goes into the a l l i a n c e and i t i s pooled there i n order to get the
most purchasing power, the way i t ha|q;>enft*niMii!with the federal government, so
that the a l l i a n c e , j u s t l i k e the federal government, or in Minnesota, l i k e
some of the very large purchasers of care there, i n California l i k e the
(Calpers ?) system, they stand there with a l l of t h i s purchasing power. Then
the health plans , l i k e Blue Cross and the others, come and say, ^^We can
deliver the guaranteed benofits package a t t h i s price with these kinds of
extra b e n e f i t s . " And then each year, every consumer, as you do now with the
federal plan, you w i l l get a brochure about a l l of the plans. The alliance i s
merely a collection agency, basically. Every- plan that i s qualified has the
right to bid for your money, and you then t e l l the a l l i a n c e , ^^Send my money
to Blue C r o s s , " and that's how you get your health care.
SEN. KASSEBAUM: I j u s t got a note that my two — I have two
minutes remaining. But j u s t to b r i e f l y say, however, the a l l i a n c e i s
appointed by the governor or the legislature of a state?
MRS. CLINTON: Right.
SEN. KASSEBAUM: The governor?
, T
MRS. CLINTON: Well, we're — you know, we're open — the
governors think that i t ought to be the governors; l e g i s l a t o r s think they
ought to have a role.
SEN. KASSEBAUM: But they have a great deal of authority i n
setting out some very firm guidelines, and then I suppose, responsible to the
guidelines of the national board, who supersede, do they not, some directions
to the a l l i a n c e s ?
MRS. CLINTON: What we would l i k e i s to have federal guidelines —
for example, what i s a qua.Tifled health plan, and what i s the benefits
package? — and then each a l l i a n c e would implement those federal guidelines.
But we also want to give some f l e x i b i l i t y to a l l i a n c e s because we know that,
you know, western Kansas i s not the saune as Kansas City. So we want some
f l e x i b i l i t y so that an a l l i a n c e could have some opportunity to maybe do
things a l i t t l e b i t d i f f e r e n t l y i n one part of the state from the other, but
they would a l l have to meet the basic federal guidelines of what the health
plans would have to be.
^
SEN. KASSEBAUM: Thank you.
SEN. KENNEDY: Senator P e l l ?
i ,
SEN. CLAIBORNE PELL (D-RI): Thank you, Mr. Chairman. And I
congratulate you on choosing t h i s room, where, so many h i s t o r i c events have
occurred, for t h i s hearing on a subject and a prograui whose time has not only
come but we're seizing i t , and I hope under the leadership of Mrs. Clinton,
we w i l l move ahead with i t .
I think the affection and regard of the country for you were
shown at the State of the Union speech, the j o i n t session speech, when the
applause was louder than I've heard for anybody who was not the principal
speaker themselves i n the 33 years I've been i n the Senate, and the affection
and regard i s universal, I'think.
The question s p e c i f i c a l l y that I have i n mind concerns
unemployment. This l i t t l e — your eyes may be better than mine, you can see
�1
— shows that the unemployment in my state of Rhode Island i s far worse than
i t i s in any other state of the union, on the average in the country as a
whole. Who would pay the premiums on t h i s health plan when one i s unemployed?
Would i t be the employer? There i s no employer. Would i t be the public, or
who?
MRS. CLINTON: I t would be the public through the federal
government. The federal government w i l l provide the insurance share for the
unemployed. And when someone i s employed and unemployed during the year,
there w i l l be a combination of contritoutlonB'f rom the~employer and employee
when the person i s employed, and then the federal government w i l l subsidize
the remaining necessary prrmium contribution.
SEN. PELL: In that regard, how does t h i s l i t t l e card work for
(those things ? ) . I t was presented to me. I t ' s got somebody else's name, I
regret to say, on i t . But how does i t work in fact? I s i t l i k e
a charge card, a credit card?
MRS. CLINTON: That's the way we would l i k e to see i t work because
one of the ways we think we can save b i l l i o n s - o * dollars in t h i s system i s to
move toward electronic b i l l i n g , to move toward single forms, to t r y to
simplify the collection of the health care dollars, and we would l i k e to see
i t working as a credit card in which we w i l l have much more economies of
scale in terms of collecting and paying out money throughout the system.
SEN. PELL: Thank you.
The columnist, Ann Landers, wrote a column which, without
objection, I'd l i k e to see inserted in the record.
SEN. KENNEDY: I t w i l l be inserted.
SEN. PELL: Thank you. In which i t pointis out the number of deaths
from guns. And as you may know, the annual cost of hospital care associated
with firearms treatment i s $1 b i l l i o n . In Rhode Island alone, the estimated
annual health care costs attributed to those k i l l e d by firearms between 1984
and 1990 was $22 million. Trtiat would be your reaction to the thought of
introducing l e g i s l a t i o n that would have a tax on firearms, and that tax
devoted to the health plan?
MRS. CLINTON: Well, senator, that i s not part of the president's
proposal, but I think that there i s interest i n that proposal. I was asked
the same question yesterday i n the House, and — you know, targetting some
kind of payment for violent crime to our health care system might be
something worth considering.
SEN. PELL: Another question: that i s the research i n the
hospitals. We have i n my state a very fine teaching hospital, and I'm ciirious
how the president's health plan w i l l impact on the quality of the research.
As you know, when you have a research i n s t i t u t i o n i t Increases the quality of
care. I t also Increases the expense.
MRS. CLINTON: Right. That's a very important question and one
that we have talked a l o t with the deans of our various medical schools
around the country.
We believe that the academic health centers ought to be what we
would c a l l the kind of qua.lity foundation for t h i s health care plan. Rather
than reinventing the wheel and creating any new kind of bureaucracy or entity
to keep track of quality and to t r y to determine outcomes related to
procedures, we would l i k e to see that research and that kind of quality
reporting function r e a l l y housed our medical schools around the country. We
think they are f u l l y capable of doing that work.
And we also know that many medical schools and academic health
I'
�centers have higher costs because their care that they deliver i s so highly
specialized. So we have sone special provisions to help support f i n a n c i a l l y
those academic health centers so that they are available to patients not only
in the states where they are, but also around the coxintry i f they've
developed a certain technique or procedure that should be used because of i t s
importance.
So we take very seriously the role of the academic health centers
and have some provisions that we think w i l l strengthen t h e i r position i n the
health care system.
r)4iiiiiMt|tii|{iiii|i|ttj{'i
SEN. PELL: Thank you very much.
MRS. CLINTON: Thank you, senator.
SEN. KENNEDY: Senator Jeffords.
SEN. JAMES M. JEFFORDS (R-VT): Thank you, Mr. Chairman, and f i r s t
I want to commend Senator Kassebaum for a l l of her help and leadership on our
side of the a i s l e , and I want to commend you, Mr. Chairman, for your efforts
leading up to t h i s important occasion. I know that you are delighted as I eua
that the process i s now underway to finally-maJee-health reform a r e a l i t y .
I also want to commend you, Mrs. Clinton, for your efforts,
particularly for your and your s t a f f ' s willingness to work with a l l of us, my
party especially. I know i t was helpful for us, and I hope i t was helpful for
you.
'
I am sure managing your task force of 500 was a tough job. But I
suspect i t was nothing compared to the task force of 535 that are here on the
Capitol H i l l that you now have to deal with. Thus, the toughest part
certainly remains before us.
The p r i n c i p l e s that guide your effort and most of the major
policy choices you have made mirror my own. You have made a great s t a r t , but
a vast amount of work s t i l l neads to be done. I hope we can improve upon your
proposal, p a r t i c u l a r l y with regard to financing, bringing costs down, and
promoting good health.
To do so, I am convinced, w i l l require the talents and energy of
Republicans as well as Democrats. No party has a monopoly on wisdom or
experience. And you i n your role as the f i r s t navigator, knowing better than
most that we are s a i l i n g to rather largely uncharted waters, I think i t i s
c r i t i c a l to the country that t h i s be a bipartisan effort. I know of no better
way to ensure i t than to join as a cosponsor of your l e g i s l a t i o n upon i t s
introduction. I w i l l do so.
But I want to do more than t h i s . I want t h i s b i l l to be broadly
bipartisan. And I pledge to do what I can to make t h i s a b i l l Republican
colleagues can support. I have been thinking about our nation's health care
problems for many years and have definite ideas on what our health care goals
ought to be and how they can be accomplished.
I don't think anyone would disagree with the administration's
goals.
t
Everyone i n thi|i nation needs the security of knowing that no
matter whatever e l s e happens i n their l i f e , they can count on the fact that
they have good health care, good quality health care. We need a much simpler
health care system with far l e s s paperwork. F i n a l l y , we need to be sure that
our new system w i l l get health care costs under control.
I look forward to working with you, the administration, my
colleagues on both sides of the a i s l e on t h i s essential effort. I agree with
the administration's approach and w i l l do what I can to ensure that the
h i s t o r i c proposal becomes law next year.
Now a question — I don't —
�MRS. CLINTON: May y. j u s t say thank you very much, Senator
Jeffords.
I know that you share the president's and my belief that t h i s i s an issue
beyond partisan p o l i t i c s , and I think most of the members of t h i s body share
that same belief, and we w i l l look forward to working with you and other
Republicans. We've learned a great deal' frbm ybU and the work that you had
done, and I read your b i l l , I read Senator Kassebaum's b i l l , we've learned a
lot about the appropriate way to address our health care needs, and I'm very
grateful for your commitment today tO'°be •co-sponsier~and to work with us so
that we can make that this,issue i s beyond p o l i t i c s and that we get the very
best possible resolution fo::; the American people.
SEN. JEFFORDS: I thank you for those words, and we're a l l
dedicated to help.
F i r s t I want to, as a question — I want to applaud your efforts
with respect to state f l e x i b i l i t y , and someone might accuse me of being a
l i t t l e parochial i n t h i s , but you know Vermont has been working very, very
hard to come forth with t h e i r own health care plan, and they are concerned,
though, that they may be r e s t r i c t e d by the national plan which we come forth
with, so I think success in reform and getting an approval depends upon the
states being able to support i t .
I understand that you have indicated an openness to changes, but
to what extent do you f e e l state f l e x i b i l i t y i s important to your proposal?
MRS. CLINTON: I think i t ' s very important. Senator, and Vermont
i s just one of several states that has shown tremendous leadership i n moving
ahead and r e a l l y demonstra'>.ing to the country the kinds of steps that needed
to be taken. So we want to maximize state f l e x i b i l i t y .
On the other hand, we have to recognize that there are states
that have been very blunt in saying they don't want anything to do with
health care reform. I t i s not an issue they f e e l comfortable tackling, and
they don't want the responsibility. So s t r i k i n g the right balance between
those states that r e a l l y should be encouraged to move forward and given the
framework to move forward i n and the kind of federal program that w i l l be
needed to insure security for every American so that states that don't want
to move forward w i l l be motivated to do so i s one of the balances we have to
s t r i k e , and we w i l l certainly look forward to working with you i n madcing sure
we s t r i k e that right balance.
I personally prefer maximum f l e x i b i l i t y . I think the problems i n
Vermont are different from the problems i n Arkansas, and I want both states
to deal with them responsibly, so I think that's the way we should approach
this.
SEN. JEFFORDS: My f i n a l question w i l l t e s t a l i t t l e b i t of that
f l e x i b i l i t y i n the sense of the state of Vermont's desires. My question i s
under the Clinton plan, w i l l the state of Vermont be allowed to require that
doctors be paid the same rate whether they see someone young or old or
whether they work for a large company or small company?
MRS. CLINTON: Do you mean an all-payer rate system for
physicians?
SEN. JEFFORDS: An all-payer rate system.
MRS. CLINTON: Yes,!I was asked that question yesterday by
Maryland. Maryland already'has an all-payer hospital system. They're
developing an all-payer physician system, and I think that that i s one of
those areas that we would permit states to move forward on i f that's what
they thought was i n t h e i r best interests.
�SEN. JEFFORDS: Thank you. I look forward to working with you.
Thank you, Mr. Chairman.
MRS. CLINTON: Thank you very much. Senator.
SEN. KENNEDY: We j u s t want to express certainly our appreciation
:o Senator Jeffords for h i s support. We're obviously eager to work with a l l
>f our colleagues to t r y find important common ground. We welcome i t .
Senator Metzenbaum?
SEN. HOWARD METZENBAUM (D-OH): Mrs. Clinton, as I sat here, I was
l i n k i n g to myself that you and your' 1iu8Bati<i'°¥re t i ^ l y linlque, because both
^ou and your husband are knowledgeable about the s p e c i f i c s of t h i s program.
\nd I have served here with five different presidents, but I remember the
record of many other presidents as well. And I don't remember any other
president, and certainly noi other presidential spouse, that was as f u l l y
involved and f u l l y knowledgieable about a l e g i s l a t i v e program as the two of
/ou are. Your husband the other evening, the president, tadcing questions for
3ver two hours and then, as I \inderstand i t , staying for another hour
answering additional questions. I think the-American-people probably hasn't
— have not realized that you're j u s t t o t a l l y unique in the fact that you
have not only said ^^I'm for t h i s program. I t ' s a great piece of legislation;
I ' l l sign i t . " Whatever the case may be. But you know t h i s program. You're a
part of i t . You helped create i t , as well as did the president. And I think
the American people have a right to be very proud.
And as I sat here t h i s morning and I heard my colleague Senator
Jeffords speak, I said to myself, ^ ^ I don't know what i t i s that creates
Republicans of that flavor, but he follows Bob Stafford and George Aiken, Jim
Jeffords, and I f e e l very proud to have the privilege of serving with him.
Having said that, l e t me ask you a couple of questions. We're
talking about a program that now costs about $940 b i l l i o n a year, almost a
t r i l l i o n dollars a year. I am concerned to see how we go about consumer
control, consumer — not alone window dressing, but actually having consumer
rights. We'll have health a l l i a n c e s , 50 percent by employers, 50 percent by
consumers. But the employers w i l l be an Integrated group in a l l probability.
They'll work together. I'm concerned how does the consumer, r e a l l y the
American public, get t h e i r voice heard and have a right to control t h i s
system, not j u s t be a party to i t .
MRS. CLINTON: Well, Senator, we believe that the principal
difference i n what we are proposing i s that, for the f i r s t time ever,
consumers w i l l be maiking the decisions that count. They w i l l be deciding
which health plan they w i l l j o i n . To go back to Senator Kassebaum's inquiry,
i t w i l l be the consumer, not the employer and not the a l l i a n c e and not any
government agency, whether i t be Medicaid or anything else, which w i l l
determine what health plan a particular individual decides to j o i n .
Every year, consumers w i l l be, i n effect, voting with t h e i r feet
i f they're not s a t i s f i e d with the service they got or they've met somebody
that they prefer i n a different plan. Well, they w i l l be able to madce that
decision. So that the ultimate market and competitive forces that we think
w i l l lead to high-quality health care being delivered most e f f i c i e n t l y w i l l
rest upon millions and millions of individual consumer decisions. The richest
person and the poorest person w i l l have the saume vote, because they w i l l each
decide, you know, where they want to go. And that w i l l make a difference in
how health care i s delivered.
Secondly, as you point out, the kind of a l l i a n c e structure that
we are envisioning w i l l be governed by an employer representative andi
consumer representative board, with consumers having 50 percent of the seats
�(
^hat are on there. And I would anticipate, given the kind of interest i n
lealth care that we are a l l seeing, there w i l l be a very active consumer
::orBtituency i n which people w i l l be making a l l kinds of judgments about
lealth plans, w i l l be getting information out to each other. I think we'll
see a l o t of very positive{consumer a c t i v i t y .
And then the l a s t thing I would say i s that for the f i r s t time
consumers w i l l have good information about quality and w i l l be able to madce
decisions. That w i l l i n turn, I hope, drive the hospitals, the physicians,
the insurers and others to be respons^rve becauscr"they w i l l have to deliver
the quality information and then i t w i l l serve as a basis for both the
representatives a t the alliance level and the individual consumer to make
decisions.
SEN. METZENBAUM: Would i t make good sense to put some l i m i t on
administrative expenses that see to i t that insurance companies operate
ef jficiently? As you know, average insurance company administrative expenses
today run about 25 percent. Medicare administrative expenses run about 3
percent; and Canada has administrative costs of 1-percent. And I'm concerned
that whether i t ' s Blue Cross, Blue Shield or the Prudential Insurance Company
or the Metropolitan L i f e Insurance Company, whatever the case may be, that
those — they a l l w i l l build i n a factor of high administrative costs. And
I'm concerned as to whether — there won't be enough competition to drive the
down and whether or not we as l e g i s l a t o r s out not to be placing some limits
on the administrative costs.
MRS. CLINTON: Senator, I don't believe that w i l l be necessary,
for the following reasons. I f we reform the Insurance market and we
particularly reform the non-group and small group market, we w i l l be
eliminating a l o t of the administrative cost that currently i s i n the
insurance system. I f we further begin to eliminate preexisting conditions and
make i t clear that people cannot be denied coverage on the basis of
underwriting and determining how much of a r i s k that they present, that w i l l
eliminate an additional very large portion of the administrative expense that
currently drives up costs within the private insurance market.
I think those two changes will have a big impact on the kinds of
decisions that insurers make, and they will then find it in their interest to
become more efficient and to make decisions more quickly on the basis of
trying to get the highest quality care to people at the lowest possible
price. So I don't think that we need to regulate that. I think the market
will take care of that as we make the kinds of changes that we hope you will
make in the legislation to eliminate preexisting conditions, to reform the
insurance market, the administrative load will go down dramatically. ^Ski^-^
SEN. METZENBAUM: Thank you very much, Mr. Chairman.
y'
SEN. KENNEDY: I s n ' t that the case with the California public
employees, too, about 1.5 percent administrative costs?
MRS. CLINTON: That's right. And that i s i n effect a very large
alliance, I mean as we think about i t , and i t has been able to drive a very
hard bargain with the insurers who provide the services through the plans
that are available to the members.
SEN. KENNEDY: Senator Coats?
SEN. DAN COATS (R-IN): Thank you, Mr. Chairman.
And, Mrs. Clinton, thank you for appearing before us. I hope t h i s
— what I say i s n ' t — I hope I'm not the f i r s t dark cloud to appear on the
horizon today for you. And I hope what I say i s not Interpreted as being
partisan p o l i t i c s , because I do agree with every member on t h i s committee,
and with you, that there are I n e f f i c i e n c i e s and distortions i n our health
�::are system that are robbing people of care that they need, and i t ' s costing
i l l of us more money than we ought to spend. And I think we a l l agree that
reforms are needed and necessary.
The question i s not whether but how we go about doing i t .
I have joined some senators i n offering a proposal to deal with
those reforms. I t ' s different than what you're advocating. And i t ' s primarily
i i f f e r e n t because i t ' s based on some different assua^tions.
I would l i k e to j u s t outline four of those assumptions and then ask the
[question as to whether or not you think"tlibse' assumptions are valid, invalid,
andi i f invalid, why, and how we might address that.
The f i r s t assumption that we're operating under i s that
government, for a l l of i t s good intentions, i s l e s s e f f i c i e n t than the
private sector. My experience with government, my constituents' experience
with goverrunent i s that i t i s — because i t i s not driven by a market system,
does not have a p r o f i t motive — i s less e f f i c i e n t . I think anybody who
stamds five minutes i n a post office and then goes and v i s i t s UPS sees the
difference between a government- run operation-amd
a private-run operation. I f we look at the state l e v e l , I j u s t the l a s t two
days have gone through the process of helping my 16-year old son attain a
driver's license. I t has been a nightmare for my wife and
I to go through the l i n e s and the forms and the delays j u s t to get a driver's
license.
The second assumption that we're operating under i s that
p o l i t i c a l process often, almost always overwhelms the marketplace. Outside my
office every day that we're i n session, there i s a steady stream of people
coning to t r y to influence the p o l i t i c a l process saying,
Include our
program, include our b e n e f i t . " And whether i t ' s health care or any other
aspect of what government does, i t seema that the ultimate decision i s not a
marketplace decision but a p o l i t i c a l decision, and therefore, we're concerned
that a health plan which b a s i c a l l y says these are the benefits that w i l l be
available w i l l simply invite many more saying, ^^Include u s , " and whether i t
makes economic sense or not, they w i l l t r y to garner enough support from the
p o l i t i c a l process to be included.
Thirdly, i t ' s my experience and our assumption that costs that
government estimates for the costs of a program are always grossly, grossly
underestimated. I went back and looked a t the congressional record for when
we enacted Medicare, and the projections that were l i s t e d by Congress for
ex]penditures under j u s t Part A of Medicare — they ran those out to 1990.
They said by 1990 we would be spending $9 b i l l i o n a year on Part A of
Medicare. The actual expenditure i n 1990 was $67 b i l l i o n , 7-1/2 times the
estimate. So we may estimate figures here today associated with t h i s health
care plan. My experience i s , l i k e every other program government gets
involved i n , i t grows, partly because of t h i s p o l i t i c a l process and the
i n e f f i c i e n c i e s , i t grows far beyond our estimates.
And our f i n a l assumption i s that a great deal of health care
ex]penditure i s , as your hunband pointed out i n h i s speech to the Congress,
caused by human behavior, choices that we as human beings make.
Now, I appreciated your husband saying we must do much better
than t h i s , but my experience i s that human beings react to incentives,
positively to rewards and negatively to penalties. I t seems to me that any
health care plan that i s truly going to modify human behavior and therefore
help hold down health care costs, whether i t ' s smoking, excessive drinking,
unwarranted sexual practices that lead to disease, on and on — lack of
�exercise, overeating, et cetera — that, i f we're going to effect that, we
need a system of rewards or a system of penalties. Why should someone who i s
exercising behavior that r e s u l t s in lower health care costs be paying the
same thing as someone who i s disregarding that? And why shouldn't there be a
differential?
Those are some basic assumptions on which we are basing our plan.
I don't think I see those Assumptions i n your plan. Are my assumptions valid?
I f not, why are they invalid? And how are we going to reconcile the
difference?
.„
MRS. CLINTON: Senator, those a r e —
SEN. KENNEDY: Just before Mrs. Clinton answers, we — over in the
House, they r e s t r i c t e d Mrs. Clinton to two minutes, one for the question, and
she had to sandwich her answer into that two minutes. We've developed
marvelous s k i l l s here, where within our five minutes we ask a l o t of
questions and l e t you take the time. We want to give you the assurance that
you take whatever time you want to respond to the cumulative questions of our
colleagues.
- "
MRS. CLINTON: Thank you.
SEN. COATS: Since i/e didn't have opening statements, I thought
I'd s l i p mine i n in my questions. (Laughter.)
MRS. CLINTON: I appreciate that. Senator. And l e t me s t a r t by
saying that I don't know that any of your assumptions in general are wrong.
But in particular, as applied to the health care system, I don't believe they
are applicable. And l e t me run through them. And, in fact, what we are trying
to do i s to create a system in which there truly i s some kind of a market and
some kind of competitive pressures that w i l l enable us to move t h i s health
care system to a much more e f f i c i e n t level than i t current i s operating on.
Your f i r s t assumption about government being l e s s e f f i c i e n t than
the private sector i s not true in the health care system as i t ' s currently
structured. I think that one of the senators e a r l i e r referred to the fact
that the administrative costs in Medicare are much l e s s than they are in the
private sector. The private sector has become much l e s s e f f i c i e n t i n health
care delivery, in health care pricing than you would think i t should be, but
i t has done so because of the kinds of incentives i t has followed.
So that, for example, the heavy administrative percentage that
you w i l l find i n the private sector insurance market i s due to a very clear
decision, which i s the more money we can spend maJcing sure we don't insure
people who might cost us money, the more money we w i l l make. So, therefore, v
the kind of underwriting practices and the kind of s e l l i n g practices that are
aimed at insuring people are aimed in part at eliminating from coverage
people who might be a cost on the insurance system.
And i n order to choose among everyone s i t t i n g in t h i s room who i s
and who i s not a good r i s k , that takes a l o t of time and a l o t of manpower, a
lot of personnel cost. And so I think that, i f you look at the way the
current private sector operates, you w i l l find an enormous auaount of
efficiency — Dr. Koop has pointed out not only on the insurance side, but on
the medical decision-making side.
Now, part of that i s driven by decisions that are made i n
government as well as i n the private sector. But goverrunent followed the
private sector i n deciding to reimburse for medical care based on procedure
and on t e s t s and on diagnosis, on the kind of fee for service model that we
have grown up with in our country.
So i n both the private sector and the government sector with
�respect to health care we do not have a r e a l market. And you w i l l find
a great deal of inefficiency i n the private sector i n the health care market.
Someone has pointed out recently that many of our industries have
lad to become more e f f i c i e n t i n the l a s t 20 years because of external
::ompetltion. We are now prpducing high q[uality cars i n ovu: country that are
very productive and are r e a l l y giving a good run for the money against our
competitors. But i t took outside competition to come i n and do that. We have
to create a competitive marketplace. We do not currently have one.
The second point about the p o l i t i c a l procesBnoverwhelming the
marketplace i s also i n general true, and we have to be very careful about
that i n fashioning t h i s health care reform. Senator Kassebaum and I have
talked about t h i s , because i n her b i l l she puts the decision about what
benefits w i l l be covered at the level of the national board to take them out
of p o l i t i c s , to take them out of the h a l l s so that you don't have people
grabbing as you walk down the hallway saying ^^Include t h i s , ' ' ^^Include
that,"
Include my favorite particular kind of treatment."
We thought very hard about thaty-and-I-had a very good meeting
with Senators Kassebaum and Danforth in which they, I thought, very c l e a r l y
explained why they favored that approach. We decided that i n i t i a l l y we should
have the benefits package approved by the Congress so that individual
citizens could know what was i n i t . But then we agree that any changes to i t ,
any enhancements to i t should be moved to the national board, as the
Kassebaum-Danforth b i l l had originally suggested, because we don't want the
p o l i t i c a l process overwheliping the marketplace. And we agree with you that
that's something we have tb guard against.
The third assumption about cost estimates by government being
underestimated i s absolutely right, but i n the health care systetm cost
estimates by the private sector h&ve also been grossly underestimated. And I
think i n large measure you would see a p a r a l l e l i n the increase i n goveriment
exi)enditures that i s a t least equal to i f not s l i g h t l y below the increase i n
private sector expenditures i n the health care system. And those two go hand
in hand.
I t i s very d i f f i c u l t for you as a senator to maOce projections
ab(}ut what Medicare or Medicaid w i l l cost because what happens i s you set a
certain amount of money to be available i n the budget. And what the private
sector does i s to s h i f t costs that they don't get from the budget out of your
decisions onto the private/sector. And what the private sector consistently
has done both i n employers buying Insurance and insurers pricing insurance
and doctors making decisions i s consistently to underestimate what health
care costs and, I would argue, what i t should cost.
So t h i s i s an issue that i s not j u s t a goveriu&ent issue, t h i s i s
a private sector issue. And one of the reasons we want to have some market
foirces and some competition i n the system i s so that cost estimates can be
made on the basis of delivering health care not on a diagnosis-procedure
basis, but on a per capita basis in which decision-makers — insurers,
doctors, hospitals, and others — have to make decisions so that costs w i l l
be kept down, that we no longer write a blank check.
And f i n a l l y , I think that there i s no doubt that human choices
drive health care costs l i k e i t does in most other areas of our l i v e s , and
what we are trying to do i s to have a system i n which everybody i s part of
that system, because to leave some out who madce bad choices i s
a cost to us whether we l i k e i t or not.
Everyone who makes a bad choice who i s iminsured or who i s
insured who drives our costs up w i l l eventually cost us something, either i n
�more tax dollars, or in higher insurance premiums. I f we have everybody
covered and everybody i n the system so that we f i n a l l y can stop the cost
shifting, then I think health plans and individuals w i l l be able to make cost
conscious choices that w i l l give them the benefits of their decisionmaking.
But I think u n t i l we get everybody i n the System, then the human choices thai
w i l l inevitably drive health care costs one direction or the other w i l l
continue to be shifted on to the backs of those who choose not to, but
nevertheless w i l l pay the cost for them.
SEN. KENNEDY: Thank you v e r y much*'IT -"^
Senator Dodd?
SEN. DODD: I t ' s hard to follow that answer, that was so b r i l l i a n t
in response, in my view. (Laughter.) To j u s t bring you back do%m to the real
world here, f i r s t of a l l , l e t me j u s t say i n response to — and I have great
respect for my colleague from Indiana. He and I — we would have not passed
family and medical leave l e g i s l a t i o n without Dan Coats — picking up on the
points you made, Mrs. Clinton, about the bipartisanship, but I appreciate
your mentioning that because t h i s committee has had great success through
that vehicle.
But frankly, the notion somehow that someone going to your local
post office as opposed to going to UPS, or a 16-year-old waiting in l i n e to
get a driver's license or a 16-year-old showing up with h i s parents because
he has cancer or a tumor trying to access the medical system in t h i s country
i s profoundly different, and we may have differences about how best to
address t h i s system, but I think drawing comparisons between systems where
people have choices and problems where people have no choices i s completely
unwarranted, but I appreciate the points that are made by that comparison.
Let me begin, as well, i f I can very b r i e f l y , by commending our
chairman. This i s an extremely important issue and you rightly pointed out at
the outset that for many of us here who have arrived in the l a s t decade or so
this has been f a i r l y new, but for the chairman of t h i s committee, t h i s has
been a lifetime commitment, h i s public service, going back, as I r e c a l l , with
the Kennedy-Corman (sp) l e g i s l a t i o n , Ribicoff Long (sp), my predecessor in
the Senate, the great debates. Senator — Congressman Dingell's father deeply
committed to EhealthF EcareF. So there's a long history here, but the
chairman of t h i s committee has worked t i r e l e s s l y from the day he arrived to
t h i s day, and i t ' s an extremely important day for him as chairman of t h i s
committee, that we are f i n a l l y going to end up dealing with t h i s issue. And I
didn't want to begin my remarks and questions to you without recognizing his
tremendous contribution to what we've achieved already i n that particular
fight.
Let me turn to a particular constituency that i s of great
interest to you — your involvement with the Children's Defense Fund,
and your involvement i n Arkansas over the years with regard to
children. A quarter of the population of t h i s country i s under age 18, and
yet a third of the \ininsured in t h i s country are children. Of the 37 to 38
million, 12 m i l l i o n have no Insurance. In my state, 54 percent of the
uninsured are children in the state of Connecticut, the most affluent state
on a per capita basis in the United States.
In many ways, the current system i s r e a l l y stacked against
children. Adults arguably have some choices about where they can go, but
children are e n t i r e l y dependent upon what happens to t h e i r parents.
I f you lose your job, you lose your insurance, your c h i l d does
immediately. Preexisting conditions. Children's needs, p a r t i c u l a r l y i n the
�1^
preventive area, are different than others. Again, I'm preaching to the choir
on t h i s particular issue, but I don't think there ought to be too much debate
here about that particular constituency and our common determination to see
to i t that these — the most innocent, i n many ways, in our society — are
getting t:he kind of proper care and coverage vinder a system presently, as I
said at the outset, that i s stacked against them.
I wonder i f you might j u s t spend a couple of minutes focusing —
you rightly talked about women at the outset of your remarks, but I think
children — they don't have lawyers,-t;hBy^don't havBi"the right to vote, they
don't make campaign contributions. My fear i s in t h i s debate they're going to
be l e f t side and brought in as sort of an afterthought, and I hope that's not
the case. And i f you could j u s t spend a couple of minutes addressing that
particular constituency, I'd appreciate i t .
MRS. CLINTON: Senator Dodd, I'd be happy to, and I want to thank
you for never forgetting that constituency and the work that you have done
over the years to make sure that children's needs are not forgotten. And I
suppose on an emotional level i t ' s the most Important thing^to me because I
don't know that anyone can look into the eyes of
a child who i s sick and has been made sicker because of decisions that had to
be made on the basis of cost that kept a parent away from getting care when
needed without feeling tha^: there i s something seriously wrong with the way
we are taking care of our children.
And I don't think there are any stories that have moved me more
than the s t o r i e s of parents who have j u s t given up everything i n order to
take care of t h e i r children's health needs. I mean, i t i s a bizarre situation
to have a country i n which,there i s parent after parent — and we can give
you their names and t h e i r addresses and their phone numbers — who had to
give up a job when they l o s t tiieir insurance, whether i t was taken away from
them because of a child's i l l n e s s or whether i t was priced so high that they ^
could no longer afford i t , to go on welfare to be able to taike care of their
children's medical needs. I mean, that i s Absolutely the wrong message. I t ' s
the wrong message that you have t r i e d to send, that Senator Coats with his
work on behalf of children has t r i e d to send, and i t i s something we have to
end.
I think that one of the great benefits that we w i l l have from
health care reform i s insuring the kind of primary and preventive care tihat
a l l children need to be healthy. We w i l l cover vaccinations. We w i l l cover
well-child care. I mean, I have to confess, l i k e many people before I had
children, I didn't think about what my insurance policy did or didn't cover,
and I remember t:he shock I f e l t when I realized that my very good insurance
policy would not pay for the well-child exaui. They would pay i f Chelsea were
sick and I brought her to the hospital for some kind of treatment, but they
wouldn't pay for me to make sure she was kept well. And I thought that was
absolutely backwards then,iand I s t i l l believe that i t i s .
So, i f we emphasize primary and preventive care for children,
then I think we w i l l begin,'to reverse what has been a neglect of our children
in our health care system i f we ensure that: no parent, whether that parent
loses the job that t:hey had or can't find a job or whatever their circumstances
might be, w i l l have to worry about tadcing care of t h e i r children, and we w i l l
once and for a l l end t h i s travesty of having people give up jobs to go on
welfare to be able to take care of their children.
I t ' s one of the reasons why the Academy of Pediatrics has
endorsed t h i s plan because they see f i r s t hand every day the costs of what i t
means for parents to wonder whether they can afford the x-ray that the doctor
�says they should have or whether they can f i l l the nresrr-1'i
leave the doctor's office with, holding Jn i i e i r S a n S ?
^
''^^^
You know, for years, I worked as a member of the board of
directors of the Arkansas Children's Hospital, and I could - - l i u s t h«v
alLso^n^;^^^ i?'^^
» combin^?i;n o? such gra??tu5e Jnd
Mon/
^ ^""^
Pa^^ent ever to ha?e to worr?
about whether or not they can afford to taki care of their child I SoS^
^ !IH 1° ^o^y about that. I cannot imagine what that must feel like ^ d we
need to end i t , and this would help-os-do t h a t . — - ~
CE*U
TN/^r^r* » m i
i _
SEN.
DODD: Thank
you very much.
Thank you, Mr. Chairman.
SEN. KENNEDY: Thank you very much.
Senator Gregg.
SEN. JUDD GREGG (R-NH): Thank you.
And l e t me associate myself with the accolades which are ver-i.
have to f4irt;;rz^r2ot"^ns.^L?ieiru? in^^'^i
But,
at the same time, there's f i v e major new entitlement-
and small business entitlement, which U a h u g H S e ? Jn
toe^SmrDSSia.
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f i P ^ i ^ n c ^ with government t e l l i
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l » 9 " i « t . in t r y i n : ' t o " b ? 4 i r 2 i u ' S . * $ ^ y
hin^<„„ S?'=°'>'^ilf' there i s the — and so, there the boot doesn't f i t the
t" At TS^iiv
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national board, and the power which i s beina
la d at the feet of this national board i s awesome esoeciallv i l 5?- '
�l^
So, I don't see t h i f l e x i b i l i t y and I don't see the simplicity. I
see rather an organization^that i s dominant at the center to the detriment of
the states' capacity to have f l e x i b i l i t y .
So I don't see where those f i t .
And then there's t h i s whole question of competition, which i s the
way you drive costs. And you've certainly spoken about that t h i s morning. But
underlying t h i s competition you've got standby price controls, you've got a
proposal which b a s i c a l l y i s global budgeting i n the- capacity of the national
board to review the premiums that are set, amd you've got the question of the
national board i t s e l f , which e s s e n t i a l l y , to simplify i t and to characterize
i t , i s a nationalization of the health industry; to tadce 14 percent of the
health industry, which i s in the American economy, comes under the control of
that board. So I don't see that competition e x i s t s there.
The states have f l e x i b i l i t y only to the extent that they
basically follow what the federal government guidelines are. I f a state
wishes to do something other than health alliance, i f a state wishes to do
something other than single payer, then as I understand i t , that f l e x i b i l i t y
i s extremely limited.
^ ,
So the debate here; as I see i t , i s not over universal coverage
or security. Those are goals that I accept. I t ' s not over the w e l l - child
programs or primary care. Those a l l have to be i n whatever package comes
through. As I see i t , the debate here i s over whether or not there should be
universal control centralized in the hands of a few to the detriment of the
many — the many being the states and the l e g i s l a t u r e s and the governors and
the people in the local communities who t r a d i t i o n a l l y have made these health
care decisions.
And I guess my question goes to t h i s i^sue. As I understand i t ,
the powers that l i e here are that i f a state does not come forward with a
plan — and you alluded to t h i s e a r l i e r — which conforms to federal
guidelines, which was the phraseology I believe you used, or federal
framework, then the national board deems that the state i s not i n compliance;
and then they t e l l the secjretary of Health and Human Services t h i s and she
then has the power to withdraw from the states a l l f i n a n c i a l support that's
going to the states and a l l fimctions which Healtih and Human Services deals
with. Secondly, the national board then has the authority to draft a plan for
the states and i n s t i t u t e i t . And thirdly, the secretary of the treasury has
the authority to u n i l a t e r a l l y , without even congressional approval, as I
understand i t , assess a tax on business a c t i v i t y within the states.
Are those three powers appropriately described? I f they're not
appropriately described, could you give me your definition of them that l i e
with the national board's decision that a state i s not in adequate
compliance?
MRS. CLINTON: Well, Senator, we view what you j u s t described as
an absolute l a s t resort. And the only reason that i t ' s even in there i s
because, very honestly, there are some states that have told us privately
that they j u s t don't want anything to do with health care reform because i t ' s
just too complicated. And then there are other states l i k e Vermont and
Florida and Washington and C a l i f o r n i a and Hawaii and Minnesota that are
chomping at the b i t , they can't get t:here too soon.
So what we're trying to do i s to give as much encouragement to
states as possible. And we w i l l enhance the f l e x i b i l i t y . As I mentioned with
Senator Jeffords, any ideas that you have, and p a r t i c u l a r l y I'd welcome yours
as a former governor, that would give states that kind of f l e x i b i l i t y , we're
�ready to look at and to extend.
But t h i s i s a federally-guaranteed prograun. We do want every
American to have access to the same benefits, so that i f you l i v e in New
Hampshire you've got them and i f you l i v e i n Arkansas you've got them. And i f
we have a state, for whatever bizarre combination of reasons, that doesn't
want to do anything, they don't want to make their own choices, they don't
want to do what Maryland has done or what Minnesota has done, they don't want
to do anything; they don't want to guarantee the benefits package to their
citizens, they j u s t don't want to''get:-lnto"t±[e UuBlneBS^ of tirying to be a
leader and a state that takes that responsibility, then we believe there has
to be some fallback position. Now, I think i t i s highly unlikely.
.I
I can't even imagine a p o l i t i c a l circumstance in which a state
would not be w i l l i n g to do what i t needed to do, and given f l e x i b i l i t y , what
i t thought was right for i t s e l f .
This i s not a program l i k e some programs i n the past where only a
few people have been affected by them. This i s a program that w i l l affect
everyone, so I imagine that the p o l i t i c a l situation in most states w i l l lead
every governor I've ever met and every state legislature I've ever heard
about to do what they think i s right for their state.
But in the event of some unforeseen circumstance where a state
refuses or i s unwilling to do so, we do thing there needs to be some kind of
enforcement mechanism so that i f you l i v e in one state you're not denied what
you would have i f you lived across the border or i n any other state. And
that's the only reason that that's in there. We honestly don't see i t ever
coming into play, but we needed something there as — going back to Senator
Coats example — as a kind of s t i c k as well as a carrot.
I f there are additional ways that you would l i k e to see state
f l e x i b i l i t y considered, i f tJiere are additional ideas that you think would
meet the basic requirements of providing universal coverage within a state
and doing i t i n a way that i t appropriate to a particular state, we are —
you know, we welcome that. We want to hear more about that.
And l e t me j u s t say a f i n a l word about the national board. The
national board i s meant to be a coordinating and advisory board. I f the way
we have described some of i t s functions sound too regulatory, we want to take
a look at that. That has not been our intention. We wanted to perform the
functions of being available to — in the worst case, as I've j u s t described,
help make sure a state does what i t should do, and i t s ultimate
responsibility to i t s c i t i z e n s , but i t ' s mostly there i n a kind of monitoring
advisory capacity. And we'll be happy to s i t down and go through the very
s p e c i f i c powers and to t a l k why we think they are necessary, and to have your
response to that.
, ,
SEN. GREGG: Thank vou.
'
SEN. KENNEDY: Senator Simon.
*
SEN. SIMON: Thank you, Mr. Chairman, and we thank you for yoxir
leadership which has — I think everyone agrees has been superb. Let me also
join Senator Dodd i n thanking the chairman. Senator Kennedy, for h i s yeoman
work through the years i n t h i s f i e l d . We're a l l grateful to him.
You mentioned in your opening remarks t h i s room where we have had
many h i s t o r i c gatherings. One thing i s different. In every other involvement
here. Democrats were over there and Repviblleans were over here. I hope i t i s
significant — Democrats are moving to the right. Republicans are moving to
the liBft i n t h i s room here. (Laughter.)
To my colleague. Senator P e l l , who brought up the question of
�violence and health , I would be happy to join him, i f we need additional
revenue — l e t ' s have a 25 percent tax on handguns and a 50 percent tax on
assault weapons, and we would be helping the health of t h i s nation in more
ways than one, so Clay P e l l , i f you want to move in that direction, I ' l l join
you on that.
One word for a l l of my colleagues as well as those i n the
administration. I think i t i s important that we move expeditiously here. I f
t h i s drags on too long, people are going to look at the — focus on the
minutiae, they're going to distortT'Absolutely we oughtr to hold hearings like
t h i s and we'll hold plenty of them. We're — the chairman t h i s morning was
talking about 29 hearings. Let's focus on everything we should, but l e t ' s
move and move rapidly so that we give the American people what they're
entitled to.
You opened your remarks talking about research. There are those
who say, in the pharmaceutical industry, that t h i s i s going to hurt research.
There are those in the university community who are concerned
about the research aspects. I would be interested i n yoxir response to their
concerns.
MRS. CLINTON: I can understand those concerns. Senator, because
t h i s has been an issue that we have r e a l l y struggle with. We have t r i e d to
balance what we consider the necessary kind of investment in research and
development that we want to see biomed companies and pharmaceutical companies
pursue as well as other research that i s perhaps located on our campuses.
But with respect, p a r t i c u l a r l y to pharmaceutical and other kinds
of research, we have dilemma. There are some i n t h i s body, as you well know,
who believe that pharmaceutical pricing has been unjustified, much too high,
not related to a return on the investment into the research and development
of the products. There are others who believe that i t i s one of our most
profitable industries and that i t has been
a great boon, both in job creation and in bringing down medical costs and
human suffering because of the kinds of investments and that i t ' s only f a i r
for those companies to r e a l i z e a good return on those investments. Both are
probably right — both positions — and what we have got to figure out how to
do i s to encourage research, madce sure there always i s a f a i r and profitable
return on the investments }.n research, but not permit the kind of pricing
that has caused our drug prices to r i s e at three times the rate of inflation,
and causes drugs that are produced in t h i s country wit:h a combination of
government-funded research and private research to be sold at l e s s of
a cost overseas than they are sold to the taxpayers who paid for the
research.
U
So we've t r i e d to s t r i k e a balance, and that balance would ask
that as we move forward with prescription drugs being available to Americans,
which w i l l put more money into the pharmaceutical Industry, that Medicare,
for example, be permitted to have a discount on the price of tihose drugs. We
think that that i s a f a i r request for the kind of dollars that w i l l be going
into drug companies. We also think, with respect to breadcthrough drugs, there
ought to be some review and then the publishing of information about those
drugs that would be widely available to consumers — not to stop them, not to
c h i l l t h e i r development or t h e i r marketing, but to make available information
about what t h e i r r e a l costs and what their efficacy i s as anticipated by the
research.
But I mentioned yesterday — and I'm s t i l l very struck by the
story
I heard j u s t a few days ago of the s p e c i a l i s t at Mayo C l i n i c who discovered
�:hat a p i l l that i s used to de-worm animals i s useful in helping people with
:olon cancer, and he teauned up with one of our major pharmaceuticals, and
:hey did the research together, and i t wasn't, as he described i t , very
3omplicated research. I t was merely to make sure that the components in the
irug used for animals were safe for hiimahs amid that i t would have a good
effect on humans. And at the end of t h i s work, the company began to
nanufacture the drug, and the only difference, as he described i t , i n the
irug was that i t was made smaller because sheep w i l l have to swallow a bigger
p i l l than the r e s t of us do. Well, the^net r e s u l t i s r t h a t i f you went into a
vet or you went into an animal feed store, you'd buy that p i l l for s i x cents;
i f you wanted to prescribe i t for your patient for colon cancer, i t would
cost s i x dollars a p i l l .
Now t h i s physician said that he had always been a strong believer
in the use of pharmaceuticals, he had been a strong supporter of the
pharmaceutical Industry because he had seen with h i s own eyes what miracles
could be done. But he could not, for the l i f e of him, understand what the
costs were that would permit that company to recover that kind of p r o f i t on
that particular p i l l .
So that's the kind of concern we have. How do we get to market
with good research, supported research, the kind of help that our people
need? How do we insure that our pharmaceuticals continue to grow and be
productive, and how do we be sure that we get good value for the dollars we
spend? So that's how we've t r i e d to balance that.
SEN. SIMON: Thank you. Thank you, Mr. Chairman.
SEN. KENNEDY: Thank you very much. Senator Thurmond.
SEN. THURMOND: Thank you, Mr. Chairman. Mr. Chairman, I would
l i k e to join my colleagues in extending a warm welcome to the f i r s t lady,
Mrs. H i l l a r y Rodham Clinton, an able person who i s dedicated to improving the
health care of our people. Now Mrs. Clinton, i t i s a pleasure to have you
here t h i s morning.
Mr. Chairman, we a l l agree that our health care system needs
comprehensive reform. However, while we attempt to address the problems of
our health care system, we need to preserve the successful parts of our
present system.
As you know, America now has the highest-quality health care
system in the world. We need to maintain the quality of services for the 85
percent of Americans who currently enjoy health care coverage and cover those
currently without a health care plan.
Mr. Chairman, I believe we should ensure that coverage i s
available to a l l Americans. We should not allow the cancellation of health
care coverage because of i l l n e s s not allow coverage to be denied because of
a preexisting condition. Further, I believe that coverage should be portable.
I f some individuals lose t h e i r jobs or decide to change jobs, they should be
free from the fear that they would have to tadce a reduction in the amount of
h&alth care coverage or that they may lose i t entirely. We must preserve the
a b i l i t y of Americans to choose from
a variety of health care plans and to choose their primary physician. We
should provide patients with information that w i l l help them madce cost
effective choices by providing patients with t h i s information and the a b i l i t y
to choose. We would encourage competition and r a i s e the quality of care
provided.
Mr. Chairman, i f we provide information and incentives concerning
pz-eventive health care, I believe we could prevent many of the health care
�problems we have today. Each of us must take responsibility to practice
preventive health care — proper diet, reasonable exercise, and an optimistic
attitude toward l i f e promote health. The savings Incurred by practicing
Dreventive health care are not e a s i l y imagined, but surely they are cheaper
knd cause l e s s suffering than practicing curative medicine . I strongly
suggest that serious consideration be given to including preventive health
caie i n any prograun that is> adopted.
Finally, Mr. Chairman, the cost of the health plan i s the number
one health issue to Americans, accordtngmto the Watlrstreet Journal.
Americans do not want their health care costs to r i s e and the quality of
health to diminish because of sweeping new government controls over the
health care system. We must find some way to pay for these reforms without an
undue burden on business, or taxpayer or others.
Again, Mr. Chairman, I would l i k e to welcome the f i r s t lady here
today. Mrs. Clinton, thanks for your testimony, amd I look forward to working
with you to address the health care problems facing America today.
I have two questions. I f time doesn't permit, I ' l l j u s t ask one.
Mrs. Clinton, some antitrust experts in the health care f i e l d
compliment the recent DOJ-FTC statements of antitrust enforcement policy as
being useful and clear summaries of existing enforcement p o l i c i e s . However,
the antitrust experts are concerned that the policy statements do not
significantly change current antitrust enforcement p o l i c i e s . The question i s ,
do you contemplate that additional policy statements from the enforcement
agcmcies w i l l be forthcoming or w i l l other antitrust adjustments be necessary
as part of health care refomn?
MRS. CLINTON: Thank- you. Senator. And could I j u s t say amen to
your opening statement? I thought — especially the emphasis on primary and
preventive health care i s absolutely on target, and you are a l i v i n g example
of that that I hope everybody w i l l pay attention to. (Laughter.)
Senator, we did believe that we made some progress, and we want
to p a r t i c u l a r l y thank Senator Metzenbaum and Congressman Brooks for t h e i r
support for the statements that were made by the Department of J u s t i c e and
the FTC. We are s t i l l concerned that physicians do not know whether or not
they can join together to become accountable health plans either on t h e i r own
or with hospitals, and we do want to c l a r i f y that because I think i t ' s very
imiportant that doctors around the country f e e l they have the same opportvmity
to offer an organized health plan to their communities as insurance companies
or HMOs currently do. So, we are s t i l l looking at that. We are working with
the AMA about that. We are going to t r y to c l a r i f y i t . And i f we think any
c l a r i f y i n g l e g i s l a t i o n i s necessary, we w i l l be recommending that, and we
would welcome any ideas you have as to how we could achieve our common goals
about the a n t i t r u s t enforcement so that we can have a health care system that
r e a l l y i s competitive.
SEN. THURMOND: Thank you very much. My time i s — I won't have
time to ask the second question. We'll submit i t for the record, i f you don't
mind answering that.
MRS. CLINTON: Yes, s i r .
SEN. THURMOND: Thank you, Mr. Chairman.
SEN. KENNEDY: Thank you very much.
Mrs. Clinton, Senator Harkin, as you know, i s the floor manager
for the HHS appropriations l e g i s l a t i o n and i s on the floor and has been there
a l l morning. And he deeply regrets he couldn't be here.
Senator Mikulski.
�If
SEN. BARBARA MIKULSKI (D-MD): Thank you very much, Mr. Chairman.
And, Mrs. Clinton, r e a l l y a cordial welcome here today. I believe
you are the f i r s t f i r s t lady i n American history to come before the United
States Congress and offer ^.estimony on s o c i a l policy. The other two f i r s t
ladies who came offered comment on a policy inlt^iated by others, but I
believe you are the f i r s t f i r s t lady to come who i s actually the architect or
the chief architect of a plan.
I would l i k e to compliment the president for attempting to
achieve a national goal of safety-and—SBCtirlty f o r - a l l Americans in the area of
health care and the effort that you've made i n tadcing that national goal and
trying to operationalize i t into a health plan. I t i s not easy to
operationalize idealism. I t i s not easy to operationalize noble intentions.
But I believe that you and the president have imdertaken to do that, and I
think we see i t r e f l e c t i v e i n the plan that you've put forth here today. You
have taken the ordinary s t o r i e s of people and translated them in the most
significant public policy i n i t i a t i v e in three decades.
I think a l l of us owe accolades to the core benefit package that
has been established that emphasizes prevention, primary care, and personal
responsibility, and understanding the needs of women, children and the
elderly. The fact that we are so — our conversation i s focused on so many
details i s a tribute to what i s already agreed upon in the conversation,
particularly related to the core benefit package and the emphasis on those
three areas.
My question goes to picking up on the health a l l i a n c e . I t r u l y
believe that what you want to achieve i s a combination of marketplace
discipline and yet allowing mission-driven plans focusing on those ideals to
go into place. I'm concerned, Mrs. Clinton, that i f the emphasis — with tJie
health a l l i a n c e , they w i l l be able to choose the plan, and I'm concerned that
i f the c r i t e r i a i s solely or primarily cost, the cost of the plan,
mission-driven plans, those that are
primarily operated by non-profits, those providers that serve
either urban areas or r u r a l areas, that w i l l , by the very nature of who they
serve, be high cost, be pushed aside, and that i t ' s not that we'll have too
l i t t l e of marketplace a c t i v i t y or too l i t t l e competition, but we w i l l have
too much, and that instead of having a commvmity of health care, i t w i l l a l l
be focused only on the marketplace.
Could you comment on that?
MRS. CLINTON: That's a very important question. And, you know, as
you were talking. Senator, I was thirdcing back to our morning at Jimmy's
Diner and a l l the people who told us their stories, and every one of those
was a responsible, tax-paying, hard-working American c i t i z e n , every single
one of them, and every one of them was having trouble getting affordable
health care that would be available to them.
And I think i t i s important that we have a system i n which many
different kinds of health plans can compete; but I guess I see i t a l i t t l e
bit d i f f e r e n t l y . I see the(mission-driven — which i s a wonderful phrase r the mission-driven health providers being more than ready to step into t h i s
system. And l e t me j u s t give you a few examples of what I mean by that, f
I f you look at our plan, i t i s remarkably similar to the plan put
forward by the Catholic Hospital Association. The Catholic Hospital
Association worked for two years before my husband was even elected
\
president, came up with a plan in which they talked about having networks \of
health care providers competing for business that would be provided to peoble
�round our =°""t"^• J ^ ^ J ^ - ^ ' i ^ ' ? j i ^ ' i ^ i i ^ y
cases, they've
i l l be advantaged because they have t M « n so
» ^^ ^
^ i ^ e r cities
rovided so
S L T ^ r T ^ U r S n T S S i i S ^ base that couldn't
nd rural areas "here ttere was a ye^^a
g
^ ^^^^
^ ^^^^^^^
S " c o « ? n ^ ! : |SoS5S'?e!:S^is:m4nt that w i l l enable t h e . to be even .ore
repetitive.
^ ,
Mayo C l i n i c ,
. „ u l t i 4 p e c i l l t y , ' n o n - p r o f i t c l i n i c . Doctor.
lecisions about how they provide the
eoonoSy because
S^'dlfJerent^model than the f o r - p r o f i t model l i k e Mayo C l i n i c , are going to be
L t i e m e l y we?fposiS?oneS to become health providers to »any more people
extremely wex^p
assure that, these networks are going to have to
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roM see the plan heading iij terms of providing a safety net for long-term
:are that does provide forVfamily responsibility but does not set people up
Cor family bankruptcy.
MRS. CLINTON: Well, that's — I don't think there's any issue
that
'
,
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4.
r hear more about from both older people and people our age whose parents are
getting into situations where they need some kind of continuing care.
We have a couple of parts of t h i s proposal that I think w i l l
help. One i s that we want to extend-long-term'ciir»-CDVBrage t>y making sure
we've got in place the services that older c i t i z e n s need. And so to that end,
we want states to develop more home-based care and community-based care that
w i l l be reimbursable and w i l l be much more available. We also want to raise
thp spend-down l i m i t so that families don't have to impoverish themselves to
the extent we require now before they're e l i g i b l e for nursing home care. We
waiit to provide reimbursement for sub-acute care at nursing homes rather than
in the much more expensive hospital setting.
I f you take these various pieces, you-can see how each meets a
need that i s not met now, starting with home-based care. We do not provide
the kind of f i n a n c i a l support that many families would need in order to keep
an older r e l a t i v e at home,.and i t i s a very penny-wise and poimd-foolish
policy, as well as one that I think i s unfair to families. I f a family wants
to take on the responsibility, some l i t t l e b i t of help, whether i t ' s a
v i s i t i n g nurse or some other person to come in to help or provide respite
care, i s the right thing to do and i t ' s much less expensive than having
someone go into a nursing home.
With respect to community-based care, I would only repeat the
example that I saw the f i r s t time I v i s i t e d an adult day care center i n the
l a s t nine months; i t was at Saint Agnes Hospital in Philadelphia. That
hospital wanted to provide a service to the community, so they told families
that i f you keep your older r e l a t i v e at home but you both work during the
dciy, then bring them to the hospital. We'll watch them during the day; i f
anything happens, we'll be able to provide medical care. Well, the hospital
had to charge something, and the hospital t r i e d to keep the costs as low as
possible, but they had to charge about $35 or $40.
Well, that's about $200 a week for a working family. That i s more
than most working families can afford to pay. And so the net r e s u l t was that
b«5cause there was no reimbursement help for working families, most of those
families, according to the St. Agnes medical s t a f f , were forced to put their
r e l a t i v e s i n nursing homes, which then cost the state and the federal
government much more than maybe helping to support a $35 or $40-a-day charge.
And then f i n a l l y , with the sub-acute care, I mean, you know that
under Medicare many older patients and disabled patients, patients who are
under very severe medical conditions and often on l i f e support are kept in
hospitals because i f they are moved out of the hospital government assistance
for their care stops. I did not have to face that issue with my father, but I
would have i f he had not died.
And so a l l of a sudden, what you think you have available in
terms of f i n a n c i a l assistance ends. And many doctors have me as favors to
families under great f i n a n c i a l and emotional stress they keep patients i n
hospitals far longer than they should because they know to discharge them to
a nursing home or discharge them to home, i s an xinconscionable psychological
and f i n a n c i a l burden on many families.
We need alternatives to that, and providing t h i s kind of long-
�:ex*m care — reimbvirsing for sub-acute maintenance care and nursing homes —
/ i l l help so many fauailies. And those are the t:hings we want to provide.
SEN. MIKULSKI: Thank you very much, Mrs. Clinton, and thank you
lor the kind words you said about the Maryland program.
SEN. KENNEDY: Very good.
Senator Hatch.
^
SEN. ORRIN G. HATCH (R-UT): Ttiank you, Mr. Chairman.
Welcome to the committee, Mrs. Clinton, and I j u s t want to say
i t ' s always good to be with you, always"'good to see'you again. I also want to
thank you for elevating our nation's dialogue on these c r i t i c a l health care
issues. I thirdc you've done that single- handedly. And you and the president
have c l e a r l y done your homework on t h i s issue, amd you deserve a l o t of
credit, in my opinion, for your hours of study and your eloquent defense of
the administration's plan. So I for one personally admire you for getting
into t h i s battle — (laughs) — doing what you've done, and I want to work
with you on t h i s .
I agree with a l l of the principles for reform which the president
articulated l a s t week. We do need to provide health security for our
c i t i z e n s . We do need to reduce costs. We do need to reduce bureaucracy. We do
need to eliminate fraud and greed.
A l l of those are important, but the problem i s , we don't need to
create more problems than we f i x . And that's what people are worried about
with a massive, sweeping change in our health care system. I t ' s
a matter of great, great concern to a l o t of us.
I t ' s no secret that I have some problems with the
administration's approaches to health care. For example, I don't believe that
we need a National Health Benefits Board to r e a l l y determine what health care
should be in t h i s country. I believe more employer mandates would be
devastating to job creation. And, of course, there's always the question of
how are going to finance t h i s beast? I t ' s a very, very tough question. But I
look forward to seeing the d e t a i l s , looking at the plan when you get i t done,
hopefully within the next couple weeks. And as I've said before, I want to
work with you and help you to the extent that I can. I'm afraid there's a l o t
of work to do, no matter what or how we look into t h i s particular issue.
I'd maybe j u s t ask one s p e c i f i c question, and that's t h i s . I know
t h i s sounds t r i t e , but price controls didn't work i n the '70s, and I don't
think they're going to work any better now. And obviously, we a l l want to get
health costs under control. I r a i s e the saoae issues that you've already
discussed with regard to innovation and technology. But I'm afraid that
global budgeting i s going to r e s u l t i n rationing, pure and simple. And i n
order to control costs, you simply have to control volume as well i n order
for i t to work. So I think i t would be useful i f you could walk us through
exactly how the global budget w i l l work, explaining how the costs are going i
to be restrained without reduction i n quality of care, choice, accesB, or
technical innovation.
And l e t me j u s t say t h i s : one of my friends, a r e a l l y great
author i n t h i s country who's a doctor, an i n t e r n i s t , Robin Cook (sp), who
wrote ^^Coma" and the recent best-seller ^^Terminal."
He i s writing a new> novel that should come out before the end of
t h i s year which w i l l show the horrors of and the nightmares of global
budgeting and goverrunent management of health care . I think we'll a l l want
to read i t because i t w i l l be right in point with what we're discussing here
today. And I know you're concerned about those matters, too — but I f you
�>1
:ould walk us through how the global budget would work, explaining how the
::osts — how we can constrain costs without the reductions in quality care,
::hoice, access, technological innovation, et cetera.
MRS. CLINTON: Senator, that's obviously one of the key issues,
and l e t me s t a r t by saying"^that the term **global budget" i s r e a l l y a
nisnomer because there i s not any intention to, i n any way, budget every
tiealth expenditure that any American would make. That i s not at a l l the
intention. But i t i s to budget what would be the guaranteed benefits package,
but anything that any individual wished"to"'8pend—tB-'clearly available for
that individual to do. The marketplace w i l l be there for individuals to take
advantage of.
But with respect to trying to provide some budgetary d i s c i p l i n e
with the delivery of the guaranteed benefits package, we are operating on the
basis of several b e l i e f s about the best way to do that that I'd l i k e to share
with you. The f i r s t i s that rationing already tadces place i n our country. I t
happens every single day in every single community, and i t i s done by
removing people from the insurance r o l l s , I t i s done putting-barriers to
access, i t i s done by making i t much more d i f f i c u l t for some people to pay
for their health care than for others. And the net r e s u l t i s that many people
are already suffering the effects of rationing because we have a kind of
non-system of health care in which those of us who are able have the benefits
of the very best health car^ in the world. But i f we compare ourselves to
some of our competing countries, on many health indicators, we do not do a
very good job for our entirie population. So rationing i s already happening.
And in fact, what we want to do i s increase the market and increase the
competitive forces that w i l l make health care more available to the entire
society.
The second point i s that tiiere has now been, I think, very
ccnvincing work that I would l i k e to share with you and to provide to you
about what we are currently doing with respect to delivering health care
across our country by the kind of differences in costs that e x i s t from one
part of our country to another, and a number of people have been studying
t h i s . This i s what Dr. Koop has been doing since he l e f t being surgeon
general. He and Dr. Winberg (sp) at Dartmouth are two of the leading
researchers in t h i s area. J.t you have, as we currently do — i n j u s t one of
our programs, take Medicare — a 300 percent d i f f e r e n t i a l between the
delivery of care i n Miauni, Florida and the delivery of care in Wisconsin, or
as Senator Durenburger never t i r e s of pointing out to me, a 100 percent or
200 percent d i f f e r e n t i a l between Minnesota Medicare delivery and a place l i k e
Philadelphia with no differ'snce in quality that anybody can point to, that
points out very c l e a r l y the.z there I s a huge amo\int of inefficiency i n the
way we are delivering healt:h care right now.
Now why i s i t that i f health care has been delivered at one-half
the cost in New Haven, Coimecticut, compared to Boston, Massachusetts, or
one-third the cost i n Wisconsin compared to Miauni, Florida, or many other
e>:amples I could point out to you, why hasn't the whole market figured out
that they can deliver health care more e f f i c i e n t l y i f they followed what
Minnesota has done than i f they follow what another commxmity has done.
Well, that i s because, going back to Senator Coats' example, we
don't have any incentives, in fact we've got tihe wrong incentives, i n the
health care system as i t i s currently structured. We reiml)urse on
a basis of diagnostic treatment, on procedure, not on the basis of what i s
the quality outcome that w i l l be delivered for a particular population.
�f
I showed yesterday, and I have got i t , I think, again today, t h i s
onsumer guide t h i t makes the point better t h a n i ^ o ^ ^ ^ ; .
tv
onsumer Guide to Coronary(Artery Bypass Graft Surgery." I t i s put out by
he SS^8y?vania health c l r e cost containment council. What P«nn»y^;:?Si*/*«
^en doing for a number of years i s going to every hospital that Performs
^rSna?y bypass surgeries, finding out how much they charge and what happened
i o " S e ^ a t U n t , how many died, what kinds of recovery and other problems did
:hey have^ ^^^^
^^^^^^
can g e f taill'HIlame'<JS»ratt^>n f cSt $21,000 or
184 000 There i s no difference in quality. In fact, i f you look at t h i s
'onk^li: S ? d e , ?hS hospital that i l delivering the surgery for $21,000 i s
i o i n r a s ^ o d or better a job than hospitals delivering i t for two or three
l ? f ? u ? times that amount. There i s no current incentive in our system to
aove anv other hospital i n Pennsylvania to close that gap.
no^e any o i ^ r ^ ^P creating a market-driven, competitive system and by
Drovidinq good consumer information, we w i l l begin to see hospitals get those
hoZs mote^iTline with each other. So,-in-factrr Instead of rationing care
i f more hospitals in Pennsylvania delivered a high- quality coronary bypass
at $21,000, you'd have more people taken care of than you do currently when
the
waY'we°view the budget i s as a backstop. I t w i l l not come
into effect i n the vast majority of cases. Because we believe that good
information and decision-making on the part of Providers w i l l begin to move
t h i s system i n a more rational way so that we w i l l have better-quality health
care for l e s s money. We view the budget as a disciplinary backstop. I t i s
available i n the event that a particular region such as those whose co«ts are
a l eady so high doesn't begin to bring them into some kind of °°-P*fi!°"J^^J
th.»ir neighbors who provide high quality at a much lower cost. So, the budget
i s there, not to be imposed, but to serve as a backstop.^
And I know my time i s up, but we could go through very
.H«„IH
technically and explain how i t would be enforced i n the event that i t should
be triggered, but l e r e a l l y don't believe i t w i l l be triggered in most
i n s S n ? ! s i f people pay attention to what we know i s out there about how to
provide quality health care at l e s s cost.
SEN. HATCH: Well, thank you.
, ^ ^
Thank you, Mr. Chairman. That's a l l I need to ask today.
SEN. KENNEDY: Thank you very much.
Senator Bingaman.
^ .
SEN. JEFF BINGAMAN (D-NM): Thank you, Mr. Chairman.
I ' l l j o i n a l l the others in congratulating you, Mrs. Clinton, and
the president for your leadership and also Senator Kennedy for h i s long
record of leadership on t h i s issue.
4.-4*. v^^«„oo
I wanted to ask you about the cost containment part of i t because
I know that's central to your plan. One of the suggestions -- I introduced a
b i l l l a s t year based on work that the Jackson Hole group had done, and an
essential part of what they proposed, what I proposed, in that b i l l to
contain cos^Swas a l i m i t I n t h l amount of the employer's contribution which
would be tax free to the employee. And I know that Alan Enthoven (sp) has
continued to urge that that be considered i n t h i s plan.
I t does seem to me that i f I have a choice of a high-cost plan
that perhaps i s doing bypass surgery at $84,000 a crack and «
P^*"
that's doing bypass surgery at $21,000 a crack, we ought to build a l l the
incentives i n we can for mo to choose the low-cost plan,
^ P*^
,
tax on the increased cost of going to the high-cost plan would, I think, be a
�strong incentive.
What's your thinking for not including that in what you're
/_
planning to propose?
MRS. CLINTON: Well, Senator, l e t me s t a r t by saying I don't think
that in a competitive market where health providers are coming to get your
dollar and mine, and we're madcing the choice, that there are going to be very
many providers that w i l l be able to afford the $84,000 bypass surgery very
much longer. They're going to have to become more cost-effective because the^
w i l l have to charge the dif ferencfe; ~We"are'~asking consamers to make
cost-conscious decisions. I f I choose to join the most expensive health care
plan, I w i l l pay the difference, and that w i l l be the choice that I make.
But t:he issue about taxing health benefits i s one that we have
r e a l l y struggled and worried over because we have a great deal of respect fo:
Alan Enthoven (sp) and for the people who have worked on managed competition
and believe that we have a managed competition system i n many of the features
that we've adopted. But we have several big problems with, starting with the
taxing of health care benefits immediately when-the plan began. And they
include the following.
I f you s t a r t a health care reform proposal that w i l l affect the
whole country, we know that people are starting at different levels of
insurance right now. Some people have bargained for their health insurance,
some employers have offered health benefits as a competitive device to keep
employees and to hire employees, so we're starting with d i f f e r i n g levels of
health insurance.
The guaranteed benefits package that we are offering we believe
i s a very good benefits package, and i t does emphasize primary and preventivle
health care, but i t does not include some of the features that are available
in insurance p o l i c i e s that are currently insuring millions of Americans. So
to say at the very beginning these millions of Americans are going to be
worse off than they would be without reform struck us as unfair. So what we
decided to do instead was to say we intend to i i ^ o s e a tax cap but we want tb
give everybody enough notice, employers and employees, so that they can get \
ready for i t , so that they can see how our system operates, so that they can \
feel secure that they're not giving up benefits that they've either bargained^
for or paid for in wages. So we do believe in a tax cap, and
a tax cap w i l l be added, but i t w i l l be several years out, a f t e r the system
has actually gotten up and consumers can see what the benefits are for them.
The second i s that to impose a tax cap right now would be to
r a i s e taxes on over 35 million working Americans. I don't know how we could
do that. I don't think the president feels comfortable coming to you and
saying, ^ ^Remove the tax trea1:ment for health care benefits, and oh, by the
way, that's a tax hike on 35 million Americans," and I can guarantee you
once your constituents figured that out, you would hear
a l o t from them because they would think i t was unfair, also.
But I do think i t ' s f a i r to say we want you to madce costconscious decisions. And we have seen companies where t h i s bas worked; we
have seen states where i t has worked. The state of Minnesota decided i t would
only pay i t s employer share for state employees into the lower cost plan and
people switched. Many employers who have given lower cost alternatives to
their workers have saved money because people have switched.
So that's our thinking behind i t . Yes, we believe i t ' s a tool.
Yes, we want i t included. But to do i t now would r e s u l t i n a tax increase on
over 35 million Americans, which we don't think at t h i s point i n time i s f a i r
�to do.
SEN. BINGAMAN: Well thank you for c l a r i f y i n g that. I t ' s obvious
you've given i t a l o t of thought.
Let me ask one othar incentive-related question. One of the
incentives that e x i s t s i n t:he present system of health care i s an incentive
not to smoke. Most — or at least many health care providers or plans give
you a discount i f you do not smoke. That, as I understand what you're
proposing, that would not be available.
You have an assessment provivionniin the plaii7~'or contemplate one,
for employers of over 5,000 who decide to opt out. I think you charge them a
certain percentage. Why does i t not madce sense to maintain some kind of
additional cost for individuals who choose to smoke or for employers with
workforces that choose to smoke? Would that not put t:he Incentive where you
want i t , as we t a l k about responsibility i n the health care system?
MRS. CLINTON: Well, Senator, I think that we ought to take a
close look at that again. You know we are going to propose taxing tobacco,
which we consider a disincentive to smokingy-and we hope p a r t i c u l a r l y for
young people. I f there i s a way, without getting back into the problems
caused by experience rating and underwriting practices that draw l i n e s
between people, where we can j u s t target certain very limited behaviors, we
w i l l look at that again, because I share your saune belief about trying to
encourage wellness and discourage harmful behaviors. But we don't want to
s t a r t down a slippery slopu where then, well, you know, young people are
healthier than old people so young people should pay less than old people,
you know. Once we get back into that, then we are back into a l l of the
administrative costs and the vmderwritlng practices that eliminate people
from care, and we don't want that to happen. SEN. BINGAMAN: No, I agree
entirely. And I think your decision to j u s t impose the tax on tobacco
products made a l o t of sen^e and was an exception to the community-based plan
and might be i n t h i s other area as well.
Thank you, Mr. Chairman.
SEN. KENNEDY: Senator Durenberger?
SEN. DAVE DURENBERGER (R-MN): Mr. Chairman, Mrs. Clinton, thank
you. Let me begin by saying that the people that I represent l i k e you
a lot. Many of them even t r u s t you, which i s very unusual for people that
work i n t h i s town. And I think i t ' s because you're one of the f i r s t national
leaders to take responsibility for actually getting something done, and they
feel that. And even though they may not know enough about the plan or not
trust the financing and so forth, I must say that the sense of responsibility
for doing something has not been l o s t on my constituents. They also
appreciate your mentioning Mirmesota so often, but on the second round I wish
you would mention Massachusetts a couplf of times. (Laughter.) But i t i s a
unique constituency and I've been blessed to represent i t for a long time and
whatever I have to say by way of a question w i l l r e f l e c t our experiences i n
Minnesota.
One of the things £hat I hope we can agree on, and I'm j u s t going
to suggest one, but we donft have to do i t now, i s I think we need a goal for
a l l of t h i s that people ca^ relate to — I mean, why are we doing a l l this?
— so we don't get bogged down i n a l l of the mechanics.
And I've always used the goal of equal access to high quality
care or to a system of high quality care through universal coverage of
financial r i s k , and then, I'd l i k e to add, and a community commitment to the
health of our c i t i z e n s .
There's nothing i n there about basic benefits or insurance
�companies or health alliances or any of that sort of thing, but i t ' s an
important measure because as we undertadce t h i s task there's two r e a l l y
important things that we don't have i n our country today that we need to get
to i t . One i s cost containment, and the other i s the goal of universal
coverage. And so my question i s going to be a question I've discussed with
you before, and that i s why can't we do one before the other?
In order to devise an effective reform strategy, we somehow have
to figxire out how to get the costs under control, and the r e a l i t y from my
experience has been that people contral"caBt8V PeoplB~control costs. And this
i s particularly true i f you want to maintain high guaiity. Government can
control costs by putting l i d s on things, but then something else loses i n the
system: you go to rationing your quality or whatever. But the r e a l i t y i s i n
whatever we buy, whatever we use i n our society, i t i s people — people —
that contain the costs.
Communities as markets are very, very important, because
communities are a series of relationships between people who have certain
needs and people who can meet those needs. -It-^s- i n communities where you have
care-givers — i n our context, the medical — care-givers and consumers
meeting on a daily basis. So the r e a l i t y i s that communities across t h i s
country are containing costs.
You have mentioned,Minnesota. You've mentioned other states.
There are employer coalitions. That's a sense of community. There are
multi-specialty c l i n i c s , and you've mentioned one of them, David Nexon's (sp)
favorite, but there's also the Cleveland, and then there's Oxner (sp), and
there are smaller ones i n many of o\ir communities. There are efforts to
increase consumer information. You mentioned Pennsylvania. They're a l l over
the place.
A l l of t h i s i s being done i n communities. And the reason I need
to stress t h i s i s that i t i s communities that madce the difference, i t ' s not
state governments. Nothing that's happened i n Minnesota has happened because
the state goverrunent said i t needed to happen. I t happened because people
wanted i t to happen. And you've already mentioned Duluth and the difference
between Duluth and Philadelphia and Wisconsin and Miami and so forth.
So the issue i s , r e a l l y , how do we spread t h i s across the
country? And there the issue i s , what's the government role? And t h i s I s the
issue that's dividing some of us: what i s the government's role i n a l l of
this? And I'm going to suggest two.
The f i r s t i s the national government ought to set the rules for a
sound marketplace. I f we want high quality and we want cost containment, i f
we want more for l e s s , wc need to get productivity, we need dynausic markets,
what are the rules for dynamic markets? And i t defies any logic of any
experience I've had that 51 states can come up wlt:h rules for markets, for
products l i k e health care and medical services.
So the second part of the goal i s the issue of iiniversal access.
And there the government role i s probably even clearer, although even
Republicans d i f f e r on t h i s .
The f i r s t role i s the state role, and that i s to madce services
available to people who can't get them from a market. And most of us who know
anything about markets know that markets can get you higher quality for a
lower price, but they can't do equity. They can't get doctors to go out into
t h i s part of northern Minnesota, you know, where there's only two people per
square mile. They can't get good diagnostic equipment into certain areas.
Only government can do that. So, one of the r e s p o n s i b i l i t i e s of government i s
�to make services available, and that's going to require subsidies, and that's
one of the things that state goveriunents r e a l l y ought to be concentrating on,
and they're not doing i t today* They're leaving i t to some medical
marketplace.
The second i s the affordability of the premium prices that we now
pay for our coverage, and c l e a r l y that's a national issue. Tomorrow, you'll
be before the Finance Committee, and we'll t a l k adx}ut low- income, elderly,
disabled, and doing something about our p o l i c i e s . And before t h i s committee,
you'll talk about the employer's rollFTmd^'Bo fortllT^'" "
But I'm sort of setting up t h i s question by saying we have to get
to a market, we have to get the people to contain the costs, and we have to
get the goverrunent to make the access to the system affordable i n some way.
Right now, the American people, as reflected by the people i n my state,
believe that you can get to a market without universal coverage. We're doing
i t i n Minnesota. Even though there's cost shifting, we're moving to a market.
I t ' s happening i n Utadi and Oregon and i n paxrts of New York and lots of other
places. They're moving to cost containment,--even though there e x i s t s some
cost shifting. So, I have a hard time with the notion t:hat you have to have
universal coverage i n order to make a market work.
But even more important than that, i t seems that — we've already
talked about the fact that Americans don't want t h e i r taxes raised. You've
just said they don't want their taxes raised on their benefits. We a l l know
the d i f f i c u l t y you have there. And beyond that, beyond that, the reason they
don't want t h e i r taxes raised i s they're not sure the plan's going to work.
And i s there not then some value i n demonstrating that our particular or your
particular approach to markets and medicine, which no one has seen before,
actually works i n some communities i n t h i s country before we move to a
national, universal coverage system?
MRS. CLINTON: Senator, as always, you ask the most interesting
and challenging questions because of your concern and commitment to t:his
issue. And I've appreciated greatly the times we've spent together talking
about t h i s .
And I guess I would answer i n t h i s way, that we have seen markets
beginning to work, the one^ that you neuned. We know, we believe, the
conditions that markets need to be able to work effectively, and we do need
to define whatever the government role i s i n creating that national market so
that we w i l l have a sound and effective one.
The problem that I have i n putting cost containment before
universal coverage or vice versa i s that i n any decent marketplace, you would
have people flooding to Minnesota to figure out how to keep costs down. You'd
have people flooding to the university i n Duluth to figure out how to t r a i n
more family care providers than are trained by any other medical school.
You'd have people lined up at Rochester, New York's boundary, saying show us
how you keep those costs do%m i n Rochester, New York.
That has not happened. And i t hasn't happened because there i s no
market there and there i s no r e a l pressure for that market to be created by
the kind of market that there would be i f somebody thought they could buy a
car for one-third the price i n one state than they would i n the other. You'd
have an exodus into that state.
Part of the reason there i s n ' t i s because we don't have either a
good theory for cost containment with t:he right incentives b u i l t i n that w i l l
move the market i n that direction across the country and not j u s t i n the
pockets where i t ' s moving. And the other i s there are a l l these escape valves
because we don't have universal coverage.
�people don't feel ihe P J ^ n j ^ ^ f r a v r r t S t t . ^ ^ ' ^ L ' J h a t
,ift their costs to " " " e j ^ ' ^ S S n
neighboring - " ^ ' / I S ^ ' r e s t i l l
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Clinton, When Ser^tor Mil^u «ki^ ^^^^^^^ ^ e S t r i o d r n e ^ ^hSe 2 l l too often
testified, I ^^^^"^ °^„«ild help you through this jo^'^^^.gevelt once said,
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senator
minutes - s^"*
to my central question. I do ^ ^ ^ ^ ^ J ^ ^ ^ ^ o p l e in the
highlight a^<^^^f
h set of issues because «^«"^^^*iSuc health and the
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cities and in the ^ ^ ^ i ^ ^ ^ T c infrastructure, and they re no^ q
competing
Minnesota, I think we nav
�of benefits and for universal health care coverage. We can't overpromise, and
we have to be clear about when we're going to come through.
Now my question. The thing that you say that i s so powerful, the
thing that the president said that was so powerful i s there's a card, and
there w i l l be a comprehensive package of benefits, and no one can tadce that
away. And I think we're also talking about quality of service.
Now when we t a l k about quality of service, I would l i k e to zero
in on a technical point, but I think i t ' s basic, and that has to do with the
average price plan. And for those wha'^donfttdknowTVtnitrthe average price plan
i s about, t:hat means that i n any given state, i f one plan i n a state or a
region i s $800 and another plan i s $300, that 80 percent employer
contribution w i l l go to the $500 average price plam.
MORE
35th add missing
—
36thadd
MRS. CLINTON: And you're absolutely right, and none of us do. I
mean, what we are trying to create, as Senator-Durenberger said, i s a dynaunic
market that responds to price and quality and gives r e a l choice to consumers,
unlike what e x i s t s in many places now where there i s no choice whatsoever;
you don't have a low, medium or average or high plan, you've got very l i t t l e
access. And we want to increase that and we're going to watch that very
carefully.
SEN. KENNEDY: Thank you very much. We have one f i n a l questioner
here, our good friend Senator Wofford, who has been one of our r e a l leaders
on health care , and we'll,hear h i s questions now.
We know that you have another hearing to t e s t i f y , so we w i l l not
have a second round of questions, although we'll ask our colleagues i f they
do have questions to submit them in %n:itlng. And after Senator Wofford, i f
there i s a member that wanted to say a very brief f i n a l comment, we'd
entertain that as well.
Senator Wofford?
SEN. HARRIS WOFFORD (D-PA): Mrs. Clinton, I'm happy to j o i n
Senator Jeffords and others as a cosponsor of t h i s b i l l because I think i t
not only r e f l e c t s my own b i l l of a year and a half ago, but i t ' s designed to
meet the t e s t s that the president put to us, and they were the t e s t s that I
put to the people of Pennsylvania two years ago.
Mr. Chairman, you have carried t h i s b a l l through thick and thin
over the years, and too many of those years have been thin years. Harry
Truman was beaten back when he t r i e d to advance t h i s b a l l half a century ago,
and Richard Nixon 25 years ago. But I believe t:his time, thanks to a
president of the United States who i s committed and to the f i r s t lady of the
land and the extraordinary work that you have done, Mrs. Clinton, we're going
to tadce the b a l l across the goal l i n e t h i s time. You won't f i x the common
cold, but I do think that you are going to — we together, as we press hard,
are going to f i x many of the major problems of our system that are vexing the
American people.
Before I ask the question I want to ask about early r e t i r e e s and
workers compensation and possible savings there i n t h i s system, I would l i k e
to introduce you to someone behind you who helped me advance the b a l l up in
Pennsylvania, Dr. Robert Rynick (ph), who was the — Robert, stand up a
minute — a leading ophthalmologist of Pennsylvania, who said to me, when we
were talking about how to reform the health care system, ^«Senator, we can
reform the system, we can decide how i f we set the goal. And I j u s t wish
you'd tadce t h i s Constitution and tadce i t to the people of Pennsylvania and
�jay, in this Constitution i f you're charged with a crime you have a right to
Laii^er; i t ' s even more fimdamental i f you're sick to have a right to a
lector."
. .^^
I took the ball from him and ran with i t , and you're throwing the
jreat ball to us now to madce a reality of that.
On early retirees, I'd be interested in yoxir reminding this
learing what you're proposing there, including any comments you have on any
short-term measures to stop the sound — the great retreating sound of
companies pressed by their own cost-crislB withdrawlng-from reducing or
cancelling the benefits for early retirees.
MRS. CLINTON: Thank you. Senator. But before I start, I must say
that none of us might be sitting here i f it: had not been for your courageous
campaign that was waged on providing health care to every citizen of
Pennsylvania. And that was a c a l l that went out around the country with your
victory, and I'm just pleased that you w i l l be part of actually delivering on
that promise to your people and to the people of this nation. And I'm very
grateful for the leadership you've shown on this issue;•
I know of your deep concern about retirees, particularly those
are being denied health benefits which they thought they had, in a sense,
paid for through collective bargaining agreements and through other
agreements with employers over their work lives, and i t i s a serious problem.
And i t i s a problem both for the individual who i s , perhaps, unpredictably in
their lives denied health care when they most need i t , and i t i s an economic
problem for many of our companies which have labored under much greater costs
than their competitors in trying to meet their health care needs.
We have proposed that the burden of retiree benefits of those who
retire between the ages of 55 and 65 after a certain set period of work who
are not yet eligible for Medicare be taken off of the backs of the employers
and be shared between the employers and the federal government. We have
costed this out at about $4-1/2 billion a year. We believe i t i s sound public
policy because i t does release an enormous amount of economic potential in
the marketplace by taking this burden that some employers bear but most do
not. The employers would continue to be responsible for a portion of the
payment under t:heir contracts or they could make some kind of lump »u»
payment, but the federal government would pick up the rest, which would
guarantee health security to those individuals who are caught between their
work lives and Medicare e l i g i b i l i t y , which we think would be an appropriate
kind of security to extend to them with their making the contribution as they
were able. And i f they went to work after they retired, they would be
required to do so.
SEN. WOFFORD: Do you have any thoughts on a stop-gap measure such
as some of us are proposing between now and when we deliver the goods of a
universal, affordable healtih security system?
MRS. CLINTON: We w i l l certainly look at that. I'm aware of the
legislation that you have sponsored and your strong statements on behalf of
that legislation. Obviously, we hope that the Congress w i l l deal with health
care reform expeditiously so that i t may not be necessary for any transition
or stop-gap, but we w i l l certainly keep that under consideration.
SEN. WOFFORD: And any last words or f i r s t words on worker's
compensation and how i t w i l l be included in this as a way of savings for
business?
MRS. CLINTON: We very much would like to see the worker's
compensation health care benefits integrated into the national healt^ care
system. We think that would be a great benefit to small business
�particularly, but to a l l business t:hat are now paying increasingly high
worker's compensation premiums. We also would l i k e to work toward an
integration of the entire worker's comp system i f we are able to make
adequate substitutes for workplace safety and the kinds of inducements for
safety that the current system provides through the experience rating of
insurance premiums i n that system. But at the very beginning, we would l i k e
to begin by integrating that portion of worker's comp into the health care
payment that the employer and employee would share amd having the accoimtable
health plans then contract to deliverTthe! kinds oftiBlitth services that
workers might need, including rehabilitation services.
SEN. WOFFORD: Thank you.
SEN. KENNEDY: We computed the time. We find Senator Kassebaum had
one minute l e f t , and i t seems she has one very small question. And I think
we'd l i k e to j u s t — (laughter).
SEN. KASSEBAUM: The advantages of being a ranking member and a
thoughtful chairman. I appreciate i t , amd I appreciate, Mrs. Clinton, a l l the
time you've given. But there i s a witness coming tomorrow, and
I would kind of l i k e to get your answer to t h i s question.
I'm sure each and every one of us here have at one time or
another t r i e d to help constituents in our states r a i s e money to cover costly
experimental procedures, p e r t i c u l a r l y transplant procedures, and have done
fundraisers and so forth. In t h i s case, t h i s i s a mother who has
a malignant melanoma whose self-Insured — her employer's self-insured plan
doesn't cover costly procedure — experimental procedure.
She has gone through a l l the t r a d i t i o n a l treatment protocols and
they haven't worked, and they're recommending a bone marrow transplant. Would
such a procedure be covered under the plan as i t ' s devised now — the costly
experimental procedures, transplants?
MRS. CLINTON: I f a procedure'ls truly experimental, so that i t
has not yet proven i n appropriate research t r i a l s i t s c l i n i c a l efficacy for
treating a certain disease, i t w i l l not be considered for inclusion i n the
guaranteed benefits package, but accountable health plans, as they do now,
w i l l certainly be free to offer any procedure that they choose to do so. Once
a procedure i s s t i l l considered experimental but provable, then i t may be
considered by the national board to be Included i n the benefits package. So
there w i l l be some time lag there.
What we have been t e l l i n g people in the condition of the woman
you described i s that health plans ctirrently madce available around the
country some procedures that other health plans do not. There are some that
provide reimbursement for ^ n e marrow kinds of procedures with respect to
breast cancer and other kirids of cancer, and other plans whic:h do not. We
believe that that w i l l continue to be the case, but now t:he consvimer w i l l be
able to choose the plan that does provide that kind of treatment so that
there w i l l be a clear up-front commitment i f 7- we provide the service even
though i t i s s t i l l considered maybe experimental and not t o t a l l y proven, you
or I w i l l be able to j o i n that. Or we w i l l be able to buy i n the supplemental
Insurance market coverage for that, which i s not now readily available.
So we think that the net effect w i l l be that t h i s woman, and
women l i k e her, w i l l have much greater choice to gain coverage for t:his
procedure before the national board were to decide i t could be part of the
benefits package as a matter of course.
SEN. KASSEBAUM: So you wouldn't appeal to the a l l i a n c e ? The
health a l l i a n c e would not make a decision regarding —
MRS. CLINTON: Well, the health a l l i a n c e would i n the f i r s t
�tl j. • •
":r>'-
instance decide whether i t was going to offer that service, and i f i t did,
then i t would be part of the benefits that the health plan i t s e l f were to
offer. And what we also think would be available i s the point-of-service
option that we want every plan to offer, including the closed panel HMOs,
that that would then be a r e f e r r a l . There might have to be some additional
payment, but i t wouldn't be the kind of h o r r i f i c costs that now are faced by
individuals who are out there a l l by themselves.
And I'd be happy, i n preparation for your witness tomorrow.
Senator, to have written do%m exactry^mat••'OUr prOCBdlirB i s with some
examples and some scenarios as to how we believe i t would work, i f that would
be helpful.
SEN. KASSEBAUM: Thank you very much.
SEN. KENNEDY: Just a closing brief comment for any senator.
Senator Dodd?
SEN. DODD: Thank you very much, Mr. Chairman. And j u s t very
briefly, i f I can. One, I j u s t wanted to — I appreciate your comments about
the pharmaceutical industry. Senator Simon raised the-issue and you talked
about trying to find t h i s mix here. And I j u s t — and I know you're aware of
t h i s , and l i k e any other industry there are good guys and bad guys, I guess.
But important to note, I think, that i t tadces on the average about $400
million and 12 years for a product to go from laboratory to market, and only
about one i n 5,000 actually make i t from the laboratory to the market.
And so as we look at individual pieces here and i t can cause our
level of anger to r i s e . But looking overall a t the Incredible contribution
overall that that industry has made to the health of t h i s country i s
something that I think needs to be emphasized. And I r a i s e that i n the
context — and maybe you'd made a brief comment on i t , i f you would ~ I've
listened to you countless times — and talk about the role of the private
sector, how important i t l u , that whatever, plan we develop be extremely
sensitive to small business i n t h i s country, how c r i t i c a l that component i s
to t h i s country's economic success. There i s out there t h i s notion somehow
that t h i s i s a n t i - business, that t h i s i s p a r t i c u l a r l y anti-small business.
Nothing could be furt:her from t:he truth for those of us who have
listened to you and listened to t h i s plan get developed. And I wonder i f you
might j u s t take a moment tb comment on that p a r t i c u l a r broad c r i t i c i s m that I
think many of us hear from our p a r t i c u l a r constituencies.
MRS. CLINTON: Well, Senator, I r e a l l y appreciate that
opportunity.
I guess I'd s t a r t by saying I think i t would be hard to design a system that
i s more anti-business than the one we currently have, i n which business bears
the bulk of responsibility, pays most of the b i l l s , and has u n t i l very
recently had very l i t t l e to say or very l i t t l e control over the kinds of
costs i n the health care system that have increased t h e i r costs and, in many
industries, lowered t h e i r competitiveness.
What I believe i s t:he f a i r e r approach to what we are doing i s to
recognize that business has borne the burden for tadcing care of most
Americans. Ninety percent of those Americans who are insured are insured
through t h e i r employer. And what we want to do i s to build on the system and
to begin to madce i t work for a l l businesses.
Those businesses, large and small, that have been responsible,
provided health care benefits, deserve to have some kind of cap or some kind
of discount, some kind of effort made to help them control t h e i r costs,
because they've having such a hard time doing that. And that's p a r t i c u l a r l y
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different <rie«^i°'!;;^ stands in recess.
• ^ . " V T z ^ : ^ e J S you, Mr. Chairman.
~\END
~•
�HEARING OF THE HOUSE EDUCATION AND LABOR COMMITTEE
CLINTON ADMINISTRATION HEALTH CARE REFORM PLAN
CHAIRED BY: REP. WILLIAM D. FORD (D-MI);
WITNESS: HILLARY RODHAM CLINTON
WEDNESDAY, SEPTEMBER 29, 1993
REP. FORD: I'd l i k e to annoiince that the first>il&dy can be with
us for two hours, and i n the interest of ensuring that a l l
members of the committee have am opportunity to audc t h e i r question, we're
cfoing to l i m i t opening statements to one minute each to the chair amd the
iranking Republican and the chair of the Ladsor-Mamagement Subcommittee amd the
i.-anking Republican on that committee. I ' l l ask vmamimous consent, without any
objection, a l l opening statements presented by the members w i l l be inserted
at t h i s point i n the record.
The other part of t h i s that I-want to-mention to you i s that
we'll operate on a two-minute rule instead of the t r a d i t i o n a l f i v e - minute
rule, and I ' l l have to be very strong i n enforcing the two- minute rule with
tihose l i t t l e l i g h t s down there; otherwise, we're going to leave junior
members of the committee without an opportunity to have t h e i r question. And
I'd ask the cooperation of the members.
Did I leave anything out. B i l l ?
REP. BILL GOODLING (R-PA): Not that I know of. I think you
covered i t a l l .
Mrs. Clinton, i t ' s a r e a l honor for t h i s committee to have you
here. I would observe that you've set some kind of a record, I believe, not
only i n appearances by a f i r s t lady more times than a l l of the other f i r s t
ladies put together who deigned to come to the Congress and talk to us, but
:Ln the number of major committees that you've t e s t i f i e d before i n j u s t t h i s
week. I t ' s almost at the same frenetic pace that we've seen you operate at
t h i s year i n doing what we thought at the beginning of the year, very
frankly, even the most optimistic and hopeful of us, was not going to be
possible.
The work that you and your task force have done across t h i s
<:!ovmtry i n gathering together the wisdom and thought of so many diverse
groups of people and individuals i n our society,to put together an
understandable outline of a possible successful universal medical care
program for American c i t i z e n s i s the most exciting thing that we've had a
chance to be a small part of.
This i s a one-in-a-generation opportunity, as I perceive i t . I
had the good fortune to be here when we passed Medicare, and I've been proud
of that for many years since, except we didn't'go far enough. We ran out of
gas with the war i n Vietnam and other things tadcing our presidential
leaderchip away from us.
Then the Clintons caune to town. And for the f i r s t time, many of
us who have spent a good many years here actually had hopes that you were
going to bring enough attention to t h i s issue to ignite the American people
behind a genuine e f f o r t to provide universal medical care.
We believe that we've reached that c r u c i a l point because now the
discussion has changed i n t:he Congress from whether we need such a plan to
how best do we do such a plan. And I'm sure that by the time we're through
with t h i s , not only i n t h i s committee but others, we w i l l incorporate the
�l)est of Republican plans with the best of the president and your plan and the
lieat of anybody else's ideas that look l i k e t h e y ' l l make your objectives as
articulated by the president a week ago Wednesday come true. There are very
high hopes i n t h i s country riding on your success, and t h i s committee w i l l , I
assure you, work to do everything we can to make i t come to pass.
Mr. Goodling.
REP. BILL GOODLING (R-PA): Thank you, Mr. Chairman.
I , too, want to welcome the f i r s t lady and congratulate her for
bringing health care reform to the forefront i n thirniierican debate. Since
t:he president's prograun and the minority's prograun have the same s i x major
goals in mind, we should be able to work out something in a bipartisan
jfashion. I would hope that would happen because I believe i t ' s very important
t:hat something as major as t h i s — we're talking about a t r i l l i o n dollar part
of our economy — be done in a bipartisan fashion. So we w i l l look forward to
1:he d e t a i l s so that we can offer our suggestion's and recommendations i n ways
we think i t can be changed to be even better. That would be our hope. So we
look forward to t h i s period.
—
And then also I want to thank you for coming before the task
force that I served on on several occasions so we could exchange ideas. And
I think i t helped us, and I hope i t helped you. And, of course, I know you
remembered long-term care and home care, because you heard that several times
before us. So again, thank you for coming, and we look forward to
participating and being a part of a reform system that w i l l benefit a l l
i\mer leans.
Thank you.
REP. FORD: Thank you very much, Mr. Goodling.
Mr. Williams. Mr. Williams i s the chairman of the subcommittee
that w i l l carry the lion's share of the burden for hearings around the
country on t h i s . I f you want a hearing anytime of the day or night anyplace
in the country, see Pat — (laughter) — and h e ' l l take care of i t for you.
REP. PAT WILLIAMS (D-MT): Thank you, Mr. Chairman.
Mrs. Clinton, welcome. You are, as you know, the nation's 38th
f i r s t lady. I t was May 27th, 1789 when our f i r s t f i r s t lady. Lady Washington,
joined her husband, the nation's new and;first.president, i n New York
following an arduous coach ride from t h e i r home i n Mount Vernon.
At the time, i t was written — and I quote — * * I f providence
i t s e l f had divinely intervened, a woman who better looked and played the part
could no have been found."
Well, since t:hat f i r s t f i r s t lady, America has celebrated i t s
president's wife — Abigail and Bess, and Mary Todd, and Jackie, and Nancy,
but none, Mrs. Clinton, have had i n t h e i r husband's f i r s t ear the effect that
you have had on a c r i t i c a l , major, domestic issue. Americans are lucky more
than a few times In both t h e i r choices of presidents and p a r t i c u l a r l y
fortunate i n t h e i r president's choice of a wife. And i f providence had
divinely Intervened, I think we could say of you what people of the time said
of that f i r s t lady 38 ago — we're delighted you're here. We're delighted
with your aggressive and i n t e l l i g e n t work on t h i s important piece of national
l e g i s l a t i o n . And my committee members and I look forward to continue working
with you, and we thank you for working with us to t h i s point.
Thank you, Mr. Chairman.
REP. FORD: Now, Mrs. Clinton, I would invite you — I noticed i n
many, many meetings that I have attended with you that you rarely have notes,
and i f you have them you don't bother with them too much. I've seen you write
�a speech l i t e r a l l y Abradiaun Lincoln style on the back of
a piece of paper on the way to a college commencement and give i t as i f you
had practiced i t for weeks. So you proceed in the way you f e e l most
comfortable to put on the Record here what you want in the way of
a national health prograun, and then we w i l l open i t up to questions.
MRS. CLINTON: Thank you, Mr. Chairman. I want to thank you and
the members of t h i s committee for the extraordinary help and openness you
have sho%m to me and to others working on behalf of the president in the l a s t
months concerning reforming our health care system"^' " ^
This committee has been w i l l i n g and very ably been w i l l i n g to
address some of the major issues facing our country and some of our most
serious s o c i a l problems. I know the president and the nation p a r t i c u l a r l y
appreciate your work on the Family and Medical Leave Act and the National
Service B i l l .
In the months ahead, your commitment to confronting the greatest
domestic challenge of our day w i l l be c r i t i c a l to our nation's future. After
years of s t a l l i n g and f a l s e s t a r t s , -we a l l -now-have an h i s t o r i c opportunity
t:o accomplish what our goverrunent has never succeeded at before — providing
health care for every American c i t i z e n , health care that i s secure and can
never be taken away.
You know better than I the countless t a l e s that come across your
desks, that meet you as you t r a v e l around your d i s t r i c t s , that are told to
you at town meetings. You hear from those who have no health insurance and
used to have i t , but a job was lost, a faunily member was sick, a preexisting
condition prevented existing coverage from being continued. You, l i k e I , have
had to t a l k with parents who have actually given up jobs and gone on welfare
to get medical benefits because there was no other way to take care of a sick
child. You have had the kinds of conversations and heard the s t o r i e s that are
:really behind why we are here today.
The s t a t i s t i c s , whether we talk about the two million people who
lose t h e i r insurance each month for some time or the 40 percent of insurers
who refuse to cover people with preexisting conditions, can, i f we are not
careful, be j u s t that, only s t a t i s t i c s . And the stories and the human face
that we need to put on t h i s problem can, i f we are not careful, fade behind
the s t a t i s t i c s , the d e t a i l s , the problems that we read about. So, I hope, as
we move forward i n t h i s great national discussion, that each of us has i n the
back of our mind the picture of some person who w i l l be helped by what we
w i l l do. And we w i l l keep and remind each other of the s t o r i e s of the r e a l
people who stand to gain because of the action you w i l l tadce.
The human dimensions of health care reform are only one part,
although the most Important part, of what we are facing. We also know, and
you know better than most i n the country, the economic dimensions of what
confronts us. We have seen;the federal budget continue to hemorrhage because
of health care costs that could not be kept under control. We have seen state
and local budgets likewise hemorrhage because they were unable to keep up
with the soaring costs of health care. For the f i r s t time ever i n our history
t h i s year, the states of our country w i l l pay more for health care tham they
pay for higher education. Many states and many c i t i e s have been forced to lay
off police o f f i c e r s , to refuse that neighborhood's plea for more police on
the streets because they have to keep paying more money into a system that i s
not providing any more or better care, but which continues to cost us more
every year.
What we have to confront now i s the opportvmity of preserving
�%rhat i s best about our health care system. And there can be no argument; we
have the best health care system i n the world for those of us able to afford
to access i t . But we also know, i f we are honest with ourselves, that while
we must preserve what i s right about the American health care system, we must
also f i x what i s broken, because what i s broken i s in danger of undermining
even further what i s right about American health care.
When the president launched t h i s effort to try to come forward
with
a proposal that you could seriously debate and moviriitoward enacting with
appropriate changes, he caune to that triM'the per^pSCtiwe of a governor; he
came from wrestling with budgets from a state where you always have to
balance the budget, a state where i f revenues don't match expenses you have
t:o cut across the board. He knew very well what the costs were that were
driving h i s budget, l i k e every other state budget, to the kinds of d i f f i c u l t
choices that a l l of us have seen faced.
He asked that we look at every possible alternative to t r y to
come up with a proposal that would help to •so-lve -tihe health care problems
that we have. He was committed to a very simple p r i n c i p l e : preserve what i s
right about our system and f i x what i s wrong. To achieve that goal, we
explored a number of different options and we looked at plans that work a l l
over the world and those that work right here at home that offer high-quality
health care to people at an affordable price. We looked at countries that
provide health care through a single-payer system or through a public/private
system. We looked at how much i t costs to do that. We looked at the kind of
experiments and models that we see from our own state of Hawaii to
California's pension retirement system, to Minnesota's large employers, to
Rochester, New York's system, and on do%m the l i s t of what worked i n many of
our own states.
We concluded that what was best for us to do and to present to
you was to take what works i n our system and to build on i t . And what works
for most Americans who are insured — 90 percent of Americans who are
privately insured are insured through the employment-based insurance system .
After lengthy review, we concluded that the best system for t h i s country i s
to build on the system we already have — the employer/employee partnership.
I t i s a imiquely American solution to an American problem. I t i s the least
disruptive option that we could consider because we have used t h i s system for
50 years or more and most Americans are fauniliar with i t .
Most Americans who are insured get t h e i r insurance through t h e i r
workplace. I t i s a partnership. Everyone — the employer and the employee —
share the burden of coverage. No one i s able to escape some responsibility;
everyone participates. I f we tadce the existing,system that we currently have
and add to i t those businesses that do not currently insure and those
employees who do not ciirrently contribute to any healt:h insurance, we w i l l
have gone a very long way toward solving our health care financing problems
without changing the way i t i s currently done for most people right now.
This i s the proposal that we have developed, with great
s e n s i t i v i t y toward the costs that i t would require for those businesses that
have never provided insurance and t h e i r employees. We know i t can work
because we have one state, Hawaii, where i t i s working, where i t has worked
for a number of years, and where the vmemployment rate has consistently been
below the national average.
In our attempt to structure an employer-eiqployee-based system
that would cover a l l of the employed, we have been p a r t i c u l a r l y sensitive to
the needs and requirements of small business. Small business today f a l l s into
11^
�t:wo categories, those who currently insure and those who do not. I f one looks
at the p r o f i l e s of the currently- insuring small business sector, i t i s , by
and large, the f a s t e s t - growing part of the small business community because
i t offers health insurance as a benefit that i t understands i s a competitive
advantage.
For those small businesses that do not currently insiire, we have
structured t h i s system so that they w i l l receive a discount. They w i l l be
able to enter a reformed insurance market i n which the kinds of
^discrimination against non-group and-'^siiia!tlr«groQp~±nBnrBd businesses w i l l be
eliminated. They w i l l be able to enter an insurance market i n which
preexisting conditions w i l l be eliminated. And they w i l l be able to pool
their premium d o l l a r s with those of many, many other small and mediiun and
large businesses as well as individuals i n order to obtain the best possible
price for insurance.
In addition, small businesses of 50 or fewer employees and with
low-wage workers w i l l not only be protected with a discount i n a reformed
insurance market but w i l l have the amount of money they have to pay for a
premium capped. We have also been very sensitive to the costs i n the Workers'
Compensation and health parts of many businesses' expenses, and we intend to
integrate those costs into the system.
For these and many other reasons we could discuss, we believe
that t h i s i s not only the f a i r e s t but the most feasible way to move toward
universal coverage.
Obtaining universal coverage i s , we believe, a condition for
being able to contain costs i n the entire system. They go hand i n hand.
We also think that extending the employer-based system to a l l
employers and employees removes the subsidization that has existed between
some employers now who have not only paid the premiums to insure t h e i r own
employees, but because t h e i r neighbors down the street or t h e i r competitors
in the business have not, they have i n d i r e c t l y subsidized many other
businesses as w e l l .
The issue of how we best finance health care reform, and
particularly achieve, universal coverage i s one that I know w i l l be
vigorously discussed i n the next months. We concluded that amongst the
alternatives that are available, which include either a very large tax that
would replace private sector investment or an individual mandate which would
put the entire r e s p o n s i b i l i t y on the individual and, we are concerned,
disrupt employment patterns now, p a r t i c u l a r l y those that provide insurance,
that therefore the best way i s to take what we know what Americans are
familiar with and make i t better, make i t f a i r e r , and make everyone within i t
responsible. U n t i l every American has health security, no American i s f u l l y
secure, and neltiher i s our nation.
No solution w i l l be perfect. But i f we can agree on reforms that
are f a i r , compassionate, workable, p r a c t i c a l , then we believe we can a l l
reach the destination that the president described i n h i s speech l a s t week.
With your help and your continuing counsel that you have been so w i l l i n g to
provide up u n t i l now, I am very confident that we w i l l achieve t h i s goal and
that a l l of us w i l l be able to look into the faces of those Americans whom we
see every day and know everyone we see i s f i n a l l y secure i n the health care
they deserve to have.
Thank you, Mr. Chairman.
f
•
REP. FORD: Thank you. And I'm going to — we've c a l l e d the floor
to ask them to hold up the vote. To members who would l i k e to leave and vote
and come back as quickly as possible, we'll s t a r t with the questions while
�you're gone. You have two minutes and 30 seconds. (Recess.)
REP. FORD: (Sounds gavel.) Mrs. Clinton, while we s t i l l have
members coming back, we do have members here who would be prepared to go
aihead, and we can maximize our opportunity with you i f we do proceed at t h i s
time. I'd l i k e to recognize Chairman B i l l Clay.
REP. WILLIAM L. CLAY (D-MO): Thank you, Mr. Chairman.
And thank you, Mrs. Clinton, for coming over. Let me say that I
hope you'll accept my invitation-as'Chalnutn of tihu'mist Office and c i v i l
SService Committee to v i s i t with us next week and explain the proposal of the
9-1/2 million federal and i>ostal ei^loyees.
During the l a s t decade or so, millions of organized workers
negotiated generous health care benefits from their employers i n l i e u of wage
increases. And many of these companies have reluctantly granted these
l>enefits. As I read i t , the standard benefits package proposed by the
president i s not as generous as some of these negotiated health benefit
packages. So, my question i s — are two-questtons. Will these workers now
suffer a reduction i n health benefits after having given up wage increases to
get them? And, secondly, what does the president's proposal do to ensure that
these hard-fought-for gains are not taken away?
MRS. CLINTON: Congressman, the answer to the f i r s t i s that there
ishould be no discrimination against those plans that already e x i s t that
provide greater benefits for a considerable peij-lod of time. The comprehensive
Isenefits package that w i l l be guaranteed i s a good one, but there are some
liealth plans, not j u s t those that have been negotiated, but have been offered
hy employers, that do have benefits that are i n excess of what w i l l be
(guaranteed.
Those w i l l be grandfathered i n for a number of years. They w i l l
continue to be available by either negotiated agreement or employer offering.
Because we share your concern that while wages have remained f l a t for much of
the l a s t 15 to 18 years, compensation has increased, where i t has increased,
and that i s not universal, by putting benefits into the entire compensation
package. So, we do want to permit negotiated agreements and employer
agreements to be able to continue.
Now, a t a certain point, and we anticipate i t w i l l tadce about 10
years to get to t h i s point, we believe that the guaranteed benefits package
w i l l have been improved with some additional benefits that we w i l l propose to
be added i n a phased-in way over the next 10 years. At that point, then
employers s t i l l may continue to provide additional benefits, and they can be
bargained for, but benefits over the guaranteed package w i l l no longer be tax
preferred, but that w i l l not happen for at least 10 years.
REP. CLAY: Thank you.
REP. FORD: Mr. P e t r i .
REP. TOM PETRI (R-WI): Thank you very much, Mr. Chairman.
Thank you for appearing before our committee. As I understand the
president's proposal, when choosing a healt:h plan^ the employee reaps a l l the
benefits a t the margin of being price sensitive as to premium costs since the
employer's contribution i s a fixed dollar aunount; that i s to say, 80 percent
of the premium of the average cost plan.
But i n terms of cost sharing under fee-for-service plans, the
president's plan does not allow for anything similar to that. The employer
pays a f l a t 20 percent of the fee, so that a t the margin, he or she has only
a 20 percent incentive to be price sensitive. So I'd l i k e to know how you
would react to allowing fee-for-service plans to use more innovative
�cost-sharing strategies.
For exaunple, a fee-for-service plan might pay a f l a t 80 percent
of the average price of a medical service in a particular market, or the plan
might pay a l l of the f i r s t 60 percent of the average price plus half of any
remainder up to 100 percent of the average price prevailing in the market. In
that case, i f the average price for the service were $100 and the consumer
obtained the service for that amount, he or she would s t i l l pay $20, or 20
percent out of pocket and get $80 from the health plan. But i f you went to a
lower-priced provider, he'd s p l i t the savings'TO^StXwith the plan, and i f you
went to a higher-priced provider, he'd pay a l l of the extra cost above $100
himself. This kind of cost-sharing structure gives the consumer a stronger
incentive to be price sensitive.
Would you consider something along these lines to help control
rising health care costs?
MRS. CLINTON: We w i l l certainly look at that proposal.
Congressman. We believe that putting the decision-madcing into the hands of
^the consvuners — especially because i t ' s not--^t»t the 20 percent premium cost
that w i l l make them price conscious, i t i s the differential in co-pays and
deductibles within the various plans that w i l l also madce them price conscious
— that w i l l really help move this marketplace to become a market, which i t
w
is not now. But we would be happy to look at your proposal and to report back
to you how we would analyze that, and I ' l l be glad to get that done for you.
REP. PETRI: Thank you. I have (12 ?) other questions I ' l l submit.
I don't know i f you or your staff would have a chance to address them or not.
MRS. CLINTON: We w i l l . We w i l l absolutely address them.
Congressman, any questions that you have.
/
JgEP P^RI: Thank you.
\L/
REP. FORD: MrTMurphy?
REP. AUSTIN J . MURPHY (D-PA): Thank you, Mr. Chairman. Mrs.
Clinton, thank you for donating so much of your time arul devoting so much of
your time and talent to a major concern of a l l of our peoples.
In southwestern Permsylvania, we're served with small businesses,
hospitals with under-200-bed capacity, faunily physicians, elderly, and
workers who are employed in agriculture, small business and small industry.
Both the providers and the patients continue to t e l l me that
a major problem with the current system i s that i t caters to big business,
big hospitals, big medical groups, and big insurers. And I'd like to know, in
the proposal that the president and you ha^ve been crafting, what specifics do
you recommend to alleviate these concerns for what we consider i s smaller
towns or smaller areas, less-populated areas in our country?
MRS. CLINTON: Congressman Murphy, the providers and patients in
your d i s t r i c t are right t:hat much of the health care system i s driven by big
institutions, and that smaller and medium-sized, whether they be businesses
or hospitals or groups of doctors, are becoming less and less able to have
any control over their own destinies when i t comes to health care. We have a
n\imber of features that we think w i l l help reverse that situation in
southwest Permsylvania as well as other places in the covmtry.
F i r s t of a l l , by pooling the purchasing power that w i l l come from
putting small and medium-sized businesses and Individuals and self- employed
and farmers into the saune purchasing pool, what we c a l l the alliance, they
w i l l for the f i r s t time be able to drive dotm the rate that insurance costs
them, just the way some big businesses can drive
a good bargain with insurers now. That has not been available to the rest of
us, and we w i l l be able to enjoy that.
r
�r loenefit
Secondly, by insurance market reforms, which p a r t i c u l a r l y w i l l
the non-group and the small-group insured, we w i l l see big savings
iDecause we w i l l see the administrative costs that are now associated with
^providing insurance decrease because there w i l l not be any need for them.
Right now insurers, as you know, madce t h e i r money by drawing l i n e s between
people, trying to get the best possible deal. That w i l l no longer be
permitted.
Thirdly, with the idea of networks of care, of integrated service
delivery networks, there w i l l be opportunities for^Bvall hospitals and for
groups of doctors i n r u r a l areas to j o i n together and to be linked with not
only themselves and neighboring to%ms but perhaps going as far as Pittsburgh
to be part of some integrated delivery network, where they are a l l part of
delivering the care, they stay right i n their ovn hometown, but they get the
advantages that come from being part of a bigger system even though they stay
right where t:hey are.
And I think f i n a l l y i t i s very d i f f i c u l t i n many r u r a l areas of
our country to s t a b i l i z e any kind of-lieaith-cacrensystem, because i n r u r a l
areas you have a higher proportion than usual of uninsured people. By madcing
sure everybody i s insured, by giving 100 percent tax deductibility to the
self-employed, to the farmer, to the small business that i s a family
enterprise, you w i l l be creating an insured pool that you don't have right
now in southwest Permsylvania. And because everybody w i l l be i n the system
you w i l l be able to support more providers than you can now.
And I guess f i n a l l y I would j u s t say we have some incentives to
get more providers into r u r a l areas: to forgive the loans of medical
students, to have more technological developments that w i l l link r u r a l
providers with those in small c i t i e s and large c i t i e s . And I know something
that's p a r t i c u l a r l y important to you because of your wife's profession, we
think nurses ought to be better u t i l i z e d i n both r u r a l and urban areas
because they can provide care at many levels of primary care need i n a very
cost effective, high quality way.
So those are some of the things that we tJiink w i l l enhance care
in your p a r t i c u l a r d i s t r i c t .
REP. MURPHY: Thank you.
Thank you, Mr. Chairman.
REP. FORD: Mr. Kildee.
REP. DALE E. KILDEE (D-MI): Thank you, Mr. Chairman.
Mrs. Clinton, as you know, in'my congressional d i s t r i c t of F l i n t ,
Michigan and Pont lac, Michigan, the largest pvurchaser of health insvurance for
both active and r e t i r e e s i s the automotive industry. The three CEOs were at
the White House t h i s morning with your husband. I happened to be with them
there. And under that system currently a l l of the premium i s paid by the
employer. W i l l there be any taxation of the premium when i t i s f u l l y covered
by the employer?
MRS. CLINTON: No. We have decided, congressman, that although we
would set a proportion for an 80-20 contribution that i f an employer chose to
pay 90 or 100 percent that that would be permissible. I t ' s only, as i n answer
to the previous (question, when the benefits exceed the guaranteed benefits
package at the end of the t o t a l phase-in period — i n about ten years — then
the provision of benefits over the guaranteed package w i l l be taxable. But up
u n t i l that point, no. And i n terms of the mix of the employer-employee
contrIbution, no.
REP. KILDEE: So the benefits over a certain l e v e l after ten years
�would be taxable, but the difference between 80 percent and 100 percent would
not be subject to taxation.
MRS. CLINTON: That's right. We believe that that i s s t i l l open to
negotiation between the parties, i f that's what they choose to do.
REP. KILDEE: A l l right. Thank you very much, Mrs. Clinton.
REP. FORD: Ms. Roukema.
REP. MARGE ROUKEMA (R-NJ): Thank you, Mr. Chairman.
And Mrs. Clinton, I aun deeply sorry that I was not able to be
here at the beginning of your speechr««™^-your- sta1:»«wnt7-And I deeply regret
that I missed my one minute of fame. (Laughter.)
I have a l o t of questions s p e c i f i c a l l y r e l a t i n g to the question
of corporate a l l i a n c e s and our d i r e c t j u r i s d i c t i o n . But i f you w i l l forgive
me and i f the chairman w i l l forgive me, I think there w i l l be many other
opportunities for us to go into the corporate a l l i a n c e questions as i t
relates to ERISA j u r i s d i c t i o n and in more d e t a i l than
I think we want to go into tcxiay. But I do have, because of my concern about
the quality of care, what I think are~m-isund«rstramdings'of how those cost
escalations have gone up.
I wanted to give you two case studies that were recently given to
me by a cardiac surgeon at the University of Medicine i n New Jersey i n the
Newark location. And give me your insights and perspectives on that based on
your study.
The cardiac surgeon indicated — and t h i s i s not a question about
immigrant care, i t ' s a question about uninsured care. Medicaid, okay? An
immigrant came i n from a Third World country for surgery on a tumor. During
the examination the doctors found that there was a pronounced heart murmur.
In addition, there was an infection to the heart. She was kept in the
hospital for several weeks to c l e a r up the infection. Her heart valve proved
to be defective and i t was replaced, which i s major cardiac surgery. She i s
s t i l l awaiting her operation for the tumor. This has gone on for many months,
and she has received excellent care, the cost of which i s uncompensated care
to the hospital that exceeds $500,000 and may reach a million before she
finishes getting the excellent care that she's e n t i t l e d .
This has gone on for many months, and she has received excellent
care, the cost of which i s uncompensated care to the hospital that exceeds
$500,000 and may reach a million before she finishes getting the excellent
care that she's e n t i t l e d .
In contrast, the surgeon has a friend who happens to be h i s
barber. And the barber has insured h i s family for approximately $4,000 and
was told by the insurance company that, i f he paid another $2,0000, there'd
be no problem with h i s — with any preexisting condition he might have.
Needless to say, that proved not be true. His insurance was cancelled. He's a
hard-working man who has always t r i e d to take care of h i s family. And now he
cannot afford the open- heart surgery that he needs.
Could you give me your perspective on that and how t h i s prograun
w i l l address those problems?
MRS. CLINTON: Those are two very good s t o r i e s to i l l u s t r a t e
exactly what's wrong, and they are —
REP. ROUKEMA: (Off mike) — New York and New Jersey today.
MRS. CLINTON: And they could be repeated, as you know so well,
Congresswoman, a l l over t h i s country, in every c i t y i n New Jersey and every
other c i t y represented here.
Well, l e t ' s s t a r t with the uncompensated care, the woman who i s
in the hospital and who i s being taken care of. She i s receiving the care she
�should, but i t i s being paid for by a l l the rest of us. I t i s being paid for
by raising ovu: taxes at the state and local and federal levels. And i t i s
Iseing paid for by Increasing the cost of insurance. Now, you could not draw,
iperhaps, a direct line between the uncompensated care being given the woman
and the extra $2,000 being requested from the barber, but there i s an
indirect line there. The reason health insurance premiums have gone up, and
particularly gone up for small business and for family-o%med businesses and
:for the self-insured, i s because we have so much cost-shifting going on in
ithe system. And that cost-shifting IsrrthW'paid^^flHr'rDn the backs of people
who are Insured, who continue to be asked for more and more money.
What we would propose i s that, i f this woman in your f i r s t
:Lnstance has ever worked at a l l or has any faunily member who has ever worked
at a l l or i f she i s on EMedicaidF and has worked or has a family member who
has worked, now for the f i r s t time they and their employers w i l l be making
some minor contribution. I t might be with a small business as l i t t l e as $350
a year, but i t w i l l , when aggregated vith many others like her, help to pay
for the costs of hospital care 1 ike "you- have-tleser-ibediWith respect to your barber, that w i l l not happen. No preexisting
conditions w i l l be permitted. Insurance companies w i l l not be allowed to draw
those kinds of distinctions and eliminate some people from care by madcing i t
cost more than they can afford or having fine print in an insurance policy so
that, when you need treatment, a l l of a sudden you find i t i s not covered.
This barber and the heart surgery that he needed w i l l be covered. And based
on the comprehensive benefits package that we think should be available to
every American, the $4,000 that he i s paying now i s about what i t should
cost. I t should not cost more than that, you know, give or tadce a few hundred
dollars depending upon where you live.
^
And so, in both of those instances, we think this plan w i l l help
address the problems that are presented to the hospital, to society, and to
that individual family.
;
REP. ROUKEMA: Thank you. I think you'v((^ covered the bases there,
with only caveat which I would like to advance to you, and you've heard me
say this before. I want a l l of those things to happen that you've just
outlined, but I don't want the cost of i t to be charged to my constituents
who cvurrently are enjoying good care from good employers who have been good
citizens. I don't want them to have subtracted from their care eitr quality
of care or extension of care or cost of care.
MRS. CLINTON: And you have made that point so well in a l l of our
meetings, and I must say that the two issues that are involved in that — the
one that you raised with me several times about taxing benefits that are
already in existence —
REP. ROUKEMA: Yes. Correct.
'' '
MRS. CLINTON: — I know that there are members of this house, and
particularly Republican members, who believe strongly that taxing benefits in
order to force lower-cost plans i s the appropriate way to go. I agree with
you, Congresswoman. That would be a direct tax on more than 35 million
Americans who have paid either in lost wages or in their own out-of-pocket
costs for those health benefits. And I just don't think at this point we
could turn around and tell:35 million Americans like the ones in your
district we're going to madce these reforms, but you are going to be worse off
after we do i t . What we've tried to structure i s so that well-insured w i l l
pay the same or less than what they pay now for their benefits. And we think
that w i l l be true for about 63 to 65 percent of Americans. Another 20 percent
or so w i l l pay some more, but they w i l l get more benefits. These are people
�J
who have only a catastrophic policy or only a major medical. The benefits
w i l l get w i l l be better for them because they w i l l be more comprehensive and
they w i l l be cheaper over time because they w i l l have locked-in benefits at
an affordable price.
Now, there w i l l be some people — about, we think, 12 percent or
so — who are going to pay more, but they are predominately young, single
people who have gotten the best rates from insurance companies because
insurance companies love to insure them because they're not old and crotchety
and nearly sick or f i l l e d with achesrTmd'TJalWB"TtkBFthe" r e s t of us as we age.
And I said yesterday, you know, we have a l o t of young people around the
IShite House who are i n t h e i r twenties, and several of them have come up and
said, **You know, I mean, I'm never going to get s i c k . " And I say, **Well,
that's fine; then i f we could figure out a way for you to sign a release
that, i f you ever have an automobile accident and you're lying on the side of
the road, we a l l drive by you because you're not insured, then you don't have
to be insured. But that's not the way l i f e works. Believe i t or not, some day
you, too, w i l l be old and you may also be sickv-"
So for that group of our society, they w i l l pay a l i t t l e b i t more
for their benefits, but as they get older, they w i l l pay l e s s because they
w i l l have gotten insured i n a system where everybody i s covered.
REP. ROUKEMA: Thank you.
Thank you. That's a very comprehensive^response.
REP. FORD: Mr. Williams.
REP. PAT WILLIAMS (D-MT): Thank you. '
Mrs. Clinton, you w i l l r e c a l l from our t r i p to Montana a few
months ago — the f i r s t lady, Mr. Chairman, caune to Montana, spoke with a
couple of thousand Montanans. You'll remember, I think, Mrs. Clinton, that
among the people you talked to were several who worried about what would
happen i n the next several years, perhaps out as f a r as ten years i f nothing
i s done. That i s , what w i l l happen to t h e i r premiums, claims denials, reduced
benefits, costs? We haven't heard much yet i n t h i s debate about the cost of
continuing down the saune path. Would you address that?
MRS. CLINTON: You're right. I had a great time i n Montana —
(laughs) — congressman. That was —
REP. WILLIANS: We enjoyed having you.
MRS. CLINTON: And you're right, because,I think that every time
we t a l k about t:he future and what t h i s reform should be, we ought to remember
the system we have right now.
^
You know, some people have said to me, ^^You know, t h i s reform
sounds complicated," and I have said ^^Well, tadce a few minutes and s i t down
and t r y to explain to somebody the system we have right now." I mean, a l l of
you should t r y to do that. I have t r i e d to do that, and i f you want to get
complicated, t r y to explain what we now have i n thia country: who's in, who's
out, under what conditions, based on what you pay, whether you've ever been
sick. You know, i t j u s t i s unbelievable.
But what i s absolutely clear i s that the average American family
now pays something over $7,00 for t h e i r health care. That's premiums and out
of pocket expenses. Without any change i n the system, without insuring one
more of the 37 million uninsured, the average American family w i l l pay more
Ithan $12,000 by the year 2000. And we'll have seen a reduction i n wages of
about $650. You w i l l also continue to see very f l a t wage levels i n t h i s
country as more and more money i s poured into benefits i n a way to t r y to
keep workers and keep productivity and keep some kind of competitive
�advantage. You w i l l also see the continuing hemorrhaging of the budgets at
the federal, state, and l o c a l l e v e l .
So I don't think anyone who looks at t h i s system as i t currently
i s operating can have much confidence that i t can continue to function very
well for most people into the future.
And I would add yet another issue that I think i s important. Some
people i n talking about reform have said ^^Well, how w i l l you be able to
maintain quality, get everybody i n , and not have to madce some hard decisions
about who gets care and who doesn't g«t"c«r*?:"''lVBr5rrday i n t h i s country
people are denied care. They are denied the kind of care they need because of
i n a b i l i t y to pay for i t or access to i t .
Some of you may have seen over the weekend a very moving a r t i c l e
by
a pediatrician i n Boston who wrote about what i t ' s l i k e to have faunilles
coming i n , and when they are told *^Here i s what you need for the medication
for your c h i l d , " or ^^Here's what we'd l i k e to do to X- r a y , " they say they
can't afford i t , t h e y ' l l j u s t take their-chancBBT-We have a-lot of that going
on right now.
In the current situation i f i t doesn't change, we w i l l have even
more of i t , and we w i l l t r u l y have a two-class health care system: for those
of us able to afford i t and access i t , and then whatever i s l e f t for
everybody e l s e . And I always am of the philosophy that, you know, there but
for the grace of God go I .
None of us knows what w i l l happen to any of us, or any faunily
member whom we love, i n the next 10 years. And we j u s t need to be sure that
we have a health care system we would l i k e to be able to use and that we
would want our family members to be able to use and to be able to afford to
iise.
, 1
REP. WILLIAMS: Thank you.
,
j
REP. FORD: Thank you.
i ,i
Mr. Goodling?
REP. WILLIAM GOODLING (R-PA): Thank you, Mr. Chairman. I have
several questions that I w i l l submit that they asked me back i n the d i s t r i c t .
This i s a more fonial question that I ' l l ask, so I ' l l refer to my
notes, and i t deals with how the subsidies to the a l l i a n c e s w i l l be
allocated. I t ' s my understanding that i n the regional a l l i a n c e s there w i l l be
b i l l i o n s of d o l l a r s provided to subsidize the unemployed, the early retirees,
the premiums that are capped between 3.5 and 7.9 for smaller and large
employers. And my question i s , f i r s t , to what extent w i l l these subsidies be
funded from existing programs — Medicare, Medicaid — whatever the federal
government may have, spending reductions, cigarette tax and so forth.
And secondly, what kind of formula w i l l the national health board
use to allocate the subsidies to the regional alliances? And i f i t i s n ' t
enough money that they allocate, how i s i t paid for?
MRS. CLINTON: Congressman, I would love to supplement what I say
in writing because that's an extremely complicated and important question.
But l e t me j u s t t r y b r i e f l y to answer your concerns.
The money for the subsidy w i l l come from several sources. I t w i l l
come from the pooling of the federal resources that are cur^rently being used
to help support our existing system that we w i l l no longer need to put to
those uses. Let me give you one example.
You a l l know about,disproportionate share. Those are the payments
that go to states and l o c a l goverrunents to support institutions that have a
very high rate of uncompensated care — to get back to the question about the
�woman i n the hospital. There w i l l be a dramatic decrease in uncompensated
care once everybody i s tadcing responsibility and everybody i s making a
contribution. That source of funds w i l l be available.
In addition, there w i l l be a tobacco tax that has been talked
about that w i l l r a i s e money for the next several years at the rate of between
75 cents and a dollar, and tihat, too, w i l l be available for the federal
subsidies. There are other kinds of sources of federal funds that w i l l become
available as savings are realized. And I w i l l give you one example of that.
You heard Congressman Kildee mention' thv'^uto^companies. Our auto
companies are currently paying very high rates of insurance for their insured
employees. In a system where everybody i s in and the r i s k i s shared across
the entire community, the aunount of money that that industry w i l l pay w i l l be
(decreased. As i t comes down, there w i l l no longer be money put into tax-free
laenefits l i k e health care, but we hope i t w i l l go into wages, new
investments, p r o f i t s , those kinds of investments and other expenditures that
are taxable. That w i l l increase the amount of money coming into the treasury.
i!md we have costed t h i s out with the Treasury-Department, and that i s another
source of the federal funds that w i l l be available to support the system.
But I ' l l be happy to submit a very detailed l i s t of how a l l of
that works. But the money that we w i l l spend for the unemployed and for the
r e t i r e e s have a l l been costed out on an annual basis, and there are funding
basis, and there are funding sources identified that w i l l support each of
those.
REP. GOODLING: Thank you very much, Mr. Chairman.
REP. FORD: We do note that we haye some slippage i n time, and i n
order to provide the courtesy that each of our members deserve i n asking a
question, I want to again remind the members that we do have
a time l i m i t . We also want to comply with the f i r s t lady's time constraints
here.
We now recognize Mr. Owens.
REP. MAJOR OWENS (D-NY): Like most of my colleagues, Mrs.
Clinton,
t
I applaud the package that — the basics of the package that you have
presented. The administration has done a very, good job. I do worry, however,
about the complexities of administering certain parts of i t . And I'm a
cosponsor of the single-payer option, H.R. 1200. And I wonder, you do say in
your plan that states would have that option of
a single-payer plan. Under what conditions would you allow states to play out
that single-payer option under your plan? Would federal agencies be
instructed to do everything possible to fa^cilitate the successful
establishment of a single-payer plan i n the state, or would i t be seen as a
competing idea that the bureaucracy might be h o s t i l e to? Have you thought
that through, and can you elaborate, please?
MRS. CLINTON: Well, I hope not because we want to give a l o t of
state f l e x i b i l i t y . Congressman, to states. And the single-payer option would
have to be adopted i n a state by l e g i s l a t i v e enactment, and so long as the
state guaranteed the benefits package every American i s entitled to and were
able to demonstrate that i t could reach universal coverage and that i t could
competently carry out the provision of health care, we don't think there
should be any obstacles.
This i s something that we have been requested to provide by
states that are p a r t i c u l a r l y concerned about t h e i r s i z e . In fact. Congressman
Williams' state i s one of the f i r s t that asked me to be sure that t h i s were
an option, not that they're going to do i t , but that i t would be an option
�that they could a t least consider because Montana has, what, 880,000 people,
I guess, right? And a very huge land mass. And so, they were concerned about
how to promote competition and a market i n some parts of that state where
there were no people except very sparsely populated. So, we think t h i s i s
something that states should have the right to consider, and we certainly
intend to madce i t as hospitable an envirorunent for them to consider i t as
possible.
REP. OWENS: There are a l o t of people i n the large state of New
York who think i t ' s a good idea, too. rrMf^iiiwis^- «jWiiHwi»l»if™ T
REP. FORD: Mr. Sa%ryer.
REP. TOM SAWYER (D-OH): Thank you, Mr. Chairman.
Mrs. Clinton, my thanks are the saune as those of my colleagues.
One of tJie j u r i s d i c t i o n s that t h i s committee enjoys i s the whole
question and definition of who i s an employer and who i s an employee. And one
of the other cross-currents that we're concerned wit:h, of course, i s higher
education. We know you've tadcen care of dealing with independent students,
full-time students up to the age -of-^^-r-be-l-±eve-; But iifith-the changing
demographics of the American campus, with the enormous gray areas i n
different kinds of employment, I include full-time independent students
beyond that age, stipend- supported teaching assistants, work-study program
participants and even National Service Prograun employees, do we have a clear
definition of, i n circumstances l i k e that, who i s the employer and who i s the
employee and how people i n these kinds of circumstances are covered under the
health care prograun? MRS. CLINTON: Well, Congressman, I hope we do, but l e t ' s
take a look a t i t to make sure, because you r a i s e some categories of people.
And I would assume that you would trace the source of payment and consider
that the employer, but there are some issues that I see imbedded i n your
question that we need to be very conscious of. So, i f we could, l e t us look
at those categories and make sure that my understanding of how i t would be
done i s accurate and get you back something i n writing for your
consideration.
REP. SAWYER: Thank you.
REP. FORD: Mr. Gunderson.
REP. STEVE GUNDERSON (R-WI): Thank ybu, Mr. Chairman.
Mrs. Clinton, I think I've figiired out a way to extend two
minutes into a long Q&A period.
As you know, we i n t h i s committee have j u r i s d i c t i o n over the
Department of Labor. And i n the absence of the actual l e g i s l a t i v e vehicle,
there seems to be a lack of d e t a i l on the role of the Department of Labor i n
implementing and policing the health care a l l i a n c e s . I f I understand
correctly from what I've read, they w i l l have a role to regulate the —
define and regulate the operating standards of a health care a l l i a n c e , the
f i n a n c i a l operations. They w i l l be responsible for setting up a guaranteed
insurance fimd and the l i k e .
I f you could explain to us both what the role of the Department
of Labor w i l l be i n regulating t h i s health care delivery system and contrast
that with HCFA or HHS i n particular so we understand what our j u r i s d i c t i o n a l
responsibility i s and i s not, that would be helpful. And i f a t some point i n
time, you would send to t h i s committee some indication of what you see as the
potential cost and creation of a regulatory system i n DOL from a budget
perspective, that would be helpful.
MRS. CLINTON: Well, Congressman, we hope that t h i s d i v i s i o n of
r e s p o n s i b i l i t i e s w i l l be cost-effective because we're trying to build on what
the Department of Labor has h i s t o r i c a l l y done. And l e t me j u s t run through
�the l i s t of r e s p o n s i b i l i t i e s that we have assigned to the Department of
Labor.
The f i r s t would be to ensure that a l l employers f u l f i l l e d the
obligation to provide health coverage through a qualified health plan. I n
other words, madcing sure that employers are doing what they're supposed to do
under an employer-based system. The only comparison we have i s the state of
Hawaii, which has, as you know, an employer-based system, and the Department
of Labor there administers t h i s compliance function with two people. I mean,
i t should not be, we don't believe, urtl«S«''iltr jU8t"gBttS' caught i n the
Washington bureaucracy monster, i t should not be a major responsibility, but
one that they w i l l have oversight over.
In addition, there w i l l be large employers who w i l l want to form
corporate a l l i a n c e s , t h e i r own self-insured a l l i a n c e s .
Just as with ERISA now, they w i l l be submitting t h e i r plans to
the secretary of labor, and the secretary of labor w i l l review those plans.
There w i l l be a determination i n the event of a merger or acquisition or
bankruptcy as to how the health obli«rattlons-wouid- continue i n a self-insured
corporate a l l i a n c e that w i l l also be part of the secretary's responsibility
in the event that those conditions were to pass.
I f a corporate a l l i a n c e does not have the fiduciary capacity to
sustain i t s e l f , then that would be brought to the attention of the secretary
of labor, again pretty much p a r a l l e l i n g the kind of ERISA r e s p o n s i b i l i t i e s
that are currently delegated to the secretary of labor. And then there are
s p e c i f i c duties under that, which we w i l l enumerate for you, which w i l l be i n
the l e g i s l a t i o n , but I ' l l be glad to have a l e t t e r sent up to you i n order to
demonstrate the p a r t i c u l a r s under those two big areas of the
employer-employee relationship and the corporate a l l i a n c e that we think the
secretary should carry out, and we'll do our best to give you our estimate
about any additional costs that might be involved i n that. We've asked the
department to be costing that out for us.
REP. GUNDERSON: I n the interest of my colleagues, i f you would
also follow up — I'm unclear as to what the regulatory authority of DOL i s
regarding the operations oif a health a l l i a n c e versus what would be the
t r a d i t i o n a l , should we say, state or local regulation of that health
a l l i a n c e . I've gotten mixed signals i n those discussions and would l i k e to
understand that much better.
MRS. CLINTON: Just i n general, the DOL obligation runs primarily
to the corporate a l l i a n c e , so the general health a l l i a n c e which everyone else
i s using to purchase t h e i r insurance through w i l l not have DOL involvement.
REP. FORD: Mr. Payne?
REP. DONALD PAYNE (D-NJ): Thank you very much.
Madam F i r s t Lady, l e t me also congratulate you on your commitment
and the knowledge that you have shown i n t h i s very complicated task. Your
efforts to the covmtry are certainly appreciated.
Let me ask t h i s question. After some research on the subject, I
have found that managed competition r e s t s on the concept of competing quality
and service among health care providers, where they would compete for
business based on the quality of care provided to patients. The concept
operates under the assumption that there are many providers from which to
choose. I r e a l i z e that your proposal r e s t s on the concept of competing plans;
however, medically- underserved areas such as urban areas l i k e Newark, where
I l i v e , do not have large numbers of physicians from which to choose. What
incentives, then, w i l l be extended to physicians to serve i n
medically-imderserved settings l i k e an urban area of Newark?
�MRS. CLINTON: We intend. Congressman, to have incentives for both
underserved urban and underserved r u r a l areas because we agree with you that
in the absence of providers, there cannot be any competition i n order for the
consumer to have choice and to get a better deal i n the health insurance that
he or she buys.
So we have looked at several things that ve need to be doing. We
need to have a concerted effort in providing motivation and incentives for
people to go into underserved areas, and so to that end we tend to kind of
resurrect and fund the National Healtir~S«i*vlce"CorpBV which provides young
physicians the opportvmity to pay back t h e i r loans or to have loan
forgiveness i f they are w i l l i n g to spend time i n c i t i e s such as Newark or
others that are underserved.
Additionally, we want to provide linkage between the providers
who are already there, and the c l i n i c s , and the hospitals that are there by
labeling them what we c a l l essential providers, which means that we know that
they need to be t:here i n order for people to be aa>le to have access to health
care. And as an e s s e n t i a l provider, -there-would-iae*some funds targeted to
help support those i n s t i t u t i o n s i n those areas.
Additionally, i n underserved commimities now, one of the biggest
problems i s the number of uninsured workers. In Newark or i n any other urban
area, people have income, but they do not have access to health insurance,
which i s priced out of t h e i r market, or they work for employers who do not
help them by providing health insurance. Once everybody i s Insured and
everybody i s making a contribution, there w i l l be f i n a n c i a l incentives for
more providers to offer services i n underserved areas. Part of the reason
they are underserved now i s that that combination of Medicare and Medicaid,
coupled with uncompensated care for the iminsured, madces i t extremely
d i f f i c u l t for a l l but the most mission-driven providers l i k e religious
hospitals and other community health centers — for them to be able to
sustain t h e i r practice i n those areas.
So the combination of increasing the providers, providing
essential community provider support, and getting some reimbursement to go
into the system because everyone w i l l be insured, we think w i l l provide the
kind of service that the people i n your d i s t r i c t deserve to have.
REP. FORD: Mrs. Unsoeld.
REP. UNSOELD: Thank you, Mr. Chairman. Thank you for a l l the work
you've done, and thank you.particularly for changing the role model of our
future children's books because you certainly have done that, and my
grandchildren are going to appreciate i t .
I liked what you had to say about not wanting to discourage the
states, and I come from Washington State, where we have a l o t of s i m i l a r i t i e s
in the proposal. Three years ago — two years ago, we urged states to
improvise because we didn't think — we didn't know we were going to have you
around to help us do t h i s , and how do we not wipe out what they have done,
because I would hate to t e l l them that a l l of t h e i r endeavor and hard work
was j u s t wasted. For exaunple, overlapping in tax — cigarette t — tobacco
tax, the difference i n threshold of what the self-insurer employer would be
— 5,000 or 7,000, and there are other things l i k e that. How, p r a c t i c a l l y ,
can we handle that?
MRS. CLINTON: Well, I think that with those states l i k e yours and
your neighbor, with Congresswoman Mink's state of Hawaii, that have made so
many innovative reforms and moved forward without any national program — we
need to be very sensitive to that, and we need to look at those states and
make sure t:hat they do have r e a l f l e x i b i l i t y to continue doing what their
�legislators have voted for, and what on a bipartisan basis they have
supported.
Everything i n the plan the president has presented i s i n place
somewhere i n America, or has been passed i n legislation somewhere i n America.
We know there i s evidence t h i s w i l l work, and we get that from states and
local communities and individual providers who have made those kinds of
decisions. But we're going to have to look at i t on a kind of a case-by-case
basis, because we want to s t r i k e the right balance between having appropriate
f l e x i b i l i t y so that states can pursue'^art^theythinlr i s best for them and
having the federal framework so that a guaranteed right to health security i s
absolutely an American c i t i z e n s , whether he l i v e s i n Washington, or Arkansas,
or Florida. So you'll have to work with us and help us, and certainly I know
you w i l l represent the concerns of the state of Washington so that we strike
the right balance.
REP. UNSOELD: Because many of the states that have made progress
have come to t h i s committee for ARISA waivers, for exaunple, t h i s i s the
subcommittee and the committee. We hope- you wil-Sr madce-use of-us.
MRS. CLINTON: Yes, we w i l l .
REP. FORD: Mr. Armey.
REP. ARMEY: Thank you, Mr. Chairman. Mrs. Clinton, l e t me also
express my appreciation to you for the work you've done and your willingness
to come before t h i s committee today, and t e l l you what a joy i t i s to see you
here.
MRS. CLINTON: Thank you. REP. ARMEY: I listened to the chairman's
opening statement, and while I don't share the chairman's joy on our holding
hearings on a government-run health care system, I do share h i s intention to
make the debate, the l e g i s l a t i v e process as exciting as possible.
MRS. CLINTON: I'm sure you w i l l do that, Mr. Armey. (Laughs.)
REP. ARMEY: We'll do the best we can.
MRS. CLINTON: YOU and Dr. Kevorkian. (Laughter, applause.)
REP. ARMEY: I have been told about your charm and wit, and l e t me
say — (laughter) — the reports on your charm are overstated and the reports
on your wit are understated.
MRS. CLINTON: Thank you, thank you very much.
REP. ARMEY: (Laughing) — l e t me turn to the compassionate side
of my nature for a moment.
Let's imagine a t y p i c a l American faunily. The husband has an
i n t e r n i s t he l i k e s , the wife has her gynecologist with whom she i s confident
and comfortable, the children have a pediatrician they l i k e . I s there any
chance under your plan that t h i s faunily would have to go to doctors other
than the doctors they've known and r e l i e d on for years?
MRS. CLINTON: I hope not. I can't say that i n every instance, i n
every faunily that i t would not happen, but with the guarantees that we w i l l
build into t h i s system, that for example, every region, every community has
to have access to a fee-for-service network that every network that every
doctor can j o i n with the assurance that no provider of health care t:hrough
any of t:hese plans can any longer discriminate against doctors so that
doctors w i l l have the choice to be members of more than one plan.
We think i t w i l l be unlikely, but I cannot t e l l you that i t would
never happen.
But i n t h i s kind of plan that we're proposing, for most Americans
they w i l l have greater choice. And for those of us who are insured with
doctors whom we l i k e , we w i l l be able a t least, a t the very least, to choose
the fee-for-service network i n which a l l of our doctors participate, i f
�that's what our choice happens to be.
REP. ARMEY: Thank you.
MRS. CLINTON: Thank you.
REP. FORD: Ms. Mink.
REP. PATSY T. MINSK (D-HA): Thank you very much, Mr. Chairman.
I , too, want to add my words of commendation, Mrs. Clinton, for
your t o t a l grasp of t h i s very complicated issue. And I know that members of
Congress are going to deal| with not onlyr*td!iW4!bro«}?t<d!VBXies tihat you've raised,
but also the n i t t y - g r i t t y . And some of those are somewhat troubling, amd I
asked a couple of questions the other day having to do with the part-time.
I do have a nanny problem. How are you going to provide i n t h i s
plan for the part-time workers, assuming that i n i t i a l l y they f e e l they cam
madce t h e i r contribution and survive with the matching that the government
w i l l provide so that they could have the saune premium benefits that everybody
else i n America would enjoy? But somewhere along the line there might be some
d i f f i c u l t i e s that are unexpected dn-"-^^
^
a family such as a single mother with two or three children. What
mechanisms would be put i n place to protect such a person so that along the
way the concept of universality i s never lost and that t h i s individual riding
up and down the r o l l e r coaster of l i f e w i l l always have the comfort of
knowing that there w i l l be a health plan there available for her faunily,
notwithstanding her i n a b i l i t y to come up with her premium matches?
MRS. CLINTON: Well^ congresswoman, i n the kind of part-time work
category that you're describing, we know people go i n and out of work, they
work different numbers of hours, different weeks of the year. Sometimes they
don't work at a l l . And t h i s i s a p a r t i c u l a r l y important group of people to
try to cover because temporary, part-time work i s one of the fastest-growing
parts of our economy i n large measure because employers who even insure
prefer to get employees at a l e v e l below what the insurance requirement would
be so that they don't have to provide those benefits.
And i t causes a l o t of uninsured, uncompensated care for the
individuals and for society. I f an individual works at any time during the
year, there w i l l be a contribution which that individual and the employer
make that w i l l be minimal because they w i l l be largely low-wage employees,
and the discounts and the caps as to the contributions w i l l apply. I f that
person during the year no longer i s working, then they w i l l be subsidized out
of the federal government pool because we want to have a true safety net.
Right now the only safety net i s to f a l l into welfare. We are going to tadce
the Medicaid prograun and integrate i t into the health care prograun so that
there w i l l be a seaunless process by which people w i l l come i n and out of
employment, they w i l l not have to go into different programs, they w i l l
continue to be covered.
^
The insurance premium w i l l be paid i n the f i r s t instance by the
employer-employee contribution, the second instance by the federal government
madcing that contribution on behalf of the individual i f that individual i s
unemployed. So we think we have covered the entire work cycle as people go i n
and out of i t .
I f a person i s an independent contractor and therefore they w i l l
be responsible as a self-employed individual, they w i l l madce t h e i r small
contribution; the r e s t of t:he subsidy w i l l be provided by the federal
government. The portion that the individual has to pay w i l l be tax deductible
because i t i s going to be treated as though they were a small business. So we
think we've tadcen care of a l l the different kinds of employment situations
�and nobody w i l l lose t h e i r coverage at any point during the year. They w i l l
be continually covered.
REP. MINK: So i f an individual under those circumstances i s
unable to madce the matching premium, no matter how low i t i s , what w i l l be
the mechanism for collecting those unpaid premiums that that individual or
family should have paid i f they could have?
MRS. CLINTON: Well, there w i l l be a collection mechanism so that
when they s t a r t to work again, they w i l l make those contributions, so that i t
w i l l be collected eventually, but th»'^carB"''«lirTtI0trbe"denied and the
coverage w i l l not be denied i n the meantime.
REP. MINK: I appreciate very much the reference to Hawaii because
I do f e e l we have a premium plan i n Hawaii, but one of our most d i f f i c u l t
areas has been how to cover t h i s part-time segment of our society, so we
continue to have a 3, 4, 5 percent. Although we have t r i e d to be
comprehensive, t h i s area has been elusive. And so I think that i n looking at
our plan, we have to find some way to madce sure that these individuals are
covered. We have a gap program now to t r y to-xrover-these individuals in
Hawaii, but we're not offering them the same program that everybody else has.
Now, i n trying to accommodate coverage for a state l i k e Hawaii
into t h i s comprehensive plan, are we going to be allowed under t h i s plan to
retain these provisions that we've worked out over the l a s t 17 or 18 years?
Because we're not i n t h i s 80-20 percent. We have a cap on the
amount of money than an employee can be required to pay, and that cap i s very
low. I t ' s 1-1/2 percent of the payroll. Ahd as a consequence, i f we move into
the requirement as one of the bases of a waiver, then for a large percentage
of our population, t h e i r contributions w i l l have to increase.
So i t i s a concern that people are r a i s i n g and hoping that there
w i l l be a mechanism for Hawaii to opt out and s t i l l havthe basic requirements
adhered to so that universality can be accomplished.
.
MRS. CLINTON: And we w i l l be sensitive to that.
V
^ P . MINK;„ Thank you.
•
"SEP. FOSD: Let me remind the members that v^'Ye Ihinning verjT
tight on being able to accommodate everybody here. And I don't want to be
impolite to anyone, but I'm going to s t a r t banging t h i s thing when the light
turns to red after t h i s .
Mr. Andrews?
i
i
REP. ROBERT ANDREWS (D-NJ): Thank you very much, Mr. Chairman.
Mrs. Clinton, thank you for the effort you put forward on t h i s
and for coming to t h i s committee so many times. We appreciate i t .
I had a woman i n my office yesterday who l o s t her job as a bank
t e l l e r in 1992. She i s unemployed. Her husband works for a small business
that does not offer health insurance. So the family i s uninsvured. She's
looking for work and hopefully w i l l find i t i n the next couple of months. I
wonder i f you could t e l l me iinder the proposed plan what would have happened
to that faunily had the plan been i n place and what w i l l happen to them i f she
succeeds i n finding
, .
i
a job i n the next couple of months.
MRS. CLINTON: Congressman, because she and her husband had both
been employed, they would have each made a contribution. I f they had
children, one of them would have made a plightly bigger contribution to tadce
care of the children. And each of t h e i r employers would have made a
contribution, and depending upon the s i z e and f i n a n c i a l a b i l i t y of the
employer, they would have made a contribution that was appropriate to them.
That would have covered them for the entire year. Then, even though she lost
f.
�her job in this year, they would s t i l l have remained covered. There would
have been no interruption in their coverage whatsoever.
Now, the following year, i f she i s s t i l l unemployed, then they
have two choices. The husband can insure the entire family, which includes
his wife. They can claim that she i s unemployed amd, although he i s employed,
he's going to cover himself and the children, and as an imemployed worker,
she can get some help for her insurance. When she becomes employed, then she
goes back into the employee pool. But the coverage never stops. I t always
continues for them.
--r-sjrr'•'"•'•-y•• -—,rTrT..'iSiTf~ —
REP. ANDREWS: Would the coverage be offered by the saune provider?
Let's say that she had signed up for an HMO in her region. Would that
provider continue to provide her coverage even though she was separated from
employment?
MRS. CLINTON: Yes, s i r .
REP. ANDREWS: How often w i l l the re-enrollment periods be? Once a
year?
MRS. CLINTON: Yes, annually.
——«———
—
REP. ANDREWS: Thank you very much.
MRS. CLINTON: Thank you.
REP. FORD: Mr. Fawell?
REP. HARRIS FAWELL (R-IL): Thank you. After seeing how you
impaled my comrade in arms here — (laughter) —
MRS. CLINTON: I just couldn't resist after his most recent
comment.
I apologize. I couldn't resist.
REP. FAWELL: Well, I Shall proceed most cautiously, with great
respect. (Laughter.)
MRS. CLINTON: Nobody's quoted you saying anything to me, Mr.
Fawell, so —
REP. FAWELL: Well, that's fine. (Laughter.) That's good.
(Laughter.) A key to your plan i s based on the assumption of savings, an
assumption which Senator Moynihan at least had,some trouble with and used the
word ^^fantasy." In turn, a key to the envisioned savings i s price controls
upon both the private and public sector of health care. But in 40 centuries,
and as recently as 1971, '73, price controls have not worked either in terms
of controlling prices or in terms of quality and/or rationing of that which
is subject to price controls. What makes you think price controls w i l l work
this time?
MRS. CLINTON: Congressman, I don't think price controls w i l l work
this time, and we want to move away from what i s in the current system in
both the public and the private sectors, where individual procedures are
given a price. That's what happens now in Medicare and Medicaid. It's what
happens now in many of the private insurance plans.
We do believe there needs to be some kind of a budget in both the
public and the private sectors. And what we think would be the appropriate
way for the private sector to function i s for them to reorganize themselves.
We believe there are great savings in the private sector i f health care i s
delivered more efficiently and that as those savings are realized, they w i l l
compound, because other providers w i l l see how efficiently care i s being
provided. And there are many examples of that arovmd the nation.
But in the event that i t does not move as expeditiously as i t
should once a market i s actually in place, we think there needs to be
a budget that would have some way of trying to keep premium increases in line
with what would be the rate of inflation, plus population gro%rth. We do not
�anticipate that budget ever being enforced i n most Instances. We see i t as a
backup. But we want to get away from the micromamagement, price control,
individual procedure approach that has not worked and move toward a per
capita system i n which the decisions are made by the individuals who should
make them, the doctors and the hospital administrators and those people. And
we think that w i l l work better.
But I know there i s some disagreement about even having a premium
cap as a fallback backstop. We j u s t think i t would be a good budget
discipline to stand behind the compet"±ti:ve-'forceB"7"^rn-—
REP. FAWELL: Thank you.
REP. : Thank you.
Mr. Reed.
REP. JACK REED (D-RI): Thank you, Mr. Chairman.
Mrs. Clinton, I want to thank you — thank you very much, Mrs.
Clinton, for joining us today, and I want to also commend you for your
extraordinary e f f o r t s . You talked about integrating the worker's compensation
system into health care reform, amd-I feel-thia—is-a-^reat-opportunity to
address a very serious problem for small businesses. Could you elaborate on
your thoughts on how the integration w i l l take place, but p a r t i c u l a r l y witdi
attention to the benefits that w i l l accrue to small business because of this?
MRS. CLINTON: Yes. As you well know, worker's comp benefit prices
have gone up even faster than health care i n most states. And what we intend
to do i s to take the health care portion of worker's comp and integrate i t
into the universal health care system. And so, that when small businesses
come to pay for t h e i r contribution to their employees' health care, they
would be having the opportunity to combine a part of t h e i r worker's comp
benefits so that they wouldn't be paying duplicate, that the employee would
be receiving health care benefits in their health plan, and i t would be
funded by the contributions from the employer and the employee.
We also would l i k e to see the entire worker's compensation system
changed and integrated into either an unemployment maintenance system or a
health and r e h a b i l i t a t i o n / l o s t wages system. And we intend to set up a
commission to look at a l l the states and to work toward doing that. But in
the short run, we want to tadce those worker's comp health care benefits and
remove them as an extra burden on business and have them become part of what
the employer pays for when they pay for healthi care.
REP. REED: So that when we're talking about what small business
might have to pay to be part of the health care system, there'd be a
compensating savings from any business with respect to workers compensation
costs?
I
MRS. CLINTON: Yes, s i r .
REP. REED: Thank you very much, Mrs. Clinton.
REP. FORD: Mr. Roemer?
REP. TIM ROEMER (D-IN): Welcome, Mrs. Clinton. And s i x months
ago,
I certainly admire the commitment and concern ypu brought to t h i s issue, and
now greatly admire the knowledge and expertise and energy that you bring to
t h i s issue, and we look forward on t h i s committee to working c l o s e l y with
you.
There's the old saying that an ounce of prevention i s worth a
pound of cure, and we're hopeful that t h i s plan w i l l bring an ounce of
prevention and a pound of cure to a very much a i l i n g and broken health care
system in t h i s country. And one of my concerns with t h i s health care system
i s how i t a f f e c t s our children and how i t affects future generations. And I
�know you, too, share that concern with your work on the Children's Defense
Fund.
Could you share with the committee how we w i l l address problems
for our children, where we currently rank 19th i n infant mortality, amd how
t h i s plan w i l l put more emphasis on primary care check-ups for our children
and immunizations and inocvilations; and how we cam encourage more frequent
v i s i t s for primary care for those children and how we can get them ac:cessed
to our community health care c l i n i c s , p a r t i c u l a r l y i n inner c i t y areas.
MRS. CLINTON: Mr. Roemer, thaufUfiyfU ifor^y^arruoncern about
children's health . And I well remember ovir v i s i t together where we met a l l
of those children at the community center. And —
REP. ROEMER: Mrs. Clinton, I hope you don't have to buy Ninja
Popsicles for the whole country i f you t a l k about t h i s —
MRS. CLINTON: Well I was grateful, though, to at l e a s t t r y onel
(Laughter.) And I thank you for that. . Under the guaranteed benefits
package, the kind of preventive services that you and I want for a l l children
w i l l be available: prenatal care,-immunizations-,-well-child care — and i t
w i l l become the standard so that everyone w i l l have the obligation and the
responsibility, because they w i l l now have the Insurance coverage, to be sure
their children do get those kinds of preventive services. In addition, we
w i l l make primary care more available. We hope to increase the number of
primary care physicians who are available in a l l regions of our covmtry.
The American Academy of Pediatrics has endorsed the president's
plan because of the emphasis on children and preventive care for children.
And I j u s t have to believe that i f we f i n a l l y get every c h i l d into the
system, i f we make sure that prevention i s emphasized, that we w i l l see these
s t a t i s t i c s that I think are embarrassing and shauneful for our country begin
to decline, as they should. And we anticipate that happening and w i l l look
forward to working with you to make sure i t does.
REP. ROEMER: Thank you very much.
MRS. CLINTON: Thank you.
REP. ROEMER: Nice to see you again.
REP. FORD: Mr. Engel.
REP. ELIOT L. ENGEL (D-NY): Thank you, Mr. Chairman.
Mrs. Clinton, you certainly have our accolades and our gratitude
for the work that you've done. I was so happy to hear the president mention
about expansion of senior c i t i z e n programs, p a r t i c u l a r l y prescription drug
programs and long-term care and in-home care. We know that those are things
that seniors across the covmtry r e a l l y look for. I'm wondering i f you could
comment on some of those expansions.
And also. New York has l e s s of a percentage of uninsured than
most other states because we provide very generous benefits to many of our
people in need. There i s a concern that there might be a lessening of health
coverage. For instance, mental health coverage i s provided to many Medicaid
patients, and i n the new plan there seems to be l e s s of
a coverage than New York currently gives. Can you also a l l a y some of our
fears that as a r e s u l t of the quality of care that New York has been
providing that we w i l l not have a lessening of, care? And also with the
maintenance of e f f o r t requirements i n the healt:h plan, that states l i k e New
York don't lose care and at the same time wind up subsidizing other states as
well.
MRS. CLINTON: Congressman, I w i l l get you answers on the l a s t two
that are s p e c i f i c to New York, and in the time I have l e t t a l k about
prescription drugs and long-term care, because you are r i g h t . Those are the
�•I
two concerns we hear most from older Americans because they are the two
biggest gaps that older Americans face with our existing EMedlcareF prograun.
The kinds of prescription drug benefits that older Americans need w i l l enable
them to meet t h e i r medication needs i n a much more cost e f f e c t i v e manner than
they now can. We think that's good not only for the individual, but also for
society because too often older Americans are self-medicating, are choosing
between prescription drugs and food at the end of the week or the end of the
month, are seeing t h e i r l i f e savings eaten up by very high drug prices. And
so i f we can provide the kind of preear^sptton dxppilNmef i t ' t h a t the president
has proposed we w i l l not only meet a great need, ve think we w i l l save money
because 23 percent of the hospital admissions for older Americans i n mamy
parts of our country are due to conflicting drugs or inadequately ingested
drugs or from the kind of decisions older Americans madce where the l i t t l e
p i l l bottle says ^^Tadce four times a day" amd they say **Well, i f I tadce one
time a day i t ' l l l a s t four times as l o n g , " and i t doesn't work, so they end
up back i n the hospital. I t ' s those kinds of decisions we think are costly
that having a good, s o l i d , affordable-preserip%4on^-dru9 benefit w i l l help us
control.
And i n addition, the long-term care piece i s so important because
right now there i s not adequate support for home-based and community- based
care, and we need to provide that. I t ' s the right thing to do, i t preserves
individual and family dignity, and i t saves money i f i t ' s done.
REP. ENGEL: Thank you very much.
REP. : Mr. Scott.
, ,
REP. ROBERT C. SCOTT (D-VA): Thank you.
Mrs. Clinton, I want to congratulate you again, as you've been
congratulate before, for your hard work. I t ' s already been mentioned, your
work on the Children's Defense Fund and also has not been mentioned, your
work on the Southern Regional Task Force on Infant Mortality.
So the work on prevention and the work on health care i s not new.
I want to congratulate you on your plan. I t provides not only the
preventive care and the mental health but also vmiversal access. I applaud
you on the funding mechanism. I t appears f a i r except for the regressive
tobacco tax. Sidasidies to a l l e v i a t e the hardships of small businesses and
low-income workers. One thing that I think i s iaqportant for the low-Income
workers i s that we not saddle the employers with a mandate that w i l l cause
job losses, and you've been sensitive to that. And also, the disincentive in
our present system for people getting off welfare. You say that people move
onto welfare. Those already on welfare can't move off because they don't have
the health benefits.
So, without asking a question, because obviously I have to run
and catch up with my colleagues to cast a vote, I would j u s t l i k e to point
out the s e n s i t i v i t y that I have for the low-income worker and also point out
ny concern that they keep t h e i r card, however i t ' s paid, t h e y ' l l keep their
insurance.
MRS. CLINTON: Yes, s i r .
REP. FORD: And I think that's been worked out. And whether the
subsidies w i l l be for the 20 percent or the 80 percent, and how the subsidies
actually work. But I think the point that you've already tadcen care of i s ,
however that complication works, the person w i l l have coverage throughout
their l i f e , coverage that cannot be tadcen away.
MRS. CLINTON: That's right. And Congressman, I want to thank you
for bringing up the welfare (lock ?) prograun. We think there are somewhere
between 500,000 and 600,000 Americans who we could move from welfare to work
�but for the fact that they are dependent upon their medical benefits that
they would lose i f they were to move off of welfare, and that i s a t e r r i b l e
indictment of our welfare system.
Thank you.
REP. : Mr. Ballenger?
REP. CASS BALLENGER (R-NC): Thank you.
Mrs. Clinton, happy to be with you. And sadly, we're going to
have four straight five-minute votes i n j u s t a second, so l e t me quickly say
that I'm a small business o%mer do%mr in'^K^rth C«]|[Olinar I have 200 employees,
and because of the problems we had with health insurance, we got together
^
with 32 other small businesses i n western North Caurolina and formed a
self-funded association. And our insurance costs have gone down for the l a s t
two years because we are j u s t being better run than we were before.
But l e t me ask you a question. My understamding i s that employers
having fewer than 5,000 full-time employees are forced to give up t h e i r
current self-funded plans and contribute instead to a regional health
a l l i a n c e . Under what circumstances vould~employers whcare currently covered
under a self-funded association plan that operates i n several states or
nationwide be able to continue t h e i r coverage by electing t h e i r former plan?
I s such a thing possible?
MRS. CLINTON: Congressman, that's a good question, and several
members have asked us that i n the l a s t few weeks as the plan has been
circulated, and we w i l l take a hard look at that as to whether or not an
association with 5,000 meml^srs could be equivalent to a corporate a l l i a n c e
and t r y to draw some parity there.
Of course, we're concerned about a couple of things that we'll
have to t r y to work out the d e t a i l s about. One i s that we don't permit any
return to the kind of experience rating %hat used to work against you as a
small business owner, that we don't i n any way discriminate against any group
of either employers or employees, either Inside or outside of the alliance,
and that any who are s e l f - insured under any circumstance have to provide the
same kind of benefits as would be available inside the a l l i a n c e .
But we w i l l take a look at that and see whether there i s some
equivalence there that we could draw. Of course, I think that what you've
found by moving into that larger group i s exactly what we think w i l l be found
for a l l small businesses when they move into a larger group. They w i l l
exactly see what you have neen, only I would anticipate even greater savings
because of the larger economies of scale that w i l l come to even the larger
pools. But we w i l l get you an answer s p e c i f i c a l l y about your inquiry.
REP. BALLENGER: The one difference I see i s the fact that we run
the a l l i a n c e and i n the new system i t appears that the a l l i a n c e w i l l run us.
MRS. CLINTON: Well, the a l l i a n c e w i l l be governed by a board that
consists half of employers |i<;— employer representatives and half of consumers,
who w i l l be, by and large, |employees or other c i t i z e n s of the area, so we've
tried to structure i t so that i t w i l l have the best features of exactly the
kind of approach that you have found successful. And we're continuing to look
at that to madce svure that i t does have those features because we don't want
i t to run you. We want the employerB and consumers who are paying the b i l l s
to rvm i t . That's the whole change we're trying to bring about, so instead of
having insurance companies or government bureaucrats dictate what the
conditions are, i t w i l l come from t:he grass roots up for everybody.
REP. BALLENGER: Thank you, ma'am.
REP. : Mr. Becerra.
REP. BECERRA: Mrs. Clinton, thank you very much for being with
i
�1. ill
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•
US, and I , too, applaud a l l of the e f f o r t s that you have made, and of course,
the president as w e l l .
|
I f I could follow up on something that the gentlewoman from New
Jersey raised with regard to the immigrant women, I hope we don't lose sight
of the fact that whether or not i t ' s an immigrant women who i s costing us
$500,000 to $1 m i l l i o n for tJiat p a r t i c u l a r heart transplant or heart surgery,
i f i t ' s a middle-class person, an immigrant, wealthy or poor person, no one
w i l l ever pay the $500,000 to $1 million health b i l l through h i s or her own
pocket. We w i l l a l l end up paying-far'rthart:-part±cul«r procedure, and I think
that's important to note.
Further, as — more i n terms of the issue of the immigrant, i t
seems to me that the question i s not so much w i l l we have to pay more for
someone else, but how i s i t that a l l of us who reside in t h i s country w i l l
contribute our f a i r share to pay for the health care which we w i l l a l l at
some point need — as we a l l say from cradle to grave — and i t seems to me
we have to find a way to provide money to the pot.
But I'm a b i t concerned that because we're talking i n terms of
c i t i z e n s and those who are lawfully here that we neglect those who are here
without documentation, and oftentimes, they are the people that put the food
on our table, that sew the clothes that we wear, tadce care of the children
that we have, yet when i t comes to t h e i r health care we often find that they
may not be covered. I j u s t wondered i f you could comment on that.
MRS. CLINTON: You are right. Congressman. We do have a
distinction in t h i s plan. The guaranteed health benefits and the health
security card w i l l be available to American c i t i z e n s and legal residents.
They w i l l not be available to vmd(x:umented workers and i l l e g a l a l i e n s .
Now we know that we w i l l continue to have large numbers of such
workers i n our country, and we know that they w i l l need medical care, so we
w i l l continue to provide fimding to support emergency care and public health
kinds of services that are required.
But we've t r i e d very hard to deal with the legitimate concerns of
many, in many communities our country, that they do not believe we should do
anything that might encourage any more i l l e g a l Immigration, that we need to
take care of, f i r s t and foremost, our c i t i z e n s and legal residents who are
here struggling and deserve to have health care and may often themselves be
uninsured or not tadcen care of. And that's the approach that we've tadcen in
t h i s proposal. But we s t i l l provide emergency care and public health care to
anyone who's i n the country who needs i t .
REP. : Mr. Green?
REP. GENE GREEN (D-TX): Thank you. Madam Chairman.
Mrs. Clinton, i t ' s great to have you here, and after Pat Williauns
said about he's glad that the president chose you as h i s spouse, after almost
24 years, my wife has convinced me that she chose me as her spouse and i t
wasn't the other way around.
Let me ask a question, though, on how t h i s relates, since we are
the Education and Labor Committee and I'm on Labor Management, so we'll do
t h i s , but I also spend a l o t of time on the education side of i t . The
administration has proposed as part of the elementary- secondary
re-authorization that we use — the schools also provide health care
screenings for children. And I was wondering i f the security health plan
would provide that, or would we have to also dip i n our education funds that
we're struggling to use. And I would hope i t would be an umbrella plan when
we talk about i t . Health care includes, you know, obviously screenings and
preventive care that I knov you've talked about on a great deal of — a great
�many occasions.
MRS. CLINTON: You know, I'm afraid I'm not familiar with what the
provisions i n the education b i l l currently are with respect to that, but I ' l l
be happy to look into that^ And we do, i n the health care reform, propose
some public health outreach kinds of i n i t i a t i v e s , including bringing services
to schools where we think that students may be more e a s i l y accessed. But I ' l l
have to give you a s p e c i f i c answer about the relationship with the education
b i l l . Congressman. I j u s t don't know the answer to that.
REP. GREEN: Okay. Thank you.^''^'»i««Mi'iii»mi "««r«-•^^''•i'Thank you, Madaun Chairman. REP. : Mr. Baurrett?
REP. BILL BARRETT (R-NE): Thank you. Madam Chair.
I , too, Mrs. Clinton, l i k e the previous speadcers, thank you for
your sharing of your time and your talent before t h i s f u l l committee.
I guess, l i k e Mr. Murphy — h i s question triggered, i n my thinking —
I come from a very large r u r a l d i s t r i c t , where the small hospitals are
closing and the doctors are caught with the bureaucratic Medicare/Medicaid
and going to greener pastures i n the-urban areats and so- forth. But I also
have another unique problem i n that my d i s t r i c t i s elderly, percentage-wise
very elderly. And I guess the question i s simply t h i s : What happens i n your
plan i f the insurance companies elect not to bid for the a l l i a n c e ' s business?
In other words, why would companies want to i f they had to tadce everyone? Has
that been a concern for you and your task force?
MRS. CLINTON: YesCongressman, and we are p a r t i c u l a r l y concerned
about r u r a l areas where there are not s u f f i c i e n t providers now. But i n
looking at what has proven successful i n providing r u r a l health care
delivery, we think we have b u i l t i n a number of those features, starting with
providing an adequate funding base i n your d i s t r i c t now. Because what i s
often found i n r u r a l areas i s not only a heavier-than-usual Medicare load,
but a heavier-than-usual vuiinsured population. Oftentimes, agricultural areas
and small towns and small businesses don't have any insurance base i n the
existing market, because they have been priced out of i t .
So we do believe there w i l l be some new resources coming i n .
We also want to begin to provide a better reimbursement rate for
rural areas. We think the d i f f e r e n t i a l between urban and r u r a l areas under
Medicare has been too great. We think there needs to be some better
relationship there and more reimbursement going into our r u r a l areas.
We also want to identify r u r a l hospitals and c l i n i c s as essential
community providers, which means they w i l l receive funding because we know
they have to be there. So they w i l l be targetted for these additional funds.
find we have some work force recommendations so that i t w i l l be more
attractive for physicians and nurses and others to go into rxiral areas
l:)ecause they w i l l get t h e i r education loans paid back or t h e i r loans w i l l be
forgiven. And t:hen, with some technological developments, we think care can
kte delivered e f f i c i e n t l y i n r u r a l areas from even urban centers.
A l l of those thing^, we believe, w i l l help your d i s t r i c t , and
we'd be glad to provide additional information to you about them.
REP. BARRETT: Thank you. And I appreciate that. As a matter of
fact, my time has expired.II do have a s e r i e s of questions similar and I'd
l i k e permission to submit them for your written response.
MRS. CLINTON: Yes, please.
REP. FORD: Mrs. Clinton, there are a number of members who have
made a similar request. And i f you'll submit them to the chair we'll send
them over, and then the answers w i l l be contemporaneous with your time on the
record.
�REP. BARRETT: Thank you, Mr. Chairman.
REP. FORD: Ms. Woolsey.
REP. LYNN WOOLSEY (D-CA): Mrs. Clinton, I want to congratulate
you. You're providing our country with the basis of such an in-depth,
meaningful debate on the most Important issue that we have before us: health
care reform. And I r e a l l y am certain that we'll come out with the best plan
in the world when we're finished, but we have to be w i l l i n g to work as hard
as you've worked up u n t i l t:his point and work together. And with that, we'll
do i t . One area that i s of particulan'^^xroncenT t0~«B^a~vomen's reproductive
health services, including abortion . And with the co- mingling of federal
funds with t h i s health a l l i a n c e s or to the health a l l i a n c e s through subsidies
to employers and consumers, how can we guarantee that women's health services
— including abortion — are provided at the level currently provided through
private plans?
MRS. CLINTON: Well, congresswoman, what we have t r i e d to do i s to
s t r i k e j u s t that balance. We don't want to add to or subtract from the rights
for services that are currently available. And-^-in most instances where there
i s insurance coverage, pregnancy-related services has been deemed to include
abortion where that i s appropriate between a physician and a patient.
We anticipate plans that w i l l continue, with the understanding
that there are permitted conscience exemptions for providers who do not
choose to participate.
In addition, we believe that our preventive services, including
family planning, w i l l be very important i n reducing the need for abortions.
So we're trying to s t r i k e t:he balance between pretty much providing what i s
available now for individuals, plus Increasing the aunount of preventive
services to t r y to diminish the number of necessary abortions.
REP. WOOLSEY: Thank you.
j
REP. FORD: Mr. Romero-Barcelo.
DEL. CARLOS ROMERO-BARCELO (D-PR): Thank you, Mr. Chairman.
Mrs. Clinton, not only Congress but I think the whole country i s
proud of the fact that — the way you have immersed yourself i n t h i s subject
and the grasp that you have of t h i s subject. And I myself would l i k e to thank
you very much for what you have done, and I'm sure that you must f e e l very,
very proud and pleased that after almost nine months of strenuous work and
dedication a national health care reform proposal that w i l l bring spiraling
health costs under control and provide a l l American faunilies with the peace
of mind and the security they deserve has been developed under your guidance.
U n t i l now, American c i t i z e n s in the t e r r i t o r i e s have been treated
as sharecroppers not as equal partners in the nation since the beginning of
the Medicaid prograun. Now, for the f i r s t time i n the history of t h i s nation,
a l l Americans, including those in the t e r r i t o r i e s , w i l l have access to
i^uality, affordable health care, not as a privilege, but as a right.
As you well know, t:hroughout thiis whole process I worked very,
very hard to madce sure that the American c i t i z e n s l i v i n g Puerto Rico and the
other t e r r i t o r i e s w i l l be treated equally with t h e i r fellow c i t i z e n s in the
50 states. Today I aun p a r t i c u l a r l y pleased to say that a l l of them. Including
those i n Puerto Rico and the ot:her t e r r i t o r i e s , have for the f i r s t time been
included i n a national health care prograun as f u l l and equal partners.
In a nation as large and diverse as ours, any proposal to solve a
complex problem such as t h i s , no matter how good i t i s , i s always going to be
c r i t i c i z e d by at l e a s t a few. Some of my colleagues may not l i k e t h i s plan,
either for partisan reasons or for personal reasons or simply because they're
afraid of change. And to a l l of them
�I say that we should i n a l l fairness acknowledge that the president and Mrs.
Clinton have done an outstanding job i n presenting a very well thought-out
and balanced health care reform proposal. They're presenting a plan that
addresses a l l the tough issues. The least t h i s proposal deserves i s serious
and constructive thought.
And once again, Mrs. Clinton, I want to t:hank you for the great
compassion and the concern that throughout t h i s process you have shown for
the urgent health care needs of the nation's middle c l a s s , workers and
disadvantaged. And I want to thank 7Dii~and"ttte p r w l d e n t on behalf of a l l of
the people of Puerto Rico who w i l l be forever grateful to you and the
president.
Thank you.
,
MRS. CLINTON: Thank you very much.
REP. FORD: Mr. de Lugo?
DEL. RON DE LUGO (D-Virgln I s l a n d s ) : Thank you very much, Mr.
Chairman.
Mrs. Clinton, I want to thank yovr very-much for the -help you gave
us i n getting into the — t h i s health care plan. This i s the most s o c i a l
l e g i s l a t i o n of our lifetime, and for the f i r s t time when a president of the
United States says ^ ^ a l l Americans" i t w i l l Include a l l Americans. I want to
thank you again that you put a l l of us i n the t e r r i t o r i e s i n the plan —
4-1/2 m i l l i o n of us. I t ' s going to mean a l o t to us.
I wondered, has thought been given to possible technical
assistance as we t r y to come into t h i s plan?
MRS. CLINTON: Yes. And I appreciate your comments as well,
because we mean what we say when say American c i t i z e n , and Americans should
be treated the same no matter where they are. But we also recognize that
there may need to be some technical assistance provided i n order to ensure
that what t h i s l e g i s l a t i o n w i l l ultimately contain can actually be delivered
effectively. And we w i l l provide that as well.
DEL.
DE LUGO: Thank you.
,
,.
i
REP. FORD: Mr. Faleomavaega?
DEL ENI F.H. FALEOMAVAEGA (D-Amerlcan Saunoa): Thank you, Mr.
Chairman.
I suppose for want of a better term. Madam F i r s t Lady, I would
l i k e to also echo the sentiments that have been expressed by my colleagues,
again extending our appreciation for the dynaunic leadership that you've
demonstrated i n providing for our nation's health care needs. I t may well be
said that the soul and the s p i r i t of our nation's health care system w i l l be
attributed highly to your leadership. Madam F i r s t Lady, and I want to commend
you for that.
I think our previous colleague from the t e r r i t o r y of Guaun, a
retired Marine general, said a very sentimental statement to me t:he other
day. He said, ^^We are equal i n war for those of us from the t e r r i t o r i e s , but
not in peace." And a l l we're suggesting here i s perhaps not to forget the
4-1/2 m i l l i o n c i t i z e n s who die in our — in the wars that we fought and make
sure that they are also provided for.
The problem that I'm faced with, and i t troubles me sometimes,
too — you know, those of us — I'm sure the president, the p o l i t i c i a n s here
in the Congress, our state governors — when something happens to you, you
get f i r s t - c l a s s treatment. Recently, our governor had to be medevaced from
Samoa to the state of Hawaii, which i s about 2,500 miles distance. How do we
provide for a system where the average American cannot afford t h i s kind of a
:first-class treatment given to those of us supposedly because of the
\
�capacities that we serve as public servants? How can we provide a sense of
equity for those who simply do not have that luxury? Can you help me with
that?
MRS. CLINTON: Well, I think we have to s t a r t by making sure
everybody has access to comprehensive health care benefits, and then we have
to determine what additional steps might be needed in order to madce those
benefits r e a l to provide access. I don't know that we w i l l ever have a
system, however, i n which every c i t i z e n on Saunoa w i l l be a i r l i f t e d to Hawaii.
I don't know that that would be at aU'wHAln th«~r«al«" of tare possible. But
what you are describing in terms of i n a c c e s s i b i l i t y to certain l e v e l s of care
i s not unique, as you know, to the t e r r i t o r i e s . We have problems l i k e that in
many of our Western states; p a r t i c u l a r l y in Alaska. We have problems l i k e
that in many of our underserved urban states, where maybe the best medical
center in the world i s only five miles away, but i t might as well be 5,000
miles away.
So what we have to do i s s t a r t by getting vmiversal coverage,
getting a guaranteed set of benefits that is-«^resented by that health
security card, and then working to make sure technologically and other ways
we get whatever benefits we possibly can delivered in the most cost
effective, highest quality way to thereatest number of Americans.
DEL. FALEOMAVAEGA: Our president commented in h i s statement
before the Congress that somebody — we have to pay for t h i s system. I t ' s
somewhat of a sad commentary in our nation — bere i n our nation's c a p i t a l we
have people sleeping on the s t r e e t s . Does the system provide for t h e i r needs
— the homeless, the poor, those who r e a l l y are not able to get on t h e i r feet
in some way or form simply because of unskilled work capacity? I mean, can we
address t h e i r needs as well i n t h i s system?
MRS. CLINTON: We Intend to address the needs of every American.
There w i l l obviously be those who f a l l through the cracks of whatever system
we design, and we w i l l j u s t have to continue making sure that there i s
constant outreach and that t h e i r needs are met. But I think i t i s a good
beginning to make sure everybody — t:he currently Insured and the uninsured
— never have to worry about ever losing theii^ Insurance coverage again. And
1:hen we'll be able to concentrate on those individuals and those regions of
our country and t e r r i t o r i e s where delivery of pare i s a problem. But we have
to s t a r t by getting everybody i n the system an^,doing the very best job we
can to design i t so that i t provides high quality care to everyone at an
affordable price.
;
DEL. FALEOMAVAEGA: Thank you, Madame F i r s t Lady.
Thank you, Mr. Chairman.
REP. FORD: Thank you very much, and thanks to the cooperation of
the committee we did i t . (Laughter.) This i s not a committee that i s
disciplined well enough to get anything done that f a s t .
Mrs. Clinton, I kept my question, to very l a s t to madce sure that I
didn't tadce somebody e l s e ' s time. And you and p[ have talked about t h i s , and
I've talked to your task force about i t .
You've been to my d i s t r i c t several times. You know that most of
my constituents, notwithstanding the great u n i v e r s i t i e s I have there, are
blue-collar workers i n an industry where j u s t the beginning of l a s t week they
announced another 75,000 jobs would be gone i n the next couple of years.
When I hear about t:hat, what Instantly goes through my
constituents' mind i s that the person who i s wo|:king for General Motors had
f u l l y paid health insurance, and now that family i s not going to have health
Insurance. And most of my people who lose the jobs, as they've been losing
M .' •'
�them for several years now i n the downsizing of the auto Industry, have right
at the center of t h e i r concern that they're losing a job with am employer
who's been providing as a r e s u l t of c o l l e c t i v e baurgalning health benefits for
them. And they're not l i k e l y to get a job that either pays as much or gives
them access, not even the a b i l i t y to buy into a decent pool. Would you t e l l
them now — and I ' l l repeat i t over and over — whether or not the
president's plan i s intended to make sure that that kind of person doesn't
get l e f t out and they can quit worrying about their health insurance going
with t h e i r job?
--n^P'TTwjJin'ff'''
'
,•
MRS. CLINTON: Mr. Chairman, that's exactly what t h i s plan i s
intended to do.
'
This i s not a plan j u s t to madce sure the uninsured are insured.
This i s a plan to madce sure that the very well-insured, no matter what
happens to them, whether they have a job or they don't have a job, w i l l
always, always have health security. And you can go home and t e l l a l l those
wonderful people tdiat I have met i n your d i s t r i c t that t h i s plan i s what w i l l
guarantee them the kind of health-care coverage»that they've-always been able
to take for granted because they had an agreement that enabled them to count
on health care benefits. This w i l l enable them, no matter whether they are
s t i l l working a year from today or not, to have a guaranteed set of benefits
that i s a good set of benefits that w i l l take care of them and t h e i r
families.
REP. FORD: I thank you very much. That's a better message for me
to tadce home than a l l the pork I could get in an appropriation b i l l around
here. (Laughter.)
^
Pat, would you l i k e to close i t off now?
REP. PAT WILLIAMS (D-MT): Just to again, on behalf of the members
of my committee and perhaps the f u l l committee, thank you for the generosity
in your time. And we look fbrward to continue working with you. We understand
that the f u l l committee and my subcommittee have s i g n i f i c a n t j u r i s d i c t i o n
because of the employer-employee mandates. We know that's the heart of your
program, and we're hopeful, with continued good access to you and to those
who have worked with you, and we want to assure you that you have the saune
kind of access to both of the chairs as well as our members.
MRS. CLINTON: Thank you very much.
REP. FORD: I almost forgot something. Our member, Karen English
of Arizona, i s i l l today and extremely frustrated that she can't be here. She
would l i k e to submit a couple of questions and w i l l do i t i n the same way
that I referred to the gentleman from Nebraska. I know that Karen would be
devastated that she couldn't be here to meet with you. You have met with her
isefore and talked with her. You know she's a very valuable member of t h i s
committee.
Let me thank you for t h i s committee and the whole Congress. You
know, I know what was going through t h e i r minds i n the other committees. You
made me proud to be a part, proud to be a part of our national government
with your performance here;and what you've been doing i n front of the other
committees. I think there's going to be an awful l o t of young people who are
going to aspire to be l i k e you. And that w i l l be good for t h i s country. Thank
you very much for your help to us.
MRS. CLINTON: Thank you, Mr. Chairman.
- END -
�E X E C U T I V E
O F F I C E
OF
THE
P R E S I D E N T
O l - O c t - 1 9 9 3 12:42pm
TO:
(See
Below)
FROM:
J e f f r e y L. E l l e r
O f f i c e o f Media A f f a i r s
SUBJECT:
HRC T r a n s c r i p t from Senate Finance
9/3 0
HEARING OF THE SENATE FINANCE CMTE:
HEALTH SECURITY ACT OF 1993
CHAIRED BY: SENATOR DANIEL PATRICK MOYNIHAN (D-NY)
WITNESS: HILLARY RODHAM CLINTON
THURSDAY, SEPTEMBER 30, 1993
SEN. MOYNIHAN: Mrs. C l i n t o n , we welcome you. T h i s i s an
a u s p i c i o u s o c c a s i o n i n every sense. I t was i n 193 5 t h e Committee on Economic
S e c u r i t y , which was headed by t h e -- by F r a n c i s P e r k i n s as s e c r e t a r y o f
l a b o r , which proposed t o P r e s i d e n t Roosevelt, and he i n t u r n t o t h e Senate,
what became t h e S o c i a l S e c u r i t y A c t o f 1935. They had contemplated i n c l u d i n g
h e a l t h s e c u r i t y as p a r t o f S o c i a l S e c u r i t y . They chose i n t h e end n o t t o do
so o u t o f a sense t h a t i t would be more t h a n Congress was ready f o r a t t h e
t i m e , perhaps t h e people. I n 1945, P r e s i d e n t Truman r e t u r n e d t o t h e i s s u e -s u b j e c t , as l a t e r d i d P r e s i d e n t Nixon. But those i n i t i a t i v e s f a i l e d a l s o .
But now, a t l a s t , i t ' s c l e a r t h a t t h e t i m e has come round f o r an
e x t r a o r d i n a r y moment o f n a t i o n a l consensus which you have helped t o shape i n
a most e x t r a o r d i n a r y way. So i t ' s w i t h a g r e a t sense o f p l e a s u r e t h a t I
welcome you and t u r n t o my c o l l e a g u e and f r i e n d , t h e former chairman, r a n k i n g
member. Senator Packwood.
SEN. BOB PACKWOOD (R-OR): Mr. Chairman, thank you.
Mrs. C l i n t o n , t h e r e a r e two s u b j e c t s I want t o mention i n my
opening s t a t e m e n t . One i s t h e b i l l i n g e n e r a l , and t h e o t h e r , secondly,
f r a n k l y , i s a b o r t i o n . On t h e b i l l i t s e l f , as you're w e l l aware, I am somewhat
p l e a s e d w i t h t h e approach t h a t you a r e t a k i n g . I l i k e t h e u n i v e r s a l coverage.
I l i k e t h e e l i m i n a t i o n o f t h e p r e e x i s t i n g i l l n e s s as a d i s q u a l i f i c a t i o n . I
l i k e -- I c a l l i t an i n d i v i d u a l mandate, where t h e people a r e g o i n g t o have
t o buy. The employer w i l l share t h e c o s t , which i s v e r y s i m i l a r t o t h e German
p l a n . And I l i k e moving toward t h e community r a t i n g . A l l o f those
i n t e r e s t i n g l y i s what Hawaii has now, w i t h no p r i c e c o n t r o l s i n Hawaii. They
have c o m p e t i t i o n among t h e i r p r o v i d e r s . But i n essence, t h e y have those f o u r
issues covered.
I f I have any m i s g i v i n g , and i t i s your f a u l t o r your husband's
f a u l t o r your a d m i n i s t r a t i o n ' s f a u l t , i t i s a m i s g i v i n g based upon h i s t o r y ,
and t h a t ' s t h e c o s t e s t i m a t e s o f what we hope we can save and what we hope
the new e n t i t l e m e n t s w i l l n o t c o s t . And t h e o n l y reason I say t h a t i s , over
the l a s t q u a r t e r o f a c e n t u r y , we have a l l been wrong. You have done more t o
�attempt t o q u a n t i f y t h e c o s t as a c c u r a t e l y as p o s s i b l e as I t h i n k can humanly
be done, b u t I would s t i l l b e t a dime t o a d o l l a r t h e y ' r e wrong, and maybe
t h a t ' s j u s t 25 years o f b e i n g burned.
So I would hope we don't jump t o o q u i c k l y i n t o new spending
e n t i t l e m e n t programs, and you have t h r e e b i g ones i n t h i s , b e f o r e we a r e sure
t h a t t h e r e a r e g o i n g t o be some s a v i n g s .
We must g e t o u r f r i e n d s and neighbors and o u r l o v e d ones t o g e t
t h e i r f l u shot t h i s year and every year. And i t ' s a good time f o r o l d e r
Americans t o p r o b a b l y g e t t h e i r Pneumonia shot t o o , which i s a l s o p a i d f o r by
�Medicare . Modern medicine has come such a l o n g way from t h e plagues and the
epidemics o f t h e p a s t . But now we r e a l l y can reduce t h e impact o f t h e f l u ,
b u t o n l y when we take r e s p o n s i b i l i t y f o r our own h e a l t h and f o r t h e h e a l t h of
our l o v e d ones and get v a c c i n a t e d .
So, I ' d l i k e t o thank everyone and I'm g o i n g t o h o l d every press
person accountable f o r making phone c a l l s today, because we r e a l l y need t o
get t h e word o u t .
DR. LEE: Doctor P h i l Lee from the P u b l i c H e a l t h S e r v i c e . I j u s t
want t o s t r e s s s e v e r a l p o i n t s t h a t have been made by t h e S e c r e t a r y ; f i r s t ,
t h a t not o n l y s h o u l d those aged 65 and o l d e r get t h e i r f l u shots t h i s year
and get them e a r l i e r t h a n we n o r m a l l y recommend -- t h e reason f o r t h e e a r l y
recommendation -- i t would be i n October -- n o r m a l l y we recommend between the
1 5 t h o f October and t h e 15th o f November. The Centers f o r Disease C o n t r o l and
P r e v e n t i o n has a l r e a d y d e t e c t e d t h i s h i g h e r r i s k s t r a i n -- A B e i j i n g , i t ' s
c a l l e d 3292H3N3 s t r a i n -- has a l r e a d y been d e t e c t e d .
So, we're recommending t h a t i n October everyone over 65 get t h e
f l u s h o t s . I n a d d i t i o n , t h e r e are i n d i v i d u a l s a t r i s k under t h e age o f 65 -and I w i l l mention some o f those i n a moment -- who a l s o s h o u l d r e c e i v e t h e i r
f l u shots from t h e i r p h y s i c i a n s . The reason t h a t we're recommending t h i s as
an e a r l y shot -- one i s t h e v i r u s has a l r e a d y been d e t e c t e d ; second, t h a t
t h i s -- as t h e S e c r e t a r y has i n d i c a t e d -- produces s i g n i f i c a n t l y h i g h e r
m o r b i d i t y and p o s s i b l y much h i g h e r m o r t a l i t y i n t h e e l d e r l y and groups a t
h i g h e r r i s k t h a n t h e normal annual f l u epidemics.
So, t h i s i s not an o r d i n a r y year. T h i s i s a year when i t ' s o f
even g r e a t e r importance t h a n ever t o have those f l u s h o t s . I would c e r t a i n l y
i n c l u d e myself among those, as a 69 y e a r - o l d i n d i v i d u a l . I've a l r e a d y had my
Pneumonia shot by my p e r s o n a l p h y s i c i a n and i n t e n d e a r l y i n t h e month t o get
my f l u shot as w e l l .
The o t h e r s a t r i s k , i n a d d i t i o n t o those 65 and o l d e r , i n c l u d e
r e s i d e n t s o f n u r s i n g homes and o t h e r c h r o n i c care f a c i l i t i e s housing persons
o f any age w i t h c h r o n i c medical c o n d i t i o n s , a d u l t s and c h i l d r e n w i t h c h r o n i c
d i s o r d e r s -- c a r d i o v a s c u l a r o r r e s p i r a t o r y p a r t i c u l a r l y -- and t h i s would
i n c l u d e c h i l d r e n w i t h asthma. C h i l d r e n are more l i k e l y t o get t h e f l u ,
t h e y ' r e not as l i k e l y t o be s e v e r e l y a f f e c t e d as o l d e r a d u l t s -- b u t , i n t h i s
case, c h i l d r e n w i t h asthma v e r y d e f i n i t e l y , o r c h i l d r e n w i t h c h r o n i c
r e s p i r a t o r y problems, v e r y d e f i n i t e l y , a d u l t s who have r e q u i r e d medical
f o l l o w - u p o r who have been h o s p i t a l i z e d d u r i n g t h e p a s t y e a r because o f
Diabetes o r o t h e r c h r o n i c m e t a b o l i c d i s o r d e r s , k i d n e y d y s f u n c t i o n s , b l o o d
d i s o r d e r s , who have immuno-suppression -- e i t h e r t h r o u g h cancer chemotherapy,
o r perhaps i n d i v i d u a l s w i t h HIV i n f e c t i o n , o r AIDS -- should a l s o have those
f l u s h o t s , and have them e a r l y .
So t h a t i t ' s a n a t i o n w i d e e f f o r t . I t w i l l i n v o l v e p h y s i c i a n s and
o t h e r h e a l t h p e r s o n n e l -- nurses, h e a l t h departments, p r i v a t e p r a c t i t i o n e r s
-- t h r o u g h o u t t h e c o u n t r y i n o r d e r t o achieve t h e g o a l s t h a t we're s e t t i n g
f o r t h i s year.
A l t h o u g h t h e outbreaks, as I've noted, have o c c u r r e d s p o r a d i c a l l y
�i n the p a s t , I can't s t r e s s enough the seriousness of t h i s p o t e n t i a l
epidemic, t h e urgency o f g e t t i n g t h e immunization, and g e t t i n g them i n
October. And we're f o r t u n a t e t h a t t h a t Centers f o r Disease C o n t r o l and
P r e v e n t i o n , which conducts c o n s t a n t s u r v e i l l a n c e on t h e v i r u s e s -- t h e
i n f l u e n z a l v i r u s e s -- t h a t are out t h e r e , has detfected -- and t h e y do t h i s
w o r l d w i d e ; t h e y g a t h e r i n f o r m a t i o n ; t h e y ' r e c o n s t a n t l y l o o k i n g f o r what
v i r u s e s are upcoming. They have d e t e c t e d t h i s A B e i j i n g s t r a i n . Cases have
been a l r e a d y r e p o r t e d i n August i n L o u i s i a n a . And t h a t ' s t h e reason f o r t h i s
u r g e n t recommendation. So, I would j u s t s t r o n g l y second t h e S e c r e t a r y ' s
recommendation.
And I j u s t would make one f i n a l p o i n t . This e f f o r t i s an
i n d i c a t i o n o f b o t h t h e S e c r e t a r y ' s commitment t o p r e v e n t i o n and the
P r e s i d e n t ' s commitment, which he has s t r e s s e d over and over a g a i n i n h i s
h e a l t h care r e f o r m p r o p o s a l s . Thank you.
Bruce.
BRUCE VLADECK: Thank you, P h i l .
Good morning. I'm Bruce Vladeck, A d m i n i s t r a t o r o f t h e H e a l t h Care
F i n a n c i n g A d m i n i s t r a t i o n , which i s r e s p o n s i b l e f o r management o f the Medicare
and M e d i c a i d programs. The S e c r e t a r y and Dr. Lee have touched on most of the
i m p o r t a n t i s s u e s f o r t h e purposes o f t h i s morning's announcement. But l e t me
j u s t emphasize a few p o i n t s .
As t h e S e c r e t a r y noted, t h e problems o f i n f l u e n z a have been w i t h
us f o r hundreds o f y e a r s , b u t t h i s i s the f i r s t f l u season s i n c e t h e Medicare
program began i n 1966 t h a t immunization a g a i n s t the f l u i s covered under Part
B f o r a l l Medicare b e n e f i c i a r i e s . And t h e r e f o r e , i t ' s i m p o r t a n t t o get the
word out n o t o n l y how i m p o r t a n t i t i s t o t h e h e a l t h o f people 65 and o l d e r
t h a t t h e y g e t t h e i r s h o t s , b u t now, f o r t h e f i r s t t i m e , t h e c o s t o f those
shots are covered. And, indeed, the Congress and we f e l t i t so i m p o r t a n t t o
encourage people t o get t h e i r shots t h a t , u n l i k e almost every o t h e r
o u t p a t i e n t s e r v i c e i n t h e Medicare program, f o r p a r t i c i p a t i n g p h y s i c i a n s , f l u
shots have no d e d u c t i b l e and no out o f pocket payment f o r b e n e f i c i a r i e s a t
a l l . I f t h e i r p h y s i c i a n s t a k e assignment o r i f t h e y r e c e i v e t h e s e r v i c e s a t a
v a r i e t y o f i n s t i t u t i o n a l p r o v i d e r s , c l i n i c s , and so f o r t h , t h e r e i s no cost
t o t h e b e n e f i c i a r y from g e t t i n g t h e shot. I t ' s i m p o r t a n t , as a m a t t e r of
p o l i c y t o encourage people t o get p r e v e n t i v e s e r v i c e s of t h i s s o r t .
That i s a s t o r y t h a t i s repeated, u n f o r t u n a t e l y , many, many times
a l l over t h i s c o u n t r y , and i t ' s a s t o r y among t h e many t h a t we have heard
t h a t argue v e r y s t r o n g l y why t h i s system o f h e a l t h care needs t o be changed
because o f t h e impact i t has on w e l f a r e dependency, on j o b l o c k and on o t h e r
f a c t o r s t h a t are undermining t h e w e l l - b e i n g of American f a m i l i e s .
I n t h e past few weeks, Mr. Chairman, you and o t h e r d i s t i n g u i s h e d
members o f t h i s committee have r a i s e d tough and i m p o r t a n t q u e s t i o n s about how
best we can f i n a n c e h e a l t h care r e f o r m . T h i s i s , as we a l l know, a s u b j e c t of
g r e a t c o m p l e x i t y , one t h a t has been s t u d i e d e x h a u s t i v e l y , b u t which i s s t i l l
s u b j e c t t o a g r e a t many q u e s t i o n s . We have t o , i n t h e coming weeks and months
ahead, work c l o s e l y t o g e t h e r t o understand as f u l l y as we are a b l e t h e k i n d s
�of i s s u e s t h a t are r a i s e d by t h e reforms t h a t are o f f e r e d , n o t o n l y by the
p r e s i d e n t , b u t by the Republican s e n a t o r s r e p r e s e n t e d here on t h i s committee
and o t h e r s .
We have t o be sure t h a t we g e t t h e best v a l u e f o r the h e a l t h care
d o l l a r s we c u r r e n t l y spend and t h a t we do t h e best j o b we can t o r e f o r m t h e
system so t h a t h e a l t h care i s d e l i v e r e d more e f f i c i e n t l y a t h i g h e r q u a l i t y t o
a l l Americans. The simple f a c t i s t h a t Americans are spending n e a r l y now $1
t r i l l i o n a year on h e a l t h care, and we are n o t g e t t i n g our money's w o r t h . We
have a h e a l t h care system t h a t s t i f l e s c o m p e t i t i o n , breeds i n e f f i c i e n c y ,
embraces bureaucracy and encourages waste.
You know as w e l l as any t h e comparative f i g u r e s on h e a l t h care
spending among t h e c o u n t r i e s w i t h whom we compete. Senator Packwood j u s t
mentioned Germany. They spend l e s s t h a n 9 p e r c e n t o f t h e i r gross domestic
p r o d u c t on h e a l t h care and t h e y i n s u r e a l l Americans ( s i c ) and guarantee
b e t t e r b e n e f i t s t o a l l o f t h e i r c i t i z e n s . We spend $1 t r i l l i o n every year,
l e a v i n g m i l l i o n s o f Americans l a c k i n g i n s u r a n c e and m i l l i o n s more on t h e
verge o f l o s i n g i t because o f t h e changes i n t h e economy.
And t o o many Americans g e t the most expensive h e a l t h care i n the
most expensive p l a c e , t h e emergency room. That care i s not f r e e even i f t h e y
leave t h e h o s p i t a l w i t h o u t themselves p a y i n g t h e b i l l . That care i s p a i d by
the r e s t o f us.
And we know a l l t o o w e l l how paperwork, a d m i n i s t r a t i o n and
bureaucracy c o s t us a t l e a s t 10 cents o f every h e a l t h care d o l l a r . And f o r
s m a l l businesses, a d m i n i s t r a t i v e c o s t s eat up one o u t o f every t h r e e h e a l t h
care d o l l a r s . And f i n a l l y , t h e J u s t i c e Department e s t i m a t e s t h a t h e a l t h care
f r a u d , because o f the k i n d o f system we c u r r e n t l y have, robs t h e American
t a x p a y e r s and those who buy t h e i r own i n s u r a n c e o f a t l e a s t $80 b i l l i o n a
year.
And we a l s o have a system w i t h t h e wrong k i n d o f i n c e n t i v e s , and
t h e r e are many examples o f t h a t t h a t I would be g l a d t o go i n t o l a t e r , b u t
j u s t l e t me g i v e two. One i s t h a t we do n o t emphasize p r i m a r y and p r e v e n t i v e
h e a l t h c a r e . We pay f o r care u s u a l l y a f t e r a s i t u a t i o n has developed where i t
i s more expensive t o care f o r i t i n s t e a d o f t a k i n g care o f i t a t an e a r l i e r
and l e s s expensive p o i n t i n t i m e .
And we a l s o b a s i c a l l y i n t h i s i n d u s t r y o f h e a l t h care have
c o n t i n u e d what most o t h e r i n d u s t r i e s gave up decades ago. We pay by
piecework. We reimburse p h y s i c i a n s and h o s p i t a l s and o t h e r h e a l t h care
p r o v i d e r s on a piecework b a s i s , which, as human n a t u r e w i l l t e l l us, r e s u l t s
i n more p i e c e s b e i n g added t o t h e p i e t o be d i v i d e d t h a n care b e i n g d e l i v e r e d
i n a c o s t - e f f e c t i v e way.
There i s no mystery, however, about how we pay f o r c a r e . More
t h a n h a l f o f Americans' annual h e a l t h care b i l l , and t h a t i n c l u d e s b o t h
p u b l i c and p r i v a t e funds, comes from employers and i n d i v i d u a l s , those who
c r e a t e t h e j o b s , work hard, p l a y by the r u l e s and pay l a r g e l y f o r our h e a l t h
care system. They pay f o r insurance premiums and t h e y pay b o t h t h r o u g h
business and t h r o u g h i n d i v i d u a l payments. They pay t h r o u g h o u t - o f - p o c k e t
�expenses, and t h e y pay taxes t o cover t h e p u b l i c programs t h a t i n c l u d e
Medicare, Medicaid, t h e v e t e r a n s program, CHAMPUS, and o t h e r f e d e r a l o u t l a y s
such as uncompensated care payments.
T h i s committee and m i l l i o n s o f Americans a r e a s k i n g t h e r i g h t
q u e s t i o n , who's g o i n g t o pay t h e b i l l as we move beyond today's i n s e c u r e
system and guarantee h e a l t h s e c u r i t y t o every American? The p r e s i d e n t has
decided, f i r s t and foremost, t h a t we s h o u l d n o t r a i s e a broad-based t a x t o
f u n d h e a l t h care r e f o r m . I n s t e a d , we s h o u l d b u i l d on what works, b u t make i t
work f o r everyone. Our g o a l i s t o take t h e w o r l d ' s f i n e s t p r i v a t e h e a l t h care
system and make i t work b e t t e r .
There a r e t h r e e p r i m a r y sources o f f u n d i n g f o r t h i s h e a l t h
s e c u r i t y p l a n . One i s t o ask a l l o f t h e Americans, 3 0 m i l l i o n , who work and
have no i n s u r a n c e and t h e i r employers t o c o n t r i b u t e something t o t h e i r own
h e a l t h c a r e . That w i l l i n c l u d e a s k i n g those who a r e c u r r e n t l y on Medicaid and
Medicare who a l s o work s i m i l a r l y t o make a c o n t r i b u t i o n .
Second, t o l i m i t t h e growth i n t h e f e d e r a l h e a l t h care programs,
not t o c u t them, b u t t o reduce t h e r a t e o f i n c r e a s e i n t h e p r i m a r y programs
of Medicare and Medicaid. And, t h i r d , t o t a x tobacco. That i s
a t a x t h a t i s n o t broad- based, b u t i s h e a l t h d i r e c t e d t h a t we t h i n k c o u l d be
used t o f u n d c e r t a i n o f t h e h e a l t h care e x p e n d i t u r e s necessary and t o ask a
c o n t r i b u t i o n from l a r g e s e l f - i n s u r e d c o r p o r a t i o n s t h a t choose t o c o n t i n u e t o
i n s u r e themselves.
R i g h t now, n i n e o f every t e n Americans who have h e a l t h insurance
get i t t h r o u g h t h e i r employer. Even w i t h a l l t h e problems a s s o c i a t e d w i t h
h e a l t h i n s u r a n c e today, h i g h d e d u c t i b l e s , co-payments, incomprehensible
p o l i c i e s and i n s e c u r i t y , t h i s way o f g e t t i n g and p a y i n g f o r h e a l t h care works
f o r most Americans, l i k e those o f us i n t h i s room. Under o u r h e a l t h s e c u r i t y
p l a n , employers and i n d i v i d u a l s who pay premiums today w i l l c o n t i n u e t o do
so.
And s i x o f every t e n Americans who c u r r e n t l y has insurance w i l l
pay t h e same o r l e s s as t h e y do today f o r coverage t h a t i s as good o r b e t t e r
t h a n what t h e y g e t today.
And I want t o repeat t h a t , because t h i s i s a v e r y i m p o r t a n t
p o i n t . We e s t i m a t e t h a t a p p r o x i m a t e l y 63 p e r c e n t o f Americans who c u r r e n t l y
have h e a l t h i n s u r a n c e w i l l pay t h e same o r l e s s t h a n t h e y pay today f o r
coverage t h a t i s as good o r b e t t e r t h a n what t h e y g e t now.
Here's what i s d i f f e r e n t : We're g o i n g t o make o u r employer-based
h e a l t h care system work f o r everyone. As Senator Packwood p o i n t s o u t , t h e
i n d i v i d u a l w i l l be r e s p o n s i b l e f o r making a c o n t r i b u t i o n , b u t t h e employer
w i l l a l s o be s u p p o r t i n g t h a t c o n t r i b u t i o n . Every i n d i v i d u a l w i l l have t o take
r e s p o n s i b i l i t y and pay something, and t h a t i s where t w o - t h i r d s o f t h e
f i n a n c i n g f o r premiums w i l l come from.
We b e l i e v e t h i s approach w i l t p r o v i d e t h e l e a s t d i s r u p t i o n - - f o r
people who have b e n e f i t s who have f o u g h t hard f o r t h e i r h e a l t h b e n e f i t s and
l i k e how t h e y g e t them now. And i t i s an idea t h a t some would argue i s a
p r e t t y o l d - f a s h i o n e d one because i t b u i l d s on t h e system we have. I t was
�advocated, as you p o i n t e d o u t , Mr. Chairman, by P r e s i d e n t Nixon, i n t r o d u c e d
by Senator Packwood, and i t w i l l p r o v i d e a f a m i l i a r way f o r Americans t o know
t h e y w i l l be secure.
We cannot r e f o r m t h e insurance market and j u s t l e t i t go a t t h a t .
There w i l l n o t be any way, by merely r e f o r m i n g t h e insurance market, t o
p r o v i d e u n i v e r s a l coverage w i t h o u t some system i n which everyone c o n t r i b u t e s .
I f we r e f o r m t h e insurance market, though, and p r o v i d e d i s c o u n t s t o s m a l l
businesses and low-income workers and t h e employed who do n o t work, t h e n we
b e l i e v e we can cover t h e v a s t m a j o r i t y o f Americans who now have no
insurance.
There w i l l be some who w i l l f a l l t h r o u g h t h e c r a c k s . For example,
Mr. Chairman, as you r i g h t l y p o i n t o u t , those who are homeless, who are not
connected t o any k i n d o f i n s t i t u t i o n . But a t l e a s t we w i l l have a v e r y
l i m i t e d number o f people w i t h whom t o d e a l . Hawaii, which has had
employer/employee system, s t i l l has t r o u b l e c o v e r i n g about 3 t o 5 p e r c e n t of
the p o p u l a t i o n , people who do f a l l i n those c r a c k s , and t h e y are c o n t i n u i n g
t o work on t h a t . But t h e y are a t 95 p e r c e n t of coverage a t a c o s t l e s s than
what t h e r e s t o f us pay, w i t h v e r y h i g h consumer s a t i s f a c t i o n .
Even w i t h t h i s approach, though, t h e r e w i l l be people who have
every r i g h t t o ask, ''Why do I have t o pay a n y t h i n g ? ' ' They w i l l say, f o r
example, ''I'm young and h e a l t h y and I w i l l not get s i c k ' ' o r ' ' I ' v e f o u g h t
hard f o r my h e a l t h b e n e f i t s ; I a l r e a d y pay a l o t , and I don't want t o pay a
penny f o r a n y t h i n g e l s e ' ' o r , i n t h e case o f s m a l l business, ' ' I don't t h i n k
I can a f f o r d t o pay a n y t h i n g . ' ' We b e l i e v e the answer t o these q u e s t i o n s goes
beyond r e s p o n s i b i l i t y and d i r e c t l y t o t h e h e a r t o f what h e a l t h r e f o r m and
h e a l t h s e c u r i t y i s a l l about.
Because t h e f a c t o f t h e m a t t e r i s t h a t even young people who
t h i n k t h e y are i m m o r t a l do get s i c k , do have a c c i d e n t s , do end up i n our
emergency rooms, and t h e r e s t o f us pay. And people who have good h e a l t h
b e n e f i t s today are j u s t a p i n k s l i p away from having no b e n e f i t s as c o u n t l e s s
thousands o f workers who have been l a i d o f f from v e r y w e l l - e s t a b l i s h e d f i r m s
i n t h e p a s t years can a t t e s t t o . And t h e s m a l l business owner who cannot i n
today's market a f f o r d h e a l t h insurance i s a l s o t a k i n g a g r e a t r i s k , t h e r i s k
t h a t a f a m i l y member w i l l get s i c k and t h e business c o u l d v e r y w e l l be
bankrupted as he o r she faces a mountain o f medical b i l l s .
The second element i n t h e f i n a n c i n g p l a n i s something Washington
hears a l o t about: t r y i n g t o l i m i t t h e growth o f government spending. We a l l
know, and you know b e t t e r t h a n most i n t h i s committee, t h a t i t i s tough t o
s t o p , l e t alone t r y t o c o n t r o l , government spending. But we do t h i n k we can
slow t h e r a t e o f i n c r e a s e down. And we i n t e n d t o do so not w i t h a cap t h a t i s
not s p e c i f i e d , b u t w i t h s p e c i f i c , s c o r a b l e , l i n e - b y - l i n e savings p r o p o s a l s .
T h i s p r e s i d e n t -- l e t me be c l e a r -- has no i n t e n t i o n o f p u t t i n g
Medicaid o r Medicare b e n e f i c i a r i e s a t r i s k . Indeed,, under, t h i s p r o p o s a l ,
Medicare r e c i p i e n t s w i l l see an i n c r e a s e i n t h e i r b e n e f i t s under t h e h e a l t h
s e c u r i t y p l a n because, f o r t h e f i r s t t i m e , we w i l l be p r o v i d i n g Medicare
b e n e f i c i a r i e s w i t h p r e s c r i p t i o n drug coverage t h a t t h e y need and new o p t i o n s
�for
l o n g - t e r m care t h a t t h e y deserve.
T h i s p r e s i d e n t would not ask f o r these k i n d s o f savings o u t s i d e
t h e c o n t e x t o f o v e r a l l h e a l t h care r e f o r m . We know a l l t o o w e l l t h a t , i f we
s i m p l y pared back t h e growth o f f e d e r a l programs and d i d not address the
p r i v a t e s i d e o f the h e a l t h e q u a t i o n , t h e r e s u l t would be more o f t h e same:
more c o s t - s h i f t i n g , more p r e s s i n g down on one s i d e of t h e h e a l t h b a l l o o n ,
o n l y t o f i n d t h e o t h e r s i d e expanding, more s k y r o c k e t i n g b i l l s f o r people who
have p r i v a t e h e a l t h insurance and, u n f o r t u n a t e l y , more and more d o c t o r s
r e f u s i n g t o t r e a t Medicare p a t i e n t s o r r e f u s i n g t o take Medicare as the o n l y
payment f o r t h e s e r v i c e .
By c o n t r o l l i n g t h e c o s t s o f h e a l t h care i n c r e a s e s on t h e p r i v a t e
s i d e , we w i l l h e l p s t o p c o s t - s h i f t i n g and s t o p g i v i n g d o c t o r s any reason t o
do what t h e y are d o i n g now: dumping Medicare and Medicaid p a t i e n t s out o f
t h e i r o f f i c e s and i n t o emergency rooms. We w i l l , i n s h o r t , t u r n t h e
i n c e n t i v e s i n today's system t h e r i g h t s i d e up f o r the f i r s t t i m e .
There are a number o f s e r i o u s h e a l t h care r e f o r m p r o p o s a l s now on
t h e t a b l e i n Congress, i n c l u d i n g one supported by s e v e r a l Republican members
here today under t h e l e a d e r s h i p o f Senator Dole and, p a r t i c u l a r l y . Senator
Chafee. They c a l l f o r comparable Medicare savings. This committee, I know,
w i l l debate how f a s t those savings can be achieved and how b i g those savings
can be. But I t h i n k we a l l agree t h e r e w i l l have t o be savings, and t h e y w i l l
be the second major source o f f i n a n c i n g f o r h e a l t h r e f o r m .
And f i n a l l y , Mr. Chairman, we do ask t h e Congress t o p l a c e a t a x
on tobacco and t o r e q u i r e l a r g e c o r p o r a t i o n s who c o n t i n u e t o s e l f - i n s u r e t o
do t h e i r p a r t t o pay f o r t h e h e a l t h care i n f r a s t r u c t u r e , p a r t i c u l a r l y
academic h e a l t h c e n t e r s and r e s e a r c h t h a t we a l l use and which we a l l b e n e f i t
from. Other p l a n s , as you know, have suggested a broad-based t a x . Others have
suggested capping t h e t a x b e n e f i t s on h e a l t h b e n e f i t s .
Both o f these, make no mistake about i t , are t a x i n c r e a s e . I f we
were t o t r y t o s u b s t i t u t e f o r t h e p r i v a t e s e c t o r investment now a broad-based
tax, i t would be an enormous, l a r g e -- I can't even t h i n k o f a l l t h e
s u p e r l a t i v e s you'd have t o have - - o f about $500 b i l l i o n i n new t a x e s . We do
not b e l i e v e anyone can j u s t i f y p u t t i n g t h a t k i n d o f money i n t o t h i s e x i s t i n g
i n e f f i c i e n t system.
L i k e w i s e , t o f u n d h e a l t h care r e f o r m w i t h t a x caps would be a t a x
i n c r e a s e on a t l e a s t 3 5 m i l l i o n American workers now who have g i v e n up wage
i n c r e a s e s i n r e t u r n f o r h e a l t h care b e n e f i t s . I t would r e s u l t i n
a s u b s t a n t i a l m i d d l e - c l a s s income t a x i n c r e a s e t h a t a t t h i s p o i n t i n t i m e ,
u n t i l r e f o r m has begun, we do not s u p p o r t . We do support changing the t a x
t r e a t m e n t on h e a l t h care b e n e f i t s once r e f o r m has o c c u r r e d once comprehensive
b e n e f i t s have been secured and t o draw a l i n e t o remove t a x p r e f e r e n c e on any
h e a l t h care e x p e n d i t u r e above t h a t l i m i t .
Mr. Chairman, t h e k i n d o f q u e s t i o n s t h a t you w i l l face and t h e
debates t h a t we w i l l a l l have i n t h e next months are v e r y e x c i t i n g q u e s t i o n s
f i n a l l y t o be f a c i n g as a c o u n t r y . I t h i n k t h a t , i f we e n t e r i n t o t h i s debate
w i t h t h e s p i r i t t h a t we have had i n t h e c o u n t r y i n the l a s t s e v e r a l weeks, we
�are guaranteed t h a t t h i s Congress w i l l produce a r e s u l t t h a t t h e y w i l l be
proud o f and t h a t Americans w i l l f e e l good about.
The p r e s i d e n t stands ready t o work w i t h a l l members on b o t h s i d e s
of t h e a i s l e and i n b o t h houses so t h a t a l l o f us a r e a b l e t o , as p u b l i c
stewards, f u l f i l l one o f t h e g r e a t needs o f o u r c o u n t r y b o t h i n human and
economic terms. And i t ' s a p l e a s u r e t o be here t o t a l k w i t h you about t h a t .
SEN. MOYNIHAN: Mrs. C l i n t o n , we thank you f o r y o u r superb opening
remarks. We observe you no l o n g e r have a t e x t , and you don't even use notes
at t h i s p o i n t . And t h i s , o f course, i s n o t t h e f i r s t o c c a s i o n we've met w i t h
you. From t h e b e g i n n i n g you have come and t a l k e d t o us on a b i p a r t i s a n b a s i s ,
and I p a r t i c u l a r l y would thank you f o r n o t i n g Senator Dole, Senator Chafee.
Senator Durenberger has been v e r y a c t i v e as t h e r a n k i n g member o f Senator
R o c k e f e l l e r ' s Subcommittee on Medicare and Long-Term Care. And Mr. Chafee i s
matched w i t h Mr. R i e g l e on t h e Committee on H e a l t h f o r F a m i l i e s and t h e
Uninsured, w h i c h i s , o f course, a p a r t i c u l a r concern o f y o u r s .
The Committee on Finance has t h e d i s t i n c t i o n o f h a v i n g among i t s
members t h e m a j o r i t y l e a d e r o f t h e Senate and t h e R e p u b l i c a n l e a d e r o f t h e
Senate. And I'm sure t h e committee would d e f e r t o them i n t h e opening
questions.
And good morning, Mr. Leader.
SEN. GEORGE MITCHELL (D-ME) ( M i n o r i t y L e a d e r ) : Mr. Chairman,
thank you v e r y much. I ' d l i k e , i f I might, t o use my t i m e t o make j u s t a
b r i e f statement.
SEN. MOYNIHAN: Yes. And can we agree t h a t , w i t h t h e e x c e p t i o n o f
our - - o f t h e two l e a d e r s , t h a t we w i l l keep o u r s e l v e s t o f i v e - minute
questions?
SEN. MITCHELL: W e l l , I ' l l observe t h e f i v e minutes as w e l l so we
can a l l be -- ( l a u g h t e r ) -SEN. MOYNIHAN: (Off mike) -- depends on i t . He might as w e l l
know.
SEN. MITCHELL: Thank you, Mr. Chairman.
Mrs. C l i n t o n , I j o i n my c o l l e a g u e s i n welcoming you here today.
Your w i l l i n g n e s s t o t e s t i f y b e f o r e f i v e committees o f Congress t h i s week i s
evidence o f y o u r commitment t o r e f o r m . I commend Chairman Moynihan f o r
h o l d i n g t h i s h e a r i n g today. I l o o k f o r w a r d t o w o r k i n g w i t h him and o t h e r
members o f t h e committee. Republicans and Democrats, t o enact comprehensive
h e a l t h care r e f o r m .
Members o f t h i s committee have t r a d i t i o n a l l y worked on a
b i p a r t i s a n b a s i s on h e a l t h care i s s u e s . Over many y e a r s I've worked c l o s e l y
w i t h s e v e r a l o f t h e Republicans on t h i s committee who a r e committed, as we
a l l a r e , t o p r o v i d i n g access t o q u a l i t y h e a l t h care f o r t h e poor, f o r t h e
e l d e r l y , t h e d i s a b l e d , and o t h e r s who a r e w i t h o u t access t o care and t o
p r o v i d e peace o f mind t o those who now have i n s u r a n c e b u t f e a r l o s i n g i t .
We face a l e g i s l a t i v e c h a l l e n g e t h a t w i l l t a k e a l l o f t h e
knowledge, t h e e x p e r i e n c e , and t h e c o o p e r a t i o n t h a t members o f t h i s committee
have developed over many years o f work. The need f o r a f f o r d a b l e h e a l t h care
�f o r a l l Americans i s n o t a p a r t i s a n i s s u e . H e a l t h care i s a fundamental human
need and, I b e l i e v e , a fundamental r i g h t o f every c i t i z e n i n a democratic
society.
Our c h a l l e n g e i s t o p r o v i d e access t o a f f o r d a b l e h e a l t h care t o
every American. To achieve t h i s g o a l , t h e a t t i t u d e s , t h e h a b i t s , and t h e
b e h a v i o r o f every h e a l t h care consumer and p r o v i d e r must change. R i s i n g
h e a l t h c o s t s t h r e a t e n t h e l o n g - t e r m f i s c a l h e a l t h o f t h e n a t i o n . They
represent t h e s i n g l e g r e a t e s t c o n t r i b u t o r t o the f u t u r e growth o f the f e d e r a l
budget d e f i c i t , a d e f i c i t which d r a i n s needed savings and investment from t h e
p r i v a t e s e c t o r . Yet d e s p i t e t h e t r u l y enormous n a t i o n a l r e s o u r c e s devoted t o
h e a l t h care i n o u r s o c i e t y , we have a system which doesn't serve a l l o f o u r
people.
No American has s e c u r i t y i n t h e h e a l t h care system today. A j o b
l o s s , an unexpected i l l n e s s o r a c c i d e n t may r e s u l t i n t h e l o s s o f h e a l t h
i n s u r a n c e even f o r those now covered. Any p l a n f o r r e f o r m must meet t h e
t h r e s h o l d t e s t o f p r o v i d i n g h e a l t h coverage f o r every American and assure
t h a t h e a l t h care c o s t s a r e c o n t r o l l e d .
I b e l i e v e t h e p r e s i d e n t ' s p l a n meets t h a t t h r e s h o l d t e s t . I t w i l l
assure access t o h e a l t h coverage f o r every American f a m i l y . The p l a n a l s o
c o n t a i n s m e a n i n g f u l c o s t containment s t r a t e g i e s t o reduce t h e r a t e o f
i n c r e a s e i n t h e c o s t s o f h e a l t h care.
The p r e s i d e n t ' s p l a n i s t h e c u l m i n a t i o n o f many months o f work by
many persons e x p e r t i n v a r i o u s d i s c i p l i n e s . I t b u i l d s on t h e work o f many
years by members o f Congress, i n c l u d i n g s e v e r a l members o f t h i s committee,
and many o r g a n i z a t i o n s d e d i c a t e d t o p r o v i d i n g h e a l t h care t o e v e r y American.
I t ' s not s u r p r i s i n g that the president's determination t o reform
the system has found s t r o n g support i n t h e American business s e c t o r . Those
who pay t h e b i l l s f o r h e a l t h i n s u r a n c e know t h a t t h e y cannot c o n t i n u e t o
absorb these r i s i n g c o s t s w i t h o u t s e r i o u s l y undermining t h e i r c o m p e t i t i v e n e s s
i n t h e f r e e market.
Those who argue t h a t h e a l t h care r e f o r m w i l l c o s t more a r e making
the assumption t h a t no one i s p a y i n g those c o s t s today. That's a wrong
assumption. The c o s t s o f care a r e b e i n g p a i d today, b u t n o t always by t h e
people who r e c e i v e t h e c a r e .
There w i l l be much o p p o s i t i o n t o t h i s p r o p o s a l . There w i l l be
w e l l - o r g a n i z e d and w e l l - f i n a n c e d e f f o r t s t o d e f e a t i t . There w i l l be c l a i m s
t h a t i t w i l l h u r t business and c o s t j o b s and produce no b e n e f i t s , i g n o r i n g
the f a c t t h a t t h e c u r r e n t system h u r t s b u s i n e s s , c o s t s j o b s , and leaves many
without benefits.
I do n o t assume t h a t every member here w i l l agree w i t h every p a r t
of t h i s program. Indeed, I assume t h e c o n t r a r y . Each o f us has t h e r i g h t -indeed, t h e o b l i g a t i o n -- t o work f o r those r e v i s i o n s we b e l i e v e a p p r o p r i a t e .
I b e l i e v e t h e p l a n undoubtedly can be and w i l l be improved by c o n s t r u c t i v e
s u g g e s t i o n s from many o f t h e members o f t h i s committee.
I applaud t h e e f f o r t s o f Senators Chafee and Dole and o t h e r
members o f t h e Republican h e a l t h care t a s k f o r c e . T h e i r p r o p o s a l c o n t a i n s
�many p r o v i s i o n s which a r e s i m i l a r t o those found i n t h e p r e s i d e n t ' s p l a n .
There i s s u b s t a n t i a l common ground on which t o b u i l d . I l o o k f o r w a r d t o a
v i g o r o u s and w e l l - i n f o r m e d debate on t h e s i g n i f i c a n t d i f f e r e n c e s which e x i s t
i n t h e two p l a n s as w e l l .
Whatever t h e outcome o f t h e debate over those d i f f e r e n c e s , i t ' s
i m p o r t a n t t h a t on those areas where t h e r e i s agreement, we r e c o g n i z e i t and
t o g e t h e r b u i l d on i t .
Americans w i l l be b e s t served by a process i n which a l l
s i g n i f i c a n t p o i n t s o f view a r e debated f u l l y , w i t h reason and c i v i l i t y . We
w i l l have a b e t t e r p l a n a t t h e end, and we w i l l have b u i l t t h e consensus
necessary i f a l l p a r t i c i p a n t s know t h a t t h e i r v o i c e s have been heard, t h e i r
ideas t h o r o u g h l y debated. And I b e l i e v e , Mr. Chairman and Mrs. C l i n t o n , t h a t
the r e s u l t w i l l be one o f t h e g r e a t events i n r e c e n t American h i s t o r y when we
next year enact comprehensive h e a l t h care r e f o r m .
SEN. MOYNIHAN: Thank you, s i r . And I t a k e i t t h a t was a
statement, b u t I would l i k e t o assume Mrs. C l i n t o n w i l l agree.
MRS. CLINTON: Yes, s i r . (Laughter.)
SEN. MOYNIHAN: N o t h i n g be added.
Senator Dole?
SEN. BOB DOLE (R-KS) ( M i n o r i t y L e a d e r ) : Thank you, Mr. Chairman.
And f i r s t I want t o thank Senator Moynihan f o r convening t h i s meeting. I t ' s
g o i n g t o be t h e f i r s t o f many, many, many h e a r i n g s . I t ' s a v e r y d i f f i c u l t
i s s u e , p r o b a b l y t h e i s s u e o f t h i s c e n t u r y i f we approach i t p r o p e r l y . And I
a l s o want t o underscore what an e x t r a o r d i n a r y j o b you've done, Mrs. C l i n t o n ,
not o n l y i n your t e s t i m o n y . To go b e f o r e f i v e committees i s c r u e l and unusual
punishment, except f o r t h i s committee. (Laughter.) And a l s o f o r your work i n
h e l p i n g c r a f t t h e p r o p o s a l t h a t you've been d i s c u s s i n g .
I wanted t o underscore many o f t h e t h i n g s t h a t Senator M i t c h e l l
has s a i d .
F i r s t o f a l l , I don't t h i n k t h e r e ' s any doubt about anybody on
e i t h e r s i d e o f t h e a i s l e o r anybody i n Congress who's n o t prepared t o t r y t o
r e f o r m o u r h e a l t h care system. But I guess t h e q u e s t i o n i s how do we go about
i t and how do we do i t , because as you've i n d i c a t e d , o u r h e a l t h care system,
n o t w i t h s t a n d i n g i t s f l a w s , i s t h e envy o f t h e w o r l d . So we have t o s t a r t o f f
w i t h t h a t v e r y p o s i t i v e premise t h a t we're f o r t u n a t e i n America t o have t h e
h e a l t h care d e l i v e r y system we have today. And how do we change i t t o t a k e
care o f t h e 30 m i l l i o n o r 35 m i l l i o n ?
And I t h i n k I can speak f o r e v e r y Republican -- I hope every
Republican. We have o u r -- o u r i n t e n t i o n i s t o be v e r y p o s i t i v e . As I've s a i d
p u b l i c l y -- I spoke w i t h t h e AMA b e f o r e I came over. I hope t h a t doesn't
p r e j u d i c e my remarks. But we're g o i n g t o s t a r t down t h e road t o g e t h e r . Now,
t h e r e may be a s e p a r a t i o n somewhere down t h e road, b u t we want t o s t a r t down
the road t o g e t h e r . T h i s i s a v e r y important-issue... I n my view, i t ought t o
have broad b i p a r t i s a n s u p p o r t , n o t j u s t enough t o make 51 o r 52 o r 53.
Because, i n my view, i f i t ' s b r o a d l y supported i n t h e Congress by Democrats
and Republicans, i t ' l l be, I t h i n k , b e t t e r r e c e i v e d a l l across America.
�And so, as f a r as I'm concerned, n o t h i n g ' s o f f t h e t a b l e . No
p r e c o n d i t i o n s . We hope t h a t ' s t h e view o f t h e a d m i n i s t r a t i o n , because as
Senator M i t c h e l l p o i n t e d o u t , even though t h e committee's --we have a good
r e c o r d o f b e i n g v e r y b i p a r t i s a n here. I can r e c a l l i n t h e l a t e '60s, e a r l y
'70s we had t h e ''3D approach'' t o h e a l t h c a r e . I t h i n k Durenberger, Dole and
D a n f o r t h . And I t h i n k we had t h e f o u r t h D; Domenici came i n a l i t t l e l a t e r .
And we were t r y i n g t o do many o f t h e t h i n g s t h a t you're d o i n g today, and we
worked t o g e t h e r w i t h Democrats and Republicans.
And I hope -- and I don't t h i n k t h e r e has been any e f f o r t t o
l a b e l people who may have q u e s t i o n s o r maybe disagreements. Maybe t h e y ' r e
d o c t o r s . Maybe t h e y ' r e h o s p i t a l a d m i n i s t r a t o r s . Maybe t h e y ' r e p h a r m a c i s t s .
Maybe t h e y ' r e i n s u r a n c e companies. I hope we j u s t don't w r i t e them o f f as
some s p e c i a l i n t e r e s t group. And maybe we have t o have a v i l l a i n , b u t I hope
t h a t we t r e a t t h e i r v o i c e s l i k e t h e v o i c e s o f a l l Americans who have r e a l
concerns about t h e program. They need t o be heard, and we need t o r e s p e c t
t h e i r thoughts.
So I a l s o want t o p u t i n a p l u g f o r t h i s committee. O b v i o u s l y , we
t h i n k i t ' s about t h e b e s t committee around. And we're v e r y proud o f i t s
l e a d e r s h i p , w i t h Senator Moynihan and Senator Packwood. They've r e s o l v e d some
of t h e t h i c k i e s t -- you know, t r i c k i e s t i s s u e s , most c o n t r o v e r s i a l i s s u e s ,
g e n e r a l l y i n a v e r y b i p a r t i s a n way and -- whether i t ' s w e l f a r e r e f o r m o r
r e w r i t i n g t h e t a x code i n 1986. And I b e l i e v e w i t h o u r h e l p we can h e l p
achieve b i p a r t i s a n consensus on h e a l t h c a r e . We know t h e r e a r e o t h e r
committees t h a t have o t h e r i n t e r e s t s and c e r t a i n l y w i l l have some
jurisdiction.
There a r e some disagreements. I mean, I t h i n k i t ' s f a i r l y obvious
t h e r e a r e some disagreements, mandates t h a t b o t h e r us even though you suggest
t h a t t h a t may n o t be such a b i g problem. I t h i n k we have t o l o o k a t o u r
s t a t e s . I n my s t a t e o f Kansas, 99.4 p e r c e n t o f t h e employers have 250
employees o r l e s s . Many -- most o f them a r e much, much l e s s -- 25, 35
employees. We o n l y have about 60 employers i n my s t a t e w i t h over 1,000
employees, and o n l y two o r t h r e e w i t h over 5,000. So -- and t h e r e a r e a l o t
of s t a t e s , as I l o o k around here, t h a t f i t t h a t same c a t e g o r y , s m a l l e r , r u r a l
states.
We may have a l i t t l e d i f f e r e n t view on some o f these areas. We're
concerned about p u r c h a s i n g monopolies, r i s k t o q u a l i t y and c h o i c e , and t h e
c r e a t i o n o f new e n t i t l e m e n t s . We c e r t a i n l y agree w i t h t h e hope t h a t we can
achieve enough savings t o have p r e s c r i p t i o n s and l o n g - t e r m care and t a k e care
of e a r l y r e t i r e e s , b u t a g a i n I t h i n k we have t o be v e r y s p e c i f i c about t h e
costs.
But I t h i n k f i n a l l y I would say t h a t whatever e l s e happens, t h i s
i s s u e i s a l l about h e a l t h care f o r American people. And I t h i n k we have t o
t a l k as h o n e s t l y as we can t o t h e American people -- no r o s y . s c e n a r i o s , no.. .
smoke and m i r r o r s , and no j u g g l i n g o f t h e books. That's t r u e o f us o r anybody
e l s e . Republicans o r t h e a d m i n i s t r a t i o n . Because t h e r e ' s no doubt about i t ,
somebody has t o s a c r i f i c e . And t h e t h i n g t h a t r e a l l y i n t e r e s t e d me was
�P r e s i d e n t C l i n t o n ' s s i x t h p o i n t he made, h i s s i x t h p r i n c i p l e -r e s p o n s i b i l i t y . I mean, my view i s i f we're g o i n g t o d e l a y r e s p o n s i b i l i t y f o r
10 years f o r i n d i v i d u a l s i n some cases, we may never have r e s p o n s i b i l i t y . And
i t seems t o me i f we want people t o b e t t e r use t h e system and save money i n
the system, t h e r e ' s g o t t o be some i n d i v i d u a l r e s p o n s i b i l i t y . We t h i n k t h a t ' s
p r e s e n t i n p r o b a b l y b o t h packages, b u t I t h i n k i t ' s v e r y i m p o r t a n t .
And I ' d j u s t say f i n a l l y , n o t t o p e r s o n a l i z e a n y t h i n g , b u t I ' v e
had a l o t o f h e a l t h care i n my l i f e and I know t h e importance o f i t , o f good,
a f f o r d a b l e , a c c e s s i b l e h e a l t h care, and I've even e x p e r i e n c e d when you d i d n ' t
have t h e money t o pay f o r i t , how i m p o r t a n t i t i s t o know how i t ' s g o i n g t o
be p a i d f o r . And I t h i n k many hundreds o f thousands, maybe m i l l i o n s o f
Americans have had s i m i l a r experiences.
So o u r g o a l s h o u l d be t o p r o v i d e q u a l i t y care f o r n e a r l y a l l
Americans. You s a i d some w i l l s l i p t h r o u g h t h e c r a c k s . No q u e s t i o n about i t .
We're n o t g o i n g t o be a b l e t o reach everyone. So I t h i n k we ought t o remember
the H i p p o c r a t i c p r i n c i p l e t h a t guides o u r h e a l t h care p r o v i d e r s -- do no
harm. I t h i n k we may do a l o t o f good, b u t -- ( i n a u d i b l e ) -- don't do any
harm.
And we don't want t o b u r y t h e American people under an avalanche
of bureaucracy. When we're t a l k i n g about r e i n v e n t i n g government, we don't
want t o r e i n v e n t bureaucracy. And I t h i n k t h e r e i s some concern when you have
t h i s v e r y p o w e r f u l , seven-member board, and when some o f t h e s t a t e s under t h e
h e a l t h a l l i a n c e w i l l be spending I don't know how many t i m e s more f o r t h e
h e a l t h p o r t i o n t h a n t h e y spend f o r -- t h e s t a t e spends f o r a l l i t s o t h e r
f u n c t i o n s , t h e e n t i r e budget. So i t ' s g o i n g t o be a b i g , b i g r e s p o n s i b i l i t y
to make c e r t a i n t h a t any new bureaucracy t h a t ' s c r e a t e d i s g o i n g t o work
w i t h o u t c a u s i n g a d d i t i o n a l h a r d s h i p s . Because one t h i n g t h a t I f i n d -- and I
don't t h i n k I'm any e x c e p t i o n -- i t ' s n o t Republican o r Democrat -- I don't
care how good t h e package sounds; t h e American people a r e concerned about b i g
government. And we're t a l k i n g about one-seventh o f o u r economy, 14, 15
p e r c e n t . And you may promise e v e r y t h i n g , f r e e t h i s and f r e e t h a t and f r e e
t h a t , b u t somehow when t h e government g e t s i n v o l v e d i n i t , people a r e v e r y
concerned, and I hope t h a t we can somehow work t o g e t h e r . We a r e p r e p a r e d t o
do t h a t , and we c e r t a i n l y a p p r e c i a t e your b e i n g here t h i s morning.
Thank you, Mr. Chairman.
SEN. MOYNIHAN: Thank you. Senator Dole.
Mrs. C l i n t o n would you l i k e t o -- ?
MRS. CLINTON: No, I j u s t want t o thank Senator Dole f o r t h e k i n d
of l e a d e r s h i p t h a t you've shown on t h i s i s s u e and your w i l l i n g n e s s t o work i t
t h r o u g h , j u s t as you s a i d . We do want t o p r e s e r v e what i s b e s t about t h e
American h e a l t h system and f i x what i s broken, and I t h i n k i f we have i n mind
t h a t t h a t ' s t h e approach we want t o t a k e and we t h e n r e a l l y h o l d up t o
s c r u t i n y a n y t h i n g we're g o i n g t o do-to see whether i t advances t h a t and . . _ ..
advances, I t h i n k , t h e g o a l s we a l l agree on o f s e c u r i t y and r e s p o n s i b i l i t y
and q u a l i t y and choice and s i m p l i c i t y and s a v i n g s , I'm v e r y c o n f i d e n t t h a t
we're g o i n g t o be a b l e t o come up w i t h b i p a r t i s a n support f o r a package t h a t
�w e ' l l a l l be a b l e t o advocate f o r . We may not a l l l i k e 100 p e r c e n t o f what's
i n i t , b u t i n t h e n a t u r a l course o f p u t t i n g i t t o g e t h e r , we w i l l have made
the r i g h t d e c i s i o n f o r t h e American people.
SEN. MOYNIHAN: L e t ' s s t a r t , t h e n , i n t h e s p i r i t t h a t Senator
M i t c h e l l and Senator Dole addressed, and which you and P r e s i d e n t C l i n t o n
have, on some o f t h e i s s u e s t h a t we as the Finance Committee have t o ask
ourselves.
The p r e s i d e n t on September 22nd had a group o f us down t o t h e
White House. You were t h e r e , Mr. M i t c h e l l was t h e r e and Mr. Dole was t h e r e ,
as were a number o f us, Mr. Chafee. And t h e p r e s i d e n t s a i d a t t h a t t i m e t h a t
he wanted t o b u i l d i n t o t h i s l e g i s l a t i o n what he c a l l e d a c o n t i n u i n g r e a l i t y
check. He spoke o f a system o f -- what k i n d o f m o n i t o r i n g system we b u i l d . I f
we might s t a r t t h a t r e a l i t y check r i g h t o f f , a t l e a s t f o r me t h e f i r s t
q u e s t i o n i s t h a t t h e a d m i n i s t r a t i o n seems t o contemplate a h e a l t h care system
i n the n a t i o n which has zero growth.
One o f t h e budget documents you've g i v e n us speaks o f h e a l t h -i t says, ''Health premiums are a l l o w e d t o grow a t t h e i n f l a t i o n r a t e over
t i m e ' ' -- t h a t ' s a quote -- which means t h e y don't grow a t a l l i n r e a l terms.
The b a s i c t a b l e i n t h e p r e l i m i n a r y document which we've had f o r
a couple o f weeks shows the p r i v a t e s e c t o r by t h e end o f t h i s decade growing
at CPI p l u s p o p u l a t i o n , which i s i n f l a t i o n p l u s p o p u l a t i o n , which i s no
growth, and Medicare and Medicaid a t CPI p l u s p o p u l a t i o n p l u s f o u r - t e n t h s of
one p e r c e n t . And I make t h e p o i n t t h a t Medicaid, f o r example, t h i s year i s
growing a t 16.5, so t h e r e ' s a change contemplated. The q u e s t i o n i s , how would
t h a t s u r v i v e a r e a l i t y check? Here are t h e numbers. Between 1960 and 1992,
the c u m u l a t i v e i n c r e a s e i n t h e CPI, t h e consumer p r i c e index, i s 375 p e r c e n t .
The c u m u l a t i v e i n c r e a s e i n medical p r i c e s i s j u s t about 875 p e r c e n t . So we
see p r i c e s behaving v e r y d i f f e r e n t l y , and p r i c e s do behave d i f f e r e n t l y . I n
t h a t p e r i o d t h e p r i c e s o f computers would have dropped 90 p e r c e n t . But i n the
main, u n l e s s -- i t ' s c o n c e i v a b l e t h a t i n n o v a t i o n i n medicine c o u l d t u r n out
t o be c o s t r e d u c i n g and l a b o r s a v i n g , but i t has not been.
And what are we t o say? Are we r e a l l y t h i n k i n g zero growth i n
cost?
MRS. CLINTON: Mr. Chairman, we are t h i n k i n g zero growth as a
budget t a r g e t t h a t t h i s c o u n t r y s h o u l d be moving toward, and l e t me, i f I
c o u l d , j u s t expand on s e v e r a l p o i n t s t h a t you made.
We b e l i e v e -- and I don't t h i n k you can f i n d any h e a l t h economist
o r s t u d e n t o f t h e h e a l t h care system who would d i s a g r e e -- t h a t t h e r e are
c o n s i d e r a b l e , s u b s t a n t i a l savings i n t h e e x i s t i n g system t h a t can be r e a l i z e d
b o t h on a one-time o n l y b a s i s and on a c o n t i n u i n g b a s i s . There are v a r y i n g
e s t i m a t e s as t o what those savings a r e . Dr. Koop says, f o r example, t h a t
based on t h e work he has done w i t h Dr. Jack Wynberg (sp) a t Dartmouth and
o t h e r s who have b e e n - s t u d y i n g - h e a l t h care e x p e n d i t u r e s t h a t t h e r e may be as
much as $200 b i l l i o n o f unnecessary c o s t s w i t h i n t h e h e a l t h care system. And
even i f we t a k e an e s t i m a t e below t h a t o r above i t , wherever i t comes o u t , we
know t h e r e are s u b s t a n t i a l one-time and c o n t i n u i n g savings i n t h e system.
�We a l s o know t h a t the r e o r g a n i z a t i o n o f h e a l t h care i n t o
d i f f e r e n t k i n d s o f ways o f d e l i v e r i n g i t t h a n we c u r r e n t l y r e l y on are much
more e f f i c i e n t , and t h e r e are many examples of t h a t , whether one looks a t the
Mayo C l i n i c p r o v i d i n g h i g h q u a l i t y h e a l t h care a t a cost t h i s y e a r o f an
i n c r e a s e o f o n l y 3.9 p e r c e n t -- which i s about t h e t a r g e t and s l i g h t l y below
the t a r g e t t h a t we have aimed f o r - - o r whether one l o o k s a t t h e g i a n t
C a l i f o r n i a pension and r e t i r e m e n t system t h a t i s now r e a l i z i n g savings
because o f t h e way i t has used i t s p u r c h a s i n g power t o achieve t h e k i n d s of
h e a l t h care r e d u c t i o n s i n the c o s t s of i n s u r a n c e , o r whether one looks a t the
c i t y i n y o u r s t a t e -- Rochester -- which i s a much b e t t e r o r g a n i z e d h e a l t h
care market t h a n most o f our c i t i e s , o r whether one l o o k s a t Medicare
expenditures.
You can l o o k a t d i f f e r e n t p a r t s o f our c o u n t r y where Medicare i s
d e l i v e r e d a t a c o s t r a n g i n g between one and t h r e e times g r e a t e r , so t h a t , f o r
example, i f you are i n Miami, F l o r i d a , you w i l l pay t h r e e times f o r a
Medicare p a t i e n t what you would pay i n t h e s t a t e o f Wisconsin. To use one of
Senator Durenberger's f a v o r i t e examples, i f you are i n D u l u t h , Minnesota, you
w i l l t a k e care o f a Medicare p a t i e n t a t o n e - h a l f t h e c o s t of what i s t h e cost
i n P h i l a d e l p h i a . And t h e r e are many, many examples o f t h a t . And t h e r e i s no
d e m o n s t r a t i o n o f any l e s s q u a l i t y b e i n g g i v e n t o t h e Medicare p a t i e n t who i s
taken care o f a t l e s s o f a c o s t .
One o f the t h i n g s t h a t you and I have had the o p p o r t u n i t y t o t a l k
about i n t h e p a s t i s what i s the r e a l i t y o f h e a l t h care c o s t i n c r e a s e s around
the w o r l d , which i s t h a t h e a l t h care has, as a s e r v i c e which i s l a b o r
i n t e n s i v e , i n c r e a s e d when o t h e r goods and s e r v i c e s have achieved p r o d u c t i v i t y
decreases. And your computer example i s a p e r f e c t example. And one o f t h e
d i f f e r e n c e s , though, i n our h e a l t h care s e c t o r t h a n i n those w i t h whom we
compete i s t h a t even though t h e i r increases have c o n t i n u e d , we have grown a t
a much g r e a t e r r a t e o f i n c r e a s e w i t h o u t c o v e r i n g everybody i n a u n i v e r s a l
system t h a t would p r e v e n t cost s h i f t i n g .
And I would argue t h a t , you know, the economic t h e o r y o f the cost
disease, w h i c h you know so w e l l , which p o i n t s out t h e d i f f e r e n c e i n s e r v i c e
and l a b o r - i n t e n s i v e s e r v i c e s , o f t e n uses t h e example t h a t a Mozart q u a r t e t
b e i n g p l a y e d i n t h e 18th c e n t u r y and b e i n g p l a y e d i n t h e 20th c e n t u r y s t i l l
r e q u i r e s f o u r people. There's no p r o d u c t i v i t y i n c r e a s e i f you're g o i n g t o
p l a y t h a t q u a r t e t . The problem w i t h t h e American h e a l t h care system i s i f you
can imagine t h a t q u a r t e t has added people t o h o l d t h e c h a i r s , t o hand t h e
v i o l i n s i n , and has r e q u i r e d t h e musicians t o s t o p a t t h e t h i r d o r f o u r t h
page o f t h e music t o c a l l somebody t o make sure t h e y can go on t o the next
bar.
And t h a t i s t h e k i n d o f waste and i n e f f i c i e n c y t h a t permeates our
h e a l t h care system, and we b e l i e v e v e r y s t r o n g l y t h a t i f we don't s e t the
k i n d o f v e r y s t r o n g g o a l s t h a t we can achieve i n b o t h t h e p u b l i c and t h e
p r i v a t e s e c t o r , we w i l l c o n t i n u e t o reward t h i s piecework, i n e f f i c i e n t
d e l i v e r y system t h a t does not guarantee q u a l i t y a t a l l . I t h i n k most o f us on
t h i s committee would be more than pleased t o get a l l o f our h e a l t h care from
�a Mayo C l i n i c , and we would get i t a t much l e s s o f a c o s t than i f we went t o
many o f t h e h o s p i t a l s w i t h i n a few m i l e s o f t h i s b u i l d i n g .
SEN. MOYNIHAN: Mrs. C l i n t o n , I have t o say t o you t h e o n l y t h i n g
t h a t you -- the one o p t i o n you have not considered s u f f i c i e n t l y i n t h i s whole
p l a n i s i f we"can j u s t move every -- h a l f the p o p u l a t i o n t o Minnesota, h a l f
t o Hawaii, o u r problems would be s o l v e d . (Laughter.)
MRS. CLINTON: W e l l , you know, Mr. Chairman, we have laughed t h a t
i f you l o o k a t c o s t d i f f e r e n t i a l s around t h i s c o u n t r y , l i t e r a l l y you c o u l d
p r o v i d e cheaper h e a l t h care i n o u r f e d e r a l programs i f you handed people
r o u n d - t r i p , f i r s t c l a s s a i r f a r e t i c k e t s t o f l y t o Rochester, New York, o r
Rochester, Minnesota o r many o f the o t h e r f i n e i n s t i t u t i o n s t h a t d e l i v e r
h i g h - q u a l i t y h e a l t h care a t l e s s o f a c o s t .
SEN. MOYNIHAN: W e l l , Senator Durenberger does not say o t h e r w i s e .
A v o t e has been c a l l e d , Mrs. C l i n t o n . And t h i s i s u n f o r t u n a t e ,
but we're a t the end o f a f i s c a l year. There a r e two v o t e s . I f we h o l d t i l l
11:15, we c o u l d a l l be back.
(Off mike d i s c u s s i o n . )
The committee w i l l recess, stand i n recess u n t i l 11:15.
(Recess.)
SEN. MOYNIHAN: The hour o f 11:15 having come and somewhat passed,
we welcome once a g a i n the f i r s t l a d y t o t h i s f i n a l h e a r i n g -- f i n a l h e a r i n g
which she w i l l address - - o n the H e a l t h Care A c t o f 1993. I would note t h a t
we don't have a b i l l as y e t , but o f course, i n due t i m e , we w i l l do.
And o u r next -- i n o u r o r d i n a r y sequence, so we t u r n t o t h e
former chairman and r a n k i n g m i n o r i t y member. Senator Packwood.
SEN. PACKWOOD: Mr. Chairman, I understand we're g o i n g t o h o l d
p r e t t y c l o s e l y t o o u r f i v e - m i n u t e r u l e -SEN. MOYNIHAN: We are g o i n g t o s t a y t o t h a t r u l e , s i r .
SEN. PACKWOOD: Okay. Very q u i c k l y on a b o r t i o n , and then I ' l l
move on t o something e l s e . W i l l the p r e s i d e n t ' s b i l l -- i t i n c l u d e s
p r e g n a n c y - r e l a t e d s e r v i c e s -- w i l l i t i n c l u d e a b o r t i o n ?
MRS. CLINTON: I t w i l l i n c l u d e p r e g n a n c y - r e l a t e d s e r v i c e s , and
t h a t w i l l i n c l u d e a b o r t i o n i n plans as insurance p o l i c i e s c u r r e n t l y do.
SEN. PACKWOOD: Good. Now, the new e n t i t l e m e n t s . And here's t h e
problem w i t h t r y i n g t o e s t i m a t e c o s t . A l l medical s e r v i c e s seem t o be d r i v e n
more by volume t h a n t h e y do by p r i c e on occasion. You've got a p r o v i s i o n
where you're g o i n g t o p i c k up 80 percent o f the r e t i r e m e n t c o s t s f o r those
between 55 and 64 t h a t a r e now b e i n g p a i d f o r by the company. Do I have i t
right?
MRS. CLINTON: Yes.
SEN. PACKWOOD: Okay. Now, you're the company, and you've got a
30-year p l a n . Somebody age 55 can r e t i r e , and t h e y get $1,000 a month. And
t h e i r h e a l t h p l a n c o s t s $300 a month t o c a r r y them. And t h e company's having .
t o s h r i n k . I t ' s g e t t i n g more p r o d u c t i v e . So i t says t o t h i s person, ' ' S a l l y ,
Joe, l i s t e n , I ' l l make you a d e a l . I ' l l sweeten t h i s o f f e r and w e ' l l g i v e you
$1,100 a month t o r e t i r e . ' ' And Joe o r S a l l y says, ''Well.'' ''And no change
�i n your h e a l t h p l a n . ' ' S a l l y o r Joe says, ''Great.'' The government p i c k s up
$240 o f t h e 300. How do you -- and, t h e r e f o r e , t h e company saves money. How
do you e s t i m a t e ahead o f t i m e what t h e volume o f t h a t i s g o i n g t o be?
MRS. CLINTON: Senator, we have t r i e d w i t h t h e a s s i s t a n c e o f t h e
Treasury Department and t h e O f f i c e o f Management and Budget and HCFA and a l l
of t h e o t h e r government a c t u a r i e s t o make t h e v e r y best c a l c u l a t i o n s we can.
And we've c o s t e d t h a t o u t t o be about a $4-1/2 b i l l i o n annual c o s t . And -SEN. PACKWOOD: But how do you g e t there? How do you know?
MRS. CLINTON: W e l l , you know, as you p o i n t e d o u t r i g h t l y i n your
opening statement, t h e r e i s a l o t o f e s t i m a t i n g t h a t goes on w i t h h e a l t h
care, and t h e r e ' s no p r e c i s i o n a t t a c h e d t o i t . But we have l o o k e d a t b o t h
r a t e s o f r e t i r e m e n t and r a t e s o f r e t i r e m e n t when b e n e f i t s were o f f e r e d l i k e
e a r l y r e t i r e m e n t bonus packages and have used those f i g u r e s i n terms o f t h e
percentage o f t h e w o r k f o r c e w i l l i n g t o go i n t o r e t i r e m e n t . Now, t h e company
w i l l , as you p o i n t o u t , s t i l l bear some o f t h a t r e s p o n s i b i l i t y . A number o f
e a r l y r e t i r e e s go t o work somewhere e l s e o r s t a r t t h e i r own s m a l l business.
So t h e r e w i l l c o n t i n u e t o be c o n t r i b u t i o n s coming i n t h a t r e g a r d .
We have done t h e best we can a t e s t i m a t i n g i t , and I ' l l be happy
t o l a y o u t a l l o f t h e e s t i m a t i n g t h a t has gone on based on t h e f i g u r e s t h a t
are a v a i l a b l e t o us. But I don't know t h a t anyone can t e l l you how p r e c i s e
t h a t i s t o what percentage o r decimal p o i n t . But we have s a t i s f i e d o u r s e l v e s
t h a t we have t h e best p o s s i b l e e s t i m a t e , g i v e n t h i s p o l i c y .
SEN. PACKWOOD: A second example r e l a t e d t o t h e same s i t u a t i o n .
We're g o i n g t o p i c k up t h e c o s t f o r p r e s c r i p t i o n drugs f o r Medicare. Somebody
on Medicare goes t o t h e d o c t o r , and t h e d o c t o r says, ''Well, go home and take
two a s p i r i n . ' ' And t h e person says, ''Doc, can't you g i v e me a
p r e s c r i p t i o n ? ' ' And t h e d o c t o r says, ''Well, sure.'' And i t ' s p a i d f o r now.
How do you a v o i d t h i s ? I mean, t h a t i s n a t u r a l human n a t u r e . How do you
estimate that?
MRS. CLINTON: W e l l , you're r i g h t t h a t t h e r e has been t h a t k i n d o f
s i t u a t i o n , b u t we don't b e l i e v e t h a t i t w i l l be i n c r e a s e d t h r o u g h t h i s . I n
f a c t , what we t h i n k i s t h a t we w i l l b e g i n t o g e t a b e t t e r handle on
c o n t r o l l i n g p r e s c r i p t i o n c o s t s and c o n t r o l l i n g t h e h o s p i t a l i z a t i o n and o t h e r
r e l a t e d h e a l t h care c o s t s t h a t a r e due t o inadequate p r e s c r i b i n g o r t h e
i n a b i l i t y t o pay f o r p r e s c r i p t i o n s . And l e t me j u s t g i v e you an example.
Based on t h e i n f o r m a t i o n a v a i l a b l e t o us, i t i s e s t i m a t e d t h a t a p p r o x i m a t e l y
23 p e r c e n t o f Medicare r e c i p i e n t s a r e a d m i t t e d t o t h e h o s p i t a l because o f
problems h a v i n g t o do w i t h p r e s c r i p t i o n s .
Some o f i t i s c r o s s - m e d i c a t i o n , where one d o c t o r doesn't know
what t h e o t h e r d o c t o r i s g i v i n g and t h e r e ' s no o r g a n i z e d managed care system
t o keep t r a c k o f t h a t . So t h e p a t i e n t goes and g e t s one t h i n g f o r one and
t h e n something e l s e , and those i n t e r a c t , and nobody even know t h a t she was
t a k i n g b o t h . Some o f i t i s due t o what happens now v e r y o f t e n when a
p r e s c r i p t i o n i s g i v e n t o an o l d e r c i t i z e n ; t h e y can't a f f o r d t o do i t i n t h e
way t h a t t h e p i l l s say. For example, take f o u r times a day and t h e n g e t
r e f i l l e d . So t h e y s e l f - m e d i c a t e , and t h e y take one a day because t h e y t h i n k
�it'll
l a s t f o u r times as l o n g and t h e y end up back i n the h o s p i t a l .
So i f you l o o k a t the c o s t s we are c u r r e n t l y i n c u r r i n g because o f
m e d i c a t i o n - r e l a t e d problems, we t h i n k we w i l l a c t u a l l y be s a v i n g money. And
t h e r e may be, as you p o i n t out r i g h t l y , the o c c a s i o n a l example where somebody
wants a p r e s c r i p t i o n i n s t e a d of t a k i n g a s p i r i n s . We t h i n k t h a t i s outweighed
by the k i n d of b e n e f i t s t h a t b e t t e r m e d i c a t i o n w i l l p r o v i d e i n terms o f
b e t t e r h e a l t h care a t more of a c o s t - e f f e c t i v e d e l i v e r y t h a n the k i n d of
h o s p i t a l i z a t i o n t h a t r e s u l t s now from the inadequacies.
SEN. PACKWOOD: The l a s t q u e s t i o n on my f i r s t go-around. You v ^ r y
k i n d l y -- the a d m i n i s t r a t i o n v e r y k i n d l y g r a n t e d Oregon's Medicaid waiver
when we c o u l d not get i t from the p r e v i o u s a d m i n i s t r a t i o n . And Oregon has set
up a p r i o r i t i z e d l i s t of medical s e r v i c e s , and from number one t o number 686
as I r e c a l l . And number one i s the one t h a t ' s most l i k e l y t o make you w e l l .
And -- i n f a c t , some a t the bottom we're not g o i n g t o do a n y t h i n g a t all;:because t h e r e i s known t r e a t m e n t . There's no p o i n t i n spending money on
something t h a t no one t h i n k s w i l l work. But p a r t of what's i n t h e r e a l s o i s
c o s t i s p a r t o f the f a c t o r of c o n s i d e r a t i o n . And as you might expect, v e r y
h i g h on the l i s t are p r e v e n t i v e s e r v i c e s . I t ' s cheap medicine, and i t works
v e r y w e l l and pays o f f bundles i n the end. But i t i s a r a n k i n g of procedures
below which we won't pay f o r some. Do you t h i n k the n a t i o n ought t o be moving
in that direction?
MRS.
CLINTON: I t h i n k t h a t the n a t i o n i s i m p l i c i t l y moving i n
t h a t d i r e c t i o n every day i n the f a c t t h a t we r a t i o n care t o many c i t i z e n s who
e i t h e r cannot a f f o r d i t o r access i t too l a t e f o r i t t o do them any good.
Dr. Koop t o l d me the o t h e r day t h a t an u n i n s u r e d p a t i e n t who
e n t e r s the h o s p i t a l w i t h the same a i l m e n t as an i n s u r e d p a t i e n t i s t h r e e
t i m e s more l i k e l y t o d i e t h a n the i n s u r e d p a t i e n t . That's the most dramatic
example o f the d e c i s i o n s t h a t are c u r r e n t l y g o i n g on i n our h e a l t h care
system.
And I b e l i e v e t h a t as we change the i n c e n t i v e s i n our h e a l t h care
system t o t h a t we don't reward d o i n g procedures f o r which t h e r e i s no known
c l i n i c a l e f f i c a c y i n the way t h a t i t i s b e i n g performed or the cost f a r
outweighs any k i n d of b e n e f i t any p a t i e n t c o u l d d e r i v e , d o c t o r s w i l l be
making those d e c i s i o n s , and p a t i e n t s w i l l be more u n d e r s t a n d i n g of them because t h e y won't be made i n a k i n d of a r b i t r a r y way but as a r e s u l t of the
b e t t e r k i n d of d e c i s i o n - m a k i n g we would l i k e t o see as a h a l l m a r k of the
h e a l t h care system.
SEN. PACKWOOD: Thank you, Mrs. C l i n t o n .
Thank you, Mr. Chairman.
SEN. MOYNIHAN: Thank you. Senator Packwood.
Senator Baucus.
SEN. MAX BAUCUS (D-MT): Thanks v e r y much, Mr. Chairman.
Mrs. C l i n t o n , a l l of us commend and p r a i s e you and the p r e s i d e n t .
I t h i n k i t ' s c l e a r t h a t our c o u n t r y ' s on the verge of making a t r u l y h i s t o r i c
s t e p which w i l l not o n l y b e n e f i t the people i n d i v i d u a l l y but g i v e them h e a l t h
care t h a t t h e y do not now have a t lower c o s t , but even i n a more fundamental
�sense make American people f e e l even b e t t e r about the c o u n t r y , o u r s e l v e s as a
people, because we w i l l be j o i n i n g the ranks o f o t h e r n a t i o n s where h e a l t h
care i s e s s e n t i a l l y a r i g h t . I t ' s something t h a t a l l o f us as c i t i z e n s are
e n t i t l e d t o . And you are t r y i n g t o s t e e r us i n t h a t d i r e c t i o n , t h e p r e s i d e n t
i s t r y i n g t o s t e e r us i n t h a t d i r e c t i o n , and we a l l are tremendously g r a t e f u l
and a p p r e c i a t i v e o f t h e e f f o r t s you're t a k i n g . I t ' s t r u l y monumental, i t ' s
t r u l y h i s t o r i c , and i t ' s w o n d e r f u l t h a t we're d o i n g t h i s .
As we move i n t h i s d i r e c t i o n , each o f us has unique concerns
because we do, a f t e r a l l , r e p r e s e n t d i f f e r e n t s t a t e s . One o f t h e main
concerns i n our p a r t o f t h e c o u n t r y i s r u r a l h e a l t h care, as you w e l l know.
And the problem, r e a l l y , i s -- i t ' s c o s t and i t ' s a l s o access. I t ' s b o t h . I n
Montana, f o r example, over t h e l a s t decade h e a l t h care c o s t s f o r t h e average
Montana f a m i l y rose 400 p e r c e n t f a s t e r than wages. I n a d d i t i o n , i n Montana we
spend about $3,000 a year per f a m i l y on h e a l t h care, and our average income
per f a m i l y i s about $28,000: one o f the lowest i n t h e n a t i o n . And access,
t o o , i s a major problem.
I t h i n k h a l f o f t h e c o u n t i e s i n the s t a t e o f Montana have no d o c t o r s who w i l l
d e l i v e r b a b i e s , and t h e r e are many c o u n t i e s w i t h no d o c t o r s whatsoever. And
i t ' s -- I t h i n k i t ' s e i g h t c o u n t i e s . We have 56 c o u n t i e s . But e i g h t j u s t have
no p h y s i c i a n s whatsoever.
I know t h e r e are many p r o v i s i o n s i n your p l a n which v e r y d i r e c t l y
address r u r a l h e a l t h care, and when you were v i s i t i n g Montana i n A p r i l -- t o
B i l l i n g s , Montana and t o Great F a l l s , Montana --we were a l l v e r y impressed
w i t h your u n d e r s t a n d i n g and sense o f the n a t u r e o f t h e r u r a l communities i n
the West when you c o i n e d a phrase, f r a n k l y , t h a t ' s become v e r y p o p u l a r when
you s a i d ''Hey, t h i s i s not j u s t o r d i n a r y r u r a l America, t h i s i s
h y p e r - r u r a l , ' ' you s a i d , ' ' t h i s i s mega- r u r a l . ' ' And i t i s t r u e . The r u r a l
communities i n t h e West are f a r t h e r away than are r u r a l communities, say, i n
the East. And c o u l d you j u s t go over what you p l a n t o do and what t h i s p l a n
c o n t a i n s t h a t v e r y d i r e c t l y addresses the concerns o f many Americans who are
i s o l a t e d and who pay v e r y h i g h c o s t s today because t h e y ' r e unable t o e n j o y
the b e n e f i t s o f -- are unable t o e n j o y t h e b e n e f i t s t h a t people i n t h e c i t i e s
have?
MRS. CLINTON: Senator, I would happy t o , and I am v e r y g r a t e f u l
f o r t h e o p p o r t u n i t y t h a t I had t o go w i t h you t o Montana. I care deeply about
r u r a l h e a l t h care. The f i r s t t h i n g I ever d i d when I found myself i n 1979
b e i n g m a r r i e d t o t h e governor o f a s t a t e t h a t was p r e d o m i n a n t l y r u r a l was t o
work on a t a s k f o r c e t o t r y t o improve access t o r u r a l h e a l t h care i n
Arkansas. But as I t o l d you, t h e r e i s r u r a l h e a l t h care, and t h e n t h e r e i s
r u r a l h e a l t h care, and some o f the d i f f i c u l t i e s t h a t you face i n Montana are
even more d r a m a t i c t h a n what we f a c e d i n Arkansas i n t r y i n g t o make sure
access was r e a l f o r our people.
We have g i v e n a l o t o f time and a t t e n t i o n t o t h i s , and.there are
a number o f ways t h a t we b e l i e v e i t should be addressed.
The f i r s t i s t h a t t h e r e i s a h i g h e r p r o p o r t i o n o f u n i n s u r e d
Americans i n r u r a l areas than t h e r e i s i n any o t h e r p a r t o f our c o u n t r y .
�That, combined w i t h a h i g h e r than average p r o p o r t i o n o f t h e e l d e r l y , places
the p r i m a r y burden on f i n a n c i n g h e a l t h care i n many r u r a l areas on t h e backs
of Medicare and t h e u n i n s u r e d . Through u n i v e r s a l coverage, we w i l l be
p r o v i d i n g more resources f o r reimbursement i n t h e r u r a l areas by e n s u r i n g
'that t h e r e a r e no u n i n s u r e d and t h a t t h e r e a r e c o n t r i b u t i o n s made t h a t w i l l
be a v a i l a b l e f o r r e i m b u r s i n g f o r c a r e .
Secondly, we b e l i e v e t h e r e s h o u l d be what we c a l l e s s e n t i a l
p r o v i d e r s i n b o t h underserved r u r a l and underserved urban areas t h a t a r e
. t a r g e t e d f o r a d d i t i o n a l f u n d i n g because o f t h e d i f f i c u l t y o f b e i n g a b l e t o
support emergency f a c i l i t i e s o r h o s p i t a l f a c i l i t i e s i n many r u r a l areas, even
though we might now have a b e t t e r - i n s u r e d p o p u l a t i o n t o take advantage o f
those.
The t h i r d i s we want t o p r o v i d e more p h y s i c i a n s and nurses and
i o t h e r a l l i e d h e a l t h care p r o f e s s i o n a l s i n r u r a l areas. And we have t a r g e t e d
a s s i s t a n c e t o p h y s i c i a n s and nurses, p a r t i c u l a r l y advanced p r a c t i c e nurses t o
^ go i n t o r u r a l areas i n r e t u r n f o r h a v i n g e d u c a t i o n a l loans p a i d back o r even
f o r g i v e n . We a l s o want t o be sure t h a t o t h e r s t a t e s do what Montana has done,
which i s t o make i t p o s s i b l e t o keep emergency rooms open even though a
d o c t o r may n o t be t h e r e , by p e r m i t t i n g t h e laws t o p e r m i t t h a t k i n d o f
e n t e r p r i s e where emergency t e c h n i c i a n s , p h y s i c i a n a s s i s t a n t s , and advanced
; p r a c t i c e nurses a r e a v a i l a b l e i n r u r a l areas t h a t are o t h e r w i s e t o t a l l y
inaccessible.
We a l s o b e l i e v e t e c h n o l o g y can p l a y a major r o l e i n b r i n g i n g
s t a t e - o f - t h e - a r t medical care t o r u r a l areas, and we have seen some
remarkable examples o f t h a t . There a r e now some good models b e i n g used where
over hundreds o f m i l e s an x - r a y can be read b e i n g h e l d i n a d o c t o r ' s o f f i c e
i n a r u r a l area a t an urban medical c e n t e r . And i t can be done over e x i s t i n g
equipment t h a t i s n o t v e r y expensive r i g h t now. We want t o p r o v i d e i n c e n t i v e s
f o r moving i n t h a t d i r e c t i o n .
So, those a r e some o f t h e t h i n g s t h a t we t h i n k w i l l enhance r u r a l
care, b u t I would j u s t add, as you w e l l know. Senator, t h a t i t i s v e r y
d i f f i c u l t t o imagine how, i n many o f our r u r a l areas, t h e r e w i l l ever be a
s u f f i c i e n t level of competition that w i l l realize the kind of e f f i c i e n c i e s
t h a t we expect t o see i n urban and suburban areas. And I t h i n k we have t o
c o n t i n u e t o be v e r y s e n s i t i v e t o t h e needs i n t h e r u r a l communities t o make
sure t h a t t h e r e i s a base l e v e l o f d e l i v e r y o f h i g h - q u a l i t y care a v a i l a b l e
f o r every American no m a t t e r where t h a t American l i v e s .
SEN. BAUCUS: Thank you v e r y much, Mrs. C l i n t o n .
I might say, Mr. Chairman, i t ' s my b e l i e f , a f t e r s t u d y i n g t h e
p l a n , t h a t h e a l t h care i n r u r a l America w i l l be b e t t e r t h a n t h e s t a t u s quo,
s i g n i f i c a n t l y b e t t e r t h a n t h e s t a t u s quo.
MRS. CLINTON: Thank you. Senator.
SEN. MOYNIHAN: Thank you, Senator Baucus.
Senator Roth.
SEN. WILLIAM V. ROTH, JR. (R-DE): I t ' s a g r e a t p l e a s u r e t o
welcome you here, Mrs. C l i n t o n .
�One o f t h e g r e a t concerns, o f course, i s coverage o f t h e
u n i n s u r e d . And, as you know, I've been v e r y much i n t e r e s t e d i n t h e
p o s s i b i l i t i e s o f u s i n g t h e f e d e r a l employee h e a l t h b e n e f i t program as a means
of p r o v i d i n g coverage t o m i l l i o n s o f u n i n s u r e d who a r e w o r k i n g f o r s m a l l
business.
I ' d p o i n t o u t t h a t t h i s has been a v e r y s u c c e s s f u l program. For
example, t h i s year, i t s c o s t i s o n l y i n c r e a s i n g 3 p e r c e n t , w e l l below t h e
average. I n f a c t , 4 0 p e r c e n t a r e g e t t i n g a decrease. They a r e adding
p r e v e n t i v e measures t o i t . So, i t ' s a program t h a t I t h i n k can be s a i d t h a t
i s working very w e l l .
I t was my i d e a t h a t we would open t h i s up t o s m a l l business so
t h a t t h e y c o u l d p r o v i d e i n s u r a n c e a t t h e same low p r i c e s , I t h i n k r o u g h l y
$577 f o r t h e i n d i v i d u a l , $1,000 -- a l i t t l e over $1,000 f o r a f a m i l y . T h i s
has n o t been i n c l u d e d as p a r t o f t h e p l a n . I would ask -- I would hope t h a t
you would t a k e a second l o o k a t i t , as i t does seem t o me a means o f
p r o v i d i n g coverage. You've g o t a network t h a t covers t h e r u r a l areas as w e l l
as t h e urban. I t would n o t r e q u i r e t h e c r e a t i o n o f
a new bureaucracy. And y e t , we c o u l d g i v e good coverage. So, I wonder i f you
would care t o comment on t h a t .
MRS. CLINTON: Senator, you're a b s o l u t e l y r i g h t t h a t t h e k i n d o f
program t h a t t h e f e d e r a l employees h e a l t h b e n e f i t s program p r o v i d e s i s t h e
model f o r what we a r e a t t e m p t i n g t o do n a t i o n a l l y . We have l o o k e d v e r y
c l o s e l y a t t h a t . And as you know, t h e f e d e r a l government pays a c o n s i d e r a b l e
p o r t i o n o f t h e share f o r t h e employee. And r e a l l y , t h e i d e a o f t h e a l l i a n c e
t h a t u n d e r l i e s o u r program i s again t h a t a l l employers would, i n e f f e c t ,
f o l l o w t h e model o f t h e f e d e r a l government and p o o l t h e i r resources t o
r e a l i z e t h e same k i n d o f g a i n s t h a t you p o i n t o u t t h i s program has achieved.
We t h i n k t h a t a l t h o u g h i t i s a good model and one t h a t we have
l e a r n e d a l o t from, t h a t i n i t s c u r r e n t c o n d i t i o n , i t would n o t meet a l l o f
the needs we have t o reach u n i v e r s a l coverage. I f you would l i k e us t o l o o k
f u r t h e r a t whether g i v e n t h e same p r o p o r t i o n a t e s h a r i n g , I t h i n k i t ' s 70/30
now, t h a t i f a l l employers were w i l l i n g t o have a 70/30 s p l i t , how many
employers c o u l d be covered and what t h e problems w i t h access would be, we
w i l l g i v e you a r e p o r t on t h a t . We have l o o k e d a t t h a t . I don't have a l l o f
t h a t i n f o r m a t i o n w i t h me.
But we do b e l i e v e t h a t u s i n g t h a t as a model i s what we have
t r i e d t o do, and t h a t many o f t h e best f e a t u r e s o f t h a t f e d e r a l program w i l l
be i n t h e n a t i o n a l program t h a t t h e p r e s i d e n t has proposed. But w e ' l l be
happy t o p r o v i d e you more s p e c i f i c i n f o r m a t i o n o f t h e p l u s e s and t h e minuses
t h a t we c a l c u l a t e d a f t e r l o o k i n g a t i t as t h e way t h a t you had recommended
b e i n g a v a i l a b l e f o r b u y - i n s on t h e same b a s i s .
SEN. ROTH: One o f t h e advantages, as I mentioned, o f course, i s
you don't have t o c r e a t e a new bureaucracy. And my u n d e r s t a n d i n g i s t h a t - you are k e e p i n g t h e p o s t a l employees i n i t s c u r r e n t form. So, t h e r e i s some
precedent f o r keeping t h i s k i n d o f a program.
I ' d l i k e t o t u r n f o r a moment t o t h e q u e s t i o n o f -- r e a l l y a two-
�p a r t q u e s t i o n . I t h i n k we're a l l concerned about how we pay f o r i t . And,
c e r t a i n l y , a l o t o f t h e c a l l s t h a t I am g e t t i n g from home a r e , what's going
t o happen t o Medicare? There's a l o t of -- a Mrs. S t r e e t s ( s p ) , f o r example,
i s w o r r i e d about what's g o i n g t o happen t o her p r o p o s a l and so f o r t h . I t h i n k
t h a t t h e r e are some s e r i o u s q u e s t i o n s i n t h i s area as t o the s'avings. As I
understand i t , you expect t o save something l i k e 20 p e r c e n t o f t h e i n c r e a s e d
c o s t s over t h e next f i v e y e a r s . I n t h e judgment o f many people, t h a t cannot
be j u s t made from e l i m i n a t i n g waste, f r a u d and abuse, but would r e q u i r e v e r y
s u b s t a n t i a l c u t s . What i s t h e answer t o t h i s ? Because Medicare o b v i o u s l y i s
of g r e a t importance t o t h e s e n i o r c i t i z e n .
And t h i s b r i n g s me t o t h e second p a r t o f t h e q u e s t i o n , because,
as was s a i d e a r l i e r , a l o t o f these e s t i m a t e s are r e a l l y g u e s s t i m a t e s . I
mean, t h e y ' r e t h e best you can g e t , but t h e r e ' s no assurance o f t h e i r
accuracy. Would we be wise t o t r y some d e m o n s t r a t i o n programs b e f o r e we move
nationwide? We're t a l k i n g about a seventh o f t h e economy. We're t a l k i n g about
j o b s , so t h a t whatever we do w i l l i n f l u e n c e not o n l y t h e q u a l i t y and k i n d of
h e a l t h c a r e , but t h e economy and growth o f j o b s .
Are we wise t o p u t i t i n n a t i o n w i d e , o r would i t -- i s t h e r e any
m e r i t t o t h e i d e a o f t r y i n g some o f these p r o p o s a l s f i r s t on a d e m o n s t r a t i o n
basis?
MRS. CLINTON: W e l l , Senator, I t h i n k i t ' s v e r y i m p o r t a n t t o be
c a u t i o u s and t o be v e r y c a r e f u l , but I would respond by s a y i n g t h e r e are many
examples around t h e c o u n t r y o f h i g h - q u a l i t y care b e i n g g i v e n t o Medicare
r e c i p i e n t s a t much l e s s o f a c o s t t h a n i n o t h e r p a r t s o f the c o u n t r y . I n
e f f e c t , we have d e m o n s t r a t i o n p r o j e c t s . We can p o i n t
t o a number o f s t a t e s and a number of communities where Medicare
r e c i p i e n t s are t a k e n care o f v e r y w e l l a t o n e - h a l f o r o n e - t h i r d the c o s t of
Medicare r e c i p i e n t s i n t h e e x a c t l y same s i t u a t i o n but i n another p a r t o f our
c o u n t r y . And what we f e a r i s t h a t i f we don't b u i l d on what we know works,
which i s changing t h e i n c e n t i v e s i n our h e a l t h care system, b e t t e r o r g a n i z i n g
t h e way h e a l t h care i s d e l i v e r e d , and persuading people t h a t t h e y w i l l get
h i g h - q u a l i t y care i f t h e i r p h y s i c i a n s and t h e i r h o s p i t a l s are making t h e
d e c i s i o n s i n s t e a d o f insurance companies and government b u r e a u c r a t s , t h a t we
w i l l o n l y f a l l f u r t h e r and f u r t h e r behind t h e c o s t curve.
So I b e l i e v e -- and I w i l l be, again, v e r y happy t o share t h i s
i n f o r m a t i o n w i t h you -- t h e r e are a number o f examples a l l over t h e c o u n t r y
of what works, which i s why we f e e l c o n f i d e n t , as does Senator Chafee i n h i s
p r o p o s a l , t h a t we can reduce t h e r a t e of i n c r e a s e i n Medicare w i t h o u t
undermining q u a l i t y f o r Medicare r e c i p i e n t s . I don't t h i n k you would f i n d the
p r e s i d e n t , I know you wouldn't f i n d any of t h e senators on t h i s committee
s u p p o r t i n g t h a t r a t e of r e d u c t i o n i f they thought i t would i n any way h u r t my
mother o r any of your f a m i l y members. But we have t o o many examples now of
how i t can be done b e t t e r a t lower .cost. w i t h , t h e same-or b e t t e r . q u a l i t y a n d
t h a t ' s what we're c o u n t i n g on the r e s t o f t h e c o u n t r y b e i n g a b l e t o do as
well.
SEN. ROTH: W e l l , I would o n l y add we do have a number o f
�p r o p o s a l s . We have t h e Chafee, we have t h e C l i n t o n p l a n . I guess my q u e s t i o n
i s would i t be wise t o t r y those o u t f i r s t , because I don't t h i n k a n y t h i n g i s
e x a c t l y t h e same t h a t ' s i n o p e r a t i o n a t t h e c u r r e n t t i m e .
MRS. CLINTON: I t h i n k b o t h o f them. Senator, r e c o g n i z e t h a t u n t i l
we g e t t b u n i v e r s a l coverage, we do n o t i n any way c o n t r o l o u r h e a l t h care
d e s t i n y , because we have t o o many d e c i s i o n s t h a t a r e s t i l l made f o r t h e wrong
reasons. But I t h i n k b o t h i n t h e Senate Republican approach as w e l l as t h e
p r e s i d e n t ' s , i t r e s t s on v e r y s t r o n g evidence t h a t we can do t h i s b e t t e r and
t h a t we a r e n o t g o i n g t o s a c r i f i c e q u a l i t y o r care f o r o u r c i t i z e n s .
SEN. ROTH: Thank you, Mr. Chairman.
SEN. MOYNIHAN: Thank you. Senator Roth.
Senator R o c k e f e l l e r , who i s chairman o f t h e Subcommittee on
Medicare and Long-Term Care. Senator R o c k e f e l l e r .
i
SEN. JOHN D. ROCKEFELLER I V (D-WV): Thank you, Mr. Chairman.
Mrs. C l i n t o n , as you know, t h e p r e s i d e n t ' s p l a n i n c l u d e s a
mandate on, i n a sense, employers b u t a l s o on i n d i v i d u a l s . Both have t o have
r e s p o n s i b i l i t y . The Republican p l a n has a mandate on i n d i v i d u a l s and n o t on
employers. You touched on t h a t i n your statement, b u t I ' d l i k e t o have you,
i f you would be w i l l i n g t o , t o expand as t o why i t was t h a t t h e
a d m i n i s t r a t i o n chose t h a t approach, q u e s t i o n number one.
Question number two, t h e Republican p r o p o s a l , which has a l o t i n
i t which i s i n common w i t h t h e p r e s i d e n t ' s p r o p o s a l , and I t h i n k t h e r e ' s n o t
-- t h a t cannot be s a i d enough. Senator Dole has t a l k e d about s t a r t i n g down
the road t o g e t h e r . I t h i n k we're g o i n g t o be t r a v e l l i n g
a l o n g way t o g e t h e r . But one o f t h e t h i n g s t h e y have i s a t a x cap t h a t l i m i t s
the d e d u c t i b i l i t y o f h e a l t h i n s u r a n c e t o t h e average cost o f o n e - t h i r d o f t h e
p o l i c i e s i n t h e area, i n whatever area t h a t might be.
I would l i k e t o g e t you, i f you would, Mrs. C l i n t o n , t o expand upon your
views about t h a t .
MRS. CLINTON: Thank you, s e n a t o r . And I a l s o a p p r e c i a t e a l l o f
y o u r h e l p and guidance and t h e v i s i t t o West V i r g i n i a t h a t we had t h a t p u t
faces on a l l o f these problems f o r us.
The approach t h a t t h e p r e s i d e n t has chosen, t o b u i l d on t h e
employer-employee system o r , as Senator Packwood says, t h e i n d i v i d u a l mandate
i n terms o f making sure everybody who i s employed c o n t r i b u t e s t o t h e i r
i n s u r a n c e , was chosen f o r s e v e r a l reasons:
F i r s t because i t i s t h e way most people c u r r e n t l y g e t i n s u r a n c e .
Over 90 p e r c e n t o f those who a r e i n s u r e d a r e i n s u r e d t h r o u g h an
employer-employee r e l a t i o n s h i p .
Secondly, because i t i s t h e most f a m i l i a r and t h e way t h a t most
Americans a r e used t o g e t t i n g t h e i r i n s u r a n c e . We t h i n k i t w i l l be t h e l e a s t
d i s r u p t i v e t o b o t h people's u n d e r s t a n d i n g o f insurance and t h e i r acceptance
of i n d i v i d u a l r e s p o n s i b i l i t y because i t i s what o t h e r s a r e d o i n g .or have .±ieend o i n g . T h i r d l y , t h e employer-employee system g i v e s us an e x i s t i n g way t o make
sure t h a t payments a r e made and can be c o l l e c t e d . We a n t i c i p a t e v e r y l i t t l e
a d d i t i o n a l paperwork o r d i f f i c u l t y f o r employers o r employees because t h e y
�would, as t h e y c u r r e n t l y do, whether i t i s FICA or S o c i a l S e c u r i t y , be
l o o k i n g a t a t a b l e and t h e n f i l l i n g out t h e i r c o n t r i b u t i o n which w i l l be
f l o w i n g t o these a l l i a n c e s . For those who a l r e a d y are i n s u r e d , t h e y do the
same, o n l y t h e y pay t h e i r insurance company. So we don't t h i n k t h a t the
d i f f i c u l t i e s t h a t one would have i n moving toward a system of u n i v e r s a l
coverage w i l l be s i g n i f i c a n t a t a l l .
I n c o n t r a s t , a l t h o u g h we v e r y much applaud the Senate Republican
approach of making sure we reach u n i v e r s a l coverage and choosing an
i n d i v i d u a l mandate as the r o u t e t o get t h e r e , we have s e v e r a l w o r r i e s t h a t we
w i l l be w o r k i n g w i t h the Senate Republicans on t o make sure we f u l l y
u n d e r s t a n d t h e i r approach over the next s e v e r a l weeks.
Among those w o r r i e s are t h a t i f we have a l e g i s l a t i v e l y r e q u i r e d
i n d i v i d u a l mandate, we w o r r y t h a t the numbers of people who c u r r e n t l y are
i n s u r e d t h r o u g h t h e i r employment w i l l decrease, because t h e r e w i l l no l o n g e r
be any reason f o r many employers who have s t r u g g l e d t o ensure t h e i r workers,
p a r t i c u l a r l y those whose incomes are not s i g n i f i c a n t , t o f e e l t h a t
r e s p o n s i b i l i t y , because by f a i l i n g t o i n s u r e , the i n d i v i d u a l s w i l l be
mandated t o have i n s u r a n c e , and i n d i v i d u a l s below a c e r t a i n l e v e l of income
w i l l become the government's r e s p o n s i b i l i t y . They w i l l f a l l i n t o the subsidy
pool.
I t ' s v e r y t o p r e d i c t how many or a t what r a t e t h a t would p o s s i b l y
i n c r e a s e the number of u n i n s u r e d , but we w o r r y t h a t t h a t would be one o f the
u n i n t e n d e d consequences.
Secondly, u n l i k e the e x i s t i n g employer-employee system, we have
g r e a t concerns about how the a d m i n i s t r a t i v e s t r u c t u r e t o t r a c k the i n d i v i d u a l
c o n t r i b u t i o n , t o c o l l e c t i t , and t o t h e n connect i t w i t h h e a l t h i n s u r a n c e
would be set up.
I n our e f f o r t s t o t r y t o work w i t h Treasury, and OMB and o t h e r s
t o c r e a t e t h a t i n d i v i d u a l subsidy system, i t s t r u c k us as e x t r e m e l y
c o m p l i c a t e d and b u r e a u c r a t i c , and a l s o maybe more i n t r u s i v e , because i n s t e a d
of the employer-employee t r a n s a c t i o n , w i t h the money coming i n , i n d i v i d u a l s
would have t o perhaps show t h e i r income t a x r e t u r n s , t h e y ' d have t o have
t h e i r income t r a c k e d because t h e y would e i t h e r be up o r below the subsidy
l e v e l a t c e r t a i n p e r i o d s or c e r t a i n y e a r s . So we b e l i e v e i t would be much
more d i f f i c u l t t o a d m i n i s t e r the i n d i v i d u a l mandate system.
And f i n a l l y , we w o r r y t h a t t h e r e would be some i n c e n t i v e t o keep
wages lower so t h a t i n d i v i d u a l s would remain i n the s u b s i d y p o o l as opposed
t o b e i n g covered by t h e i r employer, w i t h whatever c o n t r i b u t i o n might be
a v a i l a b l e , which would r e s u l t i n , perhaps, a f u r t h e r s p l i t t i n g o f the k i n d of
care t h a t ' s a v a i l a b l e between those who can a f f o r d and have some k i n d of
employer c o n t r i b u t i o n and those who do n o t .
So those are some of the reasons t h a t we have p r e f e r r e d the
employer-employee system, and we t h i n k w i t h the. a d d i t i o n of_discounts.jfQrL__
s m a l l b u s i n e s s , w i t h a subsidy system t h a t works t h r o u g h t h a t r e l a t i o n s h i p
which would be, we b e l i e v e much e a s i e r t o a d m i n i s t e r , we have t a k e n care of
t h e b i g g e s t problems t h a t an employer-employee approach have.
�And I know my time i s up, b u t l e t me j u s t t r y t o b r i e f l y answer
your second q u e s t i o n - SEN. MOYNIHAN: Mrs. C l i n t o n , may I say Senator R o c k e f e l l e r ' s time
i s up. Your t i m e i s never up. (Laughter.)
MRS. CLINTON: Thank you, Mr. Chairman.
W e l l t h e n , on my t i m e . Senator, I w i l l answer your q u e s t i o n , t h e
second one you posed.
We a l s o looked v e r y hard a t t h e p r o p o s a l t h a t i s common i n
managed c o m p e t i t i o n approaches t o c o n t r o l l i n g h e a l t h care c o s t s , o f imposing
a t a x cap and l i m i t i n g d e d u c t i b i l i t y . And we b e l i e v e t h a t e v e n t u a l l y t h a t
should be a f e a t u r e i n o u r system. But we have a l o t o f d i f f i c u l t y w i t h
s t a r t i n g i t a t t h e b e g i n n i n g o f r e f o r m because c u r r e n t l y t h e r e a r e m i l l i o n s ,
and our e s t i m a t e i s a t l e a s t 35 m i l l i o n working Americans p l u s t h e i r
dependents, who c u r r e n t l y have h e a l t h care b e n e f i t s t h a t would be t a x e d i f
e i t h e r t h e approach o f t a x i n g a t t h e average cost o f o n e - t h i r d t h e p o l i c i e s
i n t h e area, o r t h e approach t h a t some o f t h e managed c o m p e t i t i o n advocates
propose, which i s t a x i n g a t t h e lowest cost p l a n i n t h e area, were t o go i n t o
effect.
We would t h e n be i n a p o s i t i o n i n t h e a d m i n i s t r a t i o n and t h e
Congress o f t e l l i n g m i l l i o n s o f Americans, a v e r y , v e r y b i g percentage, t h a t
h e a l t h care r e f o r m means f o r you r i g h t now a b i g t a x i n c r e a s e . I don't t h i n k
t h a t ' s t h e i n i t i a l message t h a t any o f us want t o d e l i v e r , when we know
t h e r e ' s a l r e a d y more money b e i n g spent i n t h i s system t h a n we need t o spend,
and when we know t h a t m i l l i o n s o f those same Americans have seen t h e i r wages
h e l d f l a t , have n o t r e a l i z e d any k i n d o f i n c r e a s e i n t h e i r wages comparable
w i t h what t h e i r p r o d u c t i v i t y o r wage increases i n o t h e r s e c t o r s s h o u l d have
brought them, because t h e i r compensation has been i n e f f e c t made up o f h e a l t h
care b e n e f i t s .
So what we b e l i e v e i n s t e a d i s t h a t we should w a i t u n t i l we have
our h e a l t h care r e f o r m i n p l a c e , t h e comprehensive b e n e f i t s package i s
secure, and t h e n we say w i t h f a i r n o t i c e t o these Americans, a t a c e r t a i n
d a t e , you w i l l be t a x e d f o r any e x p e n d i t u r e above t h a t .
And i n a d d i t i o n t o t h e problem o f t h e t a x i s s u e , i s t r y i n g t o admi
lowest c o s t p l a n i n a r e g i o n , o r t h e average cost o f t h e lower o n e - t h i r d o f t
When we went t o t h e Treasury people t o t a l k t o them, how t h e y
would do t h a t , t h e y were j u s t beside themselves, because you would have t o
t r a c k t h a t c o s t , p l u s you would have t o t r a c k t h e i n d i v i d u a l ' s payment, p l u s
you would have t o have some k i n d o f t a x p r o o f as t o what t h a t was, and t h e
c o m p l e x i t y and a d m i n i s t r a t i v e bureaucracy necessary t o a d m i n i s t e r t h a t i s
substantial.
So f o r those two reasons, we decided we would w a i t u n t i l t h e
system was up and g o i n g , g i v e everybody f a i r n o t i c e , and t h e n t a x a t a l e v e l
t h a t was more u n i f o r m around t h e c o u n t r y .
SEN. ROCKEFELLER: Thank you, Mr. Chairman.
SEN. MOYNIHAN: Thank you. Senator R o c k e f e l l e r .
Could I j u s t express a p p r e c i a t i o n f o r t h e s e n s i t i v i t y you have
�shown t o t h e q u e s t i o n o f c o m p l e x i t y o f a d m i n i s t r a t i o n . That i s t h e continuous
concern o f t h i s committee w i t h t h e Treasury Department, what t h e form looks
l i k e . And a l s o , t o say t h a t i t would be j u s t about 50 years ago t h a t Robert
K. Murton ( s p ) , a t Columbia U n i v e r s i t y , who i s s t i l l t h r i v i n g , wrote h i s
essay on t h e u n a n t i c i p a t e d consequences o f s o c i a l ' a c t i o n , and I was pleased
t o see you use t h a t phrase, and we w i l l be t h i n k i n g about u n a n t i c i p a t e d
consequences a l l t h r o u g h t h i s , which i s a necessary way t o go about i t .
Because you t h i n k about i t doesn't mean you can't come up w i t h some answers.
Senator D a n f o r t h .
SEN. DANFORTH: Mrs. C l i n t o n , I want t o ask you a g e n e r a l q u e s t i o n
o f p h i l o s o p h y , and then i f I have t i m e , f o l l o w up on whether o r n o t t h i s can
be accomplished i n f a c t . My q u e s t i o n i s whether you would agree w i t h me t h a t
somehow t h e r e s h o u l d be some way o f t e l l i n g people t h a t t h e y cannot have t h e
medical care t h a t t h e y might want f o r themselves o r t h e i r f a m i l y , and w e ' l l
g i v e you some examples.
The s o - c a l l e d Baby K case t h a t ' s been p u b l i c i z e d r e c e n t l y , a baby
born w i t h a c o n d i t i o n c a l l e d a n i n c e p h a l y ( p h ) , t h e b r a i n i s m i s s i n g , t h e baby
can't t h i n k , t h e baby can't f e e l , t h e baby has been kept a l i v e , I t h i n k f o r
11 months, w e l l over $1,000 a day because t h e mother says I want t h e baby
kept a l i v e ; t h e Siamese t w i n case i n I t h i n k Pennsylvania, one baby d i e d , t h e
o t h e r has a one p e r c e n t chance o f s u r v i v a l . The more p r e v a l e n t case, t h e low
b i r t h weight baby, t h e baby under one pound, t h e l i k e l i h o o d i s o n l y 15
p e r c e n t o f these babies w i l l be f u n c t i o n a l , enormous c o s t o f keeping them
a l i v e , average o f $150,000 each.
On t h e o t h e r edge o f l i f e , a case I heard o f y e s t e r d a y , a 92
y e a r - o l d man who r e c e i v e d a pacemaker, and then e v e r y t h i n g i n between. The
case o f somebody who's d y i n g who wants t o be kept a l i v e f o r another t h r e e
months, s i x months a t a v e r y h i g h c o s t .
P h i l o s o p h i c a l l y , b e f o r e we g e t t o t h e mechanism q u e s t i o n , should
somebody a t some l e v e l be i n a p o s i t i o n t o say no?
MRS. CLINTON: Senator, I t h i n k t h e r e should be a d i s c u s s i o n i n
t h i s c o u n t r y about what i s a p p r o p r i a t e care and t h a t a l o t o f these v e r y hard
d e c i s i o n s t h a t you have j u s t o u t l i n e d should be made w i t h more thought and
more concern about b o t h t h e human and t h e economic c o s t . So I would agree
t h a t f o r b o t h moral and e t h i c a l reasons, as w e l l as economic ones, t h e r e has
t o be t h e k i n d o f v e r y d i f f i c u l t c o n v e r s a t i o n t h a t you a r e s u g g e s t i n g .
I have thought a l o t about t h i s and I have had a l o t o f time t o
t h i n k about i t b o t h on a p e r s o n a l l e v e l , when I was i n t h e h o s p i t a l w i t h my
f a t h e r , and spending l i t e r a l l y a l l day every day t a l k i n g t o d o c t o r s and
nurses about t h e v e r y k i n d s o f cases t h a t you are o u t l i n i n g . And I have had a
l o t o f t i m e t o t h i n k about i t i n t h i s p o s i t i o n t h a t I am i n .
And I t h i n k t h a t t h e r e i s more o f a l i k e l i h o o d t h a t we can
a c t u a l l y have t h a t .conversation .once.jve e s t a b l i s h h e a l t h s e c u r i t y and a more
r a t i o n a l system o f making d e c i s i o n s about p r o v i d i n g care t o people. And I
would j u s t g i v e you an example t h a t s t r u c k me r e c e n t l y .
The h o s p i t a l a d m i n i s t r a t o r o f a v e r y l a r g e h o s p i t a l came t o me as
�a p a r t o f a group v i s i t i n g , as a d e l e g a t i o n brought i n by t h e member o f
Congress, and he s a i d t h a t he had r e c e n t l y asked one o f h i s c a r d i a c surgeons
why t h e c a r d i a c surgeon had a d m i t t e d a 9 2 - y e a r - o l d man f o r a quadruple
bypass. And t h e c a r d i a c surgeon had s a i d , ''Well, because he was r e f e r r e d t o
me by t h e c a r d i o l o g i s t who r e f e r s me a l l o f my cases, and I d i d n ' t want t o
say no because he might send h i s cases t o another c a r d i a c surgeon.'' And the
h o s p i t a l a d m i n i s t r a t o r s a i d , ''Well, do you t h i n k i t was m e d i c a l l y
a p p r o p r i a t e f o r you t o accept t h i s surgery?'' And he s a i d , ''No, i t wasn't
a p p r o p r i a t e o r necessary, but t h a t ' s t h e way t h e system works.''
SEN. DANFORTH: I t h i n k t h a t t h e r e ' s maybe a harder q u e s t i o n , and
t h a t i s t h e q u e s t i o n o f the person o r the person's f a m i l y who s i m p l y wants
t h e t r e a t m e n t no m a t t e r what t h e c o s t . And t h e r e i s a t r e a t m e n t t h a t ' s
a v a i l a b l e , f o r example, t o keep t h i s baby g o i n g who can't t h i n k . And -- I
mean, I guess the t h r e s h o l d q u e s t i o n i s : Under any circumstances, should
t h e r e be somebody out t h e r e o r something somewhere a t some l e v e l t h a t says,
''No, I mean, i t ' s p o s s i b l e t o do t h i s ; i t ' s p o s s i b l e t o p e r f o r m whatever
t h i s procedure i s , but even though you want i t , t h e answer t o you i s , no, you
can't have i t ' ' ?
MRS. CLINTON: I t h i n k t h a t , i f we do t h i s h e a l t h care r e f o r m
r i g h t and we c r e a t e the k i n d o f s e c u r i t y we're t a l k i n g about so t h a t people
w i l l know t h a t t h e y ' r e not b e i n g denied t r e a t m e n t f o r any reason o t h e r than
i t i s not a p p r o p r i a t e , i t w i l l not enhance o r save t h e q u a l i t y o f l i f e , we
w i l l have a much b e t t e r chance o f having t h a t k i n d o f c o n v e r s a t i o n , and
p h y s i c i a n s w i l l , once again, have much more l a t i t u d e and d i s c r e t i o n i n
a d v i s i n g f a m i l i e s i n an honest manner about what t h e r e a l c o s t s a r e . So I
t h i n k we w i l l get t o t h a t p o i n t , b u t I t h i n k , i n o r d e r t o get t o t h e r e and t o
b r i n g t h e c o u n t r y a l o n g w i t h us, we have t o make some o f these o t h e r changes
f i r s t t o e s t a b l i s h t h e k i n d o f c l i m a t e i n which those c o n v e r s a t i o n s can take
place.
SEN. MOYNIHAN: Thank you. Senator D a n f o r t h .
Senator Breaux?
SEN. JOHN BREAUX (D-LA): Thank you v e r y much, Mr. Chairman.
Thank you, Mrs. C l i n t o n , and welcome t o t h e committee. I t h i n k
t h a t what you and t h e p r e s i d e n t have done on t h i s h e a l t h care debate i s t r u l y
remarkable i n a t l e a s t two s i g n i f i c a n t ways. I c e r t a i n l y hope t h a t what you
a l l have accomplished becomes a p a t t e r n o r a b l u e p r i n t perhaps f o r f u t u r e
l e g i s l a t i v e a c t i o n on major and c o n t r o v e r s i a l l e g i s l a t i v e p r o p o s a l s . I t h i n k
i t ' s remarkable, f i r s t , i n o u t l i n i n g v e r y c l e a r l y t h e g o a l s o f t h i s v e r y
c o m p l i c a t e d e f f o r t -- u n i v e r s a l access t o h e a l t h c a r e ; comprehensive,
s t a n d a r d i z e d package; and q u a l i t y h e a l t h care f o r everybody. I t h i n k you a l l
have done a r e a l remarkable j o b i n s p e l l i n g t h a t out -- what we want and what
the goal i s .
The second-area-I t h i n k t h a t i s t r u l y r e m a r k a b l e _ i & - t h e way t h i s
process has been put t o g e t h e r . We can l e a r n a l o t from t h a t . You have had -and t h e p r e s i d e n t has had p r i v a t e meetings w i t h Republican s e n a t o r s , p r i v a t e
meetings w i t h Democratic s e n a t o r s , and p r i v a t e meetings w i t h b o t h o f us
�t o g e t h e r i n t h e same room.
You have done t h e same t h i n g , I t h i n k , a l s o on t h e House s i d e . So
I t h i n k i t ' s t r u l y remarkable as t o what has been accomplished so f a r .
I t h i n k t h a t as we move towards r e a c h i n g those g o a l s , however, we
have t o decide which p a t h we're g o i n g t o t a k e . I t h i n k t h e r e a r e two o p t i o n s .
One i s t h e p a t h o f i m p r o v i n g t h e marketplace, changing t h e r u l e s so t h a t
c o m p e t i t i o n can work b e t t e r t h a n i t does r i g h t now because r i g h t now doesn't
work v e r y w e l l . The second p a t h we can t a k e i s more government r e g u l a t i o n ,
more government bureaucracy, e i t h e r a t a s t a t e l e v e l o r a l o c a l l e v e l o r a t t
d i f f i c u l t i f we t r y and mix t h e two. I t h i n k t h a t when you t r y and add some r
system t h a t ' s s a y i n g we're g o i n g t o improve t h e c o m p e t i t i o n system, i t gets v
w i t h o u t messing up c o m p e t i t i o n . And t h a t ' s my concern as we move down t h i s pa
I had i n t r o d u c e d , and we've d i s c u s s e d t h i s a number o f t i m e s , i n
the l a s t Congress t h e b i l l t h a t was c a l l e d managed c o m p e t i t i o n , w i t h a number
of CO-sponsors, which was, I t h i n k , a more pure c o m p e t i t i o n w i t h o u t t h e
r e g u l a t o r y regimes. I want t o work v e r y c l o s e l y w i t h t h i s a d m i n i s t r a t i o n on
m a r r y i n g these concepts, and h o p e f u l l y , w e ' l l be a b l e t o do t h a t .
My q u e s t i o n t h i s morning i s I'm concerned t h a t by adding some
r e g u l a t o r y r e q u i r e m e n t s t o t h e p r o p o s a l , and by adding what I t h i n k a r e
d i s i n c e n t i v e s t o changing t h e way people buy h e a l t h care, t h a t we make i t
d i f f i c u l t t o reach t h e g o a l s and make c o m p e t i t i o n l e s s p o s s i b l e .
The p o i n t I have i n t h e s h o r t t i m e I have i s , as I understand t h e
p r o p o s a l , i s t h a t a f t e r t h e law i s enacted f o r 24 months, two y e a r s , we are
hoping t o make some r a t h e r dramatic r e d u c t i o n s i n t h e c o s t o f h e a l t h care i n
t h i s c o u n t r y . I f we do n o t , t h e premium caps k i c k i n . I am concerned t h a t 24
months i s n o t n e a r l y enough t i m e t o a l l o w t h e c o m p e t i t i o n t o r e a l l y work,
p a r t i c u l a r l y i n areas t h a t don't have any c o m p e t i t i o n now, and I'm concerned
t h a t t h e r e a r e d i s i n c e n t i v e s t h a t have been added t h a t r e a l l y make i t even
more d i f f i c u l t . And t h e d i s i n c e n t i v e s a r e t h e complete employer d e d u c t i o n
regardless of the price of the plan. I t h i n k that's a r e a l d i s i n c e n t i v e t o
p u r c h a s i n g t h e l e a s t c o s t l y p l a n . Not t a x i n g t h e employee b e n e f i t s i f they
are i n excess o f t h a t p l a n f o r e i t h e r 10 years o r t o t h e year 2000 I t h i n k i s
a d i s i n c e n t i v e . Q u i t e f r a n k l y , I t h i n k t h e p r e s c r i p t i o n drugs b e i n g made
a v a i l a b l e w i t h o u t r e q u i r i n g Medicare r e c i p i e n t s t o change t h e i r h a b i t s by
j o i n i n g an a l l i a n c e i s a p a r t i c u l a r problem area. I t h i n k a l l these a r e areas
t h a t we can work on t o t r y and reach some compromise, and I guess my q u e s t i o n
would be: I s t h e r e any p o s s i b i l i t y o r any thought about t r y i n g t o d e l a y o r
spread o u t t h e time i n which t h e premium caps would k i c k i n i n o r d e r t o g i v e
the c o m p e t i t i o n t h e t i m e t o be p u t i n t o p l a c e and a c t u a l l y s t a r t showing some
r e s u l t s ? I mean, I t h i n k i t ' s 1996, o r what about t h e y e a r 2000, o r i s t h e r e
some t y p e o f phase-in t h a t can be considered?
MRS. CLINTON: Senator, we would c e r t a i n l y work w i t h you t o
c o n s i d e r e x a c t l y t h o s e lssues.__We -are i r y l n g : - t o do two ..things -simultaneously,and I c e r t a i n l y understand how t r y i n g t o do two t h i n g s s i m u l t a n e o u s l y
sometimes c r e a t e s perhaps some q u e s t i o n as t o how you can g e t b o t h done. But
we a r e t r y i n g t o c r e a t e i n c e n t i v e s t h r o u g h t h e market and t h r o u g h enhanced
�c o m p e t i t i o n t o r e o r g a n i z e o u r h e a l t h care system so t h a t s e r v i c e s a r e
d e l i v e r e d more e f f i c i e n t l y a t h i g h q u a l i t y . A t t h e same t i m e , we have t o
r e c o g n i z e we s t a r t from v e r y d i f f e r e n t stages o f development i n d i f f e r e n t
p a r t s o f t h e c o u n t r y w i t h i n c r e d i b l y d i f f e r e n t p r a c t i c e s t y l e s used by
p h y s i c i a n s t h a t have i n c r e a s e d c o s t s d r a m a t i c a l l y i n those r e g i o n s .
So, what we a r e l o o k i n g f o r -- and we w i l l work v e r y c l o s e l y w i t h
you because I share your concern --we want t h e c o m p e t i t i v e market f o r c e s t o
work, b u t when you c r e a t e a new system i n which t h e c o s t s i n some areas o f
our c o u n t r y a r e t h r e e times what t h e y a r e i n o t h e r s , and where, i f t h e r e
i s n ' t any f e e l i n g on t h e p a r t o f t h e p r o v i d e r s t h a t t h e r e i s some budgetary
d i s c i p l i n e w a i t i n g o u t t h e r e f o r them, I w o r r y t h a t you w i l l n o t c r e a t e t h e
k i n d o f i n c e n t i v e s f o r t h e changes i n p r a c t i c e s t y l e s t o occur t h a t w i l l
c r e a t e e x a c t l y what you and I want, which i s a much more c o m p e t i t i v e ,
m a r k e t - d r i v e n , h i g h - q u a l i t y h e a l t h care system.
Now, whether we can g e t t o where we need i n two years o r over a
l o n g e r p e r i o d o f t i m e , we a r e v e r y open t o t a l k i n g w i t h you about t h a t . But
t o go back t o t h e example I t a l k e d w i t h Senator D a n f o r t h about, t h i s h o s p i t a l
a d m i n i s t r a t o r t o l d me t h i s s t o r y about t h i s i n a p p r o p r i a t e care i n t h e c o n t e x t
of s a y i n g t o me t h a t he a p p r e c i a t e d having some k i n d o f premium cap o u t t h e r e
as a backstop because, he s a i d , o t h e r w i s e i t w i l l be v e r y d i f f i c u l t f o r me as
a h o s p i t a l a d m i n i s t r a t o r t o go t o t h i s c a r d i a c surgeon o r f o r h i s c o l l e a g u e s
t o go t o him and say, ''Remember we g o t t o g e t h e r l a s t year and we made these
d e c i s i o n s about what we were g o i n g t o be d o i n g t h i s year and how we were
g o i n g t o be p r o v i d i n g care, and t h i s i s why we need t o do i t because we've
got t h i s budget backstop up t h e r e t h a t might p o s s i b l y reduce o u r income i f we
don't do i t r i g h t ? ' '
And so, on p s y c h o l o g i c a l as w e l l as economic grounds, some form
of d i s c i p l i n e i n a marketplace t h a t , f r a n k l y , has had none, i n w h i c h b l a n k
checks have been w r i t t e n by b o t h t h e government and p r i v a t e i n s u r e r s u n t i l
v e r y r e c e n t l y , seems t o us a f e a t u r e t h a t needs t o be t h e r e as a backup. But
how we g e t t h e r e , when i t ' s t r i g g e r e d , under what circumstances, we're v e r y
open t o t h a t . We want t o g e t t o t h e same p l a c e , and we v e r y much want t o work
w i t h you on t h a t .
SEN. MOYNIHAN: Thank you. Senator Breaux.
Senator Chafee?
SEN. JOHN H. CHAFEE (R-RI): Thank you, Mr. Chairman.
Mrs. C l i n t o n , I want t o j o i n i n welcoming you here and pay
t r i b u t e t o y o u r t i r e l e s s e f f o r t s i n t h i s area. I'm a b s o l u t e l y c e r t a i n t h a t
h e a l t h care would n o t have t h e prominence i t has now b u t f o r y o u r p e r s o n a l
involvement, and I t h i n k we're a l l g r a t e f u l t o you. You've been w o n d e r f u l .
I j u s t would l i k e t o p o i n t o u t one t h i n g i n c o n n e c t i o n w i t h y o u r
c o n v e r s a t i o n w i t h Senator R o c k e f e l l e r and t h e p o i n t s he r a i s e d .
Your p l a n does have an i n d i v i d u a l mandate t o . t h e e x t e n t o f t h e 20.
percent.
MRS. CLINTON: Yes, s i r .
SEN. CHAFEE: I n o t h e r words, t h e i n d i v i d u a l i s r e s p o n s i b l e f o r
�p a y i n g a p o r t i o n o f h i s o r h e r -- t h e employee -- insurance . Whereas ours
makes t h e i n d i v i d u a l 100 p e r c e n t , yours makes him 20 p e r c e n t . So i t ' s a
d i f f e r e n c e o f degree -MRS. CLINTON: That's r i g h t .
SEN. CHAFEE: -- more than" t h e t o t a l d i f f e r e n c e .
The o t h e r p o i n t i s , s o r t o f r e f e r r i n g back t o what you were
t a l k i n g w i t h Senator Breaux about, r e g a r d i n g t h e t a x a t i o n o f b e n e f i t s over a
c e r t a i n l e v e l . I n o u r p l a n we go i n t o t h a t ; your p l a n you d e f e r t h a t , b u t as
I understand i t , i t i s your i n t e n t i o n t h a t down t h e road t h a t would occur.
MRS. CLINTON: Yes.
SEN. CHAFEE: There would be a l e v e l -- c a l l i t t h e reasonable
l e v e l o f b e n e f i t s . A n y t h i n g above t h a t would be t a x a b l e t o t h e employee and
n o n - d e d u c t i b l e by t h e employer.
MRS. CLINTON: That's a b s o l u t e l y r i g h t , senator.
SEN. CHAFEE: The t h r u s t o f t h e v a r i o u s b i l l s , as I see i t , i s t o
p r o v i d e coverage f o r those who a r e n o t covered now. And t h i s i s c o s t l y , b u t
i t ' s w o r t h i t , we b e l i e v e . However, i n one i n s t a n c e i t seems t o me t h a t t h e
a d m i n i s t r a t i o n has embarked on p r o v i d i n g coverage by t h e government f o r those
who a r e a l r e a d y covered. And t h i s I have g r e a t d i f f i c u l t y w i t h , and I'm
r e f e r r i n g t o page 13 o f t h e p l a n summary, i n d e a l i n g w i t h r e t i r e e s . And I ' l l
b r i e f l y read i t : ''Americans who r e t i r e b e f o r e 65 and were employed f o r a t
l e a s t t h e amount o f t i m e used as a s t a n d a r d t o q u a l i f y f o r S o c i a l S e c u r i t y
purchase h e a l t h coverage t h r o u g h t h e i r r e g i o n a l a l l i a n c e and pay o n l y t h e
employee share o f t h e premium f o r t h e i r h e a l t h p l a n . The f e d e r a l government
pays t h e 8 0 p e r c e n t o f t h e employer's share.''
And i t seems t o me t h a t t h i s i s a v e r y , v e r y expensive
u n d e r t a k i n g . What you're d o i n g i s s a y i n g t h a t an employee who i s r e t i r e d
whose employer c u r r e n t l y i s p r o v i d i n g a l l o r a s u b s t a n t i a l p o r t i o n o f h i s o r
her i n s u r a n c e w i l l no l o n g e r have t o do t h a t -- employer: t h e government w i l l
do i t . And I see t h a t b e i n g v e r y c o s t l y . And f u r t h e r m o r e , we g e t i n t o t h i s
p o i n t you've made w i t h Senator Moynihan, o u r chairman, u n a n t i c i p a t e d
consequences o f s o c i a l a c t i o n . Many more employers, I b e l i e v e , w i l l choose t o
have t h e i r employees go t h i s r o u t e . I mean, what a bonanza. The government i s
g o i n g t o s t e p i n and pay t h i s 80 p e r c e n t . Could you e x p l a i n why you chose
that?
MRS. CLINTON: Yes, senator, and I want t o s t a r t , though, by
t h a n k i n g you f o r your l e a d e r s h i p on t h i s i s s u e and your i n c r e d i b l e
w i l l i n g n e s s t o educate and t o t a l k w i t h us about t h e approaches t h a t you've
t a k e n and t h a t you have worked on f o r many years. I'm v e r y p e r s o n a l l y
g r a t e f u l t o you.
T h i s i s a p o l i c y d e c i s i o n t h a t i s c e r t a i n l y one t h a t we w i l l be
d e b a t i n g and d i s c u s s i n g . And i t comes o u t o f s e v e r a l sources o f concern.
The f i r s t i s , t h e r e i s a growing tendency f o r businesses t h a t
have c o n t r a c t u a l o b l i g a t i o n s t o r e t i r e e s f o r them t o abrogate o r l i m i t those
h e a l t h b e n e f i t s i n some f a s h i o n , whether i t ' s an o u t r i g h t a b r o g a t i o n o f t h e
c o n t r a c t o r some attempt t o n e g o t i a t e below whatever t h e l e v e l o f promised
�b e n e f i t s were, so t h a t i n f a c t t h e r e are more and more people i n t h i s time
p e r i o d b e f o r e t h e y ' r e e l i g i b l e f o r Medicare who are f i n d i n g themselves
w i t h o u t h e a l t h coverage and who are n o t employed because t h e y had taken e a r l y
r e t i r e m e n t o r reached t h e r e q u i s i t e r e t i r e m e n t age. T h i s i s becoming a
problem f o r t h e g e n e r a l s o c i e t y t h a t we b e l i e v e we're g o i n g t o have t o d e a l
with.
Secondly, those companies t h a t are c o n t i n u i n g t o p r o v i d e r e t i r e e
b e n e f i t s a r e d o i n g so a t an e x t r a o r d i n a r y c o s t t h a t we t h i n k s h o u l d be more
b r o a d l y shared by t h e g e n e r a l p u b l i c because t h e i r commitment t o r e t i r e e
h e a l t h care i s t a k i n g o u t o f investment, wages, wage i n c r e a s e s , p r o f i t s ,
money t h a t s h o u l d r i g h t l y go t h e r e i n s t e a d o f t a k i n g care o f t h e work f o r c e
t h a t i s no l o n g e r w o r k i n g .
We t h i n k t h a t , f o r example, those i n d u s t r i e s -- l a r g e l y t h e o l d e r
m a n u f a c t u r i n g i n d u s t r i e s -- t h a t assumed these r e s p o n s i b i l i t i e s a r e b e g i n n i n g
t o make a comeback.
They are i n c r e a s i n g t h e i r p r o d u c t i v i t y , t h e y are competing w i t h
t h e Japanese, and t h e Europeans and o t h e r s , b u t t h e y a r e d o i n g so s t i l l w i t h
one hand t i e d behind t h e i r back because o f t h e e x t r a o r d i n a r y h e a l t h care cost
which t h e y have borne, which i n many i n s t a n c e s t h e y have borne n o t j u s t f o r
t h e i r own employees and r e t i r e e s , b u t i n d i r e c t l y f o r o t h e r businesses t h a t
have s h i f t e d t h e c o s t onto them, because t h e y were w i l l i n g t o p i c k up those
c o s t s . And we c o n s i d e r t h a t t h a t k i n d o f b e n e f i t , which -- ( i n a u d i b l e ) -- t o
t h e e n t i r e p o p u l a t i o n i n i n d i r e c t ways, ought t o be borne by t h a t e n t i r e
population.
And f i n a l l y , we have c o s t e d t h i s o u t as I expressed t o Senator
Packwood, i t i s about f o u r - a n d - a - h a l f b i l l i o n d o l l a r s , b u t we t h i n k t h a t i t
i s an investment i n our c o m p e t i t i v e n e s s and our m a n u f a c t u r i n g base, as w e l l
as p i c k i n g up t h e c o s t o f people who are f a l l i n g i n t o t h e u n i n s u r e d t h a t i s
w o r t h making. But o b v i o u s l y , we are more t h a n open t o t a l k i n g w i t h you and t o
e x p l o r i n g SEN. CONRAD: Thank you, Mr. Chairman, and a g a i n I want t o thank you
f o r h o l d i n g t h i s h e a r i n g and b r i n g i n g us t o g e t h e r around t h i s i s s u e because
o b v i o u s l y t h i s i s t h e focus f o r t h e r e s t o f t h e year and much o f next as
w e l l . And I want t o thank you, Mrs. C l i n t o n , f o r t h e l e a d e r s h i p t h a t you have
shown. I t h i n k your competence j u s t shines out and I t h i n k t h a t has made a
d i f f e r e n c e i n t h e way people are approaching t h i s i s s u e , and I t h i n k t h a t ' s a
r e a l c o n t r i b u t i o n t o the country.
Let me ask t h i s . One o f t h e u n d e r l y i n g assumptions i s t h a t we can
save money by changing t h e i n c e n t i v e s i n t h e system, as I understand i t . The
c u r r e n t i n c e n t i v e s i n t h e system r u n toward d o i n g more procedures, d o i n g more
t e s t s , n o t o n l y because you make more money i f you're a p r o v i d e r t h a t way,
b u t a l s o because you p r o t e c t y o u r s e l f from m a l p r a c t i c e , and so we a l l
understand t h e i n c e n t i v e s r u n toward i n c r e a s i n g c o s t s i n t h e system.<
As I understand i t , one o f t h e g o a l s , o f - _ t h i s p l a n - i s t o _ change.
those i n c e n t i v e s so t h a t we b e g i n t o c o n t r o l c o s t s . O b v i o u s l y when you change
i n c e n t i v e s i n t h i s system, t h a t then c r e a t e s a p o t e n t i a l v u l n e r a b i l i t y o f
p r o v i d i n g t o o l i t t l e care, d o i n g t o o few t e s t s , d o i n g t o o few procedures.
�What i s y o u r r e a c t i o n t o those who say I'm v e r y concerned t h a t we're g o i n g t o
wind up w i t h a system i n which t h e i n c e n t i v e s r u n toward d o i n g t o o l i t t l e
r a t h e r t h a n t o o much?
MRS. CLINTON: Senator, I would ask them h o n e s t l y t o l o o k a t t h e
system we have today, where because o f t h e wrong i n c e n t i v e s , we do t o o much
a t t o o h i g h a c o s t , f o r t o o few people. And what we need t o be d o i n g i s
f i g u r i n g o u t how t o d e l i v e r h i g h q u a l i t y h e a l t h care t o everybody. And t h e r e
are s e v e r a l examples I would j u s t l i k e t o share w i t h you.
I have p u l l e d t h i s o u t a t every h e a r i n g and I keep i t w i t h me
because I t h i n k i t ' s t h e best example o f what I am t a l k i n g about.
I f you t a k e a l o o k a t t h i s Consumer Guide t o Coronary A r t e r y
Bypass G r a f t Surgery t h a t i s p u t o u t by t h e Pennsylvania H e a l t h Care Cost
Containment C o u n c i l , i t makes t h e p o i n t t h a t I would l i k e t o answer those who
worry about t h i s .
T h i s document has a l l o f t h e c o s t s o f p r o v i d i n g c o r o n a r y bypass
s u r g e r y i n a l l o f t h e h o s p i t a l s i n Pennsylvania t h a t p e r f o r m t h e s u r g e r y . The
cost runs from $21,000 t o $84,000. The i n f o r m a t i o n has t r a c k e d t h e q u a l i t y
i n d i c a t o r s as t o what happens t o t h e p a t i e n t s who r e c e i v e t h i s s u r g e r y ,
i n c l u d i n g how many d i e from t h i s s u r g e r y , and t h e y have done so by comparing
p o p u l a t i o n and demographic s t a t i s t i c s o f t h e p a t i e n t s , so t h a t we compare
apples and apples.
I f you l o o k a t t h i s , t h e h o s p i t a l t h a t i s d o i n g c o r o n a r y bypass
s u r g e r i e s a t $21,000 has b e t t e r q u a l i t y t h a n many o f t h e h o s p i t a l s p e r f o r m i n g
s u r g e r i e s a t much, much h i g h e r c o s t s . Now, i f more h o s p i t a l s i n Pennsylvania
l e a r n e d how t h e h o s p i t a l i s d o i n g i t f o r $21,0000, you would a c t u a l l y have
more c o r o n a r y bypass s u r g e r i e s a b l e t o be done i n Pennsylvania a t l e s s cost
than i s now happening, and t h a t i s repeated a l l over t h e c o u n t r y .
The second example I would j u s t l i k e b r i e f l y t o mention was
e x p l a i n e d i n a speech t h a t I heard when I was i n Minnesota w i t h Senator
Durenberger. A p h y s i c i a n t h e r e who was t h e c h i e f o f q u a l i t y and t h e head o f
one o f t h e v e r y l a r g e h e a l t h networks i n Minnesota t a l k e d about how one o f
the h e a l t h care p r o v i d e r s i n Minnesota has c r e a t e d a new t e s t t o determine
whether a lump i n a woman's b r e a s t i s o r i s n o t cancerous, w i t h o u t h a v i n g t o
have a s u r g i c a l b i o p s y . And t h i s p h y s i c i a n s a i d t h a t t h i s procedure i s much
cheaper, l e s s i n v a s i v e and can be done more q u i c k l y than o f t e n a woman having
t o w a i t and h a v i n g s l e e p l e s s n i g h t s u n t i l she has h e r s u r g e r y . Why i s i t n o t
b e i n g done? Because i t would r e q u i r e , i n t h i s d o c t o r ' s words, ''surgeons
g i v i n g up up t o $40,000 i n income t o r a d i o l o g i s t s . ' ' So t h e r e ' s no i n c e n t i v e
i n t h e c u r r e n t system t o move toward a procedure t h a t has here t o make these
d i f f e r e n t c h o i c e s , b u t t h e r e i s no q u e s t i o n t h a t these d i f f e r e n t choices
would p r e s e r v e and even enhance q u a l i t y i f we c o u l d s t r u c t u r e o u r h e a l t h care
system so those choices were made i n s t e a d o f o t h e r ones.
SEN. CONRAD: A l l r i g h t s _-L-thinks J'jiu r i g h t - a t ..the e n d xif. .my i i m e ^
Mr. Chairman, and i n t h e i n t e r e s t o f a l l o w i n g o t h e r s t h e i r f u l l t i m e , I ' l l
deed back what I have.
SEN. MOYNIHAN: You're v e r y generous. Senator Conrad. Thank you.
�And Senator Durenberger?
SEN. DAVE DURENBERGER (R-MN): Mr. Chairman, thank you. I thank my
c o l l e a g u e from N o r t h Dakota.
And thank you v e r y much, Mrs. C l i n t o n , f o r s h a r i n g your t i m e ,
your t a l e n t and your commitment w i t h us. Thank you a l s o f o r m e n t i o n i n g
Minnesota w i t h some frequency, which leads me t o a p o i n t t h a t you and
I t a l k e d about y e s t e r d a y i n another committee, and t h a t i s t h a t e v e r y t h i n g
t h a t ' s g o i n g on i n Minnesota i s because people want i t t o go on, not t h e
government i n s i s t e d on i t . Not a t h i n g t h a t you've heard from Mrs. C l i n t o n
today, nor t h a t you've heard from me over t h e y e a r s , i s because Minnesota
s t a t e government s a i d i t ought t o happen. I t ' s because people who are
p r o v i d e r s o f care, consumers o f care, insurance p l a n s , c r e a t i v e d o c t o r s ,
c r e a t i v e m u l t i - s p e c i a l i t y groups have decided t h a t the r e l a t i o n s h i p between
the consumer and t h e p r o v i d e r o f care i s c r i t i c a l t o i m p r o v i n g q u a l i t y and
lowering costs.
T h i s committee i s a v e r y awesome p l a c e because we have $903
b i l l i o n i n m e d i c a l spending t h i s year, 14 p e r c e n t o f t h e GNP. F o r t y - two
p e r c e n t o f i t comes from government, most o f t h a t t h e f e d e r a l government, and
p r a c t i c a l l y a l l o f i t i s generated by the p o l i c i e s made by our - - u s and our
predecessors. And t h a t ' s an i n c r e d i b l y awesome r e s p o n s i b i l i t y . Economic
p o l i c y , t a x p o l i c y . Medicare, Medicaid -- go on up and down t h e l i n e -- most
o f t h e d r i v i n g f o r c e s i n t h e income s e c u r i t y system o r i g i n a t e i n t h i s
committee. So I t h i n k t h a t ' s why your time spent here i s i n c r e d i b l y v a l u a b l e .
Two o b s e r v a t i o n s t h a t I ' d l i k e t o make about the s o - c a l l e d t a x
cap and y o u r response t o t h a t and t h e FEHBP.
H e a l t h care r e f o r m means -- has t o mean t h a t the t a x p a y e r s o f
t h i s c o u n t r y can't have t h e government s u b s i d i z e e x t r a v a g a n t b u y i n g . And
t h a t ' s y o u r husband's s i x t h p r i n c i p l e : r e s p o n s i b i l i t y . We can't j u s t have
r e s p o n s i b i l i t i e s f o r t h e docs and t h e h o s p i t a l s . We have t o have
r e s p o n s i b i l i t y f o r everybody, and people have t o s t a r t t a k i n g t h a t
responsibility.
The FEHBP. I f we're g o i n g t o cop out t o t h e P o s t a l S e r v i c e p l a n
o r any e x i s t i n g p l a n t o not take on the d r i v i n g f o r c e i n t h i s community t h a t
causes t h e h e a l t h care c o s t s i n t h i s community t o be h i g h e r t h a n anywhere i n
the c o u n t r y -- Medicare i n t h i s D i s t r i c t o f Columbia i s a t t h e t o p i n t h e
c o u n t r y -- 33 p e r c e n t -- not because people are more i l l . Take t h a t out o f
i t . J u s t because o f the way Medicare -- t h e way h e a l t h care i s p r a c t i c e d here
i n the D i s t r i c t o f Columbia. T h i r t y - t h r e e p e r c e n t h i g h e r here, above t h e
n a t i o n a l average. Hawaii i s 43 p e r c e n t below t h e n a t i o n a l average. And so i s
-- and Oregon i s down t h e r e , and Wyoming and Utah and a bunch o f o t h e r
states.
Those o f us who are b u y i n g i n t h e p r i v a t e s e c t o r here p r o b a b l y
pay 60 p e r c e n t , 100 p e r c e n t , 20.0. p e r c e n t .above t h e n a t i o n a l average, what
you'd pay anywhere e l s e , i n t h i s community. So, u n l e s s we take t h a t
r e s p o n s i b i l i t y p r i n c i p l e s e r i o u s l y and we d e a l w i t h the b i g h e a l t h a l l i a n c e
o r whatever you want t o c a l l i t around here t h a t might change t h e way
�medicine's p r a c t i c e d , t h e FEHBP, and do t h a t r i g h t up f r o n t where everybody
can see i t , everybody can take r e s p o n s i b i l i t y , I don't t h i n k we're g o i n g t o
make i t .
Secondly, t o g e t a t t h e p o i n t we t a l k e d about y e s t e r d a y and s o r t
of i l l u s t r a t e d by Bob Packwood's d e s c r i p t i o n o f take two a s p i r i n and
something, t h e answer t o t h e q u e s t i o n i s , i f t h e d o c t o r knew t h e d o c t o r knew
the d o c t o r was r e s p o n s i b l e f o r t h e q u a l i t y o f your care and gave you what you
a c t u a l l y needed, and you and t h e d o c t o r were rewarded a t t h e end by something .
o t h e r t h a n one o f these p r e s c r i p t i v e b e n e f i t p l a n s , you wouldn't worry.
That's t h e answer t o t h e problem.
So, I need -- perhaps, I need you t o share w i t h us why we can't
do Medicare r e f o r m r i g h t now, why you can't come t o us, and t h e p r e s i d e n t
can't come t o us w i t h a p l a n t o p r o v i d e -- s i n c e we've had (tougher r i s k ?)
c o n t r a c t s g o i n g s i n c e 1986, and we know what's happening o u t t h e r e . The
people who a r e d o i n g e f f i c i e n t h e a l t h care i n our communities t h r o u g h
(tougher r i s k ?) c o n t r a c t s a r e b e i n g p e n a l i z e d .
I ' l l g i v e you an example -- New York. I n 1994, here's what HCVA
j u s t decided. T h i s proves t h a t t h e r e are savings i n t h e market, b u t i t a l s o
proves how dumb government i s , i . e . , HCVA. (Laughter.) I n 1994, t h e (tougher
r i s k ?) c o n t r a c t o r s i n New York who c u r r e n t l y charge Medicare $569 t o g e t
i n t o one o f these p l a n s w i l l go up 15 p e r c e n t . I n M i n n e a p o l i s and St. Paul,
where t h e charge f o r t h e v e r y same s e r v i c e f o r t h e v e r y same k i n d o f people
i s o n l y $351, t h e y ' r e g o i n g down. And t h a t ' s f o r t h e b e n e f i t o f everybody
here, who i s making, you know, t h e c u r r e n t p o l i c y . Now why, i f we have a l l
these d e m o n s t r a t i o n s around t h e c o u n t r y , why, i f t h e y ' r e t h a t s u c c e s s f u l , why
don't we j u s t go t o changing Medicare r i g h t now? Give t h e e l d e r l y t h e same
k i n d o f comprehensive b e n e f i t t h a t we're p r o m i s i n g everybody e l s e , p u t i t
t h r o u g h one o f these accountable h e a l t h p l a n s . We have t h e model o f t h e
(tougher r i s k ?) c o n t r a c t s o p e r a t i n g i n many o f o u r communities. Why n o t j u s t
do i t ?
MRS. CLINTON: W e l l , Senator, you make a v e r y c o m p e l l i n g argument
about what i s c u r r e n t l y g o i n g on i n Medicare, and we ought t o be a b l e t o
f i g u r e o u t i n c e n t i v e s so t h a t more people w i l l use those systems t h a t a r e
b e t t e r o r g a n i z e d , and we'd be happy t o work w i t h you on t h a t .
You know, as you know i n t h i s committee b e t t e r t h a n most, d e a l i n g
w i t h Medicare and e x p l a i n i n g i t and making sure t h e p u b l i c understands what
you're t r y i n g t o do i s a b i g t a s k . But i f we c o u l d come up w i t h a b i p a r t i s a n
approach t h a t would e x p l a i n how we a r e a c t u a l l y making Medicare b e t t e r , then
I t h i n k we ought t o take a hard l o o k a t t r y i n g t o do t h a t . I have no problem
w i t h d o i n g t h a t a t a l l , because you're a b s o l u t e l y r i g h t , t h e r e i s no
e x p l a n a t i o n o t h e r t h a n t h e way care i s d e l i v e r e d and o r g a n i z e d t o e x p l a i n
these d i f f e r e n c e s i n c o s t .
And y e t , we have a system t h a t .rewards i n e f f i c i e n c y , and p e n a l i z e s . ,
e f f i c i e n c y . Minnesota w i l l g e t l e s s money because i t ' s done b e t t e r . New York
and many o t h e r s , n o t t o p i c k on New York, w i l l g e t more money because they
are n o t as e f f i c i e n t . And t h a t i s n o t t h e r i g h t k i n d o f i n c e n t i v e s t h a t we
�want t o have i n t h e system. So, we'd be happy t o work w i t h you t o t r y t o
f i g u r e out how t o r e v e r s e those i n c e n t i v e s w i t h i n the e x i s t i n g Medicare
system.
SEN. MOYNIHAN: Thank you. Senator Durenberger.
Mrs. C l i n t o n , may I say t h i s b e i n g the U n i t e d S t a t e s Senate, i t ' s
a l l r i g h t t o p i c k on New York. (Laughter.)
MRS. CLINTON: I l o v e New York, Mr. Chairman. I t ' s New York, New
York, as f a r as I'm concerned.
SEN. MOYNIHAN: Senator B r a d l e y .
SEN. BILL BRADLEY (D-NJ): Thank you v e r y much, Mr. Chairman.
Let me say, f i r s t o f a l l , Mrs. C l i n t o n , I t h i n k you're p r o v i d i n g
an enormous p u b l i c s e r v i c e t o the c o u n t r y . I'm p e r s o n a l l y g r a t e f u l , and I
t h i n k t h e r e are m i l l i o n s o f people who are v e r y pleased t h a t you're d o i n g
what you're d o i n g and you're where you a r e .
One o f the most, I t h o u g h t , p o i g n a n t moments i n t h e p r e s i d e n t ' s
speech t h e o t h e r n i g h t on h e a l t h care was when he l e v e l e d w i t h t h e American
people about t h e i r own s e l f - d e s t r u c t i v e b e h a v i o r and t h e f a c t t h a t i t ' s going
t o be p r e t t y d i f f i c u l t t o get h e a l t h care c o s t s under c o n t r o l i n the l o n g r u n
i f every American doesn't r e c o g n i z e t h a t t h e y have a p a r t i n t h i s process. He
mentioned tobacco and he mentioned v i o l e n c e .
Now, on tobacco, as you know, as anyone knows who l o o k e d a t t h i s ,
the O f f i c e o f Technology Assessment says t h a t c o s t s are $68 b i l l i o n a year,
$2.59 per pack. I t seems t o me t h a t i n t a l k i n g about a tobacco t a x t h a t . A,
i t should be v e r y h i g h , and, B, i t should be t a l k e d about i n terms o f h e a l t h ,
not o n l y i n terms o f revenue.
On v i o l e n c e , one o f t h e most s t a r t l i n g numbers t h a t I've come
across i n r e c e n t years i s t h a t i f you want t o be a gun d e a l e r i n America, i t
c o s t s you between $30 and $75 t o g e t a l i c e n s e . There are 276,000 gun d e a l e r s
i n America. There are more gun d e a l e r s i n America than t h e r e are gas
s t a t i o n s . And t h a t , t o me, i s a remarkable number.
And I t h i n k i t ' s d i r e c t l y r e l a t e d t o t h e a c c e s s i b i l i t y t h a t guns
have i n t h e c o u n t r y today. And i f we s i m p l y p u t a 25 p e r c e n t s a l e s t a x on the
s a l e o f t h e gun and r a i s e t h e d e a l e r s ' fees from 30 t o 75 t o $2,500, we'd
r a i s e $600 m i l l i o n . That would be a t a x d i r e c t l y on t h e p u r v e y o r s o f v i o l e n c e
i n terms o f t h e s a l e s o f t h e means o f v i o l e n c e .
Now, what i s your o p i n i o n on t h e tobacco t a x , how h i g h do you
t h i n k i t ' l l be, and what i s t h e i n c r e a s e i n t h e d e a l e r s ' f e e -- how do you
r e a c t t o t h a t , and how do you r e a c t t o a 25 p e r c e n t s a l e s t a x on handguns and
on automatic weapons?
MRS. CLINTON: W e l l , s e n a t o r , w i t h r e s p e c t t o t h e tobacco t a x , we
agree w i t h you t h a t tobacco should be t a x e d as p a r t o f t h i s package, and
l a r g e l y f o r h e a l t h reasons, and p a r t i c u l a r l y t o t r y t o d e t e r smoking among
young people. And we' re., ..you. know, s t i l l - t r y i n g to-make sure t h a t , we-.know
e x a c t l y how much revenue we w i l l need, but t h e t a x w i l l be between 75 cents
and a d o l l a r a d d i t i o n a l t o what i s a l r e a d y the f e d e r a l t a x .
Speaking p e r s o n a l l y -- and t h a t ' s a l l I can do w i t h r e s p e c t t o
�your second p r o p o s a l -- I'm a l l f o r t h a t . I j u s t don't know what e l s e we're
g o i n g t o do t o t r y t o f i g u r e o u t how t o g e t some handle on t h i s v i o l e n c e . And
one o f my b e s t f r i e n d s , a woman I ' v e gone t o school w i t h s i n c e grade school
who i s a f u l l - t i m e homemaker, has t h r e e c h i l d r e n i n a suburb o f Chicago, i s j
opened a s t o r e i n a s t r i p m a l l across t h e s t r e e t from t h e l o c a l h i g h s c h o o l ,
have p i c k e t e d , t h e y have t r i e d t o t a l k w i t h t h i s person, they've even t r i e d t
t h a t he c o u l d s t i l l be i n business, and he's j u s t a b s o l u t e l y pleased as he ca
from t h e h i g h s c h o o l . He t h i n k s i t w i l l i n c r e a s e h i s t r a d e remarkably.
And I share my f r i e n d ' s o u t r a g e , you know. She's somebody who i s
not p o l i t i c a l and doesn't march o r p i c k e t , b u t t h e r e ' s j u s t something wrong
when i t ' s t h a t easy t o s e l l guns t o h i g h school s t u d e n t s a f t e r s c h o o l . And
t h i s i s a suburb, and we know what happens now i n every p a r t o f o u r c o u n t r y
w i t h t h a t k i n d o f a v a i l a b i l i t y o f weapons i n t h e hands o f teenagers. And I
know Senator Chafee has been concerned about t h i s i s s u e f o r a l o n g t i m e , and
i t has t o be addressed. And we w i l l l o o k a t your p r o p o s a l and be happy t o
t a l k w i t h you about i t . I'm speaking p e r s o n a l l y , b u t I f e e l v e r y s t r o n g l y
about t h a t .
SEN. BRADLEY: W e l l , l e t me say t h a t t h e r e i s no more i m p o r t a n t
p e r s o n a l endorsement i n t h e c o u n t r y today, and I thank you v e r y much.
(Laughter.)
SEN. MOYNIHAN: Thank you. Senator B r a d l e y .
May I j u s t i n t e r j e c t t h e t h o u g h t , Mrs. C l i n t o n , t h a t t h e
e p i d e m i o l o g i s t s have begun t o t h i n k i n terms o f p e r s o n a l v i o l e n c e , handgun
v i o l e n c e and t h e consequences and t r y i n g t o t h i n k , as e p i d e m i o l o g i s t s w i l l ,
i n terms o f v e c t o r s and so f o r t h . And t h e p o i n t can be made t h a t guns don't
k i l l people, b u l l e t s k i l l people.
We have a t w o - c e n t u r y s u p p l y o f handguns i n t h i s c o u n t r y . There
have been 50 m i l l i o n s o l d s i n c e J i m Brady was s h o t . We o n l y have about<
a f o u r - y e a r s u p p l y o f ammunition. And t h e f e d e r a l government t h r o u g h t h e
Bureau o f A l c o h o l , Tobacco, and Firearms -- which doesn't seem t o know t h i s ,
but i t i s t h e f a c t -- has t h e r i g h t t o t a x t h e s a l e and manufacture o f
b u l l e t s , o f ammunition. That's r i g h t t h e r e i n t h e s t a t u t e . And I t h i n k t h e y
do i s s u e -- f o r $30 you can manufacture 300 m i l l i o n rounds o f 9 m i l l i m e t e r
ammunition and you don't have t o r e p o r t back. I suggest -SEN. PACKWOOD Could I g i v e you an addendum t o t h a t ?
SEN. MOYNIHAN Sure.
SEN. PACKWOOD I quoted y o u r f i g u r e when I was i n Oregon l a s t
week i n some h e a r i n g , and I s a i d ''Whether o r n o t gun r e g i s t r a t i o n works I'm
not sure, b u t t h e r e ' s a r e l a t i v e l y s h o r t supply o f ammunition which c o u l d be
e a s i l y r u n o u t . ' ' I s a i d ''There i s n o t a c e n t u r y ' s supply o f ammunition i n
t h i s c o u n t r y . ' ' The w i t n e s s says ''There i s i n my basement.'' (Laughter.)
SEN. MOYNIHAN: ( I heard ?) t h e sometime gunnery o f f i c e r o f t h e
U n i t e d S t a t e s Ship Q u i r i n u s ( s p l - s a y .'_-'-If--±t' s - i n h i s basement^, i t won't-Ise
w o r t h a damn i n about t e n y e a r s ' t i m e . ' ' (Laughter.) Powder, t h e s e c r e t a r y o f
t h e Navy w i l l assure, powder degenerates v e r y f a s t , .45 c a l i b e r p i s t o l s do
not. And t h a t ' s -- I ' l l s t o p r i g h t t h e r e . But you took t h a t note down, d i d
�you not?
MRS. CLINTON: Yes, I d i d . (Laughter.)
SEN. MOYNIHAN: Senator R i e g l e .
SEN. DONALD W. RIEGLE JR. (D-MI): Thank you v e r y much, Mr.
Chairman, and l e t me j u s t say t o o u r v e r y d i s t i n g u i s h e d guest, you're j u s t
g i v i n g t e r r i f i c l e a d e r s h i p t o t h i s c o u n t r y , and you r a i s e a l e v e l o f hope f o r
people across t h e n a t i o n t h a t something good can happen by g i v i n g i t t h i s
i n t e n s e p e r s o n a l l e a d e r s h i p as you have. And I've had a chance t o watch t h a t
at c l o s e range, as we a l l have. I t ' s j u s t r e a l l y been e x t r a o r d i n a r y , and I
thank you f o r everybody i n Michigan, everybody across t h e c o u n t r y .
I want t o j u s t make two p o i n t s . One i s t h a t on t h i s committee
now, t h e r e a r e f o u r o f us who have announced we w i l l n o t be seeking
r e e l e c t i o n i n 1994, so Senator Wallop and Senator D a n f o r t h and Senator
Durenberger and I a r e i n t h a t group, and so we a l l n o t o n l y a r e r e l i e v e d o f
the t i m e and t h e e f f o r t t h a t i t takes t o be engaged i n a campaign, b u t i t
g i v e s us t h e chance t o work across t h e p a r t i s a n a i s l e , which we r e a l l y must
do t o succeed i n t h i s e f f o r t . And you've been so d i l i g e n t i n your e f f o r t s t o
t a l k w i t h members on b o t h s i d e s , and we've t a l k e d p r i v a t e l y and we t a l k e d
down a t t h e White House t h e o t h e r day w i t h t h e p r e s i d e n t , when a l l o f us were
t h e r e , about t h i s i s t h e o n l y way we can g e t t h i s done. The o n l y c o n c e i v a b l e
way t h a t we can enact h e a l t h care over t h e next year i s by w o r k i n g on a
bipartisan basis.
And I want t o j u s t say a g a i n t o Senator Chafee, t h e r a n k i n g
member on t h e Subcommittee on t h e Uninsured, t h a t I am chairman o f , and t o
the c o l l e a g u e s on t h a t s i d e , I i n t e n d t o do t h i s i n a f u l l y b i p a r t i s a n way,
and I have a l s o s a i d t h a t t o o u r c o l l e a g u e s over on t h e Labor and Human
Resources Committee. And B i l l Roth and I came here t o g e t h e r 27 years ago i n
the same p a r t y . So i t ' s easy f o r us t o work t o g e t h e r d e s p i t e an o c c a s i o n a l
d i f f e r e n c e here o r t h e r e .
So you've g o t a pledge from me t h a t f o r my p a r t we're g o i n g t o
work across t h i s p a r t y a i s l e and t r y t o g e t t h i s done. And Senator Dole has
s a i d as much, and I have complimented him f o r d o i n g t h a t .
Let me j u s t t a l k about t h e comprehensiveness o f t h e program and
how q u i c k l y we a r e a b l e t o phase i t i n . We have t a l k e d b e f o r e about t h e f a c t
t h a t we have t h i s v e r y i m p o r t a n t model f o r us i n Hawaii, where we've had now
comprehensive h e a l t h care f o r about 20 y e a r s . And t h e c o s t o f h e a l t h care as
a p e r c e n t o f t h e Hawaiian economy i s about e i g h t p e r c e n t , t h e r e s t o f t h e
c o u n t r y i t ' s 14 p e r c e n t . So we know t h a t a f t e r t h a t 2 0 year e x p e r i e n c e , t h a t
we a r e g e t t i n g t h i s huge f i n a n c i a l d i v i d e n d , p l u s t h e h e a l t h outcomes are
much b e t t e r .
But when you go over t h a t 20 year h i s t o r y , i t t a k e s t h e f i r s t 10
years b e f o r e those c o s t l i n e s r e a l l y break a p a r t and you r e a l l y s t a r t t o g e t .
the b i g f i n a n c i a l b e n e f i t s and savings o f good p r i m a r y care and good
preventive care.
Now o u r problem here i s g o i n g t o be how q u i c k l y do we phase t h i s
�in? And t h e problem i s g o i n g t o be, we're going t o t r y t o measure t h e
r e s u l t s , e s s e n t i a l l y over a f i v e year budget time frame, and we're b a s i c a l l y
g o i n g t o be measuring p u b l i c c o s t s , because t h a t ' s what we d e a l w i t h , so
we're g o i n g t o have t o do something s p e c i a l t o f a c t o r i n t h e p r i v a t e savings
and t h e impacts o u t t h e r e , and then we've g o t t o t h i n k about what t h e time
frame i s over which we r e a l l y measure t h e r e t u r n s o f t h i s program.
I f we t r y t o j u s t t a k e and f i n a n c e i t based on t h e r e t u r n s over
f i v e y e a r s , when you l o o k a t Hawaii, t h a t ' s n o t g o i n g t o be a l o n g enough
time p e r i o d i n which t o r e a l l y understand how these savings w i l l accrue as we
a v o i d a l o t o f diseases, we a v o i d a l o t o f problems o f people w i t h h i g h cost
care and so f o r t h .
So I am wondering what your thought i s as t o how we s o r t o f
r e c o n c i l e t h a t , i n terms o f how we t h i n k t h r o u g h t h i s q u e s t i o n o f how we cost
t h i s o u t so t h a t we don't f o o l o u r s e l v e s , i n a sense undershoot on t h e f r o n t
end, when we've g o t t o make, i n a sense, t h e investment i n good h e a l t h i n
o r d e r t o save t h e huge d o l l a r s l a t e r on down t h e l i n e ?
MRS. CLINTON: Oh, Senator, t h a t i s such a good q u e s t i o n and i t i s
made so c o m p l i c a t e d by t h e way t h e f e d e r a l budget i s s t r u c t u r e d and operates,
because i t i s v e r y hard t o achieve savings based on investments i n
p r e v e n t i o n , o r savings based on c o m p e t i t i o n i n t h e p r i v a t e s e c t o r as p a r t o f
the budget a n a l y s i s and p r o j e c t i o n s .
I t has been one o f t h e issues t h a t I have r e a l l y s t r u g g l e d over
as I have t r i e d t o understand i t , and I j u s t hope t h a t t h i s committee, which
c e r t a i n l y has so much c r e d i b i l i t y on these i s s u e s , w i l l c o n t i n u e t o s t r e s s
t h a t even though something may n o t be s c o r a b l e i n Washington, D.C, budget
t a l k doesn't mean i t ' s n o t r e a l . You know, we know t h a t p r e v e n t i o n w i l l work
i f we can g e t p r e v e n t i o n i n p l a c e . I t i s a b s o l u t e l y one o f t h e c l e a r e s t
commitments we can make t o g e t t i n g c o s t s under c o n t r o l . But we a l s o know t h a t
some people w i l l c l a i m , w e l l , u t i l i z a t i o n w i l l go up a l i t t l e . I f everybody
i s g o i n g t o g e t p r e v e n t i o n , u t i l i z a t i o n w i l l go up.
W e l l , u t i l i z a t i o n should go up, we want i t t o go up. The average
c i t i z e n o f Hawaii has more d o c t o r v i s i t s than t h e average c i t i z e n o f t h e
o t h e r 4 9 s t a t e s . But because t h e y a r e d o c t o r v i s i t s f o r p r i m a r y and
p r e v e n t i v e care, as more l i k e l y t o occur t h e r e than here, t h e i r o v e r a l l c o s t s
are l e s s . So yes, we w i l l have some i n c r e a s e d c o s t s i n t h e b e g i n n i n g t o g e t
t h i s system s e t up, and what we're g o i n g t o have t o f i g u r e o u t how t o do, i s
w i t h i n t h e c o n s t r a i n t s t h a t t h i s budget imposes on your d e l i b e r a t i o n s and on
your a b i l i t y t o d e a l w i t h your c o l l e a g u e s , we have t o e x p l a i n t h a t .
And we have t h e o t h e r problem, which we b e l i e v e , c o m p e t i t i o n w i l l
i n c r e a s e savings as p r a c t i c e s s t y l e s change, as a d m i n i s t r a t i v e loads go down,
and a l l t h e t h i n g s you know so w e l l , b u t we can't g e t those scored e i t h e r
because t h e y ' r e n o t c o n s i d e r e d w i t h i n t h e budget w o r l d t h a t e x i s t s here, t o
be savings t h a t can be a c t u a l l y l a i d o u t f o r people t o see and r e a l i z e .
So we have t o be w i l l i n g t o make a s t r o n g s t a n d f o r investment
and s t i c k t o i t because we know i t w i l l pay o f f i f we do.
SEN. RIEGLE: I thank you, and I ' l l j u s t say, Mr. Chairman -- I
�know my t i m e i s up -- maybe one o f t h e t h i n g s we can do i s when we l a y out
the c o s t numbers, do i t w i t h the f i v e - y e a r p r o j e c t i o n s , t h e t e n , t h e f i f t e e n ,
and maybe even t h e twenty, r e c o g n i z i n g t h a t t h a t ' s what experience has taught
us so t h a t we don't f o o l o u r s e l v e s on how we r e a l l y get t h i s j o b done and
save t h e money a t t h e same t i m e .
SEN. MOYNIHAN: Good -- t h a t ' s a good p r o p o s a l , and l e t ' s , indeed,
undertake t o do. Senator -- thank you. Senator R i e g l e .
Senator Daschle.
SEN. GRASSLEY ( ? ) : Mr. Chairman, w i l l I get a chance t o -SEN. MOYNIHAN: Yes, s i r , you're a f t e r Senator Daschle.
SEN. DASCHLE: Thank you, Mr. Chairman. Mrs. C l i n t o n , I -- Senator
Grassley and I may be t h e l a s t two q u e s t i o n e r s you get t h i s week, and
I want t o commend you f o r t h e q u a l i t y of y o u r answers. The c l a r i t y and the
command o f t h e f a c t s t h a t you've demonstrated a l l week i s a d m i r a b l e , and I
a p p r e c i a t e v e r y much your c o n t r i b u t i o n t o t h e debate t h i s e n t i r e week.
Somebody recommended today t h a t maybe somebody o f f e r you a s w e a t s h i r t t h a t
says, ' ' I s u r v i v e d . ' ' I t h i n k i t ought t o be ' ' I f l o u r i s h e d , ' ' because a l l
week l o n g you c e r t a i n l y have done t h a t .
You've answered i n c h a r a c t e r i s t i c f a s h i o n my concerns about some
of t h e aspects o f the p l a n i n r u r a l America, but I was home t h i s l a s t
weekend, and t h r e e concerns are r a i s e d t h a t perhaps you might be able t o
address: t h e f i r s t , from insurance h o l d e r s who have been t o l d by some t h a t
t h i s i s g o i n g t o r a d i c a l l y change t h e way t h e y buy i n s u r a n c e ; t h e second, by
s t a t e o f f i c i a l s who express concern t h a t we may be d e a l i n g w i t h y e t another
unfunded mandate as we change the s t r u c t u r e i n t h e r e l a t i o n s h i p between the
f e d e r a l government and the s t a t e s i n a d d r e s s i n g governmental r e s p o n s i b i l i t y ,
and t h e t h i r d has t o do w i t h those who b e n e f i t from a l t e r n a t i v e h e a l t h care
-- home h e a l t h care and o t h e r forms o f care, e s p e c i a l l y e v i d e n t i n r u r a l
America. But i f you c o u l d address those t h r e e concerns, I would a p p r e c i a t e
it.
MRS. CLINTON: Thank you v e r y much. Senator, and thank you f o r a l l
of y o u r h e l p on g e t t i n g t h i s p r o j e c t underway and p a r t i c u l a r l y f o r the h e a l t h
care u n i v e r s i t y work t h a t you d i d . W i t h r e s p e c t t o insurance h o l d e r s , we are
t r y i n g t o d e s i g n t h i s so t h a t those who are c u r r e n t l y i n s u r e d w i l l see v e r y
l i t t l e change. Every year t h e y w i l l be g i v e n the o p p o r t u n i t y t o choose what
h e a l t h p l a n t h e y w i s h t o s i g n up w i t h . They w i l l t h e n have a c o s t t h a t i s
assigned t o t h a t h e a l t h p l a n based on how t h e h e a l t h p l a n has c o s t e d out i t s
s e r v i c e s . Under our system t h e n , the employer and t h e employee w i l l be making
a c o n t r i b u t i o n t o t h e a l l i a n c e , and t h e i n d i v i d u a l w i l l see v e r y l i t t l e
d i f f e r e n c e i n terms of making payments i n t o t h e a l l i a n c e as opposed t o making
payments i n t o t h e insurance company. The most i m p o r t a n t f e a t u r e w i l l a c t u a l l y
be enhanced, and t h a t i s the i n d i v i d u a l i n s u r e d w i l l have t h e choice as t o
what p l a n t o use h i s insurance d o l l a r s f o r . That d e c i s i o n w i l l not be made by
h i s employer i f he has insurance t h r o u g h an employer. So we r e a l l y are t r y i n g
t o keep t h i s system as much l i k e what most Americans know r i g h t now, and we
b e l i e v e t h a t we can do t h a t .
�w i t h r e s p e c t t o the unfunded mandate f o r s t a t e s , t h a t i s an issue
we've spent a l o t o f t i m e t a l k i n g w i t h t h e s t a t e s about, p a r t i c u l a r l y the
governors w i t h whom we have worked c l o s e l y . We c e r t a i n l y do not i n t e n d f o r
t h i s t o be i n any way an unfunded mandate.
The s t a t e s f e e l v e r y s t r o n g l y , and w i t h good cause. They've had
more t h a n t h e i r share o f unfunded mandates. And the most d i f f i c u l t t o deal
w i t h has been h e a l t h care, p a r t i c u l a r l y i n t h e Medicaid program, where now,
f o r t h e f i r s t t i m e , s t a t e s are spending more on Medicaid t h a n t h e y are
spending on h i g h e r e d u c a t i o n . So, we understand t h a t t h a t i s a l e g i t i m a t e
f e a r on t h e p a r t s o f s t a t e s and we i n t e n d t o g i v e s t a t e s f l e x i b i l i t y and
r e s p o n s i b i l i t i e s t h a t t h e y have l a r g e l y asked us t o g i v e them, but not the
k i n d o f c o s t s t h a t come from unfunded mandates.
And t h e n , f i n a l l y , w i t h r e s p e c t t o a l t e r n a t i v e h e a l t h care,
p a r t i c u l a r l y home h e a l t h care, t h i s i s one o f these d i f f i c u l t i e s t h a t we have
where, on t h e one hand, I t h i n k t h e r e are l e g i t i m a t e q u e s t i o n s r a i s e d about
should we s t a r t a new program l i k e l o n g - t e r m care? You know, t h i s i s a new
investment t h a t we would fund t h r o u g h t h e r e d u c t i o n s i n t h e r a t e o f growth of
Medicare. On t h e o t h e r hand, i f we do not p r o v i d e some support f o r l o n g - t e r m
care, p a r t i c u l a r l y f o r home h e a l t h care, we w i l l spend more money t h a n we
w i l l i f we make t h e investment i n l o n g - t e r m care now, i t i s our b e l i e f .
So, we want t o be p r o v i d i n g a b e t t e r a r r a y o f a l t e r n a t i v e s t o
c i t i z e n s , p a i c u l a r l y i n t h e l o n g - t e r m care area, t h r o u g h home-based care and
community-based care. And we t h i n k t h a t i n v e s t i n g i n t h a t now w i l l reap
d i v i d e n d s down t h e road, b o t h i n terms o f human and f a m i l y concerns, as w e l l
as economic. So, t h a t ' s how we would l i k e t o b e g i n t o address what are
r i g h t f u l l y seen as a l t e r n a t i v e , but c o s t - e f f e c t i v e , ways o f t a k i n g care o f
people.
SEN. DASCHLE: Thank you, Mrs. C l i n t o n .
Thank you, Mr. Chairman.
'
SEN. MOYNIHAN: Thank you. Senator Daschle.
Senator Grassley.
SEN. CHARLES E. GRASSLEY (R-IA): Mrs. C l i n t o n , Senator
Durenberger asked you about Medicare b e i n g i n c l u d e d . I want t o h i t i t from a
l i t t l e d i f f e r e n t angle. Your p l a n c a l l s f o r s t a t e s h a v i n g t h e o p t i o n o f
t a k i n g over Medicare. My governor, former Governor Ray (sp) as w e l l , are -he's p r e s i d e n t o f t h e Blue Cross/Blue S h i e l d , and t h e n our h o s p i t a l
a s s o c i a t i o n , l o t s o f o t h e r s as w e l l b e l i e v e t h a t you're never r e a l l y g o i n g t o
have h e a l t h care r e f o r m unless Medicare i s p u t i n t o i t . So, maybe i n my
s t a t e , we might opt f o r t h a t . So, I have some q u e s t i o n s about how t h i s might
work. And t h e y ' r e k i n d o f based on t h e f e a r t h a t , you know, we've got 65, 70
p e r c e n t o f our people i n our h o s p i t a l s are Medicare r e c i p i e n t s , and so we
don't get reimbursed on t h e c o s t o r on t h e charges f o r t h a t .
F i r s t , c o u l d you t e l l us how t h e amount o f Medicare money coming
t o a s t a t e from t h e f e d e r a l l e v e l would be c a l c u l a t e d ? Would i t be on a per
c a p i t a amount based on h i s t o r i c a l reimbursement p a t t e r n s ? Or would i t be on
some s o r t o f new reimbursement methodology? And i f i t would be a new
�methodology, how would i t work i n general?
Now, I ask t h i s q u e s t i o n , as you p r o b a b l y know, because Iowa has
one o f t h e l o w e s t c o s t and charge s t r u c t u r e s f o r h e a l t h care i n t h e c o u n t r y .
And people i n our s t a t e b e l i e v e now and have b e l i e v e d f o r y e a r s t h a t Medicare
doesn't pay i t s f a i r share o f t h e c o s t s , not o f t h e charges, o f t r e a t i n g
Medicare b e n e f i c i a r i e s . Our p r o v i d e r s b e l i e v e t h a t Medicare doesn't pay more
t h a n 70 o r 80 p e r c e n t o f what i t c o s t s t o t r e a t a p a t i e n t . And I've a l r e a d y
mentioned t h a t these c o s t s are a t t h e bottom o f -- f o r my s t a t e o f a l l t h e
s t a t e s . So, a reimbursement p a t t e r n t h a t f r e e z e s i n what i s now an inadequate
reimbursement l e v e l wouldn't be f a i r f o r my s t a t e .
One a d d i t i o n a l p o i n t , and t h e n I ' l l l e t you answer. I f t h e s t a t e
were t o t a k e t h i s over and under your p l a n was s l o w i n g down Medicare, would
the slowdowns t h a t are a t t h e f e d e r a l l e v e l a l s o a p p l y on t h e same b a s i s t o
what t h e s t a t e s might have, i f t h e y assume t h a t cost?
MRS. CLINTON: Senator, those are r e a l l y i m p o r t a n t q u e s t i o n s . And
t h e way t h a t I would have t o answer them i s i t w i l l depend upon how we
f i n a l l y decide t o d e a l w i t h Medicare i n t h i s l e g i s l a t i o n . The way t h e p l a n i s
c u r r e n t l y proposed, we would be s t a r t i n g from t h e h i s t o r i c a l l e v e l s t h a t
c u r r e n t l y e x i s t . And I share your concern. I come from Arkansas. I t h i n k
Arkansas' r a t e i s even below Iowa's r a t e . And i t i s something t h a t has been a
p a r t i c u l a r burden on r u r a l s t a t e s l i k e ours because you s t a r t w i t h a
d i f f e r e n t i a l where Medicare pays l e s s t h a n t h e p r i v a t e s e c t o r and t h e n you
add burdens by making i t v e r y d i f f i c u l t f o r a l o t o f s t a t e s and l o c a l i t i e s t o
even r e a c h what i s a f a i r d i f f e r e n t i a l because we don't get reimbursed a t the
same r a t e as o t h e r s . So, I'm v e r y conscious o f t h i s .
And what we have s t r u g g l e d w i t h and what I would v e r y much
a p p r e c i a t e b e i n g a b l e t o work w i t h you and your s t a f f on i s i f we don't s t a r t
from t h e h i s t o r i c a l r a t e s and t h e n move toward a f a i r a l l o c a t i o n , we don't
know a t what l e v e l we c o u l d s t a r t . Because we've got b u i l t - i n c o s t s i n many
o f these systems t h a t we're g o i n g t o have t o g e t out b e f o r e we can reach a
f a i r e r l e v e l o f reimbursement across t h e c o u n t r y .
I t concerns me because a l r e a d y now you've got s i t u a t i o n s where
Medicare p a t i e n t s are b e i n g t a k e n care o f e x t r e m e l y w e l l i n Iowa o r Arkansas
or Minnesota a t o n e - h a l f o r o n e - t h i r d t h e cost o f what i s b e i n g p a i d f o r
Medicare p a t i e n t s elsewhere.
We want t o b r i n g t h e c o s t s i n those o t h e r s t a t e s down. That i s
the whole t h e o r y b e h i n d what we are d o i n g . But we w o r r y t h a t , i f we s t a r t e d
by s a y i n g j u s t o f f t h e b a t , ''Okay, S t a t e X, you've been reimbursed a t two o r
t h r e e t i m e s what Iowa has g o t t e n ; you're not g o i n g t o get t h a t anymore,''
t h a t would cause t o o much o f a d i s r u p t i o n i n t h e e x i s t i n g system. So we want
t o t r y t o b r i n g i t down g r a d u a l l y . We a l s o want t o t r y t o f i g u r e out how t o
do what Senator Durenberger i s s a y i n g , which i s , t h r o u g h t h e s t a t e s -- i s our
p r o p o s a l -- you would--begin t o move people i n t o more c o s t - e f f e c t i v e settings.,..
You would b e g i n t o p r o v i d e more care t o more Medicare r e c i p i e n t s f o r a b e t t e r
value f o r the d o l l a r .
So we have l o o k e d a t i t on a s t a t e - b y - s t a t e b a s i s as opposed t o a
�n a t i o n a l r e f o r m . But we're open t o l o o k i n g a t b o t h your q u e s t i o n s and Senator
Durenberger's q u e s t i o n s , because the bottom l i n e i s we know t h a t Medicare
r e c i p i e n t s i n Iowa are b e i n g w e l l taken o f and t h e y ' r e b e i n g g i v e n care a t
l e s s c o s t t h a n o t h e r s t a t e s , and we need t o reward Iowa f o r d o i n g a good j o b
i n s t e a d o f p e n a l i z i n g Iowa, which i s what we c u r r e n t l y do. And so we had
t h o u g h t t h e b e s t way t o proceed was t o g i v e more a u t h o r i t y t o t h e s t a t e s ,
which i s what t h e s t a t e s have asked us -- l i k e , you know, I know b o t h
Governor Ray and your c u r r e n t governor -- because t h i n k , f r a n k l y , t h e y can do
a b e t t e r j o b t h a n the f e d e r a l government. But we need t o l o o k a t b o t h a s t a t e
approach, which i s what we f a v o r , and t h e n a t i o n a l approach t h a t Senator
Durenberger has a l l u d e d t o . And w e ' l l be g l a d t o do t h a t .
SEN. MOYNIHAN: Thank you. Senator Grassley.
I would note t h a t the house o f 1:00 i s approaching, and t h e r e ' s
o n l y so much we c o u l d ask of our w i t n e s s .
Senator M i t c h e l l has been p a t i e n t l y w a i t i n g t o ask some
questions.
SEN. MITCHELL: Thank you, Mr. Chairman.
Mrs. C l i n t o n , my q u e s t i o n b u i l d s upon t h a t of Senator Grassley
and y o u r response t o i t and r e l a t e s t o some of t h e c r i t i c i s m t h a t ' s been made
of t h e p r e s i d e n t ' s p l a n . F o l l o w i n g the p r e s i d e n t ' s address l a s t week, i n the
o f f i c i a l response t o t h a t address, i t was c r i t i c i z e d as, quote, ''a
o n e - s i z e - f i t s - a l l f e d e r a l h e a l t h care system,'' unquote. We each r e p r e s e n t
d i f f e r e n t s t a t e s . I and o t h e r s on t h i s committee r e p r e s e n t s t a t e s which are
c a l l e d r u r a l , w i t h r e l a t i v e l y sparse p o p u l a t i o n s l i v i n g p r i m a r i l y i n s m a l l
towns spread over l a r g e areas of l a n d . And t h e people of Maine want some
assurance t h a t t h i s w i l l not be a o n e - s i z e - f i t s - a l l f e d e r a l h e a l t h care
system, t h a t w h i l e t h e r e w i l l be a b a s i c package o f b e n e f i t s which w i l l
p r o v i d e h e a l t h care s e c u r i t y t o a l l Americans and w i l l t r a v e l w i t h t h a t
American wherever he o r she goes, t h a t t h e method o f d e l i v e r i n g h e a l t h care
w i l l be s u b s t a n t i a l l y l e f t t o the s t a t e s , p r o v i d e d t h e y meet the t h r e s h o l d
requirement o f s e c u r i t y f o r a l l Americans.
I s t h i s c r i t i c i s m accurate? W i l l t h e r e be a o n e - s i z e - f i t s - a l l
f e d e r a l h e a l t h care system. W i l l Maine have t o do what New York does and
C a l i f o r n i a have t o do what West V i r g i n i a does? Or w i l l t h e s t a t e s have
f l e x i b i l i t y i n the d e l i v e r y of h e a l t h care?
MRS. CLINTON: Senator, we are t r y i n g v e r y hard t o design i t so
t h a t s t a t e s do have f l e x i b i l i t y w i t h i n a f e d e r a l framework. This w i l l be, I
t h i n k , one o f t h e d i f f i c u l t c h a l l e n g e s you w i l l face i n t h e Congress. There
are s t a t e s t h a t are v e r y anxious t o take on the c h a l l e n g e o f h e a l t h care
r e f o r m , t h a t they've a l r e a d y passed l e g i s l a t i o n t h e y want t o see implemented,
t h a t t h e y have a t r a c k r e c o r d of d o i n g something s u c c e s s f u l -- l i k e a Hawaii,
f o r example -- and t h e y are j u s t chomping a t the b i t f o r you t o g i v e them the
k i n d o f framework i n which t h e y can proceed. There are o t h e r s t a t e s t h a t
don't want a n y t h i n g t o do w i t h h e a l t h care r e f o r m whatsoever. They don't see
i t as t h e i r r e s p o n s i b i l i t y . They want t h e f e d e r a l government t o d i c t a t e the
terms, and t h e y want t o be t o l d what t h e y ' r e supposed t o do and how t h e y ' r e
�supposed t o get i t done w i t h as l i t t l e i n t e r f e r e n c e as t h e y can put up w i t h ,
but j u s t b a s i c a l l y f u l f i l l a f e d e r a l program.
We b e l i e v e t h a t t h e r e ought t o be a f e d e r a l framework w i t h s t a t e
f l e x i b i l i t y and t h a t s t a t e s ought t o be g i v e n the o p p o r t u n i t y t o d e s i g n t h e i r
d e l i v e r y systems t o meet the p o p u l a t i o n needs of t h e i r s t a t e s . The Congress
w i l l have t o decide how t o make sure every s t a t e meets i t s b a s i c o b l i g a t i o n ,
so t h a t i f any s t a t e i s u n w i l l i n g t o make d e c i s i o n about h e a l t h care, t h e n
the f e d e r a l government w i l l have t o be sure t h a t the people i n t h a t s t a t e are
p r o t e c t e d . But o t h e r t h a n t h a t , we want t h e r e t o be s t a t e f l e x i b i l i t y t o the
e x t e n t we p o s s i b l y can d e s i g n i t .
SEN. MITCHELL: What assurance can you p r o v i d e now t o the people
of Maine who l i v e i n r u r a l areas and s m a l l towns t h a t the d e l i v e r y and
q u a l i t y of care t o them and t o o t h e r Americans i n r u r a l s e t t i n g s w i l l not be
d i m i n i s h e d , but r a t h e r w i l l be enhanced under the p r e s i d e n t ' s program?
MRS.
CLINTON: Senator I t h i n k t h e r e are a number of f e a t u r e s
t h a t , i n Senator Baucus' words e a r l i e r , w i l l be g r e a t l y b e n e f i c i a l , enhance
the d e l i v e r y o f h e a l t h care i n r u r a l areas. I've d r i v e n t h r o u g h Western
Maine. I know t h a t people are s p a r s e l y p o p u l a t e d i n those b e a u t i f u l f o r e s t s .
And we want t o be sure t h a t we have a system of d e l i v e r i n g h e a l t h care i n
r u r a l areas t h a t i s f i r m l y grounded i n a s o l i d f i n a n c i n g mechanism, which i s
why we want everybody i n the system and everybody making a c o n t r i b u t i o n which
i d e n t i f i e s p r o v i d e r s i n those s m a l l communities as e s s e n t i a l so t h a t t h e y are
g i v e n a a d d i t i o n a l support t o be t h e r e when the people need them, where we
have the k i n d of i n c e n t i v e s f o r p h y s i c i a n s and nurses t o p r a c t i c e i n r u r a l
areas by f o r g i v i n g loans and by e x t e n d i n g l o a n paybacks and where we use
t e c h n o l o g y b e t t e r t h a n we have t o get h e a l t h care s e r v i c e s i n t o remote and
r u r a l areas.
Those are some of the f e a t u r e s t h a t I f e e l v e r y c o m f o r t a b l e
t e l l i n g the people of Maine t h a t t h e y can count on, because i t w i l l enhance
what t h e y have now and g i v e them h e a l t h s e c u r i t y , which t h e y do not have now.
SEN. MITCHELL: Mrs. C l i n t o n , f i n a l l y , on the q u e s t i o n of the
r e f o r m i s f i n a n c e d , I have here a c h a r t which appears i n the m a t e r i a l s
prepared by the a d m i n i s t r a t i o n c o v e r i n g the p e r i o d 1994 t h r o u g h 2000,
a seven-year p e r i o d . Some of the c r i t i c s of the p r e s i d e n t ' s p l a n have used
t h i s c h a r t t o suggest t h a t t h e r e w i l l be $700 b i l l i o n i n , quote,
''new
government spending'' or $600 b i l l i o n i n , quote, ''new government spending.''
I'm g o i n g t o ask, Mr. Chairman, t h a t the c h a r t be p l a c e d i n the
r e c o r d a t an a p p r o p r i a t e p o i n t .
But as I read t h i s c h a r t , I i n t e r p r e t i t t h a t t h e r e w i l l be
a p p r o x i m a t e l y $350 b i l l i o n over seven years f o r such new b e n e f i t s , the
r e m a i n i n g $350 b i l l i o n w i l l be merely t r a n s f e r e n c e o f c u r r e n t Medicare and
Medicaid r e c i p i e n t s i n t o the a l l i a n c e s and f o r d e f i c i t r e d u c t i o n . I s t h a t
your u n d e r s t a n d i n g as w e l l ?
MRS.
C
money. Senator, w i l l
come from employer/employee c o n t r i b u t i o n s t h a t are not now b e i n g made, from
�r e d u c i n g t h e r a t e o f i n c r e a s e i n Medicare and Medicaid, from r e a l l o c a t i n g
e x i s t i n g f e d e r a l f u n d i n g sources, such as d i s p r o p o r t i o n a t e share, which w i l l
no l o n g e r be needed because we w i l l be d e c r e a s i n g u n i n s u r e d c a r e , and from
the tobacco t a x and t h e c o n t r i b u t i o n s from c o r p o r a t i o n s t h a t choose t o s t a y
out o f t h e system. And t h a t ' s a v e r y b r i e f overview o f where we're g e t t i n g
the money from, which we w i l l , o b v i o u s l y , be g o i n g i n t o g r e a t d e t a i l w i t h
t h i s committee i n t h e weeks ahead.
SEN. MITCHELL: A l l r i g h t . Mr. Chairman, i f I might j u s t note f o r
the r e c o r d -- I know my time i s up -- t h a t t h e areas i n which t h e funds w i l l
be used, a c c o r d i n g t o t h i s c h a r t , a r e l o n g - t e r m care b e n e f i t s f o r t h e
e l d e r l y , Medicare drug b e n e f i t , a p r e s c r i p t i o n drug b e n e f i t which does n o t
now e x i s t , p u b l i c h e a l t h and a d m i n i s t r a t i o n , a l a r g e o f p a r t o f which I
understand w i l l go t o i m p r o v i n g t h e d e l i v e r y and q u a l i t y o f care i n r u r a l
areas, and f i n a l l y , t h e l a r g e s t amount w i l l be s u b s i d i e s f o r low-income f i r m s
and workers. That, I understand, i s what you t a l k e d about e a r l i e r i n t h e
d i s c o u n t f o r s m a l l business and i n t h e e f f o r t t o h e l p s m a l l businesses. Am I
correct i n that?
MRS. CLINTON: Yes, s i r .
SEN. MITCHELL: I thank -SEN. MOYNIHAN: We w i l l p l a c e t h a t i n t h e r e c o r d . Be happy t o do
i t . There's a d e f i c i t r e d u c t i o n o f $91 b i l l i o n i n a l l i a n c e coverage. And
w e ' l l p r o b a b l y g e t r e v i s e d numbers b e f o r e we -MRS. CLINTON: Yes, s i r .
SEN. MOYNIHAN: -- t h e f i n a l l e g i s l a t i o n , which i s -MRS. CLINTON: W e l l , i n f a c t , we're t a k i n g i n a l l o f t h e advice
and s u g g e s t i o n s t h a t a l l t h e members a r e g i v i n g us and r e v i s i n g t h e p l a n as
we speak, so -- b u t these a r e t h e broad o u t l i n e s .
SEN. MOYNIHAN: Thank you, and thank you. Senator M i t c h e l l . And
now, t h e one Senator who has n o t been heard, has w a i t e d v e r y p a t i e n t l y .
Senator Boren.
SEN. BOREN: Thank you v e r y much Mr. Chairman and Mrs. C l i n t o n .
I ' l l t r y t o be b r i e f , we a p p r e c i a t e t h e amount o f time you have shared w i t h
us, and a p p r e c i a t e a l s o t h e h a r d work and p e r s o n a l commitment t h a t you have
brought t o t h i s i s s u e , and a l s o t h e d e c i s i o n o f t h e p r e s i d e n t t o t a c k l e t h i s
head on. I t h i n k we a l l r e a l i z e we have a l o t o f problems i n t h i s c o u n t r y
because a d m i n i s t r a t i o n s o f b o t h p a r t i e s , and members o f b o t h p a r t i e s i n t h e
Congress have wanted t o shy away from tough issues -- would be v e r y d i f f i c u l t
t o r e s o l v e . And I t h i n k t h e p r e s i d e n t deserves a l o t o f c r e d i t f o r b e i n g
w i l l i n g t o t a k e t h i s one on head on and face up t o i t .
I suppose my b i g g e s t concern, because I share a l l o f t h e goals
t h a t have been announced i n terms o f t h e p r e s i d e n t ' s program, i s t o make sure
t h a t we a r e a d e q u a t e l y p a y i n g f o r i t . I don't t h i n k t h e r e has been a n y t h i n g
t h a t has caused Americans t o become more c y n i c a l about government, than t h e
f a c t t h a t we have overpromised sometimes, and u n d e r d e l i v e r e d , and t h a t we
c e r t a i n l y , n e a r l y always missed o u r e s t i m a t e s , so t h a t t h e d e f i c i t s have been
h i g h e r t h a n a n t i c i p a t e d . That's happened t o us i n budget, a f t e r budget, a f t e r
�budget.
I t h i n k i t ' s understandable t h a t some Americans have s k e p t i c i s m
as t o whether o r n o t we're p r o m i s i n g t o o much and p r o v i d i n g t o o l i t t l e
revenue t o s u s t a i n i t .
One o f t h e c r i t i c i s m s t h a t has been r a i s e d has been o f t h e $51
b i l l i o n p r o j e c t e d f i g u r e t h a t would come from a n t i c i p a t e d new revenues due t c
i n c r e a s e d wages and p r o f i t s . I wonder i f i n making t h a t e s t i m a t e , i f i t was
c o n s i d e r e d t h a t some companies, r a t h e r t h a n p a y i n g e i t h e r h i g h e r wages o r
d i s b u r s i n g p r o f i t s , might choose t o r e i n v e s t t h e i r money i n t a x exempt ways,
ways f o r example t h a t would a l l o w them t a x d e d u c t i b l e d e p r e c i a t i o n o r o t h e r
ways t h a t might reduce t h e revenues. And I wonder, more b r o a d l y , t h a t i f
indeed we f i n d t h a t we have u n d e r e s t i m a t e d t h e c o s t s and o v e r e s t i m a t e d o u r
a n t i c i p a t e d revenues, t h a t we do g e t a gap between t h e money a v a i l a b l e and
the o u t f l o w , i s t h e r e some mechanism a n t i c i p a t e d i n t h e p l a n f o r d e a l i n g w i t h
that?
Small businesses t e l l me, f o r example, w e l l , we're due t o g e t
t h i s subsidy, b u t what i f t h e p l a n c o s t s more t h a n a n t i c i p a t e d , o r what i f
the revenues don't come i n t o pay f o r i t as we a n t i c i p a t e ? W i l l we see t h a t
s u b s i d y c u t back?
I guess t h e b a s i c q u e s t i o n i s i f t h e e s t i m a t e s end up n o t b e i n g
a c c u r a t e , w i l l we s o l v e t h a t gap by c u t t i n g back on t h e amount o f t h e
b e n e f i t s , s c a l i n g them back t o what we can a f f o r d , o r w i l l we s o l v e t h a t by
p u t t i n g a d d i t i o n a l c o s t s on t h e businesses and o t h e r s t h a t w i l l be p a y i n g f o r
the s e r v i c e ?
MRS. CLINTON: Well Senator, l e t me answer y o u r q u e s t i o n i n
s e v e r a l ways. L e t me s t a r t w i t h t h e revenue g a i n s t o be a n t i c i p a t e d from
f r e e i n g up funds f o r i n c r e a s e d t a x a b l e t r a n s a c t i o n s , such as i n c r e a s e d wages,
p r o f i t s , o r whatever.
T h i s i s a f i g u r e t h a t has undergone i n t e n s e s c r u t i n y . I t has been
run t h r o u g h t h e Treasury models. They have p u t i n t o those assumptions m a t t e r s
such as you r a i s e d , what would be t h e t r a d e - o f f i f X p e r c e n t went i n t o
n o n - t a x a b l e t r a n s a c t i o n s o r investment? And I am sure t h a t t h e Treasury
people w i l l be a b l e t o e x p l a i n t h a t i n much more d e t a i l t h a n I can.
But i t i s t h e k i n d o f change i n p o l i c y t h a t we t h i n k i s n o t
uncommon t o t h i s committee, because f o r example, i f you were t o make a p o l i c y
change t o s h i f t funds from non-taxable compensation t o t a x a b l e income o r t o
d e a l w i t h p e n s i o n income i n a d i f f e r e n t way, you would r u n t h e same k i n d o f
m o d e l l i n g i n t h e t r e a s u r y t h a t we have done t o come up w i t h t h i s f i g u r e .
And so I t h i n k t h a t t h e Finance Committee p a r t i c u l a r l y w i l l
u n d e r s t a n d how we a r r i v e d a t t h a t .
Now, c l e a r l y , t h e r e has t o be an u n d e r s t a n d i n g t h a t t h a t i s an
approximate f i g u r e , because who knows p r e c i s e l y how new revenues w i l l be
used. But those k i n d s o f assumptions have been taken i n t o account.
....
W i t h r e s p e c t t o a gap t h a t might develop between t h e c o s t s o f t h e
program and t h e amount o f money a v a i l a b l e t o pay f o r i t i n b o t h t h e p r i v a t e
and t h e p u b l i c s e c t o r , l e t me answer t h a t i n s e v e r a l ways.
�F i r s t , i n a l l o f t h e c o s t p r o j e c t i o n s t h a t we have g i v e n you and
t h a t we have worked i n t e r n a l l y , we have t r i e d t o be c o n s e r v a t i v e . We have
not, f o r example, i n c l u d e d any o f t h e savings t h a t we t h i n k w i l l accrue
because o f c o m p e t i t i o n and because o f changes t h a t p h y s i c i a n s and h o s p i t a l s
w i l l engage i n on t h e i r own t h a t w i l l r e s u l t , as I s a i d e a r l i e r , i n more
coronary by-pass s u r g e r i e s b e i n g done c l o s e r t o 21,000 i n s t e a d o f 84,000.
None o f those f i g u r e s a r e i n these cost e s t i m a t e s . We b e l i e v e -- and we
b e l i e v e we have v e r y s t r o n g support f o r t h i s -- t h a t t h i s p r o p o s a l w i l l
r e a l i z e a v e r y s i g n i f i c a n t amount o f savings. So we t h i n k t h a t helps t o
cushion whatever gap t h e r e i s .
I n a d d i t i o n t o t h a t , we have i n c l u d e d padding, i f you w i l l . We
have t r i e d t o be as c o n s e r v a t i v e as p o s s i b l e . For example, i n l o o k i n g a t how
much t h e b e n e f i t s package would c o s t , we have t r i e d t o r u n t h r o u g h a l l k i n d s
of s c e n a r i o s -- what w i l l happen i f t h e r e ' s an earthquake i n C a l i f o r n i a
f o l l o w e d by a plague -- and we've t r i e d t o make sure t h a t we have s u f f i c i e n t
d o l l a r s a l l o c a t e d f o r t h a t so t h a t t h e r e i s t h e o p p o r t u n i t y f o r t h i s gap t o
be f i l l e d . We do n o t a n t i c i p a t e t h a t w i t h t h e combination o f t h e revenue t h a t
we have a l r e a d y l a i d o u t , w i t h t h e savings t h a t t o some degree o r o t h e r
everyone i s c o n f i d e n t w i l l come i f we pursue t h i s p l a n , and w i t h t h e k i n d o f
a d d i t i o n a l f u n d i n g we have p u t i n t o cushion any e v e n t u a l i t y t h a t we can a t
l e a s t f o r e s e e a t t h i s p o i n t t h a t t h e r e should be grounds f o r concern about
any i n d i v i d u a l o r business h a v i n g t o s t e p up and f i l l t h e gap.
Now, we know t h a t even though we i n t e n d t o g e t savings out o f
t h i s system t o make i t more c o m p e t i t i v e t h a t t h e h i s t o r y o f h e a l t h care costs
i s t h a t t h e y a t some p o i n t w i l l c o n t i n u e t o r i s e because something w i l l
happen t h a t w i l l cause more care t o be g i v e n a t c e r t a i n p e r i o d s o f time o r
whatever.
I t i s d i f f i c u l t a t t h i s p o i n t t o know what t h a t c o n t i n u e d growth
r a t e might be, b u t we t h i n k i f we b r i n g t h e base down, i f we squeeze out t h e
savings and t h e cost t o be o b t a i n e d from i t , we w i l l be a l o t b e t t e r o f f than
we a r e on t h e c u r r e n t course, where t h e gap between any o f us who are i n s u r e d
and u n i n s u r e d i s growing b i g g e r , and t h e gap between what we pay and w i l l
have t o pay i s growing l a r g e r . So t h a t ' s t h e k i n d o f a n a l y s i s we have
undergone t o g e t t o t h e p o i n t where we a r e , and we're g o i n g t o be s h a r i n g
o b v i o u s l y much more o f t h e d e t a i l s o f t h a t w i t h you as we c o n t i n u e w i t h t h i s .
SEN. BOREN: Thank you v e r y much.
SEN. MOYNIHAN: Thank you. Senator Boren.
Now, Mrs. C l i n t o n , a r e t h e r e any q u e s t i o n s you would l i k e t o ask
us? (Laughter.)
MRS. CLINTON: Do you a l l ever take a l u n c h break? (Laughter.)
SEN. MOYNIHAN: I t h i n k on t h a t p r a c t i c a l note, I ' d l i k e t o
express t h e g r e a t g r a t i t u d e o f t h e committee, I t h i n k we a l l -- what do you
say we g i v e a l i t t l e hand here. (Applause.)
Thank you v e r y much, and t h e committee stands adjourned.
END
Distribution:
TO
TO
TO
TO
TO
B a r r y J. T o i v
Marsha S c o t t
Carter W i l k i e
Kimberly T i l l e y
E r i c Berman
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Health Care Task Force Records
Creator
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White House Health Care Task Force
Is Part Of
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
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<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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Paper
Dublin Core
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First Lady’s Hearing Testimony, 09/1993
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 2
Is Part Of
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Box 9
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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Preservation-Reproduction-Reference
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2/6/2015
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42-t-12092992-20060885F-Seg2-009-001-2015
12092992
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https://clinton.presidentiallibraries.us/files/original/b4e76c63f9203cce4625a73fb9bd4bc7.pdf
b5fd53f528e93dcf821f048d707c4c3f
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Text
FOIA Number:
2006-0885-F
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administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
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OA/ID Number:
3681
FolderlD:
Folder Title:
Congressional Briefing Memos - POTUS
Stack:
Row:
Section:
Shelf:
Position:
s
52
3
8
2
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECT/TITLE
Jack Lew & Chris Jennings; re: Legislative Status of Academic
Health Center Issue (1 page)
05/05/1994
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number;
3681
FOLDER TITLE:
Congressional Briefmg Memos - POTUS
2006-0885-F
ip2853
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Freedom of Information Act - |5 U.S.C. 552(b)l
PI
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b{2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA)
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b(4) Release would disclose trade secrets or confidential or financial
information |(bX4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
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National Security Classified Information 1(a)(1) of the PRA]
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RR. Document will be reviewed upon request.
I
�THE WHITE HOUSE
WASH INGTON
July 31, 1994
MEETING WITH SENATOR MITCHELL
Date: August 1, 1994
Location: Oval Office
Time: 9:15 - 10:00 a.m.
From: Patrick J. Griffin
I. PURPOSE
•
For Senator Mitchell to brief you on the health reform proposal he plans to present to
Members and release to the public on Tuesday.
•
To give your first cut reaction to his proposal and to give you an opportunity for last
second suggestions prior to the plan's unveiling.
•
To seek his advice as to the optimal role for you and the First Lady to play in publicly
supporting Senator Mitchell's proposal.
•
To offer whatever assistance the White House can provide to him particularly with
regard to outreach to specific swing members, "hand holding" with nervous groups and
the provision of resource materials for supporting members use on the Senate floor.
U.
BACKGROUND
As you recall from your meeting with Senator Mitchell last week, his proposal
guarantees a failsafe trigger mechanism to a 50-50 employer/employee mandate,
which has a carve out for firms with fewer than 25 employees. The only way the
trigger would not be pulled is if Congress approves an altemative recommendation by
a national commission which has been certified to reach universal coverage by other
means. The primary potential problem is that it may not achieve universal coverage
that is affordable, since it is likely to have inadequate cost containment.
For the last two months, Senator Mitchell has raised serious reservations about the
likelihood of the Senate being able to pass an employer mandate. In response, he has
advocated that the best way to address this problem is to develop a package of
insurance refonns and subsidies that could legitimately be scored as achieving 95
percent coverage. In so doing, he feels he may be able to attract some members to
vote for a triggered fallback employer mandate if these members believe that you can
reach the 95 percent coverage goal without a mandate.
�s
For the last week, he and his staff have been working intensively with the
Congressional Budget Office to target subsides efficiently in such a way as to
significantly enhance coverage. It is unclear whether he can achieve the 95 percent
target, but it may be possible. Even if he can find a way to reach the coverage goal, it
is unclear whether he can pay for it, particularly because he is still including Medicare
prescription drug and long-term care benefits.
Having said this, what seems extremely likely is that it will be even more difficult to
pay for a mandate. This is because covering at least 5 percent more of the population
in combination with the additional subsidies for businesses and families that we are
providing significantly increase costs.
As of this evening, it seemed unlikely that they were going to find sufficient revenues
or savings to fill the financing hole. The key to the financing question is likely to be
whether he incorporates a stronger cost containment provision that he has heretofore
hesitated to advocate. (His primary concem is that it weighs the package down with
another extremely difficult political burden.)
Senator Mitchell has indicated that he will outline and release his plan to his
Democratic colleagues at 12:30 on Tuesday. He will follow that presentation with a
floor speech, a press briefing and a meeting with health care interest groups. Last
Friday, he met with these groups seeking their input and advice regarding his proposal.
From all reports it was a positive and constructive meeting but our Public Liaison staff
remain extremely nervous about the reaction our base supporters are likely to have to
the Mitchell plan.
ni.
PARTICIPANTS
The President
Senator Mitchell
Hillary Rodham Clinton
Leon Panetta
Patrick Griffin
Harold Ickes
Ira Magaziner
rV.
SEQUENCE OF EVENTS
Closed Meeting with Senator Mitchell in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
Jul, 29, 1994
^ c o i o - O - S ^ S - e '
PRIVILEGED AND GQNSBfiifflAfc MEMORANDUM
TO: HILLARY RODHAM CUNTON
FR: STEVE EDELSTEIN AND MAUREEN SHEA
This memorandum is in preparation for your trip to Boston on Sunday. Health issues of
particular concem to the delegation include both the biotechnology industry and research and
teaching hospitals. Senator Kennedy's unwavering support is essential, but we also need to
pay attention to Senator Kerry whose only public comments have been ambivalent. Rules
Chairman Moakley is, of course, moving to center stage.
SENATOR EDWARD tTED) KENNEDY
(D-MW.
Senator Kennedy is key to insuring that our left liberal base supporters do not bolt when
Senator Mitchell unveils his bill. While it might do us some good politically to have some
unhappiness on the left, we cannot afford to lose our hard core liberal and union support in
the coming floor debate.
Senator Kennedy isfrustratedwith the Majority Leader's unwillingness to start with a stronger
package in the bill he introduces. His issues of particular concem at the moment are:
•
Children: He wants all uninsured children to be covered as soon as possible,
preferably by 1996;
•
Workers: He may offer an amendment, as in Hawaii, to require an earlier 50-50
phase-in of workers, but not their dependents; and the
•
Bradley Amendment: Kennedy wants it dropped.
Senator Kennedy's criticism of Pizza Hut and other restaurants which insure their workers
abroad but not in the United States received a good deal of press. The Massachusetts
Restaurant Association held a news conference stating their disagreement with him and their
fear that a mandate would cost 20,000 jobs in the state. However, they did not endorse his
opponent. Mitt Romney.
�Political observers feel Senator Kennedy's re-election bid is going to be more difficult than
originally anticipated both because of the anti-incumbent political mood and his own past
negatives.
In a lengthy interview with the Boston Globe earlier this month. Senator Kennedy said that
his tough re-election reflects the public's impatience with slow-moving institutional politics
and its desire for easy answers to thorny problems, mentioning jobs, health care, and crime.
He vowed to fight any health care bill that does not guarantee universal coverage to all
Americans, and predicted the President would veto any measures without an employer
mandate. He added: " I won't vote for is anything that is going to condition the
implementation of that legislation on future congressional action." Kennedy told the Globe
that no matter what the details of the final bill, the President will "reap the lion's share of the
credit." Keimedy said he would urge the President to veto a partial bill and wage war on the
issue in the November elections.
Kennedy reiterated his position that constituent pressure on Republicans will keep them from
filibustering. Kennedy said he "relished the opportunity" to debate his Senate colleagues on
the issue of universal health coverage. " I can't wait to deal with our colleagues — when I
say we are offering the people of Massachusetts the same thing I have and they are going to
say no," Kennedy said. "They are going to say no to that, when 75% of the people say yes?"
SENATOR TOHN KERRY
(D-MA).
Senator Kerry has not cosponsored any of the major health reform bills and the Boston Globe
has called him "conspicuously absent" from the HSA. While he is being deferential to
Senator Kennedy and we expect him to be with us in the end. Senator Kerry's comments of
late show a real need for some shoring up. In recent visits with health care providers in
Massachusetts, he has been quite critical of both the health care debate and reform proposals.
While he said he expected the Senate to pass a phased-in version of universal coverage, he
added that all the proposals make unrealistic promises about what can be achieved. He feels
"the govemment is reaching too far," saying " I want to build aframeworkand then let the
marketplace duke it out." These remarks were made after visiting a HMO which lobbied
against the "any willing provider" proposals. Kerry asked them to discuss whether the United
States could set a budget limit on health care spending the way the HMO develops its
budgets.
In a meeting this month with the South Shore Hospital staff he said that legislators have to
make choices on health care rather than promises to deliver every suggestion at top quality.
"There is a lack of candor in the health care debate. I'm looking for some truth...not this
whole bunch of rhetoric." He told them he favored universal care that would be paid for by
some mandates to individual and businesses, but that he had not decided whether he favors
broad mandates on business. He advocated prevention and keeping health care in the
marketplace as a way to keep costs down and quality high. "The Wal-Mart syndrome has its
place, but it isn't everywhere."
�Administrative simplification and insurance reform are of particular interest to him.
Presumably he will be reassured by the compromises made to help the biotech industry which
is strong in Massachusetts. He will undoubtedly also support the additional hospital funds
contained in the Labor Committee bill. Local groups report that he opposes taxation of health
benefits.
Kerry serves on the Small Business as well as Banking and Commerce Committees. He
voted for NAFTA, National Service, and the Budget.
CHAIRMAN TOE MOAKLEY (D-MA):
The Chairman of the Rules Committee is a HSA and McDermott cosponsor who prefers the
single-payer approach. Congressman Moakley is a party person who, while usually willing
to listen to both Republicans and Democrats, dismisses Republican complaints that health care
is being decided behind closed doors. "If they're left out, it's because they want to be left out.
We'd love to have them play because we're going to need every vote that we can get."
Moakley has predicted that his committee will allow the House to vote on more than one
health care plan and "plenty" of amendments. Undoubtedly reflecting the interests from
which he had already heard, he mentioned biotechnology companies, foot doctors, nurses and
insurance companies as being among the health care "variables" for which there may be
amendments. However, despite those comments, he will undoubtedly go along with the
leadership decision on amendments. He opposes abortion and said this month he thinks it
should have a vote on the floor.
In response to the Massachusetts biotechnology industry, Moakley wrote the President this
May opposing the HSA's establishment of a breakthrough drug committee, saying it would
"irreparably damage America's preeminence in biotechnology." Massachusetts has 142
biotechnology companies which employ over 17,600 people.
Moakley voted for Family and Medical Leave and the Budget and against NAFTA. He did
not vote on National Service.
CONGRESSMAN MARTIN MEEHAN (D-MAY.
While he has not cosponsored any of the major health plans, freshman Congressman Meehan
has told the Administration that he will support anything that gets to universal coverage. He
recently said: "Given that health care represents one-seventh of the economy, reform has to
be gradual. I would accept a process over the next four or five years." He is worried about
two areas in reform - the insurance industry, which is the largest employer in his district, and
small business.
Local groups report that he supports universal coverage unequivocally and will vote for a tax
to get it done. They said his greatest fear is that nothing will be passed, and that he wants to
see both greater simplicity in insurance cuid cost cutting. He advocated that nurse
�practitioners be granted earlier access into the system. A Roman Catholic, he cosigned the
DeFazio-Schroeder letter on abortion benefits.
Meehan represents a liberal constituency and made his reputation as a crime fighter when, as
an assistant district attorney, he dealt with white collar and violent crime, as well as hate
crimes against gays. He serves on the Small Business and Armed Services Committees.
Meehan has been a good vote for the White House, voting for Family and Medical Leave,
Budget Reconciliation, National Service, and NAFTA.
�TO:
STAFF SECRETARY
FR:
STEVE EDELSTEIN AND MAUREEN SHEA
DATE:
7/29/94
I n f o r m a t i o n from our data base on h e a l t h c a r e f o r Reps. Menendez
and T o r r i c e l l i f o r Monday's t r i p :
CONGRESSMAN ROBERT MENENDEZ (D-NJ): Congressman Menendez i s a
freshman who r e p r e s e n t s p a r t s o f Jersey C i t y , Newark and
E l i z a b e t h , While h e a l t h care c o s t s were one o f t h e focuses o f
h i s 1992 campaign, he has t o l d l o c a l groups t h a t he has n o t
c o s i g n e d any o f t h e major h e a l t h r e f o r m b i l l s because o f concerns
about s m a l l business and h i s doubts t h a t a b i l l w i l l pass t h i s
y e a r . I n a f a l l meeting w i t h t h e A d m i n i s t r a t i o n , he s a i d he was
w o r r i e d about those who are a l r e a d y w e l l - i n s u r e d and about t h e
bureaucracy, t h e impact on Medicaid, responsiveness t o m i n o r i t y
groups, and f i n a n c i n g . He has t o l d l o c a l groups t h a t he agrees
s t r o n g l y w i t h u n i v e r s a l coverage, p a r t i c u l a r l y s i n c e 25% o f h i s
c o n s t i t u e n t s a r e u n i n s u r e d . The groups say he i s p r e p a r e d t o
s u p p o r t c o s t containment and t a x i n g o f b e n e f i t s .
I n January he t o l d t h e S t a r Ledger;
"We c a n ' t w a i t any l o n g e r
f o r t h e h e a l t h c a r e system t o h e a l i t s e l f .
The Congress needs t o
p r o v i d e t h e l e g i s l a t i v e medicine t o h e a l our s i c k l y h e a l t h c a r e
system."
CONGRESSMAN ROBERT TORRICELLI (D-NJ); While Congressman
T o r r i c e l l i c a l l e d h e a l t h care r e f o r m "a h i s t o r i c m i s s i o n " and a
" b l u e p r i n t f o r those o f us i n Congress who are committed t o
r e d u c i n g c o s t s and p r o v i d i n g coverage t o every American c i t i z e n , "
he has n o t cosponsored any o f t h e major h e a l t h r e f o r m b i l l s . A t
a s p r i n g town h a l l meeting, he was v e r y s u p p o r t i v e o f t h e b i l l ,
and f a m i l i a r enough w i t h t h e d e t a i l s t o handle q u e s t i o n s w e l l .
Questions, as one might expect i n New Jersey, i n c l u d e d t h o s e from
people opposed t o a b o r t i o n and o t h e r s w o r r i e d about t a x i n g and
l o s i n g coverage.
T o r r i c e l l i has s a i d he s u p p o r t s u n i v e r s a l coverage and t h e use o f
market f o r c e s t o slow c o s t s . He s u p p o r t s t h e tobacco t a x . He
would l i k e t o see a b i l l which won't harm s m a l l businesses o r
r a i s e t a x e s . I n response t o an i r a t e l e t t e r from a n t i - c h o i c e
c o n s t i t u e n t s , T o r r i c e l l i s a i d t h a t i n d i v i d u a l p l a n s and p r o v i d e r s
"would have t h e o p t i o n t o exclude coverage f o r c e r t a i n m e d i c a l
procedures."
�TO:
STAFF SECRETARY
FR:
STEVE EDELSTEIN AND MAUREEN SHEA
DATE:
7/28/94
The f o l l o w i n g i s i n f o r m a t i o n from our data base on Rep. A l a n
Wheat and h i s p r i m a r y opponents's h e a l t h c a r e p o s i t i o n s .
CONGRESSMAN ALAN WHEAT (D-MO); A HSA cosponsor. Wheat says "To
g i v e up on u n i v e r s a l coverage would be a m i s t a k e . " He would l i k e
r e f o r m t o i n c l u d e more p r e v e n t i v e c a r e , l o n g - t e r m c a r e and cover
p r e s c r i p t i o n drugs. He wants t o curb i n s u r a n c e company
r e s t r i c t i o n s , s a y i n g ; " T h i r t y - f i v e m i l l i o n w o r k i n g people c a n ' t
get coverage because o f p r e - e x i s t i n g c o n d i t i o n s .
Insurance
companies say t h e y can f i x t h e problems.
I say, why a r e n ' t t h e y
doing i t ? "
Last year. Wheat a l s o discussed coverage o f F e d e r a l
employees and r e t i r e e s .
H i s main p r i m a r y opponent, Jackson County E x e c u t i v e Marsha Murphy
i s c a l l i n g him a b i g spender and t o o l i b e r a l f o r M i s s o u r i . Her
husband i s a p h y s i c i a n and she i s opposing "government
b u r e a u c r a c i e s " i n f a v o r o f an i n c r e m e n t a l approach.
"The n a t i o n
may have t o r e f o r m t h e h e a l t h care system one s t e p a t a t i m e .
The d e c i s i o n s we are making are t o o monumental t o r u s h them."
She s u p p o r t s u n i v e r s a l access and "managed c o m p e t i t i o n r o o t e d i n
the p r i v a t e s e c t o r . " "We must i n s u r e t h a t h e a l t h c a r e coverage
i s a v a i l a b l e t o every American - a t an a f f o r d a b l e p r i c e - from
the d o c t o r o f our c h o i c e . " She q u e s t i o n s t h e employer-mandate,
s a y i n g " I do t h i n k t h a t i t ' s c r i t i c a l t h a t we n o t have any j o b
l o s s " by imposing such a h e a l t h c a r e r e q u i r e m e n t on b u s i n e s s .
" I f we l o s e j o b s , we w i l l have more people uncovered." She
s u p p o r t s r e g u l a t i n g t h e i n s u r a n c e i n d u s t r y t o bar companies from
not c o v e r i n g people w i t h p r e - e x i s t i n g c o n d i t i o n s . She a l s o
favors p o r t a b i l i t y .
The o t h e r Democratic c a n d i d a t e s i n t h e race h o l d a v a r i e t y o f
views:
N i c h o l a s Clement - s u p p o r t s s i n g l e payer
G e r a l d O r t b a l s - minimal r e f o r m on areas o f consensus
Jim Hawley - doesn't b e l i e v e i n u n i v e r s a l coverage
Ned S u t h e r l a n d - s u p p o r t s s i n g l e payer
Jim Thomas - a f f o r d a b l e u n i v e r s a l h e a l t h c a r e - i s a s m a l l
businessman who does n o t o f f e r h e a l t h b e n e f i t s
Wheat i s unusual i n a number o f r e s p e c t s .
The son o f an A i r
�Force c o l o n e l , he i s one o f the few members of Congress from a
career m i l i t a r y family. Perhaps h i s growing up i n an i n t e g r a t e d
sector o f American l i f e accounts i n part f o r the a b i l i t y he has
shown t o a t t r a c t non-black voters. A t r a i n e d economist and
former s t a t e l e g i s l a t o r . Wheat i s part of the younger generation
of mainstream-oriented blacks.
Wheat voted f o r Family and Medical Leave, National Service, and
Budget R e c o n c i l i a t i o n but against NAFTA.
�THE WHITE H O U S E
WAS
HIN GTO N
July 27, 1994
MEETING WITH SENATOR GRAHAM
Date: July 28, 1994
Location: Oval Office
Time: 5:50 - 6:20 PM
From: Patrick J. Griffin
I. PURPOSE
To underscore the importance of health care reform to your Presidency and to the
Democratic Party and to seek his support for a bill that achieves universal coverage.
•
To illustrate your flexibility and willingness to compromise for a universal coverage
bill.
n.
BACKGROUND
As Chairman of the Senate Democratic (Campaign Committee, he would like to be a
player in the health care debate. Senator Graham is a Health Security Act cosponsor.
He supports universal coverage and is comfortable with the employer mandate and
will work with Senator Mitchell to achieve those goals.
Of late, Graham has become concemed that, with the leadership is focusing all
energies on drafting a bill with a mandate to achieve universal coverage, not enough
attention is being paid to what will happen if such a provision fails. He believes that
a fallback position should be developed that is more ambitious than the "rump group"
proposal rather than permitting their proposal to succeed by default. To this end, he
has been exploring an amendment which would provide flexibility for states to pursue
their own universal coverage initiatives in the absence of a federal universal coverage
law. fra Magaziner has met with Senator Graham and other White House staff has
met with the Senator's staff to discuss this issue. The Senator and his staff have
promised to coordinate with the Majority Leader's office. We have offered to provide
additional technical assistance as needed.
�III.
PARTICIPANTS
The President
Senator Graham
Patrick Griffin
Harold Ickes
Steve Ricchetti
IV.
SEQUENCE OF EVENTS
Closed Meeting with Senator Graham in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE W H I T E H O U S E
WAS
H I N GTO N
July 27, 1994
MEETING WITH SENATOR BRADLEY
Date: July 28, 1994
Location: Oval Office
Time: 6:30 - 7:00 PM
From: Patrick J. Griffin
I. PURPOSE
•
To underscore the importance of health care reform to your Presidency.
•
To obtain an assessment of where he stands with respect to a fallback employer
mandate, which has a cost containment mechanism similar to his proposal that was
included in the Finance Committee bill. (This is very similar to the bill Senator
Mitchell is now developing)
•
To thank him for his thoughtful efforts at the Finance Committee and to urge to him
to work with Senator Mitchell to develop a bill that achieves universal coverage that
moderates can support.
•
To convey how much you have tried to reach out to Republicans, yet every time you
do they move too far to the right to catch up.
n.
BACKGROUND
With the Finance Committee mark-up, Senator Bradley appears to have finally
engaged the issue of health care reform. He participated in the work of the "rump
group" focusing particularly on market-oriented altematives to the premium caps
which he opposes. His proposal to unpose a 25% tax on high cost insurance plans
was adopted by the Committee. This provision engendered strong union opposition,
something he had not anticipated. While he voted for the Finance Committee mark,
he is concemed it may be seriously underfunded.
�In a phone conversation with Secretary Reich last month, Bradley expressed his
support for shared responsibility but noted that he did not think the Senate leadership
would be able to get sufficient votes for the mandate even though polls show that the
American people support it. He believes we need to craft a bill that can get 60 votes
and that a 51 vote majority won't do.
Senator Bradley also described, in general terms, a proposal he was working on. It
apparently would require employers to maintain their existing plans and provide the
same benefits to all eligible employees. An assessment would be imposed on firms
that did not offer insurance and these funds would be used to help provide coverage to
the uninsured. If a goal of 94% coverage was not reached, a commission would make
recommendations to achieve that goal with an up or down vote by the Congress.
III.
PARTICIPANTS
The President
Senator Bradley
Patrick Griffin
Harold Ickes
IV.
SEQUENCE OF EVENTS
Closed Meeting with Senator Bradley in the Oval Office.
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE W H I T E H O U S E
WAS H1N GTO N
July 27, 1994 DETERMINED TO BE AN AD.MINISTRATIVE
MARKING Per E.O. 12958 as amended, 850.3.3 (c)
Initials:
PRIVILEGED AND CONFFBENTHEE MEMORANDUM
TO: Hillary Rodham Clinton
FR: Chris Jennings, Steve Edelstein, and Maureen Shea
This memorandum is in preparation for your meeting tomorrow with the Senate supporters of
universal coverage. In addition, Melanne is working to arrange an oral briefing prior to the
meeting.
BACKGROUND:
Senators Daschle and Rockefeller requested this meeting as an opportunity to "rally the
troops" before floor consideration. They have been putting pressure on Majority Leader
Mitchell, and urging others to do likewise, to stay with universal coverage. A number would
prefer no bill to one that is seriously weakened. There is a sense that Mitchell's retirement is
causing both him and his staff to be less firm in their resolve than they might otherwise be.
They will want reassurance that the Administration is holding the line on universal coverage
and that the Mitchell bill will meet that standard. They will also be interested to hear about
the ammunition, in terms of the latest materials and reports, that have been produced to help
them win this fight. Finally, those attending will likely want an opportunity to ask some final
questions.
UPDATE ON THE MITCHELL BILL;
There was good news and potentially problematic news coming out of the President's meeting
with Senator Mitchell today. The good news is that Senator Mitchell has agreed to a
legislative initiative that guarantees a failsafe trigger mechanism with an employer/employee
mandate. The only way the trigger will not be pulled is if Congress approves an altemative
recommendation by a national commission which has been certified to reach universal
coverage by another means. The potential problem is that while you may achieve something
that is close to universal coverage you may not achieve coverage that is affordable (because it
does not have adequate cost containment). A copy of the current language on the Mitchell
trigger mechanism is attached for your review.
�TALKING POINTS:
•
Expression of Appreciation: This is an opportunity to again thank those who have
been real troopers for the cause of universal coverage from the beginning. You may
also wish to note that their willingness to "hang in there" when the notion of universal
coverage has come under great scmtiny means a great deal to you personally.
•
Reassurance on Universal Coverage: The administration is unified in its support for
universal coverage and all administration principles are continuing to emphasize this
bottom line in every available fomm.
•
Reassurance on the Mitchell Bill: We are confident from our conversations with
him that Senator Mitchell's bill will achieve universal coverage.
•
Review of Materials: You may wish to review some of the materials which have
been produced recently that are good ammunition for the fight for universal coverage
over the next few weeks:
Catholic Hospital Association Report
Academic Health Leaders Letter
List of Supportive Businesses
Treasury Report
Gleason Charts
•
Critical Role: Their visibility and ability to shape what happens on the floor,
particularly their readiness to deal with whatever amendments may be offered, is vital.
Other Issues: They may well ask about the CBO report on the Finance Committee
Bill. We do not want to be in the position of criticizing the bill, however the outside
groups and a number of these Senators have been active in their opposition to it. If
asked you may wish to note you understand the report has yet to come out but from
press reports it appears that it does not reach universal coverage, a fact that Chairman
Moynihan acknowledged when the bill passed in Committee.
�Trigger Proposal
On January 15, 2000, the Health. Care Coverage Conmiission would determine
whether the voluntary system has achieved 95 percent coverage nationwide.
First Alternative " CoYerage Targft AchieveA If the Commission determines that
at least 95 percent of all Americans had health coverage, they would send
rcconmiendations to the Congress on how to expand coverage to the same levels
as achieved in Social Security and Medicare No further action would be
required.
Second Alternative - Coverage Targpt Not Achlpveti: If coverage is below 95
percent, the Commission would send to Congress by May 15, 2000 one or more
legislative proposals on how to expand coverage to the same levels as achieved in
Social Security and Medicare,
Such legislation would be referred to tbe relevant committee(s) and would be
considered in both the House and the Senate under the expedited process
provided for in the Finance Committee bill. The legislation would be fuUy
amendable and require the President's signature.
In order for the legislation to be eligible for this expedited procedures, GAO
would have to certify that the legislation would in fact accomplish its objective in
a deficit neutral manner. Prior to the bill being brought up on the Senate floor,
prior to third reading, and prior tofinalpassage of the conference report, a 60
vote point of order would lie against such legislation if it does not have the G A O
certification.
If such legislation is not enacted by December 31, 2000, an employer mandate
would go into effect on January 1, 2002 in those states where coverage is below 95
percenL
Under the mandate, employers with 25 or more employees would have to pay 50
percent of their employees' premium costs, with the employee paying ihe
remainder. Firms employing fewer than 25 workers would be exempt from the
employer mandate. Individuals would be required to have health insurance.
Subsidies would be available to reduce both employer and individual costs:
o
Employers would pay the lesser of SO percent of the premium or 8 percent
of each employee's wage.
o
Employees with Adjusted Gross Income under 200 percem of poverty
would be subsidized on their 50 percent share of the premium on a slidiag
scale basis. However, no individual would pay more than 8 percent of
their Adjusted Gross Income for the 50 percent share of their premium.
0
Non-workers and those in exemptfirmswould receive the same subsidies
for their 50 percent share of the premium as employees in covered firms.
They would also be subsidized on the "employer" share of the premium
according to a different sliding scale that phases out by 200 percent of
poverty.
�THE W H I T E H O U S E
WASH INGTON
July 21, 1994
MEETING WITH SENATOR FEINSTEIN
Date: July 22, 1994
Location: Oval Office
Time: 1:40 - 2:10 PM
From: Patrick J. Griffin
PURPOSE
To recognize her difficult political position while underscoring the importance of
health care reform to your Presidency and the Democratic Party.
To use your comments before the NGA to your advantage as a tangible example of
your openness to altematives which reach your bottom line goal.
To lock in her support for the Mitchell bill which addresses her concerns particularly
with regard to small business and premium caps.
n.
BACKGROUND
Senator Feinstein's overriding concem is her reelection which many now consider to
be a toss-up. Once a cosponsor of the HeaUh Security Act, she is the only Senator to
remove his or her name from the bill. Pro-reforms groups are escalating their
pressure on her to try and win back her support and have reported some positive
progress. Her Republican opponent, Rep. Mike Huffington, has criticized her for
backing away, saying: "it's the only principle of a career politician. Save your own
skin."
On health care reform, she is sending mixed signals and is very vague about whether
or not she will be there for the White House when needed. The Senate vote-counters
are very nervous about getting her vote in the end. However, the issues about which
she is concerned - small business, bureaucracy, cost containment, and premium caps are all addressed in the Mitchell bill. She has said she would be open to a
compromise if it helps small businesses.
�In a July 14 conversation with Secretary Reich, Feinstein made clear that she prefers
CALPERS, California's voluntary pool, to an employer mandate and she does not
understand why a mandate is necessary. While not completely closed to the mandate
concept, she was getting more so every day. Second, she expressed her displeasure
with the DNC ads, particularly the one featuring Rep. Gingrich, because she felt they
made all of Congress look bad and hurt her re-election chances. Finally, she noted
that she was not hearing from her constituents on health care.
A DNC surrogate speaker. Dr. Sue Bailey, met with Feinstein at a fundraiser Monday
evening and reported:
• On health care reform: The Senator was very angry, arguing tliat Congress had not
been adequately consulted about constituent concems prior to introduction of the HSA.
She said she was no longer a cosponsor because the bill was not popular at home.
She could not support an 80-20 employer mandate and wanted more state control.
She said the Finance Committee mark was closest to her current thinking.
• On her re-election: She felt she was not getting enough help from the DNC,
particularly financially. She would like more help in her race from both the White
House and the DNC.
Dr. Bailey's impression was that sufficient attention to her reelection concems could
overcome the Senator's reservations on health care reform.
ni.
PARTICIPANTS
The President
Senator Feinstein
Patrick Griffin
Harold Ickes
IV.
SEQUENCE OF EVENTS
Z
Closed meeting with Senator Feinstein in the Oval Office.
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE W H I T E H O U S E
WAS H I N GTO N
July 21, 1994
MEETING WITH SENATOR LAUTENBERG
Date: July 22, 1994
Location: Oval Office
Time: 1:00 - 1:30 PM
From: Patrick J. Griffin
I. PURPOSE
To underscore the importance of health care reform to your Presidency and to the
Democratic Party and to seek his support for a bill that achieves universal coverage.
To illustrate your flexibility and willingness to compromise for a universal coverage
bill.
Clarify your comments before the NGA conference.
H.
BACKGROUND
As he seeks his third term, Senator Lautenberg is locked once again in what is
expected to be yet another closely contested race. His vote will ultimately rest on his
calculation of the political consequences of his vote.
Given the strong anti-tax sentiment in New Jersey, a key concem is minimizmg the
need for new federal revenues and stressing the importance of health reform for deficit
reduction. With strong pharmaceutical and insurance industry presence in his state,
weakening strong cost containment efforts is more critical to Senator Lautenberg than
the employer memdate.
ra.
PARTICIPANTS
The President
Senator Lautenberg
Patrick Griffin
Steve Ricchetti
�IV.
SEQUENCE OF EVENTS
Closed Meeting with Senator Lautenberg in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE W H I T E H O U S E
WAS H I N GTO N
July 21, 1994
MEETING WFTH SENATOR FEINSTEIN
Date: July 22, 1994
Location: Oval Office
Time: 1:40 - 2:10 PM
From: Patrick J. Griffin
I.
PURPOSE
To recognize her difficult political position while underscoring the importance of
health care reform to your Presidency and the Democratic Party.
To use your comments before the NGA to your advantage as a tangible example of
your openness to altematives which reach your bottom line goal.
To lock in her support for the Mitchell bill which addresses her concerns particularly
with regard to small business and premium caps.
U.
BACKGROUND
Senator Feinstem's overriduig concem is her reelection which many now consider to
be a toss-up. Once a cosponsor of the Health Security Act, she is the only Senator to
remove his or her name from the bill. Pro-reforms groups are escalating their
pressure on her to try and win back her support and have reported some positive
progress. Her Republican opponent, Rep. Mike Huffington, has criticized her for
backing away, saying: "it's the only principle of a career politician. Save your own
skin."
On health care reform, she is sending mixed signals and is very vague about whether
or not she will be there for the White House when needed. The Senate vote-counters
are very nervous about getting her vote in the end. However, the issues about which
she is concemed - small business, bureaucracy, cost containment, and premium caps are all addressed in the Mitchell bill. She has said she would be open to a
compromise if it helps small businesses.
�In a July 14 conversation with Secretary Reich, Feinstein made clear that she prefers
CALPERS, Califomia's voluntary pool, to an employer mandate and she does not
understand why a mandate is necessary. While not completely closed to the mandate
concept, she was getting more so every day. Second, she expressed her displeasure
with the DNC ads, particularly the one featuring Rep. Gingrich, because she felt they
made all of Congress look bad and hurt her re-election chances. Finally, she noted
that she was not hearing from her constituents on health care.
A DNC surrogate speaker. Dr. Sue Bailey, met with Feinstein at a fundraiser Monday
evening and reported:
• On health care reform: The Senator was very angry, arguing that Congress had not
been adequately consulted about constituent concerns prior to introduction of the HSA.
She said she was no longer a cosponsor because the bill was not popular at home.
She could not support an 80-20 employer mandate and wanted more state control.
She said the Finance Committee mark was closest to her current thinking.
• On her re-election: She felt she was not getting enough help from the DNC,
particularly financially. She would like more help in her race from both the White
House and the DNC.
Dr. Bailey's impression was that sufficient attention to her reelection concems could
overcome the Senator's reservations on health care reform.
ni.
PARTICIPANTS
The President
Senator Feinstein
Patrick Griffin
Harold Ickes
IV.
SEQUENCE OF EVENTS
Z
Closed meeting with Senator Feinstein in the Oval Office.
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE W H I T E H O U S E
WAS HI N GTO N
July 20, 1994
MEETING WITH SENATOR KOHL
DATE:
LOCATION:
TIME:
FROM:
July 21, 1994
Oval Office
5:45 - 6:15 p.m.
Patrick J. Griffin
I. PURPOSE
To underscore the importance of health care reform to your Presidency and to the
Democratic Party. And noting his important vote with the Administration on the
budget, to seek his support on this critical issue as well.
To illustrate your flexibility and willingness to compromise for a bill that achieves
universal coverage.
To clarify your comments before the NGA conference.
n.
BACKGROUND
Senator Kohl is up for reelection this fall. While he is viewed to be in good shape to
retain his seat, he is naturally concemed about any potentially negative political fall
out from health care refonn. Thus far he has not committed to any of the major
refonn plans.
Senator Kohl supports universal coverage. Despite some concems about the employer
mandate, he has said he is open to such a requirement as long as there are sufficient
subsidies for small businesses. He has stronger reservations about changes to the
insurance industry, the second largest employer in Wisconsin. He expressed concem
with premium caps. The cost contaimnent provisions in Senator Mitchell's bill may
well be the key to his vote.
Senator Kohl recently issued a statement decrying the partisanship of the new DNC ad
campaign on health care reform. He would like to enact reform without "polarizing"
the country and feels strongly that we should be building a coalition behind a
bipartisan bill.
�III.
PARTICIPANTS
The President
Senator Kohl
Patrick Griffin
Harold Ickes
IV.
SEQUENCE OF EVENTS
Closed Meeting with Senator Kohl in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE WHITE H O U S E
W A S HI N G T O N
July 20, 1994
MEETING WITH SENATOR HOLLINGS
DATE:
LOCATION:
TIME:
FROM:
July 21, 1994
Oval Office
11:30 a.m. - 12:00 p.m.
Patrick J. Griffin
I. PURPOSE
To underscore the importance of health care reform to your Presidency and to the
Democratic Party. And noting his important vote with the Administration on the
budget, to seek his support on this critical issue as well.
To illustrate your flexibility and willingness to compromise for a bill that achieves
universal coverage and to emphasize the connection between universal coverage and
deficit reduction.
To clarify your comments before the NGA conference.
n.
BACKGROUND
Hccilth care reform has not been a priority issue for Senator Hollings. His main
concern is that any reform plan be fiscally sound, pay for itself and not add to the
budget deficit.
Shortly after the Administration's plan was unveiled, he expressed concem that too
many promises were being made and there was insufficient funding to pay for them.
In particular he thought the Medicare cuts were too large. While he is not
antagonistic to an employer mandate, he is concemed about the impact on small
businesses. He would prefer a value added tax, a funding mechanism he has long
favored.
Senator Hollings is a strong advocate for community health centers. The cunent
federal program which serves 7 million Americans is based on a program he started
when he was Govemor of South Carolina. He has expressed concem that these health
centers may be jeopardized by reform.
�III.
PARTICIPANTS
The President
Senator Hollings
Patrick Griffin
Harold Ickes
IV.
SEQUENCE OF EVENTS
Closed Meeting with Senator Hollings in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE W H I T E H O U S E
WAS HI N GTO N
July 20, 1994
MEETING WITH SENATOR EXON
DATE:
LOCATION:
TIME:
FROM:
July 21, 1994
The Oval Office
10:45 - 11:15 a.m.
Patrick Griffin
PURPOSE
To underscore the importance to the success of this Presidency and the Democratic
Party of passing a health care bill that achieves universal coverage.
To build on his perception of your comments at NGA by saying that you are glad he
heard it as you intended — that you are flexible as long as it achieves your bottom
line of universal coverage.
To seek his support and assistance in reaching out to those members he has been
working with and others who look to him for guidance.
To seek his assessment of Senator Keney's position on health care reform and to
express your gratitude for Exon's willingness to work quiefly to find a Democratic
consensus.
n.
BACKGROUND
Senator Exon sees himself as a key centrist vote on health care, one who can be of
assistance in getting other moderates to vote for passage of health care reform. In
May he told the Omaha World-Herald: "I have been working very quietly and
behind the scenes with a whole group of senators on both sides of the aisle to fashion
a workable and a passable health care plan." The paper said that while Exon does not
criticize Kerrey's efforts to reach a bipartisan solution, his own strategy is to reach a
Democratic consensus on a plan that can pick up enough Republican support to
prevent a filibuster. To this end, he reacted favorably to the reports from the NGA.
He was quoted as saying, "Good for him! Until the president said something like that,
I think we were dead in the water" [Los Angeles Times] and "This may get us to a
place where we can negotiate [Washington Post].
�Senator Exon has raised three issues of primar}' interest to him. First, he is concerned
about the size of the benefit package. He believes it should be an "Escort not a
Cadillac." Second, he believes that states, not the federal government, should choose
whether or not to fund abortion. Finally, he has sought relief for small business from
the employer mandate. He has said he might be able to support a 50-50 split. He has
also said that universal coverage should be a priority but should be phased-in.
In the July 13th Washington Post, he noted the confusion surrounding the health care
debate. Of his constituents he said, "people are more and more unsure of what it
means to them."
III.
PARTICIPANTS
The President
Senator Exon
Patrick Griffin
Harold Ickes
IV.
SEQUENCE OF EVENTS
Closed meeting with Senator Exon in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE WHITE H O U S E
WAS H IN G T O N
July 19, 1994
MEETING WITH SENATOR BREAUX
Date: July 20, 1994
Location: Oval Office
Time: 4:45 - 5:15 p.m.
From: Patrick J. Griffin
I. PURPOSE
•
To illustrate your flexibility and willingness to compromise for a bill with universal
coverage.
•
To underscore the importance of health care reform to your Presidency and to the
Democratic Party.
•
To encourage him to work with Senator Mitchell to develop a proposal that achieves
universal coverage that has the potential of attracting other moderate members.
•
Clarify your comments before the NGA conference.
n.
BACKGROUND
While Senator Breaux has been in the middle of the health care debate, first as
sponsor of the Senate counterpart to the Cooper bill then as a Democratic participant
in the "mmp group" in the Finance Committee, his health care views are not deeply
ideologically or philosophically held. Throughout the process, he has offered a
number of proposals m attempts to achieve a compromise. In fact, facilitating the
final health care deal is clearly his overriding motivation and desire.
He has devoted most attention to the most controversial issues — the coverage and
cost containment. He dislikes both employer mandate and premium caps, preferring
instead voluntary, market-oriented approaches. In recent public statements he has
sought to promote the Finance Committee mark as a good vehicle for floor
consideration and a significant achievement toward health care reform worthy of the
President's signature should it reach his desk. He also rejected a 50-50 mandate as
unworkable stating "it is something that has high costs associated with it and demands
more in tax revenue than I think can pass or should pass." [New Orleans TimePicayune, 7/15/94]
�Although this is the case, he did advocate a fallback 50/50 small business carve out
compromise to Senator Mitchell last week. In this proposal, Senator Breaux suggested
that a National Commission make a recommendation to Congress how to achieve
universal coverage. If Congress did not enact the Commission's recommendations, the
fallback mechanism would automatically go into place. He presented this option to
the "mmp group" and Senator Keney led the opposition to it.
III.
PARTICIPANTS
The President
Senator Breaux
Patrick Griffin
Steve Ricchetti
IV.
SEQUENCE OF EVENTS
Closed Meeting with Senator Breaux in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE WHITE H O U S E
WAS HIN GTO N
July 19, 1994
MEETING WITH SENATOR LAUTENBERG
Date: July 20, 1994
Location: Oval Office
Time: 7:00 - 7:30 p.m.
From: Patrick J. Griffin
I. PURPOSE
To underscore the importance of health care reform to your Presidency and to the
Democratic Party and to seek his support for a bill that achieves universal coverage.
To illustrate your flexibility and willingness to compromise for a universal coverage
bill.
Clarify your comments before the NGA conference.
n.
BACKGROUND
As he seeks his third term. Senator Lautenberg is locked once again in what is
expected to be yet another closely contested race. His vote will ultimately rest on his
calculation of the political consequences of his vote.
Given the strong anti-tax sentiment in New Jersey, a key concem is minimizing the
need for new federal revenues and stressing the importance of health reform for deficit
reduction. With strong pharmaceutical and insurance industry presence in his state,
weakening strong cost containment efforts is more critical to Senator Lautenberg than
the employer mandate.
III.
PARTICIPANTS
The President
Senator Lautenberg
Patrick Griffin
Steve Ricchetti
�IV.
SEQUENCE OF EVENTS
Closed Meeting with Senator Lautenberg in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE WHITE H O U S E
WAS HIN GTO N
July 19, 1994
MEETING WITH SENATOR FORD
Date: July 20, 1994
Location: Oval Office
Time: 6:15 - 6:45 p.m.
From: Patrick J. Griffin
I. PURPOSE
•
To underscore the importance of health care reform to your Presidency and to the
Democratic Party.
•
To ask advice on how to pass a bill which achieves universal coverage and his
assistance in reaching out to other members to gain a majority for Senator Mitchell's
bill.
•
To illustrate your flexibility and willingness to compromise for a bill with universal
coverage.
•
Clarify your comments before the NGA conference.
II.
BACKGROUND
Representing the state of Kentucky, Senator Ford has one overriding concem in the
health care reform debate — the tobacco tax. If he achieves what he believes to be a
satisfactory accommodation on the level of the tobacco tax, he can be a valuable ally.
Senator Ford is a good vote counter and a shrewd dealmaker and can be helpful in
reaching out to other members to gain a majority for Senator Mitchell's bill.
Over the last two weeks, Ford has been contacted by DNC Chairman David Wilhelm
and Secretary Reich on health care refonn. He again stressed his concerns about the
tobacco tax. In his meeting with Chairman Wilhelm, he expressed his opposition to a
proposal by Governor Jones of having a slightly higher tax and using the additional
amount to help fund conversion to other crops.
�Senator Ford made clear that he will be there and that he wants to help the
Administration work this out, but in his view the votes are not there and a lot of work
needs to be done. He also expressed some frustration that with the exception of a
meeting with the First Lady early on to discuss tobacco issues, he had not been
brought in to seek his advice and assistance with political strategy.
III.
PARTICIPANTS
The President
Senator Ford
Patrick Griffin
Steve Ricchetti
IV.
SEQUENCE OF EVENTS
Closed Meeting with Senator Ford in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�THE WHITE HOUSE
WAS H I N GTO N
July 16, 1994
MEETING WITH SENATOR DECONCINI
Date: July 17, 1994
Location: Oval Office
Time: 1:45 - 2:15 PM
From: Patrick J. Griffin
I. PURPOSE
To obtain a read as to where Senator DeConcini cunently stands with regard to health
reform and a triggered-in mandate.
To illustrate your flexibility and willingness to compromise for a bill with universal
coverage, but to seek his assistance in helping Senator Mitchell craft a strong, political
realistic initiative.
n.
BACKGROUND
Senator DeConcini has not ever mled out an employer mandate as a way to achieve
universal coverage, as long as it was not overly burdensome — particularly to small
business. In the past, he has raised concerns about assuring that any plan be
(1) fiscally responsible, (2) include some tax on alcohol as well cis tobacco, (3) not
include coverage for abortion, and (4) not be over-reliant on excessive Medicare cuts.
As you know, Senator DeConcini is retiring from the Senate this year. His future
plans have not been completely finalized, but he is completely satisfied with the
responsiveness of the Administration on this subject. He also is concemed about his
Chief of Staff and perhaps others, but we do not expect this subject to come up at the
meeting.
III. PARTICIPANTS
The President
Patrick Griffin
�rV.
SEQUENCE OF EVENTS
Closed meeting with Senator DeConcini in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
�f
THE WHITE H O U S E
1,
.
W A S H I NGTON
July 15, 1994
MEETING WITH SENATOR HEFLIN
'
I
Date: July 17, 1994
Location: Oval Office
Time: 2:30 - 3:00 PM
From: Patrick J. Griffin
I. PURPOSE
To acknowledge the difficulties Senator Heflin faces in his home state in supporting
health reform, particularly should Senator Shelby — as expected — not support the
bill.
Noting his important vote with the Administration on the budget, to seek his support
with another critical vote for your Presidency — health care reform which achieves
universal coverage.
To illustrate your flexibility and willingness to compromise for a bill with universal
coverage.
,
/
,
,
;/
11.
BACKGROUND
'
\
Senator Heflin is not particularly well-versed on issues of health care reform.
However, in private meetings he has expressed some frustration at the seeming
inability of Senators to work out the problems on this issue so they could get it done.
At public events in Alabama he has expressed support for the concept of universal
coverage. He also noted that he did not know how that could be achieved without
some kind of employer mandate. However, Senator Heflin does share the concem of
many moderate and Southem members about the impact of the mandate on small
businesses. He advocates folding in the health component of workers' compensation
insurance as a way of ameliorating the impact of the mandate on small business.
One issue with which he is quite familiar and has definite views is tort reform. He
opposes caps on damages as a means of malpractice reform.
�III. PARTICIPANTS
The President
Patrick Griffin
rV.
SEQUENCE OF EVENTS
Closed meeting with Senator Heflin in the Oval Office
V.
PRESS PLAN
Closed Press. (White House photographer will be present.)
<
�THE WHITE H O U S E
WAS H IN G T O N
July 14, 1994 • '
RECOMMENDED TELEPHONE CALL
TO:
Democratic Senators who arc our health care supporters.
The names we arc requesting you to call as soon as feasible are:
Senators' Baucus, Boxer, Daschle, Dodd, Glenn, Graham,
Mathews, Reid, Rockefeller, Sarbanes, and Sasser.
DATE-
July 15, 1994
RECOMMENDED BY:
Patrick Griffin
PURPOSE:
To call a number of our core group Democratic supporters, to
shore up their support for health refomi and to re-energizc their
efforts to successfully pass a bill out of the Senate.
BACKGROUND:
Earlier today you, the Vice President and the First Lady
,•
- concluded it would be highly advisable to reach out to our
Democratic base. We are following up with our first cut list of
members.
,
' .
•. '
The list of members are taken from our cunent analysis of
where Democratic Senators stand with regard to our whip
counts. This list is attached for your use.
TOPICS OF DISCUSSION: Attached are suggested talking points for these calls.
CONTACT PERSON AND
I ' ^ ' ^ ^
TELEPHONE NUMBERS: White House Operator w;ll connect. :
:
DATE OF SUBMISSION:. July 14, 1994
ACTION:
:j
'
.]•• -
"
' •
_ _
�THE W H I T E H O U S E
WAS
H IN GTO N
July 14, 1994
GENERAL I I I < : A L T H REEOIIM TALKING POINTS:
Phone Calls to "Solid Base and Core" Senators
When wc started this effort to reform our health aire system we knew il
would not be easy. However, I am convinced we am get il done.
I need your support now more than ever. I believe that we have got to
deliver on universal coverage and that failing to do so will hurt my
Presidency and the Democratic party.
1 urge you to let Senator Mitchell know that you believe that a strong bill
can pass the Senate.
>,
. *
'
Whatever specific concerns you may have, 1 am confident that they can
be worked out. We arc willing to work with you and the Majority Leader
to make that happen. '
�THE W H I T E H O U S E
WAS H INGTO N
SENATE STATUS (7/14/94)
[Democrats and Senator Jeffords Only]
Solid Base
27 (27)
Core
8 (35)
Likely
8 (43)
Good Chance
4(47) .
Swing
10 (57) ,
Akaka
Boxer
Bingaman
Daschle
Dodd
Glenn
Graham
Harkin
Inouye
Kennedy
Leahy
Ixvin
Metzenbaum ..
Mikulski
Mitchell
Moseley-Braun
MoynihanMunay
Pell
Pryor
Reid
Riegle r
Rockefeller
Sarbanes
Simon
Wofford '
Baucus
Bumpers
Byrd
Feingold
Kerry
Mathews
Sasser
Wellstone
Biden
Campbell
Deconcini
Dorgan*
Exon
Heflin
Kohl
Robb
Bradley
Breaux*
Feinstein
Hollings*
Boren
Bryan*
Conrad*
Ford
Johnston*
Keney
Lautenberg*
Liebennan*
Nunn
Shelby '.
Jeffords
= Facc-to-Face Meetmgs Held or to be Scheduled
•
•
�TH E W H I T E
HOUSE
WA S H I N G T O N
CALiVMKi:riNc; L I S I m PRINC IPALS
LQIUS
CALL
liinganian
Bumpers
• • • ''
'
HcOin
Jeffords
•
Kcnncciy , , . '
Kerry
Leahy
Metzenbaum
Mikulski
',
_
Mitchell
' • '
Mosclcy-Brauii •
Prvor
Riegle
Wellstone
>,
MELT
Campbell
• F.xon
l-'cingold
Feinstein
• llcflin
1 A-'V 111
Robb
�THE WHITE H O U S E
WAS HIN G T O N
July 13, 1994
MEETING WITH SENATOR JOSEPH LIEBERMAN
DATE:
LOCATION:
TIME:
FROM:
I.
July 14, 1994
Oval Office
1:00 - 1:30 p.m.
Patrick L Griffin
PURPOSE
n.
•
To acknowledge Senator Lieberman as a player in the health care debate.
•
To enlist his assistance in doing outreach to other moderates in the Senate.
•
To urge him be a positive force for the Democratic effort rather than
inadvertently giving assistance to the Republicans
BACKGROUND
Senator Lieberman, an origmal cosponsor of the Breaux Bill, has been working with
the Chafee "mmp" group. Althou^ at present it appears that he may be
disassociating himself from the effort, it is clear he was one of the originators
circulating a letter to the Majority Leader stating that, in order to achieve strong
bipartisan support in the Senate, his bill should build on a soft trigger mechanism,
such as the one passed by the Senate Fmance Committee.
He very much wants to be a player on health care reform and he wants to assure that
his problems are addressed. While he should support the employer requirement, he
and the insurance industry in his home state have major concems about the premium
caps and any cost containment altematives.
III.
PARTICIPANTS
The President
Senator Lieberman
Leon Panetta
Patrick Griffin
Harold Ickes
.
�IV.
SEQUENCE OF EVENTS
Closed meeting with Senator Lieberman in the Oval Office.
V.
PRESS PLAN
Closed Press. (White House Photographer will be present.)
�MAY 24, 1994
MEMORANDUM FOR THE PRESIDENT
FROM: PAT GRIFFIN
CHRIS JENNINGS
JACK LEW
This memorandum is in preparation for your meeting tomonow with the Congressional
Democratic leadership and Chainnen of the major committees of jurisdiction.
MAIORITY LEADER GEORGE MTTCHELL:
The Majority Leader is fully engaged and reaching out to Finance Committee Democrats and
Republicans in search of common ground. Like the White House, Mitchell's working
relationship with Chairman Moynihan and his staff is a tenuous one. Mitchell has completed
his presentations to the Senate Caucus on the employer mandate and cost containment, and on
alternative approaches for dealing with small business and the deficit. Those presentations
have been generally well received. The Majority Leader seems very appreciative of the
ongoing support and technical assistance provided by the White House and the rest of the
Administration for his caucus presentations as well as for other committee members. He
continues to believe that we must strengthen the Democratic base and improve the package as
the best way to increase the level of Democratic commitment and attract moderate
Republicans.
This week the Wall Street Joumal described Mitchell as confident of passage this session but
"subdued."
MAIORITY WHIP WENDELL FORD:
Senator Ford's primary concem remains tobacco, but nothing close to a deal has been
mentioned. If he can get something for tobacco, he is likely to be with us in the end. At the
moment, he is, of course, running against a significant tide of negative public and media
attention focused on the tobacco industry. While he genuinely would like to see health
reform enacted this year, he feels he has not been adequately consulted throughout the
process.
�CHAIRMAN OF THE FINANCE COMMITTEE DANIEL PATRICK MOYNIHAN;
Chairman Moynihan remains very sensitive about how he feels the White House and Senator
Mitchell are dealing with his Committee. This week's TIME discusses White House efforts to
appease the "brilliant but unpredictable" Chairman. E.J. Dionne reported in Tuesday's
Washington Post that Moynihan still needs to be convinced that universal health coverage can
be achieved without unanticipated negative consequences. The New York Times editorial on
the HSA imperiling city hospitals may bolster the Chairman's concem about treatment of New
York State in reform.
CHAIRMAN OF LABOR AND HUMAN RESOURCES EDWARD KENNEDY:
Sen. Kennedy intends to finish his committee's mark-up before the recess. He is moving the
debate to the center, and while he is getting Republican support for amendments, it is
exceptionally unlikely that any Republican, other than Sen. Jeffords, will vote for the final
committee version. Kennedy's efforts to reach bipartisan consensus are providing helpful
cover for the White House in the media.
Some writers have noted that Kennedy faces a tough reelection and called his flexibility a
sign of weakening in his and the White House's political position.
SPEAKER OF THE HOUSE THOMAS FOLEY:
While still predicting passage of health care legislation this year. Rep. Foley has suggested
that there may be no August recess in order to pass the bill. He remains critical of welfare
being considered this year.
MAJORITY LEADER RICHARD GEPHARDT:
Rep. Gephardt is following Senator Mitchell in becoming engaged in the substance of the
legislation, and the White House is providing him technical assistance as we have Mitchell.
Gephardt stated that Breaux's softening on the employer mandate makes it possible for other
conservative Democrats to embrace universal coverage. Like the Speaker, Gephardt fears that
welfare reform will sap needed energy and resources from health care.
MATORFTY WHIP DAVID BONIOR:
The Majority Whip, also a member of the Rules Committee, has said when the
legislation reaches the floor, his preference would be to allow Members to vote on a small
number of "broad choices" - such as the HSA, a Canadian-style plan, and a Republican
aUemative, rather than permitting amendments on specific bills.
�CHAIRMAN OF THE EDUCATION AND LABOR COMMTTTFE RH J . FORD:
The subcommittee anticipates finishing its work before the Memorial Day recess. While the
subcommittee has increased spending, the Committee continues to offer the leadership the
easiest chance to craft a bill for the floor. Gephardt has indicated that he wants to work with
them more closely in the full committee. The subcommittee has been a preliminary
battleground over abortion rights.
CHAIRMAN OF ENERGY AND COMMERCE COMMITTEE JOHN DINGELL:
The Chairman calls trying to find sufficient votes to get the bill out of his committee like
"balancing peas on a knife." He asserts that he has urged the President to campaign for
heahh care and against Republican gridlock.
CHAIRMAN OF WAYS AND MEANS DAN ROSTENKOWSKI:
Chainnan Rostenkowski continues to forge ahead to try and get a bill out of his Committee.
The Washington Post had an extensive report on Rep. Rostenkowski's deal with the Health
Insurance Association of America in order to preclude their advertising during his markup.
While the report exaggerates concessions which Rostenkowski has made, the Chairman has
agreed to limit the community rating requirement to firms of 100 or fewer, rather than 1,000
or fewer. The deal is reputed to improve his chances of gaining support from Reps.
Hoagland (D-NE) and Neal (D-MA).
�THE WHITE HOUSE
WAS HI N G T O N
May 6, 1994
Memorandum for the President:
From:
Pat Griffin
Chris Jennings
Subject:
Legislative briefing on Chairman Moynihan
The following is a brief update on recent developments regarding Chairman Moynihan and
health care reform in preparation for your trip to New York on Monday.
CHAIRMAN DANIEL PATRICK MOYNIHAN (D-NY):
Chairman Moynihan has been intrigued by the question of what constitutes universal
coverage. At the Finance Committee hearing this week on the CBO's analysis of the
Cooper/Breaux, he made a pointing of sfressing CBO testimony that the bill could cover 90plus percent of the population within 18 months. He called it "pretty impressive."
However, CBO Director Reischauer also testified that the Health Security Act would result in
99.7% of the population being covered. Senator Daschle also suggested a comparison to
Social Security. Chairman Moynihan looked it up and found that the participation rate for
Social Security was 98%, higher than he had expected.
The Finance Committee is still trying to meet the Memorial Day time frame for reporting out
their bill but have raised concems about getting CBO budget estimates on the Chafee and
Nickles biUs in time. Should they not get the estimates by Memorial Day, as is likely, it
would raise significant timing issues.
Finance Committee Member David Boren's effort to do outreach to Senator Chafee may be
constmctive, not only in opening a dialogue with moderate Republicans in the Senate, but
also in sending positive signals to the House Energy and Commerce Committee and help to
move their deUberations forward. The actions of these two committees, which closely reflect
the make-up of their houses, often influence each other.
�THE W H I T E H O U S E
WAS HIN GTON
May 5, 1994
Memorandum for the President
From:
Pat Griffin
Chris Jennings
Jack Lew
Subject: Legislative Briefing for Rhode Island Town Hall
The foUowing are brief profiles and summaries of the health care views of select members of
the Rhode Island, Connecticut, Massachusetts, and Vermont delegations in preparation for
the town hall meeting scheduled for Monday.
While there are particular concems for each member and each state, in general they share a
concem about the impact of health reform on small business and on seniors.
RHODE ISLAND
SENATOR CLAIBORNE PELL (D-RD:
The Chairman of the Foreign Relations Committee is a Health Security Act cosponsor and
long-time advocate of "cradle to grave" health coverage. His primary health concems are
long-term care (Rhode Island has one of the highest percentages of elderly of any state in the
country), preventive services, effects on research, and expanding the use of non-physician
health providers. Pell is concemed about ethical consideration in the plan's coverage of
organ transplants. He has raised the possibility of a tax onfirearmswhich would be devoted
to health care.
Pell voted for the Budget, National Service, and NAFTA.
SENATOR TOHN CHAFEE (R-RD;
Senator Chafee is undoubtedly bolstered by the cosponsorship of his bill by Senators Boren
and Kerrey. Chafee has predicted that the Senate will approve a bill by an 80-to-20 margin
and recentiy reiterated his dedication to the goal of universal coverage. He remains
committed to his own plan, discussing it again in the informal session Dole gathered on the
plane retuming from the Nixon funeral.
Chafee voted for National Service and NAFTA and against the Budget.
�CONGRESSMAN JACK REED (D-RI 2nd District - Providence):
A member of the Education and Labor and Judiciary Committees, Congressman Reed has not
cosponsored any of the major healtii reform bills, but has made very supportive statements
about tiie President's plan. He notes tiiat healtii care costs for an average family in Rhode
Island had risen from $1,900 in 1980 to $4,914 in 1991. He has a sfrong interest in
children's issues.
Reed voted against NAFTA and for Family and Medical Leave, National Service and tiie
Budget.
CONGRESSMAN RONALD MACHTLEY (R-RI 1st District - Newport; Pawtucket):
Congressman Machtiey, one of the most liberal House Republicans, is tiie front-mnner in the
race for Govemor. He is a Cooper-Grandy cosponsor and voted for FamUy and Medical
Leave, National Service, and NAFTA and against Budget ReconciUation. He has stated that
98% of the businesses in Rhode Island would be considered small and therefore worries
about the impact on health reform on them. However, that concem is tempered by his
statement that: "...this is the country that put a man on the moon and brought him back
again. So we certainly can solve what is essentially a managerial problem." He is a
supporter of reproductive rights.
Machtiey serves on the Armed Services and Small Business Committees. Sen. Kennedy's
son is mnning for his Congressional seat.
CONNECTICUT
SENATOR CHRISTOPHER DODD (D-CT):
Senator Dodd is a Health Security Act cosponsor and a major spokesman for children's
issues. He is said to be urging his colleagues to begin seeking compromises, calling the
employer mandate "a hard sell." On tiie powers of the alliances, Dodd predicts they will
ultimately be much less than tiie President proposed, saying "People are heading for the hills
on that one." In addition to Labor, Dodd is on the Banking and Foreign Affairs Committees.
The premium cap issue will be a difficult one for both Connecticut Senators and the
importance of cost containment to achieve universal coverage should be stressed.
Dodd voted for the Budget, National Service, and NAFTA.
�SENATOR .JOSEPH LIEBERMAN (D-CT):
While Senator Lieberman cosigned the Breaux bUl, he has been the most positive of their
cosponsors in supporting the concept of universal coverage. Lieberman would like to be a
player between the Breaux and Administration camps and signed Wofford's universal
coverage letter. Lieberman now believes reform will pass this session. Despite recent press
reports that he is adamantiy opposed to a business mandate that should not be constinied as
opposition to any employer requirement but rather a concem for the impact on small
employer of a mandate on all business.
Lieberman is in his first term and is expected to win reelection easily. Three RepubUcans
are vying to challenge him and all are in the health field - one is a conservative pediatrician,
another an eye surgeon who supports a single payer system for catasfrophic illness, and the
third a health-services executive. The premium cap issue will be a difficult one for both
Connecticut Senators and the importance of cost containment to achieve universal coverage
should be sfressed.
He voted for the Budget, National Service, and NAFTA and is a member of the Small
Business and Armed Services Committees.
CONGRESSMAN SAM GETDENSON (D-CT 2nd District - New London):
Rep. Gejdenson is a Health Security Act and McDermott cosponsor and sits on the Foreign
Affairs, Natural Resources, and House Administration Committees. Early in the discussions
he was concemed about what those in the middle class who are already covered will get from
reform recalling the experience with Medicare catasfrophic. He is expected to have the
toughest re-election race of his delegation. The President and First Lady visited his district in
February to focus on senior citizens and the high cost of prescription dmgs.
He voted against NAFTA and for Family and Medical Leave, National Service and Budget
Reconciliation.
CONGRESSWOMAN NANCY TOHNSON (R-CT 6th District - New Britain)
Congresswoman Nancy Johnson, of the Ways and Means Committee, is a moderate
Republican and both a Cooper and Michel cosponsor. She stated recently that she thought
"the winds are shifting. We're moving into the time of compromise." The Republican
leadership has authorized her to negotiate approaches to make the Michel bill more attractive
to moderate and conservative Democrats. Johnson has called the employer mandate the
biggest issue for Republicans, saying "Almost anything else can be worked out." She told
the Washington Post in April that her main issue is: Is the public willing to pay the cost of
guaranteeing health coverage to all Americans?
�Johnson has also said that if Congress failed to address the issues of fairness, access and
security in health care this year, it wiU "be one of the saddest and darkest pages in our
history." That said, however, she maintains that only a plan that avoids proposals in which
tiie federal govemment calls the shots wUl pass. Her husband is a physician and she has said
repeatedly that doctors are not the cause of the country's health care ills. Her district is one
where "insurers, rural hospitals and small business speak loudly."
Politically, her pro-choice stand has helped her with women and progressive Republicans in
the past. She signed the letter to Cooper regarding inadequate coverage of women's health
in his bill and the Planned Parenthood New York Times ad in support of fuU reproductive
services in health reform legislation. Local groups report that she is making the argument
that any health care reform that hurts smaU business will disproportionately affect women,
and that any health reform that discourages private research efforts will also
disproportionately effect women's health.
Johnson voted for Family and Medical Leave, NAFTA, and Nation Service and against
Budget ReconcUiation.
CONGRESSWOMAN BARBARA KENNELLY (D-CT 1st District - Hartford):
A Health Security Act cosponsor, Congresswoman Kennelly is key on Ways and Means and
predicts the House wiU pass a reform bill this year. Privately, she has told groups that she
expects the committees to be pzuticularly hard on alliances and/or the opt out level, but
ultimately she predicts Congress will move back closer to the HSA. Kennelly faults the bill
for the amount of federal regulation, saying there is widespread feeling on Capitol Hill that
"It would be almost impossible to carry out." However, she tells "Members that they should
be nervous if they don't pass a credible bUl. We will do what has to be done." She
maintains that some Democrats are concemed about extending the four-yeartimetablefor full
phase-in the HSA, fearing that if the President loses in 1996, a Republican administration
would not fulfill the commitment to universal coverage. Kennelly has one of the largest
insurance constituencies in the country.
She voted for National Service, Family and Medical Leave and the Budget and against
NAFTA.
�MASSACHUSETTS
SENATOR EDWARD M. KENNEDY (D MA);
The Chairman of the Labor and Human Resources Committee has said that his committee
can report out something close to the HSA but expressed a sfrong desire to work out
modifications that would bring GOP support. However, such an accommodation appears
unlikely. He likes to paraphrase Mark Twain on both the plan and the aUiances, saying
reports of thefr death are premature. While he would prefer to get a better sense of where
the Finance Committee is going before his Committee writes its bUl, he has scheduled markup for May 18th in hopes of maintaining our legislative momentum and completing action by
the Memorial Day Recess. Kennedy insists it will be hard for members to vote against
health care just before their constituents decide whether or not to vote for them.
SENATOR TOHN KERRY (D-MA):
Senator Kerry has not cosponsored any of the major health reform bills and the Boston Globe
has called him "conspicuously absent" from the HSA. Administrative simplification and
insurance reform are of particular interest to him. Presumably he will be reassured by the
compromises being made to help the biotech industry which is sfrong in Massachusetts. He
serves on the Small Business as well as Banking and Commerce Committees.
Kerry voted for NAFTA, National Service, and the Budget.
CONGRESSMAN RICHARD NEAL (D MA 2nd District - Northampton)
A new member of the Ways and Means Committee, Congressman Neal has not cosponsored
any of the major health reform bills. He says he embraces the concept of universal health
coverage but does not want to endanger jobs. His district includes large insurance companies
and he has been targeted by the National Restaurant Association radio spots. After the
spring recess, Neal said many senior citizens told him: "'I've got a good plan, leave me
alone.'" He has told groups he is committed to passage of the HSA but won't cosponsor
because he wants to see where his Committee ends up. He wants the bill to include yearly
mammograms for women over 50 as a basic benefit and a comprehensive mental health
package. He wants an exemption for Shriners hospitals (which do not charge for services)
and more money for teaching hospitals. Neal would like to see improved osteoporosis
research. Considered a liberal, Neal is close to the leadership and to Congressman Moakley.
He has voted against federal funding for abortions, even in the case of rape or incest.
Neal voted with the White House on the Budget, National Service and Family and Medical
Leave but against NAFTA.
�CONGRESSMAN JOHN OLVER (D-MA 1st Dl^^trirt - Amhprst):
Congressman Olver is a McDermott cosponsor who has told groups he would support a final
bill which is affordable, universal, and has buUt-in quality confrols. As a state legislator,
Olver worked for universal health care and to allow minors access to abortion services. He
is serving his first full term and sits on the Appropriations Committee. His district includes
dying textile industries, educational institutions, and stmggling smaU businesses. Olver is a
liberal who believes that "compassion still has a place in govemment." He has voiced
concems for veterans and preventive measures, especiaUy for chUdren.
Olver voted against NAFTA but for Family and Medical Leave, National Service and the
Budget.
VERMONT
SENATOR PATRICK LEAHY (D-VT):
The Chairman of the Agriculture Committee is a Health Security Act cosponsor and sfrong
proponent of mral issues and state flexibility. WhUe praising the Administrations' push for
more efficient tracking and transmission of individuals' health history, Leahy wants to be
sure that individuals' privacy is protected. He is sensitive to the attention afforded to Jim
Jeffords, Vermont's other Senator,
Leahy voted for NAFTA, National Service, and the Budget.
SENATOR JIM .JEFFORDS (R-VT);
The Boston Globe has written very positive pieces about Sen. Jefford's cosponsorship of the
Health Security Act. They concluded that the combination of Jeffords' and Kennedy
"suggest that New England congressional members may play a pivotal role in shaping the
health care debate." Jeffords continues to praise the fact that Vermont will be able to
experiment with its own system for universal coverage. He was instmmental in the HSA's
provision to expand funding for WIC, the nutrition program for women and children.
Jeffords voted for NAFTA and National Service and against the Budget.
�CONGRESSMAN BERNARD SANDERS ff-VT At Large):
A McDermott cosponsor. Independent Congressman Sanders votes like a liberal Democrat.
He is a self-styled socialist who sometimes anger colleagues on both sides of the aisle. As
Vermont considers health reform legislation, Sanders sought Administration assistance,
specifically a legal opinion from the Attorney General, to counter critics' arguments that
ERISA prevented states from moving ahead on their own single payer plans. In his view this
argument is being advanced to thwart momentum toward health care reform.
Sanders voted with the Administration on National Service, the Budget and FamUy and
Medical Leave but against NAFTA.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECT/TITLE
Jack Lew & Chris Jennings; re: Legislative Status of Academic
Health Center Issue (1 page)
05/05/1994
RESTRICTION
P5
COLLECTION:
CHnton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefmg Memos - POTUS
2006-0885-F
jp2853
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�THE WHITE HOUSE
WASHINGTON
May 5, 1994
MEMORANDUM FOR THE PRESIDENT
From:
Pat Griffin
Chris Jennings
Jack Lew
Subject:
Legislative Briefing for Women's Health Event
The foUowing are brief profiles of the Senators and Representatives attending tomorrow's
women's health event. They are aU cosponsors of the Health Security Act and they were
invited to bring their spouses or their mothers.
SENATORS
SENATOR CLAIBORNE PELL (D-RD:
The Chairman of the Foriegn Relations Committee is a long-time advocate of "cradle to
grave coverage" and particularly concemed about long-term care, preventive services and
expanding the use of non-physican health providers. You will be in his state on Monday for
a health care town haU meeting.
REPRESENTATIVES
CONGRESSMAN NEIL ABERCROMBIE (D-HD and Dr. Nancie Carrowav (Spouse):
Rep. Abercrombie is a McDermott cosponsor and Uke otiiers in the Hawau delegation,
protective of state flexibility.
CONGRESSMAN THOMAS BARRETT (P-WD;
Freshman Congressman Barrett represents MUwaukee. He and his wife are expecting their
second child at the end of this month.
CONGRESSWOMAN CORRINE BROWN (D-FL):
Freshman Representative Brown came to Congress with healUi care as a priority, particularly
early preventive care for chUdren.
�CONGRESSMAN BOB CARR (D-MD and Kate (Spouse);
Rep. Carr, one of the "Watergate babies," is also a Cooper cosponsor and running for Sen.
Riegle's seat.
CONGRESSMAN NORM DICKS (D-WA) and Suzie (Spouse):
The Speaker's point man on Appropriations is a soUd supporter.
CONGRESSMAN RICHARD DURBIN (D-IL) and Ann Durbin (Mother):
A leading proponent of anti-smoking concems. Rep. Durbin has received considerable press
of late on his batties with the tobacco lobby.
CONGRESSWOMAN ANNA ESHOO (D-CA) and Alice Georges (Mother):
Freshman Rep. Eshoo attended last Friday's White House diimer and held three health care
town meetings in her district over the weekend. Her district includes SiUcon VaUey and
Alain Enthoven is one of her constituents.
CONGRESSMAN BOB FILNER (D-CA) and .lane Merrill Fihier (Spouse):
A freshman member who was a "Freedom Fighter" in the south, Filner is concemed about
veterans and undocumented workers.
CONGRESSMAN BARNEY FRANK (D-MA) and Elsie Frank (Mother):
Rep. Frank is also a McDermott cosponsor. He often uses his mother as a surrogate to
endorse local candidates when he cannot. His mother is a leader of aging groups in
Massachusetts.
CONGRESSMAN SAM GEIDENSON(D-CT) and .Tuljia Geidensen (Mother):
Congressman Gejdenson's mother, a Holocaust survivor, is a dairy farmer and also mns her
son's campaign office. Gejdenson, having squeaked through in '92, faces another very tough
reelection.
CONGRESSWOMAN EDDIE BERNICE .TOHNSON (D-TX) and Lillie Mae White
•Tohnson (Mother);
Freshman Representative Johnson is a nurse from Dallas with a district both African
American and Hispanic.
CONGRESSWOMAN BARBARA KENNELLY (D-CT) and Barbara Bailev (Mother);
Rep. KenneUy is key on the Ways and Means Committee. Her district wiU be linked by
satellite to your town meeting in Rhode Island on Monday.
CONGRESSMAN SANDER LEVIN (D-MD
Ways and Means' Levin, who played a central role in mark-up at the Health Subcommittee,
has said that he is looking toward more changes in the biU at the fiiU Comnuttee level to
limit the impact on smaU businesses.
�CONGRESSWOMAN CYNTHIA MCKINNEY (D-GA) and Leob MrKinngv (Mother)!
Freshman Rep. McKiimey is also McDermott cosponsor and attended your meeting
Wedensday with the women House members. Her mother was a nurse in mral Georgia for
almost 40 years.
CONGRESSWOMAN PATSY T. MINK (D-ffl) and lohn Mmk (Spouse);
A member of the Education and Labor Committee, Rep. Mink is also a McDermott
cosponsor and attended your meeting Wednesday with the women House members.
CONGRESSWOMAN ELEANOR HOLMES NORTON (D-DC) and Vela Hohnes
(Mother);
Also a McDermott cosponsor. Rep. Norton is concemed about treatment of the District of
Columbia under the HSA, particularly how the aUiances wiU affect quaUty of care.
CONGRESSMAN DONALD PAYNE (D-N.D;
A former Pmdential Insurance employee, Payne is also a McDermott cosponsor. Today's
Roll Call Usts him as the frontrunner to replace Rep. Mfiime as chair oftiieCongressionla
Black Caucus in the next Congress.
CONGRESSMAN ROBERT C. SCOTT (D-VA) and MaP Hamlin Scott (Mother):
Freshman Rep. Scott is also a McDermott cosponsor and serves on Education and Labor.
He is opposed to the tobacco tax and worries about the effect of health reform on historicaUy
black hospitals.
CONGRESSMAN TED STRICKLAND (D-OH):
A member of Education and Labor, Strickland has pledged not to accept the health care
coverage offered to Members of Congress untU aU Americans have coverage. He is a
psychologist who won his seat with 51% of the vote.
CONGRESSWOMAN KAREN THURMAN (D-FL) and Donna Loveland (Mother);
Freshman Congresswoman Thurman won a close race and has primarily mral concems in
health reform.
CONGRESSMAN ROBERT UNDERWOOD (D-GUAM) and Lorrame (Spouse);
Delegate Underwood hopes the health care reform biU wiU address the issue of "Compactimpact" aid for Guam which has large numbers of immigrants from Micronesia.
CONGRESSMAN PAT WILLIAMS (D-MT At-Large) and Carol (Spouse);
As you know. Rep. WiUiams' Education and Labor Subcommittee is presentiy engaged in
markup of health reform and mayfinishnext week.
�THE WHITE HOUSE
WAS HI NGTON
May 3, 1994
MEETING WITH MEMBERS OF THE CONGRESSIONAL WOMEN'S CAUCUS
DATE:
LOCATION:
TIME:
FROM:
I.
II.
May 4, 1994
Oval Office
9:45 am
Pat Griffin
PURPOSE
•
To provide an opportunity to the women House Members that was provided to
the women Senators to express their health care views and concems.
•
To reiterate the commitment to comprehensive benefits, including coverage of
special concem to women.
•
To enlist tiie support of the members in passing health care reform tiiis year.
BACKGROUND
After your November meeting with the Senate Democratic women, the House
Democratic women requested a simUar meeting and they are fmstrated that it has not
happened sooner. The meeting was originally intended to be bipartisan, but
Representative Olympia Snowe, tiie Co-Chair of the Caucus for Women's Issues
could not attend. As a result, this meeting may be somewhat more contentious and
more frank in tone.
The Women's Caucus has expressed two main concems regarding health care reform:
more explicit and expansive coverage of mammograms and coverage of reproductive
services. The meeting may well be influenced by the activities of the House
Education and Labor Committee, which is currentiy marking-up their version of
health reform in subcommittee. The subcommittee mark broadens the mammogram
benefit in the Health Security Act by expanding coverage without co-pays. The HSA
would cover mammograms but would pay 100% only every other year for women 50
and older. At other times, the service would be covered but women would be
required to pay 20% of the cost. The subcommittee mark provides 100% coverage
every other year for women age 40-49 and every year for women 50 and above. Of
note also, is that tiiere may be a vote in the subcommittee later tiiis week on abortion
coverage. As a result, this meeting may center on abortion no matter how we try to
broaden or shift the focus.
�III.
PARTICIPANTS
The President
Representative
Representative
Representative
Representative
Representative
Representative
Representative
Representative
Schroeder
Slaughter
Lowey
Collins
McKinney
Mink
Schenk
Velasquez
Pat Griffin
Susan Brophy
Jack Lew
Janet Murguia
(See attachment for profiles of the participating members.)
SEQUENCE OF EVENTS
Closed meeting with members in the Oval Office.
VI.
PRESS PLAN
Closed Press. (White House Photographer will be present.)
�May 3, 1994
MEETING WTTH MEMBERS OF THE CONGRESSIONAL WOMEN'S CAUCUS
Profiles of Participating Members
The foUowing are brief profiles and summaries of the health care views of the women
House members you will be meeting with tomorrow.
CONGRESSWOMAN PATRICIA SCHROEDER (D-CO 1st District - Denver):
The Co-Chair of the Congressional Caucus on Women's Issues, Congresswoman Schroeder
has not cosponsored any of the major health reform bills. She was the lead witness at the
House Govemment Operations Subcommittee on Human Resources hearing on the National
Cancer Institutes mammography guidelines. She said the NCI recommendation change fits a
federal pattern of being "very fast and loose with women's health. We are very, very tired
of it. This is one of the final insults." If reproductive services are not included, she will
vote against health care reform.
Schroeder has voted with the White House on NAFTA, National Service, the Budget, and
Family and Medical Leave.
CONGRESSWOMAN LOUISE SLAUGHTER (D-NY 28th District - Rochester):
Congresswoman Slaughter is a Health Security Act cosponsor and Chairs the Women's
Health Task Force of the Congressional Caucus for Women's Issues. On demands that the
HSA cover mammography screening exams for women 40-49, she has said: "We insist that
no woman is left out ... simply because she cannot pay. Women are just beginning to realize
how littie the federal govemment cares about their health." She is also interested in the
elderly, prescription drugs, and malpractice reform.
She has also expressed concem about the impact of reform on the City of Rochester's
successful efforts to control costs and expand coverage.
A member of the Rules and Budget Committees, Slaughter voted for Family and Medical
Leave, National Service and Budget Reconciliation and against NAFTA.
�CONGRESSWOMAN NTTA LOWEY (D-NY 18th District - Parts of Bronx and
Queens, lower Westchester):
Congresswoman Lowey, an Appropriations member, has not cosponsored any of the major
health reform biUs. She is Chairwoman of the Pro-Choice Task Force of the Congressional
Women's Caucus. She cosigned the Planned Parenthood ad in the New York Times about
coverage of women's health, as weU as the letter to Sen. Moynihan and Rep. Rangel
outlining seven reasons why the HSA could mean high health care costs for New Yorkers.
(A copy of the seven points are attached for your review.)
Lowey voted witii the White House on Family and Medical Leave, tiie Budget, and National
Service, and NAFTA.
CONGRESSWOMAN CARDISS COLLINS (D-IL 7th District - Chicago):
Congresswoman Collins is a HSA and McDermott cosponsor and a member of the Energy
and Commerce Committee and chairs the subcommittee with jurisdiction over insuranc
industry regulation. Her Chicago district is poor, and largely African American. She is
generally considered a Uberal vote.
She voted for Family and Medical Leave, the Budget, and National Service and against
NAFTA.
CONGRESSWOMAN CYNTHIA MCKINNEY (D-GA 11th District - Atlanta):
Freshman Congresswoman McKinney is a HSA and McDermott cosponsor. McKinney
represents a black-majority district which includes working class suburbs and areas of rural
and urban poor. Her mother was a nurse in mral Georgia for almost 40 years. McKinney is
a member of the Agriculture and Foreign Affairs Committees.
McKinney voted against NAFTA, and for National Service, the Budget, and Family and
Medical Leave.
CONGRESSWOMAN PATSY T. MINK (D-HI 2nd District - Oahu):
Congresswoman Mink is a member of the Education and Labor Committee and a HSA and
McDermott cosponsor. She is a strong pro-choice voice and wants to ensure state flexibility
to protect Hawaii's existing health care reform efforts.
Mink voted with the Administration on National Service, Family and Medical Leave, and the
Budget, and against on NAFTA.
�CONGRESSWOMAN LYNN SCHENK (D-CA 49th - San Diego):
As a key vote on Energy and Commerce, freshman Congresswoman Schenk has gamered
considerable press attention and concessions from Chairman Dingell. Her principal concems
have been eliminating the breakthrough dmg provisions opposed by the biotech industry;
reducing the impact on small business and women's health coverage, particularly
reporductive services. She opposes the long-term care provisions, based on concems over
the cost.
Schenk voted against NAFTA, but for the Budget, Family and Medical Leave, and National
Service.
CONGRESSWOMAN NYDIA VELAZQUEZ (D-NY 12th District - Lower Manhattan,
parts of Brooklyn and Queens):
Freshman Velazquez is a McDermott cosponsor who sits on the Small Business Committee
and Banking Committees. She is pro-choice and concemed about the health problems that
effect the latino community ~ large numbers of uninsured; heavy concentration of Medicaid
benefiticiaries; high incidences of infant mortality, tuberculosis, HIV; and the need for basic
primary care for women. She cosigned the letter to Sen. Moynihan and Rep. Rangel about
how New York would fare under the HSA.
Velazquez voted with the Administration on Family and Medical Leave, the Budget, and
National Service, and against on NAFTA.
�03/03/94
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SEVBN REASONS WKY THE HEALTH SECURITY ACT CODIiD
MEAN HIGH HEALTH CAES COSTS FOR NSW YORKERS
1.
N a t i o n a l p u b l i c h e a l t h iaamaa ahould be addrgaaed a t the
federal level
Right now. New York C i t y has some of the highesc health r.Piret
costs i n the coTJintry. Some of the h i g h costs are l o c a l i n o r i g i n _
( o f f i c e r e n t , c i t y and s t a t e taxes, high wages, <nf^iirance) and i t i s
reasonable t h a t under the Health S e c u r i t y Act (H.R. 3600] our h e a l t h
care costs would b« somewhat higb«r than average because of these
local factors But what about other f a c t o r s ? Should New Yorkers pay nnre f o r
h«alth c2are because we have a d i s p r o p o r t i o n a t e share o£ the nation's
AIDS and t u b e r c u l o s i s p a t i e n t s , honeless people and i l l e g a l aliens?
These issues have always been seen as n a t i o n a l problems e i t h e r
because they t h r e a t e n the h e a l t h of the whole country (AIDS and TB)
or because there i s a unique f e d e r a l r o l e i n v o l v e d ( i l l e g a l
immigration).
For example, the AIDS v i r u s , u n l i k e c i t y and s t a t e taxes,
respects no j u r i s d i c t i o n a l boundaries; and c o n t r o l l i n g i l l e g a l
immigratior. i s a f e d e r a l r e s p o n s i b i l i t y , even though the c i t i e s and
s t a t e s p i c k up much cf the tab f o r i l l e g a l immigrant h e a l t h care
under the proposed reform plan. Right nov, NYC spends w e l l over a
b i l l i o n d o l l a r s a year on AIDS and TB alone, and estimates are t h a t
h e a l t h care costs f o r i l l e g a l immigranta could be aa h i y l i as $500
m i l l i o n a year. Because these costs a r i s e from problems t h a t are
n a t i o n a l i n gcjcjpti o r l e d e t a l i n r e s p o n s i b i l i t y , t h e y s h o u l d be borne
by the country as a whole, noc j u s t members of a p a r t i c u l a r r e g i o n a l
dlllance.
Under tli«s H e a l t h Secur-ity A o t , Mew Y o r k o r s w i l l pay stor<»
because the tremendous f i n a n c i a l burden from t h i s
high-cost
p o p u l a t i o n w i l l be borna ainioot ©utiroly b y f a m i l i e s i n th« r A g i o n a l
alliance.
But j u s t as we consider the C a l i f o r n i a earthquake a
n a t i o n a l d i s a s t e r t o be pairf f n r w i t h n a t i o n a l d o l l a r s , t h e
costs
associated w i t h epidemics l i k e AIDS and TB, and the added cost of
i vft-r-i ng h e a l t h care t o the growing numbers of i l l e g a l a l i e n s ,
homeless, and v i c t i m s of v i o l e n t crime should be borne n a t i o n a l l y ,
not j u s t by those i n urban r e g i o n a l a l l i a n c e s . H.R. 3600 sets aside
a w o e f u l l y inadequate $800 m i l l i o n t o help r e g i o n a l a l l i a n c e s i n
extremely d i s t r e s s e d areas .
T h i s fund should be g r e a t l y expanded so f a m i l i e s i n r e g i o n a l
a l l i a n c e s w i t h high-cost populations w i l l be spared e x o r b i t a n t
h e a l t h care premiums. These n a t i o n a l h e a l t h care c r i s e s costs
should be f a c t o r e d out of the equation used t o determine r e g i o n a l
h e a l t h care a l l i a n c e premiums. Funds from the new c i g a r e t t e excise
t a x c o u l d go i n t o an account co pay the h e a l t h care costs f u r Lhe
diseases and population groups t h a t f a l l c l e a r l y w i t h i n the n a t i o n a l
domain.
we nave always l o a k e d
humelessuess, v i o l e n c e ,
illeg-nl
i m m i g r a t i o n and i n f e c t i o u s diseases as n a t i o n a l issues and should
tBuuyaize t h i s undei; health cnr-c ireform.
�03/03/94
2.
12:43
^
The qeoaraphic boundaries of the regional health a l l i a n c e could
l o c k I n very high pr'"«-i"™« for New Yorkers
The mapping of the regional health a l l i a n c e s w i l l have a
tremendous impact on the p r i c e of health care for f a m i l i e s i n each
region. That i s because i n d i v i d u a l premiums w i l l roughly equal the
-cost of providing health care to everyone i n the regional a l l i a n c e
divided by the region's population. Under H.R. 3600, the
geographical boundaries of the regional health a l l i a n c e s would be
s e t by each s t a t e . But the l e g i s l a t i o n does not speak to the l i k e l y
i s o l a t i o n of c i t i e s into t h e i r own regional health a l l i a n c e s , a
d i s t i n c t p o s s i b i l i t y that would s h e l t e r s t a t e residents from the
r e l a t i v e l y higher costs of d e l i v e r i n g health care i n large c i t i e s .
A regional health a l l i a n c e encompassing only New York C i t y and
i t s immediate suburbs would r e s u l t i n s u b s t a n t i a l l y higher premiums
for c i t y r e s i d e n t s than for those i n other p a r t s of the s t a t e . Soma
estimates put the cost o£ premiums i n a N7C-only h e a l t h a l l i a n c e as
high as 1.5 to twice, the cost of premiums i n r u r a l and suburban
a l l i a n c e s . While insurance premiums today are higher i n the City,
h e a l t h care reform should seek to address some of the i n e q u i t i e s now
present, not reinforce or even worsen them.
One p o s s i b l e solution would be to prohibit s t a t e s from
i s o l a t i n g high cost areas into one regional a l l i a n c e . A second
s o l u t i o n would set a l i m i t on the d i f f e r e n c e s i n premium costs
between a l l i a n c e s throughout the country to 20% above or below the
mean average of a l l regional a l l i a n c e s .
3.
index small business wacre subaidv for high cost areas
The p a y r o l l caps on small businesses' h e a l t h care expenses are
an important s t a r t toward helping many of them cope with the costs
of providing insurance for t h e i r employees. However, the caps w i l l
not provide much of a safety net for small businesses located i n New
York C i t y . That i s because high wage and low wage areas are treated
identically.
The Health Security Act l i m i t s small business contributions for
h e a l t h care to 3.5% of p a y r o l l for companies where the average wage
i s $12,000 or l e s s . The l i m i t " f l o a t s " up to a maximum of 7.9% when
the average employee wage i s $24,000. But $12,000 i n New I b e r i a ,
L o u i s i a n a goes alot farther than $12,000 i n New York C i t y . Even i n
New York State the cost of l i v i n g v a r i e s g r e a t l y . According to the
NYS Department of Labor the average wage of an employee i n a New
York C i t y business with l e e s than 20 employees i s $37,147. I n Seneca
County i n the Finger Lakes the average wage i s $13,924. So, the
caps w i l l help many businesses i n Seneca County but very few i n New
York C i t y .
One p o s s i b l e solution i s to l i n k the p a y r o l l cap l e v e l s to the
l e v e l of wages or the cost of l i v i n g i n a p a r t i c u l a r area. There i s
a precedent for t h i s i n federal l o c a l i t y pay, which provides a cost
of l i v i n g d i f f e r e n t i a l for federal employees i n higher wage areas.
4.
The e f f e c t of health care reform on teaching hoapitala
New Yor.k C i t y boasts some of the country's most advanced
[gjOOS
�03/03/94
i;::44
'or
r e s i d e n t s . These teaching f a c i l i t i e s and t h e i r residents supply
much needed care throughout the c i t y , p a r t i c u l a r l y the p u b l i c
h o s p i t a l s . Health care reform could hurt New York's teaching
h o s p i t a l s by l i m i t i n g the niimber o£ medical residency s l o t s and by
providing a low l e v e l of federal payments f o r medical education.
NYC i n s t i t u t i o n s r e l y h e a v i l y on medical residents to provide
care, e s p e c i a l l y the public h o s p i t a l s . The governor's task force on
h e a l t h r e c e n t l y estimated that New York State h o s p i t a l s could lose
3,800 r e s i d e n t s l o t s , most of them i n C i t y i n s t i t u t i o n s . And while
the f e d e r a l government w i l l make funds a v a i l a b l e to help pay to
replace l o s t resident s l o t s , the funds are inadequate and phase out
a f t e r f i v e years.
In the b i l l , federal payments to h o s p i t a l s for resident
t r a i n i n g would be based on a national average with an as-yet
u n s p e c i f i e d geographic adjustment, instead of today's h o s p i t a l s p e c i f i c method of payment. Because of New York's higher operating
c o s t s the Greater New York Hospital Association (GNYHA) has
estimated that area h o s p i t a l s would lose approximately $600 m i l l i o n
over f i v e years under a national average scheme. I n addition,-since
p u b l i c h o s p i t a l s — which serve a disproportionate share of lowincome people
use more residents, they would face the brunt of
t h i s l o s s of funds.
On top of that, the Medicare cuts proposed by the
Administration w i l l take $2,2 B i l l i o n out of New York h o s p i t a l
revenues over f i v e years. These funds (so c a l l e d " i n d i r e c t medical
education" funds) support b a s i c care, t r a i n i n g and research.
Part of the solution must address the geographic adjustment to
make sure that i t r e f l e c t s a c t u a l cost d i f f e r e n c e s between regions.
5.
The p a y r o l l cap should apply to afcat-o and l o c a l goverT»n«'T^^rt
Under H.R. 3600, no employer w i l l pay more than 7.9% of t h e i r
p a y r o l l f o r employee health care -- except s t a t e and l o c a l
governments. The b i l l delays the implementation of a p a y r o l l cap
for s t a t e and l o c a l governments u n t i l 2002. This inequitable
treatment of p r i v a t e and public employers i s d i f f i c u l t to j u s t i f y .
State and l o c a l governments are s u f f e r i n g from the same high
i n c r e a s e s i n health care costs that p r i v a t e businesses face. I n
f a c t , growth of health care costs has been a major component of
s t a t e and l o c a l budgetary problems for the past decade.
New York C i t y ' s Office of Management and Budget has estimated
that t h i s delay could cost the C i t y an estimated $300 m i l l i o n i n the
f i r s t year of reform alone and as much as $600 m i l l i o n i n 1997.
The p a y r o l l cap should apply to s t a t e and l o c a l governments
r i g h t away.
6,
The Medicaid matching formula muat be changed and maintenance
of e f f o r t proviaiona should not penalize s t a t e s that have a
histozry of carino for the poor
Under the Health Security Act, Medicaid r e c i p i e n t s w i l l be
i n t e g r a t e d i n t o the health care system. While t h i s may help provide
more equitable health care, there are two major Medicaid i s s u e s to
be addressed i n health care reform: the federal match and
igiooe
�New York State gets only a 50% federal matching payment on
Medicaid dollars from the federal government because i t i s .
considered a r i c h state. "Poor" states, l i k e Mississippi, get up to
an 80% match tor Medicaid spending. The federal match i s ^onfair to
New York because i t i s based only on a state's per capita income and
doesn't consider a state's poverty luvel. The match ahould be
reformulated along the l i n e s of GAG recommendations to take a
s t a t e ' s poverty level into account when determining the federal
matchUnder the maintenance of payment provision, each state w i l l
oonLliiue to contribute i t s current Medicaid payment to the regional
h e a l t h a l l i a n c e . New York provides a high l e v e l of benefits for i t s
Medicaid rtcipienta, covering more eervicec than other Btat«»«, .=in i t
has higher per person Medicaid costs. Other states that provide
leaa comprebennive oare w i l l pay l e s s to th« regional health
a l l i a n c e s for their Medicaid recipients, but t h e i r c i t i z e n s would
got the sane aoii^roheiiaive benefitn aa New Yorkers under- reform.
Tbe maintenanci*. of «ffort provision should be adjusted s a as
not to punish states that have h i s t o r i c a l l y provided q u a l i t y care to
i t s ponr population.
7.
Tha long t e m care program r«'^T"^"'«'"formula i s unfair
The Health Security Act's new long term care program tunnels
money to state programs to provide home health assistance to f r a i l
seniors and disabled persons. The new federal funding for t h i s
program i s significant, however, state reimbursement formulas should
not be based on a variation of the Medicaid formula and the program
ahould not reward states that have done nothing on long term care i n
the past at the expense of those states that have.
Using the Medicaid formula as a baalti Loi: long term care
funding i s unfair to New York for the same reasons that the Medicaid
formula i s unfair to New Yuik. I n addition, the long term care
matching formula would u n f a i r l y subsidize some s t a t e s ' long term
oare a l f c r t s almost completely (95%) , rcgardlccc of t h e i r long term
care e f f o r t s in the past. However, Hew York, which has an h i s t o r i c
QOismitment to pirovidi&g long tczsi oare £or ssaiors and disabled
parsons, would receive the lowest matching formula for t h i s program.
Due to the unfair formula and other problems, the governor's
bask force recently aetimat<?d t-har. thp long term program could add
$1.3 BILLION i n costs to New York between FY97 and FY03 .
�AprU 28, 1994
Memorandum for the President
From:
Subject:
Pat Griffin
Chris Jennings
Jack Lew
Legislative Briefing for Regional Media Day
The following are brief profiles and summaries of the health care views of the members of
the Montana, Oregon and Washington delegations in preparation for your meeting with the
regional media from those states scheduled for Friday.
MONTANA
SENATOR MAX BAUCUS (D-MT)
The Chairman of the Environment and Public Works Committee also serves on Finance and
Agriculture. Senator Baucus is a Health Security Act cosponsor whose primary concems are
small business, rural access and real cost containment. Baucus is a single payer advocate
who has long has difficulties with the employer mandate. He cosigned the letter to the
President on the domestic oil and gas industry. Regarding the Finance Committee closeddoor deliberations this week, he told the Washington Times, they are "nowhere close" to a
solution. "This is the biggest jigsaw puzzle this country has ever seen. It's tough to put the
pieces together, let alonefindthe shape." Although expressing concems about the health
reform debate. Sen. Baucus has been consistently strong in his support for universal coverage
and comprehensive reform.
Baucus voted for NAFTA, National Service, and Budget Reconciliation.
SENATOR CONRAD BURNS (R-MT)
Senator Bums is Montana's junior Senator and running this year for reelection. Bums is a
quiet Senator with a conservative voting record. A Chafee cosponsor, he wants welfare
reform to be handled before health care. Bums is not convinced that the President is taking
health care reform in the right direction. He fears the President's plan will somehow evolve
into a plan like Canada's which he believes to be ineffective. He thinks the solution lies in
an incremental approach and insurance reform. He believes insurance companies should be
required to offer a variety of plans that address the issues of preexisting conditions,
portability, and community rating. Congress should work to prevent cherry picking and
redlining by the insurance companies and to address tort reform and long-term care.
�With the many small businesses and farms in Montana, Bums opposes the employer
mandate. He is concemed that discounts for small businesses and low-income individuals
provided in the HSA will eventually be terminated, just like the wool subsidies. He feels a
viable system will be one that is supported by vouchers. He cosigned the March letter to the
President about the domestic oil and gas industry.
Bums voted against NAFTA, National Service, and the Budget.
CONGRESSMAN PAT WILLUMS (D-MT At-Large):
Congressman William's Education and Labor Subcommittee is presently in mark-up and
expected to wrap up by the end of next week. A HSA cosponsor, he believes that the nation
will pay later if preventive care and women's health are not adequately covered. Williams
told USA Today April 22: "If this nation attempts to do health care on the cheap, we will be
back here in a decade or two...trying to fix it." His bill replaced mandatory alliances with a
voluntary alliance system that preserves all the functions of mandatory alliances. It also
assesses a one percent payroll tax on all companies with more than 5,000 workers. The
latter would be used, in part, to increase the subsidy to small business and low income
individuals. His also includes a more generous package of benefits. Williams expects both
his mark and a single payer bill to pass the Subcommittee.
He is also concemed about Native Americans and wants regulation of insurance to protect
consumers (e.g. claims dispute resolution and prompt claims payment standards). He does
not support federal funding of abortions.
Williams, having won with 50% in 1992, is expected to have another stiff challenge this
year. He voted against NAFTA but for National Service, Family and Medical Leave and the
Budget.
�OREGON
SENATOR MARK HATFIELD (R-OR):
The Ranking Minority Member on the Appropriations Committee, Senator Hatfield is a
Chafee cosponsor. He considers his proudest accomplishment "helping establish Portland as
a center for medical research." He has joined Sen, Harkin in introducing legislation that
would place one percent of all health insurance premiums in a trust fund for medical research
at NIH. Both Senators hope that this provision will be folded into reform legislation.
Earlier this month Hatfield presided over an Appropriations Committee field hearing on rural
health care in Pendleton, Oregon. Eastern Oregon already suffers from a lack of physicians
for its wide open spaces, and it is predicted that a new crisis in that area will be brought on
by the advancing age of its doctors. The Senator testified that the hearing "reaffirmed my
belief that the solution to rural America's health care needs does not lie in a program which
the federal govemment designs and manages."
Hatfield is anti-choice and we will lose him if he perceives the plan to be subsidizing
abortion. However, he did back amendments to allow family planning at Tide X clinics. He
is also concemed about medical education reform. State flexibility will be crucial to his
vote. Along these lines, Hatfield was pleased with the decision to approve the Oregon
waiver. He has a personal interest in Alzheimer's disease because of his father and
sponsored legislation for ID bracelets for victims.
Hatfield voted for National Service and NAFTA and against the Budget and was a cosponsor
of the Family and Medical Leave Act. Hatfield is deeply religious and has never voted for a
defense authorization bill. He was one of two Republicans voting for the 1995 budget.
SENATOR BOB PACKWOOD (R-OR):
The Ranking Republican on Finance, Senator Packwood said this week that he would
reconsider his previous opposition to the idea of taxing health benefits, saying the high cost
of health insurance raises the question "whether we have encouraged, because of the tax
code, too much health coverage - Cadillac coverage when we should have a Chevrolet." He
predicts there will be some form of mandate (on employers, individuals or a hybrid); a slow
phase-in to universal coverage; a bare-bones benefits package; and no price controls. He
also sees insurance reforms to protect consumers from losing coverage. "That will be the
skeleton from which we'll work, and there may not be much morefleshon the skeleton as
we initially pass it. I do not think a bill that raises lots of taxes to pay for lots of benefits
will pass." He does not see the alliances surviving. Senator Packwood has not cosponsored
any of the major health bills. He is, of course, a strong pro-choice proponent.
Packwood voted against National Service and the Budget and for NAFTA.
�CONGRESSMAN PETER DEFAZIO (D-OR 4th District - Eugene);
Congressman DeFazio is not cosponsoring any of the major health bills. He is known to
have a populist, activist approach — a characteristic which has alienated some of his
colleagues. While he usually votes with his party, he is prone to go his own way on the
votes that matter most to the leadership. His district is made up of loggers,fishermenand
environmentalists. DeFazio is a former Congressional aide who handled seniors' issues, he
now sits on the Public Works and Natural Resources Committees. He is also a member of
the Rural Health Care Coalition.
He voted against NAFTA and for Family and Medical Leave, National Service, and the
Budget.
CONGRESSWOMAN ELIZABETH FURSE (D-OR 1st District - Portland):
Freshman Congresswoman Furse is a McDermott cosponsor and strong proponent of abortion
rights. Secretary Shalala was in her district at the end of March. Purse's constituents are
sti-ong single payer advocates and she was noncommittal. Ultimately, however, HHS feels
she will be with the Administi-ation. She cosigned the Planned Parenthood New York Times
ad on treatment of women in health reform. She comes to her first term in Congress with a
life-time of commitment to political activism. From South Africa where she marched against
apartheid to her founding of the Oregon Peace Institute, Furse has consistentiy worked for
human rights, peace, justice and environmental responsibility. Furse represents westem
Portland and its suburbs and won her election with 52% of the vote. She promised to
replace the current health care system with a national health care system. She sits on the
Armed Services and Banking Committees and is a member of the Rural Health Care
Coalition.
Furse voted for Family and Medical Leave, National Service, and the Budget and against
NAFTA.
CONGRESSMAN MIKE KOPETSKI (D-OR 5th District - Salem):
Congressman Kopetski is not mnning for reelection and has not cosponsored any of the
major healtii reform bills. A moderate to liberal member of the Ways and Means
Committee, he is also head of the House Mental Health Working Group. Kopetski has
pushed hard for parity for mental health benefits in the reform package and does not feel the
HSA goes far enough in this area. He is working on an amendment to give incentives to
businesses for employers to provide parity of treatment benefits for mental health. He is
concemed tiiat tiie 7,9% employer cap does not apply to tiie public sector at tiie sametimeit
does for private businesses. He strongly opposes sin taxes, tobacco in particular, as the
�primary funding source because they will mean a declining revenue base. He also feels it
will hurt states because of their increasing reliance on these same revenues. He would prefer
a broad-based tax, such as a payroll or advertising tax, A strong supporter of labor, he has
expressed concems that the Administration's benefit package would not be as generous as
those included in current union contracts. Despite these reservations, on April 14, after a
day of closed-door meetings of Democrats on Ways and Means, Kopetski said: "We're
going to surprise people with how united we're going to be."
Kopetski voted with the Administration on NAFTA, Family and Medical Leave, the Budget,
and National Service.
CONGRESSMAN RON WYDEN (D-OR 3rd District - Portland):
While Rep. Wyden is not cosponsoring any of the major health reform bills, he has strong
concems in this area. As the former executive director of Oregon's Gray Panthers, he is an
ardent advocate for the interests of the elderly. It was Wyden's request which began the
recentiy released GAO study on the variations in the approval and denial of Medicare claims
for the same services in different states. Wyden said the report also contained a warning for
"all major national health reforms plans," contending that they would resemble Medicare in
their use of private insurance companies to administer a system of defined benefits. He has
introduced a bill to enable records of malpractice lawsuits and disciplinary action taken
against physicians to be made available to the public through a national data bank. He hopes
the bill will be attached to the broader national health care reform. Wyden, a member of the
Small Business Committee as well as Energy and Commerce, cites the employer mandate as
the "hot button issue" in this debate. He is an enthusiastic supporter of Oregon's health care
reform demonstration program and is a strong proponent of abortion rights.
A close ally of Chairman Dingell, Wyden maintains that the Dingell draft gives members the
chance to say back home that "Congress is being responsive." A team player, Wyden is also
close to Congressman Waxman,
Wyden voted with the Administration on NAFTA, Family and Medical Leave, the Budget,
and National Service.
Oregon State Notes:
Oregon is one of the states affected by the cut in Indian Healtii Services. The
Portland area office of the IHS is waiting to leam how much of its 1994 budget of $103.4
million might be stripped. Their area covers Oregon, Washington and Idaho and services
about 75,000 Indians. IHS says 18,440 Oregon Indians used the service last year. In
Portland, an estimated 15,000 Indians are served by a single clinic.
�WASHINGTON
SENATOR SLADE GORTON (R-WA);
Senator Gorton is considered by some to be the most vulnerable of the Senate Republicans
this year. A Chafee cosponsor, he voted for NAFTA and against National Service. Gorton
sits on the following Committees - Budget, Commerce, and Appropriations, as well as the
Select Committees on Indian Affairs and Intelligence. He was encouraged by the Oregon
waiver and hopes that the Administration plan will give the states equal flexibility.
SENATOR PATTY MURRAY (D-WA);
Senator Murray is a Health Security Act cosponsor. While she is concemed about state
flexibility and long-term care, she has been particularly outspoken on women's health in
general, and breast cancer screenings and reproductive rights in particular. She supports the
employer mandate, saying it is already the comerstone of our system today. Senator Murray
has introduced a bill designed to raise the excise tax on firearms and earmark the revenue for
health care. Murray is on the Budget, Appropriations, and Banking Committees. The
National Joumal reported last month that liberal junior Democrats may look to her for
leadership both because she is well-liked and because her state has already been through a
round of health care reform.
She voted for NAFTA and National Service and announced for Budget Reconciliation.
SPEAKER OF THE HOUSE TOM FOLEY (D-WA STH DISTRICT - Spokane);
Early this month, he predicted on "Today" that the House and the Senate would pass health
care bills by July, that differences would be worked out in August and that the bill would be
on the President's desk by September.
CONGRESSWOMAN MARIA CANTWELL (D-WA 1st District - Seattle):
Freshman Congresswoman Cantwell has not cosponsored any of the major health reform
bills. She appeared early on to be a class leader, mirroring her rapid rise as a member of
the Washington State Legislature. She is close to House Speaker Foley and sits on the
Democratic Policy and Steering Committee, the Public Works and the Foreign Affairs
Committees. Her health care views are not known but she may be protective of the
biotechnology industiies in her nortiiem Seattie district. This fall, she expressed concem
about the interaction between the revenues used tofinanceWashington's refonn initiative and
those used to fiind the HSA. She was particularly worried that Washington residents might
be taxed twice. She is a Roman Catholic.
�Cantwell voted for Family and Medical Leave, NAFTA, National Service, and Budget
Reconciliation.
CONGRESSMAN NORM DICKS (D-WA 6th District - Bremerton):
An aggressive legislator regarded as the Speaker's point man on Appropriations,
Congressman Dicks is a HSA cosponsor. His district includes Tacoma and Bremerton and
the area now famous - or infamous - for the spotted owl. He is pro-choice and concemed
about federal employees in health care reform.
He voted for National Service and Family and Medical Leave, NAFTA and Budget
Reconciliation.
CONGRESSWOMAN JENNIFER DUNN (R-WA 8th District - BeUevue):
A freshman who won her seat in herfirsteffort at public office, Congresswoman Dunn was
state GOP chairman for 11 years. She is a Michel cosponsor who voted against Family and
Medical Leave, National Service and the Budget, and for NAFTA. Dunn, who supports
abortionrights,won narrowly in the primary over an ardent abortion opponent. Dunn won
the general with 60% of the vote against a businessman who switched parties in the course of
the 1992 election cycle. Dunn represents Puget Sound and suburbs of Bellevue. She is a
member of the Public Works Committee and the Wednesday Group.
Her general health care views are not known.
CONGRESSMAN .TAY INSLEE (D-WA 4th District - Yakima):
Freshman Congressman Inslee is a former state legislator who won his seat in Congress by
628 votes. He has not cosponsored any of the major health bills and declares himself
completely open-minded on health care reform. Inslee has told the Administration that he
could vote for the reform package and against his constituents if convinced of the soundness
of thefinancingand that we were being responsible in creating any new entitiements. He
says that while his constituents don't believe that govemment can do anything right,
eliminating preexisting condition exclusions and guaranteeing portability are clear winners for
them. He has been interested in the impact on small businesses and family farms. To his
small business constituents, he points out that they already face an employer mandate from
Washington's health reform law and that a national mandate would help them compete with
businesses in other states. Inslee is a member of the Agriculture and Science Committees.
Inslee voted against the Budget but for Family and Medical Leave, National Service, and
NAFTA.
�CONGRESSMAN MIKE KREIDLER (D-WA 9th - Tacoma):
Freshman Congressman Kreidler, a HSA cosponsor and a member of the Energy and
Commerce Committee, comes to Congress with a stiong background in health care. Kreidler
says he supports the single payer proposal but doesn't believe it is politically doable.
Kreidler calls McDermott's single payer bill a "counterweight" but adds: "It's a great
unknown how far the President can move to the right and how much McDermott and the
single payers can insist they won't budge." He has criticized business groups for
withholding support from the HSA and accuses the insurance industry of being overcome
with "crazed fanaticism." In March, he Veterans Affairs Committee approved a bill
cosponsored by Kreidler which would allow the Department of Veterans Affairs to participate
in state health care reform plans, including Washington State's.
In the Washington legislature, Kreidler was Chairman of the Senate Health and Long-Term
Care Committee and helped write their present reform plan. He is a practicing optometrist
who worked for 20 years in a managed care system and holds a Masters Degree in Public
Health. Kreidler also serves on the Veterans' Affairs Committee and was in the Army
Reserve for 20 years.
He voted for NAFTA, the Budget, Family and Medical Leave and National Service.
CONGRESSMAN JIM MCDERMOTT (D-WA 7th - Seattle):
Congressman McDermott continues to make it clear that single payer advocates should not be
taken for granted - "The assumption has been made that they just snap theirfingersand we'll
be there...That's just not tme." (Washington Post April 26) With his cosponsors he has
written to Chairman Rostenkowski that he would not vote for any bill that does not provide
universal coverage by 1997 and offer a comprehensive range of benefits.
Not surprisingly, he joined 111 House members in a letter urging the President to defend
firmly tiie ability of individual states to enact their own single payer option. While
McDermott felt that the Stark bill was inadequate, he voted for it to keep health reform
moving. He maintains that "The only thing tiiat keeps the American people from having this
[single payer] is this tortured effort to keep insurance companies as thefinanciersof health
care."
McDermott voted with the Administration on NAFTA, Budget, Family and Medical Leave,
and National Service.
�CONGRESSMAN AL SWIFT (D-WA 2nd District - Everett):
Congressman Swift, a HSA and McDermott cosponsor, is not mnning for reelection fulfilling a promise made during the term limit campaign in Washington State. He believes
that "McDermott provides a counter-balance to Cooper. It's McDermott who helps define
the middle." Swift has said that the President must convince the public that doing nothing
about health care would result in additional huge jumps in health care costs and that
legislating a program is a less costiy altemative in the long mn. Swift also maintains that the
President has to "create an atmosphere in which lawmakers will be willing to vote for reform
even if they know it will likely give fodder to their opponents in the upcoming election there will be no safe votes."
He has been a supporter of reproductive rights.
On National Service, Family and Medical Leave, NAFTA and the Budget, Swift voted with
the White House.
CONGRESSWOMAN .TOLENE UNSOELD (D-WA 3rd District - Olvmpia):
Congresswoman Unsoeld is a HSA cosponsor and stiong advocate for inclusion of abortion
services in the final health care package. She signed the New York Times Planned
Parenthood ad on women's health and the letter to Rep. Cooper on the same topic. It is not
clear how she will vote if reproductive services are not included. However, Unsoeld is a
protege of Speaker Foley and will want to be helpful to the leadership and the Administration
on this issue.
Unsoeld voted against the Administiation on NAFTA, but with it on Budget, Family and
Medical Leave, and National Service.
Washington State News;
On March 21 the Seattie Times, in response to a Molly Ivins column, ran an editorial
supporting the McDermott bill as "far less cumbersome than anything so far advocated by
Clinton, Cooper or Chafee."
On the other hand, the Tacoma Moming News Tribune reported in March that
"Hundreds of Canadians are going to Whatcom County for medical care, especially radiation
therapy and other cancer treatment, to avoid delays under their own national health care
system."
�THE WHITE HOUSE
WAS H I NGTON
April 15, 1994
Memorandum for the President
From;
Pat Griffin
Chris Jennings
Jack Lew
Subject:
Legislative Briefing for Wisconsin trip
The following are brief profiles and summaries of the health care views of the members of
the Wisconsin Congressional delegation in preparation for your trip to Wisconsin on
Monday.
SENATOR RUSSELL FEINGOLD (D-WD:
Freshman Senator Feingold, described by the press as a "passionate" single payer supporter,
has made strong public statements on behalf of the Administration's health care reform
efforts. Feingold believes that the reason people aren't hearing much about single payer is
that corporate America and its Congressional friends are doing everything in their power to
make them believe single payer is not an option. He has not cosponsored any reform
legislation but should be with the Administration when needed.
He is an ardent advocate of community-based long-term care and is supportive of the Health
Security Act's long-term care provisions which he believes are modeled on the Wisconsin
plan, which he helped craft when serving in the State Senate. In a February 2 press release,
Feingold said that if private insurance is to play a role infinancinglong-term care, it should
be shaped off the Medicare supplemental insurance model. He would like an approach which
gives the consumer flexibility in long-term care, possibly through private long-term care
insurance to cover the consumer's portion of the costs under the HSA.
In the last few weeks, he has tried to carve out a role for himself in the health care debate by
focusing on long-term care issues. His lack of committee assignments of jurisdiction will
make this difficult but the aging advocate community is pleased that anyone is attempting to
champion this issue. His other essential components for reform are: universal coverage;
limiting the cost of insurance premiums; and cost control.
Feingold voted for Budget Reconciliation and National Service and against NAFTA.
�SENATOR HERB KOHL (D-WD:
Senator Kohl, who is mnning for reelection, has not cosponsored any of the major healtii
care legislation and has been very critical of the White House strategy and package. He is
very worried about his race and Wisconsin Democrats share his concem. Despite that, he
has expressed to Secretary Shalala his desire to work with the Administration.
Kohl believes "everything is negotiable except universal coverage." He wams, however, that
we may have to phase-in coverage over a longer period oftime~ ie, the year 2000. He
does not support single payer. Kohl doesn't like premium caps which he considers cost
contiol and has told the press that competition between plans in the open market place should
be the main contributor to controlling health care costs. Kohl would also like to abandon
mandatory alliances.
As a businessman (a chain of grocery stores and owner of the Milwaukee Bucks) and a
member of the Small Business Committee, Kohl is particularly interested in the impact of
reform on small business. While not totally comfortable with the employer mandate, he
concedes he doesn't know how else to achieve universal coverage. In early discussions, he
indicated he could accept an employer mandate if coupled with adequate subsidies.
However, he appears somewhat offended at the notion of exempting small business.
Kohl voted for Budget Reconciliation and National Service and against NAFTA.
CONGRESSMAN DAVE OBEY (D-WI. 7th District - Wausau):
The new Chairman of the Appropriations Committee is as complex a person as one is likely
to find in the Congress. A skilled and pragmatic legislator, Obey is often moved to outrage
when he feels people or issues are being treated unjustiy. He is a tme liberal who believes
strongly in the institution of Congress. His district includes dairy and potato farms, paper
mills and port facilities.
Obey is an original cosponsor of the Health Security Act. He has admitted he doesn't agree
with everything in it, but said it offers three essential elements: coverage for everyone; cost
controls; and requiring nearly everyone - including employers - to contribute to coverage.
Obey has pledg^ to vote for whatever funds are necessary for universal coverage. He
believes in a short phase-in period and wants to see long-term care covered. In fact, he has
said he would actively oppose the package if long-term care is not adequately addressed. He
is also concemed about mral coverage.
While Obey has praised the President's "guts" in taking on health care, he has also cautioned
that "people are wondering if he'll walk away like he did on the energy tax." Obey thinks
that Congress can accomplish most of the President's agenda - including health care and
welfare reform and a tough crime bill - before the 1994 election.
On a personal note. Congressman Obey's father-in-law passed away last week.
�CONGRESSMAN PETER BARCA (D-WI. 1st District - Racine):
Congressman Barca now holds former Secretary Aspin's seat but may have some trouble
retaining it. While Barca has been supportive publicly of the health care effort, he has not
cosponsored any of the reform bills. Privately, he has told the Administration that he
doesn't want to take a position at thistime,but will be there in the end.
Barca campaigned against new taxes and for controlling health care costs while expanding
access. He has said that health reform must maketiiepurchase of health insurance possible
for all Americans and include coverage of preexisting conditions. He supports provisions
calling for everyone to pay something towards coverage.
Barca served in the state legislature and was also a teacher of emotionally disturbed children
and job training specialist for people with disabilities. A Catholic, he said he would support
the Freedom of Choice Act. He voted against NAFTA but fortiieBudget Reconciliation
bill.
Recent Developments: In an April 11 USA Today story on the district recess, they reported
that while "Barca may not have all the answers on health care, after simulating CPR in a
moving ambulance, Barca says he is searching for federal dollars to repair his district's pockmarked Highway P.
CONGRESSMAN THOMAS BARRETT (D-WI. 5th District - Milwaukee):
Freshman Congressman Barrett, a Health Security Act cosponsor, comes to the House from
the State Senate. He represents Milwaukee and the most Democratic district in Wisconsin.
He serves on the Banking, Govemment Operations, and Natural Resources Committees.
Congressman Barrett campaigned for national health insurance to cover the uninsured with a
broad revenue base. He also supports federally regulated health care standards and federally
set spending levels. In the state legislature he was known as a conscientious lawmaker who
worked "doggedly" on health care reform.
On December 24, Barrett told the Milwaukee Sentinel that his Christmas wish was for
"access to health care for everyone, an end to violence on our stieets and in our schools, the
continued health of our economy, and a healthy second child for my wife, Kris, and me."
The baby is due at the end of May.
He voted for the Budget and Family and Medical Leave and against NAFTA.
�CONGRESSMAN GERALD KLECZKA (D-WI; 4th District - Milwaukee):
In tiie Ways and Means Healtii Subcommittee, Rep. Kleczka was unhappy about many
aspects of Stark's approach, but voted to report it out to keep the process moving. While
Rep. Levin got most of the press attention, Kleczka played tiie good soldier and should be
thanked. He has not cosponsored any of the major deserves credit. Kleczka has said that
while he prefers a single payer approach, there is not enough support in Congress for it to
pass. Regarding the Health Security Act, Kleczka has expressed concems about
bureaucracy, financing, and taxation of employee benefits. He has called the President's
proposal "far from perfect" and said that "everything except universal" is on tiie table. He
predicts that Congress will still be grappling with tiie employer mandate in "tiie last hour" of
this year's debate.
Kleczka's amendment to more fairly allocate premium costs based on type of family passed
in the Subcommittee. It establishes four different classes of family groups to set premiums
instead of the two proposed by Stark. The Subcommittee also adopted Kleczka's amendment
to guard against penalizing one state for the excesses of another.
Kleczka is close to labor and normzilly votes with Chairman Rostenkowski. A smoker,
Kleczka has received political donations from the tobacco lobby. Known as a street-smart
and combative politician, Kleczka is considered safe in his south Milwaukee district. He is
Catholic and opposed abortion until the Webster mling, when he voted for federalfiindingof
abortions in cases of rape and incest.
REPUBLICANS
CONGRESSMAN STEVE GUNDERSON (R-WI. 3rd District - Eau Claire):
Congressman Gunderson announced in Febmary that he would seek only one more term in
Congress. He serves on Education and Labor, tiie House Republican Task Force on Healtii
and is a member of the Wednesday Group as well. Gunderson is a Cooper-Grandy
cosponsor. He has said he would like to see the bipartisanship represented in NAFTA and
National Service extended to the health care debate. He voted for both. Gunderson voted
against Family and Medical Leave and Budget Reconciliation.
On health care issues, Gunderson is concemed that people do not understand the issues and
that the specter of the Medicare "Catasti-ophic" bill haunts tiiis debate. He is worried that
managed competition could fail mral areas due to the lack of sufficient medical resources.
He is also concemed about emergency services with waivers and outpatient clinics. He
opposes the national health board, additional bureaucracy and the employer mandate.
Gunderson has said he likes Cooper because of its strong mral health components and has
noted that it contains provision of a mral health reform bill he introduced in 1993, such as
100 percent deductibility of the cost of health insurance premiums for the self-employed.
�CONGRESSMAN SCOTT KLUG (R-WI. 2nd District - Madison):
Congressman Klug is a new member of the Energy and Commerce Committee and a Cooper
cosponsor. Klug voted for Family and Medical Leave, National Service, and NAFTA and
against Budget Reconciliation.
He has told Secretary Shalala tiiat he is a "tine believer" in tiie Cooper bill, but wants to add
the Health Security Act's mral health provisions. He also wants to rework the teaching
hospital funding provision. Klug opposes the employer mandate but could accept a tax cap.
He is willing to work the size of the HIPCs to 250 or more and wants a commission to
establish a benefit package.
In the past, he has called for early intervention programs for at-risk children. He is prochoice. Klug cosigned the letter to the President on the domestic oil and gas industry. He is
being targeted with radio and TV ads telling voters to demand the same healtii care coverage
which is available for Members of Congress.
CONGRESSMAN TOM PETRI (R-WI. 6th District - Oshkosh):
Congressman Petri is a moderate to conservative who is in the Michel tradition of wanting to
work with the Majority to produce results. While Petri has not been a past player in health
care, he has stated his hope that there could be a bipartisan effort to pass meaningful health
reform this year. For that reason, he is considered a Republican target on the Education and
Labor Committee. In January he praised the President for "putting health care, welfare, and
crime on the front bumer." He went on to say that "despite our differences, I'm going to try
my hardest to help the President reach acceptable agreements on these issues."
Petri is a Cooper and Michel cosponsor and is planning to introduce his own bill. It would be
a variation of Cooper, guaranteeing a catasfrophic benefit package and with a tax cap
applying to individual deductibility. He would like to avoid govemment mandates and is
concemed about mral delivery. He has asked about allowing fee-for-service plans to use
more innovative cost-sharing strategies.
Petri voted for Family and Medical Leave and NAFTA and against Budget Reconciliation
and National Service.
CONGRESSMAN TOBY ROTH (R-WI. 8th District - Green Bav);
In his 8th term, Rep. Roth is most visible as an opponent of foreign aid in the House. He has
not cosponsored any of the major health reform legislation. In January he predicted that
while the President could get health care reform passed, a "health care reform package that
replaces today's system with government bureaucrats will not be in the nation's best
interest."
�Roth has a stubborn streak that borders on obstinacy, and even some Republicans say he is
difficult to work with. He is a member of tiie Banking, Finance and Urban Affairs and
Foreign Affairs Committees.
At home, his district consists mostiy of working class people who are employed in the dairy
and paper industries. However, it also includes white-collar jobs in insurance,financeand
health care.
Roth voted for NAFTA and against Family and Medical Leave and the Budget.
CONGRESSMAN JAMES SENSENBRENNER (R-WI. 9th District - Milwaukee
Suburbs);
Rep. Sensenbrenner is a Michel cosponsor who believes in universal access, not universal
coverage. He will never win any popularity contests in the House, as colleagues on both
sides of the aisle find him to be impolite, officious, pompous and nitpicky. The Ninth is
Wisconsin's most staunchly Republican district. Sensenbrenner is a member of the Judiciary
and Science, Space and Technology Committees. A strong abortion opponent, he used the
1992 debate on the Freedom of Choice Act to propose a "conscience clause" amendment that
would have allowed states to shield institutions such as religious hospitals from performing
abortions.
Sensenbrenner voted for NAFTA and against the Budget and Family and Medical Leave,
WISCONSIN NOTES: Michael Bolger, President and CEO ofttieMedical College of
Wisconsin, was quoted last week in a Los Angeles Times article about teaching hospitals'
fears of viability because of the proposed cuts in Medicare payments and insurance
companies looking for bargains.
On April 14, Dr. Mary Horowitz, a Milwaukee blood specialist who performs about
50 bone marrow transplants a year, testified before the Ways and Means Health
Subcommittee saying that bone marrowti^ansplantswhich may offer the only hope of
surviving some types of leukemia are often denied because patients can't pay or their
insurance doesn't cover tiie $150,(X)0 cost. She noted that while tiie common belief is that
high-tech care is more readily available in the U.S., the U.S. ranked 7th of the 10
industrialized nations studied in providing this procedure.
�April 15, 1994
Memorandum for the President
From:
Pat Griffin
Chris Jennings
Subject;
Legislative Briefing for Senate Democratic Retreat
The following are brief profiles and summaries of the healtii care views of the
Democratic Senators in preparation for your attendance at their retreat in Jamestown on
Saturday.
SENATOR DANIEL AKAKA (D-HI) - Senator Akaka is a Healtii Security Act cosponsor
whose primary interest is state flexibility to allow Hawaii to continue with its health care
plan. He serves on the Energy and Veterans' Affairs Committees. Akaka has voted against
NAFTA and for National Service and Budget Reconciliation
SENATOR MAX BAUCUS (D-MT) - The Chairman of tiie Environment and Public Works
Committee also serves on Finance and Agriculture. Senator Baucus is a Health Security Act
cosponsor. Small business and mral access are his primary concems. Baucus is a single
payer advocate who has never liked the employer mandate. He cosigned the letter to the
President on the domestic oil and gas industry. Baucus voted for NAFTA, National Service,
and Budget Reconciliation.
SENATOR JOE BIDEN (D-DE) - Judiciary Chairman Biden has not cosponsored any of tiie
major health reforms bills and has expressed major reservations about the President's plan
and how it has been perceived by and sold to the general public. He is one of the few
Democratic members who declined to sign Senator Wofford's universal coverage letter.
Biden is naturally interested in the malpractice and anti-tmst provisions which fall within his
committee's jurisdiction. To date he has not expressed any major objections to our policy in
these areas. Biden voted for Budget Reconciliation, National Service, and NAFTA.
SENATOR JEFF BINGAMAN (D-NM) - An important member of tiie Labor Committee
and Human Resources Committee, Senator Bingaman has not cosponsored any of the major
health reform bills but did sign Sen. Wofford's universal coverage letter. New Mexico and
the District of Columbia share the distinction of having the highest uninsured population in
the country. Long a supporter of managed competition, he has not raised major concems.
For months, he has pursued the idea that the cigarette tax should be applied to cigarettes sold
through army Pxs. Otiier key issues for him are mral concems and the impact on small
business. He recentiy signed the letter to Chairman Dingell linking the needs of the oil states
with health reform. He voted for National Service, NAFTA, and Budget Reconciliation.
�SENATOR DAVID BOREN (D-OK) - Senator Boren is positioning himself as tiie key
negotiator on the Finance Committee. He has not cosponsored any of the major health
reform bills and advocates an incremental approach. Senator Moynihan's staff, remembering
Boren's performance on the budget, are uncertain of counting on his vote for health care
reform and feel some of the Republicans may be easier to get. Boren voted with the
administration on National Service and NAFTA as well as Budget Reconciliation. He has
denied the mmors that he will resign in this Congress to become President of the University
of Oklahoma.
SENATOR BARBARA BOXER (D-CA) - A cosponsor of tiie Healtii Security Act, Senator
Boxer voted for Budget Reconciliation and National Service but against NAFTA. Her
overriding issue will continue to be maintaining full reproductive services in the reform bUl.
She cosigned the Planned Parenthood ad on women's health care in the New York Times.
Other important issues to her are children and treatment of veterans. She serves on the
Banking, Budget, and Environment Committees.
SENATOR BILL BRADLEY (D-NJ) - Senator Bradley is a member of tiie Finance
Committee and has major reservations about the Health Security Act. He refused to sign
Sen. Wofford's universal coverage letter and it is unclear why. Bradley is not comfortable
with the soundness of thefinancingor the complexity of the bill. However, he has not
focused on health care as yet. He has told pharmacists that he fears the HSA will devastate
pharmaceutical R&D. Bradley voted for Budget Reconciliation, NAFTA, and National
Service.
SENATOR JOHN BREAUX (D-LA) - The Senate sponsor of Cooper-Grandy, Senator
Breaux said last weekend that Congress must compromise quickly on health care or face the
same kind of advertising and lobbying campaigns that helped kill the BTU tax. He
downplayed the significance of his letter linking the interests of the oil and gas states with
health reform. Breaux voted for National Service and NAFTA and against Budget
Reconciliation.
SENATOR RICHARD BRYAN (D-NV) - Senator Bryan has not been vocal on healtii
issues but does have significant small business and mral concems. He is mnning for
reelection and has not cosponsored any of the major health reform bills. He has said that
because prescription dmgs account for the highest out-of-pocket health care expenses for the
elderly, he wants to be sure that issue is addressed in any reform bill. Bryan voted against
NAFTA and Budget Reconciliation and for National Service. He serves on the Banking and
Commerce Committees.
SENATOR DALE BUMPERS (D-AR) - A Healtii Security Act cosponsor. Chairman
Bumpers' overriding concem is his small business constituency. Recentiy Bumpers held
hearings featuring Reich and Bowles which focused on the employer mandate's impact on
business and its effect on jobs. Bumpers was noncommittal during those hearings, but
expressed surprise that under the HSA employers would still have to pay full workers'
compensation premiums, even though insured workers could get care in the new health
system. Bumpers cosigned the letter to the President on the domestic oil and gas industry.
�SENATOR ROBERT BYRD (D-WV) - The Appropriations Chairman has yet to focus on
health care and has not cosponsored any of the major bills. His primary concems are
financing and his committee's jurisdiction over discretionary programs. Byrd has specifically
mentioned possible redundantfinancingreceived by community health centers for various
health care services. Byrd voted for Budget Reconciliation but against both National Service
and NAFTA.
SENATOR BEN NIGHTHORSE CAMPBELL (D-CO) - Senator CampbeU is a Healtii
Security Act cosponsor but worried about the burden on small business. He is a member of
the Veterans Committee as well as Banking and Energy. He voted against NAFTA but for
Budget Reconciliation and National Service. Health care is a very personal issue for
Campbell. His mother was hospitalized with tuberculosis and his father battied alcoholism.
Campbell and his sister grew up in different orphanages. "For me, health care became the
fulcmm for a down and out tough life." Recentiy Campbell criticized the budget cuts in
Indian health care and cosigned the letter to the President on the domestic oil and gas
industry.
SENATOR KENT CONRAD (D-ND) - Senator Conrad is a critical swing vote on tfie
Finance Committee. Although a Health Security Act cosponsor, he is still uncomfortable
with aspects of the legislation. Senator Conrad's foremost health concems are mral health
care and effects on small business. He has said that the alliances would cause "chaos,"
feeling they are too bureaucratic and regulatory as currentiy stmctured. He has called the
Administration's cutback in spending on Indian health care "disgraceful and outrageous."
Conrad cosigned the letter to the President on the domestic oil and gas industry. Conrad
voted against NAFTA and for the Budget and National Service.
SENATOR TOM DASCHLE (D-SD) - As Majority Leader Mitchell's designee to
coordinate the health care legislation in the Senate, Daschle has been very helpful in
developing a strategy for packaging and selling the health care reform package. He is the
only Senator to announce his desire to become Majority Leader in the next Congress.
Daschle was very pleased with the Rural States Fomm held in South Dakota in January
which featured the First Lady. He has consistentiy worried that people do not understand the
real costs of the current health system. Serving on the Finance as well as Agriculture and
Veterans' Committee, Daschle has voted with the White House on the Budget, National
Service, and NAFTA.
SENATOR DENNIS DECONCINI (D-AZ) - Senator DeConcini has not cosponsored any of
the major health bills. While he is willing to work with the concept of managed competition,
he wants to preserve some of the current system and is opposed to new taxes paying for
health care. He is particularly concemed about the effects on small business and incentives
for doctors to treat Medicaid patients. We are told that he often refers to the care necessary
for his elderly mother. DeConcini, serving in his last Congress, voted for National Service
and NAFTA and against the Budget. He is on Veterans' Affairs and the Select Committee
on Indian Affairs as well as the Judiciary Committee,
�SENATOR CHRISTOPHER DODD (D-CT) - Senator Dodd is a Healtii Security Act
cosponsor and major spokesman for children's issues. This week's Clamegie Corporation
report on the plight of young children supports his long-term concem for children. In
addition to Labor, he is on the Banking and Foreign Affairs Committees. Dodd voted for the
Budget, National Service, and NAFTA.
SENATOR BYRON DORGAN (D-ND)) - Altiiough he signed Senator Wofford's universal
coverage letter, Senator Dorgan has not cosponsored the Health Security Act. He is
concemed about its potential negative impact on small business and the "bureaucratic" nature
of the alliances, as well as the cost of the benefit package. Dorgan is on the Select Indian
Affairs and Commerce Committees. He voted for the Budget and National Service. He was
not present for the NAFTA vote due to the death of his daughter after she underwent surgery
for a congenital heart ailment. Dorgan signed the letter to the President on the domestic oil
and gas industry.
SENATOR JAMES EXON (D-NE) - Senator Exon has not cosponsored any oftiiemajor
health bills. He prefers a phase-in of coverage and a basic benefit package - an Escort not a
Cadillac. He is concemed about small business and mral coverage. He serves on Armed
Service, Budget and Commerce and voted against NAFTA and National Service and for the
Budget.
SENATOR RUSSELL FEINGOLD (D-WI) - Freshman Senator Feingold is described as a
"passionate" single payer supporter and has not cosponsored any of the reform legislation.
He is a strong proponent of community-based long-term care for both the elderly and
disabled. He serves on the Agriculture and Foreign Relations Committees and voted for the
Budget and National Service but against NAFTA.
SENATOR DIANNE FEINSTEIN (D-CA) - Senator Feinstein is a Healtii Security Act
cosponsor and also voted for Budget Reconciliation and National Service but against
NAFTA. Recentiy she has raised the concems of large employers, particularly retailers,
who employ thousands of low wage workers and worry about the plan's cost and potential
job losses. She cosigned the Planned Parenthood New York Times ad on women's health
care. The daughter of a physician, Feinstein wants to ensure choice of doctors. She serves
on Judiciary and Appropriations Committees.
SENATOR WENDELL FORD (D-KY) - Rules Committee Chairman Ford has one
overriding issue in the health debate - a deal on tobacco taxes. He has said he likes the
objectives of the HSA, particularly universal coverage and controlling medical costs, but is
undecided on the employer mandate and the alliances. He favors insurance reforms to make
coverage more accessible but is uncertain as to what specifics he would support. Ford's
daughter has undergone chemotherapy following a mastectomy and his brother-in-law is a
pediatrician. Ford has not cosponsored any of the major health bills. He cosigned the letter
to the President on the domestic oil and gas industry. Ford voted against NAFTA but for the
Budget and National Service,
�SENATOR JOHN GLENN (D-OH) - Senator Glenn is a cosponsor of tiie HSA and has
been very supportive in his public statements about the need for reform. As Chairman of the
Govemment Affairs Committee, he will be most interested in the plan's impact on Federal
employees, Glenn voted against NAFTA and for the Budget and National Service.
SENATOR BOB GRAHAM (D-FL) - Senator Graham is a Healtii Security Act cosponsor
who believes the plan is especially beneficial to Florida because it has a disproportionately
large elderly population. As Chairman of the Senate Democratic Campaign Committee, he
would like to be a player in the health care debate. He serves on the Veterans' and Armed
Services Committees, and voted for NAFTA, the Budget, and National Service.
SENATOR TOM HARKIN (D-IA) - While a HSA cosponsor, Harkin is hopeftiltiiattiie
Administration will support his legislation to set up a tmst fund for medical research in the
bill. This week the Iowa Hospital Association was in Washington warning that their
hospitals' losses for treating Medicare patients could rise by nearly 80% under the HSA. In
his response, Harkin stated that he is "very concemed" and had fought to reduce savings
from Medicare in the 1993 budget debate. He also pointed out that tiie HSA included
coverage of prescription dmgs and provisions for long-term care, saying that both were "of
vital importance to Iowa's elderly." A member of the Labor Committee, Harkin voted for
NAFTA, the Budget, and National Service. Two of Senator Harkins' sisters had breast
cancer and inclusion of preventive services in the benefit package is key for him. Harkin,
who has a brother who is deaf, is a leading advocate in the Senate for those with disabilities.
SENATOR HOWELL HEFLIN (D-AL) - Senator Heflin had been noncommittal until April
1 when the National Health Care Campaign reports he told a local group that he supports
universal coverage and does not see how it can be achieved without employer mandates. He
has not cosponsored any of the major health reform bills. Because of his sister's personal
experience with misdiagnosis of a brain tumor, he is a stiong advocate for choice of
provider. A member of the Judiciary and Small Business Committees, Heflin voted against
NAFTA and for the Budget and National Service.
SENATOR ERNEST HOLLINGS (D-SC) - Senator Hollings has not cosponsored any of
the major health reform bills, earlier having expressed interest instead in a Medicaid buy-in.
He believes the only way to get enough money for health care reform is through a VAT. He
fears there is no mechanism to pay for the "cradle to grave" coverage and that the Medicare
cuts are too large. He is not antagonistic to the employer mandate. A strong advocate of
community health centers which he instituted in South Carolina, but is concemed that they
are jeopardized in the plan. Hollings chairs the Commerce Committee and voted for the
Budget but against National Service and NAFTA.
SENATOR DANIEL INOUYE (D-HI) - A Wellstone and Healtii Security Act cosponsor.
Senator Inouye will want to continue the special exemption to retain Hawaii's current system.
The Chairman of Select Indian Affairs and serving on Appropriations and Commerce, Inouye
voted against NAFTA but for the Budget and National Service. He is a long-time advocate
for expanding the role of nurses, social workers, psychologists and other non-physician
health providers.
�SENATOR BENNETT JOHNSTON (D-LA) - Senator Johnston has not cosponsored any of
the major health reform bills. The entire Louisiana delegation is concemed about how
reform will affect tiieir state's extensive public hospital system. Johnston cosigned tiie recent
letter relating oil and gas and health care needs. In addition to chairing the Energy
Committee, he serves on Budget and Appropriations. Johnston voted against the Budget but
for National Service and NAFTA.
SENATOR EDWARD M. KENNEDY (D-MA): The Chairman of tiie Labor and Human
Resources Committee has said that his committee can report out something close to the HSA
but expressed a stiong desire to work out modifications that would bring GOP support. He
likes to paraphrase Mark Twain on both the plan and the alliances, saying reports of their
death are premature.
SENATOR BOB KERREY (D-NE) - Despite his frequent criticism oftiieAdministiation's
health reform efforts, Senator Kerrey feels he has not been properly praised for the positive
comments he has made. Kerrey has not cosponsored any of the major health reform
proposals. His own reform agenda includes: universal eligibility, individual responsibility,
and education. He has been very firm on the issue of insurance reform and vocal in
questioning the financing. Kerrey voted for NAFTA and the Budget but against National
Service. He serves on the Agriculture and Appropriations Committee.
SENATOR JOHN KERRY (D-MA) - Senator Kerry has not cosponsored any oftfiemajor
health reform bills and the Boston Globe has called him "conspicuously absent" from the
HSA. Administrative simplification and insurance reform are of particular interest to him.
Kerry wants to protect the biomedical and biotechnology industry, which is a growth sector
in Massachusetts. Kerry voted for NAFTA, National Service, and tiie Budget. He serves on
the Small Business as well as Banking and Commerce Committees.
SENATOR HERBERT KOHL (D-WI) - Senator Kohl, who is mnning for reelection, has
not cosponsored any of the major health care legislation and has been very critical of the
White House strategy and package. Kohl believes "everything is negotiable except universal
coverage" and that Republicans cannot afford to be the "just say no" party on health care
reform. Insurance companies are the second largest employer in Wisconsin, which may be a
concem for him. As a businessman and a member of the Small Business Committee, Kohl is
particularly interested in the impact of reform on small business but appears open to
employer mandates. While he doesn't support the employer mandate per se, he concedes he
doesn't know how else to get to universal coverage. Kohl serves on the Judiciary and Small
Business Committees. He voted against NAFTA and for tiie Budget and National Service,
SENATOR FRANK LAUTENBERG (D-NJ) - Senator Lautenberg's upcoming reelection
has made him skittish on health care - he has not cosponsored any of the major bills. He is
trying to balance his support for universal health care with concem about financing. He is
particularly worried that health reform will hit two big industries in New Jersey:
pharmaceutical and insurance companies. Lautenberg serves on SmaU Business,
Appropriations and Budget. He voted against the Budget and NAFTA and for National
Service.
�SENATOR PATRICK LEAHY (D-VT) - The Chairman oftfieAgriculttire Committee is a
Health Security Act cosponsor and stiong proponent of mral issues and state flexibihty.
While praising the Administrations' push for more efficient tracking and transmission of
individuals' health history, Leahy wants to be sure that individuals' privacy is protected.
Leahy voted for NAFTA, National Service, and the Budget.
SENATOR CARL LEVIN (D-MI) - Senator Levin is a Healtii Security Act cosponsor and
protective of Michigan's auto industry, unions, and the unions' retirees. He has cautioned
against over-promising on what the bill will do. Levin voted for the Budget and National
Service and against NAFTA. He serves on Small Business and Armed Services.
SENATOR JOSEPH LIEBERMAN (D-CT) - While Senator Lieberman is a Breaux
cosponsor, he has been the most positive of their cosponsors in supporting the concept of
universal coverage. He is nervous about the employer mandate. He is in his first term and
expected to be reelected easily this year. His opponent is a conservative physician,
Lieberman would like to be a player between the Breaux and Administration camps.
Lieberman signed Wofford's universal coverage letter. He voted for the Budget, National
Service, and NAFTA and is a member of the Small Business and Armed Services
Committees.
SENATOR HARLAN MATHEWS (D-TN) - Senator Matfiews is a Health Security Act
cosponsor who chose not to mn to retain his seat. He would like to see more action on the
state level, especially experimental programs and worries that sin taxes and payroll taxes
would kill the tobacco industry. Mathews is on Energy and Foreign Relations and voted for
NAFTA, National Service and the Budget.
SENATOR HOWARD METZENBAUM (D-OH) - While he has serious reservations about
insurance companies taking over the allizuices. Senator Metzenbaum is a cosponsor of the
Health Security Act. He has threatened to withdraw his support because of his opposition to
the antitmst exemption. He is also a Wellstone cosponsor. In addition to Labor,
Metzenbaum sits on Judiciary and Environment. He voted for the Budget and National
Service and against NAFTA.
SENATOR BARBARA MIKULSKI (D-MD) - Senator Mikulski is a Healtti Security Act
cosponsor who voted against NAFTA but for Budget Reconciliation and National Service.
On Monday at a hearing to examine the issue of long-term care, she urged the adoption of
minimum federal standards for home care providers, to protect the elderly from abuse. She
appeared to accept the problem of trying to set federal standards. Fernando Torres-Gil
committed to develop training programs to help states increase the quality of their in-home
care workers. Mikulski will be energized if she fears reproductive rights are endangered.
She would like to see explicit guarantees for mammograms for all women in their 40s.
Mikulski is on both Labor and Appropriations and has been working with Senator Kassebaum
on women's health issues and long-term care.
SENATOR GEORGE MITCHELL (D-ME) - The Majority Leader is committed to passing
comprehensive health care reform in this his final Congress.
�SENATOR CAROL MOSELEY-BRAUN (D-IL) - A Healtii Security Act and WeUstone
cosponsor. Senator Moseley-Braun voted for NAFTA, Budget ReconciUation and National
Service. Her key issues in health care include: coverage of reproductiverights;children'
issues; and protection for minority populations and community providers. She cosigned the
Planned Parenthood ad on women's health in the New York Times.
CHAIRMAN DANIEL PATRICK MOYNIHAN (D-NY); The Finance Committee
Chairman is not expected to attend, maintaining that he did not know about this longscheduled retreat. At this week's Finance Committee meeting, Moynihan predicted mark-up
in June.
SENATOR PATTY MURRAY (D-WA) - Senator Murray is a Healtii Security Act
cosponsor. She voted for NAFTA and National Service and announced for Budget
ReconciUation. Her particular issues are state flexibihty, women's health, particularly breast
cancer screenings and reproductiverights,and long-term care. Senator Murray has
introduced a bill designed to raise the excise tax onfirearmsand earmau^k the revenue for
health care. Murray is on the Budget, Appropriations, and Banking Committees. The
National Joumal reported last month that liberal junior Democrats may look to her for
leadership both because she is well-liked and because her state has already been through a
round of health care reform.
SENATOR SAM NUNN (D-GA) - The Chairman oftfieArmed Services Committee is a
cosponsor of the Breaux bUl. He voted for NAFTA and National Service and against the
Budget. He prefers a bipartisan incremental approach and fears overly optimistic fiscal
projections and potential damage to smaU business. Senator Nunn's wife has a particular
interest in mental health care.
SENATOR CLAIBORNE PELL (D-RI) - The Chairman of tiie Foreign Relations
Committee is a Health Security Act cosponsor and long-time advocate of "cradle to grave"
health coverage. His primary health concems are long-term care - Rhode Island has one of
the highest percentages of elderly of any state in the country - preventive services, effects on
research, and expanding the use of non-physician health providers. He has raised the
possibility of a tax onfirearmswhich would be devoted to health care. PeU voted for the
Budget, National Service, and NAFTA.
SENATOR DAVID PRYOR (D-AR) - Senator Pryor is a Healtii Security Act cosponsor
whose major issue is cost containment of prescription dmgs. He is also concemed with
long-term care, mral health, and small business. Pryor is on the Finance and Agriculture
Committees and voted for the Budget, NAFTA, and National Service. He also signed the
letter to the President on the domestic oil and gas industry.
SENATOR HARRY REID (D-NV) - Senator Reid is a Healtfi Security Act cosponsor
whose primary issues are mral health and inclusion of lead screening. He refers to the HSA
as a system of "employer responsibility" saying it builds on existing practice and makes it
more fair. Reid is on the Select Indian Affairs and Appropriations Committees and voted
against NAFTA but for the Budget and National Service.
�SENATOR DONALD RIEGLE (D-MI) - The Banking Committee Chairman would Uke to
leave the Senate having helped to pass comprehensive healtfi care reform. He is a HSA
cosponsor and sits on the Finance Committee. Riegle has always wanted long-term, not just
five year, budgets and believes that health care savings should be used to fund the health care
system ~ not for deficit reduction. His bottom line is cost containment and universal
coverage. He voted against NAFTA, for the Budget, and announced for National Service.
SENATOR CHUCK ROBB (D-VA) - Robb beUevestfiatcost-containment is tfie key to
health care reform but has not cosponsored any of the major biUs. With his reelection
questionable at best, he has been relatively silent on health care. A member of the Armed
Service and Commerce Committees, he voted fortiieBudget, NAFTA, and National Service.
SENATOR JAY ROCKEFELLER (D-WV) - The Chairman oftfieVeterans' Affairs
Committee and member oftfieFinance Committee, Senator Rockefeller continues to be
committed to passage of comprehensive reform during the Clinton Presidency. WhUe saying
he would not forego universal coverage, he has said he would be wilUng to agree to slow the
timetable for achieving it. He has urged greater intensity in the grass roots efforts.
RockefeUer voted against NAFTA and for National Service and the Budget.
SENATOR PAUL SARBANES (D-MD) - Senator Sarbanes, who is up for reelection, has
not cosponsored any of the major health reform biUs this Congress. Federal employees and
retirees are a large proportion of his constituents. He may have a dentist as his RepubUcan
opponent. Sarbanes serves on Budget, Banking and Foreign Relations and voted for the
Budget and National Service but against NAFTA.
SENATOR JIM SASSER (D-TN) - The Budget Committee Chairman has not cosponsored
any of the major health reform bUls and is also mnning this year. Field reports say that he
is hoping for an early compromise in the House and may have a physician as an opponent.
Sasser is most proud of his three year battie to pass legislation to reform and clean up the
fraud and abuse in the durable medical equipment industry. Sasser voted against NAFTA
and for the Budget and National Service.
SENATOR RICHARD SHELBY (D-AL) - Senator Shelby is a mental healtii advocate who
has not cosponsored any of the major reform bUls. Having just undergone prostate cancer
surgery, he may not be at the retreat. He is anti-employer mandates, anti-rate setting, and
has significant smaU business concems. Shelby voted against the Budget and NAFTA but for
National Service. He sits on the Energy and Armed Services Committee and signed the
letter to the President on the domestic oil and gas industry.
SENATOR PAUL SIMON (D-IL) - While a cosponsor ofttieHealtti Security Act, Senator
Simon has not been very engaged of late and may be recovering from his balanced budget
loss. Simon's primary health care issues are: linking TV violence, gun contiol, and health
care; long-term care; and children's and minority issues.
Simon voted for NAFTA, tfie Budget, and National Service. In addition to the Labor
Committee, he is on Judiciary and Budget. He cosigned the letter to the President on the
domestic oil and gas industry.
�SENATOR PAUL WELLSTONE (D-MN) - Senator WeUstone is committed to healtii care
reform, preferring his single payer biU but willing to work witti ttie Administration. In order
to "galvanize tiie public," WeUstone has advocated a "Healtii Care Day" ttiis spring modeled
on Earth Day. He has a stiong interest in mental healtti and substance abuse benefits.
WeUstone was surprised to leam that workers' compensation insurance programs covering
job-related injuries would not be folded into the healtti plan coverage. He voted for ttie
Budget and National Service and against NAFTA. He serves on both Labor and SmaU
Business Committees.
SENATOR HARRIS WOFFORD (D-PA) - Duringttierecess, Wofford criticizedtfiebUl as
"too long and complicated," saying he would offer amendments to diminish the govemment's
role and simpUfytfiebiU's stincture. He cited as an example tiie 15 pages devoted to
defining "family." ( The achial definition of "family" is a paragraph -tiiereare 12 pages on
family for enroUment purposes.) He also proposed amendments on long-term care and to
protect retiree health benefits. These criticisms appear to stem from a combination of
political sensitivities - a need to react to Sen. Specter who has been hammering on the
bureaucracy angle - and a substantive concem that the bill is too comprehensive. Because of
its all-encompassing nature, it is easy for opponents to focus on the minutiae, distracting
attention from the main issues of reform. If it were stripped down, Wofford feels the debate
could retum to the most important principles, leaving the details to regulations. A Health
Security Act cosponsor who serves on Labor and SmaU Business, Wofford voted for National
Service and the Budget and against NAFTA.
�April 14, 1994
Memorandum for the President
From:
Pat Griffin
Jack Lew
Chris Jennings
Subject;
Legislative Briefing for Regional Media Day
The following are brief profiles and summaries of the health care views of the targeted
House and Senate Members from the states (Louisiana and Houston, Texas) participating in
the regional press briefing tomorrow.
LOUISIANA;
Senator J. Bennett .TOHNSTON (D-LA):
Senator Johnston chairs the Energy & Natural Resources Committee and has not cosponsored
any of the major health reform bills.
With regard to the HSA, Johnston is most concemed about its financing and the mandatory
alliances as well as the impact of reform on small business and mral areas. He is also
concemed about the treatment of Louisiana's extensive charity hospital system, which he
wants to preserve and integrate into the new system. Johnston supports preventive care and
opposes abortion services as part of the benefits package.
Johnston cosigned the recent letter relating relief for the oil and gas industry with health care
legislation. According to Johnston, these issues are "equally important." Johnston originally
signed the Wofford letter in support of universal coverage, then removed his name for
reasons that remain unclear. His staff members have said he withdrew his name because the
letter went a littie further than his stated public position.
Votes:
FOR:
Family & Medical Leave
NAFTA
AGAINST:
Budget Reconciliation
�Senator John BREAUX (D-LA):
Senator Breaux serves on the Finance Committee and the Senate sponsor of the Cooper bill.
This week, Breaux said that Congress must compromise quickly on health care or face the
same kind of advertising and lobbying campaigns that helped kill the BTU tax. The desire
for action may also be fueled by the fear of diminished bargaining power in the face of an
unfavorable CBO analysis which, according to the Washington Post, will estimatettiathis
biU would increase the federal deficit by at least $150 billion over six years and leave about
25 million people uninsured.
Breaux has criticized the HSA for employer mandates and over-reUance on govemment
regulation to control costs. He also opposes price caps to control costs. He has repeatedly
mentioned that reforming the health care system will take longer than 24 months and he
believes the HSA attempts to accomplish too much too soon. He prefers a longer phased-in
schedule for universal coverage.
Breaux cares deeply about small business and mral health care and believes that health care
and welfare reform deserve equivalent priority. He recentiy downplayed the significance of
his letter linking relief for the oil and gas industry to health care legislation.
Votes:
FOR:
Family & Medical Leave
NAFTA
AGAINST:
Budget Reconciliation
Congressman William JEFFERSON (D-LA-2nd District):
Congressman William Jefferson is in his second term representing the New Orleans area and
is a member of the Ways and Means Committee,
He has not cosponsored any of the major health care bills in this Congress, however, he
supports universal coverage. He has said he supports a single payer system but is not a
McDermott cosponsor. Jefferson has expressed concem about many elements of reform:
escalating costs, impact of controlling costs on quality of care, security, portability, choice of
doctor, preventive care and long-term care. He supports abortion as part of the benefits
package. As a former malpractice attomey, Congressman Jefferson is sensitive to changes in
malpractice laws and favors using a negligence standard rather than limiting damage awards.
He cosigned the letter relating relief for the oU and gas industi7 witti health care legislation.
Votes:
FOR:
Family & Medical Leave
Budget Reconciliation
AGAINST:
NAFTA
�Congressman W.J. "Billv" TAUZIN (D-LA-3rd District):
Congressman Tauzin is a member of the Energy and Commerce Committee who will be
difficult for vote for the Chairman to get. He is a strong advocate of oil and gas interests;
on non-industry issues, he is often a key swing vote, reluctant to take sides early on and
eager to negotiate. Tauzin is a cosponsor of the Rowland-Bilirakis bUl and a cosponsor and
stiong supporter of the Cooper bill. According to NEA field reports, he believes the Cooper
bill, not the HSA, wUl be the starting point.
He is protective of small business interests, and opposes a universal coverage guarantee,
premium caps, and the state single payer option. He argues that 30 - 35% of Louisianans
are uninsured, and that an employer mandate would impose too large a burden for local
employers to absorb. In your meeting with Tauzin in early March, he mentioned his
opposition to employer contributions and his belief that the alliances are overly regulatory as
currentiy stmctured. He also noted that abortion remains a critical issue for him. He said
that he will not support a plan that includes federal funding of abortions.
He cosigned the letter tying reUef for the oil and gas industry with health care legislation.
However, he recentiy declined signing a subsequent letter on the subject circulated by
Chairman Dingell in hopes of securing his vote. On April 8 he was quoted in the TimesPicayune saying, "The issue of whether this country is going to recognize its obligation to
maintain the domestic oil industry is very important, but it's a separate issue. I am not about
to be a party to any linkage or attempts to trade or manipulate my vote on health care
reform."
Votes:
FOR:
National Service
AGAINST:
Family & Medical Leave
Budget Reconciliation
NAFTA
Congressman Cleo FIELDS (D-LA-4th District):
Freshman Congressman Fields is a former state legislator who represents parts
of Monroe, Shreveport, and Baton Rouge. He now sits on the Small Business
and Banking Committees. On health care reform, he is expected to take his
cues from the Congressional Black Caucus. Fields removed his name from
the McDermott bill because insurance representatives were tying up his
phones. It is unlikely that he has tmly changed his position. He has said that
he does not want abortion to become the focus of the health care debate
however it is "not a make it or break it" issue for him.
Votes:
FOR:
Family & Medical Leave
Budget Reconciliation
AGAINST:
NAFTA
�Congressman .lames A. "Timmv" HAYES (D-LA-7th District):
Congressman Hayes is a moderate Democrat who has attimescomplained of
being bypassed by the Democratic leadership. At othertimes,he has worked
with Majority Leader Gephardt to fashion bUls which can attract conservativeleaning Southem Democrats. Hayes's blue collar district has suffered from the
decline of Louisiana's oil industry.
Hayes is a cosponsor of the Cooper and Rowland bills. In late March, Hayes
said that he favors universal coverage and wants to vote for a bill that includes
it. He believes the Cooper bill does not go far enough but sees it as a good
starting point. If there is no agreement on universal coverage, he would still
vote in favor of a bill that dealt with insurance reform and moved forward to
change the health care system. In essence, he generally supports the goals of
the Administration and would vote for them as a package.
He has attended health care meetings in his district to Usten to consumer
concems, and has shown particular interest in low-income problems. Many of
his constituents are Catholic, and Hayes is anti-choice. He opposes the
abortion provision in the HSA and wants a vote to remove it. But he has also
said that, "I would not feel inclined to be opposed to major health care
legislation, assuming I supported it, based on the abortion question alone."
He cosigned the letter relating relief for the oil and gas industry with health
care legislation.
Votes:
FOR:
NAFTA
AGAINST:
Family & Medical Leave
Budget Reconciliation
�HOUSTON
Congressman Michael ANDREWS (D-TX-25th District):
Congressman Andrews came in a distant third in the March Senate primary.
He is a Cooper cosponsor and member of the Ways and Means Health
Subcommittee. Andrews offered an amendment to increase the tobacco tax in
Stark's biU - a cause he has long advocated. He was the only Democrat to
vote against Stark's bill and called the subcommittee's effort a waste of time
because they will "totally have the revenue proposals eviscerated" in fiiU
committee. Andrews and Rep. Cardin joined four Republicans in passing an
amendment that would limit non-economic damages available in medical
practice lawsuits to $350,000. He believes the full committee must "move
toward the center" and that there has to be a more bipartisan effort for health
care reform to pass in the House. Congressman Andrews' district is known as
the health capitol of the world and he is close to the Texas AMA.
Votes:
FOR:
Family & Medical Leave
Budget ReconcUiation
NAFTA
AGAINST:
Congressman Jack BROOKS (D-TX-9th District):
The Chairman of the Judiciary Committee considers himself "Just a Democrat,
no prefix or suffix." A Health Security Act cosponsor, he is key not only to
the Texas delegation but to the House in general. Known to be partisan,
knowledgeable, witty and effective. Brooks has stiong support from his
district's union members and minority population. He cosigned a letter to the
President linking relief for the domestic oil and gas industry and health care
reform.
Votes:
FOR:
Family & Medical Leave
Budget Reconciliation
AGAINST:
NAFTA
�Congressman Gene GREEN (D-TX-29th District):
Freshman Gene Green, a member of the Education and Labor Committee, has
not cosponsored any of the major health reform bills. A lawyer, he represents
largely working class neighborhoods of Houston. He believes the "rising cost
of health care is crippling the ability of American companies to compete" and
says "inaction by this body can no longer be excused." Local groups report he
supports universal coverage, choice of doctor, and prescription dmg and longterm care benefits. He likes to tell a story about a local florist who is a small
business owner and pays for health coverage but would like others to do the
same in order to "level the playing field."
Votes:
FOR:
Family & Medical Leave
Budget Reconciliation
AGAINST:
NAFTA
Congressman Craig WASHINGTON (D-TX-18th District):
A new member of the Energy and Commerce Subcommittee on Health,
Congressman Washington became the first incumbent of this election year to
lose his seat when he was beaten in the March primary. Washington is a
stiong single payer advocate and McDermott cosponsor. Washington's wife is
a physician and practices general medicine in Washington. As a state senator
he was responsible for passage of the first legislation in Texas to provide
funding for AIDs education and treatment. He will probably center his
concems on children, minority and urban health matters and has intioduced a
bill to establish a center for rare disease research.
Votes:
FOR:
Family & Medical Leave
Budget Reconciliation
AGAINST:
NAFTA
�April 7, 1994
Memorandum for the President
From:
Pat Griffin
Chris Jemiings
Jack Lew
Subject:
Kansas City, Missouri Town Hall Legislative Briefing
The following are brief profiles and summaries of the health care views of the targeted
House and Senate Members from the states participating in the town meeting being broadcast
from Kansas City on Thursday, April 7th.
MISSOURI
SENATOR .lOHN DANFORTH (R-MO) - As he leavesttieSenate, Senator Danforth, a
Chafee cosponsor, clearly would like to see passage of health reform as part of his legacy.
Strategically, Danforth believes that while the Finance Committee is key, it is more
important to get the bill out of the two committees to the floor for a leadership substitute
amendment. Danforth's issues are:
Controlling Costs - He believes we need to have strong cost contiols in any health care
reform legislation and as a result has been one of two Senate Republicans (Sen. Kassebaum
is the other) who have been openly willing to consider premium caps.
Limiting Entitiements - He is wary of increasing Federal entitlements for retirees,
prescription dmgs, and long-term care
Employer Mandate - He dislikes the term and believes we need to find a new way to
describe it. He also feels we must limit the burden on small businesses but seems open to
considering some level of employer requirement as part of the overall solution
Govemment Role - He thinks we will have to remove the stigma of govemment attached to
the alliances and make them more flexible, including a cap lower than 5,000
Rationing - He supports rationing and feels we should be more explicit about the need to do
so. For this reason, he is more comfortable with the concept of premium caps.
�KANSAS
State Notes: A recent statewide survey shows that three out of four Kansans are happy with
their health care, have their own physicians, and are not worried about losing coverage if
they change jobs. At the sametime,because of uncertainty fueled by talk of health care
reform, providers are experiencing layoffs and mergers.
Planned Parenthood has begun a media campaign to build support for coverage of women's
medical needs, including reproductive services.
MINORITY LEADER ROBERT DOLE (R-KS); Senator Dole is continuing to balance his
partisan and presidential ambitions, downplaying the need for comprehensive health care
reform but appearing willing to seek a bipartisan solution. He now credits the President and
First Lady with "putting health care on the national agenda and keeping it there." Publicly
he has stated that he prefers a voluntary, incremental approach, with major overhaul
"market-tested" before covering all Americans. All of this is part of his positioning of
himself within his party. Many hope that in the end he will be a bridge to significant
Republican support but we cannot rely solely on him in seeking their votes.
His possible points of compromise are: a requirement that all individuals be required to buy
health insurance; greater emphasis on preventive care; anti-tmst and medical malpractice
reform; and voluntary insurance purchasing cooperatives. He also mentioned insurance
reforms and subsidies to low-income Americans to help them purchase insurance.
SENATOR NANCY KASSEBAUM (R-KS): Senator Kassebaum introduced her own
comprehensive health reform package called "Basicare." This bill is notable because it
reaches universal coverage (through an individual mandate) and its tough cost contiols
(achieved through premium caps). She continues to believe that a bipartisan compromise is
still far off. She predicted in January that Congress would pass an incremental plan, not a
comprehensive one, and that the President would get the credit for it. She worries about
both the cost to small business and the regulatory nature of the plan.
Kassebaum is working with Sen. Mikulski on women's health issues and long-term care. On
a personal level, Kassebaum is quite sensitive to what can be the "horrendous costs" of
health care, citing both her own experience keeping her bedfast mother at home and
fundraisers she has attended for people with particular health problems.
�CONGRESSMAN JIM SLATTERY (D-KS); Congressman Slattery is one ofttiethree
critical Democrats remaining from whom Chairman Dingell has yet to get a commitment.
Reports after Slattery's meetings with the President and the First Lady in early March were
that they had a positive impact on the Congressman. However, just prior to the recess he
was more difficult and backtracking from the more optimistic signals he was sending. In
particular, he was talking about different phase-in schedules to further limit the impact on
small businesses.
Slattery is mnning for Govemor and considered the likely winner in the primary. His
district includes a substantial number of insurance agents and he has been inundated by mail
they have encouraged. One of those agents is a close personal friend and the treasurer of his
gubernatorial campaign.
While Slattery supports the goal of universal coverage, he does not want to "borrow one
dime from our kids and grandkids to pay for our current health care." This is consistent
with his leadership among moderate to conservative members on budget and fiscal issues.
Slattery describes the health care debate as follows: "It's going to be the Gettysburg of
political battles. I'm hoping it doesn't become the Verdun."
CONGRESSMAN DAN GLICKMAN (D-KS) - Congressman Glickman is a moderate to
conservative Democrat who is considered Kansas' most powerful Democrat in Washington.
Glickman is popular in the state and was widely mentioned as a candidate for the Senate to
succeed either Dole or Kassebaum.
i
Glickman is the House sponsor of Senator Kassebaum's BasiCare Health Access and Cost
Control Act and considers himself the bridge between the Democratic and Republican
sponsors of the bill. Congressman Glickman has always preferred his Basicare approach
which he touts as the first tmly bipartisan proposal to reform health care introduced in this
Congress. He believes his bill is the common ground compromise approach.
In meetings with Administration representatives, Glickman has stated his support for costcontainment as long as it did not include excessive intervention. He would like to minimize
taxes used tofinancereform but also has reservations about an employer mandate. He
warned against underestimating the concem in the House about the impact of reform on
small business.
�NEBRASKA
SENATOR JIM EXON (D-NE); Senator Exon prefers a phase-in of coverage and a basic
benefit package - an Escort not a Cadillac - with possible expansion at a later date. He is
concemed about small business and mral coverage. Exon has been active in denying
federally funded direct benefits to undocumented workers, including blocking their receipt of
Medicare funds except for schoolchildren or those in need of emergency medical care. Local
groups report that Exon does not think there is public support for health care reform and that
he has not forgotten being bumed on catastrophic care.
SENATOR BOB KERREY (D-NE): Despite his frequent criticism of the Administiation's
health reform efforts. Senator Kerrey feels he has not been properly praised for the positive
comments he has made. Kerrey has not cosponsored any of the major health reform
proposals. His own reform agenda includes: universal eligibility, individual responsibiUty,
and education. He has been very firm on the issue of insurance reform and vocal in
questioning the financing.
CONGRESSMAN PETER HOAGLAND (D-NE): A moderate Ways and Means
Democrat, Congressman Hoagland has not cosponsored any of the major reform bills. His
opponent began campaigning early in his district where Hoagland is considered vulnerable
after winning with 51%. That may well account in part for his repeated statements in favor
of bipartisanship. His mother died of lung cancer and he is a strong proponent of the
tobacco tax. Hoagland has voted in favor of abortion rights. He has five hospitals in his
district which represent the largest workforce in the area. He is protective of the insurance
companies in Nebraska. He supports voluntary aUiances and believes insurance companies
should be allowed to compete with them.
He shares the concem of other moderate Members about the impact of reform on small
businesses. Hoagland has said he wants as much universal coverage "as we can afford."
But has recentiy been talking more about universal access than universal coverage. Current
Nebraska Govemor Ben Nelson's Blue Ribbon health care panel recently recommended small
group market health insurance reforms as the best first step. This seems to be putting
pressure on Hoagland to move in that direction. He is circulating a possible compromise in
the Ways and Means committee. Most notably it includes an employer mandate and smaU
business subsidies, but not cost containment!
�OKLAHOMA
SENATOR DAVID BOREN (D-OK): Senator Boren has yet to cosponsor any ofttiemajor
health reform legislation. He told a health care fomm last weekend that only a "bipartisan,
consensus approach" will suffice for health care. He joined with a number of other oil state
members in signing a letter to the President, the subtext of which was relief for the domestic
oil industry as part of the deal for health care reform. A subsequent letter to this effect has
been circulated by Chairman Dingell in his efforts to secure the votes he needs on the Energy
and Commerce Committee.
Boren feels he is in-step with his state in preferring a hybrid of an employer and individual
mandate, with benefits phased in and smallfirmsprotected. He sees himself as a bridge to
moderate Republicans. He is, of course, critical on the Finance Committee. He has denied
reports that he would resign by the end of the year to become President of the University of
Oklahoma.
CONGRESSMAN BILL BREWSTER (D-OK): Congressman Brewster, a Ways and Means
Committee member, is a licensed pharmacist and proud of his status as one offivehealth
professionals in Congress. In Oklahoma City last weekend he claimed that "no one is
coming to me saying 'You guys have got to pass the President's plan.'" The press reported
that he received warm applause when saying the best reform would be "incremental." As a
conservative member from a conservative district, Brewster has not cosponsored any of the
major health reform bills and feels littie or no urgency for their passage. Politically he wants
to retain full flexibility in his negotiating position for later in the game. Simultaneously he is
positioning himself to mn for Sen. Boren's seat should it become open.
I
His "live or die" issue continues to be the inclusion of a "willing provider" provision, which
allows any provider willing to accept a plan's price to participate which is important to local
pharmacies that compete with larger chains. He shares the concem of many moderate
members on the employer mandate and its impact on small businesses but in private meetings
has not mled out the possibility of supporting some form of mandate. He also shares their
perception that the alliances, as currentiy stmctured, are overly bureaucratic. In addition ,
he has expressed some skepticism about the financing of reform, particularly the degree to
which all proposals rely on savings to Medicare and Medicaid. With 70% of mral hospitals
receipts in Oklahoma coming from these programs, he is wary of further cuts.
The Ways and means staff is presentiy quite pessimistic about the prospects of getting
Congressman Brewster. It is their suggestion that we not go directiy to his district to court
him but rather use a visit as a reward once he has given some indication that he is interested
in engaging constmctiveiy.
�April 7, 1994
Memorandum for the President
From:
Pat Griffin
Jack Lew
Subject;
Kansas Small Business Event Legislative Briefing
CONGRESSMAN JIM SLATTERY (D-KS)
Chairman Dingell needs Jim Slattery's vote to report health care reform out of the
Energy and Commerce Committee. While Dingell is still three votes short, Slattery is the
toughest to win and may be the linchpin to the others. Rick Boucher (D-VA) and Rick
Lehman (D-CA) are likely to follow if Slattery is on board.
The business fomm in Kansas is designed to help Dingell in his effort to win
Slattery's vote and to give Slattery cover he may need to make a commitment. Slattery has
been closely involved in the design of the event, which is set up to meet his concem that we
field questions from skeptics as well as supportive businesses.
Issues of concem
Dingell has invested a great deal of time and effort to modify his approach to satisfy
Slattery. After this trip, he plans to make a final effort to get a commitment from Slattery.
The following description of Slattery's concerns also indicates how Dingell has tried to
address them. We are not taking a position either supporting or opposing the Dingell
approach, but as a practical matter, Slattery is being asked to vote for this proposal and not
the Administration's Health Security Act.
(1)
Employer contributions. In general, Slattery is worried that employer
contributions not impose too great a burden on marginal businesses, and specifically, he is
concemed about the impact on small businesses and farmers. In Committee, Dingell has
fashioned a modified plan which would exempt businesses of ten or less from the mandate,
and apply special mles to farmers to soften the impact, particularly on employers of seasonal
farm workers. Dingell would subsidize low wage workers who are not covered at work.
Dingell has indicated that in winning these final votes, it is necessary for or approach to
appear as different as possible from the Health Security Act. At the sametime,he is trying
to keep the actual policy as close as possible.
�(2)
Fiscal responsibility. Consistent with his longstanding position as a budget
hawk, Slattery is concemed that health care reform not create new entitiements until we are
certain that they can be paid for. He would prefer to have the funding in place before
spending begins. Dingell is hoping to address this concem by making certain he presents a
bill which CBO will score with deficit reduction. He will also tighten the enforcement
mechanism in the Health Security Act.
(3)
Independent Agents. Slattery has been outspoken about the need to preserve a
role for independent insurance agents. He cares about this issue in part because one of his
leading local supporters is an insurance agent. Dingell has addressed this issue as weU by
substantially revising the approach to alliances. While he has replaced mandatory alliances
with voluntary alliances, there is still enforceable community rating. He has shifted the
responsibility for cost containment to the states.
CONGRESSMAN DAN GLICKMAN (D-KS)
Congressman Glickman is a moderate to conservative Democrat who is considered
Kansas' most powerful Democrat in Washington. Glickman is popular in the state and was
widely mentioned as a candidate for the Senate to succeed either Dole or Kassebaum.
Glickman is the House sponsor of Senator Kassebaum's BasiCare Health Access and
Cost Control Act and considers himself the bridge between the Democratic and Republican
sponsors of the bill. Congressman Glickman has always preferred his Basicare approach
which he touts as the first tmly bipartisan proposal to reform health care introduced in this
Congress. He believes his bill is the common ground compromise approach.
In meetings with Administration representatives, Glickman has stated his support for
cost-containment as long as it did not include excessive intervention. He would like to
minimize taxes used to finance reform but also has reservations about an employer mandate.
He wamed against underestimating the concem in the House about the impact of reform on
small business.
�April 4, 1994
Memorandum for the President
From:
Pat Griffin
Jack Lew
Subject:
Charlotte Town Hall Legislative Briefing
CONGRESSMAN ALEX McMILLAN (R-NC; 9th District-Chariotte):
Congressman McMillan is a Cooper and Michel cosponsor and member of the Energy and
Commerce Committee. A key ally of the Republican leadership, he is retiring at the end of
this session. McMillan's two primary health related issues are the tobacco tax and protection
of small business. He has a substantial number of insurance companies headquartered in his
district. A former supermarket executive, McMillan opposes any Federal mandates on
business. He has been critical of the HSA's malpractice reforms, calling them "toothless."
McMUlan plans to introduce his own health care legislation which would provide vouchers to
help low income Americans buy health coverage.
CONGRESSMAN RICK BOUCHER (D-VA; 9th District-Abingdon):
Congressman Boucher, a member of the Energy and Commerce Committee, has not
cosponsored any major health reform bills, and has told the Administration he does not want
to begin discussions until the tobacco tax is settled. Since he circulated the staff draft two
weeks ago, Chairman Dingell has devoted considerable energy to win support from Boucher.
He believes that any concessions which are necessary to win support from Jim Slattery wiU
also address Boucher's small business concems, and that tobacco will be the remaining issue.
Boucher has talked about reducing the tobacco tax and funneling some money back to
tobacco farmers to help them grow and market altemative crops.
After discussions with Dingell, Boucher hasfloateda conversion/tobacco buyout proposal
with his growers with no success. At the moment, Dingell's hope is that Boucher wUl
simply choose to fight the tobacco fight later in the process, since the tax is not in the
jurisdiction of the Energy and Commerce Committee. From Dingell's perspective, his best
prospect with Boucher right now is to avoid confrontation over tobacco and to deal with his
other concems in the health care bill. In addition to tobacco farms, his district includes a
new and highly successful pharmaceutical supply company, and a manufacturer of cigarette
filters. Boucher has also expressed reservations about the employer mandates and aUiances.
When motivated, he can be a consensus builder, but as of the moment he is one of the three
members from whom Chairman Dingell is still seeking a commitment.
�CONGRESSMAN L. F. PAYNE (D-VA; 5th District-Danville);
A Cooper cosponsor and member of the Ways and Means Committee, Congressman Payne
has several thousand tobacco farmers among his constituents. His district is also home to
Jerry Falwell and Republicans have strengthened their base there in the wake of the
gubematorial election. Thus, Payne is keeping his distance from the Administration.
However, he wants to vote for a bill in this session, citing his reasons as insecurity among
his constituents, the underserved mral areas, and the exploding costs of the present system.
While supporting the Cooper bill, he does not seem to fully understand it. Payne has said he
supports universal access, not universal coverage. In addition to opposing the tobacco tax his best line being: "This is called a sin tax. But I didn't see the President in Hollywood
calling for a tax on R-rated movies."- he questions the employer mandate and believes it will
cost jobs. Payne has been a consistent supporter of abortionrightsand civilrights.He
appeared with the First Lady on an earlier satellite hook-up.
CONGRESSMAN J.J. (JAKE) PICKLE (D-TX; l(Hh District-Austin):
After a career in which he has been a key player on major issues, including Social Security,
Congressman Pickle is retiring at the end of this session. Pickle, who is on Ways and
Means, supports the reform effort and universal coverage but has not cosponsored any of the
major bills. He has said that overall he favors the Cooper plan but acknowledges that
competition can't solve everything. Pickle is close to the AMA and the hospital industry,
and his most consistent question is about the future for third party administrators, who mn
plans for individual businesses and groups of firms. He also has raised the affects on small
business, coverage of early retirees, the alliances, and global budgets. Pickle worked with
Rep. Stark in an unsuccessful attempt to rescue the catastiophic health insurance legislation
several years ago. While Pickle rarely bucks his Chairman and his issues are secondary, on
this key issue in his last Congress, he has not yet made a commitment. In meetings with the
Administration, however, he has made clear that he can support universal coverage and
employer mandate.
�April 4, 1994
Memorandum for the President
From;
Pat Griffin
Jack Lew
Subject:
Charlotte Town Hall Legislative Briefing
CONGRESSMAN ALEX McMILLAN (R-NC; 9th District-Charlotte):
Congressman McMUlan is a Cooper and Michel cosponsor and member of the Energy and
Commerce Committee. A key ally of the Republican leadership, he is retiring at the end of
this session. McMillan's two primary health related issues are the tobacco tax and protection
of small business. He has a substantial number of insurance companies headquartered in his
district. A former supermarket executive, McMillan opposes any Federal mandates on
business. He has been critical of the HSA's malpractice reforms, calling them "toothless."
McMillan plans to introduce his own health care legislation which would provide vouchers to
help low income Americans buy health coverage.
CONGRESSMAN RICK BOUCHER (D-VA; 9th District-Abingdon):
Congressman Boucher, a member of the Energy and Commerce Committee, has not
cosponsored any major health reform bills, and has told the Administiation he does not want
to begin discussions until the tobacco tax is settied. Since he circulated the staff draft two
weeks ago. Chairman Dingell has devoted considerable energy to win support from Boucher.
He believes that any concessions which are necessary to win support from Jim Slattery will
also address Boucher's small business concems, and that tobacco will be the remaining issue.
Boucher has talked about reducing the tobacco tax and funneling some money back to
tobacco farmers to help them grow and market altemative crops.
After discussions with Dingell, Boucher hasfloateda conversion/tobacco buyout proposal
with his growers with no success. At the moment, Dingell's hope is that Boucher will
simply choose to fight the tobacco fight later in the process, since the tax is not in the
jurisdiction of the Energy and Commerce Committee. From Dingell's perspective, his best
prospect with Boucher right now is to avoid confrontation over tobacco and to deal with his
other concems in the health care bill. In addition to tobacco farms, his district includes a
new and highly successful pharmaceutical supply company, and a manufacturer of cigarette
filters. Boucher has also expressed reservations about the employer mandates and alUances.
When motivated, he can be a consensus builder, but as of the moment he is one of the three
members from whom Chairman Dingell is still seeking a commitment.
�CONGRESSMAN L. F. PAYNE (D-VA; 5th District-Danville);
A Cooper cosponsor and member of the Ways and Means Committee, Congressman Payne
has several thousand tobacco farmers among his constituents. His district is also home to
Jerry Falwell and Republicans have strengthened their base there in the wake of the
gubematorial election. Thus, Payne is keeping his distance from the Administration.
However, he wants to vote for a bill in this session, citing his reasons as insecurity among
his constituents, the underserved mral areas, and the exploding costs of the present system.
While supporting the Cooper bill, he does not seem to fully understand it. Payne has said he
supports universal access, not universal coverage. In addition to opposing the tobacco tax his best line being: "This is called a sin tax. But I didn't see the President in Hollywood
calling for a tax on R-rated movies."- he questions the employer mandate and beUeves it wiU
cost jobs. Payne has been a consistent supporter of abortionrightsand civil rights. He
appeared with the First Lady on an earlier satellite hook-up.
CONGRESSMAN J.J. (JAKE) PICKLE (D-TX; 10th District-Austin):
After a career in which he has been a key player on major issues, including Social Security,
Congressman Pickle is retiring at the end of this session. Pickle, who is on Ways and
Means, supports the reform effort and universal coverage but has not cosponsored any of the
major bills. He has said that overall he favors the Cooper plan but acknowledges that
competition can't solve everything. Pickle is close to the AMA and the hospital industry,
and his most consistent question is about the future for third party administrators, who mn
plans for individual businesses and groups of firms. He also has raised the affects on small
business, coverage of early retirees, the alliances, and global budgets. Pickle worked with
Rep. Stark in an unsuccessful attempt to rescue the catastiophic health insurance legislation
several years ago. While Pickle rarely bucks his Chairman and his issues are secondary, on
this key issue in his last Congress, he has not yet made a commitment. In meetings with the
Administration, however, he has made clear that he can support universal coverage and
employer mandate.
�TEL:
Feb 28*94
2 2 : 5 9 No.030
THE WHITE HOUSE
WASH1NGTO N
February 28, 1994
MEETING WITH REP. BILL BREWSTER (D-OK)
DATE: Tuesday, 3/1
LOCATION: Oval Office
TIME; 1:15 - 1:45 pm
From: Pat G r i f f i n
I . PURPOSE
To touch base with key comiaittee members regarding health
care reform, discuss concerns and encourage support for the
Health Security Act.
I I . BACKGROtJND
Congressman Brewster has not cosponsored any of the major
reform b i l l s . He has voted with the Administration 75% of the
time — voting against Family and Medical Leave and Budget
Reconciliation, but for NAFTA. Despite h i s position on the Ways
and Means committee, as a conservative member from a conservative
d i s t r i c t , Brewster has not f e l t compelled to get out i n front on
health care reform. He notes that i n p o l l s of h i s constitutents
health care comes up fourth or f i f t h among t h e i r p r i o r i t y
concerns. As a result, Brewster w i l l need some work to convince
him of the urgency of t h i s issue and that a major i n i t i a t i v e ,
rather than minor tinkering, i s necessary to resolve i t . I n
addition to Ways and Means, he i s a member of both the Mainstream
Forum and the Conservative Democratic Foxrum.
More s p e c i f i c a l l y , with regard to the Administration's
proposal, he shares the concern of many moderate members on the
employer mandate and i t s impact on small businessses as well aa
t h e i r perception of the overly bureaucratic nature of the
alliancQS as currently structured.
Congressman Brewster i s a licensed pharmacist, one of only
five health professionals i n the Congress. I n various meetings
with Administration representatives, he has made clear that while
he has not focused much on ovarall reform, he w i l l be protective
of h i s profession. To that end, he wants a reform proposal to
include a " w i l l i n g provider" clause, allowing any provider
w i l l i n g to accept a plan's price to p a r t i c i p a t e . This i s an
issue of primary importance to local pharmacies as they seek to
compete with the larger chains and managed care pharmacies.
P.05
�TEL:
Feb 28'94
22:59 No.030 P.06
He has expressed some skepticism with regard to the
financing of reform, particularly the degree to which a l l
proposals r e l y on saving in Medicare and Medicaid. He notes that
in Oklahoma 70% of r u r a l hospital receipts come from these
programs, and he would not support further cuts i n them.
Roger Altman's assesment of Brewster i s that he has lots of
problems but i s not hard and fast against anything. He was
negative about a l l i a n c e s , arguing that as structured they could
give a small number of insurance companies a near monopoly.
Brewster also complained that we did not go f a r enough on tort
reform.
In a recent meeting with the F i r s t lady he expressly did not
rule out eventually supporting some form of an employer mandate.
He also pointed out that Senator Boren's active speaking at home
against the employer mandate made i t harder for him, and said
that anything we could do to help on that front would be
appreciated.
Chairman Rostenkowski's staff director urges us not to give
up on Brewster even though i t w i l l tak a l o t of work to get him.
I I I . PARTICIPANTS
*Rep. B i l l Brewster
*The Vice President
*Pat G r i f f i n
IV. PRESS PLAN
White House photo only.
V. SEQUENCE OF EVENTS
VI. REMARKS
None required.
�TEL:
Feb
28'94
2 2 : 5 7 No.030
THE WHITE HOUSE
WASH INGTON
February 28, 1994
MEETING WITH REP. JIM SLATTERY (D-KS)
DATE: Tuesday, 3/1
LOCATION: Oval Office
TIME: 12:30-1:00 pm
From: Pat G r i f f i n
I.
PtTRPOSE
To touch base with key committee members regarding
health care reform, discuss concerns and encourage support for
the Health Security Act.
II.
BACKGROUND
Congressman Slattery i s a moderate to conservative
Democrat who has been w i l l i n g to buck the leadership i n order to
reduce the budget d e f i c i t . He i s running for Governor t h i s year
and has not cosponsored any major health care b i l l s i n t h i s
Congress. However, l a s t congress he introduced a small group
market health insurance reform b i l l which was the companion b i l l
to Sen. Bentsen's l e g i s l a t i o n . He voted against Family and
Medical Leave and NAFTA but for Budget Reconciliation.
In addition to Energy and Commerce, Slattery i s a
member of the Veterans' Affairs committee, the Rural Health Care
Coalition and the Mainstream Forum. I n the 100th Congress, he
was part of the Energy & Commerce committee's "Group of Nine"
which t r i e d to work with a l l sides on the Clean Air Act.
Moderates and conservatives look to him for leadership,
especially on budget and f i s c a l issues.
Although he has indicated a willingness i n the past to
spend more federal dollars on health care (Slattery was the lead
House sponsor of legislation to expand Medicaid coverage to poor
children in 1990), he i s very concerned about the funding aspects
of the Health Security Act. While Slattery has stated that he
supports universal coverage and a community rated health
insurance system, he i s very concerned with the employer mandate
and the amount of the payroll tax. His r u r a l d i s t r i c t i s
crawling with independent insurance agents who have received a
commitment from Slattery to offer a "voluntary a l l i a n c e "
amendment which allows for competition at the committee mark-up.
Last week. Rep. John Kasich (R-IN) met with Slattery to discuss
expanding h i s amendment into an alternative that would b a s i c a l l y
provide small group market health insurance reform and universal
access. Per chairman nlnaell's reeniesl^. please encourage
Slattery to work with the Chairman to solve the problem and
r e s t r a i n from working outside the committee process.
P.02
�TEL:
Feb 28'94
22:58 No.030 P.03
Slattery worries that the benefit package may be too r i c h
and that the Medicare and Medicaid savings are too excessive for
his r u r a l hospitals and doctors to bear.
Slattery has consistently supported the Hyde Amendment and
has said that he w i l l oppose any plan which allows federal funds
to pay for abortion. He supports lots of state f l e x i b i l i t y . At
his Feb. 16th town h a l l meeting on health care he said that he
walked away with the impression that his constituents think the
President's plan i s s t i l l too regulatory and allows government to
play too large a role.
III.
AGENDA ITEMS
(1)
Acknowledge that Congress i s looking for ways to
close the gap between Administration and CBO
spending projections. I t i s important that t h i s
not be viewed as an alternative to guraranteed
comprehensive benefits, but an additional hurdel
to clear. CBO has confirmed that t o t a l national
health care spending w i l l come down from i t s
present level under the Health Security Act.
Several different changes which would reallocate
costs could reduce federal government
expenditures.
(2)
Counter the assertion that the Health Security Act
i s a "caddilac benefit package." The
comprehensive package i s close both to the average
and the midpoint of private insurance today.
One benefit which accounts for almost half of the
difference between the Health Security Act premium
and Blue Cross/Blue Shield standard option i s
preventive health — a benefit which Slattery
strongly endorses i n the context of children's
health. Removing t h i s benefit would make the plan
much closer to a bare bones plan, but would also
leave exposed the very population he i s trying to
protect.
(3)
The Health Security Act was designed to be a
capped entitlement rather than an open ended
entitlement.
I f the entitlement cap does not work
properly, i t can be fixed.
IV.
PARTICIPANTS
* Rep. Jim Slattery
* The vice President
* Pat G r i f f i n
V.
PRESS PLAN
White House photo only.
�TEL:
VI.
SEQUENCE OF EVENTS
VII.
REMARKS
None required.
Feb 28*94
22:58 No.030 P.04
�TEL:
Feb 2 8 ' 9 4
2 2 : 5 9 No.030 P.07
THE WHITE HOUSE
WASH INGTON
February 28, 1994
MEETING WITH REP. PETER HOAGLAND (D-NE)
DATE: Tuesday, 3/1
LOCATION: Oval Office
TIME: 6:15-6:45 pm
From: Pat G r i f f i n
I.
PURPOSE
To touch base with key committee members regarding
health care reform, discuss concerns and encourage support for
the Health Security Act.
II.
BACKGROUND
A moderate Ways and Means Democrat, Congressman
Hoagland has not cosponsored any of the major reform b i l l s .
Hoagland has voted with the Administration on Family and Medical
Leave, Budget Reconciliation, and NAFTA. He i s considered
vulnerable i n h i s d i s t r i c t where he won with 51% and h i s opponent
began campaigning early. That may well account i n part for h i s
repeated statements in favor of bipartisanship. Hoagland i s a
member of the Mainstream Forum and the Rural Health Care
Coalition.
Congressman Hoagland's mother died of lung cancer and
he i s a strong proponent of the tobacco tax.
Mutual of Omaha
and Blue cross and Blue Shield insurance companies both maintain
a large presence in h i s d i s t r i c t . But surprisingly, i t i s the
presence of f i v e hospitals in Omaha that represent the largest
work force in h i s d i s t r i c t . Therefore, he i s very concerned
about loss of health care jobs as part of health care reform
which was reported in today's Washington Post.
Labor unions are
not necessarily a large base in h i s d i s t r i c t but contribute
s i g n i f i c a n t l y toward h i s PAC fund. Their influence has softend
his support of Cooper's tax cap on benefits. However, he i s very
supportive of a managed competition model rather than a
regulatory model. He believes the Administration proposal i s
much too regulatory. Early on he talked about supporting
universal coverage but has definitely changed h i s tone and now
talks about the importance of achieving universal access f i r s t .
Leaving insurance companies free to compete with a l l i a n c e s
i s an issue of c r i t i c a l importance to Hoagland. He also supports
voluntary a l l i a n c e s . And consistent with moderate members
concerns he i s very worried about the employer mandate and i t s
impact on small businesses in his d i s t r i c t . Patient choice i s
also a very important issue for him. He supports the r u r a l
�• TEL:
Feb 28*94
23:00 No.030 P.08
piece" i n the Administration proposal.
Current Nebraska
Governor Ben Nelson's Blue Ribbon health care panel recently
recommended small group market health insurance reforms as the
best f i r s t step toward reform. This seems to be putting pressure
on Hoagland to move i n that direction.
F*w»Bure
Roger Altman's assesment i s that Hoagland very much wants to
be for something i n the area of health care refonn.
(Note: The President may want to thank Congressman Hoagland for
allowing h i s Administrative Assistant, Kathleen Ambrose, to be
loaned out to the President for the Brussels stop during the NATO
summit).
III.
PARTICIPANTS
*Rep. Peter Hoagland
*The Vice President
*Pat G r i f f i n
IV.
PRESS PLAN
White House Photo only.
V.
SEQUENCE OF EVENTS
VI.
REMARKS
None required.
�(
THE WHITE
HOUSE
WASHI NGTON
Febmary 21, 1994
MEETING WITH SENATE REPUBLICANS/MITCHELL AND DEM CHAIRS
DATE:
Febmary 22, 1994
LOCATION: Red Room and Old Family Dining Room
TIME:
7:30 pm
FROM:
Pat Griffin
I.
II.
PURPOSE
•
To reinsUtute an open and constmctive dialogue with Republicans without
giving any appearance (whether privately or publicly) of negotiating.
•
To illustrate commitment to work with Republicans in the Senate who are
serious about health reform and (hopefully) to increase hesitation among
moderate Republicans to be open to forming a coalition with conservative
Republicans.
•
To lock in commitment for universal coverage and to hold frank discussion
about the political and policy concems surrounding altematives to the
combination employer/individual requirement included in the Health Security
Act (e.g. the shortcomings of the individual requirement).
BACKGROUND
On March 3rd and 4th, the Senate Republicans are holding a retreat to, among other
things, attempt to unify all 43 remaining Republicans (Senator Jeffords is already on
our bill) behind a proposal that bridges the differences between the Chafee proposal
and the Nickles/Hatch proposal. (Each bill has approximately half of the
Republicans.) If a compromise position emerges, there may well be more than
enough votes to sustain a vote against cloture on a filibuster. Regardless, a unified
Republican position would serve to water down the reform initiative that you have
proposed and make it much more difficult to retain the liberal Democratic base that
the Administration needs. With this in mind, Senator Mitchell proposed at the
Leadership meeting a week and a half ago to meet with a select group of Republicans
and the two Senate Democratic Chairmen of primary jurisdiction. The list of
Republicans: Dole, Kassebaum, Packwood, Chafee, and Nickles was selected by
Senator Dole.
�02/21/94
09:50
Q2024566220
WHITE HOUSli
•'•
The fact that this dinner/meeting is taking place has become vep. P^b^c. This is
unfortunate because it raises all sorts of speculation, most problematic ^^^ong the
House Democrats that you are beginning a negotiation with the Senate Republicans
" h T e r m • CThiJfeeds mto their fear that ,the Administration wil not ack up
the House if they take a difficult position on the employer mandate.) We must go to
some ef ort to make certain that no one leaves this meeting with that perception We
s u L s t that an open and frank discussion about the shortcomings of an individual
mandate might be the best way to achieve this. (See below.)
III.
AGENDA ITEMS
1
Appreciation for Tomin. and rnrnmitm^-nt of l^esire to Work Together With
the exception of Senator Nickles, the Republican invitees have worked for
years on health care policy at a Federal level. Dole, Chafee, Packwood, and
Kassebaum will be critical to us having any opportunity to attract and retain
Republican votes. Acknowledgement of their longstanding history in health
care is appropriate and should break some ice.
•
2
TW.n.smn of Comn.irni''nt to Universal Coverage and How to Get There. All
of the Republican attendees have all stated their commitment to universal
coverage. That fact should be noted, but a discussion of the limited ways to
• get there would be constructive.
•
I am sure we'd all agree there is littie appetite for a major new tax to pay for
extending coverage to every American.
•
We don't believe you can achieve universal coverage with an individual
mandate
It is likely that an individual will be required to pay too large a
share of their personal income for health care or possibly require a Federal
subsidy the size of which would be prohibitive (see attached).
•
We believe it is virtually impossible to achieve the goal of universal coverage
without some combination of an employer/individual mandate as we have
suggested in our bill.
•
Tell me why I am wrong.
-
�IV,
PARTICIPANTS
The President
The Vice President
The First Lady
Mrs. Gore
Pat Griffin
Harold Ickes
Ira Magaziner
Mack McLarty
George S.—
Majority Leader Mitchell
RepubUcan Leader Dole
Chairman Kennedy
Chairman Moynihan
-Senator Chafee
Senator Kassebaum
Senator Packwood
Senator Nickles
John Hilley
Sheila Burke
SEQtJENCE-OF-EVENTS
Members and staff arrive at 7:30 at the Red Room for Cocktails.
Informal greetings take place.
Guests go to Dinner in Old Family Dining Room. The President and the First Lady
open up discussion, prefaced by statements of appreciation for attendance and sincere
desire to work together to craft a bipartisan health reform bill.
VI.
PRESS PLAN
Closed press. (White House photographer will be present.)
�THE WHITE HOUSE
WASHINGTON
January 31, 1994
MEETING WITH DEMOCRATIC LEADERSHIP AND HEALTH CHAIRMEN
DATE:
LOCATION:
TIME:
FROM:
February 3, 1994
Roosevelt Room
5:15 pm
Patrick J. Griffin
cr
I.
jL .
PURPOSE
•
To reiterate our need to complete floor action on health care by both
chambers by no later than the July 4 recess.
•
To outline the "bottom line" provisions that must be part of the final biU
presented to you.
•
To open up discussions among the 5 primary Committees of jurisdiction
about how best to achieve your bottom line goals, to develop a
coordination process between the Committees, the Leadership and the
Admimstration, and to determine how the Administration can be most
helpful in this process.
•
To discuss a strategy of how best to deal with other important health care
"players" within the Congress, (e.g. Subcommittee Chairmen of Committees
of junsdiction, advocates of major alternatives. Republicans, influential
swing voters, and Chairs of other Committees of limited jurisdiction.
j;^
II.
BACKGROUND
Within the last week, either by phone or in person, you have talked with the
Democratic Leadership and Chairs of the Congressional Committees of primary
jurisdiction over health care. However, you have not had the oppormnity to hold
a discussion with all the Chairs in the same room and you have yet to outline the
substantive "bottom line" issues you believe are imperative to designing a bill that
IS acceptable to you. Such a discussion is advisable in order to give some helpful
parameters to the Chairs during their upcoming mark-up process AND to ^et any
early warmng signs about the extent to which your priorities are goinp to cause "
the Chairmen any difficulties.
�All the Chairs, with the exception of Senator Moynihan, gave the impression that
they could live with the July 4th timetable for getting the bills into conference
This week we are trying to make certain that he is also on board, so the part of
this meeting dedicated to timetable should be as limited as possible.
Mi
in.
AGENDA ITEMS
^1
Timetable and Strategy for Achieving Goal. You may wish to reiterate the
timetable that you have previously outiined with the Chairmen (i e to
have final votes on House and Senate bills by July 4 recess) and to'thank
them for their agreement to deliver within this period. You may also wish
to open up a brief discussion of how the Chairmen feel the Admimstration
can best assist them in meeting this timeframe.
"Bottom Line" Issue Discussion. To help outline the skeleton of the bill
you would like to see reported out of Committees and passed on the
respective floors, we recommend that you use this meeting as an
opportumty to outline your bottom line provisions to the participants AND
to open up a discussion about how to achieve support for these provisions
If they are consistent with what Ira has forwarded you previously, they are:
•'I;
(1)
Universal coverage by the end of the decade that utilizes an
employer-based system.
(2)
Comprehensive benefits that are defined.
(3)
Insurance market reforms - commuity rating, banning underwriting
and promoting large risk and purchasing pools - to put an end to '
insurance discrimination.
(4)
Cost containment that has an enforceable backstop.
* IMPORTANT NOTE: The Members may be nervous about
press repons regarding your statements about premium caps and
alliance structure. They may want to hear your explanation about
what happened and to, in general, discuss how best the
Administration can coordinate any public statements that suggest
any major policy shifts.
How to Deal with Other "Plavers" Discussion These Chairmen are, first
and foremost, concentrating on how they can report out decent health
�reform bills out of their Committees. Understandably, the players they are
most interested and concemed about, therefore, are their swing votes in
Committee and, in the Senate, on their Repubublican possibilities. You
may wish, to ask the Chairs about how best the Administration can help
them help us.
IV.
PARTICIPANTS
The President
The Vice President
The First Udy
The Speaker
Majority Leader Gephardt
Majority Leader Mitchell
Chairman Moymhan
Chairman Keimedy
Chairman Rostenkowski
Chairman Dingell
Chairman Ford
If r
V.
Pat Griffin
'
Harold Ickes
Chris Jemiings
jack Lew
Ira Magaziner
Janet Murguia
Steve Ricchetti
George S.
Melanne Verveer
SEQUENCE OF EVENTS
Members and staff arrive at 5:15pm.
,
The President opens up meeting and calls on the First Lady to make a few
remarks about how appreciative she has been for aU the past advice and how
much we will need the Leadership's assistance throughout the upcoming
challenging process.
The President briefly outiines the three agenda items that he would like to discuss
and opens up the discussion. Probably the most useful discussion would one that
focuses on the Members current feelings about the Administration's bottom line
issues.
VI.
PRESS PLAN
v.,Closed press. (White House photographer will be present.)
�
Dublin Core
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Title
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Health Care Task Force Records
Creator
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White House Health Care Task Force
Is Part Of
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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Congressional Briefing Memos – POTUS
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 2
Is Part Of
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Box 8
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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2/6/2015
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42-t-12092992-20060885F-Seg2-008-011-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/3eb0181b17e67c4f42d3dbd904fdefcc.pdf
5c984090df196bdf603db9bc990aef03
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Croup:
Clinton Presidential Records
Subgroup/Oflice of Origin:
1 lealth Care Task Force
Series/Staff Member:
Edelstein
Subseries:
3681
OA/ID Number:
FolderlD:
Folder Title:
Congressional Briefing Memos - First Lady 1993 |7]
Stack:
Row:
Section:
Shelf:
S
52
3
8
Position:
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. memo
Chris Jennings to Hillary Rodham Clinton; re: Meeting with
Chairman Brooks (2 pages)
03/16/1993
P5
002. memo
Chris Jermings to Hillary Rodham Clinton; re: Rockefeller,
Montgomery, Rowland Veterans Meeting (2 pages)
03/10/1993
P5
003. memo
Chris Jennings to Hillary Rodham Clinton; re: Thursday Hill Visits
with Moynihan, Sasser, & Riegle (3 pages)
02/24/1993
P5
004. memo
Chris Jennings to Hillary Rodham Clinton; re: Budget Discussion &
Health Care Reform (2 pages)
02/09/1993
P5
005. outline
re: Congressional Strategy for Health Reform (6 pages)
02/05/1993
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefmg Memos • First Lady, 1993 [7]
2006-0885-F
ip2852
RESTRICTION CODES
Pri sidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(aXl) of the PRA|
P2 Relating to the appointment to Federal office |(aX2) of the PRA|
P3 Release would violate a Federal statute |(aX3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
Financial information [(aX4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |aXS) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(aX6) of the PRA|
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA|
b(3) Release would violate a Federal statute |(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information [(bX4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(bX6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(bX7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions \(b){») of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
A>DTYPE
001. memo
SUBJECT/TITLE
DATE
Chris Jennings to Hillary Rodham Clinton; re: Meeting with
Chairman Brooks (2 pages)
03/16/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefmg Memos - First Lady, 1993 [7]
2006-0885-F
ip2852
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)l
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(bX4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(bX?) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions |(bK8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA]
National Security Classified Information |(aXl) of the PRA)
Relating to the appointment to Federal office |(aX2) of the PRAj
Release would violate a Federal statute |(aX3) of the PRAJ
Release would disclose trade secrets or confidential commercial or
financial information [(aX4) of the PRA|
Pf< Release would disclose confidential advice between Ihe President
and his advisors, or between such advisors |aX5) of the PRA|
P(> Release would constitute a clearly unwarranted invasion of
personal privacy |(aX6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�MEMORANDUM
TO:
FR:
RE:
cc:
H i l l a r y Rodham Clinton
March 16,
Chris Jennings
Meetings with Conservative/Moderate Democrats
Melanne, Lorraine, Steve
1993
Last year, the House did not have anywhere close to a
s u f f i c i e n t amount of Democratic support to even consider a vote
on l a s t year's Gephardt health care reform plan. One of the
major problems was that the moderate/conservative Democrats did
not f e e l i t necessary or i n their interest to sign on.
With the election of a new Democratic President, the
dynamics most definitely have changed. Having said t h i s , as
evidenced by the conservative Democrats position on the
President's economic package, i t cannot be assumed that these
Members w i l l jump on board the President's health care reform
plan. I f these Members can use the excuse that they have not
been consulted with or taken seriously, many may well not
hesitate to oppose the health reform proposal and offer an
alternative that a number of Republicans might find a t t r a c t i v e .
With the above i n mind, and even though I know how hectic
your schedule i s , I believe i t i s i n your and the President's
best i n t e r e s t for you to meet with the three conservative
Democratic membership organizations that have formed i n the
House. Because of his experience with these Members, Dick
Gephardt strongly endorses t h i s idea. The three groups are:
(1) the Budget Study Group — ( f i s c a l but generally not
s o c i a l conservatives). Chaired by Congressman David Price
from North Carolina;
(2) the Mainstream Forum — (perceive themselves to be
generally moderate, but frequently vote conservative).
Chaired by Congressman Dave McCurdy from Oklahoma; and
(3) the Conservative Democratic Forum — (the most
conservative organized group i n the House), Chaired by
Congressman Charles Stenholm from Texas.
Although there i s some membership overlap on these groups,
p a r t i c u l a r l y from the larger Budget Study Group, Melanne, Andie
King (from Gephardt's s t a f f ) and I believe that (unfortunately)
separate meetings are advisable. May we proceed and ask P a t t i to
s t a r t the process of scheduling these meetings?
�MEMORANDUM
TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n
Chris Jennings
Thursday Meeting w i t h Ron Wyden
Melanne, Lorraine, Kim T i l l e y
March 10, 1993
I n response t o h i s i n v i t a t i o n , you are scheduled t o meet
w i t h Ron Wyden (D-Oregon). S t a f f i n g him f o r t h i s meeting w i l l be
David Schulke, a w e l l respected and former David Pryor Senate
Aging Committee s t a f f e r .
BACKGROUND
Congressman Wyden i s w e l l known i n h e a l t h reform c i r c l e s .
He i s very adept a t p i c k i n g hot t o p i c h e a l t h issues, moving
q u i c k l y t o address them — p a r t i c u l a r l y through the press, and
i n t r o d u c i n g r e l e v a n t l e g i s l a t i o n . I n recent years, he has been
at t h e f o r e f r o n t o f such issues as p r e s c r i p t i o n drug cost
containment, long-term care p r i v a t e insurance standards, and
state f l e x i b i l i t y .
( A l l three o f these issues have also been
s t r o n g l y advocated by Senator Pryor).
During l a s t year's e f f o r t by the House t o achieve a
Democratic consensus on h e a l t h reform. Congressman Wyden and
Congressman Synar attempted t o play the mediator r o l e between t h e
Gephardt/Stark government r e g u l a t i o n approach and t h e
Cooper/Andrews/Stenholm managed competition approach. He
believes there i s some middle ground and he wants t o be one o f
the Members who helps you f i n d i t . Although he w i l l work c l o s e l y
w i t h Chairmen D i n g e l l and Waxman, he views himself as a major
player as w e l l and hopes you w i l l t r e a t him as one. Apparently,
FYI, he was very happy t h a t you mentioned h i s name i n yesterday's
meeting w i t h the Energy and Commerce Committee.
LIKELY DISCUSSION
A number o f issues may come during your discussion w i t h
Congressman Wyden, i n c l u d i n g : (1) How best t o t a l k about
revenues and recapture provisions, (2) How best t o t a r g e t
wavering Members and what Wyden's r o l e can be i n t h i s regard; and
(3) t h e p r o v i s i o n o f s t a t e f l e x i b i l i t y and, somewhat r e l a t e d , t h e
s t a t u s o f the Oregon waiver request. This v i s i t i s very
important t o Congressman Wyden. I f i t t u r n s out l i k e I b e l i e v e
i t w i l l , you w i l l have another strong and h e l p f u l a l l y i n t h e
House.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. memo
SUBJECT/TITLE
DATE
Chris Jennings to Hillary Rodham Clinton; re: Rockefeller,
Montgomery, Rowland Veterans Meeting (2 pages)
03/10/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefmg Memos - First Lady, 1993 [7]
2006-0885-F
jp2852
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
IPl National Security Classified Information |(aXl) of the PRA|
1P2 Relating to the appointment to Federal office ((aX2) of the PRAj
?3 Release would violate a Federal statute ((aX3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information |(bXl) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA|
b(3) Release would violate a Federal statute |(bX3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�MEMORANDUM
TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n / K i m T i l l e y
C h r i s Jennings
Tuesday Meeting w i t h Congressman McDermott
Melanne
March 8, 1993
F o l l o w i n g up on your meeting w i t h t h e l e a d Senate sponsor
( S e n a t o r W e l l s t o n e ) o f t h e s i n g l e payer b i l l t h a t most o f t h e
h a r d c o r e advocates s u p p o r t , we t h o u g h t i t a p p r o p r i a t e t h a t you
h o l d a s i m i l a r meeting w i t h t h e b i l l ' s l e a d House sponsor
(Congressman McDermott). Tuesday, a t 1:15, you a r e scheduled f o r
j u s t such a meeting.
I n attendance w i l l be Barbara Smith
(Congressman McDermott's h e a l t h s t a f f p e r s o n ) .
Congressman McDermott and over 50 House cosponsors, a l o n g
w i t h Senator W e l l s t o n e i n t h e House, i n t r o d u c e d t h e i r s i n g l e payer l e g i s l a t i o n l a s t Wednesday. As you may r e c a l l from t h e
W e l l s t o n e memo, t h e 1995 new F e d e r a l c o s t s r e q u i r e d by t h i s b i l l
amounts t o a p p r o x i m a t e l y $551 b i l l i o n .
I t i s payed f o r by
i n c r e a s e s i n income t a x e s , p a y r o l l t a x e s , c o r p o r a t e t a x e s and
o t h e r revenue r a i s e r s . By 1996, however, o v e r a l l p r i v a t e / p u b l i c
spending w i l l be l e s s t h a n what i t would be under c u r r e n t
projections.
( A t t a c h e d f o r / y o u r r e v i e w i s some background
i n f o r m a t i o n on t h i s b i l l ) . /
Both McDermott and W e l l s t o n e s t a t e d i n t h e i r p r e s s
c o n f e r e n c e remarks t h a t t h e y have every i n t e n t i o n o f w o r k i n g
c l o s e l y w i t h t h e C l i n t o n A d m i n i s t r a t i o n on h e a l t h r e f o r m and
suggested t h a t t h e y a r e open t o a l t e r n a t i v e approaches t h a t meet
t h e i r b a s i c (access, c h o i c e and a f f o r d a b i l i t y ) p r i n c i p l e s . They
s a i d t h a t t h e y a r e c o m f o r t a b l e t a k i n g t h i s p o s i t i o n because t h e y
b e l i e v e t h a t t h e r e i s a g r e a t d e a l o f common ground between t h e
h e a l t h r e f o r m p r i n c i p l e s and g o a l s t h a t have been o u t l i n e d by t h e
C l i n t o n A d m i n i s t r a t i o n and where t h e i r b i l l i s .
I t i s i m p o r t a n t t o t h e Congressman t h a t everyone
acknowledges t h a t h i s b i l l i s NOT t h e same b i l l as t h e o l d Russo,
single-payer b i l l .
He b e l i e v e s he moved t h e b i l l more t o t h e
c e n t e r by p r o v i d i n g much more s t a t e f l e x i b i l i t y i n h i s v e r s i o n .
He b e l i e v e s these m o d i f i c a t i o n s came a t t h e expense o f
r e l a t i o n s h i p s w i t h some o f t h e more "pure-minded" s i n g l e - p a y e r
advocates.
He (and p a r t i c u l a r l y h i s s t a f f , i t seems) would l i k e
t o hear some r e c o g n i t i o n o f t h i s " s a c r i f i c e . "
�MEMORANDUM
T O : / ; r H i l l a r y Rodham C l i n t o n
Ff</^^hri.s Jennings
March 7,
1993
REConversation
with Senator Pryor
^
cc: Melanne, Ira Magaziner, Howard Paster,^teve Ricchetti^
This afternoon, I had a very good conversation with
David Pryor about the ongoing debate around health care and
reconciliation and, of more immediate note, the Byrd
waiver/budget resolution issue. The long and short of the
discussion:
Senator Pryor believes that there are no downsides to the
President requesting assistance from Senator Byrd. He f e e l s an
attempt should be made because he believes that we should not so
e a s i l y give up at least the option of reducing the number of
required votes for health care by nine. Senator Pryor believes a
one-on-one meeting (or even a phone conversation) between the
President and Senator Byrd has great potential to be f r u i t f u l .
To those who argue that there would be a p o l i t i c a l r i s k to
asking and not receiving assistance, or asking and receiving, but
owing a c h i t to Senator Byrd, Senator Pryor disagreed. He
believes that there are no r i s k s . F i r s t , even i f Senator Byrd
rejected the request, he would keep i t confidential since he
would love having been called on by the President i n the f i r s t
place; i n other words, he would never embarass the President.
Secondly, even i f a c h i t was required. Senator Pryor believes
that health care and the d i f f i c u l t i e s of passing i t merit giving
a favor away.
Perhaps most interesting. Senator Pryor feels that the
Administration should not turn i t s back on an opportunity i t
might l a t e r regret not taking. (Senator Pryor has heard Senator
Byrd say too many times that he might have done something
different i f one President or another had bothered to ask him).
Lastly, Senator Pryor said he would be w i l l i n g to c a l l the
President to share h i s views on t h i s matter i f you thought i t
would be of assistance or of some relevance. (Although, i n h i s
usual self-depricating way, he said he did not think he was
necessarily the one to do i t ) .
J)elKi/^ <^k*fV
S^irA
uyO^(^A c^c^tA<r\
^
S-w
(U<: l i ^
�MEMORANDUM
TO:
FR:
RE:
cc:
Secretary Shalala
February 26,
C h r i s Jennings X-2645
Update on H e a l t h Care and R e c o n c i l i a t i o n
K e v i n , J e r r y , Karen, Judy, Ken, A t u l
1993
There have been many rumors c i r c u l a t i n g around t h e H i l l t h a t
Members a r e becoming so nervous about t h e economic package t h a t
t h e L e a d e r s h i p and/or t h e rank and f i l e may n o t have t h e stomach
t o add h e a l t h c a r e t o t h e budget r e c o n c i l i a t i o n b i l l .
In this
v a i n , t h e r e have been r e p o r t s o f a p o s s i b l e two r e c o n c i l i a t i o n
s t r a t e g y (one f o r d e f i c i t r e d u c t i o n and one f o r h e a l t h ) .
A l t h o u g h Wednesday t h e r e appeared t o be g r e a t angst about t h i s i n
t h e House, t h e r e appeared t o be an e a s i n g o f concern by t h e end
o f t h e day y e s t e r d a y .
The c u r r e n t l y accepted l e g i s l a t i v e s t r a t e g y , t h e r e f o r e ,
c o n t i n u e s t o be t h a t t h e House and t h e Senate w i l l pass t h e
budget r e s o l u t i o n , w i l l move on t o b r i n g up and pass t h e s t i m u l u s
package, and t h e n move q u i c k l y t o c o n s i d e r a t i o n o f t h e
r e c o n c i l i a t i o n package. Of/inost importance t o you, t h e
L e a d e r s h i p o f b o t h Houses remain v e r y open t o i n c o r p o r a t i n g
(under a wide v a r i e t y o f s c e n a r i o s ) t h e h e a l t h i n i t i a t i v e i n t o
the r e c o n c i l i a t i o n b i l l .
L a t e Wednesday evening, I had two c o n v e r s a t i o n s w i t h t h e
C h i e f o f S t a f f o f M a j o r i t y Leader M i t c h e l l ' s o f f i c e , John H i l l e y ,
and t h e c h i e f h e a l t h a n a l y s t o f t h e Senate Budget Committee,
Kathy Deignan. (John d e b r i e f e d me on t h e Wednesday a f t e r n o o n
m e e t i n g w i t h t h e Chairmen and Kathy updated me on some budget
r e s o l u t i o n i s s u e s t h a t are e x t r e m e l y i m p o r t a n t ) . The i n f o r m a t i o n
I r e c e i v e d was r e l a y e d t o Mrs. C l i n t o n and I r a , and I b e l i e v e i t
i s i m p o r t a n t t h a t you and t h e Department ( i n p a r t i c u l a r , J e r r y
and Karen) have i t as w e l l . H i g h l i g h t s o f t h e c o n v e r s a t i o n :
John s t a t e d t h a t t h e r e remains a consensus among t h e Senate
Chairmen t h a t t h e r e w i l l not be a s u f f i c i e n t number o f v o t e s
f o r two t a x b i l l s and t h a t a one-vote r e c o n c i l i a t i o n
s t r a t e g y remains t h e best (and p r o b a b l y t h e o n l y ) o p t i o n t o
pursue i f t h e r e i s a d e s i r e t o pass h e a l t h r e f o r m t h i s y e a r
i n t h e Senate.
�John (who used t o be the S t a f f D i r e c t o r of the Senate Budget
Committee) said t h a t i t would be d i f f i c u l t t o impossible, on
both procedural and p o l i t i c a l grounds, t o develop -- much
l e s s pass -- a second r e c o n c i l i a t i o n b i l l . Assuming a second
b i l l i s even possible (and t h a t i s not even c l e a r t o him),
he c i t e d 3 primary other reasons why i t would be
problematic:
(1) i t i s d i f f i c u l t t o see how a second r e c o n c i l i a t i o n
package would pass a budget r u l e s t e s t known as the
r e c o n c i l i a t i o n "preponderance" t e s t because, t o do so, the
b i l l must fundamentally be a d e f i c i t r e d u c t i o n b i l l .
He
b e l i e v e s i t would be v i r t u a l l y impossible f o r a h e a l t h
reform b i l l t o meet t h i s t e s t because i t i s d i f f i c u l t t o see
how i t would be possible t o come up w i t h the taxes and cuts
necessary t o meet the d e f i c i t reduction t e s t AND t o
underwrite the costs of a health care package.
(2) any attempt t o get around the preponderance t e s t
(perhaps by s p l i t t i n g up the d e f i c i t r e d u c t i o n p r o v i s i o n s
between the two separate packages) would l i k e l y i n v i t e even
more p o l i t i c a l problems f o r the f i r s t r e c o n c i l i a t i o n b i l l .
This i s because the tax t o cuts r a t i o s would l i k e l y be even
more d i f f i c u l t t o defend than they are now.
(3) i t i s extremely d i f f i c u l t t o see t h i s Congress f i n i s h i n g
a c t i o n on even one r e c o n c i l i a t i o n package before September.
Even i f they break a record i n t h i s regard and pass i t i n
the summer, i t i s v i r t u a l l y unthinkable t o see a second
r e c o n c i l i a t i o n process/completed t h i s year or next.
(Congress r a r e l y takes a b i t e out o f the d e f i c i t i n any
s i g n i f i c a n t way more than once every two years).
I n order t o accomodate the concerns of both the House and
the Senate, one budget r e c o n c i l i a t i o n / h e a l t h care s t r a t e g y
could be as f o l l o w s :
(1) Pass the budget r e s o l u t i o n w i t h a h e a l t h reform plug
(see discussion below) around March 20th;
(2) Immediately b r i n g up and pass the stimulus package w i t h
a commitment t h a t cuts w i l l be i n the r e c o n c i l i a t i o n
package;
(3) Have the House pass i t s r e c o n c i l i a t i o n b i l l f i r s t
WITHOUT h e a l t h reform (sometime i n l a t e May/early June);
(4) Have the Senate -- as i t usually does i n i t s more slow
and d e l i b e r a t e way — pass i t s r e c o n c i l i a t i o n b i l l WITH
h e a l t h reform a f t e r the House passes i t s b i l l ;
(5) Have the House pass a protected h e a l t h reform b i l l t h a t
they can b r i n g t o a j o i n t Senate/House conference; and
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. memo
SUBJECT/TITLE
DATE
Chris Jennings to Hillary Rodham Clinton; re: Thm-sday Hill Visits
with Moynihan, Sasser, & Riegle (3 pages)
02/24/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefmg Memos - First Lady, 1993 [7]
2006-0885-F
ip2852
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a))
Freedom of Information Act - |S U.S.C. S52(b)|
Fl National Security Classified Information 1(a)(1) of the PRA|
P'2 Relating to the appointment to Federal office l(aX2) of the PRA|
P3 Release would violate a Federal statute |(aX3) of the PRA|
r4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
I'S Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(aX6) of the PRA|
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes ((bX7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions j(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells j(bX9) of the FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�MEMORANDUM
F e b r u a r y 22,
TOFR:
H i l l a r y Rodham C l i n t o n
C h r i s Jennings
^
refanne?^rra,
1993
Howard P a s t e r . S t . v a R i c c h e t t i
a i s c u s s l c n s e a r - e r toaa^^^^^^^^^
- r o t i S r a"/«2raf;i£g^
- t the
Mitchell's office, great co'^^^J^^Ti!^ ^are i n the Budget
oVhTiitv of NOT folding i n health ^^^J® '""^j.ese^^imbirs stated
informatior^^
« ^-F artion advocated by the
The preferential course of
a vote on the
leadership of both Houses
f P^^^^es enough cover and
Budget Resolution and hope ^J^at pro^^^^^, ^ stimulus package,
assures enough support for xne
*
.
.he fear i s that there .ay he too - ^ ^ " i f - % S ? i S i e n t
c?aim that a Resolution ™«„^°^?.??on^vote on the cuts the
Sovtr and w i l l ^ ^ ' ' ^ .^^^^""ZTll l l V ^ t L v want to ensure
.
sf?hf crtr«fi?-he'irct:d mto ia„
I f the trade i s .nade « S ^ ^ f ^ ^ u s ' ^ p S S p a l S H n ' i h o r ?
vote i n order to get ^ l ^ ^ . ! * ^ " ^ impossible to see any
order i t i s highly unlikely to rmpo
^ ^,,6 Congress,
com^lehensive reform package make r t t h r o j ^^^^ a separate
: : ; ^ % i l o S % f c o n c r i r a t i L " p r o ; e s s . as some apparently have
been suggesting.
*
Here's why: The consensus " ^ . ^ f . ^ ^ . f
^L^Souse)^
committee Chairmen of
the Sen
^^^^^ ^„ the
there i s nowhere near s u f f i c i e n r ^ t-F
revenue and
^etftwice for a difficult ™*^„^|%^Pent
that, in order
outs. It is becoming more an more app^ ^ ^^^^^
^
^te^^o^nfmhuf S g f t f e c r n r i u i t i o n strategy.
�The problem i s obvious. The President wants h i s stimulus
package enacted as soon as possible because a delay i n i t s
enactment may reduce or e l i m i n a t e the p o s i t i v e economic
impact o f h i s i n i t i a t i v e . However, the m a j o r i t y i n t h e
Congress may hold h i s stimulus package hostage t o a
r e c o n c i l i a t i o n vote on cuts, thus k i l l i n g any r e a l i s t i c
o p p o r t u n i t y t o enact s u b s t a n t i a l h e a l t h reform t h i s year.
This i s NOT an acceptable trade. The f a c t t h a t B i l l C l i n t o n
gets a r e l a t i v e l y modest stimulus package enacted t h i s year
w i l l not placate any c r i t i c i s m t h a t he d i d not get h e a l t h
care reform.
The other a l t e r n a t i v e i s t o do some P r e s i d e n t i a l armt w i s t i n g t o make sure t h a t the Congress supports t h e
stimulus package without the need f o r an e a r l y
r e c o n c i l i a t i o n vote.
I f t h e above does not work, the l a t e s t compromise seeming t o
emerge on t h e H i l l today was a p r e l i m i n a r y proposal t o t h i n k
about s l i g h t l y delaying the stimulus package and
s t r e a m l i n i n g the health care i n i t i a t i v e . The idea here i s
i t would make i t easier t o f o l d the cuts, the taxes, and t h e
reform i n i t i a t i v e i n t o on r e c o n c i l i a t i o n package i n as
t i m e l y as manner as possible. Although t h i s has been
discussed, i t would probably not be accurate t o promise t h a t
Congress would complete a c t i o n on t h i s i n as quick a
timeframe as would be desirable.
John H i l l e y informed me t h a t l a t e t h i s afternoon t h e
M a j o r i t y Leader w i l l be meeting again w i t h the Senate
leadership and Chairmen on t h i s issue. He w i l l c a l l me back
w i t h developments as soon as i t i s over.
�MEMORANDUM
TO:
FR:
RE:
cc:
F i r s t Lady H i l l a r y Rodham C l i n t o n
February 15, 1993
Chris Jennings
X-2645
Tuesday House V i s i t
Melanne, P a t t i , Steve R i c c h e t t i , Lorraine M i l l e r ,
J e r r y Klepner, I r a Magaziner, Judy Feder
Tomorrow afternoon, you are scheduled t o hold the House
companion meet and greet meeting you held w i t h the Senate on
February 4 t h . You w i l l s t a r t o f f w i t h a meeting w i t h Speaker
Thomas Foley and M a j o r i t y Leader Gephardt a t 2:00 i n Room H-204
of the C a p i t o l . A f t e r about 15-20 minutes or so, you w i l l go up
t o H-324 f o r a meeting w i t h 38 Democratic Members who were
i n v i t e d by the House Leadership (see attached l i s t ) .
Following the meeting w i t h the Democratic Representatives,
you are scheduled f o r a 4:15 meeting w i t h M i n o r i t y Leader Bob
Michel and J. Dennis Hastert (R-IL) i n H-232. (Rep. Hastert was
r e c e n t l y chosen by the M i n o r i t y Leader t o serve as h i s
r e p r e s e n t a t i v e t o the Health Task f o r c e ) . A f t e r t h i s meeting,
you are scheduled f o r a meeting i n H-227 w i t h the 24 Members o f
the Republican Leader's Task Force on Health.
Because o f the success of the Senate meeting, we have
concluded t h a t i t i s advisable t o use the same type o f format ( i n
terms o f p r e s e n t a t i o n and media coverage) t h a t was chosen f o r the
Senate v i s i t . Therefore, the v i s i t s w i t h the Hosue Leadership
w i l l be b r i e f and be u t i l i z e d p r i m a r i l y f o r them t o be able t o
present you t o t h e i r Members. The Leadership i s very comfortable
w i t h you then making a presentation about the process, progress,
and s t r a t e g y o f the Administation's h e a l t h care reform e f f o r t ,
and f o l l o w i n g i t up w i t h a question and answer session.
You have done so w e l l a t these forums t h a t I b e l i e v e i t i s
unnecessary t o provide you w i t h any new t a l k i n g p o i n t s . Beyond
the more general questions about h e a l t h reform, however, you may
w e l l receive some much more focused questions about the possible
use o f h e a l t h care cuts f o r d e f i c i t reduction r a t h e r than access
expansion. Concern may w e l l be expressed by some Democrats t h a t
such an a c t i o n w i l l only make i t more d i f f i c u l t t o f i n d the
d o l l a r s necessary t o finance comprehensive h e a l t h reform.
On t h e other hand. Republicans may suggest t h a t e n t i t l e m e n t s
should be c u t severely and t h a t a l l saved d o l l a r s be dedicated t o
reduce the d e f i c i t . ( I f they do, you can t a l k about your concern
of such an a c t i o n only s h i f t i n g costs t o the p r i v a t e s e c t o r ) .
They may also r a i s e the issue of the a d v i s a b i l i t y o f r a i s i n g
revenues and imposing employer mandates on a d e l i c a t e l y
recovering economy.
�DATE: February 12, 1993
TO: Chris Jennings
FROM: Andie King
RE: briefing meeting with F i r s t Lady on health care refonn
Updated l i s t o f Members t o attend t h e meeting w i t h Mrs.
C l i n t o n on Tuesday, Feb. 16:
1. Foley
2. Gephardt
3. Bonior
4. Kennelly
5. Derrick
6. Lewis
7. Richardson
8. Hoyer
9. Fazio
10. Rosty
11. D i n g e l l
12. Ford
13. s t a r k
14. Waxman
15. Williams
16. Clay
17. Cooper
18. Mike Andrews
19. Stenholm
20. Sabo
21. McDermott
22. Conyers
/
23. Clayton
24. Cantwell
25. Matsui
2 6. Obey
27. Johnston
28. DeLauro
29. Synar
3 0. Wyden
31. Levin
32. Cardin
33. Pomeroy
34. Deutsch
35. Eddie Bernice Johnson
36. S t r i c k l a n d
37. S l a t t e r y
38. Slaughter
�e2-09-1993 17:27
202 225 1234
REPUBLICAN LEADER
P.03
MBBCBSR8 OF THE
REPUBLICAN LEADER'S TASK FORCE ON HEALTH
lOSBD CONGRESS
Bob Michel - Chairman
Newt Gingrich - Co-Chalrman
Bill Archer CTX)
Michael Bilirakis (FL)
Thomas J . Bliley, Jr. fVA)
Michael N. Castle PE)
WiUiam F. Goodling (PA)
Porter J . Goss (FL)
Fred Grandy (IA)
/'
Steve Gunderson (WI)
. / i - ll ill. T^.L- f^r^ D^VJ
^ J . Dennis Hastert (IL)-^'^"^S ^ ^ ^ ^
^
David L. Hobson (OH)
Martin R. Hoke (OH)
Nancy L. Johnson (CH
John R. Kasich (OH)
Jim McCrery (LA)
Howard "Buck" McKeon (CA)
J. Alex McMillan' (NC)
"
Dan Miller (FL)
Carlos J. Moorhead (CA)
Pat Roberts (KS)
Marge Roukema (NJ)
William M. Thomas (CA)
Robert S. Walker (PA)
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
0(4. memo
SUBJECT/TITLE
DATE
Chris Jennings to Hillary Rodham Clinton; re: Budget Discussion &
Health Care Reform (2 pages)
02/09/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefmg Memos - First Lady, 1993 [7]
2006-0885-F
ip2852
RESTRICTION CODES
Pr esidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information [(bXl) of the FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIAl
b(3) Release would violate a Federal statute ((bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute l(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |aXS) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
KR. Document will be reviewed upon request.
�C O N G R E S S I O N A L
S T R A T E G Y
GOAL
To Achieve a S u f f i c i e n t Amount of Congressional Support to Pass
an Acceptable Health Reform I n i t i a t i v e
STEPS TO ACHIEVE GOAL
1.
I n c o r p o r a t e Congress i n t o Process. Develop and implement an
a c t i v e Congressional outreach process t h a t i n c o r p o r a t e s and
i n v e s t s Members i n t o p o l i c y development. (Give s t a t u s ) .
2.
Give Progress Reports Regularly and Consult Before
Introducing/Unveiling B i l l .
The Congress, l i k e the general
p u b l i c , needs to f e e l t h a t there i s progress and they a r e
c o n t r i b u t i n g to i t .
(Process Advocated by Andi).
3.
Consult with and Don't/Onderestimate I n t e r e s t s Congress
Cares About. B u i l d on the environment of open Congressional
c o n s u l t a t i o n by making c e r t a i n the groups and i n t e r e s t s
(noble and otherwise) t h a t the Members c a r e about have a t
l e a s t the perception t h a t they too a r e being s e r i o u s l y
consulted.
As d i f f i c u l t as the provider groups w i l l be, they w i l l be
nothing next to the aging groups, the r u r a l advocates, the
s m a l l b u s i n e s s e s , unions and the Governors. These a r e the
groups the media and your Congressional d e t r a c t o r s would
love t o see you have a b a t t l e with. These a r e a l s o the
groups t h a t the Congress would l i k e hide behind i f they have
another reason to not support.
(This i s extremely d i f f i c u l t
and i n v o l v e s a great deal of cooperation and c o o r d i n a t i o n
between (1) C a r o l Rasco, I r a Magaziner, Judy Feder and the
p o l i c y development f o l k s , (2) l e g i s l a t i v e a f f a i r s , (3)
intergovernmental a f f a i r s , (4) p u b l i c a f f a i r s , (5) p u b l i c
l i a i s o n , (6) the DNC, and (7) the r e l e v a n t Departments and
Agencies).
�4.
Tap and Use F r i e n d l y Members and Committees. Most Members
would loved to be c a l l e d and asked to hold a h e a r i n g t o keep
a p a r t i c u l a r i s s u e or bad guy i n the h e a d l i n e s , or t o make a
statement/appearance i n support of the A d m i n i s t r a t i o n .
5.
C r e a t e Environment i n General P u b l i c t h a t I n a c t i o n or
Incremental Reform i s Unacceptable.
I n t h e end. Congress
responds to what i t b e l i e v e s i t s c o n s t i t u e n t s want. The
g e n e r a l p u b l i c desperately wants something, but does not
know what i t i s and i s extremely v u l n e r a b l e t o suggestion.
The p u b l i c a f f a i r s part of t h i s e f f o r t , t h e r e f o r e , i s
critical.
I f t h i s e f f o r t i s u n s u c c e s s f u l , than t h e myriad
of h e a l t h c a r e i n t e r e s t s w i l l e x c e s s i v e l y i n f l u e n c e the
debate i n Congress. The only suggestion here i s to be
cognizant of where p u b l i c events a r e held and g i v e Members
of Congress (and s t a t e and l o c a l o f f i c i a l s a s w e l l ) the
opportunity to be seen i n the p i c t u r e .
6.
Understand t h a t Most Members Won't Sign Off on Anything
U n t i l they have Seen the Response to the Proposal. We must
get a s many Members to support our proposal from the
beginning as p o s s i b l e . However, d e s p i t e e v e r y t h i n g you and
we do, i t i s important to know t h a t most Members won't jump
i n t o t h e debate with you u n t i l a f t e r you have jumped i n .
That i s why the next point i s c r i t i c a l .
,/
7.
The U n v e i l i n g of the Proposal i s J u s t the Beginning.
Members w i l l demand and have hearings h e l d . D e t r a c t o r s w i l l
have opportunity to engage i n a s s a u l t . Many i n Congress
w i l l want to s i g n i f i c a n t l y a l t e r the package, w h i l e many
o t h e r s may choose that the best course of a c t i o n i s t o hide
behind the p r o t e c t i o n of the statement, " i t ' s t h e
P r e s i d e n t ' s proposal and we must be l o y a l .
8.
L e g i s l a t i v e Strategy Must Be Developed. I f the d e c i s i o n i s
t h a t the access/coverage p r o v i s i o n s must be i n p l a c e w i t h i n
the e a r l y y e a r s , i t seems almost impossible t o see how
anything other than a r e c o n c i l i a t i o n approach w i l l work.
9.
Message That No One W i l l L i k e Everything and We W i l l Be
Reforming the Reform Must Be Given. Nothing w i l l be
p e r f e c t , but we can't accept nothing anymore.
�IN THE END. WE NEED TWO POPULATIONS (don't care about break-down)
1.
Those Members who are on board because they
support the proposal or want to be associated with
it.
2.
Those Members who are on board because they are
afraid of consequences of opposing i t .
Conclusion
To achieve a l l of the above, we must work closely with HHS
Secretary Shalala and her Assistant Secretary for Legislation,
Jerry Klepner. Jerry has already indicated h i s willingness to
provide the resources of the Department to a s s i s t i n developing
l e g i s l a t i v e strategy, analyzing internal (Administration) and
external (congressional) l e g i s l a t i v e i n i t i a t i v e s , and a s s i s t i n g
setting up the data base for the Health Task Force War Room that
Mike Lux w i l l talk about l a t e r . Since I am working for the
Department and have a good working relationship with Jerry, both
Melanne and I are very optimistic about t h i s working out.
To achieve success on my end, I w i l l have to have access to
a number of resources that are currently unavailable. I have
outlined them i n the longer memo and don't believe i t i s
necessary to d e t a i l them at /this time.
*
Immediate Scheduling:
House Majority Leadership and Member Meeting (to follow
up the Senate meeting.
Currently Scheduling a Republican Meeting as well
�February 5, 1993
MEMORANDUM FOR MRS. CLINTON
TO:
I r a Magaziner
FR:
C h r i s Jennings
RE:
Congressional Strategy f o r Health Reform
cc:
Howard Pastor, Steve R i c c h e t t i
F o l l o w i n g up on your r e q u e s t i s an o u t l i n e o f a proposed
s t r a t e g y f o r g a r n i s h i n g s u f f i c i e n t s u p p o r t i n t h e Congress f o r
the C l i n t o n h e a l t h r e f o r m i n i t i a t i v e .
/
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. outline
SUBJECT/TITLE
DATE
re: Congressional Strategy for Health Reform (6 pages)
02/05/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefing Memos - First Lady, 1993 [7]
2006-0885-F
jp2852
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |S U.S.C. SS2(b)l
PI
P2
P3
P4
b(l) National security classified information [(bXl) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIAj
b(3) Release would violate a Federal statute j(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy j(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes [(bX7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIAj
National Security Classified Information |(aXl) of the PRA|
delating to the appointment to Federal office |(aX2) of the PRA|
Release would violate a Federal statute |(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
llnancial information |(aX4) of the PRA|
P5 Release would disclose confidential advice between the President
iind his advisors, or between such advisors [a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(aX6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRIM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�MEMORANDUM
TO:
FR:
RE:
cc:
F i r s t Lady H i l l a r y Rodham C l i n t o n
February 4, 1993
C h r i s Jennings
D o l e , Chafee V i s i t F o l l o w i n g Senate Democrats M e e t i n g
Melanne, Steve R.
F o l l o w i n g y o u r Senate Democrats Meeting, you and y o u r s t a f f
are s c h e d u l e d t o meeting w i t h Senator Dole and Senator Chafee
( R - R I ) , Chairman o f t h e Republican H e a l t h Task Force.
Steve
R i c h e t t i has i n d i c a t e d t h a t t h e r e may be o t h e r s , i n p a r t i c u l a r
Senator Durenberger (R-MN).
ISSUES TO RAISE
* C o n s i s t e n t w i t h t h e P r e s i d e n t ' s appointment o f Senator
Dole as one o f t h e f o u r l e a d C o n g r e s s i o n a l h e a l t h c a r e
r e p r e s e n t a t i v e s , w i l l l o o k f o r w a r d t o b u i l d i n g on what you
f e e l w i l l be a c l o s e and p r o d u c t i v e w o r k i n g r e l a t i o n s h i p .
* I f t h e r e a r e problems, I want t o know about i t . I w i l l
be as r e s p o n s i v e as p o s s i b l e . Based on o u r p r e v i o u s
c o n v e r s a t i o n , I know t h a t t h i s w i l l be a two-way commitment.
* W i l l c o n s u l t Senator Dole as f r e q u e n t l y as p o s s i b l e .
I n t e r e s t e d i n h a v i n g a good r e l a t i o n s h i p w i t h n o t o n l y
Senator Dole, b u t w i t h a l l Republicans committed t o
e f f e c t i v e c o s t containment and u n i v e r s a l coverage.
* O u t l i n e t h e s t r u c t u r e and r o l e s o f Task Force
Groups. Omit ANY d i s c u s s i o n o f i n c o r p o r a t i o n o f
t h e work groups, however. (They s h o u l d n o t know
about t h e Democratic s t a f f r o l e a t t h i s t i m e and
i t i s unwise t o address u n l e s s r a i s e d by them).
and Working
staff into
anything
we b e l i e v e
ISSUES THEY MAY RAISE AND TO DANCE AROUND (as you have)
* They w i l l suggest t h a t t h e A d m i n i s t r a t i o n needs
R e p u b l i c a n s t o pass a b i l l and i t would be b e s t n o t t o draw
s i g n i f i c a n t l i n e s o f d e s t i n c t i o n between t h e way Democrats
and Republicans a r e t r e a t e d .
*
Raise q u e s t i o n s about f i n a n c i n g and how c o s t c o n t a i n m e n t
savings are a l l o c a t e d .
*
Raise q u e s t i o n s about l e g i s l a t i v e s t r a t e g y , i . e . what
w i l l be t i m i n g and t h e l i k e l y l e g i s l a t i v e v e h i c l e .
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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Congressional Briefing Memos – First Lady, 1993 [7]
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White House Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 2
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<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
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2006-0885-F
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MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
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Health Care Task Force
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FolderlD:
Folder Title:
Congressional Briefing Memos - First Lady 1993 [6]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
8
2
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. memo
Chris Jennings to Hillary Rodham Clmton; re: Tomorrow's Finance
Committee Meeting (3 pages)
04/19/1993
P5
002. memo
From Chris Jennings & Steve Richetti; re; Congressional
Update/Strategy for Health Reform (8 pages)
04/14/1993
P5
003. memo
Chris J. to Steve R.; re: Republican Members & Staff
Meetings/Contacts (2 pages)
04/09/1993
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefing Memos - First Lady, 1993 [6]
2006-0885-F
ip2851
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)l
Freedom of information Act - |5 U.S.C. 552(b)l
Pi National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office |(aX2) of the PRA|
P3 Release would violate a Federal statute |(aX3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 F'elease would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information |(bXl) of the FOIAj
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an agency |(bX2) of the FOIAj
b(3) Release would violate a Federal statute I(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy j(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes j(b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions j(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells j(bX9) of the FOIAj
C Closed in accordance with restrictions contained in donor's deed
of gift.
PRIVI. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR . Document will be reviewed upon request.
�DETER.MINED TO BE AN ADMINISTRATIVE
MARKING P'^rE^. 12958 as amended,Sec. 3.^{c)
Initials: ^ ^ \
Date: l " ^ / t W f
MEMORANDUM
P r i v i l e g e d and C o n f i d o n t i a l TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n
C h r i s Jennings, Steve E d e l s t e i n
House T a r g e t i n g S t r a t e g y
Legislative/Congressional D i s t r i b u t i o n L i s t
A p r i l 20, 1993
As was done w i t h t h e Senate, a t a r g e t i n g s e s s i o n was h e l d t o
determine t h e key c o n g r e s s i o n a l d i s t r i c t s needed t o pass h e a l t h
c a r e r e f o r m . To pass t h i s b i l l a s i m p l e m a j o r i t y o f 218 v o t e s
w i l l be r e q u i r e d . While t h e o v e r a l l s t r a t e g y i s s i m i l a r t o t h e
Senate, s u c c e s s f u l l y a c h i e v i n g t h i s g o a l w i l l r e q u i r e a somewhat
d i f f e r e n t approach.
House members, s i n c e t h e y f a c e r e e l e c t i o n every two y e a r s
and r e p r e s e n t , on t h e whole, more homogeneous c o n s t i t u e n c i e s ,
t e n d t o be more r e s p o n s i v e t o p u b l i c p r e s s u r e and t o p a r t i c u l a r
concerns o f t h e i r d i s t r i c t . As a r e s u l t , more so t h a n t h e
Senate, t h e substance o f o u r h e a l t h c a r e r e f o r m package,
e s p e c i a l l y t h e f i n a n c i n g mechanisms, t h e employer r o l e and t h e
o v e r a l l c o s t o f t h e package, w i l l p l a y a much more s i g n i f i c a n t
r o l e i n how members w i l l v o t e .
P a r t i c u l a r elements o f t h e package have t h e p o t e n t i a l t o
s h i f t l a r g e b l o c s o f v o t e s . For example, d e c r e a s i n g t h e burden
on s m a l l employers may i n c r e a s e t h e package' a t t r a c t i v e n e s s t o
b o t h Democrats and Republicans.
I n a d d i t i o n , i f t h e package
i n c l u d e s a l o n g - t e r m care b e n e f i t t h a t s e n i o r s groups a r e e x c i t e d
about i t may i n c r e a s e a r e a b i l i t y t o a t t r a c t more c o n s e r v a t i v e
members from s t a t e s w i t h l a r g e e l d e r l y p o p u l a t i o n s whom we would
o t h e r w i s e have l i t t l e e x p e c t a t i o n o f a t t r a c t i n g .
C o n s u l t a t i o n w i t h t h e House Leadership y i e l d e d 79 members
who t h e y a r e c o n f i d e n t w i l l s u p p o r t t h e r e f o r m b i l l .
To reach
our g o a l o f 218 from t h e r e , w i l l r e q u i r e t h e t a r g e t i n g o f r o u g h l y
250 members. The s t a t e s t a r g e t e d f o r o u r Senate s t r a t e g y match
w e l l w i t h those t a r g e t e d f o r t h e House, p a r t i c u l a r l y t h e
Republicans.
I n a d d i t i o n , i n n o n t a r g e t e d s t a t e s e x i s t i n g DNC
resources can be c o o r d i n a t e d w i t h resources o f f r i e n d l y i n t e r e s t
groups and o f s u p p o r t i v e C o n g r e s s i o n a l , S t a t e and L o c a l o f f i c i a l s
t o m o b i l i z e on t h e l o c a l l e v e l as needs a r i s e .
Here i n Washington, we must work w i t h l e a d i n g House members,
t h r o u g h t h e v a r i o u s caucuses and w i t h t h e h e l p o f i n f l u e n t i a l
i n t e r e s t groups t o b u i l d a c o a l i t i o n o f 218 members. From t h e
base o f 74 t h e l e a d e r s h i p i d e n t i f i e d , we added members o f t h e
t h r e e committees o f j u r i s d i c t i o n (Ways and Means, Energy and
Commerce and Education and Labor) and members o f v a r i o u s caucuses
which s h o u l d c o n t a i n s u b s t a n t i a l s u p p o r t i f we a r e t o be
s u c c e s s f u l ( C o n g r e s s i o n a l Black Caucus, C o n g r e s s i o n a l H i s p a n i c
Caucus, Congressional Women's Caucus, Mainstream Forum, and t h e
R u r a l H e a l t h Task F o r c e ) .
�Selected members of the rank and f i l e and the large freshman
c l a s s were also targeted. Many of these have endorsed Rep.
McDermott's single payer b i l l , the majority of whom we w i l l need
with us i n the end.
In addition to the Democratic members, a group of moderate
Republicans, were also identified. I n selecting t h i s group,
votes on the Family and Medical Leave B i l l and the Minimum Wage
increase (for those members who have served more than 2 terms)
were analyzed. This group may well provide the margin of
victory.
Attached i s the House Leadership's l i s t of r e l i a b l e votes
for health care reform as well as a l i s t s of the targeted
Democratic and Republican members by state. Pertinent
information such as relevant committee assignments, caucus
membership, b i l l sponsorship have been noted. Since support w i l l
depend very heavily on the s p e c i f i c s of the package, t h i s l i s t
may be modified as decisions are made regarding the proposal
i t s e l f . F i n a l l y , by combining the information from these House
l i s t s with the Senate l i s t , including committee assignments and
voting records, an overall state target l i s t by rank was created.
�HOUSE LEADERSfflP DEMOCRATIC RELIABLES
Member
Background Information
ARIZONA:
Coppersmith
English
Education and Labor, Caucus for Women's Issues, Mainstream Forum,
Freshman
Pastor
Hispanic Caucus
ARKANSAS:
Lambert
Energy and Commerce, Caucus for Women's Issues, Rural Health Care
Coalition, Freshman
Thornton
Mainstream Forum
CALIFORNIA:
Fazio
Rural Health Care Coalition
Matsui
Ways and Means
Mineta
Pelosi
Caucus for Women's Issues, McDermott Cosponsor
Stark
Ways and Means, Subcommittee on Health, Chair; Rural Health Care
Coalition; McDermott Cosponsor
Waxman
Energy and Commerce, Subcommittee on Health, Chair
CONNECTICUT:
DeLauro
Caucus for Women's Issues
Gedjenson
McDermott Cosponsor
Kennelly
Ways and Means, Health Subcommittee; Caucus for Women's Issues
�FLORIDA:
Bacchus
Deutsch
Johnston
GEORGIA:
Lewis
Ways and Means, Health Subcommittee; Congressional Black Caucus;
McDermott Cosponsor
HAWAD:
Abercrombie
McDermott Cosponsor
IDAHO:
LaRocco
Rural Health Care Coalition, Mainstream Forum
ILUNOIS:
Collins
Energy and Commerce, Caucus for Women's Issues, Congressional Black
Caucus, McDermott Cosponsor
Costello
Rural Health Care Coalition, Mainstream Forum
Evans
Rural Health Care Coalition, McDermott Cosponsor
Rostenkowski
Ways and Means
INDIANA:
Sharp
Energy and Commerce
KENTUCKY:
Mazzoli
Judiciary
Natcher
MARYLAND:
Cardin
Hoyer
Ways and Means, Subcommittee on Health
�MASSACHUSETTS:
Frank
Judiciary, McDermott Cosponsor
Kennedy
McDermott Cosponsor
Markey
Energy and Commerce
Olver
McDermott Cosponsor
Studds
Energy and Commerce, Health Subcommittee; Rural Health Care Coalition,
McDermott Cosponsor
MICHIGAN:
Bonior
Carr
Mainstream Forum, McDermott Cosponsor
Dingell
Energy and Commerce
Ford
Education and Labor
Levin
Ways and Means, Subcommittee on Health
Kildee
Education and Labor
MINNESOTA:
Sabo
McDermott Cosponsor
MISSOURI:
Danner
Caucus for Women's Issues, Rural Health Care Coalition, Freshman
Gephardt
Wheat
Rules, Congressional Black Caucus
MONTANA:
Williams
Education and Labor, Rural Health Care Coalition
NEBRASKA:
Hoagland
Ways and Means, Health Subconmiittee; Rural Health Care Coalition;
Mainstream Forum
�NEW YORK:
Ackerman
McDermott Cosponsor
Engel
Education and Labor, McDermott Cosponsor
Lowey
Caucus for Women's Issues, Mainstream Forum
Manton
Energy and Commerce, McDermott Cosponsor
Schumer
Judiciary, McDermott Cosponsor
Slaughter
Rules, Caucus for Women's Issues, Rural Health Care Coalition, Mainstream
Forum
NORTH DAKOTA:
Pomeroy
OHIO:
Brown
Energy and Commerce, Health Subcommittee; Freshman
Sawyer
Education and Labor
Strickland
Education and Labor, Rural Health Care Coalition, Freshman
OKLAHOMA:
Synar
Energy and Commerce, Health Subcommittee; Judiciary, Rural Health Care
Coalition
OREGON:
Kopetski
Ways and Means
Wyden
Energy and Commerce, Health Subcommittee; Rural Health Care Coalition
RHODE ISLAND:
Reed
Education and Labor, Juciciary
SOUTH CAROLINA:
Clybum
Congressional Black Caucus, Single Payer, Freshman
Derrick
Rural Health Care Coalition
�TEXAS:
Bryant
Energy and Commerce, Health Subcommittee; Judiciary
Frost
Rules
Geren
Mainstream Forum
Lauglin
Rural Health Care Coalition
V1RGINL\:
Byrne
Caucus for Women's Issues, Freshman
Moran
Mainstream Forum
Scott
Education and Labor, Judiciary, Congressional Black Caucus, McDermott
Cosponsor, Freshman
WASHINGTON:
Cantwell
Caucus for Women's Issues, Freshman
Kreidler
Energy and Commerce, Health Subcommittee; Freshman
McDermott
Ways and Means, Health Subcommittee; Rural Health Care Coalition; Sponsor
of Single Payer Bill
Swift
Energy and Commerce, Rural Health Care Coalition
Unsoeld
Education and Labor, Caucus for Women's Issues, Rural Health Care Coalition
WEST VIRGINL\:
Mollohan
Rural Health Care Coalition
Rahall
Rural Health Care Coalition
Wise
Rural Health Care Coalition
WISCONSIN:
Kleczka
Ways and Means, Subcommittee on Health
Obey
Rural Health Care Coalition
�HOUSE REPUBUCAN TARGETS BY STATE
CALFORNIA:
Horn
Freshman
Huffington
Freshman, Banking/Small Business
CONNECTICUT:
N. Johnson
Caucus for Women's Issues, Task Force on Health
Shays
Budget Committee
DELAWARE:
Castle
Freshman, Banking, Finance & Urban Affairs, Task Force on Health
FLORIDA:
Diaz-Belhart
Freshman, Congressional Hispanic Caucus
Goss
Task Force on Health, Rules
Ros-Lehtinen
Congressional Hispanic Caucus
Yoimg
Appropriations
IOWA:
Grandy*
Ways and Means, Task Force on Health, Rural Health Care Coalition
Leach
Banking, Finance & Urban Affairs, Rural Health Care Coalition
MAINE:
Snowe
Budget, Caucus for Women's Issues, Rural Health Care Coalition
MARYLAND:
Morella
Caucus for Women's Issues
MASSACHUSETTS:
Blute
Freshman
MINNESOTA:
Ramstad
Judiciary, Small Business
�NEW JERSEY:
Franks
Freshman, Budget
Roukema
Saxton
Education and Labor, Task Force on Health
C. Smith
Zinmier
Veterans Affairs
NEW YORK:
Boehlert
Rural Health Care Coalition
Fish
Judiciary
Gilman
Rural Health Care Coalition
Houghton*
Ways and Means
Lazio
Freshman, Banking/Finance & Urban Affairs, Budget
McHugh
Freshman
Molinari
Eduaction and Labor, Caucus for Women's Issues
Quinn
Freshman, Veterans Affairs
Walsh
Appropriations, Rural Health Care Coalition
OHIO:
Hoke
Freshman, Task Force on Health, Budget
Regula
Appropriations
PENNSYLVANL\:
McDade
Appropriations
Weldon
RHODE ISLAND:
Matchley
Small Business
�WISCONSIN:
Klug
Energy and Commerce
Petri
Education and Labor, Rural Health Care Coalition
* Only members of Republican Target list to vote against Family and Medical Leave
�HOUSE DEMOCRATIC TARGETS BY STATE
MEMBER
REASON TARGETED
ALABAMA:
HiUiard
Congressional Black Caucus, Single, Freshman
CAUFORNL\:
Becerra
Education and Labor, Judiciary, Hispanic Caucus, McDermott Cosponsor,
Freshman
Beilenson
Rules, McDermott Cosponsor
Berman
Judiciary, McDermott Cosponsor
Condit
Rural Health Care Coalition, Mainstream Forum
Dellums
Congressional Black Caucus, McDermott Cosponsor
Dixon
Congressional Black Caucus
Dooley
Rural Health Care Coalition
Edwards
Judiciary, McDermott Cosponsor
Eshoo
Caucus for Women's Issues, Freshman
Hamburg
McDermott Cosponsor, Freshman
Harman
Caucus for Women's Issues, Freshman
Lantos
McDermott Cosponsor
Lehman
Energy and Commerce, Rural Health Care Coalition
Martinez
Education and Labor, McDermott Cosponsor
Miller
Education and Labor, McDermott Cosponsor
Roybal-Allard
Caucus for Women's Issues, Hispanic Caucus, McDermott Cosponsor,
Freshman
Schenk
Energy and Commerce, Caucus for Women's Issues, Freshman
Torres
Hispanic Caucus, McDermott Cosponsor
�Tucker
Congressional Black Caucus, McDermott Cosponsor
Waters
Congressional Black Caucus, Caucus for Women's Issues, McDermott
Cosponsor
Woolsey
Education and Labor, Caucus for Women's Issues, McDermott Cosponsor,
Freshman
COLORADO:
Skaggs
Mainstream Forum
FLORIDA:
Brown
Caucus for Women's Issues, Congressional Black Caucus, Freshman
Gibbons
Ways and Means
Hastings
Congressional Black Caucus, Freshman
Meek
Caucus for Women's Issues, Congressional Black Caucus, Freshman
Peterson
Rural Health Care Coalition
Thurman
Caucus for Women's Issues, Freshman
GEORGIA:
Bishop
Congressional Black Caucus, Freshman
Darden
Mainstream Forum
Johnson
Mainstream Forum, Freshman
McKinney
Caucus for Women's Issues, Congressional Black Caucus, McDermott
Cosponsor, Freshman
Rowland
Energy and Commerce, Rural Health Care Coalition
HAWAH:
Mink
Education and Labor, Caucus for Women's Issues, Rural Health Care
Coalition, McDermott Cosponsor
�ILUNOIS:
Gutierrez
Hispanic Caucus, Freshman
Lipinski
Mainstream Forum
Poshard
Rural Health Care Coalition, Mainstream Forum
Reynolds
Ways and Means, Congressional Black Caucus, McDermott Cosponsor,
Freshman
Rush
Congressional Black Caucus, Freshman
Sangmeister
Judiciary
Yates
McDermott Cosponsor
INDIANA:
Long
Caucus for Women's Issues, Rural Health Care Coalition
McCloskey
Rural Health Care Coalition, Single Payer
Roemer
Education and Labor, Mainstream Forum
Visclosky
KANSAS:
Glickman
Judiciary
Slattery
Energy and Commerce, Rural Health Care Coalition, Mainstream Forum
KENTUCKY:
Baesler
Education and Labor, Rural Health Care Coalition, Freshman
LOUISUNA:
Fields
Congressional Black Caucus, Freshman
Hayes
Mainstream Forum
Jefferson
Ways and Means, Congressional Black Caucus, Mainstream Forum
�MAINE:
Andrews
McDermott Cosponsor
MARYLAND:
Mfume
Congressional Black Caucus, McDermott Cosponsor
Wynn
Congressional Black Caucus, Freshman
MASSACHUSETTS:
Meehan
Freshman
Moakley
Rules, McDermott Cosponsor
Neal
Ways and Means
MICHIGAN:
Barcia
Freshman
Can-
Mainstream Forum
Collins
Caucus for Women's Issues, Congressional Black Caucus, McDermott
Cosponsor
Conyers
Judiciary, Congressional Black Caucus, McDermott Cosponsor
Stupak
Rural Health Care Coalition, Freshman
MINNESOTA:
Minge
Rural Health Care Coalition, Freshman
Oberstar
Riu^al Health Care Coalition, McDermott Cosponsor
Peterson
Rural Health Care Forum
Vento
McDermott Cosponsor
MISSISSIPPI:
Montgomery
Rural Health Care Coalition
�MISSOURI:
Clay
Education and Labor, Congressional Black Caucus, McDermott
Cosponsor
Skelton
Rural Health Care Coalition, Mainstream Forum
Volkmer
NEW HAMPSHIRE:
Swett
Rural Health Care Coalition, Mainstream Forum
NEW JERSEY:
Andrews
Education and Labor
Hughes
Rural Health Care Coalition
Klein
Freshman
Menendez
Hispanic Caucus, Freshmsin
Pallone
Energy and Commerce, Mainstream Forum
Payne
Education and Labor, Congressional Black Caucus, McDermott
Cosponsor
Torricelli
NEW MEXICO:
Richardson
Energy and Commerce
NEW YORK:
Flake
Congressional Black Caucus, McDermott Cosponsor
Hinchey
McDermott Cosponsor, Freshman
Hochbrueckner
McDermott Cosponsor
LaFalce
Rural Health Care Coalition, McDermott Cosponsor
Maloney
Caucus for Women's Issues, McDermott Cosponsor, Freshman
McNulty
Ways and Means
�Nadler
Judiciary, McDermott Cosponsor, Freshman
Owens
Education and Labor, Congressional Black Caucus, McDermott
Cosponsor
Rangel
Ways and Means, Congressional Black Caucus, McDermott Cosponsor
Serrano
Hispanic Caucus
Towns
Energy and Commerce, Congressional Black Caucus, Rural Health Care
Coalition, McDermott Cosponsor
Velazquez
Caucus for Women's Issues, Hispanic Caucus, McDermott Cosponsor,
Freshman
NORTH CAROLINA:
Clayton
Congressional Black Caucus, McDermott Cosponsor, Freshman
Hefner
Rural Health care Coalition, Mainstream Forum
Lancaster
Rural Health Care Coalition, Mainstream Forum
Neal
Rural Health Care Coalition, Mainstream Forum
Rose
Rural Health Care Coalition
Price
Mainstream Forum
Watt
Judiciary, Congressional Black Caucus, Freshman
OHIO:
Applegate
Rural Health Care Forum, Mainstream Forum
Fingerhut
Freshman
Kaptur
Caucus for Women's Issues, Rural Health Care Coalition
Stokes
Congressional Balck Caucus, Health Brain Trust, Chair
OKLAHOMA:
Brewster
Ways and Means, Rural Health Care Coalition, Mainstream Forum
English
Rural Health Care Coalition, Mainstream Forum
McCurdy
Rural Health Care Coalition, Mainstream Forum
�OREGON:
De Fazio
Rural Health Care Coalition
Furse
Caucus for Women's Issues, Rural Health Care Coalition, McDermott
Cosponsor, Freshman
PENNSYLVANIA:
Blackwell
Congressional Black Caucus
Borski
McDermott Cosponsor
Coyne
Ways and Means
Foglietta
Kanjorski
Rural Health Care Coalition
Klink
Education and Labor, Freshman
Margolies-Mezvinsky Energy and Commerce, Caucus for Women's Issues, Freshman
McHale
Freshman
Murtha
Mainstream Forum
SOUTH CAROLINA;
Spratt
Rural Health Qu-e Coalition, Mainstream Forum
SOUTH DAKOTA:
Johnson
Rural Health Care Coalition, Mainstream Forum
TENNESEE:
Clement
Rural Health Care Coalition, Mainstream Forum
Cooper
Energy and Commerce, Rural Health Care Coalition, Mainstream Forum
Ford
Ways and Means, Congressional Black Caucus
Gordon
Rules, Rural Health Care Coalition, Mainstream Forum
Uoyd
Caucus for Women's Issues, Rural Health Care Coalition
Tanner
Rural Health Care Coalition, Mainstream Forum
�•TEXAS:
Andrews
Ways and Means
Brooks
Judiciary
Chapman
Coleman
Rural Health Care Coalition, Mainstream Forum
de la Garza
Edwards
Hispanic Caucus
Gonzalez
Green
Rural Health Care Coalition, Mainstream Forum
Johnson
Ortiz
Education and Labor, Freshman
Pickle
Caucus for Women's Issues, Congressional Black Caucus, Freshman
Sarpalius
Hispanic Caucus, Rural Health Care Coalition
Tejeda
Ways and Means
Washington
Rural Health Care Coalition, Mainstream Forum
Wilson
Hispanic Caucus, Freshman
UTAH:
Energy and Commerce, Judiciary, Congressional Black Caucus
Shepherd
Rural Health Care Coalition, Mainstream Forum
Caucus for Women's Issues, Freshman
VIRGINIA:
Boucher
Energy and Commerce, Judiciary, Rural Health Care Coalition, Mainstream
Forum
Payne
Ways and Means, Rural Health Care Coalition, Mainstream Forum
WASHINGTON:
Dicks
Inslee
�* * * * * PRIVILEGED AND C&fmBEfmXC * * * * *
TARGET STATES BY RANK*
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NEW YORK
NEW JERSEY
CALIFORNL\
FLORIDA
PENNSYLVANIA
MISSOURI
KANSAS
OREGON
LOUSIANA
CONNECTICUT
MINNESOTA
MONTANA
TEXAS
NEVADA
NEBRASKA
OKLAHOMA
ALABAMA
RHODE ISLAND
MAINE
DELAWARE
GEORGL\
VIRGINL\
ILLINOIS
VERMONT
UTAH
ARIZONA
NEW MEXICO
KENTUCKY
SOUTH CAROLINA
NORTH CAROLINA
TENNESSEE
NORTH DAKOTA
INDIANA
MICHIGAN
WYOMING
DETERMINED TO BE AN ADMINISTRATIVE
MARKINGJ'er EX). 12958 as amended, Sec. 3.3 (c)
lnitlals::fe£_ Date:l:24-^^
Ranking based on combination of Senate and House targeting priorities
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECT/TITLE
Chris Jennings to Hillary Rodham Clinton; re: Tomorrow's Finance
Committee Meeting (3 pages)
04/19/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
(Congressional Briefmg Memos - First Lady, 1993 [6]
2006-0885-F
jp2851
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�SPECIFIC POINTS TO HIT IN DISCUSSIONS WITH THE FINANCE MEMBERS
State Importance of Finance Committee. The Finance
Conunittee f e e l s that i t i s the most important Committee i n
the Senate, p a r t i c u l a r l y as i t r e l a t e s to health care
reform. I t i s , therefore, advisable to acknowledge the
Committee's role and history, as well as the many Members
who have been active i n health reform. (See attached
summaries).
Discuss Importance of Bipartisan E f f o r t . I t i s important to
stress how determined the President and you are to making
the work on t h i s l e g i s l a t i o n a bipartisan e f f o r t .
Acknowledge the longstanding tradition of bipartisanship on
the Finance Committee. ( I f the Republicans complain about
how they have been treated inequitably, you may want to
acknowledge that they have been treated on a somewhat
separate basis, but also on an equal basis. You could c i t e
the numerous meetings — see attached l i s t of meetings —
that we have held with Members and/or s t a f f ) .
Provide Update on Timing of President's Decisions.
Acknowledge the two week delay i n forwarding the f i n a l
working document to the President, but ONLY two weeks.
Stress that you anticipate that the b i l l w i l l be unveiled
and introduced soon thereafter.
I l l u s t r a t e Commitment to Pass Health Care This Year.
Because of the doubts surrounding health care, i t i s
advisable to emphasize that the President i s strongly
committed to passing health reform t h i s year.
I l l u s t r a t e Understanding of Timing and Process Constraints.
Acknowledge that the Finance Committee w i l l kept very busy
i f i t i s to mark-up both the Reconciliation b i l l and then
the health reform i n i t i a t i v e . Reiterate that i t i s the
President's desire to do j u s t that, though, and how
confident the President and you are that t h i s w i l l be
achieved with the bipartisan cooperation and guidance of
t h i s Committee. ( I f any question i s raised about the
Committee j u r i s d i c t i o n issue, you should probably state that
the President and you w i l l be working closely with the
Congressional Leadership on the matter, but that you could
not imagine that the Finance Committee would not have
primary j u r i s d i c t i o n over the b i l l ) .
�Give Commitment to Consultation. Indicate how determined
the President and you are to building on the consultation
that has already taken place. Discuss how committed the
President and you are to consulting with Senator Mitchell,
Senator Dole, Chairman Moynihan, Senator Packwood (the
Ranking Republican of the Finance Committee) and the rest of
the Committee over the next few weeks.
Acknowledge Perception Problem that Decisions are Made.
Acknowledge how anyone reading the papers might conclude
that decisions about cost control and financing have been
made. Explain how t h i s i s not the case, and that the
President does not desire to make f i n a l decisions i n t h i s
regard u n t i l after he has had direct conversations with the
Senate and House Leadership (including committees) from both
sides of the a i s l e .
Provide General Outline of Direction the President Mav Be
Headed. Although some Members have heard I r a give a general
outline of the l i k e l y direction health reform i s going, many
(and a l l Republicans) have not. This should not be a long
or detailed discussion, but i t would be good to i l l u s t r a t e
your command of the complexities of health reform. Although
they ( w i l l then) know no decisions have been made on cost
containment and financing, they w i l l want to hear you at
l e a s t acknowledge the issues. Since v i r t u a l l y every one of
these Members are from predominantly r u r a l states, some
l i k e l y to be well received issues you or I r a may want to
touch on are r u r a l and state f l e x i b i l i t y issues.
Request Suggestions. Guidance, and Questions. As i s the
case with a l l Members, they w i l l want to give t h e i r own
views. So you do not have to do a monologue, and go into
a l l the d i f f i c u l t issues on your own. Throw back some of
the questions to them. They w i l l be appreciative of the
opportunity to speak and be heard.
Consider Concluding with a Suggestion for Another Finance
Committee Meeting. Because t h i s Committee i s so c r i t i c a l ,
j u s t as you are doing with the Ways and Means Subcommittee,
you or I r a and Judy should seriously consider suggesting
holding substantive meetings with t h i s Committee during the
next few weeks.
�SENATE FINANCE COMMITTEE
DEMOCRATS
DANIEL PATRICK MOYNIHAN (D-New York) (Finance Committee Chairman)
As you know, the new Chairman has yet to take a position on
national health reform. His interests l i e primarily i n the areas
of Social Security and welfare reform. He i s not a d e t a i l person
when i t comes to the health care debate. Although a number of
people have discussed health care with him, i t i s notable that
the one who seemed to catch his fancy the most was Alan Enthoven.
The only health care-specific issues that the Senator i s
p a r t i c u l a r l y known for are: (1) his advocacy and support of New
York hospitals, (2) his concern about the mentally i l l and the
homeless, (3) his support for chemical and substance abuse i n a
benefit package, and, most recently, (4) his support of
innovation at the state l e v e l . On the l a t t e r point, he
introduced a l i b e r a l i z e d Medicaid managed care measure that the
NGA strongly supported. (This l e g i s l a t i o n was opposed by the
Children's Defense Fund because they f e l t that savings through
t h i s cost containment approach would be at the expense of the
Medicaid population).
Most recently, the Chairman and his s t a f f have been rather
pessimistic about the chances for health reform t h i s year. The
compexity, controversy, and potential expense of i t frighten
them. The Chairman, i n comments that have been somewhat
retracted by staff, has indicated his concern about any large new
taxes to fund the program and any use of price controls to
contain costs. Although he has stated to you h i s willingness to
r a i s e whatever tax i s necessary for the elimination and
integration of Medicaid into the new system, as well as a one
card for a l l system, his nervous statements should not be t o t a l l y
written off.
Senator Moynihan's most recent communication was i n a l e t t e r
to the President, i n which he reiterated his strong support for a
health security card and i n which he proposes the idea of merging
the health card and Social Security card into one.
I n the
l e t t e r , he also expressed his strong concerns that the Social
Security Commissioner has not yet been appointed.
�MAX
BAUCUS (D-Montana)
In health c i r c l e s . Senator Baucus i s best known for h i s
early 1980s work to reform the private Medicare supplemental
"Medigap" insurance market. The provisions came to be known as
the "Baucus" Amendments, for which he i s very proud. I n
addition. Senator Baucus was a member of the Pepper Commission.
Most notably, however, he voted against the f i n a l access
recommendations (they won by j u s t an 8-7 vote), primarily because
of h i s concern about the proposal's impact on small business.
Baucus i s concerned about any proposal that u t i l i z e s any employer
requirement to help finance health care. As a r e s u l t of t h i s
concern, and because the Canadian system i s quite popular i n
Montana, he i s a single-payer advocate.
He i s a member of a 5-Member working group (Daschle, Kerrey,
Bingaman, and Wofford) that i s looking at alternatives to
employer-based models. This group wrote to you on February 3rd
on principles which should be incorporated into a managed
competition framework including universal participation (no optouts), state or regional administration, and phase-in of coverage
for long-term care. More recently, on March 30th, he sent a
l e t t e r with 8 Democratic Senators from r u r a l states expressing
their belief that the allocation of health budgets among states
should not be based on h i s t o r i c a l costs but on the true cost of
providing appropriate level of care to a state's residents.
Senator Baucus believes health reform must include r e a l cost
containment, s e n s i t i v i t y to legitimate small business concerns,
and the a d v i s a b i l i t y of a special consideration for r u r a l
concerns. We have been advised by s t a f f that he i s very
committed to the concept of every c i t i z e n being i n the health
a l l i s a n c e (or HPIC). In addition, he apparently would be
supportive of a VAT tax for health care.
DAVID BOREN (D-Oklahoma)
Although not generally associated as a health care reform
leader, Senator David Boren i s the lead sponsor of the Senate
companion (S. 3299) to the House Conservative Democratic Forum's
managed competition b i l l . In recent months, however, he has
become more sensitive to the i n a b i l i t y of the Conservative
Democratic Forum's approach to adequately address the access or
cost containment challenge. Like v i r t u a l l y every member of the
Committee, he considers himself to be a strong supporter of r u r a l
health and small business issues. Like Senator Bradley, though,
he has been t r a d i t i o n a l l y more focused on tax policy than health
care.
�There have been some exceptions t o the r u l e o f Senator
Boren's non-interest/association w i t h heath care. I n a d d i t i o n t o
the CDF b i l l , he i s now supporting the concept o f s i g n i f i c a n t
s t a t e f l e x i b i l i t y w i t h i n the context o f any h e a l t h reform
proposal (OK Governor Walters i s pushing a major i n i t i a t i v e now
and wants some s i g n i f i c a n t a s s i s t a n c e / r e l i e f from the Federal
Government). I n a d d i t i o n , he sponsored l e g i s l a t i o n l a s t year t o
provide f o r an extension on higher payments t o r u r a l h o s p i t a l s
t h a t d i s p r o p o r t i o n a t e l y serve Medicare p a t i e n t s . (This
l e g i s l a t i o n passed the Congress, but was vetoed when then
President Bush vetoed the tax b i l l ) .
BILL BRADLEY (D-New Jersey)
Senator Bradley i s known more f o r h i s work on tax p o l i c y
than f o r h i s work on h e a l t h care f i n a n c i n g .
He has i n d i c a t e d an
i n t e r e s t i n i n t r o d u c i n g health care reform l e g i s l a t i o n s i m i l a r t o
managed competition model t h a t he believes the President has been
advocating. The one exception t o h i s general support o f t h e
C l i n t o n h e a l t h care approach may w e l l be w i t h regard t o
p r e s c r i p t i o n drugs. As a Senator representing the s t a t e which i s
the c a p i t a l o f the pharmaceutical i n d u s t r y , Bradley i s a f i e r c e
advocate f o r the i n d u s t r y and t h e i r concerns. With Senator
Hatch, he l e d the f i g h t against Senator Pryor's e f f o r t t o
i n f l u e n c e the i n d u s t r y t o c o n t a i n p r i c e increases t o i n f l a t i o n by
l i n k i n g t h e i r p r i c i n g behavior t o e l i g i b i l i t y f o r tax c r e d i t s .
(The Pryor proposal was endorsed by President C l i n t o n i n t h e
campaign).
As a member o f the I n f a n t M o r t a l i t y Commission, Senator
Bradley i s proud o f h i s work t o ensure t h a t the Medicaid program
was expanded t o eventually cover pregnant women and k i d s . He
also i s a strong advocate f o r p r e v e n t a t i v e care services. He has
sponsored several b i l l s on tobacco, i n c l u d i n g revised warning
l a b e l s and tobacco as a drug t o be included i n the Drug Free
Schools program.
L a s t l y , although he incurred the wrath o f some
aging groups w i t h h i s o p p o s i t i o n t o p r e s c r i p t i o n drug p r i c e
c o n s t r a i n t , he has been a long-time supporter o f home and
community-based long term care services, p a r t i c u l a r l y w i t h regard
t o r e s p i t e care services.
GEORGE MITCHELL (D-Malne) (Senate M a j o r i t y Leader)
Few M a j o r i t y Leaders i n the Senate's h i s t o r y have been as
i n t e r e s t e d and as committed t o passing comprehensive h e a l t h care
reforms.
M i t c h e l l i s the sponsor o f two Senate Democratic
leadership comprehensive reform b i l l s dealing, r e s p e c t i v e l y , w i t h
access (S. 1227, Health America) and long-term care (S. 2571, t h e
Long Term Care Family Security A c t ) .
�Senator M i t c h e l l i s leading an e f f o r t by the Democratic
P o l i c y Committee ( w i t h i n the Senate) t o attempt t o develop
consensus on the h e a l t h care issue w i t h i n the Democratic p a r t y .
For weeks now, I r a and Judy have been holding very successfuly
b r i e f i n g s w i t h , on average, 30 plus Senate Democrats a meeting.
Senator M i t c h e l l believes t h a t the s i n g l e payer approach i s
not p o l i t i c a l l y f e a s i b l e . However, a t t h i s p o i n t , h i s primary
concern and commitment i s t o push through anything, which can be
defined as t r u l y comprehensive, t h a t w i l l pass the Congress. He
has repeatedly i n d i c a t e d h i s i n t e n t i o n t o work c l o s e l y w i t h the
President t o help assure t h a t a b i l l can make i t t o the White
House before the end o f the 103rd Congress.
As you know, however, he was a strong advocate o f
i n c o r p o r a t i n g the h e a l t h care l e g i s l a t i o n i n t o the budget
r e c o n c i l a t i o n b i l l . Having f a i l e d t h a t , he and h i s lead s t a f f
are now r e l a t i v e l y p e s s i m i s t i c about a t t r a c t i n g enough
Republicans t o support a health reform i n i t i a t i v e w i t h o u t having
to make major, and perhaps unacceptable, concessions. Just
yesterday, (Sunday, A p r i l 18th), he i n d i c a t e d h i s o p p o s i t i o n t o
p r i c e c o n t r o l s , h i s uneasiness w i t h but possible openess t o a VAT
tax f o r h e a l t h , and h i s desire t o wean out a l l the fraud, abuse
and waste BEFORE contemplating large tax hikes.
DAVID PRYOR (D-Arkansas) (Aging Committee Chairman and Secretary
of the Senate)
Senator David Pryor i s p a r t o f the Senate leadership
(Secretary of the Democratic Conference). As the Chairman o f the
Senate Special Committee on Aging, he i s w e l l l i k e d and respected
by the powerful aging advocacy cormnunity. I n a d d i t i o n , he i s one
of the few Democrats t h a t the small business community genuinely
t r u s t s . Further, h i s status as a former Governor and h i s
advocacy o f state-based approaches t o comprehensive reforms has
gained him a great deal of good w i l l w i t h the Governors.
Although an unassuming Member and one who does not get o v e r l y
involved i n d e t a i l e d p o l i c y discussions, he has also emerged as
one o f the most i n f l u e n t i a l and best l i k e d Members o f the Senate.
A l l o f these r o l e s ensure t h a t he w i l l be a p a r t i c u l a r l y key
player on the h e a l t h care f r o n t .
I n terms of h e a l t h care p r i o r i t i e s , drug cost containment i s
the f i r s t , second, and t h i r d highest p r i o r i t y f o r Senator Pryor.
The concept o f l i n k i n g drug cost containment t o tax c r e d i t s
(embodied i n Pryor's P r e s c r i p t i o n Drug Cost Containment Act —
S. 2000) was endorsed by President C l i n t o n .
�In addition to h i s drug cost containment interests, he also
has a notable l e g i s l a t i v e achievement record i n r u r a l health
( r e l i e f for hospitals and incentives for primary care doctors i n
medically underserved areas), state-based reform ( h i s NGA and
Clinton candidate-endorsed Leahy/Pryor b i l l ) , and long-term care
(his proposal for Federal standards for private long-term care
insurance p o l i c i e s ) .
DONALD REIGLE (D-Mlchigan) (Finance Medicaid Subc. Chairman)
Senator Riegle considers himself to be a major player i n the
health care debate. He i s Chairman of the Finance Subcommittee
on Medicaid and was a lead sponsor of the Mitchell, Rockefeller,
Kennedy "play or pay" health care reform proposal. He has always
f e l t he did not get adequate credit for h i s work on the b i l l .
Although he sponsored t h i s b i l l , he appears to be extremely
w i l l i n g to sign on to v i r t u a l l y any approach that achieves
universal coverage and cost containment.
Senator Riegle i s very interested i n many health issues,
including: c h i l d immunization programs, r u r a l health care.
Medicare prescription drug coverage, r e t i r e e health l i a b i l i t y
concerns, long-term care, and a host of others. Senator Riegle
strongly believes that cost containment savings should be used to
help reform the health care system — NOT for d e f i c i t reduction.
Most recently. Senator Riegle has pushed h i s outreach
efforts with the Medicare Qualified Medicare Beneficiary (QMB)
program. The QMB program pays for the deductibles, premiums and
copays of low-income Medicare beneficiaries. Unfortunately, only
about 50 percent of the e l i g i b l e population receive the benefit.
This program, because i t i s p a r t i a l l y underwritten by the states,
i s one of the most unpopular benefits that the states support.
(Most of the states believe there are higher p r i o r i t i e s ) . At any
rate. Senator Riegle has introduced l e g i s l a t i o n to expand
outreach e f f o r t s at SSA offices and other areas.
(The
Administration has not yet taken a formal position y e t ) .
JAY ROCKEFELLER (D-West Virginia) (Finance Medicare Subcommittee
Chairman)
Senator Rockefeller views himself as being (and i s ) B i l l
Clinton's number one health care advocate. He was a t i r e l e s s
campaigner and defender of the Clinton health care plan and was a
National Co-Chair of the Clinton campaign. Rockefeller i s the
current Chairman of the Finance Subcommittee on Medicare and Long
Term Care. He also has chaired the Pepper Commission and the
National Commission on Children.
�In addition. Senator Rockefeller i s the founder and Chairman
of the Alliance for Health Reform, a nonpartisan organization
dedicated to advance health care reform through education of
public opinion leaders. Lastly, as you well know, h i s i s now
serving as the new Chairman of the Senate Veterans Committee.
Senator Rockefeller's health care p r i o r i t y i s very simple:
He desperately wants to see a comprehensive reform package
enacted during the Clinton Presidency. Although he thinks the
long-term outcome of such an achievement i s p o l i t i c a l l y
attractive, he i s primarily pushing t h i s reform because he i s
sincerely committed to the need for reform. I n t h i s vein, he i s
not overly committed to any one particular approach although he
has advocated an employer-based approach. He, therefore, can be
counted on to support v i r t u a l l y anything the President ends up
proposing, as long as i t achieves universal access and cost
containment.
Senator Rockefeller was very pleased with the Veterans'
meeting l a s t Thursday. He was concerned about the the AP story
the day after, but from the beginning did not believe i t was
true.
As you know, he has requested a meeting with you to discuss
substance and strategy. He very much wants t h i s to occur t h i s
week. He feels he needs a substantive background briefing to be
at h i s best i n h i s role as cheerleader i n the Congress and with
the press. At that meeting, i t i s my understanding through Steve
Ricchetti and h i s s t a f f that he may extend an invitation to you
and the President to go out to h i s house for dinner. I f you wish
to come, he w i l l suggest you using h i s house and the event for
whatever purpose you want: to have a quiet dinner out or to use
i t for a backdrop for a s o c i a l occasion for appropriate guests
interested i n health reform.
TOM DASCHLE (D-South Dakota)
Senator Daschle i s the Co-Chair of the Democratic Policy
Committee (with Majority Leader Mitchell) and he i s one of the
more well informed Democratic Members on health care issues. In
his brief tenure, he has already become very well known i n t h i s
arena, p a r t i c u l a r l y through h i s work on rural health and Medigap
insurance reform issues.
Senator Daschle and h i s s t a f f are participating i n (and
helping run) Senator Mitchell's DPC working group, but he has
also been a leader of a separate working group (Kerrey, Bingaman,
Wofford, and Baucus) that was developing alternative approaches
to health reform. This group has been r e l a t i v e l y quiet l a t e l y ,
seeming to be comfortable with working with and through the DPC
health policy group.
�Personally, Daschle i s much more comfortable with a singlepayer type approach to health care, primarily because he believes
i t i s a much easier p o l i t i c a l s e l l to h i s small business folks
and the rest of h i s constituents. He joined Senator Harris
Wofford i n introducing l e g i s l a t i o n (S.2513) to achieve t h i s end.
Daschle i s a team player, however. As part of the Senate
leadership, he can be counted on to push h i s agenda as far as i t
can go, but he w i l l also do everything he can to assure that we
pass comprehensive reform and the President's plan.
In addition. Senator Daschle i s one of the signatories of a
March 30th l e t t e r opposing the allocation of the global budget
among states based on h i s t o r i c costs. He i s very concerned that
r u r a l states would be discriminated against using such a formula.
Senator Daschle also worries that people don't understand
the r e a l costs of the current health system and how they are
paying too much i n direct and indirect spending. He feels that
education regarding these costs are c r i t i c a l so that people don't
feel the new system w i l l cost them too much money. Lastly,
Senator Daschle also supports restructuring graduate medical
education to emphasize primary care.
Most recently. Senator Daschle has requested that you j o i n
him i n South Dakota at some health care event at some point i n
the future. We are trying to be responsive to a request by him
to get someone from with working groups to go to an early May
event that he i s holding.
(We may also ask you to do a s a t e l i t e
feed for t h i s event).
JOHN BREAUX
(D-Louisiana)
Senator Breaux i s the second most junior Member of the
Finance Committee. He i s one of those "up and coming" New
Democrats for whom many see a bright future. His p o l i t i c s are
moderate to conservative but he i s known more as a pragmatist
than a idealogue.
I n the area of health care, Breaux i s yet
another of the Committee members who care deeply about small
businesses and r u r a l health care.
Previous to t h i s year. Senator Breaux was not overly active
in health care issues. That changed when he introduced the
Conservative Democratic Forum's managed competition b i l l with
Senator Boren i n 1992. He i s very concerned, however, about the
b i l l ' s limitations with regard to assuring adequate access to
health care i n r u r a l areas. He i s also concerned about whether
t h i s approach w i l l actually achieve broad-based costs savings.
Despite t h i s , he remains uncomfortable with alternative
approaches and he w i l l want to make sure that the Conservative
Democratic Forum's model i s used as much as possible during the
upcoming debate. He opposes price caps and freezes to control
costs.
�KENT CONRAD (D-North Dakota)
Kent Conrad i s the newest member of the Senate Finance
Conunittee. Senator Conrad i s known as a "budget hawk." Strong
cost controls w i l l be c r i t i c a l for h i s support. He w i l l look
closely at the financing package and how the reform plan impacts
the federal d e f i c i t . He opposes large new taxes to support
reform.
Senator Conrad's foremost health concern i s r u r a l health
care. He i s concerned both with how r u r a l health care w i l l be
addressed i n the context of managed competition as well as
current access and delivery issues. He i s aware of successful
models from his state — one a network of c l i n i c s , the other an
HMO — which have been able to increase access to primary and
preventive care. He signed the March 30th l e t t e r opposing the
allocation of the global budget among states based on h i s t o c i
costs. He i s also an advocate for the need to improve and
increase funding for the Indian Health Services. I n s u f f i c i e n t
funding has led to rationing of services. He also feels the IHS
has not been s u f f i c i e n t l y responsive to Congress or t r i b a l
leadership.
Most recently, I (Chris J.) and Christine gave him a general
health care background briefing. (He had missed one given by I r a
and wanted a private meeting). He was very appreciative and
appeared to feel much better about the direction the President
andyou are heading by the conclusion of the discussion.
8
�REPUBLICANS
BOB PACKWOOD (R-Oregon) (Finance Ranking Republican Member)
Senator Packwood i s an advocate of an employer-based
u n i v e r s a l coverage plan. He i s the only Republican on the
Finance Committee t h a t has p u b l i c l y supported an employer mandate
and as a r e s u l t , p u t t i n g him i n a somewhat uncomfortable p o s i t i o n
w i t h many i n the Senate leadership—who vehemently oppose an
employer mandate.
Packwood attacked h i s opponent's (AuCoin) single-payer
approach l a s t year as a m u l t i - b i l l i o n d o l l a r tax increase t h a t
would r e s u l t i n a government run system. The primary c r i t i c i s m
of Packwood's plan was t h a t i t d i d n ' t go f a r enough on the cost
containment side. Some of the aging advocacy groups also
c r i t i c i z e d i t f o r i t s lack of comprehensive long-term care
coverage. I n Oregon, a t l e a s t , Packwood won the debate.
Beyond the above-mentioned work, Senator Packwood has had a
notable h e a l t h care career. He has sponsored q u i t e a b i t o f
l e g i s l a t i o n dealing w i t h r u r a l h e a l t h and long-term care (LTC).
S p e c i f i c a l l y , he introduced a r e l a t i v e l y extensive p u b l i c / p r i v a t e
LTC b i l l i n the l O l s t Congress. However, because i t costed-out
as a r a t h e r expensive i n i t i a t i v e and because the aging advocates
were not e n t h r a l l e d w i t h i t , he decided t o s t i c k t o Federal
standards and tax c l a r i f i c a t i o n s f o r p r i v a t e LTC insurance
p o l i c i e s . I n a d d i t i o n , working w i t h Pryor, he introduced
l e g i s l a t i o n t h a t could provide tax c r e d i t s f o r primary care
personnel t o serve medically underserved r u r a l areas.
ROBERT DOLE (R-Kansas) (Senate M i n o r i t y Leader)
The M i n o r i t y Leader i s , without question, the most
i n f l u e n t i a l Senator among Republicans. As an a l l y , he can be
absolutely invaluable.
As an enemy, he can be v i c i o u s and
e f f e c t i v e . Currently, i t appears he i s t r y i n g t o decide whether
h e a l t h care reform should be a p a r t i s a n or a b i p a r t i s a n issue.
Dole and h i s s t a f f w i l l probably opt t o appear t o be w i l l i n g t o
work w i t h the Democrats, but w i l l eventually choose t o t u r n on
the new A d m i n i s t r a t i o n on the reform issue.
Senator Dole has a strong i n t e r e s t i n r u r a l h e a l t h and i s
c u r r e n t l y Co-Chair of the Senate Rural Health Caucus.
L e g i s l a t i v e l y he has supported i n i t i a t i v e s t o p r o t e c t the
v i a b i l i t y of small r u r a l h o s p i t a l s as w e l l as t o expand c i v i l
r i g h t s p r o t e c t i o n s and services f o r the handicapped.
9
�Yesterday (Sunday, A p r i l 18th, on Meet the Press), he
i n d i c a t e d h i s o p p o s i t i o n t o p r i c e c o n t r o l s , h i s concern about
large taxes w i t h o u t d e l i v e r i n g on cost containment f i r s t , and h i s
hesitancy about a VAT tax unless i t i s used t o replace o r o f f s e t
other taxes. Although i t may w e l l be an impossible task, we must
continue t o work t o a t l e a s t t r y t o get him on board w i t h us. I f
we do not succeed, we might have some success i n a t t r a c t i n g other
moderate Republicans f o r making the e f f o r t t o o b t a i n Dole's
support.
WILLIAM (BILL) ROTH (R-Delaware)
U n t i l the l a s t couple o f Congresses, Senator Roth was not
known f o r h i s involvement i n h e a l t h care. As Ranking Member o f
the Government A f f a i r s Committee, he has had extensive
involvement and i n t e r e s t i n the Committee's Permanent
Subconunittee on I n v e s t i g a t i o n ' s i n q u i r y i n t o the m u l t i - b i l l i o n
d o l l a r issue o f h e a l t h care fraud and abuse.
More r e c e n t l y . Roth has a c t i v e l y advocated t h a t the Federal
Employee Health Benefit Program, which the Government A f f a i r s
Committee oversees, be extended t o the working uninsured and
small businesses. (This i s s i m i l a r t o , and b u i l d s on, a proposal
t h a t has been championed by the Heritage Foundation.) Under t h i s
proposal, t h e self-employed and working uninsured would have
access t o the FEHB plans t h a t were u t i l i z i n g managed competition
as a cost containment/quality assurance mechanism. I n so doing,
these i n d i v i d u a l s would have access t o the same rates t h a t t h e
insurers charge the f e d e r a l government and t h e i r employees f o r
the b e n e f i t s .
JOHN DANFORTH ( R - M i s s o u r i )
Senator Danforth i s t o cost containment what Bob Packwood i s
t o mandates. He i s the most l i k e l y t o s t a t e t h a t strong
f e d e r a l / s t a t e caps on spending must be imposed t o e f f e c t i v e l y
contain h e a l t h care costs. He states h i s strong views on t h i s
issue repeatedly, despite admonitions from h i s s t a f f and other
Republicans t h a t such statements are not c o n s i s t e n t w i t h t h e
Republican Party l i n e .
Although w i l l i n g t o support the need f o r strong government
cost r e g u l a t i o n , he also believes t h a t t o do so would r e q u i r e
e x p l i c i t r a t i o n i n g . (He i s a b i g fan o f the Oregon w a i v e r ) .
What i s more, u n l i k e most Democrats, he desires t o p u b l i c l y
proclaim t h a t r a t i o n i n g i s necessary and something we must own up
to.
10
�JOHN CHAFEE (R-Rhode Island) (Finance Medicaid Subc. Ranking
Republican)
Senator Chafee i s the Chair of the Republican Task Force on
Health Care. He l i k e s to point out that the b i l l they introduced
in the l a s t Congress had the most cosponsors of any major
comprehensive health reform b i l l . He was not pleased with l a s t
year's health care debate with the Democrats. He believes that,
i f not for Presidential and partisan p o l i t i c s , there was enough
consensus between h i s and many Democrats' b i l l s to move forward
on many high p r i o r i t y health reform proposals such as: s e l f employed tax deduction increase to 100 percent, insurance market
reform, expansion of conmiunity health centers and other health
care delivery systems, and state experimentation.
On the Committee, Senator Chafee i s primarily known for h i s
long-standing interest i n providing alternative care settings —
through the Medicaid program -- to persons who are disabled. He
and h i s s t a f f are l i t e r a l l y heroes with many i n t h i s f i e l d ,
p a r t i c u l a r l y those who advocate non-institutional care
approaches. He i s also well known for h i s strong advocacy of,
and relationship with, community health care centers. I n
addition, he -- l i k e a number of the Finance Conunittee membership
-- are growing weary of funding programs for the elderly when
there are so many needs i n the non-elderly population.
As you know, we have been trying for weeks to i n v i t e Senator
Chafee to talk with I r a .
We sense that he and h i s s t a f f want
desperately to come i n , but are afraid to alienate Dole. On
Friday (April 16th), though, I (Chris J.) received a c a l l
indicating that he might come for a meeting. We w i l l have to
wait u n t i l Monday or Tuesday to get a confirmation. We w i l l keep
you informed.
DAVE DURENBERGER (R-Minnesota) (Finance Medicare Subc. Ranking
Republican)
Senator Durenberger i s one of the Committee's most well
versed Members on health care reform. He also i s one of the few
Members who has served concurrently on the Labor and Human
Resources Committee (the other major health care committee) and
the Finance Committee. He i s a moderate who i s viewed by the
Republican leadership as somewhat of a loose cannon. Because of
t h i s and h i s long-standing interest i n health care reform,
Durenberger, too, i s a candidate to be a possible and Important
ally.
11
�In the l a s t Congress, he joined Senator Bentsen as the lead
Republican on the Texas' Senator's incremental (insurance market
reform, etc.) health reform i n i t i a t i v e . He has been a key health
care player for years, however. He now i s the Ranking Republican
on Jay Rockefeller's Subcommittee on Medicare and Long Term Care,
and he has served as either a Chairman or Ranking Member of t h i s
Committee for years. I n addition, he served (as a Vice-Chair) on
the Pepper Commission. While he joined a l l the other Republicans
i n voting against the access recommendations of t h i s Commission,
(he did vote for the long-term care recommendations) i t i s
important to note that i t was unclear that Durenberger was going
to vote against the Pepper Commission recommendations u n t i l very
late i n the process. An important offshoot of t h i s experience,
though, was that he and Jay Rockefeller forged a close working
relationship.
Most recently, Durenberger has focused on state-based
comprehensive care i n i t i a t i v e s . This i s because he does not
believe that a consensus yet e x i s t s for national reform and
because h i s own state i s t i r e d of waiting. Minnesota has a long
tradition of moving ahead on health care reforms and i s THE
nation's c a p i t a l of managed care/HMO delivery systems. I t i s one
of the 5 or 6 states that has gone ahead and passed l e g i s l a t i o n
to implement i t s own reform proposal. Since Minnesota has
h i s t o r i c a l l y been more e f f i c i e n t i n terms of the delivery of
health care. Senator Durenberger w i l l be very concerned about the
allocation of the global budget, p a r t i c u l a r l y that i t does not
reward the i n e f f i c i e n t at the expense of the e f f i c i e n t .
Last week. Senator Durenberger called me (Chris) to talk a
l i t t l e strategy and health policy substance. He indicated h i s
nervousness with any price controls. He said he thought we could
get some savings for speeding up implementation of the new
physician payment system. He also urged us to find a way to fold
i n Medicare into whatever we do. Lastly, he again asked for a
meeting with I r a . I t has been arranged for Wednesday, A p r i l
21st, at 11:00.
CHARLES GRASSLEY (R-Iowa)
Senator Grassley i s one of those Senators who can give the
impression (because he i s far from a detail-oriented person) that
he i s l e s s than sharp and i s not a significant player. This i s
not the case. Although he may not be extremely quick, he has a
very sensitive and accurate gut for p o l i t i c s and policy and, with
a very capable s t a f f , he has managed to become quite an effective
Member of the Committee.
12
�Grassley's primary h e a l t h care i n t e r e s t has been r e l a t e d t o
r u r a l h e a l t h care. He, again l i k e most other Members of the
Committee, has been g r e a t l y concerned about perceived i n e q u i t i e s
i n reimbursement t o r u r a l providers.
ORRIN HATCH (R-Utah)
Senator Hatch i s r e l a t i v e l y new t o the Committee having
j o i n e d during the l a s t Congress. He i s one of the b r i g h t e s t
i n d i v i d u a l s i n the Senate, but has yet t o r e a l l y get a
comfortable grasp of the Finance Committee. Although he i s w e l l
known f o r h i s very conservative philosophy, he has i n recent
years appeared t o become more open t o more t r a d i t i o n a l l y moderate
approaches.
For example, although he i s close w i t h the drug
i n d u s t r y , he has been w i l l i n g t o push them t o be more responsive
on p r i c i n g issues.
Up u n t i l 1993, he served as e i t h e r the Chairman or the
Ranking Republican of the much more c o n f l i c t - o r i e n t e d Labor and
Human Resources Committee. I n t h i s capacity, he became extremely
w e l l informed about PHS, NIH, and FDA issues. On h e a l t h reform
issues, he can be expected t o be very supportive of marketo r i e n t e d reforms t o the h e a l t h care system. I n t h a t v e i n , he
w i l l be extremely uncomfortable w i t h employer mandates and
discussions of g l o b a l budgeting and enforcement. He has
introduced l e g i s l a t i o n t o reform the medical malpractice system
and sees t h i s as an important means f o r reducing h e a l t h care
costs.
MALCOLM WALLOP (R-Wyoming)
Senator Wallop was j u s t renamed t o the Finance Committee
t h i s term. I n h i s previous tenure (1979-1988) he demonstrated an
i n t e r e s t i n r u r a l h e a l t h concerns but focused p r i m a r i l y on tax
matters. He i s known f o r h i s very strong conservative views. I n
the l a s t Congress, he cosponsored the Republican reform b i l l and
Senator Hatch's b i l l t o improve the medical l i a b i l i t y system. I f
there i s one Member of the Conunittee we can almost c e r t a i n l y
w r i t e o f f as a possible supporter, i t i s Senator Wallop.
13
�-it
DATE
MEMBER(S)
MET WITH
SUBJECT
2/4
DOLE/CHAFEE
HRC/ICM/JF
process, general
discussion
2/23
DURENBERGER
HRC/ICM
3/10
Senate Republican
Members
HRC
Bond
Burns
Chafee
C!ohen
Craig
Danforth
Dole
Durenberger
Gregg
Kassebaum
Mack
Murkowski
Nichols
Packwood
Roth
Simpson
Stevens
Thurmond
(others were present as
well)
general
discussions about
process and about
directions
for/components of
reform
3/10
JEFFORDS
ICM
3/12
Senate Republican Staff
ICM
3/23
Senate Republican Staff
Walter Zellman
Rick Kronick
Lois Quam
New System
Development
Governance
4/1
Senate Republican Staff
ICM
short-term
controls
Gary Claxton
Insuramce Reform
Sheila Burke
Christy Ferguson
Ed Mihulski
[4/19
Senate Republican staff
«
�DETERMINED TO BE A.N AD.MLNISTRATIVE
.MARKING Per E^ 12958 as amended, Scc^.3 (c)
Initiak^ trC-r^
n«t.. \ ^ J{\c^j V\
PRIVILEGED AND ePNFTDWWTIftT;
MEMORANDUM
TO: D i s t r i b u t i o n
FR: Chris Jennings
RE: Upcoming CBO r e p o r t s
A p r i l 15, 1993
I n n o t - f o r - a t t r i b u t i o n conversations w i t h key Congressional
s t a f f e r s , i t has come t o my a t t e n t i o n t h a t the Congressional
Budget O f f i c e (CBO) i s about t o release four d i f f e r e n t r e p o r t s
r e l a t e d t o h e a l t h care. The r e p o r t s and t h e i r p r o j e c t e d release
dates are:
CBO REPORT SUBJECT
PROJECTED RELEASE DATE
1.
Single Payer/All Payer Update
Report. Apparently concludes t h a t
a l l payer r a t e s would s i g n i f i c a n t l y
reduce the subsidy l e v e l the Feds
would have t o pay f o r i n d i v i d u a l s
and/or employers (b/c i t would
reduce plan c o s t s ) . I b e l i e v e
Stark w i l l l i k e t h i s one, and might
well publicize.
W i t h i n Two Weeks
2.
Managed Competition Report.
W i t h i n About a Month
L i k e l y w i l l conclude t h a t
t r a d i t i o n a l model o f managed
competition w i l l not save money
over the short term. I f i t w i l l
save any money, t h e r e p o r t apparently
concludes i t w i l l take 7 t o 10 years.
3.
Report Evaluating Cost o f
By t h e End o f the Month
Uncompensated Care. Apparently
concludes t h a t a l l uncompensated
care i s recovered by h o s p i t a l s , w i t h
at l e a s t 50 percent o f i t paid through
p r i v a t e sources.
4.
Report Evaluating Simulated
About Two Months Away
Models. This r e p o r t reviews
b i l l s t h a t have already been
introduced and broadly models them
t o determine how much they cost/save.
�I f handled well, none of the previously mentioned reports
should cause us much heartburn. To the contrary, they could help
strengthen our case as long as we know what i s i n them and how to
best spin any response to questions about them.
In that vein, I am trying to obtain pre-publication copies
of the reports. I w i l l keep a l l relevant parties apprised of the
luck I am having i n t h i s regard.
I t i s possible that a discussion of these reports may come
up i n tomorrow's " l e t ' s t r y to be on the same page" meeting with
CBO, the House and Senate Leadership/Committee s t a f f , and I r a .
Obviously, however, any discussion about the reports should not
be originated by us. We are NOT the Congress and we should NOT
know about the reports unless we have been e x p l i c i t l y informed
about them by the Chairmen who requested them.
Housekeeping on the CBO meeting with I r a , Ken and whoever
else goes. Attendees at the meeting are l i k e l y to be CBO's Chuck
Seagraves, Paul Van de Water (sp?) — Chuck's boss, and Kathy
Langwell. These are the numbers crunchers and are very
i n f l u e n t i a l people. Reischauer, I am informed, w i l l NOT be i n
attendance. From the Congress: Andie King, Mitchell's Bob
Rosen, the House and Senate Budget Committees, the House Ways and
Means Conunittee (the primary host), the Energy and Commerce
Committee, the Senate Finance Committee, and the Senate Labor and
Human Resources Committee.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. memo
SUBJECT/TITLE
DATE
From Chris Jennings & Steve Richetti; re: Congressional
Update/Strategy for Health Reform (8 pages)
04/14/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefing Memos • First Lady, 1993 [6]
2006-0885-F
jp2851
RESTRICTION CODES
Pr ssidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIAj
b(3) Release would violate a Federal statute j(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy j(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
flnancial institutions j(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIAj
National Security ClassiHed Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRAj
Release would violate a Federal statute |(aX3) of the PRAj
Release would disclose trade secrets or confldential commercial or
flnancial information [(aX4) of the PRAj
PS Release would disclose confldential advice between the President
and his advisors, or between such advisors ja)(5) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy j(aX6) of the PRAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile deflned in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�APPENDIX 1
SUMMARY OF CONGRESSIONAL MEETINGS
(Through spring recess)
HOUSE OF REPRESENTATIVES
MenUsers met with:
Democrats - 128
Republicans - 26
TOTAL 154
Members Remaining:
Democrats - 127
Republicans - 149
Independent - 1
Vacancies 4
TOTAL 281
Meetings with Member of the Committee of Jurisdiction:
WAYS AND MEANS
Democrats - 20 of 24
Democrats Remaining:
Andrew Jacobs (IN)
Harold Ford (TN)
William Coyne (PA)
B i l l Brewster (OK)
ENERGY AND COMMERCE
Democrats - 21 of 27
Republicans - 4 of 14
Republicans Remaining:
B i l l Archer (TX)
Philip Crane (IN)
Clay Shaw (FL)
Don Sundquist (TN)
Jim Bunning (KY)
Amo Houghton (NY)
Wally Herger (CA)
Mel Hancock (MO)
Rick Santorum (PA)
Republicans - 6 of 17
Democrats Remaining:
Republicans Remaining;
P h i l i p Sharp (IN)
Al Swift (WA)
Ralph Hall (TX)
Rick Boucher (VA)
Thomas Manton (NY)
Craig Washington (TX)
Jack F i e l d s (TX)
Michael Oxley (OH)
Dan Schaefer (CO)
Joe Barton (TX)
Fred Upton (MI)
C l i f f Stearns (FL)
B i l l Paxton (NY)
Paul Giilmor (OH)
Scott Klug (WI)
Jim Greenwood (PA)
Michael Crapo (ID)
�EDUCATION AND LABOR
Democrats - 12 o f 24
Republicans - 3 of 15
Democrats Remaining:
Republicans Remaining;
B i l l Clay (MO)
George M i l l e r (CA)
Austin Murphy (PA)
Dale Kildee (MI)
Matthew Martinez (CA)
Donald Payne (NJ)
Jolene Unsoeld (WA)
Robert Andrews (NJ)
Jack Reed ( R I )
Tim Roemer ( I N )
Robert Scott (VA)
Karan English (AZ)
Eni F.H. Faleomavaega
(Amer. Samoa)
Scotty Baesler (KY)
Tom P e t r i (WI)
Dick Armery (TX)
H a r r i s Fawell ( I L )
Paul Henry (MI)
Cass Ballenger (NC)
Susan M o l i n a r i (NY)
B i l l B a r r e t t (NE)
John Boehner (OH)
Randy Cunningham (CA)
Peter Hoekstra (MI)
Howard McKeon (CA)
Dan M i l l e r (FL)
SENATE
Members met w i t h :
Democrats - 45
Republicans - 20
TOTAL 65
Members Remaining:
Democrats - 12
Republicans - 23
TOTAL 35
Meetings w i t h Members o f t h e Committees o f J u r i s d i c t i o n :
FINANCE
Democrats - 9 o f 11
Republicans - 7 o f 9
Democrats Remaining:
Republicans Remaining;
David Boren (OK)
B i l l Bradley (NJ)
O r r i n Hatch (UT)
Malcolm Wallop (WY)
LABOR AND HUMAN RESOURCES
Democrats - 11 o f 11
Republicans - 5 o f 7
Democrats Remaining:
Republicans Remaining:
None
Dan Coats ( I N )
O r r i n Hatch (UT)
�CONGRESSIONAL MEETINGS
FEBRUARY 3, 1993
Rep. Dick Gephardt
HRC
FEBRUARY 4, 1993
11:30 AM
Rep. Pete Stark
IM, HP
2:30 PM
Sen. George M i t c h e l l
HRC, IM, JF
3:00 PM
Senate Democrats
HRC, IM, JF
Sens. M i t c h e l l , Baucus, Bingaman,
Boxer, Breaux, Bumpers, Conrad,
Daschle, Feingold, Harkin, Kennedy,
Kerrey, Leahy, Lieberman,
Metzenbaum, M i k u l s k i , Moseley-Braun,
Moynihan, P e l l , Pryor, Riegle,
Robb, Rockefeller, Wellstone,
Wofford
4:00 PM
Sens. Bob Dole and John Chafee
FEBRUARY 10, 1993
11:30 AM
Sen. Jay Rockefeller
HRC, IM, JF
HRC
FEBRUARY 11, 1993
Sen. H a r r i s Wofford
Health Reform Conference
Harrisburg, PA
3:00 PM
Sen. M i t c h e l l ' s O f f i c e
FEBRUARY 15, 1993
10:00 AM
Rep. Jim McDermott
IM
IM
FEBRUARY 16, 1993
2:00 PM
House Democratic Leadership Tom Foley, Dick Gephardt
HTC, IM, JF
�House Democrats HRC, IM, JF
Andrews, Bonior, Cardin,
C. Collins, Conyers, Cooper,
de l a Graza, Derrick, Fazio, Ford,
Hoyer, E.B. Johnson, Johnston,
Levin, Lewis, Matsui, McDermott,
Meek, Obey, Richardson, Rose,
Rostenkowski, Slattery,
Slaughter, Stark, Stenholm,
Strickland, Synar, Waxman,
Williams, Wyden
4:00 PM
House Republican Leadership
Bob Michel, Newt Gingrich,
Dennis Hastert
HRC, IM, JF
House Republicans B i l i r a k i s , B l i l e y , Goodling,
Goss, Grandy, Gunderson, Hoke,
N. Johnson, Kasich, McCrery,
Moorhead, McMillan, Roberts,
Roukema, Thomas, Walker
HRC, IM, JF
FEBRUARY 18, 1993
11:00 AM
Rep. Dan Rostenkowski
HRC
12:30 PM
Rep. B i l l Ford
HRC
Re. John Dingell
HRC
1:30 PM
FEBRUARY 23, 1993
2:00 PM
Congressional Women's Caucus
HRC
Pat Schroeder, Olympia Snowe
Furse, Kaptur, Lambert, Lowey,
Maloney, Mink, Morella, Slaughter,
Waters
3:45 PM
Rep. Pete Stark
HRC
4:30 PM
Rep. Henry Waxman
HRC
5:15 PM
Rep. Pat Williams
HRC
FEBRUARY 24, 1993
11:00 AM
Sen. David Durenberger
HRC
�11:30 AM
House Democratic Leadership and
Committee Chairs
Gephardt, Lewis, Richardson,
Rostenkowski, Stark, Dingell,
Waxman, Ford, Williams
HRC,
IM, JF
FEBRUARY 25, 1993
Sen. Jim Sasser
HRC
Sen. and Mrs. Reigle
HRC
Sen. Paul Wellstone
HRC
MARCH 2, 1993
12:00 PM
1:00 PM
Congressional Black Caucus
HRC
Clayton, Collins, Conyers, Flake,
Franks, McKinney, Meek, Mfume,
Moseley-Braun, Norton, Rangel,
Stokes, Waters, Watt
2:00 PM
Congressional Hispanic Caucus
HRC
Serrano, Roybal-Allard, Pastor,
de l a Graza, de Lugo, Ortiz,
Richardson, Torres, Ros-Lehtinen,
Becerra, Bonilla, Diaz-Balart,
Guttierrez, Mendez, Romero-Barcelo,
Tejeda, Velazquez, Underwood
MARCH 4, 1993
Senators Breaux and Johnston,
Rep. Jefferson
Louisiana Trip
HRC
DPC
IM, JF
Mitchell, Daschle, Akaka, Baucus,
Bingaman, Boxer, Bryan, Campbell,
Conrad, Dodd, Exon, Feingold,
Feinstein, Graham, Hollings,
Kennedy, Kerrey, Kerry, Lautenberg,
Leahy, Lieberman, Levin, Mathews,
Metzenbaum, Mikulski, Moynihan,
P e l l , Pryor, Reigle, Robb, Rockefeller,
Sarbanes, Sasser, Simon, Wellstone,
Wofford
�MARCH 5, 1993
2:00 PM
Bob Reischauer, D i r e c t o r CBO
IM
Sen. Dianne F e i n s t e i n
IM
Rep. John Conyers
HRC
1:00 PM
Rep. Jim McDermott
HRC
2:00 PM
Chmn. John D i n g e l l and
HRC
Energy and Commerce Cmte
S. Brown, H a l l , K r e i d l e r , Lambert,
Lehman, Margolies-Mevzinsky,
Markey, Pallone, Richardson,
Schenk, S l a t t e r y , Studds, Tauzin,
Towns, Waxman
2:00 PM
Sen. Jeffords
MARCH 6, 1993
10:00 AM
MARCH 9, 1993
IM
MARCH 10, 1993
3:00 PM
Republican Task Force
HRC
Dole, Chafee, Bond, Burns, Cohen,
Craig, Danforth, Gregg, Kassebaum,
Mack, Murkowski, Nickles, Packwood,
Roth, Simpson, Stevens, Thurmond
MARCH 11, 1993
11:00 AM
Rep. Ron Wyden
HRC
1:00 PM
Sen. Edward Kennedy
IM
2:00 PM
Senate Women's Caucus
M i k u l s k i , Kassebaum, Boxer,
F e i n s t e i n , Moseley-Braun, Murray
HRC
3:30 PM
Veterans Issues
Sen. Jay Rockefeller,
Rep. Sonny Montgomery,
Rep. Roy Rowland
HRC
�3:30 PM
Gephardt, Rostenkowski, Stark,
D i n g e l l , Waxman, Ford, W i l l i a n s
IM, JF
5:00 PM
Sen. Daniel P a t r i c k Moynihan
HRC
5:30 PM
House Republicans
B l i l e y , Gingrich, Goss, Hastert,
Johnson, Thomas
IM
MARCH 12, 1993
Sen. Bob Graham, Rep. Sam Gibbons HRC
RWJ Forum - Tampa, FL
1:45 PM
Senate Republican S t a f f
MARCH 15, 1993
Sen. Tom Harkin, Sen. Charles
Grassley, Rep. N e i l Smith
RWJ Forum - Des Moines, IA
Finance Committee S t a f f Lawrence O'Donnell, S t a f f D i r .
IM
HRC
CJ, KP, SR
MARCH 17, 1993
Chmn Dan Rostenkowski and
HRC
Democratic Ways and Means Members
Andrews, Cardin, Gibbons,
Hoagland, Jefferson, Kennelly,
Kopetski, Levin, Lewis, Matsui,
McDermott, McNulty, Neal, Payne,
Pickle, Reynolds, Stark
2:00 PM
Rep. Jack Brooks
HRC
7:30 AM
House Republicans
B l i l e y , Goss, Grandy, Hastert,
N. Johnson, McMillan, Thomas
IM
3:45 PM
Reps. Mike Andrews, Jim Cooper,
Charles Stenholm, Lewis Payne
HRC
4:15 PM
Sen. Bob Kerrey
HRC
MARCH 18, 1993
�Rep. Reynolds
HRC
MARCH 22, 1993
Sen. and Mrs. Don Reigle,
MEG, CR, DS
Rep. and Mrs. John D i n g e l l ,
Sen. Carl Levin, Rep. John Conyers
RWJ Hearing - Dearbome, MI
MARCH 23, 1993
9:15 AM
DPC S t a f f Meeting
John H i l l e y , Abby Safford,
Diane Dewhirst, Debra Silimeo,
Greg B i l l i n g s , Michael Werner,
Lawrence O'Donnell, Laura Quinn,
Jim G o t t l i e b , Larry Stein,
P a t r i c i a Z e l l , John B a l l
Begala, BB, CJ
MARCH 24, 1993
Democratic Policy Committee
IM, JF
Sens. M i t c h e l l , Akaka, Baucus,
Bingaman, Boxer, Bryan, Conrad,
Daschle, DeConcini, Dodd,
Feingold, Glenn, Graham, H o l l i n g s ,
Johnston, Kennedy, Kerry, Leahy,
Levin, Mathews, Moseley-Braun,
Reid, Wellstone, Wofford
MARCH 25, 1993
7:30 AM
House Republicans
B l i l e y , Goss, Grandy, Hastert,
N. Johnson, McMillan, Thomas
IM
2:00 PM
Democratic Committee Members
IM
Education & Labor, Energy &
Commerce, Ways & Means
Andrews, Cardin, Cooper, Engel,
Lambert, Levin, McDermott, Synar,
Tauzin, Pallone, Woolsey, S l a t t e r y ,
Rostenkowski, D i n g e l l , Waxman,
Richardson, Markey, H a l l , Studds,
Margolies-Mezvinsky, Kennelly,
Hoyer, Fazio, K r e i d l e r , Bryant,
K l i n k , Sawyer
�MARCH 30, 1993
5:30 PM
Mainstream Forum McCurdy, Bacchus, Browder, Carr,
Cooper, Danner, Glickman, Geren,
Green, Moran, Payne, Penny,
Peterson, Price, Orton, Rowland,
Slattery, Spratt, Tanner
IM
MARCH 31, 1993
8:00 AM
House Democratic Caucus IM, JF
Barlow, Cooper, DeLauro, Derrick,
Dingell, Durbin, F i l n e r , Gephardt,
Geren, Gordon, Hamilton,
Hochbrueckner, Hoyer, Hughes,
Inslee, D. Johnson, E.B. Johnson,
Kaptur, Kennelly, Lancaster, Levin,
Lewis, Lloyd, Lowey, McDermott,
Moran, Obey, Olver, Pomeroy,
Richardson, Romero-Barcelo, Sawyer,
Shephard, Sisisky, Skaggs, N. Smith,
Stark, Stupak, Synar, Thurman,
Velazquez, Volkmer, Wise, Woolsey
Ways and Means Health Sub.
Stark, Levin, Cardin, McDermott,
Andrews, Klezka
APRIL 1, 1993
7:30 AM
House Republicans
B l i l e y , Goss, Grandy, Gunderson,
Hastert, N. Johnson, McMillan,
Roberts, Thomas
Quam
�HEALTH REFORM LEGISLATIVE STRATEGY
APPENDIX 2
THE CONGRESSIONAL PERCEPTION PROBLEM
There are a number of reasons why the Congress, and
p a r t i c u l a r l y the Leadership, i s apparently growing i n c r e a s i n g l y
dubious about the prospects of h e a l t h reform t h i s year. Although
each of the following, to various degrees, can and w i l l go away
once we have a plan and we have developed an acceptable
l e g i s l a t i v e s t r a t e g y with the Congressional l e a d e r s h i p , i t i s
u s e f u l to review the l i s t to understand why some i n the Congress
and i n the press are c u r r e n t l y s k e p t i c a l .
(1)
Reports of D i s a r r a y i n the White House. They are hearing
and reading that the White House i s i n d i s a r r a y around the
process of developing an i n i t i a t i v e and t h a t a s i g n i f i c a n t
delay i s very p o s s i b l e ;
(2)
C a n c e l l a t i o n of House Leadership Meeting i n Conjunction with
New York Times A r t i c l e Hurt. Although l a s t F r i d a y ' s House
Leadership meeting was c a n c e l l e d by Majority Leader Gephardt
(for f e a r of the consequences of another Stark o u t b u r s t ) ,
there appears to be a perception that t h i s sent another
s i g n a l t h a t h e a l t h care could wait;
(3)
Skepticism that B i l l Outside of R e c o n c i l i a t i o n i s P o s s i b l e .
The Chairmen continue to strongly b e l i e v e t h a t h e a l t h c a r e
outside of the r e c o n c i l i a t i o n b i l l i s v i r t u a l l y impossible,
p a r t i c u l a r l y i n the Senate, and are extremely s k e p t i c a l t h a t
two tax hike and b e n e f i t cut proposals can r e c e i v e s e r i o u s
c o n s i d e r a t i o n i n one year;
(4)
Current Senate Delay on R e c o n c i l i a t i o n i s C r e a t i n g Problems.
They view that the White House has an o v e r l y o p t i m i s t i c
expectation of a completion time for the r e c o n c i l i a t i o n b i l l
(they c i t e Republican trouble-making. Democratic Member
nervousness, and numerous p o l i t i c a l l y - s e n s i t i v e p r o v i s i o n s
i n the b i l l t h a t w i l l be d i f f i c u l t to mark-up i n Committee);
�(5)
Fear that President Isn't Assuming Enough Time for Congress.
The Committee Chairmen apparently do not believe that we
f u l l y recognize and appreciate the d i f f i c u l t y of the
abbreviated time constraints we may be assuming for hearings
and mark ups of a health reform b i l l . More to the point,
the House Chairmen — and p a r t i c u l a r l y the Subcommittee
Chairmen and their Members — are becoming more wary that
the assumed timing strategy does l i t t l e other than " r o l l
over" the Committees. Because they have yet to f e e l
"adequately consulted" on the substance of the proposal,
they are very nervous. Moreover, because our strategy
assumes House passage f i r s t , the House Chairmen are also
concerned that the Senate w i l l delay so long as to
p r a c t i c a l l y force acceptance of the Senate version; and
(6)
Concern that CBO Numbers Will K i l l Any Chances of Reform.
Recent public and private signals by CBO's Robert Reischauer
about how l i t t l e savings v i r t u a l l y any cost containment
alternative can achieve over the next five plus years r a i s e s
great concern that we w i l l be forced into an a l l and
s i g n i f i c a n t tax strategy. The prospect of a major tax
package on the heels of reconciliation, even for health
care, frightens most Members; and
(7)
Concern that the President i s not Actively Engaged.
Although you, I r a , Judy, Howard, Steve and others have sent
unambiguous signals that the President i s committed to
getting reform done t h i s year, the media coverage and the
perception of internal squabbling i s r a i s i n g questions i n
the minds of Members and s t a f f . Added on top to the sense
that the President himself has not d i r e c t l y raised the
health care issue since the State of the Union, the Congress
i s not confident i t "knows" where the President now stands
on t h i s issue.
�APPENDIX 3
CONGRESSIONAL MEETINGS TO BE SCHEDULED (4/13/93)
Group, Caucus o r Delegation
Date
Task Force Rep.
C o n g r e s s i o n a l B l a c k Caucus
(Hearing)
A p r i l 13th
TC, AS, CH
House Democratic L e a d e r s h i p S t a f f
Contact: Andie K i n g 225-0100
A p r i l 1 3 t h - 1:30
IM, J F
Ways and Means Subcmte on H e a l t h
Contact: David Abernathy
225-7785
A p r i l 1 4 t h - 10:00
*HRC, IM, J F
Senate Democratic S t a f f
Contact: John H i l l e y
A p r i l 1 5 t h - 10:00
IM, J F
House Democratic L e a d e r s h i p S t a f f
Contact: Andie K i n g
225-0100
A p r i l 1 5 t h - 2:00
IM, J F
Veterans Group Event
Sec. Brown, Sen R o c k e f e l l e r
Rep. Montgomery, Rep. Rowland
Contact:
V i c Raymond 523-1802
A p r i l 1 5 t h - 10:00
*HRC, IM
C o n g r e s s i o n a l Women's Caucus
(Follow up)
Contact: L e s l i e Primmer
Week o f A p r i l 1 2 t h
IM, J F
Week o f A p r i l 1 9 t h
*BC, AG, HRC
224-5556
225-6740
Democratic C o n g r e s s i o n a l Leadership
M i t c h e l l , Foley, Gephardt
C o n t a c t s : John H i l l e y ( M i t c h e l l ) 224-5556
Bonnie Lowery ( F o l e y ) 225-8550
Andie K i n g (Gephardt)
225-0100
�Group. Caucus or Delegation
Task Force Rep.
Date
Senate Democratic Leadership
M i t c h e l l , Kennedy, Moynihan, R i e g l e
R o c k e f e l l e r , Breaux, Ford, P r y o r , Daschle
C o n t a c t : John H i l l e y
224-5556
House Democratic Leadership
Foley, Gephardt, Rostenkowski, S t a r k ,
D i n g e l l , Waxman, Ford, W i l l i a m s
C o n t a c t : Andie King 225-0100
R e p u b l i c a n C o n g r e s s i o n a l Leadership
M i c h e l , H a s t e r t , Dole, Chafee
C o n t a c t : David Kehl ( M i c h e l ) 225-6201
S h e i l a Burke ( D o l e ) 225-5311
*BC, AG, HRC
Week o f A p r i l 1 9 t h
*BC, AG, HRC
Week o f A p r i l
19th
*BC, AG, HRC
Week o f A p r i l 1 9 t h
A p r i l 20th -
*HRC, IM
C o n g r e s s i o n a l H i s p a n i c Caucus
(Hearing)
C o n t a c t : Rick Lopez 226-3430
A p r i l 21 - 1:00
BV, CS, ER, RV
Senate Democrats R e t r e a t
C o n t a c t : John H i l l e y 224-5556
A p r i l 24th
*HRC, IM, J F
House Demcratic Caucus
Contact: M e l i s s a Schulman
Week o f A p r i l 2 6 t h
*HRC, IM, J F
Senate Republican H e a l t h Task Force
Chafee, e t . a l .
Contact: C h r i s t y Ferguson 224-2921
Week o f A p r i l 2 6 t h
*HRC, IM, J F
Senate R u r a l H e a l t h Caucus
( F i r s t Meeting)
Contact: P e t e r Reinecke ( H a r k i n ) 224-3254
S h e i l a Burke ( D o l e ) 224-5311
Week o f A p r i l 26
IM, J F
Senate Finance Committee
Democrats and Republicans
C o n t a c t : Lawrence O'Donnell
224-4515
226-3210
�Group. Caucus or Delegation
Date
House R u r a l H e a l t h Caucus
( F i r s t Meeting)
C o n t a c t : Rebecca T i c e (Stenholm) 225-6605
Freshman Democratic House Members
( F i r s t Meeting)
C o n t a c t : Lenwood Long ( C l a y t o n ) 225-3101
C o n s e r v a t i v e Democratic Forum
( F i r s t Meeting)
C o n t a c t : Rebecca T i c e (Stenholm)
Task Force Rep.
IM, J F
Week o f A p r i l 26
IM, J F
Week o f A p r i l 26
Week o f A p r i l 26
IM
Week o f A p r i l 26
IM
House Democratic Committee C o n s u l t a t i o n
C o n t a c t : Andie King 225-0100
Week o f A p r i l 2 6 t h
*HRC, IM, JF,
(BC?, AG?)
Senate Democratic Leadership C o n s u l t a t i o n
C o n t a c t : John H i l l e y 224-5556
Week o f A p r i l 2 6 t h
*HRC, IM, JF
(BC?, AG?)
C o n g r e s s i o n a l Republican L e a d e r s h i p C o n s u l t a t i o n
C o n t a c t s : S h e i l a Burke 224-5311
Dave Kehl 225-6201
Week o f A p r i l 2 6 t h
*HRC, IM, JF
(BC?, AG?)
House Democratic Committee C o n s u l t a t i o n
C o n t a c t : Andie King 225-0100
Week o f May 3 r d
*HRC, IM, JF
(BC?, AG?)
Senate Democratic Leadership C o n s u l t a t i o n
C o n t a c t : John H i l l e y 224-5556
Week o f May 3 r d
*HRC, IM, JF
(BC?, AG?)
C o n g r e s s i o n a l Republican L e a d e r s h i p C o n s u l t a t i o n
C o n t a c t s : S h e i l a Burke 224-5311
Dave Kehl 225-6201
Week o f May 3 r d
*HRC, IM, JF
(BC?, AG?)
Budget Study Group
( F i r s t Meeting)
C o n t a c t : Gene C o n t i ( P r i c e )
225-6605
225-1784
�Group. Caucus or Delegation
House Democratic Caucus
C o n t a c t : M e l i s s a Schulman
226-3210
Senate Democratic P o l i c y Conunittee
C o n t a c t : Greg B i l l i n g s o r M i c h a e l Werner
224-3232
House R e p u b l i c a n Task Force
C o n t a c t : Tandi 225-2976
Task Force Rep.
Date
Every
Wed.
Every Thurs.
Every Thurs.
�I n d i v i d u a l Meaabers
Rep. McDermott
(Sponsor, S i n g l e Payer B i l l )
C o n t a c t : B a r b a r a Smith 225-3106
Rep. LaFalce
(Chmn, Small Business Cmte)
C o n t a c t : Jeanne Roslanowsick
*HRC, IM
IM
226-5821
Rep. Stokes
(Chmn, CBC H e a l t h B r a i n T r u s t )
C o n t a c t : L e s l i e Stokes
225-7032
DS t h e n IM
Rep. Clay
(Chmn, Post O f f i c e and C i v i l S e r v i c e )
C o n t a c t : G a i l Weiss 225-4054
IM o r JF
Rep. Serrano
(Chmn, H i s p a n i c Caucus)
C o n t a c t : R i c k Lopez 226-3430
DS o r IM
Rep. Moakley
(Chmn, Rules Cmte)
Contact:
Mid May
*HRC
�APPENDIX 4
MEMORANDUM
TO: H i l l a r y Rodham C l i n t o n
March 22, 1993
FR: Chris Jennings
RE: Senate Republicans t o Target as Possible Supporters and
Senate Democrats t o A t t r a c t and Keep on Board
cc: Legislative/Congressional D i s t r i b u t i o n L i s t
As you know, i t i s now v i r t u a l l y c e r t a i n t h a t the
President's h e a l t h care proposal w i l l r e q u i r e a t l e a s t one 60
Member vote t o have a chance o f passing the Senate. ( I f the
proposal i s merged i n t o r e c o n c i l i a t i o n , 60 votes w i l l be required
t o waive the Byrd r u l e ; i f i t i s a f r e e standing b i l l , 60 votes
w i l l be required t o achieve c l o t u r e on debate and t o b r i n g an end
to a l i k e l y Republican f i l l i b u s t e r ) .
With the above i n mind, and because we cannot count on a l l
57 Democrats ( p o s s i b l y 56 by the time o f the r o l l c a l l ) t o vote
w i t h us, we must b u i l d on and improve our ongoing e f f o r t s t o
a t t r a c t a core group o f Republicans t o vote w i t h the President on
his h e a l t h reform proposal. S i m i l a r l y , we must a t t r a c t and
r e t a i n support from a f a i r l y s i z a b l e l i s t o f Democrats who, f o r a
v a r i e t y o f reasons, may be nervous about v o t i n g w i t h us.
I n an e f f o r t t o pool the i n f o r m a t i o n we have on the t a r g e t
Senate Members, we convened a group i n c l u d i n g Steve R i c c h e t t i and
his s t a f f , Melanne, C h r i s t i n e Heenan, HHS's J e r r y Klepner, Karen
P o l l i t z and Alan Hoffman, DNC's Celia Fischer, and Steve
Edelstein and h i s War Room s t a f f . (The group now meets every
F r i d a y ) . We found ourselves t o be i n s i g n i f i c a n t agreement on
which Senators we c u r r e n t l y believe t h a t the A d m i n i s t r a t i o n and
the DNC should t a r g e t ; I have attached a l i s t and some crossreferencing i n f o r m a t i o n about t h i s l i s t f o r your use. I n
a d d i t i o n , the i n f o r m a t i o n we produced through t h i s discussion
w i l l be summarized and d i s t r i b u t e d i n short order.
The 14 Republicans we chose are the ever-shrinking number o f
Members who -- because they are viewed as moderates, have s p e c i a l
populations t o worry about, and/or are coming up on an e l e c t i o n
or r e t i r e m e n t — are the most l i k e l y t o cross over and support
us. (FYI, according t o Republican s t a f f , these Members w i l l
attempt t o s t i c k together i n a block so as t o strengthen t h e i r
bargaining leverage IF any such m i n o r i t y block o f Republicans
forms; i n other words, they plan t o exert tremendous pressure on
one another t o block "straggler" Republican support).
The Democrats we chose are those who are h i s t o r i c a l l y
moderate t o conservative Members o r who, because o f t h e i r
constituency o r Committee assignment, are p a r t i c u l a r l y s e n s i t i v e
t o s p e c i f i c s p e c i a l i n t e r e s t concerns. I t i s important t o s t r e s s
t h a t , as we are t a r g e t i n g these Members, we must not ignore o r
a l i e n a t e our r e l a t i v e l y s o l i d progressive support base.
�REPUBLICANS
Senator
Relevant Committee Assignment
1.
2.
3.
Christopher Bond (MO)*
Conrad Burns (MT)* XX
John Chafee (RI) XX
Appropriations Committee
Appropriations Committee
FINANCE COMMITTEE, Health Care
Task Force Chair
4.
5.
6.
B i l l Cohen (ME) XX
Alfonse D'Amato (NY) XX
John Danforth (MO)
Judiciary Committee
Appropriations Committee
FINANCE COMMITTEE
7.
8.
9.
Dave Durenberger (MN) XX
Mark H a t f i e l d (OR)
Jim J e f f o r d s (VT) XX
FINANCE and Labor Committees
Appropriations Committee
Labor Committee
10. Nancy Kassebaum (KS)
11. Connie Mack (FL)* XX
12. Bob Packwood (OR)
Labor Conunittee, Ranking
Appropriations Committee
FINANCE COMMITTEE, Ranking
13. B i l l Roth (DE)* XX
14. Arlen Specter (PA)* XX
FINANCE & Gov. A f f a i r s
Appropriations and J u d i c i a r y
Although a l l w i l l be a great challenge, these 5 Senators
w i l l be the most d i f f i c u l t t o get on board.
XX
Notably, 9 out of the 14 targeted Members have Democratic
Senator counterparts. ( I n f a c t , 11 of 14 have Democratic
Governors). I f these Dems are on board, i t w i l l make i t much
more d i f f i c u l t f o r Republicans t o oppose the C l i n t o n plan.
NOTE: Seven out of the 14 are e i t h e r Finance or Labor Committee
Members or both ( i n the case of Durenberger) — the two
primary Senate health committees. Five of these Members
serve on the a l l - i m p o r t a n t Finance Conunittee.
L a s t l y , although h i g h l y doubtful supporters, s i g n i f i c a n t
e f f o r t s should be made t o make the f o l l o w i n g i n f l u e n t i a l Members
uncomfortable about engaging i n a c t i v e opposition: (1) Bob Dole
(KS, M i n o r i t y Leader, & Finance Conunittee Member), (2) Alan
Simpson (WY, M i n o r i t y Whip, J u d i c i a r y Conunittee), (3) Orin Hatch
(UT, Finance and J u d i c i a r y Committee, Ranking Member), and
(4) Pete Domenici (NM, Budget Committee Ranking Republican and
Appropriations Committee).
�DEMOCRATS
Senator
Relevant Comp'<-»"t-«»*^ Assignment
1.
Max Baucus (MT)
Finance Committee
2.
David Boren (OK) *
Finance Committee
3.
B i l l Bradley (NJ)
Finance Committee
4.
John Breaux (LA)
Finance Committee
5.
Richard Bryan (NV)
6.
Dennis DeConcini (AZ) *
Appropriations, J u d i c i a r y
7.
Chris Dodd (CT)
Labor and Human Resources
8.
Jim Exon (NB) *
9.
Wendell Ford (KY)
10. Bob Graham (FL)
11. Howell H e f l i n (AL) *
J u d i c i a r y Committee
12. Earnest H o l l i n g s (SC)
Appropriations Committee
13. J. Bennett Johnston (LA) *
Appropriations Conunittee
14. Bob Kerrey (NB)
Appropriations Conunittee
15. Herb Kohl (WI)
J u d i c i a r y Committee
16. Bob Krueger (TX)
17. Frank Lautenberg (NJ)
Appropriations Committee
18. Joseph Lieberman (CT)
19. Daniel P a t r i c k Moynihan (NY)
Finance Committee
20. Sam Nunn (GA) *
21. Harry Reid (NV)
Appropriations Committee
22. Charles Robb (VA)
23. Richard Shelby (AL) *
*
I n d i c a t e s the 7 Senators who probably w i l l be t h e most
d i f f i c u l t t o get on board.
�TOTAL STATES/MEMBERS TARGETED IN THE PRELIMINARY SENATE STRATEGY
State
Senator(s)
Governor
1.
2.
3.
4.
5.
Alabama
Arizona X
Connecticut
Delaware
Florida
H e f l i n and Shelby
DeConcini
Dodd and Lieberman
Roth
Graham and Mack
Hunt (R)
Symington (R)
Weicker ( I )
Carper (D)
C h i l e s (D)
6.
7.
8.
9.
10.
Georgia X
Kansas
Kentucky X
Louisiana
Maine X
Nunn
Dole and Kassebaum
Ford
Breaux and Johnston
Cohen
M i l l e r (D)
Finney (D)
Jones (D)
Edwards (D)
McKeman (R)
11.
12.
13.
14.
15.
Minnesota
Missouri
Montana
Nebraska
Nevada
Durenberger
Bond and D a n f o r t h
Baucus and Burns
Exon and K e r r e y
Bryan and Reid
C a r l s o n (R)
Carnahan (D)
R a c i o t (R)
Nelson (D)
M i l l e r (D)
16.
17.
18.
19.
20.
New J e r s e y
New Mexico X
New York
Oklahoma
Oregon
Bradley/Lautenberg
Domenici
D'Amato and Moynihan
Boren
Hatfield/Packwood
F l o r i o (D)
K i n g (D)
Cuomo (D)
W a l t e r s (D)
Roberts (D)
21.
22.
23.
24.
Pennsylvania X
Rhode I s l a n d
South C a r o l i n a X
Texas X
Specter
Chafee
Hollings
Krueger
Casey (D)
Sundlun (D)
Campbell (R)
R i c h a r d s (D)
25.
26.
27.
28.
29.
Utah
Vermont X
Virginia X
Wisconsin X
Wyoming X
Hatch
Jeffords
Robb
Kohl
Simpson
L e a v i t t (R)
Dean (D)
W i l d e r (D)
Thompson (R)
S u l l i v a n (D)
20 o u t o f 29
a r e Dem Govs.
This includes t h e 4 a d d i t i o n a l t a r g e t Republican Senators o f
Dole, Simpson, Hatch, and Domenici.
T o t a l Number o f Senators:
NOTE;
41*
I f t h e DNC does not have the resources t o t a r g e t a l l 29
s t a t e s , they should choose ( g e n e r a l l y ) t o e l i m i n a t e
f i r s t those s t a t e s t h a t have only one t a r g e t Senator
and whose Senator does not serve on t h e Finance
Conunittee. There are 12 such s t a t e s marked w i t h an X,
but my 6 lowest p r i o r i t i e s would be Georgia, Kentucky,
New Mexico, Texas, Wisconsin, and Wyoming. ( I can t a l k
about others i f necessary; i n a d d i t i o n , exceptions t o
the Finance and/or 2 Member r u l e might be Delaware,
Utah, and Alabama).
�MEMORANDUM
TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n
Chris Jennings
Ways and Means Subcommittee Meeting
Melanne, I r a , Judy, Steve, Lorraine
A p r i l 13, 1993
Because o f i t s j u r i s d i c t i o n . Members, s t a f f resources and
e x p e r t i s e , t h e House Ways and Means Committee and i t s
Subconunittee w i l l probably be the most i n f l u e n t i a l body i n t h e
Congress as i t r e l a t e s t o health care. As c h a l l e n g i n g as i t may
be, we must have and continue t o b u i l d a close and productive
working r e l a t i o n s h i p w i t h the Committee.
With t h i s i n mind, you, I r a and Judy are scheduled t o meet
w i t h t h e Ways and Means Subconunittee on Health i n t h e Roosevelt
Room tomorrow morning. This meeting was o r i g i n a l l y requested by
the Subconunittee f o l l o w i n g the l a s t Subcommittee Members' meeting
w i t h I r a and Judy on March 31st.
To focus discussion, the Subcommittee Members requested t h a t
the meeting review two major issues: (1) System Organization:
Federal and State Roles and (2) Cost Containment:
Short-Term and
Long-Term (but w i l l focus p r i m a r i l y on short-term). I n terms o f
meeting format, t h e Subconunittee has suggested t h a t you or I r a ,
f o r each issue, give a b r i e f 15 minute presentation, followed by
a 45 minute Q&A session. Attached f o r your use i s a summary o f
the d i r e c t i o n and options I r a and h i s work groups have been
discussing f o r a l l o f these issues.
I n p r e p a r a t i o n f o r t h i s meeting, Pete Stark suggested t h a t
a l l t h e Subcommittee Members submit questions t h a t they may pose
during your meeting. The questions w i l l be focused on t h e two
issues o u t l i n e d above. As o f 6:30 t o n i g h t t h e questions had y e t
t o a r r i v e , but we w i l l send them over as soon as they a r r i v e .
L a s t l y , as you w i l l r e c a l l , t h e l a s t time you met w i t h t h e
Committee, we had a press leak problem. At some p o i n t d u r i n g t h e
meeting, w i t h o u t being o v e r l y c o n f r o n t a t i o n a l , you may want t o
discuss t h e importance o f keeping these meetings q u i e t , so t h a t
we can have as c o n s t r u c t i v e and productive a working r e l a t i o n s h i p
as p o s s i b l e . This, i n my mind, i s e n t i r e l y appropriate and
should be w e l l received by most.
�WAYS & MEANS-
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JANKI MAY1. CMII> C O U M U M O
COMMITTEE ON WAYS AND MEANS
l^u. THOUAt. CKJfOHHIA
NANCT L JOWiSOH. CONHimeUT
f W ) eiuNBY. n w A
U.S. HOUSE OF REPRESENTATIVES
WASHINGTON, DC 20516
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JIM McCWtT, LOUtSUMA
SUBCOMMITTEE ON HEALTH
i x 0«HC«
DAN ROtttMCOWtK;. ILUMOIt
A p r i l 13, 1993
MU, AUC'UK. T l X M
TO:
Chris Jennings
FROM: David Abernethy N Z ^ ^ S ^ g X ^
SUBJ.:
Questions for tomorrow's meeting
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
*****i,i,**1ci,*1,*1,1,**ic**1t*iiit1,1,
It*
Attached are the questions we discussed. The f i r s t s e t are from
the Chairman of the Subcommittee. I am enclosing the copies of
the questions from individual members so that you w i l l be aware
of their concerns. Please c a l l me i f you have any questions.
�RCV BY:Xerox Telecopier 7020 ; 4-13-93 ; 5:48PM ;
WAYS & MEANS-
2024562539;« 3
Questions
1.
I f a state f a i l s to insure that health plans provide
coverage tc a l l low-income persons, w i l l the Federal
government, by default, cover the low-income population?
2.
What short-term cost containment strategies are under
consideration?
3.
4.
*
Will these options be administered by the Federal
government or by states?
»
Will there be a Federal program which would go into
effect auring the time prior to the development of any
state-administered option?
*
Have you considered the effect on scorable savings of
Federal versus state administration of the cost
containment program?
What long-term cost containment strategies are unde'consideration?
*
At what point would the short-term strategies give way
to the long-term strategies?
*
What would be the mechanism for making the change from
the short-term to the long-term?
*
How w i l l budget l i m i t s , allocated to the States, and
ultimately to l o c a l health a l l i a n c e s (HIPCs), be
enforced?
Under the proposed plan, the state would designate one or
more e n t i t i e s to serve as a health a l l i a n c e (HIPC).
This health a l l i a n c e w i l l have unprecedented
r e s p o n s i b i l i t i e s , including: enforcement of budgets,
selecting and approving health plans, enforcing compliance
with insurance standards, r i s k adjustments, etc.
*
Who w i l l supervise the HIPCs? The states or the Federal
government?
�RCV BY:Xerox Telecopier 7020 ; 4-13-93 ; 5:49PM ;
5.
WAYS & MEANS-
2024562539;« 4
Other e n t i t i e s already e x i s t at the state and Federal l e v e l
to perform most of these functions.
*
What i s the value of adding an additional bureacratic
layer to duplicate existing programs?
6.
What Medicare savings are expected to be included i n the
package?
7.
What w i l l be the allowed rate of growth in health spending,
once the national health budget i s established? What i s the
target percent of GDP for health by the year 2000?
8.
Will states be required to establish HIPCs —
opt for a single payer system?
9.
There i s a history of fraud and abuse in loosely-organized
networks that cover low-income and Medicare b e n e f i c i a r i e s .
*
10.
even i f they
Does the plan envision creation of new types of
networks at the local level? Perhaps plans organized
medical societies?
by
*
Would these plans be licensed or q u a l i f i e d under
existing state and Federal laws?
*
What w i l l be done to protect vulnerable populations
from the kinds of fraud and abuse which have occured in
the past?
How can we assure portability, i f each State i s permitted to
do something different?
�RCV BY:Xerox Telecopier 7020 : 4-13-93 ; 5:50PM i
WAYS & MEANS-
2024562539;» 5
MEMORANDUM
TO: Tricia Neuman
FROM: Sean
RE:
Mr. Cardin's questions for Hillary Rodham Clinton
In order of importance and likelihood of actually being asked:
1.
Will states have the f l e x i b i l i t y to maintain existing cost
containment systems or develop new ones in addition to whatever i s in
the President's package?
2.
w i l l the federal government provide the states with the
tools they need (ERISA, Medicare waivers, etc.) to implement these cost
containment measures?
V
w i"?
going to be given budgets or budget targets,
how w i l l baseline budgets be determined?
,
ttie President's package propose s t r i c t controls on
the apportionment of graduate medical education slots in order to
address the current imbalance of generalist versus specialist doctors
per the recommendations of the Physician Payment Review Commission?
5.
w i l l participation in purchasing cooperatives be mandatory
for businesses of a certain size?
�RCV BY:Xerox T e l e c o p i e r
PIPR 13 ' 9 3 1 4 : 3 7
7020 : 4-13-93 ; 5:50PM
FROM L E U I N - D . O .
WAYS & MEANS-
2024562S3g:« 6
PfiGE.302
8AND» M. LEVIN
tV¥ MITMCT, MCMIOAV
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Houc of KqireftcntBtttieB
Questipjn* for Health Reform Maetlna — Apyil IA. igga
CongrtviDcm Sander Levin
COST coirrAiMWgwTt
1) At many Town Neatings people bave said -- one vay or another
tbe experts say that $100 billion in health oare spending
is nov being vested, uo don't tax ne more until you get rid
or the wests end ineffioienolee. Hew will reeeras he
structured to sigairicantly and Tislhly reduoe vaste M>tb in
the short aad long tem?
2)
At a Houndtable neeting we had yesterday in Kiohlgan to talk
about the solutions to our health care problens, a sajority
of Interest groups were represented, and tha points were
«ade that ateaningful competition can only occur in the
presdTice of budgetary preesures, and our current problems
ere in soae ways the result of conpetition opereting without
any finanoial constraints. Hov will the transitioul syatea
place limita ea doctor, hospital and pharMoeutieal spending
to produoe oost ooBtrols ia the short term aad promote
oempetltiea overell?
yfe&ERAT. -
STATE
ROI.gS?
1)
Assuming substant.iel state flexibility, how will i t be
essured that a state does aot attaint to "gema" the 9jBt9ti,
by implsmentiag stretegies vhieta ellow lower oost health
beaefitt to younger workers as a meehaaism for attraetlag
aew buslaesses to their state?
3}
At our Roundtable yesterday, there was a greet deal of
discussion about prevention end health education
espeeielly focusing on preventable behaviors such es drug
abuse, smoking, and violenoe. sow will the respoasibility
fMT laereesiag heelth edueatiea geaerelly be detezmiaed?
Will i t be primerily e rederel or e state funetloa?
3)
Assuming substantial state flexibility, how will
eeeouatabilitj for the erees of gualityf access, aeeessarY
data GOlleotioa, ead rsouirsd service uaiformity be assured?
�RCV BY:Xerox Telecopier 7020 ; 4-13-93 ; 5:52PM ;
CoMMnni ON WAVI ANO MEANS
SUlCOMMimi ON HIAUH
WAYS & MEANS-
JIM MCDERMOTT
7TH DISTRICT, WASHINGTON
2024562539;«
7
COXNAIRMAN
CONGRESSIONAL URBAN CAUCUS
SuscoMMrrrEE ON HUMAN RESOURCES
CHAIRMAN
CoNORissiONAL TASK FORCE ON
INTSRNATIONAL HIV/AIDS
CHAIRMAN
COMMITTEE ON STANDARD* of
OMICIAL CONDUCT
COMMITTEE ON DISTRICT OF COLUMBIA
CHAIRMAN
SUICOMMITTEE ON FISCAL AMAIRS
AND HEALTH
SUICOMMITTEE ON JUDICIARV AND
EDUCATION
. J|pu$e of Slepre2!entatibe£(
Sla<[)tngton, S C 20515
SSCRETARY-TREASURER
ARMS CONTROL AND FOREION
Poucv CAUCUS
ELICTID REGIONAL WHI^. ZONE 2
QUESTIONS FOR MEETING
WITH MRS. CLINTON
APRIL 14,- 1993
1. Assuming a global budget, will the global budget apply to
a l l providers and a l l insurance markets,.including secondary
insurance markets and self-insurers outside the HIPCs? I f not,
how will cost-shifting and escalation to the non-regulated market
be controlled?
2.
What i s the extent of the states' responsibility for staying
within budget and how i s i t enforced?
3. Has a goal been established for a specific numerical
reduction in administrative,expense and what are the mechanisms
for reduction in administrative expense?
4.
Since copayments are a utilization control mechanism to
achieve cost-containment, how will they be structured to avoid
creating administrative expense ai^d corr5)lexity?
1707 LONOWORTH BUILtMNG
WASHINGTON, DC 2081S-4707
(202) 22B-3lOe
1S09 7TH AVENUE. Suns 1213
RRINTIO ON RECYCLED RARER I
SEATTLE, WA BB101-1398
(206) BB3-7170
�LEGISLATIVE UPDATE
Congressman Stokes recenUy introduced legislation, H.J. Res. 136, designating Apnl 1993 as
National African American Health Awareness Month. The Resolution recognizes the need for
national attention to the serious health problems which impact the African American
community in particular. As outlined in the 1985 Report of the Sa:retary s Task Force on
Black and Minority Health, minorities are not equitable beneficiaries from advances m the
medical arena. The report concluded that minorities suffer nearly 60,000 deaths annuaUy.
That figure has now sl^rocketed to approximately 75,000 deaths each year.
The Stokes' Resolution fmds historical precedent in a previous effort by Booker T.
Washington
In 1915, Washington instituted the observance of "National Negro Health week .
This iiStiative was aresponseto the then health care crisis of African Americans and became
orecedent for a nationwide commemorative. Under the direction of the U.S. Pubbc Health
Service from 1932 through 1950, "National Negro Health Week" was observed durmg the first
week of April
House Joint Resolution 136 adopts the month of April m recognition of this
observance. The measure is pending consideration by the House Committee on Post Office
and Civil Service.
In addition the Department of Health and Human Services has selected the National
Medical Association to lead its initiative in bringing this problem to the forefront The
National Medical Association will lead health and civic organizations across the Umted States
in health promotion and disease prevention efforts that address this serious issue.
ltCl|Cl|c>l<ltll|<>t<>l'*>t<
Both the House and Senate have acted favorably on the Nationallnstitutes of Health
Reauthorization Act. This bill was quickly brought back for consideration after being vetoed
last year by President Bush. The NIH bill reauthorizes several of the research mstitutes at
NIH and establishes other authorities under NIH. The bill incoiporates several provisions
that Congressman Stokes offered in legislation during last year's deUberations on NIH and
efforts he has formulated through his work on the Appropnations Committee. These
initiatives focus on minority health and minority biomedicalresearchconcems at NIH.
Specifically the NTH bill requires that minorities and women be included as subjects in NIHfilnded research projects except in special circumstances. This would be in situations where
it would be inappropriate to the puipose of theresearch;where it could put the participants
at-risk; and where it is detennined to be inappropriate under the circumstances specified by
the Director of NIH.
The legislation also provides for the establishment of a scholarship and loan repayment
program to address the continued under-representation of individuals from disadvantaged
backgrounds pursuing careers in biomedicalresearchand in mid-level and senior scientific
and administrative positions at NIH. Such a program allows NIH to enhance it ability to
recruit and retain scientists and administrators while increasing theirrepresentationof
individuals from disadvantaged backgrounds within their professional force.
A kev provision of the NIH measure is the statutory authorization of the Office of Research
on Minority Programs which has been in existence since 1990. The NIH bill would allow this
program to carry out a coordinated and strategic plan to implement NIH's mmonty health
initiative. Through this office, NIH can work to meet its goals of improvmg health m
minority communities and attracting minorities into careers of medicine and research.
Congressman Stokes was the catalyst behind the creation of this office in 1990.
The NIH Reauthorization Act is awaiting House and Senate conference action.
�April 13, 1993
Attached are three sets of memoranda related to
proposals for national health refonn:
Tab A:
A description of the role of state
and federal government
Tab B:
A description of a national health
budget and administrative
simplification as sources of longterm cost containment
Accompanied by a longer paper
related to global health budgeting
Tab C:
A brief description of options for
short-term cost controls
Accompanied by a s l i g h t l y longer
description of each option and a
paper providing further d e t a i l s
about each option
�APRIL 13,
1993
SUMMARY OF ISSUES UNDER NATIONAL HEALTH REFORM:
FEDERAL/STATE RELATIONSHIP
LONG-TERM COST CONTAINMENT
SHORT-TERM COST CONTAINMENT
I n the new system, we assume a cooperative f e d e r a l - s t a t e
r e l a t i o n s h i p . The f e d e r a l government w i l l not regulate the new
system h e a v i l y ; r a t h e r , i t w i l l set parameters t o ensure t h a t the
n a t i o n a l goals of u n i v e r s a l access, high q u a l i t y care and cost
containment are met.
States w i l l have s u b s t a n t i a l f l e x i b i l i t y and a u t h o r i t y t o
implement the new system. They w i l l have the f i n a n c i a l
r e s p o n s i b i l i t y t o meet a budget and w i l l be responsible f o r
overruns. The f e d e r a l government w i l l provide the s t a t e s w i t h
the t o o l s t o enforce the budget.
This memorandum describes p r e l i m i n a r y proposals f o r n a t i o n a l
h e a l t h reform r e l a t e d t o f e d e r a l - s t a t e r e l a t i o n s , long-term cost
c o n t r o l s obtained through a n a t i o n a l h e a l t h budget and through
a d m i n i s t r a t i v e s i m p l i f i c a t i o n and options f o r short-term cost
c o n t r o l s . S p e c i f i c options described represent one set among
several under consideration and are intended f o r i l l u s t r a t i v e
purposes.
FEDERAL GOVERNMENT ROLES AND
RESPONSIBILITIES:
Under n a t i o n a l health reform, the f e d e r a l government w i l l :
• E s t a b l i s h guarantees f o r health-care
coverage and d e l i v e r y t o be c a r r i e d out by
the states
• Ensure p r o t e c t i o n of c i t i z e n s i f s t a t e s
f a i l t o meet f e d e r a l standards
• E s t a b l i s h an employer and i n d i v i d u a l
r e s p o n s i b i l i t y to contribute to health
insurance costs
• Enforce a n a t i o n a l health budget, holding
s t a t e s accountable f o r spending t o meet the
budget
• Determine the annual increase i n the
n a t i o n a l health budget
�• E s t a b l i s h and oversee formulas f o r
a d j u s t i n g payments t o h e a l t h plans based on
demographic and c l i n i c a l c h a r a c t e r i s t i c s o f
enrolled patients
• Update and r e f i n e t h e comprehensive b e n e f i t
package
• E s t a b l i s h and oversee f e d e r a l subsidies f o r
low-income persons and e l i g i b l e small
employers
• E s t a b l i s h and implement n a t i o n a l q u a l i t y
and access standards
• Manage and analyze n a t i o n a l c o l l e c t i o n o f
i n f o r m a t i o n r e l a t e d t o health care access,
q u a l i t y and coverage
• E s t a b l i s h a mechanism f o r assessment o f
h e a l t h technology and emerging treatments
• Oversee f e d e r a l funding f o r t r a i n i n g o f
h e a l t h professionals
• Provide t e c h n i c a l assistance and s t a r t - u p
grants t o support t h e development o f consumer
h e a l t h a l l i a n c e s and health plans
• Administer any l i m i t s placed on t a x d e d u c t i b i l i t y o f employer c o n t r i b u t i o n s t o
premiums i n excess o f l o c a l l y established
benchmark premium
• Override s t a t e anti-managed competition
laws and other s t a t u t e s i n c o n s i s t e n t w i t h t h e
p r i n c i p l e s o f the new health care system
• Delegate these functions v a r i o u s l y t o a
n a t i o n a l h e a l t h board and an executive branch
agency
STATE GOVERNMENT: ROLES AND RESPONSIBILITIES:
Under n a t i o n a l h e a l t h reform, t h e states w i l l :
• E s t a b l i s h a t l e a s t one consumer h e a l t h a l l i a n c e
• I f they choose, opt out o f t h e consumer
h e a l t h a l l i a n c e s t r u c t u r e and operate as a
�s i n g l e payer t h a t negotiates d i r e c t l y w i t h
providers or sets all-payer rates
• Set boundaries f o r consumer health
a l l i a n c e s t o ensure:
- Minimum population of one
m i l l i o n , or e n t i r e s t a t e population
i f less than one m i l l i o n
- No d i s c r i m i n a t i o n against lowincome or h i g h - r i s k populations
- Contiguous boundaries
• Administer and assure compliance w i t h
n a t i o n a l health budget
• Establish and enforce performance standards
f o r consumer health a l l i a n c e s under f e d e r a l
rules, including:
- Enrollment i n health plans of a l l
persons r e s i d i n g i n assigned
geographic area
- I n c l u s i o n of a range of h e a l t h
plans w i t h i n budget t a r g e t s
- Solvency requirements
- Appointments t o , composition o f ,
and membership on policy-making
boards
- Administrative expenses
• Protect people e n r o l l e d i n h e a l t h plans or
h e a l t h a l l i a n c e s i n case of f i n a n c i a l f a i l u r e
• Operate a s t a t e health plan i f necessary t o
c o r r e c t gaps i n the market
�MEDICAID:
Under n a t i o n a l h e a l t h reform. Medicaid b e n e f i c i a r i e s w i l l
e n r o l l i n h e a l t h plans o f f e r e d through consumer h e a l t h a l l i a n c e s :
• Medicaid b e n e f i c i a r i e s w i l l receive subsidies toward
the cost o f premiums and co-payments on the same basis
as other low-income people
• Health plans w i l l provide supplemental services such
as t r a n s p o r t a t i o n and c l i n i c a l case management as
appropriate t o ensure access t o care
• States w i l l continue t o c o n t r i b u t e t o t h e cost o f
care f o r low-income people:
- I n i t i a l l y under a requirement f o r
maintenance o f e f f o r t and l a t e r subject t o a
new formula determined by a commission and
adopted by Congress through an expedited
procedure
- Requirements f o r maintenance o f e f f o r t
could include a l l s t a t e health expenditures,
not j u s t Medicaid
�LONG-TERM COST CONTAINMENT: A NATIONAL HEALTH BUDGET
National h e a l t h reform w i l l e s t a b l i s h a budget f o r h e a l t h
care spending c o n s i s t i n g o f two p a r t s :
• The f e d e r a l government w i l l enforce an
annual budget f o r spending through consumer
health alliances
- Determined by the average premium
(weighted by enrollment i n each
plan) f o r the comprehensive b e n e f i t
package
- Enforced a t the s t a t e l e v e l
- States held accountable f o r
spending i n excess o f the budget
- States and h e a l t h a l l i a n c e s w i l l
meet budget l i m i t s through:
A u t h o r i t y t o negotiate
and regulate premiums
A u t h o r i t y t o freeze
enrollment i n plans
A u t h o r i t y t o set and
regulate payments t o
providers
A u t h o r i t y t o approve
investments i n h e a l t h
resources and technology
• S e l f - i n s u r e d plans also w i l l be r e q u i r e d t o
meet s t a t e budgets
The f e d e r a l government w i l l enforce budget l i m i t s through
the f o l l o w i n g mechanisms:
• Allow s t a t e s t o share i n savings f o r
f e d e r a l subsidies i f costs increase less than
budgeted
• Require s t a t e s t h a t exceed budget t o submit
plans f o r c o r r e c t i o n
• Require s t a t e s t o finance a d d i t i o n a l cost
of subsidies t o small employers, i n d i v i d u a l s
and f a m i l i e s i f budget exceeded
�• I f budget exceeded i n successive years:
- Impose a penalty t a x on
providers, w i t h revenues t o pay f o r
f e d e r a l subsidies
- Implement r a t e s e t t i n g
- Operate consumer health a l l i a n c e
• Consistent w i t h the n a t i o n a l health budget,
the f e d e r a l government w i l l c o n s t r a i n
payments t o providers t o l i m i t spending f o r
i t s programs
LONG-TERM COST CONTAINMENT: ADMINISTRATIVE SIMPLIFICATION
National h e a l t h reform w i l l e s t a b l i s h r u l e s intended t o
reduce burdensome data c o l l e c t i o n and information processing
while assuring privacy and s e c u r i t y o f personal h e a l t h
information:
• S i m p l i f y information c o l l e c t i o n
requirements f o r b i l l i n g and enrollment
purposes
• Require use o f n a t i o n a l , standard forms
• Require use o f n a t i o n a l , standard data sets
f o r f i n a n c i a l , c l i n i c a l , q u a l i t y and other
information
• Develop n a t i o n a l procedures f o r
coordination o f b e n e f i t s u n t i l new h e a l t h
system f u l l y implemented
• Develop and adopt unique provider, p a t i e n t ,
plan and e m p l o y e r - i d e n t i f i c a t i o n numbers
• Set n a t i o n a l communication standards f o r
e l e c t r o n i c data interchange
• Set uniform n a t i o n a l r u l e s
privacy and s e c u r i t y
• S i m p l i f y u t i l i z a t i o n review
regarding
�FOR OmOAL USE ONLY (GROUP 4 — PAGE 1)
GROUP 4: GLOBAL BUDGETS
Note: The budget strucnire presented here presumes the follomng:
1.
•
That states would have substantial latitude, and that the federal government
would be unwilling to create an uncapped federal liabilityforlow-income
subsidies in a system that is not largely within its awn control. These
assumptions, taken together, lead to a system in which states are financially
accountable for the cost oflow-irKome subsidies in excess of the allowable
iTu:rease in the budget.
•
Thai there should be a federal guarantee to slow health spending Cincluding
private spending). This assumption leads to the need for a federally-defined
outside limit on the rate of increase in health spending (at leastforthe
guaranteed comprehensive benefits within the purchasing cooperative), mth some
sanctions if spending within a state rises at a more rapid rate. It is presumed
that elements of the federal program (e.g. a limit on the tax favored status of
health coverage) would restrain spending.
HOW IS THE BUDGET DEFINED?
a.
Private spending budget. There would be a budget for private health care
spending that would be defined as the average premium (weighted by
enrollment in each plan) for the guaranteed comprehensive benefits.
The budget would not include speiding for supplemental benefits, balance
billing (if permitted), out-of-pocket costs (though consumer costs for the
comprehensive benefits would be expected to rise along with the budget), and
public health.
[Note: The viability of a budget only on the guaranteed benefits presumes that
the guaranteed pacfcage is relatively comprehensive. To the extrait that is not
the case, a budget applied to supplemental covoage as well might be
appropriate.]
i.
Enforcement inside the purchasing cooperative. The budget would
be strictly enforced inside the purchasing cooperative.
States would have broad authority to control health care spending, and
PRELIMINARY STAFF WORE3NG PAPER FOR ILLUSTRATIVE PURPOSES ONLY
�FOR OFHCIAL USE ONLY (GROUP 4 — PAGE 3)
•
A budget inyfosed only on the purchasing cooperative could
raise difficidty equity issues. Ifper capita spending inside the
purchasing cooperative were substantially lower than outside,
two tiers of quality might develop (or be perceived as
developing).
It would difficult to efforce directly a budget on self-insured employers
outside the purchasing cooperative. However, large employers
exceeding a spending target could be required tofointhe purchasing
cooperative. This would bring these employers wider the budgetary
control of the purchasing cooperative. This approach would work as
follows:
•
Multi-year Target. Large employer spending would be
monitored on the same multi-year budget cycle as used for states
and purchasing cooperatives. A multi-year budget is
particularly important for individual employers, since even large
employers experierwe substantial random variation in costs from
year to year.
•
Spending Targets. If the rate of increase in spending for the
guaranteed comprehensive benefits by a large employer exceeded
the allowable increase in the federally-defined budget over the
multi-year cycle, the employer would be required tofointhe
purchasing cooperative. The Society of Actuaries would develop
a methodology for separating the cost of the guaranteed benefits
from an employer's total health expenses (which might include
supplemental benefits).
•
Premium for Large Employers. A large employer required to
foin the purchasing cooperative would pay ^ purchasing
cooperative the same premium that would have been charged if
the employer hadfoinedthe cooperative voluntarily.
Public spending budget. There would be a budget for federal Medicare
spending. [Note: We are working on options for how a Medicare budget
could be defined and enforced.]
Federal spending for low-income subsidies would also be limited, as described
in Section 6b below.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY
�FOR OFFICIAL USE ONLY (GROUP 4 - PAGE 5)
(
a.
Formula example. Note, in particular,fliatthe period for narrowing
differentials could be compressed (e.g., to S years) or extended and that the
rural offsetfigurecould be adjusted.
In thefirstyear of the global budgeting system, a state's budget will largely
reflect its historical expenditure level. At the end of seven years, each state
will have the same budget except for adjustments for differoices in
demographics and input prices.
Let
Hj = historical expenditure level for state i, trended forward by national
target growth rates to year 1 of budget
T = national budget level
Tj = adjusted national budget level for state i = T*Pi*Di
Bi = actual budget for state i
Pj = input price index for state i
Di = demographic adjustment for state i.
In year 1, B, = (.14*Ti)+(.86*Hi). Each year the weights change by .14 so
that in the seventh year Bi=Ti. This transition is similar to the PPS and
Medicare fee schedule transitions.
Pi is a weighted average of expenditure-specific input price indices (e.g.,
hospitals, physicians, and drugs) where the weights for Pj are based on
national spending patterns. Initially, the HCFA hospital wage index would be
used for hospital expenditures, although eventually a broader wage index could
replace it. "The Geographic Cost of Practice Index (GCPI) would be used for
physician expenditures. However, the GCPI will be multiplied by 1.20 for
"very rural areas" (defined, for example, as areas with population densities
below SO persons per square mile) to recognize the difficulty of attracting
physicians to these areas. Drug expoiditures will not be adjusted for
geographic variations — the index will be 1 everywhere.
b.
The Commission would make its determiruttion based on Ae faaors described
below. Congress will vote on the annual allocation to States on an up-ordown vote. If Congress refects the Commissions recommendations, tiie
allocation would be the baseline. The Commission shall allocatefimdsso as
to narrow variations in spending due to practice pattern variations and
differences in health resource endowments.
Updates of tfie budget baseline should r^lea two sets of factors:
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY
�FOR OFnCL\L USE ONLY (GROUP 4 — PAGE 7)
an increase in unemployment — since federal financing for subsidies
would account for the number of people recdving subsidies.
(Note that spending rising £fister than the federally-defined budget
would mean that employer and consumer premiums would also rise.)
ii.
If health spending in a state rose slower than the federally defined
budget, then the state would retain the savings in federally-financed
low-income subsidies that would resultfromlower than budgeted health
care spending in the state.
iii.
State financial accountability for low-income subsidies would compound
over time. For example, consider a state that exceeded the federallydefined budget by 1 % in a givwi year, but then tracked allowable
budget increases thereafter. The state would always be spending more
than was budgeted, and would therefore have to finance the additional
low-income subsidies that result.
iv.
Technically, state financial accountability would be tied to the amount
the state is over (or under) budgetrelativeto the weighted average
premium in the purchasing cooperative, r^ardless of how subsidies
are structured. For example, if total subsidies in a state were $1 billion
and the state exceeded the budget (i.e. the weighted average premium
in the purchasing cooperative) by 1%, then the additional state financial
responsibility would be $10 million.
(Subsidies may very well be based on the benchmark premium, which
could increase at faster or slower rate than the weighted average
premium. However, tying statefinancialaccountability to the
benchmark premium would provide a strong incentive for a state to
hold down the cost of the benchmark plan, potentially resulting in a
deterioration in quality in that plan relative to others.)
V.
c.
The National Health Board (or a Commission) would prcpait a formula
with the characteristics described above. The formula might
s^ropiiately be designed in conjunction with developmrait of
maintenance of effort provisions for state Medicaid spending.
Outside limit on state health care spending. As described above, the
federally-defined budget update would determine the levd of federally-financed
low-income subsidies, with states financially accountable for subsidies in
excess of this amount.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY
�FOR OFnCIAL USE ONLY (GROUP 4 - PAGE 9)
iii.
Federally-imposed ratesetting.If spending exceeded the outside limit
over an oitire multi-year budgeting period, the federal govemment
would implement rate-setting systems in that state, which would assure
compliance with the federally-defined budget.
4
In order to implement rate-setting systems that are best suited to
local circumstances, the federal govemmoit would have
flexibility to implement different systems in diffment states and
various approaches by provider type.
•
For staff model HMOs and other fiilly-capitated delivery
systems, the federal govemment would impose the expenditure
limit through limitations in premium increases.
•
The federal government's systems would remain in effect imtil
the state provided the federal govemment with evidence that its
proposed expenditurerestraintpolicies would achieve
confonnance with the federally-defined budget.
4
In carrying out itsfiinctions,the federal govemment could
require states, health plans, providers, and insurers to submit
relevant information to assess compliance with the expenditure
limits and to assure timely and effective implementation of any
necessary federal actions.
budprop2.wp
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY
�Short-term cost c o n t r o l options
Option 1: Insurance premium regulation
•
Would set allowable r a t e s o f increase f o r
insurance premiums (or premium equivalents
for self-insured firms).
•
L i m i t s one o f the most v i s i b l e costs t o
consumers and introduces t h e concept o f
operating under a budget.
Option 2: All-payer rate setting
•
Would extend Medicare payment methodology t o
a l l payers and set r a t e s t o c o n t r o l spending.
•
System already i n use; familiar to providers,
Option 3: Provider price controls
•
Would c o n t r o l p r i c e s based on h i s t o r i c a l
l e v e l s , without regard t o whether o r not t h e
charges were excessive i n t h e f i r s t place.
•
Could be imposed immediately.
Option 4: Marginal revenue^^fe^xes
•
Would impose a temporary revenue surtax on
providers whose revenue growth exceeds a
target.
•
Could be imposed immediately.
Option 5: Voluntary c o n t r o l s
•
Would r e q u i r e e n l i s t i n g i n d u s t r y i n v o l u n t a r y
c o n t r o l s and passing standby a u t h o r i t y f o r
the President t o impose mandatory c o n t r o l s i f
the v o l u n t a r y goals are not met.
•
Mandatory c o n t r o l o p t i o n could be developed
during a t r i a l period f o r the v o l u n t a r y
controls.
�Short-term cost control options
Option 1: Insurance premium regulation
This o p t i o n c a l l s f o r s e t t i n g allowable r a t e s o f
increase f o r insurance premiums (or premium equivalents
for self-insured firms).
Regulating premium increases l i m i t s one o f t h e most
v i s i b l e costs t o consumers and introduces t h e concept
of operating under a budget. I t may also thwart p r i c e
gouging during t h e t r a n s i t i o n .
However, implementing premium r e g u l a t i o n r e q u i r e s a
complex a d m i n i s t r a t i v e apparatus. L i m i t i n g premium
increases may lead t o "dumping" o f insured i n d i v i d u a l s
w i t h c o s t l y h e a l t h conditions, denials o f treatment o r
reimbursement, or bankruptcy o f insurance companies.
Effectiveness also depends upon e n l i s t i n g s t a t e s as
enforcers.
Option 2: All-payer rate setting
This o p t i o n c a l l s f o r extending t h e Medicare payment
methodology t o a l l payers and s e t t i n g r a t e s t o c o n t r o l
spending.
Health care providers and insurers t h a t have served as
c a r r i e r s o r f i s c a l intermediaries f o r Medicare a l l have
experience and mechanisms i n place t o implement t h i s
method of cost c o n t r o l . Some states t h a t have adopted
a l l - p a y e r r a t e s e t t i n g have had success i n c o n t r o l l i n g
costs i n t h e p r i v a t e sector.
However, experience under Medicare i n d i c a t e s t h a t
volume increases may o f f s e t some savings. Cost
s h i f t i n g t o unregulated sectors may occur u n t i l r a t e s
are established ( f o r o u t p a t i e n t services, f o r example).
Even i f r a t e - s e t t i n g aims t o make no
aggregate change i n provider payment l e v e l s ,
i t w i l l r e d i s t r i b u t e income among providers,
since t h e new rates w i l l d i f f e r from c u r r e n t
charges. Providers w i l l face a double
shakeup--first, r a t e - s e t t i n g ; then, managed
competition. Turning h e a l t h care upside down
once might be thought enough.
Option 3: Provider price
controls
This o p t i o n would c o n t r o l p r i c e s based on h i s t o r i c a l
�l e v e l s , without regard t o whether or not t h e charges
were excessive i n the f i r s t place. Prices would be
d e c o n t r o l l e d as managed competition becomes f u l l y
operational.
Price c o n t r o l s can be imposed immediately. They do
not threaten any sharp change i n current p r o v i d e r
incomes.
However, p r i c e c o n t r o l s are l i k e l y t o t r i g g e r an
increase i n volume, which w i l l o f f s e t some savings.
They are hard t o enforce, e s p e c i a l l y on physicians.
The longer they are i n place, the greater t h e
i n e q u i t i e s and unintended consequences.
Option 4: Marginal revenue taxes
This o p t i o n imposes a temporary revenue surtax on
providers whose revenue growth exceeds a t a r g e t .
The surtax can be imposed immediately and w i l l deter
volume increases. Although evading t h e c o n t r o l s would
be a form o f t a x evasion, providers may w e l l f i n d ways
t o game the system and l e g a l l y avoid t h e t a x . They
could also respond t o marginal revenue taxes by t u r n i n g
away p a t i e n t s .
This o p t i o n i s untested and could adversely a f f e c t t h e
development o f e f f i c i e n t plans experiencing r a p i d
growth.
Option 5: Voluntary controls
This o p t i o n c a l l s f o r e n l i s t i n g i n d u s t r y t o adopt
v o l u n t a r y c o n t r o l s , w i t h standby a u t h o r i t y f o r t h e
President t o impose mandatory c o n t r o l s i f t h e v o l u n t a r y
goals are not met. A mandatory c o n t r o l o p t i o n could be
developed during a t r i a l period f o r t h e v o l u n t a r y
c o n t r o l s . This o p t i o n might make providers more
favorable t o the plan.
This o p t i o n does not ensure cost savings.
�AN OPTION TO FREEZE KSD CONTROL PROVIDER PRICES
This option i s designed to reduce aggregate health
spending as much as possible and as •oon as possible.
care
TIMING:
o First, prohibit increases in provider prices.
o After 3 to 9 nonths replace the freeze with a system that
i s flexible and enforceable. Officials from Carter's Council on
Wage and Price Stability (CWPS) state that an inflexible freeze of
longer than 5-6 months would lead to rapidly declining compliance.
o
Decontrol prices gradually, as managed competition
addresses the causes of cost growth.
GENERAL DESIGN:
o As with a l l price control options, ban increases in balance
billing and limit balance billing, e.g., to 20%. To f a c i l i t a t e
enforcement, allow consvuners to sue providers who violate balanced
billing guidelines for triple damages.
o To combat anticipatory price hikes, begin the freeze by
requiring that prices be rolled back a constant percentage.
o For administrative simplicity, do not control wages or input
prices.
o In stage 2, set price growth, e.g., equal to inflation.
Anticipate volvime offsets, e.g., of 50 % for physicians. Define
criteria for special exemptions, and establish a review process.
DESIGN BY SECTOR:
Physicians: MDs typically earn a fee for service, (FFS), or
a fixed "capitated" payment per patient. Physicians' revenues were
$152 billion in 1991, (20% of NHE) and are projected to grow at
5.8% annually in real dollars during the 1990s; 361,000 MDs are
office-based.
o For FFS payments, a l l private third party payers,
including self-insured employers, would freeze usual and customary
rates, effectively capping reimbursements to MDs.
Third party
payers that do not use usual and customary rate screens to limit
payments to physicians would be mandated to use an acceptable
screen within 3 months of the date the freeze begins. To be
'acceptable' the usual and customary screen would be derived from
a data base that meets Federal quality standards, e.g., a random
sample of sufficient size, etc.
o
For capitated payments, health plans would freeze
payment schedules to preferred provider organizations, or to
independent practice associations. Changes in bonuses, or other
compensation would be banned.
Hospitals:
Payments to hospitals are based on charges,
capitation, or private DRGs.
For-profit and not-for-profit
�hospitals could be treated identically. Revenue of 7000 hospitals
was $324 billion in 1991, and i s expected to grow at 5.8 % annually
in real dollars dxuring the 1990s.
o DRGs and capitated payments are typically negotiated by
the health plan with the hospital. Prohibit health plans from
increasing payments above historic levels.
o For hospitals paid on the basis of charges, the lack of
standardized billing codes may prompt the spurious redefinition of
products. Therefore ban charge-based billing and base payments on
average revenues per admission. These are calculable using IRS
revenue data, and HAA admissions data.
HMOs: Premia for staff model HMOs could either be frozen amd
controlled or left alone.
Compliance by 550 HMOs could be
monitored Federally.
OTHER: Dentists, medical labs and some nursing homes are also
compensated by third party payers. These could also be subject to
controls.
ENFORCEMENT:
o Require quarterly compliance reports of a l l third-party
payers, including HMOs and self-insured employers to a Federal
Office of Health Care Cost Control.
o Interested third party payers may monitor provider prices
more cost-effectively than Federal agencies. Additional record
keeping by health plans and by providers, nonetheless, appears
necessary.
o CWPS in 1978 used 300 staff to supervise voluntary price
controls for 2000 large manufacturing firms.
EFFECTIVENESS: The medical services deflator during the Nixon price
controls grew by about 2% less than in preceding periods. Medical
care spending growth during the freeze was about 2.5% less than
earlier periods, and during Phase 2 about 1% less.
�MARGINAL REVENUE TAXES
SUMMARY: Impose temporary revenue surtaxes on providers whose
revenue growth exceeds a target.
DESIGN: The tax could begin at two cents on the dollar for
revenues greater than a base, e.g., last year's adjusted gross
revenue, as reported to the Internal Revenue Service. I t would
rise linearly to 30 cents on the dollar for revenues greater ^ a n
115 percent of the base. Variations would include beginning the
tax above the base, raising i t more sharply as revenue increases
above the base, and giving different tax schedules to different
classes of providers. Since the IRS collects revenue data from a l l
providers, including not-for-profit hospitals, this approach could
be effective January 1994.
New providers, e.g., recently graduated physicians, could be
given special schedules so that their base revenue i s the average
revenue for new physicians in their specialty. Corporate mergers
could be taxed using the sum of the base revenues of the merged
entities. Other new physicians' practices could simply be given a
base equal to the average revenue of their type of practice.
SCOPE: This approach, with variations, could be applied to
hospitals, physicians, nursing homes, medical labs, and dentists.
ENFORCEMENT: Despite the extensive experience of the IRS, the
extent of compliance i s uncertain, because providers would try to
shelter revenue. Accounts receivable could be given to collection
agencies with understandings to undertake long-term investments.
Medical practices could be reorganized, and billings collected by
entities without visible connections to the practices. Medical
practices that own rental income could s e l l these assets to allow
for greater tax free growth in medical revenue.
Relatively low tax rates, carefully drafted legislation and
s t r i c t enforcement could increase compliance. In addition third
party payers could be required to report to the IRS summaries of
payments made to particular providers.
EFFECTS: Unlike price controls, marginal revenue taxes would not
increase the volume and intensity of services.
By causing
physicians to take more leisure, they may lead physicians to
cutback either patient loads or the intensity of service. Prices
may r i s e . A graduated revenue tax allows some f l e x i b i l i t y to a l l
providers.
�ALL PAYER RATE SETTING OPTION
Extend Medicare payment methodology to a l l payers and s e t
rates so that spending I s controlled.
I. .
Implementation Schedule
For
For
II.
1994:
•
DHHS completes i n i t i a l schedule nodifleatiozus for
hospital Inpatient, physicians
•
DHHS uses Medicare data or limited private data t o
calculate conversion factors/standardized payment
amounts
•
DHHS establishes volume controls using Medicare as
a proxy
•
DHHS completes Medicare software adaptation
•
During f i r s t 6-9 months a f t e r enactment. Insurers
adopt rates or contract with Medicare contractors
1995:
•
DHHS w i l l complete rates for hospital outpatient
services
•
More extensive private data for physician
conversion factors and volume standards/controls
w i l l be available
•
DHHS w i l l refine data to handle uncompensated care
and other hospital adjustments
•
DHHS may include hospital outpatient s e r v i c e s i n
ratesetting, covering about 75% of health spending
•
DHHS w i l l begin/consider development of a wider
variety of volume control mechanisms. Including
medical group controls, bundled payments for some
ambulatory services, e t c .
Administration and Monitoring
•
Requires start-up costs for both the federal govemment
and insurers, to a l e s s e r degree for providers
•
Requires establishment of a national all-payer database
which may be valuable for other purposes
�•
[
^
_
Requires continued data collection for updating prices,
enforcing volume standards, and acccxnodating potential
savings slippages
I I I . Implications of A l l Payer Rate Setting
•
Slow phase-in schedule l i m i t s scope of spending
controlled:
Would cover only about 60-65% of t o t a l health care
spending during the f i r s t year. Could not
implement rates for outpatient hospital during
f i r s t year.
Volume controls would be limited to withholds and
for physician spending would have to be based on
Medicare experience as a proxy during f i r s t year.
•
Negative consequences may Inhibit smooth t r a n s i t i o n to
managed competition:
Provider dislocations
Lock-in of current resource allocations I n a way
inconsistent with managed competition
•
!
Imposing structure could potentially smooth the
transition to managed competition by:
Continuing controls for fee for service sectors
Standardizing service definitions for payers and
consumers
Serving as a point of reference for the purchasing
cooperatives i n rate negotiation
�TIMELINE FOR IMPLEMENTING ALL PAYER RATESET7TMC APPROACH
for July 1994 Implemsntatlon
April 1993
Complete detailed workplans for APRS, for
hospital, phyaician, and other aervloet
Kay 1993
Begin developing payment rates for pediatric,
0B-67N, and preventative services
June-Aug. 1993
Developmental to develop
physician conversion factors
June-July 1993
Modify Medicare software packages
accommodate changes for non-Medicare
Aug.-Sept. 1993
Validate software, test in large Medicare
contractors
October 1993
Legislation enacted
October 1993
Begin training private insurers in use of
software, payment rules (e.g., surgical global
packages, DRO bundling)
Nov. 1993 to
March 1994
May-June 1994
hospital
and
to
Large insurers install conversion programs to
uss Medicare adapted software
Small insurers
contract
contractors to price claims
with
Medicare
For 1995
May to
December 1993
Oct. 1993 to
Sept. 1994
Dec. 1993 to
Aug. 1994
Developmental work to develop hospital
specific and physician area conversion factors
Insurers would adopt converted
validate before paying claims
software,
Payment rates for hospital outpatient services
would be developed and provided to Insurers
Fall 1994
Standardised claims forms and structure for
data collection would be available to be
adopted by private insurers
Jan. 1995
Implementation of APRS for hospital (Inpatient
and outpatient), physician, lab, nedical
eqniipment, and ambulatory surgery settings
�Health Insurance Premium Regulation as an Interim Measure
I . Why
Premiums are highly v i s i b l e . Consumers w i l l gain
immediately and help enforce i t ;
Creates incentives t o control costs without requiring
governmental micro-management;
Conpatible with capitated payment systems;
Promotes move t o managed competition (e.g., costeffective provider networks, global budgets)
May be necessary t o prevent opportunism by some
insurers during t r a n s i t i o n .
I I . What
Set allowable rate of increase f o r :
•
Actual premiums for policies currently i n force;
•
Average premi\im per covered l i f e for each insurer i n
states that have already iitqplemented small group
reforms;
•
Premium equivalent
insured firms.
(applicable premi\am) f o r s e l f -
I I I . How
•
Maximal use of existing state regulatory resources;
•
For self-insured firms, use IRS authority t o audit and
enforce premium equivalents f i l e d pursuant t o COBRA;
•
Supplement state departments with federal resources
— People or technical assistance i n most states
— Coir^lete o f f i c e i n nine r e l a t i v e l y small states.
Primary State functions:
•
C e r t i f y corrpliance with target;
•
Respond t o consumer complaints;
�•
Recommend hardship adjustments to the cap;
•
Implement a credible random audit process;
•
Guarantee continuity of coverage for currently insured.
Primary Federal functions:
•
Retain ultimate authority and responsibility for
premium control program, including setting the targets;
•
Review state certifications of non-compliance, choose
and apply penalties, including: premium tax surcharges,
fines, corporate income tax surcharges, revoke the
right to self-insure;
•
Make final determinations of hardship exemptions;
IV. Problems and Solutions
Without consumer protections, this could INCREASE uninsured.
Therefore, for the currently insured, require limited market
reforms, including: guaranteed renewability, limited preexisting condition restrictions, no medical underwriting,
retroactive reinstatement, and balanced billing limits.
Allow higher rates of increase to states who wanted greater
reform or to expand access quicker.
Mechanisms for insuring continuity of coverage for the
currently insured:
•
Market absorption;
•
Guaranteed issue for currently insured;
•
Residual pools — carriers of last resort, state high
risk pools, joint underwriting agreements.
V. Implementation Requirements
•
Pennsylvania regulates coverage for 12 million people
with a staff of 40. Most states would need at least a
few more trained staff, and a Federal staff of at least
100-150 vould be required. Three months between the
passage of legislation and the start of the program
would be highly desirable.
�Increase Use of Managed Care as an Interim Cost Control Measure
This option focuses on increasing the use of managed care in the public and private
sectors and fostering greater competition among plans.
A.
Private Sector Options
e
Give employees In companies with multiple plans greater incentive to
choose lower-cost providers
For employers offering their employees a choice of health care plans,
employers would pay a set dollar amount regardless of the cost of the
plan. The amount could be set at the lowest-priced option, the highestpriced option, or some amount in between. Employees would be
allowed to take the difference between the employer contribution and
the price of the plan they chose as additional wages or as tax-free
savings contributions. At Alcoa, this led to an increase from 15 to 68
percent in the number of persons in lower cost plans. At Xerox, this
practice lowered rates of increase for AU plans because they were put
into price competition with each other. Larger employers without
multiple plans could be encouraged to offer multiple options through tax
incentives.
•
Give employees in small firms the option of choosing to join larger
Federal or state pools.
The Federal Employee's Health Benefits Plan or state employee's health
plans could be opened to small employers on a risk-adjusted basis.
Government plans offer a wide selection of plans, group rates, and
reduced administrative costs. This would be coupled with a defined
contribution requirement as for employers offering multiple plans.
e
Reduce the tax code bias towards excessive health spending
This could be accomplished either by imposing a limit on the amount of
employer-provided health benefits which may be deducted or excluded
from income. The cap should be set so that individuals choosing a low
cost plan receive the full tax deduction and exclusion.
e
Remove barriers to managed care
Remove state laws that limit managed care plans' ability to contain
costs, such as:
e willing provider requirements
�e
e
e
e
e
e
open pharmacy requirements
benefit mandates
utilization review restrictions
freedom of choice requirements
restrictioru on negotiating discounts with providers
Implement standardized performance/quality measures
Hospitals would be required to report in a standardized, severityadjusted format the extent of variation in physician practice patterns
(resource utilization, length of stay and charges per patient) and clinical
indicators of quality (mortality and morbidity rates, readmissions, and
rates of immunizations, C-sections, pap smears, etc.). Health plans and
employers could then use these quality-cost comparisons to martage
hospital networks better.
In Cincinnati, four large employers convinced all 14 of the city's
hospitals to submit such data. After a single year, the hospitals reduced
their average length of stay per patient by 0.6 days and their average
charges per patient by 5 percent, for a one-year savings of $75 million.
B.
Public Sector Options
•
increase the use of managed care in Medicare
Medicare beneficiaries would be offered an open annual enrollment in
qualifying area HMOs and the traditional Medicare fee-for-service plan.
HMOs would bid for the right to serve the Medicare population and
would offer a more generous benefits package than traditional fee-forservice Medicare. Beneficiaries and fiscal intermediaries would be given
some of the savings from a move to lower-cost plans.
Alternatively, if the integration of Medicare into the managed care
institutions is not to occur for several years, a Medicare PPO could be
established in each state. Beneficiaries who joined the PPO would be
given some share of the savings, as well as additional benefits.
e
Require increased coinsurance for Medigap policy-holders
Medigap coverage of Medicare's cost sharing requirements has been
estimated to add 24 percent to Medicare's costs because of induced
demand. Increased cost sharing would lower the burden of this induced
demand to the government and make Medicare HMOs more attractive
to beneficiaries.
�Remove barriers to use of managed care in Medicaid
Currently, states must receive HCFA and legislative waivers in order to
use managed care effectively for their Medicaid populations. Those
restrictions, intended to ensure quality care, would be repealed and
replaced with quality, marketing and solvency standards.
�MEMORANDUM
TO:
Distribution
FROM:
Steve Ricchetti
Chris Jennings
DATE:
April 13, 1993
There has been a great deal of discussion and reporting about the need for bipartisan consultation on health care, springing in part from our current difficulty in
moving the stimulus package in the Senate. I want to emphasize to everyone that the
Administration's Health Clare Task Force began an on-going dialogue with House and
Senate Republicans many weeks ago.
It would be both erroneous and potentially damaging for a perception to develop
that our work with Congressional Republicans only began after they employed delaying
tactics in the debate on the stimulus. We have actively solicited their advice and ideas
on health reform since ourfirstweek. We fully expect, however, that for partisan
political purposes some Republicans will attempt to promote this notion and I want to
urge everyone involved in our health reform effort to watch for this characterization and
be aware that it is factually incorrect.
You should know that the President asked the bi-partisan leadership for designees
to consult with the Health Care Task Force as early as January 26. Senator Dole
appointed himself and Rep. Michel appointed Rep. Dennis Hastert (R-IL). Mrs. Clinton
met with Senators Dole and Chafee on Februaiy 4 and with members of the Senate
Republican Caucus on March 5. We have also been holding weekly meetings with
Republican Members on the House Health Task Force and staff and the staff of the
Senate Health Task Force since Februaiy, typically with Ira Magaziner leading the
presentation and dialogue.
The staff of the Senate Republican Health Task Force has suggested that more
active member-level discussions be delayed until we have a better sense internally about
what our proposal will contain. As decisions about our plan are being made, we will
reach out to this group agaiiL It is important to note, however, that we have always
encouraged and been open to meeting with Republican Senators.
It is clear that on eaqh of our major initiatives during the next two years we will
need and will be soliciting bi-partisan support for our proposals. I want everyone to be
aware of the on-going efforts to consult with Republicans on health reform and to tiy to
win their support for our program.
#####
Attachment
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. memo
SUBJECT/TITLE
DATE
Chris J. to Steve R.; re: Republican Members & Staff
Meetings/Contacts (2 pages)
04/09/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefmg Memos First Lady, 1993 [6]
2006-0885-F
jp2851
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - (5 U.S.C. 552(b)l
PI
P.'.
P;i
P4
b(l) National security classified information I(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(bX4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the F01A|
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financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9)of the FOIA|
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office |(aX2) of the PRA|
Release would violate a Federal statute |(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
Pi'i Release would disclose confidential advice between the President
and his advisors, or between such advisors |aX5) of the PRA|
P(i Release would constitute a clearly unwarranted invasion of
personal privacy ((aX6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�DATE
MEMBER(S)
MET WITH
SUBJECT
2/4
DOLE/CHAFEE
HRC/ICM/JF
process, general
discussion
2/23
DURENBERGER
HRC/ICM
3/10
Senate Republican
Members
HRC
Bond
Burns
Chafee
Cohen
Craig
Danforth
Dole
Durenberger
Gregg
Kassebaum
Mack
Murkowski
Nichols
Packwood
Roth
Simpson
Stevens
Thurmond
(others were present as
well)
3/10
JEFFORDS
ICM
3/11
House Republican
Members/Staff
ICM
3/12
Senate Republican Staff
ICM
3/18
House Republican
Members
ICM
Hastert
Goss
Johnson
Thomas
Blily
McMillin
general
discussions about
process and about
directions
for/components of
reform
MALPRACTICE
�MEMBER(S)
MET WITH
SUBJECT
3/23
Senate Republican Staff
Walter Zellman
Rick Kronick
Lois Quam
New System
Development
Governance
3/25
House Republicans
Members
ICM
GLOBAL
BUDGETS
Lois Quam
RURAL HEALTH
CARE
ICM
short-term
controls
j DATE
Hastert
Gross
Johnson
Thomas
Grandy
Blily
McMillin
4/1
House Republicans
Members
Hastert
Goss
Johnson
Thomas
Grandy
BUly
McMillin
Roberts
Gunderson
4/1
Senate Republican Staff
Sheila Burke
Christy Ferguson
Ed Mihulski
�MEMORANDUM
TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n
A p r i l 3, 1993
Chris Jennings
Long Term Care/The Hill/AARP
Steve, Lorraine, Melanne, I r a , Jerry, Judy, Karen
On Friday, A p r i l 2nd, Robyn Stone and I met w i t h Congressman
David Obey. This meeting i s worthy of p a r t i c u l a r note because
Mr. Obey went out o f h i s way t o send the strongest message
possible t h a t he would not support any h e a l t h reform plan UNLESS
i t had s i g n i f i c a n t long term care provisions. Although he
s p e c i f i c a l l y said he was not sending a t h r e a t , the Congressman
stated t h a t he would hold J o i n t Economic Committee hearings a l l
over the n a t i o n i f the plan was not responsive t o h i s concerns.
Mr. Obey stated a drug b e n e f i t alone f o r the Medicare
population would not be s u f f i c i e n t f o r h i s older c o n s t i t u e n t s o r
himself. He went on t o say t h a t he feared t h a t the President and
h i s s t a f f were t h i n k i n g too small and r i s k e d l o s i n g i n f l u e n t i a l
supporters f o r h i s plan. He counseled t h i n k i n g bold when i t came
t o h e a l t h care and suggested t h a t the President should look a t
VAT o r other t r a n s f e r taxes t o finance a more ambitious plan.
I n short, the Congressman has concluded t h a t the President
w i l l be h i t w i t h the tax and spend l a b e l whether he l i m i t s h i s
package t o access o r expands i t t o include long term care. He
t h e r e f o r e suggests t h a t the President might as w e l l give the
Members and the grass roots advocacy groups the b e n e f i t s they
need t o s e l l the package over the objections o f the tax c r i t i c s .
We discussed w i t h him the d i f f i c u l t i e s o f coming up w i t h a
t r a d i t i o n a l comprehensive long term plan f o r under $45 b i l l i o n .
We then discussed a l t e r n a t i v e approaches t h a t would move towards
coverage of home care and, eventually, t o nursing home coverage.
Although not appeased, he seemed t o appreciate the hour and a
h a l f b r i e f i n g . I t i s c l e a r , however, t h a t he i s someone t o t r e a t
w i t h care on t h i s issue.
A somewhat s i m i l a r discussion was held w i t h Senator Simon on
Monday, March 29th. He r e i t e r a t e d h i s strong support f o r long
term care p r o v i s i o n s . The Senator c i t e d how h i s m u l t i - b i l l i o n
long term care b i l l was attacked by Labor Sec. Lynn M a r t i n as a
huge tax and spend measure when she was running against him.
W i t h i n one day, he says, she withdrew the c r i t i c i s m because her
t r a c k i n g p o l l s were so negative about her a t t a c k .
F i n a l l y , AARP i s g e t t i n g very nervous about the prospects o f
an "unacceptable" and m i n i m a l i s t i c long term care package. While
budget c o n t r a i n t s are obvious, we must be very c a r e f u l w i t h t h i s issue.
�MEMORANDUM
TO: H i l l a r y Rodham C l i n t o n
March 20, 1993
FR: Chris Jennings
RE: Senate Republicans t o Target as Possible Supporters and
Senate Democrats t o A t t r a c t and Keep on Board
cc: Legislative/Congressional D i s t r i b u t i o n L i s t
As you know, i t i s now v i r t u a l l y c e r t a i n t h a t the
President's h e a l t h care proposal w i l l r e q u i r e a t l e a s t one 60
Member vote t o have a chance o f passing the Senate. ( I f the
proposal i s merged i n t o r e c o n c i l i a t i o n , 60 votes w i l l be required
to waive the Byrd r u l e ; i f i t i s a f r e e standing b i l l , 60 votes
w i l l be r e q u i r e d t o achieve c l o t u r e on debate and t o b r i n g an end
to a l i k e l y Republican f i l l i b u s t e r ) .
With the above i n mind, and because we cannot count on a l l
57 Democrats ( p o s s i b l y 56 by the time of the r o l l c a l l ) t o vote
w i t h us, we must b u i l d on and improve our ongoing e f f o r t s t o
a t t r a c t a core group o f Republicans t o vote w i t h the President on
his h e a l t h reform proposal. S i m i l a r l y , we must a t t r a c t and
r e t a i n support from a f a i r l y s i z a b l e l i s t o f Democrats who, f o r a
v a r i e t y o f reasons, may be nervous about v o t i n g w i t h us.
I n an e f f o r t t o pool the i n f o r m a t i o n we have on the t a r g e t
Senate Members, we convened a group i n c l u d i n g Steve R i c c h e t t i and
his s t a f f , Melanne, Chris^tine Heenan, HHS's J e r r y Klepner, Karen
P o l l i t z and Alan Hoffman-, DNC's Celia Fischer, and Steve
E d e l s t e i n and h i s War Room s t a f f . (The group now meets every
F r i d a y ) . We found ourselves t o be i n s i g n i f i c a n t agreement on
which Senators we c u r r e n t l y believe t h a t the A d m i n i s t r a t i o n and
the DNC should t a r g e t ; I have attached a l i s t and some crossreferencing i n f o r m a t i o n about t h i s l i s t f o r your use. I n
a d d i t i o n , the i n f o r m a t i o n we produced through t h i s discussion
w i l l be summarized and d i s t r i b u t e d i n short order.
The 14 Republicans we chose are the e v e r - s h r i n k i n g number o f
Members who — because they are viewed as moderates, have s p e c i a l
populations t o worry about, and/or are coming up on an e l e c t i o n
or r e t i r e m e n t — are the most l i k e l y t o cross over and support
us. (FYI, according t o Republican s t a f f , these Members w i l l
attempt t o s t i c k together i n a block so as t o strengthen t h e i r
bargaining leverage IF any such m i n o r i t y block o f Republicans
forms; i n other words, they plan t o e x e r t tremendous pressure on
one another t o block " s t r a g g l e r " Republican s u p p o r t ) .
The Democrats we chose are those who are h i s t o r i c a l l y
moderate t o conservative Members o r who, because of t h e i r
constituency o r Committee assignment, are p a r t i c u l a r l y s e n s i t i v e
to s p e c i f i c s p e c i a l i n t e r e s t concerns. I t i s important t o s t r e s s
t h a t , as we are t a r g e t i n g these Members, we must not ignore o r
a l i e n a t e our r e l a t i v e l y s o l i d progressive support base.
�REPUBLICANS
1.
2.
3.
Senator
Relevant Committee Asstgiunent
Christopher Bond (MO)*
Conrad Burns (MT)* XX
John Chafee (RI) XX
Appropriations Committee
Appropriations Committee
FINANCE COMMITTEE, Health Care
Task Force Chair
4. B i l l Cohen (ME) XX
5. Alfonse D'Amato (NY) XX
6. John Danforth (MO)
Judiciary Committee
Appropriations Committee
FINANCE COMMITTEE
7. Dave Durenberger (MN) XX
8. Mark H a t f i e l d (OR)
9. Jim J e f f o r d s (VT) XX
FINANCE and Labor Committees
Appropriations Committee
Labor Committee
10. Nancy Kassebaum (KS)
11. Connie Mack (FL)* XX
12. Bob Packwood (OR)
Labor Committee, Ranking
Appropriations Committee
FINANCE COMMITTEE, Ranking
13. B i l l Roth (DE)* XX
14. Arlen Specter (PA)* XX
FINANCE & Gov. A f f a i r s
Appropriations and Judiciary
Although a l l w i l l be a great challenge, these 5 Senators
w i l l be the most d i f f i c u l t t o get on board.
XX
Notably, 9 out of the 14 targeted Members have Democratic
Senator counterparts and 11 out of 14 have Democratic
Governors. I f these Dems are on board, i t w i l l make i t much
more d i f f i c u l t for Republicans to oppose the Clinton plan.
NOTE: Seven out of the 14 are either Finance or Labor Committee
Members or both ( i n the case of Durenberger) — the two
primary Senate health committees. Five of these Members
serve on the all-important Finance Committee.
L a s t l y , although h i g h l y d o u b t f u l supporters, s i g n i f i c a n t
e f f o r t s should be made t o make the f o l l o w i n g I n f l u e n t i a l Members
uncomfortable about engaging i n a c t i v e opposition: (1) Bob Dole
(KS, M i n o r i t y Leader, & Finance Committee Member), (2) Alan
Simpson (WY, M i n o r i t y Whip, J u d i c i a r y Committee), ( 3 ) Orin Hatch
(UT, Finance and J u d i c i a r y Committee, Ranking Member), and
(4) Pete Domenici (NM, Budget Committee Ranking Republican and
Appropriations Committee).
�DEMOCRATS
Senator
Relevant Committee Assignment
1.
Max Baucus (MT)
Finance Committee
2.
David Boren (OK) *
Finance Committee
3.
B i l l Bradley (NJ)
Finance Committee
4.
John Breaux (LA)
Finance Committee
5.
Richard Bryan (NV)
6.
Dennis DeConcini (AZ) *
Appropriations, J u d i c i a r y
7.
Chris Dodd (CT)
Labor and Human Resources
8.
Jim Exon (NB) *
9.
Wendell Ford (KY)
10. Bob Graham (FL)
11. Howell H e f l i n (AL) *
J u d i c i a r y Committee
12. Earnest H o l l i n g s (SC)
Appropriations Committee
13. J. Bennett Johnston (LA) *
Appropriations Committee
14. Bob Kerrey (NB)
Appropriations Committee
15. Herb Kohl (WI)
J u d i c i a r y Committee
16. Bob Krueger (TX)
17. Frank Lautenberg (NJ)
Appropriations Committee
18. Joseph Lieberman (CT)
19. Daniel P a t r i c k Moynihan (NY)
Finance Committee
20. Sam Nunn (GA) *
21. Harry Reid (NV)
Appropriations Committee
22. Charles Robb (VA)
23. Richard Shelby (AL) *
*
Indicates the 7 Senators who probably w i l l be the most
d i f f i c u l t to get on board.
�TOTAL STATES/MEMBERS TARGETED IN THE PRELIMINARY SENATE STRATEGY
State
Senator(s)
Govemor
1.
2.
3.
4.
5.
Alabama
Arizona X
Connecticut
Delaware
Florida
H e f l i n and Shelby
DeConcini
Dodd and Lieberman
Roth
Graham and Mack
Hunt (R)
Symington (R)
Weicker ( I )
Carper (D)
C h i l e s (D)
6.
7.
8.
9.
10.
Georgia X
Kansas
Kentucky X
Louisiana
Maine X
Nunn
Dole and Kassebaum
Ford
Breaux and Johnston
Cohen
M i l l e r (D)
Finney (D)
Jones (D)
Edwards (D)
McKernan (R)
11.
12.
13.
14.
15.
Minnesota
Missouri
Montana
Nebraska
Nevada
Durenberger
Bond and Danforth
Baucus and Burns
Exon and Kerrey
Bryan and Reid
C a r l s o n (R)
Carnahan (D)
R a c i o t (R)
Nelson (D)
M i l l e r (D)
16.
17.
18.
19.
20.
New J e r s e y
New Mexico X
New York
Oklahoma
Oregon
Bradley/Lautenberg
Domenici
D'Amato and Moynihan
Boren
Hatfield/Packwood
F l o r i o (D)
King (D)
Cuomo (D)
Walters (D)
Roberts (D)
21.
22.
23.
24.
Pennsylvania X
Rhode I s l a n d
South C a r o l i n a X
Texas X
Specter
Chafee
Hollings
Krueger
Casey (D)
Sundlun (D)
Campbell (R)
Richards (D)
25.
26.
27.
28.
29.
Utah
Vermont X
Virginia X
Wisconsin X
Wyoming X
Hatch
Jeffords
Robb
Kohl
Simpson
L e a v i t t (R)
Dean (D)
Wilder (D)
Thompson (R)
S u l l i v a n (D)
20 out of 29
are Dem Govs.
This includes the 4 additional target Republican Senators of
Dole, Simpson, Hatch, and Domenici.
T o t a l Number of Senators:
NOTE:
41*
I f the DNC does not have the resources to target a l l 29
states, they should choose (generally) to eliminate
f i r s t those states that have only one target Senator
and whose Senator does not serve on the Finance
Committee. There are 12 such states marked with an X,
but my 6 lowest p r i o r i t i e s would be Georgia, Kentucky,
New Mexico, Texas, Wisconsin, and Wyoming. ( I can t a l k
about others i f necessary; I n addition, exceptions to
the Finance and/or 2 Member rule might be Delaware,
Utah, and Alabama).
�MEMORANDUM
TO:
FR:
RE:
cc:
H i l l a r y Rodham Clinton
March 19, 1993
Chris Jennings tCO"
Senator Chafee's statements on gun control
Melanne, Kim T i l l e y , Steve R., I r a , Christine,(Steve E,
Following up on your request, attached i s a copy of Senator
Chafee's complete April 30, 1992 Senate floor statement regarding
guns and their impact on children, education, and health care.
Also attached i s a June 9, 1992 Washington Post Op Ed piece by
Senator Chafee that nicely summarizes the much longer statement
and outlines h i s Intention to Introduce l e g i s l a t i o n to ban the
sale, manufacture and possession of ALL handguns.
Both statements c i t e a 1991 Advisory Council on Social
Security estimate that concludes that the overall health care
cost of firearm i n j u r i e s (from i n i t i a l emergency room care and
accompanying hospital stays, amubalance services, follow-up
v i s i t s , and rehabilitation) i s more than $4 BILLION a year.
Significantly, 86 percent of t h i s health care treatment tab i s
underwritten by government sources. The dollars spent on each
gun shot injury averages out, according to Chafee, to be
approximately $16,700 per patient.
The two Chafee statements were faxed today to Congressman
Reynolds' o f f i c e . Judging from how quickly he was to jump to
publicly recount your (personal and I thought private) general
support of the concept behind his l e g i s l a t i o n ( i n particular, the
provision to tax guns and ammunition), I am sure he w i l l followup with your suggestion to hold a conversation with Senator
Chafee.
�03/16/93
19:10
NO. 216
STXTEKZIIT BY SENATOR JOHN C H A r U I S THE
RBGARDIHG GUNS AND
CHILDREN, EDUCATION,
April
30,
U.S.
AMD
SENATE
HEALTH
1992
On Tuesday, the Senate spent 4 hours debating the matter of
whether or not t o approve the minting of new coins. Yet on t h a t
day, as i s the case every day, an average of 27 adults and
c h i l d r e n across the country were k i l l e d by ^^and^uns, and 39 went
t o the h o s p i t a l t o be t r e a t e d f o r handgun wounds.^ ^ J . 5
LvL*
p a t i e n t s , some w i l l be permanently and severely disabled, others
w i l l go back t o t h e i r homes and family, wondering what type of
society they l i v e i n where handguns are so commonplace.
We have many demands, challenges, and problems f a c i n g the
Senate and our nation; and we need t o spend f a r more of OUT
valuable time and resources focusing not on parochial or p o l i t i c a l
matters, but on those which are the most c r i t i c a l t o our n a t i o n a l
well-being.
Two among the most pressing issues before us stand out: 1)
the need t o improve the q u a l i t y of our education; and 2) the need
t o reduce the costs of our health care. But t i e d i n e x t r i c a b l y t o
progress on both of these matters i s recognition of the costs
placed on each by our n a t i o n a l firearms p o l i c y ; and t h a t i s what i
wish t o spend some length of time discussing t h i s afternoon.
I f we hope t o achieve progress on education, i t i s imperative
t h a t educators be able t o spend t h e i r time and t h e i r resources on
t h e i r p r i n c i p a l task: educating our young people. Likewise, i f we
are t o move forward on h e a l t h care, i t i s c r i t i c a l t h a t we ensure
t h a t our population i s as healthy and f i t as possible, and thus
reduce the demands f o r e.v.pensive health care services.
Yet today, educators are d i s t r a c t e d from educating, "^nd
p u p i l s are d i s t r a c t e d from learning, by the ever-increasing and
f r i g h t e n i n g presence of handguns w i t h i n our schools. And our
e f f o r t s t o hold down h e a l t h care costs l i t e r a l l y arc being shot
down by the more than $4 b i l l i o n required t o be spent every year
on the ghastly woundings and deaths from handguns.
How many handguns are there i n t h i s country? I t i s estimated
t h a t there are roughly 66 m i l l i o n of these deadly weapons i n the
U.S
today. I n 1982, there were "only" 53 m i l l i o n . That's a 25
percent increase i n ten years! According t o the Bureau of
Alcohol, Tobacco, and Firearms (BATF), we can expect t o add 2
m i l l i o n handguns every year. That i s hardly a comforting thought!
Handguns — these guns so e a s i l y concealed under a jacket or
i n a shoulderbag — cause untold damage and s u f f e r i n g i n t h i s
n a t i o n . The s t a t i s t i c s are staggering, f r i g h t e n i n g , and shameful.
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NO. 216
Every year, handguns are estimated to be involved in at least
10,000 murders and 15,000 woundings — that translates to about 27
persons k i l l e d and 41 persons injured every day! Every year, we
set a new record in handgun deaths: since 1988, handgun murders ~
which represent 75 percent of a l l firearms murders ~ have gone up
each year by nearly 1,000 deaths.
Handguns are involved in an average of 33 rapes, 575
robberies, and 1,116 assaults every day. Handguns are responsible
for 70 percent of a l l firearms suicides, about 3,200 of which
every year are teen suicides; and i t i s a disgusting, t e r r i b l e
fact that these guns constitute the most efficient, effective, and
lethal suicide method.
I . GUNS AND EDUCATION
Yet access to handguns has become easier, not more d i f f i c u l t ;
and their owners, younger. Children not yet old enough to drive
are matter-of-factly carrying guns on their person every day.
Children take guns to school as i f they were lunchboxes; they go
to gun-sellers, not to their teacher, to settle a fight with
another student; and they bring guns, not toys, to classroom Showand-Tell.
Can children obtain handguns? The answer clearly i s *'yes-"
In 1989, in a national student survey, nearly half of all^tenth
grade boys and about one-third of eighth-grade boys said yes,
they could obtain a handgun. Eighth-graders are 12 years old.
Not only do these youngsters carry guns, they take these guns
to school
Five years ago, an estimated 270,000 students carried
handguns to school at least once; and roughly 135,000 boys ~ whom
research reveals are far more l i k e l y than g i r l s to choose guns as
their weapon — carried .guns t o -school every day.
Since then, the problem has become worse. According to a
1990 national survey, one out of every 5 eighth-graders says that
he or she has witnessed weapons at school. That should come as^no
surprise, considering the number of youngsters that *pack a gun
to go to school. In I l l i n o i s , 33 percent of high school students
have carried guns to school. Texas reports that 40 percent of
eighth- and tenth-grade boys who were surveyed had carried a gun
to school at least once.
Nationwide, a f u l l nineteen percent of some 11,000 students again, one in every 5 students — surveyed by the Centers for
Disease Control admitted that yes, they had carried a gun to
school just in the past month.
I find these s t a t i s t i c s to be absolutely stunning — and
incredibly depressing. We're talking about young children!
003
�03/1E/93
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NO. 216
Given the number of gun-toting youngsters, i t i s no wonder
that gun incidents at school are becoming far more frequent.
California o f f i c i a l s have reported a 200-percent increase in
student gun possession incidents between 1986 and 1990; Florida,
too, has reported a sharp jump in student gun incidents. Here in
the Washington area, in nearby Prince George's County, 23
incidents — more than twice the number of last year — involving
guns on school property have occurred since July, and t h i s school
year i s not over yet.
In nearly every instance these guns were handguns.
Right now, there i s so much violence, and so many guns, at
schools that some students are scared to go to school. According
to the Department of Justice, 37 percent of public school students
nationwide fear they w i l l be the subject of an attack at or on the
way to school. So what do these children do?
One method of protection i s simply to stay away from school,
and some children do. An I l l i n o i s study reports that one in 12
students i s so scared of someone hurting them at school that they
are staying home to avoid facing that risk.
But students can't play hookey forever, and another,
increasingly popular, way students conquer their fear i s to carry
a handgun for "protection." They take their new-found security
blanket to school; and the presence of that gun in turn feeds the
very fear i t was meant to assuage. Other students are driven to
take their own "protective" measures; and the horrible ripple
effect goes on.
The end result? Our schools, designed as places of learning,
.••now are becoming places of tension and violence. ' 'It has come to
the point where many urban schools conduct random gun searches,
and safety d r i l l s include dropping to the floor at the f i r s t sound
of gunfire. Meager school budgets must find money for metaldetectors . That i s the l a s t thing on which our schools should
have to spend limited resources — those funds should be going
toward textbooks, more teachers, or classroom and sports
equipment!
But what choice do school administrators have? Children are
learning to believe that guns are a way to resolve t h e i r problems.
In e a r l i e r times, a student dispute might mean a f i s t f i g h t after
class. Now the quarrel often i s settled — quite openly — with a
gun. Just over a month ago, a 16-year-old boldly walked into a
Potomac, Maryland, high school chemistry class and f i r e d his
handgun at point-blank range at his intended student victim, who
somehow miraculously escaped the bullet.
1304
�03/16/93
19:12
NO. 216
This i s an ever-more common pattern. Look a t J e f f e r s o n High
School i n Brooklyn, where i n the course of a dispute, a student
k i l l e d one teen and another young "innocent bystander," bringing
the death t o l l ~ a death t o l l for schools?? — for t h i s school
year t o 56. Look a t the Crosby, Texas, high school, where a 15year-old g i r l shot a 17-year-old boy i n the lunchroom f o r
i n s u l t i n g her. Look at the third-grader i n Chicago who p u l l e d a
handgun from h i s bookbag and shot a student i n the spine. Look a t
the 11-year-old i n Clinton, Maryland, who brought a f u l l y loaded
.38 c a l i b e r revolver t o school t o "impress h i s f r i e n d s . " And look
at my own State of Rhode I s l a n d , where three weeks ago p o l i c e
confiscated a handgun from a 15-year-old junior high school boy
who was waving i t i n front of other students i n the school
hallway.
"We've never seen a year l i k e 1991-92," says the head of the
National School Safety Center, r e f e r r i n g to new highs i n school
gun v i o l e n c e .
No wonder 10 percent of parents at every income l e v e l worry
about t h e i r c h i l d r e n ' s p h y s i c a l s a f e t y . No wonder a recent "Dear
Ann Landers" column on guns i n schools provoked more than 12,000
responses from angry and worried parents, and r e s u l t e d i n a second
day's column devoted s o l e l y to the p r i n t i n g some of these
responses.
Children who are not yet 18 years old are becoming inured t o
the violence that i s not only on the s t r e e t s , but i n t h e i r
schools. They are becoming accustomed t o the notion t h a t guns
help you get what you want — be i t an added measure of s a f e t y ,
new respect, or some quick cash. I t ' s j u s t business as u s u a l .
That acceptance i s dangerous. We cannot a f f o r d t o bring up
future generations -Vfho are hardened and deadened to a c u l t u r e of
violence.
Let me share with my colleagues a story so b i z a r r e , so
h o r r i f y i n g , that i t seems more l i k e a f i c t i o n than f a c t . I n my
State of Rhode Island, j u s t a few weeks ago, a teenage boy was
given a c l a s s assignment t o "write an i n t e r e s t i n g s t o r y . " The
three-paragraph essay he turned i n was e n t i t l e d "Man K i l l e r . " I t
consisted of an interview with h i s 14-year-old f r i e n d about what
i t f e l t l i k e t o k i l l a l o c a l shopkeeper. Let me read (verbatim)
the f i r s t few l i n e s :
"WHAT I T FEEL LIKE THINKING HOW A KILLER FEEL LIKE. WELL,
IT FEEL NORMAL, SAID THE *KILLER.'
ITS JUST LIKE STEPPING
ON A COCKROACH... I FEEL BAD FOR THE GUY SAID THE KILLER.
BUT I HAD TO DO I T . "
The boy's teacher, uneasy, and not sure that the story was
D05
�03/16/93
19:12
NO.216
actually fiction, turned the paper over to the police. With i t ,
they were able to arrest the 14-year-old suspect.
I warn my colleagues: increasingly in our schools children
are exposed to guns, children are becoming used to guns, and
children are using guns. And these are children - gun use can
start as early as at eight years old.
This i s appalling. We are desperately trying to improve our
educational system. Schools, already burdened with many
responsibilities, have more than enough problems to deal with
right now. We have youngsters with learning d i f f i c u l t i e s ,
youngsters who don't get enough to eat, youngsters ^^^h drug
problems, youngsters from totally shattered families. And now i t
appears ihat wI can't even guarantee children a safe place to work
and learn. This i s outrageous! And i t i s simply intolerable.
How exactly are children to learn anything i f they l i v e in
fear of walking down the h a l l and walking into some f a t a l ,
senseless dispute? They can't. I f we can't even guarantee
children, parents, and teachers that they w i l l be safe m school,
any new and innovative ways of improving our education system w i l l
be useless.
Is this the way our nation becomes competitive?
way we prepare for the next century? No.
I s this the
I I . GUNS AND HEALTH CARE
Let me turn to the cost exacted by guns to our health care
system.
Gun-related violence i s choking city emergency departments,
hospital resources, and indeed our entire health care system. We
pay dearly ~ not only i n terms of monies, but in terms of
precious lime and resources - to patch up ^^^ose who have been
shot by a gun. Often, the more serious the wound, the higher the
costs -- and the higher the likelihood that the person won't make
it
Bone-shattering, nerve-cutting gunshot wounds and gunshot
deaths place incredible stress on our health care system and are
major contributors to i t s escalating costs.
What are the health care burdens and costs associated with
gunshot wounds? Let's take a look at the number of firearms
deaths and firearms i n j u r i e s .
How many firearms-related DEATHS do we suffer each year?
Thousands: about 60 percent of the 23,000 annual homocides are
firearms-related, and 75 percent (or around 10,000) of these
involve handguns. And these account only for those deaths that
are w i l l f u l and intentional; adding in the accidental firearms
D06
�03/16/93
19:13
deaths boosts the annual number by another 7 percent
NO. 216
(or 1,500).
Now l e t ' s turn to firearms INJURIES. According to a 1991
General Accounting Office estimate, every year more than 65,000
persons — ISO per day — are injured seriously enough to be
hospitalized for firearms injuries. About 12,250 of these are
estimated to be victims of accidental injury; the remaining 53,000
or so are thought to have received intentional injury.
(I want to again emphasize here that handguns play a
particularly prominent role in firearms deaths and i n j u r i e s . IIn
1990, handguns were the weapon used in at least 10,000 murders,
which i s about 43 percent of ALL murders. As for handgun
injuries, an estimated 15,000 persons are shot and i^Dured by
handguns during the course of a crime; v i r t u a l l y a l l —
95.5
percent — of those wounded required medical attention and care.)
These injuries place a huge burden on health care providers.
"We used to see one or two major trauma victims a day... usually
car accidents or f a l l s , " says the chairman of the emergency
medicine department at a major California hospital. "Now, we see
probably four to eight every day, and of those, 30-40 percent are
gunshot wounds or stabbings... The other evening, we had five
gunshot wounds in three hours, and the ages were 12, 15, 16, i s ,
and 22." An emergency room doctor in New York adds: "Knives are
passe. Today, everybody has a gun... As proud as I am of the
advances of trauma technology, I must t e l l you that the weapons
technology has outstripped our therapeutic s k i l l s . "
Emergency rooms and hospitals providing trauma care are
reeling from the added demands of gunshot victims to the
overwhelming caseload they already carry. One-third of community
hospitals now are reporting "emergency department gridlocx at
least weekly. Gun wounds increasingly contribute to t h i s turmoil.
No wonder the American Medical Association, the American
College of Emergency Physicians, and the Emergency Nurses
Association a l l endorse handgun control provisions. Their members
have the g r i s l y job of cleaning up the bloody mess of gunshot
wounds.
The financial drain caused by this carnage i s staggering. A
1990 Bureau of Justice S t a t i s t i c s report concluded that 68 percent
of victims of handgun injuries incurred during a crime required
overnight hospital care; 32 percent remained in the hospital for 8
days or more. Hospitals are among the most expensive venues for
health care services in our system!
Hence, the costs associated with gunshot wounds are
tremendous. Eight years ago, data compiled by three researchers
at San Francisco General Hospital calculated that the hospital
D07
�03/ip/93
19:13
NO.216
006
b i l l for patching up gunshot victims — 80 percent of whom had
Sandgun wounds
ringed from $559 to $64,470 per patient. The
average cost was $6,915; and the average stay, 6.2 days.
Recent data, compiled i n the past few years, reveals even
greater costs: the American College of Emergency Physicians
Reports that based on data collected at a ma^or t^°«Pi^^l ^ ^ ' I j ^ ,
the 1989-91 period, the cost per gunshot victim ranged from $402
S274 189 The average cost? $9,646. The average stay? About
7 diys
inotheS study,Conducted during 1988-90 at the University
of Arizona Emergency Medical Research Center, concluded that
gunshot costs ringed from $9,800 to $125,300
victim. Again,
the average cost per gunshot victim was high: §l6,7uq.
Think of that: i f the average cost i s .^l^'^O^'
estimated number of total gunshot injuries i s «5,000, the annual
cost of hospitalization for firearms injury i s at least $1.1
b i l l i o n . And this amount does not include additional charges,
such as those for physician services, ambulance services, follow
up care, and rehabilitation.
^
^
This i s an important point: health care for gunshot victims
does not stop when they are discharged from the hospital^ For
some, i t i s just the beginning. In too many cases, the bullet or
b u n k s caSse permanent damage for which intensive rehabilitation
i s necessary.
Thus, up the costs go again. Since firearms are responsible
for a substantial number of a l l traumatic spinal cord inDuries,
let's take as an example spinal cord injury rehabilitation. ^ At
one t y p i c a l rehabilitation center specializing i n spinal-injury
treatment, a f u l l 35 percent of the spinal patients are gunshot
victims, second only to the 40 percent of auto victims. The
• center's daily — DAILY — per patient rate for care i s $1,500.
How many days do these patients stay? Depending on how f u l l y
or cleanly the bullet has severed the spinal cord, the spinal
injury patients suffer p a r t i a l or complete paralys-is. Paraplegic,
or p a r t i a l l y paralyzed, patients usually receive around 75 days o.
care, during which time they receive intensive occupational and
Physical therapy. Cost: $112,500. Quadriplegic patients, those
paralyzed in a l l four limbs, usually stay for 5 months. Cost.
1225,000. This cost i s incurred in addition to the $100,000 that
i s commonly required for acute care of such serious i n j u r i e s .
Amazingly, and sadly, fully half of the gunshot spinal injury
patients are under age 25.
When you add up the costs, from the i n i t i a l emergency room
> ,
care and accompanying hospital stay, to the ambulance services,
follow-up visits, and rehabiliation treatment, the overall cost o.
�03/16/93
19:14
NO. 216
firearms to our health care system i s colossal: an estimated $4
b i l l i o n , according to the Chair of the 1991 Advisory Council on
Social Security.
Who pays this monumental b i l l ? Who else? — the taxpayers.
An estimated 86 percent of the staggering costs associated with
firearm injury are paid by government sources.
What people just don't seem to realize, or to think much
about, i s that guns are as significant a cause of harm, and
expense, to individuals as are motor vehicles. We hear quite
often that injuries are a leading cause of death in the U.S., and
that motor vehicle injuries account for a significant portion of
these i n j u r i e s . Yet most don't realize that guns rank right up
there with motor vehicles.
According to data compiled by the Injury Prevention Network,
32 percent of a l l f a t a l injuries are caused by motor vehicles;
firearms follow in second place with 22 percent. Combined, the
two account for over half of a l l injury-related f a t a l i t i e s i n the
United States.
In fact, in 1990, firearms overtook motor vehicles to claim
the dubious honor of being the leading cause of injury-related
death in Louisiana and (for the f i r s t time) in Texas. In other
words, gunshot wounds in those two states cause more deaths than
automobile accidents. And while the incidence of motor vehicle
deaths i s going down, that of firearms deaths i s going up.
Let's face the facts: guns cause great physical damage. That
damage, in turn, i s forcing the ever-rising costs of health care
up, up, up.
I I I . SUMMARY: WHAT CAN WE
DO?
In sum, we have scared children, we have scared parents, we
have t e r r i b l e , bloody violence, and we have t e r r i b l e gun-related
health and societal costs.
I t ' s time to wake up. This i s a matter that affects a l l of
us. There are many who think: "Well, that gun problem i s limited
to thuggish drug dealers k i l l i n g other drug dealers, and anyway,
i t only happens in those low-income neighborhoods."
To those who comfort themselves that this i s someone else's
problem — a low-income neighborhood's problem, an urban problem,
a minority problem — to them I say, "Wake up!" We a l l need to
care, and not just because the problem i s spreading, but because
we're talking about children to whom we as a society have a
responsibility.
D09
�03/16/93
19:15
NO. 216
Other industrialized nations do not tolerate handgun
slaughter. Canada, which l i k e the U.S. has a Wild West, pioneer
heritage, has stronger gun control laws and an annual firearmrelated death rate of around 1,400 — only about 180 of which are
gun homicides. Those s t a t i s t i c s are much higher than those i n
European nations, but they are negligible in comparison to our
23,000 firearms murders. As for handguns, less than 300,000
Canadians own one. We Americans own 66 million, and i f handgun
manufacturers l i k e the Jennings family have their way, we can look
forward to being flooded with thousands more cheap S35 models in
the near future.
Guns cause t e r r i b l e damage in this country, yet we do l i t t l e
to prevent i t . Have we simply become accustomed to the k i l l i n g s ?
Are we compliant witnesses to the "terrible s t i l l n e s s of death" —
as one witness to a violent shooting called i t — now being heard
around the country?
I think — I know — that this country must not be. We are a
caring nation; a nation of people who are appalled at these acts
of devastation. We must not become inoculated to such violence.
I am going on record today to say that more must be done —
and I'm talking about measures to r e s t r i c t the incredibly,
insanely easy access to guns in this country. I am working on a
proposal that I consider to be the best solution, and intend to
present i t to my colleagues shortly, in the coming weeks. I t i s
time to act. We cannot go on this way.
D10
�TI!ESDAY,JUN-E9, 1992 AT
John H. Chafee
Ban Handguns!
Reccntiy, ihe Senate spent aa cotire day
debating wbetber or not lo mint oew coma.
By the end of that day, 3« CO every day « t h e
year a total o( 27 chiWren aod adulu oaboo.
iride' were nmrdered by handguns: and another 33 used a handgun to take their own
lwe&. Doans <A other* woe grievously
wounded by bandguos.
What are we goaig to do about this riaoghter? One suggestion—a good ooe—is a cational waiting period before tbe purchase of
a handgun. However, tbe situation we faa
deinaads much more than the screening of
felons. We need to shut off the spigot tbat is
pounng more than 2 million hwuJguns eadi
year uuo our society.
Few of t»—induding myselL wntfl I had the
opporti««y to study i t — r e ^ the citraordtnary extent to wbicb handgms play havoc wnh
our best policy efforts. We have a whopping 66
nuUian handguns tn the United Statea. taxt
ilian twice the 31 ndlion d 20 ytars ago: and 2
mJhon more of these deaifly guns are added to
the ai3enal each year. Handguns, so easily
avadabie and so easily cowaled. are pushaig
OCT viotem death rate to leveb unfaeard of n
thb natm let aVooe overseas; and each >ear
tbcy are invohwd in hundreds of thousands of
rapes, robberies and assault*.
There isn't a citiien ia this nation who
isai womed about two critical oatwnal
needs: tmprovmg our education system aod
reducmg tbe costs of our health care system.
But it IS well-oigb impossible to make prog-
The financial drain caused by this car nage
bandgun on school grounds. No wonder a
recent "Dear Ann Landers" column oo guns ^/ b staggeruig: The cost of a gunshot i; \faxy
averages $16,700 per patient Aod oosts
in schoo!s provoked more than 12.000 redon't stop upon discharge from the boa pttAi;
sponses from angry, worried parents.
there arc bdls for foUow-up care, medic i t k o .
How ironic: We are desperately trying to
aod rehabiliution treatment (mittal ret abiB-lation costs lor SJMIUI oord trauma, a coninion gunshot injury, range up to $27( I.OOOper patient). When »dded op. tbe o remO
health care oost offirearmsis cx>lo6saL aaoie
than $4 billkm annually. Who pay^ Ai esbniated 86 percent of this biO i» pad hr
govenunent—Le., the taxpayers.
I shortly wiH introduce kgisUtioa bi uing
tbe sale, manulactuie or poaaessino of iiaiid-
ress on either matter without recognizing
the costs placed on each by our current
handgun policy. It is truly shocking—and
intoleraWe. Today, educators and chiWren
are distracted by the frightening presence of
handguns m oui schools. And efforts to hoW rmprove our educational system, yet bow can
down health care costs are being shot down
children learn if they are afraid of walking
by tbe billions of dollars' worth of damage
into some faul dispute? If we can't guarancaused by handgun wounds.
tee safety m sctwd. innovative ways of
Five years ago. an estimated 270,000
improving our education system wiD be usestudents earned handguns to school at least
less. Is this the way our nation wants to
once: today, it is worse. There are so many
prepare for the next century?
handguns in school that some students are
Health care, another national priority, sufalxaid to go to school What do they do?
fers
equally heavy costs. Tbe tens of thouMany turn to a handgun of their own. wtuch
feeds the very fear it was meant to assuage. sands of bone-shattenng, nerve<utting gunshot wounds place incredible stress on cur
Thb borriWe ripple effect carries on up to
health care system and are major contribuschool adiranistrators. who must find momes
tors to its escalatmg costs. Urban emergenin meager school bodgeu to purchase
$4,000 metal detectors instead of textbooks. cy rooms arefloodedwith gunshots injuries.
But what choice do schools have? Eariier. And despijie emergency teams' hard work,
a student dispute might mean a fisllight: weapons te<ihnok>gy is outstripping advances
in iherape;yiic skills, as one physicians noted.
DOW. the quarrel often is settled with a
&
right to bear arms. But if there b use
argument that is utter nonsense, this is it.
Not cmly have its proponents not read their
CoQStitntioa lately, bot they haven't foUowed
more than 50 years of remarkably ooanimous court holdings against that erroneous
suppositioo.
As for those wt» wiD argtie tbat hxndgtns.
in the home are needed for protectxio, Vaei\
haven't reviewed the horrific statistics'dej
° tailing that handguns are far. br mor^'IOcelf
'to Idfl • loved one than an intnider. ' ' Soooer or later (aod I bcliere noner
rather than later), handgun violeoce
touch tbe bfe of someooe in every Anieiicu
famdy. Handguns, when introduoed into the
already volatile mix of conditions that teadxo
Ttolenoe, act as a matdi to dry powder, f^.
U b time to acL We cannot go on fifo t ^
Baalhem!
The writtr is a Rtputitcan senator
RhodehUtnd. •
guns (with exceptioRs for law eofon noent
and licensed target chibs)^A radkal \ tjpo*-.
al? Hardly. What 1 wooM cmB ra<! a i b
aUowing the tcrribte status tioo to con inoe.-;
There will be those who wiB argi J that
there exists a fundamental conatit itjaoal •
frm:
�
Dublin Core
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Title
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Health Care Task Force Records
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White House Health Care Task Force
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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Paper
Dublin Core
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Congressional Briefing Memos – First Lady, 1993 [6]
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
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2006-0885-F Segment 2
Is Part Of
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Box 8
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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Preservation-Reproduction-Reference
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2/6/2015
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42-t-12092992-20060885F-Seg2-008-009-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/6080de95ed256df4ea28995705205fe4.pdf
863fb12f723deb522a6ec49965b0df79
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3681
FolderlD:
Folder Title:
Congressional Briefing Memos - First Lady 1993 [5]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
8
2
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. memo
Chris Jemiings to Hillary Rodham Clinton; re: Senate Leadership
Lunch (2 pages)
05/04/1993
P5
002. memo
Chris Jennings to Hillary Rodham Clinton; re: Senate Labor &
Human Resources Meeting (2 pages)
05/03/1993
P5
003. memo
Chris Jermings to Hillary Rodham Clinton; re: Tuesday Meeting with
Congressman McDermott (2 pages)
04/28/1993
P5
004. memo
Chris Jermings to Hillary Rodham Clinton; re: Congressional
Leadership Meeting (1 page)
04/26/1993
P5
005. memo
Chris Jermings to Hillary Rodham Clinton; re: Meeting with
Chairman John Dingell (2 pages)
04/25/1993
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefing Memos - First Lady, 1993 [5]
2006-0885-F
ip2850
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office |(aX2) of the PRA|
P3 Release would violate a Federal statute |(aX3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information ](bX4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the F'OIA]
b(7) Release would disclose information compiled for law enforcement
purposes ](b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions [(bX8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(bX9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SUBJECT/TITLE
DATE
Chris Jermings to Hillary Rodham Clinton; re: Senate Leadership
Lunch (2 pages)
05/04/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefing Memos • First Lady, 1993 [5]
2006-0885-F
ip2850
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. S52(b)]
PI National Security Classified Information ](aXl) of the PRA]
1'2 Relating to the appointment to Federal office [(aX2) of the PRA]
P3 Release would violate a Federal statute ](aX3) of the PRA]
IM Release would disclose trade secrets or confidential commercial or
financial information ](a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors la)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRAJ
b(l) National security classified information [(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency l(bX2) of the FOIA]
b(3) Release would violate a Federal statute ](bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information ](bX4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ](b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions ](bX8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells ](bX9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
i'RM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PROFILES - SENATE DEMOCRATIC LEADERSHIP
May 2, 1993
SENATOR GEORGE MITCHELL (D-ME) (Majority Leader)
Few Majority Leaders in the Senate's history have been as interested and as committed
to passing comprehensive health care reform. Senator Mitchell believes that the single-payer
approach is not politically feasible. However, at this point, his primary concern and
commitment is to push through anything, which can be defined as truly comprehensive, that
will pass the Congress. He has repeatedly indicated his intention to work closely with the
President to help assure that a bill can make it to the White House before the end of the
103rd Congress.
As you know, however, he was a strong advocate of incorporating the health care
legislation into the budget reconciliation bill. Having failed that, he and his lead staff became
relatively pessimistic about attracting enough Republicans to support a health reform initiative
without having to make major, and perhaps unacceptable, concessions. Two weeks ago,
(Sunday, April 18th), he indicated his opposition to price controls, his uneasiness with, but
possible openness to, a VAT tax for health, and his desire to wean out all the fraud, abuse
and waste BEFORE contemplating large tax hikes.
Recent Developments; He was very enthused about the First Lady's presentation in
Jamestown and the meeting at the White House on Tuesday. He appears to be rededicatcd to
passing health reform this year. Along these lines. Senator Mitchell is checking into the
possibility of folding the necessary tax increases for health care into reconciliation so that
there would be only one tax hike vote. (This approach probably would not be ready for an
informed discussion because staff has not worked it through yet.) We advise not to bring up
this specific approach unless Mitchell does so first.
SENATOR WENDELL FORD (D-KY) (Majority Whip)
Senator Ford, the Chairman of the Rules Committee and the Majority Whip, will want
to support the President. During his reelection campaign this year he talked about wanting to
work with a president who would sign health care legislation passed by the Congress, but he
is also a fierce protector of the interests of his state. As he says, "if it is not good for
Kentucky, I'm not for it." As a result Ford can be expected to fight to protect the tobacco
interests of his state. He is also nervous about mandated benefits and wants freedom of
choice for consumers. He also has a personal interest in health care since his brother-in-law
is a pediatrician in Kentucky. (Having said that, he frequently complains that his wife's
brother makes too much money).
�Senator Ford opposes giving states too much flexibility, ostensibly because some may not be
prepared for the responsibility. But more likely, it comes down to politics. Kentucky's
Governor, Brereton Jones, has been working on his own state reform plan. Unlike other
Congressional delegations which are promoting their state's reform efforts. Ford may be
looking to undercut Jones as a political payback. In 1991, Jones, then the Lt. Governor,
scared Ford out of the Democratic primary for Governor with his large war chest and by
commenting that the Governorship of Kentucky was a full-time job, not an interim step to
retirement. Democratic politics in Kentucky is a blood sport and the Governor's office is the
most coveted prize. Senator Ford, a participant of this sport of longstanding, certainly has not
forgotten.
Recent Developments: At the retreat in Jamestown he noted that his state produces coal,
liquor, tobacco and that the Administration has been hitting all these industries and will
continue to do so. He expressed a willingness to take the hit on sin taxes but needs a quid
pro quo (something for his 95,000 farmers). We anticipate that he would like a percentage of
the tax collected to go back to tobacco fanners. He would like a meeting with the First Lady
to negotiate. We recommend that the First Lady place a call to initiate discussions. Perhaps
a meeting can be avoided by taking this approach.
SENATOR DAVID PRYOR (D-AR) (Secretary of the Democratic Conference)
Senator David Pryor is part of the Senate leadership (Secretary of the Democratic
Conference). As the Chairman of the Senate Special Committee on Aging, he is well liked
and respected by the powerful aging advocacy community. In addition, he is one of the few
Democrats that the small business community genuinely trusts. Furthermore, as a former
Governor and as a result of his advocacy of state-based approaches to comprehensive reform,
he has a great deal of good will with the Govemors. Although an unassuming Member and
one who does not get overly involved in detailed policy discussions, he has emerged as one
of the most influential and best liked members of the Senate. All of these roles ensure that
he will be a key player on the health care front.
In terms of health care priorities, drug cost containment is the first, second, and third
highest priority for Senator Pryor. The concept of linking drug cost containment to tax
credits (embodied in Pryor's Prescription Drug Cost Containment Act — S. 2000) was
endorsed by President Clinton.
In addition to his drug cost containment interests, he also has a notable legislative
achievement record in rural health (relief for hospitals and incentives for primary care doctors
in medically underserved areas), state-based refonn (his NGA and Clinton candidateendorsed Leahy/Pryor bill), and long-term care (his proposal for Federal standards for private
long-term care insurance policies).
�Recent Developments: He continues to be concemed about the plan's impact on small
business. Although he likely will be a loyal supporter, he would be a better advocate if he
were more convinced that small business won't be unduly burdened by health reform. He
backs the use of a dedicated tax for health care, perhaps a VAT. He also supports the
inclusion of a significant long-term care benefit. He believes that as long as we will be
spending billions of dollars, we should make certain the plan attracts popular support.
Senator Pryor believes that such a broad-based source would reduce the subsidy on small
businesses and provide a stronger financial backing for long term care. Lastly, he strongly
believes that this plan must be sold at the local level and that the Administration needs to
make sure that there are people in the states who can talk knowledgeably in support of the
plan once it has been announced.
SENATOR TOM DASCHLE (D-SD) (Co-Chairman, Democratic Policy Committee)
Senator Daschle is the Co-Chair of the Democratic Policy Committee (with Majority
Leader Mitchell) and he is one of the more well informed Democratic Members on health
care issues. Senator Daschle and his staff are participating in Senator Mitchell's DPC
working group, but he has also been a leader of a separate working group (Kerrey, Bingaman,
Wofford, and Baucus) that was developing altemative approaches to health reform. This
group has been relatively quiet lately, seeming to be comfortable working with and through
the DPC health policy group.
Personally, Daschle is much more comfortable with a single-payer type approach to
health care, primarily because he believes it is a much easier political sell to the small
businesses in his state and the rest of his constituents. He joined Senator Harris Wofford in
introducing legislation (S.2513) to achieve this end. Daschle is a team player, however. As
part of the Senate leadership, he can be counted on to push his agenda as far as it can go, but
he will also do everything he can to assure that we pass comprehensive reform and the
President's plan.
Over the last few months, Senator Daschle has expressed concerns about specific
health issues. He was one of the signatories of a March 30th letter opposing the allocation of
the global budget among states based on historic costs. He is very concemed that rural states
would be discriminated against using such a formula.
Daschle also worries that people don't understand the real costs of the current health
system — how much they are paying in direct and indirect spending. He raised this point in
an editorial which appeared in the Washington Post this past Monday (4/26). He believes
education regarding these costs are critical so that people don't feel the new system will cost
them too much money. Lastly, Senator Daschle also supports restructuring graduate medical
education to emphasize primary care.
�Recently, Senator Daschle requested that the First Lady join him in South Dakota at a
future health care event, preferably over the summer. Lois Quam, a member of the working
group, participated in an event he held this past weekend.
Recent Developments: Senator Daschle was very pleased with Lois Guam's participation in
his event on Saturday, May 1. He was ecstatic about the First Lady's presentation to the
Senate on Friday (April 30) and happy with the direction the Administration is taking on
reform. He is now focusing on selling the plan. He wants to make sure that the
Administration has a communications plan in place to sell the plan. Daschle stressed the
importance of using state and regional media as part of this strategy. He also believes that
state legislators will be key because of the role they will play in designing the state plans but
the Administration must go to them to get them involved. In addition at every meeting he
again expresses his belief that we need to use new language to describe the plan. We are
going to work closely with him and Senator Kerrey on this issue.
SENATOR DANIEL PATRICK MOYNIHAN (D-NY) (Chairman, Senate Finance
Committee)
As you know, the new Chairman has yet to take a position on national health reform.
His interests lie primarily in the areas of Social Security and welfare reform. He is not a
detail person when it comes to the health care debate. Although a number of people have
discussed health care with him, it is notable that the one who seemed to catch his fancy the
most was Alain Enthoven.
The only health care-specific issues that the Senator is particularly known for are: (1)
his advocacy and support of New York hospitals, (2) his concern about the mentally ill and
the homeless, (3) his support for chemical and substance abuse in a benefit package, and,
most recently, (4) his support of innovation at the state level. On the latter point, he
introduced a liberalized Medicaid managed care measure that the NGA strongly supported.
(This legislation was opposed by the Children's Defense Fund because they felt that savings
through this cost containment approach would be at the expense of the Medicaid population).
Recently, the Chairman and his staff have been rather pessimistic about the chances
for health reform this year. The complexity, controversy, and potential expense of it frighten
them. The Chairman, in comments that have been somewhat retracted by staff, has indicated
his concern about any large new taxes to fund the program and any use of price controls to
contain costs. Although he has stated to you his willingness to raise whatever tax is
necessary for the elimination and integration of Medicaid into the new system, as well as a
one card for all system, his nervous statements should not be totally written off.
�Senator Moynihan's most recent communication was a letter to the President, in which
he reiterated his strong support for a health security card and in which he proposes the idea of
merging the health card and Social Security card into one. In the letter, he also expressed his
strong concems that the Social Security Commissioner has not yet been appointed.
Recent Developments: At the First Lady's meeting this week with the Senate Finance
Committee, Moynihan was among those who agree not to rush this thing. He expressed the
view that the Administration should take more time if needed to do it right. In Jamestown,
he again advocated combining the Health Card with the Social Security Card. We trust that
dinner with Senator Moynihan and his wife last Tuesday went very well. He did not make
the Friday (April 30) Senate bipartisan meeting.
SENATOR EDWARD KENNEDY (D-MA) (Chairman, Senate Labor and Human
Resources Committee)
Senator Kennedy, Chairman of Labor and Human Resources Committee, is the Senator
most closely associated with health care issues. He has been working on comprehensive
health reform issues for well over two decades. Although previously a strong single payer
advocate, in recent years, Kennedy has moved to employer-based approaches. He has come
to believe that using business to significantly underwrite the cost of health reform will
substantially reduce the need for federal tax increases and therefore make the package more
saleable to both the Congress and the American public.
He joined with Majority Leader Mitchell, Senator Rockefeller and Senator Riegle in
introducing a "play or pay" employer-based health care model. Despite the backing of these
Democratic leaders, it received surprisingly little rank-and-file support. Perhaps as a result
of this, he has come to believe that only a plan backed by a President can be enacted. For
this reason, Kennedy will likely be open to any comprehensive reform approach that meets
the criteria of universal coverage, cost containment and quality assurance.
He is also concemed about coverage for long-term care. He introduced a substantial
and expensive ($45 billion a year when fully phased-in) long-term care plan with Senator
Mitchell. This also gamered little support. Alternatively, he worked with Senators Pryor,
Hatch, Packwood and Bentsen in passing a long term care insurance standards bill. This
attempt was blocked because it did not include the tax clarifications that the insurance
industry sought in any type of insurance standard package for long-term care.
In addition to all these reform efforts. Senator Kennedy has been extremely active in
the public health service areas. His interests are broad ranging, from concerns about tobacco
advertising to adequate funding of AIDS research and services, to Head Start to extensive
oversight over FDA, to an effective illicit drug strategy to minority health.
�Recent Developments: Most recently the Senator has been making press for primary or sole
jurisdiction over health care reform. Howard, Steve and Chris met with Labor Committee
Staff Director Nick Littlefield recently. At that meeting, he was informed that we appreciated
their suggestions but would defer to the Majority Leader on this highly controversial issue.
The Committee has also agreed to hold hearings that are consistent with our message in early
to mid May. Specifically, they will focus on the cost of not doing health reform and the cost
effectiveness of mental health coverage in the benefit package. Lastly, he will want to be
significantly consulted in the upcoming weeks.
SENATOR JAY R O C K E F E L L E R (D-WV) (Chairman, Finance Subcommittee on
Medicare and Long-Term Care)
Senator Rockefeller views himself as being —and is — the President's number one
health care advocate. He was a tireless campaigner and defender of the Clinton health care
plan and was a National Co-Chair of the Clinton campaign. Rockefeller is the current
Chairman of the Finance Subcommittee on Medicare and Long Term Care and is the new
chair of the Senate Veterans Committee. He also has chaired the Pepper Commission and the
National Commission on Children. In addition. Senator Rockefeller is the founder and
Chairman of the Alliance for Health Reform, a nonpartisan organization dedicated to
advancing health care reform through education of public opinion leaders.
Senator Rockefeller's health care priority is very simple: He desperately wants to see
a comprehensive reform package enacted during the Clinton Presidency. Although he thinks
the long-term outcome of such an achievement is politically attractive, he is primarily
pushing this because he is sincerely committed to the need for reform. In this vein, he is not
overly committed to any particular approach although he has advocated an employer-based
approach. He, therefore, can be counted on to support virtually anything the President ends
up proposing, as long as it achieves universal access and cost containment.
Recent Developments: At his one on one meeting with the First Lady he was upset with
members of the Administration who he thinks are less than supportive of reform. He thinks
Moynihan can be brought on board. He urged using the phone more to increase contact with
members. He felt that the Finance Committee Republicans that we should target are Chafee,
Danforth and Durenberger. (He seemed less confident about Packwood). He also expressed
his willingness to play the heavy on taxes with the public, press, and members. He was
extremely impressed with your presentation in both Jamestown and in Friday's bipartisan
Senate meeting. He did raise some concem about the First Lady's use of the $100 billion
new health care spending figure.
�SENATOR DONALD R I E G L E (D-MI) (Chairman, Finance Subcommittee on Health
for Families and the Uninsured)
Senator Riegle considers himself to be a major player in the health care debate. He is
Chainnan of the Finance Subcommittee on Medicaid and was a lead sponsor of the Mitchell,
Rockefeller, Keimedy "play or pay" health care reform proposal. He has always felt he did
not get adequate credit for his work on the bill. Although he sponsored this bill, he appears
to be extremely willing to sign on to virtually any approach that achieves universal coverage
and cost containment.
Senator Riegle is very interested in many health issues, including: child immunization
programs, rural health care. Medicare prescription drug coverage, retiree health liability
concerns, long-term care, and a host of others. Senator Riegle strongly believes that cost
containment savings should be used to help pay for reforming the health care system — NOT
for deficit reduction.
Recent Developments: At the April 20th meeting with the Finance Committee, he stated that
he wanted to look at longer budget periods than five years (he can't understand why we are
always locked into a five year budget plan). At the Jamestown retreat, he reiterated his belief
that it is important to look at national spending, not just Federal spending because most of the
saving will come from the private sector. He also felt that we needed to look at a change in
the language used to explain the plan.
SENATOR BARBARA MIKULSKI (D-MD) (Assistant Floor Manager)
Senator Mikulski is known as an outspoken liberal. She supports the Clinton health
reform plan in principle but is concerned about the influence of the Jackson Hole group who
she calls "a bunch of geriatric Republicans that represent everything that's wrong with health
care." As a former social worker, she would like to see greater use of non-physician health
professionals to deliver care.
She is a champion of women's health and an avid pro-choice advocate. The plan's
position on women's reproductive health services will be critical. She is concerned about
improving research into women's health and eliminating the gender bias of NIH research.
She is also a strong advocate for seniors. She introduced and passed the Spousal
Impoverishment provisions in 1988 so that seniors did not have to spend down all of their
assets to qualify for benefits. As the new Chair of the Labor Subcommittee on Aging, she is
promoting the expansion of home and community-based long-term care services.
On the Appropriations Committee, she heads the HUD/VA and Independent Agencies
Subcommittee. VA—the largest managed health care system—is a big concern for Mikulski.
She cites the Canadian experience where under the massive change to a single payer system,
veterans lost out. She feels strongly that veterans need a seat at the reform table.
�Recent Developments: At the Senate Retreat and at most other recent meetings. Senator
Mikulski stressed talking the people's language on health reform and asked for a mechanism
to assure this happens. She is afraid our plan may be too complicated for Members to
explain and for people to understand. She also said that the Democratic women Senators
would lead the floor fight for reproductive health benefits in the package.
SENATOR JOHN BREAUX (D-LA) (Deputy Assistant Whip)
Senator Breaux is the second most junior Member of the Finance Committee. He is
one of those up and coming "New Democrats" for whom many see a bright future. His
politics are moderate to conservative but he is known more as a pragmatist than an idealogue.
In the area of health care, Breaux is yet another of the members who care deeply about small
businesses and rural health care.
Previous to this year. Senator Breaux was not overly active in health care issues. That
changed when he introduced the Conservative Democratic Fomm's managed competition bill
with Senator Boren in 1992. He is very concemed, however, about the bill's limitations with
regard to assuring adequate access to health care in rural areas. He is also concerned about
whether this approach will actually achieve broad-based cost savings. Despite this, he
remains uncomfortable with altematives and he will want to make sure that the Conservative
Democratic Fomm's model is used as much as possible during the upcoming debate. He
opposes price caps and freezes to control costs.
Recent Developments: At the Finance Committee meeting on April 20, Senator Breaux
stated that he was very encouraged about what he was hearing. He believes people want
health care reform but it will be important to sell the benefits first (and sell people on what
they are getting). He wants the plan to be bipartisan and thinks it should contain malpractice
reform. This week he has made very positive public comments about the prospects for health
reform and praised the consultative process with both Democrats and Republicans on health
care reform.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. memo
SUBJECT/TITLE
DATE
Chris Jennings to Hillary Rodham Clinton; re: Senate Labor &
Human Resources Meeting (2 pages)
05/03/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefmg Memos - First Lady, 1993 [5]
2006-0885-F
Jp2850
RESTRICTION CODES
Presidential Records Act - ]44 U.S.C. 2204(a)J
Freedom of Information Act - ]5 U.S.C. 552(b)|
PI
P2
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P4
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C. Closed in accordance with restrictions contained in donor's deed
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RR. Document will be reviewed upon request.
�SENATE LABOR AND HUMAN RESOURCES COMMITTEE
DEMOCRATS:
SENATOR EDWARD KENNEDY (D-MA) (Chairman, Labor and Human Resources
Committee) - Senator Kennedy, Chairman of the Labor and Human Resources Committee, is
the Senator most closely associated with health care issues. He has been working on
comprehensive health care reform issues for well over two decades. Although previously a
strong single payer advocate, in recent years, Kennedy has moved to employer-based
approaches. He believes that using business to significantly underwrite the cost of health care
reform will substantially reduce the need for federal tax increases, and therefore make the
package more sellable to both the Congress and the American public.
He joined with Majority Leader Mitchell, Senator Rockefeller and Senator Riegle in
introducing a play or pay employer-based health care model. Despite the backing of these
Democratic leaders, it received surprisingly little rank-and-file support. Perhaps as a result
of this, Senator Kennedy has come to believe that only a plan backed by the President can be
enacted. For this reason, Kennedy will likely be open to any comprehensive reform approach
that meets the criteria of universal coverage, cost containment, and quality assurance.
He is also concemed about coverage for long term care. He introduced a substantial and
expensive ($45 billion a year when fully phased-in) long term care plan with Senator
Mitchell. This also garnered little support. Altematively, he worked with Senators Pryor,
Hatch, Packwood and Bentsen to pass a long term care insurance standards bill. That attempt
was blocked because it did not include the tax clarifications that the insurance industry
sought.
In addition to all these reform efforts, Senator Kennedy has been extremely active in the
public health service areas. His interests are broad ranging, including concerns about tobacco
advertising, adequate funding of AIDS research and services, Head Start, extensive oversight
of FDA, effective illicit drug strategy, and minority health.
Recent Developments: Recently, Kennedy has been pressing for primary or sole jurisdiction
over Health Care Reform. Howard, Steve and Chris met with Labor Committee Staff
Director Nick Littlefield. At that meeting he was informed that we appreciated their
suggestions but would defer to the Majority Leader on this highly controversial issue. The
Committee has also agreed to hold hearings that are consistent with our message in early to
mid-May. Specifically, they will focus on the cost of not doing health care reform and the
cost effectiveness of mental health coverage in the benefit package (Mrs. Gore is scheduled to
testify.). Lastly, Senator Kennedy will want to be significantly consulted in the upcoming
weeks.
�SENATOR CLAIBORNE P E L L (D-RI) (Chairman, Labor Subcommittee of Education)
Senator Pell is the most senior member of the Senate Labor and Human Resources Committee
and a long-time advocate of "cradle to grave" health coverage. On health care reform, he is
not an ideologue and is not committed to any method of reform. In 1972, he joined in
introducing legislation which would have mandated employer-based health care reform. As a
member who has been working on the issue for sometime, he would enjoy seeing actual
progress.
Because of his well-to-do elderly constituency. Senator Pell voted to repeal the Catastrophic
Health Care Reform legislation. This is significant because it may indicate that a prescription
drug benefit that most well-to-do elderly already have will not be adequately responsive to
an influential constituency of his. This helps explain why Senator Pell's top health care
concerns include coverage for long term care - Rhode Island has one of the highest
percentages of elderly of any state in the country - preventive services and expanding the
use of non-physician health provider. He is opposed to smoking and has sponsored
legislation to provide grants to states for health promotion programs. He is also interested in
studying other countries' health care systems and taking lessons from their experiences. At
Friday's bipartisan Senate meeting (April 30), Senator Pell asked if the Task Force was
looking at other countries as models for reform.
SENATOR HOWARD METZENBAUM (D-OH) (Chairman, Labor Subcommittee on
Labor) - Senator Metzenbaum strongly believes in the need for health care reform and has
cosponsored Senator Wellstone's single payer bill. He is concerned about the managed
competition approach because he fears that it is too easy on the special interests, especially
the insurance companies. He believes to truly reform the health care system, the
Administration must be willing to take on and defeat the special interests and take the
program to the American people. He views health care as a social good that should be
provided to all people and believes the system should be based on providing services to
people at the lowest possible cost. Metzenbaum strongly favors rate setting and a national
budget.
Senator Metzenbaum also favors eliminating fraud and abuse in the system. He has major
criticisms of HCFA for not fencting out fraud and abuse. Other concerns arc anti-trust (he
chairs the Judiciary subcommittee), malpractice reform and long term care.
Recent Developments: Senator Metzenbaum's staff has indicated a great concern about the
apparent Administration infatuation with caps for medical malpractice. He is strongly
opposed to caps and might even oppose the legislation if they are included at the time of
introduction. He has also expressed concern that quality standards may be vulnerable to the
Administration's decision to cut back on what we view as unnecessary regulation and he
would like us to proceed cautiously in this area.
�SENATOR CHRISTOPHER DODD (D-CT) (Chairman, Labor Subcommittee on
Children) - Senator Dodd chairs the Labor and Human Resources Subcommittee on
Children, Families, Alcohol and Drugs. He has been one of the chief architects of the Act for
Better Child Care and the Family and Medical Leave Act. He has also championed full
funding for Head Start and expansion of childhood immunization programs. On health care
reform, Dodd is keeping an open mind and is inclined to wait for President Clinton to take
the lead.
In the last Congress he cosponsored Senator Bentsen's heahh care reform legislation.
However, despite his close friendship with Senator Kennedy, he did not cosponsor the "pay or
play" plan put forth as a Democratic leadership proposal. This may be attributable to the fact
that Connecticut is the insurance capital of America with many large and midsize insurers
based there. Connecticut also is home to many drug manufacturers and he is concerned that
they will be hit too hard under cost control proposals. He notes that this is the only industry
in his state to have an increase in jobs over the last five years. He is supportive of the
Pharmaceutical Manufacturers Association's proposal to negotiate price reductions with the
Administration.
SENATOR PAUL SIMON (D-IL) (Chairman, Labor Subcommittee on Employment) Senator Simon is very interested in health care reform, and leans toward a single payer
approach but also cosponsored the Leadership's HealthAmerica bill. He is close to organized
labor and sponsored amendments to strengthen the cost containment provisions of
HealthAmerica proposed by the AFL-CIO. He has also been one of the Senate's strongest
advocates for long term care and has cosponsored many bills in this area. He is very
interested in children's and minority issues. He has a long standing interest in education,
particularly higher education. He is a strong supporter of increasing enrollment of minorities
in health professional schools.
Recent Developments: Senator Simon recently met with Robyn Stone and reiterated his avid
support of a significant long term care plan. He cites his Senate campaign in which he
advocated comprehensive long term care legislation which outlined specific tax mechanisms.
This plan received a great deal of support in the state, so much so that his opponent, thenSecretary Lynn Martin, pulled ads attacking the tax because they were so negatively received
by the electorate.
SENATOR TOM HARKIN (D-IA) (Chairman, Labor Subcommittee on Disability
Policy) - Senator Harkin has not sponsored any reform legislation or backed any particular
reform approach. He has focused instead on specific issues that will need to be components
of an overall plan. He has a strong interest in all rural issues. He was recently named CoChair of the Senate Rural Health Care Coalition. Harkin is a leading advocate in the Senate
for anything related to people with disabilities. (He has a brother who is deaf.) His
sponsorship of the Americans with Disabilities Act is perhaps the major achievement of his
�political career. Ensuring that the plan provides access to health care, including long term
care for people with disabilities, is a major concem.
Senator Harkin is especially interested in prevention; he sponsored a bill giving money to
states for preventive health programs. As a member of the Labor Committee and Chairman
of its Appropriations Subcommittee on Human Resources, he is a key player on public health
legislation and funding. Inclusion of preventive services in the benefit package will be key as
Senator Harkin opposes co-pays for these services.
SENATOR BARBARA MIKULSKI (D-MD) (Chair, Labor Subcommittee on Aging) Senator Mikulski is known as an outspoken liberal. She supports the Clinton health care
reform plan in principle but is concerned about the influence of the Jackson Hole group who
she calls "a bunch of geriatric Republicans that represent everything that's wrong with health
care." As a former social worker she would like to see greater use of non-physician health
professionals to deliver care.
She is a champion of women's health and an strong pro-choice advocate. The plan's position
on women's reproductive health services will be critical. She is concerned about improving
research into women's health and eliminating the gender bias of NIH research. She is also a
strong advocate for seniors. She introduced and passed the Spousal Impoverishment
provisions in 1988 so that seniors did not have to spend down all of their assets to qualify for
benefits. As the new Chair of the Labor Subcommittee on Aging, she is promoting the
expansion of home and community-based long term care services.
On the Appropriations Committee, she heads the HUD/VA and Independent Agencies
Subcommittee. VA, the largest managed health care system, is a big concern for Mikulski.
She cites the Canadian experience where under the massive change to a single payer system,
vets lost out. She feels strongly that vets need a seat at the reform table.
Recent Developments: At the Senate retreat. Senator Mikulski stressed talking the people's
language on health care reform and asked for a mechanism to assure this happens. She also
said that the Democratic women Senators would lead the floor fight for reproductive health
benefits in the package.
SENATOR JEFF BINGAMAN (D-NM) - Senator Bingaman joined the Labor and Human
Resources Committee in May of 1990. While he does not have a long record on the issue of
health care reform, he has been exhibiting increasing interest in the subject. He supports the
managed competition model's focus on market adjustment of health care costs but has also
supported an eventual cap on health care spending. He has cosponsored legislation with
Senator Durenberger to implement the Jackson Hole group recommendations - a managed
competition model which rejects global budgets. However, in hearings last December of the
Labor Committee, Bingaman expressed strong support for the idea of a global budget to
�"limit the amount of revenue going into the system, limit the amount of premiums that people
can pay into the HPICs." He is a strong advocate of rural health and prevention. He has
expressed concem about the effects that employer-based health care reform could have on
small businesses.
Recent Developments: Reportedly, Senator Bingaman was unhappy over our language
change from "HIPC" to "Alliance." He feels "cooperatives" are rural friendly. At
Jamestown, Bingaman raised concems about small business. He felt that a payroll
contribution of 7 to 8 % was too high. In his view, we should lead with cost containment
and make sure small businesses are protected.
SENATOR PAUL WELLSTONE (D-MN) - Senator Wellstone is very interested in health
care reform. In March, he reintroduced his single payer bill, the Senate counterpart of the
McDermott bill. Despite his strong bias toward single payer and his suspicions of managed
competition, he has expressed a willingness to work with you. His strong desire for reform
and his belief that we must act now make him likely to support the Administration plan. He
has a strong interest in mental health and substance abuse benefits. He modified his previous
bill to strengthen its mental health provisions. Other concems include rural health, consumer
choice and state flexibility (so that Minnesota might pursue a single payer option).
Recent Developments: Senator Wellstone indicated concem regarding talking points
distributed by the Task Force to the members of Congress, particularly how single payer was
characterized. At the retreat, he stated that he doesn't want anyone to be able to opt out of
the Purchasing Cooperative because he fears that healthy people will opt out. He asked for a
meeting with Ira. At the Senate meeting on Friday, Senator Wellstone mentioned that he had
spoken to the First Lady by phone. Follow-up action by Ira is being arranged.
SENATOR HARRIS WOFFORD (D-PA) - Since his Senate race victory, which was
widely attributed to his support of health care reform. Senator Wofford has actively pursued
this issue in the Senate. He is part of the group of five (with Senators Daschle, Baucus,
Kerrey and Bingaman) on a single financing state-implemented health system with a national
health board approving state plans. Employers and individuals would pay a progressive
premium to a fund which would be retumed to the states on a percentage basis. The original
Daschle-Wofford bill was called the American Health Security Act, partially because
Wofford believes so strongly in the importance of the success of the Social Security system.
He believes that his proposal took into account a middle road between the single payer and
managed competition crowds. He believes everyone should be required to participate in the
Health Alliances (no opt-outs), that the program must be state or regionally administered, and
that long term care coverage is essential. He has previously expressed concern over what he
felt was the lack of discussion by the Administration of long term care in connection with
reform.
�He is working with the Democratic Policy Committee health working group and is looking at
the health insurance purchasing cooperatives and how they could work. He is very
intellectual and savvy about how difficult some of the concepts are for the public to
comprehend. For example, he dislikes intensely the term "global budget," believing that it is
too large to understand and turns people off. He believes that President Clinton and
Congress must do a lot of educating on health care reform.
Recent Developments: It has been more and more clear to the Senator that his election is
tied to Health Care Reform. He will be very helpful. Language used to describe and sell the
plan is very important to him. He is very appreciative that the First Lady attended his forum
in Harrisburg earlier this year. At the Senate retreat. Senator Wofford stated his support for
short term cost controls. He believes that abortion should be out of health reform and does
not want the federal government overriding state abortion restrictions.
�REPUBLICANS:
SENATOR NANCY KASSEBAUM (R-KS) (Ranking Republican Member, Labor and
Human Resources Committee) - Senator Kassebaum is the new ranking-minority member
of the Labor and Human Resources Committee. As such, she'll be working closely with
Chairman Kennedy on many provisions the committee has jurisdiction over.
Kassebaum has taken a strong interest in health care reform and has introduced her own
reform bill, the BasiCare Health Access and Cost Control Act (S. 325). This legislation
provides tough cost controls, focussing on controlling what insurance companies can charge
for premiums. She would finance this bill through raiding the Social Security Trust Fund.
When the First Lady met with the Senate Women's Caucus, Kassebaum pushed for a national
commission on abortion, like the base closure commission, so that the members would have
one up or down vote on the issue.
She is very concerned about over-regulation by HHS and the federal government generally.
Along with Senator Metzenbaum, Kassebaum authored legislation on orphan drugs; their bill
would have eliminated the current regime in which dmgs for rare diseases enjoy special
market exclusivity for the pharmaceutical manufacturer.
While considered a moderate. Sen. Kassebaum will toe the party line if she perceives an issue
is being politicized. If she senses this is happening with health reform, we will have little
chance of winning her support.
Recent Developments: Senator Kassebaum has expressed concerns about the Health
Alliance. Specifically, whether they will remain a non-profit entity or whether they will
become government or quasi-governmental agencies. She interested to know if large groups
with healthy populations are penalized for opting out, whether sick groups that opt out will
get a subsidy. Kassebaum is also interested in how the global budgets will be allocated to the
states and how these state budgets will be enforced. Her elderly mother lives at home, so
Kassebaum also has a personal concem about long term care. We believe she is one of our
top Republican chances. She is also scheduled to meet with you and Ira on Thursday along
with Sens. Danforth, Burns and Reps. Glickman and McCurdy sometime next week.
SENATOR J I M JEFFORDS (R-VT) - Senator James Jeffords is a progressive Republican
who has shown a fair amount of interest in health-related matters. He has sponsored his own
bill (The Medicare Health Act), a single-payer approach with 70% federal financing. He
believes his is a unique approach and really hopes that the Administration considers his
proposal seriously.
According to his staff, the main agenda item for Senator Jeffords this year will be the ERISA
preemption. This is an especially important issue for Vermont, which currently has a waiver
�application in order to pursue comprehensive reform in the state. As a result, he would also
like to see state flexibility built into a comprehensive reform initiative.
Senator Jeffords is an advocate of improving access to health in mral areas. As part of health
reform, Jeffords believes there needs to be an emphasis on primary care and efforts that
encourage providers to enter primary care. He also favors loan deferment programs and
expansion of the National Health Service Corps (NHSC) which aim to address the provider
shortage issue in mral communities. Jeffords has raised questions regarding how managed
competition will effect the need for primary practitioners.
Jeffords has also taken an active stance on lifting the ban on fetal tissue research, increasing
AIDS education, and eliminating the special market exclusivity for producers of orphan dmgs
(drugs for rare diseases.)
Recent Developments: Jeffords has been taking a lot of credit lately for the fact that the
President advises the plan will be providing lots of state flexibility. This public credit-taking
has alienated Senator Leahy in particular because Senator Leahy believes he is the leader in
this area.
SENATOR DAN COATS (R-IN) - Senator Dan Coats is more conservative across a wide
spectrum of social issues than almost any other member of the committee. He is strongly
opposed to abortion. He is the author of several amendments to require parental consent in
the case of abortion for minors (one of which passed the Senate).
On the other hand. Coats, the ranking member on the Children and Families subcommittee,
has been a fairly strong advocate for child welfare and has broken with the Republican party
to these ends. He is viewed to have something of a pragmatic streak on certain issues and is
not afraid to differ with his party on these issues. He supported the Family and Medical
Leave Act and extending tax credits for families with children. He has been supportive of
Senator Dodd in his efforts and is more of an enabling ranking member rather than an
obstructing one.
SENATOR JUDD GREGG (R-NH) - Senator Judd Gregg, the newest member of the
Senate Labor and Human Resources, was elected governor of New Hampshire in 1988 and
re-elected in 1990. He is the son of Hugh Gregg, a former Republican govemor of New
Hampshire. During his two terms in office, he showed a strong interest in and commitment
to environmental protection and economic development. He took a conservative position on
spending and taxes.
Senator Gregg was a member of the House of Representatives from 1980 until he assumed
the governorship of New Hampshire. He served on the Ways and Means Health
Subcommittee and voted along conservative lines. He was involved in the movement to
8
�repeal Medicare Catastrophic. New Hampshire recently took flack in an article in the
Washington Post where the state shifted Medicaid funds to balance their state budgets.
Senator Gregg was Governor and said to approve of the plan.
SENATOR STROM THURMOND (R-SC) - Senator Thuraiond has not played a strong
role in health-related matters. The one area of health where Thurmond has shown a strong
interest is in research. He backed the NIH reauthorization and supports fetal tissue research.
He is also concerned about AIDS funding, which he thinks should be increased; he feels there
is an improper perception about funding imbalances between AIDS and other disease research
activities. Thurmond has a daughter who is diabetic and testifies before the Appropriations
Committee on behalf of diabetes funding yearly. He also supports more funding for cancer
research.
Senator Thurmond also has a longstanding interest in alcohol education issues. He was the
primary sponsor of the legislation which requires a Surgeon General's warning label on
alcohol beverage containers. He currently is advocating legislation requiring similar warnings
for alcohol advertising.
Thurmond has real concerns about the budget deficit and will interested in the impact of
reform on the deficit.
SENATOR ORRIN HATCH (R-VT) - Senator Hatch is relatively new to the Committee
having joined during the last Congress. He is one of the brightest Senators, but has yet to
really get a comfortable grasp of the Finance Committee. Although well known for his very
^"x^onservative philosophy, in recent years he has appeared to become more open to more
traditionally moderate approaches. For example, although close to the dmg industry, he has
been willing to push them to be more responsive on pricing issues.
Up until 1993, he served as cither the Chairman or the Ranking Republican of the much more
conflict-oriented Labor and Human Resources Committee. In this capacity, he became
extremely well informed about PHS, NIH, and FDA issues. On health reform issues, he can
be expected to be very supportive of market-oriented reforms to the health care system. In
that vein, he will be extremely uncomfortable with employer mandates and discussions of
global budgeting and enforcement. He has introduced legislation to reform the medical
malpractice system and sees it as an important means for reducing health care costs.
Recent Developments: Senator Hatch has just hired a health care staff person straight from
Reagan/Bush DHHS. It is unclear what impact this will have on his willingness to be
constructive on health care debates—more likely to be negative. Sen. Kennedy, who is close
to Hatch, believes we should not write him off. He views Hatch as a potential coalition
builder between moderate Republicans and Democrats.
�SENATOR DAVE DURENBERGER (R-MN) - Senator Durenberger, the ranking
Republican on the Finance Committee on Medicare, is one of the Committee's most well
versed Members on health care reform. He also is one of the few Members who has served
concurrently on the Labor and Human Resources Committee (the other major health care
committee) and the Finance Committee. He is a moderate who is viewed by the Republican
leadership as somewhat of a loose cannon. Because of this and his long-standing interest in
health care reform, Durenberger, too, is a candidate to be a possible and important ally.
In the last Congress, he joined Senator Bentsen as the lead Republican on the Texas Senator's
incremental (insurance market reform, etc.) health reform initiative. He has been a key health
care player for years, however. He now is the ranking Republican on Jay Rockefeller's
Subcommittee on Medicare and Long Term Care, and he has served as either a Chairman or
ranking Member of this Committee for years. In addition, he served (as a Vice-Chair) on the
Pepper Commission. While he joined all the other Republicans in voting against the access
recommendations of this Commission, (he did vote for the long-term care recommendations)
it is important to note that it was unclear that Durenberger was going to vote against the
Pepper Commission recommendations until very late in the process. An important offshoot of
this experience, though, was the close working relationship he forged with Rockefeller.
Most recently, Durenberger has focused on state-based health reform initiatives. He does not
believe that a consensus yet exists for national reform and his own state is tired of waiting.
Minnesota has a long tradition of moving ahead on health care reforms. It is one of the 5 or 6
states that has gone ahead and passed legislation to implement its own reform proposal.
Minnesota is also THE nation's capital of managed care/HMO delivery systems. As a result,
Minnesota has historically been more efficient than other states in terms of the delivery of
health care. Senator Durenberger will be very concerned about the allocation of the global
budget, particularly that it does not reward the inefficient at the expense of the efficient.
Senator Durenberger called Chris Jennings on April 17th and indicated his nervousness with
any price controls. He said he thought we could get some savings from speeding up
implementation of the new physician payment system. He also urged us to find a way to fold
in Medicare into whatever we do. At a meeting with Ira Magaziner on April 21, Durenberger
stressed that he, unlike some Republicans, thinks we can and should do health care this year,
although he expressed reluctance about universal coverage (and its associated costs) in the
near term. Feedback from Gov. Carlson's office was very positive, but Durenberger is still
telling the press that he's against new taxes and isn't sure the bill can be moved this year.
Recent Developments: At the Bipartisan meeting in the Senate last Friday, April 30th,
Senator Durenberger outlined the issues which are most problematic for Republicans:
employer mandates, global budgets and standby authority for cost controls, the degree of
federal control over states and in turn state authority over the Health Alliances, and the $100
billion price tag.
10
�PERSONAL AND e O N F X S ^ T X E : ^ MEMORANDUM
DETERMINED TO BE AN ADMINISTRATIVE
MARKING PcrLO. 12958 as amended. Sec, 3.3 (c)
Initials:
Date: 1 ^ / 1 ^ 7 A f
TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n
Chris Jennings
B i p a r t i s a n S e n a t o r s Meeting
Melanne,/^tevp, I r a , Judy
A p r i l 29, 1993
Senator M i t c h e l l and Senator Dole have extended i n v i t a t i o n s
t o a l l t h e i r rank and f i l e Members t o attend tomorrow morning's
meeting w i t h you, I r a , and Judy. The c o l l e c t i o n o f Senators w i l l
l i k e l y be diverse, but i t remains unclear how many Members w i l l
be i n attendance.
BACKGROUND
M a j o r i t y Leader M i t c h e l l has asked t h a t you s t a r t o f f a t h i s
o f f i c e about 5-10 minutes before the 9:00 s t a r t up time. The
M a j o r i t y Leader w i l l then escort you t o the Members meeting.
I n the f r o n t o f the room w i l l be a t a b l e f o r Senator
M i t c h e l l , Senator Dole, you, I r a , and Judy. S i m i l a r t o
Jamestown, Senator M i t c h e l l w i l l make a short i n t r o d u c t o r y
statement. He w i l l recognize Senator Dole f o r a quick comment,
and then the f l o o r w i l l be yours. Senator M i t c h e l l i s expecting
you t o g i v e a 10-15 minute presentation. He has suggested t h a t
you stay away from financing, but focus more on the general
o u t l i n e o f the plan (see attachment 1) and the process by which
you e n v i s i o n i t g e t t i n g completed, introduced, and passed.
Following your remarks. Senator M i t c h e l l and Senator Dole
w i l l c a l l on t h e i r Members f o r questions, statements, e t c . At
t h i s p o i n t , you should f e e l f r e e t o c a l l on I r a and Judy t o help
answer questions.
POINTS TO HIT IN YOUR REMARKS
Although there a number of messages t h a t would be wonderful
t o convey i n your presentation, four come immediately t o mind:
(1)
Health Care This Year. The President and you are no less
committed t o g e t t i n g health care passed t h i s year and we
w i l l be working c l o s e l y w i t h the Democratic and Republican
Leadership of both Houses t o determine the best t i m e t a b l e
f o r assuring t h i s outcome ( t h e Panetta remarks have severely
reduced expectations);
�(2)
Bipartisan Issue. Health care i s a bipartisan issue and we
intend to be spending a great deal of time meeting with a l l
Members interested i n achieving the President's goal of cost
containment and universal coverage. (The l a t e s t report i s
that, despite the bipartisan Finance Committee meeting, the
scheduled bipartisan Senate Labor and Hiiman Resources
Committee meeting, and the scheduled Congressional
Republican Leadership meeting — see attachment 2 and i t s
l i s t of meetings, the Republican Members s t i l l f e e l l e f t out
of our process);
(3)
Uniquely American Plan. We believe we can learn from and
incorporate the best ideas of many Members into a workable,
uniquely American health care reform proposal. (Few Members
have a good feel for what direction we are heading and i t
might be somewhat comforting to c i t e examples of merging
principles of managed competition and single payer plans.)
(4)
Everyone I s Held Accountable. Everyone w i l l be held
accountable and to contribute to the new system. While we
w i l l ask businesses to contribute, employees w i l l be asked
to do their f a i r share as well. Likewise, j u s t as we w i l l
ask insurers, pharmaceutical manufacturers, and other health
care providers to contribute to t h i s reform, we must require
that the Goverrunent be held accountable as well. We can no
longer j u s t cut reimbursement, without reducing the
bureaucratic burdens we place on providers. Similarly, i t
i s high time we started to seriously address the medical
malpractice issue as well. (Republicans l i k e to hear the
phrases: "no free loaders" and "individual responsibility."
I t i s important for us to avoid the perception that we w i l l
be placing a l l the burdens on businesses; along these l i n e s ,
please try to avoid the word MANDATE.)
BACKGROUND MATERIALS
Attached for your review tonight i s a l i s t (attachment 3) of
a l l the Senators and their current placement on our health care
reform "whip" l i s t . As you w i l l note, we have 22 r e l i a b l e votes
( a l l Democrats), 24 leaning yes votes ( a l l Democrats), and 20
Members who are very achievable votes i f we work them right (ten
Democrats and ten Republicans) for a t o t a l of 66 possible votes.
In addition, Steve Edelstein's War Room and I
to summarize the current health positions of every
l i s t s (attachment 4) are divided into a Democratic
l i s t i n alphabetical order. We hope you find t h i s
be useful.
have attempted
Senator. The
and Republican
information to
�^ •
OVERVIEW OF HEALTH REFORM:
ALL AMERICANS ARE GUARANTEED:
•
COMPREHENSIVE BENEFITS
•
SECURITY AND PORTABILITY OF COVERAGE
•
CHOICE OF PLANS AND PROVIDERS
•
HIGH QUALITY CARE
FEDERAL GOVERNMENT WILL:
•
DEFINE BENEFITS
•
DEVELOP QUALITY, ACCESS, INSURANCE STANDARDS
•
REFORM MALPRACTICE
•
ESTABLISH FRAMEWORK FOR STATE-RUN SYSTEMS
•
SET BUDGETS
STATES WILL:
•
SET UP ALLIANCE TO REPLACE FRAGMENTED INSURANCE
MARKET
•
GUARANTEE AFFORDABLE COVERAGE THROUGHOUT STATE
•
ENFORCE QUALITY, ACCESS AND INSURANCE STANDARDS
•
ENFORCE BUDGETS
HEALTH ALLIANCES WILL:
•
ENSURE AVAILABILITY OF VARIETY OF HEALTH PLANS
•
NEGOTIATE PREMIUMS WITH HEALTH PLANS
•
MANAGE ENROLLMENT
•
PROVIDE CONSUMER EDUCATION AND PROTECTION
HEALTH PLANS WILL:
•
ACCEPT ALL APPLICANTS AT COMMUNITY RATE
.
PROVIDE GUARANTEED
RATE
4-M-MBmEAT 1
BENEFg^^M^^^^p-UPO^^^^
MARKINGforE^. 12958 as amended. S^c. 3.3 (c)
i n i t i a i 5 : : : l ^ i V i _ 0,,,, [ a / t G / l /
mVILCCBDft
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS
PROBLEM
LACK OF SECURITY
SOLUTION
• ALL AMERICANS ARE INSURED
• INSURANCE CANNOT BE DENIED OR TAKEN AWAY
REGARDLESS OF HEALTH STATUS
• BENEFITS AT A COMPARABLE LEVEL CONTINUE
REGARDLESS OF EMPLOYMENT OR INCOME STATUS
• ALL AMERICANS AND THEIR EMPLOYERS PAY INTO THE
SYSTEM AT THE SAME RATE REGARDLESS OF THEIR
HEALTH STATUS
CONSUMER CONFUSION
• GREATER CHOICE OF PLANS POR MANY AMERICANS
• SIMPLE UNDERSTANDABLE BENEFITS PACKAGE
• ONE COVERAGE PACKAGE FOR A FAMILY
• NO COVERAGE BATTLES AMONG INSURERS
• GUARANTEED ACCESS TO PLANS
• CONSUMER COMPLAINT MECHANISM IN PLANS AND
ALLIANCE
• SIMPLE REIMBURSEMENT AND CLAIMS FORMS
• PUBLISHED QUALITY INFORMATION
4-ai-MiniiMT a
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONTD)
PROBLEM
PROVIDER HASSLE
SOLUTION
STANDARD REIMBURSEMENT AND ENCOUNTER FORM
SIMPLIFICATION OF REGULATIONS
HIGH ADMINISTRATIVE COSTS
• ELIMINATION OF INSURANCE UNDERWRITING AND
MULTIPLE RISK PRODUCTS
• SIMPLIFICATION OF CLAIMS AND REIMBURSEMENT
- MOVE TOWARDS CAPITATED PAYMENT SYSTEMS
- SIMPLE UNIVERSAL CLAIMS AND REIMBURSEMENT
FORMS DRIVEN BY UNIVERSAL ENCOUNTER FORMS
• ELIMINATION OF DUAL COVERAGE AND COVERAGE
DETERMINATION PRACTICES
• SIMPLIFICATION OF PRODUCT REDUCES NEED POR
AGENT TO ASSIST CONSUMERS
• REDUCTION IN COSTS OF SMALL GROUP
ADMINISTRATION
• REDUCTION IN REGULATORY REQUIREMENTS ~ FORM
FILLING
• REDUCTION IN MALPRACTICE PREMIUMS
• REDUCTION IN TIME SPENT BY PROVIDERS AND
INSURERS INVESTIGATING OR DEBATING
REIMBURSABIUTY
4-M-«B11KAT •
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONTD)
SOLUTION
PROBLEM
• BUDGETED/CAPITATED SYSTEMS DISCOURAGE
UNNECESSARY UTILIZATION AND INTENSITY OF SERVICE
BY PROVIDERS
UNNECESSARY TESTS AND
PROCEDURES
• GATEKEEPERS QN HMOs OR PPOs), SOME USE OF COPAYS
IN FEE FOR SERVICE PLANS AND PRICE COMPETITION
WILL DISCOURAGE UNNECESSARY CONSUMER USAGE
• NATIONAL TECHNOLOGY ASSESSMENT AND BETTER
INFORMATION ON PRACTICE PATTERN DIFFERENCES AND
EFFECTIVENESS OF TREATMENT WILL ENHANCE COST
CONSCIOUS/HIGH QUALITY PRACTICE
• BUDGETED/CAPITATED SYSTEMS ENCOURAGE MORE
PRUDENT USE OF TECHNOLOGY AND MORE COST
EFFECTIVE CAPITAL INVESTMENT
• MALPRACTICE REFORMS WILL CUT THE COSTS OP
MALPRACTICE INSURANCE AND DEFENSIVE MEDICINE
I UNDERSERVED POPULATIONS
> UNIVERSAL COVERAGE
> INCREASED INVESTMENTS IN INFRASTRUCTURE IN
POOR URBAN AND RURAL AREAS AND IN PUBUC HEALTH
» PREVENTION OP "RED LINING* OP HEALTH ALLIANCES
> RISK ADJUSTMENT OP POOR POPULATIONS
» HEALTH ALLIANCE RESPONSIBILITY POR BUILDING
HEALTH NETWORKS WHERE NONE EXIST
4-M-MIIEnaUT «
WmUWBPXJUHIIiKIIJUii
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONTD)
SOLUTION
PROBLEM
INADEQUATE LONG-TERM CARE
• EXPANDED OPPORTUNITIES FOR HOME CARE AS
BEGINNING OF SOCIAL INSURANCE PLAN
• RAISING MEDICAID SPEND DOWN LIMTTS
• INCENTIVES/REGULATION FOR PRIVATE INSURANCE
MARKET
«-M-MRmAT •
nBvnjKm A
�HOW THE NEW SYSTEM MAINTAINS WHAT
PEOPLE L I K E IN THE CURRENT SYSTEM
MAINTAIN NEGK)TIATED BENEFTTS
• LARGE EMPLOYERS AND EMPLOYEES CAN MAINTAIN
THEIR CURRENT PLANS AS LONG AS THEY MEET
FEDERAL STANDARDS
- EMPLOYERS CAN CONTINUE TO PAY MORE GENEROUS
PREMIUM SHARES AND COST-SHARING THAN
NATIONALLY GUARANTEED BENEFTTS PACKAGE IN A
TAX SUBSIDIZED MANNER
MAINTAIN HIGH QUALTTY SYSTEM
MAINTAIN CHOICE OP DOCTOR
• QUALTTY OF SYSTEM WILL IMPROVE WTTH BETTER
PRACmCE GUIDEUNE INFORMATION, QUALTTY REPORT
CARD, CONSUMER SURVEYING
• QUALTTY INFORMATION WILL BE MORE AVAILABLE TO
CONSUMERS
• BUDGETED FEE POR SERVICE NETWORK ALLOWS ALL
AMERICANS TO CHOOSE THEIR DOCTORS AS THEY CAN
TODAY
• AVAILABILTTY OP MULTIPLE PLANS OP DIFFERENT
TYPES ALLOWS CONSUMERS GREATER CHOICE OP TYPE
OF CARE THAN MANY HAVE TODAY
4-M-MKnDUT t
nnviLEaBi ft
�MEETINGS WITH CONGRESSIONAL REPUBLICANS
From the onset of the Administration's work on the h e a l t h
care reform proposal, the Health Care Task Force and i t s Work
Groups have made a concerted e f f o r t t o reach out t o House and
Senate Republicans f o r t h e i r guidance and support. We b e l i e v e i t
i s e s s e n t i a l t o have t h e i r involvement t o make the package as
strong as possible and t o assure i t s prompt and necessary
passage. We are t h e r e f o r e concerned t h a t there i s any perception
t h a t the White House, i n any way, has not a c t i v e l y sought the
advice and p a r t i c i p a t i o n of Republicans from the beginning.
I t i s very important t o note t h a t the President has i n s i s t e d
on s i g n i f i c a n t Republican involvement from the moment he
established the Health Care Task Force. On January 26th, he
requested t h a t the House and Senate Democratic and Republican
Leadership appoint representatives t o the Task Force. Senator
Dole chose himself and Representative Michel appointed
Representative Dennis Hastert (R-IL) t o serve on h i s behalf.
Since t h a t time, Mrs. C l i n t o n and/or I r a have attempted t o
hold meetings on a v i r t u a l l y weekly basis w i t h House and Senate
Republicans and/or t h e i r s t a f f s . The House has chosen t o send
i t s Members t o the meetings, while the Senate Health Care Task
Force has chosen t o send s t a f f . The s t a f f of the Senate
Republican Health Task Force has suggested t h a t more a c t i v e
Member-level discussions be delayed u n t i l there i s a b e t t e r sense
of what our f i n a l proposal w i l l be.
Since the President i s now focusing and narrowing the
options f o r h i s proposal, we have begun an a c t i v e e f f o r t t o hold
b i p a r t i s a n meetings w i t h House and Senate Republicans. On A p r i l
20th, Mrs. C l i n t o n p a r t i c i p a t e d i n a b i p a r t i s a n Finance Committee
meeting. She w i l l hold a s i m i l a r b i p a r t i s a n meeting w i t h the
Senate Labor and Human Resources Committee on May 4 t h . I n
a d d i t i o n , the President and the F i r s t Lady have already scheduled
a meeting w i t h the Republican Congressional Leadership on May 6th
t o commence serious P r e s i d e n t i a l - l e v e l discussions.
Attached i s a l i s t of the numerous meetings t h a t Mrs.
C l i n t o n , I r a Magaziner, Judy Feder and t h e i r designees have held
w i t h Senate Republicans. I hope you w i l l f i n d t h i s i n f o r m a t i o n
to be h e l f p u l .
�DATE
MEMBER(S)
MET WITH
SUBJECT
2/4
DOLE/CHAFEE
HRC/ICM/JF
process, general
discussion
2/23
DURENBERGER
HRC/ICM
3/10
Senate Republican Members
HRC
Bond
Burns
Chafee
Cohen
Craig
Danforth
Dole
Durenberger
Gregg
Kassebaum
Mack
Murkowski
Nichols
Packwood
Roth
Simpson
Stevens
Thurmond
(others were present as well)
general discussions
about process and
about directions
for/components of
reform
3/10
JEFFORDS
ICM
3/11
KASSEBAUM
(as part of Women Senators
meeting)
HRC
3/12
Senate Republican Staff
ICM
3/23
Senate Republican Staff
Walter Zellman
Rick Kronick
Lois Quam
New System
Development
Governance
ICM
short-term controls
4/1
Senate Republican Staff
1
||
1
Health Reform
Issues of special
interest to women
1
\
Sheila Burke
Christy Ferguson
Ed Mihulski
4/19
Senate Republican staff
Gary Claxton
Insurance Reform
|
4/20
DURENBERGER
ICM
Overall Reform
|
�Senate Finance Commitee: bipartisan meeting
4/20
HRC/ICM, JF
Overall reform, costs, y
financing
Rural Health Care
Chafee
Packwood
Danforth
Roth
Grassley
Hatch
Wallop
4/29
Senate Republican Staff
Lois Quam
4/30
Entire Senate (including
Republicans)
HRC, ICM, JF
|
1
1
1
^ 1
1
y^^vt^; Qtf^ ^ S a rrx —
i
__
�SENATORS' CURRENT STATUS
RELIABLE
LEAN YES
NEED WORK
4/29/93
LEAN NO
NO
Akaka
Biden
Baucus
Shelby
Bennett
Boxer
Bradley
Bingaman
Broion
Coats
Daschle
Breaux
Boren
Bums
Cochran
1 Feingold
Bryan
DeConcini
D'Amato
Coverdell
\
1 Feinstein
Bumpers
Exon
Dole
Craig
\
1 Harkin
Byrd
Heflin
Domenici
Dole
Inouye
Campbell
Johnston
Gorton
Faircloth
Kennedy
Conrad
Krueger
Grassley
Gramm
Leahy
Dodd
Nunn
Hatch
Gregg
Mikulski
Dorgan
Reid
Lugar
Helms
MltcheU
Ford
Bond
Pressler
Kempthome
MoseleyBraun
Glenn
Chafee
Roth
Lett
Murray
Graham
Cohen
Specter
McCain
PeU
HoUings
Danforth
McConnell
Pryor
Kerrey
Durenberger
Murkowski
Riegle
Kerry
Hatfield
Nlckles
Rockefeller
Kohl
Jefford
Simpson
Sarbanes
Lautenberg
Kassebaum
Smith
Sasser
Levin
Mack
Stei>ens
Lieberman
Packwood
Thurmond
|
H Simon
|
1
H
1
H
Wellstone
Mathews
Wallop
1
Wofford
Metzenbaum
Warner
H
Moynihan
Robb
1 Democrats 22
Democrats 24
Democrats 10
Democrats 1
Democrats 0
1 Republicans 0
Rcpub/icans 0
Repub/fcans JO
Repub/fcans 12
Republicans 21
1 TOTAL 22
TOTAL 24
TOTAL 20
TOTAL 13
TOTAL 21
�•
•V
P R O n L E S - SENATE DEMOCRATS
April 29, 1993
SENATOR DANIEL AKAKA (D-HI) - State flexibility is of primary importance to
Senator Akaka. He wants a waiver to allow Hawaii to continue its present employer-based
system. He was a cosponsor of Senator Mitchell's "HealthAmerica" plan in the last Congress,
but is open to virtually any approach that achieves cost containment and universal access, as
long as it provides for significant state flexibility.
Recent Developments: Hawaii is moving to press the House and Senate Committees to
obtain ERISA waiver as soon as possible even if that means before health care reform is
passed. Senator Akaka can be expected to support this effort.
SENATOR MAX BAUCUS (D-MT) - Senator Baucus was a member of the Pepper
Commission. Most notably, however, he voted against the final access recommendations —
they won by just an 8-7 vote — primarily because of his concem about the proposal's impact
on small business. Baucus is concemed about any proposal that utilizes any employer
requirement to help finance health care. As a result of this concem, and because the
Canadian system is quite popular in Montana, he is a single payer advocate.
He is a member of a 5-Member working group (Daschle, Kerrey, Bingaman, and Wofford)
that is looking at altematives to employer-based models. This group wrote to the First Lady
on February 3rd outlining principles which should be incorporated into a managed
competition framework including universal participation (no opt-outs), state or regional
administration, and phase-in of coverage for long-term care. More recently, on March 30, he
sent a letter with eight Democratic Senators fi-om rural states stating their position that the
allocation of health budgets among states should not be based on historical costs but on the
true cost of providing an appropriate level of care to a state's residents.
Senator Baucus believes health care reform must include real cost containment, sensitivity to
legitimate small business concems, and special consideration for rural concems. We have
been advised by staff that he is very committed to the concept of every citizen being in the
HIPC or health alliance. In addition, because it is more broad-based than an employer
mandate, he apparently would be supportive of a VAT tax for health care.
Recent Developments: At the April 20 meeting with Finance Committee members. Senator
Baucus stressed the need for the plan to contain costs with some sort of global budget. He
shared the view of other committee members that the Administration should take longer if
necessary, but make sure health reform is done right. At Jamestown, he reiterated his view
on the need for strong cost containment and a global budget. He also wanted to know the
administrative savings which would reduce the need for taxes. Senator Baucus also stated
that he thought the First Lady was the best salesperson for health care reform.
�SENATOR JOE BIDEN (D-DE) - Senator Joseph Biden is the Chainnan of the Judiciary
Committee. This position will become increasingly important as the President sends to the
Hill a choice for the vacant seat on the Supreme Court. Confirmation hearings might tie up
Senator Biden's time this summer. For the health care debate, however, Biden has been
relatively quiet. He has said in the past that he is still teaming the issue. One key will be
the DuPont Corp., which is pushing national health insurance. Biden has said that he does
not favor single payer and is concemed that play-or-pay could lead to rationing. He is noncommittal but skeptical on managed competition and is especially concemed about HMOs.
His committee will be responsible for marking-up the portions of the reform package dealing
with malpractice or tort reform. In addition, any modifications to or clarifications of the
anti-trust laws come under his jurisdiction as well.
SENATOR JEFF BINGAMAN (D-NM) - Senator Bingaman joined the Labor and Human
Resources Committee in May of 1990. While he does not have a long record on the issue of
health care reform, he has been exhibiting increasing interest in the subject. He supports the
managed competition model's focus on market adjustment of health care costs but has also
supported an eventual cap on health care spending. He has cosponsored legislation with
Senator Durenberger to implement the Jackson Hole group recommendations - a managed
competition model which rejects global budgets. However, in hearings last December of the
Labor Committee, Bingaman expressed strong support for the idea of a global budget to
"limit the amount of revenue going into the system, limit the amount of premiums that people
can pay into the HPICs." He is a strong advocate of rural health and prevention. He has
expressed concem about the effects that employer-based health care reform could have on
small businesses.
Recent Developments: Reportedly, Senator Bingaman was unhappy over our language
change from "HIPC" to "Alliance." He feels "cooperatives" are rural friendly. At
Jamestown, Bingaman raised concems about small business. He felt that a payroll
contribution of 7 to 8 % was too high. In his view, we should lead with cost contaiimient
and make sure small businesses are protected.
SENATOR DAVID BOREN (D-OK) - Although not generally thought of as a health care
reform leader. Senator Boren is the lead sponsor of the Senate companion (S. 3299) to the
House Conservative Democratic Forum's managed competition bill. In recent months,
however, he has become more sensitive to the inability of the Conservative Democratic
Fomm's approach to adequately address the access or cost containment challenge. Like
virtually every member of the Committee, he considers himself to be a strong supporter of
rural health and small business issues. With Senator Bradley, though, Boren has been
traditionally more focused on tax policy than health care.
There have been exceptions to the rule of Senator Boren's general non-interest/association
with health care. In addition to the CDF bill, he is now supporting the concept of significant
�stateflexibilitywithin the context of any health reform proposal (Oklahoma Govemor Walters
is pushing a major initiative now and wants some significant assistance/relieffromthe Federal
Govemment). In addition, Boren sponsored legislation last year to provide for an extension
of higher payments to rural hospitals that disproportionately serve Medicare patients. (This
legislation passed the Congress, but was included in the tax bill which was vetoed by thenPresident Bush.)
Recent Developments: On April 28, his staff called saying Senator Boren was concerned
that the premium payroll approach sounded too much like a pay or play plan. He hates this
concept. Chris Jennings assured staff that nothing could be furtherfromthe truth, but he may
need more convincing.
SENATOR BARBARA BOXER (D-CA) - As a new member of the Senate, Senator Boxer
is very interested in working with the leadership. While in the House, she cosponsored the
Russo single payer bill (predecessor to the current McDermott Bill) but was not an enthusiast.
She is particularly interested in issues conceming women and children. Senator Boxer
believes that health care refonn should cover reproductive services, including abortion
services.
Boxer outlined her basic approach to health care reform in a letter to the First Lady on
February 5. In the letter, the Senator emphasized the following principles: care should be
affordable and universal; benefits should not be based only on employment; and coverage
should include professionals other than doctors. To achieve these goals, the Senator called
for a minimum benefits package, increased preventative care, coverage of reproductive
services, increased public health education, services for women in crisis, and services for
children. Finally, the Senator called for "full representation" for women on any boards,
advisory committees or any other bodies created by health reform legislation.
In meetings with the HCTF, she has also expressed concems over how the Veterans Health
System will be integrated into the plan.
Recent Developments: At the Jamestown retreat, she has strongly urged that abortion
services be covered upfrontin the benefit package and protectedfromany hostile amendment
on the Senate Floor. She also raised the possibility of sin taxes being earmarked for children.
SENATOR BILL BRADLEY (D-NJ) - Senator Bradley is known more for his work on tax
policy than for his work on health care financing. He has indicated an interest in introducing
health care reform legislation similar to the managed competition model that he believes the
President has been advocating. The one exception to his general support of the Clinton health
care approach may well be with regard to prescription drugs. As a Senator representing the
state which is the capital of the pharmaceutical industry, Bradley is a fierce advocate for the
�industry and their concems. With Senator Hatch, he led thefightagainst Senator Pryor's
effort to influence the industry to control price increases by linking their pricing behavior to
eligibility for tax credits. (The Pryor proposal was endorsed by the President during the
campaign.)
As a member of the Infant Mortality Commission, Senator Bradley is proud of his work to
ensure that the Medicaid program was expanded to eventually cover pregnant women and
children. He also is a strong advocate for preventative care services. He has sponsored
several bills on tobacco, including revised warning labels and tobacco as a drug to be
included in the Drug Free Schools program. Lastly, although he incurred the wrath of some
aging groups with his opposition to prescription drug price constraints, he has been a longtime supporter of home and community-based long term care services, particularly with
regard to respite care services.
Recent Developments: At this week's Finance Committee meeting. Senator Bradley asked
for an estimate of how much the plan is going to cost and how much revenue is expected to
be needed. He is very concemed about taxes and is a great advocate of going slow on this
issue. "It is more important to get it right."
SENATOR JOHN BREAUX (D-LA) - Senator Breaux is the second most junior Member
of the Finance Committee. He is one of those up and coming "New Democrats" for whom
many see a bright future. His politics are moderate to conservative but he is known more as
a pragmatist than a idealogue. In the area of health care, Breaux is yet another of the
Committee members who care deeply about small businesses and rural health care.
Prior to this year. Senator Breaux was not overly active in health care issues. That changed
when he introduced the Conservative Democratic Fomm's managed competition bill with
Senator Boren in 1992. He is very concemed, however, about the bill's limitations with
regard to assuring adequate access to health care in rural areas. He is also concemed about
whether this approach will actually achieve broad-based cost savings. Despite this, he
remains uncomfortable with the altematives and he will want to make sure that the
Conservative Democratic Forum's model is used as much as possible during the upcoming
debate. He opposes price caps andfreezesto control costs.
Recent Developments: At the Finance Committee meeting on April 20, Senator Breaux
stated that he was very encouraged about what he was hearing. He believes people want
health care reform but it will be important to sell the benefits first (and sell people on what
they are getting). He wants the plan to be bipartisan and thinks it should contain malpractice
reform. This week he has made very positive public comments about the prospects for health
care reform and praised the consultative process with both Democrats and Republicans. In
addition, he invited Ira Magaziner to join him and the President at the Democratic Leadership
Conference meeting in New Orieans. (It is now unclear whether he will attend.)
�SENATOR RICHARD BRYAN (D-NV) - Senator Bryan is a former govemor of Nevada
who was to fill the seat of retiring Senator Paul Laxalt. Not very vocal on health issues,
Bryan has significant small business and rural concems. He probably will be hesitant to
support a bill that at least some small businesses will not support. He has not taken a
position on a particular plan, but he does not think single payer will work and is unsure about
managed competition's applicability to rural areas. Senator Bryan has publicly supported
Senator Pryor's prescription drug legislation and supports insurance reform. Raising taxes
might frighten him, and he does not think we need immediate access. He is up for reelection in 1994.
SENATOR DALE BUMPERS (D-AR) - Senator Bumpers has waited to see what the
White House will do and has resisted efforts to be pushed into Daschle's camp. As Chairman
of the Small Business Committee, Bumpers has a particular sensitivity to the needs of small
business. He could well be an important surrogate speaker in his position as Committee
Chairman, especially if he not only supports the bill but is comfortable enough to positively
talk it up. He is known for his great concem about children's issues. He therefore can be
expected to support phasing-in coverage for children first, if such a phase-in is necessary.
SENATOR ROBERT BYRD (D-WV) - Senator Byrd is one of the most senior members of
the Senate and a former Majority (and Minority) Leader. As you know, Senator Byrd
publicly announced his intention to oppose the use of reconciliation to pass the HCTF bill.
Senator Byrd mostly has funding concems, especially any specific directions for the
Appropriations Committee on funding that might be included in a health care reform bill. He
is also concerned about jurisdiction, particularly if health care financing might "take over"
some discretionary programs. He generally puts his energies into "infrastmcture." Byrd has
specifically mentioned possible redundant financing received by community health centers for
various health care services. He has no preference on the overall approach, and he will likely
defer to Senator Rockefeller on this. Byrd has a "wait and see" approach with the
Administration and will want to look at the whole package.
SENATOR BEN NIGHTHORSE CAMPBELL (D-CO) - Senator Campbell is the only
member of the Senate who is of Native American descent. He is on record in support of
managed competition, but has not taken a position on the Administration's deliberations. He
is, however, comfortable with the process. Senator Campbell has a special concem with the
Indian Health Service and will probably keep his eye out for any changes.
SENATOR KENT CONRAD (D-ND) - Senator Conrad is the newest member of the
Senate Finance Committee. He is known as a "budget hawk." Strong cost controls will be
critical for his support. He will look closely at the financing package and how the reform
plan impacts the federal deficit. He opposes large new taxes to support reform.
�Senator Conrad's foremost health concem is rural health care. He is concemed both with how
rural health care will be addressed in the context of managed competition as well as current
access and delivery issues. He is aware of two successful models from his state - one, a
network of clinics, the other an HMO - which have been able to increase access to primary
and preventive care. He signed the March 30 letter opposing the allocation of the global
budget among states based on historic costs. He is also an advocate for the need to improve
and increase funding for the Indian Health Service, where insufficient fiinding has led to
rationing of services. He also feels the IHS has not been sufficiently responsive to (Tongress
or tribal leadership.
Recently, Chris Jennings and Christine Heenan gave him a general health care background
briefing. (He had missed one given by Ira and wanted a private meeting.) He was very
appreciative and, by the conclusion of the discussion, appeared to feel much better about the
direction in which the President and the First Lady are heading.
Recent Developments: At the Finance Committee Meeting this week Senator Conrad was
very concemed about mandates. He fears that small businesses will be saddled with too large
a burden. He advocated simple, understandable language and provisions that he could explain
to his largely rural constituents.
SENATOR TOM DASCHLE (D-SD) - Senator Daschle is the Co-Chair of the
Democratic Policy Committee (with Majority Leader Mitchell) and he is one of the more
well-informed Democratic members on health care issues. Senator Daschle and his staff are
participating in Senator Mitchell's DPC working group, but he has also been a leader of a
separate working group (Kerrey, Bingaman, Wofford, and Baucus) that was developing
altemative approaches to health care reform. This group has been relatively quiet lately,
seeming to be comfortable working with and through the DPC health policy group.
Personally, Senator Daschle is much more comfortable with a single payer type approach to
health care, primarily because he believes it is a much easier political sell to his small
business folks and the rest of his constituents. He joined Senator Wofford in introducing
legislation (S.2513) to achieve this end. Daschle is a team player, however. As part of the
Senate leadership, he can be counted on to push his agenda as far as it can go, but he will
also do everything he can to assure that we pass comprehensive reform and the President's
plcin.
In addition, Daschle is one of the signatories of a March 30 letter opposing the allocation of
the global budget among states based on historic costs. He is very concemed that rural states
would be discriminated against if such a formula were used.
Senator Daschle also worries that people do not understand the real costs of the current health
system - how much they are paying in direct and indirect spending. He raised this point in
an op ed piece which appeared in the Washington Post this past Monday (April 24). He
�believes education regarding these costs is critical to insure that people don't feel the new
system will cost them too much money. Daschle also supports restructuring graduate medical
education to emphasize primary care.
Most recently. Senator Daschle requested that the First Lady join him in South Dakota at a
health care event in June, July or August. In addition, he asked that we send someone to a
health event in early May. Tlie Daschle office seems pleased that we are sending Working
Group Member, Lois Quan, to that event.
Recent Developments: At the meeting with the Finance Committee members last week, he
again expressed his belief that we need to use new language in describing the plan, for
example, using "system-wide" rather than "Federal program". He believes that changing the
language will change people's perceptions.
SENATOR DENNIS DECONCINI (D-AZ) - Senator DeConcini, who is up for re-election
m 1994 and recently separatedfromhis wife, is opposed to new taxes paying for the health
care package. While he is willing to work with the concept of managed competition, he
wants to preserve some of the current system. He is particularly concemed about the effects
on small business and incentives for doctors to treat Medicaid patients. While he has not
raised it so far, he will presumably also be worried about undocumented workers and Native
Americans.
Recent Developments: At the Jamestown Senate Retreat, Senator Deconcini stated that he
opposes including abortion in the benefit package and that, if it is included, a way must be
determined to separate out public financing.
SENATOR CHRISTOPHER DODD (D-CT) - Senator Dodd chairs the Labor and Human
Resources Subcommittee on Children, Families, Alcohol and Drugs. He has been one of the
chief architects of the Act for Better Child Care and the Family and Medical Leave Act. He
has also championed full funding for Head Start and expansion of childhood immunization
programs. On health care reform, Dodd is keeping an open mind and is inclined to wait for
President Clinton to take the lead.
In the last Congress he cosponsored Senator Bentsen's health care reform legislation.
However, despite his closefriendshipwith Senator Kennedy, he did not cosponsor the "pay or
play" plan put forth as a Democratic leadership proposal. This may be attributable to the fact
that Connecticut is the insurance capital of America with many large and midsize insurers
bzised there. Coimecticut also is home to many drug manufacturers and he is concemed that
they will be hit too hard under cost control proposals. He notes that this is the only industry
in his state to have an increase in jobs over the last five years. He is supportive of the
Pharmaceutical Manufacturers Association's proposal to negotiate price reductions with the
Administration.
�SENATOR BYRON DORGAN (D-ND)) - Senator Dorgan can be expected to back the
package as long as careful attention is given to the problems of rural areas. In addition to
mral health care, his major concem is cost containment. He can also be expected to watch
out for coverage for Native Americans. Although hisfreshmanstatus might not be influential
in the Senate, Dorgan still has wide respect in the House where he was a member of the
Ways and Means Committee.
SENATOR JAMES EXON (D-NE) - While Senator Exon has put forth a wait-and-see
attitude, he advocated "doing it this year" to Ira on March 4. He consults closely with Frank
Banett, chair of the Govemor of Nebraska's Blue Ribbon Panel on Health Care. His
Nebraska colleague. Senator Kerrey, can influence him but Kerrey's support will not
guarantee Exon's.
Recent Developments: At the Senate retreat. Senator Exon asked if the program could be
funded by sin taxes alone and how VA and Indian Health facilities would be treated under
reform. He also wondered whether supplementary insurance would be available. He praised
the First Lady's explanation of how health care reform would work in the states, stressing that
she had made his work easier.
SENATOR RUSSELL FEINGOLD (D-WD - Freshman Senator Feingold has also adopted
a wait-and-see attitude but is likely to support the President. In meetings with the HCTF he
has discussed the need for long term health care, particularly home and community based care
for the elderly and the disabled. Feingold is also concemed abut coverage for farmers. At the
state level he was a sponsor of single payer legislation in Wisconsin.
SENATOR DIANNE FEINSTEIN (D-CA) -Just two years after an unsuccessfulranfor
Govemor, Feinstein was elected to serve out the final two years of the Senate seat vacated by
Pete Wilson. Senator Feinstein focused her campaign on the economy and health care
reform, but, in an effort to overcome a reputation of weakness on women's issues, she also
raised issues like abortionrights,sexual harassment, equal pay, child care and breast cancer
research.
Senator Feinstein has been very open to the proposals of the Health Care Task Force, but has
raised concems that not enough attention is being focused on women's health issues. She
would like to ensure that reproductiverightsare covered and that women are included in NIH
and FDA research.
Senator Feinstein is also very interested in cost containment mechanisms. While she supports
strong upfront cost containment, she questions whether the capping of costs will work to
8
�control costs and has concems regarding the impact of wage and price controls. As such, she
also strongly supports medical malpractice reform. The daughter of a physician, Feinstein
wants to ensure choice of doctors. She would also like to see the benefit package emphasize
prevention and primary care. As a former mayor who lived through the crisis of a hospital
strike, Senator Feinstein is concemed that spending limits would create a backlash from labor.
Finally, she is very concemed that enough attention and financial resources go to the fight
against AIDS.
SENATOR WENDELL FORD (D-KY) - Senator Ford, the Chainnan of the Rules
Committee and the Majority Whip, will want to support the President. During his reelection
campaign this year he talked about wanting to work with a president who would sign health
care legislation passed by the Congress, but he is also a fierce protector of the interests of his
state. As he says, "if it is not good for Kentucky, I'm not for it." As a result Ford can be
expected to fight a tobacco tax. He is also nervous about mandated benefits and wants
freedom of choice for consumers. He also has a personal interest in health care since his
brother-in-law is a pediatrician in Kentucky.
Senator Ford oppposes giving states too much flexibility, ostensibly because some may not be
prepared for the responsibility. But more likely, it comes down to politics. Kentucky's
Govemor, Brereton Jones, has been working on his own state reform plan. Unlike other
Congressional delegations which are promoting their state's reform efforts. Ford may be
looking to undercut Jones as a political payback. In 1991, Jones, then the Lt. Govemor,
scared Ford out of the Democratic primary for Govemor with his large war chest and by
commenting that the Governorship of Kentucky was a full-time job, not an interim step to
retirement. Democratic politics in Kentucky is a blood sport and the Governor's office is the
most coveted prize. Senator Ford, a participant of longstanding, certainly has not forgotten.
Recent Developments: At the retreat in Jamestown Senator Ford noted that his state
produces coal, liquor, and tobacco and that the Administration has been hitting all of these
industries and will continue to do so. He expressed a willingness to take the hit on sin taxes,
but needs a quid pro quo (something for his 95,000 farmers). Interestingly, he would like a
meeting with the First Lady to negotiate.
�SENATOR JOHN GLENN (D-OH) - Senator Glenn has held hearings on the Gennan and
French systems as models for health care reform. He supported pay or play but not the
Leadership's HealthAmerica bill. His concems include the impact of reform on small
business, retiree health benefits, and potential changes to Medicare and Medicaid.
In a previous meeting with the DPC, Glenn questioned where the savings would come from
in the new system. He thinks that doctors have been unfairly vilified in debates over health
care costs. He says that their income accounts for less than one-fifth of health care spending.
He is more intrigued by the large percentage of lifetime health care costs which occur during
the last four months of life as an area for health savings.
As Chairman of the Govemment Affairs Committee, Glenn is likely to be interested in and
actively involved with any proposal that would fold the Federal Employees Health Benefit
Plan into the new system. Since advocates for federal employees are now asking that they be
treated the same as other large employers, they are likely to express serious reservations about
the cunently envisioned program. It is therefore advisable to meet with Senator Glenn and
other chairmen of jurisdiction before any decision is made public.
SENATOR BOB GRAHAM (D-FL) - Senator Graham wants to support the President and,
not surprisingly, is most concemed about long term care being included in the final package.
With Florida recently enacting health care legislation, he may be sensitive about state
flexibility. He is supportive of employer mandates and wants to be a player on global
budgets. However, he would be concemed if Florida were somehow adversely affected in
comparison to other states. His staff is working on the White House Long Term Care
Working Group. In previous meetings with the HCTF, he was worried about the role of the
Public Health System.
SENATOR TOM HARKIN (D-IA) - Senator Harkin has not sponsored any reform
legislation or backed any particular reform approach. He has focused instead on specific
issues that will need to be components of an overall plan. He has a strong interest in all raral
issues. He was recently named Co-Chair of the Senate Rural Health Care Coalition. Harkin
is a leading advocate in the Senate for anything related to people with disabilities. (He has a
brother who is deaf.) His sponsorship of the Americans with Disabilities Act is perhaps the
major achievement of his political career. Ensuring that the plan provides access to health
care, including long term care for people with disabilities, is a major concem.
Senator Harkin is especially interested in prevention; he sponsored a bill giving money to
states for preventive health programs. As a member of the Labor Committee and Chairman
of its Appropriations Subcommittee on Human Resources, he is a key player on public health
legislation and funding. Inclusion of preventive services in the benefit package will be key as
Senator Harkin opposes co-pays for these services.
10
�SENATOR HOWELL HEFLIN (D-AL) - Senator Heflin has been noncommittal,
preferring to wait for the plan and concrete numbers on how and where the money is spent
before taking a position. He appears to be open to the concept of reform but will need
education on the issue.
Recent Developments: Senator Heflin expressed concem about how health care reform
would be financed. He likely will also have strong reservations about medical malpractice
reform if it includes caps.
SENATOR ERNEST HOLLINGS (D-SC) - While Senator Hollings wants to support the
President's plan, he is worried about employer mandates without cost controls and raral
coverage. He is also concerned by the CBO testimony which stated when cost savings might
be realized under a managed competition plan. He steered clear of the leadership bill,
expressing interest instead for a Medicaid buy-in. He believes the only way to get enough
money for health care refonn is through a VAT. In meetings with Ira he has stated his hope
that the money will be in hand when the bill is ready and his support for a single vote on the
package.
SENATOR DANIEL INOUYE (D-HI) - According to Senator Rockefeller, Senator Inouye
is expected to be supportive of the President's plan. Specifically, the Senator will want to
continue the special exemption to retain Hawaii's cunent system. He is working with Senator
Akaka to secure a waiver through the House and Senate committees. He was a cosponsor of
HealthAmerica in the last Congress, and he is a cunent cosponsor of Senator Wellstone's
single payer bill. Senator Inouye is also Co-Chair of the Senate Committee on Indian Affairs
and may be watchful of changes to IHS.
SENATOR BENNETT JOHNSTON (D-LA) - Senator Johnston has been noncommittal on
health reform but wants to be a constructive player. He may defer to his Louisianan
colleague. Senator Breaux, who has shown increasing interest in health care reform. They
share concems on its impact on small business and raral areas. Johnston's major concem is
preventive care and he will be willing to compromise on other issues if this is made a high
priority in the package. While he is not opposed to managed competition he sees problems
with regional pricing. In discussions with the HCTF in the past, he has asked whether
everyone will be in the purchasing cooperative and whether doctors will be able to charge
higher fees outside of the package. Johnston is also concemed with thefinancingof the
health care package.
SENATOR EDWARD KENNEDY (D-MA) - Senator Kennedy, Chairman of the Labor and
Human Resources Committee, is the Senator most closely associated with health care issues.
He has been working on comprehensive health care reform issues for well over two decades.
11
�Although previously a strong single payer advocate, in recent years, Kennedy has moved to
employer-based approaches. He believes that using business to significantly underwrite the
cost of health care reform will substantially reduce the need for federal tax increases, and
therefore make the package more sellable to both the Congress and the American public.
He joined with Majority Leader Mitchell, Senator Rockefeller and Senator Riegle in
introducing a play or pay employer-based health care model. Despite the backing of these
Democratic leaders, it received surprisingly little rank-and-file support. Perhaps as a result
of this, Senator Kennedy has come to believe that only a plan backed by the President can be
enacted. For this reason, Kennedy will likely be open to any comprehensive reform approach
that meets the criteria of universal coverage, cost containment, and quality assurance.
He is also concemed about coverage for long term care. He introduced a substantial and
expensive ($45 billion a year when fully phased-in) long term care plan with Senator
Mitchell. This also gamered little support. Altematively, he worked with Senators Pryor,
Hatch, Packwood and Bentsen to pass a long term care insurance standards bill. That attempt
was blocked because it did not include the tax clarifications that the insurance industry
sought.
In addition to all these reform efforts, Senator Kennedy has been extremely active in the
public health service areas. His interests are broad ranging, including concems about tobacco
advertising, adequate funding of AIDS research and services. Head Start, extensive oversight
of FDA, effective illicit drag strategy, and minority health.
Recent Developments: Most recently, Kennedy has been pressing for primary or sole
jurisdiction over Health Care Reform. Howard, Steve and Chris met with Labor Committee
Staff Director Nick Littlefield last week. At that meeting he was informed that we
appreciated their suggestions but would defer to the Majority Leader on this highly
controversial issue. The Committee has also agreed to hold hearings that are consistent with
our message in early to mid-May. Specifically, they will focus on the cost of not doing
health care reform and the cost effectiveness of mental health coverage in the benefit package
(Mrs. Gore is scheduled to testify.). Lastly, Senator Kennedy will want to be significantly
consulted in the upcoming weeks. He had requested, and we have scheduled, a bipartisan
meeting for the First Lady with his committee for Tuesday, May 4.
SENATOR BOB KERREY (D-NE) - Senator Keney has displayed a keen interest in the
area of health care reform since first coming to the Senate. In his first year, he sat in on
deliberations of the Pepper Commission although he was not a member. He also made health
reform one of the centerpieces of his presidential bid.
In the last Congress, he introduced a comprehensive health reform bill which is actually quite
similar to theframeworkbeing developed by the Task Force. In the Keney bill, however,
except all businesses would be required to join state-run purchasing groups rather than
12
�privately-ran groups. At his last meeting with the First Lady on March 18, he was very
complimentary about Ira's presentation at the March 4 briefing for the Democratic Senators.
In a note to Senator Rockefeller, Keney wrote that he "likes what he is hearing out of the
White House."
He has made financing a primary focus and advocates creating a health care trast fund ran on
a pay as you go basis. Sources of financing for his bill include: a payroll tax on employers
and employees; cunent federal health spending except for Veterans (for whom he believes a
separate system must be maintained); new taxes on cigarettes and liquor, taxes on Social
Security benefits; and increasing income subject to tax as well as increasing the top rate. At
his last meeting with the First Lady he expressed interest in providing language to help sell
the plan.
Recent Developments: - Senator Keney has recently circulated a proposal in the Senate to
create a trast fund which would account for all health expenditures including the Federal
Employee Health Benefit Package and NIH. He suggests proposing appropriate taxes
designated for health care reform before the introduction of a comprehensive plan.
SENATOR JOHN KERRY (D-MA) - Senator Kerry has represented Massachusetts since
1984. He is best known for his involvement with the POW/MIA issue. While not a major
player on health policy in the Senate, Kerry does have some significant health views. He
favors a managed competition approach to reform and wants to support the President.
Administrative simplification and insurance reform are of particular interest to him. Kerry
wants to protect the biomedical and biotechnology industry, which is a growth sector in
Massachusetts. Senator Kerry is a Vietnam veteran and may be sensitive to major changes in
the VA. He wams that expectations are high and urges regular meetings with Senators.
Recent Developments: In Jamestown, Senator Kerry expressed concem about the adverse
impact of managed competition on teaching hospitals.
SENATOR HERBERT KOHL (D-WD - Senator Rockefeller believes Senator Kohl will
likely support the President. Senator Kohl is one of the wealthiest members of the Senate
and spent freely of his own money to win this seat. Using the slogan "Nobody's Senator But
Yours," Kohl tried to portray himself in a positive light as a candidate not beholden to special
interests. He is up for re-election in 1994. He does not support single payer and has not
taken a position on managed competition. He is comfortable with employer mandates if
coupled with adequate subsidies. Insurance companies are the second largest employer in
Wisconsin, which may be a concem for him. He is a member of the Mitchell working group
and members of his staff are participating on the HCTF working groups.
13
�SENATOR BOB KRUEGER - Senator Kraeger is fighting for his political life trying to
hold onto Secretary Bentsen's former Senate seat to which he was appointed. He recognizes
the importance of the issue, but is preoccupied with his election May 1.
Recent Developments: Mrs. Gore is going to Texas for a campaign event on April 30.
SENATOR FRANK LAUTENBERG (D-NJ) - Senator Lautenberg is very concemed that
health reform will hit two big industries in New Jersey: pharmaceuticals and insurance
companies. This coupled with the fact that he is up for re-election in 1994 means he is
skittish on certain aspects of the plans. Govemor Florio's re-election effort in 1993 may also
influence Senator Lautenberg's vote. He was pushed by Senator Daschle on single payer; he
resisted saying he was in the managed competition mode. While nervous about employee
mandates, Lautenberg wants to be part of the whole team and believes he can serve as a
liaison with the business community. Lautenberg's other concems include transportation
services to help provide access to health care in raral areas and the overase of technology.
Recent Developments: Senator Lautenberg used the opportunity of the retreat in Jamestown
to ask that the Administration tone down its anti-drag company rhetoric.
SENATOR PATRICK LEAHY (D-VT) - Senator Leahy is Chainnan of Agriculture
Committee. As such, he notes that one-quarter of all Americans live in raral areas and
provisions need to be made to ensure that they have access to needed health care services.
He was one of the few cosponsors of the Leadership's HealthAmerica bill and is likely to
support the Administration's plan. Leahy will want to see provisions in the legislation for
state flexibility so that they can move ahead now. In the last Congress he sponsored the
Lcahy-Payor bill, legislation endorsed by the NGA, to provide waivers to states willing to
undertake comprehensive health care reform.
Recent Developments: Senator Leahy was recently upset about a ramor that the
Administration was going to name the provision on state flexibility in the reform legislation
for his Republican Senate colleague from Vermont, Jim Jeffords. In conversations with the
Senator's office, Chris Jennings reassured his staff that there was no trath to this ramor and
that we appreciated and understood the Senator's longstanding interest in and leadership on
this issue. He is very interested in holding an event in Vermont, perhaps highlighting the
flexibility issue, and would like to work with us on it. He reiterated his strong support for
state flexibility in Jamestown. Lastly, in june, there will a Democratic Govemors Association
meeting which Leahy will likely attend. He and Govemor Dean may ask the First Lady to
attend also.
14
�SENATOR CARL LEVIN (D-MI) - Senator Cari Levin has served Michigan since 1978.
His brother, Sander, is a Member of the House of Representatives, where he sits on the Ways
and Means Committee. Along with Senator Riegle, they are protective of Michigan's auto
industry, unions, and the unions' retirees. Senator Levin is concemed about cost control and
particularly about the President's plan having sufficient cost control mechanisms (a chief
concern of organized labor and the large industrial manufacturers of his state). He want
states to haveflexibilityto design and implement their own cost control measures. Senator
Levin is also worried that a tax cap will be a benefits reduction (another union concem). He
has also wanted to know how many people will have greater benefits than minimum benefits.
Senator Levin also has raral and small business concems. The Senator supports inclusion of
good primary, preventive, hospice and home care services in the reform package. A
cosponsor of HealthAmerica in the 102nd Congress, Senator Levin favors managed
competition and is on record as wanting to support the Administration's plan.
Recent Developments: In Jamestown, Levin wonied about having two big tax votes in one
year. He also expressed concern about reduction in benefits for those who cunently have
good benefits (i.e. unions).
SENATOR JOSEPH LIEBERMAN (D-CT) - Senator Liebennan is in hisfirstterm and is
up for re-election in 1994. Generally, he is supportive of managed competition (he liked the
Cooper Bill), but has a real problem with global budgets and caps. He believes, however,
that the plan needs to have significant cost containment.
The Senator believes that before the plan is announced, the White House should have a
process to hear people's concems. He also thinks that it is critical to educate the public so
people understand the problems with our health system, and what solutions are necessary.
He's very concemed we may lose the middle class because of a big new tax. He is
encouraged by what he has heard about the Administration's proposal, but has a wait and see
attitude.
Recent Developments: Senator Lieberman felt more comfortable about the process after the
First Lady's presentation at Jamestown. Interestingly, he raised small business much more
than insurance industry concems. He feels that if the middle class gets more benefits they
will be willing to pay for reform.
SENATOR HARLAN MATHEWS (D-TN) - Senator Mathews was appointed to fill the
term of Vice President Gore. He is not interested in returning to the Senate, and will serve
until Tennesseans elect a new Senator to fill the Vice President's term. Mathews is generally
supportive of the managed competition concept. While he has not backed the
Administration's reform efforts publicly, Mathews is supportive with some modifications. He
would like to see more action on the state level, especially experimental programs. Vice
President Gore will be influential in getting his vote.
15
�Recent Development; At Jamestown, Senator Mathews was worried that sin taxes and
payroll taxes would kill the tobacco industry.
SENATOR HOWARD METZENBAUM (D-OH) - Senator Metzenbaum strongly believes
in the need for health care reform and has cosponsored Senator Wellstone's single payer bill.
He is concemed about the managed competition approach because he fears that it is too easy
on the special interests, especially the insurance companies. He believes to traly reform the
health care system, the Administration must be willing to take on and defeat the special
interests and take the program to the American people. He views health care as a social good
that should be provided to all people and believes the system should be based on providing
services to people at the lowest possible cost. Metzenbaum strongly favors rate setting and a
national budget.
Senator Metzenbaum also favors eliminating fraud and abuse in the system. He has major
criticisms of HCFA for not fencting out fraud and abuse. Other concems are anti-trast (he
chairs the Judiciary subcommittee), malpractice reform and long term care.
Recent Developments: Senator Metzenbaum's staff has indicated a great concem about the
apparent Administration infatuation with caps for medical malpractice. He is strongly
opposed to caps and might even oppose the legislation if they are included at the time of
introduction. He has also expressed concem that quality standards may be vulnerable to the
Administration's decision to cut back on what we view as unnecessary regulation and he
would like us to proceed cautiously in this area.
SENATOR BARBARA MIKULSKI (D-MD) - Senator Mikulski is known as an outspoken
liberal. She supports the Clinton health care reform plan in principle but is concemed about
the influence of the Jackson Hole group who she calls "a bunch of geriatric Republicans that
represent everything that's wrong with health care." As a former social worker she would like
to see greater use of non-physician health professionals to deliver care.
She is a champion of women's health and an strong pro-choice advocate. The plan's position
on women's reproductive health services will be critical. She is concemed about improving
research into women's health and eliminating the gender bias of NIH research. She is also a
strong advocate for seniors. She introduced and passed the Spousal Impoverishment
provisions in 1988 so that seniors did not have to spend down all of their assets to qualify for
benefits. As the new Chair of the Labor Subcommittee on Aging, she is promoting the
expansion of home and community-based long term care services.
On the Appropriations Committee, she heads the HUD/VA and Independent Agencies
Subcommittee. VA, the largest managed health care system, is a big concem for Mikulski.
She cites the Canadian experience where under the massive change to a single payer system,
vets lost out. She feels strongly that vets need a seat at the reform table.
16
�Recent Developments: At the Senate retreat, Senator Mikulski stressed talking the people's
language on health care reform and asked for a mechanism to assure this happens. She also
said that the Democratic women Senators would lead the floor fight for reproductive health
benefits in the package.
SENATOR GEORGE MITCHELL (D-ME) - Few Majority Leaders in the Senate's history
have been as interested in and as committed to passing comprehensive health care reforms.
Senator Mitchell believes that the single payer approach is not politically feasible. However,
at this point, his primary concem and commitment is to push through anything, which can be
defined as traly comprehensive, that will pass the Congress. He has repeatedly indicated his
intention to work closely with the President to help assure that a bill can make it to the White
House before the end of the 103rd Congress.
Senator Mitchell was a strong advocate of incorporating the health care legislation into the
budget reconciliation bill. Having failed in that, he and his lead staff are now relatively
pessimistic about attracting enough Republicans to support a health care reform initiative
without having to make major, and perhaps unacceptable, concessions. Two weeks ago
(Sunday, April 18), he indicated his opposition to price controls, his uneasiness with but
possible openness to a VAT tax for health, and his desire to wean out all the fraud, abuse and
waste BEFORE contemplating large tax hikes.
Recent Developments: He was so enthused about the First Lady's presentation in Jamestown
and the meeting at the White House on Tuesday, April 27, that he invited the First Lady to
Friday's bipartisan meeting which is open to all Senators. Mitchell seems rededicatcd to
passing health care reform this year.
SENATOR CAROL MOSELEY-BRAUN (D-IL) - Senator Moseley-Braun is one of the
freshman members of the Senate. She is a single payer advocate, and is somewhat skeptical
of the managed competition model. The Senator believes that there should be one entity
collecting revenues for the health care system, and that health care insurance providers
unnecessarily duplicate services.
The Senator is particularly interested in financing mechanisms, and would have supported
Senator Wellstone's American Health Security Act, introduced March 3, save for her
reservations over his approach to funding. She is concemed by public reports of the proposed
sin tax, which she feels will not be sufficient tofinancehealth care reform. If a sin tax is not
sufficient, and given the tax increases in the President's economic proposal, the Senator is
curious about what other mechanisms the Health Care Task Force is considering for revenue.
Senator Moseley-Braun is also interested in the composition and mechanism for creating a
basic package of services. She is interested in seeing an increase in resources and focus on
primary and preventive care. She would like to make sure that long term care is part of the
17
�reform package, and was a little concemed about signals sent during the meeting with the
Congressional Black Caucus on this issue.
The Senator also feels that if managed competition is chosen as the avenue to health care
reform, a mechanism should be put in place to insure that health insurance provider
cooperatives have an incentive to serve consumers in urban andraralpoverty areas.
Additionally, the Senator is interested in a slow phase-in of veterans into an overall health
reform package.
Recent Developments: At the meeting with Democratic women Senators at Jamestown,
Moseley voiced her support for the inclusion of reproductive services in thefinalpackage.
SENATOR DANIEL PATRICK MOYNIHAN (D-NY) - As you know, the new Finance
Committee Chairman has yet to take a position on national health care reform. His interests
lie primarily in the areas of Social Security and welfare reform. He is not a detail person
when it comes to the health care debate. Although a number of people have discussed health
care with him, it is notable that the one who seemed to catch his fancy the most was Alain
Enthoven.
The only health care-specific issues that the Senator is particularly known for are: his
advocacy and support of New York hospitals; his concem about the mentally ill and the
homeless; his support for chemical and substance abuse in a benefit package; and, most
recently, his support of innovation at the state level. On the latter point, he introduced a
liberalized Medicaid managed care measure that the NGA strongly supported. (This
legislation was opposed by the Children's Defense Fund because they felt that savings through
this cost containment approach would be at the expense of the Medicaid population.)
Recently, the Chairman and his staff have been rather pessimistic about the chances for health
care reform this year. The complexity, controversy, and potential expense of itfrightenthem.
The Chairman, in comments that have been somewhat retracted by staff, has indicated his
concem about any large new taxes to fund the program and any use of price controls to
contain costs. Although he has stated his willingness to raise whatever tax is necessary for
the elimination and integration of Medicaid into the new system, as well as for a one-cardfor-all system, his nervous statements should not be totally written off.
Recent Developments: At the First Lady's meeting this week with the Senate Finance
Committee, Moynihan was among those who cautioned againstrashinghealth care reform.
He expressed the view that the Administration should take more time if needed to do it right.
In Jamestown, he advocated combining the Health Card with the Social Security Card, a view
he reiterated in a letter to the President. We trast the First Lady's dinner with Senator
Moynihan and his wife on Tuesday went very well.
18
�SENATOR PATTY MURRAY (D-WA) - Senator Munay was a state senator in
Washington before being elected to the U.S. Senate this past fall. She serves on the Budget,
Appropriations and Banking Committees. As a former state legislator. Senator Munay will
be highly sensitive to ensuring state flexibility, especially in light of the Washington State
legislative health care initiative. Although she has not taken a public position on a particular
health plan, she has indicated she will likely support the President as long as the plan extends
coverage and allows for state irmovation.
Senator Munay is an advocate for women's health, including extreme concern about breast
cancer and screenings. She also strongly backs long term care as part of reform. She is very
concemed about eliminating pre-existing condition exclusions. Senator Munay will soon
introduce legislation (similar to Congressman Reynolds' bill) designed to raise the excise tax
on firearms and earmark the revenue for health care.
Recent Developments: At Jamestown, Senator Munay advocated including reproductive
rights in the final package.
SENATOR SAM NUNN (D-GA) - Senator Nunn is known more for his Armed Services
Committee work than for health care. Treatment of CHAMPUS and other Department of
Defense health programs under the reform plan will be a major concern. Senator Nunn hasn't
taken a position on a type of plan. However, he is extremely opposed to employer mandates.
In fact, the Senator states that President Clinton has assured him the plan will not include
employer mandates. He is strongly in favor of tight entitlement caps. He is unsure how a
global budget will work on private spending. As a Senator from Georgia, he also has strong
raral health concems.
Recent Developments: Senator Nunn co-chairs a commission which will soon be making
recommendations on health care reform. Reports are that they are leaning towards a managed
competition type approach with an individual mandate. This sounds like the Republican plan
on which we believe Senator Chafee is working. It is unlikely that they will support even
temporary price controls. It is unclear whether they will endorse the concept of universality.
SENATOR CLAIBORNE PELL (D-RI) - Senator Pell is the most senior member of the
Senate Labor and Human Resources Committee and a long-time advocate of "cradle to
grave" health coverage. On health care reform, he is not an ideologue and is not committed
to any method of reform. In 1972, he joined in introducing legislation which would have
mandated employer-based health care reform. As a member who has been working on the
issue for sometime, he would enjoy seeing actual progress.
Because of his well-to-do elderly constituency. Senator Pell voted to repeal the Catastrophic
Health Care Reform legislation. This is significant because it may indicate that a prescription
drag benefit that most well-to-do elderly already have will not be adequately responsive to
19
�an influential constituency of his. This helps explain why Senator Pell's top health care
concems include coverage for long term care - Rhode Island has one of the highest
percentages of elderly of any state in the country - preventive services and expanding the
use of non-physician health provider. He is opposed to smoking and has sponsored
legislation to provide grants to states for health promotion programs. He is also interested in
studying other countries' health care systems and taking lessons from their experiences.
SENATOR DAVID PRYOR (D-AR) - Senator Pryor is part of the Senate leadership
(Secretary of the Democratic Conference). As the Chairman of the Senate Special Committee
on Aging, he is well liked and respected by the powerful aging advocacy community. In
addition, he is one of the few Democrats that the small business community genuinely trasts.
Further, as a former Govemor his advocacy of state-based approaches to comprehensive
reform has gained him a great deal of good will with the Govemors. Although an
unassuming member and one who does not get overly involved in detailed policy discussions,
he has emerged as one of the most influential and best liked members of the Senate. All of
these roles ensure that he will be a key player on the health care front.
In terms of health care priorities, drag cost containment is the first, second, and third highest
priority for Senator Pryor. The concept of linking drag cost containment to tax credits embodied in Pryor's Prescription Drag Cost Containment Act S. 2000) was endorsed by President Clinton.
In addition to his drag cost containment interests, Pryor also has a notable legislative
achievement record in raral health (relief for hospitals and incentives for primary care doctors
in medically underserved areas), state-based reform (his NGA and Clinton candidateendorsed Leahy/Pryor bill), and long term care (his proposal for Federal standards for private
long term care insurance policies).
Recent Developments: At the Finance Committee meeting April 20, Senator Pryor supported
the view that more time should be taken to assure that you do it right. He backs the use of a
dedicated tax for health care, perhaps a VAT. He also supports the inclusion of a significant
long term care benefit. He believes that as long as we will be spending billions of dollars,
we should make certain it attracts popular support for the plan. Of the Finance Committee
Republicans, he would rank Danforth, Packwood, Chafee, Durenberger in order of likelihood
to support the plan.
SENATOR HARRY REID (D-NV) - Senator Reid is in his second term in the United
States Senate. Traditionally not outspoken on health issues, he spends most of his time with
his Appropriations and Environment and Public Works Committees. He has yet to take a
position on a particular reform model. He is waiting to see what the HCTF and the President
have developed. The Senator stresses raral health issues, and wants lead screening
emphasized. He's concemed about mandated benefit packages because he believes they have
20
�not worked at the state level. He is also wonied about the impact of reform on physicians'
eamings.
SENATOR DONALD RIEGLE (D-MI) - Senator Riegle considers himself to be a major
player in the health care debate. He is Chairman of the Finance Subcommittee on Medicaid
and was a lead sponsor of the Mitchell, Rockefeller, Kennedy "play or pay" health care
refonn proposal. He has always felt he did not get adequate credit for his work on the bill.
Although he sponsored this bill, he appears to be extremely willing to sign on to virtually any
approach that achieves universal coverage and cost containment.
Senator Riegle is very interested in many health issues, including: child immunization
programs; raral health care; Medicare prescription drag coverage; retiree health liability
conccms; long term care; and a host of others. He strongly believes that cost containment
savings should be used to help reform the health care system — NOT for deficit reduction.
Recent Developments: At the April 20 meeting with the Finance Committee he stated that
he wanted to look at longer budget periods than five years (he can't understand why we are
always locked into a five year budget plan). He believes it is important to look at national
spending, not just Federal spending, because most of the savings will come from the private
sector. He also felt that we needed to look at and change the language used to explain the
plan.
SENATOR CHUCK ROBB (D-VA) - Senator Robb believes that cost-containment is the
key and that it should be stringent. He has not taken a position on any particular health plan,
but likes what he hears so far from the Task Force. He is likely to be supportive. He was an
active member of the Mitchell working group and was comfortable with its overall approach.
Also, he was a member of the National Leadership Commission on Health Care which
predated the National Leadership Coalition. Senator Robb is up for re-election in 1994.
Recent Developments: At the Senate retreat, the Senator was concemed about taxes needed
tofinancereform, especially sin taxes.
SENATOR JAY ROCKEFELLER (D-WV) - Senator Rockefeller views himself as being and is - Bill Clinton's number one health care advocate. He was a tireless campaigner and
defender of the Clinton health care plan and was a National Co-Chair of the Clinton
campaign. Senator Rockefeller is the cunent Chairman of the Finance Subcommittee on
Medicare and Long Term Care and is the new chair of the Senate Veterans Committee. He
also has chaired the Pepper Commission and the National Commission on Children. In
addition, Senator Rockefeller is the founder and Chairman of the Alliance for Health Reform,
a nonpartisan organization dedicated to advancing health care reform through education of
public opinion leaders.
21
�Senator Rockefeller's health care priority is very simple: He desperately wants to see a
comprehensive reform package enacted during the Clinton Presidency. Although he thinks
the long-term outcome of such an achievement is politically attractive, he is primarily
pushing this because he is sincerely committed to the need for reform. In this vein, he is not
overly committed to any particular approach although he has advocated an employer-based
approach. He, therefore, can be counted on to support virtually anything the President ends
up proposing, zis long as it achieves universal access and cost containment.
Recent Developments: At his one-on-one meeting with the First Lady he was upset with
Vice President Gore, Secretary Bentsen, and Director Panetta who he thinks are less than
supportive of reform. He thinks Senator Moynihan can be brought on board. He urged using
the phone more to increase contact with members. He felt that the Finance Committee
Republicans that we should go after are Senators Chafee, Danforth and Durenberger (he
seemed less confident about Senator Packwood). He also expressed his willingness to play
the heavy on taxes with the public, press, and members.
SENATOR PAUL SARBANES (D-MD) - Senator Sarbanes is in his third term and is up
for re-election in 1994. He originally supported Kennedy's Single Payer plan in 1972, but
realizes it won't work today. Cunently, he is not committed to a specific approach and is
open to different options. He has a wait and see attitude on the HCTF deliberations, but he
wants to help Clinton and will support Mitchell, Rockefeller and the Democratic Leadership.
Recent Developments: In Jamestown, Senator Sarbanes expressed interest in knowing who
would be hurt by health care reform — what industries, what individuals. Because of his
position as Vice-Chair of the Joint Economic Committee, these questions were not surprising.
SENATOR JIM SASSER (D-TN) - Senator Sasser is one of the more popular, populist,
and liberal southem Democrats in the Senate. He and his staff have been very supportive of
attempting to develop consensus on health care reform for years. But, like others, he never
could find the dollars or support for a significant package. As a result, he has focused on
more incremental and populist reforms. He is most proud of his three year battle to pass
legislation to reform and clean up thefraudand abuse in the durable medical equipment
industry. He introduced and passed legislation within last year's tax bill (later vetoed by
then-President Bush) to place restrictions on how the industry could bill Medicare for this
equipment. In addition, he was one of Senator Pryor's strongest allies in the Senate when he
tried to take on the pharmaceutical industry pricing behaviors and their abuse of an offshore
tax credit.
SENATOR RICHARD SHELBY (D-AL) - As you know, the media has made much of the
rift between Senator Shelby and the White House. He is a conservative Democrat whose vote
is considered tough to get. While he has said that he is waiting to see what the President
22
�puts forth he has expressed some clear views regarding health care reform. He opposes
"single payer" or any other "top-down" system. He believes there needs to be local control
and decision making. He is anti-employer mandates, anti-rate setting, and has significant
small business concems. Some self-insured people have used managed care very well in
Alabama.
Recent Developments: Last month. Senator Shelby sent a "Dear Colleague" asking for
cosponsors for his resolution expressing "sense of the Congress that any National Health Care
reform legislation must ensure that every person covered under the plan has access to
coverage for medically and psychologically necessary treatments for mental disorders. Such
access should be equitable to coverage provided to treatments for physical illnesses."
SENATOR PAUL SIMON (D-IL) - Senator Simon is very interested in health care reform,
and leans toward a single payer approach but also cosponsored the Leadership's
HealthAmerica bill. He is close to organized labor and sponsored amendments to strengthen
the cost containment provisions of HealthAmerica proposed by the AFL-CIO. He has also
been one of the Senate's strongest advocates for long term care and has cosponsored many
bills in this area. He is very interested in children's and minority issues. He has a long
standing interest in education, particularly higher education. He is a strong supporter of
increasing emollment of minorities in health professional schools.
Recent Developments: Senator Simon recently met with Robyn Stone and reiterated his avid
support of a significant long term care plan. He cites his Senate campaign in which he
advocated comprehensive long term care legislation which outlined specific tax mechanisms.
This plan received a great deal of support in the state, so much so that his opponent, thenSecretary Lynn Martin, pulled ads attacking the tax because they were so negatively received
by the electorate.
SENATOR PAUL WELLSTONE (D-MN) - Senator Wellstone is very interested in health
care reform. In March, he reintroduced his single payer bill, the Senate counterpart of the
McDermott bill. Despite his strong bias toward single payer and his suspicions of managed
competition, he has expressed a willingness to work with you. His strong desire for reform
and his belief that we must act now make him likely to support the Administration plan. He
has a strong interest in mental health and substance abuse benefits. He modified his previous
bill to strengthen its mental health provisions. Other concems include raral health, consumer
choice and state flexibility (so that Minnesota might pursue a single payer option).
Recent Developments: Senator Wellstone indicated concem regarding talking points
distributed by the Task Force to the members of Congress, particularly how single payer was
characterized. At the retreat, he stated that he doesn't want anyone to be able to opt out of
the Purchasing Cooperative because he fears that healthy people will opt out. He asked for a
meeting with fra. Ira will conduct a telephone meeting on Friday and then determine if a
23
�one-on-one discussion is necessary.
SENATOR HARRIS WOFFORD (D-PA) - Since his Senate race victory, which was
widely attributed to his support of health care reform. Senator Wofford has actively pursued
this issue in the Senate. He is part of the group of five (with Senators Daschle, Baucus,
Keney and Bingaman) on a singlefinancingstate-implemented health system with a national
health board approving state plans. Employers and individuals would pay a progressive
premium to a fiind which would be returned to the states on a percentage basis. The original
Daschle-Wofford bill was called the American Health Security Act, partially because
Wofford believes so strongly in the importance of the success of the Social Security system.
He believes that his proposal took into account a middle road between the single payer and
managed competition crowds. He believes everyone should be required to participate in the
Health Alliances (no opt-outs), that the program must be state or regionally administered, and
that long term care coverage is essential. He has previously expressed concem over what he
felt was the lack of discussion by the Administration of long term care in connection with
reform.
He is working with the Democratic Policy Committee health working group and is looking at
the health insurance purchasing cooperatives and how they could work. He is very
intellectual and savvy about how difficult some of the concepts are for the public to
comprehend. For example, he dislikes intensely the term "global budget," believing that it is
too large to understand and turns people off. He believes that President Clinton and
Congress must do a lot of educating on health care reform.
Recent Developments: It has been more and more clear to the Senator that his election is
tied to Health Care Reform. He will be very helpful. Language used to describe and sell the
plan is very important to him. He is very appreciative that the First Lady attended his foram
in Harrisburg earlier this year. At the Senate retreat. Senator Wofford stated his support for
short term cost controls. He believes that abortion should be out of health reform and does
not want the federal govemment overriding state abortion restrictions.
24
�PROFILES - SENATE REPUBLICANS
April 29, 1993
SENATOR ROBERT F. BENNETT (R-VT) - Senator Robert F. Bennett of Utah at 59 is
the oldest member of the Senate'sfreshmanclass, and enters having made a fortune in private
industry. He cunently serves on the Committee on Energy and Natural Resources, the
Committee on Banking, Housing, and Urban Affairs, the Committee on Small Business, and
the Joint Economic Committee.
Senator Bennett has co-sponsored no legislation with significant health policy implications.
CHRISTOPHER "KIT" BOND (R-MO) - The junior SenatorfromMissouri recently won
hisfirstre-election campaign, and is ready to continue his spirited partisanship. A former
chair of the Republican Govemors Association, Senator Bond has opposed a number of
relatively popular initiatives, such as the Americans With Disabilities Act and the 1990 Civil
Rights Act. Senator Bond cunently serves on four business and money related committees:
the Banking Committee, the Appropriations Committee, the Budget Committee, and the
Committee on Small Business.
In the 102d Congress, Senator Bond co-sponsored a Republican health care initiative that
sought a $150 billion solution to the lack of universal coverage, and when asked whether he
was submitting the bill over Bush Administration objections said, "[Sununu] is not driving our
bus." [im:, 11/8/91]
Senator Bond recently introduced an administrative reform bill addressing the high cost of
health care administration, and which also excludes the increased costs or cancellation for
sickness, saying "the loss of insurance coverage when a child becomes very ill is not
risk-sharing, it'srisk-avoidance.The broad health care reform is vital. It is a very, very
complex problem, but there are certain, I think, readily agreed upon steps that we ought to
take. I don't expect that we're going to get health care reform solved within the first 100
days. I think we can take some very significant steps, and I hope we will." [FNS. 1/4/93]
Senator Bond was a leader of the eight Republican co-sponsors of the Family and Medical
Leave Act, and also co-sponsored Senator Dole's recent bill on Medicare (S. 176), which
revises Medicareraleswith respect to raral and community hospitals and payment for new
providers. If a moderate Republican bloc forms to negotiate with the Democrats on health
reform as it did on Family and Medical Leave, Bond could be key.
SENATOR HANK BROWN (R-CO) - Senator Brown was elected in 1990 to the United
States Senate. He previously was a member of the House, where he served as a member of
the Ways and Means committee. Generally moderate with some liberal votes. Brown has
worked to protect Colorado's environment and is pro-choice. He railed against the 1987-88
Democratic Welfare Reform, and persuaded the House to endorse instead the workfare
�measure that became law. He also was on the ethics committee that investigated fonner
Speaker Wright. In the House he sponsored a tough campaignfinancereform.
SENATOR CONRAD BURNS (R-MT) - Senator Bums is Montana's junior Senator. The
best description of him appeared in the 1992 edition of The Almanac of American Politics:
"Bums...is almost a stereotypical Easterners' version of a westem politician. He picks his
teeth with a pocketknife, chews tobacco, and tells deadpan jokes." Bums came to the Senate
in 1988, defeating incumbent John Melcher.
Senator Bums is a quiet Senator with a conservative voting record. Although he is on the
Republican Health Care Task Force and on Pryor's Aging committee, he is not very
outspoken on health issues. He is a cosponsor of Senator Kassebaum's BasiClare Health
Reform Bill and is interested in meeting with you next week. He is particularly supportive of
the bill's raral health provisions.
SENATOR JOHN CHAFEE (R-RI) - Senator Chafee is the Ranking Republican on the
Finance Committees Medicaid Subcommittee and
Chair of the Republican Task Force
on Health Care. He likes to point out that the bill they introduced in the last Congress had
the most cosponsors of any major comprehensive health reform bill. He was not pleased with
last year's health care debate with the Democrats. He believes that, if not for Presidential and
partisan politics, there was enough consensus between his and many Democrats' bills to move
forward on many high priority health reform proposals such as: self-employed tax deduction
increase to 100 percent, insurance market reform, expansion of community health centers and
other health care delivery systems, and state experimentation.
On the Finance Committee, Senator Chafee is primarily known for his long-standing interest
in providing altemative care settings — through the Medicaid program — to persons who are
disabled. He and his staff are literally heroes with many in this field, particularly those who
advocate non-institutional care approaches. He is also well known for his strong advocacy
of, and relationship with, community health care centers. In addition, he — like a number of
the Finance Committee membership — are growing weary of funding programs for the
elderly when there are so many needs in the non-elderly population.
As you know, we have been trying for weeks to invite Senator Chafee to talk with Ira. We
sense that he and his staff want desperately to come in, but are afraid to alienate Dole. On
April 16th, though. Task Force staff received a call indicating that he might come for a
meeting. A meeting has now been scheduled for next week.
Recent Developments: Chafee's office has tentatively scheduled a 5/6 appointment with fra.
At that time we think it would be appropriate and advisable for you to drop by or have him
drop by immediately following that discussion.
�SENATOR DAN COATS (R-IN) - Senator Dan Coats is more conservative across a wide
spectram of social issues than almost any other member of the committee. He is strongly
opposed to abortion. He is the author of several amendments to require parental consent in
the case of abortion for minors (one of which passed the Senate).
On the other hand. Coats, the ranking member on the Children and Families subcommittee,
has been a fairly strong advocate for child welfare and has broken with the Republican party
to these ends. He is viewed to have something of a pragmatic streak on certain issues and is
not afraid to differ with his party on these issues. He supported the Family and Medical
Leave Act and extending tax credits for families with children. He has been supportive of
Senator Dodd in his efforts and is more of an enabling ranking member rather than an
obstracting one.
SENATOR THAD COCHRAN (R-MS) - Senator Thad Cochran, Republican from
Mississippi was elected to the Senate in 1978, and has had relatively easy bids for re-election
since then. He is up for re-election in 1996. He won his bid for the chairmanship of the
Senate Republican Conference in 1990, when he challenged Senator Chafee for the position
and won 22 to 21. His conservative stand on almost all issues and chairmanship of the
conference reflects his Republican leadership role in the Senate. He sits on the Committee on
Governmental Affairs; the Committee on Appropriations; the Committee on Agriculture,
Nutrition, and Forestry; the Select Committee on Indian Affairs; and the Committee on Rules
and Administration.
Earlier this year, Senator Cochran said, "[I]t needs to be understood that the Republican
contribution on the health care issue discussion indicated a willingness to work together, and
an acknowledgement that this is one of the most serious problems we face in the country
today, and that it ought to be given a very high priority. So I don't think we ought to
misunderstand what the commitment is. And the commitment is to try to work in a bipartisan
way to solve these problems that exist in the health care area, acknowledging that they're
complicated, multifaceted." [Reuter Transcript Report, 1/26/93]
Recent Development: Recently he sided with Senator Reid in an attempt to eliminate the
Senate Select Committee on Aging. The attempt failed and strained the previously cordial
relationship between Cochran and Senator Pryor.
SENATOR WILLIAM "BILL" COHEN (R-ME) - Senator Bill Cohen from Maine was
elected to the Senate in 1978, winning against Senator Hathaway by a large margin. His
platform then focused on military strength, and that won him a seat on the Senate Armed
Services Committee. He is cunently on the Senate Committee on the Judician.'; the Senate
Committee on Governmental Affairs; the Senate Committee on Armed Services; the Senate
Special Committee on Aging; and the Joint Committee on the Organization of Congress. He
is considered to be an unpredictable and at times a liberal Republican, whose home state
�priorities often override partisan votes.
Last session. Senator Cohen worked on a health care package which included a refundable tax
credit for health insurance premiums and a nationwide low-cost basic benefits package.
On January 27, 1993, Senator Cohen submitted S. 223, the Access to Affordable Health Care
Act, a bill to contain health care costs and increase access to affordable health care, and for
other purposes. The bill uses a managed competition model for reform. It also has
provisions to improve health delivery in raral and underserved areas, reform malpractice,
controls drag costs and emphasizes preventive health. Senator Cohen also co-sponsored
Senator Mitchell's Freedom of Choice Act.
Senator Cohen is one of the ten Republican Senators it looks like we have a possibility of
getting at the present time. He also requested that you attend an event in Maine at the same
time you were in Nebraska with Senator Keney. You may wish to extend your regrets.
Doing something in Maine which does not heavily involve Senator Mitchell is not
recommended. An underlying rivalry exists between Sens. Mitchell and Cohen.
SENATOR PAUL COVERDELL (R-GA) - Senator Coverdell won a ran-off election
against Sen. Wyche Fowler in December. He headed the Peace Corps under President Bush
and formerly chaired the Georgia Republican Party. His strength is in the raral areas, and
conservative areas of Southem Georgia. Known as a conservative, it is unlikely that Senator
Coverdell will vote against the Republican leadership this early in his first term.
No significant health views are known at this time.
SENATOR LARRY CRAIG (R-ID) - After ten years in the House, Senator Larry Craig
won his bid for Senate in 1990, filling the open Senate seat vacated by the retiring Senator
McLure in 1990. As Idaho's junior senator, he believes strongly in economic development
and is opposed to environmental restrictions and govemment regulations. He cunently sits on
the Senate Committee on Energy and Natural Resources; the Senate Committee on
Agriculture, Nutrition, and Forestry; the Senate Special Committee on Aging; and the Joint
Committee on Aging.
Senator Craig co-sponsored Senator McCain's Medicare Provider Payment Equity Act of
1993, which is designed to amend the Social Security Act to repeal the reduced Medicare
payment provision for new providers. He also co-sponsored Senator Dole's recent bill on
Medicare (S. 176).
�SENATOR ALFONSE D'AMATO (R-NY) - Senator D'Amato is New York's junior
Senator and a product of the political machine of Nassau County's Republican Party. In the
Senate, he has maintained a machine politician's attention to local concems and constituent
services. D'Amato has a good working relationship with his colleague form New York,
Senator Moynihan. He plays the role of "Senator Pothole" to Moynihan's more statesmanlike role.
Having won the seat initially in a three-way race, he often been high on Democratic target
lists. Yet he has proved to be an elusive target. Last fall, he was reelected easily to a third
term over New York Attorney General Bob Abrams, after beating ethics charges back in
1991. For all these reasons, Senator D'Amato has eamed a reputation as a scrapper with an
instinct for survival — a reputation which he cultivates at every opportunity.
D'Amato is expected to be cool to the Administration's health care proposal. It is theorized
that he will be mainly interested in the impact on his large urban medical centers and
hospitals, the financial burden on his middle class suburban constituents and increases in
benefits for the elderly.
SENATOR JOHN DANFORTH (R-MO) - Senator Danforth, senior senator from Missouri
recently announced his plans not to ran for reelection in 1994. Within the Republican Party,
Senator Danforth is to cost containment what Bob Packwood is to mandates. He is the
Republican Senator most likely to advocate that strong federal/state caps on spending must be
imposed to effectively contain health care costs. He states his strong views on this issue
repeatedly, despite admonitions from his staff and other Republicans that such statements are
not consistent with the Republican Party line.
He is one of two cosponsors of Sen. Kassebaum's BasicCare Health Access and Cost Control
Act. At the press conference announcing the introduction of the bill, Sen. Danforth again
focused on cost control noting, "the easiest thing to do is to introduce a bill that provides for
universal coverage. The hardest thing to do is to provide for cost control." [FNS. 2/4/93]
Although willing to support the need for strong govemment cost regulation, he also believes
that to do so would require explicit rationing (He is a big fan of the Oregon waiver). What is
more, unlike most Democrats, he desires to publicly proclaim that rationing is necessary and
something we must own up to.
The Senator has been vocal lately opposing the possibility of new taxes for health care
reform, saying, according to The New York Times, "it would be 'extremely difficult' for
Congress to pass new taxes for health care on top of those sought for deficit reduction." He
is also quoted as saying, "How many big tax bills is Congress going to pass in a year?... How
much is the country going to swallow in a year?" [NYT, 2/21/93]
�Recent Developments: At 4/20 Meeting with HRC and the Finance Committee, Sen.
Danforth stated that Democrats and Republicans are not too far apart on this issue. He also
stated that universal coverage is important, but that it should be phased in over a longer
period of time. He believes the tax cap should apply to both employees and employers and
seemed happy with the First Lady's response to that point. Most recently, in conversations
with the Senator's senior staff, it appears likely that he and Sen. Kassebaum would like a
meeting with fra and or the First Lady in the very near future. The meeting is being arranged
now. The First Lady will likely invite him to a meeting soon. (rev. 4/28)
SENATOR ROBERT DOLE (R-KS) - The Minority Leader is, without question, the most
influential Senator among Republicans. As an ally, he can be absolutely invaluable. As an
enemy, he can be vicious and effective. Cunently, it appears he is trying to decide whether
health care reform should be a partisan or a bipartisan issue. Dole and his staff will probably
opt to appear to be willing to work with the Democrats, but will eventually choose to turn on
the new Administration on the reform issue.
Senator Dole has a strong interest in raral health and is cunently Co-Chair of the Senate
Rural Health Caucus. Legislatively, he has supported initiatives to protect the viability of
small raral hospitals as well as to expand civil rights protections and services for the
handicapped.
On Meet the Press (Sunday, April 18), he indicated his opposition to price controls, his
concem about large taxes without delivering on cost containment first, and his hesitancy
about a VAT tax unless it is used to replace or offset other taxes.
Senator Dole continues to profess a desire to work with Democrats on health reform. Earlier
this year, Senator Dole said: "[i]f we're going to have health care reform, it's got to be
bipartisan. Nobody has the votes for health care reform. We don't have the votes. We're the
minority. Democrats don't have the votes because they have different ideas. But it seems to
me this issue is so important that it shouldn't be politicized. Now, politics—there's a place
for it, and there's a place not for it, and 1 think health care reform is one of those areas."
[Renter Transcript Report. 2/16/93]
Although it may well be an impossible task, we must continue to work to at least try to get
him on board with us. If we do not succeed, we might have some success in attracting other
moderate Republicans for making the effort to obtain Dole's support.
Recent Developments: Along these lines, we recommend that you invite Senator Dole in for
a meeting to discuss where he sees health care legislation when you see him at tomonow
morning's meeting. Regardless of your success in bringing Dole on board, the very fact that
you attempted to do so has a very real potential to attract other moderate Republicans who
will be given cover to come in for individual meetings.
�SENATOR PETE DOMENICI (R-NM) - Senator Pete Domenici of New Mexico was
elected to the Senate in 1972, and served as chairman of the Senate Budget Committee from
1981 to 1987. Since then, he has served as ranking Republican on the Committee. Although
the growing budget deficit concems him and he has tried to reduce the deficit, he is reluctant
to diverge publicly from the Republican party lines. A partisan Republican, his willingness to
back higher taxes to cut the deficit has hurt him with fiscal conservatives.
Commenting on the President's economic team in December, the Senator said, "you can't get
the federal budget under control without dramatically reducing the increasing costs of health
care." [Reuter Transcript Report. 12/10/92] Senator Domenici released a report last October
with Senator Nuim that suggested that to control escalating federal health care costs. Congress
should enact legislation by December 1993 to cap spending on entitlement programs such as
Medicare and Medicaid.
Senator Domenici is also extremely concerned about the issue of mental health and believes
that significant mental health provisions should be included in the benefit package. He has
introduced legislation to ensure that any reform plan contain mental health provisions.
Recent Developments: On April 29, Senator Domenici attended a briefing on the Hill on
Mental Health Issues by Mrs. Gore. In his remarks, he appeared to indicate that he would
support a health care reform bill but it was not clear whether this could be interpreted as
support for the Administration's plan.
SENATOR DAVE DURENBERGER (R-MN) - Senator Durenberger, the ranking
Republican on the Finance Committee on Medicare, is one of the Committee's most well
versed Members on health care reform. He also is one of the few Members who has served
concunently on the Labor and Human Resources Committee (the other major health care
committee) and the Finance Committee. He is a moderate who is viewed by the Republican
leadership as somewhat of a loose cannon. Because of this and his long-standing interest in
health care reform, Durenberger, too, is a candidate to be a possible and important ally.
In the last Congress, he joined Senator Bentsen as the lead Republican on the Texas Senator's
incremental (insurance market reform, etc.) health reform initiative. He has been a key health
care player for years, however. He now is the ranking Republican on Jay Rockefeller's
Subcommittee on Medicare and Long Term Care, and he has served as either a Chairman or
ranking Member of this Committee for years. In addition, he served (as a Vice-Chair) on the
Pepper Commission. While he joined all the other Republicans in voting against the access
recommendations of this Commission, (he did vote for the long-term care recommendations)
it is important to note that it was unclear that Durenberger was going to vote against the
Pepper Commission recommendations until very late in the process. An important offshoot of
this experience, though, was the close working relationship he forged with Rockefeller.
�Most recently, Durenberger has focused on state-based health reform initiatives. He does not
believe that a consensus yet exists for national reform and his own state is tired of waiting.
Minnesota has a long tradition of moving ahead on health care reforms. It is one of the 5 or 6
states that has gone ahead and passed legislation to implement its own reform proposal.
Minnesota is also THE nation's capital of managed care/HMO delivery systems. As a result,
Minnesota has historically been more efficient than other states in terms of the delivery of
health care. Senator Durenberger will be very concemed about the allocation of the global
budget, particularly that it does not reward the inefficient at the expense of the efficient.
Senator Durenberger called Chris Jennings on April 17th to talk about health policy substance
and strategy. He indicated his nervousness with any price controls. He said he thought wc
could get some savings for speeding up implementation of the new physician payment system.
He also urged us to find a way to fold in Medicare into whatever we do. Lastly, he again
asked for a meeting with Ira and it was ananged for April 21st.
Recent Developments; At a meeting with Ira Magaziner on April 21, Durenberger stressed
that he, unlike some Republicans, thinks we can and should do health care this year, although
he expressed reluctance about universal coverage (and its associated costs) in the near term.
Feedback from Gov. Carlson's office was very positive, but Durenberger is still telling the
press that he's against new taxes and isn't sure the bill can be moved this year.
SENATOR LAUCH FAIRCLOTH (R-NC) - Senator Lauch (pronounced "Lock") Faircloth
is a Republican Senator from North Carolina. He is a freshman member and won by
defeating incumbent Democrat Teny Sanford. Senator Faircloth is a conservative from a
tobacco-growing state. As such, he will have particular concems about increases in taxes on
cigarettes and tobacco products. With the strong influence of fellow North Carolinian and
arch conservative Jesse Helms, it is not expected that he will be with us. It is even more
unlikely that he will support the Administration and go against the Republican Leadership.
SENATOR SLADE GORTON (R-WA) - Senator Slade Gorton won and then lost his first
Senate scat, and then after saying he was through with politics, ran again in 1988 and won.
He has taken the lead on CAFE standards and backed import fees on cars that did not comply
with the Clean Air Act. He is up for re-election in 1994, and cunently sits on the Senate
Committee on Commerce, Science, and Transportation; the Senate Committee on
Appropriations; the Senate Select Committee on Indian Affairs; the Senate Committee on the
Budget; and the Senate Select Committee on Intelligence.
Senator Gorton is a co-sponsor of Senator Dole's Medicare reform bill. Senator Gorton
wrote to you on March 23rd, where he outlined that his most pressing concem is state
flexibility. He was encouraged by the Oregon waiver and hope that the Administration plan
will be as equallv flexible. "Like you 1 believe we absolutely must have national health care
8
�reform as soon as possible," but did not elaborate.
SENATOR PHIL GRAMM (R-TX) - Phil Gramm is a highly partisan, extremely
outspoken Senator who has strong convictions in his beliefs. He is a former professor at
Texas A&M and previously served in the House of Representatives. He is a supply-sider
committed to carrying on the Reagan legacy. Formerly a Democrat, Gramm was a lead
sponsor of two major pieces of budget legislation: the Gramm-Latta budget resolution of
1981, Reagan's budget "cutting" package, and the Gramm-Rudman-HoUings budget deficit
reduction act of 1985.
Gramm is not expected to be helpful to the Administration. In fact, he is in a heated debate
over how the Republicans should proceed with health care. Gramm has joined with Senator
McCain and other conservative Republicans promoting the use of Medical IRA's as their
health reform vehicle. The other side is favored by Chafee and Packwood, who believe that
some sort of govemment program must be initiated. Caught in the middle of this straggle is
Senator Dole, who is tr>'ing to keep both sides together as he did on the stimulus plan.
Gramm is considered a leading candidate to succeed Dole as Minority Leader. He is also
ramored to be considering a ran for the presidency in 1996.
SENATOR CHARLES GRASSLEY (R-IA) - Senator Grassley is one of those Senators
who can give the impression (since he is not a detail-oriented person) that he is less than
sharp and not a significant player. This is not the case. Although he may not be extremely
quick, he has a very sensitive and accurate gut for politics and policy and, with a very
capable staff, he has managed to become quite an effective member of the Finance
Committee.
Grassley's primary health care interest has been raral health care. He, again like most other
Finance Committee members, has been greatly concemed about perceived inequities in
reimbursement toraralproviders.
Recent Development; Senator Grassley, as he stated in the recent Finance Committee
meeting, appreciated your coming to Iowa. He was, according to Senator Pryor, impressed
with your presentation before the Finance Committee and, again only according to Sen. Pryor,
said "Hillary is too smart for Republicans." He has also indicated his support for malpractice
reform.
SENATOR JUDD GREGG (R-NH) - Senator Judd Gregg, the newest member of the
Senate Labor and Human Resources, was elected govemor of New Hampshire in 1988 and
re-elected in 1990. He is the son of Hugh Gregg, a former Republican governor of New
Hampshire. During his two terms in office, he showed a strong interest in and commitment
to environmental protection and economic development. He took a conservative position on
spending and taxes.
�Senator Gregg was a member of the House of Representatives from 1980 until he assumed
the govemorship of New Hampshire. He served on the Ways and Means Health
Subcommittee and voted along conservative lines. He was involved in the movement to
repeal Medicare Catastrophic. New Hampshire recently took flack in an article in the
Washington Post where the state shifted Medicaid funds to balance their state budgets.
Senator Gregg was Govemor and said to approve of the plan.
SENATOR ORRIN HATCH (R-UT) - Senator Hatch is relatively new to the Committee
having joined during the last Congress. He is one of the brightest Senators, but has yet to
really get a comfortable grasp of the Finance Committee. Although well known for his very
conservative philosophy, in recent years he has appeared to become more open to more
traditionally moderate approaches. For example, although close to the drag industry, he has
been willing to push them to be more responsive on pricing issues.
Up until 1993, he served as either the Chairman or the Ranking Republican of the much more
conflict-oriented Labor and Human Resources Committee. In this capacity, he became
extremely well informed about PHS, NIH, and FDA issues. On health reform issues, he can
be expected to be very supportive of market-oriented reforms to the health care system. In
that vein, he will be extremely uncomfortable with employer mandates and discussions of
global budgeting and enforcement. He has introduced legislation to reform the medical
malpractice system and sees it as an important means for reducing health care costs.
Recent Developments: Senator Hatch has just hired a health care staff person straight from
Reagan/Bush DHHS. It is unclear what impact this will have on his willingness to be
constractive on health care debates—more likely to be negative. Sen. Kennedy, who is close
to Hatch, believes we should not write him off. He views Hatch as a potential coalition
builder between moderate Republicans and Democrats.
SENATOR MARK HATFIELD (R-OR) - Senator Mark Hatfield, the senior Senator from
Oregon, is Ranking Minority Member on the Senate Appropriations Committee. Senator
Hatfield is on our "Big 8" list, meaning he is one of our eight republican targets.
Senator Hatfield is knowTi to be deeply religious, and has never voted for a defense
authorization bill. He was opposed to the Gulf war resolution, as well as the altemative
economic sanctions. Hatfield is pro-life and we will lose him if he perceives the plan to be
subsidizing abortion. However, he did back amendments to allow family planning at Title X
clinics. Senator Hatfield was a Republican co-sponsor on the Family and Medical Leave
Act.
Senator Hatfield would like to see the Administration stress medical research. He believes it
is cost effective and is a worth while investment. He also has a concern about raral health
care delivery and medical education reform. State flexibility will be a crucial to his vote.
10
�Along these lines, Hatfield is pleased with the decision to approve Oregon waiver.
SENATOR JESSE HELMS (R-NC) - Senator Helms is arguably the most conservative of
all the cunent Senators. In fact, he has probably caught the ire of every liberal group in the
country at one point or another. He won re-election in 1990 in a racially charged election
against Harvey Gant. Helms is the ranking member of the Senate Foreign Relations
committee. He works hard to protect the tobacco farmers in North Carolina. It is probably
safe to put Senator Helms in the "no" category.
SENATOR JIM JEFFORDS (R-VT) - Senator James Jeffords is a progressive Republican
who has shown a fair amount of interest in health-related matters. He has sponsored his own
bill (The Medicare Health Act), a single-payer approach with 70% federal financing. He
believes his is a unique approach and really hopes that the Administration considers his
proposal seriously.
According to his staff, the main agenda item for Senator Jeffords this year will be the ERISA
preemption. This is an especially important issue for Vermont, which cunently has a waiver
applicarion in order to pursue comprehensive reform in the state. As a result, he would also
like to see state flexibility built into a comprehensive refonn initiative.
Senator Jeffords is an advocate of improving access to health in raral areas. As part of health
reform, Jeffords believes there needs to be an emphasis on primary care and efforts that
encourage providers to enter primary care. He also favors loan deferment programs and
expansion of the National Health Service Corps (NHSC) which aim to address the provider
shortage issue in raral communities. Jeffords has raised questions regarding how managed
competition will effect the need for primary practitioners.
Jeffords has also taken an active stance on lifting the ban on fetal tissue research, increasing
AIDS education, and eliminating the special market exclusivity for producers of orphan drags
(drags for rare diseases.)
Recent Developments; Jeffords has been taking a lot of credit lately for the fact that the
Resident advises will be providing lots of state flexibility. This public credit-taking has
alienated Sen. Leahy in particular because Senator Leahy believes he is the leader in this area.
SENATOR NANCY KASSEBAUM fR-KS) - Senator Kassebaum is the new rankingminority member of the Labor and Human Resources Committee. As such, she'll be working
closely with Chairman Kennedy on many provisions the committee has jurisdiction over.
Kassebaum has taken a strong interest in health care reform and has introduced her own
reform bill, the BasiCare Health Access and Cost Control Act (S. 325). This legislation
11
�provides tough cost controls, focussing on controlling what insurance companies can charge
for premiums. She would finance this bill through raiding the Social Security Trast Fund.
When the First Lady met with the Senate Women's Caucus, Kassebaum pushed for a national
commission on abortion, like the base closure commission, so that the members would have
one up or down vote on the issue.
She is very concemed about over-regulation by HHS and the federal govemment generally.
Along with Senator Metzenbaum, Kassebaum authored legislation on orphan drags; their bill
would have eliminated the cunent regime in which drags for rare diseases enjoy special
market exclusivity for the pharmaceutical manufacturer.
While considered a moderate, Sen. Kassebaum will toe the party line if she perceives an issue
is being politicized. If she senses this is happening with health reform, we will have little
chance of winning her support.
Recent Developments; Her elderly mother lives at home, so Kassebaum as a particular
interest in long term care. We believe she is one of our top Republican chances. She wishes
to come meet with you and Ira along with Sens. Danforth, Bums and Reps. Glickman and
McCurdy sometime next week.
SENATOR DIRK KEMPTHORNE (R-ID) - Senator Kempthome is a freshman member
from the State of Idaho. He won the election and replaced retiring Sen. Steve Symms. Idaho
is a very conservative state and one of the few states that have two Republican Senators. As
afreshman,it is not expected that he will break out of the pack and go against the
Republican leadership. Idaho is a frontier states like Wyoming, Montana and the Dakota's.
The leadership of other frontier Senators like Simpson, Wallop, Craig, and Bums will
probably influence Kempthome.
SENATOR TRENT LOTT (R-MS) - Senator Lott is from the State of Mississippi. He
was elected to the Senate in 1988, after serving in the House of Representatives. Senator Lott
rose to the rank of Minority Whip in the House before moving on to the Senate. He has fit
into the Republican leadership in the Senate. While in the House, he spearheaded a
combative and outspoken role for the minority, rather than the conciliatory, work within the
system long favored by House Minority Leader Michel. Senator Lott is an obvious threat to
Dole, and may be one of the reasons why Dole has been so combative of late. As a result of
the defeat of the President's Economic Stimulus package. Dole has solidified his leadership
position and has kept Lott at bay—for now.
Lott is a partisan, but is not afraid to go against the grain. He voted against the 1990 budget
deal, probably in part because of his dislike for John Sununu. Lott has not made his health
views known publicly known, however, they are expected to be conservative.
12
�SENATOR RICHARD LUGAR (R-IN) - Senator Richard Lugar is most known for his
work on foreign affairs. He is the former chair of the Foreign Relations Committee, and is
widely recognized for his moderate foreign relations views, even though he was one of the
most ardent defender of the Nicaraguan Contras. Lugar is a conservative, having a National
Journal rating of 86% conservative on economic issues, 62% conservative on social issues
and 68% on foreign issues. As ranking member on the Agriculture committee, he helped
scale back the 1990 farm bill, some of which to the angst of Dole. Lugar has tried for years
to become a more active part of the leadership.
His health views are not widely known. It is expected that they will be conservative,
watchful of raral health care delivery, and will probably follow Dole's lead. Even though
Indiana is an industrial state, he doesn't pay much heed to organized labor.
SENATOR CONNIE MACK (R-FL) - Senator Mack was a Democrat until 1979 and a
Republican Member of the House of Representatives from 1982 through 1988. In the House,
he was a member of the Gingrich crowd, taking full advantage of C-SPAN and railing
against the Democrats in Congress. A Reagan backer. Mack went to the Senate by touting
his conservativeness: supply-sider, anti-choice (which he switched), support for the Contras,
and Gramm-Rudman. Mack won a nanow victory over now-Florida Lt. Govemor Buddy
MacKay in 1988. Mack is up for re-election in 1994.
Mack has lost some of his ardent conservatism that won him the Senate Scat in 1988. He has
a good working relationship with Graham. He is a strong supporter of Israel. He was
opposed to Medicare Catastrophic in 1988, when everybody else loved it, and cashed in the
political benefits when sentiments turned.
He remains fairly quiet on health issues. Health reform may pose a difficult challenge in his
reelection effort. Florida's recent state reform efforts may contribute to a pro-reform mindset
in the state. He also cannot ignore the huge senior citizen communities in Florida. They will
undoubtedly scream bloody murder if there is any changes in Medicare or incrcjises on
wealthy seniors without conesponding increases in benefits. If the plan includes prescription
drag coverage and long-term care services seniors support, his opposition could prove very
costly. At the same time, he has to appease Miami's Cuban community, which will want
expanded coverage for the poor and recent immigrants—they are also very conservative and
vote that way.
SENATOR JOHN MCCAIN (R-AZ) - Senator John McCain of Arizona is conservative
with a career-military background. As a former prisoner of war himself, he has focused on
the POW/MIA issue in his work on the Armed Services Committee.
In the area of health care, he sponsored the Children's Health Care Improvement Act of 1993
(S. 28), which seeks to improve the health of the Nation's children. He has also sponsored
13
�the Medicare Provider Payment Equity Act of 1993 (S. 31), which would repeal the reduced
Medicare payment provision for new providers. The Senator also co-sponsored Senator
Dole's Medicare reform bill.
Senator McCain is siding with Senator Gramm in the health care rift in the Republican party.
As you know, there is a growing ideological debate among the Senate Republicans on how to
proceed on health care. On the one side is the Gramm-McCain group which espouses the
use of Medical IRAs as a way to make health care available to consumers. On the other side
of the debate is the Chafee side, which favors a more government-sponsored approach to
curing what ills our health care system. Senator McCain is sympathetic to the pharmaceutical
industry.
SENATOR MITCH MCCONNELL (R-KY) - Kentucky's junior Senator, Mitch
McConnell, first came to the Senate on Reagan's coat-tails in 1984. He held his seat in a
narrow victory in 1990 in a widely Democratic state, by defeating a liberal physician ranning
for state-wide office for the fist time. Senator McConnell serves on the Appropriations
Committee, the Agriculture Committee, the Rules Committee, and the Select Committee on
Ethics. He champions tobacco interests, and opposed the 1990 Budget Agreement partially
because of it's cigarette tax proposal.
Senator McConnell is a co-sponsor of Senator Dole's Medicare reform bill. McConnell was
recently named head of the Better America Foundation, which was developed to form
Republican positions on issues like health care reform.
SENATOR FRANK MURKOWSKI (R-AK) - Alaska Senator Frank Murkowski is
generally a free-market oriented conservative, supporting, for example, opening the Alaska
Natural Wildlife Reserve to oil exploration, and other forms of Alaskan development.
Senator Murkowski serves on the Foreign Relations Committee, the Veterans' Affairs
Committee (which he chaired in 1985 and 1986), and two committees cracial to Alaska:
Energy and Natural Resources, and Indian Affairs. Senator Murkowski won re-election last
fall by a 14 point margin.
In the 102d Congress, Senator Murkowski co-sponsored Senator Hatch's Health Care Access
and Affordability Act.
SENATOR DON NICKLES (R-OK) - Senator Don Nickles of Oklahoma recently won his
third term to the Senate, and continues to advocate the conservative views that brought him to
Washington with Reagan in 1980. He has been very active in setting the overall tone of
Republican policy as Chair of the Senate Republican Policy Committee. On the Energy
(Committee, Senator Nickles has actively sought increased energy exploration in places like
ANWR. In addition to his seat on Indian Affairs, Nickles also serves on two key money
14
�committees: Budget and Appropriations.
Senator Nickles co-sponsored Senator Dole's Medicare reform bill. When asked for a point
of agreement between Republicans and Democrats, Senator Nickles said, "Streamlining and
coordinating administrative costs in health care." [Qannell, 12/18/92] During his campaign
this fall. Senator Nickles emphasized medical malpractice reform and vouchers for people
unable to afford health insurance.
SENATOR BOB PACKWOOD (R-OR) - Senator Packwood is an advocate of an
employer-based universal coverage plan. He is the only Republican on the Finance
Committee that has publicly supported an employer mandate. As a result, he finds himself in
somewhat of an uncomfortable position with many in the Senate Republican leadership, who
vehemently oppose an employer mandate.
During his campaign for reelection last fall, Packwood singled out health care as an issue on
which he was closer to then-Govemor Clinton than his opponent. Representative Les AuCoin.
He also attacked AuCoin's single-payer approach last year as a multi-billion dollar tax
increase that would result in a govemment ran system. The primary criticism leveled against
Packwood's plan was that it didn't go far enough to control costs. Some aging advocacy
groups also criticized it for its lack of comprehensive long-term care coverage. In Oregon, at
least, Packwood won the debate.
Beyond the above-mentioned work, Senator Packwood has had a notable health care career.
He has sponsored quite a bit of legislation dealing with raral health and long-term care.
Specifically, he introduced a relatively extensive public/private long-term care bill in the
101st Congress. However, because it costed-out as a rather expensive initiative and because
the aging advocates were not enthralled with it, he decided to stick to Federal standards and
tax clarifications for private long-term care insurance policies. In addition, working with
Pryor, he introduced legislation that would provide tax credits for primary care personnel to
serve medically undeserved raral areas.
Recent Developments: At the Finance Committee meeting April 20, Packwood asked about
the stracture and role of a tax cap and was interested in how much subsidies would be
required.
SENATOR LARRY PRESSLER (R-SD) - Senator Lany Pressler is a moderate to
conservative Democrat from the State of South Dakota. Known mostly for wanting
Congressional reform, he has fought against pay raises and other issues that are popular back
home. Senator Pressler has a tendency to vote the ways the cunent political winds are
blowing. Early in his career, he was known as a liberal Republican, then a conservative and
is now known as a moderate Republican. Senator Pressler was nanowly re-elected to the
Senate in 1990, and is expected to face a strong challenge from the very popular
15
�Congressman-at-large, Tim Johnson, next time around. While many negative articles written
about Pressler, much can happen in the four years.
His health views are not widely known. And it also unclear whether he will fall to either the
Chafee or Gramm side of the cunent Republican health care debate.
SENATOR WILLIAM (BILL) ROTH (R-DE) - Until the last couple of Congresses,
Senator Roth was not known for his involvement in health care. As Ranking Member of the
Govemment Affairs Committee, he has had extensive involvement and interest in the
Committee's Permanent Subcommittee on Investigation's inquiry into the multi-billion dollar
issue of health care fraud and abuse.
More recently. Roth has actively advocated that the Federal Employee Health Benefit
Program, which the Govemment Affairs Committee oversees, be extended to the working
uninsured and small businesses. (This is similar to, and builds on, a proposal that has been
championed by the Heritage Foundation.) Under this proposal, the self-employed and
working uninsured would have access to the FEHB plans that were utilizing managed
competition as a cost containment/quality assurance mechanism. In so doing, these
individuals would have access to the same rates that the insurers charge the federal
government and their employees for the benefits.
SENATOR ALAN SIMPSON (R-WY) - Wyoming's junior Senator, Alan Simpson, handily
won re-election in 1990, and cunently serves in the Republican leadership as Minority Whip.
Simpson serves on the Judiciary Committee, the Environment and Public Works Committee,
the Veterans' Affairs Committee, and the Special Committee on Aging. He has taken partisan
positions on issues like the Clean Air Act and other environmental issues, but breaks with
many Republicans in his pro-choice stance.
Senator Simpson rates the following as his top priorities: state flexibility, raral and frontier
delivery problems, managed competition's applicability to raral areas and incentives for
medical personnel to serve in underserved areas.
Recent Development; Senator Simpson is cunently siding with the Chafee side of the
Senate Republican health care debate. Also in a letter to the First Lady in early March, he
was very complimentary about her meeting with the Republican Senators and her mastery of
health care reform.
SENATOR BOB SMITH (R-NH) - Senator Smith is the Senior Senator from the state of
New Hampshire. A former real estate agent, he first lost his bid for Congress in 1980, lost in
the primary for Govemor 1982 and finally won a House scat in 1984. Smith took over for
retiring Senator Gordon Humphrey in 1990. Humphrey retired after serving two terms in the
16
�Senate, probably the only Republican pushing for term limits to actually hold trae to that
pledge.
He is known as a conservative who will toe the party line. He is deeply concemed about acid
rain, and has worked hard on that issue. However, acid rain is just about the only issues
where Senator Smith has strayed from conservatism. His health views are not widely known,
but they are expected to be conservative. Committee, and the Select Committee on
Intelligence.
SENATOR ARLEN SPECTER (R-PA) - Pennsylvania's Senator Arlen Specter defeated
Lyrm Yeakel last fall, despite the initial momentum generated by his opponent over the
Senator's questioning of Anita Hill. He has long staked out claim to traditionally Democratic
issues, like support for labor and women's rights. He cunently serves on the Judiciary
Committee, the Energy and Natural Resources Committee, the Appropriations Committee, the
Veterans' Affairs Committee, and the Special Committee on Aging.
During last fall's campaign. Senator Specter proposed a health care reform package focused
on preventative care, while increasing federal funding for health care. He also touted his cosponsorship of the "Health Care Access and Affordability Act of 1992," a consumer choice
based health care reform proposal.
SENATOR TED STEVENS (R-AK) - The senior Senator from Anchorage, Ted Stevens, is
very popular in Alaska. With Alaska's unusual relationship with the federal govemment,
Senator Stevens has taken an active role in matters related to federal employment, serving on
the Governmental Affairs subcommittee handling the civil service. An active legislator.
Senator Stevens serves on six other committees: Commerce, Appropriations, Rules, Ethics,
Intelligence, and the Joint Committee on the Organization of Congress.
Interestingly, Senator Stevens co-sponsored Senator Wellstone's Antiprogestin Testing Act of
1993 (S. 222), which requires the Commissioner of Food and Drags to collect information
regarding the drag RU-486 and review the information to determine
whether to approve RU-486 for marketing as a new drag. He also co-sponsored Senator
Lautenberg's Preventing Our Kids From Inhaling Deadly Smoke (PRO-KIDS) Act of 1993
(S. 261).
Recent Development: Senator Stevens appears to be siding with the Gramm-McCain
faction's health reform approach based on "Medical IRAs" and consumer choice.
SENATOR STROM THURMOND (R-SC) - Senator Thurmond has not played a strong
role in health-related matters. The one area of health where Thurmond has shown a strong
interest is in research. He backed the NIH reauthorization and supports fetal tissue research.
17
�He is also concemed about AIDS funding, which he thinks should be increased; he feels there
is an improper perception about funding imbalances between AIDS and other disease research
activities. Thurmond has a daughter who is diabetic and testifies before the Appropriations
Committee on behalf of diabetes funding yearly. He also supports more funding for cancer
research.
Senator Thurmond also has a longstanding interest in alcohol education issues. He was the
primary sponsor of the legislation which requires a Surgeon General's warning label on
alcohol beverage containers. He currently is advocating legislation requiring similar warnings
for alcohol advertising.
Thurmond has real concems about the budget deficit and will interested in the impact of
reform on the deficit.
SENATOR MALCOLM WALLOP (R-WY) - Senator Wallop was just renamed to the
Finance Committee this term. In his previous tenure (1979-1988) he demonstrated an interest
in raral health concems but focused primarily on tax matters. He is known for his very
strong conservative views. In the last Congress, he cosponsored the Republican reform bill
and Senator Hatch's bill to improve the medical liability system. He is very strong on state
flexibility, federal costs, frontier/raral issues, and adamantly opposed to employer mandates.
He has serious doubts about Managed Competition's applicability to serve raral areas.
Senator Wallop wants us to be extremely cautious, because we can hurt far more than we can
help. If there is one Member of the Committee we can almost certainly write off as a
possible supporter, it is Senator Wallop.
Recent Development: As you know, Senator Wallop was in attendance when you spoke to
the members of the Senate Finance committee recently but did not say anything.
SENATOR JOHN W. WARNER (R-VA) - Senator John Wamer of Virginia won
reelection in 1990 with no significant opposition, but has recently lost his position as Ranking
Minority Member of the Armed Services Committee to Sen. Thurmond. He has generally
taken conservative positions, but is pro-choice and favors repeal of the Hatch Act. In
addition to Armed Services, Senator Wamer serves on the Environment and Public Works
Committee, the Rules
18
�DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per E.O. 12958 as ameiided,Sfc 3.3 (c)
Initials:
PRIVILEGED AND g01iH»PBi«aftfe' MEMORANDUM
TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n
A p r i l 29, 1993
Chris Jennings
Teleconference C a l l w i t h Congressman Valentine
Melanne, Steve, Lorraine
I am t o l d you w i l l be making a teleconference c a l l f o r t h e
f i r s t i n a s e r i e s o f " C i t i z e n Meetings" w i t h Congressman
Valentine. He i s extremely a p p r e c i a t i v e o f your w i l l i n g n e s s t o
do t h i s f o r him.
On A p r i l 20th, I met w i t h Congressman Valentine t o give him
a sense o f d i r e c t i o n as t o where the p o l i c y discussions were
going and t o give him the o p p o r t u n i t y t o ask questions and give
advice. His D i s t r i c t i s the headquarters f o r a number o f
research hubs o f the pharmaceutical i n d u s t r y . I n a d d i t i o n , being
from North Carolina, he i s very concerned about discussions about
tobacco taxes.
Although he was concerned about the d i r e c t i o n he thought we
were headed, he made i t c l e a r ' t h a t he d i d not want t o stand i n
the way o f reform. He f e e l s s t r o n g l y t h a t costs our t o t a l l y out
of c o n t r o l and we must get a handle on them. His message t o me
about the pharmaceutical f i r m s and the tabacco farms was mostly
o r i e n t e d t o assuring t h a t they were t r e a t e d " f a i r l y . " He was, i n
other words, not a t a l l searching f o r any s p e c i a l treatment.
He i s f a r from a d e t a i l person, but I get the sense t h a t he
has a very good "gut" sense o f p o l i t i c s . He i s also i n f l u e n t i a l
w i t h the moderate t o conservative wing o f the Democratic p a r t y .
I f we a c t u a l l y a t t r a c t e d h i s vote, i t would probably mean we were
i n a good p o s i t i o n t o a t t r a c t other votes as w e l l .
L a s t l y , he asked me t o forward t o you t h a t he has been
t a l k i n g you up throughout h i s d i s t r i c t .
He believes you are one
of the few people i n the n a t i o n who has a chance o f s u c c e s s f u l l y
taking on t h i s very d i f f i c u l t issue. You may want t o thank him
for that.
Attached you w i l l f i n d copies o f a l l the m a t e r i a l s he has
sent out regarding h i s " C i t i z e n Meeting."
I t h i n k you w i l l f i n d
more than you need f o r t h i s conversation.
PHOTO*^OPY
PRESEiwl^/4TI0N
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. memo
DATE
SUBJECT/TITLE
Chris Jemiings to Hillary Rodham Clinton; re: Tuesday Meeting with
Congressman McDermott (2 pages)
04/28/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefmg Memos - First Lady, 1993 [5]
2006-0885-F
.ip2850
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA)
b(3) Release would violate a Federal statute |(bX3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(bX4)of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(bX6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes I(bX7) of the FOIAl
b(8) Release would disclose information concerning the regulation of
financial institutions |(bX8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA|
National Security Classified Information [(aXl) of the PRA)
Relating to the appointment to Federal office |(aX2) of the PRAJ
Release would violate a Federal statute |(aX3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |aXS) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(aX6) of the PRAl
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�SENT BY;
4-28-33 ; S-im ;
CONG MCDERMOn-
202 456 7733:* 2/ 4
U.S. REP. JIM MCDERMOTT'S
CHECKLIST OF CRITERIA
FOR MEASURING
HEALTH CARE REFORM PROPOSALS
1.
Does it provide insurance coverage to every American?
Nearly 40 million Americans do not have health insurance coverage today. That total
increases by 100,000 each month. An almost equal number (nearly 40 million) are
dangerously under-insured. Any refonn proposal must extend quality coverage to
these Americans.
2.
Is that coverage portable, stable and continuous?
A major problem for people who have insurance is the fear that they will lose it if
they move to another job, due to a "pre-existing condition" which won't be covered
under their new employer's plan, or otherrestrictionsand inadequacies in the plan
offered by their new employer.
3.
Is the Standard benefit package comprehensive enough to
prevent the need for a large secondary insurance market which
leads to two-tier medicine and uncontrollable costs?
In a democracy, it is important to have a quality health care system available to all.
If the standard benefit package guaranteed to all citizens provides only minimal
benefits, then some people will look for a "better deal." People will try to cither
"buy out" of the national system or buy more private insurance. If the standard
package of benefits is a generous one, people will stay in the system, preserving the
ability to control costs.
4.
Does it allow individuals or families to choose their own
physician or other health care provider?
Americans cite the ability to choose their own physician as the single most important
aspect of any health care plan, even over cost and convenience. They do so by large
margins. One of the fundamental elements of healing is therelationshipbrtween the
healer and the patient. If the patient has no choice, you take away an essential
element of the health process.
— more
�SENT BY:
4-28-93 : 5:11PM ;
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202 456 7739:# 3/ 4
McDermott's checldist
page-2-
5.
Does it guarantee coverage regardless of physical condition or
the presence of a pre-existing condition?
Increasingly, insurance in this country is only available for those things for which
you do not need insurance. If you have a cancer, insurance companies will cover
everything but cancer. If you have heart problems, they will cover everything but
heart problems. Anyreformplan must correa this fundamental problem.
6.
Does it provide for effective, veriflable cost-containment?
Currently. America's health care system essentially has no co.st controls. We cannot,
as a nation or as individuals, afford this any longer. Anyreformplan must have
verifiable cost-containment.
7.
Does the cost-containment apply to the entire health care
delivery system without loopholes or exemptions for the
secondary insurance market or self-Insured entities?
It is increasingly difficult to control costs and stop wasteful spending if large numbers
of people are "outside the system." To be effective, cost-containment measures must
be applied to the entire health care delivery system.
8.
Is there one simplified federal administrative system that applies
to all Americans, rather than multiple bureaucracies which do
the same thing for different groups?
A central goal of any health carereformplan should be to simplify the system
to make it understandable for ordinary citizens and to make it easier to identify and
eliminate waste. Over-lapping layers of federal bealth care bureaucracies for sepunxc
benefit programs needlessly waste health care dollars. Waste is also an unavoidable
aspect of having 1,500 different private health insurance companies. According to the
GAO, Americans incur neariy S60 billion a year in unnecessary health care costs
simply because of all the different forms and paperwork issued and required by so
many different companies.
9.
Does the health care delivery system enhance access to health
care in rural areas and the inner cities?
More than 35 % of Americans live in rural areas or inner cities. Both have been
chronically under-served by the current health care system. Any national health care
system must correct this inadequacy.
- more ~
�SENT BY:
4-28-93 ; 5:12PM :
CONG MCDERMOTT-
202 456 7739:# 4/ 4
McDermott's checklist
page-3-
10. Does it eliminate interference between doctors and patients by
insurance companies second guessing medical decisions and allow
health professionals to make theur own medical decisions?
Maintaining America's high quality of bealth care must be a fundamental goal of
whatever health carereformplan America adopts. The current system's case by case
randomreviews,which inserts insurance companies between the patient and the
health care provider through "pre-certification" requirements for hospital admissions,
length of hospital stays, and even for ^>ecific medical procedures, have not been
effective in controlling health care costs. What we need is a system that allows
doctors to make their own medical decisions, but which also teaches them how to
deliver better medicine by developing better practice patterns.
11. Does the system dramatically reduce administrative costs of the
health care budget?
Almost a quarter of all health care dollars in America are consumed by
administrative expenses of insurance companies. This is simply uriacceptable. If we
are to make the kinds of savings necessary to finance compr^ensive health care
coverage for all Americans thisfiguremust be reduced. And it can be reduced. For
example, under Canada's "single payer" system, for example, only 3 percent of all
helath care dollars are consumed by administrative expenses.
�PERSONAL AND .^ONraPENTMt&^MEMORANDlJM
DETERMINED TO BE A.\ ADMINISTRATIVE
<ING Per E.O.
12958 as
as araendfd,
amended, Sec_3.3
I
MARKINGJPer
m 12958
Sec,3.3 (c)
s:.7lg-e
Date:l^\G/\\
Initials:.
TO:
FR:
RE:
cc:
H i l l a r y Rodham Clinton
Chris Jennings
House Leadership and Chainnan Meeting
Melanne, Steve, Lorraine, I r a
A p r i l 27, 1993
Attached i s Lorraine's memo to the President preparing him
for tomorrow night's health care dinner meeting with Speaker
Foley, Dick Gephardt, David Bonior, Barbara Kennelly, Dan
Rostenkowski, John Dingell, William Ford, Pete Stark, Henry
Waxman, and Pat Williams. This meeting, l i k e the Senate retreat
and a l l the Congressional Leadership Meetings with the President,
has the potential to turn the Members around from quiet naysayers
to strong advocates who can influence the rank and f i l e .
BACKGROtJND
The feedback from today's meeting with the House and Senate
Leadership (from senior level s t a f f ) has been very positive. The
President and you have apparently succeeded i n getting the
Leadership (at the very least, Mitchell and Gephardt)
s i g n i f i c a n t l y invested i n strategizing as to how best to get a
health reform b i l l passed.
I f tomorrow's meeting with the rest of the House Leadership
achieves the same result, I believe the President and you w i l l
have made important headway towards making health care reform an
i n i t i a t i v e the Leadership and Chairmen WANT to pass — not HAVE
to t r y to pass.
The two goals of the meeting are the same as always: F i r s t ,
i t i s important to i l l u s t r a t e your understanding of the
d i f f i c u l t i e s the Leadership faces i n passing the r e c o n c i l i a t i o n
b i l l . Second, to emphasize the commitment to pass health care
and the need for t h e i r assistance i n order to accomplish t h i s
goal.
One l a s t b i t of advice. I t i s also the same old tune:
Encourage and make a point of allowing a l o t of time for the
Members to talk and give p o l i t i c a l advice. The worst outcome of
tomorrow's meeting would be for any one of the Members to be
s i l e n t for the night. Keep them talking and I am sure the
meeting w i l l be a great success.
�THE WHITE H O U S E
WASHINGTON
April
21,
1993
HEALTH CARE DINNER WITH HOUSE MEMBERS
DATE:
LOCATION:
TIME:
FROM:
I.
A p r i l 21, 1993
old Family Dining Room
8:00 pm
Lorraine Miller/Chris Jennings
PURPOSE
You w i l l meet with ten Members of the House Leadership,
including the Chairmen and Subcommittee of the three primary
Committees of j u r i s d i c t i o n over health care. The purpose of
t h i s meeting i s to ascertain the willingness of these
Members to work together to pass a your health reform
i n i t i a t i v e t h i s year and to invest them i n a strategy and
timeframe to do so.
II.
BACKGROUND
Tomorrow's meeting builds on the discussion you held today
with the Speaker and the two Majority Leaders. Just as you
engaged the senior Congressional Leadership i n your efforts
to pass health reform, the goal of the dinner meeting i s to
do the same with the Members who must get the l e g i s l a t i o n
out of their Committees in a timely manner.
This meeting has the very r e a l potential to set the tone for
the type of cooperation the Administration w i l l receive i n
i t s efforts to gain prompt consideration and passage of your
health reform b i l l . Similar to today's meeting, we believe
that tomorrow night's discussion w i l l focus predominantly on
the problems of the introduction of a health care b i l l could
cause to the prospects of the passage of r e c o n c i l i a t i o n . I n
addition, the Members w i l l l i k e l y focus on the bottom-line
issues of cost and financing. They w i l l also t e s t to see i f
you have the commitment and understanding necessary to work
t h i s complex and controversial through the Congress. They
may also want to see i f you have the public message, as well
as the policy substance, necessary to i n c i t e the public to
push the Congress forward.
A successful meeting would invest the Members into the
process of strategizing about the best time for introduction
of the b i l l , the timeframe for hearings and mark-up
(including Rules Committee consideration), and the most
opportune time for positive action on the House floor.
�In addition, to timing strategy, the Members w i l l want to
give t h e i r advice on how to gain the necessary p o l i t i c a l
support for the l e g i s l a t i o n through the policy development
process. Like most Members, they prefer to t a l k , rather
than l i s t e n , and you should probably invite as much advice
and guidance as possible.
I I I . PARTICIPANTS
(See attached l i s t ) .
IV.
PRESS PLAN
Closed press.
V.
SEQUENCE OF EVENTS
* President and F i r s t Lady enter Dining Room for greetings.
* Dinner and Discussion Commences
VI.
REMARKS
*
Health care reform i s a p r i o r i t y for me, and I believe
i t i s i n both our economic and p o l i t i c a l best interest
to pass i t t h i s year.
*
Legislation of t h i s magnitude obviously cannot pass
without the cooperation, guidance and support of a l l of
you. I wanted to take t h i s opportunity to tap into
your resevoir of experience about both the process,
p o l i t i c s , and substance of health care.
*
You a l l have been working on t h i s issue for years and
years. I f fact, some of you (Dingell) have been
working on t h i s issue for decades.
*
I am well aware of the concerns about the potential
problems of introducing health care too soon to the
deliberations on the reconciliation package. However,
I do not want t h i s potential problem to unnecessarily
block progress on passing health care t h i s year.
*
I need you to build on the assistance you have already
provided to the F i r s t Lady i n developing a passable
plan i n the f i r s t place. I need your help to develop a
l e g i s l a t i v e strategy that w i l l work to secvire passage
in the House. I need your assistance to work the b i l l
through the Committee process. I need your help to
gain the rank and f i l e support necessary to pass t h i s
b i l l . And I need your help to place pressure on the
Senate to do the same.
�PROFILES - HOUSE DEMOCRATIC LEADERSfflP
April 27, 1993
SPEAKER TOM FOLEY (Speaker of the House)
For some time he has been saying publicly how he doubts that it can be passed this
year. It part this can be viewed as areflectionof signals he is picking up from the members.
However, it should also be noted that health carereformhas never been a priority issue for
the speaker. But he certainly wouldnn't stand in the way ofreformif he thought there was
sufficient support for it. He supports the use of a VAT if needed as afinancingmechanism.
REP. DICK GEPHARDT (M^orlty Leader)
The House Majority Leader has been a strong supporter of the health care reform
effort. He was very pleased with today's (4/27) meeting. He will work the committee to pass
reconciliation quickly toremoveany obstacles withregardto the health bill. He is pleased
that the tax requirements for funding the health legislation arc not as large as he has been
reading in the paper.
REP. DAN ROSTENKOWSKI (Chairman, House Ways and Means Committee)
Last Congress, Rostenkowski introduced an employer-based, global budget universal
access plan. It was more an initial attempt to enter the health care debate than any deep
commitment to the approach. His primary concern will be protecting the jurisdiction of his
committeeratherthan the details of the plan itself. Lately, he has been one of the members
preaching to take the time to ensure the plan is doneright,even if it means missing the
deadline. He wants health care reform but remains to be seen whether he will go to it with
the enthusiasm he brought the 1986 Tax Reform Bill. There arc some who feel he may be
playing down the possibility of passage this year so that he can come to therescue,as he has
done in similar situations in the past.
REP. PETE STARK (Chairman, Ways and Means Subcommittee on Health)
For sometime Stark has backed a single-payer model for health carereformbased on
extension of Medicare to the entire population. As vice-chairman of the Pepper Commission
he voted against its pay-or-play plan — partly because it was not a single payer plan but
more importantly because in his view it made concession to more moderate to conservative
elements of the Commission without winning their support. Starkrecentlyreleaseda letter
from the Director of Cal Pers (the insurance plan for Califomia Public Employees) in which
the Director denied that his approach was managed competition. His behavior is often
unpredictable. However, herespectsRostenkowski and will be unlikely to go against his
chairman.
�REP. JOHN DINGELL (Chainnan, House Energy and Commerce Committee)
Chairman Dingell has beenreintroducinghis father's single-payer bill since he first
arrived nearly 40 years ago. However, like Rostenkowski, he is likely to be more concemed
by jurisdictional issues than the details of the plan. In meetings he has expressed his view
that the plan should guarantee universal coverage to acute care services with state flexibility
to develop their own plans. He thinks the plan should also include cost containment,
malpracticereformand coverage for preventive services including family plaiming. He wants
reform passed this year and was upset byrecentcommentfromDirector Panetta.
REP. HENRY WAXMAN (Chafrman, Energy and Commerce Subcommittee on Health
and the Environment)
Rep. Waxman is one of the most well-versed members of the Congress on the details
of health reform issues. His primary concems will be assuring universal coverage as quickly
as possible and barring against substandard coverage for poor and low-income individuals.
To that end he will be wary of any plan that gives states to much flexibility and will push for
specific federal standards.
REP. BILL FORD (Chairman, House Education and Labor Committee)
As a representative of a heavily industrial district in Michigan, Rep. Ford is very
concerned about the impact of health reform on the U.S. Auto industry, their workers and
retirees. Not surprisingly, he is a strong advocate for focusing on strong cost contaiimient, a
position adopted by many unions and big manufacturing corporations. He can also be
expected to oppose a tax cap on insurance benefits or any other proposal which might
undermine negotiated union benefits. Like most Committee Chairs, he will be protective of
his jurisdiction and will want to bereassuredthat his committee will not take a back seat to
the Ways and Means and Energy and Commerce Committees.
REP. PAT WILLIAMS (Chairman, Education and Labor SubcommlUee on LaborManagement Relations)
Williams is Chairman of the Education and Labor Subcommittee dealing with ERISA
and Labor issues (including employer requirements). He wants his subcommittee and the full
committee to be taken seriously as one of the three committees of jurisdictions, a full partner
with Ways and Means and Energy an Commerce. He is open to any option forreformas
long as it is comprehensive. The House Leadership has him on their safe list, but he should
be given enough attention to make sure he is happy. His recent trip to Montana with the
First Lady should have gained some good will although he may harbor some bruised feelings
over his perception that he was excludedfrominitial planning discussions about the trip.
�REP. DA\TD BONIOR (M^orlty Whip)
The First Lady met with Rep. Bonior today. Hereiteratedhis strong support and
commitment to passing healthreformthis year. Bonior is one of the most accurate vote
counters in the House and one of the most effective Whips in a number of years. He will be
critical to assuring sufficient votes on the House Floor infinalpassage. He has major
concems, however,regardingabortion. He has indicated to others that he would have
difficulty lobbying for a bill that includes abortion services unless it can be separated out is a
separate component of the legislation.
REP. BARBARA KENNELLY (Deputy Majority Whip)
As a representative of Hartford, CT, the insurance capitol of the United States, Rep.
Kennelly will be sensitive to the impact ofreformon the insurance industry. She is
considered an expert on tax issues, particularly the taxation of insurance benefits. Despite her
insurance concems, she wants health carereform.She can be a valuable ally both with the
Congressional Women's Caucus and the House's Old Guard.
�MEMORANDUM
TO:
FR:
DATE:
Requestors f o r I n f o r m a t i o n on Meetings w i t h R e p u b l i c a n s
C h r i s Jennings
A p r i l 27, 1993
From t h e onset o f t h e A d m i n i s t r a t i o n ' s work on t h e h e a l t h
c a r e r e f o r m p r o p o s a l , t h e H e a l t h Care Task Force and i t s Work
Groups have made a c o n c e r t e d e f f o r t t o reach o u t t o House and
Senate Republicans f o r t h e i r guidance and s u p p o r t . We b e l i e v e i t
i s e s s e n t i a l t o have t h e i r i n v o l v e m e n t t o make t h e package as
s t r o n g as p o s s i b l e and t o assure i t prompt and necessary passage.
We a r e t h e r e f o r e concerned t h a t t h e r e i s any p e r c e p t i o n t h a t t h e
White House, i n any way, has n o t a c t i v e l y sought t h e a d v i c e and
p a r t i c i p a t i o n o f R e p u b l i c a n s from t h e b e g i n n i n g .
I t i s v e r y i m p o r t a n t t o n o t e t h a t t h e P r e s i d e n t has i n s i s t e d
on s i g n i f i c a n t R e p u b l i c a n i n v o l v e m e n t from t h e moment he
e s t a b l i s h e d t h e H e a l t h Care Task Force. On January 2 6 t h , he
r e q u e s t e d t h a t t h e House and Senate Democratic and R e p u b l i c a n
L e a d e r s h i p a p p o i n t r e p r e s e n t a t i v e s t o t h e Task Force.
Senator
Dole chose h i m s e l f and R e p r e s e n t a t i v e M i c h e l a p p o i n t e d
R e p r e s e n t a t i v e Dennis H a s t e r t ( R - I L ) t o serve on h i s b e h a l f .
Since t h a t t i m e , Mrs. C l i n t o n and/or I r a have a t t e m p t e d t o
h o l d meetings on a v i r t u a l l y weekly b a s i s w i t h House and Senate
Republicans and/or t h e i r s t a f f s .
The House has chosen t o send
i t s Members t o t h e m e e t i n g s , w h i l e t h e Senate H e a l t h Care Task
Force has chosen t o send s t a f f .
The Senate R e p u b l i c a n Task Force
has suggested t h a t more a c t i v e Member-level d i s c u s s i o n s be
d e l a y e d u n t i l we have a b e t t e r sense about what our f i n a l
p r o p o s a l w i l l be. As t h e s e d e c i s i o n s are made, we w i l l r e a c h o u t
t o t h e s e Members a g a i n . I t i s e s s e n t i a l t o remember, however
t h a t we have always encouraged and been open t o m e e t i n g w i t h
Republican Senators.
To h e l p c l e a r up any m i s p e r c e p t i o n w i t h r e g a r d t h i s i s s u e , I
have a t t a c h e d a l i s t o f t h e numerous meetings t h a t Mrs. C l i n t o n ,
I r a Magaziner, Judy Feder and t h e i r designees have h e l d w i t h
R e p u b l i c a n s over t h e l a s t two and h a l f months. I hope you w i l l
f i n d t h i s i n f o r m a t i o n t o be h e l f p u l .
Please do n o t h e s i t a t e t o
c o n t a c t me w i t h any q u e s t i o n s a t 456-2645.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AMD TYPE
004. memo
SUBJECT/TITLE
DATE
Chris Jennings to Hillary Rodham Clinton; re: Congressional
Leadership Meeting (1 page)
04/26/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefing Memos - First Lady, 1993 [5]
2006-0885-F
jp2850
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. SS2(b)|
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA)
b(3) Release would violate a Federal statute |(bX3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(bX4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(bX6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(bX7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions j(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells j(bX9) of the FOIAj
National Security Classified Information 1(a)(1) of the PRAj
F'.elating to the appointment to Federal office |(aX2) of the PRAj
F:elease would violate a Federal statute |(aX3) of the PRAj
V.elease would disclose trade secrets or confidential commercial or
Tinancial information 1(a)(4) of the PRAj
PS R:elease would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C'. Closed in accordance with restrictions contained in donor's deed
of gift.
PRIVI. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RF.. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
A \ D TYPE
005. memo
SUBJECT/TITLE
DATE
Chris Jennings to Hillary Rodham Clinton; re: Meeting with
Chairman John Dingell (2 pages)
04/25/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number;
3681
FOLDER TITLE:
Congressional Briefing Memos - First Lady, 1993 [5]
2006-0885-F
Jp2850
RESTRICTION CODES
Presidential Records Act - j44 U.S.C. 2204(a)j
Freedom of Information Act - jS U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information j(bXl) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency j(bX2) of the FOIAj
b(3) Release would violate a P'ederal statute j(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy j(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(bX7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions j(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIAj
National Security Classified Information j(aXl) of the PRAj
H.elating to the appointment to Federal office j(aX2) of the PRAj
K elease would violate a Federal statute j(aX3) of the PRAj
R elease would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (aXS) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
ptTSonal privacy 1(a)(6) of the PRAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�DRAFT ONLY, SUBJECT TO REVIEW
TOP 15 TARGETED HOUSE MEMBERS
DEMOCRATS:
McCurdy
OK
Cooper
TN
Valentine
NC
Murtha
PA
Chapman
TX
Rowland
GA
Glickman
KS
Volkmer
MO
Dooley
CA
REPUBLICANS
N. Johnson
CT
Leach
IA
Boehlert
NY
Goss
FL
Houghton
NY
Shays
CT
TOP 85 TARGETED HOUSE MEMBERS
DEMOCRATS
Condit
CA
Waters
CA
Schroeder
CO
Gibbons
FL
�DRAFT ONLY, SUBJECT TO REVIEW
Hutto
FL
Bishop
GA
Darden
GA
Johnson
GA
Poshard
IL
Long
IN
Roemer
IN
Hayes
LA
Meehan
MA
Minge
MN
Peterson
MN
Montgomery
MS
Skelton
MO
Swett
NH
Andrews
NJ
Hughes
NJ
Pallone
NJ
Payne
NJ
Torricelli
NJ
LaFalce
NY
Serrano
NY
Hefner
NC
Lancaster
NC
Rose
NC
Price
NC
Applegate
OH
�DRAFT ONLY, SUBJECT TO REVIEW
Fingerhut
OH
Kaptur
OH
Stokes
OH
Brewster
OK
English
OK
Foglietta
PA
Kanjorski
PA
Margolies-Mezvinsky PA
Spratt
SC
Johnson
SO
Clement
TN
Ford
TN
Gordon
TN
Lloyd
TN
Tanner
TN
Andrews
TX
Brooks
TX
Coleman
TX
de l a Garza
TX
Edwards
TX
Green
TX
Gonzalez
TX
Ortiz
TX
Pickle
TX
Sarpaulis
TX
Tejeda
TX
�DRAFT ONLY, S U B J E C T TO
Wilson
TX
Sheperd
UT
Boucher
VA
Pickett
VA
Inlee
VA
REPUBLICANS
Huffington
CA
Castle
DE
Ros-Lehtinen
FL
Snowe
ME
Morella
MO
Blute
MA
Ramstad
MN
Roukema
NJ
Saxton
NJ
Smith
NJ
Zimmer
NJ
Fish
NY
Gilman
NY
Lazio
NY
Molinari
NX-
Quinn
NY
Soloman
NX-
Walsh
NY
Hoke
OH
REVIEW
�DRAFT ONLY, SUBJECT TO REVIEW
Regula
OH
McDade
PA
Weldon
PA
Matchley
RI
Petri
WI
TOP 15 MEMBER ON THE FW LIST
Gingrich
GA
Armey
TX
Thomas
CA
Burton
IN
Walker
PA
Rohrbacher
CA
Kasich
OH
Hyde
IL
DeLay
TX
Dornan
CA
Drier
CA
Sundquist
OK
Cox
CA
McCollum
FL
�April 23, 1993
MEMORANDUM FOR HILLARY RODHAM CLINTON
FROM:
SUBJECT:
Kim Tilley
Briefings for Saturday, April 24th
Attached is the following information for tomorrow:
Logistical Briefing
- Attending Democratic Senators and Spouses List
- Conference Itinerary
Memo from Chris Jennings
Profiles - Senate Democrats
- Target List
Health Costs Without Reform
Briefing for the President
- Talking Points for Senate Diimer
- Issue Concerns of Senators
�April 23, 1993
DEMOCRATIC SENATORS CONFERENCE
DATE:
LOCATION:
TIME:
FROM:
April 24, 1993
Jamestown, VA
9:30 a.m.
Kim Tilley
I. PURPOSE
To share information on the health care reform package and to convince the Democratic
Senators of the Administration's seriousness in passing legislation this year.
II. BACKGROUND
I
As can be seen on the following list, many of the Senators have brought their spouses
and a few have brought their chidren.
|
The relaxed atmosphere should allow more opportunity for a productive exchange with
the Senators. This will be your first chance you've had to meet with many of these
Senators.
III. PARTICIPANTS
Democratic Senators (See attached list.)
Judy Feder
Ira Magaziner
Melanne Verveer
Chris Jennings
IV. PRESS PLAN
Qosed.
�V. SEQUENCE OF EVENTS
o Senator Mitchell introduces HRC;
o HRC remarks - length as necessary;
o Ira and Judy remarks;
o Q&A - HRC, Ira, Judy w/ Members
IV.
REMARKS
See following memo.
�List of Senate Attendees
Senator and Mrs. Daniel Akaka (Millie)
Senator and Mrs. Max Baucus (Wanda)
Senator and Mrs. Jeff Bingaman (Anne)
John (13)
Setxator Barbara Boxer and Stewart Boxer
Senator Bill Bradley
Senator and Mrs. John Breaux (Lois)
Senator Dale Bumpers
Senator and Mrs. Kent Conrad (Lucy)
Senator and Mrs. Tom Daschle (Linda)
Senator Dennis I>eConcii\l
Senator Christopher Dodd
Senator and Mrs. Byron Dorgan (Kim)
Brendan (5) and Haley (3)
Senator Jim Exon
Senator Rvissell Feingold
Senator Wendell Ford
Senator and Mrs. John Glenn (Annie)
Senator Bob Graham
Senator and Mrs. Tom Harkin (Ruth)
Senator and Mrs. Howell Heflin (Elizabeth Ann)
Senator and Mrs. Fritz HoUlngs (Peatsy)
Senator and Mrs. Bennett Johnston (Mary)
Senator Edward Kennedy
Senator Robert Kerrey
Senator John Kerry
Senator Frank Lautenberg and Bonnie Englelwrt
Senator and Mrs. Patrick Leahy (Marcelle)
Senator and Mrs. Carl Levin (Barbara)
tz\
r^ir
Senator and Mrs. Joseph Lieberman (Hadassah)
Hannah (5) and au pair
Senator and Mrs. Harlan Mathews (Patsy)
Senator and Mrs. Howard Metzenbaum (Shirley)
Seruitor Barbara Mikulski
Senator George Mitchell
Senator Carol Moseley-Braun
Senator Patrick Moynihan
^ . /--v
Senator Patty Murray and Rob Munray
Ha ndy (l 6) and Sarah 03)
Senator Sam Nuim
Senator Claiborne Pell
Senator David Pryor
Senaotr and Mrs. Harry Reid (Undra)
Senator and Mrs. Don Riegle (ton)
A^niey w) ano
Senator and Mrs. Cnarles Robb (Lynda)
Senator Jay Rockefeller
Senator and Mrs. Paul Sarbanes (Christine)
Senator and Mrs. Paul Simon (Jeanne)
Senator and Mrs. Paul WeUstone (Sheila)
Senator and Mrs. Harris Wofford (Clare)
r
�Democratic Conference Schedule
Friday, April 23, 1993
9:00 a.m.
11:30 a.m.
11:45 a.m.1:00 p.m.
1:00 - 2:30 p.m.
Bus departs Fort Myer Memorial Chapel ior Jamestown
Box breakfast and coffee to be served
Conference registration
Luncheon buffet
Panel 1: State of the Nation/Mood of the Electorate
Lobby
Plflniatlon
Plantation
Tazewell
•
Sen. Bob Graham
Moderator
• Stan Greenberg, President
Greenberg Research
• Mandy Gmnwald, Partner
Grunwald, Eskew and Donilon
• Bob Shrum. Founding Partner
Doak, Shrum, Harris, Carrier, Devine
2:30 p.m.
2:45 - 4:45 p.m.
Break
Panel 2: The Administration's Economic Policy
Tazewell
•
Sen. Wendell Ford
Moderator
• Hon. Robert B. Reich
Secretary of Labor
• Hon. Kobert E. Rubin
Assistant to the President for Economic Policy
• Dr. Laura D'Andrea Tyson
Chair. Council of Economic Advisors
4:45 - 6:00 p.m.
Free time
6:00 • 7:00 p.m.
Reception
7:00 - 9.00 p.m.
Dinner/Speaker
Introduced by Sen. Barbara Mikulski
Hon. Madeleine K. Albright
U.S. Ambassador to the United Nations
Moody's Tavern
Plantation
�Democratic Conference Schedule
Saturday, April 24,1993
7:00 - 9:00 a.m.
9.-00-11:00 a.m.
Burwell
Breakfast
Tazewell
Panel 3: Health Care Policy
Presentation ot Policy Options
11H)0-11:15 a.m.
11.15 a.m.12:00 Noon
12:00-2:00 p.m.
•
Senator George J. Mitchell
Moderator
.
First Lady Hillary Rodham Clinton, Chair
Health Care Task Force
•
Hon. Ira Magaziner
Senior Advisor to the President for Policy Development
.
Hon. Judy Feder
Deputy Assistant Secretary for Planning and Evaluation.
Department ot Healtn and Human services
Break
Communication Strategies lor Healtti Care
•
Sen. Tom Daschle
Moderator
•
Arnold Bennett, Media Director
Families USA
Luncheon/Speaker
•
Tazewell
Plantation
introduced by Sen. Claiborne Pell
Ambatsador^aaarge and Special Advisor to the Secretary of
State on the Newly Independent States
2.00 • 6:45 p.m.
Free time
7:00 - 8:00 p.m.
Reception
8:00 p.m.
Dinner
,^ ^ _
President Clinton and Vice President Gore
Plantation Deck
Plantation/Burwell
�Democratic Conference Schedule
Sunday, April 25,1993
7:00 - 9:00 a.m.
10:00 a.m.
9:00-11:00 a.m.
^\^3lt^.
Breakfast
Have bags ready for pickup in room (bus nders only)
Church (on your own)
Lunch with Senator Mitchell
•
12:30 p.m.
3:00 p.m.
Burwell
Private session for Members and spouses only
Depart Conference Center
Arrival at Fort Myer Memorial Chapel
Riverview/Golf Club
�PERSONAL AND eONFIDgNTtAfe MEMORANDUM
DETERMINED TO BE AN AD.MINISTRATIVE
MARKING Per EJ9. 12958 as amended, Sec^3.3 (c)
InitiaU- ' A G S ^ \
Date:_Lf^
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings
Senate Retreat
Melanne, Steve, Distribution
April 22, 1993
It is not an overstatement to say that this Saturday's Senate retreat represents an
extremely important opportunity to convince a generally skeptical group of Senators that
pasXg heaUh care reJorm this year is not only achievable, but des rable. The best way
raccomplish this goal is to clearly illustrate that it is in the nation's economic mterest
to pass reform and! more importantly, it is politically attractive and necessary to do so.
Consultations with the Senate Democratic Policy Committee (DPC). Membe^
and their staff, as well as the political (Steve) and commumcations staff withm the White
House, have produced a virtual consensus that the best presentation you can make is
more inspirational than it is substantive. Your presentation will probably be most
effective if it addresses Members' gut concerns, rather than their generally limited policy
interests.
In effect, you need to set the stage for the Senators to be willing and interested in
eiving fair and full consideration to Ira's and Judy's presentation that will immediately
follow yours. Based on our recent discussions, we have concluded that it would appear
to be advisable for you to consider touching on the following points m your presentation:
Economic and Political Benefits of Passing Reform.
POSSIBLE DISCUSSION: The status quo will bankrupt our people, our
businesses, and the Government. Our constituents desperately want reform. Not
acting on a need so great will blow an opportunity to deliver on their desire for us
to help provide health care security. (This would be a great spot to discuss what
you have seen and heard in your travels around the country).
�Pride in the Policy Development Process.
...
,
P S S S I B L E DISCUSSION: (Mrs. Clinton: There have been so ^lany <:nticisms of
fhe process that we think you might want to take this opportumty to briefly - and
with light humor address this issue). A few specific suggestions:
- Critics Charpe We Have a Closed Process.
POSSIBLE DISCUSSION: The truth and irony is that our process may well be
ihe most open in the history of the Federal Government. How can anyone
seriously argue that 500 people, made up of over 100 C:ongressional staff
r^embers, wdl over 50 physicians, numerous other health care professionals
(including nurses, social workers, pharmacists, and many others) a.nd
eprese^^^^^^^^^^ from virtually every Department within the A d m i m — is a
closed process? This OPEN, albeit unwieldy, process has yielded some of the best
wo
ffiS
ever been produced by the Federal Govermnent. I am particularly
proud and appreciative of the Congressional involvement of you and your taffe.
In fact, at least 24 of the Members represented today graciously have lent their
talented staff to this work effort.
- rritirs (liarge Outside Interp'^t^ Have Been Shut-Qutpn<;STRLE DISCUSSION: If these criticisms were not taken so seriously, tney
would be humorous. The fact of the matter is that we have held meetings with
well over 500 different organizations in just the last 2 months.
.- Critics Charpe We are Moving; Too Fast.
P O ? i S l l 5 i f e j S S I O N : If we are going to pass a bill this year, we must move
qdckly enough to get a bill up to the Congress in time for action. We wJl not
sacrifice the quality of our work, but deadlines are forcing us to produce the
i X m a t i o n we need to make sound and timely policy recommendations to the
President.
The Numbers Must Be Accurate.
^ ^ v i.
POSSIBLE DISCUSSION: The detailed process we have undertaken is
producing some of the most solid health care numbers ever produced^ This is
e sential because we all know that the numbers drive much of the debate^^^^^^^^^^
their accuracy is essential to making informed decisions. We are detenmned to
assure that any policy decisions you or we make are not undermined by last
S o n d re-estimates Although we have made great progress m obtaimng accurate
numbers, we still are not yet where we want them to be. You can be assured,
however, that we will share them with you as soon as they are.
What we do know is this: Americans spend an enormous amount of money on
health care today. As the attached chart documents, taxpayers are not only paying
�significant private premiums, but they are also underwriting enonnous public
health costs.
Members Must Be Comfortable With, and Have Contributed to, the Policy.
OTL:
and
Z ^ U n , •« ^^ow a„d n^d ^0 Know
more about All of you can make contributions to our decisions that will make
Se PrSwent-rprl^^^^ stronger. We want to build on the discussions we have
?a« and berintaemiveconsultations with you. We will be setung up the best
tay to acMeve iSs though Senator Mitchell, but we are committed to heanng and
learning from you.
The Policy and the Message About the Policy Must Be Simple.
^ S S f f i L E D^^^^^^
As we are developing the policy, we are well aware f h ^ ^ to ma^^^^^^
suggestions made by many of you - that we must strive
t o ^ k e both ?he new system and a way to explain it very simple. We must for
example develop the best ways to discuss and illustrate what we are already
paTngtr he^^^^
so that everyone focuses on system-wide costs and savmgs,
and not just Federal budget impacts.
AS we are doing this, we and all Democrats must be ^^le to h^hlight t^^^^^^^^^
in 30-60 second sound-bites, and be able to explain and defend it to constituents
in 5 n^nurprese^^^^^^^
We are spending a great deal of time and resources m
s t u d S o w best to do this. With the benefit of your own experience and the
wof^wfarrdoTng in this area, we are confident that we will achieve the goal of
simplicity and comfort with the plan and its description.
Health Care Reform is Important to Achieve This Year.
pSsmL^Dlf^^
We know this task will be difficult, and we know the
Senate has a great deal of work to do in a relatively short pertod of time We
beSeve, t r u ^ t h a t working in close consultation with the leadership, Chainnen
and all other Members, we can and we will get the job done.
Health Care: A Promising Opportunity, Not a Political Burden.
P S B L T D I S C U S S I O N : Mrs. Clinton: This could be the conclusion of your
femarl^ You may want to discuss how many of these Members have been
ar^nTfor year^ if not decades, and have become increasingly frustrated about
C mtle p^o^^^^^^ has been made on this and many other in^portant issues. If
pass he^h care reform, we may be able to break this cycle -dj-^^^^^^^
address the needs and desires of their constituents. (We want Senators to start to
Lei Uke they want to do health care refonn - not out of any obligation to the
�President, you, or anyone else - but because they believe it is in their constituents
and their own interest to do so).
CONCLUSION
Following your presentation, Ira and Judy will provide a broad and brief
description of the direction the President and you are headed emphasizing how he p an
would address the system's current problems/shortcomings. (A copy of the shdes that
they will use in their discussion is attached). •
After Ira and Judy speak, the DPC is hoping there will be ample time remaining
for YOU Ira and Judy to field questions and suggestions from the Senators. (It would,
therefore, appear to make sense that you stay up front with Ira and Judy as they are
making their presentation).
Finally, also attached for your use, is a health care summary of each of the
Democrats who are scheduled to be in attendance. Also enclosed is a hst of ten
Senators who we believe it would be particularly helpful you attempt to -buttonhole if
you get any opportunity to do so.
�P R O F I L E S - gFNATF. DEMOCRATS
SFN DANIEL AKAKA (D-HI) - State Flexibility is of primary importance to Senator
S a ^
v l ; i l 3 a waive/to allow Hawaii to conUnue its present system. He is a
co-sponsor of Health America.
Recent Developments: Hawaii is moving to press the House ^"^^ Senate Comim^^^^^
obSn ^ E R I S A waiver as soon as possible even if that means before health reform is
Itis possible he may raise this issue with you. He has also asked that a s aff
P s o n who specializes in mental health serve on the working group addressing that
issue.
cfTvi MAY RAT i n IS fD-MT) - Senator Baucus was a member of the Pepper
C o L ^ n XVLta^^^^^
he voted against thefinalaccess recommendations
ahrwon by ju^t an 8-7 vo e), primarily because of his concern about the proposal s
moacTon smSl business. Baucus is concemed about any proposal that utilizes any
e3over r e Z ement to helpfinancehealth care. As a result of this concern, and
" ^ ! ^ l e i Z ^ Z ^ ^ n system'is quite popular in Montana, he is a single-payer advocate.
He is a member of a 5-Member working group (Daschle, Kerrey, Bingaman, and
WoffordTthTi looking at alternatives to employer-based models. Tins group wrote to
Z on Febrtiary 3rd on principles which should be incorporated into a managed
including universal participation (no opt-outs), state or regional
a ^ S a t i o t a n d phase-in of coverage for long-term care. More recently, on March
^ Z T e sent a letter with 8 Democratic Senatorsfrommral states expressing their belief
?ht'the X c ^ r o f realth budgets among states should not be based on historical costs
but on the trtie cost of providing appropriate level of care to a state's residents.
Senator Baucus believes health reform must include real cost ^o^taimnent semiti^ty to
WUimate small business concerns, and the advisability of a special consuleration for
xSaUonce^ We have been advised by staff that he is very committed to the concept
S e l T c T t S n being the HPIC or health alliance. In addition, he apparently would be
supportive of a VAT tax for health care.
Recent Developments: At a the April 20th meeting with Fiance Committee members.
Sen Bau^s stressed the need for the plan to contain costs with some sort of global
budget He shared the view of other committee members that you should take longer if
�necessary, but make sure it is done right.
SEN lEFF BINGAMAN (D-NM) - Senator Jeff Bingaman joined Senate Labor and
Human Resources committee in May of 1990. While he does not have a long record on
the issue of health care reform, he has been exhibiting increasing interest in the subject.
He supports the managed competition model's focus on market adjustment of health
care costs but has also supported an evenmal cap on health care spending. He has
cosponsored legislation with Senator Durenberger to implement the Jackson Hole group
recommendations (a managed competition model which rejects global budgets).
However, in hearings last December of the Labor Committee, Bingaman expresses
strong support for the idea of a global budget to "limit the amount of revenue going into
the system, limit the amount of premiums that people can pay into the HPICs. He is a
strong advocate of rural health and prevention. He has expressed concem about the
effects that employer-based health care reform could have on small businesses.
Recent Developments:
Reportedly, Sen. Bingaman was unhappy over our language
change from "HIPC" to "Alliance." Bingaman feels that "cooperatives" are mral friendly.
SEN BARBARA BOXER (D-CA) - As a new member of the Senate, Boxer is very
interested in working with the leadership. While in the House, she co-sponsored the
Russo single payer bill (predecessor to the current McDermott Bill) but was not an
enthusiast. She is particularly interested in issues concerning women and children.
Senator Boxer is believes that health care reform should cover reproductive services,
including abortion services.
Senator Boxer outlined her basic approach to health care refonn in a letter to the First
Lady on Febmary 5th. In the letter, the Senator emphasized the following pnnciples:
care should be affordable and universal; benefits should not only be employment based;
and coverage should include professionals other than doctors. To achieve these goals,
the Senator called for a minimum benefits package, increased preventative care, the
coverage of reproductive services, increased public health education, services for women
in crisis, and services for children. Finally, the Senator called for "full representation for
women on any boards, advisory committees or any other bodies created by health reform
legislation.
In meetings with the HCTF, she has also expressed concerns over how the veterans
health system will be integrated into the plan.
,
r .
Recent Developments: She has strongly urged that abortion services be covered up front
in the benefit package and protected from any hostile amendment on the Senate hloov.
She feels so strongly about this that we are concerned that she may raise this issue in
Saturday's Question and Answer Session.
�SFN BILL BRADLEY (D-NJ) - Senator Bradley is known more for his work on tax
policy t^^^
health care financing. He has
cated an —
^^^^
introducing health care reform legislation similar to managed ^^P.^.t^t^J^ ^^^^^^^^
believes the President has been advocating. The one exception to his general support ot
W s effort 7o Muence the industry to contain price increases to inflation by hnkmg
fhrprfdng behalr to eligibility for tax credits. (THe Pi^or proposal was endorsed by
President Clinton in the campaign).
As a member of the Infant Mortality Commission, Senator Bradley is proud of his work
^fen.^rthat the Medicaid program was expanded to eventually cover pregnant women
H HH. He Ifso^a stro^^^
for preventative care services. He has sponsored
:etraf billfon X^^^^
warning labels and tobacco as a dmg to be
S e d in tSe Dmg Ree Schods program. Lastly, although he incurred the v^ath of
Tome ltiZ. groups with his opposition to prescription dmg price constramt, he has been
aTn^ttal fupporter of home and community-based long term care services, particularly
with regard to respite care services.
Recent Developments: At this week's Finance Committee meeting. Sen Bradley asked
for a^ est7mate of how much the plan is going to cost, and how much revenue is
expected to be needed. He is very concerned about taxes.
SFN TOHN BREAUX (D-LA) - Senator Breaux is the second most junior Member of
fhe F i n a n c ^ C o ^ t t He is one of those "up and coming" New Democrats for whom
r^Lv L e a brigh^^^
His politics are moderate to conservative but he is known
S a pral^ t^than a idealogue. In the area of health care, Breaux is yet another
of the C o i L i L e members who care deeply about small businesses and mral health
care.
Previous to this year. Senator Breaux was not overly active in health care issues. That
I Z ^ d ^ ^ V ^ M r ^ ^ ^ ^ ^ ^ the Conseivative Democratic Fomm's managed competi^^^^
bUl 4 h Senator Boren in 1992. He is very concemed, however, about the bill s
Umi^fiom with regard to assuring adequate access to health care in mral areas. He is
alTconSrred abfut whether this approach will actually achieve broad-based costs
satdnr S t e this, he remains uncomfortable with alternative approaches and he 1
TntTo m a k r l r l that the Conservative Democratic Fomm's models u^^^^^ as much as
possible during the upcoming debate. He opposes pnce caps andfreezesto control
costs.
Recent Developments: At the Finance Committee meeting Sen. Breaux stated that he
�reform.
SEN. DALE BUMPERS (D-AR) - Bumpers ha^wal^d to see ^ ^ ^ ^ ^ l l J ^ - ^ f ^ i : : !
l i : L " 1 1 : h t r p — ^
S X nteds of smaU business.
I s vorknowTe hS great concern about children's issues. He therefore can be
^ l « e S p o n coverage of children be phased-in firs, if such a phase-in is
necessary.
C17XI iriTMT roNRAD fD-ND) - Kent Conrad is the newest member of the Senate
^ l l m p l c f s th^Tderal deficit. He opposes large new taxes to support reform.
=w^st=:^utx:;dS=p^^^^
well as cunent access and delivery issues. He is aware of successful "^odds from his
Insutficiem funding has led to rationing of services. He also feels the IHS has not been
sufficiently responsive to Congress or tribal leadership.
Recently, Chris Jemiings and ChrisUne Heenan gave him a general health c^re
hackeround briefing. (He had missed one given by Ira and wanted a pr vate meeting),
n f r " 7 ^ appredative and appeared to feel much better about the direction the
Presidem and you are heading by the conclusion of the discussion.
Recent Developments: At the Finance Meeting this week Sen Conrad was veoc^cerneHbout mandates. He fears that small businesses will be saddled with too
much.
SEN TOM DASCHLE (D-SD) - Senator Daschle is the Co-Chair of the Democratic
altemative approaches to health reform. This group has been relatively qmet lately.
�seeming to be comfortable with working with and through the DPC health policy group.
Personally Daschle is much more comfortable with a single-payer type approach to
heluh care primarily because he believes it is a much easier political sell to his small
bus ne^foto and the rest of his constituents. He joined Senator Harris Wofford in
taoducingTegUlation (S.2513) to achieve this end. Daschle is a team player however.
T p a r t JtteSenate leadership, he can be counted on to push his agenda as far as it
S^'go"but he will also do everything he can to assure that we pass comprehensive
reform and the President's plan.
In addition. Senator Daschle is one of the signatories of a March 30th letter opposing
the allocation of the global budget among states based on histonc costs. He is very
concemed that mral states would be discriminated against usmg such a formula.
Senator Daschle also worries that people don't understand the real costs of the current
health system and how they are paying too much m direct and mdirect spendmg. He
feels that education regarding these costs are critical so that people don t feel the new
system will cost them too much money. Lastly, Senator Daschle also supports
restmcturing graduate medical education to emphasize pnmary care.
Most recently, Senator Daschle has requested that you join him in South Dakota at some
health care event at some point in thefriture.We are trying to be responsive to a
request by him to get someonefromwith working groups to go to an early May event
Recent De^eloTments: At the meeting with the Finance Committee "^^^^^^^ this week
he again expressed his belief that we need to use new language m describing the plan for
example using "system-wide" rather than "Federal program". Changing the language will
change people's perception.
SEN DENNIS DECONCINI (D-AZ) - DeConcini, who is up for re-election in 1994 and
recently separated from his wife, is opposed to new taxes paying for the health care
package While he is willing to work with the concept of managed competition, he wants
to prese"rve some of the cunent system He is particularly concemed about the effec s
on small business and incentives for doctors to treat Medicaid patients. Wh^l^ he has
not raised it so far, he will presmnably also be worried about undocumented workers and
Native Americans.
SEN BYRON DORGAN (D-ND)) - He can be expected to back the package as long as
careful attention is really given to the problems of mral areas In addition to rural
health care, his major concem is cost containment. He can also be expected watch out
for coverage for Native Americans.
�SFN TAMES EXON (D-NE) - While Exon has put forth a wait-and-see attitude he
coHea^rSen. Kerrey can influence him but Kerrey's support tor the plan will not
guarantee Exon's support.
SEN RUSSELL FEINGOLD (D-WI) - AfreshmanSenator, Feingold has ajso adopted a
wak Vnd^^fee a i ^
but is likely to support the President. In meetings with the HCTF
r i ^ d i s ^ s ^ d S^^^^
for long term health care, particularly home and commumty
bLe?care for the elderly and the disabled. He is also concerned abut coverage for
f ^ ^ c r M c ^ ^ ^ ^ ^ ^ level he was a sponsor of single-payer legislation m Wisconsm.
SFN WENDELL FORD (D-KY) - The Chairman of the Rules Committee will want to
s u o t X P^esidT Dm^^^ his reelection campaign this year he talked about wanting
r w o r > ^ t h r;^^^^^^^^^ who would sign health care legislation passed by the Congres.
but he is also afierceprotector of the interests of his state. As he says, if it s not good
for Ken ucky I'm not for it." As a result Ford can be expected to fight a tobacco tax.
H e S s o ne'rvous about mandated benefits and wants freedom of choice for consumers^
He also has a personal interest in health care since his brother-in-law is a pediatrician m
Kentucky. However, he has also stated that he believes physicians are overpaid.
SFN TOHN GLENN (D-OH) - Glenn has held hearings into the German and French
S n i ^ o d e r f o r h^^^^^
He supported pay or play but not the Leadership s
H e a l ^ e r i c a bill. His concerns include the impact of reformon^^^a^l business,
retiree health benefits, and potenfial changes to Medicare and Medicaid.
In a previous meeting with the DPC he questioned where the savings would come from
n theTw system. He thinks that doctors have been unfairly vilified m debates over
hellth caTe costs He says that their income accounts for less than one-fifth of health
L r Ven^^^^^^^^^^
-trigue^
' ' ' ' ' P ^ " ^ ^ ^ ' ^ lifetime health care costs
whTch occur during the last four months of life as an area for health savings.
As chainnan of the Govemment Affairs Committee, he is likely to be interested in and
^ t i f e ™ ved with any proposal that would fold the FEHBP P ^ - - ^ X u h T
system Since advocates for federal employees are now strongly advocating that they
houM be treated the same as large employers, they are hkely to express senous
reservafions about the currently envisioned program. It is therefore advisable fo meet
;^th CWmian Glemi and other Chairmen of jurisdiction before any decision is made
public.
�SFN ROB GRAHAM (D-FL) - Graham wants fo support the President and not
n^.iK;i;tv He is okav on employer mandates and wants to be a player on giuua
flexibility. "^J^^,
^^^^^^ if Florida was somehow adversely affected in
&
the Public Health System.
SFN TOM HARKIN (D-U) - Senator Harkin has not sponsored any «f<>™ 1=^'^''°"
S " ' . a r
r e f L approach^ He ^ ^ J ^ : ^ ^ ^ ^ ^ ^ : ^ : ^ ^ ' ^ ^
will need to be components of an overa plai. He h^ C a l Health Care Coalition. He
^:*sTto heaTtrcare
long-.efm care for people with disabihties is a major
concern.
He is especially interested in prevention, sponsored a bill giying money to states for
So^f'f^.o'i^-^^^^^^^^^
on p™Uc h e l ie^lation andfanding.Inclusion of prevenuve services in benefit
package will be key. Harkin opposes co-pays for these services.
Hr.wi?l I HFFLIN (D-AL) - Heflin has been noncommittal, preferring to wait tor
need education on the issue.
SFN FRNEST HOLLINGS (D-SC) - While Hollings wants fo support the President's
S
he^oni"d a^^^^^^^^^
items: employer mandates without cost contro s;
plan^ tie is worrieu
testimony when cost savings might be realized under a
mral coverage; and by the CBO testimony^w
^
.^^^^^^^
instead for a ^ ^ . ^ ^ ^ ^ J ^ ^
^th Ira he has stated his hope that the money
^1 b^ r h l n T l ^ n T b i U i^^^^^^^^^^^^
support for a single vote on the package.
SFN RFNNETT JOHNSTON (D-LA) - Sen. Johnston has been noncommittal on health
concerr^^
(
impact on small business and rural areas. His major concern is
�preventive care and he will be willing fo compromise on other issues if it is made a high
nrioritv in the oackaee. While he is not opposed to managed competition he sees
I Z ^ r ^ ^ ^ r l ^ Z l pricing. In discussfons with the HCTF in the past, he has asked
whetheTe^Une will be in the HPIC and whether doctors will be able to charge higher
foes outstdeT^^ package. Johnston is also concerned with thefinancingof the health
care package.
SFN EDWARD KENNEDY (D-MA) - Senator Kemiedy, Chairman of Labor and Human
R e r ^ ^ c T c ^ t o e e , is the Senator most closely associated with health care issues. He
h i been working on W e h e n s i v e health reform issues for well over two decades.
X u g h previously a strong single payor advocate, in recent years, Kemtedy has moved
W employer-based approaches because he believes that usmg business to sigmf cantly
u n d S e the cost of health reform wiU substantially reduce the need tor tax federal
tacre^es and therefore make the package more sellable to both the Congress and the
American public.
He joined with Majority Leader Mitchell, Senator Rockefeller and Senator Riegle in
"triducing a play or pay employer-based health care model. Despite the backing of
these S o c r L i c
it received surprisingly little rank-and-file support. Perhaps
i a result of this, he has come to believe that only a plan backed by a President can be
enacted For this reason, Kennedy will likely be open fo any comprehensive reform
approach that meets the criteria of universal coverage, cost containment and quahty
assurance.
He is also concemed about coverage for long-term care He introduced a substantial
and expensive ($45 billion a year when frilly phased-in) long-term care plan with Senator
Mitchell. This also gamered little support. Altematively, he worked with Senators
Pryor Hatch, Packwood and Bentsen in passing a long term care insurance standards
bill This attempt was blocked because it did not include the tax clanfications that the
insurance industry sought in any type of insurance standard package for long terni care.
In addition fo all these refonn efforts, Senafor Kemiedy has been extremely active in the
public health service areas. His interests are broad ranging, from concen^ about tobacco
advertising fo adequate fiinding of AIDS research and services, to Head Start to
extensive oversight over FDA, fo an effective illicit dmg strategy to minonty health.
Recent Developments: Most recently making press for primary or sole jurisdiction over
Health Care Refonn. Howard, Steve and Chris met with Labor Committee Statt
Direcfor Nick Littlefield last week. At that meeting he was informed that we
appreciated their suggestions but would defer to majority leader on this highly
controversial issue. The Committee has also agreed to hold heanngs that are consistent
with our message in early fo mid May. Specifically, they will focus on the cost of not
doing health reform and the cost effectiveness of mental health coverage in the benefit
8
�package. Lastly, he wUl want to be significantly consulted in the upcoming weeks.
SEN. BOB KERREY (D-NE) - K e - y has displayed a k^^^^^^^^^^
the centerpieces of his presidential bid.
in the last Congress, Sen. Kerrey introduced ^ comprehensive hea^^^ ? o " e p U h i ; '
expressed interest in providing language to help sell the plan,
of a comprehensive plan.
SFN TOHN KERRY (D-MA) - Senator John Kerry has represented Massachusetts since
m 4 S r ™ i s I T i o i o w n for his involvement with the POW/MIA issue. Not
Town ?o be a ml^r player on health policy in the Senate, he does have some sigmficant
t m ^ l l s He favors a managed competition approach fo reform and wants to
suoDort th^^^
Administrative simplification and insurance reform are of
oarfi^ ar t n S W fo protect biomedical and biotech industry, which is a growth
L c ^ ^ M S ^
Senator Keny is a Vietnam veteran, and may be sensitive to
major changes in the VA. Senator Kerry warns that expectations are high and urges
regular meetings with Senators.
SEN FRANK LAUTENBERG (D-NJ) - Senator Lautenberg is very concerned that
heahh r ^ m will hit two big industries in New Jersey: pharmaceuticals and insurance
comrade"
wifh the fact that he up for re-election n 1994, which mean
S h n e s on certain aspects of the plans. Governor Florio re-election effort m 1993,
�may also influence Senator Lautenberg's vote. The pushed by Sen. D^hle on Single
Paver he resisted saying he was in the Managed Competition mode. While nervous
IbTut'emp^ee manlfes, Uutenberg wants to be part of the whole team and beheves
he can sewe as a liaison with the business community. Other concerns include
transpor^aTon services to help provide access to health care in rural areas and about the
ovemse of technology.
SEN PATRICK LEAHY (D-VT) - Senafor Leahy is chairman of the Senate Agriculture
ComnSu™ AS such, he notes that one quarter of all Americans Uve in mral areas and
pro^sions need to be made to ensure that they have access to needed health care
s e ^ c « . He was one of the few cosponsors of the leadership's HealthAmerica Bill and
s hkely to support the Administration's plan. leahy will want to see provisions m the
e S o nfor^stateflexibilityso that they can move ahead now In the last congress he
s p o C e d the Leahy-Pryor bill, legislation endorsed by the NGA, to provide waivers to
states wilUng to undertake comprehensive health care reform.
Recent Developments: Senator Leahy was recently upset about a mmor that the
Administration was going to name the provision on stateflexibihtyin he reform
legislation for his Republican Senate colleaguefromVermont, Jim Jeffords. In
c ^ ^ e ^ ^ i l with the Senator's office, Chris Jemiings reassured his staff that there was
no tmth fo this mmor and that we appreciated and undersfood the Senator s
fongstanding interest in and leadership on this issue. He is very interested m holding an
evem in Vermont, perhaps highlighting theflexibilityissue, and would like fo work with
us on It.
SEN CARL LEVIN (D-MI) - Senator Carl Levin has served Michigan smce 1978 His
brother, Sander, serves in the House of Representatives, and is a member of the House
Ways and Means Committee. Along with Senafor Riegle, they are protective of
Michigan's aufo industry, unions, and the union's retirees. Senator Levin is concerned
2 u t cost control, and is veiy concerned about the President's plan having sufficient cost
confrol mechanisms (a chief concern of orgamzed labor and large mdustnal
manufacturers of his state). He want states fo haveflexibilityto design and impkment
their own cost control measures. Senator levin is also womed that a tax cap will be a
benefits reduction (another union concern). He has also wanted to know how many will
have greater benefits than minimum benefits. Senafor levin also has ^'•al ^"'l,^"^^^ ^^^
business concems. The Senafor supports inclusion of good primary Feventive hospice
and home care services in the refonn package, a co-sponsor of HealthAmerica in the
lS2nd Congress, Senator Levin favors Managed Competifion and is on record as wantmg
to support the Administration's plan.
SEN JOSEPH LIEBERMAN (D-CT) - Senafor Ueberman is in hisfirstterm and is up
for r*e-election in 1994. Generally, he is supportive of Managed Competition (he liked
10
�the Cooper Bill), but has a real problem with global budgets and caps. He believes,
however, that the plan needs to have significant cost containment.
The Senator believes that before the plan is amiounced, the White "ous^^^^^^^^^^^
nrocess to hear people's concerns. He also thinks that it is critical to educate the public
roeoDle understand the problems with our health system, and what solutions are
nec'esL'^He"^^^^^^
we may lose the middle class because of a big new tax.
He Is eS^ouraged by what he has heard about the Admimstration's proposal, but has a
wait and see attitude.
SEN HARLAN MATHEWS (D-TN) - Senator Mathews was appointed to fill the term of
v l ^ P ^ d ^ G o r e . He is not interested in retuming to the Senate, and ^^all serve until
T Z I I S ^ elect a new senator to fill the Vice President's term. S-ator Ma^^^^^^^^^^
generally supportive of the Managed Competition concept. And while he has not backed
?he a d " a S o n ^ reform efforts publicly, he is supportive with some m o d ~ s ^
He would^like to see more action on the state level, especially experimental programs.
Vice President Gore will be influential in getting his vote.
SEN HOWARD METZENBAUM (D-OH) - Senator Metzenbaum strongly believes in
fhe neeJforhealth care reform and has cosponsored Senator Wellstone's single payer
m
He is concemed about the managed compefition approach because he fears tha^^it
is too easy on the special interests, especially the insurance companies. He beheves to
tmly r e f ^ L t^^^ health care system, the Administration must be willing to take on and
defeat the special imerests and take the program to the American people He views
health care Is a social good that should be provided to all people and tha the system
should be based on providing services to the people at lowest possible costs.
Metzenbaum sfrongly favors rate setting and a national budget.
Senator Metzenbaum also favors eliminafing fraud and abuse in the system. He h ^
malor JrWcism of HCFA for not feneting out fraud and abuse. Other concems are anti3
(He chairs the Judiciary subcommittee), malpractice reform and long-term care.
Recent Developments: Senafor Metzenbaum's staff has indicated a great concem about
f h T a p p S Administration infatuation on caps for medical malpractice. He is strong^^^^
ODoosed fo caps and might even oppose the legislation if they are mcluded at the tirne of
S ? S o n He has also expressed concem that quality standards may be vulnerable to
irAdSmstration's decision fo cut back on what we view as umiecessary regulation and
he would like us to proceed cautiously in this area.
SEN BARBARA MIKULSKI (D-MD) - Senator Mikulski is known as an outspoken
fiberklW
family Baltimore roots make her one of the most pragmatic and
11
�sensitive members. She supports the Clinfon health reform plan in principle but is
concerned about the influence of the Jackson Hole group who she calls a bunch of
geriatric Republicans that represent everything that wrong with health care As a former
social worker she would like to see greater use of non-physician health professionals to
deliver care.
She is a champion of women's health and an avid pro-choice advocate. The plans
posifion on women's reproductive health services will be critical. She is concerned about
improving research info women's health and eliminating the gender bias of NIH
research She is also a strong advocate for seniors. She introduced and passed the
Spousal Impoverishment provisions in 1988 so that seniors did not have to spend down
all of their assets fo qualify for benefits. As the new Chairman of the Labor
Subcommittee on Aging, she is promoting the expansion of home and commumty-based
long-term care services.
On the Appropriations Commitfoe, she heads the HUD/VA and Independent Agencies
Subcommittee. VA-the largest managed health care system-is a big concern for
Mikulski She cites the Canadian experience where under the massive change to a single
payer system, vets lost out. Shefoelsstrongly that vets need a seat at the reform table.
Recent Developments: Sen. Mikulski asked for and received meeting for Dr. James
Block president of Johns Hopkins University Medical Center. She appreciated Ira
Magaziner coming fo hill fo meet with him. She wants a Maryland event fo replace the
event cancelled due to snow.
SEN GEORGE MITCHELL (D-ME) - Few Majority Leaders in the Senate's history
have* been as interested and as committed to passing comprehensive health care reforms.
Mitchell is the sponsor of two Senate Democratic leadership comprehensive reform bills
dealing, respectively, with access (S. 1227, Health America) and long-term care (S. 2571,
the Long Term Care Family Security Act). In addition, he is leading an effort by the
Democratic Policy Committee (within the Senate) to attempt to develop consensus on
the health care issue within the Democratic party.
Senator Mitchell believes that the single payer approach is not politically feasible.
However, at this point, his primary concern and commitment is to push through anything,
which can be defined as tmly comprehensive, that will pass the Congress. He has
repeatedly indicated his intention fo work cfosely with the President fo help assure that a
bill can. make it to the White House before the end of the 103rd Congress.
As you know, however, he was a strong advocate of incorporating the health care
legislation into the budget reconciliation bill. Having failed that, he and his lead staff
C'
12
�are now relatively pessimistic about attracting enough Republicans to support a health
reform initiative without having to make major, and perhaps unacceptable, concessions.
Just yesterday, (Sunday, April 18th), he indicated his opposition to price controls, his
uneasiness with but possible opemiess fo a VAT tax for health, and his desire fo wean
out all the fraud, abuse and waste BEFORE contemplating large tax hikes.
SEN CAROL MOSELEY-BRAUN (D-IL) - Senator Mosely-Braun is one of the
freshman members of the Senate. She is a single payer advocate, and is somewhat
skeptical of the managed competifion model. The Senafor believes that there should be
one entity collecting revenues for the health care system, and that health care insurance
providers unnecessarily duplicate services.
The Senator is parficularly interested infinancingmechanisms, and would have
supported Senafor Wellstone's American Health Security Act, introduced March 3, save
for^ her reservafions over his approach to fonding. She is concerned by public reports of
the proposed sin tax, which shefeelswill not be sufficient tofinancehealth care reform.
If a sin tax is not sufficient, and given the tax increases in the President's economic
proposal, the Senator is curious about what other mechanisms the Health Policy lask
Force is considering for revenue.
Sen Moseley-Braun is also interested in the composition and mechanism for creating a
basic package of services. She is interested in seeing an increase in resources and focus
on primary and preventative care. She would also like to make sure that long-term care
is part of the reform package, and was a little concemed about signals sent dunng the
meeting with the Congressional Black Caucus on this issue.
The Senator alsofeelsthat if managed competifion is chosen as the avenue to health
care reform, a mechanism be put in place to insure that health insurance provider
cooperatives have an incentive to serve consumers in urban and mral poverty areas.
Additionally, the Senator is interested in a slow phase-in of veterans into an overall
health reform package.
SEN DANIEL PATRICK MOYNIHAN (D-NY) - As you know, the new Chairman has
yet to take a position on national health reform. His interests Ue primarily in the areas
of Social Security and welfare reform. He is not a detail person when it comes to the
health care debate. Although a number of people have discussed health care with him,
it is notable that the one who seemed to catch his fancy the most was Alan Enthoven.
The only health care-specific issues that the Senator is particularly known for are: (1)
his advocacy and support of New York hospitals, (2) his concern about the mentally ill
and the homeless, (3) his support for chemical and substance abuse in a benefit package,
and, most recently, (4) his support of innovation at the state level. On the latter point,
13
�he introduced a liberalized Medicaid managed care measure that the NGA strongly
supported. (This legislation was opposed by the Children's Defense Fund because they
felt that savings through this cost containment approach would be at the expense ot the
Medicaid population).
Recently, the Chairman and his staff have been rather pessimistic about the chances for
health reform this year. The complexity, controversy, and potential expense of it frighten
them The Chairman, in comments that have been somewhat retracted by statt, has
indicated his concem about any large new taxes to frind the program and any use of
price controls to contain costs. Although he has stated to you his willingness to raise
whatever tax is necessary for the elimination and integration of Medicaid into the new
system, as well as a one card for all system, his nervous statements should not be totally
written off.
Senator Moynihan's most recent communication was in a letfer to the President, in which
he reiterated his strong support for a health security card and in which he proposes the
idea of merging the health card and Social Security card into one. In the letter, he also
expressed his strong concerns that the Social Security Commissioner has not yet been
appointed.
Recent Developments: At your meeting this week with the Senate Finance Committee
Moynihan was among those who agree not to msh this thing. He expressed the view that
the Adminisfration should take more time if needed to do it nght.
SEN PATTY MURRAY (D-WA) - Senator Murray was a state senator before being
elected to the U.S. Senate this past fall. She serves on the Budget, Appropriations and
Banking committees. As a former state legislator, she will be sensitive to ensuring state
flexibility, especially in light of the Washington state legislative health care imtiative.
While she has not taken on a public position on a particular health plan, she has
indicated she wiU likely support the President as long as it extends coverage and allows
for state innovation.
Sen Murray is an advocate for women's health, including extreme concem about breast
cancer and screenings. She also strongly backs long-term care as part of reform. She is
very concerned about eliminating pre-existing conditions exclusions. Senafor Munay will
soon introduce legislation (similar to Congressman Reynold's bill) designed to raise the
excise tax onfirearmsand earmark the revenue for health care.
SEN SAM NUNN (D-GA) - Senator Nunn is known more for his Armed Services
committee work, than for health care. Treatment of CHAMPUS and other Departmem
k
14
�of Defense health programs under the reform plan will be a major concern. Senator
Nunn hasn't taken a posifion on a type of plan. However, he is extremely opposed to
employer mandates. In fact, the Senator states that President Clinton has assured him
the plan v^ll not include employer mandates. He is strongly in favor of fight entitlement
caps. He is unsure how a global budget will work on private spending. As the Senator
from Georgia, he also has strong mral health concems.
Recent Developments: Nunn co-chairs a Commission which will soon be making
recommendations on health care reform along the lines of managed competition.
Reports are that they are leaning towards an individual mandate and it is likely that they
will not support even temporary price controls. It is unclear whether they will endorse
the concept of universality.
SEN. CLAIBORNE PELL (D-RI) - Senator Claiborne Pell is the most senior member of
the Senate Labor and Human Resources Committee and a long-time advocate of "cradle
to grave" health coverage. On health care reform, he is not an ideologue and is not
committed to any method of reform. In 1972, he joined in introducing legislation which
would have mandated employer-based health care reform. As a member who has been
working on the issue for sometime and would be joyous to see actual progress.
Because of his well-to-do elderly constituency. Senator Pell voted to repeal the
Catastrophic Health Care Reform legislation. This is significant because it may indicate
that a prescription dmg benefit that most well-to-do elderly already have will not be
adequately responsive to an influential constituency of his. This helps explain why
Senator Pell's top health care concerns include coverage for long-term care [Rhode
Island has one of the highest percentages of elderly of any in the country] and preventive
services [he is opposed to smoking and has sponsored legislafion to provide grants to
states for health promotion programs] and expanding the use of non-physician health
providers. He also interest in studying other country's health care systems and taking
lessons from their experiences.
SEN. DAVID PRYOR (D-AR) - Senator Pryor is part of the Senate leadership (Secretary
of the Democratic Conference). As the Chairman of the Senate Special Committee on
Aging, he is well liked and respected by the powerful aging advocacy community. In
addition, he is one of the few Democrats that the small business community genuinely
tmsts. Further, his status as a former Governor and his advocacy of state-based
approaches to comprehensive reforms has gained him a great deal of good will with the
Governors. Although an unassuming Member and one who does not get overly involved
in detailed policy discussions, he has also emerged as one of the most influential and
best liked Members of the Senate. All of these roles ensure that he will be a particularly
key player on the health care front.
15
�In terms of health care priorities, dmg cost containmem is the first, second, and third
highest priority for Senafor Piyor. The concept of linking dmg cost containnien to tax
credits (embodied in Pryor's Prescription Dmg Cost Containment Act - S. 2000) was
endorsed by President Clinton.
In addition to his dmg cost containment interests, he also has a notable legislative
achievement record in mral health (relief for hospitals and incentives for primary care
doctors in medically underserved areas), state-based reform (his NGA and Clinfon
candidate-endorsed Leahy/Pryor bill), and long-form care (his proposal for Federal
standards for private long-term care insurance policies).
Recent Developments: At the Finance meeting April 20th, Sen. Pryor supported the view
that more time should be taken fo assure that you do it right. He backs the use of a
dedicated tax for health care, perhaps a VAT. He also backs the mckision of a longterm care benefit. He believes that as long as we will be spending billions of dollars, we
should make certain that it attracts popular support for the plan You may wish to
acknowledge receiving the testimony Senator Pryor sent fo you from the heanng he held
recently on long-term care, parficularly that of the 10-year-old which you found so
moving Also Senafor Pryor has scheduled a hearing on May 6thfocusingon individual
responsibility. You are cunently scheduled to attend a breakfast he is holding
beforehand.
SEN HARRY REID (D-NV) - Senator Harry Reid is in his second term in the Senate.
Traditionally not outspoken on health issues, he spends most of his time with his
Appropriations and Environment and Public Works committees. He hasyet fo take a
position on a particular reform model. He is waiting fo see what the HCTF and the
President have developed. The Senator stresses mral health issues, and wants lead
screening emphasized. Concerned about mandated benefit packages, because he
believes they have not worked at the state level. He is also worried about the impact of
reform on physicians' earnings.
DONALD RIEGLE (D-MI) - Senator Riegle considers himself to be a major player in
the health care debate. He is Chainnan of the Finance Subcommittee on Medicaid and
was a lead sponsor of the Mitchell, RockefeUer, Kennedy "play or pay" health care
refonn proposal. He has always felt he did not get adequafo credit for his work on the
bill Although he sponsored this bill, he appears to be extremely willing to sign on to
virtually any approach that achieves universal coverage and cost containment.
Senator Riegle is very imerested in many health issues, including: child immunization
oroerams, mral health care. Medicare prescription dmg coverage, retiree health liability
concems, long-term care, and a host of others. Senafor Riegle strongly believes that cost
containment savings should be used to help reform the health care system - NOT for
16
�deficit reduction.
Most recently. Senator Riegle has pushed his oufreach efforts with the Medicare
Qua ified Medicare Beneficiary (QMB) program The QMB program pays ^ r the
deductibles, premiums and copays of low-income Medicare beneficiaries Unfortunately,
only about 50 percent of the eligible populatfon receive the benefit. This P r y ^m'
because it is partially underwritten by the states, is one of the most unpopular benefits
?hat the state? support. (Most of the states believe there are higher priorities)^^^^^
rate Senator Riegle has introduced legislation fo expand outreach efforts at SSA offices
and other areas. (The Administration has not yet taken a formal position yet).
Recent Developments: At the April 20th meeting with the Finance Commitfoe he stated
S e r e s l in looking at longer budget periods than five years (he can't understand why
we are always locked info a five year budget plan). He believes t is important to look at
national, nol justfederal,spending because most of the saving will come from the p vafo
sector. He also felt that we needed to look at and change the language used fo explam
the plan.
SENATOR CHUCK ROBB (D-VA) - Senafor Robb believes that cost-containment is the
key and that it should be stringent. He has not taken a position on any particular health
plln, but likes what he hears so far from the Task Force. He is likely to be supportive.
He was an active member the Mitchell working group and was conifortable with its
overall approach. Also, he was a member of the Natfonal Leadership Commission on
Health Care which predafod the National Leadership Coalition. Senafor Robb is up for
re-election in 1994.
SEN TAY ROCKEFELLER (D-WV) - Senator Rockefeller views himself as being (and
is) BUl Clinfon's number one health care advocafo. He was a tireless campaigner and
defender of the CUnfon health care plan and was a NaUonal Co-Chair of the Chnfon
campaign. Rockefeller is the cunent Chairman of the Finance Subcommitfee on
Medicare and Long Term Care. He also has chaired the Pepper Commission and the
National Commission on Children.
In addition. Senator Rockefeller is the founder and Chairman of the Alliance for Health
Reform, a nonpartisan organization dedicated to advance health care reform through
education of public opinion leaders. Lastly, as you weU know, his is now serving as the
new Chairman of the Senate Veterans Committee.
Senator Rockefeller's health care priority is veiy simple: He desperately wants to see a
comprehensive refonn package enacfed during the Clmton Presidency. Although he
thinks the long-forai outcome of such an achievement is politically attractive, he is
primarily pushing this reform because he is sincerely committed fo the need foj reform
In this vein, he is not overly commitfod fo any one particular approach although he has
17
�advocafod an employer-based approach. He, therefore, can counted on to su^
virlually anything the President ends up proposing, as long as it achieves umversal access
and cost containment
s^n^tnr Rockefeller was very pleased with the Veterans' meeting last Thursday He was
"ed"^^^^^^^^^^^^
stoVthe day after, but from the begimiing did not beheve it
was tme.
Recent Developments: At his one on one meeting with you he was upset with Gore,
Bentslr, Pan^^^^ who he thinks are less than supportive of reform. He thinks Moymhan
can be brought on board. He urged using the phone more to increase contact vath
members Hefeltthat of the Finance Committee Republicans that we should go afte
S e e DaSorth and Durenberger (He seemed less confident about Packwood). Will
plaf^; heavy on taxes with the public, press, and members. It may well be worth
S r a t i n g your desire to meet with him on a substantive level over the next few weeks.
SENATOR PAUL SARBANES (D-MD) - Senator Sarbanes is in his third term and is up
for re-efectfon in 1994. He originally supporfod Kemiedy's Single Payer plan in 1972, bu
:ai :e: h won't work today. Cunently, he is not committed to a ^ P ^ c — h ^^^^^ is
«o^n tn different ootions He has a wait and see attitude on the HCTP dehberations,
E r w " h : & ^ and WiU support Mitchell, Rockefeller and the Democratic
Leadership.
SENATOR PAUL SIMON (D-IL) - Senator Simon is very inforesfod in health care
feforni and leans toward a single payer approach but also cosponsored the Leadership s
H e a S L e r i c a bill. He is close fo organized labor and sponsored ajndmen^o
strengthen the cost contaimnent provisions of HealthAmenca proposed by the AFL-CIO.
He h S also been one of the Senate's strongest advocatesforlong-form care and has
" spo^ored m^^^^^^^^^ this area. He is very inforested in children's and tmnority
issues He has a long standing inforest in education issues, pamcularly higher education.
He ?s a^trong supp^^^^^ of increasing enrolhnent of minorities in health professional
schools.
Recent Developments: Sea Simon recently met with Robyn Stone and reiterated his
a-^d supVoTof a significant long-term care plan. He cites his Senate campaign m which
adXated compLensive long-term care legislation which outhned specific m
mealnisms Tliis plan received a great deal of support in the state so much so that his
opponent Aen-Sec?etary Lynn Martin pulled ads attacking the tax because they were so
negatively received by the electorate.
SENATOR PAUL WELLSTONE (D-MN) - Senafor Wellstone is very inforested in health
18
�care reform. In March, he reintroduced his single-payer bill, the Senate counterpart of
the McDermott bill. Despite his strong bias toward single-payer and his suspicions of
managed competition, he has expressed a vdllingness to work with you. His strong desire
for reform and his belief that we must act now make him likely to support the
Administration plan. He has a strong interest in mental health and substance abuse
benefits. He modified his previous bill to strengthen its mental health provisions. Other
concerns include mral health, consumer choice and state flexibility (so that Minnesota
might pursue a single payer option).
Recent Developments: Indicated concern regarding talking points distributed by the Task
Force to the members of Congress particularly how single payer was characterized.
SENATOR HARRIS WOFFORD (D-PA) - Since his Senate race victory which was widely
attributed to his support of health reform. Senator Wofford has actively pursued this
issue in the Senate. He is part of the group of five (with Daschle, Baucus, Kerrey and
Bingaman) on a singlefinancingstate implemented health system with a national health
board approving state plans. Employers and individuals would pay a progressive
premium to a fond which would go back to the states on percentage basis. The original
Daschle-Wofford bill was called the American Health Security Act, partially because
Wofford believes so strongly in the importance of the success of the Social Security
system. He believes that his proposal took into account a middle road between the
single payer and managed competition crowds. He believes everyone should be required
to participate in the Health Alliances (no opt-outs), that the program must be state of
regionally administered and the long-term care coverage is essential. He has previously
expressed concem over what he felt was the lack of discussion by the Administration of
long-term care in connection with reform.
He is working with the Democratic Policy Conunittee health working group and is
looking at the health insurance purchasing cooperatives and how they could work. He is
very intellectual and savvy about how difficult some of the concepts are to comprehend
by the public. For example he dislikes intensely the term "global budget, believing that it
is too large to understand and turns people off. He believes that Clinton and Congress
must do a lot of educating on health care reform.
Recent Developments: It has become clear to the Senator that his election is tied to
Health Care Reform. He will be very helpfol. Language use to describe and sell the
plan are very important to him. He is very appreciative of your attending his fomm in
Harrisburg earlier this year.
19
�TEN SENATE TARGETS
Of the 45 members who will be attending the retreat, we have targeted 10
members who we feel it is particularly advisable you try to seek out. Below is a list ot
Sermembers and a brief explanation of why they have been chosen and what you may
want to discuss with them:
Sen JefLBinfiaman - Garamendi-like plan advocate whose state has many small
businesses he is concemed about. Wants fo be recognized as a player who has
introduced particularly noteworthy legislation.
Spn, Dpnnis Deconcini - Swing Democrat nervous about taxes and excessive burden on
small business. Stress importance to economy, benefits for semors, and the
importance of his support for and advice on the health refonn legislation.
Sen. James Exon - A conservative Democrat and a swing vote on this issue. He is
concerned that his absence at the Nebraska event - despite your invitation - may
have been taken as a slight by you. You may want to foil him you completely
undersfood he had a long-standing family obligation and look forward to working
with him on this issue.
Spn. Howell HeHin - A conservative Democrat, a swing vote on this issue and influential
with Southern Democrats. Stress how important reform is to his constifoents and
how much we are counting on his leadership among the Southern Democrats. He
will be a major roadblock on ANY cap proposal related to medical malpractice
reform. You may want to ask his advice on this issue.
Spn, Ernest Hollings - A moderate to conservative Democrat and a swing vote on this
issue Stress importance for economy and competitiveness. Thank him tor his
strong support on the stimulus package and seek out any advice he may have on
health reform.
Sen. Edward Kennedy - Although extremely pleased with everything you and fra have
done, you may want to take this opporfonity to acknowledge his recent and
repeated requests that we be sensitive to his jurisdictional mterests. No
commitment should be made, of course, since we will be trying to work this out
with the Majority Leader. The primary reason we have placed him on this hst.
however, is that he is one of the two primary Chairman in the Senate and we
�want to make sure he always feels in the loop.
sen PatridLtota • Upset over rumor that a provision ot the bill on ^tateflexibi%was
^ ^ " ^ ^ f ' g r ^ d for Ws Republican Senate counterpart from Vermont '-nMfords.
No truth to the mmor. You may want to say that, when we think of state
MbTl « we think of his leadership on this issue. (Ust year he introduced the
NGA endorsed Leahy-Piyor bill). You may also want to share tha we are
Thfn^ing of some w e of event in Vermom (perhaps attended by Mrs. Gore) on
tetsue of stateflexibility.You may want to seek his advice on how best to set
this up.
Sen D M i e L P a l n c k ^ ^ - Ml of our reports from the Senafo stm indicate that he
^^^^-^SJiMd^^
and appreciated. Although he P-babl^^^^^^^^ not
resDond to a "substantive" health care conversation, a personal, informal
dIsLssfon is p'b^^^^^ extremely advisable. You may also want fo reiforafo your
and the President's desire to get reform passed this year.
Sen Paul Wellstonc - Was upset over the Talking Points we sent to the members of
^'^'^-^^J^r^rtic
description of Single-Payer. You may want fo stress the
coZon^luL between our approach and his, and your desire fo build on the
constmctive diafogue you started in his office several weeks ago.
Sen Harris WofTord - In his brieftimein the Senafo. he has become a leading
^ ^ ' - ^ T ^ ^ ^ l . e a l i ^ reform. You may want fo touch base with hjm and remind
h m how much we are counting on his leadership and support. He wan s to
a L e us on how best we can develop and sell a package; it seems advisable to
invite him to provide you counsel on this issue.
�04/23/9
18:09
©202 401 5325
Average person's health spending
without health reform
Average personal Income
Average person's health bill
Health insurance
Medicare payroll tax
Workers' comp/disability/industrial inplant
Out-of-pocket
Other spending at health facilities
Federal taxes, fees, & other payments
Federal employees' health premiums
Federal contributions to Medicare HI
Medicare (general revenue)
Medicaid
Other federal health programs
State & local taxes, fees, & other paynnents
State/local employees' health premiums
State/local contributions to Medicare HI
Medicaid
Hospital subsidies
Other programs
121002
T.\SK FORCE RM118
1994
$22,369
$3,696
$1.044
$434
$100
$782
$113
$643
$53
$11
$169
$246
$174
$569
$149
$24
$186
$81
$130
2000
$32,447
$6,167
$1,742
$725
$167
$1,305
$188
$1.073
$88
$19
$283
$411
$290
$950
$246
$39
$310
$135
$218
Average
Annual
Growth Rate
6.46%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
8.91%
�04/23/93
16:03
;.^.;02 401 5325
TASK FORCE RMl 18
"Average person's health ap«nding, 1994"
Explanation of categories:
Average personal income i s 1991 personal income from the Economic
Report o f the President, p r o j e c t e d by r a t e of increase i n GDP
(using HCFA GDP projectiion) t o 1994.
Average person's h e a l t h b i l l i g n a t i o n a l health expenditures
d i v i d e d by population.
Health insurance i a the sum of employer and employee
c o n t r i b u t i o n s t o h e a l t h insurance premiums and i n d i v i d u a l p o l i c y
premiums.
Medicare p a y r o l l tax i s the sum of employer and enployee
c o n t r i b u t i o n s t o Medicare h o s p i t a l insurance t r u s t funds and
premiums paid by i n d i v i d u a l s t o HI & SMI t r u s t funds.
Workers' compensation, d i s a b i l i t y / i n d u s t r i a l i n p l a n t i s the sum
of employer payments f o r workers' compensation and temporary
d i s a b i l i t y insurance and cost of i n p l a n t h e a l t h services.
Out-of-pocket
i s out-of-pocket spending by i n d i v i d u a l s .
Other spending a t h e a l t h f a c i l i t i e s i s non-patient revenue raised
by h e a l t h care providers (e.g, through parking fees, g i f t shop
p r o f i t s , etc.) .
Federal taxes, fees, & other payments represents h e a l t h
expenditures made by the f e d e r a l govezmment. This i s the sum of
f e d e r a l c o n t r i b u t i o n s f o r f e d e r a l employees' h e a l t h insurance
premiums, c o n t r i b u t i o n s t o Medicare HI t r u s t fund. Medicare
expenditures from general revenue sources, f e d e r a l share of
Medicaid, ajid other h e a l t h programs.
State & l o c a l taxes, fees, & other payments represents health
expenditures made by s t a t e and l o c a l governments. This i s the
sum of s t a t e and l o c a l c o n t r i b u t i o n s f o r t h e i r employees' health
insurance premiums, c o n t r i b u t i o n s t o Medicare HI t r u s t fund,
s t a t e / l o c a l share of Medicaid, and other h e a l t h programs.
�04/23/93
16:04
O202
401 5325
T.KSK FORCE R.M118
Assumptions i n estimating "Avg. person's health spending, 1994"
1
2.
3
F u l l cost t o buBinesses f o r h e a l t h insurance premiums and
Medicare p a y r o l l t a x i s borne by employees, t h e r e f o r e , cost
i s not passed t o consumers.
Federal h e a l t h spending i s f u l l y financed by revenues and
Medicare taxes and does not c o n t r i b u t e t o the f e d e r a l budget
deficit.
C o s t - s h i f t i n g by h o s p i t a l s and other providers i s i m p l i c i t l y
r e f l e c t e d l a r g e l y w i t h i n the cost of h e a l t h insurance. A
very small p o r t i o n may be r e f l e c t e d w i t h i n s t a t e and l o c a l
h o s p i t a l subsidies.
^'^^^
�THE WHITE H O U S E
WASHINGTON
April 22, 1993
MEETING WITH SENATE DEMOCRATS AT
DEMOCRATIC POUCY COMMITTEE
ANNUAL DEMOCRATIC CONFERENCE
DATELOCATION:
TIME:
From:
SATURDAY, APRIL 24, 1993
JAMESTOWN, VA
8:00 pm Dinner
Steve Ricchetti
PURPOSE
To join Democratic members of the Senate at a dinner during the
Democratic Policy Committee's annual conference.
II.
BACKGROUND
This is the fourth annual Democratic PoUcy Committee Senate Conference,
which is chaired by Senator Mitchell and co-chaired by Senator Daschle.
The two day conference is an informal series of panels which examme
issues relevant to the legislative agenda. Forty-six of the fifty-seven
members of the Caucus will be attending, a record level of attendance.
See attached for background on Senators attending the Conference.
m.
PARTICIPANTS
The First Lady
The Vice President
See attached list of Senators.
IV.
PRESS PLAN
Qosed.
�SEQUENCE OF EVENTS
You will be participating in the dinner on Saturday evening at 8:00 p.m.
One half hour into the dinner. Senator Mitchell will introduce Vice
President Gore. The Vice President will make brief remarks. Senator
Mitchell will then introduce you. and you will make brief remarks (five
minutes). An informal session of Q & A with Senators will follow.
VI.
REMARKS
See attached talking points.
�TALKING POINTS FOR SENATE DINNER
~ Thank you for all of your hard work on the major elements of our
economic package.
~ Certainly we are disappointed with the outcome of the vote on the jobs
bill. I appreciate the fact that this Caucus stuck with us and that almost
everyone voted mlh us for cloture on the Mitchell/Byrd compromise.
- But I know that this is a long term game, we'll learn from this
experience and hopefully we'll be more help to you on our next imtiative.
~ We are approaching the hundred day mark of this Administration.
We've already accomplished a great deal in three months: Passage of the
budget in near record time. Family and Medical Leave, and Motor Voter.
- We've also launched our reinventing govemment initiative, have begun
to cut waste in government, have had extensive bi-partisan consultation on
Russian aid, and made progress toward resolving an important regional
economic/environmental concem at the Forest Conference. Just last week
we introduced our proposal on educational reform.
-. Next week we intend to formally introduce our initiatives on campaign
finance reform and national service. I will be working with you over the
next few months on reconciliation issues. A rapid completion of the
reconciliation bill is a high priority for me in moving ahead with the
economic plan.
- In the next several weeks, the Health Care Task Force will be reporting
its recommendations to me. Many of your staff have participated in this
extraordinary process of developing a comprehensive health care reform
proposal.
~ I am grateful for the work of your staff who have dedicated countless
hours to our effort.
- I rely on your advice and counsel, and thank you for what you have
already done.
�BACKGROUND ON SENATORS
• Senator Akaka:
He has voted consistently with us on the budget.
Senator Baucus:
He recently travelled with the First Lady to Montana for a
health care event. The Environment and Public Works
Committee, of which he is Chairman, had jurisdiction over
the EPA bill. The bill is pending and is scheduled to come
before the Senate on Tuesday for a vote. You should
reinforce that this is very important and that he protect the
bill, and stress to him that you want the bill left in its current
form.
• Senator Bingaman:
He has invited you to come to New Mexico sometime in June
for a fundraising event. His wife Anne is in line for a
position (antitrust) at the Department of Justice, and we are
trying to place her. He is very interested in defense
conversion issues.
Senator Boxer:
Her son, Doug, worked on the transition team and is now at
Legislative Affairs at HHS. She has been very supportive.
She will likely want to talk to you about campaign finance
reform, specifically the proposed plan to eliminate bundling.
Many women Congressional Members are upset about the
effects of this on Emily's List.
Senator Bradley:
He has some pharmaceutical industry concems that he may
raise with you in connection mth the health care debate. He
has asked for a meeting v^dth you and pharmaceutical CEOs
before the health care legislation is out. He also has concems
and has been critical about tax legislation.
Senator Breaux:
He was not satisfied with the Administration's strategy on the
Stimulus Bill, and may communicate that to you. He is
concerned we may be moving away from the "main stream"
message, which he believes, helped to secure your election.
He recently travelled with the First Lady and Senator
Johnston to Louisiana for a health care event
Senator Bumpers:
�Senator Conrad:
Senator Daschle:
Senator DeConcini:
He is very concerned about the effects of the energy tax on
agriculture, particularly because of his bid for reelection in
1994. We tried to accommodate him on some of those issues
in negotiations on the budget His wife, Lucy Calautti, is
Senator Dorgan's AA, and was attacked on Capitol Hill last
year in a highly publicized mugging.
He is the co-chair of the Democratic Policy Committee
(DPC), and is responsible for much of the weekend program.
The White House staff met with him this week to discuss
better coordination of White House message with the DPC.
He recently chaired a hearing on the White House budget
Despite early skepticism, he is working with us on the White
House supplemental, over which he has jurisdiction. He
has asked for a grazing fee hearing to be held by the
Department of Interior in Arizona, a request that Secretary
Babbitt is prepared to grant. He has invited Vice President
Gore to attend a Washington D.C. fundraiser for him.
Senator Dodd:
He may want to discuss the effects of health care reform on
the commercial insurance industry, much of which is based in
Connecticut. He recently lost his well liked office manager,
Leslie Finn, to cancer.
Senator Dorgan:
He has requested a meeting with you regarding the taxation
of foreign businesses. This request is pending.
Senator Exon:
There have been several occasions in which he voted against
us on the budget. He is a big St. Louis Cardinals fan.
Senator Feingold:
He is interested in overseas broadcasting consolidation
(dismantling Radio Liberty and Radio Free Europe) and
thinks we are backing away from this issue.
Senator Ford:
His daughter is undergoing chemotherapy for a recent
mastectomy. His committee has jurisdiction over campaign
finance reform, and he will be active in directing floor
strategy for campaignfinancerefonn. He is very concemed
about sin taxes, and may communicate his concems.
Senator Glenn:
His committee has jurisdiction over reinventing government
proposals and over EPA cabinet level status.
�Senator Graham:
He is Chairman of the Democratic Senatorial Campaign
Committee. You should talk to him about Senator Knieger's
race and the Senate Class of '94.
Senator Harkin:
His wife, Ruth, has been appointed to head Overseas Private
Investment Corporation.
Senator Heflin:
In response to his concems regarding the funding of a
fertilizer plant in Alabama, we modified the budget
successfully. He has been helpful to us when we have
needed him on budget and stimulus votes. His wife's
nickname is Mike.
Senator Hollings:
He has been enormously helpful to us on budget votes.
Senator Johnston:
He travelled with the First Lady to Louisiana with Senator
Breaux for a health care event. He is concemed about the
completion of the Red River Waterway project ($ 1.8 billion
project) in Louisiana which was not funded for in the budget,
and inland waterway user fees. He also has strong
reservations on the energy tax.
• Senator Kennedy:
Try to avoid discussing health care jurisdiction with him.
We are working with the Senate Leadership to work through
jurisdictional issues on health care. We have committed to
honoring a fundraising request in Massachusetts.
• Senator Kerrey:
He travelled v^dth the First Lady to Nebraska for a health
care event. He voted against us on amendments to the
Stimulus Bill.
• Senator Kerry:
As the former Chairman of the Select Committee on
POW/MIA Affairs, he met with General Vessey late this
week.
Senator Lautenberg:
Senator Leahy:
He has some pharmaceutical industry concerns that he may
raise with you in connection with the health care debate. He
is separated from his wife, and will be accompanied by
Bonnie Engelbart.
He said in the Wall Street Joumal last week that he had not
been notified about Russian aid (see attached). Tony Lake
did notify him.
�Senator Levin:
He may raise his concerns over CAFE standards and auto
emissions with you.
• Senator Lieberman:
He will probably bring up the Seawolf submarine issue with
you. We have committed to honor a fundraising request in
Connecticut, though the date is not yet set.
• Senator Mathews:
He voted consistently with us, although he is considered to be
a deficit hawk.
• Senator Metzenbaum:
His daughter. Shelly, was recently appointed to a top position
at the EPA. We have thus far unsuccessfiiUy tried to place
her husband, Steve Kelman, in numerous agencies. Senator
Metzenbaum this week gave afieryspeech on the Senate
floor in opposition to the increased funding of the
intelligence budget
Senator Mikulski:
You should avoid discussing the issue of her Appropriations
Subcommittee (VA, HUD and Independent Agencies)
gaining jurisdiction over National Service. (The decision will
ultimately be made by Senator Mitchell).
• Senator Mitchell:
We have accepted his fundraising request in Maine on June
19th.
Senator Moseley-Braun:
Congratulate her on her engagement to Kgosie Matthews
(Pronounced Josie. with a Spanish "j"). She has consistently
supported us.
* Senator Moynihan:
He recently had a very productive meeting with the First ^
Lady. We are planning to set up a one-on-one meeting with
you and Senator Moynihan regarding reconciliation the week
of May 3.
Senator Murray:
She has been very helpful to us. As a former kindergarten
teacher, she is particularly concerned with children's issues.
Senator Nunn:
He met with James Lee Witt this week to discuss his
disappointment with the FEMA declaration in Georgia.
FEMA did not declare affected areas in Georgia a major
disaster, because it did not meet those standards. Georgia is
contesting this decision, which was announced in March.
FEMA is likely to turn down the appeal. (There have been
no instances of overturning a FEMA decision in this
�Administration. Overturning of a FEMA decision has
occurred only a few times in the last decade).
Senator Pell:
He is interested in Russian aid, and is wary of a military
solution to the situation in Bosnia.
Senator Pryor:
Senator Reid:
Senator Riegle:
He has been very supportive of us. He is concemed about
the Yucca Mountain nuclear waste repository. He and
Senator Bryan recently met with Mack McLarty regarding
their concerns about Indian Gaming. He was a Capitol
Policeman while in law school. His wife, Landra, was
seriously ill a few years ago with a heart problem.
He has requested a meeting between the Michigan
Congressional Democrats and Cabinet level agencies which
have jurisdiction over auto issues. This meeting will be
taking place soon.
• Senator Robb:
We just recently agreed to sign aftindraisingletter for him.
The letter should be on your desk in the next few days for
signature.
Senator Rockefeller:
He has been very helpful to the First Lady in the health care
realm. He met with her this week.
• Senator Sarbanes:
He has been extremely helpfiil to us on the economic
package. He is very concerned about the reductions for
federal employees in the budget, but has not voiced this
publicly.
Senator Simon:
He is very interested in a balanced budget constitutional
amendment.
Senator Wellstone:
He has been supportive of us.
• Senator Wofford:
We have committed to honor a fundraising request in
Pennsylvania, although the date is not yet set
Note:
• marks Senators who are up for reelection in 1994.
�
Dublin Core
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Title
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Health Care Task Force Records
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White House Health Care Task Force
Is Part Of
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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Congressional Briefing Memos – First Lady, 1993 [5]
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
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2006-0885-F Segment 2
Is Part Of
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Box 8
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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Preservation-Reproduction-Reference
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2/6/2015
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42-t-12092992-20060885F-Seg2-008-008-2015
12092992
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https://clinton.presidentiallibraries.us/files/original/c111c79a757bd677fdf4b3d6d9100aae.pdf
f110021ede8409119b48b801f9e0790b
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/llecord Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Scries/Staff Member:
Hdelstein
Subscrics:
OA/ID Number:
3681
FolderlD:
Folder Title:
Congressional Briefing Memos - First Lady 1993 [4]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
8
2
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
ClOl. memo
Chris Jemiings & Steve Richetti to Hillary Rodham Clinton; re:
Proposed Schedule for Congressional Consultative Meetings & PreIntroduction Briefings (2 pages)
05/31/1993
P5
002. memo
Chris Jennings to Hillary Rodham Clinton; re: Rockefeller/Daschle
Meeting (1 page)
05/27/1993
P5
003. memo
Chris Jermings to Hillary Rodham Clinton; re: Kassebaum/Glickman
"BasiCare" Meeting (2 pages)
05/18/1993
P5
004. memo
Chris Jennings to Hillary Rodham Clinton; re: Current Congressional
Status & Suggested Upcoming Weeks (4 pages)
05/10/1993
P5
005. memo
Chris Jennings to Hillary Rodham Clinton; re: KasseBaum/Glickman
"BasiCare" Meeting (2 pages)
05/05/1993
P5
006. memo
Chris Jennings to Hillary Rodham Clinton; re: Republican Leadership
Meeting (2 pages)
05/05/1993
P5
C:OLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
F OLDER TITLE:
Congressional Briefing Memos - First Lady, 1993 [4]
2006-0885-F
ip2849
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)l
PI National Security Classified Information [(aXl) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRA|
F3 Release would violate a Federal statute |(aX3) of the PRA|
F4 Release would disclose trade secrets or confidential commercial or
financial information [(aX4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [aXS) of the PRA]
F6 Release would constitute a clearly unwarranted invasion of
personal privacy [(aX6) of the PRA|
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA|
b(3) Release would violate a Federal statute |(bX3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions |(bK8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
F RM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per E.O. 12958 as amended, Sec.
Sec. 3.3 (c)
Initials:
. Date: VZ\A, \ ^ / \
PRIVILEGED AND O B m ^ ^ ^ A . MEMORANDUM
TO:
FR:
RE:
cc:
HUlary Rodham Clinton
Chris Jennings
Dinner hosted by Congressman Kasich
Melanne. Steve. Lorraine. Distribution
June 12. 1993
On Monday evening you are scheduled to attend a dinner at
Congressman John Kasich's home. In attendance will be a number of other
Republicans interested in health reform, including: Wayne Allard (CO). Dennis
Hastert (IL), David Hobson (OH), Nancy Johnson (CT), Jim Kolbe (AZ), Alex
McMillan (NC), Dan Miller (FL). Deborah Pryce (OH). Christopher Shays (CT).
and Olympia Snowe (ME).
Attached are brief summary backgrounds on each of the attendees. It is
difficult to characterize this group of Members because they are so different.
Their ideologies range from moderate to very conservative, their influence on
other Members ranges from modest to significant, and their backgrounds and
understanding about health care vary greatly as well. Regardless, however,
they are all now very Interested in the health care issue and are very much
looking forward to Monday evening.
BACKGROUND
I believe that Melanne received this invitation directly from Congressman
Kasich. As one of the up-and-coming Members, and because of his growing
influence and national prominence (as a result of his recent work on a
Republican budget alternative ~ see attached). Melanne felt it would be a good
idea to take him up on his desire to have an informal discussion on health
reform.
In late May, Congressman Kasich and his House Republican Budget
Members released the attached "White Paper on Health Reform." The report
does not purport to have all the answers, but it does strongly advocate a
stereotypical conservative approach to health reform, such as the use of
MediSave Accounts, means-testing Medicare. Increasing Medicare beneficiary
copayments, and categorical spending targets for health entitlements (but not
for the private sector.
�The "White Paper" also includes a number of suggestions that are
consistent with what you and Ira have working on including: Developing
incentives for greater use of competition in the Medicare and Medicaid
programs, providingflexibility/waiverauthority to the states, reducing health
care fraud, assuring insurance portability, establishing purchasing groups,
and addressing the medical liability problem.
The report concludes with this statement:
With all the above in mind, two fundamental points emerge from
this analysis: policymakers should not put government first in
seeking solutions to the nation's health care problems; and true
reform must include restoring personal responsibility and the
vitality of the doctor-patient relationship. Any reform attempts
that circumvent these fundamental budgetary and economic
factors will fail.
I am not exactly certain how the "doctor-patient relationship" and the
degree to which reform relies on the government can be described as
"fundamental budgetary and economic factors." However, the quotation may
give you an idea of the philosophical priorities of at least Congressman Kasich.
More importantly, since we intend to rely on the Federal Government as little
as possible and retain (and enhance) the option of choice of doctor in the
President's plan, I thought you might find the reference to be helpful.
�HOUSE REPUBLICAN HEALTH CARE DINNER MEETING
JUNE 14, 1993
CONGRESSMAN TOHN KASICH fR-OH): Congressman Kasich was first elected to the
House in 1982. He was reelected with 70% of the vote and has not fallen below that mark
since. The Congressman is acknowledged by most to be one of the most intellectually gifted
Members in the House. Yet, until recently, he has appeared to take on a role similar to
Justice Scalia; that is, a very smart Member who had not been very successful in influencing
his colleagues.
In recent years, he has made a name for himself by advocating tough measures to control
federal spending. In 1989, he proposed a federal budget freeze that would have held all
discretionary' spending to fiscal 1989 levels. The bill was defeated by a large margin on the
House floor 30-393. His 1990 proposal went further,freezingall domestic and defense
spending le\ els. It received very little support as well. This year he took on the lead in
crafting the House Republican's alternative to the President's budget. His proposal was
praised by some in the media for backing up the usual Republican rhetoric, with specific cuts,
how it would be possible to significantly reduce the deficit without raising taxes. However,
although the proposal did receive more Republican support than usual, it still obviously failed
to gain sufficient support for passage by the House Budget Committee.
Until this year, other than advocating large cuts in Federal health programs and his opposition
to public funding for abortions, he did not appear to have any detailed position on health care.
In late May, however, he released a "White Paper on Health Reform." In the report, he took
— not too surpisingly — a rather stereotypical conservative position on health reform. (The
specifics have been outlined in the cover memo.)
CONGRESSMAN WAYNF AI.IARD fR-CO): Successor to current Senator Hank Brown,
Allard is considered likely to follow Brown's fairly conservative voting pattern. He served
eight years as a Colorado State Senator prior to his election to the House in 1990. He
opposes abortion except in cases of rape, incest, or where the mother's life is in danger. Due
to the rural makeup of his district, he sits on the Agriculture committee and will be interested
in rural health care. He also sits on the Small Business Committee and may be sensitive to
small business concerns.
CONGRESSMAN DENNIS HASTERT fR-IL); Congressman Hastert was selected by
House Minority Leader Michel to be his point person on health care refonn. A fellow
lUinoisan, his appointment was a surprise, considering that he is only in his fourth term in the
House and his second term on the Energy and Commerce Committee. Congressman Hastert
does not have a long track record in the House or in health care reform. A staunch
conservative, Hastert seems to be a "Michel style" House Republican willing to offer
proposals and be a part of the process rather than the more confrontational Gingrich-Armey
approach.
�Before entering politics, Congressman Hastert was a teacher and coach for 16 years. ^ He
served in the Illinois Assembly for five years prior to running for Congress. Hastert's district
is on the line between suburban Chicago and the "down state" area resulting in a mix of
suburbs, small industrial towns and agricultural areas. Congressman Hastert is conservative,
and, according to the Almp^nac of American Politics. ..."is one of the party's most fervent
opponents of taxes."
Congressman Hastert co-sponsored many Republican health bills in the 102nd Congress
including the bill introduced by the Republican Leader Bob Michel. This year, Hastert has
sponsored his own "Health Care Choice and Access Improvement Act" (HR 150), which
would reform the small group insurance market, increase the tax deductibility for the selfemployed, and allow employers to establish tax-free Medi-Save accounts.
Congressman Hastert has been pleased and appreciative of the weekly briefings by fra and
other members of the working groups to Republican members.
CONGRESSMAN DAMP HORSON fR-OH): Hobson was elected in 1990 after a
successful 8 year stint in the Ohio State Senate, which he culminated as president pro tem. fri
the State legislature, he was appointed to the Health Committee at an early stage of his
career. Despite his lack of background on health issues he became engrossed in the subject
and sponsored many health care bills in Ohio including measures dealing with AIDS, aging
and mental health. His comprehensive AIDS bills was criticized heavily by conservatives, but
he pushed it through the Republican controlled Senate. He has attended (and seemingly
appreciated) a number of the Republican Task Force briefings by fra.
CONGRESSWOMAN NANCY lOHNSON fR-CT) Congresswoman Nancy Johnson is a
moderate Republican with a rather inconsistent voting record. Her tendency to vote
independently, both in committee and on the floor, made it difficult for her to get the
committee posts she sought. Congresswoman Johnson can also be angrily partisan. She
supported Newt Gringrich, an advocate of confrontation rather than cooperation with the
majority, in his contest for Minority Whip. Perhaps as a result, in the 101st Congress, she
became" the first Republican woman ever to serve on Ways and Means. On the Committee
she has earned praise for her efforts to craft a comprehensive package of child care initiatives.
With her seat on its Health Subcommittee, she has focused on Medicare, health, and child
care.
She has been an active member of the '92 Group, a coalition of moderate Republicans,
working on ways to set budget priorities and reduce the deficit and served as the co-chair in
the 100th Congress, fri 1988, she joined Lowell Weicker in an effort to moderate the GOP's
opposition to abortion rights and restore support for the Equal Rights Amendment in the
party's platform, but their efforts were rejected.
Johnson is a strong supporter of outcomes research. She does not see insurance reform as the
key to cost control. She seems to be leaning toward requiring the individual to obtain health
care coverage. Her husband is an oncologist, and she has said repeatedly that doctors are not
the cause of the country's health care ills.
�fri recent comments, Congresswoman Johnson expressed her support for folding some of the
less controversial aspects of health care reform such as insurance reform and establishment of
the HIPCs into the reconciliation bill so that it can move more quickly. This is consistent
with many of the moderate Republicans who would just assumed get passed "what we can
agree on" ~ insurance refomi, malpractice reform, delivery system reform, etc. ~ and agree
to disagree on all the rest for the moment. (She has major problems, she says, with price
controls, global budgets, and employer mandates.)
Obviously, being from Connecticut, she is sensitive to the concerns of the insurance industry
and, to some extent, the pharmaceutical manufacturers. She does not like to dwell on their
shortcomings and is uncomfortable with negative rhetoric aimed at these industries.
Finally, it is very clear that she genuinely likes and trusts the First Lady. She has stated,
however, that she is afraid that Mrs. Clinton may be overiy influenced by overiy liberal
thinkers who have an overly optimistic trust in the govemment to solve the health refrom
challenge.
CONGRESSMAN TIM KOLBE fR-AZ): Kolbe has been in the house since 1984
representing the east side of Tucson, Arizona. His district includes many high-tech
businesses and defense contractors. Previously he served in the Arizona legislature where he
earned a reputation as a moderate spurring Arizona to finally enter the Medicaid program. In
the House, he votes consistently with the GOP and his record on economic issues is among
the most conservative. At the same time, Kolbe is a long time supporter of abortion rights.
He sits on Appropriations and Budget Committees. There is speculation that he may
challenge embattled Democratic Senator Dennis Deconcini in 1994.
CONGRESSMAN ALEX MrMTT.LAN fR-NC): Conservative but pragmatic. Congressman
McMillan has become a key ally of the House Republican leadership. For example,
McMillan supported the 1990 bipartisan budget summit agreement backed by congressional
leaders and the President, even though it included gasoline and cigarette taxes. A former
businessman, he consistently opposes Federal mandates on business. He voted against an
increase in the minimum wage and against the family medical leave bill.
McMillian has been a leader on the House Republican Task Force on Health studying health
care reform. He co-sponsored the House Republican health care reform bill, which has been
reintroduced in the 103rd. He led the subgroup examining administrative reforms in health
care and cosponsored a separate health care administrative reform bill. He also has
introduced malpractice reform legislation. There are a substantial number of insurance
companies headquartered in his district.
CONGRESSMAN DAN MILLER fR-FL): Congressman Miller is afreshmanmember.
He is a political novice with a business background. He is on the Education and Labor and
Budget Committees and the Republican Task Force on Health. He was, and may still be, on
the Board of the Manatee Memorial Hospital. Miller supports a cap for medical malpractice
lawsuits, arguing that it is one of the only ways to get health care costs under control.
�CONGRESSWOMAN DEBORAH PRYCE fR-OH): Pryce comes to the Hill after an
eight year stint as a Municipal Court Judge in Ohio. She won her election with a narrow
44% of the vote due in part to some controversy over her abortion views. Even though she
is personally opposed to abortion, she has said that she will support the Freedom of Choice
Act, allowing states to impose "reasonable restrictions." Her views on health care and not
known. She sits on the Budget Committee.
CONGRESSMAN CHRISTOPHER SHAYS fR-CD: After years at odds with Other
members of his party in the Connecticut House for being too liberal. Shays won his seat in
the House in a special election in 1987. His district contains some of the wealthiest
communities in the national as well as the corporate headquarters for such companies as
Xerox, Pitney-Bowes and GTE.
Congressman Shays sometimes moves in directions that make the Republican leadership
uncomfortable. He parted with the Bush White House on such issues as abortion rights and
parental leave. Despite some of his social views which he argues reflects his urban
constituency, Shays considers himself more conservative than many in his party on federal
spending. He fought for a seat and won a seat on the Budget Committee arguing that his
economics positions were more in line with the mainstream of his party.
His health care views are not known but given his voting record on social issues he is
considered a primary Republican target by both the White House and Congressman Bonior.
CONGRESSWOMAN OLYMPIA SNOWE fR-ME): Congresswoman Olympia Snowe is
in her eighth term and represents that northem half of Maine. She was elected when thenCongressman Bill Cohen decided to nin for the Senate. Snowe has served as an effective
member of the House, working with both sides of the aisle to find common ground.
At times, she can be a liberal Republican working with members like Pat Schroeder and
Barbara Boxer on abortion issues and fetal tissue research. At other times, she can be strictly
partisan, aligning herself with Congressman Kasich on the budget committee and one of Newt
Gingrich's biggest supporter in his run for Majority Whip.
Congresswoman Snowe is the co-chair of the Congressional Caucus on Women's Issues. She
is also energized by local issues. A knowledgeable moderate Republican tells us that the best
way to get her vote is to have local groups bring pressure on her. While it is assumed that
Snowe will want abortion coverage in the final package, she did not co-sign the May 13
letter on that issue. She is married to the Governor of Maine, John R. McKeman.
�278 FORD HOUSE OFFICE BLDG.
WASHINGTON, D.C. 20515
(202)226-7270
JOHN KASICH, (OH). RANKING MEMBER
ALEX MCMILLAN, (NC)
JIM KOLBE, (AZ)
CHRIS SHAYS, (CT)
OLYMPIA SNOWE. (ME)
WALLY HERGER, (CA)
JIM BUNNING, (KY)
LAMAR SMITH, (TX)
CHRIS COX. (CA)
WM-NE ALLARD. (CO)
DAVID HOBSON. (OH)
DAN MILLER, (FL)
RICK LAZIO, (NY)
BOB FRANKS, (NJ)
NICK SMITH, (Ml)
BOB INGLIS. (SC)
MARTIN HOKE, (OH)
RICHARD E. MAY, STAFF DIR.
COMMITTEE ON T H E B U D G E T
REPUBLICAN CAUCUS
U.S. HOUSE OF REPRESENTATIVES
Put Consumer Back in Health Care Market,
Urges Republican Budget Committee Report
May 25„ 1993
(Washington, D.C.) — Successful reform of the nation's health care system wiU depend on boosting the
control and decision-making power of American consumers, according to an analysis released today by
Republican members of the House Committee on the Budget
The committee Republicans' White Paper on Health Care Reform also partly blames inefficient
govemment spending for contributing to health care cost inflation, and says that controlling govemment
health outlays — if done in the proper way — can help ease the upward pressure on costs.
"We don't pretend that thisreportcontains the silver bullet on health carerefonn,"said Representative
John R, Kasich, Ranking Republican on the House Budget Committee. "We don't presume that our
suggestions can solve every problem in the health care market. But it is clear that unless we restore the
consumer's role in the maricet, we will face a future of runaway health care costs, or rationing of services,
or both."
According to the report, "The evolution of health care financing in the United States, encouraged by
govemment tax policy, has increasingly isolated and insulated consumers from financial decisions about
their own health care.... The prevailing third-party financing arrangement creates incentives for ovemse
of services and, consequently, higher spending — and the maricet hasrespondedaccordingly. Equally
important, the arrangement has deprived consumers ofrealcontrol over their health care decisions."
This situation is a fundamental contributor to the rapid upward spiral of health care spending, the report
says. The analysis concludes that imless consimiers arerestoredto their appropriaterolein the health care
— the samerolethey play in other maricets — health carerefonnwill fail to achieve the twin goals of
controlling spending and providing broad access to prompt, high-quality health care.
"Any successfulreformof the health care system must promote the vitality of thisrelationship."The paper
notes that the consumer-providerrelationshiplies at the heart of what are typically called "maiketoriented" approaches to health carereform.The analysis also contends that U.S. health care "suffers not
from a lack ofresources,but from inefficient use of the resources available. Health carerefomican and
should befinancedout of existing resources."
[Copies of the White Paper on Health Care Reform are available from the House
Committee on the Budget Republican Staff, 278 Ford House Office Building, Washington,
D.C, 20515, (202) 226-7270.]
�White Paper
on Health Care Reform
by the
Republican Members
House Committee on the Budget
John R. Kasich, Ranking Repubiblcan
May 20,1993
�Contents
Inuxxluciion
^
Background and Trends
2
Causes of the Growth in Health Spending
6
The Growing Role of Govemment Financing
Tax Policy
The Declining Role of Consumers
Additional Concerns for Reform
6
8
10
12
Access to Health Insurance
12
Other Factors
13
Refomi Opdons
1^
Promoting the Consumer's Role
MediSave Accounts
Tax Deduction for the Self-Employed
Medicare and Medicaid Health
Allowance Checks
Cutting Spending First
Controlling Govemment Spending
Bringing Competition to Medicare
and Medicaid
Income Testing Entitlements
Managed Care for Medicaid
Categorical Spending Targets for
Health Entitlements
Cutting Spending First
Other Potential Refomis
State-Based Reforms
Fraud
Portability
Purchasing Groups
Legal Reform
15
15
15
16
16
16
16
17
17
17
18
18
18
18
18
18
19
Conclusion
19
Endnotes
20
Appendix I
Myths and Facts about Health Care
22
�Introduction
Of all the genuine problemsrelatedto health care in the United States, one stands out as
central to the debate overreformingthe system: health care spending is high and appears
to berisingat unsustainable rates.
For individual Americans, the rapid pace of national health care spending growth
translates into a variety of personal concerns: fhistration over their personal health care
costs and insurance premiums; a sense that they arereceivingless care; concern about the
quality of care they receive; and fear that they might find themselves exposed to
unexpected, and possibly catastrophic, medical costs. It also has sensitized Americans to
the plight of those unable to obtain or afford health insurance coverage.
Various proposals for addressing these problems have been developed over the past
several years. The Clinton Administration is expected toreleaseitsreformproposals in
the near fiimre. Still other altematives soon will be offered in Congress. Also proposed
eariier this year was a health care reform plan developed by the House Republican
Leader's Task Force on Health Care.' Legislation defining the "building blocks" of the
Task Forcereformplan currentiy is being developed.
As a contribution to the Leader's Task Force, this paper seeks to offer a concise
assessment of the health carereformissue from the perspective of Republicans on the
House Committee on the Budget The perspective focuses on budgetary considerations,
which will be substantial in anyrefomistrategy. Buttiiisanalysis also takes into account
the fundamental economic factors of the health care maiket, especially thosetiiata^Jear
to be driving up spending. The analysis leads to two primary findings:
D
The government's expanding role in keaUk carefinancingover the past 30 years
has had an inflationarj impact coinciding wUh — endinaB UkeUhood substantially contributing to — the rapid growdi of heaiih care spending. Therefore, it is
unreasonable to believe that expanding the government's role as a purchaser in the
market can successfiilly address the true causes (as opposed to the symptoms) of
rising healtii care costs.
�a
The evolution of health care financing in Ae United States, encouraged by
govemment tax policy, has increasingly isolated and insulated consumers from
financial decisions about their own health care. This pattern has interfered with one
of the principal relationships on which successful and efficient markets depend — the
relationship between the consumer and tiie provider. Health insurance in the United
States is notreallyinsurance but is, instead, a costiy system of prepaid health care
fmanced principally by Uiird parties. Prices and levels of service are negotiated
chiefly by those fmancing the system — govemment or private-sector insurers — and
health care providers. The consumer — the patient — is a secondary participant.
The prevailing third-party fmancing arrangement creates incentives for ovemse of
services and, consequentiy, higher spending — and the market has responded
accordingly. Equally important, the arrangement has deprived consumers of real
control overtiieirhealtii care decisions. Therefore, any successfulreformof the healtii
care system must promote tiie vitality of thisrelationship.The consumer-provider
relationship lies at the heart ofreferencesto "market-based" reforms.
Addressingtiietwo concerns mentioned above will not cure every problem in die United
States' healtii care market. The market tirily is complex. The system feamres a variety of
advanced and expensive technologies. The availability of providers and services is not
uniform across the country; people in mral areas tend to have fewer choices of healtii care
providerstiiantiiosein uiban areas. Some of the most costiy medical services occur near
the end of a patient's life, a facttiiatdeepens the gravity of moral and ettiical decisions
facing families and physicians at such times. Furthemiore, restoring more healtii care
decision-making to consumers wiU not prevent some consiuners from making unwise or
inefficient decisions. Nor is this discussion intended to suggest that govemment should
have noroleat all in healtii care. Certain problems — such as providing a safety net to
insure the poor and persons witii serious healtii conditions who cannot find affordable
coverage intiiemarket — may demand a government response.
But neitiier will additionalresourcesoffertiieresponsesnecessary. Healtii care in the
United States suffers not from a lack ofresources,but from inefficient use of the
resources available. Health care reform can and should befinancedout of existing
resources. Witii that in mind, two essential points should be clear firomtiieanalysis below:
tiiat policy-makers should not put govemment first in seeking solutions to tiie nation's
healtii care problems; and tiiat Q^erefonnmust includerestoringpersonal responsibility
and the vitility of the doctor-patientrelationship.Anyreformattempts that circumvent
these fundamental budgetary and economic faaors will fail.
Background and Trends
During the past 25 years, the share oftiieU.S. economy devoted to health care has more
than doubled, from 6 percent of Gross EXimestic Product (GDP) in 1965 to about 12
percent in 1990. This year, spending on healtii care in tiie United States will total roughly
�$912 billion. That figure is projected to grow to almost $1.7 trillion, or 18 percent of
GDP, by 2000.^ Per capita healtii care spending, in constant 1993 dollars, increased from
$443'in 1965 to $2,879 in 1990. It is expected to be $3,604 in 1993,risingto $4,087 in
1995 and $5,568 in 2000 (all in constant 1993 doUars).
The rapid growtii of national healtii spending has coincided witii an expanding
govemmentrolein healtii care financing. In 1965. federal, state, and local governments
furnished 24.7 percent oftiietotal fiinds paid for healtii care. This figureroughlymatched
tiie share of financing by private insurance (24 percent) and was far lesstiiantiieportion
funded by out-of-pocket payments (45.7 percent). Sincetiien,tiiepublic share of national
healtii spending has grown to moretiian42 percent oftiietotal, whiletiieportion assumed
by out-of-pocket and healtii insurance funding has declined. As shown in Table 1 below,
this trend is expected to continue.
Table 1: Projections of National Health Expoiditares to 2000, by Source of Funds.
(By FUcil Ye«r)
1965
1983
1987
1990
1992
2000
In BillkMis of Current DoJlars
PrivaU
Health Insurance
Out of Pocket
Other
Subioul
Public
Fe<lerml
Suie tnd Lcx:il
SutHOUl
ToUl
10
19
2
31
111
81
18
211
155
109
22
286
222
136
31
390
266
153
36
455
499
240
61
800
5
5
10
103
44
148
144
64
208
195
91
286
255
123
378
583
249
832
42
359
494
675
832
1,631
310
18.4
4.3
54.7
30.6
14.7
3.7
49.0
30.6
35.7
PcrceaUge oTToUl
Private
Health Insurance
Out of Pocket
Other
Subtotal
24.0
45.7
5.5
75.3
31.1
22.7
5.1
58.8
3U
22.0
4.5
57.8
32.9
20.1
4.6
57.8
Public
Fe<leral
Sute and I^ocal
Subtotal
11.6
13.2
24.7
28.8
12.4
41.2
29.1
13.0
42.2
lis
ii8
42.4
45.4
51.0
100
100
100
100
100
100
ToUl
28.9
Source: Caagrettional Budget Office.
The growtii in national healtii eiqjenditures is partiy a namral [rfienomenon in a mature
and wealtiiy economy. "As national income rises, people may choose to purchase healtii
servicestiiatimprovetiieirquality of Ufe, as well asttiebasic servicesttiatare essential
�to good healtii," writestiieCongressional Budget Office. "In addition, tiie governments
of wealtiiier countries may be able to spend more on public healtii and research."
Nevertheless, U.S. healtii expenditures are growing at aratetiiatfar exceeds normal
expectations andtiiatmay be fastertiiantiieeconomy can sustain.
To federal policy-makers, a principal concern about tiie trend in national healtii care
spending is its projected impaa ontiieoverall federal budget. As shown in Table 2 on
page 5, Medicare and Medicaid — tiie Federal Government's two dominating healtii
programs — are expected to grow from $198 billion in FY 1992 to $608 billion in FY
2002. Duringtiiisperiod,tiieshare of total federal outiays consumed bytiieseprograms
wiU nearly double, from 14.1 percent to 26.3 percent By 2002. spending for Medicare
and Medicaid wiU exceedtiiatfor Social Security and will nearly matchtiietotal for all
discretionary programs. Put anotiier way. federal healtii spending will increasingly crowd
out otiier programs intiiecompetition for federal resources, or will demand substantially
higher deficit spending or tax revenues.
Medicare and Medicaid also are projected to bettielargest contributor to fiimre federal
deficit spending. The Congressional Budget Office projectsttiat"under current policy tiie
federal deficit, after declining intiiefirsthalf ofttie1990s, wiU swell to moretiian$500
billion by tiie year 2002, largely as a result of increased spending for Medicare and
Medicaid." [Emphasis added.]*
Figure 1: Health Care Expenditures by Source, 1970-2000.
On Billions of Dollar?)
1975
1970
•
Federal
1960
1965
1990
1996
2000
BB State & Local • Out of Pocket O Ottw Prtvote
Source: Statistical Abstract cfthe VnUtd Slates 1992, VS. Deptmnent ot Commerce, Ecooomicf aid Sutiaticj
Adminiilration. Bureau ol the Ceniui; Congretiional Budget 0£Bce.
�This projection is confirmed elsewhere. An April 1993 study byttieCommittee for a
Responsible Federal Budget says, in part: "If govemmem were to raise revenues and
redu^ non-healtii care spending enough to balancetiiebudget next year, witiun a decade
we once again would face $300 biUion-per-year deficits, unless we did sometiung to
restraintiiegrowth in healtii expendimres."^
CBO also warns about tiie serious economic dragtiiatwouldresultfromttiislevel of
deficit spending inttiefollowing passage:
Federal borrowing of this magnitude will significanily affect the economy because it will
cut into private saving that would otherwise have been used for mvestment here or
abroad. CBO's calculations suggest that if federal spending on Medicare and Medicaid
could be held 10 its 1991 share of GDP. output (real GDP) would be about 1.1 percent
higher than the CBO baseline by the year 2002. Incomes (as measured by real gross
national product) could rise even more - - by about 14 percent - because seivmg costs
on debt to foreigners would be reduced*
Table 2: Projected Distribution of Federal Outlays.
(By Fiscal Year)
2002
In BUIkMis of Current DolUrs
All Discretionary
Social Security
Medicare and Medicaid
[Medicare]
[Medicaid]
All Other OuUays
541
285
198
1130]
[68]
378
539
319
259
1167]
192]
390
554
351
329
[2111
[118]
409
584
385
405
[259]
11461
465
616
420
495
1316]
[179]
524
650
459
608
[389]
[219]
595
Total (induding deposit insurance,
net interest, and offsetting receipu)
1,402
1407
1,643
1,839
2,055
2312
In PcrctnUscs oTToUl OttUayt
All Discretionary
Social Security
Medicare and Medicaid
[Medicare]
[Medicaid]
All Other OuUayi
38.6
20J
14.1
[931
[4.9]
27.0
35.8
21.2
17.2
111.11
16.11
25.9
33.7
21.4
20.0
[12.8]
[7il
24.9
31.8
20.9
22.0
(14.11
[7.91
253
30.0
20.4
24.1
[15.4]
[8.7]
25.5
28.1
19.9
26.3
[16.8]
(9i]
25.7
Total (including deposit iniunnce,
net iniereii, and offsetting irceipu)
loao
100.0
100.0
100.0
100.0
loao
Source: Coogrtssiooal Budget Office, Th. Economic
Budget
In^licati^of Rising Health Care Costs. October 1992; The Eco^
January 1993.
A- ^ / " ^ ^ J * " " J ^ ' ^ . ^ T I Z '
Budget 0-/oot F»aU years 1994.1998,
�Causes of the Growth in Health Spending
A variety of factors are typically cited as partial explanations for inefficiencies in the
healtii care market and the special difficulties consumers may have in making maiket
choices. For example, it is often noted that in seeking healtii care, Americans tend to
possess far less infonnation about ttie choices and costs of Ueatment ttian ttiey do for
otiier goods and services. They generally puttiiemselvesintiiehands of a single medical
provider whose judgments and recommendations tiiey accept. Furtiiemnore.ttieyoften do
so in a time of relative urgency — tiiey are generally ill or in pain. In addition,
competition among health care providers is not uniform across the country. People in rural
areas have far fewer choices of medical providers than do those in urban areas. Those
whose medical costs are funded by public health insurance or healtii maintenance
organizations are oftenrestrictedin their choices of providers and services.
But not all oftiiesefactors arc unique to medical care. People seeking automobile repairs
often mm to just one mechanic and are usually much less well-informed tiian tiie
mechanic about therepairstiiatare necessary and tiie appropriate costs. The consumer
also may considerttieneed for autorepairsurgent. Yet consumers can exercise decisionmaking power in tiiis maricet, and the maricet does appear to work more efficientiy tiian
tiiat of healtii care, despite the similarities.
Three other factors do have a special impact on ttie health care market and are of
particular interest for federal budgeting. These factors are tiie expanding role of
govemment financing; tiie impact of govemment tax policy; and — partiy as a
consequence of the two — the decliningroleof consumers in decisions about their own
healtii care and healtii care spending.
1. The Growing Role of Goveniment Financing
As noted above, the public sector hasrepresentedan increasing share of health spending
over tiie past 30 years, largelytiiroughttieexpansion of healtii care programs such as
Medicare and Medicaid. This trend will continue in the future. One affect of this trend has
been an interference witii fundamental maricet mechanisms ttiat normally would resutiin
spending growth. As the Cwigressional Budget Office puts it:
Although there is strong justification for government involvement in health care, tfiis
involvemetu may cause markets to work less well in conventional terms of efficiency.
When the govemment subsidizes the purchase or becomes the insurer, the budget
constraints on consumers of health care are relaxed and, as a result, lose some
effectiveness in controlling less-valued spending. Likewise, federal budget constraints for
health care do not operate with the same force as they do in the private sector or in much
of the rest of the public-sector budget^
In Other words, government spending on healtti care is intrinsically less efficient than
private-sector spending. Therefore, overall national health care spending is driven higher
because of the government's growing participation in the market CBO also writes:
"Altiioughtiieseprograms [government healtii programs] provide essential — and in some
�cases life-saving — medical care to millions of people,ttieprograms also dulltiieprice
signalsfiromtiiehealtii care maricets, encouraging ovemse of services."*
In economic terms, "ovemse" delates into higher spending. Considering tiiat
govemment has assumed an ever-increasing share of healtii care spending—now totalling
about 42 percent of aU national healtii care outiays — it seems cleartiiatgovemment
spending is largelyresponsiblefortiieovemse of healtii care services and,tiierefore.tiie
rise in healtii costs. The government has essentially "bid up"tiieprices oftiienation's
healtii care services.
Figure 2: Public versus Private Health Care Spending.
(Af PercenUges ol Total Spending)
1975
1980
1985
1990
1995
2000
Source: Statistical Abstract of the Unixed Stales 7992; CongreMicnal Budget Office
Otiier cost-drivers in Medicare and Medicaid includettiefollowing:
o
Open Checkbooks. Programs sponsored byttiegovemment tend to cover most of
ttie services beneficiariesreceive.This tends to discourage cost-consciousness on die
part of consumers and providers when evaluating discretionary healtii care choices.
Theresultis an ovemse of government-financed services.
D Increase in Services. Policy-makers have expandedttiemedical servicesttiatwill be
financed by the govemment through botti Medicare and Medicaid. In the case of
Medicaid,ttieexpansion of services beyondttieiroriginal "safety-net" function has
created a disincentive forrecipientsto leave the program because they thenriskbeing
left witii no coverage.
�D Rising Prices. Government healtii programs have had to respond to botti medical
inflation and general inflation intiieeconomy.
Q Demographic Changes. The aging of tiie U.S. population and extended life spans
have increased tiie number of beneficiaries and tiie number of years for which tiieir
healtii care isfinancedby the government.
o
Fraud. Fraud intiiesystem cost tiie Federal Government an estimated $8.58 billion
to $28.6 biUion in 1993.'
Nor has tiie public sector been successfiil inrestrainingttiegrowtti of its own healtii
expenditures. CBO notestiiatfederal entitiement programs have tended simply toriseto
meet increasing medical costs. This process dearly has maintained ttie spiral of nsmg
healtii costs generally. Whenttiegovemment has attempted to limit spending on healtti
care programs, it has relied mainly on two instruments: loweringreimbursementsto
hospitals and doctors and placing limits onttieexpansion of current healtti care programs.
These efforts have had Utile, if any. discernible effect inreducinghealtii expenditures. In
1983, Congress passed a new payment system for hospitalreimbursement.The prospective
paymem system (PPS) designated 470 Diagnosis Related Groups (DRGs) and setflatfees
for each group (witii certain cost adjustments). The result was a change intiiemetiiod of
healtii care delivery, but no cost reduction. One effect of ttiis change in payment is tiiat
hospital bed occupancy has steadUy decUned since 1983. buttiieintensity and volume of
services have increased.
Various budget reconcUiation acts have reducedreimbursementrates to doctors and ottier
providers, but have not produced real savings. In some cases,reimbursementrates are now
too low to cover ttie cost of providing services to Medicare patients. This forces cost
shifting to private payers, driving up insurancerates.The 1990 Budget ReconcUiation Act
Umited tiie expansion of entitiement programs, including Medicare and Medicaid, by
enforcing a pay-as-you-goftmdingmechanism. Underttieprocedure, expansions of federal
entitiemem programs must befinancedeittier by reductions in ottier entitiements or
increases in taxes. This has done notiiing. however, to Umit spending increases m tiie
programs tiiat already exist
Nevertheless, variousrefonnproposals seek to expandttieroleof government, in most
cases to provide insurance coverage tottioseunable to obtain insurance inttiemaricet.
Among ttie government-oriented proposals are conversion to a Canadian-style "singlepayer" system, and "play-or-pay" schemes ttiat mandate employers to provide group
insurance witti an expanded government program to coverttiosestiU left unprotected. But
tiie historical experience witti govemment healtti programs gives ample reason to doubt
ttiat expanding ttie role of govemment wUl be consistent witti ttie goal of slowmg ttie
upward spiral of healtii care costs.
2. Tax Policy
Government tax policy encourages employers to ftimish healtti insurance to onployees
tiuxjugh deductibility of employer-paid premiums. The strategy has been effective in
8
�expanding private healtii insurance to a large portion oftiiepopulation. Butttieexpansion
has come witii an economic price, as described in the foUowing passage by CBO:
[Federal tax pohcy] has also encouraged inefficiency because of the resulting failure to
confront choices. Favorable tax treatment of employer-paid health insurance premiums
reduces the effective price and so increases the amount of health insurance through a
hidden subsidy. Such tax breaks cause even higher levels of health expenditure at the
expense of tax revenues that would otherwise be collected."
The deductibility of premiums has helped promote healtii insurance arrangementsttiatare
not reaUy insurance but are instead a costty system of prepaid healtti care (see the
discussion ofttieconsumer's decUningrolebelow). It also has distortedttieperceived
value of employer-paid healtti benefits. According to a smdy byttieNational Center for
PoUcy Analysis, federal tax law makes $1.44 of healtii benefits equivalent to a doUar of
take-home pay for employees intiie15- percent tax bracket This occurs becatise gross
wages of $1.44 would be reduced by 44 cents in taxes. This discrepancy is worse in tiie
28-perceni lax bracket where $1.97 of healtii insurance benefits is equivalent to a doUar
of take-home pay." It is more valuable tottieemployee to demand a doUar more in
healtii coveragetiianin wages. A March 30. 1993 Medical Benefits article"revealedtiie
cost per employee of healtii benefits increased from $1,724 in 1984 to $3,968 in 1992 —
a 130.2-percent increase in six years.
Tax deductibiUty is not avaUable tottieself-employed, who must payttiefiUlcost of
coverage witii funds left over after taxes. Large corporations, meanwhUe. bid ttie price
of healtii insurancetiiroughthe use of the tax incentive, making coverage even more
expensive for smaUer businesses.
The stmcmre of tax deductibUity also favorsttieformation of employee-based insurance
poolsratiiertiianotiier possible groupings. Many other kinds of insurance — automobile
insurance, for example — arc organized onttiebasis ofregions.This makes possible the
formation of larger and more diverse insurance pools. Such pools mitigaterisksto tiie
insurer, aUowing for lower insurance premiums than might otherwise occur.
Tax deductibUity also has had a significant impact on federalrevenues.It is estimated tiiat
tiie effective subsidy of healtii insurance premiumstiirou^ttietax code wUl total $69.4
bilUon in FY 1994. Whentiiisamount is added to direa govemment outiays for healtii
care,tiiegovernment's share of healtti care financing nationaUy exceeds 51 percent
It is desirable poUcy to continue usingttietax code to promotettiepurchase of healtti
insurance. If so, however,recognizingthe economic effects of the current structure may
help redesign ttie code for greater efficiency or equity. For example, c^anding
deductibility to individuals andttieseU"-cmployed would he^ correct existing inequities
and would lead to greater maricet efficiency. Tax deductibiUty also could berefinedto
encourage more cost-efficient kinds of insurance, such as coveragettiatprotects against
catastrophic costs but leaves consumers with morercsponsibUityfor discretionary, nonemergency, health care decisions.
�3. The Declining Role of Consumers
Govemmem spending and tax poUcies have contributed to atiiird.and cmcial, problem:
Witiirespectto American healtii care,tiieprincipal maricet mechanism —tiierelauonship
betweentiieconsumer andttieprovider - has been distorted. Botii pubUc and pnvate
healtii insurance have tended to isolate and insulate consumers from making decisions
abouttiieirown medical care - decisionstiiatwouldrequirettiemto measurettiebenefits
tiiey expect againsttiiepricestiieyare wUling to pay.
It is understandablettiatconsumers should want protectionfiomtiiecatastiophic costs ttiat
come from, say,ttieneed for major surgery or long hospital stays. But simUar financial
protections have extended to far moreroutinemedical services — an arrangement Uiat
amounts to prepaid healtii care ratiiertiianhealtii "insurance" comparable to otiier kmds
of insurance. Consequentiy.tiieshare of healtii care costs paid by consumers directiy out
of pocket decUned from 45.7 peiwm in 1965 to 18.4 percent in 1992 (see Table 1. page
3 and Figure 3, page 11). CBO describestiieimpact as foUows:
Most health payments are made by a third party - an insurance company or a
govemment program — on a fee-for-service basis, and this reinforces the bias m health
caie toward higher spending and away from cost control Neither the padait nor the
doctor is likely to care much about the costs of the treatment at Ae pomt of service. Feefor-service arrangements with distant third-party reimbursement ensure that patienu have
an incentive to accept, as weU as providers have lo offer, any treatment that may possibly
have a positive benefit, with little regard for cost
These features may encourage spending «i health care procedures or services that cost
more than the value consumers place on the benefits. The same features may spur the
development and use of new, ofiai expensive, medical technologies and drugs even when
their benefits may be small compared with the costs. People who have msurance face a
low out-of-pocket charge for health services at the point of deUvery, and as a result go
to doctors more often and have more tesu and elaborate treatmentflianpeople who are
faced with the full prices. One hypothesis is that cost-increasing technology raises the
demand for health insurance and, hence, for health care, but the development of costincreasing technology is itself encouraged by more extensive insurance. Together, it is
argued, the two effects produce an upward spiral of health care costs. Because third-party
reimbursement, based on provider charges, dominates the markeU competitive pressures
do not encourage the efficient provision of services. Doctors compete for patient loyalnes,
and hospitals compete for physician refenals but providers do not tend to compete with
one another over fees."
Once attiird-partypayer seeks to control costs — typicaUy by Umitingttiekinds and
amounts of servicesttiatwiU befinanced—ttiepatiem begins to lose conuol over healtti
care services Negotiations over what services wUl be provided and at what costs take
place betweentiieprovider andtiiepayer,tiiepatient is not a player inttieprocess. This
situation already occurs in many govemment and private insurance arrangements.
The most extreme forni oftiiird-partypaymem is a Canadian-style "single-payer" system,
in whichtiiegovemmem istiieinsurer. Just as in anyttiird-partyarrangement controUing
costs in a single-payer system, negotiations over costs involvettiepayer andttieprovider
but nottiiepatient Because patients do not makettiespending decisions involved in ttieir
treaunents,ttieydo not contiolttietreatmentsttieyreceive.
10
�Figure 3: Percentages of Health Expenditures Paid Out of Pocket
(As PercenUges ol Total Spending)
1950
1960
1970
1960
1990
Source: The Heartland Inftitute, Why We Spend Too Much on HeaUh Care, 1992.
To control spending, single-payer systems commonly resort to price controls or "global
budgeting." If tiiey did not take such steps, patients would tend to ovenise services
(becausetiieyare not payingtiiebUls), leading to higher spending — spendingtiiatwould
quickly outpace any savings achieved by simpUfying or streamliningttiesystem's
administration. This is why resorting to a so-called "single-payer" system — or to other
strategies that limit the number of insurance providers — cannot accommodate the twin
goals of restraining the growth in spending levels and assuring the patients' control over
their own health care decisions.
Further Umits on patient choices wUl bettiecertainresultof aibitittfy schemes such as
price controh and global healtti care budgeting. These mechanisms seek to limit the
amount of aggregate health care spending on the surface, without addressing the factors
that truly drive costs upward. This inevitably leads torationingof healtii care services,
long waiting lines, and Umits on advanced, and often life-saving, treatments. EquaUy
important itfiirtherdeprives patients of wxitrol overtiieirown healtti care, because ttieir
treatinents are stiU governed, at least in part, bytticpricettieproviderreceivesfor ttie
service — andttiatprice is determined by someone otherttianthe patient
The govemment is an especiaUy strong craitiibutor tottiisproblem. Because it represents
moretiian50 penxnt ofttienation's healtti care spending,ttiegovemment is a massive
11
�tiiird-party payer (and one ttiat is. as noted above. intrinsicaUy less effiaent tiian its
private-sector counterparts). Furthermore, tiie govemmem has no competitors, and
tiierefore lacks any maricet incentive to become more efficiem. This is anotiier
fundamental reason to doubt tiiat broadly expanding govemmem programs can
successftiUy addresstiiebasic causes ofrapidlyrisingnational healtii care costs.
But appropriate altematives totiiird-partypayments — optionstfiatcan slowtfiegrowtii
of healtii care spending and also maintain individuals' control overtiieirown healtii care
— involve shifting greaterresponsibiUty.and more oftiiecosts, back to consumers. This
probably would require higher deductibles in private and government insurance programs.
especiaUy for price-sensitiveroutineor non-catastrophic medical services.
To a large degree, tiiis process already is occurring; insurers have for several years looked
to adjusonents in deductibles and copayments as metiiods of containing tiieir own costs.
But American consumers are not Ukely to welcome an expansion oftiiisapproach eageriy
unlesstiieyrecognizetiiepersonal benefitstiieywouldreceivefiomit Policy-makers wiU
need to help consumers understand tiiat only by assuming greater personal responsibility
for tiieir own healtii care can tiiey achieve tiie benefits of botiirestrainingtiiegrowtii m
costs and maintaining control overtiieservicestiieychoose. Altemativesttiatpledge botii
benefits witiiout demanding greater consumer responsibility offer a promise tiiat cannot
be ftilfiUed.
Additional Concerns for Reform
1. Access to Health Insurance
Altiiough access to healtii insurance is not a centraltiiemeof tiiis analysis, it is an
important and often-mentioned concern in ttie healtti care debate. But access to insurance
is not distinct fiom issues of cost. Indeed, it isreasonableto conclude tiiat if effective
mechanisms for controUing costs were developed,ttiecosts of healtti insurance could be
moderated, making coverage available to a wider population. Hence, gaimng control of
rising healtii care costs can itself contiibute to expanding access to insurance. Conversely,
attempting to expand insurance coverage witiiout genuinely addressing ttie cost-dnvers
described above wiU only transfer cost pressures elsewhere,resultingin rationing, slower
improvements inttiequality of care, and less control by consumers.
A few additionalremaricsabout access to insurance also are appropriate.
Altiiough a lack of health insurance does not necessarily deprive individuals of health
care — medical etiiics andttielaw requirettiatpersons who are wittiout healtti insurance,
or who are unable to pay forttieirown services. stiUreceivehealtii care when necessary
—tiieuninsured can face considerable difficulties overttieircare. Some hospitals wiU not
accept tiiem. They are disinclined to seek healtii maintenance or preventive care, which
can leadtiiemto more serious healtii conditions whichtiienrequire emergency treatinents.
12
�The chUdren of tiie uninsured often do not receive immunizations and otiier regular
treatments tiiat are important to their development.
The costs of tiiis uncompensated care are covered partiaUy by Medicare and Medicaid
payments to hospitals. Some costs also are shifted to private healtii plans. A certain
perx^emage of every patiem's biU can be directiy attributed totiieunrecovered cost of such
services This may not betiiemost desirable or efficient means offinancinguncompensated care, and it certainly meanstiiatsuch patients have Uttle control over tiie healtii care
services they receive.
Second istiienumber of uninsured Americans. The commonly acceptedfigureasserts tiiat
about 37 mUlion Americans have no healtii insurance aUtiietime.But a U.S. Bureau of
ttie Censusreportfor tiie most currem period for whichreUabledata are available —
January 1987tiiroughtiiefourth quarter of 1990 — offerstiiefoUowing breakdown:
•
Sixteen miUion people (plus or minus 1.2 mUlion) were uninsured fortiieentire year.
D
Nine miUion (plus or minus 0.9 miUion) were uninsured fortiieftUl28-montii period
of tiie study.
•
Thirty-two miUion (plus or minus 1.2 miUion) were not covered by any kind of
insurance on average in any given montii.
a
Seventy-nine percent (plus or minus 0.8 percent) of aU people had continuous healtii
insurance coverage for aU of 1987.
D Fifty percent ofttiepersons witiiout healtii insurance coverage inttiefourth quarter
of 1990 were under tiie age of 25. a grouptiiataccounts for 36 percent oftiieentire
population. This is also tiie age group ttiat is just entering ttie job maricet and
tiierefore subject to probationary waiting periods before becoming eligible for ftiU
workfiringebenefits such as healtii insurance.'*
The breakdown above is not intended to suggest tiiat tiie problem of access to healtii
insurance is unimportant. The intern is simply to show tiie tme contours of tiie access
issue so tiiat policyreformscan be appropriately designed.
2. other Factors
Various otiier factors compUcate tiie problem of medical costs and access to healtii
insurance. Altiiough ttiey are not ttie primary focus of ttiis paper, ttiey must be
acknowledged. Amongttiesefactors arettiefoUowing:
•
State Mandated Services. States have established mandates ttiat require specific
kinds of benefits in healtti insurance plans sold wittiin ttieir borders. The weUintentioned original goal oftiiesemandates was to protect consumers by ensunng ttiat
what ttiey purchased truly was healtii insurance. But tiie number of mandates has
tended to grow, sometimesrequiringcoveragetiiatis not critical to entire populations.
13
�NamraUy. tiie expansion of mandates, by requiring greater coverage, has driven up
premiums for health insurance.
Some employers escape state mandates by insuringtiiemselves.Witii tiiis approach,
employers' healtii benefits are covered by tiie federal Employee Retirement Income
Security Aa (ERISA). This approach, however, is possible only for large compames
tiiat can pool sufficientresourcesto adequately protect tiieir employees. .
Malpractice and Defensive Medidne. According to a smdy by Lewin-VHI Inc. of
Washington D.C. ttie potential savings fromrefonningttiemedical malpractice
system could range ftom $7.5 bUUon to $76.2 bUUon over five years. The savmgs
would be achieved by discouraging "defensive medicine." which Lewin-VHI defines
as "changes in practice earned out by healtti care providers forttiesole purpose of
avoiding malpractice claims."'*
Pre-existing CondiUons. Many Americans have difficulty obtaining or keeping healtii
insurance because of medical conditionsttiatinsurers consider too risky. The problem
cannot easily beresolved.Requiring insurers to cover such persons would undoubtedly lead to higher premiums for ottier cUents. Alternatively, ttie government could
assume insuranceresponsibilityforttieseindividuals; butttienotiier consumers would
StiU finance tiie msui^ce tiirough taxes ratiier tiian premiums. Pubhc and social
values support providing coverage for such persons. This is an area m which a
governmentresponsemay weU be appropriate.
Reform Options
The preceding discussion should make it clear ttiat two basic principles must guide any
successfiilreforaiof tiie U.S. healtii care system. These principles are tiie foUowmg:
o
The consumer's roU in heaiih cart decision-making must be promoted. Not aU
consumers wiU make ttie wisest and most efficiem choices at aUtimes.But m ttie
aggregate,ttiecoUection of choicesfteelymade by consumers isttiebest mecharasm
for promoting efficiency inttiehealtti care economy. Furthennore.ttieonly way to
assuretiiatpatients control decisions aboutttieirown healtti care is byrestonngttieir
direct participation in making those choices.
D
Restraint of govemment spending on health care can itself ease Ae upward
pressure on national health costs. The expansion of governmentfinancmghas
coincided witii tiie accelerated pace of healtti care cost increases. Government now
finances more ttian 50 pen:em ofttienation's healtti care. If govemment financmg
is not conooUed. it wUl continue to fiiel ttie upward spiral of healtti costs.
But conUoUing government spending in tiic proper way also is necessary. Art)iu^ry
mechanisms, such as price conttols and global budgeting, faU to address ttie
14
�underiying causes of cost increases. Consequentiy,ttieyonly lead to rationing and to
further limits on the consumer's control over healtii care. Govemment spending
constraints must address the tme cost drivers in health care, mainly by promoting the
consumer's participation in the market
The foUowing account lists various options that would addressreformissues analyzed
in this paper.
1. Promoting the Consumer's Role
Altiiough private health insurers must be the main players in this process, the Federal
Govemment can legislate specific changes that boost the consumer's participation. Among
these are the foUowing:
a
MediSave Accounts
MediSave accounts would aUow individuals to set up health saving accounts with tax
free contributions ftom eitiier the employer or the individual, or a combination of
both. The individual would then purchase healtii insurance with a high deductible,
and hold the balance of deposits in the account to pay for incidental medical
expenses. Any unspent funds wouldroUover and accme to individual.
Qearly, a ceno^al premise of MediSave is to promote the consumer's decision-making
role in purchasing healtii insurance. To the extent that consumers shopped for poUcies
that best served their needs, a degree of competition and cost-consciousness would
be restored to the market The strategy also could provide consumers with an
economic incentive to look after their general healtii more carefiiUy. Its roU-over
provisions would aUow consumers to accumulate savings in their overaU health care
spending — savings achieved through preventive care and health maintenance.
The National Center for Policy Analysis has argued that when consumers control
tiieir own healtii care doUars, as provided under MediSave, ttieir increased costconsciousness promotes competition and, therefore, lower prices in insurance
premiums and healtii care services. The strategy also prcMnotes ttie vitaUty of the
doctor-patientrelationshipand tends to give patients more control over the services
for which they choose to be insured.
The MediSave stiTitegy is included in tiie RepubUcan Leader's Task Force Healtti
Care Refonn legislation in the current Cwigress."
o
Tax Deduction for the Self-Enq>lo7cd
This option, also contained in the Leader's Task Force plan, would make health
insurance premiums paid by the self-employed 100 percent deductible. PoUcy-makers
may also wish torefinethe tax code so that deductibiUty ai^Ues to coverage that
encourages the purchase of real health insurance — which would restore greater
consumerresponsibilityin price-sensitive non-catastroprfiic services —ratherthan
broad prepaid medical care coverage."
15
�o
Medicare and Medicaid Health Allowance Checks
When an individual goes into the hospital under a pubUc insurance program such as
Medicare, tiie doctor performs the procedures and tiie bUl is sent to tiie insurance
providers who administer the Medicare program under the Health Care Financing
Administration (HCFA) in Washington. The bUl is paid directiy to tiie hospital and
doctor and a dizzying array of bills and copies of biUs are sent totiiepatient. biUing
him or her for various copayments and deductibles. The patient/consumer is basicaUy
at tiie mercy of tiie doctor, hospital, and HCFA.
Federal, state, and local govemment dollars could bere-packagedin such a way so
that aU senior citizens, poor people, and others deemed eUgible for public insurance
could receive money from the government based on their economic need. They also
could receive a 100-percent tax deduction for the amount they would spend out-ofpocket for healtti insurance each year up to a national standard for basic health
insurance coverage. In such an arrangement, each person could negotiate and bargain
with a wide array of insurance companies and purchasing organizations to buy the
best kind of healtii insurance for their own needs. This procedure boost competition
and wouldrestorethe consumer's role in choosing healtii insurance.'*
The principle worics in the existing veterans program with the GI BiU. Each veteran
gets an amount of money to attend any coUege he or she chooses. It also worics in
the VA Housing program, in which veterans can buy a house based on their choice,
not what the govemment tells them they have to purchase.
Q Cutting Spending First
The House Republican Budget Committee budget proposal for Fiscal Year 1994 —
described in tiie 84-page document titied Cutting Spending First — caUed for $93
biUion in Medicare and Medicaid savings over five years. A ceno-al feamre of these
savings was the expanded use of deductibles and copayments by beneficiaries of these
large health care programs.
Such an approach requires that beneficiaries assume more responsibiUty for tiieir
healtii care choices. But it maintains their control over those choices, producing
savings in health care spending without sacrificing consumer choices."
2. Controlling Government Spending
Slowing tiie growth of govemment spending in healtii care can by itself help slow cost
increases generaUy by reducing demand. Amoig potential strategies are the foUowing:
D Bringing Competition to Medicare and Medicaid
Costs could bereducedby requiring the use of competitive, maiicet-based systems to
provide Medicare and Medicaid services. This could be done by integratingtiietwo
systems and then requiring health insurance providers to submit competitive bids for
titlerightto serve Medicare and Medicaid patients. Competing for the contract for
Medicare and Medicaid would provide a powerful incentive to hospitals, physicians,
16
�and otiiers to careftUly consider tiie way tiiey do business and take steps to reduce
costs. Requiring providers to compete witii one anotiier would provide an incentive
to cut their healtii care costs.
•
Income Testing Entitlements
The cunent Medicare program provides tiie same level of coverage to aU eligible
participantsregardlessof income. Consequentiy, even wealtiiy individuals receive
medical care at tiie expense of taxpayers.
Govemmem healtii care costs could be reduced by targeting healtii care assistance to
tiie most needy and requiring wealtiiier persons to assume more of tiieir own costs.
Income testing tiie Medicare hospital coverage deductible fortiiosewitii adjusted
gross incomes of $100,000 or more would save $1 biUion in tiie next four years.
13 Managed Care for Medicaid
The Arizona Healtii Care Cost Containment System (AHCCCS. pronounced "access")
is mn in tiie fashion of a healtii maintenance organization (HMO). Every person
enroUed intiieprogram joins a managed care plan, meaning a group of doctors and
hospitalsreceivea fixed montiily sum for each patient tiiey agree to Ueat Every
patient has a personal doctor. Patients and doctors are satisfied, and costs per patient
are about 5 percent lowertiianin otiier sutes wherettiequality of care often is lower.
Arizona hastfieonly sute-wide Medicaid managed care demonstt-ation project under
waiver autiiority approved by tiie Secretary of Healtii and Human Services.
According to tiie latest evaluation by tiie Healtii Care Financing Administi-ation.
AHCCCS has held down costs considerably compared to Q-aditional fee-for-service
Medicaid plans, despite enroUment increases. For tiie two years examined. FY 1990
and
1991,tiieaverage per capiu cost increased 26 percent in AHCCCS compared
to a 33-percent increase in traditional programs. Overttielife ofttiedemonsu^tion
(FY 1983 to FY 1991)ttieaverage annual increase in AHCCCS per capiU cost was
6.8 percent, compared to 9.9 percent for a traditional Medicaid program.
Sutes should be encouraged to pursue tills option and not discouraged by a lengtiiy,
tedious waiver application pn)cess. The Federal Govemment should explore broader
application of managed care in tiie Medicaid program.^'
•
Categorical Spending Targets for Health Entitlements
In tiie case of Medicare and Medicaid, Congressional failure to contain spending over
tiie past decade has led to a simation in which Medicare is growing 30 percent a year
and Medicaid is growing at 18 pendent a year. Categorical urgets inttiesetwo federal
healtii programs would force Congress to take action to deal witiittieunderlying cost
drivers in tiie healtii system. If no action is taken to reduce spending,reformexisting
programs orrepealcoverage, tiie autiiorization committees would have to propose
specific lax increases tofinancetiiespending levels in excess oftiietargets. If such
tax increases also were rejeaed. tiien a categorical sequester would take place only
on tiie spending categories tiiat exceeded tiie spending target fortiiatyear.
17
�D Cutting Spending First
AS mentioned above,tiieHouse Republican Budget Committee proposal forJFY 1 ^
recommended $93 biUion ui Medicare and Medicaid Savings over five years. These
S r c ^ u l d i achieved witiiout any major overtiaul of t ^ healtii care system, and
would ease upward pressure on national healtii care costs.
3. Other Potential Reforms
various otiierrefomishave been developed to addressrelatedP-^W^^^.^^jJ;^*^^,
maricet Each can make a valuable contribution toreducmgcosts and miproving access
w i ^ u t p^ce controls or otiier govemment interferences. AmongtiiemarettiefoUowmg.
o
State-Based Refomis
Medicaid, being a shared federal-sute program, binds sutes becausettieguideUnes
are mandated in Washington. To make subsuntial changes intiieway it admmisters
Medicaid, a sute must obuin a waiver ftom tiie Healtii Care Fmancing Admmistration (HCFA). tiie departmem tiiat oversees Medicaid and Medicare. This process is
botii lengtiiy and tedious botii in obuining tiie initial and tiien m reuimng i t
Enhanced Medicaid waiver autiiority would give sutes more flexibibty to manage
tiieir healtii care needs and tiieir budgets."
•
Fraud
Altiiough estimates are rough, losses due to healtii care fijud may "nge from 3
percent to 10 percem of tiie nation's toul healtii care biU. This transla^s to
somewhere between $27 bUlion and $91 bUUon being lost amiuaUy to schemes
specificaUy designed to cheattiiesystem. LegislationtitiedttieHealtii Care Cnmmal
O^er^Tct is iSng developed to specificaUy urgetttieorganized cnmmal acuvity
in healtii care. This legislation wUl give law enforcemem tiie tools it needs to smp
awaytiiefinancialmotivation for tills kind of criminal activity f "^^1"
zurc and forfeimre." Such approaches already have proven successfiil m otiier areas.
•
PortabiUty
AU Americans should have access to appropriate healtti care even ifttieyhave preexisting conditions tiiat deter insurers. The most effective metiiod forrcachmgttus
go^ is to place ttie purchasing power of healtti insurance witti ttie mdividu^.
preventing canceUation as a part of a group, and poUciesttiatguaranteerenewal.Preexisting condition criteria, waiting periods, and portabUity issues would dmiirush w.^
individual based poUcies. PortabiUty is amittier healtti care issue addressed m ttie
Republican Leader's proposed legislation,"
•
Purchasing Groups
To conuin healtti care cost pressure must be brought to bear on physicians, hospiuls
and ottier healtii care providers to lowerttieircost Purchasing groups can often bnng
greater pressure on providers to be more cost conscious,ttierebyreapingsavmgs for
participants. Those participants might be individuals. famUies or smaU employers.
18
�These an-angements also make healtii insurance more accessible to more people. Such
plans already in existence have found lower healtii infiation, lower premiums, and
increased access.
Legal Reform
One possibUity for easing tiie problem of malpractice and defensive medicine would
be an artjitration system such astiiatproposed undertiieMedical Malpractice Refonn
Act of 1993. The Act calls for patients and medical providers to meet in binding
art)itt-ation in contested cases beforeresortingto tiie expensive process of lawsuits.
Reducing tiie risk of lawsuits would aUow medical providers to focus on providing
only tiiose procedures tiut are medicaUy necessary ratiier tiian providing a case
history to protecttiieprovider against potential lawsuits. Patients would also receive
more immediate compensation for injuries caused by incompetence or negligence and
a higher percenuge of tiie claim tiian under current law.
Conclusion
This analysis has sought to focus on aspects ofttiehealtii care markettiiatlie witiiin tiie
expertise oftiieHouse Committee on tiie Budget. SpecificaUy,tiiecommittee has a nattiral
concern witii tiie effect of rapidly increasing healtii care expendimres on ttie federal
budget — and especiaUy on futtire budget deficits.
The analysis has concludedttiattiierapidgrowtii of governmentfinancingof healtii care
has itself contributed to tiie rise in healtii care costs generaUy. Therefore. conuoUing
govemmem spending, if done property, can ease upward pressure on healtii costs. The
analysis also makes cleartiiata major problem intiieAmerican healtii care maricet is ttiat
consumers have been progressively insulated and isolated fiom ttieir own healtii care
decisions. The basicrelationshipbetween consumers and healtii providers must be
revitaUzed if healtii carerefomisare to achieve tiie twin goals of conttoUing costs and
maintaining patients' control over tiieir own care.
This discussion does not suggest tiiat goveniment should have no role at aU in healtti care.
Certain problems — such as insuringttiepoor and persons witti serious healtti conditions
who cannot find affordable coverage in ttie maricet — may demand a govemmem
response. But neitiier wiU additional resources offertiieresponsesnecessary. Problems
witii healtii care in tiie United Sutes derive not from a lack ofresoun:es,but from
inefficient use oftiieresounds available. Healtii carerefonncan and should be financed
out of existingresources,tiiroughgreater efficiency inttieuse ofttioseresources.
Witii aU tiie above in mind, twofimdamentalpoints emerge from tiiis analysis: policymakers should not put government first in seeking solutions to ttie nation's healtii care
problems; and tiut refomi must includerestoringpersonalresponsibilityand tiie vitality
19
�of tiie doctor-patiemrelationship.Anyrefomiattemptstiiatcircumvemttiesefimdamenul
budgetary and economic factors wUl fail.
Budget Committee RepubUcans stronglyrecommendtiiatthese ^ g j ^ j f ^ ^ ^ ^ ^ ^
account in anyrefomistrategy, and sundreadyto assist tiie RepubUcan Leader s Task
Force on Healtii Care intiiiseffort
Endnotes
,.
Michel. Bob. et . L . the Action Now HealU, Orc Refonn A a (H.R. 101). 103.d C « . g « . .
2.
Congressional Budget Office.
3.
Congr«sional Budge. Office. Projections of National HeaUh ExpendUures, Oc«*er 1992, p. 8.
4.
Congressional Budge. Office, Economic Implications cf Rising heaUh Care Costs, Goober 1992, ^ 8.
5.
Commit^e for a Ren»nrible Federal Budget. Health Care Reform Project -
Phase I : Cost Consainmen. and
Incremental Reform, April 1993.
6.
Congressional Budget Office, Economic Implications cf Rising Health Care Costs, Goober 1992. p. 8.
7.
Congressional Budge. Office, Economic Implications
8.
Ibid., p. 19.
Rising Health Care Costs, Oc«*er 1992, p ^ 19-20.
innslate to $27 billion to $91 billion.
10.
Congressional Budget Office. Projections of National HeaUh E n u r e s , 0 « o b « 1992, p. 11.
„.
Ga^Robbin..Aldon.Rob«™,J0h„C.Goodn«n,H<^O..//«.i./.Ca..S,.«.mW^^^
Analysis, February 1993.
12.
"1992 Health Care Beoefiu Survey: Medical PUn.," Medical BenefUs, M«ch 30, 1993. p. 1
13
Congressional Budget Offic*, Projections of National HeaUh ExpendUures, Goober 1992. pp. 10-11.
Commerce Ecaiomic n d Sutiibci AdnuniBiation, Bureau
15.
Rubin. Roben I . , M.D., ^
the Cewui.
McndeUon, D«uel N.. Estimating the Casts ofDefensi^ Medicine, Uwi„-VHI Inc..
January 27, 1993.
16.
Michel. Bob, et al, .he AcUon Now Heal* Care Refonn A a (HJt 101). 103ri C o « g « . .
17.
Ibid.
,g.
Por a discussion of
. n « , e . « . u i . w«Ud . p ^ y U> M e j i c ^ . - ^ ^ ^ ^ ^ ' ' ^ ^ ' P ' " ^ ^ ^ ^ '
for Lcw-lncome Families, by U.e Hou« Wedne«Uy Group, March 30. 1992, p. 23.
20
�19.
See Culling Spending First, by the Republican Memben, House Committee on the Budget, March 10,1993, pp. 31 39.
20.
See Cutting Spending First, pp. 33-34.
21.
See Cutting Spending First, p. 32.
22.
Cutting Spending First, pp. 31-39.
23.
See Uie Action Now Health Care Refonn plan.
24.
See Kolbe, Jim, et. aL, the HeaUh Care Frmud Act (H.R. 4930). 102nd Congress.
25.
Michel, Bob, et aL, the Action Now Health Care Refonn Act
21
�Appoidix I
Myths and Facts about Health Care
The American public and its leaders seem to have reached simUar conclusions on tiie
major problems facing tiie healtii care system — soaring spending and inappropnate
coverage. But just belowtiiesurface,tiiisconsensus breaks down and confiision abounds.
The foUowing mytiis and facts may help clarify some oftiiesemisunderstandings.
MYTH #1: Thirty-seven miUion Americans pennanentiy lack healtii insurance coverage.
FACT: According to a U.S. Bureau oftiieCensus Cument Population Report written by
Katiileen Short, fortiiemost cunem period oftimefor which reliable dau is available.
January 1987 to tiie fourth quarter of 1990. tiie foUowing facts are:
o
Sixteen miUion people (plus or minus 1.2 mUlion were uninsured for tiie entire year.
•
Nine miUion people (plus or minus 0.9 miUion) were uninsured for tiie hiU 28-montii
period of the smdy.
a
Thirty-two mUlion people (plus or minus 1.2 miUion) were not covered by any kind
of insurance on average in any given montii.
a
Seventy-nine percent of aU people (plus or minus 0.8 percent) had continuous healtii
insurance coverage over tiie entire 1987 year.
o
Fifty percent of tiie persons witiiout healtii insurance coverage in tiie fourth quarter
of 1990 were under tiie age of 25. an age group tiiat accounts for 36 percem of tiie
entire population. This is also tiie age group just enteringtiiejob market and subject
to probationary waiting periods before becoming eligible forftiUfiingebenefits.
This is not to suggesttiiattiieproblem oftiieuninsured is unimportant. ReganUess of tiie
number,tiieuninsured often can face difficulties wittittieircare. Some hospitals wUl not
accept tiiem. They are disinclined to seek healtti maintenance or preventive care, which
can leadtiiemto more serious healtii conditions whichtiienrequireemergency treattnents.
The children of tiie uninsured often do not receive immunizations and otiier regular
treatinents tiiat are important to tiieir developmem. The details above are intended simply
to iUuminate tiie characteristics of tiie uninsured population.
MYTH HZ: Not enoughresourcesare being spent on healtti care in America.
FACT A: America wUl spend close to $998 bUlion, or more ttian 15 percent of Gross
Domestic Product (GDP) on healtii care in FY 1994. Thisrepresentsa per capiu expense
of about $3,992. This is moretiian25 percent higherttianttienext indusuialized counti^,
Canada, which spends 11 percent of GDP on healtii care.
22
�FACT B: Medicare cost per enroUee for FY 1994 is expected to be moretiian$5,235.
FACT C: Medicaid cost per recipient for FY 1994 is expected to be moretiian$6,461.
The federal share is about $3,615;tiiesute and local matching share is moretiian$2,884.
MYTH #3: There is not 100-percent access to healtii care in America today. FACT: Uidividuals who do not have any healtii insurance or healtii coverage or are unable to pay currentiy receive care by law. These costs are covered partiaUy by Medicare
and Medicaid payments to hospitals and cost shifting to private healtii plans. A percenuge
of every patient's bUl can be directiy attributed tottieunrecovered cost of such services.
This does not mean, however,ttiatttielack of insurance among some Americans, is not
a problem. Altiiough a lack of health insurance does not necessarily deprive individuals
of health care — medical etiiics andtiielawrequirettiatpersons who are witiiout healtii
insurance, or who are unable to pay for tiieir own services. stiUreceivehealtii care when
necessary —ttieuninsured can face considerable difficulties over tiieir care.
MYTH #4: Poor people receive most of tiie federal entitiement doUars budgeted for
healtii care.
FACT A: People making more tiian $30,000 of income received close to 40 percent of
aU Medicare doUars, or more tiian $60 biUion. aUocated in FY 1993.
FACT B: Less tiian 42 percent of tiie Medicaid budget goes directiy for healtii care for
recipients;tiiebulk of tiie Medicaid budget goes to hospitals and providers each year in
the form of grants or aUowances for construction and otiier projects.
MYTH #5: Medicare beneficiaries pay ttie fiUl cost of MedicarettuoughttieirPart B
(SMI) premiums for physicians services at a cost of $36.60 per montii.
FACT A: The federal taxpayer subsidizes 75 percent of tiie cost of Medicare Part B
through generalrevenues,or more than $133 bUUon for FY 1994.
FACT B: When Medicare was passed into law in 1965, half of Part B coverage was paid
by tiie enroUeetiirougha premium, and half was paid byttiegovernment Ifttieoriginal
ratio were stiU in place today, $77.6 bUlion would be saved over ttie next five years
according to CBO. Part B premiums would be $73.20. rattierttian$36.60. per montti.
FACT C: The maricet value of a healtti insurance plan similar tottiatreceived by a Medicare beneficiary could range from $350 to $700 per montti or more intticmarket
MYTH #6: Most of ttie federal entitiement healtii program money goes toward routine
primary physician health care, disease prevention and weUness.
23
�FACT: Twenty-eight percent oftiieMedicare budget is spent on recipients intiielast year
of a beneficiary's Ufe witii tiie majority of it being spent intiielast 30 days.
MYTH #7: The eligibility age for Medicare is due to go up to age 67 whentiieeligibility
age for Social Security goes up.
FACT A: The eligibility age for Medicare is not scheduled to increase. Social Security
is scheduled to begin to go up in tiie year 2000 by two montti increments per year until
2005 when age 66 wiU betiieretirementage until tiie year 2016. Then it wiU go up again
in two montii increments per year untiltiieretirementage for Social Security becomes age
67 intiieyear 2022.
FACT B: IftiieeligibiUty age for Medicare were torisefrom age 65 to age 67 on January 1, 1994, $77.7 biUion would be saved overttienext five years according to CBO.
MYTH #8: The cost of medical malpractice inttiemedical care system is very smaU,
accounting for less than $1 biUion per year.
FACT: According to a smdy by Lewin-VHI Inc. of Washington D.C, ttie potential
savings fromreformingtiiemedical malpractice system could range from $7.5 bUUon to
$76.2 bUlion over five years. The savings would be achieved by discouraging "defensive
medicine," which Lewin-VHI defines as "changes in practice carried out by healtii care
providers for the sole purpose of avoiding malpractice clauns."
24
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AP)D TYPE
001 . memo
SUBJECT/TITLE
DATE
Chns Jennings & Steve Richetti to Hillary Rodham Clinton; re:
Proposed Schedule for Congressional Consultative Meetings & PreIntroduction Briefings (2 pages)
05/31/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefmg Memos - First Lady, 1993 [4]
2006-0885-F
ip2849
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C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�SCHEDULE FOR CONGRESSIONAL CONSULTATIVE MEETINGS AND
BRIEFINGS
CONSULTATIVE MEETINGS:
Sunday. June 6 t h :
House Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, JF
(To h e l p s t a f f p r e p a r e members f o r meeting w i t h F i r s t
Lady)
Senate Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, JF
(To h e l p s t a f f p r e p a r e members f o r meeting w i t h F i r s t
Lady)
June 8 t h :
House Leadership and Chairmen of Committee of J u r s i d i c t i o n
HRC, IM, JF
L o c a t i o n : White House
(To b r i e f Members and s e t up c o n s u l t a t i v e p r o c e s s )
Foley
Gephardt
Bonior
Rostenkowski
Stark
Dingell
Waxman
Ford
Williams
Senate Leadership and Chairmen of Committees of J u r i s d i c t i o n
HRC, IM, JF
L o c a t i o n : White House
(To b r i e f Members and s e t up c o n s u l t a t i v e p r o c e s s )
Mitchell
Ford
Pryor
Daschle
Moynihan
Kennedy
Rockefeller
Riegle
Mikulski
Breaux
�Wednesday, June 9th;
C o n g r e s s i o n a l R e p u b l i c a n L e a d e r s h i p - HRC,
L o c a t i o n : White House
IM, JF
Dole and designees
M i c h e l and designees
Daschle Message/Whip Group:
R o c k e f e l l e r , Pryor, Daschle, K e r r e y , W o f f o r d , B o n i o r ,
Gephardt ( i f a v a i l a b l e and w i l l i n g ) , and o t h e r House Member
"friends."
(WEEKLY MEETING)
S t a f f : J e f f E l l e r , Bob Boorstin, Steve R i c c h e t t i , C h r i s
Jennings, Melanne Verveer, J e r r y Klepner, Karen P o l l i t z
Thursday,
June 10th:
S i n g l e Payer Leaders - HRC, IM, JF
L o c a t i o n : C a p i t o l H i l l (Gephardt t o Host)
McDermott
Conyers
Wellstone
Conservative Democratic Forum - HRC, IM, JF
Location: C a p i t o l H i l l (Gephardt to Host)
Cooper
Andrews
Stenholm
Breaux
Boren
Daschle Focus Group:
Daschle/Pryor and moderate/conservative Democrats:
Breaux, Reid, Exon, and Conrad
S t a f f : R i c c h e t t i , Jennings, Klepner, P o l l i t z
F r i d a y . June 11th ( P o s s i b l y Saturday, June 12th. as w e l l )
House Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, JF
(Ongoing d e t a i l e d s t a f f - l e v e l d i s c u s s i o n s )
Senate Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, JF
(Ongoing d e t a i l e d s t a f f - l e v e l d i s c u s s i o n s )
Bryan,
�Monday. June 14:
House Ways and Means Committee - HRC, IM, JF
Location: Capitol H i l l
(Chairman determines attendees and whether
bipartisan)
Senate Finance Committee - HRC, IM, JF
Location: Capitol H i l l
(Bipartisan)
House Energy and Commerce Committee - HRC, IM, JF
Location: Capitol H i l l
(Chairman determines attendees and whether
bipartisan)
Daschle Message/Whip Group:
R o c k e f e l l e r , P r y o r , Daschle, Kerrey, W o f f o r d , B o n i o r ,
Gephardt ( i f a v a i l a b l e and w i l l i n g ) , and o t h e r House Member
"friends."
(WEEKLY MEETING)
S t a f f : J e f f E l l e r , Bob B o o r s t i n , Steve R i c c h e t t i , C h r i s
Jennings, Melanne Verveer, J e r r y Klepner, Karen P o l l i t z
Tuesday. June 1 5 t h ;
Senate Labor and Human Resources Committee - HRC, IM, JF
Location: Capitol H i l l
(Bipartisan)
House Education and Labor Committee - HRC, IM, JF
Location: Capitol H i l l
(Chairman determines attendees and whether b i p a r t i s a n )
House Caucuses - IM, JF
C o n g r e s s i o n a l Black Caucus
C o n g r e s s i o n a l Caucus on Women's Issues
Wednesday. June 1 6 t h :
House Democratic Whip O r g a n i z a t i o n - HRC, IM, JF
Location: Capitol H i l l
House Republican H e a l t h Care Task Force - HRC, IM, JF
Location: Capitol H i l l
U.S. Senate ( B i p a r t i s a n ) - HRC, IM, JF
Location; Capitol H i l l
House Caucuses - IM, JF
C o n g r e s s i o n a l H i s p a n i c Caucus
�To Be Scheduled:
Other Meetings w i t h Committees as Needed Location; Capitol H i l l
Biden, J u d i c i a r y
R o c k e f e l l e r , Veterans
Nunn, Armed S e r v i c e s
Bumpers, Small Business
Glenn, Governmental A f f a i r s
Inouye, I n d i a n A f f a i r s
IM, JF, Other S t a f f
Brooks, J u d i c i a r y
Montgomery, Veterans
Dellums, Armed S e r v i c e s
LaFalce, Small Business
Clay, Post O f f i c e
M i l l e r , N a t u r a l Resources
�PRE-UNVEILING BRIEFINGS;
Saturday. June 1 9 t h :
House Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, JF
(Ongoing d e t a i l e d d i s c u s s i o n s and t o h e l p s t a f f p r e p a r e
members f o r meeting w i t h P r e s i d e n t and F i r s t Lady)
Senate Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, JF
(Ongoing d e t a t i l e d d i s s c u s s i o n s and t o h e l p s t a f f p r e p a r e
members f o r meeting w i t h P r e s i d e n t and F i r s t Lady)
Sunday. June 2 0 t h :
House Leadership and Chairmen of Committee of J u r s i d i c t i o n
HRC,
BC(?)
L o c a t i o n : White House
Foley
Gephardt
Bonior
Rostenkowski
Stark
Dingell
Waxman
Ford
Williams
Senate Leadership and Chairmen of Committees of J u r i s d i c t i o n
HRC,
BC(?)
L o c a t i o n : White House
Mitchell
Ford
Pryor
Daschle
Moynihan
Kennedy
Rockefeller
Riegle
Mikulski
Breaux
C o n g r e s s i o n a l R e p u b l i c a n L e a d e r s h i p - HRC,
L o c a t i o n : White House
Dole and designees
M i c h e l and designees
BC ( ? )
�Monday. June 2 1 s t ;
Senate Democratic P o l i c y Committee - BC?, HRC, IM, JF
Location; Capitol H i l l
House Democratic Caucus - HRC, IM, JF
Location; Capitol H i l l
Tuesday, June 22nd:
House R e p u b l i c a n Caucus - HRC, IM, JF
Location;
Capitol H i l l
Senate Republican P o l i c y Committee - HRC, IM, J F
Location: Capitol H i l l
House Democratic S t a f f B r i e f i n g - IM, JF o r a p p r o p r i a t e s u r r o g a t e
Location: Capitol H i l l
House R e p u b l i c a n S t a f f B r i e f i n g - IM, JF o r a p p r o p r i a t e s u r r o g a t e
Location: Capitol H i l l
Senate S t a f f B r i e f i n g - IM, JF o r a p p r o p r i a t e s u r r o g a t e
Location; Capitol H i l l
Other Meetings with Committees and Members as Needed
�SCHEDULE FOR CONGRESSIONAL CONSULTATIVE MEETINGS AND BRIEFINGS
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
6/6
6/7
6/8
6/9
6/10
6/11
6/12
House
Leadership
and Cmte
o f Jdx
Staff
House
Leadership
and Chmn o f
Cmtes o f
Jdx
Cong.
Republican
Leadership
Single
Payer
Leaders
HRC/IM/JF
HRC/IM/JF
House
Leadership
and Cmtes
o f Jdx
Staff
IM/JF
HRC/IM/JF
Senate
Leadership
and Cmte
o f Jdx
Staff
Senate
Leadership
and Chmn o f
Cmtes o f
Jdx
IM/JF
HRC/IM/JF
IM/JF
Daschle
Message/
Whip Group
CDF
HRC/IM/JF
Eller/SR/CJ
et. a l .
Senate
Leadership
and Cmtes
o f Jdx
Staff
IM/JF
Daschle
Focus Group
SR/CJ
et. a l .
Other Meetings w i t h A d m i n i s t r a t i o n S t a f f t o be Scheduled.
|
1
�SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
6/13
6/14
6/15
6/16
6/17
6/18
6/19
Senate
Finance
Committee
Senate
Labor and
Human
Resources
Committee
House
Democratic
Whip Org.
HRC/IM/JF
HRC/IM/JF
House
Leadership
and Cmtes
o f Jdx
Staff
IM/JF
HRC/IM/JF
House
Energy and
Commerce
Committee
House
Education
and Labor
Committee
House
Republican
H e a l t h Care
Task Force
HRC/IM/JF
HRC/IM/JF
HRC/IM/JF
Senate
Leadership
and Cmtes
o f Jdx
Staff
IM/JF
Ways and
Means
Conunittee
Cong.
Caucus on
Women's
Issues
U.S. Senate
Bipartisan
HRC/IM/JF
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IM/JF
Daschle
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Caucus
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Caucus
IM/JF
Eller/SR/CJ
IM/JF
�SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
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SATURDAY
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House
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of Cmtes
o f Jdx
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House
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Caucus
BC(?)/HRC/
IM/JF
HRC/IM/JF
HRC/BC(?)
Senate
Leadership
and Chmn
o f Cmtes
o f Jdx
House
Democratic
Caucus
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Conunittee
HRC/IM/JF
HRC/IM/JF
HRC/BC(?)
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1
�DETERMINED TO BE A.N ADMIMSTFi\TiVE
MARKINGPer EX). 12958 as amen
IfHtUlv^fS-'
Date: A
PERSONAL AND -eeWFaEPmiTiAL MEMORANDUM
TO;
FROM:
RE:
cc:
H i l l a r y Rodham C l i n t o n
May 5, 1993
C h r i s Jennings, Steve E d e l s t e i n
Meeting w i t h Senator W e l l s t o n e and S i n g l e Payer Groups
Melanne, Steve, I r a , Judy, Mike
Background:
F o l l o w i n g up on y o u r t e l e p h o n e c o n v e r s a t i o n w i t h Senator
W e l l s t o n e l a s t week, you a r e scheduled t o meet w i t h him and
r e p r e s e n t a t i v e s o f o r g a n i z a t i o n s which s u p p o r t t h e s i n g l e payer
approach t o h e a l t h c a r e r e f o r m . Senator W e l l s t o n e has t r i e d t o
keep t h e meeting s i z e manageable by a l l o w i n g each group t o send
o n l y one r e p r e s e n t a t i v e . There w i l l p r o b a b l y be about 15 groups
r e p r e s e n t e d a t t h e meeting.
Yesterday, C h r i s spoke w i t h Senator W e l l s t o n e and suggested
t h a t he c a l l Congressman McDermott t o a d v i s e him about t h i s
meeting and i n v i t e him t o a t t e n d . Senator W e l l s t o n e assured him
t h a t he would, b u t as o f t h i s w r i t i n g i t i s u n c l e a r whether t h e
Congressman w i l l be a t t e n d i n g . I n a d d i t i o n , t h i s morning, C h r i s
i n f o r m e d Barbara Smith o f Congressman McDermott's s t a f f o f t h e
meeting. She t h o u g h t i t would be no problem i f McDermott d i d n o t
attend.
Format:
Senator W e l l s t o n e w i l l open t h e meeting and i n t r o d u c e you.
I t i s t h e n expected t h a t you g i v e b r i e f remarks (5-10 m i n u t e s ) .
A f t e r your remarks. Senator W e l l s t o n e w i l l t h e n t u r n i t over t o
representatives of the organizations attending t o give
p r e s e n t a t i o n s on i s s u e s t h e y c a r e about.
P o i n t s t o H i t i n Your Remarks:
(1)
Shared P r i n c i p l e s . There i s a l o t o f common ground between
our approach and t h e s i n g l e payer approach. We share a
commitment t o p r o v i d i n g coverage t o a l l Americans t o a
comprehensive s e t o f b e n e f i t s . We agree on t h e need t o
f u n d a m e n t a l l y o v e r h a u l our h e a l t h c a r e system t o b e t t e r
c o n t r o l c o s t s , reduce paperwork and s t r e a m l i n e
a d m i n i s t r a t i o n . We a r e a l s o committed t o m a i n t a i n i n g
q u a l i t y and consumer c h o i c e .
(2)
S t a t e F l e x i b i l i t y . S t a t e f l e x i b i l i t y w i l l be c e n t r a l t o our
p l a n . T h i s w i l l a l l o w s t a t e s t o implement s i n g l e payer
models i f t h e y f e e l i t b e s t meets t h e needs o f t h e people o f
that state.
�(3)
H e a l t h Care T h i s Year. We share y o u r sense o f t h e urgency
o f t h e problem and t h e need t o a c t sooner r a t h e r t h a n l a t e r
on h e a l t h c a r e r e f o r m .
We have a g r e a t o p p o r t u n i t y t o pass
h e a l t h care reform t h i s year.
(4)
P r a i s e Senator W e l l s t o n e . You may w i s h t o thank Senator
W e l l s t o n e f o r a r r a n g i n g t h i s meeting and f o r h i s l e a d e r s h i p
and deep commitment t o t h i s i s s u e .
Issues o f Concern;
The groups w i l l l i k e l y r a i s e t h e f o l l o w i n g i s s u e s i n t h e i r
presentations:
(1)
No Opt Outs. They advocate a s i n g l e - t i e r system and f e e l
l e t t i n g groups o p t - o u t w i l l undermine t h i s and may l e a v e
t h o s e l e f t i n t h e p l a n w i t h i n f e r i o r coverage and s e r v i c e .
(2)
F a i r Financing.
They f a v o r p r o g r e s s i v e
r a t h e r t h a n a premium.
(3)
Comprehensive B e n e f i t s . They want t h e b e n e f i t package t o be
as comprehensive as p o s s i b l e i n c l u d i n g coverage f o r l o n g term c a r e , mental h e a l t h , and r e h a b i l i t a t i o n s e r v i c e s .
(4)
P u b l i c A c c o u n t a b i l i t y . They back consumer p a r t i c i p a t i o n
a l l o v e r s i g h t and g o v e r n i n g boards.
(5)
Freedom o f Choice. They b e l i e v e consumers s h o u l d remain
f r e e t o p i c k t h e i r own d o c t o r s .
(6)
Affordability.
They oppose co-pays and d e d u c t i b l e s
covered s e r v i c e s .
(7)
U n i v e r s a l i t y . They want everyone covered w i t h a
r a p i d phase-in.
tax-based f i n a n c i n g
on
for
fairly
Background M a t e r i a l s :
A t t a c h e d f o r your i n f o r m a t i o n , i s a background p r o f i l e o f
Senator W e l l s t o n e and a memo by Mike Lux o f P u b l i c L i a i s o n on t h e
groups who w i l l be a t t e n d i n g .
�SENATOR PAUL WELLSTONE (D-MN)
Senator Wellstone is very interested in health care reform. In March, he reintroduced
his single payer bill, the Senate counterpart of the McDermott bill. Despite his strong bias
toward single payer and his suspicions of managed competition, he has expressed a
willingness to work with you. His strong desire for reform and his belief that we must act
now make him likely to support the Administration plan.
Senator Wellstone has a strong interest in mental health and substance abuse benefits.
He modified his previous bill to strengthen its mental health provisions. Last week (4/29), he
attended a briefing by Mrs. Gore on mental health issues for Members of Congress and staff.
Wellstone expressed his strong support for including mental health servcies in the benefits
package. He also raised the possiblity of forming a Senate Mental Health Working Group
along the lines of the group lead by Congressman Kopetski in the House. Other concerns
include rural health, consumer choice and state flexibility (so that Minnesota might pursue a
single payer option).
Recent Developments: Senator Wellstone indicated concern regarding talking points
distributed by the Task Force to the members of Congress, particularly how single payer was
characterized. At the retreat, he stated that he doesn't want anyone to be able to opt out of
the Purchasing Cooperative because he fears that healthy people will opt out.
�T H E WHITE H O U S E
WASHINGTON
May 5, 1993
MEMORANDUM FOR CHRIS JENNINGS
SUBJECT:
HRC Meeting With Senator Wellstone
FROM:
Mike Lux
I have divided the single payer groups attending the Wellstone
meeting into three different categories:
1. Groups that are r e a l i s t i c and are working very constructively
with us to get a package they can support:
AFSCME
Communications Workers of America
National Farmers Union
ILGWU
2. Groups that have been very tough negotiators, and are a
l i t t l e more purist than those i n the f i r s t category. We can
probably get these groups on board i n the end.
Consumers Union
Citizen Action
National Council of Senior Citizens
Church Women United
National Association of Social Workers
American Public Health Association
3. Groups that are more pure, and are t o t a l l y committed to a
single payer approach. Whether we ever get them on board i s a
r e a l question.
Public Citizen
Neighbor to Neighbor
NETWORK
Gray Panthers
�DETERMINED TO BE AN ADMINISTRATIVE
MARKlNG^erE.0.12958 as amended, Sjcc. 3.3 (c)
Initials:
Date: i ^ x J ^ i j J —
PRIVILEGED AND eONFTDETiTTOn:
M E M O R A N D U M
TO:
FR:
RE;
cc:
H i l l a r y Rodham C l i n t o n
C h r i s Jennings, Steve E d e l s t e i n
Meeting w i t h Senator Ford
Melanne, Steve, D i s t r i b u t i o n
May 27, 1993
Tomorrow you a r e scheduled t o meet w i t h Senator Ford. The
purpose o f t h i s meeting i s t o e s t a b l i s h a d i a l o g u e and a
r e l a t i o n s h i p i n preparation f o r future negotiations regarding
p o s s i b l e tobacco t a x p r o v i s i o n s as p a r t o f f i n a n c i n g package f o r
the h e a l t h r e f o r m i n i t i a t i v e .
I n a t t e n d a n c e w i l l be M i l e s Coggans, s p e c i a l a s s i s t a n t t o
the P r e s i d e n t on A g r i c u l t u r e . A t t a c h e d f o r your r e v i e w i s ( 1 ) a
memo d i s c u s s i n g t h e impact o f a p o s s i b l e c i g a r e t t e t a x on tobacco
p r o d u c t i o n and t h e p o t e n t i a l c o s t o f a m e l i o r a t i n g t h a t impact ( 2 )
a memo p r e p a r e d by USDA which p r o v i d e s a background on tobacco
(3) a memo from USDA t o M i l e s Coggans o u t l i n i n g t h e v a r i o u s ways
tobacco r e c e i v e s s u p p o r t from t h e F e d e r a l government, and ( 4 ) a
summary o f Senator Ford's h e a l t h background.
BACKGROUND:
Senator Ford wants v e r y much t o be t h e dealmaker r e g a r d i n g
any tobacco t a x t h a t i n c l u d e d i n t h e f i n a n c i n g p r o v i s i o n s o f t h e
A d m i n i s t r a t i o n ' s h e a l t h r e f o r m p l a n . As you know, tobacco i s a
s i g n i f i c a n t p a r t o f Kentucky's farm economy and as such any t a x
on tobacco w i l l have a major impact on key c o n s t i t u e n t s o f h i s
state.
Senator Ford has a w e l l earned r e p u t a t i o n i n t h e Senate f o r
a g g r e s s i v e l y p r o t e c t i n g h i s home s t a t e i n t e r e s t s . However, i n
p r e v i o u s d i s c u s s i o n s w i t h t h e Senator he has i n d i c a t e d some
w i l l i n g n e s s t o d i s c u s s a tobacco t a x as l o n g as t h e i r was some
e f f o r t t o h e l p t h e Kentucky's tobacco growers.
Senator Ford does n o t view t h i s meeting as a d e a l c u t t i n g
meeting, b u t r a t h e r a g e n e r a l d i s c u s s i o n o f t h e i s s u e s and an
o p p o r t u n i t y t o e s t a b l i s h a r e l a t i o n s h i p t o f a c i l i t a t e such a
m e e t i n g a t a f u t u r e d a t e . You may w i s h , however t o use t h i s
m e e t i n g as an o p p o r t u n i t y t o demonstrate your u n d e r s t a n d i n g o f
the i s s u e s s u r r o u n d i n g t h e tobacco "tax and farm s u b s i d i e s .
You may a l s o w i s h t o seek Senator Ford's o p i n i o n about t h e
a d v i s a b i l i t y o f i n c l u d i n g Congressman Rose a t f u t u r e d i s c u s s i o n s
between you and t h e Senator on t h i s i s s u e . Congress Rose o f
N o r t h C a r o l i n a e n v i s i o n s a s i m i l a r d e a l making r o l e on a tobacco
t a x f o r h i m s e l f i n t h e House.
�Cigarette Tax Increase and Tobacco Quota Buyout
The A d m i n i s t r a t i o n , some members of Congress, and others have
proposed r a i s i n g c i g a r e t t e excise taxes t o help pay f o r health
care reform.
D i f f e r e n t amounts of increase have been proposed
but they range from a few cents t o $2.00 per pack.
the
To evaluate
f u l l p o t e n t i a l e f f e c t s of the increase we w i l l assume the tax
i s jumped $2.00 per pack.
An increase of $2.00 per pack of 20 i n the Federal excise tax
would reduce U.S. c i g a r e t t e consumption by 25 t o 40 percent from
500 b i l l i o n t o 300 t o 375 b i l l i o n c i g a r e t t e s .
As a r e s u l t , U.S.
tobacco production could f a l l as much as 30 percent.
To s o f t e n the impact of the decline i n U.S. tobacco production, a
proposal has been made t o pay quota owners t o r e t i r e unneeded
quotas.
Quotas are pounds of tobacco f o r which government p r i c e
support i s a v a i l a b l e .
Since quotas cannot be sold between
counties, the c a p i t a l i z e d value of quota varies widely from as
l i t t l e 25 cents i n some marginal producing counties t o as much as
$3.50 per pound i n some of the most extensive producing counties.
A wider v a r i a t i o n probably e x i s t s f o r burley quota values than
f o r f l u e - c u r e d but both vary considerably.
Burley and flue-cured
are the major c i g a r e t t e kinds of tobacco grown i n the United
States.
Burley i s grown mainly i n Kentucky and Tennessee and ••
flue-cured i s produced mostly i n North Carolina, South Carolina,
Georgia, and V i r g i n i a .
�The average c a p i t a l i z e d value of flue-cured and burley quotas
probably averages $2.00 t o $2.50 per pound.
purposes, we w i l l use $2.25 per pound.
For i l l u s t r a t i v e
I n 1993, the flue-cured
e f f e c t i v e quota t o t a l s 890 m i l l i o n pounds and the burley
e f f e c t i v e quota t o t a l s 730 m i l l i o n pounds.
I f an a d d i t i o n a l
$2.00 per pack excise tax was imposed, flue-cured and burley
quotas would f a l l about 500 m i l l i o n pounds.
The flue-cured quota
would f a l l about 230 m i l l i o n pounds and burley about 270 m i l l i o n
pounds because of the decline i n c i g a r e t t e consumption and costsaving measures f o r producing c i g a r e t t e s .
The r e l a t i v e decline
i n burley would be greater because a larger share of burley i s
used domestically t o produce c i g a r e t t e s . At an average r a t e of
$2.25 per pound, i t would require about $1.1 b i l l i o n to buy out
the unneeded burley and flue-cured quotas.
I n a d d i t i o n , i f other
tobacco product taxes were increased at the same rate as
c i g a r e t t e s , another $100 m i l l i o n would be required to purchase
f i r e - c u r e d , dark a i r - c u r e d and cigar acreage allotments
(Production i s c o n t r o l l e d by acres rather than pounds f o r these
kinds).
There are about 450,000 i n d i v i d u a l tobacco quota owners i n 15
states i n the United States.
burley quotas.
Around 300,000 or two-thirds are
There are about 55,000 flue-cured quotas and
95,000 f i r e - c u r e d , dark a i r - c u r e d , and cigar acreage allotments.
About 200,000 of the burley quotas are 2,000 pounds (1 acre) or
less.
These quota owners would l i k e l y have the greatest i n t e r e s t
i n s e l l i n g quota-.
Flue-cured quotas are much larger averaging
�over 16,000 pounds p e r quota.
125,000 b u r l e y quotas,
allotments
A l i k e l y scenario might see
15,000 f l u e - c u r e d , and 30,000 o t h e r
retired.
An i n c r e a s e i n t h e Federal c i g a r e t t e excise t a x would c l e a r l y
i n c r e a s e Federal revenues.
tax
A $2.00 a pack i n c r e a s e i n t h e excise
c o u l d i n c r e a s e Federal t a x revenues $30 t o $35 b i l l i o n .
However, consumption would l i k e l y d e c l i n e more than c o u l d be
a t t r i b u t e d t o t h e Federal t a x i n c r e a s e because States would
likely
i n c r e a s e t h e i r e x c i s e taxes and manufacturers
would
likely
i n c r e a s e p r i c e s more than t h e amount of t h e t a x i n c r e a s e t o
r e c o v e r losses from lower c i g a r e t t e consumption.
The a d d i t i o n a l
d e c l i n e i n consumption a t t r i b u t a b l e t o f a c t o r s o t h e r than t h e
F e d e r a l t a x i n c r e a s e would r e p r e s e n t a r e d u c t i o n i n p o t e n t i a l t a x
receipts.
Consequently, Federal e x c i s e t a x c o l l e c t i o n s a f t e r a
$2.00 h i k e might be c l o s e r t o $25 b i l l i o n than $35 b i l l i o n .
Gains from t h e i n c r e a s e i n Federal t a x revenues w i t h a h i g h e r
c i g a r e t t e t a x would be o f f s e t by s e v e r a l l o s s e s .
would d e c l i n e by $2 t o $3 b i l l i o n
S t a t e taxes
(unless r a t e s were i n c r e a s e d ) ,
b o t h a g r i c u l t u r a l and n o n a g r i c u l t u r a l jobs would be l o s t - e s t i m a t e s i n d i c a t e 1 t o 1.5 m i l l i o n jobs c o u l d be l o s t .
Some
community i n f r a s t r u c t u r e s c o u l d be decimated by r e d u c t i o n s i n •
tobacco p r o d u c t i o n , p a r t i c u l a r l y m a r g i n a l p r o d u c i n g
areas.
Tenants, farmworkers,' tobacco warehouse o p e r a t o r s , chemical,
fuel
and f e r t i l i z e r d e a l e r s , bankers, equipment d e a l e r s and o t h e r s -
�t o g e t h e r w i t h former tobacco growers might w e l l leave some
tobacco growing areas.
A l t h o u g h a buyout o f quotas would s o f t e n the impact o f reduced
tobacco p r o d u c t i o n i n l o c a l economies, t h e r e i s a concern t h a t
much o f t h e money would not be r e i n v e s t e d l o c a l l y .
Consequently,
o t h e r economic a s s i s t a n c e i n a d d i t i o n t o a quota buyout might be
needed.
C l e a r l y , t e n a n t s who own l i t t l e o r no quota would be
h u r t by a b i g drop i n tobacco p r o d u c t i o n and farmworkers
employment o p p o r t u n i t i e s would be reduced.
Because tobacco farms a r e s m a l l , t r a d i t i o n a l crops such as corn
and soybeans do n o t come c l o s e t o r e p l a c i n g tobacco as a source
of income.
Other h i g h v a l u e crops such as v e g e t a b l e s o f f e r
only
l i m i t e d o p p o r t u n i t i e s because these crops can be produced more
e c o n o m i c a l l y i n o t h e r areas.
Consequently, o t h e r economic
a s s i s t a n c e i n a d d i t i o n t o a quota buyout might be needed t o
r e t r a i n t e n a n t s and farm o p e r a t o r s f o r o f f - f a r m j o b s , e x p l o r e
alternative
agricultural
e n t e r p r i s e s and p r o v i d e t r a i n i n g
l i m i t e d number o f people, p r o v i d e investment c a p i t a l
for a
f o r new farm
and nonfarm b u s i n e s s v e n t u r e s t o generate economic a c t i v i t y and
h e l p r e p l a c e t h e t a x base l o s t because o f reduced tobacco
production.
A l t h o u g h tobacco f a r m i n g areas would experience t h e
g r e a t e s t impact o f a $2.00 F e d e r a l t a x i n c r e a s e , reduced
c i g a r e t t e consumption would cause unemployment, o f c i g a r e t t e
m a n u f a c t u r i n g p l a n t workers, w h o l e s a l e r s , d i s t r i b u t o r s , and
retailers.
�MAY 27, 1993
MEMORANDUM TO:
HEALTH CARE TASK FORCE
FROM:
U.S.D.A.
SUBJECT:
BACKGROUND ON TOBACCO
Tobacco is produced in 20 states. In 15 states, tobacco production is under the Federal
price support-production control program. Growers vote whether or not they wish to be
covered by the Federal program. If covered, they are guaranteed minimum prices for their
tobacco. Most costs of operating the tobacco program are borne by growers and
manufacturers.
Tobacco is produced on relatively small farms. There are two major cigarette kinds: fluecured and burley. Burley is grown mainly in Kentucky and Tennessee. Flue-cured is
produced mainly in North Carolina, South Carolina, Virginia, and Georgia. Burley farms
are small averaging only about 3 acres of tobacco per farm. Flue-cured farms are somewhat
larger and average around 25 acres per farm. About 2,200 pounds of tobacco is produced
per acre. Gross income from an acre of tobacco totals nearly $4,000 per acre. Net income
totals $1,000 to $2,000 per acre. After falling sharply in the mid-1980's, grower incomes
have increased from 1986 to 1992. However, big jumps in cheaper imported leaf is causing
production to decline in 1993. Unless imports are curtailed, further declines in production
are expected in subsequent years.
Traditionally, tobacco growers, warehouse operators, export dealers, and cigarette
manufacturers have been united on issues facing the tobacco industry. However, large
increases in imports have caused some grower groups to question their commitment to
support for limiting increases in Federal excise taxes. For their support, growers are seeking
a commitment from tobacco companies that they will limit imported leaf use in their
cigarette blends. Some grower groups prefer that the commitments be incorporated into law
because they feel cigarette compames reneged on promises of the mid-1980's to limit use
of imported leaf.
The proposed Federal cigarette tax increase of $1.00 to $2.00 per pack of 20 cigarettes would
reduce U.S. consumption 25 to 40 percent. Tobacco production would decline 25 to 30
percent. The relative decline in burley would be greater because a larger share of burley
is used domestically to produce cigarettes. Because tobacco farms are small, traditional
crops such as corn and soybeans do not come close to replacing tobacco as a source of
income. Other high value crops such as vegetables offer only limited opportunities because
�these crops can be produced more economically in other areas.
To soften the impact of the decline in U.S. tobacco production, a proposal has been made
to pay quota owners to retire unneeded quotas. Quotas are pounds of tobacco for which
government price support is available. The capitalized value of quotas averages about $2.25
per pound. With a $2.00 per pack increase in the Federal excise tax, about 500 million
pounds of current quota would be unneeded. Consequently, at the current capitalized rate,
about $1.1 billion would be needed to buy out quotas. Around 170,000 of the 450,000 quotas
might be sold under such a program.
In addition to quota owners, a drop in tobacco production would hurt tenants who own little
or no quota and farm workers. Consequently, in addition to a quota buy out, assistance for
retraining for off-farm jobs, investment capital for new farm and non-farm businesses, and
exploration of alternative agricultural enterprises for a limited number of people would be
needed.
Tobaccos' political base is far-reaching. It is a major source of income in 6 states and is
grown in 14 others.
�199 1 BURLEY TOBACCO
LIST RANKING FOR EFFECTIVE QUOTAS
PARTY STATE CONG.
DIST.
RANK REPflESENTATIVE
, 9 9 1 BURLEY TOBACCO
POUNDS
POUNDS
rRANKREPBE5f?n^^
t
S c o t t y Baesler
D
KY
06
162.244.766
2
W i l l i a m H. Natchor
D
KY
02
137,183.403
3
04
125,365,214
Ike Skelton
J i m Bunning
R
KY
4
J a m e s H. Quillen
R
TN
01
73.014.959
Robert W. Goodlatte
5
T o m Barlow
D
KY
01
64,024,880
John T. Myert
6
Harold Rogers
R
KY
05
52.151,602
7
Bart Gordon
D
TN
06
50.781.804
Mel Hancock
8
J i m Cooper
D
TN
04
33,992,064
Bud Cramer
9
Rick Boucher
D
VA
09
33,949,265
10
Lee H, Hamilton
D
IN
09
22,870.524
1 1
Charles H. Taylor
R
NC
11
20.767.283
Dan Burton
^
OH
02
17.763.911
Bill Emerson
12
13
D o n Sundquist
R
TN
07
15.388.842
14
J o h n J . " J i m m y " D u n c a n , Jr.
R
TN
02
14,367,044
15
Cass Ballenger
R
NC
10
13,149.774
16
S t e p h e n L. Neal
D
NC
05
17
T e d Strickland
D
OH
18
Pat Danner
D
19
Nick Joe Rahall II
20
Marilyn Lloyd
21
Alan B. MoHohan
Norman Si»i«kV
Tim Hutchinson
J. Alex McMillan
Tony Pi
John A. Boehner
9.210.333
5
Thomas J. Bliley. J ' -
06
8.473.616
7
Howard Coble
MO
06
7,271.025
7
Melvin Watt
0
WV
03
4.253.729
D
TM
03
4,191,937
Robert E. Wise, Jr.
D
WV
02
3,534.626
22
Bob Clement
D
TN
05
3,436.634
23
J o h n S. Tanner
D
TN
08
1,190,785
24
R o m a n o L. Mazzoli
D
KY
03
960.995
25
Lewis F. Payne, Jr.
D
VA
05
613.951
26
Frank McCloskey
D
IN
08
571.664
27
Philip R. Sharp
D
IN
02
447.746
28
N a t h a n Deal
D
GA
09
239.891
29
D a v i d L. Hobson
R
OH
07
179,462
30
Harold L. Volkmer
D
MO
09
153,938
31
Douglas Applegate
D
OH
18
140.523
32
David Mann
D
OH
01
139.006
33
J i m Slattery
D
KS
02
114.150
DIST.
71
72
�-
• -i -ji-vl i j i - ; ! ' u
; ' :
1991 FLUE-CURED TOfBACCO •
LIST RANKING FOR EFFECTIVE Q U O T A S
RANK REPRESENTATIVE
ilil
liiii
s
PARTY STATE CONG.
DIST
POUNDS
1
Eva C l a y t o n
D
NC
01
2
Tim Valentine
D
NC
02
3
H. M a r t i n Lancaster
192.090.160
D
NC
03
162,400.167
4
S t e p h e n L Neal
D
NC
05
5
Charles Rose
97.495.162
D
NC
07
83,900.188
287.1 15.689
6
Lewis F Payne. Jr.
D
VA
05
7
J a m e s E. C l y b u m
66.922,012
D
SC
06
65.992.461
8
W
9
J Roy R o w l a n d
G. "Bill" H e f n e r
D
NC
08
49.931,619
D
GA
08
47,634.084
10
A r t h u r Ravenel. Jr.
R '
SC
11
Jack K i n g s t o n
R
GA
D
NC
12
33,534,182
. D
NC
04
29,591,644
12
Molvin Watt
13
David E Price
.
01
35.277.070
01
34.009.365
14
J o h n M Spratt, Jr.
D
SC
05
15
25.883.888
H o w a r d Coble
R
NC
06
16
Sanford Bishop
24:029,790
D
GA
02
17
Cass Ballenger
21.334,182
R
NC
10
20,949,728
18
Douglas (Petel Peterson
D
FL
02
19
14,102.214
N o r m a n Sisisky
D
VA
04
13.745.158
20
Corrine B r o w n
D
FL
03
21
Karen L. T h u r m a n
4.693.105
D
FL
05
3.183.337
22
Floyd Spence
R
SC
02
23
Cliff S t e a m s
1.190.978
R
FL
06
1,022,344
24
Terry Everett
R
AL
02
25
734,41 3
Cynthia McKinney
D
GA
11
501,192
434,229
26
T h o m a s J Bliley. Jr.
R
VA
07
27
Robert C
D
VA
03
28
265,047
Robert W. G o o d l a n e
R
VA
06
242,232
Scort
29
Tlllie Fowler
R
FL
04
67,431
30
Earl H u t t o
D
FL
01
57.970
31
Rick Boucher
D
VA
09
42.495
32
J . Alex M c M i l l a n
R
NC
09
7,841
33
Glen Browder
D
AL
03
2,320
73
�United states
' " )!) Department of
•'Agriculture
Agricultural
Stabilization and
Conservation Service
P,0. Box 2415
Washington, D.C.
20013
TO:
Miles Goggans, Special Assistant to the President
FROM:
Dallas R. Smith, Director
Tobacco and Peanuts Division
SUBJECT:
Various Ways Tobacco Receives Support from the Federal Govemment and
Names of Principle Interested Parties on Capitol Hill.
^/iMf^ /.
BACKGROUND
Beginning with the 1982 crop, the No Net Cost Tobacco Program Act of 1982 (the Act)
mandated that the tobacco price support loan program be administered in such a manner as to
result in no net cost to the taxpayers other than such administrative expenses as are
incidental to the implementation of any commodity. The Act provides authority for USDA
to impose producer and purchaser assessments to be used to reimbursement the federal
govemment should the price support program incur losses.
However, because the law exempted price support administrative expenses and non price
support activities are not included in the No Net Cost law, USDA does incur expenditures of
approximately $31 million annually. These funds are expended through nine (9) different
USDA agencies. The following is a list of the agencies and amounts expended for FY 1992:
AGENCY
EXPENDITURE
(milIion$)
Agricultural Stabilization and Conservation Service (Price Support)
$16.3
Agriculniral Marketing Service (Market News & Standards)
1.1
Federal Crop Insurance Corporation (Indemnities and Premium Subsidy)
3.3
Agricultural Research Service (Market and Health Research)
5.5
Cooperative State Research Service (Plant Research-insects, weeds, etc.)
2.6
Extension Service (Education and Pest Management Programs)
.8
Economic Research Service (Forecasting and Projections)
.2
National Agricultural Statistic Service (Tobacco Statistic Reports)
,6
Foreign Agricultural Service (Worid Market Development)
.5
Total
30.9
CONGRESSIONAL INTEREST
Senate
Jessie Helms
Wendell Ford
Mitch McConnell
il , .!: l i n ,
-"^
^' '
House of Representatives
Charlie Rose
Eva Clayton
Scott Baesler
Steve Gunderson
Martin Lancaster
James Clybum
James Quillen
AN EQUAL OPPORTUNITY EMPLOYER
�SENATOR WENDELL FORD (D-KY) (The Senate Majority Whip)
Senator Ford, the Chairman of the Rules Committee and the Majority Whip, wants to be
helpful to the President. During his reelection campaign this year he talked about wanting to
work with a President who would sign health care legislation passed by Congress. However,
he is a fierce protector of the interests of his state. As he says, "if it is not good for
Kentucky, I'm not for it." As a result. Ford can be expected to fight any tobacco tax. He is
also nervous about mandated benefits and wants freedom of choice for consumers. He also
has a personal interest in health care since his daughter is undergoing chemotherapy following
a mastectomy and his brother-in-law is a pediatrician in Kentucky.
Senator Ford opposes giving states too much flexibility, because some may not be prepared
for the responsibility. But more likely, it comes down to local politics, and a long-standing
feud with Kentucky's Governor Brereton Jones. As a result it places Ford in the unusual
position if opposing State-based reform at the same time Kentucky's Democratic Governor is
pursuing such an initiative.
At the retreat in Jamestown, Senator Ford noted that his state produces coal, liquor, and
tobacco, and that the Administration has been hitting all of these industries and will continue
to do so. He expressed a willingness to take the hit on sin taxes, but needs a quid pro quo
(something for his 95,000 fanners).
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. memo
SUBJECT/TITLE
DATE
Chris Jennings to Hillary Rodham Clinton; re: Rockefeller/Daschle
Meeting (1 page)
05/27/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
Congressional Briefing Memos • First Lady, 1993 [4]
2006-0885-F
ip2849
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - (5 U.S.C. 552(b)|
PI National Security Classified Information |(aXI) of the PRA)
P2 Relating to the appointment to Federal office |(aX2) of the PRA|
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financial information |(aX4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |aXS) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(aX6) of the PRA|
b(l) National security classified information |(bXI) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA|
b(3) Release would violate a Federal statute |(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information |(bX4) of the FOIA]
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personal privacy [(bX6) of the FOIAj
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purposes |(bX7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions j(bX8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells j(bX9) of the FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. memo
DATE
SUBJECT/TITLE
Chris Jennings to Hillary Rodham Clinton; re: Kassebaum/Glickman
"BasiCare" Meeting (2 pages)
05/18/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
ISealth Care Task Force
I5teve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Clongressional Briefing Memos - First Lady, 1993 [4]
2006-0885-F
ip2849
RESTRICTION CODES
Presidential Records Act - j44 U.S.C. 2204(a)j
Freedom of Information Act - |5 U.S.C. S52(b)j
PI
P2
P3
P4
b(l) National security classified information j(bXI) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency i(bX2) of the FOIAj
b(3) Release would violate a Federal statute j(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information |(bX4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions j(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells [(bX9) of the FOIAj
National Security Classified Information j(aXl) of the PRA|
Relating to the appointment to Federal office |(aX2) of the PRAj
R elease would violate a Federal statute |(aX3) of the PRAj
Release would disclose trade secrets or confidential commercial or
financial information j(aX4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors jaXS) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
pi;rsonal privacy l(aX6) of the PRAj
C:. Closed in accordance with restrictions contained in donor's deed
of gift.
PRMI. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR . Document will be reviewed upon request.
�MEETING WITH CONGRESSIONAL SPONSORS OF "BASICARE" B I L L
May 19, 1993
SENATOR NANCY LANDON KASSEBAUM (R-KS)
Senator Kassebaum is the ranking-minority member of the Labor and Human Resources
Committee.
Kassebaum has taken a strong interest in health care reform and has introduced her own
refonn bill, the BasiCare Health Access and Cost Control Act (S. 325), which is the subject
of today's meeting. This legislation provides for an individual mandate and tough cost
controls. By capping insurance premiums, the bill presents a major cost containment
departure for Republicans. She would finance this bill by redirecting 1% of the current
Social Security Payroll Tax to pay for health reform. When the First Lady met with the
Senate Women's Caucus, Kassebaum pushed for a national commission, like the base closure
commission, to develop a benefits package (and get around the abortion debate issue). She
concluded that such an approach would provide a one-vote (up or down) cover for members.
Senator Kassebaum has expressed concerns about the health alliances. Specifically, whether
they will remain a non-profit entity or whether they will become govemment or quasigovernmental agencies. She's interested to know if groups with healthy populations are
penalized for opting out, whether sick groups that opt out will get a subsidy. Kassebaum is
also interested in how the global budgets will be allocated to the states and how these state
budgets will be enforced. Her elderly mother lives at home, so Kassebaum also has a
personal concern about long term care.
While considered a moderate. Sen. Kassebaum will toe the party line if she perceives an issue
is being politicized. If she senses this is happening with health reform, we will have little
chance of winning her support. She is very popular in Kansas, even polling better than Dole.
We believe Senator Kassebaum is one of our top Republican chances.
Recent Developments:At the May 4th Labor and Human Resources meeting, she raised
concerns about the use of the $100 billion as an estimate of the program. She fears such a
number could scare away too many members from even taking a look at the proposal.
Having said this, she seems genuinely impressed by and appreciative of the First Lady's
presentation.
�i
\
JOHN DANFORTH (R-MO)
Senator Danforth, the senior Senator fi-om Missouri, has announced plans not to mn for
reelection in 1994. Senator Danforth is a strong advocate of containment. He is the Senator
most likely to advocate that strong federal/state caps on spending must be imposed to
effectively contain health care costs. He states his strong views on this issue repeatedly,
despite admonitions from his staff and other Republicans that it is not consistent with the
Republican Party line.
He is one of two cosponsors of Sen. Kassebaum's BasiCare Health Access and Cost Control
Act. At the press conference announcing the introduction of the bill, Sen. Danforth again
focused on cost control noting, "the easiest thing to do is to introduce a bill that provides for
universal coverage. The hardest thing to do is to provide for cost control." [FNS, 2/4/93]
Although willing to support the need for strong govemment cost regulation, he also believes
that to do so would require explicit rationing (He is a big fan of the Oregon waiver). What is
more, unlike most Democrats, he desires to publicly proclaim that rationing is necessary cind
something we must own up to.
The Senator has been vocal in his opposition to new taxes to pay for health care reform,
saying, according to The New York Times, "it would be 'extremely difficult' for Congress to
pass new taxes for health care on top of those sought for deficit reduction." He is also
quoted as saying, "How many big tax bills is Congress going to pass in a year?... How much
is the country going to swallow in a year?" [NYT. 2/21/93]
Recent Developments: At the April 20th meeting with the Finance Committee, Senator
Danforth stated that Democrats and Republicans are not too far apart on this issue. He also
stated that universal coverage is important, but that it should be phased in over a longer
period of time. He believes the tax cap should apply to both employees and employers and
seemed happy with the First Lady's response to that point.
�SENATOR CONRAD BURNS (R-MT)
Senator Bums is Montana's junior Senator. A former livestockfieldmanand auctioneer who
later set up a radio farm news network. Bums is almost a stereotypical Easterners' version of
a western politician. Bums was elected in 1988, defeating incumbent John Melcher.
Senator Bums a low key style and a conservative voting record. Although he is on the
Republican Health Care Task Force and on Pryor's Aging committee, he is not very
outspoken on health issues. He is a cosponsor of Senator Kassebaum's BasiCare Health
Reform Bill. He is particularly supportive of the bill's mral health provisions. Bums was
very pleased to have been included (at our recommendation) in the Montana health care
forum you participated in with Senator Baucus and Congressman Williams. However, he has
asked that an administration representative appear at a health fomm he is planning in
Montana.
CONGRESSMAN DAN GLICKMAN (D-KS)
Congressman Glickman is a moderate to conservative Democrat who is known more for his
work on the House Agriculture Committee. He is very active in farm issues, and he was a
major player in the 1990 Farm Bill. He has also sponsored a number of bills that cut across
a wide range of political issues. Glickman is popular in the state and was widely mentioned
as a candidate for the Senate to succeed either Dole or Kassebaum. There had been
speculation that each might retire rather than seek reelection, however, both decided to mn
again. With Dole polling consistently in the 60s and Kassebaum in the 70s, a mn for the
Senate never materialized.
Glickman is the House sponsor of Senator Kassebaum's BasiCare Health Access and Cost
Control Act. With no extensive history or activity in health care issues, Glickman appears to
have primarily introduced the bill as a favor to Kassebaum. If this is tme, and only Glickman
may have the answer, he might have a special "in" with Kassebaum. Getting him on board
with the Administration might influence her, as well as other conservative Democrats in the
House. Of note also is the fact that he was chosen by Speaker Foley to replace Dave
McCurdy as Chairman of the House Select Committee on Intelligence. Perhaps because of
this link to the leadership, he is on Congressman Gephardt's list of reliable Democratic votes
in the House.
Congressman Glickman considers himself the bridge between the Democratic and Republican
sponsors of the BasiCare bill and therefore believes he is the "host" of this meeting. You
may wish to recognize him as a link to the Republicans and praise him for all his hard work.
Given his work on the Agriculture committee, and his constituency mral health issues are
probably a primary concern.
�CONGRESSMAN DAVE MCCURDY (D-OK)
Congressman McCurdy is a conservative Democrat who chairs the Mainstream Forum.
McCurdy is nothing if not ambitious. He wants to be a player on the national scene. He
actively considered miming for President in 1992, before deciding against it. Some felt he
pushed too hard to become Secretary of Defense, hurting his chances. He then exacerbated
his situation by criticizing the new Administration. In addition, he got himself into more
trouble with the House leadership openly by discussing the possibility of challenging Tom
Foley for Speaker of the House. Foley "rewarded" him by stripping him of his Chairmanship
of the House Select Committee on Intelligence.
Like Glickman, he does not have a strong record in health care policy nor does he serve on
any committees of jurisdiction. He may have been drawn into this largely because of his
friendship with Glickman. Perhaps he feels health care reform may be his ticket to national
stature.
Ira met with McCurdy and his Mainstream Fomm, a more moderate group than Stenholm's
Conservative Democratic Fomm, on March 30th.
Recent Development: Despite the cancelling of the initial BasiCare meeting. Congressman
McCurdy requested and met with the First Lady anyway. The meeting centered more on
general issues related to the Administration rather than health.
�BENEFITS PACKAGE
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
Sets f o r t h a s i n g l e , unifonn "minimum
but f a i r " b e n e f i t s package determined
by an "expert commission."
The C l i n t o n plan w i l l e s t a b l i s h a
comprehensive n a t i o n a l b e n e f i t s package
I n t h e l e g i s l a t i o n . The National Health
Board w i l l review and suggest
m o d i f i c a t i o n s t o Congress.
Uniform n a t i o n a l deductibles,
copayments & b e n e f i t a p p l i c a t i o n s and
standards.
Uniform n a t i o n a l deductibles, copayments
& b e n e f i t a p p l i c a t i o n s and standards
based on t h e type o f plan.
L e g i s l a t i o n l i s t s t h e f o l l o w i n g types
of services t h a t , a t a minimum, w i l l be
covered: basic h o s p i t a l i z a t i o n , basic
o u t p a t i e n t s e r v i c e , c a t a s t r o p h i c outof-pocket p r o t e c t i o n , e x t r a o r d i n a r y
long-term care costs, some proven
preventive care.
The plan w i l l l i s t types o f services
covered ( I . e . , I n - p a t l e n t / o u t p a t l e n t
h o s p i t a l services, preventive services,
l a b o r a t o r y and diagnostic services,
p r e s c r i p t i o n drugs, mental h e a l t h , home
and hospice care, r e h a b i l i t a t i v e care,
reproductive care, and v i s i o n , e t c .
�COST CONTROLS
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
Binding annual l i m i t s w i l l be placed on
the maximum allowable r a t e o f Increase
I n BasiCare premiums.
Various long and short-term cost c o n t r o l
options. I n v o l v i n g providers & I n s u r e r s ,
are being considered f o r t h e reform.
Premium cost w i l l be c o n t r o l l e d by
annual l i m i t s on maximum allowable
r a t e s o f Increase.
The n a t i o n a l budget w i l l be based on
allowable r a t e o f Increase f o r weighted
average premium.
Future allowable Increase w i l l be
measured by t h e BasiCare Commission
against t h e e s t a b l i s h e d average base
premium.
FINANCING
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
New money necessary f o r BasiCare would
come from t a k i n g 1 % o f t h e c u r r e n t
social security payroll tax.
D i f f e r e n t f i n a n c i n g options under
consideration.
�EMPLOYER/EMPLOYEE ROLES
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
BasiCare's program I s based on an
Individual required contribution. I t
does n o t r e q u i r e t h a t employers provide
or c o n t r i b u t e t o coverage o f t h e i r
employees.
The C l i n t o n p l a n includes a r e q u i r e d
c o n t r i b u t i o n from employers and
i n d i v i d u a l s . This would be a phased I n
requirement w i t h s p e c i a l accommodations
f o r small businesses.
TAX TREATMENT
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
Tax deductions f o r employers and t a x
exclusions f o r employees w i l l apply
only t o spending on t h e BasiCare
b e n e f i t s package.
Tax deductions and exclusions w i l l apply
only t o t h e n a t i o n a l l y guaranteed
b e n e f i t s package, grandfathering c u r r e n t
union c o n t r a c t s .
100% deduction f o r self-employed
I n d i v i d u a l s & farmers.
100% deduction f o r self-employed
Individuals.
�INSURANCE REFORM
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
Requires a l l p r i v a t e I n s u r e r s t o s e l l
the b e n e f i t s package and p r o h i b i t s the
s e l l i n g o f any package t h a t d u p l i c a t e s
coverage o f f e r e d I n BasiCare.
Requires a l l plans t o provide the
n a t i o n a l l y guaranteed b e n e f i t s package.
Insurers can s e l l supplemental p o l i c i e s
f o r t h i n g s t h a t aren't o f f e r e d I n the
basic package.
Rules w i l l be set up f o r entry i n t o
supplemental h e a l t h Insurance market &
the r e g u l a t i o n o f supplemental products.
L i m i t s on growth w i l l create new
e f f i c i e n c i e s i n the d e l i v e r y system
through development o f coordinated
systems o f care, n e g o t i a t e d between
providers & Insurers.
Health Plans w i l l coordinate systems and
bear the f i n a n c i a l r i s k .
Community r a t i n g w i t h adjustment f o r
age.
Community r a t e s e t t i n g and r i s k
adjustments are expected t o be made a t
the Health A l l i a n c e l e v e l . Community
r a t i n g i s l i k e l y t o be applied t o a l l
persons under the age o f 65.
Insurers cannot exclude people due t o
p r e - e x i s t i n g c o n d i t i o n , nor can they
h i k e r a t e s f o r people because o f
illness.
Insurers cannot exclude people due t o
p r e - e x i s t i n g c o n d i t i o n s , nor can they
hike r a t e s f o r people because o f
i l l n e s s , age, o r gender.
The plan w i l l f o l d i n the h e a l t h p o r t i o n
of workers' compensation and auto
insurance i n t o the h e a l t h Insurance
package.
�MALPRACTICE REFORM
KASSEBAUM/GLICKMAN PROPOSAL
caps on non-economic p u n i t i v e
damage awards
mandatory o f f s e t s o f awards f o r
c o l l a t e r a l sources o f recovery
c o u r t determined reasonable
attorney's fees
mandatory p e r i o d i c payment o f
f u t u r e awards
encourage implementation o f AOR
(alternative dispute resolution)
systems: f a u l t and n o - f a u l t
binding a r b i t r a t i o n
Special demonstration p r o j e c t s t o t e s t
implementation o f n o - f a u l t systems o f
compensation.
CLINTON PROPOSAL
The C l i n t o n plan may i n s t i t u t e a system
of medical malpractice and t o r t reform
based on " e n t e r p r i s e l i a b i l i t y " and
alternatives t o l i t i g a t i o n . Alliances
w i l l encourage implementation o f
o p t i o n a l ADR ( a l t e r n a t i v e dispute
r e s o l u t i o n ) systems. The reform may:
l i m i t non-economic damages
p r o h i b i t double recovery from
c o l l a t e r a l sources
Impose a s l i d i n g scale on
contingency fees
r e q u i r e p e r i o d i c payments o f l a r g e
awards
Impose uniform, reduced s t a t u t e s o f
limitation
Enterprise l i a b i l i t y means t h a t Health
Plans would assume l i a b i l i t y f o r a l l
a f f i l i a t e d providers.
Federal law w i l l supersede i n c o n s i s t e n t
s t a t e s t a t u t e s r e l a t e d t o medical
malpractice.
�UNDERSERVED AREAS
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
Increased funding f o r community h e a l t h
centers and other community-based
primary care f a c i l i t i e s f o r r u r a l and
underserved areas.
Increased funding f o r h e a l t h care
i n f r a s t r u c t u r e i n underserved areas.
States must ensure access f o r low Income
i n d i v i d u a l s using a range o f means
described by l e g i s l a t i o n .
LOW-INCOME COVERAGE
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
Low-Income uninsured persons w i l l be
o f f e r e d non-transferable vouchers t o
replace & expand upon c u r r e n t Medicaid
program.
Medicaid p o p u l a t i o n would be I n t e g r a t e d
i n t o t h e a l l i a n c e s and subsidized by
f e d e r a l and s t a t e d o l l a r s .
L e g i s l a t i o n w i l l s p e c i f y minimum Income
l e v e l s f o r voucher assistance. At
minimum, people below 100% o f f e d e r a l
poverty l e v e l w i l l receive f u l l
voucher.
S l i d i n g scale f o r subsidies w i l l be up
t o 200% o f poverty l e v e l .
E l i g i b i l i t y requirements:
f a m i l i e s below 200% o f f e d e r a l
poverty l e v e l w i l l received
assistance on a s l i d i n g scale
based on Income.
�1
ADMINISTRATIVE SIMPLIFICATION
1 KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
1
1
1
1
Standardized b i l l i n g and claims
processes t o c u t down on urinecessary
paperwork and lower a d m i n i s t r a t i v e
costs.
1
Standardized b i l l i n g and claims
paperwork t o c u t down on unnecessary
paperwork and lower a d m i n i s t r a t i v e
costs.
MEDICARE INTEGRATION
1 KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
1 BasiCare w i l l be expanded over time t o
encompass Medicare.
States may have t h e o p t i o n o f
encompassing Medicare over time.
Medicare b e n e f i c i a r i e s w i l l be given
i n c e n t i v e t o e n r o l l i n managed care
networks.
|
�DETERMINED TO BE AN AD.MINISTRATIVE
MARKING Per E.0.12958 as aracnd^. Sec. 3Jj[c)
InMaUr'J G r P
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1
PRIVILEGED AND CeNFIDEHII3ffi- MEMORANDUM
TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n
May 18, 1993
C h r i s Jennings
Democratic A s i a n and P a c i f i c American Meeting
Melanne, Steve, L o r r a i n e , D i s t r i b u t i o n
Tomorrow you a r e scheduled t o meet w i t h t h e Members o f t h e
( u n o f f i c i a l ) C o n g r e s s i o n a l Asian and P a c i f i c American Democratic
Caucus. One s t a f f member f o r each o f t h e a t t e n d i n g s i x Members
w i l l l i k e l y come as w e l l .
I n a t t e n d a n c e w i l l be Senator D a n i e l Akaka ( D - H I ) ,
Congresswoman Patsy Mink ( D - H I ) , Congressman Robert M a t s u i
(D-CA), Congressman Norm Mineta (D-CA), Delegate E n i F.H.
Faleomavaega (pronounced FALEO-MA-VANGA) (D-American Samoa), and
Delegate Robert Underwood (D-Guam). Senator Inouye, t h e most
s e n i o r Member, has a s c h e d u l i n g c o n f l i c t and cannot a t t e n d .
BACKGROUND
As y o u know, i t t o o k a w h i l e f o r us t o s e t up a m e e t i n g w i t h
t h i s d e l e g a t i o n . However, w h i l e t h e r e were some sore f e e l i n g s ,
your c o n v e r s a t i o n w i t h Congressman Mineta and t h e s c h e d u l i n g o f
tomorrow's meeting has t a k e n care o f a l l o f t h i s .
A t t a c h e d f o r your r e v i e w i s a summary o f t h e h e a l t h c a r e
backgrounds o f each o f t h e a t t e n d e e s . I n g e n e r a l , t h e d i s c u s s i o n
i s l i k e l y t o f o c u s on a few i s s u e s , i n c l u d i n g :
(1)
Data C o l l e c t i o n . L i k e many o f t h e o t h e r m i n o r i t i e s , t h e r e
i s a s t r o n g b e l i e f among t h e A s i a n and P a c i f i c Americans
t h a t t h e r e i s a t o t a l l y unacceptable amount o f a c c u r a t e d a t a
on s p e c i a l p o p u l a t i o n s on which t o make i n f o r m e d p o l i c y
d e c i s i o n s . As a r e s u l t , p o o r l y t a r g e t e d programs a r e
d e v i s e d based on s t e r e o t y p e s .
(2)
P u b l i c H e a l t h D e l i v e r y . TB i s a s i g n i f i c a n t problem w i t h i n
the A s i a n and P a c i f i c American community, p a r t i c u l a r l y i n
Hawaii and C a l i f o r n i a . They w i l l r a i s e t h i s i s s u e , a l o n g
w i t h t h e whole i s s u e o f h a v i n g i n s u r a n c e w i t h o u t adequate
d e l i v e r y systems. The Members a r e l i k e l y t o t a l k about
concerns about h e a l t h care c e n t e r s b e i n g abandoned and
access t o s e r v i c e d e c l i n i n g . However, as t h e y t a l k about
t h i s I s s u e , t h e y may a l s o d i s c u s s how t h e y b e l i e v e many
Community H e a l t h Centers c u r r e n t l y d i s c r i m i n a t e a g a i n s t
t h e i r constituents.
�(3)
B i l i n g u a l Capacity. The Members are l i k e l y t o r a i s e t h e
great need f o r health plans t o have b i l i n g u a l c a p a b i l i t i e s
i n order t o assure t h e most e f f e c t i v e health care d e l i v e r y
systems. They may c i t e a recent C a l i f o r n i a Medicaid
(Medical) law t h a t requires b i l i n g u a l c a p a b i l i t i e s I f 10
percent o f any single population i s i n t h e plan. The
problem w i t h t h i s approach i s t h a t 30 percent o r more o f t h e
plan's p a r t i c i p a n t s might be m i n o r i t i e s , but i n d i v i d u a l
subgroup populations (Hispanic, Black, A s i a n / P a c i f i c ) may
not exceed 10 percent. The C a l i f o r n i a delegation i s f u r i o u s
w i t h t h i s l e g i s l a t i o n because they f e e l t h e i r c o n s t i t u e n t s
are being l e f t out. The Members might suggest a c e r t a i n
number o f people or a much lower percentage number as an
alternative.
(4)
C i t i z e n s i n T e r r i t o r i e s . This issue i s s i m i l a r t o t h a t o f
Puerto Rico. Most o f the inhabitants of Guam and American
Samoa are Americans c i t i z e n s . As such, t h e Members want t o
make c e r t a i n t h a t t h e i r populations get t h e same coverage
t h a t American c i t i z e n s do. (As a r e s u l t , i t i s i n t e r e s t i n g
t o note t h a t t h e Members v i s i t i n g you have l i t t l e o r no
i n t e r e s t i n expanding care beyond American c i t i z e n s ; i n
other words, t h i s w i l l not be an undocumented persons
discussion).
The most i n f l u e n t i a l Members of t h e delegation meeting you
tomorrow are Congressmen Matsui and Mineta. I f t h i s meeting can
end w i t h them f e e l i n g comfortable w i t h the proposal, i t w i l l have
been worth t h e time.
�MEIVIBERS OF THE CONGRESSIONAL ASIAN AND PACIFIC
AMERICAN DEIVIOCRATIC CAUCUS
SENATOR DANIEL AKAKA (D-HD - State flexibility is of primary importance to
Senator Akaka. Specifically, the Senator will want to continue the special exemption to retain
Hawaii's current system. (See note below). He was a cosponsor of Senator Mitchell's play
or pay plan, "HealthAmerica" plan in the last Congress, but is open to virtually any approach
that achieves cost contaiimient and universal access, as long as it provides for significant state
flexibility.
CONGRESSWOMAN PATSY T. MINK (D-HI): Congresswoman Mink has been an
active part of Hawaii's political history even before Hawaii became a state. She will want to
protect Hawaii's flexibility in the health care package (See note below). Inclusion of abortion
services will also be key to her vote. In addition, she is a McDermott co-sponsor. Mink is a
member of the Rural Health Care Coalition and the Caucus for Women's Issues. She is on
the Budget and Natural Resources Committees. In the House, her vote is always somewhat
of a question mark. She should be with the Administration, however. But again, abortion
coverage will be key.
SPECIAL NOTE ON HAWAH: Hawaii, as well as a number of other states, are
pressing to obtain ERISA waivers as soon as possible—even if that means before health
care reform is passed. Senator Akaka, Senator Inouye and Congresswoman Mink can
be expected to support this effort. This is a controversial issue because some believe
that passing these waivers may delay health care reform. Their theory is that granting
waivers to states will reduce pressure for national reform and bolster the argument that
we should attempt state experimentation before moving to national reform. The counter
argument is that because businesses are so opposed to state by state refonns that
granting ERISA waivers now will push big business to actively advocate for national
reform. The Department of Labor initially raised internal concerns about this
legislation, and after consulting with the White House decided to take no position on this
issue.
CONGRESSMAN ROBERT MATSUI (D-CA) - Congressman Robert Matsui came to
Congress after serving on the Sacramento, California, City Council. He is a member of the
Ways and Means Subcommittee on Human Resources, and the first committee to see the
substance of the Administration's welfare reform. It is expected that welfare reform, if
released this year, will take up most of his time. You may want to mention the correlation
between health care reform and welfare reform. Attached are talking points on this
correlation.
�Matsui is generally liberal, but takes a while to lend his support. He generally defers to
Chairman Rostenkowski on the major issues. His greatest legislative accomplishment was the
passage of reparations to members of Japanese families interned during World War I I .
President Ronald Reagan signed this historic legislation in 1988.
As far as health issues are concerned, he believes we should cover pregnant women and
children first. This coverage should include immunizations. He supports of sin taxes, and
can push them on the committee. Congressman Matsui supports global caps. He also
supports the tax cap, like the one recommended by the Jackson Hole group. He states we
need a cap on premiums if employees want to make choices.
His wife, Doris, worked on the transition and is now the Deputy Director of White House
Office of Public Liaison.
CONGRESSMAN NORM MINETA (D-CA) - Congressman Mineta is the Chairman of the
House Public Works and Transportation Committee. As such, he spends most of his time on
transportation and infrastmcture issues. He was elected as part of the post-Watergate, reform
minded class of 1974. He has steadily risen through the ranks, as a quiet member, making
policy and change behind the scenes. Congressman Mineta represents Silicon Valley and
most of San Jose, Califomia. He is a leader in spearheading high tech solutions to a number
of problems. Most notably, he works on using the technology of the Silicon Valley to
improve transportation systems in the United States. His position as the chairman of the
Transportation committee is vitally important to automobile-addicted Clalifomia. Mineta is a
former mayor, known for his hands-on approach. He is also the host of today's meeting.
Chairman Mineta is expected to be helpful to the Administration and supportive of health care
reform. The Congressman's staff has relayed the message that Mineta is a managed
competition advocate, as long as there are certain provisions for underserved populations. As
a committee chair, he is part of the leadership, and it would be unusual for him to break
ranks.
DELEGATE ENI F. H. FALEOMAVAEGA (D-AM SAMOA) (Pronounced: EN-ee
Fol-ee-oh-mav-ah-ENG-uh) Delegate Faleomavaega will also push for equal treatment
and consideration with the Mainland in the health care package. Specifically, if the benefit
package is provided to all citizens then it should be provided to the people of American
Somoa who are U.S. citizens. He, as well as other members of the territories and the District
of Columbia, received limited voting ability on the House Floor this year. Because members
of the insular territories have not had the ability to vote in the past, their views on major
issues are not well known. As a territory, American Samoa has been relatively untouched by
the rest of the United States, only receiving representation in the House in the early 1980's.
He serves on the Education and Labor, Natural Resources and Foreign Affairs committees. It
is expected that he will want to discuss the territorial issues outlined at the bottom of this
summary.
�DELEGATE ROBERT UNDERWOOD (D-GU) - Congressman Underwood, like
Congressman Faleomavaega received limited voting ability on the Housefloorfor the first
time this year. Congressman Underwood took over for the retiring Republican Ben Blaz.
Unlike his pacific territorial colleague. Delegate Underwood is a member of the Congressional
Hispanic Caucus. It is expected that he will push for equal treatment and consideration for
the people of Guam, who are American citizens, in the Administration's proposals.
In March, Congressman Underwood wrote to the First Lady outlining his health conccms.
Guam, like most territories, does not receive Medicaid funds and Medicare funding is not
calculated with the same formulas as the states. Guam's Medicare funds are capped, with the
local govemment making up the difference. In addition, he noted that the territories take in
many immigrants, which put significant strains local budgets.
Special Note on the Territories: The territories who have representation in the House
include Puerto Rico, U.S. Virgin Islands, Guam and American Samoa. They are
concerned that people who live in the territories will be treated differently than people
who live in the states. Members from the territories have written on the Medicaid
inequity between mainland states and the territories (for those areas that receive
Medicaid funds). They are also on the "front lines" when it comes to immigration,
which puts strains on their health care delivery systems. Their concerns are not unlike
those members who represent rural areas; because of their geographic locations, many
of their people need to travel great distances to receive specialized medical care. In
addition, the special concerns of the territories have the support of both the chairs of the
Congressional Black Caucus and the Congressional Hispanic Caucus.
One final note: members from the territories are officially named Delegates, with the
exception of Puerto Rico, who is called the Resident Commissioner. However, they are
still members of Congress. When addressing or speaking to them, the term
Congressman or Congresswoman is appropriate.
�*
*
* DRAFT * * * P R I V I L E G E D AND eOttTXDSBTIKZ. * * * * DRAFT
M E M O R A N D U M
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TO:
H i l l a r y Rodham C l i n t o n
May 10, 1993
FROM:
Chris Jennings
RE:
Proposed Schedule f o r Congressional Consulatltve
Meetings and Pre-introduction B r i e f i n g s
I n c o n s u l t a t i o n w i t h the s t a f f o f the House and Senate
M a j o r i t y Leaders, i t has become clear t h a t i t i s advisable t o
implement a two step Congressional outreach process a f t e r t h e
f i r s t cut on f i n a l p o l i c y decisions have been made. With t h i s i n
mind, t h e attached schedule of c o n s u l t a t i v e meetings and prei n t r o d u c t i o n b r i e f i n g s was developed.
The f i r s t series o f meetings would be c o n s u l t a t i v e meetings
w i t h Members o f Congress, the purpose o f which i s t o advise
Members o f the decisions made and t o gain t h e i r input and
suggestions. A f t e r these meetings, the President can use t h i s
i n f o r m a t i o n t o make f i n a l decisions on h i s proposal.
Once f i n a l decisions have been made, then a second series o f
b r i e f i n g sessions w i l l be needed t o educate Members about t h e
plan p r i o r t o i t s i n t r o d u c t i o n so t h a t they are prepared t o
discuss the plan w i t h t h e i r constituents and help i n the e f f o r t
t o s e l l i t t o the p u b l i c .
�SCHEDULE FOR CONGRESSIONAL CONSULTATIVE MEETINGS AND BRIEFINGS
CONSULTATIVE MEETINGS:
MAY 20th or 2 1 s t :
House Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, JF
(To h e l p s t a f f p r e p a r e members f o r meeting w i t h P r e s i d e n t
and F i r s t Lady)
Senate Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, JF
(To h e l p s t a f f p r e p a r e members f o r meeting w i t h P r e s i d e n t
and F i r s t Lady)
Week of Mav 23rd:
House Leadership and Chairmen of Committee of J u r s i d i c t i o n
BC (7LIKELY?), HRC, IM, JF
Location:
White House
(To b r i e f Members and s e t up c o n s u l t a t i v e p r o c e s s )
Foley
Gephardt
Bonior
Rostenkowski
Stark
Dingell
Waxman
Ford
Williams
Senate Leadership and Chairmen of Committees of J u r i s d i c t i o n
BC (7LIKELY?), HRC, IM, JF
Location:
White House
(To b r i e f Members and s e t up c o n s u l t a t i v e p r o c e s s )
Mitchell
Ford
Pryor
Daschle
Moynihan
Kennedy
Rockefeller
Riegle
Mikulski
Breaux
�C o n g r e s s i o n a l R e p u b l i c a n Leadership - HRC, BC(?)
L o c a t i o n : White House
Dole and designees
M i c h e l and designees
S i n g l e Payer Leaders - HRC, IM, JF
McDermott
Conyers
Wellstone
C o n s e r v a t i v e Democratic Forum - HRC, IM, JF
Cooper
Andrews
Stenholm
Breaux and Boren?
House Ways and Means Committee - HRC, IM, JF
Location: Capitol H i l l
(Chairman determines attendees and whether b i p a r t i s a n )
Senate Finance Committee - HRC, IM, JF
Location: Capitol H i l l
(Bipartisan
House Energy and Commerce Committee - HRC, IM, JF
Location: Capitol H i l l
(Chairman determines a t t e n d e e s and whether b i p a r t i s a n )
Senate Labor and Human Resources Committee - HRC, IM, JF
Location: Capitol H i l l
(Chairman determines attendees and whether b i p a r t i s a n )
House E d u c a t i o n and Labor Committee - HRC, IM, JF
Location: Capitol H i l l
(Chairman determines attendees and whether b i p a r t i s a n )
House Democratic Caucus - HRC, IM, JF
Location: Capitol H i l l
House R e p u b l i c a n Caucus - HRC, IM, JF
Location: Capitol H i l l
U.S. Senate ( B i p a r t i s a n ) - HRC, IM, JF
Location: Capitol H i l l
�House Caucuses - HRC or IM
Congressional Black Caucus
Congressional Caucus on Women's Issues
Congressional Hispanic Caucus
( I f l i m i t e d time makes meetings w i t h the A d m l n s i t r a t l o n
Impossible M a j o r i t y Leader Gephardt has o f f e r e d t o serve as
the Administration's l i a i s o n t o these caucuses.)
Other Meetings w i t h Committees as Needed - HRC o r IM
Location: C a p i t o l H i l l
Biden, J u d i c i a r y
Rockefeller, Veterans
Nunn, Armed Services
Bumpers, Small Business
Glenn, Governmental A f f a i r s
Inouye, Indian A f f a i r s
Brooks, J u d i c i a r y
Montgomery, Veterans
Dellums, Armed Services
LaFalce, Small Business
Clay, Post O f f i c e
M i l l e r , Natural Resources
�PRE-UNVEILING BRIEFINGS
June 7th - June 15th:
House Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, JF
(To h e l p s t a f f p r e p a r e members f o r meeting w i t h P r e s i d e n t
and F i r s t Lady)
Senate Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, JF
(To h e l p s t a f f p r e p a r e members f o r meeting w i t h P r e s i d e n t
and F i r s t Lady)
House Leadership and Chairmen of Committee of J u r s i d i c t i o n
HRC, BC(?)
Location:
White House
Foley
Gephardt
Bonior
Rostenkowski
Stark
Dingell
Waxman
Ford
Williams
Senate Leadership and Chairmen of Committees of J u r i s d i c t i o n
HRC, BC(?)
Location:
White House
Mitchell
Ford
Pryor
Daschle
Moynihan
Kennedy
Rockefeller
Riegle
Mikulski
Breaux
C o n g r e s s i o n a l R e p u b l i c a n Leadership - HRC, BC ( ? )
Location:
White House
Dole and designees
M i c h e l and designees
�S i n g l e Payer Leaders - HRC,
IM, JF
McDermott
Conyers
Wellstone
Conservative
Democratic Forum - HRC,
IM, JF
Cooper
Andrews
Stenholm
Breaux
Boren
Senate Democratic P o l i c y Committee - BC?,
Location: Capitol H i l l
House Democratic Caucus - HRC,
Location: Capitol H i l l
IM, JF
House R e p u b l i c a n Caucus - HRC,
Location: Capitol H i l l
IM, JF
Senate R e p u b l i c a n P o l i c y Committee - HRC,
Location: Capitol H i l l
HRC,
IM, JF
IM, JF
House Democratic S t a f f B r i e f i n g - IM, JF o r a p p r o p r i a t e
Location: Capitol H i l l
surrogate
House R e p u b l i c a n S t a f f B r i e f i n g - IM, JF o r a p p r o p r i a t e
Location: Capitol H i l l
surrogate
Senate S t a f f B r i e f i n g - IM, JF o r a p p r o p r i a t e
Location: Capitol H i l l
surrogate
Other Meetings with Committees and Members as Needed - HRC
or IM
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. memo
SUBJECT/TITLE
DATE
Chris Jemiings to Hillary Rodham Clinton; re: Current Congressional
Status & Suggested Upcoming Weeks (4 pages)
05/10/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefing Memos - First Lady, 1993 [4]
2006-0885-F
jp2849
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�PRIVILEGED AND gnygFff^F^TCTa. MEMORANDUM
DETERMINED TO BE A.N AD.V1IMSTR.\TI VE
MARKINCJPerEJD. 12958 as amended, Sc«. 3.3 (c)
TO:
FR:
RE:
Hillary Rodham Clinton
May 5, 1993
Chris Jennings
Summary of David Pryor's Senate Agjng Committee Event
Tomorrow morning, you are scheduled to join Democratic and Republican
Members of the Senate Aging Committee for a closed "healthy" breakfast meeting to
discuss aging issues and preventive health care. After the breakfast, the Aging
Committee will convene a hearing on preventive health for older persons.
While the hearing will explore the senior prevention topic broadly, certain
witnesses will stress that tobacco and alcohol are leading causes of disease,
premature death, and health costs. Attached to this memo you will find a schedule
for the morning and a copy of Senator Pryor's draft opening statement.
Purpose of the Hearing (Which Follows Your Meeting)
The hearing will emphasize that the U.S. health care system is aggressive in its
diagnostic and treatment efforts once serious illnesses and injuries have occurred, but
that it is negligent and short-sighted in investing in prevention. It will suggest that
many of these illnesses and injuries could be avoided not only by investing in
preventive services, but by inclividuals taking a greater degree of self-responsibility
for their own health status.
The three leading causes of preventable health problems will be explored in
detail: tobacco, alcohol, and poor diet. Specifically, one in four Americans will die as
a result of the use of tobacco and alcohol. Tobacco killed an estimated 417,000 in
1990. Alcohol killed 107,000 in 1988.
Costs of tobacco and alcohol to society and the health care system will be
quantified. The Aging Committee will release a Congressional Office of Technology
Assessment study documenting that in 1990 tobacco cost society $68 billion, including
$21 billion to the health care system. The latest study on alcohol concludes that the
1990 costs to society were $98 billion, including $12 billion to the health care system.
This information will support any effort to move to increase disincentives (taxes) for
unhealthy behaviors, such as smoking.
�Background on the Senate Aging Committee
The Senate Aging Committee is a permanent oversight panel established in
1961. Although its House counterpart was recently eliminated. Senator Pryor
defeated an effort to kill the Aging Committee on the Senate floor by 56-43. Senator
Reid offered the amendment, even though he sits on the Committee (and will attend
the breakfast). Senator Pryor made an emotional appeal to save the Committee.
The Committee remains at risk because a Joint Committee on the Organization of
Congress will put out a report as early as August which is likely to recommend
cutting back on the number of Congressional committees.
Anything positive you can say about the Aging Committee would be deeply
and personally appreciated by Senator Pryor. Positive comments would be welcome
at the breakfast (because some of the Members voted against the continuation of the
Committee), but particularly welcome at the 9:30 press availability. You might want
to consider acknowledging some of the important work the Aging Comnruttee has
produced over the years. In particular, you could highlight its work on controlling
drug costs, raising the special concerns of rural communities, highlighting the
importance of home- and community-based long term care coverage, and
publicizing the importance of cost-effective preventive health care interventions.
Members Attending the Breakfast Meeting
The following members have indicated they will attend:
Sen. Pryor, Chairman
Sen. Glenn
Sen. Bradley
Sen. Breaux
Sen. Reid
Sen. Graham
Sen. Feingold
Sen. Krueger
Sen. Shelby
Sen. Cohen, Ranking Minority
Sen. Pressler
Sen. Grassley
Sen. Simpson
Sen. Jeffords
Sen. Durenberger
Sen. Craig
Sen. Burns (arriving late)
Many of these Members are particularly critical to us, especially Bradley, Breaux,
Graham, Cohen, Jeffords, Durenberger, and Burns. Attached for your information is
a summary of the health backgrounds of each of the Agjng Committee Members.
�SCHEDULE
May 6,1993
8:00 - 9:15 a.m.
Breakfast Meeting with Senate Aging Committee
Russell Senate Office Building, Room 428A
(Small Business Committee Hearing Room)
Meet with members of the Senate Special Committee on Agjng.
Topics of discussion limited to agjng issues and preventive health
care. You can make a brief comment on these issues followed by
a discussion moderated by Senator Pryor. Closed to press.
Quick (two nunute) photo opportunity for the media at the
beginning of the breakfast meeting. Breakfast will be low-fat,
specially overseen by cable TV personality Lynn Fischer, "The
Low Cholesterol Gourmet," who will attend.
(Lead staffer: Jonathan Adelstein for Senator Pryor. Other
majority and minority committee staff will be in the room for
breakfast, but the hearing will be closed to staff of committee
members.)
9:30 - 9:45 a.m.
Press Availability
Lisa has okayed a brief statement to the press on the importance
of agjng issues, preventive health, and the role of the Senate
Aging Committee. You will be joined only by Chairman Pryor
and Ranking Republican Member Cohen. After a very brief
number of questions. Senator Pryor will cut it off.
You then leave the Senate Office Building.
10:00 - 12:30 p.m. Hearing of the Senate Aging Committee
Title: "Preventive Health: An Ounce of Prevention Saves a
Pound of Cure."
Witnesses will testify about the cost-effectiveness of preventive
measures, even for the elderly. They will discuss the costs to
society and the health care system of risky choices such as
smoking, drinking alcohol excessively, and eating high-fat foods.
�DEMOCRATS ON SENATE AGING COMMITTEE
SEN. DAVID PRYOR (D-AR) - Senator David Pryor is Chairman of the Senate Special
Committee on Aging. He is well liked and respected by the powerful aging advocacy
community. In addition, he is one of the few Democrats that the small business community
genuinely trusts. Further, as a former Governor, his advocacy of state-based approaches to
comprehensive reform has gained him a great deal of good will with the Govemors.
Although an unassuming Member and one who does not get overly involved in detailed
policy discussions, he has emerged as one of the most influential and best liked members of
the Senate. All of these roles ensure that he will be a key player on the health care front.
In terms of health care priorities, drug cost contairmient is the first, second, and third highest
priority for Senator Pryor. The concept of linking drug cost contaiimient to tax credits
(embodied in Pryor's Prescription Drug Cost Containment Act — S. 2000) was endorsed by
President Clinton.
In addition to his drug cost containment interests, he also has a notable legislative
achievement record in rural health (relief for hospitals and incentives for primary care doctors
in medically underserved areas), state-based refonn (his NGA and Clinton candidateendorsed Leahy/Pryor bill), and long-term care (his proposal for Federal standards for private
long-term care insurance policies).
Recent Developments: He backs the use of a dedicated tax for health care, perhaps a VAT.
He also supports the inclusion of a significiint long-term care benefit. He believes that as
long as we will be spending billions of dollars, we should make certain to attract popular
support for the plan.
He and Senator Cohen joined in an effort to fight back an unsuccessful attempt to eliminate
the Aging Committee. Although the Committee won the vote on the floor of the Senate, the
committee remains vulnerable as a result of the deliberations of the Joint Committee on the
Organization of Congress.
SEN. JOHN GLENN (D-OH) - Senator Glenn has held hearings on the German and French
systems as models for health reform. He supported pay or play but not the Leadership's
HealthAmerica bill. His concerns include the impact of reform on small business, retiree
health benefits, and potential changes to Medicare and Medicaid.
In a previous meeting with the DPC, Gleim questioned where the savings would come from
in the new system. He thinks that doctors have been unfairly vilified in debates over health
care costs. He says that their income accounts for less than one-fifth of health care spending.
He is more intrigued by the large percentage of lifetime health Ciire costs which occur during
the last four months of life as an area for health savings.
�As chairman of the Govemment Affairs Committee, he is likely to be interested in and
actively involved with any proposal that would fold the Federal Employees Health Benefit
Plan into the new system. Since advocates for federal employees are now asking that they be
treated the same as other large employers, they are likely to express serious reservations about
the currently envisioned program. It is therefore advisable to meet with Senator Glenn and
other chairmen of jurisdiction before any decision is made public.
SEN. BILL BRADLEY (D-NJ) - Senator Bradley is known more for his work on tax
policy than for his work on health care financing. He has indicated an interest in introducing
health care reform legislation similar to the managed competition model that he believes the
President has been advocating. The one exception to his general support of the Clinton health
care approach may well be with regard to prescription drugs. As a Senator representing the
state which is the capital of the pharmaceutical industry, Bradley is a fierce advocate for the
industry and their concerns. With Senator Hatch, he led the fight against Senator Pryor's
effort to influence the industry to contain price increases to inflation by linking their pricing
behavior to eligibility for tax credits. (The Pryor proposal was endorsed by the President
during the campaign).
As a member of the Infant Mortality Commission, Senator Bradley is proud of his work to
ensure that the Medicaid program was expanded to eventually cover pregnant women and
kids. He also is a strong advocate for preventive care services. He has sponsored several
bills on tobacco, including revised warning labels and tobacco as a drug to be included in the
Drug Free Schools program. In addition, Senator Bradley introduced legislation this year to
rase the cigarette excise tax by $1 a pack. Lastly, although he incurred the wrath of some
aging groups with his opposition to prescription drug price constraints, he has been a longtime supporter of home and community-based long term care services, particularly with
regard to respite care services.
Recent Developments: At the 4/20 Finance Committee meeting with The First Lady,
Senator Bradley asked for an estimate of how much the plan is going to cost and how much
revenue is expected to be needed. He is very concerned about taxes and is a great advocate
of going slow on this issue. "It is more important to get it right."
SEN. BENNETT JOHNSTON (D-LA) - Senator Johnston has been noncommittal on health
reform but wants to be a constructive player. He may defer to his Louisianan colleague Sen.
Breaux who has shown increasing interest in health care reform, since they share concerns on
its impact on small business and rural areas. His major concern is preventive care and he
will be willing to compromise on other issues if this is made a high priority in the package.
While he is not opposed to managed competition he sees problems with regional pricing. In
discussions with the HCTF in the past, he has asked whether everyone will be in the
purchasing cooperative and whether doctors will be able to charge higher fees outside of the
package. Senator Johnston is also concerned with the financing of the health care package.
�SEN. JOHN BREAUX (D-LA) - Senator Breaux is the second most junior Member of the
Finance Committee. He is one of those up and coming "New Democrats" for whom many
see a bright future. His politics are moderate to conservative but he is known more as a
pragmatist than an idealogue. In the area of health care, Breaux is yet another of the
Committee members who care deeply about small businesses and rural health care.
Prior to this year, Senator Breaux was not overly active in health care issues. That changed
when he introduced the Conservative Democratic Forum's managed competition bill with
Senator Boren in 1992. He is very concerned, however, about the bill's limitations with
regard to assuring adequate access to health care in mral areas. He is also concerned about
whether this approach will actually achieve broad-based cost savings. Despite this, he
remains uncomfortable with the alternatives and he will want to make sure that the
Conservative Democratic Fomm's model is used as much as possible during the upcoming
debate. He opposes price caps andfreezesto control costs.
Recent Developments: At the Finance Committee meeting (4/20), Senator Breaux stated that
he was very encouraged about what he was hearing. He believes people want health care
reform but it will be important to sell the benefits first (and sell people on what they are
getting). He wants the plan to be bipartiscin and thinks it should contain malpractice reform,
the Senator has made very positive public comments about the prospects for health care
reform and praised the consultative process with both Democrats and Republicans. In
addition, at the invitation of Ira Magaziner, he joined the President at the Democratic
Leadership Conference meeting in New Orleans.
SENATOR RICHARD SHELBY (D-AL) - As you know, the media has made much of the
rift between Senator Shelby and the White House. He is a conservative Democrat whose vote
is considered tough to get. While he has said that he is waiting to see what the President
puts forth, he has expressed some clear views regarding health care reform. He opposes
"single payer" or any other "top-down" system. He believes there needs to be local control
and decision making. He is anti-employer mandates, anti-rate setting, and has significant
small business concerns. Some self-insured people have used managed care very well in
Alabama.
Recent Development: In March, Senator Shelby sent a "Dear Colleague" asking for
cosponsors for his resolution expressing a "sense of the Congress that any National Health
Care reform legislation must ensure that every person covered under the plan has access to
coverage for medically and psychologically necessary treatments for mental disorders. Such
access should be equitable to coverage provided to treatments for physical illnesses."
�SEN. HARRY REID (D-NV) - Senator Reid is in his second term in the United States
Senate. Traditionally not outspoken on health issues, he spends most of his time with his
Appropriations and Environment and Public Works committees. He has yet to take a position
on a particular reform model. He is waiting to see what the HCTF and the President have
developed. The Senator stresses mral health issues and wants lead screening emphasized.
He's concerned about mandated benefit packages because he believes they have not worked at
the state level. He is also worried about the impact of reform on physicians' earnings.
SEN. BOB GRAHAM (D-FL) - Senator Graham wants to support the President and, not
surprisingly, is most concerned about long term care being included in the final package.
With Florida recently enacting health care legislation, he may be sensitive about state
flexibility. He is okay on employer mandates and wants to be a player on global budgets.
However, he would be concerned if Florida were somehow adversely affected in comparison
to other states. His staff is working on the White House Long Term Care Working Group.
In previous meetings with the HCIT, he was worried about the role of the Public Health
System.
SEN. HERBERT KOHL - Senator Rockefeller believes Senator Kohl will likely support
the President. Senator Kohl is one of the wealthiest members of the Senate and spent freely
of his own money to win this seat. Using the slogan "Nobody's Senator But Yours," Kohl
tried to portray himself in a positive light as a candidate not beholden to special interests. He
is up for re-election in 1994. He does not support single payer and has not taken a position
yet on managed competition. He is comfortable with employer mandates if coupled with
adequate subsidies. Insurance companies are the second largest employer in the state of
Wisconsin, which may be a concern for him. He is a member of the Mitchell working group
and members of his staff are participating on the HCTF working groups.
SEN. RUSSELL FEINGOLD (D-WI) - Freshman Senator Feingold has also adopted a
wait-and-see attitude but is likely to support the President. In meetings with the HCTF he
has discussed the need for long term health care, particularly home and community based care
for the elderly and the disabled. Senator Feingold is also concerned abut coverage for
farmers. At the state level he was a sponsor of single-payer legislation in Wisconsin.
Recent Development: At the 4/30 bipartisan meeting with the Senate, Senator Feingold
asked about long-term care and home care. In particular he wanted to know how the states
would be affected by the Administration's proposals. This is particularly important to him
because Wisconsin is ahead of the game on this issue.
�SEN. BOB KRUEGER - Senator Krueger is fighting for his political life trying to hold onto
Secretary Bentsen's former Senate seat. He recognizes the importance of the issue, but is
preoccupied with returning to the Senate. It is difficult to foresee his positions, or even worry
about them at this point.
Recent Developments: Senator Krueger is now engaged in an election run-off with Texas
State Treasurer, Kay Bailey Hutchinson. The Republicans are gearing up for a victory as a
slap to Clinton.
�REPUBLICAN MEMBERS OF THE SENATE AGING COMMITTEE
WILLLWl "BILL" COHEN (R-ME) - Senator Bill Cohen from Maine was elected to the
Senate in 1978, winning against Senator Hathaway by a large margin. His platform then
focused on military strength, and that won him a seat on the Senate Armed Services
Committee. He is currently on the Senate Committee on the Judiciary, the Senate Committee
on Governmental Affairs, the Senate Committee on Armed Services, the Senate Special
Committee on Aging, and the Joint Committee on the Organization of Congress. He is
considered to be an unpredictable and at times a liberal Republican, whose home state
priorities often override partisan votes.
Last session. Senator Cohen worked on a health care package which included a refundable tax
credit for health insurance premiums and a nationwide low-cost basic benefits package.
On January' 27, 1993, Senator Cohen submitted S. 223, the Access to Affordable Health Care
Act, a bill to contain health care costs and increase access to affordable health care, and for
other purposes. Senator Cohen also co-sponsored Senator Mitchell's Freedom of Choice Act.
Senator Cohen is one of the ten Republican Senators we have a possibility of getting at the
present time. He requested that you attend an event in Maine at the same time you went to
Nebraska for Senator Kerrey. The First Lady may want to extend regrets. Doing something
in Maine and not heavily involving Senator Mitchell is not recommended. An underlying
rivalrj' exists between Senators Mitchell and Cohen. Apparently he may ask you again for
another event; we advise not to commit at this time.
Recent Developments: At the bipartisan meeting with the Senate last Friday (4/30),
Senator Cohen asked about global budgets and caps. In addition, he wanted to know how
price controls (if any) will work. Cohen also asked about the process and gave his advice on
consultation. In addition, he expressed interest in long-term care.
Senator Cohen joined Senator Pryor in an effort to fight back an unsuccessful attempt to
eliminate the Aging Committee. Although the Committee won the vote on the floor of the
Senate, the committee remains vulnerable as a result of the deliberations of the Joint
Committee on the Organization of Congress.
SENATOR LARRY PRESSLER (R-SD) - Senator Larry Pressler is a moderate to
conservative Republican from the State of South Dakota. Known mostly for wanting
Congressional reform, he has fought against pay raises and other issues that are popular back
home. Senator Pressler has a tendency to vote the ways the current political winds are
blowing. Early in his career, he was known as a liberal Republican, then a conservative and
is now known as a moderate Republican. Senator Pressler was narrowly re-elected to the
Senate in 1990, and is expected to face a strong challenge from the very popular
Congressman-at-large, Tim Johnson, in 1996. Lately, many negative articles have been
written about Pressler in South Dakota, which has caused his popularity to slip. However,
�much can happen in the next four years.
His health views are not widely known. And it is also unclear whether he will fall to either
the Chafee or Gramm side of the current Republican health care debate.
Recent Development: At the 4/30 bipartisan meeting with the Senate, the Senator asked
about when the Administration hopes to have floor action on the plan. He also asked about
malpractice reform.
SENATOR CHARLES GRASSLEY (R-IA) - Senator Grassley is one of those Senators
who can give the impression (since he is not a detail-oriented person) that he is less than
sharp and not a significant player. This is not the case. Although he may not be extremely
quick, he has a very sensitive and accurate gut for politics and policy and, with a very
capable staff, he has managed to become quite an effective member of the Finance
Committee.
Grassley's primary health care interest has been rural health care. Again, like most other
Finance Committee members, the Senator has been greatly concerned about perceived
inequities in reimbursement to rural providers.
Recent Development: Senator Grassley, as he stated at the 4/20 Finance Committee
meeting, appreciated The First Lady's trip to Iowa. He was, according to Senator Pryor,
impressed with your presentation before the Finance Committee and, again only according to
Senator Pryor, said "Hillary is too smart for Republicans." He has also indicated his support
for malpractice reform.
SENATOR ALAN SIMPSON (R-WY) - Wyoming's junior Senator, Alan Simpson, handily
won re-election in 1990, and currently serves in the Republican leadership as Minority Whip.
Simpson serves on the Judiciary Committee, the Environment and Public Works Committee,
the Veterans' Affairs Committee, and the Special Committee on Aging. He has taken partisan
positions on issues like the Clean Air Act and other environmental issues, but breaks with
many Republicans in his pro-choice stance.
Senator Simpson rates the following as his top priorities: state flexibility, mral and frontier
delivery problems, managed competition's applicability to mral areas and incentives for
medical personnel to serve in underserved areas.
Senator Simpson is currently siding with the Chafee side of the Senate Republican health care
debate. Also, in a letter to the First Lady in early March, he was very complimentary about
her meeting with the Republican Senators and her mastery of health care reform.
Recent Development: At the 4/30 bipartisan meeting with HRC and the Senate, Senator
Simpson asked about paying for the new health care system. In addition he asked about
CHAMPUS and DOD, what would happen to them?
�SENATOR JIM JEFFORDS (R-VT) - Senator Jim Jeffords is a progressive Republican
who has shown a fair amount of interest in health-related matters. He has sponsored his own
bill (The Medicare Health Act), a single-payer approach with 70% federal financing. He
believes his is a unique approach and really hopes that the Administration considers his
proposal seriously.
According to his staff, the main agenda item for Senator Jeffords this year will be the ERISA
preemption. This is an especially important issue for Vermont, which currently has a waiver
application in order to pursue comprehensive reform in the state. As a result, he would also
like to see state flexibihty buih into a comprehensive reform initiative.
Senator Jeffords is an advocate of improving access to health in rural areas. As part of health
reform, Jeffords believes there needs to be an emphasis on primary care and efforts that
encourage providers to enter primary c^are. He also favors loan deferment programs and
expansion of the National Health Service Corps (NHSC) which aim to address the provider
shortage issue in rural communities. Jeffords has raised questions regarding how managed
competition will affect the need for primary practitioners.
Jeffords has also taken an active stance on lifting the ban on fetal tissue research, increasing
AIDS education, and eliminating the special market exclusivity for producers of orphan dmgs
(drugs for rare diseases). In addition, Jeffords has been taking a lot of credit lately for the
fact that the President advises the Administration will be providing lots of state flexibility.
This public credit-taking has alienated Senator Leahy in particular because Leahy believes he
is the leader in this area.
Recent Development: At the May 4 bipartisan Senate Labor and Human Resources meeting,
he stated his view that we should integrate Medicare into the Administration's proposal. He
also mentioned that we should emphasize preventive care and childhood nutrition.
SENATOR JOHN MCCAIN (R-AZ) - Senator John McCain of Arizona is conservative
with a career-military background. As a former prisoner of war himself, he has focused on
the POW/MIA issue in his work on the Armed Services Committee.
In the area of health care, he sponsored the Children's Health Care Improvement Act of 1993
(S. 28) which seeks to improve the health of the nation's children. He has also sponsored the
Medicare Provider Payment Equity Act of 1993 (S. 31) which would repeal the reduced
Medicare payment provision for new providers. The Senator also co-sponsored Senator
Dole's Medicare reform bill.
Senator McCain is siding with Senator Gramm in the health care rift in the Republican party.
As you know, there is a growing ideological debate among the Senate Republicans on how to
proceed on health care. On the one side is the Gramm-McCain group which espouses the
�use of Medical IRAs as a way to make health care available to consumers. On the other side
of the debate is the Chafee side, which favors a more govenmient-sponsored approach to
curing what ails our health care system. Senator McCain is sympathetic to the
pharmaceutical industry.
DAVID DURENBERGER (R-MN) - Senator Dave Durenberger, the ranking Republican on
the Finance Committee Subcommittee on Medicare, is one of the Committee's most well
versed Members on health care reform. He also is one of the few Members who has served
concurrently on the Labor and Human Resources Committee (the other major health care
committee) and the Finance Committee. He is a moderate who is viewed by the Republican
leadership as somewhat of a loose cannon. Because of this and his long-standing interest in
health care reform, Durenberger, too, is a candidate to be a possible and important ally.
In the last Congress, he joined Senator Bentsen as the lead Republican on the Texas Senator's
incremental (insurance market reform, etc.) health reform initiative. He has been a key health
care player for years, however. He now is the ranking Republican on Jay Rockefeller's
Subcommittee on Medicare and Long Term Care, and he has served as either a Chairman or
ranking Member of this Committee for years. In addition, he served (as a Vice-Chair) on the
Pepper Commission. While he joined all the other Republicans in voting against the access
recommendations of this Commission, (he did vote for the long-term care recommendations)
it is important to note that it was unclear that Senator Durenberger was going to vote against
the Pepper Commission recommendations until very late in the process. An important
offshoot of this experience, though, was the close working relationship he forged with
Rockefeller.
Most recently, Durenberger has focused on state-based health reform initiatives. He does not
believe that a consensus yet exists for national reform and his own state is tired of waiting.
Minnesota has a long tradition of moving ahead on health care reforms. It is one of the 5 or 6
states that has gone ahead and passed legislation to implement its own reform proposal.
Minnesota is also THE nation's capital of managed care/HMO delivery systems. As a result,
Minnesota has historically been more efficient than other states in terms of the delivery of
health care. Senator Durenberger will be very concerned about the allocation of the global
budget, particularly that it does not reward the inefficient at the expense of the efficient.
Senator Durenberger called Chris Jennings on April 17 to talk about health policy substance
and strategy. He indicated his nervousness with any price controls. He said he thought wc
could get some savings for speeding up implementation of the new physician payment system.
He also urged us to find a way to fold in Medicare into whatever we do. At a meeting with
fra Magaziner on April 21, Durenberger stressed that, unlike some Republicans, he thinks we
can and should do health care this year, although he expressed reluctance about universal
coverage (and its associated costs) in the near term. Feedback from Governor Carlson's office
was very positive, but Durenberger is still telling the press that he's against new taxes and
isn't sure the bill can be moved this year.
�At the bipartisan meeting with the Senate last Friday (4/30), Senator Durenberger outlined the
major problems for Republicans: Employer mandates, global budgets, and stand-by authority
for cost controls, how much federal guidelines would be imposed on the states, how much
authority would the states have in the Health Alliances, and the $100 billion figure.
Recent Development: At the May 4th bipartisan Senate Labor and Human Resources
Committee meeting, Durenberger stressed that market based capitation, rather than
enforceable budgets should be the course the President should take. In addition, he stated that
Minnesota was good at controlling costs with a market-based system. He also asked about
Accredited Health Plans (AHP) and urged reform of the Federal Employees Health Benefit
Program (FEHBP). Lastly, Senator Durenberger urged that the President call fonner HHS
Secretary Otis Bowen to get the benefit of his views.
SENATOR LARRY CRAIG (R-ID) - After ten years in the House, Senator Larry Craig
won his bid for Senate in 1990, filling the open Senate seat vacated by the retiring Senator
McLure in 1990. As Idaho's junior senator, he believes strongly in economic development
and is opposed to environmental restrictions and goverrmient regulations. He currently sits on
the Senate Committee on Energy and Natural Resources, the Senate Committee on
Agriculture, Nutrition, and Forestry, the Senate Special Committee on Aging and the Joint
Economic Committee.
Senator Craig co-sponsored Senator McCain's Medicare Provider Payment Equity Act of
1993, which is designed to amend the Social Security Act to repeal the reduced Medicare
payment provision for new providers. He also co-sponsored Senator Dole's recent bill on
Medicare (S. 176).
SENATOR CONRAD BURNS (R-MT) - Senator Bums is Montana's junior Senator. The
best description of him appeared in the 1992 edition of The Almanac of American Politics:
"Bums...is almost a stereotypical Easterners version of a western politician. He picks his
teeth with a pocketknife, chews tobacco, and tells deadpan jokes." Bums came to the Senate
in 1988, defeating incumbent John Melcher.
Senator Bums is a quiet Senator with a conservative voting record. Although he is on the
Republican Health Care Task Force and on Senator Pryor's Aging Committee, he is not very
outspoken on health issues. He is a cosponsor of Senator Kassebaum's BasiCarc Health
Reform Bill and is interested in meeting with you next week. He is particularly supportive of
the bill's rural health provisions.
Recent Development: Senator Bums is scheduled to meet with The First Lady along with
Senator Kassebaum and Representatives Glickman and McCurdy on Thursday, May 6th.
�SENATOR ARLEN SPECTER (R-PA) - Pennsylvania's Senator Arlen Specter defeated
Lynn Yeakel last fall, despite the initial momentum generated by his opponent over the
Senator's questioning of Anita Hill. He has long staked a claim to traditionally Democratic
issues, like support for labor and women's rights. He currently serves on the Judiciary
Committee, the Energy and Natural Resources Committee, the Appropriations Committee, the
Veterans' Affairs Committee, and the Special Committee on Aging.
During last fall's campaign, Senator Specter proposed a health care reform package focused
on preventive care, while increasing federal funding for health care. He also touted his cosponsorship of the "Health Care Access and Affordability Act of 1992," a consumer choice
based health care reform proposal.
Recent Development: At the 4/30 bipartisan meeting with the Senate, Senator Spector asked
about bipartisanship and how much it would cost.
�i
, 1
PRIVILEGED ^p.^eem-iiuui^TiiiL
DETERMINED TO BE AN ADVIINISTRWITE
MARKINGJJer E A 12958 as amen()9d^e(|. 3^ (c)
TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n
C h r i s Jennings
Meeting with^Congressman McCurdy
Melanne, Steve,"', L o r r a i n e , D i s t r i b u t i o n
May 5, 1993
Tomorrow a f t e r n o o n , you are scheduled t o meet w i t h
Congressman Dave McCurdy (D-OK), t h e p r i m a r y cosponsor o f one o f
t h e o n l y comprehensive h e a l t h r e f o r m b i l l s , "BasiCare," t o have
a t t r a c t e d b i p a r t i s a n s u p p o r t i n t h e Congress.
As you know, t h i s meeting was o r i g i n a l l y b l o c k e d o f f f o r a l l
5 p r i m a r y sponsors o f t h i s l e g i s l a t i o n (Senator Kassebaum,
Senator D a n f o r t h , Senator Burns, Congressman Glickman, and
Congressman McCurdy). However, a l l t h e o t h e r Members -- l e d by
Senator Kassebaum -- t h o u g h t you (and t h e y ) deserved a b r e a k from
meetings.
(By t h e way, I s t r o n g l y b e l i e v e t h a t t h i s was a
s i n c e r e g e s t u r e o f concern f o r you on Senator Kassebaum's p a r t ;
yes t h e r e a r e some n i c e people i n t h e Congress).
BACKGROUND
BasiCare was developed p r i m a r i l y by Senator Kassebaum, who
was i t s c h i e f sponsor i n t h e Senate. J o i n i n g her a t t h e t i m e o f
i n t r o d u c t i o n were Senator D a n f o r t h and Senator Burns. Democrat
Congressman Glickman, a f e l l o w Kansan, was j o i n e d by Congressman
McCurdy i n i n t r o d u c i n g t h e companion b i l l i n t h e House.
BasiCare i s n o t a b l e because, w i t h t h e e x c e p t i o n o f an
i n d i v i d u a l , r a t h e r t h a n a j o i n t employer/employee r e q u i r e d
c o n t r i b u t i o n , the l e g i s l a t i o n i s extremely s i m i l a r t o the
p r o p o s a l t h e P r e s i d e n t and you are c o n t e m p l a t i n g .
Attached f o r
your r e v i e w i s ( 1 ) an a b b r e v i a t e d 2-page summary o f t h e b i l l ,
(2) a l o n g e r summary o f t h e b i l l , ( 3 ) a comparison o f t h e b i l l
w i t h our c u r r e n t u n d e r s t a n d i n g o f t h e A d m i n i s t r a t i o n ' s p r o p o s a l ,
and ( 4 ) t h e b i l l i t s e l f .
The Kassebaum/Glickman-McCurdy b i l l r e c e i v e d s i g n i f i c a n t
a t t e n t i o n n o t o n l y because i t r e c e i v e d n o t a b l e b i p a r t i s a n
s u p p o r t , b u t a l s o because i t c o n t a i n e d a c o s t containment
mechanism ( a b i n d i n g i n s u r a n c e premium l i m i t ) t h a t went w e l l
beyond a n y t h i n g e l s e supported by o t h e r moderate t o c o n s e r v a t i v e
Members o f Congress. As a r e s u l t , t h e b i l l ' s sponsors, p r i m a r i l y
t h e Democrats, b e l i e v e t h e l e g i s l a t i o n may r e p r e s e n t a compromise
approach t h a t a m a j o r i t y o f Congress c o u l d s u p p o r t .
Congressman McCurdy w i l l want t o d i s c u s s t h i s b i l l and a
s t r a t e g y f o r a t t r a c t i n g m o d e r a t e / c o n s e r v a t i v e Democrats.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. memo
DATE
SUBJECT/TITLE
Chris Jemiings to Hillary Rodham Clinton; re; KasseBaum/Glickman
"BasiCare" Meeting (2 pages)
05/05/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefing Memos •First Lady, 1993 [4]
2006-0885-F
jp2849
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)l
Freedom of Information Act - |5 U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(bK2) of the FOIA|
b(3) Release would violate a Federal statute [(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the F01A|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(bX6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(bK8) of the F01A|
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIAJ
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office |(aX2) of the PRA|
Release would violate a Federal statute |(aX3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |aK5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�BENEFITS PACKAGE
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
Sets f o r t h a s i n g l e , u n i f o r m "minimum
b u t f a i r " b e n e f i t s package d e t e r m i n e d
by an " e x p e r t commission."
The C l i n t o n p l a n w i l l e s t a b l i s h a
comprehensive n a t i o n a l b e n e f i t s package
in the legislation.
The N a t i o n a l H e a l t h
Board w i l l r e v i e w and suggest
m o d i f i c a t i o n s t o Congress.
Uniform n a t i o n a l deductibles,
copayments & b e n e f i t a p p l i c a t i o n s and
standards.
U n i f o r m n a t i o n a l d e d u c t i b l e s , copayments
& b e n e f i t a p p l i c a t i o n s and s t a n d a r d s
based on t h e t y p e o f p l a n .
L e g i s l a t i o n l i s t s t h e f o l l o w i n g types
o f s e r v i c e s t h a t , a t a minimum, w i l l be
covered: basic h o s p i t a l i z a t i o n , basic
o u t p a t i e n t service, catastrophic outof-pocket protection, extraordinary
l o n g - t e r m c a r e c o s t s , some proven
preventive care.
The p l a n w i l l l i s t t y p e s o f s e r v i c e s
covered ( i . e . , i n - p a t i e n t / o u t p a t i e n t
hospital services, preventive services,
l a b o r a t o r y and d i a g n o s t i c s e r v i c e s ,
p r e s c r i p t i o n d r u g s , m e n t a l h e a l t h , home
and h o s p i c e c a r e , r e h a b i l i t a t i v e c a r e ,
r e p r o d u c t i v e c a r e , and v i s i o n , e t c .
�COST CONTROLS
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
B i n d i n g a n n u a l l i m i t s w i l l be p l a c e d on
t h e maximum a l l o w a b l e r a t e o f i n c r e a s e
i n BasiCare premiums.
V a r i o u s l o n g and s h o r t - t e r m c o s t c o n t r o l
options, involving providers & insurers,
are b e i n g c o n s i d e r e d f o r t h e r e f o r m .
Premium c o s t w i l l be c o n t r o l l e d by
a n n u a l l i m i t s on maximum a l l o w a b l e
rates o f increase.
The n a t i o n a l budget w i l l be based on
a l l o w a b l e r a t e o f i n c r e a s e f o r weighted
average premium.
F u t u r e a l l o w a b l e i n c r e a s e w i l l be
measured by t h e BasiCare Commission
a g a i n s t t h e e s t a b l i s h e d average base
premium.
FINANCING
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
New money n e c e s s a r y f o r BasiCare would
come from t a k i n g 1 % o f t h e c u r r e n t
social security payroll tax.
D i f f e r e n t f i n a n c i n g o p t i o n s under
consideration.
�EMPLOYER/EMPLOYEE ROLES
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
BasiCare's program i s based on an
individual required contribution. I t
does n o t r e q u i r e t h a t employers p r o v i d e
or c o n t r i b u t e t o coverage o f t h e i r
employees.
The C l i n t o n p l a n i n c l u d e s a r e q u i r e d
c o n t r i b u t i o n from employers and
i n d i v i d u a l s . T h i s would be a phased i n
r e q u i r e m e n t w i t h s p e c i a l accommodations
f o r s m a l l businesses.
TAX TREATMENT
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
Tax d e d u c t i o n s f o r employers and t a x
e x c l u s i o n s f o r employees w i l l a p p l y
o n l y t o spending on t h e BasiCare
b e n e f i t s package.
Tax d e d u c t i o n s and e x c l u s i o n s w i l l a p p l y
o n l y t o t h e n a t i o n a l l y guaranteed
b e n e f i t s package, g r a n d f a t h e r i n g c u r r e n t
union contracts.
100% d e d u c t i o n f o r s e l f - e m p l o y e d
i n d i v i d u a l s & farmers.
100% d e d u c t i o n f o r s e l f - e m p l o y e d
individuals.
�I
INSURANCE REFORM
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
Requires a l l p r i v a t e i n s u r e r s t o s e l l
the b e n e f i t s package and p r o h i b i t s t h e
s e l l i n g o f any package t h a t d u p l i c a t e s
coverage o f f e r e d i n BasiCare.
Requires a l l p l a n s t o p r o v i d e t h e
n a t i o n a l l y guaranteed b e n e f i t s package.
I n s u r e r s can s e l l supplemental p o l i c i e s
for things that aren't offered i n the
b a s i c package.
Rules w i l l be s e t up f o r e n t r y i n t o
supplemental h e a l t h i n s u r a n c e market &
the r e g u l a t i o n o f s u p p l e m e n t a l p r o d u c t s .
L i m i t s on g r o w t h w i l l c r e a t e new
e f f i c i e n c i e s i n t h e d e l i v e r y system
t h r o u g h development o f c o o r d i n a t e d
systems o f c a r e , n e g o t i a t e d between
providers & insurers.
H e a l t h Plans w i l l c o o r d i n a t e systems and
bear t h e f i n a n c i a l r i s k .
Community r a t i n g w i t h a d j u s t m e n t f o r
age.
Community r a t e s e t t i n g and r i s k
a d j u s t m e n t s a r e expected t o be made a t
the H e a l t h A l l i a n c e l e v e l . Community
r a t i n g i s l i k e l y t o be a p p l i e d t o a l l
persons under t h e age o f 65.
I n s u r e r s cannot e x c l u d e people due t o
p r e - e x i s t i n g c o n d i t i o n , n o r can t h e y
h i k e r a t e s f o r p e o p l e because o f
illness.
I n s u r e r s cannot e x c l u d e people due t o
p r e - e x i s t i n g c o n d i t i o n s , n o r can t h e y
h i k e r a t e s f o r people because o f
i l l n e s s , age, o r gender.
The p l a n w i l l f o l d i n t h e h e a l t h p o r t i o n
o f workers' compensation and a u t o
insurance i n t o the h e a l t h insurance
package.
�MALPRACTICE REFORM
KASSEBAUM/GLICKMAN PROPOSAL
caps on non-economic p u n i t i v e
damage awards
mandatory o f f s e t s o f awards f o r
c o l l a t e r a l sources o f r e c o v e r y
c o u r t determined reasonable
attorney's fees
mandatory p e r i o d i c payment o f
f u t u r e awards
encourage i m p l e m e n t a t i o n o f ADR
(alternative dispute resolution)
systems: f a u l t and n o - f a u l t
binding a r b i t r a t i o n
Special demonstration p r o j e c t s t o t e s t
i m p l e m e n t a t i o n o f n o - f a u l t systems o f
compensation.
CLINTON PROPOSAL
The C l i n t o n p l a n may i n s t i t u t e a system
o f m e d i c a l m a l p r a c t i c e and t o r t r e f o r m
based on " e n t e r p r i s e l i a b i l i t y " and
alternatives t o l i t i g a t i o n . Alliances
w i l l encourage i m p l e m e n t a t i o n o f
o p t i o n a l ADR ( a l t e r n a t i v e d i s p u t e
r e s o l u t i o n ) systems. The r e f o r m may:
l i m i t non-economic damages
p r o h i b i t double r e c o v e r y from
c o l l a t e r a l sources
impose a s l i d i n g s c a l e on
contingency fees
r e q u i r e p e r i o d i c payments o f l a r g e
awards
impose u n i f o r m , reduced s t a t u t e s o f
limitation
E n t e r p r i s e l i a b i l i t y means t h a t H e a l t h
Plans would assume l i a b i l i t y f o r a l l
a f f i l i a t e d providers.
F e d e r a l law w i l l supersede i n c o n s i s t e n t
s t a t e s t a t u t e s r e l a t e d t o medical
malpractice.
�UNDERSERVED AREAS
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
I n c r e a s e d f u n d i n g f o r community h e a l t h
c e n t e r s and o t h e r community-based
p r i m a r y c a r e f a c i l i t i e s f o r r u r a l and
underserved areas.
Increased funding f o r h e a l t h care
i n f r a s t r u c t u r e i n underserved areas.
S t a t e s must ensure access f o r low income
i n d i v i d u a l s u s i n g a range o f means
d e s c r i b e d by l e g i s l a t i o n .
LOW-INCOME COVERAGE
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
Low-income u n i n s u r e d persons w i l l be
o f f e r e d n o n - t r a n s f e r a b l e vouchers t o
r e p l a c e & expand upon c u r r e n t Medicaid
program.
Medicaid p o p u l a t i o n would be i n t e g r a t e d
i n t o t h e a l l i a n c e s and s u b s i d i z e d by
f e d e r a l and s t a t e d o l l a r s .
L e g i s l a t i o n w i l l s p e c i f y minimum income
l e v e l s f o r voucher a s s i s t a n c e . A t
minimum, p e o p l e below 100% o f f e d e r a l
poverty l e v e l w i l l receive f u l l
voucher.
S l i d i n g s c a l e f o r s u b s i d i e s w i l l be up
t o 200% o f p o v e r t y l e v e l .
E l i g i b i l i t y requirements:
•
f a m i l i e s below 200% o f f e d e r a l
poverty l e v e l w i l l received
a s s i s t a n c e on a s l i d i n g s c a l e
based on income.
�1
ADMINISTRATIVE SIMPLIFICATION
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
S t a n d a r d i z e d b i l l i n g and c l a i m s
paperwork t o c u t down on unnecessary
paperwork and l o w e r a d m i n i s t r a t i v e
costs.
Standardized b i l l i n g and c l a i m s
processes to c u t down on unnecessary
paperwork and lower a d m i n i s t r a t i v e
costs.
1
1
|
1
MEDICARE INTEGRATION
KASSEBAUM/GLICKMAN PROPOSAL
CLINTON PROPOSAL
BasiCare w i l l be expanded o v e r t i m e t o
encompass Medicare.
S t a t e s may have t h e o p t i o n o f
encompassing Medicare o v e r t i m e .
Medicare b e n e f i c i a r i e s w i l l be g i v e n
i n c e n t i v e t o e n r o l l i n managed c a r e
networks.
|
1
|
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. memo
DATE
SUBJECT/TITLE
Chris Jennings to Hillary Rodham Clinton; re: Republican Leadership
Meeting (2 pages)
05/05/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
;5teve Edelstein
OA/Box Number: 3681
FOLDER TITLE:
(Ilongressional Briefing Memos - First Lady, 1993 [4]
2006-0885-F
jp2849
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information |(aXl) of the PRA|
P2 Relating to the appointment to Federal office |(aX2) of the PRA]
P3 Release would violate a Federal statute |(aX3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRA]
PS Release would disclose confidential advice between the President
arid his advisors, or between such advisors ]a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information ](bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency l(bX2) of the FOIA]
b(3) Release would violate a Federal statute )(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ](b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions l(bX8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells l(bX9) of the F OIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�CONGRESSIONAL REPUBUCAN LEADERSHIP MEETING
May 6, 1993
SENATE:
ROBERT DOLE (R-KS) (SENATE MINORITY LEADER)
The Minority Leader is, without question, the most influential Senator among Republicans.
As an ally, he can be absolutely invaluable. As an enemy, he can be vicious and effective.
Cunently, it appears he is trying to decide whether health care reform should be a partisan or
a bipartisan issue. Dole and his staff will probably opt to appear to be willing to work with
the Democrats, but will eventually choose to turn on the new Administration on the reform
issue.
Senator Dole, along with Senator Chafee, was the primary co-sponsor of the Health Care
Access and Equity Act of 1991, the Republican Health Care Task Force's health reform
legislation. The bill was largely a scries of incremental reforms. Senator Dole has a strong
interest in rural health and is currently Co-Chair of the Senate Rural Health Caucus.
Legislatively, he has supported initiatives to protect the viability of small rural hospitals as
well as to expand civil rights protections and services for the handicapped.
On Meet the Press (Sunday, April 18), he indicated his opposition to price controls, his
concern about large taxes without delivering on cost contaiimient first, and his hesitancy
about a VAT tax unless it is used to replace or offset other taxes.
Senator Dole continues to profess a desire to work with Democrats on health reform. Earlier
this year, Senator Dole said: "[i]f we're going to have health care reform, it's got to be
bipartisan. Nobody has the votes for health care reform. We don't have the votes. We're the
minority. Democrats don't have the votes because they have different ideas. But it seems to
me this issue is so important that it shouldn't be politicized. Now, politics—there's a place
for it, and there's a place not for it, and I think health care reform is one of those areas."
[Reuter Transcript Report. 2/16/93]
Although it may be difficult, we must continue to work to at least try to get him on board. If
we do not succeed, we might have some success in attracting other moderate Republicans for
making the effort to obtain Dole's support.
At the bipartisan Senate meeting (4/30), Senator Dole outlined his concerns about not
knowing the details of the plan and how much it would cost. Senator Dole, in essence, cohosted the event with Senator Mitchell, made brief remarks at the begiiming of the meeting
and participated in the press availability afterwards. It should be noted that the group of
Senators he has assembled for tcxiay's lunch are mostly moderate and very reasonable.
�JOHN CHAFEE (R-RI) (CHAIRMAN, REPUBLICAN HEALTH TASK FORCE)
Senator Chafee is the Ranking Republican on the Finance Committees Medicaid
Subcommittee and Chair of the Republican Task Force on Health Care. He likes to point out
that the bill they introduced in the last Congress had the most cosponsors of any major
comprehensive health reform bill. He was not pleased with last year's health care debate with
the Democrats. He believes that, if not for Presidential and partisan politics, there was
enough consensus between his and many Democrats' bills to move forward on many high
priority health reform proposals such as: self-employed tax deduction increase to 100
percent, insurance market reform, expansion of community health centers and other health
care delivery systems, and state experimentation.
On the Finance Committee, Senator Chafee is primarily known for his long-standing interest
in providing care to persons who are disabled in alternative settings under Medicaid. He and
his staff are literally heroes with many in this field, particularly those who advocate noninstitutional care approaches. He is also well knovra for his strong advocacy of, and
relationship with, community health care centers. In addition, he — like a number of the
Finance Committee membership — is growing weary of funding programs for the elderly
when there are so many needs in the non-elderly population.
At the bipartisan meeting with the Senate on Friday, 4/30, Senator Chafee asked specific
questions about purchasing co-ops, opt-outs, how global caps will work in the states, and
about the fee-for-service plan and how it will work. At a meeting with Ira on Tuesday, 5/4,
he and his staff director raised some of those same issues, specifically the scope and
responsibilities of the purchasing cooperative. At that meeting. Senator Chafee stressed the
desire of Republicans to do something on health care and to work cooperatively with the
Administration. He stressed, however, that the most likely course of action was that the
Republicans would put out their own broad plan first (possibly prior to the President's
announcement) and then sit down to negotiate, rather than do so beforehand. The overall
tone was very positive and ended with a discussion of the Senators' hope that we could
hammer out differences over the summer (the legislative reference he gave was the 1990
Clean Air Act, where Sen. Mitchell got Administration officials, Demoaats and Republicans
in a room for six weeks until they'd produced a bill they all could live with) and have joint
legislation ready by Fall.
SENATOR NANCY KASSEBAUM (R-KS)
Senator Kassebaum is the new ranking-minority member of the Labor and Human Resources
Committee. As such, she'll be working closely with Chairman Kennedy on many provisions
the committee has jurisdiction over.
�Kassebaum has taken a strong interest in health care reform and has introduced her own
reform bill, the BasiCare Health Access and Cost Control Act (S. 325), a bi-partisan health
care reform bill that proposes aggressive cost containment provisions, universal coverage
through an individual mandate, and additionalfinancingfor the programfi^omexisting Social
Security payroll taxes. By capping insurance premiums, the bill presents a major cost
containment departure for Republicans. In your meeting with the Senate Women's Caucus,
Kassebaum pushed for a national commission, like the base closure commission, to develop a
benefits package (and get around the abortion debate issue). She concluded that such an
approach would provide a one-vote (up or down) cover for members.
She is very concerned about over-regulation by HHS and the federal govemment generally.
Along with Senator Metzenbaum, Kassebaum authored legislation on orphan drugs; their bill
would have eliminated the current regime in which drugs for rare diseases enjoy special
market exclusivity for the pharmaceutical manufacturer.
While considered a moderate. Sen. Kassebaum will toe the party line if she perceives an issue
is being politicized.
Senator Kassebaum has expressed concerns about the Health Alliance. Specifically, whether
they will remain a non-profit entity or whether they will become govemment or quasigovernmental agencies. She interested to know if large groups with healthy populations are
penalized for opting out, whether sick groups that opt out will get a subsidy. Kassebaum is
also interested in how the global budgets will be allocated to the states and how these state
budgets will be enforced. Her elderly mother lives at home, so Kassebaum also has a
personal concern about community-based long term care. We believe she is one of our top
Republican chances. At the May 4th Labor and Human Resources meeting, she raised
concerns about the use of the $100 billionfigureto talk about the costs of the program. She
fears this type of talk could scare away too many members from even taking a look at the
proposal. Having said this, she seems genuinely impressed by and appreciative of your
presentation.
WILLIAM "BILL" COHEN (R-ME)
Senator Bill Cohen from Maine was elected to the Senate in 1978, winning against Senator
Hathaway by a large margin. His platform then focused on military strength, and that won
him a seat on the Senate Armed Services Committee. He is currently on the Senate
(Tommittee on the Judiciary; the Senate Committee on Governmental Affairs; the Senate
Committee on Armed Seivices; the Senate Special Committee on Aging; and the Joint
Committee on the Organization of (Congress. He is considered to be an unpredictable and at
times a liberal Republican, whose home state priorities often override partisan votes.
�On January 27, 1993, Senator Cohen submitted S. 223, the Access to Affordable Health Care
Act, a bill to contain health care costs and inaease access to affordable health care, and for
other purposes. Senator Cohen also co-sponsored Senator Mitchell's Freedom of Choice Act.
Senator Cohen is one of the ten Republican Senators we have a possibility of getting at the
present time. He requested that you attend an event in Maine at the same time you went to
Nebraska for Senator Kerrey. You may want to extend you regrets. An underlying rivalry
exists between Senators Mitchell and Cohen.
At the bipartisan meeting with the Senate Ion Friday, 4/30, Senator Cohen asked about global
budgets and caps. In addition, he wanted to know how price controls (if any) will work.
Cohen also asked about the process and gave his advice on consultation. In addition, he
expressed interest in long-term care.
He may ask you again for another event in Maine; we advise not to commit at this time.
JOHN DANFORTH (R-MO)
Senator Danforth, the senior senator from Missouri, recently announced his plans not to run
for reelection in 1994. Senator Danforth feels as strongly about the need for cost containment
as Bob Packwood does the need for mandates. He is the Senator most likely to advocate that
strong federal/state caps on spending must be imposed to effectively contain health care costs.
He states his strong views on this issue repeatedly, despite admonitions fi-om his staff and
other Republicans that such statements are not consistent with the Republican Party line.
He is one of two cosponsors of Sen. Kassebaum's BasicCare Health Access and Cost Control
Act. At the press conference announcing the introduction of the bill. Sen. Danforth again
focused on cost control noting, "the easiest thing to do is to introduce a bill that provides for
universal coverage. The hardest thing to do is to provide for cost control." [FNS, 2/4/93]
Although willing to support the need for strong govemment cost regulation, he also believes
that to do so would require explicit rationing. He is a big fan of the Oregon waiver). What
is more, unlike most Democrats, he desires to publicly proclaim that rationing is necessary
and something we must own up to.
The Senator has been vocal lately opposing the possibility of new taxes for health care
reform, saying, according to The New York Times, "it would be 'extremely difficult' for
Congress to pass new taxes for health care on top of those sought for deficit reduction." He
is also quoted as saying, "How many big tax bills is Congress going to pass in a year?... How
much is the country going to swallow in a year?" [NYT, 2/21/93]
�At the April 20th meeting with the Finance Committee, Senator Danforth stated that
Democrats and Republicans are not too far apart on health care. He also stated that universal
coverage is important, but that it should be phased in over a longer period of time. He
believes the tax cap should apply to both employees and employers and seemed happy with
your response on that point.
DAVE DURENBERGER (R-MN)
Senator Durenberger, the ranking Republican on the Finance Committee on Medicare, is one
of the Committee's most well versed Members on health care reform. He also is one of the
few Members who has served concurrently on the Labor and Human Resources Committee
(the other major health care committee) and the Finance Committee. He is a moderate who is
viewed by the Republican leadership as somewhat of a loose cannon. Because of this and his
long-standing interest in health care reform, Durenberger, could become an important ally.
In the last Congress, he joined Senator Bentsen as the lead Republican on the Texas Senator's
incremental (insurance market reform, etc.) health reform initiative. He has been a key health
care player for years, however. He now is the ranking Republican on Jay Rockefeller's
Subcommittee on Medicare and Long Term Care, and he has long served as either a
Chairman or ranking Member of this Committee. In addition, he served (as a Vice-Chair) on
the Pepper Commission. While he joined all the other Republicans in voting against the
access recommendations of this Commission— though he did vote for the long-term care
recommendations— it is important to note that it was unclear that Durenberger was going to
vote against the Pepper Commission recommendations until very late in the process. An
important offshoot of this experience, though, was the close working relationship he forged
with Rockefeller.
Most recently, Durenberger has focused on state-based health reform initiatives. He's not
sure that a consensus yet exists for national reform and his own state has moved ahead
independently. Minnesota has a long tradition of moving ahead on health care reforms. It is
one of the 5 or 6 states that has gone ahead and passed legislation to implement its own
reform proposal.
Minnesota is also THE nation's capital of managed care/HMO delivery systems. As a result,
Minnesota has historically been more efficient than other states in terms of the delivery of
health care. Senator Durenberger will be very concemed about the allocation of the global
budget, particularly that it does not reward the inefficient at the expense of the efficient.
In a phone conversation with me in late April, Senator Durenberger indicated his nervousness
with any price controls. He said he thought we could get some savings from speeding up
implementation of the new physician payment system. He also urged us to find a way to fold
in Medicare into whatever we do.
�At a meeting with Ira Magaziner on April 21, Durenberger stressed that, unlike some
Republicans, he thinks we can and should do health care this year, although he expressed
reluctance about universal coverage (and its associated costs) in the near term. Feedback on
the meeting via Governor Carlson's office was very positive, but Durenberger is still telling
the press that he's against new taxes and isn't sure the bill can be moved this year.
At the bipartisan meeting with the Senate on Friday, 4/30, Senator Durenberger outlined the
major problems for Republicans: Employer mandates, global budgets, and stand-by authority
for cost controls, how many federal guidelines would be imposed on the states, how much
authority would the states have in the Health Alliances, and the $100 billion figure.
At the May 4th bipartisan Senate Labor and Human Resources Committee meeting,
Durenberger stressed that market-based capitation, rather than enforceable budgets should the
be the course the President should take. In addition, he stated that Minnesota was good at
controlling costs with a market-based system. He also asked about Accredited Health Plans
(AHP) and urged reform of the Federal Employee Health Benefit Program (FEHBP). Lastly,
Senator Durenberger urged that the President call former HHS Secretary Otis Bowen to get
the benefit of his views.
ORRIN HATCH (R-VT)
Senator Hatch is one of the brightest Senators. He was appointed to the Finance Committee
in the last Congress, but has yet to really get a comfortable grasp of the committee. Although
well known for his very conservative philosophy, in recent years he has appeared to become
more open to more traditionally moderate approaches. For example, although close to the
drug industry, he has been willing to push them to be more responsive on pricing issues.
Up until 1993, he served as either the Chairman or the Ranking Republican of the much more
conflict-oriented Labor and Human Resources Committee. In this capacity, he became
extremely well informed about PHS, NIH, and FDA issues. On health reform issues, he can
be expected to be very supportive of market-oriented reforms to the health care system. In
that vein, he will be extremely uncomfortable with employer mandates and discussions of
global budgeting and enforcement. He has introduced legislation to reform the medical
malpractice system and sees it as an important means for reducing health care costs. Senator
Hatch recently hired a health care staff person straightfiromReagan/Bush DHHS. It is
unclear what impact this will have on his willingness to be constmctive on health care
debates—more likely to be negative. Sen. Kennedy, who is close to Hatch, believes we
should not write him off. He views Hatch as a potential coalition builder between moderate
Republicans and Democrats.
At the May 4th bipartisan meeting with the Senate Labor and Human Resources committee,
he raised the issue that anti-trust reform is necessary for cost effective joint provider
collaborations (e.g. joint ownership of high-tech, high-cost medical equipment).
�JIM JEFFORDS (R-VT)
Senator James Jeffords is a progressive Republican who has shown significant interest in
health-related matters. He has sponsored his own bill (The Medicare Health Act), a singlepayer approach with 70% federalfinancing.He believes his is a unique approach and really
hop>es that the Administration considers his proposal seriously.
According to his staff, the main agenda item for Senator Jeffords this year will be the ERISA
preemption. This is an esp)ecially important issue for Vermont, which currently has a waiver
application in order to pursue comprehensive reform in the state. As a result, he would also
like to see stateflexibilitybuilt into a comprehensive reform initiative.
Senator Jeffords is an advocate of improving access to health in rural areas. As part of health
reform, Jeffords believes there needs to be an emphasis on primary care and efforts that
encourage providers to enter primary care. He also favors loan deferment programs and
expansion of the National Health Service Corps (NHSC) which aim to address the provider
shortage issue in rural communities. Jeffords has raised questions regarding how managed
competition will effect the need for primary practitioners.
Jeffords has also taken an active stance on lifting the ban on fetal tissue research, increasing
AIDS education, and eliminating the special market exclusivity for producers of orphan drugs
(dmgs for rare diseases.) In addition, Jeffords has been taking a lot of credit lately for the
fact that the President advises will be providing lots of stateflexibility.This public credittaking has alienated Senator Leahy in particular because Leahy believes he is the leader in
this areas.
At the May 4th bipartisan Senate Labor and Human Resources meeting, he stated his view
that we should integrate Medicare into the Administration's proposal. He also mentioned that
we should emphasize preventive care and childhood nutrition.
BOB PACKWOOD (R-OR)
Senator Packwood is an advocate of an employer-based universal coverage plan. He is the
only Republican on the Finance Committee that has publicly supported an employer mandate.
As a result, hefindshimself in somewhat of an uncomfortable position with many in the
Senate Republican leadership, who vehemently oppose an employer mandate.
During his campaign for reelection last fall, Packwood singled out health care as an issue on
which he was closer to then-Govemor Clinton than his opponent. Representative Les AuCoin.
He also attacked AuCOin's single-payer approach last year as a multi-billion dollar tax
increase that would result in a govemment run system. The primary criticism leveled against
Packwood's plan was that it didn't go far enough to control costs. Some aging advocacy
groups also criticized it for its lack of comprehensive long-term care coverage. In Oregon, at
least, Packwood won the debate.
�Beyond the above-mentioned work. Senator Packwood has had a notable health care career.
He has sponsored quite a bit of legislation dealing with mral health and long-term care.
Specifically, he introduced a relatively extensive public/private long-term care bill in the
101st Congress. However, because it costed-out as a rather expensive initiative and because
the aging advocates were not enthralled with it, he decided to stick to Federal standards and
tax clarifications for private long-term care insurance policies. In addition, working with
Pryor, he introduced legislation that would provide tax credits for primary care personnel to
serve medically undeserved mral areas.
At the Finance Committee meeting April 20th, Packwood asked about the stmcture and role
of a tax cap and was interested in the degree of subsidy required under reform.
8
�HOUSE OF RFPRFSENTATIVES:
ROBERT (BOB) MICHEL (R-IL) (HOUSE MINORITY LEADER)
Congressman Michel is the leader of the House Republicans and a member as well of the
party's "old guard." Michel was first elected to the House in 1956, and in his 36 years in the
House of Representatives, his party has always been in the minority. Unlike the Senate, the
majority party in the House of Representatives controls the mles of debate. As a result, the
Republicans have virtually no power. In order to be a part of the process, they rely on
Michel's friendship and working relationship with the Demoaats. Michel was co-sponsor of
the House Repubican health care reform initiative, HR 101, which focused on insurance
reforms, malpractice reforms, and "MedSave" accounts, medical IRAs.
Michel has been the Minority Leader since 1980. He was able to bring together coalitions in
the House to produce some of the early Reagan victories. At that time, the House
Republicans thought there might be an opportunity to take a majority of the House. The
Reagan push for Social Security cuts, combined with redistricting, put that hope out of reach.
Congressman Michel is a conservative of the Eisenhower school. He is from Peoria, Illinois,
and his district is dominated by the Caterpillar factory which accounts for half of the district's
manufacturing jobs. Michel is in the middle of a huge ideological fight that is about to split
the House Republicans. Hefindshimself under constant pressure from the more conservative
elements of his party and in the House by his Minority Whip, Newt Gingrich. Gingrich and
Dick Armey of Texas favor a much more combative and aggressive approach. While Michel
is conservative enough to agree on an ideological level with the Gingrich crowd, he prefers to
offer alternatives and a more collegial approach to working with the majority.
CONGRESSMAN J. DENNIS HASTERT (R-IL)
Congressman Hastert was selected by House Minority Leader Michel to be his point person
on health care reform. A fellow lUinoisan, his appointment was a surprise, considering that
he is only in his fourth term in the House and his second term on the Energy and Commerce
Committee. Congressman Hastert is generally not known to be a mover and shaker in the
House or in health care reform. However, he does seem to reflect the "Michel style" of
House Republican. While he is a staunch conservative, he is willing to offer proposals and
be a part of the process. This is in contrast to the Gingrich-Armey approach - they favor a
much more combative and "opposition-by-press-conference" style.
�Congressman Hastert was a teacher and coach for 16 years before entering politics. He
served in the Illinois Assembly for five years before mnning for Congress. Hastert's district
is on the line between suburban Chicago and the agricultural "down state" area. His district
is a mix between suburban Chicago, small industrial towns and agricultural areas.
Congressman Hastert is conservative, and, according to the Almanac of American Politics.
..."is one of the party's most fervent opponents of taxes." In fact, in 1989 and 1990 he
introduced legislation to end the "earnings tax" on Social Security recipients, and eventually
came up with 267 co-sponsors to his measure to repeal the tax for those seniors between ages
65-69. To counter charges that the repeal would cost revenue and add to the deficit, he
stated that it would stimulate work.
Congressman Hastert co-sponsored many health bills in the 102nd Congress. He was on
board with Congressman Bliley's "Maternal Child Health Services Act"(HR 1968), with
Congressman Santomm's "Health Care Savings Plan Act (HR 4130), with Congressman
Rhodes' "Health Care Choice and Access Improvement Act" (HR 4280), and with Minority
Leader Michel's "Action Now Health Care Reform Act" (HR 5325). In addition.
Congressman Hastert has recently (in the 103rd) sponsored his own "Health Care Choice and
Access Improvement Act" (HR 150), which would reform the small group insurance market,
increase the tax deductibility for the self-employed, and allow employers to establish tax-free
Medi-Save accounts.
Congressman Hastert has been pleased and appreciative of the weekly briefings by Ira (he
seems very impressed by him) and other members of the working groups to Republican
members.
CONGRESSMAN CARLOS MOORHEAD (R-CA)
Congressman Moorhead represents the affluent middle class Los Angeles suburbs of Pasadena
and Glendale. His district, although not overwhelmingly conservative, is solidly Republican.
He was first elected in 1972 and was placed on the Judiciary Committee, where he became
one of Richard Nixon's most ardent supporters. Through the years, he has been mostly soft
spoken and relatively obscure. Now that he is the ranking member of the Energy and
Commerce Committee, he may take a more active role in formulating legislation. He is more
known for working on clean-air legislation than on health care. He is a conservative, in fact
one of the most conservative in the House. However, his low-key style will probably mean
that he will listen to the Administration's proposals before voting against them, and will likely
not be part of any vocal opposition to the plan.
10
�CONGRESSMAN THOMAS BULEY (R-VA)
Congressman Thomas Bliley is the ranking Republican member of the Subcommittee on
Health and the Environment of the Energy and Commerce Committee. He has served in the
House since 1980, and before that he served as Democratic Mayor of Richmond, Virginia.
Bliley is seen as a soft spoken, good natured Southern gentleman. He has a large minority
population in his district and occasionally votes with the Democrats to increase health
services to African-Americans, espjecially for matemal and child health care. In the past, he
has worked with Dingell on the Oversight Subcommittee, and has worked with Waxman on
issues like the Orphan Dmg Act. He is anti-choice and very protective of the tobacco
industry in Virginia. In fact, he has had heated battles with Waxman over tobacco legislation.
Bliley is expected to be open to the Administration's proposal, but is unlikely to be
supportive.
He regularly attends the Thursday morning breakfasts with Ira that Hastert arranges.
CONGRESSMAN WILLL\M (BILL) THOMAS (R-CA)
Congressman Thomas is in his first year as ranking member of the Ways and Means
Committee's Subcommittee on Health. He took over from Congressman Bill Gradison, who
now is a lobbyist for the Health Insurance Association of America (HIAA). Thomas seems to
have a more aggressive and combative approach than Gradison, but not necessarily in the
Gingrich-Armey style. He is a conservative who came to Congress in the Reagan years. He
is expected to be more of a challenge to the outspoken Stark.
Thomas is from Bakersfield, Califomia, a largely agricultural and politically conservative
district. Earlier this year. Congressman Thomas wrote the President a three page letter
outlining his health care concems. Basically, he wants health care costs contained, but is
wary of govemment regulation. He would like to scale back Medicaid to a basic benefits
package, and use the money saved to make insurance more affordable to working poor. In
addition, he believes we should: eliminate unnecessary state health insurance standards (i.e.
mandates); break down state and federal antitmst barriers to network development; eliminate
excessive paperwork and regulation; and enhance the role of the consumer in health care
choices. He also supports modest increases in insurance regulation, increased assistance to
underserved areas, and malpractice reform. Finally, Congressman Thomas states a need for
increased long-term services care and urges the adoption of lower cost home health and
hospice care. Although Congressman Thomas proposals are constmctive, they do not
guarantee any increase in access, nor is there a way to pay for any of the reforms he suggests.
11
�CONGRESSMAN BILL GOODUNG (R-PA)
congressman Bill Goodling is the ranking Republican member on the Education and Labor
Committee. Like Dingell, Goodling is one of the few Members to succeed their father in
Congress. He took over for his father in 1974, after winnmg close victories in the primary
and general elections. The middle of his district is York, one of the first stops on the
Clinton/Gore bus tour after the convention. The district is mostly mral and fakly
conservative. Goodling is a former teacher and has dedicated his life on the committee to
education issues. He has had an excellent working relationship with past Chairs of the
committee - Carl Perkins and Gus Hawkins. However, Goodling got off to a bad start in
1990, when Bill Ford took over the committee. Goodling accused Ford of being too partisan
in opposing President Bush's education programs. As far as health is concerned, Goodling is
relatively quiet, and he is not expected to be with the administration. He is not an idealogue
and his demeanor suggests that the Administration should reach out to him.
Representative Goodling sponsored a long-term care bill stressing case management,
expansion of long-term care services under Medicare, Medicaid, Older Americans Act and
VISTA, and increased use of volunteers. Long-term carefinancingwas based on sliding
scale premiums; both for new services offered, and those now offered for free.
12
�
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Health Care Task Force Records
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White House Health Care Task Force
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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Congressional Briefing Memos – First Lady, 1993 [4]
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 2
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Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. memo
Chris J. & Lynn M. to Hillary Rodham Clinton & Jeff EUer; re:
Health Care University (7 pages)
06/28/1993
P5
002. list
re: Attendees to the White House - Meeting with Hillary Rodham
Clinton on Health Care Reform (partial) (3 pages)
06/19/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefing Memos - First Lady 1993 [3]
2006-0885-F
ip2642
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MARK
MARKING
PerXO. 12958 as amended, Seti 3.3 (c)
Initials
initiais:\.i'^- ^
uate:_»_:
PRIVILEDQED AND GQWfitlliWlAL MEMORANDUM
TO:
FR:
REi
cc:
Hillary Rodham Clinton
Chris Jennings, Sean Burton
Meeting with Senator Dale Bumpers
Melanne, Steve, Lorraine, Distribution
Tomorrow you are meeting with Senator Dale Bumpers, Chair of the
Senate Small Business Committee. As you know, Senator Bumpers requested
a bipartisan meeting with you and the entire committee. You felt that with the
current tension over the budget reconciliation, it might be better to conduct a
solo meeting with the Senator at this time. If you approve, we will schedule a
meeting with the entire committee at a later date and a more appropriate time.
BACKGROUND:
As Chairman of the Senate Small Business Committee, Bumpers has a
particular sensitivity to small business needs. He would be £in important
surrogate speaker in his position as Committee Chairman, especially if he not
only supports the bill but is comfortable enough to speak on its behalf. His
link to small business is strong and hence he would be a valuable ally.
As you know he is also known for his great concern about children's
issues. He therefore can be expected to support phasing-in coverage for
children first, if such a phase-in is necessary.
Senator Bumpers has adopted a wait-and-see attitude regarding health
care. Going back to the last Congress, he resisted attempts to be pushed into
any health care camp. It is clear, however, that a small business mandate
could be hard to swallow.
As you requested, attached to this memo is the Health and Human
Services report on small business and health reform. Although not complete,
this may contain some Information that you might find helpful in your
meetings with those interested in small business. This is the same
Information that is included in the LaFalce memo.
�Finally, in an unrelated action. Senator Bumpers recently offered an
amendment to significantly modify the Administration's immunization
proposal. The amendment would allow states to penalize AFDC recipients who
fail to have their children immunized. It also mandates states to create a
vaccine bulk purchasing program for states to purchase vaccines for medicaid
recipients. It also creates a bonus program for states that prove they
increased their immunization rates for children under two to at least 50
percent. This amendment passed with a significant margin of the vote (69 to
29 in thefirstvote; 59-39 in the second vote).
Today, the Senator met with Health and Human Services Secretary
Donna Shalala. He offered to draw up a working paper on immunizations for
her to review. He might raise this issue during the course of your discussions
to outline the reasons behind his amendment. It would be best to tell him that
you are looking forward to reviewing his paper, without making any
committment.
�Health Reform and Small Business
A Look at Problems in To(day's System and
Solutions Un(der the Presi(dent's Health Reform
�Small Business and Health Care Refonn: Overview
It takes courage and ingenuity to start and succeed as a small business. It means
taking a risk with your future and betting that you succeed. As many as 1 out of 12 small
businesses fail within thefirstyear. It is not right that many small business owners also face
the risk that their famihes and employees won't have health care when they need it. It is
notrightthat those who provide coverageriskthat within a year that coverage may be taken
away or priced out of reach.
Small businesses fuel job creation and strengthen our economy. Responsible for 90%
of job growth in 1990, small businesses has become the nation's engine of economic growth.
Yet this growth is endangered by a health care system which threatens every American
business, especially small businesses. Small business owners can facefinancialdevastation
if a family member or just one employee falls ill. And employers who try to provide health
care to their employees fmd a health care system stacked against small businesses.
Nonetheless, a majority of American small businesses manage to provide coverage.
Today 62% of American businesses with less than 100 employees provide health care
coverage to their employees. And 51% of those with fewer than 25 employees provide
health care. But providing these benefits isn't easy.
"
The Clinton Administration believes that most small business want to cover their
employees -- and most do. Our health care plan will work for small business, taking away
the hassle and ensuring securit)' of affordable, predictable health care coverage. And for
those businesses who don't provide health insurance coverage, our reform will protect them
while they make the transition. The plan providesfinancialassistance and a phase-in period
so they may provide health security to their employees and families.
In today's Mom and Pop stores, the Mom or the Pop serves as the de facto benefits
depanment. Theyfillout the paperwork. They make the phone calls. They negotiate rates
and enroll their employees. They dutifully pay their premiums every month. But all too
often, within a year, their insurer will raise rates and price them out of the market - many
times for no reason. Or the insurer will refuses lo renew coverage. Then the small business
owner is back to the drawing board - spending more time and more money tofindanother
insurer -- and the cycle starts again.
The following document examines the major problems faced by small businesses in
toda/s health market and shows how health reform and the formation of health alliances
will address most, if not all, of the major problems facing small businesses.
�The Majority of Small Businesses Offer
Health Insurance to Their Employees
Do Not Offer (37.6%)
Offer (62.4%)
For Firms with Less tiian 100 Employees
Source: Dept. of Labor, Based on SBA Calculation of May 1988 CPS Survey Data
�The Small Business Obstacle Course
Time and Money
Price Discrimination
Insurance Abuses
Redlining
Underwriting
High Administrative Costs
A Volatile Insurance Market
Price Gouging
Difficulty Securing Renewal
�THE SMALL BUSINESS OBSTACLE COURSE
Problem:
SmaU business owners must go through an obstacle course of insurance abuses
and higlier costs to
provide heaUh care coverage for their employees.
Small business owners who spend the time and money to cover employees frequently
must deal v^th an insurance market which changes its rules at every stage of the
game, a volatile market, unpredictable cost increases, higher administrative costs, and
premiums rising at a faster rate than health care costs for larger employers.
Lacking a benefits department like larger firms most small business owners must
perform all the functions of such a department by themselves. Negotiating health
coverage in toda/s health care system is a process often fraught with frustration and
obstacles.
Many small business ouTiers, after setting aside the time to negotiate coverage for
their employers, encounter obstacles like "occupational redlining" a practice where
insurers \^ill simply refuse to cover entire industries perceived to be high nsk; or
medical undervvriting, basing premiums on perceived risk and medical history; or
experience rating, where insurers jack up costs if just one employee falls ill or gets
injured. Manv insurers engage in "price baiting and gouging" offering "discount" rates
for the first ye'ar of coverage only to charge much higher prices in the next year when
pre-existing condition exclusions'expire. And many small firms with sick workers find
that an insurance company uill refuse to renew their polic>' in the second year.
Not surprisinglv the hassle and discrimination in today's system make many small
owners v^orn'^aboui being able to continue to provide this coverage. The reform
plan addresses nearly all of the problems which cause the small business owner so
much hassle and time in obtaining insurance.
The Plan:
Health refonn outlaws insurance practices like undenvriting and redlining. The
health alliaJKc helps small businesses cut through the hassle.
We v^ill take the burden off the small business with health alliances which will deal
u-ith the insurance companies and bargain for competitive prices. The alliance will
take over the paperu'ork and the negotiations; provide information on plans and
increase ease of enrollment. Higher administrative costs will be reduced and the
hassle of the current system is eliminated.
The Clinton reform plan outlaws insurance abuses such as redlining, underwriting
and ex-perience ratings. Costs of premiums are controlled and the insurance market
is stabilized. Under our reform, everyone living in the same area pays a similar price
for a similar plan. And they have the security knowing those costs
be predictable
and increase at a lower rate.
�Small Business Owners
Face an Obstacle Course in Obtaining Health Insurance
sjA^
^IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIW
Uncertainty
Time & Money
n
Year 1
Health
coverage
for one
more year
High Administrative Costs
Cost Negotiations
Frustration
Redlining
"v.t-;.^
^^ uB-iia
nderw
riting
isni iiJ^
/Cost A Cost B \
$
(
\
^
\ Cost D Cost C /
V^
$
Price Discrimination
iiiiiiiiiiiii^
/
Insurance Abuses
Year 2
- or
Priced out
of market
Renewal
refused
�The New System
High Administrative Costs
;
Redlining
Cost Negotiation!^,,.,^,j/M^^^^^^^ Underwriting
Volatile Market
i
1 Price Discrimination
�Insurance Industry Abuses
• Medical Underwriting
• Experience Rating
• Price Baiting and Price Gouging
• Refusal to Renew Policy
• Occupational Redlining
�OCCUPATIONAL REDLINING
TYFES OF INDUSTRIES OFTEN EXCLUDED FROM HEALTH
INSURANCE PLANS
Amusement Parks
Asbestos-Related Industries
Auto Dealers
Aviation
Barbers and Beauty Shops
Bars and Taverns
Car Washes
Commercial Fishing
Construction
Convenience Stores
Domestic Help
Entertainment/Athletic Groups
Exterminators
Federally Funded Organizations
Florists
Foundries
Grocery Stores
Health Clubs and Spas
Hospitals and Nursing Homes
Hotels and Motels
Insurance Agencies
Interior Decorators
Janitorial Services
Junk and Scrap Metal
Law Firms
Limousine Services
Liquor Stores
Logging and Lumber Mills
Meat/Fish Packers
Mining Operations
Moving Operations
Oil Field Operations
Parking Lots
Physicians Practices
Restaurants
Roofmg Companies
Security Guard Firms
State Funded Organizations
Taxicabs
Trucking Firms (Long-Haul)
Sources:
List of "ineligible industries" and industries reqinring 'special consideration'
from selected insurance plans analyzed by the Alpha Center.
American Hospital Association. Promoting Health Insurance in the Workplace
and Local Initiatives to Increase Private Coverage (Chicago: 1988). as cited in:
United States General AcrnuntinQ Office. Health Insurance: Cost Increases Uad
to Coverage Limitaition'; and Cost-Shifting. (GAO/HRD 90-68)
�Higher Administrative Costs
• Higher Overhead
• No Benefits Department
• Faster Increases in Costs
�Small Businesses Face
Higher Administrative Costs
A d m i n i s t r a t i v e C o s t s as a
P e r c e n t a g e of C l a i m s
By F i r m S i z e
50%
40%
30%
20%
10%
0%
20-49
1-4
Source:
100-499
Firm Size
More than 10,000
Risk/Profit
General Admin.
Claims Admin.
Marketing Costs
Hay/Hugglns.
Inc.
�Employers Would Save $1,015 Per Employee
Per Year If Costs Were Controlled-Small Businesses Save Most
Employees in F i r m
1-9
10-24
25-99
100-499
500*
$0
$1000
$2000
$3000
$4000
$5000
Total C o s t s Per Employee 1992
Excess C o s t s
Source:
Lewln-ICF
�A Volatile Market
Cost Variations
Unpredictable Cost Increases
Durational Rating
Churning
�Small Groups (2-25) Face Large
Variations in Health Insurance Premiums
450%Some groups pay more than 4 timos
what other groups pay
for the same benefits.
400%-
350%
//////•///,
E 300%E
\—
CL
$
O
250%-
CD
>
^
200%
CC
150%-
100%-i
pi^^^
.
pi^^g
•
pjg^c
pianD
Plan E
Plan F
SMBUS.WQI
Source: Blue Cross/Blue Shield Association. Survey of Six Sample BC/BS Plans. January 1992.
�SUMMARY
TODAY
REFORM
High Administrative Costs: Higher
administrative costs account for as much
as 40% of the pohcy costs compared to
about 5% for large companies. [CBO,
5/92]
Cuts Administrative Costs: The health
alliance assumes the administrative
functions and costs which kill small
business owners.
The Obstacle Course: Small business
owners who cover their employees must
spend a lot of time and effort dealing
uith an insurance market which changes
its rules at each stage of the game.
Eliminates Hassle: Tbe health alliance
negotiates rates, provides information on
plans, increases ease of enrollment and
absorbs the manpower drain.
Dramatically Increasing Costs: Premiums
for small employers rise at a faster rate
than for other employers ~ as much as
509c in any given year. [NAM]
Aggressively Controls Costs: Health
reform will aggressively control cost
increases which hit small businesses
disproportionately hard.
DlfTiculty Obtaining Renewal: After a
first year of reasonable rates, small
businesses often face higher costs and
difficulty obtaining renewal.
Guarantees Renewal: Guarantees
renewal and stabilizes premiums.
Small Risk Pool: Fewer employees mean
a smaller pool to share the risk.
Insurance companies frequently charge
more for these policies and one illness
can cause plan cost to increase
dramatically.
Spreads Risk Evenly: Consolidates small
businesses in large purchasing pools to
give them the same bargaining power as
large companies.
Insurance Industry Abuses: Insurance
companies redline large sectors of the
small business market. Undenvriting and
experience rating leads to discriminatory
prices for small business policies.
Outlaws Unfair Insurance Practices:
Prohibits redlining, experience rating and
underwriting. Requires that plans charge
all firms in a given area a similar price
for the same health plan.
�Insurance Problems Facing the Small Group Employee Market
Large Volatile Variation in Premiums
o Underwriting
o High Risk
Workers in Small Firms Finance a Higher Proportion of Total Premiums
Insurance is More Expensive Relative to Large Firms
o High Administrative Costs
o Premiums Include Costs of Uninsured
o Provider Payments Substantially Above Costs
Growth in Insurance Premiums is Higher in the Small Group Market
o Less Likely to Have Established Cost Containment Programs
�A v e r a g e Insured worker's hoallh spending without health reform
1994
Average compenaaUon per worker:
lAverage Insured worker's health bill
Health insurance
Employer's share oi premium
Individual's share ol premium
Medicare payroll lax
Workera' comp/dtaabMlly/lndualrlBl InplanI
Out-of-pocket
Other spendbiB • * health f K l l l t l e a
Federal laKee, feea, A other payments
Federal employees" health promkjms
Federal contributions to Medteare HI
Medicare (general reveruje)
Medicaid
Other federal health programs
Slate ft local taM«s, t — ; A other p s y m s n l s
Stale/local employees' health premHjms
Stale/k)cal contributions lo Medicaro HI
Medicaid
Hospital subsidies
Other programs
Mid l»t|>»ilin*«i n Commtnt. Vmttn or Eroaomk AialfitJ
Health Bill a s < of
Compensntlon
$50,334
$36,299
$7,423
$4,132
S3.163
$969
$926
$246
$7B2
$113
$654
$53
$11
$169
$246
$174
$569
$149
$24
$166
$81
$130
2000
Health gill a s V. of
CompenaaUon
20.45%
11.38%
8.71%
2 67%
2.55%
O.BB%
2.15%
0.31%
1.90%
0.15%
0.03%
0.47%
0.68%
0.48%
1.57%
0.41%
0.06%
0.51%
022%
036%
$12,386
$6,895
$5,278
$1,617
$1,546
$411
$1,305
$168
$1,092
$88
$19
$283
$411
$290
$950
$248
$39
$310
$135
$218
24.61%
13.70%
10 497o
3 21%
3.07%
0.82%
2.59%
0.37%
2.17%
0.18%
0.04%
056%
0.82%
058%
1.89%
0.49%
0.08%
062%
0.27%
0.43%
]
�Current Spend'-.g
?n:'^it Health Insurance rreoium^ ny ataic.
Ai a Percent cfTacGblc Earnings
ALABAMA
ARI/.ONA
ARKANSAS
CALIFORNIA
Taatable EaniinBs
38ii9S,6l53!>S
7,47L115,760
22,072.511,494
376^575,470
CULORAJX)
c:ONNECnCUT
DELAWARE
DC
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOi;iSLANA
M-ALNt;
MARYLAND
MASSACHUSETTS
MlCHICiAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW' IIAMPSHIRE
N-EW JERSEY'
I NEW MEXICO
I NEW' YORK
NORTH CAROUN.A
NORTH DAKOTA
OHIO
OKLAHOMA
0R£GON
PENNSYLVAfaA
RHODE ISIAND
SOUTH CAROUNA
SOLTH DAKOTA
TENNESSEE
TEXAS
iriAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
47,909,041,475
8^849 PTB^JT
7^52^77319
69,107.458^
14^6,797,447
143,9M?45327
61^43^3%
30^16,622.605
2S,715.0K>3S5
34,7ft4,608.184
39,53,575,525
l23S9,9«773g3
68211,468^97
77^1£G0£17
109,409,081232
51,705,415220
20,^57356
60244,888 374
7,fC0/490,l64
17,478.B45303
15,537209212
16X)13,65066I
110JD15^51S«7
14^0,233/570
217,920464,116
72,15432,101
6,052341,293
124378,294^
32j097,793,109
32,77.^jS]8,ll2
132224^34,4<M
12fl56,4873«2
37.791JOO 551
6,456^^
47^7,609 S48
186,606311/»5
16^07 J70,729
6,477^58^00
83,l93.«3,n0
63363,931,291
15348,775513
iTOTAL
Isourcg-. Segal Sg:urjvWate_Bajc_
5«J6»280587
5,005 270.744
Premiums
3,751fiSn575
542,9«i282
3,674 537 . W
2J69,779361
31377334,190
4,135548261
4355305242
T735C92n
445,947314
10,?36,916^
6,723213,419
1346P35317
I,028354,152
t3^i40,116,472
6,713536,189
3,056P74335
2.789.136209
3^394364
3,484,793,997
1321,989294
S310P65,6B8
6503315,432
I I ,912.093,402
5314,122517
2.125383,724
6^22536523
890^1,169
1,796 356 j659
1,714563/40
1,6673203^3
9,K24j93a65
1,4M ,499381
1D235,098362
6571365,130
618523,636
13350,058430
2,890309365
3,490,744 J»0
15.138,836339
1363^,740
3,703370,746
705,755,456
4372iJ56p97
l.S,700,711323
13D9372.751
645,079.501
6,488 3GP15
6,009,^/^83
1.602,410,413
6,469,131321
49332738S
27i3TO.153,?70
PcrccDt
8.997e
10.74%
8.46%
9.63%
8.75%
5.90%
7J9%
9.73%
8.9!)%
10.47%
9.47%
11JCI0%
10.18%
9.71%
9J9%
8.82%
1026%
7.64%
834%
1039%
1028%
1034%
1033%
1138%
1028%
nx>4%
10>»1%
8.93%
9.80%
8.Q%
9.11%
1022%
10J6S%
9.00%
10J65%
1145%
10.48%
9.80%
1053%
1023%
8.41%
1050%
9.96%
7.80%
9.41%
10.44%
11J02%
9J6%
9136*
�1 Total Premium Payments asPercent of Payroll
Without Health Reform
iFirm Size
n
1994
1995
1996
1997
1098
1999
2000
All
11.54%
12 06%
12.53%
12.96%
13.42%
13.88%
14.36%
<25
25-99
100-499
500-999
1000+
ii.9e%
11.24%
11.84%
11.49%
11.41%
1Z50%
11.75%
12.38%
12.01%
11.93%
1298%
1220%
12 85%
12.47%
12.39%
13.43%
1262%
13.29%
12 90%
12.81%
13.90%
13.07%
13.77%
13.36%
13.27%
14.39%
13.52%
14.24%
13.82%
13.72%
14.89%
13.99%
14.74%
14.30%
14.20%
Source: HHS analysis usinq Urban Institute analyses of March 1992 Current Populat Ion Survey.
�Total premium payments as a percent of payroll vary by firm size
and are highest for firms with less than 25 employees.
Total premium payments as a percent of payroll ( 1 9 9 4 $)
14% r
All
<25
25-99
100-499
500-999
1,000-H
Firm size
Source: Urban Institute analyses of the March 1992 Current Population Survey.
�Total p r e m i u m p a y m e n t s a s a p e r c e n t of payroll v a r y by i n d u s t r y
and are highest for retail.
Total premium payments as a percent of payroll
14%
12.84%
12.28%
12.22%
12%
n.64%
11.46%
11.47%
11.2%
10.35%
11.17%
10.13%
10%
8%
6%
4%
2%
0%
Al
AflitouMufa
Manul.
T«ch/clafio»l WhoUeulB
Retail
Fin«noi«l
Saivioea StataAoc g o v ' i F a d . « o v ' l
Industry
Source: Urban Institute analyses of March 1992 Current Population Survey.
�Employer p r e m i u m p a y m e n t s as a p e r c e n t of payroll vary by i n d u s t r y
^
and are highest for manufacturing.
Employer premiuim payments as a percent of payroll (1994 $)
14%
10.16%
9.77%
6.85%
8.35%
8.12%
7.46%
7.S7%
0%^
8.08%
.il
Financial
S.rvleat
S.al./»oo , o v ' l F a d . BOvM
chfolatical WlialaaalB
Industry
Source: Urban Institute analyses of March 1992 Current Population Survey.
�Health Insurance Premiums Relative to Payrolls
The Distribution Under the Current System
Number of currently covered workers in premium/payron ratio group (Thousands)
30
26.676
25
18.12
20
mm
15
11.996
10
6.451
. . ..
3.29
'. -•••;;•! i\
'vi
1.26
0
0-2%
0.054
0.272
2-4%
4^6%
Alii
Ad.
6^%
a^10%
111
10-12%
12-14%
14-16%
>16%
Total premiums as a percent of total payroll
Source
: Urban Institute's TRIM2 model, based on the March 1991 Current Population Survey.
�Health Insurance Premiums Relative to Payrolls:
The Distribution Under the Current System
Number of currently covered workers In premium/payroll ratio group (Thousands)
30
25
21.915
22.977
CL,
sa
It)
OL,
20
1/1
15.722
15
tn
10
oo
•o
o
3.549
2.289
!r|'f!y'^
•o
0
0.102
0.402
0-2%
24.%
0.45
0.722
|
4-6%
6-8%
a^io%
10-12% 12-14% 14-16%
>16%
CO
Employer premiums as a percent of total payroll
Source: Urban Institute's TRIM2 m o d e l based on the March 1991 Current Population Survey.
�Health Insurance Premiums Relative to Payrolls:
The Distribution Under the Current System
Number of currently covered workers in premium/payrol) ratio group (Thousands)
30
26.676
25
20
18.12
Ifi
mm
15
11.996
10
6.451
3.29
mm'
1.26
0
0-2%
0.054
0.272
2-4%
46%
6-8%
8-10%
10-12%
12-14%
14-16%
>16%
Total premiums as a percent of total payroll
Source: Urban Institute's TRIM2 model, based on the March 1991 Current Population Survey.
�C<4
Workers: How many work for small firms?
Distribution of workers by firm size
25-99
14%
100-499
16%
500-999
6%
1000-141%
Source: The Urban Institute (1993), based on the March 1992 CPS and TRIM2.
Numbers are In thousands.
^
�Percentage of Firms Offering Health Insurance
By Firm Size
Percent
100%
91.9%
94-5%—]
;
83.1 %
' '-• - '' 1 -
80*%
-,
51.2%
;^
;v
j •'
'.; • ; •
40%
20%
,i.:
•.;. •• - . ' j .
H^--'!; .'VAll firms
1-24
25 99
100 499
Size of Firm
Source: Dept. of Labor, based on Small Business Admir, calculalions of May 1988 CPS Survey Data
500 +
�o
SI
People who work for small businesses are
more likely to be without health irisurance.
Percent of nonelderly population w i t h o u t health insurance
30%
27%
23%
25%
20%
21%
1
• --
15%
17%
li*.Br.iif.f:j:u
10%
10%
- • -
Ipiii
tn
o
o
•tli-ir;;--
5% , . . .
r4
Ifflili
0%
<25
25-99
100 or more
Nonworking
Total
Ol
o
o
o
to
o
Size of Family Head's Employer
Source: Employee Benefits Research Institute Analysis of the March 1992 CPS.
�Employer premium payments as a percent of payroll
are lowest for small firms.
Employer premium payments as a percent of payroll ( 1 9 9 4 $)
14%
12%
10%
8.99%
B.8%
d.2S%
9.21%
7.93%
8%
6%
4%
2%
0%
All
<25
25-99
100-499
500-999
1,0004-
Firm size
Source: Urban Institute analyses of the March 1992 Current Population Survey.
�Employer premium payments per worker vary by firm siz
and are the largest for large firms.
Employer Premium Payments Per Worker (Thousands)
$5
$4
$3,215
$2.98
$2,768
S2.412
$2,213
i^:;i;;-:';i-f
;! '",...1
f
1 i"*
--
T '
'
1 • %
'-
'""''.ii':
<25
r.
25-99
100-499
Firm size
500-999
I
1,000 +
C3k
�Employer premium payments per worker vary by firm size
and are the largest for large firms.
Employer Premium Payments Per Worker IThousands)
All
<25
25-99
100-499
Firm size
500-999
1,000 +
�Total premium payments per worker vary with firm size
and are highest for large firms.
Total premium payments per worker (1994 $, thousands)
$0
All
<25
25-99
100-499
500-999
1,000 +
Firm Size
Source: Urban Institute analyses of March 1992 Current Population Survey.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SUBJECT/TITLE
DATE
Chris J. & Lynn M. to Hillary Rodham Clinton & Jeff Eller; re:
Health Care University (7 pages)
06/28/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefing Memos - First Lady 1993 [3]
2006-0885-F
)P2642
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information [(bXl) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA|
b(3) Release would violate a Federal statute |(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information [(bX4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy j(bX6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes j(bX7) of the FOIAj
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b(9) Release would disclose geological or geophysical information
concerning wells j(bX9) of the FOIAj
National Security Classified Information |(aXl) of the PRA|
Relating to the appointment to Federal office |(aX2) of the PRA|
Release would violate a Federal statute [(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |aXS) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(aX6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PBM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
KR. Document will be reviewed upon request.
�WORKPLAN TIMELINE
Activity
6/27 ZZ5 7Z12 7L19 ZZ26
Target Issues
Target Personnel
Finalize Staffing
Prepare Briefing
Materials
Brief the Briefers
; (on how best to communicate/
legislative prep)
(communication
and leg. prep
continues)
Hone the Message
HRC CAUCUS PRESENTATION
CONGRESSIONAL BRIEFINGS
;
; Dry run
Ist briefing
before recess
RETURN TO briefings
and continue them
even after
introduction on a
bipartisan basis.
�DETERMINED TO BE AN AD.MINISTRATIVE
MARKINGPer£;C). 12958 as amended, See. 3.3 (c)
PRIVILEGED AND GONFfDElTRm MEMORANDUM
TO
FR
RE
cc:
Hillary Rodham Clinton
Chirs Jennings, Steve Edelstein
Meeting with Senator Jeffords
Melanne. Steve. Distribution
June 28. 1993
Tomorrow you are scheduled to meet with Senator Jeffords. This
meeting was requested by the Senator when he accompaoiied you on the flight
to Vermont. In attendance will be Mark Powden. his Legislative Director £ind
Vlckl Caldlera, his Legislative Assistant for health issues.
BACKGROUND:
As you know, Senator Jeffords is a maverick Republican with a fair
amount of interest in health-related matters. Because of his progressive views
and because we are still working hard to attract Repubicans to the President's
health reform proposal, he is one of our top Republican targets.
Earlier this year. Senator Jeffords Introduced his own health care reform
bill entitled "Medicore." For financing, this legislation relies on a modified
single-payer oriented payment approach that relies on:
(1)
70 percent federal financing (from a six percent payroll — 4
percent from the employer and 2 percent from the employee that
goes directly to the Treasury);
(2)
30 percent state financing (it could be virtually anything, including
raising copayments and deductibles); and
(3)
The elimination of all health care deductions for the employer and
the elimination of any health care deductions for any employee
cost over 2 percent of payroll.
In addition, his legislation assumes: a fairly comprehensive benefit package,
with significant mental health and dental coverage for kids; a heavy focus on
preventive and primary care; subsidies for low Income beneficiaries; and a
state-based flexibility grounding. His cost containment enforcement
mechanism is the denial of any additional Federal dollars (above the 70
percent contribution) unless there is a health care disaster.
�Senator Jeffords has been making much lately of his view that his plan
is the plan most like the proposal he perceives the administration to be
formulating. He has also been taking credit for the fact that the
Administration's plan includes state flexiblility. Although the accuracy of his
characterizations could be questioned, his continued satisfaction with our plan
(and eventually, hopefully, our Joint plan) is to be encouraged.
Tomorrow's meeting will likely revolve around a general discussion of his
bill and its similarities to the Administration plan. In addition, he is likely to
stress two Issues of particular importance to htm: 1) broad-based financing
and 2) concrete budget goals. He will be seeking to reinforce his strong
support for these prlncples as elements fo the final plan. While his bill's
approaches differ somewhat from our current plan. Jeffords feels that the two
approaches are consistent. Nonetheless, he will want reassurances that his
understanding of where we are heading on financing and a global budget is
correct and in general accordance with his views.
This should be a relatively easy, but important meeting. We are
confident that it will go well.
�Midi.
^ORE
tHE HBOICORE HMIXOHAL BEAI/EH ACT
U.S.
SanMtox J i a Jeffords
The KedlCORB National Health Act addresses several grave
problems with the current Anierlcan health care system. Rapidly
r i s i n g health care costs and expenditures burden a l l Americans
and ere one of the leading contributors to the mounting
federal budget daficlt^. Ttians r i s i n g COB^B also
exacerbate the unfairness of a health care system vhere many
Americans lack adequate, i f any, health care insurance. The
MediCORE program reforms the American health care system by
gxtaranteeing universal access to a set Ol basic CORE Services,
stemming escalating health care costs to individuals, employers
and governments, and preserving q u a l i t y and f l e x i b i l i t y i n health
care delivery. The Act i s also designed to ensure equitabln
financing f o r the provision of CORE services.
STU<E5 DSSxeH AMD
AiaUHIBTSn PUVHB TO
FItOVXDE A SET
OT CORE
BENRFXTS TO ALL STATE RKSIOERTS
The basic structure of the KediCORS program divides
reBpuiiBibilities for the design, adminlBtratlon and funding of
health care delivery between federal and state governments. The
Act charges states with the primary r e s p o n s i b i l i t y f o r desianing
and running health care programs f o r a l l U.S. citizens and lagol
residents within t h e i r t e r r i t o r y . CORE services provided under
state plans must cover medically necessary services, including
prescription drugs, mental health treatment, and substance abuse
and r e h o b i l i t a t i v e servicvsa; preventative care and long-term care
must also be covered. Those presently receiving benefits under
Medicare or Medicaid w i l l receive expanded services under the
CORE on an equal basis with other citizens.
FEDERAL MEDICORE BOARD OVERSEES STATE PROGRAMS AHD
ENSURES THAT
STATRS KKET MXNXKUH FBDSnjU. SZANDARDS
A federal HediCORE Board i s established under the Act to
oversee the design and administration of state health care p1nn».
Though states w i l l be given wide latitude to meet the special
circumstances of t h e i r population i n the design of delivery
systems, the Board w i l l ensure that states meet minimum federal
standards for universal «ceaee, p o r t a b i l i t y , adminiaeration,
B f f o r d a b i l i t y and guaiity. Tor instance, state benefit packages
must be substantially equivalent to a model set of CORE services
to be outlined by the Board. Furthermore, i n order t o ensure
q u a l i t y and f l e x i b i l i t y i n health care services, states are
encouraged to involve competition between two or more health care
providers, and at least one delivery plan must permit s i g n i f i c a n t
freedom of choice by consumers among hAa]th care providers. I f a
State chooses to contract with the Board f o r the administration
of i t s health care program, the Board w i l l use networks of
managed competition i n a l l areas of the state with s u f f i c i e n t
health earo providora. Networks of managed competition w i l l also
be used i f a state plan f a i l s to meet minimum federal standards
and i a placed i n receivership by the Board.
�FEDERAL PRZMITM OH PAlROLt A«D DNEARMSD MCQMB FRCnrtDBS ^
APPROXIMATELT 70% OF FOMDrMG FOR STAIB FLARS, WITH STATES
CORTRIBUTIBG TEE REMAIIIDER
Most of the funding for state health care plana w i l l derive
from a MediCORE T r u s t Fund t o be edminlBterod by t h e
*
federal payroll premium—4 percent from the employer and 2
percent from the employee—will provide the principle source of
monies for the Trust. Individuals who have income in addition to
their earnings will be assessed up to a 6 percent health care
premium on this additional income. These federal premiums w i l l
supply approximately 70% of the cost of running state health care
plana, states w i l l receivo from th« Trust at, least those monies
which have been generated from the MediCORE premiums upon their
residents. They will also receive an amount equal to their
portion of Medicare spending under Title XVIII of the Social
security Act for the year in which MediCORE 1B adopted. The Board
w i l l distribute additional funds from the Trust to states that
need these monies in order to provide CORE services to their
roBldents. The remaining funds for running state health care
programs w i l l be supplied by the states. States may use the 15
percent cost sharing permitted under MediCORE to offset their
financial responBibility. If states use cost sharing, their
c o i i t r i b u t i o n a t o s t a t e h e a l t h care piano w i l l be roughly equal t o
the amount they currently spend for health care.
SFEHDIMG OITOBR THE MEDICORE ACT WILL BE LIMITBD TO CORREHT LEVELS
OF HATIOKAL HEALTH CARE EZPBMDITDRES
The
financing provisionB
of t h e MediCORE p l a n a r e d e s i g n e d
to arrest the growth of health care coats by limiting the costs
of running state programs to present levels of national
expenditures on health care, adjusted for growth In Gross
Domestic Product (GDP). The MediCORt: healtn plan essentially
rediatributee monies currently being spent on health care by
govarnment. Insurance companies and individuals. Resources
available to the states through the MediCORE Trust Fund w i l l only
be increased i f Congress makes an express, public decision to
increase health care expenditures. Nevertheless, in order to
maintain flejciblllty in the system and to preserve incentives for
t e c h n o l o g i c a l advancea i n medical c a r e , i n d l v l d u a l o a r e f r o o t o
use private insurance to purchase services beyond CORE benefits,
and states themeelves may supplement CORE services at their own
expense.
ADDITIONAL FEATURES FOR COMTROLLIMG HEALTH CARE COSTS
In addition to keeping national health care expenditures at
their current levels, the MediCORE program provides for
additional mechanisms to control health care costs and spending.
States are encouraged to aevelop fee schedules for haolth care
providers, and the Board i s directed to develop model fee
schedules for the benefit of states. Limited cost sharing by
h e a l t h c a r e r e c i p i e n t s i n al.an permitted
under t h e MediCORE A c t .
Furthermore, managed competition in state programs will serve to
keep costs down. In addition, the MediCORE Board has an important
reBponsibility to study and recommend ways to reform medical
malpractice laws.
The various provisions of the MediCORE Act ensure a system
of health care delivery which i s both fair and economically
sound. MediCORE guarantees universal access to CORE health care
benefits and finances these benefits eguitablity. At the same
time, i t effectively controls health care coats and preserves
quality and f l e x i b i l i t y within the American health care systein.
�i i \ will
1
V I T : W 1.II
I u
J 1 J U
u u i J—V w y
••'X
June Ur 1993
87944
liaee that tUvoemOatnm aawtu^
•a I laarBsd frm the MBIWdW*
• toart
TBa* Is wbafc 1 baart
mailt, wbers there
wmnw.*
tar ms reelsoUon oontast last year.
OUoaas said. "We're wlUlnE to do our ^
a 5 . y s « perUA tha t M ttcrsags
ftOr sbsrs. Jn«t be kODSSt With «*• Be were mmsdlataly topliwueffsil^ •*»
BiaatbedsdtoafdtctmwpM'boDflst aboot onr Naaon's snblsms.
tha.«paDdUv c « s aersr » « s d t i » a * r B
•
ABprovtag
oor iiOtucxoem*
That is why tbe psople ot Ohio saol ms tarlallss. Tbs IfiW tax paalHga. toagn
tosto todaatry to reduce oor dspaa*hack to the Seaate sad that is what I ta eafoee strict b«dgtt«T
^ ^ ^ o r t a r M truly addraaa ths Firtatal
IBUnd to do.
tazrstad spendlBr leJanoana. i
i t n ^ t , ail Awerleaaa. senior eitlVBS
Aad tbs boaest truth is that oar nar only hops that ths hJU we
iBOludad. Should
•Jf'SS
Oonal debt U a cancer on our eoenom;. leatly oonslderlng wUl p ) * ^
Horiaoe. Howaw, sUmlnatter Boflai
IB eCrsct. iBtsnist payments on tws able b«d««ta«7 eapa aad epei
Seeortty bsnsflta dtoproportloaalely
monstrous debt consUtote a tax cm ow daetloas.
:if'v_2-j^'']\ iffseta todlsiduals on a lUed tscone.
acABomy that la fobblloy up AnMnaa*i
Furthsnnore. I wool* ha-vw lopportad While Social Security ahould not be «sjrospsrity. And It haa a stranglehoU
OB th» Amarlean dream-tbs dre«m 01 ths admlBlstnaioB'B oclgtaal gcml « clndsd ftom the debate on delioli retaetian, we must aaur* that ear tfocportunlty that 1 want to pass on to about S3 IB 'PWdu*
n y gi»i»<lchildr«n. That ia wbAt wa IB tax Incmass. U M M * * ^ " ^ ^ * iBfta toTsdce. the dsneft BOt tajd t a .
laoe. And lia time we confrontad It that thla goal allposd. sed ladaad i AKprTpactloaxta sacrtflos by «ha
JTer all ^heae reMoaa. I atost vota Be
bead OB. Not wtta cbarte mai ««*^»* ««nild have beea satlsfisd with »
CD thto maaaurs. We have got to start
Hot with cartoons and one-llBere- But weal that had aaSdoal
Increaaas aad spending eata, I t •Who* making the hard choloee iBStaad,
with real acUon.
ms as fUr to ask
-.Moseovsr. as maay of my coUaaguss
Mr. Preaident. It U the unfortunaia.
sad truth that Axnertcaas fcave grown io i » j »or« la taaas if the Oavemmsot U v e scaled throughout ttas M t a ^ j o
• J ^ ' ;
skeptical about our actions here to the will leduca Its • P « * ^ * » , S * . S S ! •IgBifiauitly lower the
CongreBB. They have grown weary of amount, to sffeot stsstteg the pehUS bodget reform must go haad to hand
r>--i>f;>rv: nj'r^ wltA health eare raforiB. We CBB 10
the blekerinff- Weary of tha eheaanl- halfway, v •• ,
Unfortunately, tUa mm^Mut* W 1 * W lobgsr afford to doortve oorselvsa tnto
n n a They expect honesty. And that e
what they deeerv?- No more bells and •vsB eome cloea to this goal. Jt oo©- thinking that ttokeilsg with Medicare
whtstlet. No more gimmicks, no smoke t a l » dose to cno hUUoD in t o l a - sod Medicaid to the answer to oor
oOBBtry'a deflolt proWam. Baalth care
«juJ DO mirror*. Juat the Ucta. And eraaMs and aaer fees OfV
polltJcUnB who will lace np to the yean, and Just »»«• J B . h^loo » ^toyt aoch aa jmpocta*it role to t m
sceadiag cuts over the saj»s psnoo. J inmomy. that without overmW health
(acta and make the hard choices.
:
M « « f o r m . Bot oBly Will thedandt
And »ar>Dortlmr thU bill la • hart think a a-to-l ratio of tax toareaaaa U MBttoos to grow, bat the ecoDomy wiU
choice. I do Dot like every page, every spendingcwu laJoea w>o atae^. i-'^irj^'- aoBttous to suffer. Health reform eaa
The bulk of budget aaflag»» hpppoxk.
provlalon. every punctuation point. I
tt>«,J^Pf**: only be achieved If it to compUta, todo not think thU bUl 1» Nirvana. I t la mataly m bllUoa -to
elodlBX all sasxnants of aocieQr. vorkBot. I B fact. tier« U p. «re«i daal bars l a v » trom liedleaxe ao4 l«sdloat4. I Uig people to addltton to ths Madlcara
eaa not. and will not aap^rt a«y
I don't like. There are thloga that I measure that onfalrly alsgiaa .out «BS aad Madloald population. , .'i.c
'
hope will get worked out In CODV I believe both my Bepoblloaa aad
ferenoe—and you can bet that tha con- group or groups fbg "Wlfi'',?**?*^*;!^ DoBkoeraUo oolleaguoa ooderstand thas
Bartlaularly thoea indlvlduala who s a »
tbreas will be hearing' lf«m me.
we seed a aeamlesa sysum Cor good
But there is one thing that la Car Sast afford it. such aa the aldjcly aad ksalth poUcy. Yet. tbs budget prepos'
the
poor.
Tha
faot
to
that
BQch
of
tWs
worae than even the moat dlstaateftil
.
^ ala ofr«red todAV oontf»dlota
. proviBloB In this bUL And that U lna<> reduction to FedsraX si«ndtog. «
know to Boceasary for good health poi- ^
acted
toto
tow,
wUl
b»
limpIy
soat5oo. It Is time to act. And it la high
time for honesty here In this town. It tfi^ftjng to psopla ooysred tiy
toy.
.
• - • • 'l'
v s J j r ^ - . l : - I, Ws liav'i haaird ft great deal about tha
la tlma to come clean about whAt naedi hsalthlBittranaa.
I a ISBg. at tha and «( the fteslds^lS 31 mllllBB «nl&a«tf«d aad tha biaqoltlaa
to De done. It le no f\»B •rotiae for taxa*.
irogram. tha deficit to mrpsctad ! • bj te.eur current baalth care policy. What
It is much eaaler to oppoee them.
Aad it li not eaay to vote for spend- trott&d C40 bUllon. i a t . shoot wba* It wa doB't foeua enough on to tha to«t
ing CUM that will hit the elderly, that waa to U90. From that point OB. i t >a that Federal anUtlemenu aad the defiwill hit reilreee. that wUl hit farmers, •xp«:ted to rlae itaadUy. Foe thaea rjwi^ cit sxe gtowtog largely due lo the tothat will hit Federal worker*. It Is soBsTthto proposal does not make the met of health care lafUUoB. By tbe
much eaaler to oppose these cuts. But I (Undameatal stnsctBral changsa
end or thto year, ws will spend note
SIS not here to t*.k« the aAay w»y eat. Twlaral domestic speBdlag " f ^ ^ f ^ 0MA IBU UlUoB OB. haaltli ear*. That a
I am hers to maks the hard cholca* to crwite vlahla tad suiUtosd daflcit » lot of health care. BBore thaa any
••rj
other todustzlalitad aattos to the
To de what la right for my Sta,t*-«nd ledoottoD.'
Fttrthar. thli proposal to ftocal year world. The pubUo aeotor c u r r e ^
for the Nation. And, Mr. Preatdeat.
IBM
baa
tf
In
tax
iBcreaaaa
Sos
erexy
&
•panda 1*22 billion OB baalth care, WS
that le Why I am going to vote for this
to spending cuts. It dosa not
»« bUUoa to Federal •peodtog. ' 5 * prfMil.
• goal of C to tax to««a«e ' ^ ^ . f ^ vate sector spenda l 4 « b i m o » . ^ WU
suDorr axoowoLivnoH
^ S ^ ' i out Idadlcare and lf«Iicald by m bQMr. JETFORDS. Mr. 'Preaident. 1 rt*S to spending * » *
today to oppose the entire bllL Daring niedge, until fiscal year I W - To borroj* Uon to public health care ipendlng. But
the past few month*, the Sen*t« ha* a, shnaa from the PrealdeBt: We can to without aay more reform, thto w l l
been carefWly revlewlBg the Preal- bettar and we must do better tot bur sf- •toiply ehlft health caw spending, addOanfS economic propoaal and wa are ftorta to olumge AiBsflca's economic to- ing to the alraady numoreu* health,
presently oonaldering the newest In- turs. We must ensure that w l K«oar case cost problems to tha pelvaU sacitailment In thle procew. the ortmlbua tog cuts at least e<ioal ths tax tocreaaa, tor. We should not forget that prt****
yi • . v-^"
•ector ipending resulia to subetaBtlal
budget reconciliation blU. 8. 1134. to this proposal. .
r bad hoped that Oo&gresa would Inv- tbiegone Oovemment tevaBua. too.
which contains many aapecU of tbat
propoeal. This propoaal does not meet srovs upon the orlgtoal propoari of- This to due to the fiaot that health t » n
my goal, or the Presl dent's, of matoh- fored by tha President. Instead, wa U tax deductible by buaineasos. to Biat^
ittff ovory Jolisj' In 1r'''«it«a<J taiai with have I senate bUI that propoass tax to- CBO pr«diAra that If we conUnua with
a dollar in reduced Oovernment epend- e i ^ e s oa Social Sacunty tenenta. a- our ourront health care tystam and
well aa a 4.»<«nt tax toarsaae on trans- BDsndlng hablta. by the year 3B00. the
lag.
portation mel. r fiMi aa loorease to tha B5>11O sactor will spend SS32 WlboB on
First. I would like to make It clear tMM en Saalal Recorlty benefits to not bealtb caro, «58S MUIOB of wWeh win
tbat tnere aro uMuay pzo-Heioau withla the place to start Purthermore. i oethis proposal that I could support. But,
^«^ersrv»pe»41« »*
Sd««io0tor •_!l^«J*«""gS!
�TW37W3
Jttiu
24,1993
CONGRESSIQfMi: U G » b < : ^ ^ S E ^ ^
Sim
be iB redosal epeadiar- PmaXa
FtoaUy. health dLre dtftswy
'a B*v MlvOTr ayeteai fbr etadeat BwiUgrowtoSMOblUtos. .
' mast be created aad evalqaiad at tte
That meaae th«t by tbe year aooOL w« State leeel. States are aero •ecedat' naadal aid. I t also save* f4.g MlUoa. It
. wUl •read SL6 trtlhaa on beaJth w e . able and able to wwmpamt -awn fefchly 'dose that by a coaiMBatleB of BW«1I«
In paccBBtage tensa. this will rsiressBt to the needs of the asople ttaa the fiOpereeataf newloaaealame tadlreet
31 percaab of the ovsnll Federal b o ^ rederm) Ocwnmeat. StaSea aioat have leodlar. decrsaalng subsfdisa paid to
et. State and local govemmanta «U1 be tb« flaxlhUIty lo daslgm the dalhierr toadere aad guanurty ageadse, aad by
•pondln? an additional 18 peruenc oa system that wcrka baat gtsea each • aseisfng fcea e a leiidera aa4 SaQ5e
:
top Of thla anouBL How meeh epaad- Stau's demagTaphle aad geographic Mac. :-v
While I am pleased that the commitIng on tealtb care Is eaongh?
aasda. Ws ar« a dtveise eentry wtth
WsU. we alraady apand S3,100 per per- dtWfM eaada. axMtm OeKlMllKr wtU mc tee waa able ta n s e t the bodgtt lasoa on bealth cars. By ceevparlaoa, w« ceont far thto aad m m m that aierT- Btracuona and rsdace maay «r tbe aispend U.700 per person on edecaUoD ona'B health c a n naeda ate met to the ceastsa coetapald to parUdpaata to tbe
eunent program, I am very eoncarnsd
and
per person on aaUoaal de- beat possible way.
'rJ ;.«n-;*ciJ
-r-: that this money to not batnr fUnaaM
fease, to fa^t. par capita haalfcb care
I bay* InaerporBiad" aJl tbea slabacktataedocatieaiprograaubattotB•psndlBg has and wlU contlaue tc l a - moats of geod health oare policy that
erease twice aa
aa par cajtfta ODP traadatea toto good budgM peUcqF to S . stead gotar ta pay eff^ car debta.
' F«r yean w« have basa told that tha
growth unleaa health oaie rafonatoa»act«d. Thla la bad news for aoth tha lOar. the Madlf»RK Haatth Aet af M L thnat ftwm foretgn eaeialea deBaaasd
budget aad the aeononoy. Moreover, we n m bUl easoee that cverr tfttoaa baa maailve deftaae bofldBpL Withcat qus»; aeoase to a COBK est cf tealth servtosa. ' UaB. thto couatoy threw ttsalf bahtod
are ipeDdlng mora oa baalth care
any other country In tha world. Oa a It w n d a * a broad banerf ^fl^""''fnr that eaU aad tpeat bBBdrsds at blUleas
per capita baala. we spend U tlmM Tj>ame to pay for kbeae baaafRs, Meiw- of Can a n oa warptoasa. sabmartnaa
more than Canada. I.T tlmea more thaa over. It aato t M r t badget geala to bt -aad battlsahlps. Bat B O « that threat
West Germany, and %2JB bfllioa mora admtototersd bf tha R n i f . j n mhw baa receded and haa been nplacsd by a
sure health car*toafferdabla..Ftoa}ly. Bew thraat^jBBt aa mrtonm and }Mt aa
thiin Great Britala.
It KlvBs Stales the ftoatotUty ta ' ^
We are spending a great dagj en
health care, but we are flnaoclhg and the health c u e deUvecr qrstem that to -. ^Ite aew threat to jiat a>»m.«kai«
delivering health care to a very inequi- m m i d s a U , salt^l ta.tha^-ad. c l I t . Vadme, S S T A ^ J ' A ^ J ^ ^ ' ^ S
• «»^^«^»«'--o^'J."^ jr^.tf-ov»e onwtiT. U ta tka Umafc Cliai ear
table aad irrsUanai way. we need to '
9 ? * ^ tacktoa .;cblldr«B arc aot getttog a fblr shot at
rationalize the system, elve beaJth viJuw
tteji.
care to everyone, and pay for health h « J t h c a n cosu. car Psdsral bta^et-.whtt tbty d a B o i ^ T j S t t o d ^
care for aTaryons. In a etralgbC ter- W^rtJlems shoBld largely ba.nder caa- •;ttoQBl B^seageh CoueTl i S a i s i n « v d , across the board ^ahloo. Wbea Vol. T h e n f o i ^ t h . aext obdos Caa- tyear atady Boggssttar that U M H I O B S
ws do tbto, we win find that bealth TO mart addwssJa wprtaiKtoiBg aa- pr«hleaa of tbe NattU>a adoleaeaa^
ears CAB be pronded so that all hot the
^
hoitaC Tba' drar aaa. tchaol ftSteJ d S S m M
poor wtl) pay g perceot of a peraoa's atf.
BJC* altgntioa to aaa v l o l « » « _ h a v . g i w ^ ^ S i J S
Jujtatf groea Income. For moat people
this oeuld be eoUected to tbe form of a
payroll premium, i percent paid by the
em^oyer. i percent paid by ths employee.
. . •
This Is much leee than the 23 percent
planped to aohtow these aav- ,Wh.B 1 to fi c h l l d r e a ^ i o e J S l S i
of payroll many auto compaalaa aad IrtjratloB
Inge by conpletaly reptaetog the earsmall amployera eurreatly pay for raat Fsdeni FamUy X o a a P m r a m jUved to poverty to 1 » 1 then to little
health c a n . Co«La ars hlgb for maay with a Federal Direct Stadeet liCaB . woader why efaUdrea hoi in aeheol and
oompaafas becauM everyone is not pay- Ftegram by UST-ai. After leotc i i ^ 9 t i » - vbeeome dislllBsiQBed with the futara.
We have a dear aad praaeat dangar
ing their fior share aad the coats of ua- tloaa and with ths —^ttsnnr ct my
eompenaated care and very alck tadl- colleagues Sanatora P B I . , K A S S B A U U . in this eouBtTT—Just aa we did decwlea
ago with oor foreign enemtsa—bat we
viduala are sot evenly borne by all
DotU. MBCVLBIZ. aad Chatnaaa KkaWith aa all toelualve health eara fl- K B v the eonuntttoe has vaftad a eesa- have yet ta take that throat ssrlOBaly
,:We have aov-aa we did wltb ear denanclng echema, baatoeBaea will be able promlse to the PresldeBt'tloittol
-: '.fisnse buildup—undSTstood that now to
to reduce product pricea and become
Tbe eammlttee eonxtnodsa aow to- ;the tlaM to build up edBfiattea. health,
more compeUtlve. AddlUonal worker* olade the nplaoemeat d oaly half
oottJd b« hired. Fair flziaiiainc for the oarreat guaranteed Isodtar vw- aad aoeSal aevvieaa proyraaM la tbe
health care will also free up laoaay to grara With direct l a a d l ^ to the aext 5 aaaie way that we coaunittad ourealvea
be seed to provide penaJons, education yean. It also astahUehea a Conmlasioir to ths cold war bolldap.
Tha problema of this oooatry have
benaflta and higher wa«es to emoloy- .ta atttdy tba advlaahUity-eg BMVIBV
eea T U S translates toto a higher folly into direct landing bafon tha end oievad hooB belBc a dlstaai Tfirtat ta a
•tandard of Uvlag and better quality of of the fifth year. ' . , . :
-i'v,- •. , - f^lghtaatog reality. We muat becto to
life for all Americas Cunlllea.
Far thoea of ua who aupport' a mors reevaluate oor prlorttiea^aad devote
Rut w« can't stop there. Wo aleo need cauuoua approach ta direct >Bdlag our lUndtog t« sohrtar the ertaie at
a health care budget. Wa hav« too thto comproBiisa rspreaeota a atap to home.
eaatolttse'a
many toeCDcIencles in our current ths right directloa.
health eara aystan. Americana cur- Compronlae allowa the eoaeepc of H Mr. LIEBERMAN. Mr. Prealds&t. yearently pay for affmlatotxauve waata, reot laadtog to be teetad bafora atovliv Caiday. .1 Sled aa anemlBMSt to-this
fraud and abuse in claioM procaaatog full speed ahead tota asehartad watara. MU which would restore one cf the
and deTeaslve medldna. that should I bellevs that direct leadtog may be tba FreeideBt's toveecmcat j^poaato to his
nfit be tn ths syatam. Tlila la tha kii>4 beat wajr to deUvor Isaaa to studaata. eoonomlc TTfi-hsgTt Thn PrseldaBe' altarnaUve mtolmom tax taform provlof health care spending nobody nseda. However. I believe Juat as Onnly
Many people believe managed competi- we need to teat that aasomptloa a M sloa. I did so becaaae J bellarad—and I
tion win BQuaeza much of tbe woeu out move Biowly so tbat tha baaaficlartaa ooatlnae le believe—that the Caagrw
of nnr health caj« gyateta. However, a of this program—the studanta-ars sot most deliver thzee t h i i « « to th* AOMPbealth care budget will aneura that lea without acoesa ta needed. loaa leaa people—deficit radaeUoa. spendwaste l i eliminated. Over the next doe- money. The commlttee'a oomaroailaa ing O B U . and toib ereatlac inveatmeat
toeaatlvea.
,. . .
ade. If growth In bealtb care speodlng doea iuat that.
V a ar« two-thinb «r tha «ay than
were Iimitad to growtH in ODP « «
Eovevsr, tha committee oomproBalM Tba bUl seat to thto floor by the 8e»^
could cut the fedaraJ deQott In half
—• •
«u* Hu* B c n H( uua uow ay tas nail
does mon than Juat move caattonaly to >to. Flaaacs Cooualttee eota sDendiur
�(
»
June 22, 1993
MEMORANDUM FOR HILLARY RODHAM CLINTON
FROM:
SUBJECT:
Kim TiUey
Briefings for Wednesday, June 23rd
Meeting w/ Rep. McDermott and Single Payor Cosponsors Briefing
- Cosponsor List and Health Care Positions
- Rep. McDermott's Health Care Reform Checkhst
- Information from "HealthUne" (6/22/93) re: Rep, McDermott's "American Health
Security News", a new weekly newsletter on the single-payer plan and health
reform.
Meeting w/ Al From
- Summary of PPI Essay
- PPI Essay on Health Care Reform by Rob Shapiro
CSIS Strengthening of America Commission Briefing
- Participants List
- Talking Points
- list of Shared Health Reform Goals w/ CSIS
- Specific CSIS Concerns and Our Response
- Profiles of Congressional Members Attending the Meeting
(The Executive Summary of the Commission's First Report as well as the Discussion
Draft on Health Care Reform are in the binder pocket.)
Sherrie Kohlenberg Briefing
Presidential Scholars Reception Briefing
(To be provided by Cabinet Affairs tomorrow.)
Ambassadors Credentialing Reception Briefing
(To be provided by the NSC tomorrow.)
�DETERMINED TO BE AN AD.MINISTRATIVE
MARKING Pcr En. 12958 as amendod, Sec.3.3 (c)
Initials: T\ ^ V
Date: \ ^ / f e / l j
PRIVILEGED AND e©f>fH^iai*l,-MEMORANDUM
TO:
FR:
RE:
Hillary Rodham Clinton
Chris Jennings, Steve Edelstein
House Single-Payer Meeting
June 22, 1993
Tomorrow you are scheduled to host a meeting of the House cosponsors of the
McDeimott/Conyers single-payer bill (H.R. 1200). Congressman McDermott requested this
meeting to give his 83 cosponsors the opportunity to hear your explanation as to why the
President's bill is very similar to H.R. 1200, (as well as to, no doubt, illustrate to you what a
big block of supporters he has for his legislation).
Many of the hard core supporters of a single payer plan appreciate the similarities
between the President's approach and their bill. However, they perceive that the President's
plan does not go far enough in their direction — that it is overly complex and does not take
advantage of the administrative simplicities that would be realized by a single-payer
approach. They also believe that the President should start with as comprehensive and
expansive a proposal as possible so as to energize the rank and file single-payer advocates.
They believe that such an approach would protect the final package as much as possible from
the inevitable watering down that goes along with the Congressional process.
From all reports, your meeting with Senator Wellstone's group of single-payer
supporters went very well. A repeat performance, perhaps with a more political spin, should
be very well received.
FORMAT
According to Congressman McDermott's office, he wants this meeting to be as much a
"working" discussion as possible. McDermott would like to lead off with a few introductory
comments of appreciation for the meeting. Then he will introduce you. At that point, you
may wish to recognize the work that he and Congressman Conyers have done in pushing their
legislation. (If Pete Stark is in the room, you may wish to acknowledge him as well.)
As with most Members, they will want to know about the status of the policy
development and the likely timing for the unveiling. Then, it might be advisable to very
briefly illustrate how our proposal meets the health reform principles (attached again for your
review/use) advocated by Congressman McDermott and his cosponsors. The Members would
then like to throw it open to questions/comments and have a healthy give and take. As of
this morning, it was very unclear how many of the 83 Members will be in attendance.
McDermott's office expects a much smaller crowd and hopes there will be few enough to
arrange the seating in a less formal manner. (It remains very unclear if this can happen if
more than 35 Members show up.)
�All in all, the single-payer Members will be a generally receptive audience. Some
recent articles/news stories about how the delay in introduction has given some special
interests the opportunity to water down the provisions of our proposal (a ridiculous
perception, of course) are making some Members anxious. Similarly frustrating to many of
these Members is the perception that the White House is turning more towards the right wing
of the Party and potentially setting up an environment in which the Administration believes it
is in its political interest to either reject or take for granted the left wing of the Party. As a
result, some of the meeting participants may be "feeling their oats" and making a stronger
push than they otherwise would. I believe, however, that some reassuring comments from
you will be more than adequate for all or most of these Members. The bottom line is that
most of them tmly want some form of comprehensive health reform, and most of them will
be with you when it is really needed. (They just don't want to be ignored; they want to be
viewed as a formidable and substantive group that should be taken seriously.)
The cosponsors of the McDermott/Conyers bill are notable for both their numbers and
their Committee assignments. The following gives you a quick break down of just who these
Members are and how we currently view them as potential supporters.
The 83 cosponsors represent over one-third of the total number of votes needed for
passage in the House. There are 25 cosponsors who sit on the three primary House
committees of jurisdiction: 4 on Ways and Means, 7 on Energy and Commerce, and
14 on Education and Labor.
Half the cosponsors (41 in all) are members of House caucuses — 29 members of the
Congressional Black Caucus, 8 members of the Congressional Hispanic Caucus and 13
members of the Congressional Caucus on Women's Issues (some are members of more than
one caucus), hi addition, 20 are Members serving their first term in Congress.
Attached is a list of the cosponsors, their party affiliation, home state, committee
assignments and caucus memberships. Freshman Members are also indicated. The list is
broken into three categories based on our targeting lists ~ Reliable, More hiclined. Need
Work.
(1) Reliable -
19 cosponsors who the House leadership believes we can count on as
"reliable" votes for the Administration's plan.
(2) More hiclined - 52 members are categorized as "more inclined," those who are likely to
vote with us in the end but cannot be taken for granted.
(3) Need Work -
11 cosponsors are listed as "need work." These Members will be the
most difficult to get on board and will need significant attention to get
their support.
�RELIABLE:
Abercrombie (D-HI)
-Armed Services; Natural Resources
Ackerman
(D-NY)
-Foreign Affairs; Merchant Marine and Fisheries; Post Office &
Civil Service
Clybum
(D-SC)
-Public Works and Transportation; Veterans Affairs;
Congressional Black Caucus; Freshman
C. Collins
(D-IL)
-Energy and Commerce; Government Operations;
Congressional Black Caucus; Congressional Caucus for
Women's Issues
Engel
(D-NY)
-Education and Labor; Foreign Affairs
Evans
(D-IL)
-Armed Services; Natural Resources; Veterans' Affairs
Frank
(D-MA)
-Budget; Public Works and Transportation
Gejdenson
(D-CT)
-Foreign Affairs; House Administration; Natural Resources
Kennedy
(D-MA)
-Banking, Finance and Urban Affairs; Veterans' Affairs
Lewis
(D-GA)
-District of Columbia; Ways & Means; Congressional Black
Caucus
Manton
(D-NY)
-Energy & Commerce; House Administration; Merchant
Marine & Fisheries
Markey
(D-MA)
-Energy & Commerce; Natural Resources
Moakley
(D-MA)
-Rules (chairman)
Pelosi
(D-CA)
-Appropriations; Select hitelligcnce; Standards of Official
Conduct; Congressional Caucus for Women's Issues
Sabo
(D-MN)
-Appropriations; Budget (chairman)
Schumer
(D-NY)
-Banking; Finance & Urban Affairs; Foreign Affairs; Judiciary
Scott
(D-VA)
-Education & Labor; Judiciary; Science, Space & Technology;
Congressional Black Caucus; Freshman
�Studds
(D-MA)
-Energy & Commerce; Merchant Marine & Fisheries
(chairman)
Swift
(D-WA)
-Energy and Commerce; House Administration
�MORE INCLINED:
Andrews
(D-ME)
-Armed Services; Merchant Marine and Fisheries; Small
Business
Becerra
(D-CA)
-Education and Labor; Judiciary; Science Space and
Technology; Congressional Hispanic Caucus; Freshman
Beilenson
(D-CA)
-Budget; Rules
Berman
(D-CA)
-Budget; Foregn Affairs; Judiciary; Natural Resources
Blackwell
(D-PA)
-Budget; Public Works and Transportation; Congressional Black
Caucus
Borski
(D-PA)
-Foreign Affairs; Public Works and Transportation; Standards of
Official Conduct
Brown
(D-CA)
-Agriculture; Science, Space & Technology (chair)
Clayton
(D-NC)
-Agriculture; Small Business; Congressional Black Caucus;
Congressional Caucus for Women's Issues; Freshman
B.R. Collins (D-MI)
-Government Operations; Post Office and Civil Service; Public
Works and Transportation; Congressional Black Caucus;
Congressional Caucus for Women's Issues
Coyne
(D-PA)
-Budget; Ways and Means
Dellums
(D-CA)
-Armed Services (Chair); Congressional Black Caucus
de Lugo
(D-VI)
-Education and Labor; Natural Resources; Public Works and
Transportation
Dixon
(D-CA)
-Appropriations; Select Intelligence; Congressional Black
Caucus
Edwards
(D-CA)
-Foreign Affairs; Judiciary; Veterans' Affairs
Faleomavaega
Hake
(D-AS)
(D-NY)
-Education and Labor; Foreign Affairs; Natural Resources
-Banking, Finance, and Urban Affairs; Government Operations;
Small Business; Congressional Black Caucus
�Furse
(D-OR)
-Armed Services; Banking, Finance & Urban Affairs; Merchant
Marine & Fisheries; Congressional Caucus for Women's
Issues; Freshman
Gutierrez
(D-IL)
-Banking, Finance and Urban Affairs; Veterans' Affairs;
Freshman
Hamburg
(D-CA)
-Merchant Marine and Fisheries; Public Works and
Transportation; Freshman
Hilliard
(D-AL)
-Agriculture; Small Business; Congressional Black Caucus;
Freshman
Hochbrueckner
(D-NY)
-Armed Services; Merchant Marine & Fisheries
Lantos
(D-CA)
-Foreign Affairs; Government Operations
Martinez
(D-CA)
-Education & Labor; Foreign Affairs; Congressional Hispanic
Caucus
McCloskey
(D-IN)
-Armed Services; Foreign Affairs; Post Office & Civil Service
McDermott
(D-WA)
-Ways & Means; District of Columbia; Standards of Official
Conduct (chairman)
McKinney
(D-GA)
-Agriculture; Foreign Affairs; Congressional Black Caucus;
Congressional Caucus for Women's Issues; Freshman
Meek
(D-FL)
-Appropriations; Congressional Caucus for Women's Issues;
Congressional Black Caucus; Freshman
Miller
(D-CA)
-Education & Labor; Natural Resources (chairman)
Mink
(D-HI)
-Education & Labor; Budget; Natural Resources
Murphy
(D-PA)
-Education & Labor; Natural Resources
Norton
(D-DC)
-District of Columbia; Post Office & Civil Service; Public
Works & Transportation; Congressional Black Caucus;
Congressional Caucus for Women's Issues
Oberstar
(D-MN)
-Foreign Affairs; Public Works & Transportation
Olver
(D-MA)
-Appropriations
�Owens
(D-NY)
-Eklucation & Labor; Government Operations; Congressional
Black Caucus
Rangel
(D-NY)
-Ways & Means; Congressional Black Caucus
Romero-Barcelo (D-PR)
-Education and Labor; Natural Resources; Congressional
Hispanic Caucus; Freshman
Roybal-Allard (D-CA)
-Banking, Finance & Urban Affairs; Small Business;
Congressional Hispanic Caucus; Congressional Caucus for
Women's Issues; Freshman
Reynolds
(D--IL)
-Ways & Means; Congressional Black Caucus; Freshman
Rush
(D--IL)
-Banking, Finance and Urban Affairs; Government Operations;
Congressional Black Caucus; Freshman
Stark
(D--CA)
-Ways & Means; District of Columbia (chairman); Joint
Economic
Stokes
(D--OH)
-Appropriations; Congressional Black Caucus
Thompson
(D--MS)
-Congressional Black Caucus; Freshman
Torres
(D--CA)
-Appropriations; Congressional Hispanic Caucus
Towns
(D--NY)
-Energy & Commerce; Government Operations;
Congressional Black Caucus
Tucker
(D--CA)
-Public Works & Transportation; Small Business; Congressional
Black Caucus; Freshman
Underwood
(D--GU)
-Armed Services; Natural Resources; Congressional Hispanic
Caucus, Freshman
Velazquez
(D--NY)
-Banking, Finance & Urban Affairs; Small Business;
Congressional Hispanic Caucus; Congressional Caucus for
Women's Issues; Freshman
Vento
(D--MN)
-Banking, Finance & Urban Affairs; Natural Resources
Washington
(D--TX)
-Energy & Commerce; Government Operations; Judiciary
Watt
(D--NC)
-Banking, Finance and Urban Affairs; Judiciary; Post Office and
�Civil Service; Congressional Black Caucus; Freshman
Woolsey
(D-CA)
-Education & Labor; Budget; Government Operations;
Congressional Caucus for Women's Issues
Yates
(D-IL)
-Appropriations
6
�NEED WORK;
Clay
(D-MO)
-Education and Labor; House Administration; Post Office and
Civil Service (Chair); Congressional Black Caucus
Conyers
(D-MI)
-Government Operations (Chair); Judiciary; Small Business;
Congressional Black Caucus
Gibbons
(D-FL)
-Ways & Means; Joint Taxation
Hinchey
(D-NY)
-Banking; Finance & Urban Affairs; Natural Resources;
Freshman
LaFalce
(D-NY)
-Banking; Finance & Urban Affairs; Small Business (chairman)
Maloney
(D-NY)
-Banking; Finance & Urban Affairs; Government Operations;
Congressional Caucus for Women's Issues; Freshman
Mfume
(D-MD)
-Banking; Finance & Urban Affairs; Joint Econmic; Small
Business; Standards of Official Conduct; Congressional Black
Caucus (Chair)
Nadler
(D-NY)
-Judiciary; Public Works & Transportation; Freshman
Payne
(D-NJ)
-Education & Labor; Foreign Affairs; Government Operations;
Congressional Black Caucus
Serrano
(D-NY)
-Appropriations; Congressional Hispanic Caucus (Chair)
Waters
(D-CA)
-Banking, Finance & Urban Affairs; Small Business; Veterans'
Affairs; Congressional Black Caucus; Congressional Caucus
for Women's Issues
�SENT BY:
•
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U.S. REP. JIM MCDERMOTT'S
CHECKLIST OF CRITERIA
FOR MEASURING
HEALTH CARE REFORM PROPOSALS
1.
Does it provide insurance coverage to every American?
Nearly 40 million Americans do not have health insurance coverage today. That total
increases by 100,000 each month. An almost equal number (nearly 40 million) are
dangerously under-insured. Any reform proposal must extend quality coverage to
these Americans.
2.
Is that coverage portable, stable and continuous?
A major problem for people who have insurance is the fear that they will lose it if
they move to another job, due to a "pre-existing condition" which won't be covered
under their new employer's plan, or other restrictions and inadequacies in the plan
offered by their new employer.
3.
Is the standard benefit package comprehensive enough to
prevent the need for a large secondary insurance market which
leads to two-tier medicine and uncontrollable costs?
In a democracy, it is important to have a quality bealth care system available to all.
If the standard benefit package guaranteed to all citizens provides only minimal
benefits, then some people will look for a "better deal." People wUl try to cither
"buy out" of the national system or buy more private insurance. If the standard
package of benefits is a generous one, people will stay in the system, preserving the
ability lo control costs.
4.
Does it allow individuals or families to choose their own
physician or other health care provider?
Americans cite the ability to choose their own physician as the single most important
aspect of any health care plan, even over cost and convenience. They do so by large
margins. One of the fundamental elements of healing is the relationship between the
healer and the patient. If the patient has no choice, you take away an essential
element of the health process.
— more —
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McDeimott's checldist
page-2-
5.
Does it guarantee coverage regardless of physical condition or
the presence of a pre-existing condition?
Increasingly, insurance in this country is only available for those things for which
you do not need insurance. If you have a cancer, insurance companies will cover
everything but cancer. If you have heart pioblems, they will cover everything but
heart problems. Any reform plan must correct this fundamental problem.
6.
Does it provide for effective, veriflable cost-containment?
Currently, America's health care system essentially has no cost controls. We cannot,
as a nation or as individuals, afford this any longer. Any reform plan must have
verifiable cost-containment.
7.
Does the cost-containment apply to the entire health care
delivery system without loopholes or exemptions for the
secondary insurance market or self-insured entities?
It is increasingly difficult to control costs and stop wasteful spending if large numbers
of people are "outside the system." To be effective, cost-containment measures must
be apphed to the entire health care delivery system.
8.
Is there one simplified federal administrative system that applies
to all Americans, rather than multiple bureaucracies which do
the same thing for different groups?
A central goal of any health care refonn plan should be to simplify the system
to make it understandable for ordinary citizens and to make it easier to identify and
eliminate waste. Over-lapping layers of federal bealth care bureauciacies for separate
benefit programs needlessly waste health care dollars. Waste is also an unavoidable
aspect of having 1,500 different private health insurance companies. According to the
GAO, Americans incur nearly S60 billion a year in unnecessary health care costs
simply because of all the different forms and paperwork issued and required by so
many different companies.
9.
Does the health care delivery system enhance access to bealth
care in rural areas and the inner cities?
More than 35 % of Americans live in rural areas or inner cities. Both have been
chronically under-seived by the current health care system. Any national bealth care
system must correct this inadequacy.
- more ~
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McDermott's checklist
page -3-
10. Does it eliminate interference between doctors and patients by
insurance companies second guessing medical decisions and allow
health professionals to make their own medical decisions?
Maintaining America's high quality of health care must be a Amdamental goal of
whatever health care reform plan America adopts. The current system's case by case
random reviews, which inserts insurance companies between the patient and the
health care provider through "pre-certification" requirements for hospital admissions,
length of hospital stays, and even for ^>ecific medical procedures, have not been
effective in controlling health care costs. What we need is a system that allows
doctors to make their own medical decisions, but which also teaches them how to
deliver better medicine by developing better practice patterns.
11. Does the system dramatically reduce administrative costs of the
health care budget?
Almost a quarter of all bealth care dollars in America are consumed by
administrative expenses of insurance companies. This is simply unacc^>table. If we
are to make the kinds of savings necessary to finance comprehensive health care
coverage for all Americans this figure must be reduced. And it can be reduced. For
example, under Canada's "single payer" system, for example, only 3 percent of all
helath care dollars are consumed by administrative expenses.
0»»
�SINGLE-PAYER: THE "LEADING ALTERNATIVE" TO CLINTON'S PLAN?
CONYERS: Cleveland PLAIN DEALER reports Rep. John Conyers
(D-MI), a "chief co-sponsor" of the single-payer American Health
Security Act, "told a gathering of union o f f i c i a l s and advocates
for the elderly that h i s b i l l i s gaining support." Conyers:
"Every industrialized society in the world has national health
care. I didn't invent i t . This i s the simplest plan, the
f a i r e s t plan, the plan America has been waiting for." He
"charged that Clinton's health care task force was formed to
create an alternative to h i s single-payer plan:" "You know what
that task force was hired for? To figure out a way to get around
my b i l l " (Scott Stephens, 6/20).
MCDERMOTT: The office of Rep. Jim McDermott (D-WA) released
the f i r s t issue of AMERICAN HEALTH SECURITY NEWS, a weekly
newsletter i t w i l l publish on the single-payer plan and health
reform. The newsletter notes the American Health Security Act
(HR 1200) now has 83 co-sponsors, making single-payer supporters
"the largest health reform block in Congress." I t c a l l s the
single-payer system "the leading alternative" to the "untried
managed competition theory favored by the Clinton health reform
task force" and says congressional wariness of managed comp i s
due to the "Star-Trek factor" — i t promises to "boldly go where
no one has ever gone before." AMERICAN HEALTH SECURITY NEWS also
reports on discussion of the single-payer system i n the media,
congressional hearings and the Congressional Record (6/16 issue).
NOT SO FAST: WASH. POST examines the Canadian health care
system and i t s efforts to contain costs. POST: "Costs of the
Canadian system are r i s i n g so fast that the government i s
struggling to find ways to curb spending on health care." POST
notes that "for years" health costs in Canada have been r i s i n g
faster than the overall i n f l a t i o n rate, due in part to an aging
population and the increased use of high technology. Efforts to
cut costs have "focused on reducing the extras:" coverage of
vision exams and dental treatments has been reduced and those
over 65 now have to pay $1.60/prescription. POST reports
hospital workers have "balk[ed]" at gov't proposals to freeze
wages and i n s t i t u t e unpaid leave days and doctors have "charged"
that proposed l e g i s l a t i o n in the province of Ontario would give
the gov't "unprecedented new powers to determine what medical
services i t w i l l pay for and how many doctors i t w i l l allow to
practice in the province." POST notes, however, that, unlike the
U.S., Canada covers a l l c i t i z e n s and spends less on admin, costs.
Univ. of Ottawa's Jane Fulton: "In Canada, we have discovered i t
i s cheaper to waste money on universal care than to continue
payments to the insurance industry" (Anne Swardson, 6/22).
(c) The American P o l i t i c a l Network, Inc.
�June 22, 1993
MEMORANDUM FOR HILLARY RODHAM CLINTON
FROM:
David Haradon
through Kim Tilley
RE:
Executive summary of Robert Shapiro's "Health Care Reform and the Laws
of Economics."
Robert Shapiro's essay, "Health Care Refonn and the Laws of Economics," discusses the
careful balance between health care reform and maintenance of a sound economy. He
points out that health care is a unique marketplace with unlimited demand and a limited
supply, forcing prices to rise faster than inflation.
To correct the imbalance he proposes a health care system based on managed
competition providing universal coverage over time. He sets forth three goals and the
methods to achieve those goals:
A. Force insurers to compete on the basis of value and price.
B. Get consumers to assume responsibility for health care choices.
C. Constrain health care providers to meet basic medical needs.
A. Force insurers to compete on the basis of value and price.
•
•
•
•
Create HPICs (Health Purchasing Insurance Cooperatives) to operate like the New
York Stock Exchange. These cooperatives would be the primary sellers of health
care benefits.
Force HPICs to eliminate pre-existing condition price discriminations by
standardizing costs.
Create strong competition forcing HMOs and HPICs to offer more efficient services
thus forcing prices down.
Create a standard national health care package that all insurance companies would
have to offer. Companies failing to offer the basic package would not be able to
compete within the HPICs.
B. Get consumers to assume responsibility for health care choices.
•
•
•
•
Create an employer mandate requiring employers to pay either a base percentage of
the workers wage or several thousand dollars towards health care (Shapiro cautions
this can only be phased in with a strong economy.)
Provide a refundable tax credit for those not covered by employers to be phased in
over several years, beginning with families with children.
Establish standard information on benefits and outcome of every plan by HPICs.
Limit amoimt companies can deduct for providing health insurance, forcing
companies to choose the most efficient and lean insurance plans.
�C. Constrain health care providers to meet basic medical needs.
•
•
•
Maintain ample incomes for medical professionals in order to maintain high quality
work force through premiums and co-payment fees.
Provide broad malpractice insurance coverage to cut down on unnecessary and costly
tests and services.
EUminate the fee-for-service and instead base fees on overall costs, much like HMOs
do currently.
Shapiro believes there are regulatory altematives to health care reform. Regulatory reform
although politically expedient, compared to managed competition, would do harm to the
economy. Regulatory alternatives that exist include:
•
•
Global budgeting - this plan has manyflaws,leaving the government to guess how
much will be spent on health care each year rather than the market forces dictating
health care spending. Shortages would leave individuals with out health care possibly
in the later months of the year.
Wage and Price Controls - this option attempts to regulate the laws of supply and
demand. There is no economic theory which supports this option especially in the
health care sector. Controls on Medicare Part-B costs have only forced those
individuals to pay 128 percent of the costs for the same treatment. Price and wage
controls would only cripple managed competition.
Mr. Shapiro believes it is the task of this Administration not to preserve the current system
nor create a new one, but to reconstruct the groimd rules upon which health care is
currently delivered, while making efforts to extend benefits to all Americans.
�w
niiu iiiiiifit
June 22,1993
Hillazy Rodham Clinton
The White House
Washington, D.C. 20500
Dear Hillary;
Before we meet tomorrow, I wanted to be sure you had a copy of the latest
draft of my upcoming PPI essay on health-care reform.
Looking forward to tomorrow,
Best,
Robert J. Shapiro
�06-22-93
:0:5DAM
FO:
ORAFi:
Health Care Reform and the Laws of Economics
Robert J. Shapiro
Aa President Clinton, Hillary Rodham Clinton and the Congress prepare their
monumental reform of the medical sector, we should recognize that its success will
be ultimately determined not by its political compromises, but by its relationship to
the way the American economy works. We can phase-in universal coverage and avoid
even higher health-care inflation, imder the laws of supply and demand, but only if
we foster market competition among providers and demand more economic discipline
and responsibility from everyone as patients.
Fcusing the Problem
At the heart of this issue is one of the oldest problems in economic policy:
what should government do when people want more of some good than the economy
will produce at prices they're willing or able to pay. Presidents facing this problem
can try to temper people's expectations, or to satisfy them and risk ityuring the
economy. President Clinton, elected to cure the economic problems created by his
predecessors, has also promised umveraal health-care coverage. The test of his
leadership will be his ability to shape a health-care package that can provide
everyone a measure of security while respecting both the laws of economics and the
measured pace of economic change,
Two of these laws are at issue. The first is that prices rise when demand for
something increases and the supplies of it don't expand as quickly. Simply extending
insurance coverage to the 35 milHon people who lack it today, in short, will inevitably
spark faster-rising medical pnees and costs. And if vmiversal coverage includes longterm care, prescription medicine, mental-health, dental treatments and more ~ as
many healtii-care reformers want -- medical-care inflation will rise even faster.
The second law that confronts health-care reform is that economic demand for
most things responds to prices. So long as conventional insurance and the current
health-care system let most of us use medical services without paying directly for
them - with little recognition of the costs - demand for health care will never be
disciplined and prices will continue to rise.
If these economic forces didn't matter, the President and Congress could simply
tell business and government to cover everyone for every condition right away. But
they do matter, as otir current problems with the healtii-care system demonstrate.
Public and private heaiih insurance for elderly and poor people and for most workers
and their families has vastly expanded our national demand for medical services.
This in tvum has pushed up the costs for those paying the bills, forcing businesses and
insurers to exclude more workers and more conditions from conventional coverage.
�06-22-33
:0:6DAM
The paradox for health-care reform is that in our current "cost-unconscious" medical
marketplace, a guarantee of umveraal coverage would price itself out of the reach of
those guaranteed it.
The basic strategy of managed competition would resolve this paradox and
control costs not by new government mandates and controls, but by creating strong,
new economic inducements to discipline demand for medical treatment and increase
the supply of efficiently-delivered care. Managed competition would restructure the
health-care marketplace by creating new incentives that (1) force insurers to compete
on the basis of value and price. (2) require all of us as patients to assume more
economic responsibility for our own health-care choices, and (3) constrain providers
to meet people's basic medical needs more efficiently, principally through Health
Maintenance or Preferred Provider organizations (HMOs and PPOs).
Rising health-care costs wouldn't be a serious problem if they didn't also reduce
our economj-'s potential. But as the share of the country's productive resources
claimed for medical services has expanded from barely 7 percent of our G.N.P, in
1970 to roughly 14 percent today, the prices that every other industry pays for basic
resources, especially capital and skilled workers, has risen. Businesses and
government could cover the nation's rising health-care bills without sacrificing
productivity and investment, if the economy were growing faster than the demand
for health care — but that can't happen when demand for mediical services is virtually
unconstrained.
Pointing a Way
Over time, we can provide basic universal health coverage without injuring the
economy. And no one should doubt that we must do so. But it will mean reforming
the basic ground rules of the health-care marketplace so that there, as everywhere
else in the economy, genuine incentives exist for everyone to exercise some
responsibility for their own health-care choices, and for providers to become much
more efficient. In the main, it will require not sweeping government regulation and
mandates, but a tough form of managed competition that forces insurers and healthcare providers to compete on the basis of value and price, and demands more
discipline and responsibility from nearly everyone.
If we choose universal coverage and a sound economy, most of us will have to
curtail our currentfreedomto choose our own medical specialists, all but the truly
poor will have to pay more of the cost of every service, and everyone will have to forgo
any prospect of winning huge malpractice awards. And if high-quality medidne is
to be part of the equation, doctors will have to retain substantial control over their
own practices, as do other professionals.
Thisasks alotofthevastmajority of Americans who aZT^ady are insured. Yet
it is this majority, not the minority who are uninsured, driving the demand for
universal coverage covering virtually any medical condition. According to surveys.
�w?f«
iruarantee that we alwaytt will have the services we need, now and
when we re older. We want to be certain that whatever our medical condition or job
status, we and our famihes can get aU the medical care we need.
By most estimates, the expansive version of universal coverage, covering
current benefits plus mental-health and dental services, medicines and long-terS
care, could mcrease the nation's health-care biUs and demand by as much as $100
bilhon a year For starters, everyone should be willing to wait before these new
benefits are added to basic insurance. Even so, universal coverage can be achieved
without stunting the economy only as pari; of far-reaching market-based reforms that
satisfactorily balance medical-care supply and demand.
Within the President's health-care task force and beyond, the advocates of a
tough fonn of managed competition are challenged by claims that government
mandates and price regulation can control costs better than a restructured healthcare marketplace. This alternative, however political expedient it mav seem, would
only defer the remorseless logic of supply and demand, and at great economic cost
It tiie economy matters along with universal coverage, the President and Congress
snotild reject this course.
The Shape of Tough-Minded Managed
Competition
The strategy for managed competition has two basic parts, addressing in turn
patients and providers. First, discipline demand for medical services by compelling
people to pay more for them. For over a decade, the standard proposal has been to
increase pressures on firms to shop for the most efficient insurance coverage by
reducing their ability to deduct all of the premiums tiiey pay for their employees.
The catch is that most companies have been insurance-shopping for a decade, with
no discemable effect on health-care prices.
'Hie economics of competition provides ways of honing this tactic for maximiun
eflrect. For example, limit the amotmt that companies can deduct for providing health
insurance for their employees to the cost of the cheapest package of basic benefits on
the market, providing a direct incentive for firms to choose the most efficient and
lean insurance plans. And heighten the pressure on everyone by counting as a
person's taxable incomes part of the premiums or payroU-fees paid in his or her name
by an employer. The object is to promote the development of a genuine insurance
marketplace in which people weigh one possible purchase against another.
Building a health-care marketplace that can satisfy people at prices they can
pay will require reforms affecting demand not only for insurance, but also for
particular medical services. Under genuine managed competition, everyone but Uie
poor pays part of tiie cost of neariy ©very service they choose, so that people assess
the value for the money in their health-care choices, as they do for other services
�06-22-S3 ;0:65AM
rub
DRAFT
The concept of choice means littie when one's life is at stake, and most people look
to medical insurance for tiie security that they won't lose their lives i f tiiey can't
afford acute treatinent. Setting aside life-and-deatii treatinent, higher personal copayments for aU ether services will offset some oftiieprice pressures associated with
timversal coverage. The bottom hne is tiiat medical prices should rise at rates more
like otiier goods and services if people wiD accept more responsibility for tiie costs of
their own care.
Employer Mandates
The principal challenge to this \'iew comes from some inside the President's
task force who want to piggyback an employer mandate requiring every company to
insure every worker, onto reforms requiring that most people pay more for insurance
but not for the treatments they choose under it. This proposal would require first,
that all employers contiibute either several thousand dollars a year for every worker
. or seven-to-nine percent of their annual payroll costs to cover part of their employees'
insurance; and second, that workers pay the rest of the premiums themselves. The
first part would guarantee coverage for every working person (and their families), the
second should direct them towards cheaper plans covering fewer services.
The economics of an employer mandate are equivocal. With more than threefourths of U.S. companies now volimtarily including insurance coverage in their
employees' market compensation, oN'idence that a mandate would devastate American
business is not strong. Why doesn't normal market competition for workers compel
the rest to offer coverage? From the worker's perspective, the pool of low-skilled
people seeking jobs is large enough so that they usually cannot bargain effectively for
health-care benefits. And by most employers' calculations, the productivity of most
low-wage workers cannot justify raising their total compensation by 20-to-30 percent
to cover health benefits.
Far from guaranteeing benefits to all low-skilled workers, a broad employer
mandate, by the economics of it, could cost some of them their jobs. Forced to make
the choice, many companies would probably replace many of their newly-expensive
low-skilled workers with more equipment or witii contracts to foreign facilities. A
special subsidy to ease the burden on small employers would help, but it also could
became an incentive for somefirmscurrentiy covering their workerstoreduce or even
Until a strong economy and tough-minded managed competition make coverage
economical for these firms, health-care reform should move very cautiously on an
employer mandate. On both equity and economic grounds, there is a strong case for
making the federal government the financier of last resort for universal coverage,
using revenues from the progressive income-tax, rather than using the regressive
payroll tax or forcing companies to trade-off health-care costs against job creation and
�06-;2-93 iO::DAM
FO'
DRAFT
investaient or using tiie regressive payroll tax. The mandate would fall on tiie
individual, and people not coveredtiiroughtheir jobs would receive a refundable tax
credit for health msurance. This credit should be phased-in over several years,
begiimmg witii famihes with smaU children, and phased-out as a family's income
H*®!," J^-??v ^ ?® 'I'reasury could befinancedthrough tiie savings ft^m limiting
the deductibihty of employer-paid premiums and the excludabihty for employeesT^
Refbrming the Health-Care
Industry
The second part oftiiemanaged-competition strategy involves reforms of the
healtii-care mdustiry itself, driven prindpaUy by poweriul statewide or regional
msurance-purchasing pools caUed HPICs (Health Purchasing Insm-ance
Cooperatives). HPICs would operate sometiiing like the New York Stock Exchange
bringingtogetiierbuyers and sellers and setting rules of trade that, in effect, compel
insurerstocompete on the basis of price and value. These cooperatives would collect
everyone s premiums and help consumers choose among competing insurers and plans
by pubhshing simple, standard information about the benefits and outcomes of every
plan.
The HPICs' new rules of trade for insurance companies would end the
pervasive price discrimination tiiat today denies people coverage or sets their
premiiuns on the basis of their pre-existing conditions. Instead, they would define
a Btendard national package of basic benefite which aU insurers would have to offer
everyone at prices unaffected by a person's healtii status. Insurers would have to
agree to these terms, or lose the right to sell their coverage through the HPICs -- a
serious threat since neariy everyone would pay their premiums through them. And
by agreeing, an insurer will have compete with rivals offering the standard national
package at less cost or with better outcomes, or face the commercial consequences.
These reforms will likely bring about a major shakeout in the insurance
industry, leaving many fewer but better insurers standing. To compete and survive,
insurers will have to direct their business to the providers that have found ways of
delivering basic services efficientiy. And there is no mystery about how these coatsaving efficiencies would be found. Managed competition will produce afiercerush
to HMOs and PPOs, which offer blanket coverage for a per-person price by staff's of
salaried doctors, nurses and other assistants instead of fee-for-service medicine by
physicians and specialists of patients' own choosing.
In theory this strategy packs real economic power; by one reasonable estimate,
a doctor in an HMO can cover two-to-threetimesthe patient-load of private, fee-forservice physicians. Yet, to date HMOs have not spread quickly. Most Americans
prefer choosing their own doctors and most doctors prefer conducting their own
practices ~ and for most people, the incentive to change has been slight since most
HMOs still price their services only a whisker under fee-for-service. In short, so fer
�06-22-03 10:6o.M
?[
DRAFT
mjIOfl have not achieved (or perhaps not yet passed on) tiie cost-saving efficiencies
required to make umversal coverage work witiiout injuring tiie economy.
r-nf. ' ^ ^ . ^ "i??^^ evidence, based on recent experience with tiie healtii plan for
«nd I w n f ^""u r ' ^ " " ' '
™ ° ^
"^^^^
niore efficiently
and cheaply when it is pari; of a managed-competition arrangement witii an HPIC
f n ' r l i L n i t ^ ' competition will help. In addition, economics c a n ^ p ^ d ^ t J ^
additional incentives not only for HMOs to contain coste, but also for HMO doctors
and nursesto recommend fewer and less costiy services. To do so, healtii-care reform
has to confront tiie high levels of uncertainty in American medicine, which promote
the prohferation of costiy treatinente. Doctors and nurses often cannot be cert;ain
how muchtestingand treatinent a patient needs or, more precisely, what services a
patient positively doesnV need. xMany physicians over-prescribe expensive procedures
whetiier or not they practice in HMOs, in order to avoid being sued for not ordering
more services that might prove helpfiil; tiiey also bear no cost for ordering services
that prove unnecessary. To drive-up tiie average HMO's cost-effectiveness, healtiicare reform has to include broad malpractice protection for physicians practicing
standard but not extraordinary medicine, and perhaps incentives for employee
ownership or profit-sharing by HMO physicians and nurses.
^""^ ^® patient's side of the examining table comes the uncertainty, how will
the quahty of care be protected as its quantity and costs are reduced? The answer
IS professionalism. The best way of ensuring that the incentives to cut coste don't end
up denying sick people tiie treatinent tiiey need is to continue to rely on tiie
independent judgment of highly-trained and well-paid physicians, nurses and other
healtii-care professionals. Insurance premiums and co-payment fees have to be set
at levels suffiaent to maintoin ample incomes for tiiese medical professionals, and
doctors and nurses have to retain the independence tiiat professionals expect ~ or
American medicme will have ro settie for people less equipped or inclined to ensure
nigh-quality care.
The Regulatory
Alternatives
The laws of economics demand a great deal of health-care reform -- apparentiy
too much for some who have urged the President to mandate universal coverage and
then contain inflation by directly regulating medical costs or prices. By all the
evidence andtiieorywe know, tiiis politicalfixwould injure both tiie economy and the
health-care system.
The two main regulatory alternatives to market-based reforms are a "global
budget and price and wage controls. Witii tiie first, the government would
determine what share oftiienation's income could go to health care by controlling tiie
levels of msurance premiums. For example, if businesses and workers are required
to pay government-set fees to HPICs to cover tiieir healtii insurance, and these fees
6
�05-22-03 :0::6AM
?G3
DRAFT
^ *
8^ch as payroll coste, medical providers
would have to fiirmsh tiieir services witii tiie resources aUowed by government
Everyone mvolved - doctors and nurses, HMOs and hospitals, insurers and suppUers
- would negotiate or contend for their shai'ea.
Such a global budget will not contain healtii-care inflation for long, because it
doesn t address the inarket pressures driving the prices. If government tiies to limit
tiie resources for healtii care, in effect, by decree, people will continuetodemand high
levels of costly services that can't be covered by the revenues aUowed by government.
mien tiiese resources run out in the eleventh or twelflh montii of tiie global budget
when tiie government guesses wrong about the revenues required to cover quality
treatinent at a paridcular hospital or HMO, in a parincuiar year, for a particular city
. important
.
7
' - ^give.
' ' f - ^ Eitiier
^^^^i.^,
a i/aiuK^uuax
year, lorsoa tiiat
parncuiar
city
sometiung
will
people
wiU go untreated
universal
sometiung
important
will give.will
Eitiier
people
wiU gothan
untreated
so and
tiiat souniversal
coverage
contracte,
or premiums
increase
by more
promised
bust the
coverage
contracte,
or
premiums
will
increase
by
more
than
promised
and
so bust the
global budget, or reimbursements will fail the following year and tiie squeeze
on
global budget,
or reimbursements
will fail
^v^^^/^„r;^^ ,
3 i.i ^
..
revenues
Pinri frenfmisnf
ml]
revenues and treatment will recur.
Price and Wage Controls, versus Qualify Health Care
The second alternative to economic competition is price and wage controls
There IS really no economic tiieory or evidence to support much hope tiiat tiiese
controls could work in tiie healtii-care sector in any recognizable way, To begin, such
conto-ols are virtually impossible to enforce in a sector like health care, with tens of
thousands of separate facilities where billions of annual transactions are carried out,
providing thousands of different services and using tens oftiiousandsof different
goods. Moreover, medical organizations already have demonstrated a protean
capacitytopreserve their revenues and profits in the face of price controls. When the
government froze Medicare Pari>B doctors' charges in the mid-lS80s, physicians
reported tiiat they were visiting ti:ieir patients more frequentiy, shifting to more
highly-reimbursed treatinente, and ordering more tests tiiat required litt;le of their
own time - and total costs continue toriserapidly.
The current controls on Medicare costs - the Prospective Payment System
which pays hospitals at set rates for each illness rather than each procedure -- are
not much more effective. Over the last several years, this system has modestly
slowed down the growth in Medicare costs; but total health-care costs have not been
restrained because hospitals offset their loss in Medicare revenues by raising the
charges on everyone else. Today, hospltels recover about 90 percent of their coste for
Medicare patiente ~ and charge privately-insured people 128 percent of tiie costs for
the same treatinent. And i f the reforms bring the entire sectors under controls,
payments will still depend on the diagnoses over which hospitals, doctors and HMOs
will always retain control.
Price and wage controls also could cripple managed competition. The conflict
�05-^2-93 iO:5DAM
FiO
DRAFT
m^!?n?°fai?%''^''''f
T""^"^ '"^^^^ °^ ^ ™ 0 ' s (or PPO's) operating
SYmS^nt^ ^e.force of managed competition enables HMOstoincreasetiiesupp^
of effiaentiy-dehvered healtii-care, controls would prevent the most efficient HMOs
from negotiating with their suppliers and doctorsforfavorable terms. redudngSeir
savings and undercuttingtiieircompetitive edge andtiiusinhibiting their growtii
^ d by targeting conti^ls onlytohealtii-care,tiie"reform" would d i ^ e l T a S d
other resourcestoindustiies paying higher. unconti-oUed prices and wages, producing
shortages of medical services when more are needed.
pi-ouucmg
Anyway to work price and wage conti'ols needfixedtergetetoregulate; but
and the practices of medical personnel.
If we redly wanttobotii estebhsh universal coverage and slowtiiegrowtii of
H!IT1 ''^'1^° !u"
* i^^ri^S
economy - government contixils can not
aeuyer us from the need to daangetiieways we consume medical care. Once again
most of us wiU have to give up therighttochoose our own specialiste, all but the
truly poor wiU have to pay part of the cost of our insurance and nearly every
Siil^a^^ce
"^^^ ^^""^ ^ ^^^^^'^ ^® ^^^y vo win large judgmente for
Even if we do all this, health-care coste will continue torisefastertiianother
goods and services for some time and not only because insurance will always
insulat^ everyonefromtiiefull disdpline of medical prices. In addition,tiienumbers
of us who are elderly and so require costly-routine care will continuetoincrease, and
the extraor^nanly-costiy AIDS epidemic will continue to spread Perhaps most
important,tiieprocesses by which we achieve technological advances in medical care
will continue to be phenomenally expensive.
Bill and Hillary Rodham Clinton's dear task is to teach Americans that the
government s real responsibility here is not to preserve the current system, nor to
replace it with federal controls, but to reform ite ground rules sotiiatintimewe can
f ^ f T r ^ X " ^ ^'^T^^® ^^^^ <^°^«cti^S spending and value in medical
treatment. Tens of millions of Americans already feel tiiat they can barely afford
health care, and with or witiiout reform most people wiU have to pay even more for
years to come. IftiiePresident and Congress respect the laws of economics as tiiey
reform tiie system, tiie additional burdens on most individuals can help keep tiieir
coverage secure and the economy sound.
8
�June 22, 1993
CSIS'S STRENGTHENING OF AMERICA COMMISSION
DATE: June 23, 1993
LOCATION: 106 Dirksen
TIME: 1:55 p.m.
FROM: Kim Tilley, Candice Waldron
I. PURPOSE
To speak to CSIS's Strengthening of America Commission Meeting regarding health care
reform.
II. BACKGROUND
Although traditionally a foreign policy think tank with an economic focus, CSIS
expanded its scope in 1990 to include domestic policy. This change was made based on
the premise that the United States had to be strong at home before it could be strong
abroad. CSIS consequently created the Strengthening of America Commission chaired
by Senators Nunn and Domenici. It is a bipartisan commission composed of
approximately 50 people pulled from business, labor. Congress, mayors, govemors and
health care experts. Last September, CSIS published its First Report that included a 20
year blueprint for balancing the budget, restructuring the tax code to eliminate its antisaving bias, and investing in human resources. The Commission's focus this year, or its
second phase, is on health care reform.
The Commission's review of the economy led to the conclusion that growing health care
costs are driving the deficit and forcing both the public and private sector to make
injurious economic trade-offs. Believing that remedying the health care situation is
essential to strengthening the economy, the Commission selected health care reform as
its next focus area. Similar to the First Report published as its recommendations on the
economy, the Commission plans to publish a report on prindples to guide health care
reform. The Commission states that its purpose is "not to develop an alternative plan to
the Administration's, but to provide an assessment of the potential fiscal and economic
effects of the plan, offer analytical and political support for those aspects of the plan that
we support, and recommend alternatives for those aspects which we believe would have
adverse fiscal and economic effects."
David Gergen is an original member of this group. Also, Walter Zelman spoke at the
Commission's retreat on May 22 and 23.
�III. PARTICIPANTS
Senator Sam Nunn and Colleen Nunn
Senator Pete Domenici
Ambassador Dave Abshire, President of CSIS (Ambassador Abshire is the former
Ambassador to NATO under Reagan Administration. He founded CSIS 30 years
ago.)
Don Moran, Vice president of Lewis-VHI and former OMB Deputy Director under
David Stockman
Debra Miller, Executive Director of CSIS Commission
Partidpants list follows.
IV. PRESS PLAN
Pool spray during remarks then closed press.
V. SEQUENCE OF EVENTS
Photo w/ David Abshire, Senators Nunn and Domenid and Debra Miller;
Welcome and opening remarks by Ambassador Abshire, Sens. Nunn and
Domenici;
Senator Nunn introduces HRC;
HRC remarks (15-20 minutes);
Q&A, discussion (Senator Nunn will lead the discussion. The participants will be
seated at tables arranged in a square to facilitate the discussion.);
HRC departs;
Don Moran discusses fiscal and economic impact of delivery system reform and
access expansion;
Debra Miller presents draft Commission statement on a vision and prindples for
comprehensive health care reform;
Meeting adjourns.
VI. REMARKS
Given the economic focus of this group, it is recommended your remarks lay the
groundwork for why we need health care reform now, and focus on the shared areas of
agreement (e.g. getting costs under control, guaranteeing health care security, relaying on
the private sector for efficiency and innovation). Talking points and likely questions to
be raised during the Q&A follow.
Ambassador Abshire would probably also appreciate your recognizing the 30th
anniversary of CSIS.
�06/22/93
16:12
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C.S.I.S.
CSIS
CSIS Strengthening of America Commission Meeting
Attendance list
June 23,1993
Senators Sam Nunn (D-GA) and Pete Domenid (R-NM), Co-Chairs
Debra L MiUer, CSIS, C:ommissioii Director
Honored Guest
Hillaiy Rodham Qinton, President's Task Force on Health Care Reform
Commissioners & Additional Members of Congress
Senator Robert Bennett, U.S. Senate
Bfll Brock, The Brock Group
Harold Brown, CSIS
Rep. Jim Cooper, U.S. House of Representatives
Senator John Danforth, U.S. Senate
Senator Pete Domenici, U.S. Senate
John Imlay, Dun And Bradstreet Software
Manny Johnson, Johnson Smick Medley Lifl, Inc., & George Mason University
Senator Nancy Kassebaum, U.S. Senate
Senator Bob Kerrey, U.S. Senate
Rep. Jim Leach, U.S. House of Representatives
Rep. Jerry Lewis, U.S. House of Representatives
Senator Joseph Lieberman, U.S. Senate
Senator Russell Long, Long Law Finn
Diana MacArthur, E)ynamac
Sue Myrick, The Myrick Agency
Al Narath, Sandia National Laboratories
Marilyn Carlson Nelson, C^lson Companies
Senator Sam Nunn, U.S. Senate
Paul O'Neill, ALCOA
Rudy Penner, KPMG Peat Marwick
Tom Pritzker, The Hyatt Corporation
Susan Rasky, U.C. Berkeley
Senator Jay Rockefeller, U.S. Senate
Barry Rogstad, American Business Conference
Rep. Roy Rowland, U.S. House of Representatives
Howard Samuel, AFL-CIO, Indastrial Union Department
Senator Alan Simpson. U.S. Senate
Barrie Wigmore, Goldman, Sachs & Company
1800 KStreetNorthwest. Suite 400 • Washmgcon DC 20006 • Telephone 202/887-0200
FAX.-202/775-3199
121002
�08/22/93
16:13
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C.S.I.S.
Health Care Experts at the Table
Sarah Brown, Institute of Medidne
Lynn Etheredgc, Health Policy Consultant
Michael Hudson, Merck & C^., Inc.
David Lansky, Center for Outcomes Research
Larry Lewin, Lewin-VHI
Alics Lusk, Electronic Data Sj'Stems
Bin McCiatchey, Georgia Health Decisions
Don Moran, Lewin-VHI
Glen Nelson, Medtronic, lac
Alida Pelrine, Engquist & Pelrine
John Rother, American Assodation of Retired Persons
Ray Scheppach, National Governors' Assodation
John Sheils, Lewin-VHI
Deborah Steelman, Law Offices of Deborah Steelman
David Tatum, Charter Medical Corporation
Gail Wilenslg', Project Hope
Bruce Wolff, AETNA Life & Casualty
John ZabrisMe, Merck & Co., Inc.
Zachariah Zachariah, Holy Cross Hospital
CSIS
David Abshire, President
Debra MiLler, Executive Direaor, Strengthening of America Commission
Anne Mutti, Deputy Director, Strengthening of America Commission
John Yochelson, VP., Economic and Business Policy
Dick Fairbanks, Senior Advisor
Invited Observers
John Abraham, American Federation of Teachers
Janet Abrams, Emory University Medical School
James BeU, Procter and Gamble
Demetri Coupounas, The Concord Coalition
Iris Feinberg, ISystems
Mike Galvin, Galvrn Enterprises
Raymond E. Hughes, Rancho Health Care Management
Oakley Johnson, American International Group
Janice Koch, Amwell Rehabilitation Center
Wendy Krasner, McDeimitt, WUl
Candzce LitteH, Health Care Technology Instimte
John Lacopo, Electronic Data Systems
Dan Lubin, KBL Heal± Care
Richard McCormack, C^amp, Earsh & Tate
Michael McShane, TRW, Inc.
Jeanette Miller, Johns Hopkins Medical School
Colleen Nunn
Bob Oswald, Health Insurance Assodation of America
Tom Tiemey, Of&ce of Mayor Norman Rice
Susan Van Gelder, Health Insurance Assodation of America
Mary Ellen Zubay, Dun and Bradstreet Software
@1003
�The American people, and e s p e c i a l l y American business, need for
health care reform to happen sooner rather than l a t e r . The
s p i r a l i n g costs and incredible i n e f f i c i e n c i e s in our health care
system are making American business less competitive, are
bankrupting government at the federal and state levels, and are
causing our people to lack security in their l i v e s .
The Clinton plan w i l l control costs and increase efficiency in
the following ways:
1. We are going to stop micro-managing and over-regulating the
health industry. Instead, we'll move to outcome based t o t a l
quality management for health providers.
2. We are going to go from 1500 different insurance forms to one
insurance form that w i l l be short and simple. Overall, the
paperwork load for hospitals, doctors, and nurses w i l l be
dramatically reduced.
3. We want to move toward a system of twenty-four hour coverage,
so that people are covered under the same health plan no matter
where they get sick or hurt. This w i l l save businesses on
worker's comp costs; w i l l bring simplicity and less paperwork to
providers, businesses and insurers; and w i l l save b i l l i o n s of
dollars i n legal fees.
4. We are going to have as part of our comprehensive benefits
package an emphasis on low cost preventative measures that are
s c i e n t i f i c a l l y proven to pay off i n l e s s dollars spent down the
road.
5. We are going to allow states a great deal of f l e x i b i l i t y i n
administering t h i s new program, because we know that the
demography and geography of d i f f e r e n t states are vastly different
from one another.
6. By providing universal coverage and preventative benefits, we
w i l l stop the cost s h i f t i n g that happens when uninsured people go
to emergency rooms for problems that could have been solved far
e a r l i e r and far cheaper with regular check ups and other
prevention. And i t w i l l mean providers w i l l no longer have to
cover the costs of charity care by passing those costs along to
the r e s t of us.
�MEMORANDUM TO:
Kim Tilly
FROM:
Lynn Margherio
SUBJECT:
CSIS Meeting
June 22, 1993
CSIS's vision for health reform, outlined in their June 18th Decision Draft, largely parallels
the goals of our health reform proposal, including:
Providing all Americans health care security
Controlling the growth of health care costs while ensuring high-quality care
Standardized benefits
Insurance reforms, including community rating
Controlling federal spending
Promoting the use of preventive health care services
Promoting health education
Sound consumer decision making through the availability of performance
reports on competing health plans
Reducing administrative costs through a single claims form
Malpractice and tort reforms
A hard line against those who abuse the system
Individual responsibility
Eliminating laws in states that make it difficult for providers to band together
in networks
Funding basic research
CSIS tends to side with the conservative approach toward health reform. They believe in
market forces over govemment regulation. And, they would prefer a more gradual phase-in
of coverage and a less-generous guaranteed benefits package.
�Their Concern:
"Global budgets for private sector spending couldfrustratethe market's efforts to lower costs
through greater competition. Limiting the rate of increase of insurance premiums would
likely result in price controls as providers and insurers stmggle for some discipline to stay
beneath the artificially imposed target ceiling."
Our Response:
Our proposal doesn't rely on the heavy hand of govemment to squeeze money from the
system; it puts in place incentives and information that make the market work more
efficiently. We're consolidating purchasing power in health alliances, enabling small
employers and their employees to negotiate better prices for their health care. We're putting
consumers in the driver's seat by giving them standardized, easy-to-understand information
about the quality and price of health plans, so that they can make informed decisions about
the health care they receive. We're collecting better information about how health care is
delivered, so that doctors are aware of the most effective health care treatments. These and
other reforms we're proposing will lead to the real savings. Budgets are only a "fail safe" if
these savings take longer to realize. They're our guarantee to employers and employees that
costs don't keep rising uncontrollably.
Their Concern:
"In considering any new or increased levy on businesses to finance reform (particularly
universal coverage), policy makers must take into consideration potential anti-employment
effects."
Our Response:
Today, companies look at their skyrocketing health care bills and realize that they can't
expand — their health care costs mean they can't afford to. Right now auto plants lay off
workers in droves and are stmggling to stay afloat — in part because they are competing
with foreign companies with much lower health care costs. Entrepreneurs wanting to strike
out on their own feel they can't afford to leave their current job because they're afraid they'll
lose their coverage. Our high health care costs are stifling job growth throughout this
economy.
By getting health care costs under control, we're benefitting not only those employers who
already provide health insurance, but those workers who today don't have piece of mind to
perform well on the job.
�Their Concern: How will small businesses be impacted?
Our Response:
The President understands the particular needs of small business. Bill Clinton was reelected
five times in a state where over 90% of our businesses have fewer than 20 employees.
Small businesses that already provide health coverage for their employees will benefit under
our plan. Today, they're discriminated against by insurance companies that charge them more
for less; that jack up their premiums when someone in the company gets sick; that cancel
their policies when they become a bad risk. Our plan will bring down the costs of health care
for these businesses; and it will make sure that they have health coverage at all times, no
matter what happens.
It's tme that some small employers will have to pay more under health reform — those they
don't provide health insurance for their workers today. Instead, other employers pay for their
workers when they get sick and show up in the emergency room. So does the govemment —
we pay hospitals and doctors to treat those people whose employers don't give them health
insurance.
Under reform, we're calling upon everyone — big business, small business, individuals,
govemment — to do their fair share. But, we won't ask them to pay more than they can
afford. We're going to make this a smooth transition so that jobs will remain secure.
Their Concern: Large health alliances will become regulators, stifling innovation and
efficiency in the private sector.
Our Response:
We're building in flexibility into our system precisely to avoid creating a huge new
bureaucracy in Washington. The heart of the proposal is decisionmaking at the local level.
The alliances that we envision will be mn by employers and employees, not govemment
regulators. Their function will be negotiating the best price for their consumers, not to police
the health care system or plan health care delivery. We're paying health plans a capitated rate
for each person they enroll. The plans, with doctors, nurses and patients, will be the ones
that decide what care makes the most sense for the patient's condition, not the health
alliances.
Alliances need to be large so that: 1) we don't create a "poor people's" system; 2) so that
they're able to negotiate good prices for their consumers; 3) spending can be controlled.
�Their Concern: "Short-term or long-term price controls would undermine delivery system
reforms and should be avoided."
Our Response:
We agree that price controls aren't perfect — they lock into place the inefficiencies in our
current system and they may make it more difficult to implement reforms. At the same time,
however, we need to get costs under control in the short term to reign in health care spending
and our ballooning federal deficit. We're working hard to balance these two concerns.
Their Concern: Managed competition and consumer choice work best when there's a stiff
limit on the tax deductibility of health benefits.
Our Response:
The tax cap is one mechanism of managed competition; it's not the only one. One of the
strongest incentives for more efficient care is providing consumers with better information on
price and quality of health plans. Armed with this information, consumers will have an
incentive to choose the lowest-cost plan that meets their standards. This, coupled with a
capitated payment to plans and better information to doctors and other health care
professionals about what treatments are the most cost effective, will provide significant
savings.
j
|
I
•
�CSIS MEETING - PROFILES OF CONGRESSIONAL MEMBERS
June 23, 1993
BACKGROUND:
Tomorrow you are scheduled to meet with the CSIS Strengthening of America
Commission. This group includes 13 Congressional members in addition to a number of
business leaders. With the exceptions of Senators Rockefeller and Kerrey, the rest of the
Senators are moderate to conservative Democrats and Republicans, the type we will need to
reach 60 votes in the Senate. The House members include key conservative southern
Democrats, Jim Cooper and Roy Rowland, as well as a primary moderate Republican target,
Jim Leach. Below arc profiles of CSIS Congressional members. Given your extensive
contacts and the personal relationships you have developed with Senators Rockefeller and
Kerrey, their profiles are not included.
PROHLES;
SENATOR ROBERT F. BENNETT OR-UT) - At 59, Senator Bennett is the oldest member
of the Senate'sfreshmanclass, and enters having made a fortune in private industry. He
cunently serves on the Committees on Energy and Natural Resources, Banking, Housing, and
Urban Affairs, Small Business, and the Joint Economic Committee. Senator Bennett has cosponsored no legislation with significant health policy implications. As afreshman.Senator
Bennett will be influenced by the Republican leadership and the senior Senator from Utah,
Orrin Hatch. Consequently, his support is unlikely.
CONGRESSMAN JIM COOPER (D-TN): Congressman Cooper is a soft-spoken former
Rhodes scholar who is in his sixth term representing his largely mral central and eastern
Teimessee district. A moderate, he has been instmmental in forging compromises on the
Energy and Commerce Committee.
Last term he was chosen to be the lead spokesman for the Conservative Democratic Forum's
health care bill based on the managed competition model developed by the Jackson Hole
Group. Congressman Cooper has expressed concerns that despite the President's endorsement
of the managed competition concept during the campaign, the proposal being developed by
the White House is straying too far from the original managed competition model towards an
approach that has much more in common with single payer or play-or-pay.
He advocates reform without significant government intmsion, opposing price controls or the
extension of Medicare rates to private insurance. He questions whether Congress has the
courage to pass a global budget restricting private sector growth and believes that even if
�passed, it would not be enforced. He is concerned about employer mandates preferring a
voluntary approach to expanding coverage.
Recent Developments: On June 2nd, Congressman Cooper sent a memo to his constituents
interested in health care reform. It is notable more for its tone than its substance. It
negatively describes the general design of the plan criticizing it for watering down the
managed competition elements and elements of the proposed plan which according to Cooper
are causing health care interest groups to line up in opposition. Cooper concludes that there
is still time for moderates to come to the rescue.
SENATOR JOHN DANFORTH (R-MO) - Senator Danforth recently announced his plans
to retire in 1994. Within the Republican Party, Senator Danforth is to cost containment what
Bob Packwood is to mandates. He is the Republican Senator most likely to advocate that
strong federal/state caps on spending must be imposed to effectively contain health care costs.
He states his strong views on this issue repeatedly, despite admonitions from his staff and
other Republicans that such statements are not consistent with the Republican Party line.
He is on the Republican Health Care Task Force and is one of two co-sponsors of Sen.
Kassebaum's BasiCarc Health Access and Cost Control Act. Although willing to support the
need for strong govemment cost regulation, he also believes that to do so would require
explicit rationing - he is a big fan of the Oregon waiver. What is more, unlike most
Democrats, he desires to publicly proclaim that rationing is necessary and something we must
own up to.
At the April 20 Finance Committee meeting with the First Lady, Senator Danforth stated that
Democrats and Republicans are not too far apart on this issue. He also stated that universal
coverage is important, but that it should be phased in over a longer period of time. He
believes the tax cap should apply to both employees and employers and seemed happy with
the First Lady's response to that point. The Senator has been vocal opposing the possibility
of new taxes for health care reform.
SENATOR PETE DOMENICI (R-NM) - Senator Domenici was first elected to the Senate
in 1972. Although a partisan Republican, his willingness to back higher taxes to cut the
deficit has hurt him with fiscal conservatives.
Domenici released a report last October with Senator Nuim that suggested that to control
escalating federal health care costs. Congress should enact legislation by December 1993 to
cap spending on entitlement programs such as Medicare and Medicaid.
He is extremely concerned about the issue of mental health and believes that significant
mental health provisions should be included in the benefit package. He has introduced
legislation to ensure that any reform plan contain mental health provisions.
�On April 29, Senator Domenici attended a briefing on the Hill on Mental Health Issues by
Mrs. Gore. In his remarks, he appeared to indicate that he would support a health care
reform bill but it was not clear whether this could be interpreted as support for the
Administration's plan.
SENATOR NANCY LANDON KASSEBAUM (R-KS) - Senator Kassebaum is the
ranking-minority member of the Labor and Human Resources Committee.
Kassebaum has taken a strong interest in health care reform and has introduced her own
reform bill, the BasiCare Health Access and Cost Control Act (S. 325), which is the subject
of today's meeting. This legislation provides for an individual mandate and tough cost
controls. By capping insurance premiums, the bill presents a major cost containment
departure for Republicans. She would finance this bill by redhecting 1% of the current
Social Security Payroll Tax to pay for health reform. When the First Lady met with the
Senate Women's Caucus, Kassebaum pushed for a national commission, like the base closure
commission, to develop a benefits package (and get around the abortion debate issue). She
concluded that such an approach would provide a one-vote (up or down) cover for members.
Senator Kassebaum has expressed concerns about the health alliances. Specifically, whether
they will remain a non-profit entity or whether they will become government or quasigovernmental agencies. She's interested to know if groups with healthy populations are
penalized for opting out, whether sick groups that opt out will get a subsidy. Kassebaum is
also interested in how the global budgets will be allocated to the states and how these state
budgets will be enforced. Her elderly mother lives at home, so Kassebaum also has a
personal concern about long term care.
While considered a moderate, Sen. Kassebaum will toe the party line if she perceives an issue
is being politicized. If she senses this is happening with health reform, we will have little
chance of winning her support. She is very px)pular in Kansas, even polling better than Dole.
We believe Senator Kassebaum is one of our top Republican chances.
Recent Developments: At the May 4th Labor and Human Resources meeting, she raised
concerns about the use of the $100 billion as an estimate of the program. She fears such a
number could scare away too many members from even taking a look at the proposal.
CONGRESSMAN J I M LEACH (R-IA): Congressman Leach is a moderate Republican
from a farm and industrial area of Iowa. He is very bright and known for intellectualizing
issues. A party maverick. Leach is considered a target but his health views, other than his
pro-choice stance, are unknown. Leach is on the Foreign Affairs and Banking Committees.
Two historical notes: Representative Leach won the seat by beating Edward Mezvinsky now the husband offreshmanRepresentative Marjorie Margolies-Mezvinsky; also. Leach
resigned from the Foreign Service to protest the firing of Archibald Cox.
�CONGRESSMAN JERRY LEWIS (R-CA): Congressman Lewis is perhaps most
noteworthy for the role he has played in the battle between the Michel and Gingrich wings of
the Republican party in the House. An 8 term Congressman and a member of the
Appropriations Committee, Congressman Lewis rose through the Republican leadership ranks
reaching the number three position. While somewhat more politically conservative than
moderate, Lewis is nonetheless identified with the accomodationist wing of the House GOP demonstrated by his support for the bipartisan budget-summit agreement that included tax
increases.
As a result of this vote, (Congressman Gingrich, who strongly opposed the compromise,
backed a challenge to Lewis' re-election as Republican Conference chahman. While this
attempt failed, Lewis was ousted at the start of this Congress by Dick Armey of Texas with
Gingrich's backing. Recently thought of as a potential successor to Minority Leader Michel,
his time now seems to have passed. Lewis has a generally conservative record, with the
exception of his work on environmental issues, a major concern in his district which borders
Los Angeles. Lewis is a former insurance agent and will likely be sensitive to their concerns.
While his specific health views are unknown, his support for our plan is unlikely.
SENATOR JOSEPH LIEBERMAN (D-CT) - Senator Uebcrman is in his first term and is
up for re-election in 1994. Generally, he is supportive of managed competition (he liked the
Cooper Bill) - but has a real problem with global budgets and caps. He believes, however,
that the plan needs to have significant cost containment.
The Senator believes that before the plan is announced, the White House should have a
process to hear people's concerns. He also thinks that it is critical to educate the public so
people understand both the problems with our health system and what solutions are necessary.
He's very concerned we may lose the middle class because of a big new tax. He is
encouraged by what he has heard about the Administration's proposal, but has a wait and see
attitude.
Senator Liebcrman felt more comfortable about the process after the First Lady's presentation
at Jamestown. Interestingly, he raised small business much more than insurance industry
concerns given that Connecticut has such a high concentration of insurance companies. He
feels that if the middle class gets more benefits they will be willing to pay for reform.
SENATOR SAM NUNN (D-GA) - As Chairman of the Armed Services Committee Senator
Nunn's health care concerns will center on treatment of CHAMPUS and other Department of
Defense health programs. Nunn hasn't taken a position on a type of plan. However, he is
extremely opposed to employer mandates. In fact, the Senator states that President Clinton
has assured him the plan will not include employer mandates. He is strongly in favor of tight
entitlement caps. He is unsure how a global budget will work on private spending. As a
Senator from Georgia, he also has strong mral health concerns.
�Senator Nuim co-chairs CSIS Strengthening of America Commission which will soon be
making recommendations on health care reform. Reports are that they are leaning towards a
managed competition type approach with an individual mandate. This sounds like the
Republican plan on which we believe Senator Chafee is working. It is unlikely that they will
support even temporary price controls. It is unclear whether they will endorse the concept of
universality.
CONGRESSMAN ROY ROWLAND (D-GA): A practidng physidan for 28 years and
one of the few health care providers in Congress, Congressman Rowland has a perspective on
health care issues that other members respect. Rowland represents a mostly conservative
district that is very mral. On health care reform, Rowland's positions track elements of
Republican proposals such as establishing Medical IRAs and increased support for
Community Health Centers. Like them, he opposes employer mandates.
He also believes the plan needs to include malpractice reform.
Rowland has also expressed concerns about how HIPCs or alliances will treat difficult to
serve populations, especially mral areas, such as the area he represents.
Rowland sponsored an "anti-hassle" bill, designed to reduce red tape in the administration of
Medicare. He aided drafting legislation to improve the health care delivery system in mral
areas and introduced legislation this year to help people obtain private long-term health care
insurance. The Congressman chairs the Hospitals and Health Care Subcommittee of the
Veterans Committee and will play a major role if there are any major changes proposed for
the VA health system.
Given his profession and his influence with other conservative southern members, Rowland is
one of our top Democratic targets but getting his support will be difficult. Congressman
Rowland voted against Administration's deficit reduction bill.
SENATOR ALAN SIMPSON (R-WY) - Wyoming's junior Senator, Alan Simpson
currently serves as Minority Whip. Simpson serves on the Judiciary, the Environment, and
the Veterans' Affairs Committees, and the Special Committee on Aging. He has taken
partisan positions on most issues but breaks with many Republicans in his pro-choice stance.
Senator Simpson rates the following as his top priorities: state flexibility; mral and frontier
delivery problems; managed competition's applicability to mral areas; and incentives for
medical personnel to serve in underserved areas.
Senator Simpson is currently positioned on the Chafee side of the Senate Republican health
care debate. In a letter to the First Lady in early March, he was very complimentary about
her meeting with the Republican Senators and her mastery of health care reform. He was
notably silent at the May 6 meeting with the Aging Committee.
�THE
VJHITE
HOUSE
WASHINGTON
June 10, 1993
PHOTO-OP WITH SHERRY KOHLENBERG AND HER FAMILY
DATE:
LOCATION:
TIME:
From:
I.
June 23, 1993
Oval Office
4:00 pm - 4:10 pm
Dawn F r i e d k i n ^ j ^
PURPOSE
You and the President w i l l meet with Sherry Kohlenberg, her
husband Larry Goldman and t h e i r son Sammy for a photo-op.
II.
BACKGROUND
You and the President called Sherry in the hospital on June
10, 1993. At that time you promised her a v i s i t to the
White House.
As you remember. Sherry Kohlenberg was one of the Faces of
Hope. She i s fighting cancer. She was receiving Taxol
treatments at NIH, but recently discovered that the Taxol i s
not working. Sherry wrote to you in March and requested
that whatever happens to her, she wants her son Sammy to
meet you. You wrote her back and promised that t h i s would
happen.
Before your photo-op they w i l l have had a f u l l tour of the
White House. After the photo-op, you and the President may
want to invite them to watch the president's next event, the
Presidential Scholars Medallion Ceremony.
I I I . PRESS
White House photographer only.
IV.
PARTICIPANTS
The President
The F i r s t Lady
Sherry Kohlenberg
Larry Goldman
Sammy Kohlenberg Goldman
V.
SEQUENCE OF EVENTS
•
•
•
VI.
Guests w i l l be escorted into the Oval Office.
Greet and photo with you and the President.
Guests escorted from Oval Office.
REMARKS
None required.
�DETERMINED TO BE A.N ADMINISTRATIVE
MARKING Per E-0.12958 as aiMndedj^SM. 3.3 (c)
PRIVILEGED AND ^ M B B ^ ^ M MEMORANDUM
TO:
FR:
RE:
Hillary Rodham Clinton
Chris Jennings, Steve Edelstein
House Single-Payer Meeting
June 22, 1993
Tomorrow you are scheduled to host a meeting of the House cosponsors of the
McDermott/Conyers single-payer bill (H.R. 1200). Congressman McDermott requested this
meeting to give his 83 cosponsors the opportunity to hear your explanation as to why the
President's bill is very similar to H.R. 1200, (as well as to, no doubt, illustrate to you what a
big block of supporters he has for his legislation).
Many of the hard core supporters of a single payer plan appreciate the similarities
between the President's approach and their bill. However, they perceive that the President's
plan does not go far enough in their direction — that it is overly complex and does not take
advantage of the administrative simplicities that would be realized by a single-payer
approach. They also believe that the President should start with as comprehensive and
expansive a proposal as possible so as to energize the rank and file single-payer advocates.
They believe that such an approach would protect the final package as much as possible from
the inevitable watering down that goes along with the Congressional process.
From all reports, your meeting with Senator Wellstone's group of single-payer
supporters went very well. A repeat performance, perhaps with a more political spin, should
be very well received.
FORMAT
According to Congressman McDermott's office, he wants this meeting to be as much a
"working" discussion as possible. McDermott would like to lead off with a few introductory
comments of appreciation for the meeting. Then he will introduce you. At that point, you
may wish to recognize the work that he and Congressman Conyers have done in pushing their
legislation. (If Pete Stark is in the room, you may wish to acknowledge him as well.)
As with most Members, they will want to know about the status of the policy
development and the likely timing for the unveiling. Then, it might be advisable to very
briefly illustrate how our proposal meets the health reform principles (attached again for your
review/use) advocated by Congressman McDermott and his cosponsors. The Members would
then like to throw it open to questions/comments and have a healthy give and take. As of
this morning, it was very unclear how many of the 83 Members will be in attendance.
McDermott's office expects a much smaller crowd and hopes there will be few enough to
arrange the seating in a less formal manner. (It remains very unclear if this can happen if
more than 35 Members show up.)
�All in all, the single-payer Members will be a generally receptive audience. Some
recent articles/news stories about how the delay in introduction has given some special
interests the opportunity to water down the provisions of our proposal (a ridiculous
perception, of course) are making some Members anxious. Similarly frustrating to many of
these Members is the perception that the White House is tuming more towards the right wing
of the Party and potentially setting up an environment in which the Administration believes it
is in its political interest to either reject or take for granted the left wing of the Party. As a
result, some of the meeting participants may be "feeling their oats" and making a stronger
push than they otherwise would. I believe, however, that some reassuring comments from
you will be more than adequate for all or most of these Members. The bottom line is that
most of them tmly want some form of comprehensive health reform, and most of them will
be with you when it is really needed. (They just don't want to be ignored; they want to be
viewed as a formidable and substantive group that should be taken seriously.)
The cosponsors of the McDermott/Conyers bill are notable for both their numbers and
their Committee assignments. The following gives you a quick break down of just who these
Members are and how we currently view them as potential supporters.
The 83 cosponsors represent over one-third of the total number of votes needed for
passage in the House. There are 25 cosponsors who sit on the three primary House
committees of jurisdiction: 4 on Ways and Means, 7 on Energy and Commerce, and
14 on Education and Labor.
Half the cosponsors (41 in all) are members of House caucuses — 29 members of the
Congressional Black Caucus, 8 members of the Congressional Hispanic Caucus and 13
members of the Congressional Caucus on Women's Issues (some are members of more than
one caucus). In addition, 20 are Members serving their first term in Congress.
Attached is a list of the cosponsors, their party affiliation, home state, committee
assignments and caucus memberships. Freshman Members are also indicated. The list is
broken into three categories based on our targeting lists — Reliable, More Inclined, Need
Work.
(1) Reliable -
19 cosponsors who the House leadership believes we can count on as
"reliable" votes for the Administration's plan.
(2) More Inclined - 52 members are categorized as "more inclined," those who are likely to
vote with us in the end but cannot be taken for granted.
(3) Need Work -
11 cosponsors are listed as "need work." These Members will be the
most difficult to get on board and will need significant attention to get
their support.
�RELIABLE:
Abercrombie (D-HI)
-Armed Services; Natural Resources
Ackerman
(D-NY)
-Foreign Affairs; Merchant Marine and Fisheries; Post Office &
Civil Service
Clybum
(D-SC)
-Public Works and Transportation; Veterans Affairs;
Congressional Black Caucus; Freshman
C. Collins
(D-IL)
-Energy and Commerce; Govemment Operations;
Congressional Black Caucus; Congressional Caucus for
Women's Issues
Engel
(D-NY)
-Education and Labor; Foreign Affairs
Evans
(D-IL)
-Armed Services; Natural Resources; Veterans' Affairs
Frank
(D-MA)
-Budget; Public Works and Transportation
Gejdenson
(D-CT)
-Foreign Affairs; House Administration; Natural Resources
Kennedy
(D-MA)
-Banking, Finance and Urban Affairs; Veterans' Affairs
Lewis
(D-GA)
-District of Columbia; Ways & Means; Congressional Black
Caucus
Manton
(D-NY)
-Energy & Commerce; House Administration; Merchant
Marine & Fisheries
Markey
(D-MA)
-Energy & Commerce; Natural Resources
Moakley
(D-MA)
-Rules (chairman)
Pelosi
(D-CA)
-Appropriations; Select Intelligence; Standards of Official
Conduct; Congressional Caucus for Women's Issues
Sabo
(D-MN)
-Appropriations; Budget (chairman)
Schumer
(D-NY)
-Banking; Finance & Urban Affairs; Foreign Affairs; Judiciary
Scott
(D-VA)
-Education & Labor; Judiciary; Science, Space & Technology;
Congressional Black Caucus; Freshman
1
�Studds
(D-MA)
-Energy & Commerce; Merchant Marine & Fisheries
(chairman)
Swift
(D-WA)
-Energy and Commerce; House Administration
�MORE INCLINED:
Andrews
(D-ME)
-Armed Services; Merchant Marine and Fisheries; Small
Business
Becena
(D-CA)
-Education and Labor; Judiciary; Science Space and
Technology; Congressional Hispanic Caucus; Freshman
Beilenson
(D-CA)
-Budget; Rules
Berman
(D-CA)
-Budget; Foregn Affairs; Judiciary; Natural Resources
Blackwell
(D-PA)
-Budget; Public Works and Transportation; Congressional Black
Caucus
Borski
(D-PA)
-Foreign Affairs; Public Works and Transportation; Standards of
Official Conduct
Brown
(D-CA)
-Agriculture; Science, Space & Technology (chair)
Clayton
(D-NC)
-Agriculture; Small Business; Congressional Black Caucus;
Congressional Caucus for Women's Issues; Freshman
B.R. Collins (D-Ml)
-Govemment Operations; Post Office and Civil Service; Public
Works and Transportation; Congressional Black Caucus;
Congressional Caucus for Women's Issues
Coyne
(D-PA)
-Budget; Ways and Means
Dellums
(D-CA)
-Armed Services (Chair); Congressional Black Caucus
de Lugo
(D-VI)
-Education and Labor; Natural Resources; Public Works and
Transportation
Dixon
(D-CA)
-Appropriations; Select Intelligence; Congressional Black
Caucus
Edwards
(D-CA)
-Foreign Affairs; Judiciary; Veterans' Affairs
Faleomavaega
Flake
(D-AS)
(D-NY)
-Education and Labor; Foreign Affairs; Natural Resources
-Banking, Finance, and Urban Affairs; Govemment Operations;
Small Business; Congressional Black Caucus
�Furse
(D-OR)
-Armed Services; Banking, Finance & Urban Affairs; Merchant
Marine & Fisheries; Congressional Caucus for Women's
Issues; Freshman
Gutierrez
(D-IL)
-Banking, Finance and Urban Affairs; Veterans' Affairs;
Freshman
Hamburg
(D-CA)
-Merchant Marine and Fisheries; Public Works and
Transportation; Freshman
Hilliard
(D-AL)
-Agriculture; Small Business; Congressional Black Caucus;
Freshman
Hochbmeckner
(D-NY)
-Armed Services; Merchant Marine & Fisheries
Lantos
(D-CA)
-Foreign Affairs; Govemment Operations
Martinez
(D-CA)
-Education & Labor; Foreign Affairs; Congressional Hispanic
Caucus
McCloskey
(D-IN)
-Armed Services; Foreign Affairs; Post Office & Civil Service
McDermott
(D-WA)
-Ways & Means; District of Columbia; Standards of Official
Conduct (chairman)
McKinney
(D-GA)
-Agriculture; Foreign Affairs; Congressional Black Caucus;
Congressional Caucus for Women's Issues; Freshman
Meek
(D-FL)
-Appropriations; Congressional Caucus for Women's Issues;
Congressional Black Caucus; Freshman
Miller
(D-CA)
-Exiucation & Labor; Natural Resources (chairman)
Mink
(D-Hl)
-Education & Labor; Budget; Natural Resources
Murphy
(D-PA)
-Education & Labor; Natural Resources
Norton
(D-DC)
-District of Columbia; Post Office & Civil Service; Public
Works & Transportation; Congressional Black Caucus;
Congressional Caucus for Women's Issues
Oberstar
(D-MN)
-Foreign Affairs; Public Works & Transportation
Olver
(D-MA)
-Appropriations
�Owens
(D-NY)
-Education & Labor; Govemment Operations; Congressional
Black Caucus
Rangel
(D-NY)
-Ways & Means; Congressional Black Caucus
Romero-Barcelo (D-PR)
-Education and Labor; Natural Resources; Congressional
Hispanic Caucus; Freshman
Roybal-Allard
-Banking, Finance & Urban Affairs; Small Business;
Congressional Hispanic Caucus; Congressional Caucus for
Women's Issues; Freshman
(D-CA)
Reynolds
(D--IL)
-Ways & Means; Congressional Black Caucus; Freshman
Rush
(D--IL)
-Banking, Finance and Urban Affairs; Govemment Operations;
Congressional Black Caucus; Freshman
Stark
(D--CA)
-Ways & Means; District of Columbia (chairman); Joint
Economic
Stokes
(D--OH)
-Appropriations; Congressional Black Caucus
Thompson
(D--MS)
-Congressional Black Caucus; Freshman
Torres
(D--CA)
-Appropriations; Congressional Hispanic Caucus
Towns
(D--NY)
-Energy & Commerce; Govemment Operations;
Congressional Black Caucus
Tucker
(D--CA)
-Public Works & Transportation; Small Business; Congressional
Black Caucus; Freshman
Underwood
(D--GU)
-Armed Services; Natural Resources; Congressional Hispanic
Caucus, Freshman
Velazquez
(D--NY)
-Banking, Finance & Urban Affairs; Small Business;
Congressional Hispanic Caucus; Congressional Caucus for
Women's Issues; Freshman
Vento
(D--MN)
-Banking, Finance & Urban Affairs; Natural Resources
Washington
(D--TX)
-Energy & Commerce; Govemment Operations; Judiciary
Watt
(D--NC)
-Banking, Finance and Urban Affairs; Judiciary; Post Office and
�Civil Service; Congressional Black Caucus; Freshman
Woolsey
(D-CA)
-Education & Labor; Budget; Govemment Operations;
Congressional Caucus for Women's Issues
Yates
(D-IL)
-Appropriations
�NEED WORK;
Clay
(D-MO)
-Education and Labor; House Administration; Post Office and
Civil Service (Chair); Congressional Black Caucus
Conyers
(D-Ml)
-Govemment Operations (Chair); Judiciary; Small Business;
Congressional Black Caucus
Gibbons
(D-FL)
-Ways & Means; Joint Taxation
Hinchey
(D-NY)
-Banking; Finance & Urban Affairs; Natural Resources;
Freshman
LaFalce
(D-NY)
-Banking; Finance & Urban Affairs; Small Business (chairman)
Maloney
(D-NY)
-Banking; Finance & Urban Affairs; Govemment Operations;
Congressional Caucus for Women's Issues; Freshman
Mfume
(D-MD)
-Banking; Finance & Urban Affairs; Joint Econmic; Small
Business; Standards of Official Conduct; Congressional Black
Caucus (Chair)
Nadler
(D-NY)
-Judiciary; Public Works & Transportation; Freshman
Payne
(D-NJ)
-Education & Labor; Foreign Affairs; Govemment Operations;
Congressional Black Caucus
Serrano
(D-NY)
-Appropriations; Congressional Hispanic Caucus (Chair)
Waters
(D-CA)
-Banking, Finance & Urban Affairs; Small Business; Veterans'
Affairs; Congressional Black Caucus; Congressional Caucus
for Women's Issues
�SECT BY:
4-28-93 : 5:11PM ;
CONG MCDERMOn-
202 456 7733:« i l 4
U.S. REP. JEM MCDERMOTT'S
CHECKLIST OF CRITERIA
FOR MEASURING
HEALTH CARE REFORM PROPOSALS
1.
Does it provide insurance coverage to every American?
Nearly 40 million Americans do not have health insurance coverage today. That total
increases by 100,000 each month. An almost equal number (nearly 40 million) are
dangerously under-insured. Any reform proposal must extend quality coverage to
these Americans.
2.
Is that coverage portable, stable and continuous?
A major problem for people who have insurance is the fear that they will lose it if
they move to another job, due to a "pre-existing condition" which won't be covered
under their new employer's plan, or other restrictions and inadequacies in the plan
offered by their new employer.
3.
Is the Standard benefit package comprehensive enough to
prevent the need for a large secondary insurance market which
leads to two-tier medicine and uncontrollable costs?
In a democracy, it is important to have a quality health care system available to all.
If the standard benefit package guaranteed to all dtizens provides only minimal
benefits, then some people will look for a "better deal." People will try to cither
"buy out" of the national system or buy more private insurance. If the standard
package of benefits is a generous one, people will stay in the system, preserving the
ability to control costs.
4.
Does it allow individuals or families to choose their own
physician or other health care provider?
Americans cite the ability to choose their own physician as the single mo.« important
aspect of any heaJtli care plan, even over cost and convenience. They do so by large
margins. One of the fundamental elements of healing is the relationship between the
healer and the patient. If the patient has no choice, you take away an essential
element of the health process.
— more
�SENT BY:
4-28-93 : 5:11PM :
CONG NCDERNOTT-
202 456 7739:# 3/ 4
McDeimott's checldist
page-2-
5.
Does it guarantee coverage regardless of physical condition or
the presence of a pre-existing condition?
Increasingly, insurance in this country is only available for those things for which
you do not need insurance. If you have a cancer, insurance companies will cover
everything but cancer. If you have heart problems, they will cover everything but
heart problems. Any reform plan must correa this fundamental problem.
6.
Does it provide for effective, veriHable cost-containment?
Currently, America's health care system essentially has no cost controls. We cannot,
as a nation or as individuals, afford this any longer. Any reform plan must have
verifiable cost-containment.
7.
Does the cost-containment apply to the entire health care
delivery system without loopholes or exemptions for the
secondary insurance market or self-insured entities?
It is increasingly difficult to control costs and stop wasteful spending if large numbers
of people are "outside the system." To be effective, cost-containment measures must
be applied to the entire health care delivery system.
8.
Is there one simplified federal administrative system that applies
to all Americans, rather than multiple bureaucracies which do
the same thing for different groups?
A central goal of any health care reform plan should be to simplify the system
to make it understandable for ordinary citizens and to make it easier to identic and
eliminate waste. Over-lapping layers of federal bealth caic bureaucracies for s^rate
benefit programs needlessly waste health care dollars. Waste is also an unavoidable
aspect of having 1,500 different private health insurance companies. According to the
GAO, Americans incur nearly S60 billion a year in unnecessary health care costs
simply because of all the different forms and paperwork issued and required by so
many different companies.
9.
Does the health care delivery system enhance access to health
care in rural areas and the inner cities?
More than 35 % of Americans live in rural areas or inner cities. Both have been
chronically under-served by the current health care system. Any national health care
system must correct this inadequacy.
~ more ~
�SOCr BY:
4-28-93 ; 5:12PM :
CONG MCDERMOTT-
202 456 7739:# 4/ 4
McDermott's checklist
page-3-
10. Does it eliminate interference between doctors and patients by
insurance companies second guessing medical decisions and allow
health professionals to make their own medical decisions?
Maintaining America's high quality of health care must be a fundamental goal of
whatever health care reform plan America adopts. The current system's case by case
random reviews, which inserts insurance companies between the patient and the
health care provider through "pie-certification" ret^uiiements for hospital admissions,
length of hospital stays, and even for specific medical procedures, have not been
effective in controlling health care costs. What we need is a system that allows
doctors to make their own medical decisions, but which also teaches them how to
deliver beaer medicine by developing b ^ r practice patterns.
11. Does the system dramatically reduce administrative costs of the
health care budget?
Almost a quarter of all bealth care dollars in America axe consumed by
administrative expenses of insurance companies. This is simply unaccqptable. If we
are to make the kinds of savings necessary to finance comprehensive health care
coverage for all Americans this figure must be reduced. Aiid it can be reduced. For
example, under Canada's "single payer" system, for example, only 3 percent of aU
helath care dollars are consumed by adminisixative expenses.
m
�,
/
/
s
/
DETERMINED TO BE AN AD.V11MSTR.4TIVE
MARKlNGPcrLO. 12958 as amended, Sec. 3.3 (c)
'(
PRIVILEGED AND est^mXSLSitOSL
MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings
Meeting With Representative Andrews
Distribution
June 21. 1993
Tomorrow you are scheduled to meet with Representative Mike Andrews
£ind a group of physicians he asked you to speak with.
Background
Andrews is, as you know, an important member of the House Ways and
Means Committee for a number of reasons: 1) he is a co-sponsor of the Cooper
managed competition bill; 2) he helps us with the conservative Democrats;
3) he Is an Influential voice in the Texas Delegation; and 4) he Is more
pragmatic regarding health care reform than Is Cooper.
As a reminder, he supports a tax cap on benefits and the use of sin
taxes — particularly cigarette taxes — to fund reform. He is nervous about
cost controls, particularly with how they would stall delivery system changes
and competitive positioning so important to the managed competition
approach.
Agenda
Andrews will open the meeting and introduce you. You will then say a
few words about the status of health reform and the importance of input from
the health care provider cormnunity. Following this brief statement, you will
introduce Ira and Phil Lee, and explsdn that while you will have to leave during
the meeting, Phil will stay to continue the discussion. The group will then
make brief presentations. After roughly 30 minutes, you and Ira will leave and
Phil Lee will continue the discussion. The list of attendees and the focus of
their remarks is attached.
While the doctors will address a number of areas concerning physicians,
this group of Texans is primarily concerned with how health reform will affect
academic health centers. It is important to stress that the Administration
recognizes the unique and important role that these institutions fill in our
society, and that we plan to preserve their role in our reform. They have also
submitted a list of questions. Attached are draft responses.
�Topic: Research and Innovation
Question: What are the necessary components In a health care system to
ensure that medical research and innovation continue to make Improvements
in the health of individuals?
Answer: Health care reform will increase funding for medical research, placing
special emphasis on prevention research and health services research.
Preventive research will target areas medical areas or conditions where there is
pressing demand and where breakthroughs promise the greatest return,
including:
Chronic and recurrent Illnesses - Including research on Alzheimer's disease,
cancer, cardiovascular diseases, bone and joint diseases, and other chronic
diseases and conditions.
Pediatric health - Including perinatal health, birth defects and diseases of
childhood, unintentional injuries, learning and cognitive development, and
adolescent health.
Mental Health and Substance Abuse - Including research on mental disorders
in children and adolescents, child abuse and neglect, women's mental health,
mental disorders in racial and ethnic minorities, mental disorders in the
elderly and their caregivers, severe mental disorders, and violence.
Substance abuse research will target vulnerable populations, including highrisk youth, and will study medications development, substance abuse, and the
relationship between substance abuse and women's health.
Infectious diseases - Focusing on new and emerging infectious diseases,
vaccine development, and fundamental vaccine research, as well as on
infectious diseases currently taking societal tolls.
Prevention Research and Resource Development - Basic science providing
foundations for prevention efforts across a range of diseases and disorder,
including behavioral and social approaches, genetics, and drugs.
Resource development will include support for research training, enhancement
of statistical and epidemiologic techniques, and informatics £ind database
management.
�Topic: Centers of Excellence and Provider Networks
Question: How can the new health care system make sure that centers of
excellence have responsibility for the most complex cases £ind are available as
a resource to primary care settings?
Answer: The new health care system will recognize the unique role centers of
excellence play in providing the most innovative and advanced treatments to
patients with rare and complicated illnesses. Health care plems that contract
with alliances will be structured in such a way that does not allow competition
to close them out or force them to compete solely on cost. Alliances will help
establish the special payment provisions and encourage the referrals that will
take place from other plans to these centers.
Topic: Primary Care
Question: What will academic health centers need to do to meet a rise in
demand for primary care health providers?
Answer: We will need a shift the emphasis In training so that academic health
centers offer training toward primary care. We might have to consider
restricting availability of positions for specialist and subspeclallst training to
make primary care practice a more attractive option. Finally, we'll need to
expand training beyond the walls of the hospital and take training to the
community settings where good, responsive primary care will be practiced.
Topic: Graduate Medical Education and Indirect Medical Education Costs
Question: How should the costs and income from tradning new health care
providers be set under the new system?
Question: How should the health care system distribute the additional health
care delivery costs associated with training new physician?
Answer: We are looking to recognize the unique costs of Medical centers
related to training and research, and to create a pool of funds dedicated
specifically to these purposes. We recognize that academic health centers
cannot compete if these costs have to be built into their regular rates. The
pools will be derived from current Medicare payments and from assessments
on premiums paid by regional or corporate health alliances.
�Topic: Clinical Research
Question: How will clinical research be paid for under the new system when
today no systematic funding mechanism today exists?
Answer: We will continue to invest in clinical research and will include
patient-care costs for clinical trials and standard premiums that are
sponsored or approved by the NIH.
Topic: Health Care Report Cards
Question: How will reports on outcomes be adjusted to account for the greater
complexity of cases seen at academic health centers?
Answer: Outcomes aren't accurate gauges of quality if they don't take Into
account the health status of the patient before seeking treatment. This is
called "risk adjusting".
Because of their excellent reputations for treating the "difficult" cases patients who have rare diseases, or who suffer from multiple complications doctors in academic health centers may treat more patients who, simply
because of their condition when they entered the hospital, aren't as likely to
fully recover.
That's why we won't use outcomes unless we have scientific research that
adjusts for those things that will affect a patient's recovery. We want to
compare apples to apples so that we don't unfairly judge an Institution or a
doctor, simply for taking on the most difficult cases.
We know it's going to take some time to get there - - look at New York State
and Pennsylvania and their experience with cardiac bypass outcomes. They
had to struggle with this for many years until they got it right. But. now. after
working with doctors, hospital administrators, and patients, they now believe
they're measuring something that works.
Topic: Quality of Care
Question: How can the quality of health care delivery be assured for the
treatment of conditions like cancer where the medical outcome does not
necessarily reflect the quality of treatment?
�Answer: Quality isn't just the measure of how well a patient feels after surgery
or whether chemotherapy works. It's much more than that. High-quality care
is when a doctor's patients feel at ease in her office; when the patient doesn't
have to wait in lines just to be seen; when necessary treatment is affordable
and close by.
Topic: Outcomes Resesu-ch and Practice Guidelines
Question: How should academic health centers participate in the development
of practice guidelines in outcomes research?
Answer: Academic Health Centers have long been the locomotive pulling us
along the tracks of medical progress. They'll continue to lead the way for us
under reform, developing the practice guidelines and researching outcomes
that will provide the foundations of our quality system.
We're providing more money to support these efforts.
�r
AesMDA yoR
MSETZKO WIXR
riRex
LXDY B Z L L M Y CXIZNTOM
OM REJa.TR CARS RErORK
TUESDAY/ JUNE 22, 1993 »
3t00 F.M.
f' ' I.
Introductions
[
I I . Remarks by First Lady
[i^v
H I . Brief Presentations by the Texas Medical Center Delegation
I'
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A. Denton cooley, KD » centers of Excellence
fi.
c.
Charles Lenaistre, MD — clinical Research and Disease
Prevention
Red Duke, MD — Trauma care and Preventative care
D. Mark Wallace, FACHE ~ Pediatric Health Care and the
Role of Tedching Hospitals
£.
Pat StarcX, PhD —• New Ideas for Meeting Demand for
Primary Care
I I I . Discussion of Academic Health centers and Health Care Reform
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S A A S U a N V
S X I K
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. Ust
DATE
SUBJECT/TITLE
re: Attendees to the White House - Meeting with Hillary Rodham
Clinton on Health Care Reform (partial) (3 pages)
06/19/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefing Memos - First Lady 1993 [3]
2006-0885-F
jp2642
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)l
Freedom of Information Act - |S U.S.C. 5S2(b)|
PI
P2
P3
P4
b{l) National security classified information l(bXl) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA]
b(3) Release would violate a Federal statute [(bX3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information ((bX4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(bX6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes |(bX7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(bX8) of the FOIAl
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA)
National Security Classified Information [(aXl) of the PRA|
Relating to the appointment to Federal offlce |(aK2) of the PRA|
Release would violate a Federal statute |(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |aX5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(aX6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
Rft. Document will be reviewed upon request.
�&TTBVDBS8 TO TRB VKITI X0U8B
Hon. Klchattl A. Andrews
P6/(b)(6)
DOB:
Charles A. LeHaistre, M.D.
M.D. Anderson cancer Center
SB#:
P6/(b)(6)
DOB:
Larry Holntire, Ph.D.
Rice University
Blonechanlcal Engineering
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William Donovan, M.D.
The Institute for Rehabilitation and Research
BS#:
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DOB:
Janes willerson, M.D.
The University of Texas Health Science Center
S8#:
DOB:
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Robert D. Wells, Ph.D.
Director of Institute of Bioscience and Technology
Texas A6M University
Biochemistry and Biophysics
ss#:
P6/(b)(6)
DOB:
Jin cuthbertson
C.E.O.
Texas Heart Institute
B8#:
P6/{b)(6)
DOB:
Denton Cooley, H.D.
Texas JLl^iXi^^lDstit^te
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Janes ''Red" Duke, M.D.
Trauma Expert
University of Texas Health Science Center
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�Bobby Alford, M.D.
Baylor College of Medicine
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William T. Butler, M.D.
President
Baylor_College__of Medicine
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DOB:
0. Howard ?razier, M.D.
Texas Heart Institute
ss#:
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DOB:
David Low, H.D., Ph.D.
University of Texas Health Soienoe Center
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Larry Mathis
C.E.O.
;;aMethodlst Hospital
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Mark Wallace
C.E.O.
Texas Children's Hospital
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Michael Jihn
C.E.O.
St. Luke's Hospital
8S#:
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DOB:
Tom Caskey, Ph.D.
Baylor College of Medicine
Institute for Molecular Genetics
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Richard Wainerdi, Ph.D.
C.E.O.
Texas Medical Center
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�Lois Moore
President and C.E.O.
Harris County Hospital District
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Pat Starck, Ph.D.
Dean
Universitit„of_ Texas School of Nursing
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Bl I
ilter KlBcher
C.E.O.
Hermann Hospital
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Charles Balch, M.D.
M.D. Jmderson Cancer Center
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�ATTENDEES TO THE WHITE HOUSE
Denton Cooley, MD
Texas Heart Institute
Having performed the world's f i r s t heart transplant in 1968,
then the world's f i r s t a r t i f i c i a l heart implant a year
later. Dr. Cooley i s one of the world's most highly
ISa"ff;^agv^lSptn|"€SSRR!quIS"rS?"€n4"r«pSIf aR5 rS^TiSSmSRI
of diseased hearts. Pounder of the Texas Heart Institute,
perhaps the nation's most respected cardiovascular care
center. Dr. Cooley has been awarded the Medal of Freedom,
and the Rene Leriche Prize, the International Surgical
Society's highest prize.
Charles A. LeMaistre, MD
M.D. Anderson cancer Center
President of the internationally-esteemed M.D. Anderson
Cancer Center, Dr. LeMaistre i s also a professor of medicine
and author of numerous articles on respiratory diseases,
oncology, and the health risks of smoking. He i s past
president of the American Cancer Society, a frequent
consultant to the National Institutes of Health, and i s
chairperson of the NASA/NIH Joint Advisory Committee on
Behavioral Research.
William T. Butler, MD
Baylor College of Medicine
President of Baylor College of Medicine, Dr. Butler also
serves as Professor of Microbiology and Immunolooy and of
Internal Medicine. In 1990 he was named Distinguished
Professor. An accomplished educator and administrator. Dr.
Butler i s an acclaimed professional and community leader.
David Low, MD, PhD
UT Health Science Center
Dr. Low i s President of the UT Health Science Center and a
well-respected researcher and author on neurology and the
electrophyslology of the central nervous system. He holds
profeBBoz-Bhipe in the Department of Neurology, the School of
Public Health and the Graduate School of Biomedical Sciences
at the UT Health Science Center.
Bobby Alford, MD
Baylor College of Medicine
Dr. Alford i s Executive Vice President and Dean of Medicine
at Baylor College of Medicine, as well as Chairman of
Otorhinolaryngology and Communicative Sciences. Often
recognized as one of the best doctors in America, Dr. Alford
specializes in otolaryngology research, and has served on
several advisory councils — Including Chairman of the NASA
Aerospace Advisory Committee and the Advisory Committee for
the Redesign of the Space Station.
Charles H. Balch, MD
M.D. Anderson Cancer Center
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�Head of the division of Surgery and Anesthesiology at M.D.
Anderson Cancer Center, Dr. Balch i s a nationally recognized
expert on melanoma and breast surgery. He Is the immediate
past president of the Society for Surgical Oncology and i s a
member of the Board of Directors for the American Society of
Clinical Oncology. He i s also the author of numerous books
and articles.
Pat Starck, PhD
UT Itealth Science Center
As Professor and Dean of Nursing at UT Health Science
Center, Dr. Starck i s a not only an authority on care and
rehabilitation techniques, but also a prodigious author on
the profession and vocation of nursing. She served the
F i r s t Lady's Health Care Task Force.
Ton Caskey, Ph.D.
Baylor College of Medicine
Director of the Human Genome Center at Baylor College of
Medicine, Dr. Caskey ranks as one of the world's leading
researchers in molecular genetics. Chairman and Professor of
Molecular Genetics at the Institute of Molecular Genetics at
Baylor, Dr. Caskey has served on numerous boards and
professional organizations and has authored numerous
articles on inherited disease and mammalian genetics. He
has recently been selected to serve on the National Academy
of Sciences.
James "Red" Duke, MD
UT Health Science Center
A well-respected trauma physician, as well as a professor of
Clinical Sciences and of surgery at UT Health Science
Center, Dr. Duke i s a founding member of the American Trauma
Society and established the internationally recognized
LlfeFlight program at Hermann Hospital, where he remains
medical director of i t s trauma and emergency services. Dr.
Duke i s probably best known for his nationally-syndicated
television segment "Texas Health Reports."
James Wilierson, MD
'
UT Health Science Center
Director of Cardiology Research and co-director of the
Cullen Cardiovascular Research Laboratories at the Texas
Heart Institute, Dr. willerson i s Chairman of the Department
of Internal Medicine at UT Health Science Center. Author of
seven texts and nearly 500 scientific articles. Dr.
willerson also serves as editor-in-chief of ctreulation. the
medical journal of the American Heart Association.
Robert Wells, Ph.D.
Texas ASM university
Institute of Biosciences and Technology
An internationally-recognized authority on the biochemistry
of hereditary processes, Dr. Wells holds the Welch
Foundation Chair in Chemistry and Texas AiM Institute of
Biosciences and Technology. Best known for his work on
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Biological
Diego from
structures. Dr. Wells served as a John Simon
Memorial Fellow at the Salk Institute for
Studies at the University of California at San
1976 to 1977.
William Donovan, MD
Texas Institute for Rehabilitation and Research
Medical Director and Chairman of the Department of Physical
Medicine and Rehabilitation for the Texas Institute for
Kenaoiiirarion ana Kesearcn, ur. uonovan I s a nlgniyrespected clinician and researcher into spinal cord injury
and amputation.
0. Howard Frazier
Texas Heart Institute
A cardiovascular surgeon, Dr. Frazier i s Chief of
Transplantation at St. Luke's Episcopal Hospital and serves
as chief of Cardiopulmonary Transplantation and co-director
of the Cullen Cardiovascular Research Laboratories at the
Texas Heart Institute. Author of more than 200 scientific
articles. Dr. Frazier i s widely recognized for developing
and testing heart assistance devices for patients awaiting
transplantation.
Larry Mclntire, MD
Rice University
Chairman of the Institute for Biosciences and
Bloengineering, Dr. Mclntire i s recognized for his work on
the cellular biochemical systems and processes. Dr. Mclntire
has coauthored more than 300 articles and presentations in
his field.
Larry Mathis
Methodist Hospital
As President and Chief Executive Officer of the Methodist
Hospital System, Mr. Mathls heads one of the country's
largest and most prestigious hospitals. Mr. Mathls i s
currently chairman of the American Hospital Association, and
a member of several national and state health care
organizations.
Mark Wallace
Texas Children's Hospital
Mr. Wallace i s Executive Director and Chief Executive
Officer of Texas Children's Hospital, the nation's largest
pediatric hospital. Texas Children's also has a teaching
a f f i l i a t i o n agreement with Baylor College of Medicine.
Michael Jhin
St. Luke's Hospital
As President and Chief Executive Officer of St. Luke's
Hospital, Mr. Jhln leads a 949-bed tertiary care teaching
hospital that i s internationally respected for i t s cardiac
program and i s a major teaching a f f i l i a t e of Baylor College
of Medicine and the UT Health Science Center.
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�Jim Cuthbertson
Texas Heart Institute
President and Chief Executive Officer of the Texas Heart
Institute, Mr. Cuthbertson heads the country's largest and
well-respected cardiovascular oare oenter. Under Nr.
Cuthbertson'8 direction, the oenter has expanded and
streamlined i t s operations, and i t s operational revenues
have more than doubled.
Walter Mlscher, J r .
Hermann Hospital
Elected to the Board of Trustees of Hermann Hospital in 1980
at age 30, Mr. Mlscher now serves as Chief Executive Officer
of one of Texas' most well-respected teaching and charitable
hospitals.
Lois Moore
Harris County Hospital District
As President and Chief Executive Officer of the Harris
county Hospital District, Ms. Moore administers the
district's three hospitals and ten community health c l i n i c s .
With 5,100 employees, the hospital district i s one of Harris
County's largest employers.
Richard Wainerdi, Ph.D.
Texas Medical Center
As President and Chief Executive Officer of the Texas
Medical Center, Dr. Wainerdi i s administrator for the
world's largest medical education, research and health care
center. Dr. Wainerdi holds several adjunct professorships in
medicine and biomedical engineering and i s the other of
nearly 200 articles on molecular chemistry nuclear
activation analysis.
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�Key Health Care Reform Issues for
Academic Health Centers
Research and Innovation. What are the necessary components in a
health care system to ensure that medical research and innovation
continue to make Improvements in the health of individuals?
Centers of Excellenee and Provider Networks. How can the new
health care system make sure that centers^of excellence have the
responsibility for the most oomplex'flaBe¥" and are available as a
resource to primary care settings? •
Primary oare« What will academic health centers need to do to
meet a rise in demand for primary care health providers?
Graduate Kedioal iduoation. How should the costs and income from
training new health care providers be set under the new system?
Indireot Medioal Edueatloa Costs. How should the health care
system distribute the additional health care delivery costs
associated with training new physicians?
Clinioal Research. How will clinical research be paid for under
the new system when today no systematic funding mechanism today
exists?
Health Care Report Cards. How will reports on outcomes be
adjusted to account for the greater complexity of cases seen at
academic health centers?
Quality of care. How can the quality of health care delivery be
assured for the treatment of conditions like cancer where the
medical outcome does not necessarily reflect the quality of
treatment?
Outeomes RsBearch and Praetice Guidelines. How should academic
health centers participate in the development of practice
guidelines and in outcome research?
�Is there another doctor in the homer
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'Are there several doctors in the house, so -we can have
a little managed competition f
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�DETERMINED TO BE AN ADMINISTRATIVE
MARKlNG,Per EjQ. 12958 as amendi^, Sac. 3.3 (c)
Initials: "^.^ ^ _ Qatf;
PERSONAL AND eONJlillLW W ^ MEMORANDUM
TO:
FR:
RE:
cc:
HUlary Rodham Clinton
June 21, 1993
Chris Jennings
Health Care/Reconciliation Senate Member Meeting
Melanne, Steve, Jerry, Karen, Distribution
Tomorrow afternoon you are scheduled to participate in a meeting with
Senators Kennedy. Rockefeller, Wofford. Dodd, Harkin, Metzenbaum, and
Wellstone. As you know, you are attending this meeting in response to a
request from Majority Leader Mitchell.
BACKGROUND
Last week, the Senate Finance Committee marked up its version of the
reconciliation bill. Within the package was an additional $19 bUlion in
Medicare cuts. These cuts have not been well received by the more liberal
element of the Democratic party and a number of Members have openly
suggested that they will try to reduce the cuts, through amendment, on the
Senate floor.
Senator Mitchell feels very strongly that the bUl passed by the Finance
Committee is the only compromise legislation that can attract a sufficient
number of Democratic votes for passage. He is extremely concerned about
amendments to reduce the Medicare cuts because he thinks their inclusion
severely threatens his ability to pass the reconcilation legislation out of the
Senate.
The liberals in the Senate, however, believe they are all too often counted
on as sure votes because they "have no where else to go." They feel they are
being taken for granted and seem to be flexing their muscles to get more
serious attention focused on them.
Senator Metzenbaum, In particular, has drafted an amendment to
eliminate the additional $19 billion in cuts and substitute an increase in the
corporate tax from 35 to 36. (An increase in the corporate tax by one percent
produces an additional $16 billion.) Joining him in at least talking about
offering such an amendment are Senators Harkin. Wellstone. Simon, and
probably others.
�Senator Mitchell views any such Medicare cut reduction amendment as
a "killer" amendment because its inclusion would likely chase away too many
moderate to conservative Democrats. He is hoping you and Senators Kennedy,
Rockefeller, and Wofford can make progress to convincing Senator
Metzenbaum and the others that, blemishes and all, the Finance-passed bill is
probably the best we can get until we get to the joint House-Senate
conference.
Although the meeting will take place in Senator Metzenbaum's ofilce, he
views Senator Kennedy as the host. (Senator Kennedy called his office up and
suggested the meeting, with the blessings of Senator Mitchell's staff.) As you
know. Senator Rockefeller's office was thinking about hosting this meeting, but
Senator Kennedy suggested that it might be better to hold the meeting in a
non-Finance Committee Member's office.
In this meeting, Senator Mitchell (who will not be in attendance) expects
that Senators Kennedy, Rockefeller, and Wofford will take positions that argue
against any £imendments to reduce the additional $19 billion in Medicare cuts.
Of all the Members present. Senator Rockefeller will no doubt be the strongest
in advocating for no amendments to the reconciliation bill. (Please see
attached comments he made before the Democratic Caucus.) All three,
however, believe that you should stick primarily to the general issue of health
reform and talk about reconciliation bill to the extent it inter-relates with
health reform.
POSSIBLE POINTS TO HIT:
*
We will never get health care unless we pass reconciliation.
The Medicare cuts are difficult and they make this a very tough vote, but
they are necessary to allow us to move on to health reform this year.
Although the Medicare cuts are not insignificant. I believe we can reduce
them in the joint Senate/House conference.
�MEMORANDUM
TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n / P a t t l
C h r i s J./Melanne
C o n g r e s s i o n a l Meetings
Steve, D i s t r i b u t i o n
June 16,
1993
Timeframe/Contact
Meeting
Purpose
P o l i t i c a l Vetting
w i t h Steve R.,
C h r i s J., J e r r y K.
Karen P. Stan G.,
Mandy G. Melanne,
Stan G., J e f f E.,
Steve E.
Sunday June 20th
To reassess c u r r e n t
or Monday, 6/21
p o l i t i c a l environment,
CHRIS J./ext 2645
timing advisability,
l e g i s l a t i v e strategy,
c o n s u l t a t i o n schedule, and p o l i t i c a l
implications of policy.
Senate/House Message
Meeting w i t h
M i t c h e l l , Gephardt,
and 10 o t h e r
Members
To respond t o Daschle's
r e q u e s t f o r HRC t o
meet w i t h these Members
to discuss " s e l l i n g "
h e a l t h care.
Senate/House P o l i c y
discussion with
M i t c h e l l , Gephardt,
B o n i e r , Daschle,
Pryor
To g e t a p o l i c y / p o l i t i c a l Thursday June 24
reads from our c l o s e s t
Congressional f r i e n d s
Contact: Chris J
from t h e l e a d e r s h i p .
(We need t o i n v i t e R o c k e f e l l e r
f o r h i s own b r i e f i n g b/c he i s
not l e a d e r s h i p -- and h i s presence may
a l i e n a t e Chairmen and o t h e r s -- i f i t ever
g e t s o u t , and because HRC promised an
individual, substantive
b r i e f i n g / m e e t i n g . We s h o u l d schedule
t h i s l a t e r i n t h e week.)
Senate Small Business
Committee Meeting.
B i l l Clay
Meeting
Managed C o m p e t i t i o n
meeting
To respond t o Sen.
Bumpers r e q u e s t f o r
a b i p a r t i s a n meeting
to discuss small
business i s s u e s and
health reform
Tuesday a f t e r n o o n
or Wednesday
lunch.
Contact:
Debra S i l i m e o
224-3232
Late i n week o f
June 2 1 s t o r
sometime t h e week
o f June 2 8 t h .
Contact:
Rosi
Smith/224-4843
To d i s c u s s impact o f
h e a l t h r e f o r m on Fed.
Empl. h e a l t h b e n e f i t s
Anytime w i t h i n
n e x t 2-3 weeks.
Contact:
Gail
Weiss/225-4054
Follow-up t o Cooper
request
Week o f June 21st
�
Dublin Core
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Title
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Health Care Task Force Records
Creator
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White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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Congressional Briefing Memos – First Lady, 1993 [3]
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White House Health Care Task Force
Steven Edelstein
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Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SUBJECT/TITLE
DATE
Judy Feder to Ira Magaziner; re: Federal Employee Health Benefits
Plan (4 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefing Memos - First Lady, 1993 [2]
2006-0885-F
ip2848
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�DETERMINED TO BE AN AD.MINISTRATIVE
MARWNG PerE.0.12958 as amended, Sac. 3J (c)
Initials:^ W
n.t.. l ^ / l ^ / I 1
PRIVILEGED AND ^ i ^ ^ ^ ^ f f i J ^ E M O R A N D U M
TO:
FR:
RE:
cc:
Hillary R(xiham Clinton
Chris Jennings, Steve Edelstein
House Wednesday Group
Melanne. Steve, Lorraine, Distribution
August 2. 1993
Tomorrow you are scheduled to meet with the House Wednesday Group.
Originally, Congressman Machtley of Rhode Island suggested a joint meeting
with the House Progressive Group (the Tuesday Group) and the House
Wednesday Group in a conversation he had with Ira. These groups are
generally made up of liberal to moderate Republicans with overlapping
memberships.
The Wednesday Group is very sensitive about their Membership list and
does not, as a rule, meet with people outside their group. Because of this,
they decided against a Joint meeting with the Progressives. However, a number
of the House Wednesday group members are also members of the House Small
Business Committee. They were Impressed by your presentation to the
Committee and thought it would be gcxxl for you to address their group as
well.
BACKGROUND:
The House Wednesday Group has been in existence for over 30 years.
Until recently, it was made up exclusively of moderate to liberal Republican
members. Lately, It has been expanded to more mainstream conservative
members with a cormnltment to doing solid policy. As a whole they consider
themselves good government types, willing to sp)end money or support a
president of another party if it addresses the needs of the American people.
More importantly, they are fairly influential members within the Republican
caucus.
The Wednesday Group has 39 members. It Includes 16 of the members
targeted by the White House or Congressman Bonior as possible Republican
votes on health care reform. Our aim is for 10 to 25 Republicans to support
our plan on the floor. Also of note, six of the members, including
Congressman Kasich and Wednesday Group Chairman Kolbe. were at the
dinner Congressman fCasich hosted earlier this spring. Brief profiles of the
members of the Wednesday Group are attached for you review.
�Last week. Congressman Hobson from Ohio introduced health reform
legislation entitled the Medicaid Health Allowance Act. They consider this to
be Wednesday Group legislation since it was based on one of their reports
called "Bridging the Gap" and because 17 of Its 24 cosponsors are members of
the Wednesday Group.
The bin £iims to control Medicaid costs while increasing coverage to low
income uninsured individuals by allowing states to enroll Medicaid recipient in
private health plans, such as HMOs and PPOs, with proven record for
controlling costs. Plans would have to meet Medicaid benefit requirements and
It would expand coverage to all those under the poverty level. It would be paid
for by redirecting the Federal Disproportionate share paid to states for
uncompensated care in hospitals. A copy of a "Dear Colleague" letter on the
bill, a summary of the bill and the executive summary of "Bridging the Gap"
are attached for your review.
Your meeting with the Wednesday Group will be somewhat of a historical
rarity. The Group very rarely asks someone who is not a member of their
organization to address the group in their ofllciEil Wednesday time slot.
FORMAT AND TALKING POINTS:
Congressman Kolbe will introduce you for brief remarks. After your
remarks the floor will be open for general discussion and questions and
answers. We would suggest opening your remarks with an overview of where
we stand on the development of the plan, followed by a briefing on the plan
with an emphasis on the impact on small businesses and their employees.
You may wish to refer to the side-by-slde chart on small business now and
under reform In you briefing materials. As with the Progressives, it would also
be advisable to talk about our continuing desire to work closely with
Republicans in finalizing the plan and enacting reform.
�Ti-^u
-•
T-Tr-uSE WEDNESDAY
3S5 Fo:d Hou5c Office Bulling. Washington, D.C. 20515
GROUP
OSce: 202-226-32.^6
Fax: 202-225-3637
MEMBERS
1993
r.-)i. Ciin^or
Tor. D:L:y
L'~-:^ Die;.::
i:r,7]'/'i: D'.'r.n
V."i;uc Gilchrcjt
Pc-^c: G - ' ^s" G ur.wL-i .vGri
F:v: Hcrr.
Ft!;': Hc-;I?;r:.
Rick Lazj'o
Jim Leach
Bob Lhingston
Jim N'lcCitr)
Joe McDade
Scott >fc!r.r.ii
Dan Miikr
Coarie MorcIIa
KOD ruriL.^..
Jim Ramsiad
Raiph Reguia
Marge Roukcma
t-,,-,1,,..,
Hen,7 HyJ-;
Lzmzr Smith
Olympia Snowc
Bill Ttomas
Frcxl Upton
�THE HOUSE WEDNESDAY GROUP
CONGRESSMAN TIM KOLBE (R-AZ). Chairman: Kolbe has been in the House since
1984 representing the east side of Tucson, Arizona. His district includes many hightech businesses and defense contractors. Previously he served in tiie Arizona
legislature where he earned a reputation as a moderate spiuring Arizona to finally
enter the Medicaid program. In the Hoiise, he votes consistently with the GOP and
his record on economic issues is among the most conservative. At the same time,
Kolbe is a long time supporter of abortion rights. He sits on tfie Appropriations and
Budget Committees. There is speculation that he may challenge embattled
Democratic Senator Dennis Decondni in 1994
His health care reform views are not known-
CONGRESSMAN DOUG BEREUTER CR-NE): Congressman Bereuter is an
independent Republican who was first elected in 1978. He has a generally
conservative record but is willing to buck his party on occasion- He is interested in
the mechanics of government and sits on the Banking and Foreign Affairs
Committees. He is a member of the Wednesday Group and also served on the Select
Committee on Himger. He is popular in his district which includes the city of
Lincoln.
Bereuter's health care views are not known but he has voted against abortion.
CONGRESSMAN WILLIAM CLINGER (R-PA): Congressman Clinger has
represented northwest and central Pennsylvania siiKe 1978. Rated a party moderate,
Clinger in conservative on economic and foreign p>olicy issues. He is the ranking
member on Government Operations and serves on Public Works and Transportation
as well.
He is part of the Wednesday Group and was a member of the Select Committee on
Narcotics Abuse and Control.
His health care views are not known but he has voted against abortion funding.
CONGRES9V1AN MICHAEL CRAPO fRrlD): (pronounced CRAY-poe) Freshman
Congressman Crapo comes to the House from the Idaho Senate where he was its
president pro tempore, making him the highest-ranking Repubb'can policy-maker in
Idaho. Crapo qmckly aligned himself this year with the freshman reformers and now
sits on the Energy and Commerce Committee. He is a fiscal conservative and won
his east Idaho seat with 61 % of the vote.
While Crapo's health care views are not known, he will be sensitive to the r^eeds of
�his district's farmers.
CONGRESSMAN TOM DELAY fR-TXl: Congressman DeLay represents a heavily
Republican district in Houston and its suburbs. He came to Congress in 1984
following a career in tiie pest control business and the state legislature. A
conservative, he backed Newt Gingrich's more moderate opponent in the race for
minority whip. DeLay serves on the Appropriations Committee and is a member of
the Wedr^esday Group.
While DeLay's health care views are not known, he has voted against abortion
funding.
CONGRESSMAN DAVID DREIER fRrCA): Congressman Dreier is a free market
conservative who believes in federal tax amnesty - a position he refined during his
years as PR director for Qaremont College. While lacking in influence among
Republicans when he served on the Banking Committee, Dreier is now in his second
term on Rules. He is a member of the Wednesday Group. He won his suburban LA
district with 58% of the vote.
Dreier's health care views are not knowrv but he has voted against abortion fimding.
He would like to eliminate the tax on Social Security benefits - a position befitting his
district's affluent retirees.
CONGRESSWOMAN JENNIFER DUNN (R-WAl: A freshman who won her seat in
her first effort at public office, Congresswoman Duim was state GOP chairman for 11
years. Dimn, who supports abortion rights, won narrowly in the primary over an
ardent abortion opponent Dunn won the ger>eral with 60% of the vote against a
businessman who switched parties in the course of the 1992 election cycle. Durm
represents Puget Sound and suburbs of Bellevue. She is a member of the Public
Works Committee and the Wednesday Group. Interestingly, she has not joined the
Congressional Women's Caucus.
Her general health care views are not known.
CONGRESSMAN HAMILTON FISH fR-NYl; The Ranking Member of the Judiciary
Committee, Congressman Fish is well-regarded for his frequent support of liberal
causes. He is one of the White House Republican targets. Fish represents
Poughkeepsie and the southern Hudson Valley. His colleagues on the Judiciary
Committee and his Administrative Assistant who is highly partisan, are influential
with Fish. His wife, Mary Ann, is a moderate Republican and would be important to
include if an effort is made to reach Congressiorial spouses. Fish is a member of the
Wednesday Group.
Fish's general views on health care are not known. He has written to the First Lady
regarding his strong support of chiropractic services in the health reform proposal.
His son has volunteered with a New York program to assist pregnant teenagers, and
�Fish asked the First Lady to meet with them. She did so in Jime. Fish suffers from
glaucoma. He has voted againstreproductiverights.
CONGRESSMAN WAYNE GILCHRESr (R-MD): Congressman Gilchrest is in his
second term, representing a district which has had a turbulent political history.
Gilchrest won with 52% of the vote to hold this eastern shore and Annapx>lis seat He
sits on the Public Works and Merchant Marine Committees, and previously served on
the Select Committees on Aging, including the Health and Long-Term Care
Subcommittee, and Himger. He is also a member of the Wedr^sday Group.
While Gilchresf s general health care views are not known, he is considered a target
by Congressman Bonior.
CONGRESSMAN PORTER GOSS (RrFLl: Congressman Goss represents an
overwhelmingly Republican district with a large elderly population. He was one of
the prime movers to repeal the Catastrophic Act His district has more hospitals
with high concentrations of Medicare patients than any other district in the covmtry.
Goss serves on both the Republican Task Force on Health and on the Rules
Committee.
His health care interests include: malpractice; rural health care; long-term care; and
veterans. Goss has voted to allow abortions in cases of rape or incest, but against
their being performed in military hospitals abroad. He has attended meetings with
both the First Lady and with Ira, including Ira's Republican breakfast meetings. Goss
is a White House target and if supportive of the package, Goss could be helpful with
other Republicans. While usually following the party line, Goss has been more
independent on environmental issues.
CONGRESaVlAN FRED GRANDY (RrlA) - Congressman Grandy's intelligence and
hard work have helj>ed him overcome his image as "Gopher" of "Love Boat" fame.
He is a former congressional aide who is now considered one of the ablest of the
younger generation of House Republicans. Grandy left the Education and Labor
Committee to serve on Ways and Means. He calls himself a "knee-jerk moderate"
and represents Sioux Qty. Many believe he will nm for the Senate at some point
Although Grandy voted against Family and Medical Leave, he remains a White
House target on health care.
Grandy is a member of the Health Subcommittee. He is regularly allied with
business and against labor interests. He has expressed concern about the need for
increased funding for immvmizations. He believes too much money is spent in the
last months of life and is concerned about coverage for self-employed individuals.
He is an abortion opponent In this Congress he has sponsored a bill to provide
basic group health care benefits, and cosponsored Rep. Michel's health care reform
bill and Rostenkowski's Medicare improvement program Grandy attended the
�February Republican meeting with the First Lady and has been attending Ira's
breakfast meetings.
CONGRESSMAN STEVE GUNDERSON fR-WD: Congressman Gunderson is from a
dairy producing area of Wisconsin. He recently broke with the Republican
leadership when he resigned his position as Chief Deputy Whip to Congressman
Newt Gingrich. Gunderson is on the Education and Labor and Agriculture
Committees and serves on the House Republican Task Force on Health. He is a
member of the Wednesday Group as well.
On health care issues, Gimderson is worried that managed competition could fail
rural areas because of the lack of siiffident medical resources. He is also concerned
about emergency services with waivers and outpatient clinics. He is on Congressman
Border's target list
CONGRESSMAN DAVID HOBSON fROH); Hobson was elected in 1990 after a
successful 8 year stint in the Ohio State Senate, which he culminated as president pro
tern. In the state legislature, he was appointed to the Health Committee at an early
stage of his career. Despite his lack of backgroimd on health issues he became
engrossed in the subject and sponsored many health care bills in Ohio including
measures dealing with AIDS, aging and mental health. His comprehensive AIDS bill
was criticized heavily by conservatives, but he pushed it through the Republican
controlled Senate. In the House, he serves on the Budget and Appropriations
Committees.
He has attended (and seemingly appreciated) a number of the Repubb'can Task Force
briefings by Ira. He also attended the dinner meeting hosted by Congressman
Kasich.
CONGRESSMAN PETER HOEKSFRA fR-MI): Freshman Congressman Hoekstra
(pronounced Hoke-stra) won national recognition by defeating Guy Vander Jagt, a
highly visible incumbent and a member of the Republican leadersliip, in the primary.
Hoekstra was a business executive without prior government experience. He is a
conservative who promised to spend only six terms in the House.
Hoekstra is a member of the Education and Labor Committee and is p>art of the
Wednesday Group.
His health views are not known at this time.
CONGRESSMAN STEVE HORN fR-CA): A freshman Congressman with extensive
Washington experience, Steve Horn is a moderate Republican in a district with 50
percent Democraticregistration.Horn is on the Government Operations and Public
Works Committees and a member of the Wednesday Group. He has been designated
a target by both the White House and Congressman Bonior. Horn worked in the
Senate when it was the Republicans who gave crucial support to civilrightsand he
�helped draft the Voting Rights Act of 1965.
While Horn's specific health care views are not known, he favors abortion rights. He
also believes in government and Congress as progressive institutions.
CONGRESSMAN AMO HOUGHTCTvJ (RrNY): The weU-Iiked former CEO of
Coming Glass, Congressman Houghton votes to the left of the House GOP
leadership. Not surprisingly, he is popular in his southern NY district where his
family is the major employer. Houghton has not had much luck with his goal of
convincing the government to run its fiscal affairs like a corporation He is a new
member of the Ways and Means Committee and previously served on the Budget
Committee and the Select Committee on Aging.
On health care matters, he is one of the few House members to vote against repeal of
catastrophic. In this Congress he has introduced HR 196 - "the Health Eqviity and
Access Improvement Act" which provides tax incentives to improve healtii access,
preempt state anti-managed care laws, reform the small group health insurance
market, reform medical malpractice liability, expand ruraJ health programs, create a
new public health program for the r^ar poor, and provide incentives to encourage
preventive services. He has raised corKrems about reducing payments for GME and
is interested in telemedicine. He has also questioned how managed comp)etition will
work in rural areas. With support from his wife and sister, he has voted pro-choice.
Houghton has attended the Republican breakfasts with Ira and is considered a White
House target and priority target of Congressman Bonior. However, he voted against
Family and Medical Leave.
CONGRESSMAN HENRY HYDE (RrlL): While best known for his skill and
creativity at advancing anti-abortion legislation and amendments. Congressman Hyde
is also known for his intellectual honesty and willingness - on occasion - to work
with Democrats. Not always a reliable partisan vote, Hyde has lost out on party
leadership positions which he has sought in the past Hyde is on both the Judiciary
and Foreign Affairs Committees and a member of the Wednesday Group.
While Congressman Hyde's abortion views are all too well known, his opinions on
other health care issues are not
CONGRESSWOMAN NANCY TOHNSON (R-CF) - Congresswoman Nancy Johnson
is a moderate Repubb'can who can also be angrily partisan She supported Newt
Gringrich, an advocate of confrontation rather than cooperation with the majority, in
his contest for Minority Whip. Her tendency to vote independentiy, both in
committee and on the floor, has made it difficult for her to get the committee f>osts
she has sought But in the 101st Congress, she became the first Repubb'can woman
ever to serve on Ways and Means, and she has earned praise for her efforts to craft a
comprehensive package of child care initiatives. With her seat on its Health
�Subcommittee, she has focused on Medicare, health, and child care.
She has been an active member of the '92 Group, a coalition of moderate Republicans
working on ways to set budget priorities and reduce the deficit and served as tiie cochair in the lOOHth Congress. In 1988, she j o i i ^ LoweU Weicker i n an effort to
moderate the GOPs opposition to abortion rights and restore support for the Equal
Rights Amendment i n the party's platform.
Johnson is a strong supporter of outcomes researcK She does not see insurance
reform as the key to cost control. She seems to be leaning toward requiring the
individual to obtain health care coverage. Her husband is an oncologist and she has
said repeatedly that doctors are not the cause of the country's health care ills.
Johnson is a White House target In recent comments, Congresswoman Johnson
expressed her support for folding some of the less controversial aspects of health care
reform, such as insurance reform and establishment of the HIPCs, into the
reconciliation bill so that it can move more quickly. This runs counter to the
prevailing Republican position which opposes such omnibus, "grab-bag" legislation
She indicated, however, cost controls and other more controversial parts of the
package should be voted on separately.
Recent Etevelopmenls: At the Jvme 14 dinner with the First Lady at Rep. Kasich's
home, Johnson stated that cost controls in the private sector are more advanced than
in the government She also expressed her worry that HIPCs would be too big.
CONGRESSMAN TOHN KASICH fR-OH); Congressman Kasich was first elected to
the House in 1982 and re-elected by wide margins ever since. The Congressman is
acknowledged by most to be one of the brightest Members in the House. Yet until
recently, his role in the Congress has been similar to Justice Scalia's on the Supreme
Court — that is, while his colleagues admire his intellect he has not been successful in
influencing them to support his positions.
In recent years, he has made a name for himself by advocating tough measures to
control federal spending. In 1989, he projxjsed a federal budget freeze that would
have held all discrefa'onary spending to fiscal 1989 levels. His 1990 proposal went
further, freezing all domestic and defense spending levels. Both measures received
little support on the House floor. This year he took on the lead in crafting the House
Republican's alternative to the President's budget His proposal was praised by some
in the media for backing up the usual Republican rhetoric, with specific cuts,
demonstrating how it would be possible to significantiy reduce the deficit without
raising taxes. It received more Republican support than his previous efforts, but it
still failed to gain suffident support for f>assage.
Until this year, other than advocating large cuts in Federal health programs and his
opposition to public funding for abortions, he did not appear to have any detailed
�position on health care. In late May, however, he released a "White Paper on Health
Reform" In the report, he took — not too surprisingly — a rather stereotypical
conservative position on health reform, such as the use of MediSave Accoimts,
means-testing Medicare, increasing Medicare benefidary cojjayments, and categorical
spending targets for health entitiements (but not for the private sector).
The "White Paper" also includes a number of suggestions that are consistent witii the
direction the Administration has been heading induding: Developing incentives for
greater use of competition in the Medicare and Medicaid programs, providing
flexibility/waiver authority to the states, reducing health care fraud, assuring
insurance p>ortability, establishing pim:hasing groups, and addressing the medical
liability problem
The report concludes that "two fundamental points emerge from this analysis: policy
makers should not put government first in seeking solutions to the nation's health
care problems; and true reform must indude restoring persor^ responsibility and the
vitality of the doctor-patient relationship. Any reform attempts that circumvent these
fundamental budgetary and economic factors will fail."
Recent Developments: On Jime 14th, Congressman Kasich hosted a dinner for the
First Lady witii some of his Repubb'can colleagues. He was very happy with the
meeting and has been saying quite positive things about the Administration's health
reform effort, espedally efforts to reach out to and consult with Republican members.
CONGRESSMAN lACK KINGSrON (R-GA): Freshman Congressman Kingston
captured a seat previously held by E)emocrats but one which has a solid Republican
base. He won with 58% of the vote in a district which iiKludes the suburbs of
Savannah and rural and coastal areas. A former insurance agent and state legislator,
Kingston serves on the Agriculture and Merchant Marine Committees. He is also a
member of the Wednesday Group. Kingston is a fiscal and sodal conservative who
campaigned promising to oppose all increases in personal or business income taxes.
His health care views are not known.
CONGRESSMAN RICK LAZIO fR-NY): Freshman Congressman Lazio defeated
incumbent Tom Downey with 53% of the vote to represent j>arts of Long Island. A
lawyer and former county legislator, Lazio is a moderate and a White House target
He serves on the Budget and Bar\king Committees. Given the nature of his election,
it is not surprising that he wants to implement wide-reaching congressional reform
His general views on health care are not known. However, he will undoubtedly be
influenced by his wife - a nurse-practitioner at a VA hospital - and his chief-of-staff who worked for former Congressman Gradison Lazio is pro-choice.
�CONGRESSMAN TIM LEACH (R-IA): Congressman Leach is a moderate Republican
from a farm and industrial area of Iowa. He is very bright and known for
intellectualizing issues. A party maverick. Leach is considered a target but his health
views, other than his pro-choice stance, are unknown. Leach is on the Foreign
Affairs and Banking Committees. Two historical rK>tes: Representative Leach won
the seat by beating Edward Mezvinsky - now tiie husband of freshman
Representative Marjorie Margolies-Mezvinsky; also. Leach resigned from the Foreign
Service to protest the firing of Archibald Cox.
CONGRESSMAN ROBERT UVINGTSTCff^ fR-LAl: Congressman Livingston's
forebears helped negotiate the Louisiana Purchase and he now represents the
southeast section of that state. Livingston is a former federal prosecutor with a
combative style who has sought but failed to gain, higher office. He is a member of
the Appropriations and House Administration Committees as well as the Wednesday
Group.
Livingston has voted against abortion funding but his other health care views are not
known.
CONGRESSMAN TIM MCCRERY (R-LAl: Congressman McCrery is a former
Democrat who now wins comfortably in this conservative north Louisiana district It
includes parts of Shreveport and Monroe. McCrery is a member of the Ways and
Means Committee, the Republican Task Force on Health, and the Wednesday Group.
He is said to be supportive of the Heritage Foundation's tax credit proposal for
health care. McCrery opposes abortion except to save the life of the woman.
OONGRESgVlAN TOE MCDADE fR-PA): The senior member of the Pennsylvania
delegation. Congressman McDade is serving his 30th year in Congress. While his
reputation may have been tarnished inside the beltway by bribery charges, his
constituents returned him with 90% of the vote. McDade represents Scranton and
coal mining areas. He is the ranking Republican on the Appropriations Committee.
While he frequentiy votes against his party, it is usually on labor-related issues.
McDade's health care views are not known but he is a White House target He
previously served on the Small Business Committee and may be sympathetic to their
views. A Roman Catholic, he opposes reproductive rights. He can be very difficult
CONGRESSMAN SCOTT MONNIS fR-CO): Serving his first term in Congress after
five in the state legislature. Congressman Mclnnis is a traditior\al conservative. He
won with 56% on the western slope of Colorado, including Pueblo. He serves on
both the Small Business and Natvural Resources Committees and is a member of the
Wednesday Group.
�While his specific views on health care are not known, he will be looking out for
rural areas as well as small business. A Roman Catholic, Mclnnis is pro-abortion
CONGRESSMAN DAN MILLER fR-FL): Congressman Miller is a freshman member
with a business but no political backgroimd. He is on the Education and Labor and
Budget Committees and the Republican Task Force on Health. He is also part of tiie
Wedr>esday Group.
Miller was, and may still be, on the Board of the Manatee Memorial Hospital. Miller
supports a cap for medical malpractice lawsuits, arguing that it is one of the only
ways to get health care costs under control.
CONGRESSWOMAN CONNIE MORELLA fR-MDl: Congresswoman Morella is very
popular both with her colleagues in the House and her constituents at home. A
moderate-to-liberal Republican, Morella's distrid indudes some of the nation's
highest per capita income suburbs, middle and lower-income neighborhoods, as well
as the major federal government health facilities. She sits on the Post Office and
Sdence and Technology Committees.
MoreUa is a White House target In February she wrote to the First Lady regarding
the introduction of H.R 286, a bill to permit certain hospitals to enter into
technology-sharing agreements and thus eliminate duplication of costiy equipment by
neighboring hospitals. After attending the First Lady's meeting with the
Congressional Caucus for Women's Issues, she wrote to Mrs. Clinton concerning: the
need to recognize violence as an health care issue; and the problems relating to the
growing number of women with AIDS who are not adequately served by health care
providers. A Roman Catholic, Morella is prcxhoice and has sponsored the Freedom
of Access to Clinic Entrances Act She will want to vote for the health care reform
package but will need local support in order to do so.
CONGRESSMAN TOM PETRI (R-WI): Congressman Petii, a member of the
Education and Labor Committee, is a moderate to conservative from a heavily dairy
area of Wisconsin He is in the Michel tradition of wanting to work with the
Majority to produce results. While Petri has not been a player in health care, he has
stated his hope that there could be a bipartisan effort to pass meaningful health
reform. For that reason, he is considered a Republican target
CONGRESSMAN ROB PORTMAN (R-OHl: The most junior member of this
Congress, Representative Portman won the seat of Republican BiU Gradison, a man
he once interned for when he was in college. Portman has extensive Washington
experience, including pracb'dng at Patton, Boggs and Blow and Director of President
Bush's Office of Legislative Affairs. Portman won the seat with 70% of the vote. He
is a member of the Small Business Committee and of the Wednesday Group.
�His health care views are not known
CONGRESSMAN TIM RAMSIAD fR-MNl: Congressman Ramstad is in his second
term and came to Congress as a former staffer in both the House and tiie Senate. He
represents suburbs of Minneapolis. He now nts on the StnaU Business and Judidary
Committees. Ramstad replaced Bill Frenzel in the House. Frenzel was moderate but
partisan and Ramstad considers him his mentor.
While Ramstad's general health care views are not known, he is a White House target
and is pro-choice. He has been interested in emergervry medical care for children
He worked on issues involving chemical dependency in young people, cocaine babies
and the handicapped while in the State Senate. At that time he also dealt with a
personal alcoholism problem
CONGRESaVIAN RALPH REGULA (R-OHl: Senior Republican Ralph Regular is
known as a partisan who also works amicably and constructively with the
Democrats. He is easily re-elected in his district which includes Canton and some
rural and Amish areas. Regula concentrates his energies on the Appropriations
Committee. He also served on the Seled Committee on Aging and its Subcommittee
on Health and Long-Term Care. This is his 10th term in the House and he strays
fiom the party line more often than most Republicans.
He is a White House target
In a May letter to the First Lady on behalf of the bipartisan Older Americans Caucus,
he advocated affordable and accessible health care. He stated their hope that the
reform package would "focus on preventative medicine, prescription drug coverage
for all Americans, long-term care coverage, and the role of Medicare." He invited the
First lady to addresstiheCaucus. Regula is most apt to be influence by local groups.
He is anti-choice.
CONGRESSWOMAN MARGE ROUKEMA (R-NT): Congresswoman Marge Roukema
is in her seventh term in the House of Representatives. As a moderate I^publican,
she has backed outiawing the hiring of permanent workers in place of striking
employees, the 1990 Qvil Rights Ad, removing AIDS from the list of diseases which
can exclude immigration and the Family and Medical Leave Act In fad, she was a
Republican leader of the Family Leave bill and opposed President Bush's veto.
Roukema currentiy serves as the ranking Republican member of the LaborManagement Relab'ons Subcommittee of the Education and Labor Committee, chaired
by Congressman Pat Williams. As a former teacher, she has spent most of her time
on the Committee focusing on education issues and her health views are not widely
known However her work on the Family and Medical Leave Ad, as well as other
moderate positions, has made her oi^ of our top Republican targets.
�CONGRESSMAN CLAY SHAW TR (R-TL): Congressman Shaw is a former mayor of
Ft Lauderdale who won in his new distrid with only 52%. Now on the Ways and
Means Committee and a member of tiie Wednesday Group, SIxxw gained a
reputation for fighting crime and drugs when he served on the Judidary Committee.
On Ways and Means, he switched his vote on catastrophic and voted to repeal it in
1989. He has been an ally of Congressman Stenhohn, both believing that parents, not
government should make decisions on child care. The Democrats are trying to
recruit Anthony Shriver to run against St\aw in 1994.
While Shaw's specific health care views are not known, he has voted against abortion
funding.
OONGRESaViAN LAMAR SMITH fR-T>0: Congressman Smith is now serving his
fourth term in Congress. His distrid includes the Austin suburbs and the vast hill
and ranching country of south central Texas. He comes from a raivrhing family and
served one term in the state legislature. Smith is very popular in his distrid and sits
on the Budget and Judidary Committees. He is also a member of the Wednesday
Group. Smith served on the Seled Committee on Children
Smith's health care views are not known but he has opposed abortion funding.
CONGRESSWOMAN OLYMPIA SNOWE (RrMEl: Congresswoman Olympia Snowe
is in her eighth term and represents that northern half of Maine. She was elected
when then-Congressman BiU Cohen dedded to run for the Senate. &\owe has served
as an effective member of the House, working with both sides of the aisle to find
common groimd. She currentiy serves as co-chair of the Congressional Caucus on
Women's Issues.
At times, she can be a liberal Republican working with members like Pat Schroeder
and Barbara Boxer on abortion issues and fetal tissue research At other times, she
can be stridly partisan, aligning herself with Congressman Kasich on the budget
committee and one of Newt Gingrich's biggest supporter in his run for Majority
Whip. She is a White House target
Congresswoman Snowe is also energized by local issues. A knowledgeable moderate
Republican tells us that the best way to get her vote is to have local groups bring
pressure on her. While it is assumed that &\owe will want abortion coverage in the
final package, she did not co-sign the May 13 letter on that issue. She is married to
the Governor of Maine, John R McKeman.
Recent Developments: At the dinner the First Lady attended at the home of Rep.
Kasich in June, Snowe advocated everyone paying and phasing in the burden on
small business. She believes everyone should be sent the message on responsibility.
�CONGRESSMAN BILL THCHVIAS (R-CA) - The Ranking Republican on the Ways and
Means Health Subcommittee, Congressman Thomas is an assertive partisan who
wants Republicans to offer dear alternatives to Democratic polides. A dose friend of
Rep. Gingrich, ThomasrepresentsBakersfield - an area with agribusiness and
aerospace and defense industries. He has been hoiK>red by the National Federation
of Independent Business.
Thomas serves on the Republican Task Force on Health. In February he wrote to the
President outlining his concerns about health care. While recognizing the need to
control costs, he did not want to do so at the expense of Limiting consumers choice or
stifling research. He also believes tiiat government controls lead to short-term
savings at the expense of optimal care and long-term ineffidendes which raise costs.
He supports incentives to allow all working Americans to purchase health insurance
and improved programs for low-income families and people on fixed incomes. He
sought discussion of the availability of quality health care in rural and large urban
areas. He wanted long-term health care addressed.
Thomas outlined his step« forreallocatingfederal resources to improve health care,
reducing health care delivery costs while increasing availability, and enharidng the
role of the consumer in health care.
Thomas attended the February Repubb'can meeting with the First Lady and has also
attended the breakfast meetings with Ira. Thomas has voted forreproductiverights.
CONGRESgVlAN CRAIG THOMAS fR-WY): Congressman Thomas holds former
Secretary of Defense Cherry's at-large seat Thomas's voting record shows him to be
one of the most conservative members of the House. He grew up in Cody with
Senator Simpson and worked for both the Farm Bureau and the Rural Electric
Assodation Thomas serves on the Banking and Natural Resources Committees and
is a member of the Wednesday Group.
Thomas's health care views are not known but he has voted for funding abortion in
cases of rape or incest He will clearly also be looking out for rural interests.
CONGRESaVIAN FRED UPTON (RrMI): Serving his fourth term in the House,
Congressman Upton is a protege of former Budget Director Stockman- Upton
represents the southwest comer of Michigan, an area of small manufacturing dties.
It is a conservative and Republican area in which he is popular. Upton is a member
of the Energy and Commerce Committee and the Wedniesday Group. He is known
to listen closely to local groups.
While Upton's health care views are not known. Congressman Bonior considers him a
priority target Upton supports abortion to save the life of the mother and in cases of
rape or incest
�AUG
3 '93 16:35
DAVID L H O B S O N
7TM DiSTKtCT. OHIO
coMMrnccj
APPROPRIATIONS
FROM HOUSE UEDNESDPY GRP.
^
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BKTnCT OmCES:
moM no ^o^^ omci
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BUDGET
STANBARPS Of OFFICIAL CONDUCT
PftGE.002
WASHMCTON o m c t
CONGRESS
^ ^ ' ^ « " C i » i3 OF
V / T THE
I PI C UNITED
U IX I I C L / STATES
O IM I CO
•~-o««^u„.,
pi.tt^.,.
HOUSE OF REPRESENTATIVES
"'^iSST*..*^
July 20.1993
THE MEDICAID HEALTH ALLOWANCE ACT OF 1993
Dear Colleague:
Today there is a serious gap between all-or-nothing Medicaid eligibility and private insurance
coverage. The people trapped in the middle - mainly the working poor - do not qualify for
Medicaid and cannot afford insurance.
"The Medicaid Health Allowance Act" is an important step toward bridging that gap. It
enables States to redirect Medicaid funds into Health Allowance Programs that enroll eligible
individuals in private-market healtn plans. This approach has several benefits.
Increased Access to Health Benefits. Every individual and family with income below
100 percent of the Federal poverty line will have access to several health benefit plans
that are guaranteed to be at least as good as Medicaid. In 1991, more than 10 million
persons below the poverty line were uninsured and not covered by Medicaid.
Cost Control States will redirect Medicaid funds into existing health systems that are
proven to hold down medical inflation, in some cases to the rale of general inflation.
These systems - HMOs, PPOs, managed care -reduceadministrative cbsts, promote
preventive care, and route beneficiaries to aK>ropriate care. In contrast, most
Medicaid is fee-for-service, and recently has grown more than 11 percent each year.
Welfare Reform. Current Medicaid eligibility is linked to other public assistance
programs so that welfare recipients who choose to workrisklosing their health
benefits. Under Health Allowance Programs, eligibility for health benefits will be
"decoupled" from public assistance, and incentives to work will be preserved.
Siare Flexibility. States will be givenflexibilityto meet local health needs. Many
States are ready to do this now. Arizona already operates a successful Medicaid
managed care program, but has to renew its Federal waiver to do so everyfiveyears.
Kentucky, Tennessee, Oregon and Hawaii have requested similar waivers.
Insurance Standards. States that want to adopt a Health Allowance Program must meet
mmimum insurance standards related to pre-existing conditions and guaranteed
renewability of insurance coverage. A majority of States already have enacted reforms
targeted toward the private insurance and the small employer group markets.
*•
Budget Neutrality. Currently the Federal government pays States to reimburse
hospitalsforthe cost of uncompensated care. Health Allowance Programs wUI
increase access to compensated care, and reduce instances of uncotnpensated care On
a State-by-State basis, the additional cost of expanding access to care is offset u$in£ a
matchmg decrease in Federal payments for uncompensated care
�The Medicaid Health Allowance Act" bridges the gap between Medicaid eligibility and
.aSordablc hca^th-Hmfrance^^ong themej thafhave emergeffas important to successful hcaltft""
are reform - increased access to care, cost eflTectiveness, minimum Insurance standards,
consistency with welfare reform, Stateflexibility,and. as t wdcome bonus, btidget neutraUty.
I hope you will join me as a oosponsor of The Medicaid Health Allowance Act." If you have
quesuons, or want to confirm your cosponsorship, please call me or Greg Moody at ^5-4324.
^ \ Sincerely,
DAVID L. HOBSON
•mis STATIOHt«r > w r t C OK ^AftH MAOf Of RiCrcUO F(BCRS
�fiUG 3 '93 16:3B
FROM HOUSE WEDNESDAY GRP.
PAGE.003
THE MEDICAID HEALTH ALLOWANCE ACT OF 1993
^'jf^dlcaid Health Allowance Aa enaUcs Statu to expand eligibflltyformedical nsistancc to 100 percent of
»c Federal poverty line and to control health care costs by redirerting Medicaid funds into Health Allowance
Programs that enroll eligible individuals in private-aarkit health plans.
I. n i L HEALTH ALLOWANCE PROGRAM
A. TM Health Allowance Program allows States to provide eligible individuals with a health allowance to
obtain an approved health benefit plan in the private insurance market.
B. The program affects the acute care portion of Medicaid only, and has no affect on long-tenn care.
C. The program takes the place of direa Medicaid reimbursemwits, and is payable to individuals' health
plans, including employer-based plans.
II. THE HEALTH ALLOWANCE PROGRAM BENEFIT PLAN
A. Health Allowance Program benefit plans are approved by States according to Federal and State standards.
B. State-approved plans must at least equal die actuarial value of a State's current Medicaid benefit package.
C. State-approved plans must include at least one health maintenance organijation (HMO) or other plan that
uses a capitated system of payments.
D. State-approved plans must conform to current State copayment requirenwnts under the Medicaid program.
111. ELIGIBILITY OF A STATE TO ADOPT A HEALTH ALLOWANCE PROGRAM
A, Eligibilit>' of a State to adopt a Health Allowance Program is determined by the Secretary of Health and
Human Services based on an application process set up by the Secretary.
B. Eligihility of a State is dependent on that State meeting certain quality assurances and insurance standards
and on the scope of the State's Health Allowance Program. Specifically, a State must:
1. Adopt and enforce quality assurance standards for health benefit plans participating in the Health
Allowance Program;
2. Guarantee minimum insurance standards related to pre-existing conditions and guaranteed renewability,
and price ranges for similar health benefit plans whhio the State; and
3. Offer the Health Allowance Program Statewide, with an allowable transhion period of three years.
IV. ELIGIBILITY OF AN INDIVIDUAL TO RECEIVE A HEALTH ALLOWANCE
A. Any Individual or family is eligible to participate in i Health Allowance Program If their income does not
exceed 100 percent of the Federal poverty line.
B. Any individual or family with income befween 100 and 200 percent of the Federal poverty line is eligible
to "buy in" to a Health Allowance Program, with government financial contributions phased out by 200
percent on a graduated scale set by the State. Employers may buy in to this program, and may make
contributions on behalf of employees.
C. Other criteria for eligibility will be determined by the State, except that a State may not exclude any
individual who is categorically eligible for Medicaid, and may not require an individual to meet anv
resource standard.
�A The financial contribution of the Federal government for a State that operates a Health AHowaoce Program
equals what would have been paid to that State under ks current Medicaid program.
B. The higher cost of (^>erating a Health Allowance Program is covered by diverting all or a port'ion of
existing disproportionate share PSH) payments to the Health Allowance Program. DSH payments are
reduced by an amount equal to the cost of the Program oo a State-by-State basis. This provision ensures
budget neutrality.
V. EVALUATIONS AND REPORTS
A. The Secretary of Health and Human Services will evaluate the impact of the Health Allowance Programs
on increasing the number of individuals with health insurance coverage and in controlling costs of health
care, and submit a repon on the Progranis to Congress.
�AUG
3 '93 16:33
FROM HOUSE WEDNESDAY GRP.
PAGE.006
Spon.so!^ of Ntedicaid Hefltth Atlowanpg Art
(as of July 27, 1993)
Rep. Dave Hobson (Ohio-7)
U;tD. aeeup
Rep. Michael Castle (Delaware-at large)
Rep. Bill Clinger (Pennsylvania-5)
Vol.p. ^ C o o ^
Rep. Paul Giilmor (Ohio-5)
Rep. Newt Gingrich (Georgia-6)
Rep. Porter Goss (Florida-14)
Rep. Fred Grandy (Iowa-5)
Rep. Steve Gunderson (Wisconsin-3)
Vo^D.
^(toop
Rep. Nancy Johnson (Connecticut-6)
Rep. John Kasich (Ohio-12)
K)6D. 6 C o u p
Rep. Jack Kingston (Georgia-1)
WiD.
^eoop
Rep. Jin: Kolbe (Arizona-5)
Rep. Rob Portman (Ohio-2)
Rep. Ralph Regula (Ohio-16)
Rep. Pat Roberts (Kansas-1)
WiD.
^(toup
WiD. ^ < ^ p
Rep. Olympia Snowe (Maine-2)
Rep. Bill Thomas (California-21)
Rep. Craig Thomas (Wyoniing-at large)
lofcp. ^Sdop
�AUG
3 '93 16:39
-
FROM HOUSE UEDNESDAY GRP.
PAGE.008
THE HOUSE WEDNESDAY GROUP
CONGRESS OF THE UNITED STATES
J86 Ford Home Office Building, Washingtoc. D.C 20515
Office: 202-226-32J6
fax: 202.225-3637
BRIDGING THE GAP
Health Care Coverage for Low-Income Families
March 30. 1992
Suramary a t t a c h e d .
I f you would l i k e f u l l documnent,
c o n t a c t Joyce McGarry at (202) 225-4324.
please
�AUG
3 '93 16:40
FROM HOUSE UEDNESDAY GRP.
PAGE.009
EXEOmVE SUMMARY
The shortcomings of today's Medicaid program call for a meaningful mtructoring to
better serve iow-ineome indJvidittb and families. This paper attempts to foctu the debate over
health care reform by highlighting several inherent problems of the Medicaid program and
proposing a strategy for improving access to health care for the nation's poor.
The ideas in this paper provide a more detailed disctmion of reform initiatives which
were first raised is the Wednesday Group paper "Moving Ahead: Initiatives for Expanding
Opportunity in America," released in October, 1991. Improving access to health care for lowincome families furthers a central theme of the reforms presented in that paper • that of
promoting independ'snce from welfare.
In this paper, we have concluded that two design innovations are imperative: 1) the
Medicaid prograjs or its replacement must be severed from its eligibility links with other cash
assistance and entitlement programs; and 2) there must be a stronger public and private
partnership to administer and deliver health care for the poor and near poor.
The direction for public policy suggested here is an attempt to bridge the gap between all
private or all Q.ubjj.c health insurance. We believe that having either all private or all public
coverage should not stand as muttiaJly exclusive alternatives to having no coverage at all.
Specifically, this paper calls for state projects to be established to show the effectiveness of a
sliding-scale health insurance allowance program that would have Medicaid work with private
insurance, rather than substitnte for private insurance. We believe that a sliding-scale health
insurance allowance will address the basic problems with Medicaid and make the program work
bener.
A health insurance allowance is a subsidy payment from the state government to an
individual, employer, or insurer, to purchase health insurance. In conjunction with state income
taji changes, a tax credit would provide each individual or household a reduction in tax dollars or
a tax refund after they purchase health insurance. Alternatively, the states could pay subsidies to
individuals, employers, or insurers to purchase health insurance. Our proposal suggests that
matching federal dollars should be available through the current Medicaid program to
demonstrate the value and workability of such health insurance allowance schemes.
The current gap between all-or-nothing Medicaid eligibility and private insurance
coverage can be bridged with a seamless program of support adjusted for income. The concept
of "seamless" refers to eliminating the current gap between those who have Medicaid and those
who have private coverage. With support on a sliding-SCale, the transition from public to private
insurance is facilitated for those whose income rises above the threshold for the full health
allowance.
lo our proposal, states would establish their own health allowance programs. Managed
care providers, particularly health maintenance organizations, would bid to participate in the
program with payment at a predetermined capitated rate. This capitated rate would be indexed
with inflation. The proposed health insurance allov^ce would be used by beneficiaries to
purchase health care coverage from one of a group of state-approved plans. Because of the oost
containment benefits, states would be required to offer at least one managed care plan.
�AUG
3 '93 16:41
FROM HOUSE WEDNESDAY GRP.
PAGE.011
rnntrni rft<t Better - The State's costs should be easier to convol under a health insurance
allowance system, because the state will no longer participate in the open-ended fee-forservice system of health care. In addition, the incentives inherent in prepaid care plans to
avoid unnecessary care and to coordinate care lead them to control costs and ensure
access.
Enhance Individual Resty)nsibiHtv - Providing B health insurance allowance directly to
individuals gives them greater control over their lives. The state governments will
provide the necessary educational information so that individuals will be able to make
responsible choices in purchasing health insurance.
�AUG
3 '93 16:41
FROM HOUSE UEDNESDAY GRP.
PAGE,010
Eligibility for the program would be based on income and family lize and be independent
of other entitlement programs - greatly simplifying the current eligibility rules and thus helping
the many Americans now without health insurance. States would reform their eligibility criteria
over time; a goal could be for individuals and families with incomes less than 100 percent of the
federal poverty level to use the full voucher amount to participate in the contracted plans.
Those whose income qualines them for the sliding-scale voucher amount, would also be able to
participate in the state-approved plans, or they could choose to use the credit towards the
purchase of their own insurance.
The speed of reform would depend on the capacity of the individual states and their
providers to absorb the changes. Each «ate would control its own pace of change, with the
flexibility to suit its own circumstances. An important part of this proposal is that states would
move beyoLd the limited demonstrations of pilot projects that are presently underway.
We propose to establish statewide projects immediately, in order to document the
effectiveness of various health insurance allovomce programs as well as to identify their
weaknesses. The federal role would be one primarily of oversight and providing partial matching
funds; the plan would be administered by the individual states. If proven effective on the sttte
level, aspects of the state programs would deserve attention on a national level.
We believe that our proposal addresses many of the problems of Medicaid, because it
would do the following:
•
ExoaadJEliaibil^ty - A system offering the states both flexibility and federal matching
dollars for a health insurance allowance to all individuals and families will allow states to
eliminate Medicaid's restrictive eligibility categories. The use of a gradually diminishing
subsidy -- rather than the present all-or-nothing eligibility — will make the program
available to those needy individuals who are now frequently excluded from Medicaid.
•
Improve Access to Care and Offer More Choice to Consumers - Currently. Medicaid
t>eneficiaries cannot use physicians who do not accept Medicaid; because of this, there
are significant limitations on choice of care providers. While the individual amount of the
state health Lcmiraoce allowance will determine which plans individuals can buy, their
access to care can be contractually required. Abo, the insurance allowance will stimulate
competition among providers of health care; this should increase choice to Medicaid
consumers. Additionally, individuals or their employen have the option to supplement
the allo«'ance to buy a more complete insurance policy.
•
Offer a Seamless Fabric of Publie-to-Private Insurance - The sHding-scaJe robsidy
facilitates movement between public and private support, so that low-income workers
whose incomes rise above the threshold for the full health insurance allowance will ttill
qualify for a percentage. This partial allowance could be used in any health Insurance
which is offered by an employer. The sliding-scale health allowance removes what some
would argue is an incentive to staying on welfare continued Medicaid coverage ~
because health insurance will be available independent of other welfare programs. A
family could purchase, with the government's help, the same health care coverage it had
when receiving the allowance.
�36 Million People Below Poverty Level
Insurance Coverage of Poor, 1991
The "Gap"...
Uninsured
Million people
29%
CL
OC
>
a
a
U'l
ill
z
o
in
Medicaid
17 Million people
47%
Other
.7 Million people
2%
ID
O
I
o
a:
Employer-Provided
4 Million people
11%
m
CO
ID
Medicare
5 Million people
13%
a
» l»r,.e..tuRcs ropicsciit
share u f t o t » l
pot.u I a t i on
tiindcr
(unJc
poverty
level)
coicrcJ
l»»
�Copyright 1993 Roll Call Associates
Roll C a l l
July
22,
1993
HEADLINE: Will Rhode Island Send Congress Yet Another Kennedy?
BYLINE: By Charles E. Cook
Anyone who stumbled i n t o the National Democratic Club Tuesday
night saw a very unusual s i g h t : House M a j o r i t y Leader Richard
Gephardt (D-Mo) was hosting a $500-per-person fundraiser f o r a
26-year o l d Rhode Island s t a t e l e g i s l a t o r who has not yet
announced h i s candidacy f o r what could be a contested Democratic
primary t o oppose Rep. Ron Machtley (R-RI).
Making the scene even more curious was the presence and
support of state House Speaker John Harwood (D) and s t a t e House
M a j o r i t y Leader George Caruolo (D), both of whom supported
Machtley's l a s t serious Democratic challenger, Scott Wolf, i n
1990. Wolf s t i l l professes t o be s e r i o u s l y considering runningfor
the seat next year i f Machtley runs f o r governor, as many expect
him t o do.
That the reception Tuesday n i g h t was a b i g success should be
no surprise, given t h a t the honoree was s t a t e Rep. P a t r i c k
Kennedy (D), son of Sen. Edward Kennedy (D-Mass) and nephew of
the l a t e President John F. Kennedy and Sen. Robert F. Kennedy
(D-NY), A f t e r high school, Kennedy moved t o the s t a t e from
McLean, Va., t o attend Providence College. He soon defeated an
incumbent Democratic state Representative i n 1988 a f t e r also
winning a delegate s l o t e a r l i e r t h a t year t o the Democratic
National Convention.
There's no doubt the young Kennedy w i l l be able to raise an
enormous amount of money for his campaign and command
considerable media attention, but i t ' s unclear what kind of race
he w i l l face. A statewide Brown University poll released e a r l i e r
this week reinforces the view of many that Machtley, who turned
45 years old l a s t week, w i l l not seek re-election and instead
make a gubernatorial bid.
In the survey, conducted July 15 to 18 of 422 registered
voters, 73-year-old Gov, Bruce Sundlun (D) was given an
"excellent" or "good" job rating by just 27 percent of the
voters, while 71 percent characterized his job as either " f a i r "
or "poor." Just 25 percent said Sundlun deserved re-election,
while 61 percent said he did not.
Kennedy's objectives at this stage are obviously to clear the
Democratic primary f i e l d of anyone of consequence, then run hard
in the general election - which could be anything from a tough
campaign against the well-regarded Machtley to a Cakewalk
open-seat general election in a state with a shallow GOP bench.
Much of Kennedy's t r i p here seemed designed to force other
Democrats out of the race, with the Gephardt endorsement and the
backing by the two state Assembly leaders sending a signal that
the f i x i s in, that the party w i l l get behind Kennedy early
without waiting to see i f anyone else chooses to run. I t
�may or may not work, but i t was certainly an in^ressive attempt.
Wolf, 40, narrowly missed unseating scandal-plagued House
Banking Committee Chairman Fernand St Germain in the 1988
Democratic primary. St Germain in turn lost to Machtley, then an
attorney in private practice, in the general election. Two years
later. Wolf secured the Democratic nomination to face Machtley
but lost, 55 to 45 percent, i n the general election.
Wolf, c u r r e n t l y Sundlun's D i r e c t o r of Housing, Energy, and
Intergovernmental Relations, says he i s s e r i o u s l y considering
running f o r the Congressional seat i f Machtley does not seek
r e - e l e c t i o n . But w i t h two narrow defeats, he can hardly a f f o r d
chancing a t h i r d loss t o Machtley and, as a r e s u l t , must hold o f f
on a decision.
But Kennedy has no such restraint and i s now a l l but
o f f i c i a l l y running, so Wolf i s forced to s i t on the sidelines and
watch the young scion line up establishment support for his own
candidacy, and possibly lock up the nomination in the process.
I f Kennedy does challenge Machtley next year, assuming he
runs a respectable race, he would s t i l l be the f i r s t Democrat in
line to run again in 1996, when Machtley i s l i k e l y to run for the
Senate. Some Kennedy backers, looking at Patrick's prospects over
the next four years, believe he almost has a lock on the seat,
one way or the other. Obviously, such statements are predicated
on voters not rejecting him on the basis of age, lack of work
experience, or the "carpetbagging" issue, which Republicans in
the state say they w i l l use, given his short history as a Rhode
Islander. But he would hardly be the f i r s t member of his family
to be ac- cused of any of these sins, with l i t t l e effect.
I f Machtley runs f o r r e - e l e c t i o n , expect a very tough and
expensive race. The Congressman won d e c i s i v e l y l a s t f a l l w i t h 70
percent of the vote i n what was widely seen as both an
anti-incumbent year and not a great year f o r GOP candidates
(President Bush received 28 percent i n t h i s d i s t r i c t , worse than
i n any other GOP d i s t r i c t i n the nation save Jack Quinn's 30th
d i s t r i c t of New York).
On the other hand, given the low p u b l i c regard f o r Congress,
the strong Democratic v o t i n g tendencies of the d i s t r i c t , and
Kennedy's t o t a l name r e c o g n i t i o n and access t o money, Machtley
would face the toughest challenge of h i s career i f he seeks
re-election.
�DETERMINED TO BE AN ADMINISTRATIVE
MARKl^G^er EX). 12958 asamended,
amended,Syc.J.3
Syc.J.3(i(c)
Initials:
t ^ V " n.t.r \ ^ / 1 ^ / ( )
PRIVILEGED AND a a M I « » » a ^ MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings. Steve Eklelstein
Congressman LaFalce and NFIB
Melanne. Steve. Distribution
August 1. 1993
Tomorrow you are scheduled to meet with the National Federation of
Independent Business (NFIB). Also participating will be Congressman John
LaFalce. Chairman of the House Small Business Committee.
BACKGROUND:
Congressman LaFalce was very pleased with your meeting last week with
the members of his small business committee. This was evidenced by his
comments to the media that day and at a House Focus Group meeting the
following day. With continued attention. LaFalce should prove a very helpful
ally.
One of the ways the congressman has offered to help is to be a conduit
to the small business community. He has a very close relationship with John
Motley of NFIB. LaFalce's goal is to have them oppose the financing
mechanism on the floor rather than high profile mobilization against the plan
as a whole. Whether or not this goal is ultimately achievable, his efforts are
certainly worthwhile.
This meeting is also a precursor to a hearing by Congressman LaFalce's
Small Business meeting the following day. representatives of 5 major small
business associations have been invited to explore how best to attain the goals
of cost containment and universal access without jeopardizing the viability of
small business. A copy of the witness list is attached for you information.
Congressman LaFalce's hearing is being held the same day you eire
scheduled to meet with the Democratic Policy Committee on Small Business.
This meeting with NFIB and the other business groups you are scheduled to
meet with on Tuesday should help with in the Senate by showing you
commitment to work with the small business community.
There are three main Issues which the Congressman has stressed with
regard to health reform and small business — 1) no payroll tax, 2) selfemployed tax deduction, and 3) folding in workers' compensation.
�8-
2-93
1 0 : 4 8 AM ; CME
06/02/93 09:41
ON SlvlALL BUSINESS
LflFffl.CE DC
20222S7209!#
57209
WITNgeagg TOR ^Uqt;aT 4 BMm.
ggftLTg CAM-BgEQSIi:
NO. 907
BUBIWESB COMMITTEE
P001
HKXRIgO OM miQMM.
* John J» Hotley, I I I , Vice ProBldent of P4fcdttr«l Governmental
Relations, National Federation of Independent Business
* Stephen Elmont, President, National Restaurant Association;
and Chaim&nr The Food Group Limited
* Gary Petty, Treasurer, small Business Legislative Council;
and President/CEO, National Moving and storage Association
* Kristin Bass, Manager of Huaan Resources Policy, Donegtic
Policy Division, U.S. Chamber of Commerce
* Susan Hager, 1992 President, National Small Business United;
and President, Hager Sharp, Inc. (Waehington, D.C.)
* Ronald Bullock, Member, National Association of
Manufacturers; and President, Bison Gear and Engineering
Corporation (Downers Grove, XL)
*** The order of the iritnetses bas not yet been deteralnsd.
2/ 5
�DETERMINED TO BE AN ADMINISTRATIVE
MAKKlNXi Per E ^ 12958 as amended, 560.3.3 (c)
PRIVILEGED AND CONFIDEJmAIr MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings, Steve Edelstein
Meeting with House and Senate Leadership
Melanne, Steve, Lorraine, Distribution
July 30. 1993
Tomorrow you are scheduled to attend a two-part meeting with the
House and Senate Leadership. The first half of the meeting will focus on the
sensitive issue of health reform Jurisdiction and wiU be attended by Speaker
Foley. Majority Leader Gephardt and Majority Leader Mitchell. There is a
three-part agenda for the second half of the meeting:
(1)
To discuss the status of the development of the plan and to share
first-run employer/employee financial Impact charts to make
Members feel more comfortable with the plan (these can be
distributed during the meeting, but must be picked up
immediately afterwords; it makes it easier to do this if you
announce this at the begiiming of the meeting);
(2)
To discuss and review the consultation, health care workshop, and
plan unveiling schedule; and
(3)
To give the Members a draft copy of the August recess
Congressional health care talking point notebook for them to
review and make suggestions before it goes to the rank and file on
Thursday.
BACKGROUND:
A week ago. Majority Leader Gephardt indicated that it would be
advisable for the Congressional Leadership to get together with you for a
detailed and quiet discussion about timing, strategy cind substance before
leaving for the August recess. Concurrent with Andie King's call to arrange
such a meeting, you indicated that you thought such a meeting would be a
good idea as well. Senator Mitchell's senior staff was not as excited about the
idea because the Senate Majority Leader (and his staff) are overwhelmed with
the reconciliation bill. (I informed Mitchell's staff that we would be happy to
hold the meeting with just the House if they preferred; they decided against
taking this approach because they thought there would be no other time to do
it before the recess.)
�MEETING ON JURISDICTION:
Over the past several weeks (If not months) we have been discussing —
on an Internal basis — our options with regard to drafting and Jurisdiction
issues. We have repeatedly come to the conclusion that we cannot proceed
without guidance/direction from the Congressional Leadership. Since the
Congressman Gephardt has had an opportunity to focus on this Issue in
recent weeks, we thought this would be a good opportunity to get a general
sense of direction from him (and Speaker Foley and Majority Leader Mitchell)
on this matter prior to their August departure.
Majority Leader Gephardt and his ofilce has recently communicated that
It Is his sense that, despite understandable urges to the contrary, it is
advisable for the legislation to be drafted and distributed In such a way as to
maintain — to the extent possible — the legislative Jurisdictional status quo.
He believes that it would be politically counterproductive for any major
Chairman to feel he is being cut out. Although Senator Mitchell has not had
much time to focus on this, it is likely he will feel similarly — particularly
when you recall that his sits on the Finance Committee, not the Labor and
Humcin Resources Committee. A memo from Andie King to Majority Leader
Gephardt on Jurisdiction issues and an outline of the various sections of the
legislation are attached for your review/use.
MEETING WITH LEADERSHIP:
Current Status of Plan and Its on Employers and Employees: The Members
(Foley. Gephardt, Mitchell. Ford. Pryor. Daschle. Bonior. Hoyer. and Fazio)
would love to get a sense of where we stand on the development of the plan
and to receive a short briefing on how its financing will affect businesses and
their employees. Attached Is a chart show that you and Ira can use for this
purpose. (It Is not imperative that you do so. however).
Consultative and Briefing Schedule; Attached Is a draft schedule for
consultative meetings and briefings in August and September prior to the
release of the plan. Feedback from the leadership on the proposed schedule
will be helpful in finalizing our briefing calendar.
Congressional Notebooks for the August Recess: Members have asked for
materials to help them discuss health reform with their constituents during
the recess. In response, we have prepared a brief discussion on the cost of
doing nothing, an overview of the plan, a message piece on the strengths of our
plan and how to talk about it. and revised questions and answers. We hope
that the leadership can review it by the end of the day Tuesday so we can
incorporate their comments, have the notebook printed and sent up to the Hill
by Thursday.
�I.
GRAPHIC REPRESENTATIONS OF THE CHANGES IN EMPLOYER AND
EMPLOYEE HEALTH CARE COSTS UNDER THE CLINTON PLAN*
* Please note that the numbers and percentages i n the following
charts are averages. Although some employers and employees w i l l
incur higher costs after reform, the majority w i l l see their
f i n a n c i a l contributions reduced under the new system.
�The Administration's Health Care Reform
Plan Cuts Costs For Small Business
14%
12.1%
12%
(iiiii
10%
ijjiplllHiipjIli
infflil!iill^ilij|=
8%
plliiili
On average, small businesses who provide coverage
will have their costs cut nearly in half
6.9%
6%
4%
Payroll Percentage Comblnea
Employer and Employee Premium Coat*
2%
0%
Today's System
Under Reform
Source: Urban Institute TRIM2 Model
FIrma with Leaa Than 25 Employeea
�Small Employers Who Currently Provide
Coverage Have Lower Yearly Premiums
Under the Health Care Reform Plan
Average Employer Contribution
$3000
Per Employee, Per Year
$2467
$2600
$2263
$2000
$1588
$1600
$1000
Today
Reform
$600
$0
Leaa than 25
25-09
Includea Only Buaineaaea That Currently Provide
Source: HHS: Urban Inatltute TRIM2 Model
�Small Employers Who Currently Provide
Coverage Have Lower Monthly Payments
Under the Health Care Reform Plan
$250
Average Employer Contribution
Per Employee, Per Month
$200
$160
$100
$60
$0
Leaa than 26
25-99
Source; HHS: Urban Inatltute TRIM2 Model
�Small Employers Pay A Smaller Percentage
of Payroll for Employee Coverage
Average P e r c e n t of P a y r o l l for Those F i r m s W h i c h
C u r r e n t l y Provide Coveraqe_
10%
What They Pay Today
Cost Under Reform
Less Than 25
26-99
Source: HHS; Urban Institute TRIM2 Model
�' 1
Today's Uninsured Small Businesses Will
Pay a Modest Amount Per Employee Under
Health Care Reform
Average Contribution Per
Employee, Per Year
Under Reform
What They Pay Now
Less Than 25
25-99
Source: HHS; Urban Institute TRIM2 Model
�Today's Uninsured Small Businesses Will
Pay a Small Monthly Amount Per Employee
Under Health Care Reform
Average Contribution Per
Employee. Per Month
Under Reform
What They Pay Now
Less Than 25
25-99
Source: HHS; Urban Institute TRIM2 Model
�•
ALL BUSINESSES DO BETTER UNDER REFORM
$4000
Average Employer Contribution
Per Employee, Per Year
$3360
$3500
$3000
/
/
$2819
./I •
$3039
A
(2637
71
$2457
$2600
$2263
$2000
$1735
$1818
71
$1775
S1588
$1500
$1000
$500
$0
L e s s than 26
26-99
mi
100-499
600-999
1000 •
r'''-"l Today
Source:
HHS: Urban
Institute
Reform
TRIM2
Mode
�ONE SMALL HRM'S HEALTH CARE COSTS: TODAY AND UNDER REFORM
Sarah Howard, runs a print shop and is herself a graphic designer in Cook County, Illinois. In today's health care system, she
could pay $11,976 per year/$996 per month in health care premiums to cover her two full-time employees, two part time employees,
herself and her family.* Under the Administration's reform plan, which cuts the high administrative costs such firms face as well
as providing subsidies for small low-wage businesses, this same employer would pay less than half — $5,005 per year/$426 per
month.
Profile of Bcncfldary
S$lary
Cost Today
Under
Reform
Cost Today:
Per Month
Under Reform:
Per Month
The Employen Sarah, the owner, has two
children. Her husband is afireelanccjournalist
and has no other coverage.
$25,000
$4,546
$1,675
$378.83
$139.58
Worker 1: George works in the front of the
shop taking print orders. He is single.
$18,000
$1,713
$1,206
$142.75
$100.50
Worker 2: Staccy, also a graphic artist, is
married with three kids. Her husband does not
work.
$7,280
$0
$325.17
$0
$27
Worker 3: Sam is a typesetter and the shop's
manager. He has two children.
$22,000
$4,004
$1,474
$333.66
$122.83
Worker 4: Mildred is a part time elderly
woman.
$7,280
$1,713
$325.17
$142.75
$27
1
Total:
$80,560
$11,976
$5,005.34
$997.99
$426.91
1
' Pre-rcform estimates are based on AHCPR estimated premiums with a 35% load — fairly standard for a very small firm
today. Estimates were prepared by Len Nichols of OMB.
�THE IMPACT OF THE CLINTON HEALTH CARE REFORM PLAN
ON INSURANCE PREMIUMS AND COVERAGE FOR SMALL BUSINESSES
�SMALL BUSINESS, HEALTH CARE COSTS, AND THE CLINTON REFORM PLAN*
Small businesses face higher costs and more unstable insurance premiums. The Clinton plan will reduce the
burdensome costs.
•
TODAY
THE CLINTON REFORM PROPOSAL
High Administrative Costs: Higher administrative
costs kill small businesses. These costs account
for as much as 40% of the policy costs compared
to about 5% for large companies.
Cuts AdministratiTe Costs: Administrative costs
will be dramatically reduced by the formation of
health alliances which will streamline and simplify
administrative functions.
Faster Rising Costs: Premiums for small
employers rise at a faster rate than for other
employers — as much as 50% in any given year.
[NAM]
Aggressively Controls Costs: Health reform will
aggressively control costs through market based
competition backed up by an enforceable budget.
Inequitable Self-Employed Tax Policy: Today,
unlike big businesses, small, self-employed
businesses cannot deduct 100 percent of their
health care cxp>enses. This has the practical effect
of further increasing the cost of insurance that is
already priced higher than that available to larger
firms.
Increases Deduction to 100% for SelfEmployed: The Administration proposal will
ensure that the self-employed are treated equally
under our nation's tax policy, allowing them to
deduct the full value of their health insurance
coverage.
Workers' Compensation Costs: In today's system,
high health care costs are surpassed only by the
skyrocketing costs of workers' compensation
insurance. Between 1980 and 1985, workers'
compensation medical cost grew more than one
and a half times as fast as medical costs and now
accounts for $24 billion a year in health care
expenditures.
Reform Workers' Compensation: The
Administration's proposal reforms the health
component of workers' compensation insurance,
making it more efficient and reducing costs by
covering work related injuries through health plans
in the same manner as non-work related injuries - eliminating duplication and improving quality
for workers who receive services.
Small Employers Have No Control: Small
businesses and their employees have little or no
ability to determine the level of premiums they pay
or the information they receive about the services
the plans provide.
Assures Employers a Place on Alliance:
Business owners will sit on alliances to ensure
sensitivity and responsiveness to needs of
employers in terms of costs, administrative
simplification and quality.
Volatile Costs: Small businesses face large
variations in the costs of similar plans. Nearly
identical benefits packages can range in price by as
much as 350%. [Blue Cross/Blue Shield, Survey
of Six Sample Plans, January 1992]
Stabilize Costs: The Administration proposal will
stop the wildfluctuationof premiums in the small
group market through community ratings and
insurance reform. We will outlaw discriminatory
pricing and ensure smaller predictable cost with
aggressive cost controls.
A l l
_
r^-.
^ _
-.^^
_ J -
V
1. _
�SMALL BUSINESS, INSURANCE ABUSES, AND THE CLINTON REFORM PLAN •
Many insurers discriminate against small businesses, often charging more for similar policies or refusin
provide coverage at all. Abuses within the insurance industry hit small businesses particularly hard
TODAY
THE CLINTON REFORM PROPOSAL
Hassle Factor: Small business owners who cover
their employees spend inordinate amounts of time
trying tofigureout a maze of insurance policies,
forms, and requirements. What's worse is that the
rules of the game are changed all the time;
unfortunately, they are changed by the seller and
not the buyer.
Eliminates Hassle: Tlie employer no longer has
to worry about the headaches of selecting
insurance for his/her employees. The
employer/employee-rxm health alliance negotiates
rates, provides information on plans, increases ease
of enrollment and absorbs the manpower drain.
Then, the employee, not the employer, chooses the
plan. Regardless of the choice, however, the
employer pays the samefixedamount.
Small Risk Pool: Fewer employees mean a
Spreads Risk Evenly: The proposal consolidates
smaller pool to share the risk. Insurers frequently small businesses in purchasing pools to give them
charge more for these policies.
the same bargaining power as large firms.
Underwriting and Experience Rating: Medical
underwriting is the practice of basing premiums on
perceived risk and medical history. Experience
rating is when insurers jack up costs after an
employee falls ill or gets injured:
Prevents insurersfromraising rates or
dropping coverage after Illness strikes: The
Administration's proposal will reform practices
such as underwriting and experience rating.
Under the Qinton plan, you can drop your
insurance plan, but they can't drop you.
Price Baiting and Gouging: Many insurers
engage in "price baiting and gouging" offering
"discount" rates for thefirstyear of coverage only
to charge much higher prices in the next year
when pre-existing condition exclusions expire.
Outlaws Price Baiting and Gouging: The plan
will end the days when insurers canraiseand
lower premiums at their whim. We will bring
predictability and fairness to the cost of insuring
families and workers.
Occupational Redlining: Some insurers simply
refuse to cover entire industries perceived to be
high risk.
Covers Everyone: Under the Qinton plan, there
is an end to occupational redlining.
Refusal to Renew Policy: After afirstyear of
Guarantees Renewal: The Clinton plan
reasonable rates, small businesses often face higher guarantees insurance renewal and stabilizes
costs and difficulty obtaining renewal.
premiums.
All
I
I
•
• _—
�August 1993
Consultative Meeting
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
1
2
3
4
5
6
7
8,
9
10
11
12
13
14
16
17
18
19
20
21
15
House & Senate
Leadership Staff
Briefing
Consult ations with key M(;mbers & Staff,as wssible
1
22
23
25
26
Consult aliens with key Mejmbers & Siaff,as |)ossible
1
29
24
30
>
27
28
|
31
Leadership and Chmn of Committees of
Jurisdiction
[^louse^mmilt^^rjuri^inio^t^^
[^cnal^^mmitt^^nuri^icno^w^^
8/2/1993
�September 1993
Consultative Meeting
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
1
Leadership and Chmn of Committees of
Jurisdiction
House Committees of Jurisdiction Staff
Senate Committees of Jurisdiction Staff
7
8
House Leadership
Conservative
& Committees of
Jurisdiction
Senate Leadership
& Committees of
Jurisdiction
Congressional
Republican
Leadership
12
Democratic
Forum
Single Payer
Leaders
Senate Finance
Committee
House Ways and
Means
Committee
13
14 Republican 15
Other meetings with House
Committees, as
16
Health Care Task
Force
U.S. Senate
(Bipartisan)
House Democratic
Whip
Organization
needed
I
19
House Energy and
Commerce
Committee
Senate Labor and
Human
Resources
Committee
House Education
and Labor
Committee
10
11
House Caucuses
Congressional
Black Caucus
Congressional
Hispanic Caucus
Caucus on
Women's Issues
17
Finalizing product and preparing for briefings
20
Senate Democratic 21
House Republican 22
23
Policy Committee
Caucus
House Democratic Senate Republican
Caucus
Policy Committee RELEASE
Congressional
House Democratic
Republican
Staff Briefing
Leadership
Senate Staff
Briefing
House Republican
18
House Leadership
House Leadership
and Cmles of
Jurisdiction Staff
Senate Leadership
and Cmtes of
Jurisdiction Staff
24
& Committees of
Jurisdiction
Senate Leadership
& Committees of
Jurisdiction
Congressional
N^ssage Group
|
25
Staff Bnefing
I
Health Care Workshops?
26
27
\
28
29
30
8/2/1993
�SCHEDULE FOR CONGRESSIONAL CONSULTATIVE MEETINGS AND BRIEFINGS
CONSULTATIVE MEETINGS:
August 16th - August 27th;
Assuming p o l i c y i s complete, we recommend t h a t t h i s b l o c k o f
t i m e be used t o c o n s u l t w i t h House and Senate L e a d e r s h i p ,
Committee C h a i r s o f J u r i s d i c t i o n , and t h e i r s t a f f , as w e l l
as r e a l i s t i c R e p u b l i c a n p r o s p e c t s . And i f t h e Members a r e
w i l l i n g , I r a , Judy and o t h e r a p p r o p r i a t e A d m i n i s t r a t i o n
r e p r e s e n t a t i v e s would f l y t o b r i e f them. T h i s w i l l s i g n a l
s e r i o u s n e s s o f i n t e n t t o i n t r o d u c e l e g i s l a t i o n by September
2 1 s t . Meetings t o be h e l d , t o t h e e x t e n t p o s s i b l e , i n o r d e r
c o n s i s t e n t w i t h rank and s e n i o r i t y .
Week o f August 1 6 t h ;
House and Senate Leadership S t a f f B r i e f i n g
IM, JF
( D e t a i l e d b r i e f i n g f o r s t a f f o f Speaker Foley, M a j o r i t y
Leader Gephardt, M a j o r i t y Leader M i t c h e l l and t h e i r
Designees)
Monday, August 3 0 t h - Thursday. September 2nd:
House Committees o f J u r i s d i c t i o n S t a f f
IM, JF
(Ongoing d e t a i l e d s t a f f - l e v e l d i s c u s s i o n s )
Senate Committees o f J u r i s d i c t i o n S t a f f
IM, JF
(Ongoing d e t a i l e d s t a f f - l e v e l d i s c u s s i o n s )
Leadership and Chairmen of Committees of J u r i s d i c t i o n
HRC, IM, JF*
(As a v a i l a b l e )
�Tuesday. September 7 t h :
House Leadership and Chairmen of Coamlttee of J i u r l s d l c t i o n
BC(?), HRC, IM, JF
L o c a t i o n : White House
(To b r i e f Members and s e t up c o n s u l t a t i v e p r o c e s s )
Foley
Gephardt
Bonior
Rostenkowski
Stark
Dingell
Waxman
Ford
Williams
Senate Leadership and Chairmen of Committees of J u r i s d i c t i o n
BC(?), HRC, IM, JF
L o c a t i o n : White House
(To b r i e f Members and s e t up c o n s u l t a t i v e p r o c e s s )
Mitchell
Ford
Pryor
Daschle
Moynihan
Kennedy
Rockefeller
Riegle
Mikulski
Breaux
C o n g r e s s i o n a l R e p u b l i c a n Leadership - BC(?), HRC,
L o c a t i o n : White House
Dole, M i c h e l and designees
Wednesday. September 8 t h :
S i n g l e Payer Leaders - HRC, IM, JF
L o c a t i o n : C a p i t o l H i l l (Gephardt t o H o s t )
McDermott and h i s "subcommittee"
Conyers
Wellstone
C o n s e r v a t i v e Democratic Forum - HRC, IM, JF
L o c a t i o n : C a p i t o l H i l l (Gephardt t o H o s t )
Cooper
Andrews
Stenholm
Breaux
Boren
IM, JF
�House Ways and Means Committee - HRC, IM, JF
Location: Capitol H i l l
(Chairman d e t e r m i n e s a t t e n d e e s and whether b i p a r t i s a n )
Senate Finance Committee - HRC, IM, JF
Location: Capitol H i l l
(Bipartisan)
Thursday.
September 9th;
House Elnergy and Commerce Committee - HRC, IM, JF
Location: Capitol H i l l
(Chairman d e t e r m i n e s a t t e n d e e s and whether b i p a r t i s a n )
Senate Labor and Human Resources Committee - HRC, IM, JF
Location: Capitol H i l l
(Bipartisan)
House E d u c a t i o n and Labor Committee - HRC, IM, JF
Location: Capitol H i l l
(Chairman d e t e r m i n e s a t t e n d e e s and whether b i p a r t i s a n )
F r i d a y . September 1 0 t h ;
House Caucuses
C o n g r e s s i o n a l Black Caucus - IM
C o n g r e s s i o n a l Caucus on Women's I s s u e s - JF
C o n g r e s s i o n a l H i s p a n i c Caucus - IM
Tuesday. September 14th:
House Democratic Whip O r g a n i z a t i o n - HRC, IM, JF
Location: Capitol H i l l
House R e p u b l i c a n H e a l t h Care Task Force - HRC, IM, JF
Location: Capitol H i l l
U.S. Senate ( B i p a r t i s a n ) - HRC, IM, JF
Location: Capitol H i l l
To Be Scheduled:
Other Meetings w i t h Committees as Needed - IM, JF, Other S t a f f
Location: Capitol H i l l
Biden, J u d i c i a r y
Brooks, J u d i c i a r y
R o c k e f e l l e r , Veterans
Montgomery, V e t e r a n s
Nunn, Armed S e r v i c e s
Dellums, Armed S e r v i c e s
Bumpers, Small Business
LaFalce, Small Business
Glenn, Governmental A f f a i r s
Clay, Post O f f i c e
Inouye, I n d i a n A f f a i r s
M i l l e r , N a t u r a l Resources
�Wednesday. September 15th - F r i d a y . September 17th;
F i n a l i z i n g product and preparing f o r p r e - u n v e i l i n g b r i e f i n g s .
PRE-UNVEILING BRIEFINGS;
FridayT R«»pt*»inber 17th or Wednesday. September 22nd;
House Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, J F
(Ongoing d e t a i l e d d i s c u s s i o n s and to help s t a f f prepare
members f o r meeting with P r e s i d e n t and F i r s t Lady)
Senate Leadership and Committees of J u r i s d i c t i o n S t a f f
IM, J F
(Ongoing d e t a i l e d d i s c u s s i o n s and to help s t a f f prepare
members f o r meeting with P r e s i d e n t and F i r s t Lady)
Saturday. September 18th or Thursday. September 23:
House Leadership and Chairmen of Committee of J u r i s d i c t i o n
HRC, B C ( ? )
Location: White House
Foley
Gephardt
Bonior
Rostenkowski
Stark
Dingell
Waxman
Ford
Williams
Senate Leadership and Chairmen of Committees of J u r i s d i c t i o n
HRC, B C ( ? )
Location: White House
Mitchell
Ford
Pryor
Daschle
Moynihan
Kennedy
Rockefeller
Riegle
Mikulski
Breaux
�Saturday. September 18th or F r i d a y . Septf*"'^^^ ?^t^T
Congressional Message Group - Stan, Mandy, Paul, J e f f , IM, J F ,
et. a l .
Location: C a p i t o l H i l l
Sunday. September 19th or Saturday. Ser''"«»'">'«»r 26th;
Health Care Workshops
( D e t a i l e d b r i e f i n g s f o r Members on s p e c i f i c t o p i c s on h e a l t h
c a r e reform) — Due to p o s s i b l e scheduling c o n f l i c t with
the House t h i s may have to be scheduled f o r the f o l l o w i n g
weekend. T h i s would a l s o delay the u n v e i l i n g by a week.
Monday. September 20th or Sunday. September 26th;
Health Care Workshops
(Continuation of b r i e f i n g s f o r Members)
Monday. September 20th or Monday September 27th;
Senate Democratic P o l i c y Committee - BC?, HRC, IM, J F
Location: C a p i t o l H i l l
(Perhaps combined with c l o s e of Health Care U n i v e r s i t y )
House Democratic Caucus - BC?, HRC, IM, J F
Location: C a p i t o l H i l l
(Perhaps combined with c l o s e of Health Care U n i v e r s i t y )
Congressional Republican Leadership - HRC, BC ( ? )
Location: White House
Dole, Michel and designees
Tuesday. September 21st or Tuesday. September 28th:
House Republican Caucus - HRC, IM, J F
Location: C a p i t o l H i l l
Senate Republican P o l i c y Committee - HRC, IM, J F
Location: C a p i t o l H i l l
House Democratic S t a f f B r i e f i n g - IM, J F or appropriate surrogate
Location: C a p i t o l H i l l
House Republican S t a f f B r i e f i n g - IM, J F o r appropriate surrogate
Location: C a p i t o l H i l l
Senate S t a f f B r i e f i n g - IM, J F or appropriate surrogate
Location: C a p i t o l H i l l
�other Meetings with Committees and Members as Needed
*
We need t o determine how best t o use Secretary Shalala,
other members o f the Cabinet, and other senior a d m i n i s t r a t i o n
o f f i c i a l s during the course o f these b r i e f i n g s .
�DETERMINED TO BE A.N AD.MINISTRATIVE
MARKlN&PerEJJ.
12958 as
as amended,
anieniJed, i>ec.
Sec. 3.3(c)
i»i/ii\rwini>irertjj. izv3»
i.i
initials:
D a t e . i W l S n l
PRIVILEGED AND OffltFKSQS^lylEMORANDUM
TO:
FR:
RE:
cc:
HiEary Rodham CUnton
Chris Jennings, Steve Eklelstein
Joint Message Group Meeting
Melanne, Steve, Distribution
July 28. 1993
Tomorrow you are scheduled to meet with the Joint Senate and House
Message Group. This is part of a weekly series of meetings with Members on
in preparation for the unveiling of the plan. Tomorrow's meeting will focus on
Questions and Answers (Q's and As) and how to respond to criticisms of the
plan. Mandy Grunwald and Arnold Bennett will lead the discussion on how to
respond to criticisms of the plan. They will be working off the set of Q's and
A's we sent up to the Hill prior to the Memorial Day recess. Obviously, the
Members would like you to participate as you see fit. Before turning it back
over to Senator Mitchell or Mandy you may wish to make a few comments
about the following subjects.
We are in the process of updating both the questions and the answers to
reflect the recommendations of the Congressional Leadership staff and the
result of the discussion at this meeting of the Message group.
TALKING POINTS:
Message Group and Focus Group Meetings; " I understand that the message
and focus group meetings have gone well in my absence. The input we have
received in those meetings will prove invaluable to us in preparing the
Congressional notebooks and other pre-launch materials."
Congressional Notebooks; "We are in the process of preparing notebooks for
the Leadership for their use and distribution to the membership as they see fit
prior to the August recess. Included in these books will be a discussion of the
"Cost of Doing Nothing." an overview of the plan (a brief description of the
policy recommendations), the strengths piece (a message piece on how to talk
about the plan) and an updated set of Q's and A's."
Update on Health Care University: "As you know, the plan is for the Health
Care University to be held on a bipartisan basis after the announcement of the
plcin. I know. White House and Department Staff are met last night with
Senator Daschle and Majority Leader Gephardt to further develop the concept
of the university. I look forward to continuing to work with the Leadership to
establish a constructive schedule for meetings and consultations over the next
few months."
�DETERMINED TO BE AN ADMINISTRATIVE
MARKIN^iJPer E^. 12958 as araendwi, Sec. 3.3 (e)
Initials: ^ ^ )
Date:i^iX^/lJ_
PRIVILEGED AND C O N F T D E K T I M : MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jermings. Steve Eklelstein
Congressman Clay
Melcinne, Steve. Lorraine. Distribution
July 28. 1993
Tomorrow you are scheduled to meet with Congressman Clay, the
Chairman of the House Post Ofilce and Civil Service Subcommittee. As such,
he has Jurisdiction over the Federal Employees Health Benefits Plan. Because
of his close relationship with Chairman Clay. Jerry Klepner will be in
attendance.
According to his staff, he has no particular agenda items for this meeting
but will be interested in a general overview of where we are with regard to the
plan. Undoubtedly, he will also wish to discuss how federal employees and
postal workers will be treated under the plan.
BACKGROUND:
A former civil rights activist. Congressman Clay is a former civil rights
activist who represents parts of St. Louis and its suburbs. Clay is known on
the Hill as one of organized labor's staunchest supporters both on his Post
Office and Civil Service Committee and on the Eklucation and Labor
Committee.
Chairman Clay should be well versed in our propxisal. His StafT Director,
Gall Weiss, served on the Working Group dealing with FEHBP. In addition,
Jerry Klepner and Walter Zelman gave a briefing for the Chairman and his
staff on the current policy. His main areas of concern will be why federal
employees are being treated differently than the employees of other large
employers and whether federal employees will see any benefit from this plan.
As a friend of organized labor, he will also be interested in how reform
will Impact those who already have benefits which go beyond our
comprehensive benefits package. In addition, some unions, like the Postal
Workers, offer their insurance plan for non-members to enroll in through
FEHBP. Whether they will be allowed to continue this practice will a matter of
concern. Also, unlike federal employees, postal workers are under a collective
bargaining agreement and enjoy more generous benefits. He will be concerned
about the impact of the plan on these benefits. There is also an issue as to
whether postal workers will be required to participate In the plan or allowed to
form their own alliance like employees of large corporations.
�TALKING POINTS:
Differential Treatment of Federal Employees: Congressman Clay Is
concerned that we are treating differently than employees of other large
employers since they will not have the option of forming their own alliance.
Underlying this concern is the fear that federal employees covild wind up
getting less in terms of benefits than they enjoy now. You may wish to
reference the political problems of designing a system which exempts
government workers. In addition, you should probably highlight the benefits
to federal employees from reform (see below).
Benefits to Federal Employees from Reform; Federal Employees, like other
with good coverage, are concerned that they will be made worse off by reform.
They were amongst the groups that Joined in the effort to repeal the
Catastrophic Act because they felt the benefit it provided was less that the one
they already enjoyed.
Increased Subsidy. To distinguish our current efforts, you may wish to
note that federal employees would receive a greater subsidy than they do now.
Under reform, they would only be responsible for 20% of the costs of coverage
as opposed to the 30% they pay now.
Easier to Compare Plans. In addition, with a standard comprehensive
benefits package it wUl be much easier for them to compare and contrast
various policies. Current policies offered through FEHBP cover different
services and have different levels of co-pays and deductibles making
comparisons difficult.
Slower Increases i n Premiums. Third, our efforts to control costs and
standardize benefits should slow the rate of increase of their insurance rates.
Under the current FEHBP program, their has been some problem with adverse
selection — older and sicker workers gravitating to more comprehensive plans
who then in turn have to raise their rates for all those they insure.
Standardization should lead to greater stability, less shifting between plans
due to benefit levels and as a result slower rates of growth In premiums.
Increased Benefits. Finally, the benefit package offered under reform is
better than the coverage they now receive with an emphasis on preventive
services not now covered.
�While many union workers enjoy more generous packages
than the rest of the population, they have been under increasing jM-essure at
the bargaining table to reduce their levels of benefits and mcrease their
contribution toward the cost of their coverage. In addition, many union
retirees are especially threatened by erosion of their coverage.
There are several points you may wish to make on this issue. Easting
collective bargcdning agreements will be honored. Even after those contracts
expire businesses and labor will befi-eeto negotiate benefits that exceed those
of our comprehensive benefit package. Our efforts to control health care costs
should be a direct benefit to union workers byfi-eeingmoney that would
otherwise go to covering increases in health care to go toward wages Instead.
Our plan will provide security to union workers and retirees by insuring they
will always be covered.
3
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SUBJECT/TITLE
DATE
Judy Feder to Ira Magaziner; re: Federal Employee Healtii Benefits
Plan (4 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3681
FOLDER TITLE:
Congressional Briefing Memos First Lady, 1993 [2]
2006-0885-F
jp2848
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information |(bXl)of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(bX6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA|
National Security Classified Information [(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute |(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�DETER.MINED TO BE AN ADMINISTRATIVE
.MARKINGPpr E ^ . 12958 as amended, Sec^J(c)
PRIVILEGED AND UJHf UjHl.iH IIAL MiLMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings, Steve Eklelstein
House Eklucation £md Labor Conunittee
Melanne, Steve, Lorraine, Distribution
July 28, 1993
Tomorrow you are scheduled to meet with Chairman Bill Ford and the
Democrats of the House Education and Labor Committee In response to a
longstanding requestfi-omthe Chairman.
BACKGROUND:
Chairman Ford wants to make certain that his committee is treated
fairly. He has noticed that you have already held meetings with the full
membership of the other cormnlttees of Jurisdiction. The Chairmeua is also
somewhat in a funk over health reform. He believes there has not been
enough Presidential visibility on this issue and fears that it may not happen.
Ford's Committee will be interested in Jurisdiction and believe they have
a role to play. They are probably right but recent informationfi-omthe House
Parliamentarian suggests that they may not have Jurisdiction over the final
plan once implemented because the legislation is more oriented toward a right
for all Americans rather than governing employer behavior. This interpretation
would be surprising to the committee and cause them great consternation.
They are not aware of it and it would be best for them not to know about it at
this time.
There is the general sense in the Congress that Eklucation and Labor is
the most liberal of the three committees with primary Jurisdiction over health
care reform. If we can gain their support up front, we will have no problem
getting any provision through. There are 27 Democrats on the Cormnittee
including three representatives of the territories. Over half, 14 in all, are
cosponsors of Congressman McDermott's single payer bill.
Education and Labor also has many more junior members than the
Ways and Means or Energy and Commerce. One third of the Democrats on the
Committee are freshmen, 17 have served less than three terms. As a result,
this committee is much less likely to get caught up in the details of the bill.
Attached for your review are brief profiles on the Democratic members of
the Education and Labor Committee.
�TALKING POINTS:
Importance of the Cnrnmittftft; You may want to begin by recognizing the
Committee as one of the three committees with primary Jiirlsdiction over
health Ccire reform and how important they will be to our legislative effort.
They have a critical role with regard to the impact on the employer/employee
relationship, the employer responsibility to contribute toward insurance
coverage £uid the Employment Retirement Income Security Act (ERISA).
Commitment to Reform; You may also wish to mention, the longstanding
commitment of the Chairman and the members of the Conunittee to health
care reform and how you look forward to working with them in the coming
months to achieve this mutual goal.
State Flexibility/ERISA Waivers; Given their Jurisdiction over ERISA, their
may well be interest in and questions regarding pending ERISA waivers In the
Reconciliation package. The Administration has no ofllcial position on the
ERISA waivers; however, that you understand that it might be subjected to a
60-vote point of order in the Senate.
Similarities to Single Payer; Given the number of McDermott cospwnsors on
the Committee you may want to touch on the common ground our approach
shares with the single payer model including: universal coverage,
comprehensive benefits package, administrative simplification, choice of
providers, and breaking the link between employment and health coverage. In
addition you may want to mention the option that states will have to adopt a
single payer model if they desire.
�HOUSE EDUCATION AND LABOR C O M M n T E E
July 29, 1993
DEMOCRATS:
CHAIRMAN WILLIAM D. FORD rD-MD: Chainnan Ford is in his 15th terai in the
House and second as Chairman of the Education and Labor Committee. He was a strong
supporter of the Family and Medical Leave Act. The Chairman believes we need to "dress
up" cost containment but that it needs to be the primary focus of the health care reform
package. He believes that universal access is fundamental. Like the rest of the Michigan
delegation, he is particularly concerned about the cost of retirees' health care. He is very
close to the UAW. Strategically, he does not want to see the plan divulged prematurely and
believes this opportunity will only come once. He supported including health care reform in
budget reconciliation. As with other chairmen, he will be protective of his jurisdiction. As a
former Chainnan of the Post Office and Civil Service Committee, he may well retain his
interest in federal employees.
CONGRESSMAN BILL CI A Y fD-MO>: Congressman Clay is both on Education and
Labor and Chairman of the House Post Office and Civil Service Committee. As such, Clay
will be protective of both his committee jurisdiction and federal employees. Care should be
taken to consult him early on any proposal to fold Federal Employees into the new system.
He may also be influenced by the Congressional Black Caucus, Congressman Stokes as well
as Chairman Ford. He is a co-sponsor of the McDermott bill. Members of his staff have
served on the working groups on federal employees and coverage for working families.
CONGRESSMAN GEORGE MILLER nO-CAl: Congressman Miller is an outspoken
liberal who has pushed for national health care since his election in 1974. Miller, a
McDermott co-sponsor, is the former Chairman of the House Select Committee on Children,
Youth and Families. Not only does he serve on Education and Labor but he is currently the
chairman of the newly renamed Natural Resources Committee (formerly the Interior and
Insular Affairs) This committee has jurisdiction over the Indian Health Service.
Miller is a goodfriendof Congressman Stark, but doesn't always follow him. He may not
want to buck the leadership on an issue of this importance. He could be helpful on the
Committee, but may be more difficult on the floor if the liberals are not happy.
CONGRESSMAN AUSTIN MURPHY fP-PA): Congressman Murphy barely survived
redistricting and retumed as the Education and Labor Committee's Chair of Labor Standards,
Occupational Health and Safety Subcommittee. Most of Congressman Murphy's legislative
work has been spent on his subcommittee.
While his health views are not widely known, he can be expected to be protective of unions
and working-class issues. He is Roman Catholic and anti-choice.
�CONGRESSMAN DALE K I L D E E fD-MD: Congressman Kildee represents a strong union
district and is one of the more liberal Members of Congress. He has a strong interest in
childrens issues and is Chairman of the Education and Labor Subcommittee on Elementary,
Secondary and Vocational Education. He sponsored the Act for Better Child Care Services,
sponsored by Chris Dodd (D-CT) in the Senate, and pushed through a bill to increase funding
for Project Head Start.
He would like to be helpful on the Committee. While he opposes abortion, his concerns will
be satisfied as long as there is a separate vote on its inclusion in the benefit package. Kildee
also sits on the Budget Committee. He is close to Congressman Bonior (D-MI) and subject
to his influence.
CONGRESSMAN PAT WILLIAMS fP-MH: Congressman Williams now represents the
entire state of Montana, having won with 50% of the vote. As Chairman of the Education
and Labor Subcommittee which deals with ERISA, he is particularly concerned that this
committee be considered a full partner with the other committees of jurisdiction. On health
issues, he is open to reform as long as it is comprehensive. He is also concerned about
Native Americans and cost controls. He believes the Federal government should deal with
primary/preventive care and catastrophic care. He wants other issues handled by private
insurance. While Williams wants reform and would like to help, his vote cannot be taken for
granted. Williams is also a member of the Agriculture and Natural Resources Committees.
CONGRESSMAN MATTHEW fMARTY^ MARTINEZ (D-CW Congressman Martinez
represents the heavily Latino and urban poor areas of East Los Angeles. A relatively quiet
member, he chairs the Human Resources Subcommittee of Education and Labor. Martinez is
a McDermott co-sponsor.
CONGRESSMAN MATOR R. OWENS fNY^: Congressman Owens' district has many of
Brooklyn's urban poor and heavy minority areas. While a McDermott co-sponsor, he has
been quiet on health issues. He is expected to follow the Congressional Black Caucus and
the work of the Education and Labor Committee.
CONGRESSMAN THOMAS C. SAWYER (Om Congressman Tom Sawyer is the former
mayor of Akron, OH, and is credited with bringing that city downtown redevelopment.
Congressman Sawyer is a moderate member who gained some public attention when he
challenged the 1990 census count. He has been quiet on health issues but is expected to want
to help the President. He also sits on the Post Office and Civil Service Committee as well as
Education and Labor.
�CONGRESSMAN DONALD M. PAYNE fN.D: Congressman Payne is a member of the
Congressional Black Caucus and may wait for them to take a position on health care reform.
He is a McDermott co-sponsor who represents Newark, New Jersey. Payne is a liberal
whose health views Eire not known. However, he is a former Prudential employee £ind
therefore may be sensitive to their views.
CONGRESSWOMAN JOLENE UNSOELD fD-WA>: Congresswoman Unsoeld won her
district with 56% in 1992 - her largest margin in her three terms. She has taken unpopular
positions against logging interests and does not appear to shy awayfromtough decisions.
Unsoeld is a member of both the Eduation and Labor and Merchant Marine Committees and
is on the Caucus for Women's Issues. She is a liberal who believes that abortion services
should be contained in the final health care package. It is not clear how she will vote if it is
not contained in the bill. On the other hand, Unsoeld is a protege of Speaker Foley and will
want to be helpful to the leadership and the Administration on this issue.
CONGRESSWOMAN PATSY T. MINK (D-HD: Congresswoman Mink has been an
active part of Hawaii's political history since before Hawaii became a state. Mink is a
member three committees - Education and Labor, Budget, and Natural Resources - as well as
of the Rural Health Care Coalition and the Caucus for Women's Issues.
She can be expected to protect Hawaii's flexibility in the health care package, as well as to
support their anticipated request for an ERISA waiver by the federal government to maintain
their current statewide health plan. Mink was a co-signer of the May 13 letter supporting
inclusion of abortion services - that issue will be key to her vote. In addition, she is a
McDermott co-sponsor. Mink attended the Congressional Women's Caucus meeting with
the First Lady in February.
CONGRESSMAN ROBERT E. ANDREWS (N.D: Congressman Andrews is in his second
term and adamantly opposed to new taxes. He voted against the stimulus package and the
budget reconciliation bill. His district includes both Prudential and pharmaceutical companies
and he is likely to be sensitive to their concerns. This year he introduced his "Comprehensive
Health Care Reform Act" which calls for: basic benefits package; universal claims form and
electronic processing; Medicaid reform and Mediccu^e expansion: employer mandates for those
with more than 50 employees; and elimination of preexisting condition exclusions.
Andrews will be influenced by Chairman Ford, organized labor and Governor Florio particularly the results of the Governor's re-election effort.
Recent Developments: At a May meeting with Chris Jennings, Andrews advocated orienting
the message toward those with health insurance. It must be seen as equal to or better than
what people have. He believes the cost issue is driving the debate. His main point is that the
message be simple, and that people have to trust it and be comfortable with it. He believes it
will be difficult to sell but he wants to be helpful.
�CONGRESSMAN JACK REED fRD: Congressman Reed is in his second term and came
to Congress after serving in the Rhode Island state legislature. He has a strong interest in
children's issues. He is on the Judiciary Committee as well as Education and Labor. His
health care positions are not known.
CONGRESSMAN TIM ROEMER (IN): Congressman Roemer is in his second term of
representing his fairly conservative district. He sits on the Education and Labor Committee
and is a member of both the Mainstream Forum and the Conservative Democratic Forum.
Senator Bennett Johnston is his father-in-law.
Roemer has not endorsed any particular health care plan but has told his constituents he does
not trust the government to solve the problem. He is said to have felt that the Conservative
Democratic Forum plan was too liberal. He is concerned about costs, Medicare, and seniors.
He has a number of Eli Lilly employees and retirees in his district. Congressman Roemer has
taken the lead in opposing IRS Sec. 936, which allows companies to move to Puerto Rico and
receive special tax breaks. This action is known as "runaway" plants, which has been
overwhelmingly used by pharmaceutical companies.
CONGRESSMAN ELIOT L. ENGEL (NY): Congressman Engel, generally a liberal, is a
new member of the Education and Labor Committee. He represents the Bronx and has been
in the House since 1988. Prior to that he was a teacher and guidance counselor.
He is a single payer advocate who co-sponsored the McDermott bill. His particular health
concerns are mental health and home and community-based long-term care.
CONGRESSMAN XAVIER BECERRA (CW: Congressman Becerra is a Freshman A t Large Whip and McDermott co-sponsor. He serves on the Judiciary Committee as well as
Education and Labor. Becerra's wife is an obstetrician. He is a member of the Congressional
Hispanic Caucus.
During his campaign, he stated that he favors national health coverage, but said that new
taxes would not be needed to fund the program.
CONGRESSMAN ROBERT C. SCOTT CVA): Freshman Congressman Scott is a
McDermott co-sponsor who is an advocate of a one-vote strategy, including health care
reform within reconciliation. He is on both Education and Labor and Judiciary. Scott's
southern Virginia district includes a large number of urban and rural poor and has three black
hospitals about which he is very concerned. In addition, he co-signed a letter to the
President with 25 other members from tobacco growing states urging that the Administration
use caution on tobacco taxes.
�CONGRESSMAN GENE GREEN (TX): Congressman Green is afreshmanand a member
of the Mainstream Forum. A lawyer, he represents the largely working class neighborhoods
of Houston. He serves on both Education and Labor and Merchant Marine and Fisheries.
He has changed his opinion on abortion and is now pro-choice.
CONGRESSWOMAN LYNN WOOKSEY rD-CA): Congresswoman Woolsey is a
freshman from the northem bay area, including Sonoma and Marin counties. Woolsey serves
on the Education and Labor Committee and belongs to the Caucus for Women's Issues.
Woolsey's health care perspective will undoubtedly be shaped by her personal experiences as
a divorced mother who was once on welfare, and as the owner of a temporary employment
agency.
She supports a national health care system and is particularly concerned about continued
coverage of sick and poor people. She is a McDermott co-sponsor but, depending on
abortion, should be supportive.
RESIDENT COMMISSIONER CARLOS ROMERO-BARCELO (D-PR): The former
Governor of Puerto Rico, Resident Commissioner Romero-Barcelo is a graduate of Yale and
was Mayor of San Juan for seven years. This is his first term in Congress. He is President
of the New Progressive Party which is pro-statehood.
On health care reform, he is most concerned about the Medicaid inequity between the States
and Puerto Rico. He will also be very protective of IRS Sec. 936, which provides tax breaks
to pharmaceutical companies which relocate to Puerto Rico.Romero-Barcelo raised these
issues at the First Lady's March meeting with the Congressional Hispanic Caucus: need for
Medicaid reform; rum excise tax cap lift insuffient to pay for all needed health care; and
proposed a new income tax to rebate toward increasing Medicaid eligibility.
CONGRESSMAN RON KLINK (PA): Freshman Congressman Klink is a member of
Steering and Policy Committee. Klink beat an incumbent Democrat in the primary who had
lost key union support—in a heavily Democratic district. Klink may, therefore, be apt to
follow labor's lead. He voted for the President's budget plan on May 27 after intense contact
and negotiations with the White House. He has strong concerns over the energy tax and has
stated (in the Post, 5/28) that he will not vote for the reconciliation if the tax is not scaled
down in the Senate. In addition to Education and Labor, he serves on Small Business and
Banking.
CONGRESSWOMAN KARAN ENGLISH fP-AZ): Congresswoman Karan English is a
freshman who has extensive experience in local and state politics. She serves on the Natural
Resources Committee, as well as Education and Labor. Her district 60% rural and
presumably she will be sensitive to those needs in health care reform.
�CONGRESSMAN TED STRICKLAND fOH): Freshman Congressman Strickland won his
first term by 51% and represents an industrial area. He is considered a liberal Democrat. He
believes in a community based and employment-based approach with small business paying
into a public insurance pool. He favors inclusion of mental health benefits in the
Administration's plan. He also favors stronger emphasis on preventive care, immunizations
and prenatal ceu-e. He has pledged not to accept the health care coverage offered to members
until all Americans have coverage. He attended a Congressional briefing on mental health
issues by Mrs. Gore, and spoke eloquently about the need for reform.
DELEGATE RON DE LUGO fVD: Delegate de Lugo is the sole representative from the
U.S. Virgin Islands. Like other members from the territories, he is pushing to ensure that
they are included in the Administration's proposal. He is a member of the Congressional
Hispanic Caucus and attended their meeting with the First Lady. De Lugo shares the caucus'
concerns regarding undocumented persons and the Medicaid inequity. The latter has always
been a problem for representatives of the territories.
DELEGATE ENI F. H. FALEOMAVAEGA (AM. SAMOA): Delegate Faleomavaega
(pronounced EN-ee FOL-ee-oh-mav-Eih-ENG-uh) will also push for equal treatment with
the Mainland with regard to health care reform. Specifically if the basic benefit package is
provided to all citizens, then it should be provided to the people of Samoa who are U.S.
citizens. As a territory, American Samoa has been relatively untouched by the rest of the
United States, only receiving representation in the House in the early 1980's. In addition to
the Education and Labor Committee, Faleomavaega also serves on Natural Resources and
Foreign Affairs.
CONGRESSMAN SCOTTY BAESLER (KY): Baesler is afreshmanand was one of 25
members to co-sign a letter to the First Lady urging caution regarding cigarette taxes. He is
a member of the Rural Health Care Coalition and a member of the Agriculture, Education and
Labor, and Veterans' Affairs Committees. Baesler has initiated a Health Care "Sounding
Board" in his district and is sensitive to the fact that his state is rather small, largely rural,
and has over 13% of the population uninsured. He did not endorse President Clinton but was
helped in his election by Senator Ford. Baesler voted against the budget reconciliation bill.
�DETERMINED TO BE AN ADMINISTRATIVE
MARKIIVG Per E£>. 12958 as amended, Sec. 3.3 (c)
Initials: _iL5s21I___ Date:
PRIVILEGED AND GGmnSEXCW. MEMORANDUM
TO: Hillary Rodham Clinton
FR: Chris Jennings, Steve Edelstein
RE: Meeting with the House Small Business Committee
cc: Melanne, Steve, Lorraine, Distribution
July 27, 1993
Tomorrow you are scheduled to meet with Congressman John LaFalce
and the bipartisan membership of his Small Business Committee. This is in
response to a longstanding request from the Congressman for such a meeting,
which he also relayed to you personally when he met with you on June 29th.
BACKGROUND;
This meeting is part of an ongoing outreach effort to the Chafrman and
to his committee. In addition to your meeting with Congressman LaFalce a
month ago, Ira has also met with him, we have held a small meeting with his
committee staff and also had Ken Thorpe brief the staff of the members who
serve on the Committee.
As you recall. Congressman LaFalce is a cosponsor of the McDermott
single payer bill. He feels that it is very important to break the link between
employment and health care. His upstate New York district, which includes
Niagara Falls, lies on the Canadian border. His constituents have a familiarity
with the Canadian system (often through friends and relatives who live there)
which makes the decision more comfortable for him.
He recdizes, however, that single payer requfres taxes which are too high.
He also believes that the dislocation of people caused by the complete
restructuring of health CEire is also a good argument against that approach.
Congressman LaFalce wants to help and while not a major player on
health Ccire, with sufficient attention, Congressman LaFalce can serve as a
useful connection to the small business community. He is close to John
Motley of NFIB. LaFalce's support may help us by taking some of the vitriol
out of their public opposition. At the very least, his approval provides us with
a credible counterweight to their attack. In addition, his conunittee can serve
as a forum for afring our message on health care and small business.
�Given the large Freshman class in the House, the House Small Business
Committee, as one of the lesser committees, has a lot of new members, as
more senior members of the committee have moved on to more coveted
assignments. The 45-member committee includes 12 Democrat and 13
Republican freshman. It is also notable for its high representation from the
House caucuses — 9 members of the Congressional Black Caucus and 2
members of the Congressional Hispanic Caucus among its 27 Democratic
members.
Attached for your review are brief profiles of the members of the Small
Business Committee and the first draft of the small business notebook
containing background information, charts and graphs which may be helpful
in your meetings with those interested in small business.
�HOUSE SMALL BUSTNFi^S COMMITTEE
July 28, 1993
DEMOCRATS:
CONGRESSMAN JOHN LAFALCE fD-NY>: The Chainnan of the Small Business
Committee, Congressman LaFalce can be a key player on health care reform and invaluable if
it supports the Administration package. His support of Family and Medical Leave was
crucial. LaFalce is on the Rural Health Care Coalition and close to labor.
Because his upper New York district borders Canada, both LaFalce and his constituents arc
familiar with and supportive of a single payer system. His role with the small business
community and closeness to the National Federation of Independent Business make him
skeptical of employer mandates. On the other hand, he understands why breaking the
employer-employee link would be difficult. He wrote to the First Lady in February opposing
employer mandates and offering to serve as liaison to the small business community. In May
he discussed with Chris Jennings his excellent relationship with the NFIB and his regular
meetings with their executive director.
He is supportive of universal coverage. The Task Force has been working closely with
LaFalce, including fra with whom he has worked in the past, and is hopeful that he will be
helpful. While LaFalce does not have legislative jurisdiction on health care, he wants to hold
hearings on its impact. His position may be influenced by his strong anti-choice views.
Recent Developments: In a June 23 meeting with the First Lady and McDermott
cosponsors, LaFalce praised the Canadian system for being totally hassle-free and for that
reason would prefer no co-payments in the reform bill. According to LaFalce, Small
businesses who operate on a very small margin face the biggest obstacles, and he believes
that anything other than a payroll tax would be more progressive. He is also concerned about
how to overcome doctor opposition.
The First Lady also had an individual meeting with Chairman LaFalce on the 29th of June.
He stated that he "feels passionately" about health care and thought that it was especially
important to sever the link between health coverage and jobs. He senses that people don't
want to pay more for what they are getting now. He recognizes that a single payer system
would mean unacceptable taxes. LaFalce believes that a good argument to make to single
payer advocates is the dislocation of people under a complete restructuring of health care.
LaFalce prefers a premium to a payroll approach. He suggested a phase in over three or four
years for low-wage workers and those under 25 to help minimize the impact on small
business.
Regarding the NFIB, LaFalce hopes they can be persuaded to be simply opposed rather than
undertaking a high mobilization opposition. He thinks their only concern is the financing
mechanism. He would try to convince them to oppose that mechanism in a floor vote but not
the whole package.
�He recommends that the President release a set of health care principles and say that he feels
his approach is best but that he is willing to look at alternatives - including financing
mechanisms. He believes that would be a challenge to Congress and employers to put up or
shut up.
In a personal note, he invited the First Lady to visit his Niagara Falls district and stated his
interest in helping in whatever way possible. If used, he will be helpful.
CONGRESSMAN NFAL SMITH fP-IA^: Congressman Smith has served in the House
since 1959 and spends most of his time working on the Appropriations Subcommittee on
Commerce, Justice, State and the Judiciary which he chairs. He is hopeful of someday
chairing the full committee. Popular in his Dcs Moines district, Smith is a skilled
parliamentarian who has never excelled at internal politics. His work on Appropriations has
kept himfroma prominent role on Small Business.
While Smith's general health care views are not known he should be supportive of the health
care package. He is a liberal who caimot understand why other members, particularly
Democrats, put deficit reduction ahead of social needs. He has voted pro-choice. In March,
He flew with the First Lady to Iowa.
CONGRESSMAN IKE SKELTON fD-MO): A pro-defense, but not necessarily proPentagon, Democrat, Congressman Skelton is in his ninth term in the House. He is a member
of the Armed Services and Small Business Committees, Rural Health Care Coalition and
Mainstream Forum. Skelton also served on the Select Committee on Aging. He has two
sons pursuing militar>' careers, one of whom served in the Persian Gulf. Congressmen Qay
and Volkmer can be influential with him, and he and Secretary of Defense Aspin worked
closely together when serving together in the House.
While Skelton's health care views are not know, he can be predicted to be sensitive to the
concerns for rural areas and small business. He has said he docs not believe the reform
package should be voted on in 1993 but that he is worried about the runaway costs of health
care. He is anti-choice.
CONGRESSMAN ROMANO MAZZOLI fP-KY): Congressman Mazzoli is best known
for his role in the landmark immigration legislation of the late 1980's. Judiciary Committee
Democrats, who felt that as Subcommittee Chairman he had sided with the Republicans too
often, ousted himfromhis chairmanship. He did not defect to the GOP, as some speculated,
and has since been retumed to his chairmanship. Mazzoli represents Louisville and its
suburbs and won with 53% of the vote in 1992. He has been less active on the Small
Business Committee and tends to be a conservative vote on budget issues.
His general health care views are not known but he is expected to support the reform
package. A Roman Catholic, Mazzoli is a strong opponent of abortion.
�CONGRESSMAN RON WYDEN (P-ORh The former executive director of Oregon's
Gray Panthers, Congressman Wyden is an ardent advocate for the interests of the elderly. An
aggressive and tenacious Member, Wyden is a committed liberal who was first elected in
1980. He represents Portland and some of its suburbs, as well as a small rural area. Wyden
won in 1992 with 77% of the vote. He serves on both Small Business and Energy and
Commerce where he is a close ally of Chairman Dingell. Wyden is a team player who will
be willing to broker a deal between liberals and conservatives. He serves on Congressman
Waxman's Health Subcommittee and is close to him as well.
Congressman Wyden is an enthusiastic supporter of Oregon's health care reform
demonstration program. He is a sfrong proponent of abortionrights,and sponsored a bill for
NIH research on RU-486. Wyden was a major sponsor of legislation to constrain the costs
of drugs sold to Medicaid patients, and recently backed a bill to establish a process to provide
reasonable prices for drugs, devices and other products receiving NIH funding. In the 103rd
Congress, he reintroduced a bill to establish Federal standards for long-term care insurance
policies. His staffer participated in Global Budget and the Quality Measurement Working
Groups.
CONGRESSMAN NORMAN STSTSKY fP-VA): Congressman Sisisky is a World War 0
veteran and successful businessman whose aim in Congress is to make the Pentagon more
fiscally responsible. He serves on the Armed Services Committee as well as Small Business
and is a member of the Rural Health Care Coalition. Sisisky serves on the Select Committee
on Aging. He is protective of both Portsmouth and the rural interests of his district, including
tobacco and peanut farmers.
Sisisky's views on health care reform are not known. He signed the March 30 letter
regarding tobacco excise taxes and has been against abortion rights. Sisisky voted against
Family and Medical Leave and is not expected to support the Administration on health care.
CONGRESSMAN JOHN CONYERS, JR. fP-MD: The Chairman of the Government
Operations Committee was instrumental in establishing the Congressional Black Caucus and
is a long-time fighter for civilrightsand minority concerns. Conyers, who is also on the
Judiciary Committee, surprised many by dropping his sometimes abrasive style and skillfully,
albeit sometimes painfully, investigating the charges against black judge Alcee Hastings,
fronically, Hastings is now afreshmanMember of Congress.
Conyers favored putting the health care package into reconciliation. He believes health care
reform is the most important program since Roosevelt but may be difficult because he
strongly supports a single payer approach. Along with Congressman McDermott, Conyers is
a leading sponsor of the House Single Payer bill andfightsfor recognition of that fact. He
attended two early meetings with the First Lady. His district is overwhelmingly black and
has all the problems one anticipates for a poor urban area. He will fight for those concerns
and, while often still a loner, is very adept at press. One of Conyers' staff members served
�on the Working Group.
CONGRF^SMAN JAMF^ BH.BRAY fD-NVl: A lawyerfroma wcU-conncctcd Law
Vegas family, Congressman Bilbray is a moderate who serves on both Armed Services and
Small Business. Despite some missteps when he first came to the House, he is known to be
highly intelligent and a successfulfighterfor his state. White House lobbyists counted him as
a "real trooper" on the economic package.
On health care, Bilbray's views arc not known. However, he has shown concern for both the
elderly and veterans and supports home care. A Roman Catholic, he has stated that after
discussion with his family, he now supports reproductive rights.
CONGRESSMAN KWEIST MFUME fP-MDh Congressman Kweisi Mftime (pronounced
Kway-see Em-fume-ay) represents most of metropolitan Baltimore. He has been able to
turn personal disappointments in his early life into positive life experiences. He was elected
in 1986, after serving on the Baltimore City Council. He was first assigned to the Banking,
Finance and Urban Affairs Committee and currently serves on the Small Business, Ethics, and
Joint Economic Committees. He has spent most of his time on the Banking Committee
working on housing issues.
Congressman Mfume is the current Chairman of the Congressional Black Caucus. The
caucus has raised two main concerns regarding health care reform. Thefirstis how to
address the needs of underserved populations. The Administration's plan must incorporate
and reach out to those who are currently underserved by the health care system. Secondly,
the caucus is concerned that doctors, who are the primary providers in many AfricanAmerican communities, are not unfairly treated by the Administration's reforms, and that in
developing networks accommodations are made for community providers. Similarly, the CBC
is interested in ensuring that traditionally black colleges are not disproportionately effected by
health care reform. Congressman Stokes has taken the lead on health care reform for the
caucus, and will be extremely influential in getting their support. Congressman Mfume has
suggested that if Stokes is happy with the Administration's proposal, they will be happy.
CONGRESSMAN FLOYP FTAKE fP-NYl: Congressman Flake is considered one of the
new generation of black House members who are willing to work for change through the
power structure rather thanfromthe outside. There has been some controversy around Flake,
a charismatic AME Minister. In 1991 the govenmient dismissed a case against him in which
he was accused of diverting federal housing fundsfromhis church for his own use. In 1988
a church panel rejected claims of sexual harassment by a woman parishioner. Flake is a
member of the Small Business and Banking Committees. He is a McDermott co-sponsor but
is expected to be supportive of the Administration's health care reform efforts. Flake believes
that VA hospitals are underutilized. He attended the First Lady's March meeting with the
CBC.
�CONGRESSMAN BH.L SARPALIUS (D-TX): This is Congressman Sarpalius' third tenn
in Congress, representing the eastern panhandle of Texas. He is a conservative Democrat
who voted as often with President Bush as with the Democrats. Sarpalius has a compelling
personal history - be was a victim of polio as a child, abandoned by his father at 10, and sent
by his alcoholic mother to a home for wayward boys. He served in the State Senate.
Sarpalius is now a member of the Agriculture and Small Business Committees. On the latter,
he chairs the Health Subcommittee. He is also a member of the Mainsfream Forum and the
Rural Health Care Coalition. He voted against the budget package in May.
Sarpalius's health care views are not known, but be is said to want to play a major role
through his Health Subcommittee. He opposes abortion.
CONGRESSMAN GLENN POSHARD (D-U.): Congressman Poshardfreadsa difficult
line between his conservative outlook and a rural constituency which presses him to vote as a
traditional labor Democrat. He serves on the Small Business Committee and is a member of
both the Rural Health Care Coalition and the Mainstream Forum.
In December he wrote to the President-Elect about health care reform, in particular the need
for access for those living in rural areas. Rural health care was one of Poshard's specialties in
the state legislature. He also asked that reform focus on: preventive health care; technology
sharing; increased usage of mid-level health care providers, including nurse-midwives, nurse
practitioners and physician assistants; conversion of unused hospital beds into paying entities;
and improved incentives to recruit health care professionals to rural areas. In March Poshard
held three district hearings on health care reform. He forwarded that testimony to the First
Lady stating that the result "confirms that major reform of our health care system is necessary
and that your efforts in this process arc indeed appreciated."
CONGRESSWOMAN EVA CLAYTON fD-NC): Congresswoman Eva Qayton has been
elected Chairwoman of the Democratic Freshman class. She represents a tobacco-producing
district and was one of the 30 co-signers of the March 30 letter urging caution on tobacco
excise taxes. Clayton sits on the Agriculture and Small Business Conmiittees. She is a
member of the Congressional Black Caucus, and attended the March 2 meeting with the First
Lady.
At that time she was concerned about the role of the Jackson Hole Group in formulating the
health care package. In a February letter to the First Lady, she outlined her experience as a
County Commissioner faced with the possibility of the only hospital in their rural community
being closed. They were not only able to save the hospital but also aeate a primary
preventive care system as well. Based on that letter, her health care focus will be on
underserved populations - both rural and urban poor - and on preventive health care. She
will be in a delicate position, balancing the conflicting tobacco and health care interests of her
district.
�CONGRF^SMAN MARTIN MEEHAN fP-MA): Freshman Congressman Mechan made
his reputation as a crimefighterwhen, as an assistant district attorney, he dealt with white
collar and violent crime, and hate crimes against gays. Meehan comes to Congress with a
liberal agenda which fits his Lowell constittiency. He may also feel the need, however, to be
independent. He serves on the Small Business and Armed Services Committees.
During his campaign, Meehan advocated a "play or pay" health care plan. He supports
universal access and has proposed a cost-contaiimient program to bring down doctor and
hospital bills. A Roman Catholic, he supports abortion rights. He also supports sin taxes.
CONGRESSWOMAN PAT PANNER fP-MO): Freshman Congresswoman Danncr
represents a largely agricultural area of Missouri - an area she served in the state senate as
well. She sits on the Small Business Committee, and is a member of the Mainstt-eam Forum.
On health care issues, Daimer opposes a national system and supports tax breaks for small
businesses which offer health insurance. She would like to see costs cut by standardizing
medical forms. She also advocates drug coverage for those under 65 and is opf)Osed to
rationing. Danner attended the Mainstream Forum meeting with Ira and the First Lady's
meeting with the Caucus for Women's Issues. Danner's family is very involved with the
medical profession: one daughter-in-law is a nurse; one son-in-law is a surgeon; and one
daughter is an anesthesiologist.
CONGRESSMAN TED STRICKLAND (OH): Freshman Congressman Sttickland won his
first term by 51% and represents an industrial area. He is considered a liberal Democrat. A
former professor who ran three times before capturing the seat, Strickland serves on both
Small Business and Education and Labor.
He believes in a community based and employment-based approach with small business
paying into a public insurance pool. He favors inclusion of mental health benefits in the
Administration's plan. He also favors stronger emphasis on preventive care, immunizations
and prenatal care. He has pledged not to accept the health care coverage offered to members
until all Americans have coverage. He attended a briefing for Congressional members on
mental health issues by Mrs. Gore, which he spoke eloquently about the need for reform.
CONGRESSWOMAN NYPTA VEIAZQUEZ fP-NY): ThefirstPuerto Rican woman to
serve in Congress, Freshman Velazquez (pronounced NYD-ec-uh vch-LASS-kez) has,
through a monthly column in the nation's largest Spanish-speaking newspaper and her work
for the Government of Puerto Rico, focused her career on the needs of Hispanics, women and
the poor. After afierceprimary, she won overwhelmingly in this district which includes
lower Manhattan, and parts of Brooklyn and Queens. In addition to the Small Business
Committee, she sits on the Banking Committee.
�In a March letter inviting the First Lady to discuss health care and tour her district, Velazquez
outlined some of the specific health problems of her Latino community: high uninsurance
rates; population most likely to receive Medicaid benefits; infant mortality; tuberculosis; HFV;
and the need for basic primary care for women. Velazquez is a McDermott co-sponsor and
sits on the Banking and Small Business Conmiittees. She is also a member of the Caucus for
Women's Issues and the Hispanic Caucus. She attended the lattcr's March 2 meeting with the
First Lady. Velazquez is pro-choice and co-signed the May 13 letter urging inclusion of
abortion services in the health care package.
CONGRESSMAN CLEO FIELDS (D-LA): Freshman Congressman Fields is a fonner
state legislator who represents parts of Monroe, Shreveport, and Baton Rouge. Fields is a
lawyer and was, at 24, the youngest member in the history of the Louisiana Senate. He won
in 1992 with 74% of the vote in his newly drawn district. He now sits on the Small Business
and Banking Committees.
On health care reform, he is expected to take his cuesfromthe Congressional Black Caucus.
His state has a large charitable hospital system. Fields attended the March 2 meeting with the
First Lady.
CONGRESSWOMAN MARTORIE MARGOLIES-MEZVINSKY fD-PA):
Congresswoman Marjorie Margolies-Mezvinsky rode a wave of anti-incumbent, antipolitician sentiment in order to eke out a slim victory in her race for the House. At one time
a reporter for WRC-TV in Washington, she is married to former Iowa Democratic
Congressman Edward Mezvinsky. She is very skittish about her district which has a
Republican edge in registration. However, her constituents are liberal on social issues and
have voted Democratic in recent elections. She has voted against the President on economic
issues, presumably out of fear of a backlashfromherfiscallyconservative constituents.
The Congresswoman's particular concerns are children and child welfare, education, and
issues related to families. She is the first unmarried American to adopt a foreign child and at
one time or another she has had 11 children growing up in her household. She sits on the
Energy and Commerce and Small Business Committees.
On health care reform, she has said she wants to be involved but most people believe she will
need serious work before she votes for the plan.
CONGRESSMAN WALTER TUCKER (D-C\): The former Mayor of Compton,
freshman Congressman Tucker's ethnically diverse district has perhaps the highest
unemployment rate in California. Tucker has a law degreefromGeorgetown University and
comes to Washington with a decidedly liberal, urban agenda. He is a member of the Small
Business Committee.
�Tucker campaigned for health care reform and for federallyfinancedinner-city health
centers, including mobile clinics. He attended the First Lady's March meeting with the
Congressional Black Caucus.
CONGRESSMAN RON KLINK (PAY Freshman Congressman Klink is a fonner television
anchorman who beat an incumbent Democrat in a heavily Democratic district. The incumbent
had lost key union support. Klink voted for the President's budget plan on May 27 after
intense contact and negotiations with the White House. In addition to the Education and
Labor Committee, he serves on the Small Business, Banking and Steering and Policy
Committees.
Klink campaigned in support of reforming the nation's health care system. He was on the
board of a health care institution in his district.
CONGRESSWOMAN L U C I L L E RQYBAL-ALLARD (D-CA): Freshman
Congresswoman Roybal-Allard represents the Congressional district with the nation's highest
concentration of Hispanics. While serving in the California Assembly, Roybal-Allard chaired
a subcommittee on health and human services. In the Congress, she is a member of the
Small Business and Banking Committees, as well as the Caucus for Women's Issues and the
Hispanic Caucus.
Roybal-Allard has taken a leadership role in the Congressional Hispanic Caucus and set up a
meeting with the First Lady and a group of Hispanic women to discuss their particular health
concerns. A Roman Catholic, Roybal-Allard is pro-choice and co-signed the May 13 letter
urging inclusion of abortion coverage in the health care package. She is a McDermott cosponsor and is particularly concerned about coverage for the uninsured.
CONGRESSMAN F J V R L H I L L I A R D fP-ALl: AfreshmanCongressmanfromrural
Alabama, Hilliard serves on both the Agriculture and Small Business Committees. He is a
lawyer who served in both the Alabama House and Senate.
Hillard campaigned on a platform which included a national health care program. He met
with Steve Edelstein to discuss health care and indicated his belief that the package should be
comprehensive, including malpractice reform. His chief-of-staff formerly worked for Qaude
Pepper and could be helpful. Hilliard is a McDermott co-sponsor. He attended the
Congressional Black Caucus's March 2 meeting with the First Lady.
CONGRESSMAN MARTIN LANCASTER (D-NC); Congressman Lancaster represents
conservative East Carolina tobacco country as well as Camp Lejeune and the Seymour
Johnson Air Force Base. Protective of his district's economic interests, Lancaster is
considered a conservative Democrat but in the Jim Hunt tradition. Lancaster serves on the
Armed Services and Small Business Committees and won with 54% of the vote in 1992.
�In March Lancaster wrote a long letter to the First Lady outlining his health care reform
concerns, including: nn-al access in a managed competition system; the need for more
primary care and fewer specialty physicians; the benefits of home health care and hospice
services; the need for preventive care; and how to address costs at the end of life. In
addition, he wrote that his wife, Alice, had worked with Mrs. Gore on the Adolescent Mental
Health Care Task Force, and that he supported inclusion of mental health services in the
reform package. He also stated that while jogging with the President, he had brought up the
issue of stateflexibilitywhich the President had assured him would be a feattire in the final
package. Lancaster was one of the 25 Members co-signing the letter to the President
concerning tobacco excise taxes. He has voted for abortion services and attended fra's
meeting with the House Democratic Caucus on March 31.
CONGRESSMAN TOM ANDREWS fP-ME): Sccond-terai Congressman Tom Andrews
is a liberal activist turned legislator. Before being elected to Congress he worked on causes
related to the poor and was executive director of the Maine Association of Handicapped
Persons. As a teenager Andrews had a leg amputated because of cancer. He is popular in his
district which encompasses Portland and former President Bush's Kennebunkport summer
home. Andrews serves on the Small Business, Armed Services, and Merchant Marine
Committees. Andrews is a McDermott co-sponsor but is expected to support the
Administration's package.
CONGRESSWOMAN MAXTNE WATERS fP-CA): A liberal activist who is outspoken
about the problems of the iimer-city urban area she represents, Congresswoman Waters
focuses her energy on the needs of the minority poor. She received a great deal of attention
when riots erupted in the Watts area of her Congressional Disttict following thefirstRodney
King verdict. A Democratic National Committeewoman, Waters was an active supporter of
Jesse Jackson's Presidential ambitions. She sits on the Small Business and Veterans' Affairs
Committees and is a member of both the Congressional Black Caucus and the Caucus for
Women's Issues. Waters attended the First Lady's meetings with the latter two groups.
She is a McDermott co-sponsor but is expected to vote for the health care package as long as
it includes abortion services. She was very active in the Qinton/Gore campaign.
CONGRESSMAN BENNIF THOMPSON fP-MS): Congressman Thompson was elected
to fill the seat of now AgriculUirc Secretary Espy. Thompson has had an active career in
local politics and holds a Master of Science degree. In addition to being a member of the
Congressional Black Caucus, Thompson is on the Small Business, Agriculttire, and Merchant
Marine Committees.
His district is the second poorest in the United States. Health care services for the large
indigent population are either non-existent or woefully inadequate. Thompson would like to
see not only adequate health care, but sufficient numbers of health care professionals, and
appropriate and affordable insurance and/or funding programs for his district.
�REPUBUCANS:
CONGRESSWOMAN JAN MEYERS (R-KS): Congresswoman Meyers is a moderate and
pro-choice with possible aspirations for statewide office. The ranking Republican on the
Small Business Committee, she has focused on extending the health insurance deduction for
the self-employed - while maintaining the GOP line against federal mandates on employers.
While Meyers' general health care views are not know, her son is a physician. A member of
the Caucus for Women's Issues, she attended their February meeting with the First Lady. She
is a Bonior target.
CONGRESSMAN LARRY COMBEST (R-TX): A protege of the late Sen. John Tower
and former Congressional staffer, Congressman Combest is known as a steady conservative
with a talent for legislative deal-making. He is safe in his western panhandle district which
includes parts of Lubbock and Amarillo. In addition to the Small Business Committee, he
serves on Agriculture. He is an ally of Rep. Stenholm and in 1990 was one of four House
members to vote 100 percent of the time with the "conservative coalition" of Republicans and
Southern Democrats. He is not, however, an ally of Newt Gingrich, as Combest prefers a
more pragmatic and behind-the-scenes role.
Combest's views on health care reform are not known. He will undoubtedly be sensitive to
rural interests. He has voted against abortion.
CONGRESSMAN RICHARD H. BAKER (R-IA.): Congressman Baker began his long
career in Louisiana politics as a labor-oriented Democrat in the state House. He switched
parties and in Congress is considered a low-key conservative party loyalist. His district is a
mix of rural areas and most of Baton Rouge and its suburban aicas. Baker serves on the
Small Business, Banking, and Natural Resources Committees. He won in 1992 with 51% of
the vote.
When Baker switched his total opf)Osition to abortion to its being allowed in cases of rape
and incest, some thought he was looking toward a statewide race. His general views on
health care reform are not known.
CONGRESSMAN JOEL HEFI.EY (R-CO): A former state legislator. Congressman
Hefley is a pro-defense, business-oriented legislator. His district includes Colorado Springs
and south central Colorado, and he won there with 74% in 1992. In addition to the Small
Business Committee, Hefley sits on the Armed Services and Natural Resources Committees.
His health care positions, others than his opposition to abortion, are not known. The single
piece of legislation with his name attached is the National Visiting Nurses Association Week.
�CONGRESSMAN RONALD MACHTI.EY fR-RD: Congressman Machtley (pronounced
MAKE-lee) is one of the House's more liberal Republicans, a position supported by his
constituents who rehimed him with 70% of the vote in 1992. He represents Providence and
eastern parts of the state which include light manufacturing. Machtley serves on the Armed
Services and Small Business Committees. He previously was a member of the Select
Committee on Children. A lawyer, Machtley is a graduate of the Naval Academy and
continues to serve in the Navy Reserves. His vote to override President Bush's veto of the
"family leave" bill was one of many against his party.
Machtley's views on health care are not known. He has been a volunteer with the YMCA
and that and his work on the Select Committee on Children clearly indicate an interest in the
young. He will also presumably look out for small business interests. He is a supporter of
reproductive rights. Congressman Bonior considers Machtley a top target.
CONGRESSMAN .TIM RAMSTAD (R-MNl: Congressman Ramstad is in his scond tenn
and came to Congress as a former staffer in both the House and the Senate. He represents
suburbs of Minneapolis. He now sits on the Small Business and Judiciary Committees.
Ramstad replaced Bill Frenzel in the House. Frenzel was moderate but partisan and Ramstad
considers him his mentor.
While Ramstad's general health care views are not known, he is pro-choice. He has been
interested in emergency medical care for children. He worked on issues involving chemical
dependency in young p>eople, cocaine babies and the handicapped while in the State Senate.
At that time he also dealt with a personal alcoholism problem.
CONGRESSMAN SAM JOHNSON (R-TX): Congressman Johnson is a former fighterpilot who lost partial use of hisrightarm while held prisoner in North Vietnam. He met his
future colleague, Senator John McCain, while there. Johnson represents north Dallas and won
with 86% of the vote in 1992. He came to Congress in 1991 after winning the seat when the
incumbent ran for mayor of Dallas.
Johnson's health care views are not known.
CONGRESSMAN BILL ZELTFF (R-NH): A protege of fonner Gov. John Sununu,
Congressman Zeliff won in 1990 on his image as a successful businessman - and after
spending $400,000 in the GOP primary. Zeliffs district includes Manchester and eastern New
Hampshire. He retained it with 53% of the vote in 1992. Zeliff
is a member of the Small Business, Goverrmient Operations and Public Works Committees.
While Zeliff s health care views are not known, one possible indicator of his views is that as
the owner of a small resort, he has linked his business success to entrepreneurialism and
frugality.
�CONGRESSMAN MAC COLLINS fR-GA): Freshman Congressman Collins won his seat
with 55% thanks to redistricting and a sfrong anti-Washington mood. His district includes
parts of Newt Gingrich's old district and is a mixture of independents, Reagan Democrats and
Republican suburbanites. It is a seat targeted by Democrats in 1994. Collins is ia truck
company owner and seen as a down-home conservative with a knack for hard-nosed
campaigning. In the state Senate, Collins is said to have used a "graceful negotiating style"
to help enact bills to combat dnig dealing and to help people get off welfare. His health care
views are unknown.
CONGRESSMAN SCOTT MCTNNTS fR-CO): Serving hisfirsttenn in Congress after
five in the state legislature. Congressman Mclnnis is a traditional conservative. He won with
56% on the western slope of Colorado, includmg Pueblo. He serves on both the Small
Business and Natural Resources Committees.
While his specific views on health care are not known, he will be looking out for rural areas
as well as small business. A Roman Catholic, Mclnnis is pro-abortion.
CONGRESSMAN MICHAEL HUFFINGTON fR-CA): Freshman Congressman
Huffington won his seat with 53% of the vote after spending the record sum of $4.2 million.
He is a former Reagan administration official and video production company owner who has
never held elective office. He holds engineering and economics degreesfromStanford and an
MBA from Harvard. Huffington serves on the Small Business and Banking Committees. He
has said he wants to eliminate all Capitol Hill perks and significantly change the way
Congress operates.
While Huffington's general health care views are not known, he campaigned against tobacco
interests. He also supports abortion rights.
CONGRESSMAN TAMES M. TALENT (R-MO): Congressman Talent comes to Congress
with substantial experience in the state legislature and a strong conservative agenda. Talent
beat President Bush's cousin in the primary andfirstterm Democrat Joan Kelly Horn in the
general. He won this largely suburban district with 50% of the vote. He sits on Armed
Services and wants to use his position on Small Business to guard against excessive
goverrmient regulation.
While Talent supports health care reform along the Imes of managed competition, he opposes
universal health coverage. He supports malpractice reform and allowing employees to
establish medical IRAs. However, he opposes government allocating health care resources.
Talent supports abortion only in cases of rape, incest or to protect the woman's life.
�CONGRESSMAN JOE KNOLT ENRERG fR-MP: Freshman Congressman Knollenberg
used his long-time party experience to win this open seat with 58% of the vote. The owner
of an insurance agency, Knollenberg now represents an upscale Republican district in
suburban Detroit. Abortionrightsadvocates thought they could win the scat given
Knollenberg's hard line on abortion - he supports it only to save the life of the mother.
Knollenberg now sits on the Banking as well as the Small Business Committee.
Other than his position on abortion, Knollenberg's views on health care arc not know.
CONGRESSMAN JAY DICKEY (R-AR): Another Freshman who was once a Democrat,
Congressman Dickey won by 52% and Democrats are looking to regain the scat in 1994. In
addition to Small Business, he sits on the Agriculture and Natural Resources Committees.
Congressman Dickey requested a meeting with the First Lady which was held on June 7. He
brought in his district working group which includes over 15 physicians and the President of
the Arkansas Medical Society. Dickey and his group met later with the President in the Oval
Office as well as having a separate meeting with Chris Jennings and Phil Lee. Dickey
indicated that he wanted to be either a Republican co-sponsor or the only Republican sponsor
of health care reform but not if it includes abortion in any form. He is concerned about the
effects of the package on small business, but that is not as important to him as malpractice
reform or abortion. He received a lot of press in his districtfromthe meetings and was most
appreciative of the time he was given. One personal note, Dickey is a polio survivor.
CONGRESSMAN JAY KIM fR-CA): Congressman Kim is thefirstKorean-American to
win a seat in Congress. His newly created seat includes parts of Orange, Los Angeles, and
San Bernardino Counties. Kim is a small business conservative and sfrong opponent of
unnecessary' government spending. He sold his construction business to avoid My appeairance
of conflict of interest - it was one of five minority-owned companies hired following the
Rodney Kingriotsin LA. An LA grand jury has subpoenaed his campaign records and
company documents in an investigation of his using corporate funds tofinancehis
campaign. In addition to Small Business, Kim is on Public Works and Transportation.
His health care views arc not known. His only child is a neurosurgeon. Kim is a libertarian
on abortion - believing it not to be the govcnmient's business.
CONGRESSMAN DONALD MANZULLO (R-ID: A hard-line conservative. Freshman
Congressman Manzullo beat a one-term Democrat with 56% of the vote - thefirstDemocrat
to hold this aging, rural district in northwest Illinois. There may be a rematch in 1994.
Manzullo sits on Foreign Affairs as well as Small Business.
Manzullo has received a lot of supportfromfundamentalist Christians and has crusaded
against abortion. His other health care views are not known, but he is apt to be concerned
about rural coverage.
�CONGRFJ5SMAN PETER G TORTOI^DSEN fR-MA): Freshman Congressman
Torkildsen served in the state legislattire and as Massachusetts Commissioner of Labor. He
strongly resembles his former boss. Governor William Weld, with liisfiscallyconservative,
pro-business stand and his support - as of April - of abortionrights.Torkildsen won his
scat with 51% of the vote and Democrats hope to rec^ture it in 1994. He sits on the Armed
Services as well as the Small Business Committee.
Health care reform is one of Torkildsen's priorities. He supports a pro-business plan of
vouchers and tax credits. He is one of Congressman Bonior's targets.
CONGRESSMAN ROB PORTMAN (R-OH): The most junior member of this Congress,
Representative Portman won the seat of Republican Bill Gradison, a man he once interned for
when he was in college. Portman has extensive Washington experience, including practicing
at Patton, Boggs and Blow and Director of President Bush's Office of Legislative Affairs.
Portman won the seat with 70% of the vote.
His health care views are not known.
�DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per E.0.12958 as amendwl, Sec. J.3 (c)
Initials: ^ O T P
Date: \ ^ \ 5> / \ I
PRIVILEGED AND QONb IDLl^ IiAI> MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings, Steve Edelstein
Meeting with Congressman Kasich
Melanne, Steve, Lorraine, Distribution
June 30, 1993
Tomorrow you are scheduled to meet with Congressman Kasich, the
ranking Republican of the House Budget Committee. In his call to you earlier
this week, the Congressman requested this private follow-up meeting to the
dinner meeting he hosted for you and ten of his Republican House colleagues
back on June 14th.
BACKGROUND:
Long an advocate of tough measures to control federal spending
(including across the board freezes), Kasich took the lead in crafting the House
Republican alternative to the President's budget. His plan was praised by
some in the media for backing up the usual Republican rhetoric, with specific
cuts, demonstrating how it would be possible to significantly reduce the deficit
without raising taxes. It also received significantly more Republican support
than his previous efforts.
Kasich is a relative newcomer to the health reform debate. However, as
you know, he released the attached "White Paper on Health Reform." As you
may recall, the report takes a rather stereotypical conservative position on
health reform, such as the use of MediSave Accounts, means-testing Medicare,
increasing Medicare beneficiary copajonents, and categorical spending targets
for health entitlements (but not for the private sector). However, it also
includes a number of suggestions that are consistent with the direction the
Administration has been heading Including: Developing incentives for greater
use of competition in the Medicare and Medicaid programs, providing
flexibility/waiver authority to the states, reducing health care fraud, assuring
insurance portability, establishing purchasing groups, and addressing the
medical liabfllty problem.
Kasich was very happy with and appreciative of the dinner meeting and
it appears to have gained much good will. Since then. Congressman Kasich,
has been quite complimentary about you, personally, and the Administration's
consultative and outreach process for health reform. He was particularly
pleased with how open you have been to Republican input and your
commitment to a bipartisan health reform effort and has made a point of
distinguishing it from other Administration initiatives.
�This meeting should allow you the opportunity to cultivate this
important relationship. Kasich, given his reputation as a smart and serious
legislator, can be very helpful with mainstream Republicans. In addition, he
seems to have gained the respect of the media so his supportive comments
about you and the process can have a positive impact externally on public
perception, as well. Even ff he ultimately opposes the plan, his positive feeling
toward you and the process may mute his criticism and moderate the
Republican opposition effort.
Recently, Kasich was widely mentioned as a leading contender for the
seat of Senator Metzenbaum, who announced Tuesday he would not seek
reelection. Kasich decided against running when his friend, Ohio Lt.-Governor
Mike DeWine, Joined the race.
�JOHN KASICH, (OH), RANKING MEMBER
ALEX MCMILLAN, (NC)
JIM KOLBE, (AZ)
CHRIS SHAYS, (CT)
OLYMPIA SNOWE, (ME)
WALLY HERGER, (OA)
JIM SUNNING, (KY)
LAMAR SMITH, (TX)
CHRIS COX, (CA)
WWi-NE ALLARD, (CO)
DAVID HOBSON, (OH)
DAN MILLER, (FL)
RICK LAZIO, (NY)
BOB FRANKS, (NJ)
NICK SMITH, (Ml)
BOB INGLIS, (SC)
MARTIN HOKE, (OH)
RICHARD E. MAY. STAFF DIR.
278 FORD HOUSE OFFCE BLDG.
WASHINGTON, DC. 20515
(202)226-7270
COMMITTEE ON THE BUDGET
REPUBLICAN CAUCUS
U.S. HOUSE OF REPRESENTATIVES
Put Consumer Back in Health Care Market,
Urges Republican Budget Committee Report
May 25„ 1993
(Washington, D.C.) — Successful reform of the nation's health care system will depend on boosting the
control and decision-making power of American consumers, according to an analysis released today by
Republican members of the House Committee on the Budget
The committee Republicans' White Paper on Health Care Reform also partly blames inefficient
government spending for contributing to health care cost inflation, and says that controlling government
health outlays — if done in the proper way — can help ease the upward pressure on costs.
"We don't pretend that this report contains the silver bullet on health care reform," said Representative
John R. Kasich, Ranking Republican on the House Budget Committee. "We don't presume that our
suggestions can solve every problem in the health care maiicet. But it is clear that unless we restore the
consumer's role in the maricet, we will face a future of runaway health care costs, or rationing of services,
or both."
According to the report, "The evolution of health carefinancingin the United States, encouraged by
government lax policy, has increasingly isolated and insulated consumers fromfinancialdecisions about
their own health care.... The prevailing third-partyfinancingarrangement creates incentives for overuse
of services and, consequently, higher spending — and the market hasrespondedaccordingly. Equally
important, the arrangement has deprived consimiers of real control over their health care decisions."
This situation is a fundamental contributor to the rapid upward spiral of health care spending, the report
says. The analysis concludes that unless consumers arerestoredto their appropriate role in the health care
— the same role they play in other maricets — health carereformwill fail to achieve the twin goals of
controlling spending and providing broad access to prompt, high-quality health care.
"Any successfulreformof the health care system must promote the vitality of thisrelationship."The paper
notes that the consumer-providerrelationshiplies at the heart of what are typically called "marketoriented" approaches to health carerefonn.The analysis also contends that U.S. health care "suffers not
from a lack ofresources,but from inefficient use of the resources available. Health carereformcan and
should be fmanced out of existing resources."
[Copies of the White Paper on Health Care Reform are available from the House
Committee on the Budget Republican Staff, 278 Ford House Office Building, Washington,
D.C, 20515, (202) 226-7270.]
�White Paper
on Health Care Reform
by the
Republican Members
House Committee on tbe Budget
John R. Kasich, Ranking Repubiblcan
May 20,1993
�Contents
Introduction
^
Background and Trends
2
Causes of the Growth in Health Spending
6
The Growing Role of Government Financing
Tax Policy
The Declining Role of Consumers
6
8
10
Additional Concerns for Refonn
12
Access to Health Insurance
Other Factors
Reform Options
12
13
Promoting the Consumer's Role
MediSave Accounts
Tax Deduction for the Self-Emptoyed
Medicare and Medicaid Health
Allowance Checks
Cutting Spending First
15
15
15
Controlling Government Spending
Bringing Competition to Medicare
and Medicaid
Income Testing Entitlements
Managed Care for Medicaid
Categorical Spending Targets for
Health Entitlements
Cutting Spending First
16
Other Potential Reforms
18
State-Based Reforms
Fraud
Portability
Purchasing Groups
Legal Reform
16
16
16
17
17
17
18
18
18
18
18
19
Conclusion
19
Endnotes
20
Appendix I
Myths and Facts about Health Care
22
�Introduction
Of all the genuine problemsrelatedto health care in the United States, one stands out as
central to the debate overrefonmingthe system: health care spending is high and appears
to berisingat imsustainable rates.
For individual Americans, the rapid pace of national health care spending growth
translates into a variety of personal concerns: frustration over tiieir personal health care
costs and insurance premiums; a sense that they arereceivingless care; concern about the
quality of care they receive; and fear that they might find themselves exposed to
unexpected, and possibly catastrophic, medical costs. It also has sensitized Americans to
the plight of those unable to obtain or afford health insurance coverage.
Various proposals for addressing these problems have been developed over the past
several years. The Clinton Administration is expected toreleaseitsreformproposals in
the near future. Still other alternatives soon will be offered in Congress. Also proposed
eariier this year was a health care reform plan developed by the House Republican
Leader's Task Force on Health Care.' Legislation defining the "building blocks" of the
Task Forcerefonnplan currently is being developed.
As a contribution to the Leader's Task Force, this paper seeks to offer a concise
assessment of the health carereforaiissue from the perspective of Republicans on the
House Committee on the Budget The perspective focuses on budgetary considerations,
which will be substantial in anyreformstrategy. But this analysis also takes into accovmt
the fundamental economic factors of the health care maiket, especially those that ! ^ a r
to be driving up spending. The analysis leads to two primary findings:
•
The govemmenfM expanding role im keatk carefimaneimgaver Ae past 30 yean
has had an inflationarj impact coinciding with — and im all Hketihood tubstantialty contributing to — the rapid growth of health care /pending. Therefore, it is
unreasonable to believe that expanding the government's role as a purchaser in ttie
maricet can successfuUy address the trae causes (as opposed to the symptoms) of
rising health care costs.
�a
The evolution of health care financing in the United States, encouraged by
government tax policy, has increasingly isolated and insulated consumer! from
financial decisions about their own health care. This pattern has interfered with one
of the principal relationships on which successful and efficient maricets depend — the
relationship between the consimfier and the provider. Health insurance in the United
States is notreallyinsurance but is, instead, a costly system of prepaid health care
financed principally by third parties. Prices and levels of service are negotiated
chiefly by those fmancing the system — government or private-sector insurers — and
health care providers. The consumer — the patient — is a secondary participant.
The prevailing third-partyfinancingarrangement creates incentives for overuse of
services and, consequently, higher spending — and the maricet has responded
accordingly. Equally important, the arrangement has deprived consumers of real
control over their health care decisions. Therefore, any successfulrefonnof the health
care system must promote the vitality of thisrelationship.The consumer-provider
relationship lies at the heart ofreferencesto "market-based" refonns.
Addressing the two concerns mentioned above will not cure every problem in the United
States' health care market. The market truly is complex. The system features a variety of
advanced and expensive technologies. The availability of providers and services is not
imiform across the country; people in rural areas tend to have fewer choices of health care
providers than those in urban areas. Some of the most costly medical services occur near
the end of a patient's life, a fact that deepens the gravity of moral and ethical decisions
facing families and physicians at such times. Furthermore, restoring more health care
decision-making to consimfiers will not prevent some consumers from making unwise or
inefficient decisions. Nor is this discussion intended to suggest that government should
have noroleat all in health care. Certain problems — such as providing a safety net to
insure the poor and persons with serious health conditions who cannot find affordable
coverage in the maricet — may demand a government response.
But neither will additionalresourcesoffer theresponsesnecessary. Health care in the
United States suffers not from a lack ofresources,but from inefficient use of the
resources available. Health care reform can and should be financed out of existing
resources. With that in mind, two essential points should be clear from the analysis below:
that policy-makers should not put government first in seeking solutions to the nation's
health care problems; and that truereformmust includerestoringpersonal responsibility
and the vitidity of the doctor-patientrelationship.Anyreformattempts that circumvent
these fundamental budgetary and economic faaors will fail.
Background and Trends
During the past 25 years, the share of the U.S. economy devoted to health care has more
than doubled, from 6 percent of Gross Domestic Product (GDP) in 1965 to about 12
percent in 1990. This year, spending on health care in the United States will total roughly
�$912 billion. Thatfigureis projected to grow to almost $1.7 trillion, or 18 percent of
GDP, by 2000.^ Per capita health care spending, in constant 1993 dollars, increased from
$443 in 1965 to $2,879 in 1990. It is expected to be $3,604 in 1993,risingto $4,087 in
1995 and $5,568 in 2000 (all in constant 1993 dollars).
The rapid growth of national health spending has coincided with an expanding
governmentrolein health carefinancing.In 1965, federal, state, and local governments
furnished 24.7 percent of the total funds paid for health care. Thisfigureroughlymatched
the share of fmancing by private insurance (24 percent) and was far less than the portion
funded by out-of-pocket payments (45.7 percent). Since then, the public share of national
health spending has grown to more than 42 percent of the total, while the portion assumed
by out-of-pocket and health insurancefiindinghas declined. As shown in Table 1 below,
this trend is expected to continue.
Table 1: Projections of National Health Expoiditiiresto2000, by Source of Funds.
(By FUcil Year)
1965
1983
1987
1990
1992
2000
In Billioiis or Current Dollars
Private
He*llh Insurance
Out of Pocket
Other
Subtotil
10
19
2
31
111
81
18
211
155
109
22
286
222
136
31
390
266
153
36
455
499
240
61
800
Public
FederaJ
Sute and Local
Subtotal
5
5
10
103
44
148
144
64
208
195
91
286
255
123
378
583
249
832
ToUl
42
359
494
675
832
1,631
24.0
45.7
5.5
75.3
31.1
22.7
5.1
58.8
313
22.0
4.5
57.8
32.9
20.1
4.6
57.8
32.0
18.4
4.3
54.7
30.6
14.7
3.7
49.0
11.6
29.1
13.0
42.2
28.9
13.5
42.4
30.6
35.7
118
113
24.7
28.8
12.4
41.2
45.4
51.0
100
100
100
100
Percentage of ToUl
Private
Health Insurance
Out of Pocket
Other
Subtotal
Public
Federal
Sute and Local
Subtotal
ToUl
too
too
Source: CoDgietiional Budget Office.
The growth in national health ejqjendittires is partly a natural phenomenon in a mature
and wealthy economy. "As national incomerises,people may choose to purchase health
services that improvetiieirquality of life, as weU as the basic services that are essential
�to good healtfi." writes the Congressional Budget Office. "In addition, the governments
of wealthier countries may be able to spend more on public health and research."
Nevertheless, U.S. health expendittires are growing at a rate that far exceeds normal
expectations and tiiat may be faster than tiie economy can sustain.
To federal policy-makers, a principal concern about tiie trend in national health care
spending is its projected impact on the overaU federal budget. As shown in Table 2 on
page 5 Medicare and Medicaid — the Federal Government's two dominating health
programs - are expected to grow from $198 billion in FY 1992 to $608 billion in FY
2002 During this period, tiie share of total federal ouOays consumed bytiieseprograms
wiU nearly double, from 14.1 percent to 26.3 percent By 2002, spending for Medicare
and Medicaid wiU exceed tiiat for Social Security and will nearly match tiie total for all
discretionary programs. Put anotiier way, federal healtii spending will increasingly crowd
out oUier programs intiiecompetition for federal resources, or will demand substantially
higher deficit spending or tax revenues.
Medicare and Medicaid also are projected to be tiie largest contributor tofiimrefederal
deficit spending. The Congressional Budget Office projectstiiat"under current policy tiie
federal deficit, after declining in tiie first half of tiie 1990s, wiU swell to moretiian$500
billion by tiie year 2002, largely as a result of increased spending for Medicare and
Medicaid." [Emphasis added.]*
Figure 1: Health Care Expenditures by Source, 1970-2000.
(In Billions of DoUan)
1975
1970
•
Federal
1960
1990
1965
BB State & Local
•
Out of Pocket •
1995
2000
Ott«r Prtvote
Source: Statistic^ Abstract cf the UnUed Slates 1992, VS. Deptmnent ci Commerce. Eoooomicf and Sutiatici
Administration, Bureau of the Census; Congrcaiitxial Budget Office.
�This projection is confimied elsewhere. An April 1993 study by tiie Committee for a
Responsible Federal Budget says, in part: "If goveniment were to raiserevenuesarid
reduce non-healtii care spending enough to balancetiiebudget next year, witiiin a decade
we once again would face $300 biUion-per-year deficits, unless we did sometiiing to
reso-aintiiegrowtii in healtii expenditures."*
CBO also warns about tiie serious economic dragtiiatwouldresultfromtiiislevel of
deficit spending intiiefollowing passage:
Federal borrowing of this magnitutle wiU signifiamtly affect the economy becatise it wiU
cut into private saving that would otheirwise have been used for investment here or
abroad CBO's calculalions suggest Aat if federal spending on Medicare and Medicaid
could be held to its 1991 share of GDP. output (real GDP) would be about 12 percent
higher than the CBO baseline by the year 2002. Incomes (as measured by real gross
national product) could rise even more — by about Z4 percent — because serving costs
on debt to foreigners would be reduced.*
Table 2: Projected Distribution of Federal Ontiays.
^^'^""^''"'^
,992
1994
1996
1998
2000
2002
In Billions of Current DoiUrs
All Discretionary
Social Security
Medicare and Medicaid
(Medicare)
[Medicaid]
All Other Outlays
541
285
198
[130]
168)
378
539
319
259
(167)
[921
390
554
351
329
(211)
[118]
409
584
385
405
(259)
[146]
465
616
420
495
[316]
[179]
524
650
459
608
(389)
[219]
595
Total (induding deposit insurance,
net interest, and offsetting receipts)
1,402
1,507
1.643
1.839
2.055
2312
28.1
19.9
26.3
(16.8)
(9.5)
25.7
100.0
In Pcrcentaces of Total OuUays
All Discretionary
Social Security
Medicare and Medicaid
[Medicare]
[Medicaid]
All Other Outlayi
38.6
20J
14.1
[931
(4.9)
27.0
35.8
21.2
17.2
[11.1]
(6.1)
25.9
33.7
21.4
20.0
[12.8]
31.8
20.9
2X0
[14.1]
n.2)
n.9]
24.9
253
30.0
20.4
24.1
[15.4]
[8.7]
25.5
Total (including deposit insurance,
net interest, and offsetting reccipu)
100.0
100.0
100.0
100.0
100.0
Source: Congressional Budget Office, The E c o ^ and Bydgel OtMlook: AH Update.
1992; ^ o « « ~ c
Implicaticms >^Rising Health Care Casts, October 1992; TV £co««~c ami Budget Omlock: Fiscal Years 1994-1998,
January 1993.
�Causes of the Growth in Health Spending
A variety of factors are typically cited as partial explanations for inefficiencies in the
healUi care maricet and the special difficulties consumers may have in making market
choices. For example, it is often noted that in seeking healtii care, Americans tend to
possess far less information about the choices and costs of treatment tiian they do for
otiier goods and services. They generally puttiicmselvesintiiehands of a single medical
provider whose judgments and recommendations tiiey accept. Furthermore, they often do
so in a time of relative urgency — they are generally ill or in pain. In addition,
competition among health care providers is not unifonn across the country. People in mral
areas have far fewer choices of medical providers than do those in urban areas. Those
whose medical costs are funded by public health insurance or healtii maintenance
organizations are oftenrestrictedin their choices of providers and services.
But not all oftiiesefactors are unique to medical care. People seeking automobile repairs
often turn to just one mechanic and are usually much less well-informed than the
mechanic abouttiierepairstiiatare necessary and tiie appropriate costs. The consumer
also may consider the need for autorepairsurgent. Yet consumers can exercise decisionmaking power in this maricet, and the market does appear to work more efficientiy than
that of health care, despite the similarities.
Three other factors do have a special impact on tiie health care market and are of
particular interest for federal budgeting. These factors are tiie expanding role of
government financing; the impact of government tax policy; and — partly as a
consequence of the two — the decliningroleof consumers in decisions abouttiieirown
health care and healtii care spending.
1. The Growing Role of Government Financing
As noted above, tiie public sector hasrepresentedan increasing share of healtii spending
over tiie past 30 years, largely through the expansion of healtii care programs such as
Medicare and Medicaid. This trend will continue in thefiiture.One affect oftiiistrend has
been an interference witii fundamental market mechanisms that normally would restrain
spending growth. As tiie Congressional Budget Office puts it:
Although there is strong justification for government involvement in health care, this
involvement may cause markets to work less well in conventional leims of efficiency.
When the government subsidizes the purchase or becomes the insurer, Ac budget
constraints on constmiers of health care are relaxed and, as a result, lose some
effectiveness in controlling less-valued spending. Likewise, federal budget constraints for
health care do not operate widi the same force as they do in die private sector or in much
of the rest oftftepublic-sector budget'
In otiier words, government spending on healtii care is intrinsically less efficient than
private-sector spending. Therefore, overall national health care spending is driven higher
because of the government's growing participation in the maricet CBO also writes:
" Altiioughtiieseprograms [government healtii programs] provide essential — and in some
�cases life-saving — medical care to millions of people,tiieprograms also dulltiieprice
signals fromtiiehealtii care maricets, encouraging overuse of services."*
In economic tenns, "overuse" translates into higher spending. Considering tiiat
government has assumed an ever-increasing share of healtii care spending—now totalling
about 42 percent of aU national healtii care outiays — it seems cleartiiatgovernment
spending is largelyresponsiblefortiieoveruse of healtii care services and,tiierefore,tiie
rise in healtii costs. The government has essentially "bid up"tiieprices of tiie nation's
health care services.
Figure 2: Public versus Private Health Care Spending.
(As Percentages of Total Spending)
1975
1980
1985
1990
1995
2000
Source: Smiislical Abstract of the Vniltd States 1992; Congressional Budget Office
Otiier cost-drivers in Medicare and Medicaid include tiie following:
o
Open Checkbooks. Programs sponsored by the government tend to cover most of
tiie services beneficiaries receive. This tends to discourage cost-consciousness on ttie
part of consumers and providers when evaluating discretionary healtii care choices.
Theresultis an overuse of government-financed services.
D Increase in Services. Policy-makers have expandedtiiemedical servicestiiatwill be
financed by tiie governmenttiiroughbotii Medicare and Medicaid. Intiiecase of
Medicaid,tiieexpansion of services beyondtiieiroriginal "safety-net" function has
created a disincentive forrecipientsto leavetiieprogram becausetiieytiienriskbeing
left with no coverage.
�o
Rising Prices. Government healtii programs have had to respond to botii medical
inflation and general inflation in the economy.
o
Demographic Changes. The aging of tiie U.S. population and extended life spans
have increased tiie number of beneficiaries and tiie number of years for which tiieir
healtii care isfinancedby the government.
o
Fraud. Fraud intiiesystem cost tiie Federal Government an estimated $8.58 billion
to $28.6 biUion in 1993.'
Nor has tiie public sector been successfiil inrcstininingtiiegrowtii of its own healtii
expenditures. CBO notestiiatfederal entitiement programs have tended simply to nse to
meet increasing medical costs. This process clearly has maintained ttie spiral of nsmg
healtii costs generally. When tiie govenunent has attempted to limit spending on healtii
care programs, it hasreUedmainly on two instnmients: loweringreimbursementsto
hospitals and doctore and placing limits on tiie expansion of canent healtii care programs.
These efforts have had Utile, if any, discernible effect inreducinghealtii expendimres. In
1983 Congress passed a new payment system for hospitalreimbursement.The prospective
payment system (PPS) designated 470 Diagnosis Related Groups (DRGs) and setflatfees
for each group (witii certain cost adjusmients). The result was a change intiiemetiiod of
healtii care delivery, but no costreduction.One effea of tiiis change in payment is tiiat
hospital bed occupancy has steadily declined since 1983. buttiieintensity and volume of
services have increased.
Various budget reconcUiation acts have reducedreimbursementrates to doctors and otiier
providers, but have not prcxluced real savings. In some cases,reimbursementrates are now
too low to cover tiie cost of providing services to Medicare patients. This forces cost
shifting to private payere, driving up insurance rates. The 1990 Budget Reconcilianon Act
Umited tiie expansion of entitiement programs, including Medicare and Medicaid, by
enforcing a pay-as-you-goftmdingmechanism. Undertiieprocedure, expansions of federal
entitiemem programs must befinancedeitiier byreductionsin otiier entitiements or
increases in taxes. This has done notiiing, however, to Umit spending increases m tiie
programs tiiat already exist
Nevertheless, variousrefonnproposals seek to expand tiie role of government in most
cases to provide insurance coverage totiioseunable to obtain insurance intiiemaricet.
Among tiie government-oriented proposals are conversion to a Canadian-style "smglepayer" system, and "play-or-pay" schemes tiiat mandate employers to provide group
insurance witii an expanded government program to coverttiosestill left unprotected. But
tiie historical experience witii government healtii programs gives amplereasonto doubt
tiiat expanding tiie role of government will be consistent witii ttic goal of slowmg tiie
upward spiral of health care costs.
2. Tax Policy
Government tax policy encourages employers to fiimish healtii insurance to employees
tiirough deductibility of employer-paid premiums. The strategy has been effective m
8
�expanding private healtii insurance to a large portion of the population. But the expansion
has come with an economic price, as described in the following passage by CBO:
[Federal tax policy] has also encouraged inefficiency becatise of the resulting failure to
confront choices. Favorable tax treatment of employer-paid health insurance premiums
reduces the effective price and so increases the amoimt of health insurance through a
hidden subsidy. Such tax breaks cause even higher levels of health expenditure at the
expense of tax revenues that would otherwise be collecled.'"
The deductibility of premiums has helped promote healtii insurance arrangementsttiatare
not really insurance but are instead a costiy system of prepaid healtii care (see the
discussion of the consumer's decliningrolebelow). It also has distorted the perceived
value of employer-paid healtii benefits. According to a study by the National Center for
Policy Analysis, federal tax law makes $1.44 of health baiefits equivalent to a dollar of
take-home pay for employees in the 15- percent tax bracket This occurs becaiise gross
wages of $1.44 would be reduced by 44 cents in taxes. This discrepancy is worse in the
28-percent tax bracket where $1.97 of healtii insurance baiefits is equivalent to a dollar
of take-home pay.*' It is more valuable to the employee to demand a dollar more in
healtii coveragetiianin wages. A March 30, 1993 Medical Benefits article"revealedtiie
cost per employee of healtii benefits increased from $1,724 in 1984 to $3,968 in 1992 —
a 130.2-percent increase in six years.
Tax deductibility is not available to the self-employed, who must pay the full cost of
coverage witiifimdsleft over after taxes. Large corporations, meanwhile, bid up the price
of healtii insurance through the use of the tax incentive, making coverage even more
expensive for smaller businesses.
The strucmre of tax deductibility also favors the formation of employee-based insurance
poolsratherthan other possible groupings. Many other kinds of insurance — automobile
insurance, for example — are organized on the basis ofregions.This makes possible the
formation of larger and more diverse insurance pools. Such pools mitigaterisksto the
insurer, allowing for lower insurance premiiunstiianmight otherwise occur.
Tax deductibility also has had a significant impact on federalrevenues.It is estimated that
the effective subsidy of health insurance prenuums throughtiietax code will total $69.4
billion in FY 1994. When this amount is added to direct government outiays for healtii
care,tiiegovernment's share of healtii carefinancingnationally exceeds 51 percent
It is desirable policy to continue using the tax code to prcraotetiiepurchase of health
insurance. If so, however,recognizingthe economic effects of the current structure may
help redesign tiie code for greater efficiency or equity. For example, expanding
deductibility to individuals andtiieself-employed would help correct existing inequities
and would lead to greater market efficiency. Tax deductibility also could berefinedto
encourage more cost-efficient kinds of insurance, such as coverage tiiat protects against
catastrophic costs but leaves consiuners with moreresponsibilityfor discretionary, nonemergency, health care decisions.
�3. The Declining Role of Consumers
Government spending and tax policies have contributed to atiiird,and cmcial, problem:
Witiirespectto American healtii care,tiieprincipal maricet mechanism —tiierelauonship
betweentiieconsumer andtiieprovider - has been distorted. Botii public and pnvate
healtii insurance have tended to isolate and insulate consumers from making decisions
abouttiieirown medical care — decisionstiiatwouldrequiretiiemto measuretiiebenefits
tiiey expect againsttiiepricestiieyare wiUing to pay.
It is understandabletiiatconsumers should want protection fromtiiecatastrophic costs tiiat
come from, say,tiieneed for major surgery or long hospital stays. But simUar financial
protections have extended to far moreroutinemedical services — an arrangement tiiat
amounts to prepaid healtii care ratiiertiianhealtii "insurance" comparable to otiier kmds
of insurance. Consequentiy.tiieshare of healtii care costs paid by consumers directiy out
of pocket declined from 45.7 percent in 1965 to 18.4 percem in 1992 (see Table 1. page
3 and Figure 3, page 11). CBO describestiieimpact as follows:
Most health payments are made by a third party - an insurance company or a
government program - on a fee-for-service basis, and this reinforces the bias m health
care toward higher spending and away &om cost conHoL Neither the patient nor the
doctor is likely to care much about the cosu of Ae treamient al Ae pomt of service. Feefor-service arrangements with distant third-party reimbursement ensure that patients have
an incentive to accept, as well as providers have to offer, any treatment that may possibly
have a positive benefit, with little regard for cost
These features may encourage spending health care procedures or services that cost
more than the value consumers place on the benefits. The same features may spur the
development and use of new, often expensive, medical technologies and drugs even when
their benefits may be small compared with the costs. People who have msurance face a
low out-of-pocket charge for health services at the point of delivery, and as a result go
to doctors more often and have more tests and elaborate treatmentflianpeople who are
faced with the full prices. One hypothesis is that cost-increasing technotogy raises the
demand for health insurance and, hence, for health caie. but the development of costincreasing lechnotogy is itself encouraged by more extensive insurance. Together, it is
argued, the two effects produce an upward spiral of health care costs. Because third-party
reimbursement, based on provider charges, dominates the market, compeuave pressures
do not encourage the efficient provision of services. Doctors compete for patiait toyalnes.
and hospitals compete for physician referrals but providers do not tend to compete with
one another over fees."
Once atiiiixl-partypayer seeks to control costs — typically by limitingtiiekinc^ and
amounts of seivicestiiatwill befinanced—ttiepatiem begins to lose conuol over healtii
care services. Negotiations over what services will be provided and at what costs take
place betweentiieprovider andtiiepayer,tiiepatient is not a player intiieprocess. This
situation already occurs in many government and private insurance arrangements.
The most extieme fonn oftiiird-partypayment is a Canadian-style "single-payer" system,
in whichtiiegoveniment istiieinsurer. Just as in anytiiird-partyarrangement conoxilling
costs in a single-payer system, negotiations over costs involvetiiepayer andtiieprovider
but nottiiepatient Because patients do not maketiiespending decisions involved in tiieir
treatments,tiieydo not conuoltiietreatmentstiieyreceive.
10
�Figure 3: Percentages of Health Expenditures Paid Out of Pocket
(As PercenUges of Tolal Speiiding)
1950
1960
1970
1960
1990
Source: The Heartland Institute. WAy We Spend Too Much on Health Care, 1992.
To control spending, single-payer systems commonly resort to price controls or "global
budgeting." Iftiieydid not take such steps, patients would tend to ovenise services
(becausetiieyare not payingtiiebills), leading to higher spending — ^ndingtiiatwould
quickly outpace any savings achieved by simplifying or streamliningtiiesystem's
administration. This is why resorting to a so-called "single-payer" system —or to other
strategies that limit the number of insurance providers — cannot accommodate the twin
goals of restraining the growth in spending levels and assuring the patients' control ove
their own health care decisions.
Further limits on patient choices will betiiecertainresultof aibio^ schemes such as
price controls and global healtii care budgeting. These mechanisms seek to limit the
amount of aggregate health care spending on the surface, without addressing the factors
that truly drive costs upward. This inevitably leads torationingof healtii care services,
long waiting lines, and Umits on advanced, and often life-saving, treatments. Equally
important itfiirtherdeprives patients of caitrol overtiieirown heaUh care, because tiieir
treatments are stiU governed, at least in part, byttiepricettieprovider receives for ttie
service — andttiatprice is detennined by someone ottiertiianttiepatient.
The government is an espedally stixing ccMitributor tottiisproblem. Because it represents
moretiian50 percent oftiienation's healtii care spending,tiiegovernment is a massive
11
�tiiird-party payer (and one ttiat is, as noted above, intrinsically less efficient tiian its
private-sector counterparts). Furthennore, tiie government has no competitors, and
tiierefore lacks any maricet incentive to become more efficient. This is anotiier
fundamental reason to doubt tiiat broadly expanding government programs can
successftilly addresstiiebasic causes ofrapidlyrisingnational healtii care costs.
But appropriate altematives totiiinl-partypayments — optionstiiatcan slowtiiegrowtii
of healtii care spending and also maintain individuals' control overtiieirown healtii care
— involve shifting greaterresponsibility,and more oftiiecosts, back to consumers. This
probably would require higher deductibles in private and goveniment insurance programs,
especially for price-sensitiveroutineor non-catastrophic medical services.
To a large degree, tiiis process already is occurring; insurers have for several years looked
to adjustments in deductibles and copayments as metiiods of containing tiieir own costs.
But American consumers are not likely to welcome an expansion oftiiisapproach eageriy
unlesstiieyrecognizetiiepersonal benefitstiieywouldreceivefrom it Policy-makers wiU
need to help consumers understand tiiat only by assuming greater personal responsibility
for tiieir own healtii care can tiiey achieve tiie benefits of botiirestrainingtiiegrowtii in
costs and maintaining control overtiieservicestiieychoose. Altemativestiiatpledge botii
benefits witiiout demanding greater consumer responsibility offer a promise tiiat cannot
be ftilfiUed.
Additional Concerns for Reform
1. Access to Health Insurance
Altiiough access to healtii insurance is not a cental tiieme of tiiis analysis, it is an
important and often-mentioned concern in tiie healtii care debate. But access to insurance
is not distinctftximissues of cost. Indeed, it isreasonableto conclude tiiat if effective
mechanisms for controlling costs were developed, tiie costs of healtii insurance could be
moderated, making coverage available to a wider population. Hence, gaining control of
rising healtii care costs can itself contribute to expanding access to insurance. Conversely,
attempting to expand insurance coverage witiiout genuinely addressing tiie cost-drivers
described above wiU only transfer cost pressures elsewhere,resultingin rationing, slower
improvements intiiequality of care, and less control by consumers.
A few additionalremaricsabout access to insurance also are appropriate.
Altiiough a lack of health insurance does not necessarily deprive individuals of health
care — medical etiiics andtiielaw requiretiiatpersons who are witiiout healtii insurance,
or who are unable to pay fortiieirown services, stillreceivehealtii care when necessary
—tiieuninsured can face considerable difficulties overtiieircare. Some hospitals wiU not
accept tiiem. They are disinclined to seek healtii maintenance or preventive care, which
can leadtiiemto more serious healtii conditions whichtiienrequire emergency treamients.
12
�The children of tiie uninsured often do not receive immunizations and otiier regular
treatments tiiat are important totiieirdevelopment.
The costs of tiiis uncompensated care are covered partially by Medicare and Medicaid
payments to hospitals. Some costs also are shifted to private healtii plans. A certain
percentage of every patient's biU can be directiy attributed totiieunrecovered cost of such
services This may not betiiemost desirable or efficiem means offinancmguncompensated care, and it certainly means tiiat such patients have littie control over tiie healtii care
services tiiey receive.
Second istiienumber of uninsured Americans. The commonly acceptedfigureasserts tiiat
about 37 million Americans have no healtii insurance alltiietime.But a U.S. Bureau of
tiie Censusreportfor tiie most currem period for whichreliabledata are available —
January 1987tiiroughtiiefourth quarter of 1990 — offerstiiefollowing breakdown:
D
Sixteen miUion people (plus or minus 1.2 million) were uninsured fortiieentire year.
o
Nine million (plus or minus 0.9 million) were uninsured for tiie ftill 28-montii period
of tiie study.
•
Thirty-two million (plus or minus 1.2 miUion) were not covered by any kind of
insurance on average in any given montii.
D
Seventy-nine percent (plus or minus 0.8 percent) of aU people had continuous healtii
insurance coverage for all of 1987.
D
Fifty percent of tiie persons witiiout healtii insurance coverage in tiie fourth quarter
of 1990 were under tiie age of 25, a grouptiiataccounts for 36 percent oftiieennre
population. This is also tiie age group tiiat is just entering tiie job maricet ^ d
tiierefore subject to probationary waiting periods before becoming eligible for ftiU
work fringe benefits such as healtii insurance.'*
The breakdown above is not intended to suggest tiiat tiie problem of access to healtii
insurance is unimportant. The intent is simply to show tiie tnie contours of tiie access
issue so tiiat policyrefonnscan be appropriately designed.
2. other Factors
Various otiier factors complicate tiie problem of medical costs and access to healtii
insurance. Altiiough tiiey are not tiie primary focus of ttiis paper, ttiey must be
acknowledged. Amongttiesefactors arettiefollowing:
o
sute Mandated Services. States have established mandates ttiat require specific
kinds of benefits in healtti insurance plans sold wittiin ttieir borders. The weUintentioned original goal ofttiesemandates was to protect consumers by ensunng ttiat
what ttiey purchased truly was healtii insurance. But tiie number of mandates has
tended to grow, sometimesrequiringcoveragetiiatis not critical to entire populations.
13
�Namrally, tiie expansion of mandates, by requiring greater coverage, has driven up
premiums for health insurance.
Some employers escape state mandates by insuringtiiemselves.Witii tiiis approach,
employers' healtii benefits are covered by tiie federal Employee Retirement Income
Security Aa (ERISA). This approach, however, is possible only for large companies
tiiat can pool sufficientresourcesto adequately protect tiieir employees. .
Malpractice and Defensive Medicine. Acconling to a study by Lewin-VHI Inc. of
Washington D C, tiie potential savings from refonning tiie medical malpractice
system could range fiom $7.5 billion to $76.2 billion over five years. The savmgs
would be achieved by discouraging "defensive medicine," which Lewin-VHI defines
as "changes in practice carried out by healtii care providers for tiie sole purpose of
avoiding malpractice claims."'^
Pre-existing Conditions. Many Americans have difficulty obtaining or keeping healtii
insurance because of medical conditionstiiatinsurers consider toorisky.The problem
cannot easily beresolved.Requiring insurers to cover such persons would undoubtedly lead to higher premiums for otiier cUents. Alternatively, tiie goveniment could
assume insuranceresponsibilityfortiieseindividuals; buttiienotiier consumers woulc^
stiU finance tiie insurance tiirough taxes ratiier tiian premiums. Public and social
values support providing coverage for such persons. This is an area m which a
governmentresponsemay well be appropriate.
Reform Options
The preceding discussion should make it clear tiiat two basic principles must guide any
successftilrefonnof tiie U.S. healtii care system. These principles are tiie following:
o
The consumer's role in health cart dedsiom-maUng must be promoted. Not all
consumers wiU make tiie wisest and most efficient choices at aUtimes.But m tiie
aggregate,tiiecollection of choices freely made by consumers isttiebest mechanism
for promoting efficiency inttiehealtii care economy. Furthennore, ttie only way to
assuretiiatpatients control decisions abouttiieirown healtii care is byrestonngtiieir
direct participation in making those choices.
n
Restraint of government spending om health care eon Itself ««<
pressure on national health costs. The expansion of governmentfinancmghas
coincided witii tiie accelerated pace of healtii care cost increases. Goveniment now
finances more tiian 50 pendent of tiie nation's healtii care. If government financmg
is not controUed, it will continue to fuelttieupward spiral of healtti costs.
But controlling goveniment spending inttieproper way also is necessary. Art)itrary
mechanisms, such as price controls and global budgeting, fail to address ttie
14
�underiying causes of cost increases. Consequentiy,ttieyonly lead to rationing and to
further limits on the consumer's control over healtii care. Government spending
constraints must address the true cost drivers in health care, mainly by promoting the
consumer's participation in the market.
The following account lists various options that would addressrefonnissues analyzed
in this paper
1. Promoting the Consumer's Role
Altiiough private health insurers must be the main players in this process, tiie Federal
Government can legislate specific changes that boost the consumer's participation Among
these are the following:
°
MediSave Accounts
MediSave accounts would allow individuals to set up healtii saving accounts with tax
free contributions from either the employer or the individual, or a combination of
both. The individual would then purchase health insurance witii a high deductible,
and hold the balance of deposits in the account to pay for incidental medical
expenses. Any unspent funds would roll over and accrue to individual.
Qearly, a central premise of MediSave is to promote the consumer's decision-making
role in purchasing healtii insurance. To the extent that consumers shopped for policies
that best served tiieir needs, a degree of competition and cost-consciousness would
be restored to the market The strategy also could provide consiuners with an
economic incentive to look after their general health more carefully. Its roll-over
provisions would allow consumers to accumulate savings in their overall health care
spending — savings achievedtiiroughpreventive care and health maintenance.
The National Center for Policy Analysis has argued that when consumers control
their own healtii care dollars, as provided under MediSave, their increased costconsciousness promotes competition and. therefore, lower prices in insurance
premiums and health care services. The strategy also prcMnotes the vitality of the
doctor-patientrelationshipand tends to give patients more control over the services
for which they choose to be insured.
The MediSave strategy is included inttieRepublican Leader's Task Force Healtti
Care Refonn legislation in the current Cwigress."
D Tax Deduction for the Sdf-Employed
This option, also contained in tlie Leader's Task Force plan, would make health
insurance premiums paid by the self-employed 100 percent deductible. Policy-makers
may also wish torefinethe tax code so that deductibility affiles to coverage that
encourages the purchase of real health insurance — which would restore greater
consumerresponsibilityin price-sensitive non-catastrophic services —rattierthan
broad prepaid medical care coverage.'^
15
�a
Medicare and Medicaid Health Allowance Chedcs
When an individual goes into the hospital under a public insurance program such as
Medicare, tiie doctor performs the procedures and the bill is sent to the insurance
providers who administer the Medicare program under the Healtii Care Financing
Administration (HCFA) in Washington. The bill is paid directiy to the hospital and
doctor and a dizzying array of bills and copies of bills are sent to the patient, billing
him or her for various copayments and deductibles. The patient/consumer is basically
at the mercy of the doctor, hospital, and HCFA.
Federal, state, and local government dollars could bere-packagedin such a way so
that all senior citizens, poor people, and others deemed eligible for public insurance
could receive money from the government based on their economic need. They also
could receive a 100-percent tax deduction for the amount they would spend out-ofpocket for healtii insurance each year up to a national standard for basic health
insurance coverage. In such an arrangement, each person could negotiate and bargain
witii a v^de array of insurance companies and purchasing organizations to buy the
best kind of health insurance for their own needs. This procedure boost competition
and wouldrestorethe consumer's role in choosing health insurance.'*
The principle worics in the existing veterans program with the Gl Bill. Each veteran
gets an amount of money to attend any college he or she chooses. It also works in
the VA Housing program, in which veterans can buy a house based on their choice,
not what the government tells them they have to purchase.
c
Cutting Spending First
The House Republican Budget Committee budget proposal for Fiscal Year 1994 —
described in tiie 84-page document titied Cutting Spending First — called for $93
billion in Medicare and Medicaid savings over five years. A ceno-al feature of ttiese
savings wastiieexpanded use of deductibles and copayments by beneficiaries of tiiese
large healtii care programs.
Such an approach requires that beneficiaries assume more responsibility for their
healtii care choices. But it maintains their contiol over tiiose choices, producing
savings in health care spending without sacrificing consumer choices."
2. Controlling Ckivemment Spending
Slowing the growth of government spending in healtii care can by itself help slow cost
increases generally by reducing demand. Amcmg potential strategies are the following:
D
Bringing Competition to Medicare and Medicaid
Costs could bereducedby requiringttieuse of competitive, maiket-based systems to
provide Medicare and Medicaid services. This could be done by integrating the two
systems and then requiring health instu^ce providers to sul»nit competitive bids for
the right to serve Medicare and Medicaid patients. Competing for tiie contract for
Medicare and Medicaid would provide a powerful incentive to hospitals, physicians,
16
�and otiiers to careftilly consider tiie way tiiey do business and take steps to reduce
costs. Requiring providers to compete witii one anotiier would provide an incentive
to cut their healtii care costs.
D
Income Testing Entitiements
The current Medicare program provides tiie same level of coverage to all eligible
participantsregardlessof income. Consequentiy, even wealtiiy individuals receive
medical care at tiie expense of taxpayers.
Government healtii care costs could be reduced by targeting healtii care assistance to
tiie most needy and requiring wealtiiier persons to assume more of tiieir own costs.
Income testing tiie Medicare hospital coverage deductible fortiiosewitii adjusted
gross incomes of $100,000 or more would save $1 billion intiienext four years.
•
Managed Care for Medicaid
The Arizona Healtii Care Cost Containment System (AHCCCS, pronounced "access")
is run in tiie fashion of a healtii maintenance organization (HMO). Every person
enrolled intiieprogram joins a managed care plan, meaning a group of doctors and
hospitalsreceivea fixed montiily sum for each patient tiiey agree totiieatEvery
patient has a personal doaor. Patients and doctors are satisfied, and costs per patient
are about 5 percent lower than in otiier sutes wheretiiequality of care often is lower.
Arizona has tiie only state-wide Medicaid managed care demonstt-ation project under
waiver autiiority approved by tiie Secretary of Healtii and Human Services.
According to tiie latest evaluation by tiie Healtii Care Financing Administi-ation,
AHCCCS has held down costs considerably compared to traditional fee-for-service
Medicaid plans, despite enrollment increases. For tiie two years examined, FY 1990
and FY 1991,tiieaverage per capita cost increased 26 percent in AHCCCS compared
to a 33-percent increase in traditional programs. Over tiie life of tiie demonstration
(FY 1983 to FY 1991) tiie average annual increase in AHCCCS per capiu cost was
6.8 percent, compared to 9.9 percent for a traditional Medicaid program.
Slates should be encouraged to pursue tiiis option and not discouraged by a lengtiiy,
tedious waiver application process. The Federal Government should explore broader
application of managed care inttieMedicaid program.^'
Q
Categorical Spending Targets for Health Entitiements
In tiie case of Medicare and Medicaid, Congressional failure to contain spending over
tiie past decade has led to a simation in which Medicare is growing 30 percent a year
and Medicaid is growing at 18 percent a year. Categorical targets intiiesetwo federal
healtii programs would force Congress to take action to deal witii tiie underlying cost
drivers in tiie healtii system. If no action is taken to reduce spending,refonnexisting
programs orrepealcoverage, tiie autiiorization committees would have to propose
specific tax increases tofinancetiiespending levels in excess oftiietargets. If such
tax increases also wererejected,tiiena categorical sequester would take place only
on tiie spending categories tiiat exceeded tiie spending target fortiiatyear.
17
�n
Cutting Spending First
As mentioned above,tiieHouse Republican Budget Committee propos^ ^ " ^ ^ ^ ^
recommended $93 billion in Medicare and Medicaid Savings overfiveyears. These
SlgTcSuld i achieved witiiout any major overtiaul of t^ healtii care system, and
would ease upward pressure on national healtii care costs.
3. Otiier Potential Reforms
Various otiierrefomishave been developed to addressrelatedproblems intiiehc^* care
m J e t Each can make a valuable contiibution toreducingcosts and miproving access
witolt See controls or ottier govenmient interferences. Amongtiiemaretiiefollowmg.
•
State-Based Reforms
Medicaid, being a shared federal-state program, binds states becausetiieguidelines
are mandated in Washington. To make substantial changes mtiieway it admmisters
Medicaid, a sute must obtain a waiverfiomttieHealtii Care Fmancing Admmistration (HO^A),tiiedepartmemtiiatoversees Medicaid and Medicare. Tlus process is
botii lengtiiy and tedious botii in obtaining tiie initial and tiien mrctaimngit
Enhanced Medicaid waiver autiiority would give states moreflexibibtyto manage
tiieir healtii care needs andtiieirbudgets."
•
Fraud
Altiiough estimates arerough,losses due to healtii care fraud mayrangefrom 3
percent to 10 percent of tiie nation's total healtii care bill. This translates to
Lewhere between $27 billion and $91 billion beiiig lost
specifically designed to cheattiiesystem. LegislauontitiedtiieHealtii Care Cnmma^
mense Act is iSng developed to specifically targettiieorgamzed cnmmal acuvity
in healtii care. This legislation will give law enforcementtiietools it needs to slnp
awaytiiefinancialmotivation fortiiiskind of criminal activity - namely asset seizure and forfeiuire." Such approaches already have proven successfiil m otiier areas.
•
Portability
All Americans should have access to apprt)priate healtii care even iftiieyhave preexisting conditionstiiatdeter insurers. The most effective metiiod for rcachmg ttus
goal is to place ttie purchasing power of healtti insurance wittittiemdividu^.
preventing canceUation as a part of a group, and policiesttiatguarantee renewal. Preexisting condition criteria, waiting periods, and portabQity issues would dmitiush wi^
individual based poUcies. Portability is amitiier healtti care issue addressed m tiie
Republican Leader's proposed legislation."
D Purdiasng Groups
To contain healtii care cost, pressure must be brought to bear on physicians, hospitals
and otiier healtii care providers to lowerttieircost Purchasing groups can often bnng
greater pressure on providers to be more cost conscious,ttierebyreapingsavmgs for
participants. Those participants might be individuals, families or smaU employers.
18
�These arrangements also make healtii insurance more accessible to more people. Such
plans already in existence have found lower healtii inflation, lower premiums, and
increased access.
Legal Refonn
One possibUity for easing tiie problem of malpractice and defensive medicine would
be an artiitration system such astiiatproposed undertiieMedical Malpractice Refonn
Act of 1993. The Act calls for patients and medical providers to meet in binding
arbitration in contested cases beforeresortingto tiie expensive process of lawsuits.
Reducing tiie risk of lawsuits would allow medical providers to focus on providing
only tiiose procedures tiiat are medically necessary ratiier tiian providing a case
history to protect tiie provider against potential lawsuits. Patients would also receive
more immediate compensation for injuries caused by incompetence or negligence and
a higher percentage of tiie claim tiian under current law.
Conclusion
This analysis has sought to focus on aspects oftiiehealtii care markettiiatlie witiiin tiie
expertise oftiieHouse Committee on tiie Budget. Specifically,tiiecommittee has a natural
concern witii tiie effect of rapidly increasing healtii care expendimres on tiie federal
budget — and especially on future budget deficits.
The analysis has concludedtiiattiierapidgrowtii of govenunentfinancingof healtii care
has itself contributed to tiie rise in healtii care costs generaUy. Therefore, controUing
government spending, if done property, can ease upward pressure on healtii costs. The
analysis also makes cleartiiata major problem in tiie American healtii care maricet is tiiat
consumers have been progressively insulated and isolated from ttieir own healtii care
decisions. The basicrelationshipbetween consumers and healtii providers must be
revitalized if healtii carerefonnsare to achieve tiie twin goals of controlling costs and
maintaining patients' control over tiieir own care.
This discussion does not suggest tiiat govenunent should have noroleat aU in healtii care.
Certain problems — such as insuringttiepoor and persons witti serious healtti conditions
who cannot find affordable coverage in tiie maricet — may demand a govemmem
response. But neitiier will additional resources offertiieresponsesnecessary. Problems
witii healtii care in tiie United States derive not fiom a lack ofresources,but fiom
inefficient use oftiieresounds available. Healtii carerefonncan and should be financed
out of existingresources,tiu-oughgreater efficiency in tiie use oftiioseresouK^es.
Witii all tiie above in mind, two fundamental points emerge fixim ttiis analysis: policymakers should not put government first in seeking solutions to tiie nation's healtii care
problems; and tnierefonnmust includerestoringpersonalresponsibilityand tiie vitality
19
�oftiiedoctor-patientrelationship.Anyrefomiattemptstiiatcircumventtiiesefimdamental
budgetary and economic factors will fail.
Force on Healtii Care intiiiseffort
Endnotes
1.
Michel. Bob. et .1.. the Action Now Health C«e Refom, A a (H.R. 101). 103M Ccngre...
2.
Congressional Budget Office.
3.
Congressional Budget Office, Proiections of National HeaUh E n u r e s , 0«ober 1992. p. 8.
4.
Congressional Budget Office. Econon^ Impttcations ^Rising h ^ h Care Costs, Goober 1992, ^ 8.
5.
Conun^ttee for a Res^sible Federal Budget. Health Care Reform Project -
Phase 1: Cost Contain^n: and
Incremental Reform, April 1993.
6.
Congressic^al Budget Office Economic Implications ^R^ing Health Care Costs, Ooober 1992. p. 8.
7.
Congressical Budge. Offi«. Economic Implications <^ Rising Health Care Costs, O o ^ 1992. pp. 19-20.
8.
Ibid., p. 19.
translate to $27 bilUon lo $91 billion.
,0
Congressional Budge. Office. Projections ofSalionat HeaUh E n u r e s , October 1992. p. 11.
„.
G.^Robbin..AldonaRob«.-.Joh„C.Gocdr„«.//-0-r//e<^*Ca,,S^^^
Analysis, February 1993.
12.
-1992 HealU, Care BenefUs Survey: Medical PUns." Medical Ben^fils, Man* 30. 1993. p. Z
,3.
Congressional Budge. Offic*. Projections of National Health E n u r e s , 0«ober 1992. pp. 10-11.
^
10S7 loon-Sdeciod I>ita from the Survey of I B K W
ConrnTrc. Economic » 1 S u u « i c Admini«i.tion. B « « u of the Census.
15.
Rubin, Robert 1., M.D.. and
t ^
N.. Esti^ing the Costs ofOefensi^ Medlcin., lxw»-VHI Inc..
January 27. 1993.
16.
Michel, Bob. et .1, the Action Now Health Ore Reform Aa (HJt 101). 103.d
17.
Ibid.
,S.
For a d i s a . . i » of this .rr^emen. u it would ^ y to M - i ^ - - ^ ^ ^ j ^ ^ ' ' ^
for Low-lncome Families, by the Hou«= Wedne«Uy Group. Mar* 30. 1992, p. 23.
20
Cmv^t.
^ '
�19.
See Cutting Spending First, by the Rq»blican Members, House Committee on the Bodga. March 10.1993. pp. 3139.
20.
See Cutting Spending First, pp. 33-34.
21.
See Culting Spending First, p. 32.
22.
Culling Spending First, pp. 31 -39.
23.
See the Aaicn Now Health Care Refomi plan.
24.
See Kolbe, Jim, a. aL. the Health Cart Frmud Aa (H.R. 4930), 102nd Congress.
25.
Michel, Bob, et aL, the Action Now Health Care Refomi Act
21
�Appendix I
Myths and Facts about Health Care
The American public and its leaders seem to havereachedsimilar conclusions on tiie
major problems facing tiie healtii care system — soaring spending and inappropriate
coverage. But just belowtiiesurface,tiiisconsensus breaks down and confusion abounds.
The foUowing mytiis and facts may help clarify some oftiiesemisunderstandings.
MYTH #1: Thirty-seven million Americans permanentiy lack healtii insurance coverage.
FACT: According to a U.S. Bureau oftiieCensus Cunent Population Report written by
Katiileen Short, fortiiemost current period oftimefor which reliable data is available,
January 1987 to tiie fourth quarter of 1990, tiie following facts are:
D
Sixteen million people (plus or minus 1.2 million were uninsured for tiie entire year.
n
Nine million people (plus or minus 0.9 million) were uninsured for tiie full 28-montii
period oftiiestudy.
o
Thirty-two million people (plus or minus 1.2 million) were not covered by any kind
of insurance on average in any given month.
a
Seventy-nine percent of all people (plus or minus 0.8 percent) had continuous healtii
insurance coverage over the entire 1987 year.
D Fifty percent of tiie persons witiiout healtii insurance coverage in tiie fourtii quarter
of 1990 were under tiie age of 25, an age group tiiat accounts for 36 percent of tiie
entire population. This is also tiie age group just enteringtiiejob market and subject
to probationary waiting periods before becoming eligible for fullfiringebenefits.
This is not to suggesttiiattiieproblem oftiieuninsured is unimportant. Regardless of tiie
number,tiieuninsured often can face difficulties witii tiieir care. Some hospitals will not
accept tiiem. They are disinclined to seek healtii maintenance or preventive care, which
can leadtiiemto more serious healtii conditions whichtiienrequireemergency treattnents.
The children of tiie uninsured often do not receive immunizations and otiier regular
treatments tiiat are important totiieirdevelopment. The details above are intended simply
to illuminate tiie characteristics of tiie uninsured population.
NfYTH #2: Not enoughresourcesare being spent on healtii care in America.
FACT A: America will spend close to $998 billion, or more tiian 15 percent of Gross
Domestic Product (GDP) on healtii care in FY 1994. Thisrepresentsa per capiu expense
of about $3,992. This is moretiian25 percent hi^ertiiantiienext industrialized country,
Canada, which spends 11 percent of GDP on healtii care.
22
�FACT B: Medicare cost per enrollee for FY 1994 is expected to be moretiian$5,235.
FACT C: Medicaid cost per recipient for FY 1994 is expected to be moretiian$6,461.
The federal share is about $3,615;tiiestate and local matching share is moretiian$2,884.
MYTH #3: There is not 100-percent access to healtii care in America today. FACT: Individuals who do not have any healtii insurance or healtii coverage or are unable to pay currentiy receive care by law. These costs are covered partially by Medicare
and Medicaid payments to hospitals and cost shifting to private healtii plans. A percentage
of every patient's bill can be directiy atoibuied to tiie unrecovered cost of such services.
This does not mean, however,ttiatttielack of insurance among some Americans, is not
a problem. Altiiough a lack of health insurance does not necessarily deprive individuals
of health care — medical etiiics andtiielawrequiretiiatpersons who are witiiout healtii
insurance, or who are unable to pay for tiieir own services, stillreceivehealtii care when
necessary — tiie uninsured can face considerable difficulties over tiieir care.
MYTH #4: Poor people receive most of tiie federal entitiement dollars budgeted for
health care.
FACT A: People making more tiian $30,000 of income received close to 40 percent of
all Medicare dollars, or more tiian $60 billion, allocated in FY 1993.
FACT B: Less tiian 42 percent of tiie Medicaid budget goes directiy for healtii care for
recipients;tiiebulk of tiie Medicaid budget goes to hospitals and providers each year in
tiie form of grants or allowances for construction and other projects.
MYTH #5: Medicare beneficiaries pay tiie fiill cost of Medicare tiirough tiieir Part B
(SMI) premiums for physicians services at a cost of $36.60 per montii.
FACT A: The federal taxpayer subsidizes 75 percent of tiie cost of Medicare Part B
tiirough generalrevenues,or more tiian $133 billion for FY 1994.
FACT B: When Medicare was passed into law in 1965, half of Part B coverage was paid
by tiie enrolleetiuougha premium, and half was paid by the government Iftiieoriginal
ratio were still in place today, $77.6 billion would be saved over ttie next five years
according to CBO. Part B premiums would be $73.20, rattierttian$36.60. per montti.
FACT C: The maricet value of a healtti insurance plan similar tottiatreceived by a Medicare beneficiary could range from $350 to $700 per montii or more intiiemarket.
MYTH #6: Most of tiie federal entitiement healtii program money goes toward routine
primary physician health care, disease prevention and wellness.
23
�FACT: Twenty-eight percent oftiieMedicare budget is spent on recipients intiielast year
of a beneficiary's life witiitiiemajority of it being spent intiielast 30 days.
MYTH #7: The eligibility age for Medicare is due to go up to age 67 whentiieeligibility
age for Social Security goes up.
FACT A- The eligibility age for Medicare is not scheduled to increase. Social Security
is scheduled to begin to go up inttieyear 2000 by two montii increments per year until
2005 when age 66 wiU betiieretirementage untiltiieyear 2016. Then it will go up agam
in two montii increments per year untiltiieretirememage for Social Security becomes age
67 intiieyear 2022.
FACT B: Iftiieeligibility age for Medicare were torisefrom age 65 to age 67 on January 1, 1994, $77.7 biUion would be saved overtiienextfiveyears according to CBO.
MYTH #8: The cost of medical malpractice inttiemedical care system is very small,
accounting for lesstiian$1 billion per year.
FACT: According to a smdy by Lewin-VHI Inc. of Washington D.C. tiie potential
savingsfiomrefonningtiiemedical malpractice system could range from $7.5 billion to
$76 2 billion overfiveyears. The savings would be achieved by discouraging "defensive
medicine," which Lewin-VHI defines as "changes in practice carried out by healtii care
providers fortiiesole purpose of avoiding malpractice claims."
24
�DETERMINED TO BE AN ADMINISTRATIVE
MARKINGJ^er EX). 12958 as amcntled, Sea. 3.3 (c)
PRIVILEGED AND (S^^^^^^SE-MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings, Steve Edelstein
House and Senate "Message" Meeting
Melanne, Steve, Lorraine, Jeff, Ira, Distribution
June 29. 1993
Tomorrow you are scheduled to attend the second meeting of the joint
House-Senate "Message" group on heailth reform. Congressmen Gephardt and
Bonior will represent the House. Senate attendees will include Senators
Mitchell, Daschle, Pryor. Kennedy, Rockefeller, Reid, Boxer, Wofford and
Kerrey. Senators Moynihan and Riegle have been invited but their attendance
was not confirmed.
This meeting is a follow-up to last week's meeting in which the Message
group laid out their "to do" list of tasks to be completed before the launch of
the plan. At tomorrow's meeting Jeff EUer will lay out the structure of the
"warroom" and discuss the message of the day briefing sheets to be faxed to
the Hill every evening. He will also describe the plan for the "Health Care
University" to educate Members, Administration officials and supporters and
field any general questions regarding the communications plan.
Bob Boorstln will respond to the first three items on their "to do" list with a
particular emphasis on the strengths of our plan. A draft of talking points on
the strengths.
Attached for your review are: 1) the message group's "to do" list. 2) the
daily message sheet faxed to the message group this evening, 3) the Health
Care University memo, and 4) the strengths talking points.
�To: Health Care Group
Fr: Senate and House Health Care Leadership
The following list includes some of the tasks that need to be cottiplcted for a successful
launch of the health care reform proposal. The tasks listed below are meant to be shared
by a variety of organizations not limited to, but including tiie White House, House. Senate,
NHCC and other grassroots organizations.
1. Launch Date Criteria/ Launch Date Public Message
• need agreement on criteria wc need to meet before we're ready to launch
For example, the President should announce his plan publicly only when:
- the policy is complete and sufficiently detailed
- back-up numbers are adequate and available (costs, savings numbers should
be vetted with CBO to avoid post-announcement controversy)
- message points and name of bill are vetted and available
- informative material on sti-engths and vulnerabilities is available
- back-up information sheets are adequate and available
- endorsing groups are identified, committed and ready to endorse publicly
- opinion-leader supponers are identified, conomlned and rcddy to support
publicly
- grass roots operation is in place
- Member information level is adequate
- Member endorsers are identified, sufficient, and ready to endorse publicly
- legal questions have been answered to the extent that no major structural
changes will be nsquired and no obviously valid constitutional problems
will arise
.
- legislative strategy is developed, agreed upon with Committee chairs
- proposed datefitsreasonably with Presidential and Congressional schedules
• need coordinated public message on launch date
2. Message
• need to develop and agree upon strong central theme
• educate Members, Administration officials, supporters re: message and how to stay
on it
• how to infuse it into all parts of effort
�3. Strengths Ifat - key strengths, talking points on our plan :
security (even if you switch jobs, lose your job or have a preexisting condition)
eliminates loopholes and fine print - no more battle with insurers
greater consumer choice of health benefits plans
improved quality of care
putting the brakes on escalating health care costs
comprehensive coverage for all Americans
simplicity, will reduce paperwork for you and your doctor
help for small businesses who will have increased bargaming power and lower
costs for premiums
^,
•
ur.
. help for big businesses who are being consumed by health care costs, tmprovmg
competitiveness and job growth
. positive impact on state and local budgets
. helps families deal witiifinancialburden of long term care
. increases role of doctors and patients in medical decisions
. more consumer information and protection
4. Vulnerability - identification and response:
families already facerisingcosts - this will increase tiicii costs
taxes will increase
^
^
government can't get anytiiing done andtiiisis just another government program
employer mandates
rationing
loss of choice
govt, workers, others who now have eKcellent coverage
abordon
OTtesTed plan, no one has tried to reform tiiis system on tiiis scale before
reform may increase spending not decrease it
unfair to young people
the system would be so complex that it would collapse
5. fippoKition research - determination of vulnerabilities of other plans
• competing proposals (on and off Hill)
n^rr^
. special interest g.x>ups who arc mounting tiieir own attack ^ ^ P ^ ^ ! ^^^5^^^
. identify health and other groups that oppose refomi. who are they? why are they
opposed? What is die effect of their opposition?
• use DPC healtii contact for information from other Senate offices
�6. Visibility
• establish weekly visibility plan
' recess plan
• media agenda before launch/aiter launch
. coordinate public events, publications, statements for maximum impact
7 Effective wavs to reach and involve Members
• Health University
• consultation groups
. effective use of existing House/Senate forums (caucus, DPC)
8. HeaUh Groups/Grassroots
• need to identify and involve the allies (consumer, labor and business organizations)
(NHCC & DPC) in grassroots effort
9. Party Grassroots
. activate party troops to educate others and build support
10. MaiUne lists
• Media: need comprehensive press lists including specialty and regional
press; coordinate existing lists (NHCC. DPC & WH)
. Academics, Health Care Leaders
. Other outreach: groups, elected officials
10, Rapid Response
' who will lead effort
• mechanism for response
U. Coordination with White House. Senate & House_
. identify point persons who will stay in daily contact with each other in White
House. Senate and House (staff) to coordinate, address issues as they develop
. establish health care working group with representatives from each
• House/Senate mirror organizations (message board groups)
• education (Health University)
• legislative scheduling (Leadership)
�12. Coordination with SUte/Other Elected Offlciah
. ways to involve Govemors active in reform
. ways to involve state legislators, mayors, etc.
13. Coordination Svsterowide
. National Steering Conamittee might be appropriate framework for coordination
among all engaged in reform effort
- Administration
- Congressional leadership
- DNC/NHCC
- DCCC and DSCC
- DGA
- Labor (AFL)
- Others
13. Calendar
. calendar for task accomplishment
�STRENGTHS OF THE PLAN
1) Security (even i f you switch jobs, lose your job or have a
p r e - e x i s t i n g condition)
"Under the current system, one i n four Americans w i l l
lose t h e i r insurance a t some p o i n t over the next two
years. Today, i f you or your c h i l d gets s i c k , i f you
switch jobs, i f you want t o s t a r t a small business, you
can lose your insurance. Under the President's plan,
y o u ' l l get h e a l t h s e c u r i t y .
Lose your job — and y o u ' l l s t i l l be covered. Get s i c k
— y o u ' l l s t i l l be covered. S t a r t a small business —
you won't have t o worry. That's what insurance i s
supposed t o be a l l about. The President's plan asks a l l
Americans t o take r e s p o n s i b i l i t y f o r t h e i r h e a l t h —
and o f f e r s h e a l t h s e c u r i t y i n r e t u r n . "
2)
Putting the brakes on escalating health care costs
"Right now, what you're charged f o r h e a l t h care i s
d r a i n i n g your savings, threatening your s a l a r y ,
bankrupting businesses and exploding our d e f i c i t . We've
got a h e a l t h care system t h a t ' s overloaded w i t h excess
paperwork, outrageous fraud and waste, and con a r t i s t s
looking f o r a f a s t buck. And i f we do nothing, t h i n g s
w i l l only get worse.
The C l i n t o n plan w i l l change the way t h i n g s work. I t
w i l l crack down on those insurance companies and drug
companies t h a t are making excessive p r o f i t s — but not
i n v e s t i n g i n b e t t e r care. We'll aggressively go a f t e r
the people t h a t e x p l o i t loopholes t o make a p r o f i t . And
w e ' l l stop the overcharging and put the brakes on
r i s i n g costs."
3)
Improved quality of care
" F i r s t , the C l i n t o n plan w i l l guarantee every American
a comprehensive b e n e f i t s package t h a t emphasizes
preventive care t o keep you healthy instead of w a i t i n g
u n t i l you get s i c k . We'll give you more primary care
doctors and nurses.
And f o r the f i r s t time, we're going t o r e q u i r e doctors
and h o s p i t a l s t o g i v e you i n f o r m a t i o n about the r e s u l t s
of the work they do. Y o u ' l l know how each h e a l t h plan
i s doing — and what the people who use t h a t plan t h i n k
of the care they get. "
�4) Greater consumer choice of health plans
"Today, you're a t the mercy of the insurance company
t h a t your boss decides t o contract w i t h . You're t o l d
what h e a l t h plan you've got t o use — and even forced
t o give up your doctor i f your doctor's not p a r t of
t h a t plan.
Under the President's plan, you're i n the d r i v e r ' s
seat. You'll get t o choose among health plans — g i v i n g
you the widest and best choice of how you get your
care."
5)
Preserves doctor choice
"The d o c t o r - p a t i e n t r e l a t i o n s h i p i s i n danger. More and
more employers are f o r c i n g t h e i r workers t o switch t o
h e a l t h plans t h a t may not allow them t o see the doctor
they're used t o .
The C l i n t o n plan w i l l preserve your r i g h t t o see the
doctor of your choice. Reform w i l l put consumers i n the
d r i v e r ' s seat. You — not your employer or some
insurance company — get t o choose your h e a l t h plan and
your doctor."
6)
Eliminates loopholes and f i n e p r i n t —
w i t h insurers
no more b a t t l e s
"We're a l l s i c k of i t : the endless, confusing forms;
the insurance p o l i c i e s t h a t you need a t r a n s l a t o r t o
understand, the f i n e p r i n t t h a t s t r i p s you of your
coverage when you need i t most.
That's why the President's plan w i l l put you in the
driver's seat. Simple forms. Plain language. A
comprehensive package of benefits — and no loopholes
or fine print to take i t away. You shouldn't have to
battle insurance companies to get the benefits you pay
for — and with the President's plan, you won't."
�7)
Comprehensive coverage for a l l Americans
"Right now, m i l l i o n s of Americans have insurance t h a t
i s n ' t there when they need i t . Some things get covered,
but o f t e n the insurance company p o i n t s t o hidden l i m i t s
i n the f i n e p r i n t t o rob you of b e n e f i t s you thought
you had.
The C l i n t o n plan w i l l guarantee every American a
comprehensive b e n e f i t s package t h a t can never be taken
away. And i t includes more than a couple of t r i p s t o
the doctor. Hospital care — covered. Lab work —
you're safe. Preventive care — so you and your
c h i l d r e n stay healthy. P r e s c r i p t i o n drugs. More options
for long-term care. Together, i t adds up t o h e a l t h
s e c u r i t y f o r a l l Americans — the knowledge t h a t you
w i l l always be able t o get the care you need when you
need i t . "
8)
S i m p l i c i t y , w i l l reduce paperwork f o r you and your doctor
"Under the C l i n t o n plan, y o u ' l l be able t o wave goodbye t o the endless, complex forms and a l l the hassles.
Because we're going t o scrap the system t h a t produces
so much paper t h a t even i f you've got the patience t o
wade through i t , you probably don't understand i t .
We'll take the forms from the 1500 d i f f e r e n t insurance
companies and make them i n t o one.
And we're going t o l e t medical p r o f e s s i o n a l s p r a c t i c e
medicine again. Today, nurses and doctors are forced t o
spend time f i l l i n g out form a f t e r form — time t h a t
could have been spent caring f o r p a t i e n t s . Some nurses
have t o f i l l out 19 forms f o r each p a t i e n t — and then
those forms are checked and checked again. That won't
happen a f t e r reform."
9)
Eliminates fraud and abuse
"Right now, fraud and abuse run rampant throughout t h e
system. While some people f i l e f a l s e claims about
procedures t h a t never happened, others f i g u r e out how
to e x p l o i t the loopholes i n the maze o f forms. E i t h e r
way, they're making a p r o f i t — and you're g e t t i n g
ripped o f f .
The C l i n t o n plan cracks down on fraud and abuse. We'll
toughen p e n a l t i e s f o r people t h a t t r y t o game t h e
system. We'll e l i m i n a t e the loopholes t h a t l e t people
make a f a s t buck. And w e ' l l hold a l l h e a l t h plans
accountable by r e q u i r i n g them t o provide easy-tounderstand information about t h e i r r e s u l t s and success
r a t e s — so abusers have no place t o hide."
�10)
Help f o r small businesses who w i l l have increased bargaining
power and lower costs f o r premiums
"Right now, t h e cost of insurance f o r small businesses
i s s p i r a l i n g out of c o n t r o l — bankrupting small
businesses across the country. The smaller your
company, the more you pay f o r insurance and the f a s t e r
your premiums are r i s i n g . And small businesses are
going broke t r y i n g t o keep pace w i t h r a p i d l y r i s i n g
premiums.
I f you're a small business owner who covers your
employees now, t h i s plan w i l l b r i n g your costs under
c o n t r o l . We'll stop the insurance schemes t h a t
d i s c r i m i n a t e against you and d r i v e your premiums
through the roof. We'll f o l d i n workers' comp and t h e
medical p a r t of auto insurance — so you don't have t o
pay f o r three insurance p o l i c i e s f o r each worker. And
w e ' l l enable you t o team up w i t h other small businesses
and negotiate f o r the same rates t h a t insurance
companies give the b i g guys.
Under the C l i n t o n plan, everyone b e n e f i t s because
everyone takes r e s p o n s i b i l i t y . Small businesses t h a t
provide insurance shouldn't have t o p i c k up the tab f o r
firms t h a t can't a f f o r d i t .
I f you're not able now t o cover your employees, reform
w i l l help make insurance a f f o r d a b l e f o r you, your
f a m i l y , and your employees. The plan w i l l ask everybody
— workers and employers a l i k e — t o chip i n f o r h e a l t h
care. And coverage would be phased i n and government
assistance provided t o make i t easier t o provide
insurance."
11)
Improving competitiveness and companies' a b i l i t y to create
jobs
"Right now, many businesses are f a l l i n g behind because
of t h e enormous burden of r i s i n g h e a l t h costs. Take t h e
auto i n d u s t r y , f o r example. Health care costs add
$1,100 t o the p r i c e o f every car made i n America —
double the cost added t o Japanese imports. So companies
can't h i r e new workers — and they're a t a disadvantage
i n the g l o b a l marketplace.
The C l i n t o n plan w i l l reduce h e a l t h costs f o r many
companies. Health reform w i l l f r e e up money t o create
new jobs and increase incomes. And the plan asks a l l
employers t o take r e s p o n s i b i l i t y f o r covering t h e i r
employees — so some businesses aren't stuck w i t h t h e
b i l l f o r people who work f o r companies t h a t don't
provide insurance."
�12)
Positive impact on state and l o c a l budgets
"Right now, h e a l t h care costs are s p i r a l i n g out o f
c o n t r o l — bankrupting s t a t e and l o c a l governments. And
our f e d e r a l d e f i c i t means we have had t o cut programs
l i k e Medicare and Medicaid — leading t o an even
greater burden on s t a t e and l o c a l budgets.
Comprehensive reform w i l l ease t h i s burden. The f e d e r a l
government w i l l lead the way, and work i n partnership
w i t h s t a t e and l o c a l governments t o c o n t r o l t h e costs
t h a t are bleeding our communities dry. State and l o c a l
governments w i l l no longer be asked t o go i t alone i n
f a c i n g exploding costs."
13)
Helps families deal with f i n a n c i a l burden of long-term care
"Too o f t e n , American f a m i l i e s are bankrupted by t h e
long-term care costs of f a m i l y members. Often, t h e
e l d e r l y and disabled are forced i n t o nursing homes
because they have no other options. We need a system
t h a t o f f e r s r e a l choices t o the e l d e r l y and t h e
disabled.
People want t o remain i n t h e i r homes and communities,
and t h e C l i n t o n plan w i l l provide services t o make t h i s
posssible f o r more Americans. There w i l l be more
services a v a i l a b l e — so t h a t seniors and disabled
c i t i z e n s who can't manage on t h e i r own can remain i n
t h e i r own homes or communities f o r as long as
possible."
14)
Increases roles of doctors and patients i n medical decisions
"Right now, doctors have too many people looking over
t h e i r shoulders, second-guessing t h e i r p r o f e s s i o n a l
judgment. They're buried under an avalanche of
paperwork t h a t does nothing t o help d e l i v e r h i g h q u a l i t y care.
The C l i n t o n plan takes away t h e hassle, t h e secondguessing by insurance company representatives a t t h e
end of a telephone l i n e , and t h e time spent doing
paperwork. I t restores t h e treasured d o c t o r - p a t i e n t
r e l a t i o n s h i p and allows physicians and p a t i e n t s t o work
together t o make medical decisions."
�15)
More constmer information and protection
"No longer w i l l consumers be a t the mercy of t h e i r
employer or insurance company when i t comes t o choosing
a h e a l t h plan or seeing a doctor. The C l i n t o n plan
empowers consumers t o make educated decisions about how
and where they get t h e i r care.
A f t e r reform, y o u ' l l get a "performance r e p o r t " t h a t
gives you easy-to-understand information on each h e a l t h
plan — what doctors and h o s p i t a l s are included, an
evaluation of the q u a l i t y of care, a consumer
s a t i s f a c t i o n survey, and the p r i c e . And you choose your
plan. I f you want t o switch plans l a t e r , you can do i t .
I t ' s simple."
16)
Emphasizes preventive care
"We have the most s o p h i s t i c a t e d h e a l t h care a v a i l a b l e
anywhere i n the world. But there's something wrong w i t h
a system where you're guaranteed a t r i p l e bypass, but
you can't be sure t h a t your c h i l d gets the shots she
needs.
This plan o f f e r s a new bargain: you take r e s p o n s i b i l i t y
f o r your h e a l t h and your c h i l d r e n ' s h e a l t h — and w e ' l l
cover preventive services: regular physicals,
immunization, and t e s t s l i k e mammograms. And you won't
have t o pay f o r them anymore.
Emphasizing preventive care i s a new approach based on
what's always worked — keeping you healthy instead o f
w a i t i n g u n t i l you get s i c k . I t w i l l improve h e a l t h and
save us a l l a l o t o f money a t the same time."
�X
/ ;
DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per
12958 as amended, Sec. 3.3 (c)
PRIVILEGED AND CT^a^^ffiB> MEMORANDUM
TO:
FR:
RE:
cc:
H i l l a r y Rodham C l i n t o n
C h r i s Jennings, Sean B u r t o n
Meeting w i t h Congressman LaFalce
Melanne, Steve, L o r r a i n e , D i s t r i b u t i o n
June 28, 1993
Tomorrow you a r e scheduled t o meet w i t h Congressman John
LaFalce from New York. As you know, t h e Congressman serves as
the Chairman o f t h e House Small Business Committee and would
p r o v i d e v a l u a b l e cover t o us should he be an e a r l y and p u b l i c
s u p p o r t e r o f t h e C l i n t o n h e a l t h r e f o r m p r o p o s a l . T h i s meeting
was scheduled t o b e g i n t o c u l t i v a t e a s t r o n g w o r k i n g and p e r s o n a l
relationship.
BACKGROUND:
I n t e r e s t i n g l y , besides b e i n g t h e House Small Business
Chairman, Congressman LaFalce i s a cosponsor o f Congressman
McDermott's s i n g l e payer b i l l .
T h i s meeting w i l l be a g e n e r a l
b r i e f i n g on h e a l t h care r e f o r m . The Congressman w i l l be
p a r t i c u l a r l y i n t e r e s t e d i n t h e elements o u r p l a n share w i t h a
s i n g l e payer system and t h e steps taken t o m i n i m i z e t h e impact on
s m a l l businesses.
The Congressman i s concerned t h a t h e a l t h c a r e r e f o r m ,
e s p e c i a l l y employer mandate approaches, c o u l d have a d e v a s t a t i n g
a f f e c t on s m a l l businesses. I t i s p r i m a r i l y t h i s concern t h a t
has l e a d LaFalce t o s u p p o r t t h e s i n g l e payer p l a n . The f a c t t h a t
h i s u p s t a t e New York d i s t r i c t l i e s on t h e Canadian b o r d e r and
t h a t many o f h i s c o n s t i t u e n t s have a f a m i l i a r i t y w i t h t h e
Canadian system ( o f t e n t h r o u g h r e l a t i v e s who l i v e t h e r e ) , makes
t h i s d e c i s i o n a l l t h e more c o m f o r t a b l e f o r him.
(It is
i n t e r e s t i n g t o n o t e , however, t h a t t h e McDermott b i l l c o n t a i n s a
6 p e r c e n t p a y r o l l t a x t o h e l p f i n a n c e t h e c o s t o f t h e measure.)
While n o t a major p l a y e r on h e a l t h care r e f o r m , w i t h
s u f f i c i e n t a t t e n t i o n , t h e Congressman w i l l l i k e l y be w i t h us i n
the end and can serve as u s e f u l c o n n e c t i o n t o t h e s m a l l b u s i n e s s
community. And a l t h o u g h h i s committee i s u n l i k e l y t o r e c e i v e
j u r i s d i c t i o n over p a r t s o f t h e p l a n , i t can serve as a forum f o r
a i r i n g o u r message on h e a l t h care r e f o r m and s m a l l b u s i n e s s . I n
meetings w i t h h i s committee s t a f f , t h e y have suggested t h e
p o s s i b i l i t y o f h o l d i n g h e a r i n g s a t an a p p r o p r i a t e t i m e on t h e
c u r r e n t problems f a c i n g s m a l l businesses i n p r o v i d i n g i n s u r a n c e
and how t h e A d m i n i s t r a t i o n ' s p l a n would h e l p .
�Over the l a s t couple of months, we developed an on-going and
generally productive r e l a t i o n s h i p w i t h the Congressman and h i s
s t a f f . We have held a small meeting w i t h h i s s t a f f and then had
Ken Thorpe b r i e f the e n t i r e s t a f f of those who serve on t h e
Committee.
I n a d d i t i o n , I r a met w i t h the Congressman l a s t month.
Although the meeting was not overly substantive, the Congressman
appeared t o s i n c e r e l y appreciate the outreach e f f o r t . Since he
has a past working r e l a t i o n s h i p w i t h I r a , Congressman LeFalce
seems t o place great t r u s t i n I r a .
L a s t l y , however, i t should be noted t h a t LeFalce f e e l s
r e l a t i v e l y close t o John Motley, of the National Federation o f
Independent Business. They worked together t o k i l l Section 89 o f
the tax code, which required health care expense r e p o r t i n g
requirements t h a t the small business community hated. With t h i s
i n mind, you may wish t o ask him t o give you guidance on how best
to work w i t h NFIB and other small business r e p r e s e n t a t i v e s .
As you requested, attached t o t h i s memo i s the l a t e s t
v e r s i o n of a small business presentation t h a t the Department of
Health and Human Services i s w r i t i n g . Although i t i s f a r from a
s t a t e t h a t we are t o t a l l y comfortable w i t h , we thought you might
f i n d t h i s information t o be useful f o r meetings w i t h small
business advocates. We w i l l provide updated versions of t h i s and
other small business documents as they become a v a i l a b l e .
�Health Reform ar\6 Small Business
A Look at Problems in Today's System and
Solutions Under the President's Health Reform
�Small Business and HeaUh Care Reform: Overvievc
It takes courage and ingenuity to start and succeed as a small business. It means
taking a risk with your future and betting that you succeed. As many as 1 out of 12 small
businesses fail within the first year. It is not right that many small business owners also face
the risk that their families and employees won't have health care when they need it. It is
not right that those who provide coverage risk that within a year that coverage may be taken
away or priced out of reach.
Small businesses fuel job creation and strengthen our economy. Responsible for 90%
of job growth in 1990, small businesses has become the nation's engine of economic growth.
Yet this growth is endangered by a health care system which threatens every American
business, especially small businesses. Small business owners can facefinancialdevastation
if a family member or just one employee falls ill. And employers who try to provide health
care to their employees find a health care system stacked against small businesses.
Nonetheless, a majority of American small businesses manage to provide coverage.
Today 62% of American businesses with less than 100 employees provide health care
coverage to their employees. And 51% of those with fewer than 25 employees provide
health care. But providing these benefits isn't easy.
"
The Clinton Administration believes that most small business want to cover their
employees -- and most do. Our health care plan will work for small business, taking away
the hassle and ensuring security of affordable, predictable health care coverage. And for
those businesses who don't provide health insurance coverage, our reform will protect them
while they make the transition. The plan providesfinancialassistance and a phase-in period
so they may provide health security to their employees and families.
In today's Mom and Pop stores, the Mom or the Pop serves as the de facto benefits
department. They fill out the paperwork. They make the phone calls. They negotiate rates
and enroll their employees. They dutifully pay their premiums every month. But all too
often, within a year, their insurer will raise rates and price them out of the market - many
times for no reason. Or the insurer will refuses to renew coverage. Then the small business
owner is back to the drawing board - spending more time and more money to find another
insurer ~ and the cycle starts again.
The following document examines the major problems faced by small businesses in
today's health market and shows how health reform and the formation of health alliances
will address most, if not all, of the major problems facing small businesses.
�The Majority of Small Businesses Offer
Health Insurance to Their Employees
Do Not Offer (37.6%)
Offer (62.4%)
For Firms with Less than 100 Employees
Source: Dept. of Labor, Based on SBA Calculation of May 1988 CPS Survey Data
�The Small Business Obstacle Course
Time and Money
Price Discrimination
Insurance Abuses
Redlining
Underwriting
High Administrative Costs
A Volatile Insurance Market
Price Gouging
Difficulty Securing Renewal
�THE SMALL BUSINESS OBSTACLE COURSE
Problem:
SmaU business owners must go through an obstacle course of insurance abuses
and higfier costs to
provide health care coverage for tfieir employees.
Small business owners who spend the lime and money to cover employees frequently
must deal v^th an insurance market which changes its rules at every stage of the
game, a volatile market, unpredictable cost increases, higher administrative costs, and
premiums rising at a faster rate than health care costs for larger employers.
Lacking a benefits department like larger firms most small business owners must
perform all the fiinctions of such a department by themselves. Negotiating health
coverage in today's health care system is a process oftenfi-aughtwith fiiistration and
obstacles.
Many small business owners, after setting aside the time to negotiate coverage for
their employers, encounter obstacles like "occupational redlining" a practice where
insurers v^ll simply refuse to cover entire industries perceived to be high nsk; or
medical underwriting, basing premiums on perceived risk and medical history; or
experience rating, where insurers jack up costs if just one employee falls ill or gets
injured. Many insurers engage in "price bailing and gouging" offering "discount" rates
for the first year of coverage only to charge much higher prices in the next year when
pre-existing condition exclusions expire. And many small firms with sick workers find
that an insurance company v.'iW refuse to renew their polic>' in the second year.
Not surprisingly the hassle and discrimination in today's system make many small
ow-ners worry about being able to continue to provide this coverage. The reform
plan addresses nearly all of the problems which cause the small business owTier so
much hassle and time in obtaining insurance.
The Plan:
Hedth refonji outlaws uisurance practices like widenvnting and redlining. The
health alliance helps small businesses cut through the hassle.
We uall take the burden off the small business with health alliances which will deal
v^ith the insurance companies and bargain for competitive prices. The alliance will
take over the paperwork and the negotiations; provide information on plans and
increase ease of enrollment. Higher administrative costs will be reduced and the
hassle of the current system is eliminated.
The Clinton reform plan outlaws insurance abuses such as redlining, underwriting
and ex-perience ratings. Costs of premiums are controlled and the insurance market
is stabilized. Under our reform, everyone living in the same area pays a similar price
for a similar plan. And they have the security knowing those costs will be predictable
and increase at a lower rate.
�Small Business Owners
Face an Obstacle Course in Obtaining Health Insurance
^iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiw
Time & Money
0
Year 1
Health
coverage
for one
more year
High Administrative Costs
Cost Negotiations
Frustration
/Cost A Cost B \
$
(
\
^
I Cost D Cost C ]
V^
$
Price Discrimination
/
•
Redlining:,^"i^'^UhderwHlng
mmtmm
' mmmm
insurance Abuses
Year 2
- or Priced out
of market
Renewal
refused
�The New System
Redlining
High Administrative Costs
Underwriting
Cost Negotiations
^ Price Discrimination
1
Volatile Market
1...
ill|!i|i|i||m|i|iij|i|i!iii|rvi'T|i'|ltTii|^^
Tll||lji||ji|i
Security
liliiliiiiiUuillli^iii^
�Insurance Industry Abuses
Medical Underwriting
Experience Rating
Price Baiting and Price Gouging
Refusal to Renew Policy
Occupational Redlining
�OCCUPATIONAL REDLINING
TYPES OF INDUSTRIES OFTEN EXCLUDED FROM HEALTH
INSURANCE PLANS
Amusement Parks
Asbestos-Related Industries
Auto Dealers
Aviation
Barbers and Beauty Shops
Bars and Taverns
Car Washes
Commercial Fishing
Construction
Convenience Stores
Domestic Help
Entertainment/Athletic Groups
Exterminators
Federally Funded Organizations
Florists
Foundries
Grocery Stores
Health Clubs and Spas
Hospitals and Nursing Homes
Hotels and Motels
Insurance Agencies
Interior Decorators
Janitorial Services
Junk and Scrap Metal
Law Firms
Limousine Services
Liquor Stores
Logging and Lumber Mills
Meat/Fish Packers
Mining Operations
Moving Operations
Oil Field Operations
Parking Lots
Physicians Practices
Restaurants
Roofmg Companies
Security Guard Firms
State Funded Organizations
Taxicabs
Trucking Firms (Long-Haul)
Sources:
List of "ineligible industries" and industries requiring "special consideration'
from selected insurance plans analyzed by the Alpha Center.
American Hospital Association, Promoting Health Insurance in the Workplace
and Local Initiatives to Increase Private Coverase (Chicago: 1988), as cited in:
United States General Accounting Office. Health Insurance: Cost Increases Lead
to Coverage Limitaitions and Cost-Shifiins. (GAO/HRD 90-68)
�Higher Administrative Costs
• Higher Overhead
• No Benefits Department
• Faster Increases in Costs
�Small Businesses Face
Higher Administrative Costs
A d m i n i s t r a t i v e C o s t s as a
P e r c e n t a g e of C l a i m s
By F i r m S i z e
50%
401,
30%
20%
10%
0%
20-49
1-4
Source:
100-499
Firm Size
More than 10,000
Risk/Profit
General Admin.
Claims Admin.
Marketing Costs
Hay /Muggins.
Inc.
�Employers Would Save $1,015 Per Employee
Per Year If Costs Were Controlled
Small Businesses Save Most
Employees in F i r m
1-9
$3862
10-24
$2930
25-99
$2769
100-499
$3^13
500*
^2852
$0
$1000
$2000
$3000
$4000
$5000
Total C o s t s Per Employee 1992
Excess C o s t s
Source:
Lewin-ICF
�A Volatile Market
Cost Variations
Unpredictable Cost Increases
Durational Rating
Churning
�Small Groups (2-25) Face Large
Variations in Health Insurance Premiunns
450%
100%-i
pi^^^
'
pi^^g
•
pi^^c
PlanD
Plan E
Plan F
SMBUS.WQ!
Source: Blue Cross/Blue Shield Association, Survey of Six Sample BC/BS Plans, January 1992.
�SUMMARY
TODAY
REFORM
High Administrative Costs: Higher
administrative costs account for as much
as 40% of the poh'cy costs compared to
about 5% for large companies. [CBO,
5/92]
Cuts Administrative Costs: The health
alliance assumes the administrative
functions and costs which kill small
business owners.
The Obstacle Course: Small business
owners who cover their employees must
spend a lot of time and effort dealing
with an insurance market which changes
its rules at each stage of the game.
Eliminates Hassle: The health alliance
negotiates rates, provides information on
plans, increases ease of enrollment and
absorbs the manpower drain.
Dramatically Increasing Costs: Premiums
for small employers rise at a faster rate
than for other employers ~ as much as
50% in any given year. [NAM]
Aggressively Controls Costs: Health
reform will aggressively control cost
increases which hit small businesses
disproportionately hard.
Difficulty Obtaining Renewal: After a
first year of reasonable rates, small
businesses often face higher costs and
difficulty obtaining renewal.
Guarantees Renewal: Guarantees
renewal and stabilizes premiums.
Small Risk Pool: Fewer employees mean
a smaller pool to share the risk.
Insurance compam'es frequently charge
more for these policies and one illness
can cause plan cost to increase
dramatically.
Spreads Risk Evenly: Consolidates small
businesses in large purchasing pools to
give them the same bargaining power as
large companies.
Insurance Industry Abuses: Insurance
companies redline large sectors of the
small business market. Underwriting and
experience rating leads to discriminatory
prices for small business poHcies.
Outlaws Unfair Insurance Practices:
Prohibits redlining, experience rating and
underwriting. Requires that plans charge
all firms in a given area a similar price
for the same health plan.
�Insurance Problems Facing the Small Group Employee Market
Large Volatile Variation in Premiums
o Underwriting
o High Risk
Workers in Small Firms Finance a Higher Proportion of Total Premiums
Insurance is More Expensive Relative to Large Firms
o High Administrative Costs
o Premiums Include Costs of Uninsured
o Provider Payments Substantially Above Costs
Growth in Insurance Premiums is Higher in the Small Group Market
o Less Likely to Have Established Cost Containment Programs
�o
SI
Average
Insured worker's health spending wlihout health reform
Health gill B3
1994
Average connpensatlon per worker:
OU
BC
Ul
CL,
tn
CO
•n
o
Oi
u>
Average insured worker's health bill
Health Insurance
Employer's share oi prernlum
Indivtoluai's share of premium
Medicare payroll tax
Workers' comp/dlsabllHy/lnduBtrlal tnplani
Out-of-pocket
Other spending
health raclllllea
Federal taxes, fees, A other paymsnta
Federal employees' health premiums
Federal conuibutions to Medicare HI
Medicare (general revenue)
Medicaid
Other federal health programs
State & local taxea, faat, A other paymanta
Slal8/<ocal employees' heaHh premiums
Stale/local contributions to Medicare HI
Medicaid
Hospital subsidies
Other programs
CM
•nd I»f|.»t1infiil f l Commtftt, B u r t n ot Etcnomk A«»lyti5 d»«».
o
o
o
(D
O
Compensation
2000
Moalth dill as V. o4
CompenaaUon
$50,334
$36,299
$7,423
$4,132
$3,163
$969
$926
$246
$782
$113
$654
$53
$11
$169
$246
$174
$569
$149
$24
$166
$81
$130
of
20.45%
11.38%
8.71%
2.67%
2.55%
O.BB%
2.15%
0.31%
1.80%
0.15%
0.03%
0.47%
0.68%
0.48%
1.57%
0.41%
0.06%
0.51%
0.22%
0.36%
$12,386
$6,895
$5,278
$1,617
$1,546
$411
$1,305
$168
$1,092
$80
$19
$283
$411
$290
$950
$248
$39
$310
$135
$218
24,61%
13.70%
10 497o
3.21%
3.07%
0.82%
2.59%
0.37%
2.17%
0.18%
0.04%
0.56%
0.82%
0.58%
1.89%
0.49%
0,08%
062%
0.27%
0.43%
�Cwrem Speadu-g 02 Pri-.iti Healtti In.suranee freoiutns ny aiaic.
As a Percent cf Ta.'Ciblc Earnings
ALABAMA
AUNSKA
ARI/.ONA
ARKANSAS
CALIFOIWIA
COLOBADO
c;oN]«(EcncLrr
DELANVAKE
DC
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDL^NA
IOWA
KANSAS
KENTUCKY
LOUIbiL«kNA
MAINt
MARYLAND
MASSACHUSETTS
MlCHICiAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW I L S L M P S H T R E
NEW JERSEY'
NEW MEXICO
NEW YOKK
NORTH CAROUN.A
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROUNA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WTOMING
TOTAL
Ta.Tcable Earnings
38^8,615398
7,471.U5,760
40,89 l i 1 2 ^
22,072^11,494
376^575,470
42,952722 P17
47^,041,475
7^52^,819
138«6,533JJ16
69,107.458^9
14^76.797,447
143,9R5<?45^7
6ip43,580jB96
30pi6,fi22/S05
28,715,089,385
34,7&4,60g.l84
39,529,575,525
12;SS9,907383
68211,468397
77,96iaM)£l7
109,409,081232
51,705,415320
20,557,»ii356
60244,888
7,fnOA90.l64
17,478JJ45^03
15,537 209212
16JD13,650^1
110JD15^51967
14^0233 JS70
217,920,564,110
72,154232,101
6,052^41293
124^78294^
32^)97,793 i09
32,T73.'> 18,112
1322242-'W,494
12^56,487^82
37,791500551
6,4565192^
47M7,fi09S4fi
186j606211/»5
16^7270,729
PremiuTO
3,751 £77 575
542,968282
3,674 ,537 3W
2369,779361
31377234,190
4,135 p48 261
42553052*2
773il09213
445,947314
6,723213,419
1346i)353l7
I,028354,152
13^*40,116,472
6,713,556,189
3,056.i)74,535
2,789,136209
3266394364
3,484,793,997
1221,989294
S210P65,688
6503215,432
I I ,912.093,402
5214,122517
2,125383,724
6222536523
890,991,169
1,796,936^659
1.714563/MO
1,6^7320343
9,K24393S65
1,4M,4<»381
19235,998 j662
6571365,130
618523,636
13250,058,130
2,890309363
3,490,744 JMO
15,138336^39
1263223,740
3,703370,746
Percent I
9.fi2Ve
727%
8.997e
10.74%
8.46%
9.63%
9.09%
8.75?6
5.90%
7.89%
9.73%
8.99%
10.47%
9.47%
11JX)%
10.18% !
9.71%
9J9%
8.82%
1026% I
7.64%
834%
1039%
1028%
1034%'
1033%
1138%
1028%
11.04%
10.41%
8.93%
9.80%
8.S3%
9.11%
1022%
10J6S%
9.00% I
10J65%
11^%
10.48% I
63363,931291
15>«,775,523
5W99280,S87
5,005 270,744
15,700,711323
1 3 » 372,751
645,079501
6,488 , ^ P 1 5
6,009 <)63/i83
1,602,410,413
6,469,131321
493327385
9.80%!
1053%
1023%
8.41% I
1050%
9.9f>%
7.80%
9.41%
10.44%
11.02% I
9J6%
2,904335,574^
.271372.153^
: • 936%]
6,477/398200
83,193,483,170
Sounx-. Social Securiri'Wage Base
705,755,456
�Total Premium Payments as Percenl of Payroll
Without Health Reform
Firm Size
1994
1995
1996
1997
1988
1999
2000
All
11.54%
12.06%
12.53%
12.96%
13.42%
13.88%
14.36%
<25
25-99
100- 499
500-999
1000+
11.96%
11.24%
11.84%
11.49%
11.41%
1Z50%
11.75%
12.38%
12.01%
11.93%
1298%
1220%
12.85%
12.47%
12.39%
13.43%
1262%
13.29%
12 90%
12.81%
13.90%
13.07%
13.77%
13.36%
13.27%
14.39%
13.52%
14.24%
13.82%
13.72%
14.89%
13.99%
14.74%
14.30%
14.20%
Source: HHS analysis using Urban jnstjjute analyses of March 1992 Current Population Survey.
�o
o
SI
Total premium payments as a percent of payroll vary by firm size
and are highest for firms with less than 25 employees.
Total premium payments as a percent of payroll (1994 $)
14%
11.96%
12%
11 :54%
11.84%
11.24%
11.49%
11.41%
10%
BB
U
1/1
8%
6%
oo
4%
o
2%
«3
0%
at
o
All
<25
25-99
100-499
500-999
1,000 +
Firm size
l-S
n
o
to
o .
Source: Urban Institute analyses of the March 1 9 9 2 Current Population Survey.
�Total premium p a y m e n t s as a percent of payroll vary by industry
and are highest for retail.
Total premium payments as a percent of payroll
14%
12.84%
12.28%
12.22%
12%
11.64%
11.47%
-11.46%
11.2%
10.35%
11.17%
10.13%
.—
10%
8%
6%
4%
2%
0%°
1
AH
AgfloullU(«
MB/IUI.
Tech/cl6ric«1 Wholaeale
Retail
Financial
Saivioe* StateAoc g o v ' l F e d .
flov't
Industry
Source: Urban Institute analyses of March 1992 Current Population Survey.
�percent u
of ^.ay.
payroll vary by industry
Employer premium payments as a
a percem
bmpiuy
H
highest for manufacturing.
Employer premiuim payments as a percern o ^ p a y r o l i n i g ^
14%
12%
10.16%
10%
9.77%
B.85%
8.8%
8.35%
8.28%
8.08%
8.12%
• 7.46%
7.&7%
8%
6%
4%
2%
1
0%
AH
Aariouilur.
M-nu(.
T.ch^olwic.1
Wb.l-.ala
Rnlail
Rn-nci.l
S-rvlcaa SiM-Aoo , o v ' l F . d . gov t
Industry
Source: Urban Institute analyses of March 1992 Current Population Survey.
�Health Insurance Premiums Relative to Payrolls:
The Distribution Under the Current System
Number of currently covered workers in premium/payroll ratio group (Thousands)
30
26.676
25
20
18.12
15
11.996
10
6.451
-• i • >
3.29
;• 1 V : -
1.26
0
D-2%
0.054
0.272
2-4%
4-6%
6^%
&-10%
10^12%
12-14%
14-16%
>16%
Total premiums as a percent of total payroll
Source: Urban Institute's TRIM2 model, based on the March 1991 Current Population Survey.
�Health Insurance Premiums Relative to Payrolls:
The Distribution Under the Current System
Number of currently covered workers ^t^ premium/payroll ratio group {Thousands)
OL.
ta
ua
a.
i/i
tn
oo
o
Ol
o
tn
n
o
o
«D
o
a2%
2-4%
4-6%
6-8%
a-10%
10-12%
12-14%
14-16%
>16%
Employer premiums as a percent of total payroll
Source: Urban Institute's T R I M 2 model, based on the March 1 991 Current Population Survey.
�Health Insurance Premiums Relative to Payrolls:
The Distribution Under the Current System
Number of currently covered workers in premium/payroll ratio group (Thousands)
02%
2-4%
4-6%
6-8%
8-10%
10-12%
12-14%
14-16%
>16%
Total premiums as a percent of total payroll
Source: Urban Institute's TRIM2 model, based on the March 1991 Current Population Survey.
�Workers: How many work for small firms?
SI
Distribution of workers by firm size
25-99
14%
ta
Ul
100-499
16%
-«;
oo
tn
o
o>
500-999
6%
(O
CM
o
o
1000 +
41%
n
<n
o
o
o
Source: The Urban Institute (1993), based on the March 1992 CPS and TRIM2.
Numbers are in thousands.
�Percentage of Firms Offering Health Insurance
By Firm Size
Percent
100%
83.1%
81%
80%
^4:5%
91 .9%
MlppPjllfpI]
60%
•J-
40%
r-t
20%
' -- -. :: r.
0%
AU firms
1-24
25 99
100-499
Size of Firm
Source: Dept. of Labor, based on Small Busir^es5 Admm calculations of May 1988 CPS Survey Data
L
500 +
�o
SI
People who work for small businesses are
more likely to be without health insurance.
Percent of nonelderly population without health insurance
30%
25%
27%
23%
. ..
21%
ta
UJ
Ou
20%
'S'
17%
i •
•-•
1
15%
tn
oo
tn
10%
o
cr>
tc
o
5%
CV4
. r i ^
• '
> > 1
';
10%
^ • » •. « 7.
<
"i i
;-
J':
' >'!^'^^^^
r
J
.v-i
) *
i/f *
I- i
.
. ( i >;:..•.
. . . .
. . -
: • *•
mmm
0%
o
i
•.:";!,'"'•.! •
.;'-'»'iiirt..V.wi»
<25
25-99
100 or more
Nonworking
Size of Family Head's Employer
O)
o
o
to
o
Source: Employee Benefits Research Institute Analysis of the March 1992 CPS.
�Employer premium payments as a percent of payroll
are lowest for small firms.
Employer premium payments as a percent of payroll (1994 $)
14^0
All
<25
25-99
100-499
500-999
1,000-f
Firm size
Source: Urban Institute analyses of the March 1992 Current Population Survey.
�Employer premium payments per worker vary by firm size
and are the largest for large firms.
Employer Premium Payments Per Worker (Thousands)
$5
$4
$3,215
$2.96
$3
*-
:J
.$2.B7a $2,412
$2,213
$2
si-i
: ( 7 l :;.'.» » i ; ^ • • i
r*p
mmm^
-'* " ' *v
• i
1 ' "
>
F«
r.
lips
; •.>'*•:}; ; ,,
:ii'' ' j ^ . ' - ' •
$1
*
'' f'.-'- '•
• ;:;
;
liif
*>i
$0
• •••fct1 .• • ' * -
'^i;i''iiillii
All
<25
25-99
100-499
Firm size
500-999
1,000 +
�Employer premium payments per worker vary by firm size
and are tfie largest for large firms.
Employer Premium Payments Per Worker (Thousands)
$5
$4
$3,215
$2.98
$3
$2,873
$2;T68
$2,412
$2,213
$2
$1
$0
All
<25
25-99
100-499
Firm size
500-999
1,000 +
�Total premium payments per worker vary with firm size
and are highest for large firms.
Total premium payments per worker (1 994 $, thousands)
$5
S3.984
$4
$3,766
$3,642
$3,511
$3,417
f
25-99
100-499
$3,713
$3
$2
$1
$0
All
<25
500-999
1,000 +
Firm Size
Source: Urban Institute analyses of March 1992 Current Population Survey.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
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2006-0885-F
Text
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Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Congressional Briefing Memos – First Lady, 1993 [2]
Creator
An entity primarily responsible for making the resource
Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 8
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Preservation-Reproduction-Reference
Date Created
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2/6/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg2-008-005-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/17d43783780c914560a7161b202c97fd.pdf
8f6a861bc252f093e885c08c9ab4fe39
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Croup:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3681
FolderlD:
Folder Title:
Congressional Briefing Memos - First Lady 1993 f 1
Staek:
Row:
Seetion:
Shelf:
Position:
S
52
3
8
2
�BRIEFING ON REP. MATSUI FOR 12/21
12/20
CONGRESSMAN ROBERT MATSUI (D-CA)! Congressman Matsui has strong
opinions on h e a l t h care and has been anxious t o share them w i t h
the F i r s t Lady and the President. We understand t h a t Matsui was
disappointed t h a t the President d i d not ask h i s h e a l t h care views
when they returned from C a l i f o r n i a on A i r Force One. Matsui has
been very p o s i t i v e i n p u b l i c about h i s b e l i e f t h a t major h e a l t h
care reform would be passed by the end of t h i s Congress. He
supports the employer mandate but has suggested the
A d m i n i s t r a t i o n look a t a l t e r n a t i v e s t o insurance premium caps.
He wants t o be sure t h a t q u a l i t y of care i s not diminished.
Recent Developments; At a December 15 Ways and Means hearing
w i t h the nation's governors, Matsui t o l d Gov. Campbell: "You
have a goal of u n i v e r s a l coverage, but you don't t e l l us how t o
get there."
A f t e r the NAFTA vote, Matsui said: "There was a p h i l o s o p h i c a l
underpinning .. t o how t h i s c o a l i t i o n came together. Health
care's a much more d i f f i c u l t package."
�BRIEFING FOR MEETING WITH SENATOR HARKIN 12/16/93
12/15
SENATOR TOM HARKIN ( D - I A ) : While Senator H a r k i n i s a co-sponsor
of t h e H e a l t h S e c u r i t y A c t , i n p u b l i c statements he has r a i s e d a
number o f concerns i n c l u d i n g Medicare c u t s , t r e a t m e n t o f c h i l d r e n
w i t h d i s a b i l i t i e s , and most r e c e n t l y f u n d i n g f o r m e d i c a l
r e s e a r c h . Not a l l o f h i s s t a t e m e n t s , however, have been
n e g a t i v e . He t o l d t h e Omaha World H e r a l d on December 8: "We've
g o t t o c o n t r o l h e a l t h care c o s t s and assure t h a t every American
has good coverage t h a t can never be t a k e n away."
Recent Developments: November 13 Washington Post:
"The n a t i o n ' s
h o s p i t a l s spend m i l l i o n s a n n u a l l y on o f f i c e p a r t i e s , a i r l i n e
t i c k e t s , t e l e v i s i o n advertising, lobbying, charitable
c o n t r i b u t i o n s , r e n t a l cars f o r executives, i n t e r n a t i o n a l t r i p s t o
drum up r e f e r r a l business and g i f t s f o r workers. The c o s t s a r e
b i l l e d t o p a t i e n t s and i n s u r e r s , w i t h Medicare expected t o pay
i t s share o f t h e t a b . " Medicare r u l e s must be made more p r e c i s e
t o e l i m i n a t e i n a p p r o p r i a t e payments, H a r k i n s a i d .
December 5: W i t h Sen. G r a s s l e y , H a r k i n t o l d an Iowa conference
t h a t t h e Medicare c u t s make t h e C l i n t o n p l a n unworkable f o r Iowa,
where many h o s p i t a l s a r e dependent on reimbursement from t h e
f e d e r a l government.
December 9 Des Moines R e g i s t e r : Renewed h i s push f o r a m e d i c a l
r e s e a r c h t r u s t f u n d t e l l i n g P h i l Lee:
" I must t e l l you, I have
a l l t h e a u t h o r i t y I need. B u t I don't have t h e money." He s a i d
he was s e n t a budget by t h e White House l a s t year t h a t s t r i p p e d
funds from many i n s t i t u t e s "and t h e y ' r e n o t g o i n g t o p u l l t h e
wool over our eyes a g a i n . " That same day i n R o l l C a l l H a r k i n
c a l l e d t h e C l i n t o n h e a l t h r e s e a r c h budget " t e r r i b l y inadequate."
He i n s i s t e d he would n o t a l l o w t h e A d m i n i s t r a t i o n t o " p l a y games"
by i n c r e a s i n g f u n d i n g f o r some diseases w h i l e h o l d i n g t h e o v e r a l l
NIH budget steady, i n e f f e c t s l a s h i n g o t h e r r e s e a r c h .
�BRIEFBOS 12/7
12/6
Notes: A December 2 Boston AP s t o r y based on a p o l l by M a r t i l l a
& K i l e y f o r t h e Massachusetts H o s p i t a l A s s o c i a t i o n shows s t a t e
r e s i d e n t s s u p p o r t i n g t h e a d m i n i s t r a t i o n ' s h e a l t h care r e f o r m p l a n
d e s p i t e t h e f a c t t h a t t h e y don't t h i n k i t w i l l lower t h e i r b i l l s
o r improve t h e q u a l i t y o f t h e i r c a r e . 62% o f t h o s e p o l l e d
s u p p o r t e d t h e p l a n , 47% t h i n k i t w i l l r e q u i r e them t o pay more,
and o n l y 10% t h i n k i t w i l l i n c r e a s e q u a l i t y .
67%, however,
b e l i e v e i t i s r i s k i e r t o leave t h e h e a l t h care system t h e way i t
i s now t h a n t o change i t . 60% a r e concerned t h e p l a n c o u l d c o s t
a l o t more t h a n t h e a d m i n i s t r a t i o n e s t i m a t e s and 59% w o r r y i t
c o u l d f o r c e s m a l l businesses t o l a y o f f workers o r c u r t a i l
hiring.
Those marked w i t h a *** have n o t h i n g new s i n c e t h e New
Hampshire b r i e f i n g .
***SENATOR WILLIAM "BILL" COHEN (R-ME); Senator Cohen i s one o f
our t o p Republican t a r g e t s b u t has been n o t a b l y s i l e n t on h e a l t h
care r e f o r m . I n t h e s p r i n g , he r e q u e s t e d t h a t you a t t e n d an
event i n Maine a t t h e same t i m e you were i n Nebraska w i t h Senator
Kerrey.
Any d i s c u s s i o n w i t h Sen. Cohen has t o be handled w i t h
extreme d e l i c a c y due t o t h e u n d e r l y i n g r i v a l r y which e x i s t s
between t h e two Maine Senators.
Cohen was e l e c t e d t o t h e Senate i n 1978 and s i t s on t h e
J u d i c i a r y , Armed S e r v i c e s , and Governmental A f f a i r s Committees,
as w e l l as t h e S p e c i a l Committee on Aging and t h e J o i n t Committee
on t h e O r g a n i z a t i o n o f Congress.
I n January Senator Cohen s u b m i t t e d S. 223, t h e Access t o
A f f o r d a b l e H e a l t h Care A c t , u s i n g a managed c o m p e t i t i o n model f o r
r e f o r m . I t has p r o v i s i o n s t o improve h e a l t h d e l i v e r y i n r u r a l
and underserved areas, r e f o r m m a l p r a c t i c e , c o n t r o l d r u g c o s t s and
emphasize p r e v e n t i v e h e a l t h . Senator Cohen a l s o co-sponsored
Senator M i t c h e l l ' s Freedom o f Choice A c t . Cohen i s concerned
t h a t a n t i - t r u s t problems p r e v e n t h o s p i t a l s from s h a r i n g
technology.
Recent Developments: Fernando T o r r e s - G i l r e p o r t s t h a t he
a t t e n d e d a l o n g - t e r m care forum w i t h Sen. Cohen i n September and
t h a t t h e Senator was v e r y p o s i t i v e about h e a l t h care r e f o r m .
SENATOR CHRIS DODD (D-CT); The Senator has been t r u e t o h i s
commitment t o be an a l l y . A co-sponsor o f t h e H e a l t h S e c u r i t y
A c t , he has been v e r y p u b l i c i n h i s s u p p o r t . There was a r e c e n t
a r t i c l e i n t h e New York Times about t h e now widespread f e a r i n
H a r t f o r d o f what w i l l happen t o those employed - many t i m e s whole
f a m i l i e s - by t h e i n s u r a n c e i n d u s t r y .
�***SENATOR JUDD GREGG (R-NH); Sen. Gregg i s f i x a t e d on what he
terms t h e "awesome" power o f t h e n a t i o n a l board. He a l s o
questions the f i n a n c i n g o f the plan. Despite h i s c r i t i c i s m o f
the p l a n , USA Today had t h i s quote on September 30: "The debate
h e r e , as I see i t , i s n o t over u n i v e r s a l coverage o r s e c u r i t y .
Those a r e g o a l s t h a t I a c c e p t . "
The f o c u s on h e a l t h c a r e has b r o u g h t o u t and r e s u r f a c e d some
i n t e r e s t i n g , some would say u n i q u e , s t o r i e s about Sen. Gregg.
Among them h i s r e f u s a l t o r e t u r n a $92,000 down payment on h i s
house t o a p o t e n t i a l purchaser a f t e r l e a r n i n g t h e buyer wished t o
back o u t because she was d y i n g o f cancer. When t h e case was
s e t t l e d o u t o f c o u r t i n September, t h e Concord M o n i t o r
e d i t o r i a l i z e d t h a t Gregg "comes across as a man w i t h a h e a r t o f a
l i z a r d . " The Boston Globe r e p o r t e d i n October t h a t Gregg had
r e c e i v e d $250,000 i n h e a l t h and i n s u r a n c e i n d u s t r y PAC
c o n t r i b u t i o n s s i n c e 1979. New Hampshire was f e a t u r e d i n an
a r t i c l e i n t h e Washington Post about s t a t e s which s h i f t e d
M e d i c a i d funds t o balance t h e i r s t a t e budgets. Senator Gregg was
Governor a t t h a t t i m e and s a i d t o have approved o f t h e p l a n .
Recent Developments:
On November 18 he t o l d t h e AP t h a t t h e
N i c k l e s b i l l " i s t h e most r a t i o n a l s o l u t i o n t o t h e problems i n
the h e a l t h c a r e system." He s a i d t h e a l t e r n a t i v e p l a n
"accomplishes i t s g o a l s w i t h o u t t h e onerous t a x i n c r e a s e s and
massive f e d e r a l i z a t i o n o f t h e h e a l t h c a r e system" which he
b e l i e v e s mark t h e C l i n t o n p l a n .
SENATOR JIM JEFFORDS (R-VT):
The Boston Globe has w r i t t e n v e r y
p o s i t i v e p i e c e s about Sen. J e f f o r d ' s c o - s p o n s o r s h i p o f t h e H e a l t h
S e c u r i t y A c t . They concluded t h a t t h e c o m b i n a t i o n o f J e f f o r d s '
and Kennedy "suggest t h a t New England c o n g r e s s i o n a l members may
p l a y a p i v o t a l r o l e i n shaping t h e h e a l t h c a r e debate." J e f f o r d s
c o n t i n u e s t o p r a i s e t h e f a c t t h a t Vermont w i l l be a b l e t o
experiment w i t h i t s own system f o r u n i v e r s a l coverage. Of t h e
F i r s t Lady, he s a i d : " I know how w o n d e r f u l a woman she i s and
how e x c i t i n g i t i s t o work w i t h h e r . "
Recent Developments:
USA Today: "That was t h e c l i n c h e r f o r me.
They have t o s t a r t o f f b i p a r t i s a n , and t h a t ' s why t h e y were v e r y
accommodating...They t o o k a l o t o f our (Vermont's) i d e a s . You
b e g i n t o t r u s t where t h e y ' r e g o i n g . "
SENATOR EDWARD KENNEDY (D-MA): Senator Kennedy has, o f c o u r s e ,
been e m b r o i l e d i n t h e e g o / j u r i s d i c t i o n f i g h t w i t h Senator
Moynihan.
Presumably i t w i l l n o t dampen h i s enthusiasm f o r t h e
b a t t l e ahead. He r e c e i v e d l a u d a t o r y p r e s s i n t h e Boston H e r a l d
f o r h i s l e g i s l a t i v e accomplishments t h i s y e a r .
SENATOR JOHN KERRY (D-MA): Senator K e r r y w i l l c e l e b r a t e h i s 5 0 t h
b i r t h d a y a t a $1,OOO-a-head p a r t y a t t h e Boston Park Plaza on
December 6. The Boston H e r a l d says t h a t Stephen S t i l l s , Don
McLean, and P e t e r , Paul and Mary w i l l be t h e r e .
�On h e a l t h care, a d m i n i s t r a t i v e s i m p l i f i c a t i o n and insurance
reform are o f p a r t i c u l a r i n t e r e s t t o Kerry. He wants t o p r o t e c t
the biomedical and biotechnology i n d u s t r y , which i s a growth
sector i n Massachusetts. As a Vietnam veteran he may be
s e n s i t i v e t o major changes i n the VA.
Recent Developments: The Boston Globe reported November 18 t h a t
Kerry i s abandoning h i s lone wolf r o l e and i s "now earning high
marks from colleagues f o r team play." This new r o l e was i n
evidence during the recent budget debates when he l e d a group o f
nine other senators i n c a l l i n g f o r a d d i t i o n a l cuts but exempting
Medicare and Medicaid so as not t o threaten health care. The
Globe noted t h a t t h i s stand also d i d not a l i e n a t e Senate
liberals.
***SENATOR PATRICK LEAHY (D-VT); - The Chairman o f t h e
A g r i c u l t u r e Committee i s a co-sponsor o f the Health S e c u r i t y Act
and p r e d i c t s t h i s i s "an area you w i l l f i n d Republicans and
Democrats coming together."
Recent Developments: A f t e r the president's speech, Leahy t o l d
the AP: "not since the Social Security Act o f 1935 has such an
ambitious and much needed proposal been put before the American
people...The d e t a i l s of the plan w i l l change, but Democrats and
Republicans are committed t o passing l e g i s l a t i o n t o make sure
every Vermonter, and every American has the h e a l t h s e c u r i t y they
need." On September 25 he said i n the Congressional Quarterly:
"Every s p e c i a l i n t e r e s t t h a t knows t h a t they may lose under t h i s
h e a l t h care plan i s going t o f i g h t . . . I t h i n k the American people
are going t o t e l l us t o go over the heads of t h e s p e c i a l
i n t e r e s t s on t h i s one."
SENATOR GEORGE MITCHELL (D-ME) - The M a j o r i t y Leader continues t o
be committed t o passing comprehensive h e a l t h care reform i n t h i s
Congress but plagued by the c o n f l i c t i n g egos of h i s Committee
chairmen - not t o mention h i s own. Concern over whether Kennedy
s t a f f e r s were overshadowing M i t c h e l l s t a f f e r s a t Tuesday's event
reached the p o i n t t h a t someone from the DPC i s f l y i n g up t o
moderate one o f the workshops so t h a t a Kennedy person would not
do i t .
Recent Developments: November 21 LA Times; " U l t i m a t e l y , I t h i n k
the choice w i l l come down t o the president's plan as modified, or
no a c t i o n . I don't t h i n k any a l t e r n a t i v e w i l l r i s e t o the l e v e l
of being a s u b s t a n t i a l competitor."
SENATOR CLAIBORNE PELL (D-RI): The Senator has long been an
advocate f o r comprehensive h e a l t h care reform and i s a cosponsor
of the Health Security Act. When the F i r s t Lady appeared before
the Labor Committee he i n q u i r e d about using a tax on firearms t o
fund h e a l t h care and about the q u a l i t y o f research on the Health
Security Act.
�REPRESENTATIVES
CONGRESSMAN TOM ANDREWS (D-ME): Second-term Congressman Andrews
i s a l i b e r a l a c t i v i s t turned l e g i s l a t o r . He i s a co-sponsor o f
the Health Security Act and the McDermott b i l l . As a teenager
Andrews had a l e g amputated because of cancer. He i s popular i n
his d i s t r i c t which encompasses Portland and former President
Bush's Kennebunkport summer home. Andrews serves on the Small
Business, Armed Services, and Merchant Marine Committees.
CONGRESSMAN PETER BLUTE (R-MA); A freshman Congressman, Blute i s
a former s t a t e l e g i s l a t o r who beat an endangered incumbent w i t h
47% of the vote. He represents Worcester and c e n t r a l and
southeast Massachusetts. He campaigned against t a x increases.
Blute serves on the Public Works and Science Committees.
Congressman Bonior considers Blute a top t a r g e t - we have him on
the "B" l i s t . He i s a Michael co-sponsor and w h i l e he says he
l i k e s the Cooper approach, he i s not a co-sponsor.
Blute may get a l o t of advice from h i s f a m i l y on h e a l t h care his f a t h e r and two brothers are u r o l o g i s t s . Brother Michael i s
at the Mayo C l i n i c i n Rochester. Blute believes i n the doctor's
adage f o r h e a l t h care reform: " F i r s t , do no harm." He would
l i k e t o see the use of t a x c r e d i t s and government vouchers t o
make h e a l t h care more a f f o r d a b l e . He has been holding forums t h i s
f a l l i n h i s d i s t r i c t on ways t o reform the h e a l t h care system.
Blute i s concerned about the plan's burden on small business and
the e f f e c t s on the biotechnology i n d u s t r y i n h i s d i s t r i c t . He i s
opposed t o a b o r t i o n except i n cases of rape, i n c e s t , or danger t o
the mother's l i f e .
Recent Developments: November 9 Worcester Telegram: Blute
advocates Michel b i l l because people w i l l be using t h e i r own
money. " I f you l i v e a healthy l i f e and don't seek high-cost
h e a l t h care t h a t you don't need, you w i l l c o n t r i b u t e t o lowering
costs." November 17 Worcester Telegram; Says he wants t o
maintain q u a l i t y and expand coverage. His biggest o b j e c t i o n i s
to the mandate on small business and he questions coverage f o r
early retirees.
CONGRESSWOMAN ROSA DELAURO (D-CT) - Universal h e a l t h care was
one of the primary campaign themes of Congresswoman DeLauro when
she won her seat i n 1990. She i s a co-sponsor of the Health
Security Act. A s u r v i v o r of ovarian cancer, she has been an
outspoken proponent of women's h e a l t h issues. DeLauro i s on the
Appropriations Committee.
Recent Developments:
I n the September 14 Congressional Record.
DeLauro made a very supportive statement about h e a l t h care reform
i n general and the C l i n t o n plan i n p a r t i c u l a r .
CONGRESSM;^ BARNEY FRANK (D-MA):
Congressman Frank combines an
�u n p a r a l l e l e d w i t w i t h outstanding l e g i s l a t i v e s k i l l s . A McDermott
co-sponsor, he supports g l o b a l budgets and l i m i t s on malpractice
awards but i s s k e p t i c a l about competition.
Recent Developments: I n October he co-signed a l e t t e r t o the
President concerning the a f f e c t s the l e g i s l a t i o n would have on
f e d e r a l employees and r e t i r e e s . A f t e r the NAFTA vote he t o l d the
New York Times t h a t the trade pact may have a u n i f y i n g e f f e c t on
the Democrats f o r h e a l t h care: "People who voted against him
w i l l be l o o k i n g f o r a way t o be w i t h him."
CONGRESSMAN GARY FRANKS (R-CT): Congressman Franks i s pro-choice
but has been q u i e t on h e a l t h care reform. He i s a co-sponsor o f
the Republican leadership's h e a l t h care reform b i l l . His mother
was a d i e t a r y aide i n a c i t y h o s p i t a l .
He i s one of Bonior's
Republican t a r g e t s .
CONGRESSMAN JOE KENNEDY (D-MA); Congressman Kennedy i s a
McDermott co-sponsor. He has worried t h a t too much would be
promised i n h e a l t h care reform and emphasized the need t o show
t h a t people would be b e t t e r o f f under the new system. He has
asked about the impact on teaching h o s p i t a l s .
CONGRESSMAN MARTIN MEEHAN (D-MA): Freshman Congressman Meehan
made h i s r e p u t a t i o n as a crime f i g h t e r when, as an a s s i s t a n t
d i s t r i c t a t t o r n e y , he d e a l t w i t h white c o l l a r and v i o l e n t crime,
and hate crimes against gays. Meehan comes t o Congress w i t h a
l i b e r a l agenda which f i t s h i s Lowell constituency. He may also
f e e l the need, however, t o be independent.
He serves on the
Small Business and Armed Services Committees.
During h i s campaign, Meehan advocated a "play or pay" h e a l t h care
plan. He supports u n i v e r s a l access and has proposed a costcontainment program t o b r i n g down doctor and h o s p i t a l b i l l s . A
Roman C a t h o l i c , he supports a b o r t i o n r i g h t s . He also supports
sin taxes.
Recent Developments: October 14 Congressional Record: " I
believe the President has proposed a workable, f e a s i b l e approach
to h e a l t h care reform." On November 18 the s t a t e AFL-CIO
"hinted" t h a t they may t a r g e t Meehan because of h i s pro-NAFTA
vote.
CONGRESSMAN JOE MOAKLEY (D-MA): As Chairman of the Rules
Committee, Rep. Moakley i s already being asked by the press about
how h i s committee w i l l handle the h e a l t h care b i l l . He i s a
Health Security Act and McDermott co-sponsor. He i s concerned
t h a t the plan not i n j u r e the many teaching h o s p i t a l s and b i o technology labs i n Massachusetts. His strong i n t e r e s t i n the
Salvadoran cause may make him p a r t i c u l a r l y s e n s i t i v e t o
undocumented workers.
�Recent Developments: November 6 Congressional Q u a r t e r I v : "The
f u n d i n g p a r t w i l l be a c l o s e d r u l e , because o t h e r w i s e you c o u l d
g e t i n t r o u b l e . . . T h e y might want t o p u t j u s t t h e b a s i c t h i n g s i n
f i r s t . . . g e t t h e u n i v e r s a l i t y o u t t h e r e , g e t t h e funding...One o f
t h e Republican p l a n s w i l l have t o be t h e r e as a s u b s t i t u t e .
U s u a l l y on something l i k e t h i s , w e ' l l make t h e m a j o r i t y p l a n t h e
b i l l and t h e n w e ' l l v o t e on t h e s u b s t i t u t e s . . . and an amendment
c o u l d be make i n o r d e r t h a t t h e r e be a v o t e on s i n g l e payer."
CONGRESSMAN RICHARD NEAL (D-MA) - While s a y i n g he wants t o
s u p p o r t t h e a d m i n i s t r a t i o n p l a n , Congressman Neal c o n t i n u e s t o
play hard-to-get.
Recent Developments: October 19 Worcester Telegram:
"Health
care r e f o r m has momentum. Somehow, some way, I'm g o i n g t o v o t e
for i t . "
However, he wants t o keep f e d e r a l i n v o l v e m e n t a t a
minimum and o b j e c t s t o f o r c i n g s m a l l business t o p r o v i d e h e a l t h
i n s u r a n c e . He says t h a t i s " e s s e n t i a l l y a p a y r o l l t a x " and he
opposes i t .
He s a i d t h a t c o s t containment i s r e l a t i v e .
"If it's
your r e l a t i v e , c o s t i s n o t an i s s u e . " He t o l d t h e s t o r y o f h i s
f a t h e r - i n - l a w ' s death from bone cancer and how t h e y would have
spent $10 b i l l i o n t o save him.
October 2 5 Massachusetts h e a l t h care meeting - he acknowledged
t h e problems o f t h e competing i n t e r e s t s o f r e s i d e n t s who s u p p o r t
a s i n g l e payer system versus t h e i n s u r a n c e companies l o c a t e d i n
his d i s t r i c t .
October 27 Worcester Telegram r e p o r t s an a i d e t o l d them Neal
wants t o pen h i s name t o t h e b i l l b u t o n l y i f i t i n c l u d e s y e a r l y
mammograms f o r women over 50 as a b a s i c b e n e f i t . The s t a f f
person goes on;
"We q u e s t i o n whether i t ' s necessary t o t a k e o u t
what works and r e p l a c e i t w i t h a government-dominated program."
CONGRESSMAN JACK REED (D-RI): Congressman Reed has y e t t o cosponsor any h e a l t h care r e f o r m l e g i s l a t i o n i n t h i s Congress.
He d i d c a l l t h e p l a n "welcome r e l i e f " f o r f a m i l i e s i n Rhode
Island.
Recent Developments: On November 4, Reed co-signed t h e l e t t e r t o
t h e P r e s i d e n t on Medicaid and Medicare c u t s . A t a meeting w i t h
S e c r e t a r y Reich on November 19, Reed q u e s t i o n e d how t h e s u b s i d i e s
would h e l p s m a l l businesses.
He was a l s o concerned t h a t Rhode
I s l a n d would be d i s c r i m i n a t e d a g a i n s t by C o n n e c t i c u t r e g i o n a l
a l l i a n c e s and would r e f u s e t o send p a t i e n t s t o Rhode I s l a n d
h e a l t h care p r o v i d e r s . He w o r r i e d about what would happen t o
i n s u r a n c e salesmen a f t e r t h e l e g i s l a t i o n passes. Rep. Reed was
h o l d i n g a town meeting t o d i s c u s s h e a l t h care r e f o r m on November
29.
***CONGRESSWOMAN OLYMPIA SNOWE (R-ME): Congresswoman Olympia
Snowe i s one o f our t o p Republican t a r g e t s . She i s a Cooper cosponsor and co-sponsor o f t h e Women's H e a l t h E q u i t y A c t o f 1993.
�I t i s t h o u g h t t h a t t h e b e s t way t o g e t her v o t e i s t o have l o c a l
groups b r i n g p r e s s u r e on her. While we should assume t h a t Snowe
w i l l want a b o r t i o n coverage i n t h e f i n a l package, she d i d n o t cos i g n t h e May 13 l e t t e r on t h a t i s s u e .
CONGRESSMAN GERRY STUDDS (D-MA): Congressman Studds i s a H e a l t h
S e c u r i t y A c t and McDermott co-sponsor. While Studds has n o t been
p a r t i c u l a r l y a c t i v e on h e a l t h i s s u e s , he has cosponsored
l e g i s l a t i o n t o r e v i t a l i z e NIH, r e v i s e orphan drug p r o v i s i o n s ,
improve F e d e r a l f u n d i n g f o r women's h e a l t h r e s e a r c h , i n c r e a s e
M e d i c a i d coverage f o r H I V - r e l a t e d s e r v i c e s , and improve
Medicare's b a s i c h e a l t h care s e r v i c e s f o r c h i l d r e n .
CONGRESSMAN DICK SWETT (D-NH): The newest co-sponsor o f t h e
H e a l t h S e c u r i t y A c t , Congressman Swett d e s c r i b e d h i m s e l f "as a
t h o r n i n t h e s i d e o f t h e a d m i n i s t r a t i o n , and t h e r e ' s n o t h i n g
b e t t e r f o r removal o f t h o r n s t h a n a l i t t l e h e a l t h care r e f o r m . "
Recent Developments: His prepared statement upon co-sponsorship
s a i d : "Our c u r r e n t system i s n e i t h e r f a i r n o t a f f o r d a b l e . There
i s something v e r y wrong when h a r d - w o r k i n g Americans pay two o r
t h r e e t i m e s more t h a n c i t i z e n s i n German, France and Japan. Even
worse, Americans can l o s e t h e i r i n s u r a n c e a t any t i m e . " Swett
c a l l e d t h e C l i n t o n p l a n "a w i n n e r . . . T h i s b i l l i s n o t a f i n i s h e d
p r o d u c t . But t h i s i s t h e b i l l t h a t ' s g o i n g t o pass and t h a t i s
g o i n g i n t h e h i s t o r y books f o r t h e hope i t g i v e s our economy and
our c i t i z e n s . "
***CONGRESSMAN BILL ZELIFF (R-NH): A p r o t e g e o f former Gov. John
Sununu, Congressman Z e l i f f won i n 1990 on h i s image as a
s u c c e s s f u l businessman - and a f t e r spending $400,000 i n t h e GOP
primary.
Z e l i f f ' s d i s t r i c t i n c l u d e s Manchester and e a s t e r n New
Hampshire. He r e t a i n e d h i s seat w i t h 53% o f t h e v o t e i n 1992.
Z e l i f f i s a member o f t h e Small Business, Government O p e r a t i o n s
and P u b l i c Works Committees. The l a r g e s t employers i n h i s
d i s t r i c t a r e L i b e r t y Mutual I n s u r a n c e , General E l e c t i o n , and
Textron.
While Z e l i f f ' s h e a l t h care views are n o t known, one p o s s i b l e
i n d i c a t o r o f h i s views i s t h a t as t h e owner o f a s m a l l r e s o r t , he
has l i n k e d h i s business success t o " e n t r e p r e n e u r i a l i s m " and
f r u g a l i t y . He has co-sponsored Rep. H a s t e r t ' s H e a l t h Care Choice
and Access Improvement A c t and Rep. Johnson's M e d i c a l M a l p r a c t i c e
Reform A c t .
�BRIEFING FOR NEW
HAMPSHIRE 12/3/93
11/30
Notes: FYI, none of the Maine, New Hampshire, or Vermont papers
are i n t h e Lexus/Nexus system.
- A November 14 e d i t o r i a l i n the Boston Herald praised Sen.
Kennedy f o r h i s l e g i s l a t i v e accomplishments t h i s year n o t i n g i n
p a r t i c u l a r h i s a b i l i t y t o work i n a b i p a r t i s a n manner. On h e a l t h
care they s a i d : " . . . i t i s p r e c i s e l y t h i s b i p a r t i s a n pragmatism
t h a t makes Kennedy key t o a successful compromise. Already,
Kennedy has forged a c o a l i t i o n on h i s committee ranging from
Republican Jim J e f f o r d s on the r i g h t t o single-payer advocates on
the l e f t . "
- I n a November 21 Boston Globe wrap-up s t o r y on President
C l i n t o n ' s f i r s t 3 00 days, r e p o r t e r David Shribmen w r i t e s ; "Both
the p r e s i d e n t and H i l l a r y Rodham C l i n t o n have shown signs of
moving beyond p a r t i s a n s h i p i n t h i s f i g h t . He has spoken openly
of h i s need f o r Republican help; she has courted Republicans w i t h
i n t e n s i t y and charm. They know t h a t changing the way h e a l t h care
works could also change the way Washington works. But a t the
same t i m e , health-care overhaul stands as a symbol of something
d i s t i n c t l y Clintonesque, His f i n g e r p r i n t s are on every page of
the p l a n , and i f i t passes i t could be the u l t i m a t e answer t o
those who argue t h a t p a r t y - or, more broadly, t h a t p o l i t i c s
i t s e l f - does not matter i n contemporary America."
- On December 1 i n Concord, NH the Home Care Association of
NH i s h o l d i n g a seminar on h e a l t h care reform.
POSSIBLE SENATORS (IN ALPHABETICAL ORDER)
SENATOR WILLIAM "BILL" COHEN (R-ME); Senator Cohen i s one of our
top Republican t a r g e t s but has been notably s i l e n t on h e a l t h care
reform. I n the s p r i n g , he requested t h a t you attend an event i n
Maine a t the same time you were i n Nebraska w i t h Senator Kerrey.
Any d i s c u s s i o n w i t h Sen. Cohen has t o be handled w i t h extreme
d e l i c a c y due t o the underlying r i v a l r y which e x i s t s between the
two Maine Senators.
Cohen was e l e c t e d t o the Senate i n 1978 and s i t s on the
J u d i c i a r y , Armed Services, and Governmental A f f a i r s Committees,
as w e l l as the Special Committee on Aging and the J o i n t Committee
on the Organization of Congress.
Last session. Senator Cohen worked on a h e a l t h care package which
included a refundable t a x c r e d i t f o r h e a l t h insurance premiums
and a nationwide low-cost basic b e n e f i t s package.
In January Senator Cohen submitted S. 223, the Access t o
A f f o r d a b l e Health Care Act, using a managed competition model f o r
�reform. I t has p r o v i s i o n s t o improve h e a l t h d e l i v e r y i n r u r a l
and underserved areas, reform malpractice, c o n t r o l drug costs and
emphasize preventive h e a l t h . Senator Cohen also co-sponsored
Senator M i t c h e l l ' s Freedom of Choice Act. Cohen i s concerned
t h a t a n t i - t r u s t problems prevent h o s p i t a l s from sharing
technology.
Recent Developments:
Fernando Torres-Gil reports t h a t he
attended a long-term care forum w i t h Sen. Cohen i n September and
t h a t the Senator was very p o s i t i v e about h e a l t h care reform.
SENATOR JUDD GREGG (R-NH) - Sen. Gregg i s f i x a t e d on what he
terms t h e "awesome" power of the n a t i o n a l board. He also
questions the f i n a n c i n g of the plan. Despite h i s c r i t i c i s m of
the plan, USA Todav had t h i s quote on September 30: "The debate
here, as I see i t , i s not ever u n i v e r s a l coverage or s e c u r i t y .
Those are goals t h a t I accept."
The focus on h e a l t h care has brought out and resurfaced some
i n t e r e s t i n g , some would say unique, s t o r i e s about Sen. Green.
Among them h i s r e f u s a l t o r e t u r n a $92,000 down payment on h i s
house even a f t e r l e a r n i n g the buyer was dying of cancer. When
the case was s e t t l e d out of court i n September, the Concord
Monitor e d i t o r i a l i z e d t h a t Gregg "comes across as a man w i t h a
heart of a l i z a r d . " The Boston Globe reported i n October t h a t
Gregg had received $250,000 i n h e a l t h and insurance i n d u s t r y PAC
c o n t r i b u t i o n s since 1979. New Hampshire was featured i n an
a r t i c l e i n the Washington Post about states which s h i f t e d
Medicaid funds t o balance t h e i r s t a t e budgets. Senator Gregg was
Governor a t t h a t time and said t o have approved of the plan.
Recent Developments:
On November 18 he t o l d the AP t h a t the
Nickles b i l l " i s the most r a t i o n a l s o l u t i o n t o the problems i n
the h e a l t h care system." He said the a l t e r n a t i v e plan
"accomplishes i t s goals without the onerous t a x increases and
massive f e d e r a l i z a t i o n of the h e a l t h care system" which he
believes mark the C l i n t o n plan.
Recent Developments;
Gregg t o l d AP a f t e r the President's speech
t h a t he opposed the p a y r o l l t a x and the n a t i o n a l board but
supported malpractice reforms, p u t t i n g checks on Medicare and
Medicaid spending and the a n t i t r u s t reforms. He f e l t h e a l t h care
p o l i c y should be c o n t r o l l e d a t the s t a t e l e v e l .
SENATOR JIM JEFFORDS (R-VT):
The Boston Globe has w r i t t e n very
p o s i t i v e pieces about Sen. J e f f o r d ' s co-sponsorship of the Health
Security Act. They concluded t h a t the combination of J e f f o r d s '
and Kennedy "suggest t h a t New England congressional members may
play a p i v o t a l r o l e i n shaping the h e a l t h care debate." J e f f o r d s
continues t o praise t h e f a c t t h a t Vermont w i l l be able t o
experiment w i t h i t s own system f o r u n i v e r s a l coverage. Of the
F i r s t Lady, he said; " I know how wonderful a woman she i s and
how e x c i t i n g i t i s t o work w i t h her."
�Recent Developments: USA Today: "That was the c l i n c h e r f o r me.
They have t o s t a r t o f f b i p a r t i s a n , and t h a t ' s why they were very
accommodating...They took a l o t o f our (Vermont's) ideas. You
begin t o t r u s t where they're going."
SENATOR PATRICK LEAHY (D-VT); - The Chairman of the A g r i c u l t u r e
Committee i s a co-sponsor of the Health Security Act and p r e d i c t s
t h i s i s "an area you w i l l f i n d Republicans and Democrats coming
together."
Recent Developments: A f t e r the president's speech, Leahy t o l d
the AP: "not since the Social Security Act of 1935 has such an
ambitious and much needed proposal been put before the American
people...The d e t a i l s o f the plan w i l l change, but Democrats and
Republicans are committed t o passing l e g i s l a t i o n t o make sure
every Vermonter, and every American has the h e a l t h s e c u r i t y they
need." On September 25 he said i n the Congressional Quarterly:
"Every s p e c i a l i n t e r e s t t h a t knows t h a t they may lose under t h i s
h e a l t h care plan i s going t o f i g h t . . . I t h i n k the American people
are going t o t e l l us t o go over the heads o f the s p e c i a l
i n t e r e s t s on t h i s one."
SENATOR GEORGE MITCHELL (D-ME) - The M a j o r i t y Leader continues t o
be committed t o passing comprehensive h e a l t h care reform i n t h i s
Congress but plagued by the c o n f l i c t i n g egos of h i s Committee
chairmen.
Recent Developments: November 2 USA Today: " I envision dozens
of amendments on what i s i n or not i n the basic b e n e f i t s
package...no l e g i s l a t i o n o f t h i s scope and s i g n i f i c a n c e could
p o s s i b l y pass through the Congress wholly unchanged. The basic
p r i n c i p l e s w i l l remain i n t a c t . " November 16 Reuters on speech t o
American Council f o r L i f e Insurance: "There i s consensus across
the country i n support of u n i v e r s a l access t o h e a l t h care f o r a l l
Americans" but stopped short o f saying how he thought such access
would be p a i d f o r . November 21 LA Times: " U l t i m a t e l y , I t h i n k
the choice w i l l come down t o the president's plan as modified, or
no a c t i o n . I don't t h i n k any a l t e r n a t i v e w i l l r i s e t o the l e v e l
of being a s u b s t a n t i a l competitor."
SENATOR BOB SMITH (R-NH): The senior Senator from New Hampshire
i s a conservative who s t r a y s only on issues r e l a t e d t o a c i d r a i n .
He serves on the Armed Services and Environment Committees, and
the Select Committee on I n t e l l i g e n c e . To no one's s u r p r i s e , he
has been h i g h l y c r i t i c a l o f the reform plan, p a r t i c u l a r l y the
employer mandate.
Recent Developments: On October 20, Sen. Smith t o l d the Boston
Globe: " I don't t h i n k he's going t o draw a l i n e i n the sand on
t h i s ( a b o r t i o n ) . He's already got enough problems w i t h h i s
h e a l t h care plan w i t h o u t adding t h i s one." On November 18 he
t o l d the AP: "We need t o reform our h e a l t h care system, n o t
replace i t , as the president's plan does. The Nickles h e a l t h
care p l a n i s consumer d r i v e n . "
�POSSIBLE HOUSE MEMBERS (IN ALPHABETICAL ORDER)
CONGRESSMAN TOM ANDREWS (D-ME): Second-term Congressman Tom
Andrews i s a l i b e r a l a c t i v i s t turned l e g i s l a t o r . Before being
elected to Congress he worked on causes related to the poor and
was executive director of the Maine Association of Handicapped
Persons. As a teenager Andrews had a leg amputated because of
cancer. He i s popular i n h i s d i s t r i c t which encompasses Portland
and former President Bush's Kennebunkport summer home. Andrews
serves on the Small Business, Armed Services, and Merchant Marine
Committees.
Andrews i s a McDermott co-sponsor but i s expected to support the
Administration's package. He attended the F i r s t Lady's July
meeting with the Small Business Committee.
CONGRESSMAN BERNARD SANDERS (I-VT): While Congressman Sanders
votes l i k e a l i b e r a l Democrat, he i s a s e l f - s t y l e d s o c i a l i s t who
can anger colleagues on both sides of the a i s l e . He s i t s on the
Banking and Government Operations Committees and has formed the
House Progressive Forum as a counterpoint to the Conservative
Democratic Forum. The HPF's other members are Reps. DeFazio,
Dellums, Evans, and Waters.
When the McDermott co-sponsors met with the F i r s t Lady i n June,
Sanders stated h i s belief that through state models, the United
States w i l l eventually come to a single payer system. I n the
102nd Congress, h i s b i l l to provide federal support to state
cancer r e g i s t r i e s became law.
Recent Developments: Rep. Sanders signed the October 15 l e t t e r
on the Access I n i t i a t i v e .
CONGRESSWOMAN OLYMPIA SNOWE (R-ME): Congresswoman Olympia Snowe
i s one of our top Republican targets. She i s i n her eighth term
and represents the northern half of Maine. Major employers i n
her d i s t r i c t include the Eastern Maine Medical Center, Central
Maine Power Co. and the Bowater Corp. She i s a Cooper cosponsor
and cosponsor of the Women's Health Equity Act of 1993. I t i s
thought that the best way to get her vote i s to have l o c a l groups
bring pressure on her. While we should assume that Snowe w i l l
want abortion coverage i n the f i n a l package, she did not co-sign
the May 13 l e t t e r on that issue. She i s married to the Governor
of Maine, John R. McKernan.
At the dinner the F i r s t Lady attended at the home of Rep. Kasich
in June, Snowe advocated everyone paying and phasing i n the
burden on small business. She believes everyone should be sent
the message on responsibility.
CONGRESSMT^ DICK SWETT (D-NH) : Congressman Swett i s a Yale
graduate and architect who i s in h i s second term. He serves on
�the Public Works Committee and was a member o f the Select
Committee on Aging. He i s member o f the Rural Health Care
C o a l i t i o n and Mainstream Forum. Congressman Lantos i s Swett's
f a t h e r - i n - l a w and r a i s e d s i g n i f i c a n t campaign c o n t r i b u t i o n s f o r
him i n 1990.
Swett voted against the budget plan.
I n February, Swett held town meetings on h e a l t h care. They
showed a wide divergence o f opinion, but p a r t i c i p a n t s d i d agree
t h a t a h e a l t h reform plan should include a number o f measures i n
the Health Security Act. Their o v e r a l l l i s t : a d m i n i s t r a t i v e
reform; p r o h i b i t i n g p r e - e x i s t i n g c o n d i t i o n exclusion;
p o r t a b i l i t y ; p r i c e c o n t r o l s on pharmaceuticals; expanded t a x
deduction f o r employer-provided h e a l t h insurance; malpractice
reform; f e d e r a l minimum standard b e n e f i t s package; and new
i n c e n t i v e s t o a s s i s t r u r a l communities. Swett i s a Cooper
cosponsor. A Mormon, Swett favors r e s t r i c t i n g abortions a f t e r
the f i r s t t r i m e s t e r .
Recent Developments: A f t e r the President's September speech,
Swett praised the ambitiousness o f the plan but added: "This
plan has a long road t o go before we see the f i n a l h e a l t h care
package...It w i l l be our j o b t o f i n d c r e a t i v e s o l u t i o n s f o r t h e
more c o n t r o v e r s i a l p o r t i o n s of t h i s reform."
CONGRESSMAN BILL ZELIFF (R-NH); A protege o f former Gov. John
Sununu, Congressman Z e l i f f won i n 1990 on h i s image as a
successful businessman - and a f t e r spending $400,000 i n the GOP
primary. Z e l i f f ' s d i s t r i c t includes Manchester and eastern New
Hampshire. He r e t a i n e d h i s seat w i t h 53% of the vote i n 1992.
Zeliff
i s a member o f the Small Business, Government Operations and
Public Works Committees. The l a r g e s t employers i n h i s d i s t r i c t
are L i b e r t y Mutual Insurance, General E l e c t i o n , and Textron.
While Z e l i f f ' s h e a l t h care views are not known, one possible
i n d i c a t o r o f h i s views i s t h a t as the owner o f a small r e s o r t , he
has l i n k e d h i s business success t o "entrepreneurialism" and
f r u g a l i t y . He has co-sponsored Rep. Hastert's Health Care Choice
and Access Improvement Act and Rep. Johnson's Medical Malpractice
Reform Act.
�BRIEFGA
BRIEFING FOR ATLANTA TRIP 11/22/93
11/19/
NOTE: We have searched the A t l a n t a papers which have had a
number of h e a l t h r e l a t e d a r t i c l e s i n c l u d i n g :
Rosalynn Carter piece on mental i l l n e s s (attached)
A r t i c l e on p r e d i c t i o n by a s t a t e f i n a n c i a l group t h a t
C l i n t o n plan would only marginally slow j o b growth because so few
i n work force there i n h e a l t h care (attached)
Surgeon General Elders addressed Democratic Women i n
November emphasizing h e a l t h education and preventive care
Study saying Georgians want u n i v e r s a l coverage and favor
competition t o b r i n g p r i c e s i n t o l i n e , but i f t h a t f a i l s , would
accept p r i c e c o n t r o l s , (attached)
SENATOR SAM NtJNN (D) ; Senator Nunn has praised the
a d m i n i s t r a t i o n f o r i t s b i p a r t i s a n approach t o h e a l t h care. While
o b j e c t i n g t o the f i s c a l p r o j e c t i o n s and problems f o r small
business, h i s r e l a t i v e q u i e t has been viewed as a r e a l plus.
Colleen Nunn, who i s p a r t i c u l a r l y i n t e r e s t e d i n mental h e a l t h
problems, attended the b r i e f i n g f o r spouses.
SENATOR PAUL COVERDELL (R): To no one's s u r p r i s e . Senator
Coverdell has c r i t i c i z e d the government's r o l e i n the reform
plan.
Recent Developments; He t o l d the Washington Times on October 14
t h a t he was stunned by the anxiety i n the h e a l t h care community
outside the beltway.
DEMOCRATIC MEMBERS
CONGRESSMAN SANFORD BISHOP. JR. (D-GA); Freshman Congressman
Bishop s i t s on three committees which w i l l have a stake i n h e a l t h
care reform - Veterans A f f a i r s , A g r i c u l t u r e , and Post O f f i c e . He
i s also a member of the Congressional Black Caucus. He opposes
the tobacco t a x and i s a McDermott co-sponsor. Bishop represents
one of the poorer p a r t s of Georgia, i n c l u d i n g both peanut farmers
and p a r t s of Columbus and Macon.
Recent Developments:
the tobacco t a x .
Rep. Bishop i s vocal i n h i s opposition t o
CONGRESSMAN GEORGE "BUDDY" DARDEN (D-GA): Congressman Darden i s
a former s t a t e l e g i s l a t o r who has sometimes r e b e l l e d against what
�he considers the l i b e r a l - o r i e n t e d Democratic Caucus. An adept
p o l i t i c i a n , Darden i s very p r o t e c t i v e of h i s d i s t r i c t ' s l a r g e s t
employer - Lockheed. Darden i s a member o f the Appropriations
Committee and the Mainstream Forum.
His h e a l t h care views are not known but he i s most apt t o be
concerned about small business, r u r a l access, and coverage f o r
veterans. The National Federation o f Independent Businesses w i l l
be p a r t i c u l a r l y i n f l u e n t i a l w i t h Congressman Darden who has been
c a l l e d "Mr. Small Business." Given t h a t r e l a t i o n s h i p , Darden's
remarks on the plan have been notably p o s i t i v e . He has a mixed
v o t i n g record on reproductive r i g h t s .
Recent Developments: Darden t o l d the A t l a n t a Journal a f t e r t h e
president's address t o Congress: "He d i d a good j o b o u t l i n i n g
the g o a l s . . . I t h i n k the president has provided us w i t h a good
framework, and he has l e f t a l o t of the d e t a i l s up t o Congress."
CONGRESSMAN NATHAN DEKL (D-GA): Freshman Congressman Deal i s a
conservative who has already a l l i e d himself w i t h Rep. Stenholm.
While Democrats dominate Deal's d i s t r i c t , Republicans are making
i n roads t h e r e . The Ninth includes the " p o u l t r y c a p i t a l o f t h e
world" and carpet making centers, thus he i s s e n s i t i v e t o small
business concerns. Deal s i t s on the Natural Resources and Public
Works Committees.
Deal campaigned against a single-payer system which he equated
w i t h " s o c i a l i z e d medicine." He supports p r i v a t e sector h e a l t h
care i n i t i a t i v e s t o reduce costs through competition. He has
said he would back l i m i t e d government assistance i f h e a l t h care
costs continue t o r i s e . Deal supports a b o r t i o n r i g h t s w i t h
parental n o t i f i c a t i o n f o r minors.
Recent Development:
He questions the costs o f the plan.
CONGRESSMAN DON JOHNSON (D-GA): Freshman Congressman Johnson i s
a former lawyer f o r the Ways and Means Committee who l a t e r served
i n the Georgia L e g i s l a t u r e . While a f i s c a l conservative, Johnson
considers himself a progressive and fought a t the s t a t e l e v e l
against pork b a r r e l i n g . He i s advocating reform o f Congress
through term l i m i t s , r o t a t i n g committee c h a i r s , and e t h i c s
reform. Johnson represents northeast Georgia, i n c l u d i n g Athens
and suburbs of Augusta. Johnson serves on the Armed Services
Committee and i s a member of the Mainstream Forum.
Recent Developments: He i s concerned about cost c o n t r o l s i n t h e
b i l l and opposes what he c a l l s " n a t i o n a l p r i c e - f i x i n g . "
CONGRESSMAN JOHN LEWIS (D-GA); Congressman Lewis has been
u n f a i l i n g l y supportive of the a d m i n i s t r a t i o n ' s e f f o r t s on h e a l t h
care reform. He i s both an a d m i n i s t r a t i o n and McDermott cosponsor.
Recent Developments:
He co-signed a l e t t e r w i t h
�Rep. Brewster regarding the p a r t n e r s h i p between the CDC and
pharmacists f o r HIV/AIDS education.
Lewis co-signed the October 15 l e t t e r on the Access
Initiative.
CONGRESSWOMAN CYNTHIA MCKINNEY (D-GA): Freshman Congresswoman
McKinney i s a c i v i l r i g h t s advocate who, i n the s t a t e
l e g i s l a t u r e , focused on less t r a d i t i o n a l r i g h t s issues such as
m i n o r i t y economic empowerment and m i n o r i t y - f e m i n i s t p o l i t i c s .
She was known t h e r e f o r her independence. She has proved t o be
very popular w i t h the n a t i o n a l media and w i l l be featured i n both
R o l l i n g Stone and Newsweek magazines i n November. McKinney
represents a b l a c k - m a j o r i t y d i s t r i c t which includes working class
suburbs and areas o f r u r a l and urban poor. She i s a member o f
the A g r i c u l t u r e and Foreign A f f a i r s Committees, and the Caucus
f o r Women's Issues and Congressional Black Caucus.
On h e a l t h issues, she i s a McDermott and a d m i n i s t r a t i o n cosponsor who also co-signed the May 13 l e t t e r concerning i n c l u s i o n
of a b o r t i o n services i n the h e a l t h care package.
She has personal knowledge of the problems o f h e a l t h care from
her mother, a nurse f o r almost 40 years, who saw the l i m i t a t i o n s
of h e a l t h care access f o r the average Georgian.
Recent Developments:
h e a l t h screenings.
She co-signed the Women's Caucus l e t t e r on
CONGRESSMAN ROY ROWLAND (D-GA):
Given Congressman Rowland's
p o t e n t i a l p i v o t a l r o l e on h e a l t h care, he has been markedly q u i e t
regarding the b i l l .
Recent Developments: A f t e r the President's speech he t o l d The
A t l a n t a C o n s t i t u t i o n . "{The President} t a l k e d about a l o t o f
t h i n g s t h a t I agree w i t h . But I'm uneasy about c r e a t i n g another
large f e d e r a l program when we don't have a way t o pay f o r i t and
i t could be worse than what we have now."
REPUBLICAN MEMBERS
CONGRESSMAN MAC COLLINS (R-GA): Freshman Congressman C o l l i n s won
h i s seat w i t h 55% thanks t o r e d i s t r i c t i n g and a strong a n t i Washington mood. His d i s t r i c t includes p a r t s o f Newt Gingrich's
o l d d i s t r i c t and i s a mixture of independents, Reagan Democrats
and Republican suburbanites. I t i s a seat targeted by Democrats
i n 1994. C o l l i n s i s i a t r u c k company owner and seen as a downhome conservative w i t h a knack f o r hard-nosed campaigning. I n
the s t a t e Senate, C o l l i n s i s said t o have used a " g r a c e f u l
n e g o t i a t i n g s t y l e " t o help enact b i l l s t o combat drug d e a l i n g and
t o help people get o f f w e l f a r e . He campaigned f o r reform o f the
�health care system.
Recent Developments: He t o l d the A t l a n t a Journal on September 23
t h a t a l l of the president's goals "can be met w i t h marketplace
reform r a t h e r than the s o c i a l i z e d system he's presented."
CONGRESSMAN NEWT GINGRICH (R-GA): Congressman Gingrich has
already won the race f o r M i n o r i t y leader i n 1994. The warm
after-glow from NAFTA w i l l c e r t a i n l y not lower the temperature o f
the h e a l t h care debate i n which Gingrich has been a leading
c r i t i c . I t may be too much t o hope f o r , but the only t h i n g which
may keep him from being M i n o r i t y Leader would be f a i l u r e t o be
re-elected t o h i s seat. He narrowly won h i s primary i n 1992 and,
w i t h e t h i c s questions outstanding, he needs t o keep mending h i s
fences a t home. His new d i s t r i c t i n the area n o r t h o f A t l a n t a i s
one of the nation's r i c h e s t and best educated. While i t i s one
of the most Republican d i s t r i c t s i n the country, Gingrich's s t y l e
has never been t e r r i b l y popular a t home - h i s defeat, however, i s
probably too much t o hope f o r .
Recent Developments: Of h i s many p u b l i c statements, t h i s one may
best summarize h i s posture on h e a l t h care: " I t ' s not a question
of whether B i l l C l i n t o n i s a good speechmaker, or whether H i l l a r y
C l i n t o n i s a good witness... the plan i s an a t r o c i t y and i t i s
unbelievable how bad i t i s , and f o r ten days now the c i t y o f
Washington has been ga-ga over p e r s o n a l i t y when i t should be
i n v e s t i g a t i n g the plan."
CONGRESSMAN JACK KINGSTON (R-GA): Freshman Congressman Kingston
captured a seat p r e v i o u s l y held by Democrats but one which has a
s o l i d Republican base. He won w i t h 58% of the vote i n a d i s t r i c t
which includes t h e suburbs of Savannah and r u r a l and c o a s t a l
areas. A former insurance agent and s t a t e l e g i s l a t o r , Kingston
serves on the A g r i c u l t u r e and Merchant Marine Committees. He i s
also a member of the Wednesday Group. Kingston i s a f i s c a l and
s o c i a l conservative who campaigned promising t o oppose a l l
increases i n personal or business income taxes.
Recent Developments: He i s worried about the e f f e c t on small
business and co-signed the l e t t e r t o the president regarding t h e
SBA.
CONGRESSMAN JOHN LINDER (R-4th): Freshman Congressman Linder i s
a d e n t i s t , and former small businessman and s t a t e l e g i s l a t o r . He
i s very conservative and won w i t h 51% of the vote i n t h i s newly
created d i s t r i c t . The d i s t r i c t i s very a f f l u e n t and includes
both Jewish and academic v o t e r s . I t embraces some A t l a n t a
suburbs and i s t h e s i t e o f the Centers f o r Disease C o n t r o l .
Linder s i t s on the Veterans' A f f a i r s Committee's Hospitals and
Health Care Subcommittee and i s on the Banking and Science
Committees as w e l l .
Linder campaigned against a b o r t i o n , f o r t o r t reform and f o r
�medical savings accounts w i t h a d e b i t card.
Recent Developments: Following the President's address, Linder
t o l d the A t l a n t a Journal. "He was impressive as usual but before
we get caught up i n s l i c k r h e t o r i c and rosy promises, we have t o
ask some hard questions. W i l l those who are happy w i t h t h e i r
current h e a l t h care get less f o r t h e i r buck?"
Rep. Linder co-signed the l e t t e r regarding the r o l e of the SBA i n
h e a l t h care.
�BRIEFING FOR MEETINGS WITH REPS. HOUGHTON. SHAYS. AND UPTON
11/16/93
11/15/93
A l l t h r e e R e p r e s e n t a t i v e s a r e "A"
l i s t Republican t a r g e t s .
CONGRESSMAN AMO HOUGHTON (R-NY); Congressman Houghton i s a
p r i o r i t y t a r g e t f o r t h e White House and Congressman B o n i o r . A
new member of t h e Ways and Means Committee and one o f t h e few
House members t o v o t e a g a i n s t r e p e a l o f c a t a s t r o p h i c , he i s
h i s t o r i c a l l y on t h e l e f t o f t h e Republican P a r t y . W i t h s u p p o r t
from h i s w i f e and s i s t e r , he has v o t e d p r o - c h o i c e .
I n t h i s Congress he has i n t r o d u c e d HR 196 - a comprehensive
h e a l t h care r e f o r m b i l l w h i c h would g i v e businesses t a x
i n c e n t i v e s f o r p r o v i d i n g h e a l t h care - and co-sponsored t h e
Michel b i l l .
Houghton c o n s i s t e n t l y a t t e n d e d t h e R e p u b l i c a n
meetings w i t h I r a .
Recent Developments:
A t a September R u r a l and Urban Workshop,
L o i s Quam noted t h a t Houghton asked about i n c e n t i v e s f o r p r i m a r y
c a r e , t h e mix o f i n c e n t i v e s and r e g u l a t i o n s , and how people cotald
receive health care across s t a t e l i n e s .
On September 23 he t o l d
t h e B u f f a l o News t h a t he w o r r i e d about t h e accuracy o f t h e
f i g u r e s and f e a r e d t h e p l a n would pose an undue c o s t burden on
business. "You don't want t o chop o f f t h e l e g o f t h e goose
t h a t ' s l a y i n g t h e g o l d e n egg."
When t h e F i r s t Lady appeared b e f o r e Ways and Means, Houghton
asked"Why i s i t t h a t t h e whole concept o f managed c o m p e t i t i o n
has moved away from t h e o r i g i n a l t h o u g h t proposed by t h e Jackson
Hole group towards mandates and f e d e r a l c o n t r o l s and p r i c e
controls?"
CONGRESSMAN CHRISTOPHER SHAYS (R-CT): W h i l e n o t on one o f t h e
key h e a l t h care r e l a t e d committees. Congressman Shays i s a t o p
R e p r u b l i c a n t a r g e t . He i s t h o u g h t t o b e l i e v e i n t h e importance
of h e a l t h care r e f o r m b u t has a number o f d i f f e r e n c e s w i t h t h e
a d m i n i s t r a t i o n p l a n . He l i k e s managed c o m p e t i t i o n b u t n o t g l o b a l
budgets and does n o t b e l i e v e i n employer mandates. On t h e
p o s i t i v e s i d e , he s u p p o r t s CHCs and coverage o f p r e - e x i s t i n g
c o n d i t i o n s . Shays b e l i e v e s i n emphasizing p r e v e n t i v e c a r e . He
i s pro-choice.
While n o t as l i b e r a l as some had hoped, he i s one o f t h e few
Republicans w i t h a p r i m a r i l y urban c o n s t i t u e n c y - a d i s t r i c t w i t h
some o f t h e w e a l t h i e s t communities i n t h e n a t i o n . Shays s i t s on
t h e Budget and Government O p e r a t i o n s Committees.
A former Peace
Corps v o l u n t e e r and s t a t e l e g i s l a t o r . Congressman Shays has been
a maverick b o t h i n t h e s t a t e house and t h e Congress.
He i s b o t h
a White House and a B o n i o r t a r g e t .
�Local groups w i l l have an important impact on Shays and Secretary
Shalala may be i n f l u e n t i a l as w e l l .
Recent Developments: I n a s t o r y about the previous day's
e^^cSonsT t h i Hartford Courant noted t h a t ;;no one Bpeaks_to
p o l i t i c a n s l i k e voters" and quoted Shays; ''^'^^^P £°^courant d i d
e l e c t i o n as of l a s t n i g h t . " The November 10 Hartford
"^^^
I s l o r y on the Connecticut Health Care Reform Project, l i s t i n g
Rep. Shays as one of the c o a l i t i o n ' s t a r g e t s .
roKnPKSSMAN FRED UPTON (R-MIL: Serving h i s f o u r t h term i ^
House, congressman Upton i s a protege of former Budget D i r e c t o r
Stock;an. Both the White House and Congressman Bonior consider
Ktm a nr-ioT-itv t a r g e t . Upton i s a member of the Lnergy anu
C o l e r ? e SeaSh I S S o m m i t L e and the Wednesday Group. He i s
known t o l i s t e n closely t o l o c a l groups.
Upton i s concerned about r u r a l ^^^^^^9^'^^^iP^^^^i^J{,o?Sion t o
f i n a n c i n g o f the a d m i n i s t r a t i o n plan. He supports a b o r t i o n t o
iave ?he l i f e of the mother and i n cases of rape or i n c e s t .
Recent Developments; On November 5 he t o l d the Washington Post
?hat he worried t h a t " i f the auto companies were forced t o lay
o « people our money ( i n Michigan) could e a s i l y run o^t w i t h a
q S a r t e r ^ o f the year) l e f t , " stranding ^ J ^ ^ i i ; ^ t ^ ^ ? ^ 3 ^ j : ^ : e
He said t h a t p o s s i b i l i t y , as r a i s e d i n the
^^^"""^
Association of America ads, seemed a l l too r e a l t o him.
�BRIEFING FOR OHIO 11/12/93
11/10/93
Kim - I have put i n here t h a t n e i t h e r Brown nor S t r i c k l a n d i s a
co-sponsor.
However, t h a t may have changed and I have asked
Steve t o check and l e t you know i f they have signed on.
Notes: There has been a good deal o f press t h i s week about
Senator Glenn's e f f o r t s t o pay o f f h i s debt from h i s race f o r the
presidency. The FEC i s prepared t o r u l e on whether or not he can
use personal funds t o pay i t o f f . On Wednesday he i s having a
fundraiser i n New York w i t h Vice President Gore t o t r y t o help
lower the debt.
SENATOR JOHN GLENN (D-OH) - Senator Glenn i s a co-sponsor o f the
Health Security Act and has been very supportive i n h i s p u b l i c
statements about the need f o r reform. Following the president's
address, Glenn s a i d : "...the biggest cost would be the b i l l t h a t
our country would be forced t o pay i f our country f a i l s t o a c t . "
He i s p a r t i c u l a r l y i n t e r e s t e d i n the large percentage o f l i f e t i m e
h e a l t h care costs which occur during the l a s t four months o f
l i f e . As Chairman of the Government A f f a i r s Committee, Glenn
w i l l be most i n t e r e s t e d i n the plan's impact on Federal
Employees.
Recent Developments;
I n the October 15 LA D a i l y News. Glenn
r e f e r r e d t o h i s parents s i t u a t i o n i n which t h e i r l i f e savings
were devoured by the costs of h i s f a t h e r ' s b a t t l e w i t h cancer.
He went on t o say t h a t he hoped the Health Security Act can ease
such burdens.
Glenn t o l d the Cleveland P l a i n Dealer on October 28 t h a t he
had co-signed the b i l l t o help get the important debate underway.
" I have not been able t o read a l l o f i t - i t i s some 1,300 pages
and they haven't sent up a section-by-section analysis y e t . But
I am a b s o l u t e l y s i g n i n g on t o the need f o r comprehensive h e a l t h
care reform." On t h a t same day he said i n the Dayton D a i l y News;
" I t r u l y b e l i e v e t h a t what we cannot a f f o r d i s t o do nothing."
SENATOR HOWARD METZENBAUM (D-OH) - W h i l e h e h a s s e r i o u s
reservations about the a l l i a n c e s . Senator Metzenbaum i s a cosponsor o f the Health Security Act. He shares the F i r s t Lady's
anger about the r o l e of insurance companies and i s worried t h a t
they w i l l take over the a l l i a n c e s . His September 23 New York
Times p r e d i c t i o n t h a t ; "The biggest j o b f a c i n g Congress on h e a l t h
care now i s t o keep the s p e c i a l i n t e r e s t l o b b y i s t s from swarming
a l l over the plan l i k e l o c u s t s devouring the harvest" was
c e r t a i n l y accurate.
Recent Developments: On November 2 Metzenbaum t o l d the AP: "As
sure as I'm s i t t i n g here those a l l i a n c e s , some o f them, w i l l
become m o n o l i t h i c . Some of them w i l l take powers unto themselves
�t h a t a r e n o t pro-consumer. I t h i n k you're headed down a r o a d
t h a t i s t r u l y r e t r o g r e s s i v e and u n r e a l i s t i c . And I t h i n k t h e
American consumer i s g o i n g t o g e t t h e s h o r t end o f t h e d e a l . "
CONGRESSMAN LOUIS STOKES (D-OH): The dean o f t h e Ohio
d e l e g a t i o n . Congressman Stokes i s a co-sponsor o f t h e H e a l t h
S e c u r i t y A c t . T h i s i s h i s t h i r d decade i n t h e House and he
r e p r e s e n t s t h e e a s t s i d e o f C l e v e l a n d as w e l l as many o f t h e
suburbs i n t o which A f r i c a n - A m e r i c a n s have been moving. As t h e
l e a d e r o f t h e C o n g r e s s i o n a l Black Caucus's H e a l t h B r a i n T r u s t , he
i s an i m p o r t a n t c o n d u i t t o t h e i r members and spokesman f o r t h e i r
h e a l t h c a r e concerns.
On a p e r s o n a l n o t e . Rep. Stokes's daughter L o r i has r e c e n t l y
become t h e co-anchor o f t h e Channel 7 evening news i n C l e v e l a n d .
I t i s t h e ABC a f f i l i a t e .
Recent Developments: F o l l o w i n g t h e p r e s i d e n t ' s October 27
speech. Stokes t o l d t h e C l e v e l a n d P l a i n Dealer t h a t t h e
p r e s i d e n t ' s f i r e had recharged t h e i s s u e : "He p u t a s i d e h i s
n o t e s and spoke extemporaneously from t h e h e a r t . That i s what
the crowd wanted t o hear."
CONGRESSMAN SHERROD BROWN (D-OH): Freshman Congressman Brown
l o b b i e d h a r d f o r a seat on Energy and Commerce i n o r d e r t o pursue
h i s i n t e r e s t i n h e a l t h care r e f o r m . While e a r l y on he i n d i c a t e d
h i s d e s i r e t o be h e l p f u l t o t h e A d m i n i s t r a t i o n on h e a l t h c a r e
r e f o r m , so f a r t h a t h e l p has n o t m a t e r i a l i z e d as evidenced by h i s
lack o f co-sponsorship o f t h e b i l l .
He has pledged t o pay f o r
h i s own h e a l t h c a r e , r a t h e r t h a n use t h e C o n g r e s s i o n a l coverage,
u n t i l a n a t i o n a l h e a l t h care program i s i n p l a c e .
As a f o l l o w - u p t o a March meeting w i t h t h e F i r s t Lady, Brown
w r o t e t o her about h i s concern t h a t t h e h e a l t h r e f o r m p r o p o s a l
"emphasize p r e v e n t i v e and c o s t - e f f e c t i v e h e a l t h s e r v i c e s , "
i n v e s t i n g i n i m m u n i z a t i o n , p r e - n a t a l and w e l l - b a b y programs i n
p a r t i c u l a r . Brown campaigned f o r a b o r t i o n r i g h t s . He i s a
s u p p o r t e r o f home-based l o n g - t e r m c a r e s e r v i c e s as a c o s t effective alternative to institutionalization.
Recent Developments: I n a September 1 AP Wire s t o r y . Brown
p r a i s e d t h e President f o r t a c k l i n g the h e a l t h care issue but
s t a t e d he f e l t " t h e t a s k f o r c e i s headed i n t h e wrong
d i r e c t i o n . . . r e g u l a t i n g t h e economy and e l i m i n a t i n g people's
freedom t o choose i s n o t an e f f e c t i v e way t o t a c k l e t h e h e a l t h
care c r i s i s . "
A t t h e Energy and Commerce h e a r i n g Brown asked: "How do you s e l l
t h i s program t o companies and t o employees...who w i l l pay more?
And how do we as a government p r o v i d e i n c e n t i v e s t o t h o s e
companies t o c o n t i n u e t h e k i n d s o f w e l l n e s s programs t h e y do."
On October 3 0 t h s u r r o g a t e Helen Smits r e p o r t e d t h a t a t a town
meeting Brown, because o f h i s i n t e r e s t i n p r o m o t i n g a h e a l t h y
�l i f e s t y l e , was concerned t h a t c o r p o r a t e spending on h e a l t h c l u b s
won't be t a x d e d u c t i b l e . He was a l s o concerned t h a t h e a l t h
a l l i a n c e s w i l l be weak. She d e s c r i b e d him as h a v i n g a l i b e r a l
c o n s t i t u e n c y b u t o n l y " s y m p a t h e t i c " t o t h e concept o f h e a l t h care
reform.
CONGRESSMAN MARTIN HOKE (R-OH); Freshman Congressman Hoke
d e f e a t e d l o n g - t e r m incumbent Mary Rose Oakar, w i n n i n g w i t h 57% o f
t h e v o t e . He r e p r e s e n t s C l e v e l a n d and i t s suburbs and i s a
member o f t h e Budget and Science Committees. He serves on t h e
Republican Task Force on H e a l t h . T h i s i s Hoke's f i r s t e l e c t e d
o f f i c e and he emphasized c o n g r e s s i o n a l r e f o r m d u r i n g h i s
campaign.
Hoke's s p e c i f i c views on h e a l t h care r e f o r m are n o t known. I n a
meeting w i t h t h e F i r s t Lady he expressed concern about p a t i e n t s
b e i n g removed from everyday d e c i s i o n s i n managed s i t u a t i o n s , and
i n c e n t i v e s f o r i n s u r a n c e companies which g i v e h i g h d e d u c t i b l e s .
Recent Developments: On September 23, Hoke s t a t e d i n t h e
C o n g r e s s i o n a l Record: " I am i n a s t a t e o f complete c o n f u s i o n
r e g a r d i n g t h e message from P r e s i d e n t C l i n t o n on h e a l t h c a r e .
What I heard a week and a h a l f ago w i t h r e s p e c t t o t h e government
i s t h a t t h e government i s broken and i t needs t o be r e i n v e n t e d .
A p p a r e n t l y now t h e government i s f i x e d and i t i s g o i n g t o save
our h e a l t h c a r e system."
On October 2 1 Hoke co-signed t h e Republican l e t t e r r e g a r d i n g
a l l e g e d Small Business A d m i n i s t r a t i o n advocacy o f h e a l t h care
reform.
CONGRESSMAN TED STRICKLAND (D-OH): Freshman Congressman
S t r i c k l a n d o f M a r i e t t a won h i s f i r s t t e r m by 5 1 % and i s
considered a l i b e r a l .
S t r i c k l a n d serves on b o t h Small Business
and E d u c a t i o n and Labor and i s c o n s i d e r e d a t o p t a r g e t .
He b e l i e v e s s t r o n g l y i n t h e i n c l u s i o n o f m e n t a l h e a l t h coverage.
S t r i c k l a n d has pledged n o t t o accept t h e h e a l t h care coverage
o f f e r e d t o members u n t i l a l l Americans have coverage. He
a t t e n d e d a b r i e f i n g f o r Congressional members on m e n t a l h e a l t h
i s s u e s by Mrs. Gore, where he spoke e l o q u e n t l y about t h e need f o r
reform.
Recent Developments: F o l l o w i n g t h e P r e s i d e n t ' s speech,
S t r i c k l a n d s a i d : "President C l i n t o n l a i d out a health-care
r e f o r m p l a n which I b e l i e v e w i l l b r i n g h e a l t h t o our h e a l t h - c a r e
system... I t i s c e r t a i n l y n o t a p e r f e c t p l a n and I don't t h i n k i t
w i l l be passed i n t h e same c o n d i t i o n i t i s i n t r o d u c e d . But I do
t h i n k i t i s a strong beginning p o i n t . "
On October 12 i n t h e Congressional Record S t r i c k l a n d defended t h e
P r e s i d e n t ' s p r o p o s a l from a t t a c k s by t h e M i n o r i t y :eader. On
October 27 he s a i d ; "My major concern i s t h a t we're r e a l i s t i c i n
�t e l l i n g the p u b l i c what i t w i l l cost...They j u s t w i l l not f o r g i v e
deception."
�PERSONAL AND ^ f f i f f i ^ m S C MEMORANDUM
TO:
FR:
RE:
cc:
HlUary Rodham Clinton
October 24. 1993
Chris Jennings
House Ctosponsorshlp Update and Requested Call List
Maggie, Melanne, Steve, Jack. Ira. Distribution
DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per E.0.12958 as amended, Sec. 3.3 (c)
Initials:
DatcJJgJl§i-iJ
Since our conversation today. Steve R. has talked with you. Cieorge.
Howard and myself on the subject of House cosponsorshlps. George advised
us NOT to call up Congressman Gephardt tonight, but rather to arrange a
conference call with his Chief of Staff. Cieorge and Steve tomorrow morning.
At that time, they will discuss House cosponsorshlp status and strategy for the
upcoming days. fWe also have a meeting scheduled tomorrow with Senator
Daschle and Congressman Gephardt's office to finalize plans for the
Wednesday event.)
During otir HUl discussions tomorrow, we will — once again —
adamantly stress the Importance of a large number of cosponsors. We will
discuss the concern about the public not being able to distinguish between the
bill transmittal and the bUl Introduction. We will also state our
disappointment about the lack of visible movement on the House
cosponsorshlp front.
In response. Congressman Gephardt, his staff, and other Leadership
Members may raise their concern that the lack of time (and insufficient
amount of information about the bill) has made It extremely difficult to get the
minimally acceptable 100 cosponsors on the bill by the scheduled Wednesday
transmittal date. They can be expected to also raise their fear about the
riskiness of a very ambitious and widely reported (but unsuccessful) attempt to
attract cosponsors. In addition, the Leadership may suggest that we not
underesthnate the newsworthlness of a health reform initiative cosponsored by
virtually every Member of the (Congressional Leadership and every Committee
Chairman (of primary jurisdiction). They will say that the unprecedented
nature of that outcome would be a very attractive story in and of Itself.
(Although we would much prefer nimaerous cosponsors. both Steve and I
believe that the White House — if need be — could spin this outcome fairly
well.) Lastly, they will also stress that they still remain confident that, by
introduction day. we will have weU over 100 cosponsors.
�In the interim, we all agree with you that we should not let valuable time
slip by without doing all we can to attract cosponsors. We will strongly
emphasize this point in our meetings with the House Leadership and staff. In
that vein, we will again offer any and all available Administration
representatives to immediately pitch in to sign up cosponsors. (E.G., we will
suggest the option of arranging for Cabinet Secretaries, their Legislation
Undersecretaries and staff, and White House officials to use their contacts with
the House to help out with cosp>onsors.)
Andfinallyand most importantly, a nimiber of very influential House
Chairmen and other key Members are worth your calling to seek their
cosponsorshlp. Most of these Members are people with whom you have
worked and developed relationships with during the past several months.
Some will ask to see more sp)ecifics. but most of these Members understand
the politics of needhig Democrats to stand with the President on this important
initiative and know we aren't expecting them to endorse every line. During
your conversations, (besides always asking for their advice) you should also
seriously consider asking them if they would be willing to try to sign up their
C:ommittee Members (or bill sponsors, in the case of McDermott). The list:
Chairman Rostenkowski:
If we do not have Chairman Rostenkowski on as
an original sponsor of the bill, the press will
read more into his absence than there really is.
Unfortunately, that is Just the point. By all
reports (from his staffs, he is not going to go on
the bill without a requestfromyou or the
President. In the conversation, you may want to
offer an Ek:onomlc Team (Ira, Bentsen, Rivlin.
etc.) briefing on thefinancingcomponents of the
bill. We would like to do this for him late
afternoon on Tuesday. (His staff will be briefed
in the morning of that day.)
Congressman McDermott:
Congressman Ciephardt has asked that you call
McE)ermott to see if he would be willing to
cosponsor. Again, there is no way he will do It
without a callfromyou (or the President). Like
all the calls, you can and should — of course —
say that a cosponsorshlp does not convey with it
total agreement, etc. You may want to tell him,
however, that it could signal support of the
attached stronger single-payer state opt out
provisions. (I will have faxed it over to Barbara
Smith by time of your call).
�Chairman Dingell:
We believe that Chairman Dingell will be happy
to add his name as an original cosponsor. but
he would appreciate (and we would recommend)
a call from you.
Chairman Ford:
Next to Chairman Dingell. we believe that
Chairman Ford will your strongest House
Chairman ally. As far as we know, his staff
remains fairly happy with everything they know
about our bill to date. To the extent possible,
we have tried to treat the Ed and Labor
Committee on equal terms with the other two
Committees. He would love to have a call from
you requesting cosponsorshlp.
Chairman Moakley (Rules): No bill will make It to the floor without a rule
from Chairman Moakley. Although he is a
single payer advocate, your visit with him earlier
this year seems to have assured his desire to be
helpful. I doubt any policy will need to be
raised, but if so you may want to discuss the
new single-payer opt out language.
Chairman Jack Brooks,
Judiciary:
We have worked hard with his staff over the last
several months to draft some language that we
believe achieves the appropriate balance on the
malpractice and anti trust issues. You may
want to thank him and his General Ciounsel.
Jonathan Yarowski. for his help. (Although they
may not like everything in the bill, you can say
we will contmue to appreciate and significantly
defer to their counsel.)
Chairman Sonny Montgomery.
Chairman Montgomery has been sajdng some
Veterans Affairs:
very positive things about the President's health
care plan. Most recently, he published an
article in Roll Call, the Capitol Hill paper that
was very favorable. You may want to mention it
and say you appreciated it. Ask him how the
veterans organizations are dohig and seek his
original cosponsorshlp. and his help with the
rest of the Committee.
�Chairman Bill Clay,
Post Office & Civil Service: Chairman Clay Just wrote an angry letter about
the FEHB issue; he had heard that we were
going to allow the FEHB employees to be
integrated on a state by state basis into the new
system, rather than wait imtil everyone was in
(at the end of 1997). He felt Ira had tumed his
back on a commitment he thought Ira had made
to the Chairman. You can say the policy will be
as he wishes, i.e., to wait imtil everyone Is in.
You should extract a high price for this, i.e., his
cosponsorshlp and his strong push for
Committee Member cosponsorshlps. (By the
way. we should also — out of courtesy on this
Issue — tell the Senate Chairman counterpart
about this decision — John Gleim. as well as
his Subcommittee Chairman. David Pryor).
Chairman Martin Sabo,
Budget;
Chairman John LeFalce,
Small Business:
Despite all the problems. CJongressman Sabo is
Still pleased with your event with him in
Mirmesota. The cosponsorshlp of the House
Budget CJommlttee could give us some needed
nimabers credibility and is worth strongly
pursuing. He also could be very helpful with his
Members.
Since dinner yesterday evening, John LeFalce
feels like he has made it to heaven. It was a
great event and he was most pleased with his
role in it. He has also been very happy with the
attention you have given him and his Committee
and has indicated his willingness to do all he
can for us on health reform. He can start with
cosponsoring the bUl and getting as many as his
Members as possible. (Every Small Business
Committee Member helps us out Just a little bit
more on one of the thorniest issues of all.)
�Chairman Dave Obey,
Jt. Economic Committee:
Chairman Ron Dellums,
Armed Services;
Chairman Kweisi Mfume,
Cngrsnl. Black Caucus:
Chairman Obey held the first health care reform
hearing after the August recess. In it, he asked
for and got Paul Starr. He was very pleased
with his testimony. Despite his past gruff
reaction to the long term care and workers
comp. provisions, he has recently been one of
our staunchest defenders. (He wants nursing
home coverage offered on a voluntary basis and
he doesn't want us to touch workers comp
provisions because he thinks his state is doing
Just fine with their program). You may want to
thank him for his very protective behavior
toward Paul Starr during the Health Care
University, (when he scolded the Members for
not being so rude to Paul). Bottom fine: he is a
fierce advocate, someone you would like to have
on your side, and a Member Clialrs a (Committee
that can be critical to helping build up
credibility on our nimibers/economic
assiunptions / etc.
Chairman Delltims does not have much
Jurisdiction beyond that of DoD. So far, we
believe the DoD folks are happy with us; he
should largely mirror their feelings. At any rate,
a call seems worthwhile.
Chairman Mfume has not always been the
easiest Member to deal with, but he is a dealer.
He may be looking for an issue, however, that
— from the beginning — he is more closely and
positively associated with the Administration.
Let's hope that health care is one of them. He
may well say he can't commit without seeing the
language, but I still think it is worth pursuing
him from the beginning.
�Congressman Lou Stokes:
Chairman Pat Schroeder,
Congressional Caucus for
Women's Issues:
Chairman Jose Serrano
Congressional Hispanic
Caucus:
Chairwoman Jill Long,
Cngrsnl. Rural Caucus:
Congressman Stokes is probably the key to the
Congressional Black (Uaucus on health care
issues. We need to talk to him and even invite
him in after the bill is transmitted to make him
feel more invested. His staff. Leslie Atkinson,
has been extremely helpful and he may
appreciate your recognizing his help through
her. In addition, he still should be somewhat
pleased with your appearance at his
Congressional Black Caucus Health "Brain
Trust" meeting.
Congresswoman Schroeder wants to be as
helpful as possible and we believe she can If she
cosponsors and asks her colleagues to do same.
You know the issues she cares about...
Chairman Serr£ino may not be open to
cosponsoring the President's plan before he sees
the exact tmdocumented alien, the privacy
protection, and other provisions of the
legislation. However, out of (Congressional
courtesy. I believe it is worth extending a hand.
She and Charlie Stenholm are most closely
associated with the Rural Caucus. Both would
be advisable to call, make the rural pitch. In
particular, and ask them to be cosponsors
(particularly Jill Long, because she has
indicated she would probably be willing to do so
even though I believe she also went on the
Cooper bill) and also ask them to pitch it to their
rural caucus colleagues.
* I have some more in mind, but this is quite a list already. These
Members have great potential to help us out a great deal in attracting
credibility and cosponsors. We will keep you informed of our Leadership
meetings and progress on our end.
�Single-Paver Opt-out Agreement
Any state may implement a single-payer system, under which:
0
All individuals and employers in the state could be required to
participate in the system pursuant to rules of the state,
except for Medicare.
0
Medicare will participate if state Is granted waiver
assuring no reduction In benefits.
A single-payer State may use any equitable financing source, so long
as it does not allow employers in the state to avoid paying the same
payroll assessments as apply in other states.
Federal funds that would have been available to the state under the
President's plan will be available to the state to implement the
single-payer program.
To implement a single-payer system, state must provide benefits at
least as good as otherwise required under the Health Security Act.
�BRIEFING FOR 10/12/93 FLORIDA TRIP
Note: Except f o r a b i t more about Sen. Mack, t h i s i s a s l i g h t l y
s h o r t e r v e r s i o n o f l a s t week's e d i t i o n and i n c l u d e s o n l y t h e two
Senators and Rep. Bacchus.
SENATOR BOB GRAHAM (D-FL) - Senator Graham's comments s i n c e t h e
P r e s i d e n t ' s address have been v e r y p o s i t i v e , p a r t i c u l a r l y as t h e
plan relates t o Florida.
He i s s u p p o r t i v e o f employer mandates and wants t o be a p l a y e r on
g l o b a l budgets. However, he would be concerned i f F l o r i d a were
somehow a d v e r s e l y a f f e c t e d i n comparison t o o t h e r s t a t e s . W i t h
F l o r i d a r e c e n t l y e n a c t i n g h e a l t h c a r e l e g i s l a t i o n , he may be
s e n s i t i v e about s t a t e f l e x i b i l i t y .
At t h e August Small Business Committee meeting, Graham expressed
concern about HMO q u a l i t y , how t o b r i n g down i n d i v i d u a l premium
c o s t s , and whether a s u b s i d y would be needed t o b r i d g e t h e gap
between c u r r e n t spending and f u t u r e . He a l s o s a i d he b e l i e v e s
r u r a l areas w i l l grasp t h e i d e a o f c o o p e r a t i v e s . b o u t t h e r o l e o f
the P u b l i c H e a l t h S e r v i c e .
Recent Developments:
A f t e r t h e P r e s i d e n t ' s speech, Graham t o l d
the S t . P e t e r s b u r g Times t h a t he s u p p o r t e d employer mandates and
government c o n t r o l s on h e a l t h c a r e c o s t s . He t o l d t h e Sun
Sentinel;
"The p r i n c i p l e q u e s t i o n I have i s , do t h e numbers add
up?" He t o l d t h e same paper on September 23; " I t h i n k i t
b e n e f i t s F l o r i d a d i s p r o p o r t i o n a t e l y , l a r g e l y because i t has a
disproportionately large elderly population. I think the
programs - community c a r e f o r t h e e l d e r l y , p r e s c r i p t i o n d r u g
b e n e f i t s f o r Medicare p a t i e n t s and removal o f some o f t h e
economic a d v e r s i t i e s f o r n u r s i n g homes - a l l t h o s e a r e b e n e f i c i a l
t o o l d e r people."
SENATOR CONNIE MACK (R-FL) - F o l l o w i n g l a s t week's c o n v e n t i o n ,
F l o r i d a Democrats a r e i n c r e a s i n g l y o p t i m i s t i c about r e p l a c i n g
Senator Mack i n 1994.
The October 3 Orlando S e n t i n e l ranked Mack
a t t h e bottom o f t h e Senate f o r e f f e c t i v e n e s s .
He won i n 1988 w i t h 50% o f t h e v o t e and i s t h o u g h t t o be
p a r t i c u l a r l y v u l n e r a b l e as an opponent o f u n i v e r s a l h e a l t h c a r e .
F l o r i d a ' s r e c e n t s t a t e r e f o r m e f f o r t s may c o n t r i b u t e t o a p r o r e f o r m mindset i n t h e s t a t e . He a l s o cannot i g n o r e t h e huge
s e n i o r c i t i z e n communities i n F l o r i d a . They w i l l oppose any
changes i n Medicare o r i n c r e a s e s on w e a l t h y s e n i o r s w i t h o u t
corresponding increases i n b e n e f i t s .
W i t h t h e p r e s c r i p t i o n drug
coverage and l o n g - t e r m c a r e s e r v i c e s i n t h e p l a n , h i s o p p o s i t i o n
c o u l d prove v e r y c o s t l y . ' A t t h e same t i m e , he has t o appease
Miami's Cuban community, which w i l l want expanded coverage f o r
the poor and r e c e n t i m m i g r a n t s . Mack serves on t h e R e p u b l i c a n
H e a l t h Care Task Force and on t h e Small Business, A p p r o p r i a t i o n s ,
and Banking Committees.
Mack has s w i t c h e d h i s p o s i t i o n on
�a b o r t i o n and i s now a n t i - c h o i c e .
As one o f t h e t h r e e R e p u b l i c a n respondents t o t h e P r e s i d e n t ' s
address. Senator Mack was c r i t i c a l o f what he f e l t would be a
l a c k Of c h o i c e o f d o c t o r s and t r e a t m e n t s i n t h e p l a n . He r e l a t e d
h i s concern t o h i s own f a m i l y ' s a b i l i t y t o choose t h e i r d o c t o r s
and t r e a t m e n t s f o r t h e i r b a t t l e s w i t h cancer. H i s b r o t h e r d i e d
o f cancer.
Recent Developments:
September 22 Washington Post: " I t h i n k
t h e y ' v e g o t major, major .problems. People who have l o o k e d a t
t h e i r p r o p o s a l s w i t h r e s p e c t t o t h e c u t s i n t h e Medicare-Medicaid
program shake t h e i r heads i n d i s b e l i e f . "
I n h i s response t o t h e P r e s i d e n t ' s speech. Mack s a i d t h a t w h i l e
Republicans a r e w i l l i n g t o work w i t h t h e P r e s i d e n t and t h e
Democrats i n Congress;
" I don't want bureaucracy t o r a t i o n
h e a l t h c a r e and d e c i d e when I'm s i c k -- and when I can see my
d o c t o r . " Mack a l s o s a i d :
"The C l i n t o n a d m i n i s t r a t i o n wants a
h e a l t h c a r e p l a n t h a t i s loaded w i t h more spending and more
bureaucracy. We would see an e x p l o s i o n i n t h e s i z e , scope and
the c o s t o f government - a $700 b i l l i o n e x p l o s i o n . "
September 23 on Good Morning America:
"We're concerned about
quality."
I n t h e September 26 S t . P e t e r s b u r g Times. Mack s a i d he
c o u l d s u p p o r t an i n c r e a s e i n c i g a r e t t e t a x e s as p a r t o f t h e
h e a l t h c a r e programs.
He hedged, however, on whether he would
s u p p o r t $0.75 t o $1.00.
He a l s o t o l d t h e Post September 28 t h a t he r e c e i v e d 210 c a l l s
a f t e r t h e speech o f which 63% opposed t h e p l a n .
CONGRESSMAN JIM BACCHUS ^D-FL); Congressman Bacchus accompanied
the P r e s i d e n t on h i s l a s t F l o r i d a t r i p . One o f h i s c o n s t i t u e n t s ,
K e r r y Kennedy, was t h e f u r n i t u r e s t o r e owner r e f e r r e d t o i n t h e
P r e s i d e n t ' s j o i n t s e s s i o n address. Mr. Kennedy met t h e P r e s i d e n t
a t Tampa. While h i s d i s t r i c t o n l y gave t h e P r e s i d e n t 3 1 % o f i t s
v o t e s , Bacchus has v o t e d 100% w i t h t h e White House. He i s a
second t e r m Congressman and former community and p o l i t i c a l
a c t i v i s t who won an open, u s u a l l y R e p u b l i c a n , s e a t . D e s p i t e
r e d i s t r i c t i n g which i n c r e a s e d t h e Republican m a j o r i t y , Bacchus
h e l d on t o t h e s e a t w i t h 5 1 % o f t h e v o t e i n 1992.
Some b e l i e v e
he w i l l r u n a g a i n s t Senator Mack. Bacchus's d i s t r i c t i n c l u d e s
aerospace i n d u s t r y i n t e r e s t s which he works t o p r o t e c t on t h e
Science, Space and Technology Committee. Bacchus a l s o serves on
the Banking Committee.
He a t t e n d e d t h e Mainstream Forum meeting w i t h I r a i n March and
v o i c e d concern about Medicare and i n c l u s i o n o f d r u g b e n e f i t s .
H i s d i s t r i c t i n c l u d e s a s m a l l number o f r e l a t i v e l y w e l l - o f f
r e t i r e e s . He i s p r o - c h o i c e . Most i m p o r t a n t , i n terms o f h i s
c o n s i d e r a t i o n o f h e a l t h c a r e r e f o r m , however, may be t h e f a c t
�t h a t Bacchus i s s i n c e r e l y community-minded and believes t h a t
government can u n i f y c i t i z e n s . I n h i s campaigns he has brought
c i t i z e n s together t o volunteer on c i v i c p r o j e c t s .
Recent Developments: At the August 3 House Focus Group,
r e f e r r e d t o himself as one of the Southern Democrats who
t o back h e a l t h care reform. He urged the White House t o
workmen's compensation i n t o the package i n order t o help
p o l i t i c a l l y . He also asked about malpractice reform.
Bacchus
wanted
fold
them
�RHODE ISLAND DELEGATION
10/7
Note: On October 1, t h e Rhode I s l a n d S t a t e Republican Chairman,
John Holmes J r . , a p p o i n t e d a nine-member t a s k f o r c e t o d i s s e c t
t h e a d m i n i s t r a t i o n ' s h e a l t h care package. The t a s k f o r c e w i l l be
c h a i r e d by an o r t h o p e d i c surgeon, A. John E l l i o t t , and i s t o
assess t h e p l a n ' s impact on t h e s t a t e . The t a s k f o r c e w i l l a l s o
f o r m u l a t e ideas f o r Republican candidates i n next year's campaign
- one o f whom may be Rep. Machtley who i s c o n s i d e r i n g r u n n i n g f o r
governor. Said Holmes; "Looking ahead t o next year's e l e c t i o n s ,
h e a l t h care i s t h e p r e v a i l i n g i s s u e which i s c e r t a i n t o have an
impact on each and every Rhode I s l a n d e r . "
The t a s k f o r c e chairman has pledged t o b r i n g a copy o f t h e
p r e s i d e n t ' s h e a l t h care l e g i s l a t i o n t o every c i t y o r town h a l l i n
t h e s t a t e and h o l d town meetings t o g i v e every Rhode I s l a n d e r a
chance t o read t h e b i l l .
The t a s k f o r c e i n c l u d e s h o s p i t a l
a d m i n i s t r a t o r s , h e a l t h care i n s u r e r s , an a t t o r n e y , nurses and
lawmakers, as w e l l as a member o f Sen. Chafee's s t a f f .
I t was
not c l e a r i f t h e AP s t o r y i n c l u d e d t h e t o t a l l i s t , b u t t h e r e was
no consumer r e p r e s e n t a t i v e among t h e names p r o v i d e d .
SENATOR CLAIBORNE PELL (D-RI)
The s e n i o r Senator from Rhode I s l a n d would undoubtedly be
d e l i g h t e d t o f i n a l l y see comprehensive h e a l t h care r e f o r m
enacted. He has l o n g sought long-term care. H i s w e l l - t o - d o
e l d e r l y c o n s t i t u e n c y w i l l n o t be p a r t i c u l a r l y impacted by t h e
p r e s c r i p t i o n drug b e n e f i t .
Recent Developments; Senator P e l l posed t h e f o l l o w i n g q u e s t i o n s
t o t h e F i r s t Lady d u r i n g her t e s t i m o n y :
How does t h e h e a l t h c a r d
work; what would be your r e a c t i o n t o t a x i n g f i r e a r m s and d e v o t i n g
t h a t t a x t o h e a l t h care; and how does t h e p r e s i d e n t ' s h e a l t h p l a n
impact on t h e q u a l i t y o f r e s e a r c h .
The l a t t e r i n r e f e r e n c e t o a
Rhode I s l a n d t e a c h i n g h o s p i t a l .
SENATOR JOHN CHAFEE (R-RI)
Senator Chafee c o n t i n u e s t o "accentuate t h e p o s i t i v e " and
l o o k f o r common ground between t h e a d m i n i s t r a t i o n and h i s h e a l t h
care r e f o r m p l a n . He i s c l e a r l y t r y i n g t o move beyond t h e
p a r t i s a n p o l i t i c s which have i m m o b i l i z e d r e f o r m i n t h e p a s t . He
o u t l i n e d a l e g i s l a t i v e calendar i n t h e LA Times as f o l l o w s ; p u t
t h e debate on an " i n f o r m a l t i m e t a b l e " w i t h a f i r s t round o f
c o n g r e s s i o n a l h e a r i n g s by Thanksgiving, r e p o r t e d o u t o f
committees by s p r i n g and p u t t o a f i n a l v o t e by August.
Recent Developments; A t t h e September 30 Finance Committee
meeting. Senator Chafee r a i s e d t h e f o l l o w i n g p o i n t s r e g a r d i n g t h e
d i f f e r e n c e s between h i s and t h e a d m i n i s t r a t i o n ' s p l a n : "a
�d i f f e r e n c e o f degree" between t h e a d m i n i s t r a t i o n ' s 20% p o r t i o n s ,
and t h e i r 100%, t h a t an i n d i v i d u a l would pay f o r i n s u r a n c e ;
a d m i n i s t r a t i o n d e f e r r i n g t a x a t i o n o f b e n e f i t s ; and coverage o f
retirees.
FIRST DISTRICT - CONGRESSMAN RONALD MACHTLEY ( R ) :
Congressman Machtley (pronounced MAKE-lee) i s one o f t h e
House's more l i b e r a l Republicans and one o f Rep. B o n i o r ' s t o p
t a r g e t s . He i s p o p u l a r i n Rhode I s l a n d and r e c e n t l y announced he
would r u n f o r governor i n '94. Sen. Kennedy's son, P a t r i c k , may
run f o r t h i s s e a t . Machtley r e p r e s e n t s Providence and e a s t e r n
p a r t s o f t h e s t a t e which i n c l u d e l i g h t m a n u f a c t u r i n g businesses.
He serves on t h e Armed S e r v i c e s and Small Business Committees.
A
lawyer, Machtley i s a graduate o f t h e Naval Academy and c o n t i n u e s
t o serve i n t h e Navy Reserves.
Machtley's views on h e a l t h care a r e n o t known. He has been
a v o l u n t e e r w i t h t h e YMCA and t h a t , a l o n g w i t h h i s work on t h e
S e l e c t Committee on C h i l d r e n , c l e a r l y i n d i c a t e s an i n t e r e s t i n
t h e young. He w i l l a l s o presumably l o o k o u t f o r s m a l l business
i n t e r e s t s . He i s a s u p p o r t e r o f r e p r o d u c t i v e r i g h t s .
Recent Developments:
F o l l o w i n g t h e p r e s i d e n t ' s speech, Machtley
t o l d t h e AP t h a t he was s k e p t i c a l o f t h e p l a n because o f t h e
e f f e c t on s m a l l b u s i n e s s . He s t a t e d t h a t 98% o f t h e businesses
i n Rhode I s l a n d would be c o n s i d e r e d s m a l l . However, he went on
t o say;
" . . . b u t t h i s i s t h e c o u n t r y t h a t p u t a man on t h e moon
and b r o u g h t him back a g a i n . So we c e r t a i n l y can s o l v e what i s
e s s e n t i a l l y a m a n a g e r i a l problem."
SECOND DISTRICT - CONGRESSMAN JACK REED (D)
Congressman Reed i s i n h i s second t e r m and came t o Congress
a f t e r s e r v i n g i n t h e Rhode I s l a n d s t a t e l e g i s l a t u r e . He has a
s t r o n g i n t e r e s t i n c h i l d r e n ' s i s s u e s . He i s on t h e J u d i c i a r y
Committee as w e l l as E d u c a t i o n and Labor. H i s h e a l t h care
p o s i t i o n s a r e n o t known and he has n o t sponsored o r co-sponsored
any h e a l t h care r e f o r m l e g i s l a t i o n i n t h i s Congress.
Recent Developments:
F o l l o w i n g t h e p r e s i d e n t ' s speech, Reed t o l d
t h e AP; "The p l a n i s welcome r e l i e f . "
He n o t e d t h a t h e a l t h care
c o s t s f o r an average f a m i l y i n Rhode I s l a n d had r i s e n from $1,900
i n 1980 t o $4,914 i n 1991.
When t h e F i r s t Lady t e s t i f i e d b e f o r e t h e E d u c a t i o n and Labor
Committee, Reed asked about t h e i n t e g r a t i o n o f t h e worker's
compensation system i n t o h e a l t h care r e f o r m and how t h a t
i n t e g r a t i o n would b e n e f i t s m a l l b u s i n e s s . A f t e r h e r r e p l y , he
concluded t h a t s m a l l business would be compensated f o r t h e c o s t
o f h e a l t h care by t h e savings from workers compensation.
�m/
m^^OPieo
Tl\^M^^^C^
CiHXM^O
0^06-
CONNECTICUT BRIEFING
10/7/93
FYI - We have checked t h e C o n n e c t i c u t papers - t h e d e l e g a t i o n has
been remarkably s i l e n t on h e a l t h care.
SENATOR CHRISTOPHER DODD (D-CT) - A t h i s June meeting w i t h t h e
F i r s t Lady, Dodd s t a t e d t h a t he i s a "complete a l l y no m a t t e r
what you do."
He c a u t i o n e d t h a t i t was i m p o r t a n t not t o appear
a n t i - b u s i n e s s . Because o f t h e importance o f insurance and drug
m a n u f a c t u r e r s i n C o n n e c t i c u t , Dodd w i l l be s e n s i t i v e t o those
p a r t s o f t h e p r o p o s a l which t o u c h them.
Recent Developments; A f t e r t h e P r e s i d e n t ' s address, Dodd t o l d
t h e H a r t f o r d Courant t h a t t h e o n l y t h i n g he would r u l e out as
p a r t o f h e a l t h care r e f o r m was an income t a x i n c r e a s e .
At t h e Labor and Human Resources Committee h e a r i n g , Dodd focused
on c h i l d r e n , a s k i n g t o be reassured t h a t t h a t p a r t i c u l a r
c o n s t i t u e n c y not be simply brought i n as an a f t e r t h o u g h t .
SENATOR JOSEPH LIEBERMAN (D-CT) - Senator Lieberman i s i n h i s
f i r s t t e r m and i s up f o r r e - e l e c t i o n i n 1994.
He has been nonc o m m i t t a l on t h e p r e s i d e n t ' s p l a n but i n g e n e r a l , he i s
s u p p o r t i v e o f managed c o m p e t i t i o n . He does not l i k e e i t h e r
g l o b a l budgets o r caps. He b e l i e v e s , however, t h a t t h e p l a n
needs t o have s i g n i f i c a n t cost containment.
At Jamestown, Lieberman r a i s e d s m a l l business much more t h a n
i n s u r a n c e i n d u s t r y concerns. He f e e l s t h a t i f t h e middle c l a s s
gets more b e n e f i t s t h e y w i l l be w i l l i n g t o pay f o r r e f o r m .
Recent Developments: Liebermann s a i d a t t h e August Small
Business Committee meeting t h a t Republicans were not t h e o n l y
ones w o r r i e d about mandates. Business looks t o t h e bottom l i n e not i d e o l o g y . He b e l i e v e s most businesses cover h e a l t h care but
i t i s a problem f o r those who don't.
CONGRESSWOMAN ROSA DELAURO (D-3RD DISTRICT - U n i v e r s a l h e a l t h
care was one o f t h e p r i m a r y campaign themes o f Congresswoman
DeLauro when she won her seat i n 1990.
A survivor o f ovarian
cancer, she has been an outspoken proponent o f women's h e a l t h
i s s u e s . DeLauro i s on t h e A p p r o p r i a t i o n s Committee.
On h e a l t h care i s s u e s , she b e l i e v e s t h a t c o s t c o n t r o l s are t h e
s i n g l e b i g g e s t i s s u e and t h a t t h e r e needs t o be a s t a n d a r d i z e d
b e n e f i t s package. She would l i k e t o see r e f o r m s t a r t i n t h e
s t a t e s . DeLauro can be pushed by t h e l e a d e r s h i p and - m a r i t a l
r e l a t i o n s h i p s aside - i s thought t o want t o be h e l p f u l t o t h e
�White House.
She can be very good working with other members
Recent Developments: At the July House Focus Group meeting,
DeLauro asked about; p r e s c r i p t i o n drugs; subsidies f o r lowincome i n d i v i d u a l s ; and academic health centers.
In the September 14 Congressional Record. DeLauro made a very
supportive statement about health care reform i n general and the
C l i n t o n plan i n p a r t i c u l a r .
�MINNESOTA DELEGATION
9/16
Senator Durenberger announced on Thursday t h a t he would n o t r u n
f o r r e - e l e c t i o n i n 1994.
This i s not s u r p r i s i n g g i v i n g the
e t h i c s and even more p e r s o n a l c l o u d under which he has been
o p e r a t i n g i n r e c e n t y e a r s . Needless t o say, t h e r e has been
c o n t i n u i n g p r e s s coverage i n Minnesota o f h i s problems and t h e y
w i l l s u r e l y be rehashed i n t h e coming days. Melanne wanted t o
emphasize t h e d e l i c a c y o f t h e F i r s t Lady's p o s i t i o n on t h i s t r i p
i n how she p o s i t i o n s h e r s e l f p u b l i c l y w i t h t h e Senator.
I n A September 9 M i n n e a p o l i s S t a r T r i b u n e s t o r y about t h e F i r s t
Lady's t r i p , t h e y quoted a White House a i d e s a y i n g "we t h i n k
Minnesota i s a v e r y key s t a t e . . . t h a t ' s done a l o t o f h e a l t h
reform w i t h i n i t s borders. I t ' s got a very i n t e r e s t i n g
b i p a r t i s a n d e l e g a t i o n t h a t has a l o t o f e x p e r t i s e . " A l s o , Kate
Michelman a t t e n d e d an August 27 NARAL f u n d r a i s e r i n M i n n e a p o l i s
and s a i d :
" I t h i n k the President i s going t o i n c l u d e i t
( a b o r t i o n ) as he s a i d , b u t I don't know i f he's g o i n g t o f i g h t
f o r i t - I f we l o s e , i t w i l l d e f i n e a b o r t i o n once and f o r a l l as a
p o l i t i c a l i s s u e and n o t as a h e a l t h i s s u e . "
The S t . Paul Pioneer Press asked r e a d e r s on September 4 t o send
i n l e t t e r s answering t h e q u e s t i o n : "What a r e y o u r e x p e c t a t i o n s
f o r f e d e r a l h e a l t h c a r e reform? What s h o u l d t h e f e d e r a l p l a n do
t o balance t h e needs f o r u n i v e r s a l access t o b a s i c c a r e and t h e
c o s t s o f making c a r e a v a i l a b l e ? " The same paper r a n an e d i t o r i a l
September 13 which concluded:
" L i k e many f o l k s , I want t o see
more d e t a i l s b e f o r e I embrace t h e C l i n t o n p l a n . But i t appears t o
i n c l u d e a l l o f t h e b e s t i d e a s f o r e x t e n d i n g coverage t o t h e
u n i n s u r e d w h i l e c u r b i n g t h e s p i r a l i n g c o s t s o f c a r e . . . The
c h a l l e n g e w i l l be t o p r e v e n t p o w e r f u l s p e c i a l i n t e r e s t s - s m a l l
b u s i n e s s , i n s u r a n c e and p r o v i d e r groups - from p i c k i n g t h e p l a n
t o p i e c e s b e f o r e i t can be enacted and t e s t e d . " The same paper
r e p o r t e d i n August t h a t Sen. W e l l s t o n e and Rep. Grams were i n
r a r e agreement t h a t t h e i r c o n s t i t u e n t s were angry about
i n a c c e s s i b l e and u n a f f o r d a b l e h e a l t h c a r e .
SENATOR PAUL WELLSTONE (D-MN) - As you know. Senator W e l l s t o n e ' s
major concern i n h e a l t h c a r e r e f o r m i s mental h e a l t h .
Despite
h i s s t r o n g b i a s toward s i n g l e payer and h i s s u s p i c i o n s o f managed
c o m p e t i t i o n , he has been w i l l i n g t o work w i t h t h e A d m i n i s t r a t i o n
and wants t o see h e a l t h c a r e r e f o r m enacted. W e l l s t o n e ' s o t h e r
concerns i n c l u d e r u r a l h e a l t h , consumer c h o i c e and s t a t e
f l e x i b i l i t y (so t h a t Minnesota might pursue a s i n g l e payer
option).
Recent Developments: At t h e August 4 Small Business Committee
meeting. Sen. W e l l s t o n e s t a t e d he t h o u g h t a p a y r o l l t a x might be
e a s i e r t h a n a premium t a x f o r s m a l l b u s i n e s s . I n a September 2
�w i l l a l l be l o s e r s . " The paper r e p o r t e d t h a t a Durenberger a i d e
s a i d t h e Senator was r e l i e v e d a t r e p o r t s t h a t t h e a d m i n i s t r a t i o n
would p h a s e - i n coverage o f t h e u n i n s u r e d . I n t h e September 4 t h
i s s u e o f t h e N a t i o n a l J o u r n a l . Senator Durenberger i s quoted as
s a y i n g t h a t t h e White House c o u l d l u r e as many a 20 GOP Senators
t o i t s s i d e i f i t makes a few key compromises t h a t he sees w i t h i n
r e a c h . I n t h e September 8 i s s u e o f t h e W a l l S t r e e t J o u r n a l , he
s t a t e d , " I l i k e t h i s i d e a o f [ o n l y Medicare and M e d i c a i d c a p s ] .
I t h i n k i t w i l l f o r c e us t o d e a l w i t h t h e e n t i r e problem."
R e i t e r a t i n g h i s b e l i e f t h a t b i p a r t i s a n agreement i s i n d e e d
p o s s i b l e , he s a i d i n t h e September 13 i s s u e o f t h e Los Angeles
Times:
"There r e a l l y a r e many more areas i n common t h a n t h e r e
are disagreements."
However, on September 14, Durenberger met w i t h C h r i s Jennings and
seems t o be moving f u r t h e r away from us, n o t c l o s e r . H i s v o t e
may w e l l depend on whether he d e c i d e s t o r u n f o r r e - e l e c t i o n .
REPRESENTATIVE MARTIN SABO (D-MN): U n f o r t u n a t e l y , t h e Minnesota
t r i p has r e s u l t e d i n b r u i s e d f e e l i n g s on t h e p a r t o f Congressman
Sabo. T h i s i s p a r t i a l l y a r e s u l t o f t h e u s u a l House/Senate
j e a l o u s i e s b u t was exacerbated by Senator Durenberger's
o v e r p l a y i n g h i s own e v e n t . I t i s t h e r e f o r e i m p o r t a n t t h i s we
s o o t h Rep. Sabo. P a r t o f Sabo's b e i n g d i s g r u n t l e d may have been
r e l a t e d t o h i s h a v i n g t o drop an ERISA w a i v e r f o r h i s s t a t e from
the budget p l a n . Sen. Durenberger had opposed t h e w a i v e r . Sabo
i s a t h o u g h t f u l l i b e r a l , r e s p e c t e d f o r h i s p o l i t i c a l s a g a c i t y and
a t t e n t i o n t o d e t a i l , and was, o f course, key t o t h e budget
debate. He i s p a r t o f t h e i n f l u e n t i a l Democratic " b a s k e t b a l l
caucus."
Sabo i s a McDermott co-sponsor. He a l s o co-sponsored Rep.
M a t s u i ' s C h i l d r e n and Pregnant Women h e a l t h i n s u r a n c e a c t .
Recent Developments:
I n a 9/14 meeting w i t h C h r i s Jennings, Sabo
seemed impressed w i t h t h e p l a n b u t s k e p t i c a l about t h e f i n a n c i n g .
A l t h o u g h he f e l t b e t t e r about t h e numbers by t h e end o f t h e
b r i e f i n g , you may want t o r e i n f o r c e t h e s o l i d i t y o f our f i n a n c i n g
p l a n . Sabo b e l i e v e s t h a t t h e p l a n spends t o o much on s u b s i d i e s
f o r s m a l l b u s i n e s s , b u t he understands t h e p o l i t i c a l n e c e s s i t y o f
them. He t h i n k s t h a t t h e a b o r t i o n i s s u e i s a p o t e n t i a l p l a n
killer.
F i n a l l y , he i s v e r y p l e a s e d w i t h t h e c o n s u l t a t i o n
process and t h e i n c l u s i o n o f Republicans.
REPRESENTATIVE BRUCE VENTO (D-MN): A former u n i o n worker,
t e a c h e r , and s t a t e l e g i s l a t o r . Congressman Vento i s a p e r f e c t f i t
f o r h i s S t . Paul d i s t r i c t . Vento i s a " l e g i s l a t i v e workhorse"
who has been known t o o v e r t a l k an i s s u e . He serves on t h e
N a t u r a l Resources and Banking Committees.
Vento i s a McDermott co-sponsor and c o n s i d e r e d e m i n e n t l y
gettable.
�REPRESENTATIVE JIM RAMSTAD (R-MN): Congressman Ramstad i s i n h i s
second t e r m . He r e p l a c e d B i l l F r e n z e l i n t h e House and Ramstad
c o n s i d e r s F r e n z e l h i s mentor. Ramstad s i t s on t h e Small Business
and J u d i c i a r y Committees.
While Ramstad's g e n e r a l h e a l t h c a r e views a r e n o t known, he i s
p r o - c h o i c e . He has been i n t e r e s t e d i n emergency m e d i c a l c a r e f o r
c h i l d r e n . He worked on i s s u e s i n v o l v i n g c h e m i c a l dependency i n
young people, c o c a i n e b a b i e s , and t h e handicapped w h i l e i n t h e
s t a t e senate. A t t h a t t i m e he a l s o d e a l t w i t h a p e r s o n a l
a l c o h o l i s m problem.
Pro-choice and c o n s i d e r e d a good guy, l o c a l
groups a r e s a i d t o be i n f l u e n t i a l w i t h Rep. Ramstad.
I n March, t h e F i r s t Lady w r o t e t o Ramstad about t h e c o i n c i d e n c e
o f b o t h Ramstad and t h e P r e s i d e n t a t t e n d i n g t h e same Boys N a t i o n s
meeting w i t h P r e s i d e n t Kennedy.
Ramstad h e l d a town h a l l meeting i n l a t e s p r i n g a t t e n d e d by L o i s
Quom. She n o t e d t h a t Ramstad was s u p p o r t i v e i n h i s comments
about t h e F i r s t Lady and about r e f o r m i n g e n e r a l . He was c a r e f u l
t o n o t e t h a t w h i l e he v o t e d a g a i n s t t h e P r e s i d e n t ' s budget, he
hoped t h a t t h e h e a l t h c a r e r e f o r m package would r e c e i v e
b i p a r t i s a n s u p p o r t . He l e f t open t h e p o s s i b i l i t y o f h i s s u p p o r t
f o r t h e package.
REPRESENTATIVE ROD GRAMS (R-MN):
Congressman Grams won h i s
e l e c t i o n w i t h t h e t h i r d l o w e s t w i n n i n g percentage o f any 1992
House c a n d i d a t e ( 4 4 % ) . H i s most p r e s s i n g concerns a r e l o w e r i n g
t h e d e f i c i t , c u t t i n g t a x e s , and d e c r e a s i n g government r e g u l a t i o n .
Facing a tough r e - e l e c t i o n i n 1994, he w i l l be s u r e t o pay c l o s e
a t t e n t i o n t o h i s d i s t r i c t ' s l a r g e employers, which i n c l u d e
Honeywell, 3M, and Northwest a i r l i n e s .
H i s h e a l t h c a r e views a r e n o t known.
opposes a b o r t i o n .
Grams co-sponsored
Care Reform A c t .
He has i n d i c a t e d t h a t he
Rep. M i c h e l ' s HR 101, t h e A c t i o n Now H e a l t h
Recent Developments: The Minnesota S t a r T r i b u n e r e p o r t e d t h a t a t
a town meeting i n August, Grams' c o n s t i t u e n t s were apprehensive
about t h e f e d e r a l h e a l t h c a r e p r o p o s a l . D u r i n g t h e r e c e s s , he
was a l s o s a i d t o have heard from a number o f c o n s t i t u e n t s angry
because t h e y f e l t h e a l t h c a r e was u n a f f o r d a b l e and i n a c c e s s i b l e .
�SEPT INDIVIDUAL MEETINGS
Kim:
The 9/14 AP s t o r y "Congressmen Mull C i g a r e t t e Tax Hikes" i s
a good summary of the tobacco p o l i t i c s .
CONGRESSWOMAN MARCY KAPTUR (D-OH): As t h e F i r s t Lady knows,
Melanne was Congresswoman Kaptur's f i r s t l e g i s l a t i v e d i r e c t o r .
Kaptur i s t h o u g h t t o be s e r i o u s l y c o n s i d e r i n g r u n n i n g f o r Sen.
Metzenbaum's seat i n 1994.
She i s a member o f t h e A p p r o p r i a t i o n s
Committee, as w e l l as t h e Caucus f o r Womens' Issues and t h e R u r a l
H e a l t h Care C o a l i t i o n . While g e n e r a l l y l i b e r a l on most i s s u e s ,
she i s f i r m l y a n t i - c h o i c e .
Kaptur a t t e n d e d t h e Congressional Women's Caucus meeting w i t h t h e
F i r s t Lady i n February and t h e House Democratic Caucus meeting
w i t h I r a i n March.
CONGRESSWOMAN BLANCHE LAMBERT (D-AR): I n meetings w i t h t h e F i r s t
Lady and I r a , Congresswoman Lambert has v o i c e d concern about
waste i n t h e system, t h e c h r o n i c a l l y i l l , r e d u c i n g o v e r a l l h e a l t h
c o s t s , and e d u c a t i n g t h e p u b l i c about those c o s t s .
CONGRESSMAN MARTIN LANCASTER (D-NC): P r o t e c t i v e o f h i s
d i s t r i c t ' s tobacco i n t e r e s t s . Congressman Lancaster i s c o n s i d e r e d
a c o n s e r v a t i v e Democrat b u t i n t h e Jim Hunt t r a d i t i o n .
Lancaster
serves on t h e Armed S e r v i c e s and Small Business Committees and
won w i t h 54% o f t h e v o t e i n 1992.
I n March Lancaster wrote a l o n g l e t t e r t o t h e F i r s t Lady
o u t l i n i n g h i s h e a l t h c a r e r e f o r m concerns, i n c l u d i n g : r u r a l
access i n a managed c o m p e t i t i o n system; t h e need f o r more p r i m a r y
c a r e and fewer s p e c i a l t y p h y s i c i a n s ; t h e b e n e f i t s o f home h e a l t h
care and h o s p i c e s e r v i c e s ; t h e need f o r p r e v e n t i v e c a r e ; and how
t o address c o s t s a t t h e end o f l i f e .
I n a d d i t i o n , he w r o t e t h a t
h i s w i f e , A l i c e , had worked w i t h Mrs. Gore on t h e A d o l e s c e n t
Mental H e a l t h Care Task Force, and t h a t he supported i n c l u s i o n o f
mental h e a l t h s e r v i c e s i n t h e r e f o r m package. He a l s o s t a t e d
t h a t w h i l e j o g g i n g w i t h t h e P r e s i d e n t , he had brought up t h e
i s s u e o f s t a t e f l e x i b i l i t y which t h e P r e s i d e n t had assured him
would be a f e a t u r e i n t h e f i n a l package. Lancaster was one o f
t h e 25 Members c o - s i g n i n g t h e l e t t e r t o t h e P r e s i d e n t c o n c e r n i n g
tobacco e x c i s e t a x e s . He has v o t e d f o r a b o r t i o n s e r v i c e s and
a t t e n d e d I r a ' s meeting w i t h t h e House Democratic Caucus on March
31.
Recent Developments: On J u l y 27, Lancaster p u b l i c l y r e i t e r a t e d
h i s b e l i e f t h a t i t would be u n f a i r t o s i n g l e o u t tobacco f o r
" s i n " t a x e s . He w r o t e t o t h e F i r s t Lady f o l l o w i n g t h e budget
v o t e and suggested t h a t t h e N o r t h C a r o l i n a d e l e g a t i o n ' s unanimous
v o t e f o r t h e budget p l a n should be r e c i p r o c a t e d by s p r e a d i n g t h e
�burden of h e a l t h care costs. I n a September 9 AP wire s t o r y
regarding the p u b l i c p o p u l a r i t y of increasing tobacco taxes,
Lancaster s t a t e d : " I t won't change my mind."
CONGRESSMAN DAVID PRICE (D-NC): Congressman Price i s a key t o
the North Carolina delegation. He s i t s on the Appropriations and
Budget Committees. He i s also a member of the Mainstream Forum.
As Price has s o l i d i f i e d h i s base, he has been more w i l l i n g t o
buck h i s d i s t r i c t , as shown by h i s backing of f e d e r a l funding f o r
a b o r t i o n and f a m i l y and medical leave.
His h e a l t h care views are not known, but he was a co-signer of
the March l e t t e r regarding tobacco excise taxes.
Recent Developments: At an August Focus Group meeting. Price
spoke about s t a t e f l e x i b i l i t y and v a r i a t i o n s between the s t a t e s .
CHAIRMAN CHARLIE ROSE (D-NC): Chairman Rose i s working w i t h the
A d m i n i s t r a t i o n and h i s f e l l o w t o b a c c o - f r i e n d l y Democrats t o f i n d
a tax formula p a l a t a b l e t o tobacco farmers. He c a l l e d a meeting
of 33 Democrats w i t h l a r g e tobacco allotments i n t h e i r d i s t r i c t s
f o r September 13. Because of the signing of the peace pact, only
three lawmakers appeared - Reps. Clayton, Lancaster, and Payne of
V i r g i n i a . Howard Paster was scheduled t o meet w i t h Rep. Rose on
September 14. I n the past. Rep.Rose has argued w i t h success t o
the leadership t h a t a setback on tobacco could defeat a l l the
Democratic Members from h i s s t a t e - a cohesive delegation which
i s l o y a l t o the leadership. I t i s a v a r i a t i o n on Rep.
Lancaster's p o i n t t h a t the North Carolina Democrats v o t i n g f o r
the f i n a l budget plan should not be f o r g o t t e n by the
Administration.
Recent Developments: I n a September 14 AP s t o r y regarding
c i g a r e t t e tax hikes. Rose said: "We're t r y i n g t o conduct
n e g o t i a t i o n s at about how we a r r i v e at a f i g u r e t h a t works f o r
everybody and I can t e l l you very c l e a r l y t h a t ' s not going t o be
easy." Asked why there would be a s i n tax on tobacco but not
alcohol. Rose answered: " I can only conclude t h a t they d r i n k
whisky and don't smoke c i g a r e t t e s . "
�September 9, 1993
MEMORANDUM FOR HILLAKY RODHAM CLINTON
FROM:
SUBJECT:
Chris Jennings
Senate Finance Briefing
Overview
The Senate Finance Committee contains among its Republican Members many of
those whose support we have the greatest chiance of gaining (Chafee, Durenburger,
Packwood, Danforth). Finance takes pride in only reporting out legislation that lias
an excellent chance of passage. The Committee has a strong tradition of woridng in a
bipartisan manner.
While some staff will have seen the specifications prior to this meeting and therefore
will have had the opportunity to brief their bosses, the Members are looking forward
to a full and thorough presentation by you on the details of the plan.
Issues
Turisdiction I know you don't want to involve the Administration in this issue,
but be prepared for the question to he raised. Given their tax-writing role,
they're very concemed by what they've seen and heard. They may approach
this in a more roundabout manner by asking how the Administration plans to
introduce the legislation. (The question was raised on whether the
Administration plaimed to introduce the health care plan as two bills — 1 bill
to Finance and 1 bill to Labor and Human Resources.) Please keep i n mind
that the programs paying for health care reform are under Fir\ance Committee
jurisdiction and they want to ensure they will have a role in determining the
future of those programs.
Financing The Members want a good understanding of how the premiums,
tax caps and subsidies work. They also want to know whether there will be a
tax on liquor as well as cigarettes. (Remember that Senator Mitchell spoke
against the liquor tax.)
Medicare/ Medicaid The Members want to know what specifically the
Administration has in mind for these programs. They also want to Icnow what
assumptions the Administration has made as to the growth of these programs.
Additional Issues The impact of reform on small business and rural areas are
strong concems for many of these members. Democrats and Republicans alike.
The issue of state flexibility is a concem as well. (Regarding the small
�business issue, attached is a distribution table of the premium impact on
employers and employees in today's system v. after reform.)
Talking Points
•
Today we are opening the Department of Health and Him\an Services'
specification book to all Congressional staff. I encoiu-age them to review the
plan and give us feedback. (You wish wish to single out Chafee and Dole for
their recent public statements.)
•
During my meetings this week, I've been encouraged by the constructive
dialogue I've had with Democrats and Republicans. As it has been all along
this process, I appreciate the wisdom and advice Tve gained from these
meetings. I also appreciate the expertise provided by your staff.
(I'll advise you of any last minute concems or issues prior to your meeting.)
�SENATE FINANCE C O M M m E E
DEMCX31ATS
CHAIRMAN DANIEL PATRICK MOYNIHAN (D-NY\ - As you know. Chairman
Moynihan has yet to take a position on health care reform but has been cautious
about passage this year. He has been particularly concemed about any new taxes
and use of price controls. Although he has stated his willingness to raise whatever
tax is necessary for the elimination and integration of Medicaid into the new system,
as well as for a one-card-for-all system, his nervous statements are a serious concern.
Moynihan has shown particular interest in these issues: New York hospitals; the
mentally ill and the homeless; inclusion of chemical and substance abuse treatment in
a benefit package; innovation at the state level. On the latter point, he introduced a
liberalized Medicaid managed care measure that the NGA strongly supported and
the Children's Defense Fund opposed. Of those who have sp>oken with Moynihan
about health care reform, Alain Enthoven is the one to whom he has listened.
Recent Developments; Moynihan was quoted in a New York Newsday editorial on
September 9 saying "You have to be very careful about what you bring into the
public sector. There is a danger that govemment will become too important in our
Uves."
SENATOR MAX BAUCUS (D-MT) - Small business and rural access will be primary
concems for Senator Baucus. Along with other members of the Fiiiance Committee,
he cautioned against moving too quickly and not getting the package done right If
he is not satisfied on small business, he could well vote against reform. Although a
member of the Pepper Commission, he voted against the final access
recommendations — they won by just an 8-7 vote — primarily because of his concem
about the proposal's impact on small business. Baucus is a single payer advocate
who has never liked utilizing an employer requirement to help finance health care.
Baucus is a member of a 5-Member working group (Daschle, Kerrey, Bingaman, and
Wofford) that has been looking at altematives to employer-based models. Senator
Baucus believes health care reform must include real cost containment and some
form of a global budget We have been advised by staff that he is very committed to
the concept of every citizen being in the HIPC or health alliance. Senator Baucus has
consistently complimented the First Lady on her role in selling health care reform.
Recent Developments: At the August Small Business Committee meeting, Senator
Baucus questioned geographic cost variations and again emphasized the need to help
mral areas expand delivery.
SENATOR DAVID BOREN (D-OK) - Senator Boren is the lead sponsor of the Senate
companion (S. 3299) to the House Conservative Democratic Forum's managed
competition bill. Like virtually every member of the Finance Committee, he
�considers himself to be a strong supporter of rural health and small business issues.
Along with Senator Bradley, Boren has been traditionally more focused on tax policy
than health care.
Boren also supports the concept of significant state flexibility within the context of
any health reform proposal (Oklahoma Govemor Walters is pushing a major
initiative now and wants some significant assistance/ relief from the Federal
Govemment). In addition, Boren sponsored legislation last year to provide for an
extension of higher payments to mral hospitals that disproportionately serve
Medicare patients. (This legislation passed the Congress, but was included in the tax
bill which was vetoed by then-President Bush).
SENATOR BILL BRADLEY (D-NW - Senator Bradley is one of the Finance Committee
members most concemed about taxes and about going slow on health care in order
to get it right He can be expected to support health care reform, with the possible
exception of prescription dmgs. New Jersey is the capital of the pharmaceutical
industry and Bradley is a fierce advocate for their concems.
Among the issues of special interest to Senator Bradley in health care reform are:
pregnant women and children, preventative care, and home and community-based
long-term care services. Given his past work on revising tobacco waming labels, he
may be an ally on increased tobacco excise taxes
SENATOR GEORGE MITCHELL ID-ME) - The Majority Leader continues to he
committed to passing comprehensive health care reform in this Congress. As you
know. Senator Mitchell has been a moving force behind the Message Group and has
been helpful and cooperative with the White House on this issue.
Recent Developments: On September 6, Senator Mitehell stated his belief that there
should be no increase in the tax on alcohol. On September 9, Mitchell, sf>eaking
about Medicare and Medicaid, spoke favorably about possible cuts as a way to bring
down the cost of health care for all Americans.
SENATOR DAVID PRYOR (D-AR) - Senator Pryor can play a critical role in health
care reform, not only because he is one of the best liked members of the Senate but
because he is known and respected by the powerful aging advocacy community. In
addition, he is one of the few Democrats that the small business commuiuty
genuinely tmsts. As a former Govemor his advocacy of state-based approaches to
comprehensive reform has gained him a great deal of good will with the Govemors.
While dmg cost containment will be his highest priority in health care reform, Pryor
will also be concemed about mral health and long-term care.
Pryor advises that of the Finance Comituttee Republicans, he would rank Danforth,
Packwood, Chafee, Durenberger in order of likelihood to support the plan.
�Recent Developments; As you know. Senator Pryor has been very helpful in
consideration of how we can best sell the health care package. At the August Small
Business Committee meeting, Pryor expressed his fear that the plan will be too
complicated to sell and that fear of the unknown will make people oppose the reform
package.
SENATOR IX)NALD RIECXE (D-MD - Serutor Riegle considers himself to be a major
player in the health care debate. He faces a particularly difficult re-election fight in
1994 as he attempts to explain his role in the Keating scandal. He appears to be
extremely willing to sign on to virtually any approach that achieves uiuversal
coverage and cost containment
Senator Riegle is very interested in a number of health issues, including: child
immunization programs; rural health care; Medicare prescription dmg coverage;
retiree health liability; and long-term care. He strongly believes that cost containment
savings should be used to help reform the health care system — NOT for deficit
reduction. He l)elieves it is important to look at natioiial spending ,not just Federal
spending, because most of the savings will come from the private sector, and that
long-term, not just five year, budgets should be used. He also feels that we need to
look carefully at the language used to explain the plan.
Recent Developments; Senator Riegle continues to believe that enacting health care
reform is a fundamental step that should be undertaken as soon as possible.
SENATOR lAY RCX3CEFELLER (D-WV) - Senator Rockefeller's health care priority is
very simple - passage of comprehensive reform during the Qinton Presidency. He
has been upset with members of the Admirustration who he felt were not supportive
of that goal. He thinks Senator Moyruhan can b>e brought on board.
He feels the Finance Conunittee Republicans to be pursued are Senators Chafee,
Danforth and Diu-enberger (he seemed less confident about Serutor Packwood). He
has also expressed his willingness to play the heavy on taxes with the public, press,
and members.
Recent Developments: On September 8, Senator Rockefeller told the Wall Street
Toumal: "I look with extreme caution at "taking" a lot of money from Medicare. What
is the trade-off; what is it spent on?"
SENATOR TOM DASCHLE (D-SD) - As Co-Chairman of the Democratic Policy
Committee, Senator Daschle has been very helpful in developing a strategy for
packaging and selling the health care reform package. Personally, Senator Daschle is
much more comfortable with a single payer type approach to health care, primarily
because he believes it is a much easier political sell to his small business and other
constituents. He is also concemed about global budgets, fearing that rural states
would be discriminated against if such a formula were used.
�As you know. Senator Daschle also worries that people do not understtmd the real
costs of the current health system - how much they are paying in direct and indirect
spending.
Recent I>evelopments; At the August 4 Small Business Committee meeting. Sen.
Daschle stated that phasing in reform will help sell i t In an August 25 USA Today
feature, entitled "South Dakota Senator: Travelling Health Care Salesman," Daschle
stated: "my biggest concem is the confusion created by the opposition... you can
scare people on health care because it is so expensive, because everyone needs i t
SENATOR TOHN BREAUX (D-LA) - While Senator Breaux's budget differences with
the White House are well known, he is a moderate to conservative who is known
more as a pragmatist than a idealogue. In the area of health care, Breaux is yet
another of the Fir\ance Committee members who care deeply about small business
and mral health care.
Prior to this year. Senator Breaux was not overly active in health care issues. That
changed when he introduced the Conservative Democratic Forvun's managed
competition bill with Senator Boren in 1992. He is very concemed, however, about
the bill's limitations with regard to assuring adequate access to health care in rural
areas. He is also concemed about whether this approach will actually achieve broadbased cost savings. Despite this, he remains uncomfortable with the altematives and
he will want to make siu-e that the Conservative Democratic Fomm's model is used
as much as possible during the upcoming debate. He opposes price caps and freezes
to control costs.
At the Finance Committee meeting on April 20, Senator Breaux stated that he was
very encouraged about what he was hearing. He believes people want health care
reform but it will be important to sell the benefits first (and sell people on what they
are getting). He wants the plan to be bipartisan and thinks it should contain
malpractice reform.
Breaux has made very positive public comments about the prospects for health care
reform and praised the consultative process with both Democrats and Republicans.
In addition, he invited Ira Magaziner to join him and the President at the Democratic
Leadership Conference meeting in New Orleans.
SENATOR KENT CONRAD (D-NDl - Senator Conrad is the newest member of the
Senate Finance Committee. He is known as a "budget hawk." Strong cost controls
will be critical for his support He will look closely at the financing package and
how the reform plan impacts the federal deficit He opposes large new taxes to
support reform.
Senator Conrad's foremost health concem is mral health care.
He is aware of two
�successful models from his state - one, a network of cliiucs, the other an HMO which have been able to increase access to primary and preventive care. He signed
the March 30 letter opposing the allocation of the global budget among states based
on historic costs. He is also an advocate for the need to improve and increase
funding for the Indian Health Service.
At a previous Finance Committee meeting. Senator Conrad was very concemed about
mandates. He fears that small businesses will be saddled with too large a burden.
He advocated simple, understandable language and provisions that he could explain
to his largely rural constituents.
Recent Developments: At the First Lady's meeting with the Small Business
Committee, Senator Conrad asked about small businesses that can't even afford the 3
1/2% payroll tax.
FINANCE COMMTITEE REPUBLICANS
SENATOR BOB PACKWOOD (R-OR) - As a member of the Finance Committee and
the only Republican to publicly support an employer mandate, Ser\ator Packwood
finds himself in an imcomfortable position with many in the Senate Republican
leadership. Diuing his re-election campaign, Packwood singled out health care as an
issue on which he was closer to then-Govemor Clinton than his Democratic
opponent Packwood is, as you know, a strong pro-choice advocate. What effect his
present political problems will have on his role in the health care debate is not clear.
At the Finance Committee meeting April 20, Packwood asked about the stmcture and
role of a tax cap and was interested in how much in subsidies would be required.
Recent Developments: As you know, at his lunch with the President and the First
Lady, Packwood said he would consider an employer mcmdate. In August, he did
not sign Sen. Pressler's GOP letter on health care and taxes.
SENATOR BOB DOLE (R-KS) - Senator Dole continues to profess a desire to work
with the Administration on health care reform. If past history holds, he may talk a
good line while ultimately turning against the White House. Regardless of your
success with Dole, the very fact that you attempted to do so has a very real potential
to attract moderate Republicans. Dole is very effective and can be very persuasive
with two of our key Republicans - Senators Chafee and Kassebaum.
Senator Dole has a strong interest in rural health and is cvurently Co-Chair of the
Senate Rural Health Caucus. Legislatively, he has supported initiatives to protect the
viability of small mral hospitals as well as to expand civil rights protections and
services for the handicapped. He is also concemed abut veterans, mental health
coverage, and the self-employed.
Publicly, Dole has indicated his opposition to price controls and to new taxes without
�delivering on cost contaiiunent first
Recent Developments;
In a spate of recent press articles. Senator Dole has
expressed an interest in working with the President on health reform. While he has
made clear his opposition to employer mandates, he has stated a willingness to
negotiate on this issue as long as the Republicans are included early on.
SENATOR WILLLVM (BILL) ROTTH (R-DE) - Until recently Senator Roth, who is up
for re-election in 1994, was not known for his involvement in health care. However,
he has written to the First Lady advocating that the Federal Employee Health Benefit
Program be extended to the working uninsured and small businesses.
Recent Development; Senator Roth did not sign Sen. Pressler's GOV letter on health
and taxes.
SENATOR TOHN DANFORTH (R-MO) - It is not yet clear how Senator Danforth's
decision to retire will affect his consideration of health care reform. Despite
admonitior\s from his staff and other Republicans, Danforth is an advocate of
imposing strong federal/state caps on health spending. He also believes that to do
so would require explicit rationing - he is a big fan of the Oregon waiver. What is
more, uiUike most Democrats, he desires to publicly proclaim that rationing is
necessary and something we must own up to.
The Senator has been vocal in opposing the possibility of new taxes for health care
reform. At the April 20 Finance Committee meeting with the First Lady, Senator
Danforth stated that Democrats and Republicai\s are not too far apart on this issue.
He also stated that universal coverage is important, but that it should be phased in.
He believes the tax cap should apply to both employees and employers and seemed
happy with the First Lady's response to that point
Recent I>evelopments; At the May 19 BasiCare meeting. Senator Daiiforth seemed to
be looking for ways to reach bipartisan agreement
SENATOR TOHN C31AFEE (R-RD - As you know. Senator Chafee's role in health
care reform is critical. He comes to it with residual feelings that if not for
Presidential and partisan politics in the last Congress, there was enough consensus
between his and many Democrats' bills to move forward on high priority health
reform proposals such as: self-employed tax deduction increase to 100 %; insurance
market reform; expansion of community health centers and other health care delivery
systems; and state experimentation.
On the Finance Committee, he is primarily known for his long-standing interest in
providing alternative care settings - through the Medicaid program - to persons who
are disabled. He and his staff are literally heroes with many in this field, particularly
those who advocate non-institutional care approaches. He is also well known for his
�strong advocacy of, and relationship with, community health care centers. In
additioiv he, like a number of the Finance Committee membership, is growing weary
of funding programs for the elderly when there are so many needs in the non-elderly
population.
Recent Developments: In recent public statements, Chafee has consistently talked
about reaching a consensus.
SENATOR DAVE DURENBERC^R (R-MN) - Senator Durenberger has been a key
health care player, serving on both the Finance and Labor and Human Resources
Committees. A moderate with serious political problems at home, Durenberger is
one of the Republicai\s the White House has a real shot at getting. While still
cautious about vmiversal coverage and any new taxes, Durenberger does believe we
can enact health care reform this year. An important offshoot of his work on the
Pepper Commission was the close working relationship he forged with Rockefeller.
Durenberger has focused on state-based health reform iiutiatives. Minnesota, the
nation's capital of managed care/HMO delivery systems, has passed legislation to
implement its own reform proposals. Senator Durenberger will be very concemed
about the allocation of the global budget particularly that it does not reward the
inefficient at the expense of the efficient
He is nervous about price controls and would like to see Medicare folded into
whatever we do.
Recent I>evelopments: In the September 4 issue of the National Toumal, Senator
Durenberger is quoted as saying that the White House could lure as many as 20 GOP
Senators to its side if it makes a few key compromises that he sees within reach.
"We're not that far apart" In the Wall Street Toumal September 8, he stated: "I like
this idea of [only Medicare and Medicaid caps]. I think it will force us to deal with
the entire problem."
SENATOR CHARLES (GRASSLEY (R-IA) - Senator Grassley is one of those Senators
who can give the impression that he is less than sharp and not a significant player.
However, he has a very sensitive and accurate sense for politics and policy and, with
a very capable staff, has managed to become quite an effective member of the
Finance Committee.
Grassley's primary health care interest has heen rural health care, particularly
perceived inequities in reimbursement to rural providers. He supports malpractice
reform. According to Senator Pryor, Grassley was impressed with your previous
presentation before the Finance Committee and said: "Hillary is too smart for
Republicans." He has also indicated his support for malpractice reform.
Recent Development: O i September 1, Grassley told the Washington Times: "As
politically popular as sin taxes might be, the public generally is very cynical about
�tax increases accomplishing anything."
SENATOR ORRIN HATCH (R-UD - Senator Hatah serves on both the Labor and
Human Resources and Finance Committees. Although well known for his very
conservative philosophy, in recent years he has sometimes been open to more
traditionally moderate approaches. For example, although close to the dmg industry,
he has been willing to push them to be more responsive on pricing issues.
On health reform issues, he can be expected to be very supportive of market-oriented
reforms to the health care system. In that vein, he will be extremely imcomfortable
with employer mandates and discussions of global budgeting and enforcement He
has introduced legislation to reform the medical malpractice system and sees it as an
important means for reducing health care costs.
He is extremely well informed about PHS, NIH, and FDA, and, as you know, is
vehemently anti-choice.
Senator Kermedy, who is close to Hateh, believes we should not write him off. He
views Hateh as a potential coalition builder between moderate Republicans and
Democrats. At the May 3 Labor and Human Resources Committee meeting, Hateh
raised questions about antitmst provisions in the final package. The First Lady
promised him an advance look at the provisions.
SENATOR MALCOLM WALLOP (R-WY) - Senator Wallop, who is up for re-election
in 1994, has demonstrated an interest in mral health concems but focused primarily
on tax matters. He is known for his very strong conservative views. In the last
Congress, he cosponsored the Republican reform bill and Senator Hateh's bill to
improve the medical liability system. He is very strong on state flexibility, federal
costs, frontier/rural issues, and adamantly opposed to employer mandates. He has
serious doubts about managed competition's applicability to serve mral areas.
Senator Wallop wants us to be extremely cautious, because we can hurt far more
than we can help.
Recent Development: In August Senator Wallop stated his belief that the cost of
health care reform is not warranted for the few people who are not presently
covered. He also stated his aversion to increased entitlements.
�iaCHANGE IN PREMIUMS FOR ALL WORKERS AND EMPLOYERS BY
FIRM SIZE; EMPLOYEE PREMIUMS AS PERCENT OF FIRM
PAYROLL
Firm Size and Current Employee Payments As Employee Payments
Employer-Sponsored
Percent of Payroll
As Percent of Payroll
Insurance Status
Today
Under Reform
TOTAL (ALL
WORKERS)
1.9%
12%
UNINSURED
INSURED
0.0%
2.4%
1.6%
1.1%
2.6%
1.4%
0.0%
4.4%
1.7%
1.4%
2.1%
13%
0.0%
2.9%
1.7%
1.4%
1.9%
12%
0.0%
2.4%
1.6%
1.4%
1.7%
1.1%
0.0%
2.0%
1.6%
1.4%
1.7%
1.1%
0.0%
2.0%
1.5%
13%
LT25
UNINSURED
INSURED
25-99
UNINSURED
INSURED
100-499
UNINSURED
INSURED
500-999
UNINSURED
INSURED
1000-4999
UNINSURED
INSURED
-
�CHANGE IN PREMIUMS FOR WORKERS AND EMPLOYERS BY
FIRM SIZE AND BASELINE HEALTH INSURANCE STATUS,
EMPLO^TR PREMIUMS AS PERCENT OF PAYROLL
Employer
Payments As
Percent of
Payroll Today
Employer
Payments As
Percent of
Payroll Under
Reform
TOTAL (ALL
WORKERS)
5.4%
62%
UNINSURED
INSURED
0.0%
6.9%
6J%
62%
3.6%
5.4%
0.0%
6.1%
5.1%
5.6%
4.6%
5.9%
0.0%
63%
6.0%
5.9%
100-499
5.8%
62%
UNINSURED
INSURED
0.0%
72%
6.4%
6.1%
63%
6.1%
0.0%
7.4%
6S%
6.1%
1000-499?
6.0%
62%
UNINSURED
INSURED
0.0%
7.0%
7.6%
6.0%
Firm Size and
Current
EmployerSponsored
Tnciirnnrp
LT 25
UNINSURED
INSURED
25-99
UNINSURED
INSURED
500-999
UNINSURED
INSURED
i
�la
CHANGE IN PREMIUMS FOR ALL WORKERS AND EMPLOYERS BY
FIRM SIZE; EMPLOYEE PREMIUMS AS PERCENT OF FIRM
PAYROLL
Firm Size and Current Employee Payments As Employee Payments
As Percent of Payroll
Percent of Payroll
Employer-Sponsored
Under Reform
Today
Insurance Status
TOTAL (ALL
WORKERS)
1.9%
12%
UNINSURED
INSURED
0.0%
2.4%
1.6%
1.1%
2.6%
1.4%
0.0%
4.4%
1.7%
1.4%
2.1%
13%
UNINSURED
INSURED
0.0%
2.9%
1.7%
1.4%
100-499
1.9%
12%
0.0%
2.4%
1.6%
1.4%
1.7%
1.1%
UNINSURED
INSURED
0.0%
2.0%
1.6%
1.4%
1000-4999
1.7%
1.1%
0.0%
2.0%
1.5%
13%
LT25
UNINSURED
INSURED
25-99
UNINSURED
INSURED
500-999
UNINSURED
INSURED
�DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per E.G. 12958 as amended, Soc. 3.3 (c)
Initials:
-Date:
PRIVILEGED AND I ^ J ^ ^ ^ ^ ^ M E M O R A N D U M
TO:
FR:
RE:
cc:
Melanne
Chris and Steve
Proposed bus trip routes
Steve, Jeff, Ira, John
September 4, 1993
After consideration of a variety of combinations, the following three routes are the
most attractive Congressional targeting options for the bus trip.* (While all three are very
attractive we have listed them in order of our preference).
1.
Omaha, Nebraska to Kansas City, Kansas:
Kerrey and Exon are key swing Democrats in the Senate. In addition, Peter Hoagland
represents Omaha and is an important moderate vote on the Ways and Means
Committee.
Kansas has two leading Republicans Minority Leader Dole and Nancy Kassebaum the
ranking republican on the Senate Labor Committee. Kansas house members include
Jim Slattery, an influential moderate vote on Energy and Commerce and Dan
Glickman, also a moderate Democrat and the lead House sponsor of Kassebaum's
health reform bill.
This route has good potential to highlight the bipartisan nature of our health reform
effort. In addition, it runs along the Missouri border. This allows our media coverage
to penetrate into Missouri — home of key Republicans Senators Danforth and Bond,
and swing House Democrats, Danner, Skelton and Volkmer.
2.
Providence, Rhode Island to Boston, Massachusetts to Burlington, Vermont
This New England swing allows us to target key Senate Republicans — John Chafee
of Rhode Island and Jim Jeffords of Vermont. It is also an opportunity to pump up a
prime ally. Senator Kennedy. Vermont also has allies Senator Leahy and Govemor
Dean. Ron Machtely of Rhode Island is one of our more likely moderate Republicans
in the House.
This trip ensures enthusiastic crowds all along the way.
3.
Shreveport, Louisiana to Houston, Texas or Dallas, Texas
Senators Breaux and Johnston are swing Democrats who we will important to our
efforts in the Senate. In addition, if we went south from Shreveport we could hit the
district of Congressman Tauzin of the Energy and Commerce Committee on the way
to Houston.
�East Texas has numerous influential moderate to conservative Democrats who we need
to shore up including Jim Chapman, John Bryant (Energy and Commerce), Jack
Brooks (Judiciary), Mike Andrews (Ways and Means), Gene Green (Education and
Labor), and Charlie Wilson. If we were to head straight east to Dallas we could touch
Chapman, Wilson, Martin Frost (Budget), Pete Geren, Charlie Stenholm and Bill
Sarpalius
While this scenario encompasses larger media markets, the drawback is that pulling
together large and enthusiastic crowds in Texas will be a difficult task.
We rejected other traditional midwestem bu trip options because of NAFTA conflict
concems
�DETERMINED TO BE AN AD.MINISTRATIVE
M A R K I N ^ c r E ^ . 12958 as amended, Sec. 3.3 (c)
initialt;
^ D^c- \ ^ (
^
(j
PRIVILEGED AND e e a a H n ^ S & M E M O R A N D U M
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings, Steve Edelstein
Health C:are Workshops
Melanne, Steve, Distribution
September 4, 1993
Based on your comments at the meeting on Thursday afternoon, wc have revised the
program and materials for the health care workshops. Attached for your review is a program
for the workshops including leads and support staff for each presentation and an outline of
each presentation. Ira has reviewed the attached and is pleased with the revisions that you
and others had suggested.
PROGRAM:
We have identified a single lead presenter for each of five sections discussing a
summary of the plan and its principles. Each of these was selected as a person who not only
has a good understanding of the policy but who could also be effective advocates for the plan.
At a meeting of the Legislative Affairs staff including Steve Ricchetti, Jack Liu and
Jerry Klepner, the consensus was that having an economic team representative at each session
was important to validate the economic aspects of the health reform initiative and to clearly
illustrate their support for it. However, under this proposal, the role we envision for theseir
role has been scaled back from that of lead presenters to a smaller role as validator.
The rest of the personnel listed for each session is there for support and to assist with
answering questions.
OUTLINE;
We have been working with HHS staff to develop each of the presentations planned
for the university. The current outline reflects the main questions which will be addressed in
each session and issues which will be discussed in response to those questions. Given the
limited time we plan to devote to presentations in order to allow sufficient time for questions
from the members, the discussion will highlight the main provisions in a summary form and
not dwell on the detailed specifications of the plan.
ACTION NEEDED:
After reviewing this memo and attachments, we will need any suggestions or
comments you may have so we can proceed with the development of the course materials.
�HEALTH CARE WORKSHOPS
OPENING SESSION - All Attendees
(Overview of Plan, Design and Philosophy)
Main Presentation: Hillary Rodham Clinton
Remarks (3-5 Minutes Each):
Donna Shalala, Lloyd Bentsen, Robert Reich,
Ron Brown
In Attendance: Janet Reno, Jesse Brown, Leon Panetta,
Clarol Rasco, Tipper Gore
GENERAL SESSION - 5 Sections
(Includes Discussion of (Consumers in the New System; Ctost Cbntainment and
Budgets; and Savings, (Tosts and Financing)
Presenters:
Session A l
Ira Magaziner, Lead
Robert Rubin, Economic Validation
Staff Support:
Gene Sperling
Rick Kronick
Phil Lee
Charlotte Hayes
Communications Staff
Session A2
Judy Feder. Lead
Leon Panetta, Economic Validation
Staff Support:
Len Nichols
Larry Levitt
Steve Ricchetti
Communications Staff
�Session A3
Paul Starr, Lead
Alice Rivlin, Economic Validation
Staff Support:
Nancy Ann Min
Bemie Arons
Karen PoUitz
communications Staff
Session A4
Ken Thorpe, Lead
Roger Altman, Economic Validation
Staff Support:
Marina Weiss
Walter Zelman
Chris Jennings
communications Staff
Session A5
Bruce Vladeck, Lead
Laura D'Andrea Tyson, Economic Validation
Staff Support:
Sherry Glied
Gary Claxton
Jerry Klepner
communications Staff
BREAKOUT SESSIONS Session B - Business in the New System
Leads: Roger Altman
Erskine Bowles, SBA
Others: Ken Thorpe.HHS
Walter Zelman
Steve Finan, Labor
Alexis Herman, OPL
Joe Stieglitz, CEA
�Session C - Providers in the New System
Leads: Phil Lee, HHS
Risa Lavizzo-Mourey, HHS
Others: Helen Smits, HCFA
Karen Pollitz, HHS
Arnold Epstein
Kathy Buto
Lynn Margherio, EOP (?)
Session D - Federal/State Roles
Leads: Larry Levitt, HHS
Sally Richardson, HHS
Others: Gary Claxton, HHS
John Hart, EOP
Christine Heenan, EOP (?)
Nancy Delew, HHS (?)
Session E - Elderly and Persons with Disabilities in the New System
Leads: Judy Feder, HHS
Fernando Torres-Gil, HHS
Robyn Stone
Others: Barbara Cooper, HHS
Portia Mittleman, HHS (?)
Session F - Underserved (Rural and Urban Populations)
Leads: Lois Quam
Kristine Gebbie
Rural:
Lois Quam
Denise Denton
Dena Puskin, HHS
Jeff Human, HHS
Mike Lincoln, IHS
Urban: Kristine Gebbie, HHS
Jo Ivy Buford, HHS
Claudia Baquet, HHS
Richard Veloz, HHS
Roz Lasker
�OVERVIEW
What is wrong with the current system?
Lack of Security
Cost
Administratively burdensome
Quality variation
Poor long-term care coverage
Fraud and abuse
What are the goals of the new system?
Create security
control cost
Enhance quality
Expand access
Reduce administrative burdens
Reduce fraud and abuse
What will the new system look like?
Federal/State Oversight
Federal/State Partnership
National Health Board
Alliances
Health Plans
What is a consumer choice system?
Premiums costs are shared between employers and employees
Consumers choose their plan
Consumers choose their providers
How will the new system improve access for consumers?
Universal coverage/security
Choice/greater market power
Benefits Package
Quality
Affordability
Administratively simple
Portability
September 4, 1993 9:02am
�How will cost be controlled?
Market Forces/COmf)etition
Budget
COst-Containment
malpractice
antitrust
workforce changes
How will it be financed?
Employer/employee contribution
Private/public sector savings
Sin taxes
September 4, 1993
9:02am
�BUSINESSES
What is wrong with the current system?
Cost
Insurance abuses (e.g. occupational redlining, medical underwriting, and experience
rating)
Administrative burden
Increasing workers compensation costs
Inequitable tax policy for self-employed
How will reform help small employers, their employees, and the self-employed?
Cost control
Workers compensation
Insurance reform
Larger purchasing pools
Shared responsibility for family coverage (two earner families)
Administrative simplification
Full deductibility for self-employed
Offer employees choice of plans
Smaller contributions and subsidies
What are tbe responsibilities of small employers?
Participation in regional alliances
How will reform help large employers and their employees?
Cost control
Workers compensation
Insurance reform
Retiree health cost relief
Shared responsibility for family coverage (dual earner families)
Administrative simplification
Offer employees choice of plans
What are the responsibilities of large employers?
For employers with less than 5000 employees
Regional alliances
For employers with 5000 or more employees
Participation in corporate alliances
Participation in regional alliances
How will reform ensure affordability for low-wage workers and employers?
Subsidies
Cost containment
September 4, 1993 9:03am
�PROVIDERS
What is wrong with the current system?
Administrative hassles (paper work and regulatory burden)
Malpractice
Workforce (too many specialists)
Medicaid reimbursement
Fraud and abuse
How will reform help hospitals? What are the responsibilities of hospitals?
Administrative Simplification
Uncompensated care reimbursement
Academic health centers
Contracting and negotiation with health plans
Providing high quality, appropriate care
How will reform help physicians? What are the responsibilities of physicians?
Administrative Simplification
Malpractice Reform
Uncompensated care reimbursement
Contracting and negotiation with health plans
Providing high quality, appropriate care
How will reform help advanced health professionals (e.g. nurses. NPs, PAs..etc). What are
tbe responsibilities of bealth professionals?
Scope of Practice
Malpractice Reform
Workforce Reform
Administrative Simplification/more time with patients
Contracting and negotiation with health plans
Providing high quality, appropriate care
What does this mean for non-traditional practitioners (chiropractors, altemative
medicine...etc).
Scope of Practice
Alliance and Plan flexibility
How will reform encourage the growth of primary care practitioners?
Graduate Medical Education
National Health Service Corps expansion
Community health center expansion
Increased Medicare reimbursement
September 4, 1993 9:02am
�How will reform improve quality?
Report Card
Outcome research
Malpractice reform
coordination of carc
Health plan accountability
September 4, 1993
9:02am
�FEDERAL AND STATE ROLES
FEDERAL ROLE UNDER THE NEW SYSTEM
What is wrong witb the current system?
Poor cost-containment efforts
State barriers to reform
Rising costs of public programs
State variations in access and cost
What is the federal framework for reform?
A new federal/state partnership
Universal coverage
comprehensive benefits package
National Health Board
Insurance Reform
What are the responsibilities of the National Health Board?
Benefits Package
Budget
Alliances
Quality standards
Approve state plans
What support is provided to states during transition?
Planning grants
Technical assistance (e.g. model laws)
Alliance start-up funds
STATE ROLE UNDER THE NEW SYSTEM
What level offlexibilityis given to states to design a system that meets their needs?
Alliances (size, location..etc.)
Health Plans
Single Payor
Medicare
What are their responsibilities?
Budget
Alliance
Assure quality and coverage
Maintenance of effort—Medicaid
Oversee insurance reform
September 4, 1993 9:05am
6
�What steps must be taken by states to implement reform?'
State plan
State statutes
Create alliances
State-federal match (for start-up)
September 4, 1993 9:05am
�ELDERLY AND PEOPLE WITH DISABILITIES
What is wrong with the current system?
Elderly
Lack of Coverage
Prescription drugs
Long-term care
Instability of Retiree benefits
People with Disabilities
Lack of Coverage
Prescription Drugs
Long-term care
Preexisting Condition Exclusions
Barriers to Independence/Disincentives to employment
Lack of Coordination of Care at a Community-based level
How will reform help the elderly?
Prescription drugs
Long-term care
How will reform help people with disabilities?
Prescription drugs
Long-term care
Insurance Reform
Tax incentives to obtain employment
How will reform help retirees under 65?
Security
Affordable coverage
What happens to Medicare under the new system?
State opt-in
Individual opt-in
Medicare HMOs
What happens to Medicaid under the new system?
The residual program
September 4, 1993 9:02am
�RURAIVURBAN UNDERSERVED
What is wrong with the current system?
Uneven distribution of providers
High cost of care
Varying quality
Poor access
financial barriers
non-financial barriers
Insufficient infrastructure
Vulnerable populations
How will reform assure access to care for underserved and vulnerable populations?
Guaranteed coverage through reform
Expand resources
Coordinate categorical programs
Assure participation of Essential Community Providers
Develop resources
providers
facilitates
network
Expansion of selected services
How will reform address the rural healtb problems?
Health Alliances
Infrastructure
Workforce
training
incentives to practice in rural areas
Network development
Essential Community Providers
Medicaid
(Community Health Centers/Migrant Health Centers
How will reform address tbe urban health problems?
Health Alliances
Infrastructure
Workforce
Essential Community Providers
Medicaid
Network development
Community Health Centers/Migrant Health Outers
September 4, 1993 9:02am
�August 5, 1993
MEMORANDUM FOR HILLARY RODHAM CUNTON
FROMSUBJECT:
Kim TiUey, Amy Nemko
Briefings for Friday, August 6
: S t V t ^ i r w l ^ Powers
Quarterly 7/24/93
Groomed No Heirs Apparent" Congressional
w/ S^nflt^r Arlen Sopcter Briefing
Summary of S. 631 "Comprehensive Access and Affordability Health Care Act of
and Differences/President's Plan v. Specter's
^ " r o f p o l f o n the RepubUcans Find Strength"
8/1/93 (NOTE: W^ile
this a S i r ^ n ' t ^ ^ ^ ^ ^ ^ ^ ^ health specific^y. it lists Sen. Specter among those
RepubUcans who vote most frequently with the Democrats.)
�DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per E.0.12958 as amen/Ied, S9C, 3.3 (c)
Initials: ^
PRIVnJEGED AND Q ^ ^ ^ ^ M E M O R A N D U M
TCh
FR:
RE:
OC
,
Hillary Rodham Chnton
Chris Jennings, Steve Edelstein
Meeting with Ways and Means Democrats
Melanne, Steve, Distribution
August 5. 1993
Tomorrow you are scheduled to meet with s « H ^ ^ . ^ ' j j X ^ ' ^ ' ^ ^ c I ) , * '
Ways and Means Committee - • . B " ' ' ? ^ f - ; 4 \ S , 2 ^ i ^ ^ , ^ ^ ^ ^ ^
Sandy Levin (D-MI), Ben Cardin (»;MD 'Peter Hoaglana^^^^
Neal (D-MA). This meeting Js -P^fanU^cause ^ h ^ " ^ ' ^ ; ^ ^ , ,
the
S u t Z m i r r ^ a H ^ B S r E i r A l ' : s : ^ l m h e r s are attached for your
review.
BACKGROUND:
congresswoman KenneUy and C„n^«^^^^^^^^
' Z ^ S ^
a ^ i l t u r o ^ ' c ' : n ' g r T ^ - n " L L and Cardin also
Admmisirawou y a.
Qi^nuld we run into any concerns from
in response to a request from these Members.
1
^^A fV.A Wnva and Means Committee being the
These members ^ ' ^ ^ ^ ^ f j ^ 'efom They would like to see the committee
primary focal pom of health ca«^e^^^^^^^
^ <„„tribuU based on their
h.VTJ^^.^^^'^^T:^ ^ ^ ^ ^ ^ - ^-^^ contribute to the health reform proposal.
»e«ottrrs:wC^^^^^^^
�FORMATS
Congresswoman KenneUy and Congressman Matsui ^^^^ <>P;^, ^^^"^.'f
then turn it over to you for brief remarks. Your remarks wxll be foUowed by an
open and informal discussion.
TALKING POINTS:
In your remarks you may wish to recognize how important you beUeve the
Ways and Means Committee is to the health care reform legislative pro^ss^ You
may a i o wiah to thank these Members for aU their assistance and guidance to
date and how much we wiU be relying on them in the commg months From
there? it would be helpful to give a brief overview of where we are m terms of
timing and process.
�MEETTING W r i H SELECT WAYS AND MEANS COMMTFTEE MEMBERS
August 6, 1993
P^^,pproc;x..x, pr^piTPT ]vf/VTS!II fP-CAl - Congressman Matsui came to Congress after
•Zn7on l e s l S
C i r C o u ^ ^
is generally liberal
a loja^ Dernocrat but
serving on uic
j
Committee, he combmes a hberal
u.,m«n Rt-^iources which will consider the Administrahon's welfare reform.
r h ^ a l S s C^^^^
Matsui suppons phasing ™ a g ^ o r ^ ^ ^ ^ ^ ^ ^
—
d
children first and introduced legislation to achieve this goal m the last Congress^ Benen«
^c S
preventive care and immunizations. He supports sm taxes and can push them on the
Trnm ttern^^^^^^^ supports a tax cap. like the one recommended by the ^-kso" "^^^^^
Te^ause he believes it is necessary to force employees to make real choices. In addihon.
Congressman Matsui supports global caps to control costs.
His greatest legislative accomplishment was the passage of ^ ' ^ J ^ ^ l ' ^ l ' ^ ^ ^ ^ ^ ^
Japanese families interred during Wodd War H. It was signed ' " ^
"'^^^^^^^^^^^
Doris worked on the Uansition and is now the Deputy Director of White House Othce ot
Pub ; U^s^n (NOTE: As you probably know. Doris was hospitalized recentiy for a few
day' after h^lg^an adverse reaction to medication. She is back at the White House and
reportedly feels fine now.)
Z ^ ^ c e ^ p H ^ of I Uaited Sta.». Rep. Ke^^lly w.11 be se„s,«v. .0
'"P^^ " f / ' ^ " ™
on thrinsuriice indusUy. Kennelly is on both the Budget Committee as well as Ways and
Mefis sSeTconside^d an expert on tax issues, particularly the taxatton of .nsuranc.
benefits.
because of the distribution tables.
r-n^r,PF5;SMAN S^^^nl^p I W I N (D-MD - Congressman Levin serves on the Ways and
Means Health Subcommittee. His brother. C^arl. represents Michigan j ^ j ^ ^ ^ S . ^en^^^^^^^
Levin is not particularly close to Stark and doesn't always follow his lead. Levin will be
LflTenced m S y by I o n s and retirees. In addition. Levin has a large t e a c h « . ^
his S t r i c t ^ d he actively defends GME payments. Levin is a quiet member but helpful
behind * I "enes He helped draft the Stark-Gephardt compromise m the 102nd and was one
of tfie last defenders of the Medicare Catastrophic Act.
�Congressman Levin believes that consumers want fraud, waste and abuse cut beforetfieywil
be S g to pay more. He believestfiattiieAdministration can cut costs by "-ng home care
a^dTvinl wills He believestfiatCongress will need plenty of Presidenhal leadership and
warns about over-promising.
rY.Mr.RF5^SMAN nVN TARDIN (D-MP) - Congressman Cardin filled Majority Leader
S a r d t ' s seat on Ways and Means in 1989. Cardin is an insider and a team player who has
been foyd to Chairman' Rostenkowski. Altiiough not particularly close to Stark, he has never
crossed him. Cardin worked witfi Stark to draft die Stark-Gephardt healtii care plan in tiie
102nd Congress. Altiiough relatively new to tiie House, is no newcomer to politics.
Maryland is a state out in front on cost conUol initiatives and Cardin will be P^°^^^f ^ ^ / j ^
S T e s . Cardin has advocated an all-payer rate setting system liketfieone he helped create
when he was intfiestate legislahire. hi addition, he believestfiefederal government should
Tdopt national standards and usetfiestates for implementation. He urges tfie President and
Ae First Lady to conduct extensive consultation before introduction. Cardin also believes tfiat
healtii care reform should be donetfiisyear.
rY^i>jr.RRSSMAlH pir-pA^n NFAr(D-MA^ - Congressman Neal is atfiree-termHouse
vetera^ r d one oftf^emany new members ontfieWays and Means Committee. He is said
T b "lo"e to tfie leadership and to Congressman Moakley. ^eal opposed *e 1990 bu g^^^
summit. He istfioughtof as fairly liberal. However, he has voted against federal fund^ngj°^
abortions, even intfiecase of rape or incest. WitfitfieChairman leaning on him and Moakley
on board witfitfiePresident, Congressman Neal should be witfi us.
i^NHRRSSMAN PlTTFR HOAGMND (D-NE) - Now in histiiirdterm intfieHouse.
Hoag Lid representstfiecity of Omaha. A recent appointee to Ways and Means, he is
consfdld a moderate Democrat. He is also a member oftfieMainstream Fo nun and tfie
Rural Healtfi Care Coalition. While he will probably be amongsttfielast Democrats on tfie
Ways and Means Committee to commit, he purportedly wants healtfi reform and tfie
le Jership believes he can be counted on to vote fortfiehealtfi care reform package.
Notably. Hoagland has voted in favor of abortionrightsand increasing the minimum wage_
He attended a meeting you had witfitfieWays and Means members on March ^tfi- He^tfi
iellation he has introducedtfiisterm includes bills to: expand home healtfi services and
prov
annual preventive examinations under Medicare; establish a demonstrahon projec
to reduce medical coststfiroughsharing of medical facilities and ^'^^^^''^^^X?";^^^^^^
daims fonns; and require hospitals to provide information to parents of newborn children on
immunization.
�INSIOC CONGRESS
C O V E R STORY
The Rostenkowski Powerhouse
Groomed No Heirs Apparent
or more than a decade, the
House Ways and Means Committee has been dominated by
the power and personality of a single
imposing figure: Dan Rostenkowski.
Now, as the Illinois Democrat confronts the biggest crisis of his political
career. Ways and Means faces an identity crisis of its own.
The future of the panel's leadership
has been thrown into question by new
evidence implicating Rostenkowski in
an alleged embezzlement scheme. If
serious criminal charges are lodged
against him, Rostenkowski will be
forced to step aside as Ways and Means
chairman until they are resolved.
Much is at sUke for the committee. A change in the chairmanship
could transform the character of the
committee, erode iU power and possibly touch off a bitter internal struggle over i u long-term leadership.
And much is at sUke for the rest of
Congress and the country. The Ways
and Means chairman has tremendous
influence over some of the most farreaching issues on the national agenda:
taxes, trade, health and welfare.
In the short term, most committee
members expect that the panel's No. 2
Democrat, Sam M. Gibbons of Florida,
would step in as acting chairman if an
indictment forced Rostenkowski out of
his post. But it is unlikely that Gibbons
would go unchallenged if Democrats
had to choose a new permanent chairman. If Rostenkowski left Congress,
some members say, the succession
struggle could be a free-for-all.
"Anybody with a modicum of arnbition would seize the moment," said
Ways and Means member Andrew Jacobs Jr., D-Ind. " I f somebody does
challenge Gibbons, that throws it
open." said another committee Democrat who, like most others interviewed,
did not want to be quoted when Rostenkowski's position is so sensitive.
never had to put together a package,
much less a bunch of packages, the
way Rostenkowski has," said Charles
B. Rangel of New York, the No. A
Democrat on the committee.
F
End of an Era
Whether the committee's next chairman is installed sooner or later, whether
the transition is rough or smooth, it will
end an era defined by Rostenkowski's
By Janet Hook
Musical Chairs
Gibbons
Range!
Ways and Means Seniority
1. Dan Rostenkowski, III.
2. Sam M. Gibbons, Fla.
3. J. J. Pickle, Texas
4. Charles B. Rangel, N.Y.
5. Pete Stark, Calif.
6. Andrew Jacobs Jr., Ind.
7. Harold E. Ford. Tenn.
8. Robert T. Matsui, Calif.
9. Barbara B. Kennelly, Conn.
distinctive leadership style.
Before Rostenkowski, the committee was run with the permissive hand
of Albert C. Ullman, D-Ore., who was
Ways and Means chairman from 1975
to 1981 and freely shared power with
his subcommittee chairmen. " I don't
believe in running a closed shop or too
tight a ship," Ullman once said.
Rostenkowski has taken a different
Uck, more like the autocracy of Wilbur
D. Mills, D-Ark., chairman from 1958 to
1975. After becoming chairman in 1981,
Rostenkowski curbed the autonomy of
Ways and Means subcommittees and
took control over hiring staff. He has
stacked the committee with loyalists (17
of the 23 Democrats now serving under
him on the committee have been appointed during Rostenkowski's reign).
He has dominated the committee's legislative work by brokering, almost single-handedly, the complex deals behind
major tax bills of the 1980s and 1990s.
There is no obvious successor to
that leadership tradition ainong the
senior members of the committee — if
only because Rostenkowski has given
them little chance to show their stuff.
"Whether you're talking about
Gibbons or anybody else, they have
Long before Rostenkowski's current legal problems, members of the
committee began spinning succession
scenarios. Thefiresof ambition were
stoked as long ago as 1989 by recurring rumors that Rostenkowski was
considering retirement.
Succession speculation intensified
the week of July 19, when news broke
that a former House postmaster had
implicated two unnamed congressmen
in an embezzlement scheme — and one
of them seemed certain to be Rostenkowski. rStory. p. 1923)
Under Democratic Caucus rules,
members have to give up their committee and subcommittee chairmanships if they are under indictment for
a felony that can be punished with
two or more years in prison.
Under current caucus rules in such
cases, the No. 2 Democrat is automatically acting chairman. However, freshman Democrats have proposed a new
rule that would subject interim chairmen te caucus approval, just as permanent chairmen are. That could pose a
new obstacle to Gibbons' assuming the
acting chairmanship.
Gibbons, 73, is an independentminded, amiable legislator. But he may
be vulnerable to a challenge because
critics say he is out of step with the
Democratic Caucus mainstream on key
issues. He is an ardent free-trade advocate in a party dominated by protectionist sentiment. He supports a valueadded tax — a controversial levy on
consumption — and has proposed extending Medicare to all Americans.
Gibbons' infiuence as the No. 2
Democrat on the committee has been
limited by his tense relations with
Rostenkowski. He was a vocal opponent of the 1986 tax overhaul — one of
Rostenkowski's proudest accomplishments. The chairman snubbed Gibbons by keeping him off the conference committee on that bill However,
Rostenkowski this month did stick to
CQ,
JULY 24. 1993 — 1929
�INSIDE C O N G R t t t
Some members and lobbyisU suggest that a challenge
seniority and named Gibbons
might arise from deep within
one of the seven Ways and
the panel's middle ranks. BeMeans Democrats on the
hind Ford in seniority are two
year's big deficit-reduction
ambitious members with close
bill.
tiestoRostenkowski: Robert T.
If Gibbons' claim to be
MaUui of California, who
Rostenkowski's successor is
would have a large bloc of votes
challenged, it will not be the
in his huge home sUte delegafirst time he has been emtion, and Barbara B. Kennelly
broiled in a succession strugof Connecticut, who has a foot
gle. In 1977, Gibbons was in
in the Democratic leadership as
line to become chairman of
a chief deputy whip.'
the Ways and Means SubA midlevel challenger at
committee on Trade, but felWays and Means would have
KEN MClNtN
low Democrats were concerned about his free-trade In 1985 action on the overhaul of the U x code. Ways and Means to surmount especially high
hurdles. He or she would have
views. Another member exerChairman Rostenkowski, right, shared little power.
to jump over senior members
cised his seniority to prefrom the House's largest and most powempt Gibbons. (Four years
he's cerUinly the most dynamic" of
erful sUte delegations, including New
later, however. Gibbons did win the
the members in line for the job.
York and Texas. Then there is the potrade chair.)
Rangel's leadership ambitions have
litical sensitivity of opposing the black
In 1981, Gibbons also lost a chance to been thwarted in the past He ran for
caucus if Rangel is in the running.
be full committee chairman after Ullmajority whip in 1986 but lost badly to
"You'd be hard pressed to go over
man was defeated for re-election in OreTony Coelho of California. Rangel was
Charlie," said one member of the
gon. Rostenkowski, who ranked ahead of
no mateh for Coelho's organizational
Democratic leadership who asked not
him, had his eye on the majority whip
skills and energetic campaigning.
to be named.
vacancy. But then-Speaker Thomas P.
Rangel refused to comment on the
O'Neill Jr. encouraged his friend RosWays and Means chairmanship. One
Hard Act To Follow
tenkowski to Uke the chairmanship and key question is whether Rangel would
Whoever succeeds Rostenkowski
keep it from Gibbons, who once ran
want to buck the seniority system to
will Uke on atoughjob — and not just
against O'Neill for a leadership post
jump over Gibbons and the No. 3 combecause he or she will be succeeding one
Gibbons has already taken steps to mittee Democrat J. J- Pickle of Texas.
of the House's most powerful figures.
keep from losing the chairmanship a
Time alone may deliver the chairmanThe next Ways and Means chairsecond time. When it was uncerUm
ship to Rangel because he is 63, while
man probably will be under pressure
whether Rostenkowski would run for
Gibbons is 73. (Pickle is 79 and considto loosen the reins of power that Rosre-election in 1992, Gibbons quietly
ered unlikely to challenge Gibbons.)
tenkowski has held so tightly. Memsolicited support from Ways and
What's more, the black caucus has
bers' admiration for the chairman's
Means DemocraU for a bid to become
traditionally supported the seniority
strong leadership has been mixed with
the next chairman. Earlier this year,
system, which has elevated several
a restlessness and a desire to have
he Ulked to House Democratic leaders
blacks into top committee positions.
more say in the committee's producU.
about the succession scenario if RosFor example, Ronald V. Dellums, a
"He is running a very tight ship,"
tenkowski were indicted. " I said, Tm
senior black Democrat from Califorsaid
former Rep. Beryl Anthony, an
ready to Uke over,"" Gibbons said.
nia, in 1985 opposed an effort to dump
Arkansas Democrat who served on
Former Rep. Eki Jenkins, a Georgia
the chairman of the Armed Services
Ways and Means. "No matter who the
Democrat who sat on Ways and Means
Committee. This year, the seniority
next chairman is, I think you'd see a
and was often at odds with Gibbons on
system delivered that job to Dellums.
more open process."
trade issues, said he did not think
Other Ways and Means members in
But under a less centralized commitGibbons' views would keep him froro
the line of succession include Pete Stark
tee,
a chairman might find it even
becoming chairman if Rostenkowski
of California, the No. 5 Democrat who is
harder to draft the politically pamful
left Congress. " I would think seniority
the panel's leading expert on medical
bills that have packed the committee s
would prevail," Jenkins said recently.
issues and will have a prominent role in
agenda in recent years. A key to Rostenthe
coming
health-care
debate.
But
his
Counting Blocs
repuution as a liberal, temperamenUl kowski's success, his admirers say, has
been his ability to persuade members to
Rangel may be in the best position
maverick is considered something of a
put aside some of their interesUtosupto challenge Gibbons, members and
liability by Ways and Means watehers.
port a larger legislative package such as
lobbyisU say. He is a senior member
After Surk in seniority is Jacobs,
this year's deficit reduction plan.
of the Congressional Black Caucus,
another maverick; he says he would
"If they had a weaker chairman, it
whose 38 House DemocraU are an imnot run for chairman.
becomes
more difficult to pass diffiporUnt voting bloc.
Next is Harold E. Ford of Tennessee,
cult
legislation,"
said Nicholas E.
" I don't think you can rule out
who was on the sidelines of committee
Calio, who was chief White House lobCharlie Rangel." said Fred Grandy of
action for six years while under indictbyist under President George Bush.
Iowa, a Republican member of the
ment for fraud and conspiracy. When he
"And most legislation that comes
committee. "One, he's a senior memwas acquitted early this year, Ford rethrough the Ways and Means Comber of the committee; two, he s no
gained the chairmanship of the Human
mittee these days is difficult"
•
dummy; and three, the black caucus is Resources Subcommittee.
mightier than it has ever been. And
1930
J U L Y 24, 1993
CQ
t
�DETERMINED TO BE A.N AD.MI.MSTRATI\ E
MARKINGPer E ^ . 12958 asamended.
amend9d,Sec.
Sc^.
3.33.3
(c)(c)
Initials: J r ^ l i l _ Date
PRIVILEGED AND Q Q ^ ^ ^ & ^ MEMORANDUM
TO.
FR:
RE:
OC
HiUary Rodham CUnton
Chris Jennings, Steve Edelstein
Senator Specter
Melanne, Steve, Distribution
^^^^^ '
Tomorrow you are scheduled to meet with Senator Arlen Specter of
Pennsylvania. We anticipate that he wiU bring one staffer along with him. but
this has yet to be confirmed.
BACKGROUND
Due to the dynamic of Pennsylvania poUtics. Senator Specter has been
taking a much higher profile on health care issues in the past year^ J^je national
attention that Senator Wofford attracted on health reform dunng his 1991
^ r ^ p a S i forced Senator Specter to spend a great deal more attention on this
^sue than he ever had previously. To prevent his opponent for h^ Senate seat
from effectively using this issue against him. Specter introduced his own health
reform bill during his reelection effort.
Governor Casey has also been active in the health reform arena. He
recently introduced a state reform plan which is very sunilar to o^YPP/^^^JV;unTversal coverage to a guaranteed benefit plan, individual choice of plan from
re7onal purchasing pools, financed by mandatory employer/employee
contributions.
As a result Specter has continued his efforts to stay in the health care
UmeUght. desp^ the fact that he was just reelected. As yoti may remember, m
Api^ he offered his biU as an amendment on the fioor to another legislation.
On a more personal note. Senator Specter is recoveringfrom°^ajor surgery
to remove a benign tumor from his brain earUer this year. In a floor statement
last month. Specter said his personal experience gave hnn new ^sights on
e s c l l X g health care coste. He warned against any rationing of health care
seJ^ces which would Umit the availabiUty of high technology services and stifle
innovation.
"When we complain about how much the coat of medical care has ™«»
inflation generally, we do not focus on new techniques which were not avadable
totTfew yea^s a'^o,- Specter said. He referenced the MEI and noted, ".t raises
'c^U buT if^obJously worth it." This concern paralleU the concerns of the
nhamaceuti^l manufacturers, which have a significant presence m Pennsylvama,
w h o ™ t h " price control could Umit their ability to produce breakthrough
�drugs and Umit high-tech treatmente.
Because of his personal and poUtical circumstances, we consider Senator
Specter to be one of our top targete and one of our most Ukely RepubUcan votes.
Senator Specter's bill focuses on reducing health care coste through
incentives for women to seek prenatal and postnatel care federal guideUnes for
terminally iU patiente who wish to forgo needless medical care and use ot
nonphysician health providers to deUver primary care servi^s. It was later
combined with the proposals of other RepubUcan members (Senators Kassebaum
Cohen. McCain, and Bond) te create the "Comprehensive Access and Affordabihty
Health Care Act of 1993 (S. 631). Citingfrustrationwith the lack of action on
health reform, he offered S. 631 as an amendment to the Department of the
Environment Act in March. It was tabled on a 65 to 33 vote.
Attached for your review is a summary of Senator Specter's health reform
legislation.
�BY:xerox Telecopier 702i ; 8- b-aa ; A:46FM ;
s 631. "Comprfthanilv* ACCBBB and Affordability
B. 631, ^''^jP^^^ c a r . Act of 1993,"
Introduced by San. Arlen Specter (R-PA)
T>^orrr»mi
The b i l l would achieve universal acceoa through a
^^^^^^^^ ^
i-£f
been supported by other moderate Republicans.
n«„«T.««*i The b i l l imposes a mandate on individuals to eWoH 1"
^ S r S ^ a n s offering basic coverage. Refundable tax credits
£:Sld\f :^?en5ertS'low- and middle-income i ^ ^ i S ^ S r i i n J J i f ? f
?h-e"arou;nJ^?hr=^^^
S a n employers would enroll in coverage through health pl«|n
purchasing cooperatives.
I
BenefitaJ. A Federal Health Board would determine the covered
K S I H S ! "
Preventive services and primary care would be
emphasized.
QualitY* A surcharge on health plan prejiums wj^i^^J^"^,^^^^^"'*'
I^VIK
HA;»i*-h Dlans would have to publish "report caras
I n d i c I ^ i A c ^ a U t y o? ca^e and consume? service. Patient Advance
d ? ? e S ? i i e 2 2SSld be promoted to reduce unwanted heroic medjcine.
.^/^nflllnaentl The Federal Health Board would determine
f S ^ a l l i S i t S Sn the allowable percentage rate of increase, in
reform would reinforce cost containment e f f o r t s .
y^nanolnot
future.
Not specified.
�T BY:Xerox
Telecopier 7021
8- 5-93 : 4:47PM :
4562888:8 3
COMPARISON OF KEY SIMIURITIES AND DIFFERENCES
PRESIDENTS PLAN VS SPECTER'S S 631
SIMILARITIES
o
All citizens would be required to carry a uniform set of effective beneflts either
through a group or Individually, l-ow Income persons would receive direct
public assistance.
o
States would establish Health Plan Purchasing Cooperatives (HPPCs) to sen/e
as collective purchasing agents for small businesses and Individuals.
o
Federal Health Board would set annual limits on health plan premium growth.
0
Plans would have to take all applicants and al! plans would be guaranteed
renewable.
o
Encourages administrative simplification, electronic billing, and computerization
of medical records.
Q
Promotes primary and preventive care and the training of those provide rs.
0
Federal Health Board would collect and distribute "report cards' on cost,
utilization, health outcomes, and patient satisfaction.
0
Encourages home- and community-based long term care.
DIFFERENCES
o
The Presldent'a plan builds on tho nation's longstanding syatem
employment-based coverage, with employers contributing a sharSiOf the
oost. Special provisions are made for small business. By contrast,
Specter's plan shirts to sn Individual mandate, significantly Increas ng
burdens on families.
peftned Benefits
,
o
The President's plan specifies guaranteed benefits that Include preventive
care, prescription drugs, pediatric dental care, and mental health. I
Specter's plan leaves the development of the basic benefits package to
the Federal Health Board, subject to limits of available financing, j
Comprehensive benefits are likely to be affordable under Specter*^ plan.
financing
o
Financing Is not specified.
�Newsday
August 1, 1993, Sunday
HEADLINE: In Opposition the Republicans Find Sh^ngth
BYLINE: Shiart Rothenberg. Shiart Rothenberg, a Washington-based political analyst,
is editor and pubUsher of The Rothenberg PoUtical Report
BODY:
FOUR DECADES after President Harry Truman won election by campaigmng
against a "do-nothing Republican Congress," and just months after a presidential
campaign marked by denunciations of legislative gridlock. Congress has once again
screeched to a near halt
While House and Senate Democrats continue to wrestle over taxes and spending.
Republicans on Capitol Hill quietly smirk at the Democrats' dilemma, providing few
votes for Democratic legislative initiatives and storing up ammunition for use in the
1994, off-year elections.
Democratic leaders in the Senate, in particular, have had trouble corralling all of
their party's members on key economic matters, let alone finding common ground
with House Democrats and the White House. RepubUcan legislators in both houses,
by contrast, have found unity: They're agamst Bill Clinton and all economic measures
proposed by the Democrats.
What is so amazmg about the Republicans' new soUdarity is that it masks fissures
within the party that became apparent only during the presidential campaign and the
postmortem. The increased assertiveness of a variety of RepubUcan think tanks and
advocacy groups smce George Bush's defeat including the conservative Empower
America and the more moderate RepubUcan Mainstream Committee and RepubUcan
Majority CoaUtion, suggests a party torn by dissension and ripe for defections.
But defeat can actually be a great force for cohesion House RepubUcans, for
example, have been unified against the Democratic leadership for years. Always
outvoted and virtually powerless, they have grown increasingly angry at what they
regard as the Democratic majority's indifference to their interests.
RepubUcan unity m the Senate, on the other hand, is relatively new, and frankly,
surprising. Congressional Quarterly calculated that four GOP senators voted with the
Democrats at least half of the time in 1992 on issues where the parties divided, and
that three others bolted their party about 40 percent of the time (see box). Combme
that record with the more general difficulty of controUing senators in an era devoid
of party discipline, and it is easy to see the opportunity given to BUl CUnton to pick
off GOP votes in the Senate.
But RepubUcan moderates and conservatives stood firm in their opposition first to
the president's budget and then to his stimulus package, and they remain sunilarly
�opposed to thereconciliationpackage, which, according to Senate rules, can't be
filibustered by opponents.
aearlv poUcy was one of the factors binding GOP senators to ^fch other During a
m ^ X ^ ^ ^ Minority Leader Bob Dole's office shortly after President Qintons
fi "t e^onor^c address, Jssouri Sen John Danforth, who wiU be rehnng next year
askeTtf^Tr^tors wh^ were present what it was that united them hi discovering a
shared^U^f^ lower taxes, i L spending and deficitreduction,moderates and
c o ^ a ^ v e L dso discovered a coSunon area of difference with CUnton's economic
approach.
Rut if nolicv was a factor in Republican cohesiveness, so was process. All GOP
se^tL^ redSellt they would'become legislative bystander., Uke their generaUy
^ S « S v e and irrelevant counteq^arts in the House, if they merely acquiesced m the
vres^nVs legislative agenda. Republican unity, therefore, was the only way to
S ^ n
RepubUc^ clout TTiat, and a desue to keep one-party government
horst^-^Jsur^ly encouraged GOP moderates to stick with their more conservative
brethren.
The so<:aUed permanent campaign has also encouraged RepubUcans to stand aside
and let the Dem^ats be blamed for raising taxes and cutting popular programs.
While GOP insiders won't admit it on the record, they hopetiieiropposition to
CUntonVeco^mic plans wUl help them appeal to disgruntled voters. "Don't Blame
M T - I VoSd For Bush- isn't just k bumper sticker. Its a potenhaUy successfiil
off-year election campaign theme.
PoUtics and poUcy have played a role in the solidifying of ^ ^ P f ^^^.^^"^^^^^
op^sition to OUiton's economic plan, but the White House also has itself to blame
for the GOFs unanimous opposition.
-CUnton's bieeest mistake wastorefiisetoreachout to RepubUcan legislators on
e c o ^ m a t g ^ / asserts atopGOP staffer. He contends t ^ Wlute House a ^ ^ ^ ^
excluded GOP senatorsfromthe poUcy process m order to deny the RepubUcans any
credit for dealing with the economy.
Whether or not you agree, its clear that the White House underestimated the
po^tiS^forRe^Ucan^^osition, and overestimated its own dout with Democratic
E^atoii Had ainton W O S G O P legislator, before he mfroduc^l l-«.econonuc
!^m,dus Dackaee he mieht weU have divided GOP opposition before it solidified. He
s S i ^ L v e l S k a i^gf^^^ the game plan of Ronald Reagan, who wasted no
W c o ^ g conservative House Democrats m 1981 on behalf of his economic
program.
The question is whether the RepubUcans' sfrategy of sitting on their hands and
forcing the Democrats to make aU thetoughdecisions is poUticaUy a wise one.
�In the near term, the GOP approach is not merely credible, it is best Suggestions
that die RepubUcans need a more positive message or should be more
accommodating toward Democratic legislators ignore the fact that elections are
generally referenda on mcumbenls, not choices between grand visions.
Writing in this newspaper a few days ago. Time magazine poUtical writer Laurence
Barrett argued that tiie GOFs lack of an agenda, except for its opposition to taxes,
could make the party look -even more sterUe" if Qinton's standing unproves. But ttie
party out of power rarely has a coherent vision, smce it usuaUy lacks a party leader
who can unite its various wings behind a smgle message. Bob Dole has a weU^amed
reputation as a party tactician, spokesman and wit, but he cannot speak for tiie
RepubUcan Party any more tiian Sen. George MitcheU or Speaker Tom Foley could
for tiie Democratic Party during tiie Bush admmish-ation.
Even more to tiie point, if tiie economy rebounds and tiie presidents standing
improves significantiy, it won't matter whetiier tiie GOP has a nice, neat agenda to
market to tfie pubUc Americans vote for results. If BiU Qmton is successhd,
RepubUcan criticism - even if it arises out of a broader, more positive message - wdl
ring hoUow.
Witii tiie president now openly complaining about congressional paralysis, some
Democrats may by to place blame on tiie GOP, much as Truman did in 1948. But
tiiat WiU be difficult to do, since, unUke tiie situation m 1948, tiie Democrats control
tiie entire legislative process, and BiU CUnton promised tiie voters tiiat his election
would end gridlock.
The RepubUcan sh-ategy, however, is not witiiout risk. Ffrst members of tiie
national media are increasingly critical of tiie party's sb-ategy. There niay even come
a point when tiie party has to spend more time defending its apprc^ch ti^
criticizine tiie president That change in focus would not only benefit tiie White
House, it would risk a weakening of ties to tiie GOP, botii on tiie part of votera and
on tiie part of nervous RepubUcan legislators seeking to demonsfrate tiieir
bipartisanship.
Second, tiie president's poor approval ratings and tiie RepubUcans' early succew in
impeding CUnton's economic program may tempt tiiem into fights where tiie partys
own position is not settied, causing even fiuiher disarray. AUeady, moderate
Republicans have voted for such Democratic initiatives as family leave -motor voter
regisfration and abortion rights, and tiie GOP has done Uttie to derail CUnton
nominees who require Senate approval. The sole issue uniting Repubbcans m
Congress is so-caUed fiscal responsibility.
Third, while forcing tiie Democrats to do aU tiie dirty work of raising taxes wiU
rive ttie GOP ammunition for next year's congressional elections, it could also lead to
hicreased pubUc discontent witii Congress and tiie two major parties, to Ross Perof s
ultimate benefit A July 19-21 CNN/USA Today/Gallup poU found fewer tiian one m
�four Americans approving of tiie job Congress is doing, andtiiatdisapproval could
easily rub off on tiie Republicans, eventiioughtiieyconb-ol neiUier chamber.
As tiie party movestowardtiie1996 presidential election, it will, of course, need to
develop a clearer, more positive message. ButtiieGOP is hardly wandering in tiie
wilderness. During tiie past few montiis, tiie Republicans have offered specific
legislative altematives concerning tiie budget, taxes and jobs, only to have tiiem
rejected by tiie Democratic majorities in tiie House and tiie Senate. And Republican
poUsters i y tfiat voters are particularly nervous about excessive govemment
spendmg, atfiemetiiatRepublicans have used betore and could raUy around agam.
RepubUcan unity is Ukely to erode when Congress and tiie White House tum to
otiier issues, including welfarereform,trade and healtii care. But if s not clear
whetiier tiie president can count on united support evenfromwitiim his owri party
ontiioseissues. If he cannot tiie GOP may want to offer its owri,fiiUyconceived
alternatives. On tiie otiier hand, tiie president's problems might be so severe tiiat Uke
tiie winner of a maratiion boxing mateh, tiie GOP need only be left standing to wm
the crown.
GOP Switeh-Hitters
The RepubUcan senators who most fi^uentiy vote witii tiie Democrats. Percentages
show how oftentiieyvoted witii tiie Democrats on issues where tiie parties divided.
James Jeffords, Vermont
1992 61%
1991 62%
1990 63%
1989 57%
Arlen Specter, Pennsylvania
1992 59%
1991 33%
1990 47%
1989 45%
Mark Hatfield, Oregon
1992 54%
1991 49%
1990 66%
1989 60%
Bob Packwood, Oregon
1992 50%
1991 40%
1990 54%
1989 44%
�David Durenberger, Mmnesota
1992 42%
1991 30%
1990 42%
1989 43%
John diafee, Rhode Island
1992 40%
1991 46%
1990 38%
1989 43%
William Cohen, Maine
1992 39%
1991 41%
1990 53%
1989 48%
SOURCE: Congressional Quarterly
�DETERMINED TO BE A.N ADMIMSTRATIVE
MARKINOPcr ¥J0.12958 as amended, Sec, 3.3 (c)
Initials \ \ O P
na>.. I ^ / ( g l V / /
PRIVILEGED AND eONTIDEWTlAL MEMORANDUM
TO:
FR:
RE:
cc:
HUlary Rodham Clinton
Chris Jennings, Steve Edelstein
Meeting with Ways and Means Democrats
Melanne. Steve. Distribution
August 5. 1993
Tomorrow you are scheduled to meet with six Democratic members of
the Ways and Means Committee — Barbara Kennelly (D-CT), Bob Matsui (DCA), Sandy Levin (D-MI). Ben Cardin (D-MD). Peter Hoagland (D-NE) and
Richard Neal (D-MA). This meeting is important because these members are
viewed as moderate, thoughtful and influential members of the fuU committee
and the Subcommittee on Health. Brief profiles of these members are attached
for your review.
BACKGROUND:
Congresswoman Kennelly and Congressman Matsui wrote the initial
letter requesting this meeting. FoUowing Pete Stark's very public critiques of
the Administration plan and its authors, Congressmen Levin and Cardin also
expressed interest in meeting. Should we run into any concerns from
Congressman Stark about meeting without him. we can truthfuUy say that It
was in response to a request from these Members.
These members are used to the Ways and Means Committee being the
primary focal point of health care reform. They would like to see the
committee continue in this role and believe that they have a lot to contribute
based on their years of experience. They are concerned that Stark's criticisms
may be driving us away from Stark, his subcommittee and the fuU committee
as weU. They will be seeking reassurance that Ways and Means has the
opportunity to participate and contribute to the health reform proposal.
Given the fact that House Majority Leader Gephardt has come to the
conclusion that it would be best not to try to craft the legislation so as to
bypass the Ways and Means committee but rather to maintain the
jurisdictional status quo. this effort by these Ways and Means members is a
positive development and should be encouraged. The stronger are relations
with the rank and file of the committee, the better position we wiU be in to
withstand Pete Stcuk's onslaught.
�FORMAT:
Congresswoman KenneUy and Congressman Matsui wiU open the
meeting then turn it over to you for brief remarks. Your remarks wiU be
foUowed by an open and informal discussion.
TALKING POINTS:
In your remarks you may wish to recognize how important you beUeve
the Ways and Means Committee is to the health care reform legislative
process. You may also wish to thank these Members for aU their assistance
and guidance to date and how much we wlU be relying on them in the coming
months. From there, it would be helpful to give a brief overview of where we
are in terms of timing and process.
�MEETING WITH SELECT WAYS AND MEANS COMMITTEE MEMBERS
August 6, 1993
CONGRESSMAN ROBERT MATSUI rP-CA) - Congressman Matsui came to Congress
after serving on the Sacramento City Council. Matsui is generally liberal and a loyal
Democrat but he often sets his own agenda. On the Ways and Means Committee, he
combines a liberal approach to tax policy with a strong interest in protecting California
businesses. He generally defers to Chainnan Rostenkowski on major issues. He is a member
of the Subcommittee on Human Resources, which will consider the Administration's welfare
refonn.
On health issues, Congressman Matsui supports phasing in coverage for pregnant women and
children first and introduced legislation to achieve this goal in the last Congress. Benefits
included preventive care and immunizations. He supports sin taxes and can push them on the
committee. He also supports a tax cap, like the one recommended by the Jackson Hole group
because he believes it is necessary to force employees to make real choices. In addition,
Congressman Matsui supports global caps to control costs.
His greatest legislative accomplishment was the passage of reparations to members of
Japanese families interred during World War II. It was signed into law in 1988. His wife,
Doris, worked on the transition and is now the Deputy Director of White House Office of
Public Liaison.
CONGRESSWOMAN BARBARA KENNELLY (D-CT) - As a representative of Hartford,
the insurance capital of the United States, Rep. Kennelly will be sensitive to the impact of
reform on the insurance industry. Kennelly is on both the Budget Committee as well as
Ways and Means. She is considered an expert on tax issues, particulariy the taxation of
insurance benefits.
Despite her insurance concems, she wants health care reform. She can be a valuable ally
both with the Congressional Women's Caucus and the House's Old Guard. In addition, she is
one of the members who urged the Administration not to be beholden to the 100 day
deadline. She also contends that the Andrews bill (the CDF managed competition bill) failed
because of the distribution tables.
CONGRESSMAN SANDER LEVIN fP-MT1 - Congressman Levin serves on the Ways
and Means Health Subcommittee. His brother, Cari, represents Michigan in the U.S. Senate.
Levin is not particulariy close to Stark and doesn't always follow his lead. Levin will be
influenced mainly by unions and retirees. In addition. Levin has a large teaching hospital in
his district and he actively defends GME payments. Levin is a quiet member, but helpful
behind the scenes. He helped draft the Stark-Gephardt compromise in the 102nd and was
one of the last defenders of the Medicare Catastrophic Act.
�Congressman Levin believes that consumers wantfraud,waste and abuse cut before they will
be willing to pay more. He believes that the Administration can cut costs by using home care
and living wills. He believes that Congress will need plenty of Presidential leadership and
warns about over-promising.
CONGRESSMAN BEN CARDIN (D-MT)) - Congressman CardinfilledMajority Leader
Gephardt's seat on Ways and Means in 1989. Cardin is an insider and a team player who has
been loyal to Chairman Rostenkowski. Although not particularly close to Stark, he has never
crossed him. Cardin worked with Stark to draft the Stark-Gephardt health care plan in the
102nd Congress. Although relatively new to the House, is no newcomer to politics.
Maryland is a state out in front on cost control initiatives and Cardin will be protective of its
initiatives. Cardin has advocated an all-payer rate setting system like the one he helped
create when he was in the state legislature. In addition, he believes the federal govemment
should adopt national standards and use the states for implementation. He urges the President
and the First Lady to conduct extensive consultation before introduction. Cardin also believes
that health care reform should he done this year.
CONGRESSMAN RICHARD NEAL fP-MA^ - Congressman Neal is a three-terai House
veteran and one of the many new members on the Ways and Means Committee. He is said
to be close to the leadership and to Congressman Moakley. Neal opposed the 1990 budget
summit. He is thought of as fairiy liberal. However, he has voted against federal funding for
abortions, even in the case of rape or incest. With the Chairman leaning on him and Moakley
on board with the President, Congressman Neal should be with us.
CONGRESSMAN PETER HOAGTAND fP-NE^ - Now in his third terai in the House,
Hoagland represents the city of Omaha. A recent appointee to Ways and Means, he is
considered a moderate Democrat. He is also a member of the Mainstream Fomm and the
Rural Health Care Coalition. While he will probably be amongst the last Democrats on the
Ways and Means Committee to commit, he purportedly wants health reform and the
leadership believes he can be counted on to vote for the health care reform package.
Notably, Hoagland has voted in favor of abortionrightsand increasing the minimum wage.
He attended a meeting you had with the Ways and Means members on March 17th. Health
legislation he has introduced this term includes bills to: expand home health services and
providing aimual preventive examinations under Medicare; establish a demonstration project
to reduce medical costs through sharing of medical facilities and resources; simplify medical
claims forms; and require hospitals to provide information to parents of newborn children on
immunization.
�DETERMINED TO BE AN AD.MINISTRATIV E
MARKlMlPerLp, 12958 as amended, Soc. 3.3 (c)
initial$3l^±
Date: A ^ Z i S Z i i
P R I V I L E G E D AND
TO:
FR:
RE:
cc:
CT^jBBEf^EfiJiO^MORANDUM
Hillary Rodham Clinton
Chris Jennings, Steve Edelstein
Senator Specter
Melanne, Steve, Distribution
Augusts, 1993
Tomorrow you are scheduled to meet with Senator Arlen Specter of
Pennsylvania. We anticipate that he wUl bring one staffer along with him. but
this has yet to be confirmed.
BACKGROUND
Due to the dynamic of Pennsylvania politics, Senator Specter has been
taking a much higher profile on health care issues in the past year. The
national attention that Senator Wofford attracted on health reform during his
1991 campaign forced Senator Specter to spend a great deal more attention on
this issue than he ever had previously. To prevent his oppwDnent for his Senate
seat from effectively using this issue against him, Specter introduced his own
health reform blU during his reelection effort.
Governor Casey has also been active in the health reform arena. He
recently introduced a state reform pl£m which is very similar to our approach
— universal coverage to a guaranteed benefit plan, individual choice of plan
from regional purchasing pools, financed by mcmdatory employer/employee
contributions.
As a result, Specter has continued his efforts to stay in the health care
limelight, despite the fact that he was just reelected. He offered his biU as an
amendment on the floor to another legislation.
On a more personal note, Senator Specter is recovering from major
surgery to remove a benign tumor from his brain earlier this year. In a floor
statement last month, Specter said his personal experience gave him new
insights on escalating health care costs. He warned against any rationing of
health care services which would limit the avsdlabUity of high technology
services and stifle innovation.
�"When we complain about how much the cost of medical care has risen
over inflation generaUy, we do not focus on new techniques which were not
avaUable just a few years ago," Specter said. He referenced the MRl and noted,
"it raises costs, but it is obviously worth it." This concern paraUels the
concerns of the pharmaceutical manufacturers, which have a significant
presence in Pennsylvania, who worry that price control could Ihnit their abihty
to produce breakthrough drugs and limit high-tech treatments.
Because of his personal and political ch-cumstsinces. we consider
Senator Specter to be one of our top targets and one of our most likely
Republican votes.
Senator Specter's blU focuses on reducing health care costs through
incentives for women to seek prenatal and postnatal care, federal guidelines for
termlnaUy lU patients who wish to forgo needless medical care and use of
nonphysician health providers to deliver prhnary care services. It was later
combined with the proposals of other RepubUcan members (Senators
Kassebaum, Cohen, McCain, and Bond) to create the "Comprehensive Access
and AffordabUity Health Care Act of 1993 (S. 631). Citing frustration with the
lack of action on health reform, he offered S. 631 as an amendment to the
Department of the Envh-onment Act in March. It was tabled on a 65 to 33
vote.
Attached for your review is a summary of Senator Specter's health
reform legislation.
�SENT BYJXerox Telecopier 7021 ; 8- 5-93 : 4;46PM
4562889;» 2
S. 631, "Comprehensive Access and Affordability
Health Care Act of 1993,"
Introduced by Sen. Arlen Specter (R->PA)
PT9?gSlT The b i l l would achieve universal access through a
mandate on individuals to secure basic health coverage. The
health care market would be reformed to promote competition
between health plans based on quality, efficiency, and customer
service. A federally imposed limit on health plan premium growth
would back up competition to control costs. Preventive care,
streamlined paperwork, malpractice reform and antitrust reform
are emphasized, as well. States could elect to purchase coverage
for Medicaid enrollees through the small employer purchasing
cooperatives. Sen. Specter introduced this legislation in|1992
and has promoted i t aggressively ever since. His efforts tiave
been supported by other moderate Republicans.
Coverage; The b i l l imposes a mandate on individuals to enroll in
health plans offering basic coverage. Refundable tax credjfts
would be extended to low- and middle-income individuals without
employer-provided coverage. The tax credit would be linked to
the amount of the lowest cost available plan. Individuals and
small employers would enroll in coverage through health plan
purchasing cooperatives.
Benefits: A Federal Health Board would determine the covered
benefits. Preventive services and primary care would be
emphasized.
Quality! A surcharge on health plan premiums would fund oiktcomes
research. Health plans would have to publish "report cardi"
indicating quality of care and consumer service. Patient Jidvance
directives would be promoted to reduce unwanted heroic med:.cine.
Cost oortifttM^^Bti The Federal Health Board would determine
annual limits on the allowable percentage rate of increase
premiums for health plans.
In addition, the individual andd
small employer health Insurance markets would be reorganiz ed into
purchasing cooperatives to promote managed competition.
Standardized claims forms, malpractice reform, and antitrust
reform would reinforce cost containment efforts.
Flnanoinai
Not specified.
statusj- In April, Sen. Specter offered his b i l l as an ameiidment
to the Department of the Environment Act of 1993. His ameiidment
was supported by 33 Republicans ( l i s t attached) though notlall of
them should be counted on to vote favorably on such a b i l l in the
future.
�SENT BYJXerox Telecopier 7021 ; 8- 5-93 ; 4:47PM ;
4562889;» 3
COMPARISON OF KEY SIMIURITIES AND DIFFERENCES
PRESIDENTS PUN VS SPECTER'S S 631
SIMILARITIES
0
All Citizens would be required to carry a uniform aet of effective benefits either
through a group or individually. Low income persons would receive direct
public assistance.
States would establish Health Plan Purchasing Cooperatives (HPPCs) to sen/e
as collective purchasing agents for small businesses and individuals.
0
Federal Health Board would set annual limits on health plan premium growth.
0
Plans would have to take all applicants and all plans would be guaranteed
renewable.
Encourages administrative simplification, electronic billing, and computerization
of medical records.
0
Promotes primary and preventive care and the training of those provide rs.
0
Federal Health Board would collect and distribute "report cards" on cost,
utilization, health outcomes, and patient satisfaction.
0
Encourages home- and community-based long term care.
DIFFERENCES
Employer Responaibiiities
0
The President's plan builds on the nation's longstanding system ol
employment-based coverage, with employers contributing a share lof the
oost. Special provisions are made for small business. By contr-ast,
Specter's plan shirts to an Individual mandate, significantly increaslno
burdens on families.
^
Defined Benafltf
o
The President's plan specifies guaranteed benefits that include preventive
care, prescription drugs, pediatric dental care, and mental hearth. 1
Specter's plan leaves the development of the basic benefits packaiie to
the Federal Health Board, subject to limits of available financing.
Comprehensive benefits are likely to be affordable under Specter*a plan.
Financing
0
Financing Is not specified.
�DETERMINED TO BE AN ADMINISTRATIVE
MARKING PerJELO. 12958 as amended, Sec. 3.3 (c)
lniti»i«^ (y-^r
Date:A^xisJlL——
PRIVILEGED AND G ^ ^ ^ & i ^ MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Qinton
Chris Jennings, Steve Edelstein
Meeting with tiie Senate Small Business Committee
Melanne, Steve, Distribution
^"^ust 4, 1993
Tomorrow you are scheduled to meet witii Senator Dale Bumpers and tiie
bipartisan membership of his SmaU Business Committee. Tb^is in ^espojise to a
loSanding requestfromtiieSenator for such a meeting. When you met wttii him
i^dfvidually onVmontii ago. he had sought a meeting with his entire committee. A the
time you both concludedtiiat,given tiie existing tension over tiie budget recooaliauon,
it was better to conduct a meeting with Senator Bumpers alone.
RACKCROUNP;
As vou knowfromyour June meeting with him. Senator Bumpers is very
concemed about the small business impact of tiic Administration's health reform plan.
He believes it is critical to reducetiieburdentotiieabsolute extent possible. He is
supportive of increasing tiie lax deduction for the self employed but he does not bebeve
that is important as many other members do.
Also at that meeting, Senator Bumpers cautioned given the highly charged
partisan atmosphere in the Senate, he is not convinced that any RepubUcans are possible
but when pressed listed a dozen members including three on tiie Small Busmess
Committee, Ranking Member Larry Pressler of Soutii Dakota, Comue Mack of Flonda,
and John Chafee of Rhode Island. Other RepubUcans on the Committee mcludc,
Christopher "Kit" Bond of Missouri, who played an integral role ontiieFamily and
Medical Leave compromise for the Republicans and Comad Bums of Montana, who has
been very appreciative of the attention received to date.
The Democrats ontiicCommittee mn the specUum politicaUyfromPaul
Wellstone to Howell Heflin. However, most sharetiieconcern of tiie Chairman over tiie
smaU business impact, particularly: Sam Nunn, Tom Harkin, Joe Ueberman, HoweU
Heflin, Frank Lautenberg and Herb Kohl.
It is important for you to know that Senator Pressler wiU hand over a letter witii
at least 40 Senate RepubUcan signatures slating opposition lo an employer mandate.
Senator Chafee directed his staff to contact us to advise youtiiathe succeeded m tonmg
down the letter somewhat He beUevestiiattiieletter gives suffiaent room for them to
eventuaUy sign off on some employer requirements. His staff, however, has notfiUedus
with confidence.
Attached for your review are brief profiles of tiie members of tiie SmaU Business
��SENATE SMALL BUSINESS COMMITTEE
August 5, 1993
pFMOCRATS;
SENATOR DALE BUMPERS (D-AR) - As Chairman of tiie Senaie SmaU Business
? ^ S e . Bumpers has a particular sensitivity to small busing needs. He would be
" o ^ i surrogate speaker in his position as Comnultee Q i a i i ^ ^ esp^^^^^^
not only supportstiiebiU but is comfortable enough to speak on its behalf. His hnk to
smaU business is strong and hence he would be a valuable aUy.
As you know he is also known for his great concern about children's issues He
tiierefore can be expected to support phasing-in coverage for children first if such a
phie i^ isTecessa^ Senator Bumpers has adopted a wait-and-see attitode regarding
heSth^e GoinVback to the last Congress, he resisted attemptstobe Pushed -to any
health Z c camp. It is clear, however,tiiata smaU business mandate could be hard to
swallow.
Recent Develop menlai In his meeting withtiieFirst Lady in Jmic. Senator Bumpers was
^ ^ ^ ^ ^ ^ ^ f f ^ t h e smaU business impact of tiie AdministraUon's health refomi
plan. He believes it is critical lo reduce the burden to the absolute ^^^.P^f •
eJ^ressed his support of increasing the tax deduction for tiie self employed but he does
not believe that is important as many otiier members do.
Also attiiatmeeting, Senator Bumpers cautioned given tiie highly charged
partisan atmosphere m the Senate, he is not convinced that any RepubUcans arc
possible.
SENATOR CARL LEVIN (D-MI) - Senator Carl Levin has served Michigan since 1978.
His brother, Sander, is a Member of tiie House of Representatives, where he sits on tiic
Wavs and Means Committee. Along with Senator Riegle.tiieyare protective of
Michigan's auto indusuy. miions. andtiieunions' retirees. Senator Levm is concerned
about cost control and particularly about tiie President's plan havmg suffiaent cost
control mechanisms (a chief concern of organized labor andtiielarge mduslnal
manufacturers of his slate). He want slates to haveflexibiUtytodesign and mtiplement
their own cost control measures.
Senator Levin is also worried that a tax cap wiU be a benefits reduction (anotiier
union concem). He has also wanted lo know how many people wUl have greater
benefitstiianminimum benefits. Senator Levin also has mral and small busmess
concems. The Senator supports inclusion of good primary, preventive, hospice and home
care services intiiereform package. A cosponsor of HealthAmenca mtiie102nd
Congress, Senator Levin favors managed competition and is on record as wantmg to
support the Administration's plan.
�(i.e. unions).
SENATOR TOM HARKIN (D-IA) - "
^^^^^^^^
legislation or backed any particular 'f'J^^^^^^^^^^
He has a strong interest in aU
issues that wUl need to be «>"^P°°^?^°f^ P'^f"^/^^^^
Health Care
rural issues. He was recentiy named C^Chau
.elated to people with
Coalition. Harkin is a leadmg ^^^^^^^"i f ' ^"'^^^^^^^
^e Americans witii
disabiUties. (He has a brother who IS de^O^^^^^
Ensuring tiiat
disabiUties, is a major concern.
SENATOR JOHN KERRY (D-MA, - ^ " ^ " ' ^ ^ ^ ^ ' ^ ' . ' ' p - ^ . ^ i ' ^ ' X ^ ^ ^ ^ ^
1984. He is best known for his mvolvement - ^ ^ ^ ' J S ^ ^ m L i p m c a n l health
„ajor player on health P"'^ » j f ' . ^ t o T ™ ^ ^ ^ ^ ^ ^
w S o support the
views. He favors a managed competition ^PF°^" '° 7 "
f partioUar interest
President
AdministraUve
^ i ^ P*e^ fbi ^
'riSfeT
L browdm^
bfo.e^^^^^
i» »
,0 him. Kerry
wants to protect
omedi^
and
^
growth sector - Massacht^et^^^^^ ^^hrSi^™<:n«nUation ot such tacUities in tbe
«>mpetition ° » ' " ^ ' ^ ^ ^ ' ^ P ^ f y k S l „
and may be sensitive to major changes
^ T v T Hf
Aa^e^ectations are high and urges regular meetings with
Senators.
SENATOR ^os.mu^^i^^^ ,'::
h'e'^o;" Biu" b r h a s ^ F o b l e m
global budgets
caps. He
UUevel h^wTver. tb« the plan needs to have significant cost contaimnent
TTie Senator beUeves that betore ^^^^^ ^ ^ ^ Z t \ : ^ t o ° e X i t ° *e pl'li^
rpeTpriu^
'dSr'p^oTms^j^^^^^
i ^ Z o ^ ^
=
wait and see attitude.
r
r u t ' t h e t d t S S S proposal, tut has a
�senator Ueberman tel.
— ^ d ^^^^^^
C r c ^ t d i r = . r S t t ' - r t r . i d d , e .ass gets more benefits, they
wiU be willing to pay for reform.
SENATOR PAui. WELLSTONE (D-M^^
oare retorm. In March, he remtroduced
f "e"'Jf^^^^^^
the McDermott bill. Despite his suong
anaged competition h^
his suspicions ot
you. His strong desire
^
iJcu
ide-s ^j^:'^^^^^^^ - "
might pursue a single payer option).
SENATOR HARRIS WOFFORD (D-PA) "
^^^s^a.rwtSht'S
widely attributed to his support
^ ' h e
w i pa" ot afivemember
pursued this issue in the Senate. 1 ° ' ' ' ' s u p p o r t i n g a
forking group (with 5^"='"''Das^^^^^^^^^^
heal/h
approving
to a £nd" hich would 1^ returned to the states on a percenuge basis.
T1,M hiU was called the American Health Security Act, partially because Wofford
be«ev J ' s : ' s " i ^ l e iniportance ot the
^^d'S^t
a^d
beUeves that his proposal took ^ ' " ^ - - / ^ ^ ^ ^ ^ ^ J ^ ^ ; " ^ ^
in
r-wtttrK^^S-^^^^^^^
care in connection with reformHe is working witiitiieDemocratic Policy Committee health working group and ^
looking^at L T e ^ b insurance p u « coope^^^^^^^^^^^
very inteUectu^ and - - y ^"1^^^^^^^^^^^
beUe>Lg that
comprehend. For example, he dislikes "^tenseiyine ic ^
president CUnton
it is too large to understand and turns people off He beUeves mat rres
^ n & L must do a lot of educating on healtii care refomi-
�Harrisburg earlier this ye.. At the^^^^^^^^^^^^^
'ZXsZTZl rSerar;o^'~^^^
state al^rUoo restrictions.
�need education on the issue.
: C c t i - e " : ™ it"^ S d ^ c a p l He attended the DPC Focus Group on
Malpractice withtiieFirst Lady.
SENATOR ™.UMUT.NBE^^^^^^^^^
health reform will hit two b g ^^ustriM m New Jersey fe^MecUon in 1994 means he is
compames. This coupled wiU. the fa«
"i'J^^P^^^^^^^
effort in 1993 may
skittish on certain aspects ot the P^"" , °°;^'™'Vu^hed by Senator Daschle on single
also influence Senator Lautenberg's vote, "e * ^ pushed by ^jmo
payer; he resisted saying he was m the " ^ f . ^ X ^TSie whole team and beUeves
Ld'l^e t r ^ p o n a S ^ s to help provide access to health car. m mral areas and
the overuse of technology.
CFK4TOR HERBERT KOHL (D-Wl) - Senator Rockefeller beUeves Senator Kohl wiU
S L ^ Z o r t T p ^ I i d e n t Senator
«
Senate
spentfreelyof hi^^^^
S T u ' u T a ' ^ S ' I ' a s aLdidate not
Sd^rr: rpS i'^isrii: i f-^on
^isiSe
HCTF working groups.
WNATOR CAROL MOSELEY-BRAUN (D-IL) - Senator Moseley-Braun is one of tbe
^ X ^ m ^ ' - f the senate She i^^^^^^^
t 1 n 1 ; » " r S ^ n r C r h^^^^^^^^
providers unnecessarily dupUcate services.
U.at health care insurance
TT,e senator is particularly ^}-'^^'^^.^
3. save
supported Senator WeUstone's AmencanHea^^lh Secun^ ^^ceC^toPUbUc reports of
to! her reservations over his approach to »
'^^'^""'^^^^^
S - s X t trtet?. td'^ntell^^r S r
Presidenfs economic
�proposal, the Senator is curious about what other mechanisms the Health Care Task
Force is considering for revenue.
senator Moseley-Braun is also^..er««^^^^^^
a basic package of services. She is "^^^^"^^^ '^.^^^^^^ _-l^e sure that long term care
!°:-it°otKoX=: meeting with the Congressional Black Caucus on this issue.
THe senator also teeU that if managed ~-PJ^;^» t^'u^tSaTht^r^^^^^
health reform package.
At the meeting with DemocraUc women Senators at Jame^owr^^^^^
her support for the inclusion of reproductive services m thefinalpackage.
voiced
�pFP^TRI.ICANSl
patients put into poverty by Medicaid.
CHRISTOPHER -KIT- BOND (-MO) ^^^^ ^tuf^t^^^e"
hisfirstre-elecUon campaign, and is ready "
former chair ot the Repub«can Goyernots A^^^^
introduced an admmistrative
7 , ^ " , Bond has opiJosed a
JP^^
* f c o n d i U o n s .
h^ t l f b t : ^ h L r r r l ^ " t i l ^
He
r ^ ^ ^ ^.e^-P-exi. of the problem.
Senator Bond was a leader of the eight •^'P"^"'--^P"-^^^^^^^
(S.
Medical Leave Act. and also ' ° \ ' P ° ' ^ ° ; ' \ ^ ^ ' ^ ° ° ^ ' ^ i ^ ^ ^ r d t ^ hospitals and
176), which revises "ed^e ™ « - ^ ^ ^ ^ l ^ ^ h ^ ^
">
^'^
S c ' ^ a r n T e r r r r m , " a s ^ r d t r F ^ y and Medical Uave. Bond could be ke,
SENATOR CONNIE MACK (R-FL) - Senator ^ ^ J ^ ^ ^ ' ^ ^ ^ l : ^ , ^ ' U L L
RepubUcan Member of the House ot ^ ' P ' ™ ^ ^ ^ ^ ^ ^
Force. While
up for re-election in 1994 and serves on
^=P"^H,7o"tXE^th the First Udy.
he remains fairly quiet on health -^"'^ " ^ ^ j f ^ ^ ^ . ' ^ T X ^ ^ ^
"is support
Mack asked to be more mvolved with the ^ f ^ ^ ^ ^ ^ ^ ^ ^ ^ for early detection
tor long-term care - but » « ' f P' " / . f ^ ' " ^ ^ ? ^ ^
Rorida's recem
Health refonn may pose a difficuU chaUenge intas« ' ' f f <>° ^ °
„
fute reform efforts may contribute to 7;'':''=^"^j7^ty J oP^te any changes in
ignore the huge senior citizen commumties "? " ° " ^ ^ „ 3 ^ S a s e s in benefits. K
Medicare or mcreases on wealthy semors
^ ^ „ s seniors support,
Uie plan includes prescription -i^^ fverage andbng^n^^^^^
^^..^
�SENATOR CONRAD BURNS (R-MT): Senator Bums is Montana's jumor Senator. A
for^t^Uvestoc^^
and auctioneer who later set up a radio -™ ^ ^ ^ J ^ ^ ^
B u ^ is almost a stereotypical Eastemers' version of a western poht.aan- Bums was
elected in 1988, defeating incumbent John Melcher.
cn.tnr Burns has a low key style and a conservative voting record. Altiiough he is on
^ e fomm you participated in with Senator Baucus and Congressman WiUiams.
SENATOR DIRK KEMFTHORNE (R-ID) - Senator Kempthorne is afreshmanmember
frnm one of the few states that has two Republican Senators. It is not expectedtiiathe
^ ™ o ; t o^^^^^^
go against t^e RepubUcan ^ ^ ^ J ^ ^
on the Armed Services, Enviromnent, and SmaU Busmess Committees.
SENATOR ROBERT F. BENNETT (R-UT) - At 59. Senator Bemiett istiieoldest
m e ^ I r o'^f fhe Senate'sfreshmanclass, and enters having - d e a^formn^^^^^^
industry He currently serves on tiie Committees on Energy and Natural Resources,
B S
Housing, and Urban Affairs, SmaU Business, andtiieJo"it Economic
S t i t t e e Senltor Bemiett has co-sponsored no legislation with sigmficant health
policy impUcations.
SENATOR JOHN CHAFEE - Senator Chafee's role in healtii care reform jf frij^^chah^ t W ^ ^ ^ ^ 23 Republican Senators (including Minority Uader Bob Dole) who
a^e^orwnfon'a biU to rival our proposal. He comes to tiie reform debate witii residual
T c l Z T Z ii not for Presidential and partisan poUtics in tiie last Congress,tiierewas
e n S C e n s u s between his and many Democrats' biUs to move forward on h i ^
p S health refomi proposals such as: seU-employed tax deduction maease to
Z ^ l c e market refonn; expansion of community healtii centers and other heal^ care
s>Sems; and stale e!cperimenlation. He is weU known for his advocacy of
community health centers.
Chafee favors a managed competition plan. His plan is similar to our^ m the
.en^ tiiat he wants to set up health insurance purchasmg cooperaUvestiiatoffer a
ch^e of DlanT ButtiieOiafee plan is in sharp contrast to ours because his plan would
not forjf S^oyei^ to pay for coverage, require companies to join the cooperatives, or
implement price controls.
The Senator Ukestobe kept appraised and "consulted- on major le^la.^o'^^^
fact, in July in the ^^.LJs^ikJm^ Chafee complained about being "left out of the
drying of tiie budget plan. Chafee is adamantly opposed to employer mandates. He
�has talked about this aspect being the "dividing line between Republican and Democratic
a^pro^ches (to iealth ca'^e)." Alfhough. in a meetmg with Ira, he recogmzed the
E t y in providing universal coverage without the use of mandates.
�. Ho. mtu3^ ^pr^enti.e
au. be emph.su,d in 0. AimlnnlrotlonH proposal?
* HowwUlthc plan ensun thai smaa ftavinm..v fuivf the ahilUy to rcmain
competitive?
'^RfJATQIi KERRY:
* wm snuJl business be abk tc f^et in^nat
i. big po.,ls so tha, their rate. or.
competitive with big business, ondlor insurano: thai is affoniable?
* HOW fast WiU the phose^in ofuniv^al covers, be? Ho. muck shock can the
system take?
* Whal is the Adwi^istratw. 's position on proRix^sivefir^ancinuv.v. a flot premium
rtgardinc health coverage?
* How will the Admini'^tration en.^rt that prr.s,rKsive smaH business elements art
heard frvm in ihe debate er. er heaUh care reform, not Just or^niz^ions thnt wiE
oppose real reform?
^PM^rqu WOFFORD:
. Haw WiU em^r^S frms end marprudl, profitoble fimus h. trrattd?
• wm formers hnve to pay for health care for scasonolfnrm workers?
SEmTQRJSEJEWl
• wm there be a payroU tax? If so. what is the br^ahJown of rates?
�gg?y>f 7WJ^ lAUTENBERQ:
• WiU the plan okdnss the issue cf mvf contoinment?
^ Howwmthe
Admini^aticn eddrtss access U* and cost of prescription drugs -
tspecially for senior citizens ?
I
^SENATQRJ^Qm^
. Row does the AdminLstrotbn propose to limU Uu harden on small
busing
Imposed by any new maruLje?
• What are the Admini^n^s
current inclinothns reiiardin^
businesses to opt (fut of reaUinal purchasing cottperaHvts?
§ENATQRMOSMMMdMi
• wm there be a payroD tax jnpased on aU business.^? What raies are being
c^s-UUred
and wfuU L its' .stimated
unpact on smoU buslnc.^c.. thai
m4
I
currently providing fuU co^ra^e for their empliyees?
• Wmiofve employers (wiih 1,000 or mi/nr employres) hr able U, opt out of this
system and offer their o>.n health plans? If so, smnU employers, the uninsured and
public employees would ^er>e
the consumer base. Wouldn't this undermine
nform and potentiaUy cause a smaUer base U, caver an incrrased share of an alder,
sicker and poorer population?
'^F.NATpR
PRESSLER:
• Does the Admirustration phn to include any employer mandates in its health care
plan ? If so, what are they?
• How does the AdminLitratun propane paying for its plan?
�^FNATi^R BOND;
• How is the Admimstration going to see that mandates and payrtdl taxes do not
have a disproportionate impact on small businmes, or discourage themfrvm hiring
new employees?
• Whnl facets nf an Admini.tmtion plan, if any. wB du.^ nn rffaH tnfn^r
individual responsibUity and aUow the states some jlexU,Uity in udminisUring the
plan?
fP.NATtpR MACK:
• wm there be employer ma^uiaUs, and if so, how wm they he implemented?
• Does the Admimstration propose to ask for a payroU tax to pay for the. reform
pcdcage?
�• fiFNATORS ATTFNDING LUNCHEON
Mr. Bumpers
•Mr. Levin
\Mr. HarKin
Mr. Kerry
Mr. Ueberman
Mr. WeUstone
\Mr. Wottord
Mr. Heflin
\Mr. Lautenberg
\Mr. Kohl
Ms. Moseley-BrBun
Mr. Pressler
Mr. Bond
Mr Bums
Mr. Mack
Mr. Kempthorne
Mr. Bunnell
Mr. Cnafee
Mrs. Hutchison
t
S^t^TORS NOT ATTENDING LUNCHEON
Mr. Nunn
Mr. Wallop
Mr. Coverdell
�DETERMINED TO BE AN ADM'N'ST^^T'VE
MARKINGPer E ^ . 12958 as amended^ed 3.3 (c)
PRTVILEGED AND eeNFtDENTM-MEMORANDUM
TO:
FR:
RE:
cc:
HUlary Rodham CUnton
Chris Jennings. Steve Edelstein
Congressman Waxman
Melanne, Steve, Lonaine. Distribution
August 4. 1993
Tomorrow you are scheduled to meet with Congressman Waxman, chainnan of
the Enerev and Commerce subcommittee on Healtii and the Environment
A c c o m p S l ^ wUl be Karen Nelson, Subcommittee Staff Director, and possibly
Mike Hash.
BACKGROUND:
Of all the Committee Leadership. Congressman Waxman has beentiieniost
openly supportive of the Administrative efforts on ^eaUh^e refonn. Ho^^^^^^^ recently
his confidence has been shaken. Because of tiie extended penod of time the
dlvSTment of tiie policy has taken,tiielack of tolM consultations with him and bs
S
an'd tiie numerous cintradictoiy press reports, he has ^ ^ " ^ ^ ^ ^ ^ ^ ^^""^
tiie prospects for reform and more uncomfortable with his unabashed support for our
efforts.
In addition. Congressman Waxman has major concems abouttiiebudget
deliberations. He beUeves the Uberals have been sold out He is unhappy about the
Medicare cuts, tiie reduction intiieEamed Licome Tax Credit U addition^^ he was
especiaUy amioyed abouttiiehandling of tiie immmiization biU. He never hked >t b"t
X t o l d it was a priority by the Administration only to be told that if he wanted tiie
program he would have tofindthe money himself.
This combined witii his displeasure overtiiehandUng of such issues as Haitian
immigrants, selection of the AIDS czar, gays intiiemUilary and abortion. He resents the
^ f e s s wdthtiieGovernors and the receptiveness to granting Medicaid waivers which
u " s into tiie stats saving money at the expense of ^ l ^ ^ : ' " ^ ^ ^ ^ ^ ^
the historic disUke of the HousefortiieSenate. He resents tiie fact the House always
goesfirston the hard choices, taketiietough hit andtiienone Senator holdtiiewhole
Thine up AU this translates into a tremendous anxiety over tiie healtii reform plan,
fspedaUy Z low-income people who he feels wiU be thefirsttobe sacnficed if costs get
too high.
Congressman Waxman has a number of specific concems regarding tiie
�^^M^ ir:»r;i^n - ^^-rem^^tnSon.
Unked.
Judv Feder met with Karen Nelsontiiisaftemoon to lay the groundwork for a
' Z t ^ : ^
TdtsS r m t y ° o " «
^ r ^ ^ ^
^ T d e - T e r a r ' ^ ; (.)
Medicaid into the system and ^e con«m * a ,
pain and suffering damages.
TALKING POINTS:
Senate to strike provisions not directiy related to defiat reduction).
You may wish to mention how
J^^^^^^^^^^
nnp^tandinE commitment to reform and his steadfast supportfortiieAdministration s
effo^Ton h t S ^ f l m . Discuss how much we need him and his expertise. Ask if he
and his staff might be accessible during Augustforconsultauon.
Medicaid; Congressman Waxman wUl want to be assuredtiiatMedicaid recipients are
folded into tiie program as quickly as possible.
Medkais; Safeguarding Medicare beneficiaries is also important to the Chairm^ You
^ ^ t o stre^ that'our plans caU for Medicare to
^^S^^^^^^^^^^^
Over time and only witii strong programmatic and benefiaary projections, stat^ may
^ve r option of folding in MedicSe recipients. In addition, individual benefijanes
may hte thToption to rlceivetiieirMedicare benefitstiiroughtiieplans offered by tiie
alUance.
�Pfnpfit Package: Congressman Waxman supports a comprehensive benefits package and
would oppose any effort to phase-in benefits. His concem is that, given political and
fiscal pressures, you might never reach comprehensive coverage for the poor. He also
will want assurances that current Medicaid benefits which are more generous thari our
plan wiU be maintained and offered as wrap-around coverage for those who are eligible.
pmplnyer Contribution; A related concern is tiie plan to whichtiierequired premium
contribution for employers is Unked. He opposes Unking it to tiic lowest cost plan,
preferring instead to link it to tiie average cost plan. He fearstiiatif you Ue it to tiie
lowest cost plan you wiU wind up with aU poor people intiiatplan. The result, m his
opinion, will be a two-tier system with plans for the poor and plans for tiie weU-to-do.
�DETER.MINED TO BE AN ADMINISTRATIVE
MARKINGPer LO. 12958 as amended, Secy 3.3 (c)
Initials: T ^ ^ ^
Date: V S S I / L S I / L L
PRIVILEGED AND eOHO^SEM^^ MEMORANDUM
TO: HUlary Rodham Clinton
FR: Chris Jennings, Steve Edelstein. Sean Burton
RE: Meeting with Senator Paul WeUstone
cc: Melanne, Steve, Distribution
August 2. 1993
Tomorrow you are scheduled to meet with Senator Paul WeUstone from
Minnesota. As you know, this meeting was scheduled at his request in a
phone conversation with you.
BACKGROUND:
We believe the meeting wUl focus on mental health Issues as weU as a
general political discussion of the current status of health reform.
Senator WeUstone is committed to improved coverage of mental health
services. This was evidenced by his attendance of Mrs. Gore's mental health
briefing up on the hill earlier this spring. At the time, he expressed some
interest in establishing a Senate Mental Health Working Group along the lines
of Congressman Kopetski's group in the House. Earlier in the year, he was
very excited about the improved mental health provisions in his health reform
bUl from those in his previous bUl.
The Senator may also touch on McDermott's working group of Single
Payer advocates in the House. Despite the fact that the Senate blU ortiy has
five current cosponsors, he may express setting up a similar group for the
Senate.
It should be noted that whUe Senator Wellstone prefers a single payer
plan for health care reform, it appears that his staff is more ideologically
attached to this approach than he is. According to Lois Quam, a member of
our working group who was instrumental in Minnesota's state reform efforts
and who also has a longstanding relationship with Senator Wellstone, he was
very helpful in mobilizing support for the passage of their reform biU even after
their commission had decided agednst a single payer model. She believes that,
in the end. there is a strong chance that he wiU do the same for our plan. To
accomplish this, however, at some point, we may need to bypass his staff and
use Lois Quam as a conduit or go directly to the Senator.
�Finally, Senator WeUstone may be Interested in discussing you plans to
visit Minnesota on August 17th. You are scheduled to participate in a forum
with Congressman Sabo. Both Senator WeUstone and Senator Durenberger
have been invited to that event but each is interested in having you participate
in a separate event with them whtie you are there.
�DETERMINED TO BE AN AD.MINISTRATIVE
MARKINGJPer EI). 12958 as amended, See. 3.3 (c)
Initials: _u_^__L.___ Date:iW(S/||
Date:-Li
PRIVILEGED AND (KXNTIDENTIAL MEMORANDUM
TO:
FR:
RE:
cc:
HUlary Rodham Clinton
August 2. 1993
Chris Jennings, Steve Eklelstein
Joint Message Group and DPC SmaU Business Focus Group
Melaoine, Steve. Distribution
Tomorrow you are scheduled to attend a two-part meeting sponsored by
the Democratic Pohcy Committee. The first half of the meeting Is the Joint
Message Group. As you may recaU, the House Members indicated today that
their workload tomorrow may make it impossible for them to attend. There is
a three-part agenda for the first half of the meeting:
1)
To discuss and review the September timetable including the
consultation, health care workshops, and plan unveiling briefing
schedules;
2)
To discuss the bipartisan health care workshops after the
Presidential address unveUing the plan; and
3)
To discuss the congressional materials we are preparing for
distribution to the members prior to the August recess.
The second half of the meeting wiU be a Senate Focus Group meeting
addressing health care reform and smaU Business. It wiU take place in a
separate room immediately foUowing the message meeting.
JOINT MESSAGE GROUP;
September Timetable: Attached Is a revised draft for consultative meetings
and briefings in August and September prior to the release of the plan. This
schedule has been revised to reflect the discussion with the Congressional
Leadership this morning.
Health Care Workshops After the Release of the Plan; The leadership has
expressed interest in holding bipartisan sessions on a variety of health care
issues foUowing the Presidential address. Their input on the date and
�structure of such sessions would be helpful.
Congressional Recess Materials; As you know, the members have asked for
materials to help them discuss health reform with their constituents during
the recess. In response, we have prepared the draft that we gave the
leadership to review this morning. It Uicludes sections on the goals of the
plan, the need for reform, the cost of doing nothing, a description of how the
new system wiU work, questions and answers about the plan, a section on
smaU business and health care, and a description of the task force process.
We wtil be incorporating their comments in order to have the notebook printed
and sent up to the HUl by Thursday. The Senate and House leadership wUl be
responsible for distribution.
SENATE FOCUS GROUP ON SMALL BUSINESS:
As of the writing of this memo 17 members were scheduled to attend the
Focus Group on SmaU Business. These Members run the poUtical spectrum
from liberal members such as Senators Mikulski and WeUstone to more
conservative members such as Senators Exon and Deconcini. They wiU be
interested in a briefing on the plan and how the financing wUl affect smaU
businesses and their employees. The theme that smaU business has been the
victim, not the viUain of the current health system should play weU. Also, the
responslbtilty theme seems to hit a responsive chord. You may wish to use the
side-by-slde chart on smaU business now and under reform from the smaU
business briefing book for this purpose. After your presentation, there wlU be
genera] discussion and questions and answers.
�Health Message Board Meeting 8-211;
(Attendance as of 6:00pm)
SENATORS
Repretentativts
Reid
Rockefeller
Wofford
Kerrey
Boxer
Riegle
Daschle
Mitchell
Kennedy
Pryor
12:30-1:30pm
Fazio
Bonior
Kennelly
Richardson
Lewis
Derrick
Hoyer
�SMALL BUSPsESS, HEALTH CARE COCTS, AND THE CLENTON REFORM PLAN*
SmaU businesses face higher costs and more unstable insurance premiums. The Clinton plan wUl reduce th
burdensome costs.
TODAY
THE CLINTON REFORM PROPOSAL
High Administrative Costs: Higher administrative
costs kill small businesses. These costs account
for as much as 40% of tbc policy costs compared
to aboul 5% lor large companies.
Cuts Administrative Costs: Administrative costs
wiU be dramatically reduced by tbe fonnation of
bealth aUiances which wiU streamline and simplify
administrative functions.
Faster Rising Costs: Premiums for small
employers rise at a faster rate than for other
employers — as much as 50% in any given year.
Aggressively Controls Costs: Health reform wiU
aggressively control costs through market t)ased
competition backed up by an enforceable budget.
|NAM']
Inequitable Self-Employed Tax Policy: Today,
unlike big businesses, small, self-employed
businesses cannot deduct 100 percent of their
health care cxf>cnses. This has the practical effect
of funher increasing the cost of insurance that is
alread) priced higher than that available to larger
firms.
Increases Deduction to 100% for SelfEmployed: The Administration proposal wiU
ensure that tbc sclf-cmployed arc treated equally
under our nation's tax policy, allowing them to
deduct tbe full value of tbeir bealth insurance
coverage.
Workers' Compensation Costs: In today's system,
high health carc costs are surpassed only by the
skyrocketing costs of workers' compensation
insurance. Betuxcn 1980 and 1985, workers'
compensation medical cost grew more than one
and a half times as fast as medical costs and now
accounts for $24 billion a year in bealth care
expenditures.
Reform Workers' Compensation: The
Administration's proposal reforms tbe bealth
comf>ODent of workers' compensation insurance,
making il more efficient and reducing costs by
covering work related injuries through bealth plans
in tbe same manner as non-work related injuries - eliminating duplication and improving quality
for workcre wbo receive services.
Small Employers Have No Control: SmaU
businesses and their employees have Uttic or no
ability to determine tbc level of premiums they pay
or the infonnation they receive about the services
the plans provide.
Assures Employers a Place on AIIiaDce:
Business owners will sit on aUiances to ensure
sensitivity and responsiveness to needs of
employers in terms of costs, administrative
simplification and quaUty.
Volatile Costs: Small businesses face large
variations in the costs of similar plans. Nearly
identical benefits packages can range in price by as
much as 350%. [Blue Cross/Blue Shield, Survey
of Six Sample Plans, January- 1992]
Stabilize Costs: Tbe Administration proposal wUl
stop tbe wild fluctuation of premiums in tbe small
group market through community ratings and
insurance reform. We will outlaw discriminatory
pricing and ensure smaller predictable cost with
aggressive cost controls.
All answers
based OD assumptions of policies which have yet to befiD&Iizedor releued.
�SMALL BUSINESS, INSURANCE ABUSES, AND THE CLINTON REFORM PLAN •
Many insurers discriminate against smaU businesses, often charging more for simUar policies or refusin
provide coverage at all Abuses within the insurance industry hit smaU businesses particularly hard
TODAY
THE CLINTON REFORM PROPOSAL
Hassle Factor: Small business owners wbo cover
their employees spend inordinate amounts of time
trying tofigureout a maze of insurance policies,
forms, and requirements. What's worse is that tbe
rules of the game arc changed all tbc time;
unfortunately, they are changed by the seller and
not the buyer.
Elimiaates Hassle: Tbe employer DO longer has 1
to worry about tbe headaches of selecting
1
insurance for his/her employees. Tbc
1
employcr/employec-run bealth alUancc negotiates 1
rates, provides information on plans, inCTeases case 1
of enrollment and absorbs the manpower drain.
1
Then, tbc employee, not the employer, chooses the 1
plan. Regardless of tbc choice, however, tbe
1
employer pays the samefixedamoimt.
1
Small Risk Pool: Fewer employees mean a
smaller pool to share the risk. Insurers frequently
charge'more for these policies.
Spreads Risk Evenly: Tbc proposal consoUdates 1
small businesses in purchasing pools to give them 1
tbc same bargaining power as large
firms.
1
Underwriting and Experience Rating: Medical
underATiting is the practice of basing premiums on
perceived risk and medical history. Experience
rating is when insurers jack up costs after an
employee falls ill or gets injured.
Prevents insurers from raising rates or
dropping coverage after Illness strikes: Tbe
Administration's proposal wiU reform practices
such as underwriting and experience rating.
Under the Qinton plan, you can drop your
insurance plan, bultiicycan't drop you.
Price Baiting and Gouging: Many insurers
engage in "price baiting and gouging' offering
"discount" rates for thefirstyear of coverage only
to charge much higher prices in the next year
when pre-existing condition exclusions expire.
Outlaws Price Baiting and Gouging: The plan 1
will end the days when insurers can raise and
1
lower premiums at tbeir whim. Wc will bring
1
predictability and fairness to tbe cost of insuring 1
famUies and workers.
1
Occupational Redlining: Some insurers simply
refuse to cover entire industries perceived to be
high risk.
Covers Everyone: Under tbe Qinton plan, there 1
is an end to occupational redlining.
1
Guarantees Renewal: Tbe Qinton plan
Refusal lo Renew Policy: Afier afirstyear of
reasonable rates, small businesses often face higher guarantees insurance renewal and stabilizes
premiums.
costs and difficulty obtaining renewal.
'
|
AI] reioni! scecarios are based oc assumption* oi pobcies which have yet to befinalizedor rele*ied
1
1
1
1
1
1
1
1
1
�DETERMINED TO BE AN ADMINISTRATIVE
MARKINGPer E.G. 12958 as amended. Sec. 3.3 (c)
Initials: ^ C r - ^ DateASJlS/_U___
P R I V I L E G E D AND eOWFlDEKIlAL MEMORANDUM
TO:
FR:
RE:
cc:
HUlary Rodham Clinton
August 3. 1993
Chris Jennings
Meeting with the Tuesday Repubhcan Discussion Group
Melanne, Steve, Lorraine. Distribution
Tomorrow you are scheditied to meet with several Members of the House
Tuesday RepubUcan Discussion Group. The meethig was arranged foUowing a
conversation between Congressman Ronald Machtley (R-RI) and Ira on a trip
to Rhode Island. (Machtley is a founding member of this group.)
BACKGROUND
The Tuesday Republican Discussion Group (also known as the Tuesday
Lunch Bunch, and previously the Progressive Discussion Group) is a group of
generaUy quite pro^esslve Republicans that started meeting together within
the last year or so. Many of the members of this group are on our best chance
Republican target Ust. A membership Ust and background summary of
expected attendees is attached.
Because there are so many Members in both the House RepubUcgui
Tuesday and House Republican Wednesday groups, we (Congressman
Machtley and us) had originaUy hoped to combine the two organizations
together for one meeting. However, the Chairman of the House Wednesday
group — Congressman Jim Kolbe (R-AZ) — expressed concern about opening
up the Wednesday group for this purpose. Respecting his wishes, we
scheduled separate meetings.
Congressman Fred Upton (R-MI) is generaUy viewed to be the Tuesday
group's leader. He recently dropped the "progressive" title out of the group's
name because he felt it scared off too many people. Since he Is a Member of
the House Wednesday group (Machtley is not). Upton did not see the rush for a
meeting with the Tuesday group. (A Tuesday meeting was hnpossible because
he had to attend the funeral of Congressman Paul Henry (R-MI)). In any
event. Congressman Upton may not be in attendance for this first meethig.
However, you should probably mention his name during your introduction.
�FORMAT AND TALKING POINTS
Congressman Machtley wiU introduce you to the Members of the group.
FoUowing the introduction, he would like you to give a brief summary of the
status and detatis of the plan. I would suggest that you focus a good portion
of your remarks on our approach with regard to smaU business. Like aU
Republicans, they also wiU Ukely be interested In hearing about our
commitment to doing serious medical malpractice reform. Other than an Issue
presentation, I would also talk about our great desh-e to work closely with and
have the support of Republicans throughout the development of the plan and
hnmediately thereafter. FoUowing yoiu- 5-10 minute presentation, he woitid
Uke you to open it up for questions, answers, suggestions.
�YES
Sherwood Boehlert
Mike Castle
*
Jennifer Dunn
Bob pranks
Dean G a l l o
.•Wayne G i l c h r e s t
*
^
Fred Grandy
Jim Greenwood
*
Steve Gunderson
Dave Hobson
3t
Pete Hoekstra
Stephen Horn
Amo Houghton
X
Nar-cy Johnsor:
3C
Peter King
Jim Kolbe
Scott d u g
Rick Lazic
Jim Leach
David Levy
Jerry Lewie
Jim McCrery
Alex McMillan
Jan Meyers
Connie Morella
John Porter
*
KO
�YES
Jack Quinn
X
Jim Ramstad
Ralph Regula
Tom Ridge
QiriB Shaye
Z
Olympia Snowe
X
Peter Torkildson
X
Fred Upton
X
B i l l Zeliff
Z
Dick Zimner
Z
Peter Blute
X
C l i f f Steams
X
NO
�THE TUESDAY GROUP
CONGRESSMAN PETER HOEKSTRA (R-MIl: Freshman Congressman Hoekstra
(pronounced Hoke-stra) won national recognition by defeating Guy Vander Jagt, a
highly visible inciunbent and a member of the Republican leadersfup, in the primary.
Hoekstra was a business executive without prior govemment experience. He is a
conservative who promised to spend only six terms in the House.
Hoekstra is a member of the Education and Labor Committee and is part of the
Tuesday and Wednesday Groups.
His health views are not knowTi at this time.
OONGRESaVlAN SCOTT KLUG (R-Wfi: An upset winner in 1990, Congressman
Klug improved his record with 63% of the vote in 1992 in normaUy Democratic
Madison. A former TV anchorman, Klug is one of the new breed of RepubUcans less worried about the free-market and defense but hostile to higher taxes and
govemment intervention He is considered conservative but thoughtful. Klug is a
new member of the Energy and Commerce Committee, part of the Tuesday Group,
and previously served on the Select Committee on Children and Education and
Labor. He is both a White House and a Bonior target
While Klug's health care views are not known, he has caUed for early intervention
programs for at-risk chUdren.
CONGRESgViAN TERRY LEWIS (R-CA); Congressman Lewis is perhaps best known
for the role he has played in the battie between the Michel and Gingrich wings of the
Republican Party in the House. An eight-term Congressman and a member of the
Appropriations Committee, Congressman Lewis rose through the RepubUcan
leadership ranks reaching the number three position WhUe somewhat more
politically conservative than moderate, Lewis is nonetheless identified with the
accorrunodating wing of the House GOP - demonstrated by his support for the
bipartisan budget-summit agreement that included tax increases.
As a result of this vote. Congressman Gingrich, who strongly opposed the
compromise, backed a challenge to Lewis' re-election as Republican Conference
Chairman. WhUe this attempt faUed, Lewis was ousted at the start of this Congress
by Dick Armey of Texas with Gingrich's backing. Recentiy thought of as a potential
successor to Minority Leader Michel, his time now seems to have passed. Lewis has
a generally conservative record, with the exception of his work on environmental
issues, a major concem in his district which borders Los Angeles.
Lewis is a former insurance agent and wiU likely be sensitive to their concems.
�WhUe his specific health views are unknown, his support for our plan is unlikely.
CONGRESSMAN ALEX McMILLAN (R-NQ: Conservative but pragmatic.
Congressman McMiUan has become a key aUy of the House RepubUcan leadership.
For example, McMiUan supported the 1990 bipartisan budget summit agreement
backed by congressional leaders and the President, even tiiough it irKluded gasoline
and cigarette taxes. A fonner busiivessman, he consistentiy opposes Federal
mandates on business. He voted against an increase in the minimum wage and
against the famUy medical leave biU.
McMiUan has been a leader on the House RepubUcan Task Force on Health studying
health care reform. He co-sponsored the House RepubUcan health care reform biU,
which has been reintroduced in the 103rd. He led the subgroup examining
administrative reforms in health care and cosponsored a separate health care
administrative reform biU. He also has introduced malpractice reform legislation
There are a substantial number of insurance companies headquartered in his district
CONGRESgVlAN lACK OUINN (RrNY): Freshman Congressman Quuin scored a
major upset by winning with 52% in a heavUy Democratic district The district
includes most of Buffalo and some of its suburbs. A seU-described moderate, Quinn
campaigned for major federal infrastmcture programs. Quinn is a former pubUc
administrator and EngUsh teacher. He is a member of the Veterans' Affairs and
Public Works Committees.
Quinn's health care views are not known but he is a White House target He is
Roman CathoUc and anti-choice.
CONGRESSMAN TOM RIDGE (R-PA): A Vietnam veteran witii a moderate voting
record, Congressman Ridge represents Erie and its surrounding steel coimtry. Ridge
comes from a working-class fairuly and is a graduate of Harvard. He serves on the
Veterans, Post Office, and Banking Conunittees. Ridge is considered a thoughtful
Republican and may run for Govemor in 1994. He is one of Congressman Bonior's
targets.
Ridge's health care views are not known He has a hearing problem himself and wiU
undoubtedly look out for veterans' interest in health care reform. A Roman CathoUc,
he has supported abortion funding in cases of rape and incest
CONGRESSMAN CHRISTOPHER SHAYS (R-CI): A former Peace Corps volunteer
and state legislator. Congressman Shays has been a maverick both in the state house
and the Congress. WhUe not as Uberal as some had hoped, he is one of the few
RepubUcans with a primairily urban constitoency - a district with some of the
wealthiest communities in the nation. 9iays sits on the Budget and Govemment
Operations Committees. He is both a White House and a Bonior target
�In December he responded to the President-Elecf s request concerning health care by
stating his support for managed competition but concem about global budgets and
employer mandates, especiaUy for sniiaU businesses. He noted that in the past he had
supported legislation which would: bring commimity health and other simUar
centers imder the Federal Tort Claims Act; cover pre-existing conditions; and
estabUsh health savings accounts. He also stated his support for preventive health
funding through early intervention, immunization and screening. He asked that any
plan adopted include malpractice reforms, paperwork simplification, and increased
funding for Community and Migrant Healtii Centers. He wants to increase penalties
for health care fraud, standardize billing, and provide incentives for hospitals to
share technology, as weU as induding coverage of mental health.
Local groups wUl have an important impact on Shays and Secretary Shalala may be
influential as weU.
Recent Developments: At the June dinner given by Rep. Kasich for the First Lady,
Rep. Shays stated his beUef that smaU business wiU opt to play but not pay as tiiey
have been.
CONGRESSMAN PETER Q TORKILDSEN (RrMAl: Freshman Congressman
Torkildsen served in the state legislature and as Massachusetts Commissioner of
Labor. He strongly resembles his former boss, Govemor WilUam Weld, with his
fiscally conservative, pro-business stand and his support - as of AprU - of abortion
rights. Torkildsen won his seat with 51% of the vote and Democrats hope to
recapture it in 1994. He sits on the Armed Services as weU as the SmaU Business
Committee.
Health care reform is one of TorkUdsen's priorities. He supports a pro-business plan
of vouchers and tax credits. He is one of Congressman Bonior's targets.
CONGRESSMAN BILL ZELIFF (R-NHl: A protege of former Gov. John Sununu,
Congressman Zeliff won in 1990 on his image as a successful businessman - and after
spending $400,000 m the GOP primary. Zeliff s district iiKludes MaiKhester and
eastern New Hampshire. He retained it with 53% of the vote in 1992. Zeliff
is a member of the SmaU Business, Govemment Operations and PubUc Works
Committees.
While Zeliff s health care views are not known, one possible indicator of his views is
that as the owner of a smaU resort, he has linked his business success to
"entrepreneuriaUsm" and fmgaUty.
CONGRESgvlAN DICK ZIMMER (R-NT): Congressman Zrnimer is serving in his
second term representing some of the coimtry's wealthiest communities. Zimmer has
a law degree from Yale and served in the State Senate. He was also head of New
�Jersey Common Cause in the 1970's. He is very conservative in fiscal matters, but
more moderate on other issues. Zimmer serves on the Govemment Operations
Committee and was a member of the Select Ccnnmittee on Aging.
WhUe his health care views are not known, he can be helpful if given a specific role.
He is a White House target His influerKe, however, is said to be limited. His
Democratic opponent in 1990 was partiaUy neutralized by 2^immer's pro-choice
stance.
�
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Title
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Health Care Task Force Records
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White House Health Care Task Force
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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Congressional Briefing Memos – First Lady, 1993 [1]
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 2
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Box 8
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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2/6/2015
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42-t-12092992-20060885F-Seg2-008-004-2015
12092992
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https://clinton.presidentiallibraries.us/files/original/62b272be4a7b2c69e4e7c89c8eab2f3c.pdf
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Health Care Task Force
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3680
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S
52
3
8
1
�Stop Benefits for Aliens?
It Wouldn't Be That Easy
By SAM HOWE V E R H O V E K
Special 10 Tht New York Timej
HOUSTON, June 7 — On a sultry day in July, a 25-year-old
woman, Laura C, waded across
the Rio Grande, slipped past the
Border Patrol in Brownsville,
Tex., and boarded a $49 Southwest
Airlines flight to Houston.
Hoping for work and a better
life, she has instead subsisted on
govemment benefits and become
one more straw threatening to
break the back of America's uneasy patience with illegal immigrants.
With at least four million illegal
aliens m the country, politicians
from Florida to California have
intrtxluced dozens of bills to stop
giving them services like education to health care.
Laura C, the unmarried mother of two children with a third on
the way when she arrived,
reached Houston with no English
and no plan beyond her sister's
assurance that she couid find
house-cleaning jobs at $40 a day.
" I had never heard of food
stamps; I had never heard of
W.LC," Laura said, naming the
two Federal programs that put
$46.50 worth of food on her family's table each week. (She did not
want her last name used for fear
of being found and deported.)
Illegal immigrants are not always a dram on the American
economy. Many pay more in direct and indirect taxes than they
get in govemment services. But
Laura and her children epitomize
the immigrants who angry taxpayers say come here m violation
of American law and live off the
American safety net.
Nevertheless, it would be extremely difficult, and perhaps
Continued on Page BIO, Column 1
Texas Is ths onty State that
hascaicuiatadtfwnet
oostrof illegai Immigraaon.
Thase figuras, caiculatad m
S^stembar 1993, are
basad on a state estimate
of 550.000 HIagal afens.
Annual revenues illegal
aliens cx>ntr1bute S290
Annual cost
$4Sa mMon
WaNar* (AJFJDX.) 1%
12%
Education
fi8%
Most of the benefits are available because Laura's baby boy,
Jacobo, born at public expense at
Ben Taub General Hospital here
five months ago, is an American
citizen.
W-^^VltiC**^'' tlZ** > .•,",-.V
SourcK TaxatOmauarinmlgmaoa
The New York Times
Who's Eligible?
The range of government oenefits available to immigrants varies
greatly depending on their legal status, but even illegal immigrants
are entitled under Federal law or court rulings to some services.
The chart shows what services are generally available to
immigrants ot• varying status
A
PROGRAM/SERVICE
Aid to Famines with
Dependent Children
(welfare payments)
Unemployment insurance
/
/
Emergency neaitn care
/
/
Meaicaia
/
/
Food stamps
/
•
/
/
•
•
•
•
/
•
•
W 1 C (suDDiemental tood
coupons tor mothers witn
small children)
Public eoucation tnrougn
12th grade including
Head Start ana scnooi
meal programs
College loans
Federal housing
/
/
/
/
DEHNING IMMIGRANT STATUS
Permanent
resident
Generally an immigrant nere witn legai papers
often awaiting aoDrovai tor ciiizensnio
Refugee
A oerson wno nas oeen arantea refugee status or
asylum Dy lne Fecera' Gove'-nmen:
Asylum applicant
A oerson m tne orocess of apolying for refugee
status
Temporary
protected status
A person m tne country legally, but required to
leave oy a certain aate
Illegal
An unoocumentea alien
Source Natiorai /mmiorairon Law Center umiea States immigraiKm ana Naturatizaiior^ Services
Coniinued From Page Al
even legally impossible, to reduce
aid to illegal immigrants significantly. Public schools would have
10 turn away children, and hospitals would have to refuse accident
victims and pregnant women.
Education and emergency medical care represent at least twothirds of the estimated $7 billion
spent each year by all levels of
government on illegal immigrants, acc-irding to (he Center tor
Immigration Studies, a research
Broup m Washington,
But longstanding Federal and state
laws and court rulings require hospitals to provide emergency care for
anyone, regardless of immigration
status, and the Supreme Court ruled
in 1982 that any child on American
soil has the right to an education.
Barring catastrophic illness, by far
the single largest cost that Laura s
family will pose to taxpayers is the
education of her three children: Jesus, 5 years old, who registered for
kindergarten last week; .Nicole, who
turns 3 in a few days, and Jacobo.
The Federal, state and local governments pay an average of $4,683 a
year for a student in Houston. If Laura's three children go through high
school, the bill would come to more
than $182,000 in today's dollars.
Nationwide, the cost of educating
illegal immigrants is estimated to be
at least $3 billion a year — and $4.5
billion when the American-born children of illegal immigrants are included.
As for health care, many proposals
10 cut aid would do little more lhan
transfer to local govemments the obligations that have been assumed by
Federal programs, like Medicaid,
which helped to pay for Jacobo's delivery in January.
Welfare, by contrast, is largely unavailable to illegal immigrants, a
vast majority of whom work and pay
some taxes. Only a small minority
receive benefits, generally through
relatives who are American citizens.
Laura does not qualifv for Aid for
Families With Dependent Children,
the welfare program that provides
cash to recipients. But for now, she
and her daughter, Nicole, qualify for
$12 a week in food coupons from the
Women, Infants and Children program, a supplemental Federal benefit for nursing mothers, who are eligible regardless of citizenship, and for
children under 5. Jacobo qualifies for
another $8 a week under this program
Any long-term benefits are likely to
come through Jacobo, whose rights to
welfare are the same as those of any
native-born American,
Politicians who favor deep reductions in all tyjses of aid to illegal
immigrants hope to change the rules.
Some, like Gov Pete Wilson of California, have called for a constitutional amendment to take awav citizenship rights from the American-bom
children of illegal aliens. A California
ballot initiative would bar illegal immigrants from schools. If approved,
the measure is certain to face legal
challenges.
There has generally been less pressure for such aggressive action in
other parts of the country — even in
places like New York and Texas,
which both have large populations of
illegal immigrants.
Proponents of the changes sav they
would discourage people like Laura
C. from entering the countrv But
manv experts, and immigrants themselves, say curtailed services would
not deter people, because their primary goal is to find a job.
"For those who have come to work
— and believe me, thai is most — ii
won't matter if vou cut the benefits."
Laura said. "There may be problems
when thev come here, thev may find
work or they may not. Maybe the
work will not pay as much as they
thought. But they'll come anyway. "
Supporters of a crackdown counter
that even if the cutoff fails to stem the
tide. It IS outrageous for taxpayers to
bear any burden for those who have
entered the country illegally
" An illegal alien dilutes in part or
altogether the legal rights and privileges of a legal citizen, " said Representative Lamar Smith of Texas, the
ill
�chairman of the House Republican
Task Force on Immigration.
But many expens warn that unless
the measuresJ)eing proposed succeed
in keeping illegal immigrants out altogether, carrying ihem out could ultimately pose health and safety problems for all Amencans.
"Let's suppose we want to reallv
save some money and get tough with
all these illegal immigrants ' said
Prof. Nestor Rodriguez, a sociologist
at the University of Houston who has
studied immigrants here. "Here is
what you would do: Close the aoors to
the hospitals, even when a woman is
coming to give birth. Lock the kids
oul of school, and tell them thev have
no future at all. Do not pay for their
immunizations. Do not let them use
clinics. That is the way to save some
really big money. Bul at what cost
later on?"
NEW
YORK
^''-^^ES.
WEDNESDAY,
-'^'^E
8. 1994
Marginal Existence
With Much Help
Laura C. and her family scrape by.
It lakes her an hour and a half to
travel across town bv bus to the cityrun West End Mulii-Service Center
where she picks up $26.50 in food
stamps and about $20 in coupons
from the Women. Infants and Children program. She also receives a
small stipend under the food-stamp
program for diapers.
In a cramped room at the welfare
center, large posters in English read
"Food Affects Our Moods" and
"Food Influences Our Appearance. "
"1 don't even know what they say, "
Laura said.
The W.I.C. coupons, stamped "least
expensive brand required," provide
the family with nine gallons of milk a
month, four dozen eggs, three pounds
of cheese, four bottles of luice, two
large boxes of cereal, two pounds of
beans, one 18-ounce jar of peanut
butter, two pounds of carrots and
eight 3'/2-ounce cans of tuna fish.
"Some weeks there isn't enough at
the end," Laura said, "but most of the
time we can get by."
Laura's older sister arrived here
illegally eight years ago and did well
enough as a maid to send money to
her parents in Veracruz, Mexico,
Unlike her sister, who has no children, Laura said her decision to come
here was less a calculated decision
than an act of desperation.
None of the three fathers, all in
Mexico, have ever seen their children
or provided support, she said.
Laura says she expected to work
and her sister to help watch the children. She worked briefly cleaning
houses for $25 a day and cooking
tamales at an outdoor market. But
then, she says, she got into a fight
with her sister, who demanded that
she get an abortion when she was six
months' pregnant with Jacobo.
She refused and moved out: she
lost both jobs because she had no one
to look after the children. One prospective employer told her that if she
applied for a job she would be reported to immigration authorities.
Desperate, she turned to a private
women's shelter, which set her up in
a rent-free one-bedroom apartment
near a huge coffee factory in Houston's East End and told her how to
apply for government benefits for her
children.
Virtually evervthing in Laura's life
is paid with scrip, which includes bus
tokens she receives from the women's shelter. The onlv cash she sees is
the occasional quarter or two she gets
when she buvs groceries.
She has built up the smallest of nest
eggs — $5.64 so tar — to pay tor a
small birthday party for Nicole this
rtwnth. Food stamps will not pay for
candles, ice cream or a toy,
Laura has used a public hospital
once, for Jacobo's birth. The hospital
bill for a birth without complications
typically costs about $1,100 in Hous-
ton. The family has also used a cityfinanced clinic several times for the
children's minor illnesses: a sore
throat; a stomach virus.
Determined
To Stay
What if all these benefits and services were cut tomorrow?
"I don't think I would leave," Laura said.
She explained the difference between Houston and Matamoros, the
Mexican border city she left,
"Here, if you see a child alone in
the street without shoes, he is cared
for," she said, ""Somehow, that child
will be cared for. There, no. There,
you see children in the street, cleaning shoes, and people pass without
seeing them,"
Many politicians argue a is precisely this perception that induces
people to come.
Representative Smith of Texas has
proposed a bill that would cut off all
benefits to illegal immigrants except
emergency health care and public
schooling. If the measure is enacted,
Laura would lose about $12 a week in
W I C. grocery coupons, and she and
the two older children could stand to
lose privileges at the city health clinic
that receives some Federal money
But Jacobo, the American-born
baby, would retain full rights to welfare and Medicaid. He would continue
to qualify for food stamps and his
portion of the W.I.C. couDons. When
he turns 5. he may qualify for larger
welfare assistance.
That entitlement has led some politicians like Governor Wilson of California to call for a constitutional
amendment to deny citizenship to the
offspring of illegal aliens.
But this would be a difficult, longterm undertaking. Supporters of the
California ballot initiative, which
would bar illegal immigrants from
the public schools, are trying a differ-
ent legal strategy. If approved, the
measure would violate Federal law
flouting the 1982 Supreme Court ruling giving all children in the United
States the right to a public education.
But some politicians say the time Is
ripe for a challenge. The Court, they
argue, is more conservative now than
It was 12 years ago, and the original
ruling was 5 to 4,
'"
:'
The proposals for aid cuts come in
tandem w:th measures for keeping
people like Laura out of the country. . '
The California initiative would in
some cases require schools and hospitals to report those suspected of
being illegal aliens.
But deportation in Laura's case
would be fraught with legal tangles,
because of her American child.
And immigration officials sav that
with 2.000 miles of shallow riverbed
and desert linking the United States
and .Mexico, sealing the border will " '
never be feasible.
,,
More than half of all illegal immi-' '
grants come from Mexico. Others fly
in from Latin America, Asia or Eu- •
rope, enter the country legally, by air
as well as over land, then become
illegal when they overstay their vi"s.
Many experts say that if the North-,
American Free trade Agreement,,'!
succeeds in elevating economic conditions in Mexico, the forces that lead»'\,
people to leave will wane.
•»
In the meantime, the question o f ' I w
what to do with Laura and her family*.*
remains. She may get a job: then Jt.
again, she may not.
t*'
•Rationally, we should cut off that*»Sl
woman s benefits and deport her if,-*"*
she's deportable. " said .Mark W. Da>»J^
vis, a former aide to Governor Wilsork'J^
and now director of the Pacific R e . ' Z .
search Institute in San Francisco.*'^
"But in both humanitarian and practical terms, we find that extremely
,
difficult to do. Humanitarian, because. ^
there are children involved. A n d . ^ ^
practically, it's problematic because>*w
she'll be back."
�12'OS/9.3
10:.5S
© 2 0 2 690 .54.32
11004/004
HHS OASH
UNDOCmffiNTED PERSONS, OR PEOPLE NOT COVERED (PNC)
Q;
A:
How many PNCs are there?
Approximately 3.2 miHioii, assuiaiftg that the PNC population is roughly ihe same as
the imdocumeated person ceiisiis.
Q:
How mich LIOJISV ;'it '-vc ii-'^y ipc'^dif^j; VM riimeigency
C:
caie fcr undociiBienteds under
Medicaid?
No one krio>v? foi im-. C-.[H>jm,.i ;'^.'XvrA-< fliev ^p-nd $1 billion pei year. If ihey
have abour h^K of [he ai.:\c.>j.f nrvds 'sc v j - i CC^SJ j;, -.-robably less lhan $2 billion,
siiict" few ^ixcA hhs'ti ux pro/.ii;]ji} --.^ \hs border.
A:
Q:
A:
Q;
A:
Whiif hapj)evied Ui ..hs tnc-ncy T.hi.t vv.if.. jr. .Ae NfedsvAid j>itv toi emcrgencv care for
PNCs:'
Tbe prog..jTXi. is [y^clmh-d ; t
>h -pvn»-'k*;:, \ipd iu nl-jav,, u i& buried in $mm's
rriainttsnance of effon- Thii i«e;jiv. -.M... ^-C^I.C: nioney ha- m^v^iy been counird, aiid
they are uiiJii".e'y t;j v,aiu p-'v -or a ticv, piugiaoi.
What kind of' data e,-abi; .
The only dnirx .^.-'^i-jbl; ;v.;
service location
i> hi ^1;^^-: Ni
PHOTOCOPY
PIUES^KVATION
�12.'0.S-'93
10;.51
QUESTION:
ANSWER;
© 2 0 2 690 .543;
IS 002-004
HH.S OA.SH
Why is ± t President y plari targeting only $200 million per year (25%
ot SSOO m illion) to care for liie uadocumcuted when the cost of
providing emergeticy chrt to that population is estimated at about SI
bilUoR in California alone"'
California'.*; eoits P.present approxiinately half of the nation's
uncovered co.st of c-3.iing for undocumenied people.
In trying 10 solve rhe nation's bealth care crisis, v.e have limited
resources to deal v.'itti the health problems of those in our
coiintiy iUegally, We want to do seme thing to help with this
pri.tbleri), bur we liave to balance those needs against the needs
of (>ux citizerufy 3 whole.
We hope tliat by piovlding univ-rrsai coverage fur all Ajnericans
v.-e will ease some cf ibe finiincial pressures on hospitals that
care for uvidocumeri.'ed people, perhaps freeLng-up resources
from other pruviously uncotnpeasated care to provide services to
uodocmnented
PHOTOCOPY
PBESEKYATION
�12/08/93
10;.57
© 2 0 2 690 .5432
El 003/004
HHS OASH
\XTLNERABLF POPULATIONS ADJUSTMExNT
QUESTION:
What wilJ happen to the Medicaid Disproportionate Share Program
under die President'* plan?
ANSWER:
We are ve-y concemed that hospitik U»ar currently take care of a high
proportion of low-income people not be .mduly hurt by reform.
On die nonti'.atv.. .vc ':.-VA{ CO help them make the iransiiion to a
competiiive nuAi^ in u;e refocined sysrem.
Under die ne-- V'uict-!able .Popuiadoiii AiljustTiiem {VPA) program,
payments vvt.iuid be oxade co eomjpeiisale fur the addirional costs of
caring for low-mcome pa-icnts *tjd i)ii.iocumented persons.
Funds AO'-ilJ be alk.-v2,«d to hospitals using a formula based on current
services to low-income patients, with an additional amount added to the
paytiients to hcspiials m Srate^ with high nimibers of undocumented
people
[•ri'ipiiiil^ v. is! he pt:y. dl'C^
by RCFA on a quartedy basis.
The po>posed level fund ing in the till is SSOfi ynliion per year. 75
pereew <.$600 miliiou) would be distributed as coinp!?.nsation for
n-eaimg low incctue people and 25 percem {$200 raillion) for treaimg
others nr,\ covered by ti-e plao.
PHOTOCOPY
�
Dublin Core
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Title
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Health Care Task Force Records
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White House Health Care Task Force
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
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<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 2
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Box 8
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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2/6/2015
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42-t-12092992-20060885F-Seg2-008-003-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/df3ed0cde69dfe71e26981c4abcad4fb.pdf
03466479d57155363b026245f08367a5
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2006-0885-F
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Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3680
FolderlD:
Folder Title:
Department of Labor (responsibilities under pian)
Stack:
Row:
Section:
Shelf:
Position:
s
52
3
8
1
�LIST OF
DOL RESPONSIBILITIES UNDER THE REFORM PLAN
DOL assures t h a t corporate a l l i a n c e employers make premium
c o n t r i b u t i o n s and monitors the states' enforcement of the
employer mandate i n regional a l l i a n c e s .
DOL develops and monitors uniform claims dispute procedures
f o r a l l health plans, an a l t e r n a t e dispute r e s o l u t i o n
program and an appeals procedure.
The reform plan would add a new t i t l e t o ERISA governing
h e a l t h care b e n e f i t s i n corporate a l l i a n c e s . This new t i t l e
would provide the framework f o r l e g a l entitlement t o the
guaranteed b e n e f i t s . DOL would d i r e c t l y regulate corporate
a l l i a n c e s by i n i t i a l l y c e r t i f y i n g operating plans and
p e r i o d i c a l l y reviewing corporate a l l i a n c e s f o r compliance
w i t h f e d e r a l reform requirements. Under t h i s new l e g a l
framework DOL would:
Establish requirements f o r disclosure t o and
n o t i f i c a t i o n o f employees.
Ensure t h a t corporate a l l i a n c e s comply w i t h new f e d e r a l
a d m i n i s t r a t i v e s i m p l i f i c a t i o n measures.
Establish f i n a n c i a l r e p o r t i n g requirements, and
regulate self-funded plans o f f e r e d by corporate
a l l i a n c e s t o assure t h e i r solvency.
Review procedures t o ensure t h a t workers are not
overcharged by corporate a l l i a n c e s f o r t h e i r share of
the cost of health care coverage.
Administer a new guaranty fund f o r self-funded
plans.
DOL monitors the management and f i n a n c i a l systems a t t h e
s t a t e and r e g i o n a l a l l i a n c e l e v e l , conducts spot a u d i t s , and
works w i t h the states t o remedy any d e f i c i e n c i e s p r i o r t o
recommending t o the Board t h a t remedial a c t i o n be taken.
DOL and HHS j o i n t l y develop protocols f o r the treatment of
work-related i n j u r i e s covered by workers' comp and j o i n t l y
s t a f f a P r e s i d e n t i a l commission examining the f e a s i b i l i t y of
f u l l i n t e g r a t i o n o f workers' comp i n t o the new health care
system.
DOL and HHS j o i n t l y operate a National I n s t i t u t e f o r Health
Care Workforce Development.
�SUMMARY OF DOL ISSUES AND RESPONSIBILITIES
I.
Security/Coverage
A.
Health s e c u r i t y card guarantees coverage.
B.
Comprehensive guaranteed
b e n e f i t package.
1.
Guarantees a l l Americans comprehensive coverage,
i n c l u d i n g mental h e a l t h services, substance abuse
treatment, some dental services and c l i n i c a l
preventive services.
2.
I n t e n years, the l e v e l and mix of the b e n e f i t
package w i l l be reviewed f o r m o d i f i c a t i o n s .
3.
Contains no l i f e t i m e l i m i t a t i o n s on coverage, w i t h
the exception of coverage f o r orthodontia.
C.
Cost Sharing —
see White House Summary
D.
Supplemental Insurance
1.
Employers may o f f e r employees supplemental
insurance f o r extra b e n e f i t s and lower cost
sharing amounts as long as they do not d u p l i c a t e
comprehensive b e n e f i t s package.
2.
Such plans w i l l be standardized f o r cost sharing
amounts; not f o r extra b e n e f i t s . Supplementals
f o r cost sharing w i l l be a v a i l a b l e only through
a l l i a n c e h e a l t h plans so plan can a d j u s t premiums
t o account f o r high u t i l i z a t i o n s by those w i t h
supplemental cost sharing insurance and t o avoid
double processing of claims by h e a l t h plan and
supplemental i n s u r e r .
3.
The cost of supplemental b e n e f i t s w i l l be taxable
f o r employees, but deductible f o r employers.
4.
Exception: a 10-year grandfather clause w i l l
p r o t e c t tax preference f o r employees r e c e i v i n g
supplemental b e n e f i t s t h a t are c u r r e n t l y being
o f f e r e d by employers.
E.
Insurance reform: no p r e c l u s i o n f o r p r e e x i s t i n g
c o n d i t i o n s , everyone must be covered, community r a t i n g .
F.
Coverage guaranteed i f you lose your job or switch
jobs. I f you lose j o b , you are responsible f o r
employee and employer share, but also e l i g i b l e f o r
�subsidies based on income.
G.
Early r e t i r e e s pay only 20%. Government or employer
picks up d i f f e r e n c e , depending on c o n t r a c t u a l
f € ^ ( i ^ t Ai^rt^
arrangements.
H.
Part-time/temporary workers covered on a prorated
basis. 30 hours per week i s considered f u l l - t i m e .
10 hour per week threshold has been eliminated.
The
I.
Self-employed responsible f o r whole cost, but premium
payments are f u l l y deductible and self-employed
e l i g i b l e f o r subsidies on both the employer and
employee side.
J.
Unemployed t r e a t e d as a l l other "non-workers" i n the
new system:
1.
I f unemployed person has working spouse, coverage
i s through the spouse.
2.
I f no one i n f a m i l y works, i n d i v i d u a l ( s )
responsible f o r whole cost, but e l i g i b l e f o r
subsidies based on income i n c l u d i n g unearned
income (which includes unemployment insurance;
under current tax law). The f i r s t $1000 of
unearned income w i l l be exempt.
3.
as
Coverage w i l l not r e q u i r e any a d d i t i o n a l
a d m i n i s t r a t i v e mechanism. Unemployed w i l l be
handled i n the same manner as other nonworkers
e l i g i b l e f o r subsidies.
I
II.
Alliances
I
A.
Regional A l l i a n c e s
1.
Basic functions included: enrollment of
i n d i v i d u a l s i n approved h e a l t h plans (e.g., s t a t e
c e r t i f i e d plans t h a t meet f e d e r a l standards and
are r e f e r r e d t o as AHPS), c e r t i f i c a t i o n of plans
c o n t r a c t i n g w i t h plans and reimbursement of plans
f o r services provided.
2.
One or more a l l i a n c e per s t a t e . Operate as e i t h e r
a n o n - p r o f i t corporation, an-iBdo|ii,iiJi,iiL jLuti>^
Hji 1111^) 111
bii'anch^
3.
un
Administered
i i j m i i i^f iiF
hill
iliili
iiiiinmt"
i'm
by states w i t h f e d e r a l oversight.
�a.
B.
DOL oversees state regulation of management
and financial operations of regional
a l l i a n c e s and the state program of audits of
regional alliance management and f i n a n c i a l
systems. Selectively conduct management and
financial audits and may recommend when
remedial action i s required.
4.
Each alliance w i l l offer at least three types of
plans: HMO, PPO, and fee-for-service. With
approval from the National Health Board, a state
may waive t h i s requirement under certain
circumstances.
,
5.
General purposes:
a.
Represent interests of consumers and
purchasers of health care services;
b.
Structure the market for health care to
encourage the delivery of high-quality care
and control of costs through a competitive
market environment that s t i l l encourages
innovation i n managed care strategies;
c.
Assure that a l l residents i n an area covered
through the regional alliance enroll i n
health plans that provide the nationally
guaranteed benefits.
6.
Large employers who chose to join a regional
a l l i a n c e make premium payments that are r i s k adjusted (e.g., experiences and phased-in over
eight years u n t i l they reach a community-rated,
per worker premium.
7.
Regional a l l i a n c e covers employees of federal,
state and local government; U.S. Postal Service
could form a corporate a l l i a n c e .
Corporate Alliances
1.
Companies, c o l l e c t i v e l y bargained multi-employer
plans (Taft-Hartley plans), and r u r a l e l e c t r i c and
telephone cooperatives with more than 5000
employees may operate a corporate a l l i a n c e i n l i e u
of participating i n the regional a l l i a n c e system.
2.
Corporate alliances can offer self-funded health
plans, as well as options to enroll i n state
c e r t i f i e d AHPs.
�3.
As c u r r e n t l y d r a f t e d , corporate a l l i a n c e s are
forced t o disband i f the number of f u l l - t i m e
employees f a l l s below 4800.
4.
An employee leasing f i r m cannot form a corporate
alliance.
5.
Temporary workers are covered by f i r m s t h a t
contract out t h e i r services.
6.
Corporate a l l i a n c e s must f o l l o w same r u l e s as
plans i n s i d e the a l l i a n c e , i n c l u d i n g choice of
plans.
7.
I f merger, a c q u i s i t i o n or bankruptcy, DOL
determines whether a corporate a l l i a n c e may
continue.
8.
Corporate a l l i a n c e s w i l l be assess a 1 percent tax
t o c o n t r i b u t e t o p u b l i c health programs funded by
regional alliances.
C.
States have single-payer option. Single-payer states
may require a l l employers and i n d i v i d u a l s t o
p a r t i c i p a t e i n the single-payer system, i n c l u d i n g
employees of corporate a l l i a n c e s r e s i d i n g i n the s t a t e .
D.
States may impose taxes and make assessments on
employers or health b e n e f i t plans i n corporate
a l l i a n c e s i f the assessments are nondiscriminatory i n
nature. States may require a l l payers, i n c l u d i n g
health b e n e f i t plans i n corporate a l l i a n c e s , t o
reimburse e s s e n t i a l community providers.
States may
also develop fee schedules f o r reimbursement of
providers i n f e e - f o r - s e r v i c e plans, i n c l u d i n g those
o f f e r e d by corporate a l l i a n c e s .
I I I . Administration
A.
National Health Board
!
I
'
1.
Reviews s t a t e implementation plans.
2.
Enforces n a t i o n a l q u a l i t y standards and adjust
comprehensive b e n e f i t s package. National Health
Board decisions r e l a t e d t o b e n e f i t s , standards of
performance and a c c o u n t a b i l i t y apply t o health
plans operating through corporate a l l i a n c e s .
3.
Sets g l o b a l budgets.
�B.
States
1.
Have primary authority to implement a l l i a n c e s and
enforce federal requirements.
2.
Responsible for meeting global budget.
3.
Certify a l l i e d health plans.
4.
ERISA preemption i s repealed for regional
alliances.
DOL
1.
'
In corporate a l l i a n c e s :
I
a.
ERISA currently regulates a l l employment
based health plans. I t establishes reporting
and disclsoure requirements and fiduciary
standards. ERISA preempts state laws and
remedies relating to health plans. I t does
not preempt state regulations of insurance
companies.
b.
The reform plan establishes and enforces new
ERISA fiduciary requirements for employers,
plan sponsors and plan f i d u c i a r i e s in
corporate a l l i a n c e s .
c.
The plan would add a new t i t l e to ERISA
governing health care benefits. This new
t i t l e would provide the framework for a legal
entitlement to guaranteed benefits for
employees in corporate a l l i a n c e s . This new
t i t l e would include new standards for health
plans that address the following issues:
(1)
Determine whether each corporate
alliance operating plan meets new
federal requirements.
(2)
Ensure everybody obtains coverage in a
plan providing at least the nationally
guaranteed package.
(3)
Set information and notification
requirements.
(4)
Ensure compliance with national
standards on uniform claims form, data
reporting, and electronic b i l l i n g .
�IV.
(5)
Establish f i n a n c i a l reporting
requirements f o r self-funded h e a l t h
b e n e f i t plans and corporate a l l i a n c e s .
(6)
Set f i n a n c i a l reserve requirements f o r
self-funded plans.
(7)
Administer a n a t i o n a l guaranty fund f o r
s e l f - funded h e a l t h plans.
2.
Oversees s t a t e enforcement of employer mandate
inside regional alliances.
3.
Monitor s t a t e oversight of f i n a n c i a l systems and
solvency of r e g i o n a l a l l i a n c e s . This
r e s p o n s i b i l i t y may involve p e r i o d i c and d i r e c t DOL
a u d i t s . DOL makes recommendations when remedial
a c t i o n i s required by National Health Board.
5.
Ensure that both regional and corporate a l l i a n c e s
establish grievance procedures and monitor the
performance of such procedures. [This i s a very
controversial issue with soma staff of the House
and Senate Labor Committees who want a highly
federalized grievance system run primarily by DOL.
I r a favors a more state-based system with DOL or
HHS oversight.]
Workers' Comp and Safety I n i t i a t i v e s
A.
I n j u r e d workers receive medical treatment through own
h e a l t h care plans — i . e . , a l l states become employee
choice states. AHPs designate WC case managers.
1.
C u r r e n t l y , whether employer or
choose the doctor/provider f o r
a major source of contention.
system, the worker chooses the
or her h e a l t h plan.
worker should
treatment i s o f t e n
Under the reform
provider under h i s
2.
Providers adhere t o a uniform fee schedule
established by the r e g i o n a l a l l i a n c e . Providers
no longer able t o charge workers' comp cases
d i f f e r e n t r a t e s than other cases. Several studies
have shown t h a t such d i f f e r e n t i a l r a t i n g i s source
of high workers comp costs i n a number of areas.
3.
To be c e r t i f i e d , a h e a l t h plan must demonstrate an
a b i l i t y t o handle workers' comp c a s e s — i . e . , must
have capacity w i t h i n plan or through
subcontractors t o provide a whole range of WC
services, such as long-term r e h a b i l i t a t i o n .
�B.
Employer purchases coverage through workers' comp
c a r r i e r s . Fee schedule established by a l l i a n c e s or
through negotiations between insurers and AHPs.
C.
Employee has f i r s t dollar coverage.
D.
Federal WC programs treated same.
E.
DOL and HHS staff Commission on Health Benefit and
Financial Integration.
1.
2.
F.
G.
Commission prepares recommendations on the
following kinds of issues:
a.
Should premiums for WC medical benefits be
experienced-rated?
b.
Should there be uniform benefit and
e l i g i b i l i t y standards for workers' medical
benefits?
c.
How to move from the current system of
prefunding of benefits i n the current
l i a b i l i t y based system, to the new system
under reform?
Commission report due to the President by
January 1, 1996.
DOL and HHS conduct demonstration programs and create
protocols for treating work-related i n j u r i e s and
illnesses.
1.
DOL and HHS already have begun developing
protocols for the treatment of common WC problems.
For example, the departments are i n f i n a l stages
of developing protocols for the treatment of back
i n j u r i e s . We hope to publish the f i n a l protocols
in the middle of next year.
2.
Development of more such protocols for the most
common types of WC i n j u r i e s can go a long way
toward reducing costs and lost time.
Increased funding for research on occupational injury
and i l l n e s s prevention.
�V.
Financing
A.
Employer/Employee Mandate
1.
B.
VI.
Employer pays minimum of 80% of average weighted
premium i n a l l i a n c e f o r each family type.
a.
Employer may choose t o pay higher share of
premium. Such a d d i t i o n a l payments would be
t a x - f r e e f o r the employer and the employee.
b.
Family types: 1) s i n g l e i n d i v i d u a l s ; 2)
couples; 3) single-parent f a m i l i e s ; and 4)
two parent f a m i l i e s w i t h c h i l d r e n .
2.
Families and i n d i v i d u a l s pay d i f f e r e n c e between
the 80% and the actual cost of the plan they
s e l e c t . This d i f f e r e n c e may be higher or lower
than 20% of the average weighted premium,
depending on whether the high or low cost plan i s
chosen.
3.
Firms i n r e g i o n a l a l l i a n c e s pay a f i x e d per-worker
c o n t r i b u t i o n f o r each employee according t o h i s or
her f a m i l y status.
a.
For two-parent f a m i l y coverage, a per worker
c o n t r i b u t i o n i s 80% of the average p r i c e
premium divided by the average number of
workers per family i n the a l l i a n c e .
b.
The family i n such cases pays the d i f f e r e n c e
between 80% of the unadjusted average p r i c e
premium and the cost of the plan t h a t the
worker selects.
other sources of funds (1994-2000)
1.
Medicare Savings ($124B)
2.
Medicaid Savings ($114B)
3.
Sin Taxes
4.
Other Federal Program Savings ($47B)
5.
Revenue Gains ($5IB)
($1055)
Subsidies
A.
The premium payments paid by employers i n r e g i o n a l
a l l i a n c e s are capped a t 7.9% of p a y r o l l .
8
�B.
Firms i n r e g i o n a l a l l i a n c e s w i t h less than 50 employees
and average wages below $24,000 are capped a t between
3.5% and 7.9% of average p a y r o l l .
C.
Worker l e d f a m i l i e s i n r e g i o n a l a l l i a n c e s are e l i g i b l e
f o r subsidies i f incomes not more than 150% of poverty
l e v e l . Subsidies are f o r premium costs and f o r costsharing and other out-of-pocket expenses.
D.
Corporate a l l i a n c e employers subsidize f u l l - t i m e
workers i n corporate a l l i a n c e earning annualized wages
of $15.000 or less. Employer c o n t r i b u t i o n i s the
greater of 80 percent of the average premium or 95
percent of the premium f o r the lowest cost plan
a v a i l a b l e t o the employee i n the corporate a l l i a n c e .
This subsidy i s not reimbursed by the f e d e r a l
government.
E.
Non-working and unemployed are e l i g i b l e f o r subsidies.
VII.
1.
Unemployed and heads of working households w i t h
earned income below 150 percent of poverty are
e l i g i b l e f o r a subsidy or discount from the
employee's share of the premium. [ I t does not
appear t h a t unemployment b e n e f i t s would be
included i n t h i s means t e s t , but we need t o double
check.]
2.
Unemployed i n d i v i d u a l s whose incomes are below 250
percent of poverty are e l i g i b l e f o r a subsidy f o r
the employer's share of premium. Unearned income
i s counted i n t h i s means t e s t and i t i s defined t o
include unemployment b e n e f i t s . [Otherwise, i t i s
unclear how t h i s subsidy w i l l work.]
Duality
A.
National Quality Management Program.
B.
Health Care Report Cards.
VIII.
OSHA
A.
Occupational safety and h e a l t h moves i n t o the
mainstream of the h e a l t h care d e l i v e r y system.
1.
B.
To be c e r t i f i e d , h e a l t h plans demonstrate a b i l i t y
t o t r e a t occupational i n j u r i e s and i l l n e s s e s .
Eventually, h e a l t h data systems evolve w i t h greater
capacity t o i d e n t i f y p a t t e r n s of i l l n e s s e s and
diseases.
�IX.
C.
Health care reform debate provides an o p p o r t u n i t y t o
emphasize p u b l i c h e a l t h nature of occupational h e a l t h ,
and help remove i t from the o f t e n contentious labor
r e l a t i o n s arena.
D.
I n response t o d r a f t proposal, DOL requested s p e c i f i c
i n c l u s i o n of occupational safety and h e a l t h as an area
t h a t would receive research funds under the new law.
Health Care Workforce Development Proposal
A.
X.
President's plan w i l l contain a program f o r ensuring an
appropriate supply and mix of non-physician h e a l t h care
providers.
1.
Creates a National I n s t i t u t e of Workforce
Development ("the I n s t i t u t e " ) j o i n t l y administered
by DOL and HHS t o study and t o make
recommendations t o National Board regarding steps
needed t o achieve appropriate workforce
adjustments.
2.
Administers t r a n s i t i o n a l grants t o improve the
employment and t r a i n i n g o p p o r t u n i t i e s f o r
a d m i n i s t r a t i v e and c l e r i c a l workers i n h e a l t h and
insurance i n d u s t r i e s who want t o upgrade s k i l l s
and move i n t o h e a l t h provider or management
p o s i t i o n s . Grants also can be used t o help nonphysician providers t o develop new s k i l l s and move
t o new provider s e t t i n g s .
3.
Proposal also provides f o r supplemental funding
and c o o r d i n a t i o n w i t h Administration's
Comprehensive Workforce Adjustment I n i t i a t i v e ,
i n c l u d i n g the c r e a t i o n of h e a l t h care jobs banks
i n Employment Service and One-Stop Centers when
they are created.
4.
Unions have asked f o r p r o v i s i o n encouraging
c r e a t i o n of employee p a r t i c i p a t i o n committees and
r e q u i r i n g j o i n t decision-making w i t h unions before
h o s p i t a l s and other providers can make s i g n i f i c a n t
service d e l i v e r y changes.
Transition
A.
Begin s t a t e implementation as e a r l y as January
B.
Implement plans i n a l l states have implemented by
January 1, 1997.
C.
Form corporate a l l i a n c e s by January 1,
10
1997.
1995.
�XI.
Miscellaneous DOL Issues
A.
COBRA c u r r e n t l y requires employers t o provide former
employees w i t h continued h e a l t h insurance coverage, a t
the i n d i v i d u a l ' s expense, generally f o r 18 months.
1.
Because the new plan w i l l provide "seamless"
coverage and subsidies f o r nonworkers, i n c l u d i n g
the unemployed, no f u r t h e r need f o r COBRA.
B.
Davis-Bacon and Service Contracts Acts contain
p r o v i s i o n s t h a t r e q u i r e i n c l u s i o n of f r i n g e b e n e f i t
costs i n t o wage r a t e s f o r f e d e r a l c o n t r a c t s . The
method of c a l c u l a t i n g h e a l t h b e n e f i t costs are very
d i f f e r e n t between the two, and i n the case of the
Service Contracts Act, the method i s c o s t l y and very
imprecise.
C.
Federal Employees Compensation (FECAL) and Longshore
and Harbor Workers' Acts: These f e d e r a l workers'
compensation laws u l t i m a t e l y would be changed t o
r e f l e c t whatever changes are recommended by the
p r e s i d e n t i a l commission on the i n t e g r a t i o n of s t a t e
workers' compensation laws i n t o the reformed h e a l t h
care system.
D.
Early r e t i r e e s :
1.
Under C l i n t o n plan, e a r l y r e t i r e e s , age 55-64,
w i l l be e l i g i b l e f o r a subsidy of 80% of the
premium. [An income t e s t f o r high income
i n d i v i d u a l s may be established, but no f i n a l
decision has been made y e t . ]
2.
P o l i c y w i l l increase m o b i l i t y out of workforce.
Could induce as many as 300,000-600,000 a d d i t i o n a l
e a r l y r e t i r e e s . This w i l l provide o p p o r t u n i t i e s
f o r younger workers. Early r e t i r e e s may re-enter
workforce from time t o time.
3.
Early r e t i r e e p o l i c y w i l l save corporations and
s t a t e and l o c a l governments an estimated $11
b i l l i o n i n 1994. Protects i n d i v i d u a l s who have
been counting on e a r l y r e t i r e e h e a l t h b e n e f i t s .
[The p o l i c y could cost the Social Security and
Medicare t r u s t funds about $2.5-3.5 b i l l i o n per
year. We are s t i l l examining p o t e n t i a l ways o f
reimbursing the funds f o r t h i s l o s s . ]
4.
A breakdown of the e a r l y r e t i r e e plan costs w i l l
be included i n the f i n a l numbers submitted t o
Congress.
11
�D0LSUM.DOC
12
�BUDGETARY EFFECTS OF HEALTH CARE REFORM
06-Sep-93
(billions of dollars)
1996
1997
1998
45
64
71
1999
79
2000
83
1994-00
33
34
33
30
160
1
2
2
2
2
9
0
5
10
15
22
28
80
0
0
10
14
15
16
17
72
New Public Heafth Spending
0
1
3
3
3
4
4
18
Administration
1
1
1
2
2
2
2
11
-12
-15
-36
-59
-81
-1()4
-134
-441
Medicare Savings
0
0
-7
-15
-23
-33
-46
-124
Medicaid Savings
0
0
-7
-15
-22
-30
-40
-114
Other Federal Program Savings
0
0
-5
-8
-10
-11
-13
-47
Revenue Effects of Mandate
0
0
-2
-6
-10
-14
-19
-51
-12
-15
-15
-15
-16
-16
-16
-105
5
-10
-25
-51
-91
1994
1
1995
7
Subsidies Net of Offsets
0
5
25
Self ^EmployedTax Deduction (100%)
0
0
Long-Term Care
0
Medicare Drug Benefit
Fiscal Years
Total New Spending
Total Savings
0
Sin Taxes and/or Corporate Assessment
Change in Deficit
.
-11
::8^
• Estimates are preliminary and do not incorporate interactive effects.
9_
350
�How Reform Is Financed
($ billion, 1994-2000)
Sources of Funds
Uses of Funds
Medicare Savings ($124)
Long-term Care ($80)
Sin Taxes ($105)
Medicare Drug Benefit ($72)
Public Health/Admin ($29)
Medicaid Savings ($114)
Other Federal Program Savings ($47)
Subsidies for low-income
firms and workers* ($169)
Revenue Gains ($51)
Deficit Reduction ($91)
Former Medicare and Medicaid
Recipients Now Covered by
Alliance Plans ($259)
Alliance Coverage ($259)
• Includes »elf-«rptoyed lax deckKUon.
Estimates are preliminary and do not Incorporate Interactive effects.
�
Dublin Core
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Title
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Health Care Task Force Records
Creator
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White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
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2006-0885-F
Text
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Department of Labor (Responsibilities Under Plan)
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 2
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Box 8
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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Preservation-Reproduction-Reference
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2/6/2015
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42-t-12092992-20060885F-Seg2-008-002-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/286ec45d0525fdfacff10f8dcd5cb0a9.pdf
8c273206d749d1c50c3ed771c2fe73ee
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3680
FolderlD:
Folder Title:
Administration/Bureaucracy
Stack:
Row:
s
52
Section:
Shelf:
Position:
8
1
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premiums t o a r o i d p a y i n g •:lai:us,
t does n o t h i r i g t:o encourage more
cost e f f e c t i v e Triedical car=: o r t^ i m i n a t e r.he wa^ste -and f r a u d
'>
p r e s e n t i u our syste'ri.
the ead, cVie? r approa-oh f a l l s f a r s h o r t
because i t r e s t s on che bej i e f t h a t consumer'3' b e i f a v i o r i s t h ^ o n l y
problem i n our h e a l t h ca:re systein.
Aa a former stat.e i:is:^utaace -;oni;nis:5ioner, and new a new '-nember
cf Congress, I ara s u r p r i s e d thac any VriOwledg«2S!ble l e - j i s l a t o r would
t a k e t h i s approach, I havs seen f i i - s t ; .hand how o u r p r e s e n t system
socks s t a t e and f e d e r a l ta^<paye>a t o pay c o n s t a n t l y h i g h e r p r i c e s .
And Aa-e:rlcani^ i n every pa-»-t c f our country know t u l l w e l l t h a t h e a l t h
care c o - t s a r e c
Liia f a m i l i e s and
:C'n ere
busin^.-jses.
Our n a t i a ; . ' * h e a l t h ;
s have n e a r l y quadrepled since li^ec.
without refort;
aad a break iroo"; t h e s t a t u s quo - - one d o l l a r i.n
every f i v e ^j^Vll go t o h e a l t h csra by t h a year 20C0. i^one o f us have
the s e c u r i t y t h a t we w i l l have adequate h e a l t h coverage i n t u t u r e
because a t t h i s r a t e , p r i v a t e i n s u r a n c e , Medicaid ard^Medicare w i l l
a l l be d r a s t i c a l l -{ s c a l e d back i n t h e next, fev,' years
When I t co'P.es
to h e a l t h care- we aze •
s t h e ver\eltcj n o r n i n g
worst response p o s a i b l e
There a r e no ffimpie ft>:e5 -t^ /
a t -;-;ormou5 prcbleni, b u t t h e
a d m i n i s t r a t i o n ' ,s ap'C: i>ach i a c (-•-he r i g h t :,ra-ck.
I t keeps h e a l t h
care i n t h e p r i v a t e s e c t o r . :.t pre'-, L b i t s insurance p r a c t i c e s which
have robbed Arrsericans o f tt-e ce^ :'':airi":y ch-sy w i l l have coverage when
they need i t .
I t f r e e s .-iCtor:.^ t r c ; t s u f f c c a t i ^ g p©perv;ork. I t g i v e s
s m a l l employers d i s c o u n t t and a
t n e g o t i a t i n g lower
h e a l t h oare c o s t s .
No one - i n c l u d i n g t h - .edministr-ation -- i s .-_.-^:tying t h i s i s a
s i l v e r b u l l e t remedy t o a l l t h e i l l s o f :ur p r e s e n t system.
(continued)
PHOTOCOPY
PRESERVATION
�10/15.''-93
16:38
POMEROY...PAGE
FOMERO't' D.C. e 94562362
NO.575
P003
2
Americana do uf-f-Lr:r a r d , hcw-ver, '.nal: "he
tnton proposal i s a
s e r i o u s e f t c r : . ..-a.
-/.hei
•;.y -iX us c^-lieve i s c u r most
s i g n i f i c a n t na" ; c r a l protal e'x-,
Ctui;" r o u a t r y deeervos^ a ruore
c o n s t r u c t i v e hip-, a'a^Li ity^'oavh -^a r tC-1 i^sue than is^ r e p r e s e n t e d by
the p a r t i a a n n-ri/i-:,.,, :;y t-h r r c r i c c f thoca wi:.o v.viuc t o p r e s e r v e a
tystern moat o?^ ia k'-iOw nee'i=?- f i x i n g .
Tiie a^jtho?-
.-^ f,*vf.:hn.!3j^ C;>ftcr"«i?a,iuf/T^ ^roii fTc'.t't/: Dakota.,
a former
i x i s u r a x i c e coiaKis^-Xf:j**cf,r f f . x & tha'c s t a t e . - cSfld t/JC f a r m e r p.i-<ssid&nt: o £
t h e l ^ ^ i t i o n a l A«JSOC ' s f i o / ; c ! JjiiSuiAiiCsf COuiffiiis^sio-iex's.
�bc~pr-Specter-healthcar
TO NATIONAL EDITOR:
U.S. SEN. SPECTER RAISES. CONCERN ABOUT BUREAUCRACY CREATED BY
CLINTON HEALTH CARE PROPOSAL IN CHART OUTLINING THE PROPOSED ENTITIES
VVASHINGTON, Oct. 8 /PRNewswire/ — Concerned about the impact of a
dramatic increase i n government bureaucracy resulting from the Clinton Health
Care Plan, U.S. Sen. Arlen Specter (R-Pa.) late yesterday presented a detailed
chart outlining the more than 130 new or expanded agencies, programs,
commissions, councils, etc. that are established by the Clinton Plan.
In a speech on the Senate'floor, Specter said he shares Clinton's
objective to provide comprehensive health care for a l l Americans, but upon
reading the 239-page report outlining the Clinton plan, he was surprised to
find 77 new e n t i t i e s — agencies, commissions, councils, and advisory groups,
and at least 54 existing e n t i t i e s which w i l l have new or expanded
responsibilities.
In h i s statement. Specter l i s t e d many of the new e n t i t i e s . " I see the
bureaus, agencies, and advisory commissions which w i l l be set up and have to
be paid for. In my position as the ranking Republican member of the Health
and Human Services Subcommittee of Appropriations, I see the d i f f i c u l t y in
allocating the existing funds to. health programs. I t i s a source of concern
to me as to where the funds w i l l come from for these new agencies and
administrations."
.^s one example of the potential problems of the new bureaucracy. Specter
cited the proposed creation of a National Health Board which w i l l have
enormous powers that have yet to be f u l l y delineated. "One of (those powers)
i s the authority to preclude someone from traveling, hypothetically, from
Camden, N.J., to Philadelphia — going from one state to another — to get
Specialized medical treatment, say from the Hospital at the University of
Pennsylvania."
"We are a l l concerned about the potential of big government and the
problem that big government has," Specter said. "We do want to be sure that
the 37 million Americans who are now not covered are covered. And we do want
to be sure that a person who changes jobs w i l l be able to have coverage. And
we want to reduce costs where they are s p i r a l i n g out of sight. But we must be
certain that we do not unduly impact or harm the existing health care system
that we have which does cover 86 percent of the American people and i s the
best health care system in the world."
/delval/
-010/8/93
/NOTE TO EDITORS: Copies of the chart are available upon request./
/CONTACT: Dan McKenna, 215-597-3581, or. Susan Lamontagne, 202-224-9031,
of Sen. Arlen Specter's o f f i c e / CO: ST: iPl'ennsylvania IN: HEA SU:
MJ-CC
— PHOlO — 5989 10-08-93 11:05 EDT
****
f i l e d by:APDF(—)
on 10/08/93 at 11:05EST ****
**** printed by:WHPR(JOPP) on 10/08/93 at 12:42EST ****
�THE
NEW
YORK
TIMES
OP-ED
TUESDAY.
SEPTEMBER 28. 1993
Rube Goldberg, Call Your Office
By Stuart M. Butler
WASHINGTON
M s Vice President Al Gore
points out in his NaM ^
tional Performance
M^i^L
Review, the Federal
M
Govemmenl excels
at
taking
simple
t.asks and making them complex.
Tliat's why we should not be surprised by the Admmisiration's prescription for remventing health care.
Ii's a bureaucrat's fantasy — and a
patient s nightmare.
The Administration could have
bused its reform program on an existing consumer-driven benefits system
that works. Instead, it opted for a
Rube Goldberg-type system based on
something that has never worked:
price controls.
Hillary Rodham Clinton's 500-person task force had as its mandate
three primary tasks: extending medical benefits to the uninsured without
breaking the bank, guaranteeing continued insurance coverage even if we
change jobs or get sick and taming
the inflated costs of health care.
rhere was a relatively simple,
straightforward model of how to do
thsit, but they ignored it: the Federal
Employees Health Benefits Program, which covers nearly 10 million
employees and retirees and their dependents — a cross-section of America, white- and blue-collar workers,
janitors, secretaries, messengers, as
well as two miUion retirees and their
spouses.
Under the Clinton plan, a national
board would tell us what package of
benefits we must have. By contrast,
under
the
Federal
employees'
system, the workers decide for themselves which services they want included and which they do not Once a
year they receive information on ail
the plans available where they live —
typically two to three dozen. The cott
of premiums, out-of-pocket expenaes
and services — it's all there in Mack
and white. They pay about one-third
of the premium and the Govemmenl
pays about two-thirds.
Federal employees get plenty of
Stuart M. Butler is vice president and
director of domestic policy studies al
the Heritage Foundation.
advice on which plans are best, from on health care each vear and how
buy medical care for us wiih tax
unions, retiree associations, advertismany physicians will be trained lo dollars. This opiion — copying Canaing and the news media. There is even serve us and in what specialities.
da propei ly — would avoid ihe cluitcr
an inexpensive, easy-to-understand
The linchpin of the Clinton cost
guide published each year by Wash- control system is a proposed cap on in the Clinton plan It is j clear and
honest choice Bul ii would mean c.\ington Consumer's Checkbook, a coninsurance prices. There would be no
sumer organization that rates olher controls on the costs of providing plicii raiioiiinn. whicn mo.'ii ol us ve
hemenily oppose
family purchases.
benefits: explicii controls would panThe other cnuitc is lo rrcnic a rc:u
The Federal employee health ic the medical communiiy. But evensystem is a Govemment program in tually, the Clinton plan would produce health care markci by platmc coniriil
name only. The Govemment doesn't sweeping, permanent price controls of health dollars firmly in the hands
of each family. Iciling families seek
fix the prices of premiums or specify by stealth.
the insurance plans or medical serva standard benefits package. All it
Here is how it would happen. First,
ices offering the best value for monreally does is make sure each plan with costs rising faster than premimeets certain financial and truth-m- ums, insurers would be forced to do
advertising standards, and acts as a the obvious: crack down even harder
clearinghouse for premium pay- on hospiuls and doctors by increasments. Costs are controlled not by ing
paperwork,
second-guessing
regulation but by individual Ameri- treatment decisions and denying
cans choosing plans on the basis of
claims. (If doctors and patients are
price and services in a highly compet- frustrated by insurance companies
itive market.
today, just wait until the insurers face
Competition works. Two weeks ago price controls.)
the U.S. Office of Personnel ManageSecond, health plans approved by
ment announced that premiums for
the alliances would be subject to fines
the several hundred plans available for exceeding their budgets, and ey. Today, those dollars arc typically
through the program would increase could pass on part of these fines to controlled by emptoyers; su families
by an average of just 3 percent next doctors and hospitals — a crude form have Utile incentive to consider value
year, that more than 40 percent of of price control. And if this failed to for money, and they risk losing coverenrollees would see decreases and hold down costs, as it would, the Clin- age if they change jobs.
that many would even get 'new or
ton plan would give states standby
Mr. Clinton wants the Government,
improved preventive care services." power to regulate prices directly.
the health alliances and ihe insurers
Very few other health plans can
Even these measures would be to control the dollars. A real consummake such sutements.
unlikely to keep the plans within er system, by contrast, would allow
Every full-time Govemment em- budget. But Washington knows how to groups ol emplovees to accept cash
ployee involved in the effort to re- deal with such problems: slap price instead of health benefiis irom their
invent health care — from the Presi- controls on doctors, hospitals and employers and use ihe money to buy
dential adviser Ira Magaziner to the medical laboratories — just as it has whatever plan they considered the
stenographers who kept the minutes done with Medicare.
best value. It would then be the workSo the Clinton health system would ers' own health plan, and would be
be Medicare writ large: constantly unaffected by a job change
HEALTH CARE
over budget, with tighter and tighter
The tax code would have to be
controls and with more paperwork
changed to give families the same tax
SECOND OPINIONS
and bureaucracy, not less. And it s relief for their chosen plan as for a
folly 10 expect such a complicated company plan ending discrimination
.isi()ii:il scri) s
Government system to deliver quali- against families who buv iheir own
ty care for a lower price. Price con- plan or pay for services directly. In— is covered by the 33-year-old Fed- trols have never achieved such surance rules would have to be
eral employee program, as are all results in the past, and they won't
amended to prevent cancellation or
members of Congress.
work now.
arbitrary premium increases during
But instead of using that program
Health care Is a vastly complicated a long-term contract. And low-incomc
as a model (as the Heritage Founda- industry that depends on millions of
families would need vouchers.
tion's own health reform plan does), Individual decisions about one of the
Such a system — similar in many
the President would establish statemost personal areas of our lives. It
respects to the Federal Employees
sponsored "health alliances " to bar- defies central planning, even by a
Health Benefits Program — would
gain with insurers on our behalf, and reinvented Government.
use the efficiency and choice ol the
shower doctors, hospitals and other
There are only two ways to provide
market to control cosis while assurproviders with new regulations. He universal coverage and control costs. ing us that an illness. <i inh change or
would set up a new National Health One is to sweep away the current
even unemplovmcni wouiOii i affect
Board to tell us what medical servsystem — insurance companies, em- our insuriincc covcrapc
ices we can and cannot have, how
ployer-provided insurance and choice
And unlike the Clinion plan, it is nr
much money we are allowed to spend of services — and lei the Govemment
theoretical leap uf faiih
THE NEW YORK TIMES. TUESDAY. SEPTEMBER 28. 1993
Why did Clinton
ignore a health
plan that works?
�y Your Future Health Plan
By DICK ARMEY
"The American Health Security Act reduces the burden of papenoork and administration; regulatory requirements decline
and consumers experience a streamlined
and simpler system."
-Introduction to tlraft
of Clinton health plan
As with the budget earlier this year
there is a disparity between what the administration claims about its health care
plan and what it does. A close analysis of
the 239-page draft circulating on Capitol
Hill reveals that the Clinton health plan
would create 59 new federal programs or
^fH
<
cr
o
o
cc
bureaucracies, expand 20 others, impose
79 new federal mandates and make major
changes in the tax code.
The accompanying chart is a simplified version of the plan. The accompanying glossary cites specific references
to the page number in the draft where
the fimctions of an agency or program
are described, unless there are too
many references to mention (for cabinet level departments) or the funcUons
are not described in detail (some local
functions).
In fairness, it should be noted that not
all the boxes on the chart are new creations. Some are existing agencies or pro-
HHS
]
PWBA
State Government
CHBl
Regional Health Alliance
.
(HA)
AHCPR I
$
PORTS
$
^
$
NCGME [ -
13
Corporate Health Alliance
(HA)
_ .OmbudsmanI
t
^ \ ^ "
FUKDINO
«
Employer 7 l«</EnipIoyei AHC tax
Noa Worker» ff^ w ^ t f tax
|"MPLOYEE| I T ^
OltiertmtMfljJM uvings
COMPKIHTS
Price
llting
Accountable Health Plan
(AHP)
PES
Provider Plan
•{Drug Co
Insured prescripiiont
NGFSFHP - ^ 2
NQMP j -
PHTP I
Regulaton
V<
(NO.N.SINGLE PAYER SYSTEM)
J
NHBl
[TREAS.j
NHAC
—I HCFA I
rHHS
DOD]
(NHB)
— j NHSC {
IHS
DOL
IT
National Health Board
LTCIAC I
LU
Rep. Armey (R., Texas) is chairman of
the House RepubUcan Conference.
Executive Office
of the President
NIH
Q.
grams given new roles in overseeing and
regulating the new Clinton health care bureaucracy. (The federal govemment now
spends 42 cents out of every health care
dollar.) The plan relies largely on the vast
expansion of existing powers.
A picture's worth a thousand words
and this flow chart makes it clear that the
Clinton plan is a bureaucratic nightmare
that will ultimately result in higher taxes
reduced efficiency, restricted choice'
longer lines and a much, much bigger federal govemment.
M
Patients I
wHwa twniii (odrag« f
1 TTTTI
nndom
MItctlon
Source: Auno,, House Republican Conterence
Niillh
ftlcurlty Cird
NHB Piiitnl 1.0
Ombudsman I "
^1
(EMPLOYEE
"•""*.! ^"oun'able Health Plan
GLOBAL
BUDGET
•
•
NHDAC yPTAC
RAAC
C0MPtM)ir«
»« ^1
HMO
Provider Plan
NPP
(AHP)
imllormtenfflnclniie
'il
HcilIK
Sfturlly Clr(
^MHB Pilieni I D
l
PPO
Provider Plan
M
Patientsj
Low-Income Subsidy
Smill Finn Subsidy
Early Retirement Subsidy
Long Term Cere Subsidy
Loan Forgiveness Program
Rural Health Program
Risk Acceptance
Subsidy Program
Indian Health
Schoianhip Program
Drug Rebate Program
Community-based Health
Loan Program
�A Clinton Plan Glossary n
AHCPR: Agency for Health Care Policy and Research-Collects and analyzes
medical data supplied by PORTs (see below). "Research activities are conducted
through intramural and extramural programs using the mechanisms of grants,
contracts, and cooperative agreements "
(p. 143)
AHP: Accountable Health Plan-"Provide coverage for the nationally guaranteed comprehensive benefit package
through contracts with regional or corporate alliances. Only state-certified health
plans are allowed to provide health insurance and benefits in regional alliances."
^
mS: Indian Health Services-Funds ing "methods to reduce variations in budmedical care for Native Americans. "Un- get targets across states due to differences
der new authority, it covers all residents, in practice pattems. physician supply,
Indian and non-Indian, living on reserva- population characteristics, and other aptions in addition to populations living near propriate factors." (p. 97)
reservations." (p. 188)
PWBA: Pension Welfare and Benefits
LTCIAC: Long-Term Care Insurance
Administration-Regulates health benefit
Advisory Council-Five-member panel applans by virtue of administering the Empointed by HHS secretary "for their ex-ployee Retirement Income Security Act
pertise in provision and regulation of long(Erisa), which would be expanded to interm care insurance" to "monitor the de"fiduciary and enforcement requirevelopment of the insurance market." (p.clude
ments for employers and others sponsor160)
,
ing health benefit plans in corporate al-'
M&M: Medlcart and Medlcald-Gov- liances." (p. 72)
emraent health insurance programs for el(p.;74)
"i <
•^<i^..y.i.ri, .J-t„it.-:^^i-.^f-,v;~.^..^
RAAC: Risk Adjustment Advisory
derly and poor Ainp|icans, respectively,
BDPC: BreaMirou^i iifiag Pricing with combined anny^ expenditures of $276 Committee-Promulgates rules and regu:
lations for the new national RiSk AdjustCommlttee-Mbnllors.. and' investigates billion (and rising)w
ment System, which adjusts "premium
breakthroug^i drugs to determine the "reaNCGME: National Council on Graduate payments-to health plans to refiect the
sonableness of laiinch prices.'': (p^ 43) t
Medical Education-Rations number of level ofriskassumed for patients enrolled
CHA: County Healta Authorities- : medical students specializing in certain
Monitors health care implementatloh at fields "based on the national need for new in coijiparison to the average population in,
thearea.'.'(p. 83)
the county level. , . physitiians in specific specialties." (p. 126)
CHBI: Commission on Health Benefits
SBC: School Based Clinics-"Provide
NGFSFHP; Nation^ .Guaranty,Fund
and Integration-Studies "the feasibility for Self-Funded Health Plans-"Inspect physical and mental health services and"
and appropriateness of transferring the fi- the books and records of self-funded health •counseling in disease prevention and
nancial responsibility for all medical ben- plans and assume control over plans if health promoUon as well as in individualefits (including those now covered under
fail to meet reserve requirements." ' ized risk, behavior reduction" in middle
workers' compensation and automobile in- ' they
schools and high schools, (p. 185)
,
surance) to the new health system." (p. (p. 73)
SGF: State Guaranty Funds-"Pay.
NHAC:
National
Health
Advisory
Com;;90)
:,, 0?'
• •':
- mlttees-Established to advise Njiffi. com- • health providers and others if a health
DOD: Department iOrDefense^^Maln- prising "representatives of-states, health' . plan is unable to meet its obligations." Retains and operates health care system with providers, employers, consumers and af- tains power to tax the premiums of otherwithin an alliance and "borrow
doctors and hospitals separate from the fected industries." (p. 45)
> •:
- plans
funds
against
future assessments in order"
Clinton health care plan;
NHB: National Health Board-A "miDOL: Department Of libor-Regulates nor oversight board" (according to HHs ' to meet the obligations of the failed plan."'
all corporate alliances and monitors per- Secretary Donna Shalala) that regulates' (p. 53)
formance of corporate, and regional al- • all aspects of the $900 billion health indusSIC: State Insurance Cominlssionliance grievance procedures;' 'r'',.' ^''.
, try and oversees all govemment health ' "Financial regulation of health plans" (p.'
FFS: Fee for Service ProvldefPlan-A care agencies and regulators, {p.- 42)
,;' 49). The National Association of Insurhealth plan "in which patients have the opNHDAC: National Health Data Advl-i ance Commissioners (NAIC) "will be in-"
tion of consulting any health provider sub- sory Council-"Oversees the information structed to make the necessary adjustject to reasonable requirements." (p. 62) • and
ments to Medigap pohcies to reflect the
activities, including standard^et- prescription
In the event an FFS plan "does not have • tingdata
dmg coverage under
and
privacy
protection,
of
the
federal
sufficient capacity to serve everyone who
Medicare."
(p.
197)
wants to enroll," new members will be de- - govemment under health care reform "
Treas.:
Treasury
Department-Levies
(p.-116)
.
•
,
,
.
.
,.
i^
termined by "a process of random selec-'
NHSC: National 'Health Service taxes to fund govemment-run health
tion." (p. 67)
Corps-Offers doctors, nurses and other system.
GAO: General Accounting Office-Au- health care providers tuition assistance in
USPS: U.S. Postal Service-Operates
dits, oversees and investigates perforfor service in poor and rural ar- as a corporate health alliance separate
mance of other agencies, and "conducts exchange
from other govemment employee plans,
eas after graduation, (p. 182)
audits of the [NHB]." (p. 46)
NIH: National Institutes of Health- (p. 65)
Global Budget-Govemment-imposed "Expands prevention research in priority
VA: Department of Veterans Affairslimit on health care spending per year.
areas." (p. 137)
Runs independent health care system for
HA: Health Alliances-Regional alNPP: National Privacy Panel-Re- American military veterans.
liances may be nonprofit corporations, in- sponsible for ensuring "privacy protection
dependent state agencies or agencies of as applied to health information." "The
state governments, appointed - by Board establishes national, unique identi"statewide Councils composed of represen- fier numbers for plans, providers and na- tatives .of employer and consumer organi- tients." (p. 112)
zations." (p. 56) "If the individual dpes not
NQMP: National Quality Management'
choose a health plan within 36 daysl the alliance assigns the individual to the lowest- Program-Centralizes patient medical information and provider practice informacost plan available." (p. 58)
tion from national network of regional
Corporate alliances; are formed by "em- - centers, and develops a "core set of meaployers with more than 5.000 employees" sures of performance that apply to all
to "provide health benefits to eligible em- health plans, institutions and practitionployees and dependents either through a ers." (p. 101)
certified self-funded employee benefit plan '
dissatisfied
or through contracts;with state-certified withOmbudsman-Patients
the
newly
developed
grievance
prohealth plans." (pp. 65-67)'• ', A
cedures ("alternative dispute resolution
HCBS: Home and Community-Based procedures") "have the option of pursuServices-"Supplements other coverage ing the issue with the ^lUance ombudsfor care," including "supervision or cues man." (p. 76)
;
r
to perform three or more of the following
PHTP:
Priority
Health
Training
Profive activities of daily living (ADLs): eatto "improve the supply,
ing, dressing, bathing, toileting and trans- grams-Designed
and quality of providers."
ferring in and out of bed." (Funding split distribution,
between state and federal govemment.) This includes physician-retraining programs. "In order to further expand the
(p. 152)
availability of primary care physicians,
HCFA: Health Care Financing Admin- support [sic] are given for the developistration-Funds and regulates Medicare ment of programs to retrain mid-career
and Medicaid. Office for Research and specialists to serve as primary care physiDemonstrations shares research responsi- cians." (p. 129)
bilities with AHCPR. (p. 143)
PORTs: Patient Outcome Research
HHS: Department of Health and Hu- Teams-Grant recipients who gather and
man Services-"Continues to administer analyze physician and hospital medical
existing programs, such as Medicaid, practice patterns (see AHCPR). (p. 140)
Medicare, and the Public Health Service
PPO: Preferred Provider Organlia... also administers and implements those tion-Network of physicians and hospitals
aspects of the new health care system not that have entered into an arrangement
delegated to the NHB or any other federal with an insurance company to provide
department." (p. 46)
care for lower costs.
H.A10: Health Maintenance OrganizaPTAC: Premium Target Advisory Comtion Provider Plan-A managed care plan mission-Appointed by NHB "to recomthat hmits choice of physicians in ex- mend adjustments to the methodology for
change for lower costs.
calculating premium targets" by explor-
�
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Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
Identifier
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2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Administration/Bureaucracy
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
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2006-0885-F Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 8
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Preservation-Reproduction-Reference
Date Created
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2/6/2015
Source
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42-t-12092992-20060885F-Seg2-008-001-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/0b7e89152fef4293f6306ffaa06bfb5f.pdf
4718ebfa81d852ac0d0a1bb18739716f
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3665
FolderlD:
Folder Title:
Dodd, Christopher (D-CT)
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
3
1
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. resume
DATE
.SUBJECT/TITLE
02/01/1993
re: Vivian Riefberg (partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3665
FOLDER TITLE:
Dodd, Christopher (D-CT)
2006-0885-F
ip2646
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204{a)|
Freedom of Information Act - |5 U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FGIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(bX6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA)
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA|
Release would violate a Federal statute [(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfllc defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�POUTICAL PROFILE
Senator Christopher Dodd is widely regarded
as a thoughtful liberal. In the Senate, he has
been identified primarily with his work on
Latin American issues and on Federal efforts
to improve the lives of children. As
Chairman of the Subcommittee on Children,
Family, Drugs and Alcoholism Senator Dodd
has introduced some of the most far-reaching
legislation to aid families with young
children.
He is credited with being one of thefirstto
focus legislative attention on the topic. With
Pennsylvania Republican Arlen Specter, he
founded the Senate Children's Caucus in
1983. Dodd first introduced his Act for
Better Child Care bill in 1987. Despite
bipartisan pledges of support for legislation to
aid working families, it took long, painful
months of negotiation to win White House
approval of a bill far more modest than
Democrats had hoped.
Senator Christopher Dodd
(D-CT)
Born:
Education:
Military:
Prev. Occup.:
Family:
Religion
Pol. Career:
Elected:
Residence:
5/27/44, Willimantic
Providence College,
B.A.; U. of Louisville,
J.D.,
Army
Reserve,
1969-75.
Lawyer
Divorced
Roman Catholic
U.S. House, 1975-81
1980
[Re-election:
19981
East Haddam
Labor,
Banking,
Budget, Foreign, Rules
In 1992, Dodd sponsored S.5, the Family and
Committees:
Medical Leave Act of 1992. Though Dodd
agreed to scale back some of the provisions
^
in the bill. President Bush refused to go along
with any bill that made the requirements
mandatory. During his tenure in the House from 1975-1981, Dodd supported gun control and
lobby-disclosure bills. He also tried to increase fuel aid for the poor.
LEGISLATIVE INTERESTS
102nd: Senator Dodd's primary focus was legislation involving children and families. While
cosponsoring many public health bills, he did not sponsor any major public health or health care
reform legislation. He did cosponsor Senator Bentsen's bill, S. 1872, making incremental
reforms in the small group insurance market.
103rd: The Senator introduced the Family and Medical Leave Act S. 5. That bill was
incorporated to H.R. 1 and signed into law by President Clinton on February, 5. Senator Dodd
has also cosponsored legislation to protect the reproductiverightsof women (Mitchell, S. 25),
and to revitalize the NIH (Kennedy, S. 1).
�Tu
vJcftords (R-VT)
supports L'C. prefers to call mandate ' ihared
responsibility"
i—
'.Kohl (D-WT)
vt
supports UC. not sure on EM - concemed about
impact on business
wants UC. suppons EM or IM
Joco-lt:-
^
CK
might suppon
supports
\ /Simpson (R-N^'Y)
The following Senators indicated -hey would support health care reform that achieves universal coverage
through an employer mandate and iha guarantees def.ned package of benetits;
vi^ampbe'd (D-CO)
)odd (D-CT)
?imon (D-IL)
Jarkin (D-IA)
^litchell '^D-ME)
AlikuLski (D-MD)
^iegit (D-MO
\Bingamaji (D-NM""^^cll (D-Ri)
©aschle i,D-SD)
vSdsser t,D-TN'j
ILeahy (D-VT)
-Murray (D-WA)
Rotkelc'iier (D-WV;
�HEALTH CARE TASK FORCE
CONGRESSIONAL CONTACT SHEET
CONTACT DATE;
6> ' \ I ' Q . ^
RECORD #:
MEMBER'S NAME; ^ ( ^ ^ A c A
MEMBER'S STAFF:
TYPE OF CONTACT:
HCTF ATTENDANCE:
MEETING:
PHONE CALL:
HRC:
OTHERS:
IRA:
JUDY:
QC^ ^ \^[/
REASON FOR MEETING ( I F NOTABLE):
TOPIC OF DISCUSSION/GENERAL NOTES:
n*?'D*tA S ^ ^ ^ urxUjA ^ LndLjULSt>U4 ^^"^^ a t:xati'l<
dCkx^d^ (DiJQocJt- room v^or
REPORT BY:
PLEASE RETURN TO ROOM 205--AS SOON AS POSSIBLE.
�-to
9i(\aA^ - H - ^ ^ ^
uolth
CK^^H^"^ ^
LoajpM npi^A"^ h^CLidK ^^-^rr^ ^CMOiO^
\ oon. Ui-Vrr told Ira
^(yY) VP^^^qWi
UD^CCLAH
<^Majr\c(td
mat^k^
�CHRISTOPHER J. DODD
United States Senator
Washington, D.C. 20510
^
March 16, 1993
H i l l a r y Rodham C l i n t o n
The White House
Washington, DC 20500
Dear Mrs. C l i n t o n :
I t i s my understanding that Dr. Donald W.
Kohn has w r i t t e n you regarding h i s i n t e r e s t i n
a i d i n g i n the development of a new n a t i o n a l h e a l t h
care p o l i c y . I endorse h i s e f f o r t s
wholeheartedly.
Dr. Kohn i s Chief of the Department of
D e n t i s t r y a t the Yale U n i v e r s i t y School of
Medicine. Given h i s expertise, I f i r m l y believe
Dr Kohn would make a valuable c o n t r i b u t i o n t o the
discussion of the needs of c h i l d r e n o v e r a l l and t o
the need f o r preventive and basic p e d i a t r i c dental
services i n any new h e a l t h program i n p a r t i c u l a r .
Dr. Kohn i s a noted c l i n i c i a n , educator and
a d m i n i s t r a t o r who i s w i l l i n g t o volunteer h i s
considerable t a l e n t s t o enhance t h i s important
effort
I urge you t o r e f e r h i s name t o the
appropriate working group. Thank you f o r your
consideration.
CHRISTOPHER J. DODD
United States Senator
�CHRISTOPHER J. DODD
United States Senator
Washington, D.C. 20510
A p r i l 5, 1993
H i l l a r y Rodham C l i n t o n
The White House
Washington, DC 20500
Dear Mrs. C l i n t o n :
I t i s my understanding t h a t Martin Schwartz,
President o f The Kennedy Center i n Bridgeport,
Connecticut, has w r i t t e n you requesting t h a t a
member o f the Board of Director's of the Center be
selected t o a i d you i n the development of a new
n a t i o n a l h e a l t h care p o l i c y . I endorse h i s
e f f o r t s wholeheartedly.
Although I am aware t h a t members of the
Health Care Task Force have been appointed, I am
sure t h a t the f i g h t f o r a f f o r d a b l e and q u a l i t y
h e a l t h care w i l l be a long one and t h e r e f o r e , ask
f o r your consideration that a representative of
The Kennedy Center be included a t an appropriate
time. The Kennedy Center i s one of the l a r g e s t
and most comprehensive r e h a b i l i t a t i o n f a c i l i t i e s
serving adults w i t h d i s a b i l i t i e s i n Connecticut.
I n a d d i t i o n , the Center has been noted as one of
three Exemplary Programs i n the nation by the U.S.
Department of Education.
I t i s l e d by a diverse
and d i s t i n g u i s h e d boarcL,^^ I h^^K|Ly recommend t h i s
group t o you and urge ffo\ to/takfe advantag^-'of
t h e i r expertise.
CHRISTOPHER J. DODD
United States Senator
�NAME
?TAF~ CONTACT
TEL
COMhi r TEES
SUBCDMMl I TEE
B A C \ G rv G U ^! Ll I N P Q M A I C r .•
I^::EY
PEOF'LE
P'ART I CULAF'
HEALTH
• R G A N I Z A T I O r j A L CCH.'
TA£i
r. CF CE
NOTET
\'
i f-1-r
-
?' 1 '-^
1^ ''^'^ ^
�142 • Senators and Staffs
Christopher J. Dodd
KEY STAFF AIDES
Name
Position
(^oug Sosni^
Stanley Israelite
(203-240-3470)
Legislative Responsibility
Admin. Asst.
State Dir.
0 ^ ^ (
Jiili^ Rossnn Sffwti-t-ft'e?^H Secy)' ^ ^ > t ^ Z/c/-^^
D -Connecticut
Reelection Year: 1992
Began Service: 1981
SR-444 Russell Senate
Office Building
Washington, DC
20510-0702
224-2823
BIOGRAPHICAL
Born: 5/27/44
Home: East Haddam
Educ: B.A., Providence
Col; J.D., U. of
Louisville
Prof.: Attorney; U.S.
House of Reps.,
1975-81
Rel.: Catholic
Dep. Press Secy
Marvin Fast
Admin. Dir.
Leslie Finn
Sr. Foreign Pol.
Bob Dockery
Adviser
^tiiaii Il'ugan
Legis. Dir.
Gillman. V/M^A
//aPf/ylAA/
Legis. Asst.
Suzanne Day
Bob Gillcash
Paul Hannah
Legis. Asst.
Legis. Asst.
Matt Hersh
Legis. Asst.
Tony Orza
Legis. Asst.
Pat Walsh
Patti Ogle
Pers. Asst.
Spec. Asst./Scheduler
W o ^ Y f ^
Foreign Policy/Foreign Aid, Intelligence
Social Security, Welfare, Unemployment
Education/Arts, Energy, Environment, Labor
Defense, Treaties
Budget Committee; Appropriations, Banking,
Small Business
Commerce/Trade, Science/Technology, Human Rights
Judiciary, Housing/Urban Issues, Transportation, Telecommunications
COMMITTEE ASSIGNMENTS
Committee
Subcommittee(s)
Banking, Housing, and
Securities, Chairman • Housing and Urban Affairs
Urban Affairs
Budget
No subcommittees
Foreign Relations
Western Hemisphere and Peace Corps Affairs, Chairman • East
Asian .md Pacific Affairs • International Economic Policy,
Trade, Oceans and Environment
Labor and Human
Resources
Children, Family, Drugs and Alcoholism, Chairman • Aging
• Education, Arts and Humanities • Labor
Rules and Administration
No subcommittees »U
,
OTHER POSITIONS
Senate Democratic Steering Committee • Democratic Senatorial Campaign Committee • Senate
Central Amencan Negotiations Observer Group, Chairman • Senate Children's Caucus, CoChairman • Northeast-Midwest Senate Coalition, Co-Chairman • House/Senate International
Education Study Group, Co-Chairman • Mexico-U.S, Interparliamentary Group, Senate Delegation, Chairman • Environmental and Energy Study Conference, Co-Vice Chair •Congressional Clearinghouse on the Future, Advisory Committee • Friends of Ireland, Executive Committee
,
STATE OFFICES
Putnam Park, 100 Great Meadow Rd,, Wethersfield, CT 06109
Summer 1992
^
© Congressional Ye'.iow Book
(203) 240-3470
�Which do you desire?
1: The current item: Brief Profile
2: All 3 items selected for Sen. Christopher J. Dodd (D-CT)
Choose ONE number: ^G2
LEGI-SLATE Report for the 103rd Congress
Fri, April 9, 1993 1:42pm (EDT)
Brief Profile:
Sen. Christopher J. Dodd
State: Connecticut
Party: Democrat
Seniority: 1981
Residence: East Haddam
Last Election %: 61/39/-Next Election: 1998
Committees:
LABOR AND HUMAN RESOURCES
FOREIGN RELATIONS
BANKING, HOUSING, AND URBAN AFFAIRS
BUDGET
RULES AND ADMINISTRATION
JOINT COMMITTEE ON PRINTING
Member Biography, Copyright (c) 1993 Staff Directories, Ltd.
Senator Christopher J. Dodd (D CT) of East Haddam. Washington office: 444
Senate Russell Office Building, zip 20510-0702, phone (202) 224-2823. Senate
service, January 3, 1981 to January 3, 1993; rank, 33rd (one of 9). Prior
House service, January 3, 1975 to January 3, 1981. Born May 27, 1944 in
Willimantic, son of the late Senator Thomas J. Dodd (D CT). Providence
College, B.A. in English literature, 1966; University of Louisville School of
Law, J.D., 1972. Admitted to Connecticut Bar, 1973. Peace Corps volunteer,
Dominican Republic, 1966-68. U.S. Army service, 1969-75. Practicing attorney.
Roman Catholic.
Committee Assignments:
Committee Assignments for
Sen. Christopher J. Dodd (D-CT)
�SENATE COMMITTEE ON BANKING, HOUSING, AND URBAN AFFAIRS
Seniority: 3rd of 11 Democrats
Economic Stabilization and Rural Development Subcommittee
Seniority: 3rd of 5 Democrats
Housing and Urban Affairs Subcommittee
Seniority: 6th of 6 Democrats
Securities Subconmiittee
Seniority: Chairman
SENATE COMMITTEE ON THE BUDGET
Seniority: 9th of 12 Democrats
SENATE COMMITFEE ON FOREIGN RELATIONS
Seniority: 4th of 11 Democrats
International Economic Policy, Trade, Oceans, and Environment
subcommittee
Seniority: 3rd of 6 Democrats
Terrorism, Narcotics, and Intemational Operations Subcommittee
Seniority: 3rd of 5 Democrats
Western Hemisphere and Peace Corps Affairs Subcommittee
Seniority: Chairman
SENATE COMMITTEE ON LABOR AND HUMAN RESOURCES
Seniority: 4th of 10 Democrats
Aging Subcommittee
Seniority: 4th of 5 Democrats
Children, Family, Drugs, and Alcoholism Subcommittee
Seniority: Chairman
Education, Arts, and Humanities Subcommittee
Seniority: 3rd of 10 Democrats
Labor Subcommittee
Seniority: 3rd of 5 Democrats
SENATE COMMITFEE ON RULES AND ADMINISTRATION
Seniority: 7th of 9 Democrats
JOINT COMMFFTEE ON PRINTING
�Seniority: 2nd of 5 Senators
Ratings by Interest Groups:
Ratings by Public Interest Groups
for
Sen. Christopher J. Dodd (D-CT)
Percent "Favorable" When Voting
Rating
Organization
~98th- ~99th- -100th- -101st- -102nd'83 '84 '85 '86 '87 '88 '89 '90 '91 '92 Cum.
AFL-CIO
100 91 95 73 100 86 100 78 92 92 93
Amer Assn of University Women
-> 100 -> 91 -> 83 -> 100 -> 100 93
Amer Civil Liberties Union
67 92 89 80 63 63 60 91 77 100 79
Amer Conservative Union
0 10 4 17 0 8 22 9 24 11 10
Amer for Constitutional Action
6 9
#
6
Amer for Democratic Action
94 100 85 85 72 89 65 65 75 75 83
Amer Security Council
-> 0 -> 20 -> 10 -> 40 -> 50 23
Business-Industry PAC
0 0 13 31 9 5 0 22 15 #
8
Chamber of Commerce
24 42 41 44 13 36 50 9 20 # 28
Consumer Federation of America
80 73 87 79 75 100 54 83 83 92 83
Independent Petroleum Assn
# 0 - 0 0
#
7
League of Conservation Voters
-> 94 -> 73 -> 83 88 82 67 82 79
League of Women Voters
100
# 86
Machinists Political League
-> 100 100 92 100 92 -> 92 # # 96
Natl Assn of Manufacturers
33 ~ 43
> 13 -> 15 20
Natl Council of Senior Citizens 100 90 90 70 78 100 70 70 80 50 82
Natl Education Assn
-> 90 83 86 -> 83 -> 91 100 100 92
Natl Farmers Union
64 63 75 92 88 100 100 67 90 70 82
Natl Fed Independent Business
-> 56 -> 57 -> 25 -> 22 33 50 40
Public Citizen Congress Watch
-> 63 -> 50 -> 82 -> 81 -> 71 70
Railway Labor Executives Assn
-> 89 -> 70 -> 80 -> 88
83
Teamsters
-> 83 -> 100 -> 91 -> 91 -> 90 92
United Auto Workers
100 92 90 69 94 95 93 94 95 79 92
KEY: # Rafing is unavailable to LEGI-SLATE.
- > Combined rating for that Congress is reported in next colunrn.
~ Rating was not published for that year.
Cum. Cumulative rating since 1979.
NOTE: Ratings are computed by LEGI-SLATE using the votes selected by each group
and their favored position on each vote. These ratings may differ slightly
from the group's published rating, because LEGI-SLATE ratings are based only
�on when the member was present and voting ~ they do NOT reflect "paired
votes" or "announced positions" when the member failed to vote.
Press ENTER to continue: ^G'^Z
�LEGI-SLATE Report for the 103rd Congress
Fri, April 9, 1993 1:47pm (EDT)
"Almanac" Profile:
The "Almanac of American Politics" is not yet available for 103rd Congress
"Almanac of American Polifics, 1992"
Copyright (c) 1991, National Journal, Inc.
Sen. Christopher J. Dodd (D), Senator from Connecticut
District background and political analysis:
Coimecticut now has two Democratic senators who have crossed political
paths during their careers. Christopher Dodd's father. Senator Thomas Dodd, was
notably more conservative on cultural and foreign issues than other Connecticut
Democrats; the current Senator Dodd has made his name as an opponent of efforts
to oust Communist-backed forces in Central America and as a backer of programs
to accoimnodate Americans' changing family lifestyles. Joseph Lieberman started
off as a liberal reformer, beating the incumbent state senate majority leader
in a primary in 1970; but he won his Senate seat in 1988 by rurming slightlybut noticeably—to the right of Republican Lowell Weicker on cultural issues
like school prayer and foreign policy.
Dodd is one of those liberal baby-boom generation politicians whose
formative political experience seems to have been service in the Peace Corps.
While others were fighting in Vietnam, and while his father was being
investigated and censured for misuse of campaign funds by the Senate, Chris
Dodd was in the Peace Corps in Moncion, Dominican Republic. (In 1969, he, like
Dan Quayle, enlisted in the National Guard.) From his work with povertystricken Dominicans, he seems to have absorbed the lesson taught by many Latin
American intellectuals, that the United States is responsible for the
backwardness of Latin economies, as well as the lesson taught by many
Americans, that the hardest task in foreign policy is preventing the United
States from supporting repressive right-wing Third World dictators.
Consequently, Dodd has been one of Congress's leading policymakers on Latin
America. Elected to the House in the Watergate year of 1974, he moved to the
Senate in 1980 after persuading fellow Watergate baby Toby Moffett not to run
in the primary and beating former New York Senator James Buckley in the
general. In the Senate, he inherited the chair of the Latin American
Subcommittee after only six years. On El Salvador, he pushed through a measure
barring military aid to that country unless the President certified progress in
human rights, and then opposed the certifications when Reagan made them. In
�September 1989, he supported military aid to El Salvador's government, but by
summer 1990, he was trying to get a negotiated settlement there by conditioning
military aid to the behavior of both the rebels and the government, and their
willingness to partitcipate in peace talks. Dodd and his allies did get a 50%
cut in aid to El Salvador, but were overruled by the administration, which felt
that the murder of two U.S. servicemen there warranted full aid to the
government. On Nicaragua, Dodd similarly is vigilant on misdeeds of the contras
and willing to overlook some violations in order to negotiate with the
Sandinistas. He was a strong and enthusiastic backer of the Arias plan in 1987,
though it's not clear whether he foresaw the Sandinista defeat in the elections
in 1989. On other Latin issues, Dodd has demurred at using U.S. power
heavyhandedly, arguing against decertifying Mexico for aid because of its lax
drug enforcement and arguing that any action against Panama's Noriega should be
multilateral. He has been less vocal about the emerging democracies of Brazil,
Argentina and other countries.
Dodd's primary domestic cause has been the ABC child care bill, a favorite
cause of baby-boom liberals who want government to take a stronger role in
helping individuals adjust to~and perhaps stimulating them to participate inchanging lifestyles. Supported by the AFL-CIO and the Children's Defense Fund,
Dodd's version of ABC would have put $2.5 billion into child care, setting
federal standards for health and safety. It would have made ineligible for
federal grants and voucher assistance most of the churches that currently
provide one-third of day care, and some said it wouldn't cover neighbors and
relatives who take care of children. Its aim seemed to be to institutionalize
pre-kindergarten day care on a national basis, and to create a corps of
caregivers in the image of the teaching profession, complete with postgraduate
training and union representation. Dodd did a good job getting the bill through
the Senate, but its approach was rejected in the House not just by Republicans,
but by young liberal Democrats like George Miller and Tom Downey; the bill
ultimately passed in October 1990 was shorn of most of the provisions of Dodd's
Senate bill.
Dodd is an agreeable man who works hard and, some say, plays hard and
remembers family debts. In March 1989, he was one of three Democratic senators
who voted for the nomination of John Tower as Secretary of Defense: in 1967,
Tower was one of two Republicans dissenting on a 92-5 vote to censure Thomas
Dodd. He has been widely popular in Connecticut, winning two Senate races
handily, the second with 65% in 1986.
The People: Population 1990: 3,287,116 (Population 1980: 3,107,576, up 5.8%
1980-90 and 25% 1970-80). 1.3% of U.S. total, 27th largest. Median age: 34.4
years. 13.6% 65 years and over. 8.3% Black, 6.5% Spanish origin, 1.5% Asian or
Pacific Islander. Households: 55.6% married couple families; 65.6% owner
occupied housing; median house value: $177,800; median monthly rent: $510. 5.1%
Unemployment. Voting age population: 2,537,535. Registered voters (1990):
1,700,871; 667,523 Democratic (39%), 461,374 Republican (27%), 534,595
unaffiliated and minor parties (34%).
�1988 Presidential Vote
Bush (R)
750,241 (52%)
Dukakis (D)
676,584 (47%)
1984 Presidential Vote
Reagan (R)
890,877 (61%)
Mondale (D)
569,597 (39%)
1988 Democratic Presidential Primary
Dukakis
140,291 (58%)
Jackson
68,372 (28%)
Gore
18,501 (8%)
Hart
5,761 (2%)
Simon
3,140 (1%)
Babbitt
2,370 (1%)
1988 Republican Presidential Primary
Bush
73,501 (71%)
Dole
21,005 (20%)
Kemp
3,281 (3%)
Robertson
3,191 (3%)
Personal: Elected 1980, seat up 1992; born May 27, 1944, Willimantic; home,
East Haddam; Providence College, B.A. 1966, University of Louisville, J.D.
1972; Roman Catholic; divorced.
Career: Peace Corps, Dominican Republic, 1966-68; Practicing attorney, 197274; U.S. House of Representatives, 1974-80.
Offices: 444 Russell Senate Office Building 20510, 202-224-2823. Also 100
Great Meadow Road, Wethersfield 06109, 203-240-3470.
Offices: 444 Russell Senate Office Building 20510, 202-224-2823. Also 100
Great Meadow Road, Wethersfield 06109, 203-240-3470.
Committees:
Senate Committee on Banking Housing and Urban Affairs (3rd of 11 Democrats).
Subcommittees: Economic Stabilization and Rural Development Subcommittee;
Housing and Urban Affairs Subcommittee; Securities Subcommittee (Chairman).
Senate Committee on the Budget (9th of 12 Democrats).
Senate Committee on Foreign Relations (4th of 11 Democrats).
Subconmiittees: International Economic Policy Trade Oceans and Enviroiunent
Subcommittee; Terrorism Narcotics and International Operations Subcommittee;
Western Hemisphere and Peace Corps Affairs Subcommittee (Chairman).
Senate Committee on Labor and Human Resources (4th of 10 Democrats).
Subcommittees: Aging Subcommittee; Children Family Drugs and Alcoholism
Subcommittee (Chairman); Education Arts and Humanities Subcommittee; Labor
Subcoimnittee.
�Senate Committee on Rules and Administration (7th of 9 Democrats).
Joint Committee on Printing (2nd of 5 Senators).
Group Ratings
ADA ACLU COPE CFA LCV ACU NTLC NSI COC CEI
1990
61 76 93 83 75
9 11 40
9 18
1989
65 - 94 54 90 22 - - 50 21
National Journal Ratings
1989 UB~1989 CONS
1990 LIB-1990 CONS
Economic
94% - 3%
79% - 20%
Social
76% - 16%
81% - 0%
Foreign
62% - 35%
56% - 40%
Key Votes
FOR: Raising the minimum wage to $4.55 per hour (S. Vote 1039)
AGAINST: Limiting debate on a capital gains tax cut (S. Vote 1295)
AGAINST: Benefits for coal miners affected by acid rain controls (S. Vote 2047)
FOR: Limiting debate on auto fuel efficiency standards (S. Vote 2248)
AGAINST: Striking provisions banning some semi-automatic weapons (S. Vote 2103)
AGAINST: Constitutional amendment banningflagdesecration (S. Vote 2128)
FOR: Limiting debate on the 1990 Civil Rights Act (S. Vote 2158)
FOR: Tabling parental notification requirement for abortions (S. Vote 2266)
AGAINST: Tabling proposed cuts in S.D.I, funding (S. Vote 1148)
AGAINST: Canceling procurement funding for two B-2 bombers (S. Vote 2209)
FOR: Reduction of U.S. forces stationed in Europe (S. Vote 2271)
FOR: 50% reduction in military aid to El Salvador (S. Vote 2293)
Election Results
1986 general Christopher J. Dodd (D) 632,695 (65%) ($2,276,764)
Roger W. Eddy (R)
340,438 (35%) ($183,632)
1986 primary
Christopher J. Dodd (D) (nominated by convention)
1980 general Christopher J. Dodd (D) 763,969 (56%) ($1,403,672)
James L. Buckley (R)
581,884 (43%) ($1,652,672)
Campaign Contributions and Expenditures
Sen. Christopher J. Dodd (D)
Receipts
$2,919,780
Expenditures
$2,650,409
Cash on Hand
$273,643
PAC Contributions
$785,161
Candidate Contributions
$0
Party Contributions
$0
Out-of-state Contributions
$874,302
Small Individual Contributions
$541,585
�Large Individual Contributions $1,424,425
Cost per Vote
$4.19
Spending Edge
$2,183,510
Debts
$1,500
Press ENTER to continue: ''G
�SENATE COMMITTEE ON BANKING, HOUSING, AND URBAN AFFAIRS
Seniority: 3rd of 11 Democrats
Economic Stabilization and Rural Development Subcommittee
Seniority: 3rd of 5 Democrats
Housing and Urban Affairs Subcommittee
Seniority: 6th of 6 Democrats
Securities Subcoimnittee
Seniority: Chairman
SENATE COMMITTEE ON THE BUDGET
Seniority: 9th of 12 Democrats
SENATE COMMITTEE ON FOREIGN RELATIONS
Seniority: 4th of 11 Democrats
Intemational Economic Policy, Trade, Oceans, and Environment
subcommittee
Seniority: 3rd of 6 Democrats
Terrorism, Narcotics, and International Operations Subcommittee
Seniority: 3rd of 5 Democrats
Western Hemisphere and Peace Corps Affairs Subcommittee
Seniority: Chairman
SENATE COMMITTEE ON LABOR AND HUMAN RESOURCES
Seniority: 4th of 10 Democrats
Aging Subcommittee
Seniority: 4th of 5 Democrats
Children, Family, Drugs, and Alcoholism Subcommittee
Seniority: Chairman
Education, Arts, and Humanities Subcommittee
Seniority: 3rd of 10 Democrats
Labor Subcommittee
Seniority: 3rd of 5 Democrats
SENATE COMMITTEE ON RULES AND ADMINISTRATION
Seniority: 7th of 9 Democrats
JOINT COMMFFTEE ON PRINTING
�CHRISTOPHER J. DODD
CONNlCTlCUT
mnitcfl Starts ^matt
WASHINGTON, OC 20510
(NOT TO BE BEXD 7ERBATIK FOR THE PURPOSE OF INTRODUCTION)
I3MITED STATES SENATOR CHRISTOPHER J , DQDD
CHRISTOPHER JOHN DODD, Democrat, was born ir. W i U imant i c ,
C o n n e c t i c u t , on May 27, 1944.
First elected to the United St:ates senate ^"^^0 0, Mr. Dodd
is serving his second term as a Senator in the 101st Congress
senator SLS i. a m.mber of.the Committee on Foreign Relate
and Chairman Of
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?983
the Committee on Rules and A d m i n i s t r a t i o n . m I S O J , he founded
the senate Children's Caucus.
p r i o r t o h i s tenure i n the
• «^ • ^ " t h . ' s c c f n a ' D i f t ^ i c t
irco.iniit'^. !rjhrs?i«"o?>:;r:::n
the House, he served On the Rules Committee, ^he J u d i c i a r y
and the Select committee on Assassinations.
Mr. Dodd i s a son of the l a t e Senator Thomas
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upper chamber of Congress.
Senator Dodd l i v e s in East Haddam,
O f f i c e s . U S Senate, Washington. D.C. 20510, (202) 224-2823;
Potnam'ptrk; lOO-Gfeat Meadow Hoad, wethersfield C o n n - icu
06109, (203) 240-3470. In-state t o l l - f r e e phone: (800) 334 534i.
NoV rrkarr\e<i^^ n o C m \ ^ r S n
updated January 1989
�CHWSTOPHEB J . DODO
eONNlCTICUT
Bnitei Starts Senate
WASHINGTON. DC 20510-0702
I
FACSIMILE TRAWSMlSStON SHEET
from th« Washington, DC Office of Senator Dodd
(202) 224-2823
PATE
TO
TlMEAiJlA^
dM/a.
hjL
FROM
NO. of p a g e s ( E X C L U D I N G C O V E R ) :
. COMMENTS
PWNHD ON R K Y C U B PAf
�CHRISTOPHER J. DODD
United States Senator
Washington, D.C. 20510
February 1,
\ A 1^/
U
r
'xB
2
^1993
1993
F i r s t Lady H i l l a r y Rodham C l i n t o n
The White House
1600 P e n n y s l v a n i a Avenue, NW
Washington, DC 20500
Dear Mrs.
Clinton:
I am w r i t i n g t o h i g h l y recommend V i v i a n R i e f b e r g f o r a
p o s i t i o n i n h e a l t h care i n t h e C l i n t o n / G o r e A d m i n i s t r a t i o n .
As t h e e n c l o s e d resume shows, V i v i a n has d e a l t w i t h t h e f u l l
range o f p e r s o n n e l , f i n a n c i a l , q u a l i t y , access and r e s o u r c e
a l l o c a t i o n i s s u e s p r e s e n t i n the h e a l t h c a r e arena. Her t e n u r e
w i t h McKinsey & Company, a l e a d i n g management c o n s u l t i n g f i r m ,
has p r o v i d e d her w i t h the s k i l l s , e x p e r i e n c e , and e x p e r t i s e t h a t
would be i n d i s p e n s a b l e t o t h e new a d m i n i s t r a t i o n .
V i v i a n ' s d i s t i n g u i s h e d r e c o r d q u a l i f i e s her f o r
p o s i t i o n s , i n c l u d i n g : Executive D i r e c t o r or O f f i c e
L e g i s l a t i v e P o l i c y , Department o f H e a l t h and Human
A s s i s t a n t Secretary/Deputy S e c r e t a r y f o r Management
and Deputy A d m i n i s t r a t o r f o r P o l i c y , Food and Drug
Administration.
a number of
of
Services;
and Budget;
V i v i a n i s h e l d i n t h e h i g h e s t r e g a r d by people b o t h on and
off Capitol H i l l .
I s t r o n g l y urge you t o g i v e her t h e utmost
c o n s i d e r a t i o n and would be happy t o t a l k w i t h you a t any t i m e
about her q u a l i f i c a t i o n s .
Sin
CHRISTOPHER J. DODD
U n i t e d S t a t e s Senator
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPK
001. resume
SUBJECr/TITLE
DATE
re: Vivian Riefberg (partial) (1 page)
02/01/1993
RESTRICIION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3665
FOLDER TITLE:
Dodd, Christopher (D-CT)
2006-0885-F
jp2646
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)l
Freedom of Information Act - |5 U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(bX4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA|
National Security Classified Information 1(a)(1) of the PRA)
Relating to the appointment to Federal office |(aX2) of the PRA|
Release would violate a Federal statute [(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�VIVIAN RIEFBERG
Professional Experience:
McKINSEY & COMPANY, Management Consulting, Washington, DC
Member, Healthcare Practice
IWl - present Engagement Manager. Direct all aspects of analysis and manage client and consulting firm
resource allocation for major client studies. Complete written reports and present fmdings to senior
diait executives. Counsel senior executives on a full range of management issues. Studies focus on
strategy and operations management for leading healthcare participants:
• Developed 3-5 year strategy for major player in healthcare information technology including
developing an overview of future structure of US healthcare system.
• Designed entry strategy in less-invasive surgery for leading hospital supply company.
• Created and initiated turnaround st^itegy for :ioi«. profit inMiranc t plan including divestiture ot
subsidiaries.
• Designed change management and strategy development program for major national insurance
carrier. Program developed to assure immediate profit improvement and to develop long-term
managed care strategy.
\%<) - m i
Senior Associate. Lead analyst for major client studies:
• Analyzed market opportunities for development of prod ucts/serv ices leading to major reform of
healthcare billing, collecting, and claims processing systems.
• Designed program to effect major change in management approach among senior management at
leading home center retailer.
• Completed market analysis and designed implementation plan for client participation in
hazardous waste field.
1W -1988
Associate. Team member and lead researcher on major client studies:
• Developed new model for healtficare delivery systems on medical and surgical wards for
leading hospital system.
• Analyzed HMO market for firm healthcare practice.
THE SIGAL-ZUCKERMAN COMPANY, Real Estate Development, Washington, DC
1988 -1989
Project Manager. Designed and implemented creation of $150 million planned unit development
(Franklin Plaza) in downtown Washington. Franklin Plaza project included land assembly and
major rezoning efforts as well as negotiations for amenities with D.C. Board of Education (historic
preservation of Franklin School) and DC Department of Public Housing (Rehabilitation of
multiple public housing units).
Lead Staff. DC Mayor's Conrunission on Downtown Housing. Served as research and editorial staff
to tliis major public-private initiative on downtovm housing.
AMERICAN MEDICAL INTERNATIONAL, Healthcare Marketing Conununications, Atlanta, GA
1984 -1985
Manager. Marketing Communications and Community Relations, Southern Region. Planned and
directed $4 million marketing communications and public affairs program for 18 hospitals in five
southern states resulting in a 15% increase in hospital emergency room use and a 22% increase in
hospital awareness levels. Super\'ised a marketing field staff of 20 and created a network
marketing approach in two target markets. Analyzed and developed a hospital service cost
accounting program to improve pricing strategies. Develoj^>ed community relations and government
affairs proi,'rams.
�OGILVY & MATHER, Public Relations, New York, NY
msi - 14,S4
Acroiint SuperviMir/Atlanta. Served as interim manager of the piihlii relations division.
Developed over $3(X)K in communication coivsulting billings. Trained and supervised three
professionals in the analysis, deveU)pment and implementation of marketing communications
programs including programs for regional participant in emergency health care clinics.
Senior Account Executive/Washington. Designed attd executed comprehensive communications
programs to reach key government personnel and community decision makers.
Account Executive/New York. Completed market analysis and designed national consumer
promotions for Dove Beauty Bar and Silhouette Book. Won David Ogilvy Award for
implementing promotion that increased Silhouette Book sales by 35%.
THE MAC GROUP, Management Consulting, Cambridge, MA
summer 198(1 Associate. Team member on mai()r client studies:
• Arranged and conducted on-site customer interviews, analyzed industry data and devised
market segmentation approaches for a major manufacturer of diagnostic imaging equipment.
• Developed industry background materials for a firm training program on the psychiatric
healthcare market.
J. WALTER THOMPSON CO., Public Relations, New York, NY
summer m )
Account Coordinator. Wrote press releases and developed media training program.
ABC-TV "GOOD MORNING AMERICA", New York, NY
sximmiT 1979
Rnsearrh Assistant. Created background papers on guests for use by program writers.
Education:
MASTER I N BUSINESS ADMINISTRATION, WITH DISTINCTION, JUNE, 1987
Harvard University Graduate School of Business Administration . Focus on healthcare management.
Admission Counselor - HBS Admission's Office. Chairperson - Women's Student Association Career Day.
Member of the Health Care, Venture Capital and Real Estate Industry Clubs. Completed field study on
congregate care living for the elderly.
BACHELOR OF ARTS DEGREE, MAGNA CUM LAUDE, I N HISTORY, JUNE, 1981
Harvard-Radcliffe College. Elizabeth Agassiz Certificate of Merit for academic excellence. Chairman Adams House Harvard-Radcliffe Fund; Events page editor - Harvard Indqiendent; Coordinated Harvard
Institute of Politics/WGBH-TV programming project resulting in joint production of two television series.
Publications:
"Healthcare Industry Overview: Is It Time for Cost Effective Bold Initiatives" coauthored with Fred Eppinger in The Healthcare Payor Annual, McKinsey & Company,
1992.
Articles on the press and politics co-authored with Edwin Diamond have appeared in
Adweek Magazine, American Film Maj,;azine and the Washini^ton journalism Review.
Community Service:
"Mentor" for DC public high school student - Mentors, Inc.
Memberships:
Harvard-Radcliffe Club - lnter\'ievving Committee; Old Town Civic Association; City
Club of Wa^hingtiMi; H,ir\-,ird Club at the National Press Club.
REFERENCES AVAILABLE UPON REQUEST
�POSITIONS I N THE CLINTON ADMINISTRATION ~ VIVIAN RIEFBERG
Office of Management and Budget
- Associate Director, Human Resources, Veterans, and Labor
- Deputy Director for Management
Council of Economic Advisers
- No particular position identified - health care interest
Department of Health and Human Services
Immediate Office of the Secretary
- Executive Secretary to the Department
- Executivo /\.^.?istant to the Secreta;-/ and White lipase Personnel
Liaison
Office of the Deputy Secretary
- Director of Intergovernmental Affairs
Office of the Assistant Secretary for Legislation
- Principal Deputy Assistant Secretary
- Deputy Assistant Secretary for Legislation (Health)
Office of the Assistant Secretary for Management and Budget
-Deputy Assistant Secretary
Health Care Financing Administration
- Deputy Administrator
Office of the Associate Administrator for Legislation and Policy
- Director
Food and Drug Administration
- Df puty Coiiurussioner for Policy
�09-22-94 11:18 AM FROM SUBCMTE ON CHILDREN
,F02
Bright Futures National GuidelinesforHealth Supervision of Infants, Children, and Adolescents
Statement by Morris Green, M.D.
Chair of the Board, Bright Futures Projert
Good morning. Dramatic social, economic, and demographic changes have affected
famiUes overtiiepast several decades. Wltii alltiiesechanges, the questioii is how
can health professionals and others who care for children and adolescents he more
effective In disease prevention and health promotion?
As witii so many child healtii issues, the Maternal and Child Healtii Bureau of tiie
Healtii Resources and Services Administration has sought the information critical to
answering this question. Pour years ago, the bureau convened a group of more than
100 distinguished professionals, from a wide range of child healtii and related
perspectives, to work togetiier ontiieBright Futures project. We were charged wltii
tiie mission of developing healtii supervision guidelines responsive totiieemerging
preventive and health promotion needs of infants, children, and adolescents.
Our work has been based on several principles. First, since health, educational, and
social problems are strongly Intenelated, none can be viewed in isolation. The health
professional must use a contextual approach and be sensitive to the world of the
child.
Secondly, health supervision requires a partnership between health professionals and
families—tiie core of any good health care system. Important health supervision
goals include enhancing families' strengths, addressing their problems and
vulnerabilities, promoting resiliency, building parental competency and confidence,
and helping famiUes share intiieresponslbiUty for preventing Ulness or disability
and promoting health.
FamiUes can prepare for healtii supervision visits by identifying questions, problems,
concems, achievements, and goals they would Uke to discuss with the healtii
supervision team.
Third, health supervision must be viewed as a process that occurs over time.
Interventions In Infancy may not result in positive or negative outcomes until
adolescence. As the healtii professional or team becomes famiUar with individual
ChUdren or adolescents andtiieirparents,tiiehealtii professional gains a better
understanding of the needs and priorities of the chUdren and their famiUes, and the
famiUes are more Ukely to accept and adopttiieprofessional's expert knowledge.
FamiUes that estabUsh an effective reUtionship wltii a primary care provider use
services more appropriately and save on heaitn costs.
Bright Futures • Morris Green, M.D., Chair, Board of Directors
National Center for Education in Maternal and Child Healtti • 2000 _l_S_th_Stre« North • Suite 701 • Arlington, VA 22201-2617
�•22-94 11:18 AM FROM SUBCMTE ON CHILDREN
Fourtii. successful interventions often reaulre effortstiiatextend beyond what can
be provided In any one setting ortiiroughany one disdpUne. Healtii supervision
can be provided in many settings, often witii collaboration between a variety of
organizations and disciplines. Integrated preventive and healtii-promoting services
may be deUvered in a physician's office, a community health cUnlc, a home, a
school, a chUd care center, a shelter, or some otiier community faculty.
The famUy andtiiechUd need to have a medical hometiiatprovides a continuing
relationship with a physidan, nurse, nurse-practitioner, dentist or team. .The team
can Include a pubUc healtii nurse, a social worker, a nutritionist, an early chUd
educator, or a child care worker.
Finally,tillshas to work attiiecommunity level. Health supervision may require
many types of Uitervention. Community supports and resources caii be orovided for
Infants who are not progressing weU developmentally or who are atriskfor abuse or
neglect; dysfunctional parents (e.g., depressed mothers, alcoholic fathers) inay be
referred for treatment; and strengtiis Identified intiiechUd or famUy may be
reinforced. ChUd health supervision also helps educate chUdren and parents about
efficient use of the health care system and other coinmunity services.
The Bright Futures recommendations for how often children require health
supervision by health professionals are based on the tenets of chUd and famUy
development. The Bright Futures periodicity schedule suggeststiieamouiit of care
needed by Infants, chUdren, and adolescents fudged not to be at undue risk.
However, healtii supervision should always be tailored to meet individual needs.
ChUdren and adolescents at greaterriskwlU need an augmented schedule and higher
intensity of care. Moreover, special populations wUl require more healtii supervision
or interventions.
Bright Futures describes the elements of health supervision. It is organized Into four
developmental sertlons: Infancy, early childhood, middle chUdhood, and
adolescence. Each developmental section provides an overview oftiiatage period,
indudUig a chart of outcomes and atobleof the strengtiis and issues for the chUd,
family and community Bright Futures also describes healtii supervision ewe, such as
preparation for the visit, the Interview between the healtii professional and the
family, developmental and educational surveUlance, observation of parent-chUd
Interaalons, the physical examination, additional screening procedures,
immunizations and antidpatory guidance.
These guidelines are an exdting response to the needs of thetimes,a vision for the
future and a direction for chUd healtii supervision well Into the 21$t century.
Spedaltiianksto Dr. Clro Sumaya, Dr. Audrey H. Nora, Dr. Woodle KesseU and Dr.
David Heppel of the Healtii Resources and Services Administration and WiUlam
Hlscock and David Greenberg of the Healtii Care Financing Adihlnistration.
September 22, 1994
P03
�P04
09-22-94 11:18 AM FROM SUBCMTE ON CHILDREN
Bright Futures National Guidelines for Health Supervision of Infants, Children, and Adolescents
Bright Futures Highlights
liifc Health supervision consists of those measures that
help promote health, prevent mortality and
morbidity, and enhance subsequent development
and maturation.
Health supervision goals Include enhancing families'
strengths, addressing families' problems, promoting
resiliency, building parental competence, and helping
famiUes share In the responsibility for preventing
illness or disability and promoting health.
i k e Health supervision requires a partnership between
health professionals and families.
Health supervision is shaped primarily by issues
raised by the parent and child, with their
expectations, questions, and concerns addressed.
.skc Since healthrisksand needs can change over a
period of weeks or months, they need to be
reassessed periodically.
J^kt The benefits of continuing health supervision are
best ensured by a medical home offering health
services that are accessible, continuous,
comprehensive, family-centered, coordinated,
compassionate and integrated into a system of care.
^jk-i Health supervision can be provided in many
settings, often with collaboration between a variety
of organizations and disciplines.
Health supervision helps educate children and
families about the efficient use of health care and
other community services.
^kt. Health supervision involves assessing the strengths
and Issues for a specific child, family, and
community.
iifc. Child development serves as the basic science for
much of health supervision, especially health
promotion.
^•z Health supervision Includes the interview, the
physical examination, observation of the child and .
family, and psychosocial, educational and
developmental surveUlance, Additional saeenitig
procedures—indudlng vision, hearing, and
metabolic screening—are also included to Identify
areas that may warrant further assessment and
iriterventlon.
.skc, Special populattons such as those with chronic illness
or disability will require more health supervision.
:)ks, Supplemental health supervision may also be
needed during periods of family transition or stress.
" .ike Health supervision that employs specific preventive
and health-promoting interventions leads to
improved outcomes. These social, developmental,
and health outcomes occur along a continuum,
varying In their timing from child to child and
family to family,
Bright Futures • Morris Green, M.D., Chair, Board of Directors
National Center for Education In Maternal and Child Health • 2000 15th Street North • Suite 701 • Arlington, VA 22201-2617
�t>ob"&
,
*BC-CT~Health Insurance, ADV23,1150
^ icy
'$adv23
O 1I O
'For release Monday AMs, Aug. 23, and thereafter
"WASHINGTON ASSIGNMENT: CONNECTICUT
"Health Care Looms As Major Issue For Conn. Insurance
"By JOHN DIAMOND= "Associated Press Writer=
WASHINGTON (AP) The insurance industry and i t s thousands of employees i n
Connecticut are anxiously awaiting the d e t a i l s of President Clinton's plans
for overhauling the nation's health care system.
And when Connecticut's Washington lawmakers retum next month, they face a
decision potentially more perilous to t h e i r p o l i t i c a l l i v e s than the tax
increases j u s t approved by Congress.
Lawmakers from other states w i l l have enough to do deciding whether the
plan serves the nation's health care needs. Connecticut lawmakers w i l l have
an added worry: How w i l l health care reform hurt an insurance industry that
i s one of Connecticut's biggest economic engines?
Insurance industry experts and representatives say that Connecticut's
largest insurance companies face both opportunities and r i s k s .
Aetna L i f e & Casualty Co., ITT Hartford, and The Travelers Cos. together
employ about 30,000 people in the state, or roughly double the workforce at
the E l e c t r i c Boat submarine shipyard in Groton.
A l l three companies profess their support for the concept of health care
reform. But they and other insurance companies may find themselves vigorously
opposed to various elements of the Clinton plan and they w i l l look to
Connecticut lawmakers to help carry their fight.
The stakes are p a r t i c u l a r l y high now, at a time when major insurers are
eliminating thousands of jobs.
Most of the Democrats in the state delegation are expected to support
Clinton's reform plan, while reserving the right to disagree with s p e c i f i c
elements of i t .
Rep. Barbara Kennelly, a deputy House majority whip, w i l l be expected to
round up votes for the administration, as she did on the budget and tax b i l l .
Rep. Sam Gejdenson i s close to House Majority Leader Dick Gephardt and
usually votes with the Democratic leadership. Rep. Rosa DeLauro i s an ardent
Clinton supporter. Sen. Christopher Dodd can be expected to work closely with
Sen. Edward Kennedy, D-Mass., chairman of the Senate Labor and Human
Resources Committee and a key a l l y of the president's on health care.
On the Republican side. Reps. Christopher Shays and Nancy Johnson are
advocates of health-care reform, although t h e i r views may d i f f e r from the
administration's on key issues.
But these GOP lawmakers also are highly sensitive to the concerns of big
insurance. Kennelly's d i s t r i c t includes Hartford, the nation's insurance
capital. Johnson's constituents include thousands who work for the major
insurers.
Sen. Joseph Lieberman, already smarting from c r i t i c i s m of h i s vote for
higher taxes and facing a re-election campaign next year, may withhold
judgment while the d e t a i l s of the plan are worked out. And Rep. Gary Franks
may be inclined to adhere to h i s free-market views and oppose any health care
plan that smacks of big government.
One immediate challenge for the insurance industry w i l l be to counteract
i t s image as the v i l l a i n behind the nation's spiraling health care costs.
•'There tends to be an adversarial nature to the debate, that insurance
companies are bad and therefore should be ignored or not listened to,•• said
Timothy R. Campbell, vice president for governmental a f f a i r s for The
Travelers. ""We don't have a hidden agenda that says, 'We don't want health
care reform.'... Our objective i s that we want to be part of a process that
works with the administration and Congress.''
An Aetna primer on the health care issue states: "'As the debate
i n t e n s i f i e s , you may, once again, hear sharp c r i t i c i s m of the "insurance"
industry. These c r i t i c i s m s do not apply to Aetna.'•
�PAGE
The Hartford Courant, September 23,
5
1993
not p o l i t i c a l l y tenable. How much i t w i l l do, though, i s another question.
A p o l l done recently for Aetna L i f e & Casualty Co. shows the public fears
the wolf i s as close as the neighbor's door. By wide margins, the p o l l found,
people are d i s s a t i s f i e d with the nation's health care system generally and
think costs are too high.
But the same p o l l showed large majorities also are s a t i s f i e d with their own
health plan and with what they pay. The r e s u l t s have been confirmed in many
other surveys.
Mark Mellman, who did the p o l l for Aetna, said the public i s schizophrenic
about health care. The mood, he said, can be summed up as, "I'm OK, but you're
not."
i
Clinton's speech t r i e d to tap into the public's anxiety over the big
picture. The president and administration o f f i c i a l s have talked long and of^ien
about workers' fears that they're just a pink s l i p away from losing health
coverage, that costs are soaring and that the present health system prevents
them from taking a better job.
,
Beginning today, however, people w i l l s t a r t t a l l y i n g up how the Clinton plan
affects tliem and answering the old Ronald Reagan question: "Are you better off
?"
That's when the general and the s p e c i f i c c o l l i d e . Just about every poll on
the subject shows the public wants better security and expanded coverage, but
isn't w i l l i n g to pay much more for i t .
Asked recently what he would rule out as part of health care reform. Sen.
Christopher J . Dodd, D-Conn., said an income tax increase. People j u s t would
not accept i t , said Dodd, the senior member of the Connecticut congressional
delegation.
r.
, ••
Thus, Clinton's options were constrained, and he remained vague to the end
about the d e t a i l s of the $ 150 b i l l i o n in cigarette taxes and other levies that
are part of h i s plan.
Instead of c a l l i n g for a huge, across-the-board tax increase, Clinton
stressed holding down health costs and using the savings to pay for expanded
coverage and increased services. But even before the plan was out, friends and
foes alike were questioning the savings Clinton said he can achieve.
One of the tools Clinton proposed using to r e s t r a i n costs i s a cap on the
amount health insurance premiums can r i s e each year. But j u s t l a s t week the
Congressional Budget Office said such caps "could be d i f f i c u l t to design and
costly to put in place."
|
I
Another Clinton proposal would r e s t r a i n the growth of Medicare by $ 124
b i l l i o n . This comes after Congress in August voted to take $ 56 b i l l i o n out of
Medicare growth over the next five years. The combined proposals are an exercise
in p o l i t i c a l fantasy, said Sen. Daniel Patrick Moynihan, D-N.Y., chairman of the
Senate Finance Committee. Reputable economists were skeptical, too.
;
�PAGE
The Hartford Courant, September 23, 1993
6
i
Important business interests oppose other parts of the president's plan.
Trying to devise a national budget for health care i s unworkable and w i l l lead
to shortages or reduced quality, they contend. And they don't l i k e what they
think would be a massive government intrusion into what now i s largely a private
health care system.
For a l l t h e i r reservations, however, business leaders say they support much
of what Clinton wants to do. More importantly. Republican leaders on Capitol
H i l l have gone to extraordinary lengths to mute their c r i t i c i s m of Clinton's
proposal. I n return, the White House repeatedly has pledged to l i s t e n to
additional ideas and negotiate over the d e t a i l s .
'
il
The unusual s p i r i t of cooperation i s r e a l , Connecticut Rep. Barbara B.
Kennelly, D-lst D i s t r i c t , said after Clinton met Wednesday morning with a
delegation of congressional Democrats and Republicans.
<.
"We certainly were agreeing more than we were disagreeing," said Kennelly, a"'
member of the House Democratic leadership. "There was excitement i n the room."
While a l l t h i s sounds very promising, Truman's experience has to be
sobering. As he recalled in h i s memoirs, there was i n i t i a l l y a good deal of
support for h i s proposal, but protracted hearings "gave the opposition time to
organize a well-financed campaign against ... the whole idea of federal action
to improve the nation's health."
I
Clinton may escape the same fate, but i t w i l l take a l o t of hard work and
continued compromise, and the president seemed at h i s meeting with the
congressional delegation to understand the challenges and opportunities ahead.
" I think now you've f i n a l l y got everybody i n the country focused on i t , " he
said, "so I think we have a moment i n history when we can seize i t and move
forward."
,
!
�S14554
CONGRESSIONAL RECORD—SENATE
lai^est new entitlement in the history
of the country.
This Is what disturbs me as we go
about this.
Secretary Shalala has l>een quoted in
the popular press that in her testimony
before the Houae she said in effect it
does not really matter wtiat the details
of the plan are; the important thing is
to get a plan in place, and then we can
fix it later.
I would Introduce Secretary Shalala
to a previous Secretary of Health, Education, and Welfare, Mr. Joe Califano.
Some people have referred to him as
the father of Medicare and Medicaid,
because he was on Lyndon Johnson's
staff when Medicare was created and he
was Secretary of HEW when Medicaid
was created. He made the point that
when Lyndon Johnson realized Medicare costs were going out of control
and the program needed to be fixed,
they could not fix it. They came to the
Congress 3 years later. Things were
locked in concrete at that point. People were satisfied with the entitlement
that had l>een created and politically it
was virtually impossible to fix it.
So the first message I hope we would
adopt here as we start down this road
is that it is more important to get it
right than to get it now. I hope Mrs.
Clinton and those who are embracing
her program will recognize the past
history which tells us the validity of
that comment and would listen to Mr.
Califano, who says if you do not do it
right the first time, you cannot change
It, rather than adopt the attitude
which Mrs. Shalala ha« adopted, which
is, as I say, it does not really matter
the details of the plan. Just get one in
place and we can nx it later. I consider
that a very dangerous direction to go.
Second, I think we should understand
we are talking al>out reengineering
one-seventh of the total economy. We
are talking al>out the greatest social
reengineering enterprise In which this
country haa ever engaged. Not only
should we do it right, but we should understand that a reengineering of this
kind should not take place without a
large and growing national consensus
l>ehind the way it is done. This is something that should not be done the way
the budget was done, with 50 votes plus
the vice President breaking the tie.
This is something we should have a
large national consensus behind.
I salute Mrs. Clinton for reaching out
to Republicans and others outside of
her tight little group which put the
health care plan together in the Hrst
place, to try to achieve that consensus.
But as we proceed, perhaps we could
understand the Importance of building
that consensus by slowing down a little
and realizing a consensus can be gathered for a numl>er of ideas that can be
held together as we move to the more
difficult ideas.
Let me give you an example the
President himself has referred to, as he
stood on the White House lawn and
talked al>out the ancient rivals of
vif,h»u D-Ki> ^ A V
. , ^ .
Yitzhak Rabin and Yasser Arafat get-
ting together and shaking hands, saying if these two cas get together and
solve these problems, surely the Repul>licans and Democrats in Congress can
get together to solve the health oare
problem.
.. : ,
That is true, but Yitzhak Rabin and
Yasser Arafat have not gotten together
to solve their problems. The details of
their agreement are that they have
gotten together to agree to agree. They
have created theframeworkof negotiation. They have not tried to tackle all
of their problems at once because they
realize how difficult those problems
are. So they are putting the more difficult problems off as they work
through the areas where they can
agree.
Following up on the President's analogy, that is what we ought to do on
health care, start with the areas where
we can get 80, 90 votes in the Senate
and say we will agree not to tackle the
more contentious ones until we have
built a consensus brick by brick, so
that the more contentious issues of
employer mandates and taxes can come
after we have created a basis of agreement on the less contentious issues of.
say, antitrust reform and common insurance practices.
Mr. President, 1 ask unanimous consent that I l>e allowed to continue for
another 3 minutes.
The ACTINO PRESIDENT pro tempore. Without objection, tt is so ordered.
'
Mr. BENNETT. I thank the Chair.
I am talking, I would hope, about a
sense of cooperation and consensus in
the Senate and the House to solve this
problem in such a way that we do not
look l>ack on it with the same sense
some of us now look l>ack bn the creation of Medicare and Medicaid and say
what kind of a mess did we make, but
that we build the bricks very carefully
and together, in such fashion that
when it Is over we do not say, gee.
President Clinton had his way with a
narrow victory or, gee, the Republicans
succeeded in rolling President Clinton
on their plan and picked up enough
Democratic support to create a Sl-vote
majority to get their plan; that we
look back on this in future years and
say the Congress and the executive
branch, working together carefully and
perhaps slowly but very accurately
over time built a health care reform
system that enjoyed the support of 76,
80 Senators of both parties and all political persuasions.
Are there deal breakers as we go
al>out this process? For me there are. I
do not want to see health alliances
that are monopolies that have regulatory powers. But I am willing to put
that off while we deal with some of the
other issues on which I think we can
reach agreement.
Mr. President. I offer congratulations
to the Clintons for their initiative In
bringing this issue to us. and I hope
they will, in the spirit that has marked
the conversations
up
^
' to this point,
'
. l>e
—
willing to back away from a sense of
October 28, 1993
great haste and urgency and come to
the notion with which I began my comments, that it is far more important
for us to do it right than it is to do it
now.
Mr. President, I suggest the absence
ofaquorum.
The ACTINO PRESIDENT pro tempore. The Senator from Utah has suggested the absence of a quorum. The
clerk will call the roll.
The bill clerk proceeded to call the
roll.
Mr. DODD. Mr. President. I ask, unanimous consent that the order for the
quorum call be rescinded.
"The ACTINO PRESIDENT pro tempore. Without objection, it is so ordered.
, ORDER OF PROCEDURE
Mr. DODD. Mr. President, as on behalf of the majority leader. I ask unanimous consent that relative to the cloture vote at 1 p.m. today the mandatory live quorum be waived:
The ACTINQ PRESIDENT pro tempore. Without oi>Jection. It is so ordered.
Mr. DODD. Mr. President, may I inquire as to whether or not the Senate
Is now in morning business.
The ACTING PRESIDENT pro tempore. The Senator is correct.
-•^•^•»-•*
THE HEALTH SECURITY ACT
Mr. DODD. Mr. President. I would
like to take a couple of minutes, If I
could, to express my immediate
thoughts on the historic announcement
that occurred yesterday. The President
of the United States and the First
Lady presented to a significant number
of Meml>ers of the House and Senate
their national health reform effort, the
Health Security Act, as it is called. I
am very proud that I will be a cosponsor of the proposal.
I would like to take Just a couple of
minutes this morning to express my
thoughts as we begin what I think will
be one of the most historic debates in
the 20th century. As we close out this
century, we will address something
that has plagued and defied previous
Congresses and administrations going
back to the earlier part of this century.
We are on the brink, in this .Congress,
of achieving something that others
have wrestled with for decades and
have l>een unable to achieve.
I l>egin the process by t>elieving we
will achieve national health care reform. We will have a Health Security
Act, after long-awaited efforts that
win give people security about their
health care and relieve their fear that
health care will bankrupt their families. I l>elieve this will Income a reality
before this Congress adjourns next
year.
Mr. President, the bill will be as I
said a moment ago one of the most important pieces of legislation considered
by Congress in the 20th century. That
U my firm view. It will appear along-
�October 28, 1993
CONGRESSIONAL RECORD—SENATE
S14555
side the Social Security legislation of over and over again, because they are than the one we currently have." I
the 1930'8 and the civil rights legisla- the principles which Americans have hope that the new system we design
tion of the 1960'8 on the pages of future talked about and cared about for such WlU achieve the goal of health security
American history books. It will appear a long period of time.
for all Americans, without burdening
alongside the great vehicles of social
The first is security; the second is small business.
reform not only because of its monu- savings; then quality, choice, simplicSome people might be surprised that
mental impact but also because of the ity, and finally, responsibility. Other a SenatorfiromConnecticut, home of
principles of security and Justice on plans, Mr. President, while they have some of our Nation's major' health inwhich it is l>ased. Like the Social Secu- merit and good points, fall short on one surance companies, is cosponsoring legrity Act, the Health Security Act will or another of these most Important islation to overhaul the health care
provide a new and desperately needed standards.
system. There Is a perception that all
guarantee for Americans. Just as
I am enthusiastic, Mr. President, Insurance companies are adsjnantly
Americans now do not have to fear old about being part of this effort, because opposed to change and that they are
age without a pension, they will no of the tone that the administration has conspiring to undermine the reform
longer have to fear Illness without set. The President and the First Lady process. In fact, a Herblock cartoon in
treatment.
have demonstrated, I think, a sincere this morning's Washington Post lumps
Like our civil rights laws, the Health willingness to listen to criticism and all of these industries together.
Security Act will make our society suggestions and to take them Into acI suggest to my colleagues that nothmore Just and more equitable. Just as count. The President has also sought ing could be furtherfiromthe truth.
Americans no longer have to fear State to form a bipartisan coalition to sup- The Insurance Industry, of which we
sanctioned discrimination based on port health care reform. I believe there are very proud in my State, and which
race, they will no longer have to fear have been more meetings and more employs more than 50,000 people, is not
health care discrimination based on consultations prior to yesterday's In- a unified monolith that speaks In one
health status or ability to pay.
troduction than at any other time In voice. Many Insurance companies
We have arrived, Mr. President, at my memory on almost any other piece strongly support reform. There has
one of those unique Junctures in Amer- of legislation—certainly any other been much misinformation on these
ican history when there is nearly uni- piece of legislation of this significance. points.
versal agreement on the need for The President and the First Lady know
For Instance, last week, there was a
change. Not everyone, obviously, that health care should not be a par- flurry of media accounts about the Coagrees on the form this change should tisan cause, but an American cause; alition for Health Insurance Choices, a
take. There is a great deal of disagree- not an issue that divides us, but one group established largely by the Health
ment on this point. But I have yet to that unites us; not a source of recrimi- Insurance Association of America, to
meet anyone in the halls of Congress or nation, but one of reconciliation.
weigh In on the health care debate.
outside of this Chaml>er who feels that
Mr. President It would be naive to You may have seen their ads on telethe status quo is preferable to real re- suggest that every part of a sweeping vision. The existence of this group was
form, and that we can continue down effort to reform one-seventh of our pointed out as evidence of a grand conthe road that we are now on. without economy would be supported unani- spiracy on the part of all health insurchange.
mously. There are certainly aspects of ance companies to derail reform.
Republicans and Democrats, doctors this health care plan that I would have
What was left out of this discussion
and patients, small businesses and written differently. I am sure that can was the fact that the health insurance
large corporations, consumers and In- be said of almost every single Member association of America does not repsurance companies, all agree that re- in this body. But we cannot allow spe- resent the entire Insurance industry. In
form Is imperative. I hope we will seize cific objections to some parts of the flaot, three of the largest health Insurthis opportunity, Mr. President, to plan to derail the entire effort. I am ance comi>anies in the United States
form a broad-based consensus about sure that will not occur.
located In Connecticut—Aetna Life and
the shape of reform and give the AmerThe fact Is that Introduction of the Casualty, Cigna, and the Traveler»-do
ican people what they deserve and have Health Security Act represents not the not iMlong to this organization and disbeen asking for for decades: A health end of this process, but rather the very associate themselves from their media
care system that works for everyone in beginning of this process. In the efforts and their propaganda.
this country, but does not bankrupt months ahead, we wlU be working toThese companies are all committed, I
the Nation as well.
gether with those who have Introduced point out, to health care reform. Not
While the introduction of this bill other plans, with those who have other only do they support many of the prinhas great signlfloance for aU of us. I Ideas, working together to shape this ciples outlined by the President, but in
know it has special signlfloance for our legislation, to make sure that it meets a number of instances they have alcolleague Senator KENNEDY of Massa- the needs of our constituents, and that ready achieved on a small scale what
chnsetta. who has been tolling away for it Is consistent with the principles es- we hope to achieve nationwide through
health care reform for the last quarter tablished by the President.
health care reform—^namely, oost reof a century as a Member of this l)ody.
During this process. Mr. President. I duction and quality control.
I want to commend. If I can. the distin- plan to focus on preventive oare and
Here is an example, Mr. President:
guished chairman of the LalK>r and the unique needs of pregnant women Cigna Healthcare's Arizona health plan
Human Resources Committee for his and children. We can no longer afford has developed an limovaUve way to
work in this area. He haa been a cham- to neglect prenatal care, and we can no manage pediatric asthma cases. It has
pion of it for years.
longer afford to neglect child immuni- Improved diagnosis of the problem, imThe case for reform is clear and com- zations. We can no longer afford to ne- plemented education progrrams, and
pelling. Our health care system is In glect the health of adolescents. I want provided medical equipment for childesperate need of repair; it must be to work toward a reform plan that pro- dren to use In their own homes. These
fixed. The system is too expensive, and vides solid t>enefit8 in these areas and steps have already saved S1.3 million
It leaves far too many people without contains provisions to make sure the and made treatment more comfortable
coverage. I see the President's plan as beneflts reach those who need them.
tor many children.
our best hope, and that is why I have
Mr. President, I also want to make
Cigna also developed a new biopsy
become an original cosponsor of the sure that the reform plan Is friendly to procedure
to detect breast cancer. This
Health Security Act.
small business, which contributes so reliable procedure saves patients the
I prefer President Clinton's proposal much to job creation In this country. Inconvenience and discomfort of major
because it is based on six critical prin- As the First Lady told me during her surgery, and it costs only one-third the
ciples, which he articulated in a Joint api>earance before the Lal>or and costs of traditional surgical biopsies.
session of Congress a few weeks ago Human Resources Committee In SepMr. President, we simply cannot
and reiterated again yesterday. Those tember. "It would be dlfflcult to create allow this opportunity to reform the
six iirlnclples deserve l>eing repeated a health care system more antlbuslness Nation's health care system to slip
�- •I" .'i.... •,
S14556
CONGRESSIONAL RECORD—SENATE
October 28, 1993
away. We must act now to provide the enough, but I would hope they limit it ence of having to beg for Information,
American people with the health care to 10 minutes because each of us are having to t>eg to be Informed. He was
system they need and the health care waiting to get to committees. If that on the phone to both Senator FEINsystem that they deserve. I commend would be satisfactory, that is flne with BTEiN and me. He said to the people of
the President and the First Lady for me if they want to go.
California, do not wait until It Is too
the efforts they have already underThe ACTINO PRESIDENT pro tem- late. We want to help. We want to
taken In this regard. We would not I>e pore. That would have to be done by swing people into action, the Forest
here today, we would not be at the unanimous consent.
Service, the Department of Defense.
point in our history, were it not for
Mr. KENNEDY. Mr. President, if the We want to help.
their efforts. As I mentioned, there are SenatorfiromMissouri has reservations
So I Just again thank my colleagues
many fine ideas that have been pre- about that then I would not offer it. for this moment. Senator FEINSTEQ<
sented by other Meml>er8 of this body But otherwise I ask unanimous consent and I are going to act as a team. One of
and other members of the other Cham- we be able to have 10 minutes.
us is going to go to California. One of
ber. At the end of the day, I suspect we
The ACTINO PRESIDENT pro tem- us wlU stay here to Inform the Senate
are going to come together on a health pore. Is there objection?
of what Is happening and do the work
care proposal that reflects the best
Mr. BOND. Mr. President, I would that needs to be done.
Ideas of all of these plans. But when concur in that and am happy to agree
I say to the people of California: Our
that day arrives, let us not forget that to the unanimous-consent request that hearts are with you. We are thousands
if not for President Clinton and Mrs. there be 10 additional minutes on that of mUes away but we see the devastaClinton, we would not have arrived at side to be controlled by Senator KEN- tion you are going through.
NEDY.
that moment.
We are very grateful that there are
In these years, 1993 and 1994, for the
The ACTINO PRESIDENT pro tem- no deaths, Mr. President, no deaths at
first time in decades, we are going to pore. The Senator from Massachusetts all. although we have had at least
finally deliate and have a health care Is recognized for 10 minutes.
30,000 people who had to flee thefr
proposal that gives people a sense of seMr. KENNEDY. Mr. President, I ask homes, and estimates rangefrom50.000
curity, and a basic l>eneflts package unanimous consent that the Repul)- to 80.000 acres burning.
that would be available to all Ameri- llcan time be extended 10 minutes.
So we will pray and we will swing
cans. And on that point, I hope there is
The ACTINO PRESIDENT pro tem- Into action, and we will be reporting to
no disagreement in this body. A plan pore. Without objection, it is so or- the Senate as the day goes on.
that is not comprehensive and does not dered.
cover all Americans does not deserve to
Mr. KENNEDY. I thank the Chafr.
be called health care reform. On that
I yield to the Senator ft^m California "7 " -^HEALTH CARE REFORM
point, I think aU of us ought to come briefly.
Mrs. BOXER. Mr. President. I am
together. I oommend my colleagues for
Mrs. BOXER. I thank my friend firom proud
to rise today as an original cotheir efforts and look forward to work- Massachusetts and I thank my Repub- sponsor
of the administration's health
lican
colleagues
for
being
so
accommoing with them.
oare
reform
bill. Yesterday's unveiling
'dating.
I yield the floor.
the Health Security Act was a hisThe ACTINO PRESIDENT pro temMr. President, I planned to be here to of
moment. After years of political
pore. The Chair recognizes the Senator speak about my support for the pro- toric
and denial, yeeirs of watching
from Massachusetts. But let the Chair posal by the President in terms of his neglect
the
numl>er
of uninsured Americans
health
care
plan,
which
is
something
advise the Senator there is 1 minute reand years of seeing our peomaining in this 30-mlnute block sched- this oountry is crying out for. But skyrocket,
more and get less, we finally
uled for the majority side. The Chair rather than do that, because of the ple pay
a comprehensive plan to reform
will fiirther advise Senators that dur- time limitation the SenatorfromMas- have
ing this 30-mlnute block the Senator sachusetts [Mr. KENNEDY] gave me per- our health care system.
The Health Security Act lives up to
from Missouri asked unanimous con- mission to speak for about 1 minute or
sent that the Senator from Utah, Mr. 2 to fiU the Senate In on what Is hap- Its title. This is a bill to give all AmerBENNBTT. be allowed to speak. He pening In California with our devastat- icans security and choice, improve the
quality, of care, reduce costs and paperconsumed 10 minutes of his time be- ing fires.
work and make everyone responsible
cause no one on the majority side was
for health care. This bill is good for
present.
America and good for California.
FIRES IN CALIFORNU
Mr. KENNEDY. Obviously, I want to
We need to look at the human faces
accommodate. I was on the floor when
Mrs. BOXER. Mr. President, the dev- behind
this issue. We need to think
Senator BENNETT was making his com- astation continues. The Santa Ana.
ments. I would hope we might l>e able winds continue, fortunately at a little about the millions of Americans who
to be extended time—I know Senator lesser si>eed than they were yesterday, work hard, play by the rules, and are
BOXER and I want to speak briefly—and but predictions are they will pick up unable to afford even the most basic
to ask whether we could use that 10 tomorrow.
' v oare for themselves and their families.
minutes and then go back to the earWe have this window when our brave One of those Americans is Donald
lier order.
flrefightlng men and women can get Greenberg of San Diego, CA. In a reMr. BOND. Mr. President, this is a out there and get some of t^ese fires cent letter to me, he wrote:
Something very terrible happened to my
very Important subject. Unfortunately, under control. We had as many as 14
we have several speakers on our side fires. My understanding is that four IkmUy bxlay. Something that made me very
My ten year old son Benjamin was rewho have markups and had planned to have been put out. There are several angry.
fused medical care by a physician because we
be here.
counties. Including Ventura, Los Ange- don't have health Insurance. * * * My son
Senator CHAFES agreed that we les, and others, that have been declared doesn't understand why dad, who works fullshould extend 2 minutes of our time to emergencies, and the Oovemor Is act- time at a very respectable company, can't
the Senator fi^m West Virginia. Then I ing to ask the President for help.
get health insurance, and frankly neither do
would Uke to yield to him. I would also
Our President will be addressing the I.
I had health Insorance once, Imt when the
then like to yield to Senator CHAFES SO Nation at a press conference. I believe
company I was working for went under, I lost
that he may go on to a markup.
he Is going to have a statement al)out my
insurance as well as my job. I haven't
I would note to the Chair that I did the fires. I just wanted to report to the
Insurance since 1990, even though I have
not yield to the Senator from Utah, a Senate—because I see here my col- had
[been] employed all along. * * • When I
mere technicality. We want to have ev- leagues who experienced these prob- moved to San Otego in 1960 health insurance
erybody heard. We have morning busi- lems In thefr own States—that the was 17 every two weeks, no dedncUble. Now
ness until 10 o'clock.
head of FEMA. the new head of FEMA, they want $400 per month.
Mr. CHAFEE. Mr. President, as far as James Witt has been Just extraorIn the months ahead, we know it's
I am concerned, if it is 10 minutes, tair dinary. Usually I have had the experi- going to be tough—chuige and leader-
�November 1, 1993
[Mr. BrNOAMAH], the SenatorfiromWest ' Perhaps Ow «ommlMdon'« most Im- : For my part, I Intmid to oontinne my
Virginia [Mr. ROCKXTKLLER], the Sen- portant achievement har been Vta Re- own longstanding commitment to preator from Delaware [Mr. ROTH], the source Motlwrs project. A tew years ventive aervicea that sapport fkunllles
Senator firom Mississippi [Mr. CoCH- ago, aa I fooosed on ways to provide and promote healthy ohUd developKAN]. the Senator ftom Colorado (Ur. supportive servioea to fkmilies early on thent. We in this body, and the Nation
BROWN], the SenatorfromRhode Island so that we oould avoid many of Uie aa a whole, cannot afford to lose sight
[Mr. P E L L ] , the SenatorfiromMaryland problems curremtly overwhelming tiie of the need to Invest in children and to
[Mr. SARBANES], and the Senator firom child welfare system, I beoame Inter- ensure that they have a good start in
Texas [Mrs. HUTCHISON] were added as ested in the approaoh of home visiting. life. Nothing else is so critical for our
cosponsors of Senate Joint Resolution
Frankly. I was not surprised to leam society and our nation's ftttore, and I
145, a Joint resolution to designate the that Lawton Chiles aod the commis- «an
of no more fitting legacy for
period conunenclng on November 21, sion had been there before me. The Be- the think
commission than to keep our at1993, and ending on November 27. 1993, source Mothers train la^peisons firom tention focused on this need.s - ,... '
and the period conunenclng on Novem- the community to work with pregnant
ber 20,1984. and ending on November 26, women in their liomes. help them leam
1994, each as "National Adoption about child development, and link LCOMMENDINO BRECK SCHOOL OF
them to all-Important health and so-,
.Week."
MINNEAPOLIS, MN
olal services in the oommunity. The • Mr. DURENBEROER. Mr. President,
SKNATB OONCURRKNT BXaOLUnON a
. At the request of Mr. RIBOLE, the commission provided invalnalds In- I rise today to recognise Breok School
names of t^e Senator from Delaware sights and advice as I developed a of Minneapolis. MN. as a "Blue Ribbon
[Mr. ROTH], the SenatorfromNebraska strong bill—ultimately enacted—to es- School of Excellence." I ask that my
[Mr. BZON], and the Senator from Ne- tablish a Federal home visiting co- colleagues Join me In expressing my
braska [Mr. KERREY] were added as co- gram.
sincerest and most heartfelt congratusponsors of Senate Concurrent ResoluThe oommlssloo. which was'acutely lations to Breck. tion 36, a concurrent resolution ex- aware that every day ws lose waiting
For more than a decade, the U.S. Depressing the sense of the Congress that for the Congress and the Federal Oov- partment of Education has recognized
United States truck safety standards emment to act means losing precious
Nation's finest schools via the Blue
are of paramount importance to the time for mothers and in&nts, moved on the
Ribbon School Program. Schools that
implementation of tbe North American its own to spread tiis Beaonroe Motheni are
selected provide an excellent model
Free-Trade Agreement.
concept.
:--~i^l^..:'S->f,:-i,-:i^
of what is right about America's
Last April, I was pleased to Join Oov- schools. Brock's selection as a blue rib'^emor Chiles and Lynda Hobb to help bon school was a natural one. Its hisADDITIONAL STATEMENTS
kick off a nar.lonal Resource Mothers tory Is a story of change, of the conproject to provide assiatanos to oom- sistent pursuit of diversity and spfrmunltles that wish to adopt this effec- Itual values, and of academic growth.
NATIONAL COMMISSION TO
tive means of rea<dilnc' mothns and
Breck is a college-preparatory school
PREVENT INFANT MORTALITY
children and improving' child bealth that actively seeks and values racial,
• Mr. DODD. Mr. President. I rise and development, - vi'^.' i ..- - iv';» . > socioeconomic, religious, geographic,
today to expreu my appreciation for • Early on, the commliaalon recognized
academic diversity. Breck's ourthe flne work of the National Commls- that .only to fbcos QA';matemal snd Uld
rtenhun
is evolutionary. The ihcnlty of
alon to Prevent Infknt Mortality. The child health services waa to perpetuate ' each discipline
decides on an essential
commission's fimding will be exitiring the fktigmentatlon of services that ' COTO of knowledge
to teach. The Breck
soon, so this Is an appropriate time to drives families to distraction. There- jedoeators then Incorporate
technology,
reflect on Its important aocompllsh- fore, the commlaalon haa reachad out ^eritlcal thinking skills, research
techments since Its Inception.
to other groapa to ihqn sJHanoes on be- id'ques, good study habits, and extemLed by Gov. Lawton Chiles of Flor- half of children and their myriad needs. 'poraneous writing snd speaking re• Ida, whom many of us knowfiromhis Two of theee IniUativea sre the Na- quirements. This effort focuses on the
distinguished service In this body, the tional Health/fidocatlon Coraorttum development of an academically wellcommission documented and forced us and the National Consortlom fbr Afri- founded students. Breck. however, is
to oonfiront the tragedy of the mtU- can American Children. ..
"'>v.,- ^niuoh more.
<- tltude of Infants in this oountry who do Mr. President, I beUave the commis- ' Besides academic preparation, Breck
not survive to see their first birthday. sion members—who, by tbe way, in- values dictate a broader view of what
If that was all the commission had clude a dear friend and oonstltaent of constitutes college jn-eparatlon. Fosdone. It would have been a slgnlflcant mine, Margaret 8. Wilson of Eastern tering physical development and emoachievement. But Oovemor Chiles and Connecticut State mrdvenlty—should tional and spiritual growth. Instilling
the other memtMrs of the commission. be highly commended for their exem- ethical values and a sense of commuIncluding Lynda Johnson Robb, were plary work on behalf of children and nity and social awareness.and promotnot content to be simply the bearers of families. The commission's staff. led hy ing an appreciation for each and every
grim tidings. They wanted to help Executive Director Rae Orad. also has individual, are all components of the
iorge the solution as weU.
t
been outstanding, an onpacalleled re- Breck college-preparatory process. All
The commission, therefore, moved on source for information on mothers and students take courses in ethics, present
to Identify promising ways to reach infianta. I parttoolarly want to thank • senior speech to the student h | ^ ,
out to expectant mothers and young Mary Carpenter, who provided a wealth 'and
make a commitment to pro^e
fkmilies. It provided leadership in mak- of information and technical advice on community
service.
ing Improving the health of mothers home visiting. ; .
Breok
School
demonstrates all that
and children a priority at the State
Mr. President, although Ute commlabest about providing a well-rounded
and local levels. It has promoted the alon is expiring, tha problem of in&tnts Is
education to students and should proneed for Integrating services for £unl- whoae lives are ovw before they have vide
an example to all schools aspiring
Ues so that they are viewed as a whole hardly begun ia atill with ns. I hope to
become
a Uue ribbon school. Breck's
and Important needa do not fkll that the Department of Healtb and mission and
value statements aay it
tiirough the cracks.
Human Services will gtv* the oommls- best and I request that they be InAbove all, the commission has under- sion adequate ftmds for a rational and cluded In the CONQRSSSIONAI. RECORD.
scored to OB and the imbllc that what dignified shut-down. • . ^
' ^ The statements follow: , . . - .
happens to children during thefr early
I also hope the Department win take
, TEX MISSION
',"•• '
years, and even before birth, plays an seriously the need for a Federal fiocal
Brack's Bllsslon Is to:
enormous role In the adults they will point on these Issues that will OU the
Prepare each student for a ooUege whose
become. In other words, a good begin- gap created by the commission's de- enltore
la compatible with the tndtvldnal's
ning truly has no end.
mise.
seeds, iBtereets and abUmes.
�PM-CT—Health Overhaul, Conn B3t,385
V
\
State Report: Connecticut Should Create New Health Agency ^
^^uA\fiX-^
^\(^iC^
C^
HARTFORD, Conn. (AP) A sweeping state report suggests Connecticut should
create a new agency to oversee competition in health care and that a l l
employers be required to buy health insurance through cooperatives.
The 44-page report from the Program Review and Investigations Committee,
an office of the General Assembly, proposes an overhaul of medical care in
Connecticut that would end regulation of hospital rates and adopt reforms
similar to those President Clinton has proposed.
" " I t ' s an excellent proposal that dovetails with a lot of discussion
that's been going on elsewhere at the Capitol,'' said Rep. Joseph Courtney,
D-Vernon, co-chairman of the legislature's public health committee.
The report contends that the state's current regulation of health care and
insurance has been fragmented and ""does not meet the needs of the state's
emerging health care market.'' I t goes on to say that the state has f a i l e d
""to provide direction toward comprehensive health care cost containment.''
The report's proposed system does not guarantee insurance for everyone,
but aims to expand access to health insurance through employers.
The report recommends:
A l l employers be required to join or form a cooperative to buy health
coverage. Employers would have to pay at least 50 percent of the premiums for
their employees.
At least three health plans be offered to each cooperative's members.
Consumers would choose among the plans selected by their employers. The health
plans would consist of managed care networks, not traditional insurance plans
that pay fees for medical services as they're rendered.
A new Agency for Health Systems be formed to oversee health insurance
plans and health care services. The agency would replace the existing
Commission on Hospitals and Health Care, which now regulates hospital rates,
and assume some functions of other state agencies.
State regulation of hospital rates and budgets would end, with rates
determined by competition. A l l groups that pay for health care would be
allowed to negotiate rates with hospitals; now, only HMOs have the right.
The report does not estimate what i t would cost to carry out i t s
recommendations.
Members of the General Assembly's program review committee were scheduled
to meet Thursday to decide how to proceed on the proposals and request any
changes, said Rep. Wade A. Hyslop J r . , D-New London, co-chairman.
****
f i l e d by:APE-(CT)
on 01/18/94 at 02:52EST ****
**** printed by:WHPR(JEL) on 01/18/94 at 09:10EST ****
�I t i s s u e d o n l y a s h o r t statement, s a y i n g i t was
' ' d i s a p p o i n t e d ' ' w i t h t h e r u l i n g and would c o n s i d e r i t s
o p t i o n s , i n c l u d i n g an appeal.
The automaker spent $3.7 b i l l i o n on h e a l t h care f o r i t s
workers and r e t i r e e s and t h e i r f a m i l i e s i n 1992.
Not c o n t e n t w i t h w i n n i n g t h e case f o r t h e e a r l y
r e t i r e e s , Leonard M o e l l e r , 66, now wants t o renew t h e case
f o r t h e 35,000 s o - c a l l e d g e n e r a l r e t i r e e s .
He a l s o wants t o see GM pay back t h e money t h e r e t i r e e s
have p u t o u t i n t h e l a s t few years as a r e s u l t o f b e n e f i t s
changes.
''We were h i r e d on a handshake, l e f t on a handshake and
t h o u g h t we had b e n e f i t s f o r a l i f e t i m e , ' ' he s a i d . ''GM
always t o l d us t h e y would take care o f us.''
/\
v
' ^ V VNf«^\U4
Study: Private Group Homes for Mentally Retarded are
I ^ W'^/)^ /v/t?^
Cheaper
^
^ ^ V^^
HARTFORD, Conn. (AP) Feb 4 -- A l e g i s l a t i v e s t u d y shows t h a t
s t a t e - o p e r a t e d group homes f o r m e n t a l l y r e t a r d e d people
are more expensive t h a n p r i v a t e l y o p e r a t e d homes.
The s t u d y by t h e s t a f f o f t h e Program Review and
I n v e s t i g a t i o n s Committee i n d i c a t e s t h a t p r i v a t e group
homes a r e cheaper i n almost every way, from s t a f f i n g c o s t s
t o p r o v i d i n g h e a l t h care s e r v i c e s .
The s t u d y shows t h a t s t a t e spends 21 p e r c e n t more f o r a
group-home c l i e n t by p a y i n g $93,447 f o r an i n d i v i d u a l i n
1991-92 t h a n t h e p r i v a t e s e c t o r does, $77,007. I t a l s o
shows t h a t t h e s t a t e spends 4 0 p e r c e n t more f o r a
r e s i d e n c e , $547,601 on average f o r 1991-92, t h a n p r i v a t e
c o r p o r a t i o n s do which spent $387,773.
The s t u d y does say t h a t s t a t e homes have on average one
more c l i e n t r e s i d i n g i n them t h a n p r i v a t e homes, and many
s t a t e c l i e n t s are more s e v e r e l y d i s a b l e d .
S t a t e Sen. J u d i t h G. Freedman, R-Westport,
co-chairwoman o f t h e committee, s a i d Thursday t h e f i g u r e s
show t h a t p r i v a t i z a t i o n o f these s e r v i c e s i s ''the wave o f
the f u t u r e . ' '
She s a i d she would l i k e t o see p r i v a t e c o r p o r a t i o n s
s l o w l y t a k e over homes and o t h e r r e s i d e n t i a l s e r v i c e s
o p e r a t e d by t h e s t a t e , and c o u l d even imagine a
scaled-down Southbury T r a i n i n g School b e i n g o p e r a t e d by a
private corporation.
�L i n d a G o l d f a r b , deputy commissioner o f the s t a t e
Department o f Mental R e t a r d a t i o n , s a i d the agency w i l l be
s t u d y i n g the f i g u r e s and d e t e r m i n i n g whether changes can
be made t o make the agency's s e r v i c e s l e s s c o s t l y . She
s a i d t h a t p a r t of t h e d i s p a r i t y c o u l d be t h a t employees o f
p r i v a t e group homes are u n d e r p a i d .
Hypochondria:
By ESQUIRE=
Imaginary o r Not, I t S t i l l
A Hearst Magazine=
Costs
For AP S p e c i a l Features=
Feb 4 -- Hypochondria c o s t s Americans m i l l i o n s o f d o l l a r s a
year, c l o g s d o c t o r s o f f i c e s and h o s p i t a l emergency rooms
and burdens our beleaguered h e a l t h care system.
F i f t y p e r c e n t o f a l l p a t i e n t s seen by p h y s i c i a n s have
' ' p r i m a r y h y p o c h o n d r i a c a l symptoms,'' Dave Lowry w r o t e i n
an a r t i c l e i n the c u r r e n t i s s u e o f Cosmopolitan, c i t i n g
f i n d i n g s from the American J o u r n a l o f Psychotherapy. And
t h e number i s i n c r e a s i n g as consumers are bombarded w i t h
health information.
Hypochondria i s a complex medical c o n d i t i o n t h a t can
have e m o t i o n a l , p s y c h o l o g i c a l and p h y s i c a l m a n i f e s t a t i o n s .
And i t f r u s t r a t e s b o t h i t s v i c t i m s and t h e d o c t o r s who t r y
to treat i t .
The hypochondriac's problems are not psychosomatic
s u f f e r e r s do not worry themselves i n t o d e v e l o p i n g u l c e r s
o r s t r e s s headaches, nor do t h e y i n v e n t i m a g i n a r y
a i l m e n t s . S u f f e r e r s experience r e a l , though r e l a t i v e l y
minor, symptoms t h a t are m a g n i f i e d and g r o s s l y d i s t o r t e d
i n t h e i r minds.
One m i s c o n c e p t i o n i s t h a t hypochondriacs most o f t e n
complain about symptoms o f s e r i o u s i l l n e s s e s such as
cancer. The most common g r i p e s are head, neck, abdominal
and chest p a i n ; insomnia, backaches, s k i n and eye
d i s o r d e r s and sexual d y s f u n c t i o n .
Sometimes a hypochondriac's p r e o c c u p a t i o n w i t h s i c k n e s s
i s sparked by a s p e c i f i c trauma. S u r v i v o r s of plane
crashes and o t h e r d i s a s t e r s , f o r i n s t a n c e , may e x p e r i e n c e
g u i l t - r e l a t e d hypochondria t h e y s u r v i v e d w h i l e so many p e r i s h e d ,
Some e x p e r t s c a l l hypochondria psychodynamic i t s
s u f f e r e r s use s i c k n e s s t o get rewards t h a t are o t h e r w i s e
u n o b t a i n a b l e . A young c h i l d may f e i g n a f e v e r t o w i n
a t t e n t i o n from busy p a r e n t s . An a d u l t who doesn't know how
t o cope w i t h mental anguish may s o l i c i t sympathy by
o b s e s s i n g about an i l l n e s s o r i n j u r y .
�committee.
I t i s one o f s e v e r a l p l a n s under c o n s i d e r a t i o n by t h e
L e g i s l a t u r e t o c r e a t e insurance f o r f a m i l i e s t o o poor t o
a f f o r d premiums but e a r n i n g j u s t enough t o be i n e l i g i b l e
for welfare.
Debate d u r i n g a committee h e a r i n g Monday was dominated
by whether the Republican-sponsored b i l l would guarantee
coverage f o r a b o r t i o n s .
The Senate p l a n s t o d i s c u s s t h e b i l l Wednesday. Rep.
W a l t e r K u n i c k i , t h e Democratic speaker o f t h e Assembly,
argues t h e b i l l does not guarantee coverage f o r everyone
and p r e d i c t s i t would be r e j e c t e d by t h e Assembly.
(\
/A
vj^
H e a l t h Costs Continue t o Grow i n S t a t e
^y
HARTFORD, Conn. (AP) Feb 15 -- While h e a l t h care c o s t s i n t h e
'hy r e s t o f t h e n a t i o n slowed down l a s t year, a new survey
lAi V'I, show t h e y grew by 10.1 p e r c e n t i n C o n n e c t i c u t .
>^
The n a t i o n a l i n c r e a s e o f 8 p e r c e n t l a s t year was t h e
—p> (V s m a l l e s t i n s i x year, p a r t l y because o f low m e d i c a l
T^'-^A" i n f l a t i o n , c o m p e t i t i o n and the s h i f t o f workers i n t o
<Arl/ ,Ai managed care p l a n s , a c c o r d i n g t o F o s t e r H i g g i n s , t h e
^ ^
c o n s u l t i n g f i r m t h a t r e l e a s e d t h e survey Monday.
V/
The survey o f 2,3 95 employers n a t i o n w i d e found t o t a l
h e a l t h b e n e f i t c o s t s averages $3,781 per employees i n
1993 .
I n Connecticut, t r a d i t i o n a l insurance costs increased
7.7 p e r c e n t on average l a s t year, t o $4,753 per employee.
H e a l t h Maintenance O r g a n i z a t i o n c o s t s i n the s t a t e
i n c r e a s e d 10.8 p e r c e n t , t o $3,647 per worker.
Distribution;
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
Pamela B a r n e t t
Kenneth R C h i t e s t e r
Paul A. Deegan
David Dreyer
S c o t t A. Johnson
David Leavy
N i c o l e R. Rabner
C h r i s t i n e A. Varney
Stephen B. Silverman
Jason S. Goldberg
Dana J. Hyde
v.^
^
�02/16/94
NQ.690
19:11
MORANDUM
TO:
FROM:
DATE:
RE:
STEVE EDELSTEIN, CHR^S JENNINGS. STEVE RICHETTI, ET. AL.
•^BERNARD CRAIGHEAD
^FEBRUARY 16, 199'
FIELD UPDATES ^ r i ^ / ^
WC
Lehman. Congressional s t a f f t o l d HHS t h a t Lehman wants t o move
c l o s e r t o President's Plan. No tangible evidence of t h i s has been
seen however. Apparently, Shalala i s going t o Lehman's d i s t r i c t
f o r a town meeting.
Maybe we can get some p u b l i c statement o f
support there.
Shays. Shays sent a l e t t e r of support t o a Leadership C o a l i t i o n on
Health Care Reform event i n Connecticut. The event was i n support
of employer mandates and universal coverage. The Shays l e t t e r was
very s o f t , I am t r y i n g t o get a copy.
Dodd. Recently Senator has t o l d constituents t h a t : 1) There are a
maximum o f 7 votes on the Fiance Committee i n support o f the
President's plan. 2) He i s concerned about long term care and
premium caps.
Liebermem. I n a r a d i o interview, Lieberman says t h a t he had been
"a l i t t l e tough on the Clinton plan."
Johnston. S t a f f e r spoke d i r e c t l y t o Senator. S t i l l non-committal,
but acknowledges t h a t there i s a r e a l problem. S t a f f e r t h i n k s we
have a shot at him.
J e f f e r s o n . Please have someone c a l l Rep. J e f f e r s o n t o discus h i s
o f f e r t o help w i t h the delegation.
Bond. The A l l i a n c e f o r the Mentally 111 attempted t o meet w i t h
Bond or h i s s t a f f l a s t week. They were turned away. They are
upset.
Hoagland. Aping our tag l i n e ,
insurance t h a t i s always there.
thing?
Kerrey.
Thinking of s t a r t i n g
reimbursement rates.
Hoagland i s c a l l i n g f o r h e a l t h
Are insurance and care the same
a move
t o increase
Medicare
Andrews (TX) . T e l l s people that he t a l k s w i t h Mrs. C l i n t o n a l l the
time. Told state convention on Saturday that he had j u s t t a l k e d t o
Mrs. C l i n t o n and t h a t now was the time f o r "them t o s t a r t
compromising over the Cooper's plan.
Told campaign s t a f f t h a t the a t t e n t i o n of the White (sending
cabinet members t o help him p o l i t i c a l l y ) i s the way t o get h i s vote.
009
�>letec ontest details,
Sda/iTyWeek.
want TO be a Cowtjo/i S^wtne^V
a mUUon copies in 1936. performed Frldey
night In CookevUle. Tenn.
wwn._Me was tooiisn. « « |«>t, ?„*":.^°Hf
necticut deleeatlon^^ere: Rep. Gaty
A. Franks. R^th District a membf r
of the Energy and Goounerce Com-
wMecfWV-
«»ees, h-"««r„ir£' • sJSi^pffiffib^^.
.JHINGtON
M WMldejit
.Clinton WM aratOng .Ws .pUn to
overhaul the nation'* hMlth ew*
system Ust year, the^lndustiy^hU ..the healtlj,'
nrop<»al would affect facreasgj Its pmaiL si
Cotftributioiwlo' members/of^Con-;;
f^iisSAf
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tijl^&^i^^n
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Johnson received $<5^M and .contributions from he^Uth and Ul'Geidenion. D.2hd. Dlstrldt.
inh.,"reKenneUy accepted $ « , 0 5 0 ^ t b « i •urance organlxatlon* because f u 200j and Rep. Christophir
ilthand j
those P " d s have j u r i s d ^ n over
p;^thDlstrirt,41.000.
Action Will- to'SftigS**
Connecticut , member; wps
the-amduhts came fro°^'V]f"r«J>« Issues affecting the l n d i « W : .
.Industry sources, •
M'benn^jsnoume^^
• Johnson Ifuppof
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IJOS ANGEUS — Hags at a 7;^«»rUpin
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f ^ On
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f ^ affliientTalos
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half-staCfforlwO students shpt in
a' caijaddng. Both teenagers, PeOlhstiicv south -of' downtown
. .,
one of them a Japanese ex- 16$ Ahgelef.- * . ' : . ' \
Their famllles arrived from Jactikiige student and the othw a
"
Japanese-American, were de- pan on S u h 4 * y ; ' * \
•^tb ahA MatsuiSra were shot as
clared dead Sunday.'
"It's such an appalling event they got out of awhlte 1994 HonIt's just very difficuJt for all of us da Cwic in a supennaricet parlcto comprehend." said Janet ixig lot in the d t / s San Pedro
Associated 7 r e A \ '
if'
; i> . Comp»*<l•ram''"''"f^Pf^
relations at Marymount College, drove off in the « r . Police louna
.T..I...M. Ito
itn died
rtimA Sunday
Qitnilav niffht
Talcuma
nlelit the car In the San Pedro area
after doctors disconnected his Sunday afternoon after
life-support systems. Go Mat- anonymous tip to police, tald Ofsuura was declared dead several ricerDonCox.
The shootings were the lead
hours later, said Harbor-UCLA
MrdicMl renter snoWrsmitn Kiin- Uf.m on mnnv Junnnese news-
^ - • - I '^'f^ir^y^^:;^;-:.''^
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Postri^v^/)
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^
W < li^yolycinf»^>\Whlfevv^ r
Siinday Mid the langrywhit^ House «
reaction tb the',»ppplnti?ieht .'of a a
partisan Republigtn \6 liu;e^gate «
• chrtl cases for lKiRe5olMti9nl"tust it
Coti). was,-pretty .t\a{urtl''lmd;ioo o
. mudi shouId.Tibt beffliadeof lt,.,,\
< Riip^'Jlm:LMCh,'R-IoVv»ii W d i h
•would be premature to draw'ahy ty
> extraordiiiarybondusions".abouta:a
telephone call senior White Ho'useie
adviser George Stephanopoulosoj
made in February to Joshua Stelner, jr,
chief of staff *t Uie Treasury De-iepartment.
Sources have described Stepfianmopoulos
Steiner,er
opoulos as
as angrily
angrily astdng
asking i)temer,er
tions to. o t n e r x n e m « « . . . . .
.
' v;-
on sm^lMie downi^^
•;
„ . ; Hillaiy
Hillar/liodhamClinton,^th*n.a
Whitewater.V.A^'^i.iVwwti^
Rodham .Clintpn,?tii*n « . -.WWtfjWt^
how
Resolution Trust came to naine -.
howResolutionTrustcametonaine
2 } i ^ . t ^ S A \ ^ a i n \ h t •vrtter and 'Ma4ison
••Vticii.^.^^m^My^.
weie *o ihterbirtiiet at Rose
P»I*".?li; S f
former federal pro«Kutor. Ja.y..B. .^tewater^dDevelopment.Co.
twined that the .O^toMjended^gp
Stephens to investigate possible
with
herhusband,
who
thm
tte
dvU cases against Madison Guaran- governor, and James B.McDougri. ..with
fin"ci«y^^'*;S^i^:
ty Savings tc loan and wheUier that J^o bwned Madison, "sjated to
son even as<^:coHapsii(g >Jtd
hiring could be reversed.
•
the state regulate™ t » » f ' M a ^ n tiieir Whitewater l<nd development
St4.hens. a fonnej;, R * P " ^ " « " was on tiie road to finandal healttu was failing. The president mainC S . attorney for the District of Co- It later collapsed, requiring a $60 tains he lost $46,000 on Whitewater.
lumbU, was sharply cnHolof Qin- miUion taxpayer bailout. • ' ' _
Leach's benign Vlew of Uie Steptiton when the president fi|fdWm M • Leadi, the senior Republican on anopoulos conversation, first repart of tiie.removal of all the U ^ . the House Banking Committee, ported Saturday in The Washington
attorneys who were appomted by who is leading the (iOP charge on Vast, was backed by House Speaker
the Bush administration. Stephens WWtS^Ter, tlid N B C i r . "Me^t Thomas S. Foley, D-Wash., and l)y
also has considered running for po- the Press" Sunday Uiat the Steph- Martin Fitzwater, who was p r « s
anopoulos phone ctH ' m t y ia-yt secretary to President George Bush.
litical office.
„ ,
He was hired by the Resolution beeJTa mistake," but he added I
" I have to admit t h a t « you startd
Trust Corp. 'in early • February; hope we don't make too much ot in George Stephanopoulos' shoes rit
would be a little difficult not to be
among the cases the agency is ex- this part of the story."
amining for possible civil "Ct'on is
Initead. Uach pressed for a full surprised and outraged by that apthe Rose U w Firm's representation coneressional investigation of the pointment" of Stephens, Titrwater
of Madison before Arkansas regula- relationship between Madison and told a C-SPAN interviewer.
tors.
tors.
Studv warne^H phnnt .QnnaHron concentration at base
�study Confirms Worst Fears on U.S. Children
A' r- ' —
—
By SUSAN CHIRA
A wide-ranging, three-year study of
young American children to be released today confirms some of society's worst fears; millions of infants
and toddlers are so deprived of medical care, loving supervision and inieilectual stimulation that their growth
into healthy and responsible adults is
threatened.
The plight of the nation's youngest
and most vulnerable children, the report says, is a result of many parents'
being overwhelmed by poveny, teenage pregnancy, divorce or work.
The report, prepared for the Carnegie Corporation of New York by a
panel of eminent politicians, doctors,
educators and business executives,
paints a bleak picture of disintegrat- I
ing families, persistent poverty, high !
levels of child abuse, inadequate
health care, and child care of such
poor quality that it threatens youngsters' intellectual and emotional developmeiiL
It is a picture of a United States
that ranks near the bottom of the
industrialized nations in providing
such services as universal health
care, subsidized child care and extensive leaves from work for families
with children under age 3, despite
recent scientific evidence that these
early years are critical in the development of the human brain.
While several reports in the last
few years have sounded the alarm
about very young children in the Unit-
Camegie Panel Sounds
Alarm With a Bleak
Portrait of Future
ed States, the Carnegie group hopes
that its accumulation of evidence, its
memt>ers' prominence and its calls
for individual as well as govemment
action may prompt some change.
"Collectively, we all have to say,
'Enough,'" said Judith E. Jones, director of the National Center for Children in Poverty who was one of the
panel's 30 members.
Other members include Dr. Jonas
Salk; Thomas H. Kean, the former
Governor of New Jersey, and Owen
Bradford Butler, chairman of Northem Telecom, one of world's largest
telecommunications companies. The
panel had included Secretary of Education Richard W. Riley and Isabel V
Sawhill, associate director of the Of
fice of Management and Budget, before their appointments to the Clinton
Administration.
The group's recommendations include offering parent education in
school and discouraging teen-agers
from Incoming parents; guaranteeing quality child care through a combination of govemment and business
support; overhauling the health care
system to provide a standard package of services like immunization for
young children and prenatal care,
and mobilizing commiuiities to examine the services available locally for
young children and to offer those
services in one place, as settlement
houses did in the early I900's.
Bowing to the pmiitical reality of
tight govemment budgets, the report i
proposes government-business part-'
nerships and local efforts. But it does
call for new Federal and state money
Continued on Page A13, Column 1
' Continued From Page AJ
to suppon high-quaiity child care, expand the Head Start preschool program to serve children under age 3
and overhaul health care.
Questioned about the report, most
experts agreed that it had properly
spotlighted the problems plaguing
Attrencan families and young children. But some policy analysts said
thf Carnegie report essentially echoed conventional wisdom and, in its
desire to remain nonpanisan, evaded
important political issues like welfare reform and the Clinton Administration's record on these issues.
""Many people voted for Bill Clinton
because they thought the items on the
Carnegie agenda would be on his
agenda," said Douglas J. Besharov, a
rMideni scholar at the American Enterprise Institute, a research organizauon. "The challenge is getting from
h^e to there in the current budget
atmosphere. And we don't know how
t^tio a lot of the things that are called
for."
"
Review of Data
•The repon„"Staning Points; Meeting, the Needs of Our Youngest Chil(Jren," was based on a review of scieatific d a u and scholarly studies and
an exammaiion of statistical indicators of children's status in this country, like the number living in singleparent homes.
. Jhe report notes that three million
children, nearly one-fourth of all
American infants and toddlers, live in
poveny. Divorce rates and the numbers of births to unmarried women
aiHl single-parent households have all
stiared in the last 30 years. Children
in single-parent households, it points
otft, are more likely to expenence
behavioral and emotional problems
lhan those in two-parent households.
The number of children entering fosiar. care jumped by more lhan 50
percent from 1987 to 1991, rismg to
460,000 from 300,000.
Repons of child abuse are rising,
ihia task force found, with one in every
I Dies, 18 Are Hurt
tn Lightning Strike
NASHVILLE, April 11 (AP) Lightnmg struck players and spectators at a Frist)ee match on Sunday,
killing 1 and mjuring 18.
"It was like a grenade that explodef^" Fred Baes of Oak Ridge told The
Tennessean, a Nashville newspaper,
'.people were standing there, and
they went, 'Bang!' Just like that. Ev^ b o d y on the field hit the ground."
Seven victims were players. The
rest were spectators at the event, in
Ezell Park, the police said. The fatality..was Shawn Adams, 29, of ChattaO ^ a , the police said. Carmen Lapama. 28, of Atlanta, was listed in
critical condition at the Southern
Hills Medical Center, a spokeswoman
(qr ttxp hospital said. Tha,iDther injured people were released on Sunday.
three abused children being a baby
less lhan a year old. More lhan half of
women with children under a year old
are workmg. Many of their children
spend most of each week in such poor
child care that it threatens to harm
their development. Amencan children are among the least likely in the
world to be immunized. And an increasing number of very young children grow up witnessing stabbings,
shootings and t)eatings as everyday
events, the task force said.
The quality of these young lives is
deteriorating even as mounting scientific evidence indicates that children's environment, from birth to age
3, helps determine their brain structure and ability uj leam, the repon
says.
Advances in molecular biology and
neurology have shown that children's
experiences in these early years can
influence how many brain cells, or
neurons, they develop, and how many
connections, or synapses, are formed
between them. Activating these synapses allows learning to take place.
Matters of Development
Scientists have leamed that as the
brain matures, underused neurons
and unactivated synapses are naturally pruned from the infant brain,
suggesting that early stimulation
shapes later brain structure.
Researchers also believe that early
stress activates hormones that can
impair learning and memory, lending
scientific evidence to sociologists' observations that children under stress
risk developing intellectual and behavioral problems.
To help insure that infants and toddlers receive the intellectual stimulation, emotional nourishment and social guidance they need, the report
calls for a nationwide commitment to
young children and offers dozens of
examples of successful local initiatives. The Avance program in Texas,
for example, offers free child care so
that Mexican-American families can
attend child-development classes. In
South Carolina, a home visiting program teams pregnant adolescents
with experienced mothers.
Because so many new mothers
work, the report focuses on family
leave and high-quality child care as a
means of relieving the plight of children. Although President Clinton last
year signed inlo law the Family
Leave and Medical Act, the lask force
says the law's provision for three
months of unpaid parental leave is
not enough for many parents. The
group calls for leaves of four to six
months with at least partial payment
of parents' wages, perhaps through
joint contributions. And i l proposes
extending the law to all businesses,
even those with fewer tlian 50 employees.
The report asks the Federal Government to offer the states financial
incentives to adopt high standards for
child care and to offer training for
those working in child care. Not onl<
can corporations help pay for chile
care, but olher financing alternatives
could be offered, like having banks
provident loans and states issue tax
exempt'oonds to child care providers
the report says.
pD
THE NEW YORK TIMES. TUESDAY. APRIL 12. mt
�] Barriers to Immunization
Peril Children, Experts Say
By WARREN E.LEARV
«nd 72 percent were is families with
incomes at or above the poverty line,
WASHINGTON, April 23 - Barriv^lgnal of Health Problems
ers to immunization are leaving mil"A case of measles or diphtheria in
lions of children needlessly at risk of a child is like the death of the miner's
measles, whooping cough, polio and canary — both signal problems in the
other pdentially serious diseases, a environment." Dr. Klerman said
panel of expens has wamed.
"The miner's canary dies because
In a repon made public on Tues- gases are present that might affect
day, the panel, o( the Institute of the miner. Cases of a vaccine-preMedicine, said fewer than 70 percent
of the country's 2-year-olds have all ventable disease signal problems in
their recommended inoculations be- the health care environment"
cause of the failure of doctors, parMore than 90 percent of the naents and health agencies to make tion's babies begin their immunizasure children are protected. It said twns on schedule, the panel said, but
the barriers included factors besides retum visits lor subsequent inoculathe availability of vaccines and their tions fall off, indicating a need for
costs.
programs to insure compliance.
"We know that underimmunized
Tracking Systems Urged
children are experiencing illnesses
that could be avoided and that some
The panel said more than 90 permay be suffering severe conse- cent of the children in the United
quences, even death," Dr. Lorraine V. States are prt)perly vaccinated before
Klerman of the University of Ala- the age of 5 because it is required for
bama, chairman of the eight-member school attendance. The repon said
panel that wrote the report, said at a Slates, which bear primary responsibriefing here.
bility for public health programs,
Children and their families are con- should mount similar campaigns to
fronted with a variety of barriers that vaccinate younger children. It recomkeep youngsters from getting the pre- mended that immunization records
ventive care they need, she said. be tracked by computer to insure
These include lack of access to health proper follow-up.
care, lack of insurance that covers
vaccinations and outmoded practices
The repon said doctors, and clinics
also have to do a belter j o of tracking the immunization status of children and reminding parents when
their children need each inoculation
in the series of 15 or so sf.uts required
from birth to 2 years of age.
The panel further urged that doctors re-examine such practices as
giving vaccinations only on specially
scheduled visits. These can be inconvenient and lead to missed opportunities for giving shots during other office visits, the panel said
at clinics and doctors' offices that
In addition, it said, health agencies
make it difficult to keep children on
'schedule for the many inoculations need to establish programs that remove barriers to proper vaccination
they need in early life.
One such program would be to keep
Praise for CUnton Program
clinics open at night and on weekends
The report praised President Clin- for working parents; another would
ton's Childhood Immunization Initia- be to reach cultural min riiies about
tive, for which Congress appropriated the imporunce of immunization.
more than $800 million this year. The
Need for Parental Education
effort provides free vaccines to the
uninsured and those on Medicaid and
The report said the Federal Govpromotes education programs and ef- emment and the states should also
* forts 10 improve the availability of consider cooperating with private
t inoculations. But the repon added health and advocacy groups to eduthat "removing the financial barriers cate parents about the benefits, and
will not, by itself, achieve full immu- occasional risks, of vaccination In
nization of preschool children."
addition, it said immunization should
In a Rose Garden ceremony on be a part of any plan for overhauling
Wednesday intended to focus atten- the health care system.
tion on the issue, the President said
The National Imnuinization Camthat the United Sutes badly trails paign, a private vaccination effort
. tnost of the work! in immunizing chil- working with kx;al coalitions in 16
; dren, Reuters reponed.
cities to improve inoculation rates,
Mr. CUmon noted that the problem endorsed the report and called for
^ is especially serious in some poor more grass-roots programs to get
urtMn and rural areas, the news agen- communities involved.
cy said, and called the illnesses re"We know that cost is not usually
sulting from this failure "a health the primary barrier to immunization
disaster and a human tragedy"
services," said Jennifer Perry of the
The Institute of Medicine, pan of
Children's Action Network, a group
the National Academy of Sciences, supported by the entertainment insaid in its repon that data from the dustry and corporations that sponFederal Centers for Disease Control sors the campaign. "We think vacand Prevention show that vaccination cine initiatives designed for and by
problems involve not only the poor groups in particular communities are
but also all racial, ethnic and econom- some of the best ways to change
ic groups In 1992, for example, 75 people's awareness and behavior
percent of all 2-vear-olds not immu- ahwut immunization to improve child
nized against measles were white. health."
Specja] 10 TV H n York Times
A report focuses on
problems with
vaccinations that
touch all groups.
�Drugmakers to Team
With Benefits Finns
Two Deals Raise Concems About Conflicts
By David S. Hilzem-ath
DRUGS, From Dl
saries are uniting. They are part of the drug inIn partnership with Value Health, Pfizer plan? dustry's response to the transformatjon of the
Two of the world's largest drug to operate networks of doctors or other hea.1h health care business in the United Sutes.
manufacturing companies said yester- care providers that wouW provkie treatment for
Over the past several years, the drug industry
day that they are joining forces with partirtilJr medical problems, said Pfizer Vice has gonefrombeing able to virtuaUy dictate drug
traditional adversaries—companies Chairman Edward C. Bessey. The treatment prices to having to contend with intense pressure
that manage prescription drug benefits those networks provkie couW involve Pfizer prod- from cheaper generic alternatives and large
Ifor health plans.
ucts, hesaid.
price-sensitive purchasing groups.
Qv / The deals align the manufacturers
"Wiat we want to do is expand the playing
Even retail drugstores, which have often paid
(p|C^ / with companies that have played a key 5dd," he sakl. "We couW go from playing in a 7 relatively high prices for brand name drugs, are
' role in the dnve for lower drug prices. percent ^ e of the health care market to playing handing together to negotiate bargains.
Some analysts said the alliances could iR a 25 percent share of the health care market"
DedsKMis about whkh drugs get prescribed,
give maniifacturers more influence
Pfizer's products will be assured of inchiskxi on once the nearly exchisive province of individual
over markets for their products and Vahie Health's list of preferred drugs in retum for
blunt the downward pressure on prices. price rebates to Vahie Health's cbents, executives doctors, are now influenced in many instances by
large health plans and their benefits managers.
SmithKline Beecham PLC, a Lon- at the two companies sakl.
Some tndusti7 observers said relationships bedon-based dnigmaker, agreed to buy • Some analysts expressed skepticism over tween manufacturers and drug benefits managDiversified Pharmaceutical Services claims that the deals will ben^ oxisumers. Tou ers raise potential conflicts of interest. For examInc. of Minneapolis, for $2.3 billion. Di- couM argue that the consumer will be less well
versified manages pharmaceutica] ben- served because the competition is reduced," sakl ple, Diversified, whose role is to seek the best
piice and quality for buyers of pharmaceuticals,
efits for nearly 11 million people in the Wertheim Schroder analyst Jonathan S. Gelles.
will
be diallenged to show no favoritism when
United States.
Noting
that
drug
benefits
managers
have
creatweighing
its owner's products against other comPfizer Inc. sakl it was forming busi- ed downward pressure on manufacturers' prices,
panies'
drugs,
analysts sakl.
ness alliances with Value Health Inc. of Robmson-Humphrey Co. analyst John Runningen
J.P
Gamier,
chairman of SmithKline s pharmaAvon, Conn., which manages prescnpn
tion drug benefits for 11.1 million peo- sakl, "Wiat better way to alleviate the pressure ceuticals division, saidtiiathis company will want
Diversified to do what is best for Diversified's cliple, including employees of large com- than to buy them.'"
But Runningen added, Tor the kxig pull, for ents, addingtiiatSmitiiKline will have a $2.3 bilpanies such as Amencan Airlines Inc.,
these guys to be successful, they've got to give lion investment intiiecompany's repuution after
Chrysler Corp. and Ford Motor Co.
the
customers more vahie for the dollar."
completing tiie purchase from United HeakhPfizer also plans to use the alliance
Pfizer spokesman McGlynn sakl competitkxi Care Corp., a managed-care company in Minneto enter the business of delivering
health care, possibly through ownership wouW be preserved because ct>y^r manufacturers apolis.
of doctors' practKes, a company execu- can establish similar relationships with benefits
SmiUiKline gainedrightsto patient data from
tive said. That could give it a new ave- managers. Health pians and other large purchas- United HealtiiCare as part of its deal to buy Dinue to promote its products to patients. ers of drugs wouW still be able to dxx»! from versified. Gamier said his company would use tiie
Drug benefits managers perform multiple sources.
The fact is we're going to be slugging it out in data to demonstrate, for example, that while one
two crucial functwns on behalf of insurof its products might be more expensivetiiana
ers and other large buyers of pharma- the markets. Those that do it better presumably competing product, it is also more effective.
ceuticals; They negotiate discounts will get the business," he said.
But Wertheim Schroder analyst Gelles quesThe strategic moves by SmithKline and
from pharmaceutical makers and draft
tioned
whether consumers would be as likely to
Pfizer
follow
pharmaceutical
giant
Merck
&
lists of preferred drugs that help determine which medicines patients receive. Co.'s purchase last year for $6 billion of Med- see datafromthe companies that reflected more
Drug companies compete to get their 00 Containment Services Inc.. a mail-order favorably on alternativetiierapiesorrivalcompaproducts on the lists and to sell drugs pharmaceutical supplier and benefits manager. nies' products.
SmithKline's stock closed yesterday at
through the benefits managers to the
The deals add to the growing concentration of
customers they serve.
power in health care, where many former adver- $28.25, up 12'/i cents. Pfizer's stock closed at
SmithKline and Pfizer said the new
$61, down 12'/2 cents.
arrangements would help them promote more cost-effective medical treatment. The data that the benefits managers gather on the treatment and
health of the people they cover identify
which drugs work best and ad>-ance
their marketing efforts. The alliance
would allow Pfizer to "develop the best
program in support of our own products," said Pfizer spokesman Brian
McGI>Tin.
See DRUGS, D3, CoL 1
Wishmjton Po»i SuH Wnttr
�Drugmakers to Team
With Benefits Firms
Two Deals Raise Concems About Conflicts
By David S. Hilzenrath
DRUGS, From Dl
saries are uniting. They are part oftiiedrug inIn partnership witii Value Healtii, Pfizer plans dustry's response totiieti^sformationof tiie
Two of the world's largest drug to operate networks of doctors or other hea.Hh health care business intiieUnited Sutes.
v. manufacturing companies said yester- care provklers that wouW provkie treatment for
Overtiiepast several years,tiiedrug industry
I day tiiat tiiey are joining forces with particWar medical problems, said Pfizer Vice has gonefrombeing able to virtually dicute drug
I traditional adversaries—companies Chairman Edward C. Bessey. The treatment prices to having to contend with intense pressure
\that manage prescnption drug benefits those networks provkie couW mvoWe Pfizer prod-from cheaper generic alternatives and large
r.K lor health plans.
ucts, he'said.
price-sensitive purchasing groups.
Qv / The deals align tiie manufacturers
•^Vhat we want to do is expand the playing
Even retail drugstores, which have often paid
/ witii companies that have played a key field," he sakl. "^e couW go from playing in a I7 relatively high prices for brand name drugs, are
^
/ role in the drive for lower drug prices. percent share of the health care market to playing' handing togetiier to negotiate bargains.
/ Some analysts said tiie alliances could in a 25 percent share oftiiehealth care market"
Decisions about whkh drugs get prescribed,
/ give manufacturers more influence
Pfizei's products will be assured induskxi on once tiie nearly exchisive province of individual
/ over markets for their products and Vahie Health's list of preiferred drugs in retum for
/ blunt the downward pressure on prices. price rebates to Vahie Healtii's cbents, executives doctors, are now influenced in many instances by
large healtii plans and tiieir benefits managers.
/
SmitiiKline Beecham PLC, a Lon- at the two companies sakl.
Some industry observers said relationships bedon-based dfugmaker, agreed to buy • Some analysts expressed skepticism over
Diversified Pharmaceutical Services claimstiiattiiedeals will benefit consumers. "Tfou tween manufacturers and drug benefits managers raise potential conflicts of interest. For examInc. of Minneapolis, for $2.3 billion. Diargue tiiat tiie consumer will be less well ple, Diversified, whose role is to seektiiebest
/ versified manages pharmaceutica] ben- couH
efits for neariy 11 million people in the served becausetiiecompetition is reduced," sakl price and quality for buyers of pharmaceuticals,
Wertheim Schroder analyst Jonathan S. Gelles.
will be diallenged to show no favonusm when
1 United States.
Noting
that
drug
benefits
managers
have
creatweighing its owner's products against otiier comPfizer Inc. sakl it was forming busi- ed downward pressure on manufacturers' prkes, panies'
drugs, analysts said.
ly ness alliances with Value Healtii Inc. of Robinson-Humphrey Co. analyst John Runningen
J.P
Gamier,
chairman of SmithWine's pharmar4 Avon, Conn., which manages prescnp^jyV tion drug benefits for 11.1 million peo- sakl, "Wiat better way to alleviatetiiepressure ceuticals division, saidtiiathis company will want
Diversified to do what is best for Diversified's cliN -^ple, including employees of large com- than to buy them.'"
But Runningen added, Tor tiie kmg pull, for ents, addingtiiatSmitiiKline will have a $2.3 bilpanies such as American Airhnes Inc.,
these guys to be successful, they've got to give lion investment in the company's repuution after
Chrysler Corp. and Ford Motor Co.
the
customers more vahie for the dollar."
completing tiie purchase from United HeahhPfizer also plans to use the alliance
Pfizer spokesman McGlynn sakl competition Care Corp., a managed-care company in Minneto enter the business of delivering
healtii care, possiblytiiroughownership wouW be preserved because ether manufacturers apolis.
of doctors' practices, a company execu- can estaUish similar relatxnships with benefits
SmitiiKline gainedrightsto patient dau from
tive said. That could give it a new ave- managers. Health pians and other large purchas- United HealtiiCare as part of its deal to buy Dinue to promote its products to patients. ers of drugs wouW still be aWe to choose tern versified. Gamier said his company would use tiie
Drug benefits managers perform multiple sources.
The fact is we're going to be slugging it out in dau to demonstrate, for example,tiiatwhile one
two crucial hinctions on behalf of insurthe
markets. Thosetiiatdo it better presumably of its products might be more expensivetiiana
ers and otiier large buyers of pharmacompeting product, it is also more effective.
ceuticals: They negotiate discounts will get the business," he said.
But Wertheim Schroder analyst Gelles quesfrom pharmaceutical makers and draft The strategic moves by SmithKline and
tioned
whetiier consumers would be as likely to
Pfizer
follow
pharmaceutical
giant
Merck
&
bsts of preferred drugstiiathelp determine which medicines patients receive. Co.'s purchase last year for $6 billion of Med- see daufromthe companiestiiatreflected more
Drug companies compete to get their co Containment Services Inc.. a mail-order favorably on alternativetiierapiesor nval compaproducts on tiie lists and to sell drugs pharmaceutical supplier and benefits manager. nies' producu.
tiu-ough the benefits managers to the The deals add to the growing concentration of
SmithKline's stock closed yesterday at
customers they serve.
power in healtii care, where many former adver- $28.25, up 12'/2 cents. Pfizer's stock closed at
SmitiiKline and Pfizer saidtiienew
$61, down 12'/2 cents.
arrangements would help them promote more cost-effective medical treatment. The data that the benefits managers gather on the treatment and
healtii of the people they cover identify
which drugs work best and ad>-ance
tiieu- marketing efforts. The alliance
would aliow Pfizer to "developtiiebest
program in support of our own products," said Pfizer spokesman Brian
McGlynn.
See DRUGS, D3, CoL 1
Wulunron Po«( SuH Wnler
�l a s t August when he crashed h i s bicycle into a car. He now
walks with a limp, has a scar on h i s head and h i s l e f t arm
i s partly paralyzed.
The 14-year-old from Kansas City, Mo., told a
congressional committee Tuesday h i s i n j u r i e s should serve
as a warning to other children.
^ ^ I f I had worn a bicycle helmet that day, I could have
saved my head, and saved a l o t of money," he told a
Senate Labor and Human Resources subcommittee on children
and family.
Marcus was among the 102 children who went to Capitol
H i l l to share t h e i r stories about i n j u r i e s that could have
been prevented. The hearing i s part of the National Safe
Kids Campaign, aimed at publicizing issues such as bike
helmets, drowning prevention, smoke detectors and safety
seats.
Former Surgeon General C. Everett Koop, chairman of the
campaign, said more than 13 million children are treated
each year for unintentional i n j u r i e s at a cost of $13.8
billion.
^^Nearly 8,000 children die each year from
unintentional injury, claiming more l i v e s than a l l other
children diseases combined," Koop told the committee.
^^Good preventive measures save families untold
suffering.''
Once a budding football player, Marcus now spends a l o t
of time at physical therapy and doing exercises to improve
the coordination in h i s hands.
^ ^ I know that doctors and hospitals and ambulances a l l
cost a l o t of money, a whole l o t more than a bicycle
. ,
helmet," he said.
The subcommittee chairman. Sen. Christopher Dodd,
(N^^
D-Conn., said preventing i n j u r i e s would bring down the
cost of health care and should be a key component in any
health reform b i l l .
Safe Kids?wants?Congress to provide subsidies for c h i l d
safety devices for low-income families, grants to states
that approve injury prevention laws and grants to t r a i n
physicians in injury prevention counseling.
Government can only do so much, however. As 11-year-old
Heather Giambo of Greenwich, Conn., put i t , ^^Kids tend to
l i s t e n more to other kids than to p a r e n t s . "
Marcus Young said he didn't want to wear h i s bike
helmet before the accident because ^ ^ I didn't think they
were cool a l o t of kids f e e l that way.''
But he encouraged parents to make safety fun for t h e i r
children. For example, helmets could be decorated with
sports logos or other designs.
^ ^ I f t h e i r helmet said Chiefs or Bulls or Rams, they
would think t h e i r helmets are cool,'' he said.
This week, the Senate i s expected to pass a b i l l
requiring toy labeling and manufacturing standards for
bike helmets.
�Health Car^Debate Opens
Amid Bursts of Hyperbole
line of his own verskm of a health plan until
i > the second week m June, when Congress
returns from its Memorial Day break, but
Mv)r committees in bodi tbe Senate wanted to use tiie next 10 days to explore
Tm going to get tiie whole body well,"
and House took up heakh care legislation the major Democratic and Republican projoked Miller, who on Tuesday had won subfor tbefirsttime yesterday, and it was nei- posals already introduced.
ther a pretty nor enlightening sight.
Tf we can be bipartisan and still achieve committee agreement to add a big package
Members of the Senate Labor and Hu- (Clinton's goal of) universal coverage, of mental healtii and substance abuse beneman Resources Committee variously called great!" Rostenkowski said. I f not, I will do fits.
the bill tiiey were consklering a "casserole what I need to do to get 20 votes in this
Yesterday's Miller amendment, apmadefr^mleftoversfromtbe prevkms eve- committee."
proved by voke vote by tiie labor-managening's meal," an airplane that cannot Oy and fc) The prospects of bipartisanship seemed ment relations subcommittee, would pro"the most important bill erf this Congress or 'Jdim bytiietimea lengthy round of opening vkie preventive and diagnostic dental care
,i^Utements had been completed. Tou can't
this decade."
to adulu as soon as the bill goes into effect
•TVe must do this togetiier." said Chair- get a bipartisan bill," said Rep. Bill Archer CUnton proposed similar adult benefiu but
,;man Edward M. Kennedy (D-Mass.), "the (Tex.), the senior Republican on the panel,
"if the price of admission to the negotia- not starting until 2001.
. ^ American people expect us to art "
tions
is agreement to heavy-handed manMiller estimatedtiiecost at $6.4 billion a
,Y1
1 wouH observe tiiat the chairman and I
dates
and
massively
higher
taxes."
year,
but subcommittee Chairman Pat Wilare peering over the opposite edees the
Rep. Fortney "Pete" Stark (D-Calif.). liams (D-Mont.) sakltiieadministi^tion esdeep psychological chasm," sakl Sen Nancy W who\'ot?S n f f " ^ ' ' " M ! ^ " "
timated it at $7.3 billion. The amendment
Landon Kassebaum (Kan.), ranking Repu^ 4 ^ m n
^ ^ " ^
hcan on tiie committee
^ f ?f
"""'^ °^
uninsured out of his was strongly backed by a coalition of 32 orSo much is at stake in tiie health care de- S^^^^J^^^"^'^^ last monUi over solid ganizations called the Coalition for Oral
bate for boti, President CbSSTa^ c^n ^e^"^"^^" ° P P ^ ' ^ ' ^ ^ "^tional ef- Healtii, consisting of pubbc healtii organizafort j?/'*!'
to deal witii
gressional Democrats tiiat leaders in botii V' J**"
^thtiiis
tiiis issue
issuehad
had been
been "fnis"frus-, tions and schools, denul trade group^ denchambers are going to extraordinary ^ " i f j ^ l T i
lengtiis to convmcetiiepubbc tiut a bib will ^ l ^ l
T"!' " " " ^ sarcasm, he invited ^arturing groups.
« by the en. U« 103,d j T > S^S'SoS^w"'^
T s ^ n - r Republican M,rg. Roak™,
By Dana Priest and Spencer Rk*
4*'
I
U J U
V ¥ 1
tiiat
-realprogress
progrS
s been
b^n^de
^ '^"^l
" ^ ^ " ^ "^"^^^
Stark's..?P'^^^"^ ^ ^ib witi, kindness" by pibng on
that_ teal
has
made.oeen maae.
y subcommittee. Thomas went on to com^o make it untenable. But she
This is a pasteurized versk)n of Qinplain^tiiat
tiie
Congressional
Budget
Office
said,
Tm
not
going to kib it witii kindness"
ton's blueprint for socialized medicine."
was
"scoring,"
or
estmiating
the
cost
of,
a
opposed
the
amendment,
Sen. Orrin G. Hatch (R-Utah) sakl seriouswide
variety
of
Democratic-sponsored
"TVe
are
legislating
witii our hearts rathly, only to laugh and repeat his phrase after
Kennedy said, '^ow, what's that again, tiie plans while delayingtiienecessary account- er tiian our heads." said Rep Steve Gunsoundbite?"
S h T l S n ^ r t ? " ' ^ ' ' " ^ ^ ^ backs, along derson (R-Wis.), alluding io the addeS
"Have you fonned a pooT to bet when a Wltii a bipartisan group of senators led by > costs
H. Chafee (R-R.I.), John C. Danforth -V wiiur A
. J Ubill might pass. Sen. Tom Harkin (D-Iowa) John
(R-Mo.), David L. Boren (DOkia ) and Bob^^
T
^
^ amendments
joked with reporters after a two-hour
Kerrey (D-Neb.).
^couM raise costs and some might get kast
monung session. "What day. what montii,
Throughout the session, Republicans ^^^''' ''"^
^oing to pay is an iswhat year?"
criticized both "employer mandates"—re- f"* that wiU plaguetiie(xmgress" until tiie
Behind the scenes, things don't look
quu-ements that employers provide msur- healtii care debate ends. He said "^t is our
quite so polarized m tiie Kennedy commit- ance for theu- workers—and higher taxes, responsibihty" now to put in what is needed
tee. A bipartisan group of senators indud- while Democrats said reachmg universal for good health and sort out cost problemsmg Democrau Harris Wofford (Pa.). Jeff coverage would require one or the other. later.
Bmgaman (N.M.) and Christopher J. Dodd ' j T f you don't bke mandates, you'b face raisMeanwhile, in an effort to give Uie pro(Conn.)
and Repubbcans Dave Durenber- ^mg taxes." Rep. Robert T. Matsui (D-Cabf)
>ddi^
cess some impetus, tiie White House has
ger (Minn.). James Jeffords (Vt) and Kas- Ji^warned. "Hard choices have to be made
invited several hundred people, including
sebaum is readymg amendments to stream- ^
Five major committees, two in tiie Sen- several heakh-related organizations, to a
^pbne tiie bib's bureaucracy and cut out some
ate and three in the House, have jurisdicl_ of tiie role of tiie states in administering tion over the initial crafting of a health care media event on Capitol Hib Tuesday for
health care.
bill. After they approve individual bibs, the whkh it is sobciting statements of support.
But few Democrats expert Repubbcans
In a letter to groups such astiieAmerileadership of each chamber wib meld them
to sign on to anythmg significant at the
and then they wib go totiiefloorsfor de- can Arthritis Associatkm and similar orgacommittee suge of the process.
bate and votes.
nizations, tiie White House offered leaders
^ "What we need m tiie end is bipartisan
Kennedy's is the only committee to be- a chance to attend a large meeting on the
support, but it doesn't have to come tiiis
gin pubbcly discussmg its own version. The Hib Wltii Cbnton to hear him discuss healtii
week." said Wofford.
Ways and Means Committee is waiting for care and. for some, an opportunity to have
Much tiie same sort of positioning and cost estm-.aies, the Senate Finance Com- theu- pictures uken withtiiepresident.
partisan mfighting marked the fonnal open- mittee IS holding pnvate talks, the House
The letter notes that the White House
tnerg\ and Commerce Committee is at a
mg of work at tiie House Ways and Means
would
be contactmg the groups for a statestalemate
and
the
House
Education
and
LaCommittee.
ment
supporting
the president's healtii rebor
Committee
is
stiJl
at
the
subcommittee
Chauinan Dan Rostenkowski (D-IU.) told
form
pnnciples
to
distribute to the news
stage.
members tiiat he would not havetiieoutIn the latter panel yesterday, an amend- media.
j_ ment bv Rep. George MiUer (D-Calif.) added a package of potentially costlv adult den- ' Staff writers David S Broder and Ann
tal benefits to a Chnton-bke national health Devroy contributed to this report.
biU it KS voting on.
THi U^»HIUTON Pt>>TTHlRsDO, M o 19, 1994
�National Journal's CMigressDaily/A.M.
May 20, 1994'Page4
Labor Panel OKs Benefits Deal; Finance Eyes Mandate Study
Both bipartisanship and confusion
reigned atJThureday afternoon's Senate
Labor and Human Resources ComifuF"
tee healthcare reform markup, as a benefits package
compromise passed 17-0 •f^~even
"though ambiguous language left the
deal^iinaliaLejincertain.
The accord — crafted by ranking
member Nancy Kassebaimi, R-Kan.,
and Sens. Jeff Bingaman, D-N.M.,
James Jeffords, R-Vt. and Christopher Dodd, D-Conn. — would give a
new National Health Board the authority to reanange or cut back benefits and
change copayments and deductibles if
federal subsidies in the plan would cause |
an unforeseen deficit increase.
Jsing procedures similar to the federal base closure commission, the board
would make lecommendations that would
be implemented unless Congress voted
to overturntfiemwithin 45 legislative days.
However, committee members were
uncertain if the board would have the
power to adjust premium caps and doctor reimbursement schedules if larger
deficits were projected.
The version of the amendment
Bingaman introduced in the morning
clearly did not give the board that authority. But liberal committee Democrats interpreted ambiguous language
that was added during the lunch break
as includingtiierevenue-raising power.
Democrats sparred over interpreting
the words "appropriate programmatic
adjustment" — which were tacked onto
the list of board powers — with most
members believing the authority had not
been granted. But, when asked, committee staff agreed with Sen. Paul Wellstone, D-Miim., who said Bingaman told
hiin^tremium c^
Jeffords aidIDodd^arStiieyTiadnoT
understood the~new version gave the
board the additional powers, and promised
to revisit tiie issue later intiiemarkup.
uted
'The intent was to give them lifmu
authority," Jeffords said. "We didn't want
them to be able to raise revenue."
-"^^The langyagFwasmisinterpfeteHby^
Labor and Human Resources Chairman Kennedy's staff, asserted Dodd —
who had appeared upset about the in-
terpretation after the markup. Dodd added
that an amendment clarifying the clause
as not including the authority was being readied by Bingaman, and tiiat he expects that amendment to pass next week.
""coinmittee would have ap^
proved the amendment at least 9-8 without the new language, Bingaman said
after the markup, with all seven committee Republicans voting with him,
Dodd and probably several other Democrats. "That's where the votes were
on this," Dodd added.
But the unclear language did pave
the way for the 17-0 vote, Jeffords noted,
adding, "Without the ambiguity there
wouldn't have been unanimity."
In addition, Bingaman said he is
working on a bipartisan deal on state
regulationstiiatcommittee Republicans
Tuesday contended created a new unfunded mandate for states.
A compromise on employer mandates will be more difficult because the
issue has become "very poUticized" and
"polarized," he added, but he said he
will still inti-oduce a plan to lessen small
business' payroll taxes.
Meanwhile, the Senate Finance
Committee Thursday continued in private meetings to struggle over the issue
of employer mandates and price con-
trols as part of healthcare refonn, with
some members citing a new Lewin-VHI
report they said suggests mandates and
price controls may not be needed.
Sen. John Breaux, D-La., who has
begun to suggest compromises on employer mandates, saidtiiereport bolstered
the view of managed competition legislation, for which he is a key sponsor.
According to several senators, the
Lewin-VHI report calculates that 97
percent of all health spending could be
covered by insurance under the managed compeution act without mandates
or price controls. And, Breaux noted,
"If you can get to 97 percent, then
you've done sometiiing very significant
without mandates or premium caps."
Calculations until this point generally have been based on the percentage of people covered under a plan. The
senators said Lewin-VHI agreed with
the CBO that reforms in the managed
competition bill would cover 91 percent
of the population.
Unc' r that plan, however, the coverage is not guaranteed. Infindingcoverage of ^7 percent of all health spending, they said the report found the uncovered generally would tend to be
younger, in good health and with low
healthcare costs.
Republican Drops Off Cooper-Grandy
House Education and Labor
Committee member Dan Miller, RFla., Thursday withdrew his name as a
cosponsor of the CooperGrandy managed competition healthcare reform bill, complaining it has "too many mandates and contains a new, budget-busting entitiement."
In a statement, Miller said he initially cosponsored the bill out of a sense
that healthcare reform should proceed
on a bipartisan basis.
However, Miller said his problems
with the substance of the bill have not
been addressed. He opposes the mandatory alliance structure, and also questioned the impact of the bill on the federal budget deficit.
"The bill creates a new entitiement
program, and as [a recent CBO] report
shows, the new program is not fully
funded," Miller contended. 'The CBO
should serve as a stark waming to all
members of Congress."
He added: "The Cooper-Grandy bill
authoro have gone out of their way to
find a way tofinancethe new entitlement. They took on the labor unions and
raised billions in new revenues through
the tax cap. They made some painful
cuts in Medicare. And yet,tiieseefforts
weren't enough tofinancetiieprogram."
Miller subsequently tumed his attention to the Rowland-Bilirakis bipartisan approach, which he called a
"more sensible blueprint for healthcare
reform." That bill basically would reform the insurance market, and it proposes some other areas of common
agreemenl.
�... As Bipartisan Efforts Continue In Senate Labor Panel
The Senate Labor and Htiman Resources Committee moved closer
to more bipartisan healthcare refoirm compromises at today's
markup, with amendments proposed by ranking member Nancy
Kassebaum, R-Kan., forming the basis of accords on public health
block grants and school c l i n i c s . In a repeat of l a s t week's
compromise on National Health Board budget reviews of the basic
benefits package, Sen. Jeff Bingaman, D-N.M., praised Kassebaum's
approach and suggested an alternative. Kassebaum's amendment
would have consolidated 19 different public health grants made by
the Centers for Disease Control into a single block grant so
states could set their own p r i o r i t i e s within federal guidelines.
Bingaman and several other Democrats — including Sens.
Christopher Dodd, D-Conn., and Paul Wellstone, D-Minn. — agreed
that states should have more control, but argued some federal
p r i o r i t i e s should remain. Bingaman suggested l e t t i n g states s h i f t
some funds between the grants when needed, and Kassebaum set the
amendment aside so compromise language could be worked out.
The s p i r i t of bipartisan accord also extended to funding
school c l i n i c s , which Labor and Human Resources Chairman
Kennedy's mark would s i g n i f i c a n t l y increase. Kassebaum's
amendmen-t would cut spending in half — from $900 million to $450
million in 2 001 — and again turn over most authority to states
to give them more f l e x i b i l i t y . Democrats, led by Sens. Howard
Metzenbaum of Ohio and Paul Simon of I l l i n o i s agreed on the local
control issue, but did not want to cut funding. Sen. Barbara
Mikulski, D-Md., suggested s p l i t t i n g the difference, and the
panel agreed to find a compromise.
The committee reverted to mostly party l i n e s , however, on
public funding of academic health centers. Kennedy's b i l l creates
a national "all-payer" system — to which a l l insuxance companies
would have to contribute — to compensate the 128 teaching and
research hospitals expected to lose funding from private
insurance companies when tougher price competition begins.
Kassebaum's amendment that would have created a national
commission to make recommendations Congress would consider under
fast track procedures was defeated in an 11-6 party-line vote, in
which only Sen. Judd Gregg, R-N.H., voted with the Democrats.
Meanwhile, the House Education and Labor Labor-Management
Subcommittee today approved a markup of l e g i s l a t i o n similar to
the Clinton healthcare plan, and reported i t to the f u l l
committee. The markup was approved 17-10 along party l i n e s .
Subcommittee Chairman Pat Williams, D-Mont., said the
subcommittee w i l l reconvene June 9 to debate and vote on a
single-payer plan. Williams released u n o f f i c i a l CBC numbers for
the approved plan, which indicated i t would cost $3 0 b i l l i o n more
over five years than the Clinton proposal, mostly due to
additional subsidies for small employers and an enhanced benefits
package.
The Congress Daily
Wednesday
May 25, 1994
�HEALTH
Dodd Warns Health B i l l In Trouble Over Patient Appeals
The healthcare reform b i l l " i s in danger of being s t i l l b o r n "
due to overly broad opportunities for appeals by patients denied
payment for medical procedures by insurance companies. Sen.
Christopher Dodd, D-Conn., said today after the Senate Labor and
Human Resources Committee rejected 9-8 h i s plan to scale back the
legal remedies in Chairman Kennedy's b i l l . "This i s the kind of
issue in my opinion that t h i s b i l l w i l l die over," he said.
Currently, patients only can be paid back for medical costs,
without any compensation for lost wages or other damages.
Kennedy's b i l l would allow patients to go to an administrative
law judge or a state or federal court and seek nearly unlimited
damages. Dodd and Sen. James Jeffords, R-Vt., proposed an
amendment that would have held damages to twice the cost of the
procedure and l o s t wages, with appeals going to an administrative
judge or to federal appeals court.
Sen. Howard Metzenbaum, D-Ohio, called the Dodd-Jeffords
effort "a cruel amendment," and declared he could not vote for
the b i l l i f i t passed. Individuals need the a b i l i t y to protect
themselves against insurance companies, he said. Dodd argued 90
percent of disputed claims are e a s i l y settled, so the system
should not be set up to ease court appeals. Kennedy suggested
keeping the Dodd-Jeffords plan for the simpler cases, and
creating a different system for the more d i f f i c u l t ones. No
compromise was found at the markup and Dodd said later he does
not expect another committee vote, but added he w i l l continue to
try to find an accord.
E a r l i e r , the committee finished work on disputed malpractice
provisions. A plan by Sen. Orrin Hatch, R-Utah, to hold legal
fees to 25 percent of settlements was approved 10-6, but was
superseded by a Metzenbaum amendment — approved 9-7 — that
limits fees to 33 1/3 percent for the f i r s t $150,000 and 25
percent thereafter. " T r i a l lawyers win again," Hatch declared.
The committee also took a small step toward matching House
Judiciary Chairman Brooks' plan to repeal the McCarran-Ferguson
insurance company antitrust exemption. The b i l l repeals the
exemption for healthcare-related insurance operations, and the
committee rejected 10-7 an amendment by Sen. Strom Thurmond, RS.C., to restore the exemption. Brooks today announced an accord
with the American Insurance Association to t r y to repeal the
exemption for a l l insurance companies, a move the Senate may be
reluctant to follow.
Meanwhile, in comments to Oregon reporters at the White House
t h i s morning. President Clinton again complained about the
partisanship surrounding the healthcare debate. " I j u s t believe
there^s got to be a way to work through t h i s , and do i t in a way
that i s kind of l e s s partisan in tone than a l o t of what we've
heard," Clinton said. " I s t i l l think t h i s town i s way too harsh.
I think that there's too much bomb-lobbing and rhetoric." He did
say he s t i l l has confidence that a health reform measure w i l l
pass Congress with bipartisan backing, adding, "There are some
people in the Republican ranks in Congress who r e a l l y want to
solve t h i s problem, and we're going to do our best to work with
them ... and do i t t h i s year."
The Congress Daily
Thursday
May 26, 1994
�Senate Labor backs legal provisions
By PAUL BASKEN=
WASHINGTON, May 26 (UPI) The Senate Labor Committee on
Thursday defended several provisions of President
Clinton's health care reform b i l l designed to protect
consumers in both t h e i r doctors' o f f i c e s and the
courtroom.
The Labor and Human Resources Committee, in a mix of
both partisan and non-partisan votes, narrowly upheld a
provision to end an exemption from federal antitrust laws
now enjoyed by health insurance companies and refused to
impose caps on punitive and non-economic court awards in
malpractice cases.
The committee also voted to further r e s t r i c t attorney
fees beyond the l i m i t s proposed in the Clinton b i l l and
rejected a proposal to l i m i t patients' rights to sue i f
they f e e l they were improperly denied health care
benefits.
The committee, after private negotiations between Democrats
and Republicans, also approved a revised pair of GOP-offered
amendments designed to increase local authorities control over
i n i t i a t i v e s proposed in the Clinton b i l l for encouraging
school-based health care services.
The voting on antitrust l e g i s l a t i o n came as the
chairman of the House Judiciary Committee, Rep. Jack
Brooks, D-Texas, said he reached an agreement on the
matter with one leading industry group, the American
Insurance Association, which represents more than 270
property and casualty insurers.
Brooks said the AIA's support for ending the antitrust
exemption the health insurance industry currently enjoys
under the McCarran-Ferguson Act ^ ^represents the f i r s t
breach i n the wall of strident opposition" within the
industry.
The Senate Labor Committee voted 10-7 i n a mixed-party
vote to r e j e c t the proposal by Sen. Strom Thurmond,
R-S.C, to r e t a i n the exemption.
Thurmond argued the repeal proposed by Clinton would
hurt smaller insurers and eventually reduce competition as
states move to f i l l the resulting void with their own
legislation.
But Sen. Christopher Dodd, D-Conn., whose state i s a
major base of the insurance industry, said the exemption
^ ^ i s no longer v i a b l e " as Congress t r i e s to encourage new
forces for competition throughout the health industry.
The committee also voted 9-8 after a sharp debate on
consumer rights to r e j e c t a bipartisan amendment that
would have limited the a b i l i t y of patients to sue i f they
f e e l they were improperly denied health care benefits.
The proposal by Dodd and Sen. James Jeffords, R-Vt.,
generally would have allowed only administrative rather
than courtroom remedies in such cases and would have
limited penalties to amount twice the value of the denied
benefit.
.J^
JC
rP
^
�THE FRIDAY BUZZ
Getting A L i t t l e Respect. The Senate Labor and Human Resources
Committee's b i p a r t i s a n progress on health care over the l a s t week
has some committee members f e e l i n g t h a t t h e i r work i s gaining i n
p r e s t i g e r e l a t i v e t o the other major panel w i t h j u r i s d i c t i o n —
the Finance Committee. "We have a very good chance t o be the
major v e h i c l e i n terms of h e a l t h care i n the Senate," Sen.
Christopher Dodd, D-Conn., said Thursday. And other committee
members said t h a t conversations w i t h Senate colleagues also
reveals increasing i n t e r e s t from outside the Labor panel. "People
are asking i f we are moving ahead," Sen. Paul Wellstone, D-Minn.,
said.
Given the Labor and Human Resources Committee's r e p u t a t i o n f o r
being a l i b e r a l bastion — i n c o n t r a s t t o the more c e n t r i s t
Finance panel — the developments of the past week are leading t o
some surprised reactions from those not on Labor and Human
Resources. There i s an "innate suspicion" of the committee as
being h e a v i l y steered by Chairman Kennedy, said ranking member
Nancy Kassebaum, R-Kan. But, she added, "even Republicans who
might be suspicious have found i t i n t e r e s t i n g . " Dodd added: " I t ' s
always a d i f f i c u l t committee. We don't succeed or f a i l l i g h t l y .
More cases than not are t o t a l successes, but when we f a i l —
Katie bar the door — we go down i n flames."
While much focus i n recent months has been on the Finance
Committee — packed w i t h such key healthcare players as Sens.
John Breaux, D-La., and John Chafee, R-R.l., M a j o r i t y Leader
M i t c h e l l and M i n o r i t y Leader Dole — some Labor panel members
t h i n k they are making important c o n t r i b u t i o n s through t h e i r
d i f f e r e n t j u r i s d i c t i o n . "The Finance Committee seems t o t h i n k
they can solve every problem through the t a x code," said Sen.
James J e f f o r d s , R-Vt. "The key matters are changing the d e l i v e r y
system." He added, " I have more confidence i n t h i s committee
being b i p a r t i s a n . "
Kassebaum t h i n k s the Labor Committee can "provide some fodder
for the Finance Committee." I t could "open up some new avenues
... where t h i n g s might coalesce," she said. She r e c e n t l y met w i t h
top Finance Committee Republicans on what they are a n t i c i p a t i n g
for t h e i r panel, and she said they are " t a k i n g a r e a l i n t e r e s t i n
what" the Labor Committee i s doing. But even Dodd — who has l e d
much of the b i p a r t i s a n e f f o r t on the committee during the past
week — admitted the comity i s s t i l l on shaky ground. "There's
always the r i s k of imploding," he said.
The Congress Daily
Friday
May 27, 1994
�\^[,r\.^iX.Y^ir^
From Boston Globe page 1
MojTiihaii set to offer health plan
Proposal may reveal Congi^' lack of support for Cliuton version
By Peter G. Gosselin
GLOBE STA>-r
WASHINGTON -Sen. Daniel Patn-ick MojTuhan
:5 at'out U) attempt a re-.-erse flip into the
:r.c; ea5ing]y muddied waters of Air.ehcan health
'.ar-e poliucs.
^omotime after Congress rsooiiXtnes luecdav.
: N en- Yor'K Demoaai and Senate Fir.ance
'
Committofe chairman wi'U float a plan that is
substantially mo2 e expansive thon he had previouslv
.'.jnted he would offer and contairic some of the mos*
cor.d-oversial elements of President ClintX)n's health
f lan,
yojTiihar.'s proposal will tome j'ost as his
tomoyrne j-h-al. Sen. Ed^-ard
Kennedy, finishes
r-ushr.L-hi- owT, CJinton-LTce bill through'thefii'ft
.=tagt -J^Q ian-Kdldngprocc-.?.-. Conhinc-d, the nvo
r^'r:ii s actions ^rj] almojf. certAi'iJv be seen as gr.-inK
t' •:• p v e - a e n i s S a g ^ n g c n a s a d c a m-jchBut in a n,ea.nu e of hoTr coinp]-,c-3t>rd tho politic^
c. hcaitr, ca:-e art bc-eoming. the effect of MovTijhan's
mtaf'.!:•€ - and perhaps e^•en it.? int^nrion - mav be
tne- vr^iy opposiUi of KEnnedy'E: The- mcoswemay
T:na.'iy and decisn-ely show that there is not enough
v;pj'On )T Congresf to pa5i an\ahing like the
p; es:dGr.t's pian, and may help con\ince the AVhitcn.vjse that the time has come loi' tnily psinfuJ
(.''•inpj'oraise.
_ A move by Mc}T.ihan to embj'act an^thIng like
t ie (:;;nton plan would be "a major rie.-elopment"
:a-d Da-ori Elumenthal, chief of hcaJt'r. pclicrfor
.^.a.c.-^achu^erTs Gone)-al Hospital and an a^vocia^e
profe.sso)- at Ha.vai-d Medical School. "It could
" - ^ ^ rhe lo&iam and wJl c^minly i-evcal the shape
nr-.^i in Conp-ess," Blumenthal taid.
_M'j>-niha-'s poutical aci'obaucs - he h&d been
•yiGcly e\7iect^d to pixjdjce a compromise pi'cposal
-.rat w-ac aimed at satisfying not Cl-intrm, but the
pvesident's cn'tics. f uch as SenaU' Mi'noiitv Leader
tob Dole of Kansa.? - are but one of the ckzyiv.g
pe.'-Joj-m.anec-s to which the public will be ti'eated in
the c?mjng-?reeki:.
^ 'Av.h fewe; than 70 ^-orking davR left before its
:al! elee'-.on recess, Congiess is running out of time
•••r nealth ca---.-. Its only hope for EutstaT,t.ial action
\ .-'AV ^ei m a z:g-za£g:ng senes of political feints and
'i- -.e- ?if.= among lav.inakers that culminates in a
F.-.rrle. jpf ctacula;' leap of faith that Washington can
•r mjre goo-l ihan hajm by i-errfanizint ^'^-^ ^^"ay
t-a: mon Am^eiicani receive and pay for their health
.•yrt.
Among othei' political pei-foiTnei-s to watch;
• Clinton: The president has stumped tne
county for such pj inciples as health insujtin'-r f nail, but has so far deflected demands to baj g-a-. rn%v
specihcs of his health plan. Aides hope to avoid
baj gainjng until compromise ve;-sions cf t!it- p-or-o^V
make it thi-ouph the first stage of the la^^-r^sk^r c
process, approval by the major congTe.s.<«or.a" '
com,mittees. Butw-ith Conp-ess stum.bling jr. it:
effort to reach ap-eemient Qinton ma>- be to'v^d f ,
begin negotiating sooner. Th,e first coi^cession.^ tvo],;
come this month.
Kennedy: Among the congrcssiona," gi-2nd»V.t>-.-)-.
of health ox-ei-haul, haNing pjvposed svcepin.'
measures as long as 20 years ago, Kenncdv ha-- - v
p)-e\?ous reform a i\-e-s fall to o^-c-ambicion
indecision and scandal. He gi-abbe^: the spo^lig"-: "a:-:
month by un\'eib'ng ^hat appeared to Ix «;
suvpil'ingly m.odej-ate compromise, hu- cr-U'c.^ v.a-\since labeled the pj-oposai "Clinton h<ia-.-v."
that beneath its snfacc ai-e all the e.ir.i»n^-- (..'r^h'president's plan and th en som.c.
Kennedy has vowed to t\'in committee yprfor his plan by the end of tnis v.-eck. An^r.-.u^
'
watchmgtosoeif he can atti'ac-t Rec-.irlicHr. iurr-.n-om panel mode: ates liki.^ Sens Xa"nc-> L
' '
Kassebaum of Kansas arid Jim Jef^ord.^ of V;;,-,:- —
and can keep doubtful Demctrau bke Jeff t ! / - <
of Kew-Me.xico ard Chri^ Dodd uf Connect:'-ut^fc
state associated with the •:n.--j3-an.-e indjit:-' '•i--,r
balking.
• Dole: The touErh-talkinir m,ino) iiv "eadti- ^-v
the yeai- suggesting he was i^Siidy to make a ccs.. v
hca.tn. but has sound^nj ino-eas;ng>- v,tgat:-.-e ?r •then. In thi.-;. he reflects the conc,ranict;cT,.< of "
pa:1y, which has f.uccet'ded in recont veavj lajT • •
by atucking Washington Tor .social programs. K i
won-ies that it will be seen a:? uneeimr if :t --u,;- ,i • •
theway ofrefo:Tr..
^^'hen. and toVnat ,;-xt.int. Do\- ygiee"-along with some of Clinton s a.-erhaul :.ieci> ~
important inea.'-U) c of the extent to which t.."- '"
president has j-ecovej-ed the pohtical mur.tnt - -,
the health issue. No one i ; p)i?d;cr;ng f-t? K/r.., r
:aw7riaker wiD buage unytmc serin.
E\-en in such company as t.ni.<:. M'nr.ih;:n .-••i-. -. •
out as perhaps the highcst-.';iakc-.f rol'tx-a' r ' i .
:
the Jot. and among the hardest to rear.
Although Mojmihan has i-epcaiod>' asH-.-i'-r he is on rhe pi e.^idcnt's health ttar.. he- hv^ r - - •
.st:ingof off-iho-cuff criticisms of the C!intcn yii:that has incensed adr'.irJstration aides.
'
The lav;?t ind'-ient occmrerl short"v he:" '••
�2«. ,
1-1
BOSTON GL03E
FAX NO, 6178293192
P. C3/07
. orgress left on its .Memonal Dav bre^k 10 djive
In this, it wili be conslde)•abi^• mo:-e air.bitiou^
ag-o. when Mo%Tuhan sauntej'ed out of a dosed, dooj- than pi-oposals by Clnton suppo; tos. some of who>f nancf. Con.mitte* meeting to announce he wouid
have suggested that the W^hite House BIBO consider '
ri.-a\v up his oA^-n compromuse health mea^ui e and to catting the port"on employci-j are require(' to
pi'iisc a n\-al to the pi-esident's plan.
contnoute from 80 pci-cent
pt.ix.-ent and *dd -g
1 i-ixid. cowntten by Finance mem.bei' John
a -tngger that actK-ates the req'jij'ement se^ft^-d' '
ti'^aux oi Louisiana and Rep. Jim Coof.e)' of
yeai'S hence only if a ceitiin fracfon of Amencans
Tennesioe, calls fo? d: opping such key e.^cment^ of
ai-e Etui uninsui'ed.
tne C.mlon plan as the "employei' mandate," tbc
The compromise wjij also include m.ost of
: '.^.qa-rement tnat Amen'ean employers p,3y for SO
Clmton's elaborate cjst cont:-ol measures that --^-^n
peix-t-t of TDf aveiagc- cost of employees' health
s\-mpaihctic analysis have sugeest.^:d ai? ove--;cenef IS p.nd cost ccntMl^. And it fa'Is sh-jrt of
sta-ingent, and that rr.ost politick oddsmakei3 believe
r:cG-jng %rhit Cunton hzs set as hi.-? cnc nonWLIJ be tne next area of eontxn-ers" in the hcal*-^
r=g:t:ahle eoal: pr^niding health cove!-ac;e for ail
debate.
j\jr.tr:c?.ns.
In di awing up such a comp} omu.fe mea-u'e
y. ).tt analy.=i5 im^)pret?d .NTc.r.ihaTi's remai'ks
Mo\mihan appears tc be abandoning his long effoi-'
^^c?^ing -ho Finanoo chaii man v-as pi epfoiw to
to co-art Dole and ot} con.^cn-aL-ves ofboth ba}t;"-:
'yan & c-cmpromise along the l)iie.v of the Coopoiand sjgTung onto the pj'csidenr's health csuse 'n a
r':-ef.-u;-- measui-e, and that his aim v^-as twofold: to
•A-holeheaited fashion he has not sbov.r, pi cvlcusl-.3[ti-iA suppon from comimittcc con.e^i-N-atives.
But e\-en as he worked on the compromise liisl \vX •>
•r-peoally Dole, whom he had been c-ouiting mih
he and his advisers appeared to retain some cruh
p.jblic remaj'ks a^l yeaj', and to fo) ce the UTiitc
about whether the CUnton p'lm has suifidrjit
r.ous:- to make substantial concessions.
support to make it through the Congress, sugcest.n;a substantially diffei ent intejTynrtation of M-hat the
iiu: late last -reek, even as .Voj-nihan was jca%-ing
.••uirf. impressions ouiside the committee meeting •
New Yoik Democi'at is -up to.
?_-.(.m. he v:(j. lelling panel m.embers in.<yde a vei-\-.
In effect MojTjhan appcair, to be advancing
o'lnvrent sw^y.
pix^sidents plan in ordei' tc foi-ce an ea'-'iv te'-t ' i - =
A^•c0IT::•r.g 10 a senior Mo^mihan aide, the
polifcal strength. Ha-.-ingrf!.jr,tcd ihj entr-eat-';--". •
.•niii-man told Don;ocrat5c colleagues and the
Clinton suppmters until now, he is about to em.b'-- -r
committ^;e s ranbng Republican that ho wou'd c)-aw t}.eb cause to see whether it is they, or thcij- cn'tL-/.
up G c-omprcm-.ji trat foDows the Ciint'.n pian in
who must comipromi^c
}'.moi" sii cf ;t£ essentjals.
His jcap fiom one side tc the otho is l:ke'\'t^.
T-.^i cirv^pv;n-jse. which Mo\T,:h&n evpec'uB to
send huge hpples rolling thi-uurh the hea't^ debf.
ri'csent :e the ranei in pnvate sometime in the next
TO! wock,> and perha.os m.onth^ u. com-•.^v,- wf-rk.t, M'V. include the president's employe}mano-ate w.th cr^y one change, that sma 1 empbva-.<
f e even:pv;(i
•
�SOCIAL POLICY
for health costs instead. But the Labor
subcommittee opted to maintain the
mandate and offer larger subsidies for
firms with fewer than 75 employees.
All told, the changes — benefits
and additional subsidies — would cost
an additional $55 billion over five
years, the CBO predicted.
The panel also approved by voice
vote May 24 an amendment by Williams that would force all companies
with more than 1,000 workers to buy
their own health insurance and pay a 1
percent payroll tax, offsetting the additional expenses by about $25 billion.
Members rejected, 11-15, an alternative by Gunderson that would have
reduced the size of firms permitted to
buy outside the alliance from those
with 5,000 workers to 50 workers.
In contrast to most of the committee's strictly party-line votes, Gunderson's amendment drew the support of
Democrats Lynn Woolsey, Calif., and
Gene Green, Texas.
Single-Payer Plan
From the outset, Williams has
vowed to provide McDermott's singlepayer bill an avenue to the floor.
"It became very clear if the single
payer racehorse was going to get on
the track, it had to come through this
gate," Williams said, noting that the
Education and Labor Committee appears to be the only one with enough
votes to pass a single-payer plan.
George Miller, D-Calif., and other
advocates touted the administrative
savings of a single-payer system —
pegged at about 10 percent annually
by the CBO.
But because the single-payer concept relies on a hefty new payroll tax,
Roukema and others predict it will not
go far in the current political climate.
" I don't see there's any real support for this in Congress and no support here on our side," Roukema said.
Williams praised the single-payer
approach as financially honest because it would be funded directly with
a payroll tax rather than through indirect premiums, co-payments or tobacco taxes.
Still, he predicted members would
view the proposed payroll tax as political dynamite.
" I doubt they will want to substitute the P-word, that is premium, for
the T-word, which is taxes. That may
ultimately be the demise" of singlepayer legislation, he said.
The subcommittee planned to debate the single-payer system June 9,
after the Memorial Day recess.
•
1390 — MAY 28, 1994
CQ
Amendments Entangle Labor Panel^
Slowing Its Momentum
A
fter moving quickly through its
first week of health care markups,
the Senate Labor and Human Resources Committee slowed considerably
in week two, postponing key decisions
on how to structure a health insurance
purchasing system, how to pay for universal coverage and how to control
costs. Instead, the panel spent three
days May 24-26 slogging through a series of tangential amendments.
Committee Chairman Edward M.
Kennedy intended to complete action
on his versions of President Clinton's
bill (S 1757) by May 27. But the
death of Jacqueline Kennedy Onassis,
Kennedy's sister-in-law, and the early
Senate adjournment May 25 cost the
committee momentum.
Still, the panel did not give up its
determination to find bipartisan agreement wherever possible. It unanimously
approved an amendment by Kennedy,
D-Mass., and ranking Republican
Nancy Landon Kassebaum of Kansas to
fund clinics in public schools. Five of
seven Republicans also joined Democrats in rejecting an earnings threshold,
or "means test," for a new long-term
care pian included in the bill.
As the panel wrapped up work
May 26, Kennedy emphasized that
members had accepted 19 of 30 Republican amendments so far. But he
acknowledged that winning GOP
votes for final passage was "still an
uphill battle."
"Is there any chance, any chance
that any member of the minority is
going to vote for this bill?" said Howard M. Metzenbaum, D-Ohio., a comment that drew laughter from both
sides and no commitments.
June Action
Just before adjourning, Jeff
Bingaman, D-N.M., distributed an
amendment on the hot-button issue of
employer mandates. The Kennedy bill,
like Clinton's, would require employers
to pay at least 80 percent of workers'
health insurance costs, thougn ^lennedy
would exempt businesses with five or
fewer workers and instead impose a 2
percent tax on them.
Bingaman, a lead player in backroom bipartisan talks, proposes to exBy Beth Donovan
I SENATE
Labor and Human Resources
Jurisdiction: Broad influence
over most elements of the plan,
except for financing, Medicare
and Medicaid.
Inclination: Ideologically split,
though not a particularly partisan
committee; liberal leanings
among most Democrats and
moderate to conservative views
among Republicans.
empt companies with fewer than 75
workers from the mandate. Companies with one to five workers would
pay a 1 percent payroll tax; those with
six to 10 workers would pay 2 percent.
Companies with 11 to 74 workers
would pay 4 percent to 8.1 percent
based on individual wages rather than
overall payroll.
Kassebaum praised Bingaman's efforts and said she intended to work
with him over the recess. But she cautioned that his alternative still did not
offer the type of "market based" system she was looking for.
Bingaman and others are also
working to meet Kassebaum's demand
to streamline the regulations and bureaucracy in Kennedy's proposal to
create state-regulated health insurance purchasing cooperatives, or alliances.
Kennedy
endorsed the
Bingaman-Kassebaum effort, and
Bingaman said he is optimistic about
reaching agreement to cut back the
detailed regulations the Kennedy bill
would impose on states that establish
alliances. But Bingaman was less certain they could reach agreement on
whether the states would be required
to create alliances. (Kennedy plan,
Weekly Report, p. 1222)
Christopher J. Dodd, D-Conn.,
said he intended to offer a darifying
amendment to language adopted May
19 that would allow an independent
board to review any benefits package
that Congress approved. Dodd^s
amendment would limit the board s
authority to recommend changes in
health care services to bring the benefits package under budget, but the
�Y~'^f\(i<i^
govermnent in the first case after passage of the
Superfund enviroiunental cleanup law, and said, " I
personally am confident that my sitting in those cases did
not present any conflict of interest."
Breyer said that Lloyd's was not a party to the cases,
though White House lawyers conceded later that Breyer does
not know whether Lloyd's insured any of the parties to the
cases.
But saying that he also wanted to avoid the appearance
of conflicts of interest, he said he would sell his
holdings in other insurance companies and wanted to
"expedite my complete termination of any Lloyd's
relationship."
Breyer stopped any new investments in Lloyd's after
1988. But, because Lloyd's consists of syndicates of
investors who back claims with their personal assets, he
still has unlimited liability for continuing losses from a
syndicate he joined in 1985.
White House Counsel Lloyd Cutler said in a television
interview Tuesday that "he's been trying for seven years
to get out of his investment in Lloyd's."
But Newsday Tuesday obtained a copy of a note to
Breyer, dated Sept. 17, 1990, from another Lloyd's
affiliate offering to cover all of his Lloyd's liabilities
if he paid them the equivalent of $245,912 and tumed over
to the affiliate many thousands of dollars in profits from
other syndicates in which he had invested.
A White House official said Tuesday night that Breyer
considered the price in the 1990 offer "exorbitant" and
that it "confirmed the practical impossibility of getting
out of the syndicate."
But in a Dec. 13, 1993, letter to Lloyd's he said he
needed to get out "because of my job" and that he feared
he would be '' captured for life" by the potential
conflicts of his investment.
The high price is an indication that the Lloyd's
affiliate calculated Breyer's liabilities in 1990 to be
far higher than the $114,000 he estimated in a statement
to the Judiciary corrunittee in April.
At least two Democratic senators, Howard Metzenbaum,
D-Ohio, and Patrick Leahy, D-Vt., indicated Tuesday that
they considered the Lloyd's affair a serious issue.
Newspaper editorials have called on the committee to delve
into the matter.
Metzenbaum said he was concerned that Breyer, though he
had stepped out of asbestos cases because of possible
conflicts with his Lloyd's investments, had failed to step
out of other enviromnental issues. He said he would grill
Breyer on the issue during Wednesday's continuation of the
hearings.
(Optional add end)
In another issue raised during Tuesday's hearings,
Breyer refiised to discuss his views on abortion, as other
nominees have before him.
Asked about Blackmun's opposition to the death penalty,
Breyer said he considered it '' settled law" that the
ultimate penalty is constitutional, and he said that
unlike some other judges with strong beliefs on the issue,
'' I have no such personal views in regard to the death
penalty."
Breyer also was asked about another hot-button issue
school prayer by ranking Republican Orrin Hatch of Utah.
Referring to a 1992 ruling that barred clergy from leading
prayers at school graduation ceremonies, the conservative
Hatch asked Breyer whether he saw a legal difference
between prayers led by students and those led by school
officials an issue that has not reached the Supreme
Court.
'' It sounds as i f it (who led the prayer) would be a
relevant fact," Breyer responded.
Distributed by the Los Angeles Times-Washington Post
News Service
Leading Lawmakers Begin to Plot Strategy on
Health Care (Washn) By Dena Bunis= (c) 1994,
Newsday=
WASHINGTON Lawmakers returning from
their July Fourth holiday say they know they have to start
seriously grappling with health care, but many say they did not
get clear or strong messages on the issue from their
constituents.
What members of Congress reported Tuesday on their
talks with the folks back home was that crime and the
economy were more important now but don't underestimate
the political potential of health care.
" I would not want to be the candidate who voted
against this and face an opponent who challenged me on it
the last two weeks of October," said Sen. Christopher
Dodd, D-Conn. "' It looks rather benign right now, but I
tell you it's a sleeping giant of a political issue if
this Congress defeats health care and you're one of the
f)eople who brought it down."
Democratic congressional leaders, whose job it will be
to take three bills in the House and two in the Senate and
produce one bill in each chamber with a chance of passage,
began meeting to plot strategy Tuesday.
"It's a fresh start now," Rep. Barbara Kennelly,
D-Coim., chief deputy whip, said as she went into a
meeting with her fellow leaders.
Majority Leader George Mitchell, D-Maine, and other
Democratic leaders still cling to the principles
of President Clinton's plan that all Americans must be
guaranteed health care by a given date and that employers
must help pay for it. But other legislators say that
unless substantial compromises are offered, nothing will
get done this year.
"This thing is getting more and more polarized, and
it's always difficult to construct a compromise when it
becomes more polarized," said Sen. John Breaux, D-La.,
part of a conservative Democratic faction that favors
caution over sweeping change.
Breaux's caution was echoed by Sen. Alfonse D'Amato,
R-N.Y., who said voters told him they're worried about
goverament taking over the health care system and limiting
their choice of doctors.
Rep. David Levy, R-N.Y., said he told one citizens'
group that he was concerned about artifical timetables
being set for the health care debate and that a bad bill
might be passed for expediency's sake. In order to fulfill
Clinton's pledge to get a health bill enacted this year.
Congress must act before adjourning for the year in
October.
'
" I said sometimes gridlock is preferable to moving
backward. I got a standing ovation," Levy said,
explaining that his constituents too are worried about
Congress doing more harm than good.
Distributed by the Los Angeles Times-Washington Post
News Service"
12 Bodies Found as Monitors Prepare to Exit
Haiti (Port-au-Prince) By Ron HoweII= (c) 1994,
Newsday=
PORT-AU-PRINCE, Haiti The chief of the internotional
human rights mission here offered a sad farewell to the
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LEXIS-NEXISW LEXIS-NEXIS'^ LEXIS-NEXISW
�THE M
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LA-NSti-AS^E: E^i&LISH
LG-A-B-DATE-.M.-DG: July s.
lao,/
LEXIS-NEXISW LEXIS-NEXISW LEXIS'-NEXISW
�Clinton has said he would be receptive to an alternative approach that
would provide the funds necessary to assure universal coverage. The only
alternative, supporters of the mandatory employer contributions argue, i s
higher taxes.
The Senate Finance Committee was expecting a grim report from the
Congressional Budget Office on the red ink i n i t s proposal to get 95 percent
of Americans covered by 2002 through insurance reforms and subsidies.
Without the mandates in Clinton's proposal that employers pay the bulk of
t h e i r workers' insurance premiums, moderate Democrats supporting the Senate
committee's plan were reportedly talking about having to come up with up to
$100 b i l l i o n i n new taxes.
One Democratic senator even urged Clinton to hole up at a suburban Air
Force base with leaders from both parties to thrash out a compromise at a
health care summit. Former President Bush did j u s t that i n 1990 and ended up
reneging on h i s 1988 campaign pledge not to r a i s e taxes.
^ ' I think the only way to bring the Newt Gingrichs and the George
Mitchells of the world together i s for the president to put them i n the room
together and say, 'OK, ladies and gentlemen, l e t ' s work something out; i f
not, l e t ' s c a l l i t q u i t s , ' said Sen. James Exon, D-Neb.
Exon also recommended a 50-50 premium s p l i t between employers and
employees instead of 80-20.
Sen. Ernest F. HoUings, D-S.C, emerged from h i s own meeting with Clinton
to question Exon's proposal for a summit. ''Everyone i s in touch with each
other already,'' he said.
HoUings said the problem i s a l l the plans now on the table are ''about
$200 b i l l i o n shy'' of being paid for.
Meanwhile, Health and Human Services Secretary Donna Shalala and Education
Secretary Richard Riley teamed up e a r l i e r with Sens. Christopher J . Dodd,
D-Conn. and Patty Murray, D-Wash., to plead for coverage for children.
" I n t h i s country today, millions of parents get up every morning and go
to work they dream the American dream for t h e i r children but they l i v e each
day with the nightmare of being uninsured,'' Shalala said.
Top business executives held dueling news conferences defending or
denouncing the notion that the government could force them a l l to buy
insurance for t h e i r workers.
And the Health Insurance Association of America, in i t s l a t e s t Harry and
Louise ad, trained i t s f i r e at the proposal to impose a new tax on the 40
percent of health plans with the most expensive benefits.
In the newest salvo i n a $14 million advertising war, Louise's s i s t e r
bemoans the tax as unfair to workers who gave up wage increases for better
benefits.
****
f i l e d by:APE-(—)
on 07/22/94 at 00:05EDT ****
**** printed by:WHPR(160) on 07/22/94 at 07:06EDT ****
�Wili«v\
^
DoleTHE NEW yOi?K TIMES NATIONAL
THLTRSDAY, ]ULY 2i
^ox)LwonA <
HE HEALTH CARE DEBATE; Pressure, Both Public and Private
THE LEGISLATION
Partisan Jockeying on Health Care Becomes Intense
By ROBIN TONER
S p f c u l 10 Th« New York Times
WASHINGTON, July 27 - President Clinton complained today that
Republicans moved "further away"
from a compromise on health care
each time he reached out to them.
Republicans, meanwhile, complained
that Democratic leaders were drafting their health care bills in secret
and demanded a week to review them
before beginning floor debate.
It was a day of partisan positioning
and private salesmanship as Democratic leaders neared the end of their
efforts to turn measures passed by
committees into bills for consideration in the House and Senate.
In the House, leaders continued to
brief small groups of members on
their draft plan, with final decisions
on the most sensitive issues, including the timing of required employer
contributions toward worker health
benefits, now expected on Thursday.
Represenutlve Richard A. Gephardt,
the House majority leader, will make
his final presenutlon to the full Democratic caucus on Friday and make
the plan public later that day, officials said.
As the outline of the plan makes its
way across the Democratic caucus,
members of the House are coming
face to face with decisions they can
no longer avoid. "Categorize me as
miserable," said Representative
Charles Wilson, Democrat of Texas.
"I'm desperately hoping that we
come up -with a plan that will make
insurance accessible to a much larger percentage of the people in my
district without having an employer
mandate."
DIARY
Health Care Developments
jiiiiiiim
YESTERDAV
Democratic leaders in Congress continued their efforts to turn
measures passed by committees Into proposals for consideration on
the House and Senate floors. President Clinton complained that
Republicans kept moving further from compromise.
CONGRESS
The Senate minority leader, Bob Dole of Kansas, demanded a week
to study the Democrats' health bills before they reached the floor,
but he denied that Republicans were trying to stall or block a health
plan. "The public doesn t want Congress to rush this, " Mr. Dole said.
"If we didn't pass It, my view Is there might be a big sigh of relief
around the country" House Democratic leaders are circulating a
draft bill that holds firm to the idea of making employers buy health
insurance for their workers, but costs are still being debated A small
group of House memtsers is nearing agreement on a scaled-down
approach that relies on insurance-law changes and Federal subsidies
for low-income people to expand coverage.
WHITE HOUSE
Mr. Clinton exhorted a gathering of thousands of advocates for the
disabled to lobby Congress for universal health care coverage. He
said he "desperately " wanted bipartisan support for a health care
overhaul, but he criticized Republicans, saying, "Every time I have
reached out, they have moved further away."
LOBBYING
The police arrested 42 advocates for universal health care as they
Uneertolnty in Senate
tried to stage a sit-in at Senator Dole's office in the Capitol and, in a
In the Senate. George J. Mitchell,
separate incident, the police blocked more than 100 protesters trying
the majority leader, was struggling
to enter the Capitol in wheelchairs.
with the same basic problem, in a
chamber where resistance is considered to be far greater to requiring
employers to contribute to the cost of
their workers' Insurance. Mr. Mitchell acknowledged today that one option under consideraUon for his pian that he will come to the floor with a Mr. Cooper said in an interview towould require employers to pay 50 plan that does not have 51 hard votes night.
Still, as health care moves toward a
percent of their workers' insurance, in suppon but will have to assemble a
majority piece by piece over weeks of historic floor debate, the atmosphere
but only if voluntary measures failed
debate.
"That
happens
all
the
time,"
has grown increasingly panisan, and
to cover a ceruin percentage of the
uninsured. Most plans under consid- he said.
votes are now widely expected to
eration, including that of the House
were many political currents follow pany lines. Mr. Clinton assenleadership, envision employers gen- at There
work
today: a leader of the self- ed today that this was the doing of
erally paying 80 percent.
styled bipartisan moderate group in Republicans, arguing that, " I desperIt is still very unclear, however, the House, Representative Jim Coo- ately want a bipanisan bill" and had
whether Mr Mitchell has the votes per of Tennessee, said his core group reached out time and again to the
even for a watered down, much de- was "close to an agreement" on a Republicans, only to be rebuffed.
layed employer mandate. He said to- bill. That group, which includes 10
'We Dare Not Walt Longer'
day that he would release his plan members evenly divided between the
Now, he said, apparently trying to
"late Uiis week or early the next," parties, is trying to fuse various bi- prepare the public for fierce panisan
although Monday or Tuesday is con- partisan approaches into a single bill combat in the weeks to come, time is
sidered the safest bet. He tried to — and get a vote on it in the House. " I running out. The health care crisis, he
shrug off the now widely held view think we're making good progress," asserted, is simply too serious to wait
SupAen Crowley/The New Yort Times
After a reception at the White House for the fourth anniversary of the
Americans with Disabilities Act, dozens of the handicapped and their
advocates tried to follow President Clinton's advice and show their
support for a change in health care to Congress. Kipp Watson of New
York City argues with officers of the Capitol police who temporarily
blocked their access to the building. They were later allowed in.
THE
NEW
YORK
T7MES,
THURSDAY,
JULY
28, 1994
for Republicans to come around. "A
lot of times, if you want bipartisan
consensus on a tough issue, it takes
forever," Mr. Clmton told some 3,000
disabled people and their advocates
gathered on the South Lawn to mark
the founh anniversary of the Amencans with Disabilities Act. "But I tell
you, we dare not wait longer.'
The President's push for universal
coverage was buttressed by one finding in an NBC/Wall Street Journal
Poll that was released tonight. The
question was, " I f Congress passes a
health care plan Uiat included a number of health care reforms but does
not guarantee health insurance for all
Americans, should President Clinton
sign the bill or veto the bill?" Twentysix percent said he should sign it, 65
percent said he should veto iL The
poll of 1,005 people was conducted
July 23-26 and had a margin of sampling error of plus or minus three
percentage points. The poll also found
that half of those surveyed disapproved of Mr. Clinton's handling of
the health care issue.
Republicans were in high dudgeon
today, mcreasing their efforts to slow
the legislative prtKess on health care.
Seeking the nonparUsan high ground
for themselves. Republicans assert
that they are trying to prevent a vote
on a complicated bill until Americans
know what ts in i t Senator Bob Packwood, Republican of Oregon, asserted
that the Republicans were in a state
of "almost unifonn anger, if we're
going to be given a bill that's 1,000
pages long and a day to study i t "
Democrats counter that this Is simply one more example of Republican
obstructionism. "All that amounts to
is a very, very convenient way of
achieving a delay for those who don't
want a health care bill," said Senator
Christopher J. Dodd, Democrat of
Connecticut
- ^kingWeekofShidy
Senator Bob Dole, the Republican
leader, has requested one week of
uninterrupted time to study the bill
from the time it is made public to the
time it is uken up on the floor Mr.
Mitchell said today that, "No one will
be rushed" on the health care bill, but
added that he had not yet decided how
to proceed. Mr. Mitchell has been
expected to go to the floor almost
immediately afterreleasinghis plan.
But the Senate's rules make it nearly
impossible to rush anything, and the
debate in the Senate is expected to
last several weeks.
Mr. Mitchell did say today thai
once debate began, the Senate would
stay in session six days a week and
keep working on the health care bill
until it was completed.
This issue of timing is not a small
thing: House leaders, as they brief
their members on their plan, have
been assuring them that Uiere will be
some kind of test vote in the Senate
before th&^ouse has to vote on the
employer mandate. There is significant apprehension in the House about
pushing forward with a painful vote
on an issue that is likely be jettisoned
in the Senate.
Today was also marked bv a nois\
demonstration outside the office o
Senator Dole, who is a chief opponen;
of bills providing universal coverage
The demonstrators chanted, "Bob
Dole sold his soul. Insurance companies pay the toll." The Capitol police
asked them to leave. When they did
not, police officers arrested 42 cn
charges of violating a District of Columbia law against demonstrations in
the Capitol.
�I Dole Seeks 'Uninterrupted' Week
= To Study Democratic Health Bill
m
By Dana Pnest
cost of legislation, has been finishing
its work on the Senate Finance Committee bill. Mitchell will use parts of
the bill as a model for his own plan.
Senate and House leaders are attempting to meld health care bills
passed this summer by four committees, getting rid of unpopular provisions and drafting new sections that
a majority of each chamber might
agree on.
Differences between Senate and
Hotise bills must ultimately be reconciled in a conference and be returned to both chambers for final
passage before gomg to President
Clinton for his signature.
Yesterday, Clinton spoke at the
White House to disability rights
groups celebrating the fourth anniversary of the passage of the Amencans with Disabilities Act.
Clinton recalled the long fight to
pass the legislation and the even kxiger effort to pass health care refonn
laws. He saki Republicans were unwilling,to compromise on a bill this
year. Tvery time I have reached
out, they have moved huther away,"
he said.
In the afternoon, 250 members of
four natitmal disability rights groups
that had been at the White House
tried to meet with lawmakers on
Capitol Hill but were barred at the
entrance by police who said they
were clearly demonstirating without
a permit. Two people were arrested.
" I just shook hands with the president, the vice president and tiieir
wives and now we're being treated
like common criminals," said Celeste
Pahner Chose, of Oakland, whose
13-year-old daughter is disabled.
Moments before, 42 members of
Citizen Action, a nationwide consumer group that advocates a Canadianstyle health plan, were arrested m
front of Dole's office.
Meanwhile, tiie General Accounting Office estimated tiiat if tiie govemment picked up the costs of providing health benefits to early
retirees (ages 55-64). as tiie Clinton
administration proposed, the cost
wouid be $184.5 billion in the years
from 1998 to 2007. Compames now
pledged to pay such benefits for
their former employees would save
$133 billion of tiiat. the report said.
Sources said that the bill House
leaders will send to the floor does not
include an eariy retirement provision.
WisnjuBlon Fnst burf Wnler
P- Senate Minority Leader Robert J.
fc Dole (R-Kan.) demanded yesterday
C. that the Senate all but shut down for
^ a week to review the health care bill
2^ his Democratic counterpart plans to
propose this week or next.
J
If the request were honored, the
prospects of passing health care legt^. isbtion this year would be pushed to
» the limit, given the little tune left on
the legislative calendar before memJ^bers go home to campaign for the
November elections,
f - This is very serious legislation,"
V.said Dole, who yesterday formallv
r i s k e d Senate Majority Leader
f JGeorge J. MitcheU (D-Maine) for a
J*week of "uninterrupted time" to
I study the bill without other legislaf tive business.
Dole, who has been criticized for
SEN. ROBERTJ. DOLE
! appearing to be obstructionist on
... "this is very serious legislation"
' health care, stressed his good relations with Mitchell and his belief
things could be worked out amica- jority for any approachto solving the
bly. But, he said, if his request is de- problem of 39 million unirisnred and
I nied, "we may" have lo have another increasing health costs.
[ course of action" which he declined
He has been rheeting privately
to specify.
with individual Democrats in his efSenate rules give R^blicans the forts to craft a health bill Mitchell
ability to delay debate easily.
had hoped to begin debate at the end
Mitchell said yesterday he wouid of July. If he finishes his plan early
review the request, which Dole next week and honors Dole's remade with three other Republican quest, it is likely debate will not besenators. There will be ample time gin until Aug. 8. The Senate's recess
for study and debate and amend- is scheduled to begin Aug, 12.
ments to the heahh care bill," Mitch"He made it clear-that oooe it
ell said. "No one win be rushed."
starts, it goes until it's finished,"
Mitchell told Donocratk senators Sen. Christopher J. Dodd (D-Conn.)
at a luncheon yesterday that he will said after the luncheon. That sort of
begin sbc-day work weeks, up from chilled the room. There was a lot of
the normal four, and promised to expulsion of air."
keep the Senate in session during
Senators said that Mitchell is conthe August recess, until health legis- sidering a health bill that would inlation is completed.
clude an "employer mandate" under
Senate and House leaders have which employers would split the cost
yet to propose the bills they hope to of insurance with their workers. It
take to the floor.
would go into effect only if voluntary
House Majority Leader Richard measures fail to cover 95 percent of
A. Gephardt (D-Mo.), who is putting the population by the year 2001.
the finishing touches on his bill,
He also is vetting the idea of givhopes to begin debate on the floor ing subsidies for health insurance to
Aug. 8 or 9 and to conclude by Aug. several categories of low-income
12. He will meet today and Friday people. Sources said Mitchell wants
with the full Democratic member- to make subsidies available to womship to discuss his bill. Gephardt has en and their children as early as
to persuade a substantial number of
1996. A year or two later, subsidies
uncommitted Democrats to support would be offered to people in bea bill that is said to contain the con- tween jobs for up to sue months and
troversial "employer mandate" refor mothers leaving welfare to begin
quirement that employers pay for
work for up to two years.
part of their employees' insurance.
One thing delaying Mitchell is that Staff writers Spencer Rich and
Mitchell has an even toupher job. the Congressional Budget Office,
Helen Dewar contributed to this
because the Senate has no clear ma- which is charged with estimating the
report.
THURSDAY. I I I Y
28.1994 THE
WASHINGTON POST
�m
Date: 08/02/94
Time: 15:17
M i t c h e l l D e t a i l i n g Compromise H e a l t h Plan
WASHINGTON (AP)
Senate M a j o r i t y Leader George M i t c h e l l t o d a y
nresented a h e a l t h r e f o r m b i l l t h a t would aim t o cover 95 p e r c e n t
of Americans by t h e year 2000 w i t h o u t r e q u i r i n g employers t o pay
t h e i r workers' insurance.
''Health care r e f o r m i s a m a t t e r o f s i m p l e j u s t i c e , " M i t c h e l l
s a i d on t h e Senate f l o o r .
' ' I t i s t i m e t o a c t , " M i t c h e l l s a i d . ^^The b i l l I w i l l
i n t r o d u c e i s a good s t a r t i n g p o i n t f o r a c t i o n .
M i t c h e l l ' s proposal includes f e d e r a l subsidies f o r m i l l i o n s o f
low-income f a m i l i e s , pregnant women, c h i l d r e n and o t h e r s i n an
e f f o r t t o expand coverage t o 95 p e r c e n t by t h e t u r n o f t h e c e n t u r y .
I f t h a t l e v e l o f coverage i s n ' t met by 2001, M i t c h e l l would
p r o v i d e a standby system t h a t c o u l d impose a r e q u i r e m e n t f o r
businesses and i n d i v i d u a l s t o s p l i t t h e c o s t o f coverage 50-50.
Small f i r m s w i l l be exempt, as would those i n any s t a t e where 95
p e r c e n t coverage had been reached.
Democrats p r a i s e d M i t c h e l l ' s work, and s a i d he had worked h a r d
t o f i n d t h e c e n t e r i n t h e p a r t y ' s 56-member caucus.
Sen. Kent Conrad, D-N.D., a member o f t h e Senate Finance
Committee who has opposed an employer mandate, c a l l e d i t ^^a superb
j o b ' ' t h a t would d r a m a t i c a l l y c o n t r o l c o s t s and expand coverage.
Sen. Jay R o c k e f e l l e r , D-W.Va,, s a i d he would t r y t o s t r e n g t h e n
the p l a n , b u t would l i k e l y v o t e f o r i t even i f he was u n s u c c e s s f u l .
' ^ I t h i n k i t ' s t h e b e s t t h a t can p o s s i b l y be done t o g e t 51
v o t e s i n t h e Senate g i v e n t h e p o l i t i c a l circumstances i n which we
operate.''
Sen. C h r i s t o p h e r J . Dodd, D-Conn., s a i d , ^ ^ I f you don't have t h e
v o t e s , you do t h e b e s t you can.''
He s a i d t h e b i l l would cover 25 m i l l i o n more Americans w i t h o u t
p r i c e c o n t r o l s o r mandatory a l l i a n c e s .
Sen. Joseph Lieberman, D-Conn., a member o f a moderate group o f
s e n a t o r s w o r k i n g on a mandate-free approach, s a i d those c o l l e a g u e s
^*are g o i n g t o be encouraged b u t n o t ready t o s i g n on.*'
He s a i d t h e o p p o s i t i o n i s a g a i n s t mandates on p r i n c i p l e , and a
watered-down mandate won't b r i n g them i n t o t h e f o l d . He s a i d he
would v o t e f o r t h e b i l l o n l y i f mandates a r e s t r i p p e d o u t .
Meanwhile t h e White House embraced Democratic h e a l t h care p l a n s
i n t h e House and Senate t h a t a r e scaled-down v e r s i o n s o f P r e s i d e n t
Clinton's i n i t i a l proposal.
W i t h t h e p r e s i d e n t ' s p l a n l o n g - s i n c e dead. Press S e c r e t a r y Dee
Dee Myers s a i d C l i n t o n w i l l lobby f o r p r o p o s a l s by House M a j o r i t y
Leader R i c h a r d Gephardt o f M i s s o u r i and M i t c h e l l . She s a i d b o t h
a l t e r n a t i v e s e v e n t u a l l y would achieve C l i n t o n ' s p r i m a r y g o a l
u n i v e r s a l coverage.
^ ^ I t i s v e r y s i g n i f i c a n t t h a t f o r t h e f i r s t t i m e i n 60 y e a r s ,
you're g o i n g t o have a b i l l on t h e f l o o r o f t h e House and on t h e
f l o o r o f t h e Senate ... t h a t f u n d a m e n t a l l y r e f o r m s t h e n a t i o n ' s
x i o a l t h c a r e s y s t e m , " Myers s a i d . ^^Thac vould n o t have happened
without t h e president's lead/ership.''
Myers s a i d C l i n t o n
s u p p o r t s t h e broad o u t l i n e s o f t h e b i l l .
C e r t a i n l y , i f Senator M i t c h e l l proposes a b i l l
which we expect
t h a t w i l l g e t t o u n i v e r s a l coverage by a date c e r t a i n , i n a
reasonable p e r i o d o f t i m e , t h e n i t ' s something t h e p r e s i d e n t can
support.''
The House J u d i c i a r y Committee, meanwhile, v o t e d t o r e p e a l t h e
IBIipii^WWWiPilW'
�HIGHLIGHTS
The Senate majority leader's health care bill would:
• STKIVE to provide insurance
coverage for at least 95 percent
of Americans by the year 2000
or possiDiy require employers
with 25 or more workers to pay
50 percent of their workers'
costs starting in 2002.
• REQUIRE employers to offer at
least three choices of health
plans.
• CURTAIL insurance companies'
ability to discnminate against
people with preexisting medical
conditions.
• PROHIBIT insurance companies
from charging the elderly more
than twice as much as the
young.
• ALLOW the poor, the
unemployed, the self-employed
and workers for companies with
fewer than 500 workers to sign
up for the same insurance
policies federal workers get.
to low-income children and
low-income pregnant women.
lABOUSN much of Medicaid; give
the poor subsidies to buy
insurance.
• COHTAIN costs by automatically
cutting back federal health
reform spendmg if costs
threaten to increase the federal
deficit.
I MCREASE cigarette taxes to 69
cents a pack; squeeze savings
from Medicare; place a 1.75
percent tax on health care
. premiums; require the most
expensive health care plans to
pay a 25 percent tax.
• PROVIDE subsidies immediately
TMl WA4MINST0N
called the Mitchell plan "a good
starting point," but promised to offer
amendments to either strengthen or
eliminate its provisions.
•^e do not bke the mandates."
said Sen. John Breaux (D-La.), a
member of a bipartisan "rump
group" that rewrote the Senate Finance Committee bill Mitchell then
used as a foundatron for his plan.
This will still be an uphill battle."
Sen. John D. "Jay" Rockefeller IV
(D-W.Va.) said Mitchell's plan "was
the only way to get 51 votes, including Wke President AJ (Jore . . . it's
the best that can be done, given the
political circumstances in which we
operate."
"It goes about as far as you can
go." saki Sen. Christopher J. Dodd
(D-Conn.), who said he believed the
bill had been sufficiently massaged
to attract the moderate Democrats
and Repubbcans it would need to
pass.
Unlike Gephardt's, the Mitchell
plan continues the practice of voluntary insurance, provides new subsidies for low-income persons and relies largely on price competition
between insurers to bring down
costs.
The combination, he said, will
bring up to 30 million uninsured people uito the system and would be not
increase the federal budget deficit.
Speaking on the Senatefioor,Mitchell said the stower time table was "a
realistic recognition of the enormously complex task of modifying
the health care system."
Mitchell proposed requiring employers in all companies to offer, but
W
not cover, three different types of
health plans, including one that offers unlimited choice of physician.
Each plan wouki be required to offer
a standard benefit package—a comprehensive list of services equal in
value to a standard option Blue
Cross/Bhie Shield plan. Indrv-iduals
and companies could purchase benefits beyond those covered in the
package.
The package includes abortksn but
Mitchell said yesterday that he expected that issue "to be settied on
the fk)or."
Empteyees of large firms likely
would continue to get insurance at
work, as nxKt do now. In an obscure
provision that would affect many
firms, the bill says, "Employers that
voluntarily contribute toward the
cost of health insurance for any empkiyee would be required to make
equal contributions for all employees.
Individuals in firms with fewer
than 500 emptoyees could voluntarily purchase insurance through statemonitored health insurance purchasing cooperatives. In these, the cost
of insurance is spread among the
"community" of people who buy insurance through each cooperative in
a given region.
Insurers would be requu-ed to sell
pobaes to people with pre-existing
conditions—pre-existing condition
exclusions would be limited to those
who had been diagnosed within the
previous six months—and could not
drop coverage when an individual
changed jobs.
To cover more uninsured, the
plan proposes a set of new subsidies
for low-income people to be phased
in beginning in 1997, but only if
funds are available v^ithout mcreasing the deficit. There are special
subsidies increases for low-income
pregnant women and children and
for the temporarily unemployed for
up to sue months.
To pay for subsidies, the bill
would cut Medicare and Medicaid,
and increase cigarette taxes by 45cents a pack to a total of 69 cents,
the same figure as the House has
proposed. It also proposes to inaease taxes on some handgun ammunition and place a new 25 percent
tax on the most expensive insurance
policies.
It wouW impose a separate 1.75
percent tax on insurance premiums
to help fund academic medical centers—a key provision for Sens. Daniel Patrick Moynihan (D-N.Y.) and
Edward M, Kennedy (D-Mass.), both
chairmen of the committees that
passed health legislation.
In another major departure from
the Clinton plan and the plan proposed by tbe House, Mitchell rejected fall-back govemment cost controls in his bill. Instead, he would
rely on the cooperatives and on price
competition to drive down insurance
prices, measures that have drawTi
skepticism from the Congressional
Budget Office.
The MitcheU plan gives considerable new responsibility to the stales
to monhor the insurance industo'.
enroll people eligible for subsidies
and implement the tax on the higher-priced insurance premiums.
Many of these same provisions were
approved in the Senate Finance
Committee bili and then foimd to be
unworkable by the CBO.
"This is a big job and it requires a
k)t of administrative work and we
don't know whether that can be
done by the states," Mitchell acknowledged. "That's a valid criticism."
If these and other voluntary measures fail to cover 95 percent of the
population by 2000, then by May 15,
2000, a national commission would
recommend to Congress v^-ays to
reach the goaJ. If Congress fails to
enact the recommendations on n
fast-track procedure by Dec. 31,
2000. then the employer mandate
would take effect beginning in 2002.
Firms with fewer than 25 employees would be exempt.
All others would t>e compelled to
pay 50 percent of their worker.-,' insurance cost, and employees would
have to pay the balance.
o
-<
ul
�MitcheU's Health Bill
Aims for 95% G)vera£;e
Rv Dana
Dana Priest
Pripcf and
:>nA Helen
Uolon rDewar
\„
By
Wishannoo Po« Staff Wmcrs ^ j
'
HEALTH. From A1
Senate Majority Leader (Jeorge J. pass his version of the legislation 1999.
Mitchell (D-Maine) yesterday un- said they wouid attempt to strike
Rep. Jim McDermott (D-Wash.),
any reference to mandates, while i leader of the group of 92 House
veiled a compromise health care bill
that falls short of the universal cov- some of Clinton's staunchest sup-| Democrats who favor a single-payer,
erage President Clinton had de- porters said they wouW attempt to government-financed health insurmanded but holds out the promise of strengthen the mandate proviswns. ance proposal, said the MitcheU biU
insuring 30 million more Americans
A group of bipartisan moderates "is simply not health care reform. It
over the next she years.
hailed Mitchell's proposal as a "hero- IS carte blanche for the msurance
Mitchell said he did not know if he ic effort," as Sen. Bob Ken-ey (D- compames to continue" donoinating
Neb.) put it, but said it fell short in the health system.
had the votes to pass his bill, but
terms of reducing govemment consenators said it offered the best
"How are the House leaders going
trols, cutting costs and assuring bi- to go out tomorrow to our members
chance of salvaging some elements
partisan backing. "As a bipartisan ef- and say we want an 80-20 split,
of CUnton's beleaguered plan to refort, this doesn't make it." said Sen. when the Senate majority leader has
vamp tiie nation's healtii care sysDave Durenberger (R-Mmn.).
tem.
capitulated and thrown in the towel?"
Senate Mmority Leader Robert J. he asked.
Just two weeks after Clinton was
Dole (R-Kan.) attempted to portray
At the other end of the House
criticized for musing that universal
coverage might actually mean cover- Mitchell's proposal as a warmed- spectrum. Rep. Jim Cooper (Dover version of Clinton's bill, saying Tenn.). who is sponsoring an altering only 95 percent of the population, the Senate's top Demoaat pro- it was "very similar . . . in that it native without any employer manposed precisely that: a voluntary prescribes more govemment, more date, said, "The House is paralyzed
taxes and more entitiements."
until the Senate acts. I don't think
plan intended to cover 95 percent of
Dole said he had no plans to in- there will be a mandate in the final
Americans by the year 2000.
voke rules forcing Mitchell to pro- bill."
Mitchell proposed a wateredduce 60 votes for passage, rather
In the Senate, many members
down version of the employer manthan a simple majority. He declined,
date, which has tied up health care
however, to rule out such a sti-ategy,
reform efforts all year. Mitchell's
which
would probably doom any
mandate would require employers to
chance
of passage. "If tiie bill is real,
pay 50 percent of the cost of insurreal bad. we may have to make some
ance for their workers. It would go
into effect in 2002 only if tiie 95 per- tough choices," he said.
Mitchell's bill is to be formally incent-coverage target were not
reached and only if Congress did not troduced today with debate scheduled to begin Tuesday. On tiie same
fmd some other way to achieve that
day, the House will begin debate on
goal.
a more comprehensive plan proThe 95 percent goal "is not uniposed last week by House Majority
versal coverage," Mitchell said, but
Leader Richard A. Gephardt (Dit would be "a truly remarkable
Mo.). It wouW be the first time in
achievement and set us on the road
U.S. history that both houses of Conto universal coverage."
gress would be debatmg large-scale
While Mitchell won widespread
health care reform, let alone simulpraise for his efforts, the proposal it- taneously.
self ran mto a cross-fire of cnticism
Leaders of both the liberal and
from left and right and some trouconservative wuigs of House Demobling shots from the middle.
crats said the MitcheU bUl undercuts
Several moderate Democrats
Gephardt's position and makes it
whom Mitchell must win over to
harder for the House to pass the bill
See HEALTH, A12. CoL 1
Ciephardt is pushing.
(jephardt's bili requires firms to
• Bis Ihi.slnvss nun vs to siilcimrs pay 80 percent of their employees'
in Itmttli reionn (II IHIIC. I'mir iH) insurance as the mainfinancingtool
for reaching universal coverage by
\tt:DNESDAl.AlGr^T3.!Q94Turtl..
p,,,^
�O
' USE IS LETTING
SENATE GO FIRST
ON imCARE
MANY DEMOCRATS HAPPY
™£,V£„.
LuiHinuea
rORH T,.^,ES. fR,D..y.
AUGUST
,
I-ron] Huue Al
happens as the bills advance. Tha;
was the stance of the A.F.L.-C.I.G..
aitnouph the African Methodist Episcopal Church came out for Senaie
passage of the bill offered by Mr.
Mitchell as the best that could be
achieved in the Senate.
gress should work through the recess,
which had been scheduled to begin
.-\UR. 12. if necessary. He said' ""We
can t rush it. We have enougn votes
not to be rushed.'"
That filibuster threat is a measure
of why the maneuvering to arrange to
have the Senate vote first may
While
Congressional
leaders
founder. The possibilitv of delav is the
scramble for votes. Mr. Clinton s
reason House leaders have not specifchief role is cheer-leading and he did
ByADAMCLVMER^
ically promised their followers that
It again tonight in a two-minute teleSpeclil 10 TTie New York Timn
they could wait until the Senate votes
first.
WASHINGTON. Aug. 4 - House vision commercial broadcast on the
Cable News Network. He emphasized
leaders today put off a vote on nation- how much Congressional leaders had
As House Speaker Thomas S. Foley
al health insurance until Aug. 19, a
said at a news conference today: "We
changed his original plan and concannot possible conduct House busidelay that is likely to give nervous
tended that the Mitchell bill and the
ness on the basis of Senate schedules.
representatives time to see how the
stronger measured offered by his
The Senate cannot conduct Senate
Senate votes before they have to stick House counterpart. Representative
business on the basis of Senate schedout their own necks on the politically
Richard A. Gephardt of Missouri,
ules."'
took "a conservative approach that
dangerous issue of requinng employkeeps what is best in the current
Hope to Avoid Delay
ers to insure their workers.
system and fixes what's wrong."
Senate Democrats, even some who
Democratic leaders in both the
In the first of a nightlv series of
would not sav if thev would support
House and Senate insisted that they
advertisements paid for bv the DemMr. Mitchell's bill, called on Republiwere not basmg decisions on what
ocratic National Committee, Mr
cans
not to delay the legislation. Senawas going on in the other chamber. Clinton said the votes would give the
tor Byron L. Dorgan of North Dakota'
The reason given for the one-week
nation "its best chance, maybe its
said, "The basic noise, if vou strip
House postponement was the time it
last chance in this century, to assure
away a lot of veneer, is from peopi
was taking legislative draftsmen and that every Amencan, regardless of
who don't want to get anvthing donSenator Christopher J. Dodd of ' .,nthe Congressional Budget Office to
wealth or privilege, will be helped or
nectlcut complained of the par r
healed when they are sick."
process vanous altematives. But
ship and said: "People are dr w
In a Wednesday night news conferDemocratic lieutenants made it clear
They don't want to see ur
-"^L
ence, Mr. Clinton repeatedly critithat the delay would bring sighs of
-'- •nfycn
cized
Republicans
from
backing
about the size of the lifebr
relief in the House.
away from their past support univerBut whal seems to h
They would like to see some early
sal coverage. Today, Vice President
dimensions to Mr. !> .
votes in the Senate, perhaps late next
Al Gore pressed that same message
measurements to oth i .
week. If the Senate Democrats preat a large rally at the Capitol.
For example, th-- A.F.
vail, then House Democrats believe
" I f Bob Dole and the special inter- tacked the Mitche'. Dili t.> >>,
' mid
they will. too.
ests win, millions of Americans will
and said it war 'detrim
to uie
lose," he said. "Bob Dole used to interests of w-.kmg famii
Many Democratic representatives
and the
support a mandate, now he doesn't. country at I'rge." T^.e labo-- organiare hoping the Senate preserves the
He used to suppon umversal cover- zation complained tha. under his
concept, even as a last resort, before
age. Now he doesn'L He used to want plan, if employer payments were rethey vote on a House bill with stiffer
health care reform this year. Now he quired in 2002, 'employers would be
requirements. Employer payments
says he would rather wait."
required to pay for only half of their
would begin in 1997 under the House
Mr. Dole, the Republican leader, workers' premium costs, significantbill. The Senate measure would not
replied in a Senate speech that he still ly less than the average employer
require them before 2002. if at all.
hoped for a bipartisan solution to the pays today." It said this would underIf the Senate can protect its emproblem. But he said Mr. Clinton's mine "a standard that has been esployer-financmg provision against
and Mr. Gore's comments would tablished through decades of collecRepublican efforts to kill it, said Repmake that harder. He said they were tive bargaining " The employer
"misleading the American public" in share in the House bill is 80 percent.
resentative Benjamin L. Cardin, a
contending that his more modest ReThe African Methodist Episcopal
Maryland Democrat and an imporpublican bill, which may be intro- Church, with four million members,
tant vote-counter, "that wouid cerduced on Friday, would not help took a simpler view of the Mitchell
tainly offer momentum to our side."
Americans now denied insurance tie- measure today. "Pragmatically
Lawmakers m both houses are esspeaking, that's about the best we are
pecially touchy about employer f i going to get from the Senate," said
nancing because whichever way they
Bishop H. Hartford Brookings, who
vote they risk alienating either small
heads the church's ecumenical and
businesses, which oppiose the concept,
urban affairs office. He said he would
or the public, especially union memprefer a faster route to universal
bers, who favor the concept
coverage, but added that this was no
In the Senate, while no one was
time to quibble.
about to claim victory on the issue,
He said sermons on health care
supporters of Senate bill, put together
would be preached in thousands of
by Senator George J. Mitchell, the
black churches. A.M.E. and others,
cause of existing medical problems. this coming Sunday, to bring home to
majority leader, were increasingly
Senator Daniel Patrick Moynihan, fence-sitting Senators like Howell
confident that the Democrats could
Democrat of New York, then said Mr. Heflin, Democrat of Alabama, Ernest
prevail on that pivotal question.
Dole was right about how the Repub- F. Hollings. Democrat of South CaroThe members of Congress were
lican leader's bill would affect people lina, and Frank R. Lautenberg, Renervously eyeing each other and worwith medical problems.
publican of New Jersey, all of whom
rying about details in bills, legislating
need black votes to be re-elected, how
Measured by Weight
from the unusual position of facing a
much health care matters to black
At
other
points
during
the
day
Senfresh issue simultaneously instead of
Amencans.
ate Republicans were scornful of the
one house waiting for the other to
"Black folks do not intend to let this
Mitchell bill. Senator Bob Packwood.
finish before starting.
Republican of Oregon, cued us 14 harvest past, " he said.
Some interest groups were emphapound weight ana said, "This weighs
sizing the differences between the
about twice as mucn as Bill Clinton
bills but were waiting to see what
did at birth, ana we know how he
prew up."
Senator Phil Gramm of Texas said.
Continued on Page A18. Column I
"No human being can absorb the
whole text " of the 1400-page bill,
which Mr. Mitchell intends to call up
Medical Residents at Risk
on Tuesday or Wednesday, and said
Moves to promote general-care
he was assigning different senators to
training are seen as a threat by New
examine different parts. And Mr.
York hospitals, reliant on residents
Dole, of Kansas, again said the Conlearning specialties. Page A18.
Delay Shifts Burden to Crucial
Chamber and Could Avert
Some Political Dangers
Moving to give
political cover to
hesitant Democrats.
�er person more than four times as
much as a younger person.
VOW'
~
Employers would have to offer insurance to their employees but
would not be required to p.nv pan '; .and said he '.vas'eager to play Uie
the premiunib. Employers wouid riJiv • : '• i'vrniin;:i';r,"
ben. Ham- VVonord iD-Fa.), a
have to oifer a beneiit packace
equivalent to those oriered to lederal .Mitchell supporter, viid that if ReDuniic.in.^ (leiav reiorni he would proBy David S. Broder
dorsed biU. Rep. Sam Gibbons (D- employees now oy the Blue Lro-.> pose an anienament to strip senators
standard
option
pian,
with
at
least
and Spencer Rich
Fla.). acting chairman of the House
their taxoaver-financed health
WMhmston COM SU« Wntfr.^
Ways and Means Committee, said in one option tor unlimited choice of uen-n;.- ai,,,i tnc\- approved health
doctor and two others.
an
mterview.
"My
advice
to
them
is
in.>L:r,T-,,. : - e\"ervone else.
House Democratic leaders, shaken by their unexpected defeat on the that we ought to go ahead. If vou For people wth low mcomes, k-.i: , I,;..', .r',eloDnlep.;^ vesteraa;..
crime biU. last night announced a de- have to wait for the CBO to give you eral subsidies wouid be available ini.•Ani(TK-;in ,'\ssociat:on of Retired
lay of indefinite duration in taking up an estimate, you wiU wait the rest of tiaUy for those with incomes up to i'ersoiis i,-..ARF;, pniKii:al voice of
your lives. I say, go ahead."
100 percent of the poverty level but ine elderlv nere. has received thouhealth care reform.
nsing to 200 percent over time to sands
It
is
tiie
bUl
tiiat
Gibbons
brought
01 call; from senior citizens proHouse Speaker Thomas S. Foley
help them pay for policies. Medicaid
(D-Wash.) came out of a late-night out of his committeetiiat.with shght patients who receive Aid to Families testmc trie group s suopon of health
meeting at the Capitol to teU report- modifications by (Gephardt, has be- with Dependent Children would be -•are biii.^ introauced bv maiority leaders that the House would stay in ses- come the measure backed by the shifted to pnvate plans, using money |ers of the House and Senate.
.\AR? lobbyist John Rother said
sion next week but work on other preskienL It includes a requirement formerly spent for their Medicaid
matters, inchiding a second effort to that all employers pay for their benefits. The costs of subsidies for !the onslaught appears to be orchesworkers'
health
insurance
and
prompass the crime biU. He refused to
the poor and the Medicaid shifts ' trated. Calls began Wednesday before
news organizations had time to report
speculate on when the health care I ises unrversal coverage by 1999.
Rep. Charles W. Stenholm (D- would be paid for by cutting project- the group s endorsement, he said, and
measure might be debated—later in
ed
growth
of
Medicare
and
Medicaid
Tex.). one of the co-sponsors of the
callers use similar language. He said
August or even after Labor Day.
conservative alternative bill, said by $228 billion and $203 biUion re- about 1,000 cailers registered com"I want to do it as soon as possi- that canvasses of moderate and con- spectively over the next mne years.
plaints on each of the past two days.
ble," he said, "but I don't know when servative Democrats yesterday conMeanwhile, as the Senate slogged
"They're from the e.xtremes," he
it wiil be."
vinced him that the bipanisan meas- through Its third day of deoate on
With Republicans threatening ure he and nine others shaped has health care proposals. Democrats said, "hardly representative. It's cerslowdown uctics in the Senate as far brighter prospectstiiantiie(Gep- groped inconclusively for alterna- tainly some script."
SLX years ago, the A.ARP's leaders
weU, tiie whole timetable for health hardt bUl. It was primarily defections tives to the plan by Mitchell to help
care legislation appeared to be in from those same conservative Dem- contain costs by taxing increases in supported a medical catastrophic insurance plan for Medicare recipients,
jeopardy. Even after bUls are passed ocrats, plus near-solid Republican costly insurance pians.
by the House and Senate, they must opposition, tiiat doomed the crime
MitcheU included the 25 percent only to have us membership revolt
be recondied by a conference com- bUl yesterday. Backers of tiie bipar- levy on mcreases in msurance pre- and force a repeal of the law.
mittee and then repassed in both tisan bUl are aiming for the same co- miums m his compromise bill after
This year, Rother said, the organihouses. Congress aims to adjourn m alition to substitute their plan for senators objected to a premium cap zation has conducted poUs determinless than two months.
proposed by Clinton. But now many ing that most of its 35 nuUion memGephardt's on the House floor.
Foley blamed the delay in the
Earlier yesterday, the House senators, Democrats as weU as Re- bers support the bills sponsored by
House on the time needed by the Rules Committee began formal publicans, have complained that the Democratic leaders m the House
Congressional Budget Office to esti- hearings on the (Jephardt biU, the bi- MitcheU's alternative smacks of a and Senate.
mate the budgetary costs of four partisan measure, a Republican al- middle<lass tax increase.
Both measures cover the AARP'S
"The language of the debate pnncipal health care goals: prescripmajor health bills awaiting House ternative and a single-payer plan
consideration. The bUls were com- that woukl estabUsh a government- makes people uncomfortable be- tion drug benefits for Medicare recippleted, in some cases, only Wednes- financed health care system similar cause it looks like we're going
to that of Canada. The committee against our own constituency," said ients and government contiibutions
day night.
But the decision, following the win set the terms of debate once Sen. Christopher J. Dodd (D-Conn.). to the costs of long-term care.
About 20 people identifying diemloss on the crime bUl and the emer- leaders deckle when they want to , Several alternatives were progence of a bipartisan conservative tackle the controversial issue CUn- ii posed in the meeting, including one selves as AARP members caUed The
alternative health biU that could gain ton has placed at tiie top of his 1994 I to tiuTi the problem over to a cost- Washmgton Post from as far away as
monitoring commission, but "there's Florida and Alabama. Most lacked demajority support on the House floor, domestic agenda.
The "middle of tiie road" healtii no agreement on anything,' said taUed knowledge of the bUls but were
suggested deep concern.by_ the
Democratic leaders about the fate of jplan introduced yesterday by a coaU- Sen. John Glenn (D-Ohio). One prob- ^ nonetheless angry that the group's
the measure being backed by Presi- ition of 10 Repubbcans and moderate lem with scrappmg the tax approach i leadership threw its support behind
Democrats attempts to solve some is that it would reduce revenue
dent Clinton.
them.
Clinton, appearing at the White of the problems of the nation's needed to finance subsidies to ex^
House after his crime biU defeat, health care system without miposing pand coverage to low-income fami- Staff writer Helen Dewar
said, "health care is not going to take new taxes or mandates requiring lies and avoid deficit mcreases.
a vacation. . . . I think (the Con- I employers to pay for insurance for
Facing a similar predicament of contributed to this report.
gress! ought to stay and work on ' their workers.
elusive consensus, a bipartisan
both" health care and crime.
The measure would expand cover- group of Senate moderates met late
White House Chief of Staff Leon : age from the current 85 percent of yesterday to agree on an alternaE. Panetta joined Foley. House Ma- the population to "around 90 percent tive—or alternatives—to Mitchell's
. or a Uttie bit better by the vear plan. With some exceptions, Repub
HEALTaFromAl
2004," said Rep. J. Roy Rowland (D- licans were pushing for a comprehensive alternative, while Demojonty Leader Richard A. (Jephardt 1 Ga.). a leader of the coaUtion.
(D-Mo.) and others in a meetuig that
"This seeks to reform the health crats, many of whom did not want to
began in Foley's office and then ! system from within—to fix the oppose Mitchell's biU as a whole,
moved across the Capitol to the of- cracks without tearing down the leaned toward selective amendfice of Senate Majority Leader waUs." said Rep. Michael BiUrakis ments.
George J. Mitchell (D-Maine). (R-Fla.), another sponsor.
Democrats also were resisting i
MitcheU said the Senate, which bepressure
by Sen. John C. Danforth :
Liberal Democrats charged that
gan debating health care three days the new biU actuaUy does very litUe. (Mo.) and other Republicans to:
ago. would continiie to plug away at
agree to stick together on everyMany Democrats, said Rep. Ron thing, as they did in Senate Finance
the issue.
Wyden (D-Ore.) "say there's nothing
House leaders have hoped that there." Under the bipartisan biU. in- Committee deliberations. "We can't
the Senate would vote first on the surers would have to accept all indi- .say we re stickmg together until we
controversial issue of requiring em- vncuals who apply, and aU firms wth have an agreement." said Sen. Kent
ployers to buy health insurance for fewer than 100 workers. These are Conrad (D-N.D.).
On t;if Senate floor. Mitchell's
their workers. But MitcheU has not the rwo groups that have most diffipi;'.n continued to come under attaci<
vet assembled enough support to
move for a vote on the so-caUed em- culty in obtaining insurance now. No ironi K'.-uubiicans wnue receiving a
one could be tumed down for a pre- mixed reaction trom uncommitted
ployer mandate.
existing condition.
Democrats uho may be critical to
Even before the fmm-faced DemRates charged tor policies pur- passage of ms pl;m.
ocratic leaders emerged from almost
Hoiaing up copies ot Mitchell's
four hours of discussions, news of chased by individuals or firms wth
the likely delay drew strong protest fewer tiian 100 workers could varv onginai drait and a subsequent retrnm kev backers of the CiLiton-en- for geography, family size and age, vised version. Sen. Bob Packwood
but insurers couid not charge an old- (R-Ore.) described them as "Lethal
Weapon 1" and "Lethal Weapon II"
Delay by Democratic Leadership
Puts Reform Timetable in Peril
�THE SENATE
G.O.R Split
Offers Hope
To Demoi^ts
OnHeamm
By ADAM CLYMER
Special iqTr« New York Tinws
; WASHINGTON. Aug. 13 - "The
only option for us Is to kill the Preslfleni's bill," said Daniel R, Coats of
Indiana.
; "Ihopethere will be a cease-fire, a
white flag raised and no more ad
liominem attacks." said William S.
Cohen of Maine.
I These are the two voices of Senate
Republicans in the health care debate. These Republicans have a lot in
common: a general belief that the
legislation proposed by Senator
George J. Mitchell, the majority leader, and backed by President Clinion,
(las loo big a role for govemment. and
• fear that Democrats are trying lo
jiish ihem and make them look "bad.
I But there is a fundamental difference. Mr. Cohen and a signific'ant
minority of his parly hope they can
)vork oul something by amending the
Mitchell bill, while Mr. Coats and a
majority of Republicans have no interest in that approach and are comr •
mitted to delaying actions as they
echo and re.-echo their denunciations.
The larger group says it needs time
to explain the evils of the Mitchell bill,
and lis members become furious
when Democrats like Edward M.
Kennedy of Massachusetts or Christopher J. Dodd of Connecticut use tiie
word filibuster in describing the Republicans' debating posture.
Listen to Senator Bob Packwood of
Oregon, the Republican floor leader
on the health care debate: "I ask you
If we cannot go home and talk to our
constituents, and if the only way we
have to gel the point across that we
feel so strongly aboul on this bill is to
talk on the floor of the Senaie, is that
some kind of an immoral, unethical
process? Is that a filibuster?"
No Brawl Oevelo||ibiC.
! But the floor debate has noC tumed
Into a brawl largely because the
Democrats are counting on ihe faction Mr. Cohen belongs to, the bipartisan mainstream coalilion, to propose
amendments to the Mitchell bill that
they can accept.
Thai is, most Democrats hope they
can find those amendments acceptable. One of their most liberal members. Senator Paul Wellstone of Minnesota, said todav that h*
>:
hr-?Jl * Democratic response Is call-
T r i i f . i l ' * ! ' ' if""" example. Senator
J.r^"'Lott. Republican O / M U « S S L
attacked the MitcheU bill « S h
10^
Going Over Oetalla
But this morning when Mr. Cohen
finished, the Democrats just araued
with him aboul the details of various
bills. For example, Mr. Cohen said
Senator Bob Dole's proposed bill
would protect consumers with oresxisilng medical condiiions from being denied insura.nce. Senator Kennedy read from the biH. and argued
that It would enable insurers to keen
on denying coverage for pre-exiaiina
cajdlttona. in contAat to
^JiuS^i.
But the tone was dvll. After all. Mr.
Cohen was on the way to another
mainstream group meeting Today's
f ^ m M . * " H""""* "ying :o find a
abortion groups nor abortion-rights
victory or defeat, some comDromise
UMt would come close to p r S i m i K
t £ v h.TJ'*«"=*P"'« report^ that
the mainstream contingent sneak
l?sE"^; °'
°«"« K thSSS
mat Mr. Dole and his even more
DIARY
Health Care Developments
VESTEROAY
The first week of CongresskKial debate oo health care en<ted
the Senate preoccupied with tong s p e e c h e s ^ R e w b l S n ? « ^ r r ^
House unable lo move forward I^IM iH^DB^M i S S i v ^
^
analyaes of proposed legislalkxT
^
.
CONORCSS
~~
SCNATC. The Democratic majority leader. Georoe J MitetwuM m
Maine, had hoped to start voting on Frktoy o T S i c I S
measure he put forward tha. intends t ? 7 , r « ^ 2 K ? i ' c S i . o .
for 95 percent of Americans by the end of the c W w v But
^
rZfh"^"^;"'""^
'° 27 more of t i i ^ T S e d ti make
speeches before moving on to voting. Many Q v r n o a t ' ^ ^ c ^
yesterday as well. So tho session wSnt o ^ ' . ^ ^ ^ i t S ^ L
substance. HOUSE. Still waiting for budge. o f f i ^ a S S ^ T o l ^ a S ^
health msurance proposals, DemocrahcleadersTn
given up on even predicting the opening date o theJ d e S T e ^ ^ K
had originally been set to star, on Monday
conservative allies look at the mainir.h'iE? *I?."P''
° ' collaborating
with Mr. Mitchell as highly offensive
Blunt Messages
. . ^ Jwttle of messages is fairly
bhint Republicans, in speeches UiM
average ckMe to an hour\«o^ the bulls bureaucratic and the Democriii
are rushing. Democrau, In speedM
of about 19 to 20 ratautea. t a y t S
Issues have been s t u d i e d ^ ataittS
and Ihe pubUc wanu actlot
Mr. Dodd complained today m m.
porters that he could not m llr. M B
to agTM OD a vote on » mlmr ameod*
the floor and said. "Our COIIM«1!.
WU: "\t geu y w « T v T ^
taued explanationa, or new versiooi
of the UU mat R ^ l i c a n a n S h i
SfU, -TTii, i. whatyou c a u T i o d
old-fashioned filibuster."
* ^
Ss"*"
that com.
PtalM UUa aftemoon. said. "We're
f2a«li!*«
tte t l m ^ need"
Astad when a vote would OOOUL ho
c
c
c
u.
ty of AnwicM OMdldOB it i B O e
MtkMil iBfayeat." ha a ^ ^ ••ud
SL^ ; M
»™thteg often enou«lv
use a term like ^Ke
everyone knew thai W M ^ . t hS
meant TTien, he scoffed at the te<A.
nique RepubUcana have d e v e ^ 2
BIU Kristol, the party theoretician,
argued UUs week Uiat Republicans
"•"•{W accept Out pala He said Uiey
would be called obstrucUonists whatever Uiey did. ao "it might aa well be
accurate."
^ Spol^fM Quit
HOM
Klajr 11,18H U>e Civil War
• « « r t l wrote. "1 WOIKM to fight it
oia oa Uiis Uaa, iftt takaa aU sum-
Senator Packwood saki, "I Uiink we
are prepared to equal General
Grant"
In fact. UM siege at SpotsyNaoia
court House waa Moody. Confedaraia
rasuaWaa ara uacartakv and fturimm^i
toww, bM iBhB forcas nffarai 3 F t
M
and wQUBdsd on May U[ a i K
M f l X U w « wara t T ^
*
He^nuUnialnUUaitrateiyfora Pnmal asamlt m
Ume. But if Uw i i M l i M i « a m % ( ^ t m d M fallal It ww v « f
and Mr. MitcheU can reach some
agreement, otMtmctionisni will be- and mattvely iadadsiva v k t t n ; r U T
WM a Victory at all And ito U M L
. (»me poUtically painful
lasted just U days, not aU suounar.
V
�Senate Takes First Votes
On Health Amendmeiits
Republicans Say They Won't Be Rushed
By Helen Dewar and Dana Pripst
rtiest
WuhMunoa Put Stiff Wnun
I
i
I
After nearly 40 hours of opening
speeches on health care, RepubUcans yesterday aUowed the Senate
to begin voting on amendments after
Democratic leaders threatened to
hold round-the-clock sessions.
RepubUcans insisted they would
not be rushed in acting on the legislation and Democrats declined to
portray it as a breakthrough that
could lead to passage of the bUl any
time soon. Seven days after debate
began on Senate Majority Leader
George J. MitcheU's scaled-back version of President CUnton's health
care proposal, the Senate approved
its first amendment, requiring health
plans to include preventive and prenatal care for pregnant women and
infants by next July.
The vote on the amendment, pro_l>osed by Sea Christopher J. Dodd
(lK:oni»-Twas o T t S ' ^ - t t ^ i ^ e l y
atong party lines. 1 grsutirtfoi* exactly thundering monient''^'r=u? it s
momentum," Dodd
after the
vote.
The vote occurred as a group of
moderate Democrats and Republicans a ti:?rted new supporters and
finisher, amendments that would
scale jack Mitchell's proposal by
Stripping much of the new government bureaucracy and regulation
from the majority leader's bUl.
At the same time, the House
Democratic leader^ were ciwe^>to a
decision to send members home on
r e c ^ without takingany.yiiiti on
health care. And a small group of
I:ey Democrats privately began
working on pioposals to scale back
the more ambitious Deniocrati^
leadership bUl before the House.
"The Amencan people need to understand the co=t [oi til? legislation j
HEALTH. From A1
to mem. We are not going to be
rushed." said Senate Minority Leacer Rooert j . Dole (R-Kan,) after a
stratein' session attended bv mo.-;'
GOP senators and Republican NHtionr.: C .mmittet Chairman Haley
baroGu:'.
i:i eNcnance ror tiie vote or.
Dod^ s L'roposal. Dole said Republicans -....I cet a vote todav on a propcs... :: 'Jl',-"' nwv.. eiiner "LO .Knock
o.: onz:.uineiiariiein >.r a more
T' '--re':cr.::,c one \» a.iow Deopie t.Vf.-^z ::.,- •• t :• :.:': i;i.-,ura:;i>- oC' -
Dianne:: ' i^^' • : : o : amennmentwnicn
< v'ouic! si.iii iiii.ii ajiion c;:
iHi:
Trie Dill, "llie ne.xr sound ynu ne:.
Will DC '.;v'jrce Mitcneii s:i:,-iii.:. 'btu;.
'ne anienament
' .•^a;a be:i. VYn.
'•ramm 'i\-Tex... "If he want.-.i;!!enaments. v.v'il eive him amendments."
Mitche:! tnreatened la;-- :viond;nto keep me senate iii continuous
session unies.- Republicans agreed
by the en.a of me day vesterdav to
votes, but D\- early yesterday Kepublican.5 inaicated they wouid
svvntch to an amendment strateev to
locus on v.-;:.;- tnev regard a.s tlaws in
the bil. Tiiey lOKed about Mitchell's
threat."! bro-uenr a Diilow, a blani-:e!
ana inv teaov Dear,' saia Sen. Dan
Coats (R-lni. .'
Democrats scheduled the Dodd
amendment
an easv earlv vote to
give them a needed break in the impasse. Kepuolicans saw it difierentiy
and argued mat the amendment simpiv would open tne ooor to government intrusion in health care.
"This Is I'jst the path i don't want
to po nou-r: • <,-jid Sen. johi»H. Chalee (R-R.l.h a .eader of the bipartisan group 0? moderates, ' rhese are
decision: that snouid be made hv
doctors, oians and individuals, not
[the government]," he adde(^
Meanwhile, the bipartisan gr^up
of scnatuis ied by Chat.ee spent
much of the day working on amendments to the MitcheU bUl.
While the group has agreed to
sidestep the contentious issue of
whether to require employers to
provide insurance for their workers
and remains divided over ways to
contain health costs, a record 19
senators—10 Democrats and nine
RepubUcans—showed up yesterday.
Tnev ajreed on \va\s to cut out
mucn Oi tne bureauri acy in the
Mitchell b.:i \ V iimiti'ie' the guvernmf.-::*'.' n,.:.-: ::: :. MUJ ;.;;(; adiustin^"'
Denenis a..r. rv s.ifddmc manv o:
state-run ;.::encics Mie bii^ would s^t
up.
On t.ne issue ot co;-t comiol. ifie
groun wants to sub. 'it.iie iviitchell's
25 percent tax on health plans that
exceed annual pnce increase ceilings
ana replace it with a 25 percent ta.\
on tne hicnest-priced plans m a gi\ en regfcin. But the alternative raises
much Jess monev than Mitchell's
tax, vnucn v\'ould mean the group
wouldmave to raise new lunds-eisewhereSor cut hack on subsidies to
low-injbme people.
Butjs oid issues were resolved
withii^tne group, new ones have
come «p. .Many members are concerned the .Viitcneil bin revises the
Civil Kiu.-.ts .net o! 19yi iri allowing
indiviauai.- to sue the govemment.
renit.". v:?.::'-. emplover- '>r msuran, •
nurcnasmc cooperatives lor discnniinaiion i:,:.--ja on race, se.x. disabiiit'.'
..u.vr.TOS PO'^T ^ F.D>ESDA1. Al Gt sT 17. 1994
and religion. Thev are particularly
concerned tnat it aiso nermits ciaiuis
of discrimination ba.sed ou ianeu;;:;-..
income and se:':uai orient;iiii/i.. i-.-:.' I'ories ii>;t now moLiaiu :;i
i ;.
ri'7nts iriilsiatln;'
'i :'e vTOiiD r .s : i i - ' i
leave f ' t - issue I'l :'r"Ti:;;::
: '
i\."f;..'
t::>'A'lsio::.^
; ;
.
:
i.ji.."-
term c ;re ana Drf-crictioi' v,rv.z i)ei:The so-cailed mainstream group led
by Chaiee has recently grown in importance as It has oecome clear that
no legislation commands majority support.
"If this mainstream group has
amendments .Mitchell can support,
ve mnv have tne makings ot sometmng tnat wiii pas.s," Sen. Jeff Bingaman (D-.N.M.) said. "The ball is sort
I,: 111 tneir court."
House Democratic leaders last
nignt were cio.-e to a decision t-i
send members nome before voting
on heaitn care. Leadership .sources
said the House probablv would take
a break, originally scheduled for
.Aug. 5. as soon as it votes again on
the embattled anti-crime bill conterence report. With the Senaie remaining m sessio" the House will
have to have \ pro lor.Tia aos^ion evpiy three days, but no legislative
business will be done.
1 he mn'n ic^son tor the delay, the
aides s.^,;d. :3 tc lei the Congressional
Budget Office iinish calculating the
budcetarv effects <if the four mam
health pla-.3 the WOMZC eventuallv
will debate.
Proponents oi the measure e.\pressed feai mat the delay coald
jeopardize the bili by leaving little
time for House and Senate conferees
to work out a compromise and then
repass the final version on both sides
of the Capitol.
Mean"-Hile, a group of House
Democrats ni?t privatelv yesterday
to lay om possible revisu.".:, in rhe
House leaO'Tstup health plan sponsored bv '.laiontv Leader Richard k.
vieonardt (l)-.\Io.;.
No decisions were made but the
discussion inv'Mved how to reduce
opposition to tl.? proposed new P--^. L
L of Mec'ic^/e.'.wmrh could liave 40
million to 50 million participants
from the ranks of the unemployed,
small biisinessei, part-time workers
and welfare cUents. One su,gpestion
was to make it apply to a far smaUer
number of people.
.Also <liscu.-,.-,ed was reducing the
burden on smaU businesses ol a renuirement that businesses pav 80 percent ot the health insurance premiums
tor their workers, .sources said one
propo,sai was to aeiav sucn an empiov -'' mandate, inceerm'j itm the tuturr
it trie nuniDer <v people witni'.;:'
::isurance remained nigi:.
^:!:t! ii riu r.s Uav:;i S. broiu r mi.:
.
ill I :' kicu Lui.iiiimli
n r)0> :.
a to in:.,
�.y^m-1
^
-rt
o
o
I
il
nance Committee Chairman Daniel
.
,,^,|, c«|iiaiu uie state oi
I'atrick Mogmaian (D-N.Y.) presided ki at Sen. Edward M. Kennedy (D- heafth care bifls inCbi^gress).
o»iiicateevefT(ne'slife.
the style of an erOdKe toostmaster, al- Mass.) and Uns eschnge occarred:
"I understand what Uie tactfcs are: biptrtlBMffoqpof moderate I
RepoMkansriskedserious wrist m- One, entitled "Dr. Gleason's OfSce
most ifflfaduigiy praising other aena- RekL* I s Uie senatorfrbmMassa- juries by waving around three 14Get
some momentum going and btrid
ready to fo ahead with Uris
Before Sen. MitcfaeTi Pbn." kwked up the perccptfon that we're domg fcr a meeUai Tneadqr to diacm their
'ors" speeches while puttn* ki a pitch chusetts
pound
verswns
of
MitcheO's
bill,
an
lie the ckcuit boart kaMe a comput- aomeUihg . . . and givetiieHouse Pbn Iv a ooniiraaise. Whle MitdMi
'or his committee's WH, which has legislatknr
exercise aimed at iOustrating its com- er.
Kennedy:
"The
American
people
The other, purporting to show some heart to go forward." sakl Sen. and tiie moderates fgree on many
heen snbsomed by a compromise
are ready to go ahead with this plexity, the number of times that "Dr. Gleason's Office After Sen. Wilham S. Cohen (R-Mame). speakmg ^ais, they arefcrapart oo mny M drafted by Mtchefl.
Mitchell has altered it andtiieheed
legislation...
Rareir were more Ibaki
for more speeches before votes are Mitchell's Plan." htokad HM a neat of the Democratk push for votes on
Dole dearly won the prkRforas- taken. Democriits preferred to wave a stack of papers.
i t •
amendments.
senators ptcsent at tl
operaUfes,
tuterammentof Uie day, however, sm^ sheet of paper, whkh Uiey sakl Sen. Coraiie MadI (H^li^iAM an
WithrKiriskofvot«!8.l
Sen. Christopher J. Dodd (IM^onn.)
To topjtaloir, Mitdiei wceiwd k
^e
k
m
d
<
r
f
waxier
sometnnes
what
contained the actual changes that intematkmal touch rtffWWfcijL
'"ore agunuiiied to
said Uie Republkan strategy was tile
Wter
yesterday from six Oemocratit:
-ndstiudone^y onea.
^ were doing here," he observed at a MitcheU had made.
ment of an artkle fromttl'tUesof opposite: stall without giving the perfterals
waming sgamst any serkk^
i laces to be. By 4 p.m.. there were news confeieiiue called to discusB a
ceptwn
of
stalling.
"This
is
what
yoo
Then there were Uie big designed- London fo inustrate Uie liii« waits for
•noments when attenda.ice was one congressional knpaase on anoUier sub- for-television charts. The flashiest treatment under govemmem-run call a good old-fashnned filibuster " he»«akenmg of his bin to wki the a ?
ject: Uie $30 BOKon crime bin.
speaker and Uw presking officer.
consisted of two large, multicokired health systems. The headlme read: said. But Republicans "know'the port of the bipartisan moderatei.
From oUiefs, Uiere was taft of kki- darts
trotted out by Sen. Thomas A. "Patient with Indigestwn Gtts April, American people don't wanttiut"and further movement awayfromtb^
The Mlh—or km—pomt of the deiaD bladden, moles and Daschle
so are trying to hkte the fact behuid Jl^of miversal, aflbnUte^dverM^
^>a^e may have come shortly after
(D-S.D.)-modeled after 1996, Appointment."
^""^•enisis" (whkh is not a dis- charts first
the "phony exercise" of seeking fuDer t»o*l «rte as to questfen e?ert more
unveiled at the White
Behind the theatrics, however, was debate, he saw
SrSS.'"^
the
�^
'Health Bill Is Put in Limbo hy Senate Democrats
As They Noiv Plan Recess Until Mid-September
practical matter, it would require an immense effort to enact even a scaled-bacl<
WASHL\GTO.\ - Senate Democrats,
leiorm bill in this period.
admitting they lack the votes to enact
.Mr. .Mitchell, who is retinns- this vear.
health-care reform, agreed to allow i;
nas made tne issue a personal crusade oi
recess until mid-September while the party sorts. But he must overcome divisions in
leadership keeps trying to reach a compro- his own party and an increasingly partisan
mise with Republican moderates.
Republican minonty. which has snown no
The abrupt shift contradicted Majonty sign of relenting, as demonstrated by us
Leader George Mitchell's oft-repeated vow
record of opposition on the anticnme bill.
Bitter Remarks by Dole
Small Businesses' Plans
Many of the same GOP moderates with
Smail-buiinegg owners are foUowmg
whom
Mr. Mitchell is dealing sided with
their big brothers into managed healththe
administration
yesterday in a pivotal
care plans. Enterprise, page B2.
vote on the anticnme legislation. Sharp,
: to keep the Senate in session through the even bitter remarks by Minority Leader
Robert Dole (R., Kan.) before the roll call
summer if needed to pass a health bill.
! While still holding out hope of enacting were hardly encouraging that he would
help to enact whatever compromise the
incremental reform legislation this year.
moderates can reach on health care.
Democrats admit the delay leaves little
Chief among this group is Sen. John
time for Congress to reach agreement
Chafee (R., R.L). the Republican leader of
before the November elections.
the bipartisan "mainstream coalition. "
"Fewer people can stop more, as time
which
represents up to 20 swing votes on
grows shorter. " said Set Chnstopher
health care. Mr. Chafee has ties to Mr.
Dodd (D., Conn.). Perhaps as important.
through their years on the Senate
, the delay now tak..: the health issue off the .Mitchell
Environment and Public Works CommitSenate floor am nto a nether world
tee. The fate of the refonn effort rests veryof negotiations fmm w'lich some expect it
much
on the ability oftiiesetwo men. who
vviii never re-emerge this year.
will meet today, to bnng toget^wr col" I believe we can get a good bill," .Mr. leagues on each side. "I stiU have some
MitcheU insisted after a party luncheon
optimism," said Mr. Chafee, who argued
yesterday. But these hopes rest on the
the delay could be a boon if aU sides cool off
CUnton administration and Democrats ac- and allow some constinctive talks.
cepting a much more scaled-back version
In remarks yesterday. President Clinof health reform than previously proton sought to play down the impact of the
posed.
Senate delay. He faces major decisions
An Easy Exit?
himself as to how far he is willing to depart
In fact, the altered schedule and prom- from his initial refonn plan. His best hope
ise of negotiations coiUd prove to be an exit is to get some combination of insurance
strategy for both sides, which want to reforms and subsidies designed to move
avoid being seen as kUling reform outtoward the goal of universal coverage. But
right. The expected retum date for the
no one expects Congress to approve comSenate is Sept. 12. And the House leaderprehensive health-care reform on the scale
ship indicated yesterday that it would
the president once envisioned, and even
extend its recess correspondingly.
the reouced subsidies backed by Mr. ChaThat leaves less than a monUi before
fee are in question.
lawmakers expect to go home again in
" I don't think doing nothing is a
October to campaign for re-election. As a choice," said Sen. Thomas Daschle (D.,
By D.v\ 1!) ROGER.-;
;
S t a f f R e p o r t e r ol T H K V\ A L L STnFF:T J O L R N A I .
S.D.). Who hopes next year to succeed Mr,
.Mitchell and who has been a close ally of
tne maioruy leaae.'" :n tne retorni effort. " I
think It would be a Dig mistake to coni'naliv^'ay and say this is not enougn.
Governors Make a Point
.Much the same view was taken b'.
V ermontGov. Howard Dean, who has oeen
a leader among the nation s governors on
health-care issues. To accommodate the
governors, the mainstream group agreed
in a meeting yesterday to modify its plan to
better integrate .Medicaid into a system oi
vouchers for lower-income families. "As a
Democrat and very strong supporter of the
president, this bill doesn't go far enough,"
said Gov. Dean of the moderates' plan. " As
an Amencan. we have to have a bill this
year, and this is probably the vehicle to get
It done. "
The decision to incorporate much of
.Medicaid into the mainstream group s
plan will enlarge the subsidies included in
It.
The moderates' discussions with governors also relate to provisions governing
what contributions states must continue Kmake to Washington, just as they currently
share in the financint' for Medicaid today.
These so-called maintenance-of-effort payments are extremely sensitive for goverriors. Rather than impose a fixed formula,
the moderates agreed to a provision that
would tend to favor states whose medical
costs rise slower than the national
average.
By the same token, Uie mainstream
proposal would achieve large savings by
cutting payments to help hospitals that
carry a disproportionate number of patients without insurance. The assumption
is that these payments won't be needed as
subsidies are extended to many poor families. But in fact, the proposed voucher
system will be implemented only slowly
from 1997 to 2004, and even then, only
households with incomes below 150% to
175% of the poverty line would be assured
of any significant subsidy.
Agriculture Agency Develops a Method
To Speed Testing of Meat for Bacteria
By ALBEKI R. KARR
S l a f / f i i - p o r i c r n l T r i ; W ALL. S I H I r I J I H U N A :
WASHINGTON The A?nr jlture Department said it has perfected a fast,
scientific method for detecting possibl\'
harmful bacteria on meat going through
commercial processing plants.
The new. five-minute "microbial" test
will enable inspectors to do a better job of
determining when beef, pork and poultrj'
carcasses have toxic bacteria, officials
said, and will help inspectors to act quickly
to correct a problem. The department has
said for many months that such a test was
in the works.
Currently, inspectors must rely on lesseffective visual detection of fecal contamination on meat carcasses - or on so-called
biologic detection, which involves analysis
of plate cultures alter 48 hours. But meat
has long passed through a slaughterhouse's processing line before the result.?
ul a biologic test are available.
Agriculture Secretary .Mike Espv saic
he told his oepanment s Food Safety ana
Inspection Service and its Agricultural
Research Service to work up a plan for
using the new test method in regular
meat inspections. Michael Taylor, the new
administrator of the inspection service,
promised rule-making that could lead m a
year to a requirement to use the new test.
Officials said the test has been tned in
12 commercial processing plants and on
more than 1.800 beef, pork and poultry
carcasses.
Gift Investigation
Mr. Espy's announcement comes as he
IS under fire for letting outside interests
pay for personal trips and tickets to sporting events. Attorney General Janet Reno
early this month asked a federal appeals
court here to name an independent counsel
to investigate charges that Mr. Espy illegally accepted gifts from poultry giant
•Tyson Foods Inc. and others with business
before the department.
This week it was disclosed that Mr.
Espy charged the govemment $849 for a
trip to the Super Bowl in January, where
his department's Smokey the Bear was
honored in two halftime videos. An Atlanta museum that is promoting SmokeVs
50th birthday paid S900 for four game
tickets that it gave the secretary.
At a news conterence called to announce tne new meat-testing approac:,.
.Mr. Espy refused to answer a question
aoout the Super Bowl tickets, saving th bneiing was on a ' techmcar issue. AL
cording to Reuters news service, he told
reporters after the session that the repor'
about the Super Bowl trip "is replete with
inaccuracies " and that after an independent counsel is named. " I will begin to
answer and tell and speak and refute " the
allegations.
Status of New Test
The new. rapid-test method i : I't yet
capable of singling out specific pathogens
such as salmonella or E.coli. which are
produced by fecal contamination and can
be deadly for consumers. But Mr. Espy
said that if his department hadn't moved
ahead with yesterday s announcement,
"there could be another accusation " that
It was dragging its heels. Critics have said
that the department has gone slower on
"zero tolerance" for poultry fecal contamination than it has for other meat. The
secretary said that when he took office,
existing rules for red-meat contamination
weren't being enforced and rules for poultry hadn't even been developed.
As for the new test, officials said that by
detecting high levels of any bacterium, the
test will enable inspectors to take steps to
reduce bacteria-narmful or otheru-isefrom meat on processing lines. The tes;
in\-olves swabbing part of ;ill of the
meat carcass with a sponge, removing thibacteria from the soonge and then analyzing the amount of those bacteria.
The new meat-inspection test adapts
technology that the beer and pharmaceutical industries are already using to detect
bacterial contamination on processing
equipment.
�1
i
I
Senators
HlALTH,ftw>AM
nance Ckimmittee Chairman Daniel
Patrick MoynaiaD (D-N.Y.) preakled ki at Sen. Edward M. Kennedy (Dandtinsexdaogeocoirred;
(he style of an enktKe toastmaster, al- Mass.)
RepoUkansriskedserraos Wrist m- One, entitied "Dr. Gleasm's OfHce
. ~~«oi«iu wimi UR tacocs are:
Rekfc Tatiieaenator frta Massarnoet unb^ngly praising other aenajuries
by
waving
around
three
14Get
some momentum going and bidd fcrameetiaf TnesdqrtoifisciMtiiek
chusettsreadyto fo diead witii tiris
'ors'speeches white puttii^ kl a pitch legisiatknT
pound verawna of Mitdien's bill, an Wore Sea MitcWTs Phn." kioked "P the peroepdoo tiut we're domg ptan
a oanpraafce. Whie Mitcbefl
'or his committee's wn, which has
exercise anned at Ohistratmg its com- He the cocttt boani nakle s comput- wnethhg . . . and give tiie House and fcr
die
Boderatea ygree on mas^
Kennedy:
"The
American
people
er.
The
other,
pwporting
to
show
been tobromed by a compromise
plexity, the number of times tiiat
some heart to go forward." sakl Sen, foais,tiieyare far apart 00 many ape.
are ready to go ahead with this MrtcbeD
"Dr.
Gleason's
Office
After
Sen
drafted by Mitchefl.
has akered it andtiieheed
Wilham S. Cohen (R-Mame). speakmg
iegislation...."
for more speeches before votes are Mitchell's Pbn." kwked like a neat of the Democratic push for votes on ctfcs. aach as thoae dealK with coat
Rarely vere more thih^
Dole deariy won the priseforas- taken. Democrats preferred to wave a stack of papers.
<»<wfc«HdhisnnncepwtfaaiiBgco>. i i •
^natofs present at (i
amendments.
npnitires.
tate ^nment of tiie day, however, smgte sheet of paper, whkhtiieysakl Sen. Connte MadI (KftHb^ttM an
With rrf>riskof votda;i
Sen. Christopher J. Dodd (D^Cbm.)
-wetand
of
womier
sometimes
what
Totopitali*,MiteWireceiredh
contained the actual changes that intematkmal touch illflHiirahi|iL
"wre aocostomed to
said Uie Republkan strategy was tile
we^
domg
here,"
he
observed
at
a
groryMteP^fromsi»DeMouaUb
MitcheU
had
made.
"nds Onn one<by o n e s , ^
ment of an artkte fhNiittl^tMesof opposite: Stan without givnigtiieperf'aces to he. By 4 p.nt, there were news confierenoe called to discuss a
Then there were Uie big designed- London to illustratetiiefai«Waits for ception of stalling. -This is what yoo Sneiab waning apmat any aeriomi
'noments when attendance was one angreswmal knpaase on anotiier sub- for-television charts. The flashiest treatment under govemment-nin call a good old-fashkmed fDibuster " heweakening of his MB to whi tto sopjecttiie$30 Bflbon crime bifl.
speaker and the preskfing officer.
consisted of two large, multicokired health systems. The headline read: said. But Republicans "know'the port of the bipartisan moderatei
From
otiiefa,
tiiere
was
taft
of
kkl"urther movement awayfromtb«
Amencan peopte don't wanttiiat"and
diarts
trotted out by Sen. Thomas A. -Pattent wfth Indigestkn Gets ADTIT
The Mgh—or kiw—pomt oftiiedec n 9rA tt^riwm^ a ^
. t . : j - .a_ »
. . . . . '"^
gab of imimsal. aflbidaUevdrerat^
'>afe may have come shortly after
Daschle (D-S.D.)-modeled after
««n»^*nw8" (whidi is not s dis- charts first unveiled at the White
1996. Appointment
Z"^'^
^
^
«rte us to question erert more
Behind the theatrics, however, was
1.^^"""
; j ? ^ « r - a t y to support ti«
�'Health Bill Is Put in Limbo by Senate Democrats
As They Noiv Plan Recess Until Mid-September
By D.w 11) ROGERS
Sla'f lieporirr o' TiiK
AI.I. S T R F F T J ' l f R S A i .
WASHI.NGTON - Senate Democrais.
admitting they lack the votes to enact
health-care reform, agreed to allow" a
recess until mid-September while the party
leadership keeps trying to reach a compromise with Republican moderates.
The abrupt shift contradicted Majonty
Leader George Mitchell s oft-repeated vow-
Small Businesses' Plans
Small-business owners are foUowing
their big brothers into managed healthcare plans. Enterprise, page B2.
to keep the Senate in session through the
summer if needed to pass a health bill.
While still holding out hope of enacting
incremental reform legislation this year.
Democrats admit the delay leaves little
lime for Congress to reach agreement
before the November elections.
"Fewer people can stop more, aS time
grows shorter." said Sen: .-Christtjpher
Dodd (D.. Conn.V. Perhaps as important,
the delay now tak,: the health issue off the
Senate floor and nto a nether world
of negotiaMons (mw w'lich some expect it
*iii never re-emerge this year.
" I believe we can get a good bill," Mr.
MitcheU insisted after a party luncheon
yesterday. But these hopes rest on the
Clinton administration and Democrats accepting a much more scaled-back version
of health reform than previously proposed.
An Easy Exit?
In fact, the altered schedule and promise of negotiations could prove to be an exit
sti-ategy for both sides, which want to
avoid being seen as killing reform outright. The expected retum date for the
Senate is Sept. 12. And the House leadership indicated yesterday that it woiUd
extend its recess correspondingly.
That leaves less than a montii before
lawmalcers expect to go home again in
October to campaign for re-election. As a
practical matter, it would require an immense effort to enact even a scaled-back
reiorm bill in this period.
.Mr. Mitchell, who is retiring this year,
nas made tne issue a personal crusade ol
sorts. But he must overcome divisions in
his own party and an increasingly partisan
Republican minority, which has snown no
sign of relenting, as demonstrated by its
record of opposition on the anticrime bill.
Bitter Remarks by Dole
Many of the same GOP moderates with
whom Mr. Mitchell is dealing sided with
the administration yesterday in a pivotal
vote on the anticrime legislation. Sharp,
even bitier remarks by Minority Leader
Robert Dole (R., Kan.) before the roll call
were hardly encouraging that he would
help to enact whatever compromise the
moderates can reach on health care.
Chief among this group is Sen. John
Chafee (R.. R.L). the Republican leader of
the bipartisan "mainstream coalition."
which represents up to 20 swing votes on
health care. Mr. Chafee has ties to Mr.
.Mitchell through their years on the Senate
Environment and Public Works Committee. The fate of the refonn effort rests very
much on the ability of these two men. who
will meet today, to bnng together colleagues on each side. " I stUl have some
optimism," said Mr. Chafee, who argued
the delay could be a boon if all sides cool offand allow some constructive talks.
In remarks yesterday. President Clinton sought to play down the impact of the
Senate delay. He faces major decisions
himself as to how far he is willing to depart
from his initial reform plan. His best hope
is.to get some combination of insurance
reforms and subsidies designed to move
toward the goal of universal coverage. But
no one expects Congress to approve comprehensive health-care reform on the scale
the president once envisioned, and even
the reduced subsidies backed by Mr. Chafee are in question.
" I don't think doing nothing is a
choice," said Sen. Thomas Daschle (D.,
S.D.I.'wno hopes next year to succeed Mr.
.Mitchell ana who has been a cicse allv i "
tne maioruy leaaer :n tne reiorni eiion. ;
think It would be a Dig mistake to come
naliway and say this is not enougn.
(iovemors Make a Point
Much the same view was taken v.
Vermont Ciov. Howard Dean, who has been
a leader among the nation s governors on
health-care issues. To accommodate the
governors, the mainstream group agreed
in a meeting yesterday to modify its plan to
better integrate Medicaid into a system oi
vouchers for lower-income families. " As a
Democrat and very strong supporter of the
president, this bill doesn't go far enough,"
said Gov. Dean of the moderates' plan. " As
an American, we have to have a bill this
year, and this is probably the vehicle to get
it done."
The decision to incorporate much of
.Medicaid into the mainstream group s
plan will enlarge the subsidies included in
It.
The moderates discussions with governors also relate to provisions governing
what contributions states must continue u
make to Washington, just as they currently
share in the financir'' for Medicaid today.
These so-called maintenance-of-effort payments are extremely sensitive for governors. Rather than impose a fixed formula,
the moderates agreed to a provision that
would tend to favor states whose medical
costs rise slower than the national
average.
By the same token, the mainstream
proposal would achieve large savings by
cutting payments to help hospitals that
carry a disproportionate number of patients without insurance. The assumption
is that these payments won't be needed as
subsidies are extended to many poor families. But in fact, the proposed voucher
system will be implemented only slowly
from 1997 to 2004, and even then, only
households with incomes below 150% to
1757(1 of the poverty line would be assured
of any significant subsidy.
Agriculture Agency Develops a Method
To Speed Testing of Meat for Bacteria
By .-iLBEKi H. KARR
Staff f i r o o r i c r nl T r i : W ALL. S i m i i Jm HNAI
WASHINGTON The Agrif Jlture Department said it has perfected a fast,
scientific method for detecting possibly
harmful bacteria on meat going through
commercial processing plants.
The new. five-minute "microbial" test
will enable inspectors to do a better job of
determining when beef, pork and poultry
carcasses have toxic bacteria, officials
said, and will help inspectors to act quickly
to cortect a problem. The department has
said for many months that such a test was
in the works.
Currentiy, inspectors must rely on lesseffective visual detection of fecal contamination on meat carcasses - or on so-called
biologic detection, which involves analysis
of plate cultures after 48 hours. But meat
has long passed through a slaughterhouse s processing line before the result.s
of a biologic test are available.
Agriculture Secretary Mike Espv saia
he told his department s Food Safety ana
Inspection Service and its Agricultural
Research Service to work up a plan for
using the new test method in regular
meat inspections. Michael Taylor, the new
administrator of the inspection service,
promised rule-making that could lead in a
year to a requirement to use the new test.
Officials said the test has been tned in
12 commercial processing plants and on
more than 1.800 beef, pork and poultrycarcasses.
Gift Investigation
Mr. Espy's announcement comes as he
IS under fire for letting outside interests
pay for personal trips and tickets to sporting events. Attorney General Janet Reno
early this month asked a federal appeals
court here to name an independent counsel
to investigate charges that Mr. Espy illegally accepted gifts from poultry giant
Tyson Foods Inc. and others with business
before the department.
This week it was disclosed that Mr.
Espy charged the govemment $849 for a
trip to the Super Bowl in January, where
his department's Smokey the Bear was
honored in two halftime videos. An Atlanta museum that is promoting Smokey s
50th birthday paid S900 for four game
tickets that it gave the secretary.
At a news conference called to announce tne new meat-testing approac;..
.Mr. Espy refused to answer a question
aoout the Super Bowl tickets, saying thbrieting was on a "'technical issue. At
cording to Reuters news service, he told
reporters after the session that the repor'
about the Super Bowl trip "is replete with
inaccuracies" and that after an independent counsel is named. "'I will begin to
answer and tell and speak and refute " the
allegations.
Status of New Test
The new. rapid-test method i : i't yet
capable of singling out specific pathogens
such as salmonella or E.coli. which are
produced by fecal contamination and can
be deadly for consumers. But Mr. Espy
said that if his department hadn't moved
ahead vnth yesterday s announcement.
" there could be another accusation" that
it was dragging its heels. Critics have said
that the department has gone slower on
"zero tolerance" for poultry fecal contamination than it has for other meat. The
secretary said that when he took office,
existing rules for red-meat contamination
weren't being enforced and rules for poultry hadn't even been developed.
.As for the new test, officials said that by
detecting high levels of any bactenum. the
test will enable inspectors to take steps to
reduce bactena-harmful or otherwisefrom meat on processing lines. The tes;
ln^•olves swabbing pan of ;ill of itv
meat carcass with a sponge, removing the
bacteria from the sponge and then analy^
ing the amount of those bactena.
The new meat-inspection test adapts
technology that the beer and pharmaceuti
cal industries are already using to detect
bacterial contamination on processing
equipment.
�,
Major Reform Unlikely in'94;
Modest Measures Are Still Alive
steps" that do more harm to the
healtii care system than good. The each other rather than drowning."
White House Chief of Staff Leon E.
president and his aides have had sevSenate Majority Leader George J. Mitch- eral discussions about formaUy caUing Panetta and Deputy Chief of Staff
eU (D-Maine) said yesterday that the Senate for a suspension of any further debate Harold Ickes yesterday both tried to
WlU recess without enactmg health care leg- on healtii care m this session of Con- leave open hope that MitcheU and his
islation, effectively ending any chance of ful- gress, but have opted in deference to group could produce something. PafiUing President CUnton's hopes for compre- MitcheU to avoid making the decision netu said. tiunk it may be healthier
henswe reform this year.
to totaUy throw ui the towel untU after for everyone to be able to take this
' Both MitcheU and CUnton yesterday said the recess.
break and to have the key parties conihe recess until after Labor Day does not
Time has always been the major tmue to negotiate in what 1 think will
mean the end of health care reform. But problem. Two weeks ago, with the be a quieter atmosphere."
Democrats and RepubUcans across the pohti- House at an impasse and waiting for
Ickes said, "^e are close to the
Tal spectrum, inchiding some of the presi- tiie Senate to act. MitcheU had said he edge" of concluding there is no pos^nt's strong defenders and many White would keep senators in six days a sibiUty for significant reform, "but
iouse ofScials, sakl the epic legislative bat- week with no vacation as long as prog- not at the edge."
^ that began last fall when Chnton deUv- ress could be made on forgmg a comOthers, however, described Ickes
ired to (x)ngress his ambitious reform plan promise bUl. Witii both bodies now as arguing privately, along with most
JS now effectively over.
staUed. the clock has started running others in the White House, that .
Most agreed that the only remaining hope toward the Nov. 8 elections, with nothing the mainstream group is
is for modtet regulatory measures and per- House and Senate members wonder- Ukely to do, considering its distance
haps k)w-income suSsklies wiien (xingress ing how eariy leaders wUl let them go from CUnton, is close to acceptable
home m October to campaign.
reconvenes Sept. 12.
to a president who in January, wieldDemocrats and RepubUcans said ing a pen, said he would veto any"There's a '({rowing consensus that an incremental apiiroach is aU we can do." said yesterday the only health care bill thing that did not provide universal
Sen. Christopiier J. Dodd (D-Conn.), who has that could -win passage m the Ukely coverage for aU Amencans.
Semor officials said that the onlv
supported Clinton-style change. "A very le- space of a month avaUable to them
gitimate question is, can you even do that? after Labor Day is one that would health care legislation that stUl is posThe dock is the 101st senator and has tre only impose new rules on the msur- sibte and that the presklent coukl sign
mendous power around here, with elections" ance industry and provide modest in- is "minimalist... and not reform, only
just eight weeks after Congress is scheduled surance subsidies for low-income health care steps that wouki aid some
people from a cigarette tax and from part of tiie population." Such legisia- .
to retnro,
multibUUon-dollar cuts in Medicare tion, for example, could indude insur-..
"The moment of truth, when you have to and Medicaid.
ance industry refonn, guaranteed covface facts, has come this week," said Sen.
MitcheU sakl he plans to use tiie erage for chUdren under a certain age, •
Harris Wofford (D-Pa.), whose 1991 upset two-week recess to negotiate with expanded prescription drug coverage.!
victory propelled the health care issue into leaders of a self-described "main- and at least temporary subsidies for
the natranal pohtical arena. A supporter of stream coaUtion" of 20 senators. The some coverage for workers who lose
broad-based reform, induding the universal loose-knit group, with an equal num- their jobs. But deciding how to pay for
coverage sought by Clinton, Wofford said ber of Democrats and Republicans, that expansion would be likely to
yesterday he believes a much scaled-back biU has proposed a plan that faUs far short cause major debate.
of (Clinton's original plan and the
"The fact of the matter is there is
'
HEALTH,FromAl
scaled-back versun of the president's no time to pick up any pieces any- \
could pass and would be a "histonc plan proposed by MitcheU,
more," said a senior official. "When
Clinton on Wednesday sharply Congress comes back, you have at
« first instaifanent... that the presicriticized the direction that group best a month. There is no conceivdent shoukl sign."
was
taking and said its refusal to able way to put together anythmg.
Part of what strangled tiie White
House hopes was the drawn-out support the cost controls and em- probably anything even modest, and combat this month over the crime ployer mandates he proposes was it is now time for us to frame this isbiU, which dragged Clinton and many "the nub of aU our other problems."
sue as afightfor the next Congress
Although liberals had hoped to and a president who won't give un •
of his aides into a two-week battie,
<.J
nrst m the iTouse and this week m make significant changes to the bi- rather than have it jUoi <Ma: ,^v/ay. "
the Sei'ate. Their vacation eaten partisan group's bUl—adding an emSixteen Democrats commiLted to
away, senators on both sides of ihe ployer mandate, dropping a pro- a umversal coverage LUl painted yesaisle pressed hard to go home once posed tax on some health benefits terday's developments as a positive —
and adding new subsidies for the step. "It reaUy is a breakthrough for ^
the crime bUl was dealt with.
:•
Asked whether health care reform poor—many members of the group all of us," said Sen. Thomas
is now offidaUy dead, CUnton said threatened to waUc away from any Daschle (D-S.D.). The recess, h e r
yesterday, " I wouldn't say tiiat." In kmd of health care reform if their said, would give Democratic leaders
^deference to Mitchell's efforts to proposal is not kept more or less in- and the mamstream group time to
',
continue informal discussions over tact.
work out their differences.
That stance has left Uberals and
;, tiie Labor Day recess, he added, "I
Several RepubUcans said yesterthink the less I say the better."
others to decide whether to accept a day that they would be willing to acs '
But privately, several officials in- bUl tiiat is far differentfiromthe one cept an mcremental approach close
\'
volved in tiie effort at the White CUnton and MitcheU proposed or to to the mainstream proposal. But othHouse acknowledged that whatever fight on, knowing there is not a major- ers readied for a fight. "These guys
may emerge from here on wiU be so ity for a more substantial measure.
have got to accept the fact that for
far from what the president once en"Everyone, including liberals, two weeks they've been draggmg a visioned as to leave him with no agrees an incremental approach is dead body around." said Sen. Phil-.'.^
choice but to opt for "strangUng it at better than nothing," said Sen. Max Gramm (R-Tex.)."... MitcheU held*"'
buth and caUing for . . . a new Con- Baucus (D-Mont.). Over the recess, up a smaU flag today, but it was a
gress with a fresh outiook."
"the mamstreamers. MitcheU and non- whiteflag"01 surrender.
A senior official saidtinsweek tiiat mainstreamers are gomg to try to aU
CUnton and his top aides have been swim togetiier witii tiie idea of helpmg
"poUticaUy gammg" what to do about
tiieu- lost hopes for major reform, vnth
CUnton opposed to what he caUs "halfFRIDAY.AliCllST2f^.lQ0iwn^^^^^^^^^^ ,
By Ann Devroy and Dana Priest
W jshmKlor Post Stiff Wmm
�4
•-' .
'.; •,
v: '
and his l i e u t e n a n t s would face a r r e s t i f A r i s t i d e regains power
as he i s scheduled t o by Oct. 15." (LAT)
I n a front-page p r o f i l e o f Gen. S h a l i k a s h v i l i , USA Today's
Judy Keen reported t h a t , " S h a l i k a s h v i l i i s no Powell and doesn't
want t o be. I n o f f i c e , Powell was p o l i t i c a l , aggressive,
sometimes contrary. He craved a t t e n t i o n . S h a l i k a s h v i l i i s
unobtrusive and adamantly a p o l i t i c a l . He i s e x a c t l y the kind of
chairman President C l i n t o n wanted." (USA Today)
•'; , •'•'• '•
POLLS —
The Los Angeles Times's David Lauter reported
'/
t h a t , "Americans generally approve of the negotiated settlement
to the c r i s i s i n H a i t i but remain s k e p t i c a l about long-term U.S.
involvement i n that country and unconvinced t h a t any v i t a l
I n a t i o n a l i n t e r e s t i s present there, according t o a Los Angeles
Times p o l l . " The d i v i d e d view of the H a i t i a n s i t u a t i o n "has had
no measurable impact on Clinton's o v e r a l l standing or on domestic
p o l i t i c s g e n e r a l l y . " (LAT) Americans approved of the agreement
- ." • 67% t o 27%, but disapproved o f sending U.S. troops t o H a i t i 53%
to 43%. (LAT) Asked i f the • President' s actions i n H a i t i made
\j
them f e e l more or less favorable t o him, 65% said H a i t i had no
e f f e c t . (LAT)
Forty-two percent approved of Clinton's o v e r a l l job-handling
'., as President; 52% disapproved. F i f t y - t w o percent said C l i n t o n was
,r, an " e f f e c t i v e " president. T h i r t y - f o u r percent said C l i n t o n was a
';. • ;
"strong and decisive leader;" 59% d i d not. (LAT) F i f t y - t w o
'.;.'•. percent disapproved of the President's handling of the economy,.'
/.
and 55% disapproved of h i s handling of f o r e i g n a f f a i r s . (LAT)
,
Forty-four percent said they were leaning toward Democrats i n the
y'. ', November e l e c t i o n s ; 43% said they were leaning toward GOP
candidates, "a r e s u l t that points toward heavy losses t h i s
November from the Democratic congressional m a j o r i t i e s . " (LAT)
'••
HEALTH CARE — ABC's Peter Jennings reported that the
struggle t o salvage health care reform was declared dead
:J
yesterday. ABC's John Cochran reported that Democrats admit
; . t h e r e i s l i t t l e they can do now but blame Republicans.
CBS's Bob
'', . S c h i e f f e r reported that i t was an "anniversary of s o r t s , " but no
one at the White House was c e l e b r a t i n g .
Cochran reported that Sen. M i t c h e l l i s considering conceding
without a vote, a d i f f i c u l t t h i n g f o r him t o do. (ABC) Cochran
also reported that on the f i r s t anniversary of the President's
health-care address. Republicans chose yesterday t o declare
health car^iii^eform dead "to cause maximum embarrassment t o the
• White Hd^rse."\
Sen. Dodd J(D-Conn.) said, " I t has become abundanr^Ty^lekr t o
me...th\at the forc^!i^-^?J"^---g r i d lock have won." (ABC) S^n. Gramm (RTex.) sa^kt,__!!2Ti tife endV . the President misjudged the'^^Ainericen
. • p e o p l e . " (ABC) /Sen. Done said, "The people do not want Congress
to pass a massilve healt>i care reform plan i n the f i n a l hours w i t h
no hearings, wirh-~n£X--tame t o read the plan much less understand
• ^ i t . " (CBS)
ABC's Jackie Judd reported that a new study by C i t i z e n
Action showed that $4 6 m i l l i o n went i n t o the campaign t r e a s u r i e s
of members of Congress. CBS's Bob S c h i e f f e r reported t h a t the ,
'.. I
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
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2006-0885-F
Text
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Dodd, Christopher (D-CT)
Creator
An entity primarily responsible for making the resource
Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
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2006-0885-F Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Preservation-Reproduction-Reference
Date Created
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2/6/2015
Source
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42-t-12092992-20060885F-Seg2-007-013-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/9269d6b51b1e6759d69af0f4faf674a6.pdf
98591e0bb777fe7f8ffb2df85057c1aa
PDF Text
Text
FOIA Nuinber:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3665
FolderlD:
Folder Title:
DeConcini, Dennis (D-AZ)
Stack:
Row:
Section:
Shelf:
S
52
3
3
Position:
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. resume
re: Andrew W. Nichols (partial) (I page)
04/22/1993
P6/b(6)
002a. memo
Nancy Carlci to Amanda Carver; re: DeConcini Family Information
(1 page)
12/17/1992
Personal Misfile
002b. resume
re: Susan Hurley DeConcini (Mrs. Dennis DeConcini) (2 pages)
12/17/1992
Personal Misfile
002c. resume
re: Susan Hurley DeConcini (2 pages)
12/18/1992
Personal Misfile
003. letter
Lenore Gaudin & Mordecai Roth to Senator Deimis DeConcini; re:
Invitation to Heaito Care Task Force (partial) (1 page)
03/12/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Heaito Care Task Force
Steve Edelstein
OA/Box Number:
3665
FOLDER TITLE:
DeConcini, Dennis (D-AZ)
2006-0885-F
ip2645
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes j(b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions j(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells j(bX9) of the FOIAj
National Security Classified Information [(a)(1) of the PRAj
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute |(aX3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�ROBERT C BYRO. WEST VIRGINIA. CHAIRMAN
DANIEL K INOUYE. HAWAII
ERNEST F HOUINGS. SOUTH CAROLINA
J. BENNETT JOHNSTON. LOUISIANA
PATRICK J. LEAHY. VERMONT
JIM SASSER. TENNESSEE
DENNIS DECONCINI, ARIZONA
DALE BUMPERS, ARKANSAS
FRANK H LAUTENBERG, NEW JERSEY
TOM HARKIN, IOWA
BARBARA A MIKULSKI. MARYLAND
HARRY REID, NEVADA
J. ROBERT KERREY. NEBRASKA
HERB KOHL. WISCONSIN
PATTY MURRAY, WASHINGTON
DIANNE FEINSTEIN, CALIFORNIA
MARK 0 HATFIELD. OREGON
TED STEVENS, ALASKA
THAO COCHRAN, MISSISSIPPI
ALFONSE M D'AMATO. NEW YORK
ARLEN SPECTER. PENNSYLVANIA
PETE V DOMENICI, NEW MEXICO
DON NICKLES, OKLAHOMA
PHIL GRAMM, TEXAS
CHRISTOPHER S BOND. MISSOURI
SLADE GORTON, WASHINGTON
MITCH McCONNELL. KENTUCKY
CONNIE MACK, FLORIDA
CONRAD BURNS, MONTANA
lamted States Rotate
COMMITTEE ON APPROPRIATIONS
WASHINGTON, DC 20510-6025
|^
^
JAMES H ENGLISH, STAFF DIRECTOR
J. KEITH KENNEDY, MINORITY STAFF DIRECTOR
A p r i l 22, 1993
Mrs. H i l l a r y Rodham C l i n t o n
Chairperson
Task Force on H e a l t h Care Refonn
The White House
Washington, D. C.
Dear Mrs. C l i n t o n :
I am w r i t i n g t o s t r o n g l y recommend Andrew W. N i c h o l s , MD,
MPH, as a c o n s u l t a n t t o t h e Task Force on H e a l t h Care Reform.
Dr. N i c h o l s i s t h e D i r e c t o r o f t h e R u r a l H e a l t h O f f i c e and
P r o f e s s o r o f F a m i l y and Community Medicine a t t h e U n i v e r s i t y o f
A r i z o n a C o l l e g e o f Medicine i n Tucson, A r i z o n a . He i s a w i d e l y r e s p e c t e d l e a d e r i n t h e Southwest on r u r a l h e a l t h and b o r d e r
h e a l t h i s s u e s who a l s o serves i n t h e A r i z o n a House o f
Representatives.
As P r e s i d e n t o f t h e Arizona-Mexico Border H e a l t h Foundation
and D i r e c t o r o f t h e A r i z o n a Area H e a l t h Education Center, Dr.
N i c h o l s has s u c c e s s f u l l y worked w i t h r u r a l and b o r d e r communities
t o address t h e i r h e a l t h care i s s u e s from a l o c a l , r e g i o n a l and
n a t i o n a l p e r s p e c t i v e . He has been a key member o f t h e N a t i o n a l
E d i t o r i a l Boards o f t h e J o u r n a l o f R u r a l H e a l t h and The AHEC
B u l l e t i n s i n c e 1985. I have no doubt t h a t t h e Task Force and i t s
w o r k i n g groups would b e n e f i t from Dr. N i c h o l s ' e x p e r t i s e and
a s s i s t a n c e . I am convinced t h a t you would f i n d Dr. N i c h o l s '
c o n t r i b u t i o n s an a s s e t t o your work on h e a l t h care r e f o r m . Dr.
N i c h o l s i s prepared t o make h i m s e l f a v a i l a b l e t o a s s i s t w i t h t h e
d i f f i c u l t t a s k a t hand.
I am e n c l o s i n g Dr. N i c h o l s ' b i o g r a p h i c a l i n f o r m a t i o n f o r
your r e v i e w .
I s t r o n g l y urge t h a t Dr. N i c h o l s be r e t a i n e d as an
e x p e r t c o n s u l t a n t w i t h t h e Task Force.
Thank you f o r y o u r
consideration.
Sincerely,
DENNIS DeCONCINI
U n i t e d S t a t e s Senator
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. resume
SUBJECT/TITLE
DATE
re: Andrew W. Nichols (partial) (1 page)
04/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3665
FOLDER TITLE:
DeConcini, Dennis (D-AZ)
2006-0885-F
jp2645
RESTRICTION CODES
Presidential Records Act - j44 U.S.C. 2204(a)j
Freedom of Information Act • |5 U.S.C. 552(b)j
PI
P2
P3
P4
b(l) National security classified information j(bXl) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIAj
b(3) Release would violate a Federal statute j(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information j(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes [(bX7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
nnancial institutions [(b)(8) of the FOIA[
b(9) Release would disclose geological or geophysical information
concerning wells [(bX9) of the FOIA[
National Security Classified Information j(aXl) of the PRAj
Relating to the appointment to Federal office j(aX2) of the PRAj
Release would violate a Federal statute j(aX3) of the PRAj
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors ja)(5) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy j(a)(6) of the PRAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�BIOGRAPHICAL SKETCH
Andrew W. Nlchosl, MD, MPH
P E R S O N A L DATAt
PLJ«:E OF BIRTH:
P6/(b)(6)
DATE OF BIRTH:
POSITION TTTLE:
P6/(b)(6)
Professor of Family and Community Medicinfi. and
Director, Rural Health Office
ADDRESS:
P6/(b)(6)
•
PHONE NUMBERS:
Office: (602) 626-7882
Homef
P6/(b)(6)
gPUCATIONAL DATA:
A.B. In Psychology and Zoology conferred 1959. Swarthmore College, Swarthmora,
Pennsylvania. With Honors.
M.D. in Medicine confen^d 1964. Stanford Medical School, Palo Aito, California.
M.P.H. In Health Services Administration and Tropical Pubfic Health conferred 1970.
Harvard School of Public Health, Boston. Massachusetts.
Postgraduate Fellowship in Community Medicine, Georgetown Unlvera'ity,
Washington, D.C, 1977-7a (While on sabbatical leave from The University of
Arizona.)
PRQFeSfiinWAL EXPERIENCE!
1986*Pre8ent
Chief, Community Medicine Section. Department of Family &
Community Medicine, College of Medicine. University of Arizona.
1983- 1388
Fogarty Senior Internatiotiai Failowship aixi Sabbatical in USMexico Border Health Studies. Mexico City. Mexico.
198S*Present
President. Arizona-Mexico Border Health Foundation
1 gas-Present
National Editorial Board, Journal of Rural HeaHh
1985-Presant
National Editorial Board. The AHgC Buitotm
1984- Pre8ent
Director. Arizona Area Health Education Center Project
�1981-Present
Chairperson, Public Haalth Committee, Arizona-Mexico
Commission
1980*Present
Director, Rural Health Office. University of Arizona
1977*1978
Robert Wood Johnson Health Policy Fellowship and Sabbatical in
Health Policy. Institute of Medicine, National Academy of
Sciences. Washington, D.C.
1970-Pre8ent
Professor, Associate Professor, and Assistant Professor of Family
and Community Medicine, University of Arizona College of
Medicine.
1968-1969
Resident in Internal Medicine at St. Luice's Hospital, New Yor1<,
New Yori<. and, simultaneously, Resident In Public Health at New
York City Health Department
1958-1988
SL-rgscn, 'J.S. PjbWz He&\ih Service with assignment lo Peace
Corps, Peni.
1964-1966
Intern and Assistant Resident In Intemal Medicine at St. Luice's
Hospital, New Yorli. New York.
PUBLICATIONS:
1992 - Nichols, A.. LaBrec, P., Homedes. N.. and Geller, S. 'Perceptions and
Preparations for Free Trade: The Use of Arizona Physician Servtoes by
Residents of Mexico.' Accepted by Saiud Ptibiica de MQ»CQ. December, 1992.
1992 - Nichols, A.: 'Health Impact of the North American Free Trade Agreement.' In
Frae Trade at thH Crossroads. 61« Arizona Town Hall, Flagstaff, Arizona,
October, 1992.
1990 - Nichols. A., LaBrec, P., Homedes, N., Geller, 8., and Estrada, A.: Utilization of
Haalth SarviciBS Along tha U.S.- Mexlcn Border Monograph No. 23, Southwest
Border Rural Health Research Center, December, 1990.
1990 - Nichols, A. and Geller, 8., "Area Health Education Center Research issues in
the 1980"s: An Agenda for the 1990's,' Journal of Rural Health. Vol. 8. No, 4, op.
543-552.
1990 - Nichols. A. W., "The Evolution of the AHEC Program: From Carnegie
Commission Report to a Nationai Resource," The National AHEC Bulletin. Fail,
1990, pp. 3-4 and 23.
1990 • Ijopes, P. and Nichols, A: "Community Rnanced and Operated Health
Services: The Case of the Ajo-Lukeville Health Service District," Journal of
Rural Health. Vol. 6. No. 3. pp. 273-285. July, 1990.
1990 • Nichols, A.: "Health Without Borders," Border Health. Vol. VI. No. 2. April, May,
June, 1990, pp. 2-5.
�1990-Nichols, A.: "Growth of Micro Campuses In Arizona: The AHEC Experience."
/^rj^pna Medicine. Vol. XLVII, No. 5, May, 1990. pp. 4-5.
1989 - Nichols. A.W., "AIDS Along the U.S. - Mextoo Border." Border Health. (Special
Issue), August, 1989, pp. 30-32.
1988 - Nichols. A.W., Kettel, LJ.: 'The Arizona Area Health Educatnn Centers: New
Solution, Old Problem or Old Solution, New Problem?" Ariyona Medicine. Vol.
148, No. 1, January, 1988, pp. 10,18.
1987 • Nichols. A., Silvestein, G.: "Financing Medical Care for the Underserved in an
Era of Federal Retrenchment: The Health Service District." Public Health
Repflftg. Vol. 102, No. 6, DHHS, November/December, 1987, pp. 689-691.
1987 - Gordon, R., McMullen, G., Weiss, B., and Nichols, A.: 'The Effect of Malpractice
Liability on Delivery of Rural Obstetrical Care." .irinrnai of Rural Health. Vol. 3.
No. 1, January, 1987, pp. 7-13.
fii20J&
1980 - Burton, L. Smith, H., and Nichols. A.. Public Health and Community
Medlcine.Thlrd Ed.. Williams and Wilkins. Baltimore, Septs^ber, 1981.599 pp.
HONORS. OFFICES AND A W A R D S :
1.
Fogarty Senior Intemational Fellow. Fogarty IntematlonalCenter, National
Institutes of Health, Washington, D.C, 1985-66. (While on sabbatical leave
from The University of Arizona.)
2.
Outstanding Health Worker of the Year Award, U.S.-Mexico Border Health
Association, 1986.
3.
Elected Chairperson. Editorial Board, Journal sH Rural Idealth, one year temis,
1988, 1989 and 1990.
4.
Elected President. U.S.^MexicQ Border Health Association, one year tenn
(1989-90), 1989.
8.
Elected Vice-President, National Organization of AHEC Program Directors, two
year term (1989-91). 1989: elected President, two year tenn (1991 -93), 1991.
a
Selected Grant Reviewer, Nationai Institute on Aging, National institutes of
Health, 1990.
7.
Merit Award, U.S.-Mexico Border Health Association, 1991.
8.
Elected Member, Arizona State Legislature, House of Representatives, two year
term (1993 - 94), 1992.
4/11 MS
Ulm
�Arizona - Senior Senator
Dennis DeConcini (D)
Of Tucson — Elected 1976
Born: May 8, 1937, Tucson, Ariz.
Education: U. of Arizona, B.A, 19.59, LL,R, 196:1.
M i l i t a r y Service: Armv, 1959-60: Army Reserve. 196067.
Occupation: Lawyer.
Family: Wife, Susan Hurley; three children.
Religion: Roman Catholic.
Political Careen Pima County attorney, 1973-76.
Capitol Office: 328 Hart Bldg. 20510; 224-4521.
In Washington: DeConcini is just brazen
enough to brush off an Ethics Committee rebuke
of the improper appearance of his involvement in
the Keating Five affair. "Aggressiveness has
always been my hallmark," he said in early 1991.
Of the five senators investigated, DeConcini was perhaps the most militant in behalf of
savings and loan magnate Charles H. Keating
Jr., and the most combative in defending himself. Throughout the H-month investigation,
DeConcini was unapologelic for his efforts to
gel federal regulators to ease up on Lincoln
Savings, and for his acceptance of .$85,000 in
campaign contributions raised by Keating.
"There is no improper conduct standard
that says you cannot intervene for someone . . .
who made a campaign contribution," he said as
the 26-day televised hearing opened.
DeConcini took the investigating committee's recommendation thai he not be punished
as a full exoneration, and he did his utmost to
make a virtue of the aggressive posture that
placed him at the heart of the Keating affair.
DeConcini is nothing if not blunt about his
mission as a senator and the way Capitol Hill
works. "It's our job to gel things done for our
constituents," he said in 1989, defending earmarks in the bill approved by the Appropriations Subcommittee on Treasury, Postal Service and General Government, which he chairs.
The Keating episode tarnished the public
perception of DeConcini as a law-and-order
Democrat. But in the Senate, it seemed lo have
little effeci. There DeConcini is known as a
moderate conservative who voles carefully and
is willing lo deal to get things done.
Even al the height of the maelstrom over the
Keating affair, DeConcini's moderate to conservative outlook continued to make his vole a
crucial one on the Judiciary Committee and the
Senate floor. He is oflen one of the last senators to
make up his mind, and along the way he is courted
by Democrats and Republicans. But if DeConcini
frequently parts company with his party's leaders, he rarely casts the vote that denies them a
victory on an issue truly dear lo Ihem,
In 1990, after Majority Leader George J.
54
Mitchell of Maine, was defeated by three votes
on a key clean air issue, he personally appealed
lo DeConcini to help him reverse the outcome.
DeConcini had opposed Mitchell on that vote,
as well as in the leadership race a year earlier.
But he agreed to withhold his vote that day,
pairing with an absent senator who supported
Mitchell and helping the majority leader score
an important victory.
DeConcini seems unbothered by the perception that his voles are often open to negotiation. In 1990, after Ohio Sen. Howard M. Metzenbaum dropped his effort to block DeConcini's
bill lo reform the federal racketeering statute
known as RICO, DeConcini gave Metzenbaum
the deciding vole on the Judiciary Committee
for the Ohioan's vertical price fixing bill, even
as DeConcini said he opposed it.
DeConcini's willingness to push RICO reform in the midst of the Keating hearing raised
a few eyebrows. While the Arizonan is just one
of many critics of the statute, the law was being
widelv used lo bring charges against executives
of fai'led S&Ls,
DeConcini's admirers saw his effort as a
positive sign that his aggressive nature was unbent by the scandal. Bul his motivation was
questioned at one 1989 Judiciary Committee
meeting at which as much lime was spent defending him as debating his bill. " I think everyone has
entered this debate with clean hands," said
Chairman Joseph R. Biden Jr. of Delaware.
DeConcini's original bill lo narrow RK^O's
reach limited the triple damages allowed under
current law, even though the government was
seeking them lo recoup a share of the S&L
funds lost. While DeConcini stood by that
amendment, he did eliminate a retroactive
clause that would have applied the new law lo
cases already in court, including Keating's,
His bill had supporters ranging from President Bush lo several Senate liberals. But the idea
of weakening RICO during the S&L crisis made
members queasy. After Metzenbaum took his
hold off the bill, it passed the committee on a 12-2
vole in early 1990, bul i l moved no further,
DeConcini's 1989 amendment to block the
�Dennis DeConcini, D-Ariz.
sale of certain military style assault weapons met a
similar fate, but if that effort was also controversial, at least it had a wider audience of enthusiasts.
At the outset, DeConcini was torn between
allies in the National Rifle Association, who
opposed any restriction on weapons sales, and
allies in law enforcement, who backed a farreaching ban offered by Metzenbaum, DeConcini tried to split the difference with an amendment banning the sale of nine assault weapons,
half as many as the Metzenbaum bill. Bul he
wound up infuriating the NRA, which launched
a brief recall drive against him.
That the conservative-minded DeConcini
had introduced the amendment gave supporters
of gun control a powerful boost. After months of
furor, the Judiciary Committee on a tense 7-6
vote supported the amendment. (Because the bill
also included an expansion of the federal death
penalty, which DeConcini also supports, he was
one of just two Judiciary Democrats to vote to
send the package to the floor,) His assault weapon
amendment was then sustained on a 52-48 vote of
the full Senate, but no agreement could be
reached with the House, and it was dropped.
The backdrop to these 101st Congress activities was the highly publicized Keating investigation. By late 1989, the $2 billion price tag on the
failure of Keating's Lincoln Savings and Loan of
California coupled with the Senate scandal
emerged as emblems of the debacle. The Keating
Five included Democratic Sens. Alan Cranston,
Donald W, Riegle Jr. and John Glenn along with
Arizona Republican John McCain.
DeConcini was forced to defend himself
against charges that he acted more as a negotiator in Keating's behalf lhan as a senator
asking legitimate questions of a regulator. During the 26 days of televised hearings in late 1990
and early 1991, he was singled out as the most
aggressive of the five senators by two key witnesses, including former Federal Home Loan
Bank Board Chairman Edwin J. Gray.
The case against the five senators hung on
the nexus between their intervention and the
political contributions they collected from
Keating. Of the $1.3 million Keating raised for
the five, a relatively small share went to DeConcini: $33,000 for his 1982 re-eleclion, and
$48,000 for 1988.
From his days as Pima County prosecutor in
the mid-1970s, DeConcini knew of Keating as a
Republican antipornography crusader and prominent businessman. The two met at a country club
in 1981, the same year DeConcini unsuccessfully
lobbied Presideni Ronald Reagan to nominate
Keating to be ambassador to the Bahamas.
After Keating's American Continental
Corp., which employed 2,000 Arizonans, bought
Lincoln in 1984, the two discussed Gray's efforts to clamp down on the thrift industry,
which neither suiiported. In 1986, DeConcini
urged Reagan to make a recess appointment of
a Keating associate to the bank board. The
president did, but the man resigned months
later under the cloud of a Justice Department
investigation of his lies lo Keating.
In 1987, it was DeConcini who called (iray lo
schedule the pivotal April 2 meeting in his Senate
office between Gray, four of the five senators, and
no staff. Gray alleged that he was asked to refrain
from enforcing a tough bank board regulation
restricting Lincoln's investments and that DeConcini offered the government a deal on
Keating's behalf. DeConcini disputed this,
A week later the five senators met with
other regulators more intimately involved in the
Lincoln case. Again, the meeting was in DeConcini's office, and again, DeConcini took the
lead. No one disputed that he opened the
session saying, "We wanted to meet with you
because we have deiermined that potential actions of yours could injure a constituent." The
meeting broke up when the regulators mentioned criminal referrals involving Lincoln.
DeConcini stopped inquiring about Lincoln
until the end of 1988, when he made repealed
calls lo M . Danny Wall, who succeeded Gray as
bank board chairman. DeConcini allegedly urged
state and federal regulators not to seize Lincoln
bul to allow Keating lo sell it.
But on April 13, 1989, American Continental filed for bankruptcy. The following day
federal regulators seized Lincoln, That fall, the
government sued Keating and American Continental, alleging among other things that Lincoln's money had been siphoned off into campaign contributions. With
that
action,
DeConcini returned the contributions raised by
Keating for his 1982 and 1988 campaigns.
Throughout the investigation and the
hearings, DeConcini look issue with the actions
of Robert S. Bennett, the special counsel assigned by the Ethics Committee to the case.
DeConcini claimed that he was acting more as a
prosecutor than an impartial investigator, DeConcini also got ensnared in an ugly dispute
with fellow Arizonan McCain, who repeatedly
contrasted his role with DeConcini's.
In the end, the Ethics Committee rebuked
DeConcini and Riegle for the appearance of
improper behavior but did not issue harsher
sanctions, saying thai the rules governing appearances of impropriety are unclear. In the cases of
Glenn and McC^ain, the commillee faulted their
poor judgment, but did not even find the appearance of wrongdoing. In Cranston's case, the panel
said he may have engaged in improper conduct
and ordered further investigation.
While DeConcini does not appear to have
suffered greatly among his colleagues as a result
of the affair, it will likely disqualify him from
being considered for a top law enforcement job.
He was on Reagan's short list for the FBI
directorship, a job he was said to be interested
in, and in early 1989, Bush asked him to become
the first drug czar, an offer DeConcini declined.
DeConcini came lo the Senate after serving
55
�Arizona - Senior Senator
as the administrator of the Arizona Drug Control
District. Drug trafficking has become a bigger
problem for Arizona, he says, because importers
of Latin American narcotics have shifted their
primary routes from Florida lo the West. As vice
chairman of the Senate Drug Enforcement Caucus, DeConcini was active in the 1986 movement
to pressure foreign governments to curb the drug
trade at its source. In the lOlst Congress, he
helped enact a pay hike for federal law enforcement officials, and unsuccessfully pushed to
increase funding for antidrug programs by taking
money from the Pentagon.
DeConcini's political position thrusts him
into the spotlight during judicial confirmation
hearings, when his vote can be pivotal. A l the
start of the 102nd Congress, he was the last
member of the Judiciary Committee to announce his opposition lo Bush's nomination of
Kenneth L. Ryskamp to the federal appeals
court; Ryskamp was rejected on a 7-6 vote.
In 1987, as the Senate weighed Reagan's
nomination of Robert H. Bork to the Supreme
Court, DeConcini was a key swing vote. Late in
the process, he announced his opposition, saying
Bork's record on discrimination was lacking. But
he worried aloud about the political ramifications
of the vote. In the end, it proved a sawy political
move. The vote rallied Arizona Democrats frustrated by his relatively conservative record, without serious risk of riling many Republicans.
Bork's strongest supporters in the state were
arch-conservatives preoccupied with trying to
keep Evan Mecham as governor during the events
leading to his impeachment. While Bork campaigned for DeConcini's 1988 opponent, the vote
never became a cutting issue.
The movement that provides refuge to
Central American immigrants is strong in Arizona, and along with Massachusetts Democratic
Rep. Joe Moakley, DeConcini favors legislation
to grant Salvadorans and Nicaraguans special
immigration status. He has managed to get the
bill through a Judiciary subcommittee several
times, but it has been blocked repeatedly by
Republican Alan K. Simpson of Wyoming.
DeConcini has become a severe critic of U.S.
missile sales if he thinks the weapons could end
up in the hands of terrorists. This has put him at
the forefront of efforts to block some arms sales to
Arab nations, sometimes even after the pro-Israel
lobby has compromised. In 1987, he sought to
prevent the sale of shoulder-fired Stinger antiaircraft missiles to Bahrain. In 1988, he led the
Senate forces opposed to the sale of Maverick airto-ground and air-to-sea missiles. In both cases,
he lost, although he did gain restrictions.
He is also a leading congressional supporter
of Angolan guerrilla leader Jonas Savimbi. In the
101st Congress, the Senate approved his amendment conditioning aid to the U.N. peacekeeping
forces in Angola on a certification that Cuba and
Angola were living up to their part of the deal.
As a freshman, DeConcini became a major
56
player during the Senate's bruising 1978 debate
over the Panama Canal treaties. Just a year into
his first term, he wound up playing the pivotal
role in ratification of the two pacts. I l was
through his reservations lo the treaties, assuring the United States the right to intervene to
keep the canal open in case of trouble, that the
leadership finally drew enough support to assure .Senate api)roval.
At Home: The only Democrat to win a
Senate election in Arizona in nearly 30 years.
DeConcini puts considerable effort inlo securing himself against a conservative challenge al
home. Coupled with a bit of luck — local GOP
warfare in 1976 and 1988 and a good Democratic year in 1982 — his efforts have kept him
from ever being seriously threatened.
In the two years leading up to his 1988 reelection, DeConcini stockpiled campaign funds
and reinforced his well-regarded organization.
The GOP, meanwhile, was caught up in a bitter
feud sparked by Mecham's election to the governorship. After a stormy 15-month tenure, a
messy impeachment fight and a threatened
recall election, the GOP-controlled Legislature
threw Mecham out of office in April 1988. Just
when the GOP might have turned its attention
to DeConcini, pro-Mecham forces ousted seven
veteran GOP legislators in the September primary, further fracturing the party.
Virtually alone, 39-year-old businessman
Keith DeGreen made scant progress against
DeConcini, until he raised questions about the
incumbent's personal finances; that issue
prompted the National Republican Senatorial
Committee lo fund a $212,000 October TV
advertising blitz on DeCireen's behalf.
In 1979, DeConcini — a multimillionaire
with vast real estate holdings — together with
his family bought 320 acres of land for $400,000.
Before the purchase, the federal Bureau of
Reclamation had been publicly considering part
of the area as a possible route for a continuation
of the Central Arizona Project (CAP), a massive
aqueduct. The government chose the sile in
1981 and five years later reached a $1.4 million
settlement for 136 acres.
DeConcini also made a 1983 investment in a
development group that was involved in a similar
deal. Land purchased by the partnership for
$13,000 per acre was condemned by the federal
government in 1984 for construction of the New
Waddell Dam, which is part of CAP. In a 1987
settlement, the partnership ceded aboul half of
its original purchase for $20,000 per acre. DeConcini divested his 3.1 percent share of the partnership before the settlement when the U.S. attorney
ruled ibat his involvement in a negotiated water
rights settlement would violate a federal law
barring contracts between the government and
members of Congress. The senator gave his share
lo his siblings, though the U.S. attorney's decision
in the case was subsequently overruled.
DeConcini said he had no privileged knowl-
�Dennis DeConcini, D-Ariz.
edge of the government's plans in either deal. He
accused DeGreen of dirty campaign tactics and
lashed out at GOP Sen. John McCain for tacitly
condoning them. The episode added some drama
to what was expected to be a walkaway win; some
polls in the campaign's final weeks showed considerable volatility in the electorate. Bul most
voters knew too little of DeGreen to switch to him.
DeConcini won with a comfortable, if not spectacular, 57 percent.
Had DeConcini not paid such careful attention to his right flank over the years, the flap
might have caused him more trouble. But ever
since 1978, when enraged conservatives put up
billboards across the state condemning his vote
for the Panama Canal treaties, the Democrat
has rarely strayed far from the center-right.
In his 1982 campaign, GOP challenger Pete
Dunn, a three-term state legislator, used the
Panama issue as part of his argument that
DeConcini was a labor-backed liberal who
"talks like Ronald Reagan in Arizona and votes
like Ted Kennedy in Washington."
But by then, DeConcini had compiled a
record that made it difficult to brand him a
liberal. In 1981, he supported the conservative
coalition of Republicans and Southern Democrats 63 percent of the time. He won re-election
with 57 percent.
DeConcini campaigned for the Senate as a
conservative in 1976, when he defeated GOP
Rep. Sam Steiger. Stressing his law enforcement background as Pima County district attorney, he called for a crackdown on organized
crime in Arizona. As it happened, neither crime
nor any other policy issue had as much to do
with the November outcome as a vicious Republican primary between Steiger and fellow
Rep. John Conlan, longtime personal enemies.
Supporters of Steiger, a Jew, accused
Conlan of pandering to anti-Semitism in a pitch
for fundamentalist Christian votes. When Steiger won the primary, Conlan refused to endorse
him, and Democrats rallied behind DeConcini
in anticipation of a rare statewide victory.
DeConcini has his base in Tucson, the
state's second-largest population center. It is
where his family made a fortune in real estate.
His father was a state Supreme Court justice
and his mother a member of the Democratic
National Committee. A brother, Dino, is a former Democratic chairman in Tucson.
Committees
Key Votes
Appropriations (8th of 16 Democrats)
Treasury, Postal Service & General Government (ctiairman):
Defense; Energy & Water Development; Foreign Operations;
Interior.
Judiciary (4th of 8 Democrats)
Patents, Copyrights & Trademarks (chairman); Antitrust,
Monopolies & Business Rights; Constitution.
Rules a Administration (5th of 9 Democrats)
Select Indian Affairs (2nd of 9 Democrats)
Select Intelligence (6th of 8 Democrats)
Veterans' Affairs (2nd of 7 Democrats)
1991
Authorize use of force against Iraq
1990
Oppose prohibition of certain semiautomatic weapons
Support constitutional amendment on flag desecration
Oppose requiring parental notice for minors' abortions
Halt production of B-2 stealth bomber at 13 planes
Approve budget that cut spending and raised revenues
Pass civil rights bill over Bush veto
1989
Oppose reduction of SDI funding
Oppose barring federal funds for "obscene" art
Allow vote on capital gains tax cut
Joint Library
Voting Studies
Joint Printing
Elections
1988 General
Dennis DeConcini (D)
Keith DeGreen (R)
Previous Winning Percentages:
660,403
478,060
1982
( 57%)
(57%)
(41%)
1976 (54%)
Campaign Finance
Receipts
1988
DeConcini (D)
DeGreen (R)
$2,818,427
$244,971
Receipts
from PACs
Expenditures
$968,495 (34%) $2,640,650
$20,350 (8%) $238,369
Year
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
Presidential
Support
S
0
40 57
61 38
52 36
46 51
43 53
45 49
42 39
32 47
61 34
51t 381
Party
Unity
S
0
74 21
64 35
61 30
73 26
62 35
62 31
50 t 24 t
55 31
52 36
59 t 24 t
Conservative
Coalition
S
0
35 59
55 45
65 30
34 59
61 37
63 28
45 21
52 32
74 20
63 t 24 t
t Not eligible for all recorded voles.
Interest Group Ratings
Year
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
ADA
61
60
55
60
45
45
60
45
45
45
ACU
20
32
33
27
52
38
38
43
60
57
AFL-CIO
56
80
92
80
60
62
75
60
82
50
ecus
50
50
21
33
35
45
38
41
53
53
57
�TO:
AMj^A DEAVER
FROM:
NANCY CARKCI
RE:
ADDITIONAL DECONCINI FAMILY INFORMATION
DATE:
February 1, 1993
Here i s the remaining information t h a t you requested:
NAMES OF CHILDREN AND THEIR OCCUPATION:
Denise-pediatrician
Christina-Lawyer (Immigration)
P a t r i c k - Lawyer and p i l o t i n the National Guard, ( f l i e s F-16s)
Richmond, 'Virginia
Bob (Denise's husband)-University of Maryland: Alumni Fund
Development
Jim ( C h r i s t i n a ' s husband)-Lawyer
I f you need f u r t h e r i n f o r m a t i o n , please do not h e s i t a t e t o
contact me a t 202-224-2203.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002a. memo
SUBJECT/TITLE
DATE
Nancy Carlci to Amanda Carver; re: DeConcini Family Information
(1 page)
12/17/1992
RESTRICTION
Personal Misfde
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3665
FOLDER TITLE:
DeConcini, Deimis (D-AZ)
2006-0885-F
jp2645
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 5S2(b)|
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute ](bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information ](b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions ](b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells l(bX9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA]
Relating to the appointment to Federal office 1(a)(2) of the PRAj
Release would violate a Federal statute |(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRIM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�,2-n-92 06:56PM FROM DeConcini Washington TO 99131045
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P003/008
U.S. Senator
Lm
DENNIS
DeCONCINI
Arizona
Member of an Arizona family long active and prominent in goveri ment, the law,
and business, Dennis DeConcini was born in Tucson on May 8, 193 7. He aitended
public schools in Tucson and Phoenix, and graduated from the Unive siiy of Arizona
in 1959 and the UA's College of Law in 1963. He served in the U.S Army «md the
Army Reserve from 1959 through 1967.
Dennis was a founder of the Tucson law firm of DeConcini and l\|lcDonal j and a
member from 1968 to 1973. He also served as chief of staff for Governi r Sam Goddard
during his term in the mid-1960s, and in 1974 he managed Raul Cast ro's successful
statewide campaign for Governor.
In 1 972 Dennis was successful in his first bid for public office
ima County Attorney. While serving as Pima County's chief prosecutor, Dennis' pr >grams in drug
fctiiforcement and consumer affairs brought local and national recognitlo 1. His SI.Iff successf ully prosecuted a number of upper-level criminal cases. One inve '.tigatior begun
under Dennis' tenure ultimately led to the arrest and conviction of a n tionally known
organized crime boss. His office was named the model office of its si e in the nation
by the National District Attorneys Association, He received the state C ^unty Attorney
of the Year award for 1975, and was elected President of the Arizon Countv Attorneys and Sheriffs Association in 1976.
In 1 976 Dennis was elected to the United States Senate. He is a nember of t w o
of the most powerful Senate committees, the Appropriations and Jui iciary Comrnittees, and is also a member of the prestigious Select Committee on itelligei ice. He
is an active legislator. As a freshman he passed more bills than any oth )r Senator, and
The Wall Street Journal described him as the most likely member of IS class to 6ucceed. He has lived up to that high expectation.
Dennis is a member of the Senate's International Narcotics Cont ol Caut us. He
has received awards from such groups as the American Legion, the ^ a t iional l-ederation of Independent Businesses, the Federal Law Enforcement Offi cef s ' Association,
the National Secunty Caucus, and Childhelp USA. He has been award 3d an honorary
Doctor of Law degree from the New York Law School and the Univeijsity of Arizona
law school.
His father, Evo, served as Pima County Superior Court Judge, Arizona Attorney
General, and as an Ari7ona Supreme Court Justice. Dennis' rnother, Ore, was the state's
Democratic National Committeewoman from 1972 through 1980.
Dennis is married to the former Susan Margaret Hurley, member of 1 pioneer Phoenix family. The DeConcinis have three children, Denise, Christina and *atrick. Dennis
plays golf and tennis, and jogs as well. He and Susan belong to the C itholic Church.
In 197G, Dennis served as head of the Arizona Bishops Pastoral COL ncll.
In 1981 Susan received her master's degree in social work. She serv JS on thrj board
of the National Office nf Snrial Responsibility, the board of trustees at Cat nolic Un versity
and the board of directors of the Child Care Action Campaign
�[2-n-92 06:56PM FROM DeConcini Washington
TO 99131045
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DeCOIMCINI BIOGRAPHY
CONTINUED
>
Committee Assignments
Appropriations Committee
CHAIRMAN, Subcommittee on Treasury, Postal Service and Genera Government
Subcommittee on Defense
Subcommittee on Energy and Water Development
Subcommittee on Foreign Operations
Subcommittee on Interior and Related Agencies
Judiciary Committee
CHAIRMAN, Subcommittee on Patents, Copyrights and Trademarks
Subcommittee on Antitrust, Monopolies and Business Rights
Subcommittee on the Constitution
Committee on Rules and Administration (No Subcommittees)
Committee on Veterans' Affairs (No Subcommittees)
Select Committee on Indian Affairs
Select Committee on Intelligence (No Subcommittees)
Commission on Security and Cooperation in Europe (Chairman)
International Narcotics Control Caucus
Western Coalition of Senators (Co-Chairman)
Legislative Accomplishments and Priorities
CRIME AND THE LAW:
"Drugs are as insidious a threat to this nation as any foreign Invaslo . We cvr\ afford
no less than a total commitment in a war on drugs."
Author of the drug interdiction section of the comprehensive " A n t i Drug Abuse Act
of 1 9 8 6 , " which is now law.
Principal author of the most comprehensive anti-drug legislation in our (jountry'j history,
the "Anti-Drug Abuse Act of 1988."
Sponsor of legislation that would increaae federal funding for dru I educa iun and
rehabilitation programs.
Sponsor of legislation which ensures federal funding for state and I cal law .infnrcement anti-drug grants.
Brought on line existing, excess military aircraft to protect U.S. bdrders frDrn drug
smugglers.
Cosponsor of an amendment that would allow the death penalty for Irug smugglers.
Author of laws which allow judges to refuse bail to drug dealers
Cosponsor of bill to create a Cabinet-level position (Drug Czar) to cc ordinat( federal
narcotics enforcement efforts.
Cosponsor of bill thot would make it more difficult for Tedetal priso rjers to unnecessarily petition federal courts for retrials or release.
Cosponsor of bill requiring mandatory prison terms for violent cri m is.
Guided into public law the Equal Access to Justice Act, which requ ir ?s fedet al aaen-
<
�,2-n-92 06:56PM FROM DeConcini Washington TO 99131045
P005/008
ECONOMY AND A BALANCED BUDGET:
"The biggest challenge we face today is our skyrocketing national detit. We rr ust make a
strong commitment to balance our federal budget in order to get this counjry back on a sound
and responsible economic footing."
Sponsor of Constitutional Amendment to balance the budget.
Opposed pay raise for members of Congress, When Congress recently put more money
in his check, he gave it back to the Treasury Department to reduce the federal debt.
Founder and Co-Chairman of the Senate Grace Commission Caucus, a bipartisan group
of Senators looking for ways to eliminate waste and abuse within t le government.
Led the fight to stop waste in government by cutting the funds the federal cjovernment
can spend on consultant services, public relations, printing and molor vehic es.
Cosponsor of a bill, now law, to establish an Inspector General in the Defense Department
to be a watchdog over U.S. military expenditures.
Coauthor of legislation, now law, which enables the federal government to employ more
aggressive methods for improving collection of debts owed the gov irnment.
Supporter of legislation that would limit spending on U.S. Senate car ipaigns, and reduce
influence of special interests.
Consistently supports U.S. efforts to impose penalties on foreign co jntries njstrictive to
U.S. exports and to open up opportunities for U.S. business abroac .
Sponsor of bill that would allow American companies holding process patentii to sue for
damages and an injunction in federal court if a foreign company or ijidividual imports or
sells in the U.S. a product made through their patented process.
Sponsor of legislation to protect the design of new American products f^om inferior, foreignmade copies.
THE ENVIRONMENT, WATER AND ENERGY:
"The beauty of our state and the quality of life it affords is unsurpassedanywhere on Rarth.
We have a special responsibility to guard and protect this national heritage, a id that iitcludes the
quality of our air."
• Founded the Western Coalition Work Group on clean air issues- co^nprised jf Western
Senators.
• Fought for the enactment of legislation protecting the quality of our nation's water and
legislation providing for the clean-up of hazardous waste sites.
• Opposed efforts in Congress to significantly weaken the clean water Icgislatinn passed by
Congress in 1986.
• Cosponsored a bill to amend the Clean Air Act to provide for reductior s in acid deposition
and sulfur emissions.
• Cosponsored a bill to provide technical assistance by the Environmenta Protect on Agency
for states developing radon programs.
• Secured significant levels of federal funding to ensure completion of the Central Arizona
Project.
• Fought for legislation that will provide vital flood control measures fcr the Phoenix area,
• Successfully fought for additional funding to properly operate Arizoi^a 's national parks.
DEFENSE AND FOREIGN AFFAIRS
"In light of the INF treaty our conventional weapons will play a major rol i in keeping peace,
For a long time I have been concerned that this nation has had the wrong defe ise spending priorities " too mtich money on strategic nuclear weapons, and too little spenton coitvention<-l weapons,
Now is the time to reverse that trend and stop short-changing our convent onal fon:es."
• Supported successful efforts to increase our national defense and sec irity by pushing for
the Apache helicopter.
• Author of successful legislation promoting democracy and human rights in the I'hilippines,
South Korea and Chile
�12-n-92 06:56PM FROM DeConcini Washington TO 9913 1 045
P006/008
fnZnl
' " ^ ^ f f^' resolution to remove Soviet and Cuban troo IS in Amiola and to encourage a peaceful settlement of that country's civil war
hfnJr^'i
hands of terrorists.
•
>3^' t ° keep sophisiit;ated U.s'. anti-air raft mis:;iles out of the
Sponsor of legislation promoting U.S.-Mexican cooperation in drug interdiction, trade and
commerce along the Southwest border
• -^^^K-^?*;*?^ legislation, now law, which'directs U.S. loans to the 'pooresi of the poor"
m Third World nations so they can help themselves. These loans are provide( from existing
accounts, and therefore cost the U.S. taxpayer no extra money.
• Supporter of efforts to increase funding for the VA's health care )udyei.
Cosponsor of an amendment, now law, that will incorporate Arizo
la's veteran cemetery
into our national sy.stem.
FAMILIES: FROM CHILDREN TO SENIORS:
"In the coming decade more and more American mothers wiil join the i o r k fort e Wh;,t h^t
Of livintj increases.
• SoonTl^hm'to""" T ' " ^
chi^d care
'"'^""^'""^
in child abuse prevention,
rtnerships for
f on-site
public-private pjrtnership.
•
Leader in fight to establish strong, but fair and flexible laws for unp lid pareiital leave for
Amencan families.
• Sponsor of resolution to significantly increase funding for program to
mprove nutrition and
. Sfnlot^Iii^''®^"^"^ low-income women, infants and preschool child en.
en.
and hand Lnn^^^^^
.ncreased funding over the Administration's re quests f.,r
^ education
'
ion
iication,
£
bHinguT,^^^^^^^^^^
'"^'"''"9
- ° " t i o n a l and]dti.t education, anS
• Opposed efforts to delay cost-of-living Social Security adjustments for seniors.
Cosponsor of bill to resolve the disparity in benefits for citizens In the
Social i:ecurity system known as the "notch group."
• Supported catastrophic health care bill for elderly
• Sponsor of first Senaie legislation to create public awareness of the iramatic increase
in
the abuse of the elderly in America.
• s X " p ^ ' ^ t t : ; ™ : e r ^ t " " ' " ' ' ' ' " ' ' - ™ ^ - e n , e n , |or h o ™ hea„h care
May 1990
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DOCUMENT NO.
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SUBJECT/TITLE
DATE
re: Susan Hurley DeConcini (Mrs. Deimis DeConcini) (2 pages)
12/17/1992
RESTRICTION
Personal Misfile
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3665
FOLDER TITLE:
DeConcini, Deimis (D-AZ)
2006-0885-F
jp2645
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Presidential Records Act - ]44 U.S.C. 2204(a)]
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PI
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P3
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b(2) Release would disclose internal personnel rules and practices of
an agency )(bX2) of the FOIA]
b(3) Release would violate a Federal statute ](bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ](b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ](bX7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells ](bX9) of the FOIA]
National Security Classified Information ](a)(I) of the PRAj
Relating to the appointment to Federal office 1(a)(2) of the PRA]
Release would violate a Federal statute |(aX3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information )(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002c. resume
SUBJECT/TITLE
DATE
12/18/1992
re: Susan Hurley DeConcini (2 pages)
RESTRICTION
Personal Misfile
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3665
FOLDER TITLE:
DeConcini, Dennis (D-AZ)
2006-0885-F
ip2645
RESTRICTION CODES
Presidential Records Act - 144 U.S.C. 2204(a)]
Freedom of Information Act - |5 U.S.C. 552(b)]
PI
P2
P3
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b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute l(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells l(bX9) of the FOIA]
National Security Classified Information l(aXl) of the PRA]
Relating to the appointment to Federal office l(aX2) of the PRA]
Release would violate a Federal statute |(aX3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors )a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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�13-02-93 01:24PM FECM SENATOR DeCONCINi
TO 94556241
F302/002
THE WHITE H O U S E
WASHINGTON
TO:
U.S. Senate Offices
FR:
Task Force on National Health Care Reform
DT:
February 23, 1993
RE:
Health Care Overview
As we proceed with the 103rd Congress, i t would be extremely
h e l p f u l t o us i f you would provide otir o f f i c e with some
background infonnation.
Please provide us with the names, work phone, home phone and fax
numbers of the following:
1. D.C.
Chief of Staff:
2. Legislative Director:
3. Health Care Legislative Assistant:
4. Press Secretary;
A l s o , pleas© share any p a r t i c u l a r concerns o f y o u r Senator and
your home state as they relate t o health care and health care
refomi.
Please return this form, along with any comments, via raesinlXie
to 456-6241 or through the mail to the attention of the Task
Force on Natio&al Health Care Iteform, Old Executive office
Building, Room 287, Washington, DC 20500.
Thank you f o r your attention and cooperation.
�DENNIS DECONCINI
WASHINGTON OFFICE:
328 HART SENATE OFFICE Bl
WASHINGTON. OC 2 0 5 1 0 12021 224-4521
ARIZONA
COMMITTEES:
APPROPRIATIONS
JUDICIARY
VETERANS- AFFAIRS
INDIAN AFFAIRS
PMOENIK OFFICE
Brnted States Senate
WASHINGTON, DC 2 0 5 1 0 - 0 3 0 2
INTELLIGENCE
EAST VAILEV OFFICE:
COMMISSION ON
40 NORTH CENTER STREET
MESA, AZ 85211
1602) 2 6 1 - 4 9 9 8
SECURITY AND COOPERATION
IN EUROPE/CHAIRMAN
PLEASE DIRECT YOUR RESPONSE TO:
March 9, 1993
WASHINGTON OFFICE
•
PHOENIX OFFICE
•
TUCSON OFFICE
•
SOUTHERN ARIZONA OFFICI
2730 EAST BROADWAY. SUI
TUCSON, A2 86716-6316021 6 2 9 - 6 8 3 1
RULES A N D A D M I N I S T R A T I O N
•
323 WEST ROOSEVELT # C
PHOENIX, A2 85003
16021 2 6 1 - 6 7 5 6
MESAOFgf^^^
H i l l a r y Rodham C l i n t o n
Chairperson
Task Force on H e a l t h Care Reform
The White House
Washington, D. C. 20500
Dear Mrs. C l i n t o n :
I commend you f o r t a k i n g on t h e most d i f f i c u l t t a s k i n a l l
of government — h e a l t h care r e f o r m . I w i s h you e v e r y success as
you p u t t o g e t h e r y o u r r e f o r m p l a n .
I am e n c l o s i n g a copy o f a 1 0 - p o i n t h e a l t h care r e f o r m
p r o p o s a l which I r e c e i v e d p e r s o n a l l y from an A r i z o n a c o n s t i t u e n t .
Dr. C l i f f o r d H a r r i s , who i s t h e head o f CIGNA, t h e l a r g e s t HMO i n
Arizona.
I am e n c l o s i n g Dr. H a r r i s ' p r o p o s a l as w e l l as h i s
b i o g r a p h y , a copy o f CIGNA's 1991 Annual Report, and t h e CIGNA
Healthplan o f Arizona.
Dr. H a r r i s would l i k e t o d i s c u s s h i s ideas and share h i s
e x p e r i e n c e w i t h an a p p r o p r i a t e member o f your Task Force, and I
r e s p e c t f u l l y r e q u e s t t h a t t h e r e l e v a n t i n d i v i d u a l ( s ) make c o n t a c t
w i t h him. While I am i n no way e n d o r s i n g Dr. H a r r i s ' p r o p o s a l s ,
I found them i n n o v a t i v e and p r o v o c a t i v e , and I concluded t h a t
t h e y m e r i t e d r e v i e w . I am p a r t i c u l a r l y i n t e r e s t e d i n your views
on h i s reinsurance/managed r a t i o n e d care program (Reform # 1 ) . I
hope you can f i n d t i m e t o r e v i e w these p r o p o s a l s and would
a p p r e c i a t e y o u r sending your a n a l y s i s t o June Tracy on my
Washington s t a f f .
Thank you f o r y o u r k i n d c o n s i d e r a t i o n o f t h i s r e q u e s t . I
w i s h you and y o u r team e v e r y success as you p u t t o g e t h e r your
comprehensive h e a l t h care r e f o r m p r o p o s a l .
Sincerely,
DENNIS DeCONCINI
U n i t e d S t a t e s Senator
DDC/mh
Enc.
�CARE FOR ALL
C l i f f o r d J . Harris, M.D., F.A.C.P.
The
increasing problems of cost and a v a i l a b i l i t y of medical care
w i l l force changes i n the p r a c t i c e of medicine i n America.
For
change to occur i n our health care system, there must be enough
discontent
to unfreeze
a t t i t u d e s and force
Society i s approaching t h i s point.
a paradigm
shift.
The many f a u l t s and problems of
medical care i n the United States have been stated and restated.
Most proposals for change are for s i n g l e problems and t h e i r remedy
will
not produce
meaningful
reform,
much
less
stop
medical
inflation.
The problems which have evolved over the years cannot be attributed
to one or even a few causes.
The proposed solutions w i l l add
s i g n i f i c a n t costs to a system already too c o s t l y .
some ethereal savings
by "cutting out the f a t " .
They allude to
Individual or
small a l t e r a t i o n s which do not change basic problems w i l l f a i l .
There are ten major reforms which i f accomplished would
f a i r n e s s , cost accountability and f i n a n c i a l c o n t r o l s .
not destroy
bring
They w i l l
competition, the p r i v a t e health insurance system, or
the p r i v i l e g e to choose d i f f e r e n t types of health care.
The
first
reinsurance
and most important reform
system which covers
i s a government sponsored
a l l medical cost a f t e r $25,000
incurred f o r an i l l n e s s or accident.
Everyone i s covered and the
cost of t h i s reinsurance program i s shared equally among a l l who
pay income taxes.
�Since
most of the high technology
care
exceeds t h i s
amount
($25,000), payment t o providers f o r these services come from the
reinsurance.
Thus, the reinsurance benefit can be structured t o
provide the best use of resources.
The reinsurance program w i l l provide the frame work f o r the most
basic change necessary t o c o n t r o l medical i n f l a t i o n .
A significant
amount o f medical diagnosis and treatment i s f o r patients with
incurable i l l n e s s e s .
Often the time and resources are provided
because there i s nothing else t h a t can be done and there i s j u s t a
chance i t w i l l prolong l i f e , no matter how poor the q u a l i t y .
As
long as insurance pays f o r the care, someone w i l l provide i t .
The reinsurance organization w i t h physicians, lawyers, e t h i c i s t s
and
clergy develop
the guidelines f o r the use of heroic and
expensive medical care.
Stroke v i c t i m s , very premature babies,
incurable cancers, progressive neurologic disease and many other
conditions w i l l have the c r i t e r i a f o r care spelled out and must be
followed f o r payment.
The development of outcome research on
9
medical care w i l l contribute s i g n i f i c a n t l y t o t h i s process.
As the high technology care and the wants of the r e c i p i e n t s expand,
the income tax surcharge increases. When the electorate decides we
are spending enough, the d i s t r i b u t i o n of benefits operating w i t h i n
the guidelines and algorithms e s t a b l i s h by panels of experts puts
the resources, t o the best use.
There i s an approximately 3% savings on the health care premium
from a n a t i o n a l reinsurance program.
�The second reform i s to change Medicare from an entitlement to a
needs program.
resources
There are some e l d e r l y who w i l l
to buy health insurance.
not have the
They w i l l r e c e i v e coverage
under a r e v i s e d and improved Medicaid program.
They, as every
other c i t i z e n , are covered by the reinsurance.
To
fund Medicare, a part of everyone's health insurance premium
(3%-5%)
social
i s automatically
placed
i n a personal
s e c u r i t y which grows and earns
account such as
interest.
This fund i s
a v a i l a b l e a t the time of retirement to purchase health insurance.
Medicaid or a Medicaid l i k e health insurance program i s the t h i r d
reform.
A s l i d i n g s c a l e of premiums from zero to the actual cost
buys the b a s i c coverage up to the $25,000 reinsurance.
Basic
coverage includes preventive care, prenatal care, f u l l p e d i a t r i c
care, and the other, usual b e n e f i t s .
care and cosmetic
surgery.
Not included i s custodial
A more l i b e r a l national policy on
income i s needed i n determining Medicaid e l i g i b i l i t y .
This i s a
Federal program with unifonn national benefits paid for through
If
taxes.
The
fourth
reform
encourages
prevention
through
meaningful
/
i n c e n t i v e s to reduce health r i s k s and' a l l o t p e n a l t i e s for r i s k y
behavior.
Health care premium_co-payments and deductibles can be
a l t e r e d f o r i n d i v i d u a l s based on known preventable
Cigarette
smoking,
uncontrolled
hypertension,
r i s k factors.
untreated
c h o l e s t e r o l , not wearing seat b e l t s , and alcohol and drug abuse are
precursors
behaviors
f o r serious future
can change.
illnesses
and accidents.
These
Well run preventive programs i n industry
�routinely demonstrate a $3-$6 return on health care costs for every
d o l l a r invested i n prevention.
A l l insurance, including Medicaid,
pay for proven prevention and screening programs.
Putting a cap on the resources going to high technology
i s the f i f t h reform.
distribute
these
to
procedures
The reinsurance program w i l l more f a i r l y
people who
will
benefit the
most.
The
marginally s u c c e s s f u l diagnostic and treatment modalities need to
be limited to i n s t i t u t i o n s of excellence and constantly evaluated
before being provided as a benefit through the reinsurance program.
A sixth
reform
i s to eliminate i n e f f i c i e n t providers.
competitive system
w i l l continue.
the
operates, gleaning of l e s s c o s t - e f f e c t i v e care
However, government systems such as the Veterans
Administration medical system
have no
As
competition.
and c i v i l i a n care i n the m i l i t a r y
They need to be
phased out.
Care
for 7
i l l n e s s e s or i n j u r i e s which are s e r v i c e connected can be provided
through the p r i v a t e sector paid for by the government.
connected
Non-service
i l l n e s s e s i n veterans get care through regular health
insurance or Medicaid as any other c i t i z e n .
Today, p h y s i c i a n s g r a v i t a t e to the higher paying s p e c i a l t i e s .
we need more primary doctors and fewer s p e c i a l i s t s .
based
p h y s i c i a n payment
systenL__should
be
Yet,
The resource
expanded
until
the
payments for procedures and high technology medicine are reduced
and the migration of physicians into these s p e c i a l t i e s ends.
The
seventh
reform
i s to l e v e l the playing f i e l d for the many
competitive health care providers and
organizations.
Fee-for-
�service,
HMO's, IPA's,
encouraged t o compete.
PPO's and any other
approach should be
Each must provide the minimum coverage of
Medicaid but can include any other benefits that they can market,
s e l l , pay for and make a p r o f i t .
State mandated benefits and other
b a r r i e r s t o managed care need to be removed.
Much of the cost of medical research
hidden i n health care c o s t s .
and medical education i s
The eighth, reform i s to pay for
education and research separately.
i s costing.
'
No one r e a l l y knows what t h i s
The payers of health care premiums should not be
expected to subsidize medical education and research.
We need
both, but the cost must be known and f a i r l y d i s t r i b u t e d among a l l
citizens.
Malpractice
judgements and settlements
p r a c t i c e defensive
are extreme.
medicine and i t i s expensive.
Physicians
Reforming the
l i t i g a t i o n system i s the ninth action needed. A f a u l t based system
with a j u r y selected from panels
of experts
and caps on awards
would protect the patient's r i g h t to sue, keep awards i n a sensible
/
.
.
.
.
range and bring j u s t i c e into the courts.
The l a s t reform i s to recognize that a s i g n i f i c a n t amount of health
care
can be moved
from
jeopardizing the patient.
the h o s p i t a l
to the home
without
I n d e e d j ^ i t often improves the outcomes.
Home health care must be a f u l l y covered benefit when i n l i e u of
h o s p i t a l care.
benefit.
S i m i l a r l y , Hospice must be a v a i l a b l e and a covered
�How w i l l these reforms a f f e c t the present competitive system?
The
wealthiest and those w i l l i n g to pay w i l l s t i l l be able to get the
most sophisticated modes of care.
Anyone may
a l s o receive such
care, but through the reinsurance system on the b a s i s of who
benefit the most.
little
will
For the overwhelming majority, there w i l l
change from the present
system.
However, the
be
uninsured
notch group w i l l disappear and everyone w i l l have access to basic
health care and meaningful prevention.
There w i l l be a reduction of the per capita resources going into
the care of the aged and a s i g n i f i c a n t increase i n our
i n c h i l d r e n , prenatal care and preventive care.
investment
Because of the
increasing proportion of the e l d e r l y in our population, the t o t a l
d o l l a r s devoted to e l d e r l y care w i l l s t i l l be large.
One of the important d r i v e r s of medical i n f l a t i o n , the application
of new
medical
technologies, w i l l be capped by the
payment p o l i c y .
reinsurance
The cap i s adjustable by the public's willingness
to pay for them through the income tax surcharge.
Through competition among health care i n s t i t u t i o n s and systems, and
the
gradual
removal
of
non-competing
institutions,
unneeded
f a c i l i t i e s and some of the " f a t " i n heaith care w i l l be eliminated.
Other medical
which
are
separately.
accountable.
activities
not
directly
such as research and medical
providing
The national investment
patient
care
education
are
funded
in these i s then measured and
�Many of the goals our society d e s i r e s w i l l be achieved
these ten reforms.
access to care.
basics.
through
They w i l l produce a s i g n i f i c a n t improvement i n
Everyone who d e s i r e s health care w i l l get the
The cost of health care w i l l be contained and we w i l l know
what i t i s costing us.
The p u b l i c must understand and accept the f a c t that our present
system i s f a i l i n g us i n order
f o r reforms to succeed.
We must
agree as a nation that f i n i t e national resources do not allow us
the luxury of giving everyone a l l of the medical care the health
care system can conceive.
These ten proposals o f f e r a s o l u t i o n to our health care dilemma by
bringing
fairness,
cost accountability, and f i n a n c i a l
while r e t a i n i n g competition
all.
Then, hopefully,
problems.
CJH453
y4/20/92
Revised 2/8/93
and choices.
controls
We w i l l t r u l y care f o r
we can move on to solve
other
social
�DENNIS D E C O N C I N I
WASHINGTON OFFICE:
328 HART SENATE OFFICE BUILDING
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(202) 2 2 4 - 4 5 2 1
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TO THE WASHINGTON OFFICE
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March 15, 1993
Mrs. H i l l a r y Rodham C l i n t o n
Chairperson
Task Force on H e a l t h Care Reform
The White House
Washington, D. C. 20500
Dear Mrs. C l i n t o n :
I am w r i t i n g t o recommend Dr. Sidney G o l d b l a t t , P r e s i d e n t and
Chief E x e c u t i v e O f f i c e r o f Sunquest I n f o r m a t i o n Systems o f Tucson,
A r i z o n a and Johnstown, Pennslyvania as a c o n s u l t a n t on h e a l t h care
reform.
Dr. G o l d b l a t t i s a p r a c t i c i n g p a t h o l o g i s t and t h e c l i n i c a l
l a b o r a t o r y d i r e c t o r o f Conernaugh Memorial H o s p i t a l . The h o s p i t a l
i s a 450-bed community t e a c h i n g h o s p i t a l and r e g i o n a l trauma c e n t e r
i n Johnston.
Dr. G o l d b l a t t i s one o f 3 founders o f Sunquest
I n f o r m a t i o n Systems, I n c . , a l e a d i n g m e d i c a l i n f o r m a t i o n system
p r o v i d e r s e r v i n g more t h a n 400 h e a l t h care f a c i l i t i e s t h r o u g h o u t
t h e n a t i o n and Canada. He i s a prominent f i g u r e i n t h e development
o f c o m p u t e r i z e d h e a l t h care i n d u s t r y .
Dr. G o l d b l a t t i s a 1959 honors graduate o f Temple U n i v e r s i t y
School o f M e d i c i n e i n P h i l a d e l p h i a . He i s a c l i n i c a l p r o f e s s o r o f
p a t h o l o g y a t Temple and a d j u n c t a s s o c i a t e p r o f e s s o r o f n a t u r a l
s c i e n c e s a t t h e U n i v e r s i t y o f P i t t s b u r g h a t Johnstown.
He i s a
member o f t h e S t e e r i n g Committee on I n f o r m a t i o n Systems on
H e a l t h c a r e I n f o r m a t i o n and Management Systems S o c i e t y .
I b e l i e v e t h a t Dr. G o l d b l a t t ' s e x p e r t i s e on t h e use o f
c o m p u t e r i z e d h o s p i t a l p a t i e n t data t o s t r e a m l i n e p r o c e d u r e s , t o
lower c o s t s and t o improve q u a l i t y o f care would be b e n e f i c i a l t o
t h e Task Force's work.
Dr. G o l d b l a t t i s prepared t o a s s i s t t h e
Task Force and can be reached t h r o u g h t h e o f f i c e o f Dennis M o r l e y ,
V i c e P r e s i d e n t o f M a r k e t i n g a t 602-570-2454.
Thank you and w i t h b e s t w i s h e s , I remain.
Sincerely,
DENNIS DeCONCINI
U n i t e d S t a t e s Senator
�WASHINGTON OFFICE:
DENNIS D E C O N C I N I
328 HART SENATE OFFICE BUILDING
WASHINGTON. DC 20510
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ARIZONA
PHOENIX OFFICE
COMMITTEES:
APPROPRIATIONS
JUDICIARY
VETERANS' AFFAIRS
INDIAN AFFAIRS
lamtefl States Senate
,;.
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323 WEST ROOSEVELT # C - 1 0 0
PHOENIX. AZ 85003
(6021 3 7 9 - 6 7 6 6
SOUTHERN ARIZONA OFFICE:
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RULES A N D A D M I N I S T R A T I O N
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C O M M I S S I O N ON
SECURITY A N D C O O P E R A T I O N
IN E U R O P E / C H A I R M A N
April
(ft
22,
1993
'*
F i r s t Lady H i l l a r y Rodham C l i n t o n
Chairperson
H e a l t h Care Task Force
'
OEOB, Room ICQ
Washington, D.C. 20500 .
Dear Mrs. C l i n t o n :
Enclosed p l e a s e f i n d a copy o f a memorandtim I r e c e i v e d from
Mr. Ronald Meyer, a Phoenix a t t o r n e y . The memorandum o u t l i n e s
h i s s u g g e s t i o n s f o r a N a t i o n a l H e a l t h Insurance Program.
I hope you f i n d Mr. Meyer's comments u s e f u l i n d e v e l o p i n g
y o u r f i n a l h e a l t h care r e f o r m p r o p o s a l . .
W i t h my b e s t w i s h e s .
Sincerely,
DENNIS DeCONCINI
U n i t e d S t a t e s Senator
DDC/jtw
'1^ •
^
�MEMORANDUM FOR A NATIONAL
HEALTH INSURANCE PROGRAM
POLICY
Discussion
The p r e s e n t d i s c u s s i o n o f a N a t i o n a l H e a l t h I n s u r a n c e Program
i s c e n t e r e d around a complete M e d i c a l Care Program w i t h Womb-Tomb
Coverage.
The p u b l i c p o l i c y
essential
care.
medical
s h o u l d be s h i f t e d
t o a concept o f
care providing a safety n e t o f basic
medical
There a r e t h r e e b a s i c arguments i n s u p p o r t o f t h i s s h i f t o f
policy.
First,
since t h i s i s t h e f i r s t experience o f t h e United
S t a t e s w i t h a government sponsored M e d i c a l Care Program, i t s h o u l d
start
with
providing
essentials i n order t o gain experience i n
o p e r a t i n g a program o f t h i s magnitude.
costs e f f e c t i v e .
reaps
Secondly,
i t would be more
A d o l l a r o f m e d i c a l c a r e spent
f a r g r e a t e r r e t u r n than i n o t h e r s .
i n some
areas
For example, a d o l l a r
s p e n t t o p r o v i d e p r e - n a t a l and i n f a n t c a r e p r o v i d e s g r e a t r e t u r n s .
Care i n t h i s area i s r e l a t i v e l y i n e x p e n s i v e and reaps b e n e f i t s i n
the
future
because
i t prevents
future
illnesses
and problems.
C o n v e r s e l y , a d o l l a r spent f o r e x o t i c organ t r a n s p l a n t s u r g e r y i s
v e r y e x p e n s i v e and reaps l i t t l e r e t u r n .
I nreturn f o r foregoing
some o f t h e e x o t i c t y p e s o f m e d i c a l c a r e , b a s i c m e d i c a l c a r e c a n
be p r o v i d e d f o r t h e e n t i r e p o p u l a t i o n .
extensive
private
participation.
T h i r d l y , i t a l l o w s f o r more
Persons
who w i s h
additional
m e d i c a l c a r e beyond t h e s t a n d a r d p r o v i d e d f o r t h e government, c a n
e i t h e r e l e c t t o pay f o r i t , o r t o purchase supplementary
insurance
�such as t h e e l d e r l y purchase Medicare Supplement i n s u r a n c e .
would
allow
employers, i n o r d e r
t o be
more
I t
competitive, t o
v o l u n t a r i l y p r o v i d e a d d i t i o n a l packages o f medical c a r e beyond t h e
b a s i c " s a f e t y n e t c a r e " t h a t t h e government i s p r o v i d i n g .
Proposal
The p o l i c y o f t h e N a t i o n a l H e a l t h I n s u r a n c e
Program w i l l be
t o p r o v i d e a b a s i c package o f m e d i c a l c a r e w h i c h i s n o t i n t e n d e d
to
be a t o t a l
program o f m e d i c a l
care.
I t would
essentially
provide the following:
A.
Complete p r e - n a t a l pregnancy and i n f a n t c a r e .
B.
Complete c h i l d c a r e t h r o u g h t h e age o f 18 y r s .
C.
Select medical care f o r a d u l t s .
D.
E x p r e s s l y e x c l u d e organ t r a n s p l a n t s , h e a r t t r a n s p l a n t s ,
etc.
E.
For t e r m i n a l i l l n e s s e s such as Cancer, AIDS, t h e emphasis
would
be o u t - p a t i e n t c o m f o r t
dignity
rather
than
care
t o maintain
extensive
surgery
human
and
hospitalization.
ADMINISTRATION
Discussion
There a r e s e v e r a l e x i s t i n g government programs t h a t can be
used
t o assist
i n developing
a Health
Compensation Program and t h e Unemployment
The
Unemployment
Compensation
Care
Program; Workman's
Compensation.
i s a federal
encourages s t a t e s t o development S t a t e Unemployment
Programs.
The f e d e r a l
government p r o v i d e d
statute
which
Compensation
q u i d e l i n e s and t h e
�s t a t e s administered t h e programs.
There were i n c e n t i v e s i n t h e
s t a t u t e f o r s t a t e s t o adopt the program.
S i m i l a r l y , t h e Workman's Compensation
guidance.
Programs provide some
States passed laws o r contained p r o v i s i o n s i n t h e i r
C o n s t i t u t i o n s which provided f o r compensation t o persons i n j u r e d
during
their
employment.
I n return
f o r not having
t o prove
t r a d i t i o n a l negligence, the employee agreed not t o recover c e r t a i n
items o f damage.
More i m p o r t a n t l y , the parameters o f t h e program
were e s t a b l i s h e d and p r i v a t e insurance c a r r i e r s were able t o o f f e r
Workman's Compensation
insurance.
For employers
who d i d not
q u a l i f y o r who d i d not wish t o o b t a i n p r i v a t e insurance, t h e s t a t e
maintained a State Compensation Fund i n order t o provide insurance
for
those
handled
types o f employers.
through
The claims and processes were
a d m i n i s t r a t i v e boards r a t h e r than through t h e
courts.
A s i m i l a r approach can be used f o r h e a l t h insurance.
The
f e d e r a l government
would s e t f o r t h t h e parameters o f a Health
Insurance Program.
States would be encouraged t o adopt i d e n t i c a l
programs.
I f s t a t e s f a i l e d t o , there would be a back-up
federal
program t o administer the Health Insurance Program f o r those s t a t e s
who
elected
not t o administer
their
own
programs.
I t
is
a n t i c i p a t e d t h a t every s t a t e would adopt a s t a t e program i n order
t o m a i n t a i n some c o n t r o l over the Health Insurance Program i n i t s
state.
Existing
Health
Insurance
Programs
and HMO's would
p a r t i c i p a t e because they have programs already i n existence which
would merely have t o be modified t o conform t o t h e parameters
�e s t a b l i s h e d by t h e f e d e r a l government.
The only d i f f e r e n c e would
be t h a t t h e scope o f t h e program would now be determined by t h e
f e d e r a l government and t h e funding o f i t would be obtained from a
d i f f e r e n t source.
remain t h e same.
companies
would
individuals.
A l l other a d m i n i s t r a t i o n and procedures would
I t would be expected t h a t some p r i v a t e insurance
elect
not t o cover
certain
employers
I n t h a t instance, there would be a back-up
or
state
insurance plan and/or f e d e r a l insurance plan t o administer the
h e a l t h program f o r these companies or i n d i v i d u a l s .
The i n d i v i d u a l p a r t i c i p a t i n g i n t h e h e a l t h plan would agree
t o l i m i t c e r t a i n areas o f l i a b i l i t i e s .
For example, an i n d i v i d u a l
would be asked t o forego claims against companies who manufacturer
c e r t a i n vaccines. Medical Mal-Practice would be governed by r u l e s
propounded by t h e agency administering the h e a l t h plan r a t h e r than
traditional
r u l e s o f negligence.
Claims would be handled by
a d m i n i s t r a t i v e agencies r a t h e r than through the c o u r t s .
exact
specifics
o f t h e program
While the
would have t o be given
great
c o n s i d e r a t i o n , t h e t h r u s t o f the program would provide t h a t i n
r e t u r n f o r a National Health Care System, c e r t a i n t r a d i t i o n a l l e g a l
r i g h t s would be given up or modified.
I n order t o maintain freedom
of choice t h e program would provide t h a t any person could purchase
h e a l t h insurance on h i s own.
That person could e l e c t not t o be a
p a r t o f t h e National Health Insurance Program
and preserve h i s
e x i s t i n g r i g h t s and choice.
Proposal
1.
The f e d e r a l government
would set f o r t h a h e a l t h insurance
�program s e t t i n g f o r t h the types o f h e a l t h care t h a t would be
provided and the cost f o r i n s u r i n g an i n d i v i d u a l o r a f a m i l y .
2.
Insurance companies and HMO's would
modify t h e i r
existing
programs t o comply w i t h the government d i r e c t i o n , but would
administer the program as i t i s being administered p r e s e n t l y .
3.
A person
being
insured under t h e program would
agree t o
c e r t a i n c o n d i t i o n s ; modifying nature o f mal-practice claims
against the doctors and drug companies and h o s p i t a l s , agreeing
t o resolve disputes through a d m i n i s t r a t i v e agencies.
4.
Each s t a t e w i l l i n i t i a t e a State Health Insurance Program t o
provide coverage t o those i n d i v i d u a l s or employers who are not
serviced by p r i v a t e insurance companies or HMO's• The f e d e r a l
government would also s e t up a Health Insurance Program, i n
case a s t a t e e l e c t s not t o i n i t i a t e a s t a t e program.
COST AND PAYMENT FOR PROGRAM
Discussion
The best insurance f o r e f f i c i e n c y and minimizing abuse i s t o
provide t h a t the i n d i v i d u a l s and companies i n v o l v e d i n the program
a l l have a p a r t i n t h e payment f o r the program.
Depending upon
what items o f coverage are deleted, the cost o f h e a l t h insurance
f o r an i n d i v i d u a l should be approximately $100.00 a month and f o r
a
family,
$250.00--$300.00 a month.
There
should
be ample
s t a t i s t i c s i n the h e a l t h care i n d u s t r y t o be able t o put a package
together o f h e a l t h care t h a t can be provided f o r t h i s p r i c e range.
As discussed i n t h e opening paragraph, i t i s a n t i c i p a t e d t h a t by
d e l e t i n g some o f t h e "high t i c k e t " items from t h e program, t h i s
�p r i c e range should be a t t a i n a b l e .
I t would f u r t h e r be a n t i c i p a t e d
t h a t t h e government would s e t t h e p r i c e on the high range.
This
would g i v e p r i v a t e insurance c a r r i e r s and HMO's an i n c e n t i v e t o
offer
a more competitive p r i c e .
employers, would
Employers,
especially
undoubtedly "shop t h e market"
for a
large
private
c a r r i e r t h a t could provide the government s p e c i f i e d coverage a t a
lower r a t e .
I f t h e government s e t t h e p r i c e t o low, no p r i v a t e
insurance c a r r i e r would o f f e r a program and t h e government would
be saddled w i t h t h e burden o f administering t h e e n t i r e program.
This w i l l
g i v e t h e government
incentive
t o be reasonable and
accurate i n s e t t i n g the p r i c e o f the insurance package.
As p r e v i o u s l y
discussed, i t would be a n t i c i p a t e d
t h a t some
employers would o f f e r a d d i t i o n a l coverage as a p a r t o f a more
competitive
compensation
t o employees.
Individuals
could
supplement t h e i r coverage w i t h a d d i t i o n a l insurance p o l i c i e s , much
in
t h e same manner as r e t i r e e s
Insurance.
hospitals
purchase
Medicare
Supplement
I n d i v i d u a l s would be f r e e t o c o n t r a c t w i t h doctors and
f o r a d d i t i o n a l o r d i f f e r e n t care over and above t h e
minimum provided i n t h e Health Insurance Program.
Nothing would
prevent i n d i v i d u a l s t o contract d i r e c t l y w i t h doctors and h e a l t h
care p r o v i d e r s f o r coverage d i f f e r e n t than t h a t provided by t h e
Health Insurance Program or above and beyond t h a t provided by t h e
Health Insurance Program.
Proposal
1.
The government would put together a Health Insurance Program
which would cost approximately $100.00 f o r an i n d i v i d u a l and
�$250.00—$300.00 f o r a f a m i l y .
2.
One t h i r d o f t h e c o s t would be p a i d f o r by t h e employee, one
t h i r d by t h e employer and one t h i r d by t h e f e d e r a l government.
3.
F o r persons t h a t a r e unemployed,
t h e h e a l t h i n s u r a n c e would
be p a r t o f t h e Unemployment Compensation package and would be
funded i n t h e same manner t h a t Unemployment Compensation i s
funded.
4.
A l l o t h e r persons would be p r o v i d e d
insurance w i t h t h e states
p a y i n g one h a l f o f t h e c o s t and t h e f e d e r a l government p a y i n g
one h a l f o f t h e c o s t .
5.
I n order
t o minimize a d m i n i s t r a t i v e
costs,
i t would
be
a n t i c i p a t e d t h a t e x i s t i n g i n s u r a n c e programs and HMO's would
provide
that
the actual health services.
t h e government
The o n l y d i f f e r e n c e i s
would be s e t t i n g t h e p a r a m e t e r s o f t h e
minimum coverage and p r o v i d i n g a mechanism f o r payment o f t h e
insurance
6.
premiums.
I t would be a n t i c i p a t e d t h a t employers and/or i n d i v i d u a l s
would purchase supplementary i n s u r a n c e p o l i c i e s t o p r o v i d e
a d d i t i o n a l coverage d e s i r e d .
I n d i v i d u a l s c o u l d make d i r e c t
payments t o d o c t o r s and h e a l t h c a r e p r o v i d e r s f o r s e r v i c e s n o t
a v a i l a b l e under t h e H e a l t h
I n s u r a n c e Program.
POLICY CONTROL
Discussion
There w i l l
be an enormous number o f r u l e s and r e g u l a t i o n s
n e c e s s a r y t o implement t h e program.
of t h e h e a l t h services provided
Most i m p o r t a n t l y , t h e scope
under t h e government program.
In
�addition,
there are issues regarding modifying t r a d i t i o n a l
mal-
p r a c t i c e c l a i m s , e s t a b l i s h i n g s t a n d a r d s f o r d o c t o r s and h e a l t h c a r e
providers, etc.
Most o f t h e s e d e c i s i o n s must be made o u t s i d e o f
t h e p o l i t i c a l arena.
However, Congress must m a i n t a i n some c o n t r o l
s i n c e i t i s f u n d i n g p a r t o f t h e program.
The e x p e r i e n c e w i t h t h e
F e d e r a l Reserve Board p r o v i d e s some guidance.
agency
which
specifies
rules
I t i s an independent
and r e g u l a t i o n s
f o r t h e banking
i n d u s t r y w h i c h a r e accomplished o u t s i d e o f t h e p o l i t i c a l
arena.
I t would be a n t i c i p a t e d t h a t t h e r e would be a F e d e r a l H e a l t h
I n s u r a n c e Board w h i c h would have members a p p o i n t e d by t h e P r e s i d e n t
and c o n f i r m e d by t h e Senate.
The members would s e r v e s t a g g e r e d
terms i n o r d e r t o p r o v i d e c o n t i n u i t y .
Since p a r t o f t h e revenue
t o s u p p o r t t h i s system w i l l have t o be a p p r o p r i a t e d by Congress,
Congress
program
would
retain
the right
p r e s e n t e d by t h e board.
t o approve
o r disapprove t h e
However, Congress c o u l d n o t
i n i t i a t e a program o r a change t o t h e program.
Proposal
1.
A N a t i o n a l H e a l t h Agency Board would c o n t r o l and a d m i n i s t e r
the
2.
N a t i o n a l H e a l t h I n s u r a n c e Program.
The members o f t h e Board would be a p p o i n t e d t o s t a g g e r e d terms
by t h e P r e s i d e n t and c o n f i r m e d by t h e Senate.
3.
The Board
would have f u l l
c o n t r o l over a l l aspects o f t h e
program.
4.
Congress would a p p r o p r i a t e t h e revenues needed t o p r o v i d e t h e
governments p o r t i o n o f t h e program and would r e s e r v e t h e r i g h t
t o approve o r d i s a p p r o v e t h e program p r e s e n t e d by t h e Board.
8
�Congress could not i n i t i a t e any changes t o t h e program.
LAW OFFICES OF RONALD W. MEYER
Ronald W. Meyer
3309 North Second S t r e e t
Phoenix, Arizona 85012
(602) 279-1663
�WASHINGTON OFFICE:
DENNIS D E C O N C I N I
328 HART SENATE OFFICE BUILDING
WASHINGTON, DC 20510
(202) 2 2 4 - 4 5 2 1
ARIZONA
COMMITTEES
PHOENIX OFFICE
APPROPRIATIONS
323 WEST ROOSEVELT # C - 1 0 0
PHOENIX. AZ 85003
(602) 379-6756
JUDICIARY
VETERANS' AFFAIRS
I N D I A N AFFAIRS
RULES A N D A D M I N I S T R A T I O N
lanited States Senate
SOUTHERN ARIZONA OFFICE:
WASHINGTON, DC 20510
2424 EAST BROADWAY
TUCSON. AZ 86719
(602) 670-6831
INTELLIGENCE
EAST VALLEY OFFICE:
C O M M I S S I O N ON
.:(«V
SECURITY A N D C O O P E R A T I O N
IN E U R O P E / C H A I R M A N
A p r i l 29,
40 NORTH CENTER STREET # 1 1 0
MESA. AZ 8521 1
(602) 3 7 9 - 4 9 9 8
1993
F i r s t Lady H i l l a r y Rodham C l i n t o n
Chairperson
H e a l t h Care Task Force
.
OEOB, Room 100
' ;
Washington, D.C.
20500
Dear Mrs. C l i n t o n :
As you know, y o u r H e a l t h Care Task Force has r e c e i v e d an
i n v i t a t i o n f r o m Mr. Joseph Ryan and t h e P r o p e r t y Owners and
R e s i d e n t s A s s o c i a t i o n o f Sun C i t y West, A r i z o n a t o h o l d an
o u t r e a c h m e e t i n g i n t h e i r community.
Enclosed f o r y o u r i n t e r e s t i s m a t e r i a l d e s c r i b i n g t h e
p r e n a t a l programs p r o v i d e d by Lenore de Gaudin and Mordecai Roth
o f Sun C i t y .
I f you d e c i d e t o h o l d a meeting i n t h a t a r e a , t h e y
would l i k e t o be i n c l u d e d .
Thank you f o r your c o n s i d e r a t i o n o f t h i s r e q u e s t .
Sincerely,
DENNIS DeCONCINI
U n i t e d S t a t e s Senator
DDC/ssu
Enclosure
••'.If!'
.
�'
•
n^-K m l " ^
^ ^ - ^ ^ Branding iron Dr
Sun City, AZ
March 12,1993
(602)933-0186
The Hohorahle Senator Dennis Deconcini
328 Hart Senate Bui lding
Washington^ DC 20Sf)0
Dear Senator Deconnnv
The enclosed proposal has Deen sent to Hillary Rodham Clinton and to
memhers ot her Health Task Force The problem ot low D i r t h w e i g h t
babies ( L R W B ) , simply stated, is that Py the time a LBWB (under 5 5 lbs )
IS brought up to discharge weight, the c o s t i s a p p r o x i m a t e l y ten
t i m e s more than tor a normal hirth weight haby The much higher
incidence ot physical and mental health problems, ano anti-social
behavior^ lead to expensive special schooling and institutional care in this
population
we can Show that our program can save $ l B i l l i o n a year by setting up
a good nutritional regimen^ using existing agencies to distribute extra,
inexpensive tood ano nutrients to expectant mothers
An invitation has been extended tor the Health Task Force to hold a
hearing in the Sun Dome by Mr Joseph Pyan anri the Property owners
and Pesidents Association ot Sun City west We asK your aid in using your
consioerabie mt luence to expedite a hearing to he held in this area, ano to
see that we are included on the agenda
We would also appreciate your help in bringing this proposal to the
attention nt those in government who can turther this program
Sincerely yours,
Lenore ae (3audin
Mordecai Roth
�Wonder babies...
their pregnancies, especially because these
women (and their babies) have already been
lu'norc Gaudin first saw Rhonda when she
hungry, ller recommendations for high
was six months prepianl. Rhonda had been
quality food box items are: powdered milk,
anore.xic (wei^hlinfi only HO pounds when she cheese, meat, powdered or fresh eggs, seeds,
became pregnant), pale, with puffy eyes and
nuts,soy products(tofu,tcmpeh),brown rice,
swollen ankles. The ri.sk of her haby beinf;
whole grains, peanut butter.
underweight and having complications was abThere is so much more that I would like lo
normally high.
convey about the work that Lenore is doing. 1 Icr
Determined to help her have a successful
techniques are a result of years of training in
delivery, Lenore worked with Rhonda to denursing, biochemistry of nutrition and psycholvelop a healthy diet.
ogy, with special emphasis on Ihe nutritional
The ne xt time ihey met. Lenore was .startled research done by Dr. Tom Brewer. I ler extraordinary ability to motivate women to make these
by Rhonda's vibrant appearance. Aboul two
changes is the key to her success. Her emphasis
months later, a healthy 7-pound. 9-ounce girl
is on empowering mothers to take active, conwas born. Hoth Rhonda and baby are thriving.
scious roles in creating the healthiest babies they
This simple success .story inakes me want
possibly c;in.
to shout 10 the worlij. Here is something terribly
The only frustration of her work is the
important that we have somehow lost sight of.
difficulty she has encountered in getting referFood creates the conditions for life. The deep
rals of pregnant women from local agencies.
significance of nutrition in the development of a
Ba.sed out of Westside 1 bod Bank, Ixnorc is
baby is so vital, so sacred that we must attend to
able to work with women in the west Valley
it with great care.
area. If you c;ui help her locate low-income
Lenore Gaudin has miraculously helped
pregnant women or are interested in supporting
many inf;uils to be bom into this world remarkher in reducing Arizona's high incidence of
able healthy, strong and intelligent just by pullow birth weight babies, please call her at (602)
ling the mothers on a simple diet. These are
93_V0186.
some of the guidelines her mothers follow:
by Penny Braun
•
lots of high quahty protein (90 to 125
grams daily)
•
adequate calories
•
"gritzing" or frequent meals so protein is constantly available to the baby
•
no restriction of salt
The results of such a diet are powerful and
direct. A bigger baby means a bigger brain and
a smarter baby. A bigger baby means a better
developed, stronger baby. A healthy mother
means an easier labor because she has stronger
muscles to delivery the baby with.
I asked Lenore what advice she would
have for food bankers when they serve
pregnant women. She spoke forcefully about
the need to be aware of the implications of
Lenore Gaudin and a dear friend meet al
Westside Food Hank.
ARIZONA'S LOW BIRTH WEIGHT BABIES
4,088 babies born in 1988 in Arizona were low birth weight
— OR —
6.2% of all babies bom in the state
$57 million to $125 million estimated cost to Arizona
According to Lenore Gaudin, these figures could easily be cut in
halfhy good nutrition for pregnant women.
Figures provided hy Children's Defense Fund,
June 15,1990
�/h
TO uEmQE TUB momEMQi
©F L©w mmiu WEmm mmwi
Lenore de Gaudin, RN, MA
9823 Branding Iron Dr.
Sun City. AZ. 85351
(602) 933-0186
Tim Strand, MD, MS, RD
P.O.Box 643219823
Phoenix, AZ. 85082
(602) 941-0416
Mordecai Roth, DOS, MPH
Branding Iron Dr.
Sun City, AZ. 85351
(602) 933-0186
�FACTS
"THE HUNDRED HIGHEST USERS OF MEDICAID DOLLARS IN
EACH STATE ARE PREMIES. . . WHO END UP WITH . . .
EXTREMELY LOUSY OUTCOMES." "BABIES WHO ARE THE
LEAST LIKELY TO BENEFIT RUN UP THE HIGHEST BILLS."
(N.Y. TIMES, SEPT. 29,1991)
EVERY YEAR IN THE U.S.A. 7% (ABOUT 300,000) OF ALL
BABIES BORN WEIGH LESS THAN 5.5 POUNDS.
IT COSTS AN AVERAGE OF $21,000 TO BRING A LBW BABY TO
DISCHARGE WEIGHT vs. $2842 FOR A NORMAL BABY.
OVER 200 STUDIES DOCUMENT THE RELATIONSHIP
BETWEEN EXCELLENT NUTRITION AND HEALTHY OUTCOME
THEREBY REDUCING THE INCIDENCE OF LBW BABIES FROM
7% TO LESS THAN 3%.
SAVINGS — OVER $1 BILLION
IN ONE CONTROLLED STUDY OF 750 WOMEN GIVEN DIETS
HIGH IN PROTEIN, VITAMINS AND MINERALS, THE INCIDENCE
OF PREMATURITY WAS REDUCED FROM 37 IN THE CONTROL
GROUP TO 0 IN THE STUDY GROUP.
ONLY 23% OF MEDICAL SCHOOLS HAVE A REQUIRED
NUTRITION COURSE.
THE MEDICAL COMMUNITY IGNORES THE RELATIONSHIP
BETWEEN COMPLICATIONS OF PREGNANCY AND AN
INADEQUATE DIET BUT RATHER DEPENDS ON DRUGS AND
HIGH TECHNOLOGY.
References available for all statements
�AN EFFECTIVE PROGRAM TO REDUCE THE INCIDENCE
OF LOW BIRTH WEIGHT BABIES
GOALS:
1. Reduce the Incidence and resultant high cost of low birth
weight babies from 7% to less than 3%.
2. Shift the emphasis from high technology and drugs for
pregnant women to a comprehensive nutritional program using
present treatment modalities where Indicated.
3. Long range, to include teaching nutrition in pregnancy and
motivational techniques for expectant mothers to all health care
providers.
PROGRAM:
1. An agressive nutritional regimen using educational and
motivational techniques for ail pregnant women with special
emphasis targeting those considered high risk.
2. Access to high quality foods and nutrients supplying 100
grams of protein and other necessary vitamins and minerals for
low income expectant mothers through existing programs such
as WIC and food stamp plans.
3. Educate health care providers to the crucial relationship of
nutrition to a healthy outcome for all expectant mothers.
�The program we have developed requires:
An agressive educational effort so that:
1.
Pregnant women would understand the importance of adequate
nutrition to their health, and to that of their babies.
2.
"Grazing" is encouraged for the baby to have food available 24
hours a day especially in the last trimester of pregnancy.
3.
Attention is paid to caloric intake for the mother's
nutritional needs rather than weight gain.
4.
Individual cultural habits and preference in taste are supported.
Supplving 100 grams of protein and necessary nutrients, especially in the
last trimester, to low income groups where the incidence of LBWB is the
highest, but who would be the easiest to reach through! clinics and existing
programs.
Educate all health providers involved in the health care of expectant mothers to the
vital need of proper nutrition.
Not only will this program reduce the incidence of LBW babies, saving hundreds of
millions of dollars in direct health costs; but, it will also save much of the untold,
indirect costs to society of developmentally disabled people, not to mention the grief
and suffering to the impaired people and to their families.
It is diffucit to assess the high cost to society of the much greater incidence of
neurological defects and sociopathic behavior in this population group as they mature
in years. There are many studies showing the higher number of LBW babies with
mental and physical health problems, needing special schools, custodial care for
many years, and the proportionately larger number of these damaged individuals
requiring incarceration.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
DATE
SUBJECT/TITLE
Lenore Gaudin & Mordecai Roth to Senator Dennis DeConcini; re:
Invitation to Health Care Task Force (partial) (1 page)
03/12/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3665
FOLDER TITLE:
DeConcini, Dermis (D-AZ)
2006-0885-F
jp2645
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)I
Ereedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information 1(a)(1) of the PRAj
P2 Relating to the appointment to Federal office |(aX2) of the PRA|
P3 Release would violate a Federal statute |(aX3) of the PRA|
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA|
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�The signatories of this letter have been directly involved as hands on health providers:
Lenore de Gaudin, RN, MA, the team leader[
P6/(b)(6)
jhas developed
nutritional programs for pregnant women for 25 years. She has taught in high schools,
universities, privately, and in groups. She has taken advanced studies in the
biochemistry of nutrition, in psychology, and has developed conclusive data of the
excellent results possible when her nutritional program for expectant mothers has
been followed. She is presently on the faculty of the University of Phoenix.
P6/(b){6)
has conducted research in clinical
Tim Strand, MD, MS, RD,
medicine and community health. For the past ten years, he has focused on factors
related to maternal and child health with special emphasis on developing prenatal
programs to reduce the incidence of toxemia of pregnancy, low birth weight, infant
infectious disease, and other malnutrition related health problems of high-risk human
populations. He is conducting ongoing studies on lactose intolerance in America and
abroad. He has developed low lactose dairy products that will improve the health,
especially during pregnancy, of Blacks, Hispanics, American Indians, and Orientals
who are prone to lactose intolerance.
Mordecai Roth, DDS, MPHJ
P6/(b)(6)
| has worked with Lenore de
Gaudin in presenting programs on the importance of good nutrition during pregnancy.
He established and administered the medical and dental programs for Cesar Chavez'
United Farni Workers in Delano, CA. and was instrumental in securing funding for, and
setting up the Oscar Romero dental clinic for Central American refugees in Los
Angeles.
Full Curricula Vitae on request.
L.
^
�UNITED STATES SENATE
WASHINGTON, DC 20510-0302
j ^ J y f U ^ ^
PUBLIC DOCUMENT
U.S.S.
OFFICIAL BUSINESS
,
-
' '
^
H<-«I+'1 Core Tax A ^rce
�DENNIS
WASHINGTON OFFICE
DECONCINI
326 HART SENATE OFFICE BUILDING
WASHINGTON. DC 20510
(202) 2 2 4 - 4 5 2 1
ARIZONA
COMMT
ITEES:
PHOENIX OFFICE:
APPROPRIATIONS
;..7
JUDICIARY
VETERANS'AFFAIRS
INDIAN AFFAIRS
RULES AND ADMINISTRATION
INTELLIGENCE
323 WEST ROOSEVELT # C - 1 0 0
PHOENIX, AZ 85003
1602) 379-6766
lanited States Senate
SOUTHEHN ARIZONA OFFICE:
WASHINGTON, DC 20510
2424 EAST BROADWAY
TUCSON. AZ 86719
(602)670-6831
EAST VALLEY OFFICE:
40 NORTH CENTER STREET # 1 1 0
MESA. AZ 8521 1
(602) 3 7 9 - 4 9 9 8
COMMISSION ON
SECURITY AND COOPERATION
IN EUROPE/CHAIRMAN
• * ' *• ^4 A p r i l 27,
1993
F i r s t Lady H i l l a r y Rodham C l i n t o n
Chairperson
H e a l t h Care Task Force
OEOB, Room 100
Washington, D.C. 20500
Dear Mrs. C l i n t o n :
I am w r i t i n g a t t h e r e q u e s t o f t h e Mesa, A r i z o n a Committee
on Aging t o i n v i t e y o u r H e a l t h Care Task Force t o c o n s i d e r
h o l d i n g an o u t r e a c h meeting i n Mesa.
; %
.
The Mesa Committee on Aging i s comprised o f consumer
advocates and h e a l t h care s e r v i c e p r o v i d e r s who o f f e r programs
and s e r v i c e s t h a t promote and m a i n t a i n t h e independence, h e a l t h
and s e l f - e s t e e m o f a s i z a b l e p o p u l a t i o n o f o l d e r c i t i z e n s i n t h e
l a r g e Mesa/East V a l l e y area. I t i s a d i s t i n g u i s h e d o r g a n i z a t i o n
w i t h h i g h l y r e p u t a b l e and e x p e r i e n c e d members.
'"Si
Mr. John M. L i n d a , C h a i r p e r s o n o f t h e Mesa Committee on
A g i n g , and Ms. Helen S t o r t z , Co-Chair o f t h e East V a l l e y
L e g i s l a t i v e Committee on Aging have o f f e r e d t o h e l p c o o r d i n a t e
such an e f f o r t which c o u l d be h e l d a t t h e Mesa S e n i o r Center, a
f a c i l i t y which can accomodate b o t h s m a l l and l a r g e groups.
Your
s t a f f can c o n t a c t t h e Committee a t 602 464-1061, o r 247 N o r t h
Macdonald, Mesa, A r i z o n a 85201. •
I t h i n k , as you do, t h a t i t i s u s e f u l t o seek i n p u t f o r
r e f o r m f r o m a l l over t h e c o u n t r y , and I encourage you t o i n c l u d e
t h e Western s t a t e s , p a r t i c u l a r l y A r i z o n a , i n your process.
Thank you f o r your c o n s i d e r a t i o n o f t h i s r e q u e s t .
Sincerely,
.
DENNIS DeCONCINI
U n i t e d S t a t e s Senator
DDC/ssu
i :
'•
t
�\
s
B a l l o t P r o p c s a l Woulid Add 4 0 C e n t s t o C i g a r e t t e Tax
By W I : J L I A M F. RAW.SON A s s o c i a t e J P r e s s W r i t e r
PHOFNIX (AP) Fei.). 1 -- A s t a t . - w i d e c o a l i t i o n k i c k e d o f f
e f f o r t t o d a y t o ge': an i n i t i a t i v ' ^ on t h e November b a l l o t
c a l l i n j f o r a new 4 0 - c e n t - a - p a c k t a x on c i g a r e t t e s .
Rev nues .raised by t h e new ta.-: an e s t i m a t e d $90
m i l l i o n t h e f i r s t year
would support a v a r i e t y o f
a n t i - s m o k i n g and h e a l t h - c a r e p r o g r a m s , a c c o r d i n g t o
A r i z o n a f o r a Heal'.h F u t u r e , t h e c o a l i t i o n b e h i n d t h e
petiti'.jn dri'^e.
Of t h e e s t i m a t e d $90 m i l l i o n , 70 p e r c e n t w o u l d be u s e d
by t h e A r i z o n a H e a l t h Care Cosi: .Jontainment System f o r
i n d i g e n t h e a l t h c a r e , 23 p e r c e n t w o u l d go t o t h e
Department o f H e a l t h Services f c r a n t i - s m o k i n g e d u c a t i o n ,
5 p e r c ^ m t t o DHS f ( ^ r r e s e a r c h i n t o s m o k i n g - r e l a t e d d i s e a s e s
and 2 p e r c e n t t o t h e D e p a r t m e n t o f C o r r e c t i o n s t o o f f s e t
any lc.;s i n r e v e n u e s f r o m t h e c u r r e n t t o b a c c o t a x u s e d t o
suppori: p r i s o n c o n . s t r u c t i o n .
F o r m e r Sen. B a r r y G o l d w a t e r w i l l s e r v e as s t a t e w i d e
chairman o f t h e campaign, which i s cosponsored by t h e
A m e r i c a n Cancer S o c i e t y , t h e A m e r i c a n H e a r t A s s o c i a t i o n ,
t h e A r i z o n a H o s p i t : i l A s s o c i a t i o n and t h e A r i z o n a Lung
Association.
' ' I t w i l l be a d e t e r r e n t , ' ' G o l d w a t e r s a i d o f t h e
propoE.'d t a x . ' ' I t won't n e c e s s a r i l y s t o p s m o k i n g , b u t i f
a p e r s ' i n has t o p.^r,' an i d d i t i o n a l 40 c e n t s a p a c k f o r
c i g a r e t e s , I t h i n k he' L 1 s t o p and t h i n k b e f o r e he does
that.''
Anni^ McNamara, p r e s i d e n t o f t l i e A r i z o n a N u r s e s '
A s s o c i a t i o n and c o - c h a i r m a n o f t h e c a m p a i g n , s a i d t h e
a n t i - s m o k i n g e f f o r t w i l l be a i m e d p r i m a r i l y a t c h i l d r e n
becaus^j 90 p e r c e n t o f a l l new smokers a r e y o u n g p e o p l e .
She sa i.d s t a t i s t i c s show t h a t c h i l d r e n b e g i n t o smoke
b e t w e e n t h e ages o f 9 and 1 1 .
' ' H i g h e r p r i c e s , t o g e t h e r w i t h an a g g r e s s i v e e d u c a t i o n
c a m p a i ( j n , a r e t h e most e f f e c t i v e way t o d i s c o u r a g e
c h i l d i - ^ n f r o m s m o k i n g b e f o r e t h e y p i c k up t h e h a b i t , ' ' she
said.
M a t t h e w G. Madonna, e x e c u t i v e v i c e p r e s i d e n t o f t h e
A r i z o n a D i v i s i o n o f t h e A m e r i c a n Cancer S o c i e t y , s a i d
A r i z o n a ' s c u r r e n t c i g a r e t t e t a x i s 18 c e n t s a p a c k , w h i c h
makes ' t t h e 3 7 t h h i g h e s t i n t h e n a t i o n .
Mas.sachusetts and C a l i f o r n i a .already have p a s s e d
s i m i l a i ' i n i t i a t i v e ; - ; , d e s p i t e m u l t i m i l l i o n - d o l l a r campaigns
a g a i n s t them b y t h e t o b a c c o i n d u s t r y , he s a i d .
�Madonna s a i d Iir.lian t r i b e s , who would not be a f f e c t e d
by the i n i t i a t i v e , w i l l be encouraged t o l e v y the t a x i n
t h e i r smoke shops .md t o use the proceeds f o r h e a l t h - c a r e
programs on t h e r e s e r v a t i o n s .
The c o a l i t i o n w i l l have u n t i l J u l y 7 t o c o l l e c t more
t h a n 105,000 p e t i t i o n s i g n a t u r e s t o q u a l i f y the i n i t i a t i v e
f o r the November b a l l o t . Madonna s a i d the p e t i t i o n s have
been on t h e s t r e e t since Jan. 1.
Two
Rhode I s l a n d H::)Sf)itals R e p o r t e d l y To Merge
^
PROVIDENCE, R.i. (AP) Feb. 1
Memorial H o s p i t a l o f Pawtucket
and Landmark Medical Center o f Woonsocket and N o r t h
S m i t h f i e l d p l a n t o merge, Memorial H o s p i t a l spokeswoman
Joan Rocha s a i d t';:^ iay.
The h o s p i t a l s s a i d they would operate under a j o i n t l y
owned h o l d i n g company, t h a t would seek i n c r e a s e d
e f f i c i e n c y and q u a l i t y ''by c o n s o l i d a t i n g and enhanching
medical s e r v i c e s and programs.''
''For the immediate f u t u r e , b o t h h o s p i t a l s w i l l
c o n t i n u e t o f u n c t i . r i as f u l l - s e r v i c e medical i n s t i t u t i o n s
i n t h e i r respectiv^^ communities,'' t h e h o s p i t a l s s a i d i n a
j o i n t statement.
The merger would c r e a t e t h e s e c o n d - l a r g e s t h o s p i t a l
e n t i t y i n Rhode I s l a n d , w i t h 527 acute-care beds and more
t h a n 20,000 annual admissions and 152,000 annual p a t i e n t
days, a c c o r d i n g t o t h e statement.
The new e n t i t y '.voiild combine Memorial's r o l e i n
preventative
h e a l r h care, f a m i l y care and m e d i c a l
r e s e a r c h w i t h Landmark's r e h a b i l i t a t i v e s e r v i c e s , e l d e r l y
care and i n - p a t i e n r p s y c h i a t r i c care, the h o s p i t a l s s a i d .
Memorial, a 319 b'-d h o s p i t a l a f f i l i a t e d w i t h the Brown
U n i v e r s i t y School of Medicine, and Landmark, which has 315
beds, b o t h a l r e a d y are p r o d u c t s o f p r e v i o u s mergers.
Memorial a c q u i r e d t h e former Notre Dame H o s p i t a l i n
C e n t r a l F a l l s i n 1989. Landmark, formed i n 1988, comprises
the former Fogarty Memorial H o s p i t a l i n N o r t h S m i t h f i e l d
and tho former Woo:;socket H o s p i t a l .
The merger woul,: i'e t h e second one proposed i n the area
i n r e c e n t months. . December, Miriam H o s p i t a l and Rhode
I s l a n d H o s p i t a l an;iounced p l a n s t o c o n s o l i d a t e .
Landmark and Memorial were two o f f o u r h o s p i t a l s l e f t
out when U n i t e d He:ilth Plans o f New England formed a
l i m i t e d h o s p i t a l n':tv;ork f o r i t s e l d e r l y s u b s c r i b e r s l a s t
�r
GOP
Health refonn cost report on trial in Texas
make t?K' label stickforher political life
dates it — and then used to either inBy Mark Potok
sure or put in a trust fund should
be on budget" said Pete Domenici of i USA TODAY
Ever since introducing his health- New Mexico, ranking Republican on
FORT WORTH - After five
reform plaa President Qimon has the Senate Budget (jDmrnittee.
months of legal maneuvers
The
White
House
is
not
standing
been trying to avoid a "tax" label.
and with her political fumre at
His health<are reform task force, idly by for bad news. The Clinton
stake. Sen. Kay Bailey HutchiChaired byfirstlady Hillary Rodham campaign for reform is continumg;
son. R-Texas. goes on trial here
•
Today,
the
first
lady
travels
to
i
Qinton, cast about for a way to protoday on ethics and cover-up
vide health insurance for all Ameri- Portland. Maine, to promote the plan i charges.
with Senate Majonty Leader George 1 In a tnai expected to last
cans without using taxes.
i from two to four weeks, the
They thought they had found it by Mitchell. D-Maine.
• Tuesday, the president talks to
creating independent alliances to
state sfirstfemale senator —
collect premiums and pay the bills. workers about health reform at a i and first indicted while in ofBut Tuesday, the Congressional GM plant in Shreveport La.
fice — faces up to 51 years in
Even Cooper, whose plan is
Budget Office is expected to give
pnson and $43,000 infinesif
emerging
as
the
chief
rival
to
QinQinton s opponents an opening to
found guilty of charges she
hammer the plan's funding appara- ton's, sees little significance to the
By Johr OuncM. AP
misused state employees when
CBO report
tus as a broad new tax.
HUrCHMON: Bling tried on
Texas state treasurer.
"I think you should take those
The CBO report to Congress will
Also at nsk: Her standing as ethicstf>doo¥«r-AJp charges
give an independent analysis of the numbers with a grain of salt and two one of the Republican Party^
cost of the amton proposal and its ef- aspirin, " Cooper said. "The federal bnghtest new political stars
numerous Democrats on similar charges, denies the accusafect on the federal budget the deficit govemment has never gotten health
•There'
s
nothing
in
Tens
estimates right Our track record is
tion: "Every time my office has
and the economy.
history
to
compare
with
this,"
The report is expected to say that appalling. That alone should make
says George Christian, a Icmg- prosecuted a higbi>roflle politiQinton's healthfinancingshould be you skeptical of federal govemment time aide to Lyndon JohoaoiL cian. I have been attacked perestimates."
part of the federal budget
"I don't think anybody can pre- sonally."
Cooper, whose plan has gained the dict how it's going to come out
Under Qinton's proposal, employHutchisoo Is accused of users and employees would split the support of an influential business
Its just one of thoae rare ing sate employees to do her
cost of health insurance premiums group, is enjoying a new celebrity
events. .., It's going to be a personal and poUticai business
80'>20''c. The money would be paid status on the health-care circuit
while serving as state treasurheck of a trial."
to quasi-public alliances, not into the Saturday he traveled to Dallas to
er, a post she held until her
Hutchison,
a
Republican
appeal to followers of Ross Perot
federal treasury.
election as senator. And she s
who
was
elected
in
a
June
Sen. John Breaux, D-La.. who But Cooper said Sunday he didn t landslide to fill the seat vacat- accused of ordering a cover-up
along with Rep. Jim Cxwper. D- seek their endorsement
by Treasury Secretary — directing employees to
He said he is in regular touch with ed
Tenn., is sponsoring a rival DemoLloyd
Bentsen, faces reelec- erase computer records — alcr^Uc plan, said the report could the White House and has the support uon this November. Until she ter a newspaper story deof 58 members of Congress.
make it harder for Qinton.
was indicted in September, her scribed how a Hutchison aide
But it also, at the same time, en- Cooper's plan relies on competisuccess
was virtually certain. used the computers to wnte pocourages the compromise," Breaux tion to bring down health-care
No
major
Republican candl- litical letters.
Hutchison lawyer Dick Desaid. 'It really doesn't change the dy- prices. It does not guarantee univer- (jate has filed against her, alsal coverage nor rely on a big buGuerta a leading Texas denamics of the debate much."
Oiough
a
half
dozen
minor
ones
•Everything that is mandatory — reaucracy to run the system.
have Former attorney general fetae lawyer who represented
that must be taken from America's
Jim Mattox leads afieldof four WtKO cult leader David Koreconomy because govemment man- • Clinton's new hurdle, 1A
, Democrats and is running hartl esh. h«i won several pre-cnai
for Hutchison's job.
> Judge John Onion Jr
I Even if there were no camI paign. the case has become banned cameras in the court1 deeply politicized. Thaf s large- room, agreeing with defense
I ly because defense lawyers arguments that Um dips from
and the GOP establishment the trial would turn up in this
here have persistentiy accused year's Senate race
• Onion agreed to move the
Travis County District Attorney Ronnie Earle. a Democrat, trial from liberal Auson, the
state capital, to tar more conof a partisan attack.
"This is purely a political servative Fort Worth.
For her part. Hutchison
show trial,"' says Fred Meyer,
chairman of the Texas Repub- faces four felooy and one mislican Party. "This was a politi- demeanor charge. Even if concal vendetta because Kay got victed, she could serve in the
MS. Senate, unlesB other sena%l<^c of the vote."
Earle, who has prosecuted tors chose to eipel her.
By Richard Wolf and Judl Hasson
USA TODAY
�Democrats t o r e s t o r e t h e exemption,
1995 .
b e g i n n i n g J u l y 1,
The s t a t e t o o k away t h e exemption l a s t year as a way t o
get s u r p l u s Medicaid money. No p a t i e n t s pay t h e t a x s i n c e
the s t a t e repays t h e h o s p i t a l s a f t e r u s i n g t h e t a x
proceeds t o c a p t u r e t h e f e d e r a l money.
The s t a t e has g o t t e n more than $600 m i l l i o n i n s u r p l u s
M e d i c a i d money s i n c e 1991 t h r o u g h schemes, such as t h e
rooms and meals t a x . Though Medicaid i s t h e s t a t e - f e d e r a l
h e a l t h care program f o r t h e poor, most o f t h e excess money
has been spent on o t h e r s t a t e programs.
At t h e t i m e , l e g i s l a t o r s assured t h e h o s p i t a l s t h e
exemption would be r e s t o r e d when t h e s t a t e no l o n g e r c o u l d
use t h e d e v i c e t o g e t t h e e x t r a f e d e r a l money.
But Rep. Raymond Buckley, D-Manchester, s a i d Wednesday
t h e t e m p t a t i o n would be t o o g r e a t t o keep t h e t a x once t h e
M e d i c a i d money i s l o s t i f t h e exemption i s n ' t p u t back
i n t o t h e law.
' ' C l e a r l y , we have t h e o b l i g a t i o n o f honor t o t h e
h o s p i t a l s , ' ' r e p l i e d Rep. Douglass Teschner, R-Pike.
But he c a u t i o n e d a g a i n s t tampering w i t h t h e t a x law f o r
f e a r o f l o s i n g t h e Medicaid money.
''We s h o u l d n ' t change a n y t h i n g r i g h t now,'' agreed Rep.
Douglas H a l l , R-Chichester. ''There's t o o much a t r i s k . ' '
H a l l e s t i m a t e d t h e s t a t e s t o o d t o l o s e between $150
m i l l i o n and $300 m i l l i o n a year i f t h e b i l l passed.
''This i s t h e l a r g e s t s i n g l e revenue source t h e s t a t e
has t o support t h e s t a t e budget,'' s a i d H a l l , a member o f
the b u d g e t - w r i t i n g committee. ''We s h o u l d n ' t p u r p o s e l y
b r i n g down t h e house o f cards today we c r e a t e d t o s u p p o r t
it. ' '
K\
\, House Panel OKs Governor's Plan t o Expand AHCCCS Coverage
VK" By NEIL BIBLER= A s s o c i a t e d Press W r i t e r =
PHOENIX (AP)Feb 17 -- Federal a p p r o v a l f o r expanding h e a l t h
coverage f o r A r i z o n a ' s needy i s l i k e l y because t h e
p r o p o s a l ' s i n l i n e w i t h P r e s i d e n t C l i n t o n ' s p l a n s and
because A r i z o n a ' s a l r e a d y d o i n g a good j o b , o f f i c i a l s say.
The House Health Committee approved Gov. Fife
*"
Symington's proposal late Wednesday despite concern that "-->^::n^,.,..
�because o f u n c e r t a i n t i e s i n f e d e r a l h e a l t h r e f o r m s ,
A r i z o n a might be stuck w i t h a l a r g e p a r t o f the b i l l i o n s
o f d o l l a r s Symington's p l a n w i l l c o s t .
The b i l l approved by 7-1 would add an e s t i m a t e d 183,000
people t o the A r i z o n a H e a l t h Care Cost Containment System,
the s t a t e ' s s u b s t i t u t e f o r the f e d e r a l M e d i c a i d program o f
h e a l t h care f o r i n d i g e n t s .
Rep. Bob Edens, R-Tempe, argued t h a t by p o l i c y
d e c i s i o n s the L e g i s l a t u r e put i n p l a c e l a s t year, AHCCCS
c o s t s and the number o f people u s i n g i t s s e r v i c e s are
d r o p p i n g , a t r e n d t h a t c o u l d be j e o p a r d i z e d by the
expansion program.
' ' I don't b e l i e v e we should take on an e n t i t l e m e n t
program of t h i s s i z e , ' ' Edens s a i d , c i t i n g t e s t i m o n y
showing i t would i n v o l v e about $7 b i l l i o n over f i v e y e a r s ,
m o s t l y i n f e d e r a l money i f a l l goes w e l l . ''Once you put
an e n t i t l e m e n t program i n p l a c e , you never get r i d o f i t . ' '
I t would cover i n d i v i d u a l s whose income i s l e s s t h a n
100 p e r c e n t o f the f e d e r a l p o v e r t y l e v e l , r a t h e r t h a n t h e
c u r r e n t 90 p e r c e n t , and would i n c o r p o r a t e the m e d i c a l l y
needy, m e d i c a l l y i n d i g e n t whose care now i s met w h o l l y by
state dollars.
I t a l s o would extend a l l AHCCCS s e r v i c e s t o those who
l i v e on I n d i a n r e s e r v a t i o n s , whose medical care now i s
l i m i t e d t o t h a t which the I n d i a n H e a l t h S e r v i c e p r o v i d e s
u n l e s s t h e y t r a v e l o f f the r e s e r v a t i o n .
Assuming the p r o p o s a l wins f u l l l e g i s l a t i v e a p p r o v a l ,
p u t t i n g i t i n t o e f f e c t would r e q u i r e a f e d e r a l w a i v e r ,
j u s t as the c u r r e n t AHCCCS program does.
But AHCCCS D i r e c t o r Mabel Chen s a i d she f e l t
n e g o t i a t i o n s f o r a f e d e r a l w a i v e r would succeed because
the f e d e r a l government a l r e a d y approves o f AHCCCS and
A r i z o n a would be o f f e r i n g ' ' t o t r y something new t o f u r t h e r
improve the M e d i c a i d system.''
Chen p o i n t e d out t h a t P r e s i d e n t C l i n t o n wants t o expand
h e a l t h coverage t o those who now have no i n s u r a n c e . ''We
are b o r r o w i n g the p r e s i d e n t ' s concept,'' she s a i d .
And committee Chairwoman Susan Gerard, R-Phoenix,
contended ''the s t a t e s t h a t get on board e a r l y w i t h p l a n s
t h a t work, t h a t set t h e i r own d e s t i n y , are g o i n g t o get
the s u p p o r t from the f e d e r a l government.''
Edens s a i d t h a t t h r o u g h e l i m i n a t i n g AHCCCS coverage o f
undocumented a l i e n s , i n s t i t u t i n g a copayment and o t h e r
p o l i c y a c t i o n s l a s t year, the system w i l l r e t u r n $28
�p e r c e n t d i s c o u n t s on p e r s o n a l a c c o u n t i n g s e r v i c e s . I n
a d d i t i o n , they o f f e r e d f r e e t a x r e t u r n p l a n n i n g and
p r e p a r a t i o n r e l a t e d t o t r a n s f e r s o f employees, f o r t h e
year o f r e l o c a t i o n .
The L o u i s v i l l e C o u r i e r - J o u r n a l o f f e r e d a 50 p e r c e n t
d i s c o u n t on six-month s u b s c r i p t i o n s w h i l e Business F i r s t ,
a weekly business p u b l i c a t i o n , s a i d i t would g i v e a 50
p e r c e n t d i s c o u n t on two-year s u b s c r i p t i o n s .
The L o u i s v i l l e B a l l e t promised vouchers f o r two f r e e
t i c k e t s p e r f a m i l y f o r 1994-95 p r o d u c t i o n s , e x c l u d i n g The
Nutcracker.
But what Columbia/HCA r e a l l y wants i s t h e c o n t r a c t t o
c o n t i n u e managing t h e U n i v e r s i t y o f L o u i s v i l l e H o s p i t a l .
That d e c i s i o n i s up t o t h e s t a t e , and n e g o t i a t i o n s a r e
c o n t i n u i n g between Finance S e c r e t a r y Pat M u l l o y and
Columbia/HCA o f f i c i a l s .
Under a c o n t r a c t i n h e r i t e d from Humana I n c . ,
Columbia/HCA t r e a t s a l l i n d i g e n t p a t i e n t s i n J e f f e r s o n
County i n r e t u r n f o r payment from t h e county, c i t y and
state.
Bosc s a i d t h e i n c e n t i v e s a r e s i m i l a r t o those o f f e r e d
t h e P r e s b y t e r i a n Church U.S.A. i n 1987 t o l o c a t e i t s
headquarters i n L o u i s v i l l e .
Four More Parts o f H e a l t h
Package Pass
SANTA FE (AP) Feb 17 -- Four more p a r t s o f t h e h e a l t h care
r e f o r m package recommended by a t a s k f o r c e won a p p r o v a l
from t h e L e g i s l a t u r e and went t o Gov. Bruce King, who has
endorsed t h e p l a n .
The b i l l s approved Wednesday i n c l u d e a mandate t h a t a
t a s k f o r c e and a commission come up w i t h p l a n s t o p r o v i d e
h e a l t i i care f o r ' a l l New Mexicans s o - c a l l e d u n i v e r s a l
coverage by Oct. 1, 1997.
One o f t h e p l a n s t h a t i s p r e s e n t e d t o t h e L e g i s l a t u r e
must be a s i n g l e - p a y e r system such as t h e one t h a t was
under c o n s i d e r a t i o n i n l a s t year's l e g i s l a t i v e s e s s i o n .
The l e g i s l a t i o n a l s o says t h e h e a l t h care t a s k f o r c e
and t h e New Mexico H e a l t h P o l i c y Commission must p r e s e n t
a p l a n t o t h e L e g i s l a t u r e next year t o p r o v i d e h e a l t h care
t o a l l u n i n s u r e d c h i l d r e n under 18 by J u l y 1995.
�BrVidaKsflvsr
^1HARON MILLER-Jaffe's health insur^^aifice horror story is in many ways like
thousands of others that have led to the
urgefit call for health reform—except for
CDS #taiL Miller-Jaffe waited weeks for the
tasdieBl review board at her HMO to ap{•ovs'the hysterectomy recommended by
tbe doctor at the very same HMO; finally,
desperate and in pain, she went outside the
iniO^^o have the procedure, paying $3,000
ia oot^f-pocket costs.
' Tb^, detail is that Miller-Jaffe was enroUed
m a health care plan that was already "refonned"—namely a managed care plan
farced upon Arizona's state employees two
year? ago. While the experiment was expected to save the state money as well as provide Btate-of-theart care, it has produced a
litany xif complaints about misdiagnoses, detayed treatment, unpaid bills and lost paperwork..
Aiuona's attempt at reform may plague
some of those enrolled, but it also offers a
warning for the rest of us. While the national
healtb care reform effort is guided primarily
bjr a ({esire to create universal coverage, the
Cintdn plan, like Arizona's, is championed by
a chief executive also determined to hold the
boe ori spending. At the heart of both plans is
a state-run form of "managed competition" in
wiiick enroUees. organized by geographic regoa, must choose from a limited number of
HMOs and other insurance plans. And the
Arixona plan'sfinalform was influenced by
lobbyists and a dedsion-making process sub' ject to political influence.
Arizona's troubles began in early 1992,
when its newly elected Republican governs,
Fife Symington, announced—in an act of
budget-cutting bravado—that the state
would not pay any mcreases in health insurance Benefits for its employees, much less a
scheduled $44 million mcrease in premiums.
Instead, the state rebid the contract to "introduce a managed competition philosophy in
an effort to control costs for the state and
emplbyees."
A^zona officials, advised by insurance
sai^^^ple and lobbyists, awarded to IntergrqiQ) Health Care Corp. a $63.8 million
dnmk of the state's contract to cover its empipjrces. As expected, the new plan, accordii^.tqa report by the state auditor general"s
office, "did result in savings to the state." But
ifi also true that state employees and retireeahave paid, in myriad other ways, a price.
^pr one, there's the matter of choice: The
state's $169 miUion contract with three diffei;^ companies left employees in rural
co^^ties without an HMO plan, a situation
tlm^i^Stite later remedied in the face of pending, l/egal action. And 80 percent of the
flip's employees, those m the Phoenix and
Tupon areas, no longer had the option of
tl)C;.9M "see any doctor you want and send
tiis^bill to the insurance company" plan. They
were forced either to use Intergroup's HMO
oSr aixitber HMO or pay higher premiums,
da^Bctibles and out-of-pocket costs to see
oma:^*^int of service" physicians.
^n>«n there are questions about InterKimper is executive editor of Common
Magazine. A longer version of this
appears in the magazine's Spring
giospOi tariMV fMMtaMi- A Kosntif re>
leased federal audit cifiimgiuup'icontract
with the Federal Employees' Health Benefits
Program for the years 1987-1991 concluded
that Intergroup overcharged the program
more than $3.6 miUion—20 percent of total
premiums. Last August, the Department of
Justice reached an out-of-court settlement
with Intergroup whereby the company
agreed to refund almost $2.6 million to the
federal program.
B
ut of greater concem to some has been
quality of care. The extent of the problemfirstcame to tight at an October
1992 meeting of Intergroup officials and
state employees enrolled in the plan. There,
one state employee stood up, holding in his
hand a small plastic tube. He said the tube
had been inserted into his bladder to relieve
kidney problems, but when it came time to
have the tube removed he had been forced to
wait for approval from an Intergroup medical
review board. One by one, others in the audience stood to express their dissatisfaction.
Soon after, a sheet of paper was circulated
around the room to coUect the names of other unhappy Intergroup members. From that
a movement was bom. Within a few months,
a letter-writing campaign to state officials
was initiated and a petition demanding better
care gathered more than 2,800 signatures,
prompting the fonnation of a special legislative committee to investigate the matter.
Nearly 300 letters from Intergroup mem-
bers to state offidalB told (tf care delayed and
denied, paperwork kiet and claims unpaid—
and the resulting physical and mental anguish. Among the most common complaini
were "having clerks with no medical trainjrtg
decide whether you get an appointment
your doctor"; a reluctance among physicians
to refer patients to specialists; and "hamg to
wait long times for appointments." (Other
complaints ranged from Intergroup's
to prescribe certain drugs to the company's
"retro-termination" policy, whereby it occa
sionally refused after the fact to pay for a
procedure it had authorized.
Intergroup says that its utilization review
committees meet weekly (ak>ng with an Intergroup representative) to approve or reject certain diagnostic tests, surgical procedures and referrals recommended by
Intergroup physicians. "Doctors on the committees make those decisions, not some
nurse in Nashville or somewhere," says Intergroup official Philip Dew, senior vice
president of medical affairs and a pediatrician who practiced at Thomas-Davis Medical
Centers for 30 years.
Even so, Jim Hemauer, a senior program
coordinator at Arizona State University's
Disabled Student Resources Office, says that
when he became ill recently, be was forced
to see an Intergroup doctor who apparently
was unfamiliar with the kind of spinal-cord
injuries that paralyzed Hemauer from the
neck down 23 years ago. The urgent-care
physician. Hemauer reported, gave him a
\
St
�7,
lecture and some antibiotic samples and sent recent HMO average of 87. And Interhim home. Convinced his life was in peril, group's number of hospital "bed days" per
Hemauer went to an outside physician, who 1,000 members declined to 243 m 1992. far
recognized the signs of an advanced pressure below the 1991 industry-wide average of
410.
ulcer and hospitalized him for surgery.
James Charles, a 50-year-okl projects spe- Intergroup officials maintain that its incencialist with the state Department of Correc- tives andfinancialsuccess do not reduce the
tions, says his wife's Intergroup doctor quality of care. At a legislative hearing last
woukln't prescribe a drug she needed for a October. Intergroup CEO Rick Barrett desciatic nerve condition; his daughter waited fended the company's performance with reweeks to receive treatment for a disabling sults of "satisfaction surveys." Ninety-one
knee injury; and his own back condition was percent of members in Intergroup's HMO
misdiagnosed by an Intergroup physician, gave the company a good, very good or exwho said nothing couW be done to rebeve his cellent rating in the latest survey, as did 51
pain. Calling Intergroup "the insurance com- percent of members in Intergroup's point-ofpany from hell," Charles and his family decid-service plan, Interflex. (A 1992 evaluation of
ed to shell out an extra $150 a month to HMOs by Consumer Reporu ranks Interswitch to another health plan, where his wife group 25th out of 46 HMOs in member satgets the prescription she needs and he is re- isfaction.)
sponding well to treatment for a herniated
Even so, allegations of poor service from
disk.
Intergroup are not new. In the late '80s, weU
Intergroup's Barrett responds that all of
these cases have been "intensely scrutinized before it won the controversial sUte conand subjected to the most stringent tesu of tract, Intergroup had been receiving a relamedical quality assurance." Moreover, he tively high number of customer complainU;
SUtes, the "evenu and perceptions report- in fact, sUte auditors charged that Intered . . . are descriptive of a cohort of individ- group had violated Arizona laws by impropuals who have actively avoided entry to a erly handling claims. Last fall, about the
managed care environment" and "these prob- same time the sUtefinedIntergroup for the
lems will not arise among a larger, more so- claims violations, a state-commisswned audit
cially diverse and representative popula- blasted the Interflex point of service plan
that had helped Intergroup win the state
tion
"
contract. None of the 300 claims sampled by
ritics, however, trace the cause of the auditors had been paid within the 14-day
these and other complainU to the fact period required by the sUte contract, and althat, as two former Intergroup physi- most one third of claims remained unpakl afcians said, the company's "primary interest ter 49 days.
is not patient care; it's the bottom line." One
of them, primary care physician Allan Kogan, Given that, critics ask, why did Intergroup
who is an enthusiastic supporter of the man- get the sUte contract'
aged care concept, says he left the HMO last Some point to a well-used revolving door.
September after a number of his patienU Among those now or recently on Interwere "hurt" by Intergroup physicians, a group's roster of top executives, directors,
consultanU and lobbyisu are three fonner
charge Intergroup denies.
A look at how Intergroup has structured aides to former Arizona governor Bruce Babthe compensation schedule for iU physicians bitt; a lawyer-lobbyist with dose ties to Gov,
suggesU that it provides incentives for less- Symington; and three former top RepuNican
er care. In addition to paying its 30 group lawmakers, one of whom, Chris Herstam,
practices a fee for each person who selecu was Symington's chief of staff when Interone of iu primary care physicians, Inter- group won the state contract. Last August,
group creates "shared-risk" pools to cover barely a year after going to Intergroup, Herhospital sUys and referrals to specialists. If a sum was nominated by Symington to head
group's hospiulization expenses come in be- the SUte agency that regulates HMOs. Barlow a predetermined amount, Intergroup and rett explains that Arizona is a small sUte and
its physician groups divide and pocket the that he's always looking for "good peosavings. If expenses go over the limit, the ple . . . . They didn't come here to sell me
costs come out of doctors' pockets.
their conucts in govemment."
In other words, while traditional fee-forBarrett says Intergroup won the contra
service physicians earn more by doing more. fair and square and while it "can be cri
Intergroup doctors earn more by doing less. justifiably, for execution of the implemenU
'Their bonuses are based on how little they tion," its business behavior is beyond redo," says one former Intergroup physician, proach. In response to employees' protesu,
adding that "even the best ones" have diffi- Arizona officials have taken steps to correct
culty making treatment decisions because
they realize a referral couM hurt them finan-some of the problems and return to their emcially or that extra hospital days "will be bad ployees some health care choices. But sUte
employees have resigned themselves to a
for their numbers."
The strategy has worked, at least finan- continued struggle for accountability and
cially. Forbes ranked Intergroup the coun- quahty care.
"Patients here are not asking for special
try's sixth-best small pubbcly traded compatreatment,"
says Jacqueline Sharkey, a Uniny in 1992; anotherfinancialanalysis noted
versity
of
Arizona
journalism professor and a
that Intergroup revenues had increased 600
percent since 1986 and praised iU "Ixjttom- leading critic of Intergroup. "They are asking
line orientation." Accenting to Intergroup's for the benefits for which they and the sUte
1992 annual report, iu medical-kies ratio— are paying millions of dollars a year. But it's
health care expenses as a percentage of pre- dearfirommy experience," she adds, "that
mium revenue—declined from 86.7 in 1990 we're going to have tofightfor the beoefiu
to 81.1 in 1992, significantly bekw the moat we are paying for."
C
73
�average of" $1,159 on every managed care patient. In addition,
the hospital lost three times more on inpatient managed care than
on inpatient charity care. POST notes that as a r e s u l t of such
cases, "many hospitals are closing or merging, and the downward
pressure on prices i s feeding the trend. The shakeout w i l l
reduce wasteful overhead expenses, but the surviving hospitals
w i l l be l e f t in a stronger bargaining position, potentially
making i t harder for insurers to extract concessions" i n
negotiating discounts. POST also notes that " i n the absence of"
premium caps, "hospitals might s h i f t even more of t h e i r costs to
the dwindling number of people in t r a d i t i o n a l " plans. But
analysts note such a move "would prove self-defeating, because i t
would accelerate the movement from t r a d i t i o n a l insurance to
managed care" (David Hilzenrath, 6/6).
EFFECT ON PATIENTS:
U.S. NEWS & WORLD REPORT n o t e s
the
recent decline in medical price i n f l a t i o n (see AHL 5/10/94). CBO
"suggests that because the slower rate of growth in HMO premiums
has been at least p a r t i a l l y offset by growth in out-of-pocket
expenses such as o f f i c e v i s i t co-payments, the t o t a l health care
costs for each enrollee may have grown more rapidly than i s
widely believed." U.S. NEWS also notes that releasing patients
early from hospitals "means that patients — rather than
providers — bear the costs." Boston College's Shindul
Rothschild: "There has been nothing to document the cost of
s h i f t i n g the burden of care to families and community-based
service" (Sara Collins, 6/13 i s s u e ) .
CAMPAIGNS OF '94
*4
ARIZONA SENATE: BRINGING HEALTH REFORM TO THE FRONTLINES
"As part of a national effort targeting opponents of" the
Clinton health plan, protesters c r i t i c i z e d 6/2 Senate candidate
Rep. Jon Kyi's (R) support of health reform b i l l s they claim
"won't improve health care access and coverage." Kyi i s running
for the seat being vacated by Sen. Dennis DeConcini (D).
Marching in Tempe, a "handful of volunteers" carried signs that
read, "Jon Kyi, give us what you've got," in reference to the
"lush health benefits given to members of Congress." AZ Citizen
Action's Karen Adams: "We're asking him and members of Congress
to give Americans the same coverage." The protest was part of a
national campaign being sponsored by groups including C i t i z e n
Action, Jobs with Justice and the DNC's Nat'l Health Care
Campaign that i s targeting "the l e g i s l a t o r in each state who
receives the most money from insurance and health care" PACs
(Kendall Ameduri, TEMPE TRIBUNE, 6/3).
SIGN THIS: A group of AZ GOP congressional candidates,
including Kyi, signed a "formal pledge" to NFIB and the Lincoln
Caucus 6/2, "promising not to support any health care reform
proposal that includes price controls, employer mandates, higher
taxes or limited choice." No Dems have signed the pledge. The
pledge-singing "was immediately dismissed as p o l i t i c a l
grandstanding by several Democrats and chastised by" C i t i z e n
Action. Dem Senate candidate Rep. Sam Coppersmith: "The pledge
... i s nothing more than a proposition put forward by the
insurance companies and others who want to stop r e a l health care
reform and that are supporting b i l l s Jon Kyi i s co-sponsoring."
The issue "became so heated that at one point, representatives
for Arizona C i t i z e n Action abruptly interrupted the GOP
candidates' news conference ... and engaged in a shouting match"
with Kyi. Kyi "accused the group and others who held nationwide
�CHRIS JENNINGS NOTES ON PRESIDENT'S MEETINGS 7/17/94
DeConcini: Wasfineon the mandate. Concerned about the numbers - doesn't think
they add up - wants additionalfinancingsources, such as alcohol tax or assessment o
employers of maybe 1% or 2%. Has a relative who is a doctor and wants to be able to
answer hisfinancingconcerns.
�Cc
Continued Prom Page A3
their families. But this formula has provoked concem among labor unions, who
fear that the lower emplover share would
undermine their own bargaining position
By HiLAjiY STOLT
with corporations which now absorb a
And DAVID ROGERS
rhirH nOK^'"'"" ^'^'^'^
more than a much larger portion of health costs.
third of the uninsured, 36.9-c, have annual
Staff Reporters of T H E W A L L STREET J O I H M * .
In recent days, there has been a
WASHINGTON - The Clinton admmis- mcomes between $20,000 and $50,000 And collage of news conferences from groups
ration scrambled to reassure its allies that
competing to be heard on the health issue
the W hite House is committed to universal Sul . thP Tr"'"'"'''^
f'ealthv including simultaneous events with the
adui s the Treasury report said more than elderly on one hand and a nonpartisan
health coverage, and it tried to put a
•lo ' actually are over 30.
human fa- e on its position bv releasing a
Rock the System" youth group cheered
repon nn the uninsured in each congresPerhaps more importantly, the report on by no less than House Speaker Thomas
sional distnct.
^
Showed how many uninsured'people there
are in each congressional distnct-a studv Foley. " I want that building to rock a little
Administration officials fanned out
Clearly aimed at embarrassing lawmaker^ bit," said the Washington Democrat, shedover V\ashin?ton to insist their ^oal reding some of his reserve and gestunng to
who
advocate less than full coverage
mains health insurance for every Amenthe Capitol nearby.
The figures are part-of a larger battle to
can. The president met with Democratic
The labor-backed Health Care Reform
counter the strong influence of business
congressional leaders. Vice President Al
Project
delivered to congressional offices
groups mostly representing small compaGore went on television. Hillary Rodham
50 Pizza Hut pizzas Tuesday topped with a
nies, that oppose the employer mandate
Chnton met with House members The
The Treasur}' used similar data to win message to support the employer mandate.
president s top economic advisers lunched
support for an expanded earned-income Today, a coalition that includes the Nawith a group of reporters and editors
ta.x credit in the administration's deficit tional Restaurant Association and the NaI have always said, from the time I
presented Imyl bill, thatl wasflexibleon reduction bill last year. But the fight now tional Federation of Independent Business
will be more difficult given business's plans a news conference to defend Pizza
how to get universal coverage and would
direc interest in the emplover mandate Hut, a unit of PepsiCo Inc., and McDonbe willing to compromise on that," Mr
and Its lopsided political contributions to
Clinton told reporters as he went into the
ald's Corp., which has been criticized in
lawmakers in recent years
meeting with lawmakers.
newspaper advertisements for paying
Figures compiled'by Common Cause worker health costs in Europe but failing to
"Universal coverage is absolutelv esthe self-styled citizens lobby, show that do so here.
sential to getting workable health-care
current House members received $69 5
re orm. Treasur\- Secretary Lloyd Bentsen
And liberal Democrats in the Senate
iTiillion from business PACs from 1991
said dunng the lunch. Budget
yesterday
staged a mock lottery to demonthrough
1993,
more
than
double
what
labor
Director-designate Alice Rivlin said uniJ'J™!,co^'e'-age was "the key to controlling PACs gave. In the Senate, where mandates strate the inequities they said would result
are in more trouble, the same ratio was from any reform proposal that fails to
more
than 4-1 in favor of business PACs achieve universal coverage. Rotating a
The full-court press on universal covermetal drum, the senators picked names of
over the 1987 to 1993 penod.
age came after President Qinton, in retheir colleagues who might be left out
marks to the National Governors AssociaEven House Democrats get more from under legislation that achieves just 959,
tion Tuesday, said that covering "95^ or
business PACs than from labor, and a K coverage, such as proposed bv the Senate
upward" of the Amencan population was
these figures understate business's real Finance Committee. The first name cho^hat he aimed for in health-care reform
mpact on members since the totals don" sen, to much laughter, proved to be the
Advisers said he had only meant to say
mciude individual contributions, which are Finance panel's own chairman. Sen. Danthat, practically speaking, even a law that
more important in the Senate
iel Patrick Moynihan (D., N.Y.).
guarantees ever>one the right to health
After the intensive White House publicH. Bimbaum contributed to
insurance wouldn't end up covering imc
ity campaign yesterday, the capital was li this-Jeffery
article.
of the population.
awash with different interpretations ofThe
However committed to universal coverpresident s aims. The president "is firm on '
age, administration officials have diverprinciples and objective, andflexibleon
gent views on strategy, given the immense
he means of achieving those objectives,"
opposition to provisions of the president"s
M ,.K^f",n^
^ader George
plan. White House officials met late into Mitchell (D.. Maine) after meeting with
the president.
the night Tuesday to discuss tactics If
defeat becomes inevitable, some are in- prJf n
° ' Louisiana, a modclined to seek compromise, fearing that a erate Democrat who has opposed the emloss could damage the president and make ployer mandate, said after the same meS^'^'^ difficult. Others, along mg that he was pleased to see the president
with liberal allies in Congress, argue that
showing "a great deal of flexibility."
the president must fight for universal
Ways and Means Committee Chairman
coverage and the proposal to require all
Sam Gibbons (D.. Fla.) told reporters at a
employers to help pay for their workers'
health insurance - even if defeat seems breakfast that he didn't see anything new
inevitable. They say the president must in the president's comments, but then went
force a showdown to keep his political on to say Mr. Clinton's words "probably
promise and to set the stage for whatever won t help efforts to win majority support
scaled-back bill can be salvaged in the tor a bill that guarantees universal coverage by requiring employers to pay part of
future.
their workers'health costs.
About 20 Democratic senators met yesThe president has been meeting reguterday to urge Qinton allies to hold their
ariy with individual senators in an at^that
M ,It sc»"f
" K ^that
! P ^can
' '^°^«'"^^«'
a fight
be won. insisting tempt to bolster his case. Sen. Dennis
Deconcini (D., Ariz.), who met with Mr.
To boost its arguments for universal
coverage, the administration issSS He- Clinton this week, said he favored manaates if some adjustment could be made to
Port suggesting, as Treasury Secretair
Bentsen said at a news conference, t S protect small employers better. Among the
options is to ask business to pay only 50% of
the uninsured "are your middle-income
n„?fi^ for insuring individual workersworking neighbors."
not 8(^c of the cost of insuring workers and
_ J ^ r d i n g to the report, which was
Please Tum to Page Al,, Column 5
-^-^^^^^^^^HlilRE^^
21, 1994
�
Dublin Core
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Title
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Health Care Task Force Records
Creator
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White House Health Care Task Force
Is Part Of
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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Paper
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DeConcini, Dennis (D-AZ)
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 2
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Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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2/6/2015
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42-t-12092992-20060885F-Seg2-007-012-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/6c92bfd8b6d87d713d8a1099c66716ec.pdf
94e9e70352c455258f384385630e3484
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
adniinistrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Recortl Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Scries/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3665
FolderlD:
Folder Title:
Danforth, John (R-MO)
Stack:
Row:
Section:
Shelf:
Position:
s
52
3
3
1
�U-10-92 01:55PM FROM SENATOR DANFORTH DC.
TO 99731045
P002
news from
Senator Jack Danforth
— Missouri
BIOCR&PRICAI. SUMMARY
John C. Danforth
Contact: Steve Hilton
202-224-6154
U.S. Senator John C. Danforth of Missouri has sponBored numerous
legislative measures iinportant to the State and nation. These
Include laws to encourage long-term economic growth; to strengthen
America's world trade policies; to improve the protections of c i v i l
rights laws; to increase production of affordable housing; and to
enhance the safety of transportation in a l l modes.
In Missouri politics and govemment, Danforth's service as State
Attorney General and U.S. Senator served to define the modern era,
establishing a competitive two-party system and setting high
standards of effectiveness and accountability for government.
Danforth ranks 25th in seniority among the 100 Senators and
serves on three key eonmlttees of tho Senate; th© Finance Coimnittee;
the Commerce, Science, and Transportation Committee; and the Select
Committee on Intelligence.
The magazine n.S. News & World Report singled out Demforth as an
example of excellence in government. David Broder of The Wft^hington
Post,, the widely respected reporter and political analyst, named
Danforth as a conspicuous example of hard work, commitanent to
p r i n c i p l e , and e f f e c t i v e n e s s .
Mationai Journal has d e s c r i b e d
Danforth as one of 31 outstanding individuals among the 535 Members
of Congress.
Danforth i s the only Republican in the history of Missouri
elected to three terms as U.S. Senator. His election to his present
term marked the record for victory i n Missouri senate races and the
record for number of counties carried i n a statewide race.
Danforth was elected Attorney General of Missouri in 1968 i n his
f i r s t race for public office. This campaign was the f i r s t Republican
victory i n a statewide race in more than 20 years and began a period
of reform and two-party politics in Missouri. He was re-elected
Attorney General i n 1972. He was elected to the Senate i n 1976 and
re-elected i n 1982 and 1988.
Danforth was the principal author and sponsor of the C i v i l Rights
Act of 1991, one of the nation's basic statutes for fairness i n
hiring, promotion and other employment practices.
Danforth was the Senate sponsor of Supreme Court Justice Clarence
Thomas, who was confirmed to the Court in 1991 to succeed Justice
Thurgood Marshall. Danforth recruited Justice Thomas to public
service i n 1974 as an Assistant Missouri Attorney General.
As a senior member of the Finance Committee, Danforth has devoted
t-t
ft ^swft- B«-'»-an-i'<;nn 4-<^ TT s
t-»v nnlfr-v nnri "intemational t r a d e
�•»
12-10-92 01:55FM FROM SENATOR DANFORTH DC,
TO 99731045
F003
i s a p r i n c i p a l author of laws to require s t r i c t on-the-job ^ e s ^ i ^ J
for drug and alcohol use by key transportation workers; to strengthen
federal and state laws against drunken driving; to impirove the
inspection of safety equipment on commercial trucks and buses; to
e s t a b l i s h national standards for licensing professional drxvers; to
increase the safety of passenger vehicles; and to expand and
modernize a i r p o r t s and the a i r transportation system. I n the lozna
Congress, he i s the principal sponsor of the Cable Television
Consumer Protection Act, which would stimulate competition m tne
cable t e l e v i s i o n industry and provide local authority over rates i n
markets where service io a nonopoly.
Danforth also i s active i n efforts to address health care costs;
to improve education; to stimulate r u r a l economic development; to
encourage s o i l conservation; to increase federal support for basic
s c i e n t i f i c research; and to reduce hunger and malnutrition throughout
the world.
Danforth has received the Preeidential World Without Hunger
Award; the L e g i s l a t i v e Leadership Award of the national Commission
Against Drunk Driving; the Outstanding Young Man Award of the
Missouri Jaycees? the Safety Man of the Year Award of the American
Trucking Associations; the Distinguished Service Award
J**®J^l
,
Louis Jaycees; the Distinguished Missourian and Brotherhood Awards of
the Mationai Conference of Christians and Jews; and the Truman
Distinguished Lecturer Award of Avila College i n Kansas C i t y . He i s
an honorary member of the Mationai Jesuit Honor Society and m
1974
was elected to the Missouri Academy of Squires.
A f i f t h generation Missourian, Danforth was bom i n St- I ^ u i s on
September 5, 1936, and raised in nearby Clayton. He received hxs
secondary education at St. Louis Country Day School and graduated
with honors from Princeton University i n 1958. i n 1963, he received
a Bachelor of Divinity degree from Yale Divinity School and a
Bachelor of T.aws degree from Yale Law School.
He and h i s wife, the former S a l l y Dobson of St. Louis, are the
parents of f i v e children, Eleanor, Mary, Dorothy, Johanna, and
Thomas.
He i s ordained to the clergy of the Episcopal Church. He served
as an a s s i s t a n t chaplain for Memorial Sloan-Kettering Cancer Center
i n Hew York C i t y , and as assistant rector at the Church of the
Epiphany i n New York City and at the Church of St. Michael and S t .
George i n Clayton. He was an associate rector of Grace Episcopal
Church i n Jefferson City, Missouri. Danforth i s a past member of the
governing board of Washington Cathedral, an Honorary Canon of C h r i s t
Church Cathedral i n St. Louis, and an Honorary Associate at St.
Alban's Church i n Washington.
^
He haa received honorary doctoral degrees from Lindenwood
College; Lewis and Clark College; Drury College; Rockhurst College;
Westminster College; Culver-Stockton College; Maryville College;
William Jewell College; Indiana Central University; Southwest Baptist
College; S t . Louis University; Virginia Theological Seminary;
Harris-Stowe College; and College of the Holy Cross.
***
February
1992
�policy. He has put forward and supported legislation to encourage
the production of affordable housing; to spur research and
development; and to foster capital formation and the modemixation ot
plant and equipment. His trade legislative accomplisbmento have been
aimed at expanding U.S. exports; establishing the concept of
reciprocity i n trade by removing foreign trade barriers to U.S. goods
and services; and providing more certain and effective assistance to
workers and firms injured by imports.
He i s the Ranking Republican Member of the Commerce Committee, a
panel with wide-ranging jurisdiction of importance to Missouri.
Danfortn has served as Chainnan of the Committee, the f i r e t Missouri
Senator to chair a major legislative committee since World War I . He
2 4 9 Russell Sanata Office Building • Wsshington, D.C. 2 0 5 1 0
�POLITICAL PROFILE
Danforth is a conservative, who as the
ranking member on Finance's Trade
Subcommittee and also the full Commerce
Committee, has focused most of his attention
on trade, transportation and other business
issues. However, humanitarian issues more
in keeping with his preparation for the
priesthood take center place on his agenda.
Included are his efforts in areas such as civil
rights and famine relief. In 1990, he
authored "living will" legislation which
allows people in advance of a medical crisis
to dictate how extensive their treatment
should be.
LEGISLATIVE INTERESTS
102nd:
Senator Danforth sponsored
legislation to help sole community hospitals
under Medicare.
Health Care Reform: Senator Danforth
cosponsored a range of bills related to health
care reform including S. 2346, the BasiCare
Health Acce*s and Cost Control Act
(Kassebaum) and S. 3387, the Health Care
Liability Reform and Quality of Care
Improvement Act (Hatch). In the 103rd
Congress Senator Danforth has co-sponsored
legislation to provide for comprehensive
health care access expansion and cost control
through reform of the private health care
insurance (Kassebaum,S. 325).
Senator John Danforth
(R-MO)
Born:
Education:
Military:
Prev. Occup:
Family:
Religion:
Pol. Career:
Residence:
Elected:
Committees:
9/5/36, St. Louis,
MO
Princeton U., A.B.;
Yale U., B.D. and
LL.B.
None reported
Lawyer; clergyman
Wife, Sally Dobson;
5 children
Episcopalian
MO Attorney
General, 1969-77;
Republican nominee
for U.S.
Senate, 1970
Newburg
1976 (Re-election
19941
Finance; Commerce,
Science, and
Transportation and
Intelligence
103rd: He has sponsored legislation to permit payments under a State Medicaid plan to vaccine
manufacturers (S. 151), The Senator has cosponsored legislation to: expand access to health
care and improve cost controls through reform and simplification of private health insurance
(Kassebaum, S. 325); and to make technical changes to the Medicare program (Dole, S. 176).
�1-36 • Senators and Staffs
John C. Danforth
KEY STAFF AIDES
Name
Position
R -Missouri
Reelection Year: 1994
Began Service: 1976
SR-249 Russell Senate
Office Building
Washington, DC
20510-2502
Robert D
McDonald
'^teve Hiltg
Clair Elsberry
(314-635-7292)
Bettie M^art
•feter Leibold^
Mark Weinberger
Jacqueline Berry
Liz McCloskey
Marc Solomon
Judy Dassira
Crystal Radcliff
Legislative Resj
ility
Admin. Asst.
News Secy
Spec. Asst. (Missouri)
\ = = -
Office Mgr.
Legis. Dir.
Counsel
Legis. Asst.
Legis. Asst.
Legis, Asst.
Pers. Secy.
Appts. Secy.
—
^
Health, Judiciary
Taxes, Banking, Finance
Labor, Housing
Education, Welfare
Defense, Agriculture, Environment
COMMITTEE ASSIGNMENTS
Committee
Subcommittee(s)
•1
•."•.\
(202) 2 2 4 - 6 1 5 4
Commerce, Science, and
Transportation. Ranking
Minority Member
National Ocean Policy Study • Ex ofTicio member of all subcommittees
BIOGRAPHICAL
Born: 9/5/36
Home; Newburg
Educ: B.A., Princeton
U.; B.D./LL.B., Yale
U.
Prof.: Attorney;
Clergyman
Rel.: Episcopalian
Finance
International Trade, Ranking Minority Member • Medicare and
Long-Term Care • Taxation
Intelligence (Select)
No subcommittees
OTHER POSITIONS
Senate Republican Policy Committee • Senate Steel Caucus • Senate Coal Caucus • Senate
Footwear Caucus • Senate Tourism Caucus • Senate Republican Task Force on Health Care
• u s. Coast Guard Academy, Board of Visitors
STATE OFFICES
Suite 440, 8000 Maryland Ave., St. Louis, MO 63105
1233 Jefferson St., Jefferson City, MO 65101
Suite 214, 339 Broadway, Cape Girardeau, MO 63701
943 U.S. Courthouse, 811 Grand Ave., Kansas City, MO 64106
Suite 705, Plaza Towers, 1736 E, Sunshine, Springfield, MO 65804
rt: !H
Summer 1992
© Congressional Yellow Book
(314) 725-4484
(314) 635-7292
(314) 334-7044
(816) 426-6101
(417) 881-7068
�MEETING NOTES FROM CHRIS JENNINGS:
SEN. DURENBERGER - 1/12 CJ WITH BOB RUBIN
T h i s was a s h o r t m e e t i n g because Rubin had t o go on b u t Sen.
seemed d i s a p p o i n t e d . Durenberger s a i d t h e P r e s i d e n t and Congress
had t o e f f e c t i v e l y d e f i n e t h e program b u t was vague i n what t h a t
meant. F e l t t h e problem i n s e l l i n g r e f o r m was n o t t h e u n i n s u r e d
but more i n f o r m a t i o n i s needed on c o s t i s s u e s and how t h e y
i n t e r r e l a t e t o h e a l t h r e f o r m . Not s u r p r i s i n g l y , he t h o u g h t t h e
A d m i n i s t r a t i o n needed t o move t o t h e r i g h t . He t h i n k s we have 11
Republicans t o d e a l w i t h b u t d i d n o t name them. H i s b i g i s s u e i s
the need t o d e f i n e u n i v e r s a l coverage. He s a i d he had asked
Kennedy t o do so b u t hadn't r e c e i v e d an adequate e x p l a n a t i o n .
Durenberger wants i t d e f i n e d i n a l e s s s t r i n g e n t way. He opened
the door on employer mandates b u t m a i n t a i n e d t h a t 80% was t o o
h i g h . He doesn't t h i n k t h e 7.9% employer cap w i l l h o l d and t h a t
i t i s a promise we c a n ' t keep. He s a i d he opposes premium caps
but won't r e j e c t them o u t o f hand and t h a t h i s s t a f f i s w o r k i n g
w i t h Kennedy's on t h i s area. Durenberger had been a t t h e Jackson
Hole meeting w i t h S h i e l d s o f Lewin ICU and s a i d t h a t S h i e l d s
s t a t e d t h a t d i r e c t subsidies t o i n d i v i d u a l s might cost less i n
s u b s i d i e s t h a n t h e employer r e q u i r e m e n t . He d i d n ' t t h i n k t h e New
R e p u b l i c a r t i c l e was so bad.
SEN. DANFORTH - l/j^6 CJ WITH IRA
D a n f o r t h was v e r y encouraging, b e l i e v i n g t h a t a major
comprehensive b i l l w i l l pass t h i s year. He doesn't t h i n k t h e
employer mandate can w i n and f e e l s we have t o l o o k a t
a l t e r n a t i v e s . He b e l i e v e s i t i s a r e d f l a g i s s u e and t h a t t h e
t e r m i n o l o g y must be changed. H i s b i g g e s t concern, however,
c o n t i n u e s t o be c o n t r o l l i n g c o s t s . He f e e l s t h a t 50% o f t h e
Republicans s u p p o r t premium caps b u t t h a t won't be enough. We
have t o l o o k a t a l t e r n a t i v e s such as t r i g g e r i n g mechanisms o r a
C o n g r e s s i o n a l f a s t t r a c k i f c o s t s a r e n ' t coming under c o n t r o l
w i t h market r e s t r u c t u r i n g . He i s a l s o concerned about i n c r e a s i n g
e n t i t l e m e n t s - r e t i r e e s , RX drugs, and l o n g t e r m c a r e . We need
t o seek t h e m i d d l e o f t h e Rep. and Dem. p a r t i e s and f e e l s t h e r e
are a l o t i n t h e Rep. moderate wing who r e a l l y want t o p l a y . He
b e l i e v e s we s h o u l d go f o r t h e Chafee Rep. crowd r a t h e r t h a n u s i n g
a one-by-one p e e l o f f s t r a t e g y . W h i l e t h e Finance Committee i s
key,
i t i s more i m p o r t a n t t o g e t t h e b i l l o u t o f t h e two
committees t o t h e f l o o r f o r a l e a d e r s h i p s u b s t i t u t e amendment
where Dole would be c r i t i c a l .
We need t o work w i t h Dole and
s h o u l d have a h i g h l e v e l m e e t i n g w i t h him soon. He f e e l s we w i l l
have t o remove t h e stigma o f government a t t a c h e d t o t h e
a l l i a n c e s . We a l s o need t o p r o v i d e more f l e x i b i l i t y w i t h t h o s e
who want c o m p e t i t i o n i n t h e a l l i a n c e s and i n t h e d e s i g n o f t h e
a d m i n i s t r a t i v e s t r u c t u r e . The cap needs t o be lower t h a n 5,000.
He ended, a g a i n , on a p o s i t i v e n o t e .
�HEALTH CARE TASK FORCE
CONGRESSIONAL CONTACT SHEET
CONTACT DATE:
C'V.A-C\.^
RECORD #:
MEMBER'S NAME:
MEMBER'S STAFF:
TYPE OF CONTACT:
HCTF ATTENDANCE:
MEETING:
PHONE CALL:
HRC:
IRA:
JUDY:
OTHERS:
REASON FOR MEETING ( I F NOTABLE)
TOPIC OF DISCUSSION/GENERAL NOTES:
ocwm'^'n ^Ko'oaJd^ aqoo&^^a t f ^ c u ^
pdJCticjL'oLM cajr\ r\%orA -^cu^ no
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,
\xs.iUx^^^
..
.
/ V M I ^-
/'^/^\
-VTJVV
/^I(A
uoouJ^ t^^^^o^ ^^uLr>s<^
REPORT BY:
PLEASE RETURN TO ROOM 205--AS SOON AS POSSIBLE.
�^ m d ^ ^ " ^ ^ ^ ^ ^ d^^ctr\^^\
K^^-^SJ
�JUL--uT-1994
la:'
Senator
FKCM
HhiJU
4566-;S5
^. Jkj4. .JCz
Defineti Comprehensive
Benefits Package
Universal Coverage
/shelby (D-AL)
concerned about cost of financing UC,
undecided on mandates
not clear
Xdurkowski (R-AK)
wants UC. didn't discuss inandates
concemed about cost
JryOT (D-AR)
wants UC. still considering mandates
OK
v/4iden (D-DE)
wants UC, leaning toward EM
prefers cafciiria plan for benefits
\/^rahara (D-FL)
wints UC, sjppcns IM
stipport.'i
A m n (D-GA)
wants UC. opposes mandates
opposes
l/4assebaum t'R-KS)
wants UC, would support 50/50 E.M
supports very basic benefits pkg w'
Imited preventive services
wants UC, doesn't think EM wiil pass without
small business exempcior
thinks wil! ti; difficult to pass
/sreaux (D-LA)
will settle for 95"'i) coverage
may support
v<:ohen (R-ME)
supports goal of 95% coverage
favors benefits commission
v^urenberger (M>J)
supports greater coverage, IM
wants benefits left up to board
j/aaforth (R-MC)
/
supports 95% coverage by 2000. opposes
mandates
suppons benefits commission
V'Ksrrcv (D-NE)
suppons UC by 2001, EM .
1 i^rv'an (D-NV)
wants UC, will have to be gradual, undecided
on mandates
concerne-i about cost of comprehensive
benefits
v^eid (D-NV)
supports UC, EM. but thinks will have to
consider triggers
OK
^^adlcy (D-NJ)
supports UC, EM, but thinks EM will kill plan
OK
j ^^organ (D-ND)
wants UC, supports IM
supports
jlv^onrad (D-ND)
wants UC, supports IM
ji/^ackwood (R-OR)
thinks UC impossible, costs too much
not clear
jv4'offord (D-PA)
wants UC, not clear on mandates
supports
1 Specter (R-PA)
wants UC, supports IM
Ivfchafee (R-Rl)
supports goal of 95% coverage, IM
wants benefits commission to de'.ermine
r-
wants UC, prefers VAT tax to pay for covercge
supports
supports UC. EM - soms small business
concems
supports
1 \/^ord (D-KY)
': vHollings ^D-SC)
j^y^Iaiiiews (D-TN)
L
.
- .t
OK
J
•
2U
�shown t o t h e q u e s t i o n o f c o m p l e x i t y o f a d m i n i s t r a t i o n . That i s t h e continuous
concern o f t h i s committee w i t h t h e Treasury Department, what t h e form looks
l i k e . And a l s o , t o say t h a t i t would be j u s t about 50 years ago t h a t Robert
K. Murton ( s p ) , a t Columbia U n i v e r s i t y , who i s s t i l l t h r i v i n g , wrote h i s
essay on t h e u n a n t i c i p a t e d consequences o f s o c i a l a c t i o n , and I was pleased
t o see you use t h a t phrase, and we w i l l be t h i n k i n g about u n a n t i c i p a t e d
consequences a l l t h r o i i g h t h i s , which i s a necessary way t o go about i t .
Because you t h i n j f ' a b o ^ \ t doesn't mean you can't come up w i t h some answers.
Senator D a n f o r t h .
SEN.( DANFORTfJ/f Mrs. C l i n t o n , I want t o ask you a g e n e r a l q u e s t i o n
of p h i l o s o p h y , asd then i f I have t i m e , f o l l o w up on whether o r n o t t h i s can
be accomplished i n f a c t . My q u e s t i o n i s whether you would agree w i t h me t h a t
somehow t h e r e s h o u l d be some way o f t e l l i n g people t h a t t h e y cannot have t h e
medical care t h a t t h e y might want f o r themselves o r t h e i r f a m i l y , and w e ' l l
g i v e you some examples.
The s o - c a l l e d Baby K case t h a t ' s been p u b l i c i z e d r e c e n t l y , a baby
born w i t h a c o n d i t i o n c a l l e d a n i n c e p h a l y ( p h ) , t h e b r a i n i s m i s s i n g , t h e baby
can't t h i n k , t h e baby can't f e e l , t h e baby has been kept a l i v e , I t h i n k f o r
11 months, w e l l over $1,000 a day because t h e mother says I want t h e baby
kept a l i v e ; t h e Siamese t w i n case i n I t h i n k Pennsylvania, one baby d i e d , t h e
o t h e r has a one p e r c e n t chance o f s u r v i v a l . The more p r e v a l e n t case, t h e low
b i r t h weight baby, t h e baby under one pound, t h e l i k e l i h o o d i s o n l y 15
p e r c e n t o f these babies w i l l be f u n c t i o n a l , enormous c o s t o f keeping them
a l i v e , average o f $150,000 each.
On t h e o t h e r edge o f l i f e , a case I heard o f y e s t e r d a y , a 92
y e a r - o l d man who r e c e i v e d a pacemaker, and then e v e r y t h i n g i n between. The
case o f somebody who's d y i n g who wants t o be kept a l i v e f o r another t h r e e
months, s i x months a t a v e r y h i g h c o s t .
P h i l o s o p h i c a l l y , b e f o r e we g e t t o t h e mechanism q u e s t i o n , should
somebody a t some l e v e l be i n a p o s i t i o n t o say no?
MRS. CLINTON: Senator, I t h i n k t h e r e should be a d i s c u s s i o n i n
t h i s c o u n t r y about what i s a p p r o p r i a t e care and t h a t a l o t o f these v e r y hard
d e c i s i o n s t h a t you have j u s t o u t l i n e d should be made w i t h more thought and
more concern about b o t h t h e human and t h e economic c o s t . So I would agree
t h a t f o r b o t h moral and e t h i c a l reasons, as w e l l as economic ones, t h e r e has
t o be t h e k i n d o f v e r y d i f f i c u l t c o n v e r s a t i o n t h a t you a r e s u g g e s t i n g .
I have thought a l o t about t h i s and I have had a l o t o f t i m e t o
t h i n k about i t b o t h on a p e r s o n a l l e v e l , when I was i n t h e h o s p i t a l w i t h my
f a t h e r , and spending l i t e r a l l y a l l day every day t a l k i n g t o d o c t o r s and
nurses about t h e v e r y k i n d s o f cases t h a t you a r e o u t l i n i n g . And I have had a
l o t o f t i m e t o t h i n k about i t i n t h i s p o s i t i o n t h a t I am i n .
And I t h i n k t h a t t h e r e i s more o f a l i k e l i h o o d t h a t we can
a c t u a l l y have t h a t c o n v e r s a t i o n once we e s t a b l i s h i i e a l t h ^ s e c u r i t y and a more
r a t i o n a l system o f making d e c i s i o n s about p r o v i d i n g care t o people. And I
would j u s t g i v e you an example t h a t s t r u c k me r e c e n t l y .
The h o s p i t a l a d m i n i s t r a t o r o f a v e r y l a r g e h o s p i t a l came t o me as
�THE NEW YORK TIMES, FRlb..Y.
OCTOBEA
], mj
2 Parties, 1 Goal v
By David
and John Danfort
WASHINGTON
ith
each
passing
year, fewer
members of
Congress
are willing
to work with their colleagues in the
opposing party. Those who do are met
with increasing criticism and suspicion in their own party caucuses. T^ie
culmination of this 20-year trend was
passage of the budget without a single
vote in Congress from the opposition
party. Party and partisanship have
become more important than policy
and partnership.
**•
If this pattern is allowed to continue, no one has more to lose than
President Clinton. He was elected as
a centrist, a "new kind of Democrat."
w
care security. We agree that health
costs cannot grow at three times the
rate of inflation. We agree ihat all
Americans should have insurance
coverage — including those who become ill and those who change jobs.
We also agree on some of the solutions: insurance market reform,
managed competition and purchasing cooperatives.
HEALTH CARE
SECOND OPINIONS
All occasional scries.
So far the Administration has made
great efforts to consult with members on both sides of the aisle —
notabl^he First Lady's three days of
testimony before committees of Congress, including our own yesterday.
But bipartisanship means more than
consultation in the drafting of a plan.
It means compromise in the passing
of a bill. It means giving up policies
desperately desired by members on
one side of the aisle in order to gain
support for a program on the other
side of the aisle.
In the end, the Administration may
have to give up votes from those
Democrats who favor a single-payer
system or massive regulation in order to gain a solid block of RepubliBut he cannot succeed as a centrist can votes. Republicans, for their part,
if the Administration continues to fol- may have to give up the votes of those
low a "Democrats oniy" strategy. who do not want Govemment to be a .
Swings to the left, necessary for votes part of the solution at all. Bipartisanin the House, will only shrink the ship means mare than just talk; real
President's political base and dam- results require real sacrifice.
age his credibility.
We want to help build consensus —
Health care may be Mr. Clinton's to initiate a process of compromise
greatest opportunity for bipartisan- between the two parties and the variship. There is much on which Repub- ous plans, a compromise that conlicans and Democrats agree. We uins costs and provides universal
agree that Americans deserve health access. In the end. if we do not pass a
credible, comprehensive health care
David L. Boren, Democrat of Ofelaho- reform package, both parties will
ma, and John C. Danforth, Republi- lose. The proposals are on the table;
can of Missouri, arc members of the now it is time to draw together the
best from each of them.
•
Senate Finance Committee.
Clinton must
give ground. So
must the G.O.P.
�BC-MO—Missouri Summit,0200
Health Care Meeting i n Kansas C i t y , Columbia
KANSAS CITY, Mo. (AP) A h e a l t h care summit w i l l be held i n two sessions
i n Kansas C i t y and Columbia l a t e r t h i s month.
Sen. Christopher S. Bond announced Friday t h a t the summit w i l l be
29 a t 8:30aj&-.-^ B a r t l e H a l l i n Kansas_Ciiy. I t w i l l be jch«Tred,. b^
Sen. Johp-'^nfortt}), R-Mo., and Sens^-^'-Sob D o l e ^ n d Nancy
Republicans.____
v
-—
Each session i n Kansas C i t y w i l l f e a t u r e presentations by C l i n t o n
a d m i n i s t r a t i o n o f f i c i a l s and panel discussions f e a t u r i n g h e a l t h care
providers, consumer representatives and others. Bond said. The president's
w i f e , H i l l a r y Rodham C l i n t o n , has been i n v i t e d t o address t h e Kansas C i t y
session.
The Missouri summit concludes Oct. 30 a t 9 a.m. a t the Holiday I n n
Executive Center-Expo i n Columbia.
""Health reform would change l i f e f o r every American,'(^ BondSsaid.
""One-seventh o f our n a t i o n a l economy would be restructured.,—iHle doctors
Americans see, the h e a l t h coverage we have and the q u a l i t y o f care our
c h i l d r e n receive could a l l be r a d i c a l l y changed. This event w i l l be a great
opportunity f o r Missourians t o share t h e i r ideas and views about t h i s v i t a l l y
important debate.••
The sessions are open t o the p u b l i c . Those wishing t o attend should obtain
r e g i s t r a t i o n forms from t h e i r senator's o f f i c e s i n Washington or Missouri. The
r e g i s t r a t i o n fee i s $25 f o r the Kansas City session, $15 f o r the Columbia
session.
f i l e d by:APW-(MO)
on 10/08/93 a t 13:17EST ****
**** p r i n t e d by:WHPR(MMIL) on 10/08/93 a t 15:58EST ****
****
�bc-CNSclinton,0927
C l i n t o n declines t o push f o r e n t i t l e m e n t cuts, disappoints d e f i c i t hawks
By Amy Bayer
Copley News Service
BRYN MAWR, Pa. President C l i n t o n landed i n a den of d e f i c i t - c u t t i n g hawks
Monday (Dec. 13) t o argue against chopping e n t i t l e m e n t programs f u r t h e r ,
warning t h a t more reductions could d e r a i l h e a l t h care reform and r i s k
impoverishing many e l d e r l y Americans.
At a conference here t o discuss reducing entitlements such as Social
Security and Medicare t o help cut the d e f i c i t , C l i n t o n defended as s u f f i c i e n t
h i s $500 b i l l i o n d e f i c i t - r e d u c t i o n package, which r a i s e d taxes, trimmed
Medicare spending and targeted only a f f l u e n t Social Security r e c i p i e n t s .
And while the president acknowledged the need f o r " " f u r t h e r cuts'* t o t r i m
the n a t i o n a l debt, he d i d not aim h i s budget axe at e n t i t l e m e n t s .
C l i n t o n , speaking t o a crowd of 2,000 c i t i z e n s i n the Bryn Mawr College
gymnasium, r e j e c t e d any f u r t h e r cut i n Social Security, which now consumes
more of the f e d e r a l budget than defense.
The retirement program has helped maintain a middle-class l i f e s t y l e f o r
e l d e r l y Americans, he said, and any cut i n b e n e f i t s could force many i n t o
poverty. ""Behind every one of these e n t i t l e m e n t s , there i s
a person,'' C l i n t o n said.
Instead, C l i n t o n blamed the d e f i c i t on runaway e n t i t l e m e n t costs i n
medical care, and prescribed h i s h e a l t h care reform plan as the best s o l u t i o n .
" " I f you r e a l l y want t o solve t h i s problem, you have t o go back and have
comprehensive h e a l t h care reform,'' he said. ""...You don't get u l t i m a t e
d e f i c i t c o n t r o l unless you do something about Medicare and Medicaid.'•
C l i n t o n came t o t h i s conservative, a f f l u e n t d i s t r i c t t o pay a p o l i t i c a l
debt t o i t s congresswoman, freshman Democrat Marjorie Margolies-Mezvinsky, who
ignored l o c a l sentiment l a s t August and voted f o r the president's
c o n t r o v e r s i a l budget. Just before casting her vote, she exacted a p r e s i d e n t i a l
promise t o appear here t o discuss a d d i t i o n a l major budget cuts.
At the conference, which she named ""The Future of Entitlements,''
Margolies-Mezvinsky made an emotional plea t o Washington t o end ""years of
f i s c a l i r r e s p o n s i b i l i t y . ' ' Her t a r g e t : entitlement programs l i k e Social
Security, Medicare and Medicaid, which together now account f o r more than h a l f
of the $1.5 t r i l l i o n f e d e r a l budget.
Social Security alone accounts f o r 21 percent of a l l f e d e r a l spending,
while Medicare and Medicaid take another 16 percent of the budget. Other
categories of entitlements take the t o t a l over 50 percent.
Clinton's presence brought n a t i o n a l a t t e n t i o n t o the conference. But i f
the congresswoman wanted t o demonstrate t o s k e p t i c a l c o n s t i t u e n t s Washington's
p o l i t i c a l w i l l t o cut popular programs, the president d i d l i t t l e t o help her
case.
Chief among Clinton's c r i t i c s were the chairmen of a b i p a r t i s a n commission
C l i n t o n established t o recommend entitlement cuts.
""Entitlements cannot be c o n t r o l l e d by h e a l t h care reform alone,'' said
Sen. John Danforth, R-Mo., who noted t h a t Clinton's h e a l t h plan earmarks 80
percent of e n t i t l e m e n t savings f o r new b e n e f i t s , not d e f i c i t c u t t i n g .
" " I t ' s not going t o happen without some serious cuts and i n every
entitlement program,'' added Sen. Bob Kerrey, D-Neb., who voted f o r the
president's budget only a f t e r p u b l i c l y lambasting i t as too weak on spending
cuts. ""The president cannot finesse t h i s . ' '
The p o l i t i c a l r i s k s of e n t i t l e m e n t reform were summed up a t the s t a r t of
the conference by A l i c e R i v l i n , deputy d i r e c t o r of the White House O f f i c e of
Management and Budget.
""Entitlement programs are hard t o t a l k about dispassionately,'' she said.
" " I t ' s always safer not t o get involved i n a debate about the f u t u r e of
�_AlS"TrLsDXv.DFn;vBf-R n . 1993
JjiiXwiiv.rov Pd^r
Clinton Lobbies for Lawmaker, Health Plan
PresidentKe^
Support for Embattled Margolies-Mezvinsky at Pennsylvan
1 ^ ,•JL Coop«r.
StitfWnUr
Mezvinskv's ••>5260 bill.on confer
ence a reference to tax increase
BRYN MAWjl, Pa.. Dec. 1 3 in Clinton s packa^je. He said th<
President Clinton and top adminads do not ser^e the pubbc interes:
istration official today conducted a
because they do not tell the truth "
layman's tutonii on the federal
Margolies-.MeAinsky also gol
budget to buiia support for his
rare words of support from a Repub
health care plan.and for a first-term
lican at the biparti^jn conterence
lawmaker in political trouble for
•Some in my party fear that 2
backing his budget package.
Uemocrat might )^et political benAbout 2,000 \»ell-dressed onlookefits by hosting^^^fifttetence or
ers piled mto Bfyn Mawr CoUege's
entitlements^Danforth saiij "Halpmnasium and listened to complex
lelujah. If w e V e - H « « c ^ e point
budget debates it the day-long semwhere
speak;ng .S^ne^tlv about eninar hosted by Rep. Marjone Martitlements IS a poh'icai plus, there
golies-Mezvinsky (D-Pa.). But one
hope for .Amerk a "
pobticai analyst doubted that MarBut even .pporters acknowlgolies-Mezvinsky moliified many
edged that M.UKobes-Mezvinsky
angry constituepts in the affluent.
still suffers p^i,i,. „|y from changKepublican-leanmg suburbs of Philadelphia she rej^esents.
PrttJdent Clinton dlscusaaa antM^m,^.
^.
rtmntasi, ing her po-Mtion )n clmton s budget
package at the i^i minute.
"I don't thiijk this solves the
• ^ e n you waifle. you get killed '
problem with hei- constituents," said
said Jun Edelstem. t dentist who
G. Terry Madcyina, a political sci1 believe you don't get entitleence professor Jat MillersvilJe UniA bit of politics spiced the dry practices in Vfm Ch«<er.
Margobes-MezvuuJnr, a former
versity. 1 think the damage has ment control, you don't get ultimate budget talk during what Alice Rivdeficit control, unless you do sometelevision reponer f I«-TH by 1 IQO
been done, polidcally."
lin,
deputy
director
of
the
Office
of
thing about Medicare and Medicaid '
In August. Margolies-Mezvinsky Clinton said, pointuig to a chart that Management and Budget, dubbed votes Ul 1992. w^ed 'urther concast a decisive! vote for Clinton's showed the two federally supported "a policy wonk day." Rivlin and Clin- troversy when .( « u rrported last
week that .onlftmc* organizers
economic pack^e—which included health programs jumped from 13 ton defended MargoUes-Mezvinsky
tax increases! unpopular among percent of entitlement spending in who has been under GOP attack ui sohcited conint)u(o» Irom insurers, hospital growoa i ^ l semor citmany Republicais—m exchange for
her district and in Washington. Riv- izen lobbies to uMtrrvnte the enhis administratfcn's participation m 1973 to 30 percent this year.
"I believe you don't get that done Im called her "a gutsy lady who tiUements confmm. Organizer'
today's conference on mandatory
raised about 1175 00« to cover the
just
by cutting Medicare and Med- cares about the future."
spending progi^ms. whose benefi"If Marge Mezvmsky hadn't $50,000 co«o<-.A...^ence and
icaid,
unless you want to hurt the
cianes range ffom the affluent elprivate sector," he said. Therefore. voted for that budget, we wouldn't a two-year foilvw.^ gn^Kt
derly to poor cl|pidren.
I think we have to have some sort of be here celebratmg economic progThe White Hommtarredmajor
Many budgaj analysts and law- health plan.'
ress and talking about entitle- con nbuton trn« ^cwanng on a
makers maintiin that growth in
Clinton also argued that Social ments," Clinton said. "We'd still be health panel vnM •^\]\\_
those entitlement programs must
security
and Medicare had lifted back m Washington throwuig mud
be curbed to reduce the annua] budmany
elderly
out of poverty. He balls at each other."
get deficit sub^antially.
said steep cuts in these programs
Clinton, who has named Sens.
Margolies-Nfczvinsky said that would push many of these citizens
Bob Kerref (D-Neb.) and John C.
the accumulated national debt of out of the middle class.
Danforth (R-Mo.) to head a com$4.7 trillion would increase $367
Befittmg an intellectual exercise mission to study entitlements, said
million by the end of today's eighton a college campus, Clinton and he hoped "there will be a great nahour conference.
other
officials defined budget tional discussion of the issues that
In a half-hour lecture and a panel
we discuss.today and . . . that this
discussion thatjhe moderated, Clin- terms. House Speaker Thomas S
ton argued th* a health care plan Foley (D-Wash.) explained the will be the begmning of a debate
meamng of -entitlements," which that will carry through for the next
like his would fe required to raw
U.mtQH further subdivided into several years."
the fastest-growing entitlenrt^
-.^tnbutory
entideraents*' availMedicaid for tip poor and MeA
aWe regardless of income ai«l those Clinton criticized a Republican
tor the elderly and disabled. 3 l
radio ad running m the Philadelphia
soleijhfor the poor.
^
area that ^ condemned Margolies-
""""
"-'^"'^^'^-'SSSiS^X^Z,,.
THE
V^stl,m:^rm POST TVSSOM. DMUM, 14. m i
�"AM-MO—Health Care-Reax,620
'Republicans Lukewarm I n Response To C l i n t o n Speech
. :
?
"By DOUG GLASS= *Associated Press W r i t e r =
KANSAS CITY, Mo. (AP) M i s s o u r i Republicans pled<^ed Wednesday t o work w i t h
P r e s i d e n t C l i n t o n t o r e f o r m t h e n a t i o n ' s h e a l t h care system, b u t s a i d t h a t ' s
e x a c t l y what C l i n t o n ' s p l a n needs: p l e n t y o f work.
A f t e r t h e p r e s i d e n t ' s address t o a s p e c i a l ' j o i n t session o f Congress,
Republican members o f t h e M i s s o u r i d e l e g a t i o n were q u i c k t o p r a i s e t h e
ultimate goal.
','
'••
But g e p t i n q t h e r e i s n ' t something t h e y expect t o happen besfore'next year,
most sa£d.
•
~ • I t h o u g h t t h e p r e s i d e n t was good i n o b s e r v i n g t h e symptoms p r o p e r l y , b u t
h i s d i a g n o s i s i s o f f and h i s cure may be worse t h a n t h e d i s e a s e , ' ' s a i d Rep.
Jim T a l e n t , a C h e s t e r f i e l d Republican.
' I f he wants my s u p p o r t , he's g o i n g t o have t o back o f f on t h e government
b a s i c a l l y ^ s o c i a l i z i n g h e a l t h care,''' s a i d Tailent, who added 'he b e l i e v e s most
Republicans oppose t h e p l a n .
The p l a n ' s g o a l t o i n s u r e so many more people w h i l e c u t t i n g c o s t s a t t h e
s^Itie t i m e W i l l h u r t q u a l i t y and a v a i l a b i l i t y . T a l e n t s a i d .
The..Clinto'ft, p l a n aims t o extend h e a l t h coverage t o .37 m i l l i j o n u n i n s u r e d
people',! and c u t t h e n a t i o n ' s $900 b i l l i o n medical b i l l w h i l e d o i n g i t .
I t : would r e q u i r e a l l employers , t o pay 80 p e r c e n t o f t h e average h e a l t h
premiufn f o r t h e i r workers. Employees would pay t h e r e s t . Sii>all businesses and
low-income workers would g e t s u b s i d i e s . ' •
*" \lri. order .to hpld the spending down, they^ve got to ration care. They
don.'t;.do- it explicitly,''- Talent said. ''They queue up and"you.just wait
months. That's what's happening in Canada.'' .
'
'
T a l e n t s a i d "."everybody's l o o k i n g a t next y e a r ' ' b e f o r e any -reform p l a n
passes • Congress.
.• U.S. Sen. John H a n f o r t h s a i d Clint:on's p r o p o s a l promised major new
b e n e f i t s w i t h o u t t h e savings t o pay f o r them: l o n g - t e r m care,, p r e s c r i p t i o n
drugs -Jfor t h e e l d e r l y , f o r example.'
""Th^ge promises would r e q u i r e huge new f e d e r a l e x p e n d i t u r e s , ' ' D a n f o r t h
s a i d . '"Where i s t h e money t o pay f o r these b e n e f i t s ? ' '
"
D a n f o r t h a l s o c r i t i c i z e d t h e p l a n f o r p r e p a r i n g " " a new l a y e r o f
government buij^eaucracy' ' i n t h e form o f h e a l t h a l l i a n c e s t h r o h g h which people
wo.uld'buy t h e i r i n s u r a n c e . The a l l i a n c e s " would have monopoly -Control over
moire -than 70 p e r c e n t o f t h e h e a l t h care market, he s a i d .
< j 6 i n i o g t h e Republican o p p o s i t i o n was U.S. Sen. C h r i s t o p h e r Bond, who s a i d
he f a v o r e d a plan- t h a t r e l i e s on »"!nore c o m p e t i t i o n , n o t government, t o
control r i s i n g costs . . . ' '
" H e a l t h r e f o r m s h o u l d c u t c o s t s , n o t j o b s , ' ' Bond s a i d . ""•Pbrping
employers t o pay 80'. p e r c e n t o f employee h e a l t h b i l l s w i l l mean j o b l o s s e s and
r e d u c t i o n s i n wages and b e n i ^ f i t s f o r employees.''
U.S. Rep. i k e S k e l t o n , a L e x i n g t o n Democrat, acknowledged- t h a t Republicans
and Democrats were l i k e l y t o s k i r m i s h over t h e burden p u t on businesses. But
RepiabLicans a r e ove^restimating t h a t impact, he said*.
"The p r e s i d e n t made i t q u i t e c l e a r t h a t i n most s m a l l b u s i i i e s s e s , trfe
c o s t s Would be l e s s , ' ' S k e l t o n s a i d . "Let's w a i t and see what's i n t h e
d e t a i l s . L e t ' s n o t rush t o judgment. ... T h i s i s a momumental p o s i t i v e st:ep
f o r every f a m i l y i n America.''
*
.
.
And. y e t he -had his' own concerns.
"Only one t i m e i f i tt^e e n t i r e speech d i d he mention t h e word ' r u r a l , ' ' '
S k e l t o n said.-- 'That was i n r e l a t i o n t o t e l e - l i n k i n g i n f o r m a t i o n to., r u r a l
doctors'. What f i t s Kansas C i t y and S t . Louis does n o t n e c e s s a r i l y f i t Stover,
Dover oi; Pleasant H i l l . •
•We have t o t a k e a" good hard l o o k a t how t h i s w i l l work, i n a s m a l l
town. ' '
•
•
"
•- .
• S k e l t o n saw a s l i g h t chance t h a t a r e f o r m package could- pass t h i s s e s s i o n .
• " " "'-'I-f we-do i t ' t h i s ' l e s s i o n , I t h i n k t h a t w i l l be a major p l u s , ' ' S k e l t o n
�HEADLINE
LENGTH
DATE
SOURCE
1'
FLOOD WASHED AWAY LAST YEAR'S PRIORITIES AREA CONGRESSIONAL
DELEGATION RETURNING TO OTHER ISSUES
Byline:
Kathleen Best and Tim Poor Post-Dispatch Washington
Bureau Robert L. Koenig of the Post-Dispatch Washington Bureau
c o n t r i b u t e d information f o r t h i s s t o r y .
ESTIMATED INFORMATION UNITS: 21.4
Words: 3279
01/23/94
ST. LOUIS POST-DISPATCH
(SLMO)
E d i t i o n : FIVE STAR
Section: WAR PAGE
Page:
OIB
(Copyright 1994)
REP. HAROLD VOLKMER, D-Mo., had planned t o spend l a s t year on
r e c y c l i n g . Rep. Glenn Poshard, D - I l l . , had wanted t o focus on
clean coal technology.
The Flood of '93 swept away both i n i t i a t i v e s .
Rising water sent members of Congress from Missouri and
I l l i n o i s t o the House and Senate f l o o r s t o f i n d money f o r v i c t i m s
and home t o see the a i d d e l i v e r e d .
The water overwhelmed p a r t i s a n d i f f e r e n c e s t h a t s p l i t the St.
Louis-area Congressional delegation on other major issues, such as
President B i l l Clinton's budget. Cooperation was strong across
s t a t e l i n e s as v;ell.
"We were very pleased," said T e r r i Moreland, d i r e c t o r of
I l l i n o i s ' Washington o f f i c e .
By year's end, St. Louis area l e g i s l a t o r s had:
Helped quadruple, t o more than $100 m i l l i o n , the f e d e r a l money
a v a i l a b l e t o buy out f l o o d v i c t i m s . They also helped ease f e d e r a l
r e g u l a t i o n s on spending money t o curb f u t u r e f l o o d damage.
Assured t h a t I l l i n o i s would pay only a 10 percent match f o r
f e d e r a l f l o o d a i d , rather than 25 percent. Missouri q u a l i f i e d f o r
the 10 percent match based on population.
Helped earmark nearly $6 b i l l i o n i n f e d e r a l d i s a s t e r a i d f o r
Midwestern farmers, businesses and homeowners.
With repeat f l o o d i n g expected t h i s spring, the issue w i l l
remain high on the agenda when Congress reconvenes t h i s week.
/Sj^. Chrirgto^(Jier,^.^)n^, R-Mo., and Rep. Pat Danner, D-Mo., w i l l
b^yseeWihg m i l l i o n * mo^e t o r e b u i l d levees. Bond, Rep. Jerry
C o s t e l l o , D - I l l . , and Sen. John C. Danforth, R-Mo., want t o reform
the t r o u b l e d National Flood Insurance Program. And Rep. Richard
Durbin, D - I l l . , wants changes i n the f e d e r a l crop insurance program.
Those i n i t i a t i v e s w i l l be vying f o r a t t e n t i o n on a crowded
Congressional calendar t h a t w i l l include Clinton's h e a l t h care
package, welfare reform and crime l e g i s l a t i o n .
And they w i l l be vying f o r money. I n a d d i t i o n t o f l o o d r e l i e f
funds, St. Louis area members of Congress w i l l be seeking money f o r
the I l l i n o i s extension of Metro Link, a proposed high-speed r a i l
c o r r i d o r between St. Louis and Chicago and road and bridge
improvements.
Here's a summary of what the members w i l l be t r y i n g t o
accomplish i n 1994 and how they performed i n 1993:
Sen. Christopher S. Bond
Bond became known as the "levee k i n g " l a s t year f o r h i s e f f o r t s
to get the f e d e r a l government t o r e b u i l d levees, e s p e c i a l l y i n
�r u r a l areas.
He c a l l s t h e C l i n t o n a d m i n i s t r a t i o n ' s f l o o d p l a i n p o l i c y
" a b s o l u t e l y haphazard."
"We have spent hundreds o f m i l l i o n s o f d o l l a r s ( i n f l o o d
r e l i e f ) and i f we don't r e p a i r t h e l e v e e s , t h e n when t h e water
comes back up i n t h e s p r i n g o f '94, we're g o i n g t o see f l o o d s
a g a i n . I t ' s a b s o l u t e l y c r a z y , " Bond s a i d .
So f a r . Bond has f a i l e d t o persuade Congress t o spend more
money r e b u i l d i n g levees i n e l i g i b l e f o r a i d from t h e Corps o f
Engineers, l a r g e l y because o f t h e c o s t s and o p p o s i t i o n from t h e
Corps and e n v i r o n m e n t a l groups.
He i s n ' t g i v i n g up. " I ' l l t e l l you what, i f t h e y a r e n ' t
i n t e r e s t e d i n f l o o d c o n t r o l , maybe we ought n o t t o be i n t e r e s t e d i n
h e l p i n g r e p a i r earthquake damage, h u r r i c a n e damage . . . We d i d n ' t
say, ^Oh, you c a n ' t l i v e i n San F r a n c i s c o because i t ' s an
earthquake zone,"' he s a i d .
Bond j o i n e d f e l l o w Republicans i n d e c r y i n g t h e C l i n t o n budget
and t h e t a x i n c r e a s e on some businesses and f a m i l i e s due t o be f e l t
i n a few months. But he l e d a b i p a r t i s a n e f f o r t i n t h e Senate f o r
the f a m i l y leave law, which a l l o w s t i m e o f f from work t o care f o r
newborns o r i l l r e l a t i v e s .
Bond w i l l c o n t i n u e t o push o t h e r f a m i l y l e g i s l a t i o n : t h e Family
P r e s e r v a t i o n Act and "Parents as Teachers," b o t h modeled a f t e r
M i s s o u r i programs.
Bond's year was marred by a l a w s u i t i n which he c l a i m e d t h a t
h i s f i n a n c i a l a d v i s e r mismanaged h i s b l i n d t r u s t , c a u s i n g him t o
l o s e more t h a n $1 m i l l i o n . The a d v i s e r charged t h a t Bond was a
p r o f l i g a t e spender. The l a w s u i t i s s t i l l i n t h e c o u r t s .
Sen,.-John"C7 D a n f o r t h
/ ^ a n f o r t h j 3 € Q l s t h e l a s t s e s s i o n o f h i s 18-year Senate c a r e e r a
''^bi-ttexsweeit t i m e , " b u t hopes he can "put some p o i n t s up on t h e
board."
The p a r t i s a n s p l i t on t h e budget l a s t year f r u s t r a t e d him. He
expects Republicans and Democrats t o cooperate more on passage o f a
n a t i o n a l h e a l t h care program.
Meanwhile, he's p r e p a r i n g t o g r a p p l e w i t h o l d e n t i t l e m e n t s as
chairman o f a commission t o l o o k a t ways o f r e d u c i n g c o s t s . The
commission hasn't y e t formed. " I wouldn't b e t much on i t , " D a n f o r t h
chuckled.
I n t h e Commerce Committee, where D a n f o r t h i s t h e r a n k i n g
R e p u b l i c a n , t e l e c o m m u n i c a t i o n s i s l i k e l y t o be t h e b i g i s s u e .
D a n f o r t h hopes t o d e r e g u l a t e t h e i n d u s t r y , w h i c h c o u l d spur changes
such as t e l e p h o n e companies g e t t i n g i n t o t h e c a b l e b u s i n e s s .
He a l s o w i l l be w a t c h i n g t r a d e l e g i s l a t i o n . He w o r r i e s t h a t
l o o p h o l e s i n w o r l d t r a d e agreements m i g h t g i v e some f o r e i g n
c o u n t r i e s an u n f a i r advantage.
Opening up t h e U.S. a i r l i n e i n d u s t r y t o f o r e i g n i n v e s t m e n t i s
a n o t h e r p r i o r i t y . "The a d m i n i s t r a t i o n has been p r o c e e d i n g w i t h
speed t h a t would make a s n a i l l o o k l i k e C a r l Lewis," he s a i d . " I t ' s
t i m e t o g e t on w i t h i t . "
Sen. Paul Simon
Simon t o o k on banks and b r o a d c a s t e r s l a s t y e a r . As a r e s u l t ,
s t u d e n t s n e x t f a l l w i l l be a b l e t o borrow money f o r c o l l e g e
d i r e c t l y from t h e government. And t e l e v i s i o n e x e c u t i v e s are
�c o n s i d e r i n g s t e p s t o curb v i o l e n t programming.
Simon's d i r e c t s t u d e n t l o a n program e v e n t u a l l y w i l l remove
banks and t h r i f t s from t h e s t u d e n t l o a n business and save hundreds
of m i l l i o n s o f d o l l a r s i n a d m i n i s t r a t i v e c o s t s and make more
students e l i g i b l e f o r loans.
On t e l e v i s i o n v i o l e n c e , t h r e a t s o f l e g i s l a t i o n f r o m Simon and
o t h e r s drove network e x e c u t i v e s t o c o n s i d e r v o l u n t a r y l i m i t s . But
he w o r r i e s t h a t a t r e n d away from v i o l e n t programming l a s t f a l l i s
" j u s t a b l i p . I f t h e ( r a t i n g s ) show a v i o l e n t program d o i n g w e l l ,
t h e ^ e r d w i l l follow."
Simor)/is n e g o t i a t i n g w i t h t h e networks, c a b l e and independent
b r o a d c ^ t e r s t o work o u t a f o r m a l agreement f o r m o n i t o r i n g TV
v i o l e n c e . I f t h e n e g o t i a t i o n s f a i l , h e ' l l propose l e g i s l a t i o n t h a t
would impose l i m i t s .
His o t h e r p r i o r i t i e s f o r 1994 i n c l u d e h e a l t h care r e f o r m , which
w i l l come b e f o r e Simon's Labor and Human Resources Committee. He
wants b e n e f i t s f o r mental h e a l t h care and p o s s i b l y f o r l o n g - t e r m
care.
Simon w i l l push again i n February f o r passage o f a balanced
budget amendment. And he's has asked Labor S e c r e t a r y Robert Reich
t o s u p p o r t another l o n g s t a n d i n g i n t e r e s t : a j o b s program t h a t Simon
would l i k e t o t i e t o w e l f a r e r e f o r m .
Sen. C a r o l Moseley-Braun
Moseley-Braun a r r i v e d i n 1993 w i t h s t a r s t a t u s as t h e Senate's
o n l y b l a c k woman, and h e r presence has made a d i f f e r e n c e ,
e s p e c i a l l y on r a c i a l i s s u e s .
At h e r u r g i n g , t h e Senate t u r n e d down a d e s i g n p a t e n t f o r t h e
U n i t e d Daughter o f t h e Confederacy. She argued t h a t symbols
a s s o c i a t e d w i t h s l a v e r y should n o t e n j o y s p e c i a l f e d e r a l
recognition.
She p u b l i c l y t o o k on Sens. O r r i n Hatch, R-Utah, and Jesse
Helms, R-N.C, when she b e l i e v e d t h e y made r a c i a l l y i n s e n s i t i v e
comments.
But p e r s o n a l problems d u l l e d some o f h e r g l i t t e r . She p a i d h e r
former f i a n c e , Kgosie Matthews, more t h a n $40,000 t o r a i s e money
f o r h e r campaign f u n d ; d u r i n g t h a t t i m e , t h e f u n d sank deeper i n
debt.
P r i v a t e l y , c o l l e a g u e s complained t h a t she was a r r o g a n t , keeping
o t h e r s w a i t i n g a t meetings and a r r i v i n g unprepared.
Her most prominent l e g i s l a t i v e achievement was an amendment t o
t h e crime b i l l t h a t w i l l be v o t e d on t h i s year. The amendment would
a l l o w c h i l d r e n as young as 13 t o be p r o s e c u t e d as a d u l t s i f t h e y
are accused o f murder o r o t h e r s e r i o u s c r i m e s .
Moseley-Braun d i d n o t r e t u r n phone c a l l s p l a c e d over a two-week
period.
Rep. R i c h a r d Gephardt
Gephardt's 1994 agenda w i l l be l a r g e l y t h a t o f t h e White House
- t h e economy, h e a l t h care and crime.
"The budget was a v e r y i m p o r t a n t achievement f o r t h e Congress
and t h e c o u n t r y , " Gephardt s a i d , l e a d i n g t o low i n t e r e s t r a t e s and
economic growth.
Gephardt's b i g l o s s l a s t year was on t h e N o r t h American Free
Trade Agreement, t h e b i g g e s t i s s u e on which he clashed w i t h
C l i n t o n . Gephardt w i l l be w a t c h i n g whether Mexican l a b o r laws a r e
�e n f o r c e d and whether l a i d - o f f American workers g e t h e l p f i n d i n g
jobs.
Gephardt s a i d he's i n t e r e s t e d , t o o , i n campaign f i n a n c e r e f o r m .
But g e t t i n g changes t h r o u g h t h e House w i l l be h a r d e r now t h a t a
p r e s i d e n t i a l veto i s u n l i k e l y .
The f l o o d dominated Gephardt's l o c a l e f f o r t s l a s t y e a r , and
h e ' l l head a t a s k f o r c e t o reassess how Congress and t h e f e d e r a l
government respond t o n a t u r a l d i s a s t e r s .
Rep. W i l l i a m L. Clay
Clay saw two o f h i s long-sought measures s i g n e d i n t o law l a s t
year.
The f i r s t i s t h e f a m i l y l e a v e law, which g i v e s workers up t o 12
weeks o f u n p a i d l e a v e f o r t h e b i r t h o f a c h i l d o r m e d i c a l
emergencies. The second was ,a change i n t h e Hatch A c t t h a t loosened
r e s t r i c t i o n s on p o l i t i c a l a c t i v i t y by f e d e r a l w o r k e r s . Clay had
worked 2 0 y e a r s f o r t h a t .
Clay a l s o worked l a s t year f o r t h e m o t o r - v o t e r law t h a t a l l o w s
people t o r e g i s t e r t o v o t e when t h e y g e t t h e i r d r i v e r s ' l i c e n s e s .
One o f Clay's p r i o r i t y i s i n l i m b o . I t ' s a b i l l t h a t would
p r o h i b i t companies from h i r i n g permanent replacements f o r s t r i k i n g
w o r k e r s . A l t h o u g h t h e House passed t h e measure, i t s t a l l e d i n t h e
Senate amid a R e p u b l i c a n - l e d f i l i b u s t e r . I t s 1994 chances a r e s l i m .
Another Clay b i l l b o t t l e d up i n t h e Senate would c r e a t e an
A f r i c a n - A m e r i c a n museum. Clay blames Helms f o r d e l a y i n g t h e
l e g i s l a t i o n , sponsored i n t h e Senate by Simon o f I l l i n o i s .
I f you want t o g e t Clay r i l e d up, mention w e l f a r e r e f o r m .
"Most o f t h e people who a r e t a l k i n g about r e f o r m a r e t a l k i n g
about p u t t i n g people o f f o f w e l f a r e , " he s a i d , an i d e a he c a l l e d
" f o o l i s h n e s s and f o l l y " because t h e r e a r e n ' t enough j o b s . " I
b e l i e v e t h e government has an o b l i g a t i o n t o p r o v i d e j o b s f o r t h o s e
who a r e on w e l f a r e and want t o g e t o f f . Most people on w e l f a r e a r e
c h i l d r e n . These areuM: a b l e - b o d i e d men and women j u s t s i t t i n g
around c o l l e c t i n g a ct)eck."
Rep. JameS'^Talent
I n h i s rreshmerrfyear i n Washington, T a l e n t watched h i s
c o l l e a g u e s l a r g e l y i g n o r e h i s e l e c t i o n pledges o f t e r m l i m i t s and a
balanced budget. T a l e n t h a s n ' t g i v e n up. He t h i n k s a balanced
budget amendment t o t h e C o n s t i t u t i o n w i l l pass t h e Senate.
T a l e n t s a i d he was d i s a p p o i n t e d i n t h e budget and t a x b i l l s
t h a t passed, b u t b e l i e v e s t h e upcoming s e s s i o n w i l l c o n t i n u e t o
r e f l e c t "an emerging b i p a r t i s a n c o a l i t i o n f o r b u d g e t a r y r e f o r m . "
W i t h McDonnell-Douglas Corp. i n h i s backyard. T a l e n t s a i d he i s
k e e p i n g an eye on defense.
" I t ' s becoming r e a l l y apparent t h a t we cannot do what t h e
a d m i n i s t r a t i o n says i t wants t o do i n t e r n a t i o n a l l y w i t h t h e k i n d o f
defense numbers we're l o o k i n g a t now," he s a i d , n o t i n g t h a t t h e
defense budget has been reduced by 30 p e r c e n t , t a k i n g i n f l a t i o n
i n t o account.
T a l e n t s a i d t h e Defense Department was r i g h t t o i s s u e McDonnell
Douglas an u l t i m a t u m on t h e C-17 cargo p l a n e ; t h e government agreed
t o buy 12 more p l a n e s , w i t h f u r t h e r purchases t o depend on t h e
company's performance.
T a l e n t s a i d , howevr, " I t h i n k t h e company i s g o i n g t o meet
t h a t challenge."
�' - T a l e r r t ^ s t a k i n g t h e c o n s e r v a t i v e Republican l i n e on h e a l t h
c a r e r e f o r m , f a v o r i n g an approach t h a t c e n t e r s on i n d i v i d u a l
m e d i c a l accounts.
On t h e l o c a l f r o n t , T a l e n t says h e ' l l work t o r a i s e t h e l i m i t s
on f l o o d i n s u r a n c e and revamp f e d e r a l c r o p i n s u r a n c e programs.
T a l e n t s a i d he hopes t o g e t a Page Avenue e x t e n s i o n
e n v i r o n m e n t a l s t u d y done by s p r i n g so c n s t r u c t i o n o f t h e new road
from S t . Charles County t o S t . L o u i s County can b e g i n .
He s a i d h e ' l l s u p p o r t Metro L i n k o n l y so l o n g as people want i t
and l o c a l o r s t a t e government w i l l pay t o o p e r a t e i t . " I f s t a t e and
l o c a l government don't f e e l s t r o n g enough about i t t o come up w i t h
an o p e r a t i n g s u b s i d y , A I don't see why we s h o u l d go ahead," he s a i d .
Rep. J e r r y - ^ o s t e l l o y
As a m ^ b e r of-^tfie House Budget Committee, C o s t e l l o expects t o
be i n t h e m i d d l e o f t h e debate over how t o pay f o r h e a l t h c a r e
reform.
So f a r , he hasn't s i g n e d on t o any r e f o r m p r o p o s a l because none
has p r o v i d e d t h e s p e c i f i c answers t o h i s q u e s t i o n s about c o s t s , t h e
f i n a n c i n g mechanism and how expanded b e n e f i t s w i l l a f f e c t s m a l l
businesses.
Nonetheless, he says he hopes Congress can pass a h e a l t h care
p l a n by l a t e summer o r f a l l .
C o s t e l l o a l s o expects crime t o rank h i g h on t h e l e g i s l a t i v e
agenda, b u t c a u t i o n s a g a i n s t h i g h e x p e c t a t i o n s . "The f a c t i s t h a t
the m a j o r i t y o f v i o l e n t crimes f a l l under t h e j u r i s d i c t i o n o f t h e
s t a t e s , n o t t h e f e d e r a l government," he s a i d . "What we can do a t
the f e d e r a l l e v e l i s s t r e n g t h e n laws and t a k e a l o o k a t new crimes
t h a t s h o u l d be c l a s s i f i e d as f e d e r a l o f f e n s e s . "
What f e d e r a l o f f i c i a l s need t o do i s , " . . . p u t r e s o u r c e s i n t o
programs t o c a t c h people a t an e a r l y age. I n o r d e r t o s t o p people
who commit v i o l e n t c r i m e s , we need t o s t r e n g t h e n e d u c a t i o n
. . .
and p r o v i d e i n c e n t i v e s t o a l l o w one p a r e n t t o s t a y a t home w i t h
their children."
On t h e l o c a l f r o n t , C o s t e l l o won f u n d i n g l a s t year f o r moving
the C a r d i n a l Creek housing complex a t S c o t t A i r Force Base and $8
m i l l i o n f o r t o extend t h e Metro L i n k r a i l l i n e from East S t . L o u i s
to Scott.
T h i s y e a r , he p l a n s t o c o n t i n u e s e e k i n g money t o t u r n S c o t t
i n t o a j o i n t c i v i l i a n - m i l i t a r y a i r f i e l d and w i l l r e q u e s t a p o r t i o n
of t h e $300 m i l l i o n needed f o r t h e n e x t phase o f Metro L i n k .
He won a p p r o v a l i n 1992 t o d e s i g n a t e a 100-acre t r a c t i n East
St. L o u i s as t h e I l l i n o i s s i t e f o r t h e J e f f e r s o n Expansion
Memorial. T h i s year he w i l l seek money t o move C o n t i n e n t a l G r a i n
from t h e t r a c t .
C o s t e l l o a l s o s a i d he wants a complete r e w r i t e o f t h e N a t i o n a l
Flood I n s u r a n c e Program so t h a t " . . .
we have new r u l e s ,
r e g u l a t i o n s and laws on who s h o u l d q u a l i f y f o r f e d e r a l funds and
who s h o u l d q u a l i f y t o be bought o u t . "
Rep. R i c h a r d D u r b i n
D u r b i n emerged l a s t year as a maverick member o f t h e " c o l l e g e
of c a r d i n a l s , " t h e nickname f o r a p p r o p r i a t i o n s subcommittee
chairmen who use t h e i r c o n t r o l o f government spending t o change
public policy.
He shook up House c o l l e a g u e s by opening up h i s a g r i c u l t u r e
�subcommittee h e a r i n g s t o t h e p u b l i c and used t h e h e a r i n g s as a
p l a t f o r m t o f o r c e changes i n t h e f e d e r a l crop i n s u r a n c e program and
i n t h e Food and Drug A d m i n i s t r a t i o n .
"Last y e a r , we drew a l i n e and s a i d i f a crop f a i l e d 70 p e r c e n t
of t h e t i m e o r more, farmers have g o t t o pay more," D u r b i n s a i d .
"We've g o t t o c o n t i n u e t o b r i n g t h a t percentage down. T h i s year, we
hope we can make 60 p e r c e n t . And over t h e next few y e a r s , we'd l i k e
t o make c r o p i n s u r a n c e a c t u a r i a l l y sound."
But change w i l l come s l o w l y . He s a i d i t w i l l be a t l e a s t 1995
b e f o r e Congress musters t h e w i l l t o t e l l farmers t h a t t h e y must
t a k e o u t c r o p i n s u r a n c e i f t h e y want t o q u a l i f y f o r f e d e r a l crop
d i s a s t e r payments. Today, few farmers t a k e o u t t h e i n s u r a n c e
because t h e government u s u a l l y b a i l s them o u t anyway.
D u r b i n , an a n t i - s m o k i n g c r u s a d e r , s a i d he aso p l a n s t o push
f o r t i g h t e r f e d e r a l r e s t r i c t i o n s on tobacco. "Tobacco doesn't
belong i n t h e A g r i c u l t u r e Department," he s a i d . " I t ' s n e i t h e r a
f o o d nor a f i b e r . Yet (tobacco i n t e r e s t s ) c o n t i n u e t o l i n e up n e x t
t o c o r n and beans and say t h e y are j u s t another c r o p . I f you view
them as a h e a l t h i s s u e , t h e i r days are numbered."
The S p r i n g f i e l d congressman, whose d i s t r i c t extends s o u t h t o
Madison County, s a i d he would a l s o l i k e t o chnge t h e whole
approach t o f e d e r a l involvement i n a g r i c u l t u r e .
"For 60 y e a r s , we've been s t u c k w i t h t h e same t h e o r y and model
b u t f a r m i n g and t h e w o r l d has changed. R i g h t now, we have s u p p l y
management where we t r y t o g e t farmers t o s e t acres a s i d e . I f t h e y
set enough a s i d e , t h e r e i s l e s s p r o d u c t and h i g h e r p r i c e s . Yet we
know t h e U.S. doesn't c a l l t h e t u n e any more when i t comes t o w o r l d
prices."
D u r b i n s a i d he w i l a l s o c o n t i n u e l o b b y i n g t h i s year t o assure
t h a t e t h a n o l i s p a r t o f t h e f u e l mix t o comply w i t h t h e f e d e r a l
Clean A i r A c t . A f i n a l f u e l r u l e w i l l be adopted t h i s year.
Rep. H a r o l d Volkmer
Volkmer, an o f t e n c r u s t y c r i t i c o f e n v i r o n m e n t a l i s t s , became a
d a r l i n g o f e n v i r o n m e n t a l groups l a s t year when he became t h e
champion o f l e g i s l a t i o n t o make i t e a s i e r f o r e n t i r e towns t o move
out of the path of f l o o d i n g r i v e r s .
Volkmer pushed t h r o u g h a measure t h a t quadrupled t o $110
m i l l i o n t h e amount o f money a v a i l a b l e f o r buyouts o f f l o o d e d homes
and businesses. And he decreased t o 25 p e r c e n t from 50 p e r c e n t t h e
l o c a l share o f p a y i n g f o r such moves.
"The buyout b i l l was my most n o t a b l e p e r s o n a l achievement,"
Volkmer s a i d . But more remains t o be done.
"We're s t i l l n o t t h e r e . We've s t i l l g o t problems w i t h l e v e e
r e p a i r s and g e t t i n g them f i x e d , rehabbing a g r i c u l t u r a l l a n d . We
s t i l l have problems," Volkmer s a i d .
The H a n n i b a l congressman had planned t o spend 1993 w o r k i n g on
l e g i s l a t i o n t h a t would i n c r e a s e r e c y c l i n g by p r o v i d i n g business t a x
c r e d i t s and m u n i c i p a l g r a n t s t o s e t up s m a l l p r o c e s s i n g c e n t e r s and
l a r g e r r e g i o n a l c e n t e r s t o t u r n garbage i n t o useable p r o d u c t s .
But t h e f l o o d pushed t h a t i n i t i a t i v e o f f Volkmer's p l a t e . He
hopes t o r e s u r r e c t i t t h i s year, a l o n g w i t h a ew i n i t i a t i v e f o r
d a i r y farmers.
"I'm w o r k i n g up a d a i r y b i l l we hope t o be a b l e t o g e t
t h r o u g h , " he s a i d . The l e g i s l a t i o n would s e t up a board made up o f
�m i l k producers and create an "assessment" system t h a t would charge
fees t o m i l k producers based on t h e i r production.
Money paid i n t o the fund would be used by the board t o buy up
surplus d a i r y products and s e l l those surpluses overseas. " I t ' s
producers helping thmselves t o keep p r i c e s from f a l l i n g through
the f l o o r and a t the same time removes surpluses form the domestic
market," VollyRer^said.
Rep. Gleni<Poshard
Poshard- wi 11-be^he man i n the middle i n 1994 as he t r i e s t o
accommodate the c o n f l i c t i n g i n t e r e s t s of two of h i s biggest
c o n s t i t u e n c i e s : farmers who want ethanol i n f u e l s and o i l and gas
producers who want t o s e l l t h e i r products.
" O i l and ethanol i n t e r e s t s don't aways coincide, but I ' l l have
t o work on both," Poshard said.
"Just about a l l the o i l I l l i n o i s produces comes from my
d i s t r i c t . O i l i s down t o $11 a b a r r e l , independents are s h u t t i n g
down and i t ' s created b i g job losses. I want t o work on
depreciation allowances f o r o i l f i e l d equipment and s t a b i l i z i n g
prices.
"We've also got t o p i n down the ethanol issue. For my d i s t r i c t
i n terms of the economy, t h a t i s a huge issue
"One doesn't necessarily support the other, but both are job
producers."
By comparison, h e a l t h care may be a breeze. Poshard i s a
co-chair of the Rural Health Care Caucus and said he w i l l push t o
assure t h a t r u r a l h o s p i t a l s and ambulance services are not put a t
r i s k by h e a l t h care reform.
He w i l l also continue t o work on campaign finance reform
l e g i s l a t i o n - a personal i n t e r e s t since Poshard accepts no money
from p o l i t i c a l a c t i o n committees.
And he said he also plans t o continue t o push f o r a d d i t i o n a l
budget cuts. Poshard was one of the 35 conservative Democrats, led
by Rep. Timothy Penny, D-Minn., t h a t pushed the president t o enact
deeper cuts l a s t year. The e f f o r t f e l l s i x votes s h o r t , Poshard
said. "We w i l l not l e t t h a t d i e . We w i l l go back and t r y t o f i n d
a d d i t i o n a l cuts and get a d d i t i o n a l votes t o pass out of here."
Rep. B i l l Emerson
Emerson was i l l and could not be reached f o r an i n t e r v i e w . His
top p r i o r i t i e s i n 1993 included a balanced budget amendment, which
did not happen, and work on a Congressional r e o r g a n i z a t i o n
committee, which held hearings throughout the year.
@Art: PHOTO
@Art Caption: (1) Photo by AP - House M a j o r i t y Leader Richard
Gephardt says h i s 1994 agenda w i l l be l a r g e l y t h a t of the White House
- the economy, h e a l t h care and crime. (2) Photo Headshot of John C.
Danforth - I n the l a s t session of h i s 18-year Senate career. Sen.
John C. Danforth w i l l be g i v i n g a t t e n t i o n t o telecommunications and
trade issues. (3) Photo by AP - I l l i n o i s Sens. Carol Moseley-Braun
and Paul Simon have l i b e r a l images but favor some conservative
causes. Simon supports a balanced budget amendment, and Moseley-Braun
backs prosecution of 13-year-olds as a d u l t s i n cases of serious
crimes.
�INSIDE CONGRESS
had lost his health insurance.
"He is surpassing Ronald Reagan as the great communicator,"
said Rep. Henry Boniila, freshman
Republican and former television
anchorman from Texas.
Even more remarkable were
the Reaganesque strains in Clinton's rhetoric. House GOP Whip
Newt Gingrich of Georgia said
Clinton's talk about the decline of
the family, the failings of the welfare system and the need to get
tough on crime sounded like a
speech Gingrich himself could
have given.
Riling, Regaling Republicans
But there still was plenty to rile
Republicans. Clinton began with a
proud litany of the bills that Congress enacted last year, crowing that
they were "all signed into law with
no vetoes."
He doted over the economy
like a proud father, attributing the
recovery to his economic program
— even though many experts say
the turnaround began before Clinton took office.
Giving a new push to welfare
reform, Clinton promised to submit his plan this spring.
" I know it will be difficult to
tackle welfare reform in 1994 at the
same time we tackle health care,"
Clinton said. "But let me point out, I
think it is inevitable and imperative."
On health care, he squarely confronted GOP critics. Citing the millions of Americans who have no health
insurance or have lost it unexpectedly,
Clinton said, " I f any of you believe
there's no crisis, you tell it to those
people, because I can't."
The partisan climax was when
Clinton made plain what his bottom
line will be in the health-care bazaar.
" I f you send me legislation that does
not guarantee every American private
health insurance that can never be
taken away," Clinton said, holding up
a pen, "you will force me to take this
pen, veto the legislation, and we'll
come right back here and start all over
again."
Turning to defense and foreign affairs, Clinton won a hearty round of
Republican applause when he said,
"We must not cut defense further."
While Republicans stood and cheered,
Democratic liberals sat in silence.
Responding to growing public concern about crime, Clinton gave a pitch
for tough anti-crime legislation. He
endorsed a Senate-passed proposal to
156 — JANUARY 29, 1994
CQ
ably as night follows day; a freetrade agreement that most Republicans would have been hard
pressed to oppose.
But this year, the agenda is
1 MagnifiBdsca le
more politically complex. Health
M e t presldenti
care, welfare and crime do not dialte11 y«•r In olfice
vide neatly along party lines; in1
deed, welfare and crime traditionBushBO%^
Ker nedy 78% '
ally are seen as GOP turf That
1
surely will divide Republicans
Elsen^
ower
70%
J
Jot nson 69%'
over how far to go in helping the
1
Mixon 63% •
president pass legislation, at the
arisk of blurring distinctions between the parties.
\
/
i 52% >
Senate Minority Leader Bob
Cli iton
^rteagan 47%
\
Dole, R-Kan., took a tough parti~
1 Ford 46%
/
Truman 43%
san line in the official Republican
1^^^
response to the address. (Text, p.
199)
J«i. Fib. Mv.
H>r J m July Aug StfK Oa Nn D K Jvi
"Far more often than not, the
president and his Democrat maAfter 12 months in office, President Clinton had the
jority have taken what we believe
approval of 54 percent of the nation, according to a
is the wrong fork in the road, not
Gallup Poll of 1,010 adults taken Jan. 15-17. Since
just on one or two matters of pol1935, Gallup has periodically asked, "Do you approve
icy, bul on their entire approach
or disapprove of the way ... is handling his job as
president?"
to government," Dole said.
George Bush had the highest approval rating after
Earlier, Republicans — even
one year in office, coinciding with the Persian Gulf war.
the notoriously low-key moderate
Harty S Truman had dropped to 43 percent after 15
Jim Leach of Iowa — pounced on
months in office.
emerging questions about Clinton
SOURCE: Gallup Poll
and Whitewater.
When Clinton started talking
MARILVN GATES DAVIS
about providing emergency aid to
impose mandatory life sentences on
help California recover from its recent
people who commit three violent
earthquake. Dole started talking
crimes — a policy opposed by many
about finding offsetting spending cuts
Democrats, including House Speaker
to pay for it.
Thomas S. Foley of Washington.
Dole's increasingly confrontational
Acknowledging Kevin Jett, a New
line on health care is a shift from last
York policeman who sat in the gallery
year, when a chorus of conciliation
behind first lady Hillary Rodham
rose from GOP ranks after the presiClinton, the president also called for
dent's health scheme was unveiled.
hiring 100,000 new police officers.
Some Republicans are wary of this
He closed the speech with an emostrategy.
tional acknowledgment of the limits of
" I think what Bob Dole is doing on
government action in confronting the
health care is what party leaders often
thorny problems he has laid on Condo — try to have a Republican posigress' doorstep.
tion," said Sen. John C. Danforth, R"The American people have got to
Mo. " I don't think there is one."
want to change from within if we are
But Republicans al opposite ends
to bring back work and family and
of the political spectrum agree that
community," he said, invoking conthe party needs to define its profile
cepts that Republicans usually use to
better in the coming year.
criticize Democratic policies.
"The Republican party has the image of being the party that's oul and
What Role for R e p u b l i c a n s ?
against things," said Boehlert, a modClinton's legislative agenda poses a
erate. "We've got to focus on what we
political test for Republicans as they
are for."
plot their strategy for this election
"We always run the risk of being
year.
viewed as obstructionists," said conLast year, there was little doubt
servative Sen. John McCain, R-Ariz.
about the role Republicans would play
"Bul we have to give voters a reason to
in congressional debate on Clinton's
give us control of the Senate and the
top priorities: a tax-increasing budget
White House. So far I don't think they
that Republicans opposed as predicthave one."
Cn&aton% Approval Rating
�r..
velers in front of Parliament on the day
Mr. Meshkov's victory was announced, tbe
bearded Mr. Los explained that "this Is not
Yugoslavia" because "people are smarter
here."
Some foreigpri observers note hopefully
that Mr. Meshkov has been watering dou-n
his rhetoric since the elections, playing up
hopes of economic union with Russia and
Clinton's Health Plan
ducking questions about his promised referendum. "He's mellowing out," says Ian
Is a Fiscal Dice Roll
Brzezinski, a consuJunt to the Ukrainian
Parliament's council of advisers.
Keeping Promises
,
\^'ASHINGTON
But Mr. Meshkov faces Intense presIt
didn
t
make
the
headlines,
but the
sure from voters and pro-Russian politi- message implied In the delicately
What If?
"tP^''
compromise worded final chapter of the Congres
•ncTwsfl
n (J#icrt resutting from a-nton hsatn
with Kravchuk and Ukraine," says the sional Budget Office's review of ft-esipUn under CSO't tmsi guest irw it p«»r>,ums
Russian Society's Mr. Los.
Clinton's health plan Is alarmingtum outtobe 10% h>gt>«,. m ciuons of aoSirj
Another deputy to Crimea's Parlia- dentThis
plan represents the federal gov • M l
•
March 27 elections, "the main purpose is to emment's biggest fiscal gamble since
H Intntti H (rtmiomi _
10*4 Migna
" ""any Russian patriots as possible Ronald Reagan simultaneously cut
'^efs'^se spending.
koi f S i ' ^ f i v^^''^'"'"'' "^^^ MeshCBO didn t put It that way, of course The
kov fulfill all his programs." The Russian- explosive warning Is buried In a chapter
bom Mr. Kruglov believes that "Russian demurely titled "Other Considerations" un
troops should be sent to Sevastopo J der
the unwieldy heading "The Effects and
necessary to reclaim Crimea. He says it
would be worth theriskof conflict, became SusUinablllty of Controls on the ^Tte of
Growth of Premiums." But It's there nonevniJ suffer less from war than
IM
2SN
uieless - and taxpayers should view it as a
In pracdce, Russian armed forces are big red flag.
S'"")'Sevastopolrightnow.
The CBO report estimates that over the
n . ^ JlL " 5 °'
Soviet Black Sea next six yean the Clinton plan would cost board sets growth rates for different re
Meet. Aboard one submarine suppori shio the govemment $130 billion more than the pons, and the congressman from El Paso
moored along a Sevastopol wharf, Captain VVhite House says. But that assumes Mr discovers that even though pren;u,~is mere
be
nrst Class Vladimir Vasukov warns "We Clinton s caps on the growth In health-care are lower than In Boston, they r
f
torise
only
by
the
same
p*rcf
nuge
are armed to the teeth." He then sorts out
spending hold. If they don't, the cost to And If the regional caps survive lui batue
his loyalties: "I'm Russian. I live ,n
taxpayers will be substantially more.
^^'"e-1 se^'e the Black Sea Fleet." He
The fundamental question about the there s still the subsuntial r.sn trui the
hits the bottom line: 'Tm registered as a
Clinton plan, the one that most tnxibles spending caps in and of tlier.seUM viu
several of Mr. CUiitoD's economic ad- provoke enough hosplui closing, a.sfninRussian officer. And Russia pays me "
visers. Is: Will those caps bold? Readlmr Ued doctors, long waiung times ind horror
Kiev's weakening hold over Crimea is
stories to force Congress to raise them
between the lines, CBO suggeststhw
SnnTn'''^
^"'^ °f Mr. Meshkov's
Lifting the caps would cn« tax
won't, but tbe report expUdtJy uys
n.nnf I"t-^*"- ^° ^""'"a" Presidential
payers
billions of doUan a ytu ia
only
that
the
caps
are
likely
to
create
runoff election, pro-Ukrainian Mykola Baadditional subsidies to lo« «a<T
Immense pressure and considerable
grov. A veteran Ukrainian apparatchik
workers and small companies How
tension" In society and tbe heaitJj-cire
frorn Kiev, and speaker of the Crimean
much? Lewin VHI, a healtb consuJOnf
system. Pressed by Republican Sen
Parliament until he resigned last week
firm In Fairfax. Va., estlmatei tJuttf
John Danforth of Missouri to elabormte
Mr. Bagrov was the architect last fall of the
tbe
Congress decides that curtinj tbe
CBO
Director
Robert
Reischauer
So?"!!."*"' created a presidency in
annual growth of health costs fnjo tbe
(lucked. "Thereaiissue," he said "is
Crimea. His aim in setting up the office
currendy projected 9% to njugtily is';
whether tbe InstltutlonaJ and political
was to appease Crimeans demanding au
Is too tough and settles for •
structure of the nation can withstand
onomy by turning the peninsula into a
growth rate, the government win luve
those pressures. And we have no abUltv
somewhat more independent pro-Kiev ento
spend an additional $17 bUJioo lanuto
Judge
that."
clave, run by himself.
ally by the year 2000 on heaJtu-cxr^
Democracy vs. NatlonaJism
The White House estimates that health- subsidies. That equals tbe Jusac* tvinsurance premiums employers pay for their |. partroent's annual budget.
But he lost. Mr. BagroVs prorram
workers will nse 9% annually in comine
gained him only m of'the final
Congress will have three C.^- CM f the
years
If there is no health-care reform. Mr
aDming mainly from the frightened minori• caps come under attack, as the CBO ;rt<icis
t-linion
proposes
a
law
to
cut
that
rate
of
ties of ethnic Ukrainians and Tatan
in half. He describes this as a they will. It can hang tough, which U-.M ^^^^
anH ?h
indigenous to Crimea, increase
backstop"
in case "managed competition- i angry doctors, infuriated hospi-.Au and
and their leader, Mustafa Cemiloglu, is
fails
to
slow
the growth in health costs. CBO enraged constituents who wiii say i/iey are
m.^ ^e^T*"
^ pro-Russian movefigures
the
caps
are about the only thing in being denied the health care tfte> »ere
whT. i^"'"^"^^R""'a usually stops the Qinton plan that
will actually work to promised. It an lift the caps, and pay for
where nationalism starts," says the wislow the growth of health-care spending It that with higher taxes or spend.ng cuts
zened 50-year-old. His Tatar people who
accepts them because Mr. Clinton would
^^'" ^ " ^ "f'
and
would like their own semi-amonomous
wnte a law with teeth to enforce them.
et the deficit widen. But, as CBO warns
state in Crimea, reluctantly backed the
there isn t any free lunch.
laws last only as long as Congress
[1!^^/M!""."
^"^y fear a repeti- and But
The Congressional Budget Office may be
the public support them. "If the reliancewrong.
tion of their past bitter experiencTof
Mr. Clinton and Ira Magauner the
Is placed on premium caps...." says Sen architect
his health plan, may be correct
( Danforth, "It's the political problem of hav- when theyof argue
that their ' managed coming the will to stick with those caps " CBO petiuon ' will squeeze
out waste and slow the
predicts
that
the
first
problems
will
surface
Some 250^000 Tatars recently have remcrease ofrisingcosts without prrxiucine
when Mr. Qinton's new National Health imsustainable pressures. But the fiscal nsks
umed to Crimea, Mr. Cemiloglu among
Board sets different premiums for different Ihey propose to take are enormous, and they
them. Speaking from his small familP
regions to reflect existing differences ingive no hint where they would get the money
health costs. Boston's premium could easily to pay for their error if they are arong.
sarai Mr. Cemiloglu says that Ukraine
must fight for Crimea "if Ukraine wSS tJ be twice the one set for El Paso, Texas
-DA\ ID WESSEL
Amencans tolerate wide regional disparities
remain an independent state "
in
private
markets,
but
such
disparities
are
Ethnic Ukrainians in Crimea share his
hard to Justify when determined by govemment. That's why Social Security benefits
before World War n, when the West
are the same across the country despite
couldn't stop Hitler." says Yuri DyS
differing living costs.
chairman of the Sevastopol branch of a
The pressure to spend more money will
Ukrainian cultural society. An oceanojra
pher working in an icy, fuel-starvS^t likely grow In the second year when the
search institute by the Sevastopol harboT
Mr. Eyln shows off the sunset view of h.c
weajjn-filled city and sums uT"?am
The Outlook ^|
S,"JtrSalS'"^''^"°"°'''»"'
THE WALL STREET JOURNAL MONDAY. FEBRUARY 14. 1994
�By CHRISTOPHER CONNELL=
A s s o c i a t e d Press W r i t e r =
WASHINGTON (AP) Feb 9 -- Republicans c l a i m t h e C o n g r e s s i o n a l
Budget O f f i c e d e l i v e r e d a knock-out blow a g a i n s t t h e C l i n t o n
h e a l t h p l a n by s a y i n g i t would worsen t h e d e f i c i t . Democratic
congressional leaders consulted w i t h President C l i n t o n
this
morning and s a i d t h e r e was no reason t o p a n i c .
' ' I t ' s n o t a problem,'' s a i d House M a j o r i t y Leader
R i c h a r d Gephardt, D-Mo., s t r e s s i n g t h a t t h e CBO r e p o r t
shows t h e White House p l a n r e a l l y can cover everybody and
s t i l l cut medical b i l l s i n the long run.
''The d i f f e r e n c e s a r e r e l a t i v e l y s m a l l and we w i l l
r e s o l v e them on t h e H i l l , ' ' s a i d Rep. John D i n g e l l ,
D-Mich., chairman o f t h e Energy and Commerce Committee.
''The p r e s i d e n t has t h e o n l y s e n s i t i v e , workable ... p l a n
t h a t p r o v i d e s u n i v e r s a l coverage f o r every American.''
D i n g e l l added, ' ' I would urge you not t o p a n i c ' ' over
the p r o j e c t e d d e f i c i t impact o f t h e p r e s i d e n t ' s
health-care plan.
The b e a r e r o f t h e news, CBO D i r e c t o r Robert D.
Reischauer, c a u t i o n e d a g a i n s t r e a d i n g t o o much i n t o h i s
agency's c a l c u l a t i o n t h a t C l i n t o n ' s p l a n would d r i v e t h e
d e f i c i t up by $126 b i l l i o n between 1995 and 2004.
I t would a l s o t r i m t h e n a t i o n ' s medical b i l l s by
o n e - t h i r d o f $1 t r i l l i o n over t h e next decade, he s a i d .
He t o l d t h e Senate Finance Committee today t h a t w i t h o u t
C l i n t o n ' s c o n t r o v e r s i a l caps on insurance premiums, t h e
c o s t s would be ' ' q u i t e a b i t h i g h e r . ' '
Reischauer urged lawmakers t o '''design a h e a l t h care
p l a n t h a t makes sense. ... You s h o u l d n ' t l e t b u d g e t a r y
t r e a t m e n t d i c t a t e program d e s i g n . ' '
Senate M a j o r i t y Leader George M i t c h e l l i t e m i z e d some o f
the p o s i t i v e p o i n t s i n t h e CBO a n a l y s i s from t h e
administration's perspective, including i t s p r o j e c t i o n
t h a t i t would lower businesses' h e a l t h i n s u r a n c e c o s t s by
$90 b i l l i o n i n 2004 a l o n e .
Reischauer s a i d t h a t ''the v a s t preponderance o f t h a t
money would be r e t u r n e d t o workers i n t h e form o f h i g h e r
wages.''
Sen. John D a n f o r t h , R-Mo., who c a l l e d h i m s e l f one o f
o n l y t h r e e Republican s e n a t o r s who s u p p o r t t h e i d e a o f
l i m i t i n g i n s u r a n c e premiums, s a i d i t would be h a r d f o r
Congress t o muster ''the w i l l t o s t i c k w i t h those caps.''
�By r e s i s t i n g White House arguments t o keep most of t h e
c o s t s p l a n o f f - b u d g e t , t h e CBO d i r e c t o r became an i n s t a n t
hero t o Republicans. That g i v e s them an opening t o l a b e l
as t a x e s t h e insurance premiums t h a t employers would pay,
and t o c l a i m C l i n t o n i s c a l l i n g f o r a huge t a x i n c r e a s e .
Rep. Dick Armey, R-Texas, chairman of t h e House
Republican Conference, h a i l e d the CBO r e p o r t ''a v i c t o r y
f o r good government and honest bookkeeping.''
But Sen. Edward Kennedy, D-Mass., a major v o i c e on
h e a l t h m a t t e r s , s a i d t h a t when t h e smoke c l e a r s , t h e CBO's
81-page a n a l y s i s w i l l be seen as ''a s o l i d v o t e o f
c o n f i d e n c e i n the a d m i n i s t r a t i o n ' s p l a n . The p l a n i s sound
e c o n o m i c a l l y . The numbers add up.''
A l i c e T. R i v l i n , the White House deputy budget d i r e c t o r
and h e r s e l f a former CBO d i r e c t o r , s a i d the r e p o r t
' ' v a l i d a t e s t h e most i m p o r t a n t aspect of t h e H e a l t h
S e c u r i t y A c t ' ' ; namely, t h a t everyone can be covered w h i l e
' ' r e d u c i n g t h e r a t e of growth of n a t i o n a l h e a l t h spending
and b r i n g i n g down f u t u r e f e d e r a l d e f i c i t s . ' '
Rep. Pete S t a r k , D - C a l i f . , chairman o f t h e House Ways
and Means h e a l t h subcommittee, s a i d , ' ' I f you hated t h e
p l a n b e f o r e , you s t i l l hate i t . I f you l o v e d t h e p l a n , you
s t i l l love i t . ' '
is
S t a r k s a i d t h e p r e s i d e n t ' s goals are r i g h t but t h e
' ' p o o r l y drawn.''
bill
''Now i t ' s up t o us t o l e g i s l a t e , ' ' S t a r k s a i d . ''We've
g o t t o come up w i t h a f i v e - y e a r p l a n t h a t does not d e s t r o y
t h e budget.''
Rep. Jim McDermott, D-Wash., c h i e f sponsor of a
C a n a d i a n - s t y l e p l a n t h a t would have the government pay
most medical b i l l s w i t h t a x e s , s a i d the CBO helped C l i n t o n
''be honest'' and ''made i t p o s s i b l e f o r us t o have a r e a l
debate on t h e s o l u t i o n . '
House Republican Whip Newt G i n g r i c h d e c l a r e d t h e CBO
r e p o r t made C l i n t o n ' s p l a n ''dead on a r r i v a l ' ' and s a i d
t h e House should get on w i t h w r i t i n g i t s own b i p a r t i s a n
bill.
The CBO s a i d the premiums i n C l i n t o n ' s p l a n would c o s t
15 p e r c e n t more than the White House e s t i m a t e d . I n
a d d i t i o n , s u b s i d i e s f o r employers would c o s t $58 b i l l i o n
i n 2000 alone, o r $25 b i l l i o n more than the
administration's figure.
I t a l s o p r e d i c t e d t h a t more low-wage workers would
q u a l i f y f o r the promised s u b s i d i e s .
�But Reischauer s a i d businesses would pay $90 b i l l i o n
l e s s f o r h e a l t h care i n 2004 under t h e C l i n t o n p l a n .
H e a l t h a l l i a n c e s would c o l l e c t and d i s t r i b u t e $585
b i l l i o n i n premiums i n 2000, t h e CBO s a i d , and almost $750
b i l l i o n by 2004.
The CBO s a i d the C l i n t o n program belongs i n the f e d e r a l
budget because ' ' i t e s t a b l i s h e s b o t h a f e d e r a l e n t i t l e m e n t
t o h e a l t h b e n e f i t s and a system o f mandatory payments t o
f i n a n c e those b e n e f i t s . ' '
The White House s a i d i t s p l a n i n c l u d e s a cap on how
much t h e government would pay i n s u b s i d i e s . But t h e CBO,
a f t e r l o o k i n g a t i t c l o s e l y , s a i d those caps ''would n o t
be l e g a l l y b i n d i n g . ' '
U.S. SENATOR SPECTER COMMENTS ON CBO'S BUDGET ESTIMATES
CONCERNING PRESIDENT CLINTON'S HEALTH PLAN
WASHINGTON, Feb. 8 /PRNewswire/ -- Responding t o t h e
C o n g r e s s i o n a l Budget O f f i c e announcement today t h a t
P r e s i d e n t C l i n t o n ' s h e a l t h p l a n would add $74 b i l l i o n t o
t h e d e f i c i t over the next s i x y e a r s , U.S. Senator A r l e n
S p e c t e r (R-PA) made t h e f o l l o w i n g statement:
"CBO has s t a t e d the obvious t h a t t h e C l i n t o n h e a l t h
b u r e a u c r a c y would be a budget b u s t e r and add enormously t o
t h e d e f i c i t . The worst p a r t i s the government w i l l
i n e v i t a b l y t r y t o pay f o r the bureaucracy by c u t t i n g t h e
q u a l i t y o f h e a l t h care.
"CBO's f i g u r e s show we should leave i n t a c t t h e c u r r e n t
system which d e l i v e r s the best h e a l t h care i n the w o r l d t o
86.1 p e r c e n t o f Americans and t h e n t a r g e t t h e s p e c i f i c
problems by c o n t a i n i n g costs and c o v e r i n g people n o t
included i n current h e a l t h plans."
Democratic Ad Lampoons Republicans on H e a l t h Care
'Crisis'
WASHINGTON (AP) Feb 9 -A new ad a i r e d today by t h e
Democratic N a t i o n a l Committee lampoons f o u r l e a d i n g
Republicans
for
s a y i n g t h e r e i s no h e a l t h care c r i s i s i n America.
''The Republicans. They s a i d t h e r e was no r e c e s s i o n .
Now t h e y say t h e r e i s no h e a l t h care c r i s i s . They j u s t
don't g e t i t , ' ' t h e n a r r a t o r says i n t h e ad, which began
a i r i n g t o d a y d u r i n g morning news programs.
�,
, ,
;
1—I
•
.
Health-Care Reform Faces Deadlock in Congr
As Lawmakers Wrangle Over Rival Proposals
By DAVID RoGBis
And HiLAKY Srovr
Staff Reportert
ef THE WAU. STREET JOVKNAI.
WASHINGTON - The great danger for
President Clinton on health-care these
days isn't Just that his plan has stalled in
Congress but that none of tbe altematives
are moving either.
"Mother Teresa couldn't get a majority
•vote on a health plan right now," says
health-care lobbyist Fred Graefe. And unless the administration or its allies move to
break the stalemate, they risk having
lawmakersrevertto the familiar Washington pose of no consensus, no action.
Still, lawmakers expect some kind of
health bill to be enacted this year. After
deadlocking earlier this week, Democrats
on the Ways and Means health subcommittee were more hopeful of agreement last
night. And ironically, theedminlstration Is
looking to Its sometime critic. California
Democratic Rep. Fortney "Pete" Stark,
to report a plan that will show some
movement towardrefonn- albeit wiUi
more of a goverament role than the
president's proposal.
'Somebody Has to Move*
"Somebody has to move," says Democratic Rep. George MUler of California,
one of about 10 liberals who participated in
a sober meeting with the president at the
White House late Wednesday. "If there's
^ :#^^;4?.^^«^S4#ilWhere It Hurts
Major trouble spots for President Clinton's health-care plan:
MANDATORY ALLIAKCES Clinton calls
for targe, regional insurance-buying pools;
rivals want voluntary arranjements, or
to permit more businesses to opt out.
PREMIUM CAPS By the year 2000,
Clinton would cap the allowable annual
increase in health-insurance premiums
at the general inflation rate. But conservatives fear price controls, while some
Democrats would trigger controls only
If competition first tails.
EMPLOYER MANDATE Clinton would
require companies to pay 80% of premium costs lor workers. Rivals want no
mandate, or want the burden placed on
the individual. Hybrid proposals could
prove hard to administer.
TAXATION OF BENEFITS Clinton would
impose a modest future cap on what
health-care benefits could be excluded
from income. Proponents of a purer
"managed competition" approach want
tax changes but disagree over where to
impose tax penalties and how to recycle
revenues as tax breaks.
In Uie case of health-care, Uiough. trigger cost contix)ls if competition alone
lawmakers must not only be cost-consdous doesn't hold down expenditures in the
but create a system Uiat works. Tbe ad- future.
ministi-ation could win votes easily enough
On a host of Issues, the middle ground
by abandoning contioversial pieces of is occupied by young, ambitious political
Its plan, but It and Congress will still need brokers who swear by the Ideas of "manto come up ?ritii solutions toreplaceJetti- aged competition," but have each made
soned provisions.
compromises to satisfy Important constituencies.
Alliance CoDcept Scares Many
The president's proposal to set up so- Jackson Hole Revisited
called "alliances" - huge, powerful reMany oftiieexperts and academics who
gional health-insurance-buying pools- helped shape tbe original managed-care
won't survive Congress. But It is still likely debate are meeting this week at Jackson
that some type of purchasing pools will be Hole, Wyo.. torevisitUie Issue. But In
enacted, since portions of Uie same idea terms of practical politics, their Ideas
Small Business's View
are part ofrivalplans proposed by Demo- are fraught with contradictions. On one
The National Federation of Independent
cratic Rep. Jim Cooper of Tennessee and hand, Uielr falUi In markets makes liberals
Buf incM laid it oppotet a poiiible Dcm*
GOP Sen. John Chafee of Rhode Island.
ocratlc health-care compromife meant
uneasy; on the oUier, Uielr willingness to
to win ima'J.bujmeM aupport. But it
The real debate over Uie purchasing use the tax code to influence Individual
indicated that the plan aeemi leii oner>
pools is about how far to go and what to healUi-care choices frightens conservaoui for imall builneifci than the CUnton
make mandatory. Supporters of the Cooper tives.
approach. Enterpriac, paf e B2.
bill believe Uiat enrollment in Uie pools
This Is clearest in the debate over tbe
adminlsti^tion's proposal to require emno consensus, nobody has to do anything. should be required of businesses wlUi
fewer Uian 100 workers. But moderate
ployers to contilbute as much as 80% of tbe
Thentimebecomes your enemy."
The White House's most urgent chal- Republicans like Rep. Alex McMillan of cost of premiums for their workers. Thai
lenge is to keep up the pressure for action North Carolina would like to see a more burden has provoked anger among businesses; Mr. Clinton brought tills on himwhile preserving the basic elements of the voluntary approach akin to Sen. Chafee's.
Clinton plan in some recognizable form. in which enrollment would be optional for self in part because he was reluctant tc
Yesterday, Mr. Clinton touted his plan all employers. Fearing that Uie alliances
buck organized labor and embrace provisamong senior citizens in Connecticut, could prove too big, like giant farm cooper- ions on the taxation of benefits that were
atives,
Uiey
also
want
more
Uian
one
where he brushed aside recent setbacks in
espoused by Uie Jackson Hole group.
House subcommittees and pointedly In a singleregionor state, to ensure
Mr. Cooper hasreshapedthese tax
praised Rep. Stark, the chairman of the competition.
provisions himself In a more regressive
Ways and Means healtii panel, as an ally Cost Controls Are at Risk
fashion, and his plan lacks any employer
committed to universal coverage.
mandate such as the one proposed by the
While
open
to
compromise,
Uie
adminFor the moment at least, there Is no isti-ation worries Uiat if it gives away too
Jackson Hole group. Mr. Chafee's plan is
broad White House strategy to Jump-start much. It will undermine Its ability to
In fact the boldest on the tax side, but by
the process. With no other health-care
proposed caps on Uie allowable rejecting
any employer mandate, his plan,
proposal in a commanding position on enforce
annual increase in health-insurance prelike
Mr.
Cooper'
, comes up short In dollars
Capitol Hill, there is no clear camp right miums.
"Frankly. I Uiink Uie premium to make health scare
tidilyaffordable for
now with which to bargain. But wlUi full caps have
very
lltUe
chance
of
passing
committee action in the House and Senate around here." says Democratic Sen. Kent working-class families.
not scheduled before mid-April In most
has encouraged Interest In a hyof North Dakota, a member of Uie bridThis
cases, the next six weeks provide a window Conrad
scheme Uiat would exempt small
Finance
Committee.
for all camps to re-evaluate and refine
business from Uie employer mandate and
Yet. as wiUi Uie buying pools. Uie cost Instead combine elements of Mr. ainton's
their positions.
contiols have been embraced In concept by plan and of Mr. Chafee's proposal Uiat ail
For the administi-ation, which lacks a moderate Republicans like Missouri Sen.
workers berequiredto buy Insurance.
clear path In the House, the most impor- John Danforth. a Finance member, and
Even some Senate conservatives speak of
tant task may be to fortifyrelationswiUi Sen. Nancy Kassebaum of Kansas. Uie
Senate GOP moderates. The moderates top GOP member of Uie Labor and Human Uie need to require employers who now
are under pressure from conservatives to Resources Committee. The White House provide Insurance to continue coverage
whatever scheme Is adopted. But any such
resist any compromise, and partisan lines privately expects premium caps will be
hybrid scheme could lead to market distorcould harden after a Senate Republican diluted
to
a
ceiling
Uiat'
s
higher
Uian
Uie
tions
because of necessarily arblti-ary defireti-eat next week. Mindful of tills. Mr.
nitions such as what constitutes a small:
ainton stiTick a bipartisan note by hosting general inflation rate, and one Uiat's
business.
a White House dinner Tuesday for sena- phased in over a longer Ume period.
Among
the
competing
plans
In
the
Ways
tors of both parties. But the dinner's
However the congressional debate un- i
outward conviviality - and wide expres- and Means Committee, for example, is one folds. It will be Influenced by forthcoming
sions of support for the president's goal of to set a series of markers Uiat would
estimates by Uie Congressional Budget
universal coverage - contrasts wiUi the
Office, which Is openly skeptical of much of
thicket of details ahead.
what pure managed competition promises.
As a rule, CBO's score-keeping convenWhat makes Uie task so difficult Isn't
tions tend to give less credit to new policy
Just the Immensity of Uie legislation, but
ideas. And one of Uierisksnow Is Uia
the fact Uiat pulling at one thread can
budget standards will discourage Innova
unravel the larger fabric. Congress is
tive thinking and lead lawmakers to make
accustomed to big budget bills Uiat can
choices that could prove more cosUy in Uit
Involve many commUtees. But the lines of
long run.
authority are much clearer in those cases,
and the pieces are Interchangeable as long
"These are Uie opening moves in abou:
as the bottom line is met.
Uiree or four different chess games, anc
Uiere are masters on all sides." says Iowa
Democratic Sen. Tom Harkin. " I never
predict Uie outcome of a chess game aftei
the opening moves."
�I n s u r e r s and o t h e r i n t e r e s t s a r e l o b b y i n g a g a i n s t t h e
b i l l , p r i m a r i l y because o f t h e premium-review p r o v i s i o n
and o t h e r powers o f t h e h e a l t h board.
' ' I would assume t h e y ( i n s u r e r s ) don't want any
s u p e r v i s i o n o f t h e i r r a t e s , ' ' Rose s a i d . ''But I t h i n k
t h a t needs t o s t a y i n . ' '
The House H e a l t h and Welfare Committee i s expected t o
b e g i n meeting about t h e b i l l Tuesday. Some changes i n t h e
o r i g i n a l p r o p o s a l a r e expected t h e n .
Gov. B r e r e t o n Jones met w i t h l e g i s l a t i v e l e a d e r s Monday
n i g h t , apparently t o discuss the s t a t u s o f the reform
b i l l . But y e s t e r d a y , Jones and o t h e r s d e c l i n e d t o d i s c u s s
what went on a t t h e meeting.
Rose acknowledged y e s t e r d a y t h a t t h e l e g i s l a t i o n i s
drawing s t r o n g o p p o s i t i o n , b u t m a i n t a i n e d t h a t ''the b i l l
as such i s n o t i n t r o u b l e . ' '
' ' I t h i n k we w i l l pass h e a l t h - c a r e l e g i s l a t i o n , ' ' he
s a i d . Rose added, however, t h a t t h e r e f o r m b i l l might
change s i g n i f i c a n t l y along t h e way.
Rose has no problems w i t h s t a t e review o f premiums.
''The problem I have i s w i t h s e t t i n g premiums from t h e
o u t s e t by t h e H e a l t h P o l i c y Board,'' Rose s a i d . ' ' I ' d be
f e a r f u l t h a t premiums might be s e t a t u n r e a l i s t i c l e v e l s ,
when you c o n s i d e r t h e people we'd be b r i n g i n g i n t o t h e
system t h a t would cause c o s t s t o go up.''
The b i l l i n c l u d e s s e v e r a l insurance reforms t h a t would
a l l o w many people t o o b t a i n coverage who now are denied
i t . People w i t h p r e - e x i s t i n g h e a l t h problems c o u l d n ' t be
denied coverage.
Governor and Speaker P i t c h H e a l t h Care Reform B i l l
By MICHAEL SCHNEIDER
A s s o c i a t e d Press W r i t e r
JEFFERSON CITY, Mo. (AP) Feb 8
Some p r o v i s i o n s o f a new
h e a l t h care r e f o r m p l a n embraced by Gov. Mel Carnahan
c o u l d p e n a l i z e young people, an insurance l o b b y i s t s a i d .
The p l a n r e q u i r e s community r a t i n g s f o r h e a l t h
i n s u r a n c e premiums. That c o u l d p e n a l i z e young, h e a l t h y
people who a r e grouped w i t h o l d e r M i s s o u r i a n s t o s e t
r a t e s , s a i d Mary H o l d g r a f , a l o b b y i s t f o r Businessmen's
Assurance Co. o f America.
''Young people have an i n c e n t i v e n o t t o buy insurance
�''They are an i m p o r t a n t c o n s t i t u e n c y t h a t ' s on t h e
p r e s i d e n t ' s s i d e but needs t o be heated up,'' says A r n o l d
Bennett o f F a m i l i e s USA, a consumer group s u p p o r t i n g
Clinton.
So f a r , C l i n t o n ' s crusade hasn't won him an endorsement
from t h e AARP, which has 33 m i l l i o n members 50 and o l d e r .
A l t h o u g h o t h e r s e n i o r c i t i z e n groups g e n e r a l l y support
C l i n t o n ' s p l a n , AARP's John Rother says: ''We s t i l l have
some s u b s t a n t i v e issues w i t h the p r o p o s a l as i t stands.
''There's a l o t o f r h e t o r i c out t h e r e t r y i n g t o
f r i g h t e n s e n i o r s about ... what's b e i n g c u t and what's n o t
b e i n g c u t , ' ' he says. ' ' I t ' s i m p o r t a n t t o l e t s e n i o r s know
what's g o i n g on.''
L a r r y Smedley o f the N a t i o n a l C o u n c i l o f Senior
C i t i z e n s , which has
5 m i l l i o n members, says o l d e r Americans want h e a l t h r e f o r m .
He says t h e message t o s e n i o r s from t h e i r o r g a n i z e d
groups i s t h a t , ''Unless we a l l work t o g e t h e r t o get i t
passed, we w i l l a l l s u f f e r . ' '
F r i d a y , H i l l a r y Rodham C l i n t o n v i s i t s a s e n i o r c i t i z e n s
c e n t e r i n Stevens P o i n t , Wis., as p a r t o f t h e White House
campaign.
W i s c o n s i n has a $40 m i l l i o n home- and community-based
l o n g - t e r m care program f o r s e n i o r c i t i z e n s a model o f
what C l i n t o n i s p r o p o s i n g .
Sen. Russel F e i n g o l d , D-Wis., who i s accompanying "Mrs.
C l i n t o n , says i t has saved the s t a t e m i l l i o n s o f d o l l a r s
by k e e p i n g people a t home, a t a,cost o f l e s s than $10,000
a year, i n s t e a d o f p u t t i n g thetft i n n u r s i n g homes which
can c o s t M e d i c a i d $30,000' a year.
Mrs.
C l i n t o n Urges Researchers To Back H e a l t h Plan
By CHRISTOPHER CONNELL
Associated
Press W r i t e r
WASHINGTON (AP) Feb 17 -- H i l l a r y Rodham C l i n t o n sat down w i t h
t h e government's t o p medical r e s e a r c h e r s and met a c h i l d
whose l i f e has been saved by e x p e r i m e n t a l gene t h e r a p y .
A f t e r w a r d s she marveled a t what she l e a r n e d and
j o k i n g l y p r e d i c t e d t h a t the N a t i o n a l I n s t i t u t e s o f H e a l t h
s c i e n t i s t s ' ' w i l l soon d i s c o v e r we a l l have p r e - e x i s t i n g
c o n d i t i o n s and are a l l t o t a l l y u n i n s u r a b l e . ' '
But she a l s o d e l i v e r e d a b l u n t message Thursday t o t h e
government's t o p d o c t o r s : Stand up f o r t h e C l i n t o n h e a l t h
r e f o r m s o r r i s k e r o s i o n o f support f o r the system t h a t
produces so many medical m i r a c l e s .
While P r e s i d e n t C l i n t o n wooed l a b o r and s e n i o r c i t i z e n
l e a d e r s a t t h e White House, the f i r s t l a d y t o l d NIH
l e a d e r s t h a t ''the s t u p i d i t y ' ' o f the way America pays f o r
h e a l t h care ' ' t h r e a t e n s the q u a l i t y o f a l l t h a t you do.''
She s a i d managed-care plans a r e r e f u s i n g t o send
p a t i e n t s t o academic medical c e n t e r s because o f t h e i r
�I n d i v i d u a l s t u d i e s were r e l e a s e d f o r a l l 50 s t a t e s ,
p a r t o f an a d m i n i s t r a t i o n e f f o r t t o demonstrate p o s i t i v e
impact f o r a p l a n t h a t has drawn c r i t i c i s m as b e i n g an
expensive experiment i n c e n t r a l i z e d bureaucracy.
Senate Republican Leader Bob Dole o f Kansas, i n an
i n t e r v i e w l a s t week, s a i d Congress would p r o b a b l y pass a
h e a l t h r e f o r m p l a n w i t h l e s s bureaucracy and government
regulation.
' ' I t ' s t a k i n g a l o t o f h i t s l a t e l y from a l o t o f
d i f f e r e n t areas,'' Dole s a i d .
The HHS s t u d y s a i d i f the b i l l i s enacted, i n the year
2000 companies i n Kansas t h a t now o f f e r h e a l t h i n s u r a n c e
would save $385 m i l l i o n o r $384 per worker
and t h e share
f o r employees w i l l drop $205 m i l l i o n , o r $205 per worker.
When companies t h a t don't c u r r e n t l y have h e a l t h
b e n e f i t s are added, the year 2000 savings i s e s t i m a t e d a t
$146 m i l l i o n f o r businesses, $130 m i l l i o n f o r workers.
''These s t u d i e s show t h a t the c o m b i n a t i o n o f guaranteed
p r i v a t e i n s u r a n c e , l o n g - t e r m care coverage and e f f e c t i v e
c o s t containment under the p r e s i d e n t ' s p l a n r e s u l t s i n
c o n s i d e r a b l e savings t o s t a t e governments as w e l l as t o
American workers and businesses,'' Thorpe s a i d .
Employers w i l l pay about 8 0 p e r c e n t o f the premiums
under t h e p r e s i d e n t ' s h e a l t h r e f o r m b i l l .
For t a x p a y e r s , the HHS r e p o r t i n d i c a t e s the b i g g e s t
s a v i n g s would come i n Medicaid, where 6.1 p e r c e n t o f
Kansans g e t h e a l t h care and where 10 p e r c e n t o f t h e s t a t e
budget went i n 1992. There are a l s o 308,000 Kansans under
age 65 who don't have h e a l t h coverage.
W i t h h e a l t h r e f o r m , Kansas c o u l d save up t o $442
m i l l i o n between 1997 and 2000 i n Medicaid c o s t s , m a i n l y
because r e c i p i e n t s would be i n c l u d e d i n new r e g i o n a l
a l l i a n c e s t h a t w i l l use t h e i r c o l l e c t i v e b a r g a i n i n g power
t o seek lower c o s t s .
M e d i c a i d expenses would reach $791 m i l l i o n i n 2000
w i t h o u t r e f o r m , compared t o $605 m i l l i o n i f i t passes
Congress, a c c o r d i n g t o the HHS study.
The HHS s t u d y noted t h a t Kansas i s s t u d y i n g access t o
h e a l t h care t h r o u g h i t s Commission on the Future o f H e a l t h
Care, b u t Thorpe s a i d the f e d e r a l p l a n would c u t c o s t s f o r
the s t a t e s and p r o v i d e money f o r people who don't have
access t o s e r v i c e s .
A d m i n i s t r a t i o n Claims M i s s o u r i , Employers Save B i g Under
H e a l t h Reform
By CURT ANDERSON=
A s s o c i a t e d Press W r i t e r =
WASHINGTON (AP) M i s s o u r i t a x p a y e r s and employers would
save m i l l i o n s o f d o l l a r s i f P r e s i d e n t C l i n t o n ' s h e a l t h
r e f o r m s pass Congress, a c c o r d i n g t o an a d m i n i s t r a t i o n
r e p o r t r e l e a s e d amid sagging support f o r t h e p l a n .
�''States are c l e a r l y among t h e winners under t h e H e a l t h
S e c u r i t y A c t , ' ' s a i d Kenneth Thorpe, a Department o f
H e a l t h and Human S e r v i c e s deputy a s s i s t a n t s e c r e t a r y who
a u t h o r e d t h e r e p o r t r e l e a s e d Tuesday.
Savings f o r s t a t e government c o u l d reach $806 m i l l i o n ,
i n c l u d i n g $750 m i l l i o n between 1996 and 2000 f o r M e d i c a i d
and l o n g - t e r m care and $56 m i l l i o n i n s t a t e employee
b e n e f i t s i n 2000 alone.
I n d i v i d u a l s t u d i e s were r e l e a s e d f o r a l l 50 s t a t e s ,
p a r t o f an a d m i n i s t r a t i o n e f f o r t t o demonstrate p o s i t i v e
impact f o r a p l a n t h a t has drawn c r i t i c i s m as b e i n g an
expensive experiment i n c e n t r a l i z e d bureaucracy and heavy
government r e g u l a t i o n .
I n an i n t e r v i e w l a s t week. Sen. John D a n f o r t h , R-Mo.,
suggested many lawmakers were l o o k i n g a t a l t e r n a t i v e s t h a t
were l e s s c e n t r a l i z e d , such as a p l a n o f f e r e d by Rep. Jim
Cooper, D-Tenn.
/
''The\more people l o o k a t t h i s i s s u e , t h e more problems
I t h e y f i n d \ . n i t and t h e c o l d e r people's f e e t become,''
D a n f o r t h s a i d . ' ' I t h i n k we're g o i n g t o pass s i g n i f i c a n t
••~~+tearl-Ua-^r^orm l e g i s l a t i o n , but i t won't go as f a r as t h e
p r e s i d e n t wants us t o go.''
I f t h e b i l l i s enacted, HHS s a i d businesses t h a t
c u r r e n t l y o f f e r i n s u r a n c e would pay $1.2 b i l l i o n l e s s o r
$521 per worker i n premiums i n t h e year 2000, w h i l e t h e
share f o r workers would be $419 m i l l i o n , o r $181 a p i e c e .
''These s t u d i e s show t h a t t h e c o m b i n a t i o n o f guaranteed
p r i v a t e i n s u r a n c e , l o n g - t e r m care coverage and e f f e c t i v e
c o s t containment under t h e p r e s i d e n t ' s p l a n r e s u l t s i n
c o n s i d e r a b l e savings t o s t a t e governments as w e l l as t o
American workers and businesses,'' Thorpe s a i d .
Some companies o f f e r l i t t l e o r no h e a l t h i n s u r a n c e
today. When those are added, t h e t o t a l savings by 2000 f o r
businesses drops t o $688 m i l l i o n and t o $272 m i l l i o n f o r
the workers.
Employers w i l l pay about 8 0 p e r c e n t of t h e premiums
under P r e s i d e n t C l i n t o n ' s h e a l t h r e f o r m b i l l .
The p r i m a r y savings t o t a x p a y e r s , a c c o r d i n g t o t h e HHS
s t u d y , w i l l be t h r o u g h slower growth i n M e d i c a i d c o s t s
because o f t h e i r i n c l u s i o n i n new r e g i o n a l a l l i a n c e s t h a t
w i l l use t h e i r c o l l e c t i v e b a r g a i n i n g power t o seek lower
costs.
R i g h t now, 9.1 p e r c e n t of M i s s o u r i ' s p o p u l a t i o n i s
e n r o l l e d i n Medicaid, which gobbled up o n e - f i f t h o f t h e
s t a t e ' s budget i n 1992. I n a d d i t i o n , 617,000, o r 14
p e r c e n t , o f t h e s t a t e ' s p o p u l a t i o n under age 65 has no
coverage a t a l l .
W i t h o u t r e f o r m s , f e d e r a l and s t a t e M e d i c a i d spending i n
M i s s o u r i would reach $1.9 b i l l i o n by 2000 compared t o
$1.5 b i l l i o n i f C l i n t o n ' s p l a n i s passed, t h e r e p o r t s a i d .
The HHS s t u d y acknowledged t h a t M i s s o u r i i s w o r k i n g on
i t s own v e r s i o n o f h e a l t h care r e f o r m , but Thorpe s a i d t h e
f e d e r a l p l a n would c u t c o s t s f o r t h e s t a t e s and p r o v i d e
money f o r people who don't have access t o s e r v i c e s .
�TEL:
Mar
ir94
13:25
No.018
Comtm
1. W« invent morm in tech's (thats good)
2. More violent - thorofore, coete aeeoclated with i t .
1 & 2 off table
3. Finenoing eyetea
4* Change incentives for 1/2 of insurance population who get
nors traditional coverage
Cong. Hoagland; Streee conpetitive framework
Lynn Etheridge - talked about medicare
Hoagland argues
1. wants to pass a b i l l
2. mandate i s moving in our direction
Omaha
1. two leading hospitals
^. percieved as a government takeover
2/24
Sen. Danforth
Kansas City - work out at Union station / train station a science
Center - Science educational center
Amtrac - NOA
Find $ - help with 777 appropriation
Mark Soloman - staff
private sector
$30-$70 million usiary - $120 million total
/"Health
/ Thinks we'll end up at Chafee
/ no way e>q;>loyer mandate w i l l pass
/ belives we oan get big b i l l
I time passes - people get more concerned(he does to) too much too
\ fast - favors a more Incremental approach
\ Avoid confrontation - thinks we ehould build members up rather
\ than confront them.
\ support not to allienate Cooper
\ concerned that 'the numbers s t i l l don't add up, get savings f i r s t .
Sen. Danforth
Wondering what he may do next - career
may go home to St. Louis and encourage churches and community
groups to adapt schools
believes he needs to go micro
believes Moynihan i s right and problem with welfare reform i s
deterioration of American family structure.
Community echools (part of crime b i l l he strongly favors.
3/1
Sen. Boren
2 d i s t r i c t judges (fed)
P.05
�Health Playing Field Shifts
Ultimate Plan May Be Found in the Senate
By DwidS. Broder
and Helen Dewv
has given any indication of supportunderstanding of how adamant the
,401 tbe Stark plan.
conservatives
led by Sen. Phil
- A aimilar drafting effort in the
bealth subcommittee of the House Gramm (Tex.) are on this issue.
L&e pUots drdingfara ludiDg on Energy and Commerce Committee
Since Uien, a number of Demoa small, fog-sfarouded atntrip, tbe WM called aS when it became clear cratic senators say that the Republichairmen five key axigreniona] t^tjubcommittee Chainnan Henry can moderates have been signaling
committees are searciiing for tbe f^(^^^p;jX:aM.) had no pros- an increased interest infindinga bicompromise oo health care legisia- ; pect-ofT6porting out anytliing close partisan agreement that would spare
tioa Uiey know is down there.
to tbe Clinton model. Committee them from pressure to join a GOP
It woo't be the Cbitoa
and pairman John D. Dingell (D-Mich.) filibuster against healtii legislation.
it won't be the Repubbcan pian, and is searching for a majority of votes in "The Republicans seem to be
itjwon't be my phn." said Rep. Jim the full committee—so far witiiout more forthcoming," Senate Labor
(^Coop«:iD-Tenn.), sponsor of one of success.
and Human ResourceCommittee
vtirSu^ attematives under considChairman Edward t^fKenr^^XDTbe
third
House
committee—Ederation. "But we are doser . . , than ucation and Labor—is a more liberal Mass.) said. "They're d&ilin|Mnie of
we have been since Harry Truman's panel that could, committee aides oiir members about areas of comprotime."
said, come cbse to giving Clinton mise. . .. There's an awful lot going
Truman's bid for nationai health what be asks. But eventiiere.small on. I think Uie White House has seen
care was Uiwarted by the opposition busiii^ses-ajTeasking Chairman Wil- ittooJL
of die American Medical Assodatxxi kam D. FordJD-Mich.) to search for Kamedy^d his committee can
and by the k»s of White House polit-ways tdTQihion thefinancialblow to report out something close to the
kai leverage, partly as a result of ad- employers wbo now offer minimal or Clinton plan but expressed a strong
ministration scandals.
no health coverage.
desire to work out modifications that
Last week, some of President
Ways and Means Chainnan Dan would bring Uie measure additional
Clinton's allies on Capitol Hill wor- Rostenkowski (D-Ill.) is expected to GOP support. Vermont Senjames
ried privatelytiiatthe Whitewater resume a similar quest if he gets M. Jeffords is tiie only Republican
investigation was distracting him past Tuesday'sfive-wayprimary in cosponsor oftiieadministration bill.
Whatever Kennedy can negotiate,
and First Lady Hillary Rodham Clm- his Chicago congressional district.
ton from the fuU-scaie offensive it
Ail of the chairmen are seeking many observers believe Uie Finance
will take to enact his ambitious variations on, or altematives to, the Committee—a more conservative
health care plan over the heavily fi- features of Chnton's proposal that panel—is Uie likeliest place for a
nanced opposition of some msurers have proved most controversial: Uie deal. In part, that is because both
requirement that private insurance Majority Leader (George J. Mitchell
and providers.
But so far, the special counsel's be provkled for aH of Uie estimated (D-Maine) and Minority Leader Rob39 milhon noo-eUerly who lack cov- ert J. Dole (R-Kan.) are on that cominquiry mto Uie Clintons' past financial activities seems only to have erage today; Uie insistence Uiat all mittee, giving it enormous clout on
stiffened Congress's determination employers pay 80 percent of Uie in- the Senate floor.
to press ahead on the president's topsurance costs for Uieir workers; Uie ConunitteeJChairman Daniel Patlegislative priority. Democratic lead- creation of regional healUi alliances ri^ Moynihjn' (D-N.Y.) has publicly
ers still think they can reach his goal (essentiaUy purchasing co-ops) to en- signitedTus eagerness to negotiate
of guaranteed insurance coverage force new rules on the quality and sometiiin^ Uiat will bring Dole and
for everyone and some oftiiembe- cost of health care plans; and federal other Republicans aboard. He has
beveti>ebasic architecture of the regulations aimed at drastically re- met indiv;, ually with almost everyducing medical inflation.
one on the committee to see where
Chnton plan may survive.
agreement mightbe^possible.
Congressional
strategists
say
it
is
Serious policy problems have
important
that
each
of
Uiese
issues
Next -eekf^^ynihanjis taking
emerged, however, in House committees handling the issue. White be dealt with in Uie legislation com- the committee "tm-anreljeat in Vu-House officials insist that they are ing from each committee—but not ginia. The goal, said a senior comnecessarily in identical fashion. If mittee aide, is to "take a step back
HEALTH.Proa Al
each of Uie "policy boxes" is filled from specific provisions of specijc
witii something, thefinalpackage bills and see where wemay haje
not giving up on getting legislation can be assembled from those parts. common
ground wpheTnajorp
out of U>e House, but attention has
lemsjaJjcMl
Although
it
has
been
assumed
tiiat
. focused increasingly on Uie Senate
House committees would move first >anfor^^ member of the coaias the arena where the needed com- on
healtii legislation. White House nattee-who. like Mitchell, is retrag
promise may be found.
officials said Uiey have no reason to this year, sakl Uiat among comnStHouse Jt^jority Leader Richard prefer
that it be done that way. Sev- ACGephardt>(I>-Mo.) said Friday, eral factors suggest Uiat reversing tee Republicans, "Uiere is a greatir
. I'm still very optimistic we can put the sequence might carry advantag- consensus Uian I expected Uiat we
should pass a healtii care bill tfts
it together oo this side of the Capi- es.^ year
and Uiat we cannot do it as!a
* td."
^ Dingell>as been adamant in stiictiy Repubbcan bill. We have lo
;
Still, he noted that "the basic poiit-WhitrHouse meetings Uiat House
ical situation is entirely different members should not be asked to come to terms wiUi moderate Dem.
over in Uie Senate. There are mod- vote for politically controversial pro- ocrats."
.'. erate Republicans there who are visions of Uie Clinton plan iftiieSen- One of thosetnoderate Den^:readyto jrfay. Over here, we have toate is to sweep Uiem intotiiedust- crats. Sen. Jo;iri3reaiK5D-La.), e<5ioedtiieview UiaTtBere is a growing
*find218 votes [for passage] among bui.
realization there will have to ^e
Democrats, because we can't count
Although^Uiey disagree on much ' some
kind of a compromise to ge^ a
- on any Republican votes. Tbe ten- elserCooper>aid he agrees that
1 snns between the singie-payer liber- House membei
:rs "do not want to
teJ^J^^Jfi.^fin
"^i
t.' als (who prefer a tax-financed, gov- BTUed again,"
were last
i." as they
thev u,Pr»
he thinks there j s
* emment-administered system] and year when Uiey voted fortiiecontro- ™o«*gnreommonabty among the rm. tbe Cooper conservatim make it versial energy tax based on BTUs or JOT plans Uiat "we codd get a bilHn
very tough."
S
British Thermal Units, only to see one morning session."
Tbefirst"markup" sesskns in the tiie Senate kill it.
Few otiiers are Uiat optimisic
. ' health subcommittee of tbe House
But despite the Clintons' WhifeBeyond Uiat problem between Uie water
problems,tiiepossibility (4 a
' Ways and Means Committee under- two
chambers, there is increasing Senate-designed compromise see4is
: lined Gephardt's point Subcommit- evidence
that, as Gephardt suggest- a growing possibility to many of ts
tee Chairman Fortney H. "Pete" ed. Republican
senators may be members.
^ Stark (DOdif.) started wiUi his ownlooking for a compromise.
variant on tbe CKnton plan, but at
- tbeendof last week was StiU search- A Senate Republican retreat on
ing for a formula that wouk] attract healtii care 10 days ago produced no
the votes of all six Democrats on the policy agreement among GOP senapanel. None of thefiveRepubtKans Itors. Instead, moderates like Sens
John H. Chafee (R.I.), Bob Packwood
(Ore.), Dave Durenberger (Minn.)
and John C. Danforth (Mo.) came
back from Annapolis with a clearer
/)1
�Ralph Nader rapped t h e proposed m a l p r a c t i c e changes,
s a y i n g 80,000 Americans are k i l l e d each year by m e d i c a l
n e g l i g e n c e . ''How can anyone argue t h a t a c o n g r e s s i o n a l
consensus has emerged t o p r o t e c t dangerous d o c t o r s w h i l e
i g n o r i n g t h e p l i g h t o f t h e i r v i c t i m s ? ' ' he asked.
The b i l l would a l l o w t h e s e l f - e m p l o y e d t o deduct 100
p e r c e n t o f t h e i r h e a l t h i n s u r a n c e expenses from t h e i r
t a x e s i n s t e a d o f 25 p e r c e n t .
That would c o s t $8 b i l l i o n over t h r e e y e a r s , b u t i n a
bookkeeping move t h e b i l l would pay f o r t h a t by f o r c i n g
the P o s t a l S e r v i c e , t h e Tennessee V a l l e y A u t h o r i t y and
o t h e r agencies t o put aside more money f o r f u t u r e r e t i r e e
health benefits.
That would r a i s e $11 b i l l i o n over f i v e years money t h e
government c o u l d spend i m m e d i a t e l y , b u t i t c o u l d r e q u i r e a
two-cent i n c r e a s e i n stamp p r i c e s . ''We're not happy w i t h
t h a t , ' ' s a i d B i l i r a k i s , i n d i c a t i n g t h e sponsors would l o o k
f o r o t h e r ways t o r a i s e t h e money.
Rowland and B i l i r a k i s got 100 c o l l e a g u e s t o s i g n a
l e t t e r t o P r e s i d e n t C l i n t o n i n October u r g i n g him t o
abandon h i s a l l - o r - n o t h i n g approach t o h e a l t h r e f o r m and
t r y some i n t e r i m steps f i r s t .
C l i n t o n , on CBS-TV, s a i d he w i l l keep f i g h t i n g f o r
u n i v e r s a l coverage ''as l o n g as I'm p r e s i d e n t . ' '
He i n d i c a t e d f l e x i b i l i t y on h i s t r o u b l e d p r o p o s a l f o r
mandatory i n s u r a n c e p u r c h a s i n g a l l i a n c e s , b u t s a i d ,
''You're g o i n g t o have t o have some way t o p r o t e c t t h e
l i t t l e guy.''
Rowland s a i d i t would be ' ' t r a g i c ' ' f o r C l i n t o n t o v e t o
the consensus b i l l , i f i t i s approved by Congress, and
expressed doubt t h e p r e s i d e n t would make good on h i s
threat.
''The more t h e p r e s i d e n t sees he's l o s i n g some steam,
the more t h e y may be amenable t o w o r k i n g t h i n g s o u t , ' '
B i l i r a k i s said.
Rowland, B i l i r a k i s and f o u r cosponsors s i t on t h e House
Energy and Commerce Committee, which announced Wednesday
i t would bypass i t s d i v i d e d h e a l t h subcommittee and t r y t o
d r a f t a b i l l i n t h e f u l l committee i n A p r i l .
House M i n o r i t y Whip Newt G i n g r i c h , R-Ga., a t a news
conference w i t h Dole and Chafee, s a i d t h e Democrats a r e
' ' w i t h i n one v o t e o f l o s i n g c o n t r o l o f ( t h a t ) committee.''
GOP Senators Meet t o Seek Common Ground on H e a l t h Care
Reform
Washington, March 3 (Bloomberg) -- D i v i d e d on how t o
achieve h e a l t h - c a r e r e f o r m . Senate Republicans l e f t today
f o r a r e t r e a t i n A n n a p o l i s , Md., t o hash out a l t e r n a t i v e s
to President Clinton's proposal.
''The American people want a second o p i n i o n , ' ' s a i d
Senate M i n o r i t y Leader Bob Dole (R-Kan.), r e f e r r i n g t o
�r e c e n t p o l l s showing d e c l i n i n g p o p u l a r support f o r t h e
president's health-reform plan.
Meanwhile, 30 congressmen i n t r o d u c e d a h e a l t h - c a r e p l a n
t h a t encompasses areas o f agreement i n t h e h a l f - d o z e n
d i s p a r a t e r e f o r m b i l l s i n Congress. The b i l l ' s p r o v i s i o n s
i n c l u d e r e i n i n g - i n i n s u r e r s a b i l i t y t o exclude coverage t o
people w i t h p r e - e x i s t i n g medical c o n d i t i o n s and a l l o w i n g
the s e l f - e m p l o y e d t o c o m p l e t e l y deduct t h e c o s t o f t h e i r
health-care insurance.
''Our b i l l i s designed t o r e - e s t a b l i s h t h e
h e a l t h - r e f o r m debate on
a f o u n d a t i o n o f agreement, r a t h e r t h a n one o f
d i v i s i v e n e s s , ' ' s a i d Rep. Michael B i l i r a k i s ( R - F l a . ) .
While Democrats have t a k e n t h e l e a d on h e a l t h r e f o r m ,
t h e y have f a i l e d t o u n i t e b e h i n d C l i n t o n ' s p l a n . The House
Ways and Means subcommittee on h e a l t h i s d r a f t i n g i t s own
p r o p o s a l . The House Energy and Commerce Committee bypassed
i t s h e a l t h subcommittee because o f f e a r s t h a t p a n e l
wouldn't support the C l i n t o n plan.
The Republicans haven't been a b l e t o u n i t e b e h i n d a
s i n g l e p l a n e i t h e r . Sens. Dole and John Chafee (R-R.I.)
sought t o lower e x p e c t a t i o n s t h a t t h e two-day meeting i n
A n n a p o l i s would produce a consensus. ''That's n o t t h e
purpose,'' s a i d Chafee, whose Republican H e a l t h Care Task
Force has i n t r o d u c e d a b i l l aimed a t a c h i e v i n g h e a l t h
coverage f o r a l l Americans by 2005.
There are s e v e r a l GOP h e a l t h p l a n s i n t h e Senate and a
b i p a r t i s a n p r o p o s a l t h a t i s b e i n g co-sponsored by Sen.
David Durenberger (R-Minn.) and Sen. John Breaux (D-La.).
The Chafee p l a n , backed by moderate Republicans, i s
c l o s e s t t o a b i p a r t i s a n p l a n sponsored Breaux and
Durenberger i n t h e Senate and Congressmen Jim Cooper
(D-Tenn.) and Fred Grandy (R-Iowa) i n t h e House. Together,
t h e y are i n t h e p h i l o s o p h i c a l c e n t e r o f t h e debate over how
t o r e f o r m t h e n a t i o n ' s h e a l t h - c a r e system.
Chafee's p l a n would r e q u i r e a l l i n d i v i d u a l s t o buy
h e a l t h - c a r e i n s u r a n c e and would phase i n f e d e r a l
a s s i s t a n c e t o t h e poor. While i t ' s t h e o n l y Republican
p l a n t o achieve t h e p r e s i d e n t ' s s t a t e d g o a l o f g u a r a n t e e i n g
u n i v e r s a l h e a l t h coverage t o a l l Americans, i t d e p a r t s
w i t h C l i n t o n on t h e mechanism f o r d o i n g so. Chafee i s
u n i t e d w i t h Republicans i n o p p o s i t i o n t o t h e p r e s i d e n t ' s
p r o p o s a l t o r e q u i r e businesses t o pay f o r 80% o f worker
h e a l t h coverage.
T h i r t y - t h r e e Senate Republicans are expected t o
p a r t i c i p a t e i n t h e A n n a p o l i s r e t r e a t . They w i l l be j o i n e d
by f o u r o r f i v e House Republicans, i n c l u d i n g M i n o r i t y Whip
New G i n g r i c h (R-Ga.), and some Republican g o v e r n o r s . While
Dole s a i d t h e r e t r e a t won't meld competing GOP h e a l t h p l a n s
i n t o one, ''we're g o i n g t o see how c l o s e we can come.''
So f a r . Republicans have formed a b e t t e r f r o n t when
c r i t i c i z i n g t h e C l i n t o n p l a n t h a n when t r y i n g t o form a
consensus on an a l t e r n a t i v e . While t h e p r e s i d e n t ' s p l a n
has been under siege. Republicans haven't c o n v i n c e d t h e
�p u b l i c t h a t t h e y can f i n d a way t o c o n t a i n s k y r o c k e t i n g
h e a l t h - c a r e c o s t s and expand access t o coverage.
Changing that may be another goal of the retreat. ''We
want the American people tp,4=inderstand we're just as
sensitive and care ju^f'a^ much about health reform as
anybody else,'' Dol^''^said. J
E a r l i e r , Seny/<fohn D a n f o ^ ^ (R-Mo.), c o n t i n u e d t h e GOP
a t t a c k on t h e C l i n t ^ x L - p l ^ r t i r I n a Finance Committee
h e a r i n g , he accused t h e a d m i n i s t r a t i o n o f n o t b e i n g
f o r t h c o m i n g about b e n e f i t s l e f t o u t o f t h e C l i n t o n p l a n .
C r i t i c a l q u e s t i o n s , such as t o whom t h e C l i n t o n p l a n
would guarantee l i v e r t r a n s p l a n t s , a r e n ' t b e i n g answered,
D a n f o r t h s a i d . ' ' I t ' s i m p o r t a n t t o say t h e r e a r e a t l e a s t
some t h i n g s o t h e r than d e n t a l care o r h e a r i n g a i d s t h a t
are j u s t n o t g o i n g t o be'' covered, he s a i d .
--Paul Heldman (202) 434-1842 ngm/mk (For more on
h e a l t h - c a r e r e f o r m : N I HCP, N I HEA; on t h e White House: N I
EXE; on Congress: N I CNG) -0- (BBN) Mar/03/94 17:36 EOS
(BBN) Mar/03/94 17:36 85
SENATORS CRITICIZE CLINTON PLAN BENEFITS PACKAGE
WASHINGTON, March 3 (Reuter) - P r e s i d e n t C l i n t o n ' s
h e a l t h r e f o r m p l a n came under f i r e Thursday from
Republican c r i t i c s who s a i d i t s standard insurance
b e n e f i t s package, which would be o f f e r e d t o a l l Americans,
was t o o generous.
D u r i n g a Senate Finance Committee h e a r i n g , lawmakers
a l s o s a i d t h e p l a n sidestepped p o l i t i c a l l y and e t h i c a l l y
d i f f i c u l t q u e s t i o n s about what types o f expensive
t r e a t m e n t s might be covered under t h e p l a n .
M i s s o u r i Republican John D a n f o r t h s a i d t h e
a d m i n i s t r a t i o n was t r y i n g t o ''fuzz up t h e i s s u e ' ' as a
p o l i t i c a l s t r a t e g y and pressed f o r a l i s t o f s e r v i c e s -such as k i d n e y t r a n s p l a n t s f o r people over age 55 o r
c o s t l y l i f e support f o r an i n f a n t born w i t h o u t a b r a i n -t h a t might be excluded.
' ' I f i n d no h i n t t h a t t h e r e are hard choices t o make.
There i s n o t t h e s l i g h t e s t i n d i c a t i o n o f any hard c h o i c e s .
There i s n o t t h e s l i g h t e s t i n d i c a t i o n t h a t a n y t h i n g w i l l
be l e f t o f f , ' ' D a n f o r t h s a i d .
' ' I t i s a d i s s e r v i c e t o t h e American people t o c r e a t e
t h a t i m p r e s s i o n , ' ' he s a i d , adding t h a t i t was i m p o s s i b l e
t o have genuine h e a l t h r e f o r m and keep ''everybody
happy.''
J u d i t h Feder, a t o p o f f i c i a l i n t h e Department o f
H e a l t h and Human S e r v i c e s , s a i d t h e p l a n p r o v i d e d
i n c e n t i v e s f o r q u a l i t y , c o s t - e f f e c t i v e h e a l t h care, w i t h
d e c i s i o n s on s p e c i f i c procedures l e f t t o p h y s i c i a n s and
their patients.
She a l s o r e b u t t e d q u e s t i o n s by some lawmakers about
whether t h e b a s i c b e n e f i t s package was t o o generous.
�Litigious Patients Leadlnsurers
To Pay for Unproven Treatments
ByGINA KOLATA
Pamela Schmale, a 39-year-old book- "In most of the litigation we've been
to provided real assistance,
keeper, says she felt that her only hope involved in, we settle early on," she obliged
and real assistance means something
of surviving advanced breast cancer said.
that works. When people say, 'If you
Recently, Ms. Gallinari got a call don't do this, I'm going to sue you,'
was to have a bone marrow transplant.
from
a
woman
with
Lyme
disease
But her insurance company said it
what they are doing is eroding any
would not pay for the expensive and whose insurance company was balking chance for society to say that we have
paying for an expensive expenmenrisky procedure, which is still undergo- at
to draw a line."
tal treatment. " I told her what to say," gotInsurance
industry spokesmen are
ing clinical testing.
and the next thing 1 knew 1 got a call
In desperation, Mrs. Schmale and from her saying the insurance compa- dismayed by the situation."In the curher husband, Arthur, mortgaged their ny had decided to pay," she said.
| rent environment it's virtually impossible or extremely difficult to ever say
house in Boring, Ore., to raise the
Examples of Legai Might
! no," Dr. Cova said. Insurance compa$100,000 *or more they would need for
Examples abound of the power of the | nies are reluctant to fight tiieir battles
the transplant And her doctors recomlegal threats. Dr. William P. Peters, in court, he said, even when their conmended lawyers who might fight their who heads a program at Duke Univer- tracts specifically say they are not
insurance company for them.
sity's medical school to treat advanced obligated to pay for the treatments
Cost of Legal Advice
breast cancer with bone marrow trans- being sought because of public sentiplants, reported that 19 of 39 women ment "Beating up insurance compaThe Schmales hired Sheldon Wein- who had been denied payments per- nies has become one of America's fahaus,^ lawyer in St Louis who persuaded their companies to pay aiter vorite indoor sports," he said.
suaded MrS. Schmale's insurance com- they hired a lawyer
Dr. Cova said patients and their docpany to pay the full cost of the transDr. Thomas Spitzer, who directs the tors often paid no heed to the wordmg
plant, which Mrs. Schmale had in Janu- bone marrow transplant program at of health insurance contracts. He said,
Massachusetts General Hospital, said "The reasoning goes as follows: ' I
ary. Although Mrs. Schmale said her
doctors told her it was too soon to know that insurance companies came want, and if I want something, I need
around after "a succession of women it; if I need i t 1 have a right to it; if 1
whether she would be helped, she was
took their claims to court and won." have a right to i t someone else has an
confident she had done the right thing.
Now, he said, "in the cases I am famil" I think it saved my hfe," she said.
iar with, they didn't even go to court." obligation to provide i t ' "
In the last several years, patients Just getting a lawyer was enough.
Dr Garber said he expected the lehave been increasingly tummg to lawDr. Curt Freed, who directs a pro- gal battles to extend to treatments that
yers to pressure insurance companies gram at the University of Colorado were enormously expensive but that
to. pay. for claims that were initially offering fetal tissue implants for pa- made only a slight difference in a padenied, and some of the claims are tients with Parkinson's disease, said tient's prognosis.
"What if bone marrow transplants
even for treatments specifically ex- that insurance companies automaticalcluded under Uieir insurance plans. ly refuse to pay for the $40,000 opera- : allow women to extend their life expection, but he added that five of eight itancy from one year to 13 months, but
While this practice can help criticallv
ill patients get access to treatments patients who hired lawyers persuaded it costs $100,000?" Dr. Garber asked.
"Are we prepared to say that because
they desperately want it raises issues the companies to reverse their deci- we
know it works, we will pay for i t no
sions.
of fairness, because the rewards go to
matter what it costs?"
"If
we
knew
a
way
other
than
pathose with the means to hire a lawyer.
"We can write an insurance contract
tients pressuring insurance companies
Mr. Weinhaus said that lawyers and suing them, we'd be happy to fol- • that will not cover it, but it will not hold
charged, on average, about $10,000 for low tiiat course," Dr. Freed said. "But up in court," he said.
an insurance case and that they were
it seems that the established procedure
not hired in such a case on a contingen- is pressure and lawsuits."
cy basis.
When to Acquiesce
The larger problem for society, some
Dr. Caplan said he often questioned
health care experts say, is that when
members of insurance company
litigious patients have their way, they
boards about how they decide when to
hinder an important part of the effort
—.
deny payments. They use these four
to control health care costs: the atcriteria: "Does this person have a lawyer? Is the person articulate? Have we
tempt to stop paying huge sums for
already tried to say no at least once? Is
therapies that have no proven value.
this a person who can muster sufficient
But tt^ litigious patients, no case is
resources to give us a hard time, by
too advanced, no treatment is too exgetting media attention or startmg a
pensive or too much of a long shot to be
letter-writing campaign?"
tried wtien the insurance companies
Dr. Alan Garber, an internist and
pay the bill And the companies, of
health economist at Stanford University, said companies tried to deny covercourse, merely pass the cost to the
age for treatments like bone marrow
other policyholders by raisuig the intransplants for advanced breast cansurance premiums.
o
cer because these therapies had not
The insurance companies usually
been proved effective.
agree to pay because of the cost of
" I would never blame people who
tolitigation and the chance that Juries
have terminal illnesses and want to
will impose large damage awards, said
grasp at every straw," Dr. Garber
Dr. John Cova, a consultant on health
said. But, he added, "the problem is
that no one else is prepared to or able
insurance to the Health Insurance Into say no."
dustry Association. Even wiien a conMr. Weinhaus said patients were not
tract expUcitiy says the company need
inclined to wait for science to declare
that a promising treatment has
Continued From Page Al
crossed the line from experimental to
proven. "When you're told that this is
the only thing that will save your life, i
not pay for an experimental treatment,
a jury often sides with the dying pa- what are you supposed to do?" he
tient The companies "are gettmg wea- asked.
But Mr. Weinhaus acknowledged
ry," Dr. Cova said. "They keep losing." that
the system was unjust "Why
Dr. Arthur Caplan, director of the
should my clients, who 1 would fight for
Center for Bioethics at the University
to the bitter end, deserve more than
of Minnesota, said the process favored anyone else?" he said.
the rich over the poor and the assertive
Dr. Norman Daniels, an ethicist and
and the articulate over thereticentand health care specialist at Tufts Univerreluctant. "Squeaky wheels get re- sity School of Medicme, said the counwarded," he said.
try could simply not afford to pay for
This kind of litigation became popu- every treatment. Whether or not it is
lar a few years ago, said Karen Gallin- officially acknowledged, he added, raart, a New York lawyer who represents tioning of medical care is a necessity.
patients against insurance companies.
"We are not obliged to provide wish
Now, Ms. Gallinari said, it is common. fulfillment or the last chance at a mirShe said she rarely had to go to court. acle," Dr. Daniels said. "We are
5
I
2
�PM-Slattery Health Refonn, Bjt,0660
; . Slattery Floats Compromise Health Reform B i l l
)
By CURT ANDERSON= Associated Press Writer=
WASHINGTON (AP) Unable to agree with Democratic versions of health care
reform. Rep. Jim Slattery i s proposing a compromise that looks a lot like a
Republican b i l l .
Slattery, D-Kan., borrowed elements of a half-dozen competing health plans
in crafting his own version, which he plans to circulate among Democrats and
Republicans next week. I t most resembles legislation introduced by Sen. John
Chafee, R-R.I.
In an interview Thursday, Slattery said his goal i s near-universal health
insurance coverage by 2000 without forcing employers to buy policies for
workers.
President Clinton and House leaders such as Rep. John Dingell, D-Mich.,
have been unable to persuade Slattery to vote for any plan that forces a l l
employers to provide insurance, even i f i t means loss of jobs.
""They have not been able to present me with an employer mandate plan that
is workable and p o l i t i c a l l y achievable,'' Slattery said in an interview.
" " I t ' s going to take a compromise effort l i k e t h i s to get i t done.*'
Slattery, who i s seeking the Democratic gubernatorial nomination i n
Kansas, i s a key vote on the House Energy and Commerce Committee chaired by
Dingell. This week, Dingell offered to exempt some small businesses from
employer mandates in the committee's version of the health reform b i l l , but
Slattery s t i l l found i t unacceptable.
""The chairman has been asking me to vote for a b i l l I don't believe in to
move the process along,•• Slattery said. " " I just don't want to do that.''
Slattery's proposal would ensure that a l l poor people receive health care
through government subsidies and provide access for everyone else to purchase
a basic health insurance plan, regardless of health or job status.
Groups of businesses and government would be formed to purchase health
care insurance at reduced prices, but participation would be voluntary.
Slattery said t h i s and other market forces would help reduce the cost of
health insurance.
In Clinton's plan, these purchasing pools are mandatory.
Other features of the measure include a provision allowing farmers and the
self-employed to deduct 100 percent of health insurance costs on their taxes,
expansion of community health centers to improve access to care and several
insurance reforms.
To pay the federal government's share, Slattery proposed a package of
taxes and cuts t o t a l l i n g up to $45 b i l l i o n a year. They include:
A 25-cents-a-pack cigarette tax hike.
Elimination of the Medicaid disproportionate share program, which pays
hospitals that treat large numbers of poor people. The impact here would be
greatest i n c i t i e s , lesser in r u r a l states l i k e Kansas.
Limits on how much health insurance expenses employers can deduct on their
taxes. People earning more than $75,000 would only be able to exclude certain
percentages of the benefits.
Savings of $10 b i l l i o n a year by reducing growth in the Medicare program.
Clinton proposes a $124 b i l l i o n cut over five years.
Although the proposal stops short of the president's demand that any
health reform b i l l provide universal coverage, Slattery said he believed his
plan would provide that coverage to 95 percent of Americans by 2000.
Those l e f t out would probably be j u s t over the poverty line but not
earning enough to purchase the basic benefits package the working poor.
Slattery said i t has become clear that many in Congress, particularly
Senate Republicans, oppose key features of the Clinton plan such as employer
mandates and mandatory a l l i a n c e s .
" " I think t h i s i s a plan that Republicans can support,•• Slattery said.
Sen. Nancy Kassebaum, R-Kan., said much of Slattery's plan resembles one
sponsored in her chamber by Sen. John Chafee, R-R.I., as well as ideas she and
f
f
j
�GOP's moderates are sitting pretty
Their votes
carry weight
in h ^ t h debate
By Richard Wolf
USA TODAY
They're a dying breed in
Washington, but tho support of
moderate Republicans will be
needed later this year lo give
life to health-care reform
Ever since Presidrni Clinton
propoesed a sweeping change of
the nation's health-care system, the emphasis has been on
attracting Democratic support.
In the House, where Democrats enjoy a sutjslantial majority, that may suffice Democratic leaders and committee
chairmen have all but given up
winning Republican support
for the evolving health-care
bill. They're making only those
changes needed to win voles on
their side of the political aisle.
But in the Senate, controlled
56-44 by DemocmLs — and in
the Senate Finance Committee, with its razor-thin 11-9
Democratic majority — Republicans will be required.
That gives the (X)P power.
"The moderate Republicans
USA TODAY
CHAFEE: Won t
show tiis cards
JEFFORDS: 'Very
strong position'
DANFORTH: Seek
ttie center
will have a very strong position," says Sen. James Jeffords.
R-Vt., the only Republican C(v
sponsoring the Clinton plan.
That strategic position will
force .Senate Democrats in pay
more than lip service to Ihe
COP'S philosophical position
— one that stresses reforms to
foster market compelilion
rather than regulation
Although their allegiance i^
spread among several health
proposals, most moderate Republica«K agree on what they
oppose — the Clinton plan,
with its mandatory employer
payments, caps on insurance
premiums and requirement
that consumers be pooled into
purchasing cooperatives.
They favor mandates that individuals buy insurance or no
manilaip'- :il :ill They lean tow.ird i:iv l""aks lo cut insurani (' cn I i.iiher than price
coniroK Ami Ihey emphasize
t>.irc lion,
( nvr-rnge at low
cost';. 1 ''h"i ilinn generous
hencriK ll iir.lu r prices.
Rc|iiiiiiii
ideas have got' iiiion because
len ll Ill
inirol the White
Drum l l
I|H' ( (ingress But
ll\c\ V
I I I .
i};ii(ired-
i)"wj>rTTf ideas and
says
Ihr P'
I n / ! );inforltl/ R-Mo.
Si-n
•1 he Ix'^i W'licvLj>fitf the best
p(ililic>~ ; i [ " t+if> same, and Ihat
IS. seek Ihc center "
Thill's w^v^j-p Sen. John Chafee. n H I . leader of Ihe moderate Ri-(iiilihcans, says his
propo^rii
AI m^d with a mandale lb ll in'li> idiials buy insurI h
ance, he can lay claim to Ginton's top goal, achieving universal coverage, without mandatory purchasing coops or
price controls or new entitlement programs.
"There should be the least
possible govemment intervention and the greatest possible
reliance on market forces."
Chafee says. But he won't bargain in public: "You don't go
into a poker game telling the
other fellow what you've got"
Sen. Bob Packwood. R-Ore ,
top Republican on Ihe Finance
Committee, figures Democrats
will have to bargain with the
GOP behind closed doors in
May or June.
His prediction: There will be
some form of mandate — on
employers, individuals or a hybrid — phased in slowly; a
bare-lK)nes benefits package;
and no price controls The result: insurance reforms lo protect consumers from losing
coverage and a go^low approach to covering everyone.
' That will be the skeleton
from which we'll work, and
there may not be much more
flesh on the skeleton as we initially pass it," F>ackwood says.
" I do not think a bill that raises
lots of taxes to pay for lots nf
benefits will pass"
Adds Sen. Dave Durenberger, R-Minn., Oie fourth GOP
moderate on the finance panel
with Packwood, Chafee and
Danforth: "We will give (Qinton) universal coverage, and
he will back off of a regulated
marketplace."
Democrats acknowledge the
potential power of Republicans' punch, particulariy on
the Finance Committee, which
rewrote major portions of Clinton's five-year. SSOO billion deficit-reduction plan last year.
"On the Finance Committee,
everybody has to be taken into
consideration." says Sen John
Breaux. I>La., one of two moderate Democrats on the panel
who often vote with the GOP.
"It's time to bring in Republican members who are willing
lo suppori the general concepts
(of health-care reform), and
there are a lot of them "
If Senate Republicans force
major changes in committee,
they will empower their party
on the Senate Boor and in conference with the House. The final package, for that reason,
could win broad GOP support.
So while House Republicans
now are limited to the role of
"vigilantes." says Rep. Dennis
Hastert, R-III.. "we have to t>e
players in this thing. "
TUESDAY. APRIL 1 2. 1994 • USA TODAY
By J«»n-PWipp» Kikuzek. AP
IN STRASBOURG, FRANCE: Vladimir Zhirinovsky tears
plants from ttieir containers, to ttirow at protesters.
Zhirinovsky on a tear
Russian ultranationalist
Vladimir
Zhirinovsky
tossed insults, plants and
stones at demonstrators
screaming "Zhirinovsky
neo-Nazi ' and "fascist out"
while visiting France.
In Strasbourg Monday
with a Russian parliamentary delegation. Zhirinovsky
also continued his tradition
of outrageous remarks.
He spat on one protester.
Then, from tiie gates of the
Russian consulate, he threw
uprooted garden plants and
stones at Uie crowd. "TU Wll
you," one witness quoted
Zhirinovsky as saying.
Zhirinovsky later condemned NATO's attack on
Serbs In Bosnla-Herregovlna: " I would have ordered
Uie bomblngf • of Uie Aviano
air base In Italy. Italy's Defense Minister Pablo Fabbri
called that statement "absurd and delirious."
• Bonil)ing Bosnia, 8A
�Sen. John Danforth, «-Mo., f i r s t proposed
-a coiiple of years ago.
""Congressman Slattery has known of a l l these ideas for some time,''
Kassebaum said. ""To step forward with these now, I'm hoping h e ' l l influence
others on the committee.''
f i l e d by:APW-(KS)
on 04/21/94 at 23:09EST ****
**** printed by:WHPR(160) on 04/22/94 at 07:36EST ****
****
�Petitions Seek California Vote on Canada-Style Health Pla
By SETH MYDANS
S[)«-nl 10 T h f NtW Y o r t T i m t s
LOS ANGELES, April 26 - Leading a nationwide push for state-run
nealth insurance systems, a coalition
"I consumer, labor and doctors'
aroups submitted petitions todav that
would allow California citizens to
vote this fall for a Canadian-stvle
single payer" plan.
Cardboard boxes containing more
:.'ian a million signatures collected bv
10,000 volunteers were being filed
with the voter registrar in each counly today, organizers said, well over
Ihe 677.000 needed to put the issue on
the Nov. 8 ballot. The signatures must
be verified by county voter reeisirars.
The plan, which would remove pri\aie insurance companies from
nealth coverage, would be financed
mostly by taxes and would guarantee
are to the state's 31 million resi:lonts. Similar plans, in which the
iiovernment is the sole health care
provider, are being considered in
.iDout 30 states, including New York
N'ew Jersey and Connecticut, though
no state has adopted one. California,
nome to one in eight Americans
would become the only state to have
placed a proposal on the ballot
'hrough a petition drive.
Opposition From Insurers
"Today was all about insuring a
;hance at votinc for and winning sin-
gle-payer health care reform in Uiis
state and pushing single-paver more
into the center of the national debate
as an option," said Martha Kowalski
organizing director for Californians
for Health Security, the group that
organized the petition drive.
Insurance companies are leading
the opposition to California's plan
arguing that it would be expensive
and would place the issue of personal
health in the hands of a govemment
bureaucracy, with all its intrusiveness and inefficiencies.
In addition, there are doubts about
the effectiveness of a law put together through the voter-iniiiative process rather than the rigors of legislative debate. For example, an overhaul of the auto insurance system
approved by voters in 1988, has been
seriously undercut bv court challenges and industry opposition.
Proposing a revamping of the current public-private system instead
Richard Coorsh, a spokesman for the
Health Insurance Association of
America, a trade group, said: "The
notion of throwing up the hands and
saying. Let the government do i f is
fairly easy to understand. But the
ramifications of turning over a significant portion of the United States
economy is likely to subject consumers to higher costs and lower qualitv
healthcare."
In San Francisco on Monday, Hillary Rodham Clinton criticized a Cana-
dian-style system, saying: "We believe there must be a private insurance market, a mixed svstem between public and private financing
and delivery. We like that competition."
President Clinton's health care
plan would give emplovers primary
responsibility for paying tor health
insurance, with workers paying a
smaller ponion and special subsidies
for small businesses with low wages
But his plan also offers states the
The aim is for taxes
to finance health
coverage.
option of adopting their own plans
including single-payer systems.
$105 Billion Annual Cosi
The California plan, estimated to
cost $105 billion a year when fully in
place in 1996, would create an elected
health care commissioner who would
negotiate fees with providers for a
broad range of services, including
long-term care, mental health services and prescription drugs. It would
allow consumers to choose their doctors, hospitals or health management
organizations and would replat
Medi-Cal and Medicare as well £
private insurance systems.
The plan would be financed by
business payroll tax, an income "ta
surcharge of 2.5 percent to 5 percem.
a $l-a-pack cigarette tax and existing
government spending, sponsors said.
They maintain that the plan would
generally cost individuals and busi-.
nesses the same amount thev now '
pay for health insurance.
"This sets up a system that is bet. \
ter than Canada's and has 40 percem '
more funding," said Glen Schneider,
campaign chairman for Californians
for Health Security.
But Mr. Coorsh countered, "It
makes little sense to borrow upon the
world's second most expensive health
care system to improve our own." He
said Canada's problems included
steadily rising costs, a reduction in
services and long waiting times for
urgent care and surgery.
Mr. Schneider said the California
plan would free an estimated $10 billion a year for health services by
cutting out "the enormous bureaucracy and waste of the California
insurance industry." It would extend
health coverage to six million legal
state residents who do not now have
health insurance, but would not cover
undocumented aliens, he said. These
illegal immigrants would continue to
be entitled to emergency care, as
they are now, he said.
Taxing Health Benefits Gets
Poor Reception at Hearing ^'
In addition, she said, because the
income tax is progressive, high-inWASHINGTON, April 26 - Mem- come people receive the greatest benbers of Congress expressed interest efit from the exclusion of health intoday in limiting tax breaks for .surance from taxable income. The
health insurance. But labor unions tax break "tends to help large firms
denounced such proposals as a new at the expense of small ones" because
tax on middle-income workers and a subsidizes a form of compensation
tax lawyers said it would be extreme- that big companies are much more
ly difficult to measure the value of likely to offer, she said.
Several Republican Senators inany benefits that might be taxed.
Senator Daniel Patrick Movnihan cluding John H. Chafee of Rhode Isof New York, chairman of the Fi- land and John C. Danforth of Missounance Committee, said President ri, as well as Senator John B. Breaux,
Clinton had raised the issue by pro- Democrat of Louisiana, endorsed the
posing a limit on the amount of health idea 01 taxing health insurance benebenefits that workers could receive fits th.i! exceed a certain amount
tax-free. The limit, which would be Senator Bob Packwood of Oregon, the
effective m the year 2004, would bo ranking Republican on the commitset at the value of a comprehensive tee. who fiercely opposed such limits
package of doctors' services, hospital in the past, said he was now receptive
care and other medical benefits listed to the idea.
by Mr. Clinton
The high cost of health insurance
The Idea of a limit on tax-free raises the question "whether we have
health benefits has attracted interest encouraged, because of the tax code
In recent weeks as a possible wav to too much health coverage — Cadillac
finance health care without raising coverage when we should have a
income taxes or requiring employers Chevrolet," Mr. Packwood said.
to pay for coverage.
Peggy Connerton, speaking for the
A.F.L.-C.I.O., said: "Eliminating or
Tax-Free Benefits
limiting the tax exclusion for health
Under current law, emplovers mav insurance benefits would be regrestake tax deductions for ' the full sive. Lower-income families with inamount of any healih benefits they surance would pay more tax as a
provide to their workers. Such cover- share of income than high-income
age IS worth perhaps $3,000 to $5,000 a families."
year for each employee. But none of ii
Congress is "playing with fire"' in
IS counted as taxable income for the considering limits on this tax break,
employees.
said Ms. Connerton. who is director of
The Congressional Joint Commit- public policy at the Service Employtee on Taxation savs that if that if all ees International Union. "1 don't
employer-provided health benefits think this proposal has been tested
were treated as income, the Govern w'lth the American people," she addment would collect $36.7 billion a year ed "Under the proposal, people with
health insurance would pay more for
in additional tax revenue.
At a hearing of the Finance Com- less coverage."
mittee loday. Rosemary D. Marcuss
M. Carr Ferguson, a tax lawyer
assistant director of the Congression- who served as Assistant Attorne\
al Budget Office, said the Govern- General in the Carter Administration. '
ment was providing a tax subsidy told Congress today that any proposal
that insulates workers from the cost's
of their health insurance.
By ROBERT PEAR
S p r r i i l l o T h p Npw York T i m p i
THE
NEW
YORK
TIMES.
Congress eyes an
estimated $36
billion in taxes.
to lax health insurance benefits must
overcome a huge practical problem:
computing the value of such benefits
for each employee.
"It's difficult to capture and measure the value of these fringe benefits
and subsidies," he said. "How do you
dricrmine that an employee's health
:i' nefii is $300 a month? Is the $300
(..nculated differently for single people married couples and families
with I hildren? Is it the samis for a
person 25 or 60 vears old? Is it the
same in New York City and Nashville'-"'
senator .Moynihan said that if Congress set a flat limit on tjie tax deduction that an employer could take for
•n employee's health benefits it
would appear arbitrary to many people. "It's difficult only if you want to
be fair," he said, adding that he understood the concerns of organized
labor.
Later today Senate Democrats met
for three hours in a closed caucus to
discuss various ways of easing the
impact on small business from anv
roquircment that emplovers provide
health insurance for their workers
More national news
appears on page A18.
WEDNESDAY.
APRIL
1994
�1
^Key lawmakers close to compromise on health-care
reform< By Peter G. Gosselin< Boston Globe<
WASHINGTON A group of Republican and
Democratic lawmakers who hold the swing votes on health
care in the Senate are close to a compromise that, while it
stops short of President Clinton's goal of covering all. would
assure that most Americans are covered by the start of the new
decade.<
The effort by the group, led by Sen. John H.
Chafee. R-R.l., illustrates the increasingly fevered search for a
political middle ground as time runs down for a health bill and
those on the political poles of the issue toy with legislative
confrontation.'"
Chafee's effons came as the White House responded
with fury to suggestions by Senate Finance Committee
chainnan Daniel Patrick Moynihan Sunday that Clinton may
have to accept a health bill that does noT meet the president's
call for universal coverage. The New York Democrat said
there is little agreement about how to pay for the goal.*'
During a private meeting with more than 100
outside allies on the health issue Monday, an angry Hillary
Rodham Clinton pounded the podium and wamed that the
Clinton plan is now at risk." She upbraded representatives of
labor, elder and health activist groups for pursuing their own
narrow interests over the goal of universal coverage.'
The first lady's comments, described by several
people who attended, were the broadest acknowledgement to
date of the depth of White House's trouble in lining up
congressional support for its proposal. They appeared to reflect
a stiffening of White House resolve on the health issue after a
week of hints the president may be ready to compromise.<
"I think she was angry and frustrated, not so much
angry at people in the room as angry at the way things are
turning out." said John Rother. chief lobbyist for the American
Association of Retired Persons.-^
As matters now stand, the health debate appears to
be flying off in two drastically different directions.<
On one hand, longtime supporters of the president's
plan, such as Senate Majority Leader George J. Mitchell of
Maine and Sen. Edward M. Kennedy, D-Mass.. seem prepared
to risk try ing to push a Clinton-like bill through the Senate
with Democratic votes alone, if necessary. Their strategy
appears to be to bring the health debate to a dramatic clima.x in
hopes of facing down Republican and conservative Democratic
opponents.<
On the other, senators such as Moynihan, Chafee
and Sen. Bill Bradley, D-N.J., are waming that such a
Democrats-only strategy would be disastrous, and are
counseling the White House to hammer out a compromise that
most members of both parties can support.<
The Chafee group's proposal would constitute a
substantial compromise for Clinton, perhaps more substantial
than the president can now contemplate. But it remains
considerably more ambitious than what many lawmakers have
said can make it through the Senate.<
Besides Chafee, the group, which has been meeting
privatelyjor^several weeks, includes Democratic Sens.fBradjiy]
JohnlBreaux of Louisiana, MaxfBaucusJof Montana, David
jBoren[of Oklahoma and KentJCSnradJof North Dakota, and
RegublicanSens. John ^anfortKjpf Missouri and Dave
|puren5er^rj[pf Minnesota. All are members of the Finance
Committee, which many believe is the only Senate panel that
could work out a compromise that would be widely acceptable
to members of both parties.<
Under the group's proposal, the White House plan to
pay for universal coverage largely by ordering the nation's
employers to contribute toward their workers' health benefits
would be replaced with a system of govemment subsidies and
a so-called "individual mandate."<
The mandate would require that if 4 percent or
more of the population is without coverage in the year 2001,
those still uninsured would have to purchase insurance or pay a
stiff tax penalty, according to sources. Currently, 15
cent of
Americans are uninsured.The proposal reflects the notion that by that point
most of the uninsured would be people who could afford
coverage, but choose not to buy it. and instead ' free-ride" on
the system, knowing they could get emergency room treatment
for little or nothing. Although the amount of the penalty has not been
worked out. one congressional staff member involved in the
group's efforts said that it would be set to be as high as a
person's insurance premium would be, so that there would be
no incentive to avoid purchasing coverage.<
White House officials are said to know the general
direction in which the group is headed, but not yet to have said
whether they can accept the proposal. Clinton met with Chafee
and other Senate moderates of both parties individuals last
week and reportedly encouraged them to assemble a
compromise plan.'
�PM-PA- Health Care,400
O f f i c i a l : Don't Succtimb To Bickering In Health Reform Debate
AP Photo PX102
By TED ANTHONY= Associated Press Writer=
PHILADELPHIA (AP) President Clinton views the next month as c r u c i a l in
Congress' attempts to pave the path toward health care reform, a top economic
o f f i c i a l says.
""This i s r e a l l y a moment of high drama in the policy debate,'' said Alice
R i v l i n , deputy director of the federal Office of Management and Budget.
Nearly 1&1/2 years into the Clinton administration, Senate and House
committees are working to c u l l the best from several proposals, including one
from the White House. Points of dispute include how universal health care
could be funded and how much i t w i l l cost.
R i v l i n acknowledged bipartisan commitment to getting things done, but she
said she worries ""squabbling over d e t a i l s ' ' could cloud honest debate.
""There i s an enormous danger of getting bogged down,'' R i v l i n said. ""We
cannot move into the next century with a rapidly advancing technology and an
aging population without reforming t h i s basic system.''
She spoke at a meeting of the Catholic Health Association, which
represents 1,2 00 health f a c i l i t i e s and organizations. I t lobbies and gathers
information on public policy issues on behalf of i t s members.
Two other speakers, both U.S. senators, said bipartisan enthusiasm about
reforming health care i s hastening the usually contentious committee process.
One predicted a plan would reach the Senate floor early next month.
Sen. John Danforth, R-Mo., a member of the Senate Finance Committee, said
a pervasive ""can-do attitude'' in Congress i s speeding progress.
""In the time that I have served in the Senate, I have never seen an issue
that i s t h i s big or t h i s complicated,'' Danforth said v i a a l i v e s a t e l l i t e
hookup.
" " I believe we're going to l e g i s l a t e , ' ' he said. ""There i s a l o t of
common ground.'•
Sen. Tom Daschle, another finance committee member, said the package w i l l
be hollow i f money i s n ' t addressed.
""Unless we deal with cost containment, ve haven't dealt with the issue
correctly,'' said Daschle, D-S.D., who also spoke v i a s a t e l l i t e .
He predicted a package would be considered by the Senate next month and
enacted by the end of the year.
Danforth drew applause when he pledged to introduce an amendment excluding
abortion from any benefits package. The Catholic Church hierarchy does not
want universal health care to include abortion funding.
" " I can't imagine anything more l i k e l y to d e r a i l health care reform,''
Danforth said. ""For p r a c t i c a l purposes as well as e t h i c a l purposes, I think
we need to make sure that abortion i s not
a part of i t . ' '
****
f i l e d by:APE-(PA)
on 06/09/94 at 01:l3EDT ****
**** printed by:WHPR(160) on 06/09/94 a t 07:36EDT ****
�b c - l i v i n g - w i l l s 06-09
Danforth Sponsors Senate Briefing on Advance Directives
and Health Care Reform
To: National Desk, Healthcare Writer
Contact: Deborah Kaufman of Choice In Dying Inc.,
212-366-5540
WASHINGTON, June 9 /U.S. Newswire/ — Sen. John C.
Danforth (R-Mo.) conducted a Senate briefing today about
l i v i n g w i l l s and other advance directives, and Congress'
role i n addressing the issue of Americans' rights to
participate i n health care decision making.
Choice In Dying, a national, not-for-profit group
responsible for creating the f i r s t l i v i n g w i l l 27 years
ago, joined the senator to conduct the discussion about
the current use of advance directives.
In opening remarks. Sen. Danforth said, ^ ^ I t i s c r u c i a l
to understand the concept and r e a l i t y of l i v i n g w i l l s and
other advance directives within the context of health care
reform. I t i s equally important that Congress respond to
Americans' concerns about their own stake in health care
decision making and about how they can e f f e c t i v e l y exert
control over these decisions. Choice In Dying has played a
valuable and c r i t i c a l role in the debate about end-of-life
decision making. The voice of Choice In Dying continues to
be one of knowledge, experience and moderation.''
According to Dr. Karen Orloff Kaplan, executive
director of Choice In Dying, ^^With the recent attention
surrounding l i v i n g w i l l s generated by former President
Richard Nixon and F i r s t Lady Jacqueline Kennedy Onassis,
the issue of patients' rights to accept or refuse medical
treatment has become an important concern for many
Americans. Choice In Dying continues to get c a l l s every
day from the general public, health care providers and
lawyers who are grappling with end-of-life issues and are
in need of assistance.''
Choice In Dying voiced support for Sen. Danforth's
i n i t i a t i v e to strengthen the federal Patient
Self-Determination Act (PSDA), enacted i n 1991, which
requires health care f a c i l i t i e s to educate patients, s t a f f
and communities about l i v i n g w i l l s and other advance
directives. ^^Although PSDA has had nationwide impact,
much work needs to be done to ensure that i t i s as
effective as i t s sponsors intended,'' said Dr. Kaplan.
Choice In Dying, a national, not-for-profit
organization, i s the nation's largest distributor of free,
s t a t e - s p e c i f i c advance directives, the general term for a
l i v i n g w i l l or a durable power of attorney for health
care. Choice In Dying, w i l l provide a free, s t a t e - s p e c i f i c
advance directive to anyone who c a l l s the "toll-free
number, 800-989-WILL (9455).
-0/U.S. Newswire 202-347-2770/
�dealth-Care Compromise Plan Drah^
By Bipartisan Group of Senate Centrists
By DA\ ID ROGERS
And HILARY STOUT
couragement to the group, and Sen. John
Danforth (R.. .Mo.i. one of the moderates,
i i a ' f R f p o r t e r s of T i i r W A L L S T R R R T J O L R . M A L
expressed optimism after meeting with
WASHINGTO.N' - A bipartisan group of President Clinton yesterday. While there
Senate moderates is crafting a compro- still are major questions atxiut the details
mise health-care plan that would set a goal
and financing of the package, it holds the
of providing at least 96^7 of Amencans potential of getting closer to the presisome insurance by the year 2001.
dent s goal of providing health coverage
The draft proposal would scale back the for all Amencans. Administration officials
health-care benefits that initially would be
have some concem, however, about the
offered under the plan in order to reduce political implications of requinng individthe cost of subsidies necessary to bring uals, rather than companies, to be responlow-income Americans into the health-care sible for obtaining Insurance.
system voluntarily. The measure wouldn't
The president yesterday continued to
require employers to purchase coverage rule out compromises offered by some
for their employees, as the president s plan members of Congress that would fall short
would. But failure to meet the goal of 96% of both his goal of universal coverage and
coverage by 2001 would trigger a require- the moderates' 96'~t standard. '.Now, I
ment that all individuals buy a policy that
refuse to declare defeat," Mr. Clinton said
covers at least catastrophic illnesses.
in comments to the Business Roundtable, a
The draft plan anticipates that signifigroup of chief executives from large comcant savings from Medicare and .Medicaid
pames. "'Why should we jump in the
programs, as well as new tobacco and
tank":*""
msurance taxes, would raise an estimated
In order to step up the pressure on
S2I50 billion over the first five years. These Congress. Hillary Rodham Clinton plans to
funds would be used to subsidize expanded go to Capitol Hill today for a Senate
coverage. To maximize those resources,
Democratic Policy Committee luncheon.
the plan would allow for the option of
The basic structure of the compromise
providing only enough insurance to cover
plan borrows heavily from ideas advanced
large out-of-pocket or catastrophic costs.
by Sen. John Chafee iR.. R.I.i. who reThe centrist bloc draws support from
mains a major actor in the coalition. But
Republicans and Democrats on the Senate the same group now includes prominent
Finance Committee. Though no final
liberal-to-moderate Democrats, such as
agreement has been reached, the discus- Sen. Bill Bradley of New Jersey and Sen.
sions could serve to help break the staleBob Kerrey of .Nebraska.
mate that threatens the administration s
One novel aspect of the plan is its
reform initiative.
willingness
to begin with a less generous
"If any group is insisting it s their wav benefit package
that can be subsidized
or no way, they'll be sitting in Washington more cheaply. While
tngger device in
alone at the end of this year with Congress 2001 would impose a the
mandate
to achieve
gone." said Sen. John Breaux iD.. La.I. a
the long-term goal of universal coverage,
member of the Finance Committee and
the burden would be softened bv allowing
part of the centrist bloc. "Both sides have
individuals to satisfy the requirement by
to move toward the center. '
buying less costly, catastrophic-coverage
The White House is lending quiet enPlrase Tum to Paqe AlO. Column
Continued From Page Ai
poUcies.
The risk is that such an approach, by
not guaranteeing the same level of coverage to all Americans, could perpetuate a
multiple-tiered health care system. Proponents answer that they aren't surrendering the goal of a higher, basic benefits
package, but they say some flexibility is
needed to phase in the plan and help
individuals adjust to any future requirement that they all buy some basic insurance
Like the administration s bill, the moderai" s plan would rely on increased to-
bacco taxes to help finance Its sub^es
But m addition, the moderates are considenng a tax on insurance providers to damp
the market for high-cost health plans and
recapture some of the industry's profits as
the coverage expands.
The new levy would substitute for the
administration s proposed caps on insur
ance premiums, which have proved to be
controversial. The ux stems from the
same cost-control theones used to justify
past proposals to limit tax benefits for the
mo;ne expensive health plans. Several tax
scMemes are being considered, but in each
cafee. the burden wouldn't fall directly on
liness or labor, but instead would apply
irst to insurance providers.
The White House has in fact provided
technical suppon in developing these tax
Ideas. Whatever its reservations about
elements of the moderates' plan, the administration welcomes any opportunity to
show progress in the Finance Committee.
The panel continues to have difficulty
getting cost estimates from the Congressional Budget Office. Both the CBO and the
committee leadership confirmed it was
unlikely the panel can get complete estimates before the July Fourth recess.
Finance Chairman Daniel Patrick Moy
nihan (D., N.Y.) surpnsed his colleagues
by holding only a morning meeting yesterday. Increased tensions have contributed
to rancor in both parties. Among the
moderates themselves, there are jealousies about who should get credit for advancing ideas. Mr. Chafee sounded an optimistic note, but there are recriminations be- I
cause the centrist bloc largely has
operated independently of Oregon Sen.
Bob Packwood, the committee's ranking
Republican.
The committee's nine Republicans met
yesterday in an unsuccessful effort to
reach some consensus among their ranks.
'"It keeps getting to the point that it is
impossible to come up with a Republican
position because some Republican always
says don"t do it because it's a political plus
to do nothing, or they say we Republicans
shouldn't support anything with a national
basic benefits package," said Sen. David
Durenberger (R., Minn.), one of the most
active GOP senators on health-care issues.
The slow, seemingly diffident pace in
the Finance Committee contrasts with that
of the House Ways and Means Committee,
where the Democratic leadership vows to
stay in session through the weekend if
needed to assure completion of a bill before
the recess. The order was given by the new
acting chairman. Rep. Sam Gibbons. In a
sinking exchange with Republicans, the
Florida Democrat found a welcome ally
yesterday in the man he succeeded as head
of the panel. Rep. Dan Rostenkowski.
Mr. Rostenkowski, who was forced to
give Hp the chairmanship after being indic^d on corruption charges this spnng
has worked with Mr. Gibbons behind the
:enes. Yesterday, the gruff Chicago DemTat weighed in with his old style, reminding Republicans that the panel could ill
afford to begin to expand the benefits
package without some means to balance
the costs involved.
In committee action yesterday. Democrats blocked a Republican-backed effort
to kill a proposed Prescription Drug Payment Review Commission, but further
concessions were made to placate elements of the pharmaceutical industry.
In a fight that divided large drug companies Uke Pfizer Inc. from generic-drug
producers, the committee also agreed to
alter a system of proposed rebates drug
manufacturers would be required to give
the govemment under a new Medicare
prescription-drug program. Companies
that hold or held patents for drugs won a
reduction of their proposed rebate from
11% to 15%. But the generic-drug industry
would now be subject to a 10% rebate for
generic drugs and over-the-counter insulin.
�Key Democrat s Key Democrat Deak
Stance Is Cool Setback to Clinton
On Health Proposal
On Health Plan universalContinued
From Page Ai
coverage. He wamed that Re1
publican threatstoblock action were "ill
advised." "People who promisetocreate
delay and gridlock do not serve the
country well." Mr. Gore said.
Mr. Borwi said that going to the voters
would be an "honorable" opUon for the
president. The more dangerous course
he argued, would betopress ahead without
By DAVID ROGERS
f^^^ll^''^"**"*'"- "1 <lon't want this
to be Ute British Steel." said the Oxfort
W ASHINGTON - Democratic Sen. Da- educated
Democrat,refeningtothe way a
vW Boren of Oklahoma, in a blow to succession
of Bridsh Labor and Conser
!Sn^^°!^ 1"°"^ '°
a health-care vative governmentsreversedone another
P'*"
Senate Finance Committee for (^ecades over the nationalization of the
oi^ir' T o ' ^^'^ « 'hat doesn't have steel industry. Mr. Boren said the U S
significant Republican support
health system can't affordrefonnstliat
only
mvitereversal,and further disnip"We would be better off doing nothing
Finance Panel's Sen. Boren
Requires GOP Support,
Sets Back White House
d^^^sn t have a sustainable consensiii." he
5'
EPA Proposes
Tougher Rules
Covering Water
NOAH
ita//Reporter 0 / T H E WAI I
.
Protection Agency, in a move that could
substantially Increase water bUls in Sme
nira wmmunlUes. proposed tightening
?n^l i V ^ drinking-water disinfectants
and Uieir byproducts.
Buttoensure Uiat water utilities don't
meet Uie proposed new standards bv decreasing disinfectants to the point of
TOing Uie likelihood of contamination,
uie EPA also proposed stiffer standards
regarding Uie presence of various microorganisms in larger water systems. These
standards include a first-eve*. Umit for
Cryptosporidium, a parasite Uiat last vear
infected MUwaukee's water aupply A
^^^^^ '"^ ^^"^
Issue of Employer Requirements
tha^l; Wren's position dashes any hope of To date, much of the debate has foo^iJl fh" ^"""'"^'s 11 Democrat cussed on whether employers should be
forcing the issue to the Senate floor by required to help pay for their workersthemselves. As a result. President Qinton
mtist step up efforts to win over m o d S insurance. Business interests fiercely opIS
"PP"" plan s pose
Zt the idea, but the administration
controls and its proposed requirement tha argues this approach only builds on toemployers pay for health care.
day s system and would servetoenforce
"I'm not going to have one of my last and finance universal coverage.
Any compromise would require blurring the lines, perhaps with a "triarer"
Mr. Boren. who isreUringafter this ses
sion of Congress.
" device to phase in the employer requirements later if voluntary measures fall to
bmSir"""'"^"'^'/^"^^""^ 'lie ^ews of a. 5^fve
expanded coverage. But while the
broader camp of conservaUves In his' White House
appears readytoaccept an
par^. came on the eve of a scheduled
meeting this morning between the presT automaac "hard trigger'' if vSuStaS
dent and the Finance CommitteeTleade - measures fail. Mr. Boren and RepubUtiS
ship, Chainnan Daniel Patrick Moynihari luce Mr. Durenberger speak of a "softer "
of New York and ranking R e p u b S S ? morecOTdiaonal approach designed only
to expedite action by a future Congress or
Independent commission.
w
spoke to Mr. Moynihan yesteitlay, is beAll of these alternatives would reduce
theresoiircesavailable upfronttoachieve
universal coverage. In the same way
scaling back the cost controls proposed by
nance, also reached out privatelytoGOP the administration would reduce projected
and sap the government's abUlty
Sens. Johnttifwof sayings
to finance die subsidies most important to
Rbode^Lsland and David D « « n j ^ 2 poor and woridng-dass families.
Huge Costs
Mr. Packwood, who currentte it th»
subject of an ethics i n q n i ^ ^ ^ ^ ^ .
The huge costs are lUustrated by a
tant to move too far from Uie W c o ^ Democratic biU pending in the House Ways
vative GOP caucus, which has7hTpSSS?^S, and Means Committee. The bill is relasfrip him of his ranking poslUori^n? tively aggressive in applying cost controls
Chafee and Durenberger aTweS as S^" ^mn, !II PJ^l^'ack some of the benefits
Johti Danforth of MissSur^.^e seen as^e promised by the Qinton plan. Medicaid
assistance largely for poor women and
children would be absortjed Into a new
govemment-nin insurance program including low-wage and small business
aJoXfSon^hVm^r^
workers, but the added subsidies wS
Pomical pressures already may hSe
eroded the Chances for agreemerBoS, on average about $39 bUllon annuaUy over Uie
J
^
I t ,1^ "i"* "^h''
^ voices arriSn! first years.
the health-reform issue should K f h i i ^ ^ I ^
*fr«y part of
to the voten this fall. And whurSie
UUs cost, but net govermnent spSSng
rn.^^ «r°*
"12.5 billionOTerUif
health coverage for all Americans, the
path to compromise is sure to reduce Z
tohiS\
revenues, includinj
tol^acco taxM, would amountto$57 biUlon
re^urrea avaiUble to him to S tSL
wnSn 'ii"I'
'™"*''
result still
betowiden Uie deflclt by about $55
get all Uie Clinton plaii. " saM Sen Jav would
billion over Uie four years
on the Finance panel. 'But as we mow ^ e e Democrats. Ways and Means D«nr'lft I S ^P^blcans. they S c I u p T ocrats are more attuned to partisan confrontation. But Uiere are e S J o e S
vice President GorerelteratMi"in
craticdefections at Uiisstage tSt toenSJ
uncertain terms 'lS^ Q E ' S pie<£e to actliig Chairman. Rep. s I T d i K ? ^5!
veto any bUl that falls Short o f ' p S t S Fla.), wdl have a sUuggie to sustain a
Piease Tum to Pope A6. Column •
o^S^ii:!^"'''^i^tiU
^ ^'eek, but Democ^^*^^ yesterdaytoput off a meeting
fniS"? 'Ws morningtoallowtimeItof
further closed-door party caucuses
mnl'^fi'."'',"'*"
«"ne If we can
Leader Richard Gephardt. "Wecan'twlL
We havetoget Uiis done UUs year."
cle
contributed to tfiis orti-
S ^ ' r ^ « < « will be proposed imetime In Uie fuhire for smaller water systems, ain EPA oflldal sajd.'
The proposed regulattoos are Uie result
of negoaations,,6egvnIn 1392. between Uie.
KPA and utilities, envl^amental p^n*
consumer groMp^ « d dtj, and s t a K -
uar legwtttion ll^ndlng^tbe Houses
The KPA etlteiiates Uiaf^ the Droomed
rule 00 dlslnfecUurtMBd their b y J S K
monUily coati. ITHiM imm.mmli occur In
water systems aarptaf fc^ Ban 10;000
K f rJ!^esttaMlte
edats for m nfcftHiMbttai rule th«
WBlle drli^iariif^^ter illiUtfKta^ prevent disease, if
> ekcess Uiey can
create byproducts potentlalftr hamiAil to
human health. The BPA ls,]>roposlng that
exisdi» Umit* ( » Ujese, byproducts be
lowered. Ftor example, Qtt- maximum allowable level (f tfUMlMMt&aDet, a chemical formed when chtorihe reacts wlUi
organic material. wnwId'KetoweredtoM
micrograms per. Jlier frag) m Mmgrams. And the BPA Is prooosing first-ever
limits fbr several oiNhc dlsfarfectants themselves, including ehtorine
Coinpleiiiaiting tbetft.ftaodards is a
P»opo«al birtber restrlctlag limits for viruses and Klanifat « type of micnH»iaolsm. and tke new Itontt firciyptoeporidiuffi.
nnal rufts are eipeetedtobe Issued by
the EPA in 1998-. The BPA official said tt»
delay was cauted by tbe needtocollect
more<letalled dttionwater quality.
�A16
THE WALL STREET JOURNAL THURSDAY. JUNE 23. 1994
POLITICS & POLICY
right alike as an eUUst prescrlpUoo.
"When real people start writing the
checks, something bad's golngto happen,"
says RepubUcIn pollster mUlam Mclnturff, waming thtt Uie rentonse cguM
make buslne^ opposition to emptoyer
mandates look^tame. Mr. Mclnturfl adds
that any specified package of beneflts
would Invite ahnual Democratic attempts
to sweeten It, ushering In "one more era of
slow death In which Republicans explain
why we can't afford this stuff."
Complaint About Conservatives
Mr. Durenberger complains that conservatives have hamstrung the Senate
GOP leadership by elevating polltktf above
health policy. He longs for a broad bteartlsan deal that would "pin ITexas Sen.] PhU
Gramm's feet to the floor." At the same
time, he blasts the White House for
having " tried to destroy . . . the middle"
and sets a high standard for accommodation: " a basically Republican health-care
bill " that would aUract a dozen or more
GOP moderates, not just a handful.
"There's no way I'm going to be with
four (Republicans! to pass health-care
reform, " he says. "Nobody would trust it If
it looks like a Democratic bill." Some
prominent Democrats, among them Finance Chairman Daniel Patrick Moynihan
of New York, all but echo that message.
And President Clinton so far has given
little Indication he is willing to sign on to
such a deal.
Sen. Durenberger says that If reform
collapses on the eve of his retirement, so lie
it. While he retain a missionary's zeal for
the "managed competition" theory that
new, pro-competition regulatory arrangements can by themselves yield Immense
savings and dramatically expanded coverage, he insists he isn't interested in
assisting the birth of an unwise alternative. "I've never seen anything where
there's more need for integrity than this. "
he says.
Finance Committee's GOP Moderates Hold Key
To Clinton s Fragile Bipartisan Hopes on Health
By JOHN HARWOOD
And DAVID RoofJis
Srnff n«-p(ii(pri nl Tiir. W A I J , S T B F F T J D I I R N A L
WASHINCTON-Unlike some Republi
can opponrnts of President Clinton's
health reform plan. Sen. Dave Duren
berger isn t running for president or for his
party s leadership. Hobbled by ethics prob
lems. he is ending a Senate career devoted
to health issues at year s end whether or
not Congress enacts reform.
"There's nothing in it for me, " the
third term senator insists. "Tm the president's best friend,
bei ause I can walk
away. "
Republican
friends like Mr.
Durenberger represent Mr. Clinton s
best hope for a
health care rompromisp that could
clear the O^mgress
with sufficient support to avoid a conservative GOP fill
buster. The Minne- Ikive Durmhergcr
sotan is one of a
handful of Republican moderates on the
pivotal Finance Committee who, for the
right terms, could join with the president s
Democratic allies to keep the faltering
Satisfaction With HMOs
A major new study found that employees
who belonged lo health maintenance
orf{anization« were ••(nificantly more
iatiRfied with their overall care than
those who had fee-for-service insurance
Article on page B7.
reform pnx pss alive. But il won't be easy,
as shown by Sen. Minority Leader Robert
Dole s move yesterday to damp efforts
by Mr. Dtirenberger and other GOP and
DcmfH r.itir moderates to find a compro
iMisc hciilth rare bill.
riic r.iiition Ihat tempfr?; the COP
rn.i.ict I''"Indoiwndrnrr' imdpr'^rnrf";
how very fragile administration hopes for
a bipartisan health-care bill have become.
Mr. Durenberger insists he is just as
willing to walk away from Mr. Clinton as
he is from his party s combative right
wing. And his own position is a moving
target that may be difficult for the admin
istratlon to satisfy.
Seeking Common Ground
Yesterday, Mr. Durenberger and fellow
GOP centrists John Chafee of Rhode Island
and John Danforth of Missouri huddled
with Democratic counterparts in search of
common ground. Shuttling between Mr.
Chafee s office and that of the entire
committee, they worked on a tentative
plan to jettison the president s embattled
proposal to require employers lo pay for
workers health insurance and substitute a
possible requirement that individuals pur
chase al least low-cost insuranre against
catastrophic expenses.
Yet it still will be diffinilt for the
centrist group, much less the full commit
lee, to unite behind even a scaled bai k
version of Mr. Clinton's desired guarantee
of universal coverage. One piece of evi
dence: The compromise-in progress is ar
tually less ambitious than a pi Ihat
Messrs. Chafee. Durenberger and other
Republican moderates offered just months
ago. Mr. liurenberger now says he never
actually believed in the "individual mandate"" included in that plan, and says that
it has become politically impractical any
way, with even Democrats stirh as David
Boren of Oklahoma pressing to soften
terms under which the mandate miEhl take
effect.
"'It s off the table.'" says Mr. Duren
berger. explaining that he stipfMirted the
idea out of tarlical necessity at a lime
when the administraiion held a stronger
hand. " This is a negotiating session. The
price keeps getting higher.'"
Like Mr. Durenberger, the other three
members of the moderate faction face a set
of oflen confiidine pressures hetween
'•'incili;iiiMii ;mil ii;ir!is;inshiti Sen Cha
fee, for instance, ts up for re-election this
fall and doesn t want to face campaign
charges that he scuttled chances for health
reform. Yet despite his sympathy for
Mr. Clinton s universal coverage goal, he
Is also a former member of the Senate
Republican leadership and Is close to Sen.
Dole.
Partisan concems also weigh on the
ranking Republican on the Finance Committee. Bob Packwood of Oregon. Like the
president, the former labor lawyer supports requiring employers to pay for their
workers" health coverage. But he now says
he doesn't feel strongly enough on the
issue tl) buck the GOP caucus, which would
have the power to strip him of his commit
tee position if he is censured for pending
sexual harassment charges later this
year.
John Danforth of Missouri, who like Mr.
Durenberger is retiring from the Senaie
this year, has an independent, unpredict
able streak. The Senate s only ordained
minister is strongly antiabortion; Hillary
Rodham Clinton s recent comments sug
gesling Ihat abortion needn't be part of the
benefits package may have been partially
intended to assuage him. But Mr. Danforth
is also co-chairman of a new commission
dedicated to reining in federal entitlement
spending, and is concerned about the
impart of a health plan.
The emerging moderate plan Is an
attempt lo navigate between Mr. Clinton's
employer mandate and the limited insur
ance reform proposals of (JOP ronserva
lives. The danger for Ihe moderates,
though, is that any reiiiiirement that indi
viduals buy coverage directly roiild easily
be attacked by populists of the left and
�Blind Eye Now, Eyeing Victory Later
Democrats Tolerate Proposal Making Workers Pay Premiums
By ADAM CLYMER
SDCCidt 10 The Nevfc > m k 1 i m c f
WASHINGTON, June 23 - The
sudden emergence of a health insurance proposal that ultimately relies
on making people pay for their own
policies has given the Administration
and Its allies a nasty choice between
principle and legislative
progress
News
The idea of making
Analysis working people, not their
bosses, responsible for
paying for health insurance ts an idea Democrats cannot
embrace with anv passion.
But the still unfolding proposal, b\
a seven-person group led by Senator
John H. Chafee, Republican of Rhode
Island, seems to be the only hope of
getting any kind of bill at all out of liie
sluggish Senate Finance Committee.
So pragmatism dictates an Administration response of tolerance, or silence or, "We haven't seen the details
so we can t comment.'"
Maintaining that noncommittal
stance requires a restraint this White
House has not always been able to
maintain. But the pressure on the
Administration right now is not as
intense as it is on the plan's advocates, especially Mr. Chafee and the
other two Republicans, Dave Durenberger of Minnesota and John C. Danforth of Missouri
Criticizing Their Own
Some of their fellow Republicans
accuse them of selling out by giving
the Democrats a one-day excursion
ticket, valid only for one trip out of
the Finance Committee. They say
that on the Senate floor. Democrats
wtll brush the plan aside and push for
making employers pay the bulk of
their workers' coverage, as other
Congressional committees have done.
"They think they are above politics," another Republican said scornfully.
In fact, the hostile Republicans are
perfectly right about the hopes of the
Democrats backing proposals similar to the Clinton plan, like Senators
George J. Mitchell of Maine, the majority leader, Edward M. Kennedy of
Massachusetts, chairman of the Labor and Human Resources Committee, and Thomas F Daschle of Soulh
Dakota, co-chairman of the Senate
Democratic Policy Committee.
Mr. Daschle, a Finance Committee
member, said he would be willing to
vote for for the emerging plan. "1
may not be excited aboul it," he said,
"but It's a meaningful contribution
and It keep the process going."
He and the others want to see the
proposal emerge from the Finance
Committee onto the Senate floor.
Clearly, they think that once the issue
is debated there that they can successfully argue that It is better policy
to have employers, with some help
from their workers, pay for health
.nsurance, than to leave it to the
workers alone
Beyond the Committee
But the Democratic hopes are not
yet supported by any vote counts.
Nobody knows how the Senate would
vote today, and of course it Is even
harder to know how the Senate will
vote in a couple of months.
And ihere ts no reason to think it
will be easv for Mr. Mitchell, Mr.
To get any health
bill out of the
Finance Committee^
leaders swallow
some bile.
Kennedy and Mr. Daschle to assemble a Senate majority for making
employers pay for insurance. When
John Breaux of Louisiana, one of the
four Democrats in the group of seven
behind the new proposal, said Mr
Kennedy could never get a Senaie
majority for the bill his committee
produced, he was not boasting idly.
Another of the group, Senator Kent
Conrad of North Dakota, argued that
their proposal, while it may seem
awkward, is the only kind of measure
that the entire Senate, like its Finance Committee, would be able to
agree on
"Whatever we do, it cannot just tie
a ticket out of the Finance Committee." said Mr. Danforth. "It would
have to be a group of senators stick-
ing together' and trving to pass what
they had put forward, he said.
A Temporary Evil?
But the relatively restrained level
of criticism from Congressional
Democrats — unlike the angry and
vocal attacks from outside organizations — shows that most of them
believe the centrists' plan is little
more than a necessarv if ugly step
toward making a law, and aii idea
with little staying power "Enough
staying power to get to the floor,"
said Senator Max Baucus of Montana,
who dropped out of the centrist group
which had once included eight senators
In the House, where fear of betrayal by the Senate is endemic, there was
little grumbling. Highly placed Congressional aides said their bosses
would worry if they thought the plan
might be adopted, but for now seemed
willing to rely on Mr. Mitchell to put a
different proposition before the Senate. The majonty leader has said he
would work with Mr. Kennedy and
with Senator Daniel Patrick Moynihan of New York, chairman of the
Finance Committee, to decide just
what combination of the bills backed
by their committees should go before
the Senaie
In the Administration, while there
was plainly some anxiety about what
the unfinished amendment would
contain, the general view was that the
sooner it could get through the Finance Committee, the belter.
They argue that once the issue is
debated on the floor of Congress, as it
never has been before, then the
American public will see the merits
of their approach and persuade Congress to vote that way. However, this
IS about the fourth moment in the
history of this legislation when the
Administration anticipated a surge of
public opinion on its side. It has been
disappointed the other times.
Hawaii Governor Signs Gay Marriage Ban
HONOLULU, June 23 (AP) - The
Governor of Hawaii has signed a bill
banning same-sex marriages, a
measure lawmakers approved after
the state Supreme Court ruled that
existing prohibitions on homosexual
matrimony may be unconstitutional.
The bill signed by Gov. John Waihee 3d on Wednesday says the ruling
encroached on the Legislature's lawmaking function and infringed on the
separation of powers of the respective branches of state govemment.
The court ruled in May 1993 that
the ban was "presumed to be unconstitutional" because it was sexual discrimination, unless the state could
show a "compelling interest" for retaining It, a very tough legal standard
to meet.
The case, brought by three homosexuals who had been denied marriage licenses, was sent back to a
lower court for further consideration
A rehearing is scheduled for April
1995.
The new law, while denying marriage for same-sex couples, also sets
up a commission to examine extending marriage benefits to them.
SHOW A CHILD THE STARS:
SUPPORT THE FRESH AIR FUND
THE NEW YORK TIMES. FRIDAY, JUNE 24, 1994
�HEALTH COALITION
STRONGLY OPPOSES
COMPROMS
IE PLAN
Capitol Hill loday. Hillary Rodham
Clinton did not mention the Finance
Committee proposal. Instead, she
stuck to a broad thematic message:
what she descritied as a need for
universal coverage.
"No other reform in our health
care system will work if" we do not
achieve guaranteed universal coverage," she said.
Mrs. Clinton also reiterated the Administration's argument that it is
middle-class Americans who are
most at risk if universal coverage is
dropped from any health care bill
"If you are rich enough,"' she said,
jabbing the air and leaning into her
lectern, "you will have health insurance. If you are poor enough, you will
have health insurance. It's the people
in the middle, the vast majority, who
are either losing it and are among the
now 40 million uninsured or who are
one job. one divorce, one accident, one
illness away from losing their insurance,'"
Two Bills Gain in House
In a day of frenetic activity on
health care, another milestone was
achieved for the cause, altieil one that
had been widely expected. The quite
liberal House Education and Latwr
Committee passed t»th a version of
Mr. Clinton's health plan and a bill
that would create a system of national health insurance financed entirely
by taxes.
Mr. Clinton said the House action
"sends a clear signal to the American
people that Congress is well on us
way to making health care history
this year" and that Congress could
"break the choke hold of special interests."
The committee vote means that
health legislation has now made it
through two of the five major Congressional committees responsible
for acting on it: Labor and Human
Resources in the Senate, Education
and Labor in the House.
But in the Senate, the Finance Committee is embarking on formal sessions of debate and voting next week
with results that are still very hard to,
predict. And in the House, the Energy'
and Commerce Committee is consid-,
ered hopelessly deadlocked
The fifth committee. House Ways
and Means, continued its painstaking
way through a bill today, and its
chairman. Representative Sam Gibbons of Florida, said that if the work
was not finished by the Fourth of July
recess, he would hold the committee
in session.
In a telling moment that underscored the struggle on health care,
Mr. Gibbons said: "1 am constantly
having to seek to hold together the 20
votes I need for passage. Believe me,
that IS not a simple task."
Full Plan Due Today
Much of the attention, however,
was focused on the rump group from
the Senate Finance Committee,
which is expected to present its plan
to the full committee on Friday. "We
haven't nailed it dovyn," one member
of that group, Senator John C. Danforth, said as a meeting of the committee broke up tonight. "We're
sleeping on it."
Il is a measure of how volatile the
health care struggle is right now that
so much reaction was provoked by
sketchy reports of the rump group's
SENATE MOVE UNDER FIRE
Labor and Civic Groups Vow
to Fight Any BillThat Puts
Burden on Individuals
By ROBIN TONEI
Special 10 The New York Times
WASHINGTON. June 23 — A broad
coalition of latior, civic and consumer
groups mounted a counterattack today against the compromise national
health insurance plan emerging in
the Senate Finance Committee.
The opponents announced that they
would fight any bill that might ultimately put a new requirement on
individuals — rather than their employers — to purchase health insurance.
Such a requirement would neither
achieve universal coverage nor provide adequate assistance to the uninsured middle-income people who, under the plan, might eventually have
to buy coverage, said the coalition,
known as the Health Care Reform
Project.
That provision is t)elieved to be a
central feature of the plan being developed by seven moderate Republicans and Democrats on the Finance
Committee. The compromise plan is
widely viewed as the best chance of
breaking the committee's stalemate
over health insurance. But one of the
moderates stressed tonight that it
was very much in a slate of flux.
In a letter to the Finance Committee, the Health Care Reform Project
said, "We strongly urge you to reject
this approach or any others that fail
to meet the test of guaranteeing all
Americans affordable, comprehensive coverage."
That was a formidable political
statement to Democrats inasmuch as
the coalition's 56 member organizations include important constituencies for health care restructuring,
including the American Association
of Retired Persons, the A.F.L.-C.I.O
and the Catholic Health Association
of the United States.
The White House today tried to
maintain official silence on the compromise proposal, which was worked
on into the evening behind closed
doors. The Administration appears to
be trying to encourage movement m
the Finance Committee, which has
tieen deadlocked for months, bul to
maintain distance from a plan vehemently opposed by some traditional
supporters of the Democratic Parly.
Behind this careful show of neutrality is the calculation of Administration allies that the plan can be fixed
later, as it moves to the full Senate,
where the leadership is expected to
produce an amalgam of the Finance
bill and a more generous measure,
closer to Presideni Clinton's original
proposal, which was passed earlier
this month by the Senate Labor and
Human Resources Committee.
In an appearance at a rally on
Continued From Page Al
plan.s
The Senate moderates are struggling to broker a compromise that
can budge a committee polarized for
months over the so-called employer
mandate: the requirement in the
Clinton bill that businesses pay most
of the cost of their workers" insurance, a provision that is anathema to
Republicans and many conservative
Democrats
.At the same time, the moderates
are trying to assure universal coverage, which IS considered the bottom
line for the Administration and most
Democrats. As a resull, they have
t)een discussing a complicated plan
that would set a goal of covering 95
percent of Americans by the year
2002 'f the goal was not met, a commission overseeing implementation
of the plan would make a recommendation on how to achieve it
In the absence of further action, a
so-called individual mandate would j
go into effect, requiring those individ-;
uals who do not receive insurance
through their employer to purchase
their own.
Senator Kent Conrad, a North Da- '
kota Democrat who is a memt)er of
the moderate group, said, "That
would be a very small slice of the
American population.""
Another Senator among the moder-i
ates, John Breaux, Democrat of Louisiana, said today that the plan under
discussion would offer substantial
subsidies to help people purchase
their own insurance. Moreover, Mr.
Breaux said, he does not believe that
the individual mandate would ever
kick in. since, he said, insurance and
market changes would bring atxiut 95
percent coverage. And one aide close
to the talks said there would tie no
real penalty on those who did not
purchase insurance.
Still, many groups long active in
the health care struggle see the legislative process taking an increasingly
conservative turn in the Finance
Committee. And today, they chose to
draw their line in the sand.
The Health Care Reform Project
declared firm opposition to any proposal that relies on an individual
mandate, arguing that It would give
many profitable employers "a free
ride,'" pose a heavy burden on middleincome people and fail to guarantee
universal coverage.
.0^
Paul HoscfroS'The New York Times
I
I
Senator George Mitchell, left, and Hillary Rodham Clinton at a health care rally on Capitol H i l l yesterday.
hi
�NBC THIS MORNING:
Gooti morning, Senator. Thank you v e r y much f o r t a k i n g
t h e t i m e t o t a l k w i t h us t h i s morning.
SEN. DANFORTH:
MR. HARRIS:
Senate Finance
was debuted on
you're t a l k i n g
be i n t r o d u c i n g
Good morning.
Now, your c o a l i t i o n o f moderates on t h e
Committee have p u t t o g e t h e r a p r o p o s a l t h a t
F r i d a y . What i s d i f f e r e n t between what
about and what Senator Moynihan i s g o i n g t o
t h i s week?
SEN. DANFORTH: We're n o t r e a l l y sure what Senator
Moynihan i s g o i n g t o be i n t r o d u c i n g . There i s no document
t h a t I know o f t h a t ' s a v a i l a b l e . A c c o r d i n g t o t h e p r e s s
r e p o r t s , i t l o o k s t o be p r e t t y c l o s e t o what we were
t a l k i n g about l a s t week when a mainstream group o f people
i n t h e Finance Committee g o t t o g e t h e r .
MR. HARRIS: Okay. Looking a t what you d i d p u t
t o g e t h e r w i t h t h e mainstreamers t h e r e i n t h e committee,
what a r e t h e key elements about your p l a n , and what i s i t
t h a t i s g o i n g t o be t h e most a p p e a l i n g t o t h o s e t h a t have
not jumped on board y e t ?
SEN. DANFORTH: W e l l , I t h i n k what's most a p p e a l i n g i s
t h a t t h i s p l a n i s g o i n g t o g e t us t o u n i v e r s a l coverage,
or something d a r n c l o s e t o i t . And i t ' s g o i n g t o happen
i n a matter o f t h e foreseeable f u t u r e .
MR. HARRIS:
How soon
SEN. DANFORTH:
MR. HARRIS:
—
But —
Meaning?
SEN. DANFORTH: W e l l , what we b e l i e v e i s t h a t by t h e
year 2002, 95 p e r c e n t o r v e r y c l o s e t o 95 p e r c e n t o f t h e
American people a r e g o i n g t o be covered by i n s u r a n c e . And
most people who d e f i n e what u n i v e r s a l coverage mean say
t h a t around 95 p e r c e n t i s i t . I mean, t h e S o c i a l S e c u r i t y
system i s a u n i v e r s a l coverage program, and y e t i t doesn't
cover 100 p e r c e n t o f t h e people — maybe about 95 p e r c e n t .
So, t h a t has been p r e t t y much t h e g o a l t h a t ' s been
accepted. And we b e l i e v e t h a t t h i s program w i l l g e t t h e r e
MR. LEVINE:
Senator D a n f o r t h —
SEN. DANFORTH: — b u t i t w i l l n o t g e t t h e r e t h r o u g h
mandates. I t w i l l n o t g e t t h e r e t h r o u g h what amounts t o
t a x i n g t h e p r i v a t e s e c t o r , which i s what mandates r e a l l y
are.
�MR. HARRIS:
Jeff?
MR. LEVINE: Senator D a n f o r t h , 95 p e r c e n t i s a l o t , b u t
5 p e r c e n t i s a l o t when you would c o n s i d e r t h e f a c t t h a t
t h e r e would be m i l l i o n s o f people w i t h o u t medical b e n e f i t s
— and these i n d i v i d u a l s a r e , presumably, t h e working
poor. What's g o i n g t o happen t o them under such a plan?
SEN.
DANFORTH:
I'm s o r r y .
Was t h a t f o r me?
MR. HARRIS:
Yes, t h a t was f o r you.
MR. LEVINE:
I t was,
Senator.
indeed, s i r .
SEN. DANFORTH: W e l l , I t h i n k t h a t t h e g o a l i s t o
expand t h e number o f people who are covered.
And t h a t ' s
what we i n t e n d t o do, and we're g o i n g t o do i t i n a couple
of ways. F i r s t , we're g o i n g t o do i t by s u b s i d i e s . We're
g o i n g t o s u b s i d i z e people who c a n ' t a f f o r d i n s u r a n c e . The
s u b s i d y i n t h i s program goes up t o people who a r e up t o
240 p e r c e n t o f t h e o f f i c i a l p o v e r t y l e v e l , which t a k e s i n
lower m i d d l e income people, as w e l l as low income people.
We are a l s o g o i n g t o do i t by i n s u r a n c e r e f o r m s , so t h a t
people c a n ' t be dropped. People who are h i g h r i s k people
can g e t i n s u r a n c e . People who change j o b s w i l l be a b l e t o
keep t h e i r i n s u r a n c e . So, t h a t i s g o i n g t o t a k e
a l o t o f t h e f e a r o u t o f t h e i n s u r a n c e system as i t e x i s t s
today.
And we b e l i e v e t h a t t h e c o m b i n a t i o n o f i n s u r a n c e
r e f o r m s , and t h e s u b s i d y program, and t h e f a c t t h a t people
w i l l be a b l e t o buy t h r o u g h c o o p e r a t i v e s , as w e l l as
i n d i v i d u a l l y — t h a t these are v e r y p o s i t i v e t h i n g s t h a t
are g o i n g t o expand coverage enormously.
We a l s o b e l i e v e t h a t t h e program t h a t we p u t t o g e t h e r
i s a v e r y good c o s t containment program. And t h e problem
w i t h h e a l t h care i s
t h a t c o s t has gone t h r o u g h t h e r o o f .
So, we have t a k e n
v e r y s e r i o u s l y t h e i s s u e o f c o s t containment.
And we
b e l i e v e t h a t t h i s program w i l l do i t .
MR. LEVINE:
Senator
—
MR. HARRIS: L e t ' s open i t — J e f f ,
i t up r i g h t now t o t h e c a l l e r s . We've
f o l k s l i n e d up w i t h some g u e s t i o n s f o r
t h i s morning.
F i r s t c a l l t h i s morning
we're g o i n g t o open
g o t a number o f
Senator D a n f o r t h
i s from New York.
New York, go ahead.
CALLER: Yes. Good morning, f o l k s . Good morning,
Senator.
My g u e s t i o n i s t h i s , t h e Washington Post
y e s t e r d a y — I'm f a m i l i a r b a s i c a l l y w i t h t h e d e t a i l s o f
�o f t h o s e a r e mechanisms which w i l l c o n t r o l c o s t .
MR. HARRIS: L e t ' s g e t back t o t h e phones now. A c a l l
from A r i z o n a t h i s morning.
Arizona?
CALLER: H i .
MR. HARRIS:
Good morning.
CALLER: H e l l o , Senator. I have watched you and
l i s t e n e d t o you f o r a l o n g , l o n g t i m e . The p r e v i o u s
c a l l e r asked about t h e mandates i n which we have t o pay
f o r 75 p e r c e n t o f your h e a l t h c a r e , and y e t Republicans
are a g a i n s t mandates f o r anybody e l s e . So, I ' l l ask you
something e l s e . L a s t y e a r , i n t h e Budget Committee, you
s a t t h e r e — and some o t h e r s — and none o f you wanted t o
t a k e away t h e d e d u c t i o n s f o r people t o j o i n t h e s e b i g c l u b s
and go o u t and p l a y g o l d f o r f o u r hours o r go t o a
r e s t a u r a n t , y e t you wanted t o c u t o f f t h e COLAs f o r
anybody making over $600 a month.
Now, you a r e on t h i s committee t h a t l o o k s l i k e i t ' s
ready t o do a h a t c h e t j o b on t h e e l d e r l y . And now, what
about COLAs? What a r e t h e s e p e o p l e , 8 m i l l i o n , who c a n ' t
a f f o r d t o buy medicine and t o buy f o o d a t t h e same t i m e —
are y o u r e a l l y g o i n g t o go a f t e r t h e i r c o s t o f l i v i n g when
— and why d o n ' t you p u t up some c h a r t s showing t h a t l e s s
t h a n h a l f o f t h e people i n '92 had over $7,500 a y e a r .
How a r e t h e y g o i n g t o pay f o r t h e i r h e a l t h care?
Medicare
doesn't cover e v e r y t h i n g ?
SEN. DANFORTH: I don't know who p u t s o u t a l l t h i s
1 r i d i c u l o u s i n f o r m a t i o n . Nobody i s s u g g e s t i n g t h a t we c u t
\^off COLAs.
MR. HARRIS:
I f you c o u l d be b r i e f . Senator.
SEN. DANFORTH:
absurdity.
MR. HARRIS:
That i s j u s t —
t h a t ' s j u s t an
We o n l y have a c o u p l e o f seconds h e r e .
I
SEN. DANFORTH: No, we've g o t t o c o n t r o l t h e g r o w t h o f
e n t i t l e m e n t programs.
There's no doubt about t h a t . B u t
we're g o i n g t o do i t f a i r l y , and we're g o i n g t o do i t i n
[ t h e r i g h t way.
MR. HARRIS: A l l r i g h t . Senator John D a n f o r t h , t h e
Finance Committee i n t h e Senate, thank you v e r y much f o r
coming i n and t a l k i n g w i t h us t h i s morning.
�i n d i v i d u a l l y — t h a t these a r e v e r y p o s i t i v e t h i n g s t h a t
are g o i n g t o expand coverage enormously.
-END-OF-AUTOBREAK(1)-AUTOBREAK(2)-FOLLOWS
BC-CNN-DANFORTH
AUTOBREAK (2)
We a l s o b e l i e v e t h a t t h e program t h a t we p u t t o g e t h e r
i s a v e r y good c o s t containment program. And t h e problem
w i t h h e a l t h care i s
t h a t c o s t has gone t h r o u g h t h e r o o f .
So, we have t a k e n
v e r y s e r i o u s l y t h e i s s u e o f c o s t containment.
And we
b e l i e v e t h a t t h i s program w i l l do i t .
MR. LEVINE:
Senator
—
MR. HARRIS: L e t ' s open i t — J e f f ,
i t up r i g h t now t o t h e c a l l e r s . We've
f o l k s l i n e d up w i t h some q u e s t i o n s f o r
t h i s morning. F i r s t c a l l t h i s morning
we're g o i n g t o open
g o t a number o f
Senator D a n f o r t h
i s from New York.
New York, go ahead.
CALLER: Yes. Good morning, f o l k s . Good morning.
Senator. My q u e s t i o n i s t h i s , t h e Washington Post
y e s t e r d a y — I'm f a m i l i a r b a s i c a l l y w i t h t h e d e t a i l s o f
your F r i d a y p r o p o s a l . The Washington Post r e p o r t s t h a t
Senator Moynihan may go ahead w i t h t h a t idea o f a n a t i o n a l
h e a l t h commission making recommendations, i f you don't
reach 95 p e r c e n t — a l t h o u g h , Moynihan s e t t h e year back
from 2002 t o 2000. My q u e s t i o n i s t h i s , o b v i o u s l y , t h a t may
not s a t i s f y President C l i n t o n ' s requirement f o r a
mechanism t o g e t you t o guaranteed u n i v e r s a l coverage.
Would you be i n t e r e s t e d i n changing t h e n a t u r e o f t h e
n a t i o n a l h e a l t h commission's recommendations i n t h e year
2000 so t h a t t h e y would be mandatory — whatever t h e y be
— meaning, t h e y would n o t be s u b j e c t t o a v o t e o f
Congress. And I'm n o t t a l k i n g about f a s t t r a c k , u n l e s s
vetoed by Congress. I'm s a y i n g mandated, p e r i o d .
MORE
BC-CNN-DANFORTH
AUTOBREAK (2)
So,
I t h i n k a l l o f those a r e market mechanisms, and a l l
�SEN.
DANFORTH:
MR. HARRIS:
But —
Meaning?
SEN. DANFORTH: W e l l , what we b e l i e v e i s t h a t by t h e
year 2002, 95 p e r c e n t o r v e r y c l o s e t o 95 p e r c e n t o f t h e
American people are g o i n g t o be covered by insurance. And
most people who d e f i n e what u n i v e r s a l coverage mean say
t h a t around 95 p e r c e n t i s i t . I mean, t h e S o c i a l S e c u r i t y
system i s a u n i v e r s a l coverage program, and y e t i t doesn't
cover 100 p e r c e n t o f t h e people — maybe about 9 5 p e r c e n t .
So, t h a t has been p r e t t y much t h e g o a l t h a t ' s been
accepted.
And we b e l i e v e t h a t t h i s program w i l l g e t t h e r e
MR. LEVINE:
Senator D a n f o r t h
—
SEN. DANFORTH: ~ b u t i t w i l l n o t g e t t h e r e t h r o u g h
mandates. I t w i l l n o t g e t t h e r e t h r o u g h what amounts t o
t a x i n g t h e p r i v a t e s e c t o r , which i s what mandates r e a l l y
are.
MR. HARRIS:
Jeff?
MR. LEVINE: Senator D a n f o r t h , 95 p e r c e n t i s a l o t , b u t
5 p e r c e n t i s a l o t when you would c o n s i d e r t h e f a c t t h a t
t h e r e would be m i l l i o n s o f people w i t h o u t m e d i c a l b e n e f i t s
— and t h e s e i n d i v i d u a l s a r e , presumably, t h e w o r k i n g
poor. What's g o i n g t o happen t o them under such a plan?
SEN.
DANFORTH:
I'm s o r r y .
Was t h a t f o r me?
MR. HARRIS:
Yes, t h a t was f o r you,
MR. LEVINE:
I t was,
Senator.
indeed, s i r .
SEN. DANFORTH: W e l l , I t h i n k t h a t t h e g o a l i s t o
expand t h e number o f people who are covered. And t h a t ' s
what we i n t e n d t o do, and we're g o i n g t o do i t i n a couple
of ways. F i r s t , we're g o i n g t o do i t by s u b s i d i e s . We're
g o i n g t o s u b s i d i z e people who c a n ' t a f f o r d i n s u r a n c e . The
s u b s i d y i n t h i s program goes up t o people who are up t o
240 p e r c e n t o f t h e o f f i c i a l p o v e r t y l e v e l , which t a k e s i n
lower m i d d l e income people, as w e l l as low income people.
We are a l s o g o i n g t o do i t by i n s u r a n c e r e f o r m s , so t h a t
people c a n ' t be dropped. People who are h i g h r i s k people
can g e t i n s u r a n c e . People who change j o b s w i l l be a b l e t o
keep t h e i r i n s u r a n c e . So, t h a t i s g o i n g t o t a k e
a l o t o f t h e f e a r o u t o f t h e i n s u r a n c e system as i t e x i s t s
today.
And we b e l i e v e t h a t t h e c o m b i n a t i o n o f i n s u r a n c e
r e f o r m s , and t h e s u b s i d y program, and t h e f a c t t h a t people
w i l l be a b l e t o buy t h r o u g h c o o p e r a t i v e s , as w e l l as
�included i n h e a l t h l e g i s l a t i o n before the committee, such
as a cap on the r i s e i n h e a l t h insurance premiums, u n t i l
next week due t o disagreements among Democrats. "We are '
s t i l l debating t h a t on our side o f the a i s l e , " said
a c t i n g Ways and Means Chairman Rep. Sam Gibbons, D-Fla.
The committee i s c u r r e n t l y considering a b i l l t h a t
r e q u i r e s employers t o pay 80% o f t h e i r workers' h e a l t h
insurance costs, as does President C l i n t o n ' s Health
S e c u r i t y Act. Gibbons has said he plans t o conclude
committee a c t i o n on the b i l l before Congress adjourns f o r
the J u l y 4 recess a t the end o f t h i s week.
The Ways and Means d e l i b e r a t i o n s progressed as
moderates on the Senate Finance Committee unveiled
a proposal f o r health-care reform which r e j e c t s t h e
employer mandate and other r e g u l a t o r y measures i n t h e
C l i n t o n plan. The Senate moderates opted instead f o r
insurance market reforms, t a x breaks and vouchers f o r the
poor t o help cover a t l e a s t 95% o f the p o p u l a t i o n by 2002.
During C l i n t o n ' s weekly Saturday r a d i o address, he said
Congress and the American p u b l i c should r e j e c t proposals
t h a t don't provide a l l c i t i z e n s w i t h h e a l t h care coverage.
Measures t h a t are " h a l f - h e a r t e d would, a t best, guarantee
t h a t t h i n g s stay only about as good as they are now - t h e
poor would get h e a l t h care, the wealthy would get h e a l t h
care, t h e middle class would get i t sometimes," C l i n t o n •
said.
During Ways and Means a c t i o n Friday n i g h t . Gibbons
o f f e r e d an amendment t o expand the e l i b i l i t y r u l e s f o r
Medicare Part C, a program t h a t would broaden the f e d e r a l
Medicare program t o provide a f f o r d a b l e health-care
coverage t o small businesses and the poor.
Gibbons amended h i s own mark t o increase the l e v e l t o
100 employees from 50, broadening the pool o f businesses
and i n d i v i d u a l s t h a t can purchase Medicare Part C
p o l i c i e s . But p r i v a t e i n s u r e r s oppose the measure,
charging t h a t i t w i l l be d i f f i c u l t t o compete w i t h a
government-financed insurance program.
(MORE) DOW JONES NEWS 06-27-94
8:12 AM
BC-CNN-DANFORTH SKED
THE FEDERAL NEWS REUTERS TRANSCRIPT SERVICE
CNN "MORNING NEWS" INTERVIEW WITH;
SENATOR JOHN DANFORTH (R-MO)
MONDAY, JUNE 27, 1994
TRANSCRIPT BY: FEDERAL NEWS SERVICE
620 NATIONAL PRESS BUILDING
�Moderate health plan may be place
Bid to please all/
won't fly on Hijl
z, J ^e.^ninqs Moss
/.ASHiNGTON ' MES
The compromise health plan
drafted by moderates on the Senate Finance Commirtee last week
: i a good example of what happens
.vnen lawmakers from the politi^ middle meet behind closed
Joors to develop policy.
The plan borrows ideas from
Democrats and Republicans. It
M ^ ^ ^ ^ K , ^ punts un the
vrrYiyc
contentious isi ivi A F ^ / f TC^ '^^^ insurance
.ANALJISIS
mandates.
It
would protect
Amencans from losing their insurance. It would reach to cover 95
percent of the pubhc
But It most hkely would not pass
m Congress.
Liberals will blast the plan because It does not have an automatic
device to force businesses to provide insurance coverage. Conservatives will balk at the new taxes
imposed and are hkely to say it is
btiU a big-govemment solution.
The middle ground — ttiat place
both sides profess a sincere desire
to find but have done little to reach
— is m reality very small.
"WiU the middle hold? That is
the issue," said Rep. Rick Boucher
of Virgima, a conservative Democrat who differs with the majority
of his party on health carc.
That middle will be tested this
week when the Finance Committee takes up the proposal unveiled
Friday by four Democrats and
three Republicans on the panel.
The plan makes uo guarantee
that every .American would have
health insurance in the near future but sets a target to have 95
percent covered by 2002 through
the use of insurance reforms and
other measures If the nation fails
to meet the aoal. a commission will
recommend solutions to Congress,
and lawmakers will be forced to
consider them but not bound to enact any chanues.
Lawmakers irom both parties
anticipated the proposal would
contain a mandate on individuals
to buy insurance if other reforms
did not work in the future The
individual mandate is not an appealing concept tor either side, although for different reasons.
By dropping mandates enarely,
the moderate lawmakers made it
more attractive to conservanves.
although other items — such as a
tax on the more expensive health
And he is almost certain to become the second president, after
Jimmy Carter, to visit black Africa. Speculation is centering
around a tnp early next year
In his speech today, Mr Clinton
is expected to describe a new era
of possibiUties for U.S. pohcy on
Afnca.
Gone is the Cold War in which
African states lined up on the U.S.
or Soviet side. And gone is the
hated apartheid system, now that
South Africa has a multiracial
elected govemment.
Already, the admimstration has
sponsored a conference — last
month in Atlanta — on South Africa's poUtical and economic development.
By Julia Malone
:0X NEWS S£HVICE
This week's conference with
about 150 academicians, reUef
It's far more them a passmg workers, business leaders, and
fancy, say President Clinton's
lawmalcers is billed as an attempt
aides.
to gather fresh ideas on how to
The president, who today will help Africa.
address the unprecedented rwoThe United States "has two
day White House conference on
Africa that opened yesterday, has stark options," President Nelson
quite simply faUen in love with Mandela of South Africa said in a
that popiUous, troubled continent. videotaped message on the conference's opening day. "On the one
Tb be sure, he has yet to overliaul
hand, to succumb to the pessimism
U.S. foreign poUcy toward Africa. of the false perception that Africa
Critics score him for shortctiang- is on a permanent decline," or
ing the continent on aid, for bun"take the cudgels and t>ecome a
gUng the Somalia aid mission and
leading partner" in the revival of
for indecisiveness on the Rwanda
the continent.
massacres.
Mr. Clinton's focus on the subThe White House conference itject inspires both hope and skeptiself almost became a pubUc relacism.
tions calamity. White House aides
"I'm looking at previous adminneglected to invite the Congresistrations," said Melvin Foote, exsional Black Caucus, long a
ecutive director of the advocacy
staimch defender of Africa aid, imgroup Constituency for Africa, a
tU the last minute.
participant in the conference. "We
None of ttiis could dampen Mr.
didn't have this kind of opportuClinton's abiding fascination with
nity to talk to the president about
Africa, say aides. At the drop of
Africa."
the hat, he can tick off the names
Even so, Mr. Foote has been disof successive regimes m remote
African states.
satisfied with the Clinton administration until now. "He's been
When Atlantic Monttily pubcaught up in his campaign promUshed Robert D. Kaplan s article
ise to focus on the domestic
"The Coming Anarchy" in February, Mr. CUnton pored over it,
agenda," Mr. Foote said, adding
scribbling furiously on the marthat there's ""a lack of talent" on
gins to rebut the bleak future it
the foreign poUcy team.
IroubledJ
Africa
fascinates
Clinton i
mm
plans — will continue to raise
strenuous opposition from a majority of Republicans.
But Democrats will have the
most problems with the proposal
because it fails to meet President
Clinton s bortom line: It does not
guarantee that by a specific date
even.' .American will have insurance coverage.
"Vou cannot pass through this
House of Representatives an option [for Congress to do something
in the future |. We have to have universal coverage by a date certain, "
said Rep. .Mike Synar, Oklahoma
Democrat and one of the president's health care cheerleaders.
Republicans know any health
bill with a strictly GOP stamp has
no chance of passage, but it could
be a good political document on
which to challenge Democrats.
'I'm not adverse to the notion
that the election might tell us
something about what the .American people want." said Sen. Pete V.
Domenici. .\ew .Mexico Republican
.Mr Domenici said the feeling
among many Republicans was
that they would have preferred not
to see the moderate GOP members
negotiating with like-minded
Democrats Instead, they wanted
to let Senate .Minority Leader Bob
Dole work out a GOP concensus
plan and remam umf led behmd it.
Other RepubUcans cited politi
cal problems they could have if £
small group of their member;
broke ranks. "Why should we
share the pam with the Democrat:
that they wiU feel" at the polls, saic
Rep Dick Armey of Texas, chair
man of the House Republican Con
ference
Rep. .Al Swift, Washington
Democrat, agreed that RepubUcans are bener off politicaUy by
sticking together "Whether or not
jthe Senate Finance moderate
plan] creates any new problem;
for us. I don't know," Mr. Swift said
•' It leaves us prerry much with thi
same splinters we've always had s(
we don t have any more politica
problems, we ve stiU got the ol(
ones. It"s the RepubUcans with tni
new problems."
The moderates who negotiatei
the compromise understand mor
than most the deUcate nature froii
both a political and poUcy view
point of the tradeoffs mvolved.
"From the standpoint of mysel
and. I think, probably other peopli
as well, we're nervous .. nervou:
about unintended results, nervou
that in attempting to do somethini
good, we do somettiing bad. " sai
Sen. John C. Danforth, Missour
Republican.
�IL(AEVIEW
0"
.0^
& OUTLOOK
Three Blind Mice
I
is that somehow t.ais L'omniission
would be insulated from politics. But
every health lobby would besiege Congress to add in its vntal treatment-the
chiropractors are now running TV
ads-and Congress rarely says no.
(We note the irony of Sen. Danforth.
who is co-chair of the entitlement commission, lecturing the world even as
he supports this new health entitlement.)
The plan imagines about S24.T billion in new spending, if you choose to
believe their guesses. This will be financed by S131 billion in new taxes, including a hit "on the top 40'"c" of all
health plans. So employers and individuals will be penalized for offering
or buying generous health insurance.
This is the begmning of the road to
govemment health rationing.
cope with any mess 0«i e Durenberger
But the worst consequence is that it
they leave behind. The third. Rhode keeps Hillary Clinton's plan politically
Island's John Chafee, represents one alive. The ""moderates" wiil now pass
of the most Democratic states in the a bill through the Senate Finance
nation and was bounced out of his Committee, where it might have
party's Senate leadership in 1990.
stalled. No wonder the First Lady and
The trio are the last of the liberal other liberals have been praising the
Republican Mohicans. They came of '"moderates" even as they refuse to
political age during the Great Society, endorse their plan: they understand
when Democrats voted to create the who's really being fooled.
entitlement state and Republicans
For some time now the White
said me-too. 'Voters understandably House strateg\" has been clear to anychose the real article over the GOP im- one with open eyes: Do anything to get
itation. But the GOP, along with the a bill through tlie Senate with 51 votes;
rest of the nation, changed in the late pass the core of the Clinton bill, in19711s and 1980s. Ronald Reagan sym- cluding an employer tax mandate,
bolized that change, along with a
through the House:
younger GOP generation more willing
combine the two in
tn challenge liberal assumptions.
the smoke-filled
These Members are the GOP future,
room of conference
yet somehow they are now being led
and come back in
around by this trio of Old Bulls.
September daring
the Republicans to
Of course, the implausibility of
filibuster. If they
their '"compromise" was becoming
can
bamboozle a
apparent even before it was ancouple of "modernounced. It included too many taxes
ate"" Republicans
even for Montana liberal Ma.x Baucus,
as political cover,
John Chafer
who pulled out of the talks. Then New
they'll
be
that
much
happier.
.Jersey's Bill Bradley distanced himself because there weren't any manIt is a remarkably partisan stratdates. Apparently we are all supposed egy, and deserves to be met with an
to be pleased that the remaining six equally firm response. There is no naretreated to a smoke-filled room to de- tional consensus for anything like the
cide how our health will be treated for Clinton plan, and no large-scale social
a generation, patting them on the back reform has ever passed in America
because they met their only apparent without a consensus represented by 75
criterion, which is that they can or 80 Senate votes. That is why we've
"agree."
been urging that reform be delayed
until after an election in which health
And while the
care is genuinely debated.
"compromise" .is
less awful than the
We trust Bob Dole understands
Clinton ' plan, it
that if he doesn't filibuster a governdoes move toward
ment takeover of health care, he has
a government-run
no chance of ever getting the GOP
health system. It
nomination for president. Democrats
would establish a
will shout "gridlock," but the polls
"Standard benefit
all show that the voters prefer gridpackage" to be delock over anything like the Clinton
termined by an unOnnfonh
plan. If Republicans can't stand for
elected Health Commission that would principle on something as fundameninevitably fall imder the control of reg- tal as how to manage one-seventh of
ulatory activists (who else would be the U.S. economy, they deserve the
atrmrfed to such a bodv?). The dream fate of the Whigs.
t
So three Republican • moderates "
have joined three Democrats of the
same species to produce a health retorm "compromise."' We hope this effort o^oes the way of the brand of Republicanism represented by the three
GOP senators who struck this dealthat is. into irrelevancy.
Far from standing for some vital
American center, these three Republicans are symbols
of the OOP's minority past. Dave
Durenberger and
Jack Danforth are
retiring this November, but somehow they still claim
to speak for the 40or-more Republicans who'll have to
OS
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2
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s
�Oeleiise c uts eyed; school in Mass. fret
By Bob Hohler
Committee, said he asked Murtha when he
confronted him over tJie proposal. •'You'll kill me
and .4,dn'a.';r!a .\pvzi
with MIT and Harvai-d "
r-.i'-l-i M w; H K^'-.-l
Nroa'-:'.-y .sain Murt.>;a rtpli-d. "Wo lust --^on't
a:, th^' :n:^r(;y fc; aor";r,,>?-|.^:at,-:
WASHINGTON - W. a , . . , , y U x r sossicr, a
oxpi-r.r.o''iar:.:i-"
Ho:i.« patinl ha.s pf'-cf-r-: .= : & s m o r p -raj", tiO
^ Hai--a'a L'r:v--.«-s:r;. wrjid
si;-.:' t.-. Mr.iJ'r^
DO)cent of Pi-c-sider.t i:;..-r,v .'= i^\^>. i:,:';!-,;j: -tir.uost
•j' its
:-r:':;;'! :ri ^.r:€--ii->-r.:ato.j IV?
r;;'
fo)-'iorpnse-;'Giat.?.j. .sr-a't r. it;,.,,, atinr?':uv^cv tr.i: p-an.
:.nnorsiries. :nc:jdir.w' s..-n:>.' ri^-y Bc^tcn-ai^a
^ But M-.a'ri.'.^y said .\r inha ag7'::'-3,J tr rr.c-;t w-.tn
college.?, orTiciais aaiu y.'.^t-'-day.
r.'rr. to discus? the prop. sal. whic'n the till
Authorities iaid Lr; .Appvopnatior.s
.\pprornarion? Comirutiee is 5xpe'.u>d tc con.^^id^r
.v.ibco.T!rJtcee on defrrns^.^ !a3t -.v^ek proposed the cut, Mo.iday. The Ho-o^e cou.d vote or the issue as early
••ATicii. ir' it s-inives d-.c .likT.siative pioteas, couid
•n-.ui.5nay,
ciusr- many u.ni\'Grs;t:?5 .sr.ou.-.o Lho^-ou-itry to lay oi=f
Degpito the ^ubccmnjttee appt oval, oppo.sitior. i '
fsii jliy. .?u.=pand some aid to gra.uuar.^ =ru>i(i;;r,s aiid
expectea to be imt^ns^ du-oughout Congi^s.:, •:x-hic"n
r&i e or olin.Lnat,-; rs.^oavch p! o_3ct£ -'rat Ln scn.e
is unlikely ro maks a f^na: d<?ci.?;'or, or; t.ho nct'^nje
••?.=e;^ 'r.i\-(? beoonc- ra!:rr.a^ ;.-5 r'f rj-.,-';' irsrjcjrion-.
b'idfvii ir.til the fall.
yi-nncrxxi'^'-.s ,;;-.:^, -r ;.5 -A;:a.'d ro
"D; astic c;itbac'Ki l;Wc that m&k? to .-sr.ie ' sair.
•'••our iV.-C nilljon -arrter tr.r...-'r.,-!- •.",4
Ssr..
Fdf.'a M. Kc-n.nircy. -Tius "ef^arch ^ ' '
-rr f^OO -.•.::i:.-,nfton; Cj^"
•eprc-sor:^ t; t backbor.i? r'chi; -a'uojn'j fur,u:-<? iiighI U;rt-nt.sr,.:-.i:-g-,
r^ic.i a<?'c-.n,<c- •/arabfuties and '• 5.', far-'-eac.-.inff '
"It :• >:.jt i.ypcfbKfj tc v«- 'hr ir.'^ n.-t^cuid bo
tc-.'.(;-::.; f.:; the '.-j-.-fOar. ec'in-irp.}-, too. "
•rrn ci.r'^d.rr t. " Kenn. dy •idcar,' ri-ar c.-.c fjii
r ^fi p; :-.i.wCr: ;f :hs ^^:i.;^^^h:::;••^5 I - :;;;u:5 of
H;.iiu5-! x-d Si.nato wj! > ejcct tho;s? -r. ••••.lighted
He. ;T..bf)- va.-;,3 :.:jf.;--o-r::3r..,:i
^arch r..r:.is
iJtj.:.tr..':'.tt..e c'uts."
vo'i.d piur.n".iit '".'•T, .$I5>; r-i]\lr.n .r':>. •:>^r to about
-Much 3''t,hc-dof3nse-rGlatx;d rur-r-ir.g- •.'•nich must
h>? fcr.owed ar^ruaiiy to 00: tinue. is .isoc rot- oa^ic
tl-:? ..'--hr. M-.irlh.-».
}v.'a.'. ^ Dc-rrociat
tx?5(.-..!by or.g.necnr,)?. computer arfl r}h---aicai
' 1 ' T a r 1 - ; Mef--?. . . . . :":t::t'?, ••v.-.x)
.ic.i;dep.ijtmer.ts. .-ifaoiut 20 peror-.t o-'MIT':
-?.:':-aivh ?ui;d.= corr.e fr&rTi the Psotagor,,
il';:.'opi-:;,';,:r:,. riiii
.i;,-;^ -r^t rhe curs
•T!-jj n-ould be a complete dsaster foi MIT,'
ia'y '•j.icri'i." - .•'f 'r'uo-rr-r
3i> ts.
said Dr. David Litater. the ujiiversity's vxs
-•lurro? anri -.t' -u:;f.:-:r:jrT.:.e rx-r n.?Ts x^^ro
prcsidar.t ar;c Jear. for r?^oaj-ch.
'• • "'^.^ .^ -'^ ^' :•
-f^t ;-ft~tev.::ay :r: ';^c prcposed
The pa:r iron, the propcsed cut:; would by
1 o "-v.-.ich v-cii-i lisal 3 v:: :ou3 'riow -x C J- tc; s
acT.is the it&ie. .\ithough oarrent spo.ndint: 'evt.j
' o^'r:- :r;- po'icy foi '
y:iZ-V&.
^ver•: not availahic for all Miisjachu.'^ortc ir-.o'rto.ti -r.s.
:-;i.:' .a .-jri:orr.'^jTt;
•.arse "i-a:
.-rcr:
I'.jr'l r'sutes reflscc Ihp depth of der'ons.i-'-e'accd
i
•!•:-.;,-0 1 to a.^.-.'r- tr.'.ch n:er..?" pilonry ro
fur;d:,'-._i: Wood* H.;le Ocear igraphi^ irisLr.itior.
'. :tO!:nir .lui-^ or: '.:ef;::3^f pxg^-^r..s'ih^r. tc
-i'22,0 tr.:;;;on, I.'ri'ivo-sicy of Massachuoscto, Srt -l
V --r;.-i^ 'uruM? tc-ciiiv.-iogy.
mi;b\i: Boston Univei'sity, ?2,C mil'u'on: a.nd Tuft:'•"A'-at a; .>;-.u doir,^';" Rep. J. .Joseph M-.^asIey. a r-^ivv>i-i;r-.-, j2C'i!,0OO.
; t.-. Bo.'irr.n Domoo: ar and tha,i rr:?j\ OT ILIO Ruii^s
OI.OEIL" iTM- r
CJ
.e
o
e
o
(A
e
QQ
GOP senators muU position on health
By .Jjll Zuck-Tiian
decided what to do. Ka.s?ebaam m a cosponsor of
(liafee 3 on'gmal bOl, biit she has not pai ricipatc'd 01
the r.aiKS vnth Chaf?e'9 ^Toup. When she talks aboW.^..SHINGTON - Ropub'Jc^r-.s on Capital HiJi
h.>alth care, she taiki? aiout fr-usti'auon and
.str-ueded mig.nd'iy ye..terday to tind their pia<-e in
anteitai-.tits in such a big bill,
~m great deha:e aiwut health care.
Ther, Lbei-e is Dave Durenberifer, a Minnesota
.^•^ 1 gi'oup of modet at>5 Seriate Republicans and
Kepubijcan who la reonr.g .at the end of this vear
einociats corfiMued to work on a compiomise
(• or' yea) s, D-.irer.berger has made health CV'-Q a
•ncaltli plan ye.?teiday, the re^i of tho GOP pondi.t^2d
pnncipal oa;i«. He server on the Labor ard Hun-a^-hethor to sign on or' stick with the minon'ty leade»",
Re.^curte-! Commii;tee. which approved a bi'J he did
Hob Dole of Kansas, wbo has promised an
not s'.ipport, on the Finance Committee, which is
altomative bill by next week.
.^oheauloti to begin work dialing a biU on Monday
"Some think the counny will be better off if it's
srd is part of the Chafee group.
not dore," said Sen. Nat-cy Kassebaum, Republican
IXirenber-gar said Dole's planned rr.easur-e i=: a
-t Ivansas. I'm ju^t confosed."
pcaitive step, bolstering whatever compromise bili
Meanwhile, the House Education and Labor
comes out of the Cbafee negotiations. "Dole show^
comnutt^efiru'shedwork on President Clinto-'s bill
this
u the middle gr'ound," Dui'enberger said.
yceterday, voting 26-17 to send it along to the House
he believes Den-.oo-r'ata think the Chafee bill wiU
..onr. .All the Repubh ar^ and two Democrats voted
be an easy vehicle to get a msOority of cotas in thi> •
againgr ic.
t inaiu-e Committeo, bui that they v\111 substitut^^
"They have broken the cliokehoid of spticial
ber .Edward M. Kennedy's bill for it on the floor.
interest and, by choosing to cover eveiyone, have
Bob Dole will make sure that doesn't happen "
•Hood up, instead, for millions of hard-woriting
U-jrenberger said.
rrdddle-class Americans," Clinton said.
Vet Dole has takenfewipesat Dursnbei ger and
Essentially, Republicans are at a crossroads ovei' John Danforth of Missouri, both of whom are
whether to support any health care lerialation at all,
i ijtinng and both of whom have been negotiating
or to wait and let the November electionE sen-e as a
with Democracs. 'They're all good people," Dole
referendum on the issue.
said. But a couple of them are leaving. The rest of
"TVie public haa oecome very" confused and
ua arc going to be aiound here."
ft-ightened of the whole issue, and some Republicans
Doie. however, ia a little mo\ii graceful when it
think Ihey can uke advantagt; of that," said A.
comes to fighting the Democrats than Rep. Newt
James Rdchley, a poJitial science professor' at
Gingrich, the Georgia Republican and House
Georgetown University. "Republitans have difficult
minority whip, Dole haa pi-omised to put together a
decioione to face."'
RepubUcan alternative bill to give hia senators
Dole is looking askance at efforts by three
something to say they are for - political c-over-.
Republicans, led by Sen. John Chafee of Rhode
Yet Gingrich managed to unify DemocTata on the
island, to negotiate a middle-gr ound health biU with
House Ways and Means Committee last week by
.:ever-3l Demoa-atic senator-s.
ack-nowledging that he told Republicans on the
'If IVe got 40 Republicans and they've got three,
committee they should tiy to kill the health bill
T doesn't take a magician to figai-e out where the
car-rently being drafted.
RopubUoans are," Dele said.
But many senatora, euch as Kas.sebaum, have not
01.OB!-: r'Ai'i-'
�DOCUMENT=
8 OF
8
PAGE =
1 OF'^'^^^^S
ACCESS # NOTP41820061
HEADLINE HEALTH PLAN GETS SPLIT VOTE CLINTON WINS 1 COMMITTEE, LOSES 1
Byline:
R.A. ZALDIVAR and BRENDA RIOS Knight-Ridder Newspapers
LENGTH
ESTIMATED INFORMATION UNITS: 4.8
Words: 650
DATE
07/01/94
SOURCE
THE NEW ORLEANS TIMES-PICAYUNE
(NOTP)
Edition: THIRD
Section: NATIONAL
Page:
A3
(Copyright 1994)
Two powerful congressional panels handed President Clinton a
* s p l i t decision on health care Thursday, complicating h i s efforts to
guarantee insurance coverage for a l l Americans.
In a hard-fought v i c t o r y for Clinton, the tax-writing House
Ways and Means Committee voted 20-18 to approve a b i l l that would
meet the president's goal of coverage for a l l and require employers
to help pay for workers' insurance.
The vote gives comprehensive health care reform a fighting
chance of passing the House but does not guarantee i t .
" I don't know i f i t ' s a giant step or a baby step," said Rep.
Dan Rostenkowski, D - I l l . , who was forced to step aside as Ways and
Means chairman after being indicted on corruption charges i n May.
He predicted that changes would be needed i f the b i l l i s to pass
the House.
Rep. William Jefferson, D-La., helped the committee break an
e a r l i e r impasse by suggesting and winning approval for a plan to
provide tax credits for small businesses forced to buy insurance
for "their workers.
"This l e g i s l a t i o n provides consumer choice and health care
secturity, plus nearly 1 m i l l i o n Louisianians w i l l have health
insurance for the f i r s t time," Jefferson said. "Others w i l l end up
with improved coverage and small businesses w i l l get tax credits
and subsidies for providing coverage."
Across Capitol H i l l , the Senate Finance Committee dealt Clinton
a serious blow as i t began drafting i t s version of health care
legislation.
By a 14-6 vote, the committee rejected the key financing
mechanism that would achieve coverage for a l l : an "employer
mandate" that would require businesses to share the cost of t h e i r
workers' health insurance.
"The employer mandate i s a flawed concept," said Sen. John
Danforth, R-Mo. " I t does amount to a tax."
Sen. Donald Riegle, D-Mich., a leading administration a l l y on
the committee, said: "We are asking people to wait for health care
coverage i n d e f i n i t e l y . We default on our moral r e s p o n s i b i l i t y
here."
The vote was a t e l l i n g sign of the Clinton plan's weakness i n
the Senate. Five of the committee's 11 Democrats joined a l l nine
Republicans to defeat the employer mandate. Opponents said i t could
not pass i n the f u l l Senate.
Without a requirement that employers share the cost of
insurance, a large tax increase would be "the only way to finance
coverage for a l l . Otherwise, experts say, Americans must learn to
l i v e with large numbers of uninsured people. Widely quoted
s t a t i s t i c s say 83 percent of Americans have coverage, while 39
m i l l i o n are uninsured.
The seesaw committee votes set the stage for a much larger
battle over the employer mandate l a t e r t h i s summer on the floor of
the House and the Senate. While polls show that the public favors
�requiring employers to help provide health insurance for their
workers, much of the business community i s adamantly opposed.
Three of the five main committees considering health care
reform legislation have now finished their work. The Senate Finance
Committee i s expected to finish by mid-July. A f i f t h panel, the
House Energy and Commerce Committee, announced that i t was
deadlocked over the employer requirement and would not report a
b i l l . The Democratic leadership in each chamber w i l l combine the
committee versions to produce the legislation that w i l l be debated
on the floor.
Clinton hailed the Ways and Means vote in a statement that
pointedly failed to mention the defeat in the Finance Committee.
Calling the vote "a giant stride," Clinton added, "The Ways and
Means Committee understands what the American people want: They
want universal coverage, "they want shared employer-employee
responsibility, "they want costs controlled."
Administration a l l i e s in the Senate said that the Finance
Committee vote i s not the final word and that they would try to
resurrect the employer mandate on the floor.
The vote "means i t can't pass in this committee - that's a l l i t
means," said Senate Majority Leader George Mitchell, D-Maine. But
Sen. John Breaux, D-La., said that i f Mitchell t r i e s to revive the
mandate, " i t would be a meltdown."
End of Story Reached
�Mitchell (D.. Maine), Joined Mr. Cbafee
and the two otiier swing RepubUcans,
Sens. David Durenberger of Minnesota
and John Danforth of Missouri, in supporting the proposal.
If anything, the Ways and Means bill is
This by itself is some tnumpn tor tne
even more dependent .in •"mployer financ'
I president.
Tiiit svBy
it.self
is someframing
tnumpnthetorfloor
tr
carefully
:ng ttian the president s in:!;al prop<3sal.
debate, the House Democratic leadership
And HaAiY STOIT
.
Xnd while trimming prop<.''sed benefits, the
now hopes to use members discomfort to bill
leans :c the left by proposing a Medithe
administration
s
advantage,
pushing
"ttASHi>'GTO.N - A3 Congress goes
;u.'-e-l;Ke insurance plan for small-business
hnmf for the holiday recess, health-care through more-comprehensive legislation.
employees who can t afford private coverreform IS tottenng between compromise The Senate, with looser procedures, will be age.
and a poliucal'showdown that could de- a more difficult arena.
This government-run option is sure to
stroy the chances for major legislation this The temptation to seek cover rather
be a target on the floor next month, but it
than change was seen in events leading up lends Itself to a possible compromise as
The divisions among lawmakers were to the plan put forward by Mr. Dole. Democrats try to reduce the cost of the
dramatized yesterday when major health Whatever the merits of proposal, Mr. Dole employer mandate. The goal already is to
finance committees took entirely opposite himself didn't see the outline crafted
provide low-cost insurance for small empositions on the central issue of whether by his staff unHl the day before- he an- ployers. One possibility would be to save
employers should be required to help nounced the proposal. And many of his more by beginning with a scaled-back
pay for their workers" insurance.
colleagues who quickly embraced the al-^ benefits package, then phase in a more
By a 20-IS margin. House Ways and temative still appear unfamiliar with generous plan over time.
.Means Committee Democrats won adop- many of the details.
The danger for the administration is
The show of GOP unity was accom- that if it moves too far to theright,it risks
Tax Rdlef on Wall Street
panied by some heavy-handed pressure on losing liberal support without having any
Th« Mo.vniliaii health bill would provide the National Federation of Independent
guarantee of winning significant Republipayroll-tax relief for wme jecuritiei
Business to support Mr. Dole's plan. The can support. Among the four Ways and
firms, .\rticle on page \U.
small-business group has been an unre- .Means Democrats opposing the bill yestertion of a landmark bill demanding hugej lenting foe of any employer mandate but day was Rep. Jim McDermott iD.. Wash.),
contributions from business to achieve had expressed support for a plan put the leading House advocate of a governPresident Clinton s goal of universal cover- forward by a bipartisan group of Finance ment-run. single-payer health system.
: The partisan skirmishing provoked a
age. Yet across the Capitol, a little morel Committee moderates.
"Disappointment does not begin to i blunt, bittersweet lecture from the comthan an hour before, the Senate Finance]
panel twice voted 14-6 to kill even standby! cover our response to your sellout: outrage mittee's former chairman. Rep. Dan Rosversions of the same type of employer; does." said Sen. Malcolm Wallop iR.. tenkowski (D.. III.), who said he sometimes
mandate.
I Wvo.i, a finance panel conservative in a missed the days of a Republican White
The sour Senate mood was captured by • letter this week to John Motley, the House, when the GOP had to be more
Republican Leader Robert Dole, holding i .VFlB's vice president. Mr. Modey, who compromising to advance its agenda.
his aching jaw after a visit to the dentist.: was careful to show support for the Dole
The bottom line is, this is a tax. It's a| plan at a press conference yesterday, said
delayed tax. " said the Kansan and would- \his group will likely back floot amendbe presidential contender. Down the street | ments to move the moderate plan to the
at the VVhite House, .Mr. Clinton was| nght.
responding in kind by painting .Mr. Dole s
Within the Finance Committee, a cenown hastily drafted reform plan this week trist bloc led b\ -er- John Chafee (R., R.I.)
as politics as usual. "
remains the tjest hope for some comproIt does a little bit for the poor: it leaves mise. Some liberal Democrats are lending
all the powerful vested-interest groups support to that effort, if only to advance the
with everything they've got, " the presi- bill to the floor.
After the committee's defeat of the
dent said. '.\nd it walks away from the
standby employer mandate, the panel
middle class and small business. "
12-8 to adopt a much milder provision
With the July Fourth recess about to votedwould
take effect if subsidies and
start, the Finance panel may linger tomor- that
market
reforms
to achieve 95% coverrow to try to finish its bill. But the holiday age by the yearfail2002.
then, the
marks a transition in the health debate. measure only would orderEven
a commission to
When lawmakers rtturn. it will move from make recommendations to Congress
as to
disparate committM lafdoms and toward what further steps are needed to reach
the
the floors of both boMMi.
95%
standard.
The administradoo ti hoping that a
A second test of the strength of the
larger forum-and mort-focused choices- centrist
came on an 11-9 vote supwill help its cause. But the fundamental porting agroup
proposed
tax on insurance comissue of whether to adopt any sort of
to discourage them from offering
employer mandate haa become a heated, panies
health plans. Labor unions
partisan battleground, thanks to the strong high-cost
opposed the tax, which is exopposition of the business community and strongly
to raise $14 billion to $17 billion over
its Republican allies. As the Senate vote pected
a
10-year
period, according to preliminary
illustrates, the prospect of compromise on administration
estimates. But eight Demothat key issue is increasingly bleak.
crats, incluling .Majority Leader George
Plans without a mandate must rely on
subsidies to help low-income families that
want to buy insurance. While these voluntary steps couid achieve significant reform, the costs would be so high that they
may be no more politically feasible than
the mandate itself.
Mr. Dole s plan, one of the least costly,
would commit on average about $20 bUlion
annually over tbe first five years. A
group of moderate Republicans Is proposing a more ambitious five-year budget of
S246 billion, or alroott S50 billion a year for
the same period: preUminary budget estimates indicate tte qpual cost of that
j)laa could grow to VMT noo biUtoo annually by 2003 and 2004.,
. .
The choice between suiMtdles and a
mandate shows tww the real diaUenge of
the president's universal coverage pledge
JULY
is an economic one. Iniunnce market
reforms, by thenuelTes. would do little for
millions of poor and worUng-daat tuniUes
that can't afford coverage. But as the
bidding now illustrates, neither party
Is comfortable walking away without
seeming to have tried to do something to
help those families.
Senate,
Of EmP^^^^ Funding Heahh Care
�maintains C l i n t o n ' s plan would ^ ^ s o c i a l i z e ' ' the system.
The r a d i o ad ^ ^urges Congress t o postpone health care
l e g i s l a t i o n u n t i l next y e a r " (EA release, 7/11). WH
spokesperson L o r r i e McHugh c a l l e d the ads an example of
^^scare t a c t i c s and spreading f a l s e i n f o r m a t i o n " (AP/N.Y.
TIMES, 7/12).
COMPROMISING: Two moderates on the Senate Finance Cmte,
John Breaux (D-LA) and John Danforth (R-MO), plan t o meet
w i t h moderate and conservative House Dems, ^^many of whom
have supported'' Rep. Jim Cooper's (D-TN) b i l l . One House
Dem s a i d t h e Finance b i l l ^ ^was the best hope f o r a c t i o n
t h i s year because i t was the only b i l l s t i l l a l i v e t h a t had
s i g n i f i c a n t b i p a r t i s a n s u p p o r t " (Clymer, N.Y. TIMES,
7/13).
MORNING DEBATE: Sen. Maj. Leader George M i t c h e l l : ^^The
e s s e n t i a l elements of reform include h e a l t h insurance f o r
a l l Americans and cost c o n t r o l s . Any b i l l t h a t I present
w i l l i n c l u d e those two p r o v i s i o n s . " Sen. Min. Leader Bob
Dole: ^^What i s u n i v e r s a l coverage, they won't t e l l us.
They keep t a l k i n g about everybody i n America. They know
t h a t ' s not going t o happen, but I t h i n k we're e n t i t l e d t o
a d e f i n i t i o n from the President or Mrs. C l i n t o n ' '
(''GMA,'' ABC, 7/13).
DEFICIT PROJECTIONS: The Admin. '* ^ f u r t h e r lowered i t s
budget d e f i c i t p r o j e c t i o n s ' ' 7/12, but ^^warned t h a t the
red i n k w i l l s w e l l l a t e r unless the h e a l t h care system i s
revamped.'' OMB p r o j e c t e d t h a t the '94 and '95 d e f i c i t s
would drop t o $220.IB and $167.IB r e s p e c t i v e l y , but w i t h o u t
enactment of h e a l t h reform, by '99 the d e f i c i t would r i s e
t o $207.4B (AP/PHILA. INQUIRER, 7/13).
PEROT: Ross Perot's United We Stand America endorsed
the h e a l t h plan proposed by Reps. Roy Rowland (D-GA) and
Michael B i l i r a k i s (R-FL) — ^^a modest h e a l t h care plan
t h a t contains an array of insurance r e v i s i o n s but i s f a r
from President C l i n t o n ' s proposal f o r u n i v e r s a l coverage.''
UWSA spokesperson Sharon Holman said the endorsement w i l l
not a f f e c t Perot's ^^promise'' t o give the RNC $1 m i l l i o n
t o produce h e a l t h care TV specials. WH spokesperson L o r r i e
McHugh: ^ ^ I f Ross Perot r e a l l y wants t o f i g h t f o r
hard-working middle-class Americans and t h e i r f a m i l i e s he
would not support l e g i s l a t i o n t h a t leaves those f a m i l i e s
out i n t h e c o l d " (AP/N.Y. TIMES, 7/12). UWSA release:
^ ^UWSA members f e e l the Rowland and B i l i r a k i s plan comes
c l o s e s t t o meeting the goal t o PUT PATIENTS FIRST''
(7/11). RNC Chair Haley Barbour: ^ ^ I was pleased but not
s u r p r i s e d t o see &1/8UWSA&3/8 endorse an approach t o
h e a l t h care reform t h a t solves the problems f a c i n g h e a l t h
care w i t h o u t d e s t r o y i n g the system'' (RNC release, 7/12).
BREAK W/TRADITION: With the r e t i r e m e n t s of Dem Sens.
George M i t c h e l l (ME), David Boren (OK) and Don Riegle
(MI), t h e a l l - m a l e Finance Cmte may f o r the f i r s t time
have female members. Several Dem contenders: Sens. Carol
Moseley-Braun ( I L ) , Barbara Boxer (CA), Bob Graham (FL) and
Richard Bryan (NV) (USA TODAY, 7/12) .
�J3)
THE LEGISLATION
Leaders Begin Job of Stitching It All Together
By ADAM CLYMER
Special (0 The New Ynrk T i m r s
WASHINGTON, July 12 - Democratic Congressional leaders today
began the delicate process of trying
to reshape health care legislation,
seeking some formula that could
transform varying bills adopted bv
lour committees into new measures
capable of winning 218 votes in the
House and 51 in the Senate.
The leaders' first efforts were tentative. There were meetings and telephone conversations intended to
make clear to the committee chairmen, as gently as possible, that their
bills would have to undergo changes'
before the full House and Senate voted on them.
The Senate majority leader,
George J. Mitchell of Maine, assured
his Democratic colleagues at lunch
that he wanted all their views before
he went forward. He is trying to discourage the development of olher alliances during his efforts to assemble
a majority behind a bill that would
guarantee health insurance for all
Americans and would probably include some requirement that employers pay a major share of the cost of
insuring their workers.
President Clinton has insisted that
Congress adopt a measure guaranteeing universal coverage, and he has
argued that employer payments are
a necessary tool to reach that goal.
The bills approved by the House Education and Labor Committee, the
House Ways and Means Committee
DIARY
Health Care Developments
DEVELOPMENTS YESTERDAY
Trie process of melding committee bills began, and ttie
Aaminislralion planned its sales campaign
IN CONGRESS
Informally and in small groups, senators met with senators
representatives met with representatives and staff mempers met with
eacti ottrer
Senate Senator George J Mitchell, the maiority leader, renewed his
call for legislation providing universal health coverage and said he
would keep the Senate in session until legislation was voted on
House Democratic leaders met to map strategy
THE WHITE HOUSE
The Administration s allies are organizing bus caravans to travel ttie
nation drumming up support lor universal coverage
and the Senaie Labor and Human
Resources Committee would all require such payments.
Despite Senator Mitchell's attempt
to keep Democrats behind the leader-
ship's effons, a bloc of moderates set
to work on their own today, proselytizing for an approach that they had
pushed through the Senate Finance
Committee. That bill has the more
modest aim of raising the level of
coverage to 95 percent by the year
2002.
Two of those moderates — Senators John B. Breaux, Democrat of
Louisiana, and John C. Danforth, Republican of Missouri — plan to meet
on Wednesday with moderate and
conservative House Democrats,
many of whom have supported a bill
offered by Representative Jim Cooper, Democrat of Tennessee. The
Cooper bill would rely heavily on
changes in insurance laws and, although it would require employers to
make insurance available to workers,
It would not require employers to pay
for it.
THE
NEW
YORK TIMES.
WEDNESDAY
JULY
13. m-i
One House Democrat, who insisted
on anonymity, said the Finance Committee product was the tiest hope for
action this year because it was the
only bill still alive that had significant
bipartisan support.
Mr. Mitchell sought to show the
Senate that he was serious about action on health care legislation. He told
the members that the current legislative session, scheduled to end for a
four-week vacation on Aug. 12, "will
be extended as long as necessary" to
get health care and other major bills
passed.
He also told them that the Senaie
would even start working five-day
weeks, although not this week or next,
with votes possible even "late Friday
evening," The Senate usually does not
schedule votes on Monday, and if it
meets Friday it usually stops voting
by 3 P,M. so that the members can
get home to their states for a full
weekend of politicking and fund raiv
ing.
t-i"-/
�PM-PA—Moderates in the Middle,790
, • i'
^I^BH'
B i p a r t i s a n Senate Group Holds Key Votes i n Health Reform
••
Eds: NOTE H a r r i s Wofford quote i n f i n a l graf
' ' '
By NITA LELYVELD= Associated Press Writer==
.
WASHINGTON (AP) Sen. Bob Kerrey ran f o r president against B i l l
Clinton
advocating a government-run, single-payer health care system. Now, he says
even the compromise health plan proposed by Senate Majority Leader George
v,
M i t c h e l l has too much government f o r him.
•'•',
Kerrey, D-Neb., i s one of several Democrats who meet r e g u l a r l y w i t h
moderate Republican colleagues John Chafee, Dave Durenberger and John Danforth
i n what they c a l l ""the mainstream group.''
While the group sometimes seems tenuously held together by a mix of fuzzy
concepts and concrete demands, i t has survived. And clear p l a t f o r m or not i t
has positioned i t s e l f f o r maximum c l o u t i n the h e a l t h reform debate.
I t s Senate Finance Committee members came together t o oppose r e q u i r i n g
employers t o buy t h e i r workers' h e a l t h insurance. And they stuck together t o
shape the panel's b i l l , which has no such mandate on employers. Much of t h a t
b i l l i s i n the plan t h a t M i t c h e l l has taken t o the Senate f l o o r .
The "mainstream"' members hope t o w i e l d equal influence i n the debate on
Mitchell's b i l l .
""Our goal i s t o hold together a b i p a r t i s a n group of senators who would be
the swing voters and would stand together u n t i l a b i l l i s f i n a l l y enacted and
would vote against the e n t i r e b i l l , i n c l u d i n g the conference r e p o r t , i f i t
doesn't meet the c r i t e r i a t h a t we t h i n k are e s s e n t i a l c r i t e r i a , ' ' Danforth
said r e c e n t l y .
;i
Among the key c r i t e r i a , says the Missouri Republican, are serious
mechanisms f o r cost containment, w i t h an emphasis on marketplace s o l u t i o n s
rather than through heavy government r e g u l a t i o n . The group also i n s i s t s on
reform t h a t encourages i n d i v i d u a l s t o make responsible decisions about t h e i r
health care and provides i n c e n t i v e s f o r businesses t o continue t o f i n d
innovative ways t o cut costs and improve coverage.
' ;
""Only i f the C l i n t o n Democrats r e a l l y need h e a l t h care reform w i l l we be
successful,'' said Durenberger, of Minnesota. ""We're a dozen i n the middle.
We know t h a t the f o l k s t h a t don't want t o do h e a l t h care reform are
predominantly on the r i g h t . I f the f o l k s on the l e f t r e a l l y want t o do health
reform, we give them a b i p a r t i s a n way t o do i t . • •
One Democratic member of the group, Kent Conrad of North Dakota, has
already peeled o f f , saying the M i t c h e l l b i l l s a t i s f i e s h i s concerns. But most
members of the ""mainstream"' group are convinced M i t c h e l l ' s b i l l i s too
r e g u l a t o r y and are committed t o opposing even h i s weakened requirement t h a t
employers help pay.
Wooing the ""mainstream"' group i s important t o Democratic leaders'
strategy.
They can hardly spare the votes of the group's Democrats, who include
Joseph Lieberman of Connecticut, John Breaux of Louisiana, B i l l Bradley of New
Jersey and David Boren of Oklahoma.
And with James Jeffords of Vermont, the sole Republican co-sponsor of
Clinton's plan Durenberger, Danforth and Chafee remain t h e i r best bet for
bipartisanship.
As Kerrey l i k e s to say, ""the road to bipartisanship runs through the >
o f f i c e s ' ' of the three moderate Republicans.
Republican leaders also have a stake in the votes of the mainstream
Republicans. After a l l , nearly every Republican senator except Chafee,
Danforth and Durenberger has signed on to Minority Leader Bob Dole's health
proposal.
The three Republicans i n the group also face an added pressure in t h e i r
own long history of thinking about and working on health reform. They worked
together for years on a Senate Republican health task force, with Chafee
chosen by Dole to be chairman.
""This started four years ago, probably longer than that,"' Danforth said.
�In the Senate where Kentuckian Wendell Ford i s the Democratic whip the
Finance Committee b i l l c a l l s for a $1 increase; a b i l l passed by the Labor and
Human Resources Committee slaps a $1.50 tax increase on a pack of cigarettes.
The current tax i s 24 cents a pack.
Liberals are coming at the leadership from a different direction.
Proposals for a single-payer system the government would pay a l l medical
b i l l s enjoy the support of 92 House Democrats, although some have already
endorsed a Clinton-style b i l l as well.
The most prominent single-payer advocate. Rep. Jim McDermott, D-Wash.,
voted against the Ways and Means Committee b i l l i n what one Democrat termed a
'"wake-up c a l l " ' to the leadership.
A key demand: a provision allowing states to establish single-payer
systems without a Ways and Means Committee-passed provision that exempts
large companies. Since insurance companies are unenthusiastic about
single-payer systems, t h i s creates additional headaches for the Democratic
leadership.
The most intractable p o l i t i c a l issue of the age abortion also looms.
The b i l l s passed by House committees include abortion as a benefit to be
incliaded i n insurance plans. The Senate Finance Committee which imposes no
requirement for businesses to cover their workers permits firms to exclude
abortion services from coverage supplied voluntarily.
Thirty-five Democrats notified Gephardt several days ago they would oppose
any b i l l that covers abortion. More than 65 Democrats returned f i r e on
Wednesday, threatening to bolt i f the f i n a l b i l l doesn"t include i t .
""We"ve got to come up with some formula that doesn't infringe on anyone's
rights,"" says Bonior.
One possible compromise: offering side-by-side insurance plans with and
without abortion, doesn"t seem to s a t i s f y either side.
Says Sen. John Danforth, R-Mo., a key swing vote i n the Senate and an
abortion foe: ""The whole enterprise (of health reform) could founder on t h i s
subject.''
f i l e d by:APE-(—)
on 07/14/94 at 23:54EDT ****
**** printed by:WHPR(160) on 07/15/94 at 07:28EDT ****
****
�REP. DAVID E. BONIOR
.. bishops-stance could have impact
BY LUCIAN PtRKiKS—TME w » S « W G T r » ,
From left. Democratic Sens. Moynihan, Mitchell and Kennedy confer on healtti
care refonn legislation In the Capitol
Abortion Issue Divides Health Care Suppor
Both Sides Threaten to Withhold Backing Unless Benefits Provisions Meet Jli
By David S. Broder
and Kevin Meriaa
Wuhmtnoa POM Sutl Mntcn
Backers of the Clinton administration health plan confronted threats
yesterday from boUi sides of the abor•tion issue that they may withhold
:their votes unless the benefits package in die bill meets their demands.
The abortion battle escalated draImadcally as Uie nation's Roman Cathj^Iic bishops announced a national
campaign to pressure Congress to
.abandon abortion coverage. House
Democratic leaders said 35 or 40
anembers otherwise supportive of the
measure might vote no because of the
.•abortion quesbon. But abortion nghts
•lawmakers countered with a list of 72
House members who say the hnal bill
;"must contain" such coverage.
: Meantime, a group of moderate
House Democrats and Republicans
emerged from a caucus saying they
•will insist on a floor vote tor the
•scaled-back alternative to the admin•istration's universal-coverage plan
•that they hope to craft. They want
eoual treatment with the version of
the Clinton pian the House Democratic leaders are wnttng and one
sponsored by advocates of a smgiepayer, Canadian-style plan.
If the moderates are able to come
up with a compromise it could complicate the already chancy prospect
of holding 218 Democratic votes lo
pass a Clinton-like bill on the House
floor next mondi.
Three congressional committees
have approved health bills m which
abortion is included in the standard
benefit package that msurers would
be required to sell and that employers would be compelled to purchase
for their workers. A fourth panel,
the Senate Finance Committee, produced a bill that uicludes no emplover-financed insurance requirement
and contains a provision allowmg
businesses to exclude abortion coverage from insurance they buy voluntarily for theu- employees.
The line m the sand drawn by the
National Conference of Catholic
Bishops was considered significant,
given that the bishops support Clin-
TODAY IN CONGRESS
SENATE
M««tj i t 8 45 a.m.
Commrtte«
A p p r o p n j t t o n i — 1 0 a m VA HUD 1
inaepaem a g e n o n suBc. mark up vetsrars
attairs 4 housing approo. bill. 138DirKsen
Ottic* BlOg
A p p r a p r l M t o n t — I B O p m Markup
penaing legislation. S-128 Caprtol
I r m r n A Natural R M o u r c M — 9 30 a m
Soentitic & technological t u s a t w raoon
policy. 356 0 0 8 .
GovwnnwnUI A f M r « — 1 0 a m Markup
pending legislation, 342 DOB
Indian A H a i n — 9 30 a m Native American
Cultural Protection & Free tiercise ol
Religion AO of 1994. G-50 DOB
Judiciary—9 30 a m. Closed. Nommano-ol Stephen G. Brever to De an associatilusiice of Supreme Court. 216 Haa Otticf
Biag
Rule* I , Administration—9 30 a m LiDrary
ot Congress operations. 301 Russell Ofnce
ewg.
Vaterani Affairs—2 0 m Mark uo veterans
health care retomi legislation 418 ROB
Salaet lntal(lg»ne»—2;30 p.m. Cioseo
Pending intelligence matters. 216 HOB
HOUSE
Meets at 10 a m.
Committees:
A f r l a i l t u r t — 1 0 : 3 0 a m General larm
commodities sut)c. 1302 Longworth House
OHice Bldg
O i s t r k t o l Colufflbi»—10:30 a m to
amend Distnct of Cdumbia Self Government
4 Governmental Reorganization Act 1 3 ' LHOB
E d u e a t l o n A L a b o r — I I a m Eiementa-,
secondarv & vocational eoucation succ
2175 RavDum House Office BIOE
Education 4 U b o r — 2 o m Laoo'
stanoaros. occupational saietv 4 hean suDc. to amend Fair LaPor standards Ac- I 9 3 a 2 2 6 1 RHOB
t n e r f y 4 Commerce— 10 a m. Heaitn &
environment subc. 2322 RHOB
Enerfy 4 Comnwrca—10 a m t n e ' t r . i
Dower SUDC. on Energy Poncv A a ot 15= "
2123 RHOB.
Energy 4 Commerce—9 30 a rr
telecommunications & finance SUDC ma-.
up Unlisted Trading Pnvileges Act of 1994,
4 Federal Communications Commission
Auth. Act of 1994. 2218 RHOB
Foreign Altairs—10 a m Asia 4 Pacific
suDc. 4 intemational security, international
organizatioits 4 human ngnts suOc. on
Taiwan, 2172 RHOB
F e r t l f n Affairs—1 p m. Western
Hemupnere affairs suDc. mark up. 2200
RHOB.
House Administration—I 30 p m
Occupational Safety 4 Heaitn Aommisttation
compliancs. H-328 Capitol
Judldary—10 a m. Oime 4 criminal lustice
suPc. 226 RHOB.
Natural Rasourcas—10 a m insular &
international aflBirs SUDC. 1324 LHOB
Natural Resourcai—10 a m National
parks, forests 4 ouoiic lands suOc. 340
Cannon House Office BidE
Post O f f k e 4 a v i l Service—10 a m
Postal ooerations 4 services suBc. to amend
U.S. Code. 311CHOB
Public Works 4 Transportation—9 30
a.m. Water resources 4 environment subc
2167 RHOB.
Seianc*. Spac* 4 Techndegy — 1 0 a m
mark up Risk Assessment Improvement Act
of 1994.2318 RHOB
Scianca. Spac* 4 Tedinology— 1 ;30 p m
Energy subc. Dept of Energy's Hydrogen
Researoi 4 Developmenl Program. 2318
RHOB.
Sclenea. Spaca 4 T e c h n o t o g y - 3 30 p m
Energy subc. Propane Eoucatron 4 Researcn
Actof 1993. 2318 RHOB
Small BuainMt—9 a m. mark up
legislatron. 2359 RHOB
Ways 4 Means—10 a m. Work £,
Responsibility Act of 1994. Health & Huma-i
Services Sec. Donna E, Shalala 1100 LHOB
Ways 4 Maans—3 D m walk.fhrough to
consider draft legislation impiementini;
GATT aereement. 1100 LHOB
Permanent Salact Intelligence—1 D m
pnysical searcnes witnin U S. (or foreii^n
Intelligenca Purposes. 2118 RHOB
ton s goal of universal coverage. fD-Ga.) and Michael Bilarakis il
House Democratic Whip David E. Fla.).
Bonior (D-Mich.), who is antiaborCooper said the caucus .igrepfi •
tion himself, said the bishops' oppo- "send a letter to the leadersniu ;
sition couid have an unpact on 35 to sisting that a bipartisan altem,iii\
40 House Democrats.
(to the Cluiton-backed bill) be cov
The bishops plan to back their po- sidered on the floor" and formen
sition with exhortations to church- smaller group, including the ifv:
goers in their 25.000 parishes to lead sponsors, to attempt to drn:
flood Congress with antiabortion tiiat alternative.
messages, and they also plan an adThey heard two of the members '
vertising campaign on die issue.
the bipartisan "gang of seven." whi.But abortion-rights supporters steered the Senate Finance Comm:'
fought back at theu- own news con- tee away trom universal covernce at
ference. " I resent that certain reli- employer mandates, tell them tne
gious groups are enteringtinspoliti- had to "set your o\^'n bottom line ^v.
cal fight in Congress." said Rep. Don stick to It." Sens. John B. Breau.x (i
Edwards (D-Calif.). adding: "We La.) and John Danforth (R-Mo.) w."
ought to fight on a different field."
quoted as saying Uiat it was the ai;
At the news conference, a letter, mant posiuon taken by their ero
drafted by Reps. Peter DeFazio (D- Uiat overcame pressure from (Teor;Ore.) and Patricia Schroeder (D- J. Mitchell (D-Maine) and other a
Colo.) and signed by 70 other mem- ministration allies on the committt'v
bers, was released. Addressed to
Forging bipartisan legislauon m.'
House Speaker Thomas S. Foley CD- be much harder in the House, stv;
Wash.), it said that "we feel com- al of those who organized vestppelled to convey to you our strong day's meeting acknowledged. "!•
commitment that any health care re- one Uiing to get seven senators ;
form package that comes before the stick together," said Grandv. "IHouse must contain coverage for something else to get 218 Hou contraceptive and abortion services members in bne."
if it IS to gain our support."
The Cooper-Grandy bill relies
It was unclear how many of the 72 taxing health plans with nch beneiisignatories to the DeFazio-Schroe- and a somewhat similar proposal :
der letter were willing to kill health part of the Senate Finance (ximmi'
reform over the abortion issue, but tee bill. The House Republican
DeFazio esunated that number at ership has adamanUy opposed ,ip
more lhan 50.
broad-based taxes to finance he.il;
"That [issue] is not negotiable, it care and none are included in tii'
is not discussionable. it is not com- Rowland-Bilirakis measure, whic
promisable." said Rep. Jerrold Nad- offers a more limited benefit pai>
ler (D-N.Y.). "We're saying there's a age and no clear timetable for insur
- hard line here. There will not be a ing_ail the uninsured.
health care bill without aboruon covGrandy said he planned to mc;
erage m It, period."
today with House Republican lev
Democratic congressional leaders ers. but a senior (X)P memwer A
are anxiously seeking a compro- attended yesterday's meeting i mise—but going about it gingerly. dieted that it would be "h.irfl to ;
The issue was broached m "carefully bipartisan agreement in the Hm;
measured tones" at a House-Senate because so many Repubbcans i. .
leadership meeting yesterday, ac- their hands are tied on anything t:,
cording to one source, indicating the smacks of taxes."
sensiuve nature of Uie discussions.
Whether a bipartisan altemitr.
House Majority Leader Richard A. would be given a shot on the HouGephardt (D-Mo.) and Bonior have floor is unclear. A spokeswoman i- •
been testing the abortion issue on (Jephardt was noncommittal, savui.;
about 100 moderate and conservative "^e'U have several altemaiiyes c
House members, who have expressed the floor and we'll take a look .::
a vanety of concems about the health what they are proposing."
measure. Bonior has been floating the
Under House procedures, a bipv
idea of universal coverage Uiat would tisan alternative would have to rprovide employees widi Uie option of "made in order" as a floor amendchoosing a plan with abortion services ment by the leadership-controlle:
or one that excludes them.
Rules Committee, or it could not cMeantime, about three dozen rep- considered. Cooper wamed Uiat
resentatives and an equal number of have blocking power if we need t
staff members standing in for oUier use it. but we hope to avoid it."
members met at mid-afternoon to
The threat would be to unite Flaunch an effort to get a less ambi- publicans and enough moderate a.,
tious plan than Clinton s to a House conservative Democrats to "ove'floor vote. The meeune mcluded co- turn the rule." forcing the leadersr.;;
sponsors of two maior oiparusan bills, to aliow other lloor amendments
one dratted by keps. ,lun Cooper (D- they wanted to cet a vote on t:
Tenn.) and Fred Grandv (R-lowa) and version of the Clinton pinn now i- tne other bv l^eps. J, Kov Rowland ing craned in Gepnardt s oiiu-.
�What Senators Are Saying
S
enators had a wide range of reactions to the latest
movement on health care, which included the emergence of the "trigger" concept. Under it, the government
wouldn't impose a requirement that employers contribute
to their workers' health insurance costs unless market
forces had failed to achieve the goal of affordable coverage
for all Americans by a certain date. (Story, p. 1612)
Following is a sample of their comments:
"The trigger is a concept that a lot
of people on either side can grab on to.
It could work for me, it depends
what's in it. It has moved the debate."
—Max Baucus, D-Mont.
"We will come to universal coverage in three, four or five years. Is that a
long time in the history of the Republic?"
—Bob Packwood, R-Ore.,
ranking member
on Senate Finance
Committee
"The so-called hard trigger idea is
no better than an employer mandate."
—John C. Danforth, R-Mo.
"The thing that counts is universal
coverage. If you don't have universal coverage, you don't
have health care reform.
"The question is: Do Republicans really want health
care reform'.' . . . Every time we offer a compromise, they
back off. . .. This raises the genuine question of whether
we are being obstructed.
—John D. Rockefeller IV. D-W.Va.
they would fit into the work being
done by House committees.
Bul the mood among House Democrats was more optimistic and feisty
than it has been ail year on health
care. That exuberance reflected their
victory in crucial votes on Ways and
Means after defeating a Republican
strategy aimed at killing the committee's hill.
Ways and Means Republicans, at
the urging of (lOF Whip Newt Gingrich of Georgia, had attempted to defeat a crucial Democratic amendment
to the health bill.
The amendment made a number of
concessions to business in order to win
moderate Democratic voles Cor the
bill.
Re[)uhlicans forced each concession to be considered separately in the
hope that the Democratic coalition
would fall apart. But i l had the opposite effect: Democrats uniled and
passed the amendment on a straight
party-line vole.
"What Ihey [Republicans] really
want is the political victory of
failure." said Rep. Vic Fazio, D-(Jalif.,
who is also chairman of the Democratic Congressional Campaign Committee. Gingrich countered, "When
the Democratic leadership gels excited and says the Republicans won't
lf)14 — J I M ' . IK. l'''M
CQ
"We're not so sure of what we are
doing in health care that we ought to
make such revolutionary steps so
quickly."
—David L. Boren, D-Okla.
"There is a general agreement that the goal ought to be
universal coverage, but then it gets to be sort of what
mechanisms do you use to get there? [The trigger] is a
critical ground for compromise."
—Kent Conrad, D-N.D.
help pass health care that's because
they define the Clinton plan as the
only thing."
However, the Republican strategy
played into standard Democratic leadership ladies for uniting rank and file
Democrats by reminding them that it
is a Republican goal to divide them.
Overall. House Democratic leaders
appear lo be pursuing dual strategies.
The chairmen of key health committees are pushing members to support
strong bills thai closely resemble Clinton's original proposal with an employer mandate. At the same time, the
leadership is making an all-out effort
lo determine what kind of bill will be
able lo command a majority of votes
on the floor. They are canvassing
members aboul the committee bills,
but also about the possibility of a hard
trigger, according to leadership aides.
"The key factor is that we need to
pass legislation that says there will be
some point in the future when everybody has insurance," said Majority
Leader Richard A. Gephardt, D-Mo.
(jephardt's involvement on health
care sharply intensified over the past
three weeks and he says he now is
spending "Iwo-lhirds of every day" on
the issue — an extraordinary amount
of lime lo work on a bill so far in
advance of floor action.
The biggest obstacle to House passage of the mandate is that Democrats
fear they will be forced to vote on it,
only to have the Senate water it down or
reject it altogether. That would leave
House members with an unpopular vote
on their record in an election year.
A similar situation occurred on a
1993 budget vote, and the experience
left many House members skittish. In
the budget debate, as soon as the
House passed the unpopular Btu energy tax. the Senate announced it was
dropping it altogether and supporting
a much smaller gasoline lax instead.
Clinton immediately went along with
the Senate, and House Democrats fell
betrayed.
" I won't do that again," said Rep.
Karen Shepherd, D-Utah, a freshman.
"The Senate has to make the primary
decision about the financing system."
But some members say the health
care debate is different in many ways
from the budget vote because the
House and Senate are working simultaneously on the bill and because
Clinton has maHe it clear he will fight
for universal coveiage.
" I wouldn't say that the fears are
gone.. . . but if we always wait for the
Senate, it's unlikely that anything will
happen," said Rep. Sander M . Levin,
D-Mich.
•
�DOCUMENT=
2 OF
3
PAGE =
1 OF
ACCESS # SLMO42010231
HEADLINE SENATORS SEEK ACCORD ON ABORTION COVERAGE
Byline:
Charlotte Grimes Post-Dispatch Washington Bureau
LENGTH
ESTIMATED INFORMATION UNITS: 3.5
Words: 437
DATE
07/20/94
SOURCE
ST. LOUIS POST-DISPATCH
(SLMO)
Edition: FIVE STAR
Section: NEWS
Page:
06A
(Copyright 1994)
*
In a search for common ground on health care, four of the
Senate's women Democrats and three male moderates from both parties
stumbled over the abortion issue Tuesday.
*
The most d i v i s i v e issue for them, said Sen. John C. Danforth,
R-Mo., one of the moderates from the Senate Finance Committee,
remains whether abortion coverage should be available at taxpayers'
expense for poor women on Medicaid.
"The common ground has to be that whatever i s done about health
* care should not advance the cause of either side," Danforth said.
He has been a staunch opponent of abortion.
Women's rights groups have maintained that, for women, health
care includes access to abortion and reproductive health-care
services. For them, part of the health care debate has been a way
to assure abortion coverage for poor women on Medicaid. From 1977
to l a s t October, Congress blocked federal funding for Medicaid
coverage of abortions, except to save a pregnant woman's l i f e .
Congress amended the law l a s t October to also include payment i n
cases of rape or incest.
The women senators - Carol Moseley-Braun of I l l i n o i s , Barbara
Mikulski of Maryland, and Dianne Feinstein and Barbara Boxer, both
of California - had sought the meeting as members of Congress
looked for coalitions and a l l i a n c e s that might smooth the way
toward a consensus, bipartisan health-care b i l l . Moseley-Braun, who
was due for a speech, had no comment as the senators scattered
after t h e i r meeting.
Mikulski, the senior woman among the Democrats and acting
spokeswoman, praised the moderates for working with would-be
opponents. But she also guickly rejected a key component of the
Finance Committee's compromise measure - a so-called "conscience
clause" that would allow employers, hospitals, doctors and
insurance plans to opt out of abortion coverage. The conscience
clause for insurance plans i s a major objection of abortion rights'
supporters.
"We don't think a plan has a conscience," Mikulski said.
Other senators attending were John B. Breaux, D-La., and John
H. Chafee, R-R.I.
In a r e f l e c t i o n of much of Congress' attention to health care
in these l a s t weeks leading up to an expected vote i n August, the
women senators and their male counterparts chiefly were opening
communications with one another across the divisions of t h e i r
interests. They struck no deals, came to no conclusions but agreed
to keep talking.
As one congressional aide described the series of s h i f t i n g
meetings among members looking for compromises and coalitions, t h i s
i s "the floating crap game" phase of Congress' work on health care.
@Art: PHOTO
@Art Caption: (1) Photo Headshot of (Carol) Moseley-Braun. (2) Photo
Headshot of (Dianne) Feinstein. (3) Photo Headshot of (Barbara)
Boxer. (4) Photo Headshot of (Barbara) Mikulski
�Clinton gives in
on coverage for
all Americans
Hillary sticks
to position
By Frank J Murray
THE WASHINGTON TIMES
Moments later, Mr Clinton dramatically blinked, offering to retreat on guaranteeing universal
coverage and employer mandates
ana at one point he even asked understanding for his Republican adversary
"Let's be fair to everybody including the leaders of the other
party, Mr Chnton said when the
chairman of the National GoverAssociation, Carroll Campbell, South Carolina Republican
bluntly corrected the accuracy of
a question f r o m Kentucky's
Democratic Gov Brereton Jones
In phrasing his question, Mr Jones
had misstated Mr Dole's comments
BOSTON - President Chnton
yesterday offered surprising semantic concessions on health care i
reform while his wife, who designed the admimstration's bill, insisted that universal coverage
makes "moral, economic and social sense."
Senate Minority Leader Bob
Dole, who addressed the nation's ^
governors before Mr Clinton, said
On Capitol Hill, lawmakers ofhe has the votes to defeat an\ effor
fered cautious comments about
to force employers to pa. ti.r
.Mr Clinton s remarks, unsure how
health insurance, and the p i . ,
dent backed away from the "em- his statements should be interployer mandate," one of the key- preted
" I don't see anything different in
stones in his plan but never
it," said Sen. Edward M. Kennedy,
veto-bait like universal coverage
Massachusetts Democrat. " I know
"We know we're not going to get
you can't reach universal coverage
right at 100 percent, but we know unless you have a single-payer systhat you've got to get somewhere
tem or a shared-responsibility sysin the ballpark of 95 percent or
tem."
upwards." Mr Clinton said yesterSen. John D. Rockefeller IV,
day. In his State of the Union adWest Virginia Democrat and andress, the president had pledged
other strong backer of Mr Clinto veto any bill that does not guarton's original health proposal, said
antee private insurance coverage
he would be "very disappointed" if
for every Amencan.
the president's comments sigIn an interview earlier yesternalled a retreat. But he said he
day on ABC's "Good Morning
interpreted the remarks as reAmerica," first lady Hillary Rodmaining true to Mr CUnton's goals.
ham Clinton took a hard stance,
"It was something that's been
saying, "The only thing that will
said many times before," said Senwork is to get everi txidy into the
ate Majority Leader George J.
system."
Mitchell of Maine. " I don'l think
She laid the groundwork several
the president walked away from
weeks ago, however, in an interemployer mandates."
view with National Public Radio
But moderate Democrats and
for easing into universal coverage Republicans saw movement in M r
rather than guaranteeing it, even
Clinton's comments, which they
though she still says that would
said was a good step.
drive up costs.
"It's a move in our direction, but
" I would not rule out a health bill
fundamentally the president is
that didn't have an employer man- holding very strongly to his
date if we knew we were moving overarching goal of universal covtoward full coverage and we had erage," said Sen. Kent Conrad,
some evidence that it would work," Nonh Dakota Democrat.
Mr Clinton told the governors.
Sen. John H. Chafee, Rhode IsYesterday's verbal duel with M r land Republican, said to a reporter
Dole became very one-sided when who described M r CUnton's comMr. Clinton adopted a conciliatory ments: "That sounds encouragattitude in the face of Mr Dole's ing."
firmness.
Added Sen. John C. Danforth,
The Republican leader prom- Missouri Republican: "Great
ised a fight against including atx>r- news."
tion benefits and vowed to defeat
Mr. Dole left before the presefforts to finance health care by ident arrived but later said that
forcing employers to pay premi- Mr. Clinton's televised speech
ums for all workers.
showed movement.
"That may happen sometime,
"He's inching our way," Mr. Dole
but it's not going to happen this said, insisting there would be no
year," M r Dole said, citing his par- more compromises coming from
ty's absolute power to derail virtu- die GOP "There's no kidding anyally any bill under Senate rules as one. We're not going to go any furlong as he keeps 40 Republican ther."
votes in line.
Meanwhile, W^ite House aides
"Tb get 40 Republicans to agree distributed an attack by the Seron anytliing is not easy. I tiiink the vice Employees International
Republicans are firm. We're pre- Union on the "American Option"
pared," M r Dole told the gover- bill Mr. Dole co-sponsors with Sen.
Bob Packwood, Oregon RepubUnors.
can.
While underscoring Mr. Dole's
admitted conflict with governors
over paying bills for the poor by
eliminating increases in state
Medicaid spending, the attached
analysis made most of M r Dole's
points:
• It will cut federal spending
$14 billion over five years.
• Coverage could not be denied
because of pre-existing conditions
or lost due to job changes.
• By subsidizing premiums for
the poor, it would cut in half the
number of uninsured over five
years.
The NGA meeting was something of a prop for speeches aimed
over the governors' heads to con-
*7 would not rule out
a health bill that
didnt have an
employer mandate if
we knew we were
moving toward full
coverage and we had
some evidence that it
would work."
— Presideni
Clinton
gressional constituencies and the
press. One Washington official of
iiis own party pointed out that Mr.
CimpbeU, who is retiring as governor, lias announced plans to take
a job with the American Council of
Life Insurance, whose stance on
the issue gives him sometliing of a
conflict of interest.
Mr. Dole was lead speaker on
the last day of the annual meeting
attended by 42 governors, and he
playied the situation theatricaUy,
assuring his audience of his reasonableness while progressively
hardening his rhetoric, even
though both men called for an end
to rhetorical excess.
"In the Senate, you only have to
count to 100,. and the numbers
aren't there. I think we've got the
votes, and I dont think it's going to
change in the next 30 days," M r
Dole said.
He got a friendly introduction
from Mr Campbell, who said the
Republican leader's bill adheres
Ul^..f.:.,AH«tt
most closely to association pohcy
except for Umiting increases in
Medicaid payments.
"In all other bills, the nonworking poor get a bener deal and better benefits than the working
poor," Mr Campbell said.
Mr Dole said he was willing to
discuss the Medicaid issue but
made no commitment to drop that
key financing mechanism. He suggested that states could be allowed
to buy private insurance for people receiving aid to dependent
children and said the poor should
get the same grade of care given
those who are t)etter off.
"Health care is too important to
be tumed into class warfare," he
said.
Pennsylvania Gov. Robert
Casey, a Democrat, who opposes
public funding of abortion raised
that issue — calhng it a "Uve grenade "— in a question to Mr Dole.
"There's going to be a f i g h t . . . .
It's just another debate that nobody needs," said M r Dole.
" I think [Mrs.] CUnton said
maybe that's a fight we can't afford
to get into, but it's going to be a
fight," Mr Dole said.
Vermont Gov. Howard Dean, a
Democrat, defended the inclusion
of abortion as a health benefit.
Mr Clinton was not asked about
abortion, but during an aside in his
speech said, "By the way, I appreciate your support for reform and
your attempt to resolve the abortion issue. Governor Casey."
With a bit of sarcasm atxiut administration imprecations that
members of Congress be good
boys and girls if they want a summer recess, Mr. Dole said he is
willing to postpone that recess to
get a health bill.
Mr. Clinton called that the most
encouraging thing he heard all day
and said the Congress should work
till October to finish the bill.
"That is what we ought to do,"
the president said.
White House officials, including
Counselor Thomas "Mack" McLarty, diligently tried to persuade
reporters there was no change of
policy — and that "moving toward" coverage for 95 percent of
the population was the same as
guaranteeing coverage for everyone.
• }. Jennings Moss in Washington
contributed to this report.
fri«n<><i \i Fn\ F<;nAY JL'LY 20. 1994
�[ITY - I 1.994
But in kowtowing to small employers, they're produced in a small enterprise or
Clontinu«f From First Page
more than 3.9% of payroll for worker healthlawmakers are provoking a backlash from large ought to be irrelevant."
costs. Firms with more than 5,000 em- big ones. "We are at a critical juncture for
The Corporate Health Care Coalition's
ployees, on Uie other hand, would pay as large companies," says G. Lawrence At- Mr. Atkins is more blunt: "Intemational
much as 7.9% of payroll for the basic kins, staff director of the Corporate Health companies that have to be in competitive
benefits package. If they decided not to Care Ckialition, a Washington group of world markets should not be in the position
participate in the new national system, about two-dozen huge companies that sup- of subsidizing domestic consumption of |
they would pay a 1% payroll tax on >op of port universal health coverage through an pizza and dry cleaning.''
i
employer mandate.
worker health costs.
For its part, the White House refuses to
But Congress has since taken the idea
"It's unreasonable to impose new taxes do anything other than express sympathy
of helping small firms to a new extreme; or assessments on those who already pay for the plight of small companies. •Small
• The bill approved by the Senate Labor for the millions of uninsured Americans employers don't offer health insurance
and Human Resources Committee asks through cost shifting, if the Congress is now because they can't afford to," says
businesses of fewer than six workers to pay unwilling to impose any obligations on Alice Rivlin, director-designate of the Ofa 1% payroll tax to guarantee their employers and individuals who now pay fice of Management and Budget, and
workers' health coverage; firms of six to 10 nothing," the group said in a letter to Mr. "making it more affordable for these busiemployees would pay 2%; and companies Clinton this week. And last month, the nesses " is essential to health-care reof 1,000 and more workers would have to Business Roundtable in Washington sent a form.
pay a 1% payroll tax and 80% of their letter to each member of Congress be- Sometlnies a SmaU Notion
employees' health-insurance premiums.
moaning "a perception that added costs
Official Washington's conciliatory
• A similar bill cleared by the House don't hurt the large employers."
of small business reflects a
Education and Labor Committee would
Some members of Congress are begin- treatinent
powerful
aura
that has grown up around
require businesses of fewer than 25 ning to pick up big business's cry. During
workers to pay no more than 2% of payroll the Finance Committee's debate, for in- small companies: They have become alfor their employees' health insurance. stance. Republican Sen. John Danforth of most as sacred as Mom and apple pie. As
Firms with more than 1,000 workers would Missouri argued that plans that differenti- large companies like Intemational Busipay 80% of each employee's premium plus ate between large and small concems are ness Machmes Corp. and General Motors
undertook highly publicized layoffs
1% of payroll.
both unfair and unwise. "Businesses will Corp.
In recent years, the notion has arisen Uiat
• The bill adopted by the House Ways be treated increasingly worse as the size of small
business is the job-creating engine of
and Means Committee would establish a the business goes up," he said. "What it the U.S.
economy.
tax credit for low-wage companies with says to business is, 'Don't grow.' "
But a recent Census Bureau study defewer than 26 employees, which would
One of the biggest nightmares for large bunks
idea. While small businesses
reduce their contiibution for worker health corporations is Uiat split rules will effec- hire atthis
a faster rate than medium and large
insurance to as little as 40% of Uie pre- tively codify the cost shifting Uiat health-concems,
they also eliminate posittons at a
miums. Large companies would pay 80%. It care reform is supposed to wipe out. "What(ar more rapid
rate. Also, jobs at small
also contains a provision that infuriates we fear is if you start exempting large businesses generally
aren't as desirable as
large firms: requiring many health-main- numbers of employers or have Uieir contiri- those at large corporations,
where Uiere
tenance organizations and other managed- butions be unreasonably low and end up are greater chances for promotion.
care networks to accept any doctor or subsidizing them by taxing (larger) comIn the end. CSX's Mr. Snow says big
hospital that agrees to the group's operat- panies . . . , you've just ended up putting companies
aren't seeking huge gains
ing rules. Managed care has been the key cost shifting into law," says Walter Maher, tbrougb healtb-care
anymore. Into most large corporations' control of medi- director of federal relations for CtaytSia stead, they are trybifrefbrm
to
cut
tbeir
kisses.
cal costs, and they fear that allowing any Corp., one of the earliest corporate sup- "We are mvolved in a kit of damage
provider to join a network would under- porters of a health-care overhaul.
control," be says, "because we see genuEcoaomk Justification?
ineriakaAat ltabw«|MntedUoBed goal of
• The b^SBjtJ^jM Senate Finance
Stepping back from the pofltlcD Jos-•
panel wouuVlM-oMt health-insurance ding,
many economists don't see mncb* tm 00 us and creMe4i Fnulkeosteinian
plans, Inchidfif Ibose underwritten by
in giving small business a monster which erodes our ability to procompanies themtelveSi Many big concems justification
break.
"There
is no good economic reason vide better healtb care and erodes our
believe this would dl^roportionately af- to subsidize small
business," aiiert»liaTfc
fect them. (Tbe panei-voted down a pror
of ted
chainnaa o( the ItuJAfmni^
posal from Its ctaalnnia^ Dtniei PatrM Panty,
General
tema
(teparlment
at
tbe
UnHsnl'
Moynihan of New Yort^ that would hav<| PennaytTBnlft's Wharton Scbool-ef
'TfWie
levied a 1% payroll tax on ffamt with moreness and Finance. "I don't know tbereason -km 08 Qlis l^ue^ ipf'^Uit conclude
Uiat
than 500 workers.)
rather than raw lobbying power." llr. no jpod deed gbea wt^prirtied."
Most of the committee bills also contain Pauiy favors a market-based sduttoo to
provisions granting states flexibUity to the nation's health-care problena.
Alarnro'sPrqpoiyAcqiiisition
establish Uwhr own health systems. Big
Ted Mannar, a prafenor at ttm Ykle
1*.--Alamco Inc
companies fear that such measures would ScbMi of Manafement wb0 adiocctet •:
eliminate an exemptloo from state bealtii- govemment-nm.
parties cer
taxpayw-ftoanced
insurance regulations that many multi- healtb system, conteads that recjilrlne tain faaandoirpfcgiwM witb 63 weUs ir
state employers now receive, ultimately lesser contributioni tor smaO '
^IBlttjiwm'' Kestlitt]L|BF
million in
subjecting them to new state taxes to pay would create dtstnrtkiM bi tke
- ..vjnllM!...
, the com
for new health systeinf>
and dlecounge
ent in
Lighter Burdens
firms.
*
of a
Currenlly, tbe
re
shiplsmrnii(t*i
cominidMMbt
ta talk tD^
cootain Dgbtar
nles tlian for tarii.'
�Page 5 'July 21, 1994
aevvirv<2--fct National Journal's CongressDaily/A.M.
Senate GOP Resolute On Re<ess Delay; Clinton, Breaux Meet
Buoyed by v/hat they sense is
growing momentum for the healthcare reform plan of Senate Minority
Jllff^yg Leader Dole and Finance
• • • • I ranking member Bob
Packwood, R-Ore., GOP senators also
are in general agreement with Dole's
call to at least delay the August recess
for a thorough consideration of the
legislation.
Based on discussions at the weekly
Senate GOP policy luncheon Tuesday, a GOP leadership aide said the
"sentiment" in the Republican ranks
is to oppose any cloture votes, so long
as a senator had an amendment to offer to the healthcare reform legislation.
"There may not be unanimity on
the substance of what we should do,
but I do think there is substantial solidarity on this," the leadership aide
said, adding, "They do not want to be
pushed into a constrained time frame"
to deal with the bill.
How much of the recess could be
lost to consideration of healthcare reform under those conditions is unclear.
The recess is scheduled to begin Aug.
13, and the aide suggested "making
plans for that first week [Aug. 15-19]
may be risky."
Asked how much more of the recess could be forgone, the aide simply replied, "You can accomplish a lot
in a week."
Meanwhile, following a White
House meeting with President Clinton late Wednesday afternoon. Sen.
John Breaux, D-La., reiterated a
mantra heard throughout the day from
congressional Democrats — that Clinton did not back down on universal
coverage in remarks Tuesday to the
nation's governors.
Clinton Tuesday had indicated
some flexibility on employer mandates and said the level of universal
coverage he wishes to obtain is not
necessarily 100 percent of the population.
"We totally agree on the goal [of
universal coverage.] He has not compromised on that at all. He has just indicated a wiUingness to look at some
other options," Breaux told reporters
at the White House.
" I think what we are being challenged to do is look at other options,
and that means that we in the Congress who are responsible for legislating have to go back to the drawing board and look at some ways to
put into place recommendations that
would ensure that universal coverage
would be reached by a certain date,"
Breaux added.
On the bill approved by the Senate Finance Committee, of which
Breaux is a member, Breaux said the
administration is concemed that in the
measure, "there is no guarantee that
anything would happen if Congress
in fact does not pass the recommendation of the commission," adding,
"That is a scenario I think needs more
work."
He was referring to the Finance
bill provision that would trigger recommendations frora a health commission unless 95 percent coverage is
reached by the year 2002.
"The president has told me he
wants to make certain that whatever
Congress passes is something that can
assure the American public that there
will be universal coverage of all
Americans with an insurance plan that
is affordable and provides adequate
healthcare," Breaux said.
"How we get there — I think he
has indicated someflexibility,"Breaux
added. "He said, 'Look, if you have a
better way of doing it, other than just
employer mandates, let me see it. If
it meets the goals, I'm willing to look
at it, and if it works, I'm willing to
support it.'"
Separately, more than 20 Democratic senators who support universal
coverage and employer mandates met
with Majority Leader MitcheU
Wednesday afternoon to discuss the
healthcare reform bill Mitchell is writing.
The group talked about strategy,
mandates and timing of phase-ins, according to Sen. Harris Wofford, DPa., but no decisions were made.
The group argued for inclusion in
the bill of universal coverage through
"shared responsibility," according to
an aide. There was no explicit discussion of Clinton's comments Tuesday on mandates and coverage, but
some members implicitly noted unhappiness with them, according to one
senator who attended the meeting.
Earlier, several GOP senators met
with Sens. John Chafee, R-R.I., and
John Danforth, R-Mo., to discuss the
centrist group bill. Sens. Christopher
Bond, R-Mo., Robert Bennett, RUtah, Slade Gorton, R-Wash., Ted
Stevens, R-Alaska, Alan Simpson,
R-Wyo., and Orrin Hatch, R-Utah,
refused to comment about the meeting afterward other than to call it productive.
Meaningfiji, world-class science is already being done
aboard the Space Shuttle. And it will be significantly
enhanced by the development of a permanent orbital
research institute, the Space Station.
�Mitchell outlines plan for health care reform
expected changes to be made to his package on die floor.
He I d oU.er Democrats mdicated, however, dial Uiey
wou^dTight to keep Uic mandate provision. They argu d
I t It should not scare anyone off because Uie mandate
Z g e r might never take effect, citing Congressional
Budget Office estimates Uiat oUier provisions m Uie biU
!o^d achteve 95 percent coverage by 2000 wiUiout
increasing Uie federal deficit.
TheT5 percent figure kicked up dust last month when
C l ^ l who had never before said publicly Uiat he would
acSpt anything less Uian 100 percent coverage mentioned
m a spe'Ih Uia't he might accept a biU Uiat achieved only
" ^ T h i s IS die best dial I can do," said Mitchell.
D-Maine, referring to die P - s - he feels from boUi
sides of die political spectrum in die Senate I did not
haJe a plan Uiat could have gotten us any higher Uian
'^CUnlo'^Taler stepped back frotn Uiat s^te°ient
reiterating his call for msurance for aU. And Mitchell
took pams to put Uie 95 percent m his bill m
His bill still drew fire from Republicans and some
Democrats who oppose even modest mandates that would be
° gg efonly asa'last resort. They railed agains it in
b S-lo-back news conferences moments afte Mitchell
someUung die president can support.
CUnton will hold a news conference ^ediiesday at p
EDT and is expected lo take questions on healUi care
" ' S ' t e the cniicism on Capitol Hill. Mitchell
expressed confidence.
,
I believe we will have legislation this year . and
I honestly believe that once we enact Uus legislation
i o f t e opponents will become me-tooers ^st like
tiey did with' Social Secunty and Medicare," MUchell
sa!d referring to die massive federal programs Uiat
l e r r e d from Congress m U.c 1960s after long and
' ' " S ; ' : f i v e percent is not, m my judgment, umversal
coverage," he said, ' but it is a very miportant ^
measurement on Uie way to umversal coverage.
The reaction to Mitchell's plan was
Senate. Many Democrats who praised it also said Uiey
wanted to change it.
• This IS a very strong sUrtmg pomt. said Sen.
John D Rockefeller IV. D-W.Va,, a Clmton ally^ This
oplTns Uie way to 51 votes-plus. I will try to make it
sponger, but if I fail. I wiU still vote for it.
EDITORS: BEGIN OPTIONAL TRIM)
A bill needs 51 votes to win in Uic Senate if all
mem^s vote. With a slun 56-mem^r majonty ar^^^at le st
a dozen Democrats not yet on his side, Mitchell will
tf> work to round up backers.
Gephardt faces a sumlar task m U.e House, Uiough Uie
Democratic majonty Uiere is much larger.
CEND O P T I O N A L TRIM)
u „ „„
Lobbyists made it clear Uiat Uiey intended to keep up
'"S^tstriustassur^
MUchell is trying, but he pst hasn't
done U" said Sen. John C. Danforth, R-Mo., a -^-^er o
a gTo^p of moderate Republicans and Democrats who back
reform but oppose mandates.
^ .
Said anoUier member. Sen. Bob Kertcy, D-Neb.,
• Clearly he's got a stmggle on his hands.
The MitcheU bill would strive to increase the number
of i ^ e n ans wiUi healUi insurance by expanding subsidies,
ms^^ting broad market reforms and setting tip volunUry
pools^o help individuals and small businesses
^ ' u ^ r o u W r e q i T employers to help workers buy
insurance only as what Mitchell called a last re«>rt^
95 percent of die population was not -vered by 2000. And
Uien, bosses would have to pay only 50 percent of
premiums.
r.r.h»rdl's plan would have all employers
By companson, Gephardt s plan wou
j^andate
nav 80 percent of workers' premiums by 1999 a manoa
vSorouJy opposed by busmess groups and not widely
popular in UTHOUSC, which is nervous about votmg on it
" ^ C ; L r i f s T r e n ' t willing to walk
Senate^lank
on tTis," said Rep. Jim Cooper, D - T - . - h - s working
on an alternative Uiat shuns mandates. The House is
paralyzed until the Senate ukes a vote on Uie employer
^Tt'senate could vote on Uie mandates m MUchelVs
J a s e'arly as next week. MUcheU w o u ^ ^ ^ ^ ^ ^
he preferred such an early test, saying only that he
Committee broadcast a television special amied at killmg
suooort for its last-resort mandate provision.
doe n't matter wheUier you kiU me now or wheUier
you p b a r m deaUi over a penod oftime,"H e r x ^ n ^ - chief executive officer of GodfaUicr's Pizza, said dunng
EDITORS: STORY CAN END HERE)
fen Phil Gramm of Texas and oUier Republicans also
took aim at Mitchell's bill before it was ouUmed,
holdi^ra news conference Monday to make U.e case for
delaying Uie debate.
• There is no consensus on healUi care here m
Washington or m U.e country." Gramm -^^
J ^
K- f«lkiTia about collectivizmg one-seventii ot me
ectomy when we don. have a strong b ^ ^^scnsus makes absolutely no sense. More importantly,
start a three-week vacat^n
Aug 15 The House leadership believes fioor <if bate the re
t u l d b^ fmished by Uien. But in die Senate, where mles
:;ow 1 ^ L e d number of amendments to be offered and
discussed. Uic process could uke several weeks.
Senate mles also penmt filibusters, unless a
.0-thirdsmajon.vo^stocuto.^^^^^^^^^
Minonty Leader Bob Dole, R-K-an., saw ui K
• don't have a filibuster sttategy."
B^t Sen. Bob Packwood. R-Ore.. said Republicans
wouldn't let MitcheU off easily.
"° W
IS a legitimate amount of time to ^bate t h i ^
Would It be immoral to spend a month on it? I dont UunK
so," he said. • • That is not a
filibuster.
^
�0
c^^^r^
THE NEW YORK TIMES. SUNDAY. JULY 24. 1994
In the Arithmetic of Health Care, It Pays to Aim for 100%
By A D A M C L Y M E R
F
R O M a (lislance, o r on lolevision. ihp a r g u m e n t
aboul w h r i h c r the nation's r p - p n g i n c r r o d h e a l i h
( a r e sy.stem should includp u n i v p r s a l coyerage
m a y .sound like j u s i another Washington squabble aboul number.s: Does i l m e a n Ihai absolulply e v e r y body would h a v e m e d i c a l i n s u r a n r e ? O r 98 percent of
A m e r i c a n s ? Oi K>> O r 91?
No, Ihe d i s p u t e goes lo both Ihe m i n d and s p i r i t of Ihe
h e a l i h c a r e issue The s p i r i t was lapped when President
Clinton suggpsled lo the nation's governors last week
l h a i he m i g h t sottle f o r 9.') percent or .so I hat enraged the
people who think Ihe nation has a m o r a l o h i i g a l i o n lo see
t h a i p v p r y o n e has hpalth insiirancp.
But Ihe m i n d is involved, too. because Ihe m a j o r
m o t i v a t i o n f o r the A d m i n i s t r a t i o n ' s effort to rpshape the
health care s y s t e m is a sense of pconomu i m p e i a t i v e :
l a m i n g r a m p a g i n g costs A n d without u n i v e r s a l coverage, its logic ( rillapses.
The fresh a r g u m e n t s for u n i v e r s a l coverage go
beyond I r a d i l i o n a l D e m o c r a t s ' concern for the d o w n t r o d den lo the New D e m o c r a t s ' concerns for the deficit a n d
Ihe e f f i c i e m y of the economy. As H i l l a r y Rodham Clinton put il last m o n l h , " A l b o l l o m , it is a question of
economics."
t he economic a r g u m e n t , spelled out last week b y a
sober cast of A d m i n i s t r a t i o n economists led by T r e a s u r y
-Secretary L l o y d Benlsen, w h o m no one in Washington
regards as H i g h l y o r e m o t i o n a l , goes this w a y :
Unless everybody
(or as close as the country can
gel) is insured, il won't bo [Missible to gpl the soaring
costs of health carp under control
Sure, ihere has been
some mfKleialion
in health care inflation in the last year
or so, hut Ihat has been out of f(-ar of controls.
Such
reslrainl
in Ihe face of legislation has happened
More;
when the legislation died, so d i d Ihe r e s t r a i n t .
Without cost c o n t r o l the U n i l e d Stales w i l l c o n t i n u e
spending m u c h m o r e on h e a l i h c a r e l h a n other c o u n t r i e s
w i i h w h o m it competes. T h i s nation now spends 14
percent of its Gross D o m e s t i c P r o d u c t on health c a r e
w i t h 20 percent in sight b y the end of t h e c e n t u r y , a n d no
other nation spends m o r e t h a n 10 percent. The e c o n o m y
is also handicapped when people a r e locked into t h e i r
Jobs b y fear of losing i n s u r a n c e if Ihey s w i t c h .
Costs cannot be c o n t r o l l e d w i t h o u t u n i v e r s a l coverage because the uninsured use the h e a l t h care s y s t e m
u n e c o n o m i c a l l y , forgoing r e l a t i v e l y inexpensive p r e v e n t i v e c a r e a n d then going to expensive e m e r g e n c y r o o m s
when they g e l sick. If the hospital cannot collect f r o m Ihe
u n i n s u r e d patient, as it usually cannot, it rai.ses i h e
charges on everyone else. People w h o have health i n s u r
ance a r e p a y i n g 10 lo 30 percent of t h e i r p r e m i u m s lo
cover the costs of people w h o d o n ' l
Spreading the Burden
T h i s is called cost-shifting, a n d e v e r y o n e says it is a
bad t h i n g , even though the ( e d e r a l G o v e m m e n l itself
c o n t r i b u t e s to the p r o b l e m hy r e i m b u r s i n g p r o v i d e r s
w e l l below w h a l they consider t h e i r t r u e costs when Ihey
t r e a t patients covered by M e d i c a i d ( I h e p o o r ) and IVIedic a r p ( I h e e l d e r l y ) . But as tne health c a r e system t r i e s to
b<-(ome less costly, one c o m p a n y a f t e r another is r c f i i s
ing lo p a y r a l e s that have been raised lo cover the
u n i n s u r e d , l h a i makes the r e i m b u r s e m e n t s even m o i e
l<)r)sided, t h r e a l e n m g the f u t u r e of the hospitals a n d
doctors who treat ihe u n i n s u r e d .
T h e r e is another cost a r g u m e n t f o r u n i v e r s a l c o v e r
a g e : I f i n s u i a n c e companies have to i n s u r e all c o m e r s
Ihey won't have lo spend ( a n d pass o n ) billions in H y i n g
lo f i g u r e out w h o is a g(xxl risk and w h o is not t h i s
u n d e r w r i t i n g is expensive, especially f o r s m a l l g r o u p s
Attainable or not, 'universal
coverage' is more than a
political slogan.
and f o r i n d i v i d u a l policies. T h e r e docs not seem l o be a n y
a g r e e m e n l on how m u c h u n d e r w r i t i n g adds t o p r e m i u m
costs, w i t h i n d u s t r y e x p e r t s guessing i l is I o r 2 percent
and A d m i n i s t r a t i o n o f f i c i a l s p u t t i n g it m u c h h i g h e r . B u l
even I p e r c e n t of Ihe a n n u a l n a t i o n a l h e a l t h i n s u r a n c e
b i l l is a lot.
Some R e p u b l i c a n s say these a r g u m e n t s e x a g g e r a t e
the p r o b l e m s . B i l l K r i s t o l , Ihe vogue R e p u b l i c a n l l i e o r c l i c i a n . contends Ihat i n s u r a n c e c o m p a n i e s c a n impose
w a i l i n g periods l h a i w o u l d d i s c o u r a g e people f r o m g e l l i n g i n s u r a n c e only when Ihey g e l sick. He says he
foresees only " a s m a l l i n c r e a s e in Ihe cosl of i n s u r a n c e
for e v e r y o n e . T h a t ' s a reasonable p r i c e f o r a l l of us lo
p a y . " With insurance already unaffordable for millions
of American.s, i l isn't c l e a r j u s t w h o M r . K r i s t o l ' s ' u s " is
.Senator C h r i s t o p h e r N. Bond, a M i s s o u r i R e p u b l i c a n
said It is easy enough l o a v o i d s h i f t i n g the costs of
m e d i c a l c a r e f o r the u n i n s u r e d ; j u s i don t p r o v i d e t h e m
w i t h a n y t h i n g b u l r e a l e m e r g e n c y c a r e if t h e y cannot
pay for it.
I he t r a d i t i o n a l Congressional r o a d o u l of a d i f f i c u l l
d i s p u t e , t r y i n g to pass a m i n i m u m b i l l a n d c l a i m i n g
great c redit f o r H, r e t a i n s c o n s i d e r a b l e appeal On h e a l t h
that a p p r o a c h w o u l d i n v o l v e i n s u r a n c e l a w changes a n d
some subsidies f o r the w o r k i n g p<K)r. o r at least the
w o r k i n g v e r y poor. But in recent d a y s A d m i n i s t r a t i o n
b a c k e r s believe I h e y have bpen m a k i n g p o l i t i c a l head-
w a y wUh the a r g u m e n t thai p a r t i a l r e f o r m could h u r t the
m i d d l e class, h e l p t h e poor, a n d l e a v e t h e r i c h alone.
Some of t h e a d v o c a t e s of i n c r e m e n t a l c h a n g e n e v e r
believed in pushing for r e q u i r e d u n i v e r s a l coverage,
o f t e n because I h e y f o u n d t h e m o s t o b v i o u s w a y l o g e t
there, requiring employers lo pay for their w o r k e r s '
insurance, politically unacceptable.
Others did favor universal coverage, but have given
up. Senator John C. D a n f o r t h , a n o t h e r M i s s o u r i R e p u b l i can, said: " l don'l Ihink it's w o r t h the fight. I i h i n k w e
c a n g e t clo.se e n o u g h " w i t h a b i l l t h e Senate F i n a n c e
C o m m i t t e e approved Ihat relies on insurance r e f o r m s
on taxes o n e x p e n s i v e h e a l t h p o l i c i e s l o d i s c o u r a g e
excess use, a n d o n subsidies i f t h e m o n e y c a n be f o u n d
0
Of c o u r s e , no one k n o w s w h e t h e r t h a t b i l l w o u l d get ' ~ ) 0
to " c l o s e e n o u g h , " o r even w h a t " c l o s e e n o u g h " is — a t
w h a l point short of 100 p e r c e n t c o v e r a g e , t h e p r o b l e m s
with partial r e f o r m would dissipate.
A n d even if the A d m i n i s t r a t i o n ' s m o t i v a t i o n is econ o m i c , the social p o l i c y a r g u m e n t s m a t t e r , t o o , a n d s«lr
Ihe e m o t i o n s of s u p p o r t e r s . T o c r i t i c s l i k e M r . K r i s t o l o r
R e p r e s e n t a t i v e D i c k A r m e y of T e x a s , t h e N o 3 H o u s e
Republican, required universal coverage involves too
m u c h g o v e r n m e n t . T o M r . A r m e y , i i is a " l a u d a b l e " i d e a
that e v e r y A m e r i c a n h a v e h e a l t h i n s u r a n c e . B u t o n c e
y o u m a k e it c o m p u l s o r y , he s a i d , h e ' s " t r o u b l e d b y t h e
coercion and pre-emption of individual r i g h t s " inherent
in a c e n t r a l g o v e r n m e n t d e c i s i o n a b o u l w h a l l e v e l of
i n s u r a n c e A m e r i c a n s need a n d h o w I h e y m u s t get i t .
T h e e m o t i o n a l a r g u m e n t f o r u n i v e r s a l c o v e r a g e is
rarely expressed w i t h m o r e f e r v o r lhan b y Senator
F d w a r d M. K e n n e d y of M a s s a c h u s e t t s . T h i s m o n l h h e
l o l d .supporters, " W e h a v e lo l a k e a c t i o n , a n d t a k e i t n o w ,
l o i n s u r e t h a i w e a r e g o i n g to h a v e a u n i v e r s a l h e a l i h
c a i e p r o g r a m that is g o i n g l o r e a c h o u l l o e v e r y A m e r i c a n " He a d d e d , " l l is m o r a l l y r i g h t . "
/
/
�(^oct-^ feller
PM Health Reform, Bjt,0564
House Democratic Leaders Hold Fast to Employer Mandates
Eds: Also moving on general news wires. With PM-Health Poll
By CHRISTOPHER CONNELL= Associated Press Writer=
WASHINGTON (AP) A draft summary of the House Democratic leaders' health
reform b i l l holds firm to the idea of making a l l employers buy health
insurance for t h e i r workers. But how much the bosses must pay i s wide open to
negotiation on both sides of the Capitol.
A seven-page draft of the plan that House Majority Leader Richard Gephardt
IS piecing together would allow small firms to buy the same coverage that
lawmakers, the president and other federal workers get.
Speaker Thomas Foley raised the p o s s i b i l i t y Tuesday that the House might
go for something l e s s than the 80-20 percent s p l i t between employers and
employees that President Clinton asked for. Senate Majority Leader George
Mitchell has already been sounding senators out on a s p l i t as low as 50-50
^ ^ I f i t ' s 80 or 75 or 70, whatever the figure i s , i t ' s a shared
responsibility between employer and employee," Foley, D-Wash., told
reporters. That "^can be discussed. Nothing there i s written in stone."
Gephardt, D-Mo., and Mitchell, D-Maine, are spearheading separate efforts
to fashion Democratic health b i l l s to bring to the floors of the House and
Senate for action before Congress leaves town in mid-August on a month-lonq
summer break.
^
Gingrich complained b i t t e r l y about the Democrats' timetable.
'^Let people read what's in them, l e t the experts critique them, l e t the
news media report on them and then vote the f i r s t week in September,'' the
Georgia Republican said on the House floor. '^Why i s the Democratic leadership
afraid to l e t the American people see what's in their health b i l l ? ' '
The summary of the plan that Gephardt hopes to unveil by Friday was far
from f i n a l . A spokeswoman, Laura Nichols, said i t was a staff-generated
document and everything was "'open to change.''
But the outline confirms that Gephardt i s sticking closely to the
blueprint that the House Ways and Means Committee produced a month ago,
including an expanded Medicare program covering tens of millions of poor
people, the uninsured and some workers in firms with up to 100 employees.
Workers in small firms would also have the option of signing up for the
Federal Employees Health Benefit Program i f they didn't l i k e the plans their
employer offered.
Moderate Republicans renewed their opposition to any requirement forcing
businesses to buy health insurance for their workers.
' " I j u s t don't l i k e the idea of mandates. I think they're a bad idea,''
said Sen. John Danforth, R-Mo.
Sen. Dave Durenberger, R-Minn., said h i s position was '"no mandates," and
Sen. John Chafee, R-R.I., said he had told Mitchell he "Midn't think I could
be much help.•'
But Sen. Jay Rockefeller, D-W.Va., said diluting the employer contribution
to 50 percent "'could make i t a tough t h i n g " for many Democrats to support.
The draft summary scraps a proposed rebate on generic drugs sold to
Medicare patients but keeps a 10 percent rebate on over-the-counter insulin
and 15 percent rebates on single-source and innovative brand-name drugs.
The summary i s s i l e n t on the d i f f i c u l t guestion of abortion coverage.
Although i t suggests sticking with a 1998 starting date for universal
coverage, Gephardt already has said that i s l i k e l y to s l i p by a couple of
years.
****
f i l e d by:APE-()
on 07/27/94 at 00:29EDT ****
**** printed by:WHPR(l60) on 07/27/94 at 07:14EDT ****
�Mitchell, Gephardt working to craft health-care
reform bill
Bv Jill Zuckman Boston Globe
WASHINGTON When .1 comes lo healUi-care reform,
Ge!rtc J - ^ I h e l l and Richard A. Gephardt, - P n t y
f
of the Senate and House, are fmdmg Uiey must lead Uieir
^ ^ r : r - : ^ - e s u r e . e ^
• , le.st 51 votes in ths Senate and 218 in the House
fte,
„sed to that, count.ng head, and p„U,ng togethe,
™I„„.,es but th„ ..me the, .ctuall, must caf. the
'""'Geoh..d. and Mitchell are .he arch.teets ot what
„e',e do':^- s..d Rep B.ll R.ehatdson. D-N M,. and dte
stiffly • • I don't make deals on mailers of this
significance." Instead, he said, Tm trying to appeal
to Uie best of my colleagues.
.
Gephardt, too, has been bnngmg lawmakers inlo his
;£::=b=^^Se^^^
' " • ' ' ( i t on one it's gentle persuasion, and
followed
W.U1 This IS Uie most important biU ever undenaken and
represents wheUier we'll remain viable as a party _
Richardson said
^ ^TpYVXAfK. P^"^^^
jonundrum has roots
For
boUi
leaders,
^e h^alA
For botn leaaers, U
uic
n^a."- care conundn.
in die personal. Gephardt's son. Malt, had cancer as a
hitd That expenence sensitized Gephardt for Uie appeals
'''•™S:::e,M.tehell,ofM...e,.sh.v.n..o.o
";;:3;rtrn".T;:sh.i,P„da,M,tchei,,
" r o t : : . ™ i ° : e Z t u . ,eade„ have done l.t.le eUe
h„ hold one n,.e.,ng a t e another »..h senators and
coLgressmen. sound.ng .hem ou,. hs.emng and even
'°'°™,',s''i'verv very d.meuU seareh for a pol.tic.l
soluu . ' s:dThom,s^M.nn, a eongresstonal audron^
^he L„;k.„gs lns...u..on - U . . no. a, all obv.ous d,.y
"'JoMhT'o'^year-old M.,.hell, *ho ,s re.tr.ng a, dt.
A r,f .h,s vear a health care package signed by
fould seal h.s ,ep„.a..on as a .opn.gh.
™,i„„K leader Further, it would conclude
healUi and later as its chairman.
rhave few thoughts of history or P O / ^ e " ' ^
said a visibly tired MitcheU, sitting at Uie head of h^^;
hoglny dining table m his office after a long s^ff
One thing I learned m every job I've had^ If
T o u r t h e veVbes^ you can and work hard at it. Uie
future Will take care of itself.
For Gephardt. 53, who ran for president ^ - ' ^ ^ ' ^ J ' ^
could grease his nse to House speaker should Thomas S^
F ^ y tave office. And, success could weU stav« ^ f f j h e
Ilate of Republican electoral wms expected in Uie House
BuT:h?:dds are against success. The subject is far
—h=z;^::t^^^^^
controls are strewn Uiroughout Uie legislatior.
In Uie House, Gephardt will tiy to P - h the b U
through wiUiout RepubUcan support. In Uie Senate.
might pick up a few RepubUcan senator . but Uien
the legislation is not Ukely to appeal to Uie House.
Mitchell takes a Socratic approach, meetmg
,ndTv dually and m smaU groups wiUi senators m his
t : aslfng question after question to fm c u s h a t
each leRislator can live wiUi to support a bill. Otiier
he has allowed senators to bnng in constiti«nU to
" t n ' ^ J ^ L : DanforUi of Missouri, who is considered one
of several RepubUcans who might support a Democratic
healUi plan, has been m to see Mitchell twic. J
wasn't what you would call negotiating. Daa^oJ^^^J^^
Indeed, when asked about deal making, Mitchell said
^ ^ U l d l ' s moUier. a Lebanese immigrant and former
textile factory worker, entered a nursing home in 1980.
l ^ n g Uiere^untU her deaUi m 1987. U was^Mi heU
said a very difficuU and pamful penod. Her assets
wer^ quickly used to pay for Uic nursing
Though she was eligible for Medicaid, ber children
decided to foot Uie biU Uiemselves. -Through Uiat,
MUchell said. " I learned a lot about how Uie system
works."
�Ft^-?>io
" It didn't do the things he wanted done," former
campaign healUi adviser Atul Gawande said of pay-or-play.
Gawanoe auucu uiai uie House version corrects some of
the problems of the original scheme.
Lawmakers battle over whether to include
abortion in bealth care plan
By Jill Zuckman Boston Globe
WASHINGTON In all Uie reams of healUi care papers
passed out by House Democratic leaders on Friday, nowhere
did the word " abortion" appear.
Yet it is a subject Uiat could easily sink Uie whole
health care effort, lawmakers acknowledge.
Currentiy, two Democrats are conducting negotiations
wiUiin theu- party to come up with a way of confronting
Uie issue wiUiout alienating lawmakers who are eiUier
against or in favor of abortion rights. But the two sides
are not close and the outcome is not expected to be known
until the last possible minute
Lawmakers who support abortion rights said Uie Florida
slaying Friday of an abortion provider and his escort has
galvanized Uiem to ensure Uiat health insurance plans
cover the procedure.
Rep. Don Edwards, a D-Calif, said Uie killings are
""the consequence of discrimination against women in
health care." He said Congress must end Uiat
discrimination by providing abortion coverage in ita
health care plan.
"Right now I do believe that Uie bmtal murders in
Pensacola really bring home to Congress the dangers of
taking this service and isolating it from the American
medical mainstream," said James Wagoner, vice president
of the National Abortion Rights Action League.
However, finding compromise language on abortion is
made more difficull by Uie fact that about 75 Democrats
have said Uiey would vote against a healUi care bill Uiat
does not cover abortion and about 35 Democrats have said
they would vote against a bill Uiat does cover abortion.
One top Democratic leadership aide said each side has
the power to topple Uie healUi care bill. But Uie aide
said the negotiations between Rep. Vic Fazio, a
California pro-choice Democrat, and Majority Whip David
Bonior, a Michigan pro-life Democrat are an effort to
find the new status quo under a different system.
Cunently, the federal govemment restricts abortions
it will pay for to about 17 million poor women who are
insured under the federal Medicaid program. Medicaid will
pay for abortions i f the pregnancy is the result of rape
or incest or if the life of the woman is in danger.
Abortion rights groups say abortions are covered for
about two-Uiirds of all women who receive private health
insurance.
The draft health care legislation released Friday by
House Majority Leader Richard A. Gephardt would cover
pregnancy-related services and family planning services,
which many interpret to include abortion, for all women.
Medicaid would be abolished under the bill.
Also, the bill says all benefits would be provided when
'"medically necessary and appropriate." Anti-abortion
activists say this would result in abortion on demand.
Douglas Johnson of the National Right to Life
Committee, said the bill would greatiy expand the numl>er
of abortions by requiring the benefits he " locally
available." In many parts of the country, there are no
abortion clinics and no doctors who perform abortions.
Several options are currently being discussed in the
House. They include;
Offering an individual conscience clause, which would
allow individuals to tum down insurance plans Uiat
contain abortion coverage. This option would also include
an exemption to religious institiitions, such as Uie
CaUiolic Church.
Leaving Uie decision to cover abortion up to Uie
various insurance companies. Sen. Dave Durenberger,
R-Minn.. wiUidrew Uiis amendment at Uie Labor and Human
Resources Committee because he had no support.
Allowing employers to exclude abortion or oUier medical
procedures Uiey find morally objectionable from Uie
insurance plans offered to Uieir workers. Sen. John
DanforUi, R-Mo., successfully attached Uiis to Uie Finance
Committee's health bill.
And excluding abortion from Uie healUi care plan, but
allowing women to buy a separate insurance plan Uiat would
cover abortion i f needed.
The last option is vehementiy opposed by women
lawmakers who support abortion rights. "Nobody ever
expects to have an abortion," said Rep. Louise Slaughter,
D-N.Y. " Nobody ever wanU one. Women won't buy it."
Senate Whitewater hearing opens with
Republican attack on Altman's testimony
By Bob Hobler Boston Globe
WASHINGTON Republican lawmakers asserted Friday that
a senior White House official told Senate investigators that
Deputy Treasury Secretary Roger C. Altinan gave President
Clinton's aides more information about a Whitewater
investigation Uian Altaian or White House officials have
acknowledged.
As the Senate Banking Committee opened its Wliitewater
inquiry, Sen. Alphonse M. D'Amato of New York said Harold
Ickes, deputy White House chief of staff, testified in a
sworn deposition Uiat Altinan told Clinton's aides on Feb.
2 about Uie status of Uie Resolution Tmst Corp.'s
Whitewater investigation.
Altinan, Uien acting head of the RTC, and Lloyd CuUer,
the special White House counsel investigating contacts
between administration officials on Whitewater, repeatedly
have said that Altman did nothing more than update White
House officials on RTC investigative procedures.
"That is simply not true," said Sen, Pete V,
Domenici, Republican of New Mexico, who quoted Ickes as
saying Altinan informed Uic White House Uiat Uie RTC would
not finish iU Wliitewater investigation before the statute
of limitations was due to expire in March.
Congress later extended the expiration date for Uie RTC
inquiry into Madison Guaranty Savings & Loan, of which
Whitewater is one aspect.
The White House, responding to a request for Ickes'
reaction, rebutted the Republican assertions.
When the administration's witnesses have a fair
opportunity to testily and answer questions about the Feb.
2 meeting, as opposed to responding to Sen. D'Amalo's
distorted characterizations, it will be clear that the
briefmg was about procedure, did not go into the substance
of the Madison inquiry, had already been provided to
oUiers in congressional briefmgs and did not impart
improper information," said Da'vid Dryer, a White House
spokesman.
Altman, in a prepared statement, also denied giving the
White House
a status report.
It " is simply incorrect," he said. " I did not have
any such information. No information of any kind was ,
provided on the status of the investigation."
(^9
�Containing Spiraling Medical Costs
Isn't Popular Topic With Reformers
Mandate to Reduce Health Spending Got 'Lost in Shuffle'
plans to select. One approach is to require all
employers to give their wori<ers a wide range
of plans to chose from, not a choice of one or
With the political spotlight locked on the ques- two. Another is to require that employers give
tion of universal coverage, the other major goal a cash rebate to workers who chose a less exof health reform—controlling spiraling medical pensive health plan while requurmg workers
costs—has either been ignored or undermined. who chose expensive plans to contnbute more
"Cost containment has been fading from the money. Both approaches have been watered
debate like the Cheshire cat," said Henry Aar- down by the vanous congressional committees.
on. Uie Brookmgs Institution health policy ex- • Health economists have long advocated a
pert. There's noUiing left but the smile."
limit on the amount of health care coverage
Sen. John C. Danforth (R-Mo.). who will
that can be provided to workers tax free as a
leave the Senate at year's end. la
way of making employees more cost-conscious
NEWS
mented last week that "cost con
about theu- health care choices. But because of
KNAirSIS
tainment is clearly the most imopposition from organized labor, the Clinton adportant issue, and it's pretty much been lost in ministrauon proposed to delay the imposition of
the shuffle."
such a ' ^ cap" until the year 2000, but even
"Let's face it, you don't see any cost-contain- that provision was elimmated from the congresment buses rolling across the country," said sional bills.
Lawrence O'Donnell Jr., staff director of the
The Senate Finance Committee, in its bill,
Senate Finance Committee, one of four con- did include a secuon that was considered a first
gressional committees that has reported a cousin to the tax cap—a steep surtax on the 40
health reform bill.
percent of health plans in every region that
Perhaps we shouldn't be surprised. After all, have the highest premiums. But a number of its
says Robert D. Reischauer, director of the Con- original Senate sponsors say that the idea may
gressional Budget Office, "cost containment hurts be unworkable because it would keep the insurwhile expanding access makes people happy."
ance market in a continuous state of turmoil.
There are two general approaches to re- • Proposals from the House and Senate taxstraining health care costs and spending, which writing committees would set no limits on prihave been rising at the rate of $40 billion a vate insurance premiums while at the same
year. The first approach, known as managed time setting strict limits on goverrunent health
competition, relies on increased competition spending and the prices that the govemment
among health packages offered by competing would pay doctors and hospitals for various proinsurance compames to hold down total spend- cedures. Some experts expect that such an aring. Although managed care has recently rangement would lead doctors and hospitals to
shown some initial success in California, it has raise prices for private patients to make up for
never been tried on a national scale.
inadequate payments from the govemment, as
The second approach uses various forms of has already happened in the Medicare and
govemment controls on premiums or hospital and Medicaid programs. Others fear that governdoctors fees which have proven only partially ef- ment-only cost controls eventually will lead Uie
fective when tried in the past. Providers also more popular doctors and hospitals to simply
wamed it could lead to a detenoration m die qual- luni away Medicare patients and others with
ity ot care or long waits for medical procedures. government msurance.
The original Clinton proposal relied on both • Many health economists point to new techapproaches. But in recent months, administra- nology as the pnmary culprit in driving up
tion supporters have discovered that while cost health spendmg. President Clinton proposed lo
containment is desu-ed m the abstract, it is of- begin to rationalize the use of new technology
ten deplored in its specifics. Under pressure by having the federal government set Imiits
from special interest lobbies, the vanous con- each year on how much could be spent on
gressional committees have chipped away at health care m each state. The president also
provisions aimed at reducing healtii spending. proposed to subject new drugs and medical
Here are a few examples:
technologies to a cost-beneiii analysis by the
• Altiiough President Clinton was cnticized for govemment. Congressional committees largely
proposing an overly nch package of basic health rejected both ideas.
benefits, the Senate and House labor commit- • Because they work closely wnih a small numtees expanded them further, mcreasing cover- ber of doctors to reduce unnecessary care,
age for preventive care, home care for the disa- health maintenance organizations have been
bled, mental illness, and dental coverage.
able to charge lower annual tees lor insurance
• The idea behind "managed competition" is lo coverage. Bul m Uie House, both of the bills
restram health spending by makmg consumers passed by committees would weaken these armore pnce-conscious in deciding which health rangements by requinng that H.MOs accept the
By Steven Pearlstem
Wnkmcun f a t Sufl Wnttr
•V MT UAT1G—TXC WASMmGTOM POST
'Cost containment h u r t s . . . accMs makes
peop<6 happy,- says CBO Mractor Reischauer.
services of any doctor or hospital willing to
abide by tiie plan's fee schedule. The Group
Health Association of Amenca. representing
HMOs, estimates that the "any willing provider" provisions would increase HMO premiums
by at least 9 percent.
• In the same vein, committee-passed bills in
both chambers would require HMOs to include
providers of "essential community services" in
their networks. The original purpose was to insure that consumers in rural and under-served
areas had access to hospitals and chnics that offered specialized care. But after lobbying, the
definition of what was "essential" was made so
broad that it could describe nearly any hospital
or medical provider.
• One key to controlling health spending, according to experts, is to cut down on care that
is unnecessary or has a low probability of success. But several of the congressional bills
would discourage health plans from exercismg
this discipline by allowuig consumers, for the
first time, to sue for punitive damages if medical services are demed.
"If these committee bills are any indication,
we're in national self denial on this question o:
getting heahh spending under control." said an
exasperated Richard Smith, director of heaitn
care policy for the Association of Pm-ate Pension and Welfare Plans, representing large co.-^poraie employers.
"The general attitude on cost containmeni ithat it is a bad Uung that lowers quality and reduces choice," said Thomas 0. Pyle, who oversees one of the country's largest healUi msurers. Metropolitan Life.
"As a general proposiuon. that's wronp—
there is a lot of unnecessary care out there ihp.;
can be eliminated \yithout sacriiicmg quaiit . .
Bul as long as that attitude prevails, it's goi;:j
to be very difficult lo mai<e much headway c:;
this issue."
�National Journal's CongressDaily/A.M.
Mitchell Bill
Continued from Page I
judgment that an immediate employer
mandate would not have been enacted
by the Senate."
The legislation includes significant new subsides to help low-income
individuals and families pay for insurance.
A Senate Democratic leadership aide
indicated 75-80 percent of Uie cost of
the subsides would be financed dirough
Uie existing Medicaid program, which
would be cut $387 billion federally over
10 years and $232 billion in state costs
over 10 years.
Mitchell's plan includes certain
expanded benefits, for such services
as prescription drugs and long-term
care.
It also would include abortion services in the basic benefits package, as
it appears in the Labor and Human Resources Committee-passed bill. However, Mitchell cautioned that the abortion issue would be considered and "settled" on the Senate floor.
After Mitchell unveiled his proposal, most members of the Senate centrist group rejected it, but at least one
said he could vote for the proposal and
another appeared to lean strongly toward it.
" I could support this bill," Sen.
Kent Conrad, D-N.D., said. "It is an
excellent package." Conrad also suggested the Mitchell plan "closely parallels what the mainstream group did."
In addition, Sen. John Breaux, DLa., said, " I think it's a very good effort," but stopped short of saying he
could vote for it in its current form.
Nonetheless, seven other centrist
group members rejected the bill at a
press conference, criticizing the triggered employer mandate, cost controls,
regulation, malpractice reform and budget fail-safe provisions.
" I think Sen. MitcheU is trying, but
he just hasn't done il," Sen. John Danforth, R-Mo., declared.
Sen. David Boren, D-Okla., added,
" I hope he will go back to the drawing
board," while Sen. John Chafee, RR.I., said, "Even though it's out there in
the distance — the employer mandate
— it's just there, and it's just not acceptable."
Boren also claimed the bill is designed with a 51-vote strategy, which
will "be ati^agedyfor the American people." Chafee agreed, declaring the plan
will not get a big bipartisan vote.
Chafee and Danforth said Mitchell's key cost containment provision
— a tax on insurance plans above a certain prenjiutn target — are only disguised premium caps, although Conrad later dalled that "an inaccurate reading." Despite the differences, Conrad
said he will remain part of the group
and plans to "continue to be active in
the effort."
Sen. Joseph Lieberman, DConn., who also is a centrist group
member, at the White House late
Tuesday said he told Clinton during
a meeting there that he feels Mitchell
has "come a long way."
But Lieberman added: "There's
still a lot of concem about the mandate being in there. I think it's unnecessary to have it in there at that
point, even as a standby. I continue to
be troubled by it." He said he and
Breaux are "working on a plan that
we think, laid on top of what Sen.
Mitchell has proposed, can guarantee
universal coverage."
Senate Labor and Human Resources Chairman Kennedy declared general support for the package, but questioned the strategy for
achieving universal coverage. "If the
95 percent threshold is met, I am concemed that the further steps invoked
to reach the goal of tme universal coverage are relatively weak," he said in
statement.
And Sen. Harry Reid, D-Nev., a
cosponsor of Clinton's original healthcare plan, had kind words for Mitchell's
effort after meeting with Clinton at the
White House Tuesday night.
"All in all, we have a much better
chance of passing healthcare than we
did yesterday," Reid said. "There are
some people who want more. There are
some people who want less. But we're
all veteran legislators and understand
legislation is the art of compromise —
and Mitchell today wrote the book on
compromise."
Augusts, 1994'Page 4
Separately, Senate Minority
Leader Dole and Finance ranking
member Bob Packwood, R-Ore., criticized the plan.
They said there is not enough time
to analyze and get feedback on the
bill, and raised the possibility of forcing extended debate. "Would it be immoral to spend a month on it?" Packwood asked.
No floor or fdibuster strategy has
yet been decided, according to Dole,
but he said "if the bill is real, real bad
I think we have to make some tough
choices."
While Dole said Uiere are some positive provisions in Mitchell's plan, he
said overall it is "very similar to President Clinton's proposal in that is prescribes more govemment, more taxes,
and more entitlements."
Meanwhile, Mitchell said he has
consulted his counterparts in the
House about his plan, and added that
he is "well aware the Senate passing
a bill does not make it law."
Many House Democrats are reluctant to proceed with voting in favor of an employer mandate if the
Senate moves toward something
softer.
One House member, Ways and
Means Health Subcommittee Chairman Pete Stark, D-CaUf, was sharply
critical of the Mitchell proposal Tuesday. Stark said that, based on a briefing Monday attended by CBO officials, Mitchell's "only got half the
bill."
Said Stark, "It's a beautiful stereo
set with no computer on the inside." He
said Uie CBO has raised sti-ong concems
about its abihty to score the Mitchell
bUl, particularly given the current stmcmre of the mandate and trigger included
in the proposal.
"There's no way to pay for it,"
Stark said. "And no way to enforce
it. He's got the tr^'^er — but there's
no gun."
But Mitchell in a floor statement
cited preliminary CBO estimates he
said indicate the bill will work, declaring, " I believe the CBO estimate
that this bill will achieve 95 percent
coverage in a deficit neutral way is
sound."
�- ' PAUt^OKTK
m IS OBSCURED
IN HEL
liTH DEBATE
\
Speojl 10 rhe New Yorli< T i n w \ *
WASHINGTON. Aug. 6 - Presi
dent Clmton's bealUi plan was inspired as much by a desire to control
costs as by a passion to guarantee
insurance for every Amencan. But
the goal of cost control has been
eclipsed by the furor over universal
coverage.
Consumer groups, business executives and labor leaders who joined the
campaign for healUi care legislation
in hopes of controlling costs are profoundly disappointed. This spreadmg
sense of unease could have deep political consequences as Mr. Clinton
nears the midpoint of a term in which
health care has preoccupied him
more than any other policy issue.
And there could be long-range implications for the economy if the debate over uniyersal coverage continues to overshadow Uie issue of cosu.
The nation will spend about SI trillion on health care this year — H
percent of Uie gross domestic product, a proportion far higher Uian Uiat
of any other nation. And Uie Congressional Budget Office says Uie share
will grow to 20 percent in Uie year
2003 under current law.
But the question of how to slow the
growth of such spending has receded
from Uie political debate. Politicians
and political advertising have instead
focused on the explosive question of
whether to require employers to buy
health insurance for their employees.
TTie health care and insurance industnes have lobbied intensively
against pnce controls and have given
millions of dollars in campaign contributions to make sure their views
Continued on Page 24, Column I
will be heard by members of Congress. The lobbyists, pointing out Uiat
market forces have already reduced
the rate of medical inflation, tell lawmakers that Uie Govemment should
not mtervene.
Advocates of cost controls worry
that in Uie search for votes in Congress the restraints could be weakened further and benefits added —
raising Uie prospect of a system more
costly than Uie current one.
Michael J. Rourke, senior vice
president of Uie Great Atlantic and
Pacific Tea Company, which operates A.& P. supermarkets, said: "The
real cnsis in health care, from our
point of view, was the cost That was
our pnmary motivation for getting
Involved in Uie healUi care reform
^ movement."
I
Kerrey Sees More Trouble
Senator Bob Kerrey, Democrat of
Nebraska, said Uiis week Uiat Uie
healUi care bills offered by Uie Democratic leaders of the Senate and Uie
House would probably "add to the
problem" of Uie Federal budget deficit and that he doubted Uiat they
would restrain healUi spending. "The
whole battie cry of universal cover-
'^ponsiouuv of pavmg tbe bufs •'he
said.
realized early or that they
would not be able to beat the insurance industry and health care providers ^ Mr Podhnr:-^' sji.j
^»
Senator John C. Danforth. Republican of .Missouri, said. "Almos; a!! the
discussion .has been about -^r.::-^'--''
. .~r>,"'a"; .;,iue tur
• ture :
ment. 'Sie count.'7, is cost containRepL''irj,r; ge.^ipraily ODCK;;?
price controls and favor the use of
market forces to restrain health
cosu. Senator Bob Dole of Kansas,
the Republican leader, boasts that his
proposal 10 expand coverage contauis
"no mandates or pnce controls " He
and other Republicans would finance
their proposals Uirough cutbacks m
Medicare and Medicaid.
The House Democratic leader
Richard A. Gephardt of Missoun'
said the bill he introduced recently
would control costs by imposing Federal fee limits on doctors and hospitals if market forces do not slow the
growth of health spending to Uie rate
of growth of the overall economy.
Focus on Universal Coverage'
Eclipses a Starting Issue
EA R
By ROBERT PEA
I
What Mitchell Wants
By contrast, the bill offered by the
Senaie Democratic leader, George J
Mitchell of Maine, contains no controls on healtii prices, costs or spending. It seeks to slow the growth of
spending by imposing a new tax on
health plans whose costs grow faster
than a prescribed pace and by encouraging competition.
Experts on health policy, mcluding
economists, labor union leaders and
executives, said cost control had faded from the debate for these reasons:
Doctors, hospitals, drug companies and others in the health care
industry have organized formidable
campaigns against any measures
that would significantly reduce their
revenues. Drug companies, for example, say they would have to curtail
research on cures for cancer or AIDS,
and hospiuls say they would have to
lay off employees or shut down.
ITYie torrid pace of medical mflation has cooled. Companies in the
health care industry, eager to fend off
price controls, have been trying hard
to curb costs. In Uie past, healUi
pnces moderated when the Govemment threatened action but shot back
up when the Uireat disappeared. This
time may be different. Fierce competition is transforming the industry as
companies cut costs, gobble up one
another and reorganize the delivery
of medical care.
^Consumers' desire to have Uie
widest choice of doctors, and the doctors' desire that patients have Uiis
choice, often run counter to the idea
of cost control. Businesses and healUi
maintenance organizations often control costs by limiting patients to a list
of approved doctors and hospitals,
which offer deep discounts in retum i
for a large volume of patienu. Mr '
Gephardt's bill would restnct sue;;
forms of managed care.
President Clinton planted the see<:s
•for such legislation when, in defeience to public opinion polls, he enshrined "choice " as one of his six
guiding principles.
'A Laudable Goal'
James A. Klein, the executive director of the Association of Private
Pension and Welfare Plans, a trade
group composed mainly of Fortune
SOO companies, said: "The Idea of
choice, a laudable goal laid out by Uie
President, has been twisted. Any
measure that structures ctwice in a
way to conuin costs is considered
bad."
Michael Podhorzer, health policy
direclor at Citizen Action, a consumer group with Uiree million members,
said Uie Administration and Congressional leaders were not emphasizing
cost control now as m u * as they
once did.
-Ltf
I
I
I
I
I
i
I
;
i
i
>
•
»
THE
NEW
j rr;r-
-
j.:
members of (.-jnarass .n -.-c :as: li
months to maKe <:u-° -ha' .-o-;t -^n
tr^is 3-° -0! paJr-.,-.-,rl^ 'Opinion polls shou, tnat tne^puDlic
wants 10 rein in health costs, but
effective measures to control costs
are often unpopular Congress rejected President Clinton's proposal to put
annual limits on Uie growUi of healUi
msurance premiums after healUi insurers. doctors and hospitals attacked Uie proposal.
Other Problems Possible
On Uie oUier hand, if Congress expands coverage without putting limIts on costs, huge problems may reSU t. The cost of Federal subsidies to
help poor people and small businesses buy healUi insurance, may soar
And If subsidies do not keep pace wiUi
premiums, many people will be unable to afford insurance, and some
businesses will decide not to offer
coverage.
In addition, healUi policy experts
say Congress is likely to finance
healUi care legislation by cutting projected spending for Medicare, and
Medicaid. If pnvate healUi costs are
not also controlled, then the disparity
between private insurance and Federal payments will grow, and doctors
may be less willing to take elderly
patients under Medicare.
Administration officials have repeatedly argued Uiat "you can't do
cost containment without universal
coverage." in Uie words of Alice M.
Rivlin, acting director of Uie Office of
Management and Budget. When people are unmsured, she said, Uiey do
not get routine preventive care and
end up in hospital emergency rooms.
What Gephardt Proposes
But Senator Kerrey gently mocked
the idea Uiat Uie nation could save
money m the long run by spending
more on health care today. "All we
have to do is spend more in order to
spend less," he said. "That's essentially Uie conclusion Uiat people have
I reached."
Under Uie Gephardt bill, Uie Gov\.
emment would, for Uie first time, set
annual health spending goals for U ^ .
nation as a whole and for each stater
If a SUte exceeded its goal, the Federal Government would enforce prtqe
controls for doctors, hospitals, pre-r
scription drugs and Uie rest of Uie,,
health care industry in that stata, >
starting in Uie year 2001.
The Govemment would set "maxi--!.
mum payment rates" so that per,'
capiu private healUi spending would"
grow no faster than the economy as a,,
whole.
.V
Under Uie Mitchell bill, Uie Goverrv^
ment would use tax policy to discoup*
age insurance companies from rai*-'"
ing premiums. The aew tax would be
25 percent of Uw amount by which
premiums exceeded a urget amount ''
set each year by Uie Internal Reve^
nue Service for each market areai"
The Urgets woukl alk>w insuranct^
premiums to rise slightly faster Uian*"
Uie Consumer Price Index.
yORK
TIMES,
SUf^DAY,
AUGUSTJ.
1994
�Senate toD^ate HealthCare Amid Mood Shih
From Bid to Compromise to Election- YearSnipin
T h u bill
hill
t h , > House
U , , , , . , , is
..
.U..J..I
, to
..
.
I
^ 7
The
the
Mhediiled
dent t'linton s agenda, the events leadmg
begin debating next week is .far i loser
up ,o the debate iHisv, <| .,,|| n„ich about
to the original Clinton blueprint. It wcuid
S ' a f R c p o r l P r , .jr T l . K W^LL S T R F E T J u l HN^L
the strengths -and weaknesses-in his adphase
in
over
five
years
a
rei]iiirement
that
WASHINGTON - What a difference a
ministration.
employers pay -id', of their workers
year niakts.
Mr. Clinton won in 1992 on the promise
Last September, when President Clin- health-insurance premiums and would ofof change. In tackling health-care reform
ton unveiled his proposal to overhaul the fer tax credits to reduce the burden on
he has taken on an issue that has repeat.:
I.'.S. health system before a joint session of low wage small companies as low as lO'"..
President Clinton, who began the year edly frustrated presidents before him And
• '
Conijress .ind a national television audience. Ihe nation seemed swept up on a by threatening to veto any bill that failed to his Ideas are a blend of ".New Democrat"
market reforms with an "Old Demoreform juggernaut that would lead to reach universal coverage, has said hoth
bills meet his goal and he would sign them. crat belief in social contracts, symhealth insurance for all.
bolized by the proposed mandate that
"Things that are this big don't get But whether either can pass itschamberbusiness help pay for its workers' insurstopped." Sen. .John Danforth. a .Mis- -iiul if they do whether their differences
souri-Republican, told The Wall Street < .111 be resolved by a House-Senate confer ance. But from the outset, his ability to
bridge the different camps in the health-reence committee-is far from clear.
Journal at the time.
form
movement has been hampered by
Today, the health-care bill that the full
From the administration's standpoint,
what some perceive as his elitist style and
Senate begins debating is considerably the most important test is whether either
persistent doubts about his character
more modest than even Republicans were house can sustain an employer manproposing last fall. Calls for bipartisan date, and many people expect an early vote "People have to trust you to take them in a
ri*.
acknowledges a senior
compromise have been replaced by elec- on the Senate bill's standby requirement.
White House official.
tion-year sniping. .And whether Congress But even if .Mr. .Mitchell succeeds with his
Sensing this. Republicans have aggreswill be ,ible to pass nmi health-care legisla- backup mandate, he isn't out of the
sively pursued the Whitewater affair and
tion this year - let alone a bill that guaran- woods in the Senate.
other such controversies, first to raise
tees medical coverage for every AmeriControversies remain over proposed doubts about Mr. Clinton s credibility
can-is very much in doubt.
taxes -especially a levy on insurance poli- among voters and now Democrats as well'
Sen. Danforth. himself, even after
cies with rapidly rising premiums - and Conservatives are most identified with
winning substantial concessions from the cost-containment provisions. .Moreover,
Democratic leadership, is now digging in
Republicans ran resort to a filibuster to these attacks. But in the short term at
his heels. 1 really see his glass as half
delay or block final action. If conservatives least, moderate Republicans have the most
empty, he says of the bill sent to the
take this course. Democrats could claim a to gain. In health-care, they have become
Senaie flmir by Majority Leader George
political victory and say the GOP ru.ned the arbiters of what is reasonable, as
Democrats, afraid of being identified with
.Mitchell, which incorporates many ideas
Mr. Clinton, look for bipartisan cover.
: .Mr. Danforth and two other GOP Finance the chance tor universal health coverage
But they will hkely face pressure to move Power of Trio
Committee colleagues have been pushing
to the right in a last attempt to pick up
" I can't support the .Mitchell bill. '
"The road to universal coverage goes
• :•
.Moreover, many of the Democrats moderate Republican votes.
through the offices" of Sens. Danforth
who should be on board if the adminThe Senate s position is so fragile
John Chafee of Rhode Island and David
istration is to prevail aren't there yet In that there is little hope among DemoDurenberger of Minnesota, Democratic
the House, Rep. Lee Hamilton of Indiana
crats that the mandate could be subSen.
Robert Keney of Nebraska said on
• who was first elected to Congress in 1964 stantially strengthened in a conference
Friday in announcing that he couldn t back
just in time to vote for .Medicare, says he with the House. For this reason, some
the Mitchell bill. The three GOP senators
can t support the House leadership bill proponents of overhaul say they believe
broke with Minority Leader Dole in June
proposed by Rep. Rahard Gephardt of that the best scenario would be for the
and joined with moderate Democrats to
Missouri in its current furm. Til not vote House leadership bill to go down to defeat
for the (;e|)hardt bill, ,\lr. Hamilton savs
I along with substitutes that will be offered draft a plan that formed the basis of the bill
approved by the Senate Finance Commit
, explaining that he favors ,i more gradiiai by Democratic liberals. Republicans and a
tee. But these three, who are now drafting
appro.u h to such a kirge social change
bipartisan group of moderates), serving as
major amendments to the .Mitchell bill
a "reality check " of sorts for liberals,
Republicans, led bv Senate Minor- ine result, these proponents hope, would
have so far refused to move closer in the
ity Le.ider Robert Dole of Kansas, argue be that lawmakers would have been alleadership measure.
that waiting to enact a bill would be better lowed to express their preference while
Going mto the fall elections, Mr Clinthan pushing through an untried scheme also opening the door to possible negotiaton badly needs a victory to show progress
that aims to restructure 15-^ of the nation's Hons on a compromise this fall.
on h's agenda^ And some believe this could
economy. Moreover, they say, some of the
be his only shot a n i e a l t t w ^ | r ^ ^
Despite the early momentum, restrucgovernment involvement in the Demo
cratic bills would leave the economv ,ind iunng the nation's health system to guarSays Sen. M i t c h i l i T T t h i ^ i k i ^ ^
the medical system worse than 'it is antee medical coverage for every citizen
succeed, it will be a very long i,me
and to constrain the rise in health-care
now.
before any president takes up this issue
costs was always an immensely difficult
again. They will say it is to difficult and it
So after a year-.ind-a-half of debate
IS too sensitive. "
lensot millionsof dollarsspenton lobbying legislative challenge. But Mr. Clinton's
.md advertising, deliberation bv five'con- allies in the health-care reform debate are
L;res.M..,i,ii. ^mmittees md ,in unrelenting in a much more difficult position than
push l)> Ihe president, Ihe debate in the fiill most people anticipated as the 103rd
House md S.-nate is . .,ming down to ,n Congress winds down.
.\ lot of us had been saying for so
l"h-hn,ir,rapsho<ji. ifk.i;i.slaii.,n,,uiM,r
'wd It all, it pn,b,ibl> wiil Iu. ,„iiv .,n' i long. Gee. we need presidential leadhighly partisan vote.
ership on this issue.' Bingo we got it
ind he really pursued it and people
The health bill the Senate takes up responded. And we forgot how entrenched
his afternoon is the result of exhaus
.'he .status quo IS, ' says Ed Howard, execuive ncj.iiation and political - alculalion tive vice president of the Alliance for
'. -'^en. .Mitchell. It falls r.ir short of
Health Reform. His nonprofit group sup11 esident ( Union s original proposal to ports universal coverage and cost controls
have employers pay ,^U', ot their workers but takes no position on how to get there.
he.ilth insurance costs and impose -overn•'""t as health care is central to Presime'"''''P^''" premiums. Instead, ,t woukl
Hit in pl;,ce a.series of financial incentives
^ind insurance-market revisions in hopes
of enticing more people and busines es
into the system.
„
..
By HiL^nY STOLT
. ,
-^-nd D.u.u RLx,m.s
Backstop Mandate
If such measures failed to result in
S^-i ' coverage by the year 2000, a ((immisMon would recommend to Congress a Z n
^ ck L
' '•''^mmendations, a
ba kstop mandate would take effect in
^002. requiring all emplovers with ''5 or
more workers to pay their employees
few ^tha^ r"" T'"'
^'^"'P'^nieri^uh
lewer lhan 2,. workers would be exempt
bu heir workers would be required by llw
Cio^JeTpSrfor'
THE WALL STREET JOURNAL TUESDAY. AUGUST 9. 1994
�'- .v
.'
"
-pfiit^fDm-
^•"We met every Thursday morning at 8:30 a.m. to educate ourselves. We had
r e t r e a t s . We l i s t e n e d to experts.''
D a n f o r t h and Durenberger are r e t i r i n g t h i s year. This i s t h e i r l a s t r e a l
chance t o make a d i f f e r e n c e . And Chafee i s one of the l e a d i n g h e a l t h e x p e r t s
i n Congress and t h e a u t h o r of h i s own h e a l t h b i l l , which would have r e q u i r e d
i n d i v i d u a l s t o buy t h e i r own i n s u r a n c e .
Chafee, of Rhode I s l a n d , and J e f f o r d s both are running for r e - e l e c t i o n
t h i s year i n h e a v i l y Democratic s t a t e s .
As for Dole's plan, Danforth minces no words:
think t h a t i t ' s a very
popular approach. I t c r e a t e s a new entitlement and i t doesn't have any cost
c o n t r o l . That's p r e t t y popular, but I don't think that we can do t h a t . ' '
With pressure on the ~"mainstreamers'' coming from both s i d e s , they are
'
g e t t i n g a b i t of advice from an u n l i k e l y source.
""Those who f i n d themselves i n the middle need to stand together sometimes
because they're pressed from both s i d e s , ' ' s a i d Sen. H a r r i s Wofford, D-Pa., a
Clinton a l l y whose upset e l e c t i o n i n 1991 r a i s e d h e a l t h reform to the top of
the n a t i o n a l agenda.
f i l e d by:APE-(PA)
on 08/10/94 a t 00:30EDT ****
**** p r i n t e d by:WHPR(160) on 08/10/94 a t 06:56EDT ****
****
�—V<^ KJ FOR.TH-
CBO Sees Democrats 'Health Bill
In Senate Expanding Coverage
, ;
By HiLAHY STOVT
Such opponents "pull the strings of
The financing struggle is one that dogs
others and inHame people by making all the reform plans before Congress. And
Staff Reporters of T H E W A L L STRFF.T J o i RNAL
charges of socialized medicine, for exam to the extent that lawmakers are unwilling
WASHINGTON-Congressional Budget pie, or that the government s going to take !u impose a mandate on business, they
Office estimates indicate the Senate Demo- over the health-care system." .Mrs. Clinton must find savings or taxes to compete in
cratic health-reform plan rapidly would ex- said. She scolded reporters for letting what has become a bidding war of subsipand insurance coverage in the U.S. but opponents such as Sen. Phil Gramm iR dies to meet set targets for coverage.
wouldn't slow rising national medical Texas) get away with saying the DemoIn the House, Republicans have so far
cratic bills in the Senate and House would
expenditures.
been reluctant to embrace taxes, and
By the year 1997. the CBO projects that produce "government-controlled" health without
revenues it is difficult to find the
the proposal could achieve coverage of 95% systems.
resources
needed to reach even 90% coverof the population by adding as many as 27 Partisan Strategy
age. This was the problem last night
million people to the insurance rolls
Mrs. Clinton suggested that the admin- facing conservative Democrats, who are
through a system of subsidies and market
istration
IS prepared to proceed with a continuing negotiations with the GOP and
reforms. This would nullify a backup
partisan
strategy
In the interest of getting are clearly disappointed with a draft plan
provision to require employers to pay 50""f
that would only achieve an estimated S8%
of their workers' insurance costs. Still, the strongest blueprint for universal cover coverage.
without further action, between 13 million age possible, •'if it's a 51-vote, fine" she
Unless the numbers are improved, the
and 14 million people would be left unin- said, referring to a scenario where Democrats would eke out passage of a bill on a effort could well flounder and create an
sured indefinitely.
bare majority, "if we'd not had a 51-vote on opening for the Democratic leadership to
In an accompanying explanation of its the budget we would not have four million win back this bloc of votes.
tiumbers. the budget office leaves itself new jobs.
some room regarding the 95% target and
The opening of Senate debate last night
also questions fhe workability of the underday of testy political maneuverlying subsidy scheme. "The proposal ng more akin to a county sheriff's race
would just meet its target of 95% covrage than
the august self-image of the chamber.
without imposing a mandate," the report
reads, but admits too that "the actual Republicans seemed mortified that their
outcome could easily fall short of the campaign committee chairman, Sen.
estimate."
Gramm. has seemed so eager to begin a
Moreover, the CBO says the annual filibuster. Anxious to shift the blame back
subsidies required simply to maintain the onto the Democrats, the GOP spent the day
95% standard would nearly triple to S194 3 accusing Majority Leader George Mitchell
billion by the year 2004. Large savings of scheduling health care for "the dark of
from Medicaid and Medicare would cover night" - just as senators often do in voting
most of these costs. But to stay within the on their pay raises.
budget, the plan depends increasingly on
The intemal differences for the GOP
revenue from a controversial new tax on appear more a matter of timing and politihigh-cost health plans.
cal judgment than outright rejection of the
This proposal is intended to damp filibuster option. "There is no desire to
rising insurance premiums but appears have a filibuster," said Sen. iNancy Kassemore successful in raising money. By the baum (R., Kan.), herself convinced the
year 2004, the CBO estimates, the tax Mitchell bill will fall "under its own
would pull in S20 billion a year; but in the weight." But if debate and amendments
same year, total national health expendi- fail to make sufficient changes, even Ms
tures would be S26 billion over the level Kassebaum, the picture of moderation is
projected by the CBO if there was no open to such confrontational tactics.
reform at all.
Scathing Attack on Mitchell
Release of the report came as a deeply
"If this is a truly bad b i l l . . . you bet I
divided Senate began a historic debate last would (filibuster)," said Oregon Sen. Bob
night on health reform. The strain of the Packwood, the ranking Republican on the
long fight showed in Hillary Rodham Clin- Senate Finance Committee. And Sen. John
ton, who decried "the hatred" and "vi- Danforth (R., Mo.), one of a trio of Repubcious" personal attacks on President Clin- licans who has worked with moderate
ton and herself in the course of the admin- Democrats on the committee, was scathing
istration's initiative. And in the House, a in regard to the plan Sen. Mitchell brought
business-backed effort to craft a more to the floor last night. "It's terrible," Mr
modest reform plan appeared in jeopardy Danforth said. "The idea that [Mr. | Mitch.because of disputes over taxes and the ell has moved anywhere in the ballpark of
failure to achieve even 90% coverage.
where we are is just flatly wrong."
"What I find regrettable is the amount
Against this backdrop, the CBO numof hatred that is being conveyed and bers are still useful for Mr. Mitchell in his
injected into our political system, the efforts to show a good-faith effort to move
first lady said in a discussion with a group toward the president's goal of universal
of reporters yesterday. " I don't have any coverage without imposing a mandate on
problem with anybody disagreeing with business. Achieving 95% coverage by 1997
this president on any policy position, I IS three years ahead of the plan's stated
don't have any problem with any member deadline, and to the extent that this
of Congress opposing health-care reform goal appears realistic, moderate Demobecause he doesn't think it's a good idea, orcrats could find it easier to vote for the
he Wants to use it as a political weapon. backup employer mandate provision.
That's politics.
The immense subsidies understate the
"But," she went on, "this personal, full costs of such a voluntary approach,
vicious hatred that for the time being is however, by tens of billions of dollars over
aimed primarily at the president and. to a the next decade. And the CBO assumes
lesser extent, myself. I think is very dan- that the states, to meet their obligations,
gerous for the political process. "
will add a l% tax of their own to insurance
Both the president and first lady have premiums, on top of a new 1.75% federal
been dogged by an increasing number of premium tax to help pay for medical
protesters at their public events. At the research and teaching institutions.
same time. Republicans have stepped up.
their attacks on Democratic health bills in
Congress.
• And DAVID ROGERS
�PM Health Reform, B j t , 790
- QAUfb^srtf
Changes Demanded on M i t c h e l l Health B i l l ; House Postpones Debate
^Og^,
Eds: Senate debate not expected t o resume u n t i l - afternoon; may be topped CftOWiV^i
: By CHRISTOPHER CONNELL= Associated Press Writer=
WASHINGTON (AP) A growing bloc of Senate moderates i s demanding changes
i n Senate M a j o r i t y Leader George M i t c h e l l ' s h e a l t h b i l l even as House leaders
are forced t o postpone t h e i r a c t i o n on reform a week or more.
President C l i n t o n . c a l l e d a Cabinet meeting today before dispatching 10
'Cabinet c h i e f s and 11 other top o f f i c i a l s t o lobby senators f o r the health
b i l l . I t came a day a f t e r a s t i n g i n g House defeat f o r h i s other major domestic
i n i t i a t i v e , a $33.2 b i l l i o n a n t i - c r i m e b i l l .
The president demanded Thursday evening t h a t Congress keep working on
crime and said, ""Health care's not going t o take a vacation e i t h e r . I t h i n k
they ought t o stay and deal w i t h both of them.'•
A f t e r two days of mostly p a r t i s a n r h e t o r i c , M i t c h e l l , D-Maine, said he
would c a l l the f i r s t votes today on amendments t o h i s 1,448-page plan, despite
Republican o b j e c t i o n s t h a t they needed more time t o study i t s provisions.
House Speaker Thomas Foley, D-Wash., a f t e r hours of t a l k s w i t h M i t c h e l l ,
White House Chief of S t a f f Leon Panetta and others, said the House debate on
health must w a i t f o r the crime b i l l t o be f i n i s h e d and f o r answers from the
Congressional Budget O f f i c e on the costs of r i v a l h e a l t h b i l l s .
Aides said they expected a t l e a s t a week's delay, and Foley would not r u l e
out the p o s s i b i l i t y of p u t t i n g a c t i o n o f f u n t i l September. " " I can't give you
an answer,'' he s a i d . " " I ' d l i k e t o do i t as,soon as p o s s i b l e . ' '
House M a j o r i t y Leader Richard Gephardt, D-Mo., denied t h a t the defeat of '
the crime b i l l boded i l l f o r passage of h e a l t h reform. ""The t i m i n g on health
care depends on g e t t i n g answers from CBO. I t has nothing t o do w i t h crime,''
he s a i d .
But even before the setback on crime, Gephardt and h i s l i e u t e n a n t s were 4-^
f a c i n g what Rep. Vic Fazio, D-Calif., acknowledged t o be a ""struggle t o round
up the votes.'•
Fourteen ""mainstream'' senators from both p a r t i e s met f o r several hours
Thursday and planned t o s i t down again today t o t r y t o develop a package of
major amendments t o M i t c h e l l ' s p l a n .
Their nucleus was the ""rump'' group t h a t pushed i t s own b i l l through the
Senate Finance Committee, i n c l u d i n g Sens. John Breaux, D-La., John Chafee,
R-R.I., and Kent Conrad, D-N.D.
""This i s the only b i p a r t i s a n e f f o r t going on i n the Senate,'' Conrad '
said. ""We need s i m p l i f i c a t i o n and s t r e a m l i n i n g . There's j u s t too much s t u f f
i n t h i s b i l l too many boards and commissions'* and too much demanded of the
states.
other Democrats also were r a i s i n g questions about M i t c h e l l ' s overhaul o f
the h e a l t h system, which aim's t o get h e a l t h insurance f o r 95 percent o f
Americans by the t u r n of the century. Today only 85 percent are covered.
""People do notr wzmt government making t h e i r health care choices for them.
Washington should not run that system^'• Sen. Herb Kohl, D-Wis., said in a
floor speech.
Mitchell's c a l l for a 25 percent tax on health plans with costs that grow
faster than average also was evoking sharp skepticism.
" " I t i s too much l i k e p r i c e c o n t r o l s , " said Sen. John Danforth, R-Mo. But
he also faulted a r i v a l Republicam plan by Senate Minority Leader Bob Dole for
doing too l i t t l e to r e s t r a i n the growth of medical costs.
Sen. Frank Lautenberg, D-N.J., even as he declared support for the
Mitchell b i l l , s a i d the tax on health plans had to be altered.
In the House, Democrats backing Gephardt's universal coverage b i l l handed
out f a i l i n g grades to the stripped-down, bipartisan health b i l l put forward by
10 moderate-to-conservative Democrats and Republicans.
They complained i t would leave as many as 30 m i l l i o n Americans without
insurance and cut Medicare without giving the e l d e r l y drug benefits or
*
anything e l s e i n return. As for holding down costs, the bipartisan plan i s
�er person more than four times as
much as a younger person.
Employers would have to offer msurance to their employees but
would not be required to pnv pnrt ': •md saia he '.v,is "encer to plav the
the premiums. Employers would .'ule • : •' i •.•rni;:i:;;i;r,'
ben. Hnrri.- Wonord (D-Fa.,',
have to offer a beneiit packace
equivaient to those offered to federnl ,\litcheil supporter, ^iid that if ReBy David S. Broder
dorsed bill. Rep. Sam Gibbons (D- employees now by the Blue Cro>.- public,i:i.-> iien\- reiorni he would proand Spencer Rich
Fla.). acung chairman of die House standard option pian. with at least pose ail anienanient to strip senators
Washmiiton fo»t Su« Wntfrs
Ways and Means Committee, said m one option tor unlimned choice of .'f their taxoaver-iinanced health
i,en-iit.- di,..! uw\- ,ippro\ed iiealtl;
an
interview, "My advice totiiemis doctor and two others.
House Democratic leaders, shakuisLira':.
- :• - evervone eise.
en by theu- unexpected defeat on the Uiat we ought to go ahead. If vou For people with low incomes, ic- j il I-;..-. :r'.eioDniep.t> \'estera,r..
have
to
wait
for
Uie
CBO
to
give
you
eral
subsidies
would
be
available
inicrime bili, last night announced a de':-;r .Aiiieric;;:; .'is.-ociation of Retired
lay of indefinite duration m taking up an estimate, you will wait the rest of tially for those wnth incomes up to i'er.sohs i.-^^ARP), priiiciDai voice ot
your
lives.
I
say,
go
ahead."
100
percent
of
the
poverty
level
but
health care reform.
It is the bill Uiat Gibbons brought nsmg to 200 percent over time to tne elderlv iiere, has received thouHouse Speaker Thomas S. Foley
out
of his committee Uiat, wiUi slight help them pay for policies. Medicaid jrfiids 01 calls from senior citizens pro(D-Wash.) came out of a late-night
patients who receive Aid to Families testmc tne group s suopon of health
; meeting at the Capitol to tell report- modifications by Gephardt, has be- with Dependent Children would be c.ire bill.i introauced bv maiontv leaders tliat the House would stay in ses- come the measure backed by the shifted to pnvate plans, using money |era of the House and Senate,
sion next week but work on oUier preskienL It includes a requirement formerly spent for their Medicaid
.AARP lobbyist John Rother said
matters, inchiding a second effort to that all employers pay for their benefits. The costs of subsidies for !the onslaught appears to be orchesworkers'
health
insurance
and
prompass the crime bill. He refused to
the poor and the Medicaid shifts ' trated. Calls began Wednesday before
speculate on when the health care I ises universal coverage by 1999.
would be paid for by cutting project- news organizations had time to report
Rep.
Charles
W.
Stenholm
(Dmeasure might be debated—later in
Tex.), one of the co-sponsors of Uie ed growth of Medicare and Medicaid' the croup's endorsement, he said, and
August or even after Labor Day.
conservative alternative bill, said by $228 billion and S203 billion re- callers use smuiar language. He said
"I want to do it as soon as possi- that canvasses of moderate and con- spectively over the next mne years. about 1,000 callers registered comble," he said, "but I don't know when servative Democrats yesterday conMeanwhile, as the Senate slogged plaints on each of the past two days,
it will be."
"They're from the extremes," he
vinced him that the bipartisan meas- through Its third day of deoate on
With Republicans threatening ure he and nine others shaped has health care proposals. Democrats said, "hardlv representative. It's cerslowdown tactics in the Senate as ' far brighter prospectstiiantiie(Gep- groped inconclusively for alterna- tainly some script."
well, Uie whole timeUble for health hardt bill. It was primarily defections tives to the plan by i\iitchell to help
SLX years ago, the A.ARP"s leaders
care legislation appeared to be in from those same conservative Dem- contain costs by taxing increases in supported n medical catastrophic injeopardy. Even after bills are passed ocrats, plus near-solid Republican costly insurance plans.
surance plan for Medicare recipients,
by Uie House and Senate, Uiey must opposition, Uiat doomed the crime
Mitchell mcluded die 25 percent only to have its membership revolt
be recondied by a conference com- bill yesterday. Backers of Uie bipar- levy on mcreases in msurance pre- and force a repeal of the law.
mittee and then repassed in both tisan bill are aiming for the same co- miums m his compromise bill after
This year, Rotiier said, the organihouses. Congress aims to adjourn in aiitioo to substitute their plan for senators objected to a premium cap zation has conducted polls deiermmGephardt's on the House floor.
less than two months.
proposed by Clinton. But now many mg that most of its 35 million memFoley blamed the delay in the
Earlier yesterday, the House senators. Democrats as well as Re- bers support the bills sponsored bv
House on the time needed by the Rules Committee began formal publicans, have complained that the Democratic leaders m the House
Congressional Budget Office to esti- hearings on Uie Gephardt bill, Uie bi- Mitchell's alternative smacks of a and Senate.
mate the budgetary costs of four partisan measure, a Republican al- middle-class tax mcrease.
Both measures covertiieAARP'S
major health bills awaiting House ternative and a single-payer plan
"The language of the debate pnncipal health care goals: prescripconsideration. The bills were com- that wouW establish a government- makes people uncomfortable bepleted, in some cases, only Wednes- financed iiealth care system similar cause it looks like we're going tion drug benefits for Medicare recipday night.
to that of Canada. The committee against our own constituency," said ients and government contiibutions
win
set the terms of delate once Sen. Christopher j . Dodd (D-Conn.). to the costs of long-term care.
But the decision, following the
Several alternatives were proAbout 20 people identifying diemloss on Uie crime bill and the emer- laders dedde when they want to
gence of a bipartisan conservative tackle the controversial issue (Clin- posed in the meeting, including one selves as AARP members called The
alternative healUi bill that could gain ton has placed at Uie top of his 1994 I to tum the problem over to a cost- Washington Post from as far away as
monitoring commission, but "there's Florida and Alabama. Most lacked demajority support on the House floor, domestic agenda.
The "middle of Uie road" healUi no agreement on anything," said tailed knowledge of Uie bills but were
suggested deep concern.by-.the
Democratic leaders about the fate of (plan introduced yesterday by a coali- Sen. John Glenn (D-Ohio). One prob-, nonetheless angry Uiat the group's
the measure being backed by Presi- I tion of 10 Republicans and moderate lem with scrapping the tax approach i
Democrats attempts to solve some is that it would reduce revenue leadership threw its support behind
dent Clinton.
Clinton, appearing at the White of the problems of the nation's needed to finance subsidies to ex^ them.
House after his crime bill defeat, health care system without imposing pand coverage to low-income famiStaff writer Helen Dcuar
said, "health care is not going to t^ke new taxes or mandates requiring lies and avoid deficit mcreases.
contributed
to this report.
I
employers
to
pay
for
insurance
for
a vacation. . . . I think (the ConFacing a similar predicament of
gressi ought to stay and work on ' their workers.
elusive consensus, a bipartisan
both" health care and crime.
The measure would expand cover- group of Senate moderates met late
White House Chief of Staff Leon •• age from the current 85 percent of yesterday to agree on an alternaE. Panetta joined Foley. House Ma- the population to "around 90 percent tive—or alternatives—to Mitchell'y
• or a littie bit better by the year plan. With some exceptions, Repub
HEALTEFromAl
: 2004." said Rep. J. Roy Rowland (D- licans were pushing for a comprehensive alternative, while Demojority L,eader Richard A. Gephardt i Ga.). a leader of the coalition.
(D-Mo.) and others in a meeting that
"This seeks to refonn the health crats, many of whom did not want to
began in Foley's office and then ! system from within—to fix the oppose Mitchell's bill as a whole,
moved across Uie Capitol to Uie of- cracks without teanng down the leaned toward selective amendfice of Senate Majority Leader walls," said Rep. Michael Bilirakis ments.
George J. Mitchell (D-Maine). (R-Fla.), another sponsor.
Democrats also were resisting i
MitcheU said Uie Senate, which beLiberal Democrats charged that pressure by Sen. John C. Danfortii:
gan debating health care three days the new bill actually does very littie. (Mo.) and other Republicans to i
ago. would continiie to plug away at
to stick together on every- •
Many Democrats, said Rep. Ron agree
the issue.
thing, as they did in Senate Fmance
Wyden (D-Ore.) "say there's nothing
House leaders have hoped that there." Under the bipartisan bill, in- Committee deliberations, "We can't
the Senate would vote first on the surers would have to accept all indi- say we're slickmg together until we
controversial issue of requiring em- \iQuals who apply, and all firms wnth have an agreement." said Sen. Kent
Conrad (D-N.D.).
ployers to buy health insurance for
tiieir workers. But Mitchell has not fewer tiian 100 workers. These are
On t:if Senate floor. Mitchell's
vet assembled enough support to the two groups that have most diffi- pinn Cfintinued to come under attack
move for a vote on the so-called em- culty m obiaimng insurance now. No ironi Rcuubiicans wnue receiving a
one could be tumed down for a pre- mixed reaction trom uncommitted
ployer mandate.
existing
condition.
Democrats who mnv be cntical to
Even before the gnm-faced DemRates
charged tor policies pur- passace ot ms plan.
ocratic leaders emerged from almost
four hours of discussions, news of chased by mdividuals or firms wnth
Holaing up copies ol Mitchell's
the likely delay drew strong protest fewer Uian 100 workers could vary oncinai arait and a subsequent re'rom key backers of the CUnton-en- for geography, family size and age, vised version, ben. Bob Packwood
but msurers couid not charge an old- (R-Ore.) described them as "Lethal
Weapon 1" and "Lethal Weapon II"
Delay by Democratic Leadership
Puts Reform Timetable in Peril
�(\)0M'
border states like Texas and to wealthv
Medicare beneficiaries
wealthy
Most debatable is" a provisinn thot
could deny Medicaid andTuSentI
Secunty Income benefits to lega^^S
Health-Reform Hopes Rest in Senate, ,
I^ere ainton Will Seek Compromises. 1 r
iu*^" '"^ sponsorship of the r
amines. The measure appears to come
power. In all the failed attempts in the Ir from a similar proposal in ?he Hou^e
s t a f f Reporter of T H E W A L L S T R E E T J O L R N A L
past, the issue has never gotten this far Repubhcan welfare bill, but Mr iXimenfH
VVASHINGTON-Democratic hopes for before in Congress. And however many IS sure to want changes, and ReVubS
health reform rest increasingly in the obstacles remain. Mr. Mitchell seems to be aides said an en-or had been made In
Seiiate. where the Clinton administration betting that senators will reach some con- dra ting legislative languagVTo" t K i i "
will try to restore some momentum this sensus rather than see the initiative die on
As now written, the biU foes fiSer too
week and test whether a compromise can their watch.
i"JT"?5
higher-income S y S
be reached with moderate Republicans
shoulder the cost for Medicare Part B
This
explains
his
single-minded
deterMajonty Leader George Mitchell yesZTf ^
physicians bins an3
terday repeated his vow to keep the cham- mination to keep the chamber working but Z
nonhospital care. Most altematives woidrt
ber in session however long it takes to as the Democratic leader, he must stniggle
produce a bill. And the Maine Democrat to hold his own party together even as he sT^So'n?*' r ^ v e m m e m S
out to Republican moderates. A SJOy from 75% of costs to 25% fnr thi
and his Republican counterpart. Sen Robert Dole of Kansas, appear locked in an J f l l f i M f l ' ^ J f t h r e a t e n i n g «^tolest But toe new billTp °/rst
often testy fight over who best represents to bolt if the bill moves too far to Uie right
And concessions sought by Mr. Chafee and Sii£.nH^ ^'^^'^^^
'"comes of
the middle ground on the issue.
his allies would make It harder for the s^;Tr th^ """^ "
eliminates the siib"The Republicans can prolong this by majority
leader to placate his already sJdy for those over $150,000
stalling, but we're going to stay until it's nervous allies
representing labor and the t h P ^ ! r j i ' ! i ' ' r " ° ' * ' '
immensity of
•' said Mr. Mitchell. "We're eideny.
legislative task Is still staggering to
staying. I can't make it clearer or sav it
many
senator,
m
a
rambling
speech
For example. Mr. Mitchell's bill inmore directly."
'
cludes
a
new
prescriptlon-dnig
benefit
for
The tensions spilled over in noor debate
late Friday and again Saturday. With each Medicare estimated at J95 billion over 2 S h ^ m p ^ ' H ^""^'^ *^°y"ihan invoked the memories oftoeworld's great
day. the GOP is under pressure to abandon the next 10 years. This has been attacked scientistii
as well as the more mys^ca
the stalling tactics that have so far blocked by Sen. John Danforth (R.. Mo.), a Chafee tenete of his
Catholic catechism
friend
and
ally,
and
the
mainstream
coalivotes on amendments to the Democratic
This
is
not
my understanding of how
tion
is
considering
an
alternative
costing
leadership bill. And Mr. Mitchell hopes to
science proceeds." said the New York
meet tomon-ow with a small bloc of moder- about a quarter as much and targeted Democrat
and fonner Harvanl teacher
ate Republicans whose votes are crucial to more to the lower-income elderiy.
building his case against an atterSpt tc;
building a working majority and breaking Worries of Labor
prescribe how many specialist^ c^S be
the current impasse.
There remain often-netUesome differ- trained in the future at federally supported
•Mr. Dole hopes to counter his rival by ences over therightsof states and conexploiting Democratic divisions and reach- sumers under whatever restructured
ing out to Southern Democratic conserva- health-care system emerges. And while ail Ghost'.'' • •
* ^ ^ ^ ' " " ^ '^^ ""'y
tives. But a hastily embraced, business- sides speak fervenUy of the need to do
backed reform plan, which is expected more to control burgeoning costs, labor
to be introduced in the Senate this week fears that a revised tax on high-cost health
has major weaknesses in its financing' plans would be hannful to supplemental
Moreover, the Kansas Republican seems
^K'M'"*
membeni.
com at appearing to obstiTict an issue as
The
United
Auto
Workers
leadership
is
sensitive to him as health care.
ainong those most won-ied by the direction
Dole Sheds Sarcasm
taken by the Mitchell bill, and the auto
I
His trademark, hard-edged sarcasm industry itself, one of the White House's
ell away quickly to a display of hurt in strongest allies, is atriskof breaking with
Ooor debate last week, when he accused the administration. A memo prepared bv
Democrats of implying that Republicans Ford Motor Co. and recently sent to
didn t "like children, " And sitting side-bv- Michigan's Senate delegation includes a
side with .Mr. Mitchell yesterday on VBC long list of objections to the Mitchell bill
-News' "Meet the Press, " Mr. Dole lashed including its failure to assure universal
out at old allies in his party who are more coverage or stronger cost containment
"pen, he said, to working with the DemoMr. Dole, for his part, is adopting a
cratic leader than the GOP.
'^^Z^^^ ^^l^^Jf^ °f P"""'"? His own
•What I don t want are three Republi- scaled-back GOP refonn plan while lendcans . . . trying to direct the rest of us 40 of ing quiet support to a new, somewhat more
us. where we should go.'".Mr. Dole said of a generous bipartisan alternative designed
so-called "mainstream" faction led by to win over conservative Democrats such
Rhode Island Sen. John Chafee "We as Sen. Sam Nunn of Georgia. Sen. Robert
haven't had the close working relationship Bennett (R., Utah) is expected to join Sen.
Pete Domenici (R., N.M.) in offering the
vf ^ n I
«^°"P that Sen
measure as a compromise, and Mr BenMitchell has. They don't talk to us very nett's presence, as a conservative freshoften. We wish they would. "
man, IS seen as a sign of Mr. Dole's tacit
Sense of History
support.
For all the current bickering, there is
The bill, which has drawn strong busian almost unique sense of history about the ness support since being intiwluced by a
health-care debate that gives it staying similar coalition in the House last week
would commit about $140 billion toward
subsidies and tax deductions to expand
health-care coverage over toe next five
years - or $33 billion more than Mr. Dole
has so far proposed. But the legislation
could require substantial revisions, and
the financing could prove embarrassing to
sponsors because of the adverse impact on
Z I
'
By DAVID ROGERS
^
�Dole Jabs at Health Care Plan;
Mitchell GUs GOP Hypocritical
By Kevin Merida
Wadungton PoU Sufl Writer
The Democratic and Republican
leaders of toe Senate waged a feisty
debate yesterday over the costs,
scope and politics of health care reform. But toey left unclear what it
would lake to reach a compromise
that would guarantee passage of legislation this year.
Senate Minority Leader Robert J.
Dole (R-Kan.) said Republicans
would start allowing floor votes on
heaito care amendments sometime
this week, but he was equivocal on
whetoer GOP senators would help
deliver a bill this year.
•WeU, if we can have a say in
whafs delivered," said Dole on
NBC's "Meet the Press." "We're not
going to just blindly deliver a health
care bill that may penalize many
Americans."
Appearing with Senate Majority
Leader George J, Mitchell (D>laine) on Uie program, Dole tried
to poke holes in Mitchell's bill, saying it is laden with new taxes, would
hurt small businesses and gives the
govemment too mufli control over
health care.
Mitchell, in tum, vigorously defended his proposal and accused Republicans of being hypocritical in
railing about government-financed
heaito care while supporting Medicare, Veterans Administiration benefits and federally subsidized care for
themselves.
"So here we have a situation."
Mitchell asserted, '\vhere they say.
'We've got govemment heaito msurance, we've got govemment care.
We like it for us and our families, but
for you, Mr. and Mrs. Average
America, that's a bad thing. You
really shouldn't have it.' "
The Mitchell proposal would cover 95 percent of Amencans by 2000,
wito employers required to pay a
portion of workers' premiums if that
goal is not achieved. President Clinton has endorsed toe Mitchell bill as
the minimum he can accept.
Mitchell said he believes health
care legislation will be passed this
year, but reiterated his support for a
veto of any bUl that oniy covers 90
or 91 percent of Americans, as some
moderate-to-conservative Demo-
HEALTH CARE HIGHLIGHT
• THE SENATE may be able to take its first votes this week on health
care refonn legislation, but senators yesterday were divided on what
plan they might adopt and on whether a bill can be passed this year
crats and Republicans have advocated. About 85 percent of Americans
already have health insurance.
The Mitchell bill drew Democratk: criticism yesterday when Sen. David L. Boren (D-Okla.) said on CBS's
Tace toe Nation" toat he toought
Uie proposal was "dead and I think
we can't even amend it." Boren is
backing a moderate House-drafted
heaito care plan toat would extend
coverage to about 90 percent of
Americans witoout raising taxes.
White House Chief of Staff Leon
E. Panetta saki on toe same program
that the Boren approach was unacceptable. Although the administration still hopes to have a heaito care
bill passed by Labor Day, Panetta
said, he conceded it would be tough
given the priority of passing the
crime bill in the House.
MitcheU said he was still open to
cooperating wito a bipartisan group
of moderates who have been meeting regularly to forge a compromise.
"I've worked closely with them," he
said. " I think toey're serious
I
think the important thing is to keep
the principles intact, but you can
have reasonable compromise on specific provisions."
One member of this nmip group.
Sen. John Breaux (D-La.), sakl on
'Face toe Nation"toathe thinks the
Mitchell bill can be improved and
passed wito a package of about eight
to 10 amendments. Breaux said the
Senate should cancel its summer vacation, 'lock the doors," and work
until a bdl is passed, while Boren
sakl it was "dangerous for us to try
to throw sometliing together in a
week's time."
Dole, who has offered a more
modest health care bill than Mitchell's, became testy when it was suggested he was being pressured by
conservatives in his party to be firm.
He also took a jab at Republican
moderates for not working more
closely wito him.
" I don't have to get permission
from anybody in my party when I
make my decision." he said. "But
what I don't want are three Republicans—Senators Uohn C.) Danforth
[Mo.l. (Davel Durenberger (Minn.)
and (John H.) Chafee (R.L|—trying
to direct the rest of us. 40 of us,
where we shoukl go. We haven't had
the ck>se working rdationahip wito
this mainstream group that Senator
Mitchell has. They don't talk U) us
very often. We wish they woukL"
�But no one knows whether senators would r e t u r n from a recess refreshed and
ready t o pass h e a l t h refonn, or disheartened and ready t o pack i t i n .
^"This i s not some s o r t of f u t i l e e f f o r t , ' ' deputy White House c h i e f of
s t a f f Harold Ickes s a i d . ""We t h i n k h e a l t h care i s a l i v e and w e l l . ' '
Some of the most p e s s i m i s t i c assessments are coming from the b i p a r t i s a n
group whose plan i s widely viewed as the only v i a b l e route t o a c t i o n t h i s
year. Prospects are """not t e r r i f i c , ' ' said Sen. Bob Kerrey, D-Neb. ""Less than
50-50,'' said another member o f the group. Sen. John Danforth, R-Mo.
I t would be strange indeed i f M i t c h e l l , Kennedy and other champions of
comprehensive reform ended up c a r r y i n g the banner f o r the i n c r e m e n t a l i s t s . But
i t very w e l l could t u r n out t h a t way, because they're also the ones most
determined t o achieve something t h i s year.
Editor's note: J i l l Lawrence i s covering the congressional h e a l t h debate
for The Associated Press.
****
f i l e d by:APE-(ME)
on 08/25/94 a t 00:24EDT ****
**** p r i n t e d by:WHPR(160) on 08/25/94 a t 06:40EDT ****
�IPossible compromise props up wilting health reform
By Alissa J. Rubin
CONGRESSIONAL OUARTtRLV
Plans in Congress for sweeping
health care reform are barely
alive. But Senate Majority Leader
George J. MitcheU, Maine Democrat, has moved quickly to eniiance toe cliances for successful
negotiations with a bipartisan
group led by Sen. John H. Chafee,
Rhode Island
RepubUcan.
In a significant gesture
b e f o r e Congress went
home for its August recess, Mr.
M i t c h e l l
agreed to use
the Chafee
group's draft
bill as the basis
Mitchell
for discussions,
saying it "clearly will not be a bill
"s comprehensive as I would prefer, but toere's much that can be
done that would represent progress."
Mr Chafee's proposal includes
insurance market reforms designed to make the industry more
competitive. His plan also would
expand subsidies to toe poor to
buy heaito insurance, but it would
not achieve universal coverage.
Senate Democrats remain divided on how far to depart from
toe goal of heaito insurance coverage for all Americans in order to
win toe Republican votes needed
to pass a bill.
A further question for Democrats is how President Clinton
would greet a bUl toat faUs far
short of iiis promise to achieve imiversal coverage and control costs.
StiU hindering toe prospects for
a compromise bill are serious political and pohcy obstacles. It appears unUkely that Senate Repubhcan leader Bob Doie of Kansas
wiir-throvv_h'' weicht behir'd any
compi^op-.ise proposal.
That means it wiU take almost
every Democrat and toe handful
of Republicans working with Mr.
Chafee and his "mainstream"
group to sustain a plan. They wiU
have to be prepared to stick togetoer tiirough toe same kind of
GOP opposition and filibustering
that stymied toe crime bill.
"Republicans will be out toere
torough toe recess saying what a
bad bUl this is," said Sen. Bob
Packwood, Oregon Republican,
who is working closely wito M r
Dole.
And toe group of Republicans in
toe "mainstream coalition" say
they are reluctant to make
changes in toeir bipartisan bill.
The group already lias worked for
montos to accommodate an array
of interests as its ranks grew from
seven senators to 20.
Several key members of this
group fear that making any furtoer changes could unravel toe
whole agreement. "We've put out a
proposal we t'anV is good. We're
not intenestea in being ni :lcei9d-
and-dimed to the left," said Sen.
John C. Danforth, Missouri Republican and a member of the
group.
However, if toe group refuses to
move at aU, it is unlikely that Senate Democrats could go along.
What Democrats want are congressional votes on several defining issues, including prescription
drug insurance for toe elderly,
long-term care, a mandate that
employers pay a portion of the
health insurance costs for toeir
workers and toe proposal to cap
deductibility of health insurance
benefits, which is anatoema to labor unions.
There are other
complex
choices to weigh. In toe past year,
it has become clear that making
insurance reforms without also
achieving universal
coverage
could actuaUy increase health insurance prices, worsening toe lot
of the middle class, which is the
bfciirock of Democratic support.
• Dis.ributed by Scripps Howard.
Safety refomi package dead for
manent replacements for striking
workers,
A toird Clinton administration labor
Labor Secretary Robert Reich all
bill, which would consolidate several
but conceded yesterday that an
worker-training programs within the
administration-backed effort to overLabor Department and streamline toe
iiaul toe Occupational Safety and
federal training bureaucracy, also
Heaito Administration (OSHA) won't
faces an uncertain future in toe short
pass tliis year, a victim of toe crowded
congressional session that begins Sept.
caleiidar on Capitol Hill and united op12. Congress still must tackle heaito
positicm from business groups.
care, toe GATT global trade treaty, and
"One cant be terribly )ptii:\istic
f^.eral appropriaaon bills in addition
about toe prospects for OSHA mfom;
to the trainiiig proposal.
this yeaif Mr. Reich told reportei s yesMr. Reich's admission did not come
terday, adding that he expected a new • as a surprise to business interest
reform measure "in some form will be
groups, wliich were united in opposiback on toe agenda next year,"
tion to toe OSHA package.
The OSHA package also represents
"The prognosis for that bill hasn't
a second straight legislative setback
been good for a long time," said Brad
fbr organized labor tliis summer A
Cameron, spokesman for the Labor
combined lobbying blitz by toe AFLPohcy Association, which represents
CIO and toe Chnton administration
some 200 of the country's biggest emfailed to break a Republican-led fibployers. "Heaito care put everything
buster in the Senate last month that
else in jeopardy, and there was a growkilled a bill banning the hiring of pering sense that the OSHA bill would proBy David R. Sands
TM£ VWSHMQTON TIMES
SAFETY
From page B7
quires stricter record keeping.
For toe first time, shop floor managers — in addition to company
owners — would have some liability for safety code violations.
The bill, co-sponsored by Sen.
Edward M. Kennedy, Massachusetts Democrat, and Rep. WiUiam
Ford, Michigan Democart, closely
tracked a similar measure that
was defeated in Congress in 1992,
in the face of opposition from the
Bush administration.
The Labor Policy Association
charged that toe Ford-Kennedy
bill could cost businesses some
$62 billion a year in new expenses,
a figure sharply cricitized by bill
supporters. M r Lunnie also said
Mr. Reich and toe administration
took none of the business community's criticisms into account when
introducing toe revised OSHA reform package earlier this year
The AFL-CIO identified the bUl
as one of its top legislative priorities for the year, saying that the
2,000 federal and state inspectors
were not up to the task of policing
voke a major battle at a time when toe
administration couldn't afford one."
" I ttiink in toe end, toe proponents of
reform just didnt make toe case for
this bill," said Peter Lunnie, senior policy <iirector for employee relations at
toe National Association of Manufacturers.
The OSHA bUl, which would have
been toe first major overhaul of toe
federal worker-safety agency since its
founding 24 years ago, would require
all but toe smaUest companies to set up
workei>employBr safety and heaito
committees, complete wito employerfunded training and education programs. The bill also extends OSHA
coverage to some 7 million publicsector employees.
The measure also stiffens fines and
penalties for companies that violate
OSHA regulations, targets high-risk
industries and workplaces, and resee SAFETY, page B9
America's 6 million workplaces.
The union group also said that 24
years after OSHA's founding, some
7 miUion U.S. workers a year are
StiU killed, injured, or made sick
on the job.
Mr Reich made his comments
yesterday after a pre-Labor Day
address in wiiich he wamed that
technology and a widening skUls
and education gap have created a
"fractured middle class," with
lower-educated and poorly trained
workers enjoying far less pay,
benefits and job security than
toeir better-trained coimterparts.
1994
�OCIAL POLICY
of GOP opposition and fUibustering that
anotner rui
run at the issue.
yj
the Congress that took a step toward
ird
gress another
stymied toe crime bill. CStory, P- 2488; mastering the health care hydra or
"Whatever we get now we're going to
have for several years to come," said
' "Republicans wiU be out there
join toe line of lawmakers who had
Sen. Dale Bumpers, D-Ark., who cauthrough the recess saying what a bad
tried but failed to address the issue?
tioned against a drastically scaled-back
biU this is," said Sen. Bob Packwood, RHealth industry interests — small
biU, but still said he wanted to see what
Ore., who is working closely with Dole.
businesses, the elderly, insurers — calMitchell and Chafee could agree on.
In fact, attoispoint there is no bill, but
culated that Congress might still proPackwood said that anything toat
duce a biU, and they vowed to continue
Need for GOP Help
looked at all like an earlier proposal by
working to ensure that their constitMitchell would be unacceptable.
uencies were taken care of. "Are we
A bipartisan plan would make Clinpacking up our bags? Absolutely not,"
And, the group of Republicans in the
ton look statesmanlike and deny Resaid Mark Isakowitz, a lobbyist for the
Mainstream coalition that is working
publicans the right to saytoeystopped
National Federation of Independent
with conservative Democrats say toey
toe health care overhaul, said many
Business, which represents small busiare reluctant to make changes in their
Democrats. 'There's no question in my
bipartisan bill. The group, led
mind that those filibustering
by Chafee and Sen. John B.
crime were filibustering health
Breaux, D-La., has already
care, and we're not going to let
worked for months to accomtoem have it," said Sen. Edmodate an array of interests as
ward M. Kennedy, D-Mass.,
its ranks grew from seven senawho is uplftii re-etecQon tois
tors to 20.
year.
Several key members of this
But Kennedy and the Demgroup fear that making any furocrats will need toe help of at
ther changes could unravel toe
least toe handful of Republiwhole agreement "We've put
cans who voted with toem on
out a propiosal we think is good.
toe crime bill. It is not clear
,
We're not interested in being
that tooee or otoer Republinickeled-and-dimed totoeleft,"
cans are willing to face the insaid Sen. John C. Dan^irtbr^ttense criticism that will come
Mo., a member of toe Mainfrom toeir party's leadership
stream group.
should toey support a DemoHowever, if the group
cratic proposal.
R UlCHAEL JENKINS
refuses to move at all, it is unFour of the swing RepubliSens. Jeffords, center, and Chafee. right, meqt Aug. 25 with
likely that Senate Democrats
can votes on toe crime biU were
Vemiont Gov. Howard Dean to discuss health care.
coidd go along. What Demopart of toe bipartisan health
crats want are floor voies on
care group: Cbafee, Danforto,
several defining issues, including preJames M. Jeffords, R-Vt, and Nancy
ness. Fortoefederation and other busiscription drug insurance for the elderly,
Landon Kassebaum, R-Kan. The power
ness groups, a scaled-back biU similar to
long-term care, a mandat| that employtoe Mainstream group's proposal would of the party's censure on the crime bill
ers pay a portion of the hadth insurance
already seemed to he having an effect on
be a victory.
costs for toeir workers and the proposal
some members' enthusiasm for continuBut a key question for Clinton and
to cap deductibility of health insurance
ing to work on health care.
the liberal Democrats is whether rebenefits, which is anathema to labor
treating from the promise to guaran" I don't like to vote against my leadunions.
tee health insurance for all Americans
er," Danforth said after toe crime bill
There are other complex choices to
would become a political liability as
vote, uTwEch he sided witotoeDemoweigh. In toe past year, it has become
did President George Bush's broken
crats. Danforth, who said he was besieged
clear that making insurance refonns
promise about raising taxes. Most
by calls from fellow Republicans to vote
without also achieving tmiversal covermembers say that achieving less than
against toe crime bill, is now taking a
age could actually increase health insurimiversal coverage could not be dehard line against compromising with toe
ance prices, worsening the lot of the
picted as a failure because even small
Democrats on heaito care.
middle class, which is the bedrock of
improvements in the health care sysDeclared Sen. Robert F. Bennett.!r
Democratic support.
tem would help some people.
R-Utah, who has worked with Chafee
For instance, if insurers are reSen. John D. fiockefieller IV, D- and with Dole: "I believe health care is ]
quired to charge everybody the same
W.Va., an ardent supporter of imiverdead for this Congress."
_^—J
amount regardless of age, sex or health
sal coverage, said that Clinton must
Other Republicans took a less pessistatus (community rating), it can
choose lietween the grand gesture of
mistic tone. "Republicans are feeling
mean that prices go up for young peovetoing a limited biU, or accepting it,
badly about toe crime vote, so they are
ple, which can force them to drop
admitting that it's not universid coverpessimistic about doing anything," said
their insurance and increase costs for
age but saying, " 'I'm going to be here
Sen. Dave Durenberger, R-Minn., who
people who have insurance.
for another two years or six years, and
has been worEing wito^ Chafee for
it's a good, decent, strong, down paymonths on a bipartisan approach. But
C o n c e m About Legacy
ment, and I can't deny help to people
he remains cautiously optimistic that if
As members sought solutions the
who need help now.' "
everyone stays at the table, there could
week of Aug. 22, they also were strugThe risk in doing a smaller biU is
be a biU that makes needed changes.
gling with what kind of legacy they
" T h e n c t t w - r i j ^ f l y g n t t n (jft
h i l l , " ha_--^
that if {ispects of it go awry, the public
, wanted to leave. Did they want to be
likely will be reluctant to allow Consaid. fW?e^ Report, p. 2458)
m
C
CQ
AUGUST 27, 1994 — 2487
�
Dublin Core
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Title
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Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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Dublin Core
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Danforth, John (R-MO)
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 2
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Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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2/6/2015
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42-t-12092992-20060885F-Seg2-007-011-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/9a95b26e8b09d81b704fa6293f99d722.pdf
c6036ed8b7f296fa1c8be3bcf1a8dd3d
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3665
FolderlD:
Folder Title:
D'Amato, Al (R-NY)
Stack:
Row:
Section:
Shelf:
Position:
s
52
3
3
1
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001a. letter
Alfonse M. D'Amato to Hillary Clinton; re: Constituent Request (1
page)
03/26/1993
P6/b(6)
001b. letter
To Senator Alfonse D'Amato; re: Consitituent Concem (1 page)
03/23/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Nuinber: 3665
FOLDER TITLE:
D'Amato, Al (R-NY)
2006-0885-F
ip2644
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - (5 U.S.C. 552(b)j
Pi National Security Classified Information 1(a)(1) of the PRA|
P2 Relating to the appointment to Federal office 1(a)(2) of the PRAj
P3 Release would violate a Federal statute |(aX3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA]
b(l) National security classified information |(bXl) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA|
b(3) Release would violate a Federal statute |(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�#003
INVENTORY LIST
Steve Edelstein, et al.
Health Care Congressional Office
(Room 488)
Magazine and Newspaper Articles of
Health Care comments by Members of Congress
Akaka-Dodd
Akaka, Daniel K.
Baucus, Max
Bennett, Robert
Biden, Joseph
Bingaman, Jeff
Bond, Christopher
Boren, David L.
Boxer, Barbara
Breaux, John B.
Brown, Hank
Bryan, Richard H.
Bumpers, Dale
Bums, Conrad
Byrd, Robert C.
Cambell, Ben Nighthorse
Chafee, John H.
Coats, Dan
Cochran, Thad
Cohen, William S.
Conrad, Kent
Craig, Larry
Coverdell, Paul
D'Amato, Al
Danforth, John
Dashle, Tomas
DeConcini, Dennis
Dodd, Christopher
Zo?io
0^
/
�New
York - Junior
Senator
Alfonse M. D'Amato (R)
Of Island Park - Elected 1980
Born: Aug. 1. 19:17, Brooklyn, N.Y.
Education: Syracuse U., B.S. I9,i9, .I.D. 1961.
Occupation: Lawyer.
Family: Wife. Penny Collenburg; four children.
Religion: Roman Catholic.
Political Career: Nassau County public administrator,
1965-68; receiver of taxes, town of Hempstead,
1969-71; Hempstead town supervisor, 1971-77; Nassau County Board of Supervisors, 1971-80, presiding supervisor, 1977-81.
Capitol Office: 520 Hart Bldg. 20510; 224-6542.
I n Washington: D'Amato was a town and
county supervisor in the years leading up to his
long-shot 1980 Senaie bid. He brought lo Congress a tried and true formula for success in
local politics — catering to his constituents'
every need — and applied it to one of the
largest constituencies imaginable: New York's
18 million people.
D'Amato ran on the right in his 1980
Senate campaign and voiced strong support for
Ronald Reagan. But he quickly established
himself as a senator who would fight for every
dime he could get for New York, especially for
the transportation and housing programs crucial to his heavily urbanized slate. On the
Appropriations Committee, he has pursued federal aid in a brazen and persistent manner,
earning the nickname "Senator Pothole."
During D'.^mato's first term, his hustling
for the home folks made him enormously popular. Winner by a narrow plurality in 1980, he
decisively won re-election in 1986. Thus, it is
ironic that as D'.Amato nears a 1992 campaign,
it is his image as a senatorial ward heeler that
most greatly threatens his career.
As the scandal involving influence-peddling
in the Department of Housing and L'rhan Development ( H l ' D l unfolded in July 1989, The New
York Times published allegations that D'Amato
had developed a too-cozy relationship with
HUD's New York regional office (which included
New -lersey and Puerto Rico as well); the article
said he used his contacts there to steer federal
housing money to his campaign contributors and
other associates, including members of his family.
.\t an October 1989 hearing on a bill to
revamp the nation's housing programs — which
D'Amato, ranking Republican on the Banking
Subcommittee on Housing, played a key role in
crafting — he answered the allegations. Saying
that trying to bring federal dollars home "is our
job, and I certainly make no apologies for that,"
D'Amato denied any wrongdoing.
"1 went to bat for every single thing that
988
had merit . . . , " he said. "I've done it for my
constituents, and the attempts to make it look
like it's for my contributors, that's totally
wrong." But the liming was unfortunate for
D'Amato: His words echoed the defense of the
"Keating Five" senators, who said they had
aided savings and loan scandal figure Charles
H. Keating Jr. only as a constituent.
That November, the Senate Ethics Committee, acting on a complaint from D'Amalo's
1986 Democratic Senate foe, Mark Green, decided to investigate the accusations. The case
dragged on into the 102nd Congress; the Ethics
Committee, which had been tied up with the
Keating Five case, was still considering whether
to pursue charges against D'Amato.
In April 1991, the CBS News program "60
Minutes" broadcast a scathing recitation of
D'Amalo's problems, dating back to his ties to
Nassau County Republican boss Joseph Margiolta. Reporter Mike Wallace said that during a
phone conversation D'Amato agreed to appear
only in an unedited interview, then unleashed a
stream of obscenities and hung up.
The incident highlighted D'.Amato's hotand-cold relationship with the media. The
same D'Amato who avoids the cameras when
his ethics are questioned has used them to his
political advantage throughout his career.
Many New Yorkers have the enduring image of D'Amato — a crusader in the federal war
against illegal drugs and advocate of the death
penally for drug "kingpins" — dressed in battle
fatigues and participating in a filmed undercover cocaine sling in 1986. In 1990, D'Amato
showed his suppori for independence in the
Soviet Baltic states by trying to enter Lithuania
without a Soviet visa.
There is more to D".-\mato than his ethics
problems, his parochial pursuits and his knack for
publicity. He may not have the biggest legislative
portfolio in the Senate, but he has inade his mark.
For more than three years leading up to its
enactment in November 1990, D'Amato worked
�Alfonse M. D'Amato,
with Housing .Subcommittee Chairman .Man
Cranston, D-Calif., to craft an ornnihus housing
bill. As the administration's point man during
the conference on the bill. D'.'^mato secured
many priorities sought by l^resident Bush and
HUD Secretary -lack F. Kemp. These included
a new program to help residents of low-income
housing purchase their homes.
D'.Amato also took the lead in shoring tip
the Federal Housing Administration's troubled
mortgage insurance program. Warning of a potential disaster on the scale of the savings-andh)an crisis, D'Amato pushed through provisions
raising the down payment required of home
buyers with FHA-backed mortgages and adding
an annual premium to buyers' mortgages.
D'.'\mato is also likely to play a major role
in a reauthorization of federal transportation
programs during the 102nd Congress. The ranking Republican on the Appropriations Subcommittee on Transportation, he is a leading
Senate proponent of mass transit. This issue
caused some of D'Amalo's strongest conflicts
with the Reagan administration. When Reagan
proposed huge cuts in transit funding in 1982,
D'Amato said, "There's no way I'm going to be
a good ol' boy and roll along with the team."
D'Amato is also on the Appropriations
Subcommittee on F'oreign Operations, where he
voices the international interests of the dozens
of ethnic communities residing in New York.
His strong support of Israel reflects that of his
large Jewish constituency.
A hardline anticommunist and a human
rights supporter, D'Amato generally has hacked
Reagan and Bush foreign policies. When he
disagrees, it is usually because he favors a
tougher line than the While House has taken.
For example, D'Amato responded in .^pril
1990 to Iraqi dictator Saddam Hussein's threats
toward Israel by proposing trade sanctions
against Iraq. His efforts were stalled by the
Bush adi'ninislration, which viewed Saddam as
a key player in Middle East politics, and by
farm-state senators, who feared a cutoff of
agricultural exports. However, with Iraqi troops
massing on the border of Kuwait that July,
D'Amato won passage of his measure, by an 8;^
12 vote, as an amendment to the lf)9(l farm bill.
Days after its passage, Iraqi troops invaded
and occupied Kuwait, While he bemoaned the
State Department's past "mollycoddling" of
Saddam, D'Amato gave solid support lo Bush's
deployment of troops to stem Iraqi aggression.
Saying the crisis was a matter of "vital, bottomline, live-or-die, long-term national interests,"
D'Amato voted for the January 1991 resolution
authorizing Bush lo use military force against
Iraq.
DAmato also takes a hawkish tone on
Appropriations' Defense Subcommittee. But his
parochial interests are also involved. D'.-Xniato
has recently had to battle budget cuts affecting
New York defense contractors; since 1989, he has
R-N.Y.
fought Pentagon plans to cancel the F-14 fighter
plane, built on Long Island by (Irumman ("orp.
In October 1986, D'Amato held up consideration of a must-pass omnibus appropriations
bill in an attempt to block an amendment to
halt production of the T-46 trainer airplane,
built by the Fairchild Republic Co. on Limg
Island. "To this product, to this company, this
is life or death.. .. I'm not going to sit by and
allow that company to be closed," he said.
.•\t noon that Oct. 17, there was still no
c"()mpron)ise and no catchall spending hill, so nonessential federal functions were shut down. Later
that day, D'Amato won a temporary reprieve for
his plane. In the end, the program was canceled.
.\t Home: Democrats tried to dismiss
I)'.-\mato as a lluke after his narrow 1980 win, but
they had to eat their words in 1986. D'.Amato's
home-state orientation and his straight talk —
delivered with his distinctive "Longlsland" accent — quickly made him a popular figure.
D'.Amato swept aside Oreen, a consumer activist,
with 57 percent of the vote to win a second term.
However, D'.Amato did not have long to
enjoy the accolades. Allegations of unethical
behavior sent D'Amalo's approval ratings
plummeting. But even if he has not fully recovered his standing hy November 1992, D'Amato
is unlikely to duck a fight. He beat all odds in
getting to the Senate in the first place.
D'.'Xmato's ties to the Nassau County OOF,
an old-fashioned political organization, have
long been controversial. Just a year after
D'.Amato was elected to the Senate, his mentor.
Nassau County Republican chairman Margiotta. was convicted of fraud and extortion.
But the Margiotta machine was also
D'Amalo's springboard. He was just out of law
school when a friend of his politically connected
father got him a job in the Island Park town
attorney's office. After serving in various local
offices, he was elected presiding supervisor of
Hempstead Township in 1977.
Had he stayed on this path, D'Amato
might have become county executive and possibly Margiotta's successor. Instead, he made an
audacious move by running for the Senate in
1980 as a conservative challenger to Sen. Jacob
K. Javits. a liberal Republican.
D'.Amato aggressively sought nomination
from the Conservative and Right-to-Life parties, neither of which liked Javits. After he won
these lines. Margiotta broke with tradition and
agreed to hack him against Javits.
I)".Amato"s campaign struck at Ja\its, then
76, as too old. too ill - he had a progressive
tnotor neuron disease — and too liberal. Javits
stressed his years of service and aired endorsements from Oerald R. Ford and Sen. Harr\
(ioldwater. But D'.Amato was armed with ample
funding and many \olunteers. He won the primary, swee|)ing .New York City's suburbs and
edging Ja\its in the ('it\ aii(i upstate.
Javits remained in the general election on
989
�New York - Junior Senator
the Liberal Party line, but his presence was
more of a hindrance to the Democratic nonii
nee, Re|). Klizabeth Holtzman.
Holtzman went after D'.Amato, bringing up
alleged illicit practices of the Nassau OOP.
D'Amato denied involvement in anything unlawful (later he was the subject of three separate investigations, all of which absoK'ed him of
any wrongdoing), and called Holtzman "an absolute witch" for attacking him. D'.Amato took
just 45 percent of the vote, but that was one
percentage point better than Holtzman.
D'Amalo's aggressive attention to New
York interests won him widespread praise, even
from Democrats such as New York City Mayor
Edward 1. Koch. Belter-known Democrats took
a pass at challenging him in 1986, so the nomination went lo Green, a former associate of
consumer crusader Ralph Nader, Again, the
Democratic nominee questioned D'Amalo's
ethics — particularly his activities as thenchairman of the Banking Subcommittee on
Securities (a Wall Street Journal article said
D'Amato had received generous campaign contributions from Wall Street firms he had aided
legislatively), and about D'Amalo's ties to the
Nassau GOP. But the accusations rolled off his
back, and he won easily.
With his new-found clout, D'.Amato
worked to establish conservative dominion in
the state GOP, but several of his efforts as a
power broker backfired. His avid support of
Kansas Sen. Bob Dole's 1988 While House bid
irritated the Bush supporters who would dominate the state's delegate-selection process.
Also in 1988, D'Amato tried to recruit
popular U.S. Attorney Rudolph W. Giuliani to
challenge Democratic Sen. Daniel Patrick Moynihan. But Giuliani demanded the right to
nominate his successor as U.S. attorney, a prerogative that was D'Amalo's as the state's leading (]0P official. D'Amato and Giuliani feuded,
and Giuliani passed up the Senaie bid.
When Guiliani quit his federal post to run
for mayor of New York City in 1989, D'Amato
supported the primary candidacy of Ronald
Lauder, a former U.S. ambassador to Austria
and son of cosmetics magnate Estee Lauder.
Bul Lauder spent over $12 million and got just
33 percent of the vole. Guiliani went on to lose
narrowly to Democrat David Dinkins.
D'Amato did score one inlraparty victory
in early 1991. His longtime aide William Powers
was elected chairman of the slale GOP,
Key Votes
Committees
Approprlalions (6th cf 13 Republicans)
Transportaticn (ranking): Defense: Foreign Operations; VA, HUD
and Independent Agencies; Treasury, Postal Service & General Government
Banking, liousing & Urban Affairs (2nd of 9 Republicans)
Housing & Urban Affairs (ranl(ing); Consumer & Regulatory Affairs;
Securities
Select Intelligence (3rd of 7 Republicans)
Elections
1986 General
Alfonse M. D'Amato (R)
Mark Green (D)
2,378,197
1,723,216
Previous Winning Percentage:
1980
(57%)
(41%)
1986
D'Amato (R)
Green(D)
$6,523,394
$1,640,154
Auttiorize use of force against Iraq
1990
Oppose protiibition of certain semiautomatic weapons
Support constitutional amendment on flag desecration
Oppose requiring parental notice for minors' abortions
Halt production of B-2 slealtti bomber at 13 planes
Approve budget ttiat cut spending and raised revenues
Pass civil rights bill over Bush veto
1989
Oppose reduction of SDI funding
Oppose barring federal funds for "obscene " art
Allow vote on capital gams tax cut
Voting Studies
( 45%)
Presidential
Campaign Finance
Receipts
1991
Receipts
from PACs
$855,518 (13%)
0
Expenditures
$8,104,587
$1,635,676
Year
1990
1989
1988
1987
1986
198S
1984
1983
1982
1981
Support
S
0
68
31
67
32
68
30
58
38
77
23
71
28
68
25
67
28
71
26
82
14
Party
Unity
S
0
68
32
52
46
70
28
65
33
66
32
69
28
67
25
67
30
76
22
81
13
Conservative
Coalition
S
0
65
32
66
32
84
16
69
28
66
30
88
8
72
19
70
27
78
17
78
17
Interest Group Ratings
Year
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
990
ADA
28
35
15
30
35
20
25
20
15
10
ACU
70
4S
80
56
70
70
85
44
50
64
AFL-CIO
44
70
57
70
53
62
36
33
46
22
ecus
67
63
64
44
56
62
78
63
47
94
�06/03/93
10:20
U.S.
©202 224 5871
©OOI
S E N A T O R
Al D'Amato '"'^
— ^ —
N E W
Y O R K
—
FACSIMILE TRANSMITTAL
Please Deliver To:
From:
C}w\;e "v^^v
f/^'^
•5
Tolal Number of Pages (including cover): _ ^
Date of Transmittal:
^hh^
Time of Transmittal: ^
Message:
Q f
co r^v c^^o-V'^r
If you do not receive ail the pages piease caN (202) 224- € 3*^ ]
�ALFONSE M. D'AMATO
NEW YORK
(• \
S>
,
n
I
ft/
304 FEDERAL BUILDING
100 STATE STREET
ROCHESTER, NY 14614
(716) 263-5866
lanitej States Senate
WASHINGTON, DC 20510-3202
March 8, 1993
Mrs. H i l l a r y C l i n t o n
O f f i c e o f t h e F i r s t Lady
1600 P e n n s y l v a n i a Avenue, N.W.
Washington, D.C. 20500
Dear Mrs. C l i n t o n :
Enclosed p l e a s e f i n d a l e t t e r o f i n v i t a t i o n from Joan E.
Tannous o f t h e DePaul M e n t a l H e a l t h S e r v i c e s o f Rochester, New
York.
As t h e l e t t e r s t a t e s , DePaul M e n t a l H e a l t h S e r v i c e s w i l l be
p l a n n i n g a luncheon and would l i k e t o have you as t h e guest
speaker. Your presence would be g r e a t l y a p p r e c i a t e d .
I t would be a p l e a s u r e t o have you i n Rochester f o r t h i s
event.
Sincerely,
A l f o n s e M. D'Amato
U n i t e d S t a t e s Senator
AMD:jcs
�/
RECIEIVED MAR 0 4 198J
DePaul Mental Health Services
1099 Jay Street
Rochester, New York 14611
(716) 436-8020 Voice/TTY • (716) 436-4836 FAX
Mark H. Fuller
Executiue Director
March 2, 1993
Senator Alphonse D'Amato
304 Federal Building
100 State Street
Rochester, New York 14614
Dear Senator D'Amato:
A copy of a l e t t e r sent to F i r s t lady H i l l a r y
Clinton has been forwarded to you. I request your review
and support as you deem appropriate.
I f you have any questions, please feel welcome to
contact me.
Thank you for your attention to this matter.
Sincerely yours.
Joan E. Tannous,
Associate Director
JET/Sjs
�2633173
P.02
DePaui Mental Health Services
1099 Jay Street
Rochester. New York 14611
(^16) 436-8020 Volce/TTV . |716) 436-4836 PAX
Mark H . Fuller
Executive Director
February 18, 1993
Ms. H i l l a r y Clinton
Office of the F i r s t Lady
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
Dear Ms. Clinton:
.rron^S^^t"/v,"\"^^^ "^^^^^ SGrvicGs I s a HOt-f or-prof I t
agency which has served the Rochester, Monroe Cou^tv
agency of Catholic Charities of the Diocese of Rochester.
in i J ^ / n ? ^nil'll^''^
r a i s i n g luncheon to be held
eLil
T
Jl^
please consider being the guest
speaker for the event at a time convenient for you!
^ comprehensive mental health f a c i l i t y
serving children, adolescents, young adults, and adults
infr,^™^^^*'*'®? please find an executive summary.
information i s available upon request.
hearing"?roryou"
-°-id«"tion.
Further
I look forward to
Sincerely,
Joan E. Tannovs,
Associate Director
JET/sjs
cc:
Senator Alphonse D'Amato
Congresswoman Louise Slaughter
TOTAL P.G2
TriT,-,i
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001a. letter
DATE
SUBJECT/I ITLE
Alfonse M. D'Amato to Hillary Clinton; re: Constituent Request (1
page)
03/26/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3665
FOLDER TITLE:
D'Amato, Al (R-NY)
2006-0885-F
Jp2644
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - [5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells j(bX9) of the FOIAj
National Security Classified Information 1(a)(1) of the PRA]
Relating to tlie appointment to Federal office 1(a)(2) of the PRAj
Release would violate a Federal statute [(aX3) of the PRAj
Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001b. letter
SUBJECT/TITLE
DATE
To Senator Alfonse D'Amato; re: Consitituent Concem (1 page)
03/23/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3665
FOLDER TITLE:
D'Amato, Al (R-NY)
2006-0885-F
ip2644
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)j
Freedom of Information Act - j5 U.S.C. 552(b)j
PI National Security Classified Information j(a)(l) of the PRAj
P2 Relating to the appointment to Federal office j(aX2) of the PRAj
P3 Release would violate a Federal statute j(aX3) of the PRAj
P4 Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRAj
b(l) National security classified information j(bXl) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency j(bX2) of the FOIAj
b(3) Release would violate a Federal statute j(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information j(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes j(b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions j(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells j(bX9) of the FOIAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�THE
WHITE
HOUSE
WASHINGTON
/
OS
iji
IX}
^ y ^ c t
(^-^y-^
^'
I J ^ Z .
-Ann33
�ALFONSE M. D ' A M A T O
NEW YORK
LEO O'BRIEN OFFICE BUILDINO
ROOM 420
ALBANY, NY 12207
(518) 4 7 2 - 4 3 4 3
lamtecl States 3tnatE
WASHINGTON, DC 20510-3202
May 20,
1993
P r e s i d e n t i a l Task Force on
H e a l t h Care Reform
The White House
16 00 P e n n s y l v a n i a Avenue
Washington, D.C. 20500
Dear D i r e c t o r :
Because o f t h e d e s i r e o f t h i s o f f i c e t o be r e s p o n s i v e t o a l l
i n q u i r i e s and communications, your c o n s i d e r a t i o n o f t h e a t t a c h e d
i s requested.
PLEASE TRY TO RESPOND WITHIN 4 WEEKS OF YOUR RECEIPT OF THIS
REQUEST. YOUR FINDINGS AND VIEWS. I N DUPLICATE, ALONG WITH
RETURN OF THIS MEMO PLUS ENCLOSURE, WILL BE APPRECIATED.
Many t h a n k s .
Sincerely,
A l f o n s e M. D'Amato
U n i t e d S t a t e s Senator
AD:amr
�ROBERT
D.
110 LAKE HILL ROAD
P.O. BOX 380
May 10,
K R O U N E R , P.C.
BURNT HILLS, NY 12027
CONSULTING ENGINEER
518^99-3333
FAX 518 384-1100
1993
Senator Alfonse D'Amato
Leo O'Brien Office Building
Room 420
Albany, New York 12207
Attention:
Subject:
Mr. David Polito
Director of State Operations
Proposed Change to Hill-Burton Act
Gentlemen:
The attached report i s a b r i e f outline of explaining the
potential annual savings of $226,000,000 annually by reducing
v e n t i l a t i o n standards from two (2) a i r changes to one (1) a i r
change i n patient bedrooms.
Calculations u t i l i z e d are based upon New York State, and
extrapolated to include the e n t i r e country.
However, i f more
precise studies are required, the magnitude of the savings w i l l
s t i l l be i n the hundreds of m i l l i o n s .
I f I can be of any further assistance on t h i s matter, please
f e e l free to contact me.
Very t r u l y yours,
iobert D. Kroune
�ROBERT
D.
110 LAKE HILL ROAD
K R O U N E R , P.C.
P.O. BOX 380
BURNT HILLS, NY 12027
CONSULTING ENGINEER
518-399-3333
FAX 518 384-1100
PROPOSED CHANGE TO THE HILL-BURTON ACT
TO REDUCE HEALTH CARE COSTS BY $226,000,000 ANNUALLY
The health care issue i s foremost on the minds of America
today.
The advocates have taken a stance on hospital costs,
doctors fees, t h i r d party insurers and the l i k e .
Each of these
involve hard choices and compromises before any l e g i s l a t i o n can
take place.
However, one factor i n the health care equation i s yet to
be addressed - ENERGY.
hospital
and nursing
Energy costs are a pass-thru by every
home
i n America.
These
costs are
ultimately reimbursed by the State and Federal governments with
the attitude that energy incentive programs have been i n place
since the 1970's.
While
consideration
was given
to such
items
as storm
windows, l i g h t i n g and insulation, no one addressed the biggest
waste of energy - VENTILATION.
The Hill-Burton act of 1948 i s
the b a s i s of v e n t i l a t i o n design for health care bedrooms. I t
mandates
that
(approximately
Z
a i r changes
40 cubic
per hour
feet/minute
of
outdoor a i r
(cfm) per patient) be
introduced to the building mechanical system, heated to 75°F i n
winter, cooled to 80°F i n summer, then be exhausted through the
patient room t o i l e t .
�I n the l a t e 1970's as the Energy Consultant to the Hospital
Association of New
York State, performing energy studies under
a $2 m i l l i o n Exxon grant,
I challenged
energy, asking the question,
t h i s blatant waste of
" I f a well constructed
residence
requires 1/2 a i r change/hour, why do patient bedrooms require 2.
a i r changes per hour?"
The
American
commissioned two
Hospital
Association
independent studies.
and
Blue
Cross
The University of Iowa
and the University of Wisconsin both returned the same r e s u l t .
One
(1) a i r change per
hour i s adequate v e n t i l a t i o n for a
hospital or nursing home patient bedroom.
The
ball
was
then
dropped
and
neither
of
these
organizations lobbied for the change i n the Hill-Burton Act.
The proposed change i n the Hill-Burton Act would save 20
cfm per patient bed i n the e n t i r e United States.
I n New
York
State's climate, 20 cfm r e l a t e s to approximately 2000 Btu/hr.
for heating and 600 Btu/hr. for cooling.
The heating and a i r conditioning savings amount to
$60/yr/patient
$125/hr/patient
with a weighted average saving of
o i l heat
e l e c t r i c heat
$100/yr/patient.
A study was performed at Mercy Hospital, Miami F l o r i d a and
the
cost
of
cooling
the
v e n t i l a t i o n a i r i n the
s l i g h t l y greater than heating i t i n the North.
South
was
�Based upon 1991 Health Care census, there are approximately
2,265,000 hospital and nursing home beds nation-wide.
The
projected savings by changing the present law from 2 a i r changes
to 1 a i r change i s $100 x 2,265,000 = $226,500,000 annually.
5/10/93
RDK
�THE WHITE HOUSE
WASHINGTON
TO:
U..S. Senctfee-Offriees Office of Senator Alfonse M. D'Amato
FR:
Task Force on National Health Care Reform
DT:
February 23, 1993
RE:
Health Care Overview
As we proceed w i t h the 103rd Congress, i t would be extremely
h e l p f u l t o us i f you would provide our o f f i c e w i t h some
background i n f o r m a t i o n .
Please provide us w i t h the names, work phone, home phone and f a x
numbers o f t h e f o l l o w i n g :
1. D.C. Chief of S t a f f :
Michael K i n s e l l a 202-224-6975 (Fax: 202-224-5871)
2. L e g i s l a t i v e D i r e c t o r :
P h i l Bechtel 202-224-8350 (Fax: 2 0 2-224-5871)
3. Health Care L e g i s l a t i v e Assistant:
Scott Amrhein 202-224-8357 (Fax: 2 0 2-224-5871)
4. Press Secretary:
Frank Coleman 202-224-6498 (Fax: 2 0 2-224-5871)
Also, please share any p a r t i c u l a r concerns of your Senator and
your home s t a t e as they r e l a t e t o health care and h e a l t h care
reform.
Please return t h i s form, along with any comments, v i a f a c s i m i l i e
to 456-6241 or through the mail to the attention of the Task
Force on Mationai Health Care Reform, Old Executive Office
Building, Room 287, Washington, DC 20500.
Thank you f o r your a t t e n t i o n and cooperation.
�commitments t o t h e subsidy p o o l s .
Study: S t a t e s Would Save Money Under C l i n t o n ' s H e a l t h Plan
*
WASHINGTON (AP^) Feb 14 -- States would save some $8 b i l l i o n
under P r e s i d e n t C l i n t o n ' s h e a l t h p l a n as t h e f e d e r a l
government s h o u l d e r s a g r e a t e r share o f p a y i n g f o r m e d i c a l
care
f o r t h e poor, a s t u d y says.
The savings might n o t m a t e r i a l i z e f o r s t a t e s a l r e a d y
accustomed t o g e t t i n g e x t r a f e d e r a l Medicaid money t h r o u g h
p r o v i d e r taxes and d o n a t i o n s , a c c o r d i n g t o t h e s t u d y by
the Urban I n s t i t u t e .
But o v e r a l l , t h e s t a t e s t h a t now c o n t r i b u t e $61 b i l l i o n
t o w a r d t h e $140 b i l l i o n Medicaid program would wind up
spending about $53 b i l l i o n under C l i n t o n ' s p l a n , t h e
r e p o r t s t a t e s . The p r e s i d e n t ' s p r o p o s a l would s u b s i d i z e
i n s u r a n c e f o r low-income f a m i l i e s and some s m a l l
businesses.
O f f i c i a l s i n some s t a t e s have expressed concern t h a t
the C l i n t o n reforms might h u r t them by e l i m i n a t i n g most
f e d e r a l s u b s i d i e s f o r t h e u n i n s u r e d and l e a v i n g i l l e g a l
immigrants uncovered,.
-fc^
^
/f'^'^^ '~~
Y
V
A task force set up by New York Gov. Mario Cuomd
\'dt.y—.^t:^'
r e c e n t l y c l a i m e d ^ t h e s t a t e would l o s e $342 m i l l i o n i n 1997 ^
b u t would g a i n money i n l a t e r y e a r s . ,
The C l i n t o n a d m i n i s t r a t i o n , by c o n t r a s t , c l a i m s i t s
r a d i c a l changes i n Medicaid would save s t a t e s $47 b i l l i o n
from 1996 t o 2000, i n c l u d i n g $24 b i l l i o n i n t h e year 2000
alone.
Under C l i n t o n ' s p l a n , most o f t h e 31 m i l l i o n people on
M e d i c a i d would g e t s u b s i d i e s t o buy r e g u l a r h e a l t h
i n s u r a n c e t h r o u g h t h e same new a l l i a n c e s t h a t would be
used by much o f t h e r e s t o f t h e p o p u l a t i o n .
The f e d e r a l and s t a t e governments would s t i l l pay f o r
M e d i c a i d f o r w e l f a r e r e c i p i e n t s , and s t a t e s would be
r e q u i r e d t o pay t h e a l l i a n c e s what t h e y now spend on
n o n - w e l f a r e Medicaid r e c i p i e n t s .
A l s o , t h e s t a t e s and Washington would s t i l l s p l i t
M e d i c a i d c o s t s o f n u r s i n g home care f o r t h e poor and some
o t h e r s e r v i c e s . But some payments t o h o s p i t a l s t h a t care
f o r t h e poor and u n i n s u r e d i n l a r g e numbers would be
largely eliminated.
'*Most s t a t e s w i l l spend l e s s from t h e i r own revenues
/
�under t h e H e a l t h S e c u r i t y Act t h a n t h e y do c u r r e n t l y ,
d e s p i t e the spending t h a t w i l l s t i l l be r e q u i r e d o f
them,'' s a i d t h e Urban I n s t i t u t e ' s John Holahan and David
Liska.
' ' I n g e n e r a l , the d i s t r i b u t i o n o f f e d e r a l spending
a f t e r r e f o r m tends t o b e n e f i t lower-income s t a t e s , ' ' t h e y
said.
They e s t i m a t e d t o t a l spending on h e a l t h and w e l f a r e
low-income r e s i d e n t s would range from $1,436 i n low-income
s t a t e s t o $2,200 i n high-income s t a t e s a 53 p e r c e n t
range.
The s t u d y e s t i m a t e d the f e d e r a l government spends $327
p e r s t a t e r e s i d e n t t h r o u g h t h e M e d i c a i d program. That
f i g u r e would c l i m b t o $482 w i t h t h e s u b s i d i e s under t h e
Clinton reform plan.
C l i n t o n H e a l t h Plan: W i l l I t Even Work?
By Karen Tumulty
(c) 1994, Los Angeles Times c
WASHINGTON
1 3 i - - A l l but l o s t i n l a s t week's f u r o r
the
Congressional Budget O f f i c e ' s a n a l y s i s o f P r e s i d e n t
C l i n t o n / s h e a l t h care fftroposal was t h e most s i g n i f i c a n t
and t r o u b l i n g s u b t e x t oY t h e s t u d y : No one can guarantee
t h a t t h e p l a n w i l l actuaVLly work.
C l i n t o n would c r e a t e
v a r i e t y o f e n t i t i e s whose t a s k s .
a c c o r d i n g t o the CBO, wovi I d verge on t h e i m p o s s i b l e . Chief
among them are g i g a n t i c e g i o n a l ' ' a l l i a n c e s , ' '
r e s p o n s i b l e f o r buying? i e a l t h ? c a r e f o r most Americans,
and a N a t i o n a l H e a l t h Board t o s u p e r v i s e t h e new system.
''NewA i n s t i t u t i o n s w i / l l be r e q u i r e d , and new
r e s p o n s i b i l i t i e s w i l l be imposed on e x i s t i n g
i n s t i t u t i o n s , ' ' t h e CBCJ r e p o r t said« ' ' T h e i r a b i l i t i e s t o
p e r f o r m w i l l be i n doubt.''
That's tough t a l k , says Lawrence O'Donnell, t h e
Democratic c h i e f o f s t a f f f o r ? t h e ? S e n a t e Finance
Committee^ which has p r i m a r y j u r i s d i c t i o n over t h e b i l l i n
the Senate.
'-'That's t h e k i n d o f sentence,'' he s a i d , ' ' t h a t would
have been i n c l u d e d i n a memo t o Howard Hughes about t h e
Spruce Goose,''.the g r a n d l y designed a i r c r a f t o f the 1940s
t h a t proved capable o f f l y i n g o n l y a s h o r t d i s t a n c e .
of
The CBO's assessment i s p a r t i c u l a r l y i m p o r t a n t because
t h e c r e d i b i l i t y t h a t the o f f i c e has developed i n n e a r l y
over
�^ Ariato
bc-clinton-analysis - a2020
(ndy) (ATTN: National editors) (includes optional trims)
SuBuner's Events x:ould Make or Break Clinton Presidency (Washn)
By Susan Page= (c) 1994, Newsday=
WASHINGTON As a make-or-break summer approaches, the White House i s
trying to quell a growing sense of panic among Democrats that President
Clinton's signature l e g i s l a t i v e goal on health care i s stalled in Congress
and that the party now seems certain to suffer serious losses in the November
midterm elections.
Democratic National Chairman David Wilhelm, after meeting with Democratic
House leaders Thursday, told Newsday that the DNC would launch a $5 million ad
campaign in about a month to boost momentum on health care as the legislation
moves to the floor of the House and Senate.
But at the moment no one knows whether the legislation w i l l get through
the key congressional committees by then a l l five of them already have missed
their informal Memorial Day deadline or what the b i l l w i l l include. ""The
number of different views far exceeds the number of senators,'' Senate
Majority Leader George Mitchell, D-Maine, said.
Meanwhile, Clinton has trouble on other fronts. An important a l l y . Rep.
Dan Rostenkowski, D - I l l . , i s expected to step down as House Ways and Means
chairman next week when he i s either indicted or accepts a plea bargain on
corruption charges. A lingering problem w i l l be revived with the threat by
Sen. Alfonse D'Amato, R-N.Y., that Senate Republicans w i l l hold a l l
legislation hostage u n t i l Whitewater hearings have been scheduled.
Thursday, after special counsel Robert Fiske J r . appealed anew for
restraint from lawmakers, Speaker Thomas S. Foley, D-Wash., said that the
House would conduct no Whitewater hearings before late July.
There was another embarrassing f i l l i p Thursday when White House
administration director David Watklns was forced to resign after reports he
had taken a Marine helicopter to play golf at a suburban course.
" " I think we now have r e a l problems,'' a senior Democrat and Clinton a l l y
said. " " I f we get bogged down on the two parts of the domestic agenda that
r e a l l y defined h i s being a new Democrat welfare reform and health care I
think we go into the (1994) elections quite weak. And I think he i s the
issue.''
The loss in a special election Tuesday of a Kentucky House seat that
Democrats had held for 129 years has fueled " " p o l i t i c a l panic'' among
congressional Democrats, he added.
""A lot of them don't think they're going to be there in January i f
they're too c l o s e l y identified with the president,'' he said. But Wilhelm said
i t was simply ""a wake-up c a l l ' ' that should propel Democrats to enact a
health care package before going home to campaign.
There are White House o f f i c i a l s who view the situation as j u s t another
chapter in a Perils-of-Pauline presidency that has become accustomed to
averting disaster at the l a s t possible moment.
The next 10 weeks are described by some as the period that may well
determine whether Clinton's term ultimately w i l l be seen as successful. He
staked much of h i s 1992 campaign on changing the health care system and has
championed i t over any other goal, including welfare r e v i s i o n . Now
administration o f f i c i a l s figure congressional committees must f i n i s h their
work by July 1 so the House and Senate can vote before they adjourn in
mid-August for summer recess. Otherwise, they say, no plan i s l i k e l y to be
enacted t h i s year, and the prospects next year w i l l be worse.
(Optional add
end)
I t i s a sign of Clinton's weakened position that Democratic congressional
leaders have told the White House not to become engaged in negotiating the
compromise package.
�govemment in the first case after passage of the
Superfund environmental cleanup law, and said, T
personally am confident that my sitting in those cases did
not present any conflict of interest."
Breyer said that Lloyd's was not a party to the cases,
though White House lawyers conceded later that Breyer does
not know whether Lloyd's insured any of the parties to the
cases.
But saying that he also wanted to avoid the apf>earance
of conflicts of interest, he said he would sell his
holdings in other insurance companies and wanted to
"expedite my complete termination of any Lloyd's
relationship."
Breyer stopped any new investments in Lloyd's after
1988. But, because Lloyd's consists of syndicates of
investors who back claims with their personal assets, he
still has unlimited liability for continuing losses from a
syndicate he joined in 1985.
White House Counsel Lloyd Cutler said in a television
interview Tuesday that "he's been trying for seven years
to get out of his investment in Lloyd's."
But Newsday Tuesday obtained a copy of a note to
Breyer, dated Sept. 17, 1990, from another Lloyd's
affiliate offering to cover all of his Lloyd's liabilities
if he paid them the equivalent of $245,912 and tumed over
to the affiliate many thousands of dollars in profits from
other syndicates in which he had invested.
A White House official said Tuesday night that Breyer
considered the price in the 1990 offer "exorbitant" and
that it 'confirmed the practical impossibility of getting
out of the syndicate."
But in a Dec. 13, 1993, letter to Lloyd's he said he
needed to get out "because of my job" and that he feared
he would be "captured for life" by the potential
conflicts of his investment.
The high price is an indication that the Lloyd's
affiliate calculated Breyer's liabilities in 1990 to be
far higher than the $114,000 he estimated in a statement
to the Judiciary committee in April.
At least two Democratic senators, Howard Metzenbaum,
D-Ohio, and Patrick Leahy, D-Vt., indicated Tuesday that
they considered the Lloyd's affair a serious issue.
Newspaper editorials have called on the committee to delve
into the matter.
Metzenbaum said he was concemed that Breyer, though he
had stepped out of asbestos cases because of {Mssible
conflicts with his Lloyd's investments, had failed to step
out of other environmental issues. He said he would grill
Breyer on the issue during Wednesday's continuation of the
hearings.
(Optional add end)
In another issue raised during Tuesday's hearings,
Breyer refused to discuss his views on abortion, as other
nominees have before him.
Asked about Blackmun's opposition to the death penalty,
Breyer said he considered it "settled law" that the
ultimate penalty is constitutional, and he said that
unlike some other judges with strong beliefs on the issue,
T have no such personal views in regard to the death
penalty."
Breyer also was asked about another hot-button issue
school prayer by ranking Republican Orrin Hatch of Utah.
Referring to a 1992 ruling that barred clergy from leading
prayers at school graduation ceremonies, the conaervative
Hatch asked Breyer whether he saw a legal difference
between prayers led by students and those led by school
officials an issue that has not reached the Supreme
Court.
•' It sounds as if it (who led the prayer) would be a
relevant fact," Breyer responded.
Distributed by the Los Angeles Times-Washington Post
News Service
Leading Lawmakers Begin to Plot Strategy on
Health Care (Washn) By Dena Bunis= (c) 1994,
Newsday=
WASHINGTON Lawmakers returning from
their July Fourth holiday say they know they have to start
seriously grappling with health care, but many say they did not
get clear or strong messages on the issue from their
constituents.
What members of Congress reported Tuesday on their
talks with the folks back home was that crime and the
economy were more important now but don't underestimate
the political potential of health care.
" I would not want to be the candidate who voted
against this and face an opponent who challenged me on it
the last two weeks of October," said Sen. Christopher
Dodd, D-Conn. '' It looks rather benign right now, but I
tell you it's a sleeping giant of a political issue if
this Congress defeats health care and you're one of the
people who brought it down."
Democratic congressional leaders, whose job it will be
to take three bills in the House and two in the Senate and
produce one bill in each chamber with a chance of passage,
began meeting to plot strategy Tuesday.
" It's a fresh start now," Rep. Barbara Kennelly,
D-Conn., chief deputy whip, said as she went into a
meeting with her fellow leaders.
Majority Leader George Mitchell, D-Maine, and other
Democratic leaders still cling to the principles
of President Clinton's plan that all Americans must be
guaranteed health care by a given date and that employers
must help pay for it. But other legislators say that
unless substantial compromises are offered, nothing will
get done this year.
"This thing is getting more and more polarized, and
it's always difficult to construct a compromise when it
becomes more polarized," said Sen. John Breaux, D-La.,
part of a conservative Democratic faction that favors
caution over sweeping change.
Breaux's caution was echoed by Sen. Alfonse D'Amato,
R-N.Y., who said voters told him they're worried about
govemment taking over the health care system and limiting
their choice of doctors.
Rep. David Levy, R-N.Y., said he told one citizens'
group that he was concemed about artifical timetables
being set for the health care debate and that a bad bill
might be passed for expediency's sake. In order to fulfill
Clinton's pledge to get a health bill enacted this year,
Congress must act before adjourning for the year in
October.
i
" I said sometimes gridlock is preferable to moving
backward. I got • standing ovation," Levy said,
explaining that his constituents too are worried about
Congress doing more harm than good.
Distributed by the Los Angeles Times-Washington Post
News Service"
12 Bodies Found as Monitors Prepare to Exit
Haiti (Port-au-Prince) By Ron Howell= (c) 1994,
Newsday=
PORT-AU-PRINCE, Haiti The chief of the intemational
human rights mission here offered a sad farewell to the
�Political N o t e s
Advertiser Misgivings Delay Magazine Promotion
By JAMKS OAO
It's a common rnoiinh promolional
d e v i c e ; a special i i d v c r l i s i n K section
IO loul a slate's economy and a l l r a c l
new businesses Bul when F o r t u n e
m a g a z i n e r e c e n l l y discussed doing
)usl such a section on New Y o r k
Stale, some i x j t c n l l a l a d v e r t i s e r s
balked
T h e i r c o n c e r n : the 10-page section
was scheduled lo a p p e a r in the Oct. 3
issue — s m a c k in I he m iddle of a guI x r n a t o r i a l race
1 he potential a d v e r t i s e r s w o r r i e d
Ihat Ihe section — a n d t h e r e f o r e t h e i r
companies — w o u l d appear to be prom o l i n g Ihe re-eleclion of Gov. M a r i o
M. Cuomo, a D e m o c r a t . Because of
t h e i r m i s g i v i n g s , the sc>rlion has been
postponed u n t i l M a r c h .
" T h e r e w a s a concern a m o n g some
companies of this being p e r c e i v e d ,
even though i t ' s not, as t a k i n g a pro("uomo p o s i t i o n , " said F r a n H a l l , d i ie<-|or«f .sp<'< ial p r o j e c t s f o r Fortune.
" I d o n ' l m e a n to say ihey a r e a n l i ("uoino; i t ' s just that they d o n ' l want
lo be seen as t a k i n g a n y p o s i t i o n . "
The section is l»eing p r o m o t e d by
Ihe Business A l l i a n c e f o r a New New
Y o r k , a joint v e n t u r e between the
stale's D e p a r t m e n t of E c o n o m i c Development and 11 New Y o r k u t i l i t i e s .
In J u l y , the alliance sent l e t t e r s to
scores of companies e n c o u r a g i n g
t h e m to purchase a d v e r t i s i n g " u n i t s "
for $19,800. A c c o r d i n g l o the letter.
the Slale planned to d i s l r i b u t e 25,000
reprints of Ihe section.
Kepiiblicans called the alliance's
efforts an a t t e m p t to pressure staterogulaied companies to u n d e r w r i t e a
< ainpai(;ii venture. " I f M a r i o Cuomo
wants to develop a n ad c a m p a i g n for
his rc eleci ion bid, he ought l o p a y f o r
ll himself. " said W i l l i a m D Powers, I
the Republican state c h a i r m a n .
-supiKirl the eventual Republican candidate But K a r e n Crowe, a spokesw o m a n for M r . G i u l i a n i , said he is
keeping his options open a n d plans
f i r s t to i n t e r v i e w a l l c o m e r s .
" H e could support any c a n d i d a t e , "
she s a i d " l l w i l l depend on w h o c a n
p r o v i d e Ihe best possible assislance
to New Y o r k . "
. _
.Slate o f f i c i a l s said the section w a s
I
l i m e d lo coincide w i t h a national convent ion of real-estate agents in New
Y o r k Cily, not the N o v e m b e r election.
" Y o u have t o l e l l y o u r story, a n d
w e ' r e noi doing i l , " said Tony GaeIano, a senior deputy c o m m i s s i o n e r
for economic development.
D'Amato Praises MltcheH,
Only to Be Corrected
Whom Will Giuliani Support?
In Primary, None of the Above
Votes in Congress
Ta//y Lasf Week in Connecticut, New Jersey and New York
Senate
1 . Heatth Care:
V o t e on an a m e n d m e n t lo a m a j o r health c a r e r e f o r m b i l l
that w o u l d r e q u i r e p r i v a t e h e a l i h insurance plans lo o f f e r c o v e r a g e of c a r c
for i n f a n t s , c h i l d r e n a n d pregnant w o m e n b y J u l y 1,1995, A p p r o v e d 55 to 42
A u g . 16.
2 . H e a l t h C a r e : Vote on a n a m e n d m e n t lo a m a j o r health c a r e r e f o r m b i l l
that w o u l d p r o v i d e m o r e assistance f o r r u r a l health care. A p p r o v e d 94 to 4,
Aug. 18.
1 2
Connecticut
Dodd (D)
Lieberman (O)
1 2
New Jersey
I I I I
11 11
Bradley (D)
Lautenberg (D)
1 2
New York
D Amalp (R)
Moynihan (D) . , ,
K E Y : • Y e a ; • N a y ; ( A ) Absent or d i d noi v o t e ; ( P ) Present.
11 I I
11 11
New Y o r k C i t y ' s Republican M a y or, Rudolph W. G i u l i a n i , has done his
1 l)esl to keep people w o n d e r i n g alx>ut
w h o m he w i l l support in this y e a r ' s
g u b e r n a t o r i a l race. A n d now he has
clouded Ihe issue f u r t h e r b y saying he
w i l l not endorse either c a n d i d a t e —
R i c h a r d M Rosenbaum o r George E.
P a t u k i — in Ihe Sept. 13 Republican
primary.
The choice posed s o m e t h i n g of a d i l e m m a for M r . G i u l i a n i . On one h a n d ,
M r . Rosenbaum, a f o r m e r state Republican c h a i r m a n , has raised money
for M r . G i u l i a n i in past races and is
clo.se to several of the M a y o r ' s top advisers.
Yel M r P a t a k i , a S l a l e Senator
f r o m P u t n a m County, is a heavy fav o n l c lo w i n the p r i m a r y . But he is
also a protege of M r . G i u l i a n i ' s someI lines Republican r i v a l , U n i l e d States
Scnaloi Alfonse M. D ' A m a t o .
M r . G i u l i a n i also faces a conundi u n i in Ihe g e n e r a l election. He
could hul l h i m s e l f a m o n g Republican
f a i l h t i i l if he d r a g s his feel in s u p i x i r l iiiH Ihcir s l a i i d a r d bearer. Bul he has
iiol ruled oul Ihe possibility of endorsinn Ihe D e n i o c r a l i c i n c u i n b e n i . Gov
M a r i o M Cuomo, who has l)eiil over
l),i< k w a i d s al t i m e s lo help Ihe c i l y
ami Us m a y o r .
Kepiihlican Slate C o m m i l l e e o f f i cials say Ihey ihink M r . G i u l i a n i w i l l
Senator D ' A m a t o has never been
shy alMMit a t t a c k i n g h i s opponents,
but last week on the Senate floor he
lavished praise on o n e : the m a j o r i t y
leader, George J . M i t c h e l l of M a i n e ,
whose health c a r e b i l l M r . D ' A m a t o
dislikes.
M r . D ' A m a t o rose t o say that the
pi (K-ess of d e b a t i n g health i n s u r a n c e
was too rushed and r e m i n d e d h i m of
events leading u p lo the vote he most
r e g r e t t e d casting in his 14 y e a r s in
the Senate: f o r the 1986 t a x act t h a t ,
a m o n g other things, e l i m i n a t e d deductibility for Individual Retirement
Accounts.
" I a l w a y s said lo myself, ' Y e a h ,
Senator M i t c h e l l voted the other w a y ,
and I applaud h i m . ' He stood up a n d
he voted that w a y . 1 wish I h a d . "
1 hen M r . M i t c h e l l asked to r e p l y :
" I thank the Senator f o r g i v i n g m e
c r e d i t , but I Ihink I belter m a k e c l e a r
that I voted f o r i l . " He added, in a
gentle reference to M r . D ' A m a l o ' s recent o u t r a g e over inconsistent testim o n y by T r e a s u r y D e p a r t m e n t o f f i c i a l s in Ihe W h i t e w a t e r i n q u i r y : " I
thought one t h i n g we t)eller do a r o u n d
here now is c o r r e c t the record as soon
as we c a n . "
M r . D ' A m a t o . hy now c h u c k l i n g
steadily, s a i d : " I was upset w i t h m y self for not h a v i n g gone down there
and voted thai w a y . "
••| w i l l mil lell you w h y . " added the
New Y o r k e r , w h o eviscerated the
yoiiiig T r e a s u r y chief of staff. Josh
Slciner, for t r y i n g to back a w a y f r o m
c i n l i a r r a s s i n g d i a r y entries under
o a l h and who seldom misses an opp o r l i i n i i y lo m a k e a i m l i l i c a l point. " I
i i y l o d o i i in m y d i a r y . I h o p e t h e d i a I y (Iocs noi h e "
CO
o
s
CO
I
IS
i
g
�NAIK
'Mainstream' effort on health praised
Hopes raised
on compromise
Republican "truth squad" dissents,
criticizes all proposals but Dole's
REUTERS NEWS AGENCY
A top White House official yesterday called a bipanisan compromise proposal on health care a
"helpful" contribution to breaking
the Senate impasse.
White House Chief of StafF Leon
Panetta said on ABC-TV's "This
Week" that he doubted the plan
could pass the Senate as it now
stands. But he praised the socalled 'mainstream ' coalition of
aboul 20 senators and said elements of the group's plan, melded
with the bill drafted by Senate Majoriry Leader George MitcheU and
endorsed by President Clinton,
could provide a successful health
care formula.
"This effort by the mainstreamis helpful." Mr. Panena said. " I f
George Mitchell and those individuals cut a deal, I think we have
a chance of getting health care reform."
Mr. Mitchell would like to win
broader support for his proposal,
but the Maine Democrat carmot
reach out too far toward the ""mainstream " group without alienating
a pivotal group of Democrats who
advocate universal coverage.
The plan by the bipartisan
group, led by Sen. John Chafee,
Rhode Island Republican, would
cover around 92 percent of Americans by the tum of the century. A
panel later would make nonbinding suggestions about expanding coverage.
The bipanisan group's package
makes deficit-cutting, not universal coverage, its pnoriry.
The group is still working on a
crucial portion of the plan — how
many low-income Americans will
get subsidies to buy insurance.
They are determined not to scale
back their goal of achieving SlOO
billion in deficit reduction over a
decade. But skimpy subsidies
could make it tougher to reach the
goal of 92 percent coverage
.Mr .Mitchell's bill aims to cover
95 percent of Americans by 2000
and achieve a modest reduction in
the nation's budget deficit m 10
years.
If subsidies, incentives and
market reforms fall short of that
coverage goal, a fallback measure
requiring employers and their
workers to split the cost ot insurance .SO-50 could be "triggered ' to
go into effect in 2002.
.Mr Panetta declined t(i speculate on whether President Clinton
would veto a bill that falls short ol
Mr .Mitchell's targets
1 think theres a aood chance
we 11 still get universal coverage."
ne said, addine that "ultimately
Bv J. Jennings Moss
T>*g vyfcSHINGTON TIMES
Part of the Republican strategy
has to been to divide the member
ship into teams, with each tean
responsible for certain issues. Tht
core group consists of about ;
dozen of the GOP's 44 senators
The game at the news conter
ences and on the floor seems to b(
who can top everybody else in rhe
torical flourish.
At the Wednesday event that fo
cused on secrecy in the Mitchel
health bill. Sen. Alfonse D'AmaK
of New York spoke about the se
t crecy provisions as "the bidder
Frankenstein that we're supposet
to eat. that we're supposed to swai
low."
"1 don't mind being held hostaei
if it means we won't let somethint
get rammed down the Amencar
people's throats," he said.
The tone of the attacks intensi
fied Friday when the Republicans
faced with the knowledge tha
about 10 of their GOP coUeague:
were putting the finishing touche
on an alternative proposal witt
like-minded Democrats, tumed oi
their own.
"It's all cut-and-paste anr
notiody knows any of the conse
quences." said Sen. Malcolm Wai
lop of Wyoming. "This is a self
promotion exercise. This is not ai
exercise in responsible poUtics. "
Mr. Gramm mocked what h'
called the ""so-caUed mainstream
group and said of the entire pre
cess: ""The American people hav
every right to be frightened. .
intend to fight them just as hard a
I fight Bill CUnton."
For these Republicans, there i
no compromise on health care
They believe the only acceptabi'
plan IS the one authored by Minor
ity Leader Bob Dole, which wouli
make some reforms to insuranci
laws and provide subsidies to poo
Amencans to buy insurance.
For his part. M r Dole has sta\-e<
away from the news conterenci
circuit. Instead.'he is involved be
hind the scenes in crafting strai
egy, being the liaison with .M:
Mitchell and using the Senav
floor as his chief forum for com
ment.
Rather than push his own plan
.Mr Dole is advancing the idea tha
the Senate should just go homi
and wait for another day to di
health reform. His consen'atui
colleagues are saying the sami
Day after day, a troupe of Senate
RepubUcans makes the journey to
the television studio a few steps
from the Senate floor to analyze
the health reform plans offered by
others.
"When I was a kid. my dad said.
'Read the fine print.'" Sen. Paul
Coverdell. a freshman from Georgia, said at Tuesday 's event. "'That's
exactly what we're going to keep
domg, day in and day out — we're
gomg to keep reading the fine
pnnt,"
The lawmakers call themselves
S6h. Daniel Patrick Moynihan
the "truth squad." They have a
^doubts a bill will pass soon.
plethora of chans to malce their
argument that President Clinton's
you want to have the trigger there" vision of health reform, as well as
to ensure movement toward uniits descendents, amounts to socialversal coverage.
ized medicine. And they retum
The head of the Senate Finance over and over to a common theme
— that Democrats are lying when
Committee. Daniel P a t r i c k
they talk about their health plans.
.Moynihan, New York Democrat,
said yesterday he doubts the SenTb stress this point. Sen. Phil
ate can pass a health bill before
Gramm — the Ibxas RepubUcan
whose nasal drawl has been the
Labor Day and that a break might
loudest voice in the crusade —
be wise.
Conservative Republicans have mentions a certain bibUcai saying
demanded that Mr. MitcheU caU a at least once every news coiiference. "Ye shall kno"" »he tmth and
recess, allow legislators to retum the truth shaU set you free," Mr,
home and resume the health care Gramm says as weary reporters
battle next month.
mouth the words along with him.
Mr Moynihan. appearing on
TWo weeks into the debate on the
CBS-TV's "'Face the Nation," said hottest issue of the Clinton presihe doubts the Senate will pass ei- dency, thebe Republicans are conther Mr. Mitchell's or the ""main- fident that their dual strategy —
stream" coalition's version of an giving the press a daily dose of
GOP criticism and arguing their
insurance tax.
The House, which has been pre- points on the Senate floor — is
occupied with the crime biU. is un- working.
likely to take up health care until
The Senate unanimously approved the only GOP amendments
next month. Majority Leader
voted on so far to the health bill by
Richard Gephardt, speaking on
NBC's "Face the Nation." pre- .Majority Leader George J. Mitchdicted his bill "or something like ell. One strips the provision for
It " would pass, even though it con- fines of up to $10,000 for busitains a tougher requirement, that nesses not offering their workers
a required package of health beneemployers pitch in 80 percent of
fits. The other bars any new health
workers' insurance costs by 1999.
So far there has been a mixed bureaucracy from operating in secret.
reaction by key Democrats to the
But in a health bill that numbers
mainstream outline. Sen. Edward
1.400 pages and proposes a sweepKennedy,' Massachusetts Demoing restructuring of the way
crat, a longtime champion of
Americans would get their health
health reform, said he hopes to "'do care, the changes are smaU ones.
business" with the bipartisan
Republicans have threatened, in
• croup.
•Mr Gramm s words, a "torrent" of
.Mr Moynihan spoke favorably amendments before the debate
of the group and said the nation ends
should adopt a
step-by-step"
Asked Friday when Republicourse toward universal coveraee
cans
would offer amendments to
thing.
But he did not give the main""The situation on the floorof ttv
stream group a blanket endorse- the heart of the .Mitchell bill —
such as stripping employer manSenate is totally chaotic. . . . It i
ment.
dates. eliminatinE some of the butotally out, of control." said Sen
Several liberal Democrats have reaucracy or killing new taxes —
TVent Lott of Mississippi, ii-.
expressed dismav that the "main- .Mr Gramm would not say and rethinks senators should go horr.i
stream" plan would leave millions fused to divulge his parrv-'s legisand Usten to their constituent(It people uninsured
lative strategy
"This thing is a disaster'
JTlic lUnoliiiiqroii CTimcc
�
Dublin Core
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Title
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Health Care Task Force Records
Creator
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White House Health Care Task Force
Is Part Of
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
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2006-0885-F
Text
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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D’Amato, Al (R-NY)
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
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2006-0885-F Segment 2
Is Part Of
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Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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Preservation-Reproduction-Reference
Date Created
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2/6/2015
Source
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42-t-12092992-20060885F-Seg2-007-010-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/36fbf64c4cf8365113a0dab5461499fa.pdf
5d89641239141054bdfa360bc0ef10eb
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. CUnton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff iVIember:
Edelstein
Subseries:
OA/ID Number:
3665
FolderlD:
Folder Title:
Craig, Larry (R-ID)
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
3
1
�,-12/10/92
15:18
® 2 0 2 224 2573
LARRY E. CRAIG
li|003
BIOGRAPHY
UNITED STATES SESATCR • IDAHO
LARRY CRAIG
Senator Larry E. Craig is serving his first
term as U.S. Senator from Idaho.
Bom on the iasaily ranch homesteaded by
his grandfather in 1899, he served as Idaho
state President and National Vice President
of the Future Fanners of America.
After graduating from the University of
Idaho where he served as Shident Body
President, he pursued graduate studies before returning to the family ranching business in 1971.
In 1974, the people of Payette and "Washington coxmties sent Larry Craig to the Idaho
State Senate, where he served three terms
before winning the 1980 race for the U.S.
Congress from Idaho's First Congressional
District He was re-elected fbur times before
winning the U5. Senate election in 1990.
A forceful advocate for common sense, conservative solutions to the nation's problems,
Larry Craig has emerged as a leaider in the
battle for a balanced budget amendment,
limited taxation and greater accountability
in government.
As a westerner and a former rancher, he
plays a leading role in thefonnationof this
nation's natural resource and agricultural
policies.
Craig is a member of the Serute Committee
on Hnergy and Natural Resources, where he
is the ranking Republican on the Subcommittee on Mineral Resources, Development
and Production. He also holds membership
on the subcommittees on Energy Researdi
and Development and on Public Lands,
National Parks and Forests.
He also serves on the Committee on Agriculture, Nutrition and Forestry, and is the
ranking Republican on the Subcommittee
on Conservation and Forestry. He also is a
memljer of the subcommittees on Rural Development and Rural Electrification, and on
Agricultural Credit.
He is a member of the Special Committee on
Aging, and of the Commission on Security
and Cooperation in Europe—the Helsinki
Commission."
The Idaho lawmaker is on the Board of Directors of the National Rifle Assodation,
and is Senate co-Chair of the Congressional
Coalition on Adoption of the National
Committee for Adoption.
He is married to the former Stuanne Scott,
and they have three children—Mike, Shae
and Jay.
�^12/10/92
15:19
© 2 0 2 224 2573
LARRY E. CRAIG
UNITED STATES SENATOR • IDAHO
SENATOR LARRY CRAlG
302 Hart Sen«le Office Building
Washington. D.C. 20510
(202) 224-2752
Boise
304 N. 8th SL
Room 149
P.O. Dox 1406
Boise. ID 83701
342-7985
Coeur d'Alene
103 N. Fourth Su
Cocur d'Alene, ID 83814
667-6130
Lttwlston
633 Main Street
Lewiston, ID 83501
743-0792
Pocatello
250 S. Fourth Stxeei
Room 216
PocatcUo.ID 83201
236-6817
Idaho Falls
482 Constimtion Way
Idaho Falls, ID 83402
523-5541
2S39 ChMining W»y
Idaho Falls. ID 83404
(After 6/1/91)
Twin Falls
LARRY
CRAIG
824 Blue Ukes BWd.. N.
TwinFsOls.ID 83301
734-6780
BIOGRAPHY
1^004
�1-32 - Senators and Staffs
Larry E. Craig
KEY STAFF AIDES
N^ine—,
Position
R -Idaho
Reelection Year: 1996
Began Service: 1991
SH-302 Hart Senate
Office Building
Washington, DC
20510-1203
(202) 2 2 4 - 2 7 5 2
FAX: (202) 224^2573
TDD: (202) 224-9377
BIOGRAPHICAL
Born: 7/20/45
Home: Payette
Educ: B.A., U. of Idaho
Prof.: Farmer; Rancher;
Idaho State Senate,
1974-81; U.S. House
of Reps., 1981-91
Rel.: Methodist
Legislative Responsibility
(^regory S.^ase^^
John h". Barclay'
(224-10091
David M. Fish^
(224^78)_
Karen E.
Astromsky
(224-1005)
Heat]i|r^ Harwell
Brooke
Roberts
(224-ion
Thomas E. Dayley
Nils W. Johnson
{2^ - - (Elizabeth
Chf. of StafF
Comms. Dir.
Andrew V.
Jazwick
Norman M.
Semanko
Damon P. Tobias
Press Secy.
Admin, Dir.
Exec. Asst. (Appts.)
Legis. Dir./Course!
Judiciary, Banking, Business, Aging
Sr. Legis. Asst.
Sr. Legis. Asst.
Agriculture Committee
Energy Committee
Legis. ^^^^^^^ ^
Legis. Asst.
Foreign Affairs, Education, Welfare,
Communications
Defense
Legis. Asst.
Transportation, Public Works
Spec. Counsel/Legis.
Appropriations, Budget/Taxes, Labor, Hous-
Asst.
ing
COMMITTEE ASSIGNMENTS
Committee
Subcommittee(s)
Agriculture, Nutrition, and
Forestry
Conservation and Forestry, Ranking Minority Member • Agricultural Credit • Rural Development and Rural Electrification
Energy and Natural
Resources
Mineral Resources Development and Production, Ranking Minority Member • Energy Research and Development • Public
Lands, National Parks and Forests
Aging (Special)
No subcommittees
OTHER POSITIONS
'
National Republican Senatorial Committee • Commission on Security and Cooperation in
Europe • Environmental and Energy Study Conference • Senate Republican Task Force on
Health Care • Congressional Coalition on Adoption, Co-Chairman • Senate Sweetener Caucus,
Co-Chairman
STATE OFFICES
Room 149, 304 No. 8th St., Boise, ID 83702
103 No. 4th St., Coeur d'Alene, ID 83814
250 So. 4th Ave., Pocatello, ID 83201
1292 Addison Ave. E., Twin Falls, ID 83301
2539 Channing Way, Idaho Falls, ID 83404
633 Mam St., Lewiston, ID 83501
Resource Center, Room 147, 304 No. 8th St,, Boise, ID 83702
Summer 1992
© Congressional Yellow Book
(208)
(208)
(208)
(208)
(208)
(208)
(208)
342-7985
667-6130
236-6817
734-6780
523-5541
743-0792
342-8234
�LARRY E CRAIG
,
^
AGRICULTURE, NUTRITION
IDAHO
AND F O R E S T R Y
HAm SENATI OfFlC. BUILOINO
(202) 2 2 4 - 2 7 6 2
ENERGY AND NATURAL
RESOURCES
mnitcd States Ornate
WASHINGTON, DC 2 0 5 1 0 - 1 2 0 3
'
0^
Mrs. H i l l a r y Rodham C l i n t o n
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
Dear Mrs. C l i n t o n :
I am pleased t o respond t o your request f o r my concerns and
thoughts on h e a l t h care reform. The work you and the Task Force
on N a t i o n a l Health Care Reform have undertaken w i l l g r e a t l y
a s s i s t the n a t i o n a l debate on h e a l t h reform. I t has c e r t a i n l y
given t h i s issue more prominence i n the minds of Idahoans.
My preference i n reforming our h e a l t h care system i s t o avoid
f u r t h e r goverrunent involvement, because I am convinced i t causes
more problems than i t solves. The Medicare program i s a good
example o f how government c o n t r o l s do not reduce costs. As you
know, since i t s i n c e p t i o n , the Medicare program has undergone a
number of r e g u l a t o r y changes designed t o c o n t r o l i n c r e a s i n g
costs. Yet Medicare continues t o be one o f the f a s t e s t growing
areas of t h e budget. According t o recent testimony provided by
the Congressional Budget O f f i c e , Medicare and Medicaid b e n e f i t s
represented 3.4 percent of the nation's gross domestic product
(GDP) i n 1992. That i s p r o j e c t e d t o grow t o 5.1 percent of GDP
by 1998. C l e a r l y , government cost c o n t r o l e f f o r t s have not
worked.
Even worse, as expenditures f o r Medicare continue t o grow,
b e n e f i c i a r i e s and providers both complain about reimbursement
r a t e s , services covered and i n c r e a s i n g bureaucratic redtape. I n
a d d i t i o n , below cost Medicare reimbursement r a t e s i n r u r a l areas
force h e a l t h care providers t o compensate by r a i s i n g p r i c e s f o r
non-Medicare p a t i e n t s . This c o s t - s h i f t i n g has c o n t r i b u t e d t o the
increase i n o v e r a l l h e a l t h care costs.
I n l i g h t of t h i s experience, I do not support an increase i n
goverrunent involvement i n h e a l t h care, i n c l u d i n g a single-payer
plan. Instead, I support changing t h e i n c e n t i v e s i n t h e system
t o make i t more cost e f f e c t i v e and i n c r e a s i n g the i n d i v i d u a l ' s
r o l e as a h e a l t h care consumer.
RESOURCE CENTER
304 NORTH 8TH STREET
ROOM 147
BOISE, IDAHO 8 3 7 0 2
304 NORTH 8 T H STREET
ROOM 149
BOISE. IDAHO 8 3 7 0 2
103 NORTH 4 T H STREET
COEUR D'ALENE. IDAHO 8 3 8 1 4
6 3 3 M A I N STREET
LEWISTON. IDAHO 8 3 B 0 1
2 5 0 SOUTH 4 T H AVCNUC 1292 ADDISON AVENUE EAST
POCATEU.0. IDAHO 8 3 2 0 1 T W I N FALLS, IDAHO 8 3 3 0 1
2 5 3 9 CHANNING W A Y
IDAHO FALLS, IDAHO 8 3 4 0 4
�I am p r i n c i p a l l y concerned about how each of the proposals being
discussed w i l l work i n a r u r a l s t a t e l i k e Idaho. "Managed
competition" has received a great deal of a t t e n t i o n , but I have
yet t o see how i t can be e f f e c t i v e i n r u r a l America.
In fact, I
have reviewed several a r t i c l e s , one of which i s enclosed, t h a t
argue i t w i l l not work i n a r u r a l s e t t i n g . I would appreciate
your comments on the enclosed a r t i c l e .
I t ' s my understanding t h a t none of the Task Force's 22 working
groups i s designated t o focus on r u r a l h e a l t h issues. I hope
t h i s does not r e f l e c t ignorance o f , o r lack of concern f o r , the
unique h e a l t h care problems of t h e r u r a l sector. Many Members of
Congress (and Washington bureaucrats) t h i n k " r u r a l " i s a
community located f i f t e e n miles of freeway away from a large
c i t y . I n Idaho, Arkansas and many other states t h i s i s simply
not the case. I n a d d i t i o n t o sheer d i s t a n c e , r u r a l states i n the
Rocky Mountain West must overcome p h y s i c a l b a r r i e r s t h a t may
a c t u a l l y prevent t r a n s p o r t a t i o n from one r e g i o n t o another during
c e r t a i n p a r t s of the year.
For t h i s reason, perhaps the most serious o f the many problems
r u r a l states must address i s access t o care — even f o r those who
are insured and can a f f o r d care. But access t o care i s n ' t j u s t a
geographic question. I n Idaho, several h o s p i t a l s have already
been forced out of business and others are s t r u g g l i n g t o survive
because of i n e q u i t a b l e reimbursement rates from Medicare.
Because you come from a r u r a l s t a t e , you doubtless know how even
a r e l a t i v e l y few h o s p i t a l closures can devastate a large
percentage o f a state's p o p u l a t i o n because o f t h e t o t a l area
served by a s i n g l e h o s p i t a l . Many o f these small h o s p i t a l s are
located i n remote areas, hundreds of miles from other h e a l t h care
facilities.
^
Also, because o f i n e q u i t a b l e reimbursement rates t o r u r a l areas,
there are shortages i n physicians and other h e a l t h care providers
(Idaho has the worst d o c t o r - t o - p a t i e n t r a t i o i n t h e c o u n t r y ) .
Our h e a l t h care p r o f e s s i o n a l s now work long, hard hours i n order
t o make up f o r s t a f f shortages. These people are dedicated t o
t h e i r work and the r u r a l communities they serve, b u t r e l i e f i s
desperately needed. I f r u r a l h o s p i t a l s are going t o be able t o
continue t o compete i n the same labor pool as t h e i r urban
counterparts, f o r the l i m i t e d ntimber o f h e a l t h care p r o v i d e r s ,
then we must change the bias of t h e system t h a t favors urban
areas.
Malpractice i s another problem area t h a t has p a r t i c u l a r l y f a r reaching e f f e c t s i n r u r a l areas. Last year, a malpractice
judgement against a l o c a l doctor f o r $2.3 m i l l i o n d o l l a r s i n
Bonners Ferry, Idaho, discouraged doctors from p r o v i d i n g
emergency room care, s i g n i f i c a n t l y l i m i t i n g the access t o care i n
the upper Panhandle area of my s t a t e . The h o s p i t a l immediately
put out a search f o r a f u l l - t i m e emergency room p h y s i c i a n , but
met w i t h the many d i f f i c u l t i e s t h a t r u r a l areas o f t e n confront i n
r e c r u i t i n g h e a l t h care providers. This s i n g l e case g r e a t l y
�a f f e c t e d t h e d e l i v e r y of care and sent an e n t i r e geographic
region i n t o a c r i s i s . For these reasons, I would encourage you
and t h e task f o r c e t o look i n t o malpractice t o r t reform.
I would also encourage t h e Task Force t o look i n t o t h e value of
the Community and Migrant Health Centers program. These programs
are very cost e f f i c i e n t and provide f o r care f o r many people i n
remote r u r a l areas.
As you gather i n f o r m a t i o n , I hope t h a t you w i l l i n c l u d e
i n f o r m a t i o n from Northwestern r u r a l s t a t e s . A t r i p t o Idaho
would c e r t a i n l y provide you w i t h a b e t t e r understanding of t h e
kinds of problems I have q u i c k l y o u t l i n e d here. I f I can be of
assistance, please do n o t h e s i t a t e t o contact me.
Again, thank you f o r t h i s o p p o r t u n i t y t o share my concerns. I
look forward t o working w i t h you and t h e a d m i n i s t r a t i o n on t h i s
very important issue.
Sir yerely.
LARRY E7|CRAIG
United States Senator
LEC/ec
�SPECIAL REPORT
T H E MARKETPLACE I N H E A L T H C A R E REFORM
The Demographic Limitations of Managed Competition
Abstract Background. The theory of managed competition holds that the quality and economy of health care
delivery will improve if independent provider groups compete for consumers. In sparsely populated areas where
relatively few providers are required, however, it is not
feasible to divide the provider community into competing
groups. We examined the demographic features of health
markets in the United States to see what proportion of the
population lives in areas that might successfully support
managed competition.
Methods. The ratios of physicians to enrollees in large
staff-model health maintenance organizations were determined as an indicator of the staffing needs of an efficient
health plan. These ratios were used to estimate the populations necessary to support health organizations with various ranges of specialty services. Metropolitan areas with
populations large enough to support managed competition
were identified.
Results. We estimated that a health care services
M
ANAGED competition has received widespread
support from members of Congress, Presidentelect Bill Clinton, large insurance companies, and editorialists writing in influential publications.'"* .\ central tenet of the managed-competition theory is that
providers are divided into competing economic units.
As discussed by Enthoven and Kronick,^'^ the most
effective competition occurs when all the doctors in a
community are grouped into several prepaid practices
with each doctor fully committed to one organization.
Health care services, however, are largely purchased
locally, and there are sparsely populated areas of the
United States where providers have a natural monopoly. In a geographically isolated area with a population base large enough to support only one hospital
and one group of physicians, it is difficult to envision
how competition would work. I f the hospital decides to increase its scope of services or its prices
substantially, threatening to build a competing hos-
market with a population of 1.2 million could support three
fully Independent plans. A population of 360,000 could
suppori three plans that independently provided most
acute care hospital services, but the plans would need to
share hospital facilities and contract for tertiary services. A
population of 180,000 could support three plans that provided primary care and many basic specialty services but
that shared inpatient cardiology and urology services.
Health markets with populations greater than 180,000
would include 71 percent of the U.S. population; those with
populations greater than 360,000, 63 percent; and those
with populations greater than 1.2 million, 42 percent.
Conclusions. Reform of the U.S. health care system
through expansion of managed competition is feasible in
medium-sized or large metropolitan areas. Smaller metropolitan areas and rural areas would require alternative
forms of organization and regulation of health care providers to improve quality and economy. (N Engl J Med 1993;
328:148-52.)
pital is a poor option, and transporting patients
to another city may be unacceptable. Similarly, if
most physicians are members of a single multispecialty group practice, purchasers have little recourse
if the physicians use more, rather than fewer, resources.
We estimated the minimal population size for a
health services market area that could support managed competition and the proportion of the population of each state and of the nation as a whole that is in
such areas.
METHODS
An estimate of the minimal population required to support managed competition is based on four assumptions: the extent to which
competing health care organizations need to be independent; the
minimal number of health care organizations needed to support
healthy competition; the ratios of physicians to enrollees and of
hospital beds to enrollees in efficiently managed health plans; and
the geographic boundaries of health services markets. This section
Reprintedfromthe New England Journal of Medicine
328:148-152 (January 14). 1993
�Vol. 328
No. 2
SPECIAL REPORT
presents ihe assumptions and methods we used to make our estimates.
To What Extent Must Competing Organizations Be
Independent?
[he "chissic ' health maintenance organization ( H M O ) — the
larc;e, siair-model prepaid group practice epitomized by KaiserPormanente or (iroup Health Cooperative oi Puget Sound — is the
[jrotolvpe of the efficient competitor. Unlike manv other forms of
managed care, classic H M O s are capable of health planning: they
regulate the supply of hospital beds, phvsicians, and other providers in relation to the size of the population they serve. Physicians
employed by classic H M O s , because they are salaried, are not subject to the tendencies toward supplier-induced demand inherent in
fec-lbr-servicc medicine; they arc able to allocate their workloads
elficientiv among various tasks, such as evaluating and counseling
patients, performing operations or diagnostic tests, and performing
the duties required for continuous improvement in the quahty of
carc. This flexibility makes it possible for classic H M O s to adapt
easilv to the changes in demand that occur when patients are i n formed about medical options and make decisions according to their
preferences.'
The efficiency of the classic H M O model contrasts sharply with
ihat ot the independent practice association ( I P A ) model, particuhirlv when individual physicians are alhliated with many health
plans, tnthoven describes the inetficiencies of an IPA market in
which each physician belongs to 10 plans;
Each doctor would have to deal with the utilization controls and
fee schedules of ten health plans, none of which would command
his loyalty. I f one health plan persuaded a doctor to adopt a more
efficient health practice, the benefit would be likely to be spread
immediately over all ten plans, reducing the incentive of any plan
to make the effort to pursue innovation at the provider level. None
of the health plans would be matching numbers of doctors to the
needs of the population."'
Between the contrasting extremes of the mature classic H M O
and the multiple-lPA model is a large, ambiguous middle ground.
Each of a set of health plans might have its own primary care
physicians and contract with the same specialists. Or, in addition to
primary care, a plan might provide some specialty services (such as
cardiology, urology, and gastroenterology), using its own physicians
during regular business hours, but it might contract with overlapping sets of providers for after-hours specialty care and for inpatient
services. When considering competition among health plans that
are less comprehensive than classic H M O s , a key factor is the configuration of inpatient hospital services in a community. I f health
plans are not large enough to own their own hospitals and hire the
full complement of specialists but, instead, contract separately with
overlapping sets of hospitals, then no organization will be responsible and accountable for population-based health planning for hospital services.
In areas in which the population is too small to allow competing
health plans to exert effective control over specialists' services and
hospital resources, some alternative or adjunct to managed competition will be required in order to achieve elTective health planning.
Conceivably, this might be accomplished by cooperative planning
efforts by the major health plans operating in a community. Alternatively, some form of government regulation of hospital capacity
and budgets may be necessary.
How Many Competitors Are Needed?
Ideally, a large number of qualified health care plans would be
available in each geographic area. No single plan would be able to
have much influence on the demand for care, thus making collusion
among plans difficult. However, the minimal number of plans needed to avoid a market with strong oligopolistic tendencies is not clear.
One competitor is obviously not enough. I f there are only two competitors, the temptation of implicit collusion will be hard to resist.
Why should the competitors work hard to restrain the growth of
costs or profits when both competitors will be better o f f i f they
1+9
engage in cozy behavior.'' There is no theoretical basis on which to
infer the minimal number of firms that can successfullv sustain
competition, but the fewer there are. the greater the tendencv toward oligopoly. Somewhat arbitrarily, we assumed that at least
three health plans are needed in order to create a situation in which
providers and plans will continually strive to improve qualitv and
economy.
What Is the Critical Population Size Needed to Sustain an
Efficient Firm?
The size of the population required for a managed-care firm to
organize efficient primary care and specialty units varies according
to specialty and according to assumptions about the minimal number of physicians needed to sustain the service. We grouped physician specialties into four categones. The first, primary care, included general intemal medicine, pediatrics, and familv medicine. For
these specialties we assumed that at least five physicians are needed
to provide full night coverage and to sustain the collegial relations
required for high-quality care in the group-practice environment.
The second category included hospital-based specialties that involve frequent night and weekend consultation fbr emergencies or
postoperative care and that are required in a full-service acute care
community hospital — specifically, emergency medicine, obstetrics
and gynecology, general surgery, orthopedics, anesthesiology, radiology, psychiatry, cardiology, and urology. For these specialties, we
assumed that three full-time physicians are needed to staff a minimal service in order to meet coverage obligations and provide highquality care. We used these specialties to estimate the lower limit of
the zones where competition based on the classic H M O model
might succeed i f there were some sharing of hospital facilities, with
staffs independent.
The third category included neurosurgery and cardiothoracic
surgery, the additional three-physician specialty services required
for a tertiary hospital. This sets the minimum for a classic H M O
that is fully independent for all clinical specialties. The fourth category consisted of other specialties involving secondary and tertiary
care that is usually not of an emergency nature — ophthalmology,
otolaryngology, dermatology, pathology, hematology and oncology,
neurology, gastroenterology, allergy and immunology, pulmonary
medicine, nephrology, rheumatology, endocrinology, infectious diseases, and plastic and reconstructive surgery. On the basis of our
estimate that 24-hour coverage is not essential for these specialties,
we assumed that the services of only one specialist are required to
achieve independence.
To estimate the population required for independence and efficiency, we examined the staffing patterns of the Group Health Cooperative of Puget Sound and four other large, nonprofit staff-model
H M O s . For each classic H M O , data were provided by the organization's medical staff office. For most specialties the number of
enrollees per specialist was averaged across plans to derive an estimate for the H M O s as a whole. T o estimate the need for primary
care practitioners we used the Group Health Cooperative's staffing
rauo for family practitioners ( I to 2000). For emergency medicine,
psychiatry, pathology, and thoracic surgery, we used data from
other sources."'' (Supplemental material on our procedures is available elsewhere.*)
The age structure of the enrollees was obtained for the age groups
« 1 4 , 15 through 44, 45 through 64, and ^ 6 5 years. The proportion
of enrollees in each age group approximated the national age distribution except for the population 65 years of age or older. The
elderly make up 12.5 percent of the national population, whereas
the percentages for the five H M O s were 11.7, 9.4, 8.0, 11.4, and 8.2
percent.
H M O s typically use fewer than 2 beds per 1000 enrollees. The
estimate of 2 beds per 1000 is compatible with the assumptions that
the population under 65 years of age uses 350 hospital days per year
•See NAPS document no. 04998 for two pages of supplementary material.
Order from NAPS c/o Microliclie Publications, P.O. Box 3513. Grand Central
Station. New York. NY 10163-3513. Remit in advance (in U.S. funds only)
$7.75 for photocopies or S4 for microficlie. Outside the U.S. and Canada add
postage of $4.50 ($1.50 for microtiche postage). There is a $15 invoicing charge
on all orders filled >Kfote payment.
�Jan. 14. 1993
THE NEW ENGLAND JOURNAL OF MEDICINE
150
per 1000 enrollees and the population 65 or older uses 2430 days per
1000; that 13 percent of the enrollees are 65 or older; and that
hospital occupancy is 85 percent.
What Are the Location and Size of Health Care Markets?
Table 1. Estimated Number of Full-Time-Equivalent Physicians
and Hospital Beds Needed, According to ttie Size of ttie
Health Plan.
No. OF tNROLLEES
SPECIALTY O» TYPE OF SERVICE
20.000
We assumed that metropolitan areas, as defined by the Office of
.Management and Budget,'" are the relevant market areas for health
services in nonrural parts of the United States. Metropolitan areas
are defined as a "place"' with a population of at least 50.000 or an
""urbanized area. " as defined by the U.S. Bureau of the Census,
with a population of 50,000 and a metropolitan area with a total
population of at least lOO.CKX). Surrounding counties are included if
they have a minimal commuting rate to the central county. This
definition of metropolitan areas results in high-density geographic
units with economic and travel ties that are consistent with a regional economic market."'"' The size and location of health services
markets for people living outside metropolitan areas are usually
determined on the basis of small-area analysis. Although we were
not able to perform such an analysis for the entire nation, previous
studies in northern New England have resulted in the division of
this territory into 72 distinct hospital market areas." We used these
areas to illustrate the constraints of demographic forces on managed care in nonmetropolitan areas.
60.000
120.000
300.000
450.000
150.0
225.0
number
Phjsiciaiis
Pnmary care (family medicine)*
(jeneral hospital services
Obstemcs-gynecology
General surgery
Oithopedics
Emergency medicine
Anesthesia
Radiology
Psychiatry
Cardiology
Urology
Subtotal
Tertiary hospital services
Thoracic surgery
Neurosurgery
Subtotal
Other specialtiest
10.0
30.0
60.0
32.6
15.8
14.9
14.7
15.0
18.2
11.4
8.5
7.7
138.8
48.9
23.7
22.3
22.1
22.5
27.3
17.1
12.8
11.5
208.2
2.2
1.1
0.9
0.9
1.0
1.2
0.8
0.6
0.5
9.2
6.5
3.2
3.0
2.9
3.0
3.6
2.3
1.7
1.5
27.7
13.0
6.3
5.9
5.9
6.0
7.3
4.6
3.4
3.1
55.5
Total
0.2
0.1
0.3
4.1
23.6
0.5
0.4
0.9
12.2
70.8
1.0
0.8
1.8
24.3
141.6
2.5
2.0
4.5
60.8
354.1
3.8
3.0
6.8
91.2
531.2
Population Requirements for Managed-Care Organizations
Hospital beds
40
240
600
900
The minimal population necessary to support a
classic HMO offering referral hospital services and
using its own staff physicians is approximately
450,000 enrollees. A health plan with 300,000 enrollees would be able to offer virtually all ambulatory and
hospital services with its own panel of providers and
own a 600-bed hospital, but it would need to contract
for some coverage of cardiothoracic surgery and neurosurgery. A plan with 120,000 enrollees could provide the full complement of acute care hospital services associated with a community hospital, using its
own staff physicians, although the cardiology and
urology services would be close to the minimal threeperson service. This plan would need approximately
240 hospital beds; it would be able to exert substantial
control over one or two hospitals, but it would have to
share some inpatient facilities with other plans. A plan
with 60,000 enrollees could support 71 full-timeequivalent physicians (Table 1) and a 3-physician
service in most of the specialties required for general
hospital services, but it would need to share cardiology
and urology services and engage in substantial sharing
of inpatient facilities with other plans. A plan with
10,000 members could support an independent primary care service but would be required to share both
physicians and inpatient hospital services in all specialties.
•Sufliiig will viry depending; on ihe mix of family pnctmoocn. inlenuiU, and pediilnciana.
tThe odier ipecialoei are ophthalmology, otolaryngology, detmatology. pathology, hemalology and oncology. iKluology. gastroenterology, allergy and immunology, pulmonary medicine, nephrology, rheumatology, endoimnology. uifecuoui diseaaei. and plastic and reconstniclive surgery.
RESULTS
Population Required for Managed Competition
Assuming that three health plans are the minimum
required for competition, then at least 360,000 persons
are needed to support three HMOs that can plan for
and deliver most general hospital services, although
sharing of acute care hospital facilities would be necessary. A smaller community of 180,000 could support
three health plans capable of providing a large portion
of physicians' services in hospitals, using physicians
120
who are employed as staff by the health plan, but they
would require shared inparient services. A community
of 30,000 might support three independent primary
care networks, but all hospital services would need to
be shared if the residents were to receive inpatient
care locally. At the other extreme, a much larger community of at least 1.2 million persons would be required to support three HMOs capable of providing
almost all services with their own resources.
Proportion of the U.S. Population Living in Competitive
Zones
Twenty-nine percent of the U.S. population lives in
markets with populadons below 180,000 and thus in
areas where substantial sharing of hospital services
would be required for use to be efficient (Table 2).
Eight percent live in markets with populations between 180,000 and 360,000, where managed competition has some potential to organize acute hospital care
at least semi-independently, but where plans would
need to be supplemented with substantial public-sector involvement in health planning. Twenty-one percent are in markets with populations between 360,000
and 1.2 million, where the demographic requirements
for HMO-based managed competition are largely met
but where some public-sector efforts are likely to be
required in the planning of tertiary hospital services.
Forty-two percent reside in markets with populations
of more than 1.2 million.
The location of these markets in the United States is
shown in Figure 1. Twenty-three states and the District of Columbia have at least one metropolitan area
�. \'ol. 328 No. 2
SPECIAL REPORT
with a population of 1.2 million or more, sufficient to
.support three classic HMOs, each owning a referral
hospital; in 10 (Arizona, California, the District of
Columbia, Illinois, Maryland, Minnesota, Missouri,
New Jersey, New York, and Texas) the majority of the
people live in such areas. However, large land areas in
the United States are outside the competitive zone for
HMOs, and no state is entirely within it. Most states
will require mixed strategies. Some part of their populations live in areas where managed competition could
be effective in promoting HMOs, but many live in
more sparsely settled areas where other strategies are
Table 2. Percentage of State (or District) Populations in DifferentSized Health Market Areas.'*
STATE O« DISTRICT
POPULATION
POPULATION OF M A R U T AREA
>III0.000
>3«0.000
>l 2 MILLION
percerttafe of state population
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New Yoric
North Carolina
North Dakou
Ohio
Oklahoma
Oregon
Pennsylvania
Rhcxle Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Tolal
4.041.000
550.000
3.665,000
2.351,000
29,760.000
3,294.000
3.287.000
666.000
607.000
12,938.000
6.478,000
1,108,000
1,007,000
11.431.000
5.544,000
2,777,000
2.478,000
3,685.000
4.220,000
1.228,000
4,781.000
6.016.000
9,295.000
4.375,000
2,573.000
5,117,000
799.000
1.578,000
1.202.000
1.109,000
7,730,000
1.515.000
17.990,000
6.629.000
639,000
10.847,000
3,146,000
2.842.000
11,882,000
1,003.000
3,487.000
6%.000
4.877,000
16,987.000
1.723.000
563.000
6,187.000
4,867.000
1.793.000
4,892,000
454.000
248.709,000
49
41
76
24
94
74
79
66
too
88
61
75
20
78
53
23
44
42
59
22
89
79
74
64
26
60
0
47
83
59
98
32
89
45
0
74
53
63
81
89
53
0
64
73
78
0
66
73
34
49
0
71
34
0
76
24
91
61
53
66
100
72
50
75
0
66
44
17
44
29
42
0
89
68
68
55
18
55
0
34
62
10
90
32
81
41
0
69
53
44
72
65
53
0
64
62
62
0
63
60
0
38
0
63
0
0
58
0
77
49
0
0
too
41
44
0
0
58
23
0
24
8
29
0
87
48
47
55
0
55
0
0
0
0
55
0
62
0
0
40
0
44
49
0
0
0
0
50
0
0
47
41
0
30
0
42
'In health markets that cross stale boundaries, people have been allocated to theu- state oi
residence.
151
needed. In 19 states the majority of the population
lives in areas of less than 180,000 population, where
hospital services must be extensively shared. In 42
states, 20 percent or more of the population lives in
such areas.
The health markets in northern New England illustrate the complexities of structuring competition in
states with no large metropolitan areas. Maine, New
Hampshire, and Vermont together contain 83 acute
care general hospitals and 2.5 million people; 64 of the
hospitals are the sole hospitals in their local areas. The
vast majority of primary care services in these areas
are delivered by local physicians who use the local
hospital for their patients. None of these areas have a
big enough population to support three independent
cardiology services. Only two market areas — Portland, Maine, and Manchester, New Hampshire (containing 13 percent of the population) — are sufficiently large to support three independent general-surgery,
emergency, and orthopedic services. Twenty-seven
percent of the population of northern New England
lives in hospital market areas that cannot support
three independent primary care competitors, assuming that each plan would need to have at least five
physicians.
DISCUSSION
We recognize several limitations to our study that
cause uncertainty about our estimates. We estimated
the minimal population required to support three efficient organizations in a steady state; population estimates may be unrealistic, however, since the motivation of competition includes growth and in small
markets this cannot occur without driving a competitor out of business. Our assumption that three competitors are sufficient to avoid collusion cannot be
supported by empirical evidence, since managed competition is an experiment that has yet to run its course.
Three may not be enough. Each of these factors would
tend to cause us to underestimate the market size required to promote efficient competition. We have also
not considered other potential limits to reform, such as
barriers to enrollment of providers and bureaucratic
inefficiencies in the case of public-sector health planning. On the other hand, since the enrollees of HMOs
tend to be younger than the general population, smaller health markets could support managed competition
with a higher proportion of elderly persons. The conclusion, however, is the same: demographic factors
will limit the full implementation of managed competition as the vehicle for reforming the U.S. health care
economy.
We hope our study will help to move the policy
debate beyond polarization, either for or against competition and regulation. The complexities and the
highly localized nature of the health care economies in
the various states indicate the need for care on the part
of state governments in setting the rules for structured
competition, or the need for alternative models of reform (based on planning and the promotion of cooper-
�152
THE NEW ENGLAND JOUR.NAL OF MEDICINE
Jan. 14. 1993
Figure 1. Health Markets with Populations £^360,000 in the United States.
Metropolitan areas (health markets) with populations 3^360,000 are shown in black.
ation as the basis for achieving the efficiencies that the
population-based perspective of the classic H M O
brings to the health care economy). Monitoring by the
states should be based on a sophisticated understanding of their health care systems, including detailed
information about the location and level of use of resources in local and regional markets. Each state will
need to recognize the limitations as well as the advantages of managed competition, particularly the need
for support within an overall regulatory framework
that can deal effectively with all the territory within its
jurisdiction.
We recommend that the states be given wide latitude to undertake experiments in setting the rules for
managing health care reform within their territory.
We expect a provocative series of experiments that
promote a variety of approaches to the complex problem of building population-based systems of care.
Some will result in as yet unanticipated hybrid solutions that reflect demographic factors, the history of
the state's health care industry, and regional traditions and preferences.
University of CalifomiaSan Diego
U Jolla. CA 92093
Dartmouth Medical School
Hanover, NH 03755
Group Health Cooperative
of Puget Sound
Seattle. WA98112
We are indebted to Chiang-Hua Chang, M.S.,
Bubolz, Ph.D., for their analytic support.
Address repnnt requests to Dr. Kionick at tfie Depanment ol Community and
Family Medicine, University of Califomia-San Diego. La Jolla. CA 92093.
Supported by a grant (HS 05745-05) from the Agency for Health Care Policy
and Research.
REFERENCES
8.
9.
10.
11.
RICHARD KRONICK, P H . D .
D A V I D C . GOODIHAN,
M.D.
12.
J O H N WENNBERG, M . D .
13.
EDWARD WAGNER, M . D . , M . P . H .
and Thomas
The guis to reform health care. New York Times. August 2. 1992:16.
Faltermayer E. Let's really cure the health system. Fortune. March 23.
1992:46-58.
Garland SB. A prescription for reform. Business Week. October 7. 1991:
59-66.
Talking points on health care. Little Rtxk. Ark.: Clinton/Gore Campaign
Committee. 1992.
Enthoven AC. Kronick R. Universal health insurance Ihrough incentives
reform. JAMA 1991:265:2532-6.
Enthoven AC. Theory and practice of managed competition in health care
financing. Amsterdam: Elsevier North-Holland. 1988.
Kasper JF, Mulley AG Jr. Wennberg JE. Developing shared decision-making programs to improve the qualitv of health care. QRB (Jual Rev Bull
1992;18:183-90.
Mulhausen R. McGee J. Physician need: an alternative projection from a
study of large, prepaid group practices. JAMA 1989;261:1930-4.
Hicks LL. Glenn JK. Too many physicians in the wrong places and speciallies? Populations and physicians from a market perspective. J Healtii Care
Marketing 1989;9(4): 18-26.
Codes, titles, and components of metropolitan areas (MSAs. CMSAs, and
PMSAs). Washington, D C : Bureau of the Census. 1990 (Department of
Commerce report 2-52.)
1990 Census of population and housing: summary population and housing
charactensucs — New Hampshire. Washington. D C : Govemment Printing Office. 1991. (Bureau of Census report CPH-l-31:A-8.)
Half the nation's population lives in large metropolitan areas. Press release of Ihe Department of Commerce. Washington. D C . February 21,
1991.
Freeman JL. The evaluation and refinement of New England Hospital
Service Area definitions. Hanover. N.H.: Dartmouth Medical School,
1991.
©Copyright, 1993, by the Massachusetts Medical Society
Printed in the U.S.A.
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AGRICUfrURE. NUTRITION
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SPECIAL COMMITTEE
ON AGING
WASHINGTON, DC 20510-1203
March 10, 1993
Mrs. H i l l a r y Rodham C l i n t o n
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
Dear Mrs. C l i n t o n :
I am pleased t o respond t o your request f o r my concerns and
thoughts on h e a l t h care reform. The work you and the Task Force
on N a t i o n a l Health Care Reform have undertaken w i l l g r e a t l y
a s s i s t t h e n a t i o n a l debate on health reform. I t has c e r t a i n l y
given t h i s issue more prominence i n the minds of Idahoans.
My preference i n reforming our h e a l t h care system i s t o avoid
f u r t h e r government involvement, because I am convinced i t causes
more problems than i t solves. The Medicare program i s a good
example of how government c o n t r o l s do n o t reduce costs. As you
know, since i t s i n c e p t i o n , the Medicare program has undergone a
nximber of r e g u l a t o r y changes designed t o c o n t r o l i n c r e a s i n g
costs. Yet Medicare continues t o be one of the f a s t e s t growing
areas of t h e budget. According t o recent testimony provided by
the Congressional Budget O f f i c e , Medicare and Medicaid b e n e f i t s
represented 3.4 percent of the nation's gross domestic product
(GDP) i n 1992. That i s p r o j e c t e d t o grow t o 5.1 percent of GDP
by 1998. C l e a r l y , government cost c o n t r o l e f f o r t s have not
worked.
Even worse, as expenditures f o r Medicare continue t o grow,
b e n e f i c i a r i e s and p r o v i d e r s both complain about reimbursement
r a t e s , services covered and increasing bureaucratic redtape. I n
a d d i t i o n , below cost Medicare reimbursement r a t e s i n r u r a l areas
force h e a l t h care p r o v i d e r s t o compensate by r a i s i n g p r i c e s f o r
non-Medicare p a t i e n t s . This c o s t - s h i f t i n g has c o n t r i b u t e d t o the
increase i n o v e r a l l h e a l t h care costs.
I n l i g h t of t h i s experience, I do not support an increase i n
government involvement i n h e a l t h care, i n c l u d i n g a single-payer
plan. Instead, I support changing the i n c e n t i v e s i n t h e system
t o make i t more cost e f f e c t i v e and i n c r e a s i n g the i n d i v i d u a l ' s
r o l e as a h e a l t h care consumer.
SS^NTR^H
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�I am p r i n c i p a l l y concerned about how each of the proposals being
discussed w i l l work i n a r u r a l s t a t e l i k e Idaho. "Managed
competition" has received a great deal of a t t e n t i o n , b u t I have
yet t o see how i t can be e f f e c t i v e i n r u r a l America.
I n fact, I
have reviewed several a r t i c l e s , one of which i s enclosed, t h a t
argue i t w i l l not work i n a r u r a l s e t t i n g . I would appreciate
your comments on the enclosed a r t i c l e .
I t ' s my understanding t h a t none of the Task Force's 22 working
groups i s designated t o focus on r u r a l h e a l t h issues. I hope
t h i s does not r e f l e c t ignorance o f , or lack of concern f o r , the
unique h e a l t h care problems of t h e r u r a l sector. Many Members of
Congress (and Washington bureaucrats) t h i n k " r u r a l " i s a
community located f i f t e e n miles of freeway away from a large
c i t y . I n Idaho, Arkansas and many other states t h i s i s simply
not t h e case. I n a d d i t i o n t o sheer d i s t a n c e , r u r a l states i n the
Rocky Mountain West must overcome p h y s i c a l b a r r i e r s t h a t may
a c t u a l l y prevent t r a n s p o r t a t i o n from one region t o another d u r i n g
c e r t a i n p a r t s of the year.
For t h i s reason, perhaps the most serious o f the many problems
r u r a l states must address i s access t o care ~ even f o r those who
are insured and can a f f o r d care. But access t o care i s n t ^ust a
aeoqraphic question. I n Idaho, several h o s p i t a l s have already
been forced out of business and others are s t r u g g l i n g t o s u r v i v e
because of i n e q u i t a b l e reimbursement rates from Medicare.
Because you come from a r u r a l s t a t e , you doubtless know how even
a r e l a t i v e l y few h o s p i t a l closures can devastate a large
percentage of a state's p o p u l a t i o n because of the t o t a l area
served by a s i n g l e h o s p i t a l . Many o f these small h o s p i t a l s are
l o c a t e d i n remote areas, hundreds of miles from other h e a l t h care
facilities.
Also, because of i n e q u i t a b l e reimbursement rates t o r u r a l areas,
t h e r e are shortages i n physicians and other health care providers
(Idaho has the worst d o c t o r - t o - p a t i e n t r a t i o m the c o u n t r y ) .
Our h e a l t h care p r o f e s s i o n a l s now work long, hard hours i n order
t o make up f o r s t a f f shortages. These people are dedicated t o
t h e i r work and the r u r a l communities they serve, b u t r e l i e f i s
desperately needed. I f r u r a l h o s p i t a l s are going t o be able t o
continue t o compete i n the same labor pool as t h e i r urban
c o u n t e r p a r t s , f o r the l i m i t e d number of h e a l t h care p r o v i d e r s ,
then we must change the bias o f t h e system t h a t favors urban
areas.
M a l p r a c t i c e i s another problem area t h a t has p a r t i c u l a r l y f a r reaching e f f e c t s i n r u r a l areas. Last year, a malpractice
judgement against a l o c a l doctor f o r $2.3 m i l l i o n d o l l a r s i n
Bonners Ferry, Idaho, discouraged doctors from p r o v i d i n g
emergency room care, s i g n i f i c a n t l y l i m i t i n g the access t o care i n
the upper Panhandle area of my s t a t e . The h o s p i t a l immediately
put out a search f o r a f u l l - t i m e emergency room physician, b u t
met w i t h the many d i f f i c u l t i e s t h a t r u r a l areas o f t e n c o n f r o n t i n
r e c r u i t i n g health care p r o v i d e r s . This s i n g l e case g r e a t l y
�a f f e c t e d t h e d e l i v e r y of care and sent an e n t i r e geographic
region i n t o a c r i s i s . For these reasons, I would encourage you
and t h e task force t o look i n t o malpractice t o r t reform.
I would also encourage t h e Task Force t o look i n t o the value of
the Community and Migrant Health Centers program. These programs
are very cost e f f i c i e n t and provide f o r care f o r many people i n
remote r u r a l areas.
As you gather i n f o r m a t i o n , I hope t h a t you w i l l include
i n f o r m a t i o n from Northwestern r u r a l s t a t e s . A t r i p t o Idaho
would c e r t a i n l y provide you w i t h a b e t t e r understanding of t h e
kinds of problems I have q u i c k l y o u t l i n e d here. I f I can be of
assistance, please do n o t h e s i t a t e t o contact me.
Aqain, thank you f o r t h i s o p p o r t u n i t y t o share my concerns. I
look forward t o working w i t h you and t h e a d m i n i s t r a t i o n on t h i s
very important issue.
LARRY ETICRAIG
United States Senator
LEC/ec
�r
LARRY E. CRAIG
AGRICULTURE, NUTRITION
AND FORESTRY
ENERGY AND NATURAL
RESOURCES
HART SENATE OFFICE BUILDINS
(202) 2 2 4 - 2 7 5 2
lamted States %mvi
SPECIAL COMMITTEE
ON AGING
WASHINGTON, DC 20610-1203
March 10, 1993
Mrs. H i l l a r y Rodham C l i n t o n
The W h i t e House
1600 P e n n s y l v a n i a Avenue, N.W.
Washington, D.C. 20500
Dear Mrs. C l i n t o n :
I am p l e a s e d t o respond t o your r e q u e s t f o r my concerns and
t h o u g h t s on h e a l t h care r e f o r m . The work you and t h e Task Force
on N a t i o n a l H e a l t h Care Reform have undertaken w i l l g r e a t l y
a s s i s t t h e n a t i o n a l debate on h e a l t h r e f o r m . I t has c e r t a i n l y
g i v e n t h i s i s s u e more prominence i n t h e minds o f Idahoans.
My p r e f e r e n c e i n r e f o r m i n g o u r h e a l t h care system i s t o a v o i d
f u r t h e r government i n v o l v e m e n t , because I am convinced i t causes
more problems t h a n i t s o l v e s . The Medicare program i s a good
example o f how government c o n t r o l s do n o t reduce c o s t s . As you
know, s i n c e i t s i n c e p t i o n , t h e Medicare program has undergone a
nvimber o f r e g u l a t o r y changes designed t o c o n t r o l i n c r e a s i n g
c o s t s . Y e t Medicare c o n t i n u e s t o be one o f t h e f a s t e s t growing
areas o f t h e budget.
A c c o r d i n g t o r e c e n t t e s t i m o n y p r o v i d e d by
t h e C o n g r e s s i o n a l Budget O f f i c e , Medicare and M e d i c a i d b e n e f i t s
r e p r e s e n t e d 3.4 p e r c e n t o f t h e n a t i o n ' s gross domestic p r o d u c t
(GDP) i n 1992. That i s p r o j e c t e d t o grow t o 5.1 p e r c e n t o f GDP
by 1998. C l e a r l y , government c o s t c o n t r o l e f f o r t s have n o t
worked.
Even worse, as e x p e n d i t u r e s f o r Medicare c o n t i n u e t o grow,
b e n e f i c i a r i e s and p r o v i d e r s b o t h complain about reimbursement
r a t e s , s e r v i c e s covered and i n c r e a s i n g b u r e a u c r a t i c r e d t a p e . I n
a d d i t i o n , below c o s t Medicare reimbursement r a t e s i n r u r a l areas
f o r c e h e a l t h c a r e p r o v i d e r s t o compensate b y r a i s i n g p r i c e s f o r
non-Medicare p a t i e n t s . T h i s c o s t - s h i f t i n g has c o n t r i b u t e d t o t h e
i n c r e a s e i n o v e r a l l h e a l t h care c o s t s .
I n l i g h t o f t h i s e x p e r i e n c e , I do n o t s u p p o r t an i n c r e a s e i n
government i n v o l v e m e n t i n h e a l t h c a r e , i n c l u d i n g a s i n g l e - p a y e r
p l a n . I n s t e a d , I s u p p o r t changing t h e i n c e n t i v e s i n t h e system
t o make i t more c o s t e f f e c t i v e and i n c r e a s i n g t h e i n d i v i d u a l ' s
r o l e as a h e a l t h care consumer.
RESOURCE CENTER
304 NORTH 8TH STREET
ROOM 147
BOISE, IDAHO 8 3 7 0 2
304 NORTH 8TH STREET
ROOM 149
BOISE. IDAHO 8 3 7 0 2
103 NORTH 4TH STREET
COEUR D ALENE. IDAHO 8 3 8 1 4
6 3 3 M A I N STREET
LEWISTON. IDAHO 8 3 5 0 1
2 5 0 SOUTH 4 T H AVENUE 1292 ADDISON AVENUE EAST
POCATELLO, IDAHO 8 3 2 0 1 T W I N FALLS, IDAHO 8 3 3 0 1
2 5 3 9 CHANNING W A Y
IDAHO FALLS, IDAHO 8 3 4 0 4
�I am p r i n c i p a l l y concerned about how each o f t h e p r o p o s a l s b e i n g
d i s c u s s e d w i l l work i n a r u r a l s t a t e l i k e Idaho.
"Managed
c o m p e t i t i o n " has r e c e i v e d a g r e a t d e a l o f a t t e n t i o n , b u t I have
y e t t o see how i t can be e f f e c t i v e i n r u r a l America.
I n fact, I
have r e v i e w e d s e v e r a l a r t i c l e s , one o f which i s e n c l o s e d , t h a t
argue i t w i l l n o t work i n a r u r a l s e t t i n g .
I would a p p r e c i a t e
y o u r comments on t h e enclosed a r t i c l e .
I t ' s my u n d e r s t a n d i n g t h a t none o f t h e Task Force's 22 w o r k i n g
groups i s d e s i g n a t e d t o focus on r u r a l h e a l t h i s s u e s . I hope
t h i s does n o t r e f l e c t i g n o r a n c e o f , o r l a c k o f concern f o r , t h e
unique h e a l t h c a r e problems o f t h e r u r a l s e c t o r . Many Members o f
Congress (and Washington b u r e a u c r a t s ) t h i n k " r u r a l " i s a
community l o c a t e d f i f t e e n m i l e s o f freeway away from a l a r g e
city.
I n Idaho, Arkansas and many o t h e r s t a t e s t h i s i s s i m p l y
not t h e case.
I n a d d i t i o n t o sheer d i s t a n c e , r u r a l s t a t e s i n t h e
Rocky Mountain West must overcome p h y s i c a l b a r r i e r s t h a t may
a c t u a l l y p r e v e n t t r a n s p o r t a t i o n from one r e g i o n t o a n o t h e r d u r i n g
c e r t a i n p a r t s o f t h e year.
For t h i s reason, perhaps t h e most s e r i o u s o f t h e many problems
r u r a l s t a t e s must address i s access t o care — even f o r t h o s e who
a r e i n s u r e d and can a f f o r d c a r e . But access t o care i s n ' t j u s t a
geographic q u e s t i o n . I n Idaho, s e v e r a l h o s p i t a l s have a l r e a d y
been f o r c e d o u t o f business and o t h e r s a r e s t r u g g l i n g t o s u r v i v e
because o f i n e q u i t a b l e reimbursement r a t e s f r o m Medicare.
Because you come from a r u r a l s t a t e , you d o u b t l e s s know how even
a r e l a t i v e l y few h o s p i t a l c l o s u r e s can d e v a s t a t e a l a r g e
percentage o f a s t a t e ' s p o p u l a t i o n because o f t h e t o t a l area
served by a s i n g l e h o s p i t a l . Many o f these s m a l l h o s p i t a l s a r e
l o c a t e d i n remote a r e a s , hundreds o f m i l e s f r o m o t h e r h e a l t h care
facilities.
A l s o , because o f i n e q u i t a b l e reimbursement r a t e s t o r u r a l a r e a s ,
t h e r e a r e shortages i n p h y s i c i a n s and o t h e r h e a l t h c a r e p r o v i d e r s
(Idaho has t h e w o r s t d o c t o r - t o - p a t i e n t r a t i o i n t h e c o u n t r y ) .
Our h e a l t h c a r e p r o f e s s i o n a l s now work l o n g , hard hours i n o r d e r
t o make up f o r s t a f f s h o r t a g e s . These people a r e d e d i c a t e d t o
t h e i r work and t h e r u r a l communities t h e y s e r v e , b u t r e l i e f i s
d e s p e r a t e l y needed. I f r u r a l h o s p i t a l s a r e g o i n g t o be a b l e t o
c o n t i n u e t o compete i n t h e same l a b o r p o o l as t h e i r urban
c o u n t e r p a r t s , f o r t h e l i m i t e d number o f h e a l t h care p r o v i d e r s ,
t h e n we must change t h e b i a s o f t h e system t h a t f a v o r s urban
areas.
M a l p r a c t i c e i s a n o t h e r problem area t h a t has p a r t i c u l a r l y f a r r e a c h i n g e f f e c t s i n r u r a l areas. L a s t y e a r , a m a l p r a c t i c e
judgement a g a i n s t a l o c a l d o c t o r f o r $2,3 m i l l i o n d o l l a r s i n
Bonners F e r r y , Idaho, d i s c o u r a g e d d o c t o r s from p r o v i d i n g
emergency room c a r e , s i g n i f i c a n t l y l i m i t i n g t h e access t o care i n
t h e upper Panhandle area o f my s t a t e . The h o s p i t a l i m m e d i a t e l y
put o u t a search f o r a f u l l - t i m e emergency room p h y s i c i a n , b u t
met w i t h t h e many d i f f i c u l t i e s t h a t r u r a l areas o f t e n c o n f r o n t i n
r e c r u i t i n g h e a l t h care p r o v i d e r s . T h i s s i n g l e case g r e a t l y
�a f f e c t e d t h e d e l i v e r y of care and sent an e n t i r e geographic
region i n t o a c r i s i s . For these reasons, I would encourage you
and t h e task force t o look i n t o malpractice t o r t reform.
I would also encourage t h e Task Force t o look i n t o the value of
the Community and Migrant Health Centers program. These programs
are very cost e f f i c i e n t and provide f o r care f o r many people i n
remote r u r a l areas.
As you gather i n f o r m a t i o n , I hope t h a t you w i l l include
i n f o r m a t i o n from Northwestern r u r a l s t a t e s . A t r i p t o Idaho
would c e r t a i n l y provide you w i t h a b e t t e r understanding of t h e
kinds of problems I have q u i c k l y o u t l i n e d here. I f I can be of
assistance, please do not h e s i t a t e t o contact me.
Again, thank you f o r t h i s o p p o r t u n i t y t o share my concerns. I
look forward t o working w i t h you and the a d m i n i s t r a t i o n on t h i s
very important issue.
Sir ^ e r e l y .
LARRY E/[CRAIG
U n i t e d S t a t e s Senator
LEC/ec
�Clinton Presidential Records
Digital Records Marker
.-.•xiimammMaimam
his is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
�SPECIAL REPORT
T H E MARKETPLACE I N HEALTH CARE REFORM
The Demographic Limitations of Managed Competition
Abstract Background. The theory of managed competition holds that the quality and economy of health care
delivery will improve If independent provider groups compete for consumers. In sparsely populated areas where
relatively few providers are required, however, it is not
feasible to divide the provider community into competing
groups. We examined the demographic features of health
markets in the United States to see what proportion of the
population lives in areas that might successfully support
managed competition.
Methods. The ratios of physicians to enrollees in large
staff-model health maintenance organizations were determined as an indicator of the staffing needs of an efficient
health plan. These ratios were used to estimate the populations necessary to support health organizations with various ranges of specialty services. Metropolitan areas with
populations large enough to support managed competition
were Identified.
Results. We estimated that a health care services
market with a population of 1.2 million could support three
fully independent plans. A population of 360,000 could
support three plans that independently provided most
acute care hospital services, but the plans would need to
share hospital facilities and contract for tertiary services. A
population of 180,000 could support three plans that provided primary care and many basic specialty services but
that shared inpatient cardiology and urology services.
Health markets with populations greater than 180,000
would include 71 percent of the U.S. population; those with
populations greater than 360,000, 63 percent; and those
with populations greater than 1.2 million, 42 percent.
Conclusions. Reform of the U.S. health care system
through expansion of managed competition is feasible In
medium-sized or large metropolitan areas. Smaller metropolitan areas and rural areas would require alternative
forms of organization and regulation of health care providers to improve quality and economy. (N Engl J Med 1993;
328:148-52.)
M
pital is a poor option, and transporting patients
to another city may be unacceptable. Similarly, if
most physicians are members of a single multispecialty group practice, purchasers have little recourse
if the physicians use more, rather than fewer, resources.
We estimated the minimal population size for a
health services market area that could support managed competition and the proportion of the population of each state and of the nation as a whole that is in
such areas.
ANAGED competition has received widespread
support from members of Congress, Presidentelect Bill Clinton, large insurance companies, and editorialists writing in influential publications.'"'' A central tenet of the managed-competition theory is that
providers are divided into competing economic units.
As discussed by Enthoven and Kronick,^'* the most
effective competition occurs when all the doctors in a
community are grouped into several prepaid practices
with each doctor fully committed to one organization.
Health care services, however, are largely purchased
locally, and there are sparsely populated areas of the
United States where providers have a natural monopoly. In a geographically isolated area with a population base large enough to support only one hospital
and one group of physicians, it is difficult to envision
how competition would work. If the hospital decides to increase its scope of services or its prices
substantially, threatening to build a competing hos-
METHODS
An estimate of the minimal population required to support managed competition is based on four assumptions: the extent to which
competing health care organizations need to be independent; the
minimal number of health care organizations needed to support
healthy competition; the ratios of physicians to enrollees and of
hospital beds to enrollees in efficiently managed health plans; and
the geographic boundaries of health services markets. This section
Reprinted from the New England Journal of Medicine
328:148-152 (January 14), 1993
�-AM-WY—D«l«gation-H«alth Reform, Bjt,390
^1^7
AdHlnistratlon's Health Ref one
^^SISS
S y ^ i S * ; a??-ReS^lican congressional delegation i s
quS?I^inr?Ae^5?intSi^a:inJstratioS.s approach to reforming the nation's
^ * ? i ? t S ? e 2 S f r i e d e r a l l y run health care system would cost even more than
h S J t r r S o r S ^ ^ o ? ^ ir?a:per°e:Si^; this weeX Sens. Malcolm
Wanop
A?ai SiSp^orbJaSSS most o? the cost increases in health care on
entitlement programs, such as Medicaid. They also acknowledged that
by the government through new mandates on society.
health care
The senator added that most Americans have few choices in what health care
that the Clinton administration i s trying to craft
that w i l l aid just 12 percent of the population.
g
Rep Cralg k o i a s ^ s S d the federal government never has done a good
job'oi pro^idlng^ealth care, and he questioned the wisdom of moving to a
••sinale oaver'' system such as the one used in Canada.
?ie^iong?essman said under such systems <=o"»^««
access to doctors and other health care, access that can lead to overuse or
'i!:p?oS:'wh"Aas discussed the administration's refo™ with F^^^^
"ti^^ikiSt^^^St^ii'^s?;! TroUT^ri
''''-Se a ? i g"ng ?o do sSmetSing this year we're going to do something even
if i t ' s Srong, because '94 i s an election year," Simpson said.
The state'I junior senator estimated that health care costs w i l l rise by
ano^Ser?900 b i l l i o n during the next four years i f nothing i s done.
• ' I t ' s just sucking us away," Simpson saia.
�Dole stands alone on sin taxes
GOP colleagues
flay comments
By Raip*"^ Z ^aiiow
A
"HE A A S > - ^ S ' 0 ^ ^'MES
•
I
'
Senate Minority Leader Bob
Doles hints that he could accept
higher "sin" taxes to pay for President Clinton's health care plan ran
into a flurry of sharp criticism from
his Republican colleagues yesterday
"I will oppose any new tax to pay
for health care." Sen Larry E. Craig
of Idaho said in a telephone interview between speaking appearances
in his home state He was one of
many Republican critics of Mr
Dole's position
Scattered across the nation during the '.Hie-^ummer congressional
\acatior Kopublican lawmakers
said the Kai--,i- Rer".:hlican's statement Sunu,i., .;.-'.
.'. ,Ji.'l;v interpreted as meaning never sav never
on alcohol and tobacco taxes could
sink his presidential hopes.
In an appearance on CNN's
"Newsmaker Sunday," Mr Dole said,
"Well. I'm not interested in taxes, but
It seems to me we can't say 'Well,
never are you going to touch the so
called sin taxes' "•
When it comes to making deeper
cuts in Medicare and Medicaid, he
said "our members
. may find
those votes tougher than voting for a
little increase in sin taxes."
From the road in his home state of
Indiana. Rep. Dan Burton said. "It's
bad. and yiolnic.'ilh it's wrong '
1 Con; tr.i.h
i^uod policy or
puli;ic> Sur. V i'.i :-;wpher S Bondof
.\U-<dun
'r, .1 car phone from
his home .itaic
•'WL' are -j^L'.'.Jing enough on
health care — i-i percent of gross
domestic product We have to cut
costs, using the competitive forces
of the marketplace, and not put more
money into the system," Mr. Bond
said.
Rep. David Dreier said from a
California highway phone booth, "It
concems me greatly that we have
people in our party advocating tax
increases when, following Bob
Dole's own refrain of 'Cut spending
first; we stood united in the Senate
and the House agamst Clinton's tax
increase."
" I am not going to vote for a hike
in sin taxes or any other taxes," said
Rep. John T Doolittle of California.
"If we are to pay for health care, we
see DOLE, page A8
DOLE
From page A1
Whatever Mr Dole intended by
his sin-tax comments, fellow Republicans said an increase m alcohol and
tobacco taxes will hurt legal sales
and reduce tax revenues, forcing
Congress to enact other taxes for
which Republicans will get blamed.
"Any time we signify a willingness
to hike taxes, it blurs the differences
Sen. Kay Bailey Hutchison of
between us and the Democrats," Mr.
Texas "thinks sin taxes are the least
Doolittle said. "We need to keep
objectionable [form of taxation], but
those differences as clear and sharp
she sees no need to raise taxes in any
as possible in order to eradicate the
way shape or form," spokesman Dasocialists that dommate our governvid Beckwith said.
ment"
Several of his colleagues seemed
"Sin taxes hit middle-income
puzzled that M r Dole would put his
wage esumers, and I'm opposed to
hopes for the 1996 Repubhcan pres
any kind of tax increases at this
ident'al nomination at risk.
time," Mr Dreier said.
" I have regard for Senator Dole as
The Republican critics were diminority leader, but if he has presvided over whether sin taxes are
safer poUtically than other taxes.
"There is a qualitative difference
between all other uxes and a sin
ux," Republican pollster Ed Goeas
said. "People almost don't consider
it a tax Since it always has been the
most acceptable of any type of taxes,
saying you would accept them
fuzzes up the Repubhan Party'.s antitax image less than would be the
case with other kinds of taxes."
idential ambitions, he has got to get
"Sin taxes are the most regressive
off this tax kick," Mr Burton said.
taxes we have," M r Bond said.
"Sin taxes mean money taken out
Many Republicans say the econof the economy and jobs lost," Mr.
omy can't afford another tax hit and
Doolittle said " I think he's dooming
that voters will blame both parties.
his bid for the presidency."
" I hear the argument that people
"If Dole does more than consider
who smoke or dnnk should have to
sin taxes, it will be bad for him bepay through taxes for the impact
cause he will be fundmg big govemthey have on society, but I look at sin
ment programs for Bill Clinton and
taxes as a hit on the economy," Mr.
will undermme the conservative
Craig said.
foundation Dole has builtfor his pub"It is another $100 billion pried
hc image this year," Repubhcan camout of the private economy and Tunpaign consultant John McLaughlin
neled through the govemment," he
said.
said. "In most instances, 30 to40perSeveral conservative RepubUcans
cent will be caught up in wages and
close to Mr Dole said his words did
salaries of govemment employees
riot signal approval of more federal
and don't go to serve the public. So I
sin taxes — now at 24 cents a pack
have never used the argument that
for cigarettes and $2.14 for a fifth of
sin taxes are less than onerous.""
a gallon of liquor.
Increasing the federal tax on alco"With Bob Dole, you have to listen
hol will affect employment at brewto exactly what he said, and all he
eries and distributors. "Clinton talks
said is that we caimnot say we'U
about creating jobs while proposing
never raise sin taxes," said Repubprograms that destroy them," Mr.
lican consultant Donald J. Devine, a
Craig said.
longtime Dole associate.
" I f those guys at the White House
think from that statement Bob Dole
has agreed to raise the cigarette tax
$2 a pack, they're smoking somfrthing more dangerous than tobacco,"
Mr. Devine said.
will have to make spending cuts elsewhere, and I am willing to do that."
"As politically popular as sin taxes
might be, the pubhc generally is
very cynical about tax increases accomplishing anything," said Sen.
Charles E. Grassley of Iowa.
taxes are the
most regressive taxes
we have'' said Sen.
Christopher S. Bond.
WEDNESDAY, SEPTEMBER I
1993 B^goglinfltimghncg
�'BC-ID—Craig-Health,Bjt,310
'Craig W i l l F i g h t For P r i v a t e H e a l t h Care
' / /'
"qkstf
BOISE, Idaho (AP) I f t h e r e ' s g o i n g t o be a b a t t l e over n a t i o n a l h e a l t h
care versus p r i v a t e systems, Idaho Sen. L a r r y C r a i g wants t o be i n i t
The Senate Republican l e a d e r . Sen. Robert Dole o f Kansas, s a i d l a s t '
weekend he c o u l d s u p p o r t h i g h e r " s i n " t a x e s t o pay f o r P r e s i d e n t C l i n t o n ' s
h e a l t h care p l a n . But he won't have t h e s u p p o r t o f C r a i g .
C r a i g opposes any n a t i o n a l i z e d h e a l t h care system and f e e l s p r i v a t e
i n d u s t r y w i l l be t h e b e s t p r o v i d e r .
• • I hear t h e argument t h a t people who smoke o r d r i n k should have t o pay
through taxes f o r t h e impact t h e y have on s o c i e t y , b u t I l o o k a t s i n taxes as
a h i t on t h e economy,'' he s a i d .
" I f we a r e g o i n g t o have a debate on t h e n a t i o n a l i z a t i o n o f t h e h e a l t h
care system, we ought t o balance t h a t debate w i t h a p r i v a t i z a t i o n o f t h e
h e a l t h care system i n t h i s c o u n t r y , ' ' C r a i g s a i d F r i d a y .
" I f i t ' s my j o b t o h e l p l e a d t h e debate on t h e p r i v a t e s i d e , I'm darned
w e l l g o i n g t o do i t , ' ' he s a i d . " I want t o make sure t h a t my g r a n d c h i l d r e n
aren't subject t o a f e d e r a l i z e d , d i l a p i d a t e d , noncaring, nondirected h e a l t h
care system.
" I want them t o have t h e b e s t and t h e f e d e r a l government c a n ' t d e l i v e r
i t , ' ' C r a i g s a i d , i n an i n t e r v i e w taped f o r t h e weekend KTVB " V i e w p o i n t ' '
program.
He s a i d t h e p r o p o s a l s would d r a i n $70 b i l l i o n t o $100 b i l l i o n from t h e
p r i v a t e s e c t o r o f t h e economy. When g o i n g t h r o u g h t h e bureaucracy
"30 t o 40
p e r c e n t w i l l g e t hung up i n t h e f e d e r a l system as i t f l o w s back. That i s n o t
a good way t o do i t , ' ' he s a i d .
C r a i g t a l k e d o f some s o r t o f t a x c r e d i t o r voucher system g o i n g t o
i n d i v i d u a l s t o pay f o r h e a l t h c a r e , r a t h e r t h a n a government system t h a t
would be cumbersome and expensive.
�September 24, 1993
CONGRESSIONAL RECORD—SENATE
S12477
CAUM of their incomes, to purchase yet
Mr. WELLSTONE. I am pleased to yet. Those regulations are not on the
a better plan, not so much a packacre of yield.
ground, and they are not implemented.
beneflts but, once aguln, the quality of
Mrs. MURRAY. In that case, would I certainly would not and I am sure
the care difference, where it Is located, the Senator from Minnesota be willing other Senators would not want to see
the whole operation of It.
to add a line that Members of Congress OMB take months and months now to
And, therefore, the only thing this will be given the same choices as all review a process that is already 4 to 5
amendment Is saying is that we have Americans when the health care plan is months behind schedule.
the same choice as probably 75 or 80 adopted?
President Clinton, in a most sincere
percent of the people we represent.
Mr. WELLSTONE. Mr. President, I way, went to Portland several months
ago to address the spotted owl issue in
Now If we want to have the choice- suggest tbe atwence of a quorum.
The PRESIDING OFFICER. The a timber summit to try to resolve the
let ua lay the cards on the table; I have
timber supply problem In the Pacific
listened for a while—If we want to have clerk win call the roll.
The assistant legislative clerk pro- Northwest, Another way he could show
the same choice as high-income,
his sincerity to the working men and
wealthier, OK, say that, because that Is ceeded to c^ll the roll.
Mr. CRAIG. Mr. President, I ask women of the forest products Industry
what we are talking about. I think It is
unanimous consent that the order for is to insist that OMB move these regua healthy principle.
lations in a timely fashion because
I remember once when the Presiding the quorum call be rescinded.
The PRESIDING OFFICER. Without they, the Forest Service, unable to
Officer presiding now came to the caumove effectively through the .appeals
cus and said, "I am considering Intro- objection, It Is so ordered.
Mr. CRAIG. Mr. President, I ask process. Is In their own way blocking
ducing an amendment that 1B going to
say until the people in this country unanimous consent that I be allowed to access to a timber supply that 1B legitihave national health Insurance cov- proceed as in morning business for a mately and legally available If It were
not for this process.
erage we should not have free cov- period of 5 minutes.
The PRESIDINO OFFICER. Without
If the flnal regs are not published by
erage." And, eventually, we ended our
objection. It is so ordered.
September 30. Senators BYRD and NICKfree coverage.
LBS have agreed to consider adding this
All this amentlment says—and It does
language to this year's Interior Appronot require, does not require—I could
FOREST SERVICE APPEALS
priations bill so that this administranot write It that way, constitutionally
SYSTEM
tion can get the message. I hope that
I could not, as a Senator, require colMr. CRAIG. Mr. President, a year does not have to happen. I hope we can
leagues to do that. All this amendment
says is when we set that average price ago, a bipartisan coalition of Senators move immediately to announce that
plan, which is going to be for the mid- worked to reform the Forest Service they have effectively passed through
dle class of America, which is going to appeals system. It was a system estab- OMB and are on the ground ready to be
be 80 Important to what happens in the lished by the Forest Service a good Implemented by the Forest Service.
I am counting, and I know other Senalliances in our States, we should number of years ago to allow private
speak to this concern that i>eople have parties to react to management deci- ators are counting. We have 7 days
In the United States of America, our sions, but over time, it had been used left—and I say that to the administraconstituents, that it is going to be a for a variety of other purposes, largely tion and to the Director of OMB—bereal good plan, so good that they will to slow, if not stop, the timber supply fore the Senate will take action again.
So I hope you can respond in a timely
Dot want to opt out of It. And if we are in certain forests of our countries.
The appeals amendment, which I fashion. You have worked your will,
not WiUing to go on record saying what
Is good for the middle class, what Is sponsored, was enacted as part of the time Is past, it is now time that the
good for the vast majority of our con- fiscal year 1993 Interior Appropriations law be effectively Implemented on the
BtituenU is good for us, then I think bill. This legislation was intended to ground on our public land forests
people have every reason to be con- reduce the confusion and the delay of across the United States.
that old process, to reduce the cost
Mr. President, I suggest the absence
cemed.
that the Forest Service was experienc- of a quorum.
Mrs. MURRAY. Will the Senator ing by the extension of some 1.500 outThe PRESIDINO OFFICER. The
yield?
standing appeals that the Forest Serv- clerk will call the roll.
Mr. WEOiLSTONE. If the Senator ice was under consideration with.
The bill clerk proceeded to call the
would Just wait for one moment.
We have made decent progress since roll.
As to the Congress bashing—and, then, but because the flnal regulations
Mr. BOND. Mr. President, I ask unanagain. I am with good friends, but It Is had not been published, although they imous consent that the order for the
worth going over. I am really tired of had worked on them, I and others be- quomm call be rescinded.
the arguments that are made every came very frustrated that nothing was
The PRESIDING OFFICER. Without
tiine I come out here on the floor or occurring. Public comment and draft of objection. It Is so ordered.
sometimes when I come out here on the the regulations was closed on May 29.
Mr. BOND. Mr. President, I ask unanfloor and introduce amendments like Four months have passed with no visi- imous consent that I may be granted
this.
ble action being taken by the adminis- permission to speak as if in morning
I have not given one interview na- tration to comply—let me repeat—to business for 5 minutes.
tionally anywhere where I do not say comply with the law.
The PRESIDINO OFFICER. Without
that I think the denigration of public
I have become impatient with a lack objection. It is so ordered.
'
service and people In public service has of this action, and I know other Sen(The remarks of Mr. BOND pertaining
gone too far and is going to lead to the ators have contacted me saying; to the introduction of S. 1494 are lodecline of democracy. I do not go any- "Where are the new appeals regula- cated in today's RBOORD under "Statewhere where I do not say, even though tions? Where is the new effort that we ments on Introduced Bills and Joint
I am sometimes viewed as the ultimate put forth?"
Resolutions")
outsider, how proud I am to be here to
So Senator DASCHLE and I wrote to
Mr. WEU^STONE addressed the
try to do well for people.
Assistant Secretary Jim Lyons on Sep- Chair.
But I want to tell you something. tember 17 asking that he take immeThe PRESIDINO OFFICER (Ms.
The Congress bashing goes on when diate action to publish the flnal regula- MOSKLEY-BRAUN). The Senator trom
people think we are setting different tions by September 90. Since then, I Minnesota is recognised.
standards. Congress bashing goes on understand Mr. Lyons has responded.
Mr. WELLSTCWE. Madam President,
when people think that what we are ap- He has cleared the regulations through I am going to send a modifled amendplying to them, the vast majority, we the Department of Agriculture and on ment to the desk in a moment.
are not willing to apply to ourselves.
to the Office of Management and BudgMr. MITCHELL. Madam President,
Mrs. BfURRAY. Will the Senator et. That is progress, and we thank hira will the Senator withhold for one movery much for it, but we are not there ment?
from Minnesota yield?
�/
PM-ID—Senators Health Care,B^t,410
^
Hundreds Turn Out For Craig-Kempthorne Health Care Meeting
_S>
bfkkS
BOISE, Idaho (AP) Several hundred people turned out at the Boise City
Council chambers for the f i r s t of four town meetings with Republican Sens.
Larry Craig and Dirk Kempthorne on the looming health care debate.
Their views covered the f u l l range in the debate that i s expected to
result in congressional decisions next summer and f a l l on the future of
America's health care system.
Craig and Kempthorne l a i d out a comparison of the half dozen plans now
being circulated in Washington, D.C, and then spent two hours on Monday
fielding questions and listening to statements from dozens of individuals.
""What I'm hearing from Idahoans i s don't create a government program,''
Craig said. ""Give us the choice.'"
Both said there appeared to be agreement on the general concepts that
access to health care must be improved, that workers should be able to take
their insurance coverage from job to job and safeguards to halt doctors from
performing unnecessary procedures just to protect themselves from potential
malpractice s u i t s .
Kempthorne said the Boise meeting and similar ones through the week in
Idaho F a l l s , Twin F a l l s and Coeur d'Alene the rest of the week are intended to
get people involved in the debate so their positions and beliefs w i l l be
available for the senators to consider when they s t a r t voting on s p e c i f i c
congressional proposals.
" " I would urge you to do everything possible to stop H i l l a r y and
Bill
(Clinton), before they do anything more to ruin our l i v e s , ' ' Jerry Pollard of
Boise said. ""We are about to cut the leg off when there might be some
Band-Aid solutions out there.''
That sentiment was shared by the majority of the more than three dozen
people who t e s t i f i e d during Monday's three-hour session that drew about 250
people.
think the best thing you could do, and Congress could do, i s nothing
knd that goes for everything, not just health care,'' Cynthia Wilcox said.
""You're spending a l l of our money. A l l of us are t e r r i b l y overtaxed.'"
However, a few of the people who t e s t i f i e d said they were in favor of the
President"s proposal.
""The people who need care the most have the most obstacles to access
i t , " ' Jo Svenson of Boise said. ""I've had some health-care problems, and I've
paid for them in large measure out of my own pocket.''
****
f i l e d by:APW-(ID)
on 01/18/94 at 05:27EST ****
**** printed by:WHPR(JEL) on 01/18/94 at 09:11EST ****
�S90
CONGRESSIONAL RECORD—SENATE
January 26,1994
with mm and women of 'gt>od .will oi^ ized -programs ultimately daas 3iot toagh-sn-crtme p m v ^ o n s , they wUl be
both parties.
\ serve the citlaenB i n .the &shion i ^ t Jettisoned i n conferanoe -or • aigmiflcanfly weakened.
f i n a l l y , last nipht, "Mr. Clinton said they would expect t o be sarved.'
^octmiingly, I again -ask President
that'Some people do j m t want to get otf j JSo, Mr. .President, I know ynu tried
cff weRkre beoatse ;then they would hard last night to sell your program. CUnton to exprras iiis support pubUcly
have to pay teoces for vupport and' But he ready to accept a illfferent pro- fsxc the following pro vteions of the Senhealth insurance for those s t i l l on wel- gmm. fie ready to work with the Con- ate-passed m-ime l ] i l l . J am only Jlsttng
fecre. 'Unbelievably, he said this was i n - grcBss i n making the kinds of adjust- some of them.
cretUtile that'they sfat>uld have to work ments that are going t o deal w i t h anti:NQ. 1, iccmiprehenslve Federal death
and pay taxes. Well, i t might be Incred- trust, that are. going to deal wi-tfa jnal- penalty. The PrraldBnt aoiist .make i t
ible to falm because he haa never been practice, that .are going to deal w i t h clear that he .oxpects -tiaa Congress t o
Involved in the ijrivate sector. But i t is driving down tdis ooeta, but are going pass a -true workahle death -penalty
time that he realises there are a lot of tjo allow our system, our quality, iie&t- that is £r«e .from any .gutting amendOS out there who Imve wcTrked-and paid| in-the-world health care.system, to re- ments, such as t3ie Racial Justice .Act,
taaes a l l of their Uvea, never taking main In the private sector where i t be- which 'death -penalty opponents jnay
anything from thePederal Oovemment longs and where i t can be controlled hy seek to add t o the biU.
but-givi'iig always.^" -'-^^^
• •
the consumer and not a Federal buNo. 2, doitth penalty for major tlrug
reaucracy sitting in Baltimore or slt- tralfickers. The Senacte added a provi1 yield the floor, -rv'r- • •
i ting i n 'Washington, DC, like our cur- sion authorizing the deaUi -penalty "bsc
Mr. CRAIO ttddressed the Chair.
The PRESIDINO OFFICER. The 'fien-,^ rent Pederal bureaucracy,, that has al- major: drug t r a f f i c k e n even wliere murready made .Medicare a xerogram that der i s not dlrectJy involved. I t is a l a'tor'from Idaho.
\
Mr. CRAIO. Madam ?r8Siaent,\ I n does not serve the citizen In the fash- /wetys indirectly involvad. The Senate
jneedB President Cltnton'a personal enlight of the time of the special omer lon that i t was deBlgned^_^
and the time of the leader i n hie opqayou made anoi^ier ap-~ dorsement of this provision because
Ing comments, l « ^ k unanimous con- peal last night. I t 'was an appeal to law- some reports indicate i ± a t the Departsent for an additional 5 minutes.
abltilng citizens—T t h i n k you called ment of Justice opposed inclusion of i t
Mr. REID. Mttdam President, the ma^ them sportsmen and hunters—to stand in the crime blU.
jorlty vriU yield 6 minutes to the Sen- out of the way of their second amendVo. 3, i& blUlon i n increased prison
ment rights so you .could control constmction. tJtven current prison
ator from Idaho.
crime.
Mr. CRAIG. I thank the Senator.
overcrowding, providing resources for
. The PRESIDING OFFICER. The SenJMr. aPresldent, I t is not the law-abid- addltiona.1 prisons is one of the -most
ator iff-recognized.
ing ci-tizen^ problem. I t is the criminal Important steps the Federal Oovemof our society who misuses the gun ment can take to keep criminals off
that has created the problem i n this the streets, and President CUnton
THE:PBESIDENT*S STATE GP THE country that "has all Americans crying should Bupi>ort this effort.
UNION MESSAGE
No. 4, t m t h in sentencing. The Amerout for a solirtlon. And tf you w i l l work
Mr. CRAIG. Madam President, last with us here i n the Senate i n the ican people are fed up w i t h a revolving
night In the State of ttte Union Ad- craflilng of a crime hill much like the door criminal Justlt^ system wherein
dress, vre heard our President vpeetls. one that we have already passed that vicious c^riminals serve only small -jwrfrom the well of the House tn an emo- goes after the criminal and not the tions of 'their sentences. The Senate
Cloually charged atatement t h a t ' I Isw-ablding.cltlsen and his or her con- crime bill conditions a State's ability
think sincerely addressed some of tho stitutional rights, then you axe going to participate in the new Federal rekey' issues that thie country and our to ifaave our .full cooperation. We will gional priscm system on the State's
citizens -demand be si)oken t o and work with you, we will devise and re- adoption of tmth-in-sentencing policlearly are beginning 'to demand that vise the crime laws of this country to cies.
No. 5, Federal anti-gang initiative.
this Congress respond to I n a respon- go after the criminal and to hold whole
the law-abiding citizen and his or her The growth In criminal street ^ n g s
sible fashion.
and the violence they spawn has -tmly
But, again, our President attempted constitutional -rights.
One other .issue, Mr. President, you made gang violence a national probto sell an Idea that the American people are rapidly heglnnlng to reject, and are Absolutely right on, and that is the lem. There are at least 216 identified
that iB his concept and his wife's con- question of welfare reform. Tf you stick gangs i n the Salt Lake City region of
to -your ideas and work with us, we w i l l my home State of Utah. The Senate
cept-of hettlth care reform.
Clearly, we til -recognize that our have wolf^ire reform and those com- adopted an amendment making I t a
health care system dbee not serve a l l binations w i l l 'Serve our country w ^ l l Federal offense to participate i n a
criminal street-gang, to recruit penons
Americans. There are those who fall for now and into the future.
into such gangs, or engage i n gang-rethrough ^the cracks and desperately
T yield the remainder of my time.
need care, and this Congress should ad"The ACTING PRESIDENT pro tem- lated crimes. T h e provision -subjects
gang membere to stiff mandatory mi-nidress 'that issue. Senator XEMPTHCHRJIK pore. The Senator from Utah.
mum penalties.
of Idaho, and myself, i n the last week,
have traveled across our State "holding
'No. 6, mandatory minimum penalties
THE NEED FO^R PRESIDENTIAL
to-wn meetings and listening to thoufor vldlent offendere. The Senate measUSADERSHIP
ON
THE
CRIME
B
I
L
L
sands of Idaho cltizeriB, and we heard a
ure provides enhanced mantiatory minvery clear message from those citizens
•Mr. HATCH. Madam President, I will imum -terms of imprisonment for the
and that was: Do not vote for the Clin- speak just a few minutes here.
use Of a firearm i n the comrnission of a
ton plan.
The American people are demanding crime.
We do not "waiTt a federall'zed, feder- that Congress take action against
No. 7, expedited deportation of alien
ally tsontrolled heatlth care system In crime. Tlie Senate has acted. We have terrorists. The Senate bill establishes a
this country. Now, -while we know Iiaseed a very tough bill.
special mechanism for removal of alien
there are needs and-while we recognise
I^est week, 1 wrote a letter to Ih-esl- terrorists.
that TOSts must be contained because dent CUnton urging him to call on the
No. 8, rural crime provisions. Tn retsour own insurance and our families' Congress to pass certain key provisions ognltlon of the growth of crime In our
welfstfe is at risk, we tllso recognize that are currently a part of the Senate Nation's m r a l areas, the Senate bill
that the Federal Oovemment largely crime bill. L w t night, the President contains a S355 million Initiative to adcreates bureaucracies that grow in size endorsed one of these measures: the dress crime In such areas. Rural States
while their ability to servo i n a busl- tairee-tlme-loser provision. I commend have a growing, crime problem and need
nesslike fashion rapidly diminlshos, him f o r this step. Still, I am concemed this additional assistance.
and the quality of what we attempt to that without his strong, apeclflc sup14o. "9, telemarketing fraud. Our Naachieve'ttoough these -kinds ^oT federal- port amd leadership on -several -worthy. tion's di tizens are inciaaBtngly being
jHHj l. l l l l l l l l l ^ l l l l M
�S8458
CONGRESSIONAL RECORD—SENATE
And yet we know the tax increase of
last year went directly at medium- and
small-sized businesses that are now the
largest employers In our country i n the
composite.
Principle 3: Excessive financial and banking regulations, which restrict the amount of
capital firms can obtain, greatly limits busl• ness and job expansion.
And, once again, the kinds of rules
and regulations that are now pouring
out of this Government, all in the
name of the environment or In the
name of better practices or certainly in
the name of Federal mandates, that
say that business and Government
ought to conduct itself In certain ways
at the local level, do nothing but restrict the econortilc climate in otir
country and make more difficult the
creation of jobs.
, Principle 4: Increasing the regulatory burden and mandating numerous employee benefits is a recipe for Job destruction.
That I just spoke to, like the Family
and Medical Leave Act—again, a job
destroyer, very destractlve i n the
workplace.
Principle 5: Sustained Job growth results
from competitive, efficient industries that
are free of excessive Government inter. ference.
Those are the industries In 21st century America that offer the working
men and women of our country the
greater opportunity, the better work
climate, and clearly the unique chance
for atlvancement and career f u l f i l l ment.
Those are the kinds of issues that
this Senate ought to be addressing. Instead, we are stepping backwards into
a century-old attitude that somehow
labor deserves the upper hand and that,
if this one side is granted the upper
hand, somehow all of the relationships
are improved. History has shown that
is simply not the case; that when people come to the table to negotiate, that
table must be level. There must be
equal balance on either side, equality
on both sides. S. 55 would destroy that
equality.'
HEALTH REFORM AND JOBS: THE
CLINTON PLAN
Mr. CRAIG. Mr. President, several
studies have been performed examining
how the Clinton health security plan
would affect jobs in America. Leading
economists predict that employer mandates. Government subsidies, and other
aspects of the Clinton plan will result
in serious wage reduction and job loss.
To avoid these adverse effects, Mr.
President, reforms cannot place intolerable burdens on employers, but rather must further expand and improve
the current system, allowing the market to develop naturally.
When President Clinton introduced
his health reform plan last year, his
administration stated that as many as
600,000 people could initially lose their
jobs, i f everything works as planned.
Since then, other studies have predicted job loss anywhere from 624,000 to
3.8 million. I n addition, as many as 23
million workers could experience lower
wages, lower benefits, or reductions in
hours worked. Any President who
could stand before the American people
and advocate a policy that would put
people out of work" amazes me.
Mr. President, employer mandates
will obviously place burdens on many
employers who do not currently offer
health Insurance to their workers. The
President's solution to ease this new
burden is to provide subsidies from the
Federal Government.
According to the Clinton health plan,
employer contributions must equal 80
percent of a "weighted average premium," and the individual employees
would pay the difference between the
80-percent employee contribution and
the actual premium. However, the proposal also places limits on the percentage of the paJroU spent on health Insurance premiums.
No employer will be required to pay
more than 7.9 percent of Oie payroll; If
health premiums exceed this amount,
the Federal Government will make up
the difference. This is the essence of
the President's Federal subsidies.
But the regulations are more complex than this, and Federal subsidies
may only add to the difficulties created by an employer mandate.
Liability is further limited as the
number of employees falls and average
wage decreases, creating a potentially
serious problem. Employee liability as
outlined i n the Clinton plan provides a
great incentive for cutting back employees and disincentive for hiring.
For example, i f a company has 49 employees with an average wage of $20,000,
hiring the 60th person would cost the
employer more than J9.000. Accordingly, a company with 50 employees
earning an average wage of $20,000 will
save over $9,000 by dismissing 1 worker.
Mr. President, the Federal subsidies
are designed to protect jobs by
releaving financial pressures placed on
employers. However, the combined effect of incentives for fewer workers
with lower incomes and increased competition among employers to attract
skilled workers will escalate employeremployee tension.
In addition, to avoid expanding entitlements and thus adding to the Federal deficit, the Clinton plan places
caps on these Federal subsidies. For example, the Congressional Budget Office
predicts that small businesses would
require $58 billion in subsidies under
the Clinton plan in the year 2000, although the subsidies are capped at $4.1
billion.
To maintain the level of Federal subsidies the President has promised, the
Federal Government would be forced
into even greater deficit spending to
make up the difference i n cost; on the
other hand, i f the Federal Government
remains true to its caps and Is forced
to cut back on subsidies, financial pressure on employers will far exceed that
predicted by the President, and job loss
will be much greater than forecasted.
July 11, 1994
Mr. President, a large portion of the
job losses will affect small businesses
with fewer than 100 workers, and an
overwhelming majority of those workers who would lose Jobs currently make
less than $40,000. I n addition, job losses
would disproportionately affect niinorities. Most of the jobs will be lost in
services, manufacturing, and retail
businesses; all States will be hit hard,
with an average job loss near 1 percent
of the total work force throughout the
country.
Whether the total number of jobs lost
Is closer to 600.000 or 4 million, almost
all Americans w i l l knew sorrfeone who
will have lost a Job as a direct result of
the Clinton health security plan.
In response to this projected job loss,
the President claims his health security plan will create new jobs. However, this will not offset the initial
shock of job loss. Jobs will not be replaced as soon as they are lost. Employers are often quick to recognize
savings opportimities by releasing
workers, but corporate expansion, on
the contrary, is generally gradual. No
wise buslnessperson welcomes possible
liabilities, and additional workers in
an unproven system appear to be exactly that.
In addition, the promised new jobs
will affect a different group of workers.
Job losses will affect a working population in services, manufacturing, and
retail; new jobs will apjsear in health
professional, policy, and administrative fields.
Mr. President, we should be protecting rather than jeopardizing jobs. The
Consumer Choice Health Security Act
(S. 1743), which I cosponsor, -will do
this. This bill is designed to guarantee
high quality, accessible health care
services.
I am particularly pleased with how
this plan would enable us to move toward achieving universal access and
comprehensive coverage. Refundable
tax credits, based on the percentage of
gross Income spent on medical services, and the introduction of medical
savings accounts are two features of
this plan which will dramatically improve access without taking the
choices from the consumer.
Mr. President, we can reform our
health care system without the serious
side-effects of job loss and decreased
wages. In supporting health care reform, my goal has been to empower
people, to let them choose their own
health plans and doctors. Individuals
are certainly better able to determine
their needs than is the Federal Government.
We do not need extensive Government intervention to provide universal
health care. On the contrary, excessive
Government involvement only increases bureaucracy, reduces quality of
services, and weakens a vibrant private
business sector. The Federal Clovernment functions best when simply developing the framework in which the market can work, and health care reform
•'W
�July 11, 1994
CONGRESSIONAL RBCORD—SENATE
should focus on building this fbundatlon.
Mr. President. I ask imanlmous <xjnsent that the following materials be
8^459
covld make onreasonsMe demands and shut
[FW>m tbe Heritaii» Poundatioa
down employeTB with no risk of their own.
BackKToander, Mar. U. OM] )^.Some coDtend that the system ts not balPRKFAKma FOR TKB "JOM SUMMR": ti^i-'
sDced. that permaneat replacement of ecoF I V E PBUICIPLSS or J O B atEATmi
nomic striker* is the equivalent of being
printed i n the R S C O B D :
DiTtiODUCTKM
flred.
Again,
this
Isn't
true.
Even
ao-eailed
"Strike BUl Could Destroy Critical
Leaders flxMn the major Industrialtxed
"permanently
Teplaced"
strikers
have
conWorkplace Balance"—an op-ed i n tocooitrtes are ichednled to meet io Detroit.
day's Christian Science Monitor, by tinuing rights to reinstatement to a)) avail- Michigan, OD Mandi 14-16, at the requeM of
able
future
Jobs.
The
KLRB
developed
adePresident Caioton, to discus* the causes of
two former members of the National
quate safeguards for economic strikes, one of the persletently Mgh levels of BnemployLabor Relations Board with more than
which puts employers onder ac afflmiattve raent in their ooimtrles. Annoonclnr the
100 years experience, between them, in continuing obligation to first offer Jobs to
goals of the eimimit in Europe this January,
employer-employee relations;
aoteloatatad economic strikers on a pref- Praatdeot Cilnton declared that, "We simply
"Preparirtg for the 'Jobs Summit': erential basis t>erore hiring new employees.
must figure oat how to crests more Jobe and
The & Princiidee of Job Creation"—a Fiirthennore. the actual namber of work- how to reward people who work both harder
Backgrouoder by the Heritage Pounda- ers replaced is minote. A Boreao of National and smarter In tbe workplace." >
, Uon;
The President Is right to focus on how to
Affairs study found Deariy 40,000 econonUc
]
"Why Bmployer Mandates Hurt strikers were replaced In 1991-1992. out of a create more Jobs Is this couDtry. Although
he
boasted dnrtar bis BtaU of tbe Dnloo adWorkers"—a Brief Analysis by the Na- U8 labor force of 126 mlllloa. That's less
than .OS percent. Nearly 7D percent of these dress that 1.6 million Jobs were created in
tional Center for PoUcy Analysis;
isasv Job growth. Ui fact. Is much weaker
" P . Y . I . : The Jobs Impact of Health 40.000 strikers were later reinstate^ to tb^r than nonnal this long attsr a recesstoB,
(3are Reforms"—a Heritage Foundation Jobs. Also, the luunber of strikes in the US Binoe Worid War Q. toul smptoyrMat
has been decreasing sinca 1947. tke first year growth has averaged *X petosnt S moMIis
Backgrounder;
A white paper prepared by the Na- the C S Department of Labor's Bnreau of after a receailoB. But stiios tte bottoBt or the
tional Federation of Independent Busi- Labor Statlatica began lo naalntain atrike Iii90-I8»i recession, total em|«Qymeiit in tke
data.
United States has cUmtasd hy J o t %h p«v
ness on the President's proposed
Current caltocUve bargaining Ic a fahr aod cent.' PiesMeat CUatoa would (io wan
•^Health Security Act'*; and
reasonable system that has worked for over ponder the anemte Job growthtaiK n n ^ b»-.
.
"Enraging Species Acf"—a Wall 60 years. We see no compelllDg evidence to cause Boropeah firms ara encionlMrad with
.IBtpeet Jotimal editorial trxna Aprtl 19, sugKeM. that any changes to this law are costly mandates and taxes on emptOfmsBt
^ 1994,
needed or e*en wanted by the American peo- that have diaoouraged hiring and heid back'
There being no objection, the mate- |Ae. In fact, a recent Oallap poll sliows that emppioyineDt KTOwth. The Prasldent should
rial was ordered to be printed tn the 57 percent of Americans oppose a ban on per- recognlza that his AdmlnlstratlOB'B poUctea
are repeatinc' the mistake of ttee Bnispeaas,
R E O O R D , a» follows:
manent replacement workers.
IProm tbe ChrtMian 8c»enoe WonJtor, Jtils
The corrent debate In Congress reflects and contributing U> alow growth of earalncs
employment la tlie United States. PQr
U. 19MI
theee CEicts. In an effort to save the Strike aod
example, the Administration has:
Bill, proponents of tbetoglslatlODare searchS T R I K E Bin. COCLD DESTROY CRmciM.
Enacteid the bigsest tax increase in AOMT-.
ing Cor an acceptable oompron^lse. However,
WoKKPLACx BALANCE
history, which wUl dlacouxage new businone ot the prc^wsed compromiaee Improve lean
(By Uowaxd Jenkins and John A Peoellot
ness Investment and Job creation by raising
For many years we serrod as repreeenta- tbe original legiaUtloo. Any Btrike Bill corporate and individual tax rates.
Uv«» ot the fedenl eovornment In vmrions compromlae would liav« the same reeolt as
Signed the mandated Pamlly and Medical
cajaclUes with tbe Nactonal Lat>or ReUtloos the original legislation—risk tree strikes.
Leave Aet. wfcicfa wfll raise lalxir costs and
Bo&rti iNUiBX We wet^ appointed board
Under the moot dtocuaaed compromise pro- force employers to be far mors selective
members under both Bep^Ucan and Demo- posal—a montLartam on hiring replaoe- aboot whom they hire, since they are recnulc admlDtetratioBS. Together we rep- meatfr-strikea would be limited to dni^tions quired to offer certain employees more Ume
reaent more ttum MX) jears of experience In of four to IC weeks. This would avoid few off.
labor-management relaUoBS.
strikes, since most strikes last lees than 10
Proposed a massive overhactl of the bealtii
Wltile ws did not always a^;ree oc the out- weeks, snd would do Httle to mitigate the care system. wMcta would raise labor coets.
come of cases tarouKht before the NLRB— dentstattng economic Impact of the original by mandating that emfrtoyers cover workers.
Riember Jenkins's decteiocs were more often Mil.
Aoeording to Lewin-VHI. one of tbe counpro-union aitd tnember Penello's dissents
BcoBomic strikes were never intended by try's leadfDg health oare econometrics ftms.
were more aft.en pro-employer—we airree CongresB to be rtsk-flw. And the right to the Clinton be<t)th {rias would mean that
that the Strike BUl would destroy the core strike WHS never guaranteed to be successful among firms now providing health InsnrBiioe,
pnodple of balance in oollecUve twrgatnlng.
19.9 percent would see cost per employee risThe Btrtke Bni. which has pasmd tbe In fbrctng an employer to accede to a union's ing $500-11 .ew per year. 61.6 percent would
Uaiim,and Is expected to be voted on today bargaining demands. To the contrary, the face coet increases per employee of 11,006by the Senate. wooM pmhiUt employers corz principle of otir national labor law Is a CaOO, while another 15.2 percent wnuW fsoe
from defendlHR their businesses by offering balance of riKhts and obligations, risks and coets per employee of more than 12.500.^
permanent Jobs lo repiacemervt workers dur- reward, which. thiDugh the dj'oaniics of colProposed worker training and unemirfoytBK a strike orer economic isscee soch as pay lective bargaining, drives parties closer to- ment insurance reform, that wooM cost begethe^
toward
lalior
contracts
and
peacefully
raises and benefits
tween J3 billion and » billion per .year.*
Proponenta of the Btrike BUI claim that negotiated setUementa.
Considered a hike In the mlntintim wage
Por
these
reasons
and
t)ased
upon
our
long
era ployers' use of permanent replacement
from J4.26 to 14.75 an hour, which would ftnrexperience
in
admlniatering
federal
labor
workers daring an economic Btrike ts a re
thor increase the disincentive to hire teencent pbenomenOD. ThJii simply Is not tme. policy we xr.aaL now speak out against tbe age and poor. Inner-city umwnjrfoyed IndividTtuf Naxional L.abor Retetions Act. enacted Btriko-replacemant leglsiaUon—in any form. uals.
in 1906. provided a delicate balance that al- We believe the Strike BIU would imperil fuMoved ahead with an ambltiotis environlows anions to strike over wage demands and ture decades of Improving cooperation tie- mental regulatory agenda ranging ftom globaUows en^ployers to defend tbelr bosJneeses tween labor and management and reuim us al warming to now logging policies.*
to the disruptive labor disputes of previous
by hiring penoanect replacerrwnt workers.
These policies signal an apparent ntfBThe strtker-reptacement lesrislatlon would decades.
nnderstaodlng of the employment and Job
Strikes in the US are at an aU-lhne low. In pcHiciee that led to the creation of over 20
destroy tbla oor« principle of Dotted States
labor law. wljJch haA been consistently sup- 1974 there were 4J4 strikes involving I.S mil- million new Jobs In the 19e0e.» Bach of these
ported by Deroocratic and Repabilcan preei- lion workers and 3B million lost workdays, new programs or propoeed policies add to the
dents and federal ccui-ts for over half a cen- compared with 1S83. whe« there were only 36 three principal gtjvemmental barriers that
major work stoppairee Involvtof 182.000 em- discourage employers Trom creating' new
tury.
Jobs: tajiee. credit barriers, and regnlatory
In oiBT eKperience. the balance of power In- ployees and 4 million loec workdays.
bereot in theae coontervallinr economic
With the incidence of strikes st a record and mandated benefit bordeoB. Tljese barweapons ia wbac has made the system work. low. It Is dlffJcolt to nnderstand why Con- riers, which have steadily increased over tbe
Take away either the right to strike or the gress would pass legislation that would actu- p««. few yeara In the United States, have disrlphi to operate with permanent replace- «Hr IncTBeise the number of strikes In Amor- couraged buelnees expansion and increased
the coet of hiring new workers. PSIlore to rementa. and the other party wll) be varc to tcaduce these barriers or—worse still—the fmOKrerreach We tear the Mrfker replacement
le^lacten will mtcomttge confrontatloD and
"risk-free " -unkea. where economic Striken
* Footnotes at (»nd of article
�S8460
CONGRESSIONAL RECORD—SENATE
position of new barriers, means that America
will become a slow-growth economy.
President Clinton should realize that high
wages and mandated benefits are ruining the
European economies and leading to high unemployment rates. In fact, several European
countries and Japan are now trying to lower
their labor costs and dismantle their generous "safety nets." Instead of continuing to
add more burdens on employers. President
Clinton should take the opportunity of the
summit to advocate five simple principles of
job creation:
Principle #1: European-style job training
and employment policies have proven incapable of keeping unemployment low or
raising the worker's overall standard of living.
Primjiple #2: High tax rates on employers
and capital is the quickest way to insure
high unemployment.
Principle »3: Excessive financial and banking regulations, which restrict the amount of
capital firms can obtain, greatly l i m i t business and job expansion.
Principle «4: Increasing the regulatory burden and mandating numerous employee benefits is a recipe for job destruction.
Principle #5: Sustained Job growth results
from competitive, efficient industries that
are free of excessive govemment interference.
Only by talking bluntly to the European
allies and shunning "solutions" to tjie continuing problems of unemployment that will
only slow wage growth, can President Clinton help the industrialized world to correct
its economic ills. Adopting European-style
employment policies, on the other hand, will
lead only to European-style results.
UNDERSTANDI.NG THE FtVE PRINCIPLES OF JOB
GROWTH
Principle #1: European-style job training
and employment policies have proven incapable of keeping unemployment low or
raising the worker's overall standard of living.
•
During his speech announcing the Jobs
summit, President Clinton declared, "We
Americans have a lot to learn from Europe
in matters of Job training and apprenticeship, of moving our jjeople from school to
work into good-paying jobs."' Undoubtedly,
Americans have much to learn from the Europeans, but not atiout their employment
policies.
The true effects of the European policies
which the I>resident and others glorify are
best illustrated by the case of Germany. German workers enjoy roughly six weeks paid
vacation each year, the shortest work week
of any major Industrial nation, high wages
(averaging S26 an hour), and extensive health
benefits mandated by the government. But
as Ferdinand Protzman of The New 'York
Times notes, "Unfortunately, (the German
system] no longer works. Instead, the social
contract that once made Germany's economy a model of stability has helped erode
the nation's competitiveness as i t struggles
to recover from the worst recession in postwar history."'
Like many of its European neighbors. Germany is struggling with what has come to be
known as "Eurosclerosis," which signifies a
stagnant growth environment. As the chart
on the following page shows, adherence to
this model has brought the European Union
(EU) slow growth and high unemployment.
Unemployment has averaged almost 10 percent over the past decade in the major European countries, and is projected to average
12.1 percent in 1994 for the members of the
EU. A t the end of last year, approximately 32
million Europeans were jobless, which is
roughly equivalent to the combined
workforces of Spain and Sweden.' Overall,
the U.S. rate of employment growth has far
outstripped Europe. Observes C. Fred
Bergsten, director of the Institute of International Economics, "The U.S, has kept
labor costs down and created 40 million new
jobs over the past 20 years. In Europe, wages
have risen about 60 percent during that span
but only 2 or 3 million jobs have been created."'"
Peter Gumbel of The Wall Street Journal
maintains this Eurosclerosis is caused by a
"tangle of labor regulations and rising costs
fbr employers [which] acts as a major disincentive to job-creation—and a powerful incentive to moving production elsewhere.""
Not surprisingly, perhaps, some 30 percent of
business surveyed recently by the German
Chamber of Commerce say they are considering shifting production to a more hospitable
business environment.
Beside the European burdens on employers
which discourage Job expansion, employment
is also discouraged through extensive unemployment Insurance programs. Explains
David R. Benderson of the Hoover Institution, "A single 40-year-old previously employed at the average production worker's
wage would get benefits equal to 59% of previous eamings in France, 58% in Germany
and 70% in the Netherlands."" These benefits can be collected for many years as well.
Hence, although the broad safety net avail-,
able to displaced workers seems compassionate on the suriace. I t actually creates
disincentives to full employment and a productive workforce. Absenteeism, for example, ran at 9 percent in Western Germany In
1992, 8.2 percent in France, and 12.1 percent
in Sweden. By way of comparison, the U.S.
rate is only 3 percent."
Also overrated is the German job training
system, which Clinton and his Labor Secretary, Robert Reich, seek to emulate. While
the German educational system focuses on
highly technical training for its future workers, the U.S. system focuses on generalized
training. Some academlt^, sucb as Lester
Thurow of MIT argue that the German approach has created a superior workforce
which enjoys a better standard of living. But
a recent comparison of the two systems by
Kenneth A. Couch, of Syracuse University,
disputes this belief. Couch concludes that,
"an apprenticeship program by itself is unlikely to have widespread positive effects either on economic measures such as employment or indirectly related social problems."" For example, comparing German
and American 24- to 33-year-old high school
graduates without further education. Couch
found roughly the same percentage were employed (with actually more Americans than
Germans possessing manufacturing jobs),
more of the Americans in the sample group
were married, and slightly more Americans
had children. Likewise, from 1983 to 1988,
Couch found American workers outperformed their German counterparts overall. America experienced average annual employment growth during the period of 2.4 percent, versus Germany's meager 0.4 percent.
And real GDP growth over the same period
averaged 3.9 percent for America and 2.3 percent for Germany. Other European countries
have fared no better relative to America.
If American policymakers choose to move
toward a more technical-based educational
system, the German approach thus is not the
obvious model to follow. As Couch notes,
"Emulating the German approach may In
fact five us an educational system that will
not perform better but will cost more than
our current one." '*
Following the Failed Model. Europeanstyle Job training and employment policies
which have been implemented in America
have met with failure. Public employment
programs have proven to be net Job destroy-
July 11, 1994
ers, since the amount of money required to
create a public sector Job is typically several
times that of private sector Job creation,'* A
recent study of public transit Investment by
John Semmens of the Chandler, Arizonabased Lassez Faire Institute, notes that for
the J61.5 billion invested since 1965, only
800.000 jobs were created. I f that same
amount of money had been invested by private business through a corporate tax cut. 8
million jobs could have been created." Likewise. Semmens found that 13 million to 20
million Jobs would have been created if the
J61.5 billion had instead been devoted to a
capital gains tax cut. or an expansion of Individual Retirement Account Investment in
Treasury bills or common stocks.'* Most important, instead of producing the high-wage,
well-skilled Jobs the current Administration
calls for so frequently, public programs only
provide low-wage, low-skill, temporary employment, which often costs taxpayers dearly in the process.
Further, i t cannot be argued that govemment sponsored employment training policies provide European citizens with greater
purchasing power and a tiigher standard of
living than Americans. Purchasing power
parity, which Is the most accurate measure
of comparative consumer power, shows that
the U.S. consiimers have a clear advantage
over foreign citizens (see table at end of article). Following Europe's poor example,
therefore, likely will lead not only to lower
growth and fewer jobs, but also to a lower
standard of living for American citizens.
The "Europeanization" of American Labor
Market. Despite the failure of the European
system to sustain employment and a higher
standard of living, America's federal labor
market policy is being molded to resemble
German. French, and other European models. This "Europeanization" of the American
labor market policy threatens to undermine
Industrial competitiveness, increase budgetary strains, and lower the average worker's standard of living.
Principle #2: High tax rates on employers
and capital Is the quickest way to Insure
high unemployment.
To hire additional workers, employers need
capital. Capital fuels Job creation by allowing employers to Invest in the various means
of production. Including land, equipment,
factories, new technologies, and labor. Capital can be acquired in one of two ways: saving i t from profits or borrowing i t . Examining each method of capital accumulation indicates why U.S. employers are finding i t increasingly difficult to obtain the fuel for Job
creation.
The Current Tax Environment. Past recoveries show that the U.S. economy is performing below typical levels. Whereas employment in the previous post-war recoveries
averaged 9.2 percent 33 months after the end
of the recession, the current recovery has
only seen approximately 2.5 percent growth
over a similar period of time. One factor that
aided recoveries during the early 1960s and
early 1980s was a reduction In tax rates.
Unfortunately, the most recent recession,
which followed the 1900 tajt hikes, has been
followed by tax rate Increases. The Clinton
tax plan adopted by Congress last year increased taxes on business and investment.
The corporate tax rate on business, for example, was raised from 34 percent to 36 percent. Likewise, top individual rates moved
up from 31 percent to as high as 42.5 percent.
This is important since approximately 80
percent of small businesses pay taxes under
the personal income tax code. The excessive
taxation of capital gains also continues. The
capital gains tax on Individuals currently
stands at 28 percent, up from 20 percent in
1986. As the chart on the following page
shows, before this rate Jump, new business
�July 11. 1994
CONGRESSIONAL RECORD — SEN ATE
incorporations had risen steadily throughout
the 1980s. After the increase, start-ups fell
immediately and sharply. The aggregate effect of these taxes is a huge barrier to job
, creation, as capital shifts from the hands of
investors to the government.
The Effects of the Tax Barrier. High taxes
reduce investment in businesses and slow Job
growth by encouraging individuals and firms
to seek alternative investments with a more
profitable return on their dollar. I t should be
no surprise that America's current savings
and investment rates are lower than those
required for robust, long-run economic
growth. This is due directly to the trade-off
investors face when contemplating increasing consumption versus saving or Investing.
Increasing consumption carries little penalty; few taxes or other disincentives exist
for immediate purchases. But forgoing current consumption to invest assets represents
an increasingly unattractive option If the re- wards of profitability springing from investment are penalized with higher tax rates.
Moreover, eamings in the U.S. are still penalized twice through taxation, first at the
corporate level and then later at the individual level. Therefore, i f an investor had JlO.OOO
to spend or Invest, spending currently would
more than likely represent a more attractive
choice than Investing.
Taxes raise the cost of capital for industrial equipment and machinery. As the
American Council for Capital Formation
(ACCF)
reports.
"Recent
research
confirmfs] . . that the volume of investment in equipment is a critical factor in the
pace of economic growth and development.
[Ilnvestment In equipment is perhaps the
single most important factor in economic
growth and development."
Yet, ACCF
points out that despite the beneficial effects
ol the tax-reducing Economic Recovery Act
of 1981 on such Investment, tax policy in the
following years became heavily biased
against such investment incentives. The tax
acts of 1982 and 1986. whiclupaised taxes, each
resulted In an Increase in the cost of capital
for equipment as Investors found such opportunities less attractive. Largely as a result
of these high-tax policies, the total cost of
capital for manufacturing equipment increased by 22.9 percent from 1981 to 1986. The
most recent revisions of the tax code are
likely to further discourage Investment, and
thereby increase barriers to expansion and
job creation.
Hence, the potential for long-term Job creation in the current tax environment is not
encourkglng. since entrepreneurs are less
able to entice Investors to risk their money
on new business ventures. Because taxes oreate disincentives to invest in businesses, capital for future Job creation is being produced
at a lower rate.
Principle #3: Excessive financial and banking regulations, which restrict the amount of
capital firms can obtain, greatly limit business and job expansion.
In recent years, the term "credit crunch "
has been coined to refer to how difficult i t
has been for many businesses to obtain
loans. One reason this crunch has occurred
has been the sharp rise in banking regulation
in recent years. In addition to $10.7 billion in
general regulatory compliance costs in 1992.
bankers face costs from lost Interest payments on reserves they are required hold at
the Federal Reserve, and deposit insurance
premiums."
The Effects of the Credit Barrier. How do
these trends affect job creation? This regulatory burden has had a restrictive effect on
credit growth in recent years. The American
Bankers Association observes that over this
same period, more than 40 major federal regulations affecting bank operations were pro
mulgated.^' Although estimates of ths regu-
latory burden on banks are not available for
previous recessionary periods, there is no
doubt that the number of regulatory restrictions and burdens the banking industry faces
have increased significantly over the past 20
years. Declares the American Bankers Association: "Hog-tJiing the banking system with
regulatory red'tape means two things—more
expensive tank credit and less of it."^^
Just as higher taxes restricted job creation
by holding back entrepreneurs, so too has
the credit crunch. Without easy access to
credit. American firms are forced to postpone plans for job expansion. A 1993 survey of
small and mid-size businesses by the Arthur
Anderson Enterprise Group revealed that 38
percent of all businesses surveyed were unable to fulfill their capital needs. Perhaps
more important. 58 percent of businesses
that were in their first three years of operation have been unable to fulfill their capital
needs. The same survey noted that, due to
the lack of capital, 39 percent of the surveyed businesses were unable to expand operations and almost 20 percent of them redtlced
employment."s Limited access to capital has
also made i t more difficult for firms to purchase their own equipment, forcing an increasing number of small businesses to lease
equipment, often at very high interest
rates.«
In response to this problem, the Clinton
Administration has called for new banking
regulations governing how loans are made.
The Administration hopes to boost the number of loans made through the Small Business Administration to "make SBA more responsive to those industries with the potential for creating a higher number of Jobs,
those Involved in international trade, and
those producing critical technologies." But
this is unlikely to be a solution to the underlying problem of restricted credit growth.
The SBA loan program accounts for only a
small percent of capital for new firms, and in
any case tends to fiinnel doUars to favored
businesses rather than the best investments.
Clinton's new plan to reform banking regulation through agency consolidation will not
help either. Monopolizing regulatory power
in the hands of one agency will make i t easier for heavy-handed and manipulative policies to be implemented, thereby raising the
regulatory burdens faced by banks. Lawrence
Lindsey. a member of the Board of Governors
of the Federal Reserve System, says, "Monopoly regulation is a bad Idea. [It] will
greatly harm both the banking IndustiV and
the economy, and lead to an unfortiinate
politiclzation of bank regulatory policy."*
Principle #4: Increasing the regulatory
burden and mandating numerous employee
benefits is a recipe for job destruction.
The number of regulations and mandated
benefit requirements that employers are
forced to comply with has grown steadily in
recent years. Estimates of the total cost
that regulations impose on the economy
range from a low of J615 billion to a high of
SI.7 trillion.2' This burden translates into
millions of foregone job opportunities." For
example, Michael Hazllla and Raymond Kopp
have estimated that environmental regulations reduced aggregate employment by 1.18
percent as of 1990,* which means over one
million jobs would have existed without the
regulations."
Regulation and mandated benefits take
their toll indirectly. When the government
increases this burden on the private sector
by promulgating new mles. firms must adJust their behavior accordingly. This adjustment process may require an increase in
worker training, paperwork requirements, or
even retooling. Regardless of the adjustment
method, costs will be Incurred. The costs of
adjustment directly affect the firm's profits
since a greater than expected amount of
earnings will be exhausW"^'compliance
measures. In addition there may be extra
costs associated with hiring new workers As
a result, firms will try to pass the costs of
adjustment on to their consumers, or. i f that
is not possible due to competitive market
conditions, scaile back future production. Investment, or new hiring. If the new compliance and adjustment costs are sufficiently
high, firms may scale back existing production and lay off workers.
The Effects of the Regulatory and Mandated Benefits Barrier. Several studies point
to the Job-destroying effect of the regulation
and mandated benefits explosion that has
taken place in recent years." With the passage of mandates included in the Clean Air
Act Amendments of 1990, the Americans
With Disabilities Act of 1990. and the CivU
Rights Act of 1991, and the Increases in the
minimum wage In 1990 and 1991, the burden*
on employers have ballooned.
The dramatic rise in the minimum wage
alone, from 13.35 in 1989 to $3.80 in 1990 and
$4.25 in 1991, helped push teenage unemployment to the highest rate In a decade. I f the
Clinton Administration proceeds with plan))
for a 50 cent hike in the minimum wage, a.ai
the labor market adjusts as i t has in thepast, there-is likely to be an increase in the
teenage unemployment rate of between 0.5
percent and 3 percent.
Another burdensome employer mandate
will be the "employer trip reduction" requirement of the Clean Air Act. Starting
this year, this will require employers in nine,
metropolitan areas to reduce the number of'
• employees driving to work. Although no employment loss estimates are available, over
12 million employees will be covered by the
act, making a difficult to believe that some
jobs will not be affected.''
Whatever this intentions, civil rights employment mandates also take their toll.
Peter Brimelow and Leslie Spencer of Forbes
recently estlniated the total cost of civil
rights regulatioii to be $236 billion, which
translates into a loss of 4 percent of GNP."
The Family and Medical Leave Act of 1993,
which grants employees as much as 12 weeks
unpaid leave each year, discourages job creation. Because many employers will not be
able to absorb tbe high costs and lost output
resulting from mandatory worker leave, the
policy will have the unintended consequence
of encouraging struggling businesses not to
hire Individuals who might take advantage
of the leave policy. The SBA has found the
overall costs of this act to total as much as
J1.2 billion.**
Other employer mandates that currently
burden the labor market include the health
care requirements found in the Consolidated
Omnibus Budget Reconciliation Act of 1985
(COBRA), the prevailing wage requirements
of the Davis-Bacon Act, and workers and unemployment compensation payments. These
factors create added disincentives to job expansion since taking on an additional worker
means steadily higher employer payroll burdens.
Employment Thresholds. In recent years,
many legislators have come to realize that
added regulation and mandates have a destructive effect on job growth, particularly
in the small business sector. But. Instead of
attempting to cruft more sensible policies or
deregulate where possible, they tend to respond to small business concerns by adopting
employment
thresholds.
Employment
thresholds exempt smaller-sized businesses
from certain regulations. For example, the
Americans With Disabilities Act currently
exempts all firms with fewer than 25 employees from the regulation; this will be lowered
to cover firms with fewer than 15 employees
after July 26. 1994. Other examples Include
the Family and Medical Leave Act. which
�S8462
CONGRESSIONAL RECORD—SENATE
exempts business with fewer than 50 employees and the Plant Qosing Law, which exempts businesses below WO employees.
These thresholds have the unfortunate
side-effect of discoiii'aging employers near
the threshold from hiring new employees.
Pointing to the Family and Medical Leave
Act. Ruth Staflord, president of the Kiva
Container Corjporaiion, says. "Fifty is the
magic number."^ Her firm, like many others, plans to hold employment stable just
under the 50 employee barrier using more
temporary or part-time workers. This phenomenon is already being seen: according \x>
the Bureau of Labor Statistics, temporary
employment grew by 20 percent in 1993, up
from B percent i n I99a
Principle .#5: Sustained job growth results
from oomjpetltive, efflcieiu, industries that
are free <3f excessive governnaent interfsrence.
Steering America onto a path of «reatfir
job creation, low unemployment, and a higher standard of l i v i i ^ will require a shift of
current American economic policy. T ^
three primary governmental barriers tA> job
expansion—high
taxes,
llmilied credit
t h r o u ^ IrratlQLnal iin&nciaJ i^egulations,. and
excessive regulations and added nmndated
t>enents—all must be corrected. Ad£iptJng the
European system would be a mistaite. America should Instead learn from history that
where goods, services, labor, and wages have
'been allowed to move or ili,ictuate freeiy,
proaperity, entrepreneurship, and high emjiloyment have been the result..
To put American back on the higi-employment. high-wage track. Pi^sident ClijaUui
should take several .sjieciPc and immedia-t^
steps to ensure American Industries remain
strong and competitive:
Step n : Lower tax rates on businesses and
capItaL The effects of high tax rates on employers and capital are direct and damaging.
Lowering both corporate tax rates and the
capital gains tax rate (i^lille indexing i t for
Inflatlonj would lirovlde an intmediate aad
Strang job scimuliis by reducing the oost of
hiring workers and unlocking the ca^tal
needed lor "business expansion.
Step P2: Select all attentjits to estabUsh a.
£uropeaa-styie employment policy, eepeclaUy expensive Job training iirograms. High
wageSu sustained emjiiloymeot, and iocreased
business activity ^hoa\& be goidlng £aals of
putiUc policy- Itlandating them should ust.
Costly and inelTactlve job training progmms
should be ruled out a« Job-oraaUng opticas.
Americans.need only look at the XaUure of
European programs to understaod why such
an approach is a mistake. Such programs require massive amount* o l public spending lor
the smaU number of jobs which .are created.
Step «3: Cap federal spending. This wiU aid
job creation by Increasing the amount of private savings available for busiiiess investment.
Step #4: Enact comprehensive regulatory
reform. The "hidden tax" of regulatioa and
increased mandated benefits directly i n crease the cost of employing workers. The
President anfi Congress should establish a
federal r ^ u l a t o r y budget and estimate tbe
employment impact of reguiations before
they take effect. The regulatory buijget
would place a l i m i t on the total cost thai; is
imposed on the economy oach year by new
federal regulations. When the budget had
been passed, no new regulatloiis could be imposed—unless other rules were withdrawn.
Step #5: Adopt rational health care reform
based upon consumer x:hoice and not new employer majidates. No new policy action
threatens to do as much damage to the labor
market in the immediate future as does maployer-based health care mandates. While reform is needed, i t shouJd not einifily push the
cost of oOBiprebeDslve health coverage Ohto
employers through expensive new payroll
taxes. AocompUsbing reform In chis manner
will resu! t in the loss of miH loos of jobs."
Step -#6: Reform America's archaic financial and banking laws Financial restriotians
such as tbe McFatdden A c t of 1927, the Bank
Holding Act <ii 1956,.and the G^ss-Stea«all
Act of 1933 retard bank etabUity and expansion and, therefore, l i m i t tJie credit oppartnnities they can offer to businesses. Eliminatii« these impediments to financial elTlcleBcy
would allow businesses to take aditanetage of
expansionary opportunities by borrowtag
needed capitaL
Step «T: Overhaul antiquated antitrust
laws. America's oatdated antitrast laws,
fiocfa as the Shermaa AnSitrust Act of 1890
and the Clayton Aatitrugt A c t ol 1914, malce
i t difficult for firms to enter into joint production allianceB that ooald raise Industrial
efficiency and txeate new i d t opportunitlee.
Step M : Pass product Haldiity reforni s'nd
other t o r t refonn legislation. Cuncntly.
America's tort system eaps ^rl'vaite sector
entrepreneariallsm, binder* prod aet innovation, and threatens t»>e contlnu8t*oB of BBmerous businesses. "Wltlioat refarms limiting
punitive damages and streamliniog cocrtly
oost prooedores, aa Increasisg nianber of
job* will be (ilaoed at rlsk.
Step #9: Continue to push for trade llberalteatiOB gWbany while eliminatlag tfomestic
barriers to free traSe. Wteile tt» Job xains
-will resalt from the wise actions a i r e a ^
taken of flasmTjg tSve •Jorth American Free
IVade AgreemeHt fNAFTA) and General
Agreement on Tariffs and Trade tOATT)
agretanerrui, fnrther efforts Should *e -made
to ejcpanS free Wade «gTeeni«rt8 while lowering the domeetSe "bailieis to imports.
Step STO: Bireonrage the ose Of -privatization and ctrntractang out wbencvBr possible.
Privatization and otjntracttng otrt not onjy
Insure that gerviteB «refleWveredmors effi•deniSy for leas money, 'ttasy also allow private nrms to rslse cai#ta! and re-Invest In
•mtJTB •productive, loitg-term private sector
jobs. 'Woe President Gore'^ National T*erformance Iteview failed to tap such methoas
of real guvenunent reforra." Undertaking
such nieasuTe* -woiild encourage increased
private sector employmenl -while demonstrating laiat the Administration Is serious abont changing ^ e wa,y Washlngtoo
works.
CONCLUSION
The Jobs Sommit affords President CUstoa <iie opportaoity to ootltoe the &iadamental prtodplee ef job creation to the ibdnstrial nBtlons ttftbe 'worid. TJnfcrtusBiteay,
many aatiaiM. specifically io Europe and
more reocBtly tim United States, hawe forgotten that iow taxes, easy aooess to credit,
rationai re^i^L^tlons, and -vigoroae exjposure
to campecitlaa. are the fbiiadaxloa €or a
healthy, job-creating eoononsy.
The moat Important lessoa that President
Cilnton can bring back from Detroit 1* that
goremment polIcioB that increase the cost off
hirinft people rama taiat fewer people will be
hired.
AQAM D. TKIERGR.
f-oJicg
Anvil^.
POCTT'OTES
'•David R. Sands. "Clinton Announces Plans for
Jobs Summit," The Washington Times, January n .
1964. V tn.
^Dmicil J. MKcheB. "The BadgtA and the Eoonony: A Finrt Yoar AssessmeBl of tlae a i n a D Prsaideacy. " UetilMgt Fsuntettoa BaokffroimiieT Vp(tate
No. Zia. Fabnwry t l a M . Z .
'Lewln-VHZ. TTi* Financial Impact oj I t e iUaltti Secunty Act (Tairfai. VAi'Lewin-'Vffl, 1V93B.
« D a v « R . Sands. "Hm BeiiuWlcans Criticize Clinton"'* Jobtem Measure."" 7^* ^^hrshmgton Times.
ruaryS. IIM. p. B i .
*Federai ibepister vajgm. a roag^ estimale of Aie
•vcrall amwint af r^aiatarjr acti<i4ty. r m t0.9ie for
July 11, 1994
i»98. tie lii«l>e«t ievoi siaoe the Outer Adminiftration lea ftfUoe in latt.
•SeeDaniel J. JfatdieU. " l a i JUtea. Fairness, and
Xconomlc Growth: Leason* from the 19liO'i. ' Heritage Foundation BackgTound£r So. 880, Octol>er Ih.
1991, p 2.
'Sands. - Clinton ABn««iiicei! Plam . .
ap crt.
•fterthmmd Protmao, "BewitilBg the tSrolract
Jor Oennany a Vaimt«< Werkera." r t e .Vcie rork
Times. February U . 1*64, p. FS.
•Stella Dawson. "CloluU Jobs Stuaruit Delayed
AmldUAFTA Baule." The Reuterj EuTepeao Business
Kevtnt. November 1.1993.
"QHOted in Prolrman, op eft.
"Peter Oumiiel, "WeeterB EUPOIK FtnSs Thai U s
Prlotic ItseU Oat o l tbe Job Mai*et.'" Tie Xall
StTtetJoumaL Decembers. 19tS,p.Al.
"i>»vid R. Heuieiaoa. "EuRisclaraeis £4>read£ to
Our Shorea.' Tbe Wall Street Jaunal, Oototjer 14.
1998, p. A18.
" PrCTtzman. op. rtl.
"Ksniwtfc A. OwM*. "Oermana airtl Jdb Tralnrng:,
Eflacation aai D»." TAe Aneriesa Bnterprwe. Kovember'DeaenTberllta. v-M"Ont.. p. U .
».See Edward X.. Huigiti*. r ^ J D , " W ^ lafrastrnfture Spending Won't Jump Btart Xhe £ c o a a m v . '
Heritage Toundatlon Sfcrafi to T^altat-Elect Clinion
"N*. 9. (JamiaTy 16, 1993.
^ JobB Semmens, '^tSoveroment luveatiuetits Tiekl
Pnor ReattMii.' Heariaan* tatstlttsu. A Hmrdan* PerVKCttae. Octabw I t . ISNL p.2.
"ioXm SemneBa. '4Meni TtmrnaH SsbsMieB: Haw ,
Oovenunent lanstnesl
Kaons Ike Bcaaoay." Xke
Freeman, February 1994. p. Jl-H.
'•Mark Bkxunfleld andlSaixo Tbomlng. Eb.T)..
"T^e Impact t>I President •Clinton's Tax Proposals
« a Ca^Kal fieimuMmi." Ameriess Owncn for Capi t a l FonBatloB. TesttmoBy t * l h « Souse may» and
Means ODmmiCtee. March IB. JM>. s. &
"Mot iBCliided ia Kim sao.t ISlUon ngare xn the
j»ttiatUJ costa Cross the FBIC IjuprovanieBC Act «f
19B1, Klilcb could pnsb regulatory cottt even higbet.
•American Bankers Aasoclatloc, "The Bankisg
iBdastrr: t * » Key *>
* " * Econoinlc Orowtb."
n k r a a r r l . l*e3.T <
•jSmertcan Banken AasKAsxlon, -iCut««t tlie
^ T k p e : Xiot Basks Oet Baa* Ss Bokiaaa." XorenlIlfiEl.
jJArUuu- AiidersoB £atai3Kiae Oraan. Swmu A)
SmaB ana Uid-Sixti Bu^aaaa: Traidt for mi.
iaae
rm. V 11
" Michsel -Sell. "Many -Small Thnrtneases Are 'Sold
oa iMMlas BnuiimajBt," •7Vi< SMI 9 m A Jovmo!, Oct o t s r a . USB. s- B£
-^Ite
Mattonsl Perfonanaus fieciew. CmaXlnc a
OosammeBt Tkat ICcrka fioUcr A OmUm I M . Seylember 7, lasa. p. M.
"Lawrence Lindacy. "Uaw U> C o r t v f t Banking."
Ftnbes. Jamiarjai. W9I.J). ItJO.
» See 'TUfmlmndled t i j !»aralataB,~ Poitej. Octdber
S . i n s . ». » . wratam O. IjaHer Tn anS ?»ai«cy A.
BDKL *««aiisB aask^ ndOsn Tax: Has ExiAostoB to
ftWttisttoa." Merilage FoiraSsXiaa Aaot^oiradcr So.
90S. July 10,1992.
>WilUani O. Latter H I . "How aegulatlaB is Oeatroyln* American Jobs." Heritage fojimUtlon
BackTrrountler Ho. S26. Febmary 18.1998•Michael HaHHa Bnfl Raymona J. KTJJJP. "Social
Cast o l EoviTODiBeBtal Qaamy ItogiAatisns: A Oeneral BqiutlbrliuB Analjila," Immat af Pmhtioal Ecimomy. V*das..N«.4. (t«9e)f>.Sn.
^ l A j i a i ajid Bard. op. at., s- *"See Latter, op. d(., p. 1: Oary Aniatson and LoweU Gallaway. "Derailing the Small Busloess Job Express." -(WaaWnrton, D.C: Stjlnt Economic C^ommit»««, Kovenrtwr f. WtW. Lowell Oallm'way m i Rlcharfl
Vedder. "Wbj Jataay OsiTX Vtork: Tke Caasec v l
Unemployment." Policy Sevieu. flaH IMt Alan
HeyBOlda. "CruelCaeM ef tbe 19M lilninuUB Wage. '
Tiie WaUStreet JCMraai. Jaly 7. JfiSe. p. Ai4.
"See "David Andrew Price. "Newest MandaJte—Everyone Into tbe fSrpool," The VaU Street Joumat
N o v e m ^ 8, >«93, V A M .
••Peler Brlanelaw asd Leshe Spenoer, "Wbefi
Qnotaa BeiSaoe Meitt. SvarrtaaAy Suneca." Firrbes.
February l i . 1803. f> U .
» Eileen Trzcinakl and KMlUaBi T. A i ^ r t . "Leave
Policies in Small Buslneaa: Kndlngs From the U.a.
Small Sasiness Admlninratlon Smplojree l ^ v e
Borvey." SmaJl Bnslnesa A<liiiliil»ti ation OTfice of
Advocacy ficseorcft Summary Number 9B. March J991.
KJaanne SaMler. ' S n a h r t a m l t r TcCuri) ImS»ol * f l^arve Lav," rite Wall atnatt jtMimst Asfnsl
i , 1983. p. Bi.
3" See Daniel J. M " ^ ' " ' ' i " H e Eoaaomic asd
Budget Impact o i the CUclon Health Plan." Heritage FoundaTJon Backgrounder Vo. 971, January 13,
1194.
"'See Seoct A. Wuisa an* Adon O. TWerer. "Tbr
National P^Tformaaoe Xeriew: r a l t i m Short st Heal
=»•<
"It,-
';'"3&
�NATIONAL JOUR^
Chr;is Jenninr,..
H f - l t h Care f a s !
TUe W h i t e H(i!.ise
Room ^•10 ri„E„n„B
W
• or (.-;(:-)
Senate GOP Vows Slow Health Debate
Thursday^
Augiisf4;'ri994
-e<3nvenes,atf9,;£inStocon.sider
ment Fjaanciaifo-ieJ
indtions'Act.fS
Key Senate Republicans Wednesday committed to slowing down work on
Majority Leader Mitchell's healthcare reform bill, pledging to take at least a
week of floor time just to explain the legislation. "We'll spend all of August here
if we have to," Finance ranking member Bob Packwood, R-Ore.,
contended at a press conference, although he and other Republicans
stopped short of calling for a filibuster. Sen. Larry Craig, R-Idaho, threatened
to go "page by page, paragraph by paragraph, until we really understand what
it means." And Sen. Phil Gramm, R-Texas, declared that no one person will
be able to comprehend the entire bill by next week — so he said he will divide
up the measure, assign sections to individual GOP senators and have them explain their designated portions on the floor That process should take a week,
he said, "and after that, the bill is dead."
Democrats chided the Republicans for their scheme, saying the American
people will recognize the actions as gridlock — for which the GOP will have
Continued on Page S
Clinton Hikes Pressure On Republicans
.... ^^^ysm^
,WKt_tewater'3^
l^^s^Jromifli^^Oiite
:'j^'kffl»miiij(gt)jnrr)"i^^
Ignoring the deep fissures in the Democratic Party that have prevented his own
healthcare reform bill from passing, President Clinton Wednesday night tried to
shift the responsibility to congressional Republicans to get on board behind universal coverage and criticized the GOP for rejecting all his proposed
compromises. "We have reached out to them, as was our responsibility to try to work together in a bipartisan fashion, and every time we have done
it, they have moved away," Clinton told a nationally televised news conference
from the White House East Room. "So the questions now should shift to them.
Are we going to cover all Americans or not? Are we going to have a bill that
provides healthcare security or not? If you don't like our approaches in the Senate and the House, what is your alternative? That's what I hope we'll see."
Clinton also defended his support of the compromise healthcare bill introduced
Tbesday by Senate Majority Leader MitcheU, saying the measure meets his "one
Continued on Page 4
House Drinking Water Talks Collapse
House Energy and Commerce Committee negotiations on legislation to reform
the Safe Drinking Water Act collapsed Tuesday night in a dispute over enforcement provisions, leading to a cancellation of a Wednesday markup and increasing
the obstacles for passing a bill this year. Aides to Energy and
ENVIRONMENT
Commerce Chainnan Dingell, Health and Environment Subcommittee Chairman Henry Waxman, D-Calif., Merchant Marine and Fisheries Chairman Studds, Govemment Operations Environment Subcommittee Chairman Mike Synar, D-Okla., and Reps. Jim Slattery, D-Kan., Thomas
Bliley, R-Va., and Blanche Lambert, D-Ark., had been negotiating for months
on the legislation. The aim of the talks was to craft a consensus bill to bridge
gaps between a coalition of states, local governments and water utilities — which
have backed a bill by Slattery and Bliley — and the position favored by environmentalists and Waxman.
With many of the issues in the legislation resolved, Waxman had scheduled
Wednesday's markup to force a conclusion of the lengthy talks in time for action
Continued on Page 8
CongressOaily/A.M. is published daily, Monday-f tiday, while Congress is in session by Notional Journal Inc. Copyright 1994 by National Journal Inc.,
1501 M St., NW, Washington, DC 20005. Reproduction and/or fox transmission of CongressDaily/A.M. is prohibited without written permission of
publisher. For more Information obout CongressDaily/A.M., or CongressDoily, the daily fax newslettet, call (202) 739-8542.
National
JoumaT
�^0 middle ground in health care war
By J Jennings Moss
Li J
"THE WASHINGTON TIMES
f |
|
Rep. Jim McDermott and Rep.
J. Roy Rov'"'"' "^'•'r.
t-hiwyB
— they are both Democra'ti, GiKgress' only doctors and two <rf the
most vocal proponents of h««)th
care reform.
But the two are leading rival
factions on how to change the
health care system. Getting them
to agree on any reform package
would be a near impossibility, a
fact that raises a conundrum for
lawmakers and the Clinton administration.
How, in a House and Senate that
up to now have been divided into
various groups — none of which
has a majority of votes — can a
majority emerge to pass a reform
bill that meets the policy and political needs of enough lawmakers?
"The problem is no one wants to
be in the middle anymore," said
Sen. John Breaux, Louisiana
Democrat and a moderate. "The
left doesn't want to come to the
middle and the right doesn't want
to come to the middle. The middle
IS where you get hit from both
sides.
In hoth houses of Congress, the
same factions exist. There are the
defenders of the Clinton approach
the backers of a Canadian-style
health care system and the incrementalists. Democrats are spht
among all three groups while Resee nEXLlH,
page AlO
publicans are confined to the incrementalist camp, although the
divisions here are numerous.
With the exception of one Republican — Sen. James Jeffords of
Vermont — only Democrats spa|sored the plan President niiiMii
outlined in September and i n t ^
duced in November. Less thanhipr
the merhbers of the party's caucMtt
added their names to the package;
Even though the Clinton plan is
officially dead, Mr. Clinton and his
backers in the Democratic leader3hip continue to hold onto the one
principle all of them say is not ne^
gotiable — that every American
should have health insurance that
:an never be taken away
" I have always felt that we are
low in a completely different time
>eriod," said Sen. John D. Rockeeller IV, West Virginia Democrat,
^or the first six to eight months of
he debate, lawmakers felt as
hough they did not need to budge
in their principles, Mr. Rockefeler said, but those days are gone.
"Now you realize there's a lot at
take, the biggest issue ever, and
've found myself being able to acept something I would not have
een able to accept three weeks
go," Mr Rockefeller said.
Rep. Sam Gibbons, Florida
)emocrat and acting chairman of
le House Ways and Means Comlittee, said the quest for a majory to pass the Democratic aproach will take place "one vote at
time— It's a daunting task."
"The two greatest divisions we
ave in the Democratic caucus are
etween those who want to do
ealth reform incrementally
irough insurance refonn and
erhaps those who would do aom*ling a little more draatic and
Congress' two
doctors offer no
second opinions
debate with a unified approach, a
group of Repubhcan and Democratic lawmakers in both houses
has been meeting to develop plans
they hope will be able to draw a
bipartisan majority in Congress.
In the House, Mr Rowland — a
general practioner from Georgia
— said he did not know how the
various factions would join together
"If there's anything that's certain in a political scenario Uke this,
it's uncertainty," said Mr Rowland,
who is part of a 10-person working
group in the House developing a
consensus plan.
Mr Rowland said that if their
solution gains a majority. Republicans would hold the key, although
60 to 70 Democrats eventually
could vote for such a package.
In the Senate, Democrats are
seen more likely to bend than RepubUcans.
think you need to get to universal
coverage with insurance reforms
and an employer mandate," he
said.
Some of the most passionate arguments for wholesale health reform have come from those who
back ehnunatmg insurance companies completely and having govemment become the sole payer of
health care.
Such a system, known as single
payer, borrows heavily from the
Canadian model. T^xes would pay
for the system, but people could
still choose private doctors.
Mr. McDermott, a practicing
psychiatrist from Seattle, is the
chief House sponsor of the singlepayer system. He has made it clear
that he will not switch to another
proposal just because it has the
backing of the Democratic leadership.
"It's a long time from last Friday
to next Tuesday A lot of things can
happen [to the leadership's proposal]. I want some room to leave
the ship but if it were to stay the
same as it is right now, it's possible
I would vote for it," he said.
Mr McDermott said he already
has beguntocanvass the 90 Democratic sponsors of the single payer
system. As long as the leadership's
reform plan does not stray too far
to the right, most analysts think
the leadership will get these votes
The full House is expected to
vote on a single-payer proposal
which wUl be offered as a substitute to the Democratic leadership's health bill, but it is given no
chance of passing.
The situation in the Senate is
different. While nearly a quarter
of the House favors the singlepayer proposal, only 5 Senators
are m favor of it. Second, the
health plan that Majority Leader
George J. Mitchell of Maine is
. scheduled to introduce today is expected to be more conservative
than its House counterpart.
"Our votes cannot be taken for
granted." Sen. Paul WeUstone, the
Minnesota Democrat who is the
chief single-payer sponsor in the
Senate, has said repeatedly.
The incrementalists favor reforming the insurance system to
protect people from losing their
coverage, providing lowerincome
Americans with some type of government help to buy insurance,
sunpUfying the bureaucracy and
reforming medical malpractice
laws.
Yet some significant differences
exist, such as whether Americans
should be forced into managed
care health plans, l b enter tbe
^
^
^
^
^
The problem for many Republi« n s is that the moderates' reforms could go too far. And for poUtical reasons, some do not want
to pass anything that would be
seen as a victory for Mr Clintwi
RepubUcans in the House and
Senate — many of whom started
off supporting various reform proposals — wiU push for votes on
distinctly Repubhcan health reform packages and a vast majority
of party members will voteforthe
packages.
Sen. Larry Craig, Idaho Republican, said conservatives ultimately agreed to back a single approach: "We're going to correct
some of the problems in the current system and let them work for
a time and see how they do."
He said he did not see Senate
RepubUcans going along with a bipartisan moderate package being
crafted in that body.
^
�
Dublin Core
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Health Care Task Force Records
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White House Health Care Task Force
Is Part Of
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
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2006-0885-F
Text
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Craig, Larry (R-ID)
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
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2006-0885-F Segment 2
Is Part Of
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Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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Preservation-Reproduction-Reference
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2/6/2015
Source
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42-t-12092992-20060885F-Seg2-007-009-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/b829f390c4bc9b88e8d813245d02406f.pdf
93edfeaa1bd9dce6e6d25c2269516d26
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff IVIember:
Edelstein
Subseries:
OA/ID Number:
3665
FolderlD:
Folder Title:
Coverdell, Paul (R-GA)
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
3
1
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TVPE
SUBJECT/TITLE
DATE
RESTRICTION
001a. form
re: Information Request (1 page)
n.d.
Personal Misfile
001b. memo
Heather Harwell to Amanda; re: Senator Craig Info (1 page)
12/10/1992
Personal Misfile
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3665
FOLDER TITLE:
Coverdell, Paul (R-GA)
2006-0885-F
ip2643
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b))
PI
P2
P3
P4
b(l) National security classified information |(bXI) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIAl
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAl
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office 1(a)(2) of the PRA|
Release would violate a Federal statute |(aX3) of the PRAj
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Paul Coverdell
R-Gcorgia
SR-204 Ru&scll Set
Office Building
Washington, DC 20510-1004
(202) 224-3643 _
BIOGRAPHICAL Born: 1/20/39 • Home: AUanta
• Edur.: Bj\., U. of Mo. • Prof.: Financial Services
Exec; Ga. State Senate, 1971-89; Peace Corps Dir,
1989-91 • Rel.: Methodist
KEY STAFF AIDE%^
^ j^^^
Chief of Staff: fiari-McClur?
Administrative AssistapL^Appt^JLMoUy
LegisUtive Director<Twry D e l g ^ l k ^
:
Office Manager GregT^oroIo^g ^^^^^^^ ^^^^
COMMITTEES: Agriculture, Nutrftlon, and^westfy,
• Foreign Relations • Small BMoiness
/AL^ ^ C
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001a. form
SUBJECT/TITLE
DATE
re: Information Request (1 page)
n.d.
RESTRICTION
Personal Misfile
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3665
FOLDER TITLE:
Coverdell, Paul (R-GA)
2006-0885-F
ip2643
Presidential Records Act - [44 U.S.C. 2204(a))
RESTRICTION CODES
Freedom of Information Act - [5 U.S.C. 552(b))
PI
P2
P3
P4
National Security Classified Information )(a)(l) of the PRA)
Relating to the appointment to Federal office |(aX2) of the PRA)
Release would violate a Federal statute [(aX3) of the PRA)
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors )aX5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy )(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
b(l) National security classified information )(bXl) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency )(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(bX3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes )(bX7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions )(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells )(bX9) of the FOIA)
�PAUL COVERDELL
GEORGIA
United States ^tnatt
WASHINGTON, DC 2 0 5 1 0 - 1 0 0 4
PAUL COVERDELL
On November 24, 1992, U.S. Senator-elect Paul Coverdell made history by
defeating incumbent
Wyche Fowler in Georgia's first General Election
Runoff.
Co verdell took 51% of the vote after neither candidate garnered the required majority
in the November 3rd General Election.
The Coverdell campaign ran strongly in all
regions of Georgia, carrying 75 counties, more than any other Georgia Republican
campaign.
People who know Paul Coverdell know he will bring conservative Georgia values
and common sense leadership to Washington.
Throughout his professional life, Paul
has challenged inefficiency and injustice and has led the fight for positive change.
For the past 30 years, Paul has been building a successful business that he
founded with his mother and father.
Today, Paul is Chairman of the Board for
Coverdell & Company, Inc., a respected financial services marketing group that serves
families in Georgia and across the nation.
While Paul was building his business, he also worked as a
"citizen-legislator"
in the Georgia State Senate to bring about important legislative change. The tough
DUI laws he sponsored are still saving lives on Georgia's streets and highways.
He
also fought for strict ethics legislation, open committee meetings and reform of the
state pension system.
For years, Paul has been working "in the trenches" to build the Republican
Party and make Georgia a true two-party state. He was elected by his peers in the
Senate to be Minority Leader... he served as Chairman of the Georgia Republican Party
from 1985 to 1987... and in 1988, he was asked to chair the Southern Steering
Committee for the Bush presidential
campaign.
In 1989, President Bush appointed Paul Coverdell to head the United States
Peace Corps. As Director, Paul revitalized the agency and instituted tough financial
management systems. He helped redefine the agency's mission to serve emerging
democracies in Eastern Europe and also created the innovative World Wise Schools
program to help students in the U.S. learn more about our changing world.
Paul received his degree from the University of Missouri.
After college, he
served as an officer in the U.S. Army in Okinawa, Taiwan and Korea from 1962 to
1964. Paul is a Methodist and he and his wife, Nancy Nally Coverdell, reside in
Atlanta, Georgia.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001b. memo
SUBJECT/TITLE
DATE
Heather Harwell to Amanda; re: Senator Craig Info (1 page)
12/10/1992
RESTRICTION
Personal Misfile
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3665
FOLDER TITLE:
Coverdell, Paul (R-GA)
2006-0885-F
.jp2643
RESTRICTION CODES
Presidential Records Act - )44 U.S.C. 2204(a))
Freedom of Information Act - [5 U.S.C. 552(b))
PI
P2
P3
P4
b(l) National security classified information [(bXl) of the FOIAl
b(2) Release would disclose internal personnel rules and practices of
an agency l(bX2) of the FOIAl
b(3) Release would violate a Federal statute l(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAl
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAl
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions )(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells )(bX9) of the FOIAj
National Security Classified Information )(a)(l) of the PRA)
Relating to the appointment to Federal office [(a)(2) of the PRA)
Release would violate a Federal statute [(aX3) of the PRA[
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRAl
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors la)(5) of the PRAl
P6 Release would constitute a clearly unwarranted invasion of
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PAUL COVERDELL
Bmted States Senate
WASHINGTON, DC 20510-1004
February 1 1 , 1993
Mrs. H i l l a r y Rodham C l i n t o n
The Task Force on N a t i o n a l H e a l t h Care Reform
The White House
Washington, DC 20500
Dear Mrs. C l i n t o n ;
You r e c e n t l y r e c e i v e d t h e enclosed l e t t e r from one o f my
c o n s t i t u e n t s , Ed S c h u t t e r o f Solvay P h a r m a c e u t i c a l s . Mr.
S c h u t t e r would l i k e t o a i d your t a s k f o r c e ' s e f f o r t s , and I
encourage you t o t a k e advantage o f h i s e x p e r t i s e .
Thank you f o r y o u r t i m e and c o n s i d e r a t i o n .
Sincerely,
Paul D. C o v e r d e l l
PDC/dhm
'
^.
.
�SOLVAY
PHARMACEUTICALS
February 5, 1993
Mrs. Hilary Rodham Clinton
White House
Washington, DC
Dear Mrs. Clinton:
Congratulations on your appointment to chair the task force on healthcare reform. I
have recently been assigned responsibilities within my company of which your reform
could greatly impact. These responsibilities include setting up a department to meet
the needs of the growing managed care segment of the healthcare market. Therefore,
I'm keenly interested in the decisions that will be made by your group.
At the same time, I could contribute valuable healthcare knowledge and experience
to your efforts. I have been in the pharmaceutical industry ( R & D and Marketing) for
nine years. Prior to this, I was employed as a hospital and nursing home pharmacist
and operated my o w n retail pharmacy for several years.
I would like the opportunity to share with you my knowledge of the industry and need
for change. Hopefully, in return you would be willing to share insight into your efforts
for healthcare reform.
In addition, I will be conducting several focus groups with managed care professionals
in the near future. I would be happy to set these up so that it would be convenient
for you or your aides to attend. This would allow you to learn, directly from people
at the front line, how these organizations really work.
I hope that you see the value that our interaction could add to your task force. It's
important that you not only talk to the experts and consultants in the healthcare area
but also people who are involved in everyday decisions within the industry. I would
appreciate a reply at your earliest convenience. Thanks for your consideration of this
request.
Sincerely,
AC
Ed Schutter
Senior Product Manager
Corporals Ol'ices 901 Sawvpr Road '," Marietta. GA 30062 r ToleDhone (404) 578 9000 [ '=^t • J04) 578-b597
Manulac',L."Pn 210 Main Street W I": Bauclette, MN 56623 1" Teleptione (218) 634-1866 I" Fa.< :2"8) 634-2785
�share o f f e d e r a l h e a l t h spending w i l l be below average,
l a r g e l y due t o t h e f i n a n c i n g s t r u c t u r e o f t h e s t a t e ' s
M e d i c a i d program.
Colorado's Medicaid expenses would come t o $168 f o r
e v e r y person i n t h e s t a t e i n 1994 w i t h o u t r e f o r m . W i t h t h e
r e f o r m , i t c o u l d drop t o $130 p e r person, a c c o r d i n g t o t h e
report.
That's w e l l below t h e average amount s t a t e s would pay
f o r government h e a l t h programs, e s t i m a t e d a t $210 p e r
capita.
Georgia Business B r i e f s :
Employer h e a l t h care c o s t s
ATLANTA (AP) Feb 15 -- Employers' h e a l t h care c o s t s rose i n
Georgia a t n e a r l y t h r e e times t h e U.S. i n f l a t i o n r a t e l a s t
y e a r and f a s t e r t h a n t h e n a t i o n a l average, a c c o r d i n g t o a
survey r e l e a s e d Monday.
Georgia employers saw h e a l t h care c o s t s jump 8.5
p e r c e n t l a s t year t o $3,359 f o r each employee, h i g h e r t h a n
the 8 p e r c e n t i n c r e a s e i n t h e n a t i o n a l average t o $3,781,
s a i d F o s t e r H i g g i n s , a New York-based c o n s u l t i n g f i r m . The
n a t i o n ' s i n f l a t i o n r a t e came i n l a s t year a t 2.9 p e r c e n t .
M i c h a e l Cadger o f F o s t e r H i g g i n s ' A t l a n t a o f f i c e s a i d
Georgia had been slow t o r e a c t t o managed c a r e , such as
h e a l t h maintenance o r g a n i z a t i o n s , which h o l d down c o s t s
but l i m i t p a t i e n t s ' choices o f p h y s i c i a n s and s e r v i c e s .
B i l l Would Create H e a l t h Care Board t o Oversee S t a t e w i d e
Plan
By NORMA LOVE
A s s o c i a t e d Press W r i t e r
CONCORD, N.H. (AP) Feb 15 -- I t ' s t i m e t o c r e a t e a home remedy
or be f o r c e d t o swallow a p o t e n t i a l l y b i t t e r f e d e r a l p i l l ,
u n i v e r s a l h e a l t h care advocates t o l d a Senate committee.
A group l e d by Sen. B e v e r l y H o l l i n g w o r t h , D-Hampton,
urged t h e P u b l i c I n s t i t u t i o n s , H e a l t h and Human S e r v i c e s
Committee on Monday n o t t o w a i t f o r t h e f e d e r a l government
t o d i c t a t e a h e a l t h care p l a n t o s t a t e s .
H o l l i n g w o r t h proposes s e t t i n g up a h e a l t h care
a u t h o r i t y t o develop a s t a t e p l a n g u a r a n t e e i n g u n i v e r s a l
coverage by 1997. The p r o p o s a l a l s o would guarantee
consumers have a say i n what t h e s t a t e adopts.
�S12280
CONGRESSIONAL RECORD — SENA! E
September 23, 1993
Additionally, we know somewhere beMake no mistake alwut I t . Amerl- programs for which there Is already ex- tween 70 and 80 percent of the Ameristing
duplication
In
the
market,
and
canB, the Govemment will be ordering
Increasing cosU, have been the result ican people are reasonably satisfied
u« to "contribute."
with the manner In which they protect
Now. most of us grew up with Web- of Goverament control of cable tele- themselves with health coverage and
vision.
WheiL_GQvenunent_
begljMto
ster's denmUon of "contribution" In
the quality of health delivery that they
mind. We thought that there was some- control the health care of Americans, receive In this country. I f we picture a
thing vaguely voluntary about a con- It win oTriy^^ase the plight- o f a I e « . chart and we have 80 to 90 percent of
tribution. Most of us believed that any AfiaTfhgnwe are taking a look at the the people who are covered, and 70 to 80
time we were ordered to do something problem that exlsU on the face of percent of the people satisfied. I t narIt was a "tax" or a "fee" or a "fine" or America with regard to the delivery of rows the scope of the problem.
some other kind of word, but I t was not health care, I t behooves us to solve the
Yet what we were Ulklng about In
problem that exists and not change the the President's speech last night is
a "contribution."
Now, as we begin to debate health system that benefits 80 to 85 percent of something that Is going to affect evcare reform, I tirge Americans not to be Americans better than any other sys- eryone, not just the people who have
caught up In words that sound comfort- tem In this world.
had some difficulty with this systeming, but to parse the real meaning of
Remember, the medical destination but everyone. So I t Is reasonable to
words and the real Intention of the leg- of the world Is the United SUtes of ask. If you currently have Insurance
islation that presumably will come be- America. Consumers of socialized, gov- and If you are currently satisfied with
fore us.
emment-controUed medicine from all what Is being delivered In the way of
Seven hundred billion dollars. Mr. over the world come here for the best health coverage In the United SUtes,
President, is not chicken scratch. and the latest medical technology. Our what win this change do to us?
Seven hundred billion dollars Is the neighbors to the north In Canada come
The first analysis that we have seen
cost of this program as estimated by down to get the care they must wait In suggesU, to create this overhaul that
the administration. Those of us who line for, lest their health be damaged affecU 100 percent, not Just the people
have been around Government for a l i t - In Canada.
who for one reason or another might
tle while may nnd I t difficult to reOur neighbors to the north In Canada not have Insurance or have become dismember the last time Govemment have a system that Is bankrupt. Two satisfied with the system, but everyoverestimated the cost of anything.
new hospitals In the prairie provinces one. If we are going to Impose what Is
The problem that we face Is that. In have been built, right across the border being suggested, another JlOO to JIM
order to make this program fall within from MonUna, and they are not going billion of new taxes to make the
that cost figure, we must now talk to be operated because they cannot be change. I t would certainly give me
about so-called mandatory caps or financed.
pause. As a i)er8on who has come out of
global budgets, amounts beyond which
There are things wrong and Ameri- the business community, I am sure it
we cannot spend.
cans know I t , with the American will give those I left behind In that
Mr. President, i f we get to the point health care system. But words of com- business pause. I f we are suggesting to
where we no longer can spend, then fort lacking In details will not solve them, as the President did last evening
presumably care will be denied or the
when he ran down the litany of Individcost will IncreaM, or taxes will rain the problem that exists and worries us uals and types of people who are golnk'
from some other place. But, presum- today.
Mr. President, I yield 10 minutes to to pay a good bit more money—youngably, when you reach the mandatory
er people, small buslnessest probably
the
Senator from Georgia.
cost cape, you cannot order care to be
even a number of large businesses—
The
ACTING
PBESIDEa^T
pro
temprovided for nothing. Or perhaps we
they are going to have to pay a good
pore.
The
Senator
from
Georgia
(Mr.
can?
deal more money to cause this program
But one must be suspect of the kind COVERDELL] IS recognized for 10 min- to come Into effect.
of care that could be provided for noth- utes.
I am reminded that we have just
Mr. COVERDELL. Mr. President, I spent 7 months In a bruising battle
ing. I doubt that there w i l l be a willing
thank
the
distinguished
Senator
from
provider at the other end.
over whether the American economy
The chairman of the Senate Finance Wyoming for yielding this time.
could withstand an enormous new u x
I , first, would like to commend the Increase. During the term of this adCommittee, having examined the flnanclng proposals, referred to them as President and First Lady for having ministration we have raised taxes J130
fantasy. I t behooves the people of brought to the forefront an Issue that billion, and the analysis of what this
America, the Senate of the United has been on the minds of so many proposal would cost Is that plus $20 or
SUtes, the House of Representatives of Americans for a considerable period of $30 billion. In other words, we spent '
the United SUtes. the administration time. I also commend the President for months fighting over whether or not
and others to examine carefully what having Invited extended debate from the economy could withstand tax leve.s
i t Is we are going to cast America Into. all sectors of our country, both par- of another $130 billion, yet we are now
We cannot bring through one act of the ties—the InvlUtlon to step forward and Ulklng about a proposal that COUJJ
Congress, one-seventh of the gross do- participate In this Issue that Is being cost anywhere from $100 to $160 blUlon.
mestic product under the heel and ever weighed by so many American families on top of the $130 billion, on top of the
watchful, total eye of the Government and businesses at this time.
$147 billion we put on the American
But I also rise to suggest that the economy just 30 months ago.
of the United SUtes, without disrupting great lines of economic commu- American i)eople should maintain a
I think probably our folks In smaii
very Inquiring mind and they should
nication.
town America and our cities struggUr*-'
ask
some
very
serious
questions
of
I t Is genuinely Important to examine
with Infrastructure are beginning ^°
what happens when the Government their Congress and of their President wonder what has happened In Washlntrenters Into the fray. Last year, Mem- with regard to the ramifications of ton If we are going to tax $147 billion
bers win recall, we were going to pro- health care reform.
The first thing I think the American and then $130 billion, and now here v.f
vide great relief to viewers of cable tely
evision. I t was going to answer our people ought to ask Is how Is this going are. again, talking about $100 to
consumers' prayers and complaints to be financed? I think that Is particu- billion. That Is $500 bUllon potential'.^
overnight. The Government was going larly pertinent when we undersUnd In new taxes In about a 36- to 48-montn
that 90 percent, 80 to 90 percent of the period.
to Uke care of us.
Can the American economy v.u >
And now we leam how. The Govera- American people today have Insurance. stand this? I think the American P*"'
ment Is going to Uke care of us by pre- In my SUte I t Is 90 percent. That pie need to renect very seriously o '
empting C-SPAN. the darling favorite ranges from SUte to SUte, but that Is that kind of a new burden.
of Members of the Senate. But many a significant portion of our population
Often, when I have had an opp
Amerloans do Uke to watch i t . And I t that Is currently participating In a protunlty to speak on the floor of the L ^
will no loncer be available. Mandated gram we say everybody should have.
�September 23, 1993
^1
•if.
CONGRESSIONAL RECORD—SENATE
S12281
The Clinton plan's global budgets and
Senate, I harksn back, as I think per- Jobe. The deserve a system that is rehaps you do, Mr. President, on the 1993 sponsive to their particular needs with- premium price controlB, which will be
elections. We ar« both pnxiucts of that. out resulting in excessive cosU or par applied arbitrarily, will further cause
Almost a revolatioB. In my SUte, we perwork requiremenU. Most of all, some insurers to drop oat of the marhad a 73-percent tumont. Unheard of. I they deserve to know that when they ket. This wUl result In reduced comdo not think they were turning out be- are sick or injured, they wlU get the petition and ultimately Increased
cause of the daallng^ personalities nec- medical attention that they need when costs. As we have seen with price conessarily that were running for public they need it without having to worry trols in the past, price ceilings typioffice. They were turning out because about losing their homes, savings, and cally serve to operate as price Qoors.
When the price controls are ultimately
there was a deep sense of frustration, financial security.
and they were saying to Washington:
Many Americans currently have good taken away, ss they inevitably wiU be
"Don't do things like you have been health care coverage at a reasonable once they've faUed, they will cause a
doing them in the past."
cost. For them, the objective of reform wave (rf hyperinflation in the health
They really were electing change In Is to ensure that they are able to main- care sector that wlU shock our econmany ways. They certainly were, In my tain their coverage no matter what omy. This, In turn, will force the GovSUte. I think they were, in the Presi- happens to them—without being sub- emmmt to further cut back on benedential election. They were asking for ject to unreasonable costs or having fits and ultimately to cut back on acchange. They were saying: "We don't their level of beneflU diminish. Other cess.
The CUnton plan may save the Govwant to do these things the way we Americans have no health insurance or
Inadequate coverage or coverage that ernment soma money in tbe short run
have been doing them."
I bave, Binoe that ttme, traveled a cosU a disproportionate share of their by imposing strong limits on Medicare
good Mt In this country and certainly iBoomee. For them, the obleetlve of re- and Medlcald-bat thia wlU be to the
tjutraslnnit my State. I haw had many, form is to ensore that they ara able to detrlmant of program beneflelailea. It
many vMturs Here frora all walks of obtain tAe fUl coverage that they la ImoosBlble ta ci^ a23» bilUon frem
Ufb, and On one mesBa^ that I hear truly need—coverage that wlU protect these peograma vtthoiik aubataotlaUy
over and over and over is: "We Just them when they are in—«t a cost that harming tha peopl* we aro tupDoeed to
be helping. These ooeta will ultimately
have too nradt grrverament tn our le affordable.
lives; we can't turn around withoat
So we need a system that meets the be shifted onto baalnesa, Of course, this
bumping into the government; we cant needs of all Americans. In developing issue ia somewhat academic because I '
run our huafnesa without govemment this torstem, we must ignore or com- agree with the dlatlagul&hcd Democrat
intervention at every step of the way; promise the Bitaations of the many Senator from New York, Senator MOT- I
we cant run our lives."
Americans whose needs are currently, NiHAN, that the proposed level of cuul
Blr. President, you know that there is being met. We must build upon tha iB Medicare and Medicaid are purej
a great dlBCOSston now about what is strengths of our current system—a S3r»- "ftotaay."
The Cllnt«Hi plan finanees itself
called Federal mandates, orders trom tera that la the envy of the entire
the Fedeo'al Ooremment to our local wmrld in terms of quality and techno- largely through the BavlBga it projects
comnranftles to do this and that, osu- logical excellence—to meet the needa will occur aa a raaalt of Ita reforms. It
attx laudable programs hut inflexible, of these who are not being served coi^ la cxtremelT unelaar how a plan that
untitraelXf burdensome wtthotit regard rently. While I agree with those who provldea S700 UlUon lo aew Federal
to how a local commrmltr can respond. say we need change, I do not agree that BpaaAtng will result In aavlnga or where
And so aa xon go tmm community to all change woaM be good. I b^jevaL^at thsee savtnga would coma froas. The
commtmltar. they are saying: "Yon t^e_change that ipguM renlEjromthi admiaiatratiaa sven has the gall to
claim that it» idan will cednca the defihave to remove thie burden that the Clinton hearth ca^^'jilan ireuM be
cit 1^ $81 Win on. They moat think that
Federal Ouveinment continues to put itS^-tonfar coaB&y:
on us."' They teH some of the most biTbe Clinton plan win either dramati- the Anarieaa peopte are prettr naive.
zarre storter of lilogfcal dealings with cally increase oar health care costs or In fact. It !• likely that the deficit wlU
the Federal boreaucracy.
dramatically decrease our quality of Increase as a reattlt of the uivreceWh3r am I talking about all this Fed- ears, depending on precisely how it Im- deoted aubaldlzatlos by Govemment
eral bm eauei acyT Because I believe the trfenwDts ita cost controls. Any health under their proposal—aubaldlsation of
American people, when they evaluate care refonn proiioaal that provides cov- tndlvldnals at all levels of Income.
History should teach oe thait projeoaO tte debate on bealth care referm, erage for tbe entire onlnaured popuought to aalr tbemsehree: Do they want lation while ensorlog aocesa to a Cad- tloBS of cosU fbr new social programs
a greater Federal role? Do they want illac standard benefiu package will in- sxe ^pteally underestimated, and estltike Federal Otivei uiueiit to ran the evitably tncreaae costa unless there are matea of cost savings are overestihealth dettvery eyatem in the United extremely strong mechanisms to con- mated. When the Medicare Program
tain such coets. However, if sucb mech- was enacted la 196&i It waa projected
States more than It already does?
I do not tMnk they do, but I guess anisms are too strong, quality will be that the coats of the ptogram la 1S90
compromteed. Tbe Clinton plan's high-; would be less than UA blllloa. The acthis debate wU) gtve ue an answer.
The health deUrery system in the ty regulatory approach ignores fun- tual costs in that year were over $100
United State* represents IS percent of damenUI laws of supply and demand,, bUllon. This underestimate of ever tenom* economy. One of the greatest prob- and will either bankrupt our country j fold should not be sorprlslng. It Is allems we have in the health delivery or destroy our health care infrastruc-jways the tendency of policy advocatos
to overestimate benefits and underestisysUun today is the Federal portion of ture.
It. We talk about the forms and the ad- The Clinton plan purporU to contain mate costs.
ministrative burdens of the health de- costs by relying on iU regional purThe Clinton plan will create yet anUvery system. Most of it is Imposed by chaeing alliances In conjunction with other huge Govemment entitlement
V£be Federal Oovemment.
global budgets limiting increases in in- program. To obtain political support, it
The ACTINO PRESIDENT pro tem- surance premiums. 'These ^purchasing offers a new health care aufasidy tbr
pore. Hie time of the Senator has ex- cooperatives are so highly regulated early retirees. This pro vision aloae will
tteat^ey will not be able to Induce coet the taxpayer over SM blUioa inipired.
Hr. tXyVBUUSLIj. Bfr. President, I stoong competition. Some viable com- tially. However. It wtll be far more
pi^ors will not be permitted by the costly to oar country tn the long run.
yieldtitefloor.
Mr. MoCAIIf. I believe that it is ee- regional alliancee to compete In the because tt win induce many iadlvlduala
sentfal that we refoim our health care market. Due to the rules of managed to retire early. TUa will occur Just
system. Amerteam deserve tbe eeeo- eompetltion whleb have been adopted when the ratio of workers to retlreea
nty of knowtnr that they will not lose by the admlnlstratton, those jriaas that will be the loweat in our hiateiv. aad
their bsaltik oare coverage If they get are la the market will be limited la we should be enoooraging peopte to re•lek^ or loeettnfr-fobor tf they change their Rexiumy to eempete rtgoroudy. tire later tn Ufa. Thta new tmprece-
.liiiiiiilK^
�S12282
CONGRESSIONAL RECORD —SENATE
September 23, 1993
Moreover, I am very concerned about
that it can allocate our re- the
dented subsidy may be good politics for claiming
projections of savings under the
sources
more
efficiently
than
the
marthe President, but it is horrendous polChafee plan. While this proposal is infiicy for our Nation.
"^The Secretary of the Treasury Is nitely more fiscally responsible than
The CUnton plan will also cause sub- even authorized under the Clinton plan the Clinton plan, it wiU not result In
stantial eoonomlo-hanlSHirto-enyjloy- to Impose payroll taxes on all employ- the savings that it claims will permit
ere and einpleifi«»- ®y imposing the re- ers in a SUte if the SUU does not us to phase in coverage of the entire
quirement that all employers must pay comply with Federal regulations. This population. You simply cannot expand
for the health insurance premiums of provision should make clear to the beneflU substantially without increastheir employees, many small and mar- public that the mandate for all employ- ing cosU unless you have a strong
ginal businesses will either become ers to pay their employees' premiums mechanism to contain coste or to alter
unviable or cut back on their oper- is actually a hidden tax on employers behavior to enhance efficiency. To the
ations. They wUl have no choice but to and employees. The administration at- credit of Chafee proposal, it does not
lay off workers, who will then be much tempU to make this hidden tax more Impose arbitrary cost controls as the
worse off than before reform. Low wage palaUble by limiting the employer ob- CUnton plan does. Unfortunately. It
workers wUl be most at-risk, because ligation to a specific percentage of its also does not induce sufficient cost
health beneflU constitute a large per- payroll. However, this just means that consciousness among consumers to encentage of their overall wage and bene- the general taxpayer will have to pay sure reduced cosU through enhanced
flU package. A recent study by the the remainder, or more Ukely, it will efficiency.
^_
„ ..v
Employment PoUcy Institute esti- Just add to our astronomical Federal
I believe that we can achieve aU that
mates that as many as 3 million Amer- deflclt and debt.
the CUnton and Chafee plans hope to
icans could lose their Jobs.
By contrast to the CUnton plan, the achieve without the reliance on purIn the reaUurant catering industry
chasing alliances to contain coste or on
alone, this study found that labor cosU Chafee proposal developed by some of speculative savings to finance exmy
Republican
coUeagues
is
decidedly
could rise 19 percent, resulting in
I)anded access. This can only be done
800 000 lost Jobe. The increased labor preferable. It does not impose a man- by dramatically increasing the cost
date
on
employers
to
pay
for
the
precos'te WlU. of course, be passed on to
consciousness of consumers, and allowconsumers. We should i ^ reeiise that miums of all their employees. Yet, it ing consumers to choose who will prothe employer mandate in the CUnton responsibly ensures that Americans vide their care and how they receive 1
proposal U reaUy an intellectually dis- will be able to obtain health Insurance. that care. Unless we impose this high
honest way of Imposing a new tax on It does not Impose arbitrary global level of personal responsibility and
the American public. It Is the eco- budgeU or price controls on the health cost consciousness, competition will
nomic equivalent of a 7.9-percent pay- care sector, but Induces cost contain- offer only limited success in containing
roll tax. Uke other taxes, it will dis- ment through strong price competi- cosU while maintaining quality. The
tion. While I do not favor the use of
courage, eooBomlc-_ACtlvlty^_8acrifl
more cost conscious consumers are, the
jobs, and result ln~3If6ercosts purchasing cooperatives, at least the more competitive the market wlU be.
alliances
in
the
Chafee
plan
are
not
Imthroughout the economy.
_
As a result, I support reform which
mandatorily on employers. The
It is amuaing to me that one of the posed
would guarantee access to protection
Chafee
plan
is
not
the
bureaucratic,
major concerns of the administration regulatory disaster that the Clinton against catastrophic illnesses and Injuin develo^ng iU plan was to simplify proposal is.
ries for all Americans. I want to make
our health care system. Yet, they have
very clear what I am talking about
In
fact,
there
are
some
elemenU
of
numaged to develop the most comwhen I discuss such catastrophic covthe
Chafee
proposal,
and
even
a
few
elepUcated. bureaucratic, regulatory laberage. I am definitely not talking
menU
of
the
CUnton
plan,
that
I
yrinth that this country will ever have
about the coverage that was included
strongly
favor.
For
example.
It
is
long
seen. Even according to the adminisin the Catastrophic Care Act of 1983.
overdue
that
we
pass
the
small
market
tration's own estimate, the new buThat was coverage that many Medicare
reaucratic stmcture wiU cost $2 bU- reforms that would prevent insurers beneficiaries did not want or were alfrom
ISIacrlmlnatlng
against
people
llon. If passed, we would be entrusting
ready paying for. I introduced the bill
the health care of our Nation to the with preexisting conditions, amd that that ultimately repealed that ill-conwould
prevent
them
from
dropping
ensame Oovemment that Vice President
sidered legislation. The primary lesson
GoRK recently said does not work and rollees or increasing their premiums of that episode, which we must keep in
when
they
get
sick.
It
Is
absolutely
esmust be reinvented.
sential that health insurance is fully mind now, is that we should not pass
) It is absolutely amazing the level of porUble. Also, provisions In the Chafee major new health care legislation until
bovemment intervention and intrusion pl«m to reform our broken malpractice the American people understand It ana
'of this plan into tho private market sysUm and to ensure administrative are ready to support it, particularly
and private lives of American citizens. efficiency have my fUU and enthusias- thefinancingprovisions.
For example, the new Federal National tic support.
The catastrophic coverage that I am
Health Board has the power and obligaproposing now is coverage of all costs
While
I
applaud
the
efforU
of
my
Retion to Issue regulations for the nabeyond a specified large deductible m
tional health care budget and to en- publican coUeagues in trying to make the event that an individual or houseClinton managed competition ap- hold incurred extraordinary heal in
force that budget. Despite all that we the
viable, I have some fundamenhave learned from the Sovieto about proach
cosU in a single year-such
tal concerns about this approach to care
the ineffectiveness of centralized plan- health
cosU for cancer, heart disease, braii
care
reform
that
made
It
imposning, it assumes that a board of bu- sible for me to support and cosponsor Injury, or other major chronic llinfs
reaucraU can manage the huge health their plan. I am opposed to the concept or dlsabiUty. This is the coverage tna^
care sector—one-seventh of our econ- of using purchasing alliances, even If Americans tmly need te ensure tn
omy—better than the decentralized de- entirely voluntary, to provide access to care they require in the event of a tr
cisions of Uie market.
health-insurance. Although the alli- health crisis. It will protect them tro^^^
Under their plan, the Secretary of ances used in the Chafee plan are fairly losing their homes and everything "
Health and Human Services has the innocuous, they open the door to the they have worked for when such cri ^
power to determine accepuble drug expansion of such alliances to the arises. Moreover, all Americana D»
prices. It is uncertain how she will quasi-governmental agencies con- an interest in insuring catastropi^'^^
make such lofty determlnanU con- templated in the Clinton proposal. I be- coste. because we must all 1*^^,
fident that she wiU not be creating a lieve that this extension of initial au- those who do not have such covers
strong disincentive for companies to thority is almost IneviUble and should and who become severely lU^ _,ouid be
develop the drugs that our citizens make us extremely wary of developing
Such catastrophic coverage w
need—poaaibly a cure for cancer or such a system. It wiU IneviUbly result available through the market
even AIDS. Again, the administration in a reduction of individual choice.
people who have Incomes large
(exhibits remarkable arrogance in
�October 5, 1993
S13049
CONGRESSIONAL RECORD—SENATE
natives to the MLS so that by the mld1990'B i t could have a meaningful basis
for comparing the system's capabilities, benefite, and coste.
To prevent the FAA from going forward with a potentially wasteful and
duplicative project, this amendment
expresses the sense of the Senate that
the FAA should not proceed to f u l l production of the MLS until i t determines
whether other altematives to the current system can meet i t needs i n a
more cost-effective manner. I f passed,
i t would put the FAA on notice that i t
should explore other less costly alternatives to the MLS before making such
a large capital Investment. In my opinion, we should not go forward with a
new precision landing system i f an existing one can be enhanced to meet our
needs at a fraction of the cost.
I understand that a lot of hurdles
must be cleared before the GPS can become a viable alternative to the MLS.
More testing will have to be done by
the FAA to make sure that the satellite-based technology w i l l be able to
work safely and effectively.
There are also political concerns. The
FAA agreed with the ICAO to go to the
MLS by 1998, and some foreign countries have expressed concern about the
FAA going forward with a navigation
system which was developed by the Defense Department. However, i f these
obstacles can be overcome, the potential savings for the taxpayers could be
significant. I f you want to make a
sutement for pmdence and fiscal responsibility, I urge you to support this
amendment.
Mr. LAITTENBERO. I thank my colleague, the Senator from New Jersey,
•for his amendment, and would be happy
to accept i t . Like him, I believe I t puts
the FAA on notice that i t w i l l have to
seriously consider alternatives to the
MLS before moving forward f u l l production. I n testimony before Congress,
officials from the FAA have said that
the agency w i l l have enough information at Its disposal by the end of 1995 to
decide whether I t would be necessary
to go forward with full-scale production of the MLS. This amendment provides an even greater Incentive for the
agency to do so.
Mr. BRADLEY. I thank the Senator
for accepting my amendment and I
thank him for his leadership on this
ImporUnt bill.
Mr. DORGAN. Madam President, during the recent debate on the energy
and water appropriations bill, I did not
have an opportunity to comment here
on the amendment by Mr. BRADLEY.
So, at this time I wish to voice my opposition to this apparently well-Intended, but poorly targeted, amendment to cut the funding provided for
Investigations, construction, and operations of water-related proJecU for the
Bureau of Reclamation and Corps of
Engineers.
I recognize appropriations for the
Corps of Engineers were increased this
year. However, I must note that the increases are largely to fUnd the very
projecte that the author of this amendment has authorized In his own subcommittee. In addition, the devasUtIng flooding In the Upper Mississippi
and Missouri River basins this year
means substantial added costs for corps
operations i n fiscal year 1994.
In particular, however, I question the
need to single out the Bureau of Reclamation construction program for further cute for next year.
The Bureau's constmction spending
has been cut sharply i n recent years. I t
was $668 million Just 2 years ago, and
the Senate committee has proposed
$461 million for next year. In fact, that
$461 million represenU an additional
cut of $10 million from the 1993 level. I f
we are looking for areas of excessive
Federal spending, I don't believe the
Bureau's constmction fund Is a fair
candidate at this juncture.
Also, I wish to thank the chairman
and his committee for the $35 million
appropriation to continue progress on
m r a l and municipal water Improvements for the Garrison diversion
project. That project In North DakoU,
as many In this body know. Is long,
long past a reasonable completion date
and we should finally provide the fUnds
and the congressional directives to
complete I t for the benefit of North Dak o U resldente.
I also appreciate the funding the
committee has provided for study of
flood control Improvemente along the
Red River of the North at Orand Forks,
ND. The Grand Forks community has
been repeatedly threatened by flooding
over the years, and I am pleased we can
start the process toward better longterm flood protection for that community.
Mr. LAUTENBERG. Madam President, I think that my colleague from
New Jersey has an excellent point to
make here. Technology Is changing
rapidly. I t Is Improving.
I support his eense-of-the Senate resolution.
Mr. D'AMATO. Madam President, I
join In supporting this reaolutlon.
The PRESIDING OFFICER. I f there
Is no further debate, without objection,
the amendment Is agreed to.
So the amendment (No. 1016) was
agreed to.
Mr. BRADLEY. Madam President, I
move to reconsider the vote.
Mr. D'AMATO. I move to lay that
motion on the table.
The motion to lay on the table was
agreed to.
The PRESIDING OFFICER (Mr.
Bryan). Who seeks recognition?
Mr. LAUTENBERG. Mr. President, I
suggest the absence of a quomm.
The PRESIDING OFFICER. The
clerk w i n call the roll.
The legislative clerk proceeded to
call the roll.
Mr. D'AMATO. Mr. President, I ask
unanimous consent that the order for
the quomm call be rescinded.
The PRESIDING OFFICER. Without
objection, i t Is so ordered.
AMENDMENT NO. IOU, AS MODIFIED
Mr. D'AMATO. Mr. President, I ask
unanimous consent that Amendment
No. 1011, by Mrs. Hutehlson, agreed to
yesterday, be modified by language
which I now send to the desk.
The PRESIDING OFFICER. Without
objection. I t Is so ordered.
The modification is as follows:
On page 37, line 12, strike "72,600,000" and
Insert the following: "$3,300,000 shall be for
the RAILTRAN Corridor project of Dallas,
Texas and Fort Worth, Texas, and
$69,300,000".
Mr. D'AMATO. Mr. President, this Is
a modification of an amendment accepted yesterday. There are no budget
Implications. I t is just corrective language. I t has been cleared by the majority.
Mr. LAUTENBERG. I suggest the absence of a quorum.
The PRESIDING OFFICER. The
clerk will call the roll.
The legislative clerk proceeded to
call the roll.
Mr. COCHRAN. Mr. President, I ask
unanimous consent that the order for
the quomm call be rescinded.
The PRESIDING OFFICER. Without
objection, I t Is so ordered.
Mr. COCHRAN. Mr. President, I ask
unanimous consent to proceed out of
order for I minute.
The PRESIDINO OFFICER. Without
objection. I t Is so ordered.
TARGETED REFORM OF HEALTH
CARE
Mr. COCHRAN. Mr. President, I bring
to the attention of the Senate an outsUndlng article that was written for
the Christian Science Monitor recently
by our colleague from Georgia, Senator
COVERDELL. The subject is "Target
Health-Care Reform."
In the article. Senator COVERDELX,
very accurately observes that the comprehensive proposal for reform that the
Clinton administration has suggested
to the Congress may be too much to digest and too much to pay for all at one
time. He suggests'lnstead trying to
Identify the most serious problems we
have In health care service delivery
and costs and put our emphasis on
dealing with those problems in an IncremenUl and targeted fashion rather
than the all-encompiisslng. and waytoo-expenslve approach that many are
suggesting the Clinton administration
plan will be.
I ask unanimous consent, Mr. President, after complimenting the distinguished Senator for this outetendlng
article, that a copy of the article be
printed In the RECORD.
There being no objection, the article
was ordered to be printed In the
RECORD, as follows:
TARQET HEALTH-CARE REFORM
(By Paul Coverdell)
I commend President Clinton for bringing
the Issue of health-care reform to the fore-front of public debate. But his speech last
Wednesday night to Congress only marks the
beginning of what mast be a long and protracted review of his plan.
�S13050
October 5, 1993
CONGRESSIONAL RECORD—SENATE
At the core of this review Is tbe Issue of D E P A R T M E N T
OF
TRANSPORhow much we want the federal government
T A T I O N A N D R E L A T E D AGENto dictate every aspect of health care in the
CIES APPROPRIATIONS ACT, 1994
United States. In the final analysis, a
The Senate continued w i t h the conhealth-care reform plan for this country
must envision the govemment as a partner sideration of the b i l l .
to the public, not as a manager. The very asMr. D ' A M A T O addressed the Chair.
pects of our nation's health care In need of
The PRESIDING OFFICER. The Senrepair are those currently managed by the a t o r from New Y o r k Is recogmlzed.
federal govemment, namely Medicaid and
AMENDMENT NO. lOlT
Medicare.
(Purpose: To express the sense of the Senate)
Tbe Clinton administration envisions a
Mr. D ' A M A T O . M r . President, I send
powerful federal entity that will coordinate
with state planning boards on tbe delivery of to t h e desk a sense-of-the-Senate
health care In the given state. Employees amendment t h a t was discussed yesterwill receive their health care through a pay- day I n t h i s Chamber. A colloquy was
ment, or tax on their companies that will be held between Senators W A L L O P , S I M P mandated. The revenues will flow to these SON, and LAITTENBERO. I t concerns
state boards, which will decide what kind of radar i n s U l l a t l o n s a t m i l i t a r y and c i coverage Is adequate and will determine who v i l i a n joint-use alrporte.
the providers will be.
The PRESIDING OFFICER. T h e
Whether I t Is a wage-based premium, pay- c l e r k w i l l report the amendment.
roll tax or any other form of tax. saddling
The legislative c l e r k read as follows:
employers with the cost is the surest way to
The Senator from New York (Mr.
lose jobs, slow the economy, and fail to solve
the need to reform tbe health-care system. D'AMATO), for Mr. WALLOP, for himself, and
The National Federation of Independent Mr. SiMPBON, proposes an amendment numBusiness and the National Restaurant Asso- bered 1017.
ciates estimate Job losses under the Clinton
Mr. D ' A M A T O . M r . President, I ask
plan would range form between 1 million and unanimous consent t h a t reading of the
3 million Jobs over five years.
amendment be dispensed w i t h .
There Is, however, an alternative to a govThe PRESIDINO OFFICER. W i t h o u t
emment run plan: an option that seeks to objection, i t Is so ordered.
Implement "targeted reform" to preserve
"The amendment is as follows:
the best elements of our existing system
At the appropriate place in the bill, insert
while working incrementally at areas needing reform. Under this plan, I believe we the foUowing:
SEC. . I t is the sense of the Senate that
must:
the Secretary of Transportation should take
Ensure portability and greater access to such action as may be necessary to revise
health care.
the Department of Transportation's cost/
Make the users—the patlentfh-more in- benefit analyses process to fully take provolved and accountable for their medical jected military enplanement and cost savcoverage.
mgs figures Into consideration with regard
Work toward medical malpractice and tort to radar installations at joint-use civilian/
military
airports. I t is further the sense of
reform.
the Senate that the Secretary of TransporEngage in administrative reform.
Alter the antitrust provisions so that high- tation shall require the Federal Aviation Adtech equipment and services can be shared ministration to reevaluate the radar needs
at the Cheyenne, Wyoming Airport, and
among institutions.
Review those people in my state of Oeor- enter into an immediate dialogue with offigla—and throughout tbe nation—who are un- cials of the Wyoming Air Ouard, F.E. Warren
insured so that we can gain a true under- Air Force Base, and Cheyenne area leaders In
btandlng of who they are and whether they the phase I I radar installation reevaiuation
of the Federal Aviation Administration and
are denied access to health care.
adjust cost/beneflt determinations based to
I also believe that the public supports his some appropriate degree on already provided
targeted approach to reforming our health- military figures and concems and other
care system.
^
emplanement projections in the region. The
On a national level, according to a CNN/ Senate lUrther believes that the Secretary of
USAToday/Oallup poll taken in May, more Transportation should report the results of
thnn 81 percent of the respondents are satls- this reevaiuation concerning the Cheyenne
Airport's and Southeast Wyoming's aircraft
flod with their health Insurance.
In Qeorgia. 88 percent of the citizens cur- radar needs to Congress within 60 days folrently are insured, while U percent are not. lowing the date of the enactment of this Act
And when Oeorglans are asked whether and explain how military figures and conthey are willing to make certain changes in cems win be appropriately solicited and
the current system to control health-care fully utilized in future radar decisions Incosts and provide health-Insurance coverage volving Joint-use airport facilities.
for uninsured people, the results are telling:
Mr. D ' A M A T O . M r . President, t h i s
Only 32 percent are willing to l i m i t their amendment haa been cleared, as I have
freedom to choose their doctor or hospital,
while 66 percent are not: only 29 percent are Indicated, b y b o t h sides. I urge I t s
willing to pay a larger share of health-care adoption.
The PRESIDINO OFFICER. Is there
costs out of their own pockets, while 66 percent are not willing; and 71 percent are un- f u r t h e r debate on t h e amendment? I f
willing to pay more In federal income taxes, not, w i t h o u t objection, the amendment
while 26 percent are.
Is agreed t o .
The amendment (No. 1017) was agreed
If we put our minds to the tme problems
that exist In . the health-care delivery sys- to.
tem, we can strengthen what works, fix what
Mr. L A U T E N B E R G . M r . President, I
is broken, and retain the superior quality of move t o reconsider the vote b y which
care this nation has come to expect. This is the amendment waa agreed to.
what the public wants, not another govemMr. D ' A M A T O . I move t o l a y t h a t
ment-mn program. The public is right.
m o t i o n on the table.
The m o t i o n t o l a y o n t h e U b l e was
agreed t o .
ORDER OF PROCEDURE
Mr. L A U T E N B E R G . M r . President, I
have a unanimous-consent request t h a t
a t 2:15 when we reconvene Senator
B U R N S be recognized t o offer an amendment.
The PRESIDING OFFICER. W i t h o u t
objection. I t Is so ordered.
Mr. G R A H A M addressed the Chair.
The PRESIDINO OFFICER. The Sena t o r from F l o r i d a [Mr. G R A H A M ] , i s recognized.
HIGH-SPEED GROUND
TRANSPORTATION
Mr. G R A H A M . M r . President, I a m
very pleased t h i s a f t e r n o o n t o offer m y
comments i n support of an I m p o r t a n t
provision w i t h i n t h i s appropriations
b i l l . T h a t Is t h e provision r e l a t i n g t o
high-speed ground t r a n s p o r t a t i o n .
T h r o u g h the leadership o f Senator
LAUTENBERG,
Senator
D'AMATO,
and
the other members of the c o m m i t t e e ,
the Senate w i l l , I hope, s h o r t l y approve
f u n d i n g f o r fiscal year 1994 of over $107
m i l l i o n f o r high-speed r a i l , i n c l u d i n g
$27.9 m i l l i o n f o r research and developm e n t o f magnetic l e v l U t l o n transporUtlon.
Mr. President, as t h e Senator f r o m
and f o r m e r Governor of a S U t e w h i c h
haa shown great Interest I n high-speed
r a i l . I know t h a t y o u are aware of the
worldwide demand f o r these technologies. I n recent weeks, the South
Korean Government has selected the
French T G V system f o r Ita high-speed
r a i l aervlce f r o m Seoul t o Pusan. The
Government expects 80 m i l l i o n passengers a year w i l l u t i l i z e t h i s highspeed r a i l service I n Korea when i t i s
f u l l y developed.
The Taiwanese Government Is plann i n g a high-speed t r a i n system t o i n crease t h e t r a v e l i n g efficiency of Ite
citizens.
The European C o m m u n i t y recently
announced ite c o m m i t m e n t of over $112
b i l l i o n t o expand Europe's I n t r i c a t e
system of supertralns.
I a m pleased t o report, M r . President,
t h a t closer t o home t h e S U t e of Florida Is c o m p l e t i n g plans t o issue a request f o r proposala i n early 1994 t o provide high-speed service connecting
M i a m i , Orlando, and Tampa.
Yet, M r . Preaident, a generation has
passed since Japan's b u l l e t t r a i n began
service, and a decade since Europe
began high-speed t r a i n service. A n d we
In the U n i t e d S U t e s s t i l l do n o t have a
high-speed r a i l system operating I n any
of our c o m m u n i t i e s .
Why Is t h i s the case? P r i m a r i l y , I t Is
because high-speed r a i l la missing the
one f a c t o r w h i c h has been essential t o
the successful deployment of every
other mode o f t r a n s p o r t a t i o n I n U.S.
h i s t o r y ; t h a t Is, substantial governm e n U l support and partnership.
T h r o u g h o u t our h i s t o r y , Goverament
has been I n a t m m e n t a l I n spawning the
development o f e v e r y t h i n g f r o m the
canal system I n t h e early p a r t o f the
�10./14/93
16:84
NO. 985
United,
FOR IMMEDIATE R2IJ5ASB
Wamommmm
WeduBBday, October 13, X993
COHTACTI CHRIS ALLEN
202/224-8049
COVERDELL CONCERNED WITH GOVERMMBHT TiWKEOTER OF HEALT'H CARE
WASHINGTON, DC ~ U.S. Senator Paul Coverdell (R-GA) today
said, "The debate over the Clinton health cere proposal comes
dcwn to one c r i t i c a l question. Do we turn over our entire health
care industry — 15% of our nation's economy — to the goverranent
to control, or do we seek ways to strengthen competition and
choice in the system so that our families are in control of their
ovm health care?"
Coverdell'» conanents cam© during a press conference on
Capitol H i l l , where he was joined by U.S. Senators Phil Granm (RTX) and John McCain (R-AZ) to discuss their oix-state Health Care
"Town Meeting" tour. On October 11 and 12, the Senators met with
physicians, hospital administrators, business representatives,
and concerned citizens in Richmond, Nashville, New Orleans,
Miami, Atlanta, and Greenville, South Carolina for an open
discussion of the Clinton health care plan and alternatives to
reforming the system.
"No one i s arguing for the status quo in our health care
syBtem. But there are fundamental concerns ever how we can
im5>rcve health care delivery. Clinton i s calling for radical
surgery. I don't agree. I believe we can target our refonn
efforts to fix what's broken and retain the superior quality of
health care this nation has come to expect.
"Although the President has yet tc present his health care
plan to Congress, we do know that the plan he and Hillary Clinton
have developed w i l l f a l l s^juarely behind the belief in a
government-run health care system. Clinton envisions a whole new
branch of the Federal govemment managing health care,
administered by seven political appointees. I t w i l l be up to
this new bureaucracy to coordinate the delivery of health care.
"Yet, the very aspects of our health care system in need of
repair are those currently managed by the Federal govemment.
Why then, in this case, would we be willing to turn the entire
system over to the Federal government. Under this plan, Clinton
w i l l Federalize health care, while saddling the costs onto
families and small businesses. This i s a prescription for job
loss, a slowed economy, and a failure to control the costs of
health care," said Coverdell.
Coverdell stressed to the Health Care Forum participants
that these types of discussions or forums are c r i t i c a l " i f we are
to get past the SO-second sound bites coming from the White House
and get down to the facts in this issue."
He cited a Washington -post, poll conducted from October 7
through 10, X993 showing that almost 80% cf the public now doubts
Clinton has a con^lete pian for reforming the health care system.
The poll also suggests that worries are increasing about the
costs and impact of the Clinton plan on health care services and
the U.S. economy.
"Americans must begin talking about the Clinton health care
proposal at the dinner table with their families, at the office
with their oo»worker8 and in their communities. This issue i s
too important to l e t Washington insiders decide the fate of the
nation's health care system alone," said Coverdell,
— 30 —
515
�Gramm
weighs in
on health
Conservative plan
seeks no new taxes
By J. Jennings Moss A
THE WASHINGTON TIMES
T
A group of conservative Republicans unveiled a health care reform
bill yesterday based on the dual
premise that the American system
of health care is not seriously broken
and that President Clinton's plan
goes too far.
"It IS built on the basic principles
that Americans have always valued
and have never failed us," said Sen.
Phil Gramm, Texas Republican and
chief author of the plan. Those principles include consurrigi_cbai£e and
private competitio
In contrast, l&r. Gramm dJ
scribed Mr. ClintorVs'ptan at "tQCfal
ized medicine" with government
taking control of health care. The
senator said of the administration's
promise to streamline the system
and cut bureaucracy; "It makes me
wonder if we're engaged in a debate
or if we're trying to tell a joke about
public policy."
One of the biggest differences is
how the two plans are financed. Both
make changes to Medicare and Medicaid to help finance the reforms, but
Mr Clinton's also calls for $105 billion in new taxes. Mr. Gramm's calls
for no new taxes.
The package Mr Gramm and others advocate is expected to be the
final major reform proposal thrown
into the health care hopper Several
— including Mr CUnton's — have
been fleshed out philosophically but
still lack details.
Of all the proposals, yesterday's
entry is the most conservative and
the one that puts the most faith in the
current system.
At the opposite end of the spectrum is one backed by liberal Democrats that calls for the federal
government to replace insurance
companies and become the sole purchaser of health care for Americans.
The others are somewhere in the
middle. Mr Clinton would require all
businesses to purchase health care
for their employees, impose a standard benefits package, limit health
costs and create a national health
board to monitor the system.
The two remaining plans include
one with the backing of 23 Senate
Republicans that requires all people
to have health insurance and a bipartisan bill from moderates in both
parties that relies on forcing more
competition among insurers.
"We are now going to be engaged
debate," said Sen. John
McCain,Vrizona Republican and a
the Gramm plan. "We have
now presented a stark alternative to
the American people of the Clinton-
see HEALTH, page AiS
THURSDAY, OCTOBER 14.1993
ANOTHER VISION
FOR HEALTH CARE
A group of conservative Republicans, led by Sen. Phil Gramm of Texas,
A group of
yesterday iunveiled their proposal to Improve the nation's health
system, the
^^^^^
th main points:
• The program would cost $144.2 billion from 1995-99, paid for with
changes to the Medicaid and Medicare programs that would save $189.7
billion. The extra $45.5 billion would go to reduce the deficit.
• A medical savings account program would be set up in two parts. The
first would be for a catastrophic insurance policy to which employers and
employees would contribute a total of $3,000 each year
The second pari would be an account to handle conventional medical
coverage. Any contributions above the level needed for catastrophic
insurance would be deposited in this account. Employees could convert any
unused money to personal use at the end of each year
• Employers would continue to receive a tax break if they offered their
workers at least three options: continuing their current health insurance,
allowing them to take the employer contribution and buy into a health
maintenance organization or other health arrangement, and permitting
them to deposit the employer contribution in a medical savings account.
• Self-employed workers would be allowed to exclude from their income a
percentage of their medical insurance costs.
• Small businesses would be allowed lo pool their health insurance
purchases.
_ Insurance companies could not refuse to cover anyone for an existing
condition but could charge them higher premiums.
_ People ineligible for Medicaid and with incomes below the poverty level
would receive a federal credit to buy insurance.
• Insurance companies would be allowed to charge those with unhealthy
lifestyles and habits higher rates.
J The malpractice system would be reformed partly by placing a $25(),000
cap on punitive damages and by limiting lawyers' contingency fees to 25
percent^
The Washington Times
HEALTH
From page Al
esque, Kafkaesque" health care pro
rwsal, he said
Sen. Pau-KXffC?erdeTh Georgia
Democrat, Ai^d^that i n ^ o days of
hearings he, MV. GrSmm and Mr.
McCain held in six states on Monday
and Hiesday, he was stunned by the
anxiety of a "destabilization of the
health care community."
"This is not going to be a Beltwaywrestled-out idea," Mr. Coverdell
said.
/""'^^"^
Rep. Bill/Archer V Ttexas, the
ranking R ^ r M i a a y t n the House
Ways and Means Committee, said
the program is designed with the belief that "this health care system is
not badly broke."
' Our challenge is to have a pro
gram that will retain that quality .
and maintain the choice w^ulfLiSwk
ing on the problems," ^Ktr. ArdEe
said.
I
^ /
Clinton administratioh—Officials
say the president is trying to accomplish the same goal. They say they
are keeping what works with the
health care system — the quality of
care and the ability of many to
choose their doctors — and fixing
what's wrong — by giving coverage
to the 37 million people without insurance and controlling costs.
Asked about the addition of the
Gramm proposid to the debate, Clinton health care spokesman Kevin
Anderson called it "the latest and the
silliest" proposal.
"It doesn't work. It doesn't do anything. It's not reform," he said.
Mr. Anderson said of Mr.
Gramm's charge that the administration is advocating socialized
medicine: "The defenders of the status quo have been waving that
bloody shirt since the 1930s and it's
not going to work."
What the Gramm plan would do is
require employers to offer their employees at least three insurance options: their current plans, the option
to buy into other plans not coiuiected
with the employer and the chance to
establish a medical savings accoimt.
Employers who did not provide the
choices would not be able to take an
existing tax break.
The medical savings account is an
idea incorporated into all the Republican proposals to some degree. Mr.
Gramm would establish the account
in two parts: a $3,000 employeremployee deposit to pay for catastrophic insurance and another account without a limit that would pay
for standard medical coverage.
If money were left over in the second account at the end of a year, the
employee could keep the money. The
philosophy that guides medical savings accounts is that they encourage
people to make smart health care
choices.
Some of the key differences with
the Clinton plan include a provision
that would let all people with preexisting conditions have health insurance but allow insurers to chtu-ge
them up to 150 percent of average
premiums. The Clinton plan would
require coverage to go to everyone at
the same cost based on the plan people choose.
The Gramm plan would allow insurance companies to charge different rates to people if they smoke,
drink too much, are overweight or
"engage in other activities that are
harmful to their health." The Clinton
plan makes no such proposal.
�SOCIAL POLICY
HEALTH
Two Ideological Poles Frame
Debate Over Reform
P
resident Clinton's healthcare proposal dominated
the debate until last fall,
when the discussion moved from
the White House to Capitol Hill.
Now Congress and the country must choose from a smorgasbord of plans representing political interests from the far left to
the far right. None will pass
without multiple changes, and in
the end, the final result is likely
to include elements from most, if
not all, of the proposals.
At the liberal end, "single
payer" advocates support a
health-care system like Canada's
that would be regulated and financed by the government
through taxes.
On the conservative end, freemarket advocates want to keep
government involvement to a
minimum and require people to be more
cost-conscious when they buy health
insurance and health-care services.
Their favorite approach is the medical
savings plan that would allow consumers
to put aside money for health expenses.
An analysis of the two plans presents
the parameters of the debate and the
ideals driving different factions. But
unlike most fringe proposals, these have
significant support. If any bill is to become law, at least some members of each
constituency must feel their views are
reflected truly enough for them to vote
for a final bill.
Between the two extremes are several proposals that would use the government's legislative power to reorganize the health-care market but would
avoid resorting to day-to-day government involvement and cost controls.
Clinton's proposal (S 1757; HR 3600)
hews closer to that of single-payer advocates than to that of the free marketeers.
But it has diverse elements and resists
ideological classification. That gives him
some flexibility to tilt in one direction or
another to pick up the votes he needs to
have a majority.
But such adjustments will be delicate. He is walking a tightrope between
By Alissa J. Rubin
from his position that "there are
no lines in the sand." He reiterated his support for a comprehensive health-care overhaul on
Oct. 27 when Clinton brought his
plan to Capitol Hill. At that
time. Dole was a cosponsor of a
bill (S 1770) drafted by John H.
Chafee, R-R.I., which has the
same goals as the Clinto'.i bill
and shares many of its components.
Dole took a tougher stance in
November when he joined 23 other
Republicans to cosign a bill (S
1743) by Don Nickles, R-Okla.,
that would avoid government controls. At the same time, presidential hopeful Dick Cheney, the secretary of Defense under President
George Bush, began saying,
"There is no health-care crisis."
PATT CHISHOLM
By Jan. 2, Dole was a convert
to Cheney's view, which was quickly
the insistence of single-payer advocates
embraced by the party's conservative
that health care be guaranteed to all
wing. He told the NBC program
Americans and the Republican convic"Meet the Press": "My view is that I
tion that government involvement be
think there isn't a crisis. We've tried
kept to a minimum. He cannot afford to
to make that clear from the start."
alienate either side altogether.
Unless he moves too far to the right,
Dole's embrace of a more conservait looks like Clinton will have relatively
tive position heightens the power of
little trouble winning the single-payer
Republicans such as Sen. Phil Gramm
supporters; their bottom line — univerof Texas, whose medical savings acsal access and state options to try singlecount plan previously had been seen
payer plans — already are in the Clinton
as marginal to the health-care debate.
plan. The trickier liaison will be with the
The "medisave" idea has become so
Republicans, who recently began to dispopular with GOP senators that now
pute Clinton's premise that the country
Chafee has added it to his far more
is facing a health-care crisis. Further,
moderate proposal. (Gramm plan, p.
after a year of insisting that everything is
26)
negotiable. Senate Minority Leader Bob
But Chafee's plan remains essenDole, R-Kan., recently said that most of
tially a modified version of Clinton's,
the elements that underpin the Clinton
while the other Republican bills take a
proposal must go, including the state
different tack. That puts Dole in a
option to create a single-payer system
position of trying to bridge huge difstatewide. (Single-payer plan, p. 24)
ferences if he is to unite the GOP beDole and other Republicans also are
hind a common plan.
strongly opposed to Clinton's plan to
The emergence of competing plans
mandate that health care be purchased
in Congress signals the complexity of
through regional health insurance buythe political and policy battles ahead
ing cooperatives, to let the government
for the administration.
set caps on the annual increase in insurOn the following pages. Congresance premiums, and to require that emsional Quarterly examines the proposployers pay for a large portion of their
als on the far ends of the health-care
employees' health insurance.
spectrum: the medical savings plan
Dole's new stance is a departure
and the single-payer plan.
CQ
JANUARY 8, 1994 — 23
�SOCIAL POLICY
^9AVER SYSTEM^
T
Highlights:
A single-payer system would nationalize the health insurance industry
by instituting a universal coverage
plan under which the government
would collect premiums (in the form
of a payroll tax). Revenues would be
used to pay providers, who would
remain in the private sector.
The plan would feature free medical care for all Americans, who
would select their own doctors.
The system would be paid for
through a combination of federal
taxes, possibly including a payroll tax
of about 8 percent.
States would be responsible for
administering the plan and for keeping down costs.
Clients in existing government
health programs, such as Medicaid
and Medicare, would be brought into
the new system.
A national board would be set up to
oversee state implementation, set
national and state budgets and
determine criteria for qualified
providers.
24 — JANUARY 8, 1994
CQ
he lawmakers who advocate a
government-financed
healthcare plan known as the single-payer
system include some of the most liberal members of Congress: a former
Black Panther, an ex-welfare mom, a
daughter of sharecroppers, a socialist,
the two openly gay members of the
House and most of the Congressional
Black Caucus. Usually, they are not
known for their backroom clout or legislative successes. They hardly fit the
"new Democrat" label embraced by
President Clinton.
And yet as Congress begins its deliberations on how to overhaul the nation's health-care system, this group
of 92 House members and five senators finds itself with a seat at the bargaining table and good prospects for
emerging from the debate with some
semblance of victory.
Of the seven major health-care
bills on Capitol Hill, the single-payer
legislation (HR 1200, S 491) sponsored
by Rep. Jim McDermott, D-Wash.,
and Sen. Paul Wellstone, D-Minn.,
sits at the far left end of the spectrum.
It would create a Canadian-style system, nationalizing the health insurance industry by instituting a universal coverage plan under which the
government would collect premiums
and pay providers. The system calls
for price controls, heavy government
involvement and a severe reduction in
the medical industry's profits. The bill
effectively would kill the health insurance industry and create a massive
new tax program.
Critics say it would bring socialized
medicine — complete with inferior
care and long waiting lines — to the
land of capitalistic opportunity. Many
Democrats dismiss the proposal out of
hand; a year ago Clinton instructed his
health-care task force to remove the
single-payer concept from the list of
options.
Nevertheless, the concept has
strong support in Washington and beyond its Beltway. In polls and town
meetings and at a specially convened
citizens' jury set up by the Jefferson
Center of Minneapolis, many Americans have expressed support for the
idea of a single-payer system, often
preferring it lo other plans.
In the House, 12 committee chairmen and 36 subcommittee chairmen
are cosponsoring McDermott's bill.
Only Clinton and single-payer supporters have received a pledge from
House Speaker Thomas S. Foley, DWash., that the full House will vote on
their legislation.
"Their ideas are very powerful and
infecting the process," said Rep. Jim
Cooper, a Tennessee Democrat promoting his own voluntary, market-oriented
health-care revamp (HR 3222), which
envisions a much smaller government
role. "While single payer won't pass on
its own, it's still a factor in the debate."
Sen. Edward M . Kennedy, DMass., has abandoned his hopes for a
Canadian-style health system and is
backing Clinton's bill. " I don't believe
a plan that doesn't have the full support of the president could pass," said
Kennedy, chairman of the Labor and
Human Resources Committee.
Still, Kennedy helped persuade
the administration to make its bill
more inviting to single-payer supporters by easing the way for individual
states to adopt single-payer plans.
And he looks to the group for assistance in fighting efforts to defeat or
alter Clinton's plan.
"There will be a lot of pressure on the
administration and on those who support the administration program to cut
back," he said. "The single payers are a
very important and significant counterweight to those kinds of pressures."
The simple math of passing legislation convinces single-payer proponents such as Rep. Barney Frank, DMass., that Clinion needs the group lo
enact major health-care legislation in
1994. No other group on Capitol Hill
has fought as long for such massive
health-care revisions as single-payer
proponents. If Clinion cannot sell this
group on a major overhaul package, to
whom can he turn? And if Clinton is
committed to his goal of universal coverage, "then the single-payer people
are essential," Frank said.
Single-payer advocates are using
their leverage to fight for items that,
at a minimum, would make the Clinton bill more palatable lo them. Their
top priority is the guarantee of health
coverage for all Americans — an issue
that may be a turning point in the
debate, because many Republicans
and conservative Democrats are pressuring Clinton to forgo i l . Giving in lo
one side risks losing the other.
Single-payer proponents also want
Clinton to slick to his promise to let
states experiment with single-payer systems. If this option is retained, and
perhaps strengthened with financial
and regulatory incentives, single-payer
proponents could claim a real victory.
Simplicity and Savings
In the complex world of heallhcare reform, the single-payer approach
�SOCIAL POLICY
..-nn-amirm-.mMimm.
\'* rTn tBsa. tmM mm'
is enticingly simple. Relying primarily
on a new payroll tax now under consideration, the government would collect hundreds of billions of dollars to
pay for medical care for every American. State and local governments
would administer the program, receiving an annual budget for all health
expenses, and dispensing the money lo
certified providers. Patients would be
free lo choose their own doctors and
would not be charged copayments or
deductibles.
McDermott, a psychiatrist who
long has advocated moving toward a
Canadian-style system, touts his plan
as one that would use government
money but maintain the health-care
industry in the private sector.
After years of studying the issue,
the grass-roots group Citizen Action
now backs the single-payer plan.
"We came to believe i l is the easiest, simplest, clearest, cheapest solution that provides all citizens with
quality health care," said spokesman
Ed Rothschild.
Most of the Congressional Black
Caucus backs the single-payer approach, in part because these members believe it would distribute the
country's medical resources more equitably.
For others, the issue is personal.
As a doctor, McDermott has seen
firsthand what he feels are the flaws
in the existing system. As a former
welfare mother. Rep. Lynn Woolsey,
D-Calif., knows what i l is like to
struggle for food, child care and
health insurance.
Joe Moakley, D-Mass.,Hhe powerful chairman of the House Rules Committee, says he came to Congress in
1973 expecting to vote for Kennedy's
universal health-care bill. Today, the
dean of the Massachusetts delegation
says he supports the McDermott bill
because he feels it would provide adequate medical care for everyone.
Besides simplicity, the singlepayer approach promises great administrative savings. The Congressional
Budget Office, the well-respected nonpartisan research arm of Congress,
ruled in December that McDermott's
bill would reduce national health expenditures by about 6 percent in 2003.
Besides achieving administrative savings, McDermott says, his bill would
force doctors and states to live wiihin
a reasonable budget.
Yet for all its simplicity and potential savings, the single-payer bill faces
enormous — many say insurmountable — hurdles. "Something about the
I Ffsv
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•nai
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mm msm eiff.'
Single-Payer Cosponsors
Introduced in the House on March 3,1993, by Jim McDermott, D-Wash., the
American Health Security Act (HR 1200) is commonly known as the singlepayer health-care plan. Of the 91 House cosponsors, 90 are Democrats, and
one, Bernard Sanders of Vermont, is an independent. (The list includes the five
Democratic delegates, who have limited voting privileges.) Cosponsors are:
Neil Abercrombie, Hawaii
Gary L. Ackerman, N.Y.
Thomas H. Andrews, Maine
Xavier Becerra, Calif.
Anthony C. Beilenson, Calif.
Howard L. Berman, Calif.
Sanford Bishop, Ga.
Lucien E. Blackwell, Pa.
Robert A. Borski, Pa.
George E. Brown Jr., Calif
William L. Clay, Mo.
Eva Clayton, N.C.
James E. Clyburn, B.C.
Barbara-Rose Collins, Mich.
Cardiss Collins, III.
John Conyers Jr., Mich.
William J. Coyne, Pa.
Ron de Lugo, Virgin Islands
Ronald V. Dellums, Calif.
Julian C. Dixon, Calif
Don Edwards, Calif.
Eliot L. Engel, N.Y.
Lane Evans, III.
Eni F. H. Faleomavaega, Am. Samoa
Sam Farr, Calif.
Cleo Fields, La.
Floyd H. Flake, N.Y.
Harold E. Ford, Tenn.
Barney Frank, Mass.
Elizabeth Furse, Ore.
Sam Gejdenson, Conn.
Sam M. Gibbons, Ra.
Henry B. Gonzalez, Texas
Luis V. Gutierrez, III.
Dan Hamburg, Calif
Earl F. Hilliard, Ala.
Maurice D. Hinchey, N.Y.
George J. Hochbrueckner, N.Y.
Eddie Bernlce Johnson, Texas
Joseph P. Kennedy II, Mass.
John J. UFalce, N.Y.
Tom Lantos, Calif.
John Lewis, Ga.
Carolyn B. Maloney, N.Y.
Thomas J. Manton, N.Y.
Edward J. Markey, Mass.
Matthew G. Martinez, Calif.
Frank McCloskey, Ind.
Cynthia McKinney, Ga.
Carrie Meek, Fla.
George Miller, Calif
Patsy T. Mink, Hawaii
Joe Moakley, Mass.
Austin J. Murphy, Pa.
Jerrold Nadler, N.Y.
Eleanor Holmes Norton, D.C.
James L. Oberstar, Minn.
John W. Olver, Mass.
Major R. Owens, N.Y.
Donald M. Payne, N.J.
Nancy Pelosi, Calif.
Nick J. Rahall II, W.Va.
Charles B. Rangel, N.Y.
Mel Reynolds. III.
Bill Richardson, N.M.
Carlos Romero-Barcelo, D/NPP-Puerto Rico
Lucille Roybal-Allard, Calif.
Bobby L Rush, III.
Martin Olav Sabo, Minn.
Bernard Sanders, l-Vt.
Charles E. Schumer, N.Y.
Robert C. Scott, Va.
Jose E. Serrano, N.Y.
Pete Stark. Calif.
Louis Stokes, Ohio
Gerry E. Studds, Mass.
Al Swift, Wash.
Mike Synar, Okla.
Bennie Thompson, Miss.
Esteban E. Torres, Calif.
Edolphus Towns, N.Y.
Walter R. Tucker III, Calif.
Robert A. Undenvood, Guam
Nydia M. Velazquez, N.Y.
Bruce F. Vento, Minn.
Craig Washington, Texas
Maxine Waters, Calif.
Melvin Watt, N.C.
Henry A. Waxman, Calif.
Lynn Woolsey, Calif.
Sidney R. Yates, III.
Kweisi Mfume, D-Md., was an original cosponsor but
withdrew his support on Nov. 22, 1993
The single-payer health-care bill in the
Senate is also called the American Health
Security Act (S 491). Paul Wellstone, DMinn., introduced the measure on March 3,
1993. Four Democrats are cosponsors.
They are:
Daniel K. Inouye, Hawaii
Howard M. Metzenbaum, Ohio
Carol Moseley-Braun, III.
Paul Simon, III.
CQ
JANUARY 8, 1994 — 25
�SOCIAL
POLICY
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single-payer system is highly egalitarian in nature," said John Shells, an
economist with Lewin-VHI Inc., a
medical consulting group based in
Fairfax, Va. "For better or worse, it
isn't the way Americans think; it's
very contrary to our culture."
Shells fears that because different
populations require different types of
medical care, the "one-size-fits-all" nature of the Canadian-style system
would be inadequate for some Americans. In some European countries with
similar health systems, patients complain that quality of care suffers and
that they must often wait a long time for
treatment, particularly for specialists.
The American Medical Association, which has not endorsed any bill
on Capitol Hill, objects to any proposal that in effect turns the medical
system over to the government.
McDermott's Response
The doctors' group is not alone in its
skepticism, although McDermott, writing in the "Canard
Watch" section of
his newsletter on
the single-payer
system, stressed
that his bill would
create a government-financed
system, not a government-run system. In one scenario, the governMcDermott
ment would collect a payroll tax that
would take the place of existing health
insurance premiums; it would allocate
money to states, which would negotiate
fees with doctors and hospitals. Medical
decisions would be left to doctors and
patients. Doctors would not work directly for the government.
Most physicians also would see their
profit margins dwindle under the single-payer plan. But some are willing to
trade profits for fewer forms and less
red tape. "We don't have for-profit fire
departments, and we don't have forprofit police and military," said David
Himmelstein, a doctor with Physicians
for a National Health Program, a singlepayer advocacy group. "Vital community functions have long been declared
not in the realm of for-profit corporations; this is clearly another one."
Perhaps the greatest political l i ability in McDermott's bill is the prospect of passing enormous new taxes,
anathema to most elected officials.
These would take the place of insurance premiums and would be needed
to pay doctors and hospitals.
26 — JANUARY 8, 1994
CQ
«fA413l».M»—
Kennedy said, "There's such distrust of government and opposition to
taxes, single-payer would be a very
tough sell."
Although the most ardent singlepayer advocates are not prepared lo give
up on their own bill, many predict their
victories will come one step at a time.
Vermont's Rep. Bernard Sanders,
an independent socialist, has drafted a
proposal to enable his stete to become
one of the first in the nation to go the
single-payer route — even if Clinton's
plan passes. The Clinton plan would
create quasi-governmental health alliances in each state to collect insurance
premiums and pay providers. Under a
single-payer system, states would create only one sUte-run health alliance.
Sanders further proposes that Vermont pay for its system with a flat
payroll tax rather than through employer and employee insurance premiums, as envisioned by Clinton.
"Most political realists understand
it's not terribly likely we'll have 218
votes in the House and 51 in the Senate," Sanders said. "While we fight as
hard as we can for HR 1200, we also, as
single-payer congresspeople, can use
our clout to make certain those states
that want to go forward with the singlepayer model will be allowed to do so."
Virtually all members supporting
the single-payer bill have indicated
they will oppose any legislation that
does not at least guarantee states the
right to test the approach. Singlepayer supporters believe that eventually others will see the value in their
approach and that the system will
sweep across the country.
Meanwhile, when it comes to voting on a health-care plan, Clinton may
be able to woo the single-payer proponents. Frank is realistic enough to
know that "the president sets the
agenda" and "the Clinton plan may be
the best we can get."
Given those political dynamics, the
single-payer camp has devised a twopart
strategy:
Push
for
the
McDermott bill and lobby for improvements in the administration bill.
Already, 46 single-payer proponents
have cosponsored Clinton's bill.
As long as Clinton stands firm in his
plan to provide coverage for all Americans and he enables a handful of singlepayer pilot programs to go forward, the
single-payer group may be satisfied that
the president's bill is moving the country in the right direction.
•
By Ceci Connolly
A
s a budget-minded mother,
Patty Wilkerson has figured
oul how to gel complete medical care
for herself and her family and keep
her costs under control.
Wilkerson, who works as a corporate secretary for Dominion Resources
Inc. in Richmond, Va., a utility holding company, uses three health care
programs — all offered by the company — and pays a tolal of aboul
$3,400 a year. That includes $1,400 for
her and her family's health insurance
premiums and a flexible spending account of $2,000 for her out-of-pocket
medical expenses. Wilkerson's health
insurance plan has low premiums, but
a high $3,000 deductible, meaning she
must pay $3,000 out of pocket before
coverage begins.
Last year, she also opened a medical savings account — a plan instituted by the company in 1990. The
account works like a standard savings
account, and she can draw on it whenever she likes. The company makes no
contribution.
"Now 1 have lots of different
sources for money in case of a medical
emergency," says Wilkerson. If she
doesn't have an emergency, she can
spend the savings account on a vacation.
Wilkerson could be a poster child
for the health-care overhaul plan proposed by Sen. Phil Gramm, R-Texas,
one of the most conservative members
of Congress.
The Gramm plan relies on the currenl health system but is designed to
reduce expenditures by using a carrotand-stick approach. People might
have to pay more oul of pocket for
their care, but Gramm says that would
prod them lo shop around for cheaper
care and use it only when needed.
Their reward would be that if they
spent less lhan Ihey had set aside,
they could use the balance for whatever purpose they chose.
Gramm's proposal, with its emphasis on limiting the role of government,
struck a popular chord among conservative Republicans, and the idea is
picking up support. In the process,
more and more Republicans are abandoning President Clinton's assumption that there is a health crisis that
requires an overhaul of the system.
Gramm's idea has enough appeal
that even moderate GOP senators feel
they need to include it as an option in
their plans. John H. Chafee, R-R.I.,
the sponsor of a health plan (S 1770)
that embraces universal coverage, has
added a version of the medical savings
�SOCIAL POLICY
mm i^mm ti-*-^ '^^9^ IMWI m
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account to his plan.
This GOP move to the right could
polarize the health-care debate, making it harder for Republicans to work
with Democrats — a virtual necessity
in the Senate, where Democrats hold a
thin majority.
••Republicans seem to be feeling
less of a need to look like they are
close lo the administration," said Joseph White, a research associate at the
Brookings Institution who specializes
in health care and politics.
Gramm's Plan
The linchpin of Gramm's plan is
the medical savings account, a relatively new and untested concept. Dominion Resources is one of only a few
companies with such a plan.
Gramm's proposal also relies on
the same type of high-deductible
health insurance plan that Wilkerson
uses. Bul in contrast lo Wilkerson's
medical savings account, Gramm's
plan would make contributions to the
account and the interest on it tax-free
if used within the year for medical
expenses, tax-deferred for any other
use.
The Gramm proposal has its roots
in two conservative articles of faith:
that individuals are the best arbiters
of their needs and means and that
taxes should be levied on consumption, not savings. Philosophically,
Gramm's proposal is virtually the opposite of Clinton's: It is likely to require people to pay more out of pocket
for health care, and it encourages
them lo use fewer services, not more
— as the Clinton plan would through
Savings Plan Backers
These 10 Republican senators are
expected to cosponsor Texas Sen.
Phil Gramm's medical savings plan
bill, which has not been introduced
yet:
Robert F. Bennett, Utah
Hank Brown, Colo.
Daniel R. Coats, Ind.
Paul Coverdell, Ga.
Lauch Faircloth, N O.
Jesse Helms, N.C.
Kay Bailey Hutchison, Texas
Trent Lott, Miss.
John McCain, Ariz.
Malcolm Wallop. Wyo.
— # . CMS
its emphasis on preventive care.
It also is anchored by the belief
that insurance insulates people from
understanding the true cost of health
care.
"The bottom line is that when
somebody goes to the hospital in
America today, somebody else pays 95
percent of the bill," says Gramm. " I f I
bought groceries like I buy health
care, I would eat differently
I'd
buy steaks; I would buy lobster, I
would feed my dog at least hamburger."
Under Gramm's proposal, which is
not aimed at universal coverage, no
employers would be required to offer
health insurance to their employees.
But if they did, they would be required to offer a catastrophic plan
with a medical savings account, in addition to whatever health insurance
plan they now offer.
A catastrophic plan, which has low
premiums, generally covers healthcare costs above $3,000 but requires
the policyholder to pay up to that
amount out of pocket. Since the catastrophic premiums are lower, Gramm
would require employers to open a
medical savings account for each employee with the balance of what they
would have paid had they given the
employee a comprehensive health insurance plan.
For example, under the medical
savings account option, an employer
currently paying $3,500 for an employee's health insurance
would
spend $1,800 on a catastrophic plan
and put the $1,700 balance in a medical savings account for the employee,
to which the employee also could contribute. The employee could use the
money to pay medical expenses. Under Gramm's plan, if the employee
did not use i l , he or she could roll it
over for the next year, or withdraw it
and use the money for a vacation, a
stereo or a new car.
All other proposed medical savings
account plans prohibit the use of the
money for any purchase other than
health care or long-term care. In the
bill (S 1743) introduced by Sen. Don
Nickles, R-Okla., the medical savings
account coupled with a catastrophic
plan is one of an array of health insurance choices that would be offered to
consumers.
The most enthusiastic support for
Gramm's idea comes from small and
medium-sized insurance companies,
many of which are represented by
a group called the Council for Affordable Health Insurance. Sen. Daniel
mghUghts:
Under Texas Sen. Phil Gramm's
proposed Comprehensive Family
Health Access and Savings Act, employers would not be required to
offer health insurance to their workers.
Employers who do provide coverage and who want to continue to
take the tax deduction for it would
have to offer employees at least
three insurance options: continuation of their current plan; coverage
in a health maintenance organization or under another arrangement
in which the employer continues to
pay the employer share of insurance
costs to the plan chosen by the
employee; or a medical savings
account program.
Under the medical savings program, an employer would put the
money used for employee health
insurance into a catastrophic insurance policy with, for instance, a
$3,000 deductible - which means
the employee would pay $3,000 out
of pocket before services were covered. Remaining money would be
put into a tax-deferred medical savings account. Employees could
make tax-free withdrawals from the
account as long as the money was
used for medical expenses. At the
end of the year, unspent funds
either could remain in the savings
account or be withdrawn by the
employee and treated as income.
CQ
JANUARY 8, 1994 — 27
�SOCIAL POLICY
-n-y '[iiiTii i l •! r - -i nr i i
R. Coats, R-Ind., and Sen. John
McCain, R-Ariz., are vigorous proponents of Gramm's plan and have
joined Gramm and other senators at a
series of town meetings to explain it.
The meetings were underwritten by
the Republican National Committee.
Coats has a history of support for policies that reflect the interests of the
insurance industry; a number of
health and life insurance companies
have headquarters or major offices in
Indiana.
Criticism
Critics, including some conservative health policy experts, say that at
best, only a minority of Americans —
those with extra disposable income —
would want to use a medical savings
account — known in shorthand as
"medisave."
"The 'medisave-only' approach
does not say much to the low-paid
working person," said Stuart Butler,
director of health policy at the Heritage Foundation. Butler sees the
medisave option as one of several
health insurance choices that ought to
be available, but not one that would
work for most people.
Butler also agrees that because
healthy people will tend to subscribe
to the medical savings account option,
there will be proportionately more
sick people in comprehensive health
insurance plans, and as a result the
cost of those plans probably would
rise.
The Health Insurance Association
of America, the largest industry group,
is studying the idea of medical savings accounts but so far has been reluctant to endorse it because of concerns about the accounts' effect on the
cost of comprehensive health-care
plans.
Others are even more skeptical.
The medisave plan is "fine as far as it
goes," says Rep. Jim Cooper, D-Tenn.,
who is promoting a plan (HR 3222)
that relies on market-oriented managed competition but with fewer government controls than the Clinton
plan.
"But what are they going to do to
help the poor?" he adds. "What are
they going to do to restructure the
system?"
However, Cooper also said he was
interested in working to see if it would
be possible to add a medical savings
account option to his plan. In the past
several Democratic members, led by
Rep. Andrew Jacobs Jr., D-Ind., and
including Sen. John B. Breaux, D-La.,
28 — JANUARY 8, 1994
CQ
Patty Wilkerson
could be a
poster chUd for
Gramm's plan.
and Rep. Richard J. Durbin, D-Ill.,
have cosponsored bills to permit the
formation of tax-exempt medical savings accounts.
In addition, economists and staff
members at the Department of the
Treasury say the plan could reduce
the country's tax revenues over the
long term because the medical savings
accounts are tax-free. "The biggest
problem is the interest on the medisave accounts," says John Shells, an
economist at Lewin-VHI Inc., a
health-care
consulting
company.
"Over time that tends to be the greatest tax loss."
First lady Hillary Rodham Clinton
told members of Congress at hearings
during the fall that the administration
feared that widespread use of medical
savings accounts could result in people
receiving less care. She worried that
people who must decide whether to
pay for a physical or examination of a
bad knee out of their savings accounts
might put off the care and use the
money for other expenses. When they
finally go to their doctors, their problems might be much worse and ultimately could end up costing the system more.
But for those who are healthy, the
proposal makes a lot of sense. Wilkerson is one of about 25 Dominion employees who like the combination of
the high-deductible plan with a medical savings account even though i l currently offers no tax advantages. She
feels it has made her a more careful
health-care consumer.
"The high deductible is making me
more accountable," says Wilkerson.
Recently she went for a comprehensive gynecological exam and was
shocked at the price, "because I was
paying for it," she says. She talked to
the health program administrator and
next time plans to bring up some of
the lab costs, which were above the
average price, with her doctor. " I love
my doctor and I wouldn't want to
change, but I would shop around for
that lab work. When I had a low deductible I didn't shop around — whatever the doctor said was just fine."
Gramm Provisions
Besides providing for medical savings accounts, the Gramm plan also
would:
• Allow employers and organizations
such as clubs and associations lo voluntarily form groups to buy insurance.
• Give tax credits to people who earn
less than the federal poverty level
(currently $6,970 a year for an individual, $14,350 for a family of four).
• Subsidize those who are uninsured
because of pre-existing medical conditions so they could buy catastrophic
coverage, if the cost exceeded 7.5 percent of their income.
• Penalize people who earn more
than 200 percent of the poverty level
who fail to buy at least a catastrophic
plan. It would deny them federal assistance for pre-existing conditions
and require them to exhaust all assets
before becoming eligible for assistance.
• Reward preventive medicine and
healthy lifestyles by allowing insurers
to charge different amounts depending on lifestyle. People who smoke,
drink, overeat or engage in olher
harmful activities would receive lower
subsidies.
• Leave intact the existing Medicaid
program, the joint federal-slate health
insurance program for the poor. Bul
Medicaid spending would be cut $101
billion over five years. The annual rate
of increase would be cut to the medical inflation rate.
• Leave intact the federal Medicare
program, which provides health insurance for the elderly and the disabled.
But Medicare spending would be cut
$62 billion over five years.
Medicare beneficiaries would have
the option of receiving government assistance up to the expected cost of
their annual Medicare coverage; they
could use the money to enroll in a
health
maintenance
organization
(HMO) or to buy a medical savings
account.
• Reform the medical malpractice
system. Under the Gramm plan, the
loser in a malpractice case would pay
court costs. Any claim of negligence
not justified or improperly advanced
would result in an automatic judgment against the plaintiff. It would
cap
non-economic
damages
at
$250,000. Punitive damages would not
be allowed against a manufacturer of a
drug or medical device if the device
had been approved by the Food and
Drug Administration.
•
By Alissa J. Rubin
�PASE
1
LEVEL 1 - 1 OF 1 STORY
Copyright 1994 The Atlanta Constitution
The Atlanta Journal and Constitution
January 26, 1994
SECTION: NATIONAL
NEWS; Section A; Page 6
LEN5TH: 350 words
HEADLINE:
1994 State of the Union Georgia Delegation
BODY:
Here's what Georgia lawntaKers said about the speech:
" I particularly applaud President Clinton's emphasis on our nation's cultural
challenges, which are beyond pure government solutions, and his appeal for
individual responsibility."
Sen. Sam Nunn (D)
"The ensuing debate on crime and health care will dictate the course of
this country. Each issue is far too important to be decided by Washington
insiders. This debate must be taken to families and communities."
Sen. Paul Coverdell (R)
" I certainly plan to work with the president on welfare reform and criminal
justice reform and health care reform to the extent that we're working on the
part that's broken."
Rep, Jack Kingston
(R-lst District)
"There's no doubt that he has a vision, that he has a plan for where he wants
to take our country."
Rep. Sanford Bishop
(D-2nd District)
"He has his sights set on the right areas and the right problems, but . . .
we have a lot of those measures already up here on the Hill."
Rep. Mac Collins
(R-3rd District)
" I t was a great campaign speech. I t lacked a single direction for this year."
Rep. John Linder
(R-4th District)
LEXIS-NEXISW LEXIS-NEXISW LEXIS-NEXISW
services of Mead Data Central, Inc.
�PAGE
1994 The Atlanta Journal and Constitution, January 26, 1994
"To fight crime, there must be a revolution of values in the spirit and
hearts of the American people."
Z
Rep. John Lewis
(D-5th District)
"If he means i t , we have a lot to work with."
Rep. Newt Gingrich
(R-6th District)
"We've heard the vision; now it's time to go to work."
Rep. George "Buddy" Darden (D-7th District)
"On health care reform, we are considerably distanced from one another. I'm
also a bit concerned about the semiautomatic weapons proposal. "
Rep. J. Roy Rowland
(D-8th District)
"We might not agree with a l l the solutions that he has proposed, but
certainly we ought to agree on the issues and hopefully work together to solve
them."
Rep. Nathan Deal
(D-9th District)
"If we can do something about [welfare reform] and his proposals on crime, I
think we can make a lot of people happy."
Rep. Don Johnson
(D-IOth District)
"President Clinton is what America needs right now."
Rep. Cynthia McKinney
(D-11th District)
LANGUAGE: ENGLISH
LOAD-DATE-MDC:
January 27, 1994
.EXIS-NEXISW LEXIS-NEXISW LEXIS-NEXIS*^
ervices of Mead Data Central, Inc.
�LOBBY REPORT FORM
Tuesday, March 1, 1994
Member of Congress: -y^i.
staff Member:
Completed h^i
A^^AMA^A
J
u
1.
^.^4^ ' { ^ ^ ^ ^ ,
i^g^g. c^.j^^
Phone:
y
^
.1
^-tPJ<.iyy^
^^/-'S-Z^
Health Care Reform
Member is co-sponsor
Does Member support health care reform that requires:
1. Universal coverage
y^y^yo^
cA^ ^^/ic-^-^.e^.^.^A,^
(^^A^--r^>^
2. Comprehensive benefits package
-
3. Waiver of pre-existing conditions
/I
4. Research funding mechanism _^
jAu.y^pA<^
'7A-A^,
5. Treatment during clinical trials
Screening Mammograms
Is Member concerned about Clinton proposed guidelines for screening
mammograms?
Research
Is Member interested in NBCC's proposal for randomized clinical trials?
•y.£,- ^ t ^ ^ ^ ^ ^ w / .
Include any additional information that reflects Member's attitude on health care
reform. Use reverse side of from, if necessary.
Please return by March 11
Mail to NBCC, P.O. Box 66373, Washington, DC 20035. Fax to (202)265-6844.
^zc^c<^^
�THURSDAY, MARCH 3, 1994
J.S. wantsfreezeon Ameses' cash
Accused spies
have $2.2 million
dictment that will follow the
pending criminal complamt," the
U.S. Attorney's Office said.
The matter will be addressed at
a hearing in U.S. District Court in
Alexandria set for March 10.
By Bill Gertz
Court documents made public
••He WASHINGTON TIMES
yesterday said fhe 52,245,311
Federal prosecutors are seek- sought by prosecutors is "the
ing a court order requiring ac- minimum amount of espionage
cused .Moscow spy Aldrich Hazen proceeds that the defendants are
.Ames and his wife to transfer $2.2 charged with having earned durmillion m foreign banks to the ing the conspiracy period charged
United States before their espi- in the criminal complaint."
Mr. Ames, a CIA counterintelonage trial.
.Mark Hulkower and Gordon D. ligence official, and his wife, MaKromberg, assistant U.S. attor- ria del Rosario Casas Ames, were
neys in Alexandria, filed a motion arrested Feb. 21 and charged by
in federal court Monday to compel the FBI with being spies for the
Soviet Union, and later Russia,
the Arlington couple to turn over
from 1985 to the present.
property and cash "obtained directly or indirectly as the result of
At the time of the couple's arespionage."
rest, investigators won a 10-day restraining order freezing all their
Prosecutors said they want the
order to prevent the Ameses from assets. The motion filed yesterday
seeks to extend the order, an ofhiding the cash or transferring it
to others. "The requested order is ficial in the U.S. Attorney's Office
said.
the only means of ensuring that
the defendants' domestic and forFederal law permits seizure of
eign assets are available for forfei- assets obtained through espionage
ture that will be sought in the in- in the same way assets of drug
V
dealers can be seized.
The order "does not seek seizure of the properties but simply
short-term restraint" to prevent
their being moved or hidden.
During a preUminary hearing
Tliesday, federal officials said the
Ameses had three bank accounts
in Zurich and Geneva, where
money from Moscow's intelligence service was deposited. One
of the accounts is in the name of
.Mrs. Ames' mother
Funds in the Swiss accounts can
be accessed with a telephone call,
they said.
Prosecutors said in the court
motion released yesterday that because of the difficulties in controlling foreign-held assets, the
Ameses should be required by the
court to "repatriate" the assets to
the United States, where they can
be frozen.
"Upon their repatriation to the
United States, the assets would be
deposited in the registry of this
court so that they can be preserved within this court's jurisdiction pending trial," the U.S. Attorney's Office said.
Mr Hulkower said m cDur! Tuesday that .Mr Ames was ;he hikjheitpaid Soviet spy, receuiny more
than S2.7 million.
According to a Ivsy Jucurnent
introduced as evidence. :he KCiB
also invested 5250,000 in bonJ-; on
.Mr Ames' behalf, earmnii •.n:L-: c>t
of more than 514,000
Not included in the 52 " niillion
estimate are twoapartrr.t-nt.s .inU a
ranch owned by the .Ameses in Colombia and a parcel of laiij in Russia set aside by the KCili '.-if :he
couple to build a countrv house
The restraining order Auuld
freeze funds in 11 accounts — in
Virginia; Bogota. Colombia,
Rome; New York City. (,eneva;
Zurich; and Washington
Mr Ames' attornes, Plato Cacheris, said he will oppose the motion. "Repatriating money' I've
never heard of it before.' Mr Cacheris told the Associated Press.
William Cummings, .Mrs Ames'
attorney, also wiU oppose the order. "My client is going to oppose
this, because she doesnt know
where this money is or even if it is
there somewhere," he said.
GOP officiak want Chafee
to omit Democratic briefers
Senate Republicans to include
GOP House members and goverTXE VWkSMlNQTOH TIMCS
nors.
MrDflle. Kansas Repubhcan,
With Senate Minority Leader
fTthe retreat to serve as the
Bob Dole's tacit approval, angry
begining^what many fear may
GOP senators forced Sen. John H.
Chafee to revamp his agenda for a -be«-tofigsearch for a unified GOP
rwo-day Republican health care alternative to President Clinton's
retreat that begins today in Aimap- health care reform bill.
'We'd like to see a Republican
olis.
consensus before we start negoNonetheless, reactions among
tiating witii the White House," said
most GOP lawmakers anending
Sen. Paul Coverdell, Georgia Rethe event ranged from bemusepublican.
ment to consternation on learning
The new agenda began crematyesterday that Bob Blendon and
ing late yesterday after heated exStan Jones are still scheduled to
pressions from conservative lawbrief retreat attendees.
makers at three Dole-led meetings
Mr Blendon is a Harvard University health specialist and con- Tuesday and another meeting yessultant to first lady Hillary Rod- terday.
ham Clinton's health care task
According to several close to the
force. Mr. Jones is a former aide to proceedings. Sens. Phil Gramm of
Sen. Edward M. Kennedy, Massa- Tfexas, John McCain of Ari2ona,
chusetts Democrat, and author of
Ti-ent Lott of Mississippi, Judd
Mr. Kennedy's health care plan.
Gregg of New Hampshire and
Thirty-six Senate Republicans;
Daniel R. Coats of Indiana perfive House Republicans, led by
suaded Mr. Chafee to revamp the
House Minority Whip Newt Ging- agenda or face a boycott by conrich of Georgia; and GOP Govs. servative colleagues.
Carroll Campbell of South Caro"We said we want to spend our
lina, Mike Leavitt of Utah and Stetime trying to get together on •
phen Merrill of New Hampshire unified plan or at least a set of
accepted invitations.
common principles rather than
Republican National Commit- going over it with pollsters and
tee Chairman Haley Barbour and having someone who may not
other conservatives began cajol- share our goals explain our;own
ing Mr Chafee, Rhode Island Re- competing plans to us," said Mr.
publicair, weeks ago to expand his McCain.
retreat's invitation list beyond
The revised agenda calls for
By Ralph Z. Hallow
fewer sessions with liberal consultants, pollsters and health care
specialists.
"I dont know that v«e need to
hear from any more pollsters, consultants or experts," said M E
CoverdelL "We know from the
polls that America rejects the
Clinton plan and prefers targeted
reform. The public Is not asking
for more govemment."
"You have to wink and wonder if
you are having someone who re^
jects those concepts briefing you,"
Mr Coverdell said.
Three "members-only" talks
among GOP lawmakers and governors seeking a unified alternative
are scheduled: one tonight, a second tomorrow morning and a third
tomorrow afternoon titied "Final
Strategy Discussion: What Should
Republicans Do?"
Suspicions about the real intentions of Mr Chafee and his apparent ideological ally on health care
— Sen. Dave Durenberger, Minn^
sota Republican — continued
unabated, despite the agenda
change.. - The word among RepubUcana
was that Mr Chafee and Mr
Druenberger were negoUting privately with moderate Democrats
on a healtb care compromise falling somewhere between Mr.
Chafee's bill—considered too liberal by most Republican! — and
Mr OintoQ's plan.
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vffeft^HE^I^fSi^
go,-wltliout coverage.":^'-^p-'Vl/y-:
^:'p(^^Q: mprhi|pj^^
Bystem can to,adapted.to^
;:M(ui b e c ^ t i ; i f l a n d
in doing > EO the majors ,
''^Mlal',|t\t^jm
'^wa8^c^nd^^e^Bid
addressed; . i ' l ' i ' i ^ ' j i * ' ' '
.Vfact,],)]^thK;jU^^^^^
plan make it ;difri-.| :
>''Ak^;s^.,i itifMMr^i, n^^t^iUn^A «; «vi««,jncel; I' i- cuIt;,to^
the • chiu
-^\;:hyyl'yfy•••\...y creato.i;^a •bureaucratic
.....
I
... . 1 "
,) 1(,
tdci^spehds^iO AA
• I'^v^J?
/president*
'eiihtQriVn)pijsid,?l8,'beih^^
•chipped away; Aitliis'rate,
] whate'verr
Congress';.
•Idbes.feme
•iflUbsMtlaliyl
•'envisioned'and
— 'will' fall far ahort of
such as life
j- addressing' the notion's
healtii-core crisis.
expectancy and
^ "
. .The shame of it'all is • •
W tiiat tremendous'political' '.\ ,infant,mortality,
^
bureau9racy:^and vreguln- '
,vate|pBurahce pro-'y,
who would: remain ,
the ; Itealth-care'' mix,' For mariHged cj)mpbtltion , i
ment policJr;? \vou\d be
eliminated wUi) a singlepayer system, since private Insurers no longer
would bo mt^or players
The adnUnintrative costs
of heaith-cai'e providers
% .to^ut io ptace nys\lm''' i. '•Canadians match
would boorreduced
significantly.
that will: not work
h0er:/iinerican
2 Ciihto/i's niaiiagsd-(Jare ' '''
Almost 100 members of
Cnngrciis have indicated
propofiui,
Tho
solution '•' Statistics.support for a single-payer
most, lilcely to meet
the"'
system — tiie largest bloc
t;eform'go&l5 of uiuvorsal.'' •'"-'. • • •..
coverage and cost containment is being labeled .'(to back any of tlie half-dozen or so ptx)posalij,
a:, politically impossible: 'niat solution ;l8 at;'>nowl-pn'.the table. Atlanta's: own Rep. John
fiiny;e-psyeni;illonallieolth-cardsystem. 11' .I; :»';''^Lewls is a co-sponsor of slncle-payor
! .Con' •: -propaganda put'out by tho insur-';!,, tion!..I'bow
should stand fast and
once industry and othars,itlie:8higle-?nyer sys-fj^flglit to glve single-payer serious consideiuiion
,toin has worked well, in Canada, That countryM'' Jn the hoRltU-core refonn debate. •
spends 50 percent' less of its gross national'-WM/AIid President Clinton should offer to stand,
product on hoaltl), caio tlian.tho, Udted'States /|i;vidth,them: It is still too early for Idm to give up
does. Yet, on,'healtii in{Ucatbra I such as life, p^^
But at the very least, he
expectancy. and inf^uit ' tnortahty;VCanadlanB)!jisho\ild ackiipv'ledgetlie
that
a single-payer
syslem
nation
than the "hnmatch
or
better
American
s.taUstlcs;,
On
.
t
o
p
^
o
f
',
lis,
a*
!
t
^
^
^
tiiat, their- system provides<,'coveraigeffor,'all,if,proved" versions,of his proposal now gaining
while on estimated 37 million'in the United i momentum in Congress.
" '
winning into a
m
[J^Secretary^ o^S'ta'toWorren di"^^
visit.t , China's leaders also realize and' ai« taking;
6i;Cl)lna went so badly; it is a wonder he bothV advantage of the fact that Wasliltigton has ,**jcl 16 travel there. After all, there were VvamI other, policy Imperatives requiring Beijing's ' ,
Jhgs that China's {ruling, authoritieswould ; cooperation , —, especiolly, increasing: TJ.S.;
'^mmb ' their node's "ot'. American concerns,'..exports and controUing weapons'proliferationi
There were many arresti^ of dissidents';and';: ';„-^^d is reluctant to jeopardize tliom by tdUch-.
hostile official rumblhigs preceding lils trip. ' ing
' off a m^ or trade war. - . , ; •, '
I
•'••r*.StlU; Christopher judged' It' worthwhile ,t6' •• Tlie sad fact Is, President Clinton has taken
•(Jonvey personally !at' the! highest level' howi hls trade ploy as far as it will go to try to leverdeep Is America's distaste for China's; harsh ' age an improved humanrightsclimate in Cld- '
•treatment: of its inhabitants yearning :,f6rj the•na, He obligated himself last year,to stand
'mo8tbaslcllberiles.;:..:"'V'j|;;'r;
, ..•
% • toiigh oh a couple of Issues — a prohibition on
The Chinese' hierarchy 'seemed,'hardly• prison-made'goods from China and ah ihsis-' !
aiffected by.hls appeals. Oh, it offered minor tence on lY'ee emigration of Chinese citizens.
concessions,'but in tlie main it was adamant to'Oh other issues like tieatment of prisoners and
tlie 'point of behig insulting. Foreign Minister saving libetans'cultural Identity, he is free to
Qlan Qicheh typified its attitude. Asked, by . interpret China's progress as he seesfit.In t
Christopher tofreethe activists jailed prior to Interests of preventing a serious bi-eakdown
his'arrival, Qian.replled. "We would not have, ' relations, he would be wise not to set too str
detained any if wo hud knoym you were not••^.•a'standard,-'
--v
.,golng to meet with any."'•^ r';
, ' , '. It feels like a setback, this rocognlHon that
S^-.Tlie Beying,regime cleariy will not back ',Washington can't force China to behave more
^down in thls^confrbhtotion. It is willing to ' decently toward its people, but it may not work
• aiccpt the pafnful consequences of Impending.out that woy over tho long run, Encountglng
IJ.S. trade penalties rather than loosen kf» gripClilnn'fl'internal economic dynamism could
oh its subjects and be embnrrnssed by having well speed tho Beijing dlctotorsliip's undoing
to make concessions in tho face of Ihreats fromfaster than all the extemal pushing and shovyih oulsldo powc)r.
ing the United States coijld muster.
�• March 25, 1994
CONGRESSIONAL RECORD—SENATE
'S3895
^ educated the public, and this .s a prac- the activity, work i t through, and
Now why? Mr. President, that Is a re• tloe that should be stopped. Then came- come up with a reasonable answer. And
the tiu-n of Mr. Runyon to express him- the stunning part of i t is that i t was markable public statement, absolutely
remarkable.
• self. I think that I t Is important to the done i n less than a year.
I would suggest that the reason is not
'Senate and to the American public
So I commend the Postmaster Genthat Mr. Runyon said that the Postal eral for taking these steps that I be- unlike the adviser. The reason for' this
Service would no longrer Instigate in its lieve will help the Postal Service and vote is because people are perceiving
enforcement division these tyijes of au- all American businesses and citizens in that that plan for reform destabilizes
too many people. I t takes a program
dits.
our country.
that everybody agrees has significant
So the effort on the part of the Senproblems and problems that need atate, without legislation, has Indeed retention, but instead of focusing on
sulted In a very positive event, a posi- •' ^' HKALTH CARE REFORM' :'
those problems, instead turns the
tive decision on the part of the U.S.
Mr.. COVERDELL. Mr. President, lights out on health care in the United
Postal Service, so American business there
is an item I want to mention here States, turns a l l the lights out and
can now concentrate on runiilngr Its this evening that haa received very l i t businesses and not on trying to under- tle public attention. We have now been tries to create a new program and turn
, stand a l l the ramifications and impll-' talking for over a year about massive the lights on In an entirely new Way.
Everybody gets asked a lot of ques. cations of remote regulations to t r y to reform for health care.
determine for a business whether or T h e President and First Lady have tions about health care reform, k n i I
: ^not Its mall was urgent or not.
come forward with a very broad, sweep- am no different from the rest; but I al' I want to publicly thank the Post- ing change In the current health care ways point to this analogy. I do not
master General and his coUeagrues for system. For the last year, there has know anybody who has never; conhearing and adhering to the sense of been enormous speculation about fronted a leak In their roof. Everybody
• the Senate, for thinking this through, whether or not this would be successful haa had a leak In their roof. I t Is seriand for coming to a very appropriate and what were the fortunes of the ous. No one Ignores a leak In their roof
• and valid decision, whereby everybody President's proposal. After the address I have never seen anybody that did
will be a winner. Their public relations he 'gave to the joint session of Con- You are running around trying to sal: will Improve, they can concentrate on gress, the numbers swelled In terms of vage an important heirloom table, your
what they need to be working on, and support for that proposal. But since grandmother's table, your new drapes
they - can get about the business of that time, with each passing day, each you just put up are being soiled, the
passing hour, support for that plan has water Is coming near an electrical
doing business.
socket that Is going to create a fire. I t
One of the reasons that I felt they begun to diminish.
Is a serious problem, and you do someshould cease and desist from the activWhy is that? Well, one gentleman—I
ity Is because I thought I t was vir- will leave him nameless this evening— thing about i t and you do I t quickly
tually moot and that they were behind who has been an advisor from time to You know, Mr. President, I have never
the curve in terms of the way people time to the President and First Lady, met an American yet who tore his or
communicate. In our exchange, I point- said that in the final analysis, the rea- her house down to the foundation and
ed out that In my Senate office, we re- son people were moving away and step- rebuilt i t to fix a leak.
ceive 500 to 1,000 letters a day. But, ping back from this plan was because
Mr. President, everybody I know
, equally important, I receive almost of its complexity. There are 1,345 pages, fixes the gable or maybe they need new
' 1,000 faxes a day. And we receive hun- I think. I t talks about massive new shingles. Maybe they need to remove
• dreds of computer messages a week. I Federal Govemment regulation and ex- the wood rot. But they target right In
asked, the Postmaster General during panded coets. But the most important on what needs attention. No one tears
the discussion, Mr. President, was he ingredient, according to this gen- the house down and starts Over.
going to put a meter on fax machines. tleman, was the fact that i t waa .terMr. President, I personally believe
Were we going to find some gadget that ribly complicated and left everybody too many of the proposals do just that
we wire to a computer on networking wondering: What In the world does that They have been written and designed
or E-mail throughout the country that mean to me?
by people who have never been In the
. would somehow monitor whether I t
The specific event to which l am re- medical system, never been a doctor,
waa a personal message, whether i t was ferring occurred within the last 10 never had to confront some of the Isvu^gent or not and, therefore, whether days: The Ways and Means Subcommit- sues directly, and as a resvUt we get
the Postal Service was supposed to re- tee on Health recently took a vote—we suggestions that simply are not pragceive some revenue?
have had a lot of votes over there in matic.
The point Is that the delivery of per- these health committees. This, I think, , I would suggest to you, Mr. Presisonal messages or business messages received about four lines in the Wash- dent, that that Is why this vote that we
that are written on a piece of paper, ington Post at the bottom of the arti- did not hear near enough about because
folded up and put In an envelope with a cle. I f you are a headline reader, you i t is a very Important one, every Memstamp, are probably. In terms of his- are never going to get to this news.
ber of the President's party refused to
tory, only moments away from being
In fact, you have to be a very thor- vote on the first real test on that plan.
moot. And what the Postal Service ough reader to get to i t . But they had
Mr. President, I yield the floor to the
ought to be focusing on Is how to adapt a vote on the President's proposal for distinguished senior Senator and coltechnology so that the Postal Service health care reform In the Ways and league from South Carolina,
is In front of this communication Means Subcommittee on Health. There
The PRESIDING OFFICER. (Mr.
ciurve.
are six Members of the President's EXON). The Chair recognizes the SenI was encouraged by statements of party, six Democrats on that commit- ator from South Carolina, [Mr THtmthe Postmaster General because, in- tee, and four minority Members, four MOND].
deed, he focused on this type of activ- Republicans.
ity. A good part of his renmrks dealt
I just found the vote absolutely
with the fact that they knew they were breathtaking. The vote i n that subr- .
LET US PRAY ' '
"V ^
facing massive changes In the ways In committee was this: every Member of
Mr. THURMOND. Mr President,
which Americans communicate, one to the President's party refused to vote there has been an article In the Readthe other. Individual to individual, on the President's proposal, and the
er's Digest In November 1992 entitled
business to business.
four Republicans voted against It.
"Let Us Pray" by Eugene H. Methvin.
So I t was encouraging. You do not
So In a vote on the President's pro- At the top of the article I t says, "Why
have many days like that i n this town. posal for health care reform In the Sub- can't the voice of the people be heard
I t was encouraging to see that the leg- committee, on Health not one Member on prayer i n schools?"
islative branch and this semi-autono- of the President's party would vote for
The article is very Interesting, and I
mous monopoly were able to engage, In It.
...
. .
,
would like to present I t to the Senate.
Mi- 1^'
�t". CITIZEN OCT I ON - 60
: 3-29-94 10:21OM
MAtUnti Jounal/TtMMUnti Canslitinion
NATION
4042641172^
202 296 4054;« 2
Tuesdw. MariJi«, 199* AJ 5
EACs^ professional^ targeting lawmakers^
of
$33,473
mA7Z ($33473
(S33J73ftom
fromPACs).
PACs).
of PAC
PAC gava
gtvt the
tha xao
09 tTi^
Oeorglani:
^
Don Johnson (D), $19,100
• Doctora', . dsatlsts'
($16,850 from PACi); John
WuMngton — Health and
nurses'
PACs: Olngricb. $11 jOO;
Under
(R),
$18,050
($15,550
insuranca execudves and profesLawla. $13,500; Rowland. $ltiS^
flrom PACs); Sanfbrd Blahop (D),
donalt have given campaign
• Hoapltal, HMO and autir
$12,500 ($10,000 firom PACs);
contributions since January 1993
Mac Collins (R). $12,200 (aU ing home PACa: Giflgri^ik
to every member of ttie Georgia
congressional delegadon except health care policy within ea ;h of frtm PACs); George "Buddy" $6,000; Uwis. $5,000; ROWIABA
i
Democrade Sen. Sam Nunn, • the industries, and bct^reen Darden (D), $11,500 ($10,000 $3,200.
• Pharmaceutical and nft^
them, it is hard to tell what ei feet,from PACs); Jack Kingston (R),
new report tayt.
Rep. Newt Gingrich, who is if any, the $11J million cor trlb- $10,208 ($9,658 firom PACa); ckl equipment PACs: GlngVi|^
House Republican whip and In uted to incumbents and (jther Cynthia McKinney (D). $7,450 S3,S00: Uwis. S9;S12: RowUitt
• .-'HIS
($6,300fromPACs): and Nathan $8,400.
Une to become the House GOP candidates will have.
• Insurance PACs: Gingnd^
laader next year, received
Figures for other Geor^ans Deal (D). $6,450 (S6.0SO tnm -520,411;
Lewis. 124,500: 2(bwPACs).
$75,961. That WM the seventh- inCoi«sssJ """^ I
' i-'^lO
Here is how much each typa land,$8,S0O.'
highest total in Congress, the re$43,000
port by Citizen Action sai^.
from P/ C«);
Gdzen Action is a non-profit
advocacy group that often disRcpressnUtives:
agrees with large segments of the
Gingrich, S7S.961 (S4:,lll
healdi and insuranca industries.
Ia report tallied gifts ttom Indi- frtm PACs); John Lewis (ID. a
viduals through June 30, 1993, chief deputy Democratic vhlp,
snd gifts from political action $56,012 ($42.S12 fTom PAO); J.
committees (PACs) through Jan. Roy Rowland (D), a physicis n on
one of the three commi tees
31.1994.
Since there are divisions over drafting health care I^Uis.
By Andrew HoHlson
HoHIson
l^SM^^BSMBS^
WASHINCTON muAU
Young adults most likely
to lacx insurance coveragje
stitute in Washington. :7.C.
"Tbay are leaving their pan nts'
ITA/r>MVTIR
homes, going to collage, lea 'ing
Nearly half of the nation's college, and thair incomes are
young adults did not have healthnot very high. They feel lilte
Insurance coverage for a month they're healthy and the risk
or more betwetn 1990 and 1992, doesnt seem that great."
Nearty one-third of chil( ran
Bccordbg to a U.S. Onsus Buware without coverage, at 1 sast
reau study released today.
Age and income were the temporarily, as were one-thu d of
strongest predictors of whether thos* between iges 2S and 34,
someone would lose coverage. and about one-Afth of those beJust 1 percent of Americana tween 35 and 64.
over 65 — most of wdiom are cov- Other census statistics 1 ave
ered by Medicare—experienced shown that about one in si van
'a lapse in cav«nge. The poorest Americana is without coverai a at
'Americans were Ave times more any one time.
Although age and lncom< aplikely to go without insurance
than thoae from the richest pear to be the strongest ind leaton of who has iniurance, emfamilies.
Nationwide, otia in fbur peo- ployment alio played an im Mrple lost insurance for a tempo- tant role. Thirteen percen: of
rary period or had no coverage atthose Who worked full-time lurall between February 1990 and ing the 1990-92 period exierlencad a loaa. in coverage, c smSaptamber 1992.
"Younger people, in general, pared with 22 percent of pe iple
are in a transition period," said who worked part-time and 3$
Sarah Snldejc. an analyst at the percent of those-yirho were t« ithEmployee Benefit Research In- out a Job for at laast a month.
By Carrie TMgardIn
�AM-Folks Back Home, 2nd Ld-Writethru, a0686,810
They Bent Lawmakers' Ears on Crime and Health Care, Not Whitewater
Eds: SUBS 9 t h graf t o CORRECT t o Dianne, sted Diane.
By MIKE FEINSILBER= Associated Press Writer=
WASHINGTON (AP) Members of Congress got an e a r f u l during t h e i r two weeks'
vacation and came back t o work Tuesday saying the country i s aroused about
crime, concerned about h e a l t h care and p r e t t y i n d i f f e r e n t about Whitewater.
' ^ I t h i n k t h e r e i s f a r more i n t e r e s t w i t h i n the Beltway,'' said Republican
Sen. Mark H a t f i e l d of Oregon, t a l k i n g about Whitewater
a term t h a t has come t o encompass everything from the investments of President
C l i n t o n and F i r s t Lady H i l l a r y Rodham C l i n t o n t o the apparent suicide of a
White House aide. He said Oregonians take news about Whitewater "^with a grain
of s a l t . • •
.
Another Republican, Dick Zimmer of New Jersey, summed up the sentiment on
Whitewater: ""My c o n s t i t u e n t s who never l i k e d C l i n t o n see t h i s as a v a l i d a t i o n
of t h e i r worst fears. His supporters see i t as a d i s t r a c t i o n . ' '
Democratic Rep. M a r j o r i e Margolies-Mezvinsky, who represents a
Republican-leaning d i s t r i c t i n the Philadelphia suburbs, said her
constituents " " f e e l they'd l i k e t o get i t a l l out on the t a b l e and move on
w i t h the issues of the day.''
But she said i t was not an obsession. " " I f at a meeting there are 20
questions, I may get one or two on Whitewater.''
Lawmakers tend t o hear what they want t o hear during t h e i r v i s i t s t o
constituents, but t h e i r time back home i s s t i l l important: a f i s t waved i n a
congressman's face has f a r more impact than columns of f i g u r e s from a p o l l .
Even d i s c o u n t i n g p a r t i s a n s h i p , these points came through i n AP interviews
w i t h the r e t u r n i n g l e g i s l a t o r s :
Crime has touched a nerve, even i n areas remote from urban t r o u b l e s . Rep.
John Boehner, R-Ohio, t o l d the House of a conversation he had w i t h a married
couple i n Youngstown, Ohio: " " I t was the fear i n t h e i r voice, the fear i n
t h e i r minds about l i v i n g i n America and the crime t h a t i s rampant i n our
neighborhoods,'' he said. ""They don't l i v e i n the inner c i t y ; they l i v e i n
the suburbs. ' •
_
.
^ ^ -,
w 4.
People give the Clintons c r e d i t f o r making an issue of h e a l t h care but
they haven't focused on the nuances of t h e i r reform proposal and they worry
about w.?shington bureaucratizing i t . They would r a t h e r have Congress do i t
r^ght tl.an do i t speedily, some said. ""No one has said t o me t h a t health care
needs t o be passed t h i s year,'' said Sen. Dianne F e i n s t e i n , D-Calif.
Whitewater and the e t h i c s of the Clintons were considered Beltway issues,
curious but remote. ""Calls come i n every day, but when I went home nobody
mentioned i t t o me, and I went a l l ove^ the s t a t e , " F e i n s t e i n said. ""Nobody
ever said, "What do you t h i n k ? ' ' '
A Republican, Sen. Arlen Specter of Pennsylvania, however, detected some
rumblings of concern. ""Most people are not prepared t o c o n v i c t them on the
basis of newspaper accounts, but they want t o know what the f a c t s are,'' he
said.
""There's a general d i s t r u s t out there,'' said another Republican, Rep.
Dean Gallo of New Jersey. ""There has been so much thrown against the w a l l
t h a t there are s i g n i f i c a n t questions i n my d i s t r i c t . ' '
Asked f o r h i s c o n s t i t u e n t s ' c h i e f concern. Sen. Connie Mack, R-Fla.,
answered i n t h r e e words ""crime, crime, crime'' w h i l e a f e l l o w F l o r i d i a n ,
Democratic Rep. Sam Gibbons, who w i l l be a key player i n the h e a l t h care
f i g h t , said, ""health care, h e a l t h care, health care, and nothing but health
care. Horror s t o r i e s about the lack of i t . Concern t h a t we won't be able t o
pass anything here. Questions.''
As f o r Whitewater, not a peep wa^ heaiM, said Gibbons: ""That s
a newspaper issue. Nobody b r o u g h t / i t up. -Wot a s i n g l e c o n s t i t u e n t . ' '
On the other hand. Sen. Paul C6verdeM, R-Ga., opened a town meeting i n
Stockbridge, Ga., saying h e a l t h (cbre rprform would be the most important
decision Congress would make i n V^xjuartter of a century. The crowd l i s t e n e d
I
I
,.^i',
f
�then peppered him f o r an hour w i t h questions on everything but. They asked
about unfunded f e d e r a l mandates. North Korea's nuclear program, r e l i g i o n i n
the workplace, even telecommunications l e g i s l a t i o n .
Another Georgian had the opposite experience. ""Within the f i r s t 15
minutes of any discussion, health care i s r a i s e d , " Rep. Sanford Bishop J r . ,
D-Ga., said.
,
Rep. Sherwood Boehlert, who has supported C l i n t o n more than any other
House Republican, said the economy s t i l l worries h i s c e n t r a l New York state
d i s t r i c t ; which w i l l lose 5,000 jobs when the size of G r i f f i s s A i r Force Base
i s reduced. ""New York state i s s t i l l h u r t i n g , " he said.
Boehlert t r a v e l e d thousands of miles meeting c o n s t i t u e n t s during the
recess but broke the t r a v e l o f f t o help h i s 22-year-old step-daughter move out
of s t a t e . Her company and her j o b had moved t o Cleveland.
****
f i l e d by:APE-(—)
on 04/12/94 a t 20:07EST ****
**** p r i n t e d by:WHPR(160) on 04/13/94 a t 07:37EST ****
�THURSDAY. JUNE 23. 1994
Make the elections a referendum on health care, Mr. President
By Paul Coverdell
f the president believes his
health care reform plan is as
superior ;is he s;iys it is, then I
challenge him loday to go ahead
and take his reform plan directly to
the people in the l ^ ^ ' i campaigns
Bypass the consultants, the pollsters, and the pundits
Let the people speak through the
election as to what they feel is the
right answer for health care
reform. Let the elections of 1994
serve as a referendum on the Clinton plan for health care reform.
This pnwides a tough challenge
for the president l i e has been used
to blaming Republicans for block
Ing his policies I le cries "gridlock "
and lays blame at the feet of Republican members of Congress
He oflen says, "I've got gridlock
caused by the Republicans. " But
Mr. President, the gridlock on your
health care reform proposal is not
I
Paul Coverdell is a
senator from Cteorgia.
Republican
being cau.sed by the Republicans or
for that matter the Democrats. The
gridlock is being caused by the
American people And they are
right to put the brakes on this pro
posal fora government takeover of
medicine
Furthermore, I call on the president to resist what we've seen in
the past two weeks through
attempts to build a power play - a
move from the bully pulpit to a
bully government — to force a
health care proposal on the American people and disregard what we
are seeing and hearing from the
public every day
The president is beginning to
kxik back to the tax policy and his
strategy of forcing the nation's
largest tax increase through the
Congress by (mly one vote. It will be
a disaster if that is what occurs on
health care reform
Fbr more than a year, the American public has listened to I>resident
Clinton talk about health care
reform, and growing m^orities now
say they are opposed to his government-nui plan Wliat went wn)ng for
the president? The rhetoric he has
used to sell the plan can't compete
with the realities of a governmentrun health care system, higher
taxes, less choice and less quality
But the president de.sperately
wants a political victory and it
seems as if he doesn't care if it is at
the expense of what the American
people want President C linton, and
those Washington wimks who met
secretly to craft the governmentrun plan, believe they know better
than Americans on this i.ssiieand if
the people won't agree with them,
they will impose their plan and subjugate the country to their idea.
lb get his victory we won't hear
the facts from M r Clinton; instead,
he will rely on the rhetoric. Mr.
Clinton won't say that 60 percent of
the public is calling on Congress to
hold off a decision on health care
reform this year and continue the
debate. M r Clintim won't tell us
that 80 percent of the American
public are satisfied and served well
by the current health care system,
lie will not say that over half of the
country oppose his plan outright.
I le has one goal in mind, and it is to
organize how he and his party leadership can force a government-run
plan on the country
If he takes his plan to the American people this fall, there will be
those of us who take an alternative
to the people We claim our plan will
do more good for America.
The alternative will seek to preserve the best elements of our existing
system while improving specific areas
in need of refi)rm. It will be based on
the simple belief that we can strengthen what works,fixwhat is broken and
retain the superior quality of care this
nation has come to expect.
The alternative proposals that
ask for targeted reforms — making
benefits easier to get, administrative reforms, malpractice legal
reforms and anti-trust reforms, and
making it easier for people to buy
insurance — is what the American
people are asking for
The American people are not
asking as the president is proposing, for larger govemment. They
are not asking for increased and
growing tax burdens on American
citizens and American businesses.
They are not asking for choices to
l>e removed, and for bureaucrats
and government employees to
make decisions about who their
I f we leamed anything form the
1992 elections we leamed that the
American people are not asking for
more government and more taxes.
The decision we as Americans
are about to make with regard to the
president's health care reform proposal will be the most important
decision we will make this quarter
century. There is no other single
proposal put forward that so directly affects so many Americans in
such a personal way.
If this decision is made outside
the Washington Beltway — i n
Atlanta, Omaha, Denver and Los
Angeles — I am convinced the
American people w i l l make the
right decision. But if this decision
is made by numl)er-crunchers and
Washington wonks, I am convinced
it will be the wrong decision.
This is the challenge tor the president. He can take his plan to the
American people in the 1994 elections and let the American people
speak directly by telling us who
they want to represent them in the
health care reform debate in the
next Congress.
In the end, the
American people know
the current system is a
good one that needs
some attention and it
needs some repairs.
But it ought not be
destroyed
doctor will or won't be, or which
hospital they can and can't go to.
In the end, the American people
know the current system is a good
one that needs some attention and
it needs some repairs. But it ought
not be destroyed.
�bc-health-ndy - al741
(ndy) (ATTN: National editors) (Includes optional trims)
Senate Committee Backs Employer Mandates for Health Care (Washn)
By Dena Bunis=
(c) 1994, Newsday=
WASHINGTON The requirement that employers contribute to t h e i r workers'
health insurance survived i t s f i r s t congressional t e s t Wednesday, but not
u n t i l senators softened the blow for the nation's smallest businesses.
Employer mandates are the most controversial element i n the national
health care debate, already the most contentious issue to h i t Capitol H i l l in
years. The White House and supporters of i t s approach to health care say i t i s
not possible to guarantee health insurance for a l l without mandates, while
most Republicans and conservatives vehemently oppose such requirements.
""We are mandating our states, our l o c a l governments, our businesses to
death i n t h i s society,•' said Sen. Orrin Hatch, R-Utah, one of s i x Republicans
to oppose the Labor and Human Resources Committee measure to include an
employer requirement i n the b i l l . The measure passed 11-6 with unanimous
support from Democrats and the vote of Sen. James Jeffords, R-vt.
Committee Chairman Edward M. Kennedy, D-Mass., had proposed requiring a l l
employers to pay 80 percent of the cost of a standard health insurance plan
with workers paying 20 percent. His proposal made an exception for businesses
with fewer than f i v e workers and an average annual wage lower than $24,000,
saying they could e l e c t to pay a 2 percent payroll tax rather than pay for
insurance.
The measure that ended up passing the committee, however, was drafted by
Sen. Jeff Bingaman, D-N.M, and would exempt companies of up to 10 workers.
Under the new measure, businesses of up to f i v e workers would be subject to a
1 percent tax i n l i e u of providing coverage, and companies with between 5 and
10 employees would pay a
2 percent tax.
In both proposals, workers i n companies that do not pay any insurance
costs would have to buy t h e i r own insurance, but the federal government would
subsidi'e t h e i r premiums, based upon t h e i r income.
Kennedy said such a softening of the requirements on business ""should
send a powerful and important signal'' that Congress wants to be sensitive to
their needs. Bingaman said after the vote he's also hoping t h i s measure w i l l
help forge a compromise among those Republicans and Democrats opposed to
mandates.
But Republicans were not convinced.
""Even though i t ' s some steps in the right direction, i t ' s s t i l l an
employer mandate,•| said Sen. Nancy Kassebaum, R-Kan., the ranking minority
member on the committee. Kassebaum supports requiring individuals to buy
health insurance but not requiring t h e i r employers to help pay for i t .
While Kennedy's committee was dealing with the issue, a group of
conservative Republicans attended a U.S. Chamber of Commerce news conference
Wednesday denouncing mandates. At the same time, the Health Care Reform
Project, a consumer and labor-based c o a l i t i o n supporting President Clinton's
plan, circulated a l e t t e r from more than 1,300 businesses and organizations
endorsing mandates. The c o a l i t i o n has already been running t e l e v i s i o n
commercials supporting mandates.
(Optional add end)
At i t s news conference, chamber o f f i c i a l s said they were asking a l l
members of Congress and congressional candidates to pledge to oppose mandates,
any new taxes on business or any expanded health bureaucracy as part of a
health care overhaul.
""We are pulling out a l l the stops,'' said Richard Lesher, president of
the U.S. chamber. He said the group, the largest business group i n the nation,
w i l l ""produce a flood of l e t t e r s and c a l l s to Congress.''
""Today the 1994 election campaign has begun,'' said Sen. Paul Coverdell,
�(t
PM Health Reform, Bjt,740
Democrats Stick to Clinton's Plan for Job-Connected Health Insurance
Eds: Senate Labor Committee resumes 8 a.m. EDT; House Ways and Means at 10
a.m.; w i l l be led
AP Photo WXlOl
By CHRISTOPHER CONNELL= Associated Press Writer=
WASHINGTON (AP) Democrats i n the House and Senate are pressing ahead with
b i l l s to guarantee that most Americans get health insurance through t h e i r
jobs. Republicans are standing firm against these employer mandates.
Rep. Sam M. Gibbons, D-Fla., today wields the gavel of the House Ways and
Means Committee for the f i r s t time as the panel s t a r t s work on the universal
coverage plan outlined Monday. I t would open up Medicare to the poor,
uninsured and workers from small firms.
The Senate Labor and Human Resources Committee, which backed both an
employer mandate and price controls on premiums Wednesday, was struggling to
wrap up i t s work tonight and become the f i r s t panel in Congress to approve
sweeping health reforms.
Senate Finance Committee Democrats were getting t h e i r f i r s t look at a
blueprint put together by Sen. Daniel Patrick Moynihan, D-N.Y., the chairman,
that was said to be close to the White House approach. Republicans w i l l get
the d e t a i l s at a private, late afternoon session of the f u l l committee.
And a House Education and Labor subcommittee was expected today to endorse
a government-financed health plan for a l l . I t would r a i s e payroll taxes while
eliminating most private insurance premiums. The same panel two weeks ago
endorsed reforms s i m i l a r to what President Clinton proposed.
Making a l l employers buy health insurance the employer mandate
was the main way that Clinton proposed to pay for covering a l l Americans by
1998. But the mandate has come under furious attack from small businesses,
especially the National Federation of Independent Business.
Several thousand blue-collar health workers ringed the Capitol Wednesday
in a noontime demonstration for reform, and Senate Majority Leader George J .
Mitchell released a l e t t e r signed by 1,300 big businesses, unions, health and
senior groups supporting an employer mandate.
""The p o l i t i c a l clout of the forces supporting comprehensive reform i s
formidable,'' said Mitchell. The groups represent 93 million Americans or
""155 times the membership of the NFIB,'' he said.
Almost simultaneously, the U.S. Chamber of Commerce held a news conference
with Republican lawmakers, launching a drive to get p o l i t i c i a n s to sign
pledges against mandates and taxes.
""Today the 1994 campaigns have begun,'' said Sen. Paul Coverdell, R-Ga.
He said constituents have already l e t members of Congress know they don't want
Clinton's ""bully government'' plan.
House Minority Whip Newt Gingrich, R-Ga., r i d i c u l e d Democratic proposals
for a mandate with ""triggers'' that would take effect in three to five years
only i f insurance and market reforms f a i l e d to cover most of the 39 million
uninsured Americans.
Trigger' i s j u s t aiiother word for mandate, j u s t l i k e "contribution' i s
a new word for taxes,'• Gingrich said.
Sen. Jay Rockefeller, D-W.Va., a stalwart supporter of the White House
b i l l and Finance Committee member, said, ""When you say a "hard trigger,'
you're also saying a mandate. I f i t ' s in the law wherein what year there
s h a l l be universal coverage then the mandate i s s t i l l in e f f e c t , ' ' he told
reporters.
Sen. Joseph Lieberman, D-Conn., one of a small group of moderates in both
parties who have met privately i n search of a bipartisan b i l l , said, " " I don't
think there are 51 votes for employer mandates in the Senate. ... The movement
here i s toward l e t t i n g market reforms work for awhile.••
The Senate Labor and Human Resources Committee rejected, 9-8, a bid by
Sen. Dave Durenberger, R-Minn., to k i l l new government power to l i m i t the
growth of private insurance premiums.
�HEADLINE Georgians' Rx: Health reform by the spoonful Fidgety lawmakers try to
make plan easier to swallow
Byline: Jeanne Cummings and Mike Christensen WASHINGTON BUREAU
LENGTH
ESTIMATED INFORMATION UNITS: 8.3
Words: 1167
DATE
07/17/94
SOURCE
ATLANTA CONSTITUTION (ATJC)
Section: NATIONAL NEWS
Page:
A/6
(Copyright 1994 The Atlanta Journal-Constitution)
Washington - After six months of committee hearings and
back-room quarreling, four major health-care reform bills have
emerged from congressional committees on Capitol Hill.
But most in the Georgia delegation want an alternative that's
more cautious. Meanwhile, Rep. J . Roy Rowland (D-Ga.), a Dublin
physician who is retiring from Congress at the end of the year,
suddenly has found himself among those charged with writing such a
plan.
A coalition of Republicans and moderate Denlocrats emerging in
the Georgia delegation is foreboding for House and Senate
Democratic leaders who still hope to gather enough votes to enact a
sweeping reform bill.
The only thing all 13 Georgia lawmakers agree on is that health
reform will be enacted this year. The question is whether to move
incrementally or to take a giant leap in overhauling the
health-care industry, which accounts for one-seventh of the U.S.
economy.
With votes by the full House and Senate expected next month,
fear of making a mistake on an issue so vital to their constituents
is prompting Georgia lawmakers to shed party labels.
. ,
House Minority Whip Newt Gingrich (R-Ga.) is abandoning efforts
to put forth a Republican-sponsored bill in the House. And all but
t w o of the state's Democrats are warning President Clinton and
Majority Leader Richard Gephardt (D-Mo.) they are not inclined to
support a bill crafted by their o w n leadership.
In a June 30 letter to Clinton, Rep. Don Johnson (D-Ga.) said he
would not support any legislation forcing employers to pay workers'
health insurance premiums.
Democrats John Lewis and Cynthia McKinney are the only Georgians
to support a Clinton-style comprehensive bill being drafted by
Gephardt that includes the so-called employer mandates, considered
the key to the president's goal of health insurance for all.
Lewis said of the Clinton plan, "It's balanced and we pay for
it."
Force employers to pay?
McKinney said she supports the House leadership effort because
it would guarantee coverage for all, control costs, include a
�standard package of benefits and offer states the option of setting
up government- run systems.
Democrat Sanford Bishop appears to be the most neutral. He has
CO- sponsored every major plan because he expects the legislation
eventually enacted to include parts of all.
The Columbus freshman said, "I agree that w e ' v e got to fix the
system. It is broken. If we fail to do that, the skyrocketing cost
of medical care is going to bankrupt our nation. I would like to
see every American, regardless of their station in life, be assured
of afforable, accessible health care."
In the House and Senate, the issue driving other Georgia
lawmakers to distraction is the employer mandate, which many
members are convinced will hurt small businesses and create job
losses because of the cost.
The White House contends that requiring employers to pay is
essential to achieving universal coverage, and Clinton has vowed to
veto legislation that does not make them pay.
If Congress rejects the mandate, the only plan Congress could
afford would be a more cautious, incremental approach, which many
believe would not do enough to address shortcomings of the current
system.
Despite pitfalls of a slower approach, most Georgia lawmakers
would prefer it. They are focusing on a proposal introduced in
March by Rowland and Rep. Michael Bilirakis (R-Fla.).
The Rowland-Bilirakis bill was bypassed by the congressional
panels that approved health bills last month. Rowland is busy
writing a new version gaining steam as a bipartisan alternative to
the measure Gephardt is creating. Supporters hope to force a vote
by the full House before the August recess.
"I hope it will work. We'll see," a distracted and tired Rowland
said last week.
On the shopping list
The go-slow House members from Georgia - Democrats Johnson,
Nathan Deal, Rowland and George "Buddy" Darden" and Republicans
Gingrich, Mac Collins, Jack Kingston and John Linder - favor a bill
that would include these provisions: stop insurance companies from
refusing coverage to people with pre-existing conditions; let
workers' carry their insurance coverage to new jobs; curb large
mapractice awards against doctors; streamline insurance
bureaucracy; let small businesses pool their resources to bargain
for coverage; establish rural health clinics; and provide tax
breaks to individuals who buy insurance.
"We should enact doable reform and build on it in coming years,"
Darden said.
Deal said, "There's not a lot to choose . . . . I'm looking for
something else."
�Kingston said, "The problem with a big government bill is we're
still fixing what isn't broken. We need to conform our reform to
the most critical areas."
Collins said such legislation "would address a large percentage
of the uninsured, and we would not be disrupting a very good,
top-quality health-care system nor would we be disrupting or have a
negative impact on the struggling economy."
Linder, who senses momentum for the Rowland approach, said, "I
think that is where we will end up."
Gingrich said he will not organize Republicans to promote their
o w n bill, preferring instead to join the coalition of Republicans
and moderate Democrats.
"There are plenty of issues that we can fight over," Gingrich
said. "To put ourselves in the posture of opposing legitimate
reform is a bad idea."
A similar struggle is occurring in the Senate, and Georgia's t w o
senators are taking a similarly cautious approach.
Republican Paul Coverdell supports a minimal reform bill by
Minority Leader Bob Dole of Kansas because "its premise is to
strengthen and make better the current system."
"It recognizes the system is serving the vast majority of us
w e l l , " Coverdell said, "and it begins to focus on those segments it
has served less successfully" while admitting that more reforms
eventually will ne needed.
Sen. Sam Nunn (D-Ga.) is a co-sponsor of a moderate measure
written by Rep. Jim Cooper (D-Tenn.) that shuns employer mandates
and a heavy reliance on government involvement.
" M y main concern is that we not wreck ourselves fiscally," Nunn
said. "We already have health care that's out of control and is
threatening our fiscal policy."
"I think to mandate that every employer have coverage right n o w
without knowing how much it's going to cost and h o w much we're
going to expand the program is also not the correct procedure,"
Nunn added.
Non of the Georgia lawmakers seems terribly concerned about
Clinton's threat to veto legislation that falls short of universal
coverage.
But "faced with a bill that achieves some of his goals and no
bill at all," Darden said, "I think he'll sign it."
�The Democrats' mystery health care legislation
Negotiations continue today in
secret as members and staff meet
he Am( ric.in people are in for in private to craft a bill that supa rnclc ;uv,ikcning in the posedly has already been passed l^y
debate to idnriii our health
the committee. It is anyone's guess
care system Coniiiess has closed
what the final product will be.
the doors on Ihe public NegotiaFurthermore, the Senate M^ortions that will .inVi t the health care ity Leader continues to craft his
of every Anicric.-m ;ire being held in
alternative health care proposal, a
secret, away Ironi the media spot- proposal that will not face any Senlight and the piihlii 's eye, as a Hnal ate hearings and will not receive
proposal IS pn p;ire(l
any debate in the public's eye before
()n ,luly
1^'»1. the Senate it is introduced on the floor of the
Finance Cnniiiiittee voted on and
Senate Early indications are that
passed a he.ilth ( ;ire reform bill. fhe American people will be given
The VVashiii^'tnn Tost declared in a no more than three days, 72 hours,
front page sinry im .luly .3. that the to review and debate the df)cument
work <if the Senate Kinance Com- prior to a vote.
mittee was coniplete; yet, I call on
We have just spent more than a
th^ reporter and others that herald- year debating the 1,400 page goved tliis action to m-t .-i copy of the bill. ernment run health care plan proThere is no hill There are no po.scd by President Clinton There
amendments There are no details. have been public forums, C-Span
No one knows what the costs will call-in shows, hearings, and town
be. On .Iiiiie I 2, some 10 days after hall meetings. The debate has been
the bill's supposed pas.sage, a 21- good and helpful.
page press siitimiary of the "hill"
Now that the camera lights are
was rele.Tsod that raises more turned off, unknown people are
questions th;in it provides answers. meeting in unknown places to crafl
A member of the committee stat- unknown legislation that will affect
ed, "We didn't vote on a bill. We every American's health care. No
passed out (if the Committee a one knows who is coming or going
bunch of KIC.IS "
fmm these meetings and what deals
This is stunning What American are being cut as the writing goes on.
would make .i ina,)i)r (uircha.se, such And through it all, the American
as a house or ,-i i ai , sight un.seen, people will be given just 72 hours to
without knowing the cost of the pur- digest the information.
chase, the w;ii raii1y. m fonditionsof
This process is wrong and repIhe sale? 'The ,uiswrr is no one. Vet, rehensible The American people
this is preeisely u li;it has taken
should reject it. They deserve to
place in the T S .Scn.iie.
know what is in health care reform
legislation and de.serve the opportunity to debate it in its entirety.
Sen. Paul ( I'vi-nlrll ;s a Rcpiihli
They deserve to read it, .see it, and
• /'("(r'ron'ii;
talk about it. And they should
By Paul Coverdell
T
demand that debate take place.
According to a CNN/USA Tbday/
Gallup Poll, they are. Almost 70 percent of all Americans say they need
more information to judge the health
care plans that have Ijeen proposed.
The stakes are too high for this
President and Congress to take tfiis
behind closed doors. Simply put we
cannot afford to make a mistake.
If the public were to t»e included
in the process. Congress would find
that more than 60 percent of the
American people are telling us to
continue the debate and bring measures in on a gradual basis.
Similarly, more than half of the
public isrejectingoutright the Clinton plan for government-run health
care By a two-to-one margin,
Americans think they will have
"fewer choices" under the Clinton
government-mn plan, and also by a
two-to-one margin Americans think
they will be worse off under a government-run plan. Also, more than
60 percent of the public believes
that if the Clinton plan or a Clintonlike plan passes Congress, there
will be "too much government"
involvement in health care.
These statistics arerevealingin
th It they show the worries many
A mericans are feehng about health
care reform and the Clinton government-run plans. Americans are
deeply concerned that in Mr Clinton's race to pass a health care
reform bill, something very important will be left out — namely, the
views of the American people.
The Wall Street .Journal notes in
an editorial, "Democrats in Congress are likely to bend or ignore
every rule in the book to force
through a health care bill the
American people will either oppose
or know little about. Backers of
government-managed health care
realize they've failed to sell the
idea to voters, but they also know
this may be their last chance to
pass it before voters have a say this
November."
Equally compelling are comments by columnist Roljert Samuelson, who wrote in a recent column,
"The most important social legislation in a quarter century should not
be approved as a last-minute, poorly imderstood patchwork. From the
start, the debate has suffered from
the Clinton's wild promises that they
could achieve 'universal coverage' at
little extra cost. This has produced
five inconsistent congressional bills
that all — in one way or another —
^
fantasize a health care f\iture that
will never happen."
If we leamed anything from the
1992 elections we leamed that the
American people are not asking fbr
more govemment and more taxes.
They are not asking for choices to
be removed, and for bureaucrats
and government employees to
make decisions about who their
doctor will or won't be, or which
hospital they can and can't go to.
Now is not the time for a power
play — or a move from the bully pulpit to bully govemment — by the
Clintons and Democratic leaders in
Congress. The American people are
urging Congress to put the brakes on
a health care reform train that
seems to be mnning out of control.
I agree. I am not interested in seeing Congress msh to pass a bill sim-
BtK^hmtOn
ply to fulfill a campaign promise
made during a presidential election.
Thke the words of M r Clinton's
leadership in Congress:
• "We're going to push through
health careregardlessof the views
of the American people," U.S. Senator Jay Rockefeller, Associated
Press, April 19;
• "We are not backing down on
our drive for the mandate
We are
going to get the votes to do it," U.S.
Rep. Sam Gibbons, Chairman of the
House Ways and Means Committee,
The Washington Post, July 10; and
• U.S. Senator Tbm Daschle said
the Democrats should be prepared
to push for a "51-vote strategy" on
health care to get a Clinton-like plan.
The Washington Times, June 22.
The decision we are about to
make will be the most important
legislative decision in this quarter
century. We owe it to the public to
debate this , issue fully. Open the
process now. There should be no
secrets.
^mCi THURSDAYJULY
28. 1994 *
�AE HEALTH CARE DEBATE: Strong Words and Symbohsm
THE CAMPAIGN
flAlK^npij
^oyaiAi
President Takes His Opponents to Task
Pounding Ltsciern, He Admonishes Protesters to Offer Some Ideas
the other foot."
It was a sharp-elbowed performance, coming after a welter of unabashedly political speeches by Democratic officials and union leaders,
and it gave a newly partisan cast to
an issue that the President has insisted is above party loyalties.
taxes and leave health care in the
hands of private insurers and doc- in places like my state."
On Capitol Hiil, Senator George .
tors.
JERSEY CITY, Aug. 1 - Pounding
Mitchell of Maine, the majoritv leac
his leciern so hard that its PresidenAfter Mr. Clinton's remarks, the er. worked to complete the bill he wi,
tial seal popped off, President Clinton
woman, Patricia Wickens, a former put before the Senate next week, dt
today gave a bristling dressing-down
chemistry teacher from Madison, ciding on elements from bills ap
to a handful of protesters who sought
N.J., said, "My main concem is ex- proved by the Senate Committees or
— with evident success — lo disrupt a
actly what Rush says," referring to Finance and on Labor and Humar
rally on behalf of the Democrats'
the conservative radio Ulk show host Resources. He plans to announce hi'
Refers to Six Plans
health care legislation.
Rush Limbaugh.
bill s provisions on Tuesday.
The President had come to Liberty
Mr. Clinton's press secretary, Dee
"You're going to be fined if you go
State Park across from the Statue of
Dee Myers, said later that he was
to a doctor outside your health unit," But Republican senators held a
Liberty and lower Manhattan to greet using the protesters as a metaphor
she said, apparently referring to the news conference to demand morr
one of the four "Health Security Ex- "for all the people who have been
health alliances that are no longer a time to study the legislation. Senator
Bob Packwood of Oregon said this
press" bus caravans that are taking saying, 'No, we can't.' "
part of the discussion in Congress.
supporters of national health insur"There's been so much criticism
Beyond the protesters, the Presi- was "not a dodge or a stall."
ance to Washington.
heaped on the existing plans that are dent's broader target was the RepubSenator Paul Coverdell of Georgia
The buses, carrying more or less out there," Ms. Myers said, referring lican Party — especially the Senate
ordinary people with accounts of
to the six plans put forth in the last 18 minority leader, Bob Dole of Kansas said It was not enough for memblrs
their own medical woes, have become
months by the White House and Dem- — and conservative advocates like of Congress to have time to studv
the focus of the White House effort to
ocrats in Congress. "He was using those who have dogged the bus cara- whatever bill is put before the Senate
depict universal health insurance as , them as a way to ask the broader van at almost every stop. Mr. Dole |but Congress should wait until the
a boon to the average American.
question: 'I've got my plan; O.K., has proposed more limited legislation I average person has had a chance t(
But from the first moments of his
what's your plan?' "
that would subsidize health insurance I read it. He said he wanted a delay o
speech, which gave a bow "to those
The immediate object of Mr. Clin- for the working poor and enact other "about a month, two weeks."
who disagree with us," Mr. Clinton
ton's sarcasm woven throughout his changes, but would not require emSenator Phil Gramm of Texas said
was instead consumed by the argu20-minute speech, was a compara- ployers to buy insurance for their "It's going to be a very long debate.'
ment of critics that his proposal
tively tiny clutch of yelling, sign-wav- workers as Mr. Clinton advocates.
He said, "The last thing the Presideni
would make the average Joe a loser.
Asks for Explanations
ing protesters some 100 yards from
and the Democrats want is for people
Both Mr. Dole and Mr. Limbaugh to get a chance to look at it."
him. Confined inside a metal fence,
well behind both his hand-picked auLIsu His Achievements
dience and television cameras, they have asserted that the plans offered
Another complaint about timing
Mr. Clinton questioned the critics'
held signs condemning abortion and by the White House and Congression- was made in the House. A bipanisan
concept of patriotism, he accused
al
Democrats
would
increase
Govaccusing the White House of favoring
group trying to put together a bill
them of opposing cheaper health inemment control of the health care relying chiefly on insurance law
socialized medicine.
surance and he said they preferred a
system,
limit
the
choices
of
doctors
At one point the President singled and treatments for many people who changes wanted an assurance that
nation of sick people to a nation of
out a woman waving a sign that are currently Insured, and raise costs they would be given timely help from
healthy ones.
the technicians who draft legislation
called guaranteed health insurance for the middle class.
Not stopping there, Mr. Clinton listso that they could offer their bill as a
socialistic,
and
said
to
her:
"You
ed at some length his own legislative want to repeal Medicare, ma'am? Do
Today the President tried to tum substitute for the Democratic leaderachievements in areas like crime,
those arguments against them, chal- ship's proposal.
you
think
that's
socialized
medicine?
gun control, family leave and budgetlenging the protesters repeatedly to
I don't."
A spokesman for Speaker Thomas
trimming. With audible satisfaction,
explain how they would solve the S. Foley said that the group would get
Medicare
is
financed
by
a
tax
on
he said that he had listened to his
Ijealth-care
problems
that
Democratthe assistance it needed, both from
citizens and employers; Mr. Clinton ic proposals have addressed.
critics for more than a year and that
|the Office of Legislative Counsel and
argues that current Democratic pronow "it is time for the shoe to be on
Citing
the
case
of
Carolyn
Landry'from the Congressional Buget Office,
posals for health care overhaul reject
Billlas, a rider on the bus caravan even If that meant the schedule for
who lost her health insurance after House action might slip a few days.
being diagnosed with chronic hepatitis C, the President tumed to the
A study released today by the An
protesters and said: "You know, I
DIARY
hear a lot of talk today about what nentierg School for CommunicaUon ai
constitutes real patriotism; what the University of Pennsylvania saic
Health Care Developments
constitutes being a real American; that the "Harry and Louise" ad cam
characterizations of what we're try- paign injected considerable confusior
ing to do with health care. 1 think into the health-care debate. The stud\
YESTtRDAV
Carolyn is a real American, and what said the press exaggerated the
amount of time and the markets ir
is their answer to her?"
the ads were broadcast, lead
President Clinton gave a hard-edged speech in Jersey City, attacking
Mr. Clinton mentioned other Amer- which
ing the White House to believe ihe\
protesters who disrupted a rally for the Democrats health care
icans suffering because of the current were
more influential than they reai
legislation
health insurance system, including a ly were.
The White House then con
barber whose health-insurance costs, ducted its
own countercampalgn
he Clinton said, were breaking his which only legitimized
the ads, thi
business; a woman whose insurance studv said.
CONGRESS
bills topped $10,000 a year; a truck
driver and his sick wife whose healthSenator George J Mitchell of Maine, the ma)ority leader, prepared to
care costs had forced them to live in a
unveil his bill looay Republicans said they wanted to delay debate
trailer. "What Is the chanters' anon the proposal for several weeks to have more time for study.
swer to him?" the President asked. •
"What is the answer to her?"
By MICHAEL WINES
Special 10 The New York Times
lllllllllllll
WHITE HOUSE
President Clinton, in New Jersey to greet a bus caravan of
supporters, asserted that critics of the Dennocratic health plan were
lear mongers who opposed cheaper health insurance Returning to
Washington, he met with Iwo Democratic Senators, Bob Graham of
Florida and Charles S Robb of Virginia, to seek their support for
universal coverage
LOBBYING
A study Dv the Annenberg School for Communication at the
Universiiv of Pennsylvania said the •Harry and Louise advertising
camoaian and the White House s response to it, nad injected
consiaeraDie confusion inio the nealth care debate.
Hawaiian System Described
,
At one point, he suggested that his '
critics had no fit replies, except those
motivated by politics and greed. After describing the universal-insurance scheme long used in Hawaii
where, he said, health care costs are
lower than average, Mr. Chnton tore
into his opponents.
"What is the answer to those who
say, 'We don't like what they did in
Hawaii; we don't want cheaper
health insurance, we don't want
healthier people; we want people to
be able to gel a free ride and stick the
taxpayers with what happens?' " He
started another sentence, then broke
off for a last jab, saying. "It's all right
if these country hospitals close down
A
.0^
�Clinton
OKstwo
Hill bills
of health
House measure calls for employers to pay for 80 percent of their
workers' health costs and the Senate bill uses an employer mandate
as a last resort.
Both houses are expected to begm work next week, but House
Speaker Thomas S. Foley said the
House could be delayed by a week
because of techmcal problems m
writing the bdls and getting costs
analyzed by the Congressional
Budget Office.
EarUer yesterday, Mr. Clinton
and Hillary Rodham Clinton welcomed more than 600 people who
tiad participated in a bus caravan
across America to build support
for universal health care. The
buses traveled along five routes
and arrived in Washington this
week.
As though offering a testimonial, John Cox — a Christian
broadcaster from Athens, Ttex.,
whose wife died of stomach cancer
while he was on the caravan — told
the crowd her medical bills were
not covered by insurance.
"We buried her Monday, and I'm
here today to tell Congress that
right is right," Mr Cox said.
Mr Clinton embraced Mr Cox
and said Congress should act upon
Sees GOP 'moving
away' into gridlock.
By J. Jennings Moss
T>« MkaHMQTON TIMES
\
/
W
President Clinton refused last
night to take sides between two
competing Democratic health
care reform proposals on Capitol
Hill, saying either would ultimately ensure all Americans have
health insurance.
At a prime-time press conference in which he accused Republicans of trying to stop refonn, Mr.
Clinton said: "My goal has been
what it has always been: I want a' Mrs. Cox's "laat wish" to pass system that will take us to imiver- sweeping health reforms.
'Somehow, some way, this fight
sal coverage. If it takes a few years
has got to be about... John and Jan
to get there, that's fine with me.
"The problem with the so-called Cox," Mr Clinton said.
Also at the White House, Chief
'half-a-loaf here is that it wont
of Staff Leon Panetta met with
work," he said.
"My own view is that the ques- representatives of 40 interest
tions now should shifttothe mem- groups that back Clinton-style rebers of the other paity, to the con- forms. Speaking to reporters l>egressional Republicans," he said, fore the private meeting began,
noting that about h*lf of the GOP Mr. Panetta dismissed a question
senators initially sponsored a bill of whether the current hearings
that would have led to universal on the Whitewater affair vwre discoverage but all have at>andoned tracting the administration.
"It's all background noise. What
that approach.
"We have reached out to them» the people really care about is
aa waa our responsibility to try to health care, " Mr Panetta said.
"The president has been before
worktogetherin a bipartisan fashion, and every time we have done the American public for almost a
it, they have moved away;" he said. year only to find the American
Republicans liave accused the public has said 'No. We do not like
•dministration and congressional this proposal.'... Now, we find ourDgBocrats of not wanting to nego- selves in the midst of a midnight
tfpB. At a press conference yester- raid" by Democrats to push for a
a|K aeveral GOP senators said vote in August, Mr. Coverdell said.
Senate Republicans said they
DHiocnits had crafted their bills
behind closed doors and were try- would liketohave a break of a couing to pass the bills in the next few ple of weeks to discuss the health
weeks without giving them proposal with their constituents.
enough time to review the legisla- The Senate Democratic plan, authored by Majority Leader George
tioa
J.
Mitchell, has 17 new taxes and
"America should be outraged at
20 new federal entities.
the idea of considering something creates
— a service that is so persooal to Republicans said.
each and every person and family _
and business, community and
state — in a rushed, secret, out-ofthe-light, frenetic form. This is not
the way to deal with 15 percent of
the American economy;;' said Sen.
Paul Coverdell, Georgia Republican.
Asked if he would prefer a provision in the House bill that would
expand Medicare to take care of
the uninsured or a section in the
Senate bill that would help the
uninsured get private insurance,
Mr. Clinton would not conunent.
"I'm not going to get into being a
legislator," he said.
Democratic leaders in both the
House and Senate say they ciu-rently do not have the votestopass
their health bills, a point White
House health adviser Ira Magaziner noted yesterday.
THURSDAY, AUGUST 4,1994
" I f you're asking me would we
win if the vote were taken today in
the House or the Senate, the answer is no," Mr. Magaziner said in
an interview with Hearst Newspapers. "But ^we're confident that
when the votes are taken, by then
we'U have them."
Both the House and Senate
Democratic bills would l ^ d to uni-
\
\
*
�(Hic lUa$l|tnf)tait (Tuitco
NATK
Mainstream' effort on health praised
Hopes raised
on compromise
Republican 'tmth squad" dissents,
criticizes all proposals but Doles
REUTERS NEWS AGENCY
A top White House official yesterday called a bipartisan compromise proposal on health care a
"helpful" contnbution to breaking
the Senate impasse.
White House Chief of Staff Leon
Panetta said on ABC-TV's "This
Week" that he doubted the plan
could pass the Senate as it now
stands. But he praised the socalled "mainstream " coalition of
about 20 senators and said elements of the group's plan, melded
with the bill drafted by Senate Majority Leader George Mitchell and
endorsed by President Clinton,
could provide a successful health
care formula.
"This effon by the mainstreamIS helpful." M r Panetta said. " I f
George Mitchell and those individuals cut a deal, I think we have
a chance of gettmg health care reform."
Mr Mitchell would Uke to wm
broader support for his proposal,
but the Maine Democrat cannot
reach out too far toward the "mainstream" group without aUenating
a pivotsd group of Democrats who
advocate universal coverage.
The plan by the bipartisan
group, led by Sen. John Chafee,
Rhode Island Republican, would
cover around 92 percent of Americans by the tum of the century. A
panel later would make nonbinding suggestions about expanding coverage.
The bipartisan group's package
makes deficit-cutting, not umversal coverage, its priority.
The group is still working on a
crucial portion of the plan — how
many low-income Americans will
cet subsidies to buy insurance.
They are determined not to scale
back their goal of achieving SlOO
billion in deficit reduction over a
decade. But skimpy subsidies
could make it tougher to reach the
goal of 92 percent coverage.
.Mr Mitchell's bill aims to cover
95 percent of Americans by 2000
and achieve a modest reduction in
the nation's budget deficit in 10
years.
If subsidies, incentives and
market reforms fall short of that
coverage goal, a fallback measure
requiring employers and their
workers to split the cost ot insurance .50-50 could be ' tngMered ' to
go into effect in 2002.
.Mr Panetta declined to speculate on whether President Clinton
would veto a bill that falls short ot
.Mr .Mitchell's tareets
I think theres a liood chance
we 11 still get universal coverage.'
ne said, addine that •uitimateh
Part of the Republican strateg^
has to been to divide the member
ship into teams, with each tean
Day after day, a troupe of Senate responsible for certain issues Tht
RepubUcans makes the journey to
core group consists of about ;
the television studio a few steps
dozen of the GOP's 44 senators
from the Senate floor to analyze
The game at the news confer
the health reform plans offered by ences and on the floor seems to be
others.
who can top everybody else in rhe
"When I was a kid, my dad said. torical flourish.
'Read the fine print."" Sen. Paul
At the Wednesday event that fo
Coverdell, a freshman from Georcused on secrecy in the Mitchel
gia, said at Tuesday's event. "That's health bill. Sen. Alfonse D'Amati
exactly what we're going to keep
of New York spoke about the se
doing, day in and day out — we're
gomg to keep reading the fine t crecy provisions as "the bidder
Frankenstein that we're supposei
pnnt."
to eat, that we're supposed to swa I
The lawmakers caU themselves
low."
the "truth squad." They have a
" I don't mind being held hostaei
plethora of charts to make their
if it means we won't let somethint
argument that President CUnton's
get rammed down the Amencar
vision of health reform, as well as
its descendents, amounts to social- people's throats," he said.
The tone of the attacks intensi
ized medicine. And they remm
fied Friday when the Republican.s
over and over to a common theme
faced with the knowledge tha
— that Democrats are lying when
about 10 of their GOP coUeague:
they talk about their health pUins.
were puttmg the finislung touche
Tb stress this point. Sen. Phil
on an alternative proposal witt
Gramm — the Tfexas Repubhcan
like-minded Democrats, tumed c
whose nasal drawl has been the
their own.
loudest voice in the crusade —
mentions a certain bibUcal saying
"It's all cut-and-paste am
at least once every news confernobody knows any of the conse
ence. "Ye shall kncv 'he truth and
quences." said Sen. Malcolm Wal
the truth shaU set you free," Mr. lop of Wyoming. "This is a self
Gramm says as weary reporters
promotion exercise. This is not ai
mouth the words along with him.
exercise in responsible poUtics "
TWo weeks into the debate on the
Mr Gramm mocked what h'
hottest issue of the Clinton presicalled the "so-caUed mainstream
dency, these Republicans are congroup and said of the entire pro
fident that their dual strategy —
cess: "The American people hav
giving the press a daUy dose of
every right to be frightened. ..
GOP criticism and arguing their
intend to fight them just as hard a
pKjints on the Senate floor — is
I fight Bill CUnton."
working.
For these RepubUcans. there i
The Senate unanimously apno compromise on health care
proved the only GOP amendments They believe the only acceptabi'
voted on so far to the health bill by
plan is the one authored by Minor
.Majority Leader George J. .Mitchity Leader Bob Dole, which woul.
ell. Une strips the provision for
make some reforms to insuranc
fines of up to $10,000 for busilaws and provide subsidies to poo
nesses not offering their workers
Americans to buy insurance.
a required package of health beneFor his part. M r Dole has s:av^
fits. The other bars any new health
away from the news conlerenci
bureaucracy from operating in secircuit. Instead.'he is involved b*:
cret.
hind the scenes in crafting strat
But in a health bill that numbers
egy, being the liaison with ,M:
1,400 pages and proposes a sweepMitchell and using the Senati
ing restructuring of the way
floor as his chief forum for com
Americans would get their health
ment.
care, the changes are smaU ones.
Rather than push his own plan
Republicans have threatened, in
.Mr Dole is advancing the idea tha
.Mr Gramm s words, a "torrent" of
the Senate should just go homi
amendments before the debate
and wait for another day to di
ends
health reform. His consen'atU'
Asked Friday when Republicolleagues are saying the sami
cans would offer amendments to
thing.
the heart of the .MitcheU bill —
"The situation on the floor of th'
such as stripping employer manSenate is totally chaotic. . . . It i
dates, eliminating some of the butotally out of control." said Sen
reaucracv or killing new taxes —
Trem Lott of .Mississippi. I i :
.Mr Gramm would not sav and rethinks senators should go hom^
fused to divulge his party s legisand listen to their constituentlative stratesv
"This thing is a disaster'
Bv J Jennings Moss
rHE WASHINGTON TIMES
S(9n, Daniel Patrick Moynihan
doubts a bill will pass soon,
you want to have the trigger there"
to ensure movement toward universal coverage.
The head of the Senate Finance
Committee. Daniel P a t r i c k
.Moynihan. New York Democrat,
said yesterday he doubts the Senate can pass a health bill before
Labor Day and that a break might
be wise.
Conservative Republicans have
demanded that Mr. MitcheU caU a
recess, allow legislators to return
home and resume the health care
battle next month.
Mr Moynihan. appearing on
CBS-TV's "Face the Nation," said
he doubts the Senate will pass either Mr Mitchell's or the "mainstream" coalition's version of an
insurance tax.
The House, which has been preoccupied with the crime biU, is unlikely to take up health care until
next month. Majority Leader
Richard Gephardt, speaking on
NBC's "Face the .Nation." predicted his bill "'or something like
It" would pass, even though it contains a tougher requirement, that
employers pitch in 80 percent of
workers' insurance costs by 1999.
So far there has been a mixed
reaction by key Democrats to the
mainstream outline. Sen. Edward
Kennedy. Massachusetts Democrat, a longtime champion of
health reform, said he hopes to "do
business" with the bipartisan
icroup.
.Mr .Moynihan spoke favorably
of the group and said the nation
should adopt a "step-by-step '
course toward universal coverage.
But he did not give the mainstream group a blanket endorsement.
Several liberal Democrats have
expressed disma\" that the "mainstream" plan would leave millions
of people uninsured
^lic iUnoliiiiqroii iTiiiico
�SOCIAL POLICY
c
tract enough moderate votes to surilies," said Edward M . Kennedy, the
ums and taxes on tobacco ana ammuvive a threatened filibuster by Senate
Massachusetts^ Democrat who pronition.
conservatives. Given that quandary,
posed national health insurjmce three
"Eighty-three percent of AmeriRepublicans — and even some Demodecades ago and now is chairman of
cans will pay more for their health
crats — suggested that he would be
the Labor and Human Resources
insurance," Wallop said. "The middle
better off abandoning his bill and
class will get squeezed coming and goCommittee. " I f iLis_good enough for
starting from scratch.
ing if this legislation is enacted."
the president, j o o d enough for the.
"Until the Mitchell bill is dead
Senate and good enough for the House
Paul Cfl52*pddtNR-Ga., said t h e ^
there is no reasonable way that an alof Representatives, it is good enough
MitcheU version has at least "220 new
ternative can be born," Phil Gramm,
for every inan^ woman-and child in
programs, 47 new bureaucracies,
R-Texas, said at an Aug. 12 news conboards and commissions."
America."
ference.
The ranking Republican on the
Democrats defended their bill, say^
At the same session, Alabama
committee said the lawmakers failed
ing the taxes financed much-needed
Democrat Richard C. Shelby called
to address the most serious cost and
programs and noting that Clinton's
(
the Mitchell plan "ill-con^
proposal to set up manda\
ceived, unworkable and
tory insurance-purchasing
\
unwanted by the American
alliances had been re\
people. . . . Other Demoplaced with voluntary purI
crats will be joining me in
chasing cooperatives.
^ deraUing this bill."
The GOP attacks, howOver four straight days,
ever, came on the heels of a
the Senate talked about
report by the nonpartisan
health care but did not
Congressional Budget Ofvote on a single amendfice, which concluded that
ment.
much of MitcheU's bill, in"It's like two fighters in
cluding a tax on the rate of
the ring in the very opengrowth of expensive insuring minutes of the first
ance plans, appears unmanround," said David Pryor,.
ageable. (CBO, p. 2347)
D-Ark. "They're just out
Some conservative Rethere sparring."
publican senators threat'^
As the two sides poked
ened to filibuster the legisand jabbed in public,
lation. And Jesse Helms, RMitchell retired to his priN.C., came close to putting
vate quarters to begin the
KATHLEEN R BEALL
off the debate for another
tedious process of rework- Sen. Packwood talks about health care at Aug. 12 news conference. year. His proposal was taing his bin to entice wary
bled (killed) 54-46. (Vote
Democrats one vote at a time.
bureaucracy problems in the current
268, p. 2377)
He already has made concessions.
system.
"We are not going to vote until we.
In an attempt to attract conservative
" I t is with deepening disappoint^ have' had the opportunity to go through
Democrats, Mitchell retreated from
ment that I have watched the evoluevery section of this bill and tell people
Clinton's ambitious goal of guaranteed
tion of the reform debate," said
what's in it," Gramm said. " I f people"^
coverage for all Americans. The legisNancy Landon Kassebaum, R-Kansas.
know what's in the Bill, it cannot pass."
lation he unveiled Aug. 2 aims for 95
"The leadership legislation that is now
BiiriHe GOP'could iiot settle on a
percent coverage by the year 2000. I t
before us reflects an unfortunate accustrategy. Several moderates criticized
includes only the possibility that emmulation of missed opportunities."—v.
Gramm for using the 'F-word.'
ployers with more than 25 workers
After receiving a phone call from
Republicans' Charge
would be required to pay 50 percent of
his aunt. Sen. Arlen Sjiecter^ R-Pa.,
their workers' health insurance costs
Already emboldened by Clinton's
said: " I have decided not to join any
after 2002. (VJeekly Report, p. 2205)
abysmal poll numbers and the defeat
filibusterattempt."
Gathered on the floor for the first
of the crime bill in the House on Aug.
week's deliberations were legislators
In the Middle
11, Senate Republicans returned to
who have spent literally decades
election-year themes that have served
To add to their headaches, the
studying the problem and awaiting
them well in the past. The often harsh
leaders of both parties watched all
this event.
assault centered on taxes and governweek as r a n k - a n d - f i l e senators
Yet the fitful opening days did litment bureaucracy.
^ shopped around for the most palattle more than lay out the broad
"Sen. MitcheU said there were four / able approach.
themes of the debate. Proponents arnew taxes in his bill," said Malcolm
Two Republicans and two Demogued that guaranteed health care is a
Wallop, R-Wyo. "Surprise, Sen.
crats announced Aug. 12 that they will
matter of fairness and decency, while
Mitchell, there are not four, but 17
introduce a Senate version of a biparopponents urged fiscal restraint and
new taxes."
tisan House bill unveiled Aug. 11. A
individual responsibility.
broader bipartisan Senate group,
Wallop asserted that the bill re" I have long felt that every Ameridubbed the "mainstream coalition,"
leased by Mitchell (S 2357) would imcan should be entitled to the same
continued to attract new members.
pose $300 billion in new taxes over the
standard of care that we in Congress
Led by John H. Chafee, R-R.I., the
next 10 years, including a 1.75 percent
demand for ourselves and our famgroup spans the political spectrum
assessment on health insurance premi-
V
2346 — AUGIJ.ST 13, 1994
CQ
�SPECIAL REPORT
Senate Democrats, including two —
Kent Conrad of North Dakota and
Bill Bradley of New Jersey — who
had been working wiith a bipartisan
group on an alternative bill that did
not have a mandate.
"The structure the majority leader has proposed is very attractive. I
could support this bill," said Conrad,
who formally endorsed MitcheU's
I Dian.
^
Liberals, whUe unhappy that
MitcheU was forced to give up on f
universal coverage and a more sweeping mandate, generaUy said they
could stay with him because the bill
Still aspires to achieve coverage for
all.
the disparity. Many Democrats say
that they like Mitchell's proposal to
consider a mandate only if other efforts fail to boost coverage. Moreover,
" they see it as the toughest measure
that can pass Congress and argue
there is no reason for the House to try
to go further.
Leadership allies privately agree
that the plan that wins final congressional approval wiU likely be
closer to MitcheU's proposal than to
Gephardt's. But they argue House
passage of the Gephardt biU is the
only way to prevent further retreat.
R MICHAEl. Jl
"The Democrats I've spoken to
Gore speaks at rally on Capitol steps Aug.'
are evenly spUt on whether MitcheU
wiU be the starting point for the
Rumors swirled that the House would House to improve or whether he said to
Partisan Fire
recess and wait for final Senate action
the House, 'Don't waste your time votBut even if Mitchell can appeal to
before proceeding. Speaker Thomas S. ing on anything more controversial,' "
senators' sense of history and win
Foley, D-Wash., squelched the talk with said Rep. Richard J. Durbin, D-Ill.
their votes for the mandate, the partihis Aug. 4 announcement of the new
That same dynamic, however, is also
san fight ahead is shaping up to be the
timetable for action, but it is clear the rocking the moderate boat. For weeks, a
nastiest in recent years. Republicans
atmosphere wiU remain volatile imtU bipartisan group has been working on a
have begun to employ inflammatory the final vote. (Box, p. 2204)
plan that they say wiU increase insurrhetoric to describe the effects of the
"Every day it gets worse," said one
ance coverage without heavy govembill on American society, and conserDemocratic member. "People are nerment involvement. They hope to comvatives appear prepared to filibuster.
vous. They don't know what they
plete it by Aug. 8. A group of 52
/
We "find ourselves in the middle
want."
Democrats signed a letter demanding a
/ of a midnight raid," said Sen. Paul
From the outset. House Democrats
vote on such a plan, and some moderate
^^,,^verdeli^R-Ga., describing how Reha^e eyed their Senate counterparts
Democrats estimate that another 30 are
ftaiBncans leel about being presented
anxiously. Those in the political midlooking for a middle-ground alternative.
with a biU that they did not help
dle and those facing tough re-elections
Republican leaders, including
write. Using language associated with
— a total estimate of 50 to 75 — are
party
firebrand Minority Whip Newt
Nazi Germany, he said that a MitcheU
reluctant to take tough votes on
Gingrich of Georgia, are now reported
proposal to create state-basecl agenhealth care imtil they know where the
to be working to join the bipartisan
cies to investigate instances of fraud Senate stands.
group.
If proposed subsidies to help
^ -and abuse would amount to setting up
House leaders cannot win passage of
low-income
people buy insurance can
r "a medical Gestapo that . . . wiU be their biU, with its controversial employer
be
kept
down
and tax increases
j knocking on your grandpirents'
mandate, without soUd backing from this dodged, many leading GOP lawmakers
I doors."
^
group. Though the formal vote counting predict they may be able to bring
L^-'^and some conservative Democrats are
has not started. Democratic leadership
along GOP support for the plan. If all
taking a less confrontational tone.
aides estimate that they start with
178 RepubUcans vote together, it only
While they had criticisms of MitcheU's
roughly 170 to 180 votes for the plan
takes 40 Democratic votes for victory.
proposal, they say they are determined
unveiled by Gephardt on July 29. Their
"We're very optimistic we'll be
to work on amendments that would
count includes virtuaUy aU 92 supporters
able to support the bipartisan plan,"^
reduce government regulation.
of a Canadian-style, govermnent-nm
said Rep. Dick Armey, R-Texas.
program. Senior Democrats outside the
Democratic leaders are working to
House Calculus
top leadership ranks say the count for
make a vote for the package painful.
The Mitchell plan also roared
Gephardt is more Uke 140 or 150 votes —
AU-eady, Gephardt calls it the "Gingrichthrough the House, shaking already
some 70 votes from passage.
bipartisan plan" — a code to signal that a
fragile political coalitions from the left
Different estimates of the impact of
vote for the plan is a vote for the enemy.
to the right.
the Mitchell plan account for much of
While the coalitions are unlikely to
Following release of the plan.
be sharply defined until the final votes
House leaders pushed back the schedare cast, the Rules Committee will
BACKGROUND
ule for consideration of health care to
open the process with televised hearthe week of Aug. 15 from the week of
ings beginning late in the week of Aug.
1994 Weekly Report:
Aug. 8. While the delay reflected
8. Some 100 witnesses are expected.
State of the Union message, p. 174
many technical matters — from slow
Dole bill, p. 1799
The outcome, however, is almost
drafting to a need for Congressional
Gephardt bill, p. 2143
certain: House leaders will not allow
Budget Office estimates — the new
Mitchell bill, p. 2205
sweeping amendments, instead sendTaxing benefits, p. 1218
political dynamic was tantamount.
ing alternative packages to the floor
Abortion,
p.
1928
As Democrats scrambled to interfor up or down votes in a process
Cost
containment,
p.
2043
pret the political impact of Mitchell's
known as "King of the HUl." (Story,
plan, the chamber became a hothouse.
p. 2212)
•
2208 — AUGUST 6, 1994
CQ
f)
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Coverdell, Paul (R-GA)
Creator
An entity primarily responsible for making the resource
Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Preservation-Reproduction-Reference
Date Created
Date of creation of the resource.
2/6/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg2-007-008-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/54881faf77edf391677455eacf259dcd.pdf
2cb80d9c6042b6f7c6890e5112f63983
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3664
FolderlD:
Folder Title:
Folder #3: [Meeting Notes Ready To Be Entered] [envelope]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
2
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�Key Issues
Global Budgets
Price Controls
Premium Regulation
Tax Cap
Defined Contribution
Regulatory HPPCs
Employer Mandate
Payroll Taxes
Size of Employer i n HPPC
/
/
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Benefits Package
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�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Folder #3: [Meeting Notes Ready to be Entered] [Envelope]
Creator
An entity primarily responsible for making the resource
Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Preservation-Reproduction-Reference
Date Created
Date of creation of the resource.
2/6/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg2-007-007-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/9c9c4788e2e0717862263021cccc29b9.pdf
3b45c59bbb9e805466edd5ac193d9b8e
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3664
FolderlD:
Folder Title:
Folder #3: [Meeting Notes]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
2
3
�PHOTOCOPY
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MEETING:
PHONE CALL:
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PHONE CALL:
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RE:
DATE:
Karen
Lori
Democratic Caucus meeting ~ Thursday, July, 15, 1993
July 16, 1993
Present: Steny Hoyer, Corrine Brown, Ronald Coleman, Peter DeFazio, Peter Deutsch,
Dan Hamburg, Maurice Hinchey, M. Margolies-Mezvinsky, Bob Menendez, David Obey,
Nancy Pelosi (walked in and out before it began), Louise Slaughter, E. de la Garza,
Cynthia McKinney.
Hoyer:
We're here to listen to Judy Feder and to discuss the message for the
August recess.
Judy:
Outlined the plan ... I took notes if you want to see how she presented it.
Coleman:
Cost containment is hard to understand and hard to talk about. What do
we say to our constituents?
Judy:
Tell them the bottomline: you will be guaranteed affordable premiums.
Coleman:
How do we explain it to the experts? Tell them we'll give them a budget
like the German system? Or tell them we'll inhibit research to cut costs?
Judy:
There will be a premium level in the alliance, so there are similariities to
the German system ~ BUT we don't intend to cut costs to a new level, we
want to slow growth. Remember there is tremendous waste in the system - we want to provide incentives for providers to deliver care in an efficient
manner.
Coleman:
What about the segment of the population not currently insured? the
unemployed? How do we bring all of those people into the system?
Judy:
Remember that a vast majority of the uninsured are employed or linked to
someone who is employed. For those remaining outside of the workplace - they will get a contribution from the alliance to help pay for their care
(from a FUTA raise). Even the unemployed will make a contribution.
Coleman:
Uncompensated care goes away ~ except for undocumented individuals.
How will aid be distributed to those people?
Deutsche:
Payroll tax? Payroll participation?
Judy:
The key is to remember that the bulk of the uninsured will be covered by
mandates contributed to employers through the alliances.
�DETERMINED TO BE AN
ADMINISTRATIVE MARKING,
Deutsche:
So all employers must provide coverage and kick money into the alliance what
i<; that
what is
that Hollar
dollar fimirp/?
figure?
Judy:
We'll share the numbers as soon as we have them ~ but the escalation is
not what you expect it to be ~ because the system is already paying for the
uninsured.
Deutsche:
Small business owners don't see it that way ~ under the current system
community health centers may deliver care to the uninsured, but the
financing doesn't come out of the pockets of small business owners.
They'll have to pay higher premiums ... or taxes ...
Hoyer:
Careful... Dick Gephardt is right... never let the word tax cross your lips.
Judy;
There will be provisions in the plan to protect small businesses who employ
low wage earners ~ their contribution will be capped at 3.5% of payroll.
Obey:
Workers comp ... in or out?
Judy:
It will be integrated.
Obey:
So you're going to blow up the current system .. the only goddamn health
system that works in the whole state of Wisconsin?! Well if you do that I
won't vote for the plan. Labor unions and insurance companies hate the
idea too.
What about LTC? Are you only going to offer bells and whistles or are
you really going to do something? Offer a buy-in to nursing home care or
forget it. That's what seniors want. The don't give a damn about homeand community-based care or prescription drugs. This will b catastrophic
all over again and I won't vote for it.
Judy:
We'll offer greater protection against impoverishment, so seniors can keep
their assets. But if you feel strongly, let's discuss it. (Obey spoke directly
to Judy about this after the meeting).
Obey:
Are you going to phase in just women and kids first? I hope not because
we don't want another welfare system. People won't like it.
Judy:
Nodded a lot.
Obey:
How will federal employees like myself be treated/ What if I get hurt and
I want to be able to be treated in DC or my district ~ will I have that
option?
�Judy:
Yes ~ you can choose a plan from the alliance that allows you to do that ~
you can purchase fee for service.
DeFazio:
How do you recapture the windfall savings?
Judy:
We are trying to avoid an assessment and direct attempt at recapture. The
reduction in Medicare and Medicaid disproportionate share payments
should balance this.
DeFazio:
For employers who pay 100% of the cost currently ~ ho do they do that
and comply with the 3.5% cap?
Judy:
That is the low figure and only for small employers of low wage workers.
DeFazio:
Do states still have the option to choose a single payer system?
Judy:
Yes.
Slaughter:
Three things: 1) preserve the Rochester plan; 2) take a look at the NY
state LTC nursing home law (Medicaid picks up the tab after year three);
and 3) what about Medicare, Medicaid, VA, IHS?
Judy:
Explained the plans for Medicare, Medicaid, VA and IHS.
Hamburg:
In my district in California patients compete for providers. How can you
make managed competition work for us? My population base is spread
over 300 miles.
Judy:
For dispersed populations we hope to foster managed cooperation. We'll
help providers outside cities be connected to physicians in cities. We'll also
encourage providers in those areas to create their own networks to deliver
care.
Hamburg:
What are your savings projections?
Judy:
Not sure ~ we're trying to be conservative ~ 13 - 15 (%?).
Hamburg:
Will insurers disappear?
Judy:
Some of the bad guys ~ those who make profits from risk selecting ~ will.
We want to encourage community based plans.
Hamburg:
Worker comp is important in my state too - in California small businesses
consider workers comp to be the "curse phrase". It's a serious impediment
�to small employers.
Obey:
Leave it to individual states to decide what to do with workers comp.
Hoyer:
My constituents agree with Hamburg's.
Obey:
This is clearly a bribe to small businesses and it will explode in my state!!
Workers comp is the only damn plan that works in my sate and I won't
have some yuppy messing it up!
Menendez:
What happens to people who have their total coverage paid for now?
Judy:
It's a loss for them. The message to them is that although they will share
responsibility for the cost of the package ~ they will see an offset in their
wages.
Menendez:
For someone who has no coverage now — what will the plan do for them?
Judy:
Their employer will contribute 80% of the premium for the average plan ~
the employee can choose among plans in the alliance - if there is a lower
cost plan, they can gain coverage without paying any out of pocket costs.
Menedez:
New Jersey bears a heavy burden for the number of undocumented
individuals ~ what will the aid to these areas look like?
Judy:
Something akin to what was in the budget bill ~ Medicaid will give money
to hard-hit areas. We will work with you to find that language.
Menedez:
You'll guarantee I can choose my own doctor?
Judy:
Every alliance will be required to offer a fee-for-service plan that will allow
you to choose your own doctor. It is true that plan may be more expensive
than the average plan.
(Chorus of Oh's from Members)
Obey:
People choose doctors when they are sick ~ not when they choose
insurance plans.
Brown:
How will minority physicians be there?
Judy:
Alliances will prohibit discrimination. Assistance will also be given to
physicians in a community to form local-based plans - I think that will help
minority physicians.
�Brown:
I want to coordinate a meeting with you and some minority physicians so
we can hear their concerns.
Judy:
They will be guaranteed the opportunity to practice.
Vote ~ end of meeting.
�To :
From:
Re:
Date:
Karen
Lori
Message meeting
July 14, 1993 at 12:30
Present: Fazio, Hoyer, Daschle, Bonior, Riegle, Kennelly, Reid, Boxer, Kerrey,
Kennedy, Gephardt, Wofford, Rockefeller. Arnold from Families USA sat next to
Daschle. Mandy, Stan, Paul, Judy and Ira sat at the table.
Daschle:
Opened the meeting and talked about the importance of outlining the
strengths of the plan. Noted the Wall Street Journal article by Marty
Feldman was the plan of attack we should expect as the process continues.
Bonior:
Talked about the process in the House. The 25 member group (House
message Board?) met for the first time last week. Tomorrow Stan
Greenberg is coming in to talk to them. "Frankly, we are a little nervous
about what the hell to say during the August recess".
Hoyer:
Said the Democratic Caucus plans to meet for 4 or 5 days during the
August recess to develop a message. We expect the package to arrive at
the end of September ~ is the right Ira? Ira agreed that they should
expect it "during" September.
Fazio:
Wants to talk about the health university. Envisions it as lasting maybe
two days, with six "classes" that are repeated for small groups of Members.
Noted the importance of focusing on interest groups. Hopes groups will
help to bring around Members who are not yet on board.
Gephardt:
Trying to do outreach to the obvious groups in his district to get them to
stand up and cheer. He's got strategy on paper and was asked to share his
plan as a prototype for other districts. The goal is to generate loud and
visible support for health care reform.
Kennelly:
Directed to White House representatives: Note thefloordebate on
abortion. Be prepared. Keep this issue on the front burner because a lot
of Members have questions.
Boxer:
"Let me be frank ~ if pro-choice advocates perceive that we are losing
ground - we don't expect to gain ground in health care reform ~ but if we
lose ground: we will be out andfightingwith the others who want to kill
this bill". She also made a comment to Judy about a way she and Judy
had discussed to keep abortion in the bill and keep everyone happy. Judy
answered that they were still working with the model she had discussed
with Senator Boxer.
Rockefeller: Questioning Boxer: "What if the plan comes out of the White House with
�abortion in it, but we take it out in Congress will you still vote against
it?"
Boxer:
"I don't know. I don't know. I don't think we will take it out".
Wofford:
Agreed with Boxer that it needs to come out of the White House with
abortion in it.
Stan:
Basically he said ~ health care reform must be treated differently than the
budget. The mistake with the budget was to allow all the focus to be on its
weaknesses. The health care reform plan must be top notch and the way
in which it becomes law must be handled with sensitivity.
Be careful how you discuss the strengths. During the campaign we talked
about change, and that was a good thing. But people do not want radical
change in something so personal. Talk about radical change e in the
system, but conservative change in personal plans. Be aware that this is a
delicate balance.
75% of Perot voters top two priorities are deficit reductions and
health care reform
Clinton voters number one priority is health care reform.
When Americans were asked to make a "forced choice" they rated
choosing their own doctors as more important than keeping health
care costs low. When asked to pick between choosing their own
doctors and being assured security that they would never lose their
insurance ~ they chose security.
A majority of the people polled supported health care reform
without even knowing the benefit package.
A majority of Perot voters favor higher taxes to support health care
reform.
•
In focus groups, participants Hked the benefit package when it was
described ~ they "breathed a sigh of relief.
Outline security. The message is: You will never lose your health care.
The Clinton health care plan: care that's always there, (both Wofford and
Boxer said they really like that line).
Stan believes we can expect an initial positive response.
In spite of press accounts, a large number of consumers know a lot about
their benefits ~ especially families living on the edge (going on and off of
�insurance). When the plan comes out, we will need a process of public
education to supplement the knowledge people already have. They must
understand the issue in order to support something that affects them so
completely.
Remember that doctors are important validators.
Fashion a strategy to encourage enthusiasm.
In our favor ~ Republicans Mali have to tread relatively lightly because they
do not have the same credibility with health care as they do with budget
matters. They can't sink the whole package.
Mandy:
Talking about change in health care is tricky ~ emphasize reform of system
to preserve what is best = SECURITY.
Health care costs have quadrupled since 1980 ~ project that growth rate
into the future.
"Everything that is wrong with the system is threatening everything that is
right. Reform what is wrong and preserve what is valued.
Gephardt:
Find a way to tell your constituents "YOU gain".
Kennedy:
We need something to say in August.
(Ira joke)
Kerrey:
We must respond to the opposition / disinformation. Silence sends a
powerful message to voters. Take credit for the change that is already
taking place as a result of the debate so far. Ex: in Nebraska the two
largest insurance companies are experimenting with managed competition.
"We are already forcing positive change TODAY".
Boxer:
Agreed. We must take credit for what we are doing. Also ~ we must
organize our friends (single payers) ~ don't leave them out of the loop so
long that they feel neglected / angry. Cultivate that support.
Reid:
Former trial lawyer. Concerned about malpractice.
Fazio:
The longer you wait on malpractice the more disappointed everyone will
be (expectations are high).
Mandy:
COMPREHENSIVE is an important word. Use points of comparison so
people understand what the plan will look like. Ex: the benefit package
will be as comprehensive as the plans currently offered by fortune 500
�companies.
Preventive care is very popular ~ makes sense ~ this part of the plan is
better than the majority of plans available today.
Emphasize that alliance will not be able to drop anyone ~ no one will lose
coverage. This is very important ~ the crux of what people hate about the
system.
Reid:
Get small business in early.
Hoyer:
Ditto. (Chorus of agreement)
Mandy:
Financing: send message about responsibility.
In committee you will have to focus attention on the strengths of the plan - therefore, you need to think of ways to create battles over key issues so
they receive press attention. Generate attention to popular pieces.
Try to generate snapshots of interest groups and how much closer they
have to health care reform over the last few years.
Hoyer:
Remember to move only one thing at a time ~ reconcihation first.
Reigle:
Striker replacement and NAFTA - do not under estimate the importance
and timing of these issues -- Clinton could very well walk into a moving
propeller blade.
Gephardt:
Biggest concern: Does the average family perceive this as good or bad?
Republicans will undermine the plan ~ can we convince the average
family that the government can give them something better than they
already have? Search for language that is convincing.
�CONCERNS/OPINIONS EXPRESSED BY SENATORS AT HEALTH FOCUS GROUP
MEETINGS WITH ADMINISTRATION
Meeting held June 8
Bingaman: Had three forums on health care recently. Opponents pack the room to give the
appearance of a "groundswell of opposition". The President should keep Congress in session
until the bill is passed.
The financing mechanism is the key. People in New Mexico are opposed to new taxes, especially
after Budget Reconciliation. He's also concerned that the burden on employers from a mandate
will lead to a loss of jobs. In New Mexico, a state health reform proposal was defeated because
opponents focused attention on taxes. He's comfortable with the framework of the plan, just
afraid of a new tax burden.
People don't believe costs will go down ~ they think we will be adding charges, not reducing
them. Businesses don't believe they'll come out ahead. They also don't completely understand
that they're paying for the employees of those companies that don't provide insurance. Small
business owners tell him "Don't make us pay for a cadillac for our workers when we can't afford
it".
He likes Boxer's idea for small business (see below). He thinks we should phase in incentives for
small business to move to higher option plan for their workers.
Boxer: We should focus on the problems of the current health system, show how bad things are.
In particular, we should use real people to show real problems, including small business owners.
In response to concems raised by Bingaman, she proposes that we give small employers an option:
let them choose if they want to provide full coverage and get favorable tax treatment, or provide
less coverage to their employees without favorable tax treatment. She believes this puts the onus
on small business, not on the Democrats in Washington.
Feingold: We are losing the battie on financing because of our inaction. "We are defending
financing schemes that we may not do". We need to be pro-active on our message. In response to
Bingaman, he believes that we will never truly convince small business owners. Therefore, it is
critical to make sure our supporters are with us. Develop a plan our supporters can get excited
about. Don't move so far to the middle that we lose our support.
Wellstone: Agrees with above. "We need to create a sense of urgency, and develop a plan our
constituency likes." He is concerned that the alliance be a consumer organization.
Meeting Held June 17
Boxer: Concerned about abortion rights. A woman must have the right to an abortion regardless
of which plan she chooses.
Metzenbaum: Doesn't want caps on damages for pain and suffering in medical malpractice
cases. He prefers caps on legal fees, with voluntary arbitration on lower level claims. Caps on
legal fees can be accomplished by limiting contingency fees. In response, Ira Magaziner suggests
a cap on noneconomic damages, but a separate fund to provide additional funds awarded by juries
for successful plaintiffs, that attorneys cannot get to. Metzenbaum is skeptical of this plan.
On antitrust, he believes that small hospitals that want to get together to, for example, buy
�equipment, should be allowed. However, the vehicle should be regulations for expedited approval
at Department of Justice ~ not a provision of federal law. He opposes exemptions for hospitals
and drug companies (with exceptions for rural areas). The antitrust exemption for insurance
companies should be repealed.
He is also concerned that providers and insurers will eventually take over
the health aUiances, and that they will therefore not be consumer-oriented. When Ira suggested that
the statute prohibit providers and insurers from being on the governing board of the alliance,
Metzenbaum agreed and recommended meeting with consumer advocate Ira Ailuck(?).
Reid: Former trial lawyer who handled medical malpractice cases. He noted that future medical
costs will be covered under the new health system. He agrees that we should limit attorney fees,
and is uncomfortable with liiniting pain and suffering for plaintiffs. He said that our message must
be that the middle class won't have a worse system after the plan is passed.
Dorgan: He says that his constituents think health care costs too much, and they hear that the
new system will cost more. This is a bad message to be sending. Rather, he said, we need to help
middle income families whose health care costs are increasing.
In addition, he doesn't understand the structural model. He doesn't think there is a successful
example of this model in existence. He notes that only one HMO has ever survived in North
Dakota.
He also said that we need to change the health care system and its incentives. For example, we
should encourage use of nurse practitioners, and not reward over-use of medical services.
Robb: Believes that cost containment is the key component of a health reform package. He has
held many forums across his state and the most anxious group are small businesses.
Meering Held June 24
Conrad: He's getting beaten up in his state by small businesses. Health care reform must be put
into context — the Budget Reconciliation bill aheady imposes burdens on businesses.
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DETERIVIiNEDTOBEAN
ADMINISJRAfliVE MARKING
INITIALS; ^ILTTDATE- 1 S J 2 ^ ^ /11
DRAFT
l '
(?-«••: - .V a r
^^^^^
Source: Congressional staff observations
Wyden:
Doesn't infitrcncrvotcs. V.^^
' Svnar:
V'"
Attempting to be influential among House freshmen. Unfriendly to
leadership and chairmen. Possibly because he's rumiing for something.
Kreidler:
A freshman leader on health issues.
Slattery:
Concerned about health care for kids and cutting the deficit. Fancies
himself as someone who can bring people together.
Obey:
Loses temper.
Chafee:
Will not vote for mandates or global budgets.
Breaux:
S ' S n " ! JohSon!"
Feingold:
>C
" ^ - ^
Active in health poHtics in state legislature.
Campbell and Boxer-
Metzenhaum-
Both are trying to get active in health care politics attending working groups.
Zealot on his issues - especially antitrust and purchasing
cooperatives.
Dingell:
(Detroit) O.K. as long as Administration sends "real package"j
Waxman:
(LA) Same place as Dingell.
Sharp:
(Muncie, IND) All right - will support package.
Markey;
(Boston Suburb) All right
Swift:
(Everett, WA) All right
�PRIVILIGED AND GQNH©EN5S»rf:
^
Collins:
(Chicago) Concerned about women's health; breast cancer; inner city
urban health problems.
Synar:
(Muskogee) Concerned about rural health; Indian health; Anti-smoking.
i^-" Tauzin:
^
2
(Louisiana) Concerned about: abortion ~ bottomline —fanatte. Also ~
small business problem with mandate.
Slattery:
Might vote with abortion ~ biggest concern is longterm deficit reduction.
Hall:
(Rockwall, TX) Will vote for reform only if Dingell "breaks his arm".
Concerned about small employers; doctors; taxes; everything. Will
probably only vote for reform at full committee ~ not at subcommittee or
on the floor.
Richardson: (Santa Fe) A House whip. Probably O.K - depends on who talked to him
last. "eaaU-be-ljnTlght-^^iratTrfteTrTTOtea:^
^A
[y^
Bryant:
(Dallas) O.K. - will vote with the President.
Boucher:
(Tide Water, VA) O.K. except for one big problem: tobacco. Half coal
and half tobacco in district.Like Tauzin on malpractice reform ~ thinks key
— must upset trial lawyers. On tobacco ~ will require some assistance to
growers.
Cooper:
Likes his own bill. Really loves tax cap ~ needs it. Need to have some
managed competition gurus tell him it's O.K. Requires personal touch
from the White House.
Rowland:
(Albany, GA) Many problems ~ Malpractice ~ hassle stuff could help.
Possible, but tough ~ maybe if Dingell leans on him.
Tobacco tax alone is a problem. Although it is possible to make shared
sacrifice arguments. Rowland walks a fine line as an MD who represents
tobacco farmers. He didn't sign the anti-cigarette tax letter to the
President with other tobacco state representatives.
His district is repubhcan. 62% new ~ mostly republican. People do not
want to pay for the poor. Agricultural district ~ self-employed - tobacco ~
Miller brewery in Albany ~ small employers ~ rural district.
LTC ~ stay away from it if it is too costly.
Influenced by Stenholm and Dingell.
�PRIVILIGED AND ©3?fFieE?TffiKThe Georgia docs have been quiet to date ~ not close with the Governor
or Senators.
u - ' Manton:
(Sunnyside, NY) Probably O.K.
L-- Towns:
(Brooklyn) Attention to urban underserved areas and community health
centers is key.
7.
Studds:
(New Bedford, Mass) Like Dingell ~ Single payer co-sponsor, but will vote
with the President.
U"
Pallone:
Probably O.K. ~ Single payer.
Washington: Probably O.K.
Schenk. Mezvinsky. Lambert:
Need profiles - working on women's issues. Can be
influential on floor and with freshmen.
Brown:
Fine
Kreidler:
Optometrist ~ likes managed competition ~ will be O.K.
Possible gettable Republicans:
Greenwood. Moorhead. Bilirakis. McMillan. Upton.
March 19, 1993, 5:00 p.m. political meeting - OEOB
Staff observations:
Make special effort with Dole and Hatch. They won't vote yes ~ but it may affect their
tone / intensity.
i'
Movnihan:
Concems: price controls ~ eliminate medicaid ~ nexus for health care
reform. Mental health and substance abuse. Concern: New York
Teaching hospitals. Likes Enthoven a lot.
Baucus:
Loves single payer. In Kerrey, Bingaman, Daschle, Wofford gang of five.
Concerns: rural health ~ Native Americans ~ Medigap history - hates
small employer mandates and taxes ~ trade nexus.
A
Boren:
Primary CDF ~ loves providers.
v.^
Bradley:
Concems: Pharmaceutical interests (though not too beholden) ~ likes
managed competition ~ nervous on price controls ~ likes LTC
�PRIVILIGED AND e O N F I © S s m « 3
4
mcrements(eg hospice and RX dmgs) ~ phase in kids first.
^
A
t
Mitchell:
Senate sponsor ~ will drop long term care if necessary. His mark.
Pryor;
Concemed with aging and LTC issues.
Ri^glg;
On board; FASB retiree health; kids first; pfcfcrs singk payfcr;strong cost
containment.
Daschle:
Detail; loves Paul Starr; single payer; loyal to Mitchell; mral health
especially frontier; vets; Medigap / insurance reforms; doesn't like taxes.
Breaux:
CDF sponsor;wants to vote with the Administration; more political than
ideological; can be influential with Johri^n; Concemed with mral health.
Conrad:
Concemed about the deficit; mral health; small business; state flexibility;
close to^^aachlg.; likes policy and detail.
Packwood:
Happy on Oregon Waiver; likes state flexibility; O.K. on employer mandate;
LTC insurance in a priority. - -^c A<
\ y Dole:
Caught in war within the Repubhcan party ~ Graham is challenging him
for leadership. He can only stay in the middle or move right. Will play
hardball. Rural health important to him. Doesn't like medical education
reforms. Close to AMA.
Roth:
FEHB ~ managed competition model - anti-fraud. Handling of this could
influence him (also Stevens).
Danforth:
Likes Oregon waiver - strong cost containment -- wants universal coverage
~ co-sponsor of Kassebaum with premium caps. ~ doesn't like mandates.
Retiring. Making nice gestures to Mrs. Clinton.Brother is the head of
Washington University (St. Louis). Loves tax cap ~ problem with
bottomline. Rural health is important.
>
Chafee:
Chairs Republican HCTF. Wants to help / caught in Republican stmggle.
Loves CHCs ~ huge supporter. Supports tax caps. Medicaid restmcture.
MRDD. Negative on elderly ~ doesn't like long term care.
•A
Durenberger:
^
A Grassley:
Talks big, but doesn't always deliver. Wants to be a player. MN
experience: Mayo; HMOs; StateflexibiUty~ knows insurance
reform. Concemed about "penalizing good states".
Bell weather repubs ~ mral advocate ~ will follow Dole. Follows gut in
�PRIVIUGED AND
^fmBmWSr
Iowa ~ populist instinct important. Des Moine is insurer dominated.
Concemed for farmers.
.y
Hatch:
Related with Keimedy - anti-employer mandate ~ abortion.
y
Wallop:
Problem.
March 29, 1993, Political meeting -- OEOB - staff observations re: Ways and Means
Stark comment to Matsui at health breakfast: told Matsui Task Force would not do any
cost containment.
Rostenkowski:
(Chicago) Protective of local interests ~ especially hospitals ~ has
authored play or pay ~ said he will follow the President ~ sending
signals to slow down ~ deficit conscious.
Gibbons:
(Tampa) Not health player ~ sponsored single payer- trade competition
conscious ~ will follow the President
Pickle:
(Austin) AMA friend ~ mral ~ doesn't like price controls.
Rangel;
(Harlem) urban; minority issues ~ Disproportionate Share Hospitals ~
single payer.
Stark:
Hates not drafting the plan ~ Hates HIPCs.
J^gQbs;
Anti-smoking ~ Organ donors ~ chairs SS subcommittee - Medical IRAs ~
Golden Rule.
Ford:
(TN) Not player ~ Uberal
M^twi;
(Sacramento) Acting chair of Human Resources Subcommittee ~ coverage
for pregnant women and kids ~ prefers regulated cost containment.
Kennelly:
(CT) Insurance ~ women's health ~ mammograms ~ urges going slow ~
deputy whip ~ Women's Caucus - HRC.
Andrews:
(Houston) Texas Medical Center ~ pro-doctor ~ CDF bill ~ cigarette tax - Bentsen.
Levin:
(Detroit) Anti-fraud ~ tax cap ~ labor.
�PRIVILIGED AND € e N F I © g N ^ a r
Cardin:
6
(Baltimore) All payer ~ State opt out.
McDermott: (Seatfle) Single payer ~ Psychology ~ mental health -- state flexibility.
Kleczka:
(Milwaukee) Moderate ~ DES - Health Subcommittee ~ concern for tax
caps " Pairs with Costello and Poshard ~ on Steering and Policy ~ loyal to
Foley and Rostenkowski.
Lewis:
(Atlanta) Single payer ~ Deputy Whip ~ Health Subcommittee ~ lots of
hospitals in district.
L.F. Payne:
(Charlotte) CDF ~ strong doctor workforce ~ cigarette tax problem ~ no
minimum wage ~ no FMLA.
Neal:
(Springfield, MA) On trade -not health - moderate district (Boland's
former district)- with Moakley.
Hoagland:
(Omaha) Mutual of Omaha in district - wants to be team player problem Probably the last one to get on board.
McNulty:
(Albany) Has bill on dental - team player - Cuomo.
Kopetski:
(Salem, Oregon) Team player - good leadership person - team player labor is a factor - mental health.
Jefferson:
(New Orleans) Clinton got him on Ways and Means - grew to 38 for him.
Brewster:
(Ada, Oklahoma) Big CDF - no on stimulus - strong for global budget critical of sin tax - close with Colin Peterson.
Reynolds:
(Chicago) Gun tax.
Staff observation:
Bond:
Strongly opposed to premium caps - perhaps open to ER / EE mandates:
paranoid of "trap" by BC. Used to Governor of MO.
I. Member Statements
House Budget hearing, March 3, 1993:
>/ Mink:
Emphasis on women's health research and ovarian cancer in particular.
�PRIVILIGED AND C O N F I D E N T B ^
\^
'
^
'
7
Snowe:
Concemed about Medicare budget cuts and fraud and abuse. Q: RE:
Medicaid growth...Does first dollar coverage promote utilization?
Shays:
Won't support new taxes for health care reform.
Orton:
Concerned about mral Utah doctors. Sbcty percent of then- patents are on
Medicare or Medicaid. There's a shortage of primary care physicians.
How will managed competition work in mral areas? Looking forward to
incentives in the President's health care reform package that will make
plan attractive to mral areas.
Smith:
(Texas) Concemed health care reform and welfare reform will threaten
deficit reduction efforts. Opposes allowing HIV positive immigrants into
the country.
Blackwell:
Supports emergency measures to stop the spread of TB among the
homeless and prisoners.
Allard:
Supports entitlement caps and raising the Medicare eligibility age to 67.
Berman:
Interested in ERISA protections against bad faith insurance.
Parker:
Concerned about pharmaceutical prices and pharmacy costs.
Slaughter:
Supports childhood vaccines and administrative simplification. Interested
in the Xerox Lifecycle program for low wage earners to improve their
health with child care costs, etc.
Senate DPC lunch. Early March:
^
^'
Bob Kerrey: Cost necessitates action. Don't paint those of us who want to delay until
1994 as obstmctionists. Short term price controls must be supportable.
^
Bingaman:
Concerned about impact of health reform on economic package. Hard to
vote for two tax bills.
Mikulski:
Supports delivery system reform. Doesn't like Jackson Hole model.
--^ Leahy:
Pushing for health care reform this year. Look at Pryor / Leahy bill and
allow states to do own plan in the interim. Howard Dean and Lawton
Chiles are pushing this.
�PRIVILIGED AND €0NFII1HNTESE^
8
C
Baucus:
Supports comprehensive health care reform with no opt out (will create
two tier system).
/
Riegle:
Wants to vote for health care reform this year.
Wellstone:
Believes states need flexibility to do different things. BeUeves the time to
move forward is now.
Akaka:
Concemed about state flexibility.
J Feinstein:
.1
Associates with Rockefeller and Kerrey. Sorry there is an arbitrary
deadUne. Won't get her vote unless cost containment is real and stable.
Conrad:
Agrees with Feinstein. Concerned, too, about the focus on Indian Health
Service and mral health.
HoUings:
Voted for President's freezes, cuts, and taxes - and the Administration still
missed target by $ 100 billion. Proposed introducing a VAT to cover cost
of health care reform.
Exon:
Next year is too late. Questioned the cost in the first year.
Daschle:
Focus on Federal cost.
-.^^ Lieberman: Noted political peril of massive tax increase. Voters do not want to be
taxed to cover the uninsured. People will only bite the bullet if they get
something m retum.
Pell:
Concemed about the perception of rationing.
Kennedy:
Concemed about long term care.
u - ' " John Kerry: BeUeves this is the moment. Be aware of huge political stakes and high
expectations. Tax aspect is dangerous. Guarantee that aU democratic
senators are invested in this process.
A
Mitchell:
Don't confuse consultation with agreement. The Administrafion faces
irreconcUable differences. Impossible to incorporate aU views. Real vote
is on an imperfect biU or compromise.
Simon:
Expectations are high. Act decisively. The greatest political danger is in
failing to do so.
�PRIVILIGED AND eONHEiBN^ffi^
Budget hearing, March 5, 1993:
Rostenkowski:
1. Intersection set this deficit reduction and health care reform.
Difficult to go up same mountain twice. Suggest that we need to
think about this.
2. Why cut payments to inner-city hospitals without comments cut
to mral hospitals - wiU cause some heartburn.
Stark:
1. Going up mountain twice.
2. Why not just do something policy context free for now - instead
of specifics.
3. Stark likes some of the specifics RAPS, GME, in context of
health reform bill they'll put IME on the table.
Part B specifics:
Allege pract; MVPs default; update cut violates the deal.
WiU support DME, EPO, RAPS, single cap reduction 10%.
Part B premium - not hugely controversial - relation between this
and health care reform - Stark wanted to incorporate premium to
pay for prescripfion dmgs.
CBO estimate - 10% below Administrafion estimates - that wiU be
a problem — not ours.
/ Matsui:
^
Pickle:
ROE for SNF - oppose.
RAPS - oppose.
/
John Lewis: Concemed for inner city hospitals
/
Kleczka:
/ Reynolds:
Liberal, Wisconsin.
Chicago inner city
�PRIVILIGED AND C O N F I S S m ? ^
1
DETERMINED TO BE AN
ADMINISJR/g])VE MARKING }
'!^TIALS:JiyrDATE:lSl^
DRAFT
3r
^' ' '
'^
^ ?
Source: Congressional staff observations
Wyden:
Doesn't iiiflucrim votes: Vv..^^
Svnar:
^
Attempfing to be influenfial among House freshmen. Unfriendly to
leadership and chaim^en. Possibly because he's mmiing for something.
Kreidlsi:
A freshman leader on health issues.
Slattery:
Concerned about health care for kids and cutting the deficit Fancies
himself as someone who can bring people together
Obey:
Loses temper.
Chafee:
WiU not vote for mandates or global budgets.
Breaux:
H e f l ' r S 2 r
Feingold:
£ m n s m aniBflxer:
-
m M s m : H-b-nunh^^^^^
MilMntmm:
^
^--^^^ ^ - " '
^obb,
Active in health poUtics in state legislature.
^
^
, ' . ^ - . < - . . ... ,. ,,v.., ; . • ,.,
Both are t^ng to ge, active in health care politics attending working groups.
Zealot on his issues - espedally antitrust and purchasing
cooperatives.
*
Dingelk
(Detroit) O.K. as long as Administration sends "real package"
Waxman:
(LA) Same place as DingeU.
^harei
(Muncie, IND) All right - wiU support package.
Markey;
(Boston Suburb) All right
Swift:
(Everett, WA) All right
(^•Sf-
v »r
�PRIVIUGED AND GQNEi©EJ«i!t
^
2
Collins:
(Chicago) Concerned about women's health; breast cancer; inner city
urban health problems.
Svnar:
(Muskogee) Concerned about mral health; Indian health; Anti-smoking.
u-" Tauzin:
(Louisiana) Concerned about: aborfion - bottomline - fenatte. Also smaU business problem with mandate.
/ A Slattery:
Might vote with abortion^- biggest concern is longterm deficit reduction.
^
HaU:
(RockwaU, TX) WiU vote for reform only if DingeU "breaks his arm".
Concerned about smaU employers; doctors; taxes; everything. WiU
probably only vote for reform at fuU committee - not at subcommittee or
on the floor.
i-- ' Richardson: (Santa Fe) A House whip. Probably O.K. - depends on who talked to him
last. "eanU^fee-brmghrt-^imt^tgir i errted:;
w
[y^
Bryant:
(Dallas) O.K. - wiU vote with the President.
Boucher:
(Tide Water, VA) O.K. except for one big problem: tobacco. Half coal
and half tobacco in district.Like Tauzin on malpractice reform - thinks key
- must upset trial lawyers. On tobacco - wiU require some assistance to
growers.
Cooper:
likes his own biU. Really loves tax cap - needs it. Need to have some
managed competition gums tell him it's O.K. Requires personal touch
from the White House.
Rowland:
(Albany, GA) Many problems - Malpracfice - hassle stuff could help.
Possible, but tough - maybe if DingeU leans on him.
Tobacco tax alone is a problem. Although it is possible to make shared
sacrifice arguments. Rowland walks a fine Une as an MD who represents
tobacco farmers. He didn't sign the anfi-cigarette tax letter to the
President with other tobacco state representatives.
His district is repubhcan. 62% new - mostly republican. People do not
want to pay for the poor. Agricultural district - self-employed - tobacco MUler brewery in Albany - smaU employers - mral district.
LTC - stay away from it if it is too costly.
Influenced by Stenholm and Dingell.
�PRIVILIGED AND SO^JFI^m^aKThe Georgia docs have been quiet to date - not close with the Governor
or Senators.
i ^ " Manton:
7.
(Sunnyside, NY) Probably O.K.
Towns;
(Brooklyn) Attenfion to urban underserved areas and community health
centers is key.
Studds:
(New Bedford, Mass) Like DingeU - Single payer co-sponsor, but wiU vote
with the President.
Pallone:
Probably O.K. - Single payer.
Washington: Probably O.K.
Schenk. Mezvinsky. Lambert:
Need profiles - working on women's issues. Can be
influential on floor and with freshmen.
Brown:
Fine
Kreidler:
Optometrist - likes managed competition - will be O.K.
Possible gettable Republicans:
Greenwood. Moorhead. Bilirakis. McMillan. Upton.
March 19, 1993, 5:00 p.m. political meeting - OEOB
Staff observations:
Make special effort with Dole and Hatch. They won't vote yes - but it may affect their
tone / intensity.
i'
Moynihan:
Concems: price controls - eliminate medicaid - nexus for health care
reform. Mental health and substance abuse. Concem: New York
Teaching hospitals. Likes Enthoven a lot.
Baucus:
Loves single payer. In Kerrey, Bingaman, Daschle, Wofford gang of five.
Concerns: mral health - Native Americans ~ Medigap history - hates
small employer mandates and taxes - trade nexus.
A
Boren:
Primary CDF - loves providers.
\^
Bradley:
Concerns: Pharmaceufical interests (though not too beholden) - Ukes
managed competifion - nervous on price controls - likes LTC
^
�PRIVILIGED AND e©NFI&gJsm?a{fc
4
increments(eg hospice and RX dmgs) - phase in kids first.
^
MitcheU:
A Pryor;
Senate sponsor - wiU drop long term care if necessary. His mark.
Concemed with aging and LTC issues.
Riegle;
On board; FASB refiree health; kids first; pFcfcrs stHgk paycr;strong cost
containment.
Daschle:
DetaU; loves Paul Starr; single payer; loyal to MitcheU; mral health
especially fronfier; vets; Medigap / insurance reforms; doesn't like taxes.
Breaux:
CDF sponsor;wants to vote with the Administration; more political than
ideological; can be influential with Johri^n; Concerned with mral health.
.-^^ Conrad:
Concemed about the deficit; mral health; small business; state flexibility;
close to_Dasi±l£.; likes policy and detaU.
^
Happy on Oregon Waiver; likes stateflexibiUty;O.K. on employer mandate;
LTC insurance in a priority. - p r ' - f <
L
Packwood:
\ y Dole:
Caught in war within the Repubhcan party ~ Graham is challenging him
for leadership. He can only stay in the middle or move right. WiU play
hardball. Rural health important to him. Dqesn_[t Uke medical educafion
reforms. Close to AMA.
^(^ Roth:
FEHB - managed competition model - anfi-fraud. Handling of this could
influence him (also Stevens).
>
Danforth:
Likes Oregon waiver - strong cost containment - wants universal coverage
- co-sponsor of Kassebaum with premium caps. - doesn't like mandates.
Retiring. Making nice gestures to Mrs. Clinton.Brother is the head of
Washington University (St. Louis). Loves tax cap - problem with
bottomline. Rural health is important.
Chafee:
Chairs Repubhcan HCTF. Wants to help / caught in Republican stmggle.
Loves CHCs - huge supporter. Supports tax caps. Medicaid restmcture.
MRDD. Negative on elderly - doesn't like long term care.
Durenberger:
A Grassley:
Talks big, but doesn't always deliver. Wants to be a player. MN
experience: Mayo; HMOs; StateflexibiUty- knows insurance
reform. Concemed about "penalizing good states".
Bell weather repubs - mral advocate - wiU foUow Dole. Follows gut in
�PRIVIUGED AND e0NRBENT5zC^
Iowa - popuUst instinct important. Des Moine is insurer dominated.
Concemed for farmers.
./
Hatch:
Related with Kennedy - anfi-employer mandate - abortion.
Wallop:
Problem.
March 29, 1993, Political meeting - OEOB - staff observations re: Ways and Means
Stark comment to Matsui at health breakfast: told Matsui Task Force would not do any
cost containment.
Rostenkowski:
(Chicago) Protective of local interests - especially hospitals - has
authored play or pay - said he will follow the President - sending
signals to slow down - deficit conscious.
Gibbons:
(Tampa) Not health player - sponsored single payer- trade competition
conscious - wiU foUow the President
Pickle:
(Austin) AMA friend - mral - doesn't like price controls.
Rangel;
(Harlem) urban; minority issues - Disproportionate Share Hospitals single payer.
Stark:
Hates not drafting the plan - Hates HIPCs.
Jagob?;
Anfi-smoking - Organ donors - chairs SS subcommittee - Medical IRAs Golden Rule.
Ford:
(TN) Not player - liberal
M^tstii;
(Sacramento) Acting chair of Human Resources Subcommittee - coverage
for pregnant women and kids - prefers regulated cost containment.
Kennelly:
(CT) Insurance - women's health - mammograms - urges going slow deputy whip - Women's Caucus ~ HRC.
Andrews:
(Houston) Texas Medical Center - pro-doctor - CDF biU - cigarette tax - Bentsen.
Levin:
(Detroit) Anti-fraud - tax cap - labor.
�PRIVILIGED AND € O N R e g N ^ f t « r
Cardin:
6
(Baltimore) All payer - State opt out.
McDermott: (Seatfle) Single payer - Psychology - mental health - state flexibility.
Kleczka:
(Milwaukee) Moderate - DES - Health Subcommittee - concern for tax
caps - Pairs with Costello and Poshard - on Steering and PoUcy - loyal to
Foley and Rostenkowski.
Lewis:
(Atlanta) Single payer - Deputy Whip - Health Subcommittee - lots of
hospitals in district.
L.F. Payne: (Charlotte) CDF - strong doctor workforce - cigarette tax problem - no
minimum wage - no FMLA.
Ngali
(Springfield, MA) On trade -not health - moderate district (Boland's
former district)- with Moakley.
Hoagland:
(Omaha) Mutual of Omaha in district - wants to be team player problem Probably the last one to get on board.
McNulty:
(Albany) Has biU on dental ~ team player - Cuomo.
Kopetski:
(Salem, Oregon) Team player - good leadership person - team player labor is a factor - mental health.
Jefferson:
(New Orieans) Clinton got him on Ways and Means ~ grew to 38 for him.
Brewster:
(Ada, Oklahoma) Big CDF - no on stimulus - strong for global budget critical of sin tax - close with Colin Peterson.
Reynolds:
(Chicago) Gun tax.
Staff observation:
Bond;
Strongly opposed to premium caps - perhaps open to ER / EE mandates:
paranoid of "trap" by BC. Used to Governor of MO.
I . Member Statements
House Budget hearing, March 3, 1993:
i/
Mink:
Emphasis on women's health research and ovarian cancer in particular.
�PRIVILIGED AND eONFIDENroB&-
7
Snowe:
Concerned about Medicare budget cuts and fraud and abuse. Q: RE:
Medicaid growth...Does first dollar coverage promote utiUzation?
Shays:
Won't support new taxes for health care reform.
Orton:
Concemed about mral Utah doctors. Sbcty percent of their patents are on
Medicare or Medicaid. There's a shortage of primary care physicians.
How wiU managed compefition work in mral areas? Looking forward to
incentives in the President's health care reform package that wiU make
plan attractive to mral areas.
Smith:
(Texas) Concemed health care reform and welfare reform wUl threaten
deficit reduction efforts. Opposes allowing HIV positive immigrants into
the country.
Blackwell:
Supports emergency measures to stop the spread of TB among the
homeless and prisoners.
Allard:
Supports entitlement caps and raising the Medicare eligibility age to 67.
Berman:
Interested in ERISA protections against bad faith insurance.
Parker:
Concerned about pharmaceutical prices and pharmacy costs.
Slaughter:
Supports childhood vaccines and admimstrative simpUfication. Interested
in the Xerox Lifecycle program for low wage earners to improve their
health with child care costs, etc.
Senate DPC lunch. Early March:
~"
Bob Kerrey: Cost necessitates acfion. Don't paint those of us who want to delay untU
1994 as obstmctionists. Short term price controls must be supportable.
y
Bingaman:
Concerned about impact of health reform on economic package. Hard to
vote for two tax bills.
Mikulski:
Supports delivery system reform. Doesn't like Jackson Hole model.
Leahy:
Pushing for health care reform this year. Look at Pryor / Leahy bill and
allow states to do own plan in the interim. Howard Dean and Lawton
Chiles are pushing this.
^
�PRIVIUGED AND eDNFmENmE-^
/
^
I
8
Baucus:
Supports comprehensive health care reform with no opt out (will create
two tier system).
Riegle:
Wants to vote for health care reform this year.
Wellstone:
BeUeves states needflexibUityto do different things. BeUeves the time to
move forward is now.
Akaka:
Concerned about state flexibility.
Feinstein:
Associates with Rockefeller and Kerrey. Sorry there is an arbitrary
deadUne. Won't get her vote unless cost containment is real and stable.
Conrad:
Agrees with Feinstein. Concemed, too, about the focus on Indian Health
Service and mral health.
HoUings:
Voted for President's freezes, cuts, and taxes - and the Administration stiU
missed target by $ 100 billion. Proposed introducing a VAT to cover cost
of health care reform.
Exon:
Next year is too late. Questioned the cost in the first year.
Daschle:
Focus on Federal cost.
Lieberman: Noted poUtical peril of massive tax increase. Voters do not want to be
taxed to cover the uninsured. People wiU only bite the bullet if they get
something in return.
Pell:
Concerned about the percepfion of rationing.
Kennedy:
Concerned about long term care.
John Kerry: BeUeves this is the moment. Be aware of huge political stakes and high
expectafions. Tax aspect is dangerous. Guarantee that aU democratic
senators are invested in this process.
/
Mitchell:
Don't confuse consultafion with agreement. The Administration faces
irreconcUable differences. Impossible to incorporate aU views. Real vote
is on an imperfect biU or compromise.
Simon:
Expectafions are high. Act decisively. The greatest political danger is in
failing to do so.
�PRIVILIGED AND (gQIvfFIDEIM^ffi^
Budget hearing, March 5, 1993:
•A-
Rostenkowski:
1. Intersection set this deficit reduction and health care reform.
Difficult to go up same mountain twice. Suggest that we need to
think about this.
2. Why cut payments to inner-city hospitals without comments cut
to mral hospitals - wiU cause some heartbum.
Stark:
1. Going up mountain twice.
2. Why not just do something policy context free for now - instead
of specifics.
3. Stark likes some of the specifics RAPS, GME, in context of
health reform bill they'U put IME on the table.
Part B specifics:
Allege pract; MVPs default; update cut violates the deal.
WiU support DME, EPO, RAPS, single cap reduction 10%.
Part B premium - not hugely controversial - relation between this
and health care reform - Stark wanted to incorporate premium to
pay for prescription dmgs.
CBO estimate - 10% below Administrafion estimates - that wiU be
a problem - not ours.
J
Matsui:
ROE for SNF - oppose.
Pickle:
RAPS - oppose.
/
John Lewis: Concemed for inner city hospitals
/
Kleczka:
/ Reynolds:
Liberal, Wisconsin.
Chicago inner city
�PRIVILIGED AND CGNFIEtiEPm^
10
notes:
Cooper:
BeUeves the President has promised to propose his bill in mentioning it.
Hillary Rodham Clinton with Energy and Commerce Democrats, March 9, 1993:
><v
Pallone:
Advocates single payer: why rejected? Is it perceived as too radical?
Slattery:
1. Need to focus on states role as cop for cost containment. States
empowered to have cost containment commissions and enforcers. They
have history of balanced budgets - Feds don't.
2. Abortion - hope bill doesn't deal with the question. Don't allow
federal funding for that. Need pro-lifers on our side. Don't force an
abortion vote.
Hall:
" .-^ Waxman:
Providers are closest to problem - often source of problems. They need to
be at the table. Head of ABA should be pressed on malpractice reform.
Energy and Commerce has jurisdiction. We all have points of view single payer isn't inconsistent with managed competition - just a way to
gather money hope we pass this faU in reconciliation.
Richardson: Hope package has strong malpracfice component. DisUkes "tax lurking in
the future".
/
^-
Slattery:
Echoed Richardson's concern - suggested deadlines not be locked in.
Brown:
Pre-natal care and immunizations - need outreach.
Tauzin:
Guarantee something - not everything - for everyone.
Margolies-Mezvinsky:
^
Expressed interest in being plugged into the debate.
Especially concemed about fraud.
Kreidler:
The bolder the better. States requireflexibUity.Low cost states shouldn't
have to fall 10% like high cost states.
Markey:
Telemedicine. Use technology to expand access and quality.
-J. Studds:
Single payer advocate. Noted the administrafion can only afford to lose
four votes on the Energy and Commerce Committee - so everyone must
�PRIVILIGED AND ieONFIDENTIAL
11
be willmg to walk a considerable distance from their first choice.
^' Lambert:
Stress mral needs NOW. Community health centers have already proven
themselves helpful. What does managed competition do for mral areas?
15 mral hospitals closed in Arkansas last year. Too much waste on
chronically Ul. How can doctors go through medical school with no
instmction in the cost of health care?
Rowland:
You can lead people farther than you can push them. Do what you must
to make the AMA feel involved.
Schenk:
Focus on mental health - give people choices. From Southern California,
biotech center, don't stifle this research and innovation. Canada and
others live off our research.
Rich Lehman:
Towns:
Majority of insured want better coverage. Minority of uninsured
want coverage. Will react negatively to big government bureaucracy
(like Medicare) - "My mother can't figure out her bill". Tort
reform: perception of fueling defensive medicine - you must
overcome. Small business: concem for affordability - don't care
what Chamber says — you have to convince SMERS (small
employers?) in my district.
ERs / trauma centers in urban areas - hope you'U visit some. There's no
uniform record keeping system - hospital closes and records are lost.
Ways and Means Budget hearing March 10, 1993
Rostenkowski:
IME
Head start investment / saving increasing. DES feels safer with 3:1 retum,
acknowledge higher estimates. Provide citation of studies for record.
Submit number, for the record, of SSA workers to address SSD backlog.
Head start speech.
DisabiUty backlog top priority. Look into telemed demos. DSH - states
match gov't for Medicaid. Will President cut some slack for hospitals?
Federal government can't offer it much longer.
Thomas:
State role in federal props - move toward bottom up.
�PRIVILIGED AND QDNffiBJ^SAL,
Matsui:
12
WiU be consistent or consfitufional (?) to raise taxes for health care reform
- hope will be on welfare, including strong child support enforcement.
Sander Levin:
Fraud and abuse - how to save more money and cut costs. HR
1255. IME - DME - also hits suburban hospitals.
Cardin:
Are you aware of any system other than single payer / all payer that saves
at an equivalent rate?
Brewster:
What percentage of welfare costs are non-medical? What percentage of
Medicaid is non-elderly? Medicare payments are insufficient, therefore
hospitals forced to cost shift. Rural hospitals are unable to reduce costs.
Johnson:
Cost shifting to seniors; to state administrative costs; look at 77 programs
in HHS and consolidate.
Reynolds:
Cost to inner city hospitals. No adult trauma units in South Side of
Chicago due to burden of gunshot victims.
Santomm:
President said only a few weeks away from welfare reform - what is the
time limit? the work component?
Andrews:
Child support enforcement.
One doUar tobacco tax. On the table? Interested in preventing teen
smoking for health and finance reasons.
[Bradley is Senate sponsor]
Rostenkowski:
i
Stark:
Ways and Means has a history of meeting budget targets - but need some
wiggle room. Hope you'U give us some.
Houghton:
GME cuts - nafional average basis is unfair. Telecommunications in
health care system could help link smaU hospitals to large hospitals managed care hard in mral areas.
Payne:
Health care reform - primary care shortage - wiU need waivers and
flexibility.
•\
j
i
\
Deficit - cost containment - cost shift.
\
\
Lewis:
Executive order to ban smoking in aU pubUc buildings. Long term care
concems.
�PRIVILIGED AND . e O S m i i m ^
13
Hancock:
Social Security eamings test
Jefferson:
Cut outpatient cap - cheaper than inpatient.
Kleczka:
Disability tmst fund status?
McCreary:
Foster Higgins - rising 10.1% ER health care costs vs. 14.9% recently.
Rangel:
Wish we could just freeze Medicare rates. Hate two cuts. What are
federal costs of dmg and alcohol abuse - homelessness - violence? We
need a dmg czar - we need a poUcy.
Kopetski:
Mental health care - Clinton philosophy to treat mental health with
parity? What if states can't afford their share of costs? Disseminate
creative / effective state experiments.
Grandy:
$300 miUion for immunizations - hope you stop short of universal
purchase. Biggest problem: lack of pubUc education - lack of parental
responsibility.
Hillary Rodham Clinton and Women Senators March 11, 1993
J
•/^
Mikulski:
^
Health care delivery reform important. Needs of women, especially
reproductive health services, in core benefit package. Health care in
different setfings. Support services too - esp. for cancer patients.
Kassebaum: Agree with Mikulski on women's health. Want woman appointed as head
of NIH. Cost containment important to economic safety. Independent
commission to determine core benefits.
Boxer:
Agree benefit package shouldn't be poUtical. Avoid abortion votes - amimidwife votes. Need to speak out on violence - anti-clinic. Delivery
system key for reaching immigrants - non-English speaking. Community
centers. PubUc health outreach. Prevention (especially teen pregnancy).
Representation Board - include gender and interests and race.
Mosley-Braun:
Murray:
Comprehensive reform; favor single payer; control cap
expenditures - CON? Push decisions closer to community level;
wellness and prevenfion; LTC must be covered; return to health
planning.
Stress long term care. Consider OBGYN as primary caregiver; Pre-existing
�PRIVILIGED AND GONFIBBiiHM:
14
conditions; reproductive health services; infant mortality
pre-natal care, healthy mothers; women and AIDS.
A
Feinstein:
^.
address through
Father was chief of surgery at San Francisco General. While she was
mayor the health budget tripled. Changing medical culture -more
corporate, concerned with costs. Keep benefit package out of poUtics. aim
for prevention; family doctors; choice of physician preserved; reliance on
para professionals. Foreigner entitlement to Medicaid - Medicaid should
not cover dmg treatment. Women's health care - cover women in cUnical
dmg trials at NIH. Don't understand how capitation wiU control costs over
the longmn. BeUeve cause of medical costs is defensive medicine medical malpractice - stress insurance reform. Stress family practice.
Cost controls must be in place within a decade. Set mulfi-year budgets.
Kassebaum: Could budget impose Umit on premiums?
J
I
Mikulski:
Good guy in health care: IRAs - pay people to stay weU. Like cafeteria
plans.
House leadership meeting, March 11, 1993
._/
V
-^j
y
DingeU:
Senate procedure.
Stark:
When wiU biU be on the floor?
Dingell:
Need to develop substance and procedure early - You'U need DNC, every
group, every resource you have. Use reconciliation as vehicle - I'm
prepared for one vote.
Gephardt:
Pass resolution next week in House - joint before April 1 - finish
reconciliation markup - then do health care biU in early summer and hold
reconciliation.
Ford:
Higher educafion provision problemafic - time sensitive.
Waxman:
Define core so we can begin to seU it - we need to figure out what our
committees should be working on.
Dingell:
Don't let our outreach supplant group outreach.
Stark:
Six months is fast. Give us specs to start marking up. We need to do
hearings on the benefit package.
�PRIVILIGED AND_e©Ni5©SN^^i^
^
^
15
Dingell:
Hearings must start as soon as you have your general direction.
Waxman:
Wants smaU core groups to make decisions.
Stark:
Cost containment? Taxes?
Waxman:
Can't do much access if we focus on cost containment alone.
Ford:
Skim off insurance company savings.
Stark:
Put everyone in early and then have political constituents to raise benefits
over time.
V Ford:
ERs in two camps: 1) Big ERs already invested 2) SmaU ERs don't want to
play at all.
^/
Teach us - let members ask questions around the table.
Waxman:
Not yet strong appreciation among Democrats of President - strong
feelings.
X ' DingeU:
Need votes the day your bUl arrives - doubtful you'll get them in the
legislative process.
March 17, 1993: Ways and Means meeting with HRC
Rostenkowski:
The public is ahead of us. If Ways and Means sticks its neck out,
we need caucus to back us up. Republicans want to participate too.
McNuldy:
Pay attenfion to addiction treatment.
Levin:
Need to combine managed competition with strong and immediate cost
containment or plan won't work. Congressional role: need real
partnership and leadership. Before you choose final options exercise fullest
exchange between the White House and Congress on substance and
poUfics. Make the case you've squeezed inefficiency from plan before you
ask Congress for more money.
Jefferson:
(former malpractice attorney) Defensive medicine doesn't fuel
technology - it's competition between hospitals and doctors and patient
demand.Caps on damage and awards won't work. Insurers raise rates
because they can. Better to define a negligence standard as mimmum
quality standard.
�PRIVILIGED AND eONFfBgN^fea^^
/•
Cardin:
Note success of Maryland aU payer rate. Stress more primary care.
Include Congress in process. Want opportunity to negotiate aU points
before introduction. Also want input after introduction.
Matsui:
No problem with Prescripfion dmgs and LTC for seniors - hope pregnant
women and kids get phased in first. Tax the devil out of tobacco $ 2.00-1and 1 rep wine and know they'U take a bit, too.
Employees are the only ones not making tough choices - need tax cap per
Enthoven and Jackson Hole.
~A Revnolds:
/
y
16
Uninsured gunshot victim in trauma center - double excise tax on firearms.
Kopetski:
Mental health: Clinton philosophy to treat it with parity to physical
health? HRC: Don't know if we can afford it - but mental health wiU be
a part of core benefit package. MK: Regarding benefit core package: it
hurts unions if it is set too low.
Pickle:
State HIPCs with global budgets - what's your position on managed care?
Any cost savings to deficit reduction?
Neal:
We'U evaluate plan after enactment? HRC: yes.
Andrews:
Support managed competifion - not sure they can be combined with global
budgets. Do caps undermine competition?
Kennelly:
Democrats need to be responsive to marketplace and unanticipated
consequences of what we do. Don't msh.
< Rostenkowski:
This committee can do your deal.
A
Kleczka:
Taxing ERs benefits above the core package?
y
Brewster:
First doUar invites abuse. BeUeve you must have a global budget to
contain costs. Need strong revenue base — sin taxes = declining revenue.
McDermott: Relafion between national and state role? National global budget is fine
but deUvery system wiU work differently in different states. State
flexibiUty? State single payer opfion? How to treat self insured plans?
^
Hoagland:
Byrd mle waiver dead? Adding health care in June could siphon off
legislative effort and attention to budget reconcihation and supplemental?
Timing?
�PRIVIUGED AND e ^ f R B E N T O f r
17
Stark:
Medicare cuts umelated -Include virtually eliminating graduate medical
education. Not sure we can do $50 billion in reconcihation and health plan
in one year. Would help us to get paper directly from you, so we can meet
next-to-impossible deadlines. Ways and Means staff could participate when
decisions are made.
Gibbons:
I'U vote for anything you send up. Timing? Financing? On mandates:
cmel to tie health care to employment. I don't favor mandates. Tend to
undermine portabiUty; hurt global competition.
^<
'—"
John Lewis: Political stakes high. Do it right.
Payne:
Appreciate attention to mral health - Medically Underserved Areas. 5,000
tobacco farmers in my district. Understand that cigarettes must
contribute - but keep in mind our economic needs in determining level of
that contribution.
Rostenkowski:
Underscore this will be difficult. I don't like timetable Don't be
disappointed. This is stiU a legislative process — hope your main
thmst will be acceptable to most of us.
Senate DPC Lunch, 3/18/93 - Judy and Ira
Bingamen:
Cost control works because states can set HIPCs Umits on premium? Only
works if aU people buy through the HIPCs.
Wellstone:
Emphasis on state flexibility -f- very important. Consumer choice is real
issue. Benefit package key, too.
Reid:
Federal benefit standard supersede state mandates? Impact on earning
capacity of physicians?
^
L^-" Conrad:
^
Levin:
No taxes promi&oll? 1. slow-phase in of access; 2. raise new taxes; 3.
slow growth of health system and recapture.
Different cost of providing health care services ...
L— Baucus:
What about supplemental coverage? Half of Montanans are self-insured concerned about different treatment. How can you community rate in
sparse areas?
Lautenberg: End duplication of capital.
'A
PeU:
Oregon waiver?
�PRIVILIGED AND •e©NFIE>fiNqffi>a.
L
18
Kennedy:
Dmg companies - half are innovative - the other half are on the dole.
How wiU HIPCs be developed?
Breaux:
Concerned about HIPCs and state flexibility. WiU you reduce cost with
caps?
I - Wofford:
Concerned about labor and tax cap. Stmcture HIPC as public corporation
v. govemment bureaucracy - therefore premiums will not equal taxes. Can
you surcharge premiums to minimize pubUc taxation?
' - ^ Graham:
Long term care -kick to states? LTC very important ui Florida. Hard to
kick to states.
Meeting with Rowland, March 24, 1993
U---" ' Rowland:
Biomedical ethic. Can we pay for it - unlike Medicare and Medicaid. If
we keep Medicare - need to means test it. Managed competition may
work - but what about mral areas. Economic impact of insurance
insolvency? Public sector - 12 doctors in community health centers in
Albany - individuals can choose their own.Federal, state local support - 3
outreach centers in mral areas - anyone can get outpatient primary care in
that State with sUding scale contribution. Doctors salaried to get rid of
abuse / incentive to over / under provide. Remove incentive - fee for
service. End doctors' ownership of ,labs. CLIA / POLs -Networking of
CHC to provide outpatient primary care. For non-LTC Medicaid - take
that money to feed outpatient CHCs. For inpatient care - aU doctors on
inpafient staff required to provide pro bono care to poor. Do beUeve we
need a global budget on Federal spending - state and local community
required to make up the difference. State and local governments should
invest in health care systems. Don't want giganfic Federal program. Prefer
to try this in three or four states prior to complete implementation.
I will support what the President wants to do if we can afford it in the long
term.
Fmmel Medicaid acute care money into CHCs.
Looking for incentive for doctors to do only what is needed, salaries or tax
incentives? Get away from micro-managing.
Notes:-- meeting with Tauzin
Tauzin:
25-30% of families in Louisiana are uninsured - High resistance to federal
govemment interference -but a poU of consfituents said "get involved" ~
�PRIVILIGED AND CONFIBENTEar
19
key = heavily regulated cost controls - mandates on smaU businesses strong sentiment for choice of plan Proposed plan: federally administered plan - standard poUcy underwritten by private insurers - let local business and employees decide
what share is - plan sets strict UabUity limits - patients contract - tax
benefit to ERS. Admit that it doesn't address unemployed.
Wants to see mral health - emphasis on training famUy doctors.
Telemedicine is important.
Can't touch abortion - WON'T VOTE FOR ABORTION COVERAGE.
Can take mandate to an extent. Working with low income - high
unemployment.
Notes - meeting with KP
Boucher:
Two broad concems: 1. Rural district (Roanoke to Cumberland Gap) managed compefition won't work there. If a cap on providers is the
alternative it wiU be hard to recmit doctors. 2. Financing - 14,000 tobacco
growers don't want a tax. 2.5) Black lung.
Single payer will work best in his district - even if mral needs are met,
tobacco remains a problem - anything over 10 cents a pack is a problem How wiU tobacco growers be compensated? Make it as attractive as
possible - Some significant share of tax revenue must go to stabilization. Even if you give some of the money back to farmers, tax must still not be
too big. - wiU vote for other taxes - Uke a VAT. ? If cannot vote for a
tax - won't be in Energy and Commerce - we'U have to use whatever
leverage we have - Payne on Ways and Means only tobacco state
represented.
Uninsured are higher than the national average - Half of the women in
home county are Medicaid eUgible - Can there be greater health benefits
or other coUateral in tobacco growing areas? 7 of 17 counfies depend on
tobacco for principle support.
Black Lung important - trying to reform Black Lung program - only 49 %
of appUcants for befits are approved - Reagan made it impossible to make
a case - passed last ear: Nafional Coal Association ready to compromise - need pressure from Administration. Cost: $40 - 50 million borne by
industry. Waiting for Reich to signal move.
�PRIVILIGED AND
20
�y ^ ^ OsM Jx5
PRIVILIGED AND eeNSBgNTOSr
DETERMINED TO BE AN
A D M I N ^ R ^ I V E MAR
INITIALS.'JSX-DATE;!^
SfiU/
t^o-^k
iA r'»A
f ^
»»• » r
DRAFT
Source: Congressional staff observations
Wyden:
Doesn't iftflueiice votes.^i^- ^(^.t I'^^iu^c.*.
Synar:
Attempting to be influential among House freshmen. Unfriendly to
leadership and chairmen. Possibly because he's mnning for something.
Kreidler:
A freshman leader on health issues.
1/
Slattery:
Concerned about health care for kids and cutfing the deficit. Fancies
himself as someone who can bring people together.
4
Obey:
Loses temper.
Chafee:
WiU not vote for mandates or global budgets.
Breaux:
CDF co-sponsors (source: Legislative Record): Boren, Nunn, Robb,
Heflfn, Exon, Johnston.
Feingold:
Active in health politics in state legislature.
,^
V,
Campbell and Boxer:
^tf^-^.;; r^cry-^v
Both are trying to get active in health care polifics attending working groups.
^
Bob Kerrey: Has been unhappy with working group process the DPC has organized.
Doesn't feel plugged in.
^
Metzenbaum:
4
DingeU:
•i Waxman:
\ ^
Zealot on his issues - especially anfitmst and purchasing
cooperatives.
(Detroit) O.K. as long as Administration sends "real package
(LA) Same place as Dingell.
Sharp:
(Muncie, IND) Allright- will support package.
Markev:
(Boston Suburb) All right
Swift:
(Everett, WA) All right
1
�PRIVILIGED AND € e N R D E N ^ f f i ^
Collins:
(Chicago) Concerned about women's health; breast cancer; inner city
urban health problems.
Synar:
(Muskogee) Concerned about mral health; Indian health; Anti-smoking.
Tauzin:
(Louisiana) Concerned about: abortion - bottomline —fanatie. Also smaU business problem with mandate.
Slattery:
Might vote with abortion - biggest concern is longterm deficit reduction.
HaU:
(Rockwall, TX) Will vote for reform only if Dingell "breaks his arm".
Concerned about small employers; doctors; taxes; everything. Will
probably only vote for reform at full committee - not at subcommittee or
on the floor.
Richardson: (Santa Fe) A House whip. Probably O.K. - depends on who talked to him
last. "eanU^be-ircnglit - bnt oftenTerttt^d^
Brvant:
(DaUas) O.K. - will vote with the President.
Boucher:
(Tide Water, VA) O.K. except for one big problem: tobacco. Half coal
and half tobacco in district.Like Tauzin on malpractice reform - thinks key
- must upset trial lawyers. On tobacco - will require some assistance to
growers.
Cooper:
Likes his own biU. Really loves tax cap - needs it. Need to have some
managed competifion gums tell him it's O.K. Requires personal touch
from the White House.
Rowland:
(Albany, GA) Many problems - Malpractice - hassle stuff could help.
Possible, but tough - maybe if DingeU leans on him.
Tobacco tax alone is a problem. Although it is possible to make shared
sacrifice arguments. Rowland walks a fine line as an MD who represents
tobacco farmers. He didn't sign the anti-cigarette tax letter to the
President with other tobacco state representatives.
His district is republican. 62% new - mostly republican. People do not
want to pay for the poor. Agricultural district - self-employed - tobacco Miller brewery in Albany - small employers - mral district.
LTC - stay away from it if it is too costly.
Influenced by Stenholm and Dingell.
�PRIVILIGED AND SeNEiSejfflMfc
The Georgia docs have been quiet to date - not close with the Governor
or Senators.
Manton:
U- Towns:
U-^
(Sunnyside, NY) Probably O.K.
(Brooklyn) Attention to urban underserved areas and community health
centers is key.
Studds:
(New Bedford, Mass) Like DingeU - Single payer co-sponsor, but will vote
with the President.
Pallone
Probably O.K. - Single payer.
Washington: Probably O.K.
^
Schenk. Mezvinsky. Lambert:
1^
Brown:
Fine
^'
Kreidler:
Optometrist - likes managed competition - wUl be O.K.
Possible gettable RepubUcans:
Need profiles - working on women's issues. Can be
influential on floor and with freshmen.
Greenwood. Moorhead. Bilirakis. McMillan. Upton.
March 19, 1993, 5:00 p.m. political meeting - OEOB
Staff observations:
Make special effort with Dole and Hatch. They won't vote yes - but it may affect theh"
tone / intensity.
^
Moynihan:
Concerns: price controls - eliminate medicaid - nexus for health care
reform. Mental health and substance abuse. Concern: New York
Teaching hospitals. Likes Enthoven a lot.
^
Baucus:
Loves single payer. In Kerrey, Bingaman, Daschle, Wofford gang of five.
Concerns: rural health - Native Americans - Medigap history - hates
small employer mandates and taxes - trade nexus.
^
Boren:
Primary CDF - loves providers.
v-^
Bradley:
Concerns: Pharmaceutical interests (though not too beholden) - lUces
managed competifion - nervous on price controls - Ukes LTC
�PRIVILIGED AND e © N H D l J O T ^
4
increments(eg hospice and RX dmgs) - phase in kids first.
^
Mitchell:
Senate sponsor - wiU drop long term care if necessary. His mark.
Pryor:
Concerned with aging and LTC issues.
Riegle:
On board; FASB retiree health; kids first; prefers-single••payer;strong cost
containment.
Daschle:
Detail; loves Paul Starr; single payer; loyal to MitcheU; mral health
especially fronfier; vets; Medigap / insurance reforms; doesn't like taxes.
t- "Breaux:
CDF sponsor;wants to vote with the Administration; more political than
ideological; can be influential with Johri^n; Concerned vidth mral health.
Conrad:
Concerned about the deficit; mral health; small business; state flexibiUty;
close toD^schki; likes policy and detail.
Packwood:
Happy on Oregon Waiver; likes stateflexibiUty;O.K. on employer mandate;
LTC insurance in a priority. -• p r i '''•4<
\ y Dole
Caught in war within the Republican party - Graham is chaUenging him
for leadership. He can only stay in the middle or move right. Will play
hardball. Rural health important to him. Doesn't like medical education
reforms. Close to AMA.
^(^ Roth:
FEHB - managed competition model - anti-fraud. Handling of this could
influence him (also Stevens).
Danforth:
Likes Oregon waiver - strong cost containment - wants universal coverage
- co-sponsor of Kassebaum with premium caps. - doesn't like mandates.
Retiring. Making nice gestures to Mrs. Clinton.Brother is the head of
Washington University (St. Louis). Loves tax cap - problem with
bottomline. Rural health is important.
y
Chafee:
Chairs Republican HCTF. Wants to help / caught in Republican stmggle.
Loves CHCs - huge supporter. Supports tax caps. Medicaid restmcture.
MRDD. Negative on elderly - doesn't like long term care.
7
Durenberger:
/
Grassley:
Talks big, but doesn't always deliver. Wants to be a player. MN
experience: Mayo; HMOs; State flexibility - knows insurance
reform. Concerned about "penalizing good states".
BeU weather repubs - rural advocate - wiU follow Dole. FoUows gut in
�PRIVILIGED AND ^ Q ^ m S ^ m ^
5
Iowa - populist instinct important. Des Moine is insurer dominated.
Concerned for farmers.
»^
Hatch:
Related with Kennedy - anti-employer mandate - abortion.
Wallop:
Problem.
March 29, 1993, Political meeting - OEOB - staff observations re: Ways and Means
Stark comment to Matsui at health breakfast: told Matsui Task Force would not do any
cost containment.
Rostenkowski:
(Chicago) Protective of local interests - especially hospitals - has
authored play or pay - said he will follow the President - sending
signals to slow down - deficit conscious.
Gibbons:
(Tampa) Not health player - sponsored single payer- trade competition
conscious - will follow the President
Pickle:
(Austin) AMA friend - mral - doesn't like price controls.
Rangel:
(Harlem) urban; minority issues - Disproportionate Share Hospitals single payer.
Stark:
Hates not drafting the plan - Hates HIPCs.
Jacobs:
Anti-smoking - Organ donors - chairs SS subcommittee - Medical IRAs Golden Rule.
Ford:
(TN) Not player - liberal
Matsui:
(Sacramento) Acting chair of Human Resources Subcommittee - coverage
for pregnant women and kids - prefers regulated cost containment.
Kennelly:
(CT) Insurance - women's health — mammograms — urges going slow —
deputy whip - Women's Caucus - HRC.
Andrews:
(Houston) Texas Medical Center - pro-doctor - CDF biU - cigarette tax - Bentsen.
Levin:
(Detroit) Anti-fraud - tax cap - labor.
�PRIVILIGED AND eOPJF^jENWarCardin:
6
(Baltimore) All payer - State opt out.
McDermott: (Seatfle) Single payer - Psychology - mental health - state flexibility.
Kleczka:
(Milwaukee) Moderate - DES - Health Subcommittee - concern for tax
caps - Pairs with Costello and Poshard - on Steering and Policy - loyal to
Foley and Rostenkowski.
Lewis:
(Aflanta) Single payer - Deputy Whip - Health Subcommittee - lots of
hospitals in district.
L.F. Payne:
(Charlotte) CDF - strong doctor workforce - cigarette tax problem - no
minimum wage - no FMLA.
Neal:
(Springfield, MA) On trade -not health - moderate district (Boland's
former district)- with Moakley.
Hoagland:
(Omaha) Mutual of Omaha in district - wants to be team player problem Probably the last one to get on board.
McNulty:
(Albany) Has bill on dental - team player - Cuomo.
Kopetski:
(Salem, Oregon) Team player - good leadership person - team player labor is a factor - mental health.
Jefferson:
(New Orleans) Clinton got him on Ways and Means - grew to 38 for him.
Brewster:
(Ada, Oklahoma) Big CDF - no on stimulus - strong for global budget critical of sin tax - close with Colin Peterson.
Reynolds:
(Chicago) Gun tax.
Staff observation:
Bond:
Strongly opposed to premium caps - perhaps open to ER / EE mandates:
paranoid of "trap" by BC. Used to Governor of MO.
I . Member Statements
House Budget hearing, March 3, 1993:
1/
Mink:
Emphasis on women's health research and ovarian cancer in particular.
�PRIVILIGED AND QQNEffiENSAfc.
7
Snowe:
Concerned about Medicare budget cuts and fraud and abuse. Q: RE:
Medicaid growth...Does first dollar coverage promote utilization?
Shays:
Won't support new taxes for health care reform.
Orton:
Concerned about mral Utah doctors. Sixty percent of their patents are on
Medicare or Medicaid. There's a shortage of primary care physicians.
How will managed competition work in mral areas? Looking forward to
incentives in the President's health care reform package that wiU make
plan attractive to mral areas.
Smith:
(Texas) Concerned health care reform and welfare reform will threaten
deficit reduction efforts. Opposes allowing HIV positive immigrants into
the country.
Blackwell:
Supports emergency measures to stop the spread of TB among the
homeless and prisoners.
Allard:
Supports entitlement caps and raising the Medicare eligibiUty age to 67.
Berman:
Interested in ERISA protecfions against bad faith insurance.
Parker:
Concerned about pharmaceufical prices and pharmacy costs.
Slaughter:
Supports childhood vaccines and administrative simpUficafion. Interested
in the Xerox Lifecycle program for low wage earners to improve their
health with child care costs, etc.
Senate DPC lunch, Early March:
A
^
Bob Kerrey: Cost necessitates action. Don't paint those of us who want to delay until
1994 as obstmctionists. Short term price controls must be supportable.
Bingaman:
Concerned about impact of health reform on economic package. Hard to
vote for two tax bills.
Mikulski:
Supports delivery system reform. Doesn't like Jackson Hole model.
Leahy:
Pushing for health care reform this year. Look at Pryor / Leahy bill and
allow states to do own plan in the interim. Howard Dean and Lawton
Chiles are pushing this.
�PRIVILIGED AND emFTBmjm^ 8
A
Baucus:
Supports comprehensive health care reform with no opt out (will create
two tier system).
_^
Riegle:
Wants to vote for health care reform this year.
Wellstone:
Believes states need flexibility to do different things. Believes the time to
move forward is now.
Akaka:
Concerned about state flexibility.
Feinstein:
Associates with Rockefeller and Kerrey. Sorry there is an arbitrary
deadline. Won't get her vote unless cost containment is real and stable.
Conrad:
Agrees with Feinstein. Concerned, too, about the focus on Indian Health
Service and mral health.
HoUings:
Voted for President's freezes, cuts, and taxes - and the Administration stiU
missed target by $ 100 billion. Proposed introducing a VAT to cover cost
of health care reform.
Exon:
Next year is too late. Questioned the cost in the first year.
Daschle:
Focus on Federal cost.
\ ^
v^/^ Lieberman: Noted political perU of massive tax increase. Voters do not want to be
taxed to cover the uninsured. People will only bite the bullet if they get
something in return.
W
PeU:
-v/ Kennedy:
Concerned about the percepfion of rationing.
Concerned about long term care.
John Kerry: Believes this is the moment. Be aware of huge political stakes and high
expectations. Tax aspect is dangerous. Guarantee that aU democratic
senators are invested in this process.
•-A
MitcheU:
Don't confuse consultation with agreement. The Administrafion faces
irreconcUable differences. Impossible to incorporate aU views. Real vote
is on an imperfect bill or compromise.
Simon:
Expectations are high. Act decisively. The greatest political danger is in
failing to do so.
�PRIVILIGED AND tX'NMUIWfL\L'
9
Budget hearing, March 5, 1993:
Rostenkowski:
1. Intersection set this deficit reduction and health care reform.
Difficult to go up same mountain twice. Suggest that we need to
think about this.
2. Why cut payments to inner-city hospitals without comments cut
to mral hospitals - will cause some heartburn.
Stark:
1. Going up mountain twice.
2. Why not just do something poUcy context free for now - instead
of specifics.
3. Stark likes some of the specifics RAPS, GME, in context of
health reform bUl they'U put IME on the table.
Part B specifics:
Allege pract; MVPs default; update cut violates the deal.
WiU support DME, EPO, RAPS, single cap reduction 10%.
Part B premium - not hugely controversial - relation between this
and health care reform - Stark wanted to incorporate premium to
pay for prescription dmgs.
CBO estimate - 10% below Administration estimates - that wiU be
a problem — not ours.
^/
Matsui:
ROE for SNF - oppose.
y^
Pickle:
RAPS - oppose.
John Lewis: Concerned for inner city hospitals
'A Kleczka:
Liberal, Wisconsin.
A^ Reynolds:
Chicago iimer city
�PRIVILIGED AND
notes:
'--y. Cooper:
Believes the President has promised to propose his biU in mentioning it.
Hillary Rodham Clinton with Energy and Commerce Democrats, March 9, 1993:
><v
Pallone:
Advocates single payer: why rejected? Is it perceived as too radical?
]^ ^
Slattery:
1. Need to focus on states role as cop for cost containment. States
empowered to have cost containment commissions and enforcers. They
have history of balanced budgets - Feds don't.
2. Abortion - hope bill doesn't deal with the question. Don't aUow
federal funding for that. Need pro-lifers on our side. Don't force an
abortion vote.
HaU:
V- Waxman:
\^
y
y
Providers are closest to problem - often source of problems. They need to
be at the table. Head of ABA should be pressed on malpractice reform.
Energy and Commerce has jurisdiction. We all have points of view single payer isn't inconsistent with managed competifion - just a way to
gather money hope we pass this fall in reconciliafion.
Richardson: Hope package has strong malpractice component. Dislikes "tax lurking in
the future".
Slattery:
Echoed Richardson's concern - suggested deadlines not be locked in.
Brown:
Pre-natal care and immunizations - need outreach.
Tauzin:
Guarantee something - not everything - for everyone.
^
Margolies-Mezvinsky:
^
Kreidler:
The bolder the better. States require flexibility. Low cost states shouldn't
have to fall 10% like high cost states.
Markey:
Telemedicine. Use technology to expand access and quality.
Y Studds:
Expressed interest in being plugged into the debate.
Especially concerned about fraud.
Single payer advocate. Noted the administration can only afford to lose
four votes on the Energy and Commerce Committee - so everyone must
�PRIVILIGED AND g O f f f T O E N S ^ ^
11
be wiUing to walk a considerable distance from their first choice.
l^--
Lambert:
Stress mral needs NOW. Community health centers have already proven
themselves helpful. What does managed competifion do for rural areas?
15 mral hospitals closed in Arkansas last year. Too much waste on
chronically ill. How can doctors go through medical school with no
instmcfion in the cost of health care?
Rowland:
You can lead people farther than you can push them. Do what you must
to make the AMA feel involved.
Schenk:
Focus on mental health - give people choices. From Southern CaUfornia,
biotech center, don't stifle this research and innovafion. Canada and
others live off our research.
Rich Lehman:
Towns:
Majority of insured want better coverage. Minority of uninsured
want coverage. Will react negatively to big government bureaucracy
(like Medicare) - "My mother can't figure out her bill". Tort
reform: perception of fueling defensive medicine - you must
overcome. Small business: concern for affordabUity - don't care
what Chamber says — you have to convince SMERS (small
employers?) in my district.
ERs / trauma centers in urban areas - hope you'll visit some. There's no
uniform record keeping system - hospital closes and records are lost.
Ways and Means Budget hearing March 10, 1993
Rostenkowski:
IME
Archer:
Head start investment / saving increasing. DES feels safer with 3:1 return,
acknowledge higher estimates. Provide citation of studies for record.
Jacobs:
Submit number, for the record, of SSA workers to address SSD backlog.
Head start speech.
Pickle:
Disability backlog top priority. Look into telemed demos. DSH - states
match gov't for Medicaid. WUl President cut some slack for hospitals?
Federal government can't offer it much longer.
Thomas:
State role in federal props - move toward bottom up.
�PRIVILIGED AND ee{4riDENTL\L
Matsui:
12
Will be consistent or constitutional (?) to raise taxes for health care reform
- hope will be on welfare, including strong chUd support enforcement.
Sander Levin:
Fraud and abuse - how to save more money and cut costs. HR
1255. IME - DME - also hits suburban hospitals.
Cardin:
Are you aware of any system other than single payer / all payer that saves
at an equivalent rate?
Brewster:
What percentage of welfare costs are non-medical? What percentage of
Medicaid is non-elderly? Medicare payments are insufficient, therefore
hospitals forced to cost shift. Rural hospitals are unable to reduce costs.
Johnson:
Cost shifting to seniors; to state administrative costs; look at 77 programs
in HHS and consolidate.
Reynolds:
Cost to inner city hospitals. No adult trauma units in South Side of
Chicago due to burden of gunshot victims.
Santomm:
President said only a few weeks away from welfare reform - what is the
time limit? the work component?
Andrews:
Child support enforcement.
One doUar tobacco tax. On the table? Interested in preventing teen
smoking for health and finance reasons.
[Bradley is Senate sponsor]
Rostenkowski
Deficit - cost containment - cost shift.
Stark:
Ways and Means has a history of meefing budget targets - but need some
wiggle room. Hope you'll give us some.
Houghton:
GME cuts - national average basis is unfair. Telecommunications in
health care system could help link small hospitals to large hospitals managed care hard in rural areas.
Health care reform - primary care shortage - will need waivers and
flexibility.
Executive order to ban smoking in all public buildings. Long term care
concerns.
�PRIVILIGED AND C O N F I D E ^ m ^
13
Hancock:
Social Security earnings test
Jefferson:
Cut outpatient cap - cheaper than inpatient.
Kleczka:
Disability tmst fund status?
McCreary:
Foster Higgins - rising 10.1% ER health care costs vs. 14.9% recently.
Rangel:
Wish we could just freeze Medicare rates. Hate two cuts. What are
federal costs of dmg and alcohol abuse - homelessness - violence? We
need a drug czar - we need a policy.
Kopetski:
Mental health care - Clinton phUosophy to treat mental health with
parity? What if states can't afford their share of costs? Disseminate
creative / effective state experiments.
Grandy:
$300 miUion for immunizations - hope you stop short of universal
purchase. Biggest problem: lack of pubUc educafion - lack of parental
responsibility.
illary Rodham Clinton and Women Senators March 11, 1993
A
Mikulski:
Health care delivery reform important. Needs of women, especially
reproductive health services, in core benefit package. Health care in
different settings. Support services too - esp. for cancer patients.
Kassebaum: Agree with Mikulski on women's health. Want woman appointed as head
of NIH. Cost containment important to economic safety. Independent
commission to determine core benefits.
Boxer:
Agree benefit package shouldn't be polifical. Avoid abortion votes - antimidwife votes. Need to speak out on violence - anti-clinic. Delivery
system key for reaching immigrants - non-English speaking. Community
centers. Public health outreach. Prevention (especially teen pregnancy).
Representation Board - include gender and interests and race.
Moslev-Braun:
Murray:
Comprehensive reform; favor single payer; control cap
expenditures - CON? Push decisions closer to community level;
weUness and prevention; LTC must be covered; return to health
planning.
Stress long term care. Consider OBGYN as primary caregiver; Pre-existing
�PRIVILIGED AND G e N P © ^ ^ ^ * ^
14
conditions; reproductive health services; infant mortality - address through
pre-natal care, healthy mothers; women and AIDS.
A~-
Feinstein:
Father was chief of surgery at San Francisco General. While she was
mayor the health budget tripled. Changing medical culture -more
corporate, concerned with costs. Keep benefit package out of politics, aim
for prevenfion; family doctors; choice of physician preserved; reliance on
para professionals. Foreigner entiflement to Medicaid - Medicaid should
not cover drug treatment. Women's health care - cover women in clinical
dmg trials at NIH. Don't understand how capitation wiU control costs over
the longmn. Believe cause of medical costs is defensive medicine medical malpractice - stress insurance reform. Stress family practice.
Cost controls must be in place within a decade. Set multi-year budgets.
Kassebaum: Could budget impose limit on premiums?
Mikulski:
Good guy in health care: IRAs - pay people to stay well. Like cafeteria
plans.
House leadership meeting, March 11, 1993
-A DingeU:
Senate procedure.
Stark:
When wiU bill be on the floor?
Dingell:
Need to develop substance and procedure early - You'U need DNC, every
group, every resource you have. Use reconciliation as vehicle - I'm
prepared for one vote.
Gephardt:
Pass resolution next week in House - joint before April 1 - finish
reconciliation markup - then do health care biU in early summer and hold
reconciliation.
Y
Ford:
Higher education provision problematic - time sensitive.
^
Waxman:
Define core so we can begin to sell it - we need to figure out what our
committees should be working on.
-/
Dingell:
Don't let our outreach supplant group outreach.
S(
y^ Stark:
Sue months is fast. Give us specs to start marking up. We need to do
hearings on the benefit package.
�PRIVILIGED AND e O K R © ^ m ! a i _ . 15
DingeU:
Hearings must start as soon as you have your general direction.
Waxman
Wants small core groups to make decisions.
Stark:
Cost containment? Taxes?
Waxman
Can't do much access if we focus on cost containment alone.
Ford:
Skim off insurance company savings.
K
Stark:
Put everyone in early and then have political constituents to raise benefits
over time.
V
Ford:
ERs in two camps: 1) Big ERs already invested 2) SmaU ERs don't want to
play at all.
Waxman:
Teach us - let members ask questions around the table.
y
i^Ford:
Not yet strong appreciation among Democrats of President - strong
feelings.
^.r>\ - t ' . • , .
...
p*V/y
X ' Dingell:
Need votes the day your bill arrives - doubtful you'll get them in the
legislative process.
March 17, 1993: Ways and Means meeting with HRC
^
Rostenkowski:
The public is ahead of us. If Ways and Means sticks its neck out,
we need caucus to back us up. RepubUcans want to participate too.
McNuldy:
Pay attenfion to addicfion treatment.
^
Levin:
Need to combine managed compefifion with strong and immediate cost
containment or plan won't work. Congressional role: need real
partnership and leadership. Before you choose final options exercise fuUest
exchange between the White House and Congress on substance and
politics. Make the case you've squeezed inefficiency from plan before you
ask Congress for more money.
y
Jefferson:
(former malpracfice attorney) Defensive medicine doesn't fuel
technology - it's compefition between hospitals and doctors and patient
demand.Caps on damage and awards won't work. Insurers raise rates
because they can. Better to define a negligence standard as minimum
quality standard.
�PRIVILIGED AND
"4-
ffONFUffiNTfT^
16
Cardin:
Note success of Maryland all payer rate. Stress more primary care.
Include Congress in process. Want opportunity to negotiate aU points
before introduction. Also want input after introducfion.
Matsui:
No problem with Prescription dmgs and LTC for seniors - hope pregnant
women and kids get phased in first. Tax the devil out of tobacco $ 2.00 +
and 1 rep wine and know they'll take a bit, too.
Employees are the only ones not making tough choices - need tax cap per
Enthoven and Jackson Hole.
Reynolds:
Uninsured gunshot victim in trauma center - double excise tax on firearms.
Kopetski:
Mental health: Clinton philosophy to treat it with parity to physical
health? HRC: Don't know if we can afford it - but mental health wiU be
a part of core benefit package. MK: Regarding benefit core package: it
hurts unions if it is set too low.
<^ Pickle:
State HIPCs with global budgets - what's your position on managed care?
Any cost savings to deficit reduction?
y
Neal:
We'U evaluate plan after enactment? HRC: yes.
V
Andrews:
Support managed compefition - not sure they can be combined with global
budgets. Do caps undermine competition?
X
Kennelly:
Democrats need to be responsive to marketplace and unanticipated
consequences of what we do. Don't msh.
A Rostenkowski:
y
This committee can do your deal.
Kleczka:
Taxing ERs benefits above the core package?
Brewster:
First dollar invites abuse. Believe you must have a global budget to
contain costs. Need strong revenue base - sin taxes = declining revenue.
McDermott: Relation between nafional and state role? National global budget is fine
but delivery system will work differently in different states. State
flexibility? State single payer option? How to treat self insured plans?
^
Hoagland:
Byrd rule waiver dead? Adding health care in June could siphon off
legislative effort and attention to budget reconcihation and supplemental?
Timing?
�PRIVILIGED AND.£ONriDEjmAIr-
17
Stark:
Medicare cuts umelated -Include virtually eliminating graduate medical
education. Not sure we can do $50 billion in reconciliation and health plan
in one year. Would help us to get paper directly from you, so we can meet
next-to-impossible deadlines. Ways and Means staff could participate when
decisions are made.
Gibbons:
I'U vote for anything you send up. Timing? Financing? On mandates:
cmel to tie health care to employment. I don't favor mandates. Tend to
undermine portability; hurt global competition.
V
^—^
X.^
John Lewis: PoUtical stakes high. Do it right.
U-^
Payne:
Appreciate attention to mral health - Medically Underserved Areas. 5,000
tobacco farmers in my district. Understand that cigarettes must
contribute - but keep in mind our economic needs in determining level of
that contribution.
Rostenkowski:
Underscore this will be difficult. I don't UketimetableDon't be
disappointed. This is stiU a legislative process — hope your main
thmst wiU be acceptable to most of us.
Senate DPC Lunch, 3/18/93 - Judy and Ira
Bingamen:
Cost control works because states can set HIPCs limits on premium? Only
works if aU people buy through the HIPCs.
Wellstone:
Emphasis on stateflexibUity-i- very important. Consumer choice is real
issue. Benefit package key, too.
A - Reid:
Federal benefit standard supersede state mandates? Impact on earning
capacity of physicians?
6-. .-• C ^ • :• . .
^
Conrad:
No taxes promi&edj* 1. slow-phase in of access; 2. raise new taxes; 3.
slow growth of health system and recapture.
Levin:
Different cost of providing health care services ...
\ ^ Baucus:
What about supplemental coverage? Half of Montanans are self-insured concerned about different treatment. How can you community rate in
sparse areas?
Lautenberg: End duplicafion of capital.
"A
PeU:
Oregon waiver?
�PRIVILIGED AND
{y
Kennedy:
Dmg companies - half are innovative - the other half are on the dole.
How wiU HIPCs be developed?
Breaux:
Concerned about HIPCs and state flexibility. Will you reduce cost with
caps?
Wofford:
Concerned about labor and tax cap. Stmcture HIPC as public corporation
V. government bureaucracy - therefore premiums will not equal taxes. Can
you surcharge premiums to minimize public taxation?
Graham:
Long term care -kick to states? LTC very important in Florida. Hard to
kick to states.
^
'—
18
Meeting with Rowland, March 24, 1993
'Rowland:
Biomedical ethic. Can we pay for it - unlike Medicare and Medicaid. If
we keep Medicare - need to means test it. Managed competifion may
work - but what about mral areas. Economic impact of insurance
insolvency? Public sector - 12 doctors in community health centers in
Albany - individuals can choose their own.Federal, state local support - 3
outreach centers in mral areas - anyone can get outpatient primary care in
that State with sliding scale contribution. Doctors salaried to get rid of
abuse / incentive to over / under provide. Remove incentive - fee for
service. End doctors' ownership of ,labs. CLIA / POLs -Networking of
CHC to provide outpatient primary care. For non-LTC Medicaid - take
that money to feed outpafient CHCs. For inpafient care - all doctors on
inpafient staff required to provide pro bono care to poor. Do beUeve we
need a global budget on Federal spending - state and local community
required to make up the difference. State and local governments should
invest in health care systems. Don't want giganfic Federal program. Prefer
to try this in three or four states prior to complete implementation.
I will support what the President wants to do if we can afford it in the long
term.
Funnel Medicaid acute care money into CHCs.
Looking for incentive for doctors to do only what is needed, salaries or tax
incentives? Get away from micro-managing.
Notes:-- meeting with Tauzin
^w^^
Tauzin:
25-30% of famUies in Louisiana are uninsured - High resistance to federal
government interference -but a poll of constituents said "get involved" -
�PRIVILIGED A N D - e e J ^ i e E N ^ E ^ 19
key = heavily regulated cost controls - mandates on small businesses —
strong sentiment for choice of plan Proposed plan: federally administered plan - standard poUcy underwritten by private insurers - let local business and employees decide
what share is - plan sets strict liability limits - patients contract - tax
benefit to ERS. Admit that it doesn't address unemployed.
Wants to see mral health - emphasis on training family doctors.
Telemedicine is important.
Can't touch abortion - WON'T VOTE FOR ABORTION COVERAGE.
Can take mandate to an extent. Working with low income - high
unemployment.
Notes - meeting with KP
Boucher:
Two broad concerns: 1. Rural district (Roanoke to Cumberland Gap) managed competition won't work there. If a cap on providers is the
alternative it will be hard to recruit doctors. 2. Financing - 14,000 tobacco
growers don't want a tax. 2.5) Black lung.
Single payer will work best in his district - even if mral needs are met,
tobacco remains a problem - anything over 10 cents a pack is a problem How will tobacco growers be compensated? Make it as attractive as
possible - Some significant share of tax revenue must go to stabilizafion. Even if you give some of the money back to farmers, tax must stiU not be
too big. - wiU vote for other taxes - like a VAT. ? If cannot vote for a
tax - won't be in Energy and Commerce - we'U have to use whatever
leverage we have - Payne on Ways and Means only tobacco state
represented.
Uninsured are higher than the nafional average - Half of the women in
home county are Medicaid eligible - Can there be greater health benefits
or other coUateral in tobacco growing areas? 7 of 17 counties depend on
tobacco for principle support.
Black Lung important - trying to reform Black Lung program - only 49 %
of applicants for befits are approved - Reagan made it impossible to make
a case - passed last ear: National Coal Association ready to compromise - need pressure from Administration. Cost: $40 - 50 million borne by
industry. Waifing for Reich to signal move.
�PRIVILIGED AND eONFIDENHAL^
20
�DETERMINED TO BE AN ADMIMSTRATIVE
MARKING Per EJD. 12958 as araendpd. Sec. 3.3 (c)
Initials: ^ < ^ P
Date: A S J 2 ^ 1 l L
MEMO
TO:
FROM:
RE:
DATE:
Karen
Lori
House Message Board meeting, Thursday, July 15, 1993
July 16, 1993
Members Present: Derrick, Obey, Bonior, DeLauro, Levin, Hoagland, Strickland,
Pomeroy, Hoyer, Cardin, Johnston, Wyden, Matsui, Shepherd.
Administration:
Stan Greenburg, Chris Jennings
Bonior:
We're here to listen to Stan tell us about pubUc opinion and the health
care reform message.
Stan:
Clarity is important - talk about strengths of the plan.
When people poUed were asked to critique the system as a whole: 72%
gave it a negative rafing and 40% gave it the lowest possible rating.
People want big change in the overaU system, but be cautious: they don't
want the mg pulled out from under them - they want quality benefits in
the short term.
People blame 1) insurance companies and RX companies 2) lawyers 3)
doctors.
People listen to: doctors.
Do battie with the insurance companies and RX companies. Necessary to
plan attack at someone and to launch battles around key strengths of the
plan (so enemies fight with us over popular measures). Their support wiU
be the last to be cultivated - focus attention on others: docs for example.
Pomeroy:
Former insurance commissioner. Hard to seU managed competition to
insurance companies anyway.
Stan:
The main doubt consumers have is: Are forces strong enough to pass this
reform? They don't believe individual Members are strong enough - and
they doubt Clinton. However - by passing the budget bill and by
introducing health care reform Clinton will be perceived as stronger.
�Levin:
What is more important: security or costs?
Stan:
Security. The message is that we achieve security through cost
containment. One is a goal - the other a vehicle.
"Comprehensive" is a key word = security. "Basic" loses strength =
welfare. People don't mind if welfare programs exist - but they don't want
to pay for them.
DeLauro:
What should we do during the recess?
Stan:
There should be two phases during recess: 1) understand the villains special interests wUl be out and wiU be strong. (Someone asked if doctors
were villains as a group or individually - Stan said doctors have credibiUty
either way) Number 2 got lost... everyone was talking.
Derrick:
(Joke) Lef s hurry up and make this happen, so we don't get so many
tough questions (basically).
Shepherd:
I talk about deficit reduction - and how reforming health care reduces the
budget deficit.
Obey:
I've held 24 hearings in my state - and I've decided this is a local issue.
Unions want to stop health care reform. They've already got the best
plans.
Stan:
It's tme that unions and seniors currently have the best coverage - so they
wiU be the most skepfical.
Hoagland:
Focus on malpractice, but make sure it is the doctors and lawyers that are
punished and not the consumer.
�MEMO
TO:
FROM:
RE:
DATE:
Present:
ORAFT
DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per LO. 12958 as amended. Sec. 3/3 (c)
l n i t i a l s : X G A £ _ Pat.- \ ^
^/1f
Wednesday, July 21, 1993, House / Senate Message Meeting
July 21, 1993
Boxer, Kennelly, Wofford, Daschle, Reid, Bonior, Fazio, Gephardt,
Richardson, Kerrey.
Administration:
David Wilhelm, Ira Magaziner, Judy Feder, Jeff Eller, Chris
Jennings.
Daschle:
Started the meeting and introduced David WUhelm.
Wilhelm:
We, like you, are busy with reconciUafion, but we've started thinking about
what to do during the August recess. Key groups, like the DNC, DCCC,
DSCC and others, have formed a working group to plan a strategy.
Sometime shortly after Labor Day we would like to organize a national day
of media events to focus attenfion on the crisis in the American health care
system. We would like for Members of Congress, Governors, interest
groups, etc. TO organize events in every district in every state. We also
plan to produce an educational video discussing the nature of the problem
and outiining the principles of health care reform. It would also be a time
to organize volunteers. A national drive could be kicked off that day, and
the President could respond with his health care reform address.
Kennelly:
Let me play devil's advocate. We had meetings on the health care crisis
two years ago. We all campaigned on the health care crisis. Isn't this old
news? The President's plan is the news - not the crisis.
Wilhelm:
I'm stmggling with this. What can we do to put the focus on health care
reform before the introduction of the President's plan? We need direction.
Boxer:
Remember, it's hard to control the message at town meetings. We don't
want to organize a national press event to emphasize that we are all over
the board on health care reform. But we do need to get people focused try organized press events. For example, Diane Feinstein and I can do fly
arounds and meet with individuals who have health problems - that way
we won't lose the message.
Wilhelm:
I certainly agree that these press events need to be controlled. The focus
needs to be on specific problems that the President's plan wiU address.
�Bonior:
Let me share that there is a general uneasiness about the lack of
information available to Members. There are a lot of health care "question
marks". Members need to have notebooks with information and good Q &
A's which they can taUor to their individual needs during the recess. My
suggestion is to proceed with three steps: 1) Provide the Members with
Uterature; 2) Hold your day of press events and hearings; 3) Finally, end
with some sort of rally when everyone comes back in September.
Richardson: I guess I am swimming against the fide - I like WUhelm's idea. We need
to focus on how the Democrats are going to unite to address the health
care crisis. I want to see headUnes that say: Democrats deal with health
care. I think a day of events - with a flexible stmcture, but on the same
day - is good.
Fazio:
I think the Barbaras are communicating that people are fatigued with the
town hall concept - I've held nine of them, people are ready for the next
step - some answers. People go to these events because they have
problems they want to see addressed. August is a hard time - schedules
are different. Let's play off the President's speech to the NGA, and spend
the rest of the time becoming educated on the specifics of health care
reform. We need to be able to give people answers.
Bonior:
Plus, we need a rest. It'U take a week or so tofinishingseUing
reconciliation as a victory.
Gephardt:
We're all saying the same thing - but let me add a bit more. There is real
value in "rigged meetings" as a ramp up to the announcement of the
President's plan. I would suggest that one or two weeks before the
announcement we get out there and get personal stories in the media. By
doing a nafional day we clearly restate the problem and make it personal.
The President can introduce an answer to the problem the next week.
Security - SimpUcity - Savings.
Daschle:
Anymore feedback? I think we need to focus on the problems and then tie
that together with the principals - say I'm committed to going back to vote
for ... The principals are the message. The video will be great - with cuts
of real people.
Gephardt:
Members wiU have to be very careful how their press event people are
chosen.
Boxer:
We'll introduce the locals - talk about their individual problems - say the
whole nation is feeling this pain - cut to film.
�Wilhelm:
Should we ask HUlary to outUne the principles in the video?
Choms of yeses.
Wilhelm:
House parties are good for press - on the night of the announcement.
Also a good time to petition for volunteers.
EUer:
President will talk to NGA on August 16. We'U finish reconcihation - do
a victory lap - reexplain - the anchor wiU be the NGA speech. In August
we'U pass to you a menu of idea - choose what works best for you. The
goal is to put a human face on the health care reform crisis.
Boxer:
FYI: we'll all give speeches on Labor Day anyway, so we can talk about
health care then too.
Daschle:
So basically, the White House has no public events scheduled in August.
Eller:
The President won't have anything scheduled after the NGA, due to his
vacation plans. But other White House officials and Secretary Shalala wiU
be available.
Daschle:
Are you working with interested nafional organizafions?
EUer:
Yes - we're working with the DNC and Rockefeller's group to reach out to
those people.
Gephardt:
Let me make this pitch: Give us enough fime in September to learn this
plan. My greatest fear is that the President wiU introduce his plan and
Democrats won't understand it and wiU stand up and oppose it vocally.
Members must be HIGHLY educated about the specifics of the plan so
they can be effective salespeople.
Boxer:
Set a date for the health care university now.
Daschle:
We'U talk about it at the next meefing.
Boxer:
Set a date now. I'm getting fmstrated.
Kerrey:
Barbara, why are you so fmstrated about the dates - are you trying to plan
a wedding?
Boxer:
You're the one we're waiting for.
Daschle:
We'U do it as soon as we get back.
�€0??FI5E?rffi^
4
Boxer:
Then give us a date - I want to tell my colleagues.
EUer:
We're not ready yet... still only have a framework.
Magaziner:
We don't want to take any focus off of reconciliation.
Kennelly:
Will we have a book of talking points before August?
Eller:
Yes.
Daschle:
We do need the books - so we can talk about what we discuss here.
Gephardt:
I agree with Barbara - we do need to look at dates.
Decided:
Monday, September 13 - national press event
Saturday and Sunday, September 18 and 19 - health care university.
Kennelly:
Aren't you worried about leaks after the university?
Gephardt:
Yes - but either you make sure the plan remains 100% top secret unfil the
President announces it and risk the Members not understand it - or you
educate the Members and risk leaks.
Kerrey:
You raised a good idea last week: picking fights that are positive, strong
issues: give us ideas. Define the key issues.
Magaziner:
OK - we'll outline that for you.
�08-04-93 ObiObFM
tHUM i B . MlTClitLL
WA;:H.
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Folder #3: [Meeting Notes]
Creator
An entity primarily responsible for making the resource
Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Preservation-Reproduction-Reference
Date Created
Date of creation of the resource.
2/6/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg2-007-006-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/70cbc088124a5f02cf6345461722a9de.pdf
5018da03cd5d112cb0fbec7a097238f3
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Edelstein
Subseries:
OA/ID Number:
3664
FolderlD:
Folder Title:
Folder #3: [Judy Whang documents]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
2
1
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. memo
Vida Benavides to Judith Whang; re: Vice President Gore's Visit to
Los Angeles Asian Pacific American Health Primary Care Facility (1
page)
09/14/1993
Personal Misfile
002. fax cover
sheet
Chris Strobel to Steve Edelstein; re: Health Care Reform Plan
(partial) (1 page)
10/01/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3664
FOLDER TITLE:
Folder #3: [Judy Whang Documents]
2006-0885-F
ip2648
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA|
b(3) Release would violate a Federal statute |(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells j(bX9) of the FOIAj
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office |(aX2) of the PRA|
Release would violate a Federal statute |(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
��AM-Health-Republicans,610
• GOP H i t s C l i n t o n H e a l t h Plan I n New Ad
•By^JOHN KING= AP P o l i t i c a l W r i t e r WASHINGTON (AP) E s c a l a t i n g t h e p a r t i s a n s h i p i n t h e h e a l t h c a r e debate,
t h e R e p u b l i c a n P a r t y u n v e i l e d a t e l e v i s i o n ad Tuesday d e r i d i n g P r e s i d e n t
C l i n t o n ' s approach as a b u r e a u c r a t i c morass t h a t would cause r a t i o n i n g and
massive j o b l o s s e s .
The GOP s a l v o was t i m e d t o t a k e advantage o f a l u l l i n t h e White House
e f f o r t t o s e l l i t s h e a l t h p l a n and, p a r t y o f f i c i a l s s a i d , t o erase any p u b l i c
p e r c e p t i o n t h a t R e p u b l i c a n c a l l s f o r h e a l t h care r e f o r m amount t o endorsements
of Clinton's proposal.
The ad campaign a l s o suggested t h e i n i t i a l s p i r i t o f b i p a r t i s a n s h i p t h a t
greeted C l i n t o n ' s plan i s f a s t crumbling.
Yet even as t h e R e p u b l i c a n N a t i o n a l Committee ad c r i t i c i z e d C l i n t o n ' s
o v e r h a u l p l a n i t a l s o underscored d i v i s i o n s w i t h i n t h e GOP ranks over how t o •
approach h e a l t h c a r e r e f o r m .
RNC Chairman Haley Barbour acknowledged c o n s i d e r a b l e d i f f e r e n c e s between
t h e major R e p u b l i c a n p l a n s b u t s a i d a l l would l e a d t o more a f f o r d a b l e h e a l t h
coverage " " w i t h o u t s o c i a l i z e d medicine o r c r i p p l i n g t h e economy.''
The 30-second TV spot i s scheduled t o begin a i r i n g Wednesday, n a t i o n a l l y
d u r i n g Cable News Network programming and a l s o i n t h e Washington area.
A l t h o u g h i t w i l l a i r i n t o next week, t h e a d v e r t i s i n g campaign i s modest
c o s t i n g r o u g h l y $80,000. Barbour s a i d t h e n a t i o n a l p a r t y was u r g i n g s t a t e GOP
o r g a n i z a t i o n s t o buy more t i m e i n t h e i r l o c a l markets.
• The ad r e p r e s e n t e d t h e f i r s t , b u t p r o b a b l y n o t t h e l a s t , f o r a y by t h e
Republican P a r t y i n t o a h e a l t h - c a r e ad war t h a t has been waging f o r weeks and
w i l l l i k e l y c a r r y w e l l i n t o n e x t year, when Congress i s expected t o adopt some
v e r s i o n o f h e a l t h care r e f o r m .
I n i t s s p o t , t h e Republican P a r t y s h a r p l y ^ c r i t i c i z e d C l i n t o n ' s p r o p o s a l
and urged v i e w e r s t o c a l l a t o l l - f r e e number so they c o u l d be m a i l e d summaries
of f o u r d i f f e r e n t p l a n s advance by c o n g r e s s i o n a l Republicans.
The GOP ad opens by e n d o r s i n g h e a l t h care f o r a l l Americans, even i n t h e
event o f j o b l o s s o r moving.
But i t says t h i s g o a l can be achieved " " w i t h o u t B i l l C l i n t o n ' s
government-run system, o r h i s 100 new government b u r e a u c r a c i e s . W i t h o u t h i s
government p r i c e f i x i n g , r a t i o n i n g and d e l a y s . W i t h o u t h i s mandates on s m a l l
business t h a t would c o s t up t o 3 m i l l i o n Americans t h e i r j o b s . ' '
C l i n t o n • s - p l a n does i n c l u d e a s t r o n g government r o l e , and Republicans
supported t h e i r ""100 new b u r e a u c r a c i e s ' ' f i g u r e by n o t i n g t h a t every s t a t e
would be r e q u i r e d t o e s t a b l i s h a t l e a s t one r e g i o n a l h e a l t h care a l l i a n c e and
an a d v i s o r y board t o m o n i t o r each a l l i a n c e .
The White House p l a n i n c l u d e s g l o b a l h e a l t h care b u d g e t i n g and caps on
insurance premium i n c r e a s e s which t h e GOP l a b e l s p r i c e f i x i n g and c r i t i c s o f
t h e p r o p o s a l have suggested i t would mean some r a t i o n i n g o f care. There have
been w i d e l y v a r i e d p r e d i c t i o n s on t h e impact t h e C l i n t o n p l a n , which r e q u i r e s
employers t o pay t h e b u l k o f h e a l t h care c o s t s , would have on p a y r o l l s .
The c r i t i c a l GOP ad echoes many o f t h e c o m p l a i n t s i n an spot p a i d f o r by
t h e H e a l t h I n s u r a n c e I n d u s t r y A s s o c i a t i o n . The i n d u s t r y has spent a t l e a s t $6
m i l l i o n on ads t h e White House has c r i t i c i z e d as m i s l e a d i n g .
Those ads a r e p a r t o f a s o p h i s t i c a t e d i n s u r a n c e i n d u s t r y campaign a g a i n s t
the C l i n t o n p r o p o s a l under t h e banner o f t h e C o a l i t i o n f o r H e a l t h Insurance
Choice, F a m i l i e s USA, a l i b e r a l consumers' gr{3up t h a t s u p p o r t s C l i n t o n ' s
approach, r e l e a s e d a copy o f an i n s u r a n c e i n d u s t r y s t r a t e g y manual t h a t f e l l
i n t o i t s hands,
jPf
The manual s a i d t h e i n s u r e r s ' c'cialition was ^ r g e t i n g s i x key s e n a t o r s and
11 r e p r e s e n t a t i v e s from f i v e s t a t e s Kansas, L o u i s i a n a , New York, Oklahoma and
J'exas,
jk. A
• .
* •
A separate outline said ^eld^|btaff workers would be responsible fo5
setting up ""SWAT'' teams to critic i^e^the Clintonjplan whenever. local'«tnembers
of Congress JiiEld district meetings. mS^ •. :•
iB'
M*"
�RNC NEWS RELEASE
leani': Au.slu'.
Co-Cha::T-iin
-\.\k) i'.arbojT
ChdUTTiT
"Thinking Like .\ Republican"
:3C Television Spot
VJPFQ
Nurse witn children
Anncr. (VO^: Kealtii care tor all Americans.,.
Even if you iDove cr lose your job?
Ves. There's a way...
Doctor's office ..crowded
patie.ats...SUPER: Headlines
of Clinton pla.1
Without Bill C'inton's government
run sysiei;!.. .cr his 100 new govemment
ixireaucracies.
!iUPER: Without price controls..
ratior!ing...deiayj...
Without his govemment price fixing...
rationing...and delays.
SUPER: 3.1 Tiillior. 1 JUS lest,
socrce. study
WithCit his mandates on small business
That v.ould cost up to 3 miUion Americans
their jobs.
Republican Plan: "Better Health
Ci^^e Wiihoui Bigger Government:
The ?epuolican Plans"
Better he^ith care...without bigger government'^'
1-80C-762-55U
Call now. Read the Republican plans.
You're thinking like a Republican.
Published by the Press OiScc 4- 3iO Fir t Strcc-. S.E. • Washington. D.C. 20003 • (202)363-8550
�«-J
,/^-w
RNC NEWS RELEASE
Haley Barbour
Chaiman
Jearje .•Austin
Co-Chairr.ian
CONTACT ANNE GAVIN
(202)863-8614
FOR I\tMEDIATE RELEA.S^:
Tuesday, October 19, 1993
STATEMENT BY CHAIRMAN HALEY BARBOUR
VVa*hington, D.C. - 1 am announcing today a Republican National Committee television
advertising campaign on heahh care reform In a moment I will show you a spot that will
begin running tomorrow
Candidly, we had no\ intended paid advertising at this point; however, some in the media
and the public have ccnilised the fact Republicans favor health care reform with the idea
we agree with the Clintons' plan orfindit accepiable I want to set the record straight.
Republicat/s do support health care refomi, and, in fact, there are Republican bills in both
Houses of Congress. Republicans would guarantee issuance and renewal of health
insurance, so families are secure the>' will not lose their insurance, if they lose or change
•obs, mcvt; or gel sick, so people with pre-existing conditions or illness cannot be denied
coverage, and so the goal of universal coverage can be attained.
Our bills also Cut costs by market reforms in insurance to give small businesses purchasing
power to reduce premiums Our bills reform the elements driving up costs, such as
medical malpractice tort liability reforms, aJnunistrative reforms in insurance and anti-trust
i'cicrm President Clinton agrees with us thai these reforms wil! save literally tens of
oillions of dollars a year. But we strongly disagree on other crucial, fundamental issues.
The proposal contained in the Clintons' 239-page plan is a government-run health carc
system, which would make the quality of our health care worse, not better. Their plan
creates over 100 new government agencies with unprecedented powers, starting with a
se\ en member, politicilly appointed National Health Board to set limits on health care
spending, both public and private, nationwide and state by state. The Clintons' plan with
Its state health monopolies takes comrcl care away from patients and their doctors and
fums it ovtr to bureaucrats. 'We have t)ie highest quality medical care in the world, and
nothing would th/eaten its quality more than a government-run system.
-More-
Mb.ished bv the Press Office ^310 First Stree;. S E -ir Washington, D.C. 20003 • (202 ) 863-8550
�The Clintons' plan requires over one hundred billion dollars of new taxes and several
hundred billion dollars :n employer mandates, which are simply payro'l taxes by another
.^ame. .And ihii is if you accept their numbers, which many people consider a fantasy Its
taxes and mandates would hurt the economy and cost literally millions of jobs
It IS critical for Amenca :o know we need not create a government-run health care system,
jeopardize the qualuy of care we now re :cive or destroy jobs to coiTcct the very real
problems of our health care The Republican plans make that plain Republicans know we
can make ;he tundamental changes needed to give American iiamilies the security they
deser\'e while reducing costs, without socialized medicine or crippling the economy,
We don't intend to -vage a multi-million dollar media campaign like the Democrats, but it
!S dear the last thing the Clinton Administration wants to talk about is the specifics of their
plan. We want people ID kjiow what Republicans propose, and we warn them to compare
our ideas witn these cf the Clintons'. When people find out the facts and leam there are
alternatives, support tot the Clintons' bureaucratic, monopolistic government approach
v.^ill dry up.
�..'I \
RNC NEWS RELEASE
Jeanie Austin
Co-Chairman
Haley Barbour
Chairman
CONTACT: ANN'S GAVTN
(202)863-8614
FOR IMMEDIATE RELEASE
T'lcsday. October 19 1993
RNC C H - \ I R I M A N ANNOUNCES HEALTH CAI^i: MEDIA OFFENSm:
Washington, D.C. - Republican National Committee Chairman Haley Barbour
louay unveiled a national advertising canipaign contrasting President Clinton's health
proposal v/ith Republican health care retomi 'mtiati\es. T he '.t'levision ad explains that the
Republican p ans offer all Americans secure, quality health care without new goverrmtent
bureaucracies, pricefixing,raiionii'.g or lost jobs. It encourages viewers to ''read the
Republican plans ' and otTers an "800" number, 1-800-762-5511, to call to receive them.
' Some in the media and the public have confijsed the faci Republicans favor health carc
reform with the idea we agree with the Clintons' plan or find it acceptable," Barbour told a
Washington news conference. " I want to set the record straight"
"The proposal contained in the Clintons' 239-page plan is a government-run health carc
system, which would make health care worse, not better And, taxes and mandates would
hurt the eccnomy ana cost literally millions of jobs Republicans know we can make the
liindairientai changes needed to give .American families the health carc security they
deifcr\e whil.- reducing costs, without sociai.zei medicine or crippling the economy,"
Barbour i^aid.
The 30-second ad M/ill begin airing nationally in selected markets, including the
Washington, D C area Barbour said consideration is baing given to expanding the
campaign into additional markets in coming weeks
'We don't intend to wage a multi-million dollar media campaign like the Democrats, but it
is clear the last thing the Clinton Administration wants to talk about is the specifics of their
pian. We want people to know what Republicans propose, and we want them to compare
our ideas with those of the Clintons'," Barbour said "When people find out the facts and
leam there are altematives, support for the Clintons' bureaucratic, monopolistic
govemment approach will dry up "
^ jl jj
Published bv rhe Press Office ' I ' 310 First Street. S.E. ^ Washington, D.C. 20003 i - (202)863-8550
�"Thinking"
Supporting Documentation
October 19, 1993
�Yes, There's a Way:
"While the Republican plans differ, all rely far less on Govemment intervention to expand
coverage or hold down costs than the Clinton plan does."
{New York Times, 9/23/93)
"None of the GOP plans would require all employers to pay for health care, as the Clinton
plan does."
(New York Times, 9/23/93)
"None would reshape the health care system in the aggressive way the President's plan
proposes, and none would impose mandatory ceilings on the growth in the nation's
meclical spending."
{New York Times, 9/23/93)
"Speaking for the White House, spokesman Kevin Anderson said the Republican plan
showed that the GOP is 'serious about reform.'"
{The Boston Globe, 9/16/93)
"The Republican proposal does not include any of the elaborate cost control measures in
Clinton's plan, relying instead on tax incentives, and market and malpractice reforms to
help slow the growth of costs."
{The Boston Globe, 9/16/93)
"Lastly, the Republican plan does not levy a tax on cigarettes or seek to contain health
care costs through a global budget."
{The Boston Globe, 9/15/93)
"The [House] plan would require all employers to provide insurance to their workers, but
would not require them to pay for it. It would institute reforms to make insurance more
affordable for small business and promote insurance purchasing pools.
"The proposal would let the uninsured buy into the federal Medicaid program for the
poor, allow states to use private insurance policies to cover Medicaid beneficiaries and let
individuals set up tax-firee accounts for medical bills."
{Reuters, 9/23/93)
"[The House GOP plan] would give low-income individuals tax breaks to help them buy
health insurance, and would try to cover the uninsured by expanding community health
centers. States would have more flexibility with Medicaid, which would give states power
to expand coverage to the poor."
(AP, 9/15/93)
�Government Run System:
"If he loses, it will probably be because his plan, with its Rube Goldberg combination of
economic theory and elaborate regulation appears to skeptical legislators to be a giant
social eiperiment It is eiactlv that." [emphasis added]
{Newsweek, 9/20/93)
"The document describes how the Federal Govemment would enforce a national healthcare budget by regulating the annual increase in premiums that could be charged for
private health insurance."
{New York Times, mim)
"The Health alliance threatens to be a monopoUstic, regulatory govemment agency that
will cause more problems than it solves."
(Alain Enthoven, member of the Jackson Hole Group, Wall
Street Journal, 10/7/93)
"President Clinton's health care plan would give the federal govemment dramatic new
regulatory power over the nation's health care, including therightto control spending,
take over state programs that fail to meet hs goals and impose a payroll tax on employers
in those states, according to a 239-page draft of the proposal."
{Washington Post, 9/11/93)
"Just days after saying he wanted to streamline Govemment and reduce Federal
regulation, Mr. Clinton now says he wants to establish a new Government agency to
regulate the $900 billion-a-year health industry, which accounts for one-seventh of the
nation's economy .... The proposed new agency, the National Health Board, would
calculate and approve health insurance premiums for most people."
{New York Times, 9/11/93)
"The 'White House seemed not to understand that hs job was to motivate the private
sector to change. Instead, it mistakenly focused its energy on govemment strategies for
managing health care costs and on the creation of quasi-governmental purchasing pools
with the power to impose regulatory constraints on health care providers."
(Paul Ellwood, president Jackson Hole Group, Wall Street
Journal, 8/10/93)
"But what has emergedfi-omeight months of formal deliberations by the administration's
health task force is a scheme of almost overwhelming complexity. It covers almost every
aspect of the nation's health care,fi-omhow college students will get health insurance to
how many medical specialists the nation will train."
{U.S News and World Report, 9/20/93)
�"President Clinton's ambitious health-care proposal promises to rely on the unseen hand of
the marketplace, but its real power stemsfromthe strong arm of govemment."
{Wall Street Journal, 9/13/93)
"Mr. Clinton is proposing the biggest Govemment program since creation of Social
Security in 1935. His proposal would affect virtually every American and would
profoundly alter legal relationships among patients, doctors, hospitals, insurance
companies, state governments and the Federal Govemment."
{New York Times, 9/27/93)
'"There is a tremendous potential for this to become highly bureaucratic and highly
regulatory,' said Uwe E. Reinhardt, a professor of political economy at Princeton
University. 'The kind of people who mn the department of motor vehicles would be the
kind of people who would staff the alliances. Who else would staff it?'"
{New York Times, 9/25/93)
"The health care plan that President Clinton champions in his speech tonight would create
a powerfiil new executive branch agency that would allocate budget dollars, interpret and
update benefits packages and monitor state plans .... Health care specialists who have
reviewed the draft plan are virtually unanimous in describing the proposed board as
possessing extraordinary authority."
{Washington Post, 9/22/93)
"If President Clinton gets his way on health care change, get ready for more bureaucracy."
{Wall Street Journal, 9/13/93)
100 New Govemment Bureaucracies
1 - "The American Health Security Act creates an independent National Health Board"
(p. 44)
1 - Establish[es] a National Health Information System, (p. 43)
1 or more - "The Board estabhshes advisory committees that include representatives of
states, health providers, employers, consumers and affected industries. (48)
2 - "A committee of the National Health Board has the authority to make public
declarations regarding the reasonableness of [dmg] launch prices." (p. 45)
50-^- - "No later than January 1, 1997, each state must establish one or more regional
health alliances." (p. 53)
50+ - "Each regional alliance establishes a Provider Advisory Board made up of
representatives of health care professionals who practice in health plans administered by
the alliance." (p. 62)
�1 - The National Health Board creates an Advisory Committee to provide technical
advice and recommendations regarding the development of therisk-adjustmentsystem,
(p. 92)
1 - National Council on Prescription Dmgs Program: Established under the National
Board to develop a universal dmg claim form. (p. 131)
1- National privacy panel: Established under the National Health Information System to
protect individuals' medical records, (p. 125)
Multiple - Community based health information systems and regional centers:
EstabUshed under the National Health Information System to collect patient
information for a national system, (p. 126)
J - Advisory Commission for premium adjustments: Under the National Board to assess
differences among premiums between health plans, (p. 107)
1 - National Health Data Advisory Council: Under the National Board to oversee the
information and data activities, including standard setting and privacy collection, (p. 130)
1 - National Quality Management Program: Established under the National
Board monitor, assess and report on quality of health care under new system, (p. I l l )
1 - National Guarantee Fund: Created under the Department of Labor as a financial
safeguard for the self-insured plans and other plans that are outside of the Health
Alliances, (p. 80)
1 - Long-Term Care Insurance Advisory Council: Established under the Dept. of HHS to
monitor the long-term care insurance market and to advise the Secretary of HHS on such
matters, (p. 181)
1 - All-Payer Health Fraud and Abuse Program: Established under the Depts. of HHS and
Justice which creates a tmst fiind to develop and implement stronger law enforcement
againstfraudand abuse in the health care industry at federal, state and local levels, (p.
196)
/ - National system of electronic claims management: The Secretary of HHS estabhshes
this national system as the primary method of determining eligibility, processing and
adjudicating claims, and providing information to the pharmacist about the patient's dmg
use under the Medicare dmg program, (p. 225)
Ten - Regional centers: The Secretary of HHS establishes ten regional centers under an
expanded National Council on Graduate Medical Education to allocate training slots
among individual residency training programs, (p. 141)
�1 - Commission on Health Benefit and Integration/Demonstration program: Study the
feasibility and appropriateness of transfening thefinancialresponsibility for all medical
benefits (including coverage through workers' compensation and automobile insurance)
into the new health system, (p. 100)
50+ - Ombudsman program: Established under Health Alliances to provide
assistance to consumers in an AlHance. (p. 62)
Price Fixing, Rationing, and Delays:
"The premise for much of the new revenue is the assumption that the federal govemment
can, by law, curb the growth of federal health spendmg."
{New York Times, 9/12/93)
"A provider may not charge or collect from a patient a fee in excess of the fee schedule
adopted by an alliance."
{The President's Health Security Plan, Times Books, p. 68)
"Health specialists said yesterday that it will be difificuk, perhaps impossible, for President
Clinton to contain costs suflBciently to make his health care plan work without severely
reducing medical services for some groups or causing economic pain for others."
{Washington Post, 9/12/93)
"The 'fat first' assumption is one of the plan's most controversial features, one many
experts beUeve is overstated and perhaps naive. They fear the cost controls proposed by
Clinton also will cause U.S. health care providers to reduce theu" level of care in many
direct and mdirect ways."
{Chicago Tribune, 10/3/93)
"Critics of the plan say the only way the Administration could achieve such bold savings is
through broad cuts in medical services."
{New York Times, 9/21/93)
"The Administration argues that there is plenty of waste in health care and the caps can
squeeze h out. But caps don't target waste; they are likely to squeeze out important
services."
{New York Times editorial, 9/16/93)
"Others fear that the Clinton plan, as it's shaping up, could lead to a rationing of medical
services."
{Wall Street Journal, 8/23/93)
"The Congressional Budget Office wamed today that one of the most important elements
of President Clinton's health plan, Federal limits on private health insurance premiums,
could harm consumers by forcing a reduction in valuable medical care and restricting
access to new medical technology."
{New York Times, 9/18/93)
�"Nevertheless, some people fear ... sticking to the caps and forcing health plans to sharply
reduce payments to doctors and hospitals ~ could prompt the providers to reduce
services. 'I think you'll see a rapid change in access to various procedures and treatments,'
said James Todd, senior vice president of the American Medical Association, which
opposes the caps." {Wall Street Journal, 9/30/93)
"Medical industry fears reforms will hurt quality."
{Washington Times, 9/23/93)
"Advocates for children and some Administration officials are saying that President
CUnton's health plan would eliminate some benefits received by miUions of poor children
on Medicaid, including many who are disabled."
{New York Times, 10/11/93)
"In the stmcture outlined by the White House, many people mayfindthemselves choosing
among unfamiUar new health plans and accepting new limits on theirfreedomto choose
doctors or hospitals, or paying extra to use the system asfreelyas they are accustomed
to."
{New York Times, 9/11/93)
"People will have to surrender somefreedomto pick their doctors and hospitals if they
want low-cost coverage. People who opt instead for maximumfreedomof choice ahnost
certainly will pay extra."
{Wall Street Journal, 9/13/93)
"It is likely that many patients would be forced to sever their relationships with their
physicians, both when the system is first implemented and possibly many times thereafter."
(Ezekiel Emanuel, Dana-Farber Cancer Institute, as quoted in
Investor's Business Daily, 10/6/93)
"Although CUnton makes it seem that patients can switch at any time to follow their
doctor, the plan allows them to switch only once a year. There is also no guarantee that
consumers who want to join the plan to which their doctor has moved will be able to do
so. The plan's draft states that if too many consumers apply to one plan, the regional
health alliance can use a lottery system to randomly pick which lucky consumers may
enroll."
{Investors Business Daily, 10/6/93)
�Mandates on Small Business:
"... Mrs. Clinton has failed to ask the question that belongs at the core of any discussion of
a health care mandate: What will be the impact on employment of a federally mandated
wage increase of $5000 ~ the employer's share of the cost of providing health insurance
coverage (for a worker with dependents) that the Administration is proposing? June
O'Neill and David O'Neill, both professors of economics at Bamch College, City
University of New York, have the answer in a study prepared for the Employment Policies
Institute. Recognizing that a mandate requiring employers to pay their workers health
insurance expenses translates directly into an increase in labor costs, the O'Neills estimate
that this increased cost will lead to the loss of 3.1 million jobs."
(Wall Street Journal, 8/20/93)
"Clinton has publicly stated that health care reform will 'boost job creation,' a claim that
unnerves many of his advisors. What they know ~ and what some of them fear Clinton
has not been told - is that the Administration's ovm preUminary computer-aided studies of
'employment effects' of health reform predict 'significant' job losses. Time has leamed that
according to one computer mn, the plan would slow net employment growth by as many
as 1 miUion jobs over five years .... Laura Tyson, chair of the President's CouncU of
Economic Advisors, cautioned that once the plan is released, respected outside economists
will mn it through standard econometric models, which wUl probably show job losses, 'and
some of those numbers might be big.'"
{Time, 9/6/93)
"Ira Magaziner, the President's top health care advisor, recently caUed worries about job
losses 'crazy.' But economists involved in the planning process have been raising the issue
all along. Administration officials are aware of the problem, although they are under strict
orders not to discuss estimates of potential job losses."
{New York Times, 8/30/93)
"A top 'White House economic aide acknowledged that the Clinton health plan could cause
the number of jobs in the economy to fall in its early years by as many as 600,000."
{Wall Street Journal, 10/7/93)
ALewin/VHI Inc. (a Fairfax, VA economic/health care consulting firm) study of the
annual cost of the employer mandate breaks down the impact by size of companies.
Figures from The Washington Post, 9/23/93, show the mandate's cost to small businesses
(those under 25 employees) would be $28 bilUon.
Emplovee Level
1-9
10-24
Currentlv Insure
$0.7
2.1
Do Not Insure
$18.8
6.4
�Funding
1
"Representative Jun Cooper, a Tennessee Democrat who reviewed the President's
proposal this week, said today, "I don't know anybody who thinks it'sfiallyfimded."
{New York Times, 9/12/93)
"The question of how tofinanceMr. CUnton's ambitious program stiU vexes many
administration officials and members of Congress, who doubt that the latest proposals wiU
produce all the revenue envisioned."
{New York Times, 9/12/93)
"After the briefings this week. Congressional experts who work on health poUcy expressed
two reactions: amazement at the complexity of the President's plan and apprehension that
the proposed cutbacks in Medicare and Medicaid were politically unrealistic. Without a
reliable means offinancing,the Govemment would be forced to reduce the size of the
proposed health program, raise taxes or borrow more money and thus increase the Federal
debt."
{New York Times, 9/9/93)
"A health-benefits actuary who has been consuUed by the White House also took issue
with some of the Administration'sfinancialestimates, particularly the projected savings in
Medicaid and Medicare. 'It's wishfial thinking,' said the consultant, who asked for
anonymity. 'The numbers are totally unrealistic.'"
{Los Angeles Times, 9/23/93)
"The "White House estimates of insurance costs for individuals and famiUes in President
Clinton's health plan were sophisticated guesses based on incomplete and largely outdated
information. That is the conclusion of actuariesfromseveral large accounting
organizations who reviewed the estimating process for the Administration."
{New York Times, 10/8/93)
'"It comes down to a leap of faith.'"
(Linda Bergthold, co-director of the White House group that
developed the proposals, as quoted in the New York Times,
10/8/93)
"A fantasy."
(Senator Pat Moynihan, describing the plan's financing.
Meet the Press, 9119193)
"Amazingly complex. It creates many bureaucracies. It is confusing. It eliminates
traditionad fee-for-service medicine as we know it."
{Time, 9/20/93)
�Health Care Reform: The Repubhcan Approaches
Republican Statement of Principles
In early September House and Senate Republicans presented First Lady Hillary CUnton with a
joint statement of health care principles, stating "We beUeve the health care delivery system needs
powerfiil new incentives for change. Individual responsibility and control are critical. No
govemment controUed system can be as responsive, as high in quality, or as cost-effective as a
system that is based on personal consumer choice and satisfaction." We support reforms which:
1. REDUCE COSTS by reliance on educated consumers, not government-imposed fiats,
and reforming such things as medical malpractice tort Uability, and other issues that
drive up costs.
2. INCREASE ACCESS and remove the fear of losing insurance because of job loss or
change, moving, or a serious illness.
3 MAINTAIN OUALITY to ensure America's health care remains the best in the worid
and consumers don't pay more for less care.
4 PROVIDE CHOICE to ensure consumers, not the federal govemment, decide how
they get their care andfromwhom.
5. PRESERVE JOBS by protecting smaU businessesfromjob-kUUng mandates and taxes.
6 ENHANCE FLEXIBILITY. aUowing states and localities options to design plans best
fitting their needs.
7. BE FAIR in tax treatment of all health care purchasers.
8. ENCOURAGE INPrVTDUAL RESPONSIBILITY, increasing options to enable
individuals to take responsibility for their care.
9 BE FINANCIALLY RESPONSIBLE, phasing-infinancingof reform as other savings
are available and not through deficit spending or increased taxes.
10. BE WORKABLE, focusing reform efforts on what is proven, rather than what a
bureaucrat designs.
These principles, agreed upon by the GOP House & Senate Health Care Task Forces, are
embraced by the Repubhcan health care plans presented here. While the approaches differ, the
plans offer health care reform that reduces costs, provides health care security and not with
govemment-mn health care that jeopardizes quaUty or care or job-killing tax increases or
employer mandates. In addition, RepubUcans have introduced a number of other measures that
would reform many elements of the health care system, including medical malpractice tort UabiUty,
insurance paperwork simplification, and mral and long-term care.
All these plans fix what's wrong with the system, while preserving what's best about American
health care ~ consumer choice of doctors, the continued development of life-saving technology,
and the highest standards of care in the worid.
�Health Equity and Access Reform Today (HEART)
Introduced by Senators John Chafee (RI) and 23 cosponsors, the Health Equity and Access
Reform Today bUl (HEART) has three principal goals: restraining mnaway health care costs,
universal health coverage, and the preservation of quality, choice, and jobs. The plan has two
distinct phases.
, ^ ..
<•
. Thefirstphase reforms the system to improve the avaUability, secunty, and affordability ot
health insurance and to improve the efficiency of health care while holding down costs. These
are reforms that can be made immediately.
. The second part phases in federalfinancialassistance for those who still cannot afford
insurance, paid for by savings quantified and captured in the above reforms. HEART would
not establish new entitlements that would remain in effect regardless of whether savings
are achieved.
The plan wiU enact the following reforms:
. Protect families by making sure they will not lose their health insurance coverage if someone
loses or changes jobs, moves, or gets sick.
. Reform the insurance market to eliminate "risk selection" ~ ending "preexisting condition"
practices, waiting periods, or rate hikes based on health status.
. Create voluntary ~ not govemment mandated or controUed ~ health insurance purchasing
cooperatives for individuals and small businesses, allowing those purchasers to use their
combmed power for lower rates without limiting consumer choice as to plans, coverage,
benefits, or doctors.
. Amend the tax code to ensure that tax deductions for health insurance are equal for all
Americans.
. Ensure that aU Americans have a minimum level of health insurance, including preventive and
primary care.
. Ensure individuals take responsibility for their own health care, by requiring that they
purchase health insurance.
. For individuals who choose to enroU in catastrophic care plans, a "medical savings account"
would be available. Contributions to this account would befiillytax-deductible if made by the
individual; if unspent at the end of the year, thefiindscould be carried over to the foUowing
year.
. Those who cannot afford coverage, but are ineUgible for Medicaid or Medicare, would receive
federal vouchers, financed only as savings are realized through cost reduction reforms.
HEART wiU achieve additional savings through the following reforms:
• Medical malpractice reform to reduce unwarranted lawsuits and excessive damage awards.
This provision frees providers from practicing "defensive" medicine, which drives up costs
without improving care.
. Administrative reforms, instituting standardized forms and estabUshing electromc information
reporting and exchange requirements to eliminate red tape and costs.
. Relaxation of anti-tmst provisions to allow hospitals and physicians to share costly medical
equipment and to more efficiently use health care resources.
• Medicare and Medicaid reforms restraining the growth in these programs.
�Other provisions of HEART include a greater emphasis on prevemative care, improved access for
those in medically underserved regions, and ensuring state flexibility to experiment with
iimovative forms of health care reform.
The Affordable Health Care Now Act of 1993
Introduced in the House by Minority Leader Bob Michel, the GOP plan builds upon the strengths
of the current system and aims to keep the individual at the heart of the system, aUowing educated
heahh care consumers to make decisions about their own health care. The plan aims to improve
access to health care, control costs, and ease the health care cost burden on smaU businesses. The
House plan provides steps that can be taken immediately to improve the system, and it does not
create huge govemment bureaucracies or a system of govemment-mn health care, as does
CUnton's proposal.
The plan would improve access to affordable health care through the following reforms:
. Require employers without existing health benefit plans to offer (to eligible employees) at
least one plan meeting a specified level of coverage. Employers would not be required to pay
premium costs.
. The plan would limit restrictions on preexisting conditions under aU employer benefit plans.
Through this provision it would end "job-lock" and increase portability by prohibiting these
restrictions for those who are continuously covered. State Medicaid reforms would ensure
that individuals have the option to purchase coverage at group rates, should they lose their
jobs.
. To increase buying power, insurance could be purchased through purchasmg cooperatives or
state-sponsored systems.
. Low-income individuals would receive tax breaks to help them buy health insurance.
• The uninsured would be covered by expanding community health centers.
. States would have moreflexibilitywith Medicaid, which would give states power to expand
coverage to the poor.
The plan reforms the insurance marketplace and controls costs through the foUoAving measures:
. Tax deductions for the self-employed, and for those not purchasing insurance through an
employer, would graduaUy be raised to 100% deductible.
. Creation of purchasing pools through which small businesses can offer coverage. Insurers
would be required to offer to businesses with between 2 and 50 employees at least three plans:
a standard plan comparable to current small group poUcies, a catastrophic plan, and a
"Medisave" plan (see below).
. By allowing Americans to start tax-free "Medical Savings Accounts," akin to IRAs, and
allowing consumers to keep any unused money at the end of the year, consumers would have
incentives to control health care spending. A Medisave account would be Unked to purchase
of a health insurance policy; money in the account would be available for long-term care,
catastrophic care, Medigap and Medicare premiums.
. Medical malpractice reforms, including a $250,000 cap on non-economic damages, a limit on
attomeys' contingency fees, and clarified standards of proof
. Administrative reforms, including standard claims forms and electronic coverage and billing
systems.
�Antitmst impediments are removed, allowing providers to enter joint ventures, and share
equipment and technology.
Aside from the above administrative savings, the House GOP plan is also paid for by raising
the federal retirement age from 55 to 62, and phasing out certain Medicare subsidies for
seniors with incomes over $100,000.
The Comprehensive Family Health Access & SayinesAct
Introduced by Senator Phil Gramm and others, the Comprehensive Family Health Access and
Savings Act reUes on consumers to make their own best decisions about coverage and care. All
health insurance poUcies are made permanent, portable, and guaranteed renewable. It ensures
consumers have a choice of doctors and insurance plans, and provides tax credits to the working
poor who carmot now afford coverage.
The plan expands consumer choice and reforms the insurance market in the foUowing ways:
. Already insured individuals are guaranteed the abUity to continue their medical coverage even
if they leave their jobs or if family situations change. All policies would be guaranteed
renewable, and no insurance company could cancel a policy or raise rates if an individual or
family member gets sick.
• Small businesses and community organizations (churches, civic groups, etc.) would be
aUowed to voluntarily pool their health insurance purchases to maximize their buying power.
• Employers would continue to receive health care tax exclusions only if they offer their
employees at least three options in selecting their employer-based coverage: they could either
maintain current coverage, switch to an HMO or any other coverage (such as voluntary health
aUiances, preferred provider organizations, or managed care), or elect to enroU in a Medical
Savings Account program (see below) with purchase of a catastrophic insurance policy.
• Medical Savings Accounts, tax-free, with fiinds contributed from employer and employee,
could be established with purchase of catastrophic insurance. Any contributions above the
level needed for catastrophic premiums would be available for standard medical coverage.
Any fiinds (beyond the deductible) remaming at the end of the year may be converted to
personal use.
• Uninsured individuals with pre-existing conditions could not be denied coverage, and some
would receive federal assistance for insurance premiums.
. Insurance companies would be aUowed to offer lower rates as incentives for individuals to
pursue healthy lifestyles.
. For low-income famiUes and individuals not eUgible for Medicaid, a sUding tax credit will be
avaUable to purchase catastrophic coverage with an emphasis on preventive care.
. The plan encourages responsibUity by individuals who are financially capable to buy health
insurance, providing that govemment assistance wUl not step in until they've exhausted their
assets.
• Self-employed individuals would receive a tax exclusion for insurance premiums equal to the
national average of employer contributions.
. Paperwork would be streamlined through the use of standardized forms for private insurers.
The plan controls costs and expanding consumer choices through Medicaid/Medicare reform:
�•
Federal contributions to states' Medicaid programs would be capped at a per capita rate
(annuaUy adjusted for medical inflation). States would have theflexibUityto either continue
their current Medicaid program, enroll recipients into a HMO or other plan, or establish
Medical Savings Accounts for recipients. States would be encouraged to develop other
innovative ways of providing Medicaid services.
. Medicare recipients would have the option to either keep their current coverage, or receive
the equivalent in govemment assistance to enroU in a HMO, other plan, or estabUsh a Medical
Savings Account with the purchase of catastrophic coverage.
. State and federal health care providers would be requu-ed to standardize forms and reduce
total paperwork burdens by 75% withinfiveyears of enactment.
The plan would reform the medical Uability system by, among other measures:
• Capping non-economic punitive damages at $250,000.
• Limiting lawyers' contingency fees to 25%.
• AUowing providers to negotiate with purchasers lunits on liability in retum for lower fees.
Consumer Choice Health Plan
To be introduced by Senator Don Nickles, the Consumer Choice Health Plan empowers
individuals with more control over their own health care plans and costs, and relies on smart
consumers ~ not govemment bureaucrats ~ to make decisions about what's best for their famUies.
The plan would:
• Guarantee access to health insurance.
• Ensure that coverage is portable, even if an individual changes jobs or gets sick,.
. Control costs and streamline the health care bureaucracy.
CCHP would guarantee access to health care for aU Americans by:
• Converting the tax exclusion for companies providing health insurance into a tax credit for
individuals and famiUes. Everyone ~ self-employed, or employed in a small busmess ~ would
receive this credit and have the option to either stay in their current plan, purchase other
coverage, join a HMO, or estabUsh a tax-free Medical Savings Account, using thesefiindsto
purchase more health benefits or catastrophic coverage.
• The tax credit would be refiindable for lower-income famiUes and individuals, meaning the
poor would receive a voucher to purchase insurance with.
. CCHP would reform the insurance market to eliminate insurers' abUity to deny coverage to
anyone with a preexisting condition.
The plan would also keep health care costs down by:
• Streamlining paperwork through a standard claims form and electronic claims processing.
• Reforming medical Uability laws.
• Reforming antitmst laws to encourage cooperation among health providers.
• Transform the Medicaid program into a block grant program for the states to allow flexibility
in providing care.
The plan is revenue-neutral ~ the cost of the tax credit would be offset by savings from phasing
out the current tax exclusion for employer-provided health insurance.
�Democratic National Committee
POLITICAL DEPARTMENT
PH 202-863-8000
rx 202-863-8196
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Printed on Recycled Riper
�09/15-'1993
07:46
FROn
fisian
finer.
Health
Forun
TO
12026986518
P. 0 2
MEMORANDUM
TO:
Dennis Hayashi, Director OCR
Vida Benavides, DNC
Judy Whang, DHHS
FROM:
Tcssie Guillemio
DATE:
September 14, 1993
SUBJECT:
Vice President Gore's L.A. Visit
Additional points to address/highlight during the visit:
Asians' familiarity with prevention and primary care services,
other than prenatal care, is minimal in their countries of origin.
This, along with the unavailabihty of such services (e.g., cancer
screenings, hypertension education, hepatitis B immunizations)
in the U.S., have resulted in low utilization of primary care,
leading to unnecessary Ulness/death and expensive health care.
The AHSA will expand access to primary care and prevention
services, including education and outreach, so that A/PI's can
more easily obtain these services (need examples of how this
may be done through private doctors and community clinics).
^^tJjU-*Ji
PoJ4^
A large proportion of A/PI's work in the low-paying service
sector (20% in 1980), and are either uninsured or underinsured.
The AHSA will allow eii^>loyers of these workers to provide
affordable coverage for healdi care through health insurance
pools that caimot discriminate based on occupation, health stams,
age or other factors, as long as they are employed.
%^Jir\^^
3.
Asians and Pacific Islanders are also among the biggest owners
of small businesses; primarily family owned sole proprietorships,
who cannot afford health insurance premiums. The AHSA will
assist small businesses.^du'ough subsidies;' to purchase health
insurance through the health alliances. The alliances will pooP^"*^ buM'w/y
^0 t ^ t U ^ ^ »j)the bargaining powet^f
purchasea in order to get the best
health care for thettestpm^, making it^^affordable for these
consumers.
^3>^
�09^15/1993 07:46
FROM
fisian
finer.
H e a l t h Forun
To 12026906518
P . 03
D. Hayashi, V. Benavides, J. Whang
9/14/93
Many A/PI community based (^4taditioQal/es8efiQalTproviders
understandjdbat a successful health care delivery system
integrates family heeds^ ra^^ptim just focusing on the
individual. The AHSA-^i^mak^ easier for community based
health care providers to coordinate cairc^^lth other family and
social servic^such as Head Start, employment and training,
child <5are, etc. It v^ill simplify admioistrative processes in
leiivering comprehensive care and encourage linkages with odier
social support services.
Most A/PI's are not familiar with how medical care is provided
in the United States (Western modes of delivery). The AHSA
promotes cultural sensivi^ and appropriateness so that
consumers can access services that take into account their
language and health seeking cultural patterns in the delivery of
care.
Data on A/PI health stams, utilization and treatment outcomes is
not readily available for health plans to use in planning and
evaluating iheir system's ability to respond to A/PI consumers.
The AHSA provides for monitoring, evaluation and quality
assurance that will collect, analyze and report A/PI ethnic and
race data.
If there are otljef points I come up with, I won't hesitate to let you
know! Theimportant thing would be for the VP to set the stage with
}!gpicture first in order to ameliorate any parochialism regarding
local issues, and ^ddn
address these salient, pertinent issues as if they were
;rnN.
everyone's concernNjJVj^
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TVPE
001. memo
SUBJECT/TITLE
DATE
Vida Benavides to Judith Whang; re: Vice President Gore's Visit to
Los Angeles Asian Pacific American Health Primary Care Facility (1
page)
09/14/1993
RESTRICTION
Personal Misfile
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3664
FOLDER TITLE:
Folder #3: [Judy Whang Documents]
2006-0885-F
ip2648
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. S52(b)]
Pi
P2
P3
P4
b(l) National security classified information |(bKl) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIAl
b(3) Release would violate a Federal statute |(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the F01A|
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA]
National Security Classified Information 1(a)(1) of the PRA|
Relating to the appointment to Federal office l(aK2) of the PRA|
Release would violate a Federal statute |(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�cc :^^///lAs
/A^^^^
MEMO
TO:
J e f f Teague
FR:
Vida Benavides
RE:
VP Gore's LA V i s i t
Asian P a c i f i c American (APA) Health Care Message Event
I am e x p l o r i n g t h e p o s s i b i l i t y of having the Vice President
v i s i t a Primary Health Care s i t e w i t h i n the Asian P a c i f i c
American community when he t r a v e l s t o Los Angeles on t h e 28th of
t h i s month.
Asian P a c i f i c Health Care Venture, Inc. i s a non p r o f i t c o a l i t i o n
baased o r g a n i z a t i o n which i s comprised of 12 community based h e a l t h
and human s e r v i c e agencies serving t h e APA communities i n LA
county.
They have a c i t e i n Korean town t h a t service t h e Korean American
community (one o f 3 community based c l i n i c s t h a t serve t h e APA
community) c a l l e d Koryo (Ko-ree-yo) Health Care f a c i l i t y .
We could h i g h t l i t e t h e f o l l o w i n g message t h a t blends
Reinventing Government and Health Care.
The Asian P a c i f i c Health Care Venture receives money from
several funding sources; l o c a l , s t a t e , f e d e r a l government. This
n o n - p r o f i t f a c i l i t y w i l l stand t o gain several b e n e f i t s from
REGO by:
1)
e l i m i n a t i n g regulatory o v e r k i l l
2)
consolidating
3)
s t r e a m l i n i n g inter-governmental ( l o c a l , s t a t e , n a t i o n a l )
r e s t r i c t i o n s and or cross-agency a c t i v i t i e s
c a t e g o r i c a l grants
The c i t e / s e r v i c e s w i l l also b e n e f i t from Health Care Reform:
1)
Health ID card; the people they serve w i l l possess
h e a l t h ID cards and therefore cooperation by i n f o r m a t i o n
sharing w i l l only b e n e f i t n o n - p r o f i t h e a l t h care
facilities
2)
This f a c i l i t y emphasizes p r e v e n t a t i v e care which i s
such a core p r i n c i p l e i n our Health Care p l a n
3)
Empowerment; shows t h a t a APA community i s demonstrating
community service by coordinating resources through
government and n o n - p r o f i t sources.
�p.2
I have someone i n Los Angeles right now exploring the p o s s i b i l i t y
She's the Executive Director of Asian American Health Forum who
3ust happens to be i n LA today for a conference.
I also have Dennis Hayashi, Director of C i v i l Rights/HHS looking
into the Health Care Plan and how a facility/services/community
benefit from the Health Care Reform.
Plans will be concrete by this Monday, Sept. 13th; Logistics,
issues, talking points and key players involved, y^^^
/U^JC^^JLBriefing w i l l be complete before i leave for Seattle, 9/22/93.
cc:
Minyon Moore
Marcy Sandoval
�SoptemtMir 13, 1993
NOTI TO:
Vida Banevldaa
Democratic National Committee
JfROM
Oannis. Mayaahi V-r^
Dlraotb'r
Offlcavior Civil Righta
SUBJECT : Vice praaidant Oore'a L^X. Vlalt
The Vloa Pr^ldent'a vlalt to an Aalan ?a^4^1c American
health clinic, wi^kh a primary cara fooua, praaai^ts an excellent
opportunity to ganarata aupport for tha AmarlcafP: Haalth Sacurlty
Aot (AHSA). Amd% polnta to ba highlighted by Ittaoh a v i s i t :
1. Tha importanca of primary care praotltlona3^|i^ la emphaalzad
heavily In the AHSA. Thara la a oommltmant tolAhi^t tha balance
in graduate training from apeolallaatlon to primary oara, with a
goal of 50% prlma;py cara phyalclana among madlcal iaohool graduates.
Thare l a alao ancouragement In the AHSA fo^^ community baaad
undergraduate and graduate madlcal training.
2.
The AHSA encourages racial diversity. (tiSupport would be
provided to programs that increase the number
minority haalth
profaaslonais. This would be done through a cbmbination of
financial aasiata^oa, increasing support for racruitnant and
retention of minorltlea, maintaining afforta tb generate interest
in haalth among pre-profeaaionala and profaa8lom|i8, and supporting
programs to ino^aase the niimber of minority faulty, researchers
and scientists.
I t would ba aignificant to emphaaize the racrultmant of
students who hava bilingual skilie.
3.
Public hajilth initiativea prioritised tn tha AHSA would
include comprehiHftsiva Immunization and control of tubarouloais,
which are a r e a s c o n c e r n to the Aalan Pacific American community.
�Page 2 - Note to Vida Banevldae
4. The AHSA seeks to invest in developing adacjuate haalth care
in underserved urban neighborhoods. Health Alf^jances would have
responsibility for building haalth natworka. in areas with
inadequate acceaa. Invaatment would be encouragibd in eOBununlty
clinics to expand/this access. There would alap ba financial
incentivee to atisract health professionals to aiteaa of inadequate
care.
5. I t la anticipated that with full implamantation of reform,
the focus of federal granta will ahlft to auppbrting aupplementai
sezvlcea, such aai transportation, outreach, nonrmedloal case
management, trafMriatlon, health eduoatibn, soolfl aupport, etc.,
90tae of which may be highlighted at the clinic ylalted.
5. Of course, the financial sacurlty provldad by tha AHSA
would guarantee that the patienta at the clinic would always
be able to receive services in one form or anothar.
'
•
.
»
�-eir93 05:43i
FROM HON, NORM MINET.^
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TO 94562362
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8Z« teoOd WV2C:gO CB-TO-OI
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Its
SI*
t
Release: Wednesday,
September 22,1993
Tessie QuiUenno
ASIAN
AMEjaCAN
HEAiirH
FORliwiNC.
Doog Suh
(415) 541-0866
ASIAN AMERICAN HEALTH FORUM SUPPORTS PRESIDENT'S
REFORM PLAN
W-9» I
BOARO lOF DIRECTORS
Hyttii(tii*I.M,MJ3,
SAN FRANCISCO - Calling it a major advancement in addressing
Shany H i i M i
ImiuLinrii!
MltiKiC. l.o»«,M.O,
inequities in the U.S, health care delivery system, the Asian American
Healtti Forum expressed qualified support for President Clinton's American
H«ilMrlt<iumtu,DS,W.
O u l v f l M ' Jeofcin*
ttiMiiiKimfwra
.^ttluir a|wn. H.O.
JcittUdC)ti<v,S4.0l
Ml* 1 4 ^ g ^ « Chot, MJ>
Health Security Act released today. "We are pleased that the AHSA
addresses many of oar concems as they relate to increasing health access
Hii.WiaI-1aiir.MU3.
for Asian and Facilic Islanders residing in the United States. There are
IViiiclwa Ingvu
still a few areas ia the President's plan that we would like more
JyiitlHlUoM
RtfctaMKing, PLEL, R.N.
information on before we issue our fiaal opinion," said Tcssie Guiflenno,
OwlMLOBiLui^
HinUUI
executive director of the national advocacy organization. Amoug these arc -v" '' ^' z
BfUd KMUnuoluUib Mtitie. M C
H]rui>|W.Oli.MJD.
hhspn t>uiichpmB>Iil
IVmC Ptnii
Callin V. QuDck, M.a
SBikSiB)i^M.I>.
quality management measures, non-financial barriers to caie, adequate A/PI
health provider involvement, and A/PI representation in governance and
policymaking in the new system,
\Mlla««|.1luM7o
niialitv Kfunflgement Data
M)>tM ^Mg, f%,D., M.O.
>iAaal4rii
Data fiom the National Center for Health Statistics indicate that
VIk«lVU)uW.MJ3i
I W l ChnllannQ
adjusted fbr health status. Asian and Pacific Islanders have the lowest rate
of doctor visits per person, as com^pared with all other population groups,
ii6
hUw Xiloiicgomcry
which may reflect problems with insunmce, since 21% of the A/PI
aaniinii'ltra
CAMni
4q}«t-^
Notional tidwatisfir Asltin ani Etdfie-Islandtr Hrahh
88^95222021 01
u n j o j M>T>*H 'J^MtJ ut|»H woaj
eZlCI C i S l / l f l / B I
�01r93 05:43AM FROM HON, NORM MINETA
TO 94562362
F009/01i
X96-a
populatira is imlnsuted. This infonnation. however, aggr^tes Asians and Pacific Islanders
together, soaking it difficult to determine the gaps in utilization and coverage by apcciflc
ethnic group. Health data is o l ^ aggregated in the same manner, but most often, Avisos
and Pacific Islanders are coded within "non-white" or •other* categories. Given the cmidiasis
on qualicy lixi^ana^ement within the health reform prq)osal, measures such as patient
satisi^iction, health |dan*s performance and outcomes should include A/PI ethnic identifiers in
data collection, analysis and reporting.
Lanaoage and Cultural Barriers
^
Many health care providers understand that there are other barners which act to deny
health c?xs: to Asian and Pacific Islanders, even Ibr those who have insurance coverage. The
President's plan to provide universal access also recognizes tiiat non-financial barriers sach as
education, geographical locarbn. race, ethnidty and language, and certain severe health
problems sadx as AIDS reduce access. The AHSA describes a number of steps that will be
talcm to ^.ssdst health plans to expend access to such "vuhierable" populations in order to
reduce dispariibies in health status.
iDctaded in these initiatives arc new giants and loans, to expand health care capacity
in unders^n'ed areas, support the development of netwoilcs of care providers, and oversee the
integration of federally iUnded providers hito die new system. Further^ new grants to states
cover aaixc^ch and enabling services (such as transportation, translation/interpretation and
(Md cars), as well as tbe integration of community health services with odier social services
aod sch^l based health services.
e8^9G22CeZI 01
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82l£t £661/18^91
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TO 94562362
F310/01
I t s SI» I
Umri^ Health Professions Development anfj Commmiitv Based Providers
>
Ms. (juiUcrmo alao said that her organization is concerned aijout security for A/PI
providera ihat represent the only linkage between tbe Western health carc delivery system and
consumsrs whose health beliefs and practices are often at odds with this system. "Because
many Asians and Pacific Islanders come from countries unfamiliar wifli the concepts of
prBTcauT^; care they do not. for instance, understand the linkage between cancer screening
and its piTssible prevention or cure. Mainstream educational campaigns don*t appropriately
targot A/FI consumers in a manner ibey accept or with language they easily underatand."
Although over 90* of A/PI physicians are specialists, they and traditional ptovidere often are
the oQiy sources of primary care to their communities because of their knowledge about
cwltaral jrmctices regarding health, apd theiefore bridge the gapforA/PI consumere who art
not well iniormed because of difficulties with cducatkxi, language or culture. This linkage is
even m^ore critical, given die AHSA's emphaais on prevention and primary care.
The AHSA protects what air called "essential oommnnlty providers" by requiring
^,
participating health plans to cover services provided to their members by these provideis.
The AHSAftutherassures the availability of essental community providers through Its
strate^es to increase the number of minority physdans, nurees and mid-level practitioners by
Ihc yc?c 200O. In is unclear whether Asian and Pacific Islanders wiU be targeted due to an
inaccurate perception that there Is an overaepiesentation of A/PI physicians in relation to the
A/PI popilation. When the p<^latico is disaggregated into ethnic communities, such as
Vietnamese, Hawaiian and Korpan, there are documented shortages in sbme communities. It
win be .\jnjznrtant that the CUnton administrationrecognizethis disparity and act to remove it.
>8'd
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'1
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TO 9455236
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9Z#
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Finally, Uic AAHF is concerned about two additional issues: services for
undocumentedftmiliesand the financial impact on Asian and Paciiic Islander family owned
businesses, since owners of family businesses and sole proprietorships and their woricers.
make up a significant proportion of the A/PI uninsured, These concems need more scmriny
and serious consideration by both the A/PI community and the Administratioo.
"As vw understand it, the American Health Security Act reflects the objectives that
our orgaaization has ftr increasing access and improving the health of Asian and Pacific
Islander Aniericans, and we support it, stated Dr. Harry Lee, president of the AAHF. Ms.
Guillcrmo fiirther states, "Intibepast w» have worked closely witii Senator Daniel Inouye (DHawaiJ)
Represcnnitive Norman Mineta CI>-San Jose) in successfully addressing the healtii
needs cf thdr A/PI constimency. Our national membership ViiU work with the
Administration and ourrepresentativesin Congress to assure that the potential oudined in die
AHSA ia transftamed into legislationtiiatwiU provide true universal access."
A4Un AsKt^iCAa Bkalth Vbnm
9 W . 32, IS?3
ce'd
B»i9SZtZ»Zt
01
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TVPE
002. fax cover
sheet
SUBJECT/TITLE
DATE
Chris Strobel to Steve Edelstein; re: Health Care Reform Plan
(partial) (1 page)
10/01/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3664
FOLDER TITLE:
Folder #3: [Judy Whang Documents]
2006-0885-F
Jp2648
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act -15 U.S.C. 552(b)l
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency 1(b)(2) of the FOIA)
b(3) Release would violate a Federal statute |(bX3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information |(bX4) of the F01A|
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
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b(9) Release would disclose geological or geophysical information
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PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(S) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRA|
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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TO 94562362
WASHINGTON OFFICt
3 3 2 1 NArtuHN H o v i i Orrici Bi»a.
WAtNiNOTON, DC 20E1B.«S1B
TiLIPHONI (202) a 2 i - ' 2 l 3 1
NORMAN Y. MINETA
MEMB Jt Of C O N O m t l
U T H D tTMCT, C Y I K I I N U
Congress of the Mtefl States
DEPUTY WHIP
CHAIRMAN
PUBUC WORKS AND
RANSPORrAnON COMMITTEE
iqiCOWMITTIII:
AVIATIOh
•CONOllilC OEVEUDPMENT
NVfSTIOATIONS ANCi OVMSIOHT
>UBLIC BUILOINQS ANO ODOUNDS
SUNFACI TRANSroKTATION
WAIERRISOUACES
lumsc of lUpreBentadDtB
IQDasliinpon, im-m
DISTRICT OFFICE;
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SAN J C W L C A 9 6 1 2 8 - 3 9 8 3
TILtriMMi | 4 0 B ) 8 1 4 . 8 0 4 8
SANTA CRU2 COUNTY:
TlUPHOMI | 4 0 » 4 3 8 . 4 8 1 8
TDD NUMUR (408) B84-6409
TO:
Steve Edelstein
WITH:
Health Care Task Torce
FROM:
Chris Strobel
WITH: Office of Congressman Norman Y. Mineta
PHONE: 202-225-2561
NUMBER OF PAGES TO FOLLOW (EXCLUDING COVER):
10
Steve:
I've Included a copy of my memo to Lorraine (2 pages), Norm's backup f o r
the Caucus meeting w i t h Secretary Shalala (4 pages), and the press release from
Asian American Health Forum expressing q u a l i f i e d support f o r the plan (4
pages).
My guess i s that the best resources here w i l l be the AAHF press release
and the questions I Included i n Norm's backup. (By the way, we r e a l l y don't
s c r i p t him t h i s closely.)
Hope t h i s helps out, and i f you need anything
over the weekend, please don't hesitate to c a l l me at
P6/(b)(6)
Chris
0
PMNTED ON MKVCLCD M P I R
— I
�Ir93 05;43AM FROM
NORM MINETA
August 10,
Date:
TO 94562362
P002/011
1993
i
Lorraine M i l l e r , Deputy Asst. t o the President
to:
Chris Strobel, Leg. D i r e c t o r , Rep. Norman Mineta
From:
Health Care Reform Plan
RE:
I've reviewed the baclcground m a t e r i a l you f o l k s provided on
the Health Care Refonn Plan. Thanks f o r sending i t over. I'm Fed
Ex'ing one of the copies out t o Norm i n our San Jose o f f i c e .
There are a couple of questions I know he's going t o have,
s p e c i f i c a l l y focusing on the issues he and the other Asian P a c i f i c
American Members raised w i t h Mrs. C l i n t o n during t h e i r meeting i n
May. We r e a l l y need t o know how those issues are dealt w i t h i n the
package before we can move ahead on t h i s .
(Also, I've turned down a number of requests from f r i e n d s i n
the press and l o b b y i s t s f o r a copy of the Q's and A's. Am I
c o r r e c t t h a t you guys would p r e f e r t h a t m a t e r i a l stay i n house?)
Here are the questions raised
(plinton:
i n the meeting
w i t h Mrs.
1)
What standards does the package contain f o r ensuring
access t o c u l t u r a l l y and l i n g u i s t i c a l l y appropriate care
f o r language m i n o r i t y and other m i n o r i t y populations?
What p o p u l a t i o n size i s necessary f o r those standards t o
k i c k - i n f o r a geographic area?
2)
To what extent w i l l the performance "report card"
p r o v i s i o n s take i n t o account the wide d i v e r s i t y i n h e a l t h
status of Asian P a c i f i c American ethnic groups? And what
i n c e n t i v e s w i l l be put i n place f o r providers t o reach
out t o populations which are c u l t u r a l l y i s o l a t e d and
medically underserved currently? This i s p a r t i c u l a r l y
important f o r native peoples i n Hawaii and the P a c i f i c
Islands t e r r i t o r i e s , as w e l l as refugee populations
throughout the country.
3)
How does the e x i s t i n g Community and Migrant Health
Centers Program f i t i n t o the s t r u c t u r e t o be established
by the reform package?
4)
What coverage i s provided f o r people i n the i n s u l a r
t e r r i t o r i e s {Guam, American Samoa, Puerto Rico and the
V i r g i n Islands)?
i
�10-0W93 05:43AM FROM HON, NORM MINETA TO 94562362
F003/011
page 2
5)
How w i l l e x i s t i n g programs f o r Native Hawaiian h e a l t h
care be a f f e c t e d by the plan?
6)
How w i l l s t a t e f l e x i b i l i t y work w i t h i n the s t r u c t u r e of
the package? More s p e c i f i c a l l y , what changes w i l l t h i s
e f f e c t t o Hawaii's current system? And w i l l there be an
expanded ERISA exemption mechanism?
7)
How does the package define "medically underserved"? I s
i t purely a geographic designation r e f l e c t i n g an o v e r a l l
shortage of care i n a given area, or does i t also
recognize populations w i t h language access problems due
t o language and c u l t u r a l needs l i v i n g i n areas t h a t
otherwise are adequately served?
I'd appreciate anything you could do t o help out w i t h f i n d i n g
mswers t o the above. I f you need any more i n f o r m a t i o n from me,
jilease don't h e s i t a t e t o c a l l a t 225-2631.
Thanks 1
�-93 05:43AM
FROM HON, NORM MINETA
ate:
September 20, 1993
TO 94562362
P004/01
i
'i'o:
Norm
^rom:
Chris
li.e:
Secretary Shalala/Asian P a c i f i c American Caucus
Health Care Reform B r i e f i n g
I
i
As I mentioned t o you p r e v i o u s l y , the plan contains a number
6f items o f major importance t o the Asian P a c i f i c American
community. I n t h i s packet, I've included the general h e a l t h care
lj>ackground you were provided f o r the J o i n t Chambers of Commerce
itieeting.
F i n a l l y , the packet contains t a l k i n g p o i n t s f o r major
issues t o touch on during the meeting.
I've also included a copy of the memo I d i d t o Lorraine M i l l e r
at the White House, summarizing the items you and the other APA
Democratic Members presented t o t h e F i r s t Lady. Most of those
issues (and a l l o f vour s p e c i f i c concerns) were included i n the
The r e s u l t s are b r i e f l y recapped here:
1)
Standards f o r ensuring access t o c u l t u r a l l y and
l i n g u i s t i c a l l y appropriate care. The plan address t h i s
i n three major ways:
State f l e x i b i l i t y t o o f f e r d i f f e r e n t i a l reimbursements
f o r services t o high r i s k populations.
Targeted loans and medical education f i n a n c i n g f o r
students from population groups under-represented i n the
h e a l t h professions.
Training t o b u i l d
cultural
s e n s i t i v i t y among h e a l t h providers i s mentioned as a
specific p r i o r i t y project.
'
The most obscure, but u l t i m a t e l y the most important, a
new " r i s k adjustment" s t r u c t u r e f o r use i n determining
how insurance companies are reimbursed f o r services.
Since insurance companies could no longer refuse t o cover
someone, there w i l l i n e v i t a b l y be d i f f e r e n t i a l s i n the
r i s k p r o f i l e s of insurance companies w i t h i n a r e g i o n a l
health alliance.
The proposed system, which must be
developed, would give higher premium payments t o those
companies which have assumed d i s p r o p o r t i o n a t e r i s k . I n
t h a t proposal, the d e f i n i t i o n of r i s k goes beyond age t o
include language and c u l t u r a l needs. The power of t h i s
s t r u c t u r e i s t h a t i t would give insurance companies a
f i n a n c i a l stake i n competing f o r the business of m i n o r i t y
communities.
�[rQS 05:43AM FRCII HON. NORM MINETA
TO 94562362
F005/(
page 2
'
2)
How w i l l performance be measured t o ensure t h a t the
d i v e r s i t y of the API community i s taken i n t o e f f e c t , and
what incentives w i l l be put i n place t o serve m i n o r i t y
populations?
The "performance report card" p r o v i s i o n s make s p e c i f i c
mention of developing sampling s t r a t e g i e s t o reach
populations t h a t are not picked up by standard surveys.
Incentives are taken care of i n the s t r u c t u r e s described
i n #1.
3)
Community and Migrant Health Centers
The p l a n continues f e d e r a l support f o r these centers, and
increases i t as p a r t of the i n f r a s t r u c t u r e development
proposals. The plan makes community loans a v a i l a b l e f o r
communities t h a t wish t o s t a r t h e a l t h c l i n i c s .
4)
Are the t e r r i t o r i e s covered?
Yes.
5)
E f f e c t s on Native Hawaiian h e a l t h care programs?
Unknown. This w i l l need t o be c l a r i f i e d a t tomorrow's
meeting, and the Hawaiian's should take the lead on t h a t
question.
6)
How w i l l s t a t e f l e x i b i l i t y work, and w i l l
expanded ERISA exemption mechanism?
there be an
Once again, p r i m a r i l y an issue f o r Hawaii. There seem
to be no problems from my reading, but the Hawaiian
Members w i l l be the best judges.
7)
D e f i n i t i o n of "medically underserved".
I s i t purely
geographic, or does i t include underserved populations,
as well?
The p l a n makes s p e c i f i c mention a t several p o i n t s of the
need t o reach underserved populations w i t h i n urban areas,
but
i t i s n ' t mentioned
everywhere.
That
isn't
necessarily a problem, but t h i s i s something we're going
t o have t o c o n t i n u a l l y stress during the l e g i s l a t i v e
process.
In a d d i t i o n , t h e Information Systems p r o v i s i o n s have a
tremendous p o t e n t i a l t o solve the problem w i t h c o l l e c t i n g data on
^mall Asian P a c i f i c American ethnic groups. The key w i l l be t o
insure t h a t data c o l l e c t e d upon enrollment i s broken down by
^ t h n i c i t y , r a t h e r than j u s t by race.
�U-GU93 05:43AM
FROM HON, NORM MINETA
TO 94562362
Py05/0!
TALKING POINTS FOR MEETING WITH SECRETARY SHALALA
When the Asian P a c i f i c American Democratic Members met
w i t h Mrs. C l i n t o n i n May, we raised a number of s p e c i f i c
issue w i t h her. I am very pleased t o see t h a t most of
these problems are dealt w i t h i n the plan.
The need f o r c u l t u r a l l y and l i n g u i s t i c a l l y appropriate
care appears throughout the plan, and i s incorporated i n
i t s basic s t r u c t u r e s .
The programs t o increase the number of h e a l t h providers
i n under-represented communities, the t r a i n i n g programs
f o r h e a l t h professionals t o educate them about c u l t u r a l
concerns, and the s t a t e program t o provide e x t r a
reimbursement f o r the services t o hard t o reach
populations are a l l e x c e l l e n t .
F i n a l l y , I am very pleased t h a t the r i s k adjustment
system, which w i l l be c r u c i a l t o making t h i s plan work,
recognizes the need f o r c u l t u r a l and language services.
I f t h i s system i s properly implemented, i t w i l l remove
any d i s i n c e n t i v e f o r providers t o cover Asian P a c i f i c
Americans.
QUESTIONS:
1)
I n the Information section (page 110 of the d r a f t p l a n ) ,
data c o l l e c t i o n from the p a t i e n t i s a p r i o r i t y . Can we
work w i t h you t c ensure t h a t t h i s i n f o r m a t i o n i s
c o l l e c t e d by i n d i v i d u a l ethnic group rather than being
lumped together by race? This i s of major importance t o
the community because of the wide v a r i a t i o n s i n h e a l t h
s t a t u s and access needs among the d i f f e r e n t API ethnic
groups.
2)
The r i s k adjustment system, which w i l l compensate h e a l t h
providers and insurance companies who have higher l e v e l s
of r i s k among t h e i r b e n e f i c i a r i e s , includes the e x t r a
services needed f o r immigrant and language m i n o r i t y
populations. That i s a major breakthrough, and one t h a t
we must see preserved as t h i s plan moves through the
Congress.
Can you t e l l us a l i t t l e more about that
s t r u c t u r e , how i t w i l l be developed, and what the
p o l i t i c a l s i t u a t i o n i s on that s p e c i f i c issue?
�•93 05:43AM FROM HON, NORM MINETA
TO 94562362
POOVO!
page 2
3)
The plan includes a program of medical education t o
increase the number of doctors and nurses from
populations under-represented i n the health professions.
W i l l those programs distinguish among Asian Pacific
ethnic groups, and w i l l language proficiency be included?
W i l l "representation" distinguish between research and
patient care, and among specialties?
4)
Finally, w i l l this plan resolve the issue of underserved
areas vs. underserved populations? As you know, when the
barriers to access t o care are language and culture, a
simple measure of how many doctors there are i n an area
doesn't measure access.
There are underserved
populations i n the middle of areas with large numbers of
doctors, but i f those doctors don't speak t h e i r language
i t doesn't help.
Our communities have been v i r t u a l l y shut out of the
community health centers system, because we are
concentrated i n urban areas. That kind of problem cannot
be allowed to continue.
�
Dublin Core
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Title
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Health Care Task Force Records
Creator
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White House Health Care Task Force
Is Part Of
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<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
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William J. Clinton Presidential Library & Museum
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2006-0885-F
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Folder #3: [Judy Whang Documents]
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
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2006-0885-F Segment 2
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Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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2/6/2015
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42-t-12092992-20060885F-Seg2-007-005-2015
12092992
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https://clinton.presidentiallibraries.us/files/original/e504d9ddabe4c8a9518f443d675df69c.pdf
c42530050711d26885e8a2316ff89af0
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Presidential Library Staff.
Collection/Record Group:
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Subgroup/Office of Origin:
Health Care Task Force
Series/Staff IVIember:
Edelstein
Subseries:
OA/ID Number:
3664
FolderlD:
Folder Titie:
Folder #3: Congressional Correspondence Logs
Stack:
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Section:
Shelf:
Position:
S
52
3
2
3
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�MEMORANDUM
To:
Chris Jennings
From:
Shirley Sagawa
Re:
Congressional Communications
Date:
February 22, 1993
cc:
Steve Richetti
Melanne Verveer
CALLS:
2/22 Spoke with Ellen Schafer with Senator Wellstone. Although she is already on the
mental health working group, she would like to be added to other working groups. I
referred her to Chris.
HRC MAIL:
The following members wrote suggesting individuals to serve on the task force:
Bob Krueger (recommending Dr. Michael DeBakey, the famous heart surgeon)
Martin Lancaster (recommending Dr. Takey Crist, a women's health expert)
Dick Swett (recommending Mr. Gene Smith, who self-published a book on mental health and
appears to have run as a long-short candidate in the New Hampshire primary this year???
and to have met President Clinton in that context)
Donald Payne (recommending Ms. Diane Lynch)
Luis Gutierrez (recommending Ms. Sally Berger, who was also recommended by Joe
Kennedy)
The following members sent infonnation for HRC's consideration:
Phil Sharp (sent Indiana Commission on State Health Policy report)
Marcy Kaptur (sent chart comparing health care bills introduced in the 102nd Congress and
asked that family and medical leave legislation be added to the health care package)
�Steve Neal (Douglas Maynard)
Esteban Torres (Richard Veloz)
Tom Daschle (Lloyd Solberg)
The following members wrote with constituent problems:
Mac Collins
The following members wrote suggesting individuals to serve on the task force:
Steny Hoyer, recommending Marion Gosnell
Romano Mazzoli, recommending Jacob Hutti and Eric Reed
Paul Henry, recommending Birthale Lambert
Herb Kohl, recommending James Shie and Susan Stein
Patty Murray, recommending Linda Duncan
Jesse Helms, recommending Landon Smith
Kweisi Mfume, recommending Sheila Jacks
Robert Torricelli, recommeding Leoncia Porter
Richard Bryan, recommending Bruce Gruenewald
Austin Murphy, recommending John E. Bonaroti
Christopher Shays, recommending Michael Vallerie
Scotty Baesler, recommending Henry V. Heuser
Albert Wynn, recommending Gray Panthers
Jim Exon, recommending Jay Matzke, Clarence Davis, and Kathleen Pallesen
Nita Lowey, recommeding Robert Levine
Bob Graham, recommeding Jerome Modell
�Bill Richardson, recommending Janet Rose
Glenn Poshard, recommending Ella Lacey
Jerry Lewis, recommending Francis Comuale
Thomas Bliley, recommending Charles L. Baird
Carl Levin, recommending David Hodgson
Ron Wyden, recommending Lester Baskin
Richard Shelby, recommending Harold Avant and Gerald Ferris
Esteban Torres, recommending Dennis Kollar
Paul Coverdell, recommending Ed Schutter
Wendell Ford, recommending James A. Kidney
Joseph Lieberman, recommending Gail Javitt
Phil Sharp, recommending Beverly Flynn
Bill Zeliff, recommending Marion Dolan
Bill Emerson, recommending O.D. Niswonger
George Darden, recommedning Billy Lee
Andy Jacobs, recommending Diane Lynch
Cliff Steams, recommending Jerome Modell
Chris Dodd, recommending Vivian Riefberg
Tom Harkin, recommending Patti McCollom
William Roth, recommending Phyllis Piser
Paul Sarbanes, recommending Denise Kishel
Harris Wofford, recommending Cheryl Cook
Ronald Dellums, recommending Richard Gongloff
�Curt Weldon, recommending Felicia Neczypor and Howard Lamplugh
Glenn English, recommending Shyamkant S. Kulkami
Mac Collins, recommending Elizabeth Johnson
Romero-Barcelo, recommending Dr. Magaly Maldonado-Oms
�MEMORANDUM
To:
Chris Jennings
From:
Shirley Sagawa
Re:
Congressional Communications
Date:
March 8, 1993
cc:
Steve Richetti
Melanne Verveer
Invitations:
James Traficant, to testify before the Subcommittee on Public Buildings and Grounds of the
House Public Works and Transportation Committee on smoking ~ declined
William Orton, to make a video for Geneva Steel's model education partnership ~ declined
The following members sent information for HRC's consideration:
*Ron De Lugo, information on the territories
Connie Morella, sent H.R. 286, which would permit hospitals to enter into technologysharing agreements through which they would be able to jointly purchase and use high-tech
equipment
Benjamin Oilman, sent H.R. 36, which would provide for coverage of periodic
comprehensive health exams, health screening, counseling, immunizations, and helath
promotion
Dick Swett, on the Canadian system
*George J. Hochbmeckner
Andy Jacob, material by Richard Worley
•Charles Taylor, material by Matt Homsby
*Joe Lieberman, material by Martin Lyons
�•Peter Visclosky, material by Jonathan Javors
Robert Menendez, videotape by Bob Brand
Charles T. Canady, invitation to visit Polk General Hospital
Bob Clement, information from Melanie Joy
The following members wrote substantive letters:
Earl Pomeroy, offering assistance as former state insurance commissioner
Elizabeth Furse, on a single payer system and the American Health Security Act of 1993,
which she cosponsored
•Charles Rangel, on substance abuse
•Dick Armey, with JEC minority papers on health care
•Jim Ramstad, on emergency medical care for children
•George Miller and members of the Committee on Natural Resources, on coverage for the
Territories
•Carlos Romero-Barcelo, on coverage of the Territories, specifically, Puerto Rico
Eva Clayton, on preventive health care, serving mral
Sent to Susannah Welford for followup
Paul Simon (Berkley Bedell)
Lee Hamilton (Anne Fowler)
Frank Lautenberg (Sally Berger)
Carol Moseley-Braun (Sally Berger)
Russell Feingold (Richard Boxer)
Dick Gephardt (Warren Fagadau)
Dan Rostenkowski (Sister Sheila Lyne)
�Y
MEMORANDUM
To:
Chris Jennings
From:
Shirley Sagawa
Re:
Congressional Mail
Date:
3/16/93
cc:
Hillary Rodham Clinton, Melanne Verveer, Steve Richetti
The following members recommending personnel to the Task Force
Jimmy Hayes (recommending Gayle B. Guidry)
Kweisi Mfume (recommending Sheila Jacks)
The following members provided background information for the Task Force
Jamie Whitten (forwarded constituent letter from nurse practitioners)
Howard Coble (forwarded constituent letter on organ donajion)
Andy Jacobs (forwarded summary of his cost containment bill)
Peter J. Viscolsky (forwarded report on health care costs in the steel industry)
The following members offered assistance
Lucien Blackwell (noted his wife had served as his top aide when he was on the City
Council)
Dan Miller (Minority Leader's Task Force on Health Care, former hospital board chairman)
Carol Mosely Braun (noted her experience with heatlh issues in the state legislature and
county executive office)
Butler Derrick
The following members invited HRC to an event
Harry Johnston (town hall on health care in Boca Raton)
�Joseph Biden (Kent General Hospital Donor Recognition Dinner)
SS phone calls
William Bald with Lynn Schenck (wants to set up a meeting
�COMMUNICATIONS TO MRS. CLINTON - WEST WING
THURSDAY, MARCH 11, 1993
Congressional M a i l
1. From Cong. Rangel, inviting you to a national conference on
urban health care hosted by Columbia University on June 7 and 8,
action taken: forwarded to Patti and Shirley. ATTACHED
7', 2. From Senator Bumpers u r g i n g your involvement w i t h the
Children's N a t i o n a l Medical Center. ATTACHED a c t i o n taken:
forwarded t o S h i r l e y .
1
�COMMUNICATIONS TO MRS. CLINTON - WEST WING
MONDAY, MARCH 8, 1993
From t h e P r e s i d e n t
1.
D e c i s i o n memo on c h i l d h o o d i m m u n i z a t i o n .
C o n g r e s s i o n a l Correspondence
1. From Congressman R a n g e l l r e g a r d i n g r e l a t i o n s h i p between drug
abuse and h e a l t h care r e f o r m . ATTACHED o t h e r a c t i o n :
forwarded
to Shirley.
^2.
From Congresswoman L o u i s e S l a u g h t e r t r a n s m i t t i n g GAO r e p o r t
on Rochester's success w i t h l o w e r i n g h e a l t h c a r e c o s t s . ATTACHED
other action:
forwarded t o S h i r l e y .
^
3. From Senator Robb recommending Josephine H a r r i o t t t o t a s k
f o r c e o r HRC s t a f f .
ATTACHED o t h e r a c t i o n : f o r w a r d e d t o
Shirley.
^15.
From Senator B i l l Roth f o r w a r d i n g resume o f c o n s t i t u e n t f o r
y t a s k f o r c e . a c t i o n : forwarded t o S h i r l e y .
r P ) 6. From Senator Paul Sarbanes f o r w a r d i n g resume o f c o n s t i t u e n t
for task force. action:
forwarded t o S h i r l e y .
'>s^ 7. From Senator W o f f o r d f o r w a r d i n g c o n s t i t u e n t l e t t e r f r o m
^1 P e n n s y l v a n i a Farmers' Union on r u r a l h e a l t h .
a c t i o n : forwarded
to Shirley
Diplomat!
1. From
Loue
acti
per
i s be
am p & t d HRC
:(5uest H
board,
ed f b r i
oncurred^'Pam r e l
d Jnout boa
�COMMUNICATIONS TO MRS. CLINTON - WEST WING
TUESDAY, MARCH 9, 1993
Congressional
(9
Mail
1. From Cong. Ronald Coleman, c h a i r of Border Caucus, d e s c r i b i n g
s p e c i a l h e a l t h concerns of the Caucus. a c t i o n taken: t o S h i r l e y
for R.
see
not see
2. From Sen. Wofford, r e f e r r i n g c o n s t i t u e n t l e t t e r
/p-^appointment with HRC about h e a l t h software package,
/ X i j t a k e n : t o S h i r l e y f o r R.
see
requesting
action
not see
3. From Sen. Howell H e f l i n forwarding i n v i t a t i o n from t h e
(oNAlabama Health Research and Education Foundation. a c t i o n taken:
y ^ / t o S h i r l e y f o r R; copy t o P a t t i .
see
not see
4. From Cong. David Mann forwarding c o n s t i t u e n t l e t t e r on h e a l t h
ipare. a c t i o n taken: t o S h i r l e y f o r R.
@
see
not see
5. From Cong. Jamie Whitten forwarding c o n s t i t u e n t l e t t e r on
h e a l t h care, a c t i o n taken: t o S h i r l e y f o r R.
see
not see
6. From Cong. Jimmy Hayes forwarding c o n s t i t u e n t l e t t e r
requesting p o s i t i o n on t a s k force. a c t i o n taken: t o S h i r l e y f o r
R.
not see
Gubernatorial
Mail
1. F r o i ^ ^ i ^ r n o r Ben N e l s o n j ^ j g l ^ E r a s k a t r a n s m i t t i n g l e t t e r from
Dr. J a y Matz^^||y^^ants^Ji4B?'^^lunteer
time on t a s k f o r c e . a c t i o n
taken: t o Shirley
regarding
ATTACHEO
�COMMUNICATIONS TO MRS. CLINTON - WEST WING
MONDAY, MARCH 15, 1993
PART I I - CONGRESSIONAL, GUBERNATORIAL AND STATE LEGISLATIVE MAIL
Senate M a i l
1. March 10 n o t e from Sen. Ted Stevens r e g a r d i n g n e c e s s i t y t o
work on h e a l t h care r e f o r m i n a b i - p a r t i s a n f a s h i o n . ATTACHED
o t h e r a c t i o n t a k e n : v e r b a l l y conveyed t o Melanne and Steve
R i c h i e t t i ; copied t o S h i r l e y .
2. March 9 l e t t e r from Sen. Dennis DeConcini f o r w a r d i n g a 10p o i n t h e a l t h c a r e r e f o r m p r o p o s a l from Dr. C l i f f o r d H a r r i s , head
of CIGNA, t h e l a r g e s t HMO i n A r i z o n a , as w e l l as h i s b i o g r a p h y ,
CIGNA 1991 annual r e p o r t , CIGNA h e a l t h p l a n f o r A r i z o n a .
(DeConcini l e t t e r and summarization o f 1 0 - p o i n t p l a n a r e
ATTACHED) o t h e r a c t i o n t a k e n : l e t t e r and package t o S h i r l e y .
3. March 11 l e t t e r from Sen. R u s s e l l F e i n g o l d r e g a r d i n g t h e need
t o remove b a r r i e r s t o home and community placement t h a t
i n d i v i d u a l s needing l o n g - t e r m care f a c e as t h e y a r e d i s c h a r g e d
from h o s p i t a l s . ATTACHED o t h e r a c t i o n t a k e n : t o S h i r l e y .
4. February 26 l e t t e r from Sen. P a t t y Murray r e g a r d i n g
mammography. ATTACHED o t h e r a c t i o n t a k e n : t o S h i r l e y .
5. March 8 l e t t e r from Sen. A l f o n s e D'Amato conveying
) c o n s ' ^ t u e n t i n v i t a t i o n t o HRC. a c t i o n t a k e n : t o S h i r l e y and
Pattf.
7. March 9 h a n d w r i t t e n l e t t e r from Sen. Bob K e r r e y conveying
l e t t e r from a f r i e n d on mental h e a l t h . ATTACHED o t h e r a c t i o n
taken: t o S h i r l e y .
9. March 15 f a x e d l e t t e r w i t h p e r s o n a l n o t e and phone c a l l from
Cf \ Sen. John Glenn i n v i t i n g you t o r e g i o n a l conference A p r i l 12 i n
Toledo he has convened on h e a l t h care, ATTACHED o t h e r a c t i o n
t a k e n : t o S h i r l e y and P a t t i ,
10. March 3 l e t t e r from Sen. Paul Simon conveying C.V. from Dr.
B i l l Drucker.
a c t i o n taken: t o S h i r l e y .
�12. March 8 l e t t e r from Sen. Robert Byrd conveying constituent
invitation, action taken: to Shirley and Patti.
13. March 8 l e t t e r from Sen. George Mitchell conveying
constituent l e t t e r on health care reform. action taken:
Shirley.
to
House of Reps
(3
1. March 9 from Cong. Jacobs conveying constituent resume,
action taken: to Shirley.
2. March 4 from Cong. Tom Barrett recommending Dr. Richard Boxer
to task force, action taken: to Shirley.
5. March 8 from Congw. Margolies-Mezvinsky conveying constituent
health care a r t i c l e , action taken: to Shirley.
Ov 6. March 10 from Cong. Kildee conveying constituent l e t t e r on
^1 health care reform, action taken: to Shirley.
/"^7.
March 9 from Cong. Tim Holden conveying constituent l e t t e r on
V_>^health care reform, action taken: to Shirley.
£^\8. March 9 from Cong. Martin Lancaster conveying constituent
_y leister on group homes for handicapped. action taken: to
Shirley.
/^^9.
March 10 from Cong. Jay Inslee conveying constituent l e t t e r
V / a c t i o n taken: to Shirley.
®
10. March 5 l e t t e r from Congw. Morella concerning battered women
and HIV.
action taken: to Shirley.
/ ^ ~ \ L 1 . March 8 from Congw. Roybal-Allard concerning health care
l^J^needs of Hispanic women, action taken: to Shirley.
12. March 5 from Cong. Dan Schaefer conveying constituent l e t t e r
L) on health care reform, action taken: to Shirley.
Cover
''ron^im Bpc>ridmx>nveyliuaFTi^^tation £pBll^he C^m^al j ^ i ^ ^ y
of ^ e JHrcionai^^socid^ion^f Negji^Bus^^ss
ressiorranr Women's ^ ^ i l ^ ^ actio^^bi^Ri: to
�Elected O f f i c i a l s Mail 3/17/93
Senate
^ f A l . 5/5 from Paul Wellstone t r a n s m i t t i n g S.491, "American Health
^ Security Act." ATTACHED other a c t i o n : t o Shirley.
rle^tffVr?
3. 5/4 and 5/12 from Pat Moynihan forwarding c o n s t i t u e n t
e t t e r s . a c t i o n taken: t o S h i r l e y .
House of Representatives
. j 1. 5/1 from Rep. Inhofe forwarding c o n s t i t u e n t l e t t e r on h e a l t h
^' care. a c t i o n taken: t o S h i r l e y .
,2. 5/15 from Congw. Roybal-Allard congratulating you on
appointment of Richard Veloz as consultant to task force and
l i a i s o n to Hispanic community. ATTACHED
3. 5/15 from Cong. Bob Clement recommending c o n s t i t u e n t t o task
v 3 f o r c e . a c t i o n taken: t o S h i r l e y .
5/12 from Cong. Lee Hamilton forwarding l e t t e r from d e n t i s t
iL-friend w i t h views on h e a l t h care reform. a c t i o n taken: t o
Shirley.
5/11 from Cong. Dave Camp forwarding c o n s t i t u e n t l e t t e r on
h e a l t h care reform. a c t i o n taken: t o S h i r l e y .
/ ^ j 6 . 5/4 from Cong. Peter Deutsch forwarding c o n s t i t u e n t l e t t e r on
' h e a l t h care reform, a c t i o n taken: t o S h i r l e y .
Governors
1. From Governor Brereton C. Jones o f Kentucky t r a n s m i t t i n g
Kentucky's h e a l t h reform plan. ATTACHED other a c t i o n taken: t o
Shirley.
�Elected O f f i c i a l Mail to Mrs. Clinton
Thursday, March 18, 1993 - Friday, March 19, 1993
Senate
f'xjy^' Fax from Sen. Reigle from March 18 D e t r o i t News on Monday's
— C l e a r i n g . ATTACHED other a c t i o n taken: t o Lisa.
2. 3/1 from Sen. Durenberger describing Minnesota h e a l t h care
marketplace. ATTACHED other a c t i o n : t o Shirley.
^\4. 2/20 c o n s t i t u e n t l e t t e r r e f e r r e d by Sen. Nunn's o f f i c e ,
a c t i o n taken: t o S h i r l e y
House
f ' ^ ^ l . March 16 from Bernard Sanders i n v i t i n g you t o Vermont as i t
^—^reviews i t s h e a l t h plan, a c t i o n taken: t o S h i r l e y .
0
^2.
March 17 from George Gekas asking f o r a meeting w i t h home
h e a l t h care representatives.
a c t i o n taken: t o S h i r l e y .
^^^3. February 24 from William Z e l i f f (2d term Repub) concerning
^ r e s u l t s o f New Hampshire h e a l t h care task f o r c e . a c t i o n taken:
to Shirley.
A-A4. March 18 f a x from Charles Schumer i n v i t i n g you t o t e s t i f y
w before House J u d i c i a r y Subcommittee on Crime and Criminal J u s t i c e
i n v e s t i g a t i n g h e a l t h fraud. a c t i o n taken: t o S h i r l e y .
you.
March 4 from Rural Health C o a l i t i o n ' s i n v i t a t i o n t o meet w i t h
a c t i o n taken: t o S h i r l e y .
(^^6. March 12 from Richard Baker expressing concern about input
from physicians, a c t i o n taken: t o S h i r l e y .
\ ' \ j j 7 . March 11 from James Greenwood forwarding c o n s t i t u e n t request,
vy a c t i o n taken: t o S h i r l e y .
^ ^ 8 . March 16 from Barney Frank forwarding l e t t e r from Charles
^^--Weingarten, Chief of Medicine a t Harvard. ATTACHED other a c t i o n
taken: t o S h i r l e y .
9. March 16 from Sherrod Brown promoting home care.
taken: t o S h i r l e y .
action
�10. March 18 without cover note from Andy Jacobs, an e d i t o r i a l
(iy]from the Indianapolis Star on health care reform. ATTACHED
'
other action: to L i s a .
�COMMUNICATIONS TO MRS. CLINTON - WEST WING
WEEK OF MARCH 22, 1993
Elected O f f i c i a l s
SENATE
irch JS^roikTed infenedy ^ife|nkingyK>u anji^the jn^sic
hiV^S^^^m^a^avVo s d i c ^ l bw^^^oui^^|g^^tT
la'^i/jean Kennedy Smi^l^^ Aim^aa^do^t^^IrXmld.
oj2.
February 4 from Tom Harkin recommending Terry Lierman to task
Q
-'^force. other action: to Shirley; Pam called h i s o f f i c e and
apologized that we had received the l e t t e r so late.
3. February 17 from Harris Wofford transmitting information from
his constituent, George Glusko, Senior VP, Finance, P o l y c l i n i c
Medical Center of Harrisburg. action taken: to Shirley with
accompanying documents.
^ 4. February's, f romConnie Ito^Jt transmittin^^«|^ta^
12lluM||heoj^^^Eted^0^^^rls^^uic^^of^^^aso:^r a^^fon
t o l s n i l k f i ^ an^waf^i.
/ ^ 7 . March 23 from Harris Wofford requesting someone from task
L y force meet with h i s constituents who have product idea for
universal b i l l i n g . action taken: to Shirley.
0
8. February 10 from Claiborne P e l l asking you to consider the
National Wellness Coalition, action taken: to Shirley.
HOUSE
0\1. March 19 from Dan Glickman regarding re-scheduling your
V meeting. action taken: to Shirley & P a t t i .
®
2. March 15 l e t t e r s from Marjorie M-Mezvinsky with constituent
l e t t e r s on health care. action taken: to Shirley.
/ ^ 3 . March 18 from Mike Parker congratulating you and urging
(^)attention to r u r a l health and mental health. action taken:
Shirley.
to
4. March 18 from Jay Inslee forwarding constituent l e t t e r on
COBRA, action taken: to Shirley.
�5. February 16 from E a r l Pomeroy re-sending his l e t t e r of
February 9. action taken: to Shirley.
6. March 11 from John Duncan forwarding constituent l e t t e r ,
action taken: to Shirley.
nv^ilffn^^^^HM^k at
rley ancTTatt"
^8.
March 16 from Karen Shepherd offering her assistance as
Kyj l i a i s o n to Freshmen and Western members once health care package
i s ready to be presented, action taken: to Shirley.
^ 9. March 15 from Sherwood Boehlert transmitting constituent
^ i n v i t a t i o n , action taken: to Shirley and P a t t i .
10. February 12 from Tom Ridge transmitting constituent
'(/^invitation, action taken: to Shirley and P a t t i .
11. March 24 from Ed Markey on potential impact of
telecommunications on health care. action taken: to Shirley.
/^^12. March 24 from Alan Wheat with recommendations of the f i f t h
V^congressional d i s t r i c t s Citizens' Committee on health care
reform, action taken: to Shirley.
r ^ l 3 . March 23 from Mac Collins reporting on h i s town meetings re
Vyhealth care. action taken: to Shirley.
/^Jl4. March 5 from Martin Lancaster with h i s views on health care
V_yreform. action taken: to Shirley.
15. March 10 from Marty Meehan describing the Unlicensed
International Medical Graduate Assistance Program at Lawrence
General Hospital. action taken: to Shirley.
r,jl6. March 23 from Glenn Poshard transmitting written testimony
^ of constituents at h i s d i s t r i c t hearings on health care reform.
action taken: to Shirley.
&
17. March 23 from Jim Nussle, Tim Penny, Herb Bateman, Jim
Lightfoot, Richard Baker, James Oberstar, Paul Gillmor, Pat
danner and John McHugh on r u r a l health, action taken: to
Shirley.
Governors
1. February 3 from Jim Hunt transmitting name to health care
task force. action taken: to Shirley.
2. February 8 from Howard Dean transmitting information about
health care reform. action taken: to Shirley.
�COMMUNICATIONS TO MRS. CLINTON - WEST WING
MARCH 29-APRIL 2, 1993
ELECTED OFFICIAL MAIL
Senate
1. March 23 from Paul Simon encouraging you to v i s i t or
'^^ acknowledge i n some way the SwedishAmerican Hospital of Rockford,
I l l i n o i s which i s one of five winners of the USA Today quality
cup competition for improvement of quality or service,
action taken: to Shirley.
2. March 15 from Paul Simon recommending you meet with Dr. Henry
at the Rehabilitation Institute of Chicago. Simon l e t t e r
(9 Betts
says Betts has invited you. action taken: to Shirley, P a t t i .
(J)3
March 24 memo from Jay Rockfeller regarding "Health Care
Reform and National Workforce Policy." action taken: to Carol,
I r a , Melanne, Maggie and Shirley.
r(c\^- March 16 from Feinstein, Boxer, Cong. B i l l Richardson, urging
^ y o u meet with a group of biotech CEO's (unspecified) . action
taken: to Shirley, P a t t i .
March 19 from Moynihan's office with constituent l e t t e r ,
action taken: to Shirley.
March 16 from Tom Daschle transmitting constituent l e t t e r ,
action taken: to Shirley.
^ 7 . March 30 from Richard Lugar transmitting constituent letter,
action taken: to Shirley.
House
vl. March 29 from Jose Serrano urging you to include t e r r i t o r i e s
'in reform package. action taken: to Shirley.
2. March 30 from James Traficant urging a representative of
j private family practice be on task force, action taken: to
^ Shirley.
'cj3. March 26 from Herb Klein referring constituent l e t t e r ,
action taken: to Shirley.
'4. undated from Pat Schroeder recommending someone c a l l Dr.
P a t r i c i a Gabow who "runs" Denver General Hospital. action taken:
to Shirley.
(^As. March 2 from Tom Barlow outlining h i s views on health care
reform, action taken: to Shirley
�3/29-4/2/93
{CT^' March 25 from Richard Durbin i n v i t i n g you and members of task
V_yforce to v i s i t South I l l i n o i s University School of Medicine,
action taken: to Shirley and P a t t i .
March 17 from Ron Wyden with kind comments and apologies for
"ouse floor schedule. action taken: to Shirley
J.. March 17 from Benjamin Oilman forwarding constituent l e t t e r .
_ ^ c t i o n taken: to Shirley
rQ\9.
March 15 from Kika de l a Garza transmitting constituent
v_yresume, action taken: to Shirley
©of
March 24 transmitting l e t t e r from Dr. Robert Blanc, Director
the I n s t i t u t e for Professional Preparation at University of
Missouri. action taken: to Shirley
/ ^ l O . March 29 from David Mann transmitting constituent l e t t e r ,
action taken: to Shirley
(Q13. March 25 from Dick Swett recommending constituent to task
force. action taken: to Shirley
(^jl4. March 24 from Frank McCloskey referring constituent mail,
action taken: to Shirley
15. March 24 from John Lewis asking that Dr. James Goodman,
Chairman of the Board of Managed Healthcare Systems and former
^ P r e s i d e n t of Morehouse School of Medicine, be consulted by task
force. action taken: to Shirley
f i ^ 16. March 21 from Jim Slattery recommending Brian Moline of
Topeka to the Board of Legal Services Corp. action taken: to
Shirley, Anne
State Mail
1. February 12 from Sandy Miller, wife of Governor Bob Miller
(D-Nev), i n v i t i n g HRC to help unveil Nevada's State Immunization
Program during National Preschool Immunization Week (April 26-3 0)
in Reno, action taken: to Shirley, P a t t i .
2. March 26 from Melinda Schwegmann forwarding constituent
l e t t e r , action taken: to Michael Sussman for response.
�COMMUNICATIONS TO MRS. CLINTON - WEST WING
WEEK OF APRIL 5, 1993
ELECTED OFFICIAL MAIL
Senate
:h TA^^om Da^^Bump^fi^handw^
)e ^md^trans^^||t o f i ^ n t ^ r y i e ^ ^ n
?dy SnrSil<^ P a l N ^ l l d o % K t e r .
noteyc»|nsmy
.sh J ^ l e m s j t ^ with
["^2. March 26 from Tom Daschle forwarding constituent l e t t e r on
v^yhealth care, action taken: to Shirley.
/r/^3. Undated from Pat Moynihan transmitting constituent l e t t e r on
^malpractice.
action taken: to Shirley.
©
4. March 22 from Larry Pressler regarding your possible
forthcoming t r i p to North Dakota on health care. He i s from
South Dakota, and suggests you t r a v e l there, too. action taken:
to Shirley.
6. March 29 from Harris Wofford with constituent l e t t e r on
health care (cardio-thoracic surgeon who wrote the computer
program FDA currently uses to review new drug applications.)
C action taken: to Shirley
7. March 23 from Slade Gorton regarding major health care reform
l e g i s l a t i o n in Washington. action taken: to Shirley
[, \9. March 30 from Don Riegle expressing concern about Mr. Rodham
^and report on Michigan health care forum. ATTACHED
House
(^jl. March 30 from B i l l Goodling with case studies on long term
care. action taken: to Shirley.
*^)2. March 29 from Marjorie M-M transmitting constituent l e t t e r ,
action taken: to Shirley.
(:^3. A p r i l 2 from Bart Gordon with idea to establish "800"
elephone communication for Medicare recipients, action taken:
to Shirley.
�Page Two
e l e c t e d o f f i c i a l mail
week of A p r i l 5, 1993
(^,)4. A p r i l 1 from Louise Slaughter with her testimony before
S t a r k ' s subcommittee on women's h e a l t h , a c t i o n taken: t o
Shirley.
c^5. March 17 from Jose Serrano conveying "Congressional Hispanic
^Caucus Health P o s i t i o n Paper." a c t i o n taken: t o S h i r l e y .
^ j 6 . March 29 from Sam Gejdenson t r a n s m i t t i n g c o n s t i t u e n t
a c t i o n taken: t o S h i r l e y .
7. A p r i l 2 f j
action t a l
letter,
ry Cames.
24 from Olympia Snowe forwarding
(3)h8.e a l tMarch
h c a r e . a c t i o n taken: t o S h i r l e y .
c o n s t i t u e n t l e t t e r on
A p r i l 6 from Jim_
10. March 31 from Peter Hoagland forwarding c o n s t i t u e n t l e t t e r
on h e a l t h care and request about your t r i p t o Nebraska. a c t i o n
taken: t o S h i r l e y , P a t t i .
/^TUl. A p r i l 2 from Ron de Lugo regarding h e a l t h care i n t h e
V - y t e r r i t o r i e s . a c t i o n taken: t o S h i r l e y .
r^l2.
A p r i l 2 from David Mann forwarding c o n s t i t u e n t
^--^action taken: t o S h i r l e y .
letter,
/C N13. March 19 from Dick Durbin conveying the P r e p s c r i p t i o n Drug
i^Consumer P r o t e c t i o n Act. a c t i o n taken: t o S h i r l e y .
r/r\lA.
A p r i l 2 from C a r r i e P. Meek with c o n s t i t u e n t speaking
V_y'engagement request.
a c t i o n taken: t o S h i r l e y , P a t t i .
((^)15. March 22 from Connie Morella forwarding c o n s t i t u e n t h e a l t h
proposal.
a c t i o n taken: t o S h i r l e y .
March 26 with scheduling request f o r c o n s t i t u e n t .
taken: t o S h i r l e y and P a t t i .
/A 16. March 30 from John S p r a t t forwarding c o n s t i t u e n t
\ ^ a c t i o n taken: t o S h i r l e y .
action
leatter.
M^17. A p r i l 2 from Ronald Coleman about border h e a l t h care,
a c t i o n taken: t o S h i r l e y .
18. March 31 from John Tanner forwarding c o n s t i t u e n t
a c t i o n taken: t o S h i r l e y .
letter,
�Page Three
elected o f f i c i a l mail
week of A p r i l 5, 1993
l 9 . A p r i l 1 from Glenn English
ytaken:
t o Shirley.
promoting telemedicine.
action
^j20. Undated handwritten note from John Dingell on Michigan t r i p ,
etc. ATTACHED
State
�MEMORANDUM
To:
Chris Jennings
From:
Shirley Sagawa
Re:
Congressional Communications
Date:
Febmary 19, 1993
cc:
Steve Richetti
Melanne Verveer
(9
As we discussed, I am keeping a log of my contacts with the Hill on health care.
CALLS:
2/5
Spoke with Theresa Alberghini of Sen. Leahy's office. She wanted to know how
state issues would be dealt with. We need to get back to her on this.
2/8
Spoke with Valerie Kennedy with Rep. Tim Valentine. She wants to receive any
documents that we circulate on the Hill. Says her boss wants to take an active role and be
on working groups, if possible.
HRC MAIL:
The foUowing members wrote suggesting individuals to serve on the task force:
Joe Kennedy (Sandy Berger, a partner with Emst and Young, former chairman of the
National Council on Health Planning and Development under Secretary Califano)
Nita Lowey (Dr. John Weisburger, director of the Naylor Dana Institute for Disease
Prevention and member, American Health Foundation)
Austin Murphy (David J. Progar, partner with a health care consulting firm)
William Hughes (Dr. Michael Cortes, who invented a computer readable card that
contains patient medical information and insurance information)
Joseph Lieberman (Bemard Kershner, a hospital adminsitrator)
Strom Thurmond (Dr. Nancy Dickey, board of tmstees of the AMA)
Bob Franks (Ronald Caplan)
�Glenn Poshard (Gary Stanley, president of Helath Care Research Corporation)
Gary Condit (Michael Lipomi of the Stanislaus Surgery Center)
The following members sent copies of their proposals for HRC's consideration:
Arlen Specter (noted he is ranking Republican the appropriations subcommittee
dealing with health care expenditures)
Collin Peterson (also offered his district in northern Minnesota for a town meeting)
George Gekas
John Porter
Larry LaRocco
William Cohen
The following members requested meetings with HRC:
Bemard Sanders (wants to bring in two Harvard Medical School physicians who have
written on the Canadian system)
John Chafee (inivted HRC to address the Senate Republican Task Force on Health
Care in Annapolis on February 26 ~ this was a copy of a letter, not the original, so I
assume it is being dealth with?)
The following members offered their assistance to the Task Force:
J. Roy Rowland (has been a family physician for 28 years in a mral area and notes
that he chairs the Veterans Affairs Hospitols and Health Care Subcommittee and is on the
Energy and Commerce Health Subcommittee)
Barbara Boxer (noted a variety of women's health concems)
Marge Roukema (noted she is ranking minority member of the Ed and Labor
subcommittee on Labor-Management Relations with jurisdiction over ERISA)
Christopher Bond (noted he is working on his own proposal regarding data systems)
Harry Reid (stressed preventive care and cost containment)
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�LA,§3^EGAS@SUN
B R I A N L . G R E E N S P U N . President
800 S. V A L L K Y V I E W B L V D . , L A S V E G A S ^ V 89107-4411
702-259-4003
P.O. B o x 4275
L A S V E G A S , N V 89127-0275
E A X : 702-259-4143
i^pch lb, i"gg3"
Nancy Hernreich ,
Special Assistant to the President
for Appointments and Scheduling
The White House
1600 Pennsylvania Avenue N.W.
Washington, D.C. 20500
Federal Express 6400928575
Dear Nancy,
Brian told the President that he would provide him with a brochure of exercise equipment
available through Execu-Fit, Inc. Please let Brian know what equipment the President would like.
Also enclosed is an invitation to The Hank Greenspun Plaza at the Jerusalem and University
Botanical Gardens, April 23, 1993. This invitation will explain the request made of the President
to write a letter to Barbara Greenspun.
\
I am providing the name and address of Dr. John N. 8 mons, the physician in Arizona that Brian
spoke to Mrs. Clinton about. She asked for this informjition
John N. Simons, M.D.
Health Campus International
7101 E. Jackrabbit Road
Paradise Valley, Arizona 85253
(602) 947-2454
Should you have any questions, I believe you have all of the numbers where Brian can be
reached.
Sincerely,
Cindy Robinette
Asst. to Brian Greenspun
/cr
Enclosures
M E M B E R : A M E R I C A N N E W S P A P E R PUBI.ISIIF.RS AS.SOCIATION • A U D I T B U R E A U O F C I R C U L A T I O N S - A S S O C I A T E D PRESS - N E W Y O R K
I IMF-S S E R V I C E • N E V A D A S T A T E P R E S S A S S O C I A T I O N -
- C A L I F O R N I A NEWSPAPER PUHLISIIERS ASSOCIATION -
�^5
SS
ss
SLO ^s
�CONGRESSIONAL REQUESTS
TO
FROM
NAME
REQUEST
DATE
HRC
RICHARD LAMM
I TALKED TO HIM AND
REFERRED HIS PLAN
TO THE WORKING
GROUPS.
4/19
MM
YALE BERRY
SENT I N PLAN.
FORWARDED TO THE
WORKING GROUP ON
COST CONTROL.
4/15
MM
JOHN MAGUIRE
SENT I N PLAN.
FORWARDED TO THE
WORKING GROUPS.
4/15
MM
JIM BEAL
SENT I N IDEAS. GAVE
TO WALTER'S GROUP
4/15
MM
JOHN LEVINGSTON
SENT I N PLAN.
FINANCE WORKING
GROUP POLICY
ASSISTANT MARGE
GEHAN TALKED TO
HIM.
4/16
SENT I N HIS IDEAS.
GAVE TO RICHETTI
AND TO THE WORKING
GROUP ON COVERAGE,
SHOWED TO CHRIS
JENNINGS
4/16
HRC
CONG.
KREIDLER
IM
CAROL
RASCOE
LARRY JINDRA
ARNOLD RELMAN
LAWRENCE GOLUB
D. OF EDUCATION
REPRESENTATIVES
HRC WANTED TO KNOW
WHETHER THESE
PEOPLE HAD BEEN
PULLED INTO OUR
EFFORT. ALL HAVE,
4/16
HRC
SEN. SASSER
DR. FRANK
CHUCKER
WANTS HIM INVOLVED,
HE WAS ASKED TO
JOIN A BRIEFING
TEAM ALREADY. I
TOLD SASSER'S
OFFICE.
4/16
BILL DRUCKER
I'LL TRY TO ADD HIM
TO A BRIEFING TEAM.
I GAVE HIM TO DR.
GLEASON,
4/27
1 HRC
SEN. SIMON
�HRC
1 HRC
HRC
1 HRC
CONG.
BARRETT
RICHARD BOXER
HE I S ALREADY
INVOLVED AS LEADER
OF THE BRIEFING
TEAM. I CALLED
BARRETT.
4/16
CONG.
COSTELLO
RICHARD MARK
JENNIFER WILL USE
HIM I N AN AUDIT
GROUP
4/19
SEN. HELMS
LINDA SPROAT
WANTS HER TO BE
INVOLVED, i GAVE
HER TO THE HPRG
GROUP TO USE
INTHEIR NURSE'S
PANEL
4/19
SENT I N HIS IDEAS.
COPY TO RICHETTI,
ADN CHRIS JENNINGS.
REFERRED TO THE
WORKING GROUPS
4/15
CONG.
REYNOLDS
HRC
SEN. BIDEN
HOWARD PALLEY
BRIEFING TEAM??
GAVE TO REDLENER
4/19
HRC
GOVERNOR
SULLIVANWYOMING
JERRY SAUNDERS
REFERRED TO WORKING
GROUPS. COPIED TO
JOHN HART. ALAN
WILL USE HIM FOR
HIS DR.S GROUP
4/19
HRC
JOHN
BALDACCI MAINE
SENATE
HRC
MIKE LOWRYGOVERNOR OF
WASHINGTON
LUANA REYES
SHE I S ALREADY A
WORKING GROUP
MEMBER. I'LL CALL
THE GOVERNOR AND
LET HIM KNOW.
4/16
HRC
CONG. PAT
SCHROEDER
DR. PATRICIA
GABOW
CALLED HER 4/14. I
GAVE HER CV TO
JENNIFER KLEIN TO
INCLUDE I N THE
ADMIN.
SIMPLIFICATION
AUDIT.
4/15
WANTS TO
BUSINESS
THE TASK
JENNIFER
MIGHT BE
USE HIM,
BE SMALL
ADVISOR TO
FORCE.
KLEIN
ABLE TO
�HRC
ROBERT FIELD
PERSONAL FRIEND OF
HRC'S, GAVE TO BILL
SAGE'S GROUP TO
CALL.
4/16
HRC
*
VIRGINIA KUTAIT
MUST ADD TO
BRIEFING TEAM. HRC
PERSONAL REQUEST.
GAVE TO REDLENER.
****
I HRC
*
PAT RILEY
NEEDS TO BE CALLED
BY WORKING GROUP
MEMBER. GAVE TO
ROBYN STONE.
4/15
HRC
*
MARK SHIELDS
WORKING GROUP
MEMBER WILL CALL
4/15
HRC
*
BRIAN CASEY
BERNIE ARONS WILL
CALL HIM.
4/15
HRC
* ELISE
DONNELLEY
DR. WENTZ
HRC
* PHIL
CORBOY
CLIFFORD
STROMBERG
I WILL GET SOMEONE
FROM BILL SAGE'S
GROUP TO CALL BOTH
CLIFFORD AND CORBOY
4/15
1 HRC
CAROLYN
RUBER
JAMES WILKINS
HE WANTS A
MEETING/CONFERENCE
CALL ABOUT
INFORMATION
SYSTEMS. THIS I S
BILL SAGE'S GROUP.
ALAN CALLED HIM.
4/15
****
*
�Date
TO:
Conaress
person
Name
A c t i o n Taken
HRC
Simon
Berkley
Bedell
CJ needs t o t a l k t o
HRC
Hamilton
Anne Fowler
talked t o
BL
Lauten.
S a l l y Berger
HRC
MosleyBraun
S a l l y Berger
BC
Feingold
R i c h a r d Boxer
BRIEFING TEAM
3/11
BL
Gephardt
Warren
Fagadau
t a l k e d t o . Wants t o
help us with
"message". BOB
BOORSTEIN
3/15
HRC
Rosten.
S h e l i a Lyne
talked t o
3/11
Winkle Lee
talked t o
3/10
II
II
3/10
CJ needs t o t a l k t o
II
HRC
Neal
Douglas
Maynard
c a l l e d , i s very happy.
Gave to Dr. R e d l i n e r .
Received follow up
from Neal saying
thanks. BRIEFING TEAM
3/10
AH
Daschle
Lloyd Solberg
BRIEFING TEAM
3/23
HRC
Murphy
David Progar
talked t o
3/10
HRC
Thurmond
Nancy Dickey
Considered f o r MD
advisory panel, b u t
d i d n ' t want t o r e s i g n
AMA board.
3/15
HRC
Gutierrez
S a l l y Berger
CJ t o o k c a r e o f h e r
HRC
Krueger
Michael
DeBakey
BREIFING TEAM
3/15
IM
Strickland
Craig
Strafford
does r u r a l h e a l t h c a r e
i s s u e s . He's an obgyn. BREIFING TEAM
Redlener
3/18
�HRC
Weldon
John McCarrin
C a l l e d 3/15 . He's a
chiropractor.
3/15
HRC
Jacobs
Diane Lynch
She w i l l send us i n f o .
She wants to help us
set up consumer focus
groups i n r e g i o n a l
areas. BOB BOORSTEIN
3/16
HRC
Lancaster
Takey C r i s t
BRIEFING TEAM
3/16
HRC
Pryor
George
Montgomery
Submitted p o l i c y p l a n .
Working group member
w i l l c a l l him back.
3/16
IM
Gregg
Marion Dolan
Spoke to 3/18. Has a
nursing degree. Wants
to be a s t a t e
coordinator for the
task f o r c e . BRIEFING
TEAM
3/18
IM
Nunn
I r i s Feinberg
web 3/16.
HRC
RomeroBarcello
Dr. M a g a l i
Maldonado
I t a l k e d t o her. She's
Puerto Rican - could
help with h i s p a n i c
outreach. BRIEFING
TEAM
3/15
HRC
Mezvinsky
Marie Savard
J i n d r a t a l k e d to her,
she's sending more
i n f o . C a l l and get
resume. B r i e f i n g Team
3/3
IM
RoyballAllard
Elena Rios
ADVISORY PANEL
3/16
IM
Barcia
Dan Sain
Barcia's o f f i c e
c a l l back.
CJ
Mezvinsky
Jake Getson
Possible c o n f l i c t o f
i n t e r e s t . I f n o t he
w i l l j o i n the b r i e f i n g
team.
Debra Cohn
Gleason w i l l c a l l and
put on a B r i e f i n g team
Peterson w i l l
c a l l back
Wants to be i n the
town meeting i n DC.
I'11 forward her to
communications. Bob
Boorstin
II
1"
SW
Warner
1
will
3/26
�HRC
FeinStein
S a l l y Berger
CJ c a l l e d
IM
Skaggs
Charles
Locker
Dr. Gleason
4/2
IM
Panetta
Jerome Blum
BRIEFING TEAM
3/18
IM
Tony Records
was r e c . by
Garamendi
BRIEFING TEAM
3/18
AS
Henry Greely
BRIEFING TEAM
3/18
MM
Ray Hunt
WCB 4/6
VWF
Treeby
Wiliamson was
r e c . by
Robert L.
Brown
STUDENT PANEL;
BRIEFING TEAM
HRC
Inga Bennett
I w i l l see i f she can
j o i n our consumer
panel *****
HRC
Jennifer
Klein
Recomended by D a n i e l
K o r n s t e i n . She i s on
the task f o r c e .
3/18
HRC
Stanley
Bergen
BRIEFING TEAM
3/12
HRC
Helen V.
Burst
BRIEFING TEAM
3/23
HRC
Ray J o u e t t
Rec. by B i l l T r i c e :
Passed t o w o r k i n g
group
4/6
HRC
Rhys W i l l i a m s
Rec. by B i l l T r i c e :
Passed t o w o r k i n g
group
4/6
HRC
J e f f r e y Houpt
Rec. by Rosalyn
C a r t e r . W i l l send
resume. BRIEFING TEAM
3/23
HRC
Mary E l l e n
Schattman
f r i e n d of HRC,
BRIEFING TEAM
c a l l e d LeeAnn x7500,
BRIEING TEAM
HP
Lee
Hamilton
Merrltt
Alcorn
HRC
Biden
Ernst
Dannemann
We sent him a l e t t e r .
3/23
�HRC
C a m i l l e Cook
Gave t o Dr, Gleason
HRC
Steve Hughes
Talked t o . W i l l g i v e
3/23
h i s name t o Dr. R, b u t
doesn't sound l i k e a
good c a n d i d a t e .
HRC
C. E v e r t t
Koop & John
Wennberg
Gave t o A l a n Hoffman
3/22
Laurence
Thorsen
Proposal passed t o
w o r k i n g group.
4/6
HRC
John Bowen
BRIEFING TEAM
3/24
HRC
Jeanne
Franklin
Native American. Works
with Navajo S e r v i c e s .
BRIEFING TEAM
3/24
HRC
Dr. Harder
BOB BOORSTEIN
3/24
HRC
Mae
Nettleship
Rec. by Anne B a t l e y .
BRIEFING TEAM
3/24
HRC
John Slaven
BRIEFING TEAM
3/24
HRC
Bevill
Poshard
4/6
HRC
ANDREWS
P h i l Pierce
BRIEFING TEAM
3/24
HRC
SASSER
Frances
Chucker
BRIEFING TEAM
3/24
MG
John Smith
BRIEFING TEAM. C a l l e d
Mark Gearan's o f f i c e .
4/7
HRC
Patricia
Quigley
STUDENT PANEL:
BRIEFING TEAM
3/24
HRC
Howard Levine
c a l l and g e t resume.
615-756-6600.******
HRC
Dean Clegham
Rec. by Tunky R e i l l y .
BRIEFING TEAM
3/24
HRC
Ronald
Dozoretz
BRIEFING TEAM
3/24
IM
P a t r i c i a Ford
Roegner
ADVISORY PANEL
3/24
HRC
Drew Kampuris
ADVISORY PANEL
3/24
HRC
Reed Tuckson
ADVISORY PANEL
3/24
CH
Kent
Westbrook
Rec, by C h a r l o t t e
Hayes, BRIEFING TEAM
3/24
HRC
Zenia Edwards
BRIEING TEAM
3/24
�Martin
Brotman
BRIEFING TEAM
3/24
HRC
Richard
Sanchez
BRIEFING TEAM
3/24
HRC
Maria New
3/24
Rec. by Pamela
Harriman. She w i l l
meet w i t h Redlener and
Jindra
LC
Susan Spear
Rec. by L i s a Caputo.
BRIEFING TEAM
3/24
Rosemarie
Hatem Bonsack
State L e g i s l a t u r e .
BRIEFING TEAM
3/24
AB
Irwin
Weinstein
Rec. by Anne B a r t l e y .
BREIFING TEAM
3/24
CH
E l l i o t Segal
BRIEFING TEAM
3/24
HRC
Tremaine
Bilings
BRIEING TEAM
3/24
Richard
Collens
Rec. by C o l i n Greer.
BRIEFING TEAM
3/24
Arlene
Collins
Rec. by C o l i n Greer.
BREIFING TEAM
3/24
HRC
Donald Pouge
W i l l check and see i f
HRC has a l r e a d y
responded. F r i e n d o f
HRC, L a r r y L e v i t t
t a l k e d t o him.
4/6
HRC
Ylene Larson
Form l e t t e r . Gave t o
Dr. R
3/24
HRC
Donna Marie
Christian
Green
Democratic N a t i o n a l
Committeewoman.
I ' l l
g i v e t o Dr.R,
HRC
C a l v i n Weise
Rec. by George
S h i e l d s . *******
HRC
E l l e n Brzytwa
C a l l and make happy
BL
Feinstein
****
HRC
B e t t y Lowe
C a l l and be n i c e *****
HRC
Virginia
Kutait
HRC says p u t h e r on
t h e b r i e f i n g team ***
�HRC
Sent i n p o l i c y p l a n .
I referred i t t o a
w o r k i n g group.
4/7
Sent i n p o l i c y
ideas.Referred t o
w o r k i n g groups.
4/7
Dr. Durwood
Flournoy
R e f e r r e d by R i t a
Taunton. Show t o Dr,
Gleason.
4/7
Fife
SymingtonGov. o f
Arizona
HRC
Durenber
ger
HRC
HRC
Mezvinsk
y
Dr. Paul
Scoles
I ' l l c a l l and say
thank you.
web
HRC
Gephardt
Marlene
Hartman
Gave t o Dr. Gleason
4/7
HRC
Dr. W i l l i a m
Houck,Jr.
Rec, by John Gardner
(South C a r o l i n a Court
of Appeals), BOB
BOORSTIN
HRC
Wayne Jones
S t a t e Rep. from Ohio.
4/8
I t a l k e d t o him on
4/8, and he i s s e n d i n g
more i n f o r m a t i o n .
I ' l l show him t o John
H a r t and Jason.
HRC
Jim Brown
Commissioner o f
Insurance, S t a t e o f
L o u i s i a n a , Wants t o
volunteer h i s services
web
NH
John Simons,
M.D.
Friend o f Clinton's. I
t a l k e d t o him and he
i s sending i n f o .
4/7
�IM
Nunn
John Watson
Need t o c a l l and say
thanks f o r the i n f o ,
****
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Folder #3: Congressional Correspondence Logs
Creator
An entity primarily responsible for making the resource
Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Preservation-Reproduction-Reference
Date Created
Date of creation of the resource.
2/6/2015
Source
A related resource from which the described resource is derived
42-t-12092992-20060885F-Seg2-007-004-2015
12092992
-
https://clinton.presidentiallibraries.us/files/original/1469c9644780f96f6b62d853402a2f34.pdf
ab2086440cb5eaf1402d2c0005a70017
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff iVIember:
Edelstein
Subseries:
OA/ID Number:
3664
FolderlD:
Folder Title:
Folder #2: Memo [Chris Jennings]
Stack:
Row:
Section:
Shelf:
Position:
S
52
3
2
^
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TVPE
DATE
SUBJECT/TITLE
RESTRICTION
001a. memo
Chris Jemiings & Sean Burton to Hillary Rodham Clinton; re:
Meeting with Senator Dale Bumpers (2 pages)
n.d.
P5
001b. draft memo
Chris Jennings & Sean Burton to Hillary Rodham Clinton; re:
Meeting with Senator Dale Bumpers (1 page)
n.d.
P5
002. memo
Chris Jennings & Sean Burton to Hillary Rodham Clinton; re:
Meeting with Congressman LaFalce (2 pages)
06/28/1993
P5
003. list
re; The Speaker, House Majority Leader, Democratic Caucus, Senate
Majority Leader, & Democratic Policy Committee (partial) (1 page)
n.d.
P6/b(6)
004. memo
Chris Jennings & Steve Edelstein to Hillary Rodham Clinton; re:
Meeting with Senators Leahy & Pryor (2 pages)
06/14/1993
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3664
FOLDER TITLE:
Folder #2: Memo [Chris Jennings]
2006-0885-F
ip2647
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)l
Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information |(aXI) of the PRA)
P2 Relating to the appointment to Federal office |(aX2) of the PRA|
P3 Release would violate a Federal statute |(aX3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |aXS) of the PRA|
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(aX6) of the PRA]
b(l) National security classified information |(bXl) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA)
b(3) Release would violate a Federal statute |(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information |(bX4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy |(bX6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes |(bX7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions |(bX8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIA]
C, Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR, Document will be reviewed upon request.
�V
PRIVILEGED AND CQNTIDRmatt MEMORANDUM
DETERMINED
BEt AAN
ADMINISTRATIVE
I N h U TO
l U U
i > AU1V1I1'>13I
K A l IV I
MARKING
G Per E.0.12958 as amenc^ed^S^.
amended. Sac. ^^.i
3.; (c)
Initials:
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings
Meeting with Congressman Cooper
Melanne, Steve, Lorraine, Ira, Distribution
June 14. 1993
Tomorrow you are scheduled to meet with Congressman Jim Cooper.
Caroline Chambers, his health legislative assistant, will be coming in with the
Congressman. Ira will also be sitting in on this meeting.
BACKGROUND
Congressman Cooper has become increasingly bitter about his
perception of the likely direction of the President's health reform proposal.
He assumes that it will reject the precepts of managed competition — as he
defines it — and fears It will be much more similar to a government
administered and regulated, single-payer plan.
In addition, as you know, the Congressman is also extremely concerned
about the plan's possible use of global budgets, short-term price control, and
employer mandates. He also believes our somewhat public rejection of pure
managed competition has been overly gratuitous.
Finally, in recent weeks, we have heard reports that he has been
unhappy with the limited amount of consultation he believes he and moderate
to conservative Democrats have received on this issue. (See attached a recent
letter to his constituents on this matter). He believes that his efforts to comply
with the Administration's wishes to not introduce reform legislation have been
unappreciated, or at least underappreciated. He apparently feels that his
decision to not Introduce his CDF proposal has made him look impotent with
his constituents and less of a "player" with his colleagues and the press.
There appears to be no specific agenda for this meeting. I would simply
advise opening it up for a substantive discussion between you, Ira and the
Congressman. I believe an honest, open exchange will be helpful. Although it
is clear you won't find agreement on anything, at least we can say we had a
direct, constructive conversation with the leader of the meuiaged competition
movement.
�JIM COOPER
47N gifTma.Tiwniiii
CoMuirrai:
•uoen
ININIV ANO COWMIWe
111 CANNON lUILAHa
«VAIMtN<ITON.DCtOIII
ConfT
i ESB of the lanftefl States
HQue or Kepruentflcltiet
IDajhlnjton, -©(t 2051J
TOI Tannus«anf Following Httlth Ctr* RtCorm
OlITHICT O^K^t:
tiOW«T(MM>T«rmT
P.O. lOX M l
IHILiYVtULTN «7ld0
TUrvONIi I 1 l - « l 4 - i n 4
T BOUTM HOHITMIT
W<NCMUini(.Tlltilll
TB.VK0NI1 f i M i 7 - 4 i f e
iwnoM
101 lAtT FIMBT NOKTH intOT
rjo. m l o t !
H0«WITeWN,TIII}|1|
HLPMOHt (lUIIT^OOe
I I I LANTMMin«0
MX a t t
OROIIVILLLTMllltl
TIUPMONt I l t - 4 « t . 1 | t 4
rroBi CongrMwun Jis Coop«r
DAtat W«dn«id«y, Jun« a, 1993
rurthwr Indication* thto votk fro« tho Wiito Houoo thot tho
btg public onnounauMnt of tho Prooldonfs hoolth o«ro r«for» plan
v i l l bo doliyod, pooiibly for 'oovorol nontho. Thm Adal«iBtr*tlon'o
ourront priority io to soo ito budgot pUn pooo tho flonoto. With
tho norrow victory in tho Kouos loot vook and oo aony oo 10 8«not«
Do«ocr*to loaning against tha plan, tha Praaidant naada to foouo
t i l Of h i i Offorti tboro. Alio, David Ooraon, tho nov Wilto Kouoo
cofcaunlaatlona diraetor, haa publicly adviaad that tha Praaidant
hold off until f a l l .
1 Ott hcpoful that Oorgon v i l l pity o koy rolo in tha final
ohaplng of tha Praaidant'o boilth oaro propooal. I worXod rooontly
with Gorjron on a privato oosaioiien vhioh propoood potoiblo
oolutiona to tho fodortl budget dafloit- i ballava ha aharaa my
rofora ovar noro govarnnant roguUtion. Ko
ohould aloo bo ablo to glva tha Praaidant good political advlca.
Tha battla in Congraoo ovar bio budgat plan v i l l pala in
oonparloon to what ia to coma on haalth cara rafonu. currantly,
Praaidant cilriton'a propoaal — to tha axtont wo Jcnow what'a in i t
— of faro l l t t l a to tha oonaarvativa and aoderata Damoorata ha will
naad to got i t paaaad. Tha alononto of ntnagod oompotition hava
baan ao watarad-dovn taat tha foundation of hia plan haa beooaa tha
global budaot and tho aaployor mandato, or payroll tax. Thooa ara
prooiooly tha faaturaa whioh oauaad modarataa te oppoaa "play-orpay" and tha Canadian-atylt aingla-payor plana.
Onoa raloaaad, tha Praaidant will noad aignificant help in
promoting hia propoaal. Tha Aflminittratlon haa aotlvaly courtad
labor uniona and aodarata oonoutter groupa auoh ao Faniliaa USA,
Jhay can ba axp«ot«d to halp aall tha rofom plan to tha public and
to Congraaa. m addition^ tha Daaoaratia National CoMlttoo ia
otaging a nationwida oatapalgn
{raportadly targeting key
oongraaBlonal diatrioti) to proaota tha Praaidant*a proposal.
The Anerloan Aeaoolation of V.mt.Lvmd Vmvmonm Lm l i k s l y -bo
andoraa tha Clinton plan bacauee i t w i l l include a naw preacription
drug benefit under Kedioare and w i l l nake a token "down-paynant"
THIt •TATIOKBRV rHIKTlO 01 rtftW MADE 01^ MCVCLID FlllUa
�on long-tara cara coverage. Kany other key groupe, howev.r, aaan
to ba lining up againat tho Adninistration.
now.r,
«i,.4«fJI^^^4V-.^*l?j"i.'^*^^^''"'**
National r«idoration of Indapandant
SiSdl?! or
I'S^
ovarything i t ha, to k i l l an SJJoJSr
iSoh'SScc:?.^^'"' " " P — ^ i ^ " iSS'tJa'lr p"ro^oVai 3 n * J f hJS
or
t^«^^7^^^^ ^
^•^^ offortt to WOO doctors.
Tha
SyPl^-^i"^ B-lpraotloa ref on., end repeal
oUnical Ub raqulraa*nti In tha CLIA law haa not
rio2^?v £S JSl ST!*"!?^?'^*
«n
Profoaaion (nada scat
hllinl l ^ ^ ^ ^ J ^ J ' / ^
Maini.tration aaea. dooaad to
naving a majority of doctora oppoiing Ita plan,
CoMei5?r;.«'l"v?^l'!^*^^
ropraiontod by tha Chanbar of
SS^I^
Afiooiatlon oi Manufacturara, are narvoua
SS2yL^-4^!f*"^°'*!. ^l«i*>ility Clinton wanta to giva atataa tc
Slliy
»yotana. And hoaplttlo may bo facad with a double
£Sr?iv^i?^i.^"^*'^' l«d a hoapi?al tax. Van wltSToJt op^oSSliJ
hi^«!?L! ^^•"•^^oupt, tha Praeldanff plan could i t i l l fail i f
ha inaiata on puohlng tha lightning rod iasue of abortion.
trvlnS''to^It!''Ih-S!f^ the lobblea in Waahington have been quietly
t S S n ^ L iJ!^*?;^^ roopootiva caaaa to the AdalniatratioS, But
dotal?
" •tK'^*'*J'i".*
P " " ^••J^'
«o
Shin thrm^n F } ^ , ' .
S^i?iP*iion
the tenaion v i l l grow.
When tha plan la finally diooloaad, all hell could braak loole.
TmfnJ^^J'l^
aoaathing If ve really ara to
''f^.r^'V"'
Flon need, to be
fJ Jh- 2? ^ 5 importantly, i t neada to work. 1 a t i l l believe that
niw S e ^ l i l l v l i ' ^ ' ^ ^ " ^''^"•'il^infl ''ith tho modoratoo in hia party
brSid lupSSrt?
*
"^^'^
paao wltS
g ^ l - i g l l - p t t U Lite into the evening laat Wadneaday, liberal
h 2 ? S ^ I ^ f " ^« Congreeo ittempted to preempt the debate over
•SSiSlfl ^rnw^*"" f""* A"°1«*»J» •ffl'Jbalbudget in the Preaident-a
^*Sif?'* ?
*»' ^« i^tar varaioni of a ooaproaiie cn
S K i 2 ? n ' j ^ ^ i ^ nf•''^, W^*^'
*™* commerce cSuilttee
S 3 i S I 2 o^.Ji^'^!:^^ included a requirement that any outa in
oSti S er^vJl!.
oponding must be matched vith oorreaponding
did r.«l°nn^J3j«.!"^^?Il hinlth, nnri nrnnfUng. Kany of ay ooileaguei
ShJ^r^^ f ! " ^ ^ ^
impllcatlona of thia language (of aciSree
FoSJ«]|?riv
i t ^o**!*atenhola
* poaaibly(D-TX),
be enforced).
Fortuj^eteiy JS^vf"*^^?!?.®'
working vith Rep. Charlie
ve were
JiiSt
nignt Lf^l.^^vf^"^'!.''*"
before the budget vote. ' i " * i ooaproaiaa near midnight the
�PRIVILEGED AND CONWiBBima MEMORANDUM
DETER.M1NED TO BE AN AOMIMSTIUTIVE
•3 (c)
MARKING Per E ^ . 12958 as amended, Ste. 3.3
inltlals;^'^^ V
TO:
FR:
RE:
cc:
3^^\'P-4^ / I 1
Hillary Rodham Clinton
June 21, 1993
Chris Jennings, Steve Edelstein
House and Senate "Message" meeting
Melanne, Steve. Lorradne, Jeff, Ira, Distribution
Tomorrow evening you are scheduled to meet with House and Senate
members to discuss plans for "selling" the health care reform plan.
Congressmen Gephardt and Bonior will be attending from the House. Senate
attendees will include Senators Mitchell, Daschle, Pryor, Kennedy. Rockefeller,
Riegle, Kerrey, Wofford. Senator Reid will probably attend. Also invited were
Senators Moynihan cind Boxer but there attendance was not confirmed.
BACKGROUND
Both Senator Daschle and Congressman Gephardt feel very strongly
about the importance of the message piece for the success of our legislative
strategy. This meeting is primarily an opportunity for these Members to lay
out their priorities on what needs to be done before the launch of the bill. And
an opportunity for us to share with them where we are in developing our
communications plan.
The Senate Democratic Policy Committee in consultation with the House
Leadership has prepared a "to do" list. That list (attached for your review) will
serve as a the basis for discussion at tomorrow's meeting. While this list was
not available in time to attach to this memo, we will make sure you receive a
copy for your review first thing tomorrow.
Jeff Eller has recommended that you highlight the planned war room
and the fact that it will serve as a resource for both the Administration and for
Congress. You may also wish to mention that we plan on learning from our
mistakes with the economic plan and will invest a great deal of resources into
close coordination with the Hill on the health care communication strategy.
Lastly, you could also discuss how much we appreciate all the hard work that
all of them have put into the development of a message strategy, and how
much we look forward to working closely with them during the upcoming
weeks and months. Since Jeff will be attending the meeting, you may wish to
recognize him and call on him to answer specific questions and suggestions
that are made by the Members.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001a. memo
SUBJECT/TITLE
DATE
Chris Jennings & Sean Burton to Hillary Rodham Clinton; re:
Meeting with Senator Dale Bumpers (2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3664
FOLDER TITLE:
Folder #2: Memo [Chris Jennings]
2006-0885-F
jp2647
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b))
PI
P2
P3
P4
b(l) National security classified information |(bXl) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA]
b(3) Release would violate a Federal statute |(bX3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the F^OIAI
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the F'OIA)
National Security Classified Information |(aXl) of the PRA|
Relating to the appointment to Federal office |(aX2) of the PRA|
Release would violate a Federal statute |(aX3) of the PRA|
Release would disclose trade secrets or confidential commercial or
financial information |(aX4) of the PRAj
P5 Release would disclose confidential advice between the President
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�Health Reform and Small Business
A Look at Problems in Today's System and
Solutions Under the President's Health Reform
�Small Business and Health Care Reform: Overview
It takes courage and ingenuity to start and succeed as a small business. It means
taking a risk with your future and betting that you succeed. As many as 1 out of 12 small
businesses fail within the first year. It is not right that many small business owners also face
the risk that their families and employees won't have health care when they need it. It is
not right that those who provide coverage risk that within a year that coverage may be taken
away or priced out of reach.
Small businesses fuel job creation and strengthen our economy. Responsible for 90%
of job growth in 1990, small businesses has become the nation's engine of economic growth.
Yet this growth is endangered by a health care system which threatens every American
business, especially small businesses. Small business owners can facefinancialdevastation
if a family member or just one employee falls ill. And employers who try to provide health
care to their employees fmd a health care system stacked against small businesses.
Nonetheless, a majority of American small businesses manage to provide coverage.
Today 62% of American businesses with less than 100 employees provide health care
coverage to their employees. And 51% of those with fewer than 25 employees provide
health care. But providing these benefits isn't easy.
"
The Clinton Administration believes that most small business want to cover their
employees -- and most do. Our health care plan will work for small business, taking away
the hassle and ensuring security of affordable, predictable health care coverage. And for
those businesses who don't provide health insurance coverage, our reform will protect them
whDe they make the transition. The plan providesfinancialassistance and a phase-in period
so they may provide health security to their employees and families.
In today's Mom and Pop stores, the Mom or the Pop serves as the de facto benefits
depanment. They fill oul the paperwork. They make the phone calls. They negotiate rates
and enroll their employees. They dutifully pay their premiums every month. But all too
often, within a year, their insurer will raise rates and price them out of the market - many
times for no reason. Or the insurer will refuses to renew coverage. Then the small business
owner is back to the drawing board -- spending more time and more money to find another
insurer ~ and the cycle starts again.
The following document examines the major problems faced by small businesses in
toda>^s health market and shows how health reform and the formation of health alliances
will address most, if not all, of the major problems facing small businesses.
�The Majority of Small Businesses Offer
Health Insurance to Their Employees
Do Not Offer (37.6%)
Offer (62.4%)
For Firms with Less than 100 Employees
Source: Dept of tabor. Based on SBA Calculation of May 1988 CPS Survey Data
�The Small Business Obstacle Course
Time and Money
Price Discrimination
Insurance Abuses
Redlining
Underwriting
High Administrative Costs
A Volatile Insurance Market
Price Gouging
Difficulty Securing Renewal
�THE SMALL BUSINESS OBSTACLE COURSE
Problem-
SmaU business ov^ners must go through an obstacle course of msurance abuses
and higlier costs to
provide heahh care coverage for their employees.
Small business owners who spend the time and money to cover employees frequently
must deal with an insurance market which changes its rules at every stage of the
oame a volatile market, unpredictable cost increases, higher admimstrative costs, and
premiums rising at a faster rate than health care costs for larger employers.
Lacking a benefits department like larger firms most small business owners must
perfon^ all the fiinaions of such a department by themselves. Negotiating health
coverage in today's health care system is a process often fraught with frnsu-auon and
obstacles.
Manv small business ov.Tiers, after setting aside the lime to negotiate coverage for
their'employers, encounter obstacles like "occupational redlining a practice where
insurers u-iU simplv refuse to cover entire industries perceived to be high nsk; or
medical under%^Tiiing, basing premiums on perceived risk and medical history; or
experience rating, where insurers jack up costs if just one employee falls ill or gets
injured Manv insurers engage in "price baiting and gouging" offering discoum rates
for the nrst year of coverage only to charge much higher prices in the next year when
pre-existing condition exclusions expire. And many small firms with sick workers find
that an in5urance company uill refuse to renew their pohc%' in the second year.
Noi ^urprisinglv the hassle and discrimination in today's system make many small
o^^'x^c^^ wor^^' aboul being able to continue to provide this coverage. The reform
plan addresses nearly all of the problems which cause the small business ou-ner so
much hassle and time in obiaining insurance.
The Plan:
Health reform outla^^s ifisurance practices like widerwHting and redlining. The
health alliarice helps small businesses cut through the hassle.
We v^-iU lake the burden off the small business with health alliances which will deal
v.-iih the insurance companies and bargain for competitive pnces. The alliance will
lake over the paperwork and the negotiations; provide information on plans and
increase ease of enrollment. Higher administrative costs will be reduced and the
hassle of the currenl system is eliminated.
The Clinion reform plan outlaws insurance abuses such as redlining, underwriting
and ex-perience ratings. Costs of premiums are controlled and the insurance market
i . qabilized Under our reform, everyone living in the same area pays a similar price
for a similar plan. And ihey have the security knowing those costs will be predictable
and increase at a lower rate.
�Small Business Owners
Face an Obstacle Course in Obtaining Health Insurance
t0\
^lllllilllllllllllllllllllllllllllllllllllllllk,
Uncertainty
Time & Money
n
Year 1
S3§?
Health
coverage
for one
more year
High Administrative Costs
Cost Negotiations
Frustration
Underwriting
/cost A Cost B \
$
(
_ y t:_.;i.d L-biTYi k-li^ii
\
^
I Cost D Cost C /
\
$
Price Discrimination
iiiiiiiiiiii^
- or
s
/
Insurance Abuses
Priced out
of market
Renewal
refused
�The New System
High Administrative Costs
Cost Negotiations
Volatile IVIarket
Redlining
Underwriting
Price Discrimination
�Insurance Industry Abuses
Medical Underwriting
Experience Rating
Price Baiting and Price Gouging
Refusal to Renew Policy
Occupational Redlining
�OCCUPATIONAL REDLINING
T i T E S OF INDUSTRIES OFTEN EXCLUDED FROM HEALTH
INSURANCE PLANS
Amusement Parks
Asbestos-Related Industries
Auto Dealers
Aviation
Barbers and Beauty Shops
Bars and Taverns
Car Washes
Commercial Fishing
Construction
Convenience Stores
Domestic Help
Entertainment,/Athletic Groups
Exterminators
Federally Funded Organizations
Florists
Foundries
Grocery Stores
Health Clubs and Spas
Hospitals and Nursing Homes
Hotels and Motels
Insurance Agencies
Interior Decorators
Janitorial Services
Junk and Scrap Metal
Law Firms
Limousine Services
Liquor Stores
Logging and Lumber Mills
Meat/Fish Packers
Mining Operations
Moving Operations
Oil Field Operations
Parking Lots
Physicians Practices
Restaurants
Roofing Companies
Security Guard Firms
Slate Funded Organizations
Taxicabs
Trucking Firms (Long-Haul)
Sources:
List of "ineligible industries" and industries requiring 'special consideration"
from selected insurance plans analyzed by the Alpha Center.
American Hospital Association, Promoting Health Insurance in the Workplace
and Loco! Initiatives lo Increase Private Coverage (Chicago: 1988). as cited in:
United States General AcconminP Office. Health Insurance- Cost Increases Lead
to Coverage Limitaitiotis and Cost-Shifting. (GAO/HRD 90-68)
�Higher Administrative Costs
• Higher Overhead
• No Benefits Department
• Faster Increases in Costs
�Small Businesses Face
Higher Administrative Costs
A d m i n i s t r a t i v e C o s t s as a
P e r c e n t a g e of C l a i m s
By F i r m S i z e
50%
40%
30%
20%
10%
0%
20-49
1-4
Source:
100-499
Firm Size
More than 10,000
Risk/Profit
General Admin.
Claims Admin.
Marketing Costs
Hay/Hugglns.
Inc.
�Employers Would Save $1,015 Per Employee
Per Year If Costs Were Controlled
Small Businesses Save Most
Employees in F i r m
1-9
10-24
25-99
100-499
$3^13
N
_
^
500*
^2852
$0
$1000
$2000
$3000
$4000
$5000
Total C o s t s Per Employee 1992
Excess C o s t s
Source:
Lewln-ICF
�A Volatile Market
Cost Variations
Unpredictable Cost Increases
Durational Rating
Churning
�Small Groups (2-25) Face Large
Variations in Health Insurance Premiums
450%
400%c
CL
o
350%-
UJ
E
300%-
1
Q.
O
250%-
>
I
200%
CC
150%-
100%-l
—^^^
•
pi^^g
'
pig^C
pianD
Plan E
Plan F
SMBUS.WQ!
Source: Blue Cross/Blue Shield Association, Survey of Six Sample BC/BS Plans, January 1992.
�SUMMARY
TODAY
REFORM
1
High Administrative Costs: Higher
administrative costs account for as much
as 40% of the policy costs compared to
about 5% for large companies. [CBO,
5/92]
Cuts Administrative Costs: The health
alliance assumes the administrative
functions and costs which kill small
business owners.
The Obstacle Course: Small business
owners who cover their employees must
spend a lot of time and effort dealing
v-ith an insurance market which changes
its rules al each stage of the game.
Eliminates Hassle: Tbe health alliance
negotiates rates, provides information on
plans, increases ease of enrollment and
absorbs the manpower drain.
Dramatically Increasing Costs: Premiums
for small employers rise at a faster rate
than for olher employers ~ as much as
50% in any given year. [NAM]
Aggressively Controls Costs: Health
reform will aggressively control cost
increases which hit small businesses
disproportionately hard.
Difficulty Obtaining Renewal: After a
Crsi year of reasonable rales, small
businesses often face higher costs and
difficulty obiaining renewal.
Guarantees Renewal: Guarantees
renewal and stabilizes premiums.
Small Risk Pool: Fewer employees mean
a smaller pool lo share the risk.
Insurance companies frequently charge
more for these policies and one illness
can cause plan cost to increase
dramatically.
Spreads Risk Evenly: Consolidates small
businesses in large purchasing pools to
give them the same bargaining power as
large companies.
Insurance Industry Abuses: Insurance
companies redline large sectors of the
small business market. Underwriting and
experience rating leads to discriminatory
prices for small business policies.
Outlaws Unfair Insurance Practices:
Prohibits redlining, experience rating and
underwriting. Requires that plans charge
all firms in a given area a similar price
for the same health plan.
�Insurance Problems Facing the Small Group Employee Market
Large Volatile Variation in Premiums
o Underwriting
o High Risk
Workers in Small Firms Finance a Higher Proportion of Total Premiums
Insurance is More Expensive Relative to Large Firms
o High Administrative Costs
o Premiums Include Costs of Uninsured
o Provider Payments Substantially Above Costs
Growth in Insurance Premiums is Higher in the Small Group Market
o Less Likely to Have Established Cost Containment Programs
�A v e r a g e Insured worlierS hoallh spending wUhout health rolorm
leahh Bill as ^ of
Compensallon
1994
Average connpensaUon per worker:
jAverage Insured worker's health bill
Health Insurance
Err^ployer's share oi premium
Individual's share ol premium
Medicare payroll I B K
Workers' comp/dlsablll1y/lndua<rlBl kiplanl
Out-of-pocket
Other spending s i healtii facilities
Federal laxee, f e e s , A other psymenta
Federal employees' healih premkjms
Federal conlributions lo Medkrare HI
Medicare (general revenue)
Medicaid
Other lederal health programs
S l s t e & local taxes, rs«s, A olhsr p s y m s n t s
Stale/local employees" health premiums
Stale/kjcal contributions lo Medicare HI
Medicaid
Hospital subsidies
Other oroorams
^ n r
<Mficc or
Mid Iif|»ilin*«l Hi Commtnt. Buftw o» Erowowic A««lr"5
Health
a s V. of
Compensallon
$50,334
$36,299
$7,423
$4,132
$3,163
$969
$926
$246
$782
$113
$654
$53
$11
$169
$246
$174
$569
$149
$24
$186
$B1
$130
r . * C . A-STH. I H I . S . . - T " « ' ! • • » » U h r „ r I h « c i o , A J m « , l - . . . l « . :
2000
•"'•i'-'^
20.45%
11.38%
8,71%
2 67%
2.55%
O.BB%
2.15%
0.31%
1.80%
0.15%
0.03%
C.47%
068%
0.48%
1.57%
0.41%
0.06%
0,51%
022%
036%
$12,386
$6,895
$5,278
$1,617
$1,546
$411
$1,305
$188
$1,092
$80
$19
$203
$411
$290
$950
$248
$39
$310
$135
$218
24.61%
13.70%
10 49%
3.21%
3.07%
0.82%
2.59%
0.37%
2.17%
0.18%
0.04%
0,56%
0,82%
0 58%
1.89%
0.49%
0.08%
062%
0.27%
0,43%
�Cwrem S p c a i c z Pri-.-tt Healtb Insoranee t'fe03IUI^^ ny ataic.
Ai a Percent cfTafcolc Eamings
Ta.icable EaniDgs
ALABAMA
AI^NSKA
ARl/.ONA
ARKANSAS
CALIFORNIA
CULORADO
CION'NECTICUT
DELAWARE
DC
FLORIDA
GEORGIA
^L^WAlI
IDAHO
ELLIVOIS
INDL^NA
I IOWA
KA.VSAS
KENTUCKY
LOlJliilANA
MALN>:
MARYLAND
MASSACHL'SETTS
MICHICiAV
MJN'NESOTA
j MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW' I-IAMPSHIRE
N'EW JERSFl'
I SEW MEXICO
INEV.'YOKK
NORTHCAROUNA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENT^SYLVAXIA
RHODE ISLAND
SOUTIICAROUNA
SOLTH DAKOTA
TENKESSEE
7,47 LU5,760
40,89 l i 1 2 ^
22,072^11,494
•176^24.975,470
42,9S2,222P17
47,909,041,475
8349p78iC7
7^52^319
69,107,458^
14^6,797.447
9,?C5*S8^
6l/)43^80396
28,715,(89385
34,7S4,60g.lS4
39,529^75^25
12^,909383
68^11,468397
77,961«0£17
109,409,081232
51,705,415220
20^57 ,S*^56
60244,888 ^''A
7,ro0<490,l64
17,478J^5^03
15437^09212
7735C9213
445,947314
10^36,916^
6,723213,419
1346J335317
1,028354,152
134>40,116A72
6,713556,189
3^»6J[>74535
2.789,136209
3266394364
3,484,793,9^
1321,989294
S210P6S.<SS
6503?15,432
115112.093,402
5314,122517
2.125383,724
186^311/»5
16^7270,729
6,477 p58?aD
83.193,483,170
63^63,931 ?91
15348,775523
58^99280587
5,005270.744
6,222536523
890^1,169
V79<),956j659
i.714iSfi3/>40
1,6*732034^
9,K24J9336S
1,4M,4W381
19^35,998 j562
6.571365,130
61853,636
13280,058430
2,890309363
3,490,744 JMO
15,138,836439
1263^23,740
3,703^,746
705,755,456
4372J356P77
15,700.711323
1309372,751
645,079404
6,488 , ^ P 1 5
6,009^63483
1.602.410,413
6,469,131321
4933Z7385
2^04335,574)606
271372.153^
16JD13,650^61
110JD1S^51967
14^0,233^70
2l7^i64,llC
72,15432,101
6,0523*1^
124378,294,987
32P97,793 i09
32,773.518,112
132224234,494
12PS6,487482
37.791300551
6.4565192,730
47^7409848
TEXAS
IITAH
VERMONT
VTRGINIA
WASHINGTON
WEST VIRGINIA
wasCONSIN
WYOMING
TOTAL
PrcmiuTO
3,751fSS^iJ75
542,968282
3,674 537 3W
2369,779 36i
31377334,190
4,135548261
4355305242
Sounx: Social S<^unrvWage Base
_
Percent
9.«%
727% '
8.997c
10.74%
U.46%
9.63%
9W%
8-75%
5.90%
7J9%
9.73%
8.95)%
10.47%
9.47%
11110%
10.18%
9.71%
939%
8.82%
1026%
7.64%
834%
1039%
1028%
1034%
1033%
1158%
1028%
11J04%
10>*1%
8.93%
9.80%
8.63%
9.11%
1022%
1048%
9.00%
1045%
1145%
10/48%
930%
1053%
1023%
8.41%
10.90%
9.96%
7.80%
9.41%
10.44%
11JD2%
9J6%
' 9^369^
�TotaTPFemlum Payments as PercBnl of Payroll
Without Health Reform
iF[rm Size
1994
1995
1996
All
11.54%
1206%
12.53%
<25
25-99
100- 499
500-999
1000+
11.96%
11.24%
11.84%
11.49%
11,41%
1Z50%
11.75%
12.38%
12.01%
11.93%
1^98%
1220%
12 65%
12 47%
12.39%
J997^
1098
1999
2000
12.96%
13.42%
13.88%
1436%
13.43%
1262%
13.29%
12 90%
12.81%
13.90%
13.07%
13.77%
13.36%
13.27%
14.39%
13..52%
14.24%
13.82%
13.72%
14.89%
13.99%
1474%
1430%
1420%
Source: HHS analysis using Urban jn|g|yte^rTalvses^f^^
1992 Currenl Pcpufalion Sun/ey.
�to
o
o
Total premium payments as a percent of payroll vary by firm size
and are highest for firms with less than 25 employees.
Total premium payments as a percent of payroll ( 1 9 9 4 $)
14%
12%
a.
1194%
-1-1,54%
-n..49%
11.41%
10%
QL.
•o
oo
m
o
<n
n
at
o
All
<25
25-99
100-499
500-999
1,000+
Firm size
o
o
o
to
o
Source: Urban Institute analyses of the March 1992 Current Population Survey.
�Total p r e m i u m p a y m e n t s a s a p e r c e n t of payroll v a r y by i n d u s t r y
and are highest for retail.
Total premium payments as a percent of payroll
.1
14%
12.84%
12.28%
12.22%
12%
11.64%
(
11.47%
11.46%
11.2%
10.35%
n.17%
10.13%
I —
10%
8%
6%
4%
2%
0%
AR
Agitaul«u<«
Manul.
T«cb/cl«rio«l Whol.sale
Retail
Fir.anol-1
S i l v i o * . St«t«floc g o v ' t F » d . flov l
Industry
Source: Urban Institute analyses of March 1992 Current Population Survey.
�Emplover premium payments as a percent of payroll vary by industry
tmpiuy
H
and are highest for m a n u f a c t u n n g .
Emplover premiuim payments as a percen^oM5avro1U1994_*)
14%
12%
10.16%
10%
8%
8.8%
9.77%
8.85%
1
8.35%
8.28%
7.57%
8.08%
8.12%
7.46%
1•
6%
4%
in.ncl.l
0%
AoriouUura
Manul.
T« ch/o1»iic.l
S.rvlc..
S l . l . A o o , o v ' l F . r f . lloV«
Wb»l»"»«
Industry
source: Urban Institute analyses of March 1992 Current Population Survey.
�Health Insurance Premiums Relative to Payrolls:
The Distribution Under the Current System
Number of currently cove
red workers in premium/pavron ratio group (Thousands)
30
26.676
25
18,12
20
m
15
11.996
mm
10
\f:*im
6.451
3.29
1.26
0
0-2%
0.054
0.272
2A%
4-6%
Jim
&B%
,1
••ml]
1
8-10%
10-12%
12-14%
14-16%
>16%
Total premiums as a percent of total payroll
source: Urban Institute's TRIM2 model, based on the March 1991 Current Population Survey,
�o
SI
Health Insurance Premiums Relative to Payrolls:
The Distribution Under the Current System
N u m b e r ot currently c o v e r e d workers in premium/pavroll ratio g r o u p (Thousands)
PL,
Ul
I/)
tn
CO
CV4
o
«3
0-2%
o
2-4%
4-6%
6-8%
8^10%
I-^-IHTD
i-t-iu/«
- -
-
Employer premiums as a percent of total payroll
Source: Urban Institute's TRIM2 model, based on the March 1 991 Current Population Survey.
o
�Health Insurance Premiums Relative to Payrolls:
The Distribution Under the Current System
Number of currently covered workers in premium/pavroll ratio group (Thousands)
18.12
*' U^-
6.451
i , ' •- " *
;
i
(f «
:. i * V J i 1
•-
' • iTiM, ?••
y ^•
!
y r
3.29
(-.•-!-:'-i.r • . ' ;
*«: -
0-2%
2-4%
4-6%
6-8%
8-10%
10-12%
12-14%
14-16%
>16%
Total premiums as a percent of t o t a l payroll
Source: Urban Institute's TRIM2 model, based on the March 1 9 9 1 Current Population Survey.
�Workers: How many work for small firms?
Distribution of workers by firm size
25-99
14%
100-499
16%
500-999
6%
1000-f
41%
Source: The Urban Institute (1993), based on the March 1992 GPS and TRIM2.
Numbers are in thousands.
�Percentage of Firms Offering Health Insurance
By Firm Size
Percent
100%r
91.9%
83.1%
81%
^mmim^^
80% 60%
51.2%
••3 J : :.!^ii:
40%
• i =;!:
:iiliifli|
20%
"!.":-.
• i^': 'iy I ' i ' ^ i ' - " ^
• i if v« Mi mmiii i«*i ^
^,1 Ij
: : i <•: -"
0%
•"V<'••'.:X'- i I
All firms
1-24
2599
100-499
Size of Firm
Source: Dept. of Labor, based on Small Business Admin calculations ol May 1988 CPS Survey Data
500+
�People who work for small businesses are
more likely to be without health insurance.
Percent of nonelderly population w i t h o u t health insurance
30%
r
25%
27%
wm
21%
20%
15%
10%
10%
5%
0%
<25
25-99
1 0 0 or more
Nonworking
Total
Size of Family Head's Employer
Source: Employee Benefits Research Institute Analysis of the March 1992 CPS.
�Employer premium payments as a percent of payroll
are lowest for small firms.
Employer premium payments as a percent of payroll (1994 $)
14%
12%
10%
B.99%
8.8%
7.54%
8%
&.2i%
9.21%
7.93%
6%
4%
2%
0%
All
<25
25-99
100-499
500-999
1,000^-
Firm size
Source: Urban Institute analyses of the March 1992 Current Population Survey.
�: Employer premium payments per worker vary by firm size
'
and are the largest for large firms.
Employer Premium Payments Per Worker (Thousands)
$5
$4
$3,215
$2.98
$3
$2,873 -
$2,768
$2,412
ih:r'-i':i-.
it;S,!.
$2,213
;•;'i
J ; ' 1 ,
'- -
1
, • •: •• .
•:;.
• i
kill''.:
:
i l l
M • i • ' ; , ; . •: .
• i
•"
1
1 •
t
in- .'TtlVL-
•?'
(: . • > ;
;
•
, 'i
i-
' - - / r ,
''•
<
(: •: ••.
•i • • • ' -
:•,(.•• J l - 1 -
i
• - V^ 1 * •
filliSljr.^ iii=i
* i
••• if
y !f i i i N i f r ; } - : !
WM
<25
1 1 Li - » i , -
,1
25-99
100-499
Firm size
:i *i .- ;.; : : } . ^- 1 :- « : • * , |
•:
1
500-999
1,000-h
�Employer premium payments per worker vary by firm size
and are the largest for large firms.
Employer Premium Payments Per Worker IThousands)
$5
$4
$3,215
$2 98
$3
32:768
*2873
42.412
$2,213
$2
$1
$0
All
<25
25-99
100-499
Firm size
500-999
1,000 +
�Total premium payments per worker vary with firm size
and are highest for large firms.
Total premium payments per worker {1994 $, thousands)
All
<25
25-99
100-499
500-999
1,000-t-
Firm Size
Source: Urban Institute analyses of March 1992 Current Population Survey.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001b. draft memo
DATE
SUBJECT/TITLE
Chris Jemiings & Sean Burton to Hillary Rodham Clinton; re:
Meeting with Senator Dale Bumpers (1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3664
FOLDER TITLE:
Folder #2: Memo [Chris Jennings]
2006-0885-F
jp2647
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)|
Freedom of Information Act - |5 U.S.C. 552(b))
PI
P2
P3
P4
b(l) National security classified information [(bXl) of the FOIA|
b(2) Release would disclose internal personnel rules and practices of
an agency |(bX2) of the FOIA|
b(3) Release would violate a Federal statute |(bX3) of the FOIA|
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy 1(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIA|
b(8) Release would disclose information concerning the regulation of
financial institutions 1(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells l(bX9) of the FOIAj
National Security Classified Information 1(a)(1) of the PRA)
Relating to the appointment to Federal office |(aX2) of the PRA]
Release would violate a Federal statute |(aX3) of the PRAj
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAj
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |aX5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PRIVILEGED AND e O N f f N D E f ^ Q r MEMORANDUM
TO: Hillary Rodham Clinton
ERi Chris Jennings, Sean Burton
REl Meeting with Congressman LaFalce
cc: Melanne, Steve, Lorraine, Distribution
June 28, 1993
DETERMINED TO BE AN .4D,MIMSTR,AT1VE
MARKINOPcr LJJ. 12958 as amended. Set. 3.3 (c)
Initials:
Tomorrow you are scheduled to meet with Congressman John LaFalce from New
York. The purpose of this meeting is to provide a general dialogue on health care reform and
to establish a working relationship for the future.
BACKGROUND:
Although not considered a "player" on health care, Congressman LaFalce has received
significant attention through his recent dealings with the Task Force. He is the chairman of
the House Small Business Committee. His first and foremost concern regarding health care
refonn is its effect on small businesses. He would like to be assured that small business will
not bear an unfair burden of the cost. Although it is doubtful that his committee will have
jurisdiction on parts of the plan, he could help us to gain credibility with the small business
community. The committee can serve as a forum for discussing issues regarding health care
and small business.
LaFalce is a co-sponsor of the McDermott single payer bill. This is primarily due to
two reasons. The first being his concern over the possibility of small business shouldering
too much of health care costs under the new plan. The second reason has to do with the
proximity of his upstate New York district to the Canadian border. Many of his constituents
have relatives living accross the border in Canada, and this has made the Congressman
comfortable with a single payer system.
We have had an on-going relationship with the Congressman and his staff. We met
with his staff on
. Members of the Task Force met with both the Democratic and
Republican staff members of the Small Business Committee in
. Ira met with the
Congressman on
.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. memo
SUBJECT/TITLE
DATE
Chris Jennings & Sean Burton to Hillary Rodham Clinton; re:
Meeting with Congressman LaFalce (2 pages)
06/28/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3664
FOLDER TITLE:
Folder #2: Memo [Chris Jennings]
2006-0885-F
jp2647
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)l
Freedom of Information Act - |5 U.S.C. 552(b)|
PI
P2
P3
P4
b(l) National security classified information l(bXl) of the FOIAj
b(2) Release would disclose internal personnel rules and practices of
an agency j(bX2) of the FOIAj
b(3) Release would violate a Federal statute l(bX3) of the FOIAj
b(4) Release would disclose trade secrets or confidential or financial
information 1(b)(4) of the FOIAj
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy j(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes 1(b)(7) of the FOIAj
b(8) Release would disclose information concerning the regulation of
financial institutions j(bX8) of the FOIAj
b(9) Release would disclose geological or geophysical information
concerning wells |(bX9) of the FOIAj
National Security Classified Information |(aXl) of the PRAj
Relating to the appointment to Federal office |(aX2) of the PRA|
Release would violate a Federal statute |(aX3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(aX4) of the PRAj
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors |a)(5) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy 1(a)(6) of the PRAj
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Health Reform and Small Business
A Look at Problems in Today's System and
Solutions Under the President's Health Reform
�Small Business and Health Care Reform: Overview
It takes courage and ingenuity to start and succeed as a small business. It means
taking a risk with your future and betting that you succeed. As many as 1 out of 12 small
businesses fail within the first year. It is not right that many small business owners also face
the risk that their families and employees won't have health care when they need it. It is
not right that those who provide coverage risk that within a year that coverage may be taken
away or priced out of reach.
Small businesses fuel job creation and strengthen our economy. Responsible for 90%
of job growth in 1990, small businesses has become the nation's engine of economic growth.
Yet this growth is endangered by a health care system which threatens every American
business, especially small businesses. Small business owners can face financial devastation
if a family member or just one employee falls ill. And employers who try to provide health
care to their employees find a health care system stacked against small businesses.
Nonetheless, a majority of American small businesses manage to provide coverage.
Today 62% of American businesses with less than 100 employees provide health care ^
coverage to their employees. And 51% of those with fewer than 25 employees provide /
health care. But providing these benefits isn't easy.
The Clinton Administration believes that most small business want to cover their
employees ~ and most do. Our health care plan will work for small business, taking away
the hassle and ensuring security of affordable, predictable health care coverage. And for
those businesses who don't provide health insurance coverage, our reform will protect them
while they make the transition. The plan provides financial assistance and a phase-in period
so they may provide health security to their employees and families.
In today's Mom and Pop stores, the Mom or the Pop serves as the de facto benefits
department. They fill out the paperwork. They make the phone calls. They negotiate rates
and enroll their employees. They dutifully pay their premiums every month. But all too
often, within a year, their insurer will raise rates and price them out of the market ~ many
times for no reason. Or the insurer will refuses to renew coverage. Then the small business
owner is back to the drawing board ~ spending more time and more money to find another
insurer ~ and the cycle starts again.
The following document examines the major problems faced by small businesses in
today's health market and shows how health reform and the formation of health alliances
will address most, if not all, of the major problems facing small businesses.
�The Majority of Small Businesses Offer
Health Insurance to Their Employees
Do Not Offer (37.6%)
Offer (62.4%)
For Firms with Less than 100 Employees
Source: Dept. of Labor, Based on SBA Calculation of May 1988 CPS Survey Data
�The Small Business Obstacle Course
Time and Money
Price Discrimination
Insurance Abuses
Redlining
Underwriting
High Administrative Costs
A Volatile Insurance Market
Price Gouging
Difficulty Securing Renewal
�THE SMALL BUSINESS OBSTACLE COURSE
Problem:
Small business owners must go through an obstacle course of insurance abuses
and higher costs to
provide health care coverage for their employees.
Small business owners who spend the time and money to cover employees frequently
must deal with an insurance market which changes its rules at every stage of the
game, a volatile market, unpredictable cost increases, higher administrative costs, and
premiums rising at a faster rate than health care costs for larger employers.
Lacking a benefits department like larger firms most small business owners must
perform all the fiinctions of such a department by themselves. Negotiating health
coverage in today's health care system is a process often fraught with frustration and
obstacles.
Many small business owners, after setting aside the time to negotiate coverage for
their employers, encounter obstacles like "occupational redlining" a practice where
insurers will simply refiise to cover entire industries perceived to be high risk; or
medical underwriting, basing premiums on perceived risk and medical history; or
experience rating, where insurers jack up costs if just one employee falls ill or gets
injured. Many insurers engage in "price baiting and gouging" offering "discount" rates
for the first year of coverage only to charge much higher prices in the next year when
pre-existing condition exclusions expire. And many small firms with sick workers find
that an insurance company will refuse to renew their policy in the second year.
Not surprisingly the hassle and discrimination in today's system make many small
owners worry about being able to continue to provide this coverage. The reform
plan addresses nearly all of the problems which cause the small business owner so
much hassle and time in obtaining insurance.
The Plan: ' Health refonn outlaws insurance practices like underwriting and redlining. The
health alliance helps small businesses cut through the hassle.
We will take the burden off the small business with health alliances which will deal
with the insurance companies and bargain for competitive prices. Tlie alliance will
take over the paperwork and the negotiations; provide information on plans and
increase ease of enrollmenL Higher administrative costs will be reduced and the
hassle of the current system is eliminated.
The Clinton reform plan outlaws insurance abuses such as redlining, underwriting
and experience ratings. Costs of premiums are controlled and the insurance market
is stabilized. Under our reform, everyone living in the same area pays a similar price
for a similar plan. And they have the security knowing those costs will be predictable
and increase at a lower rate.
�Small Business Owners
Face an Obstacle Course in Obtaining Health Insurance
•
Uncertainty
Time & Money
Year 1
——
—4
\
Healtti
coverage
for one
more year
High Administrative Costs
Cost Negotiations
Frustration
Undenivrttihg
/Cost A Cost B \
(
^
$
\
I Cost D Cost C /
\
^
$
Price Discrimination
iiiiiiiiiiiii^
/
Insurance Abuses
Priced out
of market
Renewal
refused
�The New System
High Administrative Costs
Underwriting
Cost Negotiations
Volatile Market
Redlining
Price Discrimination
Health
Security
�Insurance Industry Abuses
Medical Underwriting
Experience Rating
Price Baiting and Price Gouging
Refusal to Renew Policy
Occupational Redlining
�OCCUPATIONAL REDLINING
TYPES OF INDUSTRIES OFTEN EXCLUDED FROM HEALTH
INSURANCE PLANS
Amusement Parks
Asbestos-Related Industries
Auto Dealers
Aviation
Barbers and Beauty Shops
Bars and Taverns
Car Washes
Commercial Fishing
Construction
Convenience Stores
Domestic Help
Entertainment/Athletic Groups
Exterminators
Federally Funded Organizations
Florists
Foundries
Grocery Stores
Health Clubs and Spas
Hospitals and Nursing Homes
Hotels and Motels
Insurance Agencies
Interior Decorators
Janitorial Services
Junk and Scrap Metal
Law Firms
Limousine Services
Liquor Stores
Logging and Lumber Mills
Meat/Fish Packers
Mining Operations
Moving Operations
Oil Field Operations
Parking Lots
Physicians Practices
Restaurants
Roofing Companies
Security Guard Firms
State Funded Organizations
Taxicabs
Trucking Firms (Long-Haul)
Sources:
List of "ineligible industries" and industries reqidring "special consideration"
from selected insurance plans arialyzed by the Alpha Center.
American Hospital Association, Promoting Health Insurance in the Workplace^
and Local Initiatives to Increase Private Coverage (Chicago: 1988), as cited in:
United States General Accoiinrins Office. Health Insurance: Cost Increases Lead
to Coverage Limitaitions and Cost-Shifting. (GAO/HRD 90-68)
�Higher Administrative Costs
• Higher Overhead
• No Benefits Department
• Faster Increases in Costs
�Small Businesses Face
Higher Administrative Costs
A d m i n i s t r a t i v e C o s t s as a
P e r c e n t a g e of Claims
By Firm Size
50%
40%
30%
20%
10%
0%
20-49
1-4
Source:
100-499
Firm Size
More than 10,000
Risk/Profit
General Admin.
Claims Admin.
Marketing Costs
Hay /Muggins.
Inc.
�Employers Would Save $1,015 Per Employee
Per Year If Costs Were Controlled-Small Businesses Save Most
Employees in Firm
1-9
10-24
25-99
100-499
500 +
$0
$1000
$2000
$3000
$4000
$5000
Total C o s t s Per Employee 1992
Excess Costs
Source:
Lewin-ICF
�A Volatile Market
Cost Variations
Unpredictable Cost Increases
Durational Rating
Churning
�Small Groups (2-25) Face Large
Variations in Health Insurance Premiums
450%
400%c
a
CL
sz 350% o
03
LU
O
H—
300%
-ami
E
CL
$
o
_j
250%-
o
Relat
<D
>
.200%-
0^
150%-
100%
Plan A
Plan B
Plan C
Plan D
Source: Blue Cross/Blue Shield Association, Survey of Six Sample BC/BS Plans, January 1992.
Plan E
Plan F
SMBUS.WQ!
�SUMMARY
TODAY
REFORM
High Admmistrative Costs: Higher
administrative costs account for as much
as 40% of the policy costs compared to
about 5% for large companies. [CBO,
5/92]
Cuts Administrative Costs: The health
alliance assumes the administrative
functions and costs which kill small
business owners.
The Obstacle Course: Small business
owners who cover their employees must
spend a lot of time and effort dealing
with an insurance market which changes
its rules at each stage of the game.
Eliminates Hassle: The health alliance
negotiates rates, provides information on
plans, increases ease of enrollment and
absorbs the manpower drain.
Dramatically Increasing Costs: Premiums
for small employers rise at a faster rate
than for other employers — as much as
50% in any given year. [NAM]
Aggressively Controls Costs: Health
reform will aggressively control cost
increases which hit small businesses
disproportionately hard.
Difficulty Obtaining Renewal: After a
first year of reasonable rates, small
businesses often face higher costs and
difficulty obtaining renewal.
Guarantees Renewal: Guarantees
renewal and stabilizes premiums.
Small Risk Pool: Fewer employees mean
a smaller pool to share the risk.
Insurance companies frequently charge
more for these policies and one illness
can cause plan cost to increase
dramatically.
Spreads Risk Evenly: Consolidates small
businesses in large purchasing pools to
give them the same bargaining power as
large companies.
Insurance Industry Abuses: Insurance
companies redline large sectors of the
small business market. Underwriting and
experience rating leads to discriminatory
prices for small business policies.
Outlaws Unfair Insurance Practices:
Prohibits redlining, experience rating and
underwriting. Requires that plans charge
all firms in a given area a similar price
for the same health plan.
�O
o
SI
Insurance Problems Facing the Small Group Employee Market
Large Volatile Variation in Premiums
o Underwriting
o High Risk
a.
ta
^.
u
Workers in SmaU Firms Finance a Higher Proportion of Total Premiums
Ou,
VI
Insurance is More Expensive Relative to Large Firms
CO
as
as
o High Administrative Costs
o Premiums Include Costs of Uninsured
o Provider Payments Substantially Above Costs
IO
oo
in
o
i
•
Growth in Insurance Premiums is Higher in the Small Group Market
o Less Likely to Have Established Cost Containment Programs
CT)
o
I
�n
o
o
isured worker's hoaUfi spending without health reform
1994
Average compensation per worker:
a,
w
Ul
a.
CO
<o
ta
o
CM
o
Average Insured worker's heatth bill
Health insurance
Err^ployer's share o1 premium
Individual's share of premium
Medicare payroll tax
Workers' comp/dlsablllty/lnduatrlBl Inplant
Out-of-pocket
Other spending at health racllltles
Federal taxes, fees, & other payments
Federal employees' health premiums
Federal contributions to Medicare HI
Medicare (general revenue)
Medicaid
Other federal health programs
Stele & local taxes, fees, A other payments
Stale/local employees' health premiums
Stale/local contributions to Medicare HI
Medicaid
Hospilal subsidies
Other programs
Health Bill a s o f
Compensation
J
.•ioun-t: »>lficc ,>( l l c H I . Policy. A.SP»i. I l l i S .iia!y.«*UMng l i c a l l b C . i r l-lnancing AUminiaiiiilon: Ur1..n l«irtiimt; .nd
CM
•nd I»c|ailinenl o l Comment, Burtaii of Economic A n i l y i i s d«U.
o
o
o>
n
o
CD
$50,334
$36,299
$7,423
$4,132
$3,163
$969
$926
$246
$762
$113
$654
$53
$11
$169
$246
$174
$569
$149
$24
$186
$B1
$130
2000
Health bill as % o
Compensation
20.45%
11.38%
8.71%
2.67%
2.55%
O.BB%
2.15%
0.31 %
1.80%
0.15%
0.03%
G.47%
0.68%
0,48%
1.57%
0.41%
0.06%
0.51%
0.22%
0.36%
$12,386
$6,895
$5,278
$1,617
$1,546
$411
$1,305
$168
$1,092
$88
$19
$283
$411
$290
$950
$248
$39
$310
$135
$219
24,61%
13.70%
10.49%
3.21 %
3-07%
0.82%
2.59%
0.37%
2.17%
0.18%
0.04%
0.56%
0.82%
0,58%
1.89%
0.49%
0.08%
0.62%
0.27%
0.43%
�Current Spending on Pri- •Lie. Health insurance ireroiums ny ataic.
As a Percent of Taciblc Earnings
A L ^ A M A
AIJ\SKA
ARl/.ONA
ARKANSAS
CALIFORNIA
COLORADO
c:ONNECTTCUT
DELAWARE
DC
FLORIDA
GEORGL^
tiAWAlI
IDAHO
ELLINOIS
INDL^NA
IOWA
KANSAS
KENTUCKY
LQUISL\NA
MAINK
MARYLAND
MASSACHUSETTS
MICHICJAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
r ^ W MEXICO
NEW YORK
NORTHCAROUNA
NORTH DAKOTA
OfflO
OKLAHONtA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROUNA
SOUIH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
TOTAL
Ta.xable Earnings
385*98,615398
7,47LU5,760
40^9 I J 1 2 ^
22,072.511,494
576^575,470
42,9527Z2pi7
47509,0*1,475
8,849,078;867
7.552,877,819
l3Sj666,.'533JJl6
69,107,458^9
14$76,797,447
143,98.5^W5^7
61,043.580^%
30pl6,fi22/S05
28,715,089385
34,7S4,608,1S4
39,529,575,525
12;SS9,997383
68211,468^97
77,%13G0,617
109,409,081^2
51,705,415320
20.557,808356
60244,88837-^
7,S?0A90,161
17,478,845^03
1S,537;!09212
16P13,650^1
nOjOl5^51J>67
14550^33^70
217520,564,116
72,154332,101
6,0523*1,293
124378,294587
32p97,793i09
32,773,.518,112
132224234,494
12^56,487,582
37,791500551
6,4565925»
47^7,609348
186j6063n/)95
16^7270,729
6,477 P98?00
83,193,483,170
63363,931291
15^18,775J23
58/599280,587
5,005 270,744
2,W335,S74>50(4
PremiuTO
3,751397575
542,968282
3.674 ,537 3M
2369,779 36t
31377334,190
4,135 p48 261
4355305242
773509213
445,*i7314
10536,916577
6,723213,419
1346,035317
1,028354,152
13^,116,472
6,713,'^56,189
3,056..D74,535
2,789,136209
3266394364
3,484,793,9^^7
1321,98929*
5210565,688
6503^15,432
11512,093,402
5314,122517
2,125383,724
6222536,523
890 591,169
1,796 556 j659
l,714j663/>40
1,667,820343
9,K24393S68
1,464,499381
19235,998,662
6571365,130
618523,636
13230,058,130
2,890309363
3,490,744^)60
15,138,836^39
1263,223,740
3,703370,746
705,755,456
4,872,056^)97
15,700,711323
1 3 » 372,751
645,079501
6,4885<2P15
6,009563/^3
1,602,410,413
6,469,131.821
493327385
9.62%
7.27%
8.99%
10.74%
8.46%
9.63%
9.09%
8.75?&
5.90%
7.89%
9.73%
8.99%
10.47%
9.47%
im%
10.18%
9.71%
939%
8.82%
1026%
7.64%
8:34%
1039%
1028%
1034%
1033%
1138%
102a%
11.04%
10.41%
8.93%
9.80%
8.83%
9.11%
1022%
10J6S%
9.00%
10J6S%
1145%
10.48%
9.80%
1053%
1023%
8.41%
1050%
9.96%
7.80%
9.41%
10.44%
11.02%
9.86%
::::;:r'2:j-im^:^°-''--
II Source; Social Sccurirv Wajfe Base
dH/HdSV SHH
Percent
\
I'SSS
069
ZOZS.
CC:60
C6/C0/90
�tn
o
o
Total Premium Payments as Percent of Payroll
Without Health Reform
1994
1995
1996
1997
1998
1999
2000
All
11.54%
12,06%
1253%
12.95%
13.42%
13.68%
1436%
<25
25-99
100-499
500-999
1000+
11.96%
11.24%
11.84%
11.49%
11,41%
1250%
11.75%
1238%
1201%
11.93%
1298%
1220%
1285%
12.47%
12.39%
13.43%
1252%
13.29%
1290%
12.81%
13.90%
13.07%
13.77%
13.36%
13.27%
14.39%
13..52%
14.24%
13.82%
13.72%
14.89%
13.99%
14,74%
1430%
1420%
Firm Size
Source: HHS analysis using Urban Institute analyses of March 1992 Current Population Survey.
�to
o
o
Total premium payments as a percent of payroll vary by firm size
and are highest for firms with less than 25 employees.
Total premium payments as a percent of payroll (1994 $)
14%
12%
m
• -1-1,54%
11.84%
11.96%
11.24%
•1-1-.49%
11.41 %
10%
Ul
CU
</>
<
•
00
8%
6%
4%
tn
I/)
o
w
o>
s( O
o
o
ro
o
o
o..
2%
0%
All
<25
25-99
100-499
500-999
1,000 +
Firm size
Source: Urban Institute analyses of the IVIarch 1 9 9 2 Current Population Survey.
�Total premium payments a s a percent of payroll vary by industry
and are highest for retail.
Total premium payments as a percent of payroll
14%
12.84%
12.28%
12.22%
12%
11,64%-
"li.2%
11.47%
-1^46%-
10.35%
Ul
OL.
CO
n.17%
10.13%
10%
CO
BC
S
8%
6%
4%
o
2%
0%
Safvicea State/lcc gov't Fad. gov (
All
Ag,iounu<e
Manul.
Tach/clerical Wholesale
Retail
Financial
Industry
Source: Urban Institute analyses of March 1992 Current Population Survey.
�o
SI
Emplover premium payments as a percent of payroll vary by ir^dustry
^
and are highest for manufacturing.
^
Employer premiuim payments as a percent of payroll (1994 $)
14%
12%
10.16%
QL.
n
Ul
10%
OH
a.85%
8,8%
CO
-f.
uy
at
a
9.77%
8.35%
8.28%
8.12%
• 7.46%-
7.57% -
8%
8.08%
6%
lO
4%
o
o>
to
o
CM
2%
&
0%
o
Fmancial
M
AaricuUora
Manuf.
Taoh^cle.icBl Wholeaala
S«rvic«B Slate/^oc g o v ' i F e d .
flov't
Rs^ail
Industry
e-5
cn
o
to
Source: Urban Institute analyses of March 1992 Current Population Survey.
�60O/0 ^ T ! ^ ' ! ! ! ^ ^
- - r e d workers
P''^^'^^/payroJ/ ratio
a,
to
Total p„„i
-
'»iiJS^;rtS;
�o
(§1
Health Insurance Premiums Relative to Payrolls:
The Distribution Under the Current Systenn
Number of curre ntly covered workers in premium/payroll ratio group {Thousands)
a,
a
Ul
a.
CO
<<
CO
a
a
tn
00
IO
o
a>
to
o
CM
tn
o
n
o
to
0-2%
2-4%
4-6%
6-8%
8-10%
10-12%
12-14%
14-16%
>16%
Employer premiums as a percent of total payroll
Source: Urban Institute's TRIM2 model, based on the March 1 991 Current Population Survey.
�Health Insurance Premiums Relative to Payrolls:
The Distribution Under the Current System
Percent of currently covered workers in premium/payroll ratio group
50%
39.16%
40%
30%
26.6%
17.61%
20%
9.47%
10%
4.83%
0-2%
o
2-4%
46%
6-8%
8-10%
10-12%
12-14%
1416%
>16%
Total premiums as a percent of total payroll
n
n
o
to
o.
Source: Urban Institute's TRIM2 model, based on the March 1 9 9 1 Current Population Survey.
�Workers: How many work for small firms?
I§1
Distribution of workers by firm size
25-99
14%
a.
a
Ul
OL,
CO
f.
100-499
16%
to
a
a
tn
00
IO
o
500-999
6%
to
o
CO
n
o
o
to
o
1000-h
41%
Source: The Urban Institute (1993), based on the March 1992 CPS and TRIM2.
Numbers are In thousands.
�Percentage of Firms Offering Health Insurance
By Firm Size
Percent
100%
80% 60%
40%
20%
All firms
1-24
25-99
100-499
Size of Firm
Source: Dept. of Labor, based on Small Business Admin calculations of May 1988 CPS Survey Data
�o
SI
People who work for small businesses are
more likely to be without health insurance.
Percent of nonelderly population w i t h o u t health insurance
30%
27%
-.Cv:».::c>:ji*.:.:^s;/.i:?.
a.
a
Ul
a.
CO
to
25%
20%
j••
•--
a
a
15%
10%
IO
o
cn
to
evj
o
5%
-••
CO
o
t -33
10%
.. -
....
•: • >'
L-
17%
Ir »5t|fH*.>
-M-.-:-:'(iTv • .'-1 -,
-•^"••mf«:-:4.lf^-i:
" • ' ^ .1-
-:
S i . ^i-T:«:>r;*::--S5!»
-'* r , "
tJl
?
- » ^ . !^ »
•
&
iX>-.v
4
t * <'j"'' »
V
oo
21%
ilittilii
i ^ ?:*"J^
•o
23%
«t> !!
0%
j !',"> 1
<25
25-99
lOOornnore
Nonworking
Total
Size of Family Head's Employer
cn
o
to
o.
Source: Employee Benefits Research Institute Analysis of the March 1992 CPS.
�Employer premium payments as a percent of payroll
are lowest for small firms.
Employer premium payments as a percent of payroll (1994 $)
14%
12%
CU
a
Ul
a.
CO
CO
a
a
in
oo
tn
o
Ol
to
CM
o
CM
All
cn
o
<25
25-99
100-499
500-999
1.000-f
Firm size
c-5
cn
\
n
o
\
to
o
Source: Urban Institute analyses of the March 1992 Current Population Survey.
�Employer premium payments per worker vary by firm size
and are the largest for large firms.
Employer Premium Payments Per Worker (Thousands)
$5
$4
OL.
a
u
$3,215
Ou
to
$2.96
$3
$2,873 -
$2,766
$2,412
$2,213
IO
00
lO
•3,,-'
fliiii
-
iiilill
$2
iU j ; , : >
o
a>
CO
CM
o
CM
V. r ;^-S -
•
M
$1
L!S5ai;t<:fr<:v:v;
.».lf«:3«5
o
r j
ca
ro
o
\.
to
o.
$0
All
<25
25-99
100-499
Firm size
500-999
1,000 +
�Employer premium payments per worker vary by firm size
and are the largest for large firms.
Employer Premium Payments Per Worker (Thousands)
$5
CU
$4
a
$3,215
Ul
OL,
to
$2,98
$3
$2,873 .
*2.412
$2,213
$2
\ • • ' '•
IO
oo
o
to
CM
o
CM
$1
.:cn
o
c-5
cn
\
n
o
to
o.
$0
All
<25
25-99
100-499
Firm size
.
;
500-999
1,000 +
�Total premium payments per worker vary with firm size
and are highest for large firms.
Total premium payments per worker (1 994
thousands)
$5
$4
$3,766
$3,511
53.417
$3,642
I
—
25-99
100-499
$3
$2
$1
$0
All
<25
500-999
1,000 +
Firm Size
Source: Urban Institute analyses of March 1992 Current Population Survey.
��Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. list
SUBJECT/TITLE
DATE
re; The Speaker, House Majority Leader, Democratic Caucus, Senate
Majority Leader, & Democratic Policy Committee (partial) (1 page)
n.d.
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number:
3664
FOLDER TITLE:
Folder #2: Memo [Chris Jennings]
2006-0885-F
jp2647
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Freedom of Information Act - [5 U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of the PRAj
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P3 Release would violate a Federal statute |(aX3) of the PRAj
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C. Closed in accordance with restrictions contained in donor's deed
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PRIM. Personal record misfile defined in accordance with 44 U.S.C.
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�The Speaker
Bonnie Lowrey
O f f i c e : 225-8550
Fax:
225-3738
Home: |
P6/(b)(6)
House Majority Leader
Andrea King
Office:
Fax:
Home:
225-0100
225-3738
P6/{b)(6)
Democratic Caucus
M e l i s s a Schulman
O f f i c e : 226-3210
Fax:
225-0282
Senate Majority Leader
John H i l l e y
O f f i c e : 224-5556
Fax: REEUSED__
Home:
P6/(b)(6)
C h r i s t i n e Williams
O f f i c e : 244-5344
D i r e c t : 224-8678
Fax:
224-2151
Home: I
P6/(b)(6)
Bob Rozen
Office:
Fax:
Home:
224-5344
224-2151
P6/(b)(6)
Democratic Policy Commitee
Greg B i l l i n g s
O f f i c e : 224-3232
Fax:
228-3434
Home:
P6/(b)(6)
Michael Werner
�Office:
Fax:
224-3232
228-3432
Deborah Silimeo
Office: 224-3232
Fax: 228-3432
�PRIVILEGED AND O^yFIDEIgBa? MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings, Steve Edelstein
Meeting with Congressman Rose
Melanne. Steve. Lorraine. Distribution
June 23, 1993
DETERMINED TO BE AN AD.MIMSTRATIVF.
MARKij^PerEXD. 12958 as a r g d o d ^ ^ ^ )
Tomorrow you are scheduled to meet with Congressman Rose. The
purpose of this meeting is to establish a dialogue with the Congressman, as
has been done with Senator Ford, in preparation for future negotiations
regarding the possibility and extent of a tobacco tax as part of the financing
package for health care reform.
In attendance will be Miles Goggans, special assistant to the President
on Agriculture. Since your meeting with Senator Ford, the Department of
Agriculture has been consulting with both Ford and Rose on subsidies but not
on tobacco taxes. The Congressman and the Senator tend to separate these
two issues. To the extent possible, we need to link them so that if we assist
their constituents on subsidies, they will moderate their opposition to tobacco
taxes. Attached for your review is a memo from Miles detailing the work being
done by the Department on this issue.
BACKGROUND:
Congressman Rose sees himself as the dealmaker in the House on any
tobacco tax that may be included to finance the Administration's health reform
plan. The economy of his district in the southeastern part of North Carolina
has depended on tobacco for over 200 yeairs. Any cigarette tax, naturally,
would have a major impact on key constituents.
Rose has had some success in heading off previous efforts which would
have harmed tobacco interests. In 1981, when tobacco subsidies were under
attack, he persuaded the House leadership that a defeat on tobacco could cost
North Carolina Democratic members reelection. Since the delegation is made
up of leadership loyalist, he argued the party would be hurt over the long term.
Current budget assumptions for the financing of the Administration's
health reform plan call for a $1.00 per pack tobacco tax over the first two
years, rising to $1.50 thereafter. This would raise $11 billion the first year
(because it is less than a full year), $15 billion the second year, and $19 bUlion
in subsequent years. Cutting the rate to $.75. a figure suggested in passing by
Senator Ford in your discussions with him. would raise approximately $11
billion per year, leaving us with a $5-7 billion short fall in funds eairmarked for
prescription drug and long-term care benefits.
�G6-23-93 06;b8PM FROM USDA OFC OF THE SECY TO 94566239
FOO:
To: Chris Jennings
From: Miles Goggans
Re: Tobacco
Remember, to these folks, tobacco is not a health issue, it's an economic issue.
Much like Senator Ford, Congressman Rose will emphasize the impact a cigarette
tax will have on his growers. I suggest you seize the initiative with some of the following
statements:
••recognize that tobacco is not the oi^ly sin within a sin tax
*Need to address the issue of increasing import levels of tobacco and to insure that
imports share equitably in the health care solutions of this country. We do NOT expect
domestic growers to carry this burden alone.
•Pleased that the Administration could help Ford get the current language included
in reconciliation, but realize the need to improve upon it.
•Emphasize the absolute necessity of teamwork from the Administration, Rose and
Ford in addressing the issue. Stress the need to have Rose intimately involved and the
desire to reach an agreement with Ford.
Results of Senate measure on tobacco:
- assessment of tobacco imports and limitation on quota reductions, with a CBO
projected five year savings of $29 million.
- This requires domestic manufacturers of cigarettes to certify the percentage of
imported tobacco used, with penalties and domestic purchase requirements for any imports
in excess of 25 percent. Requires assessments on tobacco importers to contribute to the
1990 Omnibus Budget Reconciliation Act tobacco assessments and to maintain a no net cost
tobacco program. Requires comparable fees for inspecting imported and domestic tobacco.
Extends the Secretary's authority to waive quota reduction floors for the 1995 through 1998
crops. Extends current tobacco producer/purchaser assessments through 1998.
�16-23-93 06:68FM FROM USDA OFC OF THE SECY TO 94566239
PCO:
Potential Issues To Be Addressed bv Conpressman Rose
1. Domestic Content - Rose will claim that the companies are willing to increase the
level of domestic content to a higher percentage than Ford has secured (75%).
HRC: It is important to note two items: (a) currently, there is DQ legal mandate on
domestic content, and (b) a mandate, especially a high one, is sure to raise complications
with GATT. (NOTE: Brazil is a large tobacco exporter lo US and would surely object to
this change). Of course, addressing domestic content is the best way to address imports,
which is the ultimate goal of Rose.
2. Policing Mechanisms - Rose will want to add to the policing mechanisms of the
Ford language, probably by requiring that domestic content be applied by brand instead of
by company.
HRC: Companies will fight this approach vigorously. Ask Rose, "Is there another way?"
3. A potential benefit for growers is an increase in grading and inspection fees for
imported tobacco. Currently, we only inspect about 10% of imports, none of which is
applied to imported stems.
The bottom line for Charlie Rose is to attempt to curtail the increasing imports of
tobacco. By focusing on domestic content, he is in effect treating an imported product less
favorable than a domestic product, which is GATT illegal. Consider that the US is about
to file action against Sv^tzerland, because the Swiss require a percentage of their domestic
fruit and vegetables be purchased before those imported from the US. Clearly, the potential
for inconsistencies in US policies will arise.
In the end, Congressman Rose should leave with the clear impression that the
Administration is very sympathetic and is actively working lo help. There will be some trade
implications to consider, but wc will work with him in addressing them. There maSl be a
cooperative spirit between Rose, Ford and the Administration is handling this somewhat
complex issue.
�Flue-Cured Scrap
Type 92
12
10
11.14
274 % Increase From 1991 To 1992
1
8
S
CO
bo a
o
:
6
2.98
2.43
2.20
1.59
2.60
i s . *«SS!
J
^^^^
f
0.39
0
1985
1986
1987
1988
1989
1990
1991
1992
Year
Page 8
�TOTAL IMPORTS
All Types
250
209
200
150
125
102
100
101
93
88
85
<r l i .
50
• j - o - j i ^ . ' ^ ' . ' . i ' j ' . * - " ? ' . " - ' . ' - ' "-•
V
0
1985
4..
1986
5f>!
1987
1988
1989
Year
I
1990
1991
1992
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TVPE
004. memo
SUBJECT/TITLE
DATE
Chris Jennings & Steve Edelstein to Hillary Rodham Clinton; re:
Meeting with Senators Leahy & Pryor (2 pages)
06/14/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Health Care Task Force
Steve Edelstein
OA/Box Number: 3664
FOLDER TITLE:
Folder #2: Memo [Chris Jennings]
2006-0885-F
jp2647
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P3 Release would violate a Federal statute |(aX3) of the PRA|
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financial information 1(a)(4) of the PRA|
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors |aX5) of the PRA|
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C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
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�STATE OF ARKANSAS
OmCE OF THE GOVERNOR
UnU RMk 7SiOJ
Septeinber 4, 1992
The HonoralDle Davifl H. Pryor
United States Senate
267 Senate Russell O f f i c e Building
Washington, DC 20510-0402
Dear David:
I appreciate the time and e'Cort y^^
others have spent i n
develoDiag the l e g i s l a t i o n introduced by you and Seria.or
Leahy w h i l h o u t l i n e s a procese f o r assisting states t o plaii
and implement state-baeed conrprehensive health ctLze reforr^
efforts.
The ^ nnP- prc^^ shop" coTicev>t_l3J^^wAy.^ aJ)prov^L-Sytl.^S§.J-l=^
dii-irn"an-'c^iSi:.Bye.L^
c T t l t e - S r I appreciate the recognition the b x l l S-^^ee as
w i l j - l ' r y o u r personal Btatemente ir. recent veeke that the
f i r s t Choice f c r n a t i o n a l health care r e f o m I B .cr the
federal gcvemnent t o act, but i n the interiir, t h i e 3..i-l gives
Btates the needed process f o r moving aheafi.
I cMrr.^x*- y^"^ ^^fnT-ro
thia h U l toward moving us t o a
national s o l u t i o n and looJc forward t o vorking w^t^. you
f u r t h e r oa. t h i e c r i t i c a l area ct health care reforTn.
Sincerely,
B i l l Clinton
�VP2
TUB NEW
Business and Health
YORK TIMIIS.
A
The Hales' concerns were hofghlcnnJ when a
Fcdt:ral Judge In Ncwsik, cUhig the F.rlsa law,
recently invalidated the New Jerse/ surcharge cii
hospital bills. Ihe surcharge subsidized hosplUl
costs of uninsured patients.
Scnnt.jr Dave Durenberger. Republican ol JVllnncsola. said Ihe Newark ruling, which New JerseyIs appealing, threatened to sabctagc Minnesota's
JUNE 23. 1992
Milt Freiideiiheini
States Seek Aid
For the Uninsured
DELEGATION 3f 14 governors wem lo llie
While House last week seeking help for
LcKorls by states' lo bring healih cari- lo
millicns of uninsured Americans. D«spalriii{> ol
obtaining nnlional solulions tin health care in llic
elcclian year pollllcal gridlock, the governois - 9
Republicans
5 Democrats — are Irylng lo push
ahead on iheir • * » .
The stales need B u ^ Adinlrlslralian support lo
gel Congress lo waive provls.ons ol ihe Federal
law that exempts iwo-thlrds of all busloessps from
Slate I.1XCS United lo hralih Insurance. Scll-ihsured
companies inroke Ihe Empinyee Retlrcmeni Income Security ACI. called ErlsE. lo escape taxes on
Insurance premiums. 1 hey can also refuse lo cjtiiriUiie to stale pools lo Insure people vicweti as
poor risks.
Bwl Ihe Adminisiraiion, heeding Ihe concerns u(
business, reacted ccollj to the gavcmors. Alihoi^gh
most company executives ate upset aboul rapidly
rlshig health costs, many sell-insured companies
Ii;ar Ihat their expenses could grow even moic if
they lost Ihe Erisa shield anti had to comply wlih
health Insurance laws thai vary acrosj the i;oin
try. Anil |tie business lubbyiscs contend that if
Congress waived even one provision, Ihe flood
gates would op>n lo dcmollshjr^g the cnllre Erisa
statute, which protects pensions.
TUESnAY.
SluB/l Cotilcnbcrf
plans for new laxcs on Ijospttols .inJ docinrs to help
provide licalll) cuveiage lor tlic unlnsmcd. l l i e
recent New York Increases in l)os|illal charges to
conimerrial hcaltli insuic-rs rouW also be dial
lengcd. as could financing for expanded Mcdicdnl
piograms in nwiny slates.
Florida, Hawaii, Oregon and Vcrinonl. like Miii
nesoia. have pasted sweeping hcallii cnre laws
tint rouid IK! hoLbled by the Eilsa (irovislons,
Alicia Pcliine. a polit^y anilyst wi h (hp Nuimnai
Cevei nors Assocl.'.llnn. sa d. She jaid ihc governors of Colorodo. Connecticirt and Kentucky were
also concerned beciuse lliey planned wldc-ranelnn
hcillli carc legislation this year.
Tlic M governors met wiih Samuel K. Skinner
the White House chief of slufl. Uoger D. Pnrlur and
Clayton K. Yeuttcr, doniesllc |M)Hcy ndvlscfs, n n j .
Gail R. Wifcnsky. the senior lieajll]<aie adviser.
A number ol slalDS arc also seeking cxeniplions
fiom Medicaid ond Medicare iiilcs. Oregon, for
example, has been wailing for years lor a Mc'Jlcald
waiver to let Ihc slate set piiorillcs in covcilini
certain types ol pat cnts nnd Illnesses The Admin
Isiiatlan Is expected lip anriciince u declsiwi on Iho
' Oregon request this summer.,
:'.
Ilic Rovcniors as?Dclalior» is workinp, wlih Mf
Durenberger .nnd w.lli iwo DeiiMicials,' Senalni.s
David 11 Pryor ol Arknnsas and Patrick J 1 pahy
of Vci nmiil. un bills thai ivoulJ allow slates lo
ai>ply for waivers li«m certain firisn tcs(riclli>ns
for |.roRr:inis lo incrsasc access !0 hcnilh caie.
l l i c Adniinisiration does support .neasurcs lo
speeJ decisions on requcsH for Medicaid
Med can; waivers, which so.mellmes lanRuisli In
the pipeline lor threi or four years. And ll also
suppaits a proposal, spoiisorfd by Senator Daniel
Pair cU MoyniliQii. Democml of New Yor k nnd
Senator Dnrculierger, lo let s;alcs plare Medicaid
patients In H M.O.'sor physician nclw«rks wiliiuul
spcchi Federal permission.
Bul Adminlstrnlion ofllcials said tlicy opptscd
granllne l^iiia waivers, unless staici agieed to
reduce laxcs on insnratrce p emiunis; ellmii ale
hiws that rn.nndale coverage .'or hundicds of spu
ciffc health care servl -cs, jmdput pcojile into laiei:
put chasMii! j^i'.'ups, wl ich couM loi ce liospit.ils diid
d»iclois lo iccure ilicir cliarr.ts
Tlic P I yoi-Leahy bill would dcnl with soinu rrl
Ihesc concerns by exempting "mullistntc " Imstnesses hi stales where tliey lia%edoicnsolen»plnyccs - If lliey affcrc-d n package ol health benclils
cciutvalem to JZ.SW :i yrnr tor each family covnrd
and }l.?50 ior single r«npIoyces. Chrlstopiicr Ji-n
nings, a Pryoi leglsladve aide, said: ' irie sinles
could dcveluj) a niiiiiniuin package ol bciiu'lils Cut
all the good gny* mulllslnle cjiiploycrs wonlj not
have lo deal with It "
IhcDurcnbpiger waiver proiMJsnl would permll
llie Secretary of Laboi lo grain ' llrnlipd exoinp
Hons under F.rlsn." Under llils nppiojcti. sellfnsurcil ciiipliirers would pay .slnte Insnnmcc Inxcs and other Ic.-s. btil Ihey woulU still be exempted
from innnilalrd slate fapueflts.
Dr. Wllensky said the Admliihlratloii was'seri'Mii about trying to deal wllli at least some of the
Cuvorivjis' concerns "We really like Ihe slaie
lmuiv,i(ti>ns and Ilcxiblllly." sl»e said. Dul Wiitie
House oflli iais made ll clear Ih.il (he Administra
lion was not ready for F.ilsa law waivers.
�S. 3180, THE STATE CARE ACT OP 1992
SDMMARY OP MAJOR PROVISIONS
Establishment o f s t a t e Care Demonstration P r o j e c t s
*
*
^^'^^^^^waivers
Ccnmission
t o consider
sSt^aatteo ^aapnpollifccaattiionn^s^ ^f fo ^
r 5-year
o f soecifietd
^ ^ ^ ' ' ^ ^ ^ ^ ^ ^ ^ o f m d i c a r e . Medicaid and ERISA l a i t o a l l o w
ca^P L f S ""P^«"^«"t state-wide, comprehintive heal?h
care reform i n i t i a t i v e s meeting c e r t a i n c r i t e r i a
rioLnSf^f?^°'' provides f o r t i m e l y approval o f
har?hrait'?Sr???^L'^^^' T ' ' ^ ^ ' ^-F?erne^?at?on, and
demons^r^Sons^iL^^rcaSsr^"^-^^
^^^^^^^^
Demonstrations
are l i m i t e d t o 10 s t a t e s .
a5Jnts"^'Sp°?o%%TJ^for?o''
P^^'^^^
iinplementation
wj. uy uu
m.<.X-lcn t o each
approved
State.
*
The Conuaission consists of thp 'ie^n-rcit-^.^. ...^ «
Human Services, the =5cr2t^J5 o f r f S ^ ^ ^ °- ^^ealth and
appointed by tHe'S.%eJ5f:rS;d°;cni?S^4d^£? I L ^ t T n l l l .
Requirements o f State Plans
t o o b t a i n Medicare, Medicaid
Te- waivers, a
sInt a torder
e must:
Kecicaia ^nr?
and ERISA
demonstrate t h a t by the end of the f i v e - y e a r Deriod
«St g r ? ^ ' ' ^ ^ ^ ^ ?'
^"^^^^d
increases t f a i f^as^
p o i n t increase clause i s desiaSed ' tr, ^ S % • P®^'=®^t^9e
states With higher n S m J l r f o f ^ S n f n s S r e d . ^ ' ^ ! ? n ' e i t h e r
goal, coverage f o r c h i l d r e n must i n c r e a s i at'aS Igua?"
*
d o : r j ; - f " : ; . i : ' r , J ; r l , ^ ^ / - - ^ f l a t i o n w i t h m t h e State
year t h e r e a f t e r , 0 p ^ r c ^ n t l g o ^ p ^ i i ? " ! '
'
eauJ^°?o^
^^^^
be.-iefit package which i s a t l e a ^ t
�Waiver AuthorityStates t h a t meet the above c r i t e r i a would be e l i g i b l e f o r
the f o l l o w i n g waivers:
Medicaid. Waiver a u t h o r i t y allows states t o i n c l u d e
Medicaid b e n e f i c i a r i e s and Medicaid payment systems i n
plans t o r e s t r u c t u r e h e a l t h care finance and s e r v i c e
d e l i v e r y systems.
P r o t e c t i o n s f o r Medicaid B e n e f i c i a r i e s . States must
provide mandatory Medicaid services t o a l l gro-jps
c u r r e n t law requires States t o serve. States must
m a i n t a i n safeguards c u r r e n t l y s p e c i f i e d i n t h e Medicaid
program ( i n c l u d i n g procedures s u f f i c i e n t t o ensure the
high q u a l i t y and a v a i l a b i l i t y o£ care) t o p r o t e c t t h o
h e a l t h and welfare of Medicaid r e c i p i e n t s .
Medicare. Waiver a u t h o r i t y i s very l i m i t e d w i t h
respect t o Medicare. The b i l l gives states t h e a b i l i t v
t o m c i u d e Medicare i n a l l - p a y o r negotiated r a t e
systeaiE f o r h o s p i t a l s . B e n e f i t s t o Medicare
b e n e f i c i a r i e s cannot be diminished.
ERISA. Waiver a u t h o r i t y has been c r a f t e d narrowly t o
recognize the concerns of business and l a b o r .
* Allows states t o c o l l e c t assessments from ERISA
plans.
States are p r o h i b i t e d from s i n g l i n g - o u t ERISA
plans f o . assessment. The p r o v i s i o n enables s t a t e s t o
Droaden t h e i r current funding base t o support h e a l t h r e l a t e d i n i t i a t i v e s , such as r i s k pools ^or t h e
uninsured.
* Allows states t o e s t a b l i s h a standard h e a l t h b e n e f i t
package f o r employers i n t h e s t a t e . However, emplovers
w i t h sel£-fund6d h e a l t h b e n e f i t plans could (leviatS
from the standard b e n e f i t package i f the employeeo f f e r s a h e a l t h b e n e f i t plan w i t h b e n e f i t s etjual'to an
adjusted $1,250 per i n d i v i d u a l and $2,500 per f a m i l v
The p r o v i s i o n enables states t o e s t a b l i s h a minimum set
of h e a l t h b e n e f i t s f o r i t s r e s i d e n t s .
* Allows states t o develop common a d m i n i s t r a t i v e
procedures. The p r o v i s i o n exiablea states t o r e q u i r e
both h e a l t h insurers and ERISA plans t o use t h e same
procedures and processes i n the areas of claims
processing and q u a l i t y assurance.
hosn^t?^n^^n^^^
e s t a b l i s h a negotiated system o f
h o s p i t a l or other provider reimbursement r a t e s t o he
used by both h e a l t h i n s u r e r s and ERISA plans.
�£on8ression9l HecorJ
PROf-EEDINGS AND DEBATES OF THE 1 0 2 " ^ CONGRESS, SECOND SESSION
Vol. 138
WASHINGTON. WEDNESDAY, AUGUST 12, 1992
Sa. 119
Senate
Mr. PRYOR. Mr. Preaident, today I initiatives emerging from both sides cf
Bjn pleased to Join my Mend and ea- the aisle all aFj»vrre a signlfjcaat State
teemod coll©a(?ue from V©nnont, Sen- role? I believe the answer is twofold.
ator LKAHY, in introducing legislation First, all of us want to ensure that our
to provide needed flexibility to States health care system is more accountable
which are committed to comprehen- and reeponalve to local desires and
Hlvely r^foimiag tholr he<h c&re eye- needs. Second, and probably at least aa
tems. Ws are honored to be Joined is Important, i t is beciiuse the States and
this effort, by the majority leader. Sen- their Cxovernors have been the ones
ator RoCKSFKLLEK, Senator RiCBOLS. who have 8ucc«eded In progressing
Senator CKAKKE, Senator DANTORTH. from talking about the problem to acSenator KKRREY, Senator Wsi.LSTcr'Ofi, tually actln^f to solve It. In fact, more
Senator AD.\W:8, Senator AKAKA, Sen- than 15 States are working on massive
ator BiNO.\MA2«, Sdoator ORJLUAM, Sen- system-wide reeti-ucturlng. At least
four States have 8.ctually passed legisator IMOUYE. and Senator jKrpoiiD&.
lation
that begins to implement masMr. President, everyone of UB i n this
overhauls of their health care sysbody iB etrugefllng to find a workable sive
tems.
solutioti to the overwhelming^ health
caj-e chaliengpe that confront our Na- Unlike the Federal Government,
tion. No one is satisfied writh, or ac- these States have sought and, to the
extent jwssible,. achieved consensus
cepting of, the status quo.
There is no question that we muat within their own borders. These
find a way to achieve nation-wide, achievements were not accomplished
comprehensive reform of our healtb without controversy. They were also
care cystem. FoUowing Senator MrrcH- not achieved without political risk,
and courage. Most ImporELJ^'s lead. I remain committed to de- leadership,
tantly,
though,
they were achieved.
veloping^ and iiaaaing a workable and
Unfortunately,
according to a June
comprehensive national health care re1093
General
Accounting
Office report,
f(irm Initiative at the earliest poeaible
many
If
not
all
of
the
SUte
health care
moment.
reform
initiatives
cannot
be
successUnfortunately, to date, we have not fully implemented without the removal
been able to achieve consensus on a of certain Federal statutory barriers.
comprehensive health care reform In efTect. therefore, our Federal inacpackage that the President will sign tion Is not the only barrier to providInto law. I t ia i'aacinatlng to note, how- ing affordable health care to our citiever, that thoro la a common thread zens, current Federal law actually prothat runs throughout virtually every
slgnlflcant health care reform proposal vides a significant roadblock as well.
before us. Despite the differing and nu- The purpose of the legislation we are
m s r o c a a l t s m i t l V * «rmrna/'h<»B P V f t r v introducing today is to remove those
propoaal provides f o V a olgnlficant roadblocks for SUt«8 that are commitamount of State flexibility and respon- ted to overhauling their health care desibility. This l-s the case with the livery systems. Through a new Federal
Mitchell/ Kennedy/ Rockefeller/ Riegle commission, our bill sets up a streambill; i t is the case with .Senator lined, "one-stop-shop" waiver approval
KsRRKY'ii bill; i t la the caae with Sen- process that provldea narrowly craTted.
ator WELLSTOKE's bill; and It Is the but Important, waivers from Medicare.
case with the Republican Health Care Medicaid, and the Employee RetireTaf>k Force bill, whose primary author ment Income Security Act [ERISA].
Is the chairman of the task force. Sen- These waivers are absolutely necoasary
ator CMATUB. I «xn pltuised to say that to the success of stat^-based comevery one of the primary sponsors of prehensive health care reform efforts
these bills le Joining with Senator
To be eligible to receive the waivers
LEAHY and me in introducing our legisStotes must submit a plan to the Comlation today.
Why U I t t h a t the m a j o r health cuxe mission that is comprehensive, and
meets strong acceao. coat^oiitalnment.
�and quality assurance criteria. States around and between might well see
also must continue to provide Medicare their approach embodied in one « the
services to the Medicare population States' comprehensive efforts.
and federally-mandated Medicaid sorvMr. President, regardless of the apices to McdJrjald recipients.
proach. I cannot and I will not conMr. President, we have worked for tinue to look into the eyes of the Govmonths with representatives of con- ernors committed to comprehensive
Bumens, States, small and large busl- health care reforms and say. "Sorry,
neases. and many others in developing because we don't have a national soluthl6 legislation. While our bill is not tion, there can be no solution." If an
flawless, we believe it moves a long individual SrAte can come up with a
way toward btrlklng a fair and reason- program that assures access to quality,
able balance between interested par- affordable health care to its dtlsjens.
ties. Having Bald thia, as we have been who are we to stand in the way?
in the months prior to today's intro- I have long felt that we, as representduction, we remain open to construc- atives of the Fedend Goveminant, are
tive suggestions. In fact, we sincerely all-too-frequently negative and overly
hope that our introduction of this bill patemalletlc to State-born reform iniwin be te.ken aa an open invitation for tiatives on almost any issue. Somecomments and suggested improve- times it seems that if the idea isn't
ments.
ours, we always find a way to show
To further the debate on this Issue, I that it somehow Is.'-i't good enough.
am particularly pleased that the chair- Well, when it comee to health care reman of the Finance Committee, Sen- form, at least to date, we have net
ator BKNTSEN, IS planning on holding a come up with anything better than
hearlr.g on State-based health care re- what majiy of tho States are o£ferlnjf
form inlttatl'.'es in September. I would To the contrary, we have as yet to
like to take this opportunity to thank produce anything approximating comSeimtor BKNTSKN and his staff for the prehensive reform.
eccouragement and technical support There Is broad-baaed and bipartisan
they have given me and my staff support for this Important initiative. I
throu^rhout the development of this am particularly pltiased to report that,
bin.
despite the fact that the Governor—
Mr. .tYesldiict, there is no question like everyone el8t>—were forced to comthat there will be those who will op- promise on m.ary Ipsues of importance
pose thlB effort. They will cite a num- to them, the Nalli;n»-.l Governors" Assober of reasons, but I feai- the real rea- ciation [NGA] hail indicated Its support
son Is that their second choice for of this bill. I wouli5 like to thank the
health care reform is to do nothing. I NGA, as well as tlif Democratic Govdo not believe we can accept or con- ernors' Association, for their thoughtdone this poBltlon.
ful and constructive suggestions.
The first choice for restructuring our Many other organisations, in particuhealth care system, including the first lar. Families U.SA, have alao been exchoice of almost every Governor, is tremely helpful. I look forward to
that the Federal Government meet the worklnR- with all Inierostod parties to
need fyr national comprehonslve re- assure we have the strongost package
form. Howevtir. if a divided Govern- possible.
ment finsures that we cannot gain conI am also extremely pleased to not-^
sensus on the national reforms we so that Confrreesman WYDSN has already
desperately need, we simply cannot indicated his desire for Introducing the
continue to hold the SUtes hostage to companion leglslatlijn on the House
our gridlock.
side. Although not cosronsorlng this
Mr. Prcnidant, It le essential to re- leglBlatlu.n toda.y. I would also like to
member, though, that this bill can. in thank Senator DuRSMiEROER for bis iniviiiio i-t:Bi«!i;LB, work out as Deing the tereet and support of many of the confirst choice cf practically everyone. cepts outlined in thU legislation. SenFirst, it can work to fill In some of the ator L L A H Y and I aro very encouraged
detalle of the previously Introduced ua- by these duvelopmerils. I urge ail of ou.tlonsJly, comprehensive initiatives. colleagua to Join Senator LF.AHY, ConSecond, waivers are not granted in any trressman W'^^^FN. unt rr.o in our efforw
case unless the Sute-based effort is to holp the State help their,, and our,
comprehensive in nature. Finally, constituents.
while holding the States accountable
Finally, Mr. Preslcient, I would like
fcr comprehensive, affordable, quality, to take one moment to say what an
accessible hoalth care, Jt does not di- honor and a prlvil«»e-« It haa beon to
rect the States as to how they must work with Senator L E A H Y and hie fine
achieve these criteria. In other words,
advocates of single-payer approaches,
advocates
of employer-based approaches, and advocates of everything
staff on this bill. Today's introduction
of our bill represents a vindication for
his efforts and his commitment to
charge and rettructura cur health caie
system.
�T H E WHITE H O U S E
WASHINGTON
-i"A
'^^^^
1
�(
^^^^ • ' /
^^^^
Sv'
^
r
W Vwu V 7-^^ ^^^^^
7,
PHOTOCOPY
PRESERVATION
�PRIVILEGED AND CfMNOimv^amnT. MEMORANDUM
TO;
FR;
RE;
cc;
H i l l a r y Rodham C l i n t o n
C h r i s Jennings, Sean Burton
Meeting with Congressman LaFalce
Melanne, Steve, Lorraine, D i s t r i b u t i o n
June 28, 1993
/\
'
«>. c^vi/^^^'
Tomorrow you a r e scheduled t o meet w i t l / Congressman John
L a F a l c e . The purpose of t h i s meeting i s t o fessuage the
Congressman's concerns regarding the plan's e f f e c t on small
business.^
p a i a l l u l objeetivQ v ^ i l l bo t o e s t a b l i s h a working r e l a t i o n s h i p
for the f u t u r e .
BACKGROUND;
;
f
^
(
^
^^^^
Congressman LaFalce ^ h a i v a the Small Business Committee <ij3_
tho HavioQi. H i s f i r s t and foremost concern regarding h e a l t h care
reform i s i t s e f f e c t on small businesses. Although i t i s
doubtful t h a t h i s committee w i l l -claim- j u r i s d i c t i o n on p a r t s of
the plan, he could provide us a strong connection t o the small
business community.
Due t o the proximity of h i s upstate New York d i s t r i c t , many
of h i s c o n s t i t u e n t s have r e l a t i v e s l i v i n g a c c r o s s the border i n
Canada. H i s f a m i l i a r i t y t o a s i n g l e payer system l e d him to cosponsor McDermott's s i n g l e payer b i l l .
Members of the task force met with h i s s t a f f a s w e l l as the
b i p a r t i s a n s t a f f of the Small Business Committee. I r a met with
Congressman L a F a l c e on
.
DETERMI.NED TO BE AN AD.'MIMSTRATIVE
.MARKINGPer E.0.12958 as amended, Sec. 3.3 (c)
Initials: 3 Gs"
Date: i ^ L A ^ - M - l —
�w
MEMORANDUM
TO:
Those involved with First Lady correspondence
FROM:
Shirley Sagawa
RE:
Congressional mail
DATE:
June 21, 1993
This memo updates the system for responding to the First Lady's Congressional mail.
In general
Points of entry: Kelly Cames, Millie Alston, Health Care Task Force
Forward all Congressional mail to: Shirley Sagawa/Pam Barnett
See specific categories below for further steps in processing mail.
Categories of mail
Invitations and letters supporting invitations
Forward to: Pam Barnett for logging
and to:
Shirley Sagawa for response ("thanks ~ will get back to you if able to
participate")
then to:
Maggie Williams for accept/reject
Recommendations of personnel - health care task force
Forward to: Shirley Sagawa for form letter response
then to:
Sean Burton for database
and to:
Susannah Welford for phone call (if VIP)
Recommendations of personnel - other than health care task force
Forward to: Pam Barnett for logging
then to:
Shirley Sagawa for response
then to:
Anne Bartley to enter into computer
Material from constituent - health care task force
Forward to: Shirley Sagawa for form letter response (note: letter goes to constituent
(if addressed to HRC) with cc to Senator/Representative sending it)
then to:
Sean Burton for database
and to:
Susannah Welford for task force circulation (if useful)
Material from constituent or substantive letter - other than health care task force
�w
Forward to: Pam Barnett for logging
then to:
Shirley Sagawa for response and distribution
then to:
Appropriate staff person, FYI
Substantive letter from member - health care task force
Forward to: Pam Barnett for logging
then to:
Shirley Sagawa for response and distribution
then to:
Susannah Welford for task force circulation
and to:
Sean Burton for database
And to:
Chris Jennings, if newsworthy
Special requests
Forward to: Pam Barnett for logging
then to:
Shirley Sagawa for response or forwarding
A similar process has evolved to deal with letters from governors, state reps, and
mayors:
Health care
Forward to: Michael Sussman for draft response
then to:
Shirley Sagawa for review andfinalproduction
then to:
Susannah Welford for phone call or task force circulation
Other - policy related
Forward to: Shirley Sagawa for response and distribution
then to:
Appropriate staff person, FYI
Other - non-]?olicy
Forward to: Pam Barnett for response
Distribution:
Maggie Williams
Pam Barnett
Kelly Cames
Melanne Verveer
Michael Sussman
Patti Solis
Susannah Welford
Alan Hoffman
Anne Bartley
Mora Segal
Millie Alston
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
Identifier
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2006-0885-F
Text
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Original Format
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Paper
Dublin Core
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Title
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Folder #2: Memo [Chris Jennings]
Creator
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Task Force on National Health Care
White House Health Care Task Force
Steven Edelstein
Identifier
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2006-0885-F Segment 2
Is Part Of
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Box 7
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092992" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Preservation-Reproduction-Reference
Date Created
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2/6/2015
Source
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42-t-12093627-20060885F-Seg2-007-003-2015
12092992